Iddm1 and Iddm2 homozygous WOK.4BB rats develop lymphopenia, but no hyperglycemia like the BB/OK rats.

BB rats develop type 1 diabetes and WOKW rats facets of the metabolic syndrome. Both strains are common the RT1 (u) haplotype of major histocompatibility complex (MHC) which is essential for type 1 diabetes development in BB rats ( IDDM1). However, BB rats need an additional gene (lymphopenia, IDDM2, GIMAP5) to develop type 1 diabetes. Because WOKW lacks IDDM2 and does not develop hyperglycemia a congenic WOKW rat strain was generated recombining the region of chromosome 4 with IDDM2 onto the genetic background of WOKW rats (WOKW.4BB). These newly established rats and their parental WOKW rats were genetically and phenotypically characterized. Congenic WOKW.4BB rats showed a lymphopenic phenotype. The sequences of the highly polymorphic exon 2 of RT1-BB class II gene in WOKW, BB/OK, WOKW.4BB and LEW.1W rats were comparable and clearly showed the RT1 (u) haplotype. In addition, there were significant differences in metabolic traits between WOKW.4BB and parental WOKW. Although congenic WOKW.4BB rats were homozygous for IDDM1 and IDDM2 of the BB/OK rat none of WOKW.4BB rats developed hyperglycemia. This observation may be attributed to the idea that either WOKW.4BB rats need a third IDDM gene of BB/OK rats to develop hyperglycemia or WOKW background gene/s protect/s them for hyperglycemia.

[Titanium arthroplasty toe fit plus for the hallux metatarsophalangeal joint]. / Mittelfristige Ergebnisse der ToeFit-Grosszehengrundgelenksendoprothese.

AIM: This prospective report evaluates the clinical outcome of titanium arthroplasty in the management of hallux metatarsophalangeal joints. PATIENTS AND METHODS: Eigthy joints in 78 patients were treated surgically with the titanium implant for hallux metatarsophalangeal joints between January 2000 and April 2007. There were 56 women and 22 men. The mean age was 58 (range: 34 - 80) years, and the mean follow-up was 56 (range: 6 - 87) months. The pathological indications were hallux rigidus (85.5 %), metatarsalhead necrosis (8.5 %), revision of Keller-Brandes (3.6 %) and 2 cases were done as a revision of silastic to titanium prosthesis and a revision of pseudarthrosis after arthrodesis (2.4 %). The patients were subsequently examined by means of clinical and radiological assessments. The clinical function was classified using the score of Kitaoka et al. RESULTS: The mean time taken to get back to normal activities is 35.2 (range: 21 - 76) days. The average Kitaoka score improved to 75 points (p < 0.05) at 3 months postoperatively and to 85 points (p < 0.05) at 6 months postoperatively. The mean range of motion achieved was 38.6 degrees (range ex 21.5 degrees /flex 17.1 degrees ). CONCLUSION: The clinical results of titanium arthroplasty were good. The advantages of this procedure are preservation of joint movement and good pain relief with an early mobilisation.

[Correlation between sex, intrauterine position and familial predisposition and neonatal hip ultrasound results]. / Populationsbasierte Studie zu Prädispositionsfaktoren und Häufigkeit der Hüftgelenksdysplasie.

AIM: To correlate findings of hip ultrasound on day 4-10 of life with sex, intrauterine position and a positive family history for congenital hip anomalies. METHODS: The SNiP-study ( Survey of Neonates In Pommerania) registered 2256 neonates (2030 term, 226 preterm) between May 2002 and March 2004. Hip ultrasound results of 1043 term and since October 2003 33 preterm neonates were analysed. Time of ultrasound was day 4-10 after birth. Preterm neonates were examined when reaching their corrected term gestational age. Ultrasound was applied with a 7.5 MHz linear scanner and results were classified according to Graf. Chi-square and Fishers exact test were used for statistical analysis. RESULTS: 4.9 % of the screened hips were classified as IIc or higher, 3.1 % were unilateral and 1.7 % bilateral. Incidence was significantly higher (p < 0.023) in females (6.6 %) than in males (3.2 %). There was no significant difference in intrauterine position or positive family history for hip anomalies with 3.7 % for mothers, 1.2 % of fathers and 2.4 % of siblings positive. There was a higher incidence for congenital hip dysplasia in preterms with 6.1 %, which is not significant due to the limited number. DISCUSSION: Current screening methods miss up to 18 % of newborns with severe hip dysplasia. We were able to demonstrate that screening for congenital hip dysplasia with ultrasound is a diagnostic tool even during the first days of life. There is a significantly higher incidence of congenital hip dysplasia in females, but in contrast to other studies we found no significant difference in intrauterine position or familial history. Earlier diagnosis and therapy on the base of relevant risk factors might correspond with an improved prognosis and outcome. Further studies are warranted to evaluate the significance in preterm neonates.

