Keratitis neuroparalytica nach Elektrokoagulation des Ganglion Gasseri

Ohne ZusammenfassungDemonstration zu der 53. Versammlung der Deutschen Ophthalmologischen Gesellschaft in Heidelberg.     

Pars plana vitrectomy in chronic uveitis

Statistical analysis of 54 eyes with chronical endogenous uveitis, mostly juvenile, treated with simple or combined pars plana vitrectomy. Most striking is the high frequency of localized or combined cyclitis with good functional results, although complications of the disease (retinal detachment, vasculitis, PVR, macular damage) are extremely frequent in cyclitis, and this group also includes, three cases of postoperative phthisis. The best argument in favor of an chronic uveitis is the fact that an overwhelming majority of the patients were able to switch from rigorous systemic preoperative medication to simple eye drops or no treatment at all.     

《医院感染控制多媒体教学》软件的设计与应用

为加强医院感染控制，开展医院感染控制继续教育，本介绍了医院感染控制多媒体软件的设计与应用，为有效预防和控制医院感染，促进医院感染控制的进展，把感染管理工作推上新的台阶提供参考。     

Utilisation des implants biodégradables dans le traitement chirurgical des fractures et au cours des ostéotomies

Résumé L'utilisation de matériaux d'ostéosynthèse biodégradables a l'avantage d'éviter la réintervention pour extraire le matériel. Les biomatériaux de polymères polyglycolides ont été expérimentés sur plus de 3 600 animaux de laboratoire avant leur introduction en pratique clinique. Depuis 1984 nous les avons utilisés comme matériau d'ostéosynthèse dans près de 1 700 cas parmi lesquels 880 cas de fracture malléolaire, 226 cas d'ostéotomie en chevron pour hallux valgus, 65 cas de fracture de la tête radiale et 54 cas de fracture de l'olécrane. Parmi les 800 premiers cas traités par broches biodégradables nous avons obtenu des résultats favorables et sans incidents dans 91 pour cent des cas. Il y eut 7 cas de fixation défaillante nécessitant une réintervention. Il y a eu 7 cas d'infection superficielle et 3 cas d'infection profonde. Nous avons observé la formation d'une collection séreuse sous-cutanée sans influence sur le résultat radiologique ou clinique dans 52 cas (6,5 %). Au vue de ces résultats et compte tenu des avantages économiques et psychologiques des matériaux biodégradables (pas de réintervention), on peut penser que l'usage de biomatériaux rivalise favorablement avec l'usage de matériaux conventionnels dans certains types d'ostéosynthèse.

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Utilization of biodegradable implants in the surgical treatment of fractures and osteotomies

Summary The utilization of biodegradable implants instead of metals in orthopaedic surgery abolishes the need to remove the fixation material. For this study biodegradable rods and screws of self-reinforced polyglycolide, polylactide and lactide-glycolide copolymer were developed and manufactured. The clinical introduction of these implants was preceded by thorough experimental studies with 3 600 animals. From November 1984 the developed biodegradable method of osteofixation was used in 1 700 operations. These included 880 displaced malleolar fractures, 226 chevron-osteotomy for hallux valgus, 65 displaced fracture of the radial head, 54 displaced frature of the olecranon and other fresh fractures or orthopaedic operations. In the first 800 cases operated on using self-reinforced polyglycolide rods the postoperative course was uneventful (91%). Because of failure in the fixation reoperation was needed in 7 cases. A superficial wound infection was observed in 7 cases, deep infection in 3 and transient fluid accumulation in 52 cases (6,5%). Fluid accumulation did not influence the radiological or clinical end-result. The advantages of biodegradable fixation are many-sided. There is a costbenefit and clinical capacity is free for other use, and psychological advantages must be emphasised because removal of implants is not needed. The over all results of this study were considered favourable.

