Search

A case of septic Candida albicans arthritis of the knee in a patient with systemic candidiasis is presented. Systemic and intra-articular cellular immune responses to C albicans and various bacterial antigens were monitored for 15 weeks. It is shown that the candida induced blastogenesis of synovial fluid lymphocytes was much more stimulated than that of peripheral blood lymphocytes, and that the proportion of activated cells expressing HLA class II antigens was markedly increased in the synovial fluid. Strong cellular immune responses to Candida albicans could still be shown many weeks after the synovial fluid aspirates had become sterile. For the first time synovial fluid derived, CD4 positive T lymphocyte clones with specificity for candida antigens were characterised and further propagated in vitro. [ABSTRACT FROM PUBLISHER]

Study Design: Retrospective case report. Purpose: This case demonstrates that paraplegia can develop due to chylous leakage into the spinal canal without obvious retroperitoneal or intrathoracic involvement. Background Information: This clinical presentation of chylous leakage has not been reported previously. RESULTS A 61-year-old female with osteoporosis suffered a pathologic fracture of the vertebral bodies T12 and L1 and developed partial paraplegia two weeks later. Imaging showed expansive pooling of intraspinal fluid without intrathoracic or retroperitoneal involvement. A blood-tinged fluid was aspirated from dorsal. Repeated surgery by a posterior approach with drainage of the fluid did not improve the patient's condition, so she was finally transferred to our hospital. Under the suspected diagnosis of lymphatic leakage a scintiscan with 123I-iodinephenylpentadekanacid-marked cream verified the presumption of a lymph fistula at the level of T12/L1, originating from the thoracic duct. By permanent draining of the posterior fistula without suction and strict intravenous alimentation the fluid production decreased continuously and finally ceased completely. Simultaneously, the neurologic state improved gradually without returning to normal completely. Conclusions: This case demonstrates that paraplegia can develop due to chylous leakage into the spinal canal without obvious retroperitoneal or intrathoracic involvement. This differential diagnosis should be kept in mind when treating patients with abundant fluid drainage into or from the spinal canal. [ABSTRACT FROM AUTHOR]

Polymer materials are actively used in dielectric capacitors, in particular for energy storage applications. An enhancement of the stored energy density can be achieved in composites of electroactive polymers and dielectric inorganic fillers with a high dielectric permittivity. In this article, we report on the energy storage characteristics of composites of relaxor terpolymer P(VDF-TrFE-CFE) and BaZr 0.2 Ti 0.8 O 3 (BZT) nanoparticles. The choice of materials was dictated by their large dielectric permittivity in the vicinity of room temperature. Free-standing composite films, with BZT contents up to 5 vol.%, were prepared by solution casting. The dielectric properties of the composites were investigated over a wide range of frequencies and temperatures. It was shown that the addition of the BZT nanoparticles does not affect the relaxor behavior of the polymer matrix, but significantly increases the dielectric permittivity. The energy storage parameters were estimated from the analysis of the unipolar polarization hysteresis loops. The addition of the BZT filler resulted in the increasing discharge energy density. The best results were achieved for composites with 1.25-2.5 vol.% of BZT. In the range of electric fields to 150 MV/m, the obtained materials demonstrate a superior energy storage density compared to other P(VDF-TFE-CFE) based composites reported in the literature.

Major traumatic and surgical injury increase the risk for infectious complications due to immune dysregulation. Upon stimulation with interleukin (IL) 12 by monocyte/macrophages, natural killer (NK) cells release interferon (IFN) γ that supports the elimination of the pathogen. In the present study, we investigated the impact of invasive spine surgery on the relationship between monocytes and NK cells upon exposure to Staphylococcus aureus . Mononuclear cells and serum were isolated from peripheral blood of patients before and up to 8 d after surgery and stimulated with inactivated S. aureus bacteria. NK cell and monocyte function were determined by flow cytometry. NK cells continuously lost their ability to produce IFN-γ during the first week after surgery independently from monocyte-derived IL-12 secretion. IFN-γ synthesis was minimal on day 8 and was associated with decreased expression of the IL-12 receptor and activation of transcription factors required for IFNG gene transcription. Addition of recombinant IL-12 could at least partially restore NK cell function. Pre-operative levels of growth/differentiation factor (GDF) 15 in the serum correlated with the extent of NK cell suppression and with hospitalization. Thus, NK cell suppression after major surgery might represent a therapeutic target to improve the immune defense against opportunistic infections.

