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1.
Objective
To evaluate the equipment specificities of diabetic lower limb amputees.Judging criteria
Compare residual limb prosthesis, equipment of the other foot, and walking performances in diabetic and non diabetic above foot amputees.Materials and methods
Direct inclusion of 31 patients.Results
Diabetic amputees need 53 % more bilateral fittings than others—walking prosthesis on the amputated side and therapeutic footwear on the other side — because of foot trophic disorders (53 % more). There is no significant difference for other criteria.Discussion
There are only a few differences between diabetic above foot amputees and non diabetic above foot amputees when prosthesis and walking performances are compared. Therapeutic footwear is often necessary in diabetic lower limb amputees — that is why systematic foot evaluation is needed in this population. This Caribbean study showed that it may be a lack of diabetic foot care in patients that led to amputation of the foot.Conclusion
Diabetic above foot amputees need walking prosthesis and therapeutic footwear, but the diabetes has little impact on prosthetic choice and walking performance.2.
Background
In order that the thumb as the most important part of a functioning hand can assume its functions, it must be stable, sufficiently long, sensitively innervated and sufficiently able to move.Objective
Alternatives to a thumb reconstruction, demonstration of a thumb lengthening procedure using a semi-circular distraction fixator and development of therapy recommendations are presented.Material and methods
A search of the current literature on the callus distractor was carried out. The prototype of a semicircular distraction fixator is presented.Results
An average extension of 3?cm can be realised using callus distraction. The advantages predominate, so that this method should be included in every individual treatment plan, especially when other possibilities are not considered acceptable options.Conclusion
The choice of the appropriate thumb reconstruction procedure after a traumatic amputation depends on the amputation level, age, occupation and the functional necessity of the patient. Callus distraction is a technically simpler procedure in comparison to microsurgical alternatives for reconstruction of an amputated thumb. The most significant drawbacks lie in the missing fingernail area, the interphalangeal joint and the long treatment period. The five essential goals of thumb reconstruction (length, stability, movement, painless function and sensitivity) can all be addressed with this procedure.3.
Objective
Amputations and exarticulations of the toes may be necessary due to several reasons. The goal is to remove necrosis or infection prior to its spread to the midfoot region. From a functional or cosmetic point of view, amputation/exarticulation of a single toe plays no major role. However, this can be different with exarticulation of several toes.Indications
Necrosis, trauma, infection, tumor, deformity.Contraindications
Conditions where amputation/exarticulation of a toe is insufficient, e.?g., in progressing peripheral arterial disease.Surgical technique
The toe can either be amputated through the distal phalanx or exarticulated in the metatarsophalangeal joint.Postoperative management
Orthopedic shoes or orthotic devices are rarely necessary when a single toe is amputated/exarticulated. However, concomitant deformities of the foot have to be thoroughly addressed. If more than one toe is amputated, silicone spacers may be necessary to prevent the remaining toes from deviating.Results
Amputations and exarticulations of the toes are frequent and the procedure is technically simple. However, the complication rate is high due to typical indications making amputation necessary.4.
5.
6.
Objective
The goal of Pirogoff’s amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the sensation of the sole of the heel.Indications
Non-reconstructable forefoot and midfoot after complex trauma, deep bony and soft tissue infection, infected Charcot foot, necrosis or gangrene due to vasculopathy, malignant tumors and deformities.Contraindications
Possibility for reconstruction of the forefoot and midfoot, minor amputation, loss or irreversible destruction of the sole of the heel.Surgical technique
The incision runs from dorsal, 1–2?cm distal of the Chopart joint, to plantar, 5–6?cm distal of the Chopart joint for creation of an adequate plantar skin flap. Exarticulation of the foot from dorsal to plantar through the Chopart joint with preservation of the posteromedial neurovascular bundle. Enucleation of the talus. Minimal resection of the cuboidal and posterior facets of the calcaneus as well as the malleoli inclusive of the distal tibial joint surface. The calcaneus is brought under the tibia and a tibiocalcaneal arthrodesis is performed with two compression screws.Postoperative management
No weight bearing until stable scar formation, early mobilization in a walker. Interim prosthesis after 2–4 weeks and definitive prosthesis after 2–3 months.Results
From January 2010 to December 2014 six patients were treated with a modified Pirogoff’s amputation. Primary wound healing was achieved in four patients and in two patients wound healing was impaired. In one patient the wound was conservatively healed and the other patient needed below knee amputation. Early primary prosthetic treatment was possible in four patients. The tibiocalcaneal arthrodesis healed in all five remaining cases. All patients with a healed Pirogoff stump were able to walk for short distances in bare feet without the prosthesis.7.
