Advancement of physical process by mental activation: a prospective controlled study.

According to the literature, patients who are significantly impaired by physical mobility limitations can be rehabilitated if the patient's working memory is used to capacity. The conclusion that periodic mental activity improves physical rehabilitation should be evaluated. This is a prospective, controlled, and randomized open study of patients who underwent a total hip arthroplasty (THA). Sixteen patients who played the video game Dr. Kawashima's Brain Training: How Old Is Your Brain? were compared in terms of rehabilitation progress to 16 individuals who did not play. Harris Hip and Merle d'Aubigné scores were evaluated 1 d preoperation and again 12 +/- 1 d postoperation. Preoperation, no significant differences in hip scores between the gaming and control groups were found (median Harris Hip score: 39 vs 33, respectively, p = 0.304; median Merle D'Aubigné score: 12 vs 9, respectively, p = 0.254). Postoperation, there were significant differences between the gaming and control groups (median Harris Hip score: 76.0 vs 56.5, respectively, p = 0.001; median Merle D'Aubigné score: 16.0 vs 13.5, respectively, p = 0.014). Within both groups, the posttest scores significantly improved; however, the increase for the gaming group was greater for both measures. Because the influence of age, sex, and level of education can be excluded, it can be assumed that mental activities can improve physical rehabilitation after THA.

[The vacuum-assisted closure (V.A.C.) and instillation dressing: limb salvage after 3 degrees open fracture with massive bone and soft tissue defect and superinfection]. / Der Vacuum-assisted closure and instillation-" (VAC-Instill-)Verband: Extremitätenerhalt bei drittgradig offener superinfizierter Femurfraktur mit massivem Knochen- und Weichteildefekt.

We report the case of a 17-year-old boy who was hit by a high velocity train. The polytraumatized patient suffered a 3 degrees open femur defect fracture with a substantial loss of the lateral femoral muscles and significant disruption of the soft tissue of the lower leg. The enormous wound areas on the thigh and the lower leg were infected by Pseudomonas aeruginosa, Enterobacter cloacae, and Stenotrophomonas maltophilia. The enormous tissue defects and the superinfection did not leave any hope for saving the limb from amputation. After rapid aggressive debridement and pulsatile lavage, we covered the wounds as a last resort with a new technique of vacuum-assisted closure (V.A.C) and instillation (V.A.C. Instill(R)) dressings. In sequences of 1 min we instilled Lavasept, kept it for 20 min on the wound surface, and exhausted the liquid. We repeated this for 6 consecutive days and then changed the dressing. In the follow-up examinations the number of germs was significantly reduced. During follow-up care we used the V.A.C. treatment without instillation and finally we transplanted skin onto the clean wound surface and were able to save the leg of this young patient. We discharged him with a good function of his lower leg. This technique of V.A.C. Instill seems to offer great possibilities in critically infected wound situations.

[The biofeedback sole tested is a suitable device for avoiding overload under partial load]. / Kontrollierte Teilbelastung unter Verwendung einer Biofeedbackschuhsohle.

During healing of fractures and after implantation of artificial joints mobilization with partial load is a widespread and well-accepted therapeutic principle. Translating our recommendations into action, however, overtaxes many of the patients. The use of the biofeedback sole tested should guarantee avoiding overload under partial weight-bearing conditions. The distribution of the strain sensors in the biofeedback sole was primarily checked with the help of an established system controlling the distribution of strain (PAROTEC) in 17 voluntary, healthy people. Afterwards the biofeedback sole was connected to a digital recording system to analyze the number of steps overloaded in different test cycles in 50 volunteers while using crutches and performing partial load with 20 kg. The distribution of the strain sensors in the biofeedback sole is correct to control partial load under weight bearing with 20 kg. The permanent use of the biofeedback sole showed highly significant advantages in avoiding overload. The number of steps overloaded was reduced by 77%. This effect is independent from body weight or age.

[Intraabdominal abscesses. Intervention versus surgical treatment]. / Intraabdominelle Abszesse. Interventionelle versus chirurgische Therapie.

As the diagnosis of intraabdominal abscesses has been continuously facilitated by the use of ultrasound and CT-scan, interventional management by percutaneous drainage provides an excellent alternative treatment concept to conventional open surgery. With the use of special flow-suction-catheters which are placed into the abdomen under sonographic or computertomographic guidance, the success rates in the literature are ranging between 33% and 100%, depending on the initial situation, etiology and morphology of the findings. Studies performed with comparable patient collectives showed that interventional treatment methods had equal results to conventional surgery. Under favorable conditions such as in lesions situated in the periphery of the abdomen, with uncomplicated access ways through the abdominal wall and with an etiology of postoperative complications without a primary intraabdominal disease, with homogenous fluid collections in undivided or communicating spaces, the success rates can be raised to above 80%. A close cooperation between radiologists and surgeons in indication, conduct and course of treatment is indispensible for a successful application of these well tolerable interventional treatment concepts.

Culture of human peritoneum--a new method to measure the local cytokine response and the effect of immunomodulators.

The production of cytokines and chemokines, which are involved in cell activation and cell migration in native pieces of peritoneum, was measured to investigate immune regulatory reactions in the human peritoneum. The samples were obtained during abdominal surgery and cultured immediately afterwards. In order to test therapeutic options in vitro, the effect of IL-10 and IFN-gamma on the cytokine and chemokine production was also studied. The chemokine monocyte chemotactic protein-1 (MCP-1) was produced and released spontaneously. When lipopolysaccharide (LPS) was added, MCP-1 production increased. In addition, TNF-alpha production was induced by LPS. When IL-10 was added, LPS-stimulated TNF-alpha production was reduced towards baseline levels, LPS-induced MCP-1 production was reduced by 37%. IFN-gamma did not affect LPS-induced TNF-alpha and MCP-1 production, but increased baseline MCP-1 production. It can be concluded that short-time culture of native human peritoneum is a method to investigate peritoneal chemokine and cytokine production in patients undergoing abdominal surgery. Further studies are intended to detect cytokine patterns which identify patients at risk of developing peritonitis. In addition, the effects of medications may be tested in vitro in order to investigate options for preventive modulation of the peritoneal immune response in such patients.