[Complaints of patients with dysphonia]. / Klagsamkeit von Patienten mit Dysphonien.

BACKGROUND: In this study, the problems and difficulties experienced by German-speaking voice patients were assessed using a structured questionnaire. METHODS: A total of 54 patients, 30 women and 24 men, aged 48.5+/-15.8 years suffering from benign organic and functional voice disorders, underwent systematic phoniatric examination including a detailed interview about the voice problem. The same procedure was applied to 56 age and gender matched normal control persons. RESULTS: There were no significant gender or diagnosis-related differences concerning the number and type of symptoms and symptom-related complaints (p>0.05). Most patients (88.9%) felt disturbed by their voice problem in a total of 118 different daily situations. CONCLUSIONS: The way patients experience voice disorders does not depend on the origin of the disorder and not on the gender. The data allow the conclusion that the case history of dysphonic patients can be assessed by a structured voice interview.

Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting.

OBJECTIVE: Retrospective comparisons of selected patients undergoing off-pump versus conventional on-pump coronary artery bypass grafting have yielded inconsistent results and raised concerns about completeness of revascularization in off-pump coronary artery bypass grafting. METHODS: Two hundred unselected patients referred for elective primary coronary artery bypass grafting were randomly assigned to undergo off-pump coronary artery bypass grafting with an Octopus tissue stabilizer (Medtronic, Inc, Minneapolis, Minn) or conventional coronary artery bypass grafting with cardiopulmonary bypass by a single surgeon. Revascularization intent determined before random assignment was compared with the revascularization performed. All management followed strict, unbiased, criteria-driven protocols. Patients and nonoperative care providers were blinded to surgical group. RESULTS: Baseline characteristics were similar. The number of grafts performed per patient (mean +/- SD 3.39 +/- 1.04 for off-pump coronary artery bypass grafting, 3.40 +/- 1.08 for conventional coronary artery bypass grafting) and the index of completeness of revascularization (number of grafts performed/number of grafts intended, 1.00 +/- 0.18 for off-pump coronary artery bypass grafting, 1.01 +/- 0.09 for conventional coronary artery bypass grafting) were similar. Likewise, the index of completeness of revascularization was similar between groups for the lateral wall. Combined hospital and 30-day mortalities and stroke rates were similar. Postoperative myocardial serum enzyme measures were significantly lower after off-pump coronary artery bypass grafting, suggesting less myocardial injury. Adjusted postoperative thromboelastogram indices, fibrinogen, international normalized ratio, and platelet levels all showed significantly less coagulopathy after off-pump coronary artery bypass grafting. Patients undergoing off-pump coronary artery bypass grafting received fewer units of blood, were more likely to avoid transfusion altogether, and had a higher hematocrit at discharge. Cardiopulmonary bypass was an independent predictor of transfusion (odds ratio 2.42, P =.0073) by multivariate analysis. More patients undergoing off-pump coronary artery bypass grafting were extubated in the operating room and within 4 hours. Postoperative length of stay (in days) was shorter for off-pump coronary artery bypass grafting (5.1 +/- 6.5 for off-pump coronary artery bypass grafting, 6.1 +/- 8.2 for conventional coronary artery bypass grafting, P =.005 by Wilcoxon test). One patient (in the conventional coronary artery bypass grafting group) required angioplasty for graft closure within 30 days. CONCLUSIONS: When compared with conventional coronary artery bypass grafting with cardiopulmonary bypass, off-pump coronary artery bypass grafting achieved similar completeness of revascularization, similar in-hospital and 30-day outcomes, shorter length of stay, reduced transfusion requirement, and less myocardial injury.

[Injuries and overuse disorders in sports climbers: 2 case reports]. / Verletzungen und Uberlastungsbeschwerden bei Sportkletterern: zwei Fallbeispiele.

This is a report on frequent complaints of sportclimbers. A lesion of annular ligament in the ringfinger is described. Chronic swelling of the PIP joint is shown to demonstrate a frequent overuse syndrome and the possibilities in diagnosis and treatment.

[Transitory hip osteoporosis in magnetic resonance tomography]. / Die transitorische Hüftosteoporose in der Magnetresonanztomographie.

