Laparoscopic Chromopertubation, Myomectomy with Opening of the Uterine Cavity and Hysteroscopy during the Early Implantation Phase of an Undetected Pregnancy: Delivery of a Child with a Complex Brain Malformation.

A previously infertile woman underwent laparoscopic myomectomy involving opening of the uterine cavity and chromopertubation that showed closed Fallopian tubes during the early implantation stage of an undetected pregnancy. The pregnancy was not terminated, and a child with a complex brain malformation was delivered at 37 weeks of gestation by Cesarean section.

Stab injury of the superior mesenteric artery with life threatening bleeding - endovascular treatment with an unusual technique.

Endovascular microcoil embolization of the superior mesenteric artery (SMA) main trunk is not currently employed as a treatment for penetrating injury to the SMA in hemodynamically instable patients. Immediate laparotomy is the initial gold standard therapy. We report a case of successful SMA microcoil embolization with preservation of mesenteric perfusion by an unusual endovascular technique.

Mutations in 3 genes (MKS3, CC2D2A and RPGRIP1L) cause COACH syndrome (Joubert syndrome with congenital hepatic fibrosis).

OBJECTIVE: To identify genetic causes of COACH syndrome BACKGROUND: COACH syndrome is a rare autosomal recessive disorder characterised by Cerebellar vermis hypoplasia, Oligophrenia (developmental delay/mental retardation), Ataxia, Coloboma, and Hepatic fibrosis. The vermis hypoplasia falls in a spectrum of mid-hindbrain malformation called the molar tooth sign (MTS), making COACH a Joubert syndrome related disorder (JSRD). METHODS: In a cohort of 251 families with JSRD, 26 subjects in 23 families met criteria for COACH syndrome, defined as JSRD plus clinically apparent liver disease. Diagnostic criteria for JSRD were clinical findings (intellectual impairment, hypotonia, ataxia) plus supportive brain imaging findings (MTS or cerebellar vermis hypoplasia). MKS3/TMEM67 was sequenced in all subjects for whom DNA was available. In COACH subjects without MKS3 mutations, CC2D2A, RPGRIP1L and CEP290 were also sequenced. RESULTS: 19/23 families (83%) with COACH syndrome carried MKS3 mutations, compared to 2/209 (1%) with JSRD but no liver disease. Two other families with COACH carried CC2D2A mutations, one family carried RPGRIP1L mutations, and one lacked mutations in MKS3, CC2D2A, RPGRIP1L and CEP290. Liver biopsies from three subjects, each with mutations in one of the three genes, revealed changes within the congenital hepatic fibrosis/ductal plate malformation spectrum. In JSRD with and without liver disease, MKS3 mutations account for 21/232 families (9%). CONCLUSIONS: Mutations in MKS3 are responsible for the majority of COACH syndrome, with minor contributions from CC2D2A and RPGRIP1L; therefore, MKS3 should be the first gene tested in patients with JSRD plus liver disease and/or coloboma, followed by CC2D2A and RPGRIP1L.

[Angiographic embolization of seriously bleeding vessels as an emergency procedure after traumatic disruption of the symphysis]. / Notfall-Embolisation bei schwerer Blutung nach traumatischer Symphysensprengung.

Bleeding after instable fractures of the pelvic ring results in a mortality-rate of 7-21 percent. A 65-year-old male patient who fell from his horse and sustained an open book injury with disruption of the symphysis and iliosacral joint developed a dangerous haemorrhagic shock situation in the emergency room. A computer tomography with contrast medium was performed immediately. The outflow of contrast medium behind the symphysis indicated an acute arterial bleeding. An angiography revealed a bleeding from both Aa. obturatoriae and the right A. epigastrica inferior. The difficulty to stop the bleeding surgically resulted in the decision to embolize the vessels angiographically. This procedure terminated the acute bleeding and haemorrhagic shock situation immediately. The pelvic ring disruption was stabilized by internal fixation ten days later. The patient had an uncomplicated course.

[Multiple pathological fractures within the scope of DeToni-Debre-Fanconi syndrome after fumarate therapy in psoriasis]. / Multiple pathologische Frakturen im Rahmen eines DeToni-Debré-Fanconi-Syndroms nach Fumarattherapie bei Psoriasis.

