bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral Pulmonary Artery Banding before Norwood Procedure: Survival of High-Risk Patients
Authors: Schulz Antonia , Sinzobahamvya Nicodème , Cho Mi-Young , Böttcher Wolfgang , Miera Oliver , Redlin Mathias , Ovroutski Stanislav , Photiadis Joachim
Published: January 2019

Background This study reports midterm results of high-risk patients with hypoplastic left ventricle treated with initial bilateral pulmonary artery banding (PAB) before secondary Norwood procedure (NP).

Methods Retrospective study of 17 patients admitted between July 2012 and February 2017 who underwent this treatment strategy because diagnosis or clinical status was associated with high risk for NP. Survival was compared with that of patients who underwent primary NP.

Results Mean Aristotle comprehensive complexity score for NP would have been 19.7 ± 2.6. Risk factors included obstructed pulmonary venous return (n = 9), body weight < 2.5 kg (n = 7), total anomalous pulmonary venous connection (n = 3), and necrotizing enterocolitis (n = 1). Ten patients had a score ≥ 19.5. Early survival after PAB was 82.4% (14/17). NP was performed in 14 patients after improvement of clinical condition at a median age of 56 days and a weight ≥2,500 g. There was no 30-day mortality, but one interstage death. One patient died later after Glenn operation. One-year survival after primary PAB followed by NP was 70.6 ± 11.1%. During the same period, 35 patients with overall lower risk factors underwent primary NP; early postoperative survival and 1-year survival were 88.6 ± 5.4% and 68.6 ± 7.8%, respectively. There was no significant difference in survival between the two groups (p = 0.83) despite higher risk in the secondary Norwood group (p <0.0001).

Conclusions PAB before NP in high-risk patients constituted salvage management. Primary PAB provided enough time for stabilization and control of most risk factors. It allowed midterm survival equivalent to the survival after primary NP in lower risk neonates.
Gene Variants in NKX2-1 Do Not Represent a Major Etiological Factor of Primary Congenital Hypothyroidism in Mexican Population
Authors: González-del Angel Ariadna , Fernández-Hernández Liliana , Sánchez-Verdiguel Iraís , González-Núñez Aidy , Martínez-Cruz Víctor , Sánchez Carmen , Moreno-Rojas Rosario , Alcántara-Ortigoza Miguel Angel
Published: January 2019

Congenital hypothyroidism (CH), attributable to thyroid dysgenesis (TD), has an unusually high prevalence in Mexican population but the causes are unknown. NKX2-1, as a candidate gene, was subjected to automated Sanger sequencing in 122 unrelated Mexican patients with CH/TD. Although this study includes the largest number of TD-related CH patients in whom NKX2-1 has been analyzed, no pathogenic variants were detected; only three benign polymorphic changes were identified. These results suggest that NKX2-1 is not a major contributor to the etiology of CH or its high prevalence in Mexicans. Our work identifies misannotations of NKX2-1 variants in three previous published reports.
Brain Aneurysms in the Pediatric Population of Slovenia: A Case Series
Authors: Ilovar Saša , Benedik Mirjana , Vesnaver Tina , Osredkar Damjan
Published: January 2019

Background Brain aneurysms are rare in the pediatric population. The diagnosis of a brain aneurysm in a child may be difficult because of its infrequency and often subtle or nonspecific clinical presentation. Endovascular therapy and microsurgical treatment are increasingly used approaches in treating children, possibly contributing to favorable outcomes if patients are treated in a timely manner.

Objective We were interested in the clinical presentation, symptoms, diagnostics, treatment, and follow-up of pediatric patients with brain aneurysms in Slovenia.

Methods This was a retrospective review of medical documentation of children with intracranial aneurysms treated at the University Children's Hospital in Ljubljana, Slovenia, from January 1998 to December 2017.

Results We identified a cohort of eight children (median age: 14.9 years; range: 2.8–17.7). The estimated incidence of pediatric brain aneurysms in Slovenia is 0.12/100,000 children per year. We observed a male predominance (1.7:1). Half of the patients presented with acute onset of neurologic symptoms and three with subarachnoid hemorrhage. One of the patients had a related stroke. The presenting symptoms were tonic–clonic seizures, hemiparesis, paresthesias, speech disturbance, and cranial nerve palsy. The other half of aneurysms were identified incidentally. Five patients had anterior circulation aneurysms; the most prevalent location was the internal carotid artery. One patient was treated with surgical procedures, four patients were treated with endovascular procedures, and three patients were treated conservatively. Outcome was excellent in all patients.

Conclusion Endovascular interventions and microsurgical procedures appear to be safe and effective in the treatment of brain aneurysms in the pediatric population. Asymptomatic patients with brain aneurysms need close follow-up.
Lung Nodule Management: An Interventional Pulmonology Perspective
Authors: Kurman Jonathan , Mahajan Amit , Hogarth D. , Chaddha Udit
Published: January 2019

With the rising number of screening and incidentally detected lung nodules, there is an increasing need for evaluation in the safest and least invasive manner. The last two decades have seen substantial evolution in bronchoscopic approaches to diagnose these nodules. Innovative bronchoscopic techniques, often used in conjunction with each other, have significantly improved our ability to navigate to almost any part of the lung. A comprehensive knowledge of available technologies and the factors affecting diagnostic yield is essential to decide on the best way to approach a particular scenario. This article provides an overview of the technical aspects, yield, and limitations of these modalities.
Asanguineous Cardiopulmonary Bypass in Infants: Impact on Postoperative Mortality and Morbidity
Authors: Murin Peter , Boettcher Wolfgang , Ozaki Shinichi , Wloch Alexa , Cho Mi-Young , Redlin Mathias , Miera Oliver , Sinzobahamvya Nicodème , Photiadis Joachim
Published: January 2019

Background We routinely start cardiopulmonary bypass (CPB) for pediatric congenital heart surgery without homologous blood, due to circuit miniaturization, and blood-saving measures. Blood transfusion is applied if hemoglobin concentration falls under 8 g/dL, or it is postponed to after coming off bypass or after operation. How this strategy impacts on postoperative mortality and morbidity, in infants weighing ≤ 7 kg?

