Modified after care following primary management of rupture of the Achilles tendon]

During the period ranging from 1975 to 1988, 169 Achilles tendon ruptures were operated on in the Department of Traumatology and Reconstructive Surgery of Steglitz Medical Center, Free University of Berlin. The majority of these ruptures, i.e. 149 cases, were due to sports injuries. In order to comply with our patients' wish for quick rehabilitation, we have altered our follow-up treatment concept since 1982. The surgical technique remained the same in the form of a Bunnell suture with wire or absorbable suture material. There was an initial post-operative immobilization for five to seven days in a dorsal femoral plaster splint at a 30 degree bending position. The ankle joint was immobilized in a neutral position from the start. After approximately one week, the lower leg was put in a walking cast in a neutral position. The patients were allowed to put full load on the leg. After an additional four weeks, the cast was removed and functional follow-up treatment started. The two patient collectives that were compared did not significantly differ with regard to age structure and accident mechanisms or accident causes. Changes in the follow-up treatment resulted in a marked reduction in duration from 14 to 10 weeks. Standing on the toes was likewise possible after 10 weeks. Sports activities could be resumed after four instead of six months, as before. The postoperative rate of complications was low. There were only 10 infections in the total patient collective, one being a deep-wound infection requiring surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)     

Standardized setup and dosimetry in total body irradiation using 3-dimensional compensators

In order to obtain a homogenous dose distribution in total body irradiation, a compensator is inserted into the ray path. The different thickness and density of the patient is so compensated near the focus by a water equivalent metal layer. The faults arising in the calculation of the compensator are investigated. Furthermore a regulation technique is presented which allows a simple, rapid, and exact adjustment of patient, compensator, and measuring probes for dosimetry.     

Regeneration of splenic stromal elements

Splenic regeneration represents an interesting phenomenon both in relation to its role as a model system (to study the development of the complex three-dimensional architecture of an immunological organ) and because of the clinical application, namely autotransplantation of spleen. The latter is one of the attempts to restore splenic functions after splenectomy, which is known to increase a life-long risk of fatal sepsis. However, splenic functions of autotransplanted splenic tissue are known to be highly dependent on the recovery of the complex microenvironment and immunoarchitecture of the splenic compartments during the regeneration processes, but the elements inducing splenic reorganization are still unknown. Therefore, the present work investigates whether splenic stroma depleted of cells is able to induce regenerative processes after implantation. In addition, we tried to recombine stromal tissue with selected cell populations to study their influence. Cell-free stromal tissue induced angiogenesis and to a lesser extent also attracted the immigration of lymphocytes during the first 60 days of regeneration. However, after this period of regeneration, the transplants began to degenerate and were resorbed. The recombination of stromal tissue with mitogen-stimulated spleen cells only resulted in intensifying the degenerative processes, and all implants were resorbed after 120 days. Except that in the first 30 days there were some accumulations of lymphocytes that resembled primitive follicles, no splenic compartments such as red pulp, periarteriolar lymphoid sheath, or marginal zone could be detected in any of the transplants. From these results it can be concluded that splenic stroma can induce the primary events of splenic regeneration (like angiogenesis), but is not able to provide an appropriate microenvironment and immunoarchitecture for a correct repopulation and differentiation of cells. Furthermore, the recombination experiments point to a minor role of T-cells and possibly an important role for accessory cells in splenic regeneration.     

Pelvic floor muscle activity during impact activities in continent and incontinent women: a systematic review

Introduction and hypothesis

Investigating the activity of the pelvic floor muscles (PFMs) in women during impact activities such as jumping, running or coughing may elucidate different aspects of PFM activation and therefore clarify the pathophysiology of stress urinary incontinence (SUI). A systematic review (PROSPERO 2016:CRD42016035624) was conducted to summarize current evidence on PFM activity during impact activities in both continent and incontinent women.

Methods

PubMed, EMBASE, Cochrane, and SPORTDiscus databases were systematically searched for studies published up to December 2016. The PICO approach (patient, intervention, comparison, outcome) was used to construct the search queries. Original studies were included that investigated PFM activity during impact activities if they included terms related to muscle activity and measurement methods, test positions, activities performed and continence status. Two reviewers screened titles and abstracts independently to ascertain if the included studies fulfilled the inclusion criteria, and extracted data on outcome parameters.

