Painful total hip replacement due to sciatic nerve entrapment in scar tissue and lipoma

Painful total hip replacement remains a challenging problem because of the large amount of possible diagnoses. We report about a 64-year-old female patient who was misdiagnosed during 4years as psychiatric. She suffered of excruciating left retrotrochanteric pain after the implantation of a cementless total hip replacement and revision because of recurrent hip dislocations. Walking was limited to short distances using two crutches. The work-up at this time included the usual diagnoses and remained unsuccessful. No loosening, infection or malposition of the prosthesis could be found, and she had no neurologic deficits in her operated leg. An MRI was obtained to visualize the retrotrochanteric soft tissues and showed a tight scar surrounding the sciatic nerve, which was also compressed by an adjacent lipoma. Therefore, she was reoperated on to remove the lipoma and the scar tissue around the sciatic nerve. To decrease the risk of recurrent scarring around the sciatic nerve, an adhesion barrier was applied before closure. One year after the operation, the patient has no neurologic deficit, no more pain and is able to walk unlimited distances without crutches. Scar tissue around the sciatic nerve is frequently observed during revision surgery. However, we feel that sciatic nerve entrapment by scar tissue should be a part of the differential diagnosis of painful THR. MRI may be a useful tool to achieve this diagnosi

Gerdy tubercle osteotomy in surgical approach of posterolateral corner of the knee

Posterolateral corner (PLC) injuries of the knee are uncommon injury patterns that may result in significant degrees of functional disability. When surgery is necessary to address this injury a good knowledge of anatomy and a good surgical exposure is the mainstay. This report reviews the complex anatomy of the posterolateral corner (PLC) of knee and describes the osteotomy of Gerdy tubercle as a technical variant to approach this anatomical region. This surgical step allowing a good mobilisation of the multiple layers of ilio-tibial tract from distal to proximal makes an excellent exposure of the PLC structures with absence of morbidit

Vitamin E-Gehalt der Kuhmilch in Abhängigkeit von der Grasfütterung im Tal und auf alpinen Weiden

Jeweils sechs laktierende Brown Swiss Kühe erhielten entweder reine Weidefütterung, reine Grünfütterung im Stall oder eine konventionelle Silage-Kraftfutter Vergleichsration. Dies wurde nacheinander für jeweils 42 Tagen an einem raigrasreichen Talstandort (400 m) und auf einer extensiven artenreichen Alpweide (2000 m) durchgeführt. Die Konzentration an Tocopherolen (Vitamin E)in der Milch wurde mittels HPLC bestimmt. Die Vitamin E-Konzentrationen waren in den grasbasierten gegenüber den aus der Vergleichsration stammenden Milchproben generell deutlich erhöht. Einen weiteren geringen Zusatzeffekt für den Tocopherolgehalt der Milch brachte die Alpweide, wobei jedoch aufgrund der geringeren Milchleistung die tägliche Menge an mit der Milch sekretiertem Vitamin E geringer war als auf der Talweide

Artenreiches Rauhfutter als Alleinfutter und Fettsäurenmuster der Milch

In two experiments it was investigated which factors to what extent determine the fatty acid composition milk when cows are grazing high alpine pastures. The influences of altitude per se, of alpine forage quality, of concentrate-free diet type and of the overall grazing effect were separated by the experimental design. The most important factor which significantly elevated the concentrations of CLA, α-linolenic acid (ALA) and n-3 PUFA in milk fat was found to be the alpine diet type, i.e. the feeding of roughage-only (as well hay as pasture of as well lowland as alpine origin) with omission of concentrates and maize. Additionally a clear positive effect of the forage quality of alpine pastures on ALA concentration in milk fat was found. The latter effect is assumed to be linked to specific plant ingredients (eg. tannins) and to the low energy density of the alpine flora, which may influence the ruminal biohydrogenation of native ALA. An effect of altitude per se (hypoxia) was not found

Effect of Red and White Clover Added to a Rye Grass-Based Diet on Intake, Fibre Digestion and Methane Release of Dairy Cows

