[Proximal myopathy and fulminant heart failure in a 57 year-old female patient with lupus erythematosus]. / Proximale Muskelschwäche und fulminante Herzinsuffizienz bei einer 57-jährigen Patientin mit Lupus erythematodes.

A case report is presented of fulminant hydroxychloroquine-induced cardiomyopathy in a 57 year-old female patient with a long history of systemic lupus erythematosus. Diagnosis was established based on clinical findings, imaging (echocardiography and cardiac magnetic resonance imaging) as well as endomyocardial biopsy. Despite immediate discontinuation of the medication, the patient died from heart failure within a few days. Since the rare adverse effect described here might be reversible, early diagnosis and discontinuation of hydroxychloroquine are crucial for the prognosis of these patients.

S3 Dorsal Root Ganglion/Nerve Root Stimulation for Refractory Postsurgical Perineal Pain: Technical Aspects of Anchorless Sacral Transforaminal Lead Placement.

Chronic perineal pain limits patients in physical and sexual activities, leading to social and psychological distress. In most cases, this pain develops after surgery in the urogenital area or as a consequence of trauma. Neuromodulation is one of the options in chronic postsurgical perineal pain treatment. We present a case of refractory perineal pain after right sided surgical resection of a Bartholin's cyst which was treated with third sacral nerve root/dorsal root ganglion stimulation using the transforaminal approach. We describe a new anchorless lead placement technique using a unique curved lead delivery sheath. We postulate that this new posterior foraminal technique of lead placement is simple, safe, and reversible and may lower the occurrence of lead related complications.

An algorithm for assessment and treatment of postherniorrhaphy pain.

BACKGROUND: Inguinal pain after groin hernia repair is a challenging issue. About 50 % of postherniorrhaphy pain allegedly is neuropathic, treatment of which is cumbersome given the limited efficacy of current therapeutic modalities. Possibly a clear protocol assessing the type of pain and treating it accordingly could improve its treatment. METHODS: A prospective study was done to evaluate an algorithm in patients with chronic postherniorrhaphy groin pain, aiming to select those with neuropathic pain and to treat appropriately. Treatment consisted of ultrasound-guided nerve blocks as an initial treatment for neuropathic pain. If long-term pain reduction proved inadequate, peripheral nerve stimulation was offered. RESULT: After our diagnostic workup consisting of anamnesis, physical examination and imaging, 68 patients out of 105 were diagnosed as having non-neuropathic pain. These patients were referred to the most appropriate consultant, treated accordingly or sometimes pain appeared to be self-limiting. Thirty-seven (35 %) patients were diagnosed as having neuropathic pain with a median NRS of 7 (range 4-9) and were referred for further treatment to our pain clinic. The majority (21 of 28 patients) suffered ileo-inguinal nerve involvement. After ultrasound-guided nerve blocks, a permanent reduction in pain was achieved in 18 patients (62 %) with a median post-treatment NRS of 1 (range 0-3). In six patients to which an additional peripheral nerve stimulator (PNS) was offered, pain reduction to a level of mild complaints with a median NRS of 2 (range 1-8) was observed. In total, 24 of the 28 patients (83 %) diagnosed with neuropathic postherniorrhaphy pain achieved significant pain reduction after algorithm-based treatment. CONCLUSIONS: In the present study, we implemented a diagnostic workup for patients with postherniorrhaphy inguinal pain to select those with neuropathic pain. Eighty-three percent of the patients with neuropathic groin pain obtained significant improvement of their pain scores after our protocolled treatment. The effect was achieved by nerve infiltrations and in some cases by an implanted PNS when the former was unsuccessful.

[Safe reprocessing of medical devices with a view of the entire process chain. Recommendations of the VDI 5700 guidelines]. / Aufbereitung von Medizinprodukten unter Einbeziehung von Risikomanagementprozessen. Empfehlungen der Richtlinie VDI 5700.

