Zur Diagnostik und Therapie der Rückenmarksangiome

Zusammenfassung Beschreibung eines angiographisch diagnostizierten arteriovenösen Angioms des Halsmarkes, welches nach 15 Jahre langem Verlauf erkannt, palliativ operiert und kontrollangiographiert wurde.

---

Summary The authors describe an angiographically diagnosed arteriovenous angioma of the cervical spinal cord, which was recognised after a 15 year history and was then submitted to palliative surgery and subsequent control angiography.

---

Resumen Los autores describen la angiografía de un angioma arterio-venoso de la medula cervical, diagnosticado al cabo de 15 años de historia cllnica y tratado mediante una intervención paliativa.Se efectuó un control arteriográfico post-operatorio.

---

Résumé Les auteurs décrivent l'angiographie d'un angiome artério-veineux de la moelle cervicale, diagnostiqué après 15 ans d'histoire clinique et traité par une intervention palliative. Un contrÔle artériographique postopératoire a été effectué.

     

Luxation nach Hüfttotalendoprothesenrevision

With a dislocation rate of up to 35% after revision total hip arthroplasty (THA), instability is one of the major causes why this procedure fails. Independent factors for patients at risk are age, sex, and the type of revision needed. The surgical approach, implant choice, and positioning of the components are factors that the surgeon can influence to keep the dislocation rate low. Large femoral heads or double mobility (DM) cups can increase the stability of the joint. After detailed failure analysis, targeted use of different technical innovations enhances stability in revision THA and prevents further revisions.     

Diagnostik und Therapie von Funktionsst?rungen der H��ftmuskulatur nach Totalendoprothese

Abductor insufficiency after hip arthroplasty is a difficult and challenging problem whereby conservative therapy is often insufficient and surgical therapy is known to have failures with re-ruptures. Alternative approaches and arthroscopic surgery are proposed but in many cases they do not fulfill the expectations of patients.Our experience with temporary explantation of implants and transosseous refixation is good resulting in a pain-free patient in a high number of cases but the method is quite demanding and needs a cooperative patient. A functionless abductor muscle is not amenable to surgical treatment but only a surgical exploration can confirm the clinical suspicion.     

Hüftarthroskopie Minimal-invasive Diagnostik und Therapie des erkrankten oder verletzten Hüftgelenks

Arthroscopy of the hip joint has developed into a useful tool for the hip surgeon. Hip joint anatomy, however, makes special demands of the arthroscopist. He needs to be familiar with the arthroscopic anatomy of the hip and its variations. Moreover, he should have practical training in the technique of hip arthroscopy prior to his first intraoperative experience in order to avoid complications. A complete arthroscopic inspection of the hip can be achieved by using a combined procedure: whereas the central hip compartment can be scoped only by distraction of the joint, the periphery can be better seen without traction. Whether to place the patient supine or lateral is dependent on personal experience. No matter which position is used, the positioning technique has to be exact. The literature has shown that most complications are related to traction. Before the first portal is placed, the joint vacuum force should be broken by distension of air or fluid. This leads to maximum distraction of the joint and reduces the risks of damage to labrum and cartilage during first access to the joint. For a diagnostic round through the central compartment, at least two portals have to be placed. The use of a 3-portal technique increases the range of inspection. Due to the relatively thin soft tissue mantle and greater distance to neurovascular structures, the anterolateral or lateral portal should be used as the first portals to the central compartment. In addition, the anterolateral portal is the standard portal to the periphery of the hip. The posterolateral or anterior portal should be used as a supplementary portal. The following indications have been described for an arthroscopic procedure of the hip: loose bodies, labral lesions, synovial diseases such as chondromatosis and pigmented villonodular synovitis, associated lesions in underlying osteoarthritis, ruptures of the teres ligament, malorientation of the acetabulum and proximal femur and, last but not least, "idiopathic" hip pain. The use of hip arthroscopy in infectious arthritis, avascular necrosis of the femoral head, Perthes' disease, osteochondrosis dissecans and complications after total hip replacement is less frequent. Here, in addition to its diagnostic value, operative arthroscopy of the hip offers removal of loose bodies, resection of the labrum and ligaments, synovial biopsy, partial synovectomy, microfracturing, lavage and placement of intraarticular drainage. The first results of arthroscopic procedures in the hip are promising. In addition to its diagnostic value and contribution to the understanding of intraarticular anatomy and pathology, recent studies have demonstrated the advantages of the arthroscopic treatment of the hip.     

