Perinatal and long-term outcome of fetal intracranial hemorrhage: systematic review and meta-analysis.

OBJECTIVE: Fetal intracranial hemorrhage (ICH) is associated with an increased risk of perinatal mortality and morbidity. Healthcare professionals often find it challenging to counsel parents due to its rarity and diverse presentation. The aim of this systematic review and meta-analysis was to investigate the perinatal outcome of fetuses with ICH. METHODS: MEDLINE, EMBASE, ClinicalTrials.gov and The Cochrane Library databases were searched. Inclusion criteria were studies reporting the outcome of fetuses, newborns and infants diagnosed with ICH. The primary outcome was perinatal death (PND), defined as the sum of intrauterine (IUD) and neonatal death (NND). The secondary outcomes were stillbirth, NND, IUD, termination of pregnancy, need for surgery/shunting at birth, cerebral palsy (defined according to the European Cerebral Palsy Network and classified as diplegia, hemiplegia, quadriplegia, dyskinetic or mixed), neurodevelopmental delay and intact survival. All outcomes were explored in the included fetuses with ICH. A subgroup analysis according to the location of the hemorrhage (intra-axial and extra-axial) was also planned. Meta-analysis of proportions was used to combine data, and pooled proportions and their 95% CI were reported. RESULTS: Sixteen studies (193 fetuses) were included in the meta-analysis. PND occurred in 14.6% (95% CI, 7.3-24.0%) of fetuses with ICH. Among liveborn cases, 27.6% (95% CI, 12.5-45.9%) required shunt placement or surgery after birth and 32.0% (95% CI, 22.2-42.6%) had cerebral palsy. Furthermore, 16.7% (95% CI, 8.4-27.2%) of cases had mild neurodevelopmental delay, while 31.1% (95% CI, 19.0-44.7%) experienced severe adverse neurodevelopmental outcome. Normal neurodevelopmental outcome was reported in 53.6% of fetuses. Subgroup analysis according to the location of ICH showed that PND occurred in 13.3% (95% CI, 5.7-23.4%) of fetuses with intra-axial bleeding and 26.7% (95% CI, 5.3-56.8%) of those with extra-axial bleeding. In fetuses with intra-axial hemorrhage, 25.2% (95% CI, 11.0-42.9%) required shunt placement or surgery after birth and 25.5% (95% CI, 15.3-37.2%) experienced cerebral palsy. In fetuses with intra-axial hemorrhage, mild and severe neurodevelopmental delay was observed in 14.9% (95% CI, 12.0-27.0%) and 32.8% (95% CI, 19.8-47.4%) of cases, respectively, while 53.2% (95% CI, 37.0-69.1%) experienced normal neurodevelopmental outcome. The incidence of mortality and postnatal neurodevelopmental outcome in fetuses with extra-axial hemorrhage could not be estimated reliably due to the small number of cases. CONCLUSIONS: Fetuses with a prenatal diagnosis of ICH are at high risk of perinatal mortality and adverse neurodevelopmental outcome. Postnatal shunt placement or surgery was required in 28% of cases and cerebral palsy was diagnosed in approximately one-third of infants. Due to the rarity of ICH, multicenter prospective registries are warranted to collect high-quality data. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Intravenous lacosamide for treatment of absence status epilepticus in genetic generalized epilepsy: A case report and review of literature.

BACKGROUND: Nearly 10 years after its introduction into the market, the significance of lacosamide in genetic generalized epilepsies is still unclear. Its new mode of action may qualify lacosamide as a therapeutic agent in this entity, but only a limited number of cases have been published so far. AIM: To describe the efficacy of lacosamide as treatment in a patient with the absence status epilepticus. METHOD: We report on a 28-year-old woman with genetic generalized epilepsy who suffered recurrent absence status epilepticus during video-EEG-monitoring. After treatment failure of first- and second-line medication, lacosamide was administered. The outcome in this patient was evaluated, and a systematic literature review was performed for the use of lacosamide in the absence status epilepticus. RESULTS: After application of 400 mg lacosamide intravenously, the absence status epilepticus terminated within 30 minutes. No further seizures or epileptiform discharges reoccurred until the end of video-EEG-Monitoring 3 days later. CONCLUSIONS: The role of lacosamide as a therapeutic option in patients with the absence status epilepticus is unclear. Only two cases have been reported so far with conflicting results. Further randomized controlled studies are required to validate the relevance of lacosamide as treatment for status epilepticus in genetic generalized and the absence epilepsy.

