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European journal of heart failure (2020). doi:10.1002/ejhf.1749, Published by Wiley, Oxford

Purpose Surgical treatment for partial rotator cuff tears may include debridement of the tear, subacromial decompression or repair of the tear. Repair of the tear can be either in-situ repair, or completion of the tear followed by repair. Though it is agreed that surgical repair is required for tears more than 50% of the thickness of rotator cuff, there is no consensus on ideal surgical treatment of these cases. This systematic review and meta-analysis was carried out to compare functional outcomes following these two different surgical treatments of PTRC tears. Methods Search of electronic databases Google Scholar, PubMed, Ovid, and the Cochrane Register of Controlled Trials for published randomised controlled trials (RCTs) was undertaken. Search was done using a pre-designed search strategy. Critical appraisal of eligible studies was done for methodological quality using Cochrane Collaboration’s tool. Functional scores used for meta-analysis were visual analogue scale for pain, Constant Score and American Shoulder and Elbow Surgeons shoulder score. Results Four studies reporting total 282 repairs were eligible to be included in the meta-analysis. No statistically significant difference was found between the two groups in terms of Constant Score and American Shoulder and Elbow Surgeons shoulder score. Results were significantly better in the trans-tendon repair groups in terms of re-tear rates. There was no significant difference in functional outcome scores between the two groups. Conclusion Tran-tendon repair technique may offer some benefits over tear completion and repair in terms of re-tear rates. Both techniques of surgical repair have shown equivalent functional outcomes at follow up. Current literature is insufficient to show superiority of one technique over the other.

Clinical cardiology 45(4), 352-358 (2022). doi:10.1002/clc.23819, Published by Wiley, Weinheim [u.a.]

The outcome of arthroscopic anterior cruciate ligament reconstruction (ACLR) in the non-athlete population is under-reported. The study aimed to compare the functional outcomes of ACLR in the non-athlete and athlete population by patient reported outcome measures (PROMs)- International Knee Documentation Committee score (IKDC), Lysholm knee scoring scale, Forgotten joint score (FJS-12) and return to pre-injury activity level. The study also correlated the FJS-12 score with other commonly used PROM's (IKDC and Lysholm).This was a prospective comparative study including patients undergoing ACLR. Patients were divided into two groups. Group-1 (non-athletes) and Group-2 (athletes, defined as those with pre-injury Tegner activity level 5). Demographic profile, management of associated meniscal injury, perioperative and midterm complications were noted. All patients had 24 months follow-up. Knee laxity assessment by pivot shift test, functional outcome scores (Lysholm and IKDC) and FJS-12 were assessed preoperatively and postoperatively at 12 and 24 months.Group 1 and 2 included 69 and 47 participants, respectively, (total 116 patients). The mean age of group 1 was significantly higher than group 2 (33.1 ± 8.0 vs 25.0 ± 4.9 years; p 0.005). There was no statistically significant difference in PROMs and FJS-12 scores between the groups at any follow-up. Return to pre-injury Tegner activity level post-ACLR was 88.4% (n = 61) and 46.8% (n = 22) in group 1 and 2, respectively (p). The ceiling effect in FJS-12, IKDC, and Lysholm scores were achieved by 9.3%, 19.5%, and 34.7% of patients (n = 116), respectively, at 2-year follow-up. The ceiling effect of FJS-12, Lysholm, and IKDC scores between the groups at final follow-up was not statistically significant (p = 1, p = .524, p = .09, respectively).The functional outcome of ACLR was comparable between athletes and non-athletes. FJS-12 has a lower ceiling effect and better discriminatory power than Lysholm and IKDC scores. FJS-12 score can be satisfactorily used in ACLR to observe and monitor changes in patient satisfaction and outcome.II, Prospective comparative study.

