[Influence of chronic, structural changes of the muscle-tendon unit on the indication and technique of rotator cuff reconstruction]. / Einfluss chronisch-struktureller Veränderungen der Muskelsehneneinheit auf Indikation und Technik der Rotatorenmanschettenrekonstruktion.

Rotator cuff lesions are common and the incidence increases with age. After tendon rupture of the rotator cuff, the muscle-tendon unit retracts, which is accompanied by muscle fatty infiltration, atrophy, and interstitial fibrosis of the musculature, thus, fundamentally changing the muscle architecture. These changes are important prognostic factors for the operative rotator cuff reconstruction outcome. Selection of the correct time point for reconstruction as well as the optimal mechanical fixation technique are decisive for successful attachment at the tendon-to-bone insertion site. Thus, knowledge of the pathophysiological processes plays an important role. The goal of this article is to establish a relationship between currently existing evidence with respect to the preoperatively existing changes of the muscle-tendon unit and the choice of the time for the operation and the operative technique.

The development of the ITI DENTAL IMPLANT SYSTEM. Part 2: 1998-2000: Steps into the next millennium.

In 1998 and 1999, the ITI DENTAL IMPLANT SYSTEM underwent its greatest modification since it came into existence. Prosthetic possibilities with regard to implant position transfer and master-cast manufacturing have been considerably enlarged by synOcta, surgical instruments have been improved in a multitude of ways and, by introducing SLA, the sand-blasted, large grit, acid-etched surface for oral implants which shortens time to loading by 50%, the ITI and Straumann have achieved a major breakthrough in surface technology.

[Parallel use of medical services? Patterns of using complementary medicine and biomedicine]. / Parallelität? Muster der Nutzung komplementär- und schulmedizinischer Versorgungsangebote.

In order to identify behavioural patterns within the pluralistic medical system, 38 patients have been observed over a period of two years. The most notable quality of behaviour is its flexibility. Single patients use complementary medicine and biomedicine in pragmatic and differentiated ways that change over time. Parallelism can be observed among the offered medical services, while their use is to be divided into parallel, alternate, alternative and complementary forms. Phases of exclusive use of complementary medicine occur, but during the two year period under investigation, all patients have made use of biomedicine.

[Motivation for the choice of complementary and mainstream medicine. Patients' behavior in a pluralistic medical system]. / Beweggründe für die Wahl von Komplementär- und Schulmedizin. Patientenverhalten in einem pluralistischen Medizinsystem.

The reasons for choosing between various therapeutic possibilities depend in part on rational and in part on emotional factors. This project dealt with the systematic verification of some decision factors most of which were known already. The project was divided in a qualitative and a quantitative part. The qualitative segment was based on semistructured interviews with patients of general practitioners or of naturopaths. This procedure is often used in ethnological research. It identified and evaluated the main motives for the individual choices of therapies by the patients. The quantitative part of the study was carried out by a procedure often used in social sciences, namely by strictly structured telephone interviews of several thousand policyholders of the health insurance fund Helvetia. The aim of this part of the study was to verify the findings of the qualitative study and to investigate the possible significance of additional sociological factors for the choice between different therapies. The conclusions drawn from the abundance of data show that a widespread use of complementary medicine is a reality. Both parts of the project came to the same conclusions. The patients use complementary medicine in a very pragmatic way, be it alternately, be it in parallel but not necessarily in addition to mainstream medicine. The behavior of the patients is very complex, depends on many factors, and can neither be predicted nor easily influenced, not even by an additional free insurance for complementary medicine which was offered to one of the subgroups of the study (in conjunction with J. Sommer's project 'A Randomized Experiment Studying the Effect of Including Complementary Medicine in the Mandatory Benefit Package of Health Insurance Funds in Switzerland'). The interpretation of the telephone interviews concerning the significance of some of the registered sociological factors turned out to be difficult. The project aimed primarily at illustrating the use of complementary medicine and at characterizing its users.

Traditional healers in Tanzania: the perception of malaria and its causes.

