The clinical outcome of total knee arthroplasty is compromised by a previously implanted medial unicondylar knee arthroplasty

OBJECTIVE

To investigate the clinical outcome of patients that underwent conversion of a medial unicondylar knee arthroplasty (UKA) to a total knee arthroplasty (TKA) and to compare that outcome to patients that underwent primary TKA. It was hypothesized that those groups would significantly differ in terms of knee score outcome and implant survival.

METHODS

A retrospective-comparative study was conducted utilizing data from the Federal state's arthroplasty registry. Included were patients from our department that undergone a conversion of a medial UKA to a TKA (UKA-TKA group). The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) from preoperative and 1-year postoperative was used. Moreover, the implant survival was analyzed.

RESULTS

In the UKA-TKA group, there were 51 cases (age 67 ± 10, 74% women), and in the TKA group, there were 2247 cases (age 69 ± 9, 66% women). The one-year postoperative WOMAC total score was 33 in the UKA-TKA group und 21 in the TKA group (p < 0.001). Similarly, the WOMAC pain, WOMAC stiffness, and WOMAC function scores were significantly worse in the UKA-TKA. After 5 years, the survival rates were 82% and 95% (p = 0.001). The 10-years prosthesis survival was 74% and 91% in the UKA-TKA and TKA groups, respectively (p < 0.001).

CONCLUSIONS

Based on our findings it is concluded that patients who received a TKA after UKA have inferior results than those that directly receive a TKA. This is true for both patient-reported knee outcome and prosthesis survival. Converting UKA to TKA should not be seen as an easy operation, but should rather be done by surgeons with considerable experience in both primary and revision knee arthroplasty.

SAP and Partners: IS-H™ and IS-H*MED™

Objectives: The Styrian Hospital Organization with 21 hospitals including the Graz University Hospital, and the Heidelberg University Hospital implemented a new HIS based on SAP/R3™, ISH™, ISH*MED™ with the objective to have an integrated system to support patient administration and management, patient care, clinical documentation, research etc.

Methods: Heidelberg University Hospital chose a step by step method for the introduction of the system, beginning with patient administration (ISH) and proceeding with clinical functions (ISH*MED). In Styria, the full functionality was implemented – as part of the selection process – in one peripheral hospital and in the Ear, Nose and Throat (ENT) Department of the Graz University Hospital, including special documents to support the processes in the highly specialized ENTunits.

Results and Conclusions: The standard modules are performant, stable and basically well accepted. Particularly in Graz, it has been shown that the requirements of highly specialized departments for work flow management, documentation and integration of subsystems and data from different sources can be fulfilled by special documents and programs – although at the expense of additional workload particularly in the initial phases of such a project.

Foetal Gender and Obstetric Outcome

Introduction: Data on specific characteristics based on the gender of the unborn baby and their significance for obstetrics are limited. The aim of this study is to analyse selected parameters of obstetric relevance in the phases pregnancy, birth and postpartum period in dependence on the gender of the foetus. Materials and Methods: The selected study method comprised a retrospective data acquisition and evaluation from the Austrian birth register of the Department of Clinical Epidemiology of Tyrolean State Hospitals. For the analysis all inpatient singleton deliveries in Austria during the period from 2008 to 2013 were taken into account (live and stillbirths n = 444 685). The gender of the baby was correlated with previously defined, obstetrically relevant parameters. Results: In proportions, significantly more premature births and sub partu medical interventions (vaginal and abdominal surgical deliveries. episiotomies) were observed for male foetuses (p < 0.001). The neonatal outcome (5-min Apgar score, umbilical pH value less than 7.1, transfer to a neonatal special unit) is significantly poorer for boys (p < 0.001). Discussion: In view of the vulnerability of male foetuses and infants, further research is needed in order to be able to react appropriately to the differing gender-specific requirements in obstetrics.

[Perinatal mortality by mother's country of origin in Tyrol 2000-2008]

INTRODUCTION

This study analyses for the first time the Tyrolean perinatal mortality stratified by the country of origin of the mother. Data of the Tyrolean birth registry were evaluated from 2000-2008. The aim of our study was to analyse differences in perinatal mortality according to the country of origin of the mother.