Methods Six-hundred fifteen open-heart procedures performed from January 2014 to June 2018 were selected. One-hundred sixty-three patients (26.5%) were transfused on CPB (group 1), while 452 (73.5%) patients were not transfused on CPB (group 2). Operative risk and complexity were similar in both groups. Postoperative mortality and morbidity were compared. Multiple logistic regression was used to detect factors independently associated with outcome.

Results Observed mortality in nontransfused group (0.7% = 3/452) was significantly lower than expected (4.2% = 19/452): p = 0.0007, and much lower than in transfused group (6.7% = 11/163): p < 0.0001. CPB transfusion (p = 0.001) was independently associated with mortality, either acting as the sole factor or in combination with the Society of Thoracic Surgeons morbidity score (p = 0.013). Patients not transfused during CPB required less frequently vasoactive inotropic drugs (p = 0.011) and duration of their mechanical ventilation was shorter (93 ± 134 hours) than for transfused patients (142 ± 170 hours): p = 0.0003. CPB transfusion was an independent determinant factor for morbidity (p = 0.05), together with body weight (p < 0.0001), vasoactive inotropic score (p < 0.0001), CPB duration (p = 0.001), and postoperative transfusion (p = 0.009).

Conclusion The strategy of transfusion-free CPB course, feasible in most patients ≤ 7kg, was associated with improved outcome. Asanguineous priming of CPB circuit should become standard, even in neonates and infants.
Diabetics have Inferior Long-Term Survival and Quality of Life after CABG
Authors: Hokkanen Matti , Huhtala Heini , Järvinen Otso
Published: January 2019

A prevalence of diabetes is increasing among the patients undergoing coronary artery bypass grafting (CABG). Data on whether health-related quality of life improves similarly after CABG in diabetics and nondiabetics are limited. We assessed long-term mortality and changes in quality of life (RAND-36 Health Survey) after CABG.

Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared with nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 1 and 12 years later.

Thirty-day mortality was 2.7 versus 1.6 (p = 0.511) in the diabetics and nondiabetics. One- and 10-year survival rates in the diabetics and nondiabetics were 94.6% versus 97.0% (p = 0.287) and 63.5% versus 81.6% (p < 0.001), respectively. After 1 year, diabetics improved significantly (p < 0.005) in seven, and nondiabetics (p < 0.001) in all eight RAND-36 dimensions. Despite an ongoing decline in quality of life over the 12-year follow-up, an improvement was maintained in four out of eight dimensions among diabetics and in seven dimensions among nondiabetics. Physical and mental component summary scores on the RAND-36 improved significantly (p < 0.001) in both groups after 1 year, and at least slight improvement was maintained during the 12-year follow-up time.

Diabetics have inferior long-term survival after CABG as compared with nondiabetics. They gain similar improvement of quality of life in 1 year after surgery, but they have a stronger decline tendency over the years.
Kneeling after Total Knee Arthroplasty
Authors: Amin Raj M. , Vasan Vikram , Oni Julius K.
Published: January 2019

The ability to kneel is one of the many patient goals after total knee arthroplasty (TKA). Few studies have addressed patients' ability to kneel after TKA as a primary outcome. Given the altered biomechanics of the knee after TKA, the various implant designs, and multiple surgical approaches, there is a need to further understand the patient's kneeling ability after TKA. We evaluated the available literature on this topic to help to guide postoperative care recommendations. Biomechanical data show that the load borne by the patellofemoral joint is elevated significantly at all flexion angles, whereas tibiofemoral articulation pressures are elevated only at 90 to 120 degrees of flexion. However, these increased pressures are rarely borne by prosthetic knees because patients often avoid kneeling after TKA. In patients who do kneel after surgery, data show that increased range of motion promotes improved kneeling performance. Targeted interventions to encourage kneeling after TKA, including preoperative education, have not shown an ability to increase the frequency with which patients kneel after TKA. Reasons for patient avoidance of kneeling are multifaceted and complex. There is no biomechanical or clinical evidence contraindicating kneeling after TKA. There are insufficient data to recommend particular prosthetic designs or surgical approaches to maximize kneeling ability after surgery. Musculoskeletal health care providers should continue to promote kneeling to allow patients to achieve maximum clinical benefit after TKA.
Outcomes of Congenital Diaphragmatic Hernia in One of the Twins
Authors: Wang Weipeng , Pan Weihua , Chen Jie , Xie Wei , Liu Ming , Wang Jun
Published: January 2019

Objective Congenital diaphragmatic hernia (CDH) occurred in one of the twins is rarely seen. This study aims to describe the clinical features and outcomes of this special CDH.

Study Design The medical records of all CDH neonates treated in our institution between 2010 and 2016 were retrospectively reviewed. Data were analyzed using parametric and nonparametric tests, appropriately. Association between the twin pregnancy and outcomes was assessed.

