Wiener Klinische Wochenschrift最新文献

Purpose: The biopsy represents a fundamental step towards diagnosing bone and soft tissue tumors. In the case of open biopsies it is recommended to resect the biopsy tract at wide resection of bone and soft tissue sarcomas (STS); however, nowadays this topic is subject to ongoing debate as a worldwide shift from open to core-needle biopsies may lead to a decreased risk of local recurrence (LR) in the biopsy tract.

Methods: We present three patients (male, 69 years; male, 63 years; female 76 years) with chondrosarcomas treated at the Department of Orthopaedics and Trauma, Medical University of Graz: two with sarcomas involving the distal femur and one in the proximal femur. Staging showed no evidence of distant metastases (DM). Wide resection and reconstruction with modular tumor endoprostheses were performed in all three patients with the biopsy tract included in the resection specimen.

Results: In all three patients, histological analysis of the resected specimen revealed viable tumor cell nests in the biopsy tract after an open biopsy technique.

Conclusion: The three presented cases demonstrate that tumor cell seeding occurs in biopsy tracts after an open biopsy in chondrosarcoma cases. Whether the risk of developing LR from these tumor cells differs between open and minimally invasive biopsy techniques or is affected by the use of neoadjuvant chemotherapy and/or radiotherapy for other entities, requires larger cohorts and longer periods of follow-up.

Systemic lupus erythematosus (SLE), a multisystemic autoimmune disorder, carries an increased risk of lymphoproliferative diseases, with overlapping clinical features often complicating diagnostic differentiation. We describe a 54-year-old woman with established SLE involving the skin, joints and kidneys (previously managed with prednisone, cyclophosphamide and hydroxychloroquine). Following self-discontinuation of prednisone treatment, the patient developed a disease flare manifesting as a labial rash and proteinuria. Renal histopathology confirmed persistent class V lupus nephritis. Computed tomography (CT) identified left axillary lymphadenopathy, with subsequent excisional biopsy revealing features diagnostic of Castleman disease. The coexistence of SLE and Castleman disease (CD) is relatively rare. Targeted immunosuppressive therapy with tacrolimus (TAC) and mycophenolate mofetil (MMF) resulted in clinical stabilization within 3 months of treatment initiation. Proteinuria decreased from 1.35 g/24 h to 0.24 g/24 h, with a concomitant reduction in lymph node size. Clinical improvement even in the absence of glucocorticoid induction therapy offers valuable insights for clinicians.

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) encompass numerous synthetic (man-made) chemicals with widespread use in industry and consumer products. Universal and life-long human exposure is nearly unavoidable and thus health concerns have emerged over the years, including the development of cardiovascular disease (CVD). Existing evidence on the link between PFAS exposure and CVD is somewhat mixed. The aim of the present narrative review is to summarize the available evidence on the impact of varying levels of exposure to PFAS on traditional CVD risk factors as well as subclinical and overt CVD. While there is mounting evidence of the association between PFAS exposure and dyslipidemia, and PFAS exposure and hypertensive disorders of pregnancy, the evidence on the link between PFAS exposure and other CVD risk factors is less clear. Likewise, evidence on PFAS and overt subclinical and clinical CVD is inconsistent, with studies showing mixed results or even a protective association between PFAS exposure and clinical CVD. Potential mechanisms of disease involve PFAS-induced inflammation, oxidative stress and endothelial dysfunction, impacting CVD risk. Certain populations, including pregnant women, children and individuals with pre-existing conditions, are more vulnerable to PFAS-related health effects. Exposure disparities are evident, with marginalized communities facing higher exposure levels and fewer resources for mitigation. Addressing PFAS exposure requires more assessment of the impact of PFAS mixtures and potential cumulative or interactive effects and additional regulatory actions to reduce emerging PFAS and limit PFAS levels in drinking water. Interdisciplinary research efforts are crucial to fully understand the impact of PFAS and develop effective mitigation strategies.

Purpose: To evaluate the efficacy and safety of elemene pleural instillation in peritoneal dialysis (PD) patients with pleuroperitoneal communication (PPC).

Methods: This single-center retrospective study enrolled PD patients with PPC who received elemene between October 2020 and January 2022. The diagnosis was confirmed by computed tomography peritoneography (CTP), demonstrating contrast medium in the pleural cavity. Patients received intrapleural elemene (200-400 mg/m²) once or twice weekly. Primary outcomes included treatment efficacy, changes in laboratory parameters, recurrence and safety.

Results: In this study 12 patients were included. After elemene instillation (median follow-up 14.1 months), 10 patients (83.3%) successfully resumed continuous ambulatory peritoneal dialysis. Drug-related adverse events occurred in 9 patients (75.0%): chest pain alone (5, 41.7%) and chest pain with fever (4, 33.3%). All events were CTCAE grade 1 (7, 58.3%) or 2 (2, 16.7%). No significant pretreatment to post-treatment changes were observed in renal function (eGFR), coagulation parameters (PLT, PT, TT, APTT) or dialysis adequacy (Kt/V, Ccr) (all P > 0.05).

Conclusion: Elemene pleural instillation appears safe and effective for PD patients with PPC, facilitating resumption of continuous ambulatory peritoneal dialysis.

Objectives: Diagnosing hemoglobinopathies through reverse hybridization with Globin StripAssays (ViennaLab, Vienna, Austria) is widely performed. There are only two authorized hands-on DNA extraction methods for these assays: the spin Micro DNA Extraction Kit (ViennaLab, Vienna, Austria) for the α‑Globin StripAssay and GEN^XTRACT Blood DNA Extraction System (ViennaLab, Vienna, Austria) for the β‑Globin StripAssay. We set out to evaluate the performance of the automated DNA extraction with MagNA Pure 24 (Roche, Rotkreuz, Switzerland) for further testing with Globin StripAssays.

Methods: We analyzed blood samples of 41 patients with clinical suspicion of hemoglobinopathies. As the gold standard we stipulated the ViennaLab DNA extraction methods and compared them to the MagNA Pure 24 Total Isolation Kit performed on MagNA Pure. The results of the different test strips were qualitatively classified with respect to good and weak read outs, background signals as well as true/false positives or negatives.

Results: A total of 6226 StripAssay lines were analyzed. After extraction with the gold standard 98.3% had a good read out, 0.9% a weak read out and in 0.9% a background signal was identified. After extraction with MagNA Pure 99.4% had a good read out, 0.2% a weak read out and a background signal was found in only 0.5% of the lines (P < 0.001) and there were no false positives or negatives (sensitivity and specificity 100.0%).

Conclusion: The automated DNA extraction with MagNa Pure showed noninferior results when compared with the Spin Micro and GEN^XTRACT DNA extraction kits enabling the usage of the MagNa Pure for the purpose of DNA extraction for further genetic testing with Globin StripAssays.