Connectivity pattern modifies excited state relaxation dynamics of fluorophore-photoswitch molecular dyads.

In order to modulate the emission of BODIPY fluorophores, they were connected to a diarylethene (DAE) photoswitch via phenylene-ethynylene linkers of different lengths and orientations. The latter allowed for modulation of the electronic coupling in the prepared four BODIPY-DAE dyads, which were compared also to appropriate BODIPY and DAE model compounds by steady state as well as time-resolved spectroscopies. In their open isomers, all dyads show comparable luminescence behavior indicative of an unperturbed BODIPY fluorophore. In strong contrast, in the closed isomers the BODIPY emission is efficiently quenched but the deactivation mechanism depends on the nature of the linker. The most promising dyad was rendered water-soluble by means of micellar encapsulation and aqueous suspensions were investigated by fluorescence spectroscopy and microscopy. Our results (i) illustrate that the electronic communication between the BODIPY and DAE units can indeed be fine-tuned by the nature of the linker to achieve fluorescence modulation while maintaining photoswitchability and (ii) highlight potential applications to image and control biological processes with high spatio-temporal resolution.

[Cervical spine injuries in stable lower cervical spine with spinal stenosis]. / Zervikale Rückenmarkverletzungen bei stabiler unterer Halswirbelsäule mit Spinalkanalstenose.

The aim of the study was to investigate the neurological outcome of spinal cord injuries in the traumatized cervical spine with a stenosis of the spinal medullary canal. From 1992 to 1999 we treated 145 spinal cord injuries and/or injuries with an unstable cervical spine, 138 were treated operatively, in 7 patients we found an injury of the spinal cord with a stable cervical spine and a stenosis of the spinal medullary canal. The radiological diagnostics consisted of anterioposterior X-rays of the cervical spine, an X-ray view of the dens axis and a stress roentgenogramm in extension and flection. An MRI was performed within the first 12 hours after the accident. The stenosis of the spinal medullary canal was evaluated by the quotient of the mid-sagittal diameter of the spinal medullary canal as well as the vertebral body (Torg-quotient) and ranged from 0.5 to 0.8. Pathological changed values were found in 4 patients within 2 segments and in 3 patients within 3 segments. In the T2-turbospin echo sequence hyperintense lesions of the spinal cord, accordingly to an edema were found in 6 patients. The neurological evaluation was performed according to the "Standard Neurological Classification of Spinal Cord Injuries". Treatment of these 7 patients was performed conservatively, consisting of NSAR as well as Methyl-Prednisolon according to the pattern of NASCIS-II and III. The follow-up was performed after 12 to 18 months. We evaluated the X-rays in anterioposterior and lateral view, stress roentgenogramms and neurological status. Radiological findings showed stable conditions of the cervical spine with block vertebras and increased osteophytes. The neurological outcome was evaluated according to the "Motor-Score" and showed an improvement from 8 to 63 points within 13 months in one case. In 6 cases, the average "Motor-Score" of 78 increased to 100 points within 2 to 5 months after injury. Most defunctionalization symptoms were found in the upper extremities. Disturbances in fine motor movement were unable to be examined with the "Motor-Score". We can conclude that spinal cord injuries in stable cervical spines with stenosis of the spinal medullary canal can be treated conservatively with a good outcome. A regression of the neurological deficiency can be expected within 2 to 5 months, but even after one year, deficiency regression is possible.

[First experiences with unreamed AO intramedullary nail in treatment of femoral shaft fractures]. / Erste Erfahrungen mit dem unaufgebohrten AO-Marknagel (UFN) in der Behandlung von Oberschenkelfrakturen.

The unreamed femoral nail (UFN) system, with its numerous proximal interlocking options, allows a minimal invasive surgical procedure for the treatment of nearly all femoral fracture patterns. Sixty-six fractures, 5 cases of osteolysis or pathologic fractures, 2 limb shortenings and 1 lengthening (monorail technique) and 3 cases of pseudarthrosis were stabilised with the UFN from July 1994 to December 1996. The fractures were analysed according to the AO classification. We found 31 polytrauma patients with an mean ISS of 21.8 and a mean PTS of 25.4. Most of the multiply injured patients (n = 26) were stabilised with the UFN primarily. Follow-up of 44 patients ranged from 4 to 18 months postoperatively. According to our clinical and radiological score the results were excellent in 34% of cases, good in 36.3%, poor in 20.4% and bad in 9%. Average fracture healing time was about 9.8 weeks.