     

Fixation of osteotomies of the distal femur with absorbable, self-reinforced, poly-L-lactide plates

Osteotomies of the distal femur were fixed with two self-reinforced poly-L-lactic acid (SR-PLLA) plates and metallic screws placed through the plates on each side of the femur in 23 adult rabbits. They were followed-up after 3, 6, 12 and 24 weeks. After killing, radiological, histological, microradiographic and oxytetracycline fluorescence studies were performed. Except for one histologically confirmed fibrotic non-union at 24 weeks, the osteotomies healed, including one involving a rabbit which had suffered an ipsilateral femoral shaft fracture of unknown cause. No malformations were observed, and the macroscopically detected swelling was a normal postoperative reaction. This study showed that SR-PLLA plates implanted on both sides on the bone are suitable for the fixation of weight-bearing cancellous bone osteotomies in rabbits.     

Effect of totally absorbable implant volume on wound infection rate: Study of 2500 operated fractures, osteotomies, and ligament injuries

Between November 1984 and January 1994 in our department, a total of 2500 patients were treated with totally absorbable internal fixation devices. We studied these patients and analyzed results with regard to the volume of the absorbable implants and the development of wound infection. Of the 2500 patients 2044 were trauma patients and 456 were operated on for orthopedic disease. In 1466 patients treated with implants made of self-reinforced polyglycolic acid (SR-PGA) only, the patients who developed wound infection had a higher implant volume (P=0.07) than those who did not; this difference was close to statistical significance. In the 446 patients who received only implants made of self-reinforced poly-l-lactic acid (SR-PLLA), the 5 who developed wound infection had a mean implant volume more than three times that of the non-infected patients (P=0.01). We found that in the patients treated with the earlier SR-PGA implants, which contained a green staining material, there was no correlation between implant volume and incidence of wound infections. On the other hand, both the non-stained SR-PGA implants, which have been in clinical use since 1989, and the SR-PLLA implants, seem to be more predictable in terms of wound infections. We believe that this difference, is largely due to the lower level of tissue reactions with these newer implants.     

Nociceptin-induced histamine release in the brain: comparison with compound 48/80- and substance P-induced amine secretions

Inflammation Research - .     

Functional and immunogenetic characterization of FcR-blocking antibody

The characteristics and functional importance of FcR-blocking antibodies and their production were investigated after immunization with whole blood, "buffy coat" and purified platelets. We studied the presence of FcR-blocking antibody in haemodialyzed, transfused patients waiting for kidney transplantation, and we found strong correlation between the blocking effect and better graft survival. We suggest that this blocking antibody does not attack FcR as primary target. Investigation of blocking activity of ten different immune sera on 50 healthy panel cells showed that target antigen has some polymorphic varieties. On basis of family studies it seems that the target antigen is not linked to HLA haplotype. The blocking effect of sera could be removed by absorption of CD8+ cells, B lymphocytes, platelets and granulocytes, but not with erythrocytes, monocytes, CD8- cells and NK cells.     

Synovectomy of the wrist in rheumatoid arthritis and related diseases

Summary Synovectomy of the wrist was done on 77 patients (97 wrists) during 1968–1981. The age of the patients at the time of operation ranged from 18 to 77 years, mean 44.9 yrs. Clinical and radiological follow-up examinations (90 wrists) or follow-up evaluation by questionnaire (7 wrists) were made by the authors in 1982. The mean length of the follow-up period was 8.5 years. Clinical symptoms of pain, swelling, restricted motion, instability and deformity of the wrist joint were evaluated and graded according to a special score. Radiological changes due to rheumatoid arthritis and osteoarthrosis were graded and analysed. Eight wrists were arthrodesed during the follow-up. Among the remaining wrists (89 cases) pain was absent or almost absent in 39%, was less than before the operation in 49% and was unchanged or worse in 12% of cases. The respective percentages for the presence of swelling were 47%, 36%, and 17%. The range of dorsiflexion was between 0 and 70°, with an average of 27.9°. The range of volar flexion was between 0 and 75°, the mean being 28.2°. The average ulnar and radial side motions were 12.9° and 5.4°, respectively. The radiological grading of RA remained about the same in 10 wrists and did not improve in a single wrist. In the other wrists the X-ray changes progressed. The results (patient's opinion) were subjectively good in 53%, fair in 32%, and poor in 15%. The result of the synovectomy must be evaluated as poor in the wrists that were arthrodesed (8 cases). The overall objective results of the 90 wrists examined personally were: good in 54 cases (60%), fair in 17 (19%) and poor in 19 (21%). In conclusion, we recommend surgical synovectomy of the wrist for alleviation of pain and swelling in RA, despite the deterioration shown by the X-ray.

