Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating.

Patient dissatisfaction after total knee arthroplasty (TKA) is a concern. Surgical error is a common, avoidable cause of failed TKA. Correct femoral and tibial component sizing improves implant longevity, clinical outcomes, knee balance, and pain scores. We hypothesized that preoperative three-dimensional (3D) templating for robot-assisted TKA (RA-TKA) is more accurate than two-dimensional (2D) digital templating. Prospectively collected data from 31 RA-TKAs were assessed to determine accuracy pertaining to implant sizing and positioning. All cases undergoing RA-TKA undergo preoperative CT-scans as per protocol. Three blinded observers retrospectively templated these knees for TKA using standard radiographs. We compared whether 2D templating was as accurate as CT-guided templating. Postoperative radiographs were then evaluated for sizing and positioning. Intraclass correlation coefficients (ICCs) and the effect of learning curve were assessed. Preoperative femoral component 3D templating and retrospective blinded 2D templating accuracies were 96.6% and 52.9%, respectively (χ 2: 17.965; odds ratio [OR]: 24.957, 3.250-191.661; p < 0.001). Tibial component 3D and 2D templating accuracies were 93.1% and 28.7%, respectively (χ 2: 36.436; OR: 33.480, 7.400-151.481; p < 0.001). ICC for the three radiograph observers was 0.920 (95% confidence interval [CI]: 0.652-0.890; p < 0.001) for the femur and 0.833 (0.717-0.911; p < 0.001) for the tibia, showing excellent agreement. We conclude that preoperative CT-based templating for RA-TKA more accurately predicts the size of implants compared with traditional 2D digital templating. This may improve operating room efficiency and cost containment.

The learning curve associated with robotic-arm assisted unicompartmental knee arthroplasty: a prospective cohort study.

Aims: The primary aim of this study was to determine the surgical team's learning curve for introducing robotic-arm assisted unicompartmental knee arthroplasty (UKA) into routine surgical practice. The secondary objective was to compare accuracy of implant positioning in conventional jig-based UKA versus robotic-arm assisted UKA. Patients and Methods: This prospective single-surgeon cohort study included 60 consecutive conventional jig-based UKAs compared with 60 consecutive robotic-arm assisted UKAs for medial compartment knee osteoarthritis. Patients undergoing conventional UKA and robotic-arm assisted UKA were well-matched for baseline characteristics including a mean age of 65.5 years (sd 6.8) vs 64.1 years (sd 8.7), (p = 0.31); a mean body mass index of 27.2 kg.m2 (sd 2.7) vs 28.1 kg.m2 (sd 4.5), (p = 0.25); and gender (27 males: 33 females vs 26 males: 34 females, p = 0.85). Surrogate measures of the learning curve were prospectively collected. These included operative times, the Spielberger State-Trait Anxiety Inventory (STAI) questionnaire to assess preoperative stress levels amongst the surgical team, accuracy of implant positioning, limb alignment, and postoperative complications. Results: Robotic-arm assisted UKA was associated with a learning curve of six cases for operating time (p < 0.001) and surgical team confidence levels (p < 0.001). Cumulative robotic experience did not affect accuracy of implant positioning (p = 0.52), posterior condylar offset ratio (p = 0.71), posterior tibial slope (p = 0.68), native joint line preservation (p = 0.55), and postoperative limb alignment (p = 0.65). Robotic-arm assisted UKA improved accuracy of femoral (p < 0.001) and tibial (p < 0.001) implant positioning with no additional risk of postoperative complications compared to conventional jig-based UKA. Conclusion: Robotic-arm assisted UKA was associated with a learning curve of six cases for operating time and surgical team confidence levels but no learning curve for accuracy of implant positioning. Cite this article: Bone Joint J 2018;100-B:1033-42.

Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study.

