[MALDI mass spectrometry of the meniscus. Objectification of morphological findings]. / MALDI-Massenspektrometrie am Meniskus. Objektivierung morphologischer Befunde.

BACKGROUND: The classification of meniscal lesions requires correlation with clinical data. For the standardization of histopathology reports a discrimination between normal, low-grade lesions and high-grade lesions is feasible. This classification can be further specified using other methods. MATERIAL AND METHODS: Formalin-fixed, paraffin-embedded specimens of meniscal tissue from 68 patients were analyzed by matrix-assisted laser desorption ionization (MALDI) imaging. RESULTS: The classification of meniscal lesions and differentiation between low-grade and high-grade and acute versus non-acute degeneration is possible by determination of the differential expression of mass-to-charge ratios by statistical comparisons using the P-value from combined Wilcoxon and Kruskal-Wallis (PWKW) tests and a predefined average two-fold difference in intensity. CONCLUSION: The concept of a "meniscus report" is introduced for documentation of meniscus tissue specimens integrating histological, histochemical and proteomic data, thereby specifying the degree of degeneration and the assessment of acute or non-acute lesions. Mass spectrometry contributes to an objective histopathology report. An advisory opinion should always be based on close correlation of clinical and morphological evaluations.

[Training adaptation of the Achilles tendon in competitive athletes--sonographic standard values for the Achilles tendon]. / Trainingsadaptation der Achillessehne beim Hochleistungssportler--sonografische Grenzwerte für Achillessehnen.

BACKGROUND: Current theories and empirical results regarding the sonographic dimensions of the Achilles tendon as well as an alleged training adaptation of the tendon in competitive athletes are tested for the first time in a large in vivo sample. The pathological validity of a thickened tendon in competitive athletes is under scrutiny. MATERIAL AND METHOD: In addition to 202 national squad athletes from the German track and field federation, 199 age-matched normal individuals were examined sonographically. The portable ultrasound scanner Just Vision was used to compare 404 Achilles tendons of athletes with 398 Achilles tendons of normal individuals as to tendon diameter. Furthermore, pathologies were assessed. RESULTS: Achilles tendon diameter at the calcanear insertion was 4.2 ± 0.72 mm on average. Athletes' tendons were thicker than normal tendons (p < 0.001) - athletes, however, also reported more clinical symptoms (p < 0.001). In athletes, increasing diameters were associated with more clinical problems as opposed to normal individuals. At the tendon waist, diameters above 6.0 mm were very likely to go along with pathologies. CONCLUSIONS: For the first time, valid data of Achilles tendon diameters in competitive athletes and normal individuals have been presented. The emerging pattern of results clearly contradicts the notion of a physiological training adaptation of the Achilles tendon.

[Bone density and bone metabolism regulated by vitamin D receptor allele polymorphism in a German study sample]. / Knochendichte und Knochenstoffwechsel unter dem Einfluss des Vitamin-D-Rezeptor-Allel-Polymorphismus in einem deutschen Untersuchungskollektiv.

BACKGROUND: It has been reported that the spinal bone density is associated with vitamin-D-receptor (VDR) gene polymorphisms. The results of recent studies have been contradictory concerning the predictive power for low bone mineral density (BMD). Regional population-specific influences have been found to affect the vitamin-D-endocrinologic-system, diminishing the influence of VDR polymorphism on BMD and on bone turnover. We have examined the association of bone density, fracture predictivity and biochemical markers of bone turnover with VDR polymorphism in a German population. METHODS: Blood and urine were collected from a heterogeneous subset of 164 caucasian subjects with ethnic German background. Polymerase chain reaction and subsequent digestion with Bsm I were used to examine variations of VDR genotypes. The morning following initial specimen collections, both urinary excretion rate of pyridinoline crosslinks (Pyr) and serum levels of bone alkaline phosphatase (BAP) were determined. For determination of the bone mineral density, the well-established method of dual X-ray absorptiometry was used. FINDINGS: The VDR BB-genotype was associated with low bone mineral density for age-matched subjects (90.1 +/- 15.5%) versus the bb-genotype (100.8 +/- 10.8%) at the lumbar spine and at the Ward's triangle (91.8 +/- 17.9% versus 101.9 +/- 12.1%). 34.2% of BB-genotype subjects, 14.2% of bB-genotype subjects and 12.6% of bb-genotype subjects had Z-score related bone mineral density < 85%. The fracture rate at typical osteoporotic fracture sites was 23.6% for the BB-, 10.8% for the bB- and 0.0% for the bb-genotype. The urinary excretion rate of free pyridinoline crosslinks was higher for the BB-genotype than for the bB- or the bb-, however the difference was not significant. No genotype specific variations were seen for bone alkaline phosphatase. INTERPRETATION: The authors conclude from this study that bone mineral density at the axial skeleton is associated with the vitamin-D-receptor allele polymorphism and that there is an influence on bone turnover and fracture rate in a German subset. CLINICAL RELEVANCE: The analysis of the VDR-genotype can be considered as a new piece in the puzzle of the diagnostic of osteoporosis for we get prognostic hints concerning the rate of fracture.

Current status of gene therapy for rheumatoid arthritis.

