Behandlung des Morbus Sudeck

Complex regional pain syndrome (CRPS) was formerly known as “Sudeck’s atrophy”. The disease belongs to the group of neuropathic pain syndromes and is differentiated into three types. Type I is characterized by a lack of nerve lesions, type II by the presence of nerve lesions, and type III by the presence of other entities such as fibromyalgia. The exact pathogenic factors leading to the disease are still unknown and are currently the subject of investigation in various studies. These studies suggest a contribution of the central nervous system to the development and maintenance of CRPS. However, the clinical symptoms are well documented and include pain, autonomic changes and impaired motor function of the affected extremity. Diagnosis is based clinically on signs and symptoms. However, in a few cases radiography and scintiscanning may be useful to finalize the diagnosis. The treatment options are centred on the symptoms of pain, autonomic changes and functional impairment. A multidisciplinary treatment strategy is recommended, with surgeons, anaesthesiologists, physiotherapists and psychotherapists working together. Surgical intervention in this disease is only required in rare cases of neurological and bone pain, and the indications for such intervention are narrow and should be strictly observed.     

Free flap monitoring with continuous tissue oxygen tension measurement

Intraoperative and postoperative free flap monitoring by means of oxygen tension measurement was carried out in 11 patients. We used an invasive flexible microcatheter that allowed for measurement of oxygen tension in all types of free flaps. Two cases of the measured flaps were buried free flaps which do not allow monitoring by clinical assessment. All flaps monitored in this study survived. One case of displacement of the microcatheter occurred. In one patient, the tissue pO₂ monitor successfully detected early vascular thrombosis with subsequent reoperation and salvage of the free flap.     

Chronic occupational exposure to organic solvents

Summary Twenty-two persons (20 men and 2 women) were examined for their external and internal exposure to the glycol ether 1-methoxypropan-2-ol (PGME) during the production, leak testing and mounting of brake-hoses. For the measurement of external exposure, personal air monitoring was the method of choice. Average concentrations of PGME of 82.2 mg/m³ (22.3 ppm), 68.6 mg/m³ (18.6 ppm) and 11.3 mg/m³ (3.1 ppm) were found in the air of the brakehose production, leak test and mounting areas, respectively. For the estimation of internal exposure to PGME, this glycol ether was measured in both urine and blood. The biological samples were taken post-shift. The highest internal exposure levels were found in the brakehose production section and in the leak test area. The average post-shift concentrations for PGME in workers in the brakehose production section were 4.6 mg/l in urine and 13.5 mg/l in blood; the corresponding figures for workers in the leak test area were 4.2 mg/l in urine and 11.0 mg/l in blood. In blood and urine samples of workers engaged in the mounting area, PGME levels were below the detection limits. The elimination kinetics of PGME were also studied in three highly exposed persons, and mean excretion half-lives of PGME of approximately 4.4 h were found. On the basis of our results we made a rough calculation of a future biological tolerance value: we would except that concentrations of 38-109 mg per litre of blood and 10–31 mg per litre of urine would correspond to the German MAK value for PGME (375 mg/m³).     

Relation of elevated ST segment in the electrocardiogram to echocardiography determined wall kinetics in patients after myocardial infarct

The connection of ECG findings and disturbances of the kinetics after myocardial infarction was controlled on 104 patients in correlation to the echocardiography. The investigations were performed at discharge from hospital and in the 3rd month after infarction by means of ECG at rest and exercise electrocardiogramme as well as echocardiography. In this case was shown that the elevation of the ST-segment after anterior-wall infarction was above all the expression of an ischaemia and was in most cases accompanied by an akinesia of the anterior wall. Only patients with a precordial ST-elevation over 2 mm at rest with increase to more than 4 mm under exercise or patients with a smaller ST-elevation, but a symptom-limited performance to 50 Watt, connected with ST-elevation, ventricular extrasystoles or pathological diastolic pressure of the pulmonary arteries as withdrawal criterion belonged to the group with dyskinesias and aneurysms, respectively.     

Longitudinal study on potential neurotoxic effects of aluminium: II. Assessment of exposure and neurobehavioral performance of Al welders in the automobile industry over 4 years

Objectives  

This is the second of two parallel longitudinal studies investigating Al exposure and neurobehavioral health of Al welders over 4 years. While the first published study in the trail and truck construction industry examined the neurobehavioral development of Al welders from age 41–45 in the group mean (Kiesswetter et al. in Int Arch Occup Environ Health 81:41–67, 2007), the present study in the automobile industry followed the development from 35 to 39. Although no conspicuous neurobehavioral developments were detected in the first study, which furthermore exhibited the higher exposure, it cannot be excluded that exposure effects appear in earlier life and exposure stages.     

