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BACKGROUND: Spinal surgery is largely reimbursed in a differentiated manner via the DRG system. For treatments of complex paediatric deformities with increased pre and postoperative effort due to special treatment approaches, it seems that the costs for the treatment are not fully covered. MATERIALS AND METHODS: All paediatric cases with surgical treatment of the spine that were treated in a single spine centre from 2018-2020 were considered. The subgroup of patients with inpatient halo-gravity traction (halo group) before surgery was compared with all other cases treated in terms of economic and demographic factors. RESULTS: There were 86 cases that were treated surgically without halo traction and 6 cases with halo traction. The groups did not differ significantly in age (pâ¯= 0.41) or Patient Clinical Complexity Level (PCCL, pâ¯= 0.76). The average length of hospital stay in the halo group was significantly longer than in the other cases (84.2⯱ 40.1â¯d vs. 11.0⯱ 6.4â¯d; pâ¯= 0.001). Due to DRG grouping and long-stay surcharges, the mean revenue per case was significantly higher in the halo group than in the other cases ( 63,615⯱ 45,138 vs.⯠16,836⯱ 9356) (pâ¯= 0.003). The contribution margin for the period of the long-term surcharges varied between 11,394 and 9766â¯. The high additional costs due to the necessary medical devices of halo traction were not sufficiently reflected in the reimbursement. CONCLUSION: Paediatric spine surgery can be challenging in special cases. In particular, severe deformities of the spine may require additional procedures. The subgroup of patients requiring preoperative halo traction is not adequately compensated by the DRG system.
Assuntos
Escoliose , Tração , Criança , Humanos , Cuidados Pré-Operatórios , Estudos Retrospectivos , Coluna Vertebral , Resultado do TratamentoRESUMO
This article presents the rare case of a boy who was born in our hospital with valgus deformity and external rotation of the right lower leg because of congenital patellar dislocation. In the case presented a stable repositioning of the patella could be achieved by redressment with a plaster cast and leg brace. During a 4-year follow-up there were no tendencies towards dislocation during the clinical examination and no dislocation events were documented. In selected cases an attempt at conservative repositioning and retention treatment appears to be worthwhile before surgical treatment is indicated.
Assuntos
Braquetes , Moldes Cirúrgicos , Geno Valgo/congênito , Geno Valgo/terapia , Imobilização/instrumentação , Imobilização/métodos , Luxação Patelar/congênito , Luxação Patelar/terapia , Pré-Escolar , Seguimentos , Geno Valgo/diagnóstico , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Luxação Patelar/diagnóstico , Resultado do TratamentoRESUMO
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a multifactorial structural loosening in the area through the epiphyseal plate between the epiphysis and metaphysis accompanied by slippage of the femoral head in the mid-dorsal-caudal direction without additional adequate trauma. In this retrospective study, all patients with chronic SCFE were assessed who had been treated by implanting a dynamic epiphyseal telescopic (DET) screw. METHODOLOGY: All patients who had been treated at our hospital with a DET screw implant between December 2006 and November 2014 following diagnosis of chronic SCFE were included in the study. Clinical and radiological follow-up was carried out after 6 weeks, 12 weeks, and then every 6 months. RESULTS: In all patients, the SCFE proved to have been firmly fixed and no further slippage was observed in any patient on the side affected. None of the prophylactically treated hips showed secondary SCFE either. In all patients, the DET screw led to partial remodeling of the slippage. The average slippage angle according to Southwick (epsilon angle) was about 30° preoperatively and about 19° in the most recent radiological follow-up. The alpha angle according to Nötzli was about 91° preoperatively and about 62° in the most recent radiological follow-up. Most of the patients showed none treatment-related dysfunction. CONCLUSION: Surgical treatment with a DET screw seems to be a safe procedure for both the affected hip and the hip to be treated prophylactically. This method is an adequate alternative to the widespread technique of pinning with Kwires.
