Categorization of two-photon microscopy images of human cartilage into states of osteoarthritis.

OBJECTIVE: The degeneration of articular cartilage is part of the clinical syndrome of osteoarthritis (OA) and one of the most common causes of pain and disability in middle-aged and older people(1). However, the objective detection of an initial state of OA is still challenging. In order to categorize cartilage into states of OA, an algorithm is presented which offers objective categorization on the basis of two-photon laser-scanning microscopy (TPLSM) images. METHODS: The algorithm is based on morphological characteristics of the images and results in a topographical visualization. This paper describes the algorithm and shows the result of a categorization of human cartilage samples. RESULTS: The resulting map of the analysis of TPLSM images can be divided into areas which correspond to the grades of the Outerbridge-Categorization. The algorithm is able to differentiate the samples in coincidence with the macroscopic impression. CONCLUSION: The method is promising for early OA detection and categorization. In order to achieve a higher benefit for the physician the method must be transferred to an endoscopic setup for an application in surgery.

The cementless PM hip arthroplasty. Four-to-seven-year results.

We implanted 300 uncoated cementless PM prostheses into 271 patients and followed 251 (92.6%) of them for four to seven years. By then 37 had already been revised for aseptic and three for septic loosening. The survival rate with implant failure as the endpoint was 88.8% for the cup and 85.3% for the stem after six years. There was a higher risk of implant loosening in congenital dysplasia, unilateral hip arthroplasty and obesity. The results of 225 unrevised hip replacements were assessed by questionnaire. Only 27.4% of the patients were completely free from pain and 17.9% had pain on walking any distance or at all times. The walking distance was for less than 30 minutes in 40%. Because of the poor results in comparison with other prostheses we do not recommend further use of the uncoated PM prosthesis.

[Fractures of the proximal tibia and knee ligament injuries]. / Tibiakopffrakturen und Kniebandverletzungen.

The risk of secondary osteoarthritis after proximal tibial fractures is influenced by the reconstruction of both the articular surface and associated knee ligament injuries. In a follow-up of 69 operatively treated tibial head fractures 36.2% revealed ligamentous damages. At high risk were young male patients with fractures of the medial or both tibial condyles. Only 33% of the ligament damages were the cause of fracture dislocations as described by Moore. Avulsion fractures of the knee ligaments can be successfully treated on by primary fixation. For ruptures of the medial collateral ligament a functional therapy is often sufficient whereas damages of the cruciate ligaments need secondary reconstruction.

[Standardized analysis of acetabulum cup migration in hip endoprosthesis using digital image processing]. / Standardisierte Pfannenwanderungsanalyse in der Hüftendoprothetik mittels digitaler Bildverarbeitung.

Measurement of the migration of the acetabular component following total hip replacement seems to be a useful method of early detection of aseptic loosening. The methods used so far for migration analysis are either too time-consuming or too elaborate in terms of the technical equipment required, and are therefore not suitable for use in day-to-day clinical practice. Analysis software based on the methods described by Nunn and Sutherland was developed with the aid of digitized conventional radiographs of the pelvis. It allows a planar migration measurement including cup inclination following manual marking of only five reference points on a computer screen. A correction for projection enlargement and rotational malpositioning of the patient is performed. All results are stored in a data bank and automatically compared with those recorded at previous follow-ups. Five different acetabular cups were analysed by a conventional and by a digital method for calculation of intra-observer variability. The standard deviation (SD) for horizontal and vertical migration was 0.2-0.4 mm and that for inclination angle 0.8-1.4 degrees with digital evaluation. For manual measurement the SD was 0.4-0.8 mm for migration and 0.8-1.2 degrees for inclination. A pelvis phantom was measured in nine different positions (neutral, 5 degrees and 10 degrees cranial and caudal inclination, 5 degrees and 10 degrees rotation to each side). Four different acetabular cup design were examined, each of which yielded a series of nine measurements. Within these series the SD for biplanar distances varied between 0.1 mm and 1.2 mm and for inclination between 1.1 degree and 2.3 degrees. Intra-observer variability was negligible.(ABSTRACT TRUNCATED AT 250 WORDS)

[Extra-articular fractures near the knee and concomitant knee damage]. / Extraartikuläre kniegelenknahe Frakturen und begleitende Kniebandschäden.

