Osteoidosteom: CT-gesteuerte Bohrexzision und Radiofrequenzablation

Zusammenfassung: Hintergrund: Die CT-geführte Entfernung des Nidus eines Osteoidosteoms anstelle herkömmlicher Verfahren der offenen Resektion bietet den Vorteil, die Läsion intraoperativ exakt zu lokalisieren und deren Entfernung korrekt zu kontrollieren. Zudem tritt anstelle eines oft großen Eingriffs der Vorteil eines minimal-invasiven Vorgehens. Patienten und Methode: Zwischen 1996 und 2005 wurden 52Patienten anhand von Klinik und Bildgebung diagnostizierten Osteoidosteomen entweder mittels Bohrexzision (BE, n=41) oder Radiofrequenzablation (RFA, n=11) behandelt. Das Alter der Patienten lag zwischen 7 und 48 (Durchschnitt 22,3) Jahren, der Follow-up betrug 31,3Monate. Ergebnisse: Das Osteoidosteom konnte bei allen Patienten erfolgreich behandelt werden. 50Patienten waren nach einmaligem Eingriff anhaltend beschwerdefrei. Bei 2Patienten wurde in der 1. Operation der Nidus verfehlt, sodass kurze Zeit später mit der gleichen Methode eine 2. Behandlung notwendig wurde. Schlussfolgerung: Die CT-geführte Therapie des Osteoidosteoms hat dessen Behandlung durch exakte Lokalisierung und Verkleinerung des Eingriffs entscheidend vereinfacht und besser kontrollierbar gemacht. Das Verfahren kann analog zur Biopsie von Weichteil- und Knochenprozessen genutzt werden, was den Vorteil der exakten Dokumentation des Biopsieweges und der Entnahmestelle biete

Pitfalls of lateral external fixation for supracondylar humeral fractures in children

Introduction: Closed reduction and percutaneous pinning is a standard treatment for dislocated supracondylar humeral fractures in children. However, the management of these fractures remains challenging. The aim of this study was to evaluate lateral external fixation as a treatment alternative for these fractures. Materials and methods: All supracondylar fractures treated with lateral external fixation between 2005 and 2007 were evaluated retrospectively. Long-term outcome was assessed with regards to carrying angle, malalignment, and motion. Results: Twenty-eight patients with Gartland type III fractures and one with a Y-type fracture were included in the study (mean age 6.5years). Cosmetic results were excellent in 88%, good in 8%, and fair in one patient. Functional results were excellent in 83%, good in 10%, and fair in 7%. However, 3 patients (10%) showed complete radial palsy postoperatively. In all of these patients, high insertion of the proximal pin (2.9-3.6cm above the fracture) was noted. On revision, one superficial lesion and one total transection of the nerve at the level of the proximal pin was detected. One patient showed no macroscopic damage. The transected nerve was reconstructed using an autograft, and all patients completely recovered within 2-6months. Conclusion: Lateral external fixation is an alternative method for the treatment of displaced or unstable supracondylar fractures in children, facilitating reduction and improving fracture stability. However, iatrogenic radial nerve injury is a risk, and we therefore strongly recommend inserting the proximal pin under direct vision within 2cm from the fracture line using a drill sleev

Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: a systematic review

Aim: The aim of this systematic review was to identify the most recent widely accepted guidelines for risk factor control interventions and to assess their impact in patients with periodontitis. Materials and methods: The electronic search strategy included a first systematic search to identify guidelines for interventions for smoking cessation, diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar) reduction and weight loss in the general population and a second systematic search to identify the studies evaluating these interventions in periodontitis patients. Results: A total of 13 guidelines and 25 studies were selected. Most guidelines included recommendations for all healthcare providers to provide interventions and follow-up counselling with the risk factors considered in the present review. In patients with periodontitis, interventions for smoking cessation and diabetes control were shown to improve periodontal health while the impact of dietary interventions and the promotion of other healthy lifestyles were moderate or limited. Conclusions: While aiming to improve treatment outcomes and the maintenance of periodontal health, current evidence suggests that interventions for smoking cessation and diabetes control are effective, thus emphasizing the need of behavioural support in periodontal care

Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: a systematic review

Aim: This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases. Methods: A literature search was performed on different databases up to March 2019. Randomized and non-randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups. Results: Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self-inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta-analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self-inspection/videotapes. Conclusions: Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time

Verlängerung des kongenital kurzen Femurs (PFFD) mittels Hybridfixateur unter Einbeziehung des Kniegelenks

Hintergrund: Kontrakturen und Luxationen in Knie- und Hüftgelenk sind bekannte Komplikationen bei der Verlängerung des proximalen fokalen Femurdefekts (PFFD). Insbesondere ist das Kniegelenk wegen der fehlenden oder insuffizienten Kreuzbänder beim PFFD gefährdet. Achsenabweichungen muss ebenfalls besondere Beachtung geschenkt werden. Patienten und Methoden: Bei 4Patienten (Alter 2,5-11Jahre) mit PFFD (Pappas-KlasseIII (1Patient), KlasseVII (3Patienten)) wurden 5Verlängerungen mit Achsenkorrektur durchgeführt. Es wurde ein kniegelenküberbrückender Fixateur externe (Monotube, Triax®) verwendet, der Tibia und Femur mit einem Scharniergelenk verbindet und das Kniegelenk vor Kontraktur oder Luxation schützt. Die Verlängerungen lagen zwischen 3 und 11cm. Resultate: Alle Patienten erreichten nach Verlängerung die vorherige Knie- und Hüftbeweglichkeit. Eine Hüftgelenkkontraktur kann während der Verlängerung die Einbeziehung des Hüftgelenks in das Fixateursystem notwendig machen. Dies war bei den in diesem Beitrag beschriebenen 4Patienten nicht erforderlich. Schlussfolgerung: Vier konsekutive Verlängerungen bei angeborenem longitudinalem Femurdefekt erfolgten unter Luxationsschutz des Kniegelenks durch ein kniegelenküberbrückendes Flexionsbewegungen erlaubendes Fixateursystem. Bei diesen Patienten konnte eine Kontraktur bzw. Luxation vermieden werden. Wir denken, dass ein solches System bei entsprechenden Verlängerungen in Betracht gezogen werden sollt

Pitfalls of lateral external fixation for supracondylar humeral fractures in children

Introduction: Closed reduction and percutaneous pinning is a standard treatment for dislocated supracondylar humeral fractures in children. However, the management of these fractures remains challenging. The aim of this study was to evaluate lateral external fixation as a treatment alternative for these fractures. Materials and methods: All supracondylar fractures treated with lateral external fixation between 2005 and 2007 were evaluated retrospectively. Long-term outcome was assessed with regards to carrying angle, malalignment, and motion. Results: Twenty-eight patients with Gartland type III fractures and one with a Y-type fracture were included in the study (mean age 6.5 years). Cosmetic results were excellent in 88%, good in 8%, and fair in one patient. Functional results were excellent in 83%, good in 10%, and fair in 7%. However, 3 patients (10%) showed complete radial palsy postoperatively. In all of these patients, high insertion of the proximal pin (2.9–3.6 cm above the fracture) was noted. On revision, one superficial lesion and one total transection of the nerve at the level of the proximal pin was detected. One patient showed no macroscopic damage. The transected nerve was reconstructed using an autograft, and all patients completely recovered within 2–6 months. Conclusion: Lateral external fixation is an alternative method for the treatment of displaced or unstable supracondylar fractures in children, facilitating reduction and improving fracture stability. However, iatrogenic radial nerve injury is a risk, and we therefore strongly recommend inserting the proximal pin under direct vision within 2 cm from the fracture line using a drill sleeve

The state and perspectives of development of the domestic shipbuilding in the North in the first half of the 19th century through the eyes of provincial officials (data of the State Archive of the Arkhangelsk region)

