Mittelfristige Ergebnisse nach postoperativen Infektionen an der Schulter

Between 1 January 1986 and 31 December 1997, in the traumatology department of Nuremberg hospital, a total of 46 patients with postoperative infections of the shoulder were treated. The primary surgical procedure was carried out for various reasons. The diagnosis of infection was found on clinical parameters such as pain, redness, and swelling, in combination with laboratory parameters and diagnostic aspiration of joint fluid. The period between operation and infection ranged between 4 days and 9 months. The main question was whether a local infection or an infection of the glenohumeral joint, called empyema, was involved. Some cases required diagnostic aspiration. Macroscopic inspection of the fluid was helpful, as was cell counting and analysis of fluid pH [14]. The fluid was given to a gram preparation. In case of infection of the joint, diagnostic arthroscopy was performed with a saline lavage (10-15 l). Local synovectomy was carried out when local synovitis was found. Similar to the therapy of the knee, antibiotic collagen (Sulmycin-Implant) (no PMMA chains as former) was applied. We compared patients who were operated as usual, i.e., by great incision and open wound-drain (group 1, 21 patients), with patients who were operated arthroscopically assisted (group 2, 25 patients). We saw an earlier reconvalescence in the second group. Of the 46 patients, 25 were followed-up for an average of 4 years. The results were rated according to the Constant score. The mean total score of 25 patients was 61 points (range 43-78 points). Positive intra-articular bacterial culture was an important prognostic factor; inspite of an arthroscopical procedure, results were not as good as without joint infection. Generally, the arthroscopic procedure with application of the Sulmycin Implant leads to better results than the open procedure with application of PMMA chains.     

Das Non-Hodgkin-Lymphom als Differentialdiagnose der Spondylodiszitis

This case presents the history of a 56-year-old patient suffering from low back pain for a period of several weeks. The radiological und histopathological examination showed hints for a spondylodiscitis of the fifth lumbar vertebra. Due to a progressive destruction of the fifth vertebra a ventral stabilisation was performed. Again the histological examination showed the characteristics of an unspecific spodylodiscitis. The last biopsy, taken during the explantation of the fixateur interne showed a high malignant lymphoma. A course of chemotherapy was started following the CHOP-Protocol accompanied by radiotherapy. This case demonstrates that meticulous clinical examination as well as advanced radiological techniques can fail in rare differential diagnosis of spondylodiscitis.     

对甲磺酰基苯乙烯环酮类衍生物的合成及抗炎活性

目的寻找新型高效低毒的非甾体抗炎药。方法合成对甲磺酰基苯乙烯环酮类衍生物，用二甲苯致小鼠耳肿胀模型和角叉菜胶致大鼠足跖肿胀模型评价其抗炎活性，并考察连续经口给药对大鼠胃肠道（GI）的影响。结果合成了9个新化合物（ZA_1-9），结构经IR，¹HNMR，MS和元素分析确证。小鼠试验表明ZA_3,5-9的抗炎活性与双氯芬酸钠(DC)和罗非昔布(RC)相当(P>0.05)，大鼠试验显示ZA_3,7,8的抗炎活性与DC和RC相当(P>0.05)， ZA₆的抗炎作用显著强于DC和RC(P<0.05)，ZA_3,5-9对GI损伤显著小于DC (P<0.05，P<0.01)，与RC相当(P>0.05)。结论对甲磺酰基苯乙烯环酮类衍生物的抗炎作用较强，GI不良反应小，值得进一步研究。     

Die dorsale karpometakarpale Luxation des 5. Strahls

Dorsal dislocation of the fifth carpometacarpal joint after injury is rare. Only five cases are reported in the literature. We report on two cases of dorsal dislocation of the fifth carpometacarpal joint after injury and we give a review of related literature. There are two interesting aspects concerning diagnostic and therapy of dorsal dislocation of the fifth carpometacarpal joint. Anterior-posterior and lateral radiographs do not always provide adequate visualisation of this joint so a dislocation may be misdiagnosed. A radiograph taken with the forearm pronated 45 degrees from the routine anterior-posterior position better shows the dislocation. The adequate therapy consists in closed reduction, Kirschner wire fixation and cast immobilisation. A reduction without following Kirschner wire fixation - even in those dislocations that were found to be stable after closed reduction - is not recommended because of the risk of persisting pain after heavy manual work. In our two cases an instability of the fifth carpometacarpal joint existed after closed reduction. After Kirschner wire fixation and cast immobilisation for 6 weeks both patients showed 3 months after operative therapy a full range of movement and a powerful grip without any pain in the fifth carpometacarpal joint.     