Peripheral nerve blocks can be a suitable alternative to central neuraxial blockage, as the sole anaesthetic agent for better early postoperative outcomes, decreased hospital stay and earlier mobilisation after anterior cruciate ligament reconstruction (ACLR) surgery. The purpose of this study was to compare consciousness during the procedure, pain during early postoperative period ( 7 days), and perioperative outcomes following ACLR using combined sciatic, femoral, and obturator nerve blocks compared to the spinal anaesthesia.This was a prospective case-control study including patients between 18 and 55 years of age, with anterior cruciate ligament (ACL) injury confirmed clinically and radiologically and undergoing ACLR. Patients were allocated in the two groups alternatively, group 1 included patients who received combined nerve blocks, and group 2 included patients who received spinal anaesthesia for the surgery. The sensory effect, motor effect, adequacy of anaesthesia, perioperative analgesic use, duration of stay, postoperative pain (visual analogue scale 0-10 cm) and functional outcomes were noted.There were 60 patients in each group. A total of seven patients in group 1 (11%) and two patients in group 2 (3%) needed conversion to general anaesthesia (n.s.). In group 1, out of 53 patients who underwent surgery, 26 patients had no perception of surgery in the joint, 17 patients had perception of manipulation of the knee joint, 4 patients had sense of touch, and 6 patients had sensation of pain in the knee (VAS scale less than 3). In group 2, out of 58 patients, 42 patients had no perception of surgery, 12 had a perception of manipulation of the knee joint, 2 had sense of touch, and 2 had sensation of pain in the knee. Blockage of sensory effect was significantly better in group 2 (p = 0.0001). However, the motor effect was comparable between the two groups (n.s.). Group 1 had significantly better pain scores 6, 12, and 18 h after the surgery. Moreover, patients in group 1 also had faster ambulation (mean difference of 5.5 h, p = 0.0001) and reduced hospital stay (mean difference of 8.4 h, p = 0.0001).Combined sciatic, femoral, and adductor canal block is an effective sole anaesthetic modality for ACLR. The sensory effect was inferior when compared to spinal anaesthesia but sufficient for the procedure without the need for supplementation with any other anaesthetic modality. Patients receiving this combined nerve block had lesser early postoperative pain scores, earlier ambulation, and shorter hospital stay as compared to the spinal anaesthesia.Level 3.

Elevated fibroblast growth factor 23 (FGF23) levels are associated with adverse outcome in populations with cardiovascular disease and chronic kidney failure. It is unclear if FGF23 has significance in prognosis estimation in patients with acute heart failure (HF) when compared to traditional risk estimation tools. Serum levels of intact FGF23 were assessed in 139 patients admitted to the Intermediate Care Unit of a tertiary hospital for acute HF. Patients were followed-up for one year. After exclusion of patients who were lost to follow-up, data outliers, and patients with sampling errors, the final study cohort comprised 133 patients. The Seattle Heart Failure (SHF) Model was used to estimate one-year survival. FGF23 levels correlated with HF severity and were strongly associated with one-year mortality. Associations between one-year outcome and FGF23, assessed on day 1 after admission, were still evident after multivariable adjustment (OR 15.07; 95%CI 1.75–129.79; p = 0.014). FGF23 levels predicted the one-year outcome with similar accuracy as the SHF Model, both if assessed on day 1 and on day 2 after admission (FGF23d1: AUC 0.784; 95%CI 0.669–0.899; FGF23d2: AUC 0.766; 95%CI 0.631–0.901; SHF: AUC 0.771; 95%CI 0.651–0.891). The assessment of FGF23 in patients with acute HF might help identify high-risk patients that are more prone to complications, need a closer follow-up and more aggressive treatment.

Uber die letzten Jahre zeigte sich innerhalb der deutschen Bevolkerung ein deutlicher Trend hin zum Ubergewicht. Durch technologischen Fortschritt nimmt die Zahl wirbelsaulenchirurgischer Eingriffe, insbesondere von Fusionsoperationen zu. Bei adiposen Patienten sollte man sich bei der Indikation und der Op.-Vorbereitung der spezifischen pra-, intra- und postoperativen Herausforderungen bewusst sein und darauf einstellen.

Accelerated and premature cardiovascular calcification is a hallmark of patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD). The presence and the amount of cardiovascular calcification are among the driving forces of increased morbidity and mortality in renal patients. Cardiovascular calcification occurs at different sites, including the cardiac valves-a location that is of particular importance for both the patient and the treating physician. The correlation between degree of calcification and functional impairment is particularly close at the aortic valve, that is, the amount of calcification predicts the degree of stenosis. Calcific aortic stenosis (CAS) is the most prevalent valvular heart disease in Western societies. CAS is particularly prevalent in patients with underlying CKD or ESRD. CAS increases afterload and hence contributes to the widespread finding of left ventricular hypertrophy in CKD/ESRD patients. Medical treatment options to prevent the development and progression of CAS are limited. Hence, close surveillance and timely referral of patients for heart valve replacement therapy is a mainstay of current therapy. Novel treatment approaches, such as transcatheter aortic valve implantation, offer promising yet challenging options for elderly, comorbid, and often frail patients with CAS in combination with advanced CKD/ESRD.

