Survey of cattle tick, Riphicephalus (Boophilus) microplus, resistance to amitraz and deltamethrin in New Caledonia.

The evolution of tick resistance to acaricides in New Caledonia was followed in two ways: through two large scale surveys in 1998 and 2014 and through the routine analysis of samples of ticks with suspected resistance. The results of the two approaches were qualitatively similar though analysis of ticks with suspected resistance gave higher frequencies of resistance, as expected of a biased sample. Resistance tests using a larval packet test have been conducted since 1993 for deltamethrin and 2003 for amitraz. Deltamethrin was used in country-wide control from 1986 to 2003 and amitraz since 1996. This study analyzed the variation of resistance parameters such as lethal concentration 50 (LC50) and the resistance factor over 21 years for deltamethrin and LC99 over 11 years for amitraz. There was an increase in deltamethrin's annual mean LC50 from 1993 to 2004 when it reached 2.9 g/l and then a progressive decrease, reaching a level consistently below 1g/l since 2007. Even though breeders stopped using deltamethrin in New Caledonia in 2003, the percentage of susceptible strains has remained below 30% since 1998. Amitraz's LC99 mean increased significantly from 0.31 g/l in 2003 to 2.96 g/l in 2014. Whereas all tested strains in 2003 were susceptible, only 40% of strains tested at the request of farmers were susceptible in 2014. The recent territory-wide survey showed that 76.7% of strains are still susceptible. This study established that resistance to amitraz has developed slowly in New Caledonia. A reversion phenomenon may have occurred concerning deltamethrin resistance, visible through the decrease of LC50 mean and the decreased proportion of very resistant strains; however the proportion of susceptible strains remains at a low level and there is anecdotal evidence that high resistance can re-emerge rapidly.

[Midterm results after treatment of injuries of the distal extensor mechanism with the MPT-fixateur. A critical analysis]. / Mittelfristige Resultate nach Anwendung des MPT-Fixateurs bei Verletzungen des distalen Kniestreckapparates. Eine kritische Analyse.

Between 1994 and 2000 at our institution 37 patients (8 women, 29 men) with fractures of the lower patellar pole and a proximal avulsion fracture of the patellar ligament underwent a primary surgical repair and patello-tibial fixateur for external protection. All patients underwent immediately after the reconstruction a functional rehabilitation program without any movement limitation and under early full weight bearing. Postoperative follow-up after an average of 58.5 months (range 14 to 102 months) was possible in 26 patients. Physical examination, roentgenographic evaluation and isokinetic testing were performed. The clinical evaluation was carried out according to the strict criteria of the IKDC-score. The radiological measurement of the patella height was carried out using the index of Blackburne & Peel; the femoropatellar changings were registered according to the score of Sperner. The clinical evaluation showed in 8 patients a normal, in 10 patients a nearly normal, in 7 patients an abnormal and only in 1 patient a severe abnormal result. The average muscle strength deficit in comparison to the contralateral knee joint was between 10 % and 20 %. All patients showed clinically and radiologically a sufficient distal knee extensor mechanism. The patella height ratio was in the average 0.82 on the injured and 0.79 on the non-injured side. In 17 cases we didn't saw any femoropatellar arthrosis. Eight patients showed a moderate femoropatellar arthrosis. There was no case with severe femoropatellar arthrosis. By good follow-up results in general we could demonstrate the value of the MPT-fixateur as a dynamic protection method after reconstructive operations of the distal knee extensor mechanism.

Posterior atlanto-occipital dislocation and concomitant discoligamentous C3-C4 instability with survival.

