Molecular screening of cat and dog ectoparasites for the presence of Bartonella spp. in Attica, Greece.

The purpose of this study was the molecular detection of Bartonella spp. in fleas and ticks parasitizing cats and dogs from 39 locations in Attica, Greece. One hundred and forty five ectoparasites (104 fleas and 41 ticks) from 92 cats and 53 dogs were investigated individually using PCRs targeting the 16S-23S ribosomal RNA intergenic spacer (ITS) and the citrate synthase (gltA) genetic loci. Bartonella spp. were detected in 14 out of 104 fleas (13.5%) and in none of the ticks examined. Consequent sequence analysis of the amplicons from the two loci identified 3 strains as Bartonella henselae, and 11 as Bartonella clarridgeiae. Οur study demonstrates the presence of B. henselae and B. clarridgeiae in Ctenocephalides felis fleas from cat and dog in Greece. We also report a novel ITS sequence for B. clarridgeiae. Considering that fleas could pose a risk for human bartonellosis from their infected hosts, further studies on the public health risk of Bartonella presence in animal ectoparasites are warranted.

Stem cells therapy: the future in the management of systemic sclerosis? A case report.

OBJECTIVE: Systemic sclerosis (SSc) is a connective tissue disorder of unknown etiology, with heterogeneous clinical manifestations and chronic and often progressive course. The diffuse cutaneous form of SSc (dcSSc) is characterized by thickening of the skin (scleroderma) and distinctive involvement of multiple internal organs. Patients with limited cutaneous SSc (lcSSc) generally have long-standing Raynaud's phenomenon before other manifestations of SSc appear. Over the last decade the Interest of adipose-derived cell therapy in regenerative medicine has increased continuously. In compare to bone marrow-derived mesenchymal stem cells (MSCs) adipose tissue-derived stem cells (ADSCs) are considered to be ideal for application in regenerative medicine. Zuk et al., introduced a multipotent, undifferentiated, self-renewing progenitor cell population isolated from adipose tissue, called processed lipoaspirate (PLA). However, subcutaneous injections of autologous adipose tissue-derived stromal vascular fraction (ADSVF), which is known to contain mesenchymal stem cells, in hands of Patients with scleroderma for enhancing their impaired hand function is still in an experimental stage, although there are already promising results of the therapy. Commonly available therapeutic options for hands of Patients with systemic sclerosis, vasodilatator drugs and physiotherapy, have many restriction and limited effects. MATERIALS AND METHOD: A 62 years old woman with scleroderma presented with progressive digital necrosis, ulceration, gangrene and impaired wound healing, despite of conventional therapy with vasodilatator drugs. Water-jet-Assisted Liposuction (Body-jet® evo, human med AG, Schwerin, Germany) of subcutaneous abdominal fat was carried out under general anesthesia by an experienced surgeon. Autologous adipose tissue-derived stromal vascular fraction (ADSVF) was harvested by in a single-use Q-graft® collector (human med AG, Schwerin, Germany). Cells were centrifuged in 400G for 5 minutes and cell pellets were aspirated carefully in a 20mL syringe filled with 0.9% NaCl. A total of ca. 2.72 million cells have been isolated. Meanwhile middle phalangeal amputation of digit 2, 3 and 4 of the left hand were performed, without closing the skin of the amputation stumps. The SVF cell suspension was injected subcutaneous into the area of metacarpophalangeal joints in both hands, as well as into the amputation stump of the left middle finger, and under a skin necrosis in the right hand. RESULTS: The therapy was good tolerated by the patient, with absence of adverse reactions. No infection was observed, despite open amputation. Three weeks after the stem cell therapy, no need to further amputation was demonstrated. The patient is still under regular clinical observation, in order to determine the long term effects of the therapy. CONCLUSION: Application of isolated adipose tissue-derived stem cells seems to be a very promising procedure in the treatment of the manifestation of systemic sclerosis. However, more clinical and experimental studies are required, in order to understand the exact mechanisms of action and standardize the therapy.

[10 years of hand traumatology - an epidemiological, structural and economic analysis at a maximum care provider]. / 10 Jahre Handtraumatologie ­ eine epidemiologische, strukturelle und ökonomische Standortanalyse an einem Krankenhaus der Maximalversorgung.

