Metallkundliche Differenzierung von Kobalt-Chrom-Legierungen für Implantate

Background

Cobalt Chromium alloys are used in cemented total hip or knee arthroplasty as well as in metal-on-metal bearings in total hip arthroplasty. An increasing number of publications report about (allergic) reactions to wear particles of Cobalt Chromium alloys. Reactions to nickel are more frequent in comparison to Cobalt or Chromium particles. It is well known that different kinds of Cobalt Chromium alloys contain different amounts of alloying elements; nevertheless. The aim of the current work was to compare the different Cobalt Chromium alloys according to ASTM F or ISO standards in respect to the different alloying elements.

Material and methods

Co28Cr6Mo casting alloys according to ASTM F 75 or ISO 5832–4 as well as forging alloy types according to ASTM F 799 and ISO 5832 such as Co20Cr15W10Ni, Co35Ni20Cr, Fe40Co20Cr10Ni, Co20Cr20Ni, and Co28Cr6Mo were analyzed in respect to their element content of Co, Cr, Ni, Mo, Fe, W, and Mn.

Results

In 1935 the Cobalt based alloy “Vitallium” Co30Cr5Mo basically used in the aircraft industry was introduced into medicine. The chemical composition of this alloy based on Cobalt showed 30 wt.% Chromium and 5 wt.% Molybdenum. The differentiation using alloy names showed no Nickel information in single alloy names.

Conclusion

The information given about different alloys can lead to an unprecise evaluation of histopathological findings in respect to alloys or alloying constituents. Therefore, implant manufacturers should give the exact information about the alloys used and adhere to European law, Euronorm 93/42/EWG.     

Resorbierbare Implantate für Frakturfixierungen, aktueller Stand

Ohne Zusammenfassung     

Ein neues Modell der Fixationsplatte für das Kniegelenk

Ohne ZusammenfassungMit 3 Textabbildungen     

Vorhersageparameter für das Vorliegen eines Residualtumors bei der TUR-B-Nachresektion

Background

European Association of Urology (EAU) guidelines recommend a follow-up transurethral resection of bladder tumors (reTUR-B) for intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) 2-6 weeks after the initial resection. The purpose of this study was to find parameters which indicate the presence of residual tumor in reTUR-B and to evaluate the prognostic value.

Patients and methods

The data from all patients treated with TUR-B between January 2005 and December 2008 were retrospectively evaluated. The residual tumor rate was correlated with age, sex, staging, grading, risk group, multifocality and surgeon’s level of training.

Results

A total number of 555 TUR-B operations were carried out and 179 patients received reTUR-B according to the EAU guidelines. Age (p=0.8), sex (p=0.7), initial staging (p=0.2), initial grading (p=0.3) and surgeon’s level of training (p=0.7) did not have an impact on the rate of residual tumor in reTUR-B. Tumors categorized as high risk according to the EAU risk score in initial TUR-B (p<0.01) and multifocality (p=0.01) were associated with significantly higher rates of residual tumor.

Conclusions

A reTUR-B is strongly indicated in high risk bladder tumors as well as multifocal tumors showing a significantly increased residual tumor rate. Other clinical parameters showed no prognostic value for the existence of residual tumor in reTUR-B.     

Ausbildungsinitiative der Deutschen Gesellschaft für Urologie für innovative Forschung

The tasks of the Working Group on Urological Research (AuF) of the German Society of Urology (DGU) are to support communication and initiation of joint ventures in German urology and to cooperate with associated subjects and neighboring countries. The annual “wet lab workshops” needs a space between annual and “wet lab workshops” on the topics of tumor cell culture, gene silencing, proteomics, and tissue engineering and the use instead of annual topic-related symposium“urological research,” organized and carried out by the AuF as of 2009, serve to achieve a close change to closer integration of praxis and theory. This should contribute to a lasting quality improvement of the scientific work in urology. Accomplishing these objectives seems urgently necessary to preserve the interests of urologists, because more than ever research has become indispensable in an increasingly difficult environment of health care policy.     

