Titanium template for scaphoid reconstruction.

Reconstruction of a non-united scaphoid with a humpback deformity involves resection of the non-union followed by bone grafting and fixation of the fragments. Intraoperative control of the reconstruction is difficult owing to the complex three-dimensional shape of the scaphoid and the other carpal bones overlying the scaphoid on lateral radiographs. We developed a titanium template that fits exactly to the surfaces of the proximal and distal scaphoid poles to define their position relative to each other after resection of the non-union. The templates were designed on three-dimensional computed tomography reconstructions and manufactured using selective laser melting technology. Ten conserved human wrists were used to simulate the reconstruction. The achieved precision measured as the deviation of the surface of the reconstructed scaphoid from its virtual counterpart was good in five cases (maximal difference 1.5 mm), moderate in one case (maximal difference 3 mm) and inadequate in four cases (difference more than 3 mm). The main problems were attributed to the template design and can be avoided by improved pre-operative planning, as shown in a clinical case.

What comprises a good outcome in spinal surgery? A preliminary survey among spine surgeons of the SSE and European spine patients.

Standardized and validated self-administered outcome-instruments are broadly used in spinal surgery. Despite a plethora of articles on outcome research, no systematic evaluation is available on what actually comprises a good outcome in spinal surgery from the patients' and surgeons' perspective, respectively. However, this is a prerequisite for improving outcome instruments. In performing a cross-sectional survey among spine patients from different European regions and spine surgeons of the SSE, the study attempted (1) to identify the most important domains determining a good outcome from a patients' as well as a surgeon's perspective, and (2) to explore regional differences in the identified domains. For this purpose, a structured interview was performed among 30 spine surgeons of the SSE and 353 spine surgery patients (representing Northern, Central and Southern Europe) to investigate their criteria for a good outcome. A qualitative and descriptive approach was used to evaluate the data. Results revealed a high agreement on what comprises a good outcome among surgeons and patients, respectively. The main parameters determining good outcome were achieving the patients' expectations/satisfaction, pain relief, improvement of disability and social reintegration. Younger patients more often expected a complete pain relief, an improved work capacity, and better social life participation. Patients in southern Europe more often wanted to improve work capacity compared to those from central and northern European countries. No substantial differences were found when patients' and surgeons' perspective were compared. However, age and differences in national social security and health care system ("black flags") have an impact on what is considered a good outcome in spinal surgery.

First Report of Arceuthobium vaginatum subsp. cryptopodum on Pinus mugo.

Southwestern dwarf mistletoe (Arceuthobium vaginatum (Willd.) Presl subsp. cryptopodum (Engelm.) Hawksw. & Wiens, family Viscaceae) is a serious and common pathogen of ponderosa pine (Pinus ponderosa Douglas ex Lawson & C. Lawson) in Colorado, Utah, Arizona, New Mexico, and northern Mexico (1). In July 2002, this dwarf mistletoe was observed parasitizing a 1.4-m tall mugo pine (P. mugo Turra) in the Black Forest north of Colorado Springs, CO (39°02.118'N, 104°36.028'W, elevation 2,250 m). The infected mugo pine was planted as an ornamental approximately 6 m from a ponderosa pine infected with A vaginatum subsp. cryptopodum. Dwarf mistletoe shoots were produced on the only infected branch observed but this was sufficient for a positive identification of the dwarf mistletoe. Although J. Weir successfully inoculated mugo pine with western dwarf mistletoe (A. campylopodum Engelm.) and lodgepole pine dwarf mistletoe (A. americanum Nutt. ex Engelm.) (2), to our knowledge, this is the first report of a dwarf mistletoe occurring naturally on P. mugo, as well as the first report of A vaginatum subsp. cryptopodum on P. mugo (1). Specimens of A vaginatum subsp. cryptopodum from P. mugo have been deposited in the Deaver Herbarium, Northern Arizona University, Flagstaff (Accession No. 73761). References: (1) F. Hawksworth and D. Wiens. Dwarf mistletoes: biology, pathology, and systematics. USDA Agric. Handb. 709, 1996. (2) J. Weir. Bot. Gaz. 56:1, 1918.

