Scimitar syndrome presenting in adults

Scimitar syndrome is a rare and complex congenital anomaly, which is characterized by the image of a Turkish sword on the chest X-ray. Very few cases in adults are reported in the literature. The long-term results of scimitar syndrome after surgical correction remain disappointing. We report an adult patient with scimitar syndrome undergoing surgery at our center.     

How to store autologous bone graft perioperatively: an in vitro study

INTRODUCTION: Autologous bone graft is the golden standard for bone grafting, but little is known about the influence of various preservation techniques used during surgery immediately following harvest on the osseous structures and graft vitality. Several studies focussed on the optimal treatment of the bone during harvest and implantation, but only few examined the intraoperative storage conditions on the back table. The aim of our study was to examine the influence of various intraoperative preservation techniques on human cancellous bone at different points to optimize the storage during surgery. MATERIALS AND METHODS: Cancellous bone was harvested during hip arthroplasty and stored for 2 and 4 h under dry conditions, inside a swab moistened with saline solution or in saline solution, 5% glucose solution or culture medium. After the storage period, the bone was cultured and examined 7 days after the first cells grew out in one of these groups. Following the identification of the cells as osteoblast-like cells, the cultures were analysed by fluorescence staining, cell count and the XTT-test. RESULTS: Fluorescence staining revealed no avital cells in all groups. Dry storage of the bone led to significantly lower cell metabolism after 2 h compared to saline solution and 5% glucose solution. The same was true after 4 h dry storage compared to the moistened swab, and glucose and culture medium. Cell count was significantly lower after 2 h of dry storage compared to saline solution and culture medium. CONCLUSIONS: Perioperative storage of cancellous bone under dry conditions should be avoided. The bone graft should be stored in saline or 5% glucose solution or a moistened swab.     

Lack of effect on bone healing of injectable BMP-2 augmented hyaluronic acid

Introduction

Autologous bone graft is the gold standard for the filling of large osseous defects. Because of its limited supply and complications such as pain, bleeding or infection, the development of alternative bone substitutes has been the subject of several studies. In clinical practice, the most commonly used bone substitutes are calcium phosphates like hydroxyapatite or tricalcium phosphate. With the aim to improve the osseointegration of these materials, growth factors such as bone morphogenetic protein-2 (BMP-2) have been added. Preferably, an injectable bone substitute should be made available. Hyaluronic acid is a component of the extracellular matrix of many tissues, including bone. We examined the bone regenerative effect of commercially available, injectable hyaluronic acid (Hyalart^®) with and without addition of bone morphogenetic protein-2 (BMP-2).

Materials and methods

Trepanation defects of 9.4 mm diameter in the intercondylar groove of sheep femora were filled with pure and augmented (200 μg BMP-2) hyaluronic acid. As controls, empty defects and defects treated with autologous bone graft harvested from the contralateral side were used. After 3 months, the defects were analysed by fluorescence microscopy after intravital fluorescence staining, contact microradiography, histology and histomorphometry.

Results

Treatment of the defects with loaded and unloaded hyaluronic acid resulted in a significant lack of bone formation inside the defects. Untreated defects showed an amount of 5.1% newly formed bone, and defects treated with autologous bone graft revealed a bone content of 20%. The difference between both groups was statistically significant (P < 0.05). Furthermore, there was neither a remarkable effect in the periphery of the defects nor ectopic bone formation.

Conclusion

The application of the used injectable hyaluronic acid (Hyalart®) with and without BMP-2 is not advantageous as sole bone substitute for the filling of osseous defects.

     

Orthopädie und Unfallchirurgie im G-DRG-System 2008

BACKGROUND: The German DRG (diagnosis-related groups) system has been modified and updated into version 2008. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and the DRG structure were made. The modified version has been analyzed in order to ascertain whether the DRG system is suitably qualified to fulfill the demands of the reimbursement system or whether further improvements are necessary. METHODS: Analysis of the severity of relevant side-effect diagnoses, medical procedures and G-DRGs in the versions 2007 and 2008 was carried out based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). RESULTS: Changes for 2008 focused on the development of DRG structure, DRG validation and codes for medical procedures. The outcome of these changes for German hospitals may vary depending on the range of activities. CONCLUSIONS: G-DRG system has become even more complex and the new regulations have also resulted in new problems associated with complications.. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case allocation within the G-DRG system has been improved. Nevertheless, further improvements of the G-DRG system are necessary, especially for cases with severe injuries.     

Die Problematik der Delegation ärztlicher Leistungen

Ohne Zusammenfassung     

The results of the titanium-coated RM acetabular component at 20 years: a long-term follow-up of an uncemented primary total hip replacement

In a prospective study, 93 unselected consecutive uncemented hip arthroplasties were performed in 80 patients using the titanium-coated RM acetabular component and the CLS femoral component. The mean age of the patients at operation was 52 years (28 to 81). None were lost to follow-up. In the 23 patients who had died (26 hips) only one acetabular component had been revised. In the 57 living patients (67 hips), 13 such revisions had been performed. Of the 14 revisions, seven were for osteolysis, five for loosening and two for infection. Survival analysis of this implant showed a total probability of survival of 83% (95% confidence interval 73 to 90), with all revisions as the endpoint, and a probability of 94% (95% confidence interval 87 to 98) with revision for aseptic loosening as the endpoint, indicating reliable long-term fixation of the titanium-coated RM acetabular component.     