The temperature dependence of the dielectric permittivity and polarization hysteresis loops of P(VDF-TrFE-CFE) polymer films with different compositions are studied. Among them, the three compositions, 51.3/48.7/6.2, 59.8/40.2/7.3, and 70/30/8.1, are characterized for the first time. Relaxor behavior is confirmed for all studied samples. Increasing the CFE content results in lowering the freezing temperature and stabilizes the ergodic relaxor state. The observed double hysteresis loops are related to the field-induced transition to a ferroelectric state. The critical field corresponding to this transition varies with the composition and temperature; it becomes larger for temperatures far from the freezing temperature. The energy storage performance is evaluated from the analysis of unipolar polarization hysteresis loops. P(VDF-TrFE-CFE) 59.8/40.2/7.3 shows the largest energy density of about 5 J·cm -3 (at the field of 200 MV·m -1 ) and a charge-discharge efficiency of 63%, which iscomparable with the best literature data for the neat terpolymers.

Viral infections are common complications of pregnancy, with a wide range of obstetric and neonatal sequelae. Currently, there are limited data on whether SARS-CoV-2 is vertically transmitted in pregnant women tested positive for the virus. Here we describe a case of a known SARS-CoV-2-positive woman giving preterm birth to two fetuses with SARS-CoV-2 positive testing in placental tissue and amniotic fluid. The placental histological examinations showed chronic intervillositis and extensive intervillous fibrin depositions with ischemic necrosis of the surrounding villi.

Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro's and the con's of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS., (Copyright © 2019 Facts, Views & Vision.)

Study Design: A prospective, controlled, open, randomized multicenter study., Objective: The study's objective was to demonstrate equivalence of a novel, moldable, resorbable, and degradable synthetic polymer (Bone Seal) compared with a collagen fleece (Lyostypt) in efficacy and safety for topical hemostasis after iliac crest bone graft harvesting., Summary of Background Data: Harvesting cortico-cancellous bone from the iliac crest is a well established procedure in orthopedic and particularly in spine surgery. It is associated with significant morbidity at the donor site where hematoma formation may cause impaired wound healing and infections in up to 10% of cases., Methods: A total of 112 patients were included in the safety analysis. Safety was determined by a compound wound healing score and the incidence of adverse clinical effects. One hundred and eight patients were studied for equivalence in efficacy using a compound bleeding score. The handling properties and the application to the bone surface of either device were measured with two additional compound scores., Results: The mean bleeding scores in the final analysis was 4.5 +/- 1.3 for the Bone Seal group and 4.2 +/- 1.3 for the collagen fleece group. Bone Seal was better applicable to the bleeding bone surfaces than the collagen fleece, even though its handling was more complicated. Wound healing and the incidences of adverse clinical events were comparable in either study group., Conclusions: Bone Seal is an effective and safe hemostatic material for sealing bleeding bone surfaces after iliac crest bone graft harvesting. By virtue of its hemostatic efficacy, Bone Seal is preventive for wound healing disorders.

Emergency caesarean section was performed in a 40-year-old woman with solutio placentae. A Couvelaire uterus was diagnosed, showing typical blue-purple discolorations of the uterine wall, which are in fact haemorrhages caused by disseminated intravascular coagulation.

