Is there a need for a histological examination of the adenoid tissue after adenoidectomy?

OBJECTIVES: In Germany there is no uniform practice regarding the histological examination of removed tissue after an adenoidectomy. In addition, the unique benefits of routine histological examination of adenoid tissue cannot be ascertained from current literature due to varying opinion and evidence. METHODS: This study was approved by the Medical Association and Ethics Committee in Cottbus, Brandenburg, Germany. We evaluated the pre- and intra-operative examination findings (direct and indirect epipharyngoscopy, digital palpation, intraoperative macroscopic assessment and examination of removed tissue) and the histopathological findings of excised adenoid tissue. A statistical analysis of obtained results was undertaken thereafter. RESULTS: It was found that in all young patients included in the study, the histological results invariably represented lymphoepithelial hypertrophic mucosa with a varying inflammatory response, matching a clinical picture of adenoid vegetation and in keeping with the pre- and intraoperative investigations and findings. CONCLUSION: The characteristic history of adenoid vegetation in combination with a classic pre- and intraoperative clinical examination and an inconspicuous macroscopic examination of removed tissue, renders routine histopathological workup dispensable. On suspicion of deviant pathology a histopathological examination is recommended and should be undertaken.

[Clinical results and economics of two primary total knee replacement systems implanted in standardised surgical technique]. / Klinischer und ökonomischer Vergleich zweier standardisiert implantierter Knieendoprothesenmodelle.

AIM: To evaluate the differences in clinical outcome and economics of primary total knee replacements, the results with two implant types (cruciate retaining and sacrificing) were analysed. METHOD: From 1/2000 until 6/2001 twenty-two consecutive patients with primary arthrosis of the knee underwent total knee replacement with the cruciate-retaining CKS-CC knee system (= group 1: 9 men, 13 women, mean age 65.68 years). Between 8/2001 and 3/2002 twenty-two consecutive patients received the cruciate-sacrificing NexGen Full Flex implant (= group 2: 4 men, 18 women, mean age 67.18 years). The operative procedures and rehabilitation regimes were standardised. The modified Insall score, patient satisfaction, as well as implant and rehabilitation costs were evaluated. Statistical analyses were based on two theses. I) There is no difference between the clinical early and five-year results of both groups. II) The more expensive NexGen implant is less economic regarding total costs per patient. RESULTS: The more expensive, cruciate-sacrificing NexGen implant showed significantly better clinical results (p = 0.0005) and higher patient satisfaction while rehabilitation costs were lower (p = 0.003). While the clinical results remained unchanged, the revision rate after 5 years for the NexGen System was lower. CONCLUSION: Not only minimally invasive surgery, but also choosing the right type of implant may lead to better early as well as mid-term clinical results in primary total knee arthroplasty. This may also reduce total costs per patient in primary total knee arthroplasty.

Dendritic hypertrophy of Stach type VI neurons within experimentally altered ileum of pigs.

Myenteric neurons were investigated morphometrically to answer the question if type-specific somal hypertrophy of type VI neurons in mechanically stressed ileum of pigs, which was known from an earlier study, is correlated with an increased dendritic arborization, that is, with dendritic hypertrophy. Muscular hypertrophy was induced in the ileum of two juvenile pigs by narrowing the gut circumference (mechanical stenosis) and by reversing a loop of ileum which results in an antiperistaltic segment (functional stenosis), respectively. After a survival time of 6 weeks, wholemounts from the pre- and poststenotic ileal regions, from the antiperistaltic segment as well as from an age matched control animal, were silver impregnated. Dendritic parameters of Stach types IV and VI neurons were recorded using a computer-aided morphometric program and analysed statistically. Type IV neurons showed no change of dendritic parameters, neither within control nor within stenosed ileal segments. In contrast, the type VI neurons displayed increased dendritic parameters within zones of muscular hypertrophy such as total dendritic length, numbers of dendrites, of dendritic branching points and of dendritic endings. We suggest that type VI neurons may participate as descending nitrergic interneurons or motorneurons in the control of muscular function, thus, undergoing plastic changes in case of experimental muscular hypertrophy. Type IV neurons which are involved in the regulation of mucosal processes were not affected by muscular hypertrophy.

Experimental hypertrophy of myenteric neurones in the pig: a morphometric study.

