Design and evaluation of a new synthetic wrist procedural simulator (Wristsim®) for training of distal radius fracture fixation by volar plating.

Legislation concerning workload of surgical trainees and pressure to reduce learning curves have forced us reconsider surgical training. Our goal was to evaluate a synthetic procedural simulator for teaching open reduction and internal fixation (ORIF) of distal radius fractures (DRF). Twenty surgeons used a synthetic procedural simulator (Wristsim®) made by 3D printing for ORIF of DRF with a volar plate (Newclip Technics®). The evaluation consisted of grading the simulator's realism compared to the surgeons' own experience with surgery on cadavers. The Wristsim® was graded 5.10/10, compared to 8.18/10 for the cadaver specimen for introduction of the plate under pronator quadratus. For fracture reproduction, Wristsim® scored 6.40/10, with the cadaver specimen scoring 7.15/10. For fracture reduction, Wristsim® scored 5.62/10, with the cadaver specimen scoring 7.38/10. Plate application was scored 7.05/10 for Wristsim® and 8.23/10 for the cadaver. Drilling was scored 6.60/10 for the Wristsim® and 8.23/10 for the cadaver. Screw fixation was scored 7.40/10 for the Wristsim® and 8.12/10 for the cadaver. Our results demonstrated that Wristsim® is still inferior to a cadaver specimen for teaching ORIF by volar plating of DRF. A new model of Wristsim® is being developed that will address shortcomings in pronator quadratus thickness, passive ROM in flexion/extension and bone size.

Obesity as Predictor of Mortality of Colorectal Cancer: an Evidence-based Case Report.

AIM: to determine all-cause mortality and cancer-spesific mortality of colorectal cancer patient with obesity. METHODS: a search was conducted on Pubmed, Proquest, Ebsco, Scopus, and Cochrane based on clinical query. The screening of title and abstract using inclusion and exclusion criteria, filtering double, and reading full text led to one useful article. This study, which is meta-analysis was critically appraised for its validity, importance and applicability. RESULTS: the relative risk of colorectal cancer patient with pre-existing obesity having cancer-specific mortality and all-cause mortality is 1.22 (95% CI, 1.003-1.35) and 1.25 CI (95% CI, 1.14-1.3) respectively, when compared with non-obese colorectal cancer patient. CONCLUSION: pre-existing obesity is related to increased risk of all-cause mortality and cancer-spesific mortality of in colorectal patient. Control of body weight is recommended in this patient through combination of diet, physical activity, behavior therapy, pharmacotherapy, and surgery.

[Rehabilitation for paraplegics]. / Rehabilitation nach Querschnittlähmung.

Paraplegia permanently impairs the lives of patients and puts them at risk for other medical complications. Rehabilitation is very complex and has to be adjusted to the specific needs of the patient; it requires an interdisciplinary team with special training. Initial treatment of paraplegic patients aims to enable life at home whenever feasible or a nursing institution that can accommodate the patient's needs. For this, it is necessary that the patient is in stable condition, urinary and bowel continence has been established, ability to communicate is restored, and the patient is mobile within his/her means. Occupational rehabilitation should also have been started or at least offered. Another important element in the comprehensive care of paraplegic patients is lifelong follow-up.

[Septic arthritis? Gonococcal infection despite negative bacterial cultures]. / Bakterielle Arthritis? Gonokokken-infektion trotz negativen Kulturen.

Clinical signs of acute arthritis are non-specific. An acute painfull joint with effusion of unknown origin needs to be evaluated by puncture. The analysis of the synovial fluid will enable to divide an arthritis into three categories: crystal induced, rheumatological or septic arthritis. A bacterial infection should always be suspected. Cultures from blood, synovia and Gram stain do not reliably exclude a bacterial infection. If gonococcal, mycobacterial, borrelial and non-gonococcal-infective arthritis under antibiotic therapy is suspected, direct DNA-amplification can be helpful. A disseminated gonococcal infection (DGI) must be suspected on appearance of tenosynovitis, polyarthralgia and skin lesions. The clinical picture, diagnosis and therapy of a case with DGI is discussed.

