Orthop?dische Operationen und Nachbehandlungsregimes am rheumatischen Ellenbogen

This article gives an overview of the indications for operative treatment and the respective post-treatment of rheumatic elbows. The goal should be to preserve the function of the elbow joint and freedom from symptoms to prevent joint destruction which unfortunately can still be seen nowadays.     

Klinische Untersuchung des Handgelenkes und der Hand

The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i.?e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.     

Ultrasound diagnosis of the acromioclavicular joint

Although standardized sonographic techniques are available, the diagnostic capabilities of sonography in diseases and injuries of the acromioclavicular [AC] joint are not yet widely used. Nevertheless, standardized sonographic techniques are available for examining injuries and diseases of the AC joint. Analogous to X-ray techniques, the bony relations of the clavicle and the acromion can be displayed. Joint effusions and marginal alterations of the subchondral bone plate can be imaged. However, there is no reliable method to display the articular disc and the coracoclavicular ligaments. There is no reproducible method for displaying the articular disk. Tears of the deltoid and trapezius muscles and their common fascia are easily detectable in high-grade injuries of the AC joint. The differentiation between acjoint injuries, i.e. Rockwood II/Rockwood IV, is facilitated, which aids in therapeutic decision making. In combination with conventional X-ray examination, sonography of the AC joint can be used at low cost and is easy to learn.     

Biomechanical comparison of effects of supraspinatus tendon detachments,tendon defects,and muscle retractions

BACKGROUND: Rotator cuff ruptures are frequently associated with loss of strength of the shoulder. However, the characteristics of the rotator cuff tear that are responsible for the loss of force generation and transmission have not yet been identified. The purpose of this study was to compare the effects of supraspinatus tendon detachments, tendon defects, and muscle retractions on in vitro force transmission by the rotator cuff to the humerus. METHODS: The rotator cuff tendons from ten cadaver shoulders were loaded proportionally to the respective cross-sectional areas of their muscles. A fiberglass rod was cemented into the medullary canal of the humerus and connected to a three-component load cell for the measurement of the forces transmitted by the rotator cuff to the humerus. This study was performed with the humerus in a hanging arm position and with various sizes of supraspinatus tendon detachments, tendon defects, and muscle retractions. RESULTS: Detachment or creation of a defect involving one-third or two-thirds of the supraspinatus tendon resulted in a minor reduction in the force transmitted by the rotator cuff (< or =5%), while detachment or creation of a defect involving the whole tendon resulted in a moderate reduction (11% and 17%, respectively). Simulated muscle retraction involving one-third, two-thirds, and the whole tendon resulted in losses of torque measuring 19%, 36%, and 58%, respectively. Side-to-side repair of the one-third and two-thirds defects nearly restored the force transmission capability, whereas a deficit remained after side-to-side repair following complete resection. CONCLUSIONS: Our results support the rotator cable concept and correspond to the clinical observation that patients with a small rupture of the rotator cuff may present without a loss of shoulder strength. Muscle retraction is potentially an important factor responsible for loss of shoulder strength following large rotator cuff ruptures. Clinical Relevance: Supraspinatus muscle retraction diminishes glenohumeral abduction torque significantly more than either a defect in the tendon or a simple detachment of the tendon from the tuberosity. In cases of irreparable defects, side-to-side repair may be worthwhile to restore muscle tension and the integrity of the rotator cable.     

Adjuvants recognized by toll-like receptors inhibit the induction of polarized type 2 T cell responses by natural attachment (G) protein of respiratory syncytial virus

Immunization with native fusion (F) protein from respiratory syncytial virus (RSV) adsorbed to alum adjuvant generates greater than fourfold rises in serum neutralizing antibody titers in approximately 50% of seropositive humans. Using BALB/c mice we demonstrate herein that enhanced neutralization titers and accelerated clearance of virus from the lungs after challenge are possible if the attachment (G) glycoprotein is added to F protein-based vaccines. We further reveal for the first time that polarized type 2 T cell responses and immunopathology associated with G protein are inhibited by adjuvants recognized by toll-like receptors (TLR). Co-formulation with compounds that targeted TLR-2, TLR-3, TLR-4, or TLR-9 elicited significantly diminished type 2 T cell responses that caused granulocytic inflammation and eosinophilia in the airways after challenge. These results were not observed with recombinant IL-12 or QS-21. The data are important for improving combination vaccines for RSV.     

Biomechanical considerations on shoulder joint prosthesis implantation

The biomechanical goals of prosthetic reconstruction of the shoulder are to restore the normal anatomy and range of motion, and to recreate the normal soft tissue balance of the static and dynamic stabilizers of the glenohumeral joint. An unconstrained prosthesis design best reproduces the physiological articulation and original anatomy of the shoulder. Humeral head components have been recently developed, which are adaptable to the variable anatomy of the proximal humerus (third generation design). A precise reconstruction of the three dimensional structure of the proximal humerus may lead to an improved functional outcome. However, there is still a lack of biomechanical data to support this concept. The optimal design of the glenoid component remains a challenge for future research. Specific issues including the choice of biomaterials, the optimum shape, radius of curvature, surface area of the articulation, component height and stem design remain under investigation. Although the prosthetic design represents an important factor in the success of glenohumeral arthroplasty, the surgical reconstruction of the soft tissues to recreate the normal soft tissue balance as well as postoperative rehabilitation determine the functional outcome.     

Adenocarcinoma of the rectum in childhood following chemotherapy and radiotherapy for a rhabdomyosarcoma--a case report.

We report a case of rectal adenocarcinoma in a 9-year-old boy, which took the form of a second malignant neoplasm following treatment for an early childhood malignancy. The abdominal complaints were for a long time interpreted as an infectious disease. At the time of diagnosis of the rectal carcinoma, the tumor had already progressed to the stage of metastatic disease. Therapy consisted of deep anterior rectal resection and regional arterial chemotherapy for liver metastases. The child died 18 months after the diagnosis of rectal carcinoma. As survival for childhood tumors improves, rare second malignant neoplasms will become increasingly common in children and adolescents. This phenomenon emphasizes the need for continued clinical surveillance of patients who have been treated with chemotherapy or irradiation for childhood tumors. The increased risk of second malignant neoplasms and an early onset of adult-type tumors has to be considered.