Does total joint arthroplasty impair erectile function?

Introduction: Sexuality is an important factor in quality of life (QoL) and was reported to improve after total joint arthroplasty (TJA). However, one study group found evidence regarding a high rate of impaired erectile function of about 20% in male patients after TJA. As erectile dysfunction is a serious matter of concern and there are no data explaining this observation sufficiently, the purpose of this study was to revaluate the erectile function in patients after TJA. Material and methods: All consecutive male patients scheduled for TJA were enrolled in this prospective study. Evaluation was performed pre- and 6 months postoperatively with the International Index of Erectile Function (IIEF-5) questionnaire. One hundred and fifty-nine patients fulfilled the inclusion criteria, and 51 patients wished not to take part in the study. Results: From the 108 patients who were included prior to surgery, 101 (94%) were available at the 6-month follow-up. In those patients, the preoperative erectile function was normal in 38 (24.0 +/- 1.1), impaired in 45 (14.7 +/- 6.5) and with no function in 18 patients. No significant difference in the pre- (15.4 +/- 9.3) and postoperative (15.3 +/- 9.2) IIEF-5 score was observed (p = 0.59) in the total group. Similarly, subgroup analysis revealed no significant difference in patients with total hip arthroplasty (p = 0.58), total knee arthroplasty (p = 0.37) or > 70 years (p = 0.08). Conclusions: The previously reported high rate of impaired erectile function after TJA of the lower extremity could not be confirmed. Total joint arthroplasty remains a safe procedure in terms of postoperative erectile function

Myxoid liposarcoma: local relapse and metastatic pattern in 43 patients

Background: Liposarcomas are the second most common type of soft tissue sarcomas, 30-50% of these are of myxoid subtype. The aim of this retrospective study was to analyze the local control rate, the metastatic pattern and survival of patients in a consecutive single-institution series. Methods: From 1983 to 2015, 43 patients with myxoid liposarcoma of the extremities and trunk wall underwent resections. The margin was defined as R0 (wide) or R1 (marginal). Patients were followed for evidence of local recurrence or distant metastasis. Overall and recurrence-free survival was calculated. Results: The mean age was 48.6 years. The lower extremity was involved in 40 cases, the mean tumour size was 12 cm. In 31 cases a wide and in 12 cases a marginal resection was performed. Grading was G1 in 14, G2 in 25 and G3 in 4 cases. Nine patient died in follow-up, 4 of them with metastatic disease, all nonpulmonary. 5-year local recurrence (LR) free survival was 82%. 4 (9.3%) patients developed LR (all R1). Overall survival (OS) was 81% after 5 and 72% after 10 years. In multivariate analysis age and Grading proved to be significant on OS. According to univariate analysis, only age over 48 years and distant metastasis had a significant impact on overall survival. Conclusions: Patients with myxoid liposarcomas have a good prognosis. Myxoid liposarcoma has a distinct pattern of nonpulmonary metastatic disease. Therefore, patients with high-risk extremity myxoid liposarcoma should undergo imaging studies of the chest, abdomen, spine and pelvis as part of their staging and follow-up examinations preferably with whole body MRI, or CT scans and MRI of the spine and pelvic region for detection of suspected metastatic disease

Desmoid Tumours of the extremity and trunk. A retrospective study of 44 patients

Background: Desmoid-type fibromatosis (DF) is a aggressive (myo) fibroblastic neoplasm with an infiltrative growth and a tendency to local recurrence. Resection of the tumour and/or radiation were proposed as principal treatment. The aim of this retrospective study was to analyze the local control rates focusing on the effect of surgical margins and radiotherapy. Methods: From 1981 to 2014, 44 patients had been treated. Fifty four therapies had been applied, in 50 cases surgery +/-radiation therapy, NSAIDs or chemotherapy. In 4 cases a conservative approach was chosen. Thirty seven patients had primary, 17 recurrent disease. Endpoint was either local recurrence (LR), progression of residual disease or rare non-metastatic secondary lesions at the same extremity. Results: The mean age was 39,4 years. In 17 cases a R0, in 27 a R1 and in 6 cases a R2 resection was achieved. Four patients were treated conservatively. All together in 21 cases radiotherapy, in 5 NSAIDs, in 3 imatinib and in 2 cases each tamoxifen or chemotherapy had been applied. The median follow-up was 119 months. 5-year recurrence free survival after resection was 78%. 10 (20.4%) patients developed LR between 5 and 42 months after therapy. Recurrent disease was a negative factor on LR. Margins, radiotherapy, sex, or size of the tumour had no significant impact on LR. Patients younger than 40 years had a significant higher risk of LR. Conclusions: Surgical margins are less important than keeping function. Radiotherapy might be an option in unresectable lesions, the role of adjuvant radiotherapy is controversially discussed

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Radiofrequency ablation in the treatment of osteoid osteoma-5-year experience

a b s t r a c t Purpose: This study aimed to determine the success and complication rates of radiofrequency ablation (RFA) in treatment of osteoid osteoma (OO) and duration of pain relief. Furthermore value of bone biopsy prior to the RFA was evaluated. Materials and methods: Within 61 months 39 patients (23 male, 16 female, 7-53 years, mean 18.7 years, median 17 years) suffering from osteoid osteoma were treated. Lesions were located in femur (n = 20), tibia (n = 10), spine (n = 5), humerus (n = 1), radius (n = 1), talus (n = 1) and pelvis (n = 1). In children, RFA was performed under general anaesthesia, in adults conscious sedation was preferred. In 29 of 39 (74%) lesion biopsies were obtained. Cooling of skin was performed in OOs located in bones with minor soft tissue covering (tibia, radius) and saline flushing via an additional needle was performed if the OO was adjacent to nerval structures. Primary success rate, complications, symptom-free interval, follow-up and biopsy results were evaluated. Results: Within observation period (1-61 months; median: 32 months) 38 of 39 patients were successfully treated and had no more complaints. In 3 of 38 patients relapse occurred after 1, 14 and 32 months and RFA was repeated. Two major complications (broken drill, infection) and 2 minor complications (hematoma, prolonged pain) were observed. Biopsy was able to prove diagnosis in 14 of 29 (48%) cases. Conclusions: Biopsy prior to treatment is not mandatory due to a remarkable amount of false negative findings in clinically and morphologically unambiguous cases of OO. RFA is a highly effective, efficient, minimally invasive and safe method for the treatment of OO