Comparison of patients in three different rehabilitation settings after knee or hip arthroplasty: a natural observational, prospective study.

BACKGROUND: Patients after primary hip or knee replacement surgery can benefit from postoperative treatment in terms of improvement of independence in ambulation, transfers, range of motion and muscle strength. After discharge from hospital, patients are referred to different treatment destination and modalities: intensive inpatient rehabilitation (IR), cure (medically prescribed stay at a convalescence center), or ambulatory treatment (AT) at home. The purpose of this study was to 1) measure functional health (primary outcome) and function relevant factors in patients with hip or knee arthroplasty and to compare them in relation to three postoperative management strategies: AT, Cure and IR and 2) compare the post-operative changes in patient's health status (between preoperative and the 6 month follow-up) for three rehabilitation settings. METHODS: Natural observational, prospective two-center study with follow-up. Sociodemographic data and functional mobility tests, Timed Up and Go (TUG) and Iowa Level of Assistance Scale (ILOAS) of 201 patients were analysed before arthroplasty and at the end of acute hospital stay (mean duration of stay: 9.7 days +/- 3.9). Changes in health state were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 6 months after arthroplasty. RESULTS: Compared to patients referred for IR and Cure, patients referred for AT were significantly younger and less comorbid. Patients admitted to IR had the highest functional disability before arthroplasty. Before rehabilitation, mean TUG was 40.0 s in the IR group, 33.9 s in the Cure group, and 27.5 s in the AT group, and corresponding mean ILOAS was 16.0, 13.0 and 12.2 (50.0 = worst). At the 6 months follow-up, the corresponding effect sizes of the WOMAC global score were 1.32, 1.87, and 1.51 (>0 means improvement). CONCLUSIONS: Age, comorbidity and functional disability are associated with referral for intensive inpatient rehabilitation after hip or knee arthroplasty and partly affect health changes after rehabilitation.

[Salutogenic concepts in the rehabilitation of osteoarthritis]. / Salutogenetische Konzepte bei der Rehabilitation von Arthrose.

BACKGROUND: The treatment strategies for osteoarthritis (OA) are well known from numerous studies. One of the challenges is long-term patient compliance to the recommended therapies without supervision. OBJECTIVE: To examine the ability of salutogenic concepts to improve rehabilitative management of OA. MATERIALS AND METHODS: Review article introducing salutogenic concepts and their empiric evidence, focussing on Antonovsky's sense of coherence (SOC). RESULTS: The SOC consists of the three components comprehensibility, manageability and meaningfulness. SOC can be quantified by SOC-13, a self-reported measurement with 13 items. Associations of the SOC with different dimensions of health (in particular with Short Form 36, SF-36) are known from cross-sectional studies. Most studies showed a stronger correlation of the mental than the physical health dimensions of SF-36 with SOC-13. This result is consistent with baseline examinations of hip and knee OA patients before rehabilitation. At the 6-month follow-up, correlations between SOC and the changes of the SF-36 scores were weak. A salutogenically orientated instruction for self-management of symptoms in cancer patients showed significant improvement in SOC. CONCLUSION: Increasing SOC can lead to health improvements on many levels, e.g. self-efficacy, reduction of fear, coping, education, resources and compliance to treatment. Empirical proof that interventional measures increasing SOC can improve the health of OA patients is currently unavailable.

Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies - A Retrospective Study.

Purpose: The aim of the study was to evaluate safety, effectiveness, recurrence rate and 10-year survival after bronchial artery embolization (BAE) in benign and malignant etiologies. Methods: The retrospective study includes 100 BAE procedures in 88 patients. Underlying disease was classified as benign (n = 67) and malignant (n = 21) etiologies. Immediate bleeding control and procedure safety were evaluated in all patients. In 51 (58 %) patients, follow-up data with a median follow-up time of 1015 days (range, 494 to 3727 days) were acquired to assess overall survival, time-to-recurrence of bleeding and recurrence-free survival, using Kaplan-Maier estimates to compare differences between both subgroups. Results: Immediate bleeding control was achieved after 96/100 procedures (96 %), with a minor complication rate of 5.0 %. No major complications occurred. The overall survival was 74 % after 1 year and 59 % after 5 years and 10 years. There was a significant difference in survival between the malignant and benign groups (p < 0.0001). Survival was 90 %, 80 % and 76 % at 1 year, 3 years and 10 years, respectively, in the benign group and 18 % and 0 % at 1 year and 3 years, respectively in the malignant group. The median time to recurrence of bleeding and recurrence-free survival were 239 days and 94 % after 1 year and 87 % after 10 years in the benign group, compared to 66 days and 34 % after 1 year and 0 % after 3 years in the malignant group (p = 0.0107). Conclusion: BAE is a safe and highly effective treatment option in hemoptysis. However, the recurrence rate and survival are highly dependent on the underlying disease. Key Points: • BAE is a safe and highly effective treatment option in hemoptysis.• Recurrence rate and survival are strongly dependent on the underlying disease with significantly impaired results in patients with malignant diseases. • Coil embolization is an effective BAE treatment method. Nevertheless, it should be mentioned, that reinterventions can be impeded, if embolization is performed in the proximal part of bronchial arteries. Citation Format: • Syha R, Benz T, Hetzel J et al. Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies - A Retrospective Study. Fortschr Röntgenstr 2016; 188: 1061 - 1066.

The 2014 liver ultrasound tracking benchmark.

