[Technic and results of rib hump resection in thoracic scoliosis]

Description of operative procedure acc. to Naravcevic for treatment of rib hump in thoracal scoliosis (partial resection of ribs, segmental shifting) and of possible complications (injury of pleura). The indication for operation is only given by cosmetic and psychologic reasons. Report about 48 patients of Orthopedic University Hospital of Homburg/Saar who underwent operative treatment between 1975 and 1983. The average age at time of operation was 19.3 years. The most popular fixation of the resected ribs was by end-to-end connection and Mersilene-suture. There were no severe complications. The subjective results were altogether very satisfactory. The clinical control showed and average correction of the height of the rib hump of about 50%.

[Effects of the hemodialyzer on blood gases and acid-base equilibrium]

During bicarbonate and acetate dialysis the blood gas parameters and the acid-base balance values were measured before and after the dialyzer. Significant changes of these values are revealed after the dialyzer passage of the blood. This result constrains to a decoupled approach of the entire system organism-extracorporeal circulation, when the interpretation of values measured in the arterial part of this system and the judgment of the haemodialysis system following from this are concerned.

[Results of scintigraphy with labeled leukocytes for the diagnosis of infectious hip prosthesis loosening]

The present paper reports on the results of a specific scintigraphic examination method for diagnosing infections in cases of loosening of hip prostheses by means of labeled granulocytes. In 103 patients the result of the examination was compared with the result of the bacteriological and/or histological investigation following removal or replacement of the implant. Where there was an infectious loosening of the prosthesis the findings were in agreement with the results of the scintigraphic examination in 83.1% of the cases. It was possible to rule out infectious loosening of the prosthesis in 93% of the cases thus investigated.

[Apposition acetabular roof surgery with screw osteosynthesis and use of wedge osteotomy in intertrochanteric femur osteotomy]

After introductory presentation of the different methods of roofplasty of the hipsocket (including the osteotomies of the pelvis) relative to indication, advantages and disadvantages we describe a new technique of roofplasty for older children, adolescents and grownups, in which the wedge of the intertrochanteric femur osteotomy--up to now a by-product is used for a roofplasty similar to the combined operation with children. We give a presentation of the vertical and transverse apposition technique and especially of the advantage of the compression screw osteosynthesis. In particular we make a comparative evaluation to the concurrent pelvic osteotomy after Chiari. Above all we give a report of the experiences with 62 patients with 67 operations within a period of 7 years (1976-1982): We report the subjective and objective results. In general we achieved very satisfying results with a very low rate of complications.

[Operative long-term results in delayed radius head dislocation in childhood]

Only some cases and no long term follow-ups are reported in literature concerning the problem of delayed luxations of the radial head in children. 21 cases (19 acquired and 2 inherited) were treated in our hospital by operative procedure 12.5 months after the accident on the average. Disregarding one early and one late resection of the radial head we reconstructed the joint reposition and annular ligament plasty and if necessary correction osteotomy of the ulnar or shortening of the radius. Follow-up examination took place between 2 and 16 years after the operation, 7.9 years on the average. A reluxation was observed in 2 cases, a subluxation in 1 case. 2 patients showed a wrong axis and 4 patients signs of a beginning radio-humeral arthrosis, but most results were good or satisfactory. Therefore a reconstruction of a luxation of the radial head in children is recommended in delayed cases (sometimes in combination with a correction osteotomy of the ulna or radius) in contrast to other authors.

[Surgical treatment of arthritis of the thumb saddle joint]

First the etiology, clinical signs and differential diagnosis of the basal joint of the thumb are represented. Then a short summary is given about the possibilities of conservative and operative therapy. In operative treatment, there are techniques of maintaining the flexibility of this joint as well as the arthrodesis. In our clinic we prefer operative techniques by removal of the multangulum majus or implantation of an artificial joint (Francobal-endoprosthesis). The results of our 22 patients, who had an operation of an arthritis of the basal joint of the thumb were controlled clinically and radiologically. We specially controlled the function and stability of the thumb and if the patient was able to manage his occupation. In arthritis of the basal joint of the thumb, the excision of the multangulum majus had good results and may be recommended. The arthroplasty of this joint had good early results, too. Here late results remain to be seen.

