Saturation-transfer studies of ATP-Pi exchange in isolated perfused rat liver.

The rate of exchange between inorganic phosphate and ATP was measured in isolated perfused rat livers in the direction of ATP synthesis using 31P NMR spectroscopy and the saturation-transfer technique. Measurement of ATP hydrolysis was not observable, even after treatment of rats with 100 micrograms T3/day per 100 g body wt. When the perfused livers were treated with iodoacetate in order to inhibit glycolysis, NMR measurable exchange between ATP and Pi was eliminated. It is concluded that the inorganic phosphate----ATP conversion detected by saturation transfer is catalyzed by enzymes of the glycolytic pathway and that the mitochondrial ATPase rate is too slow to contribute to the observed effect.

Effect of vitamin C deficiency on hydroxylation of trimethylaminobutyrate to carnitine in the guinea pig.

The effect of ascorbate deficiency on carnitine biosynthesis was investigated in young male guinea pigs. Liver and skeletal muscle carnitine levels were reduced in scorbutic animals. Heart and kidney concentrations remained unchanged. 14C-labeled 4-N-trimethylaminobutyrate was administered to control, pair-fed and scorbutic animals and distribution of isotope in compound present in the liver after 30 min was determined. Control and pair-fed animals converted trimethylaminobutyrate to carnitine faster than scorbutic animals. Injection of ascorbate with the [14C]trimethylaminobutyrate reversed the decline in trimethylaminobutyrate hydroxylase (EC 1.14.11.1) activity in scorbutic animals.

Rate of Improvement in Clinical Outcomes with Anatomic and Reverse Total Shoulder Arthroplasty.

INTRODUCTION: The rate of clinical improvement has never been studied after anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty. This study quantifies the rate of improvement after aTSA and rTSA using five different scoring metrics for 1,641 patients. METHODS: We evaluated 1,641 (69 ± 9.3 years old) patients treated by 14 orthopaedic surgeons using either aTSA or rTSA with a single platform shoulder system. Seven hundred twenty-nine patients received aTSA, and 912 patients received rTSA. Each patient was scored preoperatively and at various follow-up intervals (2 weeks, 6 weeks, 3 months, 6 months, annually, etc.) with a maximum follow-up time of 139 months using the SST, UCLA, ASES, Constant, and SPADI metrics. In addition, range of motion was measured. The rate of improvement was analyzed using a 40-point moving filter treadline over the entire range of follow-up. RESULTS: All metrics improved in a majority of patients with less than 5% worsening after 6 months. While gains in motion were present in the majority of patients after aTSA, a higher incidence of patients failed to experience improvement in range of motion after rTSA. Clinical worsening was seen in up to 10% and 20% of the visits for active flexion and abduction and external rotation, respectively. The majority of clinical improvement after aTSA and rTSA was noted in the first 6 months with full improvement noted by 12 to 24 months. During the first 12 months, the rate of improvement associated with rTSA patients was generally 30% larger than that of aTSA patients. DISCUSSION: The results of this large-scale database analysis demonstrate the reliability of improvements in outcomes and motion achieved with both aTSA and rTSA for various indications. For both aTSA and rTSA, less than 5% of patients reported worsening in each of the five clinical metrics after 6 months postoperative follow-up time. This study is significant because it quantifies how patient outcomes improve with time following treatment with both aTSA and rTSA. These results can be used to establish realistic patient expectations regarding the typical follow-up time required for pain to be reduced and function restored following surgical treatment with a total shoulder prosthesis.

Prevalence of fungal foot infections in patients with diabetes mellitus type 1 - underestimation of moccasin-type tinea.

