Klinische und radiologische Ergebnisse nach bipolarer Radiuskopfprothese

Background

Radial head arthroplasty is considered to be the treatment of choice in non-reconstructable radial head fractures in the acute fracture situation. Despite the promising short-term results in the current literature, replacement of the radial head remains controversially discussed as long-term results are still missing. In our study, we report our 7.8-year results after treatment with the bipolar radial head prosthesis of Judet.

Materials and methods

Between 1997 and 2004, 34 patients were treated with Judet??s bipolar radial head prosthesis in our department. After a mean of 94 months (range 15?C139), 28 of these 34 patients could be re-examined. While 20 patients were treated with radial head arthroplasty primarily in a fracture situation, 7 patients were treated secondarily after failure of fixation. One patient was treated for a tumor of the proximal radius.

Results

According to the Mayo Elbow Performance Score, 16 patients achieved an excellent, 10 patients a good, 1 patient a fair, and 1 patient a poor result. The mean Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) score was 12.0 (range 0?C50.1). There was no distinct difference between primary and secondary implantation in terms of the clinical outcome. The elbow flexion averaged 125° (range 100?C150°); the mean extension deficit was 20° (range 0?C60°). The mean pronation was 66° (range 0?C90°) with a mean supination of 67° (range 0?C90°). The most common complications were osteoarthritis of the ulnohumeral joint (n=18) and degenerative changes of the humeral capitellum with erosions (n=12). Finally, 3 patients suffered a dislocation after the surgical intervention, 1 patient had an infection, and 1 patient developed a radioulnar synostosis.

Conclusion

Despite major primary complications and the high incidence of radiographic signs of degenerative changes, mainly good clinical results were achieved after 7.8 years with Judet??s bipolar prosthesis.     

The impact of imaging speed of MR-guided punctures and interventions in static organs--a phantom study

Purpose

Verification of MR-guidance with image acquisitions slower than 1 image per second as it is inevitable for some interventions. Therefore, we quantified solely the effect of acquisition-time on the efficiency of MR-guided interventions in a static phantom study.

Materials and methods

We measured the duration, accuracy and error rate of simulated interventions for different acquisition-times using a simplified interventional setup. All measurements were performed in a 1.0 T open MRI scanner. Imaging was performed with a gradient-echo sequence (flipangle = 20°; TR/TE = 12/6 ms; voxelsize = 1 mm × 1 mm; slicethickness = 5 mm; FOV = 230 mm × 200 mm; acquisition-time = 1 s). Variable acquisition times were simulated with intermediate pauses of 0, 1, 2, 3, 4 and 5 s. The interventions were performed by a total of 20 volunteers including 7 experienced interventionalists.

Results

The mean duration of the intervention was 2 min. Significant differences between experienced and unexperienced volunteers were limited to the localization of the image plane and corrections made. The mean accuracy was 5.6 mm. The time to localize the image plane increased with deceleration of imaging from 24 s to 49 s. A similar increase was observed for the intervention time (55–108 s). A significant influence of the acquisition-time on durations and corrections was only found with acquisition-times greater than 4 s per image.

Conclusion

Even image rates of several seconds per image are sufficient enough for efficient interventions in static organs. Thus, the main attention has to be turned on the visibility of the needle when sequences are optimized for MR-guidance. The minimization of imaging speed is rather of secondary interest.     

Nierenersatztherapie auf der Intensivstation

Background

Acute kidney injury is still one of the most common serious complications in critical ill patients and is associated with high mortality. Even small changes in renal function significantly influence survival and long-term prognosis.

Material and methods

Selective literature research and analysis of intensive care population with renal failure.

Conclusion

Prophylactic measures as well as early diagnosis and therapy must be the goal of a modern intensive care treatment. Various treatment modalities for renal replacement therapy allow individualized treatment of each patient. The review summarizes the main aspects on prophylaxis and early diagnosis of acute kidney injury as well as the different treatment modalities for an individualized renal replacement therapy.     

Plasma P-selectin is increased in thrombotic consumptive platelet disorders

P-selectin is a 140-kD protein found in the alpha-granules of platelets and the Weibel-Palade bodies of endothelial cells that on cell activation is expressed on the cell surface and also secreted into the plasma. The secreted form of P-selectin, like plasma P-selectin, differed from platelet membrane P-selectin in that its molecular mass was approximately 3 kD lower under reducing conditions. Both the secreted and plasma forms of P-selectin contained cytoplasmic sequence as determined by Western blot analysis with an affinity-purified rabbit anti-P-selectin cytoplasmic peptide antibody. We have measured plasma P- selectin and beta-thromboglobulin (beta TG) concurrently in (1) patients with consumptive thrombotic disorders, including disseminated intravascular coagulation (DIC), heparin-induced thrombocytopenia (HIT), and thrombotic thrombocytopenic purpura (TTP)/haemolytic uremic syndrome (HUS); (2) patients with idiopathic thrombocytopenic purpura (ITP); and (3) healthy controls. Patients with DIC, HIT, and TTP/HUS, but not ITP, had significantly elevated plasma P-selectin and beta TG levels when compared with their age-matched healthy controls. The increased plasma P-selectin and beta TG in patients with thrombotic disorders were likely to be the result of in vivo platelet and endothelial cell damage or activation. We also found that avoidance of veno-occlusion and other tedious measures customarily taken during blood collection and sample preparation to prevent in vitro platelet activation did not affect plasma P-selectin assay results. In addition, plasma P-selectin levels were not influenced by the presence of renal failure or heparin administration. These results indicate that plasma P- selectin may be a useful new marker for thrombotic diseases.     