Assuntos
Parafusos Ósseos , Epífises/cirurgia , Fixadores Internos , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Adolescente , Criança , Epífises/diagnóstico por imagem , Análise de Falha de Equipamento , Feminino , Humanos , Estudos Longitudinais , Masculino , Desenho de Prótese , Estudos Retrospectivos , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: Up to 4% of all neonates in Central Europe are born with congenital hip dysplasia (CHD), the most common congenital disease of the musculoskeletal system. However, in this retrospective analysis the outcomes of infants with CHD (type D, III or IV according to Graf) have been considered, with Pavlik therapy starting within the first 12 weeks of life. Connections between the start of therapy or the first finding according to Graf`s classification and the ultrasound result achieved, as well as the X-rays taken after 1 and 2 years, were evaluated. No repositioning under Pavlik treatment or side effects and their relevance have been evaluated, especially with regard to avascular necrosis (AVN) of the femoral head. MATERIALS AND METHODS: All infants treated using Pavlik treatment for CHD between 2010 and 2012 in our clinic were determined. A total of 62 patients with 79 pathological hips were included. The infants were classified into three groups to evaluate the influence of the start of therapy on the result: group I with the first investigation and start of treatment within the first 10 days of life, group II between the 11th day and the end of week 3, group III within preventive general examinations (U3) after the 4th week. Clinical examinations and the usual ultrasound scans were performed at an average of 1, 3, and 6 months. Furthermore, after 1 and 2 years clinical and radiological investigations were carried out, as well as further examinations depending on the findings. RESULTS: A failure of repositioning of the Pavlik treatment occurred in group I in 1 case (2.2%), in group II in 1 case (7.1%), and in group III in 2 cases (10%). This occurs in hips type D and type III in 1 case each (3.3%) and type IV in 2 cases (10.5%). Maturation disorders of the hips were found in 1 case (2.2%) in group I, 1 case (7.1%) in group II, and 3 cases (15%) in group III. Avascular necrosis of the femoral head was proven in 2 cases (4.4%) in group I, 0% in group II, and in 1 case (5%) in group III. All patients initially had femoral head necrosis of Graf type IV . All necrosis and maturation disorders were no longer visible on subsequent examinations after 2 years at the most. CONCLUSIONS: In summary, the study shows that even with a late treatment start (U3) good results could be achieved, but with a rising number of repositioning failures and femoral necroses. Ultrasound screening on U3 seems to be sufficient; however, for high-risk groups an additional screening in the first week of life should be performed, which does not replace a second evaluation at U3 if there are normal findings.
Assuntos
Braquetes , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/terapia , Imobilização/instrumentação , Imobilização/métodos , Pré-Escolar , Desenho de Equipamento , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Resultado do Tratamento , UltrassonografiaRESUMO
Routine well-child visits, implemented as a means of secondary prevention and covered by health insurance, lead to early identification of disorders and abnormalities in child development."Guiding principles for children" (by the G-BA) have determined the content of the eleven examinations, ranging from U1 immediately after birth to J1 in adolescence; eight of them take place within the first four years of age. Since cases of child maltreatment, neglect, or abuse became public in 2007, almost all German federal states have established mandatory examination and notification processes in the new child welfare surveillance programs. First results in the German federal states (six of which are exemplarily illustrated) point out that mandatory requirements have collectively increased the frequency of medical check-ups in children, especially starting from four years of age and most significantly in families with social disadvantages (young/single parents, immigrant background, uneducated or socially disadvantaged families), which have so far been difficult to reach. Subsequently, provision of primary prevention (vaccinations and health promotion advice) by pediatricians has also increased. As a sole instrument for the complete identification of threats for children's welfare, however, systems inviting and reminding parents about check-ups are only of limited benefit.
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Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/prevenção & controle , Proteção da Criança , Exame Físico/estatística & dados numéricos , Exame Físico/normas , Adolescente , Criança , Maus-Tratos Infantis/legislação & jurisprudência , Feminino , Alemanha/epidemiologia , Humanos , Relações Interinstitucionais , MasculinoRESUMO
Bone metastases are found in 29% of patients with metastatic malignant choroidal melanoma, which is associated with poor prognosis. However there are several reports about prolonged survival. The unusual case of a patient is described, who suffered from a melanoma with orbital invasion and survived more than 18 years. Metastases were found 12 years after initial therapy. Three palliative operations made a survival of further 7 years with high quality of life possible. Therefore moderately palliative operations are recommended in case of metastatic malignant choroidal melanoma.
