Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland

BACKGROUND

The burden of healthcare-associated infections (HAIs) and antimicrobial use in Swiss long-term care facilities (LTCFs) is currently unknown. This study assessed the prevalence of HAIs and antibiotic use among LTCF residents in Switzerland.

METHODS

A point-prevalence study was undertaken in LTCFs in eastern and western Switzerland from August to October 2019 according to the 'Healthcare-associated infections in long-term care facilities' (HALT) protocol. Characteristics of residents (age, sex, wounds, dementia, indwelling catheters) and institutions (specific factors, geographic region) were assessed. LTCF residents were screened for HAIs and current antibiotic treatment. Personal and institutional factors associated with HAIs were assessed.

RESULTS

In total, 1185 residents from 16 LTCFs (eight per geographic region) were screened for HAIs and antibiotic treatment. Median age was 87 years (interquartile range 79-91) and 71% were female. The prevalence of HAIs was 4.2% (west 4.3% vs east 4.2%; P=0.93), with mucocutaneous skin infections (36%) and respiratory tract infections (30%) being the most common. Independent risk factors for the presence of HAIs were presence of a chronic wound [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1-5.0; P=0.02] and being immobile (OR 1.8, 95% CI 1.0-3.3; P=0.04). Antibiotics were given to 2.9% of residents (west 3.9% vs east 1.8%; P=0.05) on the day of the survey. The most commonly prescribed antibiotics were amoxicillin-clavulanic acid and quinolones.

CONCLUSIONS

The prevalence of HAIs in Swiss LTCFs is similar to that in other European countries, whereas antibiotic consumption is lower. Further point-prevalence surveys on a broader scale are recommended to improve understanding of the burden of HAIs and antibiotic consumption in this setting.

Synthetic aperture magnetometry and excess kurtosis mapping of Magnetoencephalography (MEG) is predictive of epilepsy surgical outcome in a large pediatric cohort

OBJECTIVE

Resective surgery is the most effective treatment option for patients with refractory epilepsy; however identification of patients who will benefit from epilepsy surgery remains challenging. Synthetic aperture magnetometry and excess kurtosis mapping (SAM(g2)) of magnetoencephalography (MEG) is a non-invasive tool that warrants further examination in the pediatric epilepsy population. Here, we examined the utility of MEG with SAM(g2) to determine if MEG epileptiform foci correlates with surgical outcome and to develop a predictive model incorporating MEG information to best assess likelihood of seizure improvement/freedom from resective surgery.

METHODS

564 subjects who had MEG at the Children's Hospital of Philadelphia between 2010-2015 were screened. Clinical epilepsy history and prior electrographic records were extracted and reviewed and correlated with MEG findings. MEG assessments were made by both a neurologist and neuroradiologist. Predictive models were developed to assess the utility of MEG in determining Engel class at one year and five years after resective epilepsy surgery.

RESULTS

The number of MEG spike foci was highly associated with Engel class outcome at both one year and five years; however, using MEG data in isolation was not significantly predictive of 5 year surgical outcome. When combined with clinical factors; scalp EEG (single ictal onset zone), MRI (lesional or not), age and sex in a logistic regression model MEG foci was significant for Engel class outcome at both 1 year (p = 0.03) and 5 years (0.02). The percent correctly classified for Engel class at one year was 78.43% and the positive predictive value was 71.43.

SIGNIFICANCE

MEG using SAM(g2) analysis in an important non-invasive tool in the identification of those patients who will benefit most from surgery. Integrating MEG data analysis into pre-surgical evaluation can help to predict epilepsy outcome after resective surgery in the pediatric population if utilized with skilled interpretation.

