Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part II: clinical application of a new test battery.

PURPOSE: The purpose of this study was to utilize a novel functional test system to facilitate determining the time of return to sports following ACL reconstruction. METHODS: Sixty-nine patients with unilateral ACL reconstruction were included in this pilot study. All the patients performed a standardized test battery consisting of one- and two-legged stability tests, counter movement jumps, speedy jumps, plyometric jumps and a quick feed test. The first test was administered on average 170.7 ± 75.1 days post-operatively, and the retest was administered on average 239.1 ± 79.7 days post-operatively. The values of the subtests were compared with the normative data of healthy gender- and age-matched controls to determine the functional capacities of patients following ACL reconstruction. RESULTS: After the first and second test, 15.9 and 17.4 % of the patients met the criteria for a "return to non-competitive sports". One patient fulfilled the criteria for a "return to competitive sports" after the second test battery. The most limiting factor was a poor LSI value of <90 % if the dominant leg was involved and <80 % if the non-dominant leg was involved. CONCLUSION: This test battery demonstrates that, in terms of neuromuscular abilities, most patients, compared to healthy controls, are most likely not ready for a safe return to sports, even 8 months post-operatively. This should be considered in the future to determine when it is safe to return to sports and should avoid a premature return to competitive sports. LEVEL OF EVIDENCE: III.

Progressive cerebellar syndrome in adult coeliac disease.

A case of slowly progressing cerebellar syndrome and pathologically confirmed adult coeliac disease is presented. Neurological symptoms progressed although the patient had no enteric complaints. This case seems to be identical with 18 previously reported cases of encephalopathy and adult coeliac disease. However, the aetiology and pathogenesis of the encephalopathy are still not known.

The action of somatostatin on intestinal alkaline phosphatase stimulated by secretin and cholecystokinin-pancreozymin.

The action of somatostatin on intestinal alkaline phosphatase activity (IAP) in the duodenal juice was examined in 22 subjects undergoing diagnostic secretin-CCK-PZ-tests. Under continuous secretin-CCK-PZ-stimulation there is an increase of IAP which is followed by a period of exhaustion after 1 h of stimulation. The intravenous administration of somatostatin induces a distinct inhibition of IAP which cannot be due to the exhaustion of the enzyme synthesis. As there is a functional relationship between fat absorption and alkaline phosphatase, it is suggested that this inhibition of IAP is one of the mechanisms of the somatostatin-induced inhibition of intestinal fat absorption.

[The measurement of 75selenium in duodenal juice--an advance in the diagnosis of pancreatic function (author's transl)]. / Die Messung von 75Selen im Duodenalsaft--Eine Bereicherung der Pankreasdiagnostik

The radioactivity in the duodenal juice following the intravenous injection of 75Se-1-selenomethionine was measured in 17 normal subjects and in 14 patients with exocrine pancreatic insufficiency. The mean values of radioactivity were significantly lower during certain periods of the investigation in the patients with pancreatic insufficiency as compared with the normal subjects. The individual values, however, scattered widely and the standard deviations were large. There was a highly significant correlation between the volume of duodenal juice and the 75Se radioactivity, but no significant correlation was established between the duodenal juice radioactivity and bicarbonate or enzyme concentration i.e. specific parameters of exocrine pancreatic function. It is possible that observation period may bring less equivocal results, but this appears of doubtful practicability. Measurement of the 75Se-1-selenomethione radioactivity in the duodenal juice is only an indirect indicator of exocrine pancreatic function. It does not appear to represent any significant advance in the diagnosis of pancreatic insufficiency, since the information provided by these older-established methods is more reliable and is obtained within a similar space of time.

[Serum gastrin following renal transplantation]. / Serumgastrin nach Nierentransplantation.

Basal and postprandial serum gastrin concentrations were determined in 26 renal transplant patients and compared with the values found in 5 normal subjects. All subjects received a solid test meal consisting of 25 g protein, 47 g fat and 58 g carbohydrates. All patients were in a non-uraemic state and received combined prednisolone-azathioprine treatment. 5 patients had a peptic ulcer. There was no significant difference in the mean serum gastrin concentrations of the two groups, either with respect to basal or postprandial values. On calculating mean gastrin concentrations of patients given high (over 20 mg daily) or low (under 20 mg daily) prednisolone dosage, again no difference was found in comparison with the normal subjects. Similarly, no difference was observed in the mean serum gastrin levels between ulcer patients and normal controls. We conclude from these results that, in contrast to the findings in chronic uraemic patients, gastrin metabolism is normal in renal transplant recipients and that the high indicence of gastrointestinal complications, especially peptic ulcer, cannot be due to a disturbed gastrin metabolism in these patients.

[Sarcoidosis of the nervous system. Clinical and diagnostic synopsis based on two cases]. / Zur Sarkoidose des Nervensystems. Klinische und diagnostische Synopsis an Hand von 2 Fällen.

This paper reports two cases of neurosarcoidosis . Initially the clinical picture involved only the nervous system. Later on manifestations pertaining to other systems were detected by interdisciplinary investigations. The resulting diagnostic problems, the value of additional investigations and the therapeutic management are discussed on the basis of the two presented cases.

