[Patch augmentation of the rotator cuff. A reasonable choice or a waste of money?]. / Patch-Augmentation der Rotatorenmanschette. Sinnvolle Alternative oder Geldverschwendung?

BACKGROUND: Although reconstruction methods have improved, tendon retears remain a major complication associated with rotator cuff repair. With the application of patches, either by interposition or by augmentation, surgeons can attempt to close an irreparable cuff defect or improve the mechanical and biological properties of tendons respectively. OBJECTIVES: Which factors need to be considered when using a patch and what outcome can be expected? MATERIALS AND METHODS: Based on the current literature, an overview of the techniques and materials in use and biomechanical and clinical experience is provided. RESULTS: The literature shows clear improvements in the biomechanical properties of a repair with patch augmentation; in particular, weakened tendons of the anterior supraspinatus and superior infraspinatus benefit most. It is important to keep in mind that each patch material has its own individual properties, which makes comparison of the various patch types difficult. The current scientific evidence is promising, although larger level 1 studies are still required. CONCLUSIONS: The general use of patches cannot be recommended at this time. Nevertheless, the use of a patch should be considered in patients who are at a high risk of recurrent retears. In future, patches will probably be applied mainly as part of a combined effort, together with biological measures to further reduce retear rates.

[Domestic violence against women of a crisis intervention population - forms of violence and risk factors]. / Häusliche Gewalt bei Frauen einer Kriseninterventionspopulation - Formen der Gewalt und Risikofaktoren.

UNLABELLED: BACKGROUND AND HYPOTHESES: Domestic violence is common and can lead to severe physical and psychological problems. Thus, we have investigated the frequency of occurrence, forms and risk factors of domestic violence against female patients on a crisis intervention ward. METHODS: 115 women were screened with the "screening spouse violence" (SPG) and the "index of spouse abuse" (ISA). RESULTS: The life time prevalence concerning spouse violence was 70 %. Out of 74 women who were currently living in a relationship 28 (38 % )were victims of violence in the last 12 months prior to their admission. Women who experienced violence had a significantly lower level of education. CONCLUSION: Screening for domestic violence in female patients in the field of crisis intervention and psychiatry should become a standard of "good clinical practice".

[Western Ontario shoulder instability index (WOSI): translation and cross-cultural adaptation for use by German speakers]. / "Western Ontario Shoulder Instability Index" (WOSI) : Ubersetzung und transkulturelle Anpassung für den deutschsprachigen Gebrauch.

BACKGROUND: Outcome assessment after orthopaedic interventions is becoming more and more important. However, there are no disease-specific instruments for patient self-assessment of shoulder instability. The goal of our study was to translate and test the Western Ontario Shoulder Instability Index (WOSI) using a standardised approach. The guidelines of the American Association of Orthopedic Surgeons were used for the translation and cross-cultural adaptation process. MATERIAL AND METHOD: Understanding was tested in 20 healthy subjects, and reliability and validity were quantified in 30 patients with shoulder instability. The quality of the translated version was described using the criteria of homogeneity, reliability, and construct validity. RESULTS: The test-retest reliability of the total score [intraclass correlation coefficient (ICC), 0.87] and of the subscores with the ICC (sports, leisure, and work 0.73; sensitivity 0.81; physical symptoms 0.82; and behaviour 0.90) was high. The internal consistency of the total scale was also high (Cronbach's alpha 0.89). CONCLUSIONS: The WOSI covers a broad range of symptoms and impaired functioning in patients with shoulder instability. The German translation shows good results regarding understanding, homogeneity, reliability, and validity. Therefore, it is a useful instrument for self-assessment in patients with shoulder instability.

[Early results of NeuFlex silastic implant in MCP arthroplasty]. / Frühresultate des arthroplastischen Grundgelenkersatzes mit der NeuFlex-Silikonprothese.