METHODS

58 787 single births were assessed between the years 2000-2008. Mothers with similar experiences of how to access the health-care system were aggregated into 5 groups: (1) "Tyrol/Austria", (2) "western Europe/West", (3) "former Yugoslavia/eastern Europe", (4) "Turkey" and (5) "other countries". The odds ratio for perinatal mortality according to the country of origin of the mother was calculated in a multivariate model. The following independent variables were included: age of mother at birth, parity, housewife during pregnancy, week of gestation at the first check-up visit, smoking, preterm delivery and weight of the newborn.

RESULTS

The number of mothers of Tyrolean/Austrian origin decreased over the years by 2% whereas the number of mothers from Western Europe/West increased by 3%. The other migration groups remained constant or were slightly decreased. In the multivariate model; the perinatal mortality [odds ratio (CI)] was for the subgroups "Turkey" 1.06 (0.61-1.83) and for "western Europe/West" 1.09 (0.64-1.86), and therefore almost identical with the reference subgroup "Tyrol/Austria" (OR=1); the perinatal mortality was significantly increased with 2.14 (1.37-3.34) for the subgroup "former Yugoslavia/eastern Europe and for the subgroup "other countries" 2.54 (1.21-5.36). The variables "age under 18 years" OR 1.99 (0.80-4.93) and "mulitpara" OR 1.30 (0.96-1.74) were not significantly increased. Significantly increased was "preterm delivery" OR 4.53 (2.80-7.33) and "low birthweight" (<1 500 g) OR 53.60 (32.02-89.73) and 1 500 to 2 499 g OR 4.85 (2.96-7.96). There are considerable differences comparing the odds ratios between the 5 subgroups for perinatal mortality. The subgroups "Turkey" and "western Europe/West" have a similar odds ratio compared to the reference group "Tyrol/Austria". The subgroups "former Yugoslavia" and "other countries" have a significantly increased perinatal mortality (OR 2-2.5).

CONCLUSION

The good outcome of the mothers from "Turkey" can be seen as similar to the "Latina paradoxon", which means a better outcome of pregnancy and birth of mothers from "Turkey", even though they are more comparable with other migrant groups in some risk factors, such as a lower socioeconomic standard, late check-ups, language difficulties and cultural factors. A single case analysis would be necessary to examine the exact causes.

Critical consideration of precipitate analysis of Fe-1 at.% Cu using atom probe and small-angle neutron scattering

An Fe-1 at.% Cu model alloy was examined by atom probe (3DAP) and small-angle neutron scattering (SANS) to verify the accordance of the gained results. The Fe-Cu alloy was heat-treated for various times at 500°C, forming Cu-rich precipitates within the Fe matrix. The chemical compositions of the precipitates and matrix found by 3DAP were used to calculate the magnetic scattering contrast. Additionally, a magnetic moment of the precipitates that contain a significant amount of Fe was taken into account for the calculation of magnetic scattering contrast. This in turn is used for the evaluation of the magnetic scattering curves gained by SANS. Both the 3DAP data as well as the scattering curves were analyzed with regard to radius, number density, and volume fraction of the precipitates as a function of aging time. The results yielded by both techniques are in good agreement and correspond to the development of the hardness of the alloy. Minor differences can be related to the cluster search algorithm used for the analysis of the 3DAP data as well as Fe overestimation based on different field phases.

Konsensuelles Zweitbefunden von Mammographien in der Praxis

PURPOSE

To evaluate retrospectively the results of consensus double reading of mammograms in a private practice for a period of 1.5 years (November 2001 to March 2003).

MATERIALS AND METHOD

Two independent experts with dedicated training read all mammograms on a weekly basis. All mammograms including sonographic examinations were evaluated independently and categorized using the BI-RADS classification. The achieved consensus included a possible recommendation for recall or therapy. A total of 3936 mammograms and 1912 sonography studies were evaluated. All cases with BI-RADS 4 and 5 categories were compared with the histologic results. For a period of three months, the acceptance of double reading including a delay of the final report by one week was tested with a questionnaire and informed consent sheet.

RESULTS

BI-RADS categories 4 and 5 were found in 57 cases, with 41 consensus results by two independent readers and 26 carcinomas verified by histology. No consensus could be reached in 16 patients, of which 10 had a final histologic result, with 5 benign lesions and 5 carcinomas of less than 1 cm in diameter. Clinical symptoms or alterations were absent in all patients. The 5 carcinomas were discovered by the double reading procedure. The result of the questionnaire (695 questionnaires) showed a refusal rate of 0.7 %, with only 5 women refusing the opportunity of double reading their mammograms.

