[Cost coverage for complex paediatric spinal deformities with preoperative halo traction-an economic problem?] / Kostendeckung bei komplexen pädiatrischen Wirbelsäulendeformitäten mit präoperativer Halotraktion ­ ein wirtschaftliches Problem?

BACKGROUND: Spinal surgery is largely reimbursed in a differentiated manner via the DRG system. For treatments of complex paediatric deformities with increased pre and postoperative effort due to special treatment approaches, it seems that the costs for the treatment are not fully covered. MATERIALS AND METHODS: All paediatric cases with surgical treatment of the spine that were treated in a single spine centre from 2018-2020 were considered. The subgroup of patients with inpatient halo-gravity traction (halo group) before surgery was compared with all other cases treated in terms of economic and demographic factors. RESULTS: There were 86 cases that were treated surgically without halo traction and 6 cases with halo traction. The groups did not differ significantly in age (p = 0.41) or Patient Clinical Complexity Level (PCCL, p = 0.76). The average length of hospital stay in the halo group was significantly longer than in the other cases (84.2 ± 40.1 d vs. 11.0 ± 6.4 d; p = 0.001). Due to DRG grouping and long-stay surcharges, the mean revenue per case was significantly higher in the halo group than in the other cases (€ 63,615 ± 45,138 vs. € 16,836 ± 9356) (p = 0.003). The contribution margin for the period of the long-term surcharges varied between 11,394 and 9766 €. The high additional costs due to the necessary medical devices of halo traction were not sufficiently reflected in the reimbursement. CONCLUSION: Paediatric spine surgery can be challenging in special cases. In particular, severe deformities of the spine may require additional procedures. The subgroup of patients requiring preoperative halo traction is not adequately compensated by the DRG system.

[Conservative treatment of congenital patellar dislocation]. / Konservative Therapie bei kongenitaler Patellaluxation.

This article presents the rare case of a boy who was born in our hospital with valgus deformity and external rotation of the right lower leg because of congenital patellar dislocation. In the case presented a stable repositioning of the patella could be achieved by redressment with a plaster cast and leg brace. During a 4-year follow-up there were no tendencies towards dislocation during the clinical examination and no dislocation events were documented. In selected cases an attempt at conservative repositioning and retention treatment appears to be worthwhile before surgical treatment is indicated.

[Treatment of chronic slipped capital femoral epiphysis : Use of dynamic epiphyseal telescopic screws]. / Behandlung der chronischen Epiphyseolysis capitis femoris : Einsatz der dynamischen epiphysären Teleskopschraube.

BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a multifactorial structural loosening in the area through the epiphyseal plate between the epiphysis and metaphysis accompanied by slippage of the femoral head in the mid-dorsal-caudal direction without additional adequate trauma. In this retrospective study, all patients with chronic SCFE were assessed who had been treated by implanting a dynamic epiphyseal telescopic (DET) screw. METHODOLOGY: All patients who had been treated at our hospital with a DET screw implant between December 2006 and November 2014 following diagnosis of chronic SCFE were included in the study. Clinical and radiological follow-up was carried out after 6 weeks, 12 weeks, and then every 6 months. RESULTS: In all patients, the SCFE proved to have been firmly fixed and no further slippage was observed in any patient on the side affected. None of the prophylactically treated hips showed secondary SCFE either. In all patients, the DET screw led to partial remodeling of the slippage. The average slippage angle according to Southwick (epsilon angle) was about 30° preoperatively and about 19° in the most recent radiological follow-up. The alpha angle according to Nötzli was about 91° preoperatively and about 62° in the most recent radiological follow-up. Most of the patients showed none treatment-related dysfunction. CONCLUSION: Surgical treatment with a DET screw seems to be a safe procedure for both the affected hip and the hip to be treated prophylactically. This method is an adequate alternative to the widespread technique of pinning with K­wires.

[Pavlik harness for the treatment of congenital hip dysplasia types D III and IV]. / Pavlik-Bandage zur Therapie der kongenitalen Hüftdysplasie Typ D, III und IV.

