[A new total knee arthroplasty with physiologically shaped surfaces. Part 2: First clinical results]. / Eine neuartige Kniegelenksendoprothese mit physiologischer Gelenkform. Teil 2: Erste klinische Ergebnisse.

The human medial tibial plateau is concave, whereas the lateral tibial plateau is convex. In a normal knee, the convex femoral condyles roll and glide on the tibia during the standing phase of walking. The designs of most commercially available knee prostheses do not take this morphological feature into consideration. The novel design of the AEQUOS G1 knee replacement prosthesis is based on the natural anatomy of the knee joint, with a convex lateral tibia plateau and a sagittal offset of the medial and lateral compartments. Following extensive development and testing, initial clinical results of the AEQUOS G1 prosthesis in a mulitcenter study are presented. From Mai 2005 to March 2007, 158 patients in 4 clinics underwent total knee arthroplasty with the AEQUOS G1 and agreed to participate in the study. Patients were evaluated preoperatively and at 3, 6 and 12 months of follow-up using a standardized protocol that included the American Knee Society Score (AKSS), the Oxford Knee Score (OKS) and the Visual Analog Scale (VAS) for pain. After 3 months, 151 patients appeared for follow up appointments, after 6 months, 134, and after 12 months, 127. The mean range of motion preoperatively was 97.0 degrees (+/-19.9 degrees ) and 107.5 degrees (+/-15.9 degrees ) 12 months after surgery. The AKSS, as well as the modified OKS, significantly improved (p<0.0001) from preoperative scores of 98.8 (+/-35.8) and 37.3 (+/-6.9) points, respectively, to 165.8 (+/-34.1) and 21.9 (+/-7.8) points, preoperatively, and 12 months postoperatively. The VAS score significantly decreased (p<0.001) from 7.4 (+/-1.8) points preoperatively to 1.9 (+/-2.2) points 12 months postoperatively.One implant was revised because of arthrofibrosis and another due to patellar luxation. Two patients required revision because their implants revealed malalignement with ligamentous instability. No infections, aseptic loosening or other implant-specific complications were observed at this early follow-up. Good clinical results were observed at early follow-up with the AEQUOS G1 knee arthroplasty. However, longer follow-up is necessary for a general evaluation of the implant.

[Pathogenesis of Dupuytren's disease]. / Untersuchungen zur Genese der Dupuytrenschen Erkrankung.

Liver studies performed in 47 patients with Dupuytren's contracture revealed a high level of hepatitis A contamination; in addition, procollagen III levels were distinctly lowered as compared to normal values, and liver enzyme values were pathologic in 32%. A disturbance of collagen metabolism must, therefore, be considered as a possible cause of Dupuytren's contracture.

[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.

[Acid reduction after SPV and after H2 receptor blocking substance cimetidine. Comparative studies in Shay-rats)]. / Säurereduktion nach SPV und nach H2-Rezeptoren-Blockade. Vergleichsstudie an der Shay-Ratte.

The effect of a complete selective proximal vagotomy on stomach acidity has been compared experimentally to that of the H2 receptor blocking agent cimetidine in the rat. Both methods produced a significant reduction of total acid as compared to controls, a reduction to 0.5 % for cimetidine and to 0.1 % for SPV. The acid reduction following SPV is a result of decreased production of stomach fluid as well as a decrease in degree of acidity. The acid reduction following administration of cimetidine is mainly a result of an increase in pH without any change in volume of stomach fluid production.

[Selective proximal vagotomy and pyloroplasty--long range experiments in the rat (author's transl)]. / Selektive proximale Vagotomie mit und ohne Pyloroplastik--Langzeituntersuchungen am Rattenmagen.

Following the evaluation of the result of SPV in rats by determination of reduction of acid production the effect of the same operation on gastric motility was compared to that obtained with both SPV and a simultaneous pyloroplasty in a one year study. As demonstrated radiologically, with SPV alone gastric stasis resulted in a greatly enlarged stomach with a high percentage of peptic ulcers. Animals who had SPV together with pyloroplasty showed good emptying of the stomach with few ulcers. In this group the incidence of ulceration was reduced from 45% to 5,5%.

Fracture healing under factor XIII medication.

Following application of factor XIII for 3 weeks bone healing was studied in Sprague-Dawley rats on the 20th postoperatively day qualitatively (radiographs, scintigraphy) and quantitatively (determination of callus thickness, of bone mineral content, and scintillation counting). No significant difference could be detected between animals treated with factor XIII and animals which served as controls. Therefore, a stimulating effect of factor XIII upon bone healing can not be expected in case of a normal factor XIII serum-level. The application of factor XIII is indicated only in high risk patients with a low factor XIII serum-level.

[Model for the study of influences on fracture healing. Animal experiments]. / Modell zum Studium von Einflüssen auf die Frakturheilung. Tierexperimentelle Untersuchungen.

Primary and secondary bone healing were studied for 30 and 60 days, respectively, by means of X rays, scintigraphy, determination of callus thickness, scintillation counter, and determination of bone mineral content. Primary bone healing was terminated after 30 days, secondary healing after 60 days. Scintillation counting proved to be a quantitative method, the other methods serving as controls. The different influences on bone healing can be quantitatively studied by means of this model.

[Iron absorption after gastrectomy following oral application of tardyferon]. / Eisenresorption nach Gastrektomie unter Tardyferon-Medikation.

Iron absorption was studied in 35 volunteers following oral application of Tardyferon during 21 days. In 25 patients a total gastrectomy and in 5 patients a subtotal gastrectomy have been performed, whereas 5 persons served as controls. The following parameters have been determined: Serum iron, iron binding capacity, hemoglobin, hematocrit, red blood cells and reticulocytes. The following results were obtained: Serum iron is markedly reduced in the patients with total gastrectomy during the first postoperative year, increases steadily and reaches normal values after the third postoperative year. Following oral application of Tardyferon an improved absorption is observed during the postoperative course. Because of the excellent absorption of Tardyferon it can be recommended for the oral application during the first two postoperative years.

[The topography of the hepatic vein orifices (author's transl)]. / Topographie der Lebervenenmündung

The termination of the hepatic veins in the inferior vena cava was studied in 157 bodies. Two types of termination were observed: a cranial group close to the diaphragm with orifices varying between 4 and 25 mm., and a caudal group with orifices between 0.5 and 7 mm. In the first group, three types can be distinguished. In type I (45%) there are two, in type II (40%) there are three and in type III(15%) four hepatic veins which terminate in the vena cava. The caudal group showed no regular pattern. In performing selective angiography of the hepatic veins and during pressure measurements via hepatic vein catheters, it should be remembered that in 55% more than two ostia are present in the inferior vena cava.