The size, shape, density and ring of the dwarf planet Haumea from a stellar occultation.

Haumea-one of the four known trans-Neptunian dwarf planets-is a very elongated and rapidly rotating body. In contrast to other dwarf planets, its size, shape, albedo and density are not well constrained. The Centaur Chariklo was the first body other than a giant planet known to have a ring system, and the Centaur Chiron was later found to possess something similar to Chariklo's rings. Here we report observations from multiple Earth-based observatories of Haumea passing in front of a distant star (a multi-chord stellar occultation). Secondary events observed around the main body of Haumea are consistent with the presence of a ring with an opacity of 0.5, width of 70 kilometres and radius of about 2,287 kilometres. The ring is coplanar with both Haumea's equator and the orbit of its satellite Hi'iaka. The radius of the ring places it close to the 3:1 mean-motion resonance with Haumea's spin period-that is, Haumea rotates three times on its axis in the time that a ring particle completes one revolution. The occultation by the main body provides an instantaneous elliptical projected shape with axes of about 1,704 kilometres and 1,138 kilometres. Combined with rotational light curves, the occultation constrains the three-dimensional orientation of Haumea and its triaxial shape, which is inconsistent with a homogeneous body in hydrostatic equilibrium. Haumea's largest axis is at least 2,322 kilometres, larger than previously thought, implying an upper limit for its density of 1,885 kilograms per cubic metre and a geometric albedo of 0.51, both smaller than previous estimates. In addition, this estimate of the density of Haumea is closer to that of Pluto than are previous estimates, in line with expectations. No global nitrogen- or methane-dominated atmosphere was detected.

Revision surgery after trapeziometacarpal arthroplasty.

BACKGROUND: The majority of patients with trapeziometacarpal joint (TMJ) arthritis can be successfully treated with some form of arthroplasty. Residual pain therefore is rather uncommon, but particularly difficult to treat. The aims of this study were to determine the number of patients in need of additional surgery; to identify the most common causes for persistent pain and to establish a treatment algorithm. PATIENTS: Twelve patients (11 females, 1 male) who had undergone secondary surgery after TMJ arthroplasty were retrospectively analyzed at a mean time of 32 months after the primary procedure. Parameters included the indication for secondary surgery, the type of procedure, the ultimate range of motion, residual pain levels, upper extremity function assessed by the DASH score and the distance from the first metacarpal bone to the scaphoid. RESULTS: The overall results were assessed according to the Conolly score. The revision rate after primary arthroplasty at our institution was 2.9%. Most common problems for secondary surgery included mechanical pain due to crepitation of the base of the first metacarpal bone, neuropathy of the superficial branch of the radial nerve and concomitant scaphotrapezial arthritis. A total of 19 procedures were performed resulting in two good, five fair and five poor results. A treatment algorithm is presented.

Proneurotensin 1-117, a stable neurotensin precursor fragment identified in human circulation.

Proneurotensin/neuromedin N (pro NT/NMN) is the common precursor of two biologically active peptides, neurotensin (NT) and neuromedin N (NMN). We have established antibodies against peptide sequences of the NT/NMN precursor and developed a sandwich immunoassay for the detection of pro NT/NMN immunoreactivity in human circulation. Endogenous pro NT/NMN immunoreactivity was enriched by affinity chromatography using antibodies against two different pro NT/NMN epitopes, and further purified by reversed phase HPLC. Mass spectrometry analysis revealed pro NT/NMN 1-117 as major pro NT/NMN immunoreactivity in human circulation. Pro NT/NMN 1-117 is detectable in serum from healthy individuals (n = 124; median 338.9 pmol/L). As known for NT, the release of pro NT/NMN 1-117 from the intestine into the circulation is stimulated by ingestion of an ordinary meal. Investigation of the pro NT/NMN 1-117 in vitro stability in human serum and plasma revealed that this molecule is stable for at least 48 h at room temperature. Since pro NT/NMN 1-117 is theoretically produced during precursor processing in stoichiometric amounts relative to NT and NMN, it could be a surrogate marker for the release of these bioactive peptides.

Reconstruction of the destroyed septal infrastructure.

