[Isolated metamorphopsia and visual pseudohallucinations in a patient with anti-NMDA receptor encephalitis]. / Isolierte Metamorphopsien und visuelle Pseudohalluzinationen bei einem Patienten mit Anti-NMDA-Rezeptor-Enzephalitis.

This article reports the case of a 40-year-old male patient with isolated metamorphopsia and visual pseudohallucinations lasting for 2 weeks. As the ophthalmological findings were not pathological, a further neurological examination was performed. After diagnosis of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, which can be manifested in various psychiatric, neurological and ophthalmological ways, the oligosymptomatic patient received high-dose corticosteroid treatment with intravenous immunoglobulins, which stopped the symptoms.

Hip resurfacing using a modified lateral approach with limited splitting of the gluteus medius muscle results in significant impairment of hip abductor strength.

BACKGROUND: A lateral, transgluteal approach for hip resurfacing carries the risk of approach-related weakening of the hip abductors due to unsuccessful re-adaptation of the gluteal muscles to the greater trochanter or to injury to the inferior nerve branch of the superior gluteal nerve. OBJECTIVE: We investigated whether hip resurfacing using a soft tissue-sparing, modified transgluteal approach with limited cranial splitting of the gluteus medius muscle reduces hip abductor strength and the risk of approach-related injury to the superior gluteal nerve. METHODS: Thirty-one patients (14 female, 17 male; mean age 53.5 ± 5.2 years) underwent hip resurfacing using a modified transgluteal approach with limited cranial splitting of the gluteus medius muscle. Nerve conduction signals were measured by surface electromyography (EMG), hip abductor strength by isokinetic testing a mean 36.2 months (± 11 mos) after surgery. The unoperated side was used as control. RESULTS: Surface EMG disclosed no neural lesions of the inferior branch of the superior gluteal nerve. Isokinetics revealed a significant reduction in muscle strength on the operated versus the contralateral side. CONCLUSIONS: Even a limited incision of the gluteus medius muscle resulted in significant impairment of hip abductor strength 2.5 years after surgery.

[Injuries, training and driving technique of competitive mountain-bikers]. / Verletzungen, Training und Fahrtechnik von Wettkampf-Mountainbikern.

INTRODUCTION: There are only a few studies about mountain-biking. These give a statistical review of injuries in recreational sports - sometimes related to competition sports. This study was performed to evaluate injuries, training and driving style of professional cross-country-mountain-biker. METHODS: 49 professional mountain-bikers from Germany, Austria and Switzerland were interviewed retrospectively by standardised questionnaire. RESULTS: Most commonly the cervical spine and knee (each with 25.7 %) as well as the lumbar spine (22.8 %) are affected by recurrent disorders (n = 101). These disorders are more common in the pre-season and at the end of the season. The most common fracture is the clavicula fracture (n = 15). Ligament and tendon injuries are less frequent (n = 3). Most drivers choose jogging and cross-country for compensation and stretching and massage for regeneration. A regular training for trunk strength accomplish 27 of 49 drivers. Most drivers accomplish a specific strength training in the pre-season, some drivers practise also during the season. DISCUSSION: Recurrent disorders in the cervical and lumbar spine and the knee are the most common disorders in competitive mountainbikers. Trunk training should be emphasised. Further research is needed to improve driving technique to account for the reported disorders of the musculoskeletal system.

Surgical or conservative treatment for chronic rotator cuff calcifying tendinitis--a matched-pair analysis of 100 patients.

Conservative or operative treatment for rotator cuff calcifying tendinitis was investigated in 100 patients in a matched-pair analysis. They were examined clinically and ultrasonographically 35-60 months after the initial visit. The mean Patte score was 91.8 for the patients who underwent surgical treatment and 81 for the ones who received conservative therapy (p < 0.004), while the age-related Constant-score was 103.4 and 95, respectively. Ultrasonography showed 28% calcifications in the surgical group, 18% newly formed and 10% that did not resolve after surgery. In the conservatively treated group, 33% calcifications were seen, of which 67% resolved. The number of rotator cuff ruptures was significantly higher in the conservative group. In the surgical group, 2% of partial tears and in the conservative group 5% of partial and 4% of complete cuff ruptures were found. Conservative treatment for calcifying tendinitis leads to less favourable pain results in the long term than surgical treatment. Surgery shortens the painful period and may reduce the number of future rotator cuff ruptures. Finally, the subjective functional outcome is significantly better after surgery.

[Calcifying subacromial syndrome--clinical and ultrasound outcome of non-surgical therapy]. / Kalzifizierendes Subakromialsyndrom--Klinische und sonographische Ergebnisse unter nicht-operativer Therapie.

PURPOSE: The aim of this study is to analyse the mid-term clinical and sonographical results of non-operative therapy of calcifying tendinitis. METHODS: Retrospectively the anamnestical, clinical and sonographical results after various non-operative treatment of patients with calcifying tendinitis were reviewed. For this purpose 159 patients with 178 calcifying deposits in the rotator cuff were evaluated on an average of 60 months after their first examination in our clinic (mean age: 49.2 years; sex ratio: 58% women). RESULTS: During a mean symptomatic period of 49 months, an average of 4.2 different therapeutic modalities were applied. After this time 70% of all patients showed an excellent or good result. With regard to the age-correlated Constant-Score 85% of all patients had more than 81 points, i.e. a good result. The mid-term results on a visual analogous scale from 10 (pain) to 0 (no pain) showed a decrease from 7.7 to 2.2 and this correlated with the shoulder function scores (Constant-/Patte-Score, r -0.8). After an average of 104 months 82% of the hydroxyapatite deposits could not be diagnosed by sonography (7.5 MHz.) anymore. CONCLUSION: In the treatment of calcifying tendinitis the conservative methods achieve good and excellent results in 70%. Patients should be treated with analgetics, subacromial injections, physiotherapy and ice therapy up to a period of twelve months, above all with small deposits and radiologic resorptive stadiums. The results of this study should be compared with any invasive regimen.

[Excimer laser coronary angioplasty after primary unsuccessful PTCA]. / Excimer-Laser-Koronarangioplastie nach primär erfolgloser PTCA.

Excimer laser coronary angioplasty is a new technique for ablation of coronary stenosis, however, the indications for its application are still controversial. We describe two male patients, 60 and 65 years old, who underwent unsuccessful balloon PTCA with a short, concentric and calcified coronary stenosis, although balloon inflation pressure was increased to a maximum in both cases. Excimer laser angioplasty following the failed procedures showed no evidence for tissue ablation angiographically, but a repeat attempt with balloon angioplasty was successful in both cases. Thus, laser angioplasty may be considered as an adjunct technique to balloon angioplasty after a failed PTCA in resistant, non-inflatable lesions.