Tissue characterization of symptomatic and asymptomatic disc herniations by quantitative magnetic resonance imaging

The purpose of this investigation was to determine differences in tissue composition of symptomatic and asymptomatic disc herniations as reflected in T₁ and T₂ relaxation times (quantitative magnetic resonance investigation of the lumber spine. The longitudinal and transverse magnetic rlaxation times (T₁ and T₂, respectively) were calculated from a set of 20 images obtained with five single-slice/multi-echo sequences at different repetition time values on a commercial whole-body system (1.5 T). Twenty-two symptomatic and asymptomatic disc herniations could be matched according to age, gender, disc level, and the extent of herniation (protrusion or extrusion) and were compared with regard to T₁ and T₂ relaxation times. Symptomatic disc herniations exhibited significantly (p_T1 < 0.04 and p_T2 < 0.003) shorter T₁(ΔT₁:–182.1 milliseconds, ?15%) and T₂(ΔT₂: ?11.0 milliseconds, ?21%) relaxation times than matched asymptomatic herniations. Symptomatic disc herniations also exhibited more advanced disc degeneration as graded by Pearce's criteria (p < 0.01). These results suggest that symptomatic and morphologically matched asymptomatic disc herniations differ with regard to disc matrix composition.     

Correction of degenerative scoliosis of the lumbar spine. A preliminary report

The use of the spinal internal skeletal fixation system (ISFS), originally developed for fracture treatment by Dick for the segmental correction of scoliosis, is demonstrated in eight adult degenerative lumbar spinal curves. The two main benefits of an intrapedicular screw fixation system, i.e., excellent skeletal stabilization and the ability to freely modify individual segmental vertebral position, are clearly demonstrated in this instrumentation, which is still at the prototype stage. The good preliminary results seen in this series encourages the further development of segmental intrapedicular spinal fixation systems for the treatment of scoliosis.     

Subcapital callus resection for slipped capital femoral epiphysis

Surgical Principles The lateral approach is routinely combined with an osteotomy of the greater trochanter. We resect the newly formed callus located at the anterior, posterior and caudal aspect of the femoral neck distal to the epiphysis. No shortening of the femoral neck results from this procedure. One can safely avoid a vascular injury by performing a careful dissection, since the posteriorly reflected articular capsule containing the nutrient vessels to the head is detached from the femoral neck like a banana peel. The resection manoeuvre is performed next to the physeal plate of the slipped epiphysis. After callus resection, reduction of the femoral head by longitudinal traction and internal rotation of the limb is easy. The aim is complete correction of the slippage. When there is excess physeal cartilage, we resect it with a curette and then the head is fixed using 2 screws. Revised Version from: Operat. Orthop. Traumatol. 4 (1992), 77–85 (German Edition).     

Multimodal intraoperative monitoring: towards a routine use in surgical treatment of severe spinal disorders

European Spine Journal -     

Prevention of infection in elective orthopedic interventions with special reference to alloplastic joint replacement

Based on a study of 105 patients and a comprehensive literature review we recommend a prophylactic regimen for orthopaedic procedures which is easily adaptable to the needs of individual clinics. The regimen is especially designed for joint replacements and includes basically the following four points: 1. parenteral prophylaxis with cefazolin 1 g every 6 hours for 24 hours; the first dose is given between 10 and 30 minutes before surgery (for knee-replacement the initial dose is 2 g); 2. use of bone cement impregnated with antibiotics, e.g. Palacos-Gentamycin-cement; 3. when possible the operation should be performed in a theater equipped with "ultra-clean-air" laminar air-flow and the surgeon should wear "whole-body-exhaust" suits or suits made of "Fabric 450"; 4. antibiotic selection as outlined in points one and two must be adjusted over time based on ongoing monitoring of antimicrobial resistance in the individual clinic.     

Is one assessment enough? Patterns of helping alliance development and outcome

Early therapeutic alliance is usually measured by the rating of a single session (between the third and the fifth sessions). However, there is a strong argument in favor of viewing early alliance as a developing process. This study examined the relationship between patient's rating of the helping alliance (HAq) at each session and therapy outcome. This comparison was repeated using patterns of alliance over the course of treatment. Patterns of therapeutic alliance development were detected by clustering ratings of a sample of N = 70 outpatients across four sessions of very brief psychotherapeutic intervention. Cluster analysis revealed two main patterns (shapes) of alliance development: (i) stable alliance, and (ii) linear growth pattern. These patterns are more predictive of symptom improvement and social adjustment than single ratings, whereas single ratings measuring the strength of alliance are more correlated with patient's satisfaction. Copyright © 2004 John Wiley & Sons, Ltd.     

Concurrent infections with vector-borne pathogens associated with fatal anaemia in cattle: haematology and blood chemistry

An outbreak of a fatal haemolytic anaemia in a dairy herd of cattle in Switzerland was shown to be associated with infections with five vector-borne pathogens, namely Anaplasma marginale, A. phagocytophilum, Babesia bigemina, a Theileria spp belonging to the buffeli/sergenti/orientalis complex and haemotrophic Mycoplasma spp. The latter three had not been documented before this outbreak in Switzerland. To characterise the haematological and blood chemical changes in these unique cows, packed cell volume was determined in all 286 blood samples, blood smears, and complete haematology were performed from 285 and 173 blood samples, respectively, and biochemical parameters were assayed in 105 serum samples. Regenerative anaemia was the key sign of illness. Red blood cells of anaemic cattle were hypochromic and macrocytic. Anaemic animals had reduced platelet cell counts and increased total white cell counts. In addition, increased serum bilirubin, blood aspartate aminotransferase, gamma glutamyltransferase, glutamic dehydrogenase and blood urea nitrogen and decreased magnesium, calcium and albumin levels were found in anaemic cattle when compared to animals with normal packed cell volume. Most changes could not be attributed to a single infection. A. marginale seemed to be important in causing the outbreak, but co-infections may have aggravated the disease development and clinical signs. Thus, when encountering cattle with haemolytic anaemia, all of the mentioned pathogens should be included as differential diagnosis.     

Bone and joint transplantation. Alternatives to bridging segmental bone defects and a model for allogenic bone transplantation

Fresh allogeneic diaphyseal bone segments were transplanted into 12 dogs. We attempted to improve the immunogenity and incorporation of the bone segments through "graft manipulation" with and without immunosuppression. Through clinical and radiological study during the 20-week experimental period, we observed transplant healing with differing structural phenomena. After autologous knee joint replantation in 4 dogs and allogeneic transplantation in 2 dogs (with and without revascularization and immunomodulation with Cyclosporin A) we present a canine model to investigate all open questions about the transplantation of allogeneic, fresh joints (i.e. transplant biology, immunology, and vitality).