Results after arthroscopic treatment of central traumatic lesions of the triangular fibrocartilage complex

INTRODUCTION

Injuries of the triangular fibrocartilage complex (TFCC) are of high clinical relevance; however, the clinical evidence for treatment is poor and long-term results are rarely published. The purpose of this study was to evaluate the clinical outcome of symptomatic central traumatic lesions of the TFCC (Palmer 1A) following arthroscopic debridement.

MATERIALS AND METHODS

Between 2007 and 2013, 87 patients were arthroscopically diagnosed with Palmer 1A lesion and accordingly treated with debridement. Follow-up was available for 43 patients. Activities of daily living (ADLs) were measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Pain perception was evaluated with visual analogue scale (VAS 0-10). Grip strength and wrist motion were assessed with conventional techniques using a Jamar dynamometer and a goniometer. Patient satisfaction was assessed using a questionnaire at follow-up.

RESULTS

Mean follow-up was 42.5 months (range 5-70). The mean age of the patients (22 male and 21 female) at time of surgery was 41 ± 15.9 years. No major complication occurred during surgery and follow-up. The DASH score (preoperatively 49.8 ± 19.3 vs. postoperatively 14.1 ± 17.9, p < 0.05) and pain perception (VAS: preoperatively 7.2 ± 2.0 vs. postoperatively 1.4 ± 1.6, p < 0.05) improved significantly. Grip strength was satisfactory after surgery (19.6 ± 13.1). Ulnar deviation improved significantly from 29.3 ± 10.4° to 35.6 ± 8.3° (p < 0.05) and wrist flexion improved from 53.8 ± 18.9° to 67.4 ± 12.9° (p < 0.05). Wrist extension, radial deviation, pronation and supination did not change significantly after surgery. Improved symptoms were reported by 41/43 (95.3%) patients and 40/43 (93%) patients would have had the same procedure again knowing the final outcome. Six of 43 patients (15%) had an ulnar plus variance. None of these needed ulnar shortening.

CONCLUSIONS

Central traumatic TFCC lesions can safely be treated by arthroscopic debridement. We showed a sustained pain relief with significantly improved quality of life (DASH score) and wrist motion at follow-up. This resulted in a high patient satisfaction and acceptance of the procedure.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic, level IV.

[Multidrug-resistant germs in neurological early rehabilitation (2004-2013)]

Multidrug-resistant germs are an increasing problem in neurological and neurosurgical early rehabilitation but reliable data is missing. The present study examined the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram negative germs (MRGN) in a German neurological early rehabilitation facility (BDH Clinic Hessisch Oldendorf). Observation period was 2004-2013 (10 years). MRSA prevalence on admission was 11.4%, MRGN prevalence during rehabilitation 11.8%. A combination of different multidrug-resistant germs (MRSA plus MRGN) was observed in 3.8% of all cases. VRE were first detected in 2009, prevalence was as low as 0.1%. High prevalence of MRSA and MRGN raises major financial, medical, and ethical problems in early rehabilitation facilities. The authors encourage further multi-center studies and suggest a better recompense for this group of patients in the German DRG-system (Diagnosis Related Groups).

Resonant tunnelling through a C(60) molecular junction in a liquid environment

We present electronic transport measurements through thiolated C(60) molecules in a liquid environment. The molecules were placed within a mechanically controllable break junction using a single anchoring group per molecule. On varying the electrode separation of the C(60)-modified junctions, we observed a peak in the conductance traces. The shape of the curves is strongly influenced by the environment of the junction as shown by measurements in two distinct solvents. In the framework of a simple resonant tunnelling model, we can extract the electronic tunnelling rates governing the transport properties of the junctions.

Detection and measurement of Staphylococcus epidermidis slime using an ELISA technique

A polyclonal rabbit anti-serum against the strong slime-producing Staphylococcus epidermidis strain RP62A was absorbed with the slime-negative phase variant of this strain PV1 in order to remove not slime-specific antibodies. Using this antiserum we established an ELISA which enables detection of slime production in S. epidermidis extracts. The ELISA showed high absorbance when extracts from slime-positive strains (confirmed in the tissue culture tube test) were used as antigens. The high absorbance of slime-positive strains was greatly reduced by periodate oxidation of the extracts and was resistant to proteinase digestion suggesting that the detected antigen is composed of polysaccharides. In contrast to other rapid and simple laboratory detection methods for S. epidermidis slime, the slime-specific ELISA gave positive results in the presence of human serum.

