Aortic endograft infection: open surgical management with endograft preservation.

INTRODUCTION: We report successful management of aortic endograft infection without graft explantation or extra-anatomic bypass. REPORT: A 66 year-old male who had undergone endovascular repair of an aortic aneurysm presented with abdominal pain and raised inflammatory markers following embolisation of a type-2 'endoleak'. CT scanning revealed a left psoas fluid collection. Endograft infection was diagnosed. Following failure of CT-guided drainage and conservative management, surgical drainage with irrigation drain placement was undertaken with preservation of the endograft. There was no evidence of recurrent infection after follow-up at 30 months. DISCUSSION: Aortic endograft infection may be managed without endograft removal and extra-anatomic bypass.     

Rapid prototype patient-specific drill template for cervical pedicle screw placement.

OBJECTIVE: To assess the feasibility and accuracy of a drill template for the placement of a cervical pedicle screw in a single vertebral level. MATERIALS AND METHODS: A volumetric CT scan was performed on a cadaver cervical spine. Using computer software, a drill template with a predefined trajectory was constructed that was designed to match the posterior surface of the right side of the fifth cervical vertebra. A physical template was created from the computer model using a rapid prototyping machine. The drill template was used to guide drilling of a pilot hole, and a CT scan was performed to assess the accuracy of this hole. A 3.5-mm diameter pedicle screw was placed in the pilot hole. The spine was then dissected to separate the vertebrae and the trajectory of the screw was visually inspected. RESULTS: The feasibility of this patient-specific rapid prototyping technique was demonstrated. Imaging and visual inspection confirmed accurate placement of the pilot hole and cervical pedicle screw without cortical violation. CONCLUSIONS: The potential use of drill templates to place cervical pedicle screws is promising. Our initial methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the cervical spine.     

All five digits of the hands of fetuses with Down syndrome are short.

OBJECTIVE: To compare mid-gestation sonographic measurements of all five digits of the hands of fetuses with Down syndrome with those of normal controls. METHODS: Twenty-nine fetuses between 17 and 26 weeks' gestation which had been confirmed by karyotyping to have Down syndrome were included in this prospective study. Each fetus was scanned once and the digits of only one hand were measured. Measurements were compared with those of 302 previously reported normal controls matched for gestational age. All measurements were expressed in multiples of the gestation-specific normal median (MoM) for each digit. RESULTS: Compared to 1 MoM for the length of Digits 1 to 5 from the normal population, the respective values in the Down syndrome digits were: 0.94, 0.85, 0.92, 0.88 and 0.85 MoM, representing values significantly lower than normal (P < 0.05; t-test). CONCLUSIONS: All five digits of the hands of fetuses with Down syndrome are shorter than are those of euploid fetuses. Integration of fetal digit measurement into the antenatal assessment of selected high-risk cases may be of value although confirmation of our findings should be obtained before this measurement is incorporated into Down syndrome screening in the general population.     

Iniencephaly and long-term survival: a rare case report

Introduction Iniencephaly, a neural tube defect involving occiput and inion and combined with rachischisis of the cervical, thoracic spine, and retroflexion position of the head is a very rare congenital abnormality of the fetus–newborn with a 0.1–10 of 10,000 prevalence. This abnormality’s prognosis is thought to be dismal. This abnormality can be associated with other abnormalities such as anencephaly, encephalocele, hydrocephalus, cyclopia, absence of the mandible, cleft lip and palate, cardiovascular disorders, diaphragmatic hernia, renal abnormalities, overgrowth of the arms compared to the legs, and club food and gastrointestinal atresia. Discussion Most of the patients are dead born, and the others die in a few hours. There are only six previously documented long-term survivors. In our case, our patient with iniencephalic signs and findings is still living. She is 2 years old now. We think that this patient presents a mild form of iniencephaly.     

Distale Humerusfrakturen

Distal humeral fractures are problematic both in children and in adults. While in children these fractures are very common and most of them have an extraarticular location, in adults their incidence is much lower and they more often compromise the joint. Good results cannot be achieved without due consideration for the complex anatomy of the elbow joint, the quality of the bone, the concomitant soft tissue lesions and the biomechanical aspects of the injury, to allow selection of appropriate therapy and a correctly structured aftertreatment. The soft tissue injuries that are frequently involved and the high rate of intra- and postoperative complications need particular attention. This paper reviews the epidemiology, the current standards in diagnosis and therapy, the possible complications and the results that can be expected in patients with fractures of this type.