Potential therapeutic targeting of platelet-mediated cellular interactions in atherosclerosis and inflammation.

Cellular interactions among platelets, leukocytes and endothelial cells are considered as a major cause of inflammation and atherosclerosis in many diseases. Via exposed surface receptors and released soluble substances, activated platelets play a crucial role in the initiation of inflammatory processes, resulting in endothelial injury and leading to formation of atherosclerotic plaque with possible thrombotic complications. Classic anti-platelet treatments (e.g. cyclooxygenase inhibitor or ADP-receptor antagonist) have favorable effects in patients with vascular diseases, but they also have several limitations such as increased bleeding risk or non-responsiveness. Thus, the need and opportunities for developing novel therapeutic inhibitors for platelet-mediated events are obvious. Animal and (pre)clinical human studies have suggested that some recently produced specific antagonists of P-selectin from α-granules, as well as its main ligand/receptor P-selectin Glycoprotein Ligand-1, the two major platelet chemokines CXCL4 and CCL5, as well as CD40L, may be considered potential new candidates in the treatment of atherogenesis and inflammation. In this review, we summarize the pathophysiological roles of these effectors in platelet activation and acute or chronic inflammation, and discuss the latest findings on promising antagonistic agents in basic and clinical studies in the prevention of platelet-mediated cellular interactions.

Results of humeral stump angulation osteotomy.

Between 1972 and 1989 angulation osteotomy was performed on 61 patients with long humeral stumps at the Orthopaedic Hospital of Heidelberg University. Marquardt's surgical technique was used to improve function in patients who had undergone above-elbow amputation and in children with a risk of terminal osseous overgrowth. Thirty-one patients with 43 angulation osteotomies were followed up. Of the 10 adults followed up, the osteotomy had not straightened, whereas with the 33 angulation osteotomies in children, one had straightened out within 6 months, seven within 12 months and a further 12 up to 24 months after surgery. The only recognizable reason for this difference was the patient's age depending on whether humeral growth was not yet completed. Marquardt's angulation osteotomy, however, is still the only surgical technique that improves humeral stump function, providing a rotation-stable humeral prosthesis and a free-moving shoulder joint.

Follow-up results 20 years after surgical treatment of habitual ventral shoulder luxation using the Eden-Lange technique.

After undergoing an operation according to the Eden-Lange technique, 56 patients with recurrent anterior shoulder luxation were re-examined clinically at an average follow-up period of 20 years. The mean age of the patients at the time of the operation was 24.9 years; the ratio of male to female patients was 2.3:1. The Ellman score (maximum of 27 points), stability tests, reluxation rate and X-ray examinations served as re-examination criteria. The mean score for the Ellmann test was 18.3 points; 29 patients had ventral instability. In the meantime 11 shoulders had redislocated. Fifty-one patients had arthrotic alterations in the operated shoulder. Because of the unsatisfactory functional and radiographical results, the Eden-Lange technique can no longer be accepted as the only treatment of choice for anterior shoulder dislocation.

Hip joint congruence: experimental studies.

Three-dimensional imaging of hip joint preparations was carried out by means of computed tomography (CT). On the assumption that the head of the femur and acetabulum are incongruent, a special experimental design was used to quantify the extent and direction of the gliding movement of the head and socket. A series of CT images in the supine and prone positions was made from hip preparations, and the cartilage was visualized by injecting a contrast medium. In all the preparations dorsal movement was noted in the supine position, and ventral movement in the prone position. Cryomicrotome slices of the hip preparations were used to verify the results of our CT scans and the measurements correlated with the anatomical examinations. Thus, there is a certain amount of play in the hip joint-it is not an ideal ball-and-socket joint. This knowledge is important for the planing and success of hip adjustment surgery.

A computertomographic study on the congruence of the hip joint.

This study describes investigations into the appearance of intra-articular spaces of hip joints. In CT scans of cadaver hip joints in the supine position an increased intra-articular space was found dorsally, while in the prone position the same hip joint showed an increased intra-articular space ventrally. It is assumed generally that the gap between the bone ends seen on plane X-rays represents the cartilage, but this study indicates that there may in fact be a space between the cartilage surfaces in the unloaded joint.

[Wedge osteotomy of the tibial head using fractionated drilling. A complication-reducing surgical modification]. / Tibiakopfvalgisation durch fraktionierte Bohrosteotomie. Eine komplikationssenkende Operationsmodifikation.

Two techniques of closed wedge osteotomy of the proximal tibia in 132 cases using external fixation device were compared retrospectively for neurological complication rate. While in group 1 (n = 89) wedge osteotomy was performed conventionally using an oscillating saw, in group 2 (n = 43) osteotomy was done with consecutive drill holes of increasing diameter followed by osteoclasis. Neurological complications in group 1 were found postoperatively 15.7% (transient) and after 7 months follow-up time in 12.4% (persistent), in group 2 14% transient and 4.7% persistent neurological deficits were registered. The lower complication rate in group 2 is due to the reduction of postoperative tibialis anterior syndrome (type B lesions). No differences for type C lesions (extension deficit of D1) were found. No complete peroneal palsy (type A) occurred in either group. The authors conclude that reduction of neurological complications in group 2 is related to the less extensive approach of the proposed technique.

