The rationale of opportunistic bilateral salpingectomies (OBS) during benign gynaecological and obstetric surgery: a consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG).

Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro's and the con's of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS.

[Spondylodiscitis : Current strategies for diagnosis and treatment]. / Spondylodiszitis : Aktuelle Strategien zur Diagnose und Therapie.

Spondylodiscitis is a severe infectious disease of the intervertebral discs and of the adjacent parts of the vertebral bodies, culminating in destruction of the mobile segment. It is accompanied by a mortality rate of approximately 15%. Severe courses of the disease can also lead to abscess formation and dispersal of sepsis. Malpositioning of the axis organ and deficits in neurological function up to paraplegia are also possible complications. Timely diagnostics and targeted therapy contribute to minimizing the risk of significant health disorders. This review article gives a summary of important algorithms in the diagnostics and treatment and discusses them against the background of currently available literature. According to the current state of knowledge the surgical treatment of spondylodiscitis provides many advantages and is therefore the method choice, even if a conservative approach can be successful in selected cases. The endpoints of treatment are cleansing of the infection with normalization of laboratory parameters of inflammation and the osseous fusion of the mobile segment.

Elective induction of labour increases caesarean section rate in low risk multiparous women.

The aim of this study was to compare the risk of secondary caesarean section in induced versus spontaneous labour in the second delivery of low risk women who had a vaginal delivery in their first pregnancy. The data were retrospective cohort from an existing regional database, comparing term (between 37 and 42 gestational weeks) second deliveries in cephalic position in women who had previously given vaginal birth. Diabetes, hypertension and multiple pregnancy were excluded as were those with a birth weight less than 2500 g or more than 4500 g. The difference was not significant when induction was performed after 41 weeks. The results showed a total number of 29693 deliveries were included, 21243 in spontaneous labour and 8450 after induction of labour. In the spontaneous group 312 (1.5%) underwent secondary caesarean section, as compared to 237 (2.8%) in the induced group, p < 0.001, OR 1.93 (95% confidence interval 1.63-2.29). It was concluded that elective induction of labour in low risk women who have previously given vaginal birth is associated with an almost doubled rate of secondary caesarean section if performed before 41 weeks.

[Diagnostic image (213). A pregnant woman with premature contractions and vaginal blood loss]. / Diagnose in beeld (213). Een zwangere met premature contracties en vaginaal bloedverlies.

Emergency caesarean section was performed in a 40-year-old woman with solutio placentae. A Couvelaire uterus was diagnosed, showing typical blue-purple discolorations of the uterine wall, which are in fact haemorrhages caused by disseminated intravascular coagulation.

[A novel device for active shoulder rehabilitation with glenohumeral traction or compression]. / Ein neuartiges Gerät zur aktiven Schulterrehabilitation unter glenohumeraler Traktion oder Kompression.

The equipment available for rehabilitation of patients with joint conditions still lacks a device that, in common with usual physiotherapeutic measures (manipulation, proprioceptive neuromuscular facilitation, Bobath therapy), is based on traction and/or compression or oscillating forms. The novel "Shoulder Rotator" is such a simple device for the variable treatment of shoulder disorders in all three spatial dimensions. After individual instruction, the patient performs rotating glenohumeral exercises with simultaneous glenohumeral joint traction, compression, or oscillations against static or dynamic resistance. The "Shoulder Rotator" is similar to the established continuous passive motion device for the shoulder and is mounted on a mobile chair. The electronic device control is computerised and permits a wide variety of treatment options, individual regimes, and documentation. The oscillating, compression/distraction mode of operation provides an analgesic effect. The isolated compression mode along the rotatory axis enables conditioning of joint proprioception. The distraction mode along the rotatory axis facilitates muscular relaxation. Resistive rotatory exercises strengthen the rotatory glenohumeral muscles and help centre the humeral head in the glenoid. In addition to the advantage of adding documentation of treatment progress as required for evidence-based medicine, this novel device may bring about a cost-effective, genuine quality improvement in shoulder rehabilitation.

