[Pedicled vascularized bone graft for scaphoid reconstruction after Zaidemberg]. / Das gestielte vaskularisierte Knochentransplantat zur Skaphoidrekonstruktion nach Zaidemberg.

BACKGROUND: Nonunion of the scaphoid as a result of proximal fractures, failed surgical reconstruction, and especially avascular fragment necrosis are possible indications of vascularized bone grafts. Various techniques of vascularized (pedicled and free) grafts have been described. Pedicled grafts from the direct vicinity of the wrist provide several benefits. Harvest-site morbidity is reduced and preserved graft perfusion, without the need for blood vessel anastomosis, may lead to an improved consolidation. METHODS: A common pedicled vascularized bone graft for reconstruction of the scaphoid was first described by C. Zaidemberg and colleagues in 1991. We describe 49 consecutive patients, who underwent vascularized bone-grafting, pedicled on the 1.2 intercompartmental, supraretinacular artery in a modified technique based on Zaidemberg's description. The fixation of the bone graft was performed by Kirschner wires. RESULTS: A consolidation was detected in 37 cases, and 9 cases showed a persistent nonunion (3 patients did not follow up). According to the classification of Herbert, 44 patients had a nonunion grade D2 or higher, of which 36 patients showed a bony consolidation (8 non-consolidated). Complications occurred in individual cases (1x intraoperative fracture of the radius, 4x transient irritations of the superficial branch of the radial nerve). A loss in the range of motion of the affected wrist was frequent. An indication for a pedicled graft was seen if the preoperative contrast-enhanced MRI showed an impaired perfusion of scaphoid fragments. DISCUSSION: The more advanced the changes in MRI, the more frequently treatment failed. The vascularized bone graft from the dorsal distal radius described by C. Zaidemberg et al. is one of several ways to address a circulation-impaired nonunion of the scaphoid.

[Scaphoid pseudarthrosis : Indications for avascular iliac crest or radius bone grafts]. / Skaphoidpseudarthrose : Indikationsbereiche für das avaskuläre Beckenkamm- oder Radiustransplantat.

BACKGROUND: Operative treatment of the scaphoid nonunion includes avascular corticocancellous and cancellous bone grafts and increasingly the use of vascular pedicled and free vascular corticocancellous grafts. Especially the latter require a fair amount of operative expertise and experience in microsurgical techniques. OBJECTIVE: Which criteria lead to the decision for or against an avascular graft used for reconstruction of scaphoid nonunion? Is our current classification system of a scaphoid pseudarthrosis able to illustrate our diagnostic potential in a way that makes us refer to operative procedures? METHODS: Evaluation of current literature and expert opinions RESULTS: Avascular bone grafts show a high union rate as long as a sufficient vascularisation of the remaining fragments is present. In general, patients benefit from a very good functional outcome. Even revisions of failed scaphoid union may be successfully treated with an avascular bone graft. Failures of union are repeatedly experienced in treating proximal pole fractures with critical vascularisation or extensive bone loss, especially including avascular necrosis of the proximal pole (AVN). Current classification systems do not allow description and correlation of morphologic findings so as to compare results profoundly and to recommend specific procedures. CONCLUSIONS: As long as sufficient vascularisation of remaining fragments is seen, the avascular bone graft is eligible for reconstructing scaphoid nonunion. Classification systems do not seem to reflect the status quo of diagnostic possibilities and make it difficult to provide guidelines for state-of-the-art operative procedures.

Internet use in rheumatology outpatients in 2006: gender less important.

OBJECTIVE: Exploring patients' Internet use, their online needs and requirements, expectations and attitudes towards the Internet is mandatory to effectively provide interactive online applications and information. METHODS: Within a prospective study, 153 consecutive outpatients with rheumatoid arthritis, systemic lupus erythematosus or spondyloarthritis answered a paper-based questionnaire investigating their Internet use, interests, pattern and degree of utilization. Sociodemographic and functional disability data were collected. The data were compared with our survey of 2001 and to the normal German population. RESULTS: Patients were predominantly female (69.3%; n.s.). Mean age was 45.7+/-14.4 years (n.s.). 68.6% (+18.6%, p=0.0027) reported regular Internet use for 5.0+/-2.6 yrs. Internet use in 2006 is still age- and education-dependent (p<0.001, p=0.003). Differences by gender observed in 2001 no longer existed as women increased their Internet use from 2.9 to 6.1 hours/week (p=0.001, p=0.0006). Searching for health-related information remained an important topic. Interest in e-communication and interactive applications strongly increased. Independently of gender and functional disability, patients' future online interests focussed on information on diseases, medications, health care providers and patient education. Confidence in the Internet and reliability of information were rated unchanged since 2001. CONCLUSION: Gender no longer has significant impact on Internet use. The great potentials of Internet services-well accepted by patients and contributing substantially to more effective and improved disease (self-) management strategies-should encourage rheumatologists to provide interactive applications and high-quality information on Internet platforms and in routine patient care. Continuous research to explore the effects of Internet-delivered information on patients' attitudes,expectations, behaviour and outcome is required.

