Icing the Pain-Ultrasound-Guided Cryoablation of Symptomatic Post-Amputation Stump Neuroma.

PURPOSE: To assess the feasibility and outcome of ultrasound-guided cryoablation in patients with a sensitized stump neuroma after limb amputation. MATERIAL AND METHODS: Seven patients (3 females, 4 males; mean age 42 years) were included in this retrospective study. Ultrasound-guided cryoablation of a previously identified painful stump neuroma was performed. Pain was assessed on the visual analogue scale (VAS) and compared before and after cryoablation (Wilcoxon Test). The degree of pain alleviation was correlated with patient age, duration of pain before ablation and time interval between amputation and ablation (Spearman correlation). A p-value less than 0.05 was deemed statistically significant. RESULTS: Nine cryoablations were performed for 8 neuromas. Technical success was 100%, there were no major complications. Mean follow-up was 27 months. There was a statistically significant decrease of pain from mean 8.3 / 10 (baseline) to 4 /10 (on day one), 2.1 / 10 (at one week) and 3 / 10 (at last follow-up) (p < 0.05). Patient satisfaction with cryoablation treatment was very high (median score 70 / 100). CONCLUSION: In our small population observational study, ultrasound-guided cryoablation of a sensitized stump neuroma was effective and safe for pain alleviation with very good long-term results. LEVEL OF EVIDENCE: Level 2, Observational study with dramatic effect.

[Patient volume, diagnosis and injury mechanisms in a level 1 trauma center at the beginning of the COVID-19 pandemic in comparison to the mean of the 3 previous years : A retrospective, epidemiological evaluation of 4967 patients]. / Patientenaufkommen, Diagnosen und Verletzungsmechanismen eines überregionalen Traumazentrums mit Beginn der COVID-19-Pandemie im Vergleich zum Mittelwert der 3 Vorjahre : Eine retrospektive, epidemiologische Auswertung von 4967 Patienten.

BACKGROUND: As part of the COVID-19 pandemic, political decisions were made to reduce social interaction and to reduce the number of infections. The aim was to create capacities for the in-hospital care of the patients. OBJECTIVE: The aim of the study was to check whether a reduction in the number of trauma patients compared to the mean of the previous 3 years could be observed. MATERIAL AND METHODS: We retrospectively analyzed all patients who presented in the emergency admission from 1 March to 15 April 2020 with the mean of the patients from the previous 3 years 2017-2019. The age of the patients, time of presentation, diagnoses, whereabouts of the patients, inpatient or outpatient, number and duration of the operative care and required capacity on the normal ward and intensive care units (ICU) were recorded. The injury mechanism was also examined. RESULTS: A total of 4967 patients between 1 March and 15 April were included. On average over the 3 previous years, a total of 1348 patients, i.e. 29.3 patients per day were counted in our emergency room. In 2020 a total of 923, i.e. 20 patients per day (p < 0.01) were counted. On average 227 (24.6%) were admitted to hospital compared to 311.5 (23.1%) in 2020. On average 143 operations were performed compared to 136 in 2020. The days on the ward were reduced from 2442 on average for the previous years, in 2020 to 1172 days by 52.1% (p < 0.01). The number of days on the ICU was 450 days on average in previous years and 303 days in 2020 (-32.7%, p < 0.01). CONCLUSION: The number of patients in the emergency admission was significantly reduced in the observation period in 2020 compared to the mean of the previous 3 years. This directly made resources available for the care of COVID-19 patients.

Impact of pooling on accuracy of hepatitis B virus surface antigen screening of blood donations.

Expenditure on screening blood donations in developing countries can be reduced by testing donations in pools. This study evaluated serological screening in pools for hepatitis B virus (HBV) at the Israeli national blood bank and a hospital blood bank in Gaza, the Palestinian Authority. The accuracy of HBV surface antigen (HBsAg) enzyme immunoassay performed on pools of 3-24 samples was compared with individual tests. Delay in detecting positive samples due to dilution in pools and the possibility of antibody-antigen neutralization were analyzed. The sensitivity of pooled testing for HBsAg was 93-99%, prolonging the window period by 5 days (8.3%). Neutralization of HBsAg by hepatitis B surface antibodies (anti-HBs) could be minimized by testing immediately after pooling. Serological testing for HBsAg in pools may be performed using manually created pools of up to six samples, with 5% loss in sensitivity and a risk of neutralization by anti-HBs present in the donor population. Pooling can therefore be considered as an option only in countries with a low prevalence of HBV.

Estimation of delay in detecting hepatitis C virus antibodies in pools compared to individual testing on seroconversion panels.

Testing for anti-hepatitis C virus (HCV) antibodies in pools may reduce blood screening costs, making this approach affordable for developing countries, provided that the dilution of infected blood does not significantly increase the number of undetectable viral particles, especially in seroconverters. This study assessed the delay in detection of HCV antibodies in five HCV seroconversion panels, tested in pools of 6-48 samples, and estimated the risk of transfusion-transmitted HCV caused by pooling. The delay in detection of positive samples was 5-12 days for pools of all sizes, adding 7% to the risk of HCV transmission that occurs when blood donors' samples are tested individually.

