[Arthroscopic treatment of psoas impingement]. / Arthroskopische Behandlung des Psoasimpingements.

OBJECTIVE: Tenotomy of the psoas tendon in symptomatic internal coxa saltans or psoas impingement should relieve pain. INDICATIONS: Indicated in conservative treatment-resistant internal coxa saltans and in psoas impingement. CONTRAINDICATIONS: Contraindications are symptomatic psoas pathologies in hip dysplasia patients. SURGICAL TECHNIQUE: Three different procedures exist with the arthroscopic technique, in which the psoas tenotomy can be performed at one of three different levels. These are the arthroscopic transcapsular, the endoscopic extra-articular, and the arthroscopic central techniques. POSTOPERATIVE MANAGEMENT: Forearm crutches are recommended for approximately 2-4 weeks as well as physiotherapy to strengthen the hip flexors. RESULTS: A literature-based comparison could reveal no difference between the extra-articular and transcapsular techniques. Particularly in the long term was no loss of strength evident. Various different authors describe the techniques as good, finding neither complications nor recurrence of internal snapping hip.

[Complications in hip arthroscopy and follow-up therapy. Analysis over a 5-year time period with a total of 13,000 cases]. / Komplikationen bei der Arthroskopie des Hüftgelenks und deren Therapie. Analyse eines Fünfjahreszeitraums mit insgesamt 13.000 Fällen.

BACKGROUND: In recent years arthroscopic interventions of the hip joint have become increasingly more frequent. An advantage of the procedure is that open surgery can be avoided in many cases by using minimally invasive procedures. The spectrum of indications is becoming increasingly broader and more differentiated. Complications are rare. MATERIAL AND METHODS: According to the types of complications 13,154 cases from institutions having conducted approximately 470 hip arthroscopies per year between 2008 and 2012 were collated, observed and analysed. Intraoperative or postoperative complications were taken into account. RESULTS: According to our definition, the overall complication ratio came to 6.3%. Relatively frequent complications were damage caused by inadequate setup, nerve lesions and broken instruments. Severe complications such as vascular lesions, intra-or postoperative fractures, infections and avascular necrosis are rare. CONCLUSION: In hip arthroscopy special attention has to be paid to patient positioning, traction performing and portal establishing. This procedure performed by an experienced surgeon resulted in a low ratio of complications.

[Open Bankart shoulder stabilization using bioabsorbable staples. Technique and results]. / Die offene Schulterstabilisierung nach Bankart unter Verwendung von resorbierbaren Dübeln. Technik und Ergebnisse.

In the supply of anterior unidirectional instability the open Bankart repair still represents the standard procedure. In a retrospective study 48 patients with an open repair were supplied with bioabsorbable staples and the result with 42 patients (88%) was postoperative clinically examined following 18-48 months. The middle number of dislocations of the affected shoulder was 8.8. After surgery the average Rowe Score amounted to 96.1 points. Reluxations arose with two patients. The middle external rotation of the affected side was reduced in comparison to the opposite side by 9.7 degrees. With the open supply of the unidirectional instability by absorbable staples (Suretac) an easy procedure of the open operation according to Bankart is available. Reproducible results occurred in our patients. Thus the advantages of arthroscopical operation technology with those of the open execution of capsular shift are combined applicable, providing both patient and operating surgeon a high security at a low rate of reluxation.

[Early postoperative functional differences between total knee arthroplasties supplied with mobile-bearing platform or fixed-bearing system--an analysis of gait pattern]. / Frühfunktionelle postoperative Unterschiede zwischen Knieendoprothesen mit rotierendem und festem Gleitlager - eine ganganalytische Studie.

AIM: The goal of this study was to analyze differences of gait patterns among patients with total knee arthroplasty supplied with mobile-bearing platform in contrast to patients supplied with fixed-bearing knee systems. METHOD: For that reason 17 patients with mobile-bearing knee systems and two groups of 15 patients each with fixed-bearing knee systems have been examined clinically, radiologically, and by means of gait analysis up to 6 months postoperatively. Additionally 20 knee-healthy control subjects have been gait-analyzed for comparison. RESULTS: There existed no different developments of gait characteristics between the groups of patients in the preoperative status. After the operation an increase of the ground reaction force of the operated leg was observed in all groups. The functional range of motion in the operated knee joint improved among patients postoperatively. Besides, in the group with the mobile-bearing knee a significantly stronger flection of the operated leg during the stance phase under load could be proven. Between the groups of patients the average values of the respective radiological alignments did not exhibit statistically significant differences. No severe complications have been observed. CONCLUSION: For the group of patients with fixed-bearing knee course samples have been registered, which approximate the reference values of healthy control subjects more strongly. The entire course sample is characterized by an increased range of motion of the opposite side and the adjacent joints. The parameters measurable in the gait analysis point to a better biomechanical situation after implantation of the mobile-bearing system.

