[Clubfoot treatment through the ages: the Ponseti method in comparison to other conservative approaches and operative procedures]. / Klumpfußbehandlung im Wandel der Zeit: Die Ponseti-Methode im Vergleich zu anderen konservativen Therapieansätzen sowie operativen Verfahren.

Clubfoot is one of the most common congenital deformities of the musculoskeletal system with incidence rates ranging from 0.6 to 6.8 per 1,000 live births. The treatment of clubfoot historically belongs to one of the oldest orthopedic therapies. By the end of the nineteenth century redressement with various tools, such as clamps, braces and casts was the standard treatment of clubfoot. Through further development of operational capabilities and the fact that soft tissue structures show amore resistant reaction to pressure and strain than the surrounding cartilage and bone, operative therapy was favored in the late twentieth century. Surgical correction involves the release of contracted capsular and ligamentous structures to varying degrees and the lengthening of tendons.In 1963 Ponseti published his method. He recognized that the internal rotation and plantar flexion of the calcaneus is the key deformity. However, his method first became known worldwide at the turn of the millennium as long-term results of release operations showed stiff scar healing and the risk of over-correction as problems in these operations.Many comparative studies have shown the superiority of the Ponseti method regarding invasiveness, primary correction rate, functional outcome and recurrence rate in both idiopathic and non-idiopathic clubfoot. In this article the current literature regarding this will be presented as well as prominent landmarks in the development of clubfoot treatment.

[Physical activity and tumor diseases]. / Körperliche Aktivität und Tumorkrankheiten.

Physical activity is an important health measure for many diseases but in the past its role in cancer control has been understudied and underappreciated. This chapter updates a review of physical activity and cancer risk. Overall, the research to date suggests that physical activity reduces the risk of developing some forms of cancer, helps cancer survivors cope with and recover from treatment, improves the long-term health of cancer survivors and possibly even reduces the risk of recurrence and extends survival in some cancer survivor groups. Much research remains to be done in this field but the compelling data produced so far suggests that physical activity has an important effect on the development of cancer and precursor stages.

Affinity purification of a framework 1 engineered mouse/human chimeric IgA2 antibody from tobacco.

Complex multimeric proteins such as dimeric and secretory immunoglobulin A (IgA) can be difficult to produce in heterologous systems, although this has been achieved using several platforms including plants. As well as topical mucosal applications, dimeric IgA (dIgA), and secretory IgA (sIgA) can be used in tumor and anti-viral therapy, where their more potent cell-killing properties may increase their efficacy compared to current drugs based on IgG. However, the development of therapeutic IgA formats is hampered by the need to co-express four different polypeptides, and the inability to purify such molecules using conventional protein A or protein G affinity chromatography. The light chain (LC)-specific affinity ligand protein L is a potential alternative, but it only recognizes certain kappa light chain (LC(κ)) subtypes. To overcome these limitations, we have adapted a framework-grafting approach to introduce LCs that bind protein L into any IgA. As a model, we used the chimeric anti-human chorionic gonadotropin (hCG) antibody cPIPP, since this contains a murine LC((κ)) subtype that does not bind protein L. Grafting was achieved by replacing selected framework region 1 (FR1) residues in the cPIPP LC(κ) variable domain with corresponding residues from LC(κ) subtypes that can bind protein L. The grafted antibody variants were successfully purified by protein L affinity chromatography. These modifications affected neither their antigen-binding properties nor the yields achieved by transient expression in tobacco plants. Our results therefore show that LC FR1 grafting can be used as generic strategy for the purification of IgA molecules.

[Corrective growth after vertebral body fracture in the adolescence]. / Korrigierendes Wachstum nach Wirbelköperfrakturen im Jugendalter.

We present the case of a 13-year-old female patient who sustained an incomplete burst fracture of the 1st lumbar vertebral body and an impression fracture of the 3rd vertebral body. Using a dorsal instrumentation the kyphosis of the thoracolumbar junction was treated. The radiographical follow-up indicated a correction of the involved vertebral bodies. However, complete restoration of the height of the vertebral bodies was not achieved. In view of this long-term follow-up the potential for correction of the adolescent thoracolumbar junction spine is discussed.

