Prinzipien der OSG-Arthrodese bei Gelenkinfekt

A chronic empyema of the ankle joint often develops after an open fracture or surgery. In the case of the destruction of the joint due to an infection, an arthrodesis should be performed.Normally we use an external fixator with two bone-nails placed into the calcaneus and two into the tibia. The arthrodesis is distracted and Septopal is permanently implemented. At 4-6 weeks after surgery the Septopal is removed, with distraction being reduced and a cancellous bone-graft taken from the dorsal iliac crest is performed to fill the bony defect. After bone healing, the external fixator is removed and the patient mobilized in a brace. Initially, weight-bearing is limited to 10 kg but is increased gradually to full weight. The brace is used for 6-9 months; later the patient is mobilized in orthopaedic shoes. In difficult cases, also in combination with a malposition which has to be corrected or a lengthening of the lower limb, we use the Ilizarov fixator. From 1993 to 2003 we performed arthrodeses of the ankle joint due to infectious destruction in 107 cases. In 82.2%, the empyema was caused by a fracture of the ankle joint and the following treatment. In 58% of the patients, we saw associated diseases such as obesity, alcohol abuse, diabetes and malposition of the foot. In 55% we found Staphylococcus aureus. In 86%, we used the external AO-fixator, in 14% the Ilizarov fixator. The patient retained the fixator for an average of 128 days. In our study, 92.1% of the 101 patients who had completed therapy showed a good stability an average of 4.5 years after the arthrodesis. In 5% we found partial stability, while three patients had to be amputated. In 57 patients (56.4), an arthrosis of the tarsal bones was found, and 38 patients (54.3%) of the 70 patients who at the time of the arthrodesis were still working could return to work.     

Der Phosphat-Stoffwechsel in der Dünndarmschleimhaut unter dem Einfluß der Glucose-Resorption

Ohne ZusammenfassungMit 4 TextabbildungenDie Untersuchungen wurden mit Unterstützung des Bundesministeriums für Atomkernenergie und Wasserwirtschaft sowie der Deutschen Forschungsgemeinschaft durchgeführt. Über Teilergebnisse ist bereits in vorausgegangenen Mitteilungen berichtet worden (vgl.Janke, J.: Vortrag Freiburger Med. Ges., siehe Referat Klin. Wschr.35, 1194 (1957);Gerlach, E.: Proceedings of the United Nations Internat. Conference on the Peaceful Uses of Atomic Energy, Genf, 1. bis 13. September 1958, Vol.24, 201–204).     

Changes of protein synthesis in the hypertrophying rat heart

Summary Myocardial protein synthesis was studied in rats in vivo during the first five days of the development of cardiac hypertrophy induced by aortic constriction. Using l-¹⁴C-glycine or l-¹⁴C-leucine as precursor amino acids, rates of protein synthesis were determined from the total radioactivity of proteins and the mean radioactivity of the intracellular amino acid precursor pool and the leucine pool, respectively. During the first 5 h after aortic constriction the radioactivity of proteins did not change remarkably, whereas the radioactivity of the amino acid precursor pool was significantly elevated. Myocardial protein synthesis proved therefore to be diminished in this initial phase. After 24 h protein synthesis reached the range of sham-operated controls and thereafter increased almost parallel with the elevation of the ratio heart weight/body weight. The inhibition of protein synthesis was accompanied by a moderate decrease of ATP and creatine phosphate levels. A diminution of the high energy phosphate compounds, a decreased RNA synthesis or the action of inhibitory metabolites are considered possible factors involved in the decline of protein synthesis during the early phase of cardiac hypertrophy.Preliminary reports of this investigation were presented at the 36th Meeting of the German Physiological Society, Mainz, September 1969 [42] and at the XXV International Congress of Physiological Sciences, Munich, July 1971 [43].Supported by a grant from the Deutsche Forschungsgemeinschaft (Ge 129/7,8).     

Computer-based testing of the Braden Scale for Predicting Pressure Sore Risk

The Detroit Medical Center nursing documentation system requires all staff nurses to complete the Braden Scale for Predicting Pressure Sore Risk on an Acute Care Flow Record or Critical Care Flow Sheet on every patient, every day. An audit of these records raised concern as to whether staff nurses accurately used the Braden Scale to calculate pressure sore risk. Advanced Practice and ET Nurses noted that staff nurses were rating patients at lower levels of pressure sore risk than was warranted by the patient condition. In response, a computer-based learning module with case study examples was developed and tested to teach nursing staff to accurately evaluate pressure ulcer risk by using the Braden Scale and its subscales and to identify preventive interventions based on the patient's Braden subscale scores. Following revisions of those case study example narratives that were found to be problematic, the learning/assessment module was instituted in 2002. More than 2,500 nurses at the facility were tested regarding their knowledge of pressure ulcer risk assessment and prevention using this program. On average, nurses correctly rated the Braden Scale level of risk 75.6% of the time. The percentage of correct responses was highest for very high (92%) and very low (78%) levels of risk. This finding is consistent with the observation that most nosocomial pressure ulcers in this facility occur in patients who are rated in the "mild risk" level on the Braden scale. Subscales with the lowest percentage of correct answers were moisture and sensory perception. Correct clinical identification of a Stage I pressure ulcer as it was described in writing occurred only 53% of the time. These results indicate that training and practice are needed to use an assessment scale accurately. The Detroit Medical Center plans to include the Braden Scale in annual nursing education and competency testing.     

