[Infection of a total knee prosthesis with Brucella spp]. / Infection d'une prothèse totale du genou par "Brucella spp".

Brucellosis, an "anthropophitic" disease of worldwide distribution can involve several organs and tissues but the osteoarticular disease is the most common complication. It can occur as sacroiliitis, bursitis, tenosynovitis or osteomyelitis. Prosthetic joint infection is a serious complication of total joint arthroplasty, with coagulase negative staphylococci and Staphylococcus aureus accounting for 50% of cases. Treatment of prosthetic infections remains complex. Prosthetic infections caused by Brucella spp are rarely described in the literature. We report a patient with a prosthetic joint infection due to Brucella spp, documented by a polymerase chain reaction. The patient has been cured after two-stage exchange of the prosthesis and long-term antimicrobial therapy.

Total hip arthroplasty using a cementless dual-mobility cup provides increased stability and favorable gait parameters at five years follow-up.

BACKGROUND: Rates of dislocation following primary total hip arthroplasty (THA) vary from 0.5 to 10%. Dual-mobility cups in THA demonstrate increased stability. Clinical outcomes following THA with dual-mobility cups have been reported, but gait has not been assessed. Therefore we performed a retrospective case control study to answer: (1) is gait better in patients following THA with a dual-mobility cup than in frail, elderly patients of the same age? (2) Are clinical outcomes better in patients following THA with a dual-mobility cup than in frail, elderly patients? (3) What is the dislocation rate following THA with a dual-mobility cup? HYPOTHESIS: We hypothesized that patients who underwent THA with a dual-mobility cup have a better gait compared to frail, elderly patients of the same age. PATIENTS AND METHODS: Twenty patients (22 hips), mean age 79.9±7.7 (range, 62.3-88.3) years were assessed in this retrospective case-control series 5.6±1.4 (range: 4.1-8.8) years following dual-mobility cup THA. A reference group consisted of 72 "frail elderly" patients in a rehabilitation hospital for health problems unrelated to the lower limb, with no lower limb surgery or neurological conditions. Temporal and spatial gait performance were measured with four miniature gyroscopes, mounted on each thigh and calf, while patients walked freely along a 30m corridor. Harris Hip Score, WOMAC, radiological outcomes, and dislocation rate were determined. RESULTS: All gait parameters were better in the dual-mobility group compared to the frail elderly group. The dual-mobility group had a higher cadence (100.3 steps/minute versus 75.6 steps/minute), shorter (relative to gait cycle time) stance (61.6% versus 67.8%), shorter (relative to gait cycle time) double stance (23.3% versus 36.0%), longer stride (1.13m versus 0.80m), and faster walking speed (0.96m/s versus 0.52m/s). Range of motion of the shank, thigh and knee were better in the dual-mobility group. Harris Hip Score was 87.6±13.9 (range 51-100) and WOMAC score was 11.3±12.1 (range 0-34) in the THA group. We observed no dislocations. DISCUSSION: Gait patterns five years following THA with the dual-mobility cup were better or comparable to published study populations. LEVEL OF EVIDENCE: III, retrospective case-control series.

Inhibition of synaptosomal accumulation of l-norepinephrine II: N-aryloxyalkylphentermines, quaternary d-amphetamines, and 3-aryloxypropylamines.

The inhibitory potencies of a series of N-substituted phentermines on the synaptosomal uptake of l-norepinephrine were found to be similar to those of the corresponding amphetamines. Quaternization of N, N-dimenthyl-d-amphetamine diminished, but did not abolish, its inhibitory potency, indicating that a permanently charged cation is also effective. Since the addition of an aromatic moiety at the end of a four-atom chain originating at the nitrogen of amphetamine or phentermine significantly increased inhibitor strength, several 3-aryloxypropylamines and 4-phenylbutylamine were tested, but they were much weaker inhibitors than dl-amphetamine. Thus, the observed increase in inhibitor potency apparently was not simply the result of a specific interaction of the "nonmimic" portion of the N-substituted amphetamines or phentermines.

Mycobacterium tuberculosis gene-amplification in breath condensate of patients with lung tuberculosis.

The applicability of Mycobacterium tuberculosis-gene-amplification test (NAT) in breath condensate (BC) was examined in lung tuberculosis (TB). Ten patients with bacteriologically confirmed lung TB have been examined by ligase chain reaction (LCx). In BC the NAT were negative in all patients as well as the examination of acid fast smears and of solid phase or liquid media cultures were. This indicates that the use of NAT in BC can not replace or complement sputum or materials obtained invasively in patients with lung TB.

