[Clinical experience and results of using the V.A.C. instill therapy in infected hip- and knee prosthetics]. / Klinische Erfahrungen und Ergebnisse über die Anwendung der V.A.C.-Instill bei infizierten Hüft- und Kniegelenksprothesen.

Since September 2005 our patients with acute endoprosthetic infection are treated, next to the normal wound debridement, with a full automatic vacuum drain system (V.A.C. instill system). This therapy unit entail a three step program. Based on the well known vacuum therapy, the new system contains an additional fluid drain and affecting period with an antibiotic or antiseptic instillation therapy. In the last half year we were able to treat five patients with endoprosthetic infection by using this therapy unit. In our opinion, we have a successfull method of treating patients with acute, infected big joints after endoprosthetic implantation. The therapy unit of V.A.C. instill is quickly available and easy to learn. Next to much better comfort for the patients the most advantage is to leave the prosthetic inside during the infection management with the new therapy unit. Further results in treating acute joint infections after endoprosthetic implantation must been shown, if this new method is to be the new standard in daily clinical routine.

Small bowel perforation as a complication of microsurgical lumbar diskectomy. A case report and brief review of the literature.

Ventral perforation is a rare complication of lumbar diskectomy. Injury to retroperitoneal vessels is the most common serious complication to such perforation. Ventral perforation with damage to the bowel is rarely reported. The authors present the first case report of injury to the small bowel during a microsurgical lumbar diskectomy. The case illustrates the importance of awareness of bowel injury as a possible complication of diskectomy. Possible pre- and postoperative considerations are also discussed. A brief review of the literature on bowel injuries after this common surgical procedure is also given.

The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer.

OBJECTIVE: To determine whether there is a short-term effect of spinal manipulation in the treatment of infantile colic. DESIGN: A randomized controlled trial. SETTING: A private chiropractic practice and the National Health Service's health visitor nurses in the suburb Ballerup (Copenhagen, Denmark). SUBJECTS: Infants seen by the health visitor nurses, who fulfilled the diagnostic criteria for infantile colic. INTERVENTION: One group received spinal manipulation for 2 weeks, the other was treated with the drug dimethicone for 2 weeks. OUTCOME MEASURE: Changes in daily hours of crying as registered in a colic diary. RESULTS: By trial days 4 to 7, hours of crying were reduced by 1 hour in the dimethicone group compared with 2.4 hours in the manipulation group (P = .04). On days 8 through 11, crying was reduced by 1 hour for the dimethicone group, whereas crying in the manipulation group was reduced by 2.7 hours (P = .004). From trial day 5 onward the manipulation group did significantly better that the dimethicone group. CONCLUSION: Spinal manipulation is effective in relieving infantile colic.

Reliability and concurrent validity of the BROM II for measuring lumbar mobility.

OBJECTIVE: To establish the reliability of the BROM II device for measuring lumbar mobility in the sagittal, coronal and transverse planes and its validity against the double inclinometer method. DESIGN: Blind intra- and interexaminer reliability and concurrent validity. Interexaminer reliability was determined between two examiners. SETTING: Chiropractice teaching college. SUBJECTS: Forty-seven asymptomatic chiropractic students (27 men and 20 women, age range 18 to 38 yr). MAIN OUTCOME MEASURE: Lumbar mobility measurement in degrees using the BROM II and double inclinometer techniques. RESULTS: Intraclass correlation coefficients (ICC) showed good intra- and interexaminer reliability of the BROM II for flexion (0.91 and 0.77, respectively) and lateral flexion (0.91 and 0.85 respectively). Less support was given to the reliability of the instrument in extension (0.63 and 0.35, respectively) and rotation (0.57 and 0.36 respectively). Concurrent validity of the BROM II and double inclinometer methods was partially supported (ICC in all planes range from 0.27 to 0.75). CONCLUSION: The BROM II was found to be a reliable instrument in the measurement of lumbar mobility in the sagittal (flexion) and coronal planes. However, before this device can be recommended as an assessment tool in clinical practice or clinical trials, further investigation into its reliability in a symptomatic group of patients is required. (J Manipulative Physiol Ther 1995; 18:497-502).

