[Cemented total hip arthroplasty in Germany - update 2010]. / Stand der zementierten Hüftendoprothetik in Deutschland 2010.

BACKGROUND: The results of a national survey from 1998 showed that only around 10 % of orthopaedic surgeons in Germany had strictly implemented modern third-generation cementing techniques in total hip arthroplasty (THA). A 2005 update showed an improvement up to 29.4 %. The study was repeated in 2010 in order to evaluate the current situation and to determine whether modern cementing techniques have become more popular. MATERIAL AND METHODS: A detailed, slightly modified questionnaire regarding cement and bone preparation, cementing techniques on acetabulum and femur, and implant types was sent to 492 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. The survey was conducted over 6 months. The response rate was 51.8 %, 255 questionnaires were available for evaluation and statistical analysis. RESULTS: Palacos R+G bone cement remained the most widely used cement (52.2 %). The mixing times given varied significantly. Vacuum mixing systems have again become more popular (85.2 %). In the femur 78.6 % of the surgeons attempted to preserve cancellous bone and 77.8 % used pulsatile (jet) lavage. Retrograde cement application via a cement gun was done in 85.8 %. Cement restrictors were used in more than 98 %. Only 72.7 % of the surgeons implemented sustained cement pressurisation and preferred a cement mantle thickness over 2 mm (55.2 %). Only 18.1 % drilled multiple small acetabular keyholes and 66.5 % used jet lavage. In 67.9 % no cement gun was used and in 70.7 % the cement was applied at high viscosity. Cement pressurisation was done manually in 89.1 %. The Müller straight stem device remained the most popular implant. Only 7.4 % of the centres implanted less than 20 and 40.3 % more than 100 cemented stems per year, whereby higher THA volumes correlated with better cementing technique. CONCLUSION: The results of this survey demonstrate that, in comparison to 2005, the current state of cemented THA, in particular cementing technique has generally significantly improved. Future emphasis should focus on continued surgeon education and training, as the cementing techniques are of utmost importance for long-term durability.

p16 expression in oropharyngeal cancer: its impact on staging and prognosis compared with the conventional clinical staging parameters.

BACKGROUND: Currently, staging of head neck squamous cell carcinoma (HNSCC) is on the basis of primary tumor extension (cT), lymph node involvement (cN) and distant metastasis (cM). The aim of cancer staging was to improve diagnosis, prognosis and to compare outcome results. A new subgroup of oropharyngeal squamous cell carcinoma (OPSCC) induced by human papillomavirus (HPV) infection is reported to show an increasing incidence. These HPV-positive OPSCC show distinct molecular differences, specific p16 overexpression and a significantly better prognosis. Therefore, the aim of this study was to evaluate the prognostic influence of p16 expression in OPSCC and compare its relevance with the established prognostic markers cT and cN classification and the clinical stages I-IV. PATIENTS AND METHODS: Immunohistochemistry for p16 was carried out on the basis of a tissue microarray including 102 OPSCC patients with corresponding retrospective clinicopathological and follow-up data. RESULTS: p16 is the strongest independent prognostic marker in OPSCC, surpassing the significance of cT and cN classification as well as the clinical stages I-IV. Prognosis of p16-positive OPSCC of an advanced stage reached or even exceeded prognosis of the next clinically smaller conventionally staged group of tumors. CONCLUSION: p16 is the most relevant prognostic marker in OPSCC and should be considered for inclusion into the official staging system of HNSCC.

[Carcinoma of the mouth and pharynx--better prognosis by an early diagnosis!]. / Mundhöhlen- und Rachenkarzinome durch frühzeitige Diagnose zu besserer Prognose.

Carcinomas of the mouth and pharynx rank sixth of all malignant tumours worldwide. They are responsible for 10% of the newly diagnosed malignant tumours. The median five year survival rate is 50%, depending on tumour localisation and size, but mainly determined by lymph node metastases. Carcinomas of the mouth and pharynx cause symptoms that resemble those of common harmless diseases of the head and neck such as pharyngitis. This can lead to misinterpretation by both, the patient and the doctor. Since the initial delay by the patient is difficult to influence it is very important that the doctor is aware of a possible malignant disease. Persistent common symptoms such as swallowing impairment or hoarseness, mucosal lesions, such as leukoplakia, a persistent cervical lymph node and unresponsiveness to initial treatment, must prompt the doctor to initialise appropriate diagnostic steps (incisional biopsy, e.g.). Only early diagnosis can help to improve the prognosis of patients with carcinomas of the mouth and pharynx.

Surgeon workload and motion efficiency with robot and human laparoscopic camera control.