Vermeidung, Diagnostik und Therapie von Nervenl?sionen nach H��ftendoprothesenimplantation

Nerve palsy following total hip arthroplasty is a rare complication. Developmental dysplasia of the hip, previous fracture treatment and medical comorbidities are characteristic risk factors. By accurate preparation of the patient and a careful operative technique nerve palsy can be avoided in most cases. Nerve palsy following poor patient positioning during the perioperative period should be avoided by close cooperation with anesthesiologists.In cases of postoperative nerve palsy correct diagnostics should be carried out immediately. Further treatment options should be considered to minimize the damage. For patients with definite nerve palsy, devices such as a foot drop splint are often necessary and should be carried out as soon as possible.     

Luxation des Mondbeins nach volar und nicht perinuläre Luxation der Hand nach dorsal

Ohne Zusammenfassung Mit 11 Textabbildungen.     

Bildgebende Diagnostik der Hüftdysplasie

Modern imaging techniques are an invaluable tool for assessing pathomorphological changes of the hip. Thorough diagnostic analysis and therapeutic decision making mainly rely on correct interpretation of conventional radiographic projections as well as more modern techniques, including magnetic resonance arthrography. This article gives an overview of the imaging techniques that are routinely used for assessing pathological conditions of the hip, with a special focus on diagnostic findings in developmental dysplasia of the hip as well as in femoroacetabular impingement.     

Diagnostik und Therapie der isolierten proximalen Bizepsläsion

Pathologies of the long head of the biceps tendon are a frequent cause of pain and restricted shoulder function. In most cases the anamnesis and clinical examination with a combination of specific tests for the biceps tendon lead to the diagnosis. Magnetic resonance imaging (MRI) especially with intraarticular contrast medium enables differentiation of the different biceps pathologies and additional disorders, such as rotator cuff tears. Radiological examination can rule out other bone pathologies. In cases of unclear persistent shoulder disability, diagnostic arthroscopy remains the gold standard which allows a precise diagnosis as well as direct operative treatment of the underlying pathologies. Conservative treatment consists of adaptation of physical activity, anti-inflammatory drugs as well as injections with local anesthetics. Physical therapy can further address concomitant contractures of the capsule or dyskinesia of the scapula. After failed conservative treatment, the surgical procedure depends on the underlying pathology including debridement or refixation of the biceps anchor, tenotomy or tenodesis of the biceps tendon as well as treatment of concomitant pathologies, such as rotator cuff tears.     

Aktuelle Diagnostik und Therapie der sexuell übertragbaren Infektionen

Background

In recent years, there has been an increasing incidence of sexually transmitted infections (STI), which in turn play a major role in urological clinical routine.

Objectives

Which STIs are relevant in urological clinical routine? What kind of recommendations for diagnosis and treatment exist?

Materials and methods

Review of evidence-based recommendations from the literature, current guidelines of the European Association of Urology and the Robert-Koch-Institute.

Results

STIs can be differentiated into those that cause genital, anal, perianal or oral ulcers from STIs that cause urethritis, cervicitis, or urethral or vaginal discharge. Asymptomatic courses are frequently observed. For diagnosis predominantly amplification methods are recommended. The local resistance situation should be considered. Special attention is paid to the worldwide increasing resistance of gonococci. The sexual partner should also be treated. In addition, diagnosis and therapy of other STIs should be made due to the high rate of co-infection.

Conclusions

Due to the increasing incidence of STIs, the recognition and evidence-based treatment of these infections is essential to avoid ascending infections, long-term consequences, and further transmissions. It is important to assure the infectious material before initiating therapy to be able to switch from the initially initiated calculated therapy (also considering the local resistance situation) to a test-appropriate therapy.