Nach einem kunstlichen Huftgelenksersatz klagen bis zu 6% der Patienten mit radiologisch unauffalligen Prothesen uber Schmerzen im Operationsbereich. Hier ist eine sorgfaltige Diagnostik essenziell, um die Ursachen benennen und das weitere Vorgehen planen zu konnen.

20–25% der Patienten sind nach einem Kunstgelenkersatz des Kniegelenks unzufrieden und berichten uber Belastungsschmerz, rezidivierende Schwellungszustande, Steifheit oder Instabilitatsgefuhl beim Treppensteigen. Mit einer subtilen Anamnese, korperlichen Untersuchung und Bildgebung muss versucht werden, eine exakte Ursache zu eruieren. Gelingt dies, kann eine stadiengerechte konservative oder operative Therapie durchgefuhrt werden.

Stellt sich ein Patient mit anhaltenden, nicht durch einen Unfall oder eine Arthrose zu erklarende Gelenkschmerzen vor, sollten Sie an ein Knochenmarkodem-Syndrom denken. Dieses ist zwar meist selbstlimitierend. Wichtig ist jedoch, dass eine Osteonekrose, die rasch progredient und zerstorend verlauft, nicht ubersehen wird.

Schwindel ist eines der haufigsten Beschwerdebilder. Mit wenigen Untersuchungen lasst sich der Schwindel meist einordnen. Apparative Untersuchungen sind in den seltensten Fallen wirklich notwendig und meist nicht zielfuhrend. Erfahren Sie hier, wie Sie den Schwindel Ihrer Patienten einordnen konnen und welche Therapieoptionen bestehen.

Objective: We aimed to elucidate the local role of FGF23 after myocardial infarction in a mouse model induced by left anterior descending artery (LAD) ligation.Approach and results: (C57BL/6N) mice underwent MI via LAD ligation and were sacrificed at different time-points post MI. The expression and influence of FGF23 on fibroblast and macrophages was also analyzed using isolated murine cells.We identified enhanced cardiac FGF23 mRNA expression in a time-dependent manner with an early increase, already on the first day after MI. FGF23 protein expression was abundantly detected in the infarcted area during the inflammatory phase. While described to be primarily produced in bone or macrophages, we identified cardiac fibroblasts as the only source of local FGF23 production after MI. Inflammatory mediators, such as IL-1 beta, IL-6 and TNF-alpha, were able to induce FGF23 expression in these cardiac fibroblasts. Interestingly, we were not able to detect FGF23 at later time points after MI in mature scar tissue or remote myocardium, most likely due to TGF-beta 1, which we have shown to inhibit the expression of FGF23. We identified FGFR1c to be the most abundant receptor for FGF23 in infarcted myocardium and cardiac macrophages and fibroblasts. FGF23 increased migration of cardiac fibroblast, as well as expression of Collagen 1, Periostin, Fibronectin and MMP8. FGF23 also increased expression of TGF-beta 1 in M2 polarized macrophages.Conclusion: In conclusion, cardiac fibroblasts in the infarcted myocardium produce and express FGF23 as well as its respective receptors in a time-dependent manner, thus potentially influencing resident cell migration. The transitory local expression of FGF23 after MI points towards a complex role of FGF23 in myocardial ischemia and warrants further exploration, considering its role in ventricular remodeling. (C) 2019 Elsevier Inc. All rights reserved.

Das Knochenmarkodem ist eine pathologische Vermehrung der interstitiellen Flussigkeit im Knochen, die in der Magnetresonanztomografie zur Darstellung kommt. Es kann atraumatisch, traumatisch, ischamisch oder reaktiv bedingt sein. Geht das Odem mit Schmerzen einher, wird es als Knochenmarkodemsyndrom bezeichnet, das sich in Einzelfallen zu einer Osteonekrose entwickeln kann. Zu den konservativen Therapieoptionen zahlen Prostazyklininfusionen oder Bisphosphonate. Operativ kann eine Anbohrung erwogen werden.

