Long-term results of tripolar constrained total hip arthroplasty in revision hip arthroplasty: a minimum follow-up of ten years.

AIMS: We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores. PATIENTS AND METHODS: We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated cerebral palsy, four had poliomyelitis, two had multiple sclerosis, two had spina bifida, two had spondyloepiphyseal dysplasia, one had previous reversal of an arthrodesis, and 21 had proximal femoral replacements. The mean age of patients at time of Tripolar insertions was 72 years (53 to 89); there were 69 female patients (two bilateral) and 42 male patients. All patients were followed up for a mean of 15 years (10 to 24). Overall, 55 patients (57 hips) died between April 2011 and February 2018, at a mean of 167 months (122 to 217) following their tripolar liner implantation. We extracted demographics, implant data, rate of dislocations, and incidence of other complications. RESULTS: At ten years, the Kaplan-Meier survivorship for dislocation was 95.6% (95% confidence interval (CI) 90 to 98), with 101 patients at risk. At 20 years, the survivorship for dislocation was 90.6% (95% CI 81.0 to 95.5), with one patient at risk. Eight patients (7.2%) had a dislocation of their constrained liners. At ten years, the survival to any event was 89.4% (95% CI 82 to 93.8), with 96 patients at risk. At 20 years, the survival to any event was 82.5% (95% CI 71.9 to 89.3), with one patient at risk. Five hips (4.4%) had deep infection. Two patients (1.8%) developed dissociated constraining rings with pain but without dislocation, which required re-operation. Two patients (1.8%) had periprosthetic femoral fractures, without dislocation, that were treated by revision stems along with exchange of the well-functioning constrained liners. CONCLUSION: Constrained tripolar liners used at revision hip arthroplasty provided favourable results in the long term for treatment of recurrent dislocation and for patients at high risk of dislocation. Cite this article: Bone Joint J 2019;101-B(6 Supple B):123-126.

Asymmetry between Left and Right Eyes in Keratoconus Patients Increases with the Severity of the Worse Eye.

PURPOSE: To evaluate whether the inter-eye asymmetry of keratoconus (KC) patients is different from a healthy control group and to investigate how asymmetry changes with increasing severity of the disease. METHODS: In this retrospective study, we included both eyes of 350 patients with KC (age 35 ± 13 years) and 68 candidates planned for refractive surgery (control group, age 37 ± 11 years). Inclusion criteria for the KC group were keratoconus in at least one eye with Pentacam Topographical Keratoconus Classification (TKC) of at least 0.5. Patients eligible for refractive surgery in both eyes were included in the control group. Corneal tomography as well as Ocular Response Analyzer measurements were compared between both groups. Subgroup analysis was performed with respect to the TKC staging. Asymmetry was provided as worse eye (defined by higher TKC) minus fellow eye. RESULTS: In the KC group, both eyes showed the same TKC staging in 30.6%, a difference of one stage in 34.0% and of two stages in 24.6% of the patients. The inter-eye asymmetry in the keratoconus group was significantly larger than that in the control group. Corneal power showed an asymmetry of 3.8 ± 4.0 D in keratoconus eyes versus 0.22 ± 0.17 D in the control group. Central corneal thickness (CCT) asymmetry was 34 ± 30 µm versus 6 ± 5 µm, respectively. The Keratoconus Match Index showed an asymmetry of 0.40 ± 0.35 versus 0.15 ± 0.14. The difference between both eyes increased with increasing TKC of the worse eye. CONCLUSIONS: Inter-eye asymmetry is larger in keratoconus than in normal eyes, and it increases with keratoconus severity in the worse eye.

Developmental neurotoxic effects of a low dose of TCE on a 3-D neurosphere system.

Trichloroethylene (TCE) is one of the industrial toxic byproducts that now persist in the air, soil, and water. Several studies have already illustrated the toxic effect of high doses of TCE on the biological functions of several organs. This study aims to highlight the toxic impact of a low dose of TCE (1 µmol/L) on the development of rat neural stem cells (NSCs). The subventricular zones (SVZ) of rat pup's brains were collected and minced, and the harvested cells were cultured in the presence of neural growth factors B27/N2 to develop neurospheres. The cells were then exposed to a dose of 1 µmol/L TCE for 1 or 2 weeks. The outcomes indicated a remarkable inhibitory effect of TCE on the differentiation capacity of NSCs, which was confirmed by down-regulation of the astrocyte marker GFAP The inhibitory effect of TCE on the proliferation of NSCs was identified by the reductions in neurosphere diameter, Ki67 expression, and cell cycle arrest at the G1/S phase. Immunolabelling with annexin V indicated the proapoptotic effect of TCE exposure. PCR results revealed a TCE-mediated suppression of the expression of the antioxidant enzyme SOD1. This paper illustrates, for the first time, a detailed examination of the toxic effects of an environmentally low dose of TCE on NCSs at the transcriptional, translational, and functional levels.