Results Eighty-nine patients met the inclusion criteria. In the multivariate analysis, liver herniation, observed/expected lung-to-head circumference ratio, and lower birth weight were independently related to the survival rate of CDH. Eleven patients were identified with CDH occurred in only one of the twins. Among them, seven patients (63.6%) were premature and six (54.5%) were found with low birth weight. Compared with CDH patients with singleton pregnancy, they had significantly higher rates of prematurity (p < 0.001) and lower birth weight (p < 0.001). Additionally, they had worse outcomes with a shorter duration of mechanical ventilation (p = 0.015) and lower survival rate at discharge (p = 0.024).

Conclusion Preterm birth and low birth weight are more common in CDH patients with twin pregnancy, which may lead to worse outcomes.
Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases
Authors: Sagerfors Marcus , Bjorling Patrik , Niklasson Johan , Pettersson Kurt
Published: January 2019

Background The distal radius fracture (DRF) is the most common fracture among adults. In recent years, there has been a shift toward volar locking plates in the treatment of DRFs, and this shift has taken place with a low degree of evidence.

Question/purposes Can combined volar T-plating and dorsal pi-plating of AO type C fractures yield a good functional and radiographic outcome 1 year postoperatively?

Patients and Methods In a retrospective cohort study, we evaluated 102 consecutive patients operated with combined dorsal and volar plating, of whom 80 completed the 1-year follow-up. The DRFs were operated between 2012 and 2013. All cases were AO type C2 and C3 fractures. The primary outcome was functional scoring including radiographic examination. Secondary outcome measures included range of motion, visual analog scale (VAS) pain scores, and hand grip strength.

Results The median Batra radiographic score was 84.5. Wrist extension was 74% of the uninjured side, flexion was 70%, pronation was 94%, and supination was 90%. The Patient-Rated Wrist Evaluation score was 21 points, and the Disabilities of the Arm, Shoulder, and Hand score was 19.4 points. VAS pain scores were 0 at rest and 3 during activity. Hand grip strength was 80% of the uninjured side. Radiographic outcome did not correspond to a patient-reported outcome. Hardware removal was performed in 15/80 cases.

Conclusions We conclude that a good outcome can be expected after combined dorsal and volar plating of DRFs. Radiographic outcome is not necessarily associated with functional outcome 1 year postoperatively. The rate of hardware removal was acceptable.

Level of Evidence III
Possible Role of Heat Shock Protein 70 in Childhood Seizures
Authors: Kamel Magdy Mostafa , Mounir Samir Mohammed , Okaily Nagwa Ismail , Abdelzaher Mohammed Hosny , Hassan Mohammed Hosny
Published: January 2019

Background There has been a long interest in investigating the relationship between heat shock protein (HSP) expression and the evidence of neuronal damage in the most susceptible brain areas after seizures. So, the present study aimed to assess heat shock protein (HSP70) in children with seizures (febrile seizures and epilepsy), and to find out the cutoff point of this marker that may help in confirming epilepsy diagnosis. The present study has been conducted to evaluate serum levels of HSP70 in children with epileptic and febrile seizures and to compare these results to that of healthy children.

Materials and Methods A prospective study included 85 children (32 females and 53 males) in Children and Maternity Unit, Minia University Hospital, Minia, Egypt. Children were subdivided into three groups, group (I) included 30 children with epilepsy, group (II) included 30 children with febrile seizures, and group (III) included 25 healthy children that served as a control group. HSP70 assay was performed for all included children using the enzyme-linked immunosorbent assay technique.

Results The overall results revealed significant high serum HSP70 levels in epilepsy and febrile seizures groups when compared with control group (p < 0.001). Also, HSP70 serum levels were significantly higher in epilepsy group than in febrile seizures group (p < 0.001). Serum HSP70 level at a cutoff point > 170 ng/L showed 60% sensitivity and specificity equal to 83.3% in prediction of epilepsy.

Conclusion HSP70 level was significantly higher in epileptic and febrile seizures children than normal healthy children, and HSP70 may be beneficial in confirming the diagnosis of epilepsy.
Haemostatic Profiles are Similar across All Aetiologies of Cirrhosis
Authors: Bos Sarah , van den Boom Bente , Kamphuisen Pieter , Adelmeijer Jelle , Blokzijl Hans , Schreuder Tim , Lisman Ton
Published: January 2019

Background and Aim Patients with cirrhosis may acquire profound changes in haemostasis. Although haemostatic changes in cirrhosis have been extensively studied, most studies were performed in groups of patients with mixed aetiology. As thrombotic events appear more common in some aetiologies of disease, notably non-alcoholic steatohepatitis (NASH) and cholestatic disease, we hypothesized that haemostatic changes might be different across aetiologies.

Patients and Methods We studied 109 patients with cirrhosis (31 cholestatic liver disease, 23 NASH, 37 alcoholic liver disease [ALD], 18 viral hepatitis) and 44 healthy controls. Patients with malignancy were excluded. Routine diagnostic tests of haemostasis, thrombin generation assays, fibrin permeability assays and a plasma-based fibrinolytic assay were performed.

Results All patients had comparable severity of disease according to their Model for End-Stage Liver Disease score (9 [7–11]). Plasma levels of von Willebrand factor were substantially elevated across all aetiologies, with a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 levels comparable to controls. Thrombin generation capacity was elevated in all aetiologies, most profoundly in ALD. Fibrin permeability was decreased in all aetiologies, which was accompanied by elevated fibrinogen levels. Clot lysis times were prolonged in NASH and cholestatic disease. Plasma levels of individual proteins were similarly altered in all aetiologies.

