[Distribution of lysotypes of S. typhi and S. paratyphi B in the Federal Republic of Germany in the years 1958 to 1961].
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Bacteriophage Typing↗
Biomedical subjects
S Kessler
Publications and source records attributed to S Kessler.
Fluidized-bed receptor-affinity chromatography.
A multipurpose fluidized-bed receptor-affinity purification system based upon the biological recognition between an immobilized receptor and its soluble protein ligands is described. The fluidized affinity sorbent consists of a soluble form of interleukin-2 receptor chemically bonded to an aldehyde derivative of controlled pore glass beads, which have a pore diameter of 1000 A and a particle density of 1.2-1.3 g/mL. The fluidized-bed separation device used in this study consists of a specially designed column fitted at the inlet end with a perforated distributor plate covered with a screen and the top outlet with an adjustable piston. The fluidized-bed consisting of a loose gel matrix permits the unimpeded passage of cell debris and particulate matter, while the target protein is captured by the affinity beads. Purification of the humanized-anti-Tac monoclonal antibody is used as a model system to determine the operational parameters. Also, fluidized-bed receptor-affinity chromatography has been successfully employed in the purification of recombinant interleukin-2 and single chain anti-Tac(Fv)-Pseudomonas exotoxin immunotoxin from unclarified inclusion body extracts. Overall, fluidized-bed receptor-affinity chromatography is found to be a productive affinity method suitable for the purification of recombinant human interleukin-2 and related molecules.
ADP Ribose Transferases↗
Sleep and serotonin in two strains of Mus musculus.
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Animals↗
[Chronic recurrent multifocal osteomyelitis].
The aim of this paper is to give a detailed description of the so-called "chronic recurrent multifocal osteomyelitis" (CRMO). The clinical, radiological and histopathological results of an analysis of 29 cases (15 children/adolescents and 14 adults) are presented and correlated to current data from the literature. We could delinate the following points: 1. CRMO is a systemic aseptic inflammation of the bone marrow (Osteitis), it can occur polytopically and association with pustulous dermatologic symptoms is possible. 2. It is not a rare disease 3. Osteomyelitis is probably "reactive" and a plasma-cell sclerotic process with ist own characteristic histologic three-phase course. 4. We could observe 5 specific types of localization which can be documented by X-ray or bone scan. 5. Accompanying arthritis os often present, especially "sympathetic coxitis". 6. The use of drugs in treatment of CRMO (i.e. azithromycin, calcitonin, and bisphosphonates) is discussed. In conclusion we want to point out, that 1. 99mTC bone scan should always be performed when there is suspicion for CRMO to reveal the pattern of affection, 2. the rheumatologist and dermatologist should be contacted, 3. operation is normally not necessary for treatment of the mostly self-limitin disease, and 4. the term "SAPHO syndrome" should be avoided, further differentiation of the diagnosis is necessary.
Adolescent↗
[The Pediatric Musculoskeletal Functional Health Questionnaire. A function assessment questionnaire for detection of illnesses of the locomotor system in children and adolescents--initial results of validating a German version].
AIM: It was the purpose of this investigation to create a German version of the Pediatric Musculoskeletal Functional Health Questionnaire and to test its reliability, practicability and acceptance in children and adolescents with musculoskeletal disorders. METHODS: In a first step, the Pediatric Musculoskeletal Functional Health Questionnaire was translated into the German language. Then 147 patients with musculoskeletal disorders or respectively, their parents were asked to fill in the questionnaire, in order to test the reliability, the internal consistency, the practicability, and the acceptance of this instrument. RESULTS: The test-retest reliability for the subscales was high, it ranged between r = 0.56 and 0.93. Concerning the internal consistency of items and subscales we found only moderate results. The acceptance of the Questionnaire was high in patients or, respectively, their parents with 92%. Furthermore, the instrument has shown to be practicable and economical. CONCLUSION: With the German version of the Pediatric Musculoskeletal Functional Health Questionnaire a multidimensional instrument is now available that reliably measures health status as well as therapeutic effects in children and adolescents with musculoskeletal disorders.
