Lesions of the scapholunate ligaments in acute wrist trauma – arthroscopic diagnosis and minimally invasive treatment

The final result of the treatment of distal intra-articular radius fractures depends both on the accuracy of the fracture reduction and on the presence of additional carpal injuries. In particular, lesions of the intrinsic ligaments usually lead to severe degenerative damage of the wrist joint if they are missed primarily. With the introduction of wrist arthroscopy, these tears can be evaluated and treated earlier. Since 1993 arthroscopically assisted treatment has been performed in 23 patients with distal intra-articular fractures of the radius (mainly C-fractures according to the AO classification system or group VII and VIII fractures according to Frykman). Scapholunate (SL) tears were found in 11 patients (47.8%), 7 of whom showed marked instability intraoperatively and were stabilised at the time of surgery.     

Arthroscopic technique for replacing the anterior cruciate ligament using a free patellar tendon transplant]

The replacement of the anterior cruciate ligament (ACL) by a free patellar tendon graft is a well-known procedure. The disadvantage is that the necessary arthrotomy destroys the nerve supply of the joint capsule. Therefore, we developed a procedure of ACL replacement that can be done by arthroscopy without opening the joint except for a small incision needed for the arthroscopy and working canal. The surgical technique is described.     

The Graz learning and training model for arthroscopic surgery

Summary Up to 30% of all operative procedures in orthopaedic surgery are performed arthroscopically. Because of the steadily increasing number of residents, it seems to be difficult both to maintain high standards and to guarantee an adequate training in arthroscopic surgery. However, in contrast to many other surgical techniques it is possible to learn and practice arthroscopy using artificial models and cadaver joints, provided that experienced surgeons and anatomists act as supervisors and instructors. The aim of this paper is to assess practice models and training programs which should guarantee sufficient practical experience during the training period.

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Modèle d'apprentissage et d'entraînement à la chirurgie sous arthroscopie

Résumé Jusqu'à 30% de toutes les techniques opératories en chirurgie orthopédique sont réalisées sous arthroscopie. En raison du nombre croissant de résidents, il semble difficile de maintenir à la fois le haut niveau de formation et de garantir un entraînement adéquat à la chirurgie sous arthroscopie. Toutefois, contrairement à de nombreuses autres techniques chirurgicales, il est possible d'apprendre à pratiquer l'arthroscopie en utilisant des modèles artificiels ou des articulations de cadavres, dans la mesure où des chirurgiens et des anatomistes expérimentés agissent comme enseignants et tuteurs. Le but de ce travail était d'évaluer les modèles pratiques et les programmes d'entraînement pouvant garantir une expérience pratique suffisante durant la période d'apprentissage.

     

Bedingte Reflexe als Krankheitsursache Beitrag zur ?tiologie der Polyarthritis

Bei Versuchen, in den Entstehungsmechanismus der primär chronischen Polyarthritis besseren Einblick zu erhalten, indem Bestimmungen des Elektrodermatogramms (EDG), der Spannungskennlinie und der Hauttemperatur nach Eisumschlägen auf Kniegelenke von Normalpersonen und von Polyarthritikern durchgeführt werden, ergeben sich folgende Tatsachen:

Surface phenotypes of human peripheral blood mononuclear cells from patients with gastrointestinal carcinoma

Summary Peripheral blood mononuclear cells (PBMC) from 40 patients with gastrointestinal carcinoma (GIC), 13 patients with primary carcinoma in other localizations(non-GIC), and from 57 apparently healthy donors were isolated by Ficoll-Paque gradient centrifugation. The separated cells were stained with several monoclonal antibodies and subjected to analysis on a fluorescence-activated cell sorter. A decreased percentage of PBMC expressing T cell antigens was noted amongst GIC patients, and was mainly due to a reduction of the Leu 2a subset, thus, leading to an increase in the Leu3a/Leu2a ratio from 1.4 to 2.1. Non-GIC patients had decreased numbers of both T helper and suppressor cells. Amongst PBMC from GIC and non-GIC patients a statistically increased percentage of cells expressed LeuM2 (P<0.001), LeuM3 (P<0.001), OKM 1 (P<0.005), VEP 9 (P<0.001), and HLA-DR (P<0.001) antigens compared to healthy controls. The percentage of cells bearing these monocyte/macrophage antigens correlated well with the number of cells having monocyte morphology, stained for non-specific esterase, phagocytosed latex particles, and expressed Fc IgG receptor. Our results demonstrate clearly that tumor-bearing patients have an incrased relative number of monocytes. The data suggest that cells of the macrophage lineage may be involved in defense mechanisms and changes of the immune system evoked by various tumors.This work was supported by Fonds österreichischer Krebsforschungsinstitute     

