Die Behandlung der Condylus-radialis-humeri-Fraktur im Kindesalter

Zusammenfassung: Operationsziel: Operative Reposition und Retention des Condylus radialis humeri zur Vermeidung von bleibenden Fehlstellungen, Pseudarthrosen und Gelenkinstabilitäten. Indikationen: Absolut: Primär vollständig dislozierte Frakturen oder Frakturen, die nach 4 Tagen im gipsverbandfreien Kontrollröntgen eine Sekundärdislokation von > 2 mm aufweisen. Relativ: Komplette Frakturen des Condylus radialis humeri, die im Verlauf eine Sekundärdislokation von ≤ 2 mm aufweisen. Kontraindikationen: Inkomplette, sog. hängende Frakturen des Condylus radialis humeri ohne erkennbare Sekundärdislokation im Verlauf. Operationstechnik: Offene Reposition des Condylus radialis humeri über einen lateralen Zugang am Ellenbogengelenk. Bei jüngeren Kindern (< 5 Jahre) Kirschner-Draht-Fixierung. Bei älteren Kindern (≥ 5 Jahre) oder bei unzureichender Kompression Durchführung einer radialen Zugschraubenosteosynthese. Zusätzliche Periostnaht. Weiterbehandlung: Anlage einer Oberarmgipslonguette bis zum Abschluss der Wundheilung; im Anschluss Oberarmgipsverband für insgesamt 3-4 Wochen nach der Operation. Materialentfernung bei Konsolidierung (Röntgen) nach ca. 2-3 Monaten. Keine routinemäßige postoperative Physiotherapie. Ergebnisse: Im Zeitraum vom 01.01.1999 bis 31.12.2006 wurden insgesamt 85 Kinder mit einem Altersmedian von 6,1 Jahren wegen einer Condylus-radialis-humeri-Fraktur behandelt. 47 Patienten wurden operativ versorgt, davon 31 Kinder mit einer Kombination aus Schraube und Kirschner-Drähten, 13 Kinder mit einer Schraube allein und drei Kinder nur mit Kirschner-Drähten. Die Implantate wurden im Median 8,6 Wochen (5,0-17,1 Wochen) postoperativ entfernt. Insgesamt betrug die mediane Nachbeobachtungszeit 6 Monate (2-50 Monate). Bei keinem Patienten in dieser Serie traten Spätkomplikationen im Sinne einer nicht stattgefundenen Konsolidierung und/oder einer Pseudarthrosenbildung auf. In fünf Fällen mit Hypästhesien im Bereich der Haut über dem proximalen Radius kam es binnen 6 Monaten nach der Operation zu einer vollständigen Normalisierung. Im Rahmen eines Telefoninterviews im September 2007 konnten 87% der Patienten (n = 74) nachverfolgt werden. Drei Kinder gaben eine geringe Minderung der groben Kraft des verletzten Arms im Seitenvergleich an, wobei eines dieser Kinder zusätzlich ein geringes Ellenbogenflexionsdefizit berichtete, welches im Vergleich zur letzten klinischen Untersuchung nicht progredient war. In keinem der telefonisch kontaktierten Fälle war es nötig, den Patienten aufgrund persistierender Beschwerden und/oder eines subjektiv nicht akzeptablen Behandlungsergebnisses akut erneut einzubestelle

Mechanical Complication with Broviac Repair Kit in a 4-Year-Old Boy with MEN 2a

Background. Mechanical complications in the use of indwelling central venous catheters (CVCs) such as the Broviac catheter (BC) include kinking, occlusion, dislocation or leaking. We report on a mechanical complication after using a repair kit for the BC. Method. A 4-year old boy, suffering from multiple endocrine neoplasia type 2a (MEN 2a), intestinal aganglionosis (Hirschsprung's disease), and short bowel syndrome, required a BC for home parenteral nutrition. Result. Due to recurrent leakage of the BC, 5 subsequent repairs were necessary within seven months. During one repair a metallic tube belonging to the repair kit was found to have migrated proximally to the skin entrance level within the BC and requiring surgical removal. Conclusion. To our knowledge, this is the first report focusing on such a serious complication using a BC and its repair kit. The proximal migration of this metallic tube constitutes a distinct theoretical risk of endothoracic foreign body embolization

Conservative treatment and outcome of upper cervical spine fractures in young children: A STROBE-compliant case series.

Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children

Pectus excavatum in motion: dynamic evaluation using real-time MRI.

OBJECTIVES The breathing phase for the determination of thoracic indices in patients with pectus excavatum is not standardized. The aim of this study was to identify the best period for reliable assessments of morphologic indices by dynamic observations of the chest wall using real-time MRI. METHODS In this prospective study, patients with pectus excavatum underwent morphologic evaluation by real-time MRI at 3 T between January 2020 and June 2021. The Haller index (HI), correction index (CI), modified asymmetry index (AI), and modified eccentricity index (EI) were determined during free, quiet, and forced breathing respectively. Breathing-related differences in the thoracic indices were analyzed with the Wilcoxon signed-rank test. Motion of the anterior chest wall was analyzed as well. RESULTS A total of 56 patients (11 females and 45 males, median age 15.4 years, interquartile range 14.3-16.9) were included. In quiet expiration, the median HI in the cohort equaled 5.7 (4.5-7.2). The median absolute differences (Δ) in the thoracic indices between peak inspiration and peak expiration were ΔHI = 1.1 (0.7-1.6, p .05 each). Furthermore, the dynamic evaluation revealed three distinctive movement patterns of the funnel chest. CONCLUSIONS Real-time MRI reveals patterns of chest wall motion and indicate that thoracic indices of pectus excavatum should be assessed in the end-expiratory phase of quiet expiration. KEY POINTS • The thoracic indices in patients with pectus excavatum depend on the breathing phase. • Quiet expiration represents the best breathing phase for determining thoracic indices. • Real-time MRI can identify different chest wall motion patterns in pectus excavatum

Electrocautery smoke exposure and efficacy of smoke evacuation systems in minimally invasive and open surgery: a prospective randomized study.

Worldwide, health care professionals working in operating rooms (ORs) are exposed to electrocautery smoke on a daily basis. Aims of this study were to determine composition and concentrations of electrocautery smoke in the OR using mass spectrometry. Prospective observational study at a tertiary care academic center, involving 122 surgical procedures of which 84 were 1:1 computer randomized to smoke evacuation system (SES) versus no SES use. Irritating, toxic, carcinogenic and mutagenic VOCs were observed in OR air, with some exceeding permissible exposure limits (OSHA/NIOSH). Mean total concentration of harmful compounds was 272.69 ppb (± 189 ppb) with a maximum total concentration of harmful substances of 8991 ppb (at surgeon level, no SES). Maximum total VOC concentrations were 1.6 ± 1.2 ppm (minimally-invasive surgery) and 2.1 ± 1.5 ppm (open surgery), and total maximum VOC concentrations were 1.8 ± 1.3 ppm at the OR table 'at surgeon level' and 1.4 ± 1.0 ppm 'in OR room air' away from the operating table. Neither difference was statistically significant. In open surgery, SES significantly reduced maximum concentrations of specific VOCs at surgeon level, including aromatics and aldehydes. Our data indicate relevant exposure of health care professionals to volatile organic compounds in the OR. Surgical technique and distance to cautery devices did not significantly reduce exposure. SES reduced exposure to specific harmful VOC's during open surgery.Trial Registration Number: NCT03924206 (clinicaltrials.gov)

Initial characterisation of commercially available ELISA tests and the immune response of the clinically correlated SARS-CoV-2 biobank "SERO-BL-COVID-19" collected during the pandemic onset in Switzerland

