[Human biomonitoring investigations of organochlorine compounds -- PCB, DDE, HCB, beta- and gamma-HCH, PCDD/PCDF, Dioxin-like PCB's and polybrominated biphenyl ethers]. / Humanbiomonitoring-Untersuchungen von Organohalogenverbindungen -- PCB, DDE; HCB, beta- und gamma-HCH, PCDD/PCDF, koplanaren PCB sowie polybromierten Biphenylethern.

Although PCB and PCB-containing materials are not processed for a long time, PCB is under discussion again and again caused by the pollution of indoor environments. To objectify the discussion, the dates of the PCB-biomonitoring, the organochlorine-compounds (DDE, HCB, beta-/gamma -HCH, PCDD/PCDF) and the polybrominated biphenyl ethers concerning the investigations within the project "Sentinel Health Departments" in Baden-Wurttemberg are represented. Additionally results from children from Kazakhstan (Aral-Sea area) and from teachers which are working in PCB polluted schools as well as from a long term investigated test person are reported. Blood concentrations of the following compounds decreased from 1996/97 to 2002/03: the sum of the concentration of PCB 138,153 and 180 decreased from 0.46 microg/L to 0.20 microg/L, DDE from 0.32 microg/L to 0.17 microg/, HCB from 0.20 microg/L to 0.08 microg/L, beta-HCH below the level of detection, I-TEQ NATO to 4.8 pg/g blood fat, TEQ WHO (without PCB) to 5.5 pg/g blood fat, PCB 126 to 18,8,pg/g blood fat and PCB 169 to 12.8 pg/g blood fat. The influence of breast feeding and the gender on the level of the pollution is conspicious. No local correlations were found in Baden-Wurttemberg, but they were found in comparison with the results of Kazakhstan (Aral-Sea area). The difficulty to produce time series while the analyzing pollutants are more and more decreasing, as well as the change of the calculation base of the summation of parameters like I-TEQ NATO to TEQ WHO are discussed.

[Determination of mold concentrations in homes and schools in Baden-Württemberg]. / Bestimmung der Schimmelpilzkonzentration in Wohnungen und Schulen Baden-Württembergs.

So far there have been rather few reliable and comparable data available on indoor pollution with mould. Following the publication of the Federal Environmental Agency and the Health Agency Baden-Württemberg which supports the assessment of mould pollution of indoor air, it seemed advisable to investigate as to how far these criteria can be used for the assessing the mould pollution in daily practice. The results of investigations of 130 homes and 117 classrooms in Baden-Württemberg. will be represented.

[10 years of observation by public health offices in Baden-Württemberg--assessment of human biomonitoring for mercury due to dental amalgam fillings and other sources]. / 10 Jahre Beobachtungsgesundheitsämter in Baden-Württemberg--Beurteilung der Human-Biomonitoring-Untersuchungen bezüglich der Quecksilber-Belastung durch Amalgamfüllungen und andere Quellen.

Since 1992, in Baden-Württemberg, ten-year old children have been surveyed in the project "Sentinel Health Departments" to study their exposure to environmental pollutants and possible health effects. In the four study areas 1200 children have been investigated every year initially, since 1996 every second year. The data for mercury in body fluids are reported here. The decrease in the body burden of mercury as a result of the declining usage of dental amalgam fillings, was been verified. In 1992/93, of all the children who had been surveyed, the 95 percentile for the body burden of mercury was 3.1 microg/l and in 2000/01 1.35 microg/l. Also to be discussed is the reason why mercury-based cosmetic ointments seriously exceed the HBM-II-intervention-value. Because of using these ointments, concentrations of mercury in urine up to 1400 microg/l were found. A study within the project "Sentinel Health Departments" compared the concentrations of mercury in the urine of adults with those in blood and salvia. The results support the opinion that mercury in urine is appropriate for estimating the mercury uptake from dental amalgam fillings. It can be assumed that these results reflect the situation in the entire Federal Republic of Germany. The ten years' experience confirms that the concept of the "Sentinel Health Departments" is excellently suited to obtain data relevant for environmental health of children. Environmental health protection and the essential gathering of data for future health observation in Baden-Württemberg.

