Preparation and characterization of poly-DL-alanyl rabbit gamma-globulin.
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Animals↗
Biomedical subjects
S Fuchs
Publications and source records attributed to S Fuchs.
Antigenicity of some new synthetic polypeptides and polypeptidyl gelatins.
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Antigens↗
Simpson-Golabi-Behmel syndrome with severe cardiac arrhythmias.
We report on a family with 2 affected males with the X-linked Simpson-Golabi-Behmel (SGB) syndrome. The propositus was a 33-year-old man with pre- and postnatal overgrowth, "coarse" face with hypertelorism, broad nose, wide mouth, malposition of teeth, submucous cleft, accessory nipples, broad hands with hypoplastic index finger nails, and operated left postaxial hexadactyly. From the age of 26 years he suffered from severe tachyarrhythmias, requiring recurrent defibrillations. The brother of the propositus was macrosomic at birth and had a similar facial appearance. In addition he had a pyloric stenosis and a 3/6 systolic murmur. He died at age 4 months. Cardiac defects and conduction disturbances are major components of the SBG syndrome and can be responsible for death in early infancy and perhaps for cardiac arrest in the adult.
Abnormalities, Multiple↗
Performance of two clinical decision rules for knee radiography.
We designed a prospective observational study to attempt to validate two recently described clinical decision rules for knee radiography. Consecutive patients aged > or = 15 yr with acute knee injuries occurring less than 1 wk prior to presentation were included for study. Patients with distracting conditions, open knee injuries, or previous surgery were excluded. Each patient was assessed for 7 historical and 15 physical examination criteria that were recorded on a standardized data collection instrument. Radiographs were ordered at the discretion of the attending physician and were read by two board-certified radiologists. When radiographs were not ordered, structured telephone follow-up was performed after 3 wk. The main outcome parameter was the presence or absence of a clinically significant fracture. There were 351 patients in the study; 26 (7%) had knee fractures. Fractures were significantly associated with an increased prevalence for two of the three criteria in the rule derived by Bauer: inability to weight bear immediately or in the emergency department (ED; 76.9% of patients with a fracture vs. 29.8% of patients without a fracture) and effusion (53.8% vs. 28.9%, respectively). Ecchymosis was not significantly associated with fracture (19.2% with fracture vs. 9% with no fracture). Use of the Bauer rule would have led to a radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 48.9%). Fractures were associated with a significantly increased prevalence for three of the five criteria in the decision rule proposed by Stiell: isolated patella tenderness (30.8% with fracture vs. 14.5% with no fracture), inability to flex the knee to 90 degrees (42.3% vs. 19.7%, respectively), and inability to weight bear immediately and in the ED (57.7% vs. 18.8%, respectively). Age > or = 55 yr (23.1% vs. 12.0%, respectively) and fibula head tenderness (11.5% vs. 5.5%, respectively) were not significantly associated with fracture. Use of the Stiell rule would have led to radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 49.8%). We conclude that neither clinical decision rule is 100% sensitive. Further refinement will be necessary to identify all patients with knee fractures.
Adolescent↗
Do functional deficits result from radial head resection?
The treatment of comminuted fractures of the radial head with primary or secondary head resection is controversial. To assess the outcome of patients after radial head resection, a retrospective study with clinical and radiologic follow-up including isokinetic testing was performed. Between 1981 and 1992, 151 patients underwent radial head resection for comminuted fractures. Fifty-nine patients were operated on during the first 2 weeks after injury (primary treatment), 47 patients were operated on between 3 weeks and 6 months after injury (early secondary), and 45 patients were operated on more than 6 months after injury (late secondary). Follow-up examinations of 108 patients were conducted at an average of 6 years after operation. In 64% of the patients only the radial head was fractured. In 26% of the patients the fracture was combined with a dislocation of the elbow. Results on the clinical and isokinetic tests were better for patients treated with primary resection than for patients treated with secondary resection. Of the patients treated with primary resection, 45% were subject to no restrictions in daily life and 64% had no limits at work.
Adult↗
[Treatment modalities in infected knee alloarthroplasties].