[Long-term results after therapeutic starvation (author's transl)]. / Langzeitergebnisse nach Nullkalorien-Diät

19 Persons with gross refractory obesity (7 men and 12 women) were treated by therapeutic starvation. The patients were controlled after 32 months, on average (range: 7 to 58 months), following completion of treatment. The study shows that 8 of the females gained weight, one of these attaining her pretreatment weight and another even exceeding the pretreatment figure. None of the males had regained his pretreatment weight but 4 showed an increase in comparison with the weight at the time of hospital discharge. During starvation the serum lipids showed a marked decrease, which was statistically significant in the case of cholesterol, but not triglycerides. At the time of follow-up examination the serum lipid values were about the same as before treatment. It is concluded that the long-term results of therapeutic starvation are beter in men than in women and yet this method of treatment should be attempted, when indicated according to strict criteria, in refractory cases of extreme obesity.

[The influence of somatostatin on serum gastrin concentrations in patients after total duodenopancreatectomy (author's transl)]. / Die Wirkung von Somatostatin auf die Serumgastrinkonzentration bei Patienten nach totaler Duodenopankreatektomie

Serum gastrin concentrations were measured in insulin-dependent diabetics and in patients who had undergone total duodenopancreatectomy and gastrectomy. Administration of somatostatin markedly inhibited gastrin release in the diabetic patients with an intact gastrointestinal tract. This inhibitory effect of somatostatin, however, is not detectable in the group of operated patients, who display basically low plasma gastrin levels. A marked increase in the plasma gastrin level after withdrawal of somatostatin was observed in patients with a normal gastrointestinal tract. This rebound effect was only slight in the operated patients.

[Inhibition of postprandial increase in serum triglycerides by somatostatin in man (author's transl)]. / Hemmung des postprandialen Triglyzeridanstiegs im Serum durch Somatostatin beim Menschen

A test meal containing 100 g neutral fat was administered to 10 healthy subjects. Serum concentrations of triglycerides, cholesterol, free fatty acids and gastrin were determined during an infusion of 1000 microng somatostatin/h over 3 hours. In comparison with a control group (infusion of normal saline solution), somatostatin caused almost complete suppression of the triglyceride increase. The free fatty acids showed a slight increase under somatostatin while there was no change in the cholesterol levels. Gastrin release was also completely blocked by somatostatin. The suppression of the serum triglycerides may be explained by the inhibition of digestion and absorption of fat in the small intestine under the influence of somatostatin which suppresses exocrine pancreatic secretion.

[ Somatostatin in insulin-dependent diabetics and in pancreatectomized patients (author's transl)]. / Zur Wirkung von Somatostatin bei insulinpflichtigen Diabetikern und bei pankreatektomierten Patienten

The inhibitory effect of somatostatin on the secretion of glucagon permits the examination of the effect of glucagon on some metabolic parameters in the insulin-dependent diabetic patient. The results obtained in 5 insulin-dependent diabetics and in 4 pancreatectomized patients revealed an inhibitory effect of somatostatin on blood glucose in the juvenile-type diabetics, but failed to show this influence of somatostatin in the pancreatectomized patients. These observations indicate a participation of glucagon in the generation of hyperglycaemia in diabetes mellitus. However, the failure of somatostatin to influence the blood glucose level in pancreatectomized patients contrasts with the results obtained in dogs and emphasizes the difficulty and pit falls in the application of animal experiments with somatostatin to humans.

[Exocrine pancreatic function in chronic alcoholics in Austria (author's transl)]. / Untersuchungen der exokrinen Pankreasfunktion bei chronischen Alkoholikern in Osterreich.

97 chronic alcoholic patients were investigated with regard to exocrine pancreatic function. Chronic calcifying pancreatitis was radiologically established in 7.2% of the cases. Secretin-pancreozymin tests were performed in 30 patients. Pancreatic insufficiency was found in 8 patients, while 8 patients showed marked hypersection. The daily faecal fat excretion in 10 other patients with partial gastrectomy and Billroth II operation was 5.3 g. Pancreatic disorders were, thus, detected in 53.2% cases of chronic alcoholism. This is higher than expected for Austria.

[Is there a feed-back mechanism between serum gastrin concentration and gastrin release (author's transl)]. / Besteht ein "Feed-back" zwischen Serumgastrinkonzentration und Gastrinbildung

The dialysability of gastrin heptadecapeptide was investigated in a model arrangement. The amounts of gastrin passing through the dialysis membrane during a 6-hour dialysis procedure are very small. Furthermore, the serum gastrin concentrations were measured during a 6-hour haemodialysis session with and without simultaneous pentagastrin infusion (0.003 mug/kg/h) in 8 patients on intermittent haemodialysis. There is a continuous decrease in the serum gastrin concentration during the 6-hour dialysis period with simultaneous pentagastrin infusion, while in the investigation without pentagastrin infusion phases of increase in serum gastrin levels are observed. In view of this different response of the serum gastrin curve it is suggested that a direct feed-back mechanism exists between the serum gastrin concentration and gastrin release, a mechanism which was interrupted by the pentagastrin infusion in the present investigation.

[Case report of a patient with intermittent fever, leucopenia and terminal fungal sepsis (author's transl)]. / Ein Fall mit intermittierenden Fieberschüben, Leukopenie und terminaler Pilzsepsis.

A fatal case of disseminated candidiasis with deep organ involvement is reported. The patient was employed as a radiologist for several decades and already showed X-ray-induced bone marrow damage at the onset of the disease. He suffered for several years from an unknown granulomatous systemic bacterial infection and had been treated with antimicrobial agents with varying degrees of success. Regarding prophylaxis of systemic Candida infections it is concluded that prolonged medication with glucocorticoids and antibiotics should be combined with the oral administration of antimycotic drugs in order to prevent invasion by potentially pathogenic fungi.