We report about a rare case of a pathological fracture of the shank following earlier pathological fractures at other locations in a comparatively young female patient with no history of trauma. There were no known diseases other than psoriasis. The shank fracture was treated surgically by osteosynthesis. Osteoporosis, myeloma, or malignancy as causative factors of this fracture could be excluded. Scintigraphy showed an enhancement, especially at the extremities. Other than reactive bone growth, histological examination revealed no further aspects. Laboratory analysis indicated a massive lack of vitamin D3. After transferring the patient to the internal department of our hospital, long-term medication with fumaric acid was determined to be the reason for the osteomalacia of a Fanconi's syndrome. Three months after cessation of these medicaments and treatment with active vitamin D3 metabolites, the patient was free of complaints. The radiographs showed an essential improvement of the demineralization.

Intravenous vs. oral iron supplementation during autologous blood donation.

Prior to hip replacement surgery, 197 patients (123 women, 74 men, age 18-86 years) donated up to 4 units of blood once weekly if their hemoglobin concentrations exceeded 11.5 g/dl. They received an oral (200 mg iron sulfate daily) or intravenous (200 mg iron saccharate or 125 mg iron gluconate in 500 ml 0.9% NaCl weekly) iron replacement. Correlating the number of donated blood units with the form of iron substitution, no effect of i.v. iron was seen in men. Women who received i.v. iron substitution were able to donate 4 units of blood more often than with oral iron.

[Percutaneous nucleotomy]. / Die perkutane Nukleotomie.

Percutaneous nucleotomy (PN) is a non-operative, percutaneous, intervening, radiologically controlled method for the treatment of non-sequestrated herniated discs. The diagnostic criteria are CT, MR, functional myelography with myelo-CT, discography and disco-CT. Of the indication for this procedure is strictly confined to patients pretreated in the conventional way, this method yields good or very good results in about 75-80% of cases. PN is performed under local anesthesia and under fluoroscopic control. Of the technical parameters are strictly observed, PN is considered a low-risk method. The rate of infection is lower than 1%. Even though there are no long-term results yet, the positive results we have observed for 1 to 6 years suggest that this method will become an established method of treating herniated discs, as there is little discomfort for the patient.

[Therapy of humeral head fracture. Open reposition and fixation with PDS pins]. / Zur Therapie der Capitulum Humeri-Fraktur. Offene Reposition und Fixierung mittels PDS-Stiften.

Seven patients who sustained a displaced fracture of the capitulum humeri had been treated by surgery, using a volar approach and internal fixation with PDS pins. The advantage of this method is that by using the volar approach, the displaced capitulum could be reduced properly in its exact anatomical position. The internal fixation with PDS pins was solid enough to allow early postoperative movements. A second operation to remove any material was not necessary. In all cases the clinical and x-ray results have been excellent.

[Clinical relevance of whole body skeletal scintigraphy in multiple injury and polytrauma patients]. / Die klinische Relevanz der Ganzkörperskelettszintigraphie bei mehrfachverletzten und polytraumatisierten Patienten.

The provision of care to polytraumatised patients is a particular diagnostic and therapeutic challenge. The examination data of 162 polytraumatised patients were retrospectively investigated to determine the diagnostic gain provided by skeletal scintigraphy with 99mTc-HMDP. It was found that every fresh fracture (with the exception of fractures to the skull) led to a scintigraphically clearly demonstrable remodelling reaction within ten to 14 days. The timing of the examination was of decisive importance for the information yield. Not until about the tenth to 12th day did also those fractures that showed a delayed uptake show adequately signal-intensive areas of uptake in the scintigram. Typical examples were additional fractures of the spine and pelvis in patients immobilised by fractures of the limbs. At this time, with the aim of skeletal scintigraphy, an additional fracture was found in half of all patients, and was subsequently verified radiologically. Additional diagnostic information is independent of the ability of the patient to cooperate. This was of particular importance in the case of the very severely injured and old patients. Skeletal scintigraphy can be employed with equal efficacy to reliably exclude bone injuries. Thus, skeletal scintigraphy if of particular significance in the determination of the extent of bone injury in polytraumatised patients. This applies in particular to the preparation of an expertise. Thus, as in the case of staging of malignomas, the additional performance of bone scanning twelve to 14 days after traumatisation should form part of routine care offered to polytraumatised patients.