BACKGROUND: Surgeons are now being assisted by robotic systems in a wide range of laparoscopic procedures. Some reports have suggested that robot-assisted camera control (RACC) may be superior to a human driver in terms of quality of view and directional precision, as well as long-term cost savings. Therefore, we setout to investigate the impact of RACC of surgeon motion efficiency. METHODS: Twenty pigs were randomized to undergo a standardized laparoscopic Nissen fundoplication with either a human or RACC system, the AESOP 2000. All procedures were performed by the same surgical fellow. Time was recorded for dissection and suture phases. Inertial motion sensors were used to monitor both the surgeon's hands and the camera. Digitized data were analyzed to produce summary measures related to overall motion. RESULTS: The operative times were slightly longer with RACC (mean 80.2 +/- 20.6 vs 73.1 +/- 15.4 min, not significant). With regard to operative times and surgeon motion measures, the only statistically significant differences were for setup and breakdown times, which contributed <15% to the total time for the procedure. CONCLUSION: In terms of impact on surgeon motion efficiency and operative time under normal surgical conditions, RACC is essentially the same as an expert human driver. However, careful planning and structuring of the surgical suite may yield some small gains in operative time.

Morphology and immunohistochemistry of spontaneous chronic corneal epithelial defects (SCCED) in dogs.

PURPOSE: To determine the morphologic features of the epithelium and extracellular matrix in spontaneous chronic corneal epithelial defects (SCCED) in dogs. METHODS: Forty-eight superficial keratectomy specimens were obtained after confirmation of the presence of a superficial corneal erosion for longer than 3 weeks with no discernible underlying cause. Histologic samples were examined by light microscopy, scanning electron microscopy, and transmission electron microscopy. Immunolocalization of laminin, collagen IV, fibronectin, and collagen VII was performed. RESULTS: Epithelial cells adjacent to the defect were poorly attached to the underlying extracellular matrix. A prominent superficial stromal hyaline acellular zone composed of collagen fibrils in the area of the erosion was present in most specimens. Samples exhibited a varying degree of fibroplasia, vascularization, and leukocytic infiltrate. Laminin, collagen IV, and collagen VII were usually either not present or were present only in discontinuous segments on the surface of the erosion. Fibronectin usually coated the surface of the erosion, either as a continuous sheet or in discontinuous segments. Transmission electron microscopy of 15 samples revealed that the basement membrane was either absent in the area of the erosion or was present only in discontinuous segments. Scanning electron microscopy of eight of nine samples confirmed the absence of continuous basement membrane. Epithelial and extracellular matrix components in the peripheral cornea appeared normal. CONCLUSIONS: Most canine patients with spontaneous chronic corneal epithelial defects do not have a normal basement membrane structure in the region of the epithelial defect and have other abnormalities in the subjacent extracellular matrix that may reflect a part of the underlying pathophysiology of chronic and recurrent erosions.

[Idiopathic eosinophilic esophagitis: case report]. / Idiopathische eosinophile Osophagitis: eine Fallbeschreibung.

Idiopathic eosinophilic oesophagitis is a rare differential diagnosis in patients with recurrent dysphagia. In the light of a case report and a literature review the patient's symptoms are compared with those discussed in the literature. The patient's main symptom was years-long recurrent dysphagia, sometimes with obstruction. An atopic disorder combined with peripheral eosinophilia or an elevated IgE level are found in most patients. The clinical findings are non-specific. Biopsies of the whole oesophageal mucosa produced the diagnostic histology and showed extensive infiltration by eosinophilic granulocytes. The symptoms respond well to steroid therapy.

Laparoscopic approach to wandering spleen: a case report and an update to the question.

Wandering spleen is seldom seen in everyday situations, and its prevalence is not well defined in the literature. Its causes are not precisely known, and there is controversy over its management. A 34-year-old woman experienced low-intensity abdominal pain associated with a palpable hypogastric mass, which was confirmed by imaging studies to be a wandering spleen. Because of ureteral compression, a surgical approach was decided upon, and videolaparoscopic splenectomy was chosen. This technique, comments about specific technical issues, and other treatment options presented in the literature are discussed. Videolaparoscopic splenectomy has excellent surgical results, both functional and aesthetic.

Clinical, biochemical and pathological predictors of poor response to intravenous cyclophosphamide in patients with proliferative lupus nephritis.