STUDY DESIGN: A case report is presented. OBJECTIVES: To describe the diagnostic procedure, treatment, and outcome of a 56-year-old man with posterior atlanto-occipital dislocation and concomitant discoligamentous C3-C4 instability. CASE REPORT: A 56-year-old male seat-belted driver of a car was involved in an accident. After initial spontaneous breathing and weak movements of all his extremities, artificial respiration became necessary because of increasing respiratory insufficiency. Radiologic diagnostics, including computed tomography scans, showed a posterior atlanto-occipital dislocation and a Grade 2 craniocerebral trauma with occipital subarachnoidal bleeding. Further examination showed a serial rib fracture with concomitant hemopneumothorax. After stabilization of the patient, magnetic resonance imaging of the cervical spine showed a contusion of the upper cervical spinal cord. Additionally, rupture of the interspinal ligaments and the posterior longitudinal ligament could be seen, as well as a rupture of the intervertebral C3-C4 disc. Operative stabilization was performed by posterior fusion of C0-C4 using the CerviFix-System and autogenous bone grafts taken from the iliac crest. At 12 months after the operation, the patient had only slight weakness of the left arm and a 70% limitation in the range of motion of the cervical spine. CONCLUSIONS: With improvements in advanced trauma life support, the number of patients with atlanto-occipital dislocation admitted to hospital alive is increasing, so this particular lesion must be kept in mind. When the patient survives the accident, the long-term prognosis is quite good, with a high rate of recovery after initial neurologic deficits.

[Arthroscopic and clinical evaluation after isolated, augmented anterior cruciate ligament replacement. A prospective study]. / Arthroskopische und klinische Evaluierung nach isoliertem, augmentiertem VKB-Ersatz. Eine prospektive Studie.

80 patients were examined in to perform a prospective essay on the isolated substitute of the anterior crucial ligament being done by Miniarthrotomie and two channel technique. All patients received a substitute of the anterior cruciate ligament by using an autogenous, TETRA-L3 augmentated bone tendon bone graft from the middle third of the patellar ligament of the injured knee. Clinical and arthroscopical examination was carried out in the average 28 months (24-36) after crucial ligament reconstruction, by the routinely removal of the augmentation and fixation material. Clinical examination was carried out using the strict and objective IKDC-Score. The arthroscopical evaluation of the ACL-graft was performed with our recently developed Score for ACL-graft evaluation (Marburger Arthroscopy Score for graft evaluation). The Score distinguishes between four stages: type I: tight, crucial ligament like structured graft, type II: a firm, more bundle like structured graft, type III: a lax, untidy structured graft and type IV: the rudimentary graft. A statistical analysis was performed on the question whether there is a correlation between the clinical and the arthroscopical results. Furthermore, with the Marbuger Arthroscopy Score for graft Evaluation we introduced a standardised, simple-to-use new score for the arthroscopical ACL-graft evaluation. We find a high correlation (r = 0.77) between the clinical results and the arthroscopical findings, so that from clinical evaluation there might be draw conclusion to the arthroscopical expective results with high probability. Due to our previous experience we assume the Marburger Arthroscopy Score For Graft Evaluation to be a standardised and simple assessment method for the evaluation of the ACL-graft, considering pathobiomechanical influences on the ACL-substitute.

External patellotibial transfixation: indications, operative technique and outcome.

Patellotibial transfixation with the MPT fixator is a new method of external stabilisation for lesions of the extensor mechanism of the knee joint. The biomechanical principle is the external transmission of tensile forces in the quadriceps muscle from the patella to the lower thigh and the translation of these forces into extension of the knee joint. The construction is an external patellotibial frame. In fitting method A, a Steinmann pin with central thread is inserted transversely through the patella and proximal tibia. Connection is made via laterally positioned rods with rotatable fixator jaws. In fitting method B, a Schanz screw is inserted sagittally into the proximal tibia and connected to the tibiocentral fixator jaw. In the frame construction a threaded pin is tightened into the fixator jaw. The MPT fixator is mostly used to secure suture repairs and transosseous refixations of the patellar ligament, or to reconstruct neglected patellar tendinous or osseous lesions of the distal extensor apparatus when functionally stable results cannot be obtained by osteosynthesis. The advantages of patellotibial transfixation are that: (1) a minimum of internal allogenic material is required to reconstruct the extensor apparatus and the repair is protected against excessive strain; (2) immediate functional post-operative therapy with an unlimited range of motion and early full weight-bearing is possible. Between 1990 and 1997 the MPT fixator was here used on 74 patients, 51 of whom had an acute lesion of the extensor mechanism, 19 lesions had either been neglected or subjected to an earlier operation. Among 20 of the acutely injured knee joints there were other serious associated injuries. Fitting method A was used in 48 patients and fitting method B in 26 patients. In four patients the operation was followed by severe infection, owing to the fixator in two cases. The remaining 70 patients wore the system for an average of 7.3 weeks. Eight patients with caudal comminuted fractures who had had segmental patellectomy and transosseous refixation of the patellar tendon and 15 patients who had had transosseous suture refixation of the patellar ligament after rupture at the lower pole or suture repair after intraligamentous rupture, were followed up isokinetically and radiologically with IKDC scoring for an average of 49.3 months after the operation. The outcome was classified as normal or close to normal in 19 patients and as abnormal in four. Isokinetically only five of the 23 had a 10-20% deficiency in the strength of the extensor muscles of the operated leg in comparison to the opposite side. External patellotibial transfixation with the MPT fixator produced good operative results in re-establishing the continuity of the distal extensor apparatus of the knee joint and is an effective alternative to patellotibial cerclage with wire or synthetic ligament.

