[Examination of the painful wrist]. / Diagnostik des schmerzhaften Handgelenks.

The anatomy of the wrist is complex. Mechanical, neurological or systemic causes are responsible for a painful wrist. In many cases a specific diagnosis can already be made by taking a precise medical history. Physical examination includes inspection, palpation of landmarks and a dynamic examination in regard to joint regions. Plane X-Ray examinations are the basic tools in diagnostic imaging. Additional radiographic adjustments, ultrasound-, MRI- and CT-examinations may lead to more detailed information in special cases. A diagnostic arthroscopy is accomplished, if a pathological cause for wrist-pain with non-invasive methods cannot be found.

[Examination of the painful wrist]. / Diagnostik des schmerzhaften Handgelenks.

The anatomy of the wrist is complex. Mechanical, neurological or systemic causes are responsible for a painful wrist. In many cases a specific diagnosis can already be made by taking a precise medical history. Physical examination includes inspection, palpation of landmarks and a dynamic examination in regard to joint regions. Plane X-Ray examinations are the basic tools in diagnostic imaging. Additional radiographic adjustments, ultrasound-, MRI- and CT-examinations may lead to more detailed information in special cases. A diagnostic arthroscopy is accomplished, if a pathological cause for wrist-pain with non-invasive methods cannot be found.

[Epiphyseal Bar Resection for Correction of Clinodactyly]. / Resektion der atypischen Wachstumsfuge zur Korrektur der Klinodaktylie.

BACKGROUND: Clinodactyly is a digital angulation in the radio-ulnar plane. Mostly it is seen on the little finger. The middle phalanx typically has a triangular or trapezoid shape (delta phalanx), resulting in radial deviation of the distal phalanx. Resection of the longitudinal epiphyseal bracket (physiolysis) with fat graft interposition is a possible surgical technique, which uses children's growth potential to correct the axial deviation. AIM: The purpose of our study was to review the degree of correction at least 2 years postoperatively and after an average of 5 years postoperatively, and to find out if children´s age influences the results. PATIENTS AND METHODS: 23 children (43 little fingers) underwent physiolysis and were retrospectively analyzed after a median follow-up of 5 years (2.1-7.9 years). The active range of motion of the little finger's MP, PIP and DIP joints and finger-palm-distance were measured. Lateral deviation was determined by using standardized radiographs and subsequently compared with preoperative values. Patients were divided into 2 subgroups: younger than 3 years (16 fingers, group A), older than 3 years (27 fingers, group B). The achieved correction of the lateral deviation was compared between both groups. RESULTS: All patients showed full active range of motion in all joints of treated fingers. Finger-palm-distance was 0 cm. No complications occurred. The mean preoperative deviation of all patients was 37°±11, which improved after surgery by 17°±11 (i. e. 44.0%±23.1 of initial findings). Group A demonstrated a mean preoperative lateral deviation of 40°±9, and group B a mean deviation of 36°±12. In both groups we saw a similar improvement (group A mean: 17°±10, group B mean: 17°±11). In group A there was a wider dispersion of postoperative results. In the age group 7 to 10, the results of individual cases show the large variability of the corrective potential. X-rays revealed the following incidental findings after surgery: a premature fusion of the proximal radial epiphyseal plates in 2 fingers and a sinuous-shaped proximal radial epiphyseal plate in 12 other fingers. CONCLUSION: Resection of the longitudinal epiphyseal bracket with fat graft interposition is a technically simple and effective treatment option for clinodactyly, particularly in children of 3 to 6 years of age.

Negative chemical ionization of alcohols.

Reactions of the oxygen radical anion at low pressure (ICR conditions) with aliphatic alcohols are seen to give a limited number of product anions which allows for unambiguous determination of the structure of the neutral. The reactions of OH- are also investigated and mechanisms of reactions are discussed. Analytical application of NCI is also considered. OH- negative chemical ionization mass spectra, negative metastable ion spectra, and negative collisional activation spectra (negative product from negative precursor ions) have been applied to stereochemical problems of cyclic diols. The spectra of the cis and trans isomers of 1,3- and 1,4-cyclohexanediols and 1,2- cyclopentanediols show substantial and characteristic differences. The (M-H)- alkoxide anions produced by OH- reagent ions are stabilized for the cis isomers by formation of an intramolecular hydrogen bridge involving both oxygen functions. However, trans geometry of the (M-H)- ions is indicated by abundant (M-H3)- and/or (M-H-H2O) fragment ions. The stereospecificity increases with ion internal energy (high temperature, collisional activation) or especially with ion life times (metastable ions). It is shown that in F- negative chemical ionization the relative intensities of the fluoride attachment ions MF- and of the proton abstraction ions (M-H)- reflect the stereochemistry of the cyclic diols. The results demonstrate the potential of negative ion mass spectrometry for stereochemical investigations.

Isotope-geochemical and mineralogical-petrographic characteristics of the pergamon altar marble.