The sensitivity and specificity of TOP, FDP and GDX in screening for early glaucoma.

The purpose of this study was to evaluate the efficacy of three screening tests in detecting glaucoma in its early stage: the Tendency Oriented Perimetry (TOP) and Frequency Doubling Perimetry (FDP) visual field tests, and the Glaucoma Diagnostic (GDx) nerve fibre layer analyser. Eighteen patients with glaucoma who showed an early defect on HFA c 24-2 and twenty normals underwent the three tests. TOP showed a sensitivity of 94.4% and a specificity of 75%, FDP showed a sensitivity of 72.2% and a specificity of 100%, and GDx a sensitivity of 77.7% and a specificity of 60%.

Restoration of MR-induced artifacts in simultaneously recorded MR/EEG data.

During a Magnetic Resonance sequence, simultaneously acquired ElectroEncephaloGraphy (EEG) data are compromised by severe pollution due to artifacts originating from the switching of the magnetic field gradients. In this work, it is shown how these artifacts can be strongly reduced or even removed through application of an adaptive artifact restoration scheme. The method has proved to be fully automatic and to retain high frequency EEG information, which is indispensable for many EEG applications.

Kinematics of shoulder abduction in the scapular plane. On the influence of abduction velocity and external load.

In this paper the kinematics of arm abduction in the scapular plane of 38 healthy experimental subjects is reported. The ratio of the glenohumoral and the scapulothoracic components of the motion were determined and the influence of the abduction speed and of the external load on it were investigated. The investigation of the effect of abduction speed involved all 38 subjects. Each of them performed one slow and one fast abduction. Statistical analysis showed that there were large differences between individuals, but that for any one individual the abduction process is essentially reproducible. For the one individual there is a strong, linear relationship between glenohumeral and scapulothoracic rotation. The slope of the regression of the glenohumeral component on total arm abduction varied from 0.75 to 0.5 with a sample mean of 0.66. It means that only two-thirds of arm abduction occurs in the glenohumeral joint, the remaining third taking place via scapular rotation. In slowly performed abductions the slope of the regression was significantly greater than in the high-speed movements, but differences were very small. In the investigation of the effect of external load, statistical analysis indicated that the slope of the intraindividual regression is largely independent of the load. The possibility of observer bias was analysed, too. It was found that the standard deviation of the abduction parameters determined by different observers was between 6 and 10% of that between different experimental subjects. RELEVANCE: A knowledge of the kinematics of the shoulder joint is necessary to understand subacromial pathology and in particular impingement problems. The scapulohumeral rhythm depends on the balanced and coordinated function of the muscles involved. The activation pattern of the abductor muscles, as reflected in shoulder kinematics, seems to be individual and stored as an engram.

Distribution patterns of neoglycoprotein-binding sites (endogenous lectins) and lectin-reactive glycoconjugates during cartilage and bone formation in human finger.

The distribution of endogenous lectins, visualized by labelled neoglycoproteins, and of defined oligosaccharide structures, reactive with plant lectins, during fetal development of the fingers was analyzed in sections of human 3- to 8-month-old fetal specimens. Chondrogenesis as well as ossification were correlated with characteristic modulations in the expression of both glycoligand-binding molecules and characteristic carbohydrate structures. Occurrence of xylose-specific receptors was judged to be an early sign of cartilage development. Similarly, alpha-mannosyl residues that had been attached to labelled carrier proteins were strongly bound by the extracellular matrix already during early stages of finger maturation. Staining intensity for heparin gradually increased during chondrogenesis, whereas affinity for mannose showed a stage-related decline. Binding of mannose-6-phosphate was confined to hypertrophied cartilage of primary ossification centers. Accessible binding sites for terminal N-acetylneuraminic acid and N-acetylgalactosamine moieties were detected only in osteoid. In addition to monitoring the sugar-binding capacity, presence and developmental regulation of distinct carbohydrate structures were also assessed. PSA and SBA enabled the demonstration of an abrupt loss of staining affinity in the zone of maturing hypertrophic cartilage. Succinylated WGA proved to be an apparently useful marker of evolving bone tissue. GSL-II binding was restricted to chondroclasts and osteoclasts. The findings of this investigation are consistent with the supposed role of glycoconjugate-lectin interactions in cartilage and bone development.

