Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year

Numerous variations of intramedullary nails have been devised to achieve a stable fixation and early mobilisation of pertrochanteric fracture, among which is the proximal femoral nail (PFN). We report here the results of a prospective study carried out at our institute on 100 consecutive patients who had suffered a pertrochanteric, intertrochanteric or high subtrochanteric fracture, or a combination of fractures, between December 2002 and December 2005 and were subsequently treated with a PFN. Close to anatomical reduction of the fracture fragments was achieved in 12 patients, while limited open reduction was required in 14 patients. During the follow-up period of 1 year complications occurred in 12 patients. Our results indicate the necessity of a careful surgical technique and modifications that are specific to the individual fracture pattern in order to reduce complications. Osteosynthesis with the PFN offers the advantages of high rotational stability of the head-neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking.     

Is number of chiasmata an etiological factor of male infertility？

Azoospermia and/or severe oligozoospermia can be treated as principal factors of male infertility. Specifically, azoospermia that stands for 1% of males and 10% of infertile male population has been mostly unexplained （idiopathic）, however, it is suspected for its genetic and/or molecular background？ Pertaining to molecular background of severe oligo-astheno-teratozoospermia （OAT） - the meiotic abnormalities are suspected to reach almost 20%.2 Therefore, this potentially addresses a significant number of cases that could find a possible etiological factor. Meiotic abnormalities as the authors point out encompass combination of anomalies in the process of pairing,     

Establishment of an animal model of non-transthoracic cardiopulmonary bypass in rats

Caeonvrdeairbol ptihnueglm fotuhnneacrty iso ubnrysgpe aoosfns st h(etCo PhB eo)apret tre aamtnepdo o rtnahreil ay l ut nangkosen,s-working heart.And it is an essential component ofconventional cardiac surgery.Although manyimprovements have been made to i…     

Septic conditions of the shoulder —an up-dating of treatment strategies

We report the cases of 28 patients with bacterial infections of the shoulder treated between 1979 and 1991. There were ten cases of septic arthritis, ten cases of simple osteomyelitis of the proximal humerus, four cases of septic arthritis and concomitant osteomyelitis of the proximal humerus and four cases of periarticular soft-tissue infection. The infections, except for the cases of osteomyelitis, were staged by a Classification of Exogenic Bacterial Infections (CEBI). In septic arthritis and in periarticular soft-tissue infection, the time between the initial symptoms of infection and diagnosis was about 20 days. In the cases with osteomyelitis, there was an average delay of 9 months, which was partly due to the slow evolution of plasmacellular osteomyelitis. Treatment was based on operative debridement and arthrotomy, the insertion of drains, the implantation of gentamicin-polymethylmethacrylate beads and the application of highdose parenteral antibiotics. In the postoperative period physiotherapy with early active and/or passive range-of-motion exercises favoured the draining of secretions and therefore gave better results than complete immobilisation. Treatment was evaluated using a modification of the shoulder score of Wülker et al. [17]. This study demonstrated that favourable results could only be obtained if the diagnosis was made early. This is particularly true for infections with Staphylococcus aureus (found in 19 patients). The overall result of the treatment of osteomyelitis and periarticular soft-tissue infection was good or satisfactory, while unsatisfactory results were noted for the patients with septic arthritis, particularly those with both septic arthritis and osteomyelitis.Read in part at the First European Congress of Orthopaedics, Paris, France. April 21–23, 1993     

Psychosocial aspects of road traffic trauma--benefits of an early intervention?

PURPOSE: To assess the psychosocial consequences of traffic accidents, and to evaluate the effect of an intervention programme to reduce the occurrence and extent of psychosocial residual states. MATERIAL AND METHODS: A telephone interview was conducted with 314 individuals, 1(1/2)-2 years after the accident in 1994-1995. The effect of the intervention programme was studied for inpatients, 68 in the study group, and 89 in the control group. The structured follow-up form included the Impact of Event Scale (IES). RESULTS: Half of those injured had residual physical complaints with negative effects on their work- and economic-situation. An influence on housing or the need for practical assistance was reported by 1-7%. Mental effects were reported by 4/5. IES demonstrated that 1/5 suffered a high degree of intrusion, and this occurred twice as often among females as among males. Situational anxiety occurred more often in the intervention group than in the control group, p=0.02. More individuals in the intervention group than in the control group were satisfied with the medical certificate to the insurance company, p=0.058. CONCLUSIONS: Females were afflicted by mental effects considerably more than males. The intervention programme did not appear to reduce the psychosocial sequelae. The methods within this area need to be further developed.     

