Signatures of a jet cocoon in early spectra of a supernova associated with a γ-ray burst.

Long γ-ray bursts are associated with energetic, broad-lined, stripped-envelope supernovae1,2 and as such mark the death of massive stars. The scarcity of such events nearby and the brightness of the γ-ray burst afterglow, which dominates the emission in the first few days after the burst, have so far prevented the study of the very early evolution of supernovae associated with γ-ray bursts3. In hydrogen-stripped supernovae that are not associated with γ-ray bursts, an excess of high-velocity (roughly 30,000 kilometres per second) material has been interpreted as a signature of a choked jet, which did not emerge from the progenitor star and instead deposited all of its energy in a thermal cocoon4. Here we report multi-epoch spectroscopic observations of the supernova SN 2017iuk, which is associated with the γ-ray burst GRB 171205A. Our spectra display features at extremely high expansion velocities (around 115,000 kilometres per second) within the first day after the burst5,6. Using spectral synthesis models developed for SN 2017iuk, we show that these features are characterized by chemical abundances that differ from those observed in the ejecta of SN 2017iuk at later times. We further show that the high-velocity features originate from the mildly relativistic hot cocoon that is generated by an ultra-relativistic jet within the γ-ray burst expanding and decelerating into the medium that surrounds the progenitor star7,8. This cocoon rapidly becomes transparent9 and is outshone by the supernova emission, which starts to dominate the emission three days after the burst.

Effective prevention of recurrent dislocation following primary cemented Endo-MarkIII/SP2 total hip arthroplasty using a posterior lip augmentation device.

PURPOSE: This retrospective study was performed to determine the effectiveness of preventing recurrent dislocation following primary cemented Endo-MarkIII/SP2 total hip replacement using a posterior lip augmentation device (PLAD). METHODS: Between January 2003 and Dezember 2006, 27 PLADs were used in the treatment of recurrent hip dislocation in 27 patients who had received a cemented primary total hip arthroplasty using Endo-MarkIII/SP2 (Waldemar LINK, Hamburg, Germany) components. The mean number of dislocations prior to stabilization with this specific device was 2.6 (range 2-4, SD ± 0.4) with a mean time to revision surgery of 10 months (IQR 13). The mean age of the patients at time of revision surgery was 81.5 years (range 70-94, SD ± 6.9). The control group evaluating the clinical outcome using the Harris Hip Score (HHS) also received a cemented primary total hip arthroplasty using the same implants. A retrospective clinical and radiological review was carried out at a mean follow-up of 68.5 months (range 30-103, SD ± 17.7). RESULTS: Of the 27 patients, 6 had died at the time of the latest review, with the posterior lip augmentation device still in situ and without reported further dislocation after PLAD application. In 2 of the remaining 21 patients recurrent dislocation occurred, thus a subsequent revision of respective implants had to be performed to achieve persistent joint stability. At latest follow-up no deep infection or implant loosening occurred. CONCLUSION: Surgical treatment of recurrent dislocation following primary cemented Endo-MarkIII/SP2 total hip replacement using a posterior lip augmentation device is a safe and effective procedure which can lead to a secondary stabilization of the total hip arthroplasty in about 90 % of the patients.

Increased risk for extended acetabular reconstruction in failed hip resurfacing as compared to failed total hip arthroplasty.

INTRODUCTION: Hip resurfacing (HR) is intended to preserve the femoral bone stock during primary arthroplasty. On the other hand, little has been reported regarding the intraoperative need of bone reconstruction for extended acetabular defects during hip resurfacing revision. Thus, the aim of the presented study was to identify whether there is an increased need for acetabular bone reconstruction in HR revision surgery. MATERIALS AND METHODS: We analyzed the data of 38 patients who underwent 39 conversions from a HR to a total hip arthroplasty (THA). Acetabular bone defects and the respective revision technique were compared against a temporary cohort of patients undergoing revision surgery of a conventional THA. RESULTS: In 29 HR patients revision required either autogenous or allogenous impaction bone grafting to adequately manage acetabular host bone degradation. In 10 cases additional implantation of a reinforcement device was necessary. Compared to the THA cohort revision of failed HR is associated with a significantly increased risk of higher grade bone defects (Paprosky classification) and extended acetabular reconstruction (p < 0.05). CONCLUSIONS: This study provides evidence that revision of failed HR devices is associated with an increased risk for extensive acetabular defects. Furthermore, the preoperative radiographic assessment of HR devices often underestimates the intraoperative acetabular defect. Surgeons should be aware of this fact not to technically underestimate HR revision procedures.

