Über kongenitale Zwerchfellhernie und ihre Darstellung im Röntgenbild

Ohne ZusammenfassungMit 3 Textfiguren und 2 Tafeln.Nach einer Demonstration im ärztlichen Verein zu Frankfurt a. M. am 10. VIII. 1915.     

Achilles tendon ruptures operated on under local anesthesia: Retrospective study of 81 nonhospitalized patients

During a 6-year period, 97 patients with an acute rupture of the Achilles tendon were operated on under local anesthesia as outpatients. At follow-up, 5/81 patients had some discomfort. A rerupture occurred in 3 patients shortly after commencing weight bearing and after substantial traumas. We conclude that there is no need to hospitalize patients with an Achilles tendon rupture.     

High glycogen levels in the hippocampus of patients with epilepsy.

During intense cerebral activation approximately half of the glucose plus lactate taken up by the human brain is not oxidized and could replenish glycogen deposits, but the human brain glycogen concentration is unknown. In patients with temporal lobe epilepsy, undergoing curative surgery, brain biopsies were obtained from pathologic hippocampus (n=19) and from apparently 'normal' cortical grey and white matter. We determined the in vivo brain glycogen level and the activity of glycogen phosphorylase and synthase. Regional differences in glycogen concentration were examined similarly in healthy pigs (n=5). In the patients, the glycogen concentration in 'normal' grey and white matter was 5 to 6 mmol/L, but much higher in the hippocampus, 13.1+/-4.3 mmol/L (mean+/-s.d.; P<0.001); the activities of glycogen phosphorylase and synthase displayed the same pattern. In normal hippocampus from pigs, glycogen was similarly higher than in grey and white matter. Consequently, in human grey and white matter and, particularly, in the hippocampus of patients with temporal lope epilepsy, glycogen constitutes a large, active energy reserve, which may be of importance for energy provision during sustained synaptic activity as epileptic seizures.     

Distribution of the vesicular acetylcholine transporter (VAChT) in the central and peripheral nervous systems of the rat

Expression of the acetylcholine biosynthetic enzyme choline acetyltransferase (ChAT), the vesicular acetylcholine transporter (VAChT), and the high-affinity plasma membrane choline transporter uniquely defines the cholinergic phenotype in the mammalian central (CNS) and peripheral (PNS) nervous systems. The distribution of cells expressing the messenger RNA encoding the recently cloned VAChT in the rat CNS and PNS is described here. The pattern of expression of VAChT mRNA is consistent with anatomical, pharmacological, and histochemical information on the distribution of functional cholinergic neurons in the brain and peripheral tissues of the rat. VAChT mRNA-containing cells are present in brain areas, including neocortex and hypothalamus, in which the existence of cholinergic neurons has been the subject of debate. The demonstration that VAChT is a completely adequate marker for cholinergic neurons should allow the systematic delineation of cholinergic synapses in the rat nervous system when antibodies directed to this protein are available.     

Prevalence of fishborne zoonotic parasites in important cultured fish species in the Mekong Delta,Vietnam

A seasonal investigation on the occurrence of fishborne zoonotic trematodes (FZT) in economically important mono-cultured hybrid catfish and giant gouramy was conducted in the Mekong Delta of Vietnam. Fish from carp poly-culture and intensive small-scale integrated vegetable–aquaculture–animal husbandry farming (VAC) systems were also examined. No FZT metacercariae were found in any mono-cultured hybrid catfish. FZT metacercariae were common, however, in fish from the other three systems: All metacercariae belonged to the Heterophyidae family of trematodes, Haplorchis pumilio, H. taichui, Centrocestus formosanus and Stellantchasmus falcatus. The FZT prevalence was 1.7% in mono-cultured giant gouramy, 6.6% in carp from the poly-culture and 3.0% in fish raised in the VAC system. H. pumilio was the most common FZT species constituting more than 58.0% of all metacercariae recovered. The prevalence of infection was significantly higher in the flooding season compared to the non-flooding season for both giant gouramy and fish reared in the VAC system. FZT intensity was greatest in fish from carp poly-culture, particularly in the flooding season. The results indicate that certain fish production systems are at risk for FZT, and control approaches will benefit from understanding these risk factors.     