[Results of SaluCartilage implantation for stage IV chondral defects in the knee joint area]. / Ergebnisse der SaluCartilage-Implantation bei viertgradigen Knorpelschäden im Bereich des Kniegelenks.

AIM OF STUDY: This prospective report presents SaluCartilage hydrogel implants, an alternative therapy option in the treatment of chondral defects. METHODS: For the prospective study between October 2002 and July 2003, 18 patients suffering from stage IV chondral defects received 49 hydrogel implants and were subsequently examined by means of clinical, radiological, and magnetic resonance imaging assessment. The knee function was classified using the McDermott score. RESULTS: The average McDermott score was improved to 75 points (p<0.05) after 3 months postoperatively and to 80 points (p<0.05) 6 months postoperatively, but after 12 months it decreased to 69 points. After 3 and 6 months, the MRI showed in all patients that there was fluid around the hydrogel implants without dislocation. After 12 months postoperatively the hydrogel implants had been destroyed in two patients. CONCLUSION: The short-term results showed subjective and objective improvement of the medical conditions probably because of the placeholder function. This alternative should be critically discussed because of the inadequate connection to the bone with risk of dislocation.

[Bone healing in drill hole defects in spontaneously diabetic BB/OK rats. A histomorphometric and biomechanical study]. / Knochenheilung in Bohrlochdefekten spontandiabetischer BB/OK-RattenEine histomorphometrische und biomechanische Studie.

The objective of this study was to examine changes in the histomorphometric and mechanical evaluation of the influence of the diabetic metabolic state on defect healing depending on the defect size in spontaneously diabetic BB/O(ttawa)K(arlsburg) rats. Based on blood glucose levels and postoperative insulin requirements, 120 spontaneously diabetic BB/OK rats were divided into groups with well-compensated or poorly compensated metabolic state. Sixty LEW.1A rats served as the normoglycemic controls. Bone defects of different sizes were created proximal to the knee joint space and then allowed to heal for 2, 4, and 6 weeks. Bone defect sizes > or =0.8 mm showed significant differences in the structural calculations and bone defect sizes > or =1.2 mm showed a significant decrease of all fluorochrome-based parameters of mineralization exclusively in the rats with poorly compensated diabetic metabolic state as well as significantly decreased values of biomechanical properties in comparison to the spontaneously diabetic rats with well-compensated metabolic states and to the control rats. Bone repair of minor bone defects is independent of the diabetic metabolic state in the spontaneously diabetic BB/OK rats. With controlled insulin therapy and resultant well-compensated diabetic metabolic state, severe mineralization and biomechanical disorders in healing of larger bone defects in the poorly compensated diabetic metabolic state of the experimental animal can be avoided.

Improving metabolic control reverses the histomorphometric and biomechanical abnormalities of an experimentally induced bone defect in spontaneously diabetic rats.

Insulin-dependent type 1 diabetes mellitus (IDDM) has been shown to alter the properties of bone and to impair fracture-healing in both humans and animals. The objective of this study was to examine changes in the histomorphometric and mechanical parameters of bone and remodeling during bone-defect healing, depending on the diabetic metabolic state in spontaneously diabetic BB/O(ttawa)K(arlsburg) rats, a rat strain that represents a close homology to IDDM in humans. A standardized bone-defect model was chosen and based on blood-glucose values at the time of surgery (mg%), postoperative blood-glucose course (mg%), and postoperative insulin requirements (IU/kg). A total of 120 spontaneously diabetic BB/OK rats were divided into groups with a well-compensated (n = 60; 169 +/- 102 mg%; 230 +/- 126 mg%; and 2.2 +/- 1.1 IU/ kg) or poorly compensated (n = 60; 380 +/- 159 mg%; 359 +/- 89 mg%; and 5.4 +/- 1.1 IU/kg) metabolic state. Sixty LEW.1A rats served as the normoglycemic controls (93 +/- 19 mg%). Fifteen animals from each group were killed on postoperative days 7, 14, 24, and 42, and specimens were processed undecalcified for quantitative bone histomorphometry and for biomechanical testing. Our study showed in terms of bone histomorphometry, within the first 14 days, that severe mineralization disorders occurred exclusively in the rats with a poorly compensated diabetic metabolic state with a highly significant (P < 0.001) or significant (P < 0.01) decrease of all fluorochrome-based parameters of mineralization, apposition, formation and timing of mineralization, as well as significantly decreased values of biomechanical properties (P < 0.05) in comparison to the spontaneously diabetic rats with a well-compensated metabolic state and to the control rats. Bone-defect healing in spontaneously diabetic BB/ OK rats is retarded exclusively in a poorly compensated diabetic metabolic state. This study suggests that strictly controlled insulin treatment resulting in a well-compensated diabetic metabolic state will ameliorate the impaired early and late parameters of IDDM bone-defect healing.