CONCLUSION

Double reading of mammograms by independent experts is feasible, shows a measurable increase in quality and is accepted by almost all women.

SAP and partners: IS-H and IS-H* MED

OBJECTIVES

The Styrian Hospital Organization with 21 hospitals including the Graz University Hospital, and the Heidelberg University Hospital implemented a new HIS based on SAP/R3, ISH, ISH* MED with the objective to have an integrated system to support patient administration and management, patient care, clinical documentation, research etc.

METHODS

Heidelberg University Hospital chose a step by step method for the introduction of the system, beginning with patient administration (ISH) and proceeding with clinical functions (ISH* MED). In Styria, the full functionality was implemented--as part of the selection process--in one peripheral hospital and in the Ear, Nose and Throat (ENT) Department of the Graz University Hospital, including special documents to support the processes in the highly specialized ENTunits.

RESULTS AND CONCLUSIONS

The standard modules are performant, stable and basically well accepted. Particularly in Graz, it has been shown that the requirements of highly specialized departments for work flow management, documentation and integration of subsystems and data from different sources can be fulfilled by special documents and programs--although at the expense of additional workload particularly in the initial phases of such a project.

Paperless hospital: reality, dream or a nightmare?

Public Hospitals of Styria (KAGes) are implementing new hospital information system (MEDOCS--MEdical and nursing DOcumentation and Communication network of Styria) in its 21 hospitals. One of the outstanding features of this system is the coverage of virtually all communication and documentation functions related to the patient. This should be the way to fulfill the conditions for gradually removing the paper as an information medium from daily hospital practice. This approach will be tested in the MEDOCS project at two evaluation sites. In this paper the authors discuss in form of "pros and contras" the chances and risks of this approach, as well as possible strategies during the steps of implementing the "paperless" hospital. Besides of general technological, medical and cultural considerations the paper discuss also the technical and economical aspects of "paperless" hospital implementation and production.

HIS purchase projects in public hospitals of Styria, Austria

The Steiermärkische Krankenanstaltenges. m.b.H (KAGes) is a company, owned by the province of Styria in Austria, which operates 21 hospitals with about 8000 beds and 14000 employees, serving a population of ca. 1.2 million people. KAGes has purchased a new hospital information system (HIS) for its hospitals. Within the strategic IT plan and the 'system structure new' (SSN) project, a methodology was developed for making an effective HIS purchase. Several steps of this project are described in the paper, request for product information, evaluation of vendor proposals, product presentations, test site evaluation, reference site visits and selection of vendor finalists. The authors present the internal project management methodology, including the structure of the project team, project information management through intranet, criteria for different steps of the evaluation and evaluation site organization. Four major HIS vendors with leading HIS products qualified for this stage of the project (evaluation site). About 60 teams with 400 members (end users and IT-experts) have assessed all the products installed, during one or more, repeated test sessions. The decision on which new HIS to purchase were based on the recommendations derived from this evaluation. After completing SSN-project with the suggestion to KAGes-top-management for negotiations with two vendor finalists, the new project named MEDOCS was started mid-1999. Two pilot installations (one general hospital and one teaching hospital department) are nowadays in the pilot implementation and subsequent roll-out (including substitution of the legacy system) is scheduled until the year 2003.

HIS purchase project: preliminary report

The KAGes (Krankenanstaltenges.m.b.H) is a company, owned by the state of Styria in Austria, which operates 20 hospitals with about 8,000 beds and 14,000 employees, serving a population of ca. 1.2 million people. KAGes is on its way to purchase a new hospital information system (HIS) for it's hospitals. Within the strategic IT plan and the "System Structure New" (SSN) project a methodology was developed, for making an effective HIS purchase. Several steps of this project are described in the paper: request for product information, evaluation of vendor proposals, product presentations, test site evaluation, reference site visits and selection of vendor finalists. The authors present the internal project management methodology, including the structure of the project team, project information management through intranet, criteria for different steps of the evaluation and evaluation site organization. Four major HIS vendors with leading HIS products qualified for this stage of the project (evaluation site). About 60 teams with 400 members (end users and IT-experts) have assessed all the products installed, during one or more, repeated, test sessions. The decision on which new HIS to purchase will be based on the recommendations derived from this evaluation. Two pilot installations (one general hospital and one teaching hospital department) are planned for implementation in the year 1999/2000 and subsequent roll-out (including substitution of the legacy system) is scheduled until the year 2003.

