Cor triatriatum associated with partial anomalous pulmonary venous connection to the coronary sinus: Echocardiographic and angiocardiographic features

Summary An infant girl is described who had cor triatriatum and partial anomalous pulmonary venous connection of the left pulmonary veins to the coronary sinus, the first report of this combination of lesions. The infant also had a Dandy-Walker malformation and multiple facial and intrathoracic hemangiomas. The cardiac diagnosis was made by two-dimensional echocardiography. Cardiac catheterization and angiography confirmed the findings and also demonstrated a persistent left superior vena cava draining to the coronary sinus. The infant underwent successful surgical repair. Partial anomalous pulmonary venous connection and left superior vena cava not infrequently are associated with cor triatriatum. Although two-dimensional echocardiography is sensitive for the detection of cor triatriatum, preoperative cardiac catheterization is necessary to identify unequivocally systemic and pulmonary venous connections.     

Mikrofrakturierung bei fokalem Knorpelschaden

The microfracture technique and spongiolization using Pridie drilling are the most commonly used and highly cost-efficient operative therapies for restoration of cartilage in Germany. Microfracturing can be performed arthroscopically in various joints including the knee, ankle, elbow, and shoulder joint. Specifically designed instruments are recommended for this procedure. Steadman recently reported excellent results in a series of 72 patients undergoing microfracturing with a mean follow-up of 11 years showing consistent and long-term reduction of weight-bearing pain and swelling as well as improvement of daily activities. Ideal indications for this easy arthroscopic procedure of microfracture treatment include focal lesions up to 4 cm². Some studies have demonstrated that microfracturing results not merely in the formation of fibrocartilage but also in the induction of hyaline cartilage with superior properties.     

Effect of local mupirocin application on exit-site infection and peritonitis in an Indian peritoneal dialysis population.

BACKGROUND: Staphylococcus aureus-associated peritonitis and catheter exit-site infections (ESIs) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis. Intranasal and topical use of mupirocin has been found to be an effective strategy in decreasing S. aureus-related infectious complications in persons who are carriers of S. aureus; however, there is no consensus regarding the prophylactic use of mupirocin irrespective of carrier status. We aimed to determine the potential effectiveness of application of mupirocin cream at the catheter exit site in preventing ESI and peritonitis irrespective of carrier status in a tropical country such as India. METHODS: This prospective historically controlled study was done in a total of 40 patients. From August 2003, all patients, incident and prevalent, were instructed to apply 2% mupirocin cream daily to the exit site instead of the older practice of povidone-iodine and gauze dressing. Patients were not screened to determine whether they were S. aureus carriers. The infection-related data for 1 year, until July 2004, were compared with the historical control, which was infection-related data for the year preceding the year of mupirocin application. RESULTS: Mean age of the study population was 62 years, with 61.8% being male and 64.3% being diabetic. Local application of mupirocin led to a significant reduction in the incidence density per patient-month of both ESI and peritonitis compared to controls (0.15 vs 0.37 and 0.37 vs 0.67, p = 0.01 for both). This amounted to a relative reduction of 60.5% and 55% respectively. ESI and peritonitis due to S. aureus were also significantly lower in the study group compared to controls (incidence density per patient-month 0.05 vs 0.13 and zero vs 0.17 respectively, p < 0.01 for both). There occurred no catheter removal due to infection-related complications during the study period compared to two during the control period. None of the patients reported a mupirocin-related adverse effect. CONCLUSIONS: Daily application of mupirocin at the exit site is a well-tolerated and effective strategy in reducing the incidence of ESI and peritonitis in a tropical country such as India. It can thus significantly reduce morbidity, catheter loss, and transfer to hemodialysis in peritoneal dialysis patients.     