[Aftercare and rehabilitation of HIV patients in Western Africa]. / Nachsorge und Rehabilitation bei HIV-Patienten in Westafrika.

Thanks to the modern therapy protocols, terminal prognosis of Aids disease is no longer certainty. It has now been updated to a chronic disease with good survival rates demanding follow-up and rehabilitative measures. Rehabilitative care in Western Africa is still rare. The care for Aids patients mainly concentrates on psychosocial activities offered by non-governmental Aids associations. The care is mainly outpatient; the objective is to improve the patients' compliance. Compared to western countries, African HIV-infected patients suffer even more from discrimination and are outcast from their family. Hospital-based rehabilitation is being established. Objectives are primarily to improve compliance and, secondly, to restore physical and mental efficiency as well. Favourable patient compliance is considered to be a good prognostic factor resulting in preventing recurrences and expensive therapy.

[Bilateral fibula graft. Biological reconstruction following resection of malignant bone tumors]. / Bilaterales Fibulainterponat. Biologische Rekonstruktion nach Resektion primär maligner Knochentumoren.

Bilateral vascularized fibula graft (BVFG) is actually not a satisfying method for the replacement of metadiaphyseal defects of the femur and tibia in young patients suffering from malignant bone tumors. This reconstruction was used in five patients (two female, three male, average age 15.2 years, femur n=3, tibia n=2) undergoing metadiaphyseal resection of malignant bone tumors between November 2000 and August 2003. The median length of the defect to be bridged was 16.4 cm (range 11.5-23). In the two cases of tibia reconstruction, the ipsilateral fibula was transposed into the osseous defect (fibula pro tibia). The vessels of the contralateral fibula graft were microscopically anastomosed end-to-side upon the a. and v. tibialis anterior. For the reconstruction of femoral defects, two free fibula grafts were used. All patients had multimodal treatment according to the EURO-E.W.I.N.G 99 or COSS-96 protocol. Median follow-up was at 34 months. In all cases, R0 status was achieved. None of the patients experienced local recurrence during follow-up. Radiographic signs of osseous remodeling were detected the earliest after 2 months. Full weight-bearing on the affected leg was permitted after 8-18 months. Complications occurred in four patients (bleeding 1, infection and pseudarthrosis 1, fracture 1, plate fracture 1). None of the complications led to failure of the reconstruction or to amputation. The MSTS scores was very good in two patients, good in two, and intermediate in one. Biological reconstruction of osseous defects is always desirable when possible. Good functional and durable results can be obtained using BVFG for the reconstruction of metadiaphyseal defects of the femur and tibia.

[Ablative procedures in surgical treatment of malignant bone tumors]. / Ablative Verfahren bei der operativen Behandlung maligner Knochentumoren.

Limb-sparing surgery is the treatment of choice for primary malignant bone tumors. However, ablative procedures cannot always be avoided. The indication to sacrifice the limb depends on localization, size, and biology of the tumor and does not represent failure of treatment primarily. Amputation of the limb is necessary if there is no other operative procedure to achieve negative surgical margins even if all adjunctive therapeutic options have been considered. Primary ablative resections may be indicated with both curative and palliative intent. Secondary ablative procedures mainly result from local recurrence. Late complications of endoprosthetic or allograft reconstruction also may necessitate ablative surgery. In this paper, general guidelines for ablative surgeries are presented. Following amputation, early prosthetic repair of the extremity is the goal. In those patients with consolidated stump development definitive prosthesis should be adapted. Results of hemipelvectomy and forequarter amputation from our institution are reported. However, this group of patients together with those undergoing shoulder exarticulation and forequarter amputation represent situations with no prosthetic repair possible. The loss of an extremity induces disability and restriction of ego, physical integrity, and quality of life. However, it should be borne in mind that amputation could represent the only chance of cure sometimes. Sharing the decision-making between patient and physician for this procedure is an important step to develop confidence in the therapeutic process. In this setting, direct contact between patients being confronted with the option of an amputation and those patients having already undergone rehabilitative procedures might be very useful.

