Kiefergelenkbeschwerden bei juvenilen Patienten mit rheumatischen Erkrankungen

Fragestellung

Ziel der Untersuchung war es, die Häufigkeit von klinischen Kiefergelenkbeschwerden bei Kindern mit rheumatischen Erkrankungen zu erfassen und Zusammenhänge zwischen dem Stadium der rheumatischen Erkrankung und dem klinischen Bild einer Kiefergelenksymptomatik zu evaluieren.

Material und Methodik

Im Rahmen einer prospektiven Untersuchung wurden die Kiefergelenke von 48 Kindern mit einer rheumatischen Erkrankung klinisch untersucht. Folgende Parameter wurden evaluiert: Knacken, Reibegeräusche, Druckdolenzen, Dauer der rheumatischen Erkrankung sowie die Anzahl der betroffenen peripheren Gelenke. Das Stadium der rheumatischen Erkrankung wurde mit Hilfe der Steinbrocker-Klassifikation erfasst.

Ergebnisse

Insgesamt wiesen 26 Patienten (54,17%) eines oder mehrere der o. g. Kiefergelenksymptome auf. Der Chi-Quadrat-Test ergibt keine signifikanten Zusammenhänge zwischen dem Grad der Steinbrocker-Klassifikation und dem Auftreten pathologischer Befunde am Kiefergelenk. Eine erhöhte Anzahl der von der rheumatischen Erkrankung betroffenen Gelenke führt nicht zu einem signifikanten Anstieg von pathologischen Kiefergelenkbefunden. Es zeigt sich jedoch ein signifikanter Zusammenhang zwischen der Erkrankungsdauer und dem Auftreten pathologischer Kiefergelenkerscheinungen. Knack- und Reibegeräusche kommen mit zunehmender Erkrankungsdauer signifikant häufiger vor (p=0,011).

Schlussfolgerung

Kinder mit rheumatischen Erkrankungen neigen häufiger zu Kiefergelenkerkrankungen als Kinder ohne rheumatische Erkrankungen. Mit Fortdauer der rheumatischen Erkrankung steigt die Inzidenz pathologischer Kiefergelenksbefunde.     

Qualitätssicherung an der Schnittstelle zwischen Anästhesie und Transfusionsmedizin

Background

The current situation in hospitals is characterized by financial limitations and simultaneously by increasing demands on quality and safety. The operative interface between anesthesia and transfusion medicine affects both factors.

Aim

A detailed analysis was performed to evaluate the process quality at this operative interface at the University Hospital of Göttingen. The aim of the project was to revise und develop the structures and responsibilities at this interface, to dispose of weak points and to realize the optimization potential in the supply of blood products.

Material and methods

A databank-based electronic data processing solution was established with the clear definition of responsibilities for the various workflow procedures and the written documentation of these definitions in standard operating protocols. In order to guarantee the necessary transparency a routine reporting system to the department of surgery was established. In addition, a continuous further development of the blood supply standard based on electronic report data was implemented.

Results

By implementing the above named measures the rate of supplied to transfused blood products could be increased from 43.1?% to 55.7?%. The compliance with the blood supply standard improved continually over the first 18 months from 60.3?% to 92.3?%. The rate of supplied blood product deliveries without subsequent operation could be reduced from 9.0?% to 4.6??%. As a result of this optimization the supply costs in the internal cost allocation were reduced from 9,406 € to 3,544 €.

Conclusion

The measures described are appropriate to cost-effectively improve quality and patient safety. The optimization measures presented in this article can be implemented in other hospitals to increase quality and safety after individual adjustment to the local circumstances.     

