Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip

Intramedullary nailing through the piriform fossa results in some cases in loss of abduction strength and persistent pain. Nail insertion at the tip of the greater trochanter may be favourable. The aim of this study was to assess (possible) iatrogenic injury to the abductor and external rotator musculature, branches of the superior gluteal nerve and branches of the MFCA in relation to the two different entry points. In 10 fresh human cadaver femurs, five unreamed femoral nails (UFN) were inserted through the piriform fossa and five AO prototype nails (AFN) through the trochanteric tip. The iatrogenic injury at each nailing procedure was assessed. Various muscles and tendons, branches of the MFCA along with the hip joint capsule were injured or largely at risk during nail insertion through the piriform fossa. Most of these structures were not exposed during insertion through the trochanteric tip. The reported clinical morbidity after nailing through the piriform fossa may find its origin in direct soft tissue injury and may be reduced by choosing a lateral nail entry point.     

Acidophil gek?rnte, onkocytenartige Zellen im pr?puberalen Keimepithel

Zusammenfassung In 105 Autopsien von Neugeborenen und Kindern bis 9 Jahren und in 100 Biopsien von Knaben zwischen 9 und 17 Jahren werden die Gonaden auf das Vorkommen eosinophil granulierter onkocytenartiger Zellen im Keimepithel geprüft. Im Gesamtuntersuchungsgut kommen derartige Zellen bei 19 Knaben, d.h. bei 9,2% der Fälle vor. Bei unausgewählten Autopsiefällen sind sie nur bei annähernd 3 % der Beobachtungen zu sehen, bei Biopsien dagegen, die aus dystopen Hoden der späteren präpuberalen Altersstufe stammen, bei 16% der Fälle. Morphologisch erinnern die eosinophil gekörnten Zellen an Onkocyten anderer Organe. Die Granula weisen aber gewisse gestaltliche und färberische Eigenschaften auf, die mit denjenigen typischer Onkocyten nicht übereinstimmen. Auch spricht das Auftreten dieser Zellen im Keimepithel des frühen Kindesalters gegen die Identität derartiger gekörnter Zellen mit Onkocyten. Da die eosinophil gekörnten Zellen vor allem in dystopen oder dysplastischen Hoden gefunden werden, kommt ihrem Nachweis bei Kindern möglicherweise eine gewisse Bedeutung für die prognostische Beurteilung der späteren Hodenentwicklung zu.

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Acidophilic granular oncocytic cells of the prepubertal germinal epithelium of the testis

Summary The germinal epithelium of the testes of 105 autopsied children (up to nine years of age) and 100 biopsies of retained testes (from boys nine to 17 years of age) was studied histologically for acidophilic, granular cells resembling the socalled oncocytes. Such acidophilic, granular cells were found in 19 children (9.2% of all cases). In unselected autopsies these cells were demonstrable in the testes of only three boys (3%), whereas in retained testes of boys of prepubertal ages they were found in 16 testes (16%). Morphologically the acidophilic, granular cells resemble oncocytes of other organs. Their granules, however, have specific morphologic and tinctorial qualities different from those of the oncocytes. These differences and the occurrence of the cells in the germinal epithelium of the testes of infants preclude these cells being the same as the oncocytes. Since the acidophilic, granular cells are found principally in dystopic or dysplastic testes, their demonstration in children assumes special importance for the prognostic evaluation of later development of the testis.

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Mit Unterstützung durch die Emil-Barell-Stiftung der F. Hoffmann-La Roche und Co. AG., Basel.     

Klinische Aussagekraft der frühen Potentiale sowie des späten Potentials N1 bei der Menièreschen Erkrankung und dem Hörsturz

Summary At some patients suffering from Menières disease or sudden hearing loss the brainstem potentials and the late auditory potential N₁ were registered. It could be shown that an exact differential diagnosis between these both illnesses was not possible by means of these acoustically evoked potentials. Furthermore it was not possible by means of these potentials to predict an improvement of hearing at patients with sudden hearing loss. Finally the potentials showed an increasing of their latencies which was greater at patients with sudden hearing loss than at patients with Menières disease.     

Bioavailability of progesterone from rectal dosage forms in rabbits

The systemic availability of progesterone in two rectal dosage forms was investigated in rabbits. The progesterone plasma concentration was determined as total radioactivity (progesterone and its metabolites) after a single dose of 5 mg/kg [³H]-labelled progesterone in an adeps solidus suppository (1) and in a propylene glycol enema (2) given in a randomized cross-over fashion. The equivalent dose was given intravenously (3) to the same rabbits.The maximum plasma concentration (C_max) after (1) was 0.82 ± 0.43 μg/ml and significantly lower than after (2), which was 3.81 ± 1.08 μg/ml (mean ± S.E.; P < 0.05). The time to reach the maximum plasma concentration (T_max) was for (1) 1.75 ± 0.25 h and for (2) 0.56 ± 0.32 h (mean ± S.E.; P < 0.05). The mean plasma concentration vs time curve after (3) indicates that a muhicompartment system is involved in the disposition of progesterone. The plasma half-life (t_{$\text{1}\text{2}$}) estimated from 0–6 h was 5.10 ± 1.12 (mean ± S.E.).The systemic availability (F%) of (1) from 0–6 h (AUC_0–6h) was 14 ± 8% and significantly lower than that of (2), which was 44 ± 10% (mean ± S.E.; P < 0.05).The results indicate a delayed and possibly lower absorption of progesterone from the suppositories as compared to the enema.