The natural history and treatment of delayed union stress fractures of the anterior cortex of the tibia

This study presents eight patients with stress fracture of the anterolateral cortex of the midshaft of the tibia. All of the patients, ranging in age from 14 to 23 years, were competitive basketball players who experienced pain while running or jumping for an average of 4.4 months before the diagnosis was made. Eight patients were treated with rest and/or pulsing electromagnetic field therapy. Although one of the patients required bone grafting procedure, all eight of these patients showed complete healing and were able to return to full activity after an average of 8.7 months of treatment. They have remained asymptomatic for an average of 14.7 months. The overall time from initial symptoms to return to competition averaged 12.5 months in this group of athletes. The results presented in this paper suggest that rest and pulsing electromagnetic field therapy may result in healing in some patients with delayed union stress fractures of the anterolateral cortex of the midshaft of the tibia. Although this injury is associated with a prolonged healing period, seven of eight patients with adequate followup in our study were able to return to competition without complications following treatment. One patient was asymptomatic for 33 months before experiencing a reinjury. In conclusion, we feel that diagnosis of stress fracture should be primary consideration in basketball players presenting with a prolonged history of pain on the anterolateral aspect of the midthird of the tibia. Once the diagnosis is made we recommend initial treatment consist of rest and external electrical stimulation for a minimum time of 3 to 6 months prior to considering surgical intervention.     

Afferent visual projections in three species of lungless salamanders (family plethodontidae)

Afferent visual projections were demonstrated in three species of plethodontid salamanders by means of anterograde transport of horseradish peroxidase. On the contralateral side three optic tracts and seven neuropil areas can easily be distinguished, which are similar among the three species examined as well as in European salamandrids. On the ipsilateral side the marginal optic tract shows great diversity. The retinal projections of the latter range from weakly labeled terminal fields restricted to the thalamus to heavily labeled fields covering the entire tectum opticum.     

Ein Beitrag zur Funktionsbeurteilung und Funktionsverbesserung von Daumenmißbildungen

Ohne ZusammenfassungHerrn Professor Dr. med. Dr. med. h. c. G. Hohmann zum 85. Geburtstag gewidmet.     

Zur operativen Behandlung angeborener Daumenfehlbildungen und ihrer Funktionsstörungen

Zusammenfassung Die Therapie angeborener Daumenmißbildungen ist außerordentlich schwierig. Abweichungen der anatomischen Voraussetzungen und die erstaunliche Anpassungsfähigkeit an den schweren Handdefekt sind für die Zurückhaltung bei operativer Behandlung verständlich.Einzelfälle sollten aber aus funktionellen Gründen für die Daumenbildung in Betracht gezogen werden.Als Operationsverfahren hat sich das Vorgehen von Littler-Matthews bewährt.     

Renin-angiotensin system and haemostasis gene polymorphisms and outcome after coronary artery bypass graft surgery

BACKGROUND: Coronary artery bypass graft surgery is associated with a considerable 2-year mortality rate. Gene polymorphisms of the renin-angiotensin system may be associated with the risk of hypertension and cardiovascular disease. The angiotensin I-converting enzyme DD genotype has recently been identified as independent predictor of the outcome after coronary artery bypass graft surgery. Genetic factors of the clotting system may be related to the risk of myocardial infarction and restenosis after coronary interventions. The aims of the present study were to investigate whether gene polymorphisms of the renin-angiotensin system (angiotensinogen 235 M/T, angiotensin II type 1 receptor 1166 A/C) or the clotting system (glycoprotein IIIa PlA1/PlA2 and factor V Leiden 1691 G/A) are associated with the outcome after coronary artery bypass grafting. METHODS: A study population of 247 patients was followed-up 2 years after coronary artery bypass graft surgery. The primary end-point was total mortality. The secondary end-point was mortality from cardiac cause or the need for myocardial revascularization (percutaneous coronary interventions or recurrent surgery) during follow-up. Geno typing was performed by polymerase chain reaction- and restriction fragment length polymorphism-based techniques. RESULTS: An older age and the non-use of the internal mammary artery graft were identified as independent predictors of the primary end-point after coronary artery bypass grafting. A decreased left ventricular ejection fraction was an independent predictor for the secondary end-point. No association was found between any of the genetic factors and the outcomes after coronary artery bypass graft surgery in the main factor regression models. However, the angiotensin II type 1 receptor 1166 A/C gene polymorphism modulated the effects of age on the primary end-point, and the angiotensinogen 235 M/T gene polymorphism modulated the effects of age on the secondary end-point. CONCLUSION: We conclude that there are interactions between the angiotensin II type 1 receptor 1166 A/C as well as the angiotensinogen 235 M/T gene polymorphism and age with respect to the outcome after coronary artery bypass graft surgery. The glycoprotein IIIa PlA1/PlA2 and the factor V Leiden 1691 G/A gene polymorphisms were not associated with mid-term mortality or cardiac morbidity after coronary artery bypass grafting.     

Management of acute scaphoid fractures

Scaphoid fractures are a common injury in young, active populations. Non-displaced fractures have a high union rate if promptly treated with cast immobilization. Displaced fractures and proximal pole fractures are best treated with operative fixation. There are a variety of techniques and implants available to the surgeon. The surgical approach and fixation device should be based on fracture characteristics and surgeon experience. Operative fixation of non-displaced fractures is an option in patients who would prefer to avoid prolonged cast immobilization.     

Preoperative plasma fibrinogen levels predict mortality after coronary artery bypass grafting

This study was designed to investigate whether plasma fibrinogen levels as well as the beta-fibrinogen -455 G/A genotype are associated with outcome after coronary artery bypass graft (CABG) operation. We enrolled 249 consecutive CAD patients one day before they underwent a CABG operation. Data from 220 patients with available plasma fibrinogen levels were analyzed. The primary end-point was total mortality, the secondary end-point mortality from cardiac causes or the need for myocardial revascularization. The 2-year total mortality was 9.1% in the entire cohort. Multivariable analysis revealed an independent relationship between the primary end-point and preoperative plasma fibrinogen levels but not the beta-fibrinogen -455 G/A genotype. Neither preoperative plasma fibrinogen levels nor the beta-fibrinogen -455 G/A genotype could predict the secondary end-point. We conclude, that elevated preoperative plasma fibrinogen levels, but not the beta-fibrinogen -455 G/A genotype predict the total mortality after CABG operation.