Based on the data from the State Archive of the Arkhangelsk Region, the article assesses the status of merchant and folk Pomor shipbuilding in the North in the 20th century. The key method of the research is the induction method, which is actively used in the historical school of economics, which set as its goal, including the analysis of specific economic situations in a state at a certain stage of its historical de-velopment. During the process of research, the analysis has been made of the certain cases and documents of the Arkhangelsk Society for the Study of the Russian North, as well as historical reviews of the Arkhangelsk Governorate Statistical Committee. The conclusion was made overall about the negative perception of regional authorities of the level of development of commodity turnover in the Empire, the absence of high-quality “logistics,” bureaucratic red tape, legal barriers to support shipbuilders, as well as technological advantages of foreign fishing vessels. A constructive reform of the regional authorities in the second half of the 19th century meant the plan for the development of road infrastructure between Arkhangelsk and the town of Povenets in the Olonets Province (Governorate), the development of skipper courses, the creation of a typical improved model of a karbas and a cargo schooner for training future shipbuilders, skippers

Erträge und Bodenparameter nach 20 Jahren Direktsaat und Pflug

Seit 1994 werden auf der Dauerbeobachtungsfläche Oberacker am Inforama Rütti in Zollikofen auf einem schwach humosen sandigen Lehm die beiden Anbausysteme Direktsaat und Pflug miteinander verglichen. In einem Streifenversuch mit sechs verschiedenen Parzellen werden im Rahmen einer Fruchtfolge die sechs Kulturen Eiweisserbsen – Winterweizen – Ackerbohnen – Wintergerste – Zuckerrüben – Silomais angebaut. Nach 20 Versuchsjahren wurden die Nährstoffversorgung des Bodens untersucht und die Erträge statistisch ausgewertet. Die Bodenproben wurden schichtweise bis in eine Tiefe von 50 cm entnommen und auf organischen Kohlenstoff (Corg), Stickstofftotalgehalt (Ntot), Phosphor (P), Calcium (Ca), Kalium (K), Magnesium (Mg), pH-Wert und Lagerungsdichte untersucht. Im Gegensatz zum Pflugsystem waren bei Direktsaat Corg, Ntot, K und Mg in der obersten Bodenschicht angereichert, der pH-Wert war tiefer und P und Ca zeigten leichte Konzentrationsmaxima bei rund 20 cm Tiefe. Über das ganze Bodenprofil betrachtet war der Vorrat an Corg und allen untersuchten Nährelementen in beiden Systemen vergleichbar hoch. Der über 20 Jahre gemittelte Relativertrag ist bei der Direktsaat im Vergleich zum Pflug um 2,6 % tendenziell, aber nicht signifikant höher. Bei der langjährig auf die Direktsaat abgestimmten Fruchtfolge (ab 2000 ohne Kartoffeln) mit permanenter Bodenbedeckung erbrachten Wintergetreide und Leguminosen im Direktsaatsystem sogar signifikant höhere Erträge als bei gepflügten Böden

Endochin-like quinolones (ELQs) and bumped kinase inhibitors (BKIs): Synergistic and additive effects of combined treatments against Neospora caninum infection in vitro and in vivo.

The apicomplexan parasite Neospora caninum is an important causative agent of congenital neosporosis, resulting in abortion, birth of weak offspring and neuromuscular disorders in cattle, sheep, and many other species. Among several compound classes that are currently being developed, two have been reported to limit the effects of congenital neosporosis: (i) bumped kinase inhibitors (BKIs) target calcium dependent protein kinase 1 (CDPK1), an enzyme that is encoded by an apicoplast-derived gene and found only in apicomplexans and plants. CDPK1 is essential for host cell invasion and egress; (ii) endochin-like quinolones (ELQs) are inhibitors of the cytochrome bc1 complex of the mitochondrial electron transport chain and thus inhibit oxidative phosphorylation. We here report on the in vitro and in vivo activities of BKI-1748, and of ELQ-316 and its respective prodrugs ELQ-334 and ELQ-422, applied either as single-compounds or ELQ-BKI-combinations. In vitro, BKI-1748 and ELQ-316, as well as BKI-1748 and ELQ-334, acted synergistically, while this was not observed for the BKI-1748/ELQ-422 combination treatment. In a N. caninum-infected pregnant BALB/c mouse model, the synergistic effects observed in vitro were not entirely reproduced, but 100% postnatal survival and 100% inhibition of vertical transmission was noted in the group treated with the BKI-1748/ELQ-334 combination. In addition, the combined drug applications resulted in lower neonatal mortality compared to treatments with single drugs