CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip.

Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1% mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain.

[Early results of a prospective study in patients with computer-assisted femur shaft preparation in total hip endoprosthesis implantation (Robodoc system)--indications, outcome, complications]. / Frühergebnisse einer prospektiven Studie bei Patienten mit computergestützter Femurschaftpräparation bei Hüft-TEP-Implantationen (System Robodoc)--Indikation, Ergebnisse, Komplikationen.

AIM: Indications, results, advantages and disadvantages of the computer-guided femoral preparation in total hip arthroplasty (Robodoc) in our patients are recorded and represented. METHOD: 41 patients who underwent a computer-guided femoral preparation in total hip arthroplasty (Robodoc) were examined after 1 year on average in a prospective study. The evaluation was made using the Harris Hip Score. The advantages and disadvantages of the Robodoc-assisted surgery are described. RESULTS: More than 80% of the patients had a good or very good result (> 80 points of Harris Hip Score) 3 month after surgery; after 6 months in 20 of 21 patients a score of more than 85 pts. was calculated. The following complications were noticed: thrombotic embolism (2) with one lethal embolism included, fracture of the greater trochanter using the straight stem (3), aseptic drainage due to hematoma (2). 12 patients noticed a postoperative pain at the distal marking pin location (condylus femoris medialis) for an average of 3 months. CONCLUSION: Generally, Robodoc-assisted surgery may be performed in all uncemented total hip arthroplasties. The individual indication should be checked because of the increased effort of surgery, the advantages and disadvantages, and the non-proven better long-term results in comparison to the regular technique. It seems that the Robodoc system provides advantages in post-traumatic arthritis and deformities of the proximal femur (varus and valgus neck) on account of the computer-aided preoperative planning and correct operative realization.

Cooled microwave transrectal applicator with adjustable directional beam for prostate treatment.

A new intracavitary applicator design for microwave hyperthermia, particularly for transrectal prostate treatment, is presented. It includes an exchangeable multisection antenna that enables us to create a required longitudinal heating pattern, a cooling system to shift the maximum temperature away from the surface and a microwave reflecting system embedded in the cooling system that allows one to shape the irradiation beam in a transverse direction. Independent control of the longitudinal and transverse irradiation patterns of the applicator along with the cooling system, enable precise heating of selected tissues. Results of SAR measurements, E-field measurements and steady state temperature distributions, in solid and liquid tissue-equivalent phantoms are presented. Clinical performance of this applicator was evaluated earlier in patients heated intraoperatively and in a phase I clinical study. The applicator was found capable of effectively heating a tissue volume extending radially 3-25 mm from the applicator surface, angularly defined by configuration of reflecting system and longitudinally determined by specific choice of the multisection antenna.