[Anterior cruciate ligament rupture in children with open growth plate : Diagnostics and treatment]. / Vordere Kreuzbandruptur beim Kind mit offener Wachstumsfuge : Diagnostik und Therapie.

Anterior cruciate ligament (ACL) ruptures in pediatric patients with open growth plate are of concern and the number of injuries is increasing. The possibilities for diagnostics using magnetic resonance imaging (MRI) have improved and are without radiation exposure to the growing skeleton. The MRI should be performed routinely in every case of adequate trauma also to recognize additional injuries to the knee joint. Joint effusion represents an urgent indication for further clarification. Real ACL ruptures have to be distinguished from bony avulsion injuries. Although there are different forms of treatment, biomechanically an ACL insufficiency is present. A permanent instability leads to degenerative changes of the cartilage and meniscus. Despite the different surgical techniques, the general recommendation is for replacement of the ACL. Extensive procedures with an increased risk of epiphyseal injury should be avoided and anatomical techniques should be preferred. The results are good to very good and with adequate knowledge of the special features of children, complications are rare.

[Traumatic posterior dislocation of the sternoclavicular joint. A case report of joint stabilization with gracilis tendon graft]. / Die traumatische posteriore Luxation im Sternoklavikulargelenk. Fallpräsentation einer Stabilisierung mit Grazilissehnenplastik.

Dislocation of the sternoclavicular joint is an uncommon injury. Especially posterior dislocations with potentially life-threatening complications present a challenging situation for the treating surgeon regarding diagnosis and therapy. Reduction and fixation of the joint is the treatment of choice. We present the case of such an injury in an adolescent judoka who was treated by open reduction and reconstructive surgery using the gracilis tendon graft technique.

[Operative corrections of posttraumatic deformities of the elbow joint in children]. / Posttraumatische Korrekturoperationen am kindlichen Ellenbogen.

Posttraumatic deformities with need for surgical correction are rare and demanding in the pediatric population. The consequences of a bad outcome may last a life time. The best prevention of deformities around the elbow joint is proper initial treatment. The most common deformities are cubitus varus, cubitus valgus, chronic dislocation of the radial head and pseudarthrosis of the radial condyle. In contrast to the wide spread opinion to await the effect of the further growth, the deformity should be treated contemporarily to the underlying injury. This strategy will optimize the outcome. In special cases treatment with delay is justified.

[Oblique osteotomy for post-traumatic fibula incongruity]. / Schrägosteotomie der Fibula bei posttraumatischer Inkongruenz. Einsatz zur Wiederherstellung der Symmetrie in der Knöchelgabel des Sprunggelenkes.

BACKGROUND: Injuries of the ankle joint are common and, considering that this joint is highly mechanically stressed, it seems obvious that therapy requires restoring the joint to a physiological, anatomically functional unit. In case of post-traumatic shortening, rotation and talar tilt arthritis may result because of the changed biomechanics. Before this occurs, typical clinical symptoms are recurrent swelling, pain, and limited range of motion, together resulting in reduced mobility and quality of life. With prompt indication and revision lengthening the lateral ankle and thus restoring joint congruity, patient complaints are significantly reduced and the development of advanced arthritis can be avoided. PATIENTS AND METHODS: Within a period of 7 years, 16 patients with post-traumatic shortening of the fibula were treated with oblique osteotomy and lengthening of the fibula at our department. The mean time between trauma and reconstructive surgery was 10 months, and the median follow-up period to clinic and radiological examination was 3.7 years. RESULTS AND CONCLUSION: Comparison of results before and after correction showed significant subjective improvements, and the development or continuation of post-traumatic arthritis could be hindered, of critical importance to which is prompt indication for operative joint correction, because clinical symptoms of advanced osteoarthritis of the ankle joint cannot be expected to improve.

[The televisit system in patients care after discharge in clinical use--first experiences]. / Das System der Televisite zur poststationären Patientenbetreuung im klinischen Einsatz-erste Erfahrungen.

The televisite is a form of application of telemedicine, that allows a communication between the patient and the family doctor or specialist in the clinic after discharging of hospital. Pioneers for the use of telematic projects have been up to now wide states like the USA, Canada, Norway or Australia to provide, guarantee and maintain by the means of telemedical solutions medical care in geographic regions hardly reachable and of little medical attention. In central Europe and Germany telemedicine is gaining in significance on the one hand because of increasing importance of the cost factor and resulting pressure on the public health system and on the other hand because of the rising demand of the patients for optimised medical care. It specially represents a new form of treatment in patients care after dischargement of hospital. In the year of 2002 a prospective randomised two-armed study was initiated including patients after operative intervention by arthroplasty in posttraumatic contracture of the elbow. The system of the Televisite is used for 6 weeks after dischargement and patients had been controlled ambulant after 6 months including a physical examination. The functional outcome will be scored, the duration of stay in hospital measured, the arising costs for treatment calculated and the satisfaction of the patients in handling the Televisite surveyed. Over this first results showed a shortened stay in hospital together with lowered costs in medical treatment on the one hand and on the other no difference in functional outcome could be found in comparison to the control group by additionally high grade of satisfaction with the new system.