The equipment available for rehabilitation of patients with joint conditions still lacks a device that, in common with usual physiotherapeutic measures (manipulation, proprioceptive neuromuscular facilitation, Bobath therapy), is based on traction and/or compression or oscillating forms. The novel "Shoulder Rotator" is such a simple device for the variable treatment of shoulder disorders in all three spatial dimensions. After individual instruction, the patient performs rotating glenohumeral exercises with simultaneous glenohumeral joint traction, compression, or oscillations against static or dynamic resistance. The "Shoulder Rotator" is similar to the established continuous passive motion device for the shoulder and is mounted on a mobile chair. The electronic device control is computerised and permits a wide variety of treatment options, individual regimes, and documentation. The oscillating, compression/distraction mode of operation provides an analgesic effect. The isolated compression mode along the rotatory axis enables conditioning of joint proprioception. The distraction mode along the rotatory axis facilitates muscular relaxation. Resistive rotatory exercises strengthen the rotatory glenohumeral muscles and help centre the humeral head in the glenoid. In addition to the advantage of adding documentation of treatment progress as required for evidence-based medicine, this novel device may bring about a cost-effective, genuine quality improvement in shoulder rehabilitation.

To compare perinatal outcome of singleton versus twin pregnancies a matched cohort study was performed in Flanders, Belgium. All twins delivered in the region of Flanders during 1998-1999 were compared to singletons, matched for gestational age, fetal sex and maternal parity, resulting in 4384 infants in each group. Above 32 weeks of gestation, birthweight was significantly lower in twins (2095 +/- 364 g versus 2315 +/- 523 g; p < 0.001, 95% confidence interval 193 to 246 g). Perinatal mortality was also significantly lower in twins (1.98% versus 1.26%; odds ratio for twins 0.63; 95% confidence interval 0.53-0.75; p < 0.001 ), this was mostly due to fetal and not to early neonatal mortality. Congenital malformations occurred less frequently in twins (2.5% versus 3.7%; odds ratio for twins 0.80, 95% confidence interval 0.69-0.92; p = 0.001). From gestational age of 32 weeks on, respiratory distress syndrome was less frequent in twins (6.7% versus 8.0%; odds ratio for twins 0.81; 95% confidence interval 0.68-0.97; p = 0.011 ). No significant differences were noted with regard to intraventricular haemorrhage, neonatal infections and retinopathy of prematurity. Although twins have a lower birthweight, their outcome is more favorable compared to singletons, when matched for gestational age.

We describe the mid-term clinical results of the surgical treatment of primary degenerative arthritis of the sternoclavicular joint in eight women. They had not responded to conservative treatment and underwent a limited resection arthroplasty. For pre- and postoperative clinical evaluation we used the Rockwood score for the sternoclavicular joint. Postoperatively, the Constant score was also determined. The mean follow-up was 31 months (10 to 82). The median Rockwood score increased from 6 to 12.5 points. The median postoperative Constant score was 87 (65 to 91). Four patients had an excellent, three a good, and one a poor result. All patients were pleased with the cosmetic result. Resection arthroplasty is an effective and safe treatment for chronic, symptomatic degenerative arthritis of the sternoclavicular joint with a high degree of patient satisfaction.

The purpose of this study was to evaluate the efficacy of three screening tests in detecting glaucoma in its early stage: the Tendency Oriented Perimetry (TOP) and Frequency Doubling Perimetry (FDP) visual field tests, and the Glaucoma Diagnostic (GDx) nerve fibre layer analyser. Eighteen patients with glaucoma who showed an early defect on HFA c 24-2 and twenty normals underwent the three tests. TOP showed a sensitivity of 94.4% and a specificity of 75%, FDP showed a sensitivity of 72.2% and a specificity of 100%, and GDx a sensitivity of 77.7% and a specificity of 60%.

During a Magnetic Resonance sequence, simultaneously acquired ElectroEncephaloGraphy (EEG) data are compromised by severe pollution due to artifacts originating from the switching of the magnetic field gradients. In this work, it is shown how these artifacts can be strongly reduced or even removed through application of an adaptive artifact restoration scheme. The method has proved to be fully automatic and to retain high frequency EEG information, which is indispensable for many EEG applications.

