[Visual evaluation of conventional roentgen pictures and dual x-ray absorptiometry in the diagnosis of osteopenia]. / Visuelle Beurteilung konventioneller Röntgenaufnahmen und duale Röntgenabsorptiometrie in der Diagnostik der Osteopenie.

Routine radiographs and PA dual x-ray absorptiometry (DXA) of the lumbar spine were performed in 253 patients. A T-score of -2SD (approximately 20% reduction from young normal bone mineral density (BMD)) as measured by DXA, was used as threshold for the diagnosis of osteopenia. A lumbar spine index (LSI) as proposed by Barnett and Nordin was assessed by one radiologist. The correlation between LSI and bone mineral density, measured by DXA, was poor, and our results indicate that osteopenic patients cannot be differentiated from non-osteopenic patients by LSI. 100 radiographs of the lumbar spine were evaluated by 9 observers in order to determine observer variation in the detection of osteopenia. A complete agreement between the readers for the diagnosis of osteopenia was achieved in 43 percent of all radiographs. DXA and observers agreed in 68 to 76 percent of all cases. For a decrease of BMD of more than 60 percent compared to young normal adults, as determined by DXA, all readers agreed in the diagnosis of osteopenia, whereas for higher BMD values the agreement between readers and DXA worsened. The inconsistency between DXA and observer agreement was greatest for patients with a BMD reduction between 10 and 20 percent. The mean values of the kappa-coefficients were 0.574 +/- 0.06 for interobserver variation and 0.437 +/- 0.06 for the agreement between readers and DXA-results. An only moderate kappa-coefficient of 0.573 for the intraobserver variation as determined in one reader was found.

[Analysis of errors in ICD 9 diagnostic classification in compliance with the Federal health care regulation]. / Fehleranalyse bei der Diagnoseverschlüsselung nach ICD 9 gemäss der Bundespflegesatzverordnung.

In the present study the diagnosis from 1221 letters of discharge of the years 1986 and 1987 were additionally coded by the documentation doctor of the orthopaedic department and compared with the documentation sheets and the computer lists of the administration. Supplementary to this after one year there was carried out an additional coding of the letters by the documentation doctor. The transfer errors of the administration were amounting to 1.72 p.c. with regard to three digit numbers and to 11.87 p.c. with regard to four digit coding. During the repeated examination the documentation doctor made an error of 4.3 p.c. for the three digit coding and of 15.6 p.c. if the maximum coding was required. The corresponding errors of the house physicians for three digit numbers (maximum) were amounting to 8 p.c. (33.6 p.c.) for frequent diagnoses, to 28 p.c. (48.5 p.c.) for rare diagnoses and totally 13.7 p.c. (37.8 p.c.). In the present documentation validity and reliability still shows a good result compared to other studies. Nevertheless a documentation with an error rate to such an extend is of no use for a base documentation, and this error rate must be taken into consideration in the interpretation of global medical statistics. Automatic coding systems integrated into medical writing service seems to be the only help in view of removing these problems.

[Jogging--stress-induced damage of the musculoskeletal system]. / Joggen--Uberlastungsschäden am Bewegungsapparat.

During a period of 8 months 121 male and 99 female joggers were interviewed by a standardised questionnaire in respect of their running behaviour and problems caused by jogging. Only such runners were included who had jogged regularly on at least 2 days, regarding women on at least one day per week for at least 30 minutes during the last 2 years. Additionally a detailed orthopaedic examination was carried out in the ambulance of the Orthopaedic University clinic. The overwhelming majority of male and female joggers had a secondary education and practised easy physical activities. Only 4 per cent of the interviewed persons worked physically hard. In connection with jogging, 67 male and 44 female joggers developed signs at the locomotor system. Among the major problems with regard to running were Achilles tendinitis, calf muscle strain, shin splints and complaints referring to foot deformities. Injuries were seen only rarely. Jogging on forest grounds and cinder paths is less strenuous compared to asphalt tracks or tartan paths. Training errors were among the main causes of complaints occurring during running. Traumatic or posttraumatic influences as well as incorrect footwear were of secondary importance regarding the occurrence of complaints.