BACKGROUND: Up to 4% of all neonates in Central Europe are born with congenital hip dysplasia (CHD), the most common congenital disease of the musculoskeletal system. However, in this retrospective analysis the outcomes of infants with CHD (type D, III or IV according to Graf) have been considered, with Pavlik therapy starting within the first 12 weeks of life. Connections between the start of therapy or the first finding according to Graf`s classification and the ultrasound result achieved, as well as the X-rays taken after 1 and 2 years, were evaluated. No repositioning under Pavlik treatment or side effects and their relevance have been evaluated, especially with regard to avascular necrosis (AVN) of the femoral head. MATERIALS AND METHODS: All infants treated using Pavlik treatment for CHD between 2010 and 2012 in our clinic were determined. A total of 62 patients with 79 pathological hips were included. The infants were classified into three groups to evaluate the influence of the start of therapy on the result: group I with the first investigation and start of treatment within the first 10 days of life, group II between the 11th day and the end of week 3, group III within preventive general examinations (U3) after the 4th week. Clinical examinations and the usual ultrasound scans were performed at an average of 1, 3, and 6 months. Furthermore, after 1 and 2 years clinical and radiological investigations were carried out, as well as further examinations depending on the findings. RESULTS: A failure of repositioning of the Pavlik treatment occurred in group I in 1 case (2.2%), in group II in 1 case (7.1%), and in group III in 2 cases (10%). This occurs in hips type D and type III in 1 case each (3.3%) and type IV in 2 cases (10.5%). Maturation disorders of the hips were found in 1 case (2.2%) in group I, 1 case (7.1%) in group II, and 3 cases (15%) in group III. Avascular necrosis of the femoral head was proven in 2 cases (4.4%) in group I, 0% in group II, and in 1 case (5%) in group III. All patients initially had femoral head necrosis of Graf type IV . All necrosis and maturation disorders were no longer visible on subsequent examinations after 2 years at the most. CONCLUSIONS: In summary, the study shows that even with a late treatment start (U3) good results could be achieved, but with a rising number of repositioning failures and femoral necroses. Ultrasound screening on U3 seems to be sufficient; however, for high-risk groups an additional screening in the first week of life should be performed, which does not replace a second evaluation at U3 if there are normal findings.

[Child health check-ups as an instrument in child welfare. First results of compulsory check-up systems in German federal states]. / Früherkennungsuntersuchungen als Instrument im Kinderschutz. Erste Erfahrungen der Länder bei der Implementation appellativer Verfahren.

Routine well-child visits, implemented as a means of secondary prevention and covered by health insurance, lead to early identification of disorders and abnormalities in child development."Guiding principles for children" (by the G-BA) have determined the content of the eleven examinations, ranging from U1 immediately after birth to J1 in adolescence; eight of them take place within the first four years of age. Since cases of child maltreatment, neglect, or abuse became public in 2007, almost all German federal states have established mandatory examination and notification processes in the new child welfare surveillance programs. First results in the German federal states (six of which are exemplarily illustrated) point out that mandatory requirements have collectively increased the frequency of medical check-ups in children, especially starting from four years of age and most significantly in families with social disadvantages (young/single parents, immigrant background, uneducated or socially disadvantaged families), which have so far been difficult to reach. Subsequently, provision of primary prevention (vaccinations and health promotion advice) by pediatricians has also increased. As a sole instrument for the complete identification of threats for children's welfare, however, systems inviting and reminding parents about check-ups are only of limited benefit.

[Metastatic malignant choroidal melanoma: a case report about 18 years with palliative operative treatment]. / Metastasierendes malignes Aderhautmelanom: Einzelfalldarstellung eines protrahierten Verlaufs über 18 Jahre durch palliative operative Therapie.

