[Injuries and response to overload stress in running as a sport]. / Verletzungen und Uberlastungsreaktionen im Laufsport.

Running is rarely associated with acute injuries (muscle injuries, ankle sprain, ruptures of the Achilles tendon). More than 80% of the complaints are due to overuse injuries, mainly concerning knee, foot and Achilles tendon. Risk factors are high-performance sports, high training quantity, rapid increase of training intensity, previous injuries, and skeletal axis malalignment. Running is not suitable for severely overweight people and those with significant skeletal malalignment, dysplastic hips, spondylolisthesis, or cartilage damage.

Effects of revisional ACL surgery in semi-professional athletes in "high-risk pivoting sports" with chronic anterior instability of the knee.

This is a retrospective study of semi-professional athletes in "high-risk pivoting sports" after repetitive injuries of the anterior cruciate ligament (ACL) with chronic anterior instability of the knee. Effects of revisional ACL surgery on the progression of osteoarthritis, sport capacity, and knee pain were observed. Twenty-four patients, with an average age of 25.5 years, were examined on average 36.9 months postoperatively. Compared with the preoperative findings we noted a significant increase in the Lysholm and the Tegner activity score (P < 0.001). Sixteen patients (67%) were able to continue their sporting career; 17 patients (71%) were completely satisfied with the operative result. Nevertheless, 15 patients (63%) complained of persistent pain caused by sport activity. According to the Fairbank scale, 15 patients (63%) showed an increase in osteoarthritic signs between the preoperative and follow-up roentgenograms. Furthermore, there was a highly significant correlation (P < 0.001) between progression of osteoarthritis and continuous sport activity. We conclude that, after stabilization with a "bone-tendon-bone" autograft, athletes have a good chance to return to their sport. In most patients, the knee pain persisted and progression of osteoarthritis was detected. In individuals who play sport continuously, we recommend an annual follow-up with clinical examination and roentgenographic or magnetic resonance imaging examinations.

Reconstruction plate fixation with bone graft for mid-shaft clavicular non-union in semi-professional athletes.

From 1993 to 1997, 22 semi-professional athletes (14 men and 8 women), aged 18-33 years (mountain bike racers, soccer players, handball players, swimmers, and short distance runners) with a non-union of the middle third of the clavicle were treated operatively by reconstruction plating and bone grafting. Fourteen clavicular non-unions were caused by falls. Eight non-unions were the result of a car, motorcycle, or bicycle accident. There were 19 atrophic and 3 hypertrophic non-unions. In all patients, initially a figure-of-eight strap or a sling was used for immobilization and no radiographic union was documented within 5 months. None of the athletes had gone back to their sports and all had pain and limitation of shoulder function. For open reduction and internal fixation, an AO 3.5-mm seven-hole reconstruction plate was used. The sclerotic bone ends were freshened and a cortical bone transplant or cancellous bone from the iliac crest (depending on the shortening of the clavicle) was packed around the fracture or between the reduced fracture ends. In all athletes, radiographic consolidation was achieved after an average of 14 weeks (range, 11-16 weeks) and the average increase in the Constant and Murley Score was from 79 points preoperatively to 97 points after surgery. No operative or postoperative complications occurred and all athletes returned to their sports.

[A special case: fracture of the spine with spondylodesis]. / Der besondere Fall: Fraktur einer spondylodesierten Wirbelsäule.

Fracture of spondylodesis is rare. The case of a 31-year old woman, who incurs a fracture of the fused spine 18 years after Risser's spondylodesis, is reported. This case is contrasted with two other cases exclusively known by literature.

[Treatment of bilateral dorsal dislocation fracture of the shoulder joint by total endoprosthesis replacement]. / Die Behandlung einer beidseitigen dorsalen Luxationsfraktur des Schultergelenkes durch totalendoprothetischen Ersatz.

A 48-year-old patient sustained depressed fracture dislocations of both shoulder joints during a grand mal epileptic seizure. Surgical treatment consisting of implantation of two Neer total replacements was successful: the functional result was good, and within 12 weeks the patient was free of pain and able to resume work.

[Manifestation of sarcoidosis of the optic nerve]. / Die Manifestation der Sarkoidose am N. opticus.

Under the suspicion of an optic nerve glioma a resection of the optic nerve tumour was carried out in a 58-year-old female patient with an amaurosis on the right side. The diagnosis of the sarcoidosis of the Nervus opticus was only established on the basis of the histological findings obtained in the resected optic nerve. Even after a period of observation of five years no further general pathologic signs of the sarcoidosis appeared, so that it could be assumed that this was the case of an isolated sarcoid affection of the optic nerve.

[Syphilis in HIV infection. 2 cases of neurosyphilis]. / Die Syphilis bei der HIV-Infektion. 2 Fälle von Neurosyphillis.

In HIV-infected people the course of syphilis is altered and aggressive. Besides seronegativity Neurosyphilis can manifest premature and as a outcome of failed penicillin-therapy in secondary syphilis. Two cases of neurosyphilis are reported and discussed. The usefulness of spinal fluid analysis is pointed out. Recommendations for diagnostics and therapy are given.

[Surgery of aneurysms of the cerebral arteries--results and problems]. / Hirnarterien-Aneurysmachirurgie--Ergebnisse und Probleme.

Surgery has been performed on 100 intracranial aneurysms during the past seven years. Of these, 96 involved the application of microsurgical techniques and could definitely be clipped. Lethality was 8%. Post-surgical deterioration of the clinical neurological status was observed in another 20 patients, but vanished subsequently in 16 of them. Immediate surgery within 48 hours of the subarachnoidal hemorrhage is recommended to avoid subsequent hemorrhage and prevent severe vasospasmic phenomena. Only patients whose general status is good (Hunt and Hess degree 1 or 2) are suitable for immediate surgery.

