This case report concerns a 75-year-old patient who suffered haemorrhagic shock and mors in tabula during implantation of a total hip arthroplasty. The cause was established as an injury of the external iliac vein, probably as a result of the predrilling of holes for the anchoring screws and pegs. The surgical method and topographic anatomy of the operating area are presented. Such vascular injuries are a rare but life-threatening complication of this procedure; the literature quotes a frequency of about 0.3%. So far, no fulminate venous bleeding process has been reported. Complications in such operations cannot always be avoided. However, detailed knowledge of the acetabular geometry can provide more safety for the surgeon when carrying out the secondary anchoring of a press-fit implant.

Berichtet wird über den Fall einer 75-jährigen Patientin, die während der Implantation einer Hüftgelenkendoprothese einen hämorrhagischen Schock erlitt und in tabula verstarb. Ursächlich war eine iatrogene Verletzung der V. iliaca externa, wahrscheinlich hervorgerufen durch das Vorbohren für die Verankerungsschrauben.

Zusammenfassung Primär maligne Knochentumore können überwiegend extremitätenerhaltend operiert werden. Sofern neben dem dia- und metaphysären Knochen auch gelenkbildende Abschnitte reseziert werden müssen, ist die Endoprothese – in modularer Bauweise – das verbreitetste Rekonstruktionsverfahren. Wird zur Überbrückung avitaler, kortikospongiöser Knochen (Allograft) transplantiert, können auch langstreckige ossäre Defekte unter Erhalt der Extremität belastungsstabil operiert werden. Das Risiko der Pseudarthrosenbildung und Transplantatfraktur ist dabei jedoch als hoch einzustufen. Die Rate dieser eingriffsspezifischen Majorkomplikationen kann durch Verwendung eines vaskularisierten Knochentransplantates deutlich reduziert werden. In der Zeit von 1988 bis 1999 behandelten wir 20 Patienten mit Tumoren der oberen und unteren Extremität, bei denen wir den knöchernen Defekt nach Tumorresektion mittels gefäßgestieltem Fibulatransfer überbrückten. In einer retrospektiven Studie erfassten wir standardisiert Daten zur ossären Integration der Transplantate und dem funktionellen Ergebnis im postoperativen Verlauf. Als Maßstab zur Bewertung der knöchernen Durchbauung diente das Schema des “International Symposium of Limb Salvage” (ISOLS). Das funktionelle Ergebnis wurde nach dem Enneking-Score getrennt nach oberer und unterer Extremität ermittelt. Die Transplantatstabilisierung erfolgte an der oberen Extremität ausschließlich plattenosteosynthetisch, an der unteren Extremität erfolgte in 10 von 12 Fällen die Rekonstruktion durch ein Manteltransplantat, d. h. durch eine Kombination von einem Allograft mit einer gefäßgestielten Fibula. Durchschnittlich konnte ein Funktionalitätsindex von 73% zum Zeitpunkt der jeweils letzten Nachuntersuchung ermittelt werden. Nach 18 Monaten war die radiologische Beurteilung der ossären Integration entsprechend den Kriterien des ISOLS in 75% “sehr gut”, in 11% “gut”, in 6% der Fälle “befriedigend” und in 9% “schlecht”. Wesentliche Komplikationen waren der Transplantatbruch mit einer Häufigkeit von 15% und die Pseudarthrose mit 14,3%. Der vaskularisierte Fibulatranfer ist ein operationstechnisch aufwendiges Verfahren zur Rekonstruktion langstreckiger ossärer Defekte, bietet jedoch den Vorzug einer weitestgehend biologischen Rekonstruktion mit guter Langzeiterwartung und vergleichsweise geringer Komplikationsrate.