In this paper the kinematics of arm abduction in the scapular plane of 38 healthy experimental subjects is reported. The ratio of the glenohumoral and the scapulothoracic components of the motion were determined and the influence of the abduction speed and of the external load on it were investigated. The investigation of the effect of abduction speed involved all 38 subjects. Each of them performed one slow and one fast abduction. Statistical analysis showed that there were large differences between individuals, but that for any one individual the abduction process is essentially reproducible. For the one individual there is a strong, linear relationship between glenohumeral and scapulothoracic rotation. The slope of the regression of the glenohumeral component on total arm abduction varied from 0.75 to 0.5 with a sample mean of 0.66. It means that only two-thirds of arm abduction occurs in the glenohumeral joint, the remaining third taking place via scapular rotation. In slowly performed abductions the slope of the regression was significantly greater than in the high-speed movements, but differences were very small. In the investigation of the effect of external load, statistical analysis indicated that the slope of the intraindividual regression is largely independent of the load. The possibility of observer bias was analysed, too. It was found that the standard deviation of the abduction parameters determined by different observers was between 6 and 10% of that between different experimental subjects. RELEVANCE: A knowledge of the kinematics of the shoulder joint is necessary to understand subacromial pathology and in particular impingement problems. The scapulohumeral rhythm depends on the balanced and coordinated function of the muscles involved. The activation pattern of the abductor muscles, as reflected in shoulder kinematics, seems to be individual and stored as an engram.

Isolated fractures of the Trochlea humeri are only rarely seen because in case of indirect trauma this portion of the elbow is only partially exposed to transmitted forces and in case of direct injury adjacent elements are also involved. On the lateral films a half-moon shaped fragment in front of the Humerus together with joint effusion are indicative of this type of fracture. Depending on the grade of dislocation of the fragment, which has to be shown radiologically, conservative or operative management are chosen.

103 patients with 106 Müller straight stem prostheses could be evaluated clinically and radiologically after an average follow-up period of 6.8 years (range 5 to 10 ys.). Although until now no revision for aseptic loosening has become necessary 3 p.c. of the stems and 11 p.c. of the acetabular components showed radiological loosening. The clinical results were rated as satisfactory. After surgery 67 p.c. of the patients were completely painfree, 28 p.c. still had slight pain, 4 p.c. moderate and 1 p.c. severe pain. The investigation concentrated particularly on radiographic changes of the interface of the femur. Whereas radiolucency typically was non-progressive and located in the proximal part of the femur we found an increasing atrophy of the cortical bone on the calcar. Moreover, we found a continuous and increasing subsidence of the stem during the whole period of observation. At the time of follow up 56 p.c. of the straight stems had subsided about 2 mm and more. Calcar atrophy and radiolucency were significantly less present in femurs with a tapered medullary canal than in those with a cylindrical shape.

In our laboratory for biomechanics, a new isolation amplifier was developed with which to record the electromyographic activity of muscles inaccessible to surface electrodes, in particular that of the rotator cuff. Our basic premisses were maximum safety for the patient or subject investigated, and optimal signal processing. These were achieved by a triple galvanic separation of the patient/subject from the battery power supply and the signal cables and by careful selection of the electronic components.

This paper presents the results of histologic studies conducted in the context of tenosynovectomy of the flexor tendons to treat carpal tunnel syndrome. The most common findings were inflammatory changes of the synovial sheath, vascular pathology and fibrous changes of the connective tissue.

Following irrigation-suction drainage and synovectomy in 68 knee joints for empyema between 1971 and 1987, all were available for clinical and radiological follow-up. Since in 24 cases the empyema occurred after total knee arthroplasty, this group of patients was evaluated separately. The mean follow-up time in the no-prosthesis group was 8.3 and that in the prosthesis group, 5.3 years. In particular the aetiological factors, the bacterial pathogens and the effect of infection on radiological signs of degeneration were studied. The clinical results, including subjective findings, were assessed with the aid of HSS score. Our late results show that the prognosis for knee joint empyema can be rated as good if it is diagnosed early and treated aggressively. The poor outcome in a few cases was rather the result of underlying local disease and concomitant factors, and seemed not to be an immediate consequence of the infection itself. The relatively poor results in prosthesis group have to be referred predominantly to cases dating from the early years of total arthroplasty, with implants of the metal-on-metal type.

