The clinical outcome of total knee arthroplasty is compromised by a previously implanted medial unicondylar knee arthroplasty.

OBJECTIVE: To investigate the clinical outcome of patients that underwent conversion of a medial unicondylar knee arthroplasty (UKA) to a total knee arthroplasty (TKA) and to compare that outcome to patients that underwent primary TKA. It was hypothesized that those groups would significantly differ in terms of knee score outcome and implant survival. METHODS: A retrospective-comparative study was conducted utilizing data from the Federal state's arthroplasty registry. Included were patients from our department that undergone a conversion of a medial UKA to a TKA (UKA-TKA group). The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) from preoperative and 1-year postoperative was used. Moreover, the implant survival was analyzed. RESULTS: In the UKA-TKA group, there were 51 cases (age 67 ± 10, 74% women), and in the TKA group, there were 2247 cases (age 69 ± 9, 66% women). The one-year postoperative WOMAC total score was 33 in the UKA-TKA group und 21 in the TKA group (p < 0.001). Similarly, the WOMAC pain, WOMAC stiffness, and WOMAC function scores were significantly worse in the UKA-TKA. After 5 years, the survival rates were 82% and 95% (p = 0.001). The 10-years prosthesis survival was 74% and 91% in the UKA-TKA and TKA groups, respectively (p < 0.001). CONCLUSIONS: Based on our findings it is concluded that patients who received a TKA after UKA have inferior results than those that directly receive a TKA. This is true for both patient-reported knee outcome and prosthesis survival. Converting UKA to TKA should not be seen as an easy operation, but should rather be done by surgeons with considerable experience in both primary and revision knee arthroplasty.

Atom probe study of B2 order and A2 disorder of the FeCo matrix in an Fe-Co-Mo-alloy.

The physical and mechanical properties of intermetallic alloys can be tailored by controlling the degree of order of the solid solution by means of heat treatments. FeCo alloys with an appropriate composition exhibit an A2-disorder↔B2-order transition during continuous cooling from the disordered bcc region. The study of atomic order in intermetallic alloys by diffraction and its influence on the material properties is well established, however, investigating magnetic FeCo-based alloys by conventional methods such as X-ray diffraction is quite challenging. Thus, the imaging of ordered FeCo-nanostructures needs to be done with high resolution techniques. Transmission electron microscopy investigations of ordered FeCo domains are difficult, due to the chemical and physical similarity of Fe and Co atoms and the ferromagnetism of the samples. In this work it will be demonstrated, that the local atomic arrangement of ordered and disordered regions in an industrial Fe-Co-Mo alloy can be successfully imaged by atom probe measurements supported by field ion microscopy and transmission Kikuchi diffraction. Furthermore, a thorough atom probe parameter study will be presented and field evaporation artefacts as a function of crystallographic orientation in Fe-Co-samples will be discussed.

Foetal Gender and Obstetric Outcome.

Introduction: Data on specific characteristics based on the gender of the unborn baby and their significance for obstetrics are limited. The aim of this study is to analyse selected parameters of obstetric relevance in the phases pregnancy, birth and postpartum period in dependence on the gender of the foetus. Materials and Methods: The selected study method comprised a retrospective data acquisition and evaluation from the Austrian birth register of the Department of Clinical Epidemiology of Tyrolean State Hospitals. For the analysis all inpatient singleton deliveries in Austria during the period from 2008 to 2013 were taken into account (live and stillbirths n = 444 685). The gender of the baby was correlated with previously defined, obstetrically relevant parameters. Results: In proportions, significantly more premature births and sub partu medical interventions (vaginal and abdominal surgical deliveries. episiotomies) were observed for male foetuses (p < 0.001). The neonatal outcome (5-min Apgar score, umbilical pH value less than 7.1, transfer to a neonatal special unit) is significantly poorer for boys (p < 0.001). Discussion: In view of the vulnerability of male foetuses and infants, further research is needed in order to be able to react appropriately to the differing gender-specific requirements in obstetrics.

Atom probe study of vanadium interphase precipitates and randomly distributed vanadium precipitates in ferrite.