High dose vitamin E therapy in amyotrophic lateral sclerosis as add-on therapy to riluzole: results of a placebo-controlled double-blind study

Summary. Increasing evidence has suggested that oxidative stress may be involved in the pathogenesis of amyotrophic lateral sclerosis (ALS). The antioxidant vitamin E (alpha-tocopherol) has been shown to slow down the onset and progression of the paralysis in transgenic mice expressing a mutation in the superoxide dismutase gene found in certain forms of familial ALS. The current study, a double blind, placebo-controlled, randomised, stratified, parallel-group clinical trial, was designed to determine whether vitamin E (5000mg per day) may be efficacious in slowing down disease progression when added to riluzole. Methods. 160 patients in 6 German centres with either probable or definite ALS (according to the El Escorial Criteria) and a disease duration of less than 5 years, treated with riluzole, were included in this study and were randomly assigned to receive either alpha-tocopherol (5000mg per day) or placebo for 18 months. The Primary outcome measure was survival, calculating time to death, tracheostomy or permanent assisted ventilation, according to the WFN-Criteria of clinical trials. Secondary outcome measures were the rate of deterioration of function assessed by the modified Norris limb and bulbar scales, manual muscle testing (BMRC), spasticity scale, ventilatory function and the Sickness Impact Profile (SIP ALS/19). Patients were assessed at entry and every 4 months thereafter during the study period until month 16 and at a final visit at month 18. Vitamin E samples were taken for compliance check and Quality Control of the trial. For Safety, a physical examination was performed at baseline and then every visit until the treatment discontinuation at month 18. Height and weight were recorded at baseline and weight alone at the follow-up visits. A neurological examination as well as vital signs (heart rate and blood pressure), an ECG and VEPs were recorded at each visit. Furthermore, spontaneously reported adverse experiences and serious adverse events were documented and standard laboratory tests including liver function tests performed. For Statistical Analysis, the population to be considered for the primary outcome measure was an intent-to-treat (ITT) population which included all randomised patients who had received at least one treatment dose (n=160 patients). For the secondary outcome measures, a two way analysis of variance was performed on a patient population that included all randomised patients who had at least one assessment after inclusion. Results. Concerning the primary endpoint, no significant difference between placebo and treatment group could be detected either with the stratified Logrank or the Wilcoxon test. The functional assessments showed a marginal trend in favour of vitamin E, without reaching significance. Conclusion. Neither the primary nor the secondary outcome measures could determine whether a megadose of vitamin E is efficacious in slowing disease progression in ALS as an add-on therapy to riluzol. Larger or longer studies might be needed. However, administration of this megadose does not seem to have any significant side effects in this patient population.     

Kinetic changes with fatigue and relationship to injury in female runners

PURPOSE: This research examined how ground reaction forces (GRF) changed with fatigue induced by an exhaustive treadmill run in female runners. A separate retrospective and prospective analysis correlated initial magnitude of GRF and fatigue-induced changes in GRF with lower-extremity injury. METHODS: Ninety adult female runners had vertical GRF measured before and after an exhaustive treadmill run. Subjects initially were questioned about previous running injuries, and were contacted during the following year and asked to report any additional running injuries. RESULTS: Fatigue induced by the exhaustive treadmill run resulted in decreased impact peak and loading rates in all runners by an average of 6 and 11%, respectively. The changes in GRF were attributed to altered running cadence, step length, and lower-extremity joint kinematics. It is unclear whether these changes were attempts by the runners to minimize impact forces and protect against injury, or represented a fatigue-induced loss of optimal performance capabilities. An interaction between injury in the previous year and change in impact loading rate with fatigue was observed, suggesting previously injured runners are exposed to relatively higher impact forces over time. CONCLUSION: Habitual female runners appear to adapt their running style with fatigue, resulting in altered GRF. Changes in GRF with fatigue may be associated with lower-extremity running injuries.     

Clinical trial evaluating the peroxide concentration response of whitening strips over 28 days

PURPOSE: The research evaluated the peroxide concentration whitening response following self-directed use of whitening strips over a 28-day period. METHODS: A randomized, double-blind, parallel group clinical study was conducted. 37 healthy adult volunteers were randomly assigned to one of three groups based on tooth color at screening: 1.8% hydrogen peroxide strips (HPS), 3.3% HPS or 5.3% HPS. Subjects applied the assigned maxillary strips twice per day for 30 minutes over 28 days. Tooth color was evaluated at day 7, 14 and 28 from digital images of the maxillary six anterior teeth using a standard method. Treatments were compared using analysis of covariance (adjusting for baseline) at a 0.05 level of significance. RESULTS: Hydrogen peroxide at concentrations ranging from 1.8-5.3% resulted in significant (P< 0.05) color improvement versus baseline as early as Day 7. There was a concentration-response for reduction in yellowness (deltab*) and lightness improvement (deltaL*) at all timepoints, favoring the higher concentrations. While the concentration-whitening relationship approached a linear response at Day 7, continued treatment resulted in incremental color improvement. All three peroxide concentrations were well tolerated, and no subjects discontinued early due to a treatment-related adverse event.