Histopathologische Merkmale periprothetischer Membranen in der zweizeitigen Revisionsendoprothetik

Fragestellung: Ziel dieser Arbeit war die Identifizierung neuer immunhistochemischer Marker zur Unterscheidung der Infektkonsolidierung und Infektpersistenz in der Therapie komplexer periprothetischer Infektionen, als ein wertvolles histopathologisches Diagnoseinstrument. Methodik: Anhand der gängigen Kriterien der ICM erfolgte die retrospektive Aufarbeitung und der Vergleich von 10 Fälle mit persistierender Infektion mit 9 infektfreien Fällen. Es erfolgte die Erstellung von TMAs sowie immunhistochemische Färbungen um verschiedene Marker wie CRP, Kollagen II und IV, PAX 2 und weitere zu untersuchen. Ergebnisse: Es zeigten sich signifikante Unterschiede in der Färbungsintensität von CRP, Kollagen II, Kollagen IV und PAX 2 zwischen infiziertem und nicht infiziertem Gewebe. Die Receiver-Operator-Characteristic-Analyse ergab für die Färbeintensität von CRP eine hohe Sensitivität (100%) und Spezifität (90%) bei einem Cut-off von 1,5 im gemittelten Färbescore. Die Färbeintensität von Kollagen II und IV hatte eine Sensitivität von 85%. Der Anteil positiv gefärbter Zellen pro HPF mit PAX 2 zeigte einen signifikanten Unterschied zwischen infiziertem und nicht infiziertem Gewebe. Die ROC-Analyse hatte eine Sensitivität von 85% und eine Spezifität von ca. 50%. Schlussfolgerung: Die periprothetische Infektion ist eine bedeutende Komplikation in der muskuloskelettalen Chirurgie, die mit steigenden Primärimplantationen weiterhin eine wichtige Rolle spielen wird. Die Therapie ist für die Betroffenen eine körperliche wie geistige Herausforderung und bedarf eines multimodalen Ansatzes. Neue immunhistochemische Färbungen haben bisher keinen Einfluss auf die Diagnose von PPI. Die Arbeit zielt darauf ab, eine Basis für eine neue immunhistochemische Evaluation von periprothetischen Membranen zu schaffen, um eine verlässliche Aussage zur Infektkonsolidierung treffen zu können. Durch die Erstellung von Gewebechips konnten viele immunhistochemische Marker untersucht werden, wobei CRP, PAX 2, Kollagen 2 und 4 als vielversprechende Indikatoren zur Diskriminierung zwischen infizierten und nicht infizierten Geweben identifiziert wurden

Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study

Background: Handwriting is a complex task that requires the integrity of different sensorimotor components to be performed successfully. Patients with hemophilia suffer from recurrent joint bleeds that may occur in the elbow, causing elbow dysfunction with handwriting performance impairment. In our study, we described instrumental dysgraphia that is related to functional disturbances. This pilot study aims to evaluate the handwriting performance in a group of patients with hemophilia. Methods: The study was performed at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center in Milan. Boys with severe and moderate hemophilia A and B regularly followed-up at that Center, with age between 6–19 years, were eligible. Patients were invited to the Center for one multidisciplinary evaluation of the upper limbs that included: Clinical examination, surface electromyography, and handwriting assessment. Results: All patients, but one, completed handwriting assessment. Overall, 14/19 (74%) had abnormal handwriting, which was overt instrumental dysgraphia in six (32%). There was no difference in Hemophilia Joint Health Score (HJHS) between dysgraphic and non-dysgraphic boys, while surface electromyography (sEMG) revealed a prevalence of flexor muscles of the upper limb in dysgraphic as compared with non-dysgraphic boys. Conclusions: The rather high prevalence of instrumental dysgraphia found in this pilot study deserves a further development of this preliminary experience by increasing the number of examined patients and comparing them with a control group, including quality of life and psychological assessment

Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study

Background: Handwriting is a complex task that requires the integrity of different sensorimotor components to be performed successfully. Patients with hemophilia suffer from recurrent joint bleeds that may occur in the elbow, causing elbow dysfunction with handwriting performance impairment. In our study, we described instrumental dysgraphia that is related to functional disturbances. This pilot study aims to evaluate the handwriting performance in a group of patients with hemophilia. Methods: The study was performed at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center in Milan. Boys with severe and moderate hemophilia A and B regularly followed-up at that Center, with age between 6–19 years, were eligible. Patients were invited to the Center for one multidisciplinary evaluation of the upper limbs that included: Clinical examination, surface electromyography, and handwriting assessment. Results: All patients, but one, completed handwriting assessment. Overall, 14/19 (74%) had abnormal handwriting, which was overt instrumental dysgraphia in six (32%). There was no difference in Hemophilia Joint Health Score (HJHS) between dysgraphic and non-dysgraphic boys, while surface electromyography (sEMG) revealed a prevalence of flexor muscles of the upper limb in dysgraphic as compared with non-dysgraphic boys. Conclusions: The rather high prevalence of instrumental dysgraphia found in this pilot study deserves a further development of this preliminary experience by increasing the number of examined patients and comparing them with a control group, including quality of life and psychological assessment.</jats:p

A Systematic Review on the Value of Infrared Thermography in the Early Detection of Periprosthetic Joint Infections

Abstract Background Variations in the temperature of body and skin are symptoms of many pathological changes. Although joint replacement surgery of hip and knee has been very successful in recent decades, periprosthetic infection is a growing problem and the number one reason for revision. While many studies have investigated changes in blood levels, investigation of temperature has not been performed on a regular basis. The objective of this work is to determine whether reference literature exists for the infrared thermographic examination in knee and hip arthroplasty and if reference values can be derived for the methodology or if there is a peri- and postoperative benefit. Material und Methods By means of a systematic online database search and based on the Cochrane, PICOT and PRISMA guidelines, this systematic review retrieved 254 studies. All publications with thermographic examination in arthroplasty of the hip and knee were imbedded. 249 studies were excluded due to the defined inclusion and exclusion criteria and five studies with 251 patients have finally been included in the evaluation process. This was followed by an analysis and discussion of the methodology. Results and Conclusion Infrared thermography is a useful tool in the perioperative care of patients after arthroplasty of the knee and hip joint. The technology is portable, easy to use and non-invasive. Based only on these few publications, values can be derived, which provide a guidance for the thermographic aftercare in arthroplasty surgery.</jats:p