Percutaneous needle trephination. Experience in 200 cases

Summary For many years percutaneous needle and classic burr-hole trephination with insertion of plastic catheters for external ventricular drainage are in use. The shortcomings of the conventional puncture needles were compensated for by the development of a modified instrument in recent years.In this prospective study we tried to define advantages and disadvantages of percutaneous ventriculostomy with this modified needle in a large number of patients. We treated and followed a total number of 200 patients with external ventricular drainage for various reasons (42% obstructive hydrocephalus, 27% haematocephalus, 11% malresorptive hydrocephalus, 11% elevated ICP and 9% infections). The ventriculostomy is performed — after percutaneous trepheication with a 1.5 mm drill and 1.2 mm needle under the local aesthesia as a bedside procedure. The modified blunt needle is provided with markings and a set screw which allows insertion to a prefixed depth and a sharp guide which is withdrawn after penetration of the dura. It is then bent rostrally and fixed by a plaster cast. The mean duration of drainage was 9 days (1–30 days). Mean operating time for the whole procedure including fixation and connection to the drainage system was 20 minutes. Overall complication rate was 13% (N=26). Two intracerebral haemorrhages (1%) occurred, of which one was caused by overdrainage. Five (3%) infections in primarily not infectious cases (N=182) were seen. Only one case of infection occurred without loosing of the needle on day 17. In 19 patients (10%) the needles had loosened. Fifteen times this complication was repaired in time and no infection occurred. The overall complication rate (13%) and the needle related risk of bleeding (0.5%) seem average. The true risk of infection with correct handling (0.5%) is very low despite the very long average duration of drainage. The main risk lies in the markedly high danger of loosening (10%), which entails a disproportionally high demand for nursing care. Nevertheless, we regard percutaneous needle trephination as the ventriculostomy method of choice because of its better practicability and low infection rate.     

Localization of adhesion molecules on human spermatozoa by fluorescence microscopy

Summary.  The expression of adhesion molecules on human spermatozoa of healthy probands was analysed. The localization patterns of adhesion molecules (AM) on the spermatozoal surface were documented by fluorescence microscopy. Spermatozoa were incubated with antibodies against α1 (CD49a), α2 (CD49b), α3 (CD49c), α4 (CD49d), α5 (CD49e), α6 (CD49f) chains of β1 integrins, β1 (CD29), β2 (CD18), αV (CD51), β3 (CD61) and β4 integrin chains, the LFA-3 (Lymphocyte function antigen, CD58) from the immunoglobulin superfamily and the extracellular matrix proteins laminin, fibronectin and collagen IV. For collagen IV, α1 and α2 chains no expression could be noticed. Laminin was detected at the acrosomal membrane, fibronectin and β4 chain mainly at the equatorial membrane. The fibronectin receptors α3, α4 and α5 chains of the β1 integrins were mainly located on acrosomal and equatorial membrane areas. Laminin receptor α6 chain was located postacrosomal and less frequently acrosomal. β2 chain and vitronectin receptors αV and β3 chains had a mainly postacrosomal localization pattern. LFA-3 was found constantly on postacrosomal membrane areas. Double staining technique was used to prove the simultaneous occurrence of fibronectin and its integrin receptors α3, α4 and α5 chains and of αV and β2 chains on spermatozoa. The localization patterns of integrins on double stained spermatozoa were similar to the patterns described for single stained spermatozoa. The localization of fibronectin appeared to be influenced by the presence of integrins: the typical equatorial fibronectin band disappeared in case of an equatorial localization of integrins.     

Das Lidekzem

Lidekzeme sind pathogenetisch heterogen. Ihre Behandlung ist durch die anatomischen und funktionellen Gegebenheiten der Periorbitalregion erschwert. Dies macht sie, neben ihrer h?ufigen Therapieresistenz und Rezidivneigung, zu einer gro?en diagnostischen und therapeutischen Herausforderung für Haut- und Augen?rzte.Auch ein vergleichsweise kleinfl?chiges Lidekzem kann aufgrund der belastenden Symptomatik und der hohen ?sthetischen Bedeutung dieser K?rperregion einen hohen Leidensdruck verursachen. Diese interdisziplin?re übersichtsarbeit zum Thema behandelt vor allem aktuelle pathogenetische und therapeutische Aspekte der Lidekzeme. Dr.A.Wollenberg Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universit?t München, Frauenlobstr.9-11, 80337 München, E-Mail: wollenberg@lrz.uni-muenchen.de