[Clinical experience with Mercilon and Marvelon with special reference to ovarian function]. / Klinische Erfahrungen mit Mercilon und Marvelon unter besonderer Berücksichtigung der Ovar-Funktion.

The effects of two oral contraceptive combinations either containing 0.020 mg ethynilestradiol (EE) + 0.150 mg desogestrel (Mercilon) or 0.030 mg EE + 0.150 mg desogestrel (Marvelon) were compared in two independent trials. Special attention was paid to serum levels of LH, FSH, prolactin, progesterone, testosterone, estradiol, SHBG in the first and efficacy, cycle control and tolerability in the second trial. The first trial included 71 women. Serum levels were determined in the cycle before treatment, in the third and sixth cycle of treatment and one cycle after treatment. The following difference was found: Women using the lower dosed preparation showed significantly less suppressed FSH values compared to women using Marvelon. Mean values of Estradiol and Progesterone were significantly suppressed 30% of our measurement in the lower dosed data sample showed extremely high Estradiol and Progesterone values. SHBG has increased by 200-300% and had no effect on prolactin and testosterone levels. In the second trial 781 women (5193 cycles) were evaluated. Assessment were made in the first, third and twelfth cycle of treatment. There were no marked differences between the two preparations with respect to normalisation of cycle length, bleeding duration and intensity. Differences occurred in frequencies of silent menstruation and breakthrough bleedings. They were more often by receiving 0.020 mg EE (7.7%, Mercilon) than with 0.030 mg EE (3.6%, Marvelon). With 0.020 mg EE a higher percentage of women showed body weight change. Blood pressure remained stable in both groups. Both preparations were very good tolerated with slightly more breast tenderness by taking 0.030 mg EE.(ABSTRACT TRUNCATED AT 250 WORDS)

[Contraception for adolescents and its effect on menstruation]. / Die Kontrazeption Jugendlicher und ihre Auswirkungen auf das Zyklusgeschehen.

PIP: The beginning of sex life is occurring at an ever younger age in industrial countries with the result of frequently unexpected and unwanted pregnancies. In primitive societies puberty starts later because protein-rich nutrition is lacking. The recommendation of contraceptive methods for young people in Western countries serves the same purpose of lengthening the period until sexual maturity. The extent to which contraceptive methods influence the menstrual cycle of young women depends on the level of maturity of their cycle: IUDs and hormonal contraceptives affect it, but natural methods do not. Barrier methods do not influence it either, but the condom promoted against AIDS is not reliable enough as a contraceptive. The intrauterine pessary is rarely used owing to the increased risk of genital inflammation. Effects on the cycle produce symptoms of stronger and longer bleeding and amenorrhea possibly linked to coagulation. In animal experiments corpus luteum insufficiency was demonstrated. Hormonal contraception is also the safest for young people. The degree of the suppression of the gonadal axis depends on the dose of the components and the chemical structure of the gestagens used as well as on the endocrine maturity level and ovarian susceptibility of the user. The so-called postpill amenorrhea does not occur more often than secondary amenorrhea in the general population. When using micropills sufficient suppression of the gonadal axis has to be watched, otherwise clinical symptoms of delayed ripening of the ovaries develops with additional endogenic estrogen secretion: lower abdominal pain, breast complaints, and bleeding disorders. The longterm effect of increased estrogen concentrations is characterized by oligomenorrhea and corpus luteum insufficiency in the menstrual cycles of young women.^ieng

Intrauterine occlusion body (IUB). Preliminary report.