Atom probe tomography and transmission electron microscopy were used to examine the precipitation reaction in the austenite and ferrite phases in vanadium micro-alloyed steel after a thermo-mechanical process. It was observed that only in the ferrite phase precipitates could be found, whereupon two different types were detected. Thus, the aim was to reveal the difference between these two types. The first type was randomly distributed precipitates from V supersaturated ferrite and the second type V interphase precipitates. Not only the arrangement of the particles was different also the chemical composition. The randomly distributed precipitates consisted of V, C and N in contrast to that the interphase precipitates showed a composition of V, C and Mn. Furthermore the randomly distributed precipitates had maximum size of 20 nm and the interphase precipitates a maximum size of 15 nm. It was assumed that the reason for these differences is caused by the site in which they were formed. The randomly distributed precipitates were formed in a matrix consisting mainly of 0.05 at% C, 0.68 at% Si, 0.03 at% N, 0.145 at% V and 1.51 at% Mn. The interphase precipitates were formed in a region with a much higher C, Mn and V content.

[Perinatal mortality by mother's country of origin in Tyrol 2000-2008]. / Perinatale Mortalität nach Herkunftsland der Mutter in Tirol 2000-2008.

INTRODUCTION: This study analyses for the first time the Tyrolean perinatal mortality stratified by the country of origin of the mother. Data of the Tyrolean birth registry were evaluated from 2000-2008. The aim of our study was to analyse differences in perinatal mortality according to the country of origin of the mother. METHODS: 58 787 single births were assessed between the years 2000-2008. Mothers with similar experiences of how to access the health-care system were aggregated into 5 groups: (1) "Tyrol/Austria", (2) "western Europe/West", (3) "former Yugoslavia/eastern Europe", (4) "Turkey" and (5) "other countries". The odds ratio for perinatal mortality according to the country of origin of the mother was calculated in a multivariate model. The following independent variables were included: age of mother at birth, parity, housewife during pregnancy, week of gestation at the first check-up visit, smoking, preterm delivery and weight of the newborn. RESULTS: The number of mothers of Tyrolean/Austrian origin decreased over the years by 2% whereas the number of mothers from Western Europe/West increased by 3%. The other migration groups remained constant or were slightly decreased. In the multivariate model; the perinatal mortality [odds ratio (CI)] was for the subgroups "Turkey" 1.06 (0.61-1.83) and for "western Europe/West" 1.09 (0.64-1.86), and therefore almost identical with the reference subgroup "Tyrol/Austria" (OR=1); the perinatal mortality was significantly increased with 2.14 (1.37-3.34) for the subgroup "former Yugoslavia/eastern Europe and for the subgroup "other countries" 2.54 (1.21-5.36). The variables "age under 18 years" OR 1.99 (0.80-4.93) and "mulitpara" OR 1.30 (0.96-1.74) were not significantly increased. Significantly increased was "preterm delivery" OR 4.53 (2.80-7.33) and "low birthweight" (<1 500 g) OR 53.60 (32.02-89.73) and 1 500 to 2 499 g OR 4.85 (2.96-7.96). There are considerable differences comparing the odds ratios between the 5 subgroups for perinatal mortality. The subgroups "Turkey" and "western Europe/West" have a similar odds ratio compared to the reference group "Tyrol/Austria". The subgroups "former Yugoslavia" and "other countries" have a significantly increased perinatal mortality (OR 2-2.5). CONCLUSION: The good outcome of the mothers from "Turkey" can be seen as similar to the "Latina paradoxon", which means a better outcome of pregnancy and birth of mothers from "Turkey", even though they are more comparable with other migrant groups in some risk factors, such as a lower socioeconomic standard, late check-ups, language difficulties and cultural factors. A single case analysis would be necessary to examine the exact causes.

Critical consideration of precipitate analysis of Fe-1 at.% Cu using atom probe and small-angle neutron scattering.