Transient osteoporosis of the hip (a rare clinical picture which was difficult to diagnose up to now) shows a typical signal response in Magnetic Resonance Tomography. This enables diagnosis of the disease in a single investigation. In this way, unnecessary investigations can be avoided and therapeutic consequences can be implemented as soon as possible. Magnetic Resonance Tomography is also the most sensitive technique in order to describe the course of transient osteoporosis of the hip.

[The transitory bone marrow edema syndrome of the hip]. / Das transitorische Knochenmarködemsyndrom der Hüfte.

AIM OF THE STUDY: Since MRI-studies had begun to establish the diagnosis of transitory bone marrow edema syndrome of the hip orthopedic surgeons have tried to integrate this new syndrome into the internationally accepted system of musculoskeletal diseases. Particularly, the relation to non-traumatic osteonecrosis of the femoral head and the possibilities in therapy were investigated in our clinical trial. METHODS: Our clinical trial encompassed 106 patients suffering from the transitory bone marrow edema syndrome diagnosed in our department between the years 1985 and 2000. In order to confirm this diagnosis we used the patients' histories, their clinical courses, MRI studies, scintigraphic bone scans, intraosseal pressure measurements, phlebographies, laboratory data, and histologic specimens. One half of our collective positive for transient bone marrow edema of the hip underwent core-decompression surgery (50 patients), the other half (56 patients) was treated conservatively by analgesic medication combined with restriction of weight-bearing in the affected extremity. RESULTS: Patients positive for transitory bone marrow edema syndrome of the hip are middle-aged individuals with a male to female predominance of 60 : 40. This group has no or only few risk factors usually associated with osteonecrosis of the femoral head. Thus, the missing alcoholic abuse is striking. All patients suffering from transitory bone marrow edema syndrome of the hip recovered completely independent of the therapy we initiated and none of them showed any signs of osteonecrosis. The one half undergoing surgical decompression of the edema by using a 4.5 mm drill experienced an markedly accelerated relief of their clinical symptoms as well as their signal changes on MRI studies. Conventional X-ray pictures and scintigraphic bone scans are not useful for early differentiation between early stages of osteonecrosis and bone marrow edemas. This also accounts for the historical measurements of intraosseal pressure determinations and phlebographies. In contrast to that, MRI studies are effective in early differentiation between osteonecrosis and bone marrow edema syndrome of the hip, especially when contrast medium (gadolinium) is administrated intravenously and fat-suppressed MRI-sequences find use. Beginning osteonecrosis of the femoral head shows a segmental loss of contrast medium, a "double line sign" interface to the intact bone marrow, and only in a few cases they are associated with a huge symptomatic edema. The histologic examination of specimens obtained from 43 patients with transitory bone marrow edema syndrome of the hip revealed no signs of osteonecrosis. CONCLUSION: MRI studies are useful in differentiation between bone marrow edema syndrome of the hip and non-traumatic osteonecrosis of the femoral head in each stage of these two diseases. The thorough differentiation between these two diseases is of extraordinary importance for the clinical work-up of the patients as well as for scientific reasons. The course of primary bone marrow edema is benign as it results in entire recovery. The core decompression surgery offers the chance to shorten the course of the disease.

[Differential diagnosis of pediatric hip pain in MR tomography]. / Beitrag zur Differentialdiagnose des kindlichen Hüftschmerzes in der MR-Tomographie.

The efficiency of spin echo tomography in the differential diagnosis of hip joint pain in children in comparison with other imaging methods was tested in 115 spin echo tomography examinations of 68 patients. By means of the different modes available it was possible to determine joint effusion, necrosed areas and the formation of abscesses with great accuracy. In the case of Legg-Calve-Perthes disease the MRT is especially in the early diagnosis superior to the other Methods, already in the early stage a classification in the four Catterall groups was possible. Furthermore the "head at risk" signs, except the gage-sign, were better to describe by BRI than by conventional x-rays. The MRT allows an exacter staging and a better observation of the course of disease, especially the beginning of the revitalisation of the femora epiphysis in earlier and clearer visible than in other imaging methods. Further diseases like epiphysial dysplasie, specific and unspecific coxitis and slipped capital femora epiphysis were also investigated. We regard spin echo examination in the differential diagnosis of hip pain in children indicated by the following criteria: 1. with over six weeks uncertain differential diagnosis of coxitis fugax and Legg-Calve-Perthes disease 2. with Legg-Calve-Perthes disease in the early stage for therapy option 3. with TBC- and non-TBC-coxitis as a therapy attend and diagnostic measure.