Self-assessments of patients via Tablet PC in routine patient care: comparison with standardised paper questionnaires.

OBJECTIVE: We evaluated the feasibility of electronic data capture of self-administered patient questionnaires using a Tablet PC for integration in routine patient management; we also compared these data with results received from corresponding paper-pencil versions. METHODS: Standardised patient questionnaires (FFbH/HAQ, BASDAI, SF-36) were implemented in our documentation software. 153 outpatients (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthritis) completed sets of questionnaires as paper-pencil and electronic versions using a Tablet PC. The quality and validity of data obtained using a Tablet PC and the capability of disabled patients to handle it were assigned; patients' experiences, preferences and computer/internet use were also assessed. RESULTS: Scores obtained by direct data entry on the Tablet PC did not differ from the scores obtained by the paper-pencil questionnaires in the complete group and disease subgroups. No major difficulties using the Tablet PC occurred. 62.1% preferred remote data entry in the future. Seven (4.6%) patients felt uncomfortable with the Tablet PC due to their rheumatic disease. CONCLUSIONS: Self-administered questionnaires via Tablet PC are a facile and capable option in patients with rheumatic diseases to monitor disease activity, efficacy and safety assessments continuously. Tablet PC applications offers directly available data for clinical decision-making improves quality of care by effective patient monitoring, and contributes to patients' empowerment.

Periodontal therapy in siblings with Papillon-Lefèvre syndrome and tinea capitis: a report of two cases.

OBJECTIVE: Report of clinical and microbiological periodontal findings before and 6 months after treatment of two siblings with Papillon-Lefèvre syndrome (PLS) and tinea capitis. METHODS: Two brothers, RG 3 years and NG 5 years of age, were referred for treatment due to premature mobility of their deciduous teeth. Probing depths (PPD), attachment levels (PAL-V), and furcation involvements were examined clinically. Panoramic radiographs were taken. Subgingival plaque samples within the deepest pocket of each tooth were taken and analysed by real-time polymerase chain reaction (PCR) for Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Fusobacterium nucleatum, and Prevotella intermedia. One-stage full-mouth scaling and extraction of hopeless teeth were performed under general anaesthesia, followed by systemic amoxicillin and metronidazole for 7 days. Clinical and microbiological analyses were performed 6 months after treatment. RESULTS: Before treatment, both siblings had exhibited PPD of up to 13 mm, Class III furcation defects at four teeth, and marginal suppuration. AA was detected in both patients and at all teeth at levels ranging from 3.0 x 10(2) to 5.1 x 10(6). Both patients exhibited palmar and plantar hyperkeratosis. Seven teeth were extracted from RG, and nine from NG. Six months after treatment, PPD had been reduced to

Expression and purification of human recombinant GST-FGF receptor-1.

When tumors undergo the angiogenic switch, cell growth and tissue invasion is facilitated by the formation of new capillaries from preexisting blood vessels, a process known as angiogenesis. Growth factors such as vascular endothelial growth factor/vascular permeability factor (VEGF/VPF) and fibroblast growth factor (FGF) trigger the process of angiogenesis. Here we describe a protocol for the expression and one-step purification of human recombinant GST-FGF receptor type 1 (FGFR-1) from Sf9 cells. This protocol allows generating an active kinase as indicated by its reactivity with a monoclonal antibody to phosphorylated tyrosine. The purified enzyme displays a specific activity of 1.2 x 10(4) pmol mg(-1) min(-1), which is in the range of activities reported for homogeneously purified recombinant kinases. We have employed a number of compounds to show that the GST-FGFR-1 preparation is suitable to the identification of tyrosine kinase inhibitors. Considering that inhibitors of angiogenesis may represent an attractive tool in therapeutic strategies targeting invasive metastatic tumors the results presented here, along with available data on the structure of the ATP-binding pocket of FGFR-1, should facilitate the rational design of specific FGFR-1 inhibitory compounds.

Homogeneous purification of human recombinant GST-Akt/PKB from Sf9 cells.

