A new approach towards hip-prosthesis design

Summary A new femoral prosthesis with a stemless design, different from conventional types, has been conceived in an effort to preserve the physiological stress distribution in magnitude and direction within the living bone as far as possible. The most important feature is that the hip joint forces are transmitted directly to the cortical bone of the resected femoral neck by means of a thrust plate, which maintains the physiological stress an the proximal end of the femur.The prosthesis, the instruments required for its implantation and the surgical technique are described in detail. Up to now, 3 patients have received this new prosthesis.

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Zusammenfassung Im Bestreben den physiologischen Kraftfluß im proximalen Femurende in bezug auf Größe und Richtung möglichst weitgehend zu erhalten, wurde eine neue Femurendoprothese ohne Schaft konzipiert, welche vom heute allgemein gebräuchlichen Typ wesentlich abweicht. Als entscheidendes Merkmal wird eine Druckscheibe bezeichnet, welche die auf das proximale Femurende einwirkenden Kräfte direkt auf die Corticalis des resezierten Schenkelhalses einwirken läßt, wodurch eine möglichst physiologische Beanspruchung des Knochens weiterhin ermöglicht wird. Die Druckscheibenprothese, das Instrumentarium für die Implantation und die chirurgische Technik werden im Detail beschrieben. Bis vor I Jahr wurden drei Patienten mit dieser neuen Prothese versorgt. In einer ausgedehnten field study soll sie nun in die Klinik eingeführt werden.

     

Pregnancy in diabetic women: outcome with a program aimed at normoglycemia before meals.

A program designed to achieve normal plasma glucose concentrations before meals was tested in 83 insulin-dependent diabetic women during 110 pregnancies. The women rigidly controlled their carbohydrate intake but not their total energy intake, and twice daily they injected a combination of short-acting (Toronto) and intermediate-acting (NPH or Lente) insulin. Obstetric care was highly individualized and was aimed at avoiding or minimizing the impact of complications, such as hypertension, on the fetus and ensuring fetal lung maturity before delivery. The mean plasma glucose levels before meals (+/- standard error of the mean) were 136 +/- 9, 117 +/- 5 and 101 +/- 2 mg/dl during the first, second and third trimesters respectively. Obstetric complications included hypertensive disease of pregnancy (in 30.0%) and hydramnios (in 16.4%). The mean gestational age (+/- standard deviation [SD]) was 38.1 +/- 1.8 weeks, the cesarean section rate 45.4% and the mean stay in hospital for diabetes control before delivery (+/- SD) 15.7 +/- 9.6 days. The perinatal mortality rate was 0.9%. Neonatal problems included congenital anomalies in 3.6%, somatomegaly in 24.6%, hypoglycemia in 26.5%, hypocalcemia in 17.3% and hyperbilirubinemia in 39.4%. There were nine cases (8.2%) of the respiratory distress syndrome, four (3.6%) of which were severe. These findings lend support to the importance of a policy aimed at achieving normoglycemia and fetal lung maturity before delivery, goals that are attainable without lengthy antenatal hospitalization.     

Flat penile lesions: the infectious "invisible" link in the transmission of human papillomavirus

Although it has been widely accepted that high-risk human papillomavirus (hrHPV) is sexually transmitted, limited insight is available about the clinical manifestations of hrHPV infection in men and their contribution in the viral spread. Here, we reviewed the literature on the relationship between hrHPV and the presence of penile lesions. Flat penile lesions have similar predilection sites as HPV, often contain hrHPV as identified by DNA in situ hybridization in biopsy specimens, show a high association with hrHPV as identified by PCR in penile scrapes of lesional sites and are associated with high viral copy numbers. Absence of flat lesions is generally associated with very low HPV copy numbers or absence of HPV. Therefore, we argue that these lesions form the reservoir of hrHPV in men and contribute to the viral spread. Their bare visibility with the naked eye and their high degree of spontaneous healing explain why flat penile lesions have slipped the attention of the clinician. Combining an HPV DNA test with a visual inspection after acetic acid application offers a more reliable interpretation of a positive HPV test in men, as it helps to distinguish positivity that is very likely to reflect a productive HPV infection from potentially HPV infections with very low copy numbers or HPV contamination by the sex partner. Future trials of HPV vaccines in men should take into account not only the presence of penile HPV but also the presence of flat penile lesions as an outcome measure for the efficacy of a vaccine.     

Meningiomas in five members of a family over two generations, in one member simultaneously with acoustic neurinomas.

Despite four reports of familial occurrence of meningiomas, the inheritance of this tumor remains an open question. We describe a family in which four members in two generations had meningiomas without evidence of neurofibromatosis. Another member of the family, however, had multiple meningiomas and bilateral acoustic neurinomas, while yet another had multiple café-au-lait spots. We suspect that a highly unusual presentation of neurofibromatosis explains this otherwise very unlikely occurrence.