Conclusion Our in-depth haemostatic profiling of primary, secondary and tertiary haemostasis in a group of patients with Childs–Turcotte–Pugh A/B cirrhosis showed no large differences between aetiologies, and was consistent with a general hypercoagulable profile in patients with mild cirrhosis. These results suggest that patients with cirrhosis have an increased risk of thrombosis, irrespective of their aetiology.
Primary and Posttraumatic Knee Osteoarthritis in the Military
Authors: Garcia E'Stephan , Dickens Jon , Rodriguez Marina
Published: January 2019

Osteoarthritis is a particularly burdensome and career-limiting condition for military service members. The daily demands of military service place the service members at a baseline increased risk of developing primary OA as well as increased risk of acute knee injuries that further predispose to developing posttraumatic OA. There are multiple treatment options available for primary and posttraumatic OA from osteotomy to arthroplasty.
Combination Therapy Involving Ear Cartilage Transfer and Suture-Button Suspension Arthroplasty for Symptomatic Thumb Carpometacarpal Joint Arthritis
Authors: Usami Satoshi , Inami Kohei
Published: January 2019

We describe the short-term outcomes of combination therapy involving ear cartilage transfer and suture-button suspension arthroplasty for the treatment of symptomatic thumb carpometacarpal joint arthritis. The concept is to reduce joint arthritis by separate independent approaches, which are renewing the damaged joint surface of the trapezium and first metacarpal bone suspension. Autologous ear cartilage is a desirable material for joint resurfacing arthroplasty without postoperative synovitis or infection, and it is expected to prevent bone impingement or recurrent joint arthritis when postoperative suture-button slack or failure unfortunately occurs.
Electromagnetic Navigation Bronchoscopy Triple Contrast Dye Marking for Lung Nodule Localization
Authors: Ng Calvin S.H. , Zhao Zerui , Long Hao , Lau Rainbow W.H.
Published: January 2019

Small pulmonary lesions can be difficult to localize during video-assisted thoracoscopic surgery. Electromagnetic navigation bronchoscopy (ENB) dye marking of the lesion, particularly when guided by cone beam computed tomography in the hybrid operating room (HOR), is an emerging approach. However, issues with confirmation of dye injection and intraoperative visualization of the colored dye can be unpredictable and challenging. To address these uncertainties, we present our technique of ENB dye marking localization of lung nodule using the triple-contrast dye method in the HOR.
Neurodevelopmental Outcomes in Neonates with Mild Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia
Authors: Rao Rakesh , Trivedi Shamik , Distler Amy , Liao Steve , Vesoulis Zachary , Smyser Christopher , Mathur Amit M.
Published: January 2019

Objective To review developmental outcomes of neonates with mild hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH).

Study Design Neonates ≥35 weeks' gestation with mild HIE/TH (TH group, n = 30) were matched with healthy term-born infants (control group, n = 30) and reviewed for the presence and severity of magnetic resonance imaging (MRI)-detected neurological injury. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant Development (BSID).

Results MRI injury was present in 13/30 (43.3%) neonates (11 mild, 1 moderate, and 1 severe injuries) in the TH group. The mean (standard deviation [SD]) corrected age at BSID III was 29.3 (3.9) months in the controls compared with 14.7 (3.9) months in the TH group (p < 0.01). The mean (SD) cognitive, language, and motor composite scores in neonates in the TH group (n = 16, 53.3%) and control groups (n = 30, 100%) were 99.4 (17.1) versus 93.0 (12.3), (p = 0.15), 89.5 (15.5) versus 100.2 (18.4), (p = 0.054), and 93.1 (15.4) versus 100.8 (16.3) (p = 0.13), respectively.

Conclusion Developmental outcomes of neonates with mild HIE/TH were similar to healthy, term-born neonates.
The Effect of Distraction during Labor Induction on Timing of Analgesia Request: A Randomized Clinical Trial
Authors: Dixon C. Luke , Monsivais Luis , Chamseddine Petra , Olson Gayle , Pacheco Luis D. , Saade George R. , Costantine Maged M.
Published: January 2019

Objective To assess whether distraction using music and/or video games influences timing of analgesia request and improves pain outcomes in women undergoing labor induction.

Study Design A total of 219 pregnant women with singleton gestation undergoing labor induction with a Foley bulb (FB) at term were randomized to distraction with music and video games via iPod (n = 109) or no iPod (n = 110). The primary outcome was the time from FB placement to request for pain medication. Secondary outcomes included number of patients requesting pain medication within 6 and 12 hours, type of pain medication received, pain visual analog scale scores, and patient satisfaction. Mann–Whitney's, chi-square, Kaplan–Meier's curves, and Pearson's product moment correlation were used for statistical analysis (significance: p < 0.05).

Results Baseline characteristics were similar between the two groups. There was no difference in the time from FB placement until pain medication request between the groups. There were no significant differences in secondary outcomes. Increased per cent time of iPod use correlated with a longer time until pain medication request (R
2 = 0.22, p = 0.03).