BACKGROUND: Reports in the literature on the outcome of lupus nephritis (LN) treated with intravenous (i.v.) cyclophosphamide have varied considerably. Previous studies have suggested that less than 25% of patients with LN will progress to end stage renal failure (ESRD) after 5 years. In addition it has been reported that serum creatinine and chronic histologic changes on kidney biopsy are useful markers of renal prognosis. Whether treatment with cyclophosphamide alters the predictive value of these markers in LN patients is not clear. The aim of this study was to review our experience of treating a large cohort of patients with LN treated with i.v. cyclophosphamide and to identify biochemical and histological features at the time renal biopsy which predict outcome in these patients. DESIGN: We retrospectively reviewed our experience with 43 consecutive patients who met criteria for either World Health Organization (WHO) classification III (focal proliferative) or IV (diffuse proliferative) LN and were treated with monthly i.v. cyclophosphamide. Biochemical indices of renal function and lupus disease activity were recorded. Renal biopsies, performed within two months of commencing therapy, were reviewed by two experienced pathologists and classified according to WHO classification as well as activity and chronicity index. The primary outcome variable for the analysis was the development of ESRD. RESULTS: Patients were followed for a mean of 2 years after renal biopsy. The mean dose of cyclophosphamide received by patients was 8.3 g. One patient died during follow up and 22 (51%) progressed to ESRD. A higher serum creatinine (p = 0.003) and higher score for interstitial fibrosis (p = 0.001) were associated with shorter renal survival. There was no significant association between activity index or its components or in the total chronicity score and survival free from the need for dialysis. CONCLUSION: In our experience more than half of patients treated with i.v. cyclophosphamide for LN progress to ESRD and a high serum Cr and a high degree of interstitial fibrosis on renal biopsy before treatment are associated with a worse renal prognosis.

Suprarenal aorta reconstruction using a saphenous spiral graft: case report.

We report a case of gunshot wound to the suprarenal aorta with restoration of blood flow through a saphenous spiral graft in an 18-year-old man. He was followed for a period of 27 months. The follow-up showed a progressive dilatation of the graft. This original technique for wounds of the aorta seems a reasonable alternative for trauma cases in which there is no vascular prosthetic graft.

Nutrition knowledge, attitudes, and practices of older and younger elderly in rural areas.

Using a mailed survey, we gathered data to examine selected aspects of nutrition attitudes, knowledge, and practices of two groups of randomly selected older individuals living in rural areas. In one group respondents were 75 through 85 years old, and in the other group respondents were 60 through 70 years old. A senior nutrition survey and a shelf inventory were used to obtain information from the 698 respondents. The 60- through 70-year-old group expressed significantly more (P less than .001) positive attitudes for efficacy, intention, and outcome expectation than the older group. In addition, the younger group had a higher level (P less than .01) of knowledge about fat and salt. They also tended to make more healthful food selections in 7 of 11 categories of the shelf inventory. Our study suggests that 75- through 85-year-old individuals have different nutrition attitudes, knowledge, and practices. Nutrition education should focus on positive messages that are age appropriate, practical, and achievable. Specific topics should include information about beneficial outcomes of healthful eating behaviors.

Geriatric ophthalmology.

The threat of vision loss increases with age owing to a combination of the accumulation of untreated or partially managed eye disease (for example, immune-mediated keratoconjunctivitis) as well as the late-in-life onset of certain ocular disorders such as lens subluxation/luxation syndrome and senile/age-related cataracts. In addition, the ophthalmic effects of age-related systemic diseases such as systemic hypertension can be vision threatening as well. The veterinarian must always weigh the potential ophthalmic benefits of contemporary therapy against the potential patient risk, not only when ophthalmic surgery is considered but also with the use of various drugs.

Microphthalmia, retinal dysplasia, and anterior segment dysgenesis in a litter of Doberman Pinschers.

Blindness was found in 5 of 11 7-week-old Doberman Pinscher littermates. Each eye in the affected pups had moderate to marked corneal opacification, and there was variable microphthalmia. Gross and microscopic examination of the globes revealed multiple ocular defects highlighted by anterior segment and lenticular dysgenesis, hyperplastic primary vitreous, and retinal dysplasia. The cause of the ocular malformations was undetermined.

Granuloma formation associated with subconjunctival injection of a corticosteroid in dogs.

In three dogs given a subconjunctival injection of methylprednisolone acetate for the treatment of ophthalmic disorders, a yellow mass developed at the injection site. Microscopic examination of each excised mass revealed circumscribed granulomatous inflammation surrounding a central core of amorphous foreign material.

Response of pulmonary macrophages to lead.

The intratracheal instillation of moderate doses of PbO to Long-Evans strain rats resulted in a significant increase in the number of recoverable pulmonary alveolar macrophages. The viability of recovered cells was remarkably constant throughout the experimental period of 40 days. The results obtained indicate a low order of toxicity of PbO to alveolar macrophages and show that the mucociliary escalator is a significant route of excretion of PbO from the respiratory tract. The in vitro survival of macrophages from PbO-treated rats was significantly reduced. Survival of cells from both treated and control animals was somewhat enhanced by the addition of formalinized lymphocytes to the culture medium. Morphological changes and evidence of phagocytosis are discussed.