Neurokutane Angiomatose

A 54-year-old woman developed epilepsy and gait disorder. The initial CCT showed multiple intracerebral cysts. Histologically these turned out to be cavities from repetitive bleedings out of abnormal vessels in the border region. Regular observation during 7 years showed spontaneous episodes of regression and progression of the cysts. In addition, multiple hemangiomas of the skin were found. The case presented here represents an unusual manifestation of neurocutaneous angiomatosis.     

Biodegradierbare Stifte bei osteochondralen Frakturen

Implants that are biodegradable in situ allow fixation of osteochondral fractures without the need for subsequent hardware removal. Foreign-body reactions and soft-tissue reactions during degradation have been described, varying with the composition and degradation properties of the implants. With the aim of improving the degradation characteristics, 10% tricalcium phosphate was incorporated into a poly-l/dl-lactide pin (Polypin). In an animal study over 3 years, complete degradation of the implants was observed and the implantation site was found to have filled up with bone or scar tissue. After this study, 78 human patients were treated with similar implants and followed up clinically and with conventional radiographs after an average of 39 months. The biodegradable implants had been used for fixation of osteochondral fractures in the shoulder in 5 patients, the elbow in 42, the hip in 12, the knee in 7, and the foot in 12. All fractures were found to have healed completely without displacement, and the functional results were good in all cases. No foreign-body and/or soft-tissue reactions caused by the implants were observed. The clinical results were similar to or better than results recorded in the literature.     

Endoscopic retrograde cholangiopancreatography in children and adolescents

OBJECTIVES: Endoscopic retrograde cholangiopancreatography (ERCP) is becoming a more frequently used diagnostic and therapeutic tool in children. We sought to determine the indications, feasibility, safety, and effect on patient management of ERCP in pediatric patients of varying age. METHODS: All ERCPs performed during a 4-year period in patients aged 18 years or less at an academic hospital were retrospectively reviewed. The indications, type of anesthesia administered, type of duodenoscope used, diagnostic findings, therapeutic interventions, complication rate, and effect on management were compared between children (age 0-12 years) and adolescents (age 13-18 years). RESULTS: A total of 53 procedures were performed in 43 patients whose median age was 13.5 years. ERCP was successful in 50 of 53 cases (94%) with a complication rate of 6%. Endoscopic therapy was provided in 24 of 53 cases (45%). Compared with adolescents (n = 28), children (n = 25) were more likely to receive general anesthesia (96% vs. 29%; P < 0.001) and undergo ERCP with a pediatric duodenoscope (0% vs. 40%). ERCP affected management in 73% of cases, equally in both groups. CONCLUSION: ERCP is a successful and safe diagnostic and therapeutic modality in a variety of pancreatobiliary disorders that directly affects management in children of all ages.     

Candida infection in hip alloarthroplasty

A 46-year-old polytoxicomanic patient underwent a total hip replacement for necrosis of the femoral head. The patient suffered additionally from chronic pancreatitis with insulin-dependent diabetes and polyneuropathy. Three weeks later he developed a deep wound infection followed by surgical revision. The infection persisted despite further revision operations and systemically and locally applied antibiotics. After removal of the prosthesis,microbiology revealed Staphylococcus aureus, enterococcus,and Candida parapsilosis. Five additional revision operations, application of suction-irrigation drainage, and systemically administered antibiotics could not stop the infectious process. The patient was transferred to our institution 3 months after primary surgery. The joint defect was filled with a PMMA Palacos spacer. This time biopsies were only positive for Candida albicans. After 12 days of antifungal therapy with fluconazole,microbiological biopsies were sterile. The spacer was removed and femoral extension applied. After 4 weeks of further antifungal therapy, a revision prosthesis was implanted. Until now no signs of infection have appeared.     

The value of tan lines: vulvar melanoma and ultraviolet rays

Recreational sun exposure of the general population has increased. There is less clothing on the beaches, increased accessibility to tropical beaches, and increased use of artificial suntanning equipment. The vulva, traditionally, has been protected from sun exposure. In this age of nude sunbathing, particularly within the confines of a tanning bed, it is interesting to ponder whether such exposure would affect the incidence of melanoma of the vulva.     

Prospective evaluation of 4-mm diameter endoscopes for esophagoscopy in sedated and unsedated patients

BACKGROUND: Unsedated esophagoscopy with small-diameter endoscopes is generally well tolerated but of limited sensitivity for the diagnosis of esophageal mucosal disease. This study evaluated the sensitivity of esophagoscopy performed with new 4-mm diameter prototype battery-powered and video endoscopes. Patient tolerance for an unsedated examination with the 4-mm endoscopes was assessed and the performance characteristics of the battery-powered and video 4-mm endoscopes were compared. METHODS: Patients referred for EGD were recruited to undergo an additional examination with a 4-mm endoscope. A prototype 60-cm long, 4-mm diameter battery-powered fiberoptic esophagoscope was used in the first 24 patients and a prototype 60-cm long, 4-mm diameter video esophagoscope in the next 27 patients. Examiners who were unaware of patient history and procedure indications recorded esophageal findings, ease of intubation, optical quality (5-point visual scale), and time for examination of the esophagus and then recorded esophageal findings after the standard EGD. RESULTS: The sensitivity, specificity, and accuracy for identification of Barrett's esophagus was 100%; overall sensitivity, accuracy, and specificity for detecting esophageal lesions were, respectively, 91%, 98%, and 99%. Patient tolerance (assessed by symptom scores for choking, pain, and discomfort) and acceptability of unsedated esophagoscopy with the 4-mm diameter instruments were significantly better than in a historical group of patients examined with a 3-mm diameter endoscope. The optical quality of video endoscope was rated as superior to that of battery-powered endoscope, and esophageal examination was performed significantly quicker with the video versus the battery-powered endoscope (68 vs. 137 seconds; p = 0.001). CONCLUSIONS: Unsedated esophagoscopy with 4-mm diameter endoscopes may be an alternative to EGD for screening for Barrett's esophagus. Given the current state of endoscopic technology, a minimum diameter of 4 mm is required for satisfactory esophageal imaging.