A dynamic analysis of knee ligament injuries in alpine skiing.

The aim of this study is to understand better the dynamic mechanisms of anterior cruciate ligament (ACL) rupture in alpine skiing. As a result of these findings, improvements in the boot-binding release systems are proposed. Six patients who sustained ACL rupture, aged 19 to 43 years, were studied. A step by step reconstruction of the accident was made using a questionnaire followed by an interview. The skiing equipment was tested in a specialized laboratory and the release levels of the boot-binding systems were measured in twist and in forward lean. ACL injury was confirmed by arthroscopy or surgery. Most patients had recent skiing equipment; their binding systems were correctly mounted and in perfect working order. Release levels of the bindings were equal to or slightly above those suggested by the ISO standards. The mechanisms of injury were valgus-external rotation in knee flexion of more than 90 degrees, internal rotation in knee flexion of more than 120 degrees with anterior drawer loads, internal rotation-valgus in knee flexion of less than 30 degrees with anterior drawer loads, external rotation-valgus in knee flexion of more than 120 degrees with anterior drawer loads, external rotation in knee flexion of about 100 degrees with anterior drawer loads and internal rotation-valgus. Even with a modern boot-binding system, properly adjusted, ACL injury remains possible. The improvements in the current equipment should be concerned with the behavior when confronted with combined loads producing friction in the system. We concluded that for lateral release at the toe, there should be a better compensation of the vertical parasite forces and an improvement of the antifriction devices. In order to prevent excessive anterior drawer loads on the ACL an additional release direction of the binding system, especially backwards, could, if properly adjusted, enhance the opportunities of early release in a dangerous backward lean "out of control" position.

Traumatic hernia of the abdominal wall after pelvic and acetabular fracture: a case report.

Traumatic hernia of the abdominal wall is a rare and easily missed injury in the presence of major pelvic and abdominal lesions. We present a radiographically documented case of combined pelvic and acetabular fracture with a major contralateral traumatic hernia with avulsion of the internal oblique, the external oblique and the transverse abdominal muscles diagnosed four months after the initial trauma. To our knowledge no similar case has been described in the current literature.

Percutaneous retrograde screwing for stabilisation of acetabular fractures.

OBJECTIVES: To evaluate the results of retrograde percutaneous screw fixation (PSF) in minimally or undisplaced acetabular fractures in a geriatric population. PATIENTS AND METHODS: Between July 1998 and July 2001, 21 consecutive patients with an acetabular fracture underwent fluoroscopic guided percutaneous fixation. The mean age was 81 years (range 67--90 years). In all cases, the fracture was minimally or undisplaced (<2mm). Two cannulated cancellous 7.3mm screws were inserted in a retrograde fashion to stabilise the posterior and the anterior column. Bed to chair transfer began after 24h. Weight bearing as tolerated was allowed at 4 weeks. RESULTS: Eighteen patients were reviewed at a mean of 3.5 years (range 2--5 years). Soft tissue dissection was minimal. There were no intraoperative or postoperative complications. At the latest follow-up there was no radiographical evidence of secondary displacement of fragments, degenerative changes, or screw failure. Fractures healed at a mean time of 12 weeks (range 8--15 weeks). Clinical results were satisfactory in 17 patients. CONCLUSION: Our results show that percutaneous screw fixation under fluoroscopic control is a safe technique to treat some pattern of acetabular fracture.

[Amino acid disturbances in liver failure]. / Etudes des pertubations des amino-acides dans l'insuffisance hépatique.

We have attempted to trace the development of the concept which stresses that the encephalopathy often seen with hepatic failure may be the result of derangement in amino acid metabolism in patients with failing livers. We have also proposed that the infusion of solutions which may normalize these plasma amino acids and decrease the amount of toxic aromatic amino acids within the circulation may help in the amelioration of the symptoms of hepatic encephalopathy. We believe that in our studies to date, the use of this solution has been a significant advantage in the care of these extremely ill patients. We would hope that when the solution becomes generally available, the provision of such solutions to such patients will result in the salvage of some lives lost at the present time because of hepatic failure and encephalopathy.

[Psychogenic bronchial asthma]. / Zur Psychogenie des Asthma bronchiale.

