Treatment and outcome of destructive tuberculosis of the talus.

We describe a case of isolated destructive talar tuberculosis that is, to the best of our knowledge, the first reported case in Germany. Caseous talar necrosis was finally detected after repeated surgical debridements of an infection eight months after subtalar screw arthrodesis. Following the diagnosis of TB, we performed a total of three additional surgical revisions within a three-month period; these revisions included a talectomy and an induction of a septic tibiocalcaneal arthrodesis with an external fixator that was removed after solid fusion six months later. Following this treatment regime, which included pharmaceutical anti-tuberculosis therapy, the 50-year-old male patient was fitted with orthopaedic shoes. He resumed work as a professional farmer with a number of restrictions 12 months after the diagnosis and treatment of destructive talar tuberculosis.

[Physician's role in "medical drama" pitfall? Reflection of stereotypical images of doctors in context of contemporary doctor's series]. / Die Arztrolle in der "medical drama"-Falle? Reflexion stereotyper Arztcharaktere im Kontext zeitgenössischerTV-Serien.

In contemporary U.S. doctor's series, the characters are usually represented by good-looking or typical character actors. The aim of our pilot study was to investigate whether the long-term impact of this format on German television viewers could have an influence on the choice of doctor in Germany. Two different groups of people anticipating TV consumption patterns were questioned: a first group of younger adults who knew theTV series was asked to judge their doctor choice using a web-based survey tool with respect to three criteria (sympathy, expertise and own treatment preference). The second group of adults beyond the 40th year of life who need not know theTV series were shown photos of the serial figures. Study participants should select the "doctor" of which they would most likely want to be treated and this based on two predetermined reasons (sympathy or expertise). Our results indicate that stereotypical images of doctors found high approval only in the first group of people, while the participants in the second group decided in majorityfora more realistic representation of average appearance.

[Occupational cancer of the urinary tract-incidence, reporting behavior, and administrative procedures]. / Berufsbedingte Tumoren der ableitenden Harnwege ­ Häufigkeit, Meldeverhalten und administratives Vorgehen.

Tumors of the urinary tract are among the most common types of occupational cancer. A significant proportion of about 5-15% may be of occupational etiology. Suspicion of an occupational genesis is subject to mandatory reporting. However, epidemiological analyses show that the number of reports received by accident insurance companies and employers' liability insurance associations is significantly lower than expected. Finally, the economic and administrative effort in surveying a patient's occupational history hinders adequate reporting. By routinely and systematically using a structured questionnaire as part of clinical routine in our hospital, a significantly improved detection of justified suspected cases (from about 4.8% to about 67% of the theoretically expected value) has been achieved since about 2006. In addition to improved medical care and adequate compensation for recognition as an occupational disease, disease-related care is subject to extra-budgetary remuneration in Germany (UV-GOÄ).

[Urinary bladder cancer as a late sequela of spinal cord injury : Decision-making aids for assessment of this causal association]. / Harnblasenkarzinom als Spätfolge einer Querschnittlähmung : Entscheidungshilfe für eine Zusammenhangsbegutachtung.

BACKGROUND: There is to date no convincing literature that has assessed the association between traumatic spinal cord injury (SCI) and the later development of urinary bladder cancer. The aim of this work is to present medical experts as well as the national accident insurance and the social courts decision-making aids based on the latest medical scientific knowledge, for assessment of this causal association. MATERIALS AND METHODS: A study conducted between April 1998 and March 2017 in the BG Trauma Hospital Hamburg forms the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 32 out of 6432 treated outpatient and inpatient SCI patients. Furthermore, relevant published literature was taken into consideration for the decision-making aids. RESULTS: It was found that urinary bladder cancer in SCI patients occurs at a considerably younger age as compared to the general population, more frequently shows muscle invasive carcinoma with a higher grade at first diagnosis and a higher proportion of the more aggressive squamous cell carcinoma than that of the general population. Correspondingly, the survival time is extremely unfavorable. For medical experts a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSION: The results showed that urinary bladder cancer in SCI patients differs considerably from that of able-bodied patients. These differences drastically shorten the survival time. A study on patients with spina bifida, i.e., a congenital spinal cord disorder, corroborates these observations. They indicate histopathological differences that have so far been intangible.

Comparative proteomics reveals unexpected quantitative phosphorylation differences linked to platelet activation state.