[The UFN-system (unreamed femoral nail)--avoidable intra- and postoperative complications]. / Das UFN-System--Vermeidbare intra- und postoperative Komplikationen.

We give an account of the first Austrian clinical results of a prospective study dealing with fractures of the femoral shaft treated with the UFN-system, the intraoperative handling especially considering the intra- and postoperative complications. The UFN-system combines the advantages of numerous proximal interlocking options for the treatment of nearly all femoral fracture patterns with that of the unreamed nailing (biological osteosynthesis, primary stability with individual after-treatment, high patient's comfort and early mobilisation). Within two years (VII/94-VII/96) sixty closed and four second degree open fractures were stabilized with the unreamed femoral nail. In twelve cases we used the spiral blade interlocking technique. Five times we changed from external fixator to the UFN. The fractures were classified according to the AO-classification. In 64 implanted UFN there occurred twelve intraoperative and four postoperative complications. In five cases reoperation was necessary. Failings in the operative technique, numerous different experienced surgeons and a deficient after_treatment led to our pitfalls.

[Are complications in cruciate ligament replacement operations with patellar tendon transplantation dependent on surgical technique and surgical timing?]. / Sind Komplikationen bei Kreuzbandersatzoperationen mit Patellarsehnentransplantat von OP-Technik und OP-Zeitpunkt abhängig?

HYPOTHESIS: In a retrospective study we analyzed our results of ACL reconstructions with a patellar tendon graft. We wanted to know if the complications were dependent upon timing and technique of surgery. METHOD: We reviewed 283 patients after ACL-reconstruction, who underwent an operation with bone patellar tendon graft between 1984-1993. In our study we particularly looked for complications. The overall rate of complications was 21.6% dependent on the applied technique. Infections, DVTs, limitations of movement and graft failures were the most common complications. Furthermore we analyzed the timing of operation. Arthrofribrosis was less common in the group with delayed reconstruction (6.1%) whereas in the primary reconstruction group the rate was 17.6%. For this reason we changed our management with regard to the timing of operation. Meniscal injuries were the most common additional injuries in both groups. Conservatively treated ACL-ruptures showed a high rate of mensical ruptures in combination with cartilage injuries. CONCLUSION: Because of these results we put more emphasis on patient information to achieve the optimal result and to meet the individual needs for every patient.

Unstable fractures of the upper thoracic spine.

Unstable fractures of the upper thoracic spine are a therapeutic challenge because of the high rate of associated injuries and frequent occurrence of spinal cord lesions. This study focuses on the operative treatment of these injuries. We present nine patients with unstable injuries of the upper thoracic spine. According to the classification of Magerl et al., there are seven type C and two type B fractures. Eight patients had complete transverse lesions of the cord and one had no evidence of spinal cord injury. All patients presented associated injuries: nine patients had fractured ribs, three a fractured sternum and three a severe haemothorax. All underwent operative treatment: six posterior fusions only, two anterior interbody fusions only after thoractotomy owing to severe bleeding from ruptured intercostal arteries, and one a combined fusion after failure of posterior fusion. The treatment of these patients should be individualized, depending on the associated injuries, loss of blood owing to fractured spine and ruptured vessels and depending on the back pain resulting from an unstable thorax. In general, we prefer the posterior approach to unstable fractures of the upper thoracic spine.

[Posterior dislocation fracture of the shoulder]. / Die hintere Luxationsfraktur der Schulter.

Posterior dislocation fracture of the shoulder is a rare injury that often occurs in association with a grand mal seizure. Our aim with this paper is to emphasize diagnosis and therapy. In the past 5 years seven patients with nine posterior dislocation fractures were treated operatively. In six patients a grand mal seizure was the cause of the injury and in one a direct trauma. Three four-part fractures were found in two patients and six locked posterior dislocation fractures in five patients. Clinical examination in locked posterior dislocation fractures showed a lack of external rotation, and flexion was performed by movement of the scapula. Radiological examination demonstrated an overlapping of the contours of the humeral head and the glenoid and the "trough line". The operations were performed in the time between 4 h and 10 days later. Two of three four-part fractures (in one patient) were treated with hemiarthroplasties, and one was fixed with screws. Closed reduction was attempted in six shoulders but was possible only in one patient. In this patient a redislocation occurred 3 days later and a combined anterior and posterior approach was done. A fracture of the anatomical neck was produced in another shoulder. Six open reductions and stabilizations with screws were performed, and three times we fixed the subscapular tendon in the reversed Hill-Sachs lesion with anchor sutures. Patients after grand mal seizures may have a posterior shoulder dislocation, and clinical and radiological examination should be emphasized. In locked posterior dislocation we favour early open reduction, fixation of the subscapular tendon with anchor sutures in the reversed Hill-Sachs lesion and stabilization of the lesser tuberosity with screws.