Treatment of diabetic polyneuropathy with the neurotrophic peptide ORG 2766

The efficacy of the neurotrophic peptide ORG 2766 in diabetic patients with polyneuropathy was evaluated in a double-blind, placebo-controlled, multicentre trial. One hundred and twenty four patients were randomised in five groups to receive 0.1, 0.4, 2 or 5 mg ORG 2766 or placebo, once daily, administered subcutaneously 52 weeks. Thermal discrimination thresholds (TDT) and vibration perception thresholds (VPT), motor and sensory nerve conduction velocity, Hoffmann reflex, heart rate variation during deep breathing and heart rate response after standing up, neurological examination score and neuropathic symptom score were determined at baseline and after 17, 34 and 52 weeks of treatment. Of the nerve function indices studied, at week 52 the TDT_warmth of the hand in the ORG 2766 0.1, 0.4 and 5 mg groups and the TDT_cold of the foot in the ORG 2766 0.1 and 0.4 mg groups significantly improved compared with placebo. Further significant improvement as compared with placebo was observed in the paraesthesia score at week 34 and week 52 in the ORG 2766 2 mg group. Only at week 34 had both the heartbeat variation during deep breathing and the VPT of the foot in the ORG 2766 0.1 mg group improved significantly, compared with placebo. No further statistically significant differences were observed at time for the other measures. No adverse reactions were observed. The only recorded drug-induced side effect was pain at the injection site. Taking all measures of efficacy into account, the statistically significant results observed did not show consistency within each measure. Therefore, it is concluded that ORG 2766, in contrast to earlier reports, is not effective in treating diabetic polyneuropathy.     

Vitrectomy for idiopathic epiretinal membranes causing macular pucker.

We used vitreous surgery to remove idiopathic epiretinal membranes from the macular area in 70 consecutive cases. The abnormal tissue was successfully removed in each case. Vision improved postoperatively in 61 eyes (87%), remained unchanged in six eyes (9%), and worsened in three eyes (4%). However, at the time of final examination vision was improved in only 47 eyes (67%), primarily because of the occurrence or progression of nuclear sclerosis, which occurred in 38 of 60 phakic eyes (63%). Four preoperative factors were associated with final visual acuity of 20/60 or better: (1) initial vision of 20/100 or better, (2) shorter preoperative duration of blurred vision, (3) thin epiretinal membrane, and (4) absence of traction retinal detachment.     

Comparison of written reports of mammography, sonography and magnetic resonance mammography for preoperative evaluation of breast lesions, with special emphasis on magnetic resonance mammography

Patients with abnormal breast findings (n = 413) were examined by mammography, sonography and magnetic resonance (MR) mammography; 185 invasive cancers, 38 carcinoma in situ and 254 benign tumours were confirmed histologically. Sensitivity for mammography was 83.7%, for sonography it was 89.1% and for MR mammography it was 94.6% for invasive cancers. In 42 patients with multifocal invasive cancers, multifocality had been detected by mammography and sonography in 26.2%, and by MR mammography in 66.7%. In nine patients with multicentric cancers, detection rates were 55.5, 55.5 and 88.8%, respectively. Carcinoma in situ was diagnosed by mammography in 78.9% and by MR mammography in 68.4% of patients. Combination of all three diagnostic methods lead to the best results for detection of invasive cancer and multifocal disease. However, sensitivity of mammography and sonography combined was identical to that of MR mammography (i.e., 94.6%).     

Distal myasthenia gravis: case report

We report the case of a 30-year-old woman with a 7-year history of distal lower limbs weakness that evolved to upper limbs weakness. On neurological examination, she presented normal cranial nerves, bilateral quadriceps and feet interosseous atrophy, normal muscular tonus, muscular weakness more severe in dorsal feet interosseous and anterior tibial, and decreased deep tendon reflexes. Repetitive nerve stimulation of the ulnar and fibular nerves showed a decrement greater than 10% of the compound muscle action potential. Antibody against acetylcholine receptor titer was positive. Computed tomography scan of the thorax was normal. Thyroid function tests showed evidence of hyperthyroidism. Distal muscular weakness is a rare onset presentation of myasthenia gravis. However, myasthenia gravis must be considered in the differential diagnosis of distal limb weakness.     

Familial cavernous malformations of the central nervous system and retina

We studied a family in which 4 persons from three generations had multiple cavernous malformations ("angiomas") of the central nervous system (CNS) and/or retina and found accounts in the literature of sixteen other families with this condition. In these families with familial cavernous malformation of the CNS and retina, 92% of pathologically documented vascular malformations were cavernous; 50% of those subjects affected had multiple CNS and/or retinal vascular malformations and 68% (excluding probands) were symptomatic. Cutaneous vascular lesions were an inconsistant manifestation. Autosomal dominant inheritance with high penetrance was confirmed.