[Clavicular fractures in pediatric traumatology]. / Klavikulafrakturen in der Kindertraumatologie.

Clavicle fractures are most common in children. Due to the thick periosteum that provides appositional bone proliferation on the one hand and a high potential of the medial physis for longitudinal growth on the other hand the fractures have an enormous healing potential. Both factors are also responsible for good fracture remodeling. In adolescents, the periosteal tube gets thinner and fracture types correspond to fractures in adults. Most fractures heal with good results after conservative treatment. In this article clavicle fractures in children and adolescents and options for therapy including the rare surgical treatment depending on different fracture localizations and morphologies are discussed.

Mechanisms involved in the gastro-protective effect of STW 5 (Iberogast) and its components against ulcers and rebound acidity.

The protective effect of a commercial preparation (STW 5, Iberogast), containing the extracts of bitter candy tuft, lemon balm leaf, chamomile flower, caraway fruit, peppermint leaf, liquorice root, Angelica root, milk thistle fruit and greater celandine herb, against the development of gastric ulcers was previously reported in an earlier publication (Khayyal et al., 2001). All extracts produced a dose dependent anti-ulcerogenic effect associated with a reduced acid output, an increased mucin secretion, an increase in prostaglandin E(2) release and a decrease in leukotrienes. The effect on pepsin content was not uniform and did not seem to bear a relationship with the anti-ulcerogenic activity. The best effects were observed with the combined formulation, STW 5. Furthermore, the effect of the latter in protecting against the development of rebound gastric acidity was examined experimentally in rats and compared with the effect of some commercial antacid preparations (Rennie, Talcid and Maaloxan). A model of testing rebound acidity was developed by inducing a marginal increase in gastric acidity through the administration of indomethacin, in such a way that it could be easily neutralized, allowing any eventual secondary increase in acidity to be measured within a few hours of administration. In addition, the serum gastrin level was measured after drug treatment to establish any correlation between it and any rebound acidity. The results obtained demonstrated that STW 5 did not only lower the gastric acidity as effectively as the commercial antacid, but it was more effective in inhibiting the secondary hyperacidity. Moreover, STW 5 was capable of inhibiting the serum gastrin level in rats, an effect which ran parallel to its lowering effect on gastric acid production.

Antioxidant effect of N omega-nitro-L-arginine methyl ester (L-NAME) on global cerebral ischemia in a rat model.

The antioxidant effect of the non-specific nitric oxide synthase inhibitor, N omega-nitro-L-arginine methyl ester (CAS 50903-99-6, L-NAME), was studied in a rat model of global cerebral ischemia. In addition, the influence of low doses of L-NAME on nitric oxide production, measured as nitrate/nitrite end products, was investigated in the ischemic rats. Ischemia was induced by bilateral clamping of the common carotid arteries for 60 min followed by a reperfusion period for 60 min. L-NAME was administered intraperitoneally in the doses of 1 and 3 mg kg-1, twice, immediately after ischemia and 15 min before termination of the experiment. The drug decreased the elevated activity of lactate dehydrogenase (LDH, 1.1.1.27) as well as the increased level of lipid peroxide in the rat brain. L-NAME was also capable to normalize the reduced activity of superoxide dismutase (SOD, 1.15.1.1) that was observed after ischemia. Improvement of these parameters in L-NAME-treated rats was parallel to normalization of nitric oxide production in the treated animals. These results indicate that inhibition of nitric oxide synthase, induced by L-NAME, could improve the oxidative status of the rat brain after ischemia.

Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination.

Extracts from the plants Iberis amara, Melissa officinalis, Matricaria recutita, Carum carvi, Mentha x piperita, Glycyrrhiza glabra, Angelica archangelica, Silybum marianum and Chelidonium majus, singly and combined in the form of a commercial preparation, STW 5 (Iberogast) and a modified formulation, STW 5-II, lacking the last 3 constituents, were tested for their potential anti-ulcerogenic activity against indometacin induced gastric ulcers of the rat as well as for their antisecretory and cytoprotective activities. All extracts produced a dose dependent anti-ulcerogenic activity associated with a reduced acid output and an increased mucin secretion, an increase in prostaglandin E2 release and a decrease in leukotrienes. The effect on pepsin content was rather variable and did not seem to bear a relationship with the anti-ulcerogenic activity. The most beneficial effects were observed with the combined formulations STW 5 and STW 5-II in a dose of 10 ml/kg b.w., comparable with cimetidine in a dose of 100 mg/kg b.w. The anti-ulcerogenic activity of the extracts was also confirmed histologically. The cytoprotective effect of the extracts could be partly due to their flavonoid content and to their free radical scavenging properties.

