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1.
Case Rep Orthop ; 2022: 7954052, 2022.
Article in English | MEDLINE | ID: mdl-35637771

ABSTRACT

Reconstruction of a large acetabular bone defect is a complex problem in revision hip arthroplasty. The authors report a novel method of reconstructing an uncontained acetabular defect (Paprosky type IIIb) using multiple tantalum augments. A 73-year-old female patient presented to our institution with a chronically dislocated primary left total hip arthroplasty with radiographs demonstrating migration of acetabular component and formation of pseudoarthrosis within the left ilium. Extensive arthrolysis and anatomic reconstruction of the acetabular bone defect were performed using the novel method of multiple tantalum augments. Postoperatively, recovery was initially complicated by multiple dislocations requiring an exchange to an elevated liner, however subsequently achieved good function.

2.
Orthopade ; 50(4): 326-332, 2021 Apr.
Article in German | MEDLINE | ID: mdl-32350550

ABSTRACT

A Thymic carcinoma in adults is rare. We present the case of a 47-year-old man, who was treated conservatively for spondylolisthesis L5/S1 in our institution for several years. In the further course, the patient complained about pain exacerbation with acute lower back pain. Cross-sectional scanning showed a tumor of the lumbar vertebral body three. A biopsy of this mass revealed a metastatic thymic carcinoma of the squamous cells. After palliative therapy, the patient died 9 months after initial diagnosis.


Subject(s)
Spinal Fusion , Spondylolisthesis , Thymoma , Thymus Neoplasms , Adult , Cross-Sectional Studies , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Middle Aged , Thymoma/diagnostic imaging , Thymus Neoplasms/diagnostic imaging , Thymus Neoplasms/therapy
3.
Sci Rep ; 9(1): 18401, 2019 12 05.
Article in English | MEDLINE | ID: mdl-31804584

ABSTRACT

Heterotopic Ossification (HO) is a potential long-term complication in orthopaedic surgery. It is commonly classified according to the Brooker classification, which is based on radiological findings. To our knowledge the correlation of histological features to the Brooker grade is unknown as is the association between HO and the indication for revision. The aim of this paper is to analyze the ossification grade of HO tissue in patients undergoing revision hip and knee arthroplasty and to propose a histologically based classification system for HO. We also assess the relationship between the grade of HO and the indication for revision (septic and aseptic revision). From January to May 2019 we collected 50 human HO samples from hip and knee revision arthroplasty cases. These tissue samples were double-blinded and sent for histopathological diagnostic. Based on these results, we developed a classification system for the progression of HO. The grade of ossification was based on three characteristics: Grade of heterotopic ossification (Grade 1-3), presence of necrosis (N0 or N1) and the presence of osteomyelitis (HOES-Score Type 1 to 5). Demographic data as well as surgical details and indication for surgery was prospectively collected from clinical records. Fifty tissue samples were harvested from 44 hips and 6 knee joints. Of these 33 exhibited Grade I ossifications (66%), followed by 11 Grade II (22%) and one Grade III (2%). Necrosis was noted in two tissue samples (4%) and 2 more had osteomyelitis findings according to HOES-Score. Six samples (12%) with radiologically suggestive of HO turned out to be wear-induced synovitis, SLIM Type 1. Of these cases 16 were septic (32%) and 34 aseptic (68%) revisions. Most of the HO tissue samples were classified as a low-grade. High-grade ossification-Score is rare. Higher grades of ossification seem to be associated with septic revision cases. Wear-induced synovitis potentially influences HO development. A histological scoring system for ossification grading can be derived from the data presented in this study.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Necrosis/pathology , Ossification, Heterotopic/pathology , Osteomyelitis/pathology , Synovitis/pathology , Aged , Aged, 80 and over , Disease Progression , Female , Hip Joint/diagnostic imaging , Hip Joint/pathology , Hip Joint/surgery , Humans , Knee Joint/diagnostic imaging , Knee Joint/pathology , Knee Joint/surgery , Male , Middle Aged , Necrosis/diagnostic imaging , Necrosis/etiology , Necrosis/surgery , Ossification, Heterotopic/diagnostic imaging , Ossification, Heterotopic/surgery , Osteomyelitis/diagnostic imaging , Osteomyelitis/etiology , Osteomyelitis/surgery , Prospective Studies , Radiography , Severity of Illness Index , Synovitis/diagnostic imaging , Synovitis/etiology , Synovitis/surgery
4.
Eur Psychiatry ; 56: 14-34, 2019 02.
Article in English | MEDLINE | ID: mdl-30453134

ABSTRACT

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.


Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Consensus , Practice Guidelines as Topic/standards , Adult , Attention Deficit Disorder with Hyperactivity/therapy , Central Nervous System Stimulants/therapeutic use , Europe , Female , Health Services Accessibility/standards , Humans , Male , Prevalence , Psychotherapy/methods
5.
Spinal Cord ; 55(1): 71-73, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27349610

ABSTRACT

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To analyze the role of sonography in detecting heterotopic ossification (HO) following spinal cord injury (SCI). SETTING: Department of Spinal Cord Injury and Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Germany. METHODS: Between January 2003 and December 2013, 217 patients with HO of the hips met the inclusion criteria and were included in the final analyses. The diagnosis of HO was carried out in all cases using our hospital protocol. Primary outcome measure was to calculate the sensitivity of ultrasound screening examination in detecting HO following SCI. RESULTS: The diagnosis of HO was confirmed in 217 patients after a mean interval of 64.8 days (range from 8 to 295; s.d.=40.4) via computerized tomography or magnetic resonance imaging scan. In 193 out of 217 patients, suspicious HO signs were noted in the ultrasound screening examination (sensitivity=88.9%). CONCLUSIONS: The use of ultrasound for screening for HO in SCI patients is reliable and has a high sensitivity.


Subject(s)
Hip/diagnostic imaging , Ossification, Heterotopic/diagnostic imaging , Ossification, Heterotopic/etiology , Spinal Cord Injuries/complications , Spinal Cord Injuries/diagnostic imaging , Ultrasonography , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Time Factors , Tomography, X-Ray Computed , Young Adult
6.
Spinal Cord ; 55(2): 213-215, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27752058

ABSTRACT

STUDY DESIGN: Retrospective chart review. OBJECTIVES: The present study was performed to analyze the impact of ankylosing spondylitis (AS) in developing heterotopic ossification (HO) in patients following spinal cord injury. SETTING: Department of Spinal Cord Injury and Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Germany. MATERIALS AND METHODS: Between January 2003 and December 2015, 67 patients with AS and SCI were included in the study. The control group consisted of 141 patients with SCI and without AS. The definitive diagnosis of HO was made via magnetic resonance imaging or computed tomography. Primary outcome measure was to analyze the impact of AS on the development of HO. RESULTS: Fifteen out of 67 AS patients (22.4%) had a diagnosed HO. In the control group, 28 of 141 patients (19.9%) suffered from HO. Patients with AS had no significant higher risk for HO development compared with patients without AS (RR=1.16; 95% CI=0.65-2.09). However, patients with a complete neurological deficit had a twofold higher risk for HO development (RR=2.55; 95% CI=1.26-5.16). CONCLUSIONS: AS does not increase the risk for HO development in patients with spinal cord injury.


Subject(s)
Ossification, Heterotopic/diagnosis , Ossification, Heterotopic/epidemiology , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/epidemiology , Spondylitis, Ankylosing/diagnosis , Spondylitis, Ankylosing/epidemiology , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors
7.
J Eur Acad Dermatol Venereol ; 26(4): 503-7, 2012 Apr.
Article in English | MEDLINE | ID: mdl-21569118

ABSTRACT

BACKGROUND: Although diphenylcyclopropenone (DCP) is frequently used for the treatment of alopecia areata (AA), large studies with more than 100 patients are still scarce. OBJECTIVE: To determine the efficacy of DCP immunotherapy in a large cohort of patients with AA who had been treated in our institute from January 2000 to December 2006. METHODS: A total of 142 patients with AA undergoing topical DCP therapy in a self-controlled design were evaluated retrospectively. RESULTS: Seven patients (4.9%) were anergic to DCP. Two of 135 patients (1.5%) discontinued DCP therapy because of adverse effects. Fifty-one patients (37.8%) had a complete response (CR: >90% re-growth of hair), 20 patients (14.8%) exhibited a partial response (PR: >50-90% re-growth), 26 patients (19.3%) experienced a minimal response (MR: 10-50% re-growth) and 38 patients (28.1%) had no response after DCP therapy (NR: <10% re-growth). Bivariate logistic analysis revealed that severity of hair loss at the beginning of DCP (P=0.001) is the only significant prognostic factor for therapeutic outcome. Twenty-three patients (45.1%) with CR had relapses upon discontinuation of the treatment or even during prolonged DCP therapy. CONCLUSION: Topical immunotherapy with DCP of patients with AA is rather effective and mostly well tolerated. The extent of hair loss before therapy is the main predictor for the therapeutic success of DCP. However, DCP therapy is associated with a high degree of relapse of which patients should be well informed.


