[The description of meniscopathy in the sense of German occupational disease No. 2102 : Results of an interdisciplinary working group]. / Das Krankheitsbild im Sinne der Berufskrankheit 2102 Meniskopathie : Ergebnisse einer interdisziplinären Arbeitsgruppe.

On behalf of the Medical Advisory Committee for occupational diseases at the German Federal Ministry for Work and Social an interdisciplinary working group with medical experts in the field of casualty surgery, occupational health, orthopaedics, and radiology discussed the description of meniscopathy in the sense of the German occupational disease No. 2102. According to the medical guideline "Meniscopathy" of the German Society of Orthopaedics and Casualty Surgery (2015) meniscopathy is diagnosed clinically and radiologically by magnetic resonance imaging (MRI). The working group came to the conclusion that a bilateral, at least third-grade meniscopathy according to Stoller, in the posterior part of the inner meniscus should be required in the MRI.

[Loading and performance capacity after immobilization operations of the spine]. / Belastbarkeit und Leistungsfähigkeit nach Versteifungsoperationen der Wirbelsäule.

BACKGROUND: The results of spondylodesis depend on various medical and non-medical factors. Prerequisites for a good functional result are a well-founded assessment of the indications and a technically successful execution of the intervention. Furthermore, non-medical factors also play an important role. APPRAISAL: Attention must be paid to personal context factors and environmental conditions. In addition to psychological disorders and social background conditions, the economic considerations of the patient and expected pension payments influence the desire and willingness to return to gainful employment. ASESSMENT: Based on the physical findings, the criteria for assessment of the suitability for old-age pension insurance, the reduction in earning capacity for the obligatory social insurance and establishment of the severity of the resulting impairment/handicap according to the Social Compensation Act and the Act for the Severely Handicapped (Social Act IX) in Germany are systematically presented.

[Medical appraisal of anterior cruciate ligament ruptures]. / Begutachtung der vorderen Kreuzbandruptur.

BACKGROUND: Anterior cruciate ligament tears are one of the most common human ligament ruptures. The assessment of such ruptures is particularly difficult because most ACL injuries involve minimal to no contact. The steps of the assessment are presented with the necessary requirements. METHOD: Criteria for determining the cause of anterior cruciate ligament ruptures are discussed against the background of our experience and the literature. Different definitions of causality apply to German statutory accident insurance (workers' compensation) on the one hand and to private accident insurance on the other. RESULTS: The assessment of disability within the scope of workers' compensation in most cases results in "under 10 to 30%", while in private accident insurance it is rated as 1/10 to 1/20 degree of disablement.

[Expert appraisal of spinal injuries]. / Begutachtung von Wirbelsäulenverletzungen.

Appraisals and expert opinions of clearly identified injuries of the spine, ranging from fractures and dislocations to intervertebral disc ruptures and haemorrhage into soft tissue are generally unproblematic. The residual functional deficit is commensurate with the extent of damage. However, differences between the patient's symptoms and objective findings can be unrelated to the injury, and are often explained by the actual compensation process or other psychological/psychosocial factors. The current article discusses a basis for providing expert medical opinions, as well as a number of practical tips on the German medical insurance system. Particular attention is paid to expert opinions on causality. The article also includes information on the evaluation of structural injuries to the spine on the basis of assessment criteria that have proven to be reliable and authoritative in recent decades.

[Football as risk factor for a non-injury-related knee osteoarthritis - results from a systematic review and metaanalysis]. / Fußballsport als Risikofaktor für nicht unfallbedingte Gonarthrose - Ergebnisse eines systematischen Review mit Metaanalyse.

UNLABELLED: Aim and Hyopthesis: This systematic review and the metanalysis were performed to investigate the relation between football activity and the potential risk of knee osteoarthritis (possible occupational disease). It was hypothesised that soccer players suffer more than controls from knee osteoarthritis also in cases with an absence of documented major injuries. METHODS: The review and the metaanalysis were performed accordingly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. On 2014.02.01 a search was conducted within the medical databases PubMed, Medline, Cochrane, EMBASE und Web-of-Science. A total of 4,649 papers underwent a "Title-Abstract-Review". Finally 6 publications were included in the metaanaylsis. RESULTS: There were no longitudinal community-based studies as well as no Cochrane Reviews regarding the risk of knee osteoarthritis in soccer players. After adjustment of major injuries of the knee, soccer players have a slightly increased risk for knee osteoarthritis: relative risk 1.3 (95 % CI 1.0 - 1.7); I(2) = 37.4 %; p = 0.002. In contrast, in studies without differentiation of injured and non-injured knees, the relative risk was significantly increased: 2.9 (95 % CI 2.0 - 4.1); I(2) = 56.3 %; p < 0.001. CONCLUSIONS: Soccer players are a very heterogeneous group. The soccer player's knee undergoes different loadings including minor and major injuries. But the individual load also strongly depends on the player's status, his position within the football field and many other factors. In the absence of a major trauma the soccer player has only a slightly increased risk for the development of osteoarthritis. Thus we conclude that an injury in professional football does not fulfil the characteristics of an occupational disease.