Penetrating wounds of the heart：an analysis of 61 cases

ＧＤｅｐａｒｔｍｅｎｔｏｆＴｒａｕｍａｔｏｌｏｇｙａｎｄＣａｒｄｉｏｔｈｏｒａｃｉｃＳｕｒｇｅｒｙ,ＣｈｏｎｇｑｉｎｇＥｍｅｒｇｅｎｃｙＭｅｄｉｃａｌＣｅｎｔｅｒ,Ｃｈｏｎｇｑｉｎｇ４０００１４,Ｃｈｉｎａ（ＧａｏＪＭ）ｕｎｓｈｏｔｗｏｕｎｄｈａｓｂｅｅｎｔｈｅｃｏｍｍｏｎｅｓｔｃａｕｓｅ（ａｃｃｏｕｎｔｉｎｇｆｏｒ６０％７０％）ｏｆｐｅｎｅｔｒａｔｉｎｇｉｎｊｕｒｙｏｆｔｈｅｈｅａｒｔｉｎｔｈｅＵｎｉｔｅｄＳｔａｔｅｓｏｆＡｍｅｒｉｃａｉｎｔｈｅｐａｓｔ２０ｙｅａｒｓ．１４Ｉｔｃａｕｓｅｓ…     

Molecular pathophysiology of chronic pancreatitis—an update

Conclusion The pathogenesis of chronic pancreatitis is still not completely understood. However, recent advances in cellular and molecular biology have revealed complex interactions between in.ammatory cells and pancreatic parenchyma cells, as well as alterations in nerves. Furthermore, as a result of novel technologies, it has become possible to identify key genes in the disease process of chronic pancreatitis. Tryptase,15 CRISP3,16 and COMP17 are three of the candidate genes that may serve as disease markers and therapeutic targets in the future. Further molecular and cell biology studies will increase our knowledge of the pathogenesis and pathophysiology of this disease, hopefully resulting in better diagnostic and therapeutic modalities in the future.     

Psychosocial aspects of accidental injuries — an overview

This paper reviews the current state of the art with regard to psycho-traumatological issues in accidentally injured patients. A MEDLINE search (1985–1995) yielded a total of 135 references, out of which 60 publications were selected and reviewed. The body of knowledge about the psycho-social effects of serious injuries caused by accidents seems to be still limited. There are indications that accidents leave many patients suffering from not only the physical consequences but also considerable psychological problems. A frequent clinical manifestation of such problems is post-traumatic stress disorder (PTSD), but depression, anxiety and the somatoform disorder have also been observed, possibly even more frequently. There have been substantial discrepancies in epidemiological data in the literature, partially because the samples analyzed so far have not been homogeneous enough. It is also obvious that studies have been devoted almost exclusively to disorders and handicaps following (and occasionally prior to) the traumatic event. Seldom has the study focused on patient resources: practically no studies exist on the effects of protective psycho-social factors on the healing process following accidental injuries. More research is needed in order to be able to make predictions on the expected healing of patients during the acute stage of treatment following an accident. These future studies should deliver information on identifying high-risk patients who would require specific psycho-social intervention.

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Psychosoziale aspekte von unfallbedingten verletzungen — eine Übersicht

Zusammenfassung Es wird eine Übersicht über den gegenwärtigen wissenschaftlichen Kenntnisstand bezüglich psychotraumatologischer Aspekte bei unfallbedingten Verletzungen vorgelegt. Eine computerunterstützte Literatursuche (Medline 1985–1995) lieferte insgesamt 135 Publikationen, von welchen 60 ausgewählt und analysiert wurden. Das Wissen über psychosoziale Auswirkungen unfallbedingter schwerer Verletzungen scheint noch ungenügend zu sein. Es gibt Hinweise darauf, daß viele Patienten nach einem Unfall nicht nur unter den körperlichen Verletzungsfolgen, sondern auch unter erheblichen psychischen Problemen leiden. Diese Probleme manifestieren sich oft unter dem klinischen Bild der posttraumatischen Belastungsstörung (PTBS); es werden aber auch, evtl. sogar noch häufiger, Depressionen, Angst und somatoforme Störungen beobachtet. Die epidemiologischen Daten in der Literatur variieren stark, nicht zuletzt deshalb, weil die bisher untersuchten Stichproben zu wenig homogen waren. Im weiteren fällt auf, daß das wissenschaftliche Augenmerk bisher fast ausschließlich auf Störungen und Beeinträchtigungen nach und gelegentlich auch vor dem traumatischen Ereignis gerichtet war. Eine ressourcenorientierte Perspektive ist nur selten anzutreffen: Es finden sich praktisch keine Studien über die Auswirkungen protektiver psychosozialer Faktoren auf den Heilungsverlauf nach Unfällen. Um bereits in der akuten Behandlungsphase kurz nach dem Unfall Vorhersagen über den zu erwartenden Heilungsverlauf treffen zu können, sind weitere prospektive Studien notwendig. Solche zukünftige Studien sollten Hinweise zur Identifikation von Risikopatienten liefern, denen in der Regelversorgung eine spezifische psychosoziale Intervention durch einen liaison-psychiatrischen Dienst angeboten werden müßte.

