[Complications and costs in primary knee replacement surgery in an endoprosthetics centre : Influence of state of training]. / Komplikationen und Kosten in der primären Knieendoprothetik in einem Endoprothetikzentrum : Einfluss des Weiterbildungsstandes.

BACKGROUND: This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S­Op, T­Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T­Op and S­Op were examined. MATERIALS AND METHODS: The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S­Op and those who had been operated by a T­Op was made for all parameters. RESULTS: Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p­o day. The T­Op required an average of 11 min more than the S­Op. CRP was significantly higher in the T­Op group only on the third p­o day, by 18 mg/l. In contrast, in the T­Op group, a blood loss of 181 ml was lower than in the S­Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S­Op and T­Op. DISCUSSION: In the setting of a certified endoprosthetics centre, the comparison of T­Op with S­Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.

[Joint swelling, reversible arm paresis, and elevated serum IgG4 in a 55-year-old man]. / Gelenkschwellungen, reversible Armparese und erhöhtes Serum-IgG4 bei einem 55-jährigen Patienten.

Only described in the last 10 years, IgG4-related disease is a fibroinflammatory disorder characterized by tumorous lesions with dense lymphoplasmacytic infiltration by IgG4-positive plasma cells and often elevated concentration of serum IgG4. In this paper, we present a male patient with this disease involving the lymph nodes and possibly the joints and kidneys. Infiltration of lymph node tissue with IgG4-positive plasma cells was demonstrated. The general condition of the patient improved considerably by immunosuppressive therapy.

Osteodensitometry measurements of periprosthetic bone using dual energy X-ray absorptiometry following total knee arthroplasty.

INTRODUCTION: The present study investigates the reaction of bone density as well as the possible factors influencing this reaction following a cement-free total knee arthroplasty (TKA). MATERIALS AND METHODS: Osteodensitometry scan data from 50 prospective patients with TKA was evaluated. The patients were split into two groups according to the number of follow-up investigations undertaken. No patient included in the study had received medication to increase bone density. To identify the changes in periprosthetic bone density, dual energy X-ray absorptiometry (DXA) bone density measurements in defined regions of interest (ROI) were performed over a period of 24 months postoperative. The test parameters included gender, severity of arthrosis, as well as the metric parameters T-score, body mass index, cortical bone marrow index, and the varus alignment for the respective patient. RESULTS: The most significant changes in bone density were recorded within the first 3 months postoperative, in particular, the highest bone density loss was found in the region of the proximal medial tibia. Moreover, significant gender-specific associations regarding changes in bone density were established. CONCLUSION: Finally, results achieved in the present study demonstrate that the fundamental classification in defined ROI proved to be functional and effective.

The condylar plate for treatment of distal femoral fractures: a long-term follow-up study.

The aim of this retrospective study was to present the long-term functional and radiological outcomes of indirect reduction techniques and fixation with a condylar plate for treatment of distal femoral supracondylar or intracondylar femoral fractures. The series included 24 men and 17 women, mean age 51 years, between March 1994 and April 1999. All fractures were AO type 33, and eight were open fractures. Primary iliac bone graft was used in five cases. In one case of severe osteoporosis, screw fixation was augmented with cement. There were three delayed unions, one non-union and two infections; four participants required reoperation with bone grafts. Two (5%) participants developed a second varus deformity and three a second valgus deformity; correction osteotomy with bone grafts was necessary in these cases. After a mean follow-up of 9.5 years, the mean Neer score was 82 points and indicated that function was excellent in 16, satisfactory in 9, unsatisfactory in 4 and poor in 2 cases. The mean Neer score in cases of isolated fracture was 89 points and in cases with additional injuries was 72 points. Thus the long-term results of indirect reduction techniques of distal femoral fractures treated with the condylar plate were good to excellent in 82% of cases.

[Open arthrolysis of posttraumatic elbow stiffness]. / Die offene Arthrolyse der posttraumatischen Ellenbogensteife.

