Synovial osteochondromatosis in a 9-year-old girl: clinical and histopathological appearance.

This article reports the clinical and histopathological appearance of synovial osteochondromatosis in the right knee joint of a 9-year-old girl. Initial symptoms such as monoarticular joint swelling led to further diagnostic procedures with the aid of different imaging techniques including X-ray examination and MRI. The definitive diagnosis was based on histopathological findings after performing arthroscopy of the affected joint and the intraoperative appearance of the synovial lesions. Besides antiphlogistical drug-therapy, the treatment of choice is synovectomy.

[Artificial discs: review, current status, outlook]. / Bandscheibenprothesen: Rückblick, Augenblick, Ausblick.

AIM: This paper gives an overview of the current status of artificial discs for the lumbar spine. METHODS: Recent publications and overviews in the literature with pro and contra opinions and the latest procedure of FDA approval are presented and discussed. Despite arguments to the contrary, an FDA panel is in favour of the premarket approval application for the Charité artificial disc because of good late follow-up results. Other lumbar artificial discs will follow. RESULTS: Follow-up studies only exist for the Charité and Prodisc endoprotheses. The results are comparable to those of lumbar fusion. However, randomized controlled studies are still missing. CONCLUSION: Proponents for lumbar artificial discs stand against the criticism of an unpredictable treatment for a condition that cannot be diagnosed with any precision. The current model should be a controlled indication with second opinions followed by professional surgery in spine centers.

[Osteomyelitis after endoprostheses]. / Osteomyelitis nach Endoprothesen.

Today over 170,000 total hip arthroplasties and about 70,000 total knee arthroplasties are performed in Germany. An overall infection rate of 0.5-1.4% is reported in the literature. This means that 800-1700 infections after total hip arthroplasty and 300-850 infections after total knee arthroplasty can occur. The surgical treatment of early or late infections after arthroplasty of the hip or knee needs different intervention. Depending on when the infection develops, a simple Débridement, an allinone exchange arthroplasty, or the explantation of the endoprosthesis with implantation of a spacer followed by the reimplantation of a new prosthesis must be performed. The first hint of postoperative infection is the increase of the C-reactive protein. By correct treatment of the postoperative wound the first sign of an infection can be detected early.

[Long-term results of wall stent implantation in benign prostatic hyperplasia and high risk status]. / Langzeitergebnisse der Wallstent-Implantation bei benigner Prostatahyperplasie und hohem Risikostatus.

The implantation of a Wallstent prosthesis is a minimally invasive alternative to conventional TUR-P for the treatment of infravesical obstruction owing to benign prostatic hyperplasia. We report on the long-term follow-up of 37 patients with a high-risk status for TUR-P who have been implanted since May 1990. The ASA status was: ASA I: 0, ASA II: 2, ASA III: 17 and ASA IV: 18 patients. The median follow-up is now 38.5 months. Directly after implantation, a medium increase in the maximum flow-rate from 7.5 ml/s to 16.9 ml/s was documented. Residual urine was reduced from 120 to 24.2 ml on average. After 12, 18, 24 and 36 months, average maximum flow rates of 16.1, 16.7, 12.0 and 11.6 ml/s were evaluated. The corresponding residual urine was 50.3, 121.1, 56.8 and 65 ml, respectively. Also, micturition frequency decreased from 12.4 preoperatively to 8.3, 7.6, 8.0, and 8.4 per day on average. Nearly all patients reported perineal discomfort in the 1st weeks after implantation. For this reason, the stent had to be removed in 1 patient on the 45th postoperative day. In addition, a dislocated stent had to be replaced in 2 patients. Six of 15 retention patients presented with persisting detrusor dysfunction after implantation and were therefore discharged with a suprapubic tube. Endoscopic controls showed complete urothelial coverage in 78% of our patients after 6 months. After 18 months all stents were completely covered. Long-term follow-up showed reobstruction in 6 of 37 patients (16.7%) and signs of incontinence in 4 of 37 (10.8%). The late complication rate is therefore calculated at 27.5%. Stent-related deaths could not be found. We conclude that Wallstent implantation into the prostatic urethra is an alternative to TUR-P for patients at high risk from surgery. The good postoperative results also remain stable during long-term follow-up.