Interventional management of hypervascular osseous metastasis: role of embolotherapy before orthopedic tumor resection and bone stabilization

OBJECTIVE: The purpose of this study was to evaluate, in relation to intraoperative estimated blood loss (EBL), the effectiveness of preoperative transcatheter arterial embolization of hypervascular osseous metastatic lesions before orthopedic resection and stabilization. MATERIALS AND METHODS: Between June 1987 and November 2007, 22 patients underwent transcatheter arterial embolization of tumors of the long bone, hip, or vertebrae before resection and stabilization. Osseous metastatic lesions from renal cell carcinoma, malignant melanoma, leiomyosarcoma, and prostate cancer were embolized. All patients were treated with a coaxial catheter technique with polyvinyl alcohol (PVA) particles alone or a combination of PVA particles and coils. After embolization, each tumor was angiographically graded according to devascularization (grades 1-3) based on tumor blush after contrast injection into the main tumor-feeding arteries. RESULTS: In patients with complete devascularization (grade 1), mean EBL was calculated to be 1,119 mL, whereas in patients with partial embolization (grades 2 and 3) EBL was 1,788 mL and 2,500 mL. With respect to intraoperative EBL, no significant difference between devascularization grades was found (p > 0.05). Moderate correlation (r = 0.51, p = 0.019) was observed between intraoperative EBL and tumor size before embolization. Only low correlation (r = 0.44, p = 0.046) was found between intraoperative EBL and operating time. Major complications included transient palsy of the sciatic nerve and gluteal abscess in one patient. CONCLUSION: The results of this study support the concept that there is no statistically significant difference among amounts of intraoperative EBL with varying degrees of embolization.

Reliability of radiologic assessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures

The aim of this study was to assess the ability to extract surgically relevant information from plain radiographs in trimalleolar fractures and to compare this with the information gathered from computed tomography (CT).

Could full-body digital X-ray (LODOX-Statscan) screening in trauma challenge conventional radiography?

ATLS Guidelines recommend single plain radiography of the chest and pelvis as part of the primary survey. Such isolated radiographs, usually obtained by bedside machines, can result in limited, low-quality studies that can adversely affect management. A new digital, low-radiation imaging device, the "Lodox Statscan" (LS), provides full-body anterior and lateral views based on enhanced linear slot-scanning technology in just over 5 minutes. We have the first LS in Europe at our facility. The aim of this study was to compare LS with computed tomographic (CT) scanning, as the gold standard, to determine the sensitivity of LS investigation in detecting injuries to the chest, thoracolumbar spine, and pelvis from our own experience, and to compare our findings with those of conventional radiography in the literature.

Entwicklung textiler Maschinenelemente für den Einsatz in Windkraftanlagen und Seilwinden

Es sollen hochfeste, gewichtreduzierte Zug- und Tragmittel aus hochmodularen (HM) und hochfesten (HT) Fasern validiert und dabei sowohl runde als auch flache, riemenartige Strukturen untersucht werden. Dadurch sind effizientere Fördersysteme und die Überwindung technischer Grenzen möglich. Darüber hinaus soll das Hauptkriterium für ein breites Anwendungsspektrum geschaffen werden: ein anerkanntes, zerstörungsfreies Prüfverfahren, mit dem der Austausch- bzw. Wartungszeitpunkt des textilen Tragmittels bestimmt werden kann. Können die o. g. Punkte erfolgreich bearbeitet werden, erfolgt eine Ausdehnung der textilen Strukturen in den Bereich kraftübertragender Maschinenelemente. Anhand von Feldversuchen in fördertechnischen Anlagen im Bergbau/ Intralogistik soll erstmals der vollständige Nachweis geführt werden, dass derartige textile Strukturen in technischen Anwendungen eingesetzt werden können. Der Nachweis umfasst die Validierung einer Vielzahl von Einzelschwerpunkten wie die Entwicklung einer Endlos-Herstellungstechnologie bzw. Endverbindung, die Tragmitteldimensionierung, die Erbringung von Festigkeitsnachweisen, die Erarbeitung von Vorschriften und die Erprobung der Verfahren zur Zustandsüberwachung.

Neue Generation von Aufzügen mit Faserseil

Energieeffiziente und leistungsfähige Zug- und Tragmittel aus hochmoduligen (HM) und hochfesten (HT) Fasern rücken seit einigen Jahren in den Fokus von Aufzugherstellern und Betreibern. Hauptgrund dafür ist, das die bisher eingesetzten Stahldrahtseile auf Grund ihrer vergleichsweise hohen Eigenmasse an technische Grenzen stoßen. Seile aus hochfesten Polymerfasern haben gegenüber Stahldrahtseilen eine vergleichbare oder sogar höhere Zugfestigkeit und ein vier- bis sechsfach geringeres Gewicht. Um das Potential dieser Fasern optimal auszunutzen, sind sowohl die Anordnung der Fasern als auch die Schmierstoffeinbringung zu untersuchen. Diesbezüglich wurden verschiedenen Seilkonstruktions- und Schmierstoffvarianten entwickelt und im Dauerbiegeversuch validiert.

Combination of Psychological Intervention and Phosphodiesterase-5 Inhibitors for Erectile Dysfunction: A Narrative Review and Meta-Analysis

INTRODUCTION Erectile dysfunction (ED) is an increasing health problem that demands effective treatment. There is evidence that phosphodiesterase-5 inhibitors (PDE5-Is) and psychological intervention (PI) are effective treatment options; however, little is known about their comparative efficacy and the efficacy of combined treatments. AIM The aim of this systematic review and meta-analysis is to evaluate the comparative efficacy of PI, PDE5-Is, and their combination in the treatment of ED. MAIN OUTCOME MEASURES Primary outcome was ED symptoms, and secondary outcome was sexual satisfaction of the patient. METHODS A systematic literature search was conducted in order to identify relevant articles published between 1998 and 2012. We included randomized controlled trials and controlled trials comparing PI with PDE5-I treatment or one of them against a combination of both. RESULTS Eight studies with a total number of 562 patients were included in the meta-analysis. The results of the included studies are inconclusive, though they show a trend towards a larger effect of combined treatment compared with PI or PDE5-I treatment alone. The meta-analysis found that, overall, combined treatment was more efficacious for ED symptoms than PDE5-I treatment or PI alone. Combined treatment was more efficacious than PDE5-I use alone on sexual satisfaction. No differences were found between PDE5-Is and PI as stand-alone treatments. None of the moderators (treatment duration, methodological quality, or researcher allegiance) altered the effects. CONCLUSIONS The combination of PI and PDE5-Is is a promising strategy for a favorable outcome in ED and can be considered as a first-choice option for ED patients. Stronger RCTs are required to confirm this initial finding. Schmidt HM, Munder T, Gerger H, Frühauf S, and Barth J. Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: A narrative review and meta-analysis. J Sex Med **;**:**-**.