Osteochondrale Transplantation

The statement made by the English surgeon W. Hunter in 1743 that“ulcerated cartilage is a very troublesome desease, its cure is more difficult than that of carious bone and when destroyed, it is never recovered” still applies to a great extent today. There is still no generally and comprehensively successful concept capable of producing complete healing of the damage with unrestricted resumption of sports or daily activities. Currently, small defects are treated using the microfracture method, larger lesions using osteochondral transplantation, while diffuse osteoarthritis of the whole joint usually require radical endoprosthetic resurfacing or, in younger patients, preferably arthrodesis. Autogenous cartilage-bone transplantation is a very promising technique with good results due to the fact that the defect is replaced by hyaline cylinders of healthy cartilage with the ideal histological and biomechanical characteristics of the native cartilage. Further advantages of the cartilage-bone transplantation method in comparison to other methods include low donor site morbidity, as well as immediate load-bearing and mobility. And the procedure is cost-saving.     

Die biomechanische Bedeutung des Periosts für die Epiphysenfuge

Die mechanische Widerstandsf?higkeit der distalen Radius- und Ulnaepiphysenfuge gegen Scherkr?fte wurde unter besonderer Beachtung der Periostleistung bei 72 Kaninchen im Alter von vier, acht, zw?lf und 16 Wochen getestet. Zu diesem Zweck wurden bei jedem Tier jeweils an einer Extremit?t die Weichteile bis auf das Periost abpr?pariert; auf der kontralateralen Seite wurde zus?tzlich im Bereich der Epiphysenfuge das Periost entfernt. Die Festigkeit des Epiphysenfugenknorpels nimmt mit dem Alter stetig zu. Ein auf hormonelle Umstellung zurückzuführender Abfall der Resistenz vor und w?hrend der Pubert?t wurde nicht beobachtet. Die Stabilit?t des epimetaphys?ren überganges wird in jeder Altersgruppe durch das Periost betr?chtlich erh?ht, und zwar bei jüngeren Tieren ausgepr?gter als bei ?lteren Tieren. Das biomechanische Verhalten des Periosts wird auf das Prinzip eines elastischen Schlauches zurückgeführt: Die proximalen und distalen Epiphysenfugen werden durch das fibr?se Periost, welches zwischen diesen ausgespannt und fest im Bereich des perichondralen Ringes beider Epiphysenfugen verankert ist, auf den Metaphysen gehalten. Der durch das Periost gleichm?\ig ausgeübte Tonus, der auch an der Regulierung des L?ngenwachstums beteiligt ist, erh?ht entscheidend den Widerstand der Epiphysenfuge gegen Scherkr?fte. Der beschriebene altersentsprechende Einflu\ des Periosts auf die Integrit?t der Epiphysenfuge manifestiert sich nach experimentellen Epiphysiolysen in zwei verschiedenen Verletzungstypen: In Abh?ngigkeit von dem Vorhandensein oder Fehlen des Periosts kommt es zu einem unterschiedlichen Auftreten von Epiphysiolysen des Typs I und II nach Salter und Harris. In a study of 72 rabbits, four, eight, twelve and 16 weeks old, the mechanical resistance of the distal radius and ulna epiphyseal plate against shear strength has been examined. On one side the extremity has been freed of all soft-tissue attachments except the periosteum, on the other side the periosteum of the epiphyseal plate additional has been removed. The mechanical strength of the epiphyseal cartilage increases with age. A decrease of the resistance during sexual maturation has not been observed. In all age groups the stability of the epi-metaphyseal junction is significantly higher with the periosteum. In younger animals it is more marked than in older ones. The biomechanical behaviour of the periosteum can be explained with the principle of a “traction strap”: the fibrous periosteum, firmly attached at the perichondrial ring, is stretched from epiphysis to epiphysis and fixes the epiphysis to the metaphysis. The periosteum and its continous tension takes not only part in regulating the longitudinal growth but also increases the resistance of the growth cartilage against shear strength. The dominated influence of the periosteum on the integrity of the epiphyseal cartilage is also supported by corresponding results dealing with the occurrence of Salter and Harris-type I or II fractures in absence or presence of the periosteum.      

