@article{StreckForstervonHertzbergBoelchetal.2022,
  author    = {Streck, Laura Elisa and Forster, Johannes and von Hertzberg-Boelch, Sebastian Philipp and Reichel, Thomas and Rudert, Maximilian and Rueckl, Kilian},
  title     = {The role of synovial fluid aspiration in shoulder joint infections},
  series = {BMC Musculoskeletal Disorders},
  volume    = {23},
  journal   = {BMC Musculoskeletal Disorders},
  doi       = {10.1186/s12891-022-05285-x},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300795},
  year      = {2022},
  abstract  = {Background Joint aspiration with analysis of synovial fluid white blood cell count (WBC) and microbiological culture is a widely established aspect in the diagnosis of shoulder joint infections (SJI). In case of a two stage revision for SJI, joint aspiration before re-/implantation of a total shoulder arthroplasty (TSA) was used to rule out persistent infection for years but its value is under debate. Shoulder specific data on all aspects is rare. The current study aims to answer the following research questions: Does joint aspiration have an insufficient predictive value in the diagnosis of SJI in (1) initial workup and (2) before definite arthroplasty with polymethylmethacrylate (PMMA)-Spacer in place? Methods This retrospective evaluation investigates 35 patients that were treated for SJI with a two staged implantation of a TSA after debridement and implantation of an PMMA-Spacer. Joint aspirations were performed preoperatively (PA) and before re-/implantation of the prosthesis while spacer was in place (interstage aspiration, IA). Samples were taken for microbiological culture and analysis of WBC. Sensitivity and specificity were calculated with reference to intraoperative microbiological samples. Receiver Operating Characteristic (ROC), Area-Under-Curve analysis (AUC) and calculation of the Youden index were performed to find optimum cut-off for WBC. Results The sensitivity of microbiological cultures from PA was 58.3\% and the specificity was 88.9\%. The mean WBC was 27,800 leucocytes/mm3 (range 400-96,300). The maximum Youden index (0.857) was a cut-off of 2600 leucocytes/mm3 with a sensitivity of 85.7\% and a specificity of 100.0\%. The sensitivity and specificity of IA were 0.0\% and 88.5\%, respectively. Conclusions Preoperative aspiration is likely to miss Cutibacteria spp. and CoNS and cannot rule out infection for sure. However, we recommend it for its advantages of targeted antibiotic therapy in case of germ identification. Empiric antibiotic therapy should cover Cutibacteria and CoNS even if aspiration showed negative microbiological cultures. In contrast, the diagnostic value of interstage aspiration does not qualify for its routine use.},
  language  = {en}
}
@article{KredelKunzmannSchlegeletal.2017,
  author    = {Kredel, Markus and Kunzmann, Steffen and Schlegel, Paul-Gerhardt and W{\"o}lfl, Matthias and Nordbeck, Peter and B{\"u}hler, Christoph and Lotz, Christopher and Lepper, Philipp M. and Wirbelauer, Johannes and Roewer, Norbert and Muellenbach, Ralf M.},
  title     = {Double Peripheral Venous and Arterial Cannulation for Extracorporeal Membrane Oxygenation in Combined Septic and Cardiogenic Shock},
  series = {American Journal of Case Reports},
  volume    = {18},
  journal   = {American Journal of Case Reports},
  doi       = {10.12659/AJCR.902485},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158193},
  pages     = {723-727},
  year      = {2017},
  abstract  = {Background: The use of venoarterial extracorporeal membrane oxygenation (va-ECMO) via peripheral cannulation for septic shock is limited by blood flow and increased afterload for the left ventricle. Case Report: A 15-year-old girl with acute myelogenous leukemia, suffering from severe septic and cardiogenic shock, was treated by venoarterial extracorporeal membrane oxygenation (va-ECMO). Sufficient extracorporeal blood flow matching the required oxygen demand could only be achieved by peripheral cannulation of both femoral arteries. Venous drainage was performed with a bicaval cannula inserted via the left V. femoralis. To accomplish left ventricular unloading, an additional drainage cannula was placed in the left atrium via percutaneous atrioseptostomy (va-va-ECMO). Cardiac function recovered and the girl was weaned from the ECMO on day 6. Successful allogenic stem cell transplantation took place 2 months later. Conclusions: In patients with vasoplegic septic shock and impaired cardiac contractility, double peripheral venoarterial extracorporeal membrane oxygenation (va-va-ECMO) with transseptal left atrial venting can by a lifesaving option.},
  language  = {en}
}
@phdthesis{Wind2006,
  author    = {Wind, Alexander},
  title     = {Molekularbiologische Untersuchungen zur Unterscheidung zwischen septischer und aseptischer H{\"u}ftendoprothesenlockerung},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-23214},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2006},
  abstract  = {Die aseptische Prothesenlockerung ist die bedeutendste Komplikation des k{\"u}nstlichen Gelenkersatzes. Eine geringere Bedeutung kommt der septischen Lockerung zu, doch diese hat schwerwiegende Folgen f{\"u}r den Patienten. Die aseptische und septische Prothesenlockerung k{\"o}nnen anhand charakteristischer histologischer Merkmale und mikrobiologischer Untersuchungen in den meisten F{\"a}llen voneinander unterschieden werden. So genannte low-grade Infektionen werden aber durch herk{\"o}mmliche Methoden oft nicht diagnostiziert. Um diese Art von Infektion nachzuweisen, ist ein L{\"o}sungsansatz die Charakterisierung von Zytokinmustern, die eine Differenzierung auf molekularbiologischer Ebene erlauben. In der vorliegenden In-vivo-Studie wurden Pseudomembranen von 27 Patienten mit Prothesenlockerungen aseptischer (n=21, davon n=12 mit und n=9 ohne Zementfixation) und septischer Genese (n=6) auf die mRNA-Expression vorbeschriebener Zytokine IL-1\&\#945;+\&\#946;, IL-RA, TNF-\&\#945; und ihrer Rezeptoren IL-1R1, TNFR1+R2, sowie CCR1, ein vermutlich mit der Osteolyse assoziierter Chemokinrezeptor, untersucht. Zu diesem Zweck wurde aus intraoperativ gewonnenen Gewebeproben mRNA isoliert, aus welcher cDNA synthetisiert und mit Hilfe der PCR-Reaktion amplifiziert wurde. Die sichtbar gemachten PCR-Produkte wurden gelelektrophoretisch aufgetrennt und semiquantitativ densitometrisch ausgewertet. Unsere Resultate belegen, daß sowohl in septischen als auch in aseptischen Pseudomembranen die vorgenannten Zytokine mit osteolytischer Wirkung und ihre Rezeptoren exprimiert werden, wobei die Heterogenit{\"a}t der Gewebeproben mit einem durchschnittlichen Variationskoeffizienten von Vr=0,22 ± 0,12 keine extremen Unterschiede aufweist. Einzelne signifikante Unterschiede bei den Mittelwerten der mRNA-Expression von IL-1\&\#945; und TNF-\&\#945; lassen eine Differenzierung zwischen aseptischer und septischer Genese in individuellen F{\"a}llen nicht zu. Die M{\"o}glichkeit einer Unterscheidung anhand der CCR1-Genexpression k{\"o}nnen unsere Ergebnisse nicht bekr{\"a}ftigen. Eine weitere Erh{\"o}hung der Fallzahl in Verbindung mit einem Genexpressionsarray k{\"o}nnte genauere Aussagen erm{\"o}glichen.},
  language  = {de}
}