Atopy, lung function, and obstructive airways disease after prenatal exposure to famine

BACKGROUND: Associations have been found between a large head size at birth and atopy, and between low birth weight and obstructive airways disease. A study was undertaken of people born around the time of the Dutch famine in 1944-5 to determine the effects of maternal malnutrition during specific periods of gestation on the prevalence of obstructive airways disease and atopy. METHODS: Nine hundred and twelve people aged about 50, born at term between November 1943 and February 1947 in Amsterdam, were asked about their medical history. Lung function was measured in 733 and serum concentrations of total IgE and specific IgE against mite, pollen and cat were measured in 726. Those exposed in late, mid, and early gestation (exposed participants) were compared with those born before or conceived after the famine (non-exposed participants). RESULTS: Exposure to famine during gestation affected neither the concentrations of total or specific IgE nor lung function values. The prevalence of obstructive airways disease was increased in people exposed to famine in mid gestation (odds ratio adjusted for sex 1.7, 95% confidence interval (CI) 1.1 to 2.6) and tended to be higher in those exposed in early gestation (odds ratio 1.5, 95% CI 0. 9 to 2.6). CONCLUSIONS: The observed increase in the prevalence of obstructive airways disease in people exposed to famine in mid and early gestation was not parallelled by effects on IgE concentrations or lung function. The link between exposure to famine in mid and early gestation and obstructive airways disease in adulthood suggests that fetal lungs can be permanently affected by nutritional challenges during periods of rapid growth.     

Effect of non-invasive mechanical ventilation on sleep and nocturnal ventilation in patients with chronic respiratory failure

BACKGROUND: Chronic respiratory failure (CRF) is associated with nocturnal hypoventilation. Due to the interaction of sleep and breathing, sleep quality is reduced during nocturnal hypoventilation. Non-invasive mechanical ventilation (NMV), usually performed overnight, relieves symptoms of hypoventilation and improves daytime blood gas tensions in patients with CRF. The time course of the long term effect of NMV on sleep and breathing during both spontaneous ventilation (withdrawing the intervention) and NMV was investigated in patients with CRF due to thoracic restriction. METHODS: Fifteen consecutive patients (13 women) of mean (SD) age 57.9 (12.0) years with CRF due to thoracic restriction were included in the study. During the one year observation period four polysomnographic studies were performed: three during spontaneous breathing without NMV-before initiation of NMV (T0) and after withdrawing NMV for one night at six months (T6) and 12 months (T12-)-and the fourth during NMV after 12 months (T12+). Daytime blood gas tensions and lung function were also measured. RESULTS: Spontaneous ventilation (in terms of mean oxygen saturation) progressively improved (from T0 to T12-) during both REM sleep (24.8%, 95% CI 12.9 to 36.9) and NREM sleep (21.5%, 95% CI 12.4 to 30.6). Sleep quality during spontaneous ventilation also improved in terms of increased total sleep time (26. 8%, 95% CI 11.6 to 42.0) and sleep efficiency (17.5%, 95% CI 5.4 to 29.6) and decreased awakenings (54.0%, 95% CI 70.3 to 37.7). Accordingly, REM and NREM sleep stages 3 and 4 significantly improved. However, the most significant improvements in both nocturnal ventilation and sleep quality were seen during NMV at 12 months. CONCLUSIONS: After long term NMV both spontaneous ventilation during sleep and sleep quality in patients with CRF due to thoracic restriction showed evidence of progressive improvement compared with baseline after withdrawal of NMV for a single night at six and 12 months. However, the greatest improvements in nocturnal ventilation and sleep were achieved during NMV at 12 months.