Verdrehtrauma an Schulter- und Kniegelenk

Indirect trauma to the shoulder and knee joint often results in injuries to the ligaments and the capsule, and more rarely in fractures. Anterior shoulder dislocation is common. Over the last few years arthroscopic repair of the torn labrum has become established as the therapy of choice. Isolated ruptures of the collateral ligaments of the knee can be treated functionally. A torn anterior cruciate ligament of the knee joint can be compensated by the quadriceps muscle if this is adequately prepared by special exercises. Chronic or combined instabilities should be treated surgically by ACI grafting techniques. Menisceal injuries are treated arthroscopically.     

Predicting metal uptake by wetland plants under aerobic and anaerobic conditions

Metal pollution can be a serious threat to ecosystems at a global scale. Although the bioavailability of potentially toxic metals is determined by many biotic and abiotic factors, including pH and redox potential, total metal concentrations in the soil are used widely to assess or predict toxicity. In the present study we tested the effect of desiccation of soils differing in acidification potential and total heavy metal contamination on the growth and metal uptake of three typical, common wetland species: Caltha palustris, Juncus effusus, and Rumex hydrolapathum. We found that plant growth in wet soils mainly was determined by nutrient availability, though in dry soils the combined effects of acidification and increased metal availability prevailed. Metal uptake under anaerobic conditions was best predicted by the acidification potential (sediment S/[Ca + Mg] ratio), not by total metal concentrations. We propose that this is related to radial oxygen loss by wetland plant roots, which leads to acidification of the rhizosphere. Under aerobic conditions, plant metal uptake was best predicted by the amount of CaCl2-extractable metals. We conclude that total metal concentrations are not suitable for predicting bioavailability and that the above diagnostic parameters will provide insight into biogeochemical processes involved in toxicity assessment and soil policy.     

Pulmonary MRI—a new approach for the evaluation of febrile neutropenic patients with malignancies

GOALS OF WORK: Immunocompromised patients with malignant diseases often suffer from pulmonary infections. Early detection of these life-threatening infections is crucial to start effective treatment. The gold standard for the diagnosis of these disorders is high-resolution computed tomography (HR-CT) of the chest. This method, however, has limitations, for instance, in the discrimination of early interstitial infiltrates and the use of X-rays. We conducted a study to determine the feasibility and sensitivity of magnetic resonance imaging (MRI) of the lung compared to HR-CT in immunocompromised patients with persistent fever in neutropenia and suspected pneumonia. MATERIALS AND METHODS: Between January 2003 and July 2004, 50 consecutive neutropenic patients with fever of unknown origin and negative chest X-ray were examined with HR-CT of the lungs. Patients with pulmonary infiltrates were further examined with MRI of the chest within 24 h after HR-CT using a specific lung protocol. In addition, microbiological testing was performed for the characterization of the causative pathogen. RESULTS: Of 50 patients, 35 had pulmonary infiltration according to HR-CT; these were examined with MRI of the lungs. MRI showed a high correlation (91%) with the findings in HR-CT. Both HR-CT and MRI were feasible in 94% of the examined patients. In 12 of 35 patients, fungal pathogens were identified in microbiological testing. CONCLUSIONS: MRI of the lungs is feasible in neutropenic patients with suspected pulmonary infection. Compared to HR-CT, MRI displays a high sensitivity in the detection of pulmonary infiltrates. MRI offers the opportunity of follow-up examinations without repeated X-ray exposure to the patient.     

Psychometric properties of the Confidence and Trust in Delivery Questionnaire (CTDQ): a pilot study

ABSTRACT: BACKGROUND: Assessing expecting mother's opinions prior to birth draws a comprehensive picture for the caregivers about their emotional state and their expectations. Some questionnaires to cover these aspects do exist. This study aims to present the psychometric properties of a new instrument, the Confidence and Trust in Delivery Questionnaire (CDTQ) a short but reliable a self-report instrument that focuses on confidence and trust as meaningful dimensions for expectant mothers. METHODS: A pilot validation study of 221 women 6 weeks before childbirth was conducted in Germany between October 2007 and June 2008. To detect structural relations between the items, factor and reliability analyses were applied to the CTDQ items. Factor analysis was performed by means of principal components analysis and varimax rotation. Internal reliability was assessed by Cronbach's alpha. External validation was performed using the sense of coherence (SOC) scale. RESULTS: The CTDQ comprises of 11 items. We found a 4-factor structure. The internal consistency of the whole item pool (Cronbach's alpha = 0.79) and the 4 subscales [confidence in labor (alpha = 0.82); partner's support (alpha = 0.62); trust in medical competency (alpha = 0.68); being informed (alpha = 0.60)] can be regarded as sufficient or even excellent. The 4 factors explained 69.6% of total variance. Except for a high intercorrelation (0.70) between "partner's support" and "trust in medical competence", the subscales show low intercorrelations, indicating an adequate independence of the respective subscales. Regarding the external validity we found minor respective moderate correlations with the SOC scale. CONCLUSIONS: Our data suggest that the CTDQ is a useful instrument to assess confidence and trust in delivery. With 4 clinically relevant dimensions, the CTDQ is now open for further studies in the field of labor.     

Trisomy 21 causes persistent congenital hypothyroidism presumably of thyroidal origin.

OBJECTIVE AND DESIGN: Lowered neonatal plasma thyroxine (T(4)) and mildly elevated thyrotropin concentrations together with developmental benefits from neonatally started T(4) treatment in a randomized clinical trial demonstrated Down syndrome (DS) neonates to be mildly hypothyroid, at least during their first weeks of life. To prove that this hypothyroid state persists beyond this period in all, and to elucidate its etiology, we evaluated the course of the thyroid function determinants in all DS infants participating in this 24-month trial. MAIN OUTCOME: Mean plasma thyrotropin concentrations and thyrotropin frequency distributions of 97 placebo-treated infants were persistently shifted to substantially higher concentrations, while free T(4) frequency distributions were in the lower two thirds of the reference interval. Mean thyroglobulin concentrations were normal. To normalize plasma thyrotropin, T(4)-treated DS infants (N = 99) needed rather high free T(4) concentrations, like T(4)- treated non-DS children with thyroidal congenital hypothyroidism. At ages 12 and 24 months, thyroid peroxidase antibodies were detected in 1.1% and 5.4% of all DS infants. CONCLUSIONS: These findings suggest that as a group DS infants have a novel type of persistent mild congenital hypothyroidism, presumably of thyroidal origin. The group character suggests a direct relation with the trisomic state of chromosome 21, hypothetically through genomic dosage imbalance of dosage-sensitive genes interfering with thyroid hormone production.