Viele alte Menschen sind beim Aufstehen und Gehen auf ihre Arme angewiesen. Frakturen der oberen Extremitat fuhren hier haufig zu einem schweren Mobilitatsverlust. Um die Autonomie der Patienten wiederherzustellen und Komplikationen zu vermeiden, muss der Arzt kritisch zwischen operativer und konservativer Therapie abwagen.

Die Rotatorenmanschettenruptur und die Schulterinstabilitat lassen sich durch eine strukturierte Anamnese und eine korperliche Untersuchung gut voneinander abgrenzen. Das ist wegen der unterschiedlichen Therapieansatze von hoher Bedeutung.

Kreuzschmerzen sind weit verbreitet: Beinahe 80% aller Menschen leiden einmal in ihrem Leben unter einer Lumbalgie, die sie arbeitsunfahig macht. Aber wann wird es gefahrlich, und wann ist welche Therapie indiziert?

Cardiovascular diabetology 20(1), 6 (2021). doi:10.1186/s12933-020-01175-5, Published by BioMed Central, London

This study sought to retrospectively evaluate the clinical and magnetic resonance imaging (MRI) outcomes of u-HA/PLLA pin (u-HA/PLLA: hydroxyapatite/poly-L-lactic acid) pin fixation of unstable osteochondritis dissecans (OCD) lesions of the knee.Seven adolescent patients (four females and three males) with arthroscopically unstable OCD lesions of the knee were included. The mean age at diagnosis was 13.1 years. Clinical results were evaluated preoperatively and during follow-up using the Ogilvie-Harris score (0 - 15 points). MRI scans were performed preoperatively and during follow-up, with results evaluated using the Dipaola classification (grades 1 - 4). Mean follow-up time was 29 months.The median Ogilvie-Harris score improved from 13 points (range: 10 - 14 points) to 15 points (range: 13 - 15 points). Separately, the median Dipaola score improved from 3 points (range: 2 - 4 points) to 1 point (range: 1 - 4 points). No complications such as infection, synovitis, or intra-articular adhesion were observed.Initial experiences using bioabsorbable u-HA/PLLA pins for the refixation of unstable OCD lesions in adolescents in the knee are promising, and MRI provides excellent monitoring of healing.Retrospektive klinische und MRT-basierte (MRT: Magnetresonanztomografie) Auswertung einer ersten Fallserie von mittels bioabsorbierbaren u-HA/PLLA-Pins (u-HA/PLLA: ungesintertes Hydroxylapatit/Poly-L-Laktat) fixierten instabilen Osteochondrosis dissecans (OCD)-Läsionen des Kniegelenkes.Eingeschlossen wurden sieben Jugendliche (vier weiblich, drei männlich) mit arthroskopisch instabilen OCD-Läsionen des Kniegelenkes. Das mittlere Alter bei Diagnose betrug 13,1 Jahre. Die Auswertung erfolgte präoperativ und im Follow-up über durchschnittlich 29 Monate, jeweils klinisch mit dem Ogilvie-Harris Score (0 – 15 Punkte) bzw. mittels MRT-Untersuchungen und dem Dipaola Score (Grad 1 – 4).Der mediane Ogilvie-Harris-Score verbesserte sich von 13 Punkten (Range: 10 – 14 Punkte) auf 15 Punkte (Range: 13 – 15 Punkte). Der mediane Dipaola Score verbesserte sich von 3 Punkten (Range: 2 – 4 Punkte) auf 1 Punkt (Range: 1 – 4 Punkte). Es wurden keine Komplikationen wie Infektionen, Synovitis oder intraartikuläre Adhäsionen festgestellt.Erste Erfahrungen mit bioabsorbierbaren u-HA/PLLA-Pins in der Refixierung von instabilen OCD-Läsionen im Knie sind vielversprechend. Das MRT erlaubt eine hervorragende Beurteilung des Heilungsverlaufes.

