[Diagnosis of periprosthetic joint infection : Development of an evidence-based algorithm by the work group of implant-associated infection of the AE-(German Society for Arthroplasty)]. / Diagnostik der periprothetischen Infektion : Entwicklung eines evidenzbasierten Algorithmus der Arbeitsgruppe implantatassoziierte Infektion der Arbeitsgemeinschaft Endoprothetik.

BACKGROUND: Prosthetic joint infections (PPI) will challenge orthopaedic surgeons and the health care system in the coming years. Evidence-based and reliable preoperative diagnostics are necessary for success in the field of revision arthroplasty. Especially the preoperative detection of PPI is important with respect to the treatment strategy. AIM: The aim of this study was to develop a detailed and structured standard operating procedure (SOP) to detect PPI preoperatively. METHODS: A systematic literature research was performed and relevant articles identified. After extracting the data, statistical calculations of sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were performed. The results were discussed and evaluated in four meetings analogously to standard Delphi rounds by the workgroup of implant-associated infections of the German AE (Arbeitsgemeinschaft Endoprothetik). An algorithm for the diagnostic approach according to ISO 5807 was made. RESULTS: The standardized algorithm combines a sequence of evidence-based procedures with detailed and structured main and additional criteria to every critical step in the diagnostic approach. CONCLUSION: The detection of PPI is of tremendous importance prior to revision arthroplasty and determines its success or failure. The diagnosis "prosthetic joint infection" requires a substantial change with respect to treatment concepts. The algorithm summarizes current literature and specialized expert opinions in a modern standardized format for a transparent diagnostic approach.

Aneurysmal bone cyst (ABC) : treatment options and proposal of a follow-up regime.

The aim of this study was to describe treatment -options and develop a follow-up regime for the -aneurysmal bone cyst, a neoplastic bone lesion with a noticeable recurrence rate. Reports of 28 patients and a mean follow-up of 42.2 months treated multidisciplinary were analysed. Data were complemented by a literature review including 790 patients. Patient age was from seven to 57 years, in line with the literature (1-69 years). Lesions most frequently affect long bones, spine and pelvis ; pain is the most common symptom. Treatment modalities vary, recurrences -occurred in 26.1% in our series, rates ranged from 0-60% in the literature, with the vast majority within 2 years. With regard to the findings we propose, irrespective of treatment, a follow-up regime including clinical survey and imaging, best with MRI, at 3 months, 6 months and at half-yearly intervals within the first two and yearly within the third to fifth year.

[Open biopsy of bone and soft tissue tumors : guidelines for precise surgical procedures]. / Offene biopsie von knochen- und weichteiltumoren : richtlinien für ein korrektes chirurgisches vorgehen.

OBJECTIVE: The objective of an open biopsy is to obtain a sufficient amount of representative tumor tissue in terms of adequate quality and quantity, without adverse effects on later therapy. INDICATIONS: Suspected malignancy after non-invasive diagnostic procedures. Histopathologic evaluation of tumor entity and grading. Planning of the definitive tumor resection and initiation of neoadjuvant therapeutic regimen. Obtaining unfixed, fresh-frozen tumor samples for molecular/genetic analyses or tumor tissue bank. CONTRAINDICATIONS: Hemorrhagic diathesis. Tumor is only accessible with a surgical approach leading to a significant damage of the surrounding tissue. High probability of tumor cell contamination with incisional biopsy. Poor physical status. Poor therapeutic compliance. SURGICAL TECHNIQUE: The biopsy tract should be carefully planned according to oncological principles. The operation begins with a small incision in longitudinal direction to the extremity. The shortest path between skin and lesion that avoids contamination of other compartments is selected. The biopsy tract should be located within the surgical approach which is later used for definitive tumor resection. During the definitive procedure it should be possible to resect the biopsy approach with adequate surgical margins because it is considered to be contaminated with tumor cells. In principle, a wide resection of the biopsy tract should be possible. During the operation meticulous hemostasis has to be performed because any hematoma around a tumor may contaminate the entire extremity. In cases of an intraosseous tumor a cortical window should be made to obtain intramedullary tumor tissue. Drains should be located in continuity with the skin incision or in direct extension of the wound. Wound closure with intracutaneous suture technique. Excisional biopsy in terms of marginal resection should be performed only in the presence of small, epifascial lesions that are assumed to be benign after completion of basic diagnostic procedures. In cases of larger or subfascial tumors an incisional biopsy should be conducted. POSTOPERATIVE MANAGEMENT: Compressive dressing to prevent postoperative hematoma. In cases of tumors affecting load-bearing bones, weight-bearing should be prohibited after biopsy, if there is any fracture risk. Upon receipt of the histopathological results the definitive tumor resection is planned.