While the prognosis of intra-articular fractures of the knee joint is determined by the reconstruction of the articular surfaces, ligamentous damage and resulting joint instability is a main problem with extra-articular fractures neighbouring the knee. In a follow-up of 43 cases of A 1-3 fractures according to the AO/ASIF classification, 37.2% of the patients revealed concomitant ligamentous damage. Especially supracondylar femoral fractures and the avulsion fractures of the posterior cruciate and lateral collateral ligament are at higher risk.--Ligamentous ruptures accompanying avulsion fractures should be treated primarily according to the rules of knee joint surgery. In cases of supracondylar femoral fractures after open reduction and internal fixation the recovery of knee joint motion is more important than joint stability. Therefore ligamentous repair has to be performed secondarily if necessary.

[Damage to the knee ligament as a concomitant injury in femoral shaft fractures]. / Der Kniebandschaden als Begleitverletzung bei Femurschaftfrakturen.

Knee ligament injuries associated with femoral shaft fractures can severely influence the functional results of treatment. In a follow-up of 59 operatively treated femoral shaft fractures 18.6% of the patients revealed ligamentous damages. In all cases one or both of the cruciate ligaments were injured. Especially polytraumatized car front-seat passengers are at higher risk with 30.8% ligament ruptures. While only 61.6% of the ligament injuries were primarily diagnosed, the testing of knee joint stability after osteosynthesis of a femoral fracture is essential. Furthermore arthroscopy should be performed if there is any hint of ligamentous damage. The ruptures of the anterior cruciate ligament and the ligamentous avulsion fractures can be successfully treated on by operative means.

Dermal, serological and CSF changes in amyotrophic lateral sclerosis with and without intrathecal interferon beta treatment.

In 12 patients with amyotrophic lateral sclerosis (ALS) participating in a therapeutic trial with intrathecally applied human fibroblast interferon-beta (IFN-beta) and in 9 untreated ALS patients, we found significantly elevated circulating serum IgG immune complexes (CIC), quantitative immunoglobulin changes, and creatine kinase (CK) elevation; CK reached significantly more often pathological levels in non-bulbar disease. Dermal ultrastructural changes were equally present in all treated as well as untreated ALS patients. Some time ago IL-6 was quantitatively cleaned out of the Fiblaferon-preparation. Erythrocyte sedimentation rate (ESR) rose during intrathecal IFN therapy in 9/10 ALS patients. In 4/4 adequately monitored motoneuron patients, this elevation coincided with a decrease of serum CK, while ESR and CK did not correlate in 60 non-ALS non-IFN neurological controls. Collagen ultrastructure, CSF total protein or barrier function, immune complexes, immunoglobulin quantitation and serum CK may contribute to differentiated diagnosis and should be included in future study protocols.

[Diagnosis of hypophyseal abscess using MRI and high resolution CT]. / Die Diagnostik des Hypophysenabszesses mittels MRI und hochauflösender CT.

Preoperative diagnosis of pituitary abscess is very difficult. In particular, differentiation from other cystic processes of the sellar region is delicate. The clinical and radiological findings of a case of pituitary abscess are presented. Since CT and MRI are of major importance for routine pituitary screening, the aspects of these methods are emphasized. In our experience, both methods can contribute to preoperative diagnosis.

[CT-cisternography of the basal cisterns. A roentgen anatomic study]. / CT-Zisternographie der basalen Zisternen. Eine röntgenanatomische Studie.

Air cisternograms at post mortem and positive contrast cisternograms on patients were performed in order to study intracisternal structures, particularly cranial nerves, as seen on CT. Air and contrast CT cisternograms showed excellent demonstration of the second, third, fifth, sixth, seventh and eighth cranial nerves. The ninth and tenth cranial nerves could not always be separated from each other and demonstration of the first, fourth, eleventh and twelfth cranial nerves was often not possible or was unsatisfactory. With a knowledge of the normal anatomy and of important surrounding structures, the individual cranial nerves are easily identified. The anthropologic baseline appears highly suitable for CT examination of the basal cisterns. The complementary coronal projection is also very valuable.