PURPOSE: The purpose of this study was to present and to evaluate different treatment options in the infected knee alloarthroplasty. METHODS: We followed 47 infected knee alloarthroplasties with a mean follow-up of 62 months which were surgically treated by different techniques. There were 20 cases with early infection (< or = 12 months) and 27 cases with late infections (> 12 months). RESULTS: In 10 patients a two stage exchange of the implant were undertaken. In 6 of those 10 cases the infection could be successfully treated. 30 patients underwent an arthrodesis, two of those after an unsuccessful exchange procedure. In this group only in two patients the infection was not managed successfully. 28 of the patients with an arthrodesis showed a good result of the fusion side. One case was only debrided and in 8 cases bony and soft tissue damage lead to amputation. The HSS-score showed an excellent results in 5.3%, a good result in 21%, a fair result in 26.3% and a poor results in 47.4% of the cases. Comparable distribution was documented with the Hungerford-score. Patients with a stable and painless fusion showed a comparable functional outcome to those patients with a new replacement. CONCLUSION: Revision of an infected knee implant is best managed by a two stage procedure and can lead to a good functional result. Fusion is indicated in cases with bad bony and soft tissue situation. A solid arthrodesis gives a painfree and stable extremity.
Adolescent↗
[Value of alignment osteotomy of the proximal tibia in the endoprosthesis period].
AIM OF THE STUDY: To evaluate the value of high tibial osteotomy in times of growing numbers of endoprostheses we compared our personal with other results of this method as well as of the unilateral sledge prosthesis. MATERIAL AND METHODS: Between 1972 and 1993 the high tibial osteotomy as described by Coventry was performed in 105 patients. 98 patients could be examined clinically-radiologically and evaluated with a questionnaire. The indication for surgery was given in patients with unilateral arthrosis without affection of the retropatellar joint and without significant ligamentous instability. The varus deviation was in no case more than 10 degrees. The average follow-up for the clinical-radiologic examination was 9.4 years. RESULTS: 77 patients (78.6%) were satisfied with the outcome of the surgery. Here it was seen that neither age nor pain or instability had an influence on this judgement. The walking distance on the other hand had a significant influence. Stair climbing and range of motion were significantly important as well. 23 patients gave the judgement "excellent", 31 "good", 36 "satisfactory" and 8 patients were "not satisfied". A significant influence of patient age on the judgement could not be proven. The division in the Japanese Score showed "good" results in 14%, "moderate" in 81% and "poor" in 5%. 13 knee joints (13.3%) were absolutely pain-free and in 67 cases (68.4%) there were a definite pain reduction. A significant correlation between the preoperative axis deviation and pain could not be found. An average flexion of 97.5 degree and an extension deficit of 3.3 degree on average was seen. A significant difference of range of motion dependent on age groups could not be found. In 42 knees (42.9%) the lateral ligaments were clinically stable, in 35 cases (35.7%) there was a first degree lateral stress gap and in 21 cases (21.4%) there was a second degree lateral instability. A significant correlation between the instability and age or pain could not be proven. 13 revision surgeries including 9 endoprosthesis implantations were performed. CLINICAL RELEVANCE: The study showed a high level of satisfaction with an exact surgical indication. When seeing the growing number of implanted uni- or tricompartmental endoprostheses the procedure of tibial osteotomy can be suggested for patients with unilateral arthrosis without retropatellar arthrosis, with an axis deviation less than 15 degrees, with unaffected cartilage of the contralateral compartment and without ligamentous insufficiency independent of patient age.
Adult↗
[Proprioceptive capacities of the knee joint with and without endoprosthesis].
PURPOSE OF THE STUDY: To compare the proprioceptive abilities of total knee arthroplasty patients and a control group. METHOD: In a knee arthroplasty patient group of 28 and in 25 healthy volunteers the proprioceptive function was examined. To measure the proprioceptive function the motion analysis system with reflecting markers was chosen. In each patient 16 measurements from different starting points in different joint positions with and without visual controlling were performed. RESULTS: The results demonstrated significant differences between the patients and volunteers independent of the starting point, the joint position and the visual controlling. Also the comparison with the 30 and 60 degree position showed significant differences. In the patient group were not shown significant values comparing the starting position, the visual controlling and the comparison with the healthy leg. CLINICAL RELEVANCE: Knee arthroplasty conducts to loss of proprioception in the operated and healthy leg. Visual controlling can not solve these problems. The worst results were achieved in 60 degrees position. The starting position can not influence the results.