Muscular hypertrophy in the ileum of two pigs aged 6 weeks was induced using two different surgical techniques, narrowing of the gut circumference (mechanical stenosis) and segmental reversal of an ileal loop which results in a persistent antiperistalsis of that segment (functional stenosis). These pigs were sacrificed 5-6 weeks postoperatively. Cross sections through the gut wall at various distances from the operation sites revealed marked muscular hypertrophy in the pre-stenotic regions and in the reversed segment. Whole mounts from pre- and post-stenotic, as well as reversed ileal regions, were silver- impregnated. The corresponding ileal region of a third, nonoperated pig served as control. Using a computer-aided morphometric device, somal areas of five morphological neurone types were measured at various distances orally and anally from the operation sites and along the control ileum. Values between hypertrophic and nonhypertrophic zones as well as between two corresponding zones of nonoperated ileum were compared statistically. Along the control ileum, values revealed no differences in soma sizes. Within the experimentally altered material, somal areas of type VI neurones showed marked hypertrophy related to the sites of muscular hypertrophy whereas the other types remained constant throughout (II, IV in segmental reversal) or showed slightly larger somal areas within the post-stenotic, nonhypertrophied zones (I, V, IV in stenosis). Additionally, within the reversed segment, neuronal perikarya of type I, II, IV and V neurones were larger as compared to the neighbouring regions. However, this enlargement of perikarya within the reversed segment may not be correlated with muscular hypertrophy but rather with the transections of intramural axons before reversing this segment. The results suggest that morphologically distinct neurone types may play different roles within the mechanically stressed small intestine and possibly also in the coordination of normal muscular function.

[Radiosynoviorthesis in inflammatory joint diseases]. / Radiosynoviorthese bei entzündlichen Gelenkerkrankungen.

The use of beta-(beta) emitting radionuclides for radiosynoviorthesis (RSO) has been a well established therapy for inflammed joints for more than 40 years. Radionuclides are often applied to patients with rheumatoid arthritis as local therapy. The choice of the radionuclide is empirical. The evaluation of the therapeutic success is mainly based on the improvement of the joint motion. MRI and other radiological examinations have not been proved to be reliable for diagnosis of the therapeutic success. The aims of this manuscript are to familiarize physicians with the different radionuclides, to explain the therapeutic success which can be expected due to dosimetric data, and to present the three phase bone scintigraphy as a valuable instrument for the evaluation of the therapeutic success.

Correlation between radiation dose, synovial thickness, and efficacy of radiosynoviorthesis.

OBJECTIVE: To correlate the therapeutic efficacy of radiosynoviorthesis (RSO) to radiation doses achieved. METHODS: In 20 patients with known rheumatoid arthritis, radiosynoviorthesis was performed in 36 joints. Arthritis disease activity was assessed by "blood pool scintigraphy" (n = 29) score after injection of 370 MBq 99mTc-MDP, before and at 1, 2, and 5 months after the RSO in 12 patients. For semiquantitative measurements, a region-of-interest technique was applied. Synovial thickness and response to the RSO were evaluated by joint ultrasonography. Pain levels were evaluated semiquantitatively. Dosimetry (n = 20) was calculated using planar quantification according to the MIRD scheme. RESULTS: The mean radiation absorbed dose of 186Re-sulfate to the whole body was 5.3+/-2.7 cGy, liver 10.0+/-8.1 cGy, spleen 20.3+/-22.9 cGy, kidneys 9.4+/-11.4 cGy, and at the injected joints of the shoulder 120.5+/-32.2 Gy, hand 130.0+/-12.6 Gy, elbow 83.6+/-38.7 Gy, and talar/subtalar joint 84.1+/-30.7 Gy. In 7 cases, where mandatory immobilization of the joint was not possible, the dose to the lymph nodes (n = 25) was 25.9+/-53.8 Gy (maximum 189 Gy) and to single lymph nodes 14.6+/-11.2 Gy (maximum 63 Gy). The reduced doses to the synovia (at 40% leakage) were: 169Er-citrate 73.10+/-25.25 Gy; 90Y-citrate 59.25+/-46.45 Gy; 186Re-sulfate 65.40+/-32.55 Gy. In cases of complete immobilization, the dose to the lymph nodes was negligible: 169Er-citrate (n = 7), whole body dose 0.4 cGy, lymph nodes 2.3 Gy, finger joints 132.3+/-34.3 Gy; 90Y-citrate (n = 6), whole body dose 15.5 cGy, liver dose 26.5 cGy, splenic dose 11.9 cGy, kidney dose 67 cGy, joint knee joint dose 130.1 Gy. Regarding therapeutic effect, mean reduction of the 99mTc-MDP blood pool activity was 41% at first month, 48% at second month, 48% at the fifth month, 48% in larger joints, and 63% in finger joints. Three and 6 months after RSO, sonography showed a mean reduction in synovial swelling: in the knee joint 1.67 and 4.38 mm, respectively; in the larger joints (shoulder, elbow, hand, talar/subtalar) 0.88/1.93 mm; and in finger joints 0.53/1.76 mm. Clinically, best results were observed in the finger joints. CONCLUSION: 1. We observed a significantly higher radiation absorbed dose to the lymph nodes and lower dose to the synovia in the absence of joint immobilization. Immobilization of the joint is essential. 2. At 2 months after treatment, a significant reduction of blood pool activity and synovial swelling was observed, with further improvement in the following months, especially in the finger joints. 3. There is a strong correlation between the reduction of blood pool activity, synovial swelling, and improvement of pain.

Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques.

In this prospective study high tibial osteotomy for medial gonarthrosis was performed in 95 patients (105 knee joints). The patients underwent simultaneously diagnostic and operative arthroscopic surgery of the knee joint. A follow-up arthroscopic examination could be performed in 75 patients (85 knee joints) at the time of implant removal. In group 1 (20 knee joints), the osteotomy was performed after diagnostic arthroscopy without arthroscopic operation of the knee joint. The fixation of the osteotomy was accomplished by staples, postoperative plaster fixation and physiotherapy. In group 2 (20 knee joints), osteotomy was performed without additional operative arthroscopy after diagnostic arthroscopy, internal fixation by AOT-plate, no external fixation postoperatively and physiotherapy. In group 3 (22 knee joints), osteotomy was performed with additional operative arthroscopy (Pridie drilling), internal fixation by AOT-plate no external fixation postoperatively no external fixation, physiotherapy and continuous passive motion. In group 4 (23 knee joints), osteotomy was performed with additional operative arthroscopy (abrasio-arthroplasty), internal fixation by AOT-plate, no external fixation postoperatively, physiotherapy and continuous passive motion. All patients underwent arthroscopic examination of the knee with cartilage biopsies taken from three different regions of the femoral condyle during the same operative session as the osteotomy. At follow-up arthroscopy cartilage biopsies were taken from the same regions. There was no great difference in clinical outcome after 1 year between all groups. Arthroscopy as well as routine and electron microscopy showed better cartilage regeneration in groups 3 and 4. Groups 1 and 2 showed only regeneration isles, sometimes not well fixed to the underlying bone, while in groups 3 and 4 cartilage regeneration was thicker and more stable, sometimes covering all of the pre-existing erosions. Therefore, we recommend osteotomy of the tibia for osteoarthritis together with operative arthroscopy in the same operative session.

Clinical effects of benzyl benzoate in the prevention of house-dust-mite allergy. Results of a prospective, double-blind, multicenter study.

The efficacy of the acaricide benzyl benzoate as an additive to a chemically and technically defined cleaning substance (Acarosan) was tested in a multicentric, prospective, randomized, controlled study on 118 outpatients with bronchial asthma due to house-dust-mite allergy. Subjective reports from patients and doctors revealed an improvement in clinical complaints in more than 50%, with only small differences between the verum and the placebo group. Objective parameters such as titrated skin tests, RAST, and bronchial challenge tests with histamine and Dermatophagoides pteronyssinus (D. pt.) did not reveal any significant changes either during the year of testing or between the two groups. A clinical improvement as observed in either group could not be assessed by objective parameters. Additional questions as to the merits of the possible prophylactic use of benzyl benzoate over more than 1 year remain unanswered.

[Chronic polyarthritis and radiosynoviorthesis: a prospective, controlled study of injection therapy with erbium 169 and rhenium 186]. / Chronische Polyarthritis und Radiosynoviorthese: Eine prospektive, kontrollierte Studie der Injektionstherapie mit Erbium-169 und Rhenium-186.