[Epidemiology of kyphosis in school children]. / Die Epidemiologie des Rundrückens bei Schulkindern.

At five schools in the city of Bochum a serial study was carried out with regard to pathological posture of the spine. In total 2075 pupils from 10 to 17 years of age were examined and the degree of kyphosis was determined using Debrunner's kyphometer. An angle of 40 degrees or more was supposed to be a pathological kyphosis. The rate of this kyphosis was 12 p.c. in girls and 15.3 in boys. The children with pathological curvature were compared with a group of children inconspicuous with regard to posture and selected by random. The two groups were questioned using a halfstandardized questionnaire. This was designed to obtain details of general circumstances of life, attitude in sports and medical history either in orthopedics and diseases in the family. Thereby was seen that children with pathological kyphosis practised less sports and had more orthopedic diseases, and also in their families more orthopedic problems and back pain occurred.

[Stability analysis of various forms of fusion of the lumbar vertebrae using a computer simulation model]. / Stabilitätsanalyse verschiedener Fusionsformen an der Lendenwirbelsäule mit Hilfe eines Computersimulationsmodells.

To analyze mechanical properties of a lumbar functional unit a mathematical simulation model was developed. Using this model in different lumbar fusions immediate postoperative and secondary stability was analysed. Stability of different interbody and posterior fusions was compared looking at different techniques of operation an instrumentation. The calculation showed best results in the combination of posterolateral fusion with interspinal distraction or transpedicular screw instrumentation. These showed well-balanced load carrying properties primarily and high secondary stability.

[Immunologic methods of study for evaluating the risk of anaphylactic reactions in intradisk chymopapain injections]. / Immunologische Untersuchungsmethoden zur Risikoabschätzung einer anaphylaktischen Reaktion bei der intradiskalen Chymopapain-Injektion.

According to results available to date, skin tests are of limited value in determining the risk of anaphylactic shock. By identifying specific IgE antibodies, e.g. via the Chymo-FAST test or the corresponding RAST, the risk of anaphylactic shock of 0.2%-1% in the total group of patients can be reduced to 0.05% in patients in whom the test was negative, whereas in test-positive patients the risk is above 60%. Previous intolerance reactions among the remaining 0.05% are probably due to a non-testable pseudoallergic reaction, just like the 6% mild late reactions after the injection. For the remaining risk of 0.05% in IgE-negative patients drug prophylaxis with antihistamines or if necessary even steroids will continue to be mandatory. Examination of histamine release from leucocytes, which can be conducted in very few centres only, may possibly be able to clarify in future to what extent reinjection is permissible if a disc on a different level is affected, besides other scientific problems.

[Standardized diagnosis-oriented documentation of anamnesis and findings in orthopedic disease pictures]. / Standardisierte diagnoseorientierte Dokumentation von Anamnese und Befund bei orthopädischen Krankheitsbildern.

A new standardized diagnosis related record system for orthopedic diseases is presented. 15 special record forms plus 1 general record form can reach about 80 per cent of all orthopedic diseases and will ease patients management as well as scientific evaluation.

[Rational EDP-basic documentation in the surgical clinic]. / Rationelle EDV-Basisdokumentation in der Chirurgischen Klinik.

The establishment of a clinical basis documentation has approved because of the co-operation with the service-computer-centre of the clinical administration by linking the administrative and clinical data of the patients. The most essential data like diagnosis, operation, complication, operating surgeon as well as the eventual case of death will be registered in a protocol by the ward physician. These data will be registered by a documentary assistant according to the international keys. The evaluation of the data is done by a SPSS-program. The present results demonstrate that this kind of computer assisted clinical documentation has been successful.