Variable degree of slime production is linked to different levels of beta-lactam susceptibility in Staphylococcus epidermidis phase variants

Recently we demonstrated that lack of mecA transcription was responsible for the decreased methicillin resistance phenotype of strongly slime-negative Staphylococcus epidermidis phase variants [Mempel M, Feucht H, Ziehbuhr W, Endres M, Laufs R, Grüter L (1994) Antimicrob Agents Chemother 38: 1251-1255]. In the present study we compared the beta-lactam susceptibility and the slime production capacity of 60 phenotypic variants of S. epidermidis parent strain RP62A identified by their colony morphology on congo red agar. We could show that the variable degree of slime production is linked to different levels of beta-lactam susceptibility in intermediate-stage phase variants. The increased deltahemolysin production of slime-negative phase variants may indicate an accessory gene regulator-like control.

Lack of mecA transcription in slime-negative phase variants of methicillin-resistant Staphylococcus epidermidis

Five phase variants (PV1 to PV5) of the well-characterized, slime-producing, methicillin-resistant, pathogenic strain of Staphylococcus epidermidis sensu strictu RP62A (ATCC 35984) were isolated by the Congo red agar method. In comparison with the parent strain, the phase variants showed a different colonial morphology on Congo red agar, a strongly reduced adherence capacity, and decreased levels of resistance to methicillin, oxacillin, and penicillin. All phase variants yielded biochemical reaction patterns and profiles in pulsed-field gel electrophoresis identical to those of parent strain RP62A, indicating a common origin. All phase variants proved to have the capacity to shift back to the original phenotype of parent strain RP62A. A search for the resistance mechanisms of strain RP62A revealed beta-lactamase production and the presence of mecA in PV1 to PV5 as well as parent strain RP62A. In Northern blots of total staphylococcal RNA, the phase variants showed no detectable mecA-specific transcription product, whereas parent strain RP62A revealed a strong signal, indicating that mecA transcription is not the mechanism responsible for the decreased methicillin resistance phenotype of phase variants PV1 to PV5.

Construction of a slime negative transposon mutant in Staphylococcus epidermidis using the Enterococcus faecalis transposon Tn917

The slime-producing Staphylococcus epidermidis strain sensu strictu CNS23 was transformed by protoplast transformation with the plasmid pTV1 which carries transposon Tn 917. Using this transposon mutagenesis system we obtained the Tn917-inserted mutant CT512, which has lost the ability to produce slime. A single insertion of the transposon Tn917 into the chromosome of CT512 could be detected by Southern hybridization. This mutant showed a significantly higher stability concerning its slime-negative phenotype compared with spontaneous slime-negative mutants of S. epidermidis strain CNS23. In slime-ELISA no slime-associated antigen could be detected in extracts of the transposon mutant. Compared to slime-positive S. epidermidis strains, CT512 lacked in accumulative growth in microtiter tube test.

[Perimyocarditis caused by Yersinia enterocolitica serotype 0:3]

Three days after the end of a bout of diarrhoea of 3 days' duration, a 19-year-old patient developed severe nocturnal thoracic pain unresponsive to isosorbitol dinitrate. There were no abnormal findings on physical examination, except a sweaty skin. SGOT (38 U/l), creatinine kinase (291 U/l, CK-MB 29 U/l) and lactate dehydrogenase (246 U/l) were all elevated. The ECG showed ST segment elevations in leads I, II, III, aVF and V1-V6 as well as negative terminal T waves in I, II, aVL, AVF and V3-V6, changes suggesting peri- and myocarditis. The Widal test gave a raised antibody titre (1:800) against Yersinia enterocolitica serotype O:3. Seven days later the immunoblot test demonstrated antibodies against the same organism, which was finally isolated from stool after 11 days. Treatment consisted of ciprofloxacin (500 mg twice daily for 14 days). All symptoms, as well as the biochemical and ECG abnormalities, quickly improved. The patient was discharged free of symptoms after 34 days.

Cloning and expression of Staphylococcus epidermidis urease gene sequences in Staphylococcus carnosus

The urease gene sequences of Staphylococcus epidermidis CNS23 were cloned and expressed in Staphylococcus carnosus TM300. In vitro translation of the cloned sequences revealed four polypeptides (60, 17, 11 and 7.5 kDa) that were associated with enzyme activity. Southern hybridisation experiments showed high homologies with the urease genes of Staphylococcus saprophyticus.

[Hypothyroidism and tympanic effusion. A contribution to the diagnosis and therapy of mucotympanum in the elderly]

We report two elderly patients with a chronic tympanic cavity effusion accompanied by hypothyroidism for many years. Particular diagnostic and therapeutic problems are discussed. Adequate thyroid gland hormone-substitution is the only treatment for the "thyroxin-deficiency-mucoid-middle ear effusion".