Editorial

Ohne Zusammenfassung     

Oral administration of taurolidine ameliorates chronic DSS colitis in mice.

Taurolidine (TRD) has antimicrobial and anti-inflammatory properties. However, the anti-inflammatory effects of TRD in inflammatory bowel diseases (IBD) have not been investigated. Here, we have analyzed the toxicity of TRD after oral long-term application in mice and examined the impact of oral TRD in a dextran sulfate sodium (DSS) model of experimental colitis. Female C57/BL6 mice received TRD in various concentrations (0.1% to 0.4%) for 60 days. Toxicity was evaluated by use of a disease activity index (DAI) and histological examination of major metabolic organs. Furthermore, the impact of 0.2% TRD on a chronic DSS colitis was examined by daily DAI, histological crypt damage score (CDS), bacterial translocation into mesenteric lymph nodes (MLN), and colonic expression of tumor necrosis factor (TNF) alpha, transforming growth factor (TGF) beta, interleukin (IL)-1beta, IL-6, cytochrome oxidase (COX)-2, and monocyte chemotactic protein (MCP)-1 by real-time polymerase chain reaction (PCR). Oral TRD administration for 60 days was well tolerated by the animals and did not show any toxic effects in terms of DAI and histological changes. TRD treatment of DSS colitis led to increased survival of 100%, compared to 33% in the untreated colitis group (p < or = .005). Clinical amelioration was mirrored by significantly reduced DAI and CDS in the TRD treated colitis. Colonic cytokine expression and bacterial translocation into MLN showed no differences between both groups. We thus report for the first time that oral application of TRD results in amelioration of an experimental IBD model. We hypothesize direct intraluminal antimicrobial effects of TRD as well as anti-inflammatory effects during the acute phase of DSS colitis.     

Normative values of bone parameters of children and adolescents using digital computer-assisted radiogrammetry (DXR).

PURPOSE: To verify whether estimation of bone mineral density (BMD) using digital X-ray radiogrammetry (DXR) is possible on children and to determine normative values of both such a DXR-BMD estimate and a corresponding metacarpal index (DXR-MCI) on. PATIENTS AND METHODS: In retrospect, X-rays were selected of the hands of 200 healthy Caucasian children (120 boys and 80 girls, aged 4-18 yr). The involved children were selected among a larger group of children submitted to the surgical department of our institute for evaluation of a suspected fracture after an occurred trauma. All children with a verified fracture or a chronic bone-related disease, including bone age retardation or acceleration, were excluded from the study. Furthermore, only conventional X-rays with the same film and capture parameters were included. The images were scanned and analyzed using the Pronosco X-posure system V.2 (Sectra Pronosco, Denmark). DXR-BMD, DXR-MCI, and a porosity index (DXR-PI) were automatically calculated using the midshafts of the metacarpals II-IV. Mean values of DXR-BMD and DXR-MCI were calculated separately for girls and boys in 2-yr intervals. RESULTS: In the present study the system has been demonstrated to be capable of calculating DXR-BMD from conventional X-rays of the hand from children down to approx 6 yr of age. This ability depended somewhat on the diameter and the length of the involved metacarpals. The success rate was higher for large bones than for small bones. The system succeeded in analyzing the images of 110 boys and 68 girls. Values of DXR-BMD were observed to increase with age from 0.40 g/cm2 to 0.62 g/cm2 in the male group and from 0.39 g/cm2 to 0.54 g/cm2 in the female group. Girls aged 11-12 yr had a higher DXR-BMD than did boys, corresponding to the earlier entry to puberty of girls. Standard deviations (SDs) reached values of up to 0.05 g/cm2. DXR-MCI increased with age from 0.36 to 0.47 for boys and from 0.34 to 0.49 for girls with a maximum SD of 0.06. The correlation between DXR-BMD and age was r=0.83 and r=0.84 for boys and girls, respectively. The corresponding correlations for DXR-MCI was lower, with observed correlations of r=0.63 (boys) and r=0.68 (girls), respectively, with p<0.01 in all cases. The DXR-PI did not reveal a significant correlation to age (r=-0.31 and r=0.04. respectively) and showed SDs marginally higher than the calculated mean values. CONCLUSION: The newly available DXR-methodology seems to offer the ability to determine DXR-BMD and DXR-MCI in children starting with a bone age of 6. This possibility may be of special relevance for children suffering from chronic bone diseases that require repeated X-rays of the hand (e.g. to determine bone age). The acquired normative data suggest that the measurements are of clinical value owing to low age-dependent variability (SDs) relative to an observed high increase with age. The clinical value of the porosity index (DXR-PI) remains uncertain and is limited owing to a high inter-individual variability.     

Value of ultrasonography in preoperative diagnosis of rotator cuff tears and postoperative follow-up

Four hundred and six patients presenting with shoulder pain underwent bilateral shoulder ultrasonography. Rotator cuff lesions were diagnosed in 197 patients. In 155 of the 308 patients who had additional arthrographic examinations, the arthrogram documented rotator cuff tears. Sixty-eight patients underwent surgery. There was good correlation between the ultrasonographic and arthrographic findings as well as the surgical results, with a sensitivity of 91% for each examination technique. Thirty-six postoperative patients were studied ultrasonographically; a minor to marked increase in rotator cuff echogenicity was demonstrated in them all. Its high predictive value makes ultrasonography the method of choice in diagnosing rotator cuff tears. Based on the evaluation of particular criteria, rotator cuff tears (greater than 1 cm) are commonly documented by ultrasonography. Only in patients with indeterminate or negative ultrasonograms in whom there is a high index of clinical suspicion, should arthrography be performed as a complementary imaging test. In postoperative follow-up the degree of scar formation at the reinsertion of the tendon is adequately documented by ultrasonography.     

