Use of multimodal intra-operative monitoring in averting nerve injury during complex hip surgery.

Peripheral nerve injury is an uncommon but serious complication of hip surgery that can adversely affect the outcome. Several studies have described the use of electromyography and intra-operative sensory evoked potentials for early warning of nerve injury. We assessed the results of multimodal intra-operative monitoring during complex hip surgery. We retrospectively analysed data collected between 2001 and 2010 from 69 patients who underwent complex hip surgery by a single surgeon using multimodal intra-operative monitoring from a total pool of 7894 patients who underwent hip surgery during this period. In 24 (35%) procedures the surgeon was alerted to a possible lesion to the sciatic and/or femoral nerve. Alerts were observed most frequently during peri-acetabular osteotomy. The surgeon adapted his approach based on interpretation of the neurophysiological changes. From 69 monitored surgical procedures, there was only one true positive case of post-operative nerve injury. There were no false positives or false negatives, and the remaining 68 cases were all true negative. The sensitivity for predicting post-operative nerve injury was 100% and the specificity 100%. We conclude that it is possible and appropriate to use this method during complex hip surgery and it is effective for alerting the surgeon to the possibility of nerve injury.

Short course single daily ceftriaxone monotherapy for acute bacterial meningitis in children: results of a Swiss multicenter study. Part I: Clinical results.

In a prospective Swiss multicenter study, 119 children (aged three weeks to 15.5 years) with acute bacterial meningitis were treated with single daily doses of ceftriaxone (100 mg/kg on days one and two and 60 mg/kg thereafter). All patients were randomly assigned to either short course (four, six, seven days) or full course (eight, 12, 14 days) therapy depending on whether they had contracted meningococcal, Haemophilus influenzae type b or pneumococcal meningitis. Bacteriological cure was obtained in 92 children who fully completed the study and in all the 20 culture-positive of the 27 children secondarily excluded from the study for failure to meet all bacteriological and initial safety criteria for continuation in protocol (secondary exclusions). Complete clinical recovery was noted in 105 of 119 patients (88%) and was as frequent in the short course (91%) as in the full course (89%), and as in the secondary exclusion (81%) group. All patients survived. At follow-up examination three to six months after hospital discharge only seven infants and seven children (11.8%), mostly those with poor presentation on admission (p = 0.0012), showed residual neurological sequelae. Side effects of antibiotic therapy were minor but more frequent, albeit not statistically significant (p = 0.065), in children receiving the full course therapy. The results of this study suggest that short course treatment of acute bacterial meningitis in children with single daily ceftriaxone monotherapy is as efficacious as full course therapy and at least as well tolerated.

[Epidemiology of hepatitis D virus infection]. / Zur Epidemiologie der Hepatitis-D-Virus-Infektion.

The hepatitis D (Delta) virus (HDV) is an incomplete RNA virus which only replicates when a hepatitis B virus (HBV) infection is present. The detection of anti-Delta virus antibodies (anti-Delta) indicates an ongoing or past infection with HDV. Anti-Delta were measured in serum samples of 939 individuals from various groups of patients and of healthy high risk individuals presenting different states of HBV infections. 636 samples were drawn in 1984 and 303 in 1980. In 1984 anti-Delta were most often detectable in healthy homosexuals (19 of 35 individuals = 54%), followed by healthy drug addicts (44 of 207 individuals = 22%), patients with acute hepatitis B (2 of 63 individuals) or with chronic hepatitis B (1 of 74 individuals), patients under hemodialysis or with renal allografts (2 of 90 individuals), and in healthy HBs-Ag positive blood donors (2 of 48 individuals). Within a given risk group of individuals anti-Delta was most often found in those with HBs-Ag, followed by those with anti-HBc alone or with anti-HBs. The prevalence of anti-Delta augmented from 7% in 1980 to 22% in 1984 in drug addicts and from 0 to 54% in homosexuals. The diagnostic testing for anti-Delta can presently be restricted to hepatitis B patients who are homosexuals or drug addicts. However, this policy might have to be changed if the epidemic situation changes. Vaccination against hepatitis B is the best prophylactic measure to inhibit the further spread of HDV infections.