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Neoplasias da Coroide/secundário , Neoplasias da Coroide/cirurgia , Melanoma/secundário , Melanoma/cirurgia , Cuidados Paliativos/métodos , Neoplasias Cutâneas/cirurgia , Neoplasias da Coroide/diagnóstico , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Neoplasias Cutâneas/diagnósticoRESUMO
INTRODUCTION: Gorham-Stout disease is a rare entity characterised by a massive osteolysis and typically starts monocentrically in an isolated bone. Concerning the pathogenesis, haemangiomatosis and an overstimulation of osteoclasts are discussed which cause a progressive destruction of the affected skeleton and involve neighbouring soft tissue in the further progress of the disease. CASE REPORT: This report is about a 45-year-old male who suffered a traumatic insult. X-rays showed an osteolytic lesion in the 4th lumbar vertebra with depression in the ventral roof plate. Further radiological investigation has ruled out a malignant lesion and suggested Gorham-Stout disease as a diagnosis. Therapy has been carried out using bisphosphonates as well as fractioned radiation of the vertebra with 30 Gy under which a remission was achieved. DISCUSSION: The progress of our case correlates with published data in the literature. Spinal lesions are rare, but possible neurological complications or a possible chylothorax reflect the high mortality rate. We found no complications in our case. CONCLUSION: Despite massive osteolysis with resorption of up to a whole bone segment, radiation with a dose of 22.8 Gy and the use of antiresorptive substances, as reported in our case, have often been shown to limit the destructive progression of the disease. A causal therapy of the disease is not known yet.
Assuntos
Osteólise Essencial/diagnóstico , Osteólise Essencial/terapia , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
In dioecious plants of hemp ( Cannabis sativa L.), males are regarded as heterogametic XY and females as homogametic XX, although it is difficult to discriminate the X cytologically from the Y. The Y chromosome is somewhat larger than the X. Our aim was to analyse AFLP markers on X and Y, and to use them to gain some insight into the structure of the sex chromosomes. Markers located on the sex chromosomes can be grouped into different classes, depending on the presence or absence of a fragment on the X and/or the Y. They are detected by separately analysing male and female progenies of a single cross. Five markers were found to be located on both chromosomes. A few recombinants were observed for marker pairs of this class in the male progenies. Two completely linked markers located on the Y chromosome in the male parent show a recombination rate of r = 0.25 with sex. Recombination must have occurred between the sex chromosomes in the male parent. The recombination analysis led to the conclusion that there is a pseudoautosomal region (PAR) on the sex chromosomes, allowing recombination between the X and the Y chromosome. The other regions of the sex chromosomes show only a few recombination events, for the Y as well as for the X. These results are discussed in comparison to other dioecious plants.
Assuntos
Cannabis/genética , Cromossomos de Plantas , DNA de Plantas/genética , Marcadores Genéticos , Mapeamento Cromossômico , Cruzamentos Genéticos , Ligação Genética , Recombinação GenéticaRESUMO
OBJECTIVES: The case presented here describes the clinical evolution of a malignant prolactinoma with occurrence of intra- and extra-cranial metastases. In this case, the presence of dopamine 2 receptor (D2R) was studied at the mRNA and protein level, in order to understand the pathological background of the resistance to treatment with different dopamine agonists. DESIGN: Together with an extensive description of the clinical history of this case, a combination of in vitro and in vivo techniques was performed to provide the basis of the dopamine resistance developed in the course of the disease. METHOD: A comparison of the D2R was performed in specimens obtained at presentation of the disease compared with autoptic specimens derived from local invasion and metastasis using in situ hybridization and immunohistochemical techniques. RESULTS: Intact D2R mRNA was found in the primitive tumor and metastatic tissues, whereas protein for the same receptor was present only in the tissues derived from neurosurgical operations and not in the metastases obtained post-mortem. CONCLUSION: This is the first report of the absence of D2R protein despite the retention of the transcript in an advanced stage of a malignant prolactinoma. The findings of this single case suggest the hypothesis that postranscriptional mechanisms may contribute to the development of dopamine resistance in prolactinomas.
Assuntos
Neoplasias Encefálicas/secundário , Proteínas de Neoplasias/metabolismo , Neoplasias Hipofisárias/metabolismo , Prolactinoma/metabolismo , RNA Mensageiro/biossíntese , Receptores de Dopamina D2/biossíntese , Neoplasias da Coluna Vertebral/secundário , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Bromocriptina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Humanos , Imuno-Histoquímica , Hibridização In Situ , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/líquido cefalorraquidiano , Neoplasias Hipofisárias/líquido cefalorraquidiano , Neoplasias Hipofisárias/patologia , Prolactina/sangue , Prolactinoma/líquido cefalorraquidiano , Prolactinoma/patologia , RNA Mensageiro/líquido cefalorraquidiano , Neoplasias da Coluna Vertebral/metabolismo , Neoplasias da Coluna Vertebral/patologia , Transtornos da Visão/etiologiaRESUMO
A set of 114 recombinant inbred lines of the 'International Triticeae Mapping Initiative' mapping population was grown during the seasons 1997, 1998, 1999 and 2000 under several environments. Twenty morphological (glume colour, awn colour, waxiness, leaf erectness, peduncle length), agronomical (ear emergence time, flowering time, grain filling time, ear length, plant height, lodging, grain number, thousand-grain-weight, grain weight per ear, grain protein content, winter hardiness) and disease resistance (powdery mildew, yellow rust, leaf rust, fusarium) traits were studied. Not all traits were scored in each experiment. In total 210 QTLs with a LOD threshold of >2.0 (minor QTLs) were detected of which 64 reached a LOD score of >3.0 (major QTLs). Often QTLs were detected in comparable positions in different experiments. Homologous and homoeologous relationships of the detected QTLs, and already described major genes or QTLs determining the same traits in wheat or other Triticeae members, are discussed.