GIS-based measures of environmental equity: exploring their sensitivity and significance

In order to determine whether principles of environmental justice have been violated, a large number of empirical studies have been carried out to ascertain whether minority and low-income populations are disproportionately exposed to industrial pollution. This study provides a comparative evaluation of two commonly employed proximity measures in GIS-based environmental equity assessment, examining their influence on the results of the analysis, and proposes a methodology for evaluating the significance of these results. 1990 census data on population characteristics and data from the 1995 EPA's toxic release inventory (TRI) for the City of Minneapolis, MN are used. These results also allow a preliminary assessment of environmental equity/inequity in potential exposure to airborne toxic chemicals for racial minorities, poor people and children in Minneapolis. In the third part of the paper we develop and employ a geographic randomization methodology for assessing the significance of these results.

[Diagnosis of acute subarachnoid hemorrhage--MRI with 0.5 Tesla with FLAIR sequence]

PURPOSE

Evaluation of MR imaging in patients with acute subarachnoid hemorrhage (SAH) at 0.5 Tesla using the FLAIR (Fluid Attenuated Inversion Recovery) sequence. Additionally, the value of MR angiography (MRA) in the diagnosis of intracranial aneurysms was assessed.

MATERIALS AND METHODS

19 patients with suspected acute SAH were included in this study. MR imaging was performed using an axial FLAIR sequence and axial T1, T2 and PD weighted sequences. In 16 patients an additional MRA (3D-TOF) was performed. 10 patients without SAH were examined as a control group. At the end of the study the 29 MR examinations were randomised and the images were read by two experienced radiologists; subsequently a consensus interpretation was made.

RESULTS

In 16 patients an acute SAH was verified with the FLAIR sequence, in 13 cases the origin of hemorrhage was found during surgery. In the consensus interpretation of the MR images all cases were diagnosed properly. 12 of the 16 MRA studies were of diagnostic quality, but only 6 cases were interpreted correctly.

CONCLUSION

The FLAIR sequence at 0.5 Tesla proved effective in the diagnosis of acute SAH. MRA at 0.5 Tesla failed in the detection of intracranial aneurysms.

On the relationship between measles virus and Alzheimer neurofibrillary tangles in subacute sclerosing panencephalitis

We have studied the relationship between measles virus and the accumulation of abnormally phosphorylated tau (PHF-tau) in nine cases of subacute sclerosing panencephalitis (SSPE). By assessing the presence of viral intranuclear inclusions and neurofibrillary tangles (NFT) in each case, we found no correlation between presence and amount of measles virus and the numbers of neurons containing PHF-tau. Immunohistochemical double labeling in a case with long duration of disease and severe histopathologic change revealed no strict colocalization of measles virus antigen and PHF-tau throughout different brain regions. In areas containing both antigens, most neurons carrying measles virus did not have a tangle and vice versa, eventhough some colocalization beyond that expected by chance was observed in specific cortical areas. These results indicate that, although secondary to viral infection, NFT formation in SSPE is not restricted to cells carrying viral antigen. Conversely, measles virus infected cells do not necessarily accumulate PHF-tau. This lack of colocalization at the cellular level, throughout different brain areas and among different cases suggests that the formation of NFT in SSPE is not directly induced by the infectious agent. The formation of NFT in this disease appears to be elicited through a specific type of tissue damage and, thus, to be an epiphenomenon. This pathogenetic detail may be of interest for our understanding of the role of neurofibrillary degeneration in the pathogenesis of other more frequent neurodegenerative diseases with cytoskeletal pathology.