     

Implementation of an in-house flow cytometric analysis of DNA fragmentation in spermatozoa

An increased amount of DNA fragme ntation in the spermatozoa(SDF)is linked to male in fertility.The Sperm Chromati n Structure Assay(SCSA)is widely used for analysis of SDF.However,the current software(SCSASoftR)linked to this assay is licensed and often located within larger diagnostic centers.In this study,we present a protocol for using other types of software than SCSASoftR to determine the SDF index(DFI)with clinical relevance.This protocol is engineered after collect!ng and analyzing 254 samples from fertility patients and sperm donors over a 15-month period.DFI is analyzed using a strict protocol where the spermatozoa are treated with a strong acid(pH 1.2)followed by acridine orange.DFI is determined by a standard flow cytometric software,FACSDiva 6.1.3.Analysis of the outcome of the fertility treatment is included for 137 patients receiving either intrauterine inseminations(IUI)or timed coitus(TC).The results show that the chance of pregnancy decli nes as DFI in creases.We also found that the male DFI affects the chanee of pregnancy independent of the female age.We have shown that a standard flow cytometric software can be used when determi ning a clinical releva nt DFI.These findings are a sign ificant step toward impleme nting the an alysis as a part of the routi ne,in・house diag no sing of the male fertility patient and subseque ntly optimizing the treatme nt course of the couple with reduced human and financial costs.     

Dislocation of large diameter metal-on-metal bearings an indicator of metal reaction?

We report 3 patients who underwent total hip arthroplasty (THA) using large diameter metal-on-metal bearing. These patients initially presented with pain but went on to develop dislocation of the THA while awaiting investigations. Any pain following metal-on-metal bearing THA should be taken seriously and should trigger investigations to identify a metal reaction. If left untreated, these reactions can cause progressive soft tissue necrosis leading to instability. These patients should be considered for early revision of the bearing surface to prevent further soft tissue damage.     

Electro-physiological parameters of hepatic radiofrequency ablation—a comparison of an in vitro versus an in vivo porcine liver model

Background  Radiofrequency ablation (RFA) is an inherent part of curative treatment within a multimodal therapy concept of malignant liver tumors. The biggest problem is the high rate of local recurrences in tumors with a diameter of more than 3 cm because of the high variability and poor reproducibility of the zone of ablation. No imaging modality facilitates monitoring during neither intraoperativ nor percutaneous RFA. This experimental study describes and compares an in vitro and in vivo porcine model by its electro-physiological parameters with the aim of monitoring RFA procedures. Materials and methods  RFA was performed in a perfused in vitro porcine (one RFA per liver) and in vivo porcine model (24 animals) with three different RFA systems (Rita XL 5 cm, Rita XLi 7 cm, LeVeen 5 cm). In the in vivo model, percutaneous placement of the RFA device was guided by native and contrast-enhanced CT scan. The electro-physical parameters during RFA were online (in real time) recorded by a dedicated software. After the RFA, the livers were explanted, sliced, and measured according to the consensus technique. Results  The delivered energy was in vivo versus in vitro: Rita XL 238 ± 135 kJ versus 135 ± 53 kJ (p = 0.247); Rita XLi 711 ± 180 kJ versus 159 ± 54 (p = 0.016) and with LeVeen 212 ± 71 kJ (in vivo). The LeVeen system was inconsistent in the in vitro model. This correlates to an energy consumption per ml of necrosis in vivo versus in vitro Rita XL of 8 ± 3 kJ/ml versus 6.4 ± 3.9 kJ/ml (p = 0.537), Rita XLi of 10 ± 6 kJ/ml versus 1.8 ± 0.2 kJ/ml (p = 0.016), and LeVeen of 14.0 ± 12 kJ/ml (in vivo). The volume of ablation was in vivo versus in vitro Rita XL 30 ± 10 ml versus 26 ± 17 ml (p = 0.329), Rita XLi 90 ± 58 ml versus 88 ± 21 ml (p = 0.905), and LeVeen 22 ± 11 ml versus 50 ± 12 ml (p = 0.04). The impedance during RFA were in vivo versus in vitro Rita XL 39 ± 4 Ω versus 50 ± 14 Ω (p < 0.247), Rita XLi 33 ± 5 Ω versus 61 ± 16 Ω (p = 0.016) and LeVeen 31 ± 2 Ω (in vivo). Conclusion  The volume of ablation showed analogue data in vivo and in vitro. The delivered energy and energy consumption was in vivo up to five times (Rita XLi) higher than in vitro and the impedance in vivo was always lower than in vitro. These differences observed between in vivo and in vitro were more pronounced than previously described. Thus the use of an in vitro model for research of the RFA technique must be challenged. The large deployment of the Rita XLi was a problem for percutaneous positioning of the device without direct contact to liver surface or major vessels in 80-kg pigs and to a lesser extent in in vitro liver originating from 130- to 140-kg pigs. Modern RFA systems which generate large volume of tissue necrosis can therefore only be adequately tested in a porcine model with a liver weight of at least 1.5–2 kg. Alternatively, a bovine liver model (with a liver weight up to 10 kg) should be developed in the future. Best of Abstracts—Chirurgisches Forum 2009, Deutsche Gesellschaft für Chirurgie.