Dynamic signatures of the transition from stacking disordered to hexagonal ice: Dielectric and nuclear magnetic resonance studies.

Using various temperature-cycling protocols, the dynamics of ice I were studied via dielectric spectroscopy and nuclear magnetic resonance relaxometry on protonated and deuterated samples obtained by heating high-density amorphous ices as well as crystalline ice XII. Previous structural studies of ice I established that at temperatures of about 230 K, the stacking disorder of the cubic/hexagonal oxygen lattice vanishes. The present dielectric and nuclear magnetic resonance investigations of spectral changes disclose that the memory of the existence of a precursor phase is preserved in the hydrogen matrix up to 270 K. This finding of hydrogen mobility lower than that of the undoped hexagonal ice near the melting point highlights the importance of dynamical investigations of the transitions between various ice phases and sheds new light on the dynamics in ice I in general.

Till receipts--a new approach for investigating outbreaks? Evaluation during a large Salmonella Enteritidis phage type 14b outbreak in a North West London takeaway restaurant, September 2009.

Selecting suitable controls for outbreak investigations is often difficult and if done inappropriately will lead to biased inferences. Till receipts and other sales records are frequently available on food premises, but their applicability has not been fully explored. Using data from an investigation into a Salmonella outbreak affecting 66 individuals exposed in a London takeaway restaurant, this study aimed to evaluate the use of till receipts to assess associations between sales and illness. Cases identified through local case-finding were subjected to a standardised exposure questionnaire. Till receipts over the time period when cases arose were analysed. Estimated food exposures from sales were compared to case reported exposures and till receipts analysis showed strong association between illness and consumption of rotisserie chicken (odds ratio (OR): 2.75; confidence interval (CI): 1.7-4.5). Chicken sales immediately prior to food consumption for cases were compared to two control periods in an ecological case-crossover design. On average there was an estimated increase of 3.7 (CI: 2.2-5.2) extra chickens sold in the hour immediately prior to the consumption in the cases (p<0.0001) and the risk of becoming ill at busy times increased by 5% with each additional chicken quarter sold per hour (OR: 1.05; CI: 1.03-1.08). Microbiological and environmental investigations revealed Salmonella Enteritidis phage type (PT)14b in all available cases' stool samples, two environmental samples and leftover chicken from the takeaway. The feasibility of this novel approach to obtain exposure information in the population at risk has been demonstrated, and its limitations are discussed. Further validation is required, comparing results with those in a concurrent classic case-control study.

Health-related quality of life and somatization in patients with long-term low back pain: a prospective study with 109 patients.