[Thoracolumbar injuries. Surgical treatment of patients with neurological damage]. / Torakolumbale skader. Kirurgisk behandling av pasienter med neurologiske utfall.

This article presents the neurological outcome after surgery of a series of 54 patients with damage to the spinal cord and/or cauda equina caused by thoracolumbar injuries. The fractures, dislocations or fracture-dislocations were all reduced and stabilized by a Harrington distraction device or transpedicular fixation system (posterior segment fixator). Peroperative inspection revealed that correction and distraction alone may be inadequate to achieve intraspinal decompression. Additional anterior decompression by posterolateral approach was necessary in 31 patients (57%). In this series there was an unexpected high rate of dural rents. Tears were found in 11 patients (20%) and nerve roots (cauda equina) appeared to have herniated through the tear in eight. Significant improvement of the neurological deficits was obtained in 81%. The improvement rate was much better in patients with incomplete lesions than among those with complete lesions. We are convinced that surgery improves the neurological outcome if carried out at the proper time, after sufficient decompression of the spinal cord and nerve roots, and repair of dural rents.

[Cervical disk defects. Results of surgical treatment of cervical vertebral radiculopathy]. / Cervikale skivedefekter. Resultater ved operativ behandling av cervikal vertebrogen radikulopati.

The article presents a retrospective study of a series of 213 patients treated for cervical spondylotic radiculopathy by anterior surgery. The follow-up period ranged from 2-8 years. The overall functional outcome of surgery showed a rate of improvement of 91.5% at late follow-up. In 8.5% of the patients there was no change, and none considered themselves as being worse than before surgery. The various selective symptoms and signs were analyzed. Improvement of root pain was obtained in 93.4% of the patients, of sensory deficits in 90.7% and of motor deficits in 81.8%. The rate of improvement for neck pain was 44.6%. In this series, mortality was zero and there was no peroperative neurological deterioration. 3.3% of the patients were re-operated at the previous level. A second operation at another level or levels was necessary in 5.2% of the patients. Early surgical treatment, and possibly the degree of neurological deficits, were the only factors found to influence overall functional recovery. In contrast to the overall results, and in spite of large individual variations, neither sensory nor motor deficits, nor root pain, were statistically influenced by degree of root deficits or duration of symptoms.

Cerebral vasoreactivity and blood flow before and 3 months after carotid endarterectomy.

We measured regional cerebral blood flow and cerebral vasoreactivity before and 3 months after carotid endarterectomy using xenon-133 inhalation with single-photon emission computed tomography and the acetazolamide test in 14 selected patients who had suffered cerebral transient ischemic attacks due to an ipsilateral internal carotid artery stenosis. The patients had neither clinical nor cerebral computed tomographic evidence of infarction. Baseline regional cerebral blood flow was symmetrical before and unchanged after endarterectomy. Before endarterectomy, vasoreactivity in the middle and anterior cerebral artery territories of the symptomatic side was significantly reduced (p less than 0.05); however, vasoreactivity was normalized 3 months after surgery. Our findings strongly suggest that the stenoses caused a reduction in perfusion reserve that was improved by carotid endarterectomy.

Patency and flow velocity profiles in the internal carotid artery assessed by digital subtraction angiography and Doppler studies two years after endarterectomy.

A follow-up of 55 patients 2 years after a total of 60 carotid endarterectomies. Fifty-two patients who had a total of 57 endarterectomies survived the first 2 post-operative years and were re-examined using pulsed Doppler spectral analysis and intravenous digital subtraction angiography (IVDSA). One patient had died following a stroke and 2 after a cardiac infarction. The Doppler and IVDSA examinations revealed a non-symptomatic restenosis of the relevant internal carotid artery in 2 patients. There were no relevant occlusions and no symptomatic re-stenoses were detected. Spectral spreading of the Doppler signal at the site of the endarterectomy was found in 18% of the internal carotid arteries, whereas wall irregularities (diameter reduction less than 10%) were demonstrated in 25% by IVDSA. A stenosis or occlusion was found in 14 (25%) of the 57 ipsilateral external carotid arteries.

