Mit Gentamicin oder Levofloxacin gesättigter Kollagenhydroxyapatit (Healos®)

Background

The functions of synthetic bone graft substitutes include not only structural support to provide bone healing and osseous ingrowth but also the ability to serve as a local antibiotic delivery system to prevent or treat infections of the spine.

Material and Methods

The impregnation and antibiotic efficiency of gentamicin and levofloxacin with Healos was investigated in vitro and compared with Healos without an antibiotic additive. These antibiotic-loaded bone graft substitutes were examined without dilution and with 10-fold and 100-fold dilution for activity against spondylodiscitis-causing bacteria on different agar plates using an agar diffusion method.

Results

All hydroxyapatite (HA)/collagen-saturated diluted antibiotics showed elliptical inhibition zones on the corresponding agar plates. For both antibiotics, there was a linear correlation between dilution and area of the inhibition zone.

Conclusion

The analysis showed that the antimicrobial activity of HA/collagen-saturated antibiotics corresponded to the antimicrobial dilutions. These results should be further analyzed using in vivo studies to determine the remaining antibiotic efficiency after implantation of bone graft substitutes.     

über hochziffrige eosinophilämien und neutrophilämien,eosinophile und neutrophile präleukämien und leukämien

Ohne Zusammenfassung     

Wirbelsäulenverletzungen und Unfallfolgezustände

The aim of computer-assisted navigation procedures is to increase the anatomical orientation intraoperatively, to improve the accuracy, to minimize the invasiveness and to reduce the emission of radiation. In the field of orthopedic surgery navigation has been used for over 15 years and these techniques are particularly widely used in spinal surgery. There are three major applications of navigation: CT-based (computed tomography) navigation which needs a preoperative CT scan, 2D navigation which is based on standard X-ray images of a C-arm during surgery and 3D navigation which requires an intraoperatively performed C-arm based 3D scan. Higher accuracy has been proven for instrumentation of the lumbar and cervical spine and reduced emission of radiation could be demonstrated. Higher accuracy for pedicle screw insertions of the thoracic spine is still not proven in prospective studies with sufficient numbers of pedicle screws. Navigation systems provide additional information for better anatomical orientation in spinal surgery and can reduce intraoperative fluoroscopy time. Intraoperative 3D scan technology with automatic registration is the perfect tool in spinal surgery today. Knowledge of the classical techniques remains crucial for the safety of patients.     

Oberschenkelamputation und Wirbelsäulenveränderungen

Ohne Zusammenfassung     

Teilweise und vollständige Verrenkungen und Brüche der Halswirbelsäule und ihre Spätergebnisse

Ohne Zusammenfassung     

En-bloc-Spondylektomie und Defektrekonstruktion bei Primärtumoren und Solitärmetastasen der Wirbelsäule

In primary tumors of the spine and, with limitations, solitary metastasis, the surgical approach should aim for curative treatment of the disease. Because the prognosis of malignant bone tumors is extremely limited, if an intralesional approach is performed, an extralesional en bloc resection is the treatment of choice. Therefore, it is mandatory to use an appropriate staging system. For the spine, the WBB staging system has been approved, which transfers the principles of the Enneking classification for treating primary malignant tumors of the limb to the spine. After en bloc spondylectomy, rigid and primary stable instrumented dorsoventral reconstruction must be performed - posteriorly with a dual-rod system using pedicle screws, and anteriorly in the ideal case by means of a vertebral body replacement cage. The possibility of extralesional (wide or marginal) resection of spinal tumors depends on tumor size and location. Extralesional resection and, if indicated, other neoadjuvant, adjuvant, or local therapeutic modalities have a strong positive influence on long-term survival rates. A good prognosis for primary tumors is associated with a good response to chemotherapy and extralesional resection. Solitary metastases have a much worse quod vitam prognosis. Therefore, local control of the disease in en bloc resections of solitary metastasis is a second relevant goal, although curative treatment is the primary aim.     

Primäre und sekundäre plastische Eingriffe an Gesicht und Schädel

Ohne Zusammenfassung Mit 4 Textabbildungen in 9 Einzeldarstellungen     

Reliabilität und Veränderungssensitivität der deutschen Version des Fragebogens Arm, Schulter und Hand (DASH)

BACKGROUND: Whilst there are some studies which have focussed on the validity and also others partially on the reliability of the German version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), studies regarding test-retest reliability and responsiveness do not exist. The purpose of this study was to analyse these two meaningful properties of the officially approved German version of the DASH. METHODS: Of 101 consecutive patients with distal radius fractures, 72 were followed prospectively at three time intervals. To evaluate the reliability, internal consistency (Cronbach's alpha) and correlation between the DASH points from the 12- and 13-week examinations (Spearman's correlation coefficient and intra-class coefficient) were calculated. Responsiveness was assessed using the parameters change score, standardised effect size and standardised response mean. These values were compared with the same values obtained from the traditional measures of grip strength and range of motion. RESULTS: Internal consistency and test-retest reliability of the DASH were excellent (Cronbach's alpha >0.95, Spearman's correlation coefficient r=0.912, ICC=0.945). Responsiveness of the DASH was moderate (change score=8.93, SRM=0.55, SES=0.41). Responsiveness of the ROM deficit and grip strength were larger than that for data from the DASH. CONCLUSION: The German DASH is a reliable and responsive measure. It can detect changes in disabilities over time in patients with distal radius fractures. Traditional impairment measures reflect important functional aspects and should be included in clinical outcome evaluation.     

