[Diagnostic value of unspecific requested and implemented MRI for detecting intracarpal lesions, compared to arthroscopic findings at 217 patients]. / Wertigkeit unspezifisch angeforderter und durchgeführter MRT-Diagnostik bei intrakarpalen Verletzungen im Vergleich zum Arthroskopiebefund an 217 Patienten.

AIM: The purpose of this study was to evaluate the diagnostic value of MRI for detecting intracarpal lesions in clinical routine. PATIENTS AND MATERIALS: In a retrospective study, we reviewed the charts of 506 patients who had undergone wrist arthroscopy in our department between May 1998 and November 2002. Out of 506 patients 217 had an MRI. The MRI was performed at 31 different radiology facilities using a number of techniques. The MRI results were compared with the arthroscopic findings, taking the arthroscopic results as a "gold standard" (sensitivity = SEN, specificity = SPE, positive predictive value = PPV, negative predictive value = NPV, accuracy = ACC). RESULTS: The following results were found: For tears of the scapholunate ligament the avalues are SEN 18.5 %, SPE 95 %, PPV 71 %, NPV 66 %, ACC66 %. Not one of 16 tears of the lunotriquetral ligament was found by MRI. CONCLUSION: In our data we found a low sensitivity for unspecific requested and implemented MRI for detecting intracarpal lesions. Therefore the indication for MRI should only be made after experienced hand surgeons have examined the wrist. In our opinion, only direct MR-arthrography is equal to arthroscopy, so that only an experienced radiologist who is familiar with this technique should perform the MRI diagnostics of the hand.

[Moje prosthesis for the proximal interphalangeal joint]. / Moje-Prothese im proximalen Interphalangealgelenk.

PURPOSE/BACKGROUND: The purpose of this study was to find out if the Moje implant made of ceramic material can fulfil the clinical expectations that are expected in a replacement of the proximal interphalangeal finger joint (PIP joint). The performance was compared to the results achieved with hands that did not undergo surgery. PATIENTS/MATERIAL AND METHOD: From January 2001 to March 2005 15 patients suffering from primary arthrosis received a total of 21 Moje implants as PIP joint replacements. Computer-assisted data were collected including postoperative range of movement (in both hands), strength, pain reduction, patient satisfaction and number of complications. RESULTS: The average range of motion in PIP joints replaced by the Moje implant was 18.5 degrees (minimum 7 degrees lack of extension to 69 degrees flexion) which correlates to 26% of the ROM of the other hand side). The proportion of pinch strength "thumb opposition to index finger" of the hand that underwent surgery compared to the other side was 56%. Power achieved with the Jamar dynamometer was 94.2% of that, of the non-operated hand. 80% of the patients stated an improvement of their pain situation (more than 2 points on a VAS of 1-5). Most patients were well satisfied with the outcome of the surgery. There was a need for 13 re-operations in 9 fingers. The main problems were loosening of the proximal implant, with subluxation and fractures of the cortical bone. CONCLUSION: The Moje ceramic implant does not fulfil the published ideal attributes for a PIP joint replacement as shown in the clinical results. Even a modification of the prosthesis design in 2004 has not diminished the deficits in range of motion and stability. The implant in its present design shows neither the required performance, nor the ideal attributes needed for an adequate PIP joint replacement.

[Breast reconstruction for patients with breast carcinoma : an analysis based on the data of 4,335 patients from 16 hospitals]. / Brustrekonstruktionen bei Patientinnen mit Mammakarzinom : Eine Analyse anhand der Daten von 4335 Patientinnen aus 16 Kliniken.

BACKGROUND: [corrected] The rate of breast reconstructions after mastectomy because of breast carcinoma has not been thoroughly studied, based on a representatively large data pool. METHODS: We analyzed the data of 4,335 patients with breast carcinoma from 16 hospitals together with the German Breast Center (Westdeutsches Brustcentrum). RESULTS: Of the studied patients, 34% (1,488 of 4,335) had mastectomies. Breast reconstruction was performed in 13% (197) of those with mastectomy. None of the 197 with breast reconstruction was operated on by a plastic surgeon or had a microsurgical reconstructive procedure (free flap). CONCLUSION: The aim of this study is to increase the number of breast reconstructions after mastectomy, including microsurgical procedures, and to improve cooperation between gynecologists and plastic surgeons.

[Dorsal capsulodesis versus triscaphe arthrodesis in patients with scapholunate dissociation. Do the results depend on the diagnosis or the operation?]. / Differenzialindikation der dorsalen Kapsulodese und der STT-Arthrodese bei Patienten mit einer skapholunären Dissoziation. Ist das Ergebnis abhängig von der Diagnose oder dem Operationsverfahren?