[Hypertrophic callus formation and craniocerebral trauma: early diagnosis and behavior of basic fibroblast growth factor]. / Hyperthrophe Kallusformation und Schädel-Hirn-Trauma: Frühdiagnostik und das Verhalten des basischen Fibroblastenwachstumsfaktors.

Hypertrophic callus formation in patients with severe head injury leads to an early fracture consolidation, whereas in joint fractures the enhanced ossification can even end in ankylosis of the injured joint. It is already known that these ossifications can be at least partly prevented by non-steroid anti-inflammatory drugs. Therefore, serum parameters have been determined that could predict this phenomenon. The mean values for alkaline phosphatase (ALP) and its bone isoenzyme were significantly increased in patients with severe head injury and bone fractures as soon as the 2nd week (reaching peak values in the 3rd week after injury) compared with patients with isolated fractures or head injury only and with normal healthy subjects. Procollagen I (PICP) was significantly increased even in the 1st week, reaching its peak during the 2nd week after injury. Compared with the callus volume at the time of fracture consolidation the size was determined from the X-rays--it was even possible to predict the volume of callus with the aid of these serum parameters as early as in the first few weeks after injury. A possible link between head injury and the increased bone formation could be the basic fibroblast growth factor (bFGF). In our study, bFGF was determined in serum by an immunoassay (ELISA), and an unusual pattern of dynamic change was observed in the patients with head injury and bone fractures. Compared with patients with isolated bone fractures bFGF immunoreactivity was significantly increased in patients with brain and bone lesions even in the 1st week after injury, with further peaks in the 2nd, 4th and 7th-8th weeks, with sudden decreases in between. In patients with isolated bone fractures a transient increase of bFGF was observed only during the 2nd week after injury. A similar increase was also determined in the sera of patients with head injury only, but it lasted longer. Thus, a posttraumatic increase of the serum bFGF was induced by bone as well as by brain injury, but was not causally related with the growth-promoting effects of the sera, as was proven by an in vitro analysis of the effects of the patients sera on L929 fibroblast growth.

[UFN system. A method of minimal invasive surgical management of femoral shaft fractures]. / UFN-System. Eine Methode der minimalinvasiven chirurgischen Versorgung von Oberschenkelschaftfrakturen.

The aim of this study is to present our early clinical experience using the Unreamed AO Femoral Nail (UFN). The UFN system combines the advantages of numerous proximal interlocking options for the treatment of nearly all femoral fractures patterns with those of unreamed nailing (biological osteosynthesis, preservation of the cortical blood supply, closed mediate reduction, primary stability, high degree of patient comfort). Operation time and blood loss are reduced by eliminating the reaming procedure. The risk of infection is minimized by avoiding dead space. The positioning of the patient on the operating table without the use of traction allows for a minimally invasive surgical procedure. Our report deals with intraoperative handling, intra- and postoperative complications and the prospective clinical outcome in using the solid femoral nail system in Austria. Within nearly 2 years (August 1994-April 1996) 52 closed fractures and four second-degree open fractures were stabilized using the unreamed femoral nail. In 12 cases we used the spiral blade interlocking technique. Four times we changed from external fixation to the UFN. According to the AO classification, we found 8 fractures of the proximal femur (A 1/1: 1; A3/1: 2; A3/3: 5) and 48 diaphyseal fractures (A1:4; A2: 7; A3: 16; B1: 5; B2: 6; B3: 6; C1: 1; C2: 2; C3: 1). Thirty patients were followed up over an average period of 9.1 months postoperatively. The clinical and radiological results were excellent in 20 cases; average fracture healing time was about 10.6 weeks.

[Complications in 283 cruciate ligament replacement operations with free patellar tendon transplantation. Modification by surgical technique and surgery timing]. / Komplikationen bei 283 Kreuzbandersatzoperationen mit freiem Patellarsehnentransplantat. Beeinflussung durch Operationstechnik und Operationszeitpunkt.

