Prosthetic joint infections : A retrospective study on the timing of reimplantation in a two-stage exchange

Different therapeutic options for prosthetic joint infections exist, but surgery remains the key. With a two-stage exchange procedure, a success rate above 90% can be expected. Currently, there is no consensus regarding the optimal duration between explantation and the reimplantation in a two-stage procedure. The aim of this study was to retrospectively compare treatment outcomes between short-interval and long-interval two-stage exchanges. Patients having a two-stage exchange of a hip or knee prosthetic joint infection at Lausanne University Hospital (Switzerland) between 1999 and 2013 were included. The satisfaction of the patient, the function of the articulation and the eradication of infection, were compared between patients having a short (2 to 4 weeks) versus a long (4 weeks and more) interval during a two-stage procedure. Patient satisfaction was defined as good if the patient did not have pain and bad if the patient had pain. Functional outcome was defined good if the patient had a prosthesis in place and could walk, medium if the prosthesis was in place but the patient could not walk, and bad if the prosthesis was no longer in place. Infection outcome was considered good if there had been no re-infection and bad if there had been a re-infection of the prosthesis 145 patients (100 hips, 45 knees) were identified with a median age of 68 years (range 19-103). The median hospital stay was 58 days (range 10-402). The median follow-up was 12.9 months (range 0.5-152). 28 % and 72 % of the patients had a short-interval and long-interval exchange of the prosthesis, respectively. Patient satisfaction, functional outcome and infection outcome for patients having a short versus a long interval are reported in the Table. The patient satisfaction was higher when a long interval was performed whereas the functional and infection outcomes were higher when a short interval was performed. According to this study a short-interval exchange appears preferable to a long interval, especially in the view of treatment effectiveness and functional outcome.

Avaliação dosimétrica de uma combinação de aplicadores para braquiterapia de tumores do colo uterino com acometimento da porção distal da vagina

OBJETIVO: Avaliar uma alternativa de braquiterapia para tumores do colo uterino acometendo a porção distal da vagina, sem aumentar os riscos de toxicidade. MATERIAIS E MÉTODOS: Estudo teórico comparando três diferentes aplicadores de braquiterapia intracavitária de alta taxa de dose: sonda intrauterina e cilindro vaginal (SC); sonda e anel associado ao cilindro vaginal (SA+C) e um aplicador virtual com sonda, anel e cilindro vaginal em um único conjunto (SAC). Foram prescritas doses de 7 Gy no ponto A e 5 Gy na superfície ou a 5 mm de profundidade na mucosa vaginal, mantendo as doses nos pontos de reto, bexiga e sigmoide abaixo dos limites de tolerância. Foram comparados os volumes englobados pelas isodoses de 50% (V50), 100% (V100), 150% (V150) e 200% (V200), respectivamente. RESULTADOS: Tanto SA+C quanto SAC apresentaram melhor distribuição de dose quando comparados ao aplicador SC. A distribuição de dose obtida com SA+C foi semelhante à do aplicador SAC, sendo V150 e V200 cerca de 50% maiores para SA+C, todavia, dentro do cilindro. CONCLUSÃO: A utilização de SA+C em uma única aplicação em dois tempos pode ser uma alternativa de tratamento para pacientes que apresentam tumores de colo uterino com acometimento distal da vagina.

Patient-adapted treatment for prosthetic hip joint infection.

Hip joint replacement is 1 of the most successful surgical procedures of the last century and the number of replacements implanted is steadily growing. An infected hip arthroplasty is a disaster, it leads to patient suffering, surgeon's frustration and significant costs to the health system. The treatment of an infected hip replacement is challenging, healing rates can be low, functional results poor with decreased patient satisfaction. However, if a patient-adapted treatment of infected hip joints is used a success rate of above 90% can be obtained.Patient-adapted treatment is based on 5 important concepts: teamwork; understanding the biofilm; diagnostic accuracy; correct definition and classification of PJI; and patient-tailored treatment.This review presents a patient-adapted treatment strategy to prosthetic hip infection. It incorporates the best aspects of the single and staged surgical strategies and promotes the short interval philosophy for the 2-stage approach.