[MRI-based measurement of muscle damage after minimally invasive hip arthroplasty]. / MRT-basierte Messung des Muskelschadens nach minimal-invasiver Hüftprothesenimplantation.

Muscle trauma in minimally invasive hip arthroplasty using a direct anterior approach was assessed by magnetic resonance imaging (MRI) in 25 patients preoperatively, as well as 6 months after total hip replacement. The MRI evaluation included the measurement of changes in muscle cross-sectional area (CSA = atrophy) and fatty infiltration of the muscles. Using MRI, preoperatively existing and operatively caused muscle tissue damage could be detected by assessing changes in muscle CSA and fatty infiltration. Even preoperatively, a muscular atrophy and fatty infiltration could be demonstrated in the diseased hip. Using the minimally invasive direct anterior approach, a postoperative significantly reduced CSA and significantly increased fatty degeneration was detected for the M. tensor fasciae latae and the M. glutaeus minimus. No increased damage of the M. glutaeus medius could be detected.

Voltage-induced adsorbate damping of single gold nanorod plasmons in aqueous solution.

Unbiased gold nanoparticles are negatively charged in aqueous solution but not hydrated. Optical spectroscopy of voltage-clamped single gold nanoparticles reveals evidence that anion adsorption starts at positive potentials above the point of zero charge, causing severe but reversible plasmon damping in combination with a spectral red shift exceeding the linear double layer charging effect. Plasmon damping by adsorbate is relevant for the use of nanoparticles in catalysis, in biodiagnostics, and in surface enhanced Raman scattering.

Luteal blood flow is a more appropriate indicator for luteal function during the bovine estrous cycle than luteal size.

The objective of this study was to assess the reliability of luteal blood flow (LBF) as recorded by color Doppler sonography to monitor luteal function during the estrous cycle of dairy cows and to compare the results with that for the established criterion luteal size (LS) as determined by B-mode sonography. In total, 14 consecutive sonographic examinations were carried out in 10 synchronized lactating Holstein-Friesian cows (Bos taurus) on Days 4, 5, 6, 7, 8, 10, 12, 14, 16, -5, -4, -3, -2, -1 of the estrous cycle (Day 1=ovulation). Plasma progesterone concentrations in venous blood (P(4)) were quantified by enzyme immunoassay. Luteal size was determined by sonographic measurement of the maximal cross-sectional area of the corpus luteum (CL). Luteal blood supply was estimated by calculating the maximum colored area of the CL from power Doppler sonographic images. Luteal size doubled during the luteal growth phase (until Day 7) and remained at this level during the luteal static phase (Day 8 to 16) before decreasing rather slowly during luteal regression (Days -5 to -1). Luteal blood flow doubled during the growth phase, doubled furthermore during the static phase, and decreased rapidly during luteal regression. Thus, LBF values represented highly reliable predictors of luteal status. Luteal blood flow predicted reliably a P(4)>1.0 ng/mL by reaching only 35% of the maximal values, whereas LS had to exceed 60% of the maximal values to indicate reliably a functional CL. It is concluded that LBF reflected luteal function better than LS specifically during luteal regression.

[Results of vacuum sealing therapy in joint infections]. / Ergebnisse bei der Behandlung von Gelenkinfektionen mit Vakuumversiegelung.

