Human bacterial arthritis caused by Streptococcus zooepidemicus: report of a case

SummarySeptic arthritis caused by Streptococcus zooepidemicus is a rare event in humans. Of the four cases reported in the literature, only two patients had direct animal contact, and the portal of entry remained unclear in all cases. We report herein the case of a patient who suffered a purulent arthritis of the left shoulder caused by S. zooepidemicus, successfully treated in our department. A diagnostic FDG-PET-CT scan ruled out other foci of infection, but detected a hyperkeratotic plantar chronic soft tissue lesion of the left foot, acquired in a paragliding accident 10 years earlier. The fact that the patient habitually took care of his horses barefoot in boots, identifies the cutaneous portal of entry as most likely. To our knowledge this is the first report of a septic arthritis caused by S. zooepidemicus where a cutaneous entry route is described

Konfigurierbare Sicherheit für Java Laufzeitumgebungen

Bei der Entwicklung von Java-Applikationen stehen Entwicklern eine Reihe von Mechanismen zur Verfügung, unsichere Kommunikationskan¨ale mit Verschlüsselung abzusichern. Diese Techniken sind dann in der Regel tief im Programmcode verwoben. Für Sicherheitsadministratoren ist die Verwaltung dieser Programme dann oft nicht einfach. Die Ergebnisse dieser Arbeit ermöglichen es, die von Anwendungen genutzten Sicherheitsdienste unabhängig von der Software-Entwicklung erst zum Zeitpunkt der Installation hinzuzufügen und zu konfigurieren. Dadurch wird die Anwendungsentwicklung von Sicherheitsaspekten befreit, was eine Verringerung von Aufwand und möglichen Fehlerquellen verspricht. Sicherheitsmerkmale können so auch nachträglich zu Anwendungen hinzugefügt werden, wobei die Benutzung und die Parametrisierung sämtlicher Sicherheitsdienste für jede Installation individuell festgelegt werden können. Das Java-Sicherheitsmodell wird so erweitert, dass nicht nur die Zugriffskontrolle, sondern auch weitere Sicherheitsmechanismen in einer Sicherheitspolitik definiert werden können und nicht bei der Entwicklung von Anwendungen vorgegeben werden müssen. Beispielsweise kann für Dateien oder Netzverbindungen neben den Zugriffsberechtigungen auch eine Verschlüsselung oder Integritätsprüfung konfiguriert werden. Dazu wurde eine Bibliothek von Klassen entwickelt, die in Verbindung mit einer für diese Zwecke weiterentwickelten Java Virtual Machine eingesetzt werden kann und die erforderliche Funktionalität bietet. Dabei wurden einerseits existierende Sicherheitsdienste eingebunden, andererseits aber auch neue Funktionalität zu dieser Bibliothek hinzugefügt

Association between a single-pass whole-body computed tomography policy and survival after blunt major trauma: a retrospective cohort study

<p>Abstract</p> <p>Introduction</p> <p>Single-pass, whole-body computed tomography (pan-scan) remains a controversial intervention in the early assessment of patients with major trauma. We hypothesized that a liberal pan-scan policy is mainly an indicator of enhanced process quality of emergency care that may lead to improved survival regardless of the actual use of the method.</p> <p>Methods</p> <p>This retrospective cohort study included consecutive patients with blunt trauma referred to a trauma center prior to (2000 to 2002) and after (2002 to 2007) the introduction of a liberal single-pass pan-scan policy. The overall mortality between the two periods was compared and stratified according to the availability and actual use of the pan-scan. Logistic regression analysis was employed to adjust mortality estimates for demographic and injury-related independent variables.</p> <p>Results</p> <p>The study comprised 313 patients during the pre-pan-scan period, 223 patients after the introduction of the pan-scan policy but not undergoing a pan-scan and 608 patients undergoing a pan-scan. The overall mortality was 23.3, 14.8 and 7.9% (<it>P </it>< 0.001), respectively. By univariable logistic regression analysis, both the availability (odds ratio (OR) 0.57, 95% confidence interval (CI): 0.36 to 0.90) and the actual use of the pan-scan (OR 0.28, 95% CI: 0.19 to 0.42) were associated with a lower mortality. The final model contained the Injury Severity Score, the Glasgow Coma Scale, age, emergency department time and the use of the pan-scan. 2.7% of the explained variance in mortality was attributable to the use of the pan-scan. This contribution increased to 7.1% in the highest injury severity quartile.</p> <p>Conclusions</p> <p>In this study, a liberal pan-scan policy was associated with lower trauma mortality. The causal role of the pan-scan itself must be interpreted in the context of improved structural and process quality, is apparently moderate and needs further investigation with regard to the diagnostic yield and changes in management decisions. (The Pan-Scan for Trauma Resuscitation [PATRES] Study Group, <a href="http://www.controlled-trials.com/ISRCTN35424832">ISRCTN35424832</a> and <a href="http://www.controlled-trials.com/ISRCTN41462125">ISRCTN41462125</a>)</p

