One-year follow-up data from the German Cartilage Registry (KnorpelRegister DGOU) in the treatment of chondral and osteochondral defects of the talus.

INTRODUCTION: Chondral and osteochondral lesions of the talus (OLTs) remain a challenging issue with numerous operative treatments proposed to date. The aim of this study was to evaluate 1-year follow-up data in the German Cartilage Registry (KnorpelRegister DGOU). METHODS: Among 401 patients in the database, 114 patients with a complete 1-year Foot and Ankle Outcome (FAOS) score for subscale Pain as the primary variable were included. A total of 12 different surgical treatments were performed. However, 8 techniques were carried out in negligible numbers of patients (n = 1-3), leaving 89 patients treated with the following techniques: arthroscopic antegrade bone marrow stimulation (group A; n = 32), autologous chondrocyte implantation with autologous cancellous bone grafting (group B; n = 9), matrix-augmented bone marrow stimulation (group C; n = 22), and matrix-augmented bone marrow stimulation with autologous cancellous bone grafting (group D; n = 26). Group differences and possible influencing variables such as age and sex were evaluated. Level of significance was set at p < 0.05 for all statistical tests. RESULTS: All four treatment groups showed significant improvement of the FAOS scores at 1 year postoperatively compared with their preoperative scores. No significant differences were found with respect to score changes among the groups. A positive correlation between FAOS subscale Pain improvement and defect size volume and negative correlations between increasing age and FAOS subscales Sports/Rec and QoL were found. Concomitant ankle stabilization led to greater improvement in FAOS subscales Symptoms and ADL than in patients with no stabilization. FAOS subscale Pain showed greater improvement in women than in men. CONCLUSION: All analyzed treatment options were effective for treatment of OLTs. In particular, large defects appeared to benefit from treatment. In the presence of concomitant ankle instability, a stabilizing procedure appeared to have a positive impact on the outcome.

[Combined posterior and anterior cruciate ligament reconstruction : Arthroscopic treatment with the GraftLink® system]. / Kombinierte Rekonstruktion des hinteren und vorderen Kreuzbandes : Arthroskopische Versorgung mit dem GraftLink®-System.

OBJECTIVE: Simultaneous arthroscopic reconstruction of the anterior and/or posterior cruciate ligament (ACL/PCL) using the GraftLink® system (Arthrex) to obtain stable treatment and good functional results. The transplant is protected by the safety belt like biomechanical GraftLink® principle, which is used to secure the intraoperatively obtained stability in the long term. INDICATIONS: ACL, PCL, or combined cruciate ligament rupture, especially multiligament injuries. Revision ACL and PCL reconstruction. CONTRAINDICATIONS: Preoperative fixed posterior tibial subluxation. Reduced range of motion (ROM) with an extension lag (extension/flexion 0­0-120° preoperatively required). Complex regional pain syndrome. High-grade atrophy of the quadriceps femoris muscle and osseous deformities. SURGICAL TECHNIQUE: Supine position with mobile leg and possible flexion of at least 120° allowing antegrade femoral bone tunnel replacement. Retrograde tunnel placement (e. g. using a retrocutter) is recommended in case of less than 120° knee flexion. Thigh tourniquet. Staging arthroscopy. Cruciate ligament reconstruction is realized by anatomic tunnel placement for the ACL/PCL using the GraftLink®. Recommended sequence of reconstruction: 1. tibial PCL tunnel, 2. femoral ACL tunnel, 3. femoral PCL tunnel, 4. tibial ACL tunnel. Hybrid fixation is recommended. Portals: High anteromedial, high anterolateral, posteromedial, posterolateral, small subvastus incision. POSTOPERATIVE MANAGEMENT: Combined cruciate ligament replacement: Gradual load and ROM increase in the PCL track. After postoperative week 5, increasing load up to full weight bearing, with extension/flexion 0­0-90° after week 7. Down training of the PCL track after week 13. Contact and competitive sports after 1 year. RESULTS: The GraftLink® system allows restoration of knee joint stability with good functional results. The procedure is especially suitable for complex situations like after knee dislocation with ACL and PCL reconstruction in 1 or 2 steps.

Positively and negatively charged submicron emulsions for enhanced topical delivery of antifungal drugs.

Charged submicron emulsions are a priori interesting candidates for the delivery of drugs in and/or through the skin. In the present study, it was possible by using stearylamine or deoxycholic acid (DCA) to incorporate either econazole or miconazole nitrate, respectively, in positively and negatively charged submicron emulsions. The investigation of the relationship between the physicochemical properties of the vehicles, especially the charge of the emulsion and skin permeation, was conducted ex vivo during percutaneous absorption experiments using hairless female rat skin. In addition, drug quantification was carried out using two different analytical techniques (HPLC and radioactivity measurements) in order to examine if the drug analysis approach might affect the results. The results clearly indicate that the surface-modified droplets have a significant influence on the diffusion through the skin. Furthermore, the method of preparation of the formulation and subsequently the analytical method of drug concentration measurement are able to influence the results of percutaneous experiment.

