Therapy satisfaction and health literacy are key factors to improve medication adherence in systemic sclerosis.

OBJECTIVE: Although medication adherence (MA) contributes to therapeutic outcome in systemic sclerosis (SSc), research data are scarce. Factors influencing MA in SSc are hardly known. METHOD: We conducted a monocentric, cross-sectional study on 85 patients with SSc at the University of Lübeck, Germany, using the Compliance Questionnaire of Rheumatology as the main measurement tool of MA. We also used the Scleroderma Health Assessment Questionnaire, Illness Perception Questionnaire - Revised, Health Literacy Questionnaire, Lübeck Medication Satisfaction Questionnaire (a novel instrument created for this study), and patients' demographic and clinical data, to find factors contributing to MA. RESULTS: Good MA was seen in 51.8% of patients. MA was positively associated with therapy satisfaction (p < 0.001), modified Rodnan Skin Score (p = 0.032), age (p = 0.025), intake of micronutrients (p = 0.033), number of prescribed drugs (p = 0.014), and some dimensions of health literacy. Negative associations were found for patients with weight loss attributed to SSc (p = 0.009) and the perception that the disease is caused by the patient's personality (p = 0.011) or emotional state (p = 0.037). CONCLUSION: Although most SSc patients display good MA, non-adherence remains a major problem. Patients should be assessed for non-adherence. The factors affecting MA identified herein could help to improve therapeutic outcomes.

Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial.

A Prospective randomised controlled study was done to determine statistical difference between the standard microsurgical discotomy (MC) and a minimally invasive microscopic procedure for disc prolapse surgery by comparing operation duration and clinical outcome. Additionally, the transferability of the results was determined by a bicentric design. The microscopic assisted percutaneous nucleotomy (MAPN) has been advocated as a minimally invasive tubular technique. Proponents have claimed that minimally invasive procedures reduce postoperative pain and accelerate the recovery. In addition, there exist only a limited number of well-designed comparison studies comparing standard microdiscotomy to a tubular minimally invasive technique that support this claim. Furthermore, there are no well-designed studies looking at the transferability of those results and possible learning curve phenomena. We studied 100 patients, who were planned for disc prolapse surgery at two centres [50 patients at the developing centre (index) and 50 patients at the less experienced (transfer) centre]. The randomisation was done separately for each centre, employing a block-randomisation procedure with respect to age and preoperative Oswestry score. Operation duration was chosen as a primary outcome parameter as there was a distinguished shortening observed in a preliminary study at the index centre enabling a sound case number estimation. The following data were compared between the two groups and the centres with a 12-month follow-up: surgical times (operation duration and approach duration), the clinical results, leg and back pain by visual analogue scale, the Oswestry disability index, length of hospital stay, return to work time, and complications. The operation duration was statistically identical for MC (57.8 +/- 20.2 min) at the index centre and for MAPN (50.3 +/- 18.3 min) and MC (54.7 +/- 18.1 min) at the transfer centre. The operation duration was only significantly shorter for the MAPN technique at the index centre with 33.3 min (SD 12.1 min). There was a huge clinical improvement for all patients regardless of centre or method revealed by a repeated measures ANOVA for all follow-up visits Separate post hoc ANOVAs for each centre revealed that there was a significant time-method (MAPN vs. MC) interaction at the index centre (F = 3.75, P = 0.006), whereas this crucial interaction was not present at the transfer centre (F = 0.5, P = 0.7). These results suggest a slightly faster clinical recovery for the MAPN patients only at the index centre. This was due to a greater reduction in VAS score for back pain at discharge, 8-week and 6-month follow up (P < 0.002). The Oswestry-disability scores reached a significant improvement compared to the initial values extending over the complete follow-up at both centres for both methods without revealing any differences for the two methods in either centre. There was no difference regarding complications. The results demonstrate that a shorter operation duration and concomitant quicker recovery is comprehensible at an experienced minimally invasively operating centre. These advantages could not be found at the transfer centre within 25 minimally invasive procedures. In conclusion both procedures show equal mid term clinical results and the same complication rate even if the suggested advantages for the minimally invasive procedure could not be confirmed for the transfer centre within the framework of this study.