Microbiological quality of fish grown in wastewater-fed and non-wastewater-fed fishponds in Hanoi, Vietnam: influence of hygiene practices in local retail markets

Mean water quality in two wastewater-fed ponds and one non-wastewater-fed pond in Hanoi, Vietnam was approximately 10(6) and approximately 10(4) presumptive thermotolerant coliforms (pThC) per 100 ml, respectively. Fish (common carp, silver carp and Nile tilapia) grown in these ponds were sampled at harvest and in local retail markets. Bacteriological examination of the fish sampled at harvest from both types of pond showed that they were of very good quality (2 - 3 pThC g(-1) fresh muscle weight), despite the skin and gut contents being very contaminated (10(2) - 10(3) pThC g(-1) fresh weight and 10(4) - 10(6) pThC g(-1) fresh weight, respectively). These results indicate that the WHO guideline quality of < or = 1000 faecal coliforms per 100 ml of pond water in wastewater-fed aquaculture is quite restrictive and represents a safety factor of approximately 3 orders of magnitude. However, when the fish from both types of pond were sampled at the point of retail sale, quality deteriorated to 10(2) - 10(5) pThC g(-1) of chopped fresh fish (mainly flesh and skin contaminated with gut contents); this was due to the practice of the local fishmongers in descaling and chopping up the fish from both types of pond with the same knife and on the same chopping block. Fishmonger education is required to improve their hygienic practices; this should be followed by regular hygiene inspections.     

Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up

OBJECTIVES: To compare the effect of graded physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement. METHODS: Randomised controlled trial with 12 months' follow up in a hospital setting. Ninety consecutive patients aged 18 to 55 years were enrolled. Symptom duration was between six months and three years. All fulfilled a set of diagnostic criteria for rotator cuff disease, including a positive impingement sign. Patients were randomised either to arthroscopic subacromial decompression, or to physiotherapy with exercises aiming at strengthening the stabilisers and decompressors of the shoulder. Outcome was shoulder function as measured by the Constant score and a pain and dysfunction score. "Intention to treat" analysis was used, with comparison of means and control of confounding variables by general equation estimation analysis. RESULTS: Of 90 patients enrolled, 84 completed follow up (41 in the surgery group, 43 in the training group). The mean Constant score at baseline was 34.8 in the training group and 33.7 in the surgery group. After 12 months the mean scores improved to 57.0 and 52.7, respectively, the difference being non-significant. No group differences in mean pain and dysfunction score improvement were found. CONCLUSIONS: Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training. Further studies are needed to qualify treatment choice decisions, and it is recommended that samples are stratified according to disability level.     

Enchondromas in children: imaging appearance with pathological correlation

Objective

Enchondromas are benign lesions that may present with nonspecific features on imaging in children. Correlation of histology with imaging findings is often required to make the final diagnosis of a benign lesion. The aim of this study was to review imaging and pathological findings of enchondromas in children.

Materials and methods

Imaging examinations of 12 enchondromas in 11 patients (median age 14?years) were retrospectively reviewed. Imaging evaluation included an assessment of lesion size, relationship to the growth plate, mineralization, matrix and periosteal reaction, intrinsic MR signal characteristics, and intraosseous and soft-tissue edema. Pathological findings were reviewed.

Results

Lesions were located in the phalanx in 33% (4 out of 12), metacarpal in 25% (3 out of 12), femur in 33% (4 out of 12) and tibia in 8% cases (1 out of 12). The mean size was 28?mm (range, 11–70?mm). Matrix mineralization in a typical “rings-and-arcs” pattern was observed in 20% of the lesions with available radiographs/CT (2 out of 10). Lesions were expansive with endosteal scalloping in 75% of cases (9 out 12) and contacted the growth plate in 50% of cases (6 out of 12). All enchondromas in which MR imaging was available (5 out of 5) demonstrated typical cartilaginous matrix of lobules of high T2 signal, low T1 signal, and peripheral enhancement.

Conclusion

Enchondromas in children are relatively large lesions, with frequent endosteal scalloping and rare matrix mineralization.     

Contraception for women with diabetes mellitus

Planned pregnancy is mandatory in women with diabetes, and their need for contraception is essential. Basically, the same methods can be used as in women without diabetes, but a number of specific conditions have to be considered when guiding these women, as we discuss in this review. Unfortunately, the field is limited in studies in certain areas, especially considering contraception for women with type 1 diabetes and late diabetic complications and women with type 2 diabetes. Thus, in the real clinical world, the choice of contraceptive often will be a kind of compromise, balancing pro and cons for the different available methods.