Klinische Erfahrungen mit dem Siremobil Iso-C3D-Bildwandler in der Beckenchirurgie

In pelvic and acetabular surgery intraoperative control of reduction and implant position is sometimes hard to achieve with conventional C-arm technology. The Siemens C-arm Iso-C(3D) imaging system enables axial cuts and two- or three-dimensional reconstructions to be generated. Following the good experience in surgery of the spine and extremities, its clinical applicability in pelvic surgery was evaluated in 30 patients in a prospective clinical trial. In all 20 patients with acetabular fractures reduction quality and implant position could be well assessed. In one postoperative examination an intraarticular screw placement was evident, which intraoperatively was not as clear and was revised. In one procedure an intraarticular fragment was visualized, and was extracted in the same procedure. In one procedure the use of the Iso-C(3D) system enabled the approach to be limited.In all ten pelvic ring injuries the osseous structures in the posterior pelvic ring could be visualized with an adequate image quality. Reduction quality and implant position could be assessed in all open and closed procedures. On two occasions the SI screws were navigated based upon the Iso-C(3D) dataset. Overall the use of the Iso-C(3D) system was successful in all cases. Image quality, which is clearly inferior to that of CT, was sufficient for the assessment of reduction quality and implant position. One revision was indicated, and one avoided. However, in spite of its advantages in pelvic surgery, handling, sterile covering and data transfer need to be improved. For bilateral pelvic injuries the image size is too small.     

Minimal-invasive Versorgung monokondylärer Tibiakopffrakturen

BACKGROUND: Treatment of displaced tibial plateau fractures is often complicated by high-energy trauma and soft tissue damage. Therefore, numerous techniques such as indirect or arthroscopically controlled reduction and percutaneous osteosynthesis have been described to reduce the additional surgical trauma. MATERIAL AND METHODS: Twenty-three fractures (AO type 41-B2/3, Schatzker type II-IV) were treated with percutaneous, fluoroscopically guided reduction combined with small fragment osteosynthesis using a radius T-plate. In none of the patient was cancellous bone graft performed. Only in one case was arthrotomy necessary because of uncertain image intensification findings in an obese patient. One revision was done for a 4-mm step caused by an over reduced rim fragment. Fracture healing and full weight bearing were achieved after 8-12 weeks. Neither secondary displacement nor implant loosening was seen under primary functional treatment without immobilization. RESULTS: Functional recovery showed a mean ROM of 114 degrees after 6 weeks and 121 degrees after 3 months. The radius T-plate offers enough stability to allow primary functional treatment due to early recovery of joint motion. Percutaneous reduction and small fragment osteosynthesis is a less invasive approach in the treatment of displaced monocondylar tibial plateau fractures.     

Das Mammakarzinom

Zusammenfassung Patientinnen mit fortgeschrittenem Mammakarzinom werden heute als chronisch erkrankt angesehen. Aufgrund verbesserter Therapiemöglichkeiten verläuft die Erkrankung meistens schubweise und wellenförmig über einen längeren Zeitraum. Erst spät kommt es zu einer relativ kurzen, für eine Krebserkrankung typischen Terminalphase. Erhaltung der Lebensqualität und Verlängerung des Überlebens sind gleichberechtigte Ziele eines multimodalen Therapieansatzes. Bei der Therapieplanung gilt das Motto so wenig wie nötig. Überwiegend werden medikamentöse und damit systemisch wirkende Therapien eingesetzt. Nur so kann man dem Problem der in diesem Stadium immer anzunehmenden disseminierten Multiorganerkrankung gerecht werden. Lokale operative Therapien oder Bestrahlungen von Metastasen erfolgen vor allem zur akuten Linderung einer ausgeprägten Symptomatik und im Allgemeinen zusätzlich zur systemischen Therapie.     

Gesichtspunkte bei der Therapieplanung von Gebißanomalien

Ohne ZusammenfassungMit 11 AbbildungenHerrn Professor Dr. Dr. Dr. h. c. E. Reichenbach zum 70. Geburtstag     

Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results

Seventy-five patients with hemoptysis were treated with bronchial artery embolization (BAE). The procedure was performed with Hexabrix (sodium methylglucamine ioxaglate), Mikaelson catheters, and Gelfoam particles. Angiographic evaluation of the bronchial artery anatomy revealed ten different configurations, which are described. The embolization attempt failed in three cases (4%); eight additional patients (10.7%) were excluded from the series because of inadequate data. In the remaining 64 patients, 41 underwent BAE alone and 23 underwent either chemotherapy or surgery in addition to embolization. Immediate control of hemoptysis was achieved in 49 of 64 patients (76.6%). Long-term control of hemoptysis was achieved in 46 of the 56 patients included in the long-term follow-up (82.1%). Eight of the 64 patients were lost to follow-up, which ranged from one to 47 months (mean 24.8 months). Hemoptysis recurred in 12 of 56 patients (severe in 10, mild in 2) (21.4%). Twelve patients died (21.4%), five of them due to hemoptysis (8.9%). None of the patients who died of hemoptysis had responded to initial BAE. It is concluded that BAE is an effective treatment for immediate control of life-threatening hemoptysis, allowing long-term control of bleeding in the majority of patients.     

Mechanismen der Schmerzentstehung

The interaction between neurons, tissue cells and inflammatory cells is of major importance for the development of pain in the periphery. In this interaction a variety of inhibitory and activating circuits has been identified in recent years. In addition to the receptors for classical inflammatory mediators on the sensory terminals like bradykinin, axonal ion channels have been identified as major modulators of pain and sensitization apart from their traditional role in conduction of action potentials. Sensitization of spinal nociceptive processing is crucial for the expansion of pain beyond the initially injured site and contributes to chronic pain. Learning processes and extinction of aversive memory are of major importance for the development, but also the therapy of chronic pain states.     

Kranielle Bildgebung und Serologie bei Pupillotonie nicht hilfreich

BACKGROUND: Tonic pupil (TP) is a common disorder of parasympathetic innervation. In contrast to textbook recommendations, cranial imaging is still being performed in most of the patients with TP. The intention of the present study is to show that cranial imaging is of no benefit. PATIENTS AND METHODS: The medical records of 33 patients with TP were analyzed retrospectively. All patients had undergone a complete ophthalmological, orthoptic, and neurological investigation. Cranial imaging was performed by computed tomography or magnetic resonance imaging. Serology tests were carried out in some of the patients. RESULTS: Diagnostic imaging provided no additional data revealing the underlying cause of TP. CONCLUSIONS: Cranial imaging in isolated tonic pupil is not helpful. Because of therapeutic implications, diagnostic evaluation can be recommended only in patients older than 50 years to exclude giant cell arteritis and syphilis.