Destruction of the nasal septum can produce cosmetic and functional disturbances and is most commonly caused by trauma, septal abscess, and inadequate septal surgery. A method of reconstruction of the destroyed septal infrastructure is presented using a preserved rib cartilage allograft.

Long-term results of dorsal intercarpal ligament capsulodesis for the treatment of chronic scapholunate instability.

The purpose of this study was to assess the clinical and radiological outcomes of dorsal intercarpal ligament capsulodesis for the treatment of static scapholunate instability at a minimum follow-up of four years. A total of 59 patients who underwent capsulodesis for this condition were included in a retrospective analysis after a mean of 8.25 years (4.3 to 12). A total of eight patients underwent a salvage procedure at a mean of 2.33 years (0.67 to 7.6) and were excluded. The mean range of extension/flexion was 88° (15° to 135°) and of ulnar/radial deviation was 38° (0° to 75°) at final follow-up. The mean Disabilities of the Arm Shoulder and Hand (DASH) score and Mayo wrist scores were 28 (0 to 85) and 61 (0 to 90), respectively. After significant improvement immediately post-operatively (p < 0.001 and p = 0.001, respectively), the mean scapholunate and radiolunate angles deteriorated to 70° (40° to 90°) and 8° (-15° to 25°), respectively, at final follow-up, which were not significantly different from their pre-operative values (p = 0.6 and p = 0.4, respectively). The mean carpal height index decreased significantly from 1.53 (1.38 to 1.65) to 1.48 (1.29 to 1.65) indicating progressive carpal collapse (p < 0.001); 40 patients (78%) had radiological evidence of degenerative arthritis. Capsulodesis did not maintain carpal reduction over time. Although the consequent ongoing scapholunate instability resulted in early arthritic degeneration, most patients had acceptable long-term function of the wrist.

Scaphoid morphology and clinical outcomes in scaphoid reconstructions.

Scaphoid malunion and carpal malalignment can result after scaphoid reconstruction, if the two fragments are not properly reduced before fixation. However, currently there is no information about which degree of deformity or malalignment can be tolerated without impairing clinical function. The purpose of this study was to investigate the influence of the scaphoid morphology and carpal alignment on clinical outcomes after scaphoid reconstruction. A total of 65 patients with an average age of 29 years were followed-up after a mean period of 45 months. In all patients, osseous union after a first-time scaphoid reconstruction in the middle third had been confirmed. Scapholunate (SL) and radiolunate (RL) angles were obtained on plain radiographs as were intrascaphoid (ISA) and dorsal cortical (DCA) angles and the height/length (H/L) ratio of the reconstructed scaphoid on computed tomography (CT) scans. These parameters were correlated with clinical outcome measures. RL angles correlated significantly with wrist range of motion, grip strength and pain levels, whilst SL angles, ISA, DCA and H/L ratio failed to show significant correlations. Our data suggest that clinical outcome is correlated with correct restoration of bone morphology and carpal alignment. After reconstruction, the RL angle should not exceed 10°.

[Operative treatment of paranasal sinus diseases in childhood]. / Die operative Behandlung von Nasennebenhöhlenerkrankungen im Kindesalter.

An exact knowledge of the developing anatomy and physiology, and very conservative operative technique are the prerequisites for surgical therapy of the nose and the paranasal sinuses in children. These requirements are fulfilled by uncapping of the ethmoidal cells in chronic and especially acute ethmoid sinusitis. Intranasal antrostomy allows diagnosis to be made and limited local treatment to be given in acute and chronic maxillary sinusitis. More radical surgical procedures are not indicated in children, except in those cases, where severe orbital or endocranial complications have already developed. Uncapping of the ethmoidal cells and/or intranasal antrostomy combined with the elimination of mechanical obstruction of the upper respiratory tract are necessary, when conservative treatment of acute or chronic sinusitis is unsuccessful. Continuation of conservative therapy is then no longer indicated. The uncapping of the ethmoidal cells under antibiotic cover usually leads to a complete disappearance of the symptoms within a few days, even when orbital or periorbital complications of an acute ethmoiditis have already set in. Even after unsuccessful long-term treatment of a chronic maxillary sinusitis, intranasal antrostomy is successful in 75-90 per cent of cases. Complications did not occur in a personal series of 1,349 intranasal antrostomies in children in a period of 5 years.