STUDY DESIGN: For this study, a prospective cohort of 109 patients was recruited consecutively at an orthopedic inpatient unit of a university hospital. Three self-report instruments were administered to patients with sciatica believed to be caused by a herniated lumbar disc to examine their quality of life and psychic stress at baseline and at the 1-year follow-up visit. OBJECTIVES: To investigate whether patients who have undergone a previous discectomy experience greater psychic stress than patients with no surgery, and to determine whether the groups differed regarding their health-related quality of life at the follow-up visit. SUMMARY OF BACKGROUND DATA: Previous studies have described psychic abnormalities in patients with long-term back pain, particularly patients with severe chronicity (i.e., history of surgeries and persistent problems) or those who underwent a previous discectomy. Additionally, a series of studies has shown that psychic and psychosocial parameters exert a significantly greater influence on the success of treatment than do clinical and imaging findings or the extent of disc abnormality. METHODS: The Short Form Health Survey 36, the Symptom Checklist 90, and Screening for Somatoform Disorders were administered to 109 patients consecutively treated in the authors' orthopedic university clinic, at baseline and at the 1-year follow-up visit. RESULTS: In all the patients examined, the physical and mental quality of life improved regardless of their group classification. The psychological distress, according to the Symptom Checklist 90, was clearly reduced in both groups at the follow-up visit, with the exception of somatization, as indicated by Symptom Checklist 90 and Screening for Somatoform Disorders. Whereas the patients who had undergone surgery remained nearly unchanged with regard to their somatization, the patients with no previous surgery improved significantly, as indicated by Screening for Somatoform Disorders and Symptom Checklist 90. Somatization, particularly that surveyed by the comprehensive Screening for Somatoform Disorders, proved to be quite a stabile factor over time in both groups. The extent of the physical impairment before treatment was nearly the same in both groups, as indicated by Short Form Health Survey 36. Despite a markedly higher chronicity of reported problems, patients who had undergone surgery were hardly more greatly impaired in terms of their mental quality of life and psychological distress, as indicated by Symptom Checklist 90, than those without a history of surgery. At the follow-up visit, the differences tended to be minimal as well. As compared with those who had no previous surgeries, the patients who had undergone surgery were significantly more heavily impaired in their physical quality of life despite significant improvements. CONCLUSIONS: Patients with sciatica demonstrated less abnormality in terms of the psychopathologic markers investigated than described in previous studies. Nevertheless, the predisposition to somatize influences health-related quality of life to a high degree.

[Radiological assessment of loss of disk height in acute and chronic degenerative lumbar disk changes]. / Radiologische Beurteilung der segmentalen Höhenabnahme bei akuten und chronisch degenerativen lumbalen Bandscheibenveränderungen.

AIM OF THE STUDY: A loss of disc height with increasing segmental mobility is an important reason for low back pain. The measurement of hyaluronic acid content of the nucleus pulposus prolaps shows a difference between acute (group 1) and chronic (group 2) disc degeneration. The purpose of the present investigation was to determine the decreasing of disc height between these two groups and the not-symptomatic segments of these patients. METHODS: 20 human lateral preoperative X-rays measurements according to Frobin et al. [1] were taken; group 1 with 7 patients (mean age 41 years) and group 2 with 13 patients (mean age 44 years). RESULTS: There was a significant tendency (p = 0.091) to a reduction of disc height in group 2 between symptomatic and asymptomatic discs. CONCLUSION: The used method is not suitable to answer the present question conclusively.

[Low-field MR arthrography of the shoulder: early results using an open 0.2T MR system]. / Niederfeld MR-Arthrographie der Schulter: Erste Ergebnisse mit einem offenen 0,2 T MR-System.

PURPOSE: To assess the practicability and image quality of doing MR arthrography of the shoulder using a 0.2T system. PATIENTS AND METHOD: 60 patients (24 with chronic instability, 36 with impingement syndrome) were examined in an open 0.2T MR apparatus (Magnetom Open, Siemens). After the intra-articular injections of 15-20 ml of a 2 mmol Gd-DTPA solution, coronary STIR, T1-weighted, sagittal and axial T2*-weighted FLASH 2D sequences were performed. 21 patients subsequently underwent surgery. RESULTS: Image quality of the T1- and T2*-weighted FLASH 2D sequences was regarded as good or adequate and movement artifacts were minor or moderate. STIR sequences were statistically significantly worse in respect of image quality and movement artifacts (p < 0.001, p < 0.005). The sensitivity and specificity in the diagnosis of rotator cuff rupture as confirmed by surgery was 100% (labrum lesions 100%, 93%). Agreement in the diagnosis of rupture of the supraspinatus and infraspinatus tendons was 0.93 and 0.65. CONCLUSION: MR arthrography of the shoulder using an open 0.2 T MR system provides adequate information concerning the intra articular structures of the joint. The disadvantage is the prolonged duration of the examination with the risk of poor image quality resulting from movement artifacts.