Radiological diagnosis of cervical trauma at the level C7/T1

Summary After a car accident a 23-year-old man was found to have rotational luxation of the cervical spine at the level C7/T1. The diagnosis was suspected from indirect signs on the ap X-ray and subsequently confirmed by conventional lateral tomography. Neurological symptoms were not present. Magnetic resonance imaging demonstrated dorsal protrusion of the intervertebral disc.

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Zusammenfassung Nach einem Verkehrsunfall fand sich bei einem 23jährigen Mann eine einseitige Luxation der Halswirbelsäule im Segment C7/T1. Die Diagnose wurde aufgrund indirekter Zeichen auf der ap-Übersichtsaufnahme der Halswirbelsäule vermutet und anschließend durch konventionelle laterale Tomographie bestätigt. Eine neurologische Symptomatik lag nicht vor. Die Kernspintomographie zeigte die dorsale Protrusion der Bandscheibe des luxierten Segments.

     

Iron, ascorbate and copper status of Sowetan Blacks with calcific chronic pancreatitis

Vitamin C can be used to overcome oxidative stress and ease pain in chronic pancreatitis. But its use is deprecated in conditions of tissue iron overload, because its bioactive form, ascorbate, can accelerate free-radical reactions that are driven by transition metals. We measured iron, ascorbate and copper in Sowetan Blacks (RSA) with chronic pancreatitis, obtaining serum/plasma from 14 consecutive patients and 15 controls. Compared with data from corresponding groups in Manchester, African samples had less ascorbate (p < 0.0001), but more caeruloplasmin (p < 0.0001). African and British controls had comparable iron and iron-binding capacity. Plasma from African patients had less ascorbate than that from African controls (p < 0.005) and in six samples, ferritin exceeded 300 micrograms/l (677 pmol/l). Low- molecular-mass iron or copper, capable of participating in free radical reactions, was not detected. British patients, had similar caeruloplasmin levels to African patients but higher ascorbate levels. There is no evidence of iron overload in our African samples. Outwardly healthy controls from Soweto have elevated levels of caeruloplasmin, possibly to compensate for dietary deficiency of ascorbate. Persistent oxidative stress is a unifying feature of chronic pancreatitis, but its degree is higher in African than British patients. Supplements of vitamin C should be safe in Blacks of southern Africa.      

Hypergammaglobulinemia can be associated with a positive direct antiglobulin test, a nonreactive eluate, and no evidence of hemolysis

To determine the cause of a positive direct antiglobulin test (DAT), blood banks routinely perform serologic tests on eluates prepared from DAT-positive red cells. Negative eluates traditionally have been suspected to be associated with drug reactions. This report confirms that the most frequent cause of a positive DAT and a nonreactive eluate is hypergammaglobulinemia. The results of 74 patient samples with positive DATs were analyzed retrospectively. Eluates prepared from the red cells of 54 patients (72.9%) reacted; eluates from 20 patients (27.1%) did not react. This latter group had identical serologic and clinical findings, suggesting that they made up a homogeneous group. In particular, the patients had a positive DAT, a negative indirect antiglobulin test, and a negative eluate; an increased serum concentration of IgG; and no evidence of hemolysis. In a subsequent study, DATs were performed prospectively on red cells from 44 consecutive patients with elevated serum IgG levels. The serum IgG concentration was highest in the three patients whose red cells had a positive DAT. The DAT also became positive in two patients treated with high-dose intravenous gammaglobulin (IV IgG). These studies indicate that a negative eluate from red cells with a positive DAT, a common serologic finding, is often caused by hypergammaglobulinemia. The authors postulate that IgG binds nonspecifically to the red cells because of the hypergammaglobulinemia.     

Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infection at a teaching hospital