An Fe-1 at.% Cu model alloy was examined by atom probe (3DAP) and small-angle neutron scattering (SANS) to verify the accordance of the gained results. The Fe-Cu alloy was heat-treated for various times at 500°C, forming Cu-rich precipitates within the Fe matrix. The chemical compositions of the precipitates and matrix found by 3DAP were used to calculate the magnetic scattering contrast. Additionally, a magnetic moment of the precipitates that contain a significant amount of Fe was taken into account for the calculation of magnetic scattering contrast. This in turn is used for the evaluation of the magnetic scattering curves gained by SANS. Both the 3DAP data as well as the scattering curves were analyzed with regard to radius, number density, and volume fraction of the precipitates as a function of aging time. The results yielded by both techniques are in good agreement and correspond to the development of the hardness of the alloy. Minor differences can be related to the cluster search algorithm used for the analysis of the 3DAP data as well as Fe overestimation based on different field phases.

The morphology of secondary-hardening carbides in a martensitic steel at the peak hardness by 3DFIM.

The morphology and composition of secondary-hardening M(2)C carbides in a complex steel under non-isothermal tempering condition has been investigated with three-dimensional field ion microscopy and atom-probe tomography. The technical set-up and the condition of investigations have been developed. We will reveal for the first time, a virtually non-biased image of the so-called secondary-hardening microstructure, consisting in a very fine dispersion of nanometer-sized needles, idiomorphs and blocky carbides. Needles precipitate with a large number density at the maximum hardness peak. We have found out that this mixture of shape could be explained by the onset of coarsening, but the role of local factors have been evidenced: variation of composition among the carbides and even local strain effects due to the precipitation of a second phase can play a role in changing the growth conditions.

Precipitation evolution in a Ti-free and Ti-containing stainless maraging steel.

Stainless maraging steels have a Cr content higher than 12wt% and show a excellent combination of high strength and ductility, which make them attractive for use in machinery fields and aircraft applications. The massive increase of strength during ageing treatment of maraging steels is related to a precipitation sequence of various nm-scaled intermetallic phases. The peak hardness especially in Ti-containing maraging steels can be reached after short-time ageing at temperatures around 500 degrees C. However, precipitation reactions in different stainless maraging steels are not fully understood, especially the evolution from clustering over growing to coarsening. In the present work a commercial maraging steel and a Ti-containing model alloy are investigated and compared to each other. The steels were isothermally heat treated at 525 degrees C for a range of times. Special emphasis was laid on the correlation of hardness to the formation and presence of different kinds of precipitates. The isothermal aged samples were investigated by using two advanced three-dimensional energy compensated atom probes (LEAP and 3DAP) both in voltage mode and in laser mode. The atom probe data were correlated to standard hardness measurements. The results show that the partial substitution of Al by Ti results in a different precipitation behaviour. While the Ti-free maraging steel exhibit only one type of precipitate, the Ti-containing grade shows a change in the type of precipitates during ageing. However, this change leads to an accelerated coarsening and thus to a faster drop in hardness.

[Consensus double reading of mammograms in private practice]. / Konsensuelles Zweitbefunden von Mammographien in der Praxis.

PURPOSE: To evaluate retrospectively the results of consensus double reading of mammograms in a private practice for a period of 1.5 years (November 2001 to March 2003). MATERIALS AND METHOD: Two independent experts with dedicated training read all mammograms on a weekly basis. All mammograms including sonographic examinations were evaluated independently and categorized using the BI-RADS classification. The achieved consensus included a possible recommendation for recall or therapy. A total of 3936 mammograms and 1912 sonography studies were evaluated. All cases with BI-RADS 4 and 5 categories were compared with the histologic results. For a period of three months, the acceptance of double reading including a delay of the final report by one week was tested with a questionnaire and informed consent sheet. RESULTS: BI-RADS categories 4 and 5 were found in 57 cases, with 41 consensus results by two independent readers and 26 carcinomas verified by histology. No consensus could be reached in 16 patients, of which 10 had a final histologic result, with 5 benign lesions and 5 carcinomas of less than 1 cm in diameter. Clinical symptoms or alterations were absent in all patients. The 5 carcinomas were discovered by the double reading procedure. The result of the questionnaire (695 questionnaires) showed a refusal rate of 0.7 %, with only 5 women refusing the opportunity of double reading their mammograms. CONCLUSION: Double reading of mammograms by independent experts is feasible, shows a measurable increase in quality and is accepted by almost all women.