Internet based multicenter study for thoracolumbar injuries: a new concept and preliminary results

This article reports about the internet based, second multicenter study (MCS II) of the spine study group (AG WS) of the German trauma association (DGU). It represents a continuation of the first study conducted between the years 1994 and 1996 (MCS I). For the purpose of one common, centralised data capture methodology, a newly developed internet-based data collection system ( http://www.memdoc.org ) of the Institute for Evaluative Research in Orthopaedic Surgery of the University of Bern was used. The aim of this first publication on the MCS II was to describe in detail the new method of data collection and the structure of the developed data base system, via internet. The goal of the study was the assessment of the current state of treatment for fresh traumatic injuries of the thoracolumbar spine in the German speaking part of Europe. For that reason, we intended to collect large number of cases and representative, valid information about the radiographic, clinical and subjective treatment outcomes. Thanks to the new study design of MCS II, not only the common surgical treatment concepts, but also the new and constantly broadening spectrum of spine surgery, i.e. vertebro-/kyphoplasty, computer assisted surgery and navigation, minimal-invasive, and endoscopic techniques, documented and evaluated. We present a first statistical overview and preliminary analysis of 18 centers from Germany and Austria that participated in MCS II. A real time data capture at source was made possible by the constant availability of the data collection system via internet access. Following the principle of an application service provider, software, questionnaires and validation routines are located on a central server, which is accessed from the periphery (hospitals) by means of standard Internet browsers. By that, costly and time consuming software installation and maintenance of local data repositories are avoided and, more importantly, cumbersome migration of data into one integrated database becomes obsolete. Finally, this set-up also replaces traditional systems wherein paper questionnaires were mailed to the central study office and entered by hand whereby incomplete or incorrect forms always represent a resource consuming problem and source of error. With the new study concept and the expanded inclusion criteria of MCS II 1, 251 case histories with admission and surgical data were collected. This remarkable number of interventions documented during 24 months represents an increase of 183% compared to the previously conducted MCS I. The concept and technical feasibility of the MEMdoc data collection system was proven, as the participants of the MCS II succeeded in collecting data ever published on the largest series of patients with spinal injuries treated within a 2 year period

Nonunion

The pathogenesis of bone healing disturbances is multifactorial, but especially related to impaired biology, inadequate stability, fracture gapping and infection. The key symptom is pain and discomfort at the site of nonunion while moving and weight-bearing the affected limb. Typical findings on conventional radiographs or CT support the diagnosis: missing progress of bone healing on serial images, loss of bridging trabecular bone crossing the fracture zone or hypertrophic bridging callus with persistent fracture gap. Breakage of implants is an additional, associated sign. Treatment principles consist of improvement of impaired biology and improvement of stability: restoration of axial alignment, stabilization of fracture fragments, reaming, intramedullary nailing with an increased nail diameter, compression of nonunion; and multiple interlocking. The authors prefer antegrade nailing with the patient in lateral position in femur diaphysis nonunion. Overreaming, exact positioning of the nail and interfragmentary compression are most important parts of the procedure. Exchange nailing is done as a closed procedure in hypertrophic nonunion of the tibia. For axis correction and in atrophic nonunion, the nonunion site is opened. Whenever an intact fibula blocks dynamization of the tibia, or compression across the tibial nonunion site, oblique fibula osteotomy and resection of a short segment is performed. Humerus nonunion after conservative treatment is treated with closed nailing, nonunion after nailing is treated with reaming, exchange nailing, compression and multiple interlocking. In metaphyseal nonunion, the use of an auxiliary plate; and in long oblique fractures, the use of cerclage wires is beneficial to secure fracture reduction during nail insertion and enhance stability of the nail-bone construct