Magnetic resonance imaging of an epidural spinal arachnoid cyst.

The myelography, CT and MR imaging findings in a patient with an epidural spinal arachnoid cyst are discussed. MR imaging excellently demonstrated cyst size, cyst location and cord compression, and should be the method of choice in these cases.

MRI in cervical disk herniation.

Eleven operated herniated disks in 10 patients were evaluated preoperatively with plain films, myelography and magnetic resonance imaging. Plain X-ray was a valuable supplement to MRI for studying the bony changes. Myelography showed 7 of 11 herniated disks while MRI gave correct diagnosis in all. It is concluded that MRI can replace myelography and computerized tomography in the preoperative evaluation of cervical herniated disk. The other examinations may be supplementary in some cases.

Trigeminal alveolar nerve of the lower jaw in the cichlid Tilapia mariae: evidence for continual axon generation and presence of exceptionally small myelinated axons.

Cross sections from the trigeminal alveolar nerve of the lower jaw in the cichlid Tilapia mariae were examined by electron microscopy. The nerve fibers are arranged in groups with a core of unmyelinated and small myelinated axons, surrounded by myelinated axons of varying sizes. The core contains large bundles of unmyelinated axons collectively ensheathed by circumferentially located Schwann cells, as well as smaller bundles of unmyelinated axons partly separated from each other by Schwann cell processes. Among the unmyelinated axons, occasional scattered profiles resembling growth cones are seen. The total number of axons in this tooth-related nerve increases from approximately 1,500 to 5,000, as the animals grow in length from 4.5 to 21.5 cm. Some 24-49% of the axons are unmyelinated. The myelinated axons have maximum diameters of 1.0-3.0 micron, depending on body size. Most myelinated axons have diameters less than 1.0 micron and the smallest ones reach down to 0.3 micron. These results show that there is a continual addition of axons to the alveolar nerve of the lower jaw in Tilapia mariae and that the critical diameter for myelination in this peripheral nerve is similar to that typically found in the mammalian CNS.

Induction of the heat shock regulon of Escherichia coli markedly increases production of bacterial viruses at high temperatures.

Production of bacteriophages T2, T4, and T6 at 42.8 to 44 degrees C was increased from 8- to 260-fold by adapting the Escherichia coli host (grown at 30 degrees C) to growth at the high temperature for 8 min before infection; this increase was abolished if the host htpR (rpoH) gene was inactive. Others have shown that the htpR protein increases or activates the synthesis of at least 17 E. coli heat shock proteins upon raising the growth temperature above a certain level. At 43.8 to 44 degrees C in T4-infected, unadapted cells, the rates of RNA, DNA, and protein synthesis were about 100, 70, and 70%, respectively, of those in T4-infected, adapted cells. Production of the major processed capsid protein, gp23, was reduced significantly more than that of most other T4 proteins in unadapted cells relative to adapted cells. Only 4.6% of the T4 DNA made in unadapted cells was resistant to micrococcal nuclease, versus 50% in adapted cells. Thus, defective maturation of T4 heads appears to explain the failure of phage production in unadapted cells. Overproduction of the heat shock protein GroEL from plasmids restored T4 production in unadapted cells to about 50% of that seen in adapted cells. T4-infected, adapted E. coli B at around 44 degrees C exhibited a partial tryptophan deficiency; this correlated with reduced uptake of uracil that is probably caused by partial induction of stringency. Production of bacteriophage T7 at 44 degrees C was increased two- to fourfold by adapting the host to 44 degrees C before infection; evidence against involvement of the htpR (rpoH) gene is presented. This work and recent work with bacteriophage lambda (C. Waghorne and C.R. Fuerst, Virology 141:51-64, 1985) appear to represent the first demonstrations for any virus that expression of the heat shock regulon of a host is necessary for virus production at high temperature.