Thirty-one elbow joints in 29 patients (28 males, only 1 female), operated on for osteochondritis dissecans, were available for follow-up after an average of 10 years. The mean age at diagnosis was 24.4 years, but 11 patients were younger than 20. In 23 out of 29 patients the right elbow was involved, including 2 cases with bilateral involvement. In 20 cases removing the free bodies was the only surgical procedure performed, but in 2 cases it was combined with resection of the radial head. At follow-up, only one-third of the patients had no complaints. Nevertheless, daily activity was not restricted for any of the cases. Degenerative arthritic changes were found in only a few cases. These results are illustrated by means of three typical cases, which are compared with six similar cases in the international literature.

In this study 17 patients with recurrent dislocation of the patella were followed up 10 years after Goldthwait-operation. The subjective and clinical findings were excellent rsp. good in 70%, whereas the x-ray findings showed osteoarthritis of the femoropatellar joint in 60%. Concerning the aetiopathological factors we found an increased external torsion of the afflicted extremity measured by computed tomography.

The radiation exposure during biomechanical investigation of the shoulder joint done with a digital radiography system (Polytron 1000 VR - Siemens) was measured experimentally. Total radiation dose and surface dose were determined by phantom measurements. The radiation exposure per image is about 1/6 to 1/7 of that of a conventional study. The digital radiography system used is thus suitable for kinesiologic studies of large joints in healthy volunteers.

Calcifying tendinitis of the shoulder joint is a relatively common condition. Its pathogenesis is well documented in anatomical-pathological terms. The clinical observation of four unusual locations in the upper limb makes us to suspect the same pathological process as in the supraspinatus location. The clinical course of calcifying tendinitis in a typical location is discussed in detail.

Cartilage damage in the knee joints of rats was induced with a single intraarticular injection of 10 mg papain. Such damage was indicated by a decrease in the content of glycosaminoglycans and histologically detectable alterations in the surface of patellar cartilage. Daily treatment of the rats with N-acetylglucosamine by gavage led to an increase of the glycosaminoglycans of the cartilage and of incorporation of the radioactive precursor of glycosaminoglycan synthesis, 3H-glucosamine hydrochloride, in comparison to control animals treated with saline. The incidence of pathological alterations of the cartilage in histological samples was reduced.

Basing on 13 dislocations of 215 total hip arthroplasties are presented the characteristics of this complication. All things considered the dislocation following total hip arthroplasty seems to be no serious complication, if there is no severe operation failure and if the necessary treatment consisting in plastic cast immobilisation is performed.

A series of 90 patients, 85 males and 5 females, all with ACL-ruptures had a follow up between 5 and 12 years. All of them had a primary arthrotomy with or without meniscectomy but in no case an operative repair of the ACL-rupture was done. The most concomitant injury was a torn medial meniscus in 76.3%, a damaged lateral meniscus was found in 17.1%, chondromalacia was seen in 53%, either of tibia, femur or patella. Nearly 60% of the patients could resume their former sports activities in some cases on a lower level, whereas 33% had to change their sport or even had to give up any sport. 75%-80% of the patients with partial or total meniscectomy and 90% of those without meniscectomy estimated the outcome as good or fair. In contrast to this 61% rsp. 86% of the patients with partial or total meniscectomy had an osteoarthritis of grade III and IV, patients without meniscectomy in only 23%.

Four cases of malignant synovialoma (synonym: synovial sarcoma) of the sole of the foot are reported. A striking feature of all four cases was the long delay before the final diagnosis was made. Although this condition is rare, our cases nevertheless show that chronic neuralgiform pain close to the joint should prompt consideration of this tumor in the differential diagnosis. However, even surgical revision or explorations do not always reveal the tumor.

On the basis of clinical cases, the application possibilities of a newly developed portable EMG amplifier in the field of physiotherapy. The device permits continuous recording of the EMG activity of the muscles requiring therapy over any desired period of time.