Background: In the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial) treatment with the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin significantly reduced heart failure hospitalization (HHF) in patients with type 2 diabetes mellitus (T2D) and established cardiovascular disease. The early separation of the HHF event curves within the first 3 months of the trial suggest that immediate hemodynamic effects may play a role. However, hitherto no data exist on early effects of SGLT2 inhibitors on hemodynamic parameters and cardiac function. Thus, this study examined early and delayed effects of empagliflozin treatment on hemodynamic parameters including systemic vascular resistance index, cardiac index, and stroke volume index, as well as echocardiographic measures of cardiac function.Methods: In this placebo-controlled, randomized, double blind, exploratory study patients with T2D were randomized to empagliflozin 10 mg or placebo for a period of 3 months. Hemodynamic and echocardiographic parameters were assessed after 1 day, 3 days and 3 months of treatment. Results: Baseline characteristics were not different in the empagliflozin (n=22) and placebo (n=20) group. Empagliflozin led to a significant increase in urinary glucose excretion (baseline: 7.3 ± 22.7 g/24 hrs; day 1: 48.4 ± 34.7 g/24 hrs; p

This article aimed to study in a systematic manner outcomes and complication rates after total knee arthroplasty (TKA) in patients who have undergone a prior knee arthroscopy for osteoarthritis. Our hypothesis was that a prior knee arthroscopy may be detrimental to the outcomes of knee arthroplasty in the future. Electronic searches were performed for all studies published before June 2020. We included studies in which at least one group had a non-ligament knee arthroscopy surgery prior to primary knee arthroplasty. MINORS (Methodological index for non-randomized studies) criteria was used to assess the methodological quality of all the studies. Seven retrospective studies were included in the systematic review. The total number of TKA without prior arthroscopies was 138,630, and the total TKA after a prior arthroscopy was 4372. Of the five studies that reported functional outcomes, three studies reported no difference, whereas two studies reported worse outcomes in patients with a prior knee arthroscopy. Higher rates of prosthetic joint infection and overall complications were seen in patients with a prior knee arthroscopy. Total knee arthroplasty, when preceded by knee arthroscopy for osteoarthritis may lead to an increase in complication rates like prosthetic joint infections, revision, and re-operations. However, no significant differences were observed in patient-reported functional outcomes and range of joint motion. An association with postoperative complications after subsequent TKA should be a deterrent in advocating this procedure in an arthritic knee. III.

BackgroundIn the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial) treatment with the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin significantly reduced heart failure hospitalization (HHF) in patients with type 2 diabetes mellitus (T2D) and established cardiovascular disease. The early separation of the HHF event curves within the first 3 months of the trial suggest that early hemodynamic effects may play a role, potentially mediated by direct diuretic effects of the drug. In this study we examined immediate and more delayed effects of empagliflozin on urinary volume excretion, left ventricular filling pressure and function in addition to hemodynamic parameters.MethodsIn this placebo-controlled, randomized, double blind, exploratory study patients with T2D were randomized to empagliflozin 10 mg or placebo for a period of 3 months. Urinary volume excretion, echocardiographic and hemodynamic parameters were assessed after 1 day, 3 days and 3 months of treatment.ResultsBaseline characteristics were comparable in the empagliflozin (n = 20) and placebo (n = 22) group. Empagliflozin led to a significant increase of urinary glucose excretion (baseline: 7.3 ± 22.7 g/24 hrs; day 1: 48.4 ± 34.7 g/24 hrs; p

Journal of Clinical Medicine 11(3), 601 (2022). doi:10.3390/jcm11030601, Published by MDPI, Basel