B Cell-Mediated Antigen Presentation through MHC Class II Is Dispensable for Atherosclerosis Progression

Depletion of B cells attenuates plaque development and modulates T cell responses in mouse models of atherosclerosis, suggesting that Ag presentation by B cells may promote disease progression. Thus, we set out to determine the role of B cell-mediated MHC class II (MHC II) Ag presentation during atherosclerotic plaque development. We developed murine conditional MHC II deletion and expression systems under control of the B cell-restricted CD19 promoter in an experimental model of atherosclerosis. Mice lacking MHC II expression only on B cells exhibited systemic shifts in germinal center and marginal zone B cell populations, leading to a reduced Ab response compared with littermate control animals. However, all populations were present and normal cholesterol uptake was detected in the plasma following high-fat diet treatment. In a second model, in which conditional expression of MHC II is limited only to B cells, showed similar overall cellularity characteristics compared with mice with complete MHC II deficiency. High-fat diet feeding showed no major changes in atherosclerotic plaque size or plaque cellular content in either conditional deletion or conditional expression approaches, compared with control animals. By testing the necessity and sufficiency of MHC II on B cells in the progression of atherosclerosis, we determine that MHC II on B cells does not directly regulate lesion development in murine models.

Preoperative imaging of Charcot neuroarthropathy

With about 4 million diabetics in germany and presumed inclination over the following years the treatment of diabetic complications like diabetic foot will become an even more important point. The management of Charcot’s foot has undergone fundamental change in the last few years. Formerly, treatment was almost exclusively limited to non surgical measures; since the late 1990’s, however, current practice has shifted to early, stage-appropriate surgical therapy. The aim of the present prospective study was to investigate the value of positron emission tomography (PET) in the pre-operative work-up of Charcot’s foot. PET were compared to magnetic resonance tomography (MRI). Patients, methods: MRI and PET imaging were used as part of the preoperative work-up in 18 patients with Type II diabetes mellitus. The diagnosis of Charcot’s foot requiring surgical treatment were made on the basis of clinical and radiologic criteria. Results: Of 46 Charcot’s lesions confirmed at surgery, 44 and 35 were detected by means of PET and MRI, respectively. PET can be used in the work-up of patients with metal implants where the MRI does not show adequate findings. PET shows the areas of detritus formation exhibit only moderately increased glucose metabolism and at visual interpretation do not usually impress as typical for acute osteomyelitis. Average SUV values stood at 1.2 (range: 0.5–2.9). Conclusions: The differentiation between Charcot’s lesions and florid osteomyelitis provides the surgeon with important additional information, which is often unavailable from MRI. Because of this important additional data, PET could be considered preferable to morphologic imaging (CT, projection radiography) in the preoperative work-up of Charcot’s foot.

Thermoneutrality but Not UCP1 Deficiency Suppresses Monocyte Mobilization Into Blood

RATIONALE

Ambient temperature is a risk factor for cardiovascular disease. Cold weather increases cardiovascular events, but paradoxically, cold exposure is metabolically protective because of UCP1 (uncoupling protein 1)-dependent thermogenesis.

OBJECTIVE

We sought to determine the differential effects of ambient environmental temperature challenge and UCP1 activation in relation to cardiovascular disease progression.

METHODS AND RESULTS

Using mouse models of atherosclerosis housed at 3 different ambient temperatures, we observed that cold temperature enhanced, whereas thermoneutral housing temperature inhibited atherosclerotic plaque growth, as did deficiency in UCP1. However, whereas UCP1 deficiency promoted poor glucose tolerance, thermoneutral housing enhanced glucose tolerance, and this effect held even in the context of UCP1 deficiency. In conditions of thermoneutrality, but not UCP1 deficiency, circulating monocyte counts were reduced, likely accounting for fewer monocytes entering plaques. Reductions in circulating blood monocytes were also found in a large human cohort in correlation with environmental temperature. By contrast, reduced plaque growth in mice lacking UCP1 was linked to lower cholesterol. Through application of a positron emission tomographic tracer to track CCR2⁺ cell localization and intravital 2-photon imaging of bone marrow, we associated thermoneutrality with an increased monocyte retention in bone marrow. Pharmacological activation of β3-adrenergic receptors applied to mice housed at thermoneutrality induced UCP1 in beige fat pads but failed to promote monocyte egress from the marrow.

CONCLUSIONS

Warm ambient temperature is, like UCP1 deficiency, atheroprotective, but the mechanisms of action differ. Thermoneutrality associates with reduced monocyte egress from the bone marrow in a UCP1-dependent manner in mice and likewise may also suppress blood monocyte counts in man.