International migration and the politics of admission and exclusion in postwar Europe

"Although nation-states assume territorial, political and cultural boundedness, their boundaries are not uniform barriers, but rather are characterized by varying degrees of openness and closure to international migrants. The manipulation of the permeability of these boundaries constitutes the politics of admission and exclusion.... This paper provides a discussion of the complex economic, political and social forces impinging on the politics of admission and exclusion and an analysis of how these forces have been operating in a particular historical and geographical context to determine the admission of international migrants into national territory and community.... There are signs that the integration of nation-states into regional blocs such as the EC is shifting the politics of admission and exclusion practised by the dominant member countries to the supra-national scale."

Verification of the heart rate threshold

Among the methods for determining anaerobic threshold (AT), the heart rate (HR) method seems to be the simplest. On the other hand, many conflicting results from comparing this method with others have been presented over the last 10 years. Therefore, the aim of this study was to compare the heart rate threshold (HRT) with the lactate turn point (LTP)-"second" break point of dependence of lactate (LA) to power output, ventilatory threshold (VT) and threshold determined by electromyography (EMGAT), all determined by the same exercise test and evaluated by the same computer algorithm. A group of 24 female students [mean age 20.5 (SD 1.6) years, maximal oxygen consumption 48.8 (SD 4.7) ml.kg-1.min-1] performed an incremental exercise test on a cycle ergometer (modified Conconi test) starting with an initial power output (PO) of 40 W with intensity increments of 10 W.min-1 until the subjects were exhausted. The HRT, LTP and EMGAT determination was done by computer-aided break-point regression analysis from dependence of functional measures on PO. The same computer algorithm was used for VT determination from the relationship between ventilation (V) and oxygen uptake (VO2) or carbon dioxide output (VCO2).(ABSTRACT TRUNCATED AT 250 WORDS)

Heart rate deflection related to lactate performance curve and plasma catecholamine response during incremental cycle ergometer exercise

The correlation between the behaviour of the heart rate/work performance (fc/W) curve and blood lactate ([la]b) and plasma adrenaline/noradrenaline concentrations ([A]/[NA]) during incremental cycle ergometer exercise was investigated. A group of 21 male sports students was divided into two groups: group I, with a clear deflection of the fc/W curve; group II, without or with an inverse deflection of the fc/W curve. The aerobic threshold (Thaer) and the lactate turn point (LTP) were defined. Between Thaer and maximal work performance (Wmax) the behaviour of the fc/W curve as well as the behaviour of [la-]b and [A]. [NA] were described mathematically. The fc, systolic blood pressure (BPs), W, [la-]b, [A] and [NA] at rest, Thaer, LTP, Wmax, after 3 and 6 min of recovery (Re3/Re6) were calculated. A significant difference between the two groups could only be detected for fc at LTP, Re3 and Re6 (P < 0.05). No significant correlation could be found between individual fc/W-behaviour and individual time course of [la-]b, [A] and [NA]. However, a significant correlation was visible between [la-]b/W-behaviour and individual catecholamine response. These results and the fact that the different flattening at the top of the fc/W curve was related to diminished stress-dependent myocardial function led us to the conclusion that it is possible that sympathetic drive is not directly involved in mechanisms of regulation between load dependent fc and myocardial function. In addition, individual fc/W behaviour was independent of BPs and Wmax, or individual conditions of energy supply.

[Syringomyelia as a rare cause of respiratory insufficiency requiring ventilation]

For 17 years a now 45-year-old man had suffered from progressively more severe flaccid paresis of the arms and thoracic muscles, spastic paralysis of the legs and kyphoscoliosis. Artificial ventilation was required when he contracted pneumonia. Although it was being treated with antibiotics, frequent bronchoalveolar lavage had to be done because of repeated atelectases. After 6 weeks clonuses developed in the legs, predominantly on the right, stretch synergisms and opisthotonos. The pupils were small with sluggish reaction to light, and there was a positive "doll's head" phenomenon. The level of consciousness alternated between somnolence and sleepiness. Magnetic resonance imaging demonstrated cavities in cervical and thoracic spinal cord, supporting the diagnosis of an abnormal cerebrospinal circulation due to gliosis in syringomyelia. To secure cerebrospinal fluid drainage, the cerebellar tonsils were resected, together with a duraplasty and partial resection of the atlas. Following this he became fully conscious and the spastic state improved. During the following 8 weeks it became possible gradually to wean him from the artificial ventilation and achieve satisfactory mobilization so that he could be discharged to domiciliary care.