Functional characterization of mitochondrial oxidative phosphorylation in saponin-skinned human muscle fibers.

The conditions of treatment of human skeletal muscle fibers from M. vastus lateralis with saponin were optimized to achieve complete permeabilization of cell membrane at intact mitochondrial oxidative phosphorylation. After 30 min of incubation with saponin all lactate dehydrogenase, 50% of creatine kinase, 30% of adenylate kinase and less than 20% of citrate synthase was released into the permeabilization medium. These skinned fibers behave similar to isolated mitochondria from human skeletal muscle: (i) the respiration with mitochondrial substrates can be stimulated by ADP, (ii) inhibited by carboxyatractyloside and (iii) it is possible to detect fluorescence changes of mitochondrial NAD(P)H on additions of substrates, uncoupler and cyanide. From a comparison of rates of respiration per cytochrome aa3 content of isolated human skeletal muscle mitochondria and saponin-skinned muscle fibers it was possible to calculate that almost 85% of mitochondria in those fibers are accessible for the investigation of oxidative phosphorylation. As shown by the investigation of biopsy samples of two patients with undefined myopathies these fibers are a suitable object for the replacement of isolated mitochondria in the diagnosis of mitochondrial myopathies and encephalomyopathies.

[Diskography findings and results of percutaneous laser disk decompression (PLDD)]. / Diskographiebefund und Ergebnis der perkutanen Laserdiskusdekompression (PLDD).

AIM: The aim of our study was to find a correlation between discographic findings and the clinical outcome of patients treated by PLDD. METHOD: At our clinic a total of 444 patients was treated by PLDD from 1992 until 1998. Of these, 100 patients were included into this study by chance. All patients had discography. We analysed the discographic results and correlated them with the objective and subjective outcome after PLDD. RESULTS: Best clinical results were found in the group of discographic stages 7 and 8 according to Krämer. In cases of epidural leak of contrast medium and in cases of total degeneration, the clinical results were significantly poor (stages 6 and 9). CONCLUSION: In cases of ruptured posterior longitudinal ligament, i.e., epidural leak of contrast medium in discography, PLDD is not indicated. The indication for an operation first of all depends on the clinical symptoms but the success of the operation depends on the discographic findings.

[CT diagnosis in instability of the shoulder joint]. / CT-Diagnostik bei der Instabilität des Schultergelenkes.

CT is able to demonstrate the predisposing factors for recurrent and posttraumatic subluxation of the shoulder. In addition to demonstrating bony changes in the glenoid (Bankart lesion) and in the humeral head (Hill-Sachs lesion), CT can measure the degree of retroversion of the glenoid and torsion of the humerus. Measurements on 17 shoulders with habitual and 24 shoulders with recurrent posttraumatic subluxation showed low values for glenoid retroversion as compared with a control group. Particularly patients with habitual anterior subluxation frequently showed anteversion of the glenoid. Measurements of humeral torsion showed wide scatter amongst all groups, indicating wide biological variability. The results were compared with those published in the literature and the indications and limitations of CT for the investigation of shoulder instability are discussed.

[Single intervention for treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with spondylitis]. / Die einzeitige Behandlung eines durch Salmonella typhimurium induzierten symptomatischen Bauchaortenaneurymas mit Spondylitis.

Simultaneous treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with associated spondylitis. Bacterially infected aneurysms associated with local spondylitis, while representing a potentially fatal clinical picture, are an operative challenge for vascular surgeons and orthopaedic surgeons alike. In this context, the concurrent occurrence of an infection with Salmonella typhimurium as a causative agent is a rare observation. The case report gives an outline of the simultaneous vascular and orthopaedic surgical procedure. The subrenal mycotic aneurysm was removed in a first step. The continuity of the aorta was restored centrally through an autogenic aortic graft with caudal anastomosis to a dacron vascular prosthetic tube. Initially, the latter was chosen of excessive length so as to facilitate the orthopaedic surgeon's approach. Upon completion of stabilising surgery of the vertebral column, the dacron tube was reduced in length as necessary and the surgical area was enclosed with an omentum majus plastic mesh. No complications were noted during the 18-month follow-up period.