Aims: The objective of this study was to compare early postoperative functional outcomes and time to hospital discharge between conventional jig-based total knee arthroplasty (TKA) and robotic-arm assisted TKA. Patients and Methods: This prospective cohort study included 40 consecutive patients undergoing conventional jig-based TKA followed by 40 consecutive patients receiving robotic-arm assisted TKA. All surgical procedures were performed by a single surgeon using the medial parapatellar approach with identical implant designs and standardized postoperative inpatient rehabilitation. Inpatient functional outcomes and time to hospital discharge were collected in all study patients. Results: There were no systematic differences in baseline characteristics between the conventional jig-based TKA and robotic-arm assisted TKA treatment groups with respect to age (p = 0.32), gender (p = 0.50), body mass index (p = 0.17), American Society of Anesthesiologists score (p = 0.88), and preoperative haemoglobin level (p = 0.82). Robotic-arm assisted TKA was associated with reduced postoperative pain (p < 0.001), decreased analgesia requirements (p < 0.001), decreased reduction in postoperative haemoglobin levels (p < 0.001), shorter time to straight leg raise (p < 0.001), decreased number of physiotherapy sessions (p < 0.001) and improved maximum knee flexion at discharge (p < 0.001) compared with conventional jig-based TKA. Median time to hospital discharge in robotic-arm assisted TKA was 77 hours (interquartile range (IQR) 74 to 81) compared with 105 hours (IQR 98 to 126) in conventional jig-based TKA (p < 0.001). Conclusion: Robotic-arm assisted TKA was associated with decreased pain, improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based TKA. Cite this article: Bone Joint J 2018;100-B:930-7.

A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait.

AIMS: The outcome of total knee arthroplasty (TKA) is not always satisfactory. The purpose of this study was to identify satisfaction and biomechanical features characterising the gait of patients who had undergone TKA with either an anatomical single radius design or a medial pivot design. We hypothesised that the latter would provide superior function. PATIENTS AND METHODS: This is a study of a subset of patients recruited into a prospective randomised study of a single radius design versus a medial pivot design, with a minimum follow-up of one year. Outcome measurements included clinical scores (Knee Society Score (KSS) and Oxford Knee Score (OKS)) and gait analysis using an instrumented treadmill. RESULTS: There was no statistically significant difference between the two groups for both the KSS and OKS. There was also no statistical significance in cadence, walking speed, stride length and stance time, peak stride, mid support and push-off forces. CONCLUSION: This study corroborates a previous study by the same authors that showed equally good results in clinical outcome and gait between the conventional single radius and medial pivot designs under stringent testing conditions. Cite this article: Bone Joint J 2018;(1 Supple A)100-B:76-82.

Neocentric small supernumerary marker chromosomes (sSMC)--three more cases and review of the literature.

Here we report on three new patients with neocentric small supernumerary marker chromosomes (sSMC) derived from chromosome 2, 13 and 15, respectively. The sSMC(13) and sSMC(15) had inverted duplicated shapes and the sSMC(2) a ring chromosome shape. All three cases were clinically severely abnormal. A review of the available sSMC literature revealed that up to the present 73 neocentric sSMC cases including these three new cases have been reported. Seven of these cases were not characterized morphologically; in the remainder, 80% had an inverted duplication, 17% a ring and 3% a minute shape. 81% of the reported neocentric sSMC carriers showed severe, 12% moderate and 8% no clinical abnormalities. In summary, we report three more neocentric sSMC cases, provide a review on all up to now published cases, highlight their special characteristics and compare them to centric sSMC.

[Fibrosigmoidoscopy as a screening method for colorectal neoplasms in a population of patients hospitalized in the internal medicine department]. / Fibrosigmoidoskopia jako metoda przesiewowa dla nowotworów jelita grubego w populacji pacjentów hospitalizowanych w oddziale chorób wewnetrznych.