V. Beck M. Apfelbeck M. Chaloupka A. Kretschmer F. Strittmatter S. Tritschler 《Der Urologe. Ausg. A》2018,57(1):29-33
Background
The development of a stricture of the vesicourethral anastomosis is a serious complication after radical prostatectomy. Strictures occur in 5–8% of patients after radical prostatectomy.Symptoms
Usually the clinical symptoms include an irritative and obstructive component similar to benign prostatic hyperplasia. In rare cases, patients suffer from partial or complete stress incontinence as a result of the anastomotic stricture.Diagnostics
The diagnostic workup is similar to the procedure for urethral strictures. In addition to uroflowmetry, a cystourethrogram (CUG) or, if necessary, a micturating cystourethrogram (MCU) can be performed. A urethrocystoscopy can be performed to ensure the diagnosis.Therapy
In most cases, endoscopic procedures were performed for treatment. Beside a transurethral dilation of the stricture or the Sachse urethrotomy, the most common procedure is transurethral resection to treat the stricture. However, all procedures are associated with a high recurrence rate. In recurrent strictures, open surgical procedures, usually a perineal reanastomosis, should performed early.Conclusion
Endourological procedures like transurethral resection are a good treatment option, but due to the high recurrence rates, open surgical procedures should be discussed and if necessary should be performed early.8.
S. Ochman M. J. Raschke C. Stukenborg-Colsman K. Daniilidis 《Operative Orthopadie und Traumatologie》2016,28(5):352-364
Objective
Debridement of infected tissue with the main aim being the re-establishment of mobilization with preservation of standing and walking ability. Prevention of secondary pressure points or amputations due to inadequate resection or deficient soft tissue cover.Indications
In the case of increasing necrosis of the big toe, surgical abrasion and/or amputation is considered unavoidable. Other indications where surgery could be considered include diabetes and its associated angiopathies together with peripheral arterial angiopathy.Contraindications
In the case of insufficient blood supply an expansion of the resection margins should be taken into account. If there are possible alternatives to amputation. Surgery for patients with renal failure requiring dialysis associated with increased complication rate.Surgical technique
A dorsal cuneiform resection is performed to facilitate implantation of a plantar skin transplant and wound healing. Important is the resection of bone in a slide oblique technique. Amputation scars should be outside pressure zones. Partial amputations in the area of the first ray as exarticulation or via the individual amputated segments possible (as opposed to toes 2–5).Postoperative management
Direct postoperative weight-bearing with rigid insole and dispensing aid for 6–8 weeks. Following complete wound healing, foot support with orthopedic arch and transverse strain relief should be advocated, together with a joint roll in ready-made individual shoes.Results
Both trauma and nontrauma cases were included in our present cohort. A total of 7 cases were surgically revised in 2014 due to superficial skin necrosis that was likely the result of skin tension from the wound stitches.9.
Katrin Müller 《Journal ?sthetische Chirurgie》2018,11(4):208-211
Background
New patients come more and more often over the internet; therefore internet marketing plays an increasingly important role.Question
How can physicians build an effective internet marketing strategy and avoid complications?Method
Selection and authorization of a reputable agency.Results
New customer acquisition through high visibility in the internet, at the same time increasing the image and awareness.Conclusions
In the overall “marketing mix” internet marketing has become indispensable to physicians who want to be successful. Those who are well positioned in Google are well known by their target audience and thus receive a higher response.10.
Background
Anterior cervical discectomy and fusion (ACDF) as well as posterior instrumentation of the cervical spine are frequently performed surgeries for cervical disc prolapse or spinal stenosis. Surgery itself harbors a very low risk of adverse events. Postoperative palsy of the C5 nerve root, however, is a severe complication and its origin is still not fully understood. The risk of such a C5 palsy is reported to be between 0 and 30%; 5% on average according to the literature.Objectives
To describe underlying pathomechanisms and to recommend strategies for risk reduction.Materials and methods
An extensive literature research via Medline was performed.Results
Potential risk factors are male gender, sagittal diameter below 5.6?mm, anterior approach, and higher age.Conclusions
Currently available data only originates from retrospective or anatomical studies. A prospective register study with the goal to put light on the pathogenesis is currently being performed.11.