Prolonged-release oxycodone/naloxone in postoperative pain management: from a randomized clinical trial to usual clinical practice.

OBJECTIVE: These studies evaluated the feasibility of using oral prolonged-release oxycodone/naloxone (OXN PR) for the management of acute postoperative pain. METHODS: Three studies were undertaken: (i) the analgesic efficacy of OXN PR was compared with prolonged-release oxycodone (OXY PR) in patients with knee arthroplasty in an immediate postoperative period (IPOP) study; (ii) OXN PR treatment was compared with other opioids during rehabilitation after knee arthroplasty in a noninterventional study (NIS); and (iii) surgical patients on other opioids were switched to OXN PR postoperatively during a quality improvement programme (QIP). RESULTS: In the IPOP study, the pain intensity at rest score decreased by a similar amount in the OXN PR and OXY PR groups, indicating similar analgesic efficacies. In the NIS, patient assessments indicated enhanced efficacy and tolerability for OXN PR compared with other opioids. The QIP indicated significant improvements in bowel function and less difficulty passing urine at the end of OXN PR treatment compared with baseline. No safety concerns were raised. CONCLUSIONS: The analgesic efficacies of OXN PR and OXY PR were similar in postoperative pain settings. OXN PR reduced the degree of restriction in relation to patients carrying out physiotherapy compared with other opioids, and improved bowel and bladder function.

[Effect of enucleation on the biomechanical behavior of the lumbar motion segment]. / Der Einfluss einer Nukleotomie auf die biomechanischen Eigenschaften des lumbalen Bewegungssegmentes.

OBJECTIVES: The purpose of the present investigation was to determine the influence of nucleotomy for the biomechanical properties of the lumbar motion segment. METHODS: From 11 human cadavers the lumbar-vertebral segment L3/4 was taken. The segment was tested by an 3D testing device. Measurements were taken under physiological loads up to 7 Nm. Load application was performed in flexion/extension, lateral bending and rotation direction. For each step translation and rotation were measured in three axis of space. Next measurement was performed after a nucleotomy simulated by rectangular excision of the anulus and total nucleotomy on an average of 6 g tissue. RESULTS: There was a significant relation (p < 0.05) between removed disc material and flexibility of the lumbar motion segment. CONCLUSION: The nucleotomy plays a crucial role in the segmental mobility.

[Surgical peri- and postoperative plexus anesthesia in subacromial decompression of the shoulder]. / Begleitende peri- und postoperative Plexusanästhesie bei subacromialer Dekompression der Schulter.

AIM: The aim of the present investigation was to check the peri- and postoperative plexus anesthesia on early functional outcome and postoperative analgetic consumption during subacromialen decompression until the date of discharge. METHODS: 50 patients in the period 01.01.1997 to 01.10.1998 treated by an arthroscopic or open subacromial decompression of the shoulder were registered. Pre- and postoperative functional movement and postoperative analgetic consumption within the first 12 days after the operation were compared according to the procedure used. RESULTS: The peri- and postoperative plexus anesthesia had a positive influence to early functional outcome as well as on the analgetic consumption. The results are shown in the group of arthroscopic (18) surgery and in the group of the patients operated in an open (32) technique. The patients with plexus anesthesia showed a better functional movement of the shoulder directly postoperatively and a lower consumption analgetic drags. At the time of discharge we found no significant differences between the subjects in both groups. CONCLUSION: The investigation shows that peri- and postoperative plexus anesthesia has no positive influence on the early functional outcome after subacromial decompression of the shoulder.

[3-dimensional biomechanical study of a new flexible lumbar intervertebral disk implant]. / Dreidimensionale biomechanische Untersuchung eines neuen flexiblen lumbalen Bandscheibenimplantats.