Bericht über das Kolloquium der Deutschen Gesellschaft für Neurochirurgie

Ohne Zusammenfassung     

Zum Stellenwert der laparoskopischen Sonographie für das Staging gastrointestinaler Tumoren

BACKGROUND: The objective of this study was to evaluate the impact of laparoscopic ultrasound on the staging of gastrointestinal tumors prospectively. METHODS: Between 1993 and 2000 staging laparoscopy was performed on 668 patients with various neoplasms. Laparoscopy provided adequate information regarding resectability in 366 patients. Laparoscopic ultrasonography was performed in 302 patients (45%) using an intraoperative ultrasound unit (B & K) and a semiflexible ultrasound probe (5-7.5 MHz). The results of staging laparoscopy were compared to the preoperative staging and histopathology. RESULTS: Compared to preoperative staging laparoscopic ultrasound provided additional information of therapeutic relevance in 46 of 302 cases (15%). In a group of 384 patients with tumors of the upper gastrointestinal tract, laparoscopic ultrasound was performed in 186 cases and showed occult liver metastases, M1-lymph nodes, or nonresectable disease in 26 patients. Overall, this technique improved the staging of esophageal, gastric and pancreatic cancer in 12%, 3%, and 12% of the patients, respectively. Laparoscopic ultrasound proved to be most useful in esophageal and pancreatic cancer with a rate of 52% and 20% information additional to laparoscopy. The relative contribution of laparoscopic ultrasound to the staging of gastric cancer was only 10%. CONCLUSION: Laparoscopic ultrasound improves the diagnostic accuracy of staging laparoscopy. However, routine use of this technique is only justified, if neoadjuvant therapy--particularly in controlled trials--is considered in patients with advanced gastrointestinal cancer.     

Institut für das Entgeltsystem im Krankenhaus

The Institute for the Remuneration System in Hospitals (InEK) was founded in 2001 following the introduction of the flat rate remuneration system for general full and partial inpatient somatic hospital services in Germany by the partners of the joint self-administration. It undertakes the administration and further development of the German diagnosis-related groups system (G-DRG). This includes the definitions and maintenance of the G?DRG considering the comorbidities and complexities, processing and updating of the German coding guidelines. It also includes calculation of the assessment relations of the G?DRG with appropriate supplementary and deduction charges from real costs data of hospitals. With the processing of the procedure for new investigation and treatment methods the InEK plays a decisive role in the integration of new innovative treatment methods and medications in the G?DRG system. The calculation of assessment relations to investment cost financing of hospitals is also a task of the InEK. In addition to these functions the InEK developed the flat rate remuneration system for psychiatry and psychosomatics (PEPP) and in cooperation with other states supported the implementation of flat rate remuneration systems in healthcare services.     

Simulationstraining für das Team im Rettungsdienst

Background

Simulator based training is extensively used in many non-medical high-risk industries. Critical scenarios and standard situations can be trained in complete safety.

Results and objectives

Situations which are regularly met in the field by the emergency team can be simulated. Careful planning and preparation of realistic scenarios is vital to ensure acceptance by the participants and a high rate of transfer of skills to the daily working environment. Only training which is carried out by all emergency medical personnel in the region can achieve a high level of effectiveness. The instructors of the simulation team at the Saint Josef Hospital in Freiburg developed a 1?day seminar with practical as well as theoretical contents. This was implemented over 1 year for more than 100 paramedics in the region. The concept focused on short lectures and intensive debriefings following scenarios in which the participants developed strategies for crew resource management, non technical skills and learned to put it into practice. The organizers wanted to demonstrate the practicability of a regionwide education concept in simulation and team training for the emergency medical service.

Conclusions

With the help of the carefully developed course concept an impressive training course was offered. The participants, when questioned directly after the course, were satisfied with the training and the results. In a further evaluation after some months the success and aftereffects of the project were confirmed.

     

Risikofaktoren für das Versagen von Osteosynthesen

Background

The increasing number of implantations of total knee endoprostheses shows a correlation with an increase in revision operations and periprosthetic fractures.

Objective

This article presents strategies for prevention of complications after open reduction internal fixation (ORIF) of periprosthetic fractures in addition to the classification of periprosthetic fractures of the knee joint.