Der Einsatz des Prophy-Jet®-Gerätes zur Schmelzpolitur nach der Bracketentfernung

Zusammenfassung In einer In-vitro-Studie wurde die Einsatzfähigkeit des Prophy-Jet-^®-Gerätes für die Schmelzpolitur nach Bracketentfernung untersucht. In die Studie wurden drei verschieden stark gefüllte orthodontische Kleber einbezogen: Concise^®, Genie^® und Mono Lok^®. Alle Proben wurden rasterelektronenoptisch untersucht und fotografisch dokumentiert in Vergrößerungen zwischen 20- und 10 000fach. Die Oberflächenanalyse ergab, daß das Prophy-Jet^®-Gerät allein zur Schmelzpolitur nach Bracketentfernung nicht ausreicht, um unter klinisch vertretbarem Zeitaufwand (1 Minute/Zahn) eine kunststofffreie Schmelzoberfläche zu erzielen. Nach konventioneller makroskopischer Vorreinigung mit Scalern oder rotierenden Hartmetallfinierern zeigten sich nach fünfsekündiger Prophy-Jet^®-Bestrahlung noch geringe Kleberreste. Nach zehnsekündiger Expositionsdauer waren beim Mono Lok^®-Adhäsiv keine Kleberreste mehr nachweisbar, beim Concise^®-bzw. Genie^®-Adhäsiv fanden sich noch vereinzelte geringe Kleberinseln. Das Prophy-Jet^®-Gerät erscheint zur Unterstützung der Schmelzpolitur nach Bracketentfernung sinnvoll; eine sorgfältige Vorreinigung mit Hand- oder rotierenden Instrumenten ist jedoch erforderlich, um eine weitgehende Adhäsivreduktion zu erreichen. Die konventionelle Gummi- und Bimssteinpolitur kann nach 20sekündiger Prophy-Jet^®-Bestrahlung entfallen.

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Summary The purpose of this in vitro investigation was to ascertain the effects of the Prophy-Jet^® air-powder abrasive system for enamel polishing after debonding. Three adhesives differing in filler content were included in this study: Concise^®, Genie^®, and Mono Lok^®. All specimens were examined by scanning electron microscopy and documented photographically at magnifications from 20 to 10 000. Surface analysis showed that using the Prophy-Jet^® exclusively is not sufficient to produce a clean and smooth enamel surface without residual adhesive after debonding and after one minute of exposure time, as might be justifiable in a clinical situation. After macroscopic conventional clean-up with scalers or rotary finishing instruments and five seconds of exposure time to the Prophy-Jet^® some occasional adhesive remnants could be located. After ten seconds of Prophy-Jet^® treatment all Mono Lok^®-adhesive was removed from the enamel surface; in the Concise^® and Genie^®-group few isolated adhesive remnants could be detected. The Prophy-Jet^® air-powder abrasive system was found to be efficient in supporting enamel polishing after debonding; but an accurate pretreatment with scalers or rotary finishing instruments is essential to achieve an extensive reduction of adhesive. Final polishing of the enamel surface with rubber wheels or prophy cup and pumice can be omitted after treatment with the Prophy-Jet^® for 20 seconds.

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Résumé Le but de ce travail était d'éxaminer à l'aide d'une étude in vitro, l'emploi du Prophy Jet^® pour le polissage de l'émail après l'arrachage des brackets. Dans l'étude on a analysé trois substances adhésives différentes: Concise^®, Genie^® et Mono Lok^®. Après avoir examiné les spécimens par le microscope électronique à balayage, on les a documentés à l'aide de photos d'un grossissement de 20 à 10 000. L'analyse de la surface montre que la seule application du Prophy Jet^® (après l'arrachage des brackets) ne suffit pas pour obtenir une surface d'émail sans substance adhésive en un temps clinique d'une minute par dent. Après prétraitement macroscopique selon la méthode conventionnelle (scaler ou instruments montés sur tour) il demeurait encore de petits restes de la substance adhésive après l'application du Prophy Jet^® pendant cinq secondes. Après une durée d'application de dix secondes, on ne pouvait pas déceler de restes de Mono Lok^®, tandis qu'il y avait sporadiquement des restes de Concise^® et Genie^®. Ces résultats indiquent, que le Prophy Jet^® est efficace pour le polissage de l'émail après l'arrachage des brackets, mais on a tout de même besoin d'un nettoyage précédent minutieux avec des instruments convenables (scaler ou instruments montés sur le tour) pour obtenir une réduction considérable de la substance adhésive. On peut renoncer au polissage conventionnel à l'aide de caoutchouc ou de la pierre ponce après l'application du Prophy Jet^® pendant 20 secondes.