Crystal structures of mutant forms of the Bacillus caldolyticus cold shock protein differing in thermal stability.

The cold shock proteins Bc-Csp from the thermophile Bacillus caldolyticus and Bs-CspB from the mesophile Bacillus subtilis differ significantly in their conformational stability, although the two proteins differ by only 12 out of 67 amino acid residues. The three-dimensional structure of these small and compact beta-barrel proteins without disulfide bonds, cis-proline residues or tightly bound cofactors is very similar. Previous work has shown that Bc-Csp displays a twofold increase in the free energy of stabilization relative to its homolog Bs-CspB, and indicated that electrostatic interactions are, in part, responsible for this effect. It was further described that the stability difference is almost exclusively due to surface-exposed charged residues at sequence positions 3 and 66 of Bc-Csp and Bs-CspB, whereas all other amino acid changes between both proteins have no net effect on stability. To investigate how two surface residues determine the stability of Bc-Csp, Arg3 and Leu66 were replaced by glutamic acid, corresponding to the Bs-CspB sequence. The crystal structures of the resultant protein variants, Bc-Csp R3E and Bc-Csp L66E, were determined at 1.4 A and 1.27 A resolution, and refined to R values of 13.9 % and 15.8 %, respectively. Both structures closely resemble Bc-Csp in their global fold and show different hydrogen bonding and salt-bridge patterns when two independent molecules in the asymmetric unit of the crystal are compared. To extend the study to neighbored residues that help determine the surface charge around Arg3 and Leu66, the mutant proteins Bc-Csp E46A, Bc-Csp R3E/E46A/L66E and Bc-Csp V64T/L66E/67A were crystallized. Their structures were determined at resolutions of 1.8 A, 1.32 A and 1.8 A and refined to R values of 18.5 %, 13.8 % and 19.3 %, respectively. A systematic comparison of the crystal structures of all forms of the B. caldolyticus cold shock protein shows varying patterns of hydrogen bonds and electrostatic interactions around residues 3 and 66. Thermal destabilization of the protein by mutation appears to correlate with the extent of an acidic surface patch near the C-terminal carboxylate group.

[Structural quality of oncologic rehabilitation. Viewpoint of the Professional Committee of Rehabilitation, After-care and Social Medicine of the German Cancer Society]. / Zur Strukturqualität in der onkologischen Rehabilitation. Die Sichtweise der Arbeitsgemeinschaft für Rehabilitation, Nachsorge und Sozialmedizin in der Deutschen Krebsgesellschaft (ARNS).

The article discusses the structural requirements on inpatient institutions for oncological rehabilitation and expresses the position of the German Cancer Society's Section for Rehabilitation, Aftercare and Social Medicine (ARNS). Standards are formulated concerning spatial conditions, technical equipment, personnel (number, professions, qualification) and networking conditions with regard to all cancer diagnoses. These standards are also discussed with regard to various specific cancer diagnoses such as, for example, breast cancer, gastrointestinal tumours, lung tumours and brain tumours, as well as with regard to patients in specific treatment measures such as bone marrow and stem cell transplantation.

[Process quality in oncologic rehabilitation. Viewpoint of the Professional Committee of Rehabilitation, After-care and Social Medicine of the German Cancer Society]. / Zur Prozessqualität in der onkologischen Rehabilitation. Die Sichtweise der Arbeitsgemeinschaft für Rehabilitation, Nachsorge und Sozialmedizin in der Deutschen Krebsgesellschaft (ARNS).

The article concerns itself with the issue of process quality in inpatient institutions for oncological rehabilitation and expresses the viewpoint of the German Cancer Society's Section for Rehabilitation, Aftercare and Social Medicine (ARNS). Standards for the organization of patients' access to the rehabilitation clinic, for the design of oncological-rehabilitational diagnostics, for the formation of therapeutic strategies and the rehabilitative services offered will be described.