BACKGROUND: Dorsal capsulodesis and triscaphe arthrodesis are possible treatment modalities for patients with scapholunate dissociation. In light of overlapping indications for either operation for patients with carpal instability, it is important to compare the postoperative results. METHODS: From 1998 until 2002, we operated on 87 patients suffering from scapholunate dissociation. 52 patients were treated by dorsal capsulodesis after R. Berger and 35 patients were treated by triscaphe arthrodesis as published by Watson. Of these 87 patients, we managed to follow-up 77 patients (47 dorsal capsulodesis und 30 triscaphe arthrodesis) with a physical examination, X-ray of the wrists and Krimmer Score. RESULTS: In terms of grip-strength, range of motion, functional outcome (Krimmer Score), duration of the operation and hospitalisation, the dorsal capsulodesis group performed better (p < 0.05) than the triscaphe arthrodesis group at the time of follow-up. At follow-up, pain reduction was significant in both groups (p < 0.05). Krimmer Score (functional outcome) and the rate of complication was clearly better for the dorsal capsulodesis group as compared to the triscaphe arthrodesis group. CONCLUSION: In case of non-static scapholunate dissociation, dorsal capsulodesis should be the first choice treatment. In case of a young manually working man with static scapholunate dissociation, it should be a case-to-case decision whether performing a triscaphe arthrodesis or a dorsal capsulodesis. With this investigation we wanted to discuss and demonstrate the difficulties with the differential-indication for the two operations. Generally speaking the postoperative results did not depend on the type of scapholunate dissociation (dynamic versus static) but rather on the chosen surgical procedure.

The Lly protein is essential for p-hydroxyphenylpyruvate dioxygenase activity in Legionella pneumophila.

The lly locus confers fluorescence, haemolysis, brown pigmentation and an increased resistance to light in Legionella pneumophila. In this study, we correlated the pigment production of two lly-positive L. pneumophila isolates and a recombinant lly-positive Escherichia coli strain with the presence of homogentisic acid (HGA) in the culture supernatant. The detection of HGA by high performance liquid chromatography and the data analysis of the deduced amino acid sequence of the lly gene indicate that the lly locus codes for a p-hydroxyphenylpyruvate dioxygenase (HPPD). This enzyme catalyses the transformation of p-hydroxyphenylpyruvate into HGA, which subsequently oxidises and polymerises into a melanin-like pigment. One open reading frame (ORF 1) in the lly region exhibited homologies with genes of Synechocystis sp., Petroselium crispum and Streptomyces mycarofaciens that code for methyltransferases. By screening a genomic library of L. pneumophila (serogroup 1) strain Corby with a monoclonal antibody against the legiolysin (lly), we identified two recombinant E. coli clones that did not produce the brown pigment and showed no haemolysis and fluorescence. DNA sequencing revealed that both clones contained 874 nucleotides of the N-terminal part of the lly gene. The recombinant strains expressed truncated legiolysin proteins of 39.5 and 35.7 kDa and did not produce HGA. Considering the highly conserved structure of legiolysin-like HPPD genes from other organisms, we suggest that the C-terminus of the legiolysin may be essential for the enzymatic activity that conferred pigmentation via HGA polymerisation, haemolysis and fluorescence.

[Damage pattern caused by high pressure water jets and high pressure water abrasive jets to the hand]. / Schädigungsmuster von Hochdruck-Wasserstrahlen und Hochdruck-Wasser-Abrasivstrahlen an der Hand.

Water and abrasive water jets have been developed as efficient tools for different purposes in industrial manufacturing, cleaning and dismantling, and--experimentally--in drilling and milling. In contrast to other high pressure techniques, these machines produce power densities up to 250 kW/mm2. In order to assess the range of destruction caused by water as well as abrasive water jets in human hands, cadaveric forelegs of pigs were targeted with constant nozzle geometry and working distance between cadaver and nozzle. Variable parameters investigated included pressure and time of exposure. Reproducible injury patterns were found in the forefoot of the pig, allowing for conclusions to be drawn with respect to damage assessment in the human hand.

[Arthrodesis of the rheumatoid wrist]. / Arthrodese des rheumatischen Handgelenks.

In rheumatoid wrists surgical procedures are not indicated before non surgical measures have failed to restore comfortable function or even severe instability and joint disorganisation have developed. Primarily synovectomies and stabilisation measures have to be done. Arthrodesis of the rheumatoid wrist is not indicated as often. In case arthrodesis is required in the rheumatoid wrist quality of bones and soft tissues should be taken carefully into consideration. The arthrodesis of the wrist according to Mannerfelt has been proven as a simple and safe method.

The Lly protein protects Legionella pneumophila from light but does not directly influence its intracellular survival in Hartmannella vermiformis.

The lly locus (legiolysin) mediates the browning of the culture medium of Legionella pneumophila in the late stationary growth phase, presumably as a result of synthesis of homogentisic acid. Mutagenesis of the lly gene of the L. pneumophila Philadelphia I derivative JR32 did not affect intracellular replication in the natural host Hartmannella vermiformis. The Lly-negative mutant, however, showed a markedly decreased resistance to ordinary light. The cloned lly gene conferred an increased resistance to light in recombinant L. pneumophila and Escherichia coli K-12, indicating a contribution of the Lly protein to ecological adaptation of Legionella species.

Sequence determination and mutational analysis of the lly locus of Legionella pneumophila.

