[Epidemiology, Clinical Presentation, Diagnosis and Treatment of Infections Caused by Mycobacterium chimaera]. / Epidemiologie, Klinik, Diagnostik und Therapie von Infektionen durch Mycobacterium chimaera.

The recognition, correct diagnosis and adequate clinical management of infections caused by atypical mycobacteria are challenging tasks in clinical practice. Invasive infections caused by Mycobacterium chimaera, a member of the Mycobacterium avium-intracellulare complex, have been increasingly reported over the past few years. Most infections occurred in patients who had undergone open-chest cardiothoracic surgery. Epidemiological and molecular studies showed that transmission of M. chimaera occurred through intraoperative aerosols derived from contaminated heater-cooler units, i. e. devices that are used to enable the extracardiac circuit in cardiothoracic surgery. Thus far, approximately 120 patient cases have been reported worldwide. The latency between exposure and onset of clinical symptoms may comprise several years. Clinical manifestations of M. chimaera infections include not only endocarditis and implant-associated infections, but also non-cardiac entities such as sarcoidosis-like symptoms, vertebral osteomyelitis and chorioretinitis. The pathogen can be detected in blood culture vials and in surgically obtained specimens from affected tissues, if specific microbiological tests for detection of mycobacteria are employed. There are no simple-to-use screening tests and a high clinical index of suspicion is thus mandatory in patients with previous exposure and compatible signs and symptoms. The successful treatment of M. chimaera infections requires the removal of infected devices and prolonged combination therapy with antimycobacterial drugs. This review summarises the clinical relevance, epidemiology, symptomatology, diagnosis and treatment of infections caused by M. chimaera, with a specific focus on pneumological aspects.

Computerized axiographic evaluation of condylar movements in cases with fractures of the condylar process: a follow up over 19 years.

The treatment of fractures of the mandibular condylar process(es) can be conservative or surgical. However, in many cases, a definitive judgment on the functional long-term outcome of the chosen therapy can only be given many years after the intervention. As a result, it is clearly useful to be able to review the effects of treatment undertaken at least 15 years previously. Even so, only two such studies have been identified. Therefore, the aim of the present study is to evaluate the current functional capacity of the mandibular condyles of 20 subjects who had had an uni- or bilateral fracture of the condylar process, on average 19 years ago. The individuals, who all had been treated conservatively, were compared with a control group of healthy volunteers matched for gender and age. Besides measuring maximum mouth opening (MMO), computerized axiographies in the sagittal plane were made for each condyle during MMO, maximum protrusion and maximum mediotrusion. In spite of the high degree of inter-individual variability in both groups, the data showed that the amount of condylar movement was in most cases greater in the control group. In general, it appears that the risk of developing functional problems after conservative treatment is highest in the case of a fracture of the condylar process accompanied by condylar luxation, rather than by a condylar dislocation or without it.

[Late results of 15 years and longer after mandibular condyle fractures]. / Spätergebnisse bei 15 Jahre und länger zurückliegenden Kiefergelenkfortsatzfrakturen.

A sample of 91 patients who had suffered from condylar fractures in the years 1970-1977 could be followed up. The mean follow up period was 19.8 years. As a prognostic relevant parameter the patient's age at the time of the accident as well as the type of the fracture where taken into account. Clinically young (8-11 years at the time of the accident) patient's with no or low grade dislocation showed the best results. Almost 36% of the patients with high grade dislocation or luxation presented measurable pathological changes during function. The condylar movement was assessed by using 3D-optoelectronic measurement. Despite severe radiographic alterations and hindered condylar translation in cases with high grade dislocation or luxation, mouth opening was not restricted in the majority of the patients. It seems that the lack of condylar translation is compensated by extensive rotation.