Primary malignant bone tumors can be treated predominantly with limb salvage. After resection of large articular segments adjacent to the dia- or metaphysis of long bones modular endoprosthetic devices are most commonly used for reconstruction. In case non-vascularized corticocancellous bone is transplanted in order to bridge extensive bone defects, the risk of pseudarthrosis and fracture of the donor bone is significantly higher in comparison to a free vascularized transplant. From 1988 until 1999 we treated 20 patients with extensive bone defects after resection of tumors affecting the upper and lower extremity using a vascularized fibular graft. In this retrospective analysis we collected the data focusing on bone integration and functional outcome. The graft union was classified according to the standards of the "International Symposium of Limb Salvage". Evaluation of the functional outcome was quantified using the Enneking-score. The stabilisation of the transplant was obtained exclusively by plate fixation in the upper extremity. In 10 in a total of 12 patients the reconstruction using a vascularized fibula transfer was reinforced with an allograft in the lower extremity. The functional evaluation score reached 73% of normal function at the last follow-up. After 18 months the radiographic evaluation of graft union was "excellent" in 75%, "good" in 11%, "fair" in 6% and "poor" in 9% according to the criteria of the ISOLS. Main complications were graft fracture in of 15% and pseudarthrosis in 14.3%. Reconstruction of extensive bone defects using free vascularized fibula grafts are a demanding operative procedure. The procedure combines a biologic form of reconstruction with a legitimate expectation of good long term outcome and a relatively low rate of complications.

Operationalized diagnostics deal with the standardized assessment of psychiatric symptoms as well as diagnostic criteria. As a diagnostic system based on criteria, the DSM-III was chosen to identify operationalized diagnoses based on the Present State Examination (PSE-9) and some additional DSM-III specific items. By relating PSE symptoms to the diagnostic criteria of DSM-III, an easily applicable expert system leading to DSM-III diagnoses was developed. In two samples of 30 schizophrenic and 51 depressive patients the DSM-III computer diagnoses are contrasted with the ICD-8 diagnoses of the PSE/CATEGO system. In defining a “case”, only minimal differences between the two computer programs were found. In the sample of schizophrenics, CATEGO led to 114 (81%) diagnoses and the DSM-III program to 112 (79%) diagnoses; for the depressive patients 43% cases were identified by CATEGO and 45% by the DSM-III algorithm. Comparing the diagnosis of “acute schizophrenic disorders”, both programs arrived at similar percentages. (CATEGO: 51%; DSM-III: 57%). However, CATEGO is limited to two different subtypes (295.2 and 295.3), whereas the DSM-III program covers the total range of possible schizophrenic subtypes. Furthermore, the DSM-III program identified residual subtypes of schizophrenia in 23% of the diagnostic decisions. In the short-term course of the schizophrenic patients, CATEGO identified 27%–43% with affective diagnoses with high stability per cross-section. Using the DSM-III algorithm affective diagnoses were rather rare (maximum of 17%), marking unstable changes from acute to residual states of the psychosis. In the cohort of affective patients the correspondence between both programs was quite good, especially for the patients with a diagnosis of depression, but in total the DSM-III program requires stricter criteria for affective — especially manic — disorders, whereas CATEGO needs a somewhat higher symptom level for anxiety syndromes to reach the diagnostic threshold.

A short description is given of 19 laboratory, 12 semi‐field and 5 field methods to test the side‐effects of pesticides on beneficial organisms. The methods were developed according to standard guidelines by members of the Working Group ‘Pesticides and Beneficial Organisms’ of the International Organization for Biological Control (IOBC), West Palaearctic Regional Section (WPRS); 28 members in nine countries participated and the beneficial organisms (natural enemies of insects and mites) included: 6 Hymenoptera, 4 Coleoptera, 2 Diptera, 1 Neuroptera, 1 Heteroptera, 3 Acari, 1 Aranea, 1 entomopathogenic fungus (Hyphomycetes). There is agreement that a combination of laboratory, semi‐field and field tests is needed to show the side‐effects of pesticides on beneficial organisms and that the beneficials chosen for the test should be relevant to the crop on which the pesticide is to be used.