     

Diagnostik und Therapie von Weichteilsarkomen der Extremitäten

The diagnosis of unclear soft tissue tumors represents a common problem in everyday clinical practice. Magnetic resonance imaging often reveals some first information about soft tissue tumors; however, clarification of the dignity can only be achieved by histopathological examination. Most of the lesions are benign but should be treated as a malignant tumor until this can be excluded as unnecessary surgery or biopsies can complicate treatment and worsen the prognosis. These aspects in particular are summarized and discussed in this article.     

Zusammenfassung der ��berarbeiteten Leitlinie zur Diagnostik und Therapie der Venenthrombose und der Lungenembolie

It is recommended that the clinical probability of venous thrombosis be estimated in advance using clinical scores or an examination-based clinical evaluation. Compression sonography should be used primarily to obtain images in order to diagnose or rule out venous thrombosis. Phlebography is also appropriate to diagnose or rule out the presence of venous thrombosis. Its application should, however, be reserved for unclear cases. In idiopathic venous thrombosis, the possible presence of a malignancy must be explored. Venous thrombosis during pregnancy should be evaluated with an interdisciplinary team. The main therapeutic goals for deep vein thrombosis are, among others, to minimize the risk of an embolism and to limit the growth of the thrombus formation. Therapeutic anticoagulation should be begun immediately, preferably with low molecular weight heparin or fondaparinux. Unfractionated heparin should also be used in patients with chronic renal insufficiency and in the setting of percutaneous vascular interventions. In the event of contraindications for vitamin K antagonists, low molecular weight heparin can also be used long term. Using compression therapy, the frequency and severity of a postthrombotic syndrome can be reduced. Patients with deep vein thrombosis should only be immobilized to relieve severe pain. Tumor patients with thrombosis should be treated for 3?C6?months with low molecular weight heparin instead of vitamin K antagonists. The present report summarizes the first part of the guidelines for the ??Diagnosis and treatment of venous thrombosis??.     

Diagnostik und Therapie der frischen und chronischen hinteren Kreuzbandläsion

Zusammenfassung. Rupturen des hinteren Kreuzbandes geh?ren zu den schwerwiegenden Bandverletzungen des Kniegelenks. Problematisch ist hier eine oft unzureichende Einsch?tzung und versp?tete Diagnostik der Verletzungsschwere als auch der Begleitverletzungen. Zus?tzlich ist die Versagerquote der bisherigen Rekonstruktionsverfahren unbefriedigend hoch. Das Ziel dieser übersichtsarbeit ist es, auf der Basis der eigenen Erfahrungen und dem Wissen aus dem internationalen Schriftum, einen umfassenden Einblick in die Anatomie und Biomechanik, die Unfallmechanismen und die Pathobiomechanik zu geben. Ein weiterer Schwerpunkt liegt in der Kl?rung diagnostischer Schwierigkeiten. Zur ad?quaten Berücksichtigung der Begleitverletzungen, wie z. B. der posterolaterale rotatorische Instabilit?t oder zus?tzlichen Verletzungen des vorderen Kreuzbandes wird ein differenziertes Therapiekonzept vorgestellt, um das konservative und perioperative Management zu optimieren, mit dem Ziel die hohe Quote unbefriedigender Ergebnisse weiter zu reduzieren.      

Diagnostik und Therapie der frischen und chronischen hinteren Kreuzbandl?sion

Rupturen des hinteren Kreuzbandes geh?ren zu den schwerwiegenden Bandverletzungen des Kniegelenks. Problematisch ist hier eine oft unzureichende Einsch?tzung und versp?tete Diagnostik der Verletzungsschwere als auch der Begleitverletzungen. Zus?tzlich ist die Versagerquote der bisherigen Rekonstruktionsverfahren unbefriedigend hoch. Das Ziel dieser übersichtsarbeit ist es, auf der Basis der eigenen Erfahrungen und dem Wissen aus dem internationalen Schriftum, einen umfassenden Einblick in die Anatomie und Biomechanik, die Unfallmechanismen und die Pathobiomechanik zu geben. Ein weiterer Schwerpunkt liegt in der Kl?rung diagnostischer Schwierigkeiten. Zur ad?quaten Berücksichtigung der Begleitverletzungen, wie z. B. der posterolaterale rotatorische Instabilit?t oder zus?tzlichen Verletzungen des vorderen Kreuzbandes wird ein differenziertes Therapiekonzept vorgestellt, um das konservative und perioperative Management zu optimieren, mit dem Ziel die hohe Quote unbefriedigender Ergebnisse weiter zu reduzieren.     