Magenacidität und Ulcushäufigkeit vor und nach portocavalen Anastomosenoperationen

Ohne ZusammenfassungMit 3 Abbildungen     

Comparison of silver-coated dressing (Acticoat®), chlorhexidine acetate 0.5% (Bactigrass®) and nystatin for topical antifungal effect in Candida albicans-contaminated, full-skin-thickness rat burn wounds

Background

In this experimental animal study, the effects of three different topical antimicrobial dressings on Candida albicans contaminated full-thickness burn in rats were analyzed.

Methods

In total 32 adult Wistar rats (body weight 200-220 g) were used. Silver-coated dressing (Acticoat™^®), chlorhexidine acetate 0.5% (Bactigrass^®) and Mycostatine (Nystatin^®) were compared to assess the antifungal effect of a once-daily application on experimental rat 15% full-skin thickness burn wound seeded 24 h earlier with a 10⁸ CFU/mL standard strain of C. albicans ATCC 90028. All the animals were sacrificed at post burn day 7. The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined, in addition to the cultures of left ventricle blood and lung biopsies.

Results

While there were significant differences between Acticoat™^® group (4 ± 10 × 10⁴) and control group (5 ± 6 × 10⁶), and between Nystatin group (4 ± 4 × 10⁴) and control group (P = 0.01, P = 0.01), there were no significant differences between chlorhexidine acetate 0.5% group (2 ± 3 × 10⁴) and control group (P = 0.7) respectively. Acticoat™^® and Nystatin were sufficient to prevent to C. albicans from invading to the muscle and from causing systemic infection.

Conclusions

The animal data suggest that nystatin is the most effective agents in the treatment of C. albicans-contaminated burn wounds, and Acticoat™^® is a choice of treatment on fungal burn wound infection with antibacterial effect and the particular advantage of limiting the frequency of replacement of the dressing.     

Chronische capsuläre und pericapsuläre Schulterversteifungen und ihre Beseitigung mittels Plexusanästesie

Ohne Zusammenfassung Mit 4 Textabbildungen.     

Exakte Messung des Volumeneffektes von 6%iger Hydroxyethylstärke 130/0,4 (Voluven®) während präoperativer akuter normovolämer Hämodilution

Background

What is the effect of preoperative acute normovolemic hemodilution (ANH) with 6% hydroxyethyl starch (HES) 130/0.4 (Voluven^®) on blood volume?

Methods

In 10 patients undergoing radical hysterectomy, ANH was performed to a hematocrit of 21% using 6% HES 130/0.4 (Voluven^®) whereby a replacement of blood with 115% of colloid was planned. Plasma volume (indocyanine green dilution technique) and hematocrit were determined before, 30 and 60 min after ANH. Red cell volume (labelling erythrocytes with fluorescein) was determined before and 30 min after ANH.

Results

After removal of 1,431±388 ml of blood and simultaneous replacement with 1,686±437 ml of colloid, blood volumes were 218±174 ml higher than before (at 105±4%). The volume effect was 98±12%, 30 min after ANH. Even 60 min after ANH, mean blood volumes were with 4,228±986 ml slightly higher than before ANH (102±5%). The hematocrit decreased disproportionally in relation to the residual intravascular volume. Consequently, estimating the volume effect from the changes in hematocrit led to an overestimation (about +30%).

Conclusion

Double label measurements of blood volume demonstrated that the volume effect of 6% HES 130/0.4 (Voluven^®) is about 100% in the course of ANH. The reason for the disproportionally large decrease in hematocrits could be the mobilization of a fraction of the plasma volume which was retained within the endothelial glycocalyx.     

Spondyloepiphysäre und metaphysäre Dysplasie

Spondyloepiphyseal, metaphyseal and spondylometaphyseal dysplasias are a group of hereditary skeletal diseases, which lead to small stature, axial deformities of the lower extremities and spinal deformities. They differ in pathophysiology, heredity and in their clinical and radiologic appearance. The orthopaedic surgeon treats the spinal manifestations and the axial malalignment of the disease. Among the spinal deformities there are instabilities of the upper cervical spine as well as structural deformities like kyphosis and scoliosis. More frequently, the axial malalignment caused by congenital coxa vara, severe genu varum or genu valgum requires treatment. These deformities are managed by corrective osteotomies of the proximal femur, supracondylar or proximal tibial osteotomies around the knee and by temporary epiphyseodeses. Despite a high recurrence rate requiring repeated surgery the patients report great satisfaction with the treatment results. Well-timed orthopaedic treatment helps avoid or delay the inevitable long-term sequelae of untreated patients such as painful degenerative changes of the spine or early onset of severe osteoarthritis.