Fracture of the fifth digit. An atypical presentation.

Digital fractures are a common injury in the forefoot. Most fractures, however, do not present relatively free of pain. When they present without pain or with few symptoms, they may be overlooked or misdiagnosed. The following is a case presentation of a patient who presented to Franklin Delano Roosevelt Hospital after trauma to the right fifth toe. The case was atypical in that the patient was asymptomatic despite the recent injury. Rapid conservative intervention by the patient at home, coupled with sensory neuropathy secondary to diabetes, can alter the clinical presentation as witnessed in this case. An appropriate history and physical examination combined with radiographs were essential to an otherwise ordinary clinical presentation.

Pedal nail pathology: biomechanical implications.

Proper treatment of pedal nail disorders requires a thorough understanding of the underlying etiology. As a class, biomechanical abnormalities constitute an important cause of pedal nail dystrophy. These biomechanical etiologies have been presented with regard to the three body planes. Treatments using biomechanical and orthopedic principles were explored, with an emphasis on counteracting abnormal dynamic and static forces. Additionally, sports that have a high correlation of nail pathologies have been discussed with prevention as the key element to treatment.

Functional and structural limb length discrepancies: evaluation and treatment.

The examining physician should have a high index of suspicion when evaluating patients with lower extremity and/or back pain so that the diagnosis of leg length inequality is not overlooked. If an organized and systematic physical examination is performed, the practioner will become more comfortable and competent in the diagnosis of limb asymmetry. Once the diagnosis of limb length asymmetry is made the further classification of functional versus structural limb length discrepancy will dictate what treatment will be indicated. The structural asymmetries are evaluated by the indirect method of measurement and treatment with a heel lift approximately half the measured asymmetry initially. The functional asymmetries are evaluated by the flexion and pronation tests and treated with a properly posted orthotic.

Habitual toe-walking: evaluation and approach to treatment.

Habitual toe-walking has been presented as a prolongation of a normal stage of development that requires conservative treatment to prevent or ameliorate associated gait abnormalities such as tripping and falling. An approach to the evaluation of a child with toe-walking should include (1) medical history (prenatal, intrapartum, and postnatal), (2) gait evaluation, (3) musculoskeletal examination, and (4) neurologic examination. Pathologic entities producing toe-walking have been explored in order to differentiate those conditions from idiopathic (habitual) toe-walking. The most common etiologies of toe-walking (nonhabitual) would include gastrosoleus equinus, clubfoot, or cerebral palsy. Treatment of habitual toe-walkers might include shoe therapy, orthosis therapy, auditory feedback, and surgery.

Common sports injuries to the knee.

The evaluation and treatment of knee injuries is common in the practice of sports medicine. The knee is the most commonly injured joint of the lower extremity. Therefore, the podiatrist should have an adequate knowledge and skill in the knee examination, anatomy, pathology, and biomechanics to properly diagnose and treat disorders of the joint. The etiologies of knee pain can be divided into five categories: (1) anterior, (2) posterior, (3) medial, (4) lateral, and (5) general for simplicity of description. The doctor can easily evaluate the painful knee in the athlete by remembering the major pathologies within each anatomic quadrant. Attention should be directed at those deformities of the knee that have biomechanical origins in the foot, in part or in toto. This biomechanical relationship when balanced into the treatment plan will increase the success of the management of the patient.

TEMPER: an acronym for ankle sprain rehabilitation.