[The external patello-tibial transfixation (EPTT). Part II: Clinical application and results]. / Die externe patellotibiale Transfixation. Teil II: Klinische Anwendung und Ergebnisse.

In part I of the paper the biomechanical and technical background of the EPTT using the MPT fixator and the indications for this procedure have been described. In part II we report about the clinical application of the EPTT in 67 patients with a wide spectrum of repairs and reconstructions of the extensor mechanism. 48 patients had fresh injuries, 18 of them with severe concomitant knee lesions and 19 patients had neglected rsp. unsuccessfully operated injuries. There were 4 deep infections, two of them related to the MPT fixator. In the patients with uneventful healing the fixator remained in place for 7.3 weeks in average. The clinical, isokinetic and radiological results were reviewed in 17 patients with an average follow-up time of 37.3 months. There were 5 patients with partial patellectomy and tendon reattachment because of lower patella pole comminution and 12 patients with tendon reattachment ruptured at the inferior patella pole or suture repair in midsubstance rupture. The clinical results according to the IKDC score were rated in 3 patients as normal, in 10 patients as nearly normal and in 4 patients as abnormal. This rating was highly dependend on the subjective judgement by the patients who considered their operated knees not as normal as the contralateral knees. From our clinical experiences and results we can derive that the EPTT enables the surgical management of extensor mechanism disruptions with a minimum of internal fixation material and provides a safe protection of the repairs and reconstructions during the healing period. The EPTT allows immediate unrestricted functional rehabilitation and early walking without crutches. Thus the EPTT represents an effective alternative to the patello-tibial cerclage with a wire or synthetic ligaments.

[Surgery of stomach carcinoma--established and controversial procedures. Retrospective 1-year analysis with discussion of current aspects]. / Magencarcinomchirurgie--Bewährtes und Kontroverses. Retrospektive 10-Jahres-Analyse mit Diskussion aktueller Aspekte.

BACKGROUND: Current problems in gastric cancer surgery concern the extent of gastric resection, the need for abdominal evisceration, the degree of lymphadenectomy, and optimal preoperative tumor staging procedure. PATIENTS AND METHODS: In a restrospective analysis, data on epidemiology, extent of surgery, histopathology, postoperative complications, mortality, and survival in 284 gastric cancer patients were evaluated. RESULTS: Our results are in favor of subtotal gastrectomy performed for all T stages located in the distal or middle third, provided that a tumor-free margin of 5 cm in intestinal type and 10 cm in diffuse Lauren's type tumor can be achieved. Additional organ resections are indicated only if direct tumor invasion has occurred, and should not be part of an extended lymphadenectomy procedure. The degree of lymph node removal should be guided by the primary tumor site. Multimodal therapeutic approaches and high postoperative mortality after exploratory laparotomy justify the use of diagnostic laparoscopy in T3/4 tumors and if diagnostic scans suggest possible tumor spread. CONCLUSION: Even though surgery for gastric cancer is well standardized, a tailored surgical approach to different extent of gastric cancer appears warranted.

Gastric lipoma: A rare cause of gastrointestinal bleeding.

Full text is available as a scanned copy of the original print version.

[Diagnosis and therapy of traumatic injury of the pancreas]. / Diagnostik und Therapie der traumatischen Pankreasverletzung.