In our retrospective study we reviewed 283 patients who were operated on between 1984 and 1993 after an ACL-rupture. We used a free patellar tendon bone graft in all patients. The aim was to assess the complications such as infections, thrombosis, limitation of movement and graft failures. We also looked on the timing of operation and the technique. We saw an overall complication rate of 21.6%. The most common complication was a restricted range of motion in 10.9% which required surgery. In patients treated immediately after injury (within 7 days) we found an arthrofibrosis rate of 17.6%. In delayed surgery (more than 4 weeks after injury) this complication was only seen in 6.1%. The rate of infection was 4.6%, the rate of thrombosis 1.8% and in 4,2% we had to accept an ongoing instability. With these findings we now evaluate the needs and the social environment even more closely to find the best treatment protocol for each individual. In conclusion we favour secondary ACL-reconstruction.

Released PMN elastase: an indicator of postsurgical uneventful wound healing and early inflammatory complications. A contribution to the search for objective criteria in wound healing monitoring.

Monitoring of postoperative wound healing is important for the early diagnosis of postoperative infective complications in order to decrease morbidity. The purpose of this study was to search for a discriminatory time point between uneventful wound healing and early wound infections after operations for orthopaedic trauma using PMN elastase. This proteolytic enzyme is a biochemical marker for pathological granulocyte stimulation. The two groups of injured patients comprised persons with 'per priman' (pp) wound healing without complications--group 1 (N = 31)--and the early manifestation of a bacterial wound infection 'per secundam' (ps) during the healing phase--group 2 (N = 4). In group 1, surgical trauma was accompanied by an increase in PMN elastase levels reaching the maximum within the first 3 postoperative days; values returned to normal on day 10. In group 2 PMN elastase median levels showed recurring increases throughout. No normal values were observed. There was a highly significant difference (P < 0.01) on days 4 and 5 in group 2 compared with the control group 1. Since PMN elastase can be determined on an autoanalyser, and the enzyme is of proven discriminatory value, it is suggested that this marker should become part of the daily diagnostic routine in the care of the injured.

[The postoperative cervical spine and evaluation of the spinal cord with magnetic resonance tomography]. / Postoperative Halswirbelsäule und Beurteilung des Rückenmarks mittels Magnestresonanztomographie.

We present the cases of ten patients who underwent postoperative magnetic resonance assessment after dislocation injuries of the cervical spine and treatment with anterior interbody fusion and titanium implants. Eight patients had spinal cord injuries and two had nerve root disorders. In two patients who had intracranial haematomas and dislocation fractures of the cervical spine, MRI proved useful for identification of parenchymal spinal cord injuries as the reason for transverse lesions. Severe MR findings of the parenchymal spinal cord injuries (haematoma or transection) correlated with complete transverse lesions (4 patients) and oedema of the spinal cord, with incomplete transverse lesions (3 patients). MR enables us to examine the spinal cord after operations to ensure that correct spinal cord decompression has been achieved (3 patients). MRI is useful for detecting disc protrusion or chronic spinal stenosis in patients with titanium implants. All in all, MRI is an important modality in the evaluation of the posttraumatic cervical spine.

[Hyperextension injury of the lower cervical spine and diagnosis of dorsal unstable motion segments]. / Hyperextensionsverletzung der unteren Halswirbelsäule und die Diagnostik von dorsal instabilen Bewegungssegmenten.

Five patients with hyperextension injuries and dorsally instable motion segments are presented. In the diagnosis of posterior instabilities plain roentgenograms demonstrated no characteristic signs of an injured cervical spine. Flexion and extension views detected a mild degree (2 mm) of retrospondylolisthesis in four cases and a widened disc space in one case. In all five patients the MR findings that made use suspect a posterior unstable motion segment were disc protrusions; in addition, in two patients these was hemorrhage in the spinal cord and in one patient cord edema.

[Diagnosis, therapy and prognosis of Pipkin fractures (femur head dislocation fractures)]. / Diagnostik, Therapie und Prognose der Pipkin-Frakturen (Femurkopf-Verrenkungsbrüche).

Fractures of the femoral head combined with a dislocation of the hip are rare injuries. In the period from 1975 to 1993 nine of our 231 operatively treated patients who had a hip injury sustained a Pipkin fracture. According to the history of our patients and the results of the last 18 years we discuss the possibilities of diagnosis, treatment and prognosis of the fracture of the femoral head with dislocation of the hip.

Dorsal stabilization of thoracolumbar spinal instability. Comparison of three different implantation systems.