Anatomy-based DMEK Wetlab in Homburg/Saar: Novel aspects of donor preparation and host maneuvers to teach descemet membrane endothelial keratoplasty.

Use of Descemet Membrane Endothelial Keratoplasty (DMEK) has been limited because of problems with donor preparation, i.e. tearing of the Descemet membrane and difficulties in unfolding the Endothelium-Descemet-Membrane-Layer (EDML) in the anterior chamber (AC). The purpose of this work was to describe a novel approach to teaching anatomy-based donor and recipient preparation in a DMEK-Wetlab. We teach successful mono-manual donor preparation of human corneas in organ culture not suitable for transplantation, including peripheral markers for orientation. We also teach safe recipient preparation in a freshly-enucleated pig eye in organ culture preservation medium for atraumatic introduction of the EDML roll into the AC, reliable orientation of the EDML during surgery, and stepwise unfolding within the AC. Twenty-two candidates in the 1. Homburg Cornea Curriculum HCC 2015 who practiced both preparations using three human donor corneas and three pig eyes assessed the procedure as follows: (1) overall grade of the Wetlab 1.4 (median 1, range 1 to 2 - on a scale from 1 (excellent) to 6 (terrible); (2) most participants and tutors stated that the Wetlab is most effective for colleagues who have some previous experience with corneal microsurgery. Our novel anatomy-based approach to simulating donor preparation and graft implantation for DMEK seems to meet the expectations and requirements of colleagues with previous experience in corneal microsurgery and will help to reduce the rate of complications for incipient DMEK surgeons in the future. Clin. Anat. 31:16-27, 2018. © 2017 Wiley Periodicals, Inc.

[The KAMRA™ inlay : A realistic approach?] / Das KAMRA™-Inlay : Ein realistischer Ansatz?

BACKGROUND AND PURPOSE: The KAMRA™ inlay (AcuFocus, Irvine, California, USA) is an additional option for correcting presbyopia that has been used for many years in refractive surgery. Our objective is to report our three-month postoperative results of KAMRA™ inlay implantation in terms of near, intermediate and distance vision. PATIENTS AND METHODS: All 24 patients (average age 54.1 ± 6.0 years) were treated with the KAMRA™ inlay in the non-dominant eye (75 % in the left eye) by the same surgeon (MEH). The KAMRA™ inlay was implanted under a 200 µm-thick femtosecond laser-assisted LASIK flap in 2 emmetropic presbyopic patients, 13 hyperopic presbyopic patients and 9 myopic presbyopic patients, without ocular pathologies. The uncorrected distance, intermediate, and near vision were assessed. The central corneal thickness (CCT), endothelial cell density (ECD) and visual field were assessed both pre- and post-operatively. In addition, patients were asked to complete a patient satisfaction questionnaire. Follow-ups were carried out one day, one week, and 1, 3, 6, 9 and 12 months postoperatively. RESULTS: After three months, all 24 eyes revealed an increase in the mean uncorrected distant visual acuity in the non-dominant eye from 0.4 ± 0.2 to 0.9 ± 0.1, an increase in the mean uncorrected intermediate visual acuity (logMAR, Jaeger 75 cm) from 0.6 ± 0.3 (J 11) to 0.0 ± 0.0 (J 1) and an increase in the mean uncorrected near visual acuity (logMAR, Jaeger 45 cm) from 0.6 ± 0.2 (J 9) to 0.0 ± 0.0 (J 1) monocularly. The visual acuity did not change over the time. The CCT and ECD remained unchanged compared with the findings before surgery. Subjectively, the questionnaire showed high patient satisfaction. CONCLUSION: Femtosecond laser-assisted KAMRA™ inlay implantation can be used in post-LASIK emmetropic patients and patients with a monofocal intraocular lens. It can also be combined with LASIK (for ametropic patients). The potential reversibility, low impairment of psychophysical investigations and the high degree of patient satisfaction makes this novel technique designed to increase depth of focus a reliable method for the surgical correction of presbyopia. Patient selection and centration of the KAMRA™ inlay is crucial.