Adolescent↗
[Reproducibility of radiological classification criteria of femur head necrosis].
AIM: To assess the reliability of commonly used radiographic features in osteonecrosis of the femoral head. METHOD: For staging of avascular necrosis of the femoral head two different classification systems, Ficat and ARCO, were applied. To measure the size of the necrotic lesions the combined necrotic angle of Kerboul was used. Radiographs of 49 patients with osteonecrosis of the femoral head were graded by two observers at two different time points. The Spearman's correlation coefficient was calculated for intra- and inter-observer reliability. RESULTS: We found good intra- (Spearman's correlation coefficient 0.81-0.87) and inter-observer reliability (0.71-0.74) for the Kerboul's angle. Reliability for the ARCO stage classification was acceptable for intra-observer but unacceptable for inter-observer agreement. The reproducibility of the Ficat staging system was unacceptable. CONCLUSION: The Kerboul angle is a reliable measurement to assess the severity of the osteonecrotic defects in femoral heads. The staging systems of Ficat and ARCO are not sufficiently reliable to assess the disease status of the hip alone.
Adult↗
[Chronic recurrent multifocal osteomyelitis-- I. Review].
Juvenile and adolescent "Chronic Recurrent Multifocal Osteomyelitis" (CRMO) is described on the basis of literature and analysis of 43 own cases (23 cases in children or adolescents). This systemic, non-purulent inflammatory disease occurs mainly metaphyseal in long bones, in pelvic bones or as spondylitis and is not as rare as it seemed. Basis of the disease is a primarily chronic, sterile, in phase of onset often monotopic (e.g. clavicle) and later frequently polytopic osteomyelitis, possibly triggered by an immuno-pathological process (e.g. Proprionibacterium acnes), and showing histologically plasmacellular invasion and a sclerosing process in different stages. Association with pustulous dermatosis (psoriasis, acne, palmo-plantar pustulosis) is found in about 25 % of children and adolescents and in more than 50 % of the adult patients. 5 differents types of distribution of osteomyelitic lesions can be found by using Te99m-bone scan primarily, of which the "pelvic type" is the most common. Because of the close neighbourhood of meta-/epiphyseal osteomyelitic focuses, "sympathetic arthritis" with synovitis is seen frequently. A therapeutic approach with azithromycine and calcitonine is presented.
Acquired Hyperostosis Syndrome↗
[Pelvic type of chronic recurrent multifocal osteomyelitis].
We report about the juvenile and adolescent pelvic type of CRMO in 7 girls and 4 boys. The results show from solitary up to 7 pelvic lesions (average 3 lesions) predominantly in the acetabular and paraacetabular region (sometimes with hip joint effusion as a sign for concomitant coxitis).Tc99m-bone-scan is helpful to evaluate exactly the pattern of bone affection. We find 3 stages of an primarily chronic, non-purulent osteomyelitis going along with a "plasma-cell-sclerotic process", leading to a Garrè-type sclerosing end-stage, which probably heals after some years spontaneously, projecting on clinical symptoms and radiological appearance. The concomitant coxitis ("sympathetic coxitis") is clinically often in the foreground, but reversible. Pain in case of CRMO responds surprisingly well on medication with acithromycine. Knowing about CRMO in its different clinical appearances - especially concerning what we call "sympathetic coxitis" - can be a useful for pediatric rheumatologists and orthopedic surgeons, as well as MRI-focused radiologists and pathologists. Therapy might find a useful drug in acithromycine. In conclusion we d like to point out, that CRMO is one entity under the "roof" of the so called SAPHO-syndrome, which again shows us, that SAPHO-syndrome ist not a diagnosis itself but more a sign-post on the way to a correct diagnosis.
Acquired Hyperostosis Syndrome↗
[Revision total hip arthroplasty: how do metaphyseal onset, diaphyseal fill and a three-point-stem-fixation influence the postoperative subsidence of a revision straight-stem?].
