[Proximal row carpectomy and replacement of the proximal pole of the capitate by means of a pyrocarbon cap (RCPI) in advanced carpal collapse]. / Die Resektion der proximalen Handwurzelreihe mit Ersatz des Kapitatum-Pols durch eine Pyrocarbonkappe (RCPI) beim fortgeschrittenen karpalen Kollaps.

The results of 5 patients suffering from advanced carpal collapse after proximal row carpectomy and replacement of the proximal pole of the capitate by means of a pyrocarbon cap are presented.5 patients with an average age of 40.2 years (23-66 years) suffering from advanced carpal collapse were treated by means of proximal row carpectomy and replacement of the proximal pole of the capitate between January 2005 and August 2008. Clinical and radiological follow-ups within an average post-operative period of 54.4 months (25-68 months) were conducted. For the assessment of the outcome the DASH score and the traditional Krimmer score were used.At the follow-up all patients were fully recovered and could expose the wrist to higher exertions. Radiologically the implants in 3 of 5 patients were found to be tight and at the original post-operative location in comparison with the post-operative X-rays. In 2 of 5 patients a mild seam of loosening was detected around the implant. In the traditional Krimmer score the patients reached 81 points (75-85 points) and in the DASH score 8 points (2.5-23.33 points).The described results of the present procedure define it as an alternative in treating patients suffering from advanced carpal collapse as far as evidence from this small collective can be considered. The small seam of loosening around implants in 2 of 5 patients suggests that we may expect further loosening of implants in the long run. Larger patient collectives are necessary to confirm these provisional results.

[The operative treatment of the dorsal distal phalanx near to the base (osseous pull out of the extensor tendon) with extreme exposure of the hand by athletic activities - is the hook plate a option for treatment?]. / Ist die Hakenplatte die geeignete Osteosynthese zur Versorgung der dorsalen Endphalanxbasisfraktur (knöcherner Strecksehnenausriss) beim Sportler mit starker Belastung der Finger?

AIM: Aim of the presented investigation was to work out the short- and mid-term outcomes after operative treatment of distal phalanx fractures near to the base of type Doyle IVb and IVc (osseous pull out of the extensor tendon) by means of a hook plate in patients with extreme exposure of the hand by athletic activities. PATIENTS AND METHODS: Between February 2002 and September 2009 77 patients were treated by operation in our hospital by means of a hook plate due to a traumatic fracture of the dorsal distal phalanx near to the base of type Doyle IVb and IVc (osseous pull out of the extensor tendon) by means of a hook plate (Aerni plate/S2-Prong-Plate) of Stryker Leibinger. 64 of these 77 patients incur the fracture while exercising sport. 46 of these 64 patients were clinically and radiologically followed up within a retrospective study. To assess the therapy's outcome a specific scoring scheme containing subjective and objective parameters was elaborated in order to gain a transparent result of the treatment. RESULTS: According to this scoring scheme 84.79 % of the patients reached a very good or good result. Nail growth defects by an intraoperative injury of nail matrix represents an essential complication of the presented surgical method. CONCLUSION: By means of the presented method in the majority of the cases good or very good results could be achieved. That method represents a simple, safe and less complicate possibility to treat the distal phalanx fractures near to the base type IVb and IVc according to Doyle and it is considered as a useful alternative to other procedures.

[The operative treatment of rhizarthrosis for patients with extreme exposure of the hand by athletic activities--is the trapeziectomy with interposition of an pyrocarbon spacer a option for treatment?]. / Die therapierefraktäre Rhizarthrose des Sportlers mit Belastung der oberen Extremität. Ist die Trapezektomie mit Interposition eines Pyrocarbonspacer eine Behandlungsoption?

PURPOSE: The rhizarthrosis is the most common degenerative joint disease of the hand. Incidence is detected around 10 %. For the treatment of rhizarthrosis different conservative and surgical methods are available. As many publications deal with the outcome of different surgical procedures. However there are no experiences in possibility of resuming an extreme exposure of the hand by athletic activities and the relevant timeframe between surgical treatment and the resumption as well as which of the competing surgical procedures you should suggest the patient. CASE REPORT: A female 46-year-old tennis player went to hospital in January 2005 with rhizarthrosis in stage 3 according to Eaton of the dominant right hand with pain during rest and exertion in the right basal joint. She was treated with trapeziectomy and interposition of a pyrocarbon spacer. Since the last clinical and radiological check in spring 2009, the patient is completely free of complaints and has resumed to play tennis 1 - 2 hours per day at tournament level. The correct position of the pyrocarbon spacer is radiologically verified while the joint space in the carpo-metacarpal joint is constant. CONCLUSION: The trapeziectomy with interposition of an pyrocarbonspacer is a worthfull alternative compared to other established operative techniques. The demonstrated casuistic proves that this treatment matches both the high and multiaxial stress on the first ray of athletes. Four dislocations in the examined collective and the price of the implant of 930 Euro has to be discussed critically.

Expression of prostaglandin E synthase in Barrett's cancer.

Expression of prostaglandin E synthase (PGES) - an enzyme of the prostaglandin biosynthetic pathway with suspected impact on carcinogenesis--was studied in Barrett's cancer to determine its pathogenetic role and prognostic impact in this entity. Expression analysis of PGES was performed on mRNA level (quantitative reverse transcription polymerase chain rection [RT-PCR]) in a large surgical series of 123 primary resected adenocarcinomas of the distal esophagus (Barrett's cancer). Gene expression results were correlated with clinical parameters, overall survival and expression levels of previously analyzed target genes of the cyclooxygenase (COX) pathway (COX-1, COX-2) and mediators of angiogenesis (vascular endothelial growth factor [VEGF]-A) and lymphangiogenesis [VEGF-C]. Expression of PGES was demonstrated in all 123 tumors (100%) on mRNA level (quantitative RT-PCR). Relative mRNA expression levels were highly variable between different cases. Gene expression showed a strong positive correlation with both COX isoforms (COX-1: r = 0.502, P < 0.001; COX-2: r = 0.679, P < 0.001), with the angiogenetic VEGF-A (r = 0.583, P < 0.001) and with the lymphangiogentic VEGF-C (r = 0.465, P < 0.001). PGES mRNA expression showed no significant correlation with clinicopathologic parameters (i.e. pTNM categories, UICC stage, survival). Variable overexpression of PGES seems to be potentially implicated in Barrett's carcinogenesis. Gene expression of PGES is strongly correlated with other mediators of the prostaglandin biosynthetic pathway, that is both COX isoforms (COX-1 and COX-2). However, no impact on patients' outcome in relation to PGES expression was found.

Reverse engineering of dynamic networks.

We consider the problem of reverse-engineering dynamic models of biochemical networks from experimental data using polynomial dynamic systems. In earlier work, we developed an algorithm to identify minimal wiring diagrams, that is, directed graphs that represent the causal relationships between network variables. Here we extend this algorithm to identify a most likely dynamic model from the set of all possible dynamic models that fit the data over a fixed wiring diagram. To illustrate its performance, the method is applied to simulated time-course data from a published gene regulatory network in the fruitfly Drosophila melanogaster.