The IUB or SOF-T is a further development of the IUD with additional functions and properties. In 368 IUB insertions over a period of 48 months, there was no intrauterine pregnancy. There was a low removal rate due to bleeding, pain, infection or partial expulsion in 277 insertions performed at two university centers over an average period of 8-1/2 cycles. In 80 cases tubal occlusion was directly or indirectly proven by different methods. The improved ultrasound localisation of the IUB is possibly responsible for its effectiveness and the soft ends are probably the main reason for its improved tolerance compared to other IUDs.

[Prevention of pregnancy in adolescents and premenopausal females]. / Empfängnisverhütung bei Jugendlichen und bei prämenopausalen Frauen.

The norms of our society have changed in the last decades. This also concerns our general attitude towards sexuality. Professional demands on the parents, increasing material independence of adolescents, excessive exposure to external stimuli lead to sexual contacts at a very early age. Contrary to a more accelerated physical development, which manifests itself in a progressively earlier puberty, psychic development is retarded. According to numerous studies pregnancies in adolescents do not show increased somatic complications. They do, however, influence the psychic maturation of the adolescents in a negative way. Whereas the necessity for sexual education is unquestioned, the efficacy is doubtful. Knowledge of contraception and its correct use is not enough to avoid undesired pregnancies. The psychic structure of the individual may often lead to an undesired pregnancy. Therefore, we recommend for adolescents contraceptives which are reliable, without negative effect on fertility and with neglibile side-effects. The number of failures and the inconvenience realted to their use make conventional methods unacceptable. The danger of PID and the risk of later sterility contraindicate the use of IUD in adolescents. Today the method of choice is a low-dose contraceptive which contains a gestagen of the third generation. The premenopausal state is the time in which cycles become irregular and in which an increasing hormonal insufficiency is observed. Therefore, women over forty years need reliable contraception as well as hormonal substitution. Increase of cardiovascular risk was observed in women when high-dose contraceptives were given. This was obvious in the more than forty year old women taking the pill.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sexuality and contraception in adolescence]. / Sexualität und Kontrazeption in der Adoleszenz.

PIP: Societal attitudes toward sexuality have changed radically in the last few decades. Professional demands on parents, increasing material independence of youth, and the excess of external stimuli, coupled with the average age of 1st menstruation among girls in Europe and the United States being between 12.4 and 13.6 years, have led to the start of sexual relations at younger and younger ages. Compared to the rapid physical development which is indicated by the age of puberty continually decreasing, psychological development is retarded. Adolescent pregnancies however are acknowledged to be relatively free of significant somatic complications; on the other hand, they adversely affect psychological maturation of adolescents. The necessity of sex education at present is realized; its effectiveness, however is doubtful. Knowledge of contraception and its proper application seem not to be enough to prevent unwanted pregnancies. Frequently it is the psychological makeup of the individual which leads to unwanted pregnancy. Therefore, contraceptive measures should be recommended for adolescents which are safe in practice, do not adversely affect fertility and have few side effects. Conventional methods such as the rhythm method, spermicides, and barrier methods (diaphragm and condom) should be avoided due to their complexity and high failure rates. IUDs should not be used due to the danger of pelvic inflammatory disease and risk of later sterility. Currently, the preferred method is a low dose ovulation inhibitor containing a third generation progestogen.^ieng

[Contraceptive effect of low-dosage ovulation inhibitors containing various progestagen agents]. / Der kontrazeptive Effekt niedrig dosierter Ovulationshemmer mit verschiedenen Gestagenen.

The decrease of steroid dosage in oral contraceptives resulted in a decrease of serious side effects with continued effectiveness. However, a increase in subjectively disturbing bleeding abnormalities occurred at the same time. The development of triphasic preparations was designed to eliminate these abnormal bleeding episodes by stepwise changes of the estrogen and progestagen doses. Compared to the low dosage combination preparation, triphasic preparations show often a persistence of insufficiently suppressed hormone levels in single determinations but not in mean averages of determinations. This could be an explanation for the reported pregnancies. In spite of these results, the literature reports rare failures during the administration of the triphasic preparations and additional factors could determine the contraceptive effectiveness.

