Use of an Intramedullary Locking Nail for the Treatment of Patella Fractures.

PURPOSE OF THE STUDY Treatment of patella fractures has always been difficult; especially in older patients. The aim of this study was to investigate the XS nail in the treatment of patella fractures. MATERIAL AND METHODS 49 fractures could be registered and reevaluated with a standardized questionnaire. RESULTS Mean follow-up time was 38.67 months, mean age 71.48 years. The mean OKS was 16.26 points, the Kujala Score was 81.56 points. No wound healing or revision could be detected. CONCLUSIONS The XS nail is a good treatment option with a low risk of complications also for the age-related trauma patient and for more complex patella fractures. Key words: patella, patella fracture, XS nail, locking nail, intramedullary nail, nail osteosynthesis.

[Diagnostic value of CT discography in unclear radiculopathy]. / Stellenwert der CT-Diskografie bei unklarer Radikulopathie.

A clinically evident radiculopathy without correlation in the imaging studies represents a serious problem regarding the indication, planning and execution of an operative procedure for its treatment. Both the diagnosis and treatment of such cases are deemed to be difficult without clear morphological correlation. Moreover, the surgeon lacks an important basis for the adequate planning and above all the justification of surgical treatment. Although discography with post-discographic computer tomography (CT discography) is still controversially discussed as an invasive diagnostic measure, the literature shows that this method is not only useful but also indispensable in certain cases. Based on these findings and our own empirical data, we recommend CT discography to be considered for imaging in patients suffering from lumbar radiculopathy with equivocal or insufficient MRI findings. The technique allows an accurate diagnosis and precise planning of a targeted surgical intervention such as endoscopic sequestrotomy or decompression.

[Tissue engineering of cartilage replacement material - mechanical stimulation in the in-vitro cultivation of human chondrocytes]. / Tissue Engineering von Knorpelersatzgewebe - Mechanische Stimulation in der In-vitro-Kultivierung von humanen Chondrozyten.

The treatment of cartilage defects remains a major problem in orthopaedics. With regard to cartilage tissue engineering, the reimplantation of pre-cultivated chondrocytes in the form of a chondrocyte graft is a promising alternative to conventional methods. Clinical practice requires this MACT procedure (matrix-associated autologous chondrocyte transplantation) to produce a biocompatible replacement tissue with adequate mechanical properties. Mechanical stimulation has the capacity to improve the quality of these cell-seeded biomaterials. By altering chondrocytes' cellular activities, the biological and biomechanical properties of cartilage replacement tissue can be modulated. Different systems are used for this purpose, e.g. shear, perfusion, hydrostatic pressure or compression. The mechanisms, biological effects, chances and problems of the techniques are presented and assessed. Among the stimulating techniques considered are systems that apply indirect and direct shear forces such as spinner flasks, rotating-wall bioreactors, direct tissue shear and perfusion culture systems. The application of hydrostatic pressure or compression may be brought about by either static or dynamic loading systems. Compressive loading is considered in the light of both its short- and long-term effects; additionally two exemplified systems are discussed in detail. However, despite promising approaches and seemingly favourable tissue characteristics, the in vitro culturing of functional cartilage replacement tissue with cartilage-like mechanical and biological characteristics still remains elusive. Furthermore, controlling, monitoring and regulating culturing conditions are general biotechnological requirements of a standardised in vitro cultivation. Among these, different aspects such as aseptic operation, media supplementation, nutrient and gas exchange, temperature and humidity control are considered.

All-trans retinoic acid and intra-amniotic endotoxin-mediated effects on fetal sheep lung.

