OBJECTIVES: Tibialis posterior dysfunction is often diagnosed at a very late stage. However, the early diagnosis of tibialis posterior dysfunction is crucial for therapeutic aspects and especially for the operative prognosis. The morphological correlate of the tibialis posterior dysfunction consists of degenerative changes and thickening of the posterior tibial tendon [2, 9, 11]. By means of a high frequency linear array transducer, a standardized technique of examination as well as reference values of cross-sections of posterior tibial tendon are introduced. MATERIAL AND METHODS: Investigating 51 healthy subjects (102 feet) without any foot deformities, standardized planes were defined by use of a 13 MHz linear array transducer in order to delineate the posterior tibial tendon. At exact anatomic landmarks, tendon diameters were measured using two longitudinal sections proximal and distal to the medial malleolus. Likewise, two diameters and the resulting roughly calculated cross-section of the tendon were determined, using two transverse sections at the level of the subtalar joint facet and the medial malleolus. The findings obtained by ultrasound in four female patients with the diagnosis of a tibialis posterior dysfunction confirmed during surgery are compared to the aforementioned 51 healthy subjects. RESULTS: A healthy tendon appears homogeneous and echo-rich in orthogonal ultrasound and displays average areas of 18.4 sq.mm. (SD 5.9 sq.mm.) at the subtalar joint facet level and 19.2 sq.mm (SD 4.8 sq.mm.) at medial malleolus level in transverse sections. The corresponding areas obtained in patients with tibialis posterior dysfunction were clearly enlarged than in healthy subjects. In 85% of all feet examined at the level of the medial malleolus, the tendon is surrounded by a hypoechoic halo which has a size smaller than two times the cross-section of the flexor digitorum longus tendon. CONCLUSION AND CLINICAL RELEVANCE: Reference values of tendon thickness and of intratendinous echo-structures at reproducible landmarks facilitate delimitations from pathological tendon alterations. The exact delineation of intratendineal echoes by high frequency array transducers and standardized examination techniques that measure tendons size is a prerequisite to enable an early assessment and registration of degenerative alterations and thickening of the posterior tibial tendon.

Adolescent↗

PubMedDate not supplied

Experiences with Redy-dialysis on a camper.

In April 1976 a dialysis camper with Redy-dialysis equipment was put into service by the Institute of Nephrology of the 4th Department for Internal Medicine of the City Hospital Nürnberg. In the following six years of service the bus was rented 40 times by 20 different home dialysis patients and was driven more than 100 000 km in Europe on 700 days. Two hundred and eighty haemodialyses with the Redy-system showed that this kind of dialysis during the holidays can be carried out without running a greater risk than with home dialysis itself. A home dialysis patient describes his own experiences with the 'Redy-bus'.

Adult↗

PubMedDate not supplied

[Water-, electrolyte- and acid-base equilibrium in the aged].

The functional capacity of the kidney decreases with advancing age. We not only find a reduced glomerular filtration rate but also disturbances in the functioning of the tubules which influence the capacity to dilute and concentrate the urine and the renal electrolyte excretion. In addition, the plasma-renin activity shows decreased response to stimulation; the aldosterone and vasopressin secretions are also decreased in old age. Disturbances of the water-, electrolyte and acid-base equilibrium often cause secondary renal failure. On the other hand, as the renal capacity is limited, renal disorders occurring in old age may lead to quicker decompensation.

Acid-Base Equilibrium↗