[Percutaneous treatment of varicocele: technical considerations and limitations of the method]. / Tratamento percutâneo da varicocele: considerações técnicas e limitações do método.

Three cases of varicocele were treated with good results by selective embolization of the spermatic vein. The technique of the procedure is discussed.

[Temporary postoperative protection of the anterior cruciate ligament with transarticular wire rope]. / Die temporäre postoperative Sicherung des vorderen Kreuzbandes durch ein transartikuläres Drahtseil.

This article describes an operational method for the temporary protection of the anterior cruciate ligament after acute or late ligament reconstruction. In line with the course of the anterior cruciate ligament a wire rope is transarticularly implanted and fixed with a screw each at the femur (proximally) and at the tibia bone (distally). This easily performed method permits both the healing of the ligament lesion while preserving the original ligament length and the execution of an early functional exercise therapy.

[Percutaneous nucleotomy: an alternative to chemonucleolysis?]. / Perkutane Nukleotomie: eine Alternative zur Chemonukleolyse?

In this study, we compare two groups of patients treated with chemonucleolysis (CNL) (101 patients) and percutaneous nucleotomy (PN) (100 patients) for sciatic pains. Indications for treatment were drawn along similar lines. The patients treated with CNL originated from the Department of Neurosurgery, University Hospital in Mainz and underwent treatment between 1983 and 1987. The second group with PN were from the teaching hospital in Wiesbaden and were treated during 1987 and 1988. Postoperatively, 80% of the CNL group showed good results. However, postoperative progress was slow with back spasms as a common uncomfortable side effect. In 72% of the patients in the PN group, successful treatment was demonstrated with results occurring almost immediately after treatment.

[Lumbar disc hernia: indications for percutaneous discectomy]. / Hérnia de disco lombar: indicações da discectomia percutânea.

The treatment of herniated lumbar disc by non-surgical procedures, through automated percutaneous discectomy, was introduced in Brazil by the authors in 1988. In this preliminary report the results obtained with this method in three patients are presented. Existing literature mentions a rate of 80% successful results in selected cases submitted to this treatment.

[The effect of inactivity-induced osteoporosis on the scintigraphic image of bone lesions of the wrist]. / Der Einfluss der Inaktivitätsosteoporose auf die szintigraphische Darstellung knöcherner Verletzungen im Bereich des Handgelenks.

In addition to its established oncological indications the sensitivity of bone scintigraphy is of steadily increasing significance in traumatology. Inactivity-induced osteoporosis plays a major role during the immobilization period in the plaster cast. In the region of the joints remodelling intensity may reach such a high level that the non-injured bone shows a higher rate of accumulation than the fracture. This process already begins between the third and fourth week of immobilization. The highest uptake is found after fracture of the scaphoid bone at the end of twelve weeks of immobilization. Control scintigraphies at intervals of several days are indicated to differentiate between various clinical conditions (pseudoarthrosis, activated osteoarthrosis, algodystrophy in case of doubtful x-ray results).

Percutaneous nucleotomy: a new interventional radiological technique for lumbar disk removal.

Percutaneous nucleotomy or the Onik-procedure is described as a new interventional radiological technique. Our own results in 84 patients are perfectly correlated with other surgical and microsurgical techniques with and without endoscopic control. Percutaneous nucleotomy seems to be very valuable. Precise indications and technique under fluoroscopic control and documentation may ensure 70 to 80% good and excellent results. In comparison with other interventional treatments percutaneous nucleotomy is safe, relatively simple and without major complications. In the near future percutaneous nucleotomy will have a certain place in the treatment program of radicular back pain.

[Conventional roentgen diagnosis of the proximal end of the humerus]. / Röntgen-Nativdiagnostik des proximalen Humerusendes.

Rarely the spectrum of conventional radiographic studies of the proximal humerus resp. shoulder joint is used in its full potential. This frequently results in erroneous interpretation. Five essential X-ray examinations are presented with respect to technique and diagnostic value.