Obstacles to reduction in infantile developmental dysplasia of the hip.

PURPOSE: Identification of anatomical structures that block -reduction in developmental dysplasia of the hip (DDH) is -important for the management of this challenging condition. Obstacles to reduction seen on arthrogram are well-known. However, despite the increasing use of MRI in the assessment of adequacy of reduction in DDH, the interpretation of MRI patho-anatomy is ill-defined with a lack of relevant literature to guide clinicians. METHOD: This is a retrospective analysis of the MRI of patients with DDH treated by closed reduction over a five-year period (between 2009 and 2014). Neuromuscular and genetic disorders were excluded. Each MRI was analysed by two orthopaedic surgeons and a paediatric musculoskeletal radiologist to identify the ligamentum teres, pulvinar, transverse acetabular ligament (TAL), capsule, labrum and acetabular roof cartilage hypertrophy. Inter- and intraobserver reliability was calculated. The minimum follow-up was 12 months. RESULTS: A total of 29 patients (38 hips) underwent closed reduction for treatment of DDH. Eight hips showed persistent subluxation on post-operative MRI. Only three of these eight hips showed an abnormality on arthrogram. The pulvinar was frequently interpreted as 'abnormal' on MRI. The main obstacles identified on MRI were the ligamentum teres (15.8%), labrum (13.1%) and acetabular roof cartilage hypertrophy (13.2%). The inter-rater reliability was good for TAL, capsule and pulvinar; moderate for ligamentum teres and labrum; and poor for hypertrophied cartilage. CONCLUSION: The labrum, ligamentum teres and acetabular roof cartilage hypertrophy are the most important structures seen on MRI preventing complete reduction of DDH. Focused interpretation of these structures may assist in the management of DDH.

Encouraging treatment algorithm for computer-assisted navigated total knee arthroplasty (TKA): A retrospective cohort analysis.

OBJECTIVE: Navigated computer-assisted total knee arthroplasty (TKA) shows inconclusive mid- to long-term outcome results and is limited by increased costs, surgery-time and an additional learning curve. We introduced a treatment algorithm preserving computer-assisted TKA for patients with adipositas-per-magna, posttraumatic leg-deformities, osteosynthetic material in-situ or reduced preoperative X-ray quality. METHODS: 237 primary unilateral TKA were allocated based on the treatment concept described above. A retrospective pre- and postoperative radiological analysis was performed. RESULTS: 222 TKA (93.7%) were within 3° varus/valgus of mechanical-lower-limb axis (mean absolute deviation: 1.8° ± 1.3°). CONCLUSION: This algorithm showed an excellent postoperative implantation-accuracy based on an accurate preoperative surgery-planning.

Treatment with insulin-like growth factor I alters capillary permeability in skin and retina.

Treatment with insulin-like growth factor I (IGF-I) is accompanied by mild generalized and reversible edema. These changes may be due to increased capillary permeability. Therefore, we studied the effects of subcutaneous IGF-I treatment in healthy subjects on capillary permeability of the skin and the retina. Eight healthy subjects were treated with saline or recombinant human IGF-I (rhIGF-I) (10 micrograms.kg-1.h-1 s.c.) in a randomized crossover fashion. Transcapillary diffusion of sodium fluorescein (NaF) was quantitated by video densitometry in the skin in all subjects on the 4th treatment day. In seven subjects, plasma penetration of NaF at the blood-retinal barrier was investigated using vitreous fluorometry (VF) on days 3 and 5. Fluorescent light intensities of the skin and plasma penetration determined by VF were significantly higher during the IGF-I treatment as compared with those during the control situation. In conclusion, IGF-I treatment at the above dose is accompanied by increased transcapillary diffusion of NaF in skin and in retinal vessels.

Carotenoid replacement therapy in Drosophila: recovery of membrane, opsin and visual pigment.

Rhabdomeres are substantially smaller and visual pigment is nearly eliminated when Drosophila are carotenoid-deprived from egg to adult. Rhabdomeres enlarge and visual pigment increases with carotenoid replacement in adults using carrot juice. We used a monoclonal antibody to the opsin in R1-6 receptors in the compound eye to further quantify opsin recovery in such carotenoid replacement therapy. Density of immunogold, specific to R1-6 (vs. R7), increases between days 1 and 3 of replacement as visual pigment and rhabdomeres recover. In summary, visual pigment, opsin and the opsin-containing organelle recover during carotenoid replacement therapy in carotenoid-deprived Drosophila.

Microphotometric, ultrastructural, and electrophysiological analyses of light-dependent processes on visual receptors in white-eyed wild-type and norpA (no receptor potential) mutant Drosophila.

We examined a white-eyed strain of the norpA mutant (norpA;cn bw) and white (w)norpA+ controls using microspectrophotometry (MSP), electron microscopy (EM), and electroretinography (ERG). These studies revealed that light mediates receptor demise in norpA even though norpA lacks phototransduction. Rhodopsin and the rhabdomere which houses it decrease with increasing age in norpA but not in w with rearing on a 12 h light/12-h dark cycle or in constant light. At higher temperature in norpA;cn bw and w reared in constant light, visual pigment decreases, rhabdomeres diminish, and cells die. Importantly, dark rearing blocked visual pigment loss in norpA;cn bw; the M-potential, an ERG reflection of visual pigment level, corroborated this finding. MSP showed that norpA's visual pigment loss was not due to acute loss of metarhodopsin, rhodopsin's photoproduct. NorpA blocks certain processes expected to be light elicited. The alteration of visual pigment as a function of time of day, present in w controls, is absent in white-eyed norpA, suggesting that light-induced depolarization may be necessary to entrain the rhythm. Microspectrofluorometry using the fluorescent dye, Lucifer yellow, suggested that norpA lacks a light-induced uptake mechanism; using control flies, we determined the stimulus parameters required for uptake in vivo. An attempt to "cure" norpA;cn bw by replacement "therapy" using phospholipase C, missing in norpA's phototransduction cascade, was largely unsuccessful.

[Experiences with an integrated psychological therapy program for training communication and cognitive abilities in the rehabilitation of severely ill chronic schizophrenic patients]. / Erfahrungen mit einem integrierten psychologischen Therapieprogramm zum Training kommunikativer und kognitiver Fähigkeiten in der Rehabilitation schwer chronisch schizophrener Patienten.

A therapy study was conducted with 17 seriously chronically ill schizophrenic patients. Ten patients (Experimental Group) received a psychological therapy program of training in cognitive and communication/social skills (58 sessions of 60 min.). Seven further patients constituted a Control Group. Researched was the question of the potential for change of basic disorders respectively symptoms, and its effect on social behavior. In individual cases significant changes were recorded. As to the therapeutic effects, significant findings were obtained only conditionally. Implications and consequences are discussed in the résumé.

[Treatment with dimethylaminoethanol (deanol) in neuroleptic induced tardive dyskinesia]. / Zur Therapie mit Dimethylaminoäthanol (Deanol) bei neuroleptikainduzierten Spätdyskinesien.

A double blind cross-over study of 20 patients wiht tardive dyskinesia due to chronic use of neuroleptics showed no difference between efficacity of Deanol (Deaner) and placebo. Several patients improved with Deanol (Deaner), whereas several other patients showed increasing dyskinesia. The same phenomenon could be observed in the placebo group. Tolerance of the compound was very good. Results of an additional open study however suggest that the administration of Deanol (Deaner) may be tried as long as no other means are available to define those patients who will react favorably to this medication.