Traumatic injuries of the pancreas are with 3 to 12% of all abdominal traumas an uncommon finding. Intraabdominal combined injuries and unspecific symptoms make an early detection often difficult. In the present study we report on 25 cases (4.7%) with pancreatic trauma out of 529 abdominal injuries that were treated between 1973 and 1996. In 68% of the cases, we detected simple gland lesions with an A.A.S.T.-score I-III (American Association for the Surgery of Trauma). In 32% of the cases, we found extended ruptures of the head of the gland (score IV and V). These patients presented severe therapeutic problems. 98% of our patients had combined intraabdominal injuries. With respect to imaging techniques, CT-scan and ERCP were the most sensitive procedures. Our therapeutic management included in 14 of the cases external drainage after debridement, 6 pancreatic head--and 3 left resections. 2 patients had to undergo a duodenopancreatectomy. The morbidity in our study was 33% (8 patients), whereas septic complications were most often encountered. The clinical mortality was 24% (6 patients). Based on our results, simple drainage after selective debridement may be sufficient for simple gland contusions. For the treatment of severe damages of the pancreatic head, including lesions of the pancreatic or bile duct or duodenum, adequate resection methods are recommended. An early diagnosis is mandatory facilitated by regular employment of CT-scanning and ERCP techniques.

A striated pattern of wear in ultrahigh-molecular-weight polyethylene components of Miller-Galante total knee arthroplasty.

Wear of the polyethylene tibial components is a potential cause of failure in total knee arthroplasty. In addition to pitting, burnishing, and scratching, subtle striations on the bearing portion of the tibial surface have been observed in components retrieved relatively early after implantation. The striated pattern most typically occurred in areas centrally located within the articulating surface. The striations were anteroposterior directed and were identified as local cold flow at the surface. There was a strong correlation between the medial and lateral striated areas, suggesting that these patterns are related to cyclic rolling of the knee. The general characteristics and alignment of the striations could be attributed to the compressive and tractive forces occurring during femoral rollback. For the clinician, these results suggest that kinematics, as well as contact stress, should be considered when evaluating wear of polyethylene components.

[Breast reconstruction-plasty. A modification of the Strömbeck-Wise technique]. / Die Mammareduktionsplastik. Eine Modifikation der Strömbeck-Wise-Technik.

We report about 7 patients with an modification of Strömbeck-Wise-technique in reduction mammoplasty. The average weight of reduced breast tissue was about 650 g per side. The experience of this method shows an procedure without complications, with good plastic results and an successful intraoperative symmetry adaptation.

[Diagnostic and therapeutic strategies in local recurrence of stomach carcinoma]. / Diagnostische und therapeutische Strategien beim Lokalrezidiv des Magenkarzinoms.

Despite clear margins at the time of resection, 7 to 20% of the patients experience local recurrence of the primary stomach tumor. Intraluminal recurrence is rare but curable in 50% of the cases without distant metastases. Extraluminal recurrent gastric cancer comprises the typical pattern of recurrence and cannot be removed in most of the patients. Predisposing factors that favor the development of recurrent tumors are: higher tumor stages, extended lymph node involvement, tumor grades 3 and 4, diffuse type according to Lauren's classification, and intraoperative perforation of the primary gastric carcinoma.

Long-term in vivo alterations of polyester vascular grafts in humans.

OBJECTIVES: To examine the influence of in vivo hydrolysis on the physical properties of polyester grafts and their correlation to the period of implantation in the human body. MATERIALS AND METHODS: Sixty-five explanted vascular grafts were obtained after 0-23 years of implantation due to suture aneurysms (18), occlusion (12), graft infection (12), failure of graft material (7) and post-mortem (16). The surface was examined by scanning electron microscopy, the molecular integrity by infra-red spectroscopy and physical strength by probe puncture. RESULTS: Scission of macromolecular chains and loss of strength were shown. It was demonstrated that hydrolytic degradation of polyester takes place with increasing time of implantation in humans. Analysis by linear regression showed that polyester grafts lose 31.4% of their bursting strength in 10 years and 100% in 25-39 years after implantation. CONCLUSIONS: Regular follow-ups of patients with aged vascular grafts and the precise documentation of implanted materials are necessary to estimate graft degradation.