Surgical treatment of an early enough diagnosed large bowel cancer is possible in the screening tests. Fibrosigmoidoscopy is a sensitive method of the neoplastic lesions' diagnostics in the distal large bowel and competes the tests for occult blood in stools. The aim of the study was the assessment of fibrosigmoidoscopy as a screening test in a hospitalized patients. 2405 hospitalized patients were analysed in 2 years. Fibrosigmoidoscopy was performed in 903. Polyps, mainly neoplastic were diagnosed in 115 patients and cancers in 4 cases. The percentage of the results in other countries. The acceptance of the method was high (86%). We suggest that fibrosigmoidoscopy should be performed as the screening test in the hospitalized population.

Comparison of polymerase chain reaction with standard methods in the diagnosis of Mycobacterium tuberculosis infection.

The polymerase chain reaction (PCR) method was evaluated in the detection of Mycobacterium tuberculosis in comparison with direct microscopy and culture procedures including the standard radiometric system (Bactec). Amplified DNA fragments from clinical samples were analyzed by dot-blot and non-radioactive oligonucleotide hybridization techniques or by agarose gel electrophoresis. The results revealed nested PCR to be the method of choice. The combination of three culture methods could detect Mycobacterium tuberculosis in only 79% of PCR-positive cases. The mean time required to achieve a positive culture result was 17 days in contrast to the PCR method requiring only two to three days. The nested PCR assay provided rapid and reliable results allowing a definitive diagnosis particularly in a number of samples which were negative on culture.

[Evaluation of the effectiveness of the preparation Panzytrat 20,000 U in the substitute treatment of chronic pancreatitis]. / Ocena skutecznosci preparatu Panzytrat 20,000 j w leczeniu substytucyjnym przewleklego zapalenia trzustki.

Panzytrat 20,000 U produced by Knoll is a modern galenic form of active pancreatic enzymes in the form of microgranules with uniform enzymatic composition. The studies of the preparation effectiveness were carried out in 88 patients with diagnosed exocrine failure in the course of chronic pancreatitis. The patients were taking Panzytrat 20,000 for 4 weeks in doses 3 x 1 capsule with main meals. Control examinations were performed two and four weeks after starting the treatment, assessing the patients' condition on the basis of history taking and medical examination; taking into account weight gain, duration and intensity of pain and dyspeptic symptoms, frequency and character of defeacations and possible undesirable effects. In a group of 37 patients, BNT-PABA test was also performed before the treatment and after one capsule of Panzytrat. The treatment with Panzytrat 20,000 caused a statistically significant reduction of the number of defecations, significant reduction of pain and dyspeptic symptoms. A statistically significant increase of PABA recovery in urine was also obtained after one capsule of the preparation. Practically, no unfavourable effects of the treatment were observed. The studies carried out point to the high effectiveness of Panzytrat in dose 3 x 20,000. U daily in the treatment of exocrine pancreatic failure in the course of chronic pancreatitis.

A randomized study comparing low dose ciprofloxacin and ofloxacin in the treatment of lower respiratory tract infections.

An open, randomized study was carried out to compare the efficacy of ciprofloxacin, 250 mg twice daily, and ofloxacin, 200 mg twice daily, in hospitalized patients with lower respiratory tract infections such as bacterial exacerbation of chronic bronchitis or community-acquired pneumonia. Fifty patients were treated in each group. The duration of treatment was 10 to 12 days. Microbiological examinations were carried out on sputum samples taken before, during and after treatment. In both groups, the clinical results were considered to be excellent, with clinical cure in 98% of the patients treated with ciprofloxacin and in 90% of patients treated with ofloxacin. Eradication of the initial sputum isolate was achieved in 98% of the patients of the ciprofloxacin group and in 82% of the patients of the ofloxacin group.

[Lipoidproteinosis. A report of four cases]. / Lipoïed-proteïnose 'n bespreking van 4 gevalle.

Four cases of lipoid proteinosis (Urbach-Wiethe disease) are presented. The incidence, clinical features, relevant special investigations and possible treatment of the disease are reviewed. These patients present with hoarseness and lesions of the skin and mucosa. The condition is often misdiagnosed by general practitioners and otolaryngologists.