[Significance of isthmic spondylolisthesis in expert assessment of occupational disease of the lumbar spine]. / Die Bedeutung der isthmischen Spondylolisthesis in der Begutachtung der Berufskrankheit der Lendenwirbelsäule.

In Germany, disc-related disease of the lumbar spine is eligible for workmen's compensation if caused by long-standing work requiring heavy lifting or carrying or extreme trunk-bending (BK 2108). The appraisal of causality is particularly difficult if conditions like isthmic spondylolisthesis preexist. 250 consecutive appraisals in nurses concerning the BK 2108 were analysed, 12 applicants (4.8%) had isthmic spondylolisthesis (4.6% of females and 5.9% of males). The literature about the natural history of isthmic spondylolisthesis is reviewed. A person who has isthmic spondylolisthesis is up to 25% more likely to have significant back trouble during his life than one who does not. Back pain in adults associated with spondylolisthesis is usually heralded by back pain in the late teens or early twenties. Progression of the slip is rarely seen after maturity. Due to the loss of protection by the posterior elements the disc is prone to premature degeneration which, however, does not become clinically apparent in most cases. Longstanding vocational heavy lifting or excessive stooping can negatively influence the natural history of isthmic spondylolisthesis. It can produce symptomatic disease in a person who would otherwise have remained asymptomatic, or it can cause a deterioration in those with preexisting symptoms. Criteria for the appraisal of causality are proposed. It is stressed that the course of the disease in relation to age and vocational strains has to be analysed in each individual case.

Ultrastructural study of cholestasis induced by longterm treatment with estradiol valerate. I. Tight junctional analysis and tracer experiments.

Over a period of 20 weeks estradiol valerate (1.5 mg/kg body weight/week) was administered subcutaneously to male Wistar rats from which the livers were examined at four week intervals employing a freeze-fracture technique and colloidal lanthanum tracer studies. In connection with intrahepatic cholestasis, distinct alterations in the tight junctions were observed, consisting of disorganization, rarification and proliferation. Disruption of the tight junctions was not seen and colloidal lanthanum did not penetrate into the bile canalicular lumen. Holding the view that the term "leakiness" of tight junctions should be defined with reference to the tracer employed, we conclude that in the liver one tight junctional strand is sufficient to prevent the escape of larger bile constituents such as bile acids and that a back diffusion of bile acids over the tight junctional barrier does not play a role in the pathogenesis of the estrogen-induced cholestasis. Interruptions of tight junctions, as described by other authors, are interpreted as a secondary mechanical effect. On the other hand, we consider an increased permeability of the tight junctions to water and small solute molecules as probable; possibly this increased permeability is brought about by alterations in the microfilaments. A model for the pathogenesis of the estrogen-induced intrahepatic cholestasis is proposed.

Ultrastructural study of cholestasis induced by longterm treatment with estradiol valerate. II. Gap junctional analysis.

Treatment of male Wistar rats with estradiol valerate induced alterations in hepatic gap junctions as visualized by the freeze-fracture technique. The alterations involved the spacing, and regularity of packing of the membrane particles of the P face (PF) and complementary pits on the E face (EF), as well as internalization and changes in the number, size and shape of the junctional domains. In approximately 20% of the PF's of the lateral membrane of treated animals the nonjunctional IMPs were aggregated, while the bile canalicular membrane was never involved, maintaining its random distribution of particles. It is proposed that the changes in junctional area and the more general arrangement of the junctional particles may indicate a decrease in coupling between hepatocytes. The invaginations of gap junctions may represent a means for removing gap junctional membrane from the surface or may be an expression of a higher turnover of gap junctions. We assume that the alterations observed here are due to the specific effects of estrogen. This study addresses in detail a number of possible sites of activity and modes of action for estrogen.