Hepatitis C virus infection in renal failure patients in the absence of anti-hepatitis C virus antibodies.

The magnitude and clinical significance of Hepatitis C virus (HCV) infection in dialysis patients is controversial and underestimated. This study was conducted in order to evaluate the correlation between HCV replication and antibody response to HCV in dialysis patients. HCV infection in dialysis patients was evaluated over a period of 3 years and compared to HCV infection in Liver Clinic patients. Sera were collected from 310 dialysis patients and tested for anti-HCV and HCV-RNA. In addition, HCV genotype and HCV viral load were determined in HCV-RNA-positive sera. Anti-HCV was detected in 43 (14%) of the dialysis patients. Of these, 37 (86%) were HCV-RNA-positive. Among the 267 HCV-seronegative dialysis patients, 25 (9%) were found to be HCV-RNA-positive in more than one sample during the study. These patients were characterized by low viral load; at least two orders of magnitude lower than in the group of HCV-seropositives. In contrast, in the Liver Clinic patients, HCV-RNA was found exclusively in HCV-seropositive patients. Comparison of the genotype pattern in the two groups did not reveal a difference. Our results suggest that HCV infection in dialysis units may be underestimated due to cases of low viral load, depending on the method of RNA extraction and sensitivity of the test used. Low viral load might contribute to the lack of humoral immune response seen in some dialysis patients.

Prevalence of specific IgA and IgM anti-HBc antibodies compared with HBV DNA in the sera of HBsAg chronic carriers.

OBJECTIVE: We evaluated the significance of IgA antibodies directed against the hepatitis B virus core antigen (IgA anti-HBc) as a marker for viral replication. STUDY DESIGN/METHODS: Serum samples of 143 hepatitis B surface antigen (HBsAg) carriers and 189 HBsAg-negative subjects were studied. Hepatitis B virus (HBV) DNA was detected by polymerase chain reaction. IgA anti-HBc was determined by a capture enzyme-linked immunosorbent assay developed in our laboratory. The results were compared with those for IgM anti-HBc, which were determined by a commercially available method. RESULTS: IgA anti-HBc was detected in 57 (40%) and HBV DNA in 38 (27%) of the HBsAg carriers. Among the HBsAg-negative subjects, IgA anti-HBc and HBV DNA were detected simultaneously in four samples. All 42 HBV DNA-positive samples were IgA anti-HBc positive. IgM anti-HBc was detected in 27 (64%) of them. CONCLUSIONS: IgA anti-HBc is a sensitive marker for HBV replication, and its absence may exclude HBV replication. The role of IgA anti-HBc in monitoring response to therapy and predicting clinical course is being evaluated.

HBsAg confirmation: an experimental test.

BACKGROUND: The specificity of HBsAg testing is to be confirmed with antibody blocking to avoid false positive results. OBJECTIVE: To test the experimental HrAb HBsAg-blocking activity and to use this new antibody in the verification of repeatedly reactive HBsAg blood serum samples. STUDY DESIGN: HbsAg screening of three quality control panels was followed by a comparative confirmatory test with commercial HuAb and experimental HrAb. The HrAb was used in subsequent HBsAg confirmation trials. RESULTS: A good agreement in the results obtained using the two antibodies was found, independently of the type of HBsAg neutralization step performed (either preincubation or competitive inhibition). Of the 97 repeatedly reactive HBsAg blood serum samples, 79 were 'confirmed positives'. On repeated confirmations by two antibodies, 13/18 'not confirmed' converted to 'confirmed positives', while the same five samples still remained false positive. CONCLUSION: The results suggest that (1) HrAb is as good as HuAb in HBsAg confirmation and (2) HBsAg confirmatory testing is essential in the laboratory examinations of the HBsAg repeatedly reactive samples.

[Experience in verifying hepatitis E in Ukraine]. / Opyt verifikatsii gepatita E na Ukraine.

An outbreak of viral hepatitis B at a sugar refinery in the Ukraine was verified by the detection of HBs antigens and IgM antibodies to hepatitis A virus in the radioimmunoassay. Cases of hepatitis E among workers, employed mainly in heat-treatment departments, appeared due to mass contamination of water mains with sewage water from the residential zone in the presence of a few cases of the disease.

Prospects on clinical applications of electrical stimulation for nerve regeneration.