A new acylated flavonol triglycoside from Carrichtera annua.

A new acylated flavonol triglycoside, quercetin 3-O-[(6-feruloyl-beta-glucopyranosyl)-(1-->2)-beta-arabinopyran oside] -7-O-beta-glucopyranoside (1), as well as the known flavonoid quercetin, were isolated from the whole plants of Carrichtera annua. The structure of 1 was established by UV, MS, and 1D and 2D NMR spectroscopy, including DEPT, DQF-COSY, TOCSY, HSQC, HSQC-TOCSY, and HMBC experiments.

[Fracture management during bone growth]. / Frakturversorgung am wachsenden Skelett.

In treating fractures in children, there have been more and more demands for the primary treatment to be definitively planned, i.e., for a conclusive order of events to be laid down so as to exclude the necessity for re-reductions or a change of therapy. Long-term conservative methods of treatment are becoming less and acceptable to parents and children. From the psychosocial point of view, the aim must be to avoid extensive periods of hospitalization or bedrest in traction and to dispense with repeated anesthesia for re-reduction and changes in procedure. The child should be able to leave the hospital as soon as possible after a definitive and circumscribed primary course of treatment. Since complication-free surgical interventions are now available, many more operative procedures for dealing with fractures during the years of growth have become routine in this field.

Hoffa fracture--a radiologic diagnostic approach.

Hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur. On plain radiographs the fracture line is clearly seen. However, some fractures and musculotendinous injuries may display subtle features and may be difficult to detect even with optimal images. We explain the mechanism of injury, discuss the diagnostic work-up and the operative and nonoperative management.

Influence of verapamil on the efficacy of vitamin E in preventing the ischemia-reperfusion-induced biochemical dearrangement in cerebral cortex of rat.

The possibility that verapamil (CAS 52-53-9) may intensify the efficacy of vitamin E in preventing the ischemia-reperfusion-caused biochemical dearrangement in rat cerebral cortex was investigated. A daily injection of vitamin E at i.m. dose of 175 mg/kg b.wt. for 7 days prior to subjecting the rats to 1 h bilateral occlusion of the common carotid arteries followed by reperfusion for another 1 h, moderately diminished the ischemia-reperfusion-induced increase in the activity of lactate dehydrogenase and in formation of conjugated dienes as well as in the conversion of xanthine dehydrogenase-->xanthine oxidase in cerebral cortex of rats. However, concomitant injection of verapamil at i.m. dose of 0.68 mg/kg b.wt. 15 min prior to ischemia-reperfusion together with vitamin E pretreatment afforded an elegant combined therapy that effectively abolished the dearrangement caused by ischemia-reperfusion in the above parameters. These results indicated that the protective efficacy of vitamin E against ischemia/reperfusion-induced biochemical dearrangement in cerebral cortex was intensified by concomitant use of verapamil.

[Recurrent hemarthrosis after cruciate ligament refixation by wire suture. A case report]. / Rezidivierende blutige Gelenkergüsse nach Kreuzbandrefixation durch Drahtnaht. Ein Fallbericht.

Recurrent haemarthros is described as consequence of cruciate ligament repair. The main cause of haemarthros is described after unisometric fixation of the ligaments which leads to the rupture of the synovia membrane. This is a case report of a young man, who suffered from recurrent haemarthros for several years although he has intensively examined by radiological and arthroscopical means. It was falsely presumed to be a muscular arthrophy. The cause, however, was found in a wire suture, which was used to fix the anterior cruciate ligament in the femoral bone. This suture was laying under the synovia within the ligament and there fore could be seen and taken away arthroscopically only after total synovialectomy.

Lipid peroxide, phospholipids, glutathione levels and superoxide dismutase activity in rat brain after ischaemia: effect of ginkgo biloba extract.