Forage legumes like white and red clover are widely grown in association with grass, with the intention to improve the quality of grass-based diets. However little is known about the effect of either white or red clover added to a grass-based diet on methane release, and existing studies are not conclusive. The objective of this study, applying the respiratory chamber technique, was to determine the effect of red and white clover added to a rye grass-based diet on intake, fibre digestion and methane release of dairy cows

A new conservative-dynamic treatment for the acute ruptured Achilles tendon

Introduction: There is a trend towards surgical treatment of acute ruptured Achilles tendon. While classical open surgical procedures have been shown to restore good functional capacity, they are potentially associated with significant complications like wound infection and paresthesia. Modern mini-invasive surgical techniques significantly reduce these complications and are also associated with good functional results so that they can be considered as the surgical treatment of choice. Nevertheless, there is still a need for conservative alternative and recent studies report good results with conservative treatment in rigid casts or braces. Patients/method: We report the use of a dynamic ankle brace in the conservative treatment of Achilles tendon rupture in a prospective non-randomised study of 57 consecutive patients. Patients were evaluated at an average follow-up time of 5years using the modified Leppilahti Ankle Score, and the first 30 patients additionally underwent a clinical examination and muscular testing with a Cybex isokinetic dynamometer at 6 and 12months. Results: We found good and excellent results in most cases. We observed five complete re-ruptures, almost exclusively in case of poor patient's compliance, two partial re-ruptures and one deep venous thrombosis complicated by pulmonary embolism. Conclusion: Although prospective comparison with other modern treatment options is still required, the functional outcome after early ankle mobilisation in a dynamic cast is good enough to ethically propose this method as an alternative to surgical treatmen

A study on the causes for the elevated n−3 fatty acids in cows' milk of alpine origin

The influence of grass-only diets either from rye-grass-dominated lowland pastures (400 m above sea level) or botanically diverse alpine pastures (2000 m) on the FA profile of milk was investigated using three groups of six Brown Swiss cows each. Two groups were fed grass-only on pasture (P) or freshly harvested in barn (B), both for two experimental periods in the lowlands and, consecutively, two periods on the alp. Group C served as the control, receiving a silage-concentrate diet and permanently staying in the lowlands. Effects of vegetation stage or pasture vs. barn feeding on milk fat composition were negligible. Compared with the control, α-linoleic acid (18∶3n−3) consumption was elevated in groups P and B (79%, P<0.001) during the lowland periods but decreased on the alp to the level of C owing to feed intake depression and lower 18∶3n−3 concentration in the alpine forage. Average 18∶3n−3 contents of milk fat were higher in groups, P and B than in C by 33% (P<0.01) at low and by 96% (P<0.001) at high altitude, indicating that 18∶3n−3 levels in milk were to some extent independent of 18∶3n−3 consumption. The cis-9,trans-11 CLA content in milk of grass-fed cows was higher compared with C but lower for the alpine vs. lowland periods whereas the trans-11, cis-13 isomer further increased with altitude. Long-chain n−3 FA and phytanic acid increased while arachidonic acid decreased with grass-only feeding, but none of them responded to altitude. Grass-only feeding increased milk α-tocopherol concentration by 86 and 134% at low and high altitude (P<0.001), respectively. Changes in the ruminal ecosystem due to energy shortage or specific secondary plant metabolites are discussed as possible causes for the high 18∶3n−3 concentrations in alpine mil

