Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis.

Pain reduction remains the main aim in the treatment of thumb carpometacarpal joint osteoarthritis. We performed a retrospective analysis of a case series of patients with symptomatic thumb carpometacarpal joint arthritis treated with denervation, joint lavage and capsular imbrication. A total of 60 patients participated in this study. Follow-up, including a clinical examination, was performed on 37 patients at a mean of 46 months (range 12 to 81); an additional 23 patients were followed-up by telephone at a mean of 52 months (range 14 to 93) post-operatively. The patients assessed in person showed a significant decrease in pain and a significant improvement in thumb function. The information gathered by telephone gave similar results. The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis. Advantages include the low rate of complications and invasiveness, as well as short recovery times. LEVEL OF EVIDENCE: IV.

[Dupuytren's contracture. When operate? Conservative preliminary treatment?]. / Dupuytrensche Kontraktur. Wann operieren? Konservative Vorbehandlung?

The etiology, symptomatology, clinical findings, course and staging of Dupuytren's contracture are discussed. Surgery is indicated from the second stage onwards; since pain very rarely occurs, it plays no role in establishing the indication for operation. The surgical techniques available are described. Conservative therapy has no influence on the course of the condition, while radiotherapy is inadmissible on account of its side effects. Physical therapy and physiotherapeutic pre-operative measures can improve the results of surgery.

[Fasciocutaneous flap--a simple alternative to the musculocutaneous or free, microvascular flap of the lower extremity?]. / Der fasziokutane Lappen--eine einfache Alternative zum muskulokutanen oder freien, mikrovaskulären Lappen an der unteren Extremität?

Fasciocutaneous flaps demonstrate, in comparison to subcutaneous transposition flaps, far better local hemodynamic circulation and the length to width ratio can be increased to 3:1 or 5:1 so that they provide a simple method of closure in soft tissue defects. Fasciocutaneous flaps can be prepared rapidly and simply, due to the subfascial dissection, so that traumatic soft tissue defects can be closed directly. The donor site is closed with a split skin graft. Free musculocutaneous flaps and regional musculocutaneous island flaps are far more useful in large muscular defects, degloving injuries and osteomyelitis.

[Experiences with drill biopsy in the diagnosis of breast tumors]. / Erfahrungen mit der Drillbiopsie in der Diagnostik von Mammatumoren.

We report on our experiences of 598 drill biopsies in 581 female patients. The method is suitable for clarification of dubious palpatory findings in the breast, for verification of relapse, and for receptor analysis in individual cases. It is simple to carry out, almost free of complications and provides sufficient tissue for rapid-section diagnostics. It has a high precision (90% to 92%): no false positive results were noted. The advantage, compared to excision biopsy, consists of the shortening of the duration of operation and anesthesia and better diagnostic clarification. The problem of the excision cavity is avoided. In case of a mastectomy or quadrantectomy, the primary tumor and remains connected with the tissue surrounding the tumor is available in toto for histological examination. The risk of tumor cell dissemination from drillbiopsy did not appear to be increased. The limitations of the method apply to small (less than 1 cm) not definitely palpable tumors near to the thorax wall in large, voluminous breasts. The diagnosis of specific histological types requires a high degree of experience in ultrastructural appraisal of breast tissue. A negative drill biopsy should be followed by an excision biopsy, where a carcinoma is suspected.

[High performance gymnasts during the period of growth]. / Hochleistungsturnen im Wachstumsalter.

Twenty-two high-performance gymnasts between 12 and 22 years of age were examined for possible vertebral column damage following three years of training in a federal sports center. Half of the gymnasts complained of generalized back pain. Three gymnasts presented with kyphosis, five with a flat back, three with hyperlordosis, and six with an abnormal position of the lumbar spine. Normal X-rays were obtained from four athletes, although seven presented with marked Scheuermann's disease. In three cases, differential diagnosis was necessary between spondylitic deformation with vertebral rim disarticulation and persisting apophysis. Despite the radiologically pathological findings, the gymnasts were mainly asymptomatic. This could be due to the hypertrophied dorsispinal and abdominal musculature which compensates for the pathological osseous structure. There is an urgent need for critical medical consultation in high-performance gymnastics involving children and youth.

[Experimental studies on the effect of thyrocalcitonin on secondary bone healing (author's transl)]. / Experimentelle Untersuchungen zum Einfluss von Calcitonin auf die sekundäre Knochenbruchheilung.

