[Perspectives of clinical stem cell therapy in the treatment of musculoskeletal diseases in Germany]. / Perspektiven klinischer mesenchymaler Stammzelltherapie bei muskuloskeletalen Erkrankungen in Deutschland.

AIM: The treatment of large bone defects remains a challenge for the orthopaedic surgeon. Regenerative therapies with the use of mesenchymal stem cells (MSC) may provide an alternative to autogenous bone transplantation, callus distraction or the use of allografts. MATERIAL AND METHODS: On the occasion of an expert workshop of the German Society for Orthopaedic and Trauma Surgery, a literature search regarding studies with the use of MSC was performed to evaluate its potential for future clinical studies. Furthermore, the legislative requirements were examined. RESULTS: Various in vitro and animal studies showed the benefit of MSC in bone regeneration. However, there are sparse data from clinical studies. Due to recent legislative changes there are several regulatory demands to meet if clinical studies are performed with MSC. CONCLUSIONS: For further evaluation of the role of MSC in the treatment of bone defects there is a need for clinical trials. The current paper provides some assistance for the successful application for clinical trials with MSC. Planning and performance of these studies may require early consultation with the regulatory authorities and cooperation of research centres in order to obtain authorisation for the evaluation of MSC. Preclinical data have to be obtained according to good laboratory practice with equivalent protocols that will be used in the clinical trials. In the latter the implementation of the guidelines for good clinical practice are mandatory.

Fertilisation failure after intracytoplasmic sperm injection is not associated with sperm aneuploidy of a globozoospermic patient.

The objective of this study was to determine the aneuploidy rate in spermatozoa from a globozoospermic patient who underwent three unsuccessful intracytoplasmic sperm injection (ICSI) treatment cycles together with his wife. The aneuploidy rates of chromosomes 13, 18, 21, X and Y as well as the diploidy rate in the spermatozoa of this man were evaluated by fluorescence in situ hybridisation to clarify if chromosomal aneuploidy could be a cause for the low fertilisation rate observed in this case. In the spermatozoa of our patient no increase in aneuploidy rates was found for the tested chromosomes (0.0% disomies of chromosomes 13, 18 and 21 with a diploidy rate of 0.6%; X/Y missegregation: 0.6%) indicating that the ICSI outcome of the couple was not impaired by sperm aneuploidy of the globozoospermic man.

C1q: a multifunctional ligand for a new immunoadsorption treatment.

C1q is a highly conserved protein with multiple functions involved in innate and adaptive immunity. It plays an important role in the activation of the classical pathway of the complement system to mediate the scavenging of infectious agents, apoptotic products, and immune complexes by the mononuclear phagocyte system (MPS). Exhibiting this function, C1q is able to bind various molecules (complexed IgG, IgM, fibrinogen, fibronectin, lipopolysaccharides, DNA, C-reactive protein [CRP], and viral proteins). Moreover, the collagen-like region of C1q is a target of autoantibodies. Immune complexes and anti-C1q autoantibodies are known to be involved in the pathogenesis of autoimmune diseases. Therefore, C1q is a promising candidate to extract waste material from the circulation. Following the development of the C1q immunoadsorbent, 8 patients with systemic lupus erythematosus (SLE) were treated in a first clinical trial. These preliminary results indicate that C1q immunoadsorption is a safe, compatible, and effective treatment for these patients.

[Diagnostic imaging in female infertility and sterility--desiderata and reality]. / Bildgebende Diagnostik bei weiblicher Infertilität und Sterilität--Wunsch und Realität.

For medical imaging in the pelvic region in female infertility/sterility several methods of investigation are available. Risk/benefit-considerations of the mentioned methods lead to a diagnostic gold-standard: Hysterosalpingography, laparoscopy, laparotomy. Hysteroscopy and sonography can be employed facultatively after hysterosalpingography.

[Vaginal sonography in the diagnosis of early pregnancy]. / Vaginosonographie zur Diagnostik der frühen Schwangerschaft.