[Normalization of histomorphometric and biomechanical parameters through metabolic control of fracture healing in spontaneously diabetic BB/OK rats]. / Normalisierung histomorphometrischer und biomechanischer Parameter durch kontrollierte Stoffwechselführung bei der Frakturheilung spontandiabetischer BB/OK-Ratten.

AIM: The objective of this study was to examine changes in the histomorphometrical and mechanical parameters of bone during fracture healing in dependence on the diabetic metabolic state in spontaneously diabetic BB/O(ttawa)K(arlsburg) rats. METHODS: Based on blood glucose values at the time of surgery, postoperative blood glucose course and postoperative insulin requirements, 90 spontaneously diabetic BB/OK rats were divided into groups with well compensated or poorly compensated metabolic states. Forty-five LEW.1A rats served as the normoglycemic controls. The femurs were fractured in a standardized procedure and then allowed to heal for 2, 4 and 6 weeks. RESULTS: In terms of bone histomorphometry, our study showed that, within the first four weeks after fracture, severe mineralization disorders occurred exclusively in the rats with poorly compensated diabetic metabolic states, with a significant decrease of all fluorochrome- based parameters of mineralization, apposition, formation and a significantly prolonged timing of mineralization, as well as significantly decreased values of biomechanical properties in comparison to the spontaneously diabetic rats with well compensated metabolic states and to the control rats. CONCLUSION: With a strictly controlled insulin therapy and a resulting well compensated diabetic metabolic state, severe mineralization disorders and the decreased values of biomechanical properties in the fracture repair in the poorly compensated diabetic metabolic state of the experimental animal can be avoided.

Delayed remodeling in the early period of fracture healing in spontaneously diabetic BB/OK rats depending on the diabetic metabolic state.

Several clinical series, analyzing fracture healing in patients with insulin-dependent type 1 diabetes (IDDM) demonstrated significant incidence of delayed union, non-union, and pseudarthrosis. The purpose of this study was to examine the detailed histomorphometry and histology of bone formation and remodeling during fracture healing depending on the diabetic metabolic state in spontaneously diabetic BB/O(ttawa)K(arlsburg) rats, a rat strain that represents a close homology to IDDM in man. A standardized fracture model was chosen and based on blood-glucose values at the time of surgery (mg%), postoperative blood-glucose course (mg%) and postoperative insulin requirements (IU/kg), 100 spontaneously diabetic BB/OK rats were divided into groups with well-compensated (n=50, 167+/-77 mg%; 244+/-68 mg%; 1.8+/-1.9 IU/kg) or poorly compensated (n=50, 380+/-89 mg%; 415+/-80 mg%; 6.0+/-1.0 IU/kg) metabolic state. Fifty LEW.1A rats served as the normoglycemic controls (97+/-15 mg%). Ten animals from each group were killed 1, 2, 3, 4 and 6 weeks after fracture and specimens were processed undecalcified for quantitative histomorphometry and for qualitative light microscopy. In terms of bone histomorphometry, within the first four weeks after fracture, severe mineralization disorders occurred exclusively in the rats with poorly compensated diabetic metabolic states with a significantly decrease of all fluorochrome-based parameters of mineralization, apposition, formation and timing of mineralization in comparison to the spontaneously diabetic rats with well-compensated metabolic states and to the control rats. This was confirmed histologically. Early fracture healing in the spontaneously diabetic BB/OK rats is delayed exclusively in poorly compensated diabetic metabolic states, and 6 weeks after fracture, histomorphometrically significant deficits in the measured and dynamically calculated parameters remain. This study suggests that strictly controlled insulin treatment resulting in well-compensated diabetic metabolic states will ameliorate the impaired early mineralization and cell differentiation disorders of IDDM fracture healing.

Scanning electron microscopic examinations on retarded bone defect healing in spontaneously diabetic BB/O(ttawa)K(arlsburg) rats.