The aim of this prospective study was to evaluate the efficiency of radiation synovectomy with rhenium-186 or erbium-169 in rheumatoid arthritis. In the control groups articulosynovitis was treated by injection of triamcinolonhexacetonid. Follow-up time was 3 years. Patients of the study had to fulfill the following criteria: rheumatoid arthritis (ARA criteria 1988), patient age above 40 years, standardized medical treatment with methotrexate, (started at least 6 month prior to injection therapy, given for the entiry study time), prednisolon < or = 7.5 mg/d and diclofenac < or = 150 mg/ d, and no previous surgery or injection therapy on this/these joint/s. Shoulder, elbow, wrist, and ankle joints were treated in group 1 by injection of rhenium-186 combined with triamcinolonhexacetonid, in group 2 by injection of triamcinolonhexacetonid alone. Each treatment group included 50 joints. Digital joints underwent injection of erbium-169 combined with triamcinolonhexacetonid (group 3 = 131 joints) or triamcinolonhexacetonid (group 4 = 86) alone. During the follow up period, the joints were assessed for pain, synovial swelling, joint motion, and stage of radiological destruction (Larsen-Dale-Eek). After 3 years follow-up, 228 joints met the above named criteria: group 1 = 41 joints, group 2 = 21 joints, group 3 = 131 joints, group 4 = 53 joints. Significantly better clinical results were achieved with the combined injection of rhenium-186 or erbium-169 and triamcinolonhexacetonid. Results for PIP joints were worse than for other joints, which is explained by better immobilization of the latter ones after injection. The progression in radiological joint destruction according to the stages of Larsen-Dale-Eek during the follow-up time of 3 years (= stage at 3 years minus stage prior to treatment) corresponded to the clinical results and was significantly slower in groups 1 and 3: group 1 = 0.62; group 2 = 1.7; group 3 = 0.75; group 4 = 1.43 Therefore, we recommend radiosynovectomy with erbium-169 or rhenium-168 in combination with triamcinolonhexacetonid and consequent immobilization after injection.

Radiosynoviorthesis with rhenium-186 in rheumatoid arthritis: a prospective study of three treatment regimens.

The aim of this study was to evaluate the efficiency of radiation synovectomy with rhenium-186 in rheumatoid arthritis. In this prospective, randomized trial we compared three different treatment regimens for shoulder, elbow, wrist, hip and ankle joints: group 1, injection of rhenium-186; group 2, injection of rhenium-186 in combination with triamcinolone hexacetonide; group 3, injection of triamcinolone hexacetonide alone. Each treatment group included 50 joints. Patients included in the study had to fulfil the following criteria: (1) they had to have a diagnosis of rheumatoid arthritis (ARA criteria 1988), (2) their disease-modifying drug had to be methotrexate, started at least 6 months prior to injection therapy and given for the entire study time, (3) their nonsteroidal anti-inflammatory drug had to be diclofenac given at a dose of 150 mg/day or less and (4) they were also given prednisolone at a dose of 7.5 mg/day or less. After 3 years of follow-up, 79 joints met these criteria, i.e. 71 joints were excluded from the study: 26 joints because the patients changed the disease-modifying drug (12 joints from group 1, 4 joints from group 2 and 10 joints from group 3); 45 joints because of recurrent synovitis and second-stage treatment (21 joints from group 1, 5 joints from group 2 and 19 joints from group 3). During the follow-up period, joints were assessed for pain, synovitis, joint motion and stage of radiological destruction. Best clinical results and slowest progression in radiological destruction were achieved with the combined injection of rhenium-186 and triamcinolone hexacetonide. Therefore, we recommend this treatment for articulosynovitis with the exception of severe forms, the latter because of the effective penetration range of rhenium-186.

Wear behavior and histopathology of classic cemented metal on metal hip endoprostheses.

The authors reviewed their collection of retrieved all metal hip joints (9 McKee-Farrar, 7 Müller, and 3 Huggler type prostheses) and tissues from the joint capsules and implant beds. The amount of wear was measured, and the total volume was calculated. The tissues were analyzed by atomic absorption spectral analysis or inductively coupled plasma mass spectrometry and examined by light and scanning electron microscopy. The size of particles was measured with a texture analysis system. The articulating surfaces showed many delicate scratches which represent normal wear. The calculated annual wear averaged approximately 5 mm3 per year, which is low compared with polyethylene. The cellular reaction to metal wear particles was regarded as mild. The cellular reaction to scattered and worn bone cement was always more pronounced than to metallic debris. Scanning electron microscopy confirmed the irregular shapes and mostly submicron size of the metal particles. The analytically detected metal content of the periarticular tissue was relatively low and in accordance with the wear measurements from the articulating surfaces. The excess of chromium in the tissues is discussed in the light of the elimination of cobalt as well as the relation between elements representing either corrosion products or elements still bound in wear particles.

