Die Wertigkeit der Strahlenbehandlung im Vergleich zur extrakorporalen Stoßwellentherapie (ESWT) beim Supraspinatussehnensyndrom

BACKGROUND AND AIM: Supraspinatus tendinitis is usually treated by antiinflammatoric drugs, local injections, physiotherapy or low-dose irradiation. A novel approach is the use of Extracorporeal Shock Wave Therapy (ESWT) if conservative therapies have failed. So far there has been no controlled study comparing the effectiveness of ESWT with an established conservative method of therapy such as X-ray stimulation radiotherapy. PATIENTS AND METHOD: 30 patients with chronic supraspinatus tendinitis were admitted into the prospective randomized study. After randomization the patients were treated either with X-ray stimulation radiotherapy with 6 x 0.5 Gy on the ICRU reference point (1 fraction/day) with cobalt 60 gamma rays or three times with 2000 pulses (energy flux density ED+ 0.1 mJ/mm2) in 1 week intervals using a Storz Minilith SL1. Primary endpoint was the age-corrected constant score 3 months after intervention. RESULTS: Acute side effects caused by the irradiation were not observed, as expected. One patient described pain and one patient showed a moderate skin irritation after ESWT. In the radiotherapy group average the age-corrected constant score improved from 47.6 through 79.5 points to 87.4 points. In the ESWT group it rose from 50.1 points before ESWT to 91.4 points after 12 weeks and 97.8 after 52 weeks. CONCLUSION: No statistically significant differences were proven between ESWT and radiotherapy. ESWT appears to be equivalent but not superior to radiotherapy in treating chronic supraspinatus tendinitis syndrome. A comprehensive randomized study is, however, necessary to ensure the equivalence of ESWT.     

Impact of Bacillus thuringiensis toxin Cry1Ab on rumen epithelial cells (REC) – A new in vitro model for safety assessment of recombinant food compounds

The growing use of genetically modified crops necessitates viable screening methods for safety evaluation of recombinant feed, particularly for ruminants. A new sheep rumen epithelial cell culture is introduced as an in vitro cell system for safety evaluation especially focussing on feed and food compounds. We used lactate dehydrogenase (LDH) release, WST-1 conversion, ATP content and caspase 3/7 activity to evaluate cytotoxicity of Cry1Ab, one of the newly expressed Bt-proteins in transgene maize. The results were compared to the effects of valinomycin, a potassium ionophore known to induce cytotoxic effects on a wide range of cells. Whereas no toxicity of Cry1Ab was observed in short as well as in long term experiments, even at non-physiological high concentrations, exposure to valinomycin induced apoptosis and a significant response of all viability parameters after a number of hours. The ATP content and the WST-1 conversion reflecting the energy metabolism of the cells appear to be more sensitive indicators of valinomycin toxicity than the LDH release, a parameter which reflects the membrane integrity. This study presents an in vitro model system, that may be useful as a supplementary tool in toxicity screening before testing substances on animals in vivo.     

Comparison of craniotomy and craniectomy in patients with acute subdural haematoma.

Despite the increasing acceptance of craniectomy in patients with traumatic brain injury, the value of early decompressive craniectomy in patients with acute subdural haematoma is still under debate. In this retrospective study, we reviewed 180 patients with traumatic acute subdural haematoma, 111 of whom were treated with haematoma evacuation via craniotomy and 69 of whom were treated with early decompressive craniectomy. Due to the higher incidence of signs of herniation for patients in the craniectomy group, the mortality rate in this group was higher than that in the craniotomy group (53% vs. 32.3%). However, overall there was no significant difference in outcome between the two groups. Age and clinical signs of herniation were significantly associated with an unfavourable outcome, regardless of the type of surgery. Decompressive craniectomy did not seem to have a therapeutic advantage over craniotomy in traumatic acute subdural haematoma.     

Postganglionic cholinergic dysautonomia with incomplete recovery: A clinical,neurophysiological and immunological case study