Bone metastases are found in 29% of patients with metastatic malignant choroidal melanoma, which is associated with poor prognosis. However there are several reports about prolonged survival. The unusual case of a patient is described, who suffered from a melanoma with orbital invasion and survived more than 18 years. Metastases were found 12 years after initial therapy. Three palliative operations made a survival of further 7 years with high quality of life possible. Therefore moderately palliative operations are recommended in case of metastatic malignant choroidal melanoma.

Effect of a silver device in preventing catheter-related infections in peritoneal dialysis patients: silver ring prophylaxis at the catheter exit study.

Catheter-related infections remain a significant cause of method failure in chronic peritoneal dialysis (PD) therapy. Given the increasing antibiotic resistance, such nonpharmacological strategies as local silver devices attract more interest. To establish whether a silver ring device (designed by Grosse-Siestrup in 1992) mounted onto the PD catheter and placed at the exit site at skin level is effective in preventing exit-site and other catheter-related infections, a prospective 12-month, multicenter, controlled study stratified by diabetes status was conducted. The study subjects were assessed by an extensive structured inventory, including a broad spectrum of control variables, such as age, body mass index (BMI), Staphylococcus aureus carrier status, catheter features, mode and quality of PD therapy, comorbidity, and psychosocial rehabilitation. Ten experienced German outpatient dialysis centers (seven adult, three pediatric) participated in the trial. All eligible patients (n=195) from the study area without catheter-related infections during the ascertainment period were included (incidental subjects undergoing PD therapy for at least 3 months). The main outcome measures were the occurrence of first exit-site infections (primary study end point), sinus tract/tunnel infection, and peritonitis. Ninety-seven patients were assigned to the silver ring and 98 patients to the control group. Baseline characteristics of age, sex, proportion of pediatric and incidental patients, S aureus carrier status, and other variables were similar in both groups. The incidence of infections in the silver ring group versus the control group was as follows: 23 of 97 versus 16 of 98 patients had exit-site infections, 12 of 97 versus 12 of 98 patients had sinus tract/tunnel infections, 16 of 97 versus 18 of 98 patients had peritonitis, respectively. Kaplan-Meier analysis for the probability of an infection-free interval showed no statistical difference (log-rank test) between the two groups. Displacement of the silver ring contributed to study termination in 6% of the study group patients, including two patients with catheter loss. Univariate analysis and multiple logistic regression identified younger age (<50 years), low serum albumin level (<35 g/L), number of previously placed PD catheters, short cuff-exit distance (<2 cm), and S aureus nasal carriage as risk factors for the development of exit-site infections. In conclusion, our study does not show any benefit of the silver ring in preventing catheter-related infections in PD patients. Thus, prevention of infection-related method failure in PD still has to rely on conventional antibiotic treatment strategies and less so on alternative methods.

Retention of dopamine 2 receptor mRNA and absence of the protein in craniospinal and extracranial metastasis of a malignant prolactinoma: a case report.

OBJECTIVES: The case presented here describes the clinical evolution of a malignant prolactinoma with occurrence of intra- and extra-cranial metastases. In this case, the presence of dopamine 2 receptor (D2R) was studied at the mRNA and protein level, in order to understand the pathological background of the resistance to treatment with different dopamine agonists. DESIGN: Together with an extensive description of the clinical history of this case, a combination of in vitro and in vivo techniques was performed to provide the basis of the dopamine resistance developed in the course of the disease. METHOD: A comparison of the D2R was performed in specimens obtained at presentation of the disease compared with autoptic specimens derived from local invasion and metastasis using in situ hybridization and immunohistochemical techniques. RESULTS: Intact D2R mRNA was found in the primitive tumor and metastatic tissues, whereas protein for the same receptor was present only in the tissues derived from neurosurgical operations and not in the metastases obtained post-mortem. CONCLUSION: This is the first report of the absence of D2R protein despite the retention of the transcript in an advanced stage of a malignant prolactinoma. The findings of this single case suggest the hypothesis that postranscriptional mechanisms may contribute to the development of dopamine resistance in prolactinomas.