Trapped periosteum in a distal femoral physeal injury: magnetic resonance imaging evaluation

Epiphyseal fractures are frequently associated with knee trauma during sports in children and adolescents. Usually, Salter-Harris types I and II fractures are conservatively treated. However, failed closed reduction of displaced fractures suggest the presence of trapped periosteum, with indication for surgery. The present report describes a case of Salter-Harris type I fracture of the distal femur in a child, complicated with trapped periosteum detected at magnetic resonance imaging.

Rotational assessment of distal femur and its relevance in total knee arthroplasty: analysis by magnetic resonance imaging

AbstractObjective:To define the distal femur rotation pattern in a Brazilian population, correlating such pattern with the one suggested by the arthroplasty instruments, and analyzing the variability of each anatomic parameter.Materials and Methods:A series of 101 magnetic resonance imaging studies were evaluated in the period between April and June 2012. The epidemiological data collection was performed with the aid of the institution's computed imaging system, and the sample included 52 male and 49 female patients. The measurements were made in the axial plane, with subsequent correlation and triangulation with the other plans. The posterior condylar line was used as a reference for angle measurements. Subsequently, the anatomical and surgical transepicondylar axes and the anteroposterior trochlear line were specified. The angles between the reference line and the studied lines were calculated with the aid of the institution's software.Results:The mean angle between the anatomical transepicondylar axis and the posterior condylar line was found to be 6.89°, ranging from 0.25° to 12°. For the surgical transepicondylar axis, the mean value was 2.89°, ranging from –2.23° (internal rotation) to 7.86°, and for the axis perpendicular to the anteroposterior trochlear line, the mean value was 4.77°, ranging from –2.09° to 12.2°.Conclusion:The anatomical transepicondylar angle showed mean values corresponding to the measurement observed in the Caucasian population. The utilized instruments are appropriate, but no anatomical parameter proved to be steady enough to be used in isolation.

A Sparse Bayesian Approach for Joint Feature Selection and Classifier Learning

Peer-reviewed

Novel Robot Solutions for Carrying out Field Joint Welding and Machining in the Assembly of the Vacuum Vessel of ITER

It is necessary to use highly specialized robots in ITER (International Thermonuclear Experimental Reactor) both in the manufacturing and maintenance of the reactor due to a demanding environment. The sectors of the ITER vacuum vessel (VV) require more stringent tolerances than normally expected for the size of the structure involved. VV consists of nine sectors that are to be welded together. The vacuum vessel has a toroidal chamber structure. The task of the designed robot is to carry the welding apparatus along a path with a stringent tolerance during the assembly operation. In addition to the initial vacuum vessel assembly, after a limited running period, sectors need to be replaced for repair. Mechanisms with closed-loop kinematic chains are used in the design of robots in this work. One version is a purely parallel manipulator and another is a hybrid manipulator where the parallel and serial structures are combined. Traditional industrial robots that generally have the links actuated in series are inherently not very rigid and have poor dynamic performance in high speed and high dynamic loading conditions. Compared with open chain manipulators, parallel manipulators have high stiffness, high accuracy and a high force/torque capacity in a reduced workspace. Parallel manipulators have a mechanical architecture where all of the links are connected to the base and to the end-effector of the robot. The purpose of this thesis is to develop special parallel robots for the assembly, machining and repairing of the VV of the ITER. The process of the assembly and machining of the vacuum vessel needs a special robot. By studying the structure of the vacuum vessel, two novel parallel robots were designed and built; they have six and ten degrees of freedom driven by hydraulic cylinders and electrical servo motors. Kinematic models for the proposed robots were defined and two prototypes built. Experiments for machine cutting and laser welding with the 6-DOF robot were carried out. It was demonstrated that the parallel robots are capable of holding all necessary machining tools and welding end-effectors in all positions accurately and stably inside the vacuum vessel sector. The kinematic models appeared to be complex especially in the case of the 10-DOF robot because of its redundant structure. Multibody dynamics simulations were carried out, ensuring sufficient stiffness during the robot motion. The entire design and testing processes of the robots appeared to be complex tasks due to the high specialization of the manufacturing technology needed in the ITER reactor, while the results demonstrate the applicability of the proposed solutions quite well. The results offer not only devices but also a methodology for the assembly and repair of ITER by means of parallel robots.