[Results of treatment of breast cancer with tamoxifen]. / Ergebnisse der Behandlung von Brustkrebs mit Tamoxifen.

There were 62 cases of mammary carcinoma treated with the antioestrogen tamoxifen. The age of the patients ranged from 35 to 75 years. Tamoxifen was administered in a daily dosage of 30 mg (3 x 1 tablet). Treatment was carried out as monotherapy or adjuvant therapy. Treatment was carried out for 6 months with a follow-up period of further 6 months. In the group of patients with mammary carcinoma, 23 were premenopausal without metastases after radical mastectomy and sterilisation. The remaining 39 in this group were in the menopause with metastases which were in some cases untreated and in some cases treated by mastectomy, radiation and chemotherapy (CMF-scheme). All Patients were PD in relation to further radiation and/or chemotherapy. Karnofsky-index was 60 minimum. After 4 weeks' treatment with tamoxifen both an improvement in general wellbeing and a regression of the focus of the tumour was achieved. A significant improvement in wellbeing and tumour status could be established for a total of 48 cases of mammary carcinoma. Treatment was well tolerated. Only 1 case of side effects in the form of vomiting occurred.

Sandwich-dot immunobinding assay (Sandwich-DIA), a new immunological method for the detection of diphtheria toxin.

In this paper we describe a new assay for diphtheria toxin in bacterial cultures, based on a sandwich-dot immunobinding method. This method uses horse polyclonal diphtheria antitoxin as the coating antibody and mouse monoclonal diphtheria antitoxin as the detecting antibody. The sensitivity of this new method is within a range of 5-10 ng toxin per ml in Corynebacterium diphtheriae cultures. We did not observe any false-positive reactions. As a solid phase we used nitrocellulose disks which bind protein more strongly than the commonly used plastic solid phase. Results with strong toxin producers of C. diphtheriae can be obtained as soon as 11 h after starting a bacterial test culture. To detect weak toxin producers, the cultivation period must be extended to about 18 h and the results can be obtained after about 24 h. The method presented in this paper is simpler, faster and more reliable than currently used methods.

[Results of ciprofloxacin therapy in urinary and respiratory tract infections]. / Wyniki leczenia cyprofloksacyna zakazen dróg moczowych i oddechowych.

Ciprofloxacin was administered to 218 patients with various urinary and respiratory tracts infections, including 142 patients with urinary tract infections and 76 patients with respiratory tract infections. Bacteriological tests and routine laboratory tests were performed thrice (before, during and after therapy) in all patients. Ciprofloxacin was administered orally in daily dose of 500 mg for 10 days. Daily dose was increased to 1000 mg in 23 patients with severe respiratory tract infections. Satisfactory results (recovery or regression of the symptoms of exacerbated chronic disease) were achieved in 185 patients (84.9%) and no effect in 10 patients (4.6%). Significant improvement or transient improvement were noted in 23 patients (10.5%).

Local anesthetics (benzyl alcohol, lidocaine, procainamide) inhibit aminopyrine accumulation in isolated rat parietal cells.

The present studies were designed to examine the effect of local anesthetics (benzyl alcohol, lidocaine, and procainamide) on the secretory response of parietal cells to histamine, dbcAMP, and carbachol. Studies were performed in vitro using isolated cells from rat stomachs, and acid production was determined by 14C-aminopyrine accumulation. In addition, the (H(+)-K+)-ATPase activity of microsomal vesicles isolated from parietal cells was determined. Lower concentrations of the drugs studied increased the basal aminopyrine accumulation and potentiated the secretory response of parietal cells to histamine and dbcAMP. At higher concentrations local anesthetics progressively inhibited both the basal 14C-aminopyrine accumulation and that stimulated by histamine, dbcAMP or carbachol. While a low concentration of local anesthetics increased gastric microsomal (H(+)-K+)-ATPase activity, higher concentrations inhibited enzyme activity to about 80% of those activities found in resting parietal cells. We conclude that increased aminopyrine accumulation may reflect the activation of membrane-bound enzyme(s) involved in the cAMP-dependent signal transduction pathway mediating acid secretion by parietal cells. In turn, it is possible that the inhibition of aminopyrine accumulation by local anesthetics at higher concentrations can relate to two different mechanisms: (1) the nonspecific effect of local anesthetics that causes simple proton neutralization (as weak bases), and (2) to a minor extent their inhibitory effect on proton pump activity.