The influence of ginkgo biloba extract on the lipid peroxide product (malondialdehyde, MDA), glutathione (GSH) and phospholipids levels as well as superoxide dismutase (SOD, 1.15.1.1) and lactate dehydrogenase (LDH, 1.1.1.27) activities in rat brain after occlusion of common carotid arteries was investigated. Two experimental models were studied: 60 min ischaemia without reperfusion and 60 min ischaemia followed by 60 min reperfusion. Compared to sham-operated animals, ischaemia followed by reperfusion increased cytosolic LDH activity and mitochondrial lipid peroxide content and decreased the superoxide dismutase activity and mitochondrial total phospholipids level. Preischaemic administration of ginkgo biloba extract (150 mg kg-1, p.o.) could normalize the SOD activity of the rat brain. The extract was also able to reduce the lipid peroxide and phospholipids contents of the mitochondrial rat brain. These effects could be explained on the basis of the antioxidant property of ginkgo biloba extract and suggests its beneficial role in the protection against post-ischaemic injury.

[Management of tibial shaft fracture with an unreamed intramedullary nail. A principally changed implant]. / Versorgung der Tibiaschaftfraktur mit einem ungebohrten Marknagel. Ein vom Prinzip her verändertes Implantat.

Unreamed intramedullary tibial nailing is a "biological" method of osteosynthesis. The unreamed AO tibial nail (UTN) is an implant based on a different principle, which no longer requires tight intramedullary fitting, but, as a loose-fitting nail, does need both proximal and distal interlocking. Our experience shows that the use of the solid UTN results in a shift in indications towards fractures with traumatic soft tissue lesions. For the "classical" nailing indications, the AO universal nail continues to be used.

[Surgical therapy of frequent hand injuries. Part 2: Injuries of the tendons, neurovascular bundles and soft tissues]. / Chirurgische Therapie häufiger Handverletzungen. Teil 2: Verletzungen der Sehnen, der Gefässnervenbündel und der Weichteile.

Injuries to the extensor and flexor tendons are among the most common injuries to the hand (cf. Part 1 of this overview). Severance of individual flexor tendons as also isolated injuries to individual nerves may occasionally be overlooked. In the case of doubt, operative revision is to be recommended. With the aid of dynamic fixation as described by Kleinert, good functional results can be achieved even with injuries "in no-man's-land". In the event of infections following minor injuries, conservative treatment should be applied only in the early stage; thereafter, surgical revision is indicated. In the region of the flexor tendons, immediate surgery is necessary. Also in the case of a paronychia or a panaritium, early surgical treatment of the abscess and necroses is advisable.

[Surgical therapy of frequent hand injuries. 1: Fractures and capsular ligament injuries]. / Chirurgische Therapie häufiger Handverletzungen. Teil 1: Frakturen und Kapselbandverletzungen.

The hand is often involved in accidents and injuries. Most of these injuries can be treated adequately by the physician providing initial care. This paper gives the reader an outline of the most common hand injuries with the aim of facilitating recognition of the involvement of functional structures and thus ensure proper treatment or referral to the specialist. If a good functional results is to be achieved, misalignments in the longitudinal and transverse axes or torsional misalignments must be avoided. Fixation procedures facilitate provision of early-functional aftercare. In the event of injuries to the capsular ligament, a differentiation between complete and incomplete ruptures is of decisive importance for the further treatment.

Prevention of ischemia-induced cerebral hypothermia by controlling the environmental temperature.

Regulation of brain temperature during and after cerebral ischemia plays an important role in the evolution of neuronal damage. Therefore, it is essential to maintain brain temperature at 37 degrees C during and after the ischemic insult. To get information about brain temperature during the experimental procedure, researchers in previous works have made various attempts to correlate between brain and body temperature during and after ischemia. In the present study, brain temperature was measured when ischemia was performed either at 30 degrees C or at 20 degrees C environmental temperature. For this purpose a stainless-steel guide of a temperature probe was introduced through the bregma and implanted between both hemispheres of the rat. Rats were then subjected to a 10-min period of forebrain ischemia. Cerebral temperature was measured during ischemia and up to 90 min; in some experiments up to 4 hr after ischemia. In another group of experiments, ischemia was performed also at either 30 degrees C or 20 degrees C environmental temperature, and histological assessment of the rat hippocampus was carried out. In addition, the influence of chlorpromazine as a hypothermic agent on the cerebral temperature and the neuronal loss was also tested at both of the experimental conditions. Recording the brain temperature at both of the selected environmental temperatures suggests that it is possible to preserve cerebral normothermia during and after ischemia by working at 30 degrees C environmental temperature. On the other hand, brain temperature dropped sharply immediately after ischemia when working under 20 degrees C environmental temperature, and brain tissue was thereby protected against ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation between the level of serum growth hormone; somatomedin-C; anthropometric measurements and the liver functions in chronic liver diseases.

