Kniegelenkluxationen

Zusammenfassung Kniegelenkluxationen sind seltene, aber schwer wiegende Verletzungen mit z. T. erheblichen Folgen. Begleitende Nerven- und Gefäßverletzungen sind nicht selten. Bei spontaner Reposition kann das Verletzungsausmaß initial unterschätzt werden. Die primäre Diagnostik muss die neurologische Untersuchung sowie die sichere Beurteilung des Gefäßstatus einschließen. Die Sicherung der Durchblutung des betroffenen Beins steht in der Akutphase im Vordergrund, Läsionen müssen notfallmäßig operativ versorgt werden. Bei drohendem Kompartment ist eine Faszienlogenspaltung erforderlich, die Instabilität wird temporär mittels Fixateur externe transfixiert. Bei Hochrasanztraumen sind Begleitverletzungen auszuschließen, bei sedierten und beatmeten Patienten z. B. mit Spiral-CT. Sind nur die Kreuzbänder betroffen, kann ein arthroskopisch gestützter Ersatz vorgenommen werden, Transplantate werden bevorzugt von der Gegenseite entnommen. Die im angloamerikanischen Sprachraum verwendeten Allografts haben sich in unserer Region noch nicht durchgesetzt. Bei ausgedehnten Kapselläsionen und Beteiligung der Kollateralbänder sind arthroskopische Techniken nicht indiziert, es sollte offen rekonstruiert und ggf. augmentiert werden; sekundär verbliebene Instabilitäten können gezielt dem Bandersatz zugeführt werden.     

Stereological evaluation of liver volume in living donor liver transplantation using MDCT via the Cavalieri method.

In living donor liver transplantation (LDLT), obtaining the precise volume of the graft is very important to decrease volume-related postoperative complications, especially in cases with suspected small-for size grafts. We used stereology based on the Cavalieri method (CM), a new method to measure liver graft volume, and compared the results with those obtained through intraoperative measurement (IOM) and through multidetector computed tomography (MDCT) measurement. Liver volumes estimated using the 3 methods were well-correlated with each other (r(2) = 0.94 and P < 0.001 for IOM and CM; r(2) = 0.91 and P < 0.001 for IOM and MDCT, and r(2) = 0.95 and P < 0.001 for CM and MDCT); however, they were different from each other (in descending order, 908 +/- 124 cm(2), 861 +/- 121 cm(2), and 777 +/- 168 cm(2) for MDCT, CM, and IOM, respectively). Although MDCT and CM overestimated the volumes, the results of CM were almost similar to those obtained via IOM. In conclusion, our results suggest that CM measured the liver graft volume more reliably. Thus, its use, particularly in cases with suspected small-for-size graft, may prove useful.     

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.     

Das Cinderella-Schuh-Syndrom

The Cinderella shoe syndrome specifies a commonly observed, not yet labeled disproportion of footwear and the morphologic conditions of the wearer. Disproportioned shoes and socks are worn–frequently unconsciously–due to personal reasons, fashion trends, misinformation and wrong advice; they can induce severe foot disorders. The Cinderella shoe syndrome has an important significance within the development, the treatment and the recurrence-prophylaxis of foot disorders, as well as in the assessment of possible reasons for recurrence after foot surgery. To recognize it, to treat individual psychologic reasons, to give support in the choice of footwear, to inform about and to change social reasons are all challenges of the foot surgeon.     

Developing Organ Offer and Acceptance Measures: When 'Good' Organs Are Turned Down

Turndowns of offers of deceased donor kidneys for transplantation can contribute to inefficiencies in the organ distribution system and inequality in access to donated organs. Match run data were obtained for 4967 'good' kidneys placed and transplanted in 2005 after fewer than 50 offers. These kidneys were not recovered from donation after cardiac death or expanded criteria donors, or from donors with a history of substance abuse. On average, these good kidneys were not accepted until after seven offers to candidates and after offers to 2.4 programs. Models for the likelihood of acceptance found several donor and candidate characteristics to be significantly related to acceptance rates (p < 0.05). After accounting for these variables, there remained 2- to 3-fold differences among transplant programs in acceptance rates. These models could be used to identify kidney transplant centers with exceptional acceptance practices. Several strategies might be employed to increase acceptance rates for good organs.     

Genetic association studies of interleukin-13 receptor alpha1 subunit gene polymorphisms in asthma and atopy.

Interleukin (IL)-13 plays a central role in asthma pathogenesis by binding to the IL-13 receptor, which is a heterodimer composed of the IL-13 receptor alpha1 subunit (IL-13Ralpha1) and IL-4Ralpha. The genetic diversity at the IL-13Ralpha1 gene (IL13RA1) locus on chromosome Xq24 was characterised and the association of identified polymorphisms with asthma and atopy phenotypes examined. The promoter and coding region of IL13RA1 were screened for common genetic variants, and polymorphisms found were genotyped in a large cohort of 341 asthmatic Caucasian families (each containing at least two asthmatic siblings) and 182 nonasthmatic control subjects. Genetic association was determined using case-control and transmission disequilibrium test analyses. Two common polymorphisms were identified, a newly found thymidine (T) to guanine (G) transition of nucleotide -281 (-281T>G) single nucleotide polymorphism in the IL13RA1 promoter and the previously described 1365A>G variant in the IL13RA1 proximal 3' untranslated region. No significant association of either -281T>G or 1365A>G with risk of asthma or atopy phenotypes was found, apart from a suggestive association between the IL13RA1 -281T/1365A haplotype and raised total serum immunoglobulin E levels in adult female asthmatics. These findings indicate that the interleukin-13 receptor alpha1 subunit gene -281T>G and 1365A>G polymorphisms do not contribute to asthma susceptibility or severity, although the interleukin-13 receptor alpha1 subunit gene locus might be involved in the control of immunoglobulin E production.