[Lunate malacia and its treatment with lunate excision]

The malazie of the Os lunatum ist one of the most frequent aseptic bone-necroses. It is found mainly with patients between the age of 25 and 35 years. That means that most of our patients are working full time. We give a clinical report of the disease and discuss the different aetiopathogenetic mechanisms according to the literature. In addition we give a cronological survey over possible methods of treatment both conservative and operative. We describe our method of treatment introduced by Mittelmeier (1965). In this method the gap that arises by resection of the Os lunatum is filled with a helved piece of soft tissue. This filling-material consists of a volar helved piece of the joint-capsula and of epitendinosus tissue of the deep flexor-tendons. In the Orthopaedic University Hospital in Homburg/Saar we have a casuistic of 42 cases treated by this method. This is the biggest casuistic in the literature as fare as we know. We report our results of treatment based an a clinical and X-ray examination. With this method we had satisfying longterm results in 80% of the cases. Even after years we hardly found an arthrosis between Os naviculare and radius. According to these results we recommend the method after Mittelmeier for the treatment of the malazie of the Os lunatum even for severe cases with fragmentation and collaps of the Os lunatum.

[Follow-up results following Matti-Russe grafting in navicular pseudarthrosis]

The navicular pseudarthrosis is in case of early and appropriate treatment of the navicular fracture relatively seldom. It develops often after a too late diagnosed or insufficiently treated navicular fracture. After an introduction of the pathogenetic causes of the navicular pseudarthrosis we give a survey over the operative methods of treatment represented in literature favourising the method of the implantation of a corticospongious bone-graft after Matti in the modification of Russe, which we prefer in our hospital. We base the long-term results of our treatment on a casuistic of 105 patients, operated after the method Matti-Russe. We performed a follow-up of 68 patients between 3 and 16 years after the operation (8,4 years on average). In our critical examination we put stress on the functional results, on the subjective and objective sucess of the operation, on the professional situation of the patients and its social-medical meaning. At last we give a comparison with the most extensive casuistics of the literature.

[Therapeutic attitude of kidney transplantation patients--initial results of a psychological test study]

After kidney transplantation the patient is subject to psychological stress due to problem situations. To date these problems have described only in very general clinical terms. Initial results of a psychological study on 26 kidney-transplant patients allow us to recognize factors which influence the patients' attitude to the disease and therapy. Such factors are: success of therapy, emotional tension, attitude towards the doctor and the self-confidence of the patient. The doctor-patient relation corresponds to the attitude towards therapy only in the immediate post-operative period and in patients with a negative attitude towards therapy. In the assessment of the doctor-patient relation it is only of medium importance whether the patient likes the doctor. The Study is being continued.

Heparin binding and release properties of DEAE cellulose membranes

Two cellulose-based membranes, containing 5 and 20% N, N-diethyl-aminoethyl cellulose (DEAE) respectively, were investigated for ionic attachment of heparin and heparin release. Heparinization was achieved by recirculation of a heparin-containing glycine buffer over each membrane. Heparin was determined by chemical analysis or by 99mTc labelling. The heparin uptake was shown to be linearly dependent on the heparin content in the contacting fluid. Heparin release was studied by contacting heparinized membranes with saline, glycine buffer, phosphate buffer and plasma. Incubation with plasma brought about the release of 50% of the attached heparin. Crosslinking of the heparinized membrane with glutaraldehyde reduced the heparin release by one half. The release reaction is more critical in the case of increased heparin uptake and a more efficient immobilization of heparin appears necessary.

[Treatment of irreparable scaphoid bone pseudarthrosis and necrosis by partial resection of the scaphoid]

After review of the literature on scaphoid pseudarthrosis and resection, the authors give an evaluation of twenty-five palliative operations for non-reconstructible scaphoid pseudarthrosis, (some in combination with resection of the styloid process). The results were generally good. Failures are found only in cases of insufficient proximal scaphoid resection or of preoperative wrist arthrosis which was too advanced. Partial resection of the scaphoid seems in most cases preferable to the alternative trans-scapho-lunar resection (resection of the lunate and the proximal half of the scaphoid as recommended by Steinhäuser). This bigger intervention seems justified only in cases of advanced arthrosis of the proximal wrist. In cases of severe generalised wrist arthrosis, however, arthrodesis is recommended.

[Incidence of bacterial infections during hemodialysis treatment]

44 chronic hemodialysis patients were evaluated over a period of 24 months regarding location and kind of bacterial infection, hospitalization, influence on rehabilitation and the course of infection episodes (IE). During 409,5 dialysis patients months (DPM) we observed 61 IE's, i.e. 14,9 IE per 100 DPM. Out of 59 hospitalization episodes 33 (56%) were due to bacterial infections. 774 from 1559 hospital days were caused by infections. In 6 cases IE was the cause of death. It could be excluded that duration of dialysis treatment, renal disease or uremic complications are correlating with bacterial infections.