Aged↗
[The physician's professional responsibilities, especially the responsibility for patient education].
AIM OF THE STUDY: With increasing numbers of disputs between patient and doctor the interest in correct enlightenment is rising. MATERIALS AND METHODS: A review of literature is performed to find out the different duties of patient and especially of doctor to enlighten. RESULTS: The medical profession has certain duties, not fulfilling or fulfilling of these duties results in patients claims. In addition to the duties to treat and to coordinate, there is the duty to enlighten of which there are two forms. They are called therapeutic enlightenment and informed consent. The therapeutic enlightenment should aid the collaboration of the patient in order to maximize the medical success of the treatment. The informed consent shall serve to give the patient all information about possible or necessary treatment, so that one can make a self-informed decision between treatment and non-treatment. The last form consists not only clarification about procedure but also the unavoidable risks. Because of the right of informed consent the doctor is obligated to explain the choices among possible similar treatments. CONCLUSION: The knowledge for correct enlighten can reduce the number of disputes between patient and doctor.
Humans↗
[Does the type of prosthesis have an effect on the development of periarticular ossification?].
We checked up the hip operations that were done by the same surgeon in the years 1974-76 and 1984-86. For this examination we had 115 Müller Charnley prosthesis and 75 anatomically straight stems type SF. The heterotopic ossifications were classified according to Arcq. The aim was to find out if the form and type of the femoral stem, the changing of the leg length and of the CCD-angle, the post operative CCD-angle and the number of blood transfusion influences the dimension of heterotopic ossifications. The groups with higher amount of periarticular ossification (Arcq grade 2 and 3) are generally smaller. In the case of SF prostheses the ossifications raised when the CCD angle difference also raised. But the Müller/Charnley prostheses showed quite the contrary. Though there was no significance in this manner. Although in the other controlled factors there were no significant differences. The difference that was found between the two types of prosthesis was equalized with another factor: Low-dose heparin. This was the only significant influence on heterotopic ossification.
Aged↗
[Effect of patient age on use of the knee joint score].
AIM OF THE STUDY: Clinical studies are done with the help of scores though different factors of influence lower comparability. The underlying study examines the influence of patient age as this always presents a certain span. METHOD: 96 degree I damaged knee joints were examined by 3 examiners using the Larson-, Lysholm-, Marshall-, HSS- and OAK-score. Furthermore ratings by a VAS and the Tegner activity score were done. With the Friedman test, the rank correlation coefficient by Spearman and the contingency chart by Bowker it was tested if the examiners and the scores rate equally. To find out the influence of the age three age groups were made up. RESULTS: The examiners judged significantly different excluding the Marshall and the OAK scores. In between two examiners no significant difference could be found between the young and the middle-aged patient group. Between two other examiners no significant difference was found only for the Lysholm and the HSS score in the young group and only for the Lysholm score in the middle-aged group. In the group of the senior patients no significant difference for the scores by Lysholm, Marshall and OAK were found. In the comparison of the second examiner pair no significant differences could be proven by the scores by Larson, the OAK and the HSS. All other comparisons were significantly different. In the comparison of all five scores significant differences were seen between the Larson score and the HSS and the Lysholm and the HSS. The Lysholm score proved to be the strictest, the HSS to be the leanest. CONCLUSION: Especially for the senior patients in dependency of the examiner and the chosen score significant differences were found concluding that the relevance of results lessens for future times as the score results drop with patient age anyway. The age span in one study should have a maximum of 10-20 years to reduce the influence of age on the final result.
Activities of Daily Living↗
[Is GSB knee prosthesis implantation for patellar problems still justifiable? Experiences and results based on 230 implanted GSB knee joint prostheses].