AIM: It was the purpose of this study to determine the postoperative subsidence of a cementless hip revision stem in regard to the degree of metaphyseal onset, diaphyseal fit and a three-point contact of the stem in the femur. METHODS: Data of 50 revision total hip replacements using a cementless revision straight stem (PFM-R) could be investigated. The degree of subsidence was measured on pelvic X-rays 6 and 12 months postoperatively. The degree of metaphyseal onset, diaphyseal fit and a three-point contact of the stem in the femur was determined on the immediate postoperative X-rays. RESULTS: The amount of subsidence was strongly related to the degree of metaphyseal onset. With minor onset (up to 25 % of the possible) stems subsided 9.4 (6 months), respectively, 13.2 millimeters (12 months) in average within the investigation periods. If there was a large degree of metaphyseal onset (more than 75 % of the possible) the average subsidence was only 1.6 (6 months) or 0.9 millimeters, respectively (12 months). Neither the amount of diaphyseal fit nor the presence of three-point contact of the stem in the femur influenced the subsidence significantly. Conclusion The amount of the postoperative subsidence of stems in cementless revision total hip arthroplasty is predominantly influenced by the degree of the metaphyseal onset of the prosthesis.
Adult↗
[The Knee Injury and Osteoarthritis Outcome Score--a multifunctional questionnaire to measure outcome in knee arthroplasty].
AIM: It was the purpose of this investigation to create a German version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and to test its appropriateness in patients with advanced gonarthritis. METHOD: Reliability (test-retest reliability, internal consistency), validity (convergent construct validity and divergent construct validity), sensitivity to change as well as practicability and acceptance of this questionnaire were tested in 90 patients. RESULTS: The test-retest reliability was acceptably high for all subscales, it ranged between r = 0.65 and 0.78 and the questionnaire showed a high internal consistency in almost all of the subscales. The comparison to the results of the questionnaire "Short Form-12" (SF-12) as well as to the patients self-assessment of health status showed high concordance in nearly all subscales, however it was only moderate for the symptom scale. Furthermore the KOOS was able to show significant differences between patients and healthy controls. When testing the sensitivity to change, the KOOS could demonstrate significant improvements within 3 months and the instrument has shown to be practicable with a high acceptance by the patients. CONCLUSION: With the German version of the Knee Injury and Osteoarthritis Outcome Score a multidimensional instrument is available now to measure health status as well as therapeutic effects in patients with knee problems. Modifying the subscale "symptoms" could further optimize this questionnaire in patients with advanced gonarthritis.
Adolescent↗
[The impact of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF) on osseointegration, degradation and biomechanical properties of a synthetic bone substitute].
INTRODUCTION: It was the purpose of this investigation to test the osteointegrative capacity and the degradation rate of a neutralized glass ceramic within an animal model after loading with different growth factors. MATERIALS AND METHODS: The glass ceramic GB9N was implanted in the medial tibial head of mature merino sheep (n = 48) after being loaded with either Bone Morphogenetic Protein-2 (BMP-2, 100 micro g/100 micro l), Vascular Endothelial Growth Factor (VEGF, 100 micro g/100 micro l), basic Fibroblast Growth Factor (b-FGF, 60 micro g/100 micro l) or unloaded. At 4 weeks (n = 24) and 9 months (n = 24) after operation histomorphological, histomorphometrical and biomechanical investigations were performed. RESULTS: The amount of newly formed bone was different within the study groups after 4 weeks. BMP-2 induced a significant increase in bone formation and a significant decrease of residual substitute. b-FGF and VEGF induced no such effects in comparison to the controls. Biomechanical investigations could only demonstrate slight increases of the maximal fracture load in the BMP-2 group after 4 weeks in comparison to the others. At 9 months after operation no differences concerning newly formed bone could be found in the study groups comparing to the controls. Only the amount of residual substitute was still significantly lower in the BMP-2 group. Biomechanical data could demonstrate maximal fracture loads of all study samples achieving the level of the controls. CONCLUSION: This investigation has demonstrated that by combining synthetic bone substitutes with growth factors certain parameters of the bone remodelling process can intitially be influenced in a positive way.
