[Refixation of osteochondral fragments with resorbable polylactid implants : Long-term clincal and MRI results]. / Refixation von osteochondralen Fragmenten mit resorbierbaren Polylactid-Implantaten : Klinische und MR-morphologische Langzeitergebnisse.

BACKGROUND: Refixation with resorbable implants is a common surgical treatment in patients who suffer an injury with shearing of an osteochondral flake due to trauma of the knee or the upper ankle joint. To date there are no studies which outline long-term outcomes for this procedure. The aim of this study was to evaluate long-term clinical and magnetic resonance imaging (MRI) results after refixation with resorbable polylactide (PLLA) implants. MATERIAL AND METHODS: In this retrospective study 12 patients with 13 injuries were examined 13.9 years (±1.2 years) after refixation of an osteochondral fragment of the knee (10 patients) and the upper ankle joint (2 patients) with a mean size of 3.33 cm2 (±2.33) by resorbable polylactide (PLLA) implants (nails, pins, screws, Bionx, Tampere, Finland). To objectify the clinical results eight established clinical scores (VASS, Tegner, Lysholm, McDermott, KSS, WOMAC, AOFAS, FADI+Sports) were used. Furthermore, the morphological integration of bone and cartilage was assessed by MRI (3 T) using proton-weighted and cartilage-sensitive 3D double-echo steady-state (DESS) sequences. The morphological results were objectified with a modified MRI score according to Henderson et al. RESULTS: After 13.9 years (±1.2) the patients with an injury of the knee as well as of the upper ankle joint showed good to excellent results (knee: VASS 1.2 (±1.7), Tegner 4.4 (±1.3), Lysholm 85.7 (±12.2), McDermott 90.7 (±8.6), KSS 189 (±14.2), WOMAC (6.16% (±8.45)) (upper ankle joint: VASS 2.5 (±2.5), Tegner 5.5 (±1.5), Lysholm 87 (±13), McDermott 88 (±12); WOMAC (8.54% (±8.54), AOFAS 75.5 (±24.5), FADI+Sports 118 (±18)). In all cases there was evidence of good integration of the osteochondral fragment in MRI. In five patients there was moderate subchondral cyst formation (∅ ≤1 mm); however, mild changes of the cartilage contour were found in all patients. The mean modified Henderson score achieved was 14.4 (±2.0, best 8, worst 32), which corresponds to a good morphological result. CONCLUSION: Because of good clinical and morphological results shown by MRI, refixation through resorbable implants (PLLA) can be recommended for treatment of traumatic osteochondral flakes.

[Application of geographical information systems in epidemiological studies exemplified by the ISAAC study in Munich]. / Der Einsatz von Geoinformationssystemen (GIS) in epidemiologischen Studien dargestellt am Beispiel der ISAAC-Studie München.

Geographical Information Systems (GIS) are increasingly applied as modern tools for analysis and visualization of health-related spatial data, especially in epidemiological research. GIS are used by medical researchers and executives in the public health service. A community-based survey was conducted according to the phase II protocol of the International Study of Asthma and Allergies in Childhood (ISAAC) in Munich. The spatial patterns of disease incidence were analysed and related to exposure data by GIS. The prevalence study on fourth-grade pupils (n = 3354) and school beginners (n = 2890) was conducted during the school term 1995/96 in Munich. Parental questionnaires and measurements of lung function and immunological parameters were used. The questionnaire data were integrated in a GIS database. In this paper we discuss methodological aspects of GIS-based spatial analysis related to epidemiological data. In addition, we investigate whether there were spatial clusters of children with wheeze in the last 12 months of a magnitude unlikely to occur by chance and which could indicate local health risks. The study was based on permutation tests where global and local methods were applied. No spatial clusters of children with asthma symptoms were identified in the city of Munich.

[Association between depression, temperament and personality disorder: some therapeutic implications]. / Relation entre dépression, tempérament et trouble de personnalité: quelques implications thérapeutiques.

Certain personality traits or disorders in combination with clinical signs complicate the diagnosis and treatment of depression. The approaches to the relationships between personality and mood disorders vary. Some see important links between normal personality types (or temperaments) and depression, while others see certain temperaments as sub-syndromic variants of mood disorders. Finally, a third approach proposes an analysis, drawing on Robins and Guze's criteria, of the validity of psychiatric diagnoses for determining whether this frequent comorbidity of depression and personality disorders (DSM-III) is consistent with a nosologic relationship, or is merely some definitional or other artefact. A category-based diagnostic approach provides little clarification; in some studies, a dimensional model attempts to better define the links between depression, temperament and personality and clarify the content of the apparently heterogeneous notion of depression, with therapeutic implications. Research in this area should lead to the development of increasingly specific therapeutic approaches to depression.

[Change in cardiovascular activation in learning and performance situations in children with learning disorders]. / Veränderung der Kreislaufaktivierung in Lern- und Leistungssituationen bei leistungsgestörten Kindern.

A method is demonstrated for observing and statistically testing changes in cardiovascular activity in single cases between two types of situations, in this case a playing situation and a learning situation. Using this method it could be shown an abasement of cardiovascular activity during a learning situation together with their mother or father--compared to a playing situation--for 20 hyperactive children with learning problems of an average age of 9.7 years. Together with this abasement in cardiovascular activity there was observed a deterioration in the parent-child-relation. In the singles cases however it could be observed an abasement or an increase in cardiovascular activity. When the--often punishing--parent was replaced by a person who built up a positive relation to the child, there could be observed either an increase or an abasement or no change in cardiovascular activity, the effect being replaiable. The results point up to a critical examination of actual therapeutic concepts for children with learning problems.

Attitudes towards psycho-social factors in medicine: an appraisal of the ATSIM scale.

As the importance of psycho-social factors in medicine is increasingly stressed, it is believed that attitudes towards psycho-social issues in medicine should be taken into account in the selection of medical students. The first step of a longitudinal study concerning the impact of medical studies on the students of a French-Canadian University gave us the opportunity to appraise the adequacy of Parlow & Rothman's (1974) ATSIM scale, a measure of attitudes towards psycho-social issues in medicine. We found the following correlations: (1) High scores on the ATSIM scale were negatively correlated with a relatively closed value system (high scores for dogmatism), (2) openness towards psycho-social factors in medicine and empathy were positively correlated, (3) There was a stronger correlation between the ATSIM scale and acceptance of absortion for social conditions than between acceptance of abortion for physical risks and this scale (this shows the social orientation of the ATSIM scale), and (4) hight scorers on the ATSIM scale seem to be more 'sensitive, forthright and expedient' than low scorers. Our results suggest that Parlow & Rothman's (1974) ATSIM scale might be a useful tool in the selection of medical students and further research is needed.

[The concept of differential aging (its use in health study in the workplace).]. / Le concept de vieillissement différentiel : Son utilisation dans les études de santé au travail.

Differential aging means the difference between chronological and biological age ; this concept is one of the best general health level indicators for individuals and groups, being both a diagnostic and a research instrument for the study of environmental sources of health variations. In an industrial setting, our results indicate strong over-aging in the case of unskilled manual workers, which might be related to lack of interest in the mechanical, repetitive tasks at work and to possible alienation of this employee category.