[Treatment of chronic diarrhea in dogs and cats under field conditions using oral E. coli vaccines]. / Behandlung von chronischen Durchfällen bei Hunden und Katzen unter Praxisbedingungen mittels oraler Applikation von E.-coli-Vakzinen.

An autogenous oral E. coli vaccine was tested for efficacy in the treatment of chronic diarrhoea in dogs (n = 82) and cats (n = 50) under field conditions. The data were collected through evaluation of questionnaires completed and returned by veterinarians. After oral application of the E. coli vaccine the symptoms of diarrhoea were stopped in 71% of the treated animals within two to five days. In further 15% of the cases the enteric symptoms continued but were not so severe as in the beginning of the treatment. There was no therapeutic success with the oral E. coli vaccine in further 14% of the animals in cause of food allergy, ascariasis, volvulus or pancreatic insufficiency.

[Drug monitoring: theophylline--comparison of 3 methods for determination]. / Medikamenten-Monitoring: Theophyllin--Vergleich dreier Bestimmungsmethoden.

Treatment with theophylline requires monitoring of dosage, preferably by determining the theophylline content in whole blood or serum, because theophylline pharmaco kinetics is most variable and therefore difficult to define, and because of possible interactions with other drugs. In medical practice, it is important and helpful to get the results of theophylline measurements quickly so that the dosage may be corrected directly whenever necessary. Two assays for rapid theophylline determination were compared with a standard method and with each other in respect of accuracy and practicability. Both methods a suitable for practical use.

[Amelanotic melanoma of the rectum]. / Das amelanotische Melanom des Rectums.

We report the very rare case of an amelanotic anorectal melanoma. Until now there are only three other well documented cases of that tumor-type reported in the literature. The course of disease is described from initial symptoms till 10 months after discharge from hospital and suggestions for staging, therapy and follow-up are made.

[Selected factors influencing the in vitro maturation of oocytes of cattle]. / Ausgewählte Einflussfaktoren auf die In-Vitro-Reifung von Oozyten des Rindes.

Studies were conducted into hormonal additives to medium and culturing time and their effects on in vitro maturation of bovine oocytes. The best maturation results were ensured in vitro by substitution of TCM-199 with FSH, HCG, and 17 beta-oestradiol: The stage of fertilisation capability (telophase I or metaphase II) was reached by 86% of all oocytes (115 of 134). The rate of maturation was worse with significance in FSH-free medium (62% or 101 of 163), and the amount of degenerated oocytes was twice as high (18%). Maturation in hormone-substituted medium for 28 to 30 hours is recommended under the condition that immature oocytes were cultured from juvenile antral follicles (2--5 mm in diameter).

[Inpatient therapy in child and adolescent psychiatry--analyses of a inpatient population]. / Stationäre Therapie in der Kinder- und Jugendpsychiatrie--Analysen an einer Inanspruchnahmepopulation.

The study deals with 207 inpatients' medical histories at a university clinic for child and adolescent psychiatry. Antisocial behavior, emotional and neurotic as well as psychosomatic disorders were the most frequent disorders to be treated. The inpatients were characterized through a remarkable high rate of psychosocial stress factors in their natural environment. The choice of special interventions and the length of treatment was not related to the diagnosis. The function of an inpatient treatment unit is discussed.

[Children with a specific weakness in mathematics in a referred population]. / Kinder mit umschriebener Rechenschwäche in einer Inanspruchnahmepopulation.

In the present study children with dycalculia were described and compared with children with specific reading and spelling disabilities and children without clinical diagnosis. All children were referred to a child psychiatric outpatient and inpatient department. The comparison was carried out over clinical data drawn from the general data documentation and from written case reports including diagnostical, anamnestical, symptomatological and developmental neurological data. More than 50% of the dyscalculic children displayed other child psychiatric disorders, especially emotional disorders. It is questioned in the light of developmental psychological understanding if the developmental neurological deficits of the dyscalculic children can be seen as etiological significant in the sense of basical disorders concerning the deficient development of stable conceptions of an inner number space.

Child psychiatric disorders and family dysfunction in migrant workers' and military families.

Migrant adaptation was studied in children and families of French soldiers and of Greek and Turkish migrant workers in West Berlin. In addition, a German control group was investigated. All four samples were matched with regard to sex and age of the children. Psychiatric morbidity differed significantly between the migrant groups. Disturbed parental behaviour and impaired maternal health clearly correlated with psychiatric disturbance in the children in samples. Cultural rather than socioeconomic factors seemed to be most influential with regard to psychosocial adaptation.