[Prenatal diagnosis of a right thoracic congenital ectopic kidney with a diaphragmatic hernia: a combination with a good prognosis]

Ectopic intrathoracic kidney is a rare congenital anomaly, usually asymptomatic. This anomaly is sometimes associated with a diaphragmatic hernia. Few cases of this combination have been described, often in the absence of a prenatal diagnosis. We report on the case of a female newborn infant who was diagnosed with an ectopic intrathoracic right kidney and a diaphragmatic hernia upon 33 weeks of gestation. The patient underwent surgery on the first day of life and the respiratory and renal outcomes were simple. We review the literature and discuss the seemingly good prognosis of this combination.

Psychological Aspects of Genetic Counseling: XIII. Empathy and Decency

The issues confronting genetic counselees, the demands of the "new genetics" and other factors suggest strongly the need for greater attention to counseling procedures which convey understanding of clients and help them feel more hopeful and more capable of dealing with their life problems. This should include interventions to help them feel more effective in their coping efforts as well as such ego-bolstering techniques as the expression of kindness, the provision of appropriate rewards, and other attempts to raise the client's self-esteem. These attempts should be a standard part of all genetic counseling. The traditional arguments of potential harm and time limitations often used to avoid counseling efforts are viewed through the lens of countertransference.

Psychological Aspects of Genetic Counseling. IX. Teaching and Counseling

The goals, philosophies, and procedures of the teaching and counseling approaches to genetic counseling are differentiated and compared. The teaching approach, inherited from academic practitioners earlier in this century, appears to remain the dominant form of contemporary practice. With the introduction of more nonphysician professionals, attempts are being made to combine a teaching model with counseling procedures. The goals of the two models are conspicuously different; one attempts to end up with an "educated" counselee whereas the other hopes to leave the latter psychologically more autonomous and functional. Both models have strengths and limitations. The teaching model is essentially a form of health education, not counseling, and, with some exceptions, tends to fulfill its goals. The strategy of teaching, however, tends to undermine the psychological self-directedness of counselees and thus interferes with the processes they need to draw on to make autonomous decisions. The strength of the counseling model is in helping counselees reach decisions and deal with the personal meaning of information. However, applying this model makes huge demands on the professional. Greater attention needs to be given by training programs to the pedagogical and counseling skills genetic counselors may need in their professional work.

Morning stiffness of the joints is the sole predictor of short-term response to glucocorticoid treatment in active rheumatoid arthritis (RA)

Several studies show that the application of oral glucocorticoids in patients with active RA leads to fast resolution of disease activity. Treatment strategies that include the initial application of glucocorticoids seem to have a favourable outcome in terms of long-term control of disease activity. Moreover, when tapered down to low doses, glucocorticoids show disease-modifying actions such as the inhibition of progression of structural damage to the inflamed joints. The goal of this study was to examine the predictors of short-term response to intermediate-dose glucocorticoids in patients with active RA.

[First epidemiologic data about phloroglucinol exposure during first trimester of pregnancy]

OBJECTIVE

Phloroglucinol is used to prevent gastric, intestine or urogenital spasms. In France, many pregnant women are exposed to phloroglucinol for which no data are available about its use in pregnancy. The present study, using EFEMERIS database, investigates potential teratogenic risk of phloroglucinol in pregnancy.

MATERIALS AND METHODS

EFEMERIS is a database including prescribed and delivered drugs during pregnancy (data from Caisse Primaire d'Assurance Maladie of Haute-Garonne) and outcomes (data from Maternal and Infant Protection Service and from Antenatal diagnostic Centre). Women delivered from July 1st 2004 to June 30th 2008 in Haute-Garonne and registered in the French Health Insurance Service were included into EFEMERIS database. We compared pregnancy outcomes and newborn health between women exposed to phloroglucinol during organogenesis and non-exposed women. Malformations were classified according to Eurocat classification.