There is a need to assess platelet activation in patients with thrombotic disorders. P-selectin and activated integrin αIIbß3 are usually quantified by flow cytometry to measure platelet activation. Monitoring changes in vasodilator-stimulated phosphoprotein (VASP) phosphorylation is an established method to determine the platelet-reactivity status. To study disruptions of platelet reactivity more comprehensively, we compared the human non-secretory platelet proteome after in-vitro -activation and -inhibition with their respective untreated controls using unbiased fluorescence two-dimensional differential in-gel electrophoresis. The non-secretory platelet proteome was more severely affected during inhibition than during activation. Strikingly, while VASP reached a 1.3-fold increase in phosphorylation levels in inhibited platelets, other protein kinase A targets showed several-fold stronger inhibition-induced phosphorylation levels, including LIM and SH3 domain protein 1 (6.7-fold), Src kinase-associated phosphoprotein 2 (4.6-fold), and Ras-related protein Rap1b (4.1-fold). Moreover, phosphorylation of integrin-linked protein kinase (ILK) and pleckstrin (PLEK) species was associated with P-selectin surface expression. The discrimination power between activation and inhibition was more pronounced for dephosphorylated ILK (3.79 Cohen's d effect size) and phosphorylated PLEK (3.77) species than for P-selectin (2.35). These data reveal new insights into the quantitative changes of the platelet reactivity proteome and suggest powerful alternatives to characterise their activation and inactivation potential.

[Epidemiology of urological symptoms in neurological disorders. A prospective analysis in a center for neurological rehabilitation]. / Epidemiologie urologischer Symptome bei neurologischen Erkrankungen. Eine prospektive Analyse in einer neurologischen Rehabilitationsklinik.

The frequency of urological symptoms and malfunctions was determined in a representative group of patients in a neurological rehabilitation center in Northern Bavaria. All 225 consecutive inpatients between October 2002 and April 2003 were questioned by an experienced neuro-urologist about relevant urological symptoms. The Barthel index, IPSS, and a simple quality of life score were ascertained in addition. We tried to analyze indication, frequency, and quality of any treatment for previous urological symptoms in the assigning institution. An assessment of the known therapy of urological symptoms in pretreating facilities was documented in 190 patients (84.4%). In 105 cases (55.3%) treatment was appraised as sufficient (including all patients without urological symptoms) and not sufficient in 85 cases (44.7%). At the time of admission into the rehabilitation center no urological symptoms were seen in 78 cases (35.1%); 144 patients (64.9%) presented with relevant urological symptoms. It could be pointed out that patients with urological symptoms without adequate treatment lost quality of life significantly, both at medical and at subjective assessment. Total morbidity of patients with urological symptoms was shown to be worse regarding Barthel index, IPSS, and quality of life assessed by IPSS. By providing continuous neuro-urologically qualified support, deficits due to inadequate pretreatment could be compensated in comparison to the group with appropriate pretreatment. A further optimization of the rehabilitation potential of neurologically ill patients seems possible by an implementation of urological base measures into the neurological treatment routine and improved urological training of neurological treatment teams.

[Procedures for determining occupational diseases in cases of urological disorders]. / Das Berufskrankheitenverfahren bei urologischen Erkrankungen.

According to section sign 202 of the German Social Security Code VII, individuals diagnosed with bladder cancer or renal cell cancer who had been occupationally exposed to carcinogens known to induce cancer in these human tissues must be reported to the statutory accident insurance. In this paper, the course of the administrative procedure, particularly considering the reporting procedure and screening for occupational risk factors by a CD-based tool, developed by the authors, is described.

[Is rehabilitation of erectile function following pelvic surgery reasonable? Review of the literature: from sports to PDE5 inhibitors]. / Ist eine Rehabilitation der erektilen Funktion nach beckenchirurgischen Eingriffen sinnvoll? Literaturübersicht vom Sport bis zur PDE-5-Inhibitoren-Gabe.

Increasingly, urologists are seeing patients with erectile dysfunction after pelvic operations. In most cases, radical prostatectomy is the cause. Even when a nerve-sparing procedure is performed, approximately 50% of the patients suffer from erectile dysfunction. This report discusses the causes and theoretical therapies, including lifestyle changes, strategies for neuroregeneration and the associated prevention of apoptosis of the smooth muscle of the corpus cavernosum and improvement of the corpora cavernosa by increased oxygenation. According to the international literature, many of these agents and lifestyle modifications display promise for treating impotence. Early treatment for patients recovering from pelvic operations seems to be reasonable. It is assumed that the natural recovery of erections may take as long as 18 to 24 months postsurgery or even longer; however, treatment modalities may reduce the time to erectile recovery.

A prospective study with ten years follow-up of two-hundred patients with proximal femoral fracture.