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Zusammenfassung Von 1968 bis 1981 wurde bei 77 Patienten (97 Gelenke) eine Synovektomie des Handgelenkes durchgeführt. Das Alter der Patienten zum Zeitpunkt der Operation betrug 18 bis 77 Jahre 44,9 Jahre). Die Beurteilung der Resultate durch die Autoren erfolgte mittels klinischer and röntgenologischer Untersuchung (90 Gelenke) bzw. Fragebogen (7 Gelenke) nach einer durchschnittlichen Beobachtungszeit von 8,5 Jahren. Die klinischen Symptome (Schmerz, Schwellung, Bewegungseinschränkung, Instabilität, Handgelenksdeformierung) wurden nach einer speziellen Bewertungsskala beurteilt. Radiologische Veränderungen wurden analysiert. Acht Handgelenke wurden während der Beobachtungszeit arthrodesiert. Von den bleibenden 89 Gelenken waren 39% schmerzfrei bzw. nahezu schmerzfrei, 49% hatten geringere Schmerzen als präoperativ, 12% waren unverändert oder verschlechtert. Die entsprechenden Prozentzahlen für die Bewertung der Gelenkschwellung betrugen 47%, 36% and 17%. Die Dorsalflexion betrug p. op. 0 bis 70 Grad 27,9 Grad), die Volarflexion 0 bis 75 Grad ( 28,2 Grad). Die durchschnittliche ulnar- und radialabduktion betrug 12,9 Grad bzw. 5,4 Grad. Der radiologische Schweregrad war bei 10 Gelenken unverändert, bei den übrigen Gelenken progressiv. Die subjektive Bewertung durch die Patienten war gut in 53%, befriedigend in 32% sowie schlecht in 15% der Fälle. Alle arthrodesierten Gelenke wurden als schlecht angesehen. Die objektive Beurteilung der 90 persönlich nachuntersuchten Gelenke ergab: gut 54 Fälle (60%), befriedigend 17 Fälle (19%) und schlecht 19 Fälle (21%). Zusammenfassend wird die Synovektomie des Handgelenkes bei Rheumatoidarthritis zur Verminderung von Schmerz und Schwellung trotz der beobachteten radiologischen Verschlechterung empfohlen.

     

In vitro comparative effect of Cd2+, Ni2+, and Co2+ on mouse postblastocyst development.

Postblastocyst development of mouse preembryos was studied in vitro in order to determine direct effect of Cd2+, Ni2+, and Co2+ ions on embryogenesis during the peri-implantation stage. Uterine horns were flushed on Day 4 of pregnancy and expanded blastocysts were cultured for 4 days in the presence of micromolar Cd2+ (1.1-26.4), Ni2+ (0. 1-500) or Co2+ (1-200). Area of trophoblast outgrowth was measured and used as a quantitative toxicological endpoint. Hatching, attachment, outgrowth, and formation of inner cells mass were also registered. Significant adverse effect on the development stages were observed at 2.2 microM (Cd2+), at 10 microM (Ni2+), and at 100 microM (Co2+). Cd2+ and Co2+ decreased the area of trophoblast markedly at concentrations of 1.1 and 10 microM, respectively. Ni2+ exposure resulted in a slight increase at 10 microM followed by a marked reduction in the trophoblast area at 250 microM. Reduced proliferative ability of trophoblast cells may point to compromised invasiveness of the embryo. The lowest Cd2+ concentration (1.1 microM=0.25 microg/ml) significantly deteriorating trophoblast development was found to be lower than Cd levels ranging up to 0.512 microg/g, reported in clinical ovarian samples of occupationally nonexposed women. The morphological alteration and loss of cellular contacts in blastocysts induced by exposure to Cd2+, Ni2+, or Co2+ may adversely influence adhesion and recognition events and may disturb aggregation of mononuclear trophoblastic cells to multinucleated cells in the course of peri-implantation in vivo as well.