Sequential statistical optimization of a positively-charged submicron emulsion of miconazole.

A positively charged oil/water (O/W) emulsion containing an antifungal agent was developed for ophthalmic use. An attempt was made using a sequential statistical methodology to optimize the O/W emulsion by varying both formulation and process parameters to obtain the smallest droplet size emulsion that can remain stable for a long period of time. During the first step of the study, not less than 7 parameters were found to be important--drug content, amount of lipophilic phase, poloxamer concentration, quantity of the phospholipids-stearylamine couple, pH adjustment, time of coarse emulsification and time of high pressure homogenization. A screening approach based on Hadamard's matrix was used to select the parameters displaying the most significant effects on response parameters. A first set of 8 experiments proved efficient enough to define the concentration of poloxamer and the quantity of the couple phospholipids-stearylamine, which confer the overall positive charge to the emulsified droplet, as the most significant parameters affecting the final droplet size of the emulsions formed. A 2k-type experimental design was then built with the two main factors in order to evaluate a first-order polynomial model with interaction. Poor analysis of variance results after an additional center experiment was performed revealed the lack of fit of the linear model as well as the importance of the response surface curvature due to a close optimum location. To find the optimal operating conditions the design was sequentially completed with 4 more experiments according to the Box and Wilson method. The response surfaces in 3-dimensional representation and their corresponding contour plots proved helpful in analyzing the validated models and in highlighting the precise optimum location. The optimized positive submicron emulsion is now under in vivo investigation.

[Health--disease: theory and practice of "integrative medicine"]. / Gesundheit--Krankheit: Theorie und Praxis in der "Integrativen Medizin".

Worldwide our knowledge about health and disease and the frame as well as the goals in our medical education are increasingly discussed by the medical profession and our society. Therefore some aspects are presented in order to develop perspectives for and in our thinking and actions in an 'integrative medicine'. The five entities, formulated, through Paracelsus about 500 years ago, are transformed into our time. Regardless of necessary technical advances in medicine, it becomes increasingly obvious that we still have to integrate the different entities of Paracelsus into a multilayered composite medicine in the coming decades.

[Schistosomiasis and signet ring cell carcinoma of the ileocecal valve]. / Schistosomiasis und Siegelringzellkarzinom der Ileozökalklappe.

A 24-year-old male Egyptian complained of cramp-like upper abdominal discomfort and weight loss (3 kg) over 4 weeks. Physical examination merely gave evidence of the weight loss and of a slightly prominent gas-filled abdomen, mild diffuse abdominal tenderness and considerable borborygmus. Radiology of the intestines revealed chronic subileus of the small intestine caused by stenosis of the ileocaecal valve, which was impassable by coloscope. Biopsy suggested schistosomiasis of the ileocaecal valve. Examination of the resected ileocaecum showed a typical signet-ring carcinoma of the ileocaecal valve which had infiltrated all layers but had not metastasised to the regional lymph nodes (pT3, N0, M0). Typical eggs of Schistosoma haematobium were present in the mucosa of the tumour segment and of the neighbouring tissues. It is possible that chronic intestinal schistosomiasis is a potentially precancerous condition, similar to schistosomiasis of the urinary bladder.

[Animal model for the study of the biocompatibility of root filling materials]. / Tierexperimentelle Untersuchungen zur Biokompatibilität von Wurzelfüllmaterialien.

The aim of this study was to investigate the influence of different pins usually used for intraoperative root filling on periapical bone healing. In a specially designed animal experiment it was possible to evaluate biocompatibility simultaneously with the influence of varying materials on bone regeneration in standardized defects. Bioincompatible silver, acrylate and gutta percha root filling delay and impede bone regeneration. Biocompatible aluminium oxide ceramic and titanium pins do not have any influences on spontaneous bone regeneration. Reducing the defect, however, they do improve the conditions for complete bony regeneration.

Metabolism of cholesterol and phospholipids in cultured human vascular smooth muscle cells: differences between artery and vein-derived cells and the effect of oxygen partial pressure.