Conclusion We were not able to show that distraction using music and video games delays timing of analgesia request or improve pain outcomes in pregnant women undergoing mechanical labor induction at term.
Epidemiology of Blood Culture Utilization in a Cohort of Critically Ill Children
Authors: Tran Christine Anh-Thu , Zschaebitz Jenna Verena , Spaeder Michael Campbell
Published: January 2019

Blood culture acquisition is integral in the assessment of patients with sepsis, though there exists a lack of clarity relating to clinical states that warrant acquisition. We investigated the clinical status of critically ill children in the timeframe proximate to acquisition of blood cultures. The associated rates of systemic inflammatory response syndrome (72%) and sepsis (57%) with blood culture acquisition were relatively low suggesting a potential overutilization of blood cultures. Efforts are needed to improve decision making at the time that acquisition of blood cultures is under consideration and promote percutaneous blood draws over indwelling lines.
Petrous Apex Meningioma with Extension into Meckel's Cave: Resection using a Retrosigmoid Intradural Suprameatal Approach
Authors: Munich Stephan A. , Morcos Jacques J.
Published: January 2019

The retrosigmoid intradural suprameatal approach was first introduced in 1983 by Samii et al, as a modification of the classic retrosigmoid approach intended to open Meckel's cave, exposing the trigeminal nerve and access the middle fossa.1 The area of bone resected in this approach is similar to that removed in a Kawase's approach.2 Whereas the direction of drilling in a Kawase's approach is from anterior and superior, it is from posterior and inferior in the retrosigmoid intradural suprameatal approach. Seoane and Rhoton quantified the exposure of Meckel's cave, finding that this approach allowed access, on average, to the posterior 10.3 mm of Meckel's cave.3 This was confirmed by Chanda and Nanda who found that suprameatal drilling resulted in a mean gain of exposure of the trigeminal nerve of 10.7 mm.4 In this video, we present the case of a patient when an enlarging petrous apex meningioma with extension into Meckel's cave (Fig. 1). The patient underwent a retrosigmoid intradural suprameatal approach to achieve a Simpson's grade II resection. This approach was ideally suited for this case to obtain access to tumor located at the petrous apex and within Meckel's cave (Fig. 2). Without access to Meckel's cave provided in this approach a significant portion of tumor would have remained in situ.

The link to the video can be found at: https://youtu.be/eNldkF4a_OI.
Microsurgical Reconstruction of the Plantar Foot: Long-Term Functional Outcomes and Quality of Life
Authors: Heidekrueger Paul , Ehrl Denis , Prantl Lukas , Thiha Aung , Weinschenk Fabian , Forte Antonio , Ninkovic Milomir , Broer P.
Published: January 2019

Background When faced with plantar defects, reconstruction of the weight-bearing areas presents unique surgical challenges. Several free flap modalities have been described in this respect, but there remains debate regarding the best-suited flap modality. Aim of this study was to compare free muscle and non-neurotized fasciocutaneous flaps for plantar reconstruction with respect to long-term functional outcomes.

Methods Overall, 89 patients received 100 free flaps (anterolateral thigh [ALT] n = 46; gracilis n = 54) for plantar reconstruction. The data were screened for patients' demographics, as well as perioperative details. Postoperative complications were accounted for and the two groups compared accordingly. All patients were contacted for a long-term follow-up examination.

Results There were no significant differences between the two groups regarding major (24 vs. 17%; p = 0.366) and minor surgical complications (61 vs. 70%; p = 0.318). However, the ALT group showed a significantly higher need for secondary surgeries (39 vs. 19%; p = 0.022). Sixty-eight patients (76%) returned for long-term follow-up evaluation (mean: 51.2 months, range: 13–71 months). The ALT group showed significantly less pain at the recipient (p = 0.0004) and donor (p = 0.010) sites, and scar assessment revealed significantly better results (p < 0.001). Additionally, the ALT group showed better depth (p = 0.017) and superficial (p = 0.007) sensation and enabled better shoe provision (p = 0.014).

Conclusion Both the free ALT and gracilis flaps are well suited for plantar reconstruction, yielding overall similar functional outcomes. However, the ALT flap produces less scarring and pain, while showing better recovery of sensation and enabling better shoe provision. The ALT flap thus presents our preferred option.
Telemedizin in der Therapieeinleitung schlafbezogener Atmungsstrungen
Authors: Woehrle Holger , Ficker Joachim H.
Published: January 2019

Der derzeitige Standard in Deutschland ist, dass die PAP-Therapie im Schlaflabor unter polysomnographischer Überwachung eingeleitet wird. Anschließend werdennach ungefähr 6 Wochen eine ambulante klinische Kontrolle, eventuell zusätzlich mit einer ambulanten Polygraphie sowie weitere jährliche Kontrollen empfohlen (1). Des Weiteren gibt es die Möglichkeit, die PAP-Therapie durch Analyse der im Gerät gespeicherten Daten zu verfolgen und gegebenenfalls zu optimieren. Je nach Gerätehersteller werden im Therapiegerät verschiedene Therapiedaten gespeichert (Anwendungsdauer, Anwendungsmuster, residuelle Atmungsstörungen gesamt/differenziert, Leckagen, Befeuchteranwendung, Druckverlauf), wobei keine einheitliche Validierung für einige dieser Informationen vorliegt.
Online-Schlafberatung für Schichtarbeitende
Authors: Peter Lukas , Reindl Richard , Zauter Sigrid , Richter Kneginja
Published: January 2019

Jeder sechste deutsche Beschäftigte ist in Schichtarbeit tätig. Angebote für die spezifische Problematik von Schichtarbeitenden sind dennoch selten. Eine kompakte Online-Schlafberatung wurde daher entwickelt, durchgeführt und evaluiert. Es zeigen sich signifikante Verbesserungen bezüglich Insomniesymptomen und Wohlbefinden.
Sport als Therapie im klinischen Alltag
Authors: Suhr R. , Spamer M.
Published: January 2019

