[Microangiographic evaluation of vascular supply of the medial collateral ligament of the knee joint]. / Mikroangiographische Darstellung der Gefässversorgung des medialen Kollateralbandes am Kniegelenk.

Because the vascularization of ligaments is an important factor in ligament healing we wanted to examine the vascularization status of the medial collateral ligament of the knee. The type of vascularization was examined by microangiographie of 21 postmortem preparations. We could observe a vascularization from the proximal end of the ligament by one or two major vessels in all cases. These vessels were mostly localized in the ventral third of the ligament. From the proximal to the distal part of the ligament we found a decreasing density of blood vessels. We could not observe vessel free ligament areas. Due to this vascularization status we would advise the differentiation of two ligament areas respecting the following therapy. Because of the good vascularization in the proximal part of the ligament we can accept good conditions concerning complete healing after a non-operative treatment and an operative therapy by suture or refixation. In the case of interligamentous and distal ruptures operative reconstruction by sutures often in difficult and a conservative therapy leads to a high rate of poor results. Therefore we advise fibrin bonding in these ligament areas if a surgical procedure is indicated because of the high risk of vessel strangulation after suture.

[Ligamentization as an explanation for the stability of periosteal flap repair in the replacement of the fibular ligament system]. / Die Ligamentisation als Erklärung für die Stabilität der Periostlappenplastik beim Ersatz des fibularen Bandapparates.

The gold standard in the operative treatment of chronic insufficiency of the lateral ligaments of the ankle joint is replacement with a tendon (tenodesis). The disadvantage of this method is limitation of movement. The results of the replacement of ligaments with a periosteal flap are similar to the results after tenodesis, but the rate of complications is significant lower. We investigated the histological changes in periosteal flaps in patients. We saw an alignment of the collagenous fibers in the periosteal flap 8-12 weeks after the operation. The results are statistically significant. The conclusion is that the periosteal flap in the replacement of ligaments changes into a ligament-like structure.

[Injuries in horseback riding--incidence and causes]. / Verletzungen im Reitsport--Häufigkeit und Entstehungsursachen.

This article presents the examination of 78 accidents in horseback riding, referring to their origin and kind of injury. It was found that 76% of all injuries did not occur during the active phase of riding, but in the time just before and right after it. Children without any experience in horseback riding were most susceptible to injuries. Referring to lesions occurring before and after the active phase, the longer extremity was predominantly involved (40%); furthermore, the skull was injured in 18% and the hand in 14% of all lesions. During the active phase of horseback riding, skull injuries increased to 34%. Thoracic and spinal lesions occurred in 15% each. The frequency of all lesions shows a reversed proportional dependence on the amount of experience in this sport. Severity of the accidents increases significantly with increasing demand on performance. In consideration of these studies the thesis can be advanced that coordinated prevention directly before and after the active riding phase can decrease the frequency of all accidents and especially the involvement of the lower extremity and the skull.

[Biomechanics of the knee joint after meniscus resection. Stress analysis of the cadaver knee]. / Biomechanik des Kniegelenks nach Meniscusresektion. Belastungsanalysen am Leichenknie.

Load bearing analysis has been performed in cadaver knees after different types of inner meniscus resection in extension and in 30 degrees and 60 degrees flexion. Contact areas, mean and maximum pressure differences and load flow changes were measured in the medial and lateral compartment of the knee. The investigation led to following findings: After posterior meniscal tear the resection of the tear with marginal smoothing is followed by a minimum of parameter deviation. All the other types of resection like simple tear resection, partial meniscus resection, amputation of the posterior horn or subtotal resection are accompanied by highly increased deviations of the measured biomechanical parameters. Those are not only observed in the medial part of the knee but also in the lateral compartment. At the medial site a decrease of the load bearing area and the pressure can be registered. In contrast to that there is an increase of these parameters at the lateral site. Consecutive osteoarthritis after medial meniscectomy is therefore interpreted not as a result of increased pressure but of a floating load bearing.

[Prognostic improvement by R1 and R2 lymphadenectomy in stomach carcinoma]. / Zur Frage der Prognoseverbesserung durch R1- und R2-Lymphadenektomie beim Magencarcinom.