Results

The search revealed 28 studies that fulfilled the inclusion criteria, of which 26 were cross-sectional studies. They used different electromyography measurement methods, test activities, test positions, and comparisons with other structures. Ten studies compared continent and incontinent women. The timing of PFM activity in relation to the activity of other trunk muscles seems to be a crucial factor in maintaining continence. Women with SUI have delayed PFM activity.

Conclusions

The findings of this systematic review suggest that impact activities causing involuntary and reflex PFM activity should be the subject of further study. This may help guide clinical studies to improve our understanding of how the PFMs react during impact activities and to determine best practices that can be included in rehabilitation programmes.

     

Short shrift for the sane? The hospital management of self‐harm patients with and without mental illness

In recent years the British government has sought to target service provision both on people with severe enduring mental illness and on those considered to be at risk of suicide. The study reported here suggests these policies may have had unforeseen repercussions on services for people who self-harm but have no identifiable mental illness. This paper compares the hospital management of self-harm patients with and without mental illness. Over the years 1996-2000, a total of 4,329 self-harm patient attendances were recorded at the accident and emergency department of a British hospital. Whilst patients in 63.7% of attendances could reasonably have been considered to have some form of mental illness, we found that in the remaining 36.3% of attendances (where patients had no indicator of mental illness) a particularly poor standard of service was given. We suggest that if government targets for a reduction in the suicide rate are to be met, it is crucial that there should be marked improvements in services for all self-harm patients presenting at accident and emergency departments. However, in improving services we must be vigilant to the danger that targeting those with a mental illness may mean we fail to provide even basic levels of care for others.     

DNA vaccines and apoptosis: to kill or not to kill?

The apoptotic machinery has become the latest target of vaccinologists attempting to improve the efficacy of DNA vaccines. While workers have previously sought to induce apoptotic death in transfected DCs as a means to activate immunity, a new approach (see related article on pages 109–117) instead seeks to delay apoptosis in host DCs after DNA vaccination.     

Susceptibility of clinical isolates of frequently encountered bacterial species to tigecycline one year after the introduction of this new class of antibiotics: results of the second multicentre surveillance trial in Germany (G-TEST II, 2007)

Tigecycline, a broad-spectrum antibiotic for parenteral use, was introduced in Germany in May 2006. In the G-TEST-II trial, the susceptibility of isolates, recovered in 2007 from hospitalised patients in 15 centres, was assessed against tigecycline and comparators. Susceptibility tests were performed by the microdilution procedure. This study reports on the susceptibility of the isolates of 16 bacterial species and compares the results with those of a trial (G-TEST I) conducted prior to the introduction of tigecycline. Between 2005 and 2007, tigecycline retained activity against Gram-positive and Gram-negative organisms. By contrast, the rate of vancomycin-resistant strains among Enterococcus faecium isolates almost doubled. Moreover, an increase in resistance to broad-spectrum beta-lactams and fluoroquinolones was observed for members of the family Enterobacteriaceae. Against a background of a steadily rising number of pathogens that are resistant to various antibiotic classes, tigecycline represents an important treatment option.     

Susceptibility of common aerobic pathogens to tigecycline: results of a surveillance study in Germany

Tigecycline is a novel antimicrobial agent for parenteral use encompassing a broad spectrum of bacterial pathogens, including multi-resistant organisms. Here, we report the results of the first nationwide surveillance trial that was conducted in order to evaluate the susceptibility of bacterial isolates to tigecycline in a European country prior to its clinical use. A total of 2,610 Gram-positive and Gram-negative organisms recovered from hospitalized patients were tested. Minimum inhibitory concentrations (MICs) were determined using the microdilution method. All enterococci, staphylococci (including methicillin-resistant Staphylococcus aureus; MRSA), and streptococci tested were tigecycline-susceptible, except one isolate of Staphylococcus haemolyticus. Among the Gram-negative bacteria, 100% of the Escherichia coli isolates (including extended spectrum β-lactamase [ESBL]-producers) were tigecycline-susceptible, while about 10% of the Enterobacter cloacae and Klebsiella pneumoniae isolates were resistant. Based on the results of this surveillance study, tigecycline may represent a suitable option most notably for the empiric treatment of bacterial mixed infections, including in clinical situations in which multi-resistant organisms are suspected. Members of the G-TEST Study Group are listed in the Acknowledgments section.