Abstract We report preliminary results of our provenance study of marble from the Telephos Frieze of the Pergamon altar. The emphasis here is on the stable isotope geochemistry of marble. The obtained δ(13)C values (2.4 to 3.5‰) vary insignificantly. However, the δ(18)O values give two clusters. The isotopically light marbles (close to -9.5‰) derive from panels 1-8 and the heavy marbles (-3.5 to -1.0‰) derive from panels 11-50. Mineralogical, petrographic and geochemical investigations (accessory minerals, grain size distribution, rare earth elements) further refined the marble characteristics. In spite of certain differences observed (grain size distributions, isotopy and contents of certain elements) for the two marble groups, the present data support a common provenance. So far, east Aegean islands and the Marmara region are favored.

[Mid-term results after scaphoid excision and four-corner wrist arthrodesis using K-wires for advanced carpal collapse]. / Mittelfristige Ergebnisse nach Skaphoidresektion und mediokarpaler Teilarthrodese unter Verwendung von K-Drähten bei fortgeschrittenem karpalen Kollaps.

AIM: Successful four-corner fusion after scaphoid excision provides pain relief und preserves an acceptable movability of the wrist. However, this treatment option for advanced carpal collapse is not without complications, such as malunion, hardware impingement or incomplete correction of lunate extension. K-wires, staples, Herbert screws or, recently, locking plates are all possible fixation techniques after scaphoid excision. Only a few studies including mid-term results using K-wires are available. The aim of our study was to evaluate clinical and radiological mid-term results after scaphoid excision and four-corner arthrodesis using K-wires for stage II and III scapholunate and scaphoid non-union advanced collapse. METHOD: Twelve wrists of 11 patients (4/SNAC II degrees, 3/SNAC III degrees, 0/SLAC II degrees, 5/SLAC III degrees) were treated operatively by scaphoid excision and four-corner arthrodesis. Four K-wires were used for osteosynthesis. After an average follow-up of 60.25 months, reexamination included subjective, objective and radiological values. Clinical examinations covered wrist motion, grip strength and pinch strength. These parameters were compared with preoperatively collected data and values of the unaffected side. The DASH score (disabilities of the arm, shoulder and hand), Cooney score and the visual analogue scale (VAS 0-10) were analysed. Radiographic assessment of consolidation was verified by conventional X-rays. The carpal height was compared to the preoperative value by assessing the Youm index. RESULTS: All patients were satisfied, pain relief was reported and displayed on VAS from 7.4 (5-10) to 1.4 (0-5). The mean flexion-extension arc of 76.3 +/- 28.8 degrees (59.7% of the opposite wrist), preoperatively 75 +/- 17.3 degrees, was documented. The average total arc of ulnar and radial deviation was 37.5 +/- 9.2 degrees (51% of the opposite wrist). The preoperative value was 33.5 +/- 9.8 degrees. Further clinical evaluation yielded a mean grip strength of 39.3 kp (89.5% of the anaffected side) and pinch strength of 7.6 kp (81.7%). Total DASH score and Cooney score averaged 15 and 74.17 points, respectively. Osseus consolidation was observed radiologically in all patients already after 6 weeks. The Youm index decreased from 0.55 +/- 0.054 to 0.51 +/- 0.057. The radiolunate joint space remained unaltered in height. There were no infections. Except for wire removal, no additional surgery was necessary. CONCLUSION: Scaphoid excision and four-corner arthrodesis for advanced collapse of the wrist enjoy great satisfaction by the patients, with a high degree of pain reduction. This method shows persistent strength and movability in mid-term-results. Compared to alternative fixation techniques, the use of K-wires is a low-risk and low-cost treatment option, although removal of the K-wires is commonly necessary.

Geographical variations in the carbon isotope composition of the diet and hair in contemporary man.

Geographic variations in the carbon isotope composition of the human diet and human hair were investigated. The carbon isotopic composition of common foodstuffs purchased in Chicago, USA, Tokyo, Japan and Munich, FRG, were determined by combustion and differential isotope ratio mass spectrometry. The dietary protein carbon for the United States (-18.1%) was calculated to be enriched in 13C relative to the Japanese (-21.2%) and the German (-23.6%) diets. To a large degree, the differences reflected the consumption of corn-fed animal products in the United States and Japan, as well as seafood in Japan. The carbon isotopic composition of hair (-16.4, -18.0 and -20.4%) for the three respective populations correlated with the calculated values of the dietary protein, but were 2-3% enriched in 13C. Changes in the isotopic composition of beard hair were shown to record the changes in dietary composition in travelers visiting the respective regions.

[Effect of natural isotope contents of nutrients on the background in 13C breath tests]. / Einfluss des natürlichen Isotopengehaltes von Nährstoffen auf den Untergrund bei 13C-Atemtests.

The long-term variation of the mean delta 13C-value of breath-CO2 of Europeans (base value -26%) was +/- 1% over a period of several months. However, the ingestion of products from corn, a C4-plant, caused remarkably higher shifts. In a fasted state and during rest a stability of the base value of +/- 0.3% could be attained for several hours. Longer fasting periods imply a shift of the CO2-delta-value due to the metabolism of body products. - By a change of the main energy source to corn products the delta 13C-base line could be shifted to -18% within one day. After this shift even the metabolism of products from C3-plants could be investigated. The degradation curve and the integral degradation of fats were largely dependent on the method of application, and the base value largely interfered with the results. The period of maximum disintegration for a naturally and uniformly labelled fat was different from that of an artificially labelled trilinoleate. The results shall be used for the adjustment and the correction of the base line in 13C-breath tests, especially with patients under parenteral nutrition.