Percutaneous transluminal coronary angioplasty and subsequent vascular scaffold implantation remains the prevalent invasive treatment of coronary heart disease. In-stent restenosis remained a problem with bare metal stents, until drug-eluting stents were introduced. The inhibition of the healing process by the antimitotic drug coating and the permanent metallic remnant can promote sub-acute and delayed stent thrombosis. Thus, the development of biodegradable stents emerged as a subject of research. Magnesium-based bioabsorbable devices can provide sufficient radial force in the acute phase of vessel-treatment and degrade thoroughly in aqueous environment, making them potential new candidates for vascular scaffold applications. Magnesium alloys tend to degrade very quickly due to their high electrochemical corrosion potential. Plasma Electrolytic Oxidation modification of magnesium alloys improves interface and degradadation properties and may therefore enhance the performance and suitability for vascular scaffold applications of these materials. Assuring the hemocompatibility and foremost assessing the thrombogenicity of new biomaterials prior to their use is essential in order to avoid adverse effects. The goal was to assess thrombocyte adhesion on coated Mg-RE and Mg-Zn-Ca alloys. Static experiments with human blood were carried out on the plasma-electrolytically treated or corresponding untreated Mg alloy in order to assess quantity and quality of thrombocyte adhesion via standardized SEM imaging. In a second step, a parallel plate flow chamber was designed in order to examine thrombocyte adhesion under dynamic flow conditions. During flow chamber experiments the test-materials were exposed to human thrombocyte concentrate and the number of adherent thrombocytes was assessed. The flow chamber was additionally perfused with human blood and thrombocyte adhesion was semiquantitatively and qualitatively assessed via SEM imaging and subsequent scoring. In conclusion, a new parallel plate flow chamber design simulating blood-circulation was successfully established, enabling the further assessment of platelet adhesion on bioabsorbable materials under dynamic flow conditions. Static and dynamic experiments showed, that plasma-electrolytically treated specimens showed low thrombocyte adhesion on both alloys, proposing their potential use in vascular scaffolds. The uncoated magnesium alloys showed rapid degradation along with gas formation due to the chemically active surface and therefore give concern regarding their safety and suitability for vascular applications.

Im grosten Gelenk des menschlichen Korpers, dem Kniegelenk, bilden das Tibiofemoral- und das Femoropatellargelenk im Zusammenspiel eine funktionelle Einheit. Bei Kniebeschwerden ist die klinische Untersuchung die Basis fur die weitere bildgebende Diagnostik. Vieles konnen Sie als Hausarzt im Vorfeld klaren!

Das Huftgelenk ist nicht direkt durch die Haut palpabel. Eine klinische Untersuchung ist daher anspruchsvoll und die eindeutige Zuordnung sowie Reproduzierbarkeit spezifischer Tests zu einem einzelnen Krankheitsbild nicht immer einfach. Hier erhalten Sie wertvolle Tipps.

Background Non-cemented acetabular cup components demonstrated different clinical performance depending on their surface texture or bearing couple. However, clinical osseointegration needs to be proved for each total joint arthroplasty (TJA) design. Aim of this study was to detect the in vivo migration pattern of a non-cemented cup design, using model-based roentgen stereophotogrammetric analysis with elementary geometrical shape models (EGS-RSA) to calculate early cup migration. Methods Interchangeable applicability of the model-based EGS-RSA method next to gold standard marker-based RSA method was assessed by clinical radiographs. Afterwards, in vivo acetabular cup migration for 39 patients in a maximum follow up of 120 months (10 years) was calculated using model-based EGS-RSA. Results For the axes with the best predictive capability for acetabular cup loosening, mean (±SD) values were calculated for migration and rotation of the cup. The cup migrated 0.16 (±0.22) mm along the cranio-caudal axis after 24 months and 0.36 (±0.72) mm after 120 months, respectively. It rotated − 0.61 (±0.57) deg. about the medio-lateral axis after 24 months and − 0.53 (±0.67) deg. after 120 months, respectively. Conclusions Interchangeable applicability of model-based EGS-RSA next to gold standard marker-based RSA method could be shown. Model-based EGS-RSA enables an in vivo migration measurement without the necessity of TJA specific surface models. Migration of the investigated acetabular cup component indicates significant migration values along all the three axes. However, migration values after the second postoperative year were within the thresholds reported in literature, indicating no risk for later aseptic component loosening of this TJA design.