[Simultaneous long-term measurement of duodenogastric reflux and gastroduodenal motility]. / Simultane Langzeitmessung des duodenogastralen Refluxes und der gastroduodenalen Motilität.

We combined a newly developed ambulatory fiberoptic system for detecting intragastric bilirubin (Bilitec 2000, Synectics Medical Inc., Sweden) with prolonged measurement of gastroduodenal motility in 10 healthy volunteers and 10 patients followed BI resection. Circadian intragastric bilirubin exposure and the total number of tremendous changes of bilirubin absorption (more than 20%, over a period of at least 5 min) were significantly increased in the BI-resected patients (P < 0.05). In patients the interdigestive motility cycle (IMC) was characterized by the appearance of several types of abnormally propagated phase III activity fronts. Of the tremendous increases of bilirubin absorption in the patient group, 90.1% were associated with abnormally propagated phase III activity fronts. In cases of increased duodenogastric reflux, the combination of ambulatory intragastric bilirubin measurement and long-term manometry seems to be feasible to assess motility and reflux simultaneously.

Correlations between endotoxin, interferon-gamma, biopterin and serum phospholipase A2-activities during lethal gram negative sepsis in rats.

OBJECTIVE: To establish a standardised reproducible animal model of intraperitoneal sepsis, and to investigate early immunoserological responses to find a mediator-based system for evaluation and grading of diffuse peritonitis in patients DESIGN: Prospective experimental study SETTING: 4 Teaching hospitals, Germany and Austria MATERIAL: 42 LEW. 1W rats, 12 of which acted as controls INTERVENTIONS: Gram negative sepsis was induced by intraperitoneal injection of 6 ml of a mixture of Escherichia coli (K1:H+) 10(10) organisms/ml, autogenous haemoglobin 2.9 ml (haemoglobin concentration 3%), 0.9% sodium chloride 3 ml, and suspension 0.1 ml. Control rats were given physiological saline 6 ml alone. MAIN OUTCOME MEASURES: Concentrations of endotoxin, interferon gamma (IFN-gamma), and biopterin, and serum phospholipase A2 (PLA2) activity. RESULTS: There were significant differences between the septic and control rats in concentrations of endotoxin (EU/ml) (median (interquartile range) 21.85 (2.02-159.5) compared with 0, p < 0.0001; IFN-gamma (pg/ml) 1263.0 (271.0-7575.0) compared with 101.0 (89.0-141.0), p < 0.0001; biopterin (nmol/L) 111.0 (66.4-156.3) compared with 53.7 (38.3-67.6), p < 0.001; and PLA2 (U/L) 163.0 (125.8-209.0) compared with 112.5 (88.5-126.5) p < 0.01. CONCLUSIONS: Measurements of concentrations of endotoxin, IFN-gamma, pteridines, and PLA2 activity may well be adequate markers for early recognition of sepsis, and perhaps for grading it during the first 6 hours after induction. The allow a clear distinction to be made between septic and non-septic disorders in 87% of cases.

[External patello-tibial transfixation. I: Indications and technique]. / Die externe patellotibiale Transfixation. Teil I: Indikation und Technik.

Patello-tibial transfixation using the MPT-fixator is a new kind of external fixation. The device works biomechanically transferring the quadriceps tension forces from the patella to the lower leg and converting them into extension of the knee. The fixator can be applied in two different configurations. When performing configuration A, a Steinmann pin with a central thread is transversely placed through the patella and proximal tibia. Both pins are joined to connecting rods. Configuration B differs from type A in that a Schanz screw is inserted from anterior to posterior through the proximal tibia. The frame construction is achieved by fastening the tibial-sided Steinmann pin with a special clamp at the Schanz screw. Patello-tibial transfixation is indicated in the repair of fresh extensor mechanism disruption and reconstruction of neglected rupture of the patellar tendon. The technique provides a secure protection of the repair and reconstruction against mechanical overloading during the healing period. It enables immediate functional after-treatment and mobilization with early full weight bearing.