Abhängig von der Krankheitsphase sollten sportliche Aktivitäten in die Physiotherapie einbezogen werden. Nach eingehender Untersuchung werden Therapieziele und die Behandlung auch im Hinblick auf bisher ausgeübte oder geplante Sportarten festgelegt. Neben dem Verbessern von Beweglichkeit und Gelenkachsen, können ab dem inaktiven Krankheitsstadium gezielt Bewegungsfolgen und Kraftfähigkeiten für die jeweilige Sportart trainiert werden. Direkter Bestandteil der Therapie sind sportliche Aktivitäten wie Klettern, Medizinische Trainingstherapie, Hippound Reittherapie, Wing Tsun, Jonglieren oder das Bewegungsbad. Andere Angebote wie z. B. Yoga, Tanzen, Nordic Walking oder Fußballtechniktraining dienen dem Ausprobieren für eine sportliche Aktivität zu Hause. Ob eine Klinik oder Ambulanz einen Sportkurs für die dauerhafte Teilnahme anbieten kann oder zeitlich kurzbefristete Sportangebote schafft, hängt auch von der Größe des Einzugsbereichs der Patienten ab. Ein breites Repertoire an Bewegungsprogrammen ist im Sinne der kindlichen Individualität und Komplexität chronischer (rheumatischer) Erkrankungen in jedem Fall sinnvoll. Viele dieser Angebote lassen sich jedoch nur mit Hilfe von wohltätigen Organisationen umsetzen, deren finanzielle Unterstützung daher auch für zukünftige Projekte hochgradig bedeutend ist.
Arthrogene Muskelinhibition und ihre
Bedeutung
Authors: Keller Karsten , Engelhardt Martin
Published: January 2019

Besonders nach Knieverletzungen oder -operationen ist auffällig, wie schwach die
das Kniegelenk umgebende Muskulatur ist. Für die Schwäche der Muskulatur ist
nicht nur eine Muskelatrophie verantwortlich, sondern auch der neuronale Prozess
der arthrogenen Muskelinhibition (AMI). Die Autoren beschreiben, welche
Mechanismen zu einer AMI führen und welche Auslöser bekannt sind.
The Impact of Age on Perioperative Complications after Extremity Reconstruction with the Free Gracilis Flap: A Retrospective Cohort Study Involving 153 Patients
Authors: Weitgasser Laurenz , Amr Amro , Hladik Michaela , Wechselberger Gottfried , Daigeler Adrien , Schoeller Thomas , Medved Fabian
Published: January 2019

Background The need for plastic and reconstructive surgery on elderly patients has been on the rise due to an increase in life expectancy in the past decades. Therefore, a study was conducted on young and elderly patients following microsurgical extremity reconstructions with free gracilis muscle flaps with the primary aim to investigate the influence of age and the American Society of Anesthesiologists (ASA) score on the general outcome, as well as surgical and medical complications.

Methods A retrospective analysis of 153 patients receiving free gracilis muscle flaps for extremity reconstructions between November 2009 and January 2018 was performed at two partner institutions specialized in microsurgical reconstructions. A logistic regression analysis was performed to correlate age and the ASA score with postoperative complication probability. Patients younger than 70 years were directly compared with elderly patients with respect to age, gender, ASA score, preexisting comorbidities, localization, and postoperative medical and surgical complications.

Results Age turned out to be not significantly associated with major flap complications (p = 0.925) but with higher ASA scores (p = 0.016). However, an age-related significant increase in minor flap complications could be observed in the elderly (p = 0.008). A significant correlation between minor medical complications and age could be observed (p = 0.001) in contrast to ASA score (p = 0.912).

Conclusion An increased minor flap, as well as minor and major medical complications, must be expected in extremity reconstructions with free gracilis flaps in elderly patients. Higher ASA scores correlate with a higher incidence of major flap complications. Septuagenarians are more prone to develop perioperative major medical complications than patients younger than 70 years. Age and general medical condition, coupled with the performance of each patient, should be thoroughly assessed individually to facilitate a tailored reconstructive approach using risk assessment tools and established scoring systems.
Wide Pulse Pressure Is Not Associated with Patent Ductus Arteriosus in the First Week of Life
Authors: Bin-Nun Alona , Kasirer Yair , Mimouni Francis , Schorrs Irina , Fink Daniel , Hammerman Cathy
Published: January 2019

Objectives Widened pulse pressure is generally associated with patent ductus arteriosus (PDA). Surprisingly, this is often not true for preterm infants during the first week of life when systolic and diastolic pressures are both reduced and pulse pressure may remain unchanged.

Study Design This is a retrospective, observational review of individual blood pressure (BP) parameters preterm neonates <30 weeks' gestational age during the first week of life as correlated with ductal patency and severity.

Results Sixteen preterm neonates had a closed ductus on initial echocardiogram during the first week of life; 30 had a PDA that was open but hemodynamically insignificant; and 16 were found to have a hemodynamically significant PDA. Pulse pressure showed no correlation (p = 0.266) with the degree of ductal patency, whereas diastolic BP was best correlated with ductal severity (p < 0.001).

Conclusion We found that low diastolic pressures are better correlated with ductal patency and severity than is pulse pressure in preterm neonates during the first week of life.
Impact of Capnoperitoneum on Renal Perfusion and Urine Production in Infant and Adolescent Pigs: Crystalloid versus Colloid Fluid Resuscitation
Authors: Schukfeh Nagoud , Huber Dirk , Metzelder Martin L. , Vieten Gertrud , Keil Oliver , Dennhardt Nils , Suempelmann Robert , Ure Benno M. , Kuebler Joachim F.
Published: January 2019

Background Infants are likely to develop anuria during laparoscopy which is uncommon in older patients. The reason for this susceptibility remains unknown. We compared the impact of CO2 pneumoperitoneum on renal perfusion and urine production in piglets compared with adolescent pigs. We furthermore investigated the effects of different resuscitation strategies.

