The role of fibroblasts from oropharyngeal mucosa in producing proinflammatory and mitogenic cytokines without prior stimulation.

Cytokine production by fibroblasts is not only important for immunological and inflammatory reactions in the epidermis and mucosa, but also for growth and differentiation of epithelial cells. To characterize the role of fibroblasts in the oropharyngeal mucosa, the expression of a panel of cytokines and cytokine receptors by fibroblasts isolated from normal human oropharyngeal mucosa was investigated by enzyme-linked immunosorbent assay (ELISA), reverse transcribed polymerase chain reaction (RT-PCR) and flow cytometry (FACS). Oropharyngeal fibroblasts produced the proinflammatory cytokines interleukin 1 alpha (IL-1 alpha), IL-6 and IL-8 without addition of phorbol-12-myristate-13-acetate (PMA) or biological response modifiers, suggesting an active involvement of these cells in host defence mechanisms. Keratinocyte growth factor (KGF), a growth factor for epithelial cells, and the angiogenetic fibroblast growth factors acidic and basic FGF (aFGF, bFGF) were also synthesized. Expression of receptors for IL-1, IL-4, IL-6, platelet-derived growth factor (PDGF) and epidermal growth factor (EGF) was found. These results indicate that oral fibroblasts are capable of producing a number of cytokines without the need for additional stimuli and emphasize their active regulatory role in the maintenance of the oral mucosa.

Different KGF expression in squamous cell carcinomas of the head and neck and in normal mucosa.

Fibroblast growth factors (FGFs) are major factors mediating epithelial-mesenchymal interactions in the epidermis and mucosa. In this study the expression of the FGFs keratinocyte growth factor (KGF), acidic FGF (aFGF) and basic FGF (bFGF) was examined in tumour tissue specimens from 14 patients with advanced-stage squamous cell carcinoma of the head and neck (SCCHN) and 3 SCC cell lines by reverse-transcribed polymerase chain reaction (RT-PCR) and immunohistochemistry. None of the SCC cell lines was positive for KGF mRNA, whereas all cell lines were highly positive for aFGF and bFGF. In SCCHN tissue samples the level of KGF mRNA expression was significantly lower than in normal mucosa. Tumour stroma and the submucosal areas of normal mucosa stained intensely with anti-KGF antibody in immunohistochemical slides, whereas tumour cell nests were negative. Exposure of SCC cells to KGF thus differs from normal mucosa both quantitatively and regarding spatial distribution. This fact and the overexpression of aFGF and bFGF by tumour cells potentially promote tumour growth, invasion and metastasis. Since these growth factors and their receptors are well characterized, these observations could lead to new therapeutic strategies in SCCHN, for instance by blocking their receptors or antisense targeting.

IL-1 and TNF-alpha but no IL-2 expression is found in squamous cell carcinomas of the head and neck by RT-PCR.

We studied the expression of IL-1 (Interleukin 1), IL-2, IL-4, IL-10, GM-CSF (granulocyte/macrophage colony stimulating factor), TNF-alpha (tumor necrosis factor alpha) and IFN-gamma (Interferon gamma) in tumor specimens and adjacent mucosa from 12 patients with squamous cell carcinoma of the head and neck (SCCHN) by reverse-transcribed polymerase chain reaction (RT-PCR). No IL-2 and IL-4 expression was detected in any of the tumor specimens. High level expression of IL-1 and TNF-alpha was found in all 12 samples analyzed. Expression of GM-CSF was detected in 7 (58%) of 12 tumors, IL-10 was found in 3 (25%) and IFN-gamma in 6 (50%) of the samples. No qualitative differences in the cyotokine expression pattern were found between normal and tumor tissue. Our data indicate that there is a lack of cytokines typical for a specific, T-cell mediated immune response in SCCHN. A number of cytokines which are required for the initial steps of immune response however are produced. These results might have implications for future immuno-chemotherapeutical strategies.

Pertrochanteric fractures of the femur. A comparative study of internal fixation with angle nail-plates and flexible condylar nails.

Two methods of internal fixation of pertrochanteric fractures of the femur, angle nail-plates and flexible condylar nails, were compared in a retrospective clinical study, with emphasis on the results and indications as related to the age and physical condition of the patients.

[Injuries of the rotator cuff of the shoulder - experiences in diagnosis and treatment (author's transl)]. / Verletzungen der Rotatorenmanschette der Schulter - diagnostische und therapeutische Erfahrungen.

Arthrography is an established method to verify injuries of the rotator cuff of the shoulder. In this paper referring about 32 patients with 34 cuff injuries the results after operation (16 patients) and conservative treatment (18 patients) are compared. The following statements based on our experiences are possible: If conservative treatment is without result, operation should be done within 8 weeks after the accident. - Because of the danger of exostoses at the point of the osteotomy of the acromion which includes the restriction of movement, the transacromial approach is not advisable. - If there is only a small space between the acromion and the humeral head resection of the coracoacromial ligament is an advisable method for better admittance to the shoulder joint. - A sufficient treatment in the postoperative phase is of great importance for a good functional result.

[Cardiac arrest following protamine sulphate administration (author's transl)]. / Akutes Kreislaufversagen nach Protaminsulfatapplikation.

