[Cervical spine trauma in patients with trisomy 21]. / HWS-Trauma bei Patienten mit Trisomie 21.

Atlantoaxial subluxation is predominantly found in trisomy 21. While neurological symptoms occur less frequently, fatal atlantoaxial instability with spinal cord compression has been described in trisomy 21 after minor trauma of the cervical spine. Presenting a special case we could demonstrate that atlantoaxial instability has to be ruled out in patients with trisomy 21 suffering from acute cervical spine trauma. We further recommend primary posterior fusion if the biomechanical stability of the atlantoaxial complex remains unclear after clinical and radiological exploration.

[Experiences with the classic nail in management of per-/subtrochanteric femoral fractures in elderly patients]. / Erfahrungen mit dem Classic-Nagel bei der Versorgung von per-/subtrochanteren Femurfrakturen beim alten Menschen.

In the department of trauma and reconstructive surgery at the University Hospital of Hamburg-Eppendorf (UKE) the surgical treatment of unstable per- and subtrochanteric femoral fractures (AO 31A2 and 31A3) in elderly patients with severe osteoporosis includes the implantation of dynamic hip screws (DHS) and gamma nails, as well as the straighter "classic nails". Using 43 short and 15 long classic nails, 58 fractures in seven women and 51 men, respectively, with an average age of 85 years (65-98 years) were stabilized over the last 2 years with good results (98.3% primary full weight bearing). In order to facilitate implantation of the longer nails, additional antetorsion of the femoral neck screw and improvement of the distal interlocking have been developed by the manufacturer.

[A comparative study of the characteristics of femoral hip prosthesis heads--study and results ceramic-coated hip joint heads of titanium]. / Eine Vergleichsstudie zur Oberschenkelbeschaffenheit von Hüftprothesenköpfen--Untersuchung und Ergebnisse cerid-beschichteter Hüftgelenkskugeln aus Titan.

Today, only hard/soft cup and femoral head combinations are employed for hip joint prostheses. Highly polished ceramic is a material with very good tribological properties for femoral heads, being highly resistant to mechanical wear and tear, and highly resistant to chemical reactions in the biological environment. The advantage of metal heads, in contrast, undoubtedly lies in their resistance to breakage and the ease with which their geometry can be modified with respect, for example, to antirotation angle and neck length. The ideal material for femoral heads is a combination of the two materials. The new multi-layer combination of titanium-niobium oxide/nitride ceramic coating applied to a prehardened titanium head combines the positive material properties in an ideal manner. Femoral heads made of CoCrMo, oxide-hardened titanium, aluminium oxide or multilayer titanium-niobium ceramic were compared by means of friction an wear and tear tests. The TiNb-ceramic-metal heads showed similar abrasion at the surface as the ceramic heads. At the high loads of more than 400 kp, which may also be reached under physiological conditions, the specially coated titanium-ceramic heads proved to be superior in terms of resistance to fracture and tribological properties.

[Monteggia injuries. Therapy and late results in 204 cases]. / Monteggia-Verletzungen. Therapie und Spätergebnisse von 204 Fällen.

A follow-up check of 204 Monteggia fracture-dislocation in two clinics showed that in 84% of the cases an operative treatment led to good functional late results. In 65% of the patients treated conservatively, the mobility of the elbow was evidently limited. Plate fixation has been proved to stabilize ulna fractures, a suture of the anular ligament was in the majority of cases not required.

[Arteriovenous fistula of the superior mesenteric artery after resection of the ileum]. / Arteriovenöse Fistel der A. mesenterica superior nach Ileumresektion.

Acquired arterio-venous fistulas of the superior mesenteric artery are a rare event following abdominal injuries or surgery. Clinical symptoms present as cramplike abdominal pain and diarrhea with a history of previous laparatomy or a penetrating abdominal trauma. The clinical examination may reveal a paraumbilical pulsation with flow murmur. The exact localization and the extent of the a.-v.-fistula may be established by selective arterial mesentericography. An urgent vascular reconstruction is indicated in order to prevent secondary alterations due to portal hypertension. Apart from vascular surgery, successful percutaneous catheter embolization has been reported.

[Insulin reserve and morphology of the tail of the pancreas following resection of the head of the pancreas using various surgical methods]. / Insulinreserve und Morphologie des Pankreasschwanzes nach Pankreaskopfresektion bei unterschiedlichen Methoden der Versorgung.

Four modifications of dealing surgically with the remaining pancreas after resection of the pancreatic head were compared to each other in dogs. Insulin response and corresponding blood sugar levels were controlled, the remaining pancreas was examined histologically. The obstruction of the pancreatic ducts by prolamine showed mainly sclerosis of the exocrine tissue whereas the duct ligation was followed by atrophy. The free intraperitoneal draining of the duct system showed both alterations, the pancreatojejunostomy did hardly impair the exocrine pancreas. According to the grade of sclerosis of the exocrine tissue, the insulin response was delayed followed by a pathologic glucose tolerance. This was shown particularly for the obstruction of the ducts by prolamine.

[Intravenously stimulated insulin reserve of the pancreas following experimental pancreatic duct ligation in the swine--studies 2, 4 and about 60 days following ligation]. / Die intravenös stimulierte Insulinreserve des Pankreas nach experimenteller Pankreasgangligatur beim Schwein--Untersuchungen 2, 4 und etwa 60 Tage nach Ligatur.

After pancreatic duct ligation (PDL) intravenous glucose tolerance tests (i.v. GTT) were performed in 12 pigs. The release of insulin and the corresponding blood sugar levels were controlled, the pancreata were examined histologically and immunohistochemically. In spite of a reduced number of beta-cells no reduction of glucose tolerance could be shown 60 days after PDL. Two days after the i.v. GTT showed an increased release of insulin corresponding with lowered blood sugar levels. This phenomenon is explained as a stimulated state of the beta-cell in the phase of interstitial edema.