Der Unfallchirurg
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Osteosarcoma and Ewing sarcoma are the most common chemosensitive sarcomas of the bone. ⋯ Improved insights into the molecular biology and genetics of the diseases as well as insights into the interactions between sarcoma cells and the micro-environment and the immune system are necessary to identify novel therapeutic targets in bone sarcomas. Because of the rarity of the diseases, multinational cooperation is essential to evaluate novel therapies in prospective randomized trials.
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Bone tumors and especially bone sarcomas are rare lesions of the skeletal system in comparison to the much more frequently occurring bone metastases. Despite the relative rarity they are important differential diagnoses of bone lesions. ⋯ The foundation of the imaging of bone sarcomas is the radiograph in two planes. This method delivers important information on bone tumors. This information should be analyzed with the help of the Lodwick classification, the configuration of periosteal reactions and a possible reaction of the cortex. A possible tumor matrix and the localization within the skeleton or within long bones also provide important information for differential diagnostic delimitation. Magnetic resonance imaging (MRI) with specific adapted bone tumor sequences allows an exact local staging of a bone sarcoma. In addition to local imaging a compartmental MRI which illustrates the entire extent of tumor-bearing bone and the adjacent joints should be performed to rule out possible skip lesions. The most common distant metastases of osteosarcoma and chondrosarcoma occur in the lungs; therefore, a computed tomography (CT) of the chest is part of staging. Other imaging methods, such as CT of the tumor, positron emission tomography CT (PET-CT), bone scan and whole body MRI supplement the imaging depending on tumor type.
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Review Meta Analysis
[Surveillance in patients with bone sarcomas : When, how, and for how long?].
The overall survival in patients with typical bone sarcomas such as Ewing-sarcoma, osteosarcoma, or chondrosarcoma exceeds 60% in localized disease after 5 years. Local or systemic recurrence detected by surveillance may not only improve or solve the local problem but also significantly improves the prognosis of the patient. Thus, surveillance seems to be justified. ⋯ Surveillance makes sense in any case, since the detection of a local recurrence is possible already with methods easy to apply. Whether and to what extent local imaging is used is left to the individual case. Under the current conditions in Germany, local (e.g., MRI) imaging at least every 6 months during the first 2-3 years, then possibly on an annual basis is recommended. There is no evidence-based support for the decision whether and when an X-ray of the chest is indicated and whether and when a CT scan should be performed. Striking is the lack of prospective studies on surveillance concerning both patient- and economically relevant aspects of tumor therapy.
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Peripheral nerve injuries are a common clinical problem and can represent a major challenge, especially after trauma. In order to achieve optimal therapy, an early and adequate diagnosis with subsequent therapy is critical for functional preservation and restoration. Especially after complete severance of a peripheral nerve, the surgical techniques for nerve coaptation are an important prerequisite for peripheral nerve regeneration. ⋯ In addition, the types of primary and secondary nerve reconstruction procedures are described as well as the optimal time point of nerve repair. This article provides a comprehensive overview of the possibilities for diagnosis and intervention after nerve injury, additionally including an algorithm for surgical intervention. Furthermore, possible pitfalls and factors for improving the functional outcome are presented to optimize results with trauma-related nerve injury.