[The value of surgical staging in the early stages of ovarian carcinoma]. / Die Bedeutung der Staging-Operation bei den Frühstadien des Ovarialkarzinoms.

The value of surgery in early ovarian cancer was assessed in a retrospective analysis of prognostic factors in all 222 patients with primary stage I epithelial ovarian carcinoma treated in this department between 1975 and 1987. Only cellular differentiation grade (p less than 0.03) and surgical procedure - total abdominal hysterectomy, bilateral salpingo-oophorectomy +/- omentectomy vs. unilateral salpingo-oophorectomy - (p less than 0.02) were of significant influence on estimated survival (Cox model). All other factors (age, FIGO stage, integrity of the capsule, uni-vs. bilaterality, histology) were of no prognostic importance. Unilateral salpingo-oophorectomy without any additional staging reduces the 5-year survival probability (62% vs. 84%). Future prospective studies on adjuvant therapy must be based on exact staging during surgical management before randomisation. Determination of cellular differentiation is also essential.

[The value of cytoreductive second-look surgery in advanced epithelial ovarian carcinoma]. / Die Wertigkeit der zytoreduktiven Second-look-Operation beim forgeschrittenen epithelialen Ovarialkarzinom.

40 patients with advanced epithelial ovarian carcinoma were investigated to evaluate the influence of further cytoreduction during second-look surgery on survival after termination of first-line polychemotherapy containing cisplatinum. Radical tumorectomy with no macroscopic residual tumor mass was achieved in 27.5% of cases; in 52.5% the residual tumour mass was less than 2 cm and in 20% it was more than 2 cm in diameter after cytoreductive second-look surgery. Median survival time after second-look within these three groups of patients was 15.2 months, 16.9 months and 15.3 months, respectively (Mantel test, p = 0.74). In contrast to the situation at the diagnostic operation, further cytoreduction during second-look surgery has no positive influence on survival. We therefore abandoned this operation in clinically tumour-positive patients.

First experiences with intraperitoneal chemotherapy in ovarian cancer.

The Authors report their experience with intraperitoneal chemotherapy in post surgical management of ovarian cancer. 24 patients were evaluable for the study and the results indicate that in patients with bulky disease the complication rate was high and the therapeutical outcome very poor. Only in patients with microscopic disease and residual tumor smaller than 2 cm seemed to benefit from intraperitoneal chemotherapy. Despite pharmacological advantages, Mitoxantrone causes local discomfort up to peritonitis.

[Differentiation of an outcome sample in elective labor induction with PGE2 by the oxytocin sensitivity test]. / Differenzierung des Ausgangskollektivs bei elektiver Geburtseinleitung mit PG E2 durch den Oxytozin-Empfindlichkeitstest.

The goal of the present study was to evaluate whether the implementation of an oxytocin sensitivity test in addition to pelvic scoring would improve prediction of successful induction and could lead to a further reduction in the already low rate of protracted labour and operative deliveries in cases of elective induction by means of prostaglandin (PG) E2 tablets. In order to establish the optimal dosage we compared the endocervical application of 1.5 mg PG E2 with 3 mg intravaginally. Out of 158 women without risk factors examined at term 73.5% decided to have labour induced. In the induction groups given endocervical or intravaginal PG E2 the delivery intervals were significantly shorter and the rate of operative deliveries was reduced. In comparison with those women who decided to await spontaneous onset of labour, the fetal outcome was, however, the same. The endocervical application of 1.5 mg PG E2 did not prove any better than 3 mg given intravaginally. The performance of a pretherapeutic oxytocin sensitivity test yielded additional information about the chances of inducing labour successfully. The results confirmed the efficacy and acceptance of this method of inducing labour.