[Conception and Preliminary Evaluation of a Rehabilitation-Attending Counseling Service for Caregivers of Stroke Patients]. / Konzeption und erste Evaluation eines rehabilitationsbegleitenden Beratungsangebots für Angehörige von Schlaganfallpatienten.

This paper presents the pilot project "The Caregivers' Guide", which is financed by the German Federal Ministry of Education and Research (BMBF). The project's concept is outreach-oriented and personal, giving constant support to relatives of stroke patients throughout rehabilitation. Its effects were reviewed in an accompanying study. A combination of qualitative and quantitative methods was chosen to gather data on the experiences and assessments of the caregivers, as well as changes during the counselling process. 62 caregivers completed questionnaires before and after the intervention. Additionally, 30 qualitative interviews were carried out. Positive effects could be observed in accordance with the project goals, especially regarding provision of appropriate information, burden reduction and strengthening clients' resources. The accompaniment by a fixed reference person was viewed as helpful, the combination of professional knowledge and emotional support was deemed most essential. The concept "The Caregivers' Guide" is suitable as an impetus of innovation regarding the development of counseling structures for family caregivers.

Mussel-inspired polydopamine for bio-surface functionalization.

Surface functionalization via molecular design has been a key approach to incorporate new functionalities into existing biomaterials for biomedical application. Mussel-inspired polydopamine (PDA) has aroused great interest as a new route to the functionalization of biomaterials, due to its simplicity and material independency in deposition, favorable interactions with cells, and strong reactivity for secondary functionalization. Herein, this review attempts to highlight the recent findings and progress of PDA in bio-surface functionalization for biomedical applications. The efforts made to elucidate the polymerization mechanism, PDA structure, and the preparation parameters have been discussed. Interactions between PDA coatings and the various cell types involved in different biomedical applications including general cell adhesion, bone regeneration, blood compatibility, and antimicrobial activity have also been highlighted. A brief discussion of post-functionalization of PDA and nanostructured PDA is also provided.

[Current role of minimally invasive total knee arthroplasty. A meta-analysis]. / Aktueller Stellenwert der minimalinvasiven Knieendoprothetik : Eine Metaanalyse.

Minimally invasive approaches are increasingly being used in total knee arthroplasty. By means of a review of the literature the pros and cons of minimally invasive approaches for total knee arthroplasty were analyzed. The potential advantages of reduced postoperative pain and improved early range of motion and mobility are opposed by the risks of malpositioning of the prosthetic components and impaired wound healing. Long-term improvement of knee function and quality of life should not be compromised by techniques promising temporary or secondary advantages.

[Analysis of the effectiveness of an internal hospital bone bank]. / Effektivitätsanalyse einer klinikinternen allogenen Knochenbank.

BACKGROUND: The EU guidelines 2004/23/EG and 2006/17/EG and their national implementation redefine the framework for allogenic bone banking and transplantation. Against this background an established internal hospital bone bank was analysed concerning threshold of allogenic bone and cost effectiveness in comparison to alternative methods. METHOD: Over a 30-month period we registered all arrivals and outgoings of our bone bank and their destination. We further noted all declined donations. We analysed all costs incurred and calculated costs for alternative methods. RESULTS: By means of our bone bank we are currently able to meet our own demand for bone substitutes. The maintenance costs are below the prices of alternative methods. Some donations (8%) have to be discarded due to procedural errors. CONCLUSION: Maintaining an internal hospital bone bank utilizing fresh-frozen allogenic bone is an efficient and cost-effective method of supplying bone substitutes even under the new EU guidelines if the existing process covers most conditions of the producer authorisation according to section sign 13 AMG. By harmonizing the organizational process it is possible to further improve its effectiveness.

[First results with catheter and magnetically guided and detached polymerized ferromagnetic particle filaments and heat-induced particle release using the Stereotaxis Niobe system]. / Erste In-vitro-Anwendung katheter- und magnetgesteuerter ferromagnetischer Polymerfilamente aus Nanopartikeln mit hitzeinduzierter Partikelabgabe unter Einsatz des Stereotaxis-Niobe-Systems.