The coordination of traditional and western medicine is still in its infancy in most African countries. Although there is much discussion about the contribution of traditional medicine and its practitioners, especially on the primary health care level, it has rarely be done in practice. This is probably due to the lack of knowledge of how to do it, because a serious attempt to include traditional medicine in health planning would presuppose that it is known what traditional medicine has specifically to offer for certain diseases/illnesses and how traditional healers manage such conditions. The aim of this study was to investigate the management of malaria by traditional healers in different areas in Tanzania. This included looking at the perception, the causation concepts and the knowledge about prevention of the disease/illness of malaria. For this purpose traditional healers were interviewed in different rural and urban places in Tanzania: in the Kilombero valley (Kilombero/Ulanga District), on the main island of Ukerewe (Ukerewe District), in the region near Bukoba town (Bukoba District) and in the settlement of Dar es Salaam (largest town of Tanzania). The results of the study show that most of the interviewed traditional healers were very familiar with the signs and symptoms relating to malaria, as it is defined by western medicine. Many healers were aware of different manifestations of malaria and attributed to them different local names, which match the scientific terms which describe the different types of Plasmodium falciparum malaria, such as cerebral malaria, clinical malaria or febrile type, and gastrointestinal type, respectively. Differences compared to western medical knowledge were found for concepts of causation, and in the fact that severe malaria in children may not be perceived as being associated with malaria.

Traditional healers in Tanzania: the treatment of malaria with plant remedies.

In order to collect ethnobotanical information about antimalarial plants which is essential for the further evaluation of the efficacy of plants an antimalarial remedies, we investigated the management of malaria with traditional herbal remedies, including the use, preparation and administration, by traditional healers in Tanzania. Interviews with traditional healers were conducted in different rural and urban places in Tanzania: in the Kilombero valley (Kilombero/Ulanga District), on the main island of Ukerewe (Ukerewe District), in the region near Bukoba town (Bukoba district), and in the settlement of Dar es Salaam (largest city in Tanzania). The results of the study show that all traditional healers treat malaria with herbal remedies consisting of one to five different plants. The list of plants which they use for antimalarial treatment contains a large number of species from different families. Multiple citations of plants by different healers were rare. Most of the respondents attributed to the plants mentioned, or to the remedies made from them, specific effects and sometimes side effects, explaining and illustrating their use or non-use for different patients or manifestations of the disease/illness.

Traditional healers in Tanzania: sociocultural profile and three short portraits.

Traditional healers are an important part of African societies, but unfortunately the knowledge of the extent and character of traditional healing and the people involved in the practice is limited and impressionistic. They are frequently ignored in studies of user/provider patterns, although they cover the health needs of a substantial proportion of the population. For future health planning it is necessary to know what the reasons are that even in big cities, where western health care services are available, traditional healers flourish, and even compete with each other for certain aspects. The aim of this study was to investigate certain aspects of the profession of traditional healing in general in different areas in Tanzania in order to get an idea about the kind of traditional medical services which are available, and about the people who provide such services. For this reason traditional healers were interviewed with a semi-structured questionnaire in different rural and urban places: in the Kilombero valley (Kilombero/Ulanga district), on the main island of Ukerewe (Ukerewe District), and in the region near Bukoba town (Bukoba District), and in the settlement of Dar es Salaam (largest city of Tanzania). The results of the study show that traditional healers are a very heterogeneous group of persons not having much in common relating to their religion, sex and level of education. The traditional practice is very often taken over from a family member, but also other reasons for becoming a healer, like initiation through ancestor spirits, are very frequently given. More than 50% of the respondents practice full time. These full time practitioners are mainly found among men and in the younger age group. Treatment of in-patients, who can stay in special patient-houses, is offered by half of the traditional healers. Divination used as a diagnostic tool was found mainly among men. Referral of patients to the hospital was mentioned by almost all respondents in cases where they failed with their own treatment or when they knew that the patient would be better treated in the hospital or dispensary.

