Increased interleukin-6 in collected drainage blood after total knee arthroplasty: an association with febrile reactions during retransfusion

We determined interleukin-6 (IL-6) concentrations in collected shed drainage blood intended for retransfusion in a prospective study in 81 patients after total knee replacement. We found large increases in IL-6 levels, averaging 6.5 (SD 3.9) ng/mL, in shed blood collected in the first 6 postoperative hours. 3 patients had febrile reactions after collected blood was retransfused. The IL-6 levels in the drainage blood of these patients were very high (9.6-13.4 ng/mL). In the blood collected after 6 hours, IL-6 concentrations increased to 47 (SD 33) ng/mL (p < 0.001). These results suggest a relation between increased interleukin-6 concentrations in shed drainage blood and the occurrence of febrile reactions after retransfusion of such blood.     

A new technique for esophagojejunostomy after total gastrectomy for gastric cancer

BACKGROUND: The critical part of any operation involving a proximal gastric resection is the esophageal anastomosis. Leakage from this anastomosis is one of the main reasons for postoperative morbidity and death after gastrectomy. Application of the double-stapling technique affords many of the same advantages that it does for low rectal tumors, especially in obese patients with narrow costal margins. METHODS: A new technique for esophagojejunostomy after total gastrectomy for gastric cancer is described. RESULTS: This technique has been used in 3 patients. At a follow-up of 22 months, there have been no anastomotic leaks or evidence of clinical stenoses. CONCLUSIONS: This technique minimizes manipulation and dissection around the distal esophagus. Not only does this make the operation easier, but it also allows for a longer proximal resection margin. Possibly this will result in lower rates of esophageal breakdown.     

Möglichkeiten zur vereinfachten Berechnung des Herzminutenvolumens über das Blutvolumen,die Kreislaufzeit und einen variablen Faktor k

Zusammenfassung Mit Hilfe desHamiltonschen Herzminutenvolumens wurde über die nachWollheim undLange modifizierteVierordtsche Formel der Faktork berechnet. Es ergab sich in 96 untersuchten Fällen ein funktioneller Zusammenhang zwischenk und dem Quotienten aus den einfach zu bestimmenden Kreislaufgrößen, Blutmenge und Kreislaufzeit. Bei Herz-kreislaufgesunden und kompensierten Hypertonikern erwies sich dieser QuotientBM/Ct umgekehrt proportional, bei dekompensierten Herzkranken direkt proportional dem Faktork. Aus der Regression kann, bei linearer Abhängigkeit, der Faktork jeweils berechnet werden, wenn das Blutvolumen und die Kreislaufzeit bekannt sind. Daraus kann dann über den errechneten variablen Faktork und den gemessenen Größen Blutvolumen und Kreislaufzeit auf einfache Weise ein dem derHamiltonschen Indikatorverdünnungsmethode entsprechendes Herzminutenvolumen errechnet werden. Bei Herz-Kreislaufgesunden und dekompensierten Herzkranken liegt eine gute Relation mit einer mittleren Abweichung von weniger ±10% vor. Bei kompensierten Hypertonikern dagegen stimmen die nach beiden Methoden errechneten Herzminutenvolumina im Mittel sehr gut überein, jedoch zeigen die über den Faktork bestimmten Herzminutenvolumina eine geringere Streuung, d. h. die bei derHamiltonschen Methode gefundenen großen und ganz kleinen Werte ergeben sich nach der Faktor-k-Methode nicht.Es werden die möglichen Gründe für dieses abweichende Verhalten diskutiert, wobei die Diskrepanz zwischen Umlaufzeit und Kreislaufzeit bei unkontrollierten Belastungszuständen ohne steady state und ein präinsuffizientes Kreislaufverhalten die funktionellen Beziehungen des Faktorsk stören können.Trotzdem handelt es sich bei der beschriebenen einfachen, den Patienten wenig belastenden Methode um eine exakte Messung des Herzminutenvolumens, die sich aus einer komplizierten Methode entwickelt hat und im Ergebnis dieser auch entspricht.