All-trans retinoic acid (RA) is a potent modulator of lung development. Chorioamnionitis, which is frequently associated with preterm birth, causes fetal lung inflammation and improves lung function but also results in alveolar simplification and microvascular injury. Endotoxin-mediated chorioamnionitis reduces RA concentration in the fetal lung to 16% of control values. We hypothesized that administration of RA to the fetus before induction of chorioamnionitis would preserve septation of the distal airspaces. Time-mated ewes with singletons were assigned to receive a fetal intramuscular treatment with 20,000 IU of RA in olive oil (or olive oil only) 3 hr prior to intra-amniotic injection of endotoxin (20 mg, E. coli 055:B5) or saline, at 124-day gestational age and 7 days after the fetal treatment. The right cranial lung lobe was processed for morphometric analysis. RA treatment did not affect chorioamnionitis-induced fetal and systemic inflammation or interleukin-8 concentrations in lung tissue. RA administration alone did not alter lung structure. Relative to control lungs (5 +/- 3 mL/kg), lung volume increased similarly with endotoxin (22 +/- 4 mL/kg) or RA plus endotoxin (20 +/- 3 mL/kg; P < 0.05). Alveolar wall thickness was 4.2 +/- 0.3 mum after endotoxin-induced chorioamnionitis, 6.0 +/- 0.4 mum in controls (P < 0.05 versus endotoxin) and 5.5 +/- 0.2 mum after RA and endotoxin (P < 0.05 versus control, n.s. versus endotoxin). The ratio of airspace versus tissue was 4.6 +/- 0.3 in endotoxin-induced chorioamnionitis, 2.1 +/- 0.3 in controls and 4.1 +/- 0.5 after RA and endotoxin. We conclude that fetal treatment with RA did not prevent inflammation-induced alveolar simplification.

[Laparoscopic cholecystectomy--effect of position changes and CO2 pneumoperitoneum on hemodynamic, respiratory and endocrinologic parameters]. / Laparoskopische Cholezystektomie--Einfluss von Lagerungsänderungen und CO2-Pneumoperitoneum auf hämodynamische, respiratorische und endokrinologische Parameter.

UNLABELLED: The effect of laparoscopic cholecystectomy on cardiopulmonary and endocrinological parameters results from various factors such as increased intraabdominal pressure (IAP), CO2, and the positioning. However, positioning has not yet been regarded. Reliable examination of the individual influencing factors requires standardized anesthesiological procedure and constant IAP. Presently, the effect of positioning is observed separately from those effects caused by the pneumoperitoneum with CO2 (PP) under standardized conditions. METHODS: 40 patients with no history of cardiopulmonary disease were analyzed. Preoperative medication, induction and management of general anesthesia, positioning of the patient and IAP (12 mmHg) were standardized. Hemodynamic, respiratory and endocrinological parameters were determined with the patient in a supine position and in the position typical for the procedure (15 degrees head-down and 10 degrees slant to the left), each with and without PP. Heart rate (ECG), endexpiratory pCO2 (peECO2), invasive blood pressure (radial art.), central venous pressure, partial arterial O2 saturation (psaO2), and ventilation pressures (peak, plateau) were monitored throughout anesthesia. The parameters pH, pCO2, BE, HCO3-, COHb, vasopressin, lactate, and ammonia were analysed in arterial and venous blood samples at predetermined set points: base line, 10 min after CO2 insufflation, 10 min after desufflation, and 1 h after extubation (cf. table 1). Statistical analysis was performed using the Wilcoxon-test with p < or = 0.05 considered statistically significant. RESULTS: Insufflation of CO2 lead to a 12% increase of heart rate in supine position and to even 18% in the position required for surgery. Same significant changes were observed for arterial blood pressure (21 or respectively 28%). Central venous pressure increased by more than 200% after CO2 insufflation. Endexpiratory pCO2 increased by 2.4 mmHg after CO2 insufflation in the supine position and by 5 mmHg in the surgical position. Ventilation pressures increased significantly by 16%. Analysis of the effect of PP on blood gases showed that pH decreased from 7.47 to 7.43, and arterial pCO2 increased by 5.1 mmHg to 38.7 mmHg and increased further after desufflation to values of up to 43.9 mmHg. Arterial pO2 decreased steadily (18% after insufflation). Vasopressin plasma levels increased exponentially from 3.03 to maximal values of 104.45 pg/ml. Ammonia and lactate showed the expected, nearly identical course. Lactate increased within the clinically and methodically irrelevative range, from 1.12 to 1.159 mmol/l. Ammonia decreased by 29%. CONCLUSIONS: The observed changes, i.e. heart rate, central venous pressure, and arterial blood pressure are caused and altered by CO2 insufflation and the various positioning of patients. The increased vasopressin concentration more than likely contributes to these changes. The query whether the position of the patient also causes a change in respiratory parameters and blood gas analysis cannot be differentiated except for the end-tidal pCO2. Inspite of the observed changes no cardiopulmonary complications occurred in this patient group. Therefore, it seems possible to omit invasive monitoring in cardiopulmonary healthy patients. In patients with concomitant history of cardiopulmonary disease, however, deteriorations due to laparoscopy should be thoroughly taken into consideration and studied further.