Kniegelenkluxationen

Zusammenfassung Kniegelenkluxationen sind seltene, aber schwer wiegende Verletzungen mit z. T. erheblichen Folgen. Begleitende Nerven- und Gefäßverletzungen sind nicht selten. Bei spontaner Reposition kann das Verletzungsausmaß initial unterschätzt werden. Die primäre Diagnostik muss die neurologische Untersuchung sowie die sichere Beurteilung des Gefäßstatus einschließen. Die Sicherung der Durchblutung des betroffenen Beins steht in der Akutphase im Vordergrund, Läsionen müssen notfallmäßig operativ versorgt werden. Bei drohendem Kompartment ist eine Faszienlogenspaltung erforderlich, die Instabilität wird temporär mittels Fixateur externe transfixiert. Bei Hochrasanztraumen sind Begleitverletzungen auszuschließen, bei sedierten und beatmeten Patienten z. B. mit Spiral-CT. Sind nur die Kreuzbänder betroffen, kann ein arthroskopisch gestützter Ersatz vorgenommen werden, Transplantate werden bevorzugt von der Gegenseite entnommen. Die im angloamerikanischen Sprachraum verwendeten Allografts haben sich in unserer Region noch nicht durchgesetzt. Bei ausgedehnten Kapselläsionen und Beteiligung der Kollateralbänder sind arthroskopische Techniken nicht indiziert, es sollte offen rekonstruiert und ggf. augmentiert werden; sekundär verbliebene Instabilitäten können gezielt dem Bandersatz zugeführt werden.     

The need for future surgical low rectal cancer studies

Optimal surgery remains the mainstay of best outcome for rectal cancer. The demonstration, during the 3rd Annual Pelican Surgical Workshop Symposium, of an abdomino‐perineal excision (APE) performed in the ‘Berlin position’, further added to the debate on optimal surgical technique. Much interest was created at the 1st Pelican symposium with the demonstration, by the Swedish surgeon Dr Torbjorn Holm, of a prone APE and the delivery of a ‘cylindrical’ specimen and the potential to reduce local recurrence using this approach. The high rates of local recurrence following APE and the discussions as to optimal technique have led to the development of a proposed MERCURY Study Group study to assess the benefit of a radical APE, with careful assessment of the impact that this operation may have on morbidity. A German study has also been proposed adopting the UK's multidisciplinary team approach. It aims at targeting preoperative chemoradiotherapy at those patients in whom a radical APE or total mesorectal excision is likely to result in an involved surgical resection margin. In this article we review the evidence for improving the surgical technique for low rectal cancer. We believe improvements may be best achieved through continued European prospective, multi‐centre, multidisciplinary studies.     

Is the circumferential resection margin a predictor of local recurrence after preoperative radiotherapy and optimal surgery for rectal carcinoma?

OBJECTIVE: Circumferential resection margin (CRM) involvement has been correlated with a high risk of developing local recurrence. The aim of this study was to examine the prognostic significance of the CRM involvement after curative resection of rectal cancer in patients treated with preoperative radiotherapy and postoperative chemotherapy where indicated. METHOD: All patients with rectal cancer treated in a regional central unit from 1996 to 2004 were identified. A surgical resection was performed on 257 patients, and in 229 of these this was assessed as potentially curative. The CRM was examined in all patients. A CRM of < or = 1 mm was considered positive. RESULTS: A positive margin was seen in 19 (8%) patients. At a median follow up of 40 months, only four (1.7%) patients had developed local recurrence, one of whom had a positive CRM. In the four patients the tumour was 5 cm or less from the anal verge. There were no significant differences regarding local recurrence and survival between CRM positive and negative tumours. CONCLUSION: Rectal cancer managed by combined radiochemotherapy and surgery resulted in a low positive CRM rate and a low local recurrence rate. An involved CRM was not a predictor of local recurrence.     

Amygdaloid control over interspecies and shock-induced aggression in the rat (author's transl)]

The effect of lateral amygdala or stria terminalis lesions on two different kinds of aggressive behavior have been studied in the rat. The lateral amygdala lesion does not change the non-killing rat's behavior towards mice; but it markedly reduces the shock-induced intraspecific aggression, without changing the flinch and jump thresholds to the electric shocks. A bilateral interruption of the stria terminalis elicits aggressive reactions in previously non killing rats. This initiation of mouse killing behavior is clearly facilitated through a prior food deprivation for 3 days. The interruption of the stria terminalis changes neither the shock induced aggression, nor the response thresholds. As the stria is the main efferent pathway of the cortico-medial nuclei of the amygdala, these results are in accordance with previous conclusions that tentatively localized in this part of the amygdala an essential component of a mechanism which inhibits muricide behavior in the non killing rat, probably through interactions with the olfactory input. This system is largely independent of amygdaloid structures which facilitate shock-induced intraspecific aggression.     

157. Meniscusläsion und Meniscuschirurgie bei chronisch vorderer Kreuzbandinsuffizienz

Zusammenfassung Am Bergmannsheil Bochum mussten 32 Patienten mit einer muskulär kompensierten chronischen vorderen Kreuzbandinsuffizienz wegen eines Meniscusschadens operiert werden. Insgesamt 37 Meniscusverletzungen verteilten sich auf 20 Korbhenkelrisse, 15 Verletzungen im Bereich des Hinterhomes, je eine Vorderhorn- und eine Transversalruptur. Die 32 Patienten konnten 1–6 Jahre nach erfolgter Meniscuschirurgie nachuntersucht werden. In 12 Fällen fand sich ein gutes Ergebnis. 8 Patienten mit Meniscektomie wiesen ein befriedigendes und 12 ein schlechtes Resultat auf. Die schlechten Ergebnisse fanden sich ausschliesslich bei Läsionen des Meniscushinterhornes und hilateralen Meniscusläsionen (10).     

A comparison of three methods of scoring penile circumference changes

There are presently three widely used methods of scoring penile circumference data. The present experiment attempted to determine the ability of each method to explain the variance within a data set. A total of 19 subjects were presented with 20 photographic slides assigned to five categories: neutral, female adult, female adolescent, male adult, and male adolescent. Erectile responses to each slide were recorded and the data analyzed in terms of the raw scores, percentage of full erection, and a z-score transformation. Results indicated that the z scores captured the highest proportion of the variance (52.7%), followed by the percentage scores (32.5%), and the raw scores (30.1%). Findings are discussed in terms of their research and clinical implications.     

Actual all-arthroscopic techniques for the treatment of osteochondral defects of the ankle joint

The treatment of osteochondral lesions of the talus (OCL) is demanding. Matrix associated techniques are used more and more as a standard, suggestion a more reliable healing. Nevertheless, approaching especially central and medial OCL is still demanding. Medial malleolus osteotomies routineously used, can be a source of morbidity and complications. Improving arthroscopic techniques allow an all-arthroscopic treatment of these defects.