[Antibacterial effectiveness of high-energetic extracorporeal shock waves: an in vitro verification]. / Antibakterieller Effekt hochenergetischer extrakorporaler Stosswellen: Ein in vitro Nachweis.

AIM: Extracorporeal shock wave therapy (ESWT) is used for a multitude of different indications in modern orthopedics. Local bacterial infections, like infected pseudarthrosis, are still considered as contraindications. The goal of the present study was to determine the effect of ESWT on the growth of clinically relevant bacteria in orthopedic and trauma surgery. METHODS: Standardized suspensions of five bacterial strains of bone and implant-associated infections were treated with 4 000 impulses of high-energy shock waves with an energy flux density (ED) of 0.96 mJ/mm (2) and a frequency of 2 Hz. Subsequently, viable bacteria were quantified and compared with an untreated control. RESULTS: A highly significant antibacterial effect of the ESWT was demonstrated for all bacterial strains with a reduction of growth to values between 1.1 % and 29.7 % (p < 0.01). Reference strains of Staphylococcus aureus and Staphylococcus epidermidis reacted with the highest sensitivity whereas Enterococcus faecium demonstrated the highest resistance towards high-energy shock waves. CONCLUSION: ESWT proved to exert a significant antibacterial effect on clinically relevant pathogens. Further investigations on energy flux density and impulse rates might contribute to an optimization of the bactericidal effectiveness. Infections as possible indications of the ESWT should therefore be assessed in further studies and the clinical relevance should be verified in an animal model.

Uterine position at real embryo transfer compared with mock embryo transfer.

BACKGROUND: The purpose of this study was to determine the consistency in the uterine position between mock and real embryo transfer. METHODS: We reviewed 996 consecutive embryo transfer cycles (585 patients); 74% of patients had an anteverted (AV) uterus and 26% had a retroverted (RV) uterus at mock embryo transfer. All mock and real embryo transfers were performed under abdominal ultrasound guidance. RESULTS: Of 623 fresh embryo transfers in patients with an AV uterus at mock embryo transfer, only 2% became RV, while 55% of 213 embryo transfers in patients with an RV uterus on mock embryo transfer converted to AV at real embryo transfer (P < 0.0001). For frozen-thawed embryo transfer, 12% of AV uteri at mock embryo transfer became RV, while 33% of RV uteri became AV (P = 0.01). CONCLUSIONS: Our data suggest that an RV uterus at mock embryo transfer will often change position at real embryo transfer. Misdirecting the embryo transfer catheter can be avoided by accurate knowledge of the uterine position at the time of embryo transfer, which can be more accurately assessed by routine ultrasound guidance. Additionally, patients with an RV uterus at mock embryo transfer should still present with a full bladder for embryo transfer, since a significant number will convert to an AV position.

[Leading symptom elbow pain. Differential diagnosis]. / Differenzialdiagnosen beim Ellenbogenschmerz. Denken Sie nicht nur an den Tennisarm.

Pain affecting the elbow joint may be caused by a number of different pathologies. In principle, these can be grouped by causality criteria into degenerative causes, inflammatory causes, tumor disease, congenital disease and the sequelae of trauma. The majority of these latter are associated with typical clinical symptoms that can be established with the aid of a systematic clinical examination, history-taking, inspection, palpation, an examination of joint mobility, and finally radiography. In this way, the diagnosis can rapidly be established.

[Results of surgical treatment of vulvar cancer]. / Resultate der operativen Behandlung des Vulvakarzinoms.

129 patients with carcinoma of the vulva were treated at the Dept. of Obstetrics and Gynaecology from 1966-1985. FIGO stage I was observed in 21% of the cases, FIGO stage II in 50%, FIGO stage III in 10% and FIGO stage IV in 8% of the patients. In 10% of the patients, definite classification was not possible. Mean age at the onset of the disease was 66.2 years, the mean time of observation 63 months. Kraurosis of the vulva or leukoplakia were simultaneous phenomena recorded locally in 67% of the patients. Histological investigation showed squamous cell carcinoma in 93% of the cases. The tumours were most frequently observed on the labia and the clitoris. 98% of the patients underwent surgery, 64% radical vulvectomy with inguinal lymph node disection. 56% of the patients of this group had a 5-year survival rate, which was 47% for the entire group of patients. Wound healing disorders were the most frequently observed postoperative complications. Metastasis to the inguinal lymph nodes at the time of diagnosis is the critical point of the prognosis. In the absence of lymph node involvement, 68% of the patients achieved a 5-year survival, in the presence of lymph node involvement, the 5-year survival rate was only 13%. Results obtained by this study support the view, that radical surgery at the earliest possible time is the treatment of choice for carcinoma of the vulva.