A methicillin-resistant Staphylococcus aureus (MRSA) control policy, aimed at eradication, was established at a 1000-bed hospital in 1985, applied consistently for 10.5 years, and then relaxed. Its components included screening of high-risk patients, transfer of carriers to exhaust-ventilated isolation rooms, closure of wards to new admissions when local transmission was detected, MRSA screening during outbreaks, and prospective collection of clinical and epidemiological information. During the eradication policy period, every 6 months, a mean of 5.1 patients (range 1-12) already carrying MRSA were admitted, and a mean of 3.6 (range 0-16) acquired carriage in the hospital. The largest outbreak comprised 11 patients despite epidemic MRSA strain EMRSA-16 being introduced six times, and MRSA did not become endemic. MRSA- positive admissions increased progressively from 1993; nursing staff workload increased, areas available for alternative patient accommodation were reduced, the resulting ward closures interfered with clinical services, and hence the control policy was relaxed in mid- 1995. Isolation facilities were overwhelmed with 622 new patient- isolates in the next 18 months, and there were 67 clinical infections in 1996. The proportion of blood cultures positive for MRSA rose nearly sevenfold by 1996 and 27-fold by 1997. Thus, repeated eradication of MRSA, even epidemic strains, by use of a stringent policy, is possible given sufficient resources, whereas flexible national guidelines designed to control, but not eradicate, epidemic staphylococci, are currently unlikely to be successful. The costs of eradication policies need to be weighed against those of endemicity.      

Sentinel lymph node biopsy in melanoma: Which hot nodes should be harvested and is blue dye really necessary?

Objectives

The ‘10% rule’ has become widely accepted by surgeons performing sentinel lymph node biopsy (SLNB) for melanoma. The purpose of this study was to compare the ‘10% rule’ with alternative node harvesting criteria. In particular, we were interested to see whether the use of blue dye had any impact on the sensitivity of the test and whether it is necessary to remove all hot nodes.

Sexual Function and Quality of Life for Women with Mild‐to‐Moderate Stress Urinary Incontinence

Introduction: Sexual function is affected by stress urinary incontinence with or without pelvic organ prolapse. The aim of the study was to describe the sexual function of women with mild‐to‐moderate stress urinary incontinence, with or without pelvic organ prolapse (up to stage 2) and examine correlations with symptoms and quality of life. This investigation was part of a large, randomized, clinical trial of women with stress urinary incontinence who participated in an exercise intervention. Methods: Women included in the study suffered from stress urinary incontinence as measured by a pad test and were interested in an exercise intervention. All participants underwent assessment for prolapse staging. Instruments included: the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12), Incontinence Quality of Life Questionnaire (I‐QOL), and a health and urinary leakage questionnaire. Results: One hundred and eighty‐seven ambulatory women, aged 20 to 65 years, had a mean sexual function score of 36.9 (standard deviation [SD] 5.9). No significant correlation was found between the sexual function scores and quantity of urinary leakage. A significant correlation existed between the sexual function and I‐QOL scores (P < .001). An additional finding was that women with urgency symptoms were older (P= .04) and had significantly lower sexual function scores (mean 35.7; SD 6.4) than those who did not report urgency (mean 38.7; SD 4.6; P < .001). Discussion: Women with mild‐to‐moderate stress urinary incontinence, without or with lower stages of pelvic organ prolapse, demonstrated good sexual function, which correlated with physical and psychosocial factors. Health professionals need to perform multifaceted intake assessments on women with urinary leakage to customize their health promotion regimen.     

QUADAS评价:一种用于诊断性研究的质量评价工具(修订版)

背景 QUADAS是一种新近发展起来的诊断性研究的质量评价工具。虽然已有系统评价采用了QUADAS,但尚未得以正式确证。本研究的目的是评价QUADAS的有效性和实用性。方法3位评价者采用QUADAS独立评价30项研究的质量。比较每位评价者的评分与最终结论之间的意见一致度。这主要是通过比较所有QUADAS条目的总分和每个单项的得分来实现的。20位曾在其系统评价中使用过QUADAS的评价者就其使用经验完成一份简短的问卷。结果就所有条目而言,每位评价者的评分与最终结论之间的意见一致度分别达到了91%、90%和85%。就单项QUADAS条目而言,一致度在50%至100%之间,中位值是90%。与难以解释的试验结果和退出病例相关的条目,评分结果差异最大。有关QUADAS内容的反馈意见普遍较好,仅少数评价者提出了有关QUADAS涵盖面、使用便利性、评分说明的清晰度及有效性方面的问题。结论QUADAS内容本身无需作大的修改。评价过程的主要困难出现在难以解释的试验结果和退出病例这2个条目的评分上。对这些条目的评分指南提出了修改意见。评价者必需根据其系统评价制定相应的评分指南,并确保所有评价者都清楚如何评分。评价者还应考虑是否所有的QUADAS条目都与其系统评价相关,以及其他质量条目是否应作为其系统评价的评价部分。