[Osteochondrosis dissecans of the hip in adults--differential diagnosis of free joint bodies--case report]. / Osteochondrosis dissecans der Hüfte beim Erwachsenen -- Differenzialdiagnostik freier Gelenkkörper -- Fallbeschreibung.

The causes of hip pain in adults can vary greatly. We present the case of a 44-year-old woman with recurrent hip pain over a period of years. Medical history and clinical examination did not provide any decisive information. The X-rays revealed a loose body in the cavity of the hip joint. The MRI scan made the following differential diagnosis plausible: osteochondrosis dissecans coxae, osteochondroma and chondromatosis. The final diagnosis of osteochondrosis dissecans coxae was confirmed by surgical dislocation of the hip as modified by Ganz and histological examination of the loose body. This case supports the importance of including rare lesions in the differential diagnostic work-up of joint pain. The advantages of the offset operation as modified by Ganz versus arthroscopy of the hip are outlined.

[Revision surgery for knee prostheses using the DRG system]. / Wechseloperationen in der Kniegelenkendoprothetik im DRG-System.

Due to an increasing life expectancy and earlier primary implantation of total knee replacements, the number of patients requiring revision surgery in Germany is increasing by 7% every year. These revision cases belong to the most treatment and cost intensive operations in joint replacement surgery. Presently, the description of these procedures in the German DRG system, which defines the financial reimbursement for the hospitals, is changing yearly with the development of new catalogues. The changes made from 2003 to 2005 are outlined in the following article. A correct depiction of the treatment and procedures required in such cases is a prerequisite for an adequate reimbursement. In the long-term, hospitals will only be able to offer such complex treatment forms if the financial compensation correctly reflects the costs incurred.

Interindividual reproducibility in perioperative rotational alignment of femoral components in knee prosthetic surgery using the transepicondylar axis.

Femoral component malalignment is one of the main causes of persisting anterior knee pain after knee replacement. This study examined interindividual reproducibility in perioperative definition of the transepicondylar axis (TEA) as a reference for measuring the rotational alignment of the femoral component. Eight surgeons experienced in knee prosthetic surgery marked on Thiel-embalmed cadaver specimens the reference points that they would normally use to define the TEA during knee replacement. These were digitized by a video system, and all the spots defined by the surgeon were translated into a reference picture, allowing a digital analysis of the distances between all the spots marked. The maximal distance between the spots that the participants had marked as relevant for the TEA was 13.8 mm at the lateral and 22.3 mm at the medial epicondyle. Projecting all spots marked into one picture resulted in an area of 116 mm2 on the lateral and 102 mm2 on the medial epicondyle. The median range of the fault between two different participants was 6.4 mm on the lateral side (range 13.2 mm) and 9.7 mm on the medial (range 21.6 mm). Because the rotational alignment of the femoral component is extremely relevant for successful implantation of total knee prosthesis, the interindividual discrepancy in defining the TEA as reference is rather high. As this reference line is commonly used, the perioperative variance and the resulting rotational discrepancy of the femoral component must be considered.

[Primary liposarcoma of the stomach wall--a rare mesenchymal tumor]. / Primäres Liposarkom der Magenwand--ein seltener mesenchymaler Tumor.

INTRODUCTION: Primary liposarcoma of the stomach wall is rare. Only eight cases have been described so far. MATERIAL AND METHOD: Here we report the ninth case, occurring in a 74-year-old woman who presented with weight loss and a therapy-resistant ulcer of the stomach wall. RESULTS: Pre- and perioperative findings suggested a benign lipoma of the stomach wall. The patient was treated with subtotal gastrectomy. On microscopic examination the tumor showed features of a benign lipoma but for a distinctive capillary net. Immunohistochemically the S-100 reaction was positive. Less than 1% of Ki67-positive cells could be found, thus suggesting a highly differentiated primary liposarcoma of the stomach wall. CONCLUSION: In situations where the benign or malignant nature of a submucosal lesion cannot be diagnosed with certainty a mesenchymal tumor of the stomach wall has to be included in the differential diagnosis. Here the indication for complete surgical excision and histological workup has to be set widely.

[Risk factors for anastomosis dehiscence after very deep colorectal and coloanal anastomosis]. / Risikofaktoren der Anastomoseninsuffizienz nach sehr tiefer colorectaler und coloanaler Anastomose.

INTRODUCTION: Very low colorectal anastomoses are considered to be more prone to complications than other anastomoses. We aimed to analyze possible risk factors for the surgically most relevant complication, anastomotic leakage. METHODS: Uni- and multivariate analysis of the relation between leakage and 18 patient- and procedure-dependent variables were performed in 98 patients after very low colorectal or coloanal anastomosis. RESULTS: In all, 18 patients developed a dehiscence. Two patients, both without a protective stoma, died because of the leakage (overall mortality 2%). From all analyzed variables, only smoking remained as an independent risk factor for anastomotic dehiscence. For all other parameters, such as protective stoma, experience of the surgeon, stage of tumor, radiation therapy, or the need for blood transfusions there was no significant correlation. CONCLUSIONS: From our study, a typical risk pattern for anastomotic dehiscence, with the exception of being a smoker, cannot be defined. Presumably, anastomotic leakage is being caused by a multitude of factors, such as a preexisting or intra-/postoperatively developing reduction of microperfusion, which have a strong influence but cannot be as readily evaluated as other parameters. Until this situation improves, protective stomata, which do not prevent leakage but attenuate the consequences, should be used regularly.

Advances in the use of glass-ionomeric cement. Part 1: Experimental results and portrayal of a technique.

The objective of this study was to develop a method of cement microapplication using glass-ionomeric cement. The results of an experimental study to design a microapplication method of glass-ionomeric cement (Ionocem) are presented. Typical middle ear implant materials, as well as human temporal bones and middle ear ossicles, were used to test the efficiency of this application method. Two different versions of Ionocem, low and normal viscosity, were tested under different temperatures and with several application tools. Sufficient processing time could be achieved by cooling the cement down to 4 degrees C. A subcutaneous insulin syringe with a milled-off tip proved to be cost-effective, efficient and versatile. Using this instrument, durable and secure cementation between the parts tested could be achieved. This method may be of significant importance in otologic research and microsurgical routine. In part 2, experimental animal results will follow, as the method portrayed was used to secure parts of a totally implantable middle ear hearing device.

Advances in the use of glass-ionomeric cement. Part 2: Functional results of fine application of low-viscosity glass-ionomeric cement: animal experimental results.

An experimentally developed technique for microapplication of low-viscosity glass-ionomeric cement (see part 1) was tested in animals over a 6-month period. The cement was used to firmly connect gold with titanium and gold with middle ear ossicles in 22 adult foxhounds. After a 6-month period of acoustic stimulation via parts of an implantable hearing aid, the finely applied glass-ionomeric cement was integrated in situ, stable and caused no adverse reactions. The microapplication technique used proved to be easy, effective and provided long-term stability.