Prevalence of active Charcot disease in the East Midlands of England.

AIMS: To undertake a prospective point prevalence study of the prevalence of active Charcot neuro-inflammatory osteoarthropathy (Charcot disease) in a circumscribed part of England and to audit the time elapsing between disease onset and first diagnosis. METHODS: The prevalence of active Charcot disease of the foot during a single month was assessed by specialist foot care teams at seven secondary care services in the East Midlands region of England. RESULTS: A total of 90 cases were identified, representing 4.3 per 10 000 of the 205 033 total diabetes population of the region. The time elapsed from first presentation to any healthcare professional until diagnosis was also assessed. While the diagnosis was suspected or confirmed in one-third of patients within 2 weeks, it was not made for 2 months or more in 23 patients (24%). CONCLUSIONS: Non-specialist professionals should have greater awareness of the existence of this uncommon complication of diabetes in the hope that earlier diagnosis will lead to lesser degrees of deformity.

Antibacterial essential oils in malodorous cancer patients: clinical observations in 30 patients.

Malodorous necrotic ulcers in cancer patients are of major concern as it leads to social isolation and poor quality of life. Current medications and topical therapies have proven inadequate in their ability to reduce foul smell to acceptable levels. We report the positive experience we have had in using antibacterial essential oils in patients with incurable head and neck cancer and associated malodorous necrotic ulcers. All patients received a standard course of therapy with oral or systemic antibiosis. In addition, we rinsed the ulcers with an antibacterial essential oil mix (mainly based on Eucalyptus oil) twice a day. All patients experienced complete resolution of the foul smell by only the third or fourth day of therapy. As a secondary effect we saw that besides smell reduction the oils had anti-inflammatory effects on neoplastic ulcers. In some patients ulcers started to heal and achieved complete re-epithiliazation. The patients experienced great personal relief upon resolution of their malodorous conditions. Quality of life improved significantly with the resulting reintroduction of social contact with friends and relatives.

Self-adapting washer system for lag screw fixation of mandibular fractures. Part II: In vitro mechanical characterization of 2.3 and 2.7 mm lag screw prototypes and in vivo removal torque after healing.

The aim of this study was to mechanically characterize self-tapping 2.3 and 2.7 mm titanium lag screw prototypes which are part of the newly developed 'self-adapting washer' maxillofacial lag screw osteosynthesis system. In vitro in a screw testing machine the insertion torque, maximum locking torque and axial force and the ultimate torsional strength were assessed. In vivo in six miniature pigs using a mandibular symphyseal fracture model, the removal torques after 3 and 6 months of healing were measured. Additionally the bone-metal contact (BMC) of the screws was assessed histometrically. The maximum insertion torque (0.185 Nm) was far below the mechanical limits of the screws (2.3 mm = 0.96 Nm, 2.7 mm = 1.6 Nm). A tightening of the 2.7 mm screw with an axial force of 1000 N and of the 2.3 mm screw with 500-550 N leaves a safety margin of approximately one-third on the ultimate torsional strength. Clinically these values permit the use of two 2.3 mm lag screws or one 2.7 mm lag screw in mandibular symphysis fractures since 1000 N tensile axial force are required in this indication. During screw removal after 6 months healing, torque levels close to the mechanical limits of the screws were recorded and screw failures were observed. This failure rate may have been due to the BMC of 49.8% which was in the range of titanium dental implants. Accordingly the screw heads were reinforced to prevent fractures.

[Differentiation of allotments for occupationally necessary and hygiene relevant costs of air technology designs for operating rooms]. / Differenzierung des arbeitsmedizinisch erforderlichen sowie des hygiene-relevanten Kostenanteils raumlufttechnischer Anlagen für Operationsräume.

The aeration of operation theatres serves multiple purposes. It is necessary for the regulation of room temperature (waste heat generated by the operation team and technical appliances), air exchange for oxygen supply, removal of narcotic gases and of smells (occupational limit values) as well the elimination of germs and particles emitted during operations by staff and from instruments (avoidance of germ transfer by air). This paper tries on the one hand to estimate the investment and running costs of different indoor air supplies according to the specifications given by DIN 1946, parts 2 and 4) and on the other hand to differentiate the hygienically relevant expenses of turbulent and laminar flow air supply systems. It can be seen that, due to the high heat production generated during operations, no cost can be saved through decreases in air flow volume. Depending on the operation frequency (e.g. 4 operations daily, 200-300 days per year) a hygienically relevant cost of DM 2.8-6.7 per patient is calculated for laminar flow supplies and DM 4.5-6.7 per patient for the turbulent air supply systems ("Stützstrahl"). Thus laminar flow systems are also cost-saving in comparison to turbulent air supply systems in addition to their significant technical and hygienic advantages.