The extensively discussed problem of psychopathological components in bronchial asthma has been investigated in patients of the authors' hospital. The results are compared with the most frequent opinions published. Using a questionnaire, the intensity of bodily complaints and psychic alterations was compared in following groups: asthmatics, neurotics, and patients with acute lung diseases. Considering bodily complaints, the intensity is comparable in asthmatics and neurotics, and higher than in patients with acute lung diseases. Psychic alterations are more pronounced in neurotics, and there is no difference between asthmatics and patients with acute lung diseases. The importance of these results with regard to the general assessment and the immediate medical care for patients with bronchial asthma is discussed.

[Comparative studies on the mucolytic effectiveness of Mucosolvin oral and Mucosolvin inhalant]. / Vergleichende Untersuchungen zur mukolytischen Wirksamkeit von Mucosolvin oral und Mucosolvin-Inhalat.

Here the clinic comparison between both inhaling and oral Mucosolvin therapy is reported on. To determine the virtual viscosity of sputum has proved to be the deciding parameter to measure the effect of Mucosolvin. Both Mucosolvin inhalable and oral are equally effective. But whereas with oral therapy there were no side effects (e.g. bronchospasm) necessitating withdrawal of the drug such side effects occurred with inhaling therapy. Thus Mucosolvin allowes an effective mucolytic therapy independent of using any inhalation appliance.

[Bronchoselective beta stimulators and corticoid aerosols in the treatment of asthma]. / Bronchoselektive beta-Stimulatoren und Kortikoidaerosole in der Asthmabehandlung.

In the treatment of the obstructive ventilation disturbance in bronchial asthma the beta 2-receptor stimulants and the inhalable corticoids best proved. With the help of own clinical experiences and studies of literature Arubendol, Salbutamol, Berotec, Auxiloson and Beclomethason are described and it is reported on their bronchospasmolytic qualities as well as their protective effect against repeated acetylcholin and allergen irritation, respectively. They all distinguish themselves by a selective effect on the bronchial system and in therapeutic doses they guarantee the absence of systemic side effects. Though with Arubendol a secure beta 2-receptor stimulants with a good protective effect against acetylcholin and allergen irritation is at our disposal, the application of Berotec and of in inhalable corticoid would be an effective enrichment of our antiasthmatic remedies.

[Results of hyposensitization with bee and wasp venom]. / Ergebnisse der Hyposensibilisierung mit Bienen- und Wespengift.

The immunotherapy with purified bee and wasp venom is indicated for patients with severe general reactions after insect stings, positive prick test and positive RAST. One hundred seventy four persons were treated for three years with bee venom (SSW Dresden) and 34 patients with wasp venom (Reless). Challenge by a stinging bee after treatment proved in 90 per cent complete protection. There were no general reactions during hyposensitization with wasp venom, but in 46 per cent occurred general reactions during immunotherapy with bee venom. Therefore rush desensitization should be performed in indoor patients till a top dose of 100 micrograms/ml is reached. Booster injections can be given to outdoor patients. All individuals with systemic reactions after insect stings have to get an emergency treatment kit and must be familiar with its application.

Production and characterization of antibodies to meperidine.

A mepridine-bovine serum albumin (Mep-BSA) conjugate with 15-20 moles of meperidine per mole of BSA was synthesized and characterized. Rabbits immunized with Mep-BSA produced antibodies that were assayed utilizing saturated ammonium sulfate to separate 3H-meperidine (3H-M) bound to antibody from free 3H-M. Antibody specificity was assessed by competitive inhibition studies. The nanomoles of inhibitor required to decrease the binding of 3H-M by 50% were: meperidine .046; meperidine acid, 3.2; alphaprodine, 7.8; dextromethorphan, 20; codeine, 50; and morphine 55. The sensitivity of the assay is approximately 30 ng/ml; sufficient for pharmacokinetic studies of the disposition of meperidine in man.

[Lymphogranulomatosis and persistent left superior vena cava. Contribution to the diagnostic problem of the interference of morphologically different images]. / Lymphogranulomatose und V. cava superior sinistra persistens. Beitrag zur diagnostischen Problematik bei Interferenz morphologisch unterschiedlicher Erscheinungen.

Unilateral mediastinal dilatations are suspicious of the presence of a lymphogranulomatosis. It is reported on a case in which the diagnosis of Hodgkin's disease was rendered more difficult by a persistent left superior vena cava. The discussion of the case shows that in the differential-diagnostically problematic mediastinal region - corresponding to the clinical appearance - all methods available must be used for the clarification of the etiology.