Total knee arthroplasty in a patient with chronic occlusion of the superficial femoral artery.

In a 67-year-old patient with severe valgus gonarthrosis and chronic occlusion of the superficial femoral artery on the same side, total knee replacement was performed without preceding angioplasty because the collateral circulation was intact. No tourniquet was used. To leave the peripatellar arterial ring intact on one side in this case of lateral patellar maltracking, a lateral approach was used. In this approach, a lateral release forms part of the approach itself. To achieve gentle eversion of the patella, the tibial tubercle was osteotomized. One year postoperatively, the patient was satisfied with the outcome and showed no clinical signs of any vascular deterioration. It is concluded that total knee replacement may be possible in the presence of chronic occlusion of the superficial femoral artery provided that the collateral circulation is intact.

Complications in hip arthroscopy.

Hip arthroscopy is being recognized as a valuable additional procedure in the treatment of disorders of this joint. Although initially employed as a diagnostic tool only, better understanding of the anatomy involved and advanced skills have now made surgical treatment possible. Because the techniques are still evolving, a standardized approach is just being established. Little is known on possible complications associated with the procedure, concentrating in most cases on the neurovascular structures at risk during instrument introduction. This study reports on 19 patients in whom three complications were encountered. Two were attributable to positioning problems of the patients, and one was caused by intraoperative extravasation of irrigation fluids. The available literature on complications in hip arthroscopy is being reviewed, and the prevention of complications as experienced in this series is being discussed.

[Localized pigmented villonodular synovitis: a primary overlooked diagnosis in a young female patient]. / Lokalisierte pigmentierte villonoduläre Synovitis: eine primär verpasste Diagnose bei einer jugendlichen Patientin.

Localized pigmented villonodular synovitis is a rare condition of the knee that may present with symptoms suggesting internal derangement. We report a case of juvenile patient who presented with a 1-year history of signs and symptoms of a loose body in the knee. Radiographic examination and MRI were within normal limits. The lesion was treated arthroscopically by resection.

[Long-term surgical results of osteochondrosis dissecans of the knee joint in adolescents less than 16 years of age]. / Operative Langzeitresultate der Osteochondrosis dissecans des Kniegelenkes bei Jugendlichen unter 16 Jahren.

The correct therapy of osteochondritis dissecans in patients under 16 years is very important to prevent the knee joint from secondary arthritis. We analysed clinical, radiological and with MRI the long term (10 years) results of a follow-up study on 36 patients under 16 years with 42 operatively treated osteochondritis dissecans of the knee joint. There were excellent and good results in 81% of the patients. After an average of 10 years there were no signs of arthritis which would necessitate any treatment.

[Indication and technique for hip arthroscopy: possibilities and limitations]. / Zur Indikation und Technik der Hüftarthroskopie: Möglichkeiten und Grenzen.

Arthroscopy of knee and shoulder has become an established part of orthopedic and traumatologic surgery. Hip arthroscopy is a relatively new addition to orthopedics and is more demanding for the surgeon. Indication and technique are described. Most complications can be avoided by following a meticulous technique and by knowing the standard portals. The diagnostic advantage is to see loose bodies and torn labra acetabularis, the surgical advantage consists in reduced morbidity and a shortened rehabilitation period.

Alterations of skeletal muscle in chronic heart failure.

BACKGROUND: The present study was designed to define the prevalence and characteristics of skeletal muscle alterations in patients with chronic heart failure (CHF) and their relation to exercise capacity. METHODS AND RESULTS: The ultrastructure of skeletal muscle was analyzed by ultrastructural morphometry in 57 patients with CHF and 18 healthy controls. The volume density of mitochondria (Vvm) and the surface density (Svmc) of mitochondrial cristae were evaluated as a structural correlate of oxidative capacity of skeletal muscle. Vvm and Svmc were reduced by approximately 20% in patients with severe CHF irrespective of age and etiology. The cytochrome oxidase activity in mitochondria as determined by cytochemistry and subsequent morphometry in a subset of patients (n = 10) was significantly decreased in heart failure (p less than 0.01). The capillary length density of skeletal muscle was reduced in CHF (n = 12, p less than 0.05), and the fiber type distribution was shifted to type II fibers (n = 15, p less than 0.05). Vvm and Svmc were significantly related to peak exercise VO2 (r = 0.56, p less than 0.001, n = 60) and to VO2 at anaerobic threshold (r = 0.535, p less than 0.0001, n = 60). In 16 patients with severe heart failure, Vvm was inversely related to the duration of heart failure (r = 0.545, p less than 0.03). In 11 patients who underwent repeat biopsies after 4 months, a correlation was observed between the change in Vvm and the change in peak exercise VO2 (r = 0.89, p less than 0.001). CONCLUSIONS: These findings indicate that patients with CHF develop significant ultrastructural abnormalities of skeletal muscle reflecting a depressed oxidative capacity of working muscle. It appears that these alterations of skeletal muscle contribute to the decreased exercise capacity of these patients but are, in principle, reversible by an effective treatment regimen.