A 26-year-old man presented with signs and symptoms of marked postganglionic cholinergic autonomic dysfunction manifested by non-reacting dilated pupils, paresis of accommodation, decreased salivation, dry skin, atony of the bladder, erectile impotence and complete gastrointestinal paresis. Standard neurophysiological tests for myelinated sensory and motor fibre function and quantitative methods to examine unmyelinated parasympathetic, sympathetic and afferent fibres were performed: parasympathetic function was measured by heart rate variation tests. Sympathetic cutaneous vasoconstrictor responses induced by deep inspiration were examined with laser Doppler flowmetry. Cutaneous nociceptive C-fibre function was assessed by measurement of axon reflex vasodilatation and flare size induced by histamine iontophoresis. The findings confirmed that the abnormalities were restricted exclusively to the cholinergic postganglionic autonomic systems. All other functions were completely preserved. Modern neurophysiological methods of testing sympathetic and afferent small fibre function might help in the diagnosis of cholinergic postganglionic dysautonomia in the early stages. The specificity of the dysfunction argues in favour of an immunological pathogenesis. However, antibody screening including acetylcholine receptor antibodies and voltage-gated calcium channel antibodies gave negative results. Whatever autoimmunological mechanism might be involved, the postulated antibodies act highly specifically on unknown structures of the cholinergic postganglionic autonomic neurons.     

Biomechanical testing of different osteosynthesis systems for segmental resection of the mandible.

PURPOSE: This investigation assessed the mechanical behavior of 3 different locking and nonlocking reconstruction systems-Unilock 2.4, Reconstruction 2.4, and Reconstruction 2.7-with regard to plate and screw fracture. MATERIALS AND METHODS: Five different plate/screw configurations (Unilock 2.4-locking screws, Unilock 2.4 -conventional screws, Reconstruction 2.4-conventional screws, Reconstruction 2.7-conventional screws, and Unilock 2.4-locking screws with a 1-mm gap; Synthes, Umkirch, Germany) were tested on synthetic mandibles. All mandibles were resected on the left side between the canine and third molar, reconstructed, and loaded cyclically between 30 and 300 N up to 250,000 cycles or until screw or plate failure occurred. RESULTS: No screw fractures were observed. All plates fractured close to the distal fragment. The Unilock plates fixed with locking screws withstood significantly more cycles until failure than the Reconstruction plates 2.4 fixed with conventional MF-Cortex screws. No significant differences were found in the other groups. Only 2 of the 34 plates tested, both of the Reconstruction 2.7 system, reached the runout limit. CONCLUSIONS: Unilock plates fixed with locking screws have a higher long-term stability than the Reconstruction 2.4 system. A 1-mm gap between the plate and mandible does not lead to early screw failure in the Unilock 2.4 system with locking screws. The Reconstruction 2.7 system seems superior if well contoured, because 2 of those plates reached the runout limit; however, this system is not as easy to handle as the 2.4 systems, and good contouring is difficult to achieve. Therefore, we consider the Unilock 2.4 system with locking screws the best choice.     

Open questions in hidradenitis suppurativa research: a hair biologist''s perspective

To clarify the obscure cause(s) of hidradenitis suppurativa (HS), plausible, comprehensive, and testable hypothetical pathogenesis scenarios urgently need to be developed. HS is a chronic inflammatory disorder of the pilosebaceous unit, which occurs in intertriginous, ‘apocrine’ skin after puberty, and in more women than men. The clinical picture is dominated by late events resulting from follicular occlusion and its tissue‐destructive, inflammatory sequelae, aggravated by bacterial superinfection. Likely, HS originates from events in the hair follicle epithelium outer root sheath (ORS) rather than the apocrine gland and/or its duct. Genetic and endocrine factors influence HS incidence and course, at least in defined subpopulations. If follicular hyperkeratosis, leading to the retention of follicular material, represents the earliest histological abnormality, while inflammation and apocrine involvement are secondary ones, then the cause of hyperkeratosis and hyperproliferation of ORS keratinocytes must be identified. In normal skin epithelium, this typically results from inflammatory stimuli. Because the skin epithelium is a crucial element in the control of innate immunity, one may speculate that the primary defect in HS is an insufficiently controlled and/or abnormal release of pro‐inflammatory ‘danger’ signals from the follicle ORS (e.g. chemokines, defensins, TLR ligands). This may only lead to HS, if additional predisposing factors (e.g. genetically lowered threshold for activation, or defective suppression of, innate immune response loops; constitutive overexpression of TLRs or underexpression of immunoinhibitory signals) are present and once pro‐inflammatory stimuli are further up‐regulated, e.g. by microtrauma, (neuro‐) endocrine and/or local microbial signals. In this scenario, hyperkeratosis/hyperproliferation of ORS keratinocytes only represents the first visible sign of a primary imbalance of the intrafollicular controls of epithelial innate immune mechanisms. This chiefly calls for systematic exploration of the hair follicle innate immune system in as yet uninvolved intertriginous skin of HS patients versus normal controls as a key to unravelling the elusive pathogenesis of HS.