Risk assessment of recent Egyptian H5N1 influenza viruses.

Highly pathogenic avian influenza (HPAI) viruses of the H5N1 subtype are enzootic in poultry populations in different parts of the world, and have caused numerous human infections in recent years, particularly in Egypt. However, no sustained human-to-human transmission of these viruses has yet been reported. We tested nine naturally occurring Egyptian H5N1 viruses (isolated in 2014-2015) in ferrets and found that three of them transmitted via respiratory droplets, causing a fatal infection in one of the exposed animals. All isolates were sensitive to neuraminidase inhibitors. However, these viruses were not transmitted via respiratory droplets in three additional transmission experiments in ferrets. Currently, we do not know if the efficiency of transmission is very low or if subtle differences in experimental parameters contributed to these inconsistent results. Nonetheless, our findings heighten concern regarding the pandemic potential of recent Egyptian H5N1 influenza viruses.

[Intracorneal Ring Segments to Treat Keratectasia - Interim Results and Potential Complications]. / Intrakorneale Ringsegmente bei Keratektasien - Zwischenergebnisse und potenzielle Komplikationen.

BACKGROUND AND PURPOSE: Implantation of intracorneal ring segments (ICRS) using a femtosecond laser is a minimally invasive procedure which represents a reliable option to widen the spectrum of the stage-related therapy of keratoconus in patients with contact lens intolerance, or with post-LASIK-keratectasia or pellucide marginale degeneration (PMD). METHODS: From August 2011 to September 2015, 84 eyes of 69 patients were implanted with ICRS. 74 eyes were implanted with INTACS-SK (Intacs, Addition Technology, Inc.), and 10 eyes were implanted with KeraRing SI6 (Mediaphacos Ltda.). The indication is taken in the presence of a clear central cornea and the patients had to fulfill the corneal diagnostic tests required for implantation. Tunnel creation should nowadays only be carried out by femtosecond laser, in order to avoid intra- and postoperative complications. RESULTS: Three months after surgery, the INTACS-SK group showed an increase in uncorrected distance visual acuity (logMAR) from 0.99 ± 0.35 to 0.29 ± 0.17. The KeraRing SI6 group showed an increase in uncorrected distance visual acuity (logMAR) from 0.93 ± 0.4 to 0.41 ± 0.34. The keratometric values were reduced in both groups. CONCLUSION: Uncorrected and corrected distance visual acuity can be improved by implantation of the ICRS. Progression of ectasia seems to be retarded. Consistent follow-up visits at close intervals are necessary to identify complications at an early stage. However, larger case series and a longer postoperative observation period are required. Complications after ICRS implantation are rare, due to strict patient selection and modern surgical techniques.

[PKP for Keratoconus - From Hand/Motor Trephine to Excimer Laser and Back to Femtosecond Laser]. / Perforierende Keratoplastik bei fortgeschrittenem Keratokonus - vom Hand-/Motortrepan hinauf zum Excimerlaser und zurück zum Femtosekundenlaser.

For patients with keratoconus, rigid gas-permeable contact lenses are the first line correction method and allow good visual acuity for quite some time. In severe stages of the disease with major cone-shaped protrusion of the cornea, even specially designed keratoconus contact lenses are no longer tolerated. If there are contraindications for intrastromal ring segments, corneal transplantation typically has a very good prognosis. In patients with advanced keratoconus - especially after corneal hydrops due to rupture of Descemet's membrane - penetrating keratoplasty (PKP) is still the first line surgical method. Non-contact excimer laser trephination seems to be especially beneficial for eyes with iatrogenic keratectasia after LASIK and for patients with repeat grafts due to "keratoconus recurrences" due to small grafts with thin host cornea. For donor trephination from the epithelial side, an artificial chamber is used. Wound closure is achieved with a double running cross-stitch suture according to Hoffmann. Graft size is adapted individually, depending on corneal size ("as large as possible - as small as necessary"). Limbal centration is preferred intraoperatively, due to optical displacement of the pupil. During the last 10 years, femtosecond laser trephination has been introduced from the USA as a potentially advantageous approach. Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient centration, reduces "vertical tilt" and "horizontal torsion" of the graft in the recipient bed, and thus results in significantly less "all-sutures-out" keratometric astigmatism (2.8 vs. 5.7 D), more regular topography (surface regularity index [SRI] 0.80 vs. 1.0) and better visual acuity (0.80 vs. 0.60), in comparison to the motor trephine. The stage of the disease does not influence functional outcome after excimer laser PKP. However, the refractive outcome of femtosecond laser keratoplasty resembles that with motor trephine. In contrast to the undisputed clinical advantages of excimer laser keratoplasty with orientation teeth/notches in keratoconus, the major disadvantage of femtosecond laser application is still the necessity of suction and applanation of the cone during trephination, with intraoperative disadvantages and high postoperative astigmatism.

