Vertebral body replacement system Synex in unstable burst fractures of the thoracic and lumbar spine

A prospective longitudinal study was performed to evaluate the vertebral body replacement system Synex associated with posterior fixation in unstable burst fractures of the lumbar and thoracic spine. Within 24 months, we treated 28 patients (average age, 41 years; range, 22–64 years; 14 women, 14 men) with acute unstable burst fractures without osteoporosis of the thoracolumbar region (n=16) and the thoracic (n=3) as well as the lumbar (n=9) spine in two stages (primary dorsal transpedicular stabilization and secondary vertebral body replacement). The complications were analyzed and the postoperative follow-up result was evaluated regarding stability, bone fusion, correction loss, pain and neurological status. One patient showed a transient irritation of the lumbosacral plexus and one patient had a superficial wound infection (complication rate, 7.1%). At the follow-up examination (mean follow-up, 13 months) only in two cases a minimal loss of correction (<5°) was measured. Radiologically, 27 patients showed secure bone fusions and all patients had stability of the osteosynthesis. Most of the patients stated no or just slight pain at follow-up. Only two patients with pain to a medium degree had to take painkillers. The vertebral body replacement system Synex seems to be a good alternative for vertebral body replacement in unstable burst fractures of the thoracic and lumbar spine since at present follow-up it shows a high rate of bone fusion and minimal loss of correction.     

Sticky Platelet Syndrome: An Underrecognized Cause of Graft Dysfunction and Thromboembolic Complications in Renal Transplant Recipients

Sticky platelet syndrome (SPS) leads to hyperaggregabilty of platelets in response to physiologic stimuli. In this report we describe three patients with clinical symptoms of SPS after renal transplantation. The first patient developed an infarction of her transplant kidney with additional, subsequent renal microinfarctions. The second patient suffered multiple strokes and deep vein thrombosis with episodes of pulmonary embolism and ischemic bowel disease due to colonic microinfarctions. The third patient experienced a long episode of unexplained respiratory and graft dysfunction immediately after transplantation until therapy for SPS was initiated, at which point symptoms resolved quickly. Kidney transplant recipients with SPS may be at increased risk of developing thrombosis, given that most immunosuppressive drugs are known to induce either endothelial cell damage or augment platelet aggregation. All patients awaiting renal transplantation should be screened for a history of thrombosis and, if appropriate, tested for SPS. Affected patients should receive dose-adjusted acetylsalicylic acid.     

A ‘Weight‐Listing’ Paradox for Candidates of Renal Transplantation?

Research suggests that end-stage renal disease patients with elevated body mass index (BMI) have superior outcomes on dialysis. In contrast, low and high BMI patients represent the highest risk cohorts for kidney transplant recipients. The important question remains concerning how to manage transplant candidates given the potentially incommensurate impact of BMI by treatment modality. We conducted a retrospective analysis of waitlisted and transplanted patients in the United States from 1990 to 2003. We constructed Cox models to evaluate the effect of BMI on mortality of waitlisted candidates and identified risk factors for rapid weight change. We then assessed the impact of weight change during waitlisting on transplant outcomes. Decline in BMI on the waiting list was not protective for posttransplant mortality or graft loss across BMI strata. Substantial weight loss pretransplantation was associated with rapid gain posttransplantation. The highest risk for death was among listed patients with low BMI (13-20 kg/m(2), adjusted hazard ratio = 1.47, p < 0.01). Approximately one-third of candidates had a change in BMI category prior to transplantation. While observed declines in BMI may be volitional or markers of disease processes, there is no evidence that candidates have improved transplant outcomes attributable to weight loss. Prospective trials are needed to evaluate the efficacy of weight loss protocols for candidates of kidney transplantation.     

A historical overview of spirituality in nursing.

The following article is an attempt to encapsulate an historical overview of spirituality in nursing. Despite a plethora of information relative to spirituality in nursing, the decision was to do an eclectic overview that was not reflective of any one spiritual/religious group. The authors at times found this goal difficult when writing about the Pre-Christian and Christian eras. Most of the major religions have their own perspective on the concept of spirituality, and historical personalities recorded maybe reflective of that particular religion. Another factor that impacted on the writing of this article was the concept that spirituality was not always linked specifically to religion. Spirituality was an experiential component of the wonders of nature and life, a domain that the authors took into account but did not expound upon. Finally the authors realized that spirituality has almost always been an aspect of African-American life and certainly of those in nursing. To this end the authors realize that there is a need for more research in this area.     

Seltene Verletzung bei stumpfem Bauchtrauma im Kindesalter

Presented in this work is a rare injury of a blunt abdominal trauma in a child. Besides a partial rupture of the kidney and a retro-/intraperitoneal haematoma, a further injury occurred from the accident: an initially clinically indetectable tear of the A. iliaca communis which was found intraoperatively and with systematic CT analysis. Traumatic blood vessel lesions of the abdominal aorta and in particular the iliac blood vessels are very rare in children. By such violent impact injuries, it is therefore vital to perform a clinical examination of the foot pulse, systematic analysis of radiology diagnostics, and intraoperative exploration. The growth phase should be considered for therapy of the blood vessels depending on the child's age group. As the long-term results of graft implants are practically unknown, if possible a primary suture or vein patch should be performed.     

Das Liquid-oxygen-System (LOX)

By oxygen concentration measurements (Oximeter Oxydig Dräger, Lübeck) in the EC 145 helicopter two oxygen transport and application systems were compared. The new liquid oxygen system (LOX) for the oxygen therapy was assessed in an application observation. For physical reasons fluid oxygen evaporates during the stand-by phase and an increased concentration (22.8% O₂) in the exhaust valve of LOX arises. On the other hand a high oxygen concentration (22.7% O₂) was measured in the operation mode of the conventional pressure flask gas system (GAS). No increased concentration could be measured within the helicopter cabin (HEMS, PAX) comparing both oxygen systems. For transport and application of oxygen with a very big reserve for the air dependent intensive transport the results show that LOX is a sure low pressure system (3.4 bar).