Regenerative capability is limited in higher vertebrates but present in organ systems such as skin, liver, bone, and to some extent, the nervous system. Peripheral nerves in particular have a relatively high potential for regeneration following injury. However, delay in regrowth or growth, blockage, or misdirection at the injury site, and growth to inappropriate end organs may compromise successful regeneration, leading to poor clinical results. Recent studies indicate that low-intensity electrical stimulation is equivalent to various growth factors, offering avenues to improve these outcomes. We present a review of studies using electric and electromagnetic fields that provide evidence for the enhancement of regeneration following nerve injury. Electric and electromagnetic fields (EMFs) have been used to heal fracture non-unions. This technology emerged as a consequence of basic studies [Yasuda, 1953; Fukada and Yasuda, 1957] demonstrating the piezoelectric properties of (dry) bone. The principle for using electrical stimulation for bone healing originated from the work of Bassett and Becker [1962], who described asymmetric voltage waveforms from mechanically deformed live bone. These changes were presumed to occur in bone during normal physical activity as a result of mechanical forces, and it was postulated that these forces were linked to modifications in bone structure. Endogenous currents present in normal tissue and those that occur after injury were proposed to modify bone structure [Bassett, 1989]. These investigators proposed that tissue integrity and function could be restored by applying electrical and/or mechanical energy to the area of injury. They successfully applied electrical currents to nonhealing fractures (using surgically implanted electrodes or pulsed currents using surface electrodes) to aid endogenous currents in the healing process.(ABSTRACT TRUNCATED AT 250 WORDS)

Health clinics for problem drug misusers.

This paper reports the results of an evaluation of two community based 'walk-in' health clinics for drug misusers, primarily for those injecting drugs. In 1989, these clinics were established as a means of improving the availability of health care facilities to a group of individuals known to have high morbidity. The factors leading to the establishment of this service are identified, and the first year of the service is described together with suggestions for further expansion of this service.

[Erroneous information in the epidemiological surveillance of hepatitis B]. / Ob oshibochnoi informatsii v épidemiologicheskom nadzore za gepatitom B.

False positive results obtained in the determination of the immune markers of hepatitis A by the methods of the passive reverse hemagglutination test and the enzyme immunoassay distort the course of the registration of the epidemic process and deteriorate the quality of the antiepidemic measures ensured to the population. The necessity of the standardization of available test systems is postulated.

[An information subsystem for the epidemiological surveillance of hepatitis B]. / Informatsionnaia podsistema épidemiologicheskogo nadzora za gepatitom B.

The improvement of prophylaxis and the decrease of morbidity rate in hepatitis B are possible on the basis of the introduction of the information subsystem of epidemiological surveillance into practical health service, including health service in rural areas. The necessity of ensuring the specificity of highly sensitive immunodiagnostic techniques by using the combination of these techniques and competitive radioimmunoassay, as well as increasing their availability by the cooperation of laboratories at the district and regional levels, is emphasized.

[The importance of clinical laboratory data in the differential diagnosis of group hepatitis B diseases]. / Znachenie kliniko-laboratornykh dannykh v differentsial'noi diagnostike gruppovykh zabolevanii gepatitom B.

Group disease with hepatitis B (or A against the background of chronic HBsAg carrier state) may be diagnosed (or excluded) on the basis of high (or low) detectability of HBsAg in patients with jaundice. Perfection of epidemiological diagnosis is possible with implementation of indication of not less than three immunological markers: HBsAg, IgM anti-Hbs, IgM anti-HAV.

A multivariate approach to the treatment of peripheral nerve transection injury: the role of electromagnetic field therapy.

A multivariate approach to the treatment of peripheral nerve transection injury has been used in a rat model. A pilot study (48 animals, 8 groups) examined variables associated with the method and timing of surgical repair, the arrest of wallerian degeneration, and the role of pulsing electromagnetic field therapy (PEMF) in functional recovery. A second phase (90 animals, 6 groups) then studied the timing and duration of pulsing electromagnetic field therapy as the only variable in larger groups of animals. The pilot study revealed that a vein-graft conduit did not improve functional recovery compared with standard epineurial repair. Additionally, delayed repair compared favorably with immediate repair. The use of chlorpromazine to inhibit the toxic effects of calcium influx appeared to enhance early functional recovery, and the combination of delayed nerve repair and pulsing electromagnetic field therapy seemed to consistently improve function. The second phase of the study has demonstrated (for the first time) statistical improvement in ambulation in animals treated with delayed surgical repair and prolonged pulsing electromagnetic field therapy. We postulate that future treatment of nerve transection injuries will involve a combined treatment regimen consisting of the immediate arrest of wallerian degeneration, delayed surgery, and pulsing electromagnetic field therapy.

[Screening by the method of radioimmunologic analysis]. / Skrining metodom radioimmunologicheskogo analiza.

To simplify the technique of radioimmunoassay, rubber holders were used that held the test tubes when the solid phase was washed with flow water. Instead of hermetically sealing the test tubes during incubation of the test samples and labeled antiserum, the authors have placed the samples in a polyethylene bath with wet cloth.

[A comparison of the radioimmunologic and immunoenzyme methods of detecting HBsAg]. / Sravnenie radioimunologicheskogo i immunofermentnogo metodov vyiavleniia HBsAg.

The frequency of HBsAg detection by these two methods is similar, but only half of positive results is confirmed by both methods. This discrepancy appears to be explained by inadequate technology of the reagent preparation or by impossibility to rule out false-positive results. Combinations of highly sensitive methods for HBsAg indication are recommended for clinical diagnosis of hepatitis B.