In diabetic patients, mycotic infections may increase the risk of developing diabetic foot syndrome. However, few data are available on the prevalence of fungal foot infections in patients with diabetes. During a conference attended by patients with long-term diabetes, 95 individuals with type 1 diabetes mellitus (52 men, 43 women, mean disease duration 35.8 years) were examined for fungal infections of the feet. As well as frequency of infection and risk profiles, the level of patient awareness and preventive measures taken were assessed by means of a questionnaire. Clinically, 78 patients (82.1 %) showed probable pedal fungal infections, of which 84.6 % (66/78) were mycologically confirmed by direct microscopy and/or culture. Skin mycoses were found in 9 patients (toe webs 5, soles 4), onychomycosis in 29 patients and simultaneous infection of nails and skin in 28 patients (toe webs 8, soles 20). Thirty-seven (47.4 %) of these patients had positive cultures, particularly for the dermatophyte Trichophyton rubrum (69.2 % of isolates). A significant correlation was found between infection and gender (men more frequently affected) and the age of the patients. The actual frequency of mycoses was underestimated by the patients. This correlated with the assessment of their own knowledge level concerning fungal infections: 83.2 % of patients with skin mycoses and 88.4 % of those with onychomycosis of the feet felt that they needed more information about their disease. Marked mycoses on the soles were often considered to be dry skin by the patients. The high number of infections detected is especially remarkable in that this group of patients were highly motivated. It therefore appears that diabetics require more diagnostic, therapeutic and preventive care in terms of mycotic diseases than has been previously thought.

Structural demands on computer-based medical documentation in the hospital setting.

During the last years physicians are confrontated with a significant increase of their duties in clinical documentation. By law the medical diagnoses and procedures were linked with the aspect of liquidation. In consequence it is very important that physicians work out a detailled list of options concernig the features of the medical database, which has to cover the complete clinical data input and deliver flexible utilities for detailed evaluation. Beside documentation the system has to perform as an essential tool of clinical organisation and quality control to optimize the medical and commercial efficiency of the hospital. An open interface technology should be postulated to avoid a stand alone system in the long run.

[Analysis of isokinetic and isometric muscle function after arthroscopic anterior cruciate ligament repair]. / Isokinetische und isometrische Muskelfunktionsanalyse nach arthroskopisch durchgeführten vorderen Kreuzbandersatzplastiken.

Following anterior cruciate ligament replacement plasty performed via arthroscopy, isokinetic and isometric power data were measured at the beginning and end of a sports therapy treatment course. Evaluation yielded surprising results that were partly contradictory to those communicated in current literature. Besides the dependence of force values on preset velocities of motion in dynamic measurements (isokinetics) or in static measurements (isometrics), markedly lower losses of power than expected were measured in the involved extremity on repeated power application. Possible reasons are discussed on the basis of specific innervation criteria and polymodal reflexes. We assume that muscle potential is not yet fully available after surgical intervention, due to reflexive modulations of power realisation, so that the joint and especially the anterior cruciate ligament are thus protected from damage.

Pityriasis versicolor alba.

Pityriasis versicolor alba is a hypopigmented or depigmented variant of pityriasis versicolor characterized by maculous, partly pityriasiform, scaly depigmented lesions occurring particularly in seborrhoeic areas. Long-persisting hypopigmentation after healing of the pityriasis versicolor was first described by Gudden in 1853. Hypopigmentation and depigmentation were later differentiated as an independent variant of the disease. In 1848, Eichstedt recognized the pathogen-related character of pityriasis versicolor in its hyperpigmented form. Today it is generally accepted that the disease is caused by yeasts of the genus Malassezia, of which nine species are differentiated. It is controversial whether a single species is responsible for the disease. The pathogenesis of depigmentation has not been established. A screening effect by the scale layer as well as toxic effects on pigment synthesis by fungal metabolites have been discussed. With regard to the second mechanism, the newly discovered tryptophan-derived metabolites of M. furfur might be significant. Evidence-based data concerning the therapy of pityriasis versicolor alba do not exist. According to current recommendations, pityriasis versicolor should be rapidly treated with antimycotics, followed by ultraviolet therapy to induce maturation of existent melanosomes and accelerate repigmentation. However, depigmented lesions are difficult to improve by ultraviolet therapy.