Neurological outcome after surgery for thoracic and lumbar spine injuries.

New techniques for internal fixation, employed by neurosurgeons and orthopaedic surgeons, provide reduction and stabilization with early mobilization of patients after injuries of the thoracolumbar spine. It has, however, appeared difficult to prove that the neurological outcome after surgery may be superior to conservative treatment. In this study the neurological results after surgery are evaluated in 30 patients with injuries of the spinal cord and/or cauda equina. Canal encroachment was found on tomograms or CT in all patients. The unstable fractures, dislocations or fracture-dislocations were all reduced and stabilized by the Harrington distraction device. However, peroperative inspection revealed that the Harrington instrumentation alone may be inadequate in achieving intraspinal decompression. Additional anterior decompression by posterolateral approach was necessary in 13 of the 30 patients (43%). In this series there was an unexpectedly high rate of dural tears. These were found in 8 patients (27%) and nerve roots (cauda equina) appeared to have herniated through the tear in 6 of the 8 patients. Significant improvement of the neurological deficit was obtained in 22 of the 30 patients (73%), and the improvement rate in patients with incomplete lesions of the spinal cord was 83% (25 of 30 patients). In this series there was a definite trend toward greater neurological recovery when compared to the results obtained in patients treated conservatively. The importance of a neurosurgical approach in diagnosis and treatment of these patients is stressed.

Odontogenic keratocysts. A follow-up study of 29 cases.

This study reports the incidence and recurrence rate of odontogenic keratocysts in a series of 531 jaw cysts treated at the Department of Oral Surgery, Karolinska Institute, Stockholm, from 1977 to 1984. Each case of a histologically verified odontogenic keratocyst was analysed and registered with respect to patient's age and sex, type of cyst, location and rate of recurrence. Twenty-nine odontogenic keratocysts were found (5.4% of all cysts). The most frequent locations were in the mandibular angle, ramus and third molar regions. During the observation period (1-8 years) 7 keratocysts (24%) recurred. These findings support previous observations.

Variations in middle cerebral artery blood flow investigated with noninvasive transcranial blood velocity measurements.

Observations on blood velocity in the middle cerebral artery using transcranial Doppler ultrasound and on the ipsilateral internal carotid artery flow volume were obtained during periods of transient, rapid blood flow variations in 7 patients. Five patients were investigated after carotid endarterectomy. A further 2 patients having staged carotid endarterectomy and open heart surgery were investigated during nonpulsatile cardiopulmonary bypass. The patient selection permitted the assumption that middle cerebral artery flow remained proportional to internal carotid artery flow. The integrated time-mean values from consecutive 5-second periods were computed. The arithmetic mean internal carotid artery flow varied from 167 to 399 ml/min in individual patients, with individual ranges between +/- 15% and +/- 35% of the mean flow. The mean middle cerebral artery blood velocity varied from 32 to 78 cm/sec. The relation between flow volume and blood velocity was nearly linear under these conditions. Normalization of the data as percent of the individual arithmetic means permitted a composite analysis of data from all patients. Linear regression of normalized blood velocity (V') on normalized flow volume (Q') showed V' = 1.05 Q' - 5.08 (r2 = 0.898).

Patency and flow velocity profiles in the internal carotid artery assessed by digital subtraction angiography and Doppler studies three months following endarterectomy.

Pulsed Doppler spectral analysis and intravenous digital subtraction angiography have been carried out in 55 patients, three months after a total of 60 carotid endarterectomies. Five patients were operated on both sides and there were no re-operations. There were no re-stenoses and only one of the 60 internal carotid arteries was occluded. Spectral spreading of of the Doppler signal at the site of the endarterectomy was found in 52% of the internal carotid arteries, whereas wall irregularities were demonstrated in 25% by intravenous digital subtraction angiography. A stenosis or occlusion was found in 11 (18%) of the 60 ipsilateral external carotid arteries.