[Outcome quality in oncologic rehabilitation. Viewpoint of the Professional Committee of Rehabilitation, After-Care and Social Medicine of the German Cancer Society]. / Zur Ergebnisqualität in der onkologischen Rehabilitation. Die Sichtweise der Arbeitsgemeinschaft für Rehabilitation, Nachsorge und Sozialmedizin in der Deutschen Krebsgesellschaft (ARNS).

The article is concerned with the basic ideas of outcome quality within the field of oncological rehabilitation and expresses the position which is held by the Section for Rehabilitation, Aftercare and Social Medicine within the German Cancer Society. The authors explicitly express the necessity of rehabilitation-specific goals and corresponding outcome criteria as opposed to the goals and criteria of acute oncological treatment. In the formulation of goals and criteria, the medical-somatic, occupational-rehabilitative, social and psychological levels are considered. The consequences which arise from these outcome criteria with regard to the rehabilitative health care system for cancer patients are discussed.

[Value of tumor-associated antigens CA 72-4 vs. CEA and CA 19-9 in the follow-up after stomach cancer]. / Wertigkeit des tumorassoziierten Antigens CA 72-4 gegenüber CEA und CA 19-9 in der Magenkarzinom-Nachsorge.

OBJECTIVE: To compare the value of tumour markers CA-72-4 and CA 19-9 and the cardioembryonic antigen (CEA) in the follow-up of patients after potentially curative surgery of gastric carcinoma. PATIENTS AND METHODS: CA 72-4, CA 19-9 and CEA were measured prospectively in 279 patients 1-36 months after potentially curative primary surgery for histologically proven gastric carcinoma. Evaluation was by "receiver-operating-characteristics" (ROC) curves using "believe the positive" rules as well as by linear combinations. RESULTS: Recurrences were found in 54 patients. CA 72-4 (by radioimmunoassay) was the most sensitive single test (sensitivity 43%, specificity 95%). Radioimmunological and enzyme-immunological tests of CA 79-4 correlated well (r = 0.8). The various values, obtained by certain test kits, when newly calculated for the purpose of after-care, differed markedly from upper limits reported by the manufacturers. Measurement of both CA 72-4 and CA 19-9 increased the sensitivity to 54%. INTERPRETATION: Special levels of CA 72-4 and CA 19-9 have been identified which are of value in the follow-up of patients after operation for gastric carcinoma. Single measurements of CA 74-2 are as a rule preferable to those of CA 19-9 or of both CA 11-9 and CEA. In fact, CEA should be measured only in exceptional circumstances. But combined measurements of CA 72-4 and CA 19-9 increase sensitivity and prognostic value of the results.

[Assessment of work capacity and occupational rehabilitation in curatively treated tumor patients]. / Leistungsbeurteilung und berufliche Rehabilitation bei kurativ behandelten Tumorpatienten.

Cure and long survival of cancer patients are often accompanied by reductions of performance and vocational handicaps due to the treatment or due to the cancer itself. These reductions vary according to the kind of cancer, the different therapies and the different doses as well. There is a considerable risk of late effects of chemo- and radiotherapy that can be evaluated more precisely today than in the past. Rehabilitation is able to reduce or even to prevent or compensate these reductions of performance and vocational handicaps. Rehabilitation basing on roborating measures is not suitable for these possibilities and should be given up to the benefit of a more flexible rehabilitation of cancer patients being determined by the extent of impairment and functional deficiency. This rehabilitation work includes the consideration of vocational handicaps as well.

[Subjective discomfort of stomach cancer and esophageal cancer patients in after-care]. / Subjektive Befindlichkeitsstörungen bei Magenkarzinom- und Osophaguskarzinompatienten in der Nachsorge.