[Cataract development after electrical injury]. / Kataraktentwicklung nach Stromverletzung.

Cataract development is one of the most common complications of ocular electrical injury. Our patient reported an electrical injury of his face 13 years ago that affected both eyes. Since that time he noticed progressive visual impairment of both eyes. At the time of first presentation in 2014, slit lamp examination showed characteristic opacities within the anterior and posterior subcapsular area of the lens. Cataract surgery led to full recovery of visual acuity.

[Can the implantable collamer lens with AquaPORT technology safely prevent an angle block? Early experiences in the Homburg/Saar refractive surgery center]. / Kann die implantierbare Collamer-Linse mit Aquaport eine Winkelblockproblematik sicher verhindern? Erste Erfahrungen aus dem Homburger Zentrum für refraktive Chirurgie.

INTRODUCTION: The spectrum of surgical correction of high myopia has been broadened through surgical implantation of phakic intraocular lenses (pIOL) as a possible alternative to corneal refractive surgery. The purpose of the present study was to evaluate the intraoperative and early postoperative results of patients after the implantation of a posterior chamber implantable collamer (ICL) pIOL to correct high myopia. In particular the study tried to answer the question whether the AquaPORT technology can safely prevent angle closure glaucoma. PATIENTS AND METHODS: From March 2012 to November 2013, 24 eyes from 12 patients suffering from a high myopia (-8.75 ± 4.37 D, maximum -22.75 D) underwent implantation of a posterior chamber implantable phakic collamer intraocular lens (ICL) with AquaPORT technology in the Homburg/Saar refractive surgery center. The implantable ICL consists of collamer, a collagen copolymer (Staar surgical-V4b/c). RESULTS: The mean age of the patients was 35.5 ± 1.35 years. At 12 months follow-up mean uncorrected distance visual acuity improved among the patients from 0.013 ± 0.04 preoperatively to 0.8 ± 0.45 postoperatively and the best corrected visual acuity from 0.8 ± 0.16 to 0.8 ± 0.3. Mean spherical equivalent decreased from -9.00 ± 4.68 D preoperatively to 0.12 ± 1.94 D postoperatively. A statistically significant difference in the intraocular pressure (IOP) was not observed (p = 0.3). The central distance between the posterior surface of the lens and the anterior surface of the pIOL (vault) was 0.45 ± 0.49 mm (minimum 0.064 mm, maximum 3.706 mm). Despite the AquaPORT a 28-year-old white woman suffered from a high postoperative IOP of 42 mmHg in both eyes and an ICL with diameter of 12.6 mm was substituted by an ICL with diameter 13.2 mm without complications. CONCLUSION: The implantation of an ICL with AquaPORT technology provides a reliable alternative with good postoperative visual quality to all patients with high myopia when corneal refractive surgery is not possible. In order to enable early detection and treatment of increases in IOP due to angle block, regular postoperative IOP measurements are recommended.

[Intacsintracorneal ring segments in keratoconus]. / Intrakorneale Ringsegmente beim Keratokonus.