PIP: While traditional healers are an important part of African societies, not enough is known about the extent and character of traditional healing and the people involved in the practice. The authors interviewed 23 male and 8 female traditional healers in the Kilombero Valley, on the main island of Ukerewe, in the region near Bukoba town, and in the settlement of Dar es Salaam to gain insight into what kind of traditional medical services are available and the people who provide such services. The healers are a very heterogenous group of persons without much in common with regard to their religion, sex, and educational level. The traditional practice is often taken over from a family member. Other reasons for becoming a healer, such as initiation by ancestral spirits, were also frequently given. More than 50% of the respondents practice full time; these healers are mainly male and younger. Inpatient treatment is offered by half of the healers, and divination was used in diagnosis mainly by male practitioners. Almost all healers reported referring patients to hospitals when traditional treatment failed to work or when they knew that the patient would be better treated at a hospital or dispensary.

[Conventional or complementary medicine: what criteria for choosing do patients use?]. / Schulmedizin oder Komplementärmedizin: Nach welchen Kriterien entscheiden sich die Patientinnen und Patienten?

Only a few studies have investigated in depth the motives behind the choice of conventional or complementary medicine. While some studies document failures or general mistrust of conventional medicine as the main reasons for turning to complementary medicine, others conclude that the decision to try alternative medicine is not necessarily due to disappointment with conventional medicine but rather an endeavour to do everything possible for one's own health. Patients regard complementary medicine indeed as a complement. Longer-lasting consultation and a better doctor-patient relationship are occasionally mentioned as favourable aspects of complementary medicine. Other motives are a critical attitude to modern civilization and the growing symbolic value of health. The choice may be related to the nature of the disease. Depending on the patient population involved, complementary medicine is used for either more difficult or simpler cases. As a general rule it is the chronic problems that are dealt with by complementary medicine. Users of complementary medicine cannot be regarded as a homogeneous group. Nevertheless, one Swiss study concludes that users of complementary medicine tend to be female, with higher education, from the upper middle class and aged between 30 and 50. They have postmaterialistic value priorities, holistic interpretative models of health and disease, and want to share in decision-making on treatment questions. Approaches and contexts of individual studies differ and the study populations of individual investigations are sometimes questionable. This means that some results are to be treated with caution. The literature under review rarely refers to cultural and social aspects as possible factors, and processes are likewise rarely investigated. Only one study presents behaviour in sickness as a social process which reveals how people perceive, interpret and respond to health problems. In conclusion, the sociological theories and findings involved in the entire question area are briefly outlined.

[Forces and turning moments of hip and knee joints in locomotion]. / Kräfte und Drehmomente an Hüft- und Kniegelenken beim Gehen.

In order to be helpful to orthopedic surgeons in planning operations, and providing quality control, gait analysis must provide information on forces and moments at major joints because kinematic data alone have proved to be unsatisfactory. A practical procedure for this purpose was developed and applied to 20 children and young adults, using the inverse dynamic approach. Segmental body volumes were obtained by stereophotogrammetry. Together with density values, this permits individual calculation of segmental mass center positions even in the presence of severe deformity. Segmental anatomical coordinate systems were defined and tagged by skin markers. Subsequent stereophotogrammetric gait recording by high-speed cameras and 3D force plates allowed the calculation of reactive forces and moments with their changing values over each gait cycle. For the two peaks of force transmission in the early and late stance phases, vector diagrams demonstrate 3D components of forces and moments as related to the anatomy of the thigh and shank of a normal young adult. The peak reaction force component in the longitudinal axis during initial loading about reaches body weight, the anteroposterior force 2/5th and the mediolateral component 1/25th of body weight.

[Treatment of acne and seborrhea using antiandrogens]. / Behandlung von Akne und Seborrhöe mit Antiandrogenen.

57 women suffering from seborrhea and acne were treated with low doses of estrogens and antiandrogens. A cyclic regimen comprising 21 tablets of 0.05 mg ethinylestradiol and 2 mg cyproterone acetate was used. Results were very favourable: within 6 months, 51 patients were healed or significantly improved. There were only minor side effects, and none of the women conceived. It is concluded that this combination not only provides very effective therapy but might also be the contraceptive of choice for women with skin problems.