As has been previously discussed, the incidence and resultant associated disabilities of ankle sprains have been well documented in the literature. The staggering statistics on long-term disability show that there is no such thing as a simple ankle sprain. The degree of disability is related to the extent of the initial injury as well as the follow-up medical care provided. It is this fact that requires a complete understanding of the injury as well as a proper treatment and rehabilitation program. One of the reasons cited for the long-term disability or lack of consistently good results in treating ankle sprains is the lack of uniformity in treatment. One possible reason is the lack of agreement in diagnostic techniques as well as the end diagnosis of a particular grade of ankle sprain. If a sprain is managed correctly, resultant disability will be kept to a minimum. A proper rehabilitation program may be the most important factor in preventing chronic instability. The acronym RICE falls short of complete ankle management. RICE primarily addresses the ankle edema. Thus, the patient's ankle is only partially rehabilitated. A rational approach to the management of ankle sprains is given. Upon reviewing a complete protocol for ankle sprain rehabilitation, the acronym TEMPER can be used judiciously to remember the key steps in the treatment plan. Through the use of this acronym, one can institute a complete rehabilitation program.

Common sports injuries to the foot and leg.

Running related injuries to the leg and foot account for approximately 45 per cent of the total injuries to the lower extremity. The incidence of running injuries has increased significantly in the past decade, thus, creating a demand for increased proficiency in treating runners. Specifically, overuse injuries account for most of the runner's complaints. The goal of sports medicine as mentioned previously is to keep the athlete active and injury free. To achieve this goal the etiologies of the injuries must be recognized and treated. Common, preventable causes of overuse injuries would include training errors and biomechanical factors. The biomechanical factors as they relate to foot and leg have been addressed within this article. Early recognition and biomechanical treatment will decrease the vast majority of the lower limb injuries.

Biomechanical concepts in the treatment of ulcers in the diabetic foot.

The diabetic patient and the associated pedal abnormalities pose a particularly challenging problem for the doctor from both a management and a prevention standpoint. The sequellae of diabetes mellitus have both neurologic and vascular origins. Neurologically, the diabetic is predisposed to peripheral and autonomic neuropathy, while vascular aberrations may manifest anywhere in the arterial network. Secondary breakdown of cutaneous and osseous structures are the direct result of a chronic insensitivity to pain and a faulty healing mechanism. Healing is, at best, delayed due to this inborn error of glucose metabolism. Ulceration in the diabetic patient remains one of the most troublesome complications of diabetes mellitus. The most diligent and expeditious treatment will fall short nonetheless, if the patient has not been completely educated concerning his affliction. The association of patient education and the response to therapy cannot be overstressed. The diabetic should be educated concerning proper foot care and should be made aware of the serious complications that may result from improper hygiene and pedal neglect. The patient should not assume a passive role in the treatment, but rather, actively participate in his recuperation and rehabilitation. Frankly, it is the patient's understanding of the disease process as it affects the foot and his willingness to accept part of the responsibility for his foot care that will determine the ultimate success of the treatment. The biomechanical considerations that follow the primary management of the acute presentation of diabetic lesions, are aimed at preventing further breakdown and lesion formation by minimizing the adverse effects of gait or ambulation. Biomechanical methods of treating or preventing neuropathic diabetic ulcers have been examined. The conventional medical management of neuropathic and angiopathic ulcers includes antibiosis, local debridement, and bed rest. Due to today's lifestyle, complete bed rest is not always convenient for the patient and even cooperative patients may neglect to use crutches or minimize the problem of their ulcer due to the absence of pain. The methods discussed afford the patient a more normal lifestyle; however, proper patient compliance is required. Patients who use the total contact cast must be willing to keep their weekly appointments zealously and report any problems pertaining to their treatment. After the ulcer has been closed, the patient and doctor must realize that the battle is only half over. Steps must be taken in order to deter one of the most frequent complications, reoccurrence of the ulcer.(ABSTRACT TRUNCATED AT 400 WORDS)

Cavus foot surgery: a new approach by electrodynographic evaluation.

The authors describe a calcaneal displacement rotational osteotomy for surgical correction of a cavus foot secondary to polio. The necessity of pre- and postoperative analysis of dynamic foot function with the use of the Electrodynogram is presented.