Subject(s)
Alopecia Areata/drug therapy , Cyclopropanes/therapeutic use , Immunotherapy , Administration, Topical , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cyclopropanes/administration & dosage , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
9.
Neuropsychobiology ; 55(2): 81-8, 2007.
Article in English | MEDLINE | ID: mdl-17570951

ABSTRACT

Atypical antipsychotics like olanzapine are more efficacious in treating negative symptoms and have less side effects. Nevertheless, important adverse effects of olanzapine are, for example, weight gain and hyperglycemia. Perazine in combination with carbamazepine has shown satisfying results in several single-schizophrenia patients, leading to the hypothesis of being equal or even superior to atypical antipsychotic monotherapy. The aim of the present study was to survey the hypothesis that perazine in combination with carbamazepine have an outcome and risk of side effects comparable to olanzapine. Eleven patients with DSM-IV schizophrenia received 14.0 +/- 5.0 mg/day olanzapine and 12 patients received 360.0 +/- 196.0 mg/day perazine in combination with 404.0 +/- 229.0 mg/day carbamazepine. Symptoms and neuropsychological state were assessed 3 times (days 0, 7, 21) using the Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale. The neuropsychological state was assessed by the following neuropsychological tests: Benton, d2, ZVT, VLMT and MWT-B. Data were analyzed of variance for multiple dependent variables and repeated-measures multivariate analysis of variance. Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores showed superior improvement in the group receiving olanzapine. Olanzapine offers a more favorable response in positive symptoms than does perazine in combination with carbamazepine. The effect on negative symptoms is favorable in both forms of therapy and no significant differences between the groups could be determined. In both groups, treatment was associated with improved performance in cognitive tests; however, no differences were determined in the effects of the drugs. Results suggest that olanzapine offers a better response in positive symptoms than perazine in combination with carbamazepine.


Subject(s)
Anticonvulsants/therapeutic use , Antipsychotic Agents/therapeutic use , Carbamazepine/therapeutic use , Perazine/therapeutic use , Schizophrenia/drug therapy , Adolescent , Adult , Benzodiazepines/therapeutic use , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Multivariate Analysis , Neuropsychological Tests , Olanzapine , Psychiatric Status Rating Scales , Treatment Outcome
10.
Emerg Med J ; 23(6): 428-30, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16714499

ABSTRACT

BACKGROUND: Alcoholism represents a huge socioeconomic burden in most developed societies. METHODS: In order to determine the impact of conditions associated with alcohol abuse on emergency care, in 2002 all patients with alcohol related pathology presenting to the emergency department (ED) of a large urban university hospital in Germany were assessed. RESULTS: Of 2194 patients seen by psychiatrists in the ED, the 613 cases associated with alcohol abuse represented the largest diagnostic group (30.7%). Within this group, alcohol intoxication was the most frequent diagnosis (71.4%). Patients with an alcohol related condition needed treatment by different medical specialities and required diagnostic procedures significantly more often and consequently stayed significantly longer in the ED than patients with other psychiatric presentations. CONCLUSIONS: The generally underestimated problem of alcohol abuse in Germany demands an excessive amount of manpower and resources in EDs, where a high yet expensive standard of care is provided. Against this background, how far this burden can be reduced, both in EDs and in society in general, is discussed.


Subject(s)
Alcohol-Related Disorders/psychology , Emergency Service, Hospital/statistics & numerical data , Mental Disorders/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Alcohol-Related Disorders/epidemiology , Female , Germany/epidemiology , Hospitals, University , Humans , Length of Stay , Male , Mental Disorders/epidemiology , Middle Aged , Patient Admission/statistics & numerical data , Psychiatric Department, Hospital/statistics & numerical data , Sex Distribution
11.
Addict Biol ; 10(2): 157-64, 2005 Jun.
Article in English | MEDLINE | ID: mdl-16191668