Vertebral collapse and normal peripheral blood cell count at the onset of acute lymphatic leukemia in childhood.

Acute lymphatic leukemia presenting with bone pain and spine involvement is a recognized clinicopathologic complex that can mimic a wide range of orthopaedic conditions. Bone pain as the presenting complaint is common, with a reported incidence of 27% to 50%. Radiologic abnormalities associated with leukemia in children has been described previously. In the literature, the incidence of spinal involvement is controversial, but there is agreement that the spine is less commonly involved than are the long bones. At the onset of the disease, only 10% of children have normal peripheral blood counts. If the patient has spinal involvement and a normal leukocyte count, the diagnosis is often unclear. Only three of these patients have been described in the literature; this article adds one more patient with acute lymphatic leukemia with back pain as the main symptom, vertebral collapse, and a normal peripheral blood cell count at the time of initial presentation. It illustrates that delay in diagnosis frequently occurs, with the classic features of the disease being uniformly absent.

[The femoral neck prosthesis CUT. Three- to six-year results]. / Schenkelhalsendoprothese Typ CUT. 3- bis 6-Jahres-Ergebnisse.

BACKGROUND: As the number of younger patients undergoing total hip arthroplasty is growing steadily, bone-saving implantation techniques are increasingly gaining in importance. METHODS: Fifty-six femoral neck prostheses (type CUT, ESKA Implants, Lübeck, Germany) were implanted in 50 patients between 1999 and 2002 (average age 49 years). After a mean follow-up of 4.9 years (min.: 3.2, max.: 6.5), we determined the state of all the prostheses. Forty-four patients with 50 prostheses were examined clinically with the Harris hip score and were assessed radiologically. RESULTS: The average Harris hip score improved from 48 points preoperatively to 93 points at the most recent follow-up examination. Of the 56 CUT prostheses, 6 (10.7%) had been revised. Four of these six cases (7.1%) required revision because of aseptic loosening. The radiological evaluation of these four cases revealed in three cases progressive horizontal migration with varization of the prosthesis, although the stem had been correctly positioned in primary surgery, with the femoral neck resected too widely or completely. After 4.9 years, the survival rate of the CUT prostheses is 88.4% according to Kaplan-Meier for a necessary exchange of the CUT prostheses as an endpoint. CONCLUSION: The use of the CUT prosthesis can lead to good clinical and radiological results, but shows a higher loosening rate as compared with cementless standard stems. Further studies are necessary to determine if the CUT prosthesis is a real alternative to cementless standard stems.

Proximal focal femoral deficiency -- a rare entity in the sonographic differential diagnosis of developmental dysplasia of the hip,.

In the present study, we will describe the differential diagnosis of the rare hip anomaly of proximal focal femoral deficiency (PFFD), based on an analysis of 12,488 ultrasound images of the hips of 6244 neonates, examined in our orthopaedic clinics between 1988 and 1998. The clinical manifestations and ultrasound features of PFFD will be characterised and compared with those of the normal, the mildly dysplastic, and the severely dysplastic hip. Two cases of PFFD (0.032 %) were detected during the investigation period. Both neonates had been referred to the orthopaedic clinic for further evaluation after the initial ultrasound findings suggested an anomaly in the coxal-femoral region. Correct identification of anatomical structures in the acetabular region (acetabular labrum and lower edge of the ilium) was not possible, but the iliac line, femoral head, and greater trochanter could be reliably visualised. Because of these findings, a deformity in the coxal-femoral region was suspected, and further diagnosis was recommended. PFFD was subsequently diagnosed, and specific treatment was initiated. PFFD should be suspected in any neonate with suspicious clinical findings and failure of ultrasound to clearly visualise anatomical landmarks in the region of the acetabulum (acetabular labrum, lower edge of the ilium, cartilage-bone interface) despite the use of a sufficient imaging technique. Radiographs should then be obtained to confirm or refute the tentative diagnosis. Infants with PFFD can then receive proper treatment without unnecessary therapeutic trial and error.

[Long-term results with the Harris-Galante press-fit-cup]. / Langzeitergebnisse der Harris-Galante Press-fit-Pfanne.