Background To accurately measure seroprevalance in the population, both the expected immune response as well as the assay performances have to be well characterised. Here, we describe the collection and initial characterisation of a blood and saliva biobank obtained after the initial peak of the SARS-CoV-2 pandemic in Switzerland.Methods Two laboratory ELISAs measuring IgA & IgG (Euroimmun), and IgM & IgG (Epitope Diagnostics) were used to characterise the biobank collected from 349 re- and convalescent patients from the canton of Basel-Landschaft.Findings The antibody response in terms of recognized epitopes is diverse, especially in oligosymptomatic patients, while the average strength of the antibody response of the population does correlate with the severity of the disease at each time point.Interpretation The diverse immune response presents a challenge when conducting epidemiological studies as the used assays only detect ∼90% of the oligosymptomatic cases. This problem cannot be rectified by using more sensitive assay setting as they concomitantly reduce specificity.Funding Funding was obtained from the "Amt für Gesundheit" of the canton Basel-Landschaft, Switzerland.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis study was sponsored by Jurg Sommer, head of the Amt fur Gesundheit, and the logistics of the sample collection were provided by the crisis staff and the civil protection service of the canton Basel-Landschaft.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This study is part of the project COVID-19 in Baselland Investigation and Validation of Serological Diagnostic Assays and Epidemiological Study of Sars-CoV-2 specific Antibody Responses (SERO-BL-COVID-19) approved by the ethics board Ethikkommission Nordwest- und Zentralschweiz (EKNZ), Hebelstrasse 53, 4056 Basel representative of Swissethics under the number (2020-00816).All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData are available upon reques

Volteando la tortilla. Género y maíz en la alimentación actual de México.

Ante escenarios complejos, patriarcales y desoladores que dejan ver el neoliberalismo, la globalización agroalimentaria, el calentamiento global y las contaminaciones de granos nativos por la imposición de transgénicos, nos cuestionamos si existen algunas alternativas para preservar el maíz nativo como un recurso multiestratégico (alimentario, económico, cultural, ecológico y tecnológico) tomando en cuenta las condiciones actuales de desigualdades sociales de género, etnia, clases y edad que predominan en el campo mexicano. Para responder a algunos cuestionamientos, este libro presenta algunas alternativas a través de diversas experiencias femeninas y de relaciones de género en torno al maíz y la alimentación. Todas ellas muestran que es posible construir una masa crítica para salvaguardar el maíz nativo bajo esas condiciones desoladoras, pero siempre y cuando se “voltee la tortilla”, metáfora que da pie al inicio de otra realidad humanizada y en sincronía con la naturaleza.Proyecto realizado con financiamiento Conacy

Evaluation of learning curve of Dor and Watson hemifundoplication with laparoscopic robotic remote assistance da Vinci in pigs