ABSTRACT

Twenty-six in-patients with Diagnostic and Statistical Manual version IV (DSM-IV) criteria for opioid dependence were selected at random to receive either a combination of an 11-day low-dose buprenorphine and a 14-day carbamazepine regimen (n = 14) or a combination of an 11-day methadone and a 14-day carbamazepine regimen (n = 12) in a double-blind, randomized 14-day in-patient detoxification treatment. Patients with buprenorphine and carbamazepine showed a significantly better psychological state after the first and second weeks of treatment. Above all, the buprenorphine-treated patients demonstrated a less marked tiredness, sensitiveness and depressive state as well as a more prominent elevated mood during the detoxification process. Seven non-completers (after 7 days: four of 12 = 33.3%; after 14 days: seven of 12 = 58.3%) were treated with methadone and carbamazepine and five non-completers (after 7 days: two of 14 = 14.3%; after 14 days: five of 14 = 35.7%) received buprenorphine and carbamazepine. The difference in the overall dropout rate after day 14 was not significant. The present study supports the hypothesis that the combination of buprenorphine and carbamazepine leads to a better clinical outcome than does a combination of methadone and carbamazepine in the detoxification of opioid addicts with additional multiple drug abuse. The buprenorphine and carbamazepine-regimen provides a more effective short-term relief of affective disturbances than does methadone and carbamazepine. No severe side effects occurred during the treatment period in both groups.


Subject(s)
Buprenorphine/therapeutic use , Inactivation, Metabolic/physiology , Methadone/therapeutic use , Mood Disorders/epidemiology , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders/rehabilitation , Adult , Anticonvulsants/therapeutic use , Buprenorphine/administration & dosage , Carbamazepine/therapeutic use , Diagnostic and Statistical Manual of Mental Disorders , Double-Blind Method , Drug Administration Schedule , Drug Therapy, Combination , Female , Hospitalization , Humans , Male , Methadone/administration & dosage , Mood Disorders/diagnosis , Mood Disorders/psychology , Narcotic Antagonists/administration & dosage , Opioid-Related Disorders/diagnosis
12.
Addict Biol ; 9(1): 43-51, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15203438

ABSTRACT

Although relatively little attention has been paid to the question how acute alcohol withdrawal might affect cognitive functions, this factor remains of particular interest because it influences psychotherapeutic treatment during detoxification. The clinical outcome and neuropsychological state of 37 inpatients with alcohol withdrawal was investigated in a randomized single-blind approach. Two different medical strategies [chlormethiazole (CMZ) vs. carbamazepine (CBZ)] in the treatment of inpatients with alcohol withdrawal syndrome were compared. Among comparable groups (related to gender, age, initial alcohol level, severity of abuses, severity of initial withdrawal symptoms such as tremor, perspiration, psychomotor agitation, hallucinations, orientation, intelligence, patient demographics), CBZ is just as potent as CMZ in therapy of withdrawal symptoms (circulatory function, vegetative function, psychomotor activity). Patients in both groups showed initial impairments in some neuropsychological tests (d2, Zahlen-Verbundings test, Beck Depression Inventory, Anxiety Sensitivity Index) with significant improvement during detoxification. Additionally, CBZ-treated patients showed significantly better verbal memory performance during the first days of treatment. Without any addictive potential, CBZ therapy could be very supportive in alcohol detoxification. In addition a higher verbal memory performance state could be favourable for a psychotherapeutic approach.


Subject(s)
Anticonvulsants/therapeutic use , Carbamazepine/therapeutic use , Chlormethiazole/therapeutic use , Ethanol/adverse effects , Memory/drug effects , Neuroprotective Agents/therapeutic use , Substance Withdrawal Syndrome/drug therapy , Substance Withdrawal Syndrome/etiology , Adult , Anticonvulsants/administration & dosage , Carbamazepine/administration & dosage , Chlormethiazole/administration & dosage , Cognition/drug effects , Demography , Humans , Male , Neuroprotective Agents/administration & dosage , Neuropsychological Tests , Pilot Projects , Severity of Illness Index , Single-Blind Method , Substance Withdrawal Syndrome/diagnosis
13.
Dtsch Med Wochenschr ; 125(30): 900-2, 2000 Jul 28.
Article in German | MEDLINE | ID: mdl-10962972