The aim of this study was to determine the significance of a new artificial nucleus implant for lumbar discs (polymethyl siloxane polymer, DR-PMSO) with special regard to the biomechanical properties of the spinal motion segment. The lumbar segments L1/L2 and L4/L5 were harvested from six calf cadavers. The segments were fixed on a special device mounted on a three-dimensional testing machine. Physiological load with a maximum of 7 Nm was applied in flexion/extension, right and left lateral bending, and right and left torsion. The movement of the measuring point (center of L1 and L4) was registered along three axes (sagittal, frontal, and vertical). Three cycles of measurements were performed on all specimens: (1) intact segment, (2) segment after nucleotomy, and (3) segment with PMSO. There was a statistically significant (p = 0.0313) increase in segmental mobility in all directions after nucleotomy with an increased mobility of the segment up to 30% for rotation and 50% for translation. After introduction of the PMSO implant, segmental mobility for all movement directions was restored with no statistically significant difference from the intact situation before nucleotomy. The disc material was found to be noncytotoxic according to current ISO 10993 standards.

Neutral deoxyribonucleases of HeLa S3 cells: electrophoretic separation, characterization, substrate specificity and mode of action.

Extracts of HeLa S3 cells were electrophoresed on polyacrylamide gels; gel slices were eluted and the eluates were assayed for DNase activities against native and denatured DNA substrates in the presence of MgCl2 or Na2EDTA. Aliquots of each eluate were also assayed for their ability to nick the circular supercoiled PM2 phage DNA to distinguish endonucleases from exonucleases. Peaks of endonuclease activities were characterized as forming 3'-phospho-oligonucleotides or 5'-phospho-oligonucleotides by the use of oligonucleotides produced by these enzymes as substrates for the 5'-phosphate-specific snake venom exonuclease. The total activity of DNases in gel eluates was much higher than that in cell extract applied to the gel, indicating the presence of inhibitors in the cell extract.

[Initial instability of different cages for fusion of the cervical spine]. / Die Primärstabilität unterschiedlicher Cages zur Fusion an der Halswirbelsäule.

Purpose of the present investigation is to determine the biomechanical behaviour of different cages for monosegmental fusion of the cervical spine. Three commercially available cages (BAK, NOVUS, WING) representing the different principles of intercorporal implants and a combination of intercorporal bone graft together with anterior plating were tested for their resistance and sintering patterns under axial compression conditions. Therefore, FSU (functional spine-units) of 5-months old calfs were used. After preparation, the anterior fusion was performed by an orthopaedic surgeon. Specimen were mounted in a testing machine Zwick 1425 and axial load from 100 N up to 2000 N was applied. The compressed distance was measured and put into relation to the applied load. After that, the device was unloaded and the test was repeated another 2 times to determine the plastic deformation of implant and specimen. There was no significant difference to all of the constructs in the first compression. After repeated compression, the WING-cage, the NOVUS-cage and the plate-construct showed a constant compression pattern as expression of resting stable on the vertebral endplates, whereas the cylindrical BAK-cage had a decrease in compression distance, but increase in sintering into the vertebral body. Intercorporal implants that require the destruction of the vertebral endplates as described in the Cloward dowel-technique may have a higher risk of sintering into the vertebral body and therefore of developing progressive kyphosis. By attaching lateral supporting areas this risk can be reduced and the advantage of sponges contact for fusion is preserved.

[Significance of calcium deposit elimination in tendinosis calcarea of the shoulder]. / Bedeutung der Kalkdepotelimination bei Tendinosis calcarea der Schulter.