[Cementless cup anchorage in hip endoprostheses. Comparative study of 3 cup systems with titanium surface]. / Zementlose Pfannenverankerung bei Hüftendoprothesen. Vergleichende Untersuchung dreier Pfannensysteme mit Titanoberfläche.

A wealth of commercially available hip endoprotheses makes it difficult for the practitioner to choose the best implant for each individual case. In a multi-centre study, in which 22 hospitals took part, a cementless stem was used 1172 times and was combined with 3 different cementless cup components. The follow up period ranged from 1-8 years. In 321 cases the spherical Mecring cup, in 208 cases the spherical CLS-expansion cup and in 643 cases the conical Weill-ring was implanted. The predominant indication for the THR was primary coxarthrosis (767 patients). Evaluation of clinical results was based on the Merle d'Aubigné score. Good or excellent results were found in 82% for the Mercring, in 85% for the Weill-ring and in 91% when the CLS-expansion cup was used. Whereas 88% of the patients with the Mecring or Weill-ring had minimal or no pain, 94% of the patients had minimal or no pain when the CLS-expansion cup was implanted. Aseptic loosening was found in 1.25% for the Mecring and 1.5% with the Weill-ring. In the CLS-expansion cup group, 2 cases with radiological signs of loosening were seen, but neither patient required revision. The CLS-expansion-cup with the press fit system shows better medium follow-up results in this study, than the Mecring or Weill-ring systems.

[Exchange of endoprosthesis using a proximal femur resection prosthesis]. / Endoprothesenwechsel mittels proximaler Femurresektionsprothesen.

Total hip arthroplasty (THA) with the use of a Mega prosthesis was performed on 24 patients with significant loss of bone stock in revision THA. A clinical and radiological examination was carried out according to the Enneking evaluation scheme on average 7 years after THA. Pain, active hip motion and strength of hip muscles, walking ability, and activities of daily living rated excellent or good and compared well with the results following conventional THA. Limp and positive Trendelenburg sign were common to all except one after Mega prosthesis implantation and were independent on the type of refixation of the hip abductors. Dislocation of the prosthesis occurred in 16.6% of cases and depended on the type of cup implanted. Remarkable was a periprosthetic callus formation surrounding the stem of the femoral implant.

Macromorphological comparison of frozen sections concerning the problem of congruency of the hip joint.

We report on a comparative anatomical investigation of hip joints from animals which can walk on two legs or use their distal legs for jumping. The investigation supports the results of Bläsius [1] that the hip is not congruent. The cartilage of the load induction area is thicker. This means that one can only see congruency on X-rays, because cartilage cannot be visualised.

[Clinical and radiological results with the spherical Mecring as acetabulum prosthesis in hip joint diseases]. / Klinische und radiologische Ergebnisse mit dem sphärischen Mecring als Pfannenersatz bei Hüftgelenkserkrankungen.

The recent experiences which the university hospital in Heidelberg has made with the spherical Mecring must be valued positively. Clinical, radiological and subjective dates from 147 patients were worked up retrospectively. Indeed, the positive results must be considered as relative because of the short respectively medium-term period of control. Nevertheless, the repeated improvement in the second group after a period of postexamination on a average of 3.05 years lets hope for positive long-term results. In the period between 1985 and 1990 three sockets had to be changed. The reasons that the sockets loosened were not specific for the screwing but depending on the individual patients or on the implantations and technical circumstances. The negative results achieved by Engh et al. 1990 could not be recognized (8). He measured a radiological instability of 18% and a technical instability of 28%. What Engh did was measuring simple review photographs and extracting valuable material from them while using geometrical methods. This method shows various measuring mistakes. Therefore Engh's conclusion that the screwing should not be used for implantation because of its displacement in the bones is doubtful. The doubts seem to be supported by the results of our comparison of two series of X-ray photographs with defined different pelvis positions of the same patient. The screwing seemed to be significantly displaced in cranio-medial direction. This was proved by experimental photographs with a pelvis raised to 6 cm in contralateral direction. But the results were a matter of radiological illusion. Radiological migration of the screwing is only provable by complicated X-ray analyses steered with the computer. These big X-ray series are not accessible at the time.

[CLS multicenter study--8-year results]. / CLS-Multicenter-Studie--8jährige Erfahrungen.

The principles of proximal fixation of cementless endoprostheses is established already. This theory was the subject of the present multi-center study of 22 clinics. Between 1984 and 1992 all 1830 patients with an uncemented CLS press-fit stem had a clinical and radiological follow-up examination and computer documentation. The evaluation of the clinical results are based on the Merle d'Aubigné score. In 91% we found a good or excellent result. For the remainder of patients (9%) with a score less than 14 each case has been especially analysed. The incidence of femor component loosening was less than 1% within the average follow-up time of 2.5 years. The medium-term results with the uncemented CLS press-fit stem confirmed the idea of proximal load induction on the femur.