RESULTS

Five thousand one hundred and thirty-two newborns (12.7%) exposed during organogenesis to phloroglucinol were compared to 35,223 controls (non exposed newborns). The mean number of different drugs prescribed during the first trimester of pregnancy per woman was higher in women exposed to phloroglucinol than in non-exposed women (6.4 ± 4.3 versus 2.4 ± 3.3, P < 10(-4)). Among newborns, 126 (2.5%) had a malformation versus 804 (2.3%) in control newborns (OR=1.1, [0.9-1.3]). The present study was powered to find a 1.3 fold increase in the overall rate of major anomalies.

DISCUSSION AND CONCLUSION

This first epidemiologic study about phloroglucinol in pregnancy does not support evidence of a teratogenic risk for phloroglucinol in humans.

Micro-capsules in shear flow

This paper deals with flow-induced shape changes of elastic capsules. The state of the art concerning both theory and experiments is briefly reviewed starting with dynamically induced small deformation of initially spherical capsules and the formation of wrinkles on polymerized membranes. Initially non-spherical capsules show tumbling and tank-treading motion in shear flow. Theoretical descriptions of the transition between these two types of motion assuming a fixed shape are at odds with the full capsule dynamics obtained numerically. To resolve the discrepancy, we expand the exact equations of motion for small deformations and find that shape changes play a dominant role. We classify the dynamical phase transitions and obtain numerical and analytical results for the phase boundaries as a function of viscosity contrast, shear and elongational flow rate. We conclude with perspectives on time-dependent flow, on shear-induced unbinding from surfaces, on the role of thermal fluctuations and on applying the concepts of stochastic thermodynamics to these systems.

[Closed reposition of an acute midfoot luxation fracture in Charcot arthropathy with the ring fixator]

Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation, fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails, in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of 10-20% in open surgery is high. We present a minimally invasive technique of closed reduction and application of a ring fixator for reconstruction of the foot architecture and arthrodesis of the involved joints.

[Principles of treatment for deep infections of the diabetic foot]

Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key to lower the rate of amputation. If infection has occurred antibiotics and non-weight bearing are indicated. Abscesses and phlegmons can be localized by the clinical findings, ultrasound, x-rays, computer tomography and MRI and immediate surgical treatment is necessary to prevent further spreading. In the chronic phase dead tissue, necrotic tendons and bones need to be resected. Closure of the skin can be achieved by secondary healing or other methods of plastic surgery. Persistent bony prominences have to be removed and instabilities need fusion operations. In this way many amputations can be avoided or the extent of amputation can be noticeably reduced.

Elastic capsules in shear flow: analytical solutions for constant and time-dependent shear rates

We investigate the dynamics of microcapsules in linear shear flow within a reduced model with two degrees of freedom. In previous work for steady shear flow, the dynamic phases of this model, i.e. swinging, tumbling and intermittent behaviour, have been identified using numerical methods. In this paper, we integrate the equations of motion in the quasi-spherical limit analytically for time-constant and time-dependent shear flow using matched asymptotic expansions. Using this method, we find analytical expressions for the mean tumbling rate in general time-dependent shear flow. The capsule dynamics is studied in more detail when the inverse shear rate is harmonically modulated around a constant mean value for which a dynamic phase diagram is constructed. By a judicious choice of both modulation frequency and phase, tumbling motion can be induced even if the mean shear rate corresponds to the swinging regime. We derive expressions for the amplitude and width of the resonance peaks as a function of the modulation frequency.

Staining undecalcified bone sections a modified technique for an improved visualization of synthetic bone substitutes

We describe a detailed embedding procedure for large bone specimens in methyl methacrylate and a new staining method by which thin sections (appr 100 um) of undecalcified bones with synthetic implants can be coloured. Different staining effects were obtained which greatly facilitated the evaluation of sections with bone, new forming bone and especially remnants of synthetic implants. The identification and quantification of the latter is difficult in common staining techniques. A detailed embedding - staining - mounting procedure is proposed.

Extensive subtrochanteric shortening osteotomy enables the conversion of a long lasting resection arthroplasty to a total hip replacement

This case report presents the results of a conversion hip arthroplasty after a long lasting Girdlestone situation of 15 years in combination with an extensive shortening of the leg of 7.2 centimeters. An extensive subtrochanteric shortening osteotomy of 3.5 centimeters was necessary to restore leg length and the rotational centre of the hip. Functional outcome was excellent within the long run and a restoration of the independence of the patient was achieved.