AIM: To evaluate the effect of complete elimination of the calcific deposit on the clinical outcome in patients with a recalcitrant calcifying tendinitis of the shoulder. PATIENTS AND METHODS: 50 patients with a chronic calcifying tendinitis of the shoulder (Type Gärtner I or II) underwent a single application of extracorporeal shock waves (3000 impulses, energy flux density 0.60 mJ/mm2). After one year 45 patients were evaluated radiologically and clinically. RESULTS: Radiologically a complete absorption of the calcific deposit was observed in 21 patients (47%). In 9 patients there was no radiological change. The radiological success was closely related to the radiomorphology of the deposit. 18 out of 27 good or excellent results were accompanied by a complete disintegration of the deposit. We calculated a significant dependency between complete disintegration of the deposit and a good/excellent clinical result (p = 0.0002). Patients with a completely disintegrated deposit had significantly better scores than those with a partial disintegration of the calcium (p = 0.02), and than those with no radiomorphological changes (p = 0.0003). Spearman's correlation coefficient was 0.6. CONCLUSION: Elimination of the deposit is paramount for a good clinical outcome and should be the main goal for any treatment.

[Biomechanical properties of synthetic lumbar intervertebral disk implants]. / Die biomechanischen Eigenschaften von künstlichen Implantaten der lumbalen Bandscheibe.

AIM: The aim of this study was to determine the influence of two different artificial nucleus implants for lumbar discs on the biomechanical properties of the spinal motion segment. METHODS: From 7 calf spines, the lumbar segments L2/3 and L4/5 were harvested, the lamina and the muscles were removed with care to preserve the anterior and posterior longitudinal ligament. The segments were fixed on a special testing device mounted in an universal testing machine (Zwick, Ulm, Germany). Physiological load with a maximum of 7 Nm was applied in flexion/extension, right and left side bending, and right torsion. Three cycles of measurement were performed in all specimen: a) the intact segment, b) segment after nucleotomy, c) 6 segment with 2 PDN devices (Ray Medica) and 8 segments with an autopolymerized polymer. RESULTS: There was a statistically significant (p = 0.0078/p = 0.0313) increase in segmental mobility in all directions after nucleotomy. After introduction of two PDN implants as well as the polymer implant, there was a restoration of segmental mobility for all movement directions with no statistically significant difference (p > 0.05) compared to the intact situation before nucleotomy.

[Long-term results of triple arthrodesis in neurogenic foot deformities]. / Langzeitergebnisse nach Triple Arthrodese bei neurogenen Fussdeformitäten.

The number of good results after triple arthrodesis due to neuromuscular foot disorders in literature varies between 24% and 94%. 46 patients with 64 triple arthrodesis due to neuromuscular foot disorders were reexamined 18 years (15 to 25 years) after the operation. In 36 cases arthrodesis was performed by k-wire and pin fixation and in 28 cases by k-wire and screw-fixation. For preoperative and follow-up grading the McGuire score was used which increased on the average due to the operation from 58 to 89 points. Good and excellent results were found in 91% of the patients. Triple arthrodesis in patients with neuromuscular foot disorders is recommended. It leads to functional good results with a small amount of complications.

[Scoliosis and hip flexion contracture in Duchenne muscular dystrophy]. / Skoliose und Hüftbeugekontraktur bei Duchennescher Muskeldystrophie.

UNLABELLED: Spinal deformity is common in muscular dystrophy and usually occurs after loss of walking ability. Unlike in idiopathic and other scoliosis forms, there seems to be no side preference of the convexity. Aim of the study was to analyse, if there is any relation between incidence and extent of walking ability, lower limb contractures and development of scoliosis. METHODS: In a retrospective study, 45 patients with Duchenne muscular dystrophy who underwent surgery were analysed, concerning walking ability, contractures of lower extremities and scoliosis. RESULTS: 1: No scoliosis was observed in ambulatory patients. 2: 96% of the wheelchair bound patients suffered from scoliosis. 3: 96% of the scoliosis patients had hip flexion or abduction contractures. 4: In 12 of 15 cases with side-different contractures, scoliosis tended to the side with the greater contracture. CONCLUSIONS: The influence of hip contracture and pelvic obliquity on scoliosis is discussed controversially. Concerning muscular dystrophy, there seems to be a positive correlation between convexity and hip contracture. If this is a causal relation or if there is a faster progression of structural alteration of the muscles on one side has to be further investigated.