The Challenge on Liver Ultrasound Tracking (CLUST) was held in conjunction with the MICCAI 2014 conference to enable direct comparison of tracking methods for this application. This paper reports the outcome of this challenge, including setup, methods, results and experiences. The database included 54 2D and 3D sequences of the liver of healthy volunteers and tumor patients under free breathing. Participants had to provide the tracking results of 90% of the data (test set) for pre-defined point-landmarks (healthy volunteers) or for tumor segmentations (patient data). In this paper we compare the best six methods which participated in the challenge. Quantitative evaluation was performed by the organizers with respect to manual annotations. Results of all methods showed a mean tracking error ranging between 1.4 mm and 2.1 mm for 2D points, and between 2.6 mm and 4.6 mm for 3D points. Fusing all automatic results by considering the median tracking results, improved the mean error to 1.2 mm (2D) and 2.5 mm (3D). For all methods, the performance is still not comparable to human inter-rater variability, with a mean tracking error of 0.5-0.6 mm (2D) and 1.2-1.8 mm (3D). The segmentation task was fulfilled only by one participant, resulting in a Dice coefficient ranging from 76.7% to 92.3%. The CLUST database continues to be available and the online leader-board will be updated as an ongoing challenge.

[The plain-film radiological changes in the cervical spine following a ventral fusion operation with bone cement]. / Nativradiologische Anderungen der Halswirbelsäule im Verlauf nach ventraler Fusionsoperation mit Knochenzement.

PURPOSE: The usual treatment in cervical nerve root compression syndrome is the ventral fusion with bone cement. We examined the influence of this interponate on the postoperative changes of the cervical spine. MATERIALS AND METHODS: 33 patients were followed-up postoperatively over 6 months, who were treated with 39 ventral fusions because of cervical myelopathy. The lateral view of the cervical spine was used to measure the size of the bone cement interponate, the height of the intervertebral body space and the angle of both vertebral bodies. RESULTS: There was no change on the size of the interponate. Postoperatively there was a slight enlargement of the intervertebral body space. During further follow-up examinations there was a decrease to the preoperative size because of the destruction of the endplates. Similar to this observation, there was a change of the angle in the operated segment. First there was a decrease of the angle, later an increase. 6 months postoperatively the preoperatively status was re-attained. Clinical examination of the patients revealed new neurologic deficits in 10% of the cases. CONCLUSION: We conclude that the postoperative deficits can be only partially explained because the structural changes occur with both the uncomplicated postoperative courses and in patients with postoperative deficits.

[The assessment of the morphological changes after ventral diskectomy by thin-section computed tomography]. / Beurteilung morphologischer Veränderungen nach ventraler Diskektomie mittels Dünnschicht-Computertomographie.

PURPOSE: We examined the changes of the intervertebral body space, the morphology of bone cement interponates and vertebrae after cervical discectomy and ventral fusion with high resolution CT. MATERIALS AND METHODS: CT scans were performed on 25 patients preoperatively, one week and six months after cervical discectomy and ventral fusion. RESULTS: There was no change in the size of the interponates. During follow-up new ossifications were found in 18 of the patients, two of them with neurological deficits. While directly after surgery the sagittal spinal canal diameter was enlarged, six months later particularly the lateral width was found to be reduced. After surgery soft tissue already narrowed the spinal canal in similar shape as the former prolapse. CONCLUSION: We conclude that postoperative neurologic deficits can only be partially explained by the described structural changes, because similar findings were made in uncomplicated postoperative courses as well as in patients with deficits.

[The meningeal sign: a new appraisal]. / Das Meningeale Zeichen: eine Neubewertung.

PURPOSE: To evaluate the occurrence of the meningeal sign in meningiomas and metastases. MATERIAL AND METHODS: We studied 20 patients with meningiomas and 17 patients with cerebral metastases adjacent to the dura. MRI studies (Siemens, Magnetom 1,5) included axial T1-weighted and T2-weighted unenhanced as well as gadolinium-DTPA enhanced T1-weighted (axial, coronal, sagittal) SE imaging. In all patients the tumours were resected with the attached dura mater. Histopathological examinations were done, which corresponded to the area of marked enhancement by gadolinium-DTPA. There was no correlation between the occurrence of the meningeal sign and the histopathological examinations. RESULTS: In 20 patients with meningiomas adjacent to the dura we found the meningeal sign in 11 cases. Histologically we observed an increase of collagen fibres and fibrocytes. In 5 of 17 cases with superficial cerebral metastases the meningeal sign was seen, histologically as dura infiltrations and microbleedings. CONCLUSION: The meningeal sign is not specific for meningiomas and can be observed in a wide variety of pathological entities.

[Treatment of chronic pain in Switzerland: scientific evidence]. / Behandlung chronischer Schmerzen in der Schweiz: wissenschaftliche Evidenz.

Chronic pain is often seen in the lower back region (lumbar spine). It usually influences different aspects of health and wellbeing, is often treated inadequately and causes important economic costs. Various biopsychosocial factors influence chronic pain and the outcome of medical treatment. This has lead to multidisciplinary treatment strategies. The scientific evaluation of interdisciplinary inpatient pain management programs in Switzerland shows moderate to large changes in various health dimensions in subjects with chronic non-specific back pain, fibromyalgia, chronic widespread pain, and after whiplash injury. These short- to mid-term results are confirmed by international scientific evidence. The effects of an interdisciplinary pain management program are higher than those of the standard rehabilitation. Complementary, subgroup-specific pain treatment could optimize these results.