Introduction
Early ambulation is the principal objective in trans-femoral amputees. Postamputation modifications complicate the rehabilitation process due to a reduced control at the interface between stump and prosthesis. The aim of this study is to determine whether magnetic resonance imaging depicts the amount of fatty degeneration of the thigh muscles after trans-femoral amputation (TFA).Methods
A total of 12 patients following a TFA on the basis of a bone neoplasm or metastasis with an evaluable postoperative MRI were identified. Using the Goutallier classification, the fatty degeneration of the thigh muscles was analyzed in the middle (M) and at the distal end (E) of the residual limb at T1 (10.6 months) and T2 (25.6 months).Results
Analysis at two different levels showed different grades of fatty degeneration of thigh muscles after TFA at T1 and T2. Comparing fatty degeneration at both levels of the stump, the quadriceps femoris revealed a significant change (p = 0.01) at T1 and M. sartorius and adductor (p = 0.02) at T2.Conclusions
MRI is an excellent diagnostic tool to evaluate fatty degeneration after TFA. The highest amount of fatty degeneration of the quadriceps muscle was monitored within the first 10 months. Early physiotherapy is important to strengthen the remaining stump muscles during rehabilitation.12.
Background
Sudden cardiac death is frequent, and prognosis of survival—even with an optimal rescue chain—is poor. Implantation of a miniaturized heart–lung machine during cardiopulmonary resuscitation (CPR) is referred to as extracorporeal CPR (eCPR). The current 2015 Advanced Life Support (ALS) guidelines advocate consideration of eCPR in selected patients.Objectives
Discussion of eCPR basics and requirements for material, staff, and local structures.Materials and methods
Review of current guidelines and published data.Results
eCPR, which can be performed within a controlled environment after in-hospital and out-of-hospital cardiac arrest, is associated with high technical and personnel expenses. The implantation of a heart–lung machine during CPR takes about 30 min. A study with early eCPR after sudden cardiac death reported a 54?% patient survival. Studies with greater delay between collapse and eCPR show less favorable results.Conclusion
An improved survival in selected patients using eCPR seems plausible, however has not been scientifically proven. A benefit in survival might be only achievable with early eCPR.13.
Background
Endoscopic vacuum therapy is a widespread method in the postoperative treatment of lower and upper gastrointestinal (GI) tract leakage.Objective
There is an absence of further technical development of the standardized material from 2007 for the lower GI tract.Material and methods
New strategies and new materials for endoscopic vacuum therapy are presented.Results
Alternative strategies in sponge placement, use of open-pore film drainage, use of a multiple sponge system, rinsing catheter, electronic pumps etc. enable the successful treatment of very complex pelvic defects.Conclusion
The wide variability of pelvic defects often necessitates a change in therapeutic strategies during the course of treatment for an optimized outcome.14.
T. Pillukat R. Fuhrmann J. Windolf J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(1):47-64
Objective
Bony healing of dislocated distal radius fractures after open reduction and internal stabilization by locking screws/pins using palmar approach.Indications
Extraarticular distal radius fractures type A2/A3, simple extra- and intraarticular fractures type C1 according to the AO classification, provided a palmar approach is possible.Contraindications
Forearm soft tissue lesions/infections. As a single procedure if a volar approach not possible.Surgical technique
Palmar approach to the distal radius and fracture. Open reduction. Palmar fixation of the plate to radial shaft with single screw. After fluoroscopy, distal fragments fixed using locking screws.Postoperative management
Below-the-elbow cast for 2 weeks. Early exercise of thumb and fingers, wrist mobilization after cast removal. Complete healing after 6–8 weeks.Results
Ten patients averaged 100?% range of motion of the unaffected side after 43±21 months. No complications observed. DASH score averaged 12±16 points; Krimmer wrist score was excellent in 7, good in 2, and fair in one.15.
Henry G. Smith Joseph M. Thomas Myles J.F. Smith Andrew J. Hayes Dirk C. Strauss 《Annals of surgical oncology》2018,25(2):387-393
Introduction
With modern techniques facilitating limb conservation, amputation for extremity soft-tissue sarcoma (ESTS) is now rare. We sought to determine the indications and outcomes following major amputation for ESTS and whether amputation is prognostic of oncological outcomes in primary disease.Patients and Methods
Patients undergoing major amputations for ESTS from 2004 to 2014 were identified from electronic patient records.Results
The amputation rate in primary localized disease was 4.1%. Overall, 69 patients were identified, including 23 (33.3%) amputations for primary localized disease, 36 (52.2%) amputations for recurrent disease, and 10 (14.5%) amputations for metastatic disease. The local recurrence rate for localized disease at 3 years was 10.4%. Three-year overall survival (OS) was 50.3% following curative amputation, with a median survival of 41 months, and median OS following palliative amputation was 6 months. In the context of primary, localized disease, patients undergoing amputation had a greater proportion of high-grade tumors (69.6% vs. 41.1%; p = 0.009) of greater size (median 16.0 vs. 9.0 cm; p = 0.003) when compared with patients undergoing limb-conserving surgery. The rates of systemic relapse and disease-specific survival were poorer following amputation compared with limb-conserving surgery, however mode of surgery (amputation vs. limb conservation) was only prognostic for OS.Conclusions
Amputation maintains an important role in ESTS and achieves durable local control in those unsuitable for limb-conserving surgery. Survival following amputation in the presence of metastatic disease is poor and should be reserved for patients with significant symptoms.16.