Prolonged treatment with azapropazone.

In an open study of 40 patients with chronic rheumatoid polyarthritis, azapropazone was given alone in daily doses between 1200 mg. and 1800 mg. over a period of 6 months. Six patients were withdrawn, 2 because of side-effects (1 with an allergic-type rash; 1 with ankle oedema) and 4 because azapropazone alone did not provide adequate control of their pain and discomfort. Objective assessments showed that 18 patients had a 'good' or 'very good' response to treatment, and a further 16 showed moderate improvement. These findings were supported by the patients' subjective assessment of the change in their condition from the start of the trial. In addition, 22 patients showed a significant decrease in erythrocyte sedimentation rate. There was no evidence of adverse effects on any of the haematological and biochemical parameters measured, and the incidence of side-effects was low.

Pharmacokinetic studies on diponium bromide.

The body elimination kinetics and the metabolic pathway of intravenously administered diponium bromide ((2-[alpha,alpha-dicyclopentylacetoxy)- ethyl] triethylammonium bromide) were studied. The rapid alpha- distribution phase had a t 1/2 of 4 to 11 minutes. The elimination rate varied between 2.3 and 7.7 hours. The distribution volume was 29.64 +/- 15.03 l, the total body clearance was 72.99 +/- 28.52 ml/min, and the renal clearance showed a mean value of 45.03 +/- 12.51 ml/minute. Thin layer chromatography of extracts derived from urine and faeces showed unchanged DB and a metabolite in urine; in the faeces of some volunteers three metabolites were detected, which were characterized by their Rf-values. DB does not bind to erythrocytes but to plasma proteins.

Methotrexate serum-level determinations during low-dose therapy of rheumatoid and psoriatic arthritis.

In 29 patients, 21 suffering from psoriatic arthritis and eight patients suffering from rheumatoid arthritis, methotrexate serum-levels were determined by means of radioimmunoassay. The aim of the investigation was to recognize an eventual dependence of the serum level of methotrexate on the total cumulative dose and to test the possibility of a concomitant therapy control. Beside the determinations of the serum levels of methotrexate, clinical examinations and laboratory tests were done at regular intervals. The values obtained showed no significant increase during the course of therapy compared to the values at the beginning of the treatment. Likewise no correlation to the total cumulative dose, the clinical picture or to the occurrence of side-effects could be found. Nor could any relationship between the changing of laboratory parameters and the methotrexate serum-levels be observed. No differences appeared in the methotrexate serum-levels during therapy of either rheumatoid or psoriatic arthritis patients. In conclusion it seems impossible to monitor a low-dose methotrexate therapy by continuous determinations of the serum levels of the drug.

[Extra-articular manifestations of chronic polyarthritis]. / Gelenksferne Manifestationen der chronischen Polyarthritis

Although the chronic destructive joint processes dominate the clinical picture of chronic rheumatoid arthritis, it must not been forgotten that the disease is a systemic one, whereby certain organs or organ systems are affected either clinically or subclinically. The various possible pathogenetic mechanisms are discussed and the particular type of patient with rheumatoid arthritis who appears to be prone to extra-articular manifestations is described. Subsequently, the individual organic manifestations and the clinical picture are discussed, as well as the incidence and significance of these features.

[Plasma amino acids in ankylosing spondylitis (author's transl)]. / Die Plasma-Aminosäuren bei der Spondylitis ankylosans.

The plasma amino acids of male patients with ankylosing spondylitis (ASp) and male controls were analysed and the concentrations statistically evaluated. The total concentration of all 28 amino acids in ASp-patients did not differ from the controls, but there were some distinct differences in the levels of individual amino acids, e. g. arginine and isoleucine which showed raised concentration (29% and 27%). A higher concentration was also detectable with rare amino acids, e. g. alpha-amino-adipinic acid (23%) and 1-methyl-histidine (32%). Correlation between the amino acid concentration and age was detected only in the case of citrulline. Some amino acids showed a significant correlation to one another which was sometimes evident in both groups and other times was noted in the control- or ASp-group only. If such correlations were found to be disease-dependent this finding could be helpful in the diagnosis of certain diseases.

