Because diet is a key issue in the treatment of diabetes mellitus, it is assumed that these patients are prone to eating disorders. In a multicenter study, we have therefore assessed the prevalence of eating disorders in 662 patients with insulin dependent diabetes mellitus (IDDM) (n = 340) and non-insulin-dependent diabetes mellitus (NIDDM) (n = 322). A two-stage study combining self-rating questionnaires and a standardized interview was carried out. We found a prevalence of eating disorders of 5.9% (lifetime prevalence of 10%), irrespective of gender and type of diabetes; 4.1% of the whole sample reported intentional insulin undertreatment or omission. When patients were stratified according to IDDM and NIDDM, there was no difference in the prevalence of all eating disorders (point prevalence 5.5% vs. 6.5%, lifetime prevalence 10.0% vs. 9.9%). Prevalence of bulimia nervosa (BN) was more frequent in IDDM patients (point prevalence 1.5% vs. 0.3%, lifetime prevalence 3.2% vs. 1.9%) and binge eating (BED) was more frequent in NIDDM patients (point prevalence 1.8% vs. 3.7%, lifetime prevalence 2.6% vs. 5.9%). We conclude that eating disorders seem to be equally frequent in IDDM and NIDDM patients. However, there might be different features of eating disorders in both types of diabetes.

Adolescent↗

PubMedDate not supplied

Mortality of cadaveric kidney transplantation versus combined kidney-pancreas transplantation in diabetic patients.

In the United States diabetes in now the principle cause of end-stage renal disease. For diabetic patients undergoing cadaveric kidney transplantation, a combined kidney-pancreas (KP) transplant is often recommended because this option is perceived to carry no additional risk. However, most transplant centres have restricted KP transplantation to patients with few diabetic complications and no coronary artery disease. We compared survival rates after KP transplantation with those after kidney transplantation alone in clinically similar though non-randomised patient groups. In 173 consecutive diabetic renal transplant candidates, 3-year patient survival in 54 KP recipients was 68%, versus 90% in 46 patients who received a cadaveric kidney alone (p = 0.01). The remaining patients had a living-related-donor kidney transplant, either alone (65) or followed 4-20 months later by a pancreas transplant (8), with survival similar to that with a cadaveric kidney. Independent variables associated with early death were age, history of congestive heart failure, and pancreas transplantation. A serious complication of pancreas transplantation was infection, or which 14 of 54 recipients required pancreatectomy; KP recipients had a higher death rate from infection in the first 12 months (p = 0.034). In view of the excess mortality associated with KP transplantation, we suggest that the combined operation should be reserved for young patients with no history of congestive heart failure, or for patients in whom hyperglycaemia is life-threatening. A randomised trial is needed to compare the long-term outcomes of these procedures.

Adult↗

PubMedDate not supplied

[Metal spongiosa endoprostheses for surgical revision of the hip joint].

On the basis of 60 revision operations which were carried out on hip joints with mainly aseptic loosened cemented endoprosthesis and which also had, to some extent, distinct macrophagic induced osteolysis zones, it could be shown that implants with a metal spongiosa surface structure offer a good chance of an enduring revitalisation in the anchorage position and, thereby, are able to achieve a permanently stable endoprosthesis fixation. The expansion defects could be filled by means of homologous or autologous spongiosa transplantation. The post-operative X-ray check-up showed a vital inward-growing healing. All the endoprosthesis remained in situ during the follow-up examination period of, on average, 12.1 months. In accordance with the Merle D'Aubigne hip evaluation scheme, 43.3% showed an excellent result; 40% a good one; 13.3% were satisfactory; and only 3.4% showed a bad result. Major complications which occurred were: two intra-operative femoral stem fractures which had to be taken care of osteosynthetically; a repeat operation which had to take place during the first post-operative week because of a dislocation of the socket cup; and a luxation which was revised under narcosis. In spite of an increased periarticular ossification's ratio in revision operations, second-class ossification only occurred in 16.7% of all cases and third-class ossification did not occur at all.

Adult↗

PubMedDate not supplied

[Follow-up studies of transosseous capsule-ligament sutures of the basal joint of the thumb using a standardized holder].

In cases of capsular ligament lesions at the basal joint of the thumb, transosseal reinsertion has proved to be a suitable procedure for treating both old and fresh ruptures of the ligament. Primary suturing is only possible in the rare cases where the tear is straight and the ruptured ends are close. In cases of old ruptures, if no usable ligament stump or cicatricized strand can be found, plastic surgery should be performed. Roentgenograms are made under standardized conditions using a holder in order to objectify the preoperative and postoperative findings. To this end a holder has been developed which satisfies criteria for objective assessment.

Adult↗

PubMedDate not supplied

[Complications following autologous bone transplantation at the site of removal].

Between April 1978 and December 1983, 206 operations to obtain autologous bone were performed in the Orthopedic Department of Barmbek General Hospital. In 1985, 125 patients were analyzed by means of a detailed questionnaire and a clinical examination. A total of 55.2% of the 125 patients were free of complaints following removal of bone. In 37.6% there were slight to moderate, and in 7.2% severe to extremely severe complications. The most common type of complaint was persistent postoperative pain (40%). Neural damage, i.e., hypesthesia and dysesthesia, was observed in 21.6% of the cases. An increased postoperative tendency to swelling was seen in 12.8% of the 125 patients. There was also one case of fracture of the shaft of the tibia in the area where bone had been removed. Other complications were rare. All in all, the postoperative complications following removal of a chip from the shin were the most serious. Complaints due to removal from the posterior iliac crest were considerably less severe. The least problematic courses were those after removal from the anterior iliac crest. Removal of coritcospongious chips from the tibia should be avoided if at all possible. The removal site of choice is the anterior iliac crest, unless the posterior crest has to be preferred because of the surgical technique employed.

Bone Transplantation↗

PubMedDate not supplied

[Hip endoprosthesis shaft fractures - a clinical and technological material study].

This paper begins with a discussion of purely clinical considerations concerning fractures of hip prosthesis shafts, based on findings in 19 cases treated in the University Orthopedic Clinics of Essen and Lübeck. A gradual increase in pain following stress is the principal symptom, although acute pain is not typical. In radiological diagnosis, which is indispensable, the fractures, which are initially often merely hairline cracks, must be looked for. In the patient collective analyzed, the high percentage of implantation defects was striking; this is a factor which increases the risk of fracture because it leads to loosening of the prosthesis. The authors also report on a materials investigation carried out on 18 broken prosthesis shafts. The investigation revealed that in the majority of cases loosening of the prosthesis was the decisive factor leading to the fracture; only in 3 cases was the fracture basically attributable to a fault in the material or in production.

Chromium Alloys↗

PubMedDate not supplied

[The significance of bone spurs at the base of the 2d metacarpal bone in the pathogenesis of joint arthrosis of the base of the thumb].

A causal correlation is proved between an outgrowing osseous spur at the Os metacarpale II and the rhizarthrosis. The midhand bone of the thumb is connected by a ligament with the base of the Os metacarpale II. High tensile stresses elongate the ligament and lead to its partial ossification. The ligament looses its essential function and the thumb subluxates radially.

Exostoses↗