[Changes in the sex life of female patients following intertrochanteric transposition osteotomy]. / Veränderungen der Vita sexualis bei Patientinnen nach intertrochantärer Umstellungsosteotomie.

Female patients planned for intertrochanteric osteotomy have to be advised in postoperative sexual impairment, besides surgical risks. Our investigation shows that the sexual experience was impaired postoperatively. Release from pain has to be contrasted to postoperative sexual problems.

[Spinal fractures in ankylosing spondylitis]. / Wirbelsäulenfrakturen bei der ankylosierenden Spondylitis.

In the final stage of ankylosing spondylitis the spine will be completely fixed. With loss of mobility the patients suffering of ankylosing spondylitis are susceptible to spinal fractures. Predominantly the fractures occur in the lower part of the cervical spine, caused often by minor trauma. High fatality is at a 30% rate seen as severe consequence of these fractures. Conservative and operative treatment may be used. Severe fracture dislocation and progressive neurological deficiencies are recommended to be stabilized operatively. To avoid trauma of the spine in patients with ankylosing spondylitis preventive measures seem to be possible and should be employed.

The autologous stump plasty. Treatment for bony overgrowth in juvenile amputees.

Autologous stump capping is a procedure designed to prevent bony overgrowth in skeletally immature amputation stumps. All 19 capping procedures in the lower extremities were successful after an average follow-up of 7.3 years. All patients use their prostheses, and no secondary operations have been needed for stump problems. Of the 31 cap-plasties of the humerus, six required re-operation. The overall failure rate of 12% is low compared with the failure rate of re-amputation.

[Imaging of the hip joint hyaline cartilage with MR tomography using a gradient echo sequence with fat-water phase coherence]. / Darstellung des hyalinen Hüftgelenkknorpels mit der MR-Tomographie mittels einer Gradientenecho-Sequenz mit Fett-Wasser-Phasenkohärenz.

We have been able to display the hyaline hip joint cartilage clearly and with high signal strength in the magnetic resonance image with a gradient echo sequence with 2 different fresh hip specimens from corpses and with 10 healthy test subjects (5 m, 5 f). The chemical shift artifact at the bone-cartilage boundary could be clearly reduced by optimizing the geometrical scanning parameters. A comparison between the cartilage thickness at the head of the femur measured on the anatomical specimen with the thickness measured in the magnetic resonance tomogram showed a good correlation on suitable selection of the read-out gradient. The hyaline cartilage at the head of the femur could be differentiated from the acetabular cartilage in the region of the loading zone by magnetic resonance tomography in all 10 test subjects.

[Possibilities of therapy of femur fractures following placement a of total hip endoprosthesis]. / Möglichkeiten der Therapie von Femurfrakturen bei einliegender Hüfttotalendoprothese.

The postoperative fracture of the femur following total hip arthroplasty ranks third in occurring complications and the number of such cases is increasing. Most of the patients are elderly and multi-morbid and the fractured femur had undergone previous operations. Using the literature our own experience in 15 cases and applying a fracture classification we make suggestions for treatment of the different fracture types. Considering the patients overall health it's possible to obtain good results in the operative therapy which was necessary in most cases of these femur fractures.

[Long-term results following intertrochanteric varus osteotomy in aseptic femur head necrosis in the adult]. / Spätergebnisse nach intertrochanterer Varisierungsosteotomie bei der aseptischen Hüftkopfnekrose Erwachsener.

25 patients suffering from femoral head necrosis in 30 hip joints were radiologically studied for an average of 11.6 years following intertrochanteric varus angulation osteotomy. Preoperatively only stages 2 and 3 according to Meyers were seen. The follow-up results could be distributed into 4 groups. At best the osteonecrosis was reconstructed within 6 to 9 years while the trabeculae started to become rearranged within 2 to 4 years. At worst, rapid destruction in absence of bony reaction was observed. The ability of the bone outside the osteonecrosis to react to changed circumstances following angulation osteotomy correlates with long-term results. This may indicate a general osteopathy even outside the necrotic area.

[Save the joint? Replace the joint? Long-term results and considerations in the treatment of femur head necroses in adults]. / Gelenk erhalten? Gelenk ersetzen?Langzeitergebnisse und Gedanken zur Behandlung von Hüftkopfnekrosen bei Erwachsenen.

UNLABELLED: 65 patients with necrosis of the femoral head (not caused by a trauma) in 102 hip joints were examined at an average of 9.7 years following first operation: 1st: 30 joints underwent intertrochanteric varus angulation osteotomy (follow up 11.6 y). RESULTS: 12/30 clinically not sufficient, 13/30 radiologically worse, only 2/30 improved range of movement. 2nd: 35 hip joints were treated using an artificial hip replacement (follow up 9.1 y): 77% got loose at an average of 5 years requiring 39 follow-up operations. 3rd: 5 arthrodesis were performed (follow up 11.4 y). 60% delayed nor non bony union. The results indicate a general osteopathy overlapping the size of osteonecrosis, and causing a lot of complications. Various therapeutic concepts should be considered with respect to radiological stage and age of the patient. The results of joint saving operations depend on the ability of the femoral bony structures to react sufficiently.