The reprocessing of medical devices for low pathogen or sterile use is in itself potentially risky even though the aim of reprocessing is the avoidance of hygienic or technically functional risks. The methodological principles of risk management for medical devices are described in the standard DIN EN ISO 14971. The recommendations of the Commission for Hospital Hygiene and Infectious Disease Prevention (Kommission für Krankenhaushygiene und Infektionsprävention KRINKO) of the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (Bundesinstituts für Arzneimittel und Medizinprodukte BfArM) "hygiene requirements for the reprocessing of medical devices" clarify numerous reprocessing-specific risks and are structured with reference to the different steps of reprocessing. The aim was a practical combination of the normative risk management methodology with the process-oriented KRINKO/BfArM recommendations, which has provided an interdisciplinary group of experts moderated by the Association of German Engineers (VDI). The main contents of the VDI 5700 guidelines on "hazards associated with the reprocessing--risk management in the reprocessing of medical devices--measures for risk control" and the process of the development of these guidelines is described.

[Importance of displacement ventilation for operations and small surgical procedures from the infection preventive point of view]. / Infektiologische Bedeutung von Raumlufttechnischen Anlagen (RLTA) in Operations- und Eingriffsräumen.

Surgical teams need to breathe air that is conducive to their health. An adequate exchange of air ensures oxygen supply, the ventilation of humidity, smells, toxic substances, especially narcotic gases and surgical smoke, pathogens and particles. With regard to the infection risk, DIN 1946 / 4 -differentiates between operation theaters with the highest demand for clean air (operation room class I a), operation theatres with a high demand (operation room class I b) and rooms within the operation theatres without special requirements, meaning that the microbial load in the air is close to or equal to that of normal in-room air quality (room class II). For an operation room class I a, ventilation that displaces the used air is necessary, while a regular ventilation is sufficient for operation room class I b. Because of ambiguous -results in previous studies, the necessity to define a -class I a for operation rooms is being questioned. Therefore, this review focuses on the analysis of the existing publications with respect to this -question. The result of this analysis indicates that so far there is only one surgical procedure, the -implantation of hip endoprosthetics, for which a preventive effect on SSI of a class I a ventilation (displacement of the used air) is documented. One recent study, reviewed critically here, -showed opposite results, but lacks methodological clarity. Thus, it is concluded that evidence for the requirement of operation room classes can only be derived from risk assessment (infection risk by surgical intervention, extent of possible damages), but not from epidemiological studies. Risk assessment must be based on the following criteria: size and depth of the operation field, -duration of the procedure, vascular perfusion of the wound, implantation of alloplastic material and general risk of the patient for an infection. From an infection preventive point of view, no class I a "displacement ventilation" is necessary for small surgical procedures for which the RKI recommends only a procedure room, and for surgical procedures for which a risk evaluation indicates that the air in the operation theater can be equal to normal air.

Effect of chronic nonmalignant pain on highway driving performance.

Most pain patients are treated in an outpatient setting and are engaged in daily activities including driving. Since several studies showed that cognitive functioning may be impaired in chronic nonmalignant pain, the question arises whether or not chronic nonmalignant pain affects driving performance. Therefore, the objective of the present study was to determine the effects of chronic nonmalignant pain on actual highway driving performance during normal traffic. Fourteen patients with chronic nonmalignant pain and 14 healthy controls, matched on age, educational level, and driving experience, participated in the study. Participants performed a standardized on-the-road driving test during normal traffic, on a primary highway. The primary parameter of the driving test is the Standard Deviation of Lateral Position (SDLP). In addition, driving-related skills (tracking, divided attention, and memory) were examined in the laboratory. Subjective assessments, such as pain intensity, and subjective driving quality, were rated on visual analogue scales. The results demonstrated that a subset of chronic nonmalignant pain patients had SDLPs that were higher than the matched healthy controls, indicating worse highway driving performance. Overall, there was a statistically significant difference in highway driving performance between the groups. Further, chronic nonmalignant pain patients rated their subjective driving quality to be normal, although their ratings were significantly lower than those of the healthy controls. No significant effects were found on the laboratory tests.

