Deformational behaviour of knee cartilage and changes in serum cartilage oligomeric matrix protein (COMP) after running and drop landing.

OBJECTIVE: To investigate (1) the effect of running and drop landing interventions on knee cartilage deformation and serum cartilage oligomeric matrix protein (COMP) concentration and (2) if the changes in cartilage volume correlate with the changes in serum COMP level. METHODS: Knee joint cartilage volume and thickness were determined using magnetic resonance imaging (MRI) as well as COMP concentration from serum samples before and after in vivo loading of 14 healthy adults (seven male and seven female). Participants performed different loading interventions of 30 min duration on three different days: (1) 100 vertical drop landings from a 73 cm high platform, (2) running at a velocity of 2.2m/s (3.96 km), and (3) resting on a chair. Blood samples were taken immediately before, immediately after and 0.5h, 1h, 2h and 3h post intervention. Pre- and post-loading coronal and axial gradient echo MR images with fat suppression were used to determine the patellar, tibial and femoral cartilage deformation. RESULTS: Serum COMP levels increased immediately after the running (+30.7%, pre: 7.3U/l, 95% confidence interval (CI): 5.6, 8.9, post: 9.1U/l, 95% CI: 7.2, 11.0, P=0.001) and after drop landing intervention (+32.3%, pre: 6.8U/l, 95% CI: 5.3, 8.4; post: 8.9U/l, 95% CI: 6.8, 10.9, P=0.001). Cartilage deformation was more pronounced after running compared to drop landing intervention, with being significant (volume: P=0.002 and thickness: P=0.001) only in the lateral tibia. We found a significant correlation (r(2)=0.599, P=0.001) between changes in serum COMP (%) and in cartilage volume (%) after the drop landing intervention, but not after running. CONCLUSIONS: In vivo exercise interventions differentially regulate serum COMP concentrations and knee cartilage deformations. The relation between changes in COMP and in cartilage volume seems to depend on both mechanical and biochemical factors.

[Prolonged fever and monocytosis after hemorrhoidectomy and treatment with methotrexate--listeriosis with cerebral abscess]. / Prolongiertes Fieber und Monozytose nach Hämorrhoidektomie unter Methotrexat. Listeriose mit Gehirnabzessbildung.

HISTORY AND CLINICAL FINDINGS: A 58-year-old man was admitted because of septic fever for about one week with onset two weeks after an hemorrhoidectomy. He had been receiving methotrexate (MTX) since boyhood for severe psoriasis. Fifteen years before he had undergone a splenectomy after abdominal trauma. The patient was found to have diminished cognitive functions and memory disturbance, but no focal neurological deficits. INVESTIGATIONS: Laboratory tests were negative for inflammatory disease (normal white blood cell count, CRP and procalcitonin) and serial blood cultures remained sterile. Cranial computed tomography (CCT), done because viral encephalitis was suspected, revealed a large focus in the left hemisphere, further identified as abscess on magnetic imaging. TREATMENT AND COURSE: The patient's fever subsided within two days of treatment with ampicillin and ciprofloxacin. The patient was sent to the department of neurosurgery for further diagnosis. Stereotactic biopsy revealed Listeria monocytogenes. Antibiotic treatment was modified in accordance with the microbiological results and the patient was transferred to a rehabilitation unit. CONCLUSIONS: Lack of pathological levels of CRP, procalcitonin and white blood cell count does not exclude cerebral abscess in a patient with prolonged fever and without marked neurological deficits. Preceding treatment with immunosuppressive drugs, especially MTX, and failing response to cephalosporins should lead to consideration of listeriosis in the differential diagnosis.

[Local fibrinolytic therapy of arterial occlusions of the lower extremity: initial success and clinical outcome]. / Die lokale Fibrinolysetherapie bei arteriellen Verschlüssen der unteren Extremität: Initialer Erfolg und klinischer Verlauf.

INDICATIONS: The efficiency of local fibrinolysis therapy in patients with chronic and acute peripheral arterial occlusions of the lower extremities has been investigated. PATIENTS AND METHODS: A total of 33 patients were examined following a local fibrinolysis therapy (in 14 cases with supplementary percutaneous transluminal angioplasty) for chronic or acute peripheral arterial occlusion of the lower extremities. The success of the intervention was first evaluated by angiography and then by subsequent controls by means of treadmill ergometry. RESULTS: A primary intervention success was achieved in 75.8% (25 of 33 patients) of the cases. In 18.2% (6 of 33 patients) a vascular surgical operation was required within 30 days of the intervention (5 therapy failures, 1 complication of the intervention). In two further patients, vascular surgery was necessary after five or six months. In 22 of the 25 successfully treated patients (92%), the Fontaine stage was reduced by at least one step after an average of 7.6 (range: 1 to 30) months. CONCLUSIONS: Local lysis with or without PTA represents an effective alternative therapy to vascular surgery for the treatment of peripheral arterial occlusions in not immediately endangered lower extremities. On the basis of our results and a survey of the literature, an aid for selecting therapeutic measures for patients with arterial occlusion of the extremities is presented.

[Dissection of the internal carotid artery with ascending thrombosis of the ophthalmic artery as a rare differential diagnosis of post-traumatic amaurosis]. / Dissektion der A. carotis interna mit aufsteigender Thrombosierung der A. ophthalmica als seltene Differentialdiagnose der posttraumatischen Amaurose.

The case of a 30-year-old patient is reported who presented with a right-sided amaurosis fugax and a simultaneous frontobasal fracture that had occurred after a fall. By CT angiography and MRI angiography obstruction of the ophthalmic artery following a dissection of the internal carotid artery with ascending thrombosis could be demonstrated. There was a lack of further neurological deficits because of sufficient perfusion of the cerebral arteries by the arterial circle of the cerebrum. Among the etiological variety of types of posttraumatic amaurosis, this rare cause should be taken into consideration in the etiology, diagnosis and therapy, if appropriate.