Diagnostik und Therapie akuter Beschwerden nach „HWS-Distorsion“ in Deutschland

Whiplash injury of the cervical spine is a relevant medical and socioeconomic problem, which is still the subject of controversy. We performed a survey to evaluate the current status of diagnostics, classification, treatment, and doctors' subjective opinions at surgical and trauma departments in Germany. A total of 1568 hospitals were addressed to answer a standardized questionnaire on their proceedings and opinions concerning whiplash injury. We received 540 (34.44%) completed questionnaires. There was overall agreement concerning the need for physical examination. The radiological assessment included an a.p. and a lateral plain X-ray of the cervical spine in 82.6%. The indication for functional X-rays in flexion/extension was inconsistent. On average they were performed in 39.1% of all patients. In most cases (68.9%) whiplash injury was not classified; 13.2% of doctors used the classification according to the Quebec Task Force and 13.9% according to Erdmann. A cervical collar was prescribed in 85%. While 30% of patients received only a cervical collar, 55.6% underwent additional physiotherapy. Only 8.3% were treated by physiotherapy without immobilization. The doctors' subjective opinions indicated psychological factors to be important for long-lasting problems, but not for the acute period of complaints. There is no homogeneous concept for diagnostics, classification, and treatment of patients who suffered a whiplash injury in Germany. This situation reflects the current problems in management of this condition. Scientific evidence for functional treatment to avoid adverse influence of immobilization by cervical collars has not yet been transferred to our daily routine in Germany.     

Komplikationen bei der Arthroskopie des Hüftgelenks und deren Therapie

Background

In recent years arthroscopic interventions of the hip joint have become increasingly more frequent. An advantage of the procedure is that open surgery can be avoided in many cases by using minimally invasive procedures. The spectrum of indications is becoming increasingly broader and more differentiated. Complications are rare.

Material and methods

According to the types of complications 13,154 cases from institutions having conducted approximately 470 hip arthroscopies per year between 2008 and 2012 were collated, observed and analysed. Intraoperative or postoperative complications were taken into account.

Results

According to our definition, the overall complication ratio came to 6.3%. Relatively frequent complications were damage caused by inadequate setup, nerve lesions and broken instruments. Severe complications such as vascular lesions, intra-or postoperative fractures, infections and avascular necrosis are rare.

Conclusion

In hip arthroscopy special attention has to be paid to patient positioning, traction performing and portal establishing. This procedure performed by an experienced surgeon resulted in a low ratio of complications.     

Diagnostik und Therapie der Fußfehlstellung bei Charcot-Marie-Tooth Erkrankung

BackgroundRare diseases are defined as entities when no more than 1 in 2000 people are affected. The prevalence of hereditary neuropathies is slightly lower at 1: 2500. The Charcot-Marie-Tooth (CMT) disease subsumes a group of hereditary neuropathies which, due to demyelinating or axonal degeneration, cause a loss of muscular activity and represent a disease of the musculoskeletal system. The effects on the lower extremities and especially the foot and ankle are of paramount importance for mobility and quality of life and should be presented in this article.MethodsTaking into account the current literature and the authorś clinical experience, the current state of knowledge on etiology, diagnosis and therapy of CMT diseases of the foot and ankle should be compiled and evaluated.ConclusionOrthopaedic treatment provides multiple conservative and operative techniques to reduce the consequences of neuropathic disorders for patients. The treatment is related to the symptoms. Causal therapies are currently not available.     

Diagnostik und Therapie der ligamentären Ellenbogeninstabilitäten

Posttraumatic or acute instability of the elbow can develop after complete or incomplete dislocation of the elbow. Isolated medial collateral ligament ruptures can be a result of valgus trauma and lateral collateral ligament ruptures of pivot shift or varus trauma. Chronic instability of the elbow may occur after conservative or operative treatment of a traumatic ligament rupture without stable healing. Repetitive overuse in sports or professions may also cause chronic instability. This article provides the reader an overview about current concepts in elbow instability.