Einzelreferate und Buchbesprechungen

Ohne Zusammenfassung     

Dynamic splinting following flexor tendon repair

Electromyographic investigation of subjects wearing dynamic flexor tendon repair (Kleinert) splints shows a wide variability in the amount of contraction in the flexor digitorum profundus muscle during extension of the finger. We suggest there is no advantage in giving extra resistance to the extensor muscles, and that the strength of the rubber bands needs to be only just sufficient to flex the finger passively back to its resting position.     

Synovectomy and total joint arthroplasty for recurrent hemarthroses in the arthropathic joint in hemophilia

Severe hemophiliacs with intractable bleeding into one or more joints despite adequate clotting factor replacement therapy are difficult management problems. Synovectomy has controlled bleeding only in joints without significant arthritic destruction. Total joint replacements have been performed in arthropathic joints, but not when uncontrolled bleeding was a concurrent problem. This report describes a hemophiliac with uncontrolled bleeding into an arthritic knee who was successfully managed by combining synovectomy with total knee replacement.     

Temporal lobe abnormalities in semantic processing by criminal psychopaths as revealed by functional magnetic resonance imaging

We tested the hypothesis that psychopathy is associated with abnormalities in semantic processing of linguistic information. Functional magnetic resonance imaging (fMRI) was used to elucidate and characterize the neural architecture underlying lexico-semantic processes in criminal psychopathic individuals and in a group of matched control participants. Participants performed a lexical decision task in which blocks of linguistic stimuli alternated with a resting baseline condition. In each lexical decision block, the stimuli were either concrete words and pseudowords or abstract words and pseudowords. Consistent with our hypothesis, psychopathic individuals, relative to controls, showed poorer behavioral performance for processing abstract words. Analysis of the fMRI data for both groups indicated that processing of word stimuli, compared with the resting baseline condition, was associated with neural activation in bilateral fusiform gyrus, anterior cingulate, left middle temporal gyrus, right posterior superior temporal gyrus, and left and right inferior frontal gyrus. Analyses confirmed our prediction that psychopathic individuals would fail to show the appropriate neural differentiation between abstract and concrete stimuli in the right anterior temporal gyrus and surrounding cortex. The results are consistent with other studies of semantic processing in psychopathy and support the theory that psychopathy is associated with right hemisphere abnormalities for processing conceptually abstract material.     

Long‐Term Prognostic Significance of Coronary Flow Velocity Reserve in Patients with Significant Coronary Artery Disease Not Involving the Left Anterior Descending Coronary Artery (Results from the SZEGED Study)

Objective: Coronary flow velocity reserve (CFR) by pulsed Doppler echocardiography is a useful hemodynamic index to evaluate the coronary microcirculatory dysfunction in the left anterior descending coronary artery (LAD). The present study was designed to evaluate the long‐term predictive value of CFR for mortality in patients with right (RC) and/or left circumflex coronary artery (CX) stenosis without epicardial LAD disease. Methods: A total of 49 patients with significant RC and/or CX stenosis were enrolled in this prospective follow‐up study. All patients had undergone coronary angiography demonstrating significant RC and/or CX stenosis without LAD disease and dipyridamole stress transoesophageal echocardiography as CFR measurement. Results: The success rate of follow‐up was 43 out of 49 (88%). During a mean follow‐up of 97 ± 29 months, 14 patients suffered cardiovascular deaths (12 sudden cardiac deaths and 2 strokes), and 1 patient died of pulmonal tumor. Patients who died during the follow‐up had significantly lower CFR values (1.85 ± 0.43 vs. 2.31 ± 0.57, P < 0.05). Using ROC analysis, CFR <2.09 had the highest accuracy in predicting cardiovascular survival (sensitivity 80%, specificity 57%, area under the curve 73%, P = 0.003). The logistic regression model identified only CFR as an independent predictor of survival (hazard ratio [HR] 6.26, 95% CI of HR 1.23–19.61, P = 0.024). Conclusions: Long‐term prognostic significance of CFR for the prediction of mortality has been demonstrated during a 9‐year follow‐up in patients with significant coronary artery disease not involving the LAD. (Echocardiography 2010;27:306‐310)     

Simultaneous Improvement in Aortic Distensibility and Coronary Flow Velocity Reserve after Successful Coronary Interventions

Objective: Deteriorations in coronary flow velocity reserve (CFR) and aortic distensibility have been demonstrated in coronary artery disease. The objective of the present study was a simultaneous echocardiographic evaluation of the CFR and aortic distensibility indices before and after successful percutaneous coronary interventions (PCI) in patients with left anterior descending coronary artery (LAD) disease. Methods: The study population, comprising 12 patients (4 women and 8 men) with significant proximal LAD stenosis, were compared with matched controls. Transesophageal echocardiography (TEE) was carried out to evaluate the CFR and aortic distensibility indices (the aortic elastic modulus E(p) and Young's circumferential static elastic modulus E(s)) before and after PCI to the LAD. The subjects underwent TEE on average 8 ± 11 days before PCI and 25 ± 6 weeks after PCI. Results: An improvement in CFR was demonstrated in patients with LAD stenosis after successful PCI (1.71 ± 0.36 vs. 2.08 ± 0.28, P < 0.05), which paralleled the decreases in E(p) (936 ± 544 mmHg vs. 567 ± 184 mmHg, P < 0.05) and E(s) (10,207 ± 6,295 mmHg vs. 5,831 ± 2,010 mmHg, P < 0.05) during the follow‐up. Conclusion: The aortic distensibility improves in parallel with the increase in CFR in patients with LAD stenosis after successful PCI. (Echocardiography 2010;27:311‐316)     

Developing equine mtDNA profiling for forensic application

Horse mtDNA profiling can be useful in forensic work investigating degraded samples, hair shafts or highly dilute samples. Degraded DNA often does not allow sequencing of fragments longer than 200 nucleotides. In this study we therefore search for the most discriminatory sections within the hypervariable horse mtDNA control region. Among a random sample of 39 horses, 32 different sequences were identified in a stretch of 921 nucleotides. The sequences were assigned to the published mtDNA types A–G, and to a newly labelled minor type H. The random match probability within the analysed samples is 3.61%, and the average pairwise sequence difference is 15 nucleotides. In a “sliding window” analysis of 200-nucleotide sections of the mtDNA control region, we find that the known repetitive central motif divides the mtDNA control region into a highly diverse segment and a markedly less discriminatory segment.