Ultra-sensitive TSH levels: an aid in the screening for amiodarone-induced thyroid dysfunction

Amiodarone modifies thyroid hormone secretion and hypothyroidism occurs in some cases. The latter diagnosis is often difficult and is of particular importance in these patients as it may have serious consequences for the heart. Early diagnosis is therefore essential but difficult because of the induced hyperthyroxinemia with maintenance of euthyroidism and a hypotriiodothyronemia. The diagnostic performance of an ultrasensitive method of measuring TSH (TSH-U), capable of distinguishing hyper and euthyroidism were compared with standard thyroid function tests and TSH stimulation with TRH in 50 patients treated with amiodarone. Only 6 of the 14 patients with hyperthyroxinaemia had TSH-U values in the hyperthyroid range: only one of these patients had an increased triiodothyronine. In 2 cases the THS-U was low but the T4L was normal. In 4 patients, increased TSH-U allowed diagnosis of latent or patent hypothyroidism. There was a close correlation between results of the TRH stimulation test and those of the TSH-U in all cases. This test may therefore be used as an initial screening test for thyroid dysfunction in patients on amiodarone and is simple, reliable and relatively cheap to perform. It makes it unnecessary to measure all thyroid hormonal parameters and the TRH test simultaneously.     

Is it feasible to assess self-reported quality of life in individuals who are deaf and have intellectual disabilities?

Purpose

There is consensus that Quality of Life (QOL) should be obtained through self-reports from people with intellectual Disability (ID). Thus far, there have been no attempts to collect self-reported QOL from people who are deaf and have ID.

Methods

Based on an established short measure for QOL (EUROHIS-QOL), an adapted easy-to-understand sign language interview was developed and applied in a population (n = 61) with severe-to-profound hearing loss and mild-to-profound ID. Self-reports were conducted at two time points (t₁ and t₂), 6 months apart. The Stark QOL, an established picture-based questionnaire, was also obtained at t₂ and three Proxy ratings of QOL (from caregivers) were conducted for each participant at t₁.

Results

Self-reported QOL was successfully administered at both time points for 44 individuals with mild and moderate ID (IQ reference age between 3.3 and 11.8 years).

The self-reports showed sufficient test–retest reliability and significant correlations with the Stark QOL. As anticipated, self-reported QOL was higher than proxy-reported QOL. Test–retest reliability and internal consistency were good for self-reported QOL.

Conclusion

Reliable and valid self-reports of QOL can be obtained from deaf adults with mild-moderate ID using standard inventories adapted to the linguistic and cognitive level of these individuals.

     

Quantitative assessment of fracture healing

Usually follow-up of the healing process of bone fractures is by subjective assessment of standard X-rays, based on the clinician's personal experience. It is therefore impossible to completely avoid misjudgements in the evaluation of the mechanical stability. Other authors have reported that the mechanical response of bony structures to a knock impulse allows a definitive statement about the stiffness of a fracture. The practicability of computerised sonometry in computer-aided evaluation of the mechanical vibration reaction and the acoustic transmission of sound through osseous structures for assessing stability has been proved in experimental and clinical studies. We designed an animal study that would allow a systematic correlation between the diagnostic investigations in general use. As a main goal, this study tries to correlate sonography with other quantitative techniques, even if they are not used under everyday clinical conditions. Our results show that methods based on direct assessment of the mechanical stability between fracture fragments allow a more exact evaluation of fracture healing. This study helps to classify the results of computerised sonometry together with other diagnostic procedures used for the evaluation of fracture healing, and furthermore provides a basis for clinical interpretation of the findings of a new, non-invasive technique for precise quantitative assessment of fracture healing.