Human smooth muscle (SM) cells derived from vena saphena magna, aorta abdominalis and arteria mamaria were grown in culture under 40 or 145 mmHg oxygen partial pressure (pO2) and their lipid metabolism studied. Esterification of the cellular [3H]cholesterol was higher by 2.5-fold in artery derived than in vein-derived cells and was slightly higher in cultures exposed to 145 mmHg than to 40 mmHg pO2. Cholesterol efflux in the presence of high density lipoprotein (HDL) in the incubation medium was higher in artery-derived than vein-derived cells. Apolipoprotein (apo) AI also supported cholesterol efflux to a higher extent in artery than in vein-derived cells. Cholesterol efflux in the presence of apo AI was accompanied by a decrease of 50% in cellular [3H]cholesteryl ester in both cell types. SM cultures exposed to [3H]choline incorporated about 90% of the radioactivity to phosphatidylcholine (PC) and 10% to sphingomyelin (SPM). During 5 days exposure to [3H]choline, 10 to 15% and 20 to 30% of the newly synthesized PC and SPM, respectively, were released by vein-derived cells into the incubation medium. The relative amount of SPM of the total radioactive phospholipids released by vein-derived cultures was significantly higher in cultures growing under 40 mmHg than 145 mmHg pO2 reaching a value of up to 33% of the radioactive phospholipids in the incubation medium. HDL was shown to serve as an acceptor for phospholipids released by both vein and artery-derived SM cells, while free apo AI supported phospholipid efflux in artery but not in vein-derived SM cells.(ABSTRACT TRUNCATED AT 250 WORDS)

[A thermostable alpha-amylase from Thermoactinomyces vulgaris: purification and characterization]. / Eine thermostabile alpha-Amylase aus Thermoactinomyces vulgaris: Reinigung und Charakterisierung.

Alpha-amylase from Thermoactinomyces vulgaris (strain 94-2A) was purified by cellulose chromatography and gel-chromatography on Sephadex G-75 and subsequently characterised. The enzyme shows a single band in the polyacrylamide gel electrophoresis (PAGE). The isoelectric point was determined to be pH 5.4, and the molecular mass was estimated as 53,000 Dalton by PAGE. The amino acid composition was determined; it shows characteristics of other microbial alpha-amylases. A comparison of the N-terminal sequence with that of other alpha-amylases shows a homology of 66.6% to Taka-amylase. The pH-optimum for the alpha-amylase activity is 4.8 to 6.0 and the temperature optimum 62.5 degrees C. The heat inactivation was investigated under different conditions (temperature, time, Ca2+, EDTA).

[Early manifestation of severe gestosis (pre-eclampsia) in fetal triploidy--diagnosis and obstetrical management]. / Früh einsetzende schwere Gestose (Präeklampsie) bei fetaler Triploidie--Diagnostik und geburtshilfliches Management.

A case is reported of early-onset pre-eclampsia combined with severe malformations including holoprosencephaly and hydrocephaly caused by triploidy. By ultrasonic diagnosis, maternal risks caused by either prolonged pregnancy because of immaturity or inappropriate obstetrical management, i.e. by caesarean section, could be avoided. Ventriculocentesis of the macrocephalic fetus was performed and abortion induced.

Human smooth muscle cells of the aorta and vena cava: different sensitivity to the inhibition of proliferation by heparin in vitro.

In this comparative study of the antiproliferative effect of heparin (average mol. weight 16 kD) a different heparin sensitivity between cultivated smooth muscle cells derived from the media of the human aorta and the vena cava is observed. Heparin induces a partial proliferation inhibition of 54% in the aortic- and 17% in the vena cava-derived smooth muscle cells on day seven. The increase in cell volume suggests a selection of larger volume subpopulation of cells or an influence on the G2-phase of the cell cycle. Heparin and heparin-like compounds may develop into future therapeutic drugs for the prevention of increased smooth muscle cell proliferation after vessel wall injury.

[Physiological and cell biological characterization of the protease producer Thermoactinomyces vulgaris during prolonged culture in a stirred fermenter]. / Physiologische und zellbiologische Charakterisierung des Proteasebildners Thermoactinomyces vulgaris während Langzeit-Kultivation im Rührfermentor.

The physiological behaviour of Thermoactinomyces vulgaris - producing a thermostable serine-protease - was analyzed during fermentation. During 38 h the consumption of nutrients and oxygen as well as the rates of macromolecular and protease synthesis were measured. The morphological and ultrastructural changes of the mycelia were also studied. The mycelia grew exponentially for about 5 hours. After a short lag and a second slower growth phase, growth continued about linearly until the end, as was indicated by a constant rate of incorporation of labelled thymidine. However, at the same time a changing portion of hyphae - up to 45% - underwent lysis. According to the changing ratio of growing and lysing material, regarding the physiological activity of the culture the fermentation process could be divided into 4 periods. The formation of the protease started at the transition to the slow growth phase and continued linearly. The ability to produce the protease was attributed to a mycelium being formed after the shift down caused by limitation of supply of utilizable nitrogen compounds. The end of protease production 10 h later was correlated to a drastic decrease of the respiratory activity of the mycelia, probably caused by exhaustion of easily utilizable carbohydrates.