ABSTRACT

HISTORY AND CLINICAL FINDINGS: A 51-year-old man without relevant previous illness developed vomiting and diarrhoea, later also tingling and hypaesthesias in the limbs, as well as optical hallucinations that had occurred after a mid-day meal and drinking red wine. Neurological examination revealed variable pupillary reactions with anisocoria that would change from one side to the other. There was no paresis, muscle reflexes were brisk, more so on the right. Babinski reflex was positive on the right, there was an unsustained clonus of the right foot and the coordination tests were normal. Distal symmetrical hypaesthesias and paraesthesias were present in all limbs. An exogenous psychosis with restlessness and optical hallucinations was observed. INVESTIGATIONS: Routine blood count revealed leukocytosis. Serum concentrations of cGt and GPT were raised. Cerebral computed tomography and cerebrospinal fluid as well as microbiological tests of the mid-day meal were normal. DIAGNOSIS, TREATMENT AND COURSE: As the cause of the symptoms was initially unclear the patient was admitted to hospital and monitored without any specific treatment. Within one night all symptoms had disappeared and he was discharged the next morning without any complaints. Later the red wine which he had drunk was examined toxicologically and found to contain the "designer drug" DOB (2,5-dimethoxy-4-bromamphetamine). CONCLUSION: Accidental poisoning with DOB is probably a rare event which can hardly be included in routine differential diagnosis. If an acute cerebral organic syndrome has been excluded, only toxicological investigation can help in establishing the diagnosis in such cases.


Subject(s)
DOM 2,5-Dimethoxy-4-Methylamphetamine/analogs & derivatives , Designer Drugs/poisoning , Hallucinogens/poisoning , Neurologic Examination , Wine/analysis , DOM 2,5-Dimethoxy-4-Methylamphetamine/poisoning , Diagnosis, Differential , Diarrhea , Humans , Hypesthesia , Male , Middle Aged , Vomiting
14.
Am J Psychiatry ; 152(1): 72-5, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7802124

ABSTRACT

OBJECTIVE: The present study sought to determine the prevalence of obsessive-compulsive disorder among patients with eating disorders. METHOD: Ninety-three women who met DSM-III-R criteria for anorexia nervosa or bulimia nervosa were investigated by using a semistructured diagnostic interview, the Yale-Brown Obsessive Compulsive Scale, and the Eating Disorder Inventory. RESULTS: Thirty-four patients (37%) met the DSM-III-R criteria for obsessive-compulsive disorder and also had a clinically significant score of 16 or higher on the Yale-Brown scale. These patients also had significantly higher, and hence pathological, mean scores on five of eight Eating Disorder Inventory scales than patients with eating disorders without concomitant obsessive-compulsive disorder. CONCLUSIONS: These results suggest that there is a high prevalence of obsessive-compulsive disorder among patients with anorexia and bulimia nervosa and that this prevalence may be correlated with the severity of the eating disorder.


Subject(s)
Anorexia Nervosa/epidemiology , Bulimia/epidemiology , Obsessive-Compulsive Disorder/epidemiology , Adolescent , Adult , Anorexia Nervosa/diagnosis , Bulimia/diagnosis , Comorbidity , Female , Humans , Obsessive-Compulsive Disorder/diagnosis , Personality Inventory , Prevalence , Psychiatric Status Rating Scales , Severity of Illness Index
15.
Psychother Psychosom Med Psychol ; 45(1): 8-15, 1995 Jan.
Article in German | MEDLINE | ID: mdl-7871127

ABSTRACT

The present study reports findings concerning the prevalence of obsessive-compulsive symptoms in eating disorders. Ninety-three women meeting DSM-III-R criteria for anorexia nervosa (AN) or bulimia nervosa (BN) were investigated using the Hamburg Obsession Compulsion Inventory HZI-K (Klepsch et al. 1993). Forty-six patients (49.5%) met the criteria for obsessive-compulsive disorder (OCD). This subgroup showed significant pathologically elevated scores on several scales of the Eating Disorder Inventory (Garner et al. 1983), and two different personality questionnaires (Freiburger Persönlichkeitsinventar, Fahrenberg et al. 1984; Giessen-Tests, Beckmann et al. 1983). The results demonstrate a high rate of OCD in AN and BN. The relationship between eating disorders and OCD and the question of clinical relevance is discussed.


Subject(s)
Anorexia Nervosa/diagnosis , Bulimia/diagnosis , Obsessive-Compulsive Disorder/diagnosis , Adolescent , Adult , Anorexia Nervosa/psychology , Bulimia/psychology , Female , Humans , Obsessive-Compulsive Disorder/psychology , Personality Assessment/statistics & numerical data , Personality Inventory/statistics & numerical data , Psychiatric Status Rating Scales/statistics & numerical data , Psychometrics , Reproducibility of Results
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