BACKGROUND: The proximal femoral fracture is one of the most common injuries in the elderly. Nevertheless, no results beyond the second year post surgery have been reported in the literature. Therefore, the purpose of this study was to evaluate any revision and mortality within 10 years follow-up as well as the walking ability of still alive patients. METHODS: A total of 200 consecutive patients were included. A prospective database was first used to collect the demographic data. Exactly ten years after the surgery, a final evaluation was conducted by telephone for every patient. Any revision, any contralateral as well as other fractures and the date of death were recorded. For all patients who were still alive, the mobility score according to Parker was also surveyed. RESULTS: The average age was 79.0 years (SD: 12.5); women were affected at higher numbers (73.5%). The total surgical revision rate was 17.5% (35/200), due in particular to hematoma (9×) or infection (7×). A surgical revision later than two years was only needed in three patients (1.5%). The risk of another fracture caused by a fall was 19% (38/200), most often a contralateral femoral fracture (22/200; 11%) that happened on average 51.9 months (1-97) after the initial surgery. The risk of a contralateral femoral fracture was 15.4% (22/143) in patients who survived the first year post surgery. The postoperative mortality was 1, 2, 5 and 10 years or 23.5%, 32.5%, 55% as well as 81.5%, respectively. An average Parker's mobility score of 6.3 points (0-9) was determined for the 37 patients (18.5%) who were still alive at the time of the follow-up. CONCLUSION: The long-term study showed that revision surgery was only required in 3/200 patients (1.5%) beyond the second year of that surgery. On the other hand, more than half of all patients had already passed away five years after the initial surgery. The exact incidence of a contralateral femoral fracture was 11.9%, climbing to 15.4% if the patient survived at least one year. Nearly every fifth patient experienced another fall resulting in a severe fracture requiring treatment during the long-term course.

[Prerequisites for a convincing (neuro-)urology opinion : Importance of objectivity in the legal sense of full proof, occurring under duty of compliance of the surveyed person]. / Voraussetzungen für ein überzeugendes (neuro)urologisches Gutachten : Stellenwert der Objektivierung im Sinne des Vollbeweises unter Mitwirkung(spflicht) des Probanden.

Convincing urological expert opinions require the objectification of medical history complaints of health and functional disorders in the legal sense of obtaining full proof. This means that there is such a high degree of likelihood, beyond any doubt of a reasonable person observing the condition (Bundessozialgericht Entscheidung [BSGE] 32, 203/207). This requires a comprehensive general and special medical history survey, as well as a series of urological examination procedures in the hands of experienced urologists. In addition, it is necessary to observe the fundamentals of the various legal areas, from which the opinion order comes from, without exception. However, it would not be possible in all cases to achieve an unequivocal clarification of the problem in question. Nevertheless, it should be ensured that the best possible approximation to the actual truth of the case is reached. In this way, the democratic fundamental right of all the appraised persons to equal treatment could be met in the best possible way and optimal support to the commissioning institutions would be made available.

[Treatment of overactive bladder in elderly and old people]. / Die Therapie der Blasenüberaktivität bei älteren und alten Menschen.

Overactive bladder syndrome is a widespread disorder that leads to considerable impairment of quality of life. Besides behavioural therapy (bladder training), methods used in physiotherapy, electrotherapy and instrumental biofeedback have also proved to be successful approaches to treatment. With their good clinical and urodynamic efficacy, substances with antimuscarinic action at M3 receptors in particular and possibly also at M2 receptors have proved successful as first-line agents for the treatment of overactive bladder (OAB). Despite the frequently high level of suffering and severe impairment of quality of life, however, compliance is poor. Muscarine receptors do have a significant effect on detrusor function, but numerous other mechanisms and receptor entities also play a role. Whether patient acceptance can be significantly increased by the development of selective M-receptor antagonists, improved bladder selectivity or formulating innovations remains to be proven by broad-based clinical testing and independent, comparative, scientific studies. At present, it is not possible to estimate with absolute certainty the risk of an anticholinergic-induced deterioration in cognitive abilities, in particular in elderly individuals. Initial data suggest that primarily M3-selective receptor blockage with darifenacin could be beneficial.

Peri-implant femoral fractures: The risk is more than three times higher within PFN compared with DHS.