[Generalized secondary amyloidosis in patients with chronic rheumatoid arthritis (author's transl)]. / Generalisierte sekundäre Amyloidose bei chronischer Polyarthritis

During a period of 6 years (1968 to 1973) 177 patients with rheumatoid arthritis were submitted on one or more occasions to biopsy of the rectal mucosa for the diagnosis of amyloidosis. The indications for biopsy were as follows: 1. proteinuria, even in an intermittent form, 2. progressive type of rheumatoid arthritis with high inflammatory activity, 3. rheumatoid arthritis of longer than 2 years duration with a marked tendency to joint destruction. The histological specimens were stained with Congo red and investigated in polarized light. The biopsy for amyloidosis was positive in 80 patients (45.2%) of whom 14 showed no proteinuria, even of an intermittent nature. Patients with rheumatoid arthritis survived maximally 5 years after amyloidosis had been diagnosed. No successful therapy of amyloidosis has been devised.

[The effect of oxyphenbutazone and flufenamic acid in vitro on the purine salvage pathway of human lymphocytes (author's transl)]. / Einfluss von Oxyphenbutazon und Flufenaminsäure in vitro auf den Purin-Wiederverwertungsstoffwechsel menschlicher Lymphozyten

The effect of oxyphenbutazone and flufenamic acid was investigated on the enzymes of the purine salvage pathway of human lymphocytes in vitro. A distinct decrease in adenine-phosphoribosyltransferase activity and in guanine-hypoxanthine-phosphoribosyltransferase activity was observed following the administration of either pharmacological preparation. The loss of enzyme activity was 23 to 39%. The pharmaceuticals were used at a concentration of 50 mug%.

[Treatment of interstitial pulmonary fibrosis with D-penicillamine in progressive scleroderma: a long-term study (author's transl)]. / Zur Behandlung der interstitiellen Lungenfibrose mit D-Penicillamin bei progressiver Sklerodermie (Langzeitstudie)

5 patients suffering from progressive scleroderma with interstitial pulmonary fibrosis have been treated since 1971 with D-penicillamine (Artamin) as basic therapeutic agent. All patients showed a significant tendency towards normalization of the pathological findings in regard to functional capacity of the lungs and scintigraphic and radiological assessment. These results, in our opinion, justify the recommendation of a new indication for D-penicillamine therapy, namely in cases of progressive scleroderma with interstitial pulmonary fibrosis.

[In vitro investigations on the influence of various antirheumatic drugs on the enzymes of the purine salvage pathway (author's transl)]. / In-vitro-Untersuchungen über den Einfluss verschiedener Antirheumatika auf die Enzyme des Purin-Wiederverwertungsstoffwechsels

On testing the effect of 5 drugs (azapropazone, flufenamic acid, indomethacin, oxyphenbutazone and prednisolone) commonly used in the therapy of rheumatic diseases on 3 enzymes of the purine salvage pathway (adenine-phosphoribosyltransferase, guanine-phosphoribosyltransferase and hypoxanthine-phosphoribosyltransferase) a distinct inhibitory effect of oxyphenbutazone and flufenamic acid was noted. A particularly marked effect was observed on adenine-phosphoribosyltransferase at the applied concentration (50 mug%) by both drugs but also guanine-phosphoribosyltransferase and hypoxanthine-phosphoribosyltransferase indicated reduced activities.

[Therapeutic efficacy of slow-release allopurinol in gout and hyperuricaemia (author's transl)]. / Zur Frage der therapeutischen Wirksamkeit von Allopurinol in retardform bei Gicht und Hyperurikämie.

The efficacy of a retard preparation of allopurinol is verified by biochemical, pharmacological and clinical investigations. The action of a 300 mg allopurinol tablet, with normal release and absorption parameters, is based on the specific activity of oxypurinol, a metabolite which is formed from allopurinol according to a biotransformation process. The inhibitory action of oxypurinol on xanthine oxidase amounts to only 1/5th of that of allopurinol. On the other hand allopurinol shows an extremely short half life, so that a slow-release preparation of allopurinol seems the better way of administration to get adequate uricostatic efficacy by a single dose over a 24-hour period.

[Antinuclear antibodies in ankylosing spondylitis (author's transl)]. / Antinukleäre Antikörper bei Spondylitis ankylosans (Morbus Bechterew).

Antinuclear antibodies (ANA) were found in 19.1% of patients suffering from ankylosing spondylitis (n = 320). This figure is significantly higher than the results obtained in a control group. ANA were present in all stages of the disease, including the abortive form of isolated sacroiliitis. ANA were also found in different stages of activity. In addition, ANA-positive cases showed a higher inflammatory activity. In females ANA were more frequently found than in males. There was a positive correlation between ANA and HLA B27 in 87.2%.

[Immunological features in ankylosing spondylitis (author's transl)]. / Immunphänomene bei Spondylitis ankylosans (Morbus Bechterew).