In the framework of a study on the rehabilitation needs in gastric and oesophageal cancer patients, 100 gastric and 100 oesophageal cancer patients were interviewed on their subjective emotional state and physical functioning. The potentially cured patients were admitted to our in-patient aftercare programme an average 9.5 months following primary treatment. Major psychological distress was reported by 69.5% of the patients. Brooding, unrest, nervousness, and insomnia were the most frequently named complaints in both groups. 93% reported physical limitations, and 80% felt their conditions of life more or less restricted by their disease. 50% of all patients reported lack of drive, 30% an inclination to withdraw and a basic attitude of resignation. No significant differences between gastric and oesophageal cancer patients were found concerning type and frequency of the complaint.

[The objectives, failures and new ways in hospital aftercare and rehabilitation]. / Anliegen, Fehlentwicklungen, neue Wege in der stationären Nachsorge und Rehabilitation.

One of the main aims of oncological aftercare is to improve the transition from acute into chronic medicine, i.e. from curative into rehabilitative treatment. The somatic, psychic, social, professional, and family problems due to the tumour and its therapy have to be eliminated, improved or prevented. Up to now, oncological rehabilitation often was considered an isolated measure. The lack of cooperation between curative and rehabilitative medicine often resulted in the fact that patients in need of aftercare were not sent to appropriate rehabilitation clinics. There was no feed-back between pre- and after-treating doctors. The recommendations of the commission for further development of rehabilitation in the social insurance (VDR), elaborated together with the study-group for rehabilitation and aftercare and the study-group for the protection of the quality standard in oncology, aim at improving the above mentioned target. Active and forward-looking measures should improve the significance of clinical aftercare. The documentation of rehabilitation needs will allow more differentiated rehabilitation measures and long-term evaluation of their success. For a more effective integration of rehabilitative aspects into primary treatment, there is the demand for a closer cooperation between primary care and aftercare.

[Postgastrectomy findings in the after care of 227 patients with stomach carcinoma]. / Postgastrektomiebefunde in der Nachsorge von 227 Patienten mit Magenkarzinom.

Rehabilitation needs and problems in 227 gastric cancer patients. In an investigation on needs of rehabilitation in gastric cancer we evaluated postgastrectomy problems in 227 gastrectomized patients. The average weight loss was 5% prior to operation and there was a further weight loss of 16% in the follow-up 18 months after the operation due to the postgastrectomy syndrome. The most frequent complaints of gastrectomized patients were inappetence (32%), reflux oesophagitis (25.1%), eructation (54.2%), diarrhea (22%), flatulence (36.5%), dumping syndrome (20.4%). 176 patients (78%) observed an indigestion of certain food since the operation. Postgastrectomy syndromes were more frequent in totally than in partially gastrectomized patients.

[Sensitivity and specificity of CEA, Ca 15-3 and MCA levels in visceral breast carcinoma metastasis]. / Sensitivität und Spezifität von CEA, CA 15-3 und MCA bei viszeralen Mammakarzinommetastasen.

The determination of mucin like carcinoma associated antigen (MCA) showed a sensitivity of 72% in visceral metastasis of breast cancer, of 25% in metastasis of stomach cancer and of 10.3% in metastasis of colorectal cancer. The sensitivity of CA 15-3 was 83% (n.s.) in metastasis of breast cancer, that of CEA was 29% (p less than 0.05). The sensitivity of isolated metastasis and isolated invasion of the lymph nodes was under 20% for MCA, CA 15-3 and CEA.

[Necessities, possibilities and difficulties of vocational rehabilitation in patients with early stomach carcinoma--experiences in 89 patients]. / Notwendigkeiten, Möglichkeiten und Schwierigkeiten der beruflichen Rehabilitation bei Patienten mit Magenfrühkarzinom--Erfahrungen bei 89 Patienten.

Because of the favourable prognosis in patients with early stomach cancer even extensive vocational rehabilitation measures should be taken into consideration. Opposed to that is the fact that about 40% of these patients already exceed the age limit for employment and only 10% are younger than 45 years. The polymorbidity, too, is relatively high, 21% of our patients were not capable of employment already before the outbreak of their cancer disease. The postgastrectomy syndrome prevents 40% from resuming work within the first postoperative year and jeopardizes the working capacity even after that time, at least in patients with manual occupations.