Effects of various combined oral contraceptives on sex steroids, gonadotropins and SHBG.

PIP: In women with preexisting virilization, it is advisable to prescribe contraceptive agents that do not provoke a further increase in free circulating androgens. This study evaluated the influence of 3 gestagens without androgenic effects on the endogenous sex hormone equilibrium and sex hormone-binding globulin (SHBG) concentrations. 122 women were administered 4 different combined contraceptives for up to 6 cycles. The estrogen component of each of the 4 preparations was estradiol estrogen (EE), while the gestagens were desogestrel (in 2 formulations in 2 different dosages), cyproterone acetate, and chlormadinone acetate. Most subjects had irregular cycles before treatment, and exhibited seborrhea, acne, and hirsutism. Luteinizing hormone, follicle-stimulating hormone, estrone, estradiol, progesterone, free testosterone, and dehydropeiandrosterone-sulfate levels were significantly reduced in all 4 treatment groups during tablet intake. However, SHBG concentrations increased in a highly significant manner during treatment. The elevation of SHBG is an expression of increased hepatic synthesis induced by EE. Concentrations of circulating SHBG determine the balance between estrogens and androgens. Since SHBG binds androgens better than estrogens, it effectively monitors androgenic activity. Because of their role in significantly lowering the active fraction of androgens, the preparations studied are considered appropriate contraceptives for androgenized women.^ieng

[Comparative socioeconomic, anamnestic and psychological studies of patients with uterine myoma and uterine prolapse]. / Vergleichende sozioökonomische, anamnestische und psychologische Untersuchungen an Patientinnen mit Uterusmyom und Descensus uteri.

30 female patients with the diagnosis of "uterus myomatosus" and a control group of also 30 women with the diagnosis "descensus uteri et vaginae" were examined by a standardized questionnaire containing socio-economic, anamnestic and psychological data. To get information about their personality the "Freiburger Persönlichkeitsinventar" (Freiburg Personality Inventory), half-form A, was administered at the end of the interview. The age limits were 35 and 55 years. The main socio-economic results are the following: during childhood and adolescence the myom-patients lived mainly near towns (p less than 0,01). The women of this group have better relationships to their husbands than the descensus-patients (p less than 0,01) and the husbands of the myom-patients are more often (p less than 0,01) of the same age or younger than their women. 18 out of the 30 women of the myom-group (i.e. more than 50%) said that their wish to become a mother has not been fulfilled while this answer was given by none of the 30 descensus-patients (p less than 0,01). The question is discussed in how far the uterus-myom can be understood as a somatic expression of the frustrated wish to get a child, as a "compensatory growth". Beside this, the authors are aware of the fact that other aspects, f.e. hormonal factors, may be important.

[Contraception in adolescents according to recent scientific understanding]. / Kontrazeption bei Jugendlichen entsprechend den neueren wissenschaftlichen Erkenntnissen.

PIP: Today even young adolescents are engaging in sexual intercourse. In order to prevent unwanted pregnancies, the physician must prescribe safe contraceptive methods. Treatment with oral contraceptives (OCs), probably the safest method, as a rule leads to inhibition of the hypothalamo-pituitary axis. In order to check pituitary function prior to, and during OC treatment, LH-RH tests which permit establishment of hormonal profiles by means of radioimmunoassay are now being carried out. In longterm studies, the effects of ovulation-inhibiting preparations containing different doses of estrogens and gestagens, as well as of the minipill, have been determined. Special attention has been paid to adolescent girls who still have immature cycle patterns. In light of the results, it seems that the endocrine axis of adolescents is very adaptable. So-called postpill amenorrhea was only occasionally observed with the currently used low-dose OCs. IUD insertions in adolescents should be approached with caution as this may lead to ascending genital infections and possibly to secondary sterility. (author's modified)^ieng

[Advantages and risks of hormonal contraception]. / Vorteile und Risiken der hormonalen Kontrazeption.

