[Pathogenesis of hip osteoarthritis]. / Pathogenese der Hüftgelenksarthrose. Von der Fehlbelastung zum Verschleiss.

Coxarthrosis is the most frequently occurring hip disease, is the most common type of osteoarthritis in general and is the second most frequent cause of chronic invalidity. Causes are inherited hip diseases (e.g. dysplasia), growth diseases (e. g. Perthes' disease, slipped capital femoral epiphysis), injuries (fractured femur, fractures of the femoral head or acetabulum, necrosis of the femoral head), and inflammatory, rheumatic or metabolic diseases. Hip deformities such as hip dysplasia or protrusio acetabuli lead to increased mechanical deterioration as a result of the pathological anatomy and hence to a chronically progressing degeneration (coxarthrosis). Primary coxarthrosis usually begins between the 50th and 60th year of life; the secondary disease can develop even earlier depending on cause.

[Manifestations and diagnosis of hip osteoarthritis]. / Klinisches Bild und Diagnostik der Hüftgelenksarthrose. Leitsymptom ist meist der Leistenschmerz.

The principal symptom of coxarthrosis is mostly pain in the groin. The patient often has a limping gait. The patient notices an increasing restriction in the mobility of the hips and the ability to walk. It must be borne in mind that knee pain can also be the only primary symptom of hip disease. Standard radiographs should be always taken from two different views. Magnetic resonance imaging and computed tomography are still reserved for special problems in the diagnosis of coxarthrosis.

[Conservative and surgical therapy of hip osteoarthritis]. / Behandlung der Coxarthrose. Auf welche Therapien Verlass ist.

Conservative measures generally have priority over surgical procedures. Firstly, an analgesic and antiphlogistic therapy during the acute pain phase is very effective. Secondly, retaining or improving mobility is important. The indication for surgery for hip arthritis exists when the clinical and subjective symptoms in conjunction with the radiological finding can no longer be adequately controlled by conservative measures. Surgical interventions are basically either joint-replacing or joint-saving. The goal of all corrective osteotomies is to improve the hip joint congruency and thus delay the replacement of the hip with an artificial joint. Established prosthetic models show long-term results of 15-20 years with a survival rate of more than 90%.

[Clinical picture and diagnosis of knee osteoarthritis]. / Gonarthrose-diagnostik in der Praxis.

The principal symptom of osteoarthritis of the knee is pain. As the disease progresses, attack-like symptoms with knee pain, effusion, activated osteoarthritis, increasing restriction in knee mobility and reduced walking range occur more frequently. Secondarily joint malalignments also develop. Activities such as climbing stairs or sitting for long periods with bent legs are named as sources of pain for patients with patellofemoral osteoarthritis. Medial and/or lateral osteoarthritis of the knee is very probable when the pain is described as being more lateral or medial. The standard x-ray should always be taken AP and from the side. Axial images of the patella and tangential images of the patellofemoral joint are also made for assessing the centring of the patella and for evaluating retropatellar osteoarthritis. For planning the therapy, x-rays of the knee joint AP while standing or of the entire leg while standing are essential.

[Conservative Therapy of Knee Osteoarthritis]. / Bleiben Sie kritisch bei der Wahl Ihrer Therapie!

Many highly effective measures as well as orthopaedic aids are available for the conservative therapy of knee osteoarthritis. When appropriately implemented for the stage of the disease,they can clearly alleviate the patient's symptoms. However, physiotherapy, physical therapy, balneotherapy and the usual conservative treatment options are not capable of stopping the progression of knee osteoarthritis. Other conservative therapeutic options such as magnetic field therapy, pulse signal therapy, radiotherapy, radiosynoviorthesis, acupuncture and drug therapies improve symptoms to different extents. For this reason, their application should always be critically evaluated.

[Surgical treatment of knee osteoarthritis]. / Die Achsenkorrektur kann eine Endoprothese hinauszögern.

Surgery for knee osteoarthritis is indicated if the clinical subjective symptoms in conjunction with radiological findings can no longer be adequately treated by conservative measures. Fundamentally, the treatment procedures are differentiated between joint preserving interventions (arthroscopy, knee revision, if necessary with meniscal debridement, partial synovectomy, osteophyte removal, cartilage surgery with microfracturing, autologous chrondrocyte transplantation, mosaic plasty or spacer implantation), corrective osteotomies near the knee joint and joint replacing procedures (knee endoprostheses or knee fusion [arthrodesis]).

[Dislocated supracondylar humerus fracture in the child. Surgical technique and outcome with dorsal approach]. / Die dislozierte suprakondyläre Humerusfraktur des Kindes. Operationstechnik und Ergebnisse mit dem dorsolateralen Zugang.

Anatomical reduction and stabilization of displaced supracondylar humeral fractures in children is necessary to obtain good results. For most cases percutaneous crossed pinning is recommended. Sometimes open reduction is necessary but even in these cases neurological complications and varus deformities have been reported. So the technique of open pinning was modified. From 1995 to 1998 22 children were treated by a dorsolateral approach. The fracture was stabilized by crossed pinning: The proximal K-wire is drilled 10 degrees ascending to the dorsal humerus through the medial pillar into the ventral part of the medial epicondyle, after shortening it is not bent. The distal K-wire stabilizes the lateral pillar, after shortening its end is bent down. Immobilization for 3-4 weeks, mobilization is done by the patient. The implants are removed 2 weeks later. The follow up in 21 out of 22 patients (8-57 months, mean 35 months) according to Flynn's criteria showed 16 excellent, 4 good and 1 fair result. The fair result was due to valgus deformity. One patient has been reoperated due to displacement of K-wire. Neither iatrogenic nerve lesions nor varus deformities nor infections did occur. The dorsolateral approach combined with the above mentioned technique of pinning shows excellent and good results.

Variants of phosphohexose isomerase in gastrointestinal and mammary carcinoma: isoelectric focusing patterns of normal and tumor tissues derived from surgical specimens of the same patient.

The occurrence of charge variants of phosphohexose isomerase was elucidated in cancerous and, for comparison, in noncancerous tissues obtained from the same organ. Surgical specimens from 35 patients with gastrointestinal and mammary carcinoma were studied by means of the isoelectric focusing (IEF) technique. Differences in the IEF pattern could be demonstrated in 90% of the patients with gastric cancer. Corresponding values for the patients with colorectal and mammary carcinoma were 50 and 73%, respectively. Almost all normal specimens proved to be monomorphic, revealing only the major basic band with a pI of 9.1. In most of the tumors, additional bands of pI 8.9 and 8.6 were found. This "typical" IEF pattern in tumor tissues was observed in 60% of gastric and 73% of mammary tumors, but in only 36% of colorectal tumors. The results obtained suggest that the IEF pattern of phosphohexose isomerase in tumor tissue might be a useful tool for tumor diagnosis.

Activities of phosphohexose isomerase and other glycolytic enzymes in normal and tumor tissue of patients with neoplastic diseases: comparison with serum activities and correlation to tumor staging and grading.

Of five glycolytic enzymes tested, only the serum activity of phosphohexose isomerase (PHI) was elevated in the vast majority of 140 patients with gastrointestinal, kidney or mammary carcinomas. However, in the tumor tissues all enzymes were increased to about the same extent. Thus, the measured increase in the serum activity of PHI is not due to a specific overproduction in the malignant cells. A general rise in the glycolytic enzyme activities in the malignant tissue could be detected already in early stages without metastases and in well-differentiated tumors.