Retrospektive Analyse zum onkologischen Patientengut (1992 – 2001) der Hals-, Nasen-, Ohrenklinik im Kenyatta National Hospital, Nairobi, Kenia

Das Kenyatta National Hospital (KNH) ist das Gesundheitszentrum, zu dem die Kenianer und teilweise auch Kranke aus den benachbarten Ländern kommen, wenn den Ärzten in den so genannten District Hospitals die Möglichkeiten zur weiteren Diagnostik und Behandlung fehlen. Es gibt es enorme Probleme, die so große Anzahl von Patienten zu versorgen. Das liegt zum einen an organisatorischen Defiziten, zum anderen an mangelnden Personal-, Material- und Platzressourcen. Nicht selten sterben Patienten allerdings, bevor sie von einem Arzt aufgenommen werden können. Dies gilt auch für Patienten mit fortgeschrittener Krebserkrankung. Ziel der vorliegenden Dissertation war eine erstmalige Datenerhebung zum onkologischen Patientengut der Abteilung für Hals-, Nasen- und Ohrenheilkunde am KNH Nairobi, vorgenommen im Rahmen eines Kooperationsprojektes mit der Marburger Univ.-HNO-Klinik. In diesem Rahmen sollte zudem die Infrastruktur der HNO-Abteilung hinterfragt werden, die über 40 Betten verfügt und im KNH der Chirurgischen Klinik unterstellt ist. Für die vorliegende Arbeit wurden 443 Akten von Patienten mit malignen Tumorerkrankungen im HNO-Bereich aus den Jahren von 1992–2001 erfasst und die erhobenen Daten anhand eines eigens entworfenen Fragebogens verschlüsselt und ausgewertet. In dem untersuchten Patientengut waren 75,6 % Männer. Der Altersdurchschnitt aller Patienten lag bei 48 Jahren (Standardabweichung ± 18,4 Jahre). Die malignen Tumoren waren wie folgt lokalisiert: 44,7 % im Epipharynx, 25,1 % im Larynx, 7,5 % im Hypopharynx, 5,6 % im Oropharynx und 5,4 % im Ösophagus. Insgesamt 11,7 % der 443 Patienten waren an einem an anderer Stelle lokalisierten Malignom erkrankt. Zur TNM-Klassifikation ist anzumerken, dass die Erstdiagnose in 75 % der Fälle im fortgeschrittenen Stadium (T3 und T4) gestellt wurde. In 23,9 % der Fälle wurde die Tumorgröße mit T1 und T2 angegeben. Die Symptome bestanden im Mittel schon 26 Wochen vor dem ersten Arztbesuch. Die bis zur Diagnosestellung benötigte Zeit lag im KNH im Median bei 13 Tagen. Die maligne Tumorerkrankung wurde in 81,9 % der Fälle durch Biopsie und histopathologische Begutachtung verifiziert. In 11,1 % der Fälle wurde die Diagnose nur durch Inspektion und Palpation gestellt und in 3,8 % anhand spezieller Bildgebung. Die histopathologische Begutachtung wurde im einzigen öffentlichen Pathologischen Institut Kenias im KNH vorgenommen. 53 % der Patienten mit Biopsieergebnis wiesen ein Plattenepithelkarzinom auf, 39,5 % ein lymphoepitheliales Karzinom. Ein hoher Anteil von 27,1 % der 443 onkologischen Patienten wurde ohne Therapie wieder entlassen. Der häufigste Grund hierfür waren die finanziellen Nöte der Patienten. Der Staat übernahm die Kosten für die Behandlung erst nach erwiesener Zahlungsunfähigkeit der gesamten Großfamilie, ein Nachweis, die teilweise außerordentlich schwierig zu stellen ist. Um Kosten zu sparen, wurde die Versorgung der Patienten mit Lebensmitteln und frischer Wäsche meist von den Angehörigen übernommen. Von den verbleibenden 323 Patienten wurden 79,9 % einer Strahlentherapie zugeführt, 11,1 % wurden operiert, 4,6 % der Patienten erhielten eine Chemotherapie und bei 4,4 % der Patienten wurde eine kombinierte Radiochemotherapie vorgenommen. Nachsorgeuntersuchungen wurden im KNH wegen fehlender Kapazitäten, hoher Kosten für die Patienten und organisatorischer Probleme in nur 54,8 % der therapierten Fälle durchgeführt. Die mit der vorliegenden Arbeit erstmals vorgenommene Datenerfassung zum onkologischen Patientengut der HNO-Abteilung am KNH in Nairobi kann dazu beitragen, die gemeinsam mit der Marburger Universitäts-HNO-Klinik angestrebte weitere, auch interdisziplinär vorzunehmende Optimierung im Diagnostik- und Behandlungsablauf voranzutreiben. Während finanzielle Probleme auf diesem Wege kaum nachhaltig verbessert werden können, sind es zunächst organisatorische Abläufe, die es tiefergehend zu hinterfragen gilt. Eine Fortsetzung der Erfassung statistischer Daten ermöglicht zudem die erstmalige Erstellung prognostisch relevanter Überlebenskurven