RESUMO
In 1986 Andermann et al. described a syndrome presenting with renal failure, myoclonus, cerebellar symptoms, and epilepsy. They presumed a hereditary cause. We describe the first appearance of this syndrome in Europe, affecting three family members with comparable symptoms. Two of these patients were treated by us, and the third, already decreased, is described according to the available reports. The first clinical symptoms were manifested between the ages of 14 and 20. A female patient suffered from compensated kidney insufficiency and her two brothers aged 18 and 26 required dialysis. Biopsy of kidney tissue revealed nonspecific nephritis. All cases showed a cerebellar syndrome and action myoclonus. Two of them were diagnosed with epilepsy and grand mal seizures, and all suffered from demyelinizing or mixed polyneuropathy. Anamnesis of the family seems to indicate autosomal recessive inheritance.
Assuntos
Epilepsia/genética , Falência Renal Crônica/genética , Mioclonia/genética , Adolescente , Adulto , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/genética , Aberrações Cromossômicas , Eletroencefalografia , Epilepsia/diagnóstico , Epilepsia Tônico-Clônica/diagnóstico , Epilepsia Tônico-Clônica/genética , Feminino , Genes Recessivos/genética , Humanos , Falência Renal Crônica/diagnóstico , Masculino , Mioclonia/diagnóstico , Exame Neurológico , Linhagem , SíndromeRESUMO
Catheter-related infections remain a significant cause of method failure in chronic peritoneal dialysis (PD) therapy. Given the increasing antibiotic resistance, such nonpharmacological strategies as local silver devices attract more interest. To establish whether a silver ring device (designed by Grosse-Siestrup in 1992) mounted onto the PD catheter and placed at the exit site at skin level is effective in preventing exit-site and other catheter-related infections, a prospective 12-month, multicenter, controlled study stratified by diabetes status was conducted. The study subjects were assessed by an extensive structured inventory, including a broad spectrum of control variables, such as age, body mass index (BMI), Staphylococcus aureus carrier status, catheter features, mode and quality of PD therapy, comorbidity, and psychosocial rehabilitation. Ten experienced German outpatient dialysis centers (seven adult, three pediatric) participated in the trial. All eligible patients (n=195) from the study area without catheter-related infections during the ascertainment period were included (incidental subjects undergoing PD therapy for at least 3 months). The main outcome measures were the occurrence of first exit-site infections (primary study end point), sinus tract/tunnel infection, and peritonitis. Ninety-seven patients were assigned to the silver ring and 98 patients to the control group. Baseline characteristics of age, sex, proportion of pediatric and incidental patients, S aureus carrier status, and other variables were similar in both groups. The incidence of infections in the silver ring group versus the control group was as follows: 23 of 97 versus 16 of 98 patients had exit-site infections, 12 of 97 versus 12 of 98 patients had sinus tract/tunnel infections, 16 of 97 versus 18 of 98 patients had peritonitis, respectively. Kaplan-Meier analysis for the probability of an infection-free interval showed no statistical difference (log-rank test) between the two groups. Displacement of the silver ring contributed to study termination in 6% of the study group patients, including two patients with catheter loss. Univariate analysis and multiple logistic regression identified younger age (<50 years), low serum albumin level (<35 g/L), number of previously placed PD catheters, short cuff-exit distance (<2 cm), and S aureus nasal carriage as risk factors for the development of exit-site infections. In conclusion, our study does not show any benefit of the silver ring in preventing catheter-related infections in PD patients. Thus, prevention of infection-related method failure in PD still has to rely on conventional antibiotic treatment strategies and less so on alternative methods.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/prevenção & controle , Cateteres de Demora/efeitos adversos , Diálise Peritoneal/instrumentação , Prata/uso terapêutico , Adulto , Fatores Etários , Análise de Variância , Índice de Massa Corporal , Criança , Fístula Cutânea/etiologia , Nefropatias Diabéticas/classificação , Nefropatias Diabéticas/terapia , Desenho de Equipamento , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Nariz/microbiologia , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos , Diálise Peritoneal/psicologia , Peritonite/etiologia , Estudos Prospectivos , Fatores de Risco , Albumina Sérica/análise , Staphylococcus aureus/isolamento & purificação , Resultado do TratamentoRESUMO