Mapping of quantitative trait loci determining agronomic important characters in hexaploid wheat ( Triticum aestivum L.).

A set of 114 recombinant inbred lines of the 'International Triticeae Mapping Initiative' mapping population was grown during the seasons 1997, 1998, 1999 and 2000 under several environments. Twenty morphological (glume colour, awn colour, waxiness, leaf erectness, peduncle length), agronomical (ear emergence time, flowering time, grain filling time, ear length, plant height, lodging, grain number, thousand-grain-weight, grain weight per ear, grain protein content, winter hardiness) and disease resistance (powdery mildew, yellow rust, leaf rust, fusarium) traits were studied. Not all traits were scored in each experiment. In total 210 QTLs with a LOD threshold of >2.0 (minor QTLs) were detected of which 64 reached a LOD score of >3.0 (major QTLs). Often QTLs were detected in comparable positions in different experiments. Homologous and homoeologous relationships of the detected QTLs, and already described major genes or QTLs determining the same traits in wheat or other Triticeae members, are discussed.

[Diagnosis of infectious spondylitis following urological interventions]. / Zur Diagnostik der Spondylitis infectiosa nach urologischen Eingriffen.

Spread of infection to the spine following urological surgery is extremely rare. The diagnosis is therefore often made at a late stage resulting in delayed treatment. Four patients observed by the authors are described and the diagnosis is discussed.

[Isotope methods in the diagnosis of venous disease. I. Methods of radionuclide venography (author's transl)]. / Nuklearmedizinische Untersuchungsverfahren in der radiologischen Venendiagnostik. I. Methoden der Radionuklidvenographie.

The method of radionuclide venography is best determined by the localisation and type of suspected venous abnormality. The authors describe four methods using 99mTc microspheres and 99mTc-pertechnetate. Correlation of the isotope and angiographic findings in 150 patients indicated an accuracy of 90% for the isotope methods. The risks of radionuclide venography are discussed. Isotope venography is recommended as a simple, non-invasive technique.

[Isotope methods in the diagnosis of venous disease. II. Results of radionuclide venography (author's transl)]. / Nuklearmedizinische Untersuchungsverfahren in der radiologischen Venendiagnostik. II. Ergebnisse der Radionuklidvenographie.

The frequency of scintigraphic findings in the presence of thromboses, post-thrombotic changes and in normal veins, was determined in 150 patients. The results of radionuclide venography and contrast venography in these patients have been compared. Abnormalities in veins can be detected by radionuclide venography with a high degree of accuracy. Differentiation between acute and chronic thrombosis and post-thrombotic changes can only be made by invasive contrast venography.

[99mTc marking of gel foam for catheter embolisation (author's transl)]. / 99mTc-Markierung von Gelatineschwamm für die Katheterembolisation.

A simple method is described for marking gel foam particles with 99mTc after reduction of the pertechnetate. This is carried out in the Luer lock syringe to be used for the injection. After embolisation and control angiography, the patient is placed under a scintillation camera. The position of the embolising material can then be demonstrated scintigraphically. In six patients marked emboli were found to be correctly placed. In another patient undergoing a second embolisation for a renal tumour, particles were found in the peripheral circulation.

[Isotope methods in the radiological diagnosis of venous disease. II. Indications and accuracy (author's transl)]. / Nuklearmedizinische Untersuchungsverfahren in der radiologischen Venendiagnostik. III. Indikationen und Stellenwert.

Radiological diagnostic methods for the diagnosis of abnormalities of veins were discussed in the light of 1,683 contrast venograms and isotope examinations in 650 patients with acute and chronic diseases of veins. For patients with increased thrombotic risks, the 125 I-fibrinogen test is recommended as a sensitive and simple method. Where there are symptoms of venous thrombosis, radionuclide venography, together with other noninvasive methods, may be used for establishing whether there are indications for contrast venography. These may also provide evidence of previous pulmonary emboli. These methods should also be used where there is clinical suspicion of previous pulmonary emboli. Non-invasive isotope methods have proved to be sensitive techniques for preliminary examinations and for follow-up. Contrast venography is necessary if definitive treatment is planned.