Relationship between heart rate threshold, lactate turn point and myocardial function

We examined the relationship between heart rate threshold (HRT), lactate turn point (LTP) and myocardial function expressed as left ventricular ejection fraction (LVEF) determined by radionuclide ventriculography. Two groups of subjects (G I: N = 8; G II: N = 7) with and without a deflection of heart rate performance curve (HRPC) underwent sitting cycle ergometry. HRT (G I), aerobic threshold (AeT; G I, G II), and LTP (G I, G II) were determined by means of linear regression break point analysis. Also, a break point in LVEF performance curve (LVEFBP) was obtained. Power output at HRT and at LTP was not significantly different between G I and G II (272.5 +/- 38.7 W; 294.3 +/- 20.6 W). Power output at LVEFBP (G I: 182.6 +/- 31.7 W; G II: 211.8 +/- 21.5 W) was not significantly different to power output at LTP (G I: 194.2 +/- 32.7 W; G II: 215.2 +/- 24.4 W) and HRT (G I: 193.0 +/- 38.2 W). Significant differences (p < 0.05) could only be found between G I and G II for heart rate (HR) at LTP (G I: 163.5 +/- 5.8 b.min-1; G II: 154.4 +/- 6.7 b.min-1) and LVEF at the end of the load (LVEFend) (G I: 77.9 +/- 2.9%; G II: 71.3 +/- 7.0%). The drop of LVEF at LVEFBP was significantly related to LTP in all cases. The present data suggest that the noninvasive determination of anaerobic threshold by means of heart rate curve analysis is not always possible due to different response of myocardial function and heart rate to graded cycle ergometer exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Ocular sequelae of multimodal therapy of hematologic malignancies in children

We retrospectively analyzed the ocular findings after polychemotherapy including intrathecal methotrexate, systemic corticosteroids, and prophylactic cranial irradiation in children with acute lymphoblastic leukemia (n = 16) and non-Hodgkin's lymphoma (n = 2). After a median surveillance time of 4.1 years, asymptomatic ocular abnormalities were observed in 83% of the patients: 7/18 had a decreased tear formation, 5/17 had an opacity of the vitreous body, and 13/18 had an opacity of the lens. It was not possible to determine retrospectively which therapy caused a particular effect. A comparison of the 2 irradiation techniques (with and without blocking of the lacrimal glands) showed that in 5/7 children who developed a reduced eye secretion, the lacrimal glands are within the treatment volume. Therefore, the reduced eye secretion is most likely radiation-induced. Whereas the opacities of the vitreous body were caused by thrombopenia and bleeding during the course of disease, corticoid therapy might have contributed to the lens opacities.

Heart rate threshold related to lactate turn point and steady-state exercise on a cycle ergometer

The aim of this study was to investigate heart rate threshold (HRT) related exercise intensities by means of two endurance cycle ergometer tests using blood lactate concentration [La], pulmonary ventilation (VE), oxygen uptake (VO2), heart rate (HR) and electromyogram (EMG) activity of working muscle. Firstly, 16 healthy female students [age, 21.4 (SD 2.8) years; height, 167.1 (SD 5.1) cm; body mass 62.7 (SD 7.1) kg] performed an incremental exercise test (10 W each minute) on an electrically braked cycle ergometer until they felt exhausted. The HRT and lactate turn point (LTP) were assessed by means of computer-aided linear regression break point analysis from the relationship of HR or [La] to power output. No significant difference was found between HRT and LTP for all the variables measured. Secondly, two endurance tests (ET) of 20 min duration were performed by 7 subjects. The first (ET I) was performed at an exercise intensity which was about 10% lower than the power output at HRT [61.2 (SD 3.1)% maximal oxygen uptake (VO2max)], the second (ET II) at an exercise intensity about 10% higher than the power output at HRT [79.2 (SD 3.4) % VO2max]. The parameters measured showed a clear steady state in ET I. All mean values were lower than values at HRT [power, 138.7 (SD 18.9) W; HR, 172.1 (SD 4.7) beats.min-1; VO2, 2.2 (SD 0.3) l.min-1; VE, 54.0 (SD 9.1) l.min-1; [La], 3.7 (SD 1.1) mmol.l-1; EMG, 81.1 (SD 24.0) microV] except HR which was the same.(ABSTRACT TRUNCATED AT 250 WORDS)