998 resultados para 1995_03240022 TM-34 4501307
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OBJECTIVE: External auditory canal cholesteatoma (EACC) is a rarity. Although there have been numerous case reports, there are only few systematic analyses of case series, and the pathogenesis of idiopathic EACC remains enigmatic. STUDY DESIGN: In a tertiary referral center for a population of 1.5 million inhabitants, 34 patients with 35 EACC (13 idiopathic [1 bilateral] and 22 secondary) who were treated between 1994 and 2006 were included in the study. RESULTS: EACC cardinal symptoms were longstanding otorrhea (65%) and dull otalgia (12%). Focal bone destruction in the external auditory canal with retained squamous debris and an intact tympanic membrane were characteristic. Only 27% of the patients showed conductive hearing loss exceeding 20 dB. Patients with idiopathic EACC had lesions typically located on the floor of the external auditory canal and were older, and the mean smoking intensity was also greater (p < 0.05) compared with patients with secondary EACC. The secondary lesions were assigned to categories (poststenotic [n = 6], postoperative [n = 6], and posttraumatic EACC [n = 4]) and rare categories (radiogenic [n = 2], postinflammatory [n = 1], and postobstructive EACC [n = 1]). In addition, we describe 2 patients with EACC secondary to the complete remission of a Langerhans cell histiocytosis of the external auditory canal. Thirty of 34 patients were treated surgically and became all free of recurrence, even after extensive disease. DISCUSSION: For the development of idiopathic EACC, repeated microtrauma (e.g., microtrauma resulting from cotton-tipped applicator abuse or from hearing aids) and diminished microcirculation (e.g., from smoking) might be risk factors. A location other than in the inferior portion of the external auditory canal indicates a secondary form of the disease, as in the case of 2 patients with atypically located EACC after years of complete remission of Langerhans cell histiocytosis, which we consider as a new posttumorous category and specific late complication of this rare disease.
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A 70-year-old man known for recurrent abdominal gastrointestinal stroma tumor presented with a suspicious peritoneal mass demonstrated by an abdominal CT scan. Whole-body PET showed focal FDG uptake in the right hip, whereas the peritoneal mass was FDG negative. Histologic work-up of the PET positive lesion surprisingly revealed a giant cell tumor of the tendon sheath. The benignity of the peritoneal mass was confirmed by its disappearance in repeated CT scans. In general, focally increased FDG uptake should be subject to further investigations, especially in localizations that are not consistent with typical metastatic pathways of the former primary tumor.
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e-Manufacturing™, das ist die schnelle, flexible und kostengünstige Fertigung von Produkten, Formen/Werkzeugen oder Modellen direkt aus elektronischen Daten. e-Manufacturing™ schließt Rapid Prototyping, Rapid Tooling oder Rapid Manufacturing ein, geht aber zugleich weit über den Gedanken der schnellen Verfügbarkeit hinaus. Zwar wird auch in Zukunft die schnelle Produktentwicklung eine immer wichtigere Rolle spielen, bei der e-Manufacturing™ für ein verkürztes Time to Market sorgt, Entwicklungskosten verringert und zur Risikominimierung beiträgt. Darüber hinaus entstehen aber auch neue Geschäftsmodelle, da Kleinserienproduktion, steigende Variantenvielfalt und eine individualisierte Produktion (Mass Customization) plötzlich möglich und wirtschaftlich sind und sich neue Logistikkonzepte wie (Spare) parts on demand entwickeln. Die neue Konstruktionsfreiheit des Laser-Sinterns ermöglicht neue Produktkonzepte. Minimale Einschränkungen durch das Fertigungsverfahren erlauben funktionelle Integration und die Fertigung des „Unmöglichen“, da kreisförmige und lineare Werkzeugbewegungen das Produktdesign nicht mehr beeinflussen bzw. limitieren. Auch die Fertigungskonzepte unterliegen einem Wandel und werden deutlich flexibler. Werkzeuglose Produktion, losgrößenangepasste Fertigung und dezentrale Fertigung on demand sind die Schlagworte der Zukunft. Der vorliegende Beitrag zeigt Beispiele für den erfolgreichen kommerziellen Einsatz von Laser-Sintern in allen Phasen des Produktlebenszyklus. Der Schwerpunkt liegt dabei auf der direkten Herstellung von Funktionsteilen in der Serienfertigung. Die entscheidenden Faktoren für eine erfolgreiche Einführung und Anwendung von e-Manufacturing™ werden diskutiert. Der Beitrag zeigt auf, wie die neuesten technologischen Innovationen im Laser-Sintern, speziell zur Produktivitätssteigerung, das Spektrum der Anwendungsfelder erweitern, in denen dieses Fertigungsverfahren kostengünstige Lösungen bietet.
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BACKGROUND -Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female gender is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade. METHODS AND RESULTS -A systematic Medline search was used to locate academic electrophysiologic (EP) centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to gender and their mode of management including any case of related mortality. Nineteen EP centers provided information on 34,943 ablation procedures involving 25,261 (72%) males. Overall 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in females and 169 (0.67%) in males (odds ratio 1.83, P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantial lower risk in high volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; females tended to develop more tamponades during transseptal catheterization. No gender difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high volume centers. Three cases of tamponade (1%) culminated in death. CONCLUSIONS -Tamponade during AF ablation procedures is relatively rare. Women have an almost twofold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high volume centers. Surgical back-up and acute management skills for treating tamponade are important in centers performing AF ablation.
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The treatment of peri-prosthetic joint infection (PJI) of the ankle is not standardised. It is not clear whether an algorithm developed for hip and knee PJI can be used in the management of PJI of the ankle. We evaluated the outcome, at two or more years post-operatively, in 34 patients with PJI of the ankle, identified from a cohort of 511 patients who had undergone total ankle replacement. Their median age was 62.1 years (53.3 to 68.2), and 20 patients were women. Infection was exogenous in 28 (82.4%) and haematogenous in six (17.6%); 19 (55.9%) were acute infections and 15 (44.1%) chronic. Staphylococci were the cause of 24 infections (70.6%). Surgery with retention of one or both components was undertaken in 21 patients (61.8%), both components were replaced in ten (29.4%), and arthrodesis was undertaken in three (8.8%). An infection-free outcome with satisfactory function of the ankle was obtained in 23 patients (67.6%). The best rate of cure followed the exchange of both components (9/10, 90%). In the 21 patients in whom one or both components were retained, four had a relapse of the same infecting organism and three had an infection with another organism. Hence the rate of cure was 66.7% (14 of 21). In these 21 patients, we compared the treatment given to an algorithm developed for the treatment of PJI of the knee and hip. In 17 (80.9%) patients, treatment was not according to the algorithm. Most (11 of 17) had only one criterion against retention of one or both components. In all, ten of 11 patients with severe soft-tissue compromise as a single criterion had a relapse-free survival. We propose that the treatment concept for PJI of the ankle requires adaptation of the grading of quality of the soft tissues. Cite this article: Bone Joint J 2014;96-B:772-7.
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ʿal yedê Yiṣḥāq Ben-Aryê Yôsēf Dōv ...
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Digitalisat der Ausg. Zulṣbak, 1790/91
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[Simon Frankfurt]