[The use of synthetic materials in rhinoplasty]. / Die Verwendung von Kunststoff bei Nasenplastiken.

The ideal implant does not yet exist. Generally, the use of plastic implants in rhino-surgery is of limited indication only. The use of plastic implants in septum surgery is contraindicated. Hard, rigid, insufficiently elastic and perforated implants should not be used in the nasal dorsum. The implantation of mesh material has proved a failure. Only in limited cases of a severely damaged and scarred nasal dorsum the implantation of plastic sponge is indicated. Experience teaches the critical surgeon that occasionally there are defects, which (also due to lack of suitable implant material) cannot be improved with a justifiable prospect of success.

Surgical treatment of sinusitis.

There is no doubt that there is a considerable number of cases of acute and chronic sinusitis, which can be cured only by surgical intervention. The modern philosophy should be: to choose a surgical technique as conservative as possible and as radical as necessary according to the individual case. To achieve this goal, an exact knowledge of the anatomy and pathology of the paranasal sinuses, as well as a full command of the available diagnostic methods (including sinuscopy) are essential. The sometimes dangerous complications of acute ethmoiditis in children usually can be solved by simple displacement of the middle turbinate to the center and uncapping of the ethmoidal cells assisted by antibiotic and antiphlogistic treatment. The surgical treatment of choice in cases of acute recurrent or chronic maxillary sinusitis in children (often combined with bronchial or allergic problems) is the installation of a nasoantral window from the inferior meatus, to guarantee adequate drainage. In adults, the radical techniques of Caldwell-Luc (maxillary sinus) and Riedel (frontan sinus) should be used in selected cases only. They should be replaced--if possible--by osteoplastic methods or modified techniques (frontal and maxillary sinus) or bimeatal-transnasal approach under endoscopic control (maxillary and ethmoidal sinus). Healthy and reversibly damaged mucosa should be saved; but at the cost of sacrificing the nasal function instead.

[The intermaxillary bone and Goethe's Mephistopheles]. / Der Zwischenkiefer-knochen und Goethes Mephistopheles.

The greatest anatomist of the second half of the 18th century was considered to be Petrus Camper from Holland. His theory - widespread as a dogma - stated that the anatomical difference between man and animal was the missing intermaxillary bone in man, this being the distinguishing feature between man and monkey. Against this theory Goethe set hs own reflections and observations, and on March 27th 1784 he found, by "reflection and coincidence", the intermaxillary bone in the human skull. In order to present his exciting discovery to the famous anatomist, he wanted to use as an intermediary his good friend Johann Heinrich Merck from Darmstadt who was in contact with Petrus Camper. But Merck delayed the requested forwarding of the manuscript, belittled Goethe and the significance of his treatise considerably in an accompanying letter, did not forward Camper's replies, and in the meantime even took advantage of Goethe's treatise for his own publications. It as only late that Goethe became aware of the scheming and mean behaviour of his "good friend", and he felt disappointed and betrayed by Merck. In Goethe's dramatic poem "Faust", Dr. Faust is confronted with the figure of Mephistopheles--the spirit who always plans evil and always denies. There is enough evidence to believe that the person of J. H. Merck can be recognized in this figure, and that Goethe's discovery of the human intermaxillary bone had its part in creating the figure of Mephistopheles as we know it today.

[Ivory as a nose implant performed by Jacques Joseph. Late results after more than 40 years]. / Elfenbein als Nasenimplantat bei Jacques Joseph. Spätergebnisse nach über 40 Jahren.

A report is represented on late results of saddle-nose corrections in three patients who, more than 40 years ago, underwent surgery performed by Jacques Joseph in Berlin using an ivory chip. One patient showed a very good permanent result, while the two others had implant loss, which, in one case, was due to trauma. The case reports offer an opportunity to recall a few biographical data on Jacques Joseph and on his use of ivory as an implant material.