[Whiplash-associated disorders: a challenge for the expert in compensation claims and litigation]

In the literature, the association between chronic complaints of the cervical spine and sustained"whiplash trauma" is a matter of controversy. Whiplash trauma is identified as contusion, compression, and/or sprain without definite imaging proof of injury to the bone, disk, or ligaments.However, complex chronic complaints leading to permanent and significant functional limitations in daily living and work may develop. Besides the diagnostic and therapeutic challenges for the treating physician, the expert confronted with compensation claims very often must decide whether whiplash trauma of the spine may lead to significant and permanent functional limitations or loss with chronic disorders. The data from the literature dealing with this topic are contradictory and deficient. In this article, based on the present available data from the literature, we critically examine the causality between spinal whiplash trauma and possible permanent chronic complaints in order to support the process of decision making in cases of litigation and controversial compensation claims.

[The impact of preoperative function and pain on early patient-centred outcome after total hip arthroplasty]

AIM

It was the purpose of this prospective study to investigate the impact of preoperative functional status and pain on the early patient-centred outcome after total hip arthroplasty (THA).

METHODS

67 consecutive patients scheduled for THA were included in this study. Outcome was analysed with the Western Ontario and McMaster Universities' (WOMAC) Osteoarthritis Index preoperatively and after ten days and 12 weeks, respectively. Patients were grouped with regard to their preoperative function and pain according to the WOMAC Osteoarthritis Index. Statistical analysis was performed using a multivariate regression model considering further confounding variables (age, gender, affected side, duration of surgery, and anchorage of THA).

RESULTS

All patients showed a significant functional improvement both at ten days postoperatively and after three months, respectively. Patients with a higher degree of disability preoperatively had a larger relative functional improvement according to their WOMAC score compared to patients who initially were less deteriorated. However, the latter had the better absolute scores postoperatively. Multiple regression analysis revealed gender (OR: -11.85, 95% CI: -22.65 to -1.06, p=0.03) and preoperative WOMAC score (OR: 0.34, 95% CI: 0.09 to 0.59, p<0.01) to be significant prognostic variables at ten days postoperatively. After three months, age (OR: 0.43, 95% CI: 0.04 to 0.82, p=0.03) was the only variable predicting the patient-centred outcome.

CONCLUSION

In our study sample, patient-related variables did significantly influence the patient-centred outcome after ten days (gender and WOMAC) and at three months postoperatively (age) whereas procedure-related variables did not have any impact.

Comparative assessment of outcome in osteoarthritis of the knee: the utility of knee scores

PURPOSE OF THE STUDY

The utility of scoring systems, which are used to determine health status or treatment benefit in patients with knee osteoarthritis is under discussion. Therefore it was the purpose of our investigation to evaluate the reliability and the concordance of two established knee scoring systems.

METHODS

Thirty-eight patients with unilateral knee osteoarthritis were scored by the Hospital for Special Surgery score and the Knee Society score. Two blinded observers rated the patients independently in order to determine the concordance of the scores, the correlation between the overall scores and their subscales such as "pain", "function" and "range of motion" and the inter-observer and intra-observer reliability.

RESULTS

There was a high correlation between the overall scores (r= 0.80) and between the scores and their subscales "range of motion" (r=0.89) and "function" (r=0.74). The correlation of scores for "pain" was slightly less (r=0.61). Mean inter-observer reliability ranged between r=0.58 and r=0.61. Mean intra-observer reliability was high for the overall scores as well as for the subscales of both scoring systems (r=0.64 to r=0.93 and r=0.73 to r=0.92).

CONCLUSION

We have found that the assessment of overall scores as well as of their main subscales is concordant and reliable in our patient sample. The application of these scoring systems in measuring health status in patients with knee osteoarthritis appears to be an acceptable method of audit. However, we feel that presentation of the results of knee scoring systems should include detailed information on the main subscales, since this allows for a better understanding of results.