Among modern contraceptive methods hormonal contraceptive agents, due to their reliability, are preferred. Nevertheless, it has to be considered that these steroidal hormones and their metabolites do not only possess an ovulation inhibitory effect, but that they also influence other systems, such as carbohydrate and lipid metabolism, blood clotting, fluid balance, plasma proteins as well as the entire hormonal system. These multiple side effects have positive and negative influences. By reducing the doses of estrogens and progestagens occurrence of unpleasant adverse reactions has been decreased. Some years ago, the estrogen content of oral contraceptive preparations was considered to be noxious while a favourable effect was attributed to the progestagen content. The results of biochemical studies yielded a better understanding of the effect of steroidal hormones on lipid metabolism. Fertility problems occurring after discontinuation of oral contraceptive treatment are mainly observed in women who, prior to use of oral contraceptive agents have already been suffering from functional cycle disturbances. Ovulation inhibitory preparations may also be given to adolescent girls with immature cycles. As the juvenile endocrine system is adaptable, after cessation of the ovulation inhibitory effect, the cycle returns to pretreatment patterns. It may now even be possible to administer hormonal contraceptive agents to treat endocrine disturbances.

PIP: Among modern contraceptive methods, hormonal contraceptive agents, due to their reliability, are preferred. Nevertheless, it must be considered that these steroidal hormones and their metabolites do not only possess an ovulation inhibitory effect but that they also influence other systems, such as carbohydrate and lipid metabolism, blood clotting, fluid balance, plasma proteins, as well as the entire hormonal system. These multiple side effects have positive and negative influences. By reducing the doses of estrogens and progestagens, the occurrence of unpleasant adverse reactions has been decreased. Some years ago, the estrogen content of oral contraceptive (OC) preparations was considered to be noxious while a favorable effect was attributed to the progestagen content. The results of biochemical studies yielded a better understanding of the effect of steroidal hormones on lipid metabolism. Fertility problems occurring after discontinuation of OC treatment are mainly observed in women who, prior to the use of OCs, had already been suffering from functional cycle disturbances. Ovulation inhibitory preparations may also be given to adolescent girls with immature cycles. As the juvenile endocrine system is adaptable, after cessation of the ovulation inhibitory effect, the cycle returns to pretreatment patterns. It may now even be possible to administer hormonal contraceptive agents to treat endocrine disturbances. (author's modified)

[Clinical and biochemical results during the treatment with marvelon, a new oral contraceptive (author's transl)]. / Klinische und biochemische Resultate bei der Behandlung mit Marvelon--einem neuen steroidalen Ovulationshemmer.

Marvelon was tolerated without side effects by 338 women during 2,104 cycles. Although some errors of administration were made by patients there were no pregnancies. In contradistinction to other low dosage combination oral contraceptives this new oral contraceptive has a good control of the menstrual cycle. The incidence of clinical side effects was low. An over-suppression syndrome after the discontinuation of the treatment was not observed. Hormonal assays were done in order to investigate the difficult problems of oligomenorrhoea in adolescents with oral contraception. A marked inhibition of ovulation evident by low values of pituitary ovarian hormones was found. When the treatment was discontinued the majority of the patients showed ovulation in the first post-treatment cycle.

PIP: Marvelon was tolerated without side effects by 338 women during 2104 cycles. Although some errors of administration were made by patients, there were no pregnancies. In contradistinction to other low dose oral combination contraceptives (OCs), this new OC has a good control over the menstrual cycle. The incidence of clinical side effects was low. An oversuppression syndrone after the discontinuation of the treatment was not observed. Hormonal assays were done in order to investigate the difficult problems of oligomenorrhea in adolescents with OCs. A marked inhibition of ovulation as evidenced by low values of pituitary ovarian hormones was found. When the treatment was discontinued, the majority of the patients showed ovulation in the 1st posttreatment cycle. (author's)