BACKGROUND: The incidence of relevant posttraumatic functional deficits in the sense of elbow stiffness with less than 30 degrees in extension or flexion less than 120 degrees , is unknown. A differentiation can be made between intraarticular, extraarticular and combined causes. An open procedure is indicated in elbow stiffness after correct analysis of the situation and failure of conservative treatment. MATERIALS AND METHODS: An open procedure was carried out on 35 patients between March 1995 and November 2001, 10 (3-24) months after the trauma. The mean age of the 24 men and 11 women was 45 (range 17-75) years. Of the patients 15 had distal humerus fractures, 10 radius head or neck fractures and 12 proximal ulnar fractures. RESULTS: Of the patients 11 (31%) had an excellent result in the Cauchoix and Deburge score, 15 (42%) a good, 4 (11%) a fair, 4 (11%) a bad and 1 (3%) a very bad result after a mean follow-up of 21.5 (range 9-60) months. Of the patients 11 (31%) had an excellent result in the Mayo elbow performance score, 14 (40%) a good, 5 (14%) a fair and 5 (14%) a poor result. CONCLUSION: Open arthrolysis for severe posttraumatic elbow stiffness carried out 10 months (range 3-24 months) after the accident led to good results in most cases with a clear improvement in functional mobility.

DNA polymerase alpha--primase complex of Physarum polycephalum.

DNA polymerase alpha and DNA polymerase alpha--primase complex of Physarum polycephalum were purified by rapid methods, and antibodies were raised against the complex. In crude extracts, immune-reactive polypeptides of 220 kDa, 180 kDa, 150 kDa, 140 kDa, 110 kDa, 86 kDa, 57 kDa and 52 kDa were identified. The structural relationships between the 220 kDa, 110 kDa and 140 kDa (the most abundant form) was investigated by peptide mapping. The 140 kDa form was active DNA polymerase alpha. The 57 kDa and the 52 kDa polypeptides were identified as primase subunits by auto-catalytic labelling. In amoebae, the immune-reactive 140 kDa polypeptide was replaced by a 135 kDa active DNA polymerase alpha.

Specific inhibition of Physarum polycephalum DNA-polymerase-alpha-primase by poly(L-malate) and related polyanions.

Poly(L-malate) is an unusual polyanion found in nuclei of plasmodia of Physarum polycephalum. We have investigated, by enzymatic and fluorimetric methods, whether poly(L-malate) and structurally related polyanions can interact with DNA-polymerase-alpha-primase complex and with histones of P. polycephalum. Poly(L-malate) is found to inhibit the activities of the DNA-polymerase-alpha-primase complex and to bind to histones. The mode of inhibition is competitive with regard to DNA in elongation and noncompetitive in the priming of DNA synthesis. Spermidine, spermine, and histones from P. polycephalum and from calf thymus bind to poly(L-malate) and antagonize the inhibition. The polyanions poly(vinyl sulfate), poly(acrylate), poly(L-malate), poly(D,L-malate), poly(L-aspartate), poly(L-glutamate) have been examined for their potency to inhibit the DNA polymerase. The degree of inhibition is found to depend on the distance between neighboring charges, given by the number of atoms (N) interspaced between them. Poly(L-malate) (N = 5) and poly(D,L-malate) (N = 5) are the most efficient inhibitors, followed by poly(L-aspartate) (N = 6), poly(acrylate) (N = 3), poly(L-glutamate) (N = 8), poly(vinyl sulfate) (N = 3). It is proposed that poly(L-malate) interacts with DNA-polymerase-alpha-primase of P. polycephalum. According to its physical and biochemical properties, poly(L-malate) may alternatively function as a molecular chaperone in nucleosome assembly in the S phase and as both an inhibitor and a stock-piling agent of DNA-polymerase-alpha-primase in the G2 phase and M phase of the plasmodial cell cycle.