[Trauma of the spine and intervertebral disk. A challenge for the expert in compensation claims after sustained "trifle trauma"]

In the literature, the association between chronic pain syndromes of the spine and sustained "trifle trauma" is a matter of controversy. "Trifle trauma" is identified as a contusion, compression and/or sprain without a definite, acute imaging sign of injury to the bone, the disk or the ligaments of the spine. Most of the time, striking isolated changes to the intervertebral disks are interpreted as preexisting without relevance to an acute injury. However, complex chronic pain syndromes causing permanent and significant functional limitations in daily life and work may occur. Besides the diagnostic and therapeutic challenge for the treating physician, the expert confronted with compensation claims very often has to answer questions as to whether "trifle trauma" of the spine may lead to significant and permanent functional limitations or loss with chronic pain syndromes, and what the importance of possible isolated changes in intervertebral disks is. The data from literature dealing with this topic is contradictory and deficient. In this article, we critically examine the causality between "trifle trauma" to the spine and possible permanent chronic complaints based on currently available data from the literature in order to support the process of decision making in questions of litigation and controversial compensation claims.

[Predictive factors of perioperative morbidity in revision total hip arthroplasty]

AIM

The awareness and prevention of perioperative morbidity are essential in revision total hip arthroplasty [THA]. Therefore, it was the purpose of this study to assess the rate of perioperative complications following revision THA in order to evaluate the impact of patient- and procedure-related variables.

METHODS

169 consecutive patients with a mean age of 71.7 years suffering from aseptic loosening of their THA were included in this retrospective study. Multivariate logistic regression models with estimation of the odds ratio [OR] and 95% confidence interval [CI] served to analyze the influence of operation duration, gender, revision status, ASA classification, and type of fixation of the primary implant on the perioperative morbidity.

RESULTS

68.6% of the cases were primary revisions, and 31.4% secondary or multiple revisions. 49.7% of the operations involved exchange of the complete implant whereas 39.1% comprised exchange of the cup and 11.2% exchange of the stem only. Mean operation duration was 130 minutes [min] (range: 40-260 min), and mean intraoperative blood loss was 2.6 L (0.5 to 12 L). The rate of intraoperative complications was 10.1 % with a 6.5 % fracture rate. Postoperatively the complication rate was 25.4% with an 8.3% rate of luxations. 11.8% of the patients had revision within the first three weeks after surgery. Regression models showed the significant impact of revision status (primary vs. secondary or multiple: OR 2.90, 95% CI 1.42-5.92) and operation duration (per min starting from the mean operation time: OR 1.01, 95% CI 1.00-1.02) on the resulting complication rate. Analysis of the perioperative complication rate following primary revisions revealed a significant difference (p = 0.03) between patients with cemented (15/36, 41.7%) and non-cemented (8/45, 17.8%) implants.

CONCLUSIONS

Revision status with a three-fold increase in patients with multiple revisions as well as operation duration with a 1 % increase per min starting from the mean operation time significantly influence the perioperative morbidity. Patients with a first revision, furthermore, seem to be at greater risk for an adverse event perioperatively if their implant is fully cemented. These findings should be taken into account prior to initiating surgery.

[Management of acute wounds]

Uncomplicated wounds can be treated immediately in the general practitioner's office. Management by a specialist is necessary only in the case of wounds involving the eyes, nose or mouth, or in the presence of other unusual features.

[Soft tissue infections treatable in the doctor's office]

A good number of infections requiring only minor surgery can be treated in the GP's office, simply and adequately. Of importance, however, is the physician's ability to recognize when a patient needs to be referred to a specialist. Provided the principles listed here are adhered to, treatment is usually successful. All other courses indicate a multifactorial pathology and belong in the hands of an experienced specialist.

Prenatal diagnosis of craniosynostosis: value of MR imaging

INTRODUCTION

The aim of our study was to assess the utility and reliability of magnetic resonance imaging (MRI) in antenatal diagnosis of craniosynostosis.