---

Summary Factork was calculated by the aid ofHamilton's cardiac output in accordance toVierordt's formula modified byWollheim andLange.In examinations of 96 patients a correlation betweenk and the simple calculated values of blood-volume (BM) and circulation-time (ct) was observed. In normal subjects and in patients with a compensated hypertension the quotientBM/Ct was found to be reciprocal to factork, while in patients with heart-failure it was directly proportional. In a linear dependence factork can be calculated by regression function when bloodvolume and circulation-time are known. By the aid of calculated factork and the evaluated blood-volume and circulation-time, one obtains a cardiac output which is equivalent to that ofHamiltons method. In normal subjects and in patients with heart-failure an average deviation of less than ±10% was found. In compensated hypertensives the average values of both cardiac-outputs are corresponding. But in calculating cardiac-output by aid of factork the values show less deviation in comparison with those of theHamilton method. This means that the high and the low values calculated byHamilton's method are not found with the factork-method.The reasons for this deviating behaviour are discussed. The discrepancy between circulation-time in total and in part in an uncontrolled and unsteady loading-state and in a state preceeding failure, may disturb functional relation with factork. Nevertheless we have an exact method for calculating cardiac output in a simple way which is less troublesome for patients.

---

---

Mit 7 Abbildungen und 3 Tabellen     

Primary cerebral toxoplasmosis: a rare case of ventriculitis and hydrocephalus in AIDS

We describe the clinical, radiological and neuropathological findings in an adult AIDS patient presenting with ventriculitis and hydrocephalus as the primary manifestations of cerebral toxoplasmosis. Clinical symptoms including fever, headache, changes in mental status and focal neurological deficits were non-specific. Cranial computed tomography showed a subtile ventricular dilatation whereas magnetic resonance imaging disclosed triventricular hydrocephalus due to stenosis of the aqueduct and a periventricular nodular rim of high signal intensity on T2- and proton density-weighted images. This rim also showed a slight enhancement on post-contrast T1-weighted images. Focal intracerebral lesions could not be delineated, neither by neuroimaging nor by pathology. Neuropathological examination showed severe ventriculitis with large ependymal and subependymal necrosis as well as dilatation of the lateral and the third ventricle. The only microorganism demonstrated at histology in the central nervous system was Toxoplasma gondii. We conclude that ventriculitis and hydrocephalus without any focal parenchymal lesion may be the only manifestations of CNS toxoplasmosis. It is important to recognize this unusual form of presentation of cerebral toxoplasmosis in order to perform specific therapy.     

Optimization of gadodiamide concentration for MR arthrography at 3 T

OBJECTIVE: The purpose of our study was to determine the optimal concentration of a gadolinium-based contrast agent (gadodiamide) for direct MR arthrography at 3 T compared with 1.5 T in an in vitro study. CONCLUSION: Optimized concentrations of gadolinium-based contrast agents for MR arthrography are similar at 3 and 1.5 T, although a slightly greater dilution may be useful at 3 T. Signal-to-noise ratio peak levels are significantly reduced by adding an iodinated contrast agent, relatively significantly more at 3 T than at 1.5 T.     

No difference between two doses of diclofenac in prophylaxis of heterotopic ossifications after total hip arthroplasty

BACKGROUND: In a monocentric, randomized, placebo-controlled double-blind study, we investigated the efficacy of two doses of diclofenac-cholestyramine for the prevention of heterotopic ossification (HO). PATIENTS: The study comprised 245 patients undergoing total hip arthroplasty (THA). RESULTS: With 150 mg cholestyramine-bound diclofenac (2 x 1 capsule Voltaren resinate) daily during a postoperative period of 14 days, 19% of patients showed slight HO (Brooker grade 1), and no patient had more severe ossifications (grades 2-4). In the group receiving 75 mg daily (1 x 1 capsule), 17% of patients showed grade 1 HO and 4% grade 2 HO. No patient had grades 3-4 HO. No differences in clinical results were seen between the two groups 6 months after THA. INTERPRETATION: Since the rate of adverse gastrointestinal events was lower (23% versus 38%, p = 0.02) in the group receiving the lower dose, we recommend it.     

Predictive value of the duration of sciatica for lumbar discectomy. A prospective cohort study

The optimum timing of lumbar discectomy for sciatica is imprecise. We have investigated a number of prognostic factors in relation to the outcome of radiculopathy after lumbar discectomy. We recruited 113 consecutive patients of whom 103 (91%) were followed up at one year. We found a significant association between the duration of radiculopathy and the changes in the Oswestry Disability Index score (p = 0.005) and the low back outcome score (p = 0.03). Improvement in pain was independent of all variables. Patients with an uncontained herniated disc had a shorter duration of symptoms and a better functional outcome than those with a contained herniation. Our study suggests that patients with sciatica for more than 12 months have a less favourable outcome. We detected no variation in the results for patients operated on in whom the duration of sciatica was less than 12 months.