INTRODUCTION: The spectrum of stage-related therapy of keratoconus has been broadened through surgical implantation of intracorneal ring segments (INTACS) as a possible method of reducing irregular astigmatism, leading to a reduction of corneal grafts especially in young, working-aged patients with keratoconus. The purpose of the present study was to evaluate the preoperative and postoperative results of femtosecond laser-assisted implantation of INTACS in ectatic corneal diseases. PATIENTS AND METHODS: From August 2011 to January 2013, 20 eyes from 16 patients with a clear cornea in the visual axis suffering from hard contact lens intolerance underwent surgery in the Homburg/Saar Keratoconus Center (HKC) by the same surgeon (MEH). Among these were 16 keratoconus eyes, 1 eye with pellucid marginal degeneration und 3 eyes with post-LASIK iatrogenic keratectasia. The insertion of the INTACS ring segments was achieved by a femtosecond laser-assisted procedure that created a precise 360° tunnel at a depth of 80% of the corneal thickness (395.8 ± 38.5 µm) in the 6­7 mm zone.Results. At 6 months follow-up mean uncorrected distance visual acuity improved from 0.07 ± 0.07 preoperatively to 0.6 ± 0.26 postoperatively. Mean best-corrected distance visual acuity changed from 0.4 ± 0.15 preoperatively to 0.9 ± 0.29 postoperatively. Mean sphere decreased from −7.6 ± 6.1 dpt to −1.4 ± 2.8 dpt. Astigmatism decreased from −6.0 ± 2.8 dpt preoperatively to −4.3 ± 2.0 dpt postoperatively. There was also a reduction in the mean flat K from 47.8 ± 4.7 dpt preoperatively to 44.2 ± 5.0 dpt postoperatively and in mean steep K from 51.9 ± 5.0 dpt to 48.4 ± 6.6 dpt. The central eccentricity index in the Pentacam was reduced to around 50%. Neither intraoperative nor postoperative complications (including non-responders) were observed. CONCLUSIONS: The femtosecond laser-assisted INTACS implantation provides a valid alternative to early keratoplasty for keratoconus patients with a clear central cornea and contact lens intolerance. It is a minimally invasive and reliable method for stage-related surgical management of keratoconus.

[DALK and penetrating laser keratoplasty for advanced keratoconus]. / DALK und perforierende Laserkeratoplastik bei fortgeschrittenem Keratokonus.

BACKGROUND: In cases of contact lens intolerance and/or central corneal scars, corneal transplantation is indicated for advanced keratoconus. This can be performed as deep anterior lamellar keratoplasty (DALK) or as penetrating keratoplasty (PKP). The German keratoplasty registry shows that the proportion of anterior lamellar grafts in Germany has remained stable at approximately 5 % in recent years. METHODS: Up to now DALK has not been technically standardized but can result in a good visual acuity using the big bubble technique if Descemet's membrane is laid bare intraoperatively. In 10-20 % a conversion to PKP is required if perforation of Descemet's membrane occurs. In cases of advanced keratoconus PKP is still the method of first choice especially after corneal hydrops due to rupture of Descemet's membrane. Non-contact excimer laser trephination seems to be especially beneficial for eyes with iatrogenic keratectasia after LASIK and those with repeat grafts in cases of keratoconus recurrence due to the graft being too small. For donor trephination from the epithelial side, an artificial chamber is used. Wound closure is achieved by a double running cross-stitch suture according to Hoffmann. Graft size is adapted individually depending on corneal size (as large as possible and as small as necessary). Limbal centration is given priority intraoperatively due to optical displacement of the pupil. RESULTS: Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient centration, reduces vertical tilt and horizontal torsion of the graft in the recipient bed, thus resulting in significantly less all-sutures-out keratometric astigmatism (2.8 D versus 5.7 D), higher regularity of the topography (SRI 0.80 vs. 0.98) and better visual acuity (0.80 vs. 0.63) in contrast to the motor trephine. The stage of the disease does not influence functional outcome after excimer laser PKP. CONCLUSIONS: In cases with optimal course DALK achieves the same visual outcome as mechanical PKP but the healthy endothelium can be preserved and endothelial immune reactions are prevented in keratoconus. In contrast to the undisputed clinical advantages of excimer laser keratoplasty with orientation teeth/notches in keratoconus, the major disadvantage of femtosecond laser application is still the necessity of suction and applanation of the cone during trephination.

[Prophylaxis and management of complications in penetrating keratoplasty]. / Prophylaxe und Management von Komplikationen bei perforierender Keratoplastik.

Besides routine postoperative follow-up the prophylaxis of complications in penetrating keratoplasty (PKP) includes special preoperative and intraoperative aspects. Preoperative prophylaxis consists of the therapy of systemic diseases and eyelid abnormalities, determining individual optimal graft size, avoiding PKP in cases of uncontrolled intraocular pressure, avoiding PKP in cases of corneal hydrops, pretreatment of vascularized cornea, amniotic membrane transplantation before PKP in cases of ulcerative keratitis, quality controlled organ-cultured transplants and preoperative counselling by the surgeon to ensure patient compliance. Intraoperative prophylaxis consists of controlled arterial hypotension and complete relaxation during general anesthesia, avoidance of decentration, horizontal torsion and vertical tilt using a non-contact trephination technique (preferably excimer laser) with double-running cross-stitch sutures and application of Flieringa rings in aphakic vitrectomized eyes. Postoperatively, periodical control examinations using fluorescein and blue light are indispensable. All loose sutures have to be removed as early as possible. In cases of herpetic eye disease 2 × 400 mg of oral acyclovir should be administered for at least 1 year. In cases of therapy-resistant epithelial defects 100 % autologous serum eyedrops or amniotic membrane patches are valid options. Immune reactions must be diagnosed and treated immediately with high doses of corticosteroids.