Despite the high prevalence of the disease, at present little effective pharmacological treatment of rheumatoid arthritis is available. Novel approaches utilising biological agents have resulted in the development of new antiarthritic and antiinflammatory agents, such as tumour necrosis factor-alpha (TNFalpha)-specific antibodies and interleukin-1 receptor antagonist (IL-1ra). Local gene therapy not only allows the pharmaceutical use of these biologicals, but also allows for continuous drug supply, which is necessary for chronic diseases like rheumatoid arthritis. We discuss the basics of rheumatoid arthritis therapy, candidate genes and possible gene transfer methods. A current clinical gene therapy trial is focusing on the IL-1 system using IL-1ra as a transgene. The transfer system, clinical protocol and preliminary results are described. After treatment of 11 patients we feel that gene therapy will offer potential as a new avenue to treat rheumatoid arthritis.

American football injuries in Germany. First results from Bundesliga football.

This study investigated the incidence of injury in German Bundesliga football based on the evaluation of two American football teams before and during the season 1995. Certified team physicians and team physiotherapists were the initial medical professionals providing on-site diagnosis, injury documentation and first aid for all injuries. An injury was defined as minor (group I) causing the player to miss practice or game sessions up to 1 week without requiring surgery; as severe (group II) causing the player to miss practice or game sessions for more than 1 week up to 3 months or requiring surgery; and as catastrophic (group III) if the incident led to treatment for more than 3 months, treatment in an intensive care unit or persistent neurological or orthopaedic disability or death. From the data collected it was possible to calculate the risk of injury per time of exposure per athlete. The athlete's function, influence of the weather and mechanisms of the injuries were registered. In total, 242 injuries were documented. The rate of injury was calculated as 16 per 1000 hours of practice and game per athlete. Severe injuries (group II) were found in 94 cases. Catastrophic injuries were not seen during the study. The knee was found to be the most common site of injury, while the ankle ranked second. Our study showed that the risk of injury in American football in German Bundesliga is comparable with soccer or handball.

[Instability of the shoulder joint in the athlete]. / Instabilitäten des Schultergelenkes beim Sportler.

In all shoulder instabilities it is very important to classify the type of instability precisely in order to choose the right form of therapy and predict the results. The acronyms TUBS, which means traumatic instability, unidirectional, Bankart lesion, and good response to surgery, and AMBRI, which means atraumatic aetiology, multidirectional, and good for rehabilitation, represent the complete range of possible instabilities. We discuss the subtypes in the differentiation of various instabilities and the different causes and pathologies for instability, the clinical and radiological tests possible, and the different surgical treatment options, as well as the results in the literature. A modification of the Bankart procedure and the arthroscopic Caspari capsulorrhaphy procedure for traumatic instabilities are described. The capsular T-shift by Neer and Foster is explained as a surgical treatment for multidirectional instability.

[Effects of various rehydration periods on the stability and water content of bone transplants following freeze-drying, gamma sterilization and lipid extraction]. / Einfluss verschiedener Rehydratationszeiten auf die Stabilität und den Wassergehalt von Knochentransplantaten nach Gefriertrocknung, Gammasterilisation und Fettextraktion.

UNLABELLED: Several studies demonstrated the necessity of rehydration of lyophilized bone allografts prior to implantation. The purpose of the presented study was to evaluate the influence of different rehydration periods on the stability of human cortical lyophilized and gamma-irradiated allografts, the capability of lyophilized bone for rehydration, as well as the effects of lipid extraction on rehydration. Breaking strength of lyophilized irradiated cortical bone after different rehydration periods (0.5, 1, 2, 4, 8 hours) showed no significant difference. Weight reduction after lyophilization of human femoral heads was between 7.6% and 41%. Further weight reduction occurred after lipid extraction (38.7%). Total weight loss was 56.9%. There was a significant influence of intraosseous lipid content on the rehydration capability. After lyophilization alone the rehydration weight after 8 hours was only 18.1%, whereas after lipid extraction the weight increase was 43% after 0.5 hours, 36.4% after 1 hour, 57.6% after 2 hours, 60% after 4 hours, and 92.7% after 8 hours. CLINICAL RELEVANCE: Based on the presented data rehydration time of 0.5 hours seems to have no disadvantage compared to longer time periods concerning breaking strength. Therefore a longer intraoperative time period seems not to be necessary. This is of advantage for a possible secondary contamination while the allograft is rehydrated. Rehydration after lipid extraction is more effective than rehydration after lyophilization alone. However, the question whether lipid extraction alter bone stability has to be proved in further studies.

[Bone banks in the FRG. Results of a survey]. / Knochenbanken in der BRD. Ergebnisse einer Befragung.

In a nationwide survey, 1350 departments of general surgery, trauma surgery, and orthopedic surgery were approached in an attempt to determine how many surgeons use bone grafts and how they manage their bone banks; 961 responded to the postal enquiry. Bone banks are currently in use in 471 departments. The storage temperature varies between 0 degrees C and -30 degrees C in more than 50%. In 90% bone is stored for no longer than 12 months. In only 6 bone banks secondary sterilization of the bone is performed. In 1 year, 71,000 autogeneic and 25,000 allogeneic bone grafts are performed. A further 18,000 per year could be performed if bone grafts were available. We discuss the results of the survey and present an overview of the current problems concerning storage temperature and adjuvant local antibiotics, the role of HIV in bone banking, and the possibilities opened up by secondary sterilization.