AIM: The present work aims at evaluating the clinical and radiological long-term results of the Harris-Galante press-fit cup. METHOD: At an average follow-up time of 9.5 years (min. 9, max. 10.3) 123 patients with 138 Harris-Galante press-fit cups (HGP) were examined clinically and radiology. The clinical evaluation was done with the Harris hip score. Together with the HGP, which was inserted in all cases, five different femoral stems were implanted. A lateral approach, according to the technique of Watson-Jones, was used in all cases. RESULTS: The mean follow-up Harris hip score was 89 of 100 points and is assessed as a good result. 7 cups (5%) were classed as being radiological loose, but only one case had also clinical symptoms. A total of 10 cups (6.8%) had to be revised. 3 cups (2 %) had to be revised because of aseptic loosening. This result represents a survival rate of 93.2% according to Kaplan-Meier. CONCLUSION: The long-term clinical and radiological results of the Harris-Galante press-fit cup and there fixation method can assessed as good.

[Effect of the ultrasound saw on bone growth and repair]. / Der Einfluss der Ultraschallsäge auf Knochenwachstum und -reparation.

The effects of ultrasonic saw cuts in the epiphyseal cartilage reach were investigated experimentally in dogs. Saw cuts across led to an impaired growth, whereas longitudinal cuts caused a stimulation of growth. The dimensions of the growth influence were, however, very different and not calculable. Further on, the temporal lapse of the bony repair was investigated radiologically comparatively after osteotomy by the ultrasonic saw or by the oscillated saw. The bony repair took place more slowly after ultrasonic osteotomy generally speaking. The indications and limits for the application of the ultrasonic bone saw were deduced from the investigation results by including the bibliography.

[Current status of lung preservation for organ transplantation]. / Zum gegenwärtigen Stand der Konservierung der Lunge für die Organtransplantation.

This paper gives a survey of the development and the present state of the preservation of isolated lungs intended for transplantation. Hypothermal perfusion with a colloid-containing electrolyte solution, supplemented with certain additives, without ventilation of the preserved lung is obviously a technique that is ready to be used in practice. The present priorities in experimental research are: elaboration of a standardized preservation technique, of which the expenditure can be justified in a clinical transplantation program, and establishment of parameters for the control of its efficiency.

[History of orthopedics in East Germany 1949-1990]. / Geschichte der Orthopädie in der DDR 1949-1990.

The following article deals with the essential aspects of the history of German orthopedics between 1949 and 1990 in the German Democratic Republic (GDR). Starting from the prevailing situation after World War II, the growth of orthopedic care in the GDR is described and the development of national orthopedic centers in the former GDR is summarized. In this context, reference is made to those public figures who played a leading role in this process, in particular F. Löffler, P.F. Scheel, and P.F. Matzen. In addition, the influence of social conditions in the GDR on the development of orthopedics and the resultant constraints are presented. Moreover, this contribution depicts the progress of orthopedic science in the former GDR and describes such salient aspects as the appearance of the specialized journal Beiträge zur Orthopädie und Traumatologie (Essays on Orthopedics and Traumatology), the Gesellschaft für Orthopädie der DDR (Association for Orthopedics in the GDR), and the annual conferences held by the this association.

[Vertebragenic dysphagia]. / Vertebragenbedingte Dysphagien.

UNLABELLED: Dysphagia due to external compression by anterior hyperostosis of the cervical spine is rare. The diagnosis may be established by conventional X-ray of the spine, oesophagogram, CT or MRI. CASES: We operated on one patient with an exostosis on the axis and another patient with large anterior osteophytes from C3 to C7 in Forestiers's disease. Postoperatively the patients were asymptomatic. CONCLUSIONS: Painful dysphagia due to anterior hyperostosis of the cervical spine is an indication for surgery. The anterolateral extrapharyngeal approach from C3 to C7 and the transoral intrapharyngeal approach to the vertebra C2 are preferred. In cooperation between orthopaedics and ENT the surgical treatment has no major complications and gives good functional results.

[Results of the surgical treatment of habitual and recurrent patella dislocation using Ali Krogius' method]. / Ergebnisse der operativen Behandlung der habituellen und rezidivierenden Patellaluxation nach der Methode von Ali Krogius.