Twenty patients with bilharzial periportal fibrosis (group I); 20 patients with post hepatitic cirrhosis (group II) and 20 normal controls were chosen to study the correlation between the serum level of human growth hormone (GH) and Somatomedin-C (Sm-C); and the anthropometric measurements; liver function tests and various haematological parameters. Group I showed no statistically significant difference in the mean values of serum GH before and after insulin induced hypoglycemia. The basal serum level of Sm-C showed a statistically significant decrease and highly significant decrease after insulin test. A statistically significant positive correlation was evident between the individual values of serum level of GH and Sm-C and the anthropometric measurements, haematological values and liver function tests (r = 0.41). The mean serum level of GH in group 2, showed statistically significant increase before and after insulin test. The mean serum level of Sm-C showed a statistically significant decrease before and after insulin test. A statistically significant negative correlation was found between the individual values of the serum level of GH and Sm-C and the anthropometric measurements, haematological values and liver function tests (r = 0.16).

Neuroprotective effect of memantine demonstrated in vivo and in vitro.

The purpose of the present study was to test whether the anticonvulsant, memantine (1-amino-3,5-dimethyladamantane), can protect neurons against hypoxic or ischemic damage. To this end, we used a rat model of transient forebrain ischemia and cultured neurons from chick embryo cerebral hemispheres. Ischemia was induced for 10 min by clamping both carotid arteries and lowering the mean arterial blood pressure to 40 mm Hg; the rats were allowed to recover for 7 days. Cultured neurons were made hypoxic with 1 mmol/l NaCN added to the incubation medium for 30 min followed by a recovery period of 3 days. The possible effects of memantine were compared with those produced by a typical non-competitive NMDA antagonist, dizocilpine. Similar effects were obtained with both drugs. The drugs reduced the damage caused by transient ischemia to neurons of the hippocampal CA1 subfield. Memantine (10 and 20 mg/kg) had a dose-dependent effect when administered intraperitoneally to the rats 1 h before ischemia. Dizocilpine was active in this model at a dosage of 1 mg/kg. When administered after ischemia, 10 mg/kg memantine significantly protected CA1 neurons against ischemic damage. Furthermore, the drugs protected cultured neurons against hypoxic damage. The lowest effective concentration was 0.1 mumol/l for dizocilpine and 1 mumol/l for memantine. Thus, memantine possesses neuroprotective activity but is less potent than dizocilpine.

Morbidity of schistosomiasis hematobia in an Egyptian village.

One hundred and fifty patients with active Schistosomiasis haematobium were chosen from Azizia village an endemic area. 50 healthy controls of the same age and sex groups were chosen. Patients were subjected to complete clinical and laboratory examination. Praziquantel orally in a dose of 40 mg/kg was given to each individual and its therapeutic efficacy was assessed by comparing the results of the previous investigations before and 3 months after treatment. The highest infection intensity was noticed in the small age group (A). There was a statistically significant increase of haematuria in this group, dysunia in middle age (B) and increase frequency of micturition & suprapubic tenderness in older age group (C). Ultrasonography showed partial calcification of bladder in 18% of cases in group A, 28% of cases in group B; in group C the percentage was 32% with 14% hydronephrosis, bladder mass 2%, stone bladder & ureter 6%. After praziquantel therapy there was a statistically significant (1) Reduction in haematuria, dysuria increase frequency and suprapubic tenderness (Z less than 1.96). (2) reduction of mean egg count in urine (3) significant improvement of Hb% (4) bladder calcifications showed partial improvement.