Three unrelated Rh D gene polymorphisms identified among blood donors with Rhesus CCee (r'r') phenotypes

Human red blood cells are traditionally typed as Rhesus (Rh)-positive or -negative depending on the presence or absence of the Rh D antigen. A recent report demonstrated that the Rh D gene is completely absent in Rh D-negative individuals. In this study, Rh D-negative blood donors with ccee (n = 25) and CCee (n = 3) phenotypes were examined for the presence of absence of the D gene. Polymerase chain reaction (PCR) probes that hybridize to the 5' and 3' regions of the Rh CcEe gene and the closely related D gene were used in a Southern analysis. The D gene was absent in all ccee phenotypes examined. The CCee phenotypes showed three Rh D polymorphisms: one donor lacked the D gene, one donor had a partial deletion on one D gene at the 3' region, and the remaining donor appeared to have one normal D gene within the intron/exon regions examined. We conclude that, while the D gene may be absent in the majority of Rh D-negative phenotypes, rarer polymorphisms also occur that prevent expression of the D antigen resulting in the Rh D-negative phenotype.     

Direct demonstration that autologous bone marrow transplantation for solid tumors can return a multiplicity of tumorigenic cells

Patients with solid tumors are increasingly being treated by autologous bone marrow transplantation (BMT). Although response rates appear to be increased, disease recurrence is the commonest cause of treatment failure. Whether relapse is entirely due to residual disease in the patient or arises also from infiltrating malignant cells contained in the autologous marrow transplant has not been resolved. If the latter explanation is correct, then purging would be required as part of the transplantation procedure. We used retrovirally mediated transfer of the neomycin-resistance gene to mark BM harvested from eight patients with neuroblastoma in clinical remission. The marked marrow cells were subsequently reinfused as part of an autologous BMT. At relapse, we sought the marker gene in malignant cell populations. Three patients have relapsed, and in each the marker gene was detected by phenotypic and genetic analyses of resurgent malignant cells at medullary and extramedullary sites. Analysis of neuroblast DNA for discrete marker gene integration sites suggested that at least 200 malignant cells, each capable of tumor formation, were introduced with the autologous marrow transplant and contributed to relapse. Thus, autologous BMTs administered to patients with this solid tumor may contain a multiplicity of malignant cells that subsequently contribute to relapse. The marker-gene technique we describe should permit evaluation of the mechanisms of relapse and the efficacy of purging in patients receiving autologous marrow transplantation for other solid tumors that infiltrate the marrow.     

Oxidative metabolism of the human eosinophil

We have compared the oxidative metabolism of human eosinophils (80%-90% purity) to that of neutrophils. Hexose monophosphate (HMP) shunt activity of eosinophils was higher than that of neutrophils under either resting or phagocytizing conditions. Eosinophil HMP shunt activity also was stimulated by phorbol myristate acetate, a membrane- active agent. Eosinophils showed a marked incorporation of 125I into trichloroacetic acid-insoluble material under resting conditions, which increased markedly during phagocytosis. Eosinophils likewise showed a greater reduction of nitroblue tetrazolium dye during phagocytosis than did neutrophils. Measurement of other parameters of oxidative metabolism indicated that eosinophils generated superoxide anion following phagocytosis and also elicited a burst of chemiluminescence similar to that observed during phagocytosis by neutrophils. Measurement of NADPH oxidase activity demonstrated that this enzyme was 3-6 times more active in fractions isolated from eosinophils than in corresponding fractions isolated from neutrophils; this was observed over a range of substrate concentrations. The eosinophil enzyme sedimented differently than the neutrophil enzyme with differential centrifugation; neither showed sedimentation characteristics of peroxidase. These data indicate that eosinophils possess a similar, although in some ways more potent, oxidative burst than neutrophils and are consistent with a role for NADPH oxidase in the initiation of that burst.     

Modulation der renalen Transmitter-Freisetzung durch präsynaptische Rezeptoren

Summary Renal sympathetic nerve varicosities possess a variety of receptors which when activated by appropriate agonists can modulate noradrenaline release at the local level of the kidney. Thus, activation of prejunctional ₁- and ₂-adrenoceptors, prostaglandin (PG), dopamine, adenosine and serotonin receptors inhibits, whereas activation of prejunctional ₂-adrenoceptors and angiotensin (A) II receptors enhances renal noradrenaline release. Moreover, neuronally released noradrenaline itself activates prejunctional inhibitory ₁- and ₂-adrenoceptors forming a negative feedback loop of its own release (autoinhibition). PGE₂ and adenosine locally formed in the kidney by renal nerve stimulation inhibits noradrenaline release through activation of their specific prejunctional receptor system (transjunctional inhibition).

     

Group Play Therapy for Young Children Exposed to Major Stressors: Comparison of Quantitative and Qualitative Evaluation Methods

Examined the outcome of a 16-week play group therapy intervention for six highly stressed preschool-aged children compared to a preschool-aged control group. The focus of the group was to help the children build social skills, learn to express emotions appropriately, increase understanding of stress events, and learn new coping skills. The results indicated a significant increase in anxious and externalizing behaviors during the course of the intervention for the treatment group subjects compared to controls. Furthermore, group treatment subjects also indicated a significant increase in social skills during the group intervention. However, there were no significant differences on the psycho-social measure from pre-test to post-test. Despite the lack of differences on quantitative measures of children's functioning, parent report on a qualitative measure indicated improvement in children's psycho-social functioning at the end of treatment. Implications of the play therapy group approach for children exposed to major stressors are discussed.