AIM: At present the vacuum sealing technique is acknowledged as a therapy for acute and chronic wounds. An acceleration of the healing process, due to the vacuum suction with occlusive wound dressing, leads to the shortening of a cost-effective medical treatment. This can be applied to wound treatment and infections of soft tissues, but even today there is only sparse information in this context about joint infections. METHOD: The results of therapy with the vacuum sealing technique in 68 patients with infections of the joints of an extremity or the trunk were analysed in a retrospective study without a control group. The importance of several patient-related factors for the medical treatment have been analysed. RESULTS: An adequate treatment of joint infections can be achieved even in the presence of endoprostheses or osteosynthetic material. The following factors have been found to be of significance for a prolonged medical treatment: diabetes mellitus (p=0.0052), obesity (BMI>25) (p=0.0458) and a preceding trauma (p=0.0457). CONCLUSION: The results confirm the value of the vacuum sealing technique following surgical debridement in combination with resistance tested antibiotic treatment, as a sufficient therapy for joint infections, even in patients with an endoprosthesis. This procedure leads to a safe treatment of the joint infection, combined with a good function of the treated joint, good patient comfort and a short duration of the therapy.

Molecular biological observations in some rare neoplasms: DNA ploidy and cell cycle data in liposarcoma and malignant fibrous histiocytoma.

INTRODUCTION: The prognostic significance of tumor DNA ploidy and cell cycle analysis for long-term survival has been examined in 19 patients with liposarcoma or malignant fibrous histiocytoma. In many cases, different tumor areas of primary tumors and local recurrences have been analyzed to reveal intratumoral heterogeneity. RESULTS: Among the primary tumors, there were eight aneuploid tumors, three of which showed diploid and aneuploid tumor regions. Correlations among DNA ploidy, grading, percentage of S-phase cells and infiltrative growth pattern of the tumors could be demonstrated. Poorly differentiated tumors (G3) showed aneuploidy in six of eight patients. Aneuploid tumors showed S-phase cells in 17.2% (range 3.2-38.1%), which was higher than the percentage of S-phase cells in diploid tumors (9.4%, range 2.1-27.4%). Aneuploid tumors showed a more infiltrative growth pattern (6 of 8 patients) than diploid tumors (6 of 11 patients). The median survival time of patients with diploid tumors was 86.5 months (8-144 months), compared with 40.9 months (11-54 months) for patients with aneuploid tumors. CONCLUSION: DNA ploidy and percentage of S-phase cells may be considered as prognostic factors.

[Therapy outcome of patients with soft-tissue sarcoma: retrospective analysis for identifying independent prognostic factors]. / Therapieergebnisse von Patienten mit Weichteilsarkom: Retrospektive Analyse zur Identifizierung unabhängiger Prognosefaktoren.

The postoperative outcome of 108 patients with soft tissue sarcoma (STS) of the extremities, the retroperitoneum, or the trunk was investigated retrospectively to identify independent factors for the over all survival and local tumor control. Chi-square single factor analysis and a Cox model were used to identify independent postoperative risk factors. Single factor analysis revealed a significant correlation with negative effect on overall survival for the variables metastasis (p < 0.0001), chemotherapy (p < 0.0009), surgical procedures (0.001), tumor size > 10 cm (p < 0.003), localization (retroperitoneum, trunk) (p < 0.03), and grading (G3/G4) (p < 0.03). Local tumor control was significantly correlated with the variable tumor size > 10 cm (p < 0.01). The Cox model showed a significant negative impact on overall survival for the factors metastasis (p < 0.002), tumor size > 10 cm (p < 0.004), grading (G3/G4) (p < 0.005), and sex (male) (p < 0.008). For local tumor control the variables were age (p < 0.006), and surgical procedures (p < 0.01).

Comparing satisfaction levels of inpatients and outpatients with a diabetes teaching program.

With the changing climate of health care there is an increasing need to offer diabetes education in outpatient rather than inpatient settings. This study was conducted to determine if there is a significant difference in the satisfaction level between inpatients and outpatients receiving diabetes teaching in the same program. Patient satisfaction with the practitioner is a determinant of patient learning and compliance. The study included 42 inpatients and 47 outpatients who participated in the same program and were taught by the same teaching nurses and dietitians. A questionnaire developed for this study examined six areas: (1) demographics; (2) patients' perception of understanding their diabetic condition and treatment; (3) comfort in class; (4) perception regarding treatment as an individual; (5) life satisfaction; and (6) influence of recommendations on future health. The results of the study showed a significant difference (P less than 0.05) in two areas: (1) inpatients felt that more interest and concern were shown towards them than outpatients and (2) more inpatients than outpatients felt they were treated more like individuals than cases. The results indicated that the personalized and ongoing contact inpatients have with the practitioner determine the degree of satisfaction with diabetes teaching received in these important areas.