An infrared, Raman, and X-ray database of battery interphase components

Further technological advancement of both lithium-ion and emerging battery technologies can be catalyzed by an improved understanding of the chemistry and working mechanisms of the solid electrolyte interphases (SEIs) that form at electrochemically active battery interfaces. However, collecting and interpreting spectroscopy results of SEIs is difficult for several reasons, including the chemically diverse composition of SEIs. To address this challenge, we herein present a vibrational spectroscopy and X-ray diffraction data library of ten suggested SEI chemical constituents relevant to both lithium-ion and emerging battery chemistries. The data library includes attenuated total reflectance Fourier transform infrared spectroscopy, Raman spectroscopy, and X-ray diffraction data, collected in inert atmospheres afforded by custom designed sample holders. The data library presented in this work (and online repository) alleviates challenges with locating related work that is either diffusely spread throughout the literature, or is non-existent, and provides energy storage researchers streamlined access to vital SEI-relevant data that can catalyse future battery research efforts.Comment: JML and RK jointly supervised this work. 26 pages, 8 figures, 8 table

Proximal interphalangeal joint replacement with an unconstrained pyrocarbon prosthesis (Ascension(R)): a long-term follow-up

There have been limited publications that report long-term outcomes of pyrocarbon implants. This report describes both clinical and radiographic long-term results for patients who have been treated with pyrocarbon proximal interphalangeal implants. Thirteen implants in ten patients are reported for an average follow-up of 8.3 years (range 6.2–9.3). All patients were suffering from degenerative joint disease. Five of the 13 digits were free of pain, the remaining eight digits had mild to moderate pain (visual analogue scale 2–5). The average active range of motion was 58° (SD 19°) at latest examination. X-ray results were unremarkable in six digits with an acceptable position of the prosthesis. However, in seven patients significant radiolucent lines (≥ 1 mm) were observed. Three prostheses demonstrated a migration of the proximal component, and one a subsidence of the distal component. Our study does not support the use of this implant for treatment of osteoarthritis of the finger joint owing to high complication rates and limited range of motion

Native femoral anteversion should not be used as reference in cementless total hip arthroplasty with a straight, tapered stem: a retrospective clinical study