M. De Santis 《Der Urologe. Ausg. A》2018,57(11):1342-1345
Background
Prostate cancer (PCA) seems to be more of an immunologic desert than other tumor entities. It is striking that only rarely does prostate cancer show abundant immune cells and a proimmunogenic microenvironment.Objectives
Is immunotherapy in PCA effective and which patients can benefit.Materials and methods
A review of the literature and recent congress data are presented.Results
Preliminary results with sipuleucel-T for PCA cancer were very promising showing a significant overall survival benefit in randomised phase III studies and the US Federal Drug Administration (FDA) approval for this individualised vaccine. Contrary to other tumor entities this was not the immediate breakthrough to a new therapeutic era of immunotherapy but remained an isolated case and restricted to the USA. More recently, several trials evaluated immunotherapeutic agents but missed their preliminary endpoints. Interestingly, individual patients did benefit and showed long-term remission.Conclusions
Genome sequencing and new biomarkers are also paving a novel pathway towards individualised immunotherapy for PCA. On-going research and clinical trials are exploring the question of which patients will benefit.17.
Background
Pump thromboses are a frequent complication after implantation of a left ventricular assist device (LVAD) with an incidence of 10%.Objective
Evaluation of the risk factors and the necessary diagnostic tools, such as imaging investigations, determination of laboratory parameters and device settings. Recommendations for therapy and differentiation between pharmaceutical and surgical therapy.Material and methods
A literature search of PubMed and inclusion of own hospital recommendations for actions.Results
The diagnostics of a pump thrombosis are carried out by extraction of the data stored by the LVAD and are necessary to evaluate an increased pump performance. An increased lactate dehydrogenase 2.5 fold higher than normal values is highly suspicious of a pump thrombosis. For imaging investigations echocardiography provides indirect parameters, such as increased left ventricular end-diastolic diameter (LVEDD) and progressive mitral valve regurgitation, a frequent opening of the aortic valve and the flow velocity in the outflow cannula. A computed tomography (CT) scan can be used to detect a thrombus formation in the outflow cannula. Therapy can be carried out pharmaceutically using thrombolytic agents, such as recombinant tissue type plasminogen activator (rt-PA) or by a surgical replacement of the pump.Conclusion
The identification of a pump thrombosis is determined by the inclusion of various parameters. The therapy should be carried out individually and be device-specific.18.
P. Magosch P. Habermeyer S. Lichtenberg M. Tauber F. Gohlke F. Mauch D. Boehm M. Loew F. Zeifang W. Pötzl 《Der Orthop?de》2017,46(12):1063-1072
Background
Anatomic shoulder arthroplasty in osteoarthritis with biconcave glenoid wear results in decreased functional results and a higher rate of early glenoid loosening.Aim
The aim of the data analysis of the German shoulder arthroplasty register was to clarify whether reverse shoulder arthroplasty can provide better functional results and a lower complication rate than anatomic arthroplasty in osteoarthritis with biconcave glenoid wear.Methods
The analysis included 1052 completely documented primary implanted arthroplasties with a minimum follow-up of 2 years. In 119 cases, a B2-type glenoid was present. Out of these cases, 86 were treated with an anatomic shoulder arthroplasty, and in 33 cases a reverse shoulder arthroplasty was implanted. The mean follow-up was 47.6 months.Results
The Constant score with its subcategories, as well as the active range of movement improved significantly after anatomic and after reverse shoulder arthroplasty.Discussion
We observed no difference in functional results between both types of arthroplasty; however, reverse arthroplasty showed a significant higher revision rate (21.2%) (3% glenoid loosening, 6% prosthetic instability) than anatomic shoulder arthroplasty (12.8%) (11.6% glenoid loosening, 1.2% prosthetic instability), whereas anatomic shoulder arthroplasty showed a higher rate of glenoid loosening. Functional and radiographic results of both types of arthroplasty are comparable with the results reported in the literature, although our analysis represents results from an implant registry (data pertaining to medical care quality).19.
20.
Tilman Calliess Max Ettinger Peter Savov Roman Karkosch Henning Windhagen 《Der Orthop?de》2018,47(10):871-879