SAP and partners: IS-H and IS-H* MED.

OBJECTIVES: The Styrian Hospital Organization with 21 hospitals including the Graz University Hospital, and the Heidelberg University Hospital implemented a new HIS based on SAP/R3, ISH, ISH* MED with the objective to have an integrated system to support patient administration and management, patient care, clinical documentation, research etc. METHODS: Heidelberg University Hospital chose a step by step method for the introduction of the system, beginning with patient administration (ISH) and proceeding with clinical functions (ISH* MED). In Styria, the full functionality was implemented--as part of the selection process--in one peripheral hospital and in the Ear, Nose and Throat (ENT) Department of the Graz University Hospital, including special documents to support the processes in the highly specialized ENTunits. RESULTS AND CONCLUSIONS: The standard modules are performant, stable and basically well accepted. Particularly in Graz, it has been shown that the requirements of highly specialized departments for work flow management, documentation and integration of subsystems and data from different sources can be fulfilled by special documents and programs--although at the expense of additional workload particularly in the initial phases of such a project.

HIS purchase projects in public hospitals of Styria, Austria.

The Steiermärkische Krankenanstaltenges. m.b.H (KAGes) is a company, owned by the province of Styria in Austria, which operates 21 hospitals with about 8000 beds and 14000 employees, serving a population of ca. 1.2 million people. KAGes has purchased a new hospital information system (HIS) for its hospitals. Within the strategic IT plan and the 'system structure new' (SSN) project, a methodology was developed for making an effective HIS purchase. Several steps of this project are described in the paper, request for product information, evaluation of vendor proposals, product presentations, test site evaluation, reference site visits and selection of vendor finalists. The authors present the internal project management methodology, including the structure of the project team, project information management through intranet, criteria for different steps of the evaluation and evaluation site organization. Four major HIS vendors with leading HIS products qualified for this stage of the project (evaluation site). About 60 teams with 400 members (end users and IT-experts) have assessed all the products installed, during one or more, repeated test sessions. The decision on which new HIS to purchase were based on the recommendations derived from this evaluation. After completing SSN-project with the suggestion to KAGes-top-management for negotiations with two vendor finalists, the new project named MEDOCS was started mid-1999. Two pilot installations (one general hospital and one teaching hospital department) are nowadays in the pilot implementation and subsequent roll-out (including substitution of the legacy system) is scheduled until the year 2003.

Paperless hospital: reality, dream or a nightmare?

Public Hospitals of Styria (KAGes) are implementing new hospital information system (MEDOCS--MEdical and nursing DOcumentation and Communication network of Styria) in its 21 hospitals. One of the outstanding features of this system is the coverage of virtually all communication and documentation functions related to the patient. This should be the way to fulfill the conditions for gradually removing the paper as an information medium from daily hospital practice. This approach will be tested in the MEDOCS project at two evaluation sites. In this paper the authors discuss in form of "pros and contras" the chances and risks of this approach, as well as possible strategies during the steps of implementing the "paperless" hospital. Besides of general technological, medical and cultural considerations the paper discuss also the technical and economical aspects of "paperless" hospital implementation and production.

GIS-based measures of environmental equity: exploring their sensitivity and significance.

In order to determine whether principles of environmental justice have been violated, a large number of empirical studies have been carried out to ascertain whether minority and low-income populations are disproportionately exposed to industrial pollution. This study provides a comparative evaluation of two commonly employed proximity measures in GIS-based environmental equity assessment, examining their influence on the results of the analysis, and proposes a methodology for evaluating the significance of these results. 1990 census data on population characteristics and data from the 1995 EPA's toxic release inventory (TRI) for the City of Minneapolis, MN are used. These results also allow a preliminary assessment of environmental equity/inequity in potential exposure to airborne toxic chemicals for racial minorities, poor people and children in Minneapolis. In the third part of the paper we develop and employ a geographic randomization methodology for assessing the significance of these results.