Replantation of the hallux by microsurgical techniques.

In this report three cases of successful hallux replantation are presented. The indications for this type or surgery are discussed on the basis of the functional results of these replantations. In our opinion, corrective surgery is indicated in all cases of traumatic hallux and/or multiple-toe amputations.

[Teleradiology with personal computers]. / Teleradiologie mit Personalcomputern.

A system to transmit radiographic images with the aid of a personal computer (PC) via phone line is presented. The pictures are recorded by a camcorder and digitized by the PC. They are sent to the receiver by a modem via phone line. The different steps can be programmed. MR and CT pictures as well as ordinary x-ray pictures have been transmitted. It takes about 45 s to send a picture. It arrives in good quality, and findings are clearly represented. After the sending process is completed, all pictures can be reviewed in seconds. The presented system is interesting for its low price when a PC is available.

[Imaging the spinal cord in scoliosis in magnetic resonance tomography using the 3D Fourier procedure]. / Darstellung des Myelons bei Skoliosen in der MR-Tomographie mit dem 3D-Fourier-Verfahren.

Recent progress in MR-imaging allows to acquire an entire volume using 3D-Fourier-processing, resulting in an isotope spatial resolution with a voxel-size of about one cubic millimeter. Acquisition time for a matrix of 256 x 256 x 128 amounts to less than 15 minutes, if gradient-echo-sequences are applied (FLASH/FISP). The information contained in such a huge number of data is retrieved with the aid of a special rapid data processing system. Using 3D-Fourier analyses, Spinal cord is imaged very clearly even in cases of extreme kyphoscoliosis. The cord is demonstrated by arbitrary, even curved one Millimeter slices. In addition to that the acquisition of data takes only 15 minutes, which is definitely more rapid than 2D-Fourier. Details can be figured out in a very high precision. This allows to distinguish details such as vessels, small masses and nerve roots. Furthermore the signal-to-noise-ratio of 3D-sequences is higher than in multi-slice-technique. A decisive advantage is the possibility to compute curved planes in post processing of the 3D-data-sets.

[The fixed lumbar lordosis due to slipped disks]. / Die Bandscheiben-bedingte Hüft-Lenden-Strecksteife bei Jugendlichen.

The fixed lumbar lordosis is represented by a group of characteristic symptomes; they specifically happen to the LWS of adolescents which are in a specific pathogenic situation. The cause of the fixed lumbar lordosis is almost a slipped discus. The case of an adolescent is presented, who had two operations because of twice slipped discus in one year.

[Changes in blood flow characteristics as a cause of non-traumatic femur head necrosis]. / Veränderungen der Fliesseigenschaften des Blutes als Ursache der nichttraumatischen Hüftkopfnekrose.

Most authors associate avascular necrosis of the femoral head with ischemia, caused by injuries or diseases of the nutrient vessels or by alteration of the hemorheology. We examined the rheological properties of the blood in 39 patients with nontraumatic avascular necrosis of the femoral head by following tests: viscosimetry, filtrometry and aggregation of red blood cells. Aggregation of red blood cells showed statistically significant pathologic alterations. Our results confirm that irreversible agglutination phenomenons followed by ischemia can be caused by 1. stenosis or obliteration of nutrient vessels 2. rheologic alterations of the blood.

[Activity of plasminogen activators and plasmin inhibitors in the joint capsule in various articular diseases (author's transl)]. / Untersuchungen über die gewebeständige Plasminogenaktivator- und Plasmininhibitoraktivität von Gelenkkapseln bei verschiedenen Gelenkerkrankungen.