INTRODUCTION: Information is lacking regarding incidence rates, treatment regimens, and outcomes concerning peri-implant femoral fractures (PIF). Therefore, we performed a retrospective study to provide scientific data concerning incidence and outcome of PIF following osteosynthesis of proximal femoral fractures (PFF). MATERIAL AND METHODS: We retrospectively included all patients who received osteosynthesis for PFF between 2006 and 2015 and in whom PIF was confirmed postoperatively. All available patients with PIF were contacted minimum one year post-surgery. RESULTS: A total of 1314 osteosynthesis procedures were performed, of which 705 were proximal femoral nails (PFNs), 597 were dynamic hip screws (DHSs), and 12 were screws appliances only. During the same period, 18 PIFs (1.4%) were reported. However, PIF was 3.7 times higher within PFN when compared to DHS (15/705:2.1% versus 3/597:0.5%; odds ratio: 3.7). The following analysis also included 8 patients with PIF who were referred from other hospitals, resulting in a total of 26 patients. Mean patient age was 84.8 years (range, 57-95), with a predominance in female (23×) and in the left femur (19×). PIF occurred after an average of 23.6 months (range, 1-81) post-surgery. The fractures, most of which were spiral-shaped, were most commonly treated with locking plate osteosynthesis. The surgical revision rate was 7.7%, and the one-year mortality was 23.1%. At an average of 43.0 months (range, 12-100) post-surgery, it was possible to contact 18/26 patients (69.2%), and their mean Parker Mobility Score was 5.2 points (range 2-9). CONCLUSIONS: Peri-implant femoral fracture is a rare incident within the old age traumatology of PFF. However, based on our small number of cases, it occurred within PFN much more frequently compared with DHS. Locking plate osteosynthesis has been shown to be effective and reliable. Surgical revision and mortality rates do not appear to be increased when compared to those with the initial treatment of proximal femoral fractures.

[Urinary diversion after cystectomy: aspects of quality of life and options for rehabilitation]. / Harnableitung nach Zystektomie Aspekte zur Lebensqualität und Möglichkeiten der Rehabilitation.

Radical cystectomy in combination with different types of continent and incontinent urinary diversion is an integral part of the treatment concept for bladder tumors. Although in principle this operation does not cause disability in general, it represents a potentially massive encroachment on the physical and psychological integrity of the individual. The term "quality of life" appears with increasing frequency in modern concepts of evidence-based medicine. Also recognition of the subjective assessment of treatment by those affected in comparison to the "objective" view of qualified doctors and functionaries has become more relevant.Nevertheless, few studies have analyzed the "quality of life" after cystectomy. In addition, methodological factors hinder comparability. Only a few authors have used validated measuring instruments that allow comparison of the data. Low case numbers limit the statistical significance. Besides typical postoperative consequences and their effect on quality of life, potential influences on the pre- and postoperative assessment in the intraindividual course are discussed. The authors argue in favor of postoperative urological rehabilitation in qualified urological centers to optimize physical and psychological coping with the new life situation of "cystectomy with urinary diversion."

[Structure and process quality of inpatient urologic rehabilitation]. / Struktur- und Prozessqualität der stationären urologischen Rehabilitation.

Inpatient rehabilitation and "Anschlussheilbehandlung" (rehabilitation soon after operation or acute intervention) are effective and economic for long-term improvement of urologic patients. Only therapy guided by urologic specialists during rehabilitation and afterwards guarantees the possibility of excellent results. Especially QOL and functional deficits are improved markedly by urologic rehabilitation. Therefore, inpatient urologic rehabilitation should be initiated more often in the future.

[Paratesticular mesothelioma]. / Paratestikuläres Mesotheliom.

Paratesticular mesothelioma is a very rare entity of this aggressive malignancy. In 30-40 % of all cases an exposition to asbestos exists in the anamnesis. We report on a typical case of paratesticular mesothelioma in a roof slater and tiler who had had occupational contact with asbestos-containing materials over decades. The recommended diagnostics and therapy are discussed and the importance of the identification as an occupational disease is emphasized.

Nucleotide and deduced amino acid sequence of the nonstructural phosphoprotein, NS2, of bluetongue virus serotype 17: comparison to two isolates of serotype 10.

The nucleotide sequence of bluetongue virus (BTV) serotype 17 segment 8 from North America (NA) coding for the nonstructural phosphoprotein, NS2, was determined. This segment contains 1125 base pairs and codes for a protein of 40,581 daltons containing 354 amino acids with a net charge of -8.5 at pH 7.0. The carboxyl terminal portion of the protein is very hydrophilic and has a high degree of potential alpha-helix. Serine is the major, if not the exclusive, phosphorylated amino acid residue and ten of the twenty serine residues present in NS2 are found in consensus phosphorylation sites. Comparison of the nucleotide sequence of BTV-17NA segment 8 with the sequence of BTV-10NA and BTV-10 South Africa (SA) revealed a greater degree of homology between different serotypes within the same geographical area, i.e., 17NA and 10NA, than between isolates of the same serotype located in different areas, i.e., 10NA and 10SA. The same homology relationship as above was found at the amino acid level.

