Die transtrochantäre ventrale Rotationsosteotomie bei der Behandlung der idiopathischen Hüftkopfnekrose

Zusammenfassung Das Operationsverfahren nachSugioka erm?glicht es, durch Rotation des Femurkopfes um die Schenkelhalsachse nach vorne den Nekrosebezirk aus der Belastungszone zu bringen. An Hand eigener Erfahrungen mit dieser Methode bei 9 Patienten werden Operationstechnik, Rotationsausma?, Nachbehandlung und Komplikationen besprochen. Auf Grund der befriedigenden Frühergebnisse wird auf diese japanische Methode aufmerksam gemacht.

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Summary Sugioka's operative procedure allows an anterior rotation of the femoral head upon the axis of the neck. Necrosis gets out of the weight-bearing area. We discuss the operative technique, angle of rotation, aftertreatment, and complications of 9 patients. According to the good early results we present this Japanese method.

     

Tierexperimentelle Untersuchungen zur Frage der Altersabhängigkeit funktioneller Anpassungsmuster

Zusammenfassung Bei Kaninchen wurden die Belastungsverhältnisse im Kausystem durch das Einsetzen von Aufbißschienen auf die rechten unteren Seitenzähne variiert. Aussagen über die Altersabhängigkeit der Anpassungsmuster sollten durch den Vergleich der Sekundärveränderungen bei jungen, im Wachstum befindlichen, und bei ausgewachsenen Tieren ermöglicht werden.Während bei den ausgewachsenen Tieren fast nur lokale Veränderungen beobachtet wurden, ergaben sich bei den jungen Tieren darüber hinaus Fernwirkungen im Sinne einer Wachstumsbeeinflussung des Gesichtsschädels. Bei den jungen Tieren waren somit mehrere Strukturen am Ausgleich beteiligt, und die Anpassung erfolgte rasch. Bei den ausgewachsenen Versuchstieren sahen wir nach langsamer Anpassung Anzeichen für die Gefahr pathologischer Entwicklungen und funktionell minderwertige Anpassungsformen.Die Ergebnisse sind zugleich ein Beweis für die Abhängigkeit von Gebiß und Schädel, genauer gesagt für die Auswirkungen der Kaufunktion auf die Gestaltung des Gesichtsschädels.

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Summary The functional adaptation of the jaw bones of rabbits was studied following the application of a bite-plate on the lower right molars. The results obtained in the experimental group of young animals were compared with those of adult animals.In the adult rabbits almost exclusively local changes resulted; in the young rabbits the growth pattern of the whole visceral cranium was influenced. Thus, in the young animals more structures were concerned in compensating for the differences effected in the level of occlusion and adaptation was quickly achieved. The adult animals, in contrast, showed slow adaptation, deteriorated form of adjustment and pathological reactions.

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Mit 12 Abbildungen

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Herrn Professor Dr. Felix Ascher zum 65. Geburtstag

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Vortrag gehalten auf dem Kongreß der Deutschen Gesellschaft für Kieferorthopädie 1971 in München.     

Factors associated with quality of life of outpatients with breast cancer and gynecologic cancers and their family caregivers: a controlled study

Background  

Quality of life (QOL) issues are of interest in cancer because effective methods of treatment and detection have led to an increase in the number of long-term survivors. The objectives of the study were: to assess the subjective QOL of stable Sudanese women cancer outpatients and their family caregivers, using the WHO 26-item QOL Instrument; compare with matched general population groups, as well as diabetic and psychiatric patient groups; examine patient-caregiver concordance in ratings; and assess the variables associated with their QOL, with a view to identifying factors that can enhance quality of care.     

Die Therapie des Maldescensus testis

Undescended testes is the most common urological disease in male infants, and if left untreated can quickly lead to irreparable lesions to the testicular tissue. In later life these are then the main reasons for infertility and an elevated risk of malignant transformation. Undescended testes can be treated conservatively with either intranasal GnRH (LHRH) or intramuscular hCG. These hormonal treatments should be used as the first-line treatment and must be started at the age of 4–6 months. Even in nonresponders such “hormonal priming” may have long-lasting positive effects on germ cell quality. Several operative techniques have been developed for each type of undescended testis, ranging from a laparoscopic approach to transscrotal fixation of the testis. As in the case of the hormonal treatments, the age of the patient when treated also has a major impact on the degree of success seen postoperatively. In association with a lower recommended age of under 1 year for the treatment of undescended testes, both hormonal treatment and surgical orchidopexy can contribute to improving fertility in men with a history of undescended testes.     

Predictors and outcomes of treatment in hip hemiarthroplasty dislocation

Introduction

Dislocation following hip hemiarthroplasty (HHA), its incidence, predictors, treatment outcomes and mortality were investigated in a single centre series.

Methods

The prospectively collected data on neck of femur fracture admissions compiled over 11 years were reviewed. Place of residence, place of fall, past medical history, intraoperative factors (grade of surgeon, delay in surgery, type of implant and operative time), postoperative complications and mortality were compared between patients who suffered a dislocation and those who did not. In the dislocation group, the mean number of dislocations, reduction method, type and fate of implant, and mortality were investigated.

Results

Prospective data on 8,631 admissions were collected; 41% of these were managed with a HHA. The dislocation rate was 0.76%. A delay in surgery of >24 hours was associated with a fourfold increase in the dislocation risk. The majority (81%) of dislocations occurred in the first six weeks and closed manipulation was the definitive treatment in only 23% of the cases. The mortality rate was not increased following HHA dislocation.

Conclusions

The delay in surgery was the most important predictor of HHA dislocation. Closed reduction was associated with a high failure rate. While an initial attempt at closed reduction for a first dislocation is recommended, for redislocators, we recommend early exploration/revision as an alternative to repeat manipulations.     

Der infizierte rheumatische Vorfuß—wie viel Chirurgie ist sinnvoll?

A biomechanically altered rheumatic forefoot with a resulting shoe conflict and an impaired immune system due to underlying disease and medical treatment are often cause for infection. Often infected bursae perforate into the corresponding joints and may consequently lead to severe infectious states of the foot. The multiplicity of possible biomechanical adjustments makes it difficult to develop an undisputed concept. Conservative versus operative therapeutic options are possible and may be individually applied. It should be questioned, if the same general rules in septic joint surgery also apply to the rheumatoid forefoot. This retrospective clinical study will evaluate a concept for possible operative treatment of the infected rheumatoid forefoot in selected cases. Our conception advocates operative procedures on a patient adapted basis in order to prevent recurrent infections. Suggestions for operative procedures are given.