[Kinetic and kinematic gait analysis before and after total knee endoprosthesis implantation]. / Kinetische und kinematische Ganganalyse vor und nach Knietotalendoprothesenimplantation.

OBJECTIVE: The aim of the present paper was to make an objective assessment of the surgical outcome after primary knee endoprosthesis implantation by means of gait analysis. METHOD: Kinetic and kinematic parameters of gait pattern were recorded using multi-component measuring platforms integrated into a treadmill and an optoelectric measuring system. 20 patients were investigated preoperatively and on average 14 and 28 weeks postoperatively. RESULTS: Preoperatively, on the affected side, the leg was used for a shorter time, but with much higher maximum forces. Mobility was reduced in the affected joint, in the adjacent hip joint, and in the contralateral joints when walking. After endoprosthesis implantation, the gait pattern approximated that of the reference group. The gait symmetry increased, and the time and force-related loading of the operated leg and the extent of mobility of the contralateral knee and both hips increased up to 28 weeks postoperatively. The clinical score according to Aichroth et al. showed a correlation with the measured values of the gait analysis at all times (p < 0.05). CONCLUSION: Mono-articular degenerative changes of the knee have a negative effect on the function of adjacent and contralateral joints. Endoprosthesis implantation then leads to a normalisation of pathological motion patterns, both in the operated and in the adjacent and contralateral joints. However, normal values were not yet achieved 28 weeks postoperatively, which demonstrates the possibility for further functional improvement depending on the continuity of rehabilitation.

Imaging biliary lipid secretion in the rat: ultrastructural evidence for vesiculation of the hepatocyte canalicular membrane.

Physical-chemical and biological studies of hepatic bile suggest that biliary phospholipid molecules are secreted as unilamellar vesicles. Systematic ultrastructural studies of bile canaliculi were undertaken to visualize this event. Liver tissue was obtained from normal adult male rats (control), from bile salt-depleted rats (by overnight biliary diversion), and from depleted rats infused intravenously with a hydrophilic-hydrophobic congener series of common taurine-conjugated bile salts. Livers were fixed in situ either by modified chemical methods or by ultrarapid cryofixation. In control rats, chemical fixation revealed unilamellar vesicles 63 +/- 17 (+/- SD) nm in diameter, mostly free within canalicular lumena. Vesicles were infrequent in canaliculi of bile salt-depleted rats, but were present in canaliculi of rats infused with taurocholate. In cryofixed liver tissue, vesicles 67 +/- 13 nm in diameter were observed in canaliculi of control rats and bile-salt depleted rats infused with common bile salts. The majority of these vesicles were affixed to the luminal side of the canalicular membrane. The average number of vesicles per bile canaliculus was in agreement with that estimated on the basis of biliary phospholipid secretion rates, mean vesicle size, and area of close-packed phosphatidylcholine molecules. By immunoelectron microscopy, canalicular vesicles were free of actin and of a 100 kDa canalicular membrane protein. We conclude that biliary phospholipid molecules are secreted from hepatocytes into bile canalicular lumena as unilamellar vesicles approximately 63-67 nm in average diameter. We postulate that this secretion mechanism involves lumenal bile salt-induced vesiculation of lipid microdomains in the exoplasmic hemileaflet of the canalicular membrane.

Microscope laser light-scattering spectroscopy of vesicles within canaliculi of rat hepatocyte couplets.

Employing microscope laser light-scattering spectroscopy, we investigated "primary" bile secretion into canalicular spaces of rat hepatocyte couplets in monolayer culture. Time-dependent scattered light intensities were fitted by bi-exponential decays. The "slow" decay was attributed to an undulating canalicular membrane motion, whereas the "fast" decay was consistent with rapidly diffusing intracanalicular vesicles with mean hydrodynamic radii (+/- SD) of 479 +/- 53 A. After addition of micromolar concentrations of common bile salts, increases in the amplitude of the fast component facilitated a quantitative estimate of vesicle secretion rates. A dose-response relationship with 0.1-200 microM sodium taurocholate was characterized by an initial concentration-dependent increase and then a decrease in the amplitude of the fast canalicular component. Since these taurocholate concentrations are nontoxic to cultured hepatocytes, the maximum in vesicle-sized particles at 10 microM taurocholate suggested that its critical micellar concentration of approximately 5 mM was attained within the canalicular spaces. Sodium taurolithocholate resulted in time- and dose-dependent diminution in vesicle secretion rates, which after 2 h was followed by spontaneous canalicular recovery. This suggested that acute bicellular "cholestasis" was followed by oxidative metabolism and detoxification of the monohydroxy bile salt. Microscope laser light-scattering spectroscopy should facilitate further physical-chemical and pathophysiological studies of bile secretion at the cellular level.

