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.

Improved training techniques and UltraBag system resulted in lowered peritonitis rate in an inner-city population.

Fifteen continuous ambulatory peritoneal dialysis (CAPD) patients from our dialysis unit were studied while using two different types of exchange systems: a snap-disconnect Y-set system and the Baxter UltraBag system. The incidence of peritonitis in the snap-disconnect Y-system was found to be 32 cases in 187 months, or a rate of 1 case of peritonitis every 5.8 months. When these patients switched to the Baxter UltraBag system, the incidence of peritonitis dropped to 4 cases in 175 months, or 1 case every 43.8 months, a highly significant difference. We conclude, therefore, that the UltraBag system is highly effective in reducing the incidence of peritonitis in CAPD patients.

The stump capping procedure to prevent or treat terminal osseous overgrowth.

Terminal overgrowth in transverse deficiencies and in amputations, particularly of the humerus and tibia necessitate serial trimming procedures or re-amputation. Capping using an autogenous bone graft or a titanium and polyethylene endoprosthetic cap provides a satisfactory way of avoiding these re-amputations and allowing end-bearing.

Thrombocytopenia and absent radius (TAR) syndrome.

We give details of seven children with the TAR syndrome, Thrombocytopenia with absence of the radius. Two of the children were siblings. The TAR syndrome is characterised by hypomegakaryocytic thrombocytopenia and bilateral absence of the radius. It is inherited as an autosomal recessive trait.

Prediction of intravenous theophylline dosage based on a single, nonsteady-state concentration: a clinical study of childhood status asthmaticus.

A pharmacokinetic model was applied to achieve therapeutic serum theophylline concentrations rapidly in 25 children with status asthmaticus. A sustained release theophylline preparation had been taken within 36 hours by 12 children; within 14 hours, seven had taken an immediate release preparation; for six children, no theophylline was taken before hospital admission. Single serum theophylline concentrations were determined at nonsteady-state conditions within 13.5 hours of admission (median 6.75 hours). An iterative program was applied to predict the steady-state theophylline concentration as well as necessary adjustments in dosage. Measured steady-state concentrations were then compared with the predicted values. The median measured steady-state concentration was 15 mg/L, and the median predicted steady-state level was 13 mg/L. The least squares regression line was: Measured = 0.738 predicted + 4.77; r = .721, P less than .01. No patient experienced symptoms of toxicity. This technique affords the possibility of accurate prediction of steady-state theophylline concentrations and dosing requirements with a minimum number of serum concentration determinations in children with status asthmaticus.

[Surgical therapy of severe knee flexion and hip flexion contractures in caudal regression syndrome]. / Die operative Therapie schwerer Kniebeuge- und Hüftbeugekontrakturen beim kaudalen Regressionssyndrom.

In severe cases of caudal-regression syndrome one usually can find hip-flexion and knee-flexion-contractures, which can hardly be treated. We report about a new possibility of operative treatment. In this case we correct the contractures with a shortening of the proximal part of the femur and with a resection-arthrodesis of the knee-joint. The clinical result, which we obtained by this way, allows the orthotic management with an orthoprosthesis. The maintaining mobility of the hip joint and the sitting-comfort is very sufficient.

[Limb defects of the lower extremity and their surgical treatment in cooperation with orthopedic technics]. / Gliedmassendefekte der unteren Extremität, ihre operative Behandlung in Kooperation mit der Orthopädietechnik.

Longitudinal defects of the tibia and very often also those of the fibula and femur, as well as constriction bands and certain transverse defects require both surgery as well as prostheses, orthotic devices, or so-called orthoprostheses in order to achieve an optimal therapeutic result. Examples are given of the most important surgical procedures and prostheses etc.