Sera from 50 patients with various stages of ankylosing spondylitis were tested for the presence of antinuclear antibodies (ANA), anti-DNA antibodies, rheumatoid factor and antistreptolysin. Antinuclear antibodies (immunofluorescent technique) were detected in the sera of 10 patients (20%), associated in one case with anti-DNA antibodies (immunofluorescent technique). The disease activity in ANA-positive cases was low to moderate.

[Cellular and humoral immune phenomena in psoriatic arthritis]. / Untersuchungen über zelluläre und humorale Immunphänomene bei der Arthritis psoriatica.

The function of cellular immunity factors (lymphocyte transformation and phagocytosis by polymorphonuclear leucocytes [PMN] and monocytes in connection with the concentration of intracellular ATP) and humoral immunity factors (serum concentration of immunoglobulin and complement factors C'3 and C'4) was investigated in 16 controls, 21 patients with psoriatic arthritis and 19 with psoriasis vulgaris. The results were compared with the clinical and anamnestic data of the patients. PMN phagocytosis of zymosan opsonized with rabbit standard serum was decreased in psoriasis vulgaris in comparison with the controls. Also, monocyte phagocytosis of non-opsonized zymosan was decreased in psoriatic arthritis, as compared with psoriasis vulgaris. Furthermore, in PMNs intracellular ATP was elevated in psoriatic arthritis as compared with the controls, but decreased in comparison with patients with psoriasis vulgaris. The intracellular ATP in monocytes was decreased in psoriasis vulgaris as compared with the controls. Humoral immunological findings: serum IgG concentration was higher in psoriatic arthritis than in controls and in psoriasis vulgaris. Elevated C'3 and decreased C'4 serum concentrations in psoriatic arthritis indicate an activation of the complement system.

The effect of a cartilage bone marrow extract on experimentally induced osteoarthrosis in the knee joints of rabbits. A scanning electron microscopic study.

The development of osteoarthrosis following a partial meniscectomy on the knee cartilage of rabbits (Chinchilla hybrids) was monitored with a scanning electron microscope. Simultaneously, a study was made of the effect of the cartilage bone marrow extract Rumalon trademark on the development of the osteoarthrotic changes. Twelve days after the operation, osteoarthrotic changes were evident in the untreated operated joints. After 36 days the damage caused to the cartilage was already radical. The immobility of the operated joint also gave rise to obvious changes in the cartilage of the knee joints which had not undergone an operation. The irregular weight distribution due to the fixation of one joint was apparently enough to provoke degenerative processes on the other side. When the cartilage bone marrow extract Rumalon trademark was administered three times weekly (0.5 mg/kg body weight i.m.) a distinct retardation of the osteoarthrotic development in the early stages was observed. Where the changes had penetrated to the inner cartilage layers, no difference could be established compared to the untreated animals.

The influence of synovial fluids from patients with rheumatic diseases on chick embryo fibroblasts.

Primary chick-embryo fibroblasts (PCEF) were used as target cells to measure the influence of synovial fluids of patients suffering from osteoarthritis (OA; n = 5), rheumatoid arthritis (RA; n = 12) and psoriatic arthritis (PA; n = 2). The following metabolic cell products were measured: DNA, RNA, glycosaminoglycans (GAG), sulfated glycosaminoglycans, protein and collagen, with the same joint effusions being used in each test. Since it is not a single substance that provokes a stimulating or inhibiting effect in the joint, the crude synovial fluids were applied in these preliminary experiments. It was found that each type of synovial fluid showed an influence on the biological processes in the PCEF. The DNA, RNA and GAG syntheses were strongly influenced by the joint effusions, in contrast to the protein, collagen and sulfated glycosaminoglycan syntheses which were less affected. Generally, the nucleic acid synthesis differed significantly between the OA, RA and PA synovial fluids. The addition of heparin to the synovial fluids caused an additive inhibiting effect on the DNA synthesis but did not influence the other biochemical parameters. The synovial fluids of RA patients, and to a much greater extent those of PA patients, inhibited the thymidine incorporation whereas OA synovial fluids had a less pronounced effect. This result indicates a disease-dependent composition of the synovial fluids. RNA synthesis was diminished in all three groups, but again this effect was strongest in the case of the PA synovial fluids. GAG synthesis was markedly stimulated by the PA synovial fluids and somewhat, though to a lesser extent, by the OA and RA synovial fluids. The sulfated glycosaminoglycan synthesis in the PCEF, as revealed by 35S incorporation into the GAG, was less influenced and on the whole stimulated by the OA and RA synovial fluids. The same trend could be observed with regard to the collagen synthesis. The intracellular protein synthesis was less influenced by the OA (91.9%) and more strongly suppressed by the RA (78.7%) and the PA (76.7%) synovial fluids. PCEF therefore appear to be a convenient and sensitive target cell system to study alterations of biochemical processes caused by crude synovial fluids and also of different origin by individual factors isolated from synovial fluids.