Expression in Escherichia coli and purification of biologically active L proteinase of foot-and-mouth disease virus.

The foot-and-mouth disease virus (FMDV) Lb gene was cloned into bacterial expression vectors under the control of a T7 RNA polymerase promoter. The Lb protein was expressed in both an in vitro transcription-translation system and in Escherichia coli. In vitro expression of a construct containing the Lb gene fused to a portion of the VP4 and 3D genes demonstrated cis cleavage activity that could be blocked by the thiol protease inhibitor E-64. Lb expressed in E. coli was purified from the soluble fraction by metal chelation chromatography. Purified Lb had trans cleavage activity at the L/P1 junction and cleaved the p220 component of the cap-binding protein complex.

Phylogenetic analysis of segment 10 from African horsesickness virus and cognate genes from other orbiviruses.

Utilizing the reverse transcriptase-polymerase chain reaction (RT-PCR) procedure, we have synthesized full-length copies of segment 10 from African horsesickness virus (AHSV) serotypes 1, 4 and 8. The genes were cloned, sequenced and compared with the sequence of the cognate gene from AHSV serotypes 3 and 9. Sequences were analyzed to assess evolutionary relationships among serotypes using cladistics. Based on this analysis the data support a close relationship between serotypes 4 and 9 and between serotypes 1 and 8 and a closer relationship of serotype 3 to the 4 and 9 group.

Cell type-specific variations in the induction of hsp70 in human leukocytes by feverlike whole body hyperthermia.

Fever has been associated with shortened duration and improved survival in infectious disease. The mechanism of this beneficial response is still poorly understood. The heat-inducible 70-kDa heat shock protein (Hsp70) has been associated with protection of leukocytes against the cytotoxicity of inflammatory mediators and with improved survival of severe infections. This study characterizes the induction of Hsp70 by feverlike temperatures in human leukocytes in vitro and in vivo. Using flow cytometry, Hsp70 expression was determined in whole blood samples. This approach eliminated cell isolation procedures that would greatly affect the results. Heat treatment of whole blood in vitro for 2 hours at different temperatures revealed that Hsp70 expression depends on temperature and cell type; up to 41 degrees C, Hsp70 increased only slightly in lymphocytes and polymorphonuclear leukocytes. However, in monocytes a strong induction was already seen at 39 degrees C, and Hsp70 levels at 41 degrees C were 10-fold higher than in the 37 degrees C control. To be as close as possible to the physiological situation during fever, we immersed healthy volunteers in a hot water bath, inducing whole body hyperthermia (39 degrees C), and measured leukocyte Hsp70 expression. Hsp70 was induced in all leukocytes with comparable but less pronounced cell type-specific variations as observed in vitro. Thus, a systemic increase of body temperature as triggered by fever stimulates Hsp70 expression in peripheral leukocytes, especially in monocytes. This fever-induced Hsp70 expression may protect monocytes when confronted with cytotoxic inflammatory mediators, thereby improving the course of the disease.

[Interstitial laser-induced coagulation of the prostate for therapy of benign hyperplasia]. / Die interstitielle laserinduzierte Koagulation (ILK) der Prostata zur Therapie der benignen Hyperplasie (BPH).

Interstitial laser-induced coagulation (ILC) is a new, minimally invasive, procedure for the treatment of benign prostatic hyperplasia (BPH). It is based on the placement of special light guides in the prostatic tissue, either transurethrally or perineally. The radiation source is a Nd-YAG laser, which is active for 3 or 5 min per fiber placement, respectively, with the power reduced stepwise. The coagulation necroses caused shrink during follow-up, leading to a decrease in the obstruction. In 239 patients treated in this way the mean I-PSS-Score fell from 25.4 to 8.1 points and the quality of life index from 4.1 to 1.6, the urinary peak flow rate increased from 7.7 to 16.3 ml/s, the residual urine volume fell from 151 to 32 ml, and the mean prostate volume declined from 47.4 to 32.2 ml in the first 3 months of follow up; 9.2% of the patients required further treatment within 1 year because of persistent obstruction. The complication rate was low. Statistical analysis showed no factors allowing prediction of the outcome. ILC is an effective method with few side effects and complications, and it has a wide range of indications for all BPH patients.