The lly (legiolysin) locus codes for a 39-kDa protein which confers hemolysis, pigment production, and fluorescence on recombinant Escherichia coli K-12 clones carrying the lly gene. The nucleotide sequences of the lly genes from two Legionella pneumophila isolates were determined. The lly loci exhibited identical nucleotide sequences. They contained open reading frames of 348 amino acid residues, encoding proteins with a deduced molecular mass of 38.9 kDa. N-terminal amino acid sequencing further confirmed that the Lly protein corresponds to the open reading frame sequenced. The amino acid sequence of the Lly protein exhibits a high degree of homology with the sequences of the MelA protein responsible for melanin production in the freshwater bacterium Shewanella colwelliana and the 4-hydroxyphenylpyruvate dioxygenase of Pseudomonas spp. 4-Hydroxyphenylpyruvate dioxygenase is involved in the degradation of aromatic amino acids in various organisms. An Lly-negative mutant of L. pneumophila Philadelphia I derivative JR32 and an Lly-positive transcomplementant were constructed. The Lly-negative mutant lost the ability to produce brown pigment and to confer fluorescence but retained hemolysis. Introduction of a plasmid carrying the lly locus restored pigment production and fluorescence. Intracellular survival of L. pneumophila in U937 macrophage-like cells and in Acanthamoeba castellanii was not affected by mutagenization of the lly locus.

[Filling up small bone defects with bone ceramics (hydroxylapatite)]. / Die Auffütterung kleiner Knochenhöhlen mit Knochenkeramik (Hydroxylapatit).

First clinical results using a bovine hydroxyapatite implant to fill up small bony defects after excision of enchondromas or cysts are reported in twelve patients. Incorporation without any problems was completed radiologically after six to eight weeks. Complications did not occur. Avoiding additional surgery harvesting cancellous bone chips at the iliac crest, the use of these bovine hydroxyapatite ceramic seems to be reasonable.

[Lack of effectiveness of alternative non-surgical treatment procedures of Dupuytren contracture]. / Fehlen der Effektivität der alternativ nichtchirurgischen Behandlungsverfahren bei Morbus Dupuytren.

In the early stage of the disease a group of patients was treated with radiotherapy, later another group with injections of superoxid-dismutase. The results of follow-up examinations 7 years after radiotherapy and 3 years after treatment with superoxid-dismutase respectively do not differ clearly from spontaneous course of Dupuytren's contracture grade one. At present we cannot recommend an alternative treatment for early stage Dupuytren's contracture.

[A comparison of arthrography and magnetic resonance tomography in painful limited movements of the hand]. / Vergleich Arthrographie--Kernspintomographie bei schmerzhaften Bewegungseinschränkungen der Hand.

In 18 patients with unclear pain in the wrist limiting hand movement, arthrography and magnetic resonance imaging (MRI) were compared. The FISP gradient echo sequence turned out to be superior to the T1 weighted spin-echo sequence in the imaging of the triangular fibrocartilage complex. MRI is very sensitive in detecting triangular fibrocartilage lesions and therefore represents a suitable non-invasive screening method. It is, however, not possible to assess the degree of the lesion. Ruptures in carpal tendons could only be diagnosed by means of arthrography.

[Raynaud syndrome. A case report]. / Raynaud-Syndrom. Eine Fallbeschreibung.

Symptomatology, diagnosis, treatment, and clinical course of a Raynaud syndrome in a sixteen-year old patient beginning in the second year of his life are described. He lost all distal phalanges of both hands and big toes at the age of nine. Remarkable was the laboratory finding of an extremely high serum IgE concentration. A combined therapy of plasmapheresis, immunosuppression and corticosteroids improved the clinical and laboratory findings.

[Follow-up of 425 operated ganglion patients]. / Nachuntersuchungen an 425 operierten Ganglion-Patienten.

The etiology and pathogenesis of ganglion cysts have not yet been completely illucidated. After surgical intervention there are recurrence rates of more than 30% described in the literature. Out of 425 operated patients a total of 348 patients could be reexamined. Recurrence rates as well as pre- and postoperative complaints are discussed.

[Primary pyogenic infections of the hand--a disease picture over the course of time]. / Primär pyogene Infektionen der Hand--Ein Krankheitsbild im Wandel der Zeit.

The changes and developments which have taken place during the course of the last century with respect to the occurrence, severity, bacteriology and therapy of primary pyogenic infection of the hand are discussed.

[Primary pyogenic infections of the hand and their treatment]. / Die primär pyogenen Infektionen der Hand und ihre Behandlung.

314 of 814 patients with pyogenic infections of the hand were treated conservatively. In 500 cases surgical treatment was necessary. Bacteriological findings, the value of antibiotic treatment and the necessary surgical procedures are discussed.

[Epidermolysis bullosa hereditaria]. / Epidermolysis bullosa hereditaria.

Two cases of epidermolysis bullosa hereditaria are presented. Their operative treatment is described. Distant flaps are necessary to bring resistant skin to the mechanically stressed areas of the hand. Specific after-care is essential to preserve the operative result.

[Apert syndrome--case report]. / Das Apert-Syndrom, kasuistischer Beitrag.

The Apert syndrome is a complex deformity. Blauth distinguishes three degrees of deformity in the hand; these are demonstrated in our patients. The functional results after operative treatment were satisfying.