The Methods of Possible Joint Treatment of Manure and Sewage Sludge in the Leningrad Region

The nutrient load to the Gulf of Finland has started to increase as a result of the strong economic recovery in agriculture and livestock farming in the Leningrad region. Also sludge produced from municipal wastewater treatment plant of the Leningrad region causes the great impact on the environment, but still the main options for its treatment is disposal on the sludge beds or Landfills. The aim of this study was to evaluate the implementation of possible joint treatment methods of manure form livestock and poultry enterprises and sewage sludge produced from municipal wastewater treatment plants in the Leningrad region. The study is based on published data. The most attention was put on the anaerobic digestion and incineration methods. The manure and sewage sludge generation for the whole Leningrad region and energy potential produced from their treatment were estimated. The calculations showed that total amount of sewage sludge generation is 1 348 000 t/a calculated on wet matter and manure generation is 3 445 000 t/a calculated on wet matter. The potential heat release from anaerobic digestion process and incineration process is 4 880 000 GJ/a and 5 950 000 GJ/a, respectively. Furthermore, the work gives the overview of the general Russian and Finnish legislation concerning manure and sewage sludge treatment. In the Gatchina district it was chosen the WWTP and livestock and poultry enterprises for evaluation of the centralized treatment plant implementation based on anaerobic digestion and incineration methods. The electricity and heat power of plant based on biogas combustion process is 4.3 MW and 7.8 MW, respectively. The electricity and heat power of plant based on manure and sewage sludge incineration process is 3.0 MW and 6.1 MW, respectively.

Developing co-operation of business units – exploring synergies and a joint business model

The purpose of this study was to develop co-operation between business units of the company operating in graphic industry. The development was done by searching synergy opportunities between these business units. The final aim was to form a business model, which is based on co-operation of these business units.The literature review of this thesis examines synergies and especially the process concerning the search and implementation of synergies. Also the concept of business model and its components are examined. The research was done by using qualitative research method. The main data acquiring method to the empirical part was theme interviews. The data was analyzed using thematisation and content analysis.The results of the study include seven identified possible synergies and a business model, which is based on the co-operation of the business units. The synergy opportunities are evaluated and the implementation order of the synergies is suggested. The presented synergies create the base for the proposed business model.

The Use of Radiostereometric Analysis in Fractures of the Distal Radius: From Phantom Models to Clinical Application

Radiostereometric analysis (RSA) is a highly accurate method for the measurement of in vivo micromotion of orthopaedic implants. Validation of the RSA method is a prerequisite for performing clinical RSA studies. Only a limited number of studies have utilised the RSA method in the evaluation of migration and inducible micromotion during fracture healing. Volar plate fixation of distal radial fractures has increased in popularity. There is still very little prospective randomised evidence supporting the use of these implants over other treatments. The aim of this study was to investigate the precision, accuracy, and feasibility of using RSA in the evaluation of healing in distal radius fractures treated with a volar fixed-angle plate. A physical phantom model was used to validate the RSA method for simple distal radius fractures. A computer simulation model was then used to validate the RSA method for more complex interfragmentary motion in intra-articular fractures. A separate pre-clinical investigation was performed in order to evaluate the possibility of using novel resorbable markers for RSA. Based on the validation studies, a prospective RSA cohort study of fifteen patients with plated AO type-C distal radius fractures with a 1-year follow-up was performed. RSA was shown to be highly accurate and precise in the measurement of fracture micromotion using both physical and computer simulated models of distal radius fractures. Resorbable RSA markers demonstrated potential for use in RSA. The RSA method was found to have a high clinical precision. The fractures underwent significant translational and rotational migration during the first two weeks after surgery, but not thereafter. Maximal grip caused significant translational and rotational interfragmentary micromotion. This inducible micromotion was detectable up to eighteen weeks, even after the achievement of radiographic union. The application of RSA in the measurement of fracture fragment migration and inducible interfragmentary micromotion in AO type-C distal radius fractures is feasible but technically demanding. RSA may be a unique tool in defining the progress of fracture union.