Gender-specific ischemic tissue tolerance in critically perfused skin

Purpose: The purpose of this study is to determine gender-specific differences in the development of necrosis in persistent ischemic tissue and to analyze whether differences are due to gender-specific loss of vascular reactivity or change in ischemic tolerance. Methods: Hairless mice (skh-1) of both genders were assigned to three groups of adolescent, adult, and senescent age. Critical ischemia was induced by transection of the two distal pedicles of the animal's ear. Microcirculation was assessed over a 5-day period using intravital epifluorescence microscopy. Tissue necrosis, blood flow, functional capillary density (FCD), red blood cell (RBC) velocity, and capillary diameter were analyzed. Results: Induction of persistent ischemia caused an age-dependent demarcation of nonperfused flap tissue. Adult and senescent females developed markedly more necrosis than age-matched males (49 ± 1% vs. 37 ± 3% and 53 ± 3% vs. 44 ± 2%, respectively; p < 0.05), whereas no gender-specific difference in flap necrosis was observed in adolescent animals (31 ± 2% vs. 33 ± 3%). Gender did not affect the amount of microcirculatory dysfunction in the flap. Thus, age-matched females and males exhibited a comparable decrease of FCD, RBC velocity, and capillary dilatory response. Conclusions: Both age and female gender may predispose for an increased susceptibility to develop ischemic tissue necrosis. The increased necrosis in female animals does not apply to an aggravated microvascular dysfunction, but rather to a reduced ischemic tissue toleranc

Anterior subluxation after reduction of a posterior traumatic sterno-clavicular dislocation: a case report and a review of the literature

Sternoclavicular dislocations represent a rare injury. Based on our clinical experience with a patient showing an anterior subluxation after reduction of a posterior traumatic dislocation, we review the literature. The emergent reduction of the dislocation is mandatory, always keeping in mind the potentially devastating neurovascular complications. If the treatment of a residual anterior instability remains controversial, a residual posterior instability should be treated by a surgical procedure. The optimal treatment depends mainly on each surgeon's choice and practic

Selective blockade of endothelin-B receptor improves survival of critically perfused musculocutaneous flaps

Background and aims: Insufficient perfusion of distal flap areas, which may lead to partial necrosis, still represents a challenge in reconstructive surgery. In the process of microvascular and endothelial dysfunction, endothelins (ETs) and their receptors may play an important role. Therefore, the aim of the study was to investigate in a chronic in vivo model the effect of various ET-receptor antagonists in critically perfused flap tissue. Materials and methods: A random pattern musculocutaneous flap was elevated in the back of 25 C57BL/6 mice and fixed into a dorsal skinfold chamber. Repetitive intravital fluorescence microscopy was performed over a 10-day observation period, assessing arteriolar diameter, arteriolar blood flow (aBF), functional capillary density (FCD), the area of tissue necrosis, and the development of newly formed blood vessels. ET-receptor blockers were administrated intraperitoneally 30min before induction of ischemia, as well as daily during the subsequent 4-day period, including (1) BQ-123, a specific ET-A-receptor antagonist (ET-A = 1mg/kg), (2) BQ-788, a selective ET-B-receptor antagonist (ET-B = 1mg/kg), and (3) PD-142893, a nonselective ET-AB-receptor antagonist (ET-AB = 0.5mg/kg). Animals receiving saline only served as controls (n = 7). Results: Despite an increase in aBF during the 10-day observation period (day 1 = 1.92 ± 0.29nl/s; day 10 = 4.70 ± 1.64nl/s), the flaps of saline-treated controls showed a distinct decrease in FCD (94 ± 12cm/cm2). This perfusion failure resulted in flap necrosis of 52 ± 3%. Selective blockade of the ET-B receptor caused a further increase in aBF already at day 1 (2.97 ± 0.42nl/s), which persisted during the following 10-day observation period (day 10 = 5.74 ± 0.69nl/s). Accordingly, adequate FCD could be maintained (day 10 = 215 ± 8cm/cm2; p < 0.05 vs control), resulting in a significant reduction in flap necrosis (day 10 = 25 ± 4%; p < 0,05). In contrast, neither selective blockade of the ET-A receptor nor nonselective ET-A- and ET-B-receptor blockade were able to significantly affect aBF when compared to controls (day 1 = ET-A = 1.39 ± 0.10nl/s; ET-AB = 1.53 ± 0.80nl/s; n.s.). Accordingly, flap necrosis after ET-A- and ET-AB-receptor inhibition did not differ from that of controls (day 10 = ET-A: 46 ± 10%; ET-AB = 51 ± 7%). Conclusion: Our data show that only selective ET-B-receptor inhibition is capable of maintaining nutritive perfusion and, hence, reducing necrosis in critically perfused flap tissue. Accordingly, administration of ET-B-receptor antagonists may be considered in the treatment of critically perfused flap