[Supratentorially located angioblastoma in childhood. Case report]. / Das supratentoriell gelegene Angioblastom im Kindesalter. Kasuistische Mitteilung.

In an 11-year-old girl an angioblastoma in a left parietal position has been successfully removed by a surgical intervention. The process consisted of a highly vascularized tumour part of a firm consistency, which was located in a large cyst. The pre-operatively established computer tomogram showed a hypodensity in the sense of a left parietal cyst and a pronounced environmental oedema. The occurrence of this tumour form in childhood and in the supratentorial section is a rarity.

[Ultrasonic and anatomical correlation of the normal hip in the newborn infant]. / Corrélation échographique et anatomique de la hanche normale du nouveau-né.

Ultrasound studies were made on the cadavers of seven normal new-born foetuses. The sonographic images obtained were compared with anatomical sections made in corresponding planes. An accurate analysis of the anatomy of the cartilaginous acetabular roof and labrum in these hips confirmed the accuracy of ultrasonography. Ultrasonography has made it possible to resolve certain doubts about the radiographic examination of infants between birth and the third month.

[A change in aneurysm surgery--the acute operation]. / Wandel in der Aneurysmachirurgie--Akutoperation.

Patients who have undergone aneurysmal rupture may be endangered by recurrent haemorrhage and consequences of vasospasm. The risk of recurrent bleeding may be ruled out and favourable conditions provided for active treatment of vasospasm by immediate surgical action on a ruptured aneurysm of a cerebral artery. Such action, however, should be taken not later than three days from the event of rupture. Reported in this paper is experience obtained from eleven acute operations in a total of 110 aneurysmal operations over the past seven years. Acute operation is recommended, provided that certain conditions are met.

[Recurrent aneurysmal hemorrhage following establishment of an extra-intracranial microanastomosis]. / Aneurysmarezidivblutung nach Anlage einer extra-intrakraniellen Mikroanastomose.

A report is given on the recurrent haemorrhage of a cerebral arterial aneurysm occurring three days after the establishment of an extra-intracranial microanastomosis by means of a venous transplant. The carotid ligature should be carried out in a second session. The short time interval after the haemorrhage and also the larger flow via the venous bypass is discussed as a possible cause.

[Giant aneurysm--manifestations, diagnosis and therapy]. / Das Riesenaneurysma--Manifestation, Diagnostik und Therapie.

The particularities in the clinical picture, in the diagnostic regimen and in the therapeutic schedule of eleven patients with an aneurysm showing a diameter larger than 25 mm (giant aneurysm) are presented. These aneurysms become clinically manifest as space occupation, as subarachnoid haemorrhage or TIA. 3 false diagnoses in which the aneurysm was mistaken for a cerebral tumour accentuate the necessity of a complete angiographic examination. The computer tomogram yields sufficient information permitting the suspicion of an aneurysm. In 8 patients, the direct aneurysm clipping could be performed; in 2 of them an extra-intra-cranial microanastomosis was established in the same session as a preliminary intervention. The establishment of a microanastomosis was carried out in 2 other patients. After a certain time interval, a carotid ligature (A. carotis interna) in the region of the neck was established in one of these patients. As a purely symptomatic measure for the treatment of the supratentorial pressure hydrocephalus we established a ventricular-atrial drainage in a case of basilar aneurysm. Besides 1 death and 2 severe complications, very good results could be achieved in 5 patients.

[Are subcortical signs in the EEG a reliable indication of brain stem displacement and impaction processes by intracranial space-occupying processes? A comparative computer tomography-electroencephalography study]. / Sind "subkortikale Zeichen" im EEG ein zuverlässiger Hinweis auf Hirnstammverlagerungen und Einklemmungsvorgänge bei intrakraniellen raumfordernden Prozessen? Eine computer-tomographisch-elektroenzephalographische Vergleichsstudie.

Within the scope of an elektroencephalographic-computertomographic comperative study carried out in 430 patients, the concurrence of secondary brain stem damage due to mass displacement and herniation processes and parroxysmal generalised slow activity in the EEG ("intermittant frontal delta rhythms", "projected discharges", "subcortical signs") in intracranial space-occupying processes were studied among others. The occurrence of the EEG pattern was independent of the presence of brain stem displacements in about 20 and 25 per cent, respectively, of the 152 patients with supratentorial space occupations. The absence of the characteristics on 80 per cent of the patients with clear CT criteria for a secondary brain stem impairment shows that it is not suitable as a warning sign of an imminent intracranial decompensation and that in particular from the non-occurrence in the EEG no contribution to the operative risk and to the choice of the time of the operation can be derived. A relation between the occurrence of paroxysmal slow activity and the acuity of the course of the disease or the degree of malignity of cerebral tumours could not be verified. Possible causes of the inconstant occurrence of this EEG pattern in brain stem alterations are discussed.

[The significance of computerized tomography for the diagnosis of cerebral venous and sinus thromboses]. / Die Bedeutung der Computertomographie für die Diagnostik von Hirnvenen und Sinusthrombosen.

Thromboses of cerebral veins and sinus occur both in childhood and in adult age. The clinical symptoms are variable, so that until a few years ago the diagnosis had been based exclusively on angjiography. Owing to the introduction of computer tomography, a method has now become available to the clinician which, while it does not involve great risks and stress for the patient, is of great importance in the diagnosis of thromboses of cerebral veins and sinus, especially for the observation of the course of the disease and the therapy to be employed. This is particularly true of the indication for thrombolytic and anticoagulant therapy. The computertomographic findings are described on the basis of the literature and two own observations, differentiating between direct and indirect symptoms. All changes are inconstant, which makes the appraisal difficult. At the time being, the angiographic diagnosis can rarely be renounced. Both examination methods supplement each other very well.