Follow-up examination were carried out on 43 patients with habitual or recurrent dislocation of the patella. The operation had been performed according to Ali Krogius. The subjective and objective results were summarized and the indication given hitherto was examined and corrected.

[The morphological relations of eugnathia and class-II/1 and class-III malocclusions to the changes in the topography of the cervical spine in the lateral teleroentgenogram]. / Morphologische Verknüpfungen von Eugnathien, Gebissanomalien der Klasse II/1 und Klasse III mit Veränderungen der Topographie der Halswirbelsäule im Fernröntgenseitenbild.

Relations are discussed between malocclusions and changes of the vertebral spine. It was the aim of our investigations to disclose the causal relations between changes of the position of the cervical spine and class-II/1 anomalies (49 patients), class-III anomalies (28 patients), and eugnathic maxillary conditions (50 children). 127 lateral cephalograms of the untreated 63 boys and 64 girls at the age from six to 13 years were evaluated according to 24 orthodontic and 25 orthopedic characteristics. Patients with class-II/1 anomalies and class-III anomalies showed the tendency to strongly marked lordosis of the cervical spine. The basal angles nasion-tuberculum sellae-opisthion, nasion-tuberculum sellae-basion, and nasion-dorsum sellae-basion were enlarged in class-II/1 cases and reduced in class-III cases. It could not pointed out relations between the sagittal position of the jaws and the position of the atlas; there was no existing a specific bearing of the head within the various groups.

[Anterior hyperostosis of the cervical spine: diagnostic studies and surgical therapy]. / Diagnostik und operative Therapie der hyperostotischen Spondylose der Halswirbelsäule.

BACKGROUND: Dysphagia due external compression by anterior hyperostosis of the cervical spine is rare. The diagnosis may be established by conventional X-ray of the spine, esophagogram, and CT. PATIENTS: We operated on three patients with large anterior osteophytes from C3 to C7. In two cases morphologic changes of the cervical spine were the main cause of dysphagia. One patient with progressive hypopharynx cancer had hyperostosis of cervical spine as secondary findings. RESULTS: The patients were asymptomatic, post-operatively. CONCLUSIONS: Cervical osteophytes can be detected in 20-30% of the population in asymptomatic patients. The therapeutic approach depends on the extent of dysphagic complaints. Painful dysphagia is a indication for surgery. The anterolateral extrapharyngeal approach is commonly preferred with anterior hyperostosis between C4 and C7. The transoral intrapharyngeal approach has been used in patients with hyperostosis of cervical vertebra C2/C3. Interdisciplinary orthopedic and ENT surgical treatment is without complications and yields good functional results.

[Results after resection of juxta-facet-cysts - Which role does a segmental instability play?]. / Ergebnisse nach Resektion von lumbalen Juxta-Facett-Zysten - Welche Rolle spielt die segmentale Instabilität?

This study demonstrates the results after operative treatment of patients suffering from a lumbar Juxta-Facet-Cyst. We point out diagnostical aspects, possible concomitant problems and deriving therapeutical consequences. Between 01. 01. 1998 and 31. 03. 2001 9 patients were operated on a synovial cyst or a ganglion of the facet joint at our department. 5 patients were female, 4 patients male with a mean age of 61 (45-70) years. The average clinical and radiological follow up was 11 (5-18) months postoperatively. The clinical examination revealed in 5 out of 9 patients a sensible deficit, in 3 out of 9 patients motoric disturbances. There was no positive sign of Lasegue. The resection of the cyst or ganglion was performed in all cases via a dorsal approach. 8 patients underwent for a spinal stenosis and/or an existing instability a laminectomy and a spondylodesis with an internal fixateur. The histological findings showed a synovial cyst in 6 cases and a ganglion cyst in 3 cases. At the follow up all preoperative sensible or motorical deficits had resolved. Juxta-Facet-Cysts are discovered in some cases intraoperatively by chance, the radiological methods (CT, MRT) are especially in case of a concomitant spinal stenosis uncertain. During all operations, which are performed for a spinal stenosis, one should look for a cyst. The resection of the cyst leads to good functional results, a possible instability should by addressed by a spondylodesis.