GesamtdissertationDie Durchführung abdomineller Eingriffe mit Hilfe von Fernsteuerungssystemen für endoskopische Instrumente beinhaltet große Differenzen gegenüber der konventionellen Laparoskopie. In dieser Untersuchung wurden erstmalig die Lernkurvenparameter der Hemifundoplikatio nach Dor und Watson (HDW) mit dem da Vinci System am Schwein evaluiert. An 26 Tagen führte ein allgemeinchirurgisches Team ohne Vorkenntnisse in computerunterstützter Chirurgie des Universitätsklinikums Nancy/Frankreich insgesamt 26 HDW mit da Vinci an 26 Schweinen durch. Bestimmt wurden die Dauer für Übung, Installation, Operation, Saalbenutzung, Instrumenten- und Operationstischlagewechsel sowie Komplikationen und Kosten. Median (Range) der täglichen Übungsdauer betrugen 190 (120-480) Minuten, der Installationsdauer 23 (18-120) Minuten, der Operationszeit 96 (84-155) Minuten, der Operationssaal-benutzungsdauer 201 (182-360) Minuten, der Instrumentenauswechseldauer 1 (1-5) Minuten, der Operationstischlagewechseldauer 4 (3-25) Minuten. Zur Beurteilung des Lernfortschritts wurden nach zwei Einführungstagen die nachfolgenden 24 Übungstage in drei gleichlange Gruppen unterteilt (Gruppe 1/2/3: Tag 3-10/11-18/19-26). Für alle Manipulationszeiten zeigte sich ein signifikanter Abfall zwischen Gruppe 1 und Gruppe 2 (p<0.05), nicht aber zwischen Gruppe 2 und Gruppe 3 (p>0.1), lediglich für die Installationsdauer war ein weiterer signifikanter Abfall zwischen Gruppe 2 und Gruppe 3 zu verzeichnen (p=0.012). Die Lernkurven erreichten mithin innerhalb 18 Tagen asymptotische Werte. Zweimal (8 %) kam es zu intraoperativen Blutungen durch Verletzung der Vena cava inferior. Eine Operation (4 %) musste vorübergehend, keine jedoch endgültig in eine offene Operationsvariante konvertiert werden. Von 1647 Euro für eine da Vinci -assistierte HDW am Schwein entfielen 1231 Euro (74.7 %) auf den Einsatz von da Vinci. Die Etablierung eines Fernsteuerungssystems für endoskopische Instrumente (da Vinci) erscheint mit vertretbaren Kosten und Übungszeiten möglich.There are important differences between conventional minimally invasive surgery and laparoscopic robotic remote assistance. We aimed to investigate for the first time the learning curve of Dor and Watson hemifundoplication (DWH) with the da Vinci Surgical System in pigs. A general surgery team with no prior robotic skills of the University Hospital of Nancy/France performed 26 da Vinci-assisted DWH in 26 pigs on 26 days. Time of practice, setup, operative procedure, use of operating theatre, change of instruments and of operating table, as well as complications and costs were determinated. Median (Range) of daily exercise time were 190 (120-480) min., setup 23 (18-120) min., operative procedure 96 (84-155) min., operating theatre use 201 (182-360), instruments change 1 (1-5) min. and change of operating table 4 (3-25) min. The first two days were used for initialization of the team on da Vinci. In order to judge the learning progress, the following 24 days were subdivided in three equal groups (group 1/2/3: day 3-10/11-18/19-26). There was a significant decrease between group 1 and group 2 (p<0.05) for all manipulation times, but not between group 2 and group 3 (p>0.1), only for the setup time a more significant decrease was documented between group 2 and group 3 (p=0.012). The learning curves reached asymptotic values within 18 days. We denoted intraoperative bleeding twice (8 %) by injury of Vena Cava inferior. None of the operations had to be converted in open surgery, only one (4 %) was converted temporarily. Of the total amount of 1647 Euro for one da Vinci assisted DWH in pig, 1231 Euro (74.7 %) are attributed to the use of da Vinci. The establishment of a laparoscopic robotic remote assistance (da Vinci) seems to be possible with reasonable costs and practice

Sternal Fracture in Children: Diagnosis by Ultrasonography.

Because of its subcutaneous location, the sternum can be examined sonographically using a linear scanner. We report about two children who experienced blunt chest trauma. Anterior-posterior chest X-rays were normal. Ultrasonic imaging confirmed a fracture of the sternum with dorsal displacement of the distal fragment (by 0.97 cm) in the first child and a transverse fracture of the body of the sternum without displacement in the second child. In both children, pericardial effusion was excluded by sonography. The displaced fracture of the sternum was confirmed by magnetic resonance imaging (MRI), which ruled out concomitant injuries of the soft tissues adjacent to the sternum. Both sternum fractures were managed nonoperatively. These cases serve to emphasize the importance of sonography that represents an ionizing radiation free, noninvasive, efficient, and safe imaging modality to diagnose fractures of the sternum in children while also enabling the assessment of the pericardium