Backround: Improper femoral and acetabular component positioning can be associated with instability, impingement, component wear and finally patient dissatisfaction in total hip arthroplasty (THA). The concept of "femur first"/" combined anteversion", incorporates various aspects of performing a functional optimization of the prosthetic stem and cup position of the stem relative to the cup intraoperatively. In the present study we asked two questions: (1) Do native femoral anteversion and anteversion of the implant correlate? (2) Do anteversion of the final broach and implant anteversion correlate? Methods: In a secondary analysis of a prospective controlled trial, a subgroup of 55 patients, who underwent computer-assisted, cementless THA with a straight, tapered stem through an anterolateral, minimally invasive (MIS) approach in a lateral decubitus position were examined retrospectivly. Intraoperative fluoroscopy was used to verify a "best-fit" position of the final broach. An image-free navigation system was used for measurement of the native femoral version, version of the final broach and the final implant. Femoral neck resection height was measured in postoperative CT-scans. This investigation was approved by the local Ethics Commission (No. 10-121-0263) and is a secondary analysis of a larger project (DRKS00000739, German Clinical Trials Register May-02-2011). Results: The mean difference between native femoral version and final implant was 1.9 degrees (+/-9.5), with a range from -20.7 degrees to 21.5 degrees and a Spearman's correlation coefficient of 0.39 (p < 0.003). In contrast, we observed a mean difference between final broach and implant version of -1.9 degrees (+/-3.5), with a range from -12.7 degrees to 8.7 degrees and a Spearman's correlation coefficient of 0.89 (p < 0.001). In 83.6 % (46/55) final stem version was outside the normal range as defined by Tonnis (15-20 degrees). The mean femoral neck resection height was 7.3 mm (+/-5.6). There was no correlation between resection height and version of the implant (Spearman's correlation coefficient 0.14). Conclusion: Native femoral version significantly differs from the final anteversion of a cementless, straight, tapered stem and therefore is not a reliable reference in cementless THA. Measuring anteversion of the final "fit and fill" broach is a feasible assistance in order to predict final stem anteversion intraoperatively. There is no correlation between femoral neck resection height and version of the implant

Efficacy of antibiotic treatment of implant-associated Staphylococcus aureus infections with moxifloxacin, flucloxacillin, rifampin, and combination therapy: an animal study

The efficacy of antibiotic monotherapy and combination therapy in the treatment of implant-associated infection by Staphylococcus aureus was evaluated in an animal study. The femoral medullary cavity of 66 male Wistar rats was contaminated with S. aureus (ATCC 29213) and a metal device was implanted, of which 61 could be evaluated. Six treatment groups were studied: flucloxacillin, flucloxacillin in combination with rifampin, moxifloxacin, moxifloxacin in combination with rifampin, rifampin, and a control group with aqua. The treatment was applied for 14 days. After euthanasia, the bacterial counts in the periprosthetic bone, the soft tissue, and the implant-associated biofilm were measured. Both antibiotic combination treatments (moxifloxacin plus rifampin and flucloxacillin plus rifampin) achieved a highly significant decrease in microbial counts in the bone and soft tissue and in the biofilm. Mono-antibiotic treatments with either moxifloxacin or flucloxacillin were unable to achieve a significant decrease in microbial counts in bone and soft tissue or the biofilm, whilst rifampin was able to reduce the counts significantly only in the biofilm. Antibiotic resistance was measured in 1/3 of the cases in the rifampin group, whereas no resistance was measured in all other groups. The results show that combinations of both moxifloxacin and flucloxacillin plus rifampin are adequate for the treatment of periprosthetic infections due to infections with S. aureus, whereas monotherapies are not effective or not applicable due to the rapid development of antibiotic resistance. Therefore, moxifloxacin is an effective alternative in combination with rifampin for the treatment of implant-associated infections

Development and evaluation of an image-free computer-assisted impingement detection technique for total hip arthroplasty

Periprosthetic or bony impingement in total hip arthroplasty (THA) has been correlated to dislocation, increased wear, reduced postoperative functionality with pain and/or decreased range of motion (ROM). We sought to study the accuracy and assess the reliability of measuring bony and periprosthetic impingement on a virtual bone model prior to the implantation of the acetabular cup with the help of image-free navigation technology in an experimental cadaver study. Impingement-free ROM measurements were recorded during minimally invasive, computer-assisted THA on 14 hips of 7 cadaveric donors. Preoperatively and postoperatively the donors were scanned using computed tomography (CT). Impingement-free ROM on three-dimensional CT-based models was then compared with corresponding, intraoperative navigation models. Bony/periprosthetic impingement can be detected with a mean accuracy limit of below 5° for motion angles, which should be reached after THA for activities of daily living with the help of image-free navigation technology