For the reconstruction of destroyed metacarpophalangeal (MP) joints in rheumatoid arthritis, the Swanson silicon spacer is still the golden standard. However, long-term follow-up reveals an increasing number of complications, particularly mechanical failure. In order to deal with these problems a number of new, biomechanically different silicone implants have been designed. Among these, the NeuFlex prosthesis has a preflexed hinge of 30 degrees in relation to the shaft axis, a more palmar lying center of rotation and a rectangular hinge with a collarlike platform against the bony surfaces. In a prospective study, the early results of the first thirteen patients operated with the NeuFlex arthroplasty are reported. All patients suffered from rheumatoid arthritis with destruction of the MP joints. The mean follow-up was 12.3 months. A total of 37 joints were replaced. All patients were female with an average age of 56 years. Postoperative reduction of pain, measured on a visual analog scale with the maximum of 10 (VAS), decreased from 6.6 to 0.7 (p < 0.001). Jamar grip strength improved from 4.2 kg preoperatively to 9.9 kg postoperatively (p < 0.005). Range of motion improved from 37 degrees to 57 degrees (p < 0.0001) as a result of a reduction in active extension deficit which reduced from 35 degrees to 15 degrees postoperatively. Ulnar drift was reduced from 20.2 degrees to 3.4 degrees at follow-up (p < 0.005). Radiological evaluation showed no implant failure, no subsidence, and no signs of inflammatory reaction. Overall the NeuFlex silicone implants show encouraging early results which must be confirmed in the long term.

[Arthroscopic rotator cuff repair with patch augmentation]. / Arthroskopische Rotatorenmanschettenrekonstruktion mit Patch-Augmentation.

SURGICAL OBJECTIVE: Augmentation of the rotator cuff with an ECM patch during arthroscopic rotator cuff repair is performed in order to unload the reconstruction and to activate biological healing. INDICATIONS: Reconstructable rotator cuff ruptures with reduced tendon quality. CONTRAINDICATIONS: Non-reconstructable tendon defects. SURGICAL TECHNIQUE: After tendon reconstruction the graft is shuttled and fixed on the cuff with two medially placed pulling sutures. With two lateral sutures the graft is pulled laterally over the reconstructed cuff and on the lateral tuberculum majus. AFTERCARE: Immobilization in an abduction pillow for 6 weeks with passive motion, active motion the next 6 weeks, and weight bearing after 12 weeks. RESULTS: Eight patients with a reconstructable re-rupture were augmented with an ECM patch. Short-term results after 6 months showed 5 (62.5%) healed tendons, 1 complete (12.5%) and 2 incomplete re-ruptures (25%). The CS (Constant Score) and SSV (Subjective Shoulder Value) were improved from 51 to 57% and 51 to 71%, which was not significant (p > 0.05). The Oxford shoulder score improved significantly from 21 to 38 (p < 0.05). There were no relevant intra- or postoperative complications.

Rheumatoid arthritis of the wrist. Classification related to the natural course.

The authors introduce a new functional classification of rheumatoid arthritis of the wrist. Unlike the classifications used today, it includes the aspect of the natural course of rheumatoid arthritis. The goal of this paper is to identify radiologic indicators that will classify rheumatoid arthritis into stable forms of the disease (Types I and II) and unstable forms of the disease (Type III). Of 144 wrists examined, the first available radiograph and the radiograph obtained at the time of the first surgery were assessed. The indicators measured were: carpal height ratio, ulnar translocation, radial rotation, and scapholunate dissociation. Noting the changes that occurred each year in these indicators, it was possible to identify a significant difference between stable forms (Types I and II) and unstable forms (Type III) for the parameters carpal height ratio, ulnar translocation, and scapholunate dissociation. The distribution of the indicators allowed the definition of three values: the 100% value, the cut off point, and the lower threshold value. Combining the three radiologic parameters at those values markedly enhanced the possibility to classify rheumatoid arthritis of the wrist. With the help of the three radiologic indicators carpal height ratio, ulnar translocation, and scapholunate dissociation, it is possible to classify wrists with an early stage of rheumatoid arthritis according to the Schulthess classification. The early identification of destabilizing forms of rheumatoid arthritis becomes possible, making the choice and timing of the surgical intervention easier. Wrists with a progressive unstable form of rheumatoid arthritis may be stabilized earlier.

Role of the air-water-solid interface in bacteriophage sorption experiments.