Stroking parameters in top level swimmers with a disability.

PURPOSE: The purposes of this study were to analyze velocity (V), stroke length (SL), and stroke rate (SR) values during the 100-m freestyle competitive events in top level male and female swimmers with a disability (DS) according to the international Functional Classification System (FCS) and to compare the results obtained with those of able-bodied swimmers (ABS). METHODS: DS (N = 119) and ABS (N = 32) were tested in real competitive conditions during European and French swimming championships in the A finals of the 100-m freestyle. RESULTS: V and SL increased significantly (P < 0.01) according to the level of ability from class S3 up to S10. SL values were significantly different (P < 0.01) between males and females in each class group. On the contrary, SR was not significantly different between genders, between each class group of FCS, and also with ABS. The major result of this study was that stroke length was related to velocity whereas stroke rate was not. The differences in weekly training time between each class of DS were not significantly different and showed that performances seemed to be more related to the various locomotor disabilities than to the training status. CONCLUSIONS: These findings, which are discussed, showed that stroke index (SI = V.SL) could be used as a sensitive criterion to assess the swimmer with a disability in relationship to his classification level.

Swimming performances and stroking parameters in non skilled grammar school pupils: relation with age, gender and some anthropometric characteristics.

OBJECTIVE: It was hypothesized that swimming velocity (V) and stroking parameters such as stroke length (SL), stroke rate (SR) and stroke index (SI) are influenced by age, gender, and some anthropometric characteristics. EXPERIMENTAL DESIGN: Cross-sectional study. SETTING: Grammar school pupils from French schools. PARTICIPANTS: One thousand and ninety-seven males and 961 females non skilled swimmers aged from 11 to 17. INTERVENTIONS: Usual swimming sessions (6 +/- 2 h.year-1) during a physical education program at school. MEASURES: V, SL, SF and SI (SI = V.SL) were measured or calculated from a 50-m crawl sprint and height, arm span and body mass were measured for all subjects. RESULTS: The results showed that V, SL and SI increased regularly (p < 0.01) in relation to age in both genders. SL was never significantly different between males and females. SF remained unchanged according to age and was significantly higher in males than in females. V, SL and SI were influenced by age and arm span but not SF. CONCLUSIONS: As males and females were submitted to the same swimming teaching program at school, a higher increase in muscle power and anaerobic capacity in males could explain the gender differences. These results observed in non skilled swimmers showed that the differences in stroking parameters between genders were the reverse of those of top level swimmers and that they can be used by swimming teachers in order to build some assessment tools and to better understand the improvements in swimming in relation to growth and gender.

Surgical treatment of liver injury with an absorbable mesh: an experimental study.

Uncontrollable bleeding remains a life-threatening problem in severe liver injury. The application of an absorbable mesh has been reported in a small number of patients. To evaluate an absorbable mesh wrap in standardized conditions, we performed an experimental study in 14 female pigs. A standard liver laceration imitating a blunt injury grade IV (Liver Injury Scale of the American Association for the Surgery of Trauma) was made in all animals. Heparin was administered to mimic coagulopathy. After randomization, seven animals received a polyglycolic acid (Vicryl) mesh wrap to control bleeding. Seven animals served as controls. Six of seven animals with a mesh wrap survived. Six of seven animals in the control group died (p = 0.02, Fisher's exact test). Intrahepatic pressures in the treated group varied from 3 to 55 mm Hg. Liver function tests in surviving animals were temporarily elevated. Necropsy at 2 weeks demonstrated adhesions to the wrapped lobe, but no hematoma, free bile, or abscess. Histologic examination showed a foreign-body reaction to the mesh and necrotic parts in the liver. It is concluded that an absorbable mesh wrap can effectively control bleeding from severe liver injury and improve survival in an animal model, although it may cause some damage to liver tissue.