The effect of thyrocalcitonin on secondary bone healing was studied in 180 Sprague-Dawley-rats. The right tibia of all the rats was osteotomized. Half of the animals was treated with thyrocalcitonin. Until the 60th postoperative day, the increase in 99mTc-methylendiphosphonate activity was measured and significant differences in ratios were noted. Between the postoperative days 10 to 25, there was a significant difference in the impulse quotients between the thyrocalcitonin and untreated rats (P less than 0.05). These results indicate that thyrocalcitonin may aid in secondary bone healing.

[Serum results following experimental fracture alignment and thyrocalcitonin treatment (author's transl)]. / Klinisch-chemische Serumbefunde nach experimenteller Fraktursetzung und Calcitonin-Behandlung.

Serum alkaline phosphatase activity, serum calcium and phosphorus concentrations were determined during bone healing under treatment of thyrocalcitonin. The right tibiae of 160 albino rats were osteotomized. Of these, 80 were treated with thyrocalcitonin. During the 50-day observation period, the calcium level in the thyrocalcitonin-treated sample never differed significantly from that of the control group. However, the alkaline phosphatase activity and the serum phosphorus level significantly differed from the control levels (P less than 0.05) during 4 days of observation. The increased serum alkaline phoshatase activity--a sign of osteoblastic activity--suggests that thyrocalcitonin may aid in osteogenesis and bone healing.

[Bile acid reflux following stomach surgery on rats (author's transl)]. / Gallensäurenreflux nach operativen Eingriffen am Rattenmagen.

Using rats in a standardized animal experiment, the extent of duodenogastric reflux was studied eight months postoperatively following SPV with and without pyloroplasty. The reflux was determined by enzymatically testing the concentration of bile acid secretion withdrawn from the stomach intraoperatively. Serving as comparison were laparotomies, simple pyloroplasties, and the obligatory reflux models: resection after BII without enteroanastomosis. After SPV with and without pyloroplasty, the extent of duodenogastric reflux was less than in the control group. Specimens with simple pyloroplasty displayed a significantly greater reflux. The BII group had fivefold higher reflux than the control group. Since pyloroplasty can be considered a drainage operation, there is no retention of food particles in the stomach of the rat following SPV--an occurrence expected after SPV without pyloroplasty. However, due to the retarded stomach motility, the thickened chyme tends to linger at the opening of the stomach, thus reducing the duodenogastric reflux. According to our investigations, an increased duodenogastric reflux following SPV with or without pyloroplasty does not induce changes in the mucosa of the stomach.

[Bacterial colonization following resective and non-resective stomach-surgery (author's transl)]. / Bakterielle Besiedelung nach resezierenden und nichtresezierenden Magenoperationen.

Studies on why there is a higher disposition of carcinoma developing in the residual portion of the stomach of patients having undergone resections have led to the assumption that bacterial colonization constitutes a co-carcinogenic factor. It has been the purpose of this investigation to compare the ensuing bacterial growth following resective and nonresective stomach surgery. 120 Sprague-Dawley rats were divided into six groups: 1) control group: laparotomy. (2)SPV: with assured preservation of the antrum innervation. 3) SPV + Pypl.: the pyloroplasty was performed according to the Heinecke-upsilon. Mikulicz method. 4) TV + Pypl.: abdominal severance of the trunci nervi vagi. 5) BII: antecolonic without enteroanastomosis. 6) TV + BII. Eight months postoperative a smear was obtained under general anaesthesia from the transition segment between the fundus and antrum or at the site of the anastomosis. Tests for aerobic and anaerobic bacteria as well as cultures for fungi were begun. The control and SPV + Pypl. groups did not differ significantly in total bacteria count and in the ratio of nitrobacter. In contrast, the SPV group without pyloroplasty displayed an approximately tenfold higher concentration of nitrobacters--an amount equivalent to the sum of nitrobacters in the two resection techniques. The TV + BII group had a threefold higher total bacteria count than the BII group. According to our studies, a reduced stomach acid production, the bile secretion reflux and more importantly, a retarded food passage promote intragastric bacterial growth thus expediting the formation of intragastric carcinogenic nitrosamines.

[Spinal lesions following modified exercises in adolescent high performance gymnasts]. / Wirbelsäulenschäden bei jugendlichen Hochleistungsturnern.

20 high performance gymnasts between 14 and 22 years of age had an anamnestical, clinical and radiological checkup on the spine in order to assess news training-methods. Radiologically only 3 gymnasts were found to be without any pathological manifestation. 7 cases of M. Scheuermann were located. The other athletes showed degenerative findings of vertebral columns especially in the thoracic-lumbar transition. These degenerative signs, and the fact tht the gymnasts had no spondylosis, are the result of new exercises, which avoid extreme bending load in the lowest segment of the lumbar region. Anamnestical and radiological findings do not correlate. A critical medical screening is necessary before and during high performance training.