PURPOSE: To develop a new technique for intravascular guidance and the release of magnetized ferromagnetic nanoparticles using a polymerized filament by means of an external magnetic field. MATERIALS AND METHODS: Ferromagnetic nanoscaled beads were embedded in temperature-sensitive gels to form filaments after polymerization. Deflection of the filaments was assessed in a Stereotaxis Niobe magnetic navigation system (MNS) in comparison with dedicated guide wires. The curvature was measured as a surrogate parameter for deflection. In combination with commercially available catheters, the filaments were navigated in a perfused aneurysmatic vessel model and a perfused branched vessel model under the influence of two permanent magnets of the Niobe MNS. The magnetic field vector was varied in all three dimensions. After positioning, the magnetic colloid-containing filaments were exposed to an electromagnetic field of 45 kA/m, 200 kHz for a period of 5 minutes for non-invasive heating. RESULTS: The filaments showed superior deflectability compared to the dedicated guide wires (p = 0.0091). The curvature was 0.54 +/- 0.12 mm(-1) for the filaments and 0.33 +/- 0.21 mm(-1) for the guide wires. In combination with angiography catheters, magnetic guidance and accumulation of specially designed filaments were possible in the perfused vessel model. Inductive heating allowed non-invasive disintegration and releasing of the nanoparticles in all filaments. CONCLUSION: This feasibility study shows that magnetic guidance and targeting of a specially designed magnetic colloid-containing filament and subsequent disintegration are feasible. This technique offers the potential for controlled local drug release.

Indications for total hip replacement: comparison of assessments of orthopaedic surgeons and referring physicians.

OBJECTIVES: To analyse differences of opinions on indications for primary total hip replacements (THRs) within and between groups of orthopaedic surgeons and the physicians who refer patients to them. METHODS: 22 orthopaedic centres in 12 European countries took part, resulting in a postal survey of 304 orthopaedic surgeons and 314 referring physicians. Each participant was asked to state what importance different domains (pain, functional impairment, physical examination and radiographs) have on their decision to recommend THR and to select the most appropriate level of severity of each symptom or sign for recommending THR. In addition, the participants were asked to prioritise other personal or environmental factors that affect their decision to undertake a THR. RESULTS: Rest pain, pain with activity and functional limitations were the most important criteria for THR, although range of motion and radiographic changes were of least importance. Both similarities and differences were observed within and between groups of surgeons and referring physicians in the overall approach to indications and the most appropriate level of severity of disease for recommending THR. Most surgeons agreed on severity levels in only 4 of 11 items and most referring physicians in only one. Between the groups, major differences occurred with regard to the importance of activities of daily living and the appropriate level of symptoms for THR. In general, compared with surgeons, referring physicians reported that the disease needed to be more advanced to warrant surgery. CONCLUSION: Currently, no consensus exists on objective indication criteria for THR. The observed differences between the gatekeepers (referring physicians) and surgeons can lead to variations and perhaps inequities in the provision of care.

[Is there a correlation between clinical results or quality of life and radiological findings after implantation of a total knee prosthesis?]. / Besteht eine Korrelation zwischen klinischen Ergebnissen oder der Lebensqualität und dem radiologischen Befund nach Implantation einer totalen Knieendoprothese?

AIM OF THE STUDY: To establish whether there is a clinical correlation between clinical outcome or quality of life and radiographic findings. MATERIAL AND METHODS: 17 patients (mean age 68.2 years) with total knee arthroplasty were examined after an average follow-up of 24.6 months. The examination included the HSS score for clinical parameters, and the SF-36 questionnaire quality of life. Radiographs were evaluated in accordance with Ewald and Lotke, and a schema of our own. RESULTS: The HSS score returned a mean of 81 points, and the SF-36 questionnaire showed significantly poorer results in comparison with age-matched healthy subjects. The Lotke evaluation of the X-rays showed a mean value of 76.3. Correlations between the radiographic findings and the HSS score were not seen. Correlations between X-ray parameters (Ewald and Lotke) and the SF-36 were found only for pain and vitality. CONCLUSIONS: This is the first study to investigate the correlation between clinical parameters (including quality of life) and X-ray findings. Neither the clinical score nor the quality of life score was found to correlate with the radiographic findings. Nor was more than minimal correlation found between quality of life and HSS score. These results show that the presence of radiolucent lines or deviations from the perfect prosthesis position must not necessarily be considered to be of importance for clinical outcome and quality of life.

[Quality of life improvement (SF-36) after implantation of a knee endoprosthesis]. / Lebensqualitätsgewinn (SF-36) nach Implantation einer Knieendoprothese.

From a group of 41 consecutive patients receiving an endoprosthetic knee replacement 35 patients underwent complete pre- and postoperative documentation of life quality in the short term follow-up. The comparison of pre- and postoperative life quality assessment with the SF-36 form showed significant differences on the 5% level for the categories "somatic pain" and "psychological wellness". The parameter "somatic functionality" showed with a P-value of 0.0616 almost significant improvement. The other parameters also showed improved values without reaching statistical significance. In summary, after implantation of a total knee replacement an improvement of life quality can be documented.

Interdependence of clinical and isokinetic results after bicondylar knee prostheses with special emphasis on quality of life results.