[Fasciitis necroticans -- erysipelas grangrenosum: two different clinical entities? (author's transl)]. / Fasciitis necroticans -- Erysipelas gangraenosum: Zwei verschiedene Krankheitsbilder?

Among the bacterial infections of the skin the so called fasciitis necroticans has until now received little attention in dermatological literature. The clinical picture shows great similarity to erysipelas grangrenosum. Considering the fact, that the primary infection involves the subcutaneous fatty tissue and especially in light of the different bacterial etiology with the resulting differences in therapy, it seems justified to classify fasciitis necroticans as a separate entity.

[Is there a specific cerebral organic psychosyndrome following craniocerebral trauma in childhood and adolescence? Neuropsychological and psychopathologic results]. / Gibt es ein spezifisches hirnorganisches Psychosyndrom nach Schädel-Hirn-Trauma im Kindes- und Jugendalter? Neuropsychologische und psychopathologische Ergebnisse.

The main clinical features pertaining to the concept of the "psycho-organic syndrome" (POS) were investigated in a sample of children who suffered from severe craniocerebral trauma. The results of the present study failed to confirm the existence of a typical syndrome following cerebral trauma. As 69% of the children had psychiatric disorders, the risk for developing psychiatric disorders was significantly increased in children who had incurred a cortical injury. However, the symptomatology turned out to be nonspecific both in terms of neuropsychological and psychopathological sequelae. Thus, the notion of a unique POS was not supported by our study. Instead our results indicated that the concept should be reevaluated. Beyond that, our results demonstrated how important it is to assess the various behavioral and psychological functioning variables exactly, particularly because of their impact on rehabilitative treatment.

[Structural requirements of computer-based medical documentation in a hospital setting]. / Strukturelle Anforderungen an eine EDV-gestützte medizinische Klinikdokumentation.

During the last years physicians are confronted with a significant increase of their duties in clinical documentation. By law the medical diagnoses and procedures were linked with the aspect of liquidation. In consequence it is very important that physicians work out a detailed list of options concerning the features of the medical database, which has to cover the complete clinical data input and deliver flexible utilities for detailed evaluation. Beside documentation the system has to perform as an essential tool of clinical organisation and quality control to optimize the medical and commercial efficiency of the hospital. An open interface technology should be postulated to avoid a stand alone system in the long run.

[Computer-assisted analysis of the kinematics of the upper ankle joint]. / Computergestützte Analyse der Kinematik des oberen Sprunggelenks.

Usually the upper ankle joint is described as a typical hinge though it had been often remarked that the axis of rotation moves considerably with regard to the angular adjustment between the tibia and the trochlea tali. In the present study the relation between the movements in the upper ankle joint and the geometry of the lateral ligaments was analysed. The contours and elected landmarks of 6 dissected ankle joints were measured using a digitizer which allowed the computerized scanning of motion x-rays. In addition the proximal and distal insertion planes of the lateral ligaments were registered. Mathematical procedures were applied on the experimental data to predict the kinematic principles. The model of an hinged joint could not reproduce the motion curve which was actually found. Using the model of a link chain with four pivots, which was determined by the course of the talofibular and the calcaneofibular ligament, a good correlation with the experimental results was evident. This model implies a rotary and gliding component in the movement of the tibia against the trochlea tali. Beside the correspondence with the data of the present study the model allows an easy explanation of many other well known morphologic phenomena of the upper ankle joint for which a stringent interpretation was not yet available.

[Diagnosis--therapy and documentation]. / Diagnose--Therapie und Dokumentation.

The procedures of documentation of diagnostic findings are well established--but different in their graphical and structural appearance of patients histories. Out of multiple findings a retrieval with valid informations is very clumsy. In order to increase quality a complete and reliable registration of clinical data base is necessary. For this purpose the use of electronic media is profitable if the requirements of the data-base are well defined. A nationwide agreement on one key-system--including the transformation of textual structures--is proposed. Only this way leads to comparable results in therapeutic procedures.