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Vortrag auf der wissenschaftlichen Jahrestagung der Deutschen Gesellschaft für Kieferorthopädie 1985.     

Andrologische Diagnostik

Andrology was included as a further subject for continuing education in the Model Ordinance on Continuing Education at the 106th German Physicians’ Meeting in Cologne in 2003. In addition to fertility disorders, this discipline comprises medical care for men with fertility disorders, erectile dysfunction, disorders of libido, ejaculation, and coitus, various forms of hypogonadism, and delayed puberty. Furthermore, this field also covers questions concerning male contraception, gynecomastia, and male senescence. Diagnostic procedures in andrology require close interdisciplinary cooperation with practitioners of gynecology, human genetics, and psychosomatic medicine. It includes medical history, clinical examination, and laboratory analyses. Except to confirm azoospermia, it is not possible to make a definitive prognosis for fertility based on semen analysis. Functional tests allow a better assessment of the spermatozoa’s fertility since 25–30% of men desiring a child exhibit reduced spermatozoal functions, which cannot be verified on routine semen analysis.     

Arthrogryposis multiplex congenita

From 1975 to 2004 a total of 38 children handicapped by congenital multiple arthrogryposis were cared for. The congenital joint contractures demand a major effort in terms of surgical reconstruction. In the case of distal arthrogryposis the chances that patients will be able to walk without help are good, while those with amyoplasia are likely to be dependent on mobility aids throughout their lives. The ultimate goal of treatment for patients is to develop into self-confident adults who can cope with life despite their handicaps. The hip in arthrogryposis shows variable forms of pathology, ranging from the almost normal hip to hip contractures with dislocation. Its treatment has some limited advantages, but hardly improves mobility. The knee contractures are actively treated to allow patients to sit, stand and walk better. The club foot and the rocker-bottom foot need sophisticated conservative and operative treatments. If conservative manipulation of bilateral extension contractures of the elbow fails operative treatment is carried out on the dominant side. For shoulder, hand and finger contractures conservative manipulation brings about little improvement, and surgical approaches help hardly at all.     

Management von Postintubationsstenosen bei Kindern

Extubation difficulties after long-term endotracheal intubation in neonates and infants require immediate re-intubation with a somewhat thinner endotracheal tube, continuation of long-term intubation for another 7–14 days with antibiotic and antiphlogistic therapy including antireflux treatment as well as a subtile endoscopic examination. A tracheostomy is not indicated before several attempts of extubation have failed. An anterior cricoid split should be indicated with great care and in premature neonates only. In manifest cicatrical stenoses, subtile endoscopic diagnostics are an essential prerequisite for the choice of surgical method and time of surgery. In rather mild stenoses (grade II), laryngotracheal reconstruction (LTR) with anterior wall cartilage grafting is presently regarded as method of choice. For subglottic stenoses of higher degrees (grade III and IV), partial cricotracheal resection (PCTR) is felt to be the most successful procedure. For all scarred stenoses involving the glottic level, LTR with posterior and anterior wall cartilage grafting appears to be the only suitable treatment. LTR with anterior wall grafting only as well as the PCTR can be performed as a single stage procedure with postoperative long-term intubation on an intensive care unit for one or more days. LTR with posterior and anterior wall grafting requires long-term stenting for several weeks or months depending upon the individual condition. For long-term stenting, our so-called double-tube-technique using a modified Montgomery T silicon tube together with a perforated tracheal cannula has proved to be the safest and least irksome technique.