This study presents the case history of a patient who suffered from recurrent pulmonary embolism, despite heparinisation, after a car accident and who died during preparation for caval ligature. We feel that the protamine sulphate given for neutralization of the heparin effect played an important role, since no signs of massive pulmonary embolism were found at autopsy. Protamine sulphate is known to possess a significant cardiovascular depressive action. On the basis of a survey of the literature the possible potentiation of circulatory insufficiency by changed haemodynamics following pulmonary embolism, induction of anaesthesia, and protamine sulphate is discussed. Proposals for improved management of such case are made.

[History of the early acute R.D.S. and description of a method to improve immediate postmortem fixation of the lung (author's transl)]. / Zur Histologie des Frühstadiums des akuten Lungenversagens und Beschreibung einer Technik der unmittelbar postmortalen Fixierung der Lungen.

A technique for immediate lung fixation on patients who die of ARDS is described. The advantages compared to the selective needle biopsy, the transthoracic circumscript fixation and the lung fixation organ removal are: 1. functional anatomical proportions are kept, 2. Artefact mainly caused by autolysis is avoided, 3. Simple performance and low costs. The results obtained with the described technique are presented. It is demonstrated that the changes in the initial shock phase correlate well with the pattern of its distribution. These changes are not uniform. Therefore we feel that the results with biopsy are somewhat doubtful.

How to increase the stability of external fixation units. Mechanical tests and theoretical studies.

From general physical laws simple formulae have been deduced from which the rigidity of an external fixation unit mounted in different ways becomes mathematically calculable. Furthermore, the stability of various mounting systems under bending forces was investigated experimentally. Particular attention was paid to details of operating technique which are of special importance to the stability of the whole construction. The calculated data are consistent with the mechanical test results. The best arrangement of the Steinmann pins and Schanz screws is discussed, and how to mount the frame optimally, depending on the specific type and location of the fracture. Special instructions concerning the mounting of the external fixation unit are given which, depending on the specific circumstances, guarantee optimum stability of the unit.

Experimental tests concerning the biomechanical behaviour of pertrochanteric osteosyntheses.

The biomechanical behaviour of pertrochanteric fractures stabilized by means of an angled plate or flexible condylar nails was characterized by mechanical testing. The stability and the types of motion occurring under dynamic load in the vicinity of the fracture and the effect on the implant were examined. The mechanical test results corroborated clinical experiences. In the case of extramedullary anchorage of implants, stability under load is possible only if an intact cortex on the medial side of the fracture guarantees the bearing of compressive load. With flexible condylar nails, however, it is possible to achieve a permanent load capacity up to approximately 100 kp, even if medial support is lacking, by putting the fracture in a valgus position so that the load-bearing arm is shortened. It was also possible to estimate the actual loading on the operated leg within the immediate postoperative phase by means of the "stabilization effect".

[Fractures of the distal end of the femur and their management using condyle plates]. / Frakturen des distalen Oberschenkels und ihre Behandlung mit der Kondylenplatte.

Forty-one patients with fractures of the distal end of the femur are investigated and the importance of the angular plate designed by the AO group for stabilization of these fractures is discussed. For good results it is necessary to have the complete set of instruments and to consider biomechanical principles for stable osteosynthesis, so that early active exercises can be performed. The operation is not always simple but is indicated considering the poor functional and anatomical results after conservative treatment or inadequate fixation.

[The relative elongated patellar ligament after identation of the lateral retinacula (author's transl)]. / Das relativ verlängerte Ligamentum patellae nach Einkerbung der lateralen Retinacula.

The treatment of the lateralisation of the patella can be done by lateral indentation of the retinaculum patellae (method of Viernstein). Caused by the medialisation of the patella eventually the patellar ligament can be realtively elongated. This leads to insufficiency of the extensors and therefore to prearthrosis of the knee joint. To avoid this and to conserve the sportive ability we recommend the displacement of the tuberositas tibiae to medial and distal.

[Biomechanical investigations of the ankle joint after shortening of the distal end of the fibula (author's transl)]. / Untersuchungen zur Biomechanik des oberen Sprunggelenks bei Verkürzungen des Aussenknöchels.

Shortening of the distal fibula after malleolar fracture is accompanied with important alterations of the biomechanics and the compressive forces of the ankle joint. The relationship between the extent of shortening, the degree of valgus position of the talus and the reduction of the joint surfaces is described on the basis of experimental investigations. The importance of these circumstances for treatment of malleolar fractures is discussed.

[Arthrography of the hand in an accident clinic (author's transl)]. / Zur Arthrographie des Handgelenks und ihrer unfallchirurgischen Bedeutung.

By 115 arthrographies of the wrist in patients with posttraumatic pain, the importance of the method for diagnosis in injured patients is discussed. It was possible to detect 29 cases with a lesion of the articular disc, 4 patients with ruptured radiocarpal joint and 3 cases with an injury of the distal radioulnar joint. The technique of filling the wrist is described and different manifestations of "normal" arthrogramms are exhibited.

[The traumatology of the articular disc of the wrist (author's transl)]. / Zur Traumatologie des Discus Articularis des Handgelenks. 1. Teil: Klinik und Diagnostik

Roentgenological signs, which seems typically for a posttraumatic lesion of the articular disc of the wrist in case they appeared together with a corresponding clinical manifestation, were found in arthrographies of wrist by 89 patients with posttraumatic troubles. Four different types of roentgenolo-ic alterations and the difficulties by examinating them were described. In our opinion arthrography of the wrist is a successfull method to apprehend a lesion of the triangular disc.