Conservative management of thoracolumbar burst spine fractures using Gertzbein and Load Shearing classification

. The purpose of this prospective study was to assess the efficacy of the Gertzbein classification and the Load Shearing classification in the conservative treatment of thoracolumbar burst spinal fractures. From 1997 to 1999, 30 consecutive patients with single-level thoracolumbar spinal injury with no neurological impairment were classified according to the Gertzbein classification and the Load Shearing scoring, and were treated conservatively. A custom-made thoracolumbosacral orthosis was worn in all patients for 6 months and several radiologic parameters were evaluated, while the Denis Pain and Work Scale were used to assess the clinical outcome. The average follow-up period was 24 months (range 12-39 months). During this period radiograms showed no improvement of any radiologic parameter. However, the clinical outcome was satisfactory in 28 of 30 patients with neither pseudarthrosis, nor any complications recorded on completion of treatment. This study showed that thoracolumbar burst fractures Gertzbein A3 with a load shearing score 6 or less can be successfully treated conservatively. Patient selection is a fundamental component in clinical success for these classification systems. Résumé. Cette étude a pour objectif de classer les fractures comminutives du segment thoraco-lombaire de la colonne vertébrale qui ont été traitées de manière conservatrice, conformément à la classification de Gertzbein et à la classification de la répartition des contraintes. Depuis 1997 à 1999, trente malades présentant une fracture comminutive dans le segment thoraco-lombaire de la colonne vertébrale, sans dommages neurologiques, ont été traités de manière conservatoire, conformément aux classifications de Gertzbein et à la notation de la répartition des charges. Les patients ont porté une orthèse thoraco-lombaire pendant 6 mois et on a procédé à une évaluation des paramètres radiographiques. L'échelle de la douleur et du travail de Dennis a été utilisée pour évaluer les résultats. La durée moyenne d'observation des malades a été de 24 mois (de 12 à 39 mois). Bien que les paramètres radiologiques, pendant cette période, n'aient manifesté aucune amélioration, le résultat clinique de ces patients a été satisfaisant pour 93.33% d' entre eux. L'on n'a pas constaté de complications ni de pseudarthroses. La classification de Gertzbein associe le type de fracture au degré d'instabilité mécanique et au dommage neurologique. La classification de la répartition des contraintes relie l'écrasement et le déplacement de la fracture à la stabilité mécanique. Les fractures explosives du segment lombaire de la colonne vertébrale de type A3, selon Gertzbein, degré 6 ou inférieur à 6, selon la classification des contraintes, peuvent être traitées avec succès de manière conservatrice. Le choix judicieux des patients est important pour le succès clinique de cette méthode de classification.     

Ausfallhonorar wegen Nichterscheinens zu einem Exklusiv-Termin

Abstrakt 1. Nimmt ein Patient einen ihm von seinem (Zahn-)Arzt einger?umten Exklusiv-Termin nicht wahr, obwohl er auf dessen Eigenschaft ausdrücklich hingewiesen wurde, so hat er dem (Zahn-)Arzt den Behandlungsausfall abzüglich eines angemessenen Eigenanteils des (Zahn-)Arztes zu ersetzen. 2. Die Ersatzpflicht tritt auch dann ein, wenn der Patient den Termin nicht in der in dem Behandlungsvertrag vorgesehenen Frist absagt. Eine hierfür seitens des (Zahn-)Arztes bestimmte Frist von zwei Tagen vor Behandlungsbeginn stellt sich für den Patienten grunds?tzlich auch nicht als unangemessene Benachteiligung i.S. des § 307 BGB dar. 3. Ein Anspruch des Arztes entf?llt auch bei nur mündlicher Vereinbarung nicht unter dem Gesichtspunkt des § 4 Abs. 5b BMV-Z, denn diese Vorschrift ist teleologisch dahin zu reduzieren, dass nur zahn?rztliche Honoraransprüche aus erfolgten Behandlungen schriftlich vereinbart werden müssen. Soweit es jedoch um einen vertraglichen Anspruch wegen einer Leistungsst?rung geht, vermag das Schriftformerfordernis des § 4 Abs. 5b BMV-Z grunds?tzlich nicht einzugreifen. (Leits?tze des Bearbeiters)     

Role of IL-2 in rat fetal thymocyte development

Early during rat thymus ontogeny, an important proportion of thymocytes expresses IL-2R and contains IL-2 mRNA. To investigate the role of the IL-2-IL-2R complex in rat T cell maturation, we supplied either recombinant rat IL-2 or blocking anti-CD25 mAb to rat fetal thymus organ cultures (FTOC) under several experimental conditions. The IL-2 treatment initially stimulated the growth of thymocytes and, as a result, induced T cell differentiation, but the continuous addition of IL-2 to rat FTOC, as well as the anti-CD25 administration, resulted in cell number decrease and inhibition of thymocyte maturation. These results indicate that immature rat thymocytes bear functional high- affinity IL-2R and that IL-2 promotes T cell differentiation as a consequence of its capacity to stimulate cell proliferation. Modifications in TCR alpha beta repertoire and increased numbers of NKR- P1+ cells, largely NK cells, were also observed in IL-2-treated FTOC. Furthermore, IL-2-responsiveness of different thymocyte subsets changed throughout thymic ontogeny. Immature CD4-CD8-cells responded to IL-2 in two stages, early in thymus development and around birth, in correlation with the maturation of two distinct waves of thymic cell progenitors. Mature CD8+ thymocytes maximally responded to IL-2 around birth, supporting a role for IL-2 in the increased proliferation of mature thymocytes observed in vivo in the perinatal period. Taken together, these findings support a role for IL-2 in rat T cell development.      

Serum concentrations of oestradiol-17beta, progesterone, relaxin and chorionic gonadotrophin during blastocyst implantation in natural pregnancy cycle and in embryo transfer cycle in the rhesus monkey

The present study was undertaken to assess the temporal association between the profiles of serum concentrations of oestradiol-17beta, progesterone, chorionic gonadotrophin (CG) and relaxin in pregnancies established naturally, and after embryo transfer, as well as in failed pregnancies in rhesus monkeys. In naturally mated cycles (group 1) a conception rate of 75% was obtained. In group 1, the mean day of CG detection in serum was 11.5 +/- 1.9 day post-ovulation, and for relaxin, 9.0 +/- 2.5 day post-ovulation. In group 2, embryo transfer to synchronous, non-mated surrogate recipients was performed; seven embryo transfer cycles yielded three pregnancies which were allowed to continue to term and normal infants were delivered. In embryo transfer cycles the mean day of CG detection was 14.8 +/- 1.8 day post- ovulation, and for relaxin, 11.4 +/- 2.6 day post-ovulation. A delay of about 3 days was observed in the appearance in circulation of CG (P < 0.05) and also of relaxin (P < 0.05) between natural mated and embryo transfer conception cycles. Significant differences (P < 0.05 for progesterone and P < 0.03 for oestradiol) were obtained for the areas under the curves for progesterone and oestradiol between days 12 and 16 in conception cycles compared with failed pregnancies. These data provide the first observation of the normal hormonal signals associated with maternal recognition of transferred embryos during the peri- implantation period, and suggest that the use of such an experimental primate embryo transfer model may help to elucidate components of maternal and embryonic signal-response mechanisms during embryo implantation.      

A rapid microagglutination test for the diagnosis of Legionella pneumophila (serogroup 1) infection

A rapid microagglutination test has been developed which can be performed in 30 minutes. Ninety-seven percent of 96 patients diagnosed as having Legionella pneumophila (serogroup 1) infection by indirect immunofluorescence were also detected by the rapid microagglutination test.