The plethora of extracellular stimuli modulating the status of a cell results in the engagement of relatively few pathways responsible for transducing signals to the interior of the cell. One such pathway is the activation of phosphatidylinositol 3-kinase (PI-3K), which results in the generation of a membrane-restricted second messenger, polyphosphatidylinositide 3'-phosphate. Among the enzymes activated by 3'-phosphorylated inositol lipids is Akt/protein kinase B (PKB). Here we describe a protocol for the expression and one-step purification of human recombinant GST-PKB in Sf9 cells. This scheme allows generating large amounts of homogeneously purified GST-PKB with high specific activity to be employed in high-throughput screening or structural studies.

[Relation among oral hygiene, caries and gingivitis in 4-and 5-year old children in Frankfurt/Main area]. / Beziehung zwischen Mundhygiene, Karies und Gingivitis bei 4-und 5jahrigen Kindern im Raum Frankfurt/Main.

Caries and gingivitis are plaque-induced diseases. There is no doubt a correlation between the degree of oral cleanliness and the incidence of caries and gingivitis in school children and adults. Scientific information on such a correlation in pre-school children four and five years of age, however, is only scarce. Therefore, 345 children of this age group were examined and scored for plaque, gingivitis as well as toothloss, caries and fillings. There was clearly a correlation between the degree of oral hygiene and caries and gingivitis. Children of the five-year age group were more severely involved than the four-year olds. Dental examinations of pre-school children are, according to our experience, mainly concerned with recording dental caries and toothloss. Too little emphasis is usually paid to oral hygiene status and the presence of gingivitis. The data of our study suggest that by positively influencing the oral hygiene habits of young children, not only the incidence of tooth decay can be reduced but, at the same time, the appearance of gingival inflammation can largely be prevented. This may have a positive effect on the incidence of periodontal disease during later periods of life.

Rapid method for determining the beta-lactamase-inducing potency of drugs.

A rapid semiquantitative method for determining the beta-lactamase inducing potency of drugs was developed. Bacteria carrying a gene for inducible beta-lactamase expression were inoculated at a concentration of 10(8) CFU/ml into microtiter plates for determination of MICs, which were recorded after 4 h of incubation. A suitable chromogenic beta-lactamase substrate was then added, and after incubation for another 3 h colour changes were monitored.

Ultrasonic disintegration of bacteria may lead to irreversible inactivation of beta-lactamase.

When ultrasonic disintegration of bacteria was employed to liberate intracellular beta-lactamases there was rapid and irreversible inactivation of the type-Id beta-lactamase from Pseudomonas aeruginosa. Various type-V beta-lactamases (PSE-2, 3 and 4) from P. aeruginosa, as well as Enterobacter cloacae type-Ia beta-lactamase were much less affected by sonication. None of the beta-lactamases was inactivated by French Press disruption. We suggest that French Press disruption should be the method of choice for the release of beta-lactamases, unless the enzyme in question is known to be unaffected by ultrasonic treatment.

Outer membrane permeability and beta-lactamase content in Pseudomonas maltophilia clinical isolates and laboratory mutants.

Low outer-membrane permeability appears to be responsible for the generally high degree of antibiotic resistance of Pseudomonas maltophilia. Constitutive overproduction of beta-lactamases affects the sensitivity of these bacteria only to those beta-lactam antibiotics that are hydrolyzed by strain-specific beta-lactamases and that do not efficiently induce these enzymes in inducible strains.

Interaction of the novel penem CGP 31 608 and its enantiomer with type Id beta-lactamase and penicillin-binding proteins.

The novel penem CGP 31,608 (5R, 6S, 8R) and its enantiomer CGP 32,879 (5S, 6R, 8S) were shown to be essentially stable against hydrolysis by type Id beta-lactamase isolated from Pseudomonas aeruginosa 18S/H. CGP 31 608 was a potent progressive inhibitor of this enzyme (150 = 32 microM), which was only weakly inhibited by CGP 32,879 (150 = 460 microM). CGP 31,608 had the highest affinity for penicillin-binding protein (PBP) 4 from Escherichia coli K-12 (150 = 1 microgram/ml), followed by PBPs 2 (10 micrograms/ml) and 1A/1Bs (100 micrograms/ml); CGP 32,879 did not inhibit binding of 14C-benzylpenicillin to the PBPs. The steric configuration of the beta-lactam nucleus of penems appears to strongly influence their affinity for beta-lactamases and target PBPs. The balanced spectrum of CGP 31,608 may be explained by its beta-lactamase stability and affinity for several vital PBPs.