Fixator-assisted nailing of tibial fractures: New surgical technique and presentation of first 30 cases

Background

Intramedullary nailing is considered a “gold standard” for treatment of tibial shaft fractures. However, some types of fractures are typically considered as “difficult for nailing”. This group includes the periarticular fractures, fractures of both bones at the same level, comminuted and segmental fractures of the tibia. Fixator-assisted nailing (FAN) is an effective method treatment of these types of fractures. The main requirements for the ideal reduction device are an ease of its installation and an ability of multiplanar fracture reduction. Fixator-assisted nailing (FAN) with the use of two perpendicular to each other monolateral tubular frames perfectly meets these requirements. In this study we present this new surgical technique and the analysis of first 30 cases.

The AIDS problem in accident surgery

In trauma surgery there is a particularly high proportion of patients in the age group most at risk of infection with AIDS. The result of an epidemiological study in our patients (HIV screening of all patients scheduled for surgery at a trauma center over 18 months) showed a prevalence of 0.1%. Specific therapeutic strategies must be developed to deal with the weakened immunity of HIV-infected patients. Fracture treatment in HIV-infected hemophiliacs is a special problem. Homogenous bone transplantation is described with reference to HIV. The particular danger of injury in trauma surgery is also investigated. The chain of infection is illustrated and used to demonstrate the precautions that can be taken against nosocomial HIV infections. Following infection with fluids containing HIV, specific measures must be taken. The legal aspects of HIV-antibody testing in the Federal Republic of Germany are elucidated. Finally, the problems of general preoperative HIV-antibody testing are discussed.     

Recent influenza virus A infections in forensic cases of sudden unexplained death

Summary 84 forensic necropsy cases with a history of sudden unexpected death and where no acceptable cause of death was found at autopsy (= cases of sudden unexplained death, SUD) were found to have a significantly higher rate of influenza A (H 3 N 2) infection than did matched controls of the general population and a group of forensic necropsy cases with known cause of death (NON-SUD cases).By contrast, the group of SUD cases was found to have no significantly increased infection rate with influenza H 1 N 1 and B virus, parainfluenza viruses, RS virus, adenovirus, and cytomegalovirus.The influenza A associated SUD cases had a significantly higher rate of pathological and histological findings previously described for cases of primary viral pneumonia than did SUD cases without recent influenza A infection and NON-SUD cases.These findings suggest that virological examination of SUD cases could be helpful in order to determine the probable cause of death.A considerable portion of the influenza associated SUD cases occurred during interepidemic influenza periods. Therefore, such cases could be a useful source for monitoring the interepidemic spread of influenza virus.     

A new autosomal dominant syndrome of idiopathic progressive vestibulo-cochlear dysfunction with middle-age onset.

A kindred is described with progressive autosomal dominant vestibulo-cochlear dysfunction resulting in instability in the dark, head movement dependent oscillopsia and hearing loss. The first symptoms appeared in the 4th decade and progressed to vestibular areflexia, presumably in the 5th decade and to almost total deafness in the 6th-7th decade of life. The history was negative for other neurological, otological or infectious diseases, or the use of neuro-ototoxic drugs. The affected subjects showed remarkable compensation for the loss of vestibular function.     

Correlation between velocity step and caloric response parameters

The correlation between velocity step (VS) and caloric response parameters was studied in a series of several hundred patients who underwent a neuro-otological examination. The VS parameters initial velocity (V in degree/s), time constant (T in s) and Gesamtamplitude G ( = VT in deg) were all significantly correlated with the caloric response parameters. The highest correlation coefficients were associated with G.     

Robot-assisted versus standard videoscopic aortic replacement. A comparative study in pigs.

BACKGROUND: Reconstruction of the infrarenal aorta for aneurysms is routinely performed through laparotomy. A less invasive videoscopic approach has not gained wide acceptance due to technical difficulties. Robotic systems could potentially improve imaging of the operative field and surgeon's dexterity during videoscopic surgery and therefore might facilitate the performance of this procedure. The aim of this animal study was to compare the safety and efficacy of a robot-assisted videoscopic aortic replacement to the standard videoscopic approach. MATERIALS AND METHODS: In 10 female pigs, the infrarenal aorta was partially replaced by a 10 mm polytetrafluoroethylene (PTFE) interposition graft through a videoscopic retroperitoneal approach, using the da Vinci robot system (robot group). Ten other pigs were operated on in a similar fashion, using standard videoscopic instruments (control group). Relevant procedure times, blood loss and complications were registered. Efficacy of the anastomoses was evaluated by measuring patency and blood loss after removing the clamps. Furthermore, circumference and number of stitches were evaluated at autopsy. RESULTS: The procedure, suturing and clamping times were significantly shorter in the robot group and blood loss was less. In the control group, the inferior vena cava was injured in one pig. In two cases in the control group, haemostasis could not be established after clamp removal. At autopsy, all anastomoses in the robot group were adequate. In the control group, a stitch crossing the aortic lumen was found in two distal anastomoses and a large distance (>3 mm) between two stitches was encountered at least once in 12/20 suture lines. All 20 grafts were patent. No anastomotic narrowing was encountered. The number of stitches used for proximal and distal anastomosis was higher in the robot group. CONCLUSION: This study demonstrates the superiority of robot-assisted videoscopic aortic replacement over standard videoscopic techniques in an animal model.     

Solitary bronchioloalveolar carcinoma: CT criteria

The computed tomographic (CT) scans of 30 patients with solitary bronchioloalveolar carcinoma were reviewed. Common features at CT included the peripheral or subpleural location of a pulmonary mass (25 cases), pseudocavitation (18 cases), heterogeneous attenuation (17 cases), irregular margins forming a star pattern (22 cases), and pleural tags (21 cases). Using these CT criteria, four independent observers attempted to identify cases of bronchioloalveolar carcinoma from a larger sample of lung cancers and benign lesions by categorizing a series of test cases into four probability categories. Although the bronchioloalveolar carcinomas were correctly ranked in the two highest probability categories 75% of the time (in 45 of 60 cases), there was considerable overlap with other lung lesions, particularly with adenocarcinoma and large cell undifferentiated carcinoma. However, even though the typical features of bronchioloalveolar carcinoma are not invariable or highly specific, they are characteristic enough to suggest the diagnosis.