Animals↗
[Revision total hip arthroplasty: analysis of the predictive value of a radiographic classification system for assessment of bone stock loss].
AIM: The aim of this study was to evaluate the predictive value of a radiographic classification system concerning implant and bone graft in revision total hip arthroplasty. This classification is used to assess bone stock loss prior to surgery, thus hypothetically enabling an adequate choice of the implant and bone graft required. METHOD: 33 consecutive patients with the diagnosis of aseptic failure of total hip arthroplasty were included in the study. The investigation was performed using the classification system according to Saleh et al. The predictive value was analyzed by comparing the radiographically based recommendation concerning implant and bone graft and the intraoperative procedure according to a blinded observer technique. The Spearman coefficient of correlation (r (s)) was used to establish levels of agreement among multiple ordinal variables. RESULTS: Analysis of correlation between preoperative radiological estimations and intraoperative conclusions concerning implant and bone graft revealed coefficients of correlation (r (s)) of 0.53 (p < 0.01) for the acetabular and of 0.63 (p < 0.01) for the femoral classification. CONCLUSION: Our results indicate that the Saleh classification does not provide sufficient information for preoperative assessment of the revision implant and bone graft required concerning the acetabular side, whereas planning of the operative procedure regarding the femoral implant seems to be possible. These ambivalent findings should be taken into account prior to revision total hip arthroplasty.
Acetabulum↗
[Analysis of validity and reliability of three radiographic classification systems for preoperative assessment of bone stock loss in revision total hip arthroplasty].
AIM: It was the purpose of this prospective study to analyze validity and reliability of three different radiographic classification systems, which are used to assess bone stock loss prior to revision total hip arthroplasty. METHOD: Investigation was performed using the classification systems according to 1) Paprosky et al., 2) Hungerford et al., and 3) the German Society of Orthopaedics and Traumatology (DGOT). Twenty-eight consecutive patients with diagnosis of aseptic failure of total hip arthroplasty were enrolled in the study. Interrater agreement was analyzed by evaluating the classifications preoperatively by three investigators with different level of clinical experience using a blinded observer technique. Validity was analyzed by comparison of preoperative radiographic findings (n = 3) and an intraoperative control by visualization and palpation (n = 1). Spearman coefficient of correlation (r(s)) was used to establish levels of agreement among multiple ordinal variables. RESULTS: Interrater reliability testing using paired comparison between the three investigators revealed non-homogeneous coefficients of correlation (r(s): Paprosky femur: 0.45 - 0.67, acetabulum: 0.38 - 0.63; Hungerford: 0.46 - 0.66; DGOT femur: 0.38 - 0.59, acetabulum: 0.42 - 0.76). Paired analysis of correlation between preoperative and intraoperative findings again showed non-homogeneous coefficients of correlation (r(s): Paprosky femur: 0.59 - 0.68, acetabulum: 0.39 - 0.70; Hungerford: 0.39 - 0.74; DGOT femur: 0.44 - 0.60, acetabulum: 0.36 - 0.76). In general, defects were grossly underestimated preoperatively. The level of experience did not influence the validity of measurements. CONCLUSION: Our results indicate that these classifications do not provide valid and reliable assessment of femoral and acetabular bone stock loss prior to revision total hip arthroplasty.
Acetabulum↗
[Outcome assessment in total knee arthroplasty: is the clinical measurement of range of motion a reliable measurable outcome variable?].