Konfigurierbare Sicherheit für Java Laufzeitumgebungen

Bei der Entwicklung von Java-Applikationen stehen Entwicklern eine Reihe von Mechanismen zur Verfügung, unsichere Kommunikationskan¨ale mit Verschlüsselung abzusichern. Diese Techniken sind dann in der Regel tief im Programmcode verwoben. Für Sicherheitsadministratoren ist die Verwaltung dieser Programme dann oft nicht einfach. Die Ergebnisse dieser Arbeit ermöglichen es, die von Anwendungen genutzten Sicherheitsdienste unabhängig von der Software-Entwicklung erst zum Zeitpunkt der Installation hinzuzufügen und zu konfigurieren. Dadurch wird die Anwendungsentwicklung von Sicherheitsaspekten befreit, was eine Verringerung von Aufwand und möglichen Fehlerquellen verspricht. Sicherheitsmerkmale können so auch nachträglich zu Anwendungen hinzugefügt werden, wobei die Benutzung und die Parametrisierung sämtlicher Sicherheitsdienste für jede Installation individuell festgelegt werden können. Das Java-Sicherheitsmodell wird so erweitert, dass nicht nur die Zugriffskontrolle, sondern auch weitere Sicherheitsmechanismen in einer Sicherheitspolitik definiert werden können und nicht bei der Entwicklung von Anwendungen vorgegeben werden müssen. Beispielsweise kann für Dateien oder Netzverbindungen neben den Zugriffsberechtigungen auch eine Verschlüsselung oder Integritätsprüfung konfiguriert werden. Dazu wurde eine Bibliothek von Klassen entwickelt, die in Verbindung mit einer für diese Zwecke weiterentwickelten Java Virtual Machine eingesetzt werden kann und die erforderliche Funktionalität bietet. Dabei wurden einerseits existierende Sicherheitsdienste eingebunden, andererseits aber auch neue Funktionalität zu dieser Bibliothek hinzugefügt

Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion

BACKGROUND: Surgical revision concepts for the treatment of aseptic humeral, femoral, and tibial diaphyseal nonunion were evaluated. It was analyzed if the range of time to bone healing was shorter, and if clinical and radiological long-term outcome was better following application of additional recombinant human Bone Morphogenetic Protein-7 (rhBMP-7) compared to no additional rhBMP-7 use. METHODS. In a retrospective comparative study between 06/2006 and 05/2013, 112 patients diagnosed with aseptic diaphyseal humerus (22 patients), femur (41 patients), and tibia (49 patients) nonunion were treated using internal fixation and bone graft augmentation. For additional stimulation of bone healing, growth factor rhBMP-7 was locally administered in 62 out of 112 patients. Follow-up studies including clinical and radiological assessment were performed at regular intervals as well as after at least one year following nonunion surgery. RESULTS: One hundred and two out of 112 (humerus: 19, femur: 37, tibia: 47) nonunion healed within 12 months after revision surgery without any significant differences between the cohort groups. According to the DASH outcome measure for the humerus (p = 0.679), LEFS for the femur (p = 0.251) and the tibia (p = 0.946) as well as to the SF-12 for all entities, no significant differences between the treatment groups were found. CONCLUSIONS: Aseptic diaphyseal nonunion in humerus, femur, and tibia healed irrespectively of additional rhBMP-7 application. Moreover, the results of this study suggest that successful nonunion healing can be linked to precise surgical concepts using radical removal of nonunion tissue, stable fixation and restoration of axis, length and torsion, rather than to the additional use of signaling proteins. TRIAL REGISTRATION: This clinical trial was conducted according to ICMJE guidelines as well as to the approval of the National Medical Board (Ethics Committee of the Bavarian State Chamber of Physicians; TRN: 2016-104) and has been retrospectively registered with the German Clinical Trails Register (TRN: DRKS00012652 )