To date, no detailed knowledge from animal experiments is available on the kind and extent of osseous and mineral metabolic disorders in genetically determined, insulin-dependent Type I diabetes. The purpose of this study was to examine the influence of the diabetic metabolic state in spontaneously diabetic BB/O(ttawa)K(arlsburg) rats on bone defect healing. Eighty spontaneously-diabetic BB/OK rats with a blood-glucose value of 391 +/- 106 mg% (mean +/- SD) at the time of manifestation were used in the study. Based on blood-glucose values at the time of surgery (mg%), postoperative blood-glucose course (mg%) and postoperative insulin requirements (IU/kg), the animals were divided into groups with well-compensated (n = 40, 170 +/- 101 mg%; 221 +/- 120 mg%; 2.1 +/- 1 IU/kg) or poorly compensated (n = 40; 371 +/- 158 mg%; 357 +/- 83 mg%; 5.2 +/- 1.4 IU/kg) metabolic state. Forty LEW.1A rats served as the normoglycemic controls (95 +/- 18 mg%). Using a 1-mm-diameter Kirschner wire, a hole of femoral bone ca. 1 cm proximal to the knee joint space was centrally drilled. Ten animals from each group were killed on postoperative days 7, 14, 24, and 42, and specimens were taken for analysis. Using SEM to measure regions of new bone semiautomatically and quantitatively, also determining the number, area, and circumference of regions not yet filled with new bone. Up to postoperative day 14, very significant differences (p < 0.0001) for all investigated characteristics were found between the spontaneously-diabetic BB/OK rats and the control animals--in favor of the controls--and up to postoperative day 24 within the group of spontaneously-diabetic BB/OK rats, where the well-compensated animals had significantly better results in terms of number and area of regions of bone not yet filled with new bone formations. Forty-two days postoperatively, SEM observations showed no differences between examination groups. The process of bone defect healing in spontaneously-diabetic rats was disturbed only in the early phase and exhibited retardation in its progression. After 42 days, bone defect healing was complete, regardless of the diabetic metabolic state; no differences were detected with the SEM between examination groups at this time point.

[Influence of intertrochanteric varisation osteotomy on the gait of children with Perthes disease]. / Einfluss der intertrochantären varisierenden Osteotomie beim Morbus Perthes auf das Gangbild von Kindern.

BACKGROUND: The purpose of this study was to investigate possible effects of intertrochanteric varisation osteotomy on the gait of children with Perthes disease. PATIENTS: Clinical and radiographic examinations and gait analysis were conducted on 50 children. METHOD: Gait analysis was conducted using the GANGAS system. RESULTS: Despite predominantly very good or good results shown by the clinical and radiographic examinations, gait analysis detected various functional deficits. CONCLUSIONS: The examinations show that for the group of patients described, gait analysis is a valuable method of recording functional deficits and early recognition of the need for postoperative, physiotherapeutic treatment, thus helping to avoid chronificating alterations of the gait and, consequently, potential secondary damage.

Postoperative analgesic value of the intra-articular instillation of bupivacaine and morphine after arthroscopic knee surgery.

This prospective, randomized, double-blind study was carried out with 320 patients, subdivided into 4 groups of 80 patients each, who underwent arthroscopic knee surgery during the time period from March 1995 to February 1997. Each of the 4 groups received a different solution: 15 ml of bupivacaine 0.5%, 5 mg of morphine in 15 ml of isotonic saline solution, 15 ml of bupivacaine 0.5% with epinephrine 0.0005%, or 15 ml of isotonic saline solution (control group). Within each study group, the following operations were performed: 15 cruciate ligament plasties with autologous patellar tendon grafts, 30 meniscus resections, 15 notch-plasties as preparation for anterior cruciate ligament surgery, and 20 other types of operation (plica resection, diagnostic biopsy, etc.). Pain intensity was assessed with the visual analogue scale obtained from questioning patients at 2, 4, 8, 12, and 24 h postoperatively. In terms of reducing postoperative pain and decreasing the consumption of analgesics after arthroscopic knee surgery, bupivacaine 0.5% with epinephrine 0.0005% was found to be the most effective.

Cartilage and bone containing benign mesenchymoma of the thigh and popliteal fossa.

We report a case of a large cartilage and bone containing mesenchymoma of the thigh and popliteal fossa in a 56-year-old man. Mesenchymomas are rare tumors with a histologically benign pattern. They may be associated with morbidity as a result of local infiltrative growth.