The influence of partial gastrectomy on biochemical parameters of bone metabolism and bone density

Summary Since it has been suggested that gastric resections are followed by changes in bone metabolism, the aim of our study was to determine the biochemical parameters of bone metabolism and radial and lumbar bone density in 15 male ulcus patients treated by partial gastrectomy (Billroth II). Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography was statistically significantly lower (P < 0.04) in the patient group, whereas the peripheral bone mass of the distal part of the nondominant forearm measured by single-photon absorptiometry showed no statistically significant difference. In addition, a marked increase in alkaline phosphatase (P < 0.002) and urinary excretion of hydroxyproline (P < 0.003) was found in the gastrectomy group, whereas the 25-hydroxy-vitamin D levels were found to be significantly decreased (P < 0.04). Osteocalcin, a biochemical marker for osteoblast activity, and the carboxy-terminal propeptide of type I procollagen (PICP), a marker of collagen formation, were slightly but not significantly higher in gastrectomy-treated patients. The serum parathyroid hormone levels were similar in both groups. As none of the patients had any radiologic evidence of osteopenia, the changes in biochemical parameters of bone metabolism and bone mass in patients who had undergone partial gastrectomy could be a marker of latent bone loss.Abbreviations DPA/SPA dual/single-photon absorptiometry - BMD bone mineral density - QCT quantitative computed tomography - PICP carboxy-terminal propeptide of type I procollagen - 250HD₃ 25-hydroxy-vitamin D - iPTH parathyroid hormone - OC osteocalcin - BMC bone mineral content     

Measuring the Quality of Healthcare

Recently, enormous efforts to measure the quality of healthcare have been made to attain information on ways to improve the quality of healthcare. However, this area of research is still at an early stage of development and more research is required. This article outlines a framework by which the quality of healthcare can be analyzed on the basis of the three quality dimensions introduced by Donabedian. The article then goes on to test the validity of this (theoretical) framework within an empirical analysis.Because of increasing financial shortages within health systems, this article focuses on the treatment of myocardial infarction, which is one of the costliest and most prevalent diseases. This approach establishes a link between medical and economic problems. The variables for structure quality (i.e. number of cardiologists, number of catheterization facilities) were sourced and evaluated from the ‘Herzberichte der Jahrgänge’ (‘heart reports’) compiled by Bruckenberger for the period 1994–2004 for the 16 German federal states. Data from the Federation of Quality Assurance (BQS) were used for the evaluation of process quality (i.e. adequacy of indication for coronary angiography). Finally, administrative data from the German Federal Statistical office for 1994–2004 were used to determine the variables of outcome quality (i.e. standardized mortality rate due to myocardial infarction, potential years of life lost <70 years due to myocardial infarction).Three hypotheses were tested using panel data: (i) a better structure and/or process quality increases the probability of getting a better outcome quality for the clinical picture under observation; (ii) by employing additional input factors (such as additional catheterization facilities), the probability of getting a good outcome quality is increased; and (iii) in addition to structure quality and process quality, factors lying outside of the sphere of influence of the health system have an additional influence on outcome quality (marginal gains would decrease in this case). Three models were used to test these hypotheses using fixed effects estimation.The empirical analysis produced three results. First, the analysis confirms the predicted causality between the different dimensions of quality of care for the German federal states. Notably, the number of catheterization facilities has a highly significant positive influence on the outcome quality. Second, support is found for decreasing marginal gain of inputs. Third, a good structure and a good process quality alone cannot guarantee good outcome quality. However, the analysis also showed that, in addition to healthcare provided, there are other determinants that also affect the outcome quality of healthcare. Further empirical investigation regarding the influence of these factors on the outcome dimension could elaborate on our findings and deliver additional insights.     

Recent possibilities for the treatment of osteoporosis in the aged

Treatment of idiopathic osteoporosis in the elderly presupposes exact radiological diagnosis, the exclusion of a primary illness as the cause of the pathological process and exact differential diagnosis from other metabolic osteopathies. We consider possible means of prevention of the immobilization of old people, and appropriate hormonal substitution in cases of previous illnesses which coincide with a disturbance of the gonadal function, as important prophylactic measures. In the case of manifest osteoporosis, if possible, an assignment of the disease to a manifestation with high or low bone turnover should be made, by means of biochemical adjuvants. In high bone turnover, the substitution of sex hormones or the administration of calcitonin is indicated, particularly if symptoms of pain are distinct. In osteoporosis with low bone turnover, fluoride in long-term therapy is the preferred medication. The latest studies show that a combination of fluoride and active vitamin D metabolites is preferable to monotherapy. All therapy for this disease, independent of the age of the patient, should be supported by isometric exercises, analgesics and appropriate dietary measures. Orthopaedic supporting measures should be applied only if conservative measures in acute vertebral fractures fail.