Many unstable fractures and fracture dislocations of the lower thoracic and the lumbar spine are treated operatively. Internal fixation is mostly done via a posterior approach, anchoring the screws in the pedicles of the vertebrae. In the Traumatology Section of the Department of Surgery, Graz University, three different implantation systems have been employed in recent years. Sixty of all the patients operated on were available for follow-up an average of 36 months after operation. We compared them with respect to type of implant, paying special attention to any loss of reduction.

[The unreamed tibial intramedullary nail in treatment of tibial fractures--initial experiences]. / Der unaufgebohrte Tibiamarknagel (UTN) in der Behandlung von Unterschenkelfrakturen--erste Erfahrungen.

The unreamed tibial nail (UTN) combines the advantages of the external fixator (preservation of the cortical blood supply) with that of conventional intramedullary nailing (closed system, high patient comfort, no pin problems) in the treatment of the lower leg fracture [5]. Within 1 year (III/92 to III/93) 31 closed and 2 open fractures were stabilised with UTN. In 67% (22 persons) we found fractures of the A1, A2 and A3 types according to the AO classification. In 6 patients there was a combined lesion with involvement of the ankle joint. A follow-up of 27 patients was done, extending to an average of 6 months postoperatively. The clinical and radiological results were excellent in 26; average fracture healing time was about 12-14 weeks.

[Biochemical wound monitoring. PMN elastase in different healing stages after trauma surgery-orthopedic interventions]. / Biochemisches Wundmonitoring. Die PMN-Elastase bei unterschiedlichen Heilungsverläufen nach unfallchirurgisch-orthopädischen Eingriffen.

Laboratory parameters are of proven value in the diagnosis of early postsurgical infections, since clinical aspects cannot always be clearly defined. Neutrophil granulocytes (PMN) are major inflammatory cells taking effect following ingestion and degradation of foreign material, such as bacteria and cell debris, for example after mechanical trauma. In patients who had undergone surgery we monitored the course of plasma PMN elastase in uncomplicated wound healing (n = 22), in uncomplicated wound healing associated with secondary infections (n = 6), and in defective wound healing (manifestation of a bacterial wound infection: n = 3; wound infection already manifest at the time of entry on study: n = 11). Surgical trauma was accompanied by an increase in PMN elastase and C-reactive protein (CRP) in all patients studied, reaching a maximum within the first 3 postsurgical days. When a bacterial wound infection became manifest during the course of healing there was a highly significant difference on the 4th postsurgical day (p < 0.01) compared with the group with uncomplicated healing. Since PMN elastase can now be determined automatically with an autoanalyser and a commercial kit and its discriminatory time point is as soon as 4-5 days after surgery, it is suggested that this marker should be determined routinely together with CRP in traumatology.

[Blood supply to the cervical spinal cord and possible therapeutic consequences in cervical spinal cord injuries]. / Die Blutversorgung des zervikalen Rückenmarks und mögliche therapeutische Konsequenzen bei zervikalen Rückenmarkverletzungen.

The study was designed to demonstrate the blood supply to the cervical cord through radicular branches and was carried out in 23 human cadavers into which preparations were injected by the intra-articular route. One corrosion cast of the head and neck showed extravertebral anastomotic pathways. After removal of the vertebral bodies and discs from C1 to D3, the anterior spinal artery and radicular branches were identified and dissected back to their origins from the vertebral, deep or ascending cervical arteries. Twelve preparations had only one or two radicular branches reaching the cervical spinal cord. If there is traumatic compression of an ascending branch a high risk of ischaemic damage to cranial areas of the spinal cord arises. The blood supply to the cervical enlargement of the spinal cord was provided by branches of the deep cervical artery in eight preparations, but only in one by branches of the vertebral artery. We therefore plead for decompression of the anterior spinal artery and the spinal cord and for sufficient arterial blood pressure, and give our reason for these demands.

MR findings and treatment of four patients with cervical spinal cord injuries.

We report the value of magnetic resonance imaging (MRI) in the assessment of cervical spine injuries with neurological deficit and the implications such information might have in the management of acute spinal cord injuries. Four cases are presented that were neurologically classified according to the 5-step Frankel scale. Three patients presented with an intramedullary hemorrhage. One of these patients showed additional mild compression of the spinal cord due to a retropulsed bony fragment, and one an epidural hematoma without any evidence of spinal cord compression. The fourth patient had compression of the spinal cord secondary to bony fragments from a burst fracture. We carried out two decompressions of the spinal cord by removing the disc and bony fragments. In addition, we performed two interbody fusions. In one patient we applied a halo vest, and in one case surgical intervention was not necessary after MRI assessment.