[Value of sonography in assessing nodular changes of the thyroid in an endemic goiter area]. / Zur Wertigkeit der Sonographie für die Beurteilung nodöser Schilddrüsenveränderungen im Strumaendemiegebiet.

In an area of endemic goiter 304 patients with an increased thyroid gland were examined by palpation, sonographically and partly scintigraphically. The average age was 37 (12-78) years, the average age of the patients with nodular changes of the thyroid gland 38-44 years. Patients with a diffuse struma were significantly younger with an average age of 33 years. A false-positive enlargement of the thyroid gland established by palpation occurred in 16.1% (n = 49/304). In the sonographic examination 148 out of 304 patients revealed a diffuse enlargement of the thyroid gland without provable nodular change. However, in about one third already more or less clearly characterized regressive changes could be observed. In 156 of the 304 patients 109 times solitary nodes and 47 times multinodular changes were established sonographically. In more than one third of all nodular goiters or one fifth of all patients examined a cyst was demonstrated sonographically. Two thirds of the sonographically established nodular changes were, however, solid. In 53 of all 304 examined patients could sonographically be established additional, unexpected nodes which had escaped the palpation and partly also the scintigraphic investigation. In 14% the node suspected by palpation could not be ascertained sonographically. According to the echo structure echo-poor and echo-equal solid nodes dominated. The frequency of carcinomata of the solid nodes was 6.7%. Apart from 4 echo-poorly and 2 complexly structured nodes a carcinoma of the thyroid gland demonstrated itself sonographically to the same echo. Finally conclusions are drawn for the diagnostics of the thyroid gland in the endemic area of goiter.

Thyroid status during pregnancy and post partum in regions of iodine deficiency and endemic goiter.

During pregnancy the thyroid is subjected to increased demands which is associated with a tendency to endogenous iodine deficiency. Under the conditions of insufficient iodine supply in the GDR the pathophysiological changes result in: 1. prevalence of goiter in about 60% of pregnant women; 2. enlargement of the extent of neck in more than 50% of all pregnant women examined only returning to the prepregnant status in 25%-40%; 3. prevalence of goiter in newborn with 5%; 12.8% of 1948 stilborn had macroscopically an enlarged thyroid gland, the highest weight being 45 g. More than 53% of the stilborn examined by autopsy had a thyroid weight of over 3 g; 4. in contrast to the regions with sufficient iodine supply renal iodine excretion was steadily decreasing during pregnancy and post partum, changing the iodine deficiency from grade II to grade III; 5. low iodine excretion in newborn: 1.3 +/- 0.2 microgram I/day in goitrous (1.2 +/- 0.2 nmol I/mmol creatinine) 2.2 +/- 0.4 micrograms I/day in non-goitrous (2.0 +/- 0.4 nmol I/mmol creatinine); 6. according to ETR more than 50% of the pregnant examined showed a hypothyroid tendency. The pathophysiological changes during pregnancy caused by insufficient iodine supply can be met efficiently by careful thyroid hormone treatment or by the administration of 150 micrograms I daily. A mandatory iodine salt prophylaxis is demanded.

[The radioiodine test for the evaluation of iodine deficiency in the district of Karl-Marx-Stadt and in East Germany]. / Der Radiojodtest zur Beurteilung des Jodmangels im Bezirk Karl-Marx-Stadt und in der DDR.

The values of the per cent 24 h radioiodine uptake in the GDR are above 60--70% and speak for a low alimentary intake of iodine or renal excretion of iodine below 40 micrograms J/d. Like the struma prevalences they show a tendency increasing from north to south and characterize the whole European situation of iodine deficiency including its decrease from west to east. The mean values of radioiodine uptake of 71.7 +/- 13.2% (n = 110) in euthyroids of the district of Karl-Marx-Stadt correspond to the iodine deficiency as it occurs approximately in the districts of Erfurt, Dresden, Munich or Freiburg/B. The alimentary iodine intake of 38.4 +/- 17.2 micrograms J/d and the renal iodine excretion of 29.9 +/- 16.1 micrograms J/d, calculated from the 24 h radioiodine accumulation values of 40 euthyroid persons by means of a mathematical model developed by Oddie and co-workers were low. The latter only slightly differed (P less than 0.05) from its chemically estimated excretion of iodine in the urine: 23.1 +/- 16.9 micrograms J/g creatinine (n = 73). Between the calculated and chemically estimated excretion of iodine there was a relatively strict correlation of r = 0.68 (n = 26; P less than 0.001). The introduction of an iodine prophylaxis is regarded as an urgent necessity. Later on a new estimation of the regional "normal values" is necessary for the per cent radioiodine uptake.