BACKGROUND: Hand surgery in Germany has been subject to structural changes that strongly affect the balance between medicine and economics. On the one hand there is a shift of elective hand surgery from the inpatient to the outpatient sector. On the other hand - so our observations - emergency hand trauma cases are more concentrated in bigger hospitals. Given this background there is a lack of statistical data on the management of hand trauma care and treatment of patients with hand injuries. This article discusses a 10-year-analysis of hand traumatological cases treated at a maximum care hospital regarding epidemiological, structural and economic aspects. MATERIAL AND METHODS: Using a database query using ICD codes, inpatient hand trauma cases were identified between 2009-2018 and analyzed with regard to epidemiological and economic indicators (age, gender, comorbidities, case-mix-index (CMI), revenue, length of stay, length of surgery) using PIVOT tables. Patients under the age of 16 years, forearm fractures and intensive care patients were excluded. RESULTS: In the study period the typical hand surgical trauma patient was male with an average age of 44 years. The Patient-Clinical-Complexity-Level (PCCL) was 0 in 80 % of all cases. The proportion of work-related injuries averaged around 25 %. The three top diagnose related groups (DRG) were the I32F (18.5 %), X01B (11.3 %) and the I32A (7.2 %). A striking point was the massive increase in the overall number of trauma cases over the years from approx. 300 cases in 2009 to over 1000 cases per year in 2018 with a shift of the main workload to on-call and night-shift hours away from core working times. In the study period 4 of 5 others hospitals located in a distance of 100 km reduced and stopped treatment of emergency hand cases. The average length of a hospital stay was approx. 4-5 days, the average cut/suture time less than 60 minutes and the average CMI 1.23. Those cases generate an average proceed of € 4370 in 2018, whereby the cases generated by the work-related injuries averaged € 387 less. DISCUSSION: On the assumption that the number of emergency hand trauma cases did not really increase in the study period we think that there was a concentration of such cases in a few centres still providing extensive treatment for hand injuries while in smaller hospitals care for emergency hand trauma cases is progressively reduced. However, hand injuries may be worth a second thought for economic reasons because they can create reasonable revenues with rather little effort.If a critical number of patients is exceeded, costs of service provisions can be significantly amortized by the proceed generated by treatment. In those hospitals still taking care for acute hand injuries the workload especially in standby duty increased. What may have a negative input on the numbers of treated elective hand surgery cases.

[Peripheral nerve reconstruction - diagnostics as a basis for decision-making: report of the Consensus Workshop at the 35th Meeting of the DAM]. / Periphere Nervenrekonstruktion ­ Diagnostik als Grundlage der Entscheidungsfindung ­ Bericht des Consensus-Workshops im Rahmen der 35. Jahrestagung der Deutschsprachigen Gemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM).

In the early stage of nerve lesions, the clinical differentiation between neurapraxia, axonotmesis and neurotmesis often presents a big challenge. Especially in the early stage, however, it is crucial to correctly classify the type of damage because this is what essentially determines the therapeutic concept, in particular the surgical approach and, therefore, the prognosis. A precise diagnosis not only requires detailed clinical assessment and medical history taking, but also the use of additional electrophysiological (functional) and/or imaging examinations. Electrophysiological diagnostic tests may provide information ion localization, severity, course, type of damage and incipient or past reinnervation. Preoperative functional diagnostic measures should include neurography, needle electromyography (EMG) and, if needed, evoked potentials (EP), while imaging procedures should include neural sonography and magnetic resonance imaging (MRI). As a complimentary procedure, EMG may also be performed during surgery.

An Unusual Presentation of an Osteoid Osteoma in the Lunate Bone.

An osteoid osteoma is a rare benign tumor of the carpal bones. It is extremely rarely found in the lunate bone in patients above 30 years of age. We present a case report of a 61-year-old man with an osteoid osteoma of the left wrist, which was masked by degenerative carpal bone disease and a comorbidity of an inflammatory bowel disease. The mainstay of imaging including plain radiographs, computed tomography, magnetic resonance imaging, and bone scintigraphy led to the clinical diagnosis of a lunatomalacia. The tumor was removed by coincidence during removal of the diseased lunate bone. Postoperatively, the patient was immediately free of pain and remained free at his 3 months postoperative follow-up.

Reduced Amputation Rate by Circular TNP Application on Split-Skin Grafts After Deep Dermal Foot Scalds in Insulin-Dependent Diabetic Patients.

The incidence of insulin-dependent diabetes mellitus (IDDM) is expected to increase significantly. Due to peripheral neuropathy and angiopathy in IDDM patients, feet scalding results in deep burn injuries. Regularly amputations are needed with tremendous consequences. In relatively healthy patients, split-skin graft (SSG) take is better when topical negative pressure (TNP) is applied. We compared the outcome of circular TNP dressing with that of antiseptic dressing on freshly laid SSG after tangential excision in IDDM patients with deep dermal foot scalds. Seventy patients admitted to a burn center with isolated foot burns were identified (2008-2013). Ten of them suffered from IDDM and presented with a deep dermal foot scald. After tangential excision and split-skin grafting, five of them were treated with TNP. The others received an antiseptic dressing regime. Differences were analyzed using either Chi-square or Student's t-test. Group comparison regarding age, gender, body mass index, HbA1c on arrival, glucose in serum, IDDM disease duration, and TBSA revealed no significant differences. But percentage of graft take was at a significantly higher rate in the TNP group (90.2 ± 4.017 vs 39 ± 15.362) and fewer operations had to be performed compared to the control group (2.0 ± 0.447 vs 4.6 ± 0.927). Due to reduced occurrence of necrosis, the number of amputations required was significantly lower in the TNP group. TNP application on freshly laid SSG following tangential excision in IDDM patients after deep dermal foot scalds minimized amputation rates and therefore is of great benefit for such patients.