The activity of plasminogen activators and plasmin inhibitors in articular capsules of the hip and knee joints in rheumatoid arthritis, chronic traumatic inflammation, arthrosis and aseptic loosening of prosthesis was determined histochemically and correlated with the degree of mobility in osteoarthrosis of the hip. Microscopically unchanged articular capsules were employed as reference sites. In inflammatory articular diseases the plasminogen activator activity was significantly reduced, whereas it remained unchanged in arthrosis and necrosis of the heas of the femur, and significantly enhanced in aseptic loosening of prosthesis. Plasmin inhibitor activity was established in joint capsules with inflammatory changes only; in case of rheumatic inflammation, it was higher than with traumatic inflammation. In osteoarthrosis of the hip there is a positive correlation between joint mobility and plasminogen activator activity. The results point towards involvement of the local fibrinolytic system in joint diseases; however, no definite statement can be made with regard to possible causative linkups.

[Proton spin tomography in children and adolescents with so-called idiopathic scoliosis]. / Kernspintomographische Untersuchungen bei Kindern und Jugendlichen mit sogenannter idiopathischer Skoliose.

Somato-sensory evoked potentials (SSEP) were found to be pathological mostly in the lower extremities in 26 out of 45 children suffering from so called idiopathic scoliosis. We examined the vertebral spine and the spinal cord of 8 of them (with controlled SSEP-findings) by use of conventional MR-imaging and (where necessary) 3-dimensional-data-set following the Fournier-procedure. 6 of the 8 children showed alterations as follows: 1. A lipoma spreading partly extra-, partly intraspinally. 2. Subligamentous protrusions of the intervertebral disc (2 patients). 3. Dysraphic processes (2 patients). 4. An abnormally cranial ending myelon surrounded by a widened spinal channel. The findings are demonstrated and discussed concerning the questions whether the pathological SSEP and, furthermore, the deformity of the vertebral spine could be explained thereby. We are at least able to prove that some of the children with so called idiopathic scoliosis show pathological evoked potentials and MRI-findings.

Long-term follow-up results of 97 finger replantations.

From a total number of 664 finger replantations (DII-DV) we were able to carry out a follow-up of 97 postoperative cases using the follo-wing assessment criteria: mobility, sensitivity, type of amputation, mechanism of injury, level and extent of amputation. Subjective criteria were also taken into account. Using the results of the study we have been able to formulate an evaluation as to the absolute indication for operation of fingers DII-DV.

[Osteoporosis in inflammatory bowel disease - results of a survey among members of the German Crohn's and Ulcerative Colitis Association]. / Osteoporose bei chronisch entzündlichen Darmerkrankungen - Ergebnisse einer Umfrage an Mitgliedern der Deutschen M. Crohn und Colitis ulcerosa Vereinigung (DCCV).

INTRODUCTION: Osteoporosis is a frequent and clinically important complication in inflammatory bowel disease (IBD). Prevalence and risk factors have been examined in small numbers of patients. With a nationwide survey of members of the German Crohn's and Ulcerative Colitis Association (DCCV) we wanted to evaluate the situation in a larger group of patients. METHODS: Questionnaires were sent with the autumn issue of the members journal to approx. 14,620 affected members of the DCCV. Items covered osteoporosis, clinical symptoms, anamnesis and sociodemographic topics. Results are presented as descriptive analysis and in a logistic regression analysis of factors contributing to the osteoporosis risk. RESULTS: 2,536 questionnaires could be used (17.3 %). Mean age and distribution concerning diagnosis and gender were comparable to the DCCV members in total. The prevalence of pathologic bone density was 62.3 % in those 1,265 patients (50.1 %) who underwent bone densitometry in the course of their disease. The analysis led to the following possible risk factors: disease activity (high chronic activity or more than 1 acute flare annually vs. remission, p < 0.001), lifetime steroid dosage > 10 g (p = 0.002), Crohn's disease vs. ulcerative colitis (p = 0.02), multiple bowel resection (p = 0.032), age (p = 0.018) and low body mass index (p = 0.034). 83.4 % of the patients with pathologic bone density received specific therapy, but most of those (63.5 %) were solely substituted with calcium and vitamin D. CONCLUSION: This is the first study looking at epidemiology and risk factors of osteoporosis in a large study population of patients with inflammatory bowel disease. Although the prevalence may be overestimated due to selection bias in our study, osteoporosis is confirmed as a frequent and clinically relevant complication in IBD. Bone densitometry is recommended in those patients with one or more risk factors.