[Indication and results of an alloarthroplastic hip joint replacement with the "crutch" endoprosthesis]

After discussing the relevant literature concerning indication, results and complications of total-hip-replacement by special prothesis of the upper end of the femur in cases of tumors or serious traumatic bone destructions of the intertrochanteric region of elder patients we representate our own 30 patients (from the years 1973 to 1982). Often, this special prothesis could be only a palliative regional solution in the cases of local removal of the tumor because of the advanced disease. But this treatment is important for temporary reconstruction; even in cases of aged patients with serious fragmented fractures of the pertrochanteric and subtrochanteric region we could reach an early remobilisation. This operation represents--in certain indications--an essential improvement of therapeutic facilities.

[Effect of the plan of therapy on prognosis in thyroid cancer]

The therapeutic concept used in our Department for the treatment of thyroid cancer is characterized by a facultative external irradiation of the neck region and by a mandatory and intense treatment with radioiodine. The latter includes a complete elimination of remaining normal thyroid tissue and a combined diagnostic add therapeutic radioiodine application in the follow-up of the disease. The therapeutic effect of surgery, hormone substitution, radioiodine treatment and external irradiation combined with the prognosis of thyroid cancer was obvious, but that of individual steps was difficult to separate and quantitate. External irradiation of the neck improved the prognosis of patients with anaplastic carcinoma but no significant effect was observed in patients with follicular carcinoma. Even after prophylactic treatment with high doses of radioiodine the prognosis of differentiated thyroid cancer remained to be highly dependent on biological factors. Radioiodine treatment is recommended in all patients with follicular carcinoma and in patients older than 30 years with papillary carcinoma, but prophylactic treatment should only be performed for a period of 5 years.

[Pregnancy after kidney transplantation. Report of 6 successful cases with multiple risk factors]

The long-term course before, during and after successful pregnancy in six women 3 to 6 years after receiving CD-kidney transplants from dead donors is described. Multiple risk factors such as hypertension, considerable proteinuria, preceding rejection crises etc. have been taken into account. The analysis includes the observation of a pregnancy which began already in the 1st month after transplantation. With the exception of a patient with hydronephrosis, whose functional data remained normal, the transplants of all patients showed better functional data after delivery than before pregnancy (maximum period of observation: 5 years 3 months post delivery). The patients mainly received alternating prednisolone therapy. Immunosuppression was generally reduced in the second trimester and was temporarily increased above the maintenance dosage after delivery. All children were eutrophic at birth and developed normally without complications. Important factors leading to the good overall clinical result were intensive out-patient care and the cooperation between nephrologists, urologists, gynecologists and neonatalogists. Despite our very good experience with 6 pregnancies successfully carried to full term by women with kidney transplants, the risk for mother and child should only cautiously be estimated, taking into account the results of future larger studies.

[Bipartite lunate bone]

A review on the existing literature shows that the os lunatum bipartitum is an rarely seen morphological variation of carpal bones. Clinical and radiological sings and the resulting treatment are demonstrated at a patient suffering from such an abnormality. The differential diagnostic problems as to the etiology of similar skeletal alterations are discussed.

Long-term clinical investigation of patients with ankylosing spondylitis treated with 224Ra

Between 1952 and 1980 about 250 patients with ankylosing spondylitis were treated with 224Ra at the Orthopaedic University Hospital of Frankfurt/M. In 1970, 119 of them were examined and X-rayed as was another group of 40 patients in 1980. The results of those examined could be compared with a group of patients treated without 224Ra. Patients with 224Ra demonstrated a long-lasting period of subjective improvement after the treatment, with reduced consumption of antirheumatoid and analgesic drugs, on the average. Blood examinations show inflammatory activities. Nevertheless, the ankylosing spondylitis proceeded. In the final stages of the disease, neither the clinical aspects nor the X-rays showed any specific effect due to 224Ra. Blood examinations, especially blood cells and liver, had shown no specific changes. We observed no case of malignant bone tumor. Of the 169 examined patients, 22 had a total of 32 children after the treatment with 224Ra. Among these was a set of twins with cerebral palsy and diabetes insipidus renalis. In conclusion, 224Ra in ankylosing spondylitis is a recommended treatment without higher risk compared to the common therapy with drugs.

[New aspects of steroid therapy of glomerulonephritis]

The results of a 6-month Prednisone therapy (initial 60 mg/d with later reduction of dose) are given as the immediate results of therapy (after 6 months in 128 patients) and as a late result (after 11 years in 107 patients). The course is evaluated on the basis of clinical symptoms. The early effect proved to be an improvement in 2/3 of all cases, whereby 22% were