Late results of interventional procedures utilizing coronary stents are largely determined by the rate of restenosis. So far few data are available addressing the effect of stent design, implantation pressure and morphologic factors on this crucial variable. Therefore we analyzed the coronary angiograms obtained in 259 patients before, immediately after and at 3 to 6 months following stent implantation for obstructive coronary disease. A total of 196 AVE-Micro-Stents and 142 Palmaz-Schatz-Stents were implanted into 307 stenoses. In 126 stenoses there were implanted only Palmaz-Schatz-Stents, in 170 only AVE-Micro-Stents and in 11 stenoses there were implanted Palmaz-Schatz- as well as Micro-Stents. Restenosis was defined as an over 50% stenosis at follow up. No significant difference was detected with regard to global restenosis rate at an average of 4 months following implantation (Palmaz-Schatz 33%, Micro-Stent 27%). If results were analyzed according to implantation pressure however, there was a significantly lower restenosis rate for AVE-Micro-Stents implanted with > 10 atm (17%) as compared to < or = 10 atm (35%, p < 0.02) and as compared to Palmaz-Schatz-Stents (34%, p < 0.02), which were also implanted with high pressure over 10 atm. In addition to implantation pressure, vessel segment and morphology of stenosis proved to be important determinants of late results. In this series of patients the AVE-Micro-Stent compared favourably to the Palmaz-Schatz-Stent not only with respect to a significantly lower restenosis rate, when implanted with pressures > 10 atm, but also with regard to its superior flexibility and handling characteristics.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Doença das Coronárias/terapia , Stents , Idoso , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Propriedades de SuperfícieRESUMO
A simple and highly efficient method of axillary block is described. The results of axillary block anesthesia carried out by surgeons are reported.
Assuntos
Anestesia por Condução/métodos , Plexo Braquial , Mãos/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Daily profiles of blood glucose, HbA1c, total protein and fructosamine were measured in 10 diabetic patients and the factor fructosamine x 7/g total protein was calculated. Measurements were done at 4 a.m. to be sure that the patients were sleeping for some time, during the day and the following evening at 11 p.m., when the patients were lying again, so that the influence of orthostasis, the difference between bed rest and walking could be demonstrated. The blood glucose profile was typical whereas the HbA1c concentration was very stable and constant. Total protein and fructosamine increased significantly by orthostasis; the correction of fructosamine by total protein diminished the differences, but did not completely eliminate the effect of orthostasis. However, fructosamine should be corrected by the total protein concentration in order to increase the diagnostic value of the parameter.
Assuntos
Ritmo Circadiano/fisiologia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Hexosaminas/sangue , Postura/fisiologia , Adolescente , Adulto , Glicemia/metabolismo , Proteínas Sanguíneas/metabolismo , Feminino , Frutosamina , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Escolha da Profissão , Prática Privada , Especialidades de Enfermagem , Consultores , Dinamarca , HumanosRESUMO
Late effects of radiotherapy are observed more frequently due to the improved results of the treatment of cancer and the resulting longer survival times. The big arteries, however, are only seldom attacked by late complications. The authors present a single case and stress the importance corresponding therapeutic action.
Assuntos
Disgerminoma/radioterapia , Claudicação Intermitente/diagnóstico por imagem , Lesões por Radiação/etiologia , Adulto , Aortografia , Circulação Colateral/efeitos da radiação , Artéria Femoral/efeitos da radiação , Humanos , Masculino , Fatores de TempoRESUMO
The technique of making copies on radiographic films or on multiformat cameras from computer scintigrams, computer tomograms, digital radiographs or other similar digital images should be carefully studied in order to make the best use of the characteristics of the film. Contrast transfer was studied using a nuclear medicine camera computer system with registration on radiographic film. Possible difficulties in obtaining copies and a simple software arrangement are described, which would influence contrast transmission.