Batch sorption experiments were carried out with the bacteriophages MS2 and phi X174. Two types of reactor vessels, polypropylene and glass, were used. Consistently lower concentrations of MS2 were found in the liquid phase in the absence of soil (control blanks) than in the presence of soil after mixing. High levels of MS2 inactivation (approximately 99.9%) were observed in control tubes made of polypropylene (PP), with comparatively little loss of virus seen in PP tubes when soil was present. Minimal inactivation of MS2 was observed when the air-water interface was completely eliminated from PP control blanks during mixing. All batch experiments performed with reactor tubes made of glass demonstrated no substantial inactivation of MS2. In similar experiments, bacteriophage phi X174 did not undergo inactivation in either PP or glass control blanks, implying that this virus is not affected by the same factors which led to inactivation of MS2 in the PP control tubes. When possible, phage adsorption to soil was calculated by the Freundlich isotherm. Our data suggest that forces associated with the air-water-solid interface (where the solid is a hydrophobic surface) are responsible for inactivation of MS2 in the PP control tubes. The influence of air-water interfacial forces should be carefully considered when batch sorption experiments are conducted with certain viruses.

La infección como factor pronóstico en terapia intensiva / Infection as a factor prognosis in intensive therapy

Objetivo. Estudiar la relación de la patología infecciosa como motivo de ingreso a Terapia Intensiva (UTI) y la evolución a corto plazo. Diseño. Retrospectivo y observacional. Procedimiento. Se revisaron los datos de los pacientes internados entre el 01/ 01/1996 y el 31 /12/2006. Para el análisis se crearon 6 grupos de gravedad según el escore APACHE II de ingreso. La influencia de la patología de ingreso, sexo y días de internación fue determinada con regresión logística múltiple. En cada grupo de APACHE II se analizó el riesgo de muerte de los pacientes que ingresaron por patología infecciosa. Resultados. Se analizaron 5.263 pacientes. Edad media 55,08 años (r 11-98); sexo masculino 63%; días de estadía en UTI 4,05 días (±5,44); APACHE II 11,3 (±8,27); mortalidad 22,4%; patología de ingreso: cardiovascular 31,50%, infecciosa 14,48%, neurológica 9,86%, respiratoria 8,09%, digestiva 7,30%, medio interno 3,55% y otras 25,22%. La patología infecciosa fue el único factor que fue significativo en su relación a mortalidad todos los grupos de APACHE II. Cuando se analizaron en forma conjunta todos los pacientes y se incorporó al modelo de regresión logística el valor de APACHE II, resultaron significativos: patología cardiovascular, digestiva, infecciosa, neurológica, respiratoria y APACHE II, siendo la patología infecciosa la de mayor peso estadístico. Conclusión. Nuestro estudio sugiere que la patología infecciosa es un factor de riesgo independiente de mortalidad. Por lo tanto los pacientes infectados deberían ser considerados de alto riesgo, lo que puede determinar un nivel e intensidad de atención diferencial con la finalidad de disminuir las cifras de morbimortalidad.(AU)

Infections as Prognosis Factor in Critical Care Units Objective. To study the prevalence of infectious diseases as a cause of critical care unit admission and its short-term evolution. Design. Retrospective and observational study. Procedure. The patients admitted between January, 1st, 1,996 and December, 31st, 2,006 was reviewed. For the purpose of the analysis, there were 6 groups created according to the APACHE II score, to stratify severity at intensive-care unit admission. The influence of the illness at admission, gender and days at intensive care unit was determined through multiple logistic regression. In each APACHE II group, the mortality in patients admitted for infectious diseases were analyzed. Results. 5,263 patients were analyzed. Average age: 55.08 years (r 11-98); male gender: 63 %; length of stay at intensive care unit: 4.05 days (±5.44); APACHE II 11.3 (±8.27); mortality: 22.4%; causes of admission: cardiovascular disease: 31.50%, infectious disease: 14.48%, neurological disease: 9.86%, respiratory disease: 8.09%, digestive disease: 7.30%, disorders of fluids and electrolytes 3.55% and others: 25.22%. The only significant factor among all APACHE II groups was the infectious diseases. When all patients were analyzed as a whole and the results were included in logistic regression model from APACHE II, the most significant diseases were: cardiovascular, digestive, infectious, neurological, respiratory and APACHE II. The infectious diseases had the highest statistical weight. Conclusion. Our study suggests that infectious disease is an independent mortality factor. Thus, to reduce mortality and reduce hospital costs, patients with infectious diseases should be considered high-risk patients.(AU)