Therapy strategies

Osteosynthetic treatment is only applicable in some of the cases. Although special periprosthetic, angle locking plates are available for osteosynthesis, treatment of periprosthetic fractures of the knee joint remains a challenge with a high complication rate. If the prosthesis becomes loosened, the prosthesis should be replaced and ORIF should not be performed.

Risk factors

The risk factors for failure of osteosynthesis include the prosthesis model and the associated reduction of residual bone and the mostly osteoporotic bone structures.     

II. Die Erklärung für das Ausbleiben der Füllung der Gallenblase bei der Cholecystographie

Zusammenfassung Aus den beschriebenen F?llen k?nnen wir ersehen, da? die cholecystographische Untersuchung nicht immer das genaue Bild des tats?chlichen Zustandes des Gallensystems gibt. Wenn bei intraven?ser Verabreichung des Jodkontrastmittels die Gallenblase sich innerhalb von 20 St. nicht füllt und die Klagen nicht typisch sind, müssen wir mit der M?glichkeit von Ver?nderungen oder Erkrankungen anderer Bauchorgane rechnen. In solchen F?llen müssen wir die Ursache der Nichtfüllung durch genaue R?ntgenuntersuchung des Magens und Darmes, durch wiederholte cholecystographische Untersuchung festzustellen trachten. Vortrag, gehalten auf dem XV. Ungarischen Chirurgenkongre? 28. 5. 29.     

Bedeutung der Immunochemotherapie für das Überleben von Patienten mit metastasiertem Nierenzellkarzinom

The prognosis for patients with metastatic renal cell carcinoma (RCC) remains unsatisfactory to date. Combined immunochemotherapy (ICT) strives for a synergistic effect avoiding a substantial increase of therapy-related adverse events. The combination therapy regimes consisting of either interferon-alpha-2a/vinblastine (IFN-alpha2a/VBL) or interferon-alpha-2a/interleukin-2/5-fluorouracil (IFN-alpha2a/IL-2/5-FU) demonstrated objective remission rates, surpassing the results obtained with the administration of single immunotherapeutic agents. Despite the data from a recently published study, the role of these two therapy combinations did not seem clearly defined. Therefore, we compared the impact of IFN-alpha2a/VBL and IFN-alpha2a/IL-2/5-FU on remission and survival as well as the safety profile in a retrospective study in patients with metastatic RCC.In a retrospective single-center study, 105 patients with metastatic RCC having received treatment between 1992 and 2002 with either s.c. IFN-alpha2a/ i.v. VBL ( n=70, group 1) or s.c. IFN-alpha2a/ s.c. IL-2/ i.v. 5-FU ( n=35, group 2) were evaluated. At a median follow-up of 17 months, remission and survival rates as well as the toxicity profiles of the respective groups were documented and compared.The median age throughout the entire patient population was 61 years. Patients in the IFN-alpha2a/VBL group reached a median overall survival of 20 months compared to 17 months for the patients in the IFN-alpha2a/IL-2/5-FU population ( p=0.850). The objective response rate in the first patient group reached 25.7%, whereas the tumor remission rate of group 2 amounted to 22.9% ( p=0.680). Patients showing an objective response reached a significantly higher survival rate than patients without response reaction (median survival was 36 vs 10 months, p=0.0001). The incidence of each therapy-induced adverse event was higher throughout the second treatment group. These differences were significant with respect to flu-like symptoms (85.7 vs 57.1%, p=0.003), grade 3/4 elevations of liver enzymes (14.3 vs 1.4%, p=0.007), nausea/vomiting (74.3 vs 50%, p=0.017), the severity of erythemas (74.3 vs 10%, p<0.001), and patients with lung edema (17.1 vs 2.9%, p=0.009). Eight patients discontinued the ICT, two of whom died of a myocardial infarction.Despite an overall limited prognosis, patients showing a tumor remission seem to benefit from ICT in terms of overall survival. While both treatment options offer comparable remission and survival rates, the IFN-alpha2a/VBL regimen induces fewer adverse events than the treatment with IFN-alpha2a/IL-2/5-FU.