HIS purchase project: preliminary report.

The KAGes (Krankenanstaltenges.m.b.H) is a company, owned by the state of Styria in Austria, which operates 20 hospitals with about 8,000 beds and 14,000 employees, serving a population of ca. 1.2 million people. KAGes is on its way to purchase a new hospital information system (HIS) for it's hospitals. Within the strategic IT plan and the "System Structure New" (SSN) project a methodology was developed, for making an effective HIS purchase. Several steps of this project are described in the paper: request for product information, evaluation of vendor proposals, product presentations, test site evaluation, reference site visits and selection of vendor finalists. The authors present the internal project management methodology, including the structure of the project team, project information management through intranet, criteria for different steps of the evaluation and evaluation site organization. Four major HIS vendors with leading HIS products qualified for this stage of the project (evaluation site). About 60 teams with 400 members (end users and IT-experts) have assessed all the products installed, during one or more, repeated, test sessions. The decision on which new HIS to purchase will be based on the recommendations derived from this evaluation. Two pilot installations (one general hospital and one teaching hospital department) are planned for implementation in the year 1999/2000 and subsequent roll-out (including substitution of the legacy system) is scheduled until the year 2003.

[Diagnosis of acute subarachnoid hemorrhage--MRI with 0.5 Tesla with FLAIR sequence]. / Diagnostik der akuten Subarachnoidalblutung--MR bei 0,5 Tesla mit der FLAIR-Sequenz.

PURPOSE: Evaluation of MR imaging in patients with acute subarachnoid hemorrhage (SAH) at 0.5 Tesla using the FLAIR (Fluid Attenuated Inversion Recovery) sequence. Additionally, the value of MR angiography (MRA) in the diagnosis of intracranial aneurysms was assessed. MATERIALS AND METHODS: 19 patients with suspected acute SAH were included in this study. MR imaging was performed using an axial FLAIR sequence and axial T1, T2 and PD weighted sequences. In 16 patients an additional MRA (3D-TOF) was performed. 10 patients without SAH were examined as a control group. At the end of the study the 29 MR examinations were randomised and the images were read by two experienced radiologists; subsequently a consensus interpretation was made. RESULTS: In 16 patients an acute SAH was verified with the FLAIR sequence, in 13 cases the origin of hemorrhage was found during surgery. In the consensus interpretation of the MR images all cases were diagnosed properly. 12 of the 16 MRA studies were of diagnostic quality, but only 6 cases were interpreted correctly. CONCLUSION: The FLAIR sequence at 0.5 Tesla proved effective in the diagnosis of acute SAH. MRA at 0.5 Tesla failed in the detection of intracranial aneurysms.

On the relationship between measles virus and Alzheimer neurofibrillary tangles in subacute sclerosing panencephalitis.

We have studied the relationship between measles virus and the accumulation of abnormally phosphorylated tau (PHF-tau) in nine cases of subacute sclerosing panencephalitis (SSPE). By assessing the presence of viral intranuclear inclusions and neurofibrillary tangles (NFT) in each case, we found no correlation between presence and amount of measles virus and the numbers of neurons containing PHF-tau. Immunohistochemical double labeling in a case with long duration of disease and severe histopathologic change revealed no strict colocalization of measles virus antigen and PHF-tau throughout different brain regions. In areas containing both antigens, most neurons carrying measles virus did not have a tangle and vice versa, eventhough some colocalization beyond that expected by chance was observed in specific cortical areas. These results indicate that, although secondary to viral infection, NFT formation in SSPE is not restricted to cells carrying viral antigen. Conversely, measles virus infected cells do not necessarily accumulate PHF-tau. This lack of colocalization at the cellular level, throughout different brain areas and among different cases suggests that the formation of NFT in SSPE is not directly induced by the infectious agent. The formation of NFT in this disease appears to be elicited through a specific type of tissue damage and, thus, to be an epiphenomenon. This pathogenetic detail may be of interest for our understanding of the role of neurofibrillary degeneration in the pathogenesis of other more frequent neurodegenerative diseases with cytoskeletal pathology.