[Immune reactions following excimer laser and femtosecond laser-assisted penetrating keratoplasty]. / Immunreaktionen nach Femtosekunden- und Excimerlaser-Keratoplastik.

In 10-20 % of conventional keratoplasties immunological graft reactions (TPR) occur, which may lead to endothelial cell loss and irreversible transplant rejection. Beside the optical advantages of non-mechanical excimer laser trephination, it does not seem to have immunological disadvantages (13.9 % TPR in keratoconus, 2.9 % in Fuchs' dystrophy after 3 years). The femtosecond laser-assisted keratoplasty has visual and refractive outcomes similar to conventional trephination. However, the "mushroom-shaped" trephination seems to have immunological disadvantages (21.8 % TPR in keratoconus after 14 months) and "top hat-shaped" keratoplasties seem to have no immunological disadvantages (6.6 % TPR in Fuchs' dystrophy after 14 months).

Periprosthetic fractures around total knee arthroplasty.

INTRODUCTION: The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function. METHODS: A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were 'periprosthetic fracture(s)', 'femur', 'tibia', 'patella(r)', 'complication(s)', 'failure(s)', 'risk(s)', 'prevalence', 'incidence', 'epidemiology' and 'classification(s)'. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified. RESULTS: Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement. CONCLUSIONS: Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon.

Arthroscopic excision of heterotopic calcification in a chronic rectus femoris origin injury: a case report.

Rectus femoris origin injuries in adult athletes are uncommon. In the acute phase, conservative treatment seems to have a favourable outcome, with surgical repair reserved for unsuccessful cases only. However, a group of patients may develop chronic pain and disability after recovery from the acute phase due to heterotopic calcification occurring at the site of injury. Open and arthroscopic excision of such calcifications has been described in the literature although arthroscopic excision of large calcified lesions in the rectus femoris has not been reported previously. A relevant case is presented and discussed.

The development of fibronectin-functionalised hydroxyapatite coatings to improve dermal fibroblast attachment in vitro.

The success of long-term transcutaneous implants depends on dermal attachment to prevent downgrowth of the epithelium and infection. Hydroxyapatite (HA) coatings and fibronectin (Fn) have independently been shown to regulate fibroblast activity and improve attachment. In an attempt to enhance this phenomenon we adsorbed Fn onto HA-coated substrates. Our study was designed to test the hypothesis that adsorption of Fn onto HA produces a surface that will increase the attachment of dermal fibroblasts better than HA alone or titanium alloy controls. Iodinated Fn was used to investigate the durability of the protein coating and a bioassay using human dermal fibroblasts was performed to assess the effects of the coating on cell attachment. Cell attachment data were compared with those for HA alone and titanium alloy controls at one, four and 24 hours. Protein attachment peaked within one hour of incubation and the maximum binding efficiency was achieved with an initial droplet of 1000 ng. We showed that after 24 hours one-fifth of the initial Fn coating remained on the substrates, and this resulted in a significant, three-, four-, and sevenfold increase in dermal fibroblast attachment strength compared to uncoated controls at one, four and 24 hours, respectively.

[Salzmann's nodular degeneration on a corneal graft 20 years after penetrating keratoplasty for keratoconus]. / Salzmann'sche noduläre Degeneration 20 Jahre nach perforierender Keratoplastik bei Keratokonus.

INTRODUCTION: We report a unique case of a young patient who underwent penetrating keratoplasty for keratoconus 20 years previously and presented in our department with visual deterioration due to Salzmann's nodular degeneration (SND) on the corneal graft, induced probably by underlying recurrent herpetic (HSV) keratitis. The patient was treated with phototherapeutic keratectomy (PTK) and despite the low endothelial density of the corneal graft, visual acuity was sufficiently restored. CONCLUSION: Treatment with PTK is a promising therapeutic option in SND to avoid repeat penetrating keratoplasty, even if the prognosis for the corneal graft is endangered by several risk factors (age of the graft, low endothelial density, subclinical recurrent HSV infection).