Nineteen patients were examined at an average follow-up of 2 years after total knee joint replacement without patella resurfacing. They were compared with 22 healthy subjects of the same age. Using the Hospital for Special Surgery (HSS) score the operated knee joints scored an average of 77 points, the contralateral side scored 87 points and the control group 97 points. In the SF-36 health questionnaire the patients showed highly significant deviations. Isokinetic measurements revealed a clear loss of isokinetic strength of more than 50% on average in flexion as in extension when compared to the control group and there were considerable asymmetries between the operated and the contralateral legs.

[Shoulder joint instability after primary arthroplasty]. / Schulterinstabilität nach primärem Schultergelenkersatz.

Instability is one of the most common complications after shoulder arthroplasty. The literature cites subluxation or luxation to occur between 0% and 38% in various studies. Instabilities may present either as subluxation or frank dislocation, and may be directed in an anterior, posterior, inferior or, depending on the state of the rotator cuff, cranial direction. The stability of any shoulder joint is given by the balance of the muscles directing the forces around the shoulder joint in association with the passive stabilizers of the shoulder joint capsule as well as the bony contours between glenoid and humeral head. Any disturbance of this delicate balance will lead the shoulder into instability, particular so if bony erosion patterns such as posterior glenoid wear in osteoarthritics will develop subluxation early on. Therefore implantation of any prosthesis is required to be done in the appropriate version as to avoid secondary instability through the prosthetic components. In the study undertaken here instability was found to be the most common complication in 44 shoulder revision surgeries. The result with an average Score of 41.9 recorded after Constant demonstrates that the excellent and good results obtained with primary arthroplasties can not be expected in revision surgery. Posterior instability may be present just as well as the more easily observed anterior instability. Separate to frank luxation or instability is the late cranialisation of the rotator cuff deficient shoulder which, although resulting in many cases in superior anterior subluxation, will mostly be seen as a late complication after arthroplasty.

Shoulder instability after primary shoulder joint replacement.

Instability is one of the most common complications after shoulder arthroplasty. The literature cites subluxation or luxation to occure between 0 % and 38 % in various studies. Instabilities may present either as subluxation or frank dislocation, and may be directed in an anterior, posterior, inferior or, depending on the state of the rotator cuff, cranial direction. The stability of any shoulder joint is given by the balance of the muscles directing the forces around the shoulder joint in association with the passive stabilizers of the shoulder joint capsule as well as the bony contours between glenoid and humeral head. Any disturbance of this delicate balance will lead the shoulder into instability, particular so if bony errosion patterns such as posterior glenoid wear in osteoarthritics will develop subluxation early on. Therefore implantation of any prosthesis is required to be done in the appropriate version as to avoid secondary instability through the prosthetic components. In the study undertaken here instability was found to be the most common complication in 44 shoulder revision surgeries. The result with an avarage Score of 41.9 recorded after Constant demonstrates that the excellent and good results obtained with primary arthroplasties can not be expected in revision surgery. Posterior instability may be present just as well as the more easily observed anterior instability. Separate to frank luxation or instability is the late cranialisation of the rotator cuff deficient shoulder which, although resulting in many cases in a superior anterior subluxation, will mostly be seen as a late complication after arthroplasty.

Sevoflurane for ENT-surgery in children. A comparison with halothane.

Sevoflurane, a new volatile anesthetic agent, is of great potential interest in pediatric anesthesia. Its use for ENT surgery in children was compared with halothane in this study. Altogether 40 children participated in the investigation. In 18 (median age 4.2 years), halothane was used. The remainder (median age 4.0 years) were anesthetized with sevoflurane. After rectal premedication with midazolam and atropine, anesthesia was induced by mask (the agent in O2/N2O, 40/60) using a Mapleson D system. The trachea was intubated without the use of muscle relaxants and the children were then allowed to breathe spontaneously at fresh gas flows set high enough to avoid rebreathing. Hemoglobine oxygen saturation (SpO2), inspired and expired gas concentrations, respiratory rate (RR), heart rate (HR), ECG and blood pressure were followed. Equianesthetic concentrations of the agents were used and induction characteristics were comparable between the two agents. RR and end-tidal CO2 tensions were similar in the two groups. HR and systolic blood pressures were, however, higher with sevoflurane. Cardiac arrhythmias were seen more frequently with halothane (61%) than with sevoflurane (5%). During emergence, postoperative nausea/vomiting was more frequent after halothane anesthesia. Initially, postoperative excitement occurred more often after sevoflurane, when paracetamol was given during anesthesia, which was reduced (P < 0.01) when paracetamol was given at the time for premedication. It is concluded that sevoflurane is an excellent induction agent, and maintains heart rate and systolic blood pressure better than when halothane is used. The incidence of cardiac arrhythmia is lower with sevoflurane than with halothane.(ABSTRACT TRUNCATED AT 250 WORDS)