Viipurinlahden taistelu 1944 joint-operaation näkökulmasta tarkasteltuna

Viipurinlahden taistelun kesällä 1944 on monesti esitetty olevan ensimmäinen suomalainen joint- eli yhteisoperaatio. Työ käsittelee Viipurinlahden taistelua nykyaikaisen jointoperaation periaatteiden näkökulmasta. Viipurinlahden taistelussa toimi kaikkien kolmen puolustushaaran joukkoja pienellä taistelualueella. Joint-käsitettä tarkastellaan yhdysvaltalaisten ohjesääntöjen ja suomalaisten näkemysten kautta. Yhdysvallat on yksi maailman johtavin joint-doktriinin käyttäjä. Tämän vuoksi joint-käsitettä tarkastellaan työssä pääasiassa Yhdysvaltojen ohjesääntöjen ja niihin perustuvan tiedon kautta.

Pancreatectomia distal no trauma: estudo multicêntrico

No período de cinco anos, 87 doentes com trauma pancreático foram tratados por pancreatectomia corpo-caudal em cinco serviços de emergência. A idade variou de 7 a 64 anos (média de 28), sendo que 73 (84%) eram do sexo masculino. O principal mecanismo de trauma foi o ferimento penetrante em 72,5%, com ferimentos por projéteis de arma de fogo em 3/4 dos casos. Lesões associadas ocorreram em 96% dos doentes. A extensão da ressecção pancreática correspondeu de 30% a 70%, em 62% dos casos. O baço foi preservado em 45,6% dos 57 doentes que se apresentaram sem lesão esplênica. A taxa de complicações foi de 40,2%, sendo a fístula pancreática e a pancreatite pós-operatória as mais freqüentes. A mortalidade total foi de 12 doentes (13,7%). As conclusões deste estudo foram as seguintes: a) há relação nas taxas de morbidade com o mecanismo de lesão; b) a morbidade é mais freqüente em doentes com trauma fechado; c) não há diferença na incidência de complicações com o método de fechamento do pâncreas remanescente nem com a extensão da ressecção; d) não há relação da mortalidade com o mecanismo de trauma; e) há uma tendência no aumento da taxa de mortalidade no trauma fechado com presença de lesões associadas.

Repercussões histopatológicas da colostomia no coto colônico distal desfuncionalizado: estudo experimental em ratos

O objetivo deste trabalho foi evidenciar as repercussões histopatológicas da colostomia no segmento desfuncionalizado e, dessa forma, criar um modelo experimental da colite de derivação fecal (CO). Foram utilizados 65 ratos, adultos, da raça Wistar, com peso variando de 220 a 300 g. Os animais foram divididos em 13 grupos, contendo cinco ratos. Do grupo 1 ao grupo 12, os animais foram submetidos a laparotomia mediana, sendo realizada uma colostomia terminal tipo boca única, e observados, por períodos variados de tempo, com o máximo de cem dias. Os animais, após serem mortos, foram necropsiados e retirado o segmento co1ônico desfuncionalizado para a avaliação histopatológica. Essa avaliação consistia de uma análise quantitativa, através da medida da espessura da mucosa colônica, e de uma análise qualitativa, mediante avaliação subjetiva: da presença de infiltrado inflamatório agudo ou crônico na lâmina própria; das alterações na arquitetura das criptas colônicas; da presença de hiperplasia folicular linfóide e de linfócitos na luz dos vasos da submucosa; e da presença de eosinófilos na luz intestinal. No grupo 12, após o 100° dia de pós-operatório (OPO), foi realizada a reconstrução do trânsito intestinal, e, após trinta dias, o cólon descendente foi retirado para a análise histopatológica. O método de Tukey e o teste "t" de Student foram utilizados como parte da análise dos resultados. Verificou-se uma redução estatisticamente significante da espessura da mucosa colônica a partir do 4000PO. Concluiu-se que a colostomia desfuncionalizante realizada em ratos reproduziu alterações histopatológicas compatíveis com a colite de derivação, e que estas mostraram-se reversíveis após a reconstrução do trânsito intestinal.