Minimally invasive computer-navigated total hip arthroplasty, following the concept of femur first and combined anteversion: design of a blinded randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Impingement can be a serious complication after total hip arthroplasty (THA), and is one of the major causes of postoperative pain, dislocation, aseptic loosening, and implant breakage. Minimally invasive THA and computer-navigated surgery were introduced several years ago. We have developed a novel, computer-assisted operation method for THA following the concept of "femur first"/"combined anteversion", which incorporates various aspects of performing a functional optimization of the cup position, and comprehensively addresses range of motion (ROM) as well as cup containment and alignment parameters. Hence, the purpose of this study is to assess whether the artificial joint's ROM can be improved by this computer-assisted operation method. Second, the clinical and radiological outcome will be evaluated.</p> <p>Methods/Design</p> <p>A registered patient- and observer-blinded randomized controlled trial will be conducted. Patients between the ages of 50 and 75 admitted for primary unilateral THA will be included. Patients will be randomly allocated to either receive minimally invasive computer-navigated "femur first" THA or the conventional minimally invasive THA procedure. Self-reported functional status and health-related quality of life (questionnaires) will be assessed both preoperatively and postoperatively. Perioperative complications will be registered. Radiographic evaluation will take place up to 6 weeks postoperatively with a computed tomography (CT) scan. Component position will be evaluated by an independent external institute on a 3D reconstruction of the femur/pelvis using image-processing software. Postoperative ROM will be calculated by an algorithm which automatically determines bony and prosthetic impingements.</p> <p>Discussion</p> <p>In the past, computer navigation has improved the accuracy of component positioning. So far, there are only few objective data quantifying the risks and benefits of computer navigated THA. Therefore, this study has been designed to compare minimally invasive computer-navigated "femur first" THA with a conventional technique for minimally invasive THA. The results of this trial will be presented as soon as they become available.</p> <p>Trial registration number</p> <p>DRKS00000739</p

Reproducibility of navigation based kinematic analysis of the knee – A cadaveric investigation

Purpose: Several navigation-based kinematic studies of the knee have been published recently, but little information is available about reproducibility and reliability of the acquired data. The aim of the present study first is to determine reproducibility and reliability of kinematical measurements of healthy knees and knees after TKA (total knee arthroplasty) with regards to rotational and translational measurement parameters. Second the mathematical background, applicability, and limitations of investigating navigation-based kinematics should be compiled. Methods: Using cadavers fixed by the Thiel method, in ten knees reproducibility of obtained angular and translational kinematic parameters were investigated before and after total knee arthroplasty. For this reason agreement of obtained data of a first and a second movement cycle and the same after a surgical intervention was assessed using a commercially available navigational device. Results: For both angular and translational parameters in healthy knees and knees after total knee arthroplasty mean differences between measured parameters of the first and second movement cycle and after surgical intervention of less than 0.5 degrees or millimeters (standard deviation 1.3 or less) or a inter class correlation of 0.92 and more, respectively, was found. Discussion: Use of a commercial navigation system allows highly accurate investigations of knee kinematics in cadavers before and after TKA. This technique, which does not require any specific technical knowledge of the investigator, is in accordance with current accepted biomechanical methods. (C) 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved

Significant influence of rotational limb alignment parameters on patellar kinematics: an in vitro study

Component malrotation has a major impact on patellar kinematics in total knee arthroplasty. The influence of natural rotational limb alignment on patellar kinematics is unclear so far. Based on recent clinical investigations, we hypothesized that rotational limb alignment significantly influences patellar kinematics. Patellar kinematics of ten cadaveric knees was measured using computer navigation during passive motion. Data were correlated with different rotational limb alignment parameters of preoperative CT scans. Femoral antetorsion showed a significant influence on patellar rotation, while tibial tubercle-posterior cruciate ligament distance additionally displayed a significant influence on patellar mediolateral shift (p < 0.05). Femoral posterior condylar angle was sensitive to patellar epicondylar distance, rotation and tilt (p < 0.05). Patellar rotation was influenced by five out of eight rotational limb alignment parameters (p < 0.05). Rotational limb alignment should be paid more attention in terms of clinical evaluation of patellar tracking and future biomechanical and clinical investigations