[The pivot-shift test in relation to hip position and lower leg rotation. A clinical analysis]. / Der Pivot-shift-Test in Abhängigkeit von Hüftstellung und Unterschenkelrotation. Eine klinische Analyse.

In a prospective clinical study conducted on 50 patients with isolated insufficiency of the anterior cruciate ligament (ACL), we investigated the triggering of pivot shift as a function of the position of the hip joint and the rotational position of lower leg; the results were compared with those yielded by the Lachman test. The pivot shift phenomenon was found to be more readily triggered when the hip was abducted, and especially when the investigator had specified external rotation of the lower leg at the same time. Our results show that this modification of the classic pivot shift test can fill a diagnostic gap in the clinical investigation. The pivot shift test with hip abduction and external rotation of the lower leg is a valuable alternative test for the diagnosis of ACL insufficiency.

[Rupture of the anterior cruciate ligament in the athlete]. / Die Ruptur des vorderen Kreuzbandes beim Sportler.

Athletic trauma is the main cause for rupture of the anterior cruciate ligament (ACL). In order to regain joint stability and return to unrestricted sports activities operative management is indicated. The patella tendon autograft with bone plugs on each end is presently the most commonly used graft to reconstruct the ACL. The concept of synthetic augmentation was developed for protection of the biological tissue during revascularization and remodeling. We use as augmentation device the TETRA-L3, which is a 3-mm-wide and 1-mm-thick Trevira braid. The function of the composite graft, which is sufficiently strong to allow early stress, is based on the principle of load-sharing. Isometric placement of the graft without impingement is achieved by using the miniarthrotomy technique and specially designed drill guides. Graft fixation is performed with ligament staples. An accelerated rehabilitation program emphasizing full extension and weight bearing follows. The total rehabilitation program we recommend--preoperative rehabilitation, a reliable surgical procedure, postoperative rehabilitation, and the patient's return to activity--is a team effort. A detailed follow-up evaluation of 41 athletes with ACL reconstruction using a central patellar BTB graft and synthetic augmentation with the TETRA-L3 showed that restoration of stability (KT 1000 testing, maximum manual excursion, < 3 mm difference) and full ROM, muscle strength and power (> 85% of the uninvolved knee) and functional capacity (Hop index > 90%) are the main prerequisites for sports activities at the desired level.

Anterior cruciate and medial collateral ligament injury. ACL reconstruction and functional treatment of the MCL.

Since August 1989 we have treated acute anteromedial instabilities with medial instability of 1+ and 2+ by augmented anterior cruciate ligament (ACL) reconstruction alone. Subsequently, functional therapy for the lesion of the medial collateral ligament (MCL) was carried out. In a follow-up examination, we evaluated Lysholm, Marshall, OAK and IKDC scores, measured stability with the KT 1000, and tested isokinetic muscle function in 28 patients. The majority demonstrated stable healing of the MCL and ACL and good or excellent knee functions and muscle strength.

Posterior cruciate ligament (PCL) reconstruction--an in vitro study of isometry. Part I. Tests using a string linkage model.

In six intact cadaver knees, we measured how the distance between six selected points in and around the femoral and tibial attachment area of the posterior cruciate ligament (PCL) changed with knee flexion. After complete removal of the PCL, 2-mm drill holes were made at the selected points. Each femoral point was measured against each tibial point using a heavy string that was passed through the drill holes. The distal end of the string was attached to a measuring unit. The changes in femorotibial distance were noted during flexion from 0 degrees to 110 degrees in 10 degree steps. The tibial drill hole locations had only a minor effect on the changes in femorotibial distance. The most isometric point was located in the centre of the posterior intercondylar area. The femoral locations of the drill holes were the primary determinant of whether the distance increased, decreased or remained nearly constant. According to our results, the most isometric femoral point is located at the posterosuperior margin of the anatomical PCL attachment. Using the tibial isometric point as a reference, the femoral points positioned anterior or posterior to the isometric point produced considerable changes in the femorotibial distance upon knee flexion. The anterior point led to an increase of about 7-8 mm at 110 degrees of flexion, the posterior point to a decrease of the same extent. Much smaller changes in femorotibial distance resulted from the points located superior or inferior to the femoral isometric point.(ABSTRACT TRUNCATED AT 250 WORDS)