[Isolated fracture of the trochlea humeri following direct elbow trauma]. / Isolierte Fraktur der Trochlea humeri nach direkter Ellenbogentraumatisierung.

Isolated fractures of the Trochlea humeri are only rarely seen because in case of indirect trauma this portion of the elbow is only partially exposed to transmitted forces and in case of direct injury adjacent elements are also involved. On the lateral films a half-moon shaped fragment in front of the Humerus together with joint effusion are indicative of this type of fracture. Depending on the grade of dislocation of the fragment, which has to be shown radiologically, conservative or operative management are chosen.

[5-10-year results with the straight-shaft Müller prosthesis]. / 5-10 Jahres-Ergebnisse mit der Müller-Gradschaftprothese.

103 patients with 106 Müller straight stem prostheses could be evaluated clinically and radiologically after an average follow-up period of 6.8 years (range 5 to 10 ys.). Although until now no revision for aseptic loosening has become necessary 3 p.c. of the stems and 11 p.c. of the acetabular components showed radiological loosening. The clinical results were rated as satisfactory. After surgery 67 p.c. of the patients were completely painfree, 28 p.c. still had slight pain, 4 p.c. moderate and 1 p.c. severe pain. The investigation concentrated particularly on radiographic changes of the interface of the femur. Whereas radiolucency typically was non-progressive and located in the proximal part of the femur we found an increasing atrophy of the cortical bone on the calcar. Moreover, we found a continuous and increasing subsidence of the stem during the whole period of observation. At the time of follow up 56 p.c. of the straight stems had subsided about 2 mm and more. Calcar atrophy and radiolucency were significantly less present in femurs with a tapered medullary canal than in those with a cylindrical shape.

[A needle electrode isolation amplifier for biomechanical studies]. / Ein Nadelelektroden-Isolationsverstärker für biomechanische Untersuchungen.

In our laboratory for biomechanics, a new isolation amplifier was developed with which to record the electromyographic activity of muscles inaccessible to surface electrodes, in particular that of the rotator cuff. Our basic premisses were maximum safety for the patient or subject investigated, and optimal signal processing. These were achieved by a triple galvanic separation of the patient/subject from the battery power supply and the signal cables and by careful selection of the electronic components.

[Results of histological studies of the flexor tendon sheath in 35 flexor tenosynovectomies in carpal tunnel syndrome]. / Histologische Untersuchungsergebnisse des Beugesehnengleitgewebes von 35 Beugesehnensynovektomien beim Karpaltunnelsyndrom.

This paper presents the results of histologic studies conducted in the context of tenosynovectomy of the flexor tendons to treat carpal tunnel syndrome. The most common findings were inflammatory changes of the synovial sheath, vascular pathology and fibrous changes of the connective tissue.

[Irrigation-suction drainage and synovectomy in the treatment of empyema of the knee joint]. / Die Spül-Saug-Drainage und Synovektomie in der Behandlung des Kniegelenkempyems.

Following irrigation-suction drainage and synovectomy in 68 knee joints for empyema between 1971 and 1987, all were available for clinical and radiological follow-up. Since in 24 cases the empyema occurred after total knee arthroplasty, this group of patients was evaluated separately. The mean follow-up time in the no-prosthesis group was 8.3 and that in the prosthesis group, 5.3 years. In particular the aetiological factors, the bacterial pathogens and the effect of infection on radiological signs of degeneration were studied. The clinical results, including subjective findings, were assessed with the aid of HSS score. Our late results show that the prognosis for knee joint empyema can be rated as good if it is diagnosed early and treated aggressively. The poor outcome in a few cases was rather the result of underlying local disease and concomitant factors, and seemed not to be an immediate consequence of the infection itself. The relatively poor results in prosthesis group have to be referred predominantly to cases dating from the early years of total arthroplasty, with implants of the metal-on-metal type.