In our clinical the GSB-prosthesis has proved to be a good therapeutic concept. In 1988 we controlled 230 patients who had got GSB-prostheses in the years 1979-1987. The average age of our patients was 75 years. Most times surgery had been done because of idiopathic osteoarthrosis, rarely because of post-traumatic or rheumatoid arthritis. Indications for surgery were usually severe pain, limited range of movement and deformities of the knee joint. In the beginning of the studied period we had implanted GSB-type I-prostheses, later we had implanted GSB-type II-prostheses with or without femoropatellar surface. We achieved good results in pain reduction and in range of movement. However the major complications were caused by the patella. These patients had problems at climbing stairs, pain at the beginning of movements and at getting up from chairs. They presented with increased pain sensitivity at the tip of the patella and to friction of the patella. Regular radiological findings were severe destructions or fractures of the upper patellar pole. These problems led in 40 cases (17% of our cases) to reoperations until 1988 (At all we reoperated 50 times because some patients needed additional reoperations). According to our studies results there will be a need for reoperations in about 50 other cases. We discuss the following reasons for this high rate of severe patellar complications demanding re-surgery: 1. Localisation of the patella: according to our studies the patella is frequently dranged cranially, seldom laterally. 2. Often we found an internal rotation of the tibia against the femur.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Proprioceptive function in knees with and without total knee arthroplasty.
The goal of this study was to evaluate the differences in angle reproduction capability after nonconstrained posterior cruciate ligament retaining total knee arthroplasty after a follow-up time of 63.9 months compared with the healthy contralateral leg and a control group. In 28 total knee arthroplasty patients (mean age, 65.7 yr) and 25 control subjects (mean age, 55.7 yr), 16 measurements were made between 0 degrees and 90 degrees in 30 degree steps. The leg was positioned by the examiner and then relaxed; afterward, the subject was asked to reproduce the original position. Each measurement was made with the patient or control being blindfolded and not blindfolded to assess the influence of visual control. We found significant differences in total knee arthroplasty patients in contrast to healthy subjects. Without visual control, the mean deviation of the total knee arthroplasty group starting with a 0 degree angle was 7.7+/-5.9 degrees and 4.6+/-4.7 degrees for the healthy subjects. With visual control, the mean deviation in the patient group was 11+/-7.5 degrees, and in the control group, it was 7.2+/-5.0 degrees. Total knee arthroplasty patients did not show significant differences between the operated on and the contralateral knee. Also, in the total knee arthroplasty group, significant differences could not be found comparing reproduction with and without visual control and comparing both starting positions. In the control group, significant differences could be found comparing visual and nonvisual control in the 60 degree angle. The comparison between the 30 and 60 degree repositioning from both 0 and 90 degree starting positions showed a significant difference in the 60 degree angle. In summary, reduced proprioceptive capabilities are present after knee arthroplasty in both the operated on and the contralateral leg in our study group. Postoperative complaints can perhaps be explained by a loss of proprioceptive capabilities, especially at the 60 degree angle. The operative technique should involve special care of ligaments and muscles to preserve stability and receptors as well. Rehabilitation should pay more attention to the remaining receptors.
Aged↗
Metabolic abnormality induced by streptomycin.
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Adult↗
Regulation of human renin gene transcription by cAMP.
To delineate the cis-acting elements of the proximal promoter responsible for cAMP-induced human renin gene transcription, 5'-flanking regions of the human renin gene were fused to a luciferase reporter gene and transfected in chorionic cells. Forskolin treatment induced the expression of luciferase by 2.4 fold when the reporter plasmid contained the promoter region (-582 to +16). Mutation or deletion of the CRE diminished (1.7 fold) but did not abolish cAMP-induced transcription, demonstrating that region containing the CRE and region containing a Pit-1 site were both necessary for cAMP maximal induction. Taken together, these results show that the cAMP response of the human renin gene may involve CREB binding the CRE and tissue-specific factors (from chorionic and kidney cell origin), different from Pit-1, that interact with the Pit-1 response DNA elements.
Base Sequence↗
The "hybrid" approach for revascularisation: direct myocardial revascularisation and coronary angioplasty.
We report the cases of two patients where catheter-based laser direct myocardial revascularisation has been coupled with conventional coronary angioplasty at the same sitting using the Biosense left ventricular electromechanically guided laser procedure. In both the cases, the non-revascularizable ischaemic target zone was identified using left ventricular electromechanical mapping signals, and Ho: YAG laser channels were placed at the designated target lesion following successful coronary stenting. The results did not show any procedural complications. This preliminary report suggests the feasibility and safety of this "hybrid" percutaneous approach for myocardial revascularisation.
Adult↗
[Clinical outcome and radiologic findings after knee endoprosthesis implantation].
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Aged↗
[Legislation on the matter of the protection of the health of women at work. (International study)].
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Female↗