Acetylcholinesterase: converting a vulnerable target to a template for antidotes and detection of inhibitor exposure

Applications of recombinant DNA technology, chemical synthesis on biological templates and fluorescence detection of organophosphorylation provide unexplored avenues for development of antidotes and approaches for remote detection of organophosphate nerve agents and pesticides. We discuss here how acetylcholinesterase (AChE), through appropriate mutations, becomes more susceptible to oxime reactivation. Since the reaction between organophosphate and the mutated enzyme remains rapid, regeneration of active enzyme by oxime becomes the rate-limiting step in the process to complete a catalytic cycle for generation of active enzyme. Accordingly, "Oxime-assisted Catalysis" by AChE provides a potential means for catalyzing the hydrolysis of organophosphates in plasma prior to their reaching the cellular target site. In turn, AChE, when conjugated with organophosphate, is employed as a template for 'click-chemistry, freeze-frame' synthesis of new nucleophilic reactivating agents that could potentially prove useful in AChE reactivation at the target site as well as in catalytic scavenging of organophosphates in plasma. Finally, substituted AChE molecules can be conjugated to fluorophores giving rise to shifts in emission spectra for detection of dispersed organophosphates. Since external reagents do not have to be added to detect the fluorescence change, the modified enzyme would serve as a remote sensor.     

Persistent Organochlorine Compounds in Human Milk Collected in Croatia Over Two Decades

The distribution and time trend of organochlorine pesticide (OCP), polychlorinated biphenyl (PCB), and polychlorinated dibenzo-p-dioxin/polychlorinated dibenzofuran (PCDD/PCDF) concentrations in human milk samples from Croatia collected in 1981–2003 are presented. Between 1981/1982 and 1987/1989, the concentrations of HCB, β-HCH, DDE, and total PCBs decreased about 50%, while for the last decade, the concentrations have been decreasing very slowly. In 2002/2003 the range of PCB congeners and OCPs was from below the limit of determination to 332 ng g⁻¹ milk fat. PCDD/PCDF concentrations in human milk samples collected in 1981–2000 ranged between 5.2 and 26.7 pg I-TEQ g⁻¹ milk fat and showed a decreasing trend.     

Cost-effectiveness analysis of human papillomavirus-vaccination programs to prevent cervical cancer in Austria

Objective

The study predicts long-term cervical cancer related population health and economic effects of introducing the HPV-vaccination for 12-year-old girls (and boys) in addition to current screening compared with screening only.

Method

Health effects are predicted by a dynamic transmission model. Model results are used to calculate incremental cost-effectiveness ratios (ICER) in € per life year gained (LYG) for a time-horizon between 2008 and 2060 from a public payer and a societal perspective.

Results

Vaccination of girls results a discounted ICER of € 64,000/LYG and € 50,000/LYG from a payer's and societal perspectives respectively. The additional vaccination of boys increases the ICER to € 311,000 and € 299,000/LYG respectively. Results were most sensitive to vaccination price, discount rate and time-horizon.

Conclusion

HPV-vaccination for girls should be cost-effective when adopting a longer time-horizon and a societal perspective. Applying a shorter time frame and a payer's perspective or vaccinating boys may not be cost-effective without reducing the vaccine price.     

Differential perikaryal localization in rats of D1 and D2 dopamine receptors on striatal projection neuron types identified by retrograde labeling

The localization of D1 and D2 dopamine receptors to striatal projection neuron types has been controversial, with some data favoring segregation of D1 to direct pathway neurons (substance P-containing) and D2 to indirect pathway neurons (enkephalinergic), and others reporting significant colocalization of D1 and D2 on individual projection neuron types. In the present study, we used subtype-specific antibodies against D1 and D2 and confocal laser scanning microscopy to determine their perikaryal localization in striatum in general, and in direct and indirect pathway neuron perikarya defined by retrograde labeling in particular. We found that D1 in rat was detectable on 49.5% of NeuN-immunolabeled striatal perikarya, and D2 on 61.6% of NeuN-immunolabeled perikarya, implying that at least 15–20% of D1+ neurons must possess D2 and vice versa. Secondly, we retrogradely labeled neuronal perikarya from the external globus pallidus (GPe), internal globus pallidus (GPi) or substantia nigra with rhodamine dextran amine 3 kDa (RDA3k). We found that 92% of perikarya labeled from nigra and 96% of perikarya labeled from GPi immunolabeled for D1, but only 23% of perikarya labeled from GPe immunolabeled for D1. Since direct pathway neurons (striato-nigral and striato-GPi) have a collateral projection to GPe, it is possible that many of the D1+ striatal perikarya retrogradely labeled from GPe were direct pathway neurons. About 96% of perikarya retrogradely labeled from GPe were immunolabeled for D2, while about 40% of those retrogradely labeled from GPi and 44% of those retrogradely labeled from nigra immunolabeled for D2. These findings suggest that: (1) while many striato-GPi/SN neurons possess D1 and D2, the majority mainly or exclusively possess D1 and (2) the vast majority of striato-GPe neurons mainly or exclusively possess D2.