[Osteochondrosis dissecans of the elbow joint]. / Die Osteochondrosis dissecans des Ellenbogengelenks.

Thirty-one elbow joints in 29 patients (28 males, only 1 female), operated on for osteochondritis dissecans, were available for follow-up after an average of 10 years. The mean age at diagnosis was 24.4 years, but 11 patients were younger than 20. In 23 out of 29 patients the right elbow was involved, including 2 cases with bilateral involvement. In 20 cases removing the free bodies was the only surgical procedure performed, but in 2 cases it was combined with resection of the radial head. At follow-up, only one-third of the patients had no complaints. Nevertheless, daily activity was not restricted for any of the cases. Degenerative arthritic changes were found in only a few cases. These results are illustrated by means of three typical cases, which are compared with six similar cases in the international literature.

The deltoid muscle: an electromyographical analysis of its activity in arm abduction in various body postures.

We have carried out an electromyographical examination of the activity of five different regions of the deltoid muscle during abduction/adduction in various body postures with different biomechanical actions of arm gravity. The results show that the deltoid action is highly differentiated in its different regions and is not restricted only to the generation of an abducting moment in the shoulder joint. There is obviously a biomechanical contribution, mainly by its spinal and clavicular regions, to the stabilization of the glenohumeral joint and to the control of the selected plane of abduction.

[Habitual patella dislocation and Goldthwait's surgery]. / Habituelle Patellaluxation und Operation nach Goldthwait.

In this study 17 patients with recurrent dislocation of the patella were followed up 10 years after Goldthwait-operation. The subjective and clinical findings were excellent rsp. good in 70%, whereas the x-ray findings showed osteoarthritis of the femoropatellar joint in 60%. Concerning the aetiopathological factors we found an increased external torsion of the afflicted extremity measured by computed tomography.

Candida arthritis: cellular immune responses of synovial fluid and peripheral blood lymphocytes to Candida albicans.

A case of septic Candida albicans arthritis of the knee in a patient with systemic candidiasis is presented. Systemic and intra-articular cellular immune responses to C albicans and various bacterial antigens were monitored for 15 weeks. It is shown that the candida induced blastogenesis of synovial fluid lymphocytes was much more stimulated than that of peripheral blood lymphocytes, and that the proportion of activated cells expressing HLA class II antigens was markedly increased in the synovial fluid. Strong cellular immune responses to Candida albicans could still be shown many weeks after the synovial fluid aspirates had become sterile. For the first time synovial fluid derived, CD4 positive T lymphocyte clones with specificity for candida antigens were characterised and further propagated in vitro.

[Digital roentgen analysis as a tool for kinematic studies of the shoulder--a study of radiation dosage]. / Die Röntgendigitalanlage als Instrument zur kinematischen Untersuchung der Schulter--Eine Untersuchung zur Strahlenbelastung.

The radiation exposure during biomechanical investigation of the shoulder joint done with a digital radiography system (Polytron 1000 VR - Siemens) was measured experimentally. Total radiation dose and surface dose were determined by phantom measurements. The radiation exposure per image is about 1/6 to 1/7 of that of a conventional study. The digital radiography system used is thus suitable for kinesiologic studies of large joints in healthy volunteers.

[Calcareous tendinitis--special forms of the upper extremities. Clinical aspects and differential diagnosis]. / Tendinosis calcarea--Sonderformen an der oberen Extremität. Klinik und Differentialdiagnose.

Calcifying tendinitis of the shoulder joint is a relatively common condition. Its pathogenesis is well documented in anatomical-pathological terms. The clinical observation of four unusual locations in the upper limb makes us to suspect the same pathological process as in the supraspinatus location. The clinical course of calcifying tendinitis in a typical location is discussed in detail.