METHODS

We retrospectively reviewed the MRI examinations of the head of 15 fetuses requested over a period of 11 years on the basis of sonographic suspicion of craniosynostosis. The postnatal diagnosis was available for 14 neonates.

RESULTS

No termination of pregnancy was performed. There were four neonates with sporadic multisuture craniosynostoses, three of which were syndromic, including one Crouzon and one Pfeiffer syndrome. Eight neonates were normal, two showed cranial vault deformities without synostosis, and one was lost to follow-up. MRI showed a high predictive value for craniosynostosis, as there were no false-negative or false-positive diagnoses. However, the severity of the abnormalities were underestimated in two neonates.

CONCLUSION

We suggest that prenatal MRI has diagnostic value when synostosis is suspected on ultrasonography. Moreover, MRI is accurate in the detection of associated brain abnormalities, which is an important prognostic issue in this diagnosis. Prenatal diagnosis of craniosynostosis is difficult and could benefit from three-dimensional ultrasonography and three-dimensional CT.

[Preoperative imaging of Charcot neuroarthropathy: Does the additional application of (18)F-FDG-PET make sense?]

With about 4 million diabetics in germany and presumed inclination over the following years the treatment of diabetic complications like diabetic foot will become an even more important point. The management of Charcot's foot has undergone fundamental change in the last few years. Formerly, treatment was almost exclusively limited to non surgical measures; since the late 1990's, however, current practice has shifted to early, stage-appropriate surgical therapy. The aim of the present prospective study was to investigate the value of positron emission tomography (PET) in the pre-operative work-up of Charcot's foot. PET were compared to magnetic resonance tomography (MRI).

PATIENTS, METHODS

MRI and PET imaging were used as part of the preoperative work-up in 18 patients with Type II diabetes mellitus. The diagnosis of Charcot's foot requiring surgical treatment were made on the basis of clinical and radiologic criteria.

RESULTS

Of 46 Charcot's lesions confirmed at surgery, 44 and 35 were detected by means of PET and MRI, respectively. PET can be used in the work-up of patients with metal implants where the MRI does not show adequate findings. PET shows the areas of detritus formation exhibit only moderately increased glucose metabolism and at visual interpretation do not usually impression as typical for acute osteomyelitis. Average SUV values stood at 1.2 (range: 0.5-2.9).

CONCLUSIONS

The differentiation between Charcot's lesions and florid osteomyelitis provides the surgeon with important additional information, which is often unavailable from MRI. Because of this important additional data, PET could be considered preferable to morphologic imaging (CT, projection radiography) in the preoperative work-up of Charcot's foot.

The UV Erythema Test as a Model to Investigate the Anti-Inflammatory Potency of Topical Preparations – Reevaluation and Optimization of the Method

BACKGROUND

The ultraviolet (UV) erythema test is one of the most frequently used methods to investigate the anti-inflammatory potency of topical dermatological preparations in vivo.

METHODS

The following questions were addressed in four separate studies with healthy persons (skin types 2 and 3): (1) the optimal localization was determined by comparing light scales on the back, buttocks and volar forearms; (2) the optimal UV-B dose was determined by comparing the 1-fold, 1.5-fold and 2-fold minimal erythema doses (MEDs); (3) hydrocortisone and prednicarbate were evaluated as positive controls, and a sample size calculation was performed, and (4) betamethasone valerate and pimecrolimus were tested as further positive controls in the optimized study model.

RESULTS

The back proved to be the best localization for the UV erythema test. It showed a good correlation between the light scale and the test areas. The 1.5-fold MED was the best irradiation dose. In contrast to prednicarbate and betamethasone valerate, hydrocortisone was a rather weak positive control. However, when the sample size was > or = 40 subjects, significant results were also obtained with hydrocortisone. Pimecrolimus was not effective in the UV erythema test.

CONCLUSIONS

The UV erythema test should be performed on the back with at least 40 subjects using the 1.5-fold MED. It may be useful to include a potent corticosteroid, such as prednicarbate or betamethasone valerate, in addition to hydrocortisone. The UV erythema test seems to be suitable only for substances with corticosteroid-like effects, since in this test model the calcineurin inhibitor pimecrolimus was not effective.