[Cutaneous diphtheria imported from tropical countries]. / Importierte Hautdiphtherie aus tropischen Ländern.

Two cases of imported cutaneous diphtheria from tropical areas are described. Vacationing in the Seychelles, a 29-year-old man injured his left malleolus a few weeks before his return to Switzerland. The wound did not heal and an ulcer developed. Microbiologic investigation yielded toxinogenic Corynebacterium diphtheriae. There were no signs of systemic intoxication. The man had not been vaccinated against diphtheria since childhood. In the second case a 51-year-old woman returned from Thailand and Nepal with two very painful ulcers between the toes of her right foot, which was reddish-coloured. Microbiologic investigation again yielded toxinogenic Corynebacterium diphtheriae and there was no sign of systemic intoxication. Treatment with erythromycin brought about complete healing of the ulcers.

Evaluation of phenotype of mononuclear host cells isolated from primary tumour and peripheral blood of patients with laryngeal carcinoma.

Mononuclear host cells isolated from primary laryngeal carcinoma were assessed by means of indirect immunofluorescence with a panel of monoclonal antibodies against various lymphocyte subsets and macrophages. Tumours of various staging groups were examined in parallel with cells isolated from patient and donor peripheral blood (PBL). It was found that percentage values of cells bearing T3 and T4 phenotype were reduced both in tumour infiltrating cells (TIC) and in PBL population. The fall in T4+ cells in PBL from cancer patients in T3 and T4 staging groups was statistically significant (p less than 0.01) as compared with donor cells. Corresponding values for T8+ cells from TIC were increased in T1 and T2 staging groups of cancer, but showed a gradual fall in advanced stages. The T4+/T8+ cell ratio was decreased in both TIC and PBL cells. The HNK-1+ (NK) cell pattern in TIC was analogous to that for T8+ cells, i.e. the cell percentage decreased with advance in tumour growth. Corresponding values for OKM-1+ were increased in TIC and in patient blood, though in TIC they grew in proportion to tumour growth. Ia+ (HLA-DR+) cells in peripheral blood were significantly increased in patients versus those of donors (p less than 0.01), but only in T3 and T4 staging groups of examined cancer. These results show that subsets of tumour infiltrating cells in laryngeal carcinoma are a complex phenomenon, associated with growth and progression of tumour.

EPR study of hydrated testosterone monoclinic and orthorhombic single crystals gamma-irradiated at 295 K.

The molecular structure of free radicals formed in gamma-irradiated monoclinic and orthorhombic single crystals of hydrated testosterone were investigated by EPR spectroscopy. Two different types of radical were observed. In the monoclinic form, the radical arises by the loss of a hydrogen atom from the carbon atom C(2), whereas, in the orthorhombic form, it arises by addition of a hydrogen atom to the oxygen atom O(3). The hyperfine spectrum of the radical formed in the monoclinic single crystal originates from the interaction of the unpaired electron with one alpha-proton in position 2 and two non equivalent beta-protons in position 1. In the orthorhombic single crystal, we observed interaction of the unpaired electron, which is delocalized on the carbons C(3), C(4) and C(5) with one alpha-proton in position 4 and with four nonequivalent beta-protons connected with the carbon atoms C(2) and C(6). The hyperfine tensors of the coupling and the g-tensor of the radicals are given.