Materials and Methods Male piglets (n = 21) were divided into four groups: (a) infant controls (n = 5), (b) infants with crystalloid restitution (n = 6), (c) infants with colloidal restitution (n = 5), and (d) adolescents with crystalloid restitution (n = 5). Animals were ventilated, the central vessels and ureters were cannulated, and the animals were subjected to a 3-hour, 10 mm Hg CO2 pneumoperitoneum followed by 2-hour resuscitation. Renal perfusion was assessed by fluorescent microspheres and the rate of urine flow was measured.

Results Urine production significantly decreased after insufflation only in the infant crystalloid and adolescent group, but not in controls or infants treated with colloids. In the infant crystalloid group, urine production remained at levels below 20% of baseline throughout the experiment. In this group, the renal perfusion dropped significantly after the beginning of the capnoperitoneum and remained significantly reduced throughout the experiment.

Conclusion Our data indicates that capnoperitoneum impairs renal perfusion and urine production in infants. In moderate-pressure capnoperitoneum, this effect cannot be compensated by application of crystalloids but with colloids.
Management of Chronic Infected Intra-Articular Fractures of the Proximal Tibia with Ilizarov Ring Fixation
Authors: Bhowmick Kaushik , Boopalan P.R.J.V.C. , Gunasekeran Chandrasekaran , Livingston Abel , Jepegnanam Thilak Samuel
Published: January 2019

Infected nonunion and malunion of tibial plateau are rare injuries with no standardized protocols for treatment. This study assessed the outcome of chronic infected intra-articular proximal tibial fractures with and without metaphyseal bone loss managed with the Ilizarov ring fixator. A series of six patients of intra-articular infected nonunion of the tibial plateau and two patients with malunited plateau with metaphyseal nonunion were treated in a tertiary care hospital. Three of these eight patients had a metaphyseal bone loss or bone gap after debridement and underwent internal transport with distal corticotomy to obtain the bone length. The remaining five patients underwent static ring fixation after correction of the articular deformity. Clinical evaluation was done by Knee Society Score, Rasmussen radiological and Association for the Study and Application of Methods of Ilizarov scores. All patients but one achieved union with the ring fixator. The average follow-up was 33 months (range, 12–120 months). Average time to achieve union was 11.5 months (range, 3–30). The scores were good in four patients and poor in the rest four, out of which three had undergone internal transport. Proximal tibia intra-articular infected nonunion and malunion with or without metaphyseal bone loss can be treated successfully with the Ilizarov fixator. Malunion of the tibial plateau has to be addressed in cases with varus alignment of the limb or articular step-off of ≥ 5mm between the two tibial surfaces. Patients with associated metaphyseal bone loss tend to have complications and take a longer duration to heal. Single-stage treatment avoids intra-articular malunion and loss of limb alignment.
The Role of Low Molecular Weight Heparins for Venous Thromboembolism Prevention in Medical Patients—What Is New in 2019?
Authors: Haas Sylvia
Published: January 2019

Low molecular weight heparins and fondaparinux have been the cornerstones for prevention of venous thromboembolism (VTE) in acutely ill medical patients for almost two decades. Guidelines recommend the use of these parenteral anticoagulants for 6 to 14 days but advise against extended-duration thromboprophylaxis after hospital discharge because no compelling scientific evidence has been provided for pharmacological prophylaxis beyond hospital stay. Five large randomized clinical trials, one with low molecular weight heparin and four with nonvitamin K antagonist oral anticoagulants, have failed to show significant clinically relevant benefit in this indication. Obviously, the development of VTE is more complex in medical patients than in patients undergoing major surgical procedures. Thus, it can be expected that guideline recommendations for VTE prevention with low molecular weight heparins or fondaparinux in medical patients will remain unchanged in 2019.
Conservative Treatment of an Intra-Articular Shear Fracture of the Ulnar Head
Authors: Miyamoto Hideaki , Sasaki Gen , Kurozumi Taketo , Watanabe Yoshinobu
Published: January 2019

Background Isolated intra-articular fracture of the ulnar head is rare.

Case Description A 59-year-old woman experienced an ulnar head fracture involving the distal radioulnar joint after a fall at ground level. The intra-articular fragment of the ulnar head was rotated into anatomical alignment with an above-elbow cast in 90° of supination for 4 weeks. A below-elbow night splint was retained for 2 additional weeks. Twelve months post-injury, full active motion and bone union were achieved.

Literature Review Only three studies have reported treatment of isolated intra-articular ulnar head fractures, and in all cases open reduction and internal fixation were performed.