AIM: The aim of this clinical study was to investigate the reliability of the clinical assessment (visual and goniometric) of the range of motion of the knee joint. METHOD: 30 patients were assessed concerning the range of motion of their knee joints by visual and goniometric measurements. Assessment was performed by three investigators. The obtained data were used to analyse the intra- and interobserver reliability. Statistical analysis was performed using the Spearman coefficient of correlation [r (s)]. RESULTS: Intraobserver agreement was consistent across observers regarding the visual and goniometric assessment of flexion (r (s) > 0.6), whereas reliability was uniformly low for both measurements regarding the assessment of extension (r (s) < 0.6). Interobserver agreement was consistent across all three goniometric and two out of three visual assessments regarding the measurement of flexion (r (s) > 0.6); the interobserver reproducibility of extension, however, was uniformly low both for the visual and goniometric measurements (r (s) < 0.6). CONCLUSION: Reliability of clinical assessment of range of motion should be taken critically into consideration whilst performing classical function-related scoring systems when measuring outcome after total joint arthroplasty, since these scoring systems are strongly based on a valid and reliable assessment of range of motion.
Arthroplasty, Replacement, Knee↗
[Femoral anteversion: significance of clinical methods and imaging techniques in the diagnosis in children and adolescents].
In order to investigate the correlation between different methods of AV-determination and to assess their reliability, we compared the results of clinical and sonographic examination with computed tomography and magnetic resonance imaging in 21 children (41 hips) preoperatively. The mean anteversion angles obtained by computed tomography (34.0 degrees +/- 13.7 degrees) appeared larger than the clinical (27.7 degrees +/- 8.5 degrees), sonographic (25.6 degrees +/- 8.0 degrees) and MRI-values (23.2 degrees +/- 12.8 degrees), which can be explained by the different measurement techniques. The inter-rater as well as intra-rater reliability was high in MRI (Pearson's correlation coefficient r = 0.97 and r = 0.97) and CT (r = 0.99 and r = 0.96) but slightly less in sonography (r = 0.88 and r = 0.88) and clinical investigation (r = 0.47 and r = 0.77). For routine use in screening of femoral anteversion clinical and sonographic methods are sufficiently accurate. But in determining the exact amount of torsion preoperatively and in planning of rotation osteotomies in children MRI and CT determination are superior. As magnetic resonance imaging requires no radiation dosage, shows non-ossified cartilaginous structures and proved its high reliability, it could replace other techniques in the future for that purpose.
Adolescent↗
Effects of selection for decreased movement through the Drosophila geotaxis maze.
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Animals↗
Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients.
The effectiveness of ongoing rehabilitation services for postacute stroke survivors is poorly documented. We designed a randomized control, single-blinded study to demonstrate the effectiveness of intensive outpatient therapy. The treatment intervention consisted of 1 hr each of physical and occupational therapy, four times per week, for 12 wk; therapy focused on neuromuscular facilitation and functional tasks. All subjects were screened before the therapies and after 3 mo and 9 mo. Forty-nine stroke survivors, who were at least l yr (mean, 2.9 yr) poststroke, were randomized with two treated patients to each control (no treatment supplied). All patients had received inpatient rehabilitation at the time of their acute stroke, but no patient had any ongoing therapy within the last 6 mo. The outcome measures included the Functional Independence Measure (FIM), Brunnstrom stages of motor recovery, timed mobility tasks, and the Jebson hand evaluation. We also evaluated the level of depression, self-esteem, and socialization. The treated patients demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with only 1.5 points in the control group in the FIM motor score transformed using Rasch analysis. The change from time 0 to 3 mo was significant in the treated group but not in the controls. Treated patients maintained their gains at the 9-mo follow-up, and controls lost ground. The treated group improved in terms of socialization and self-esteem as evidenced by a lower Sickness Impact Profile, whereas the controls tended to get worse. There was a trend toward less depression, but this did not reach a P = 0.05 level of significance. This study demonstrates that significant functional gains can still be attained in the postacute stroke survivor, despite prior inpatient rehabilitation services.
Acute Disease↗
Iatrogenic injury to the hypopharynx and cervical esophagus: an autopsy study.
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Autopsy↗