Closed reduction of prosthetic hip dislocation by emergency physicians

OBJECTIVE: The purpose of this study was to determine the frequency of successful closed reduction (CR) of dislocated prosthetic hips performed by emergency physicians (EPs) as well as the incidence of acute complications. METHODS: The study design was an explicit chart review set at an academic ED with an annual census of 55,000. The study was performed on March 1, 1999 to February 28, 2004. Patients were identified using coded ED diagnoses, and data were obtained by a trained abstractor. RESULTS: One hundred twelve dislocations in 66 patients had attempted CR in the ED. Eighty-one had CR attempted solely by an EP with 91% success. Twenty-eight of the remaining 31 (90%) had successful CR performed by either an orthopedic surgeon or both an EP and an orthopedic surgeon. Overall, 10 patients (9%) failed ED CR. No postreduction complications were identified in any patient. CONCLUSIONS: EPs can safely and successfully perform CR on patients with dislocated total hip arthroplasties.     

Revitalization of cortical bone allograft by application of vascularized scaffolds seeded with osteogenic induced adipose tissue derived stem cells in a rabbit model

Background  

Adipogenous tissue derived stem cells (ASC) are available in abundance in the human body and can differentiate in the presence of lineage-specific induction factors, for example, in myogenic, adipogenic, chondrogenic and osteogenic cells. The aim of this study was to evaluate the impact of osteogenic induced ASC’s (O-ASC) on revascularization and cellular repopulation of avital cortical bone employing a vascularized bovine scaffold.     

Revision surgery after trapeziometacarpal arthroplasty

Background  

The majority of patients with trapeziometacarpal joint (TMJ) arthritis can be successfully treated with some form of arthroplasty. Residual pain therefore is rather uncommon, but particularly difficult to treat. The aims of this study were to determine the number of patients in need of additional surgery; to identify the most common causes for persistent pain and to establish a treatment algorithm.     

Dose-dependent effects of a nitric oxide donor in a rat flap model

Previous studies have proven the effectiveness of nitric oxide (NO) donors to enhance flap survival in experimental models. The purpose of this study was to determine the ideal dose of the NO donor spermine/nitric oxide complex (Sper/NO) with respect to flap survival and hemodynamic side effects. Additionally, the influence of the type of application (systemically versus intra-arterial into the flap artery) was observed.Seventy-two male Wistar rats were divided into 9 experimental groups. An extended epigastric adipocutaneous flap (6 x 10 cm) based on the left superficial epigastric artery and vein was raised in each animal.The average percentage of flap necrosis was 69.8% in the control group with ischemia and 29.8% in the non ischemic controls. The average necrosis areas in the 3 groups after preischemic intravenous (i.v.) application of Sper/NO (250, 500, and 750 nmol/kg body weight) were 63.5%, 33.8%, and 38.4%, respectively. The application of similar doses into the flap artery resulted in 63.5%, 72.3%, and 64.3% flap necrosis; 52.7% average flap loss was observed in an additional group receiving Sper/NO adjusted to flap weight (500 nmol/kg flap weight). Only the intravenous application of 500 and 750 nmol/kg resulted in a significant reduction of flap necrosis compared with the ischemic controls (P < 0.01). The drop in mean arterial pressure was less after i.v. application of 500 nmol/kg Sper/NO compared with 750 nmol.Our data show that the preischemic intravenous application of 500 nmol/kg Sper/NO achieved the best results with acceptable side effects. A dose of 250 nmol/kg i.v., as well as the application of Sper/NO into the flap artery, was demonstrated to be ineffective.     

Elektronische Dokumentation handchirurgischer Verletzungen durch semantische Netze

BACKGROUND: An efficient medical documentation is mandatory for a trauma-oriented department in the DRG environment. Besides the continuously increasing clinical/administrative demands, the additional documentation for quality assurance, clinical studies, and research requires additional efforts. Standard solutions are only partially effective. Especially in hand surgery there is a high demand for sophisticated clinical documentation, represented by a wide variety of classifications in diagnosis and therapy. The standard documentation tools lack accuracy. The development of a software tool that defines administrative/business processes and simultaneously generates clinical and administrative information was the goal of this project.METHODS AND RESULTS: With a standard medical terminology, an innovative semantic network, and a completely new graphical user interface, it was possible to develop and introduce a software program specifically adjusted for hand surgery. This program facilitated for the first time a single-stage acquisition of clinically relevant scientific data and the simultaneous generation of DRG, quality assurance, and administrative data relevant for the hospital's revenues.CONCLUSIONS: The newly developed software tool is a step forward into a new dimension of medical software, obviating the need for multi/documentation and significantly improving the quality of clinically relevant medical data.     

Lokale Behandlung von Grad-IIa-Verbrennungen

BACKGROUND: A new hydrosome wound gel is based on a new mechanism of action. It contains hydrosomes that penetrate to the wound bed and supply the wound with phospholipids, which are identical to membrane phospholipids of human cells. In this manner it supports the proliferative processes during wound healing. PATIENTS AND METHODS: In a randomized, controlled, intraindividual comparative study of 47 patients with grade IIa burns, the hydrosome wound gel was tested against silver sulfadiazine cream. Digital pictures of the burn wounds were taken daily, and the wounds were analyzed in terms of their reepithelization rate. RESULTS: Wounds receiving the hydrosome wound gel healed 1.5-2 days faster than wounds treated with sulfadiazine cream (9.9+/-4.5 days vs. 11.3+/-4.9 days, p=0.015). In 66% of the patients, faster epithelization was observed with the hydrosome wound gel treatment. The hydrosome gel guaranteed secure prophylaxis against infection, and it was well tolerated and easy to apply. CONCLUSION: In this study, the treatment of grade IIa burn wounds with hydrosome wound gel led to faster wound closure compared with treatment with sulfadiazine cream. Therefore, hydrosome gel represents a good alternative to sulfadiazine cream.     

The x-ray light valve: a potentially low-cost, digital radiographic imaging system-concept and implementation considerations

New x-ray radiographic systems based on large-area flat-panel technology have revolutionized our capability to produce digital x-ray images. However, these imagers are extraordinarily expensive compared to the systems they are replacing. Hence, there is a need for a low-cost digital imaging system for general applications in radiology. A novel potentially low-cost radiographic imaging system based on established technologies is proposed-the X-Ray Light Valve (XLV). This is a potentially high-quality digital x-ray detector made of a photoconducting layer and a liquid-crystal cell, physically coupled in a sandwich structure. Upon exposure to x rays, charge is collected on the surface of the photoconductor. This causes a change in the optical properties of the liquid-crystal cell and a visible image is generated. Subsequently, it is digitized by a scanned optical imager. The image formation is based on controlled modulation of light from an external source. The operation and practical implementation of the XLV system are described. The potential performance of the complete system and issues related to sensitivity, spatial resolution, noise, and speed are discussed. The feasibility of clinical use of an XLV device based on amorphous selenium (a-Se) as the photoconductor and a reflective electrically controlled birefringence cell is analyzed. The results of our analysis indicate that the XLV can potentially be adapted to a wide variety of radiographic tasks.