Implementation of a Robotic Gynecologic Surgery Program in a Rural Setting: Impact on Presence of Assistant Surgeon and Route of Hysterectomy.

Background And Objectives: Robotic surgical technology may obviate the need for an assistant surgeon when performing hysterectomy. In rural communities where physician shortages remain a major barrier to healthcare access, reducing the number of surgeons necessary to complete a hysterectomy would be of significant consequence. We sought to investigate the impact of robotic surgery on both the presence of an assistant surgeon and route of hysterectomy following implementation of a robotic surgery program at a single-site community hospital.

Acute and adaptive motor responses to caffeine in adolescent and adult rats.

Caffeine is a psychostimulant with intake through foods or beverages tending to increase from childhood through adolescence. The goals of the present study were to examine the effects of caffeine on young adolescent Long-Evans rats and to compare the motor-behavioral responses of adolescent and adult rats to acute and chronic caffeine. Adolescent rats had a biphasic dose-response to caffeine comparable to that reported for adult rats.

Long-term results with the uncemented thrust plate prosthesis (TPP).

The long-term clinical results of a novel concept for total joint replacement called the Thrust Plate Prosthesis (TPP) are presented. Only a restricted number of patients were provided with this new prosthesis (115 at the Orthopedic Department, Canton Hospital, Chur, and 47 at the Department of Orthopedic Surgery, University of Zurich). All patients have undergone clinical and radiological follow-up covering a period from 1980 to 1991.

[Infected prosthesis of large joints].

The problems related to infections of hip- and knee-prostheses are generally known. The aim of the operation- a mobile and painless joint is jeopardized. The best therapeutic measure has to be evaluated individually by a differentiated diagnostic procedure.

[Fresh ligament injuries of the ankle joint].

Fresh lesions of the ligaments about the tibio-talar joint are quite frequent, especially laterally. An isolated rupture of the anterior fibulo-talar ligament, with an anterior subluxation of the talus, can only be demonstrated by stress films in a lateral direction and can rarely be seen in the ap-views. The suture of the fresh rupture is always indicated, thus preventing chronic instability and a disposition to arthritic degeneration of the joint.

[Transitory algodystrophy of the hip].

Despite its relative rarity, transient osteoporosis of the hip deserves to be better known since it must be distinguished from more severe conditions, such as monarthritis or neoplastic bone disease, and its prognosis is always good. The typical symptoms are illustrated from two personally observed cases. This syndrome is characterized by hip pain, limping and osteoporosis of the femoral head with preservation of the joint space.

A new approach towards hip-prosthesis design.

A new femoral prosthesis with a stemless design, different from conventional types, has been conceived in an effort to preserve the physiological stress distribution in magnitude and direction within the living bone as far as possible. The most important feature is that the hip joint forces are transmitted directly to the cortical bone of the resected femoral neck by means of a thrust plate, which maintains the physiological stress an the proximal end of the femur. The prosthesis, the instruments required for its implantation and the surgical technique are described in detail.

[Candida coxitis (author's transl)].

Following drug-induced agranulocytosis and antibiotic and steroid treatment, sepsis due to candida albicans together with bilateral fungal coxitis developed in a 41-year-old female patient. Satisfactory eradication of the inflammatory process was achieved with combined treatment with amphotericin B and 5-fluorocytosine, so that mobilisation was possible after surgical fitting of bilateral total endoprothesis.

[Indication and assessment of the surgical treatment of fractures of the os calcis (author's transl)].

The instable fractures of os calcis are usually treated by conservative methods with early functional mobilization. In a few cases we think that in the Tongue Type and especially in the Joint Depression Type of Essex-Lopresti a surgical treatment may be useful to reestablish the congruence and the gometry of the joint surfaces. Some typical cases are described.

[Biomechanical analysis of the loosening of the femur prostheses (author's transl)].

A comparison of the stresses determined in an expoxy model of the human femur both with and without an intramedullary endoprosthetic replacement indicates how loosening of the implant could occur due to inappropriate mechanical loading of the bone. The stress pattern explains the manner in which the prosthesis stem is loaded and also indicates how hip-joint forces are transmitted from the prosthesis to the bone. The results obtained were verified by strain measurements on prostheses implanted within fresh human cadaver femora.

[Surgical treatment of intra-articular calcaneus fractures].

The instable fractures of os calcis are usually treated by conservative methods with early functional mobilization. In a few cases we think that in the Tongue Type and especially in the Joint Depression Type of Essex-Lopresti a surgical treatment may be useful to reestablish the congruence and the geometry of the joint surface.

[Lengthwise growth of the lower extremities after shaft fractures in children].

Clinical and orthoradiographic follow-up of 50 tibial and 36 femoral fractures in children at an average of 4 1/2 years post trauma has revealed the follwing trends: Increased growth is irrelevant with regard to tibial fractures. Most of the conservatively treated femoral fractures were shortened at the time of follow-up, most of the operatively treated were longer than the uninjured side. This may be explained by lack of primary shortening after anatomical reduction.

[A muscle activated dynamic repair of lateral instability of the ankle (author's transl)].

A muscle activated dynamic plastic reconstruction of the fibular ligaments of the posttraumatic weak ankle is presented and the operative technique is described. The most important advantages of this operation are compared with known methods.