Clinical Relevance Our report demonstrated good results for the conservative treatment of an intra-articular ulnar head shear fracture, with early recovery of forearm rotation and wrist function.
Postoperative Complications and Impact of Diabetes Mellitus Severity on Revision Total Knee Arthroplasty
Authors: Gu Alex , Wei Chapman , Robinson Hannah N. , Sobrio Shane A. , Liu Jiabin , Sculco Thomas P. , Sculco Peter K.
Published: January 2019

Total knee arthroplasty (TKA) is a common and effective treatment of knee osteoarthritis. As the amount of TKAs performed increases, so does the number of TKA failures and subsequent revisions. Diabetes mellitus (DM) has been shown to increase complications following orthopaedic procedures. For these reasons, it is important to understand the association between severity of DM and the risk of postoperative adverse events following revision TKA. A retrospective cohort study was conducted using the American College of Surgeons' National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2007 and 2016 were identified and recorded as having noninsulin-dependent DM (NIDDM), insulin-dependent DM (IDDM), or no DM. Univariate and multivariate analysis were used to evaluate the incidence of multiple adverse events within 30 days after revision TKA. A total of 13,246 patients who underwent revision TKA were selected (without DM = 10,381 [78.4%]; NIDDM = 1,890 [14.3%]; IDDM = 975 [7.4%]). Patients with NIDDM were found to have an increased risk of developing renal insufficiency and urinary tract infection (UTI) compared with patients without DM, while patients with IDDM were found to have an increased risk of developing 10 of 20 adverse events compared with patients without DM. NIDDM is an independent risk factor for UTI and IDDM is an independent factor for development of three complications compared with no DM. Insulin dependency is an independent factor for septic shock, postoperative blood transfusion, and extended postoperative hospital stay. Relative to patients with NIDDM, those with IDDM have a greater likelihood of developing more adverse perioperative outcomes than patients without DM. Although complication rates remain relatively low, orthopaedic surgeons must consider the implications of diabetes and insulin dependence on patient selection, preoperative risk stratification, and postoperative outcomes.
Lobuläres vs. duktales Mammakarzinom
Authors: Heim Thomas
Published: January 2019

Lobuläre Karzinome machen etwa 10–15 % aller Mammakarzinome aus und sind somit der zweithäufigste Brustkrebstyp nach dem intraduktalen Karzinom. Der histologische Typ scheint sich auf die Prognose und auf das Therapieansprechen auszuwirken. Allerdings gibt es dazu noch keine prospektive Studien.
Zweitlinientherapie beim Multiplen Myelom
Authors: Krome Dr. med. Susanne
Published: January 2019

Die Internationale Arbeitsgruppe Multiples Myelom (IMWG) empfiehlt beim ersten Rezidiv eine umgehende Behandlung nur, wenn ein symptomatisches Rezidiv vorliegt. Bei einem ausschließlich biochemischen Rezidiv – rasch steigende Paraproteine oder extramedullärer Befall – rät sie zu einem beobachtenden Verhalten. Die Real-Life-Studie LEGEND kommt zu einem anderen Schluss: Patienten mit biochemischem Rezidiv profitierten von Lenalidomid plus Dexamethason mit einem längeren medianen progressionsfreien Überleben (PFS) als bei einem symptomatischen Rezidiv.
Multiples Myelom
Authors: Krome Dr. Susanne
Published: January 2019

Ein Metabolom umfasst die Gesamtheit der Stoffwechseleigenschaften von Zellen. Bislang war wenig über ein spezifisches metabolisches Muster von Myelomzellen bekannt. Die Studie belegt Unterschiede zu gesunden Kontrollen. Die Abgrenzung inner-halb der Myelom-Patientenpopulation war weniger markant.
Kolorektales Karzinom
Authors: Krome Dr. Susanne
Published: January 2019

Die Fortschritte in Diagnostik und Therapie haben die Prognose kolorektaler Karzinome verbessert. Die Frage nach den sichersten Screeningintervallen bleibt. In der randomisierten Studie erfolgte bei Patienten im Stadium II und III postoperativ ein hochoder niedrigfrequentes Screening. Die häufigeren Verlaufskontrollen hatten allerdings keine Vorteile hinsichtlich ihres Überlebens und der Rezidivrate.
Immuntherapie des fortgeschrittenen NSCLC
Authors: Kretzschmar Dr. Alexander
Published: January 2019

Patienten mit einem nicht-kleinzelligen Lungenkarzinom (NSCLC), die vor dem Beginn einer anti-PD-1/PD-L1-Therapie Steroide in einer Dosis ≥ 10 mg/d Prednisonäquivalenten erhielten, hatten einen signifikant schlechteren Outcome hinsichtlich der Responserate (Hazard Ratio [HR] 1,3; p = 0,03), dem medianen progressionsfreien Überleben (PFS) und Gesamtüberleben OS (HR 1,7; p < 0,001). Dies ergab eine große retrospektive Auswertung von Real-World-Daten aus zwei Therapiezentren.
Molekularbiologie
Authors: Krome Dr. Susanne
Published: January 2019

Zehntausende nichtproteinkodierende RNAs haben die Kenntnisse über die normale Physiologie sowie die Entstehung und Behandlung von Krankheiten auf den Kopf gestellt, schreibt Prof. Frank Slack, Harvard Medical School, Boston/USA, im New England Journal of Medicine über den überwiegenden Teil unseres Genoms. Diese RNA-Sub typen regulieren Wachstum, Entwicklung und Organfunktion. Ihre Gewebespezifität eröffnet neue, unerwartete Möglichkeiten in der Onkologie. Der größte Teil ihrer Funktionen ist allerdings noch nicht erforscht.
Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma
Authors: Tolisano Anthony , Hunter Jacob
Published: January 2019

Despite no universally accepted definition of hearing preservation following vestibular schwannoma (VS) treatment, numerous variables have been identified as possible factors that may affect hearing outcomes following radiotherapy. Age, pretreatment hearing, radiation dose, tumor location and size, length of follow-up, fractionation, and timing of radiation have all been explored, among other variables, as factors related to hearing outcomes following radiation. These variables and associated hearing outcomes will be explored in detail, summarizing the literature to date to improve patient counseling for those patients who present with serviceable hearing and are considering their VS management options.