Rapid 31P NMR test of liver function.

The 31P NMR spectrum of perfused rat liver was found to be dependent on the exogenous carbon available to the tissue. When pyruvate was supplied to liver initially perfused with lactate, Pi decreased, phosphoenol pyruvate and phosphomonoesters increased, and nucleotide pools remained the same. It is proposed that these changes can be used to evaluate liver function.

Effect of adenine on liver nucleotide after fructose loading by 31P-NMR.

Livers from 125- to 150-g rats were perfused and the effect of fructose metabolism on liver energetics was observed using 31P nuclear magnetic resonance (NMR). Livers were exposed to fructose in a nonrecirculating manner for approximately 15 min and monitored for recovery for 30 min. At concentrations ranging from 1 to 25 mM, fructose exposure led to depletion of the nucleoside triphosphate level. Subsequently, the nucleoside triphosphate level recovered fully at a fructose concentration of 1 mM; however, recovery was only 65% of the initial values if the fructose concentration was 10 mM and 55% if the concentration was 25 mM. Adenine was found to protect nucleoside triphosphate levels against the adverse effects of fructose by blocking the deamination of AMP. In the presence of adenine, AMP accumulation was observed in the NMR spectra upon exposure of the liver to fructose.

pH and compartmentation of isolated perfused rat liver studied by 31P and 19F NMR.

The phosphorus NMR spectra of isolated perfused rat liver displays a prominent inorganic phosphate peak at 2.76 +/- 0.05 ppm relative to liver glycerolphosphocholine at 0.49 ppm. From titration curves of phosphorus-containing compounds this corresponds to a pH of 7.4. The spectra also display a shoulder on the prominent inorganic phosphate peak at 2.22 +/- 0.55 ppm corresponding to a pH of 7.0. Fructose is phosphorylated in the C1 position by the liver and the resulting fructose-1-phosphate is located in the cytosol. From the titration curves, this compound was at pH 7.0. When inorganic phosphate was added to the perfusate, 13 of 25 livers showed two inorganic phosphate peaks resolved in the difference spectra, one originating from the perfusate, the other at pH 7.0. When large (50 mM) fructose doses were administered to the liver, the prominent peak decreased allowing two peaks to be resolved. FCCP treatment of the liver caused the two peaks to coalesce with the final pH of both the fructose-1-phosphate and inorganic phosphate being the same. 19F NMR of difluoromethylalanine gave an intracellular pH of 7.4 for the isolated perfused liver. The data presented do not lend themselves to satisfactory interpretation, and call into question the correctness of the traditional assignment of liver inorganic phosphate being cytosolic in origin.

[Computer-assisted implant positioning in knee endoprosthetics. Kinematic analysis for optimization of surgical technique]. / Computergestützte Implantatpositionierung in der Knieendoprothetik. Kinematische Analyse zur Optimierung der Operationstechnik.

Modern approaches in knee endoprosthetics using computer-assisted navigation systems are based on matching procedures which refer to osseous anatomical landmarks. However, surface replacement techniques require a correct position of the implants in relation to the bone, as well as an optimal postoperative interaction of the ligaments and the surface design of the endoprosthesis. Functional aspects are of elementary importance. Insufficient design of the prosthetic surface or incorrect implantation overstresses ligamentous structures and result in functional disturbance, increased wear, and early loosening of the components. The present computer model permits a quantitative analysis of different implant positions. Distal positioning of the femoral component or insufficient resection of the tibial plateau results in a lag of extension. Increased distal resection of the tibial plateau produces marked translatory instabilities in the sagital plane which exceed the absolute height of the resection in millimeters. Monocondylar replacements with preservation of the ACL react kinematically more sensitively than bicondylar endoprostheses sacrificing the ACL. The results of this study are systematically summarized in an algorithm and indicate correction steps in order to avoid functional impairment. The computer model delivers in addition some basic data for optimized navigation procedures in knee surgery and demonstrates the importance of further developments in custom-made endoprosthetics.