[Venography with 111Indium-labelled autologous thrombocytes]. / Venographie mit 111Indium-markierten autologen Thrombozyten.

111Indium-labelled thrombocytes were used for radionuclide venography in ten patients. All types of thrombi could be demonstrated with a high degree of accuracy, particularly if the marked thrombocytes were injected distally. In cases of complete occlusion by thrombus, the peripheral end of the clot appeared as a 'hot spot'. Non-occluding thrombi with a thrombogenic surface can be differentiated from lesions of the endothelium. Compared with venography using labelled microspheres, labelled thrombocytes have the advantage of demonstrating the degree of activity of the thrombotic process.

[Scintigraphic evidence of changes in liver shape following splenectomy (author's transl)]. / Zur Frage der szintigraphischen Leberformveränderungen nach Splenektomie.

It has been suggested in the literature that, following splenectomy, the shape and position of the liver become altered and that this may lead to errors in the interpretation of the liver scans. For this reason, liver scans before and after splenectomy were compared in 16 patients with Hodgkin's disease. No changes in shape or position of the liver were found which could be related to the splenectomy. However, the clinical features and treatment must be known to ensure correct interpretation.

[Radiation dose to the finger during injection of short-lived radionucleids in nuclear medicine (author's transl)]. / Zur Strahlenbelastung der Finger bei der Injektion kurzlebiger Radionuklide in der Nuklearmedizin.

The increasing use of short-lived radionucleids has shifted much of the radiation from the patient to the personnel. The purpose of this investigation, therefore, was to ascertain the greatest possible radiation dose to the fingers during injection of short-lived radionucleids. Basis for radiation measurements were small ionisation chambers attached to plastic syringes filled with radio-active material. By examples of typical situations, it was shown that the legally permissable values for partial body exposure may be exceeded. The necessity for using screening of the syringes is stressed. A simple method for making screening cylinders out of Wood's metal is described.

[133Xe-labeling of tissue adhesives for catheter embolization]. / 133Xe-Markierung von Gewebekleber für die Katheterembolisation.

A method for radio-nuclide labelling of histo-acryl/lipiodol with 133Xe gas is described. The method consists of dissolving the gas in lipiodol under sterile conditions. After embolization and angiography, the localisation of the embolizing material can be determined by means of a scintillation camera. The labelling method was used in 15 patients. In all patients the position of the embolizing material, as demonstrated by scintigraphy, corresponded with the radiological findings. It was not possible to demonstrate escape of the material by scintigraphy.

[Complex neurological investigations of space-occupying lesions in the spinal canal (author's transl)]. / Ergebnisse der komplexen neuroradiologischen Diagnostik raumeinengender Prozesse des Spinalkanals.

Problems of early diagnosis of space-occupying intraspinal lesions are discussed in relation to 335 patients on whom surgery had been carried out. Advances in neuroradiological methods are considered. The development of new contrast media has resulted in a reduction of the risk of invasive procedures and this should lead to diagnosis of space-occupying spinal lesions at a very early stage. It is now possible to diagnosis small tumours before they cause compression of the cord or of nerve roots.

[Post-operative lumbar myelogram. Morphology and indications for repeat examinations in patients with disc prolapse (author's transl)]. / Das postoperative lumbale Myelogramm. Morphologie und Stellenwert bei der Rezidivdiagnostik des Bandscheibenvorfalls.

The morphology and indications for performing post-operative contrast examinations have been analysed in 131 myelograms. Leptomeningeal reactions and adhesions were found in varying degrees of severity in 34 to 75% of post-operative cases; it proved difficult to correlate this finding with the neurological features. The value of repeat myelograms is much reduced after surgery or after previous contrast examinations. It is probable that this is due in part to tissue changes resulting from the surgery or from a proliferative reaction induced by the contrast medium.