Reduction of atherogenic risk factors by short-term weight reduction. Evidence of the efficacy of National Cholesterol Education Program guidelines for the obese.

Five hundred and ninety-nine overweight patients participated for at least 4 weeks in the weight reducing and physical activity promoting Diet and Fitness Center program at Duke University. Twenty-three percent were diabetic and 49% hypertensive. With only modest weight loss (11.8 kg in males and 8.2 kg in females) abnormal levels of blood pressure, fasting blood sugar, total cholesterol, LDL-cholesterol and triglycerides normalized. It was very rewarding to see these results achieved in a very limited period of time. Improvements in the lipid profile were consistent with the predicted outcome of obesity treatment stated by the National Cholesterol Education Program guidelines.

Intersalt in Newfoundland and Labrador.

In Intersalt, positive relations between 24-hour urinary sodium and potassium excretion and blood pressure were observed in over 10,000 men and women in 52 centers around the world. Body mass index (BMI), alcohol intake and smoking showed different associations with blood pressure in various population groups. We investigated these variables in the 2 Canadian centers and could not confirm the sodium-potassium relationship. In a multiple stepwise regression analysis, BMI and alcohol had the strongest relation with blood pressure in men. Among the female participants, BMI and sodium were the most influential factors on systolic blood pressure. For diastolic blood pressure, BMI and smoking showed the strongest significance. Neither in men nor in women could the influence of high sodium and low potassium excretion on blood pressure be discerned.

[Opinions of normal citizens on asocial behavior--various aspects, its dimensions and stability]. / Urteile von "Normal-Bürgern" über Asozialität-Aspekte, Dimensionen und Stabilität.

At an interval of six weeks 177 so-called normal citizens were questioned in respect to their opinions on antisociality. They described as antisocial primarily those persons or behaviors, which are detrimental towards others. Criminal behavior was qualified by them as extremely antisocial. Lack of education or false education were given as major causes of antisocial behavior. In part, the opinions given on specific aspects of antisociality show a systematic relationship. The intensity of this systematism disincreased, however, between the first and the second survey. Likewise, there was a significant change of the average level of specific opinions within this interval.

Radioisomers of scoparone (6,7-dimethoxycoumarin) as a tool for in vivo differentiation of various hepatic monooxygenase inducers in mice using the breath test technique.

The oxidative removal of two different methyl groups from scoparone by a cytochrome P-450-mediated reaction proceeds with greater velocity for the 6-methyl group than for the 7-methyl group. In vivo experiments in mice were carried out with the two respective radioisomers [6-methyl-14C]scoparone and [7-methyl-14C]scoparone. The consecutive administration of the scoparone to the same animal is followed by collecting the 14CO2 exhaled (breath test). The maximal exhalation rate, measured 4 min after i.p. administration of the substrates, is four times greater for [6-methyl-14C]scoparone than for the [7-methyl-14C]scoparone. The total recovery of radioactivity in the whole animal (except skin) including the exhaled 14CO2 is 86% for [7-methyl-14C]scoparone and 84% for [6-methyl-14C]scoparone. Further analysis shows that the proportion of radioactivity found in various excretory routes is different; however, in the case of the poorly exhaled [7-methyl-14C]scoparone, almost twice as much radioactivity is found in bile and urine than for the more rapidly exhaled [6-methyl-14C]scoparone, whereas liver and other organs show little changes. Pretreatment of animals with various inducers, such as phenobarbital, 3-methylcholanthrene, warfarin and cobaltous chloride, characteristically affects the ratio of the two demethylations of scoparone. In the case of warfarin pretreatment, the ratio of the 6- to 7-demethylation is elevated to nearly 6, after cobaltous chloride the ratio is lowered to 2.8, whereas phenobarbital and 3-methylcholanthrene have no effect. These results may provide possibilities of noninvasive in vivo recognition of the inductive state of a pretreated animal.

[Antisociality and school failure as judged by elementary school teachers (author's transl)]. / Asozialität und Schulversagen im Urteil von Grundschullehrern.

126 elementary school teachers were interviewed in respect to their concepts of school failure and antisociality. According to their opinions antisociality finds its expression especially in the following behaviour: delinquent and/or destructive actions against others or the state, deliberate disturbance of social peace and order in a society, and criminality. The main causes of school failure are seen in intellectual-emotional development retardation, social isolation, rejection of a child by its parents, insufficient maturity for education hereditary mental retardation and lack of intelligence. The teachers' appraisal of antisociality and school failure are largely influenced by implicit theories, by which "the antisocial" and "the school failure" are regarded as deficit personalities. The teachers are aware of the overrepresentation of children from fringe groups and low social classes among antisocial or educationally failing pupils, they do, however, not realistically recognize the respective causal relations. In difference to other social control agents, their judgements nearly deny that school failure may also be caused by teachers.