[Long-term results after lunate replacement by the vascularised os pisiform for treatment of Kienböck's disease III b]. / Langzeitergebnisse nach Transposition des gestielten Os pisiforme zur Behandlung der Mondbeinnekrose Stadium III b.

Saffar's procedure is used only rarely today. In order to assess the value of this operation in the treatment of advanced Kienböck's disease, after a mean follow-up period of 19 years we could review 7 of 12 patients who had had their lunate replaced by the vascularised pisiform. At the time of follow-up all patients were fully employed without restrictions, and no patient had had to change his job. The mean DASH score was 5.9. The average pain level by VAS was 0.9 and four patients were totally free of pain. Grip strength of the affected arm was reduced to 77% of the opposite side, the active range of motion (extension/flection) was 97 degrees, which was 72% of that of the not affected side. All patients reported high satisfaction with the results of the operation. Although the clinical results were very good, we found substantial radiographical alterations: In 5 patients we found an advanced intercarpal osteoarthritis. Four patients presented a spontaneous synostosis between the pisiform and the triquetrum. The average CHR (carpal height ratio) was 0.43. The presented long-term results after lunate replacement by the vascularised pisiform indicate a high patient satisfaction and very good functional results in spite of significant radiological changes.

Gabapentin and carbamazepine affect eye movements and posture control differently: a placebo-controlled investigation of acute CNS side effects in healthy volunteers.

This prospective study examined the effects of the new antiepileptic drug (AED) gabapentin (GBP) compared to the standard AED carbamazepine (CBZ) and placebo (PLA) on eye movements, posture and finger force control in 12 healthy volunteers who received single doses of 600 mg GBP and 400 mg CBZ in a placebo-controlled, double-blind, cross-over, randomized trial. CBZ and GBP reduced almost equally (8% vs. 10%) the mean peak saccade velocity as compared to PLA (P < 0.05). CBZ, but not GBP, significantly prolonged the duration of saccades as compared to placebo (14-24%) (P < 0.05). GBP produced a greater maximal increase of body sway than CBZ with eyes open (P < 0.01) and eyes closed (P < 0.001). CBZ and GBP did not significantly influence control of grip force. CBZ effects were better correlated with plasma levels. Subjective side effects were more pronounced with CBZ than GBP. Although CBZ and GBP cause similar CNS side effects, the effects on eye movements and body sway were different. CBZ predominantly affects saccadic eye movements, whereas GBP had more impact on posture control. Thus, electro-oculography seems to be more appropriate in the detection of CBZ-induced side effects and posturography appears to be more sensitive in the detection of side effects associated with GBP.

Evaluation of ovarian tumors in postmenopausal women by transvaginal sonography.

OBJECTIVE: The aim of the present study was the evaluation of simple reproducible sonomorphological criteria for the preoperative evaluation of ovarian tumors in postmenopausal women by use of transvaginal sonography. STUDY DESIGN: Postmenopausal women (> or =1 year of secondary amenorrhea) with ovarian tumors (n=378; tumors > or =3 cm and <3 cm but with solid parts) were examined in a prospective study by transvaginal sonography prior to surgery between 1987 and 1993. The sonomorphological criteria were correlated with the histological findings of the tumors. RESULTS: Of all ovarian tumors in postmenopausal women, 6.3% were functional cysts (follicular or corpus luteum cysts). Almost all of them were detected within the first 5 years of postmenopause. The other ovarian tumors were diagnosed as retention cysts (17.5%), benign neoplasms (39.4%), and malignant tumors (36.8%). Simple ovarian cysts (monolocular, smooth inner wall) represented sonomorphologically the second most frequent type of ovarian tumors in postmenopausal women (35.7%). Of these tumors, 9.6% were diagnosed as malignant. CONCLUSIONS: Simple reproducible sonomorphological criteria proved to be a useful clinical parameter in the preoperative evaluation of ovarian tumors.

Preoperative evaluation of ovarian tumors in the premenopause by transvaginosonography.

OBJECTIVE: The aim of the study was to establish reproducible sonomorphologic criteria by use of transvaginosonography in the preoperative evaluation of ovarian tumors in the premenopause. STUDY DESIGN: In a prospective study from 1987 to 1993 we investigated 1072 ovarian tumors. All tumors > or = 3 cm were included in the study. To avoid unnecessary operations, all tumors we rescanned after 6 weeks. The sonomorphologic criteria were correlated with the histologic findings. RESULTS: A total of 4.3% of ovarian tumors in the premenopause were malignant. In the special group of sonographically simple ovarian cysts we found 0.8% malignancies. The incorporation of a control scan after 6 weeks in the management of ovarian cysts reduces the number of unnecessary operations on functional cysts. Only 5.5% of the functional tumors were operated on. The risk for malignancy in cystic-solid ovarian tumors is 17.0%, the highest of all sonomorphologic tumor types. CONCLUSIONS: The use of reproducible sonomorphologic criteria in combination with a control scan in premenopausal women with ovarian cysts proved to be efficient to reduce the number of unnecessary operations and to evaluate the risk for malignancy.