[Reconstruction of the ruptured extensor pollicis longus tendon using a tendon interposition graft]. / Die Rekonstruktion der Extensor pollicis longus-Sehne mit einem Sehneninterponat.

To restore function of the ruptured extensor pollicis longus (EPL) tendon, two operative principles have been described: reconstruction of the original tendon using a tendon interposition graft or a tendon transposition operation, most commonly transposition of the extensor indicis. From 1992 to 1998, we reconstructed the extensor pollicis longus tendon using an interposition graft in 58 patients. 48 patients were available for follow-up after a mean of 31 months. The mean age of the 25 women and 23 men was 49 years. The time between tendon rupture and reconstruction ranged from one to 40 weeks. The tendon rupture occurred in 19 patients following a radius fracture, in 22 patients without history of trauma and in seven patients it was due to a sharp injury. Using the clinical score of Geldmacher and Köckerling, five patients achieved a very good, 35 patients a good and eight patients a satisfactory result. No patient had a poor result. According to the statistical analyses, these results were independent of the age of the patients, the origin of the rupture or the time interval between rupture and tendon reconstruction. The average DASH score measured 14. Considering our results, secondary reconstruction of the original EPL tendon appears to be a valuable alternative to the commonly performed tendon transpositions. It yields good clinical results with little remaining functional impairment and without the need to sacrifice another functional motor. We strongly recommend this technique in patients who require an independent and strong extension of the index finger in their profession (surgeons, musicians) and in patients with severe trauma that does not allow the sacrifice of another intact motor unit.

Psychological and physiological effects of MDMA ("Ecstasy") after pretreatment with the 5-HT(2) antagonist ketanserin in healthy humans.

MDMA (3,4-methylenedioxymethamphetamine, "Ecstasy") mainly releases serotonin and dopamine. In animals, pretreatment with 5-HT(2) antagonists has been shown to attenuate neurochemical and behavioral effects of MDMA. In humans, the role of 5-HT(2) receptors in the action of MDMA has not been studied. We investigated the effect of pretreatment with the 5-HT(2A/C) antagonist ketanserin (50 mg p.o.) on subjective responses to MDMA (1.5 mg/kg p.o.) in 14 healthy volunteers using a double-blind placebo-controlled within-subject design. Subjective effects were rated by psychometric rating scales. Physiological effects measured were blood pressure, heart rate, and body temperature. Adverse effects were assessed during the sessions, and after one and three days. Ketanserin attenuated MDMA-induced perceptual changes, emotional excitation, and acute adverse responses but had little effect on MDMA-induced positive mood, well-being, extroversion, and short-term sequelae. Body temperature was lower under MDMA plus ketanserin compared to MDMA alone. The results suggest a contributing role for 5-HT(2) receptors in the action of MDMA in humans.

Molecular phylogeny of some European heteronemertean (Nemertea) species and the monophyletic status of Riseriellus, Lineus, and Micrura.

The 16S rRNA mitochondrial gene was used to reconstruct the relationships among 10 heteronemertean species (subclass Heteronemertea, phylum Nemertea); Lineus ruber and L. viridis are represented by more than one specimen to assess intraspecific variation in these enigmatic species, and the analysis includes in total 14 terminal taxa incorporating one palaeonemertean species (Tubulanus annulatus) for outgroup rooting. The aligned sequences were subjected to maximum parsimony, maximum-likelihood, and neighbor-joining analyses to estimate the phylogenetic relationship of the species. The results were concordant from all analyses and indicate that neither Lineus nor Micrura are monophyletic taxa, and that there is no support from a phylogenetic point of view to establish the monotypic genus Riseriellus.

Transitional phenomena as evidenced in prayer.

In this paper, we demonstrate that the study of prayer facilitates understanding of the deeply personal object related nature of religious experience. Within prayer, individuals enter the transitional sphere and meet their God representation. Both conscious and unconscious aspects of prayer can be made available through the use of a projective test developed by the authors, known as STARR: Spiritual Themes and Religious Responses test. The data obtained suggest the usefulness of Winnicottian concepts of transitional phenomena, playing, communicating, and capacity to be alone as a contemporary psychoanalytic framework for interpreting religious experience.