In this study is reported on 401 transvaginal sonographic examinations in first trimenon of pregnancy. There were interpreted biometrical and functional findings. With 5 weeks p.m., chorion cavity can be identified by a transvaginal scan probe reaching a diameter of 3-8 mm. The vital embryo is recognized by its cardiac action with a embryonic length of 3 mm at the end of 6 weeks post menstruation. Thus with transvaginal sonography, details of embryonic development in the first trimester are visible 1-2 weeks earlier than with abdominal ultrasound examination. It is possible to estimate embryonic and trophoblastic structures of early gestation and to recognize non-viable early pregnancies.

[Development of a method for transuterine gamete transfer--initial results]. / Entwicklung einer Methode zum transuterinen Gametentransfer (GT)--erste Ergebnisse.

A new method for gamete intra fallopian transfer is described by which the tubes can be catheterised via vagina, through the endometrial cavity, in order to place gametes directly to the ampullary portion of the fallopian tube without the need for an operation or anaesthesia. In a first series two clinical pregnancies resulted from 8 transuterine transfers.

[Initial experiences with transvaginal vagino-sonographically controlled follicle aspiration in an in vitro fertilization program]. / Erste Erfahrungen mit der transvaginalen vaginosonographisch gesteuerten Follikelaspiration im IVF-Programm.

From March to May 1987 41 sonographically guided follicular punctures have been performed vaginally. Altogether 208 follicles were aspirated and 149 oocytes (71.7%) could be found. No complications like of bleeding or pelvic inflammatory disease have been observed after puncture. The sonographically guided aspiration technique has proved to possess several advantages in respect of its applicability.

[Long-term stability of enzymes in solution]. / Untersuchungen zur Langzeitstabilität von Enzymen in Lösung.

Two proteases (thermitase, a thermostable serine protease from Thermoactinomyces vulgaris and subtilisin Carlsberg) and one non-proteolytic enzyme (urate oxidase from Penicillium spp.) were used for revealing the main influences leading to the inactivation of enzyme preparations during their long-time storage at low temperatures. The temperature dependences (0 degree C-60 degrees C) of inactivation resulted in a linear Arrhenius-plot for each of the three native enzymes as well as in the presence of all stabilizing substances tested. Therefore, a method is available which shortens the time considerably needed for the experiments aimed at the discovery of substances stabilizing enzymes under storage conditions (i.e. long time at low temperatures). Because of the linear Arrhenius-plots potential stabilizers can be tested experimentally at suitable higher temperatures and one can extrapolate on their influence on the enzyme at storage temperatures (0 degree C-10 degrees C). By using this method effective combinations of stabilizers for urate oxidase were found, and possible reasons of their stabilizing influence on the enzyme are discussed.

[Diagnosis of follicle maturation and ovulation following hormonal stimulation using ultrasonography]. / Diagnostik der Follikelreifung und der Ovulation nach hormoneller Stimulation durch die Ultrasonographie.

10 patients with normal cyclus, 22 patients with FSH/HCG stimulated cyclus and 15 patients previous to laparoscopic puncture underwent ultrasound examination of follicle growth. The results were good reproducible. Ultrasonic examination of growing follicle should be done established continuously in cases of hormonal stimulation before laparoscopical puncture with regard to extracorporal fertilisation.

[Results of gonadotropin therapy in hypogonadotropic anovulation]. / Ergebnisse der Gonadotropintherapie bei hypogonadotroper Anovulation.

Combined FSH and HCG treatment was applied to patients in whom anovulation had been found to be the cause of sterility. Results were separately evaluated for patients in normal gonadotrophic conditions, on the one hand, and those in hypogonadotrophic conditions, on the other. They were compared with findings obtained from other groups between which no distinction had been possible due to the use of earlier methods for gonadotrophin determination. Lower RIA values for FSH or LH seemed to be more promising in terms of therapeutic success, with gravidity having been recorded from 44 per cent of hypogonadotrophic patients. The conclusion was drawn that prolactin-, FSH- or LH-RIA methods should be practicable for optimum treatment on a routine basis of patients with sterility due to anovulation. The data reported in this paper were derived from 54 patients in 117 therapeutic series.