In 1986 systematic R2 lymphadenectomy was introduced into the surgery for gastric carcinoma in our institution. In an historic analysis 381 patients of the years 1980-1992 were investigated. The effect of R2 lymphadenectomy was studied after R0 resection and exclusion of inhospital mortality. 81 matched pairs of patients with and without lymphadenectomy (LA) were restaged according to the latest classification of the UICC (1987) and compared in an univariate and multivariate analysis. A significant improvement of the estimated 5-year survival-rate was only seen in UICC-stages II (p = 0.05), IIIA (p = 0.01) and patients without lymph node metastases (pN0, p = 0.01). The multivariate analysis did not show an independent effect of LA on prognosis but of the oncological parameters pT and pN (p = 0.0001). We conclude that LA improves the prognosis of gastric carcinoma in certain early stages but the effect is not as impressive as expected.

[Prevention of stress ulcer today]. / Stressulkusprophylaxe heute.

This article is an overview about the scientific basis, the development and the effects and side effects of the stress ulcer prophylaxis. We analysed international publications and reviewed our own patients. According to this analysis, we could demonstrate, that stress ulcer prophylaxis, preferable with H2-antagonists, remains an unconditional necessary tool in patients undergoing surgical treatment.

[Does performance of a stress roentgen image of the upper ankle joint in acute fibular capsule ligament lesion entail an operation? An experimental study]. / Zwingt die Durchführung einer gehaltenen Röntgenaufnahme des OSG bei frischer fibularer Kapselbandläsion zur Operation? Eine experimentelle Untersuchung.

In an experimental study the sequelae of performing stress films on the ruptured lateral ligaments of the ankle joint are documented. It is shown that stress films may cause further damage on the ankle capsule when there is ligamentous disruption. After performance of stress studies a sufficient realignment of the interrupted ligaments by immobilization of the foot in a neutral (right angle) position can not be achieved. This makes, at least for younger patients, operative therapy after positive stress films advisable.

[Prospective randomized study of the comparison of the effectiveness of cefoxitin (triple dose) and cefuroxime (single shot) in preventive perioperative use of antibiotics in abdominal surgery]. / Prospektive randomisierte Studie zum Vergleich der Wirksamkeit von Cefoxitin (3fache Gabe) und Cefurexim (Single-Shot) in der perioperativen Antibiotikaprophylaxe in der Abdominalchirurgie.

In a prospective, randomized trial in 200 patients who underwent abdominal surgery, we compared the prophylactic effect of a single dose of 1.5 g Cefuroxime against three doses of 2 g Cefoxitin. The incidence of wound infections was 8.2% in both groups. No difference was found between the two groups in the incidence of other infections except for urinary tract infections, whose frequency was twice as high in the Cefuroxime-treated group. In all patients we swabbed material from the anastomosis for microbiological investigation. However, these results did not enable the prediction of a wound infection or the determination as to which specimen caused the infection. In our pharmacokinetic investigations we obtained better results in the Cefuroxime-treated group due to the drug's longer half-life. On the other hand, we found extreme interindividual variation in the results obtained in both groups. This not well known factor probably raises the incidence of wound infection.

Monoclonal antibodies specific for human cardiac myosin: selection, characterization and experimental myocardial infarct imaging.

Radiolabelled anti-myosin antibodies (AM Ab) specifically accumulate in necrotizing myocytes and, therefore, allow the scintigraphic detection of myocardial infarction. In order to provide a constant supply of myosin-specific antibodies, the somatic cell fusion technique was used for the selection and propagation of AM Ab. Out of 126 antibody producing cell lines, nine were selected for further subcloning, due to their high affinity for purified myosin. For the in vivo imaging, two IgG-antibody molecules appeared particularly useful based on their antigenic specificity as assessed by immunoblotting and indirect immunofluorescence technique. After radiolabelling with iodine-123, undigested antibody molecules or their Fab fragments were injected into 10 dogs with experimental myocardial infarction. The accumulation of radioactivity in myocardial infarction was assessed by in vivo imaging and in vitro scintigraphy of ventricular slices stained by tetrazolium. The use of undigested AM Ab resulted in a high uptake ratio of radioactivity in the infarcted as compared to normal myocardium (20:1). In vivo infarct imaging, however, was not possible due to sustained labelling of the blood pool. The uptake ratio of iodine-123 labelled Fab fragments was only 9:1, but due to a faster plasma clearance of the Fab fragments, uptake in the heart could be visualized 5 h after intravenous injection. Clear differentiation between infarcted and noninfarcted myocardium, however, was limited by accumulation of radioactivity in the thoracotomy wound, in the liver, and in the stomach.