Zusammenfassung Einleitung Ziel dieser Arbeit ist es, Veränderungen der Qualität bzw. Komplikationshäufigkeit in der Knieendoprothetik durch die Etablierung eines Endoprothesenzentrums (EPZ) zu untersuchen. Material und Methode Es handelt sich um eine retrospektive Studie, in der 100 Fälle in dem Jahr vor Einführung des EPZ an unserer Klinik (Gruppe I) mit 100 Fällen in dem Folgejahr nach Einführung des EPZ (Gruppe II) verglichen wurden. Die Daten wurden der elektronischen Patientenakte entnommen bzw. dem Entlassbrief der Rehaklinik. Es wurden die Parameter – die für die Etablierung eines EPZ gefordert sind – „Vorliegen Röntgenaufnahme“ vor der Operation und nach der Operation, „Vorliegen Ganzbeinstandaufnahme prä-OP oder Navigation“, „Vorliegen präoperative Prothesenplanung“, OP-Zeit primäre Knie-TEP im Zentrum Ergebnisse Bei den perioperativen Komplikationen fanden sich sowohl bei den lokalen als auch den systemischen Komplikationen keine statistisch signifikanten Unterschiede. Die OP-Dauer betrug in Gruppe I 82,9 min (Min.: 55, Max.: 141) und in Gruppe II 81,5 min (Min.: 57, Max.: 129; p > 0,05). In Gruppe I betrug bei 20/100 Fällen (20%) die OP-Dauer über 100 Minuten, in Gruppe II bei 13/100 (13%) (p Schlussfolgerung Durch die Einführung eines EPZ konnte in der aktuellen Studie nur bei dem Parameter „OP-Dauer über 100 Minuten“ und Vorliegen der Untersuchung der Patientenzufriedenheit eine signifikante Verbesserung erzielt werden, bei der Komplikationshäufigkeit jedoch nicht.

Mit dem Alter wird die Therapie des Morbus Parkinson zunehmend komplexer. Neben motorischen und nicht-motorischen Symptomen bestehen im fortgeschrittenen Stadium haufig Wirkfluktuationen der medikamentosen Therapie sowie neuropsychiatrische und autonome Storungen, die der Arzt mitbehandeln muss. Die Kombination aus medikamentosen und funktionellen Therapien kann die Situation verbessern.

Die Fruhsommermeningoenzephalitis (FSME) ist eine durch Zecken ubertragene Viruserkrankung des Nervensystems. Sie ist zwar wesentlich seltener als die ebenfalls durch Zecken ubertragene Borreliose, hinterlasst aber letztlich haufiger dauerhafte neurologische Defizite. Zudem ist fur die FSME keine kausale Therapie verfugbar, weshalb der Prophylaxe entscheidende Bedeutung zukommt. Im Falle einer Infektion mussen die Krankheitszeichen schnell erkannt und eine symptomatische Behandlung eingeleitet werden.

The aim of this study is to evaluate the difference in perioperative complication rate in total hip, bipolar hemiarthroplasties and total knee arthroplasty in patients with Parkinson disease in trauma and elective surgery in our Musculoskeletal Center during a period of 10 years. Between 2006 and 2016, 45 bipolar hemiarthroplasties in trauma surgery, 15 total knee and 19 total hip arthroplasties in patients with Parkinson’s disease were performed. We divided the patients in two groups. Group I included trauma cases (45) and group II elective surgery cases (34). Complications were documented and divided into local minor and major complications and general minor and major complications. Fisher’s exact test was used for statistical evaluation. In both groups, there was one local major complication (p > 0.05): In group I, there was one case of loosening of a K-wire which was removed operatively. In group II, there was one severe intraarticular bleeding requiring puncture of the hematoma. In group I, there were 38 general complications; in group II, there were 17 general complications. There was no statistical difference in complication rate (p > 0.05). Total hip arthroplasty, bipolar hemiarthroplasties and knee arthroplasty in patients with Parkinson disease is possible in elective and trauma surgery. Complication rate is higher in comparison with patients not suffering from Parkinson disease, but there is no difference in complication rate in elective and trauma surgery. Nevertheless, early perioperative neurological consultation in patients with Parkinson disease is recommended to minimize complications and improve early outcomes after arthroplasty.

Unter dem Begriff „Schultersteife“ werden Erkrankungen subsummiert, deren Leitsymptom die eingeschrankte aktive und passive Beweglichkeit der Schulter ist. Im Allgemeinen versteht man darunter die sogenannte Frozen Shoulder mit ihrem typischen zyklischen Krankheitsverlauf. Von dieser primaren Schultersteife sind die sekundare Formen abzugrenzen, bei denen andere Ursachen die Bewegunglichkeit des Schultergelenks einschranken.

Bei Schmerzen, Kraftminderung, Bewegungseinschrankungen und Instabilitat im Schulterbereich sind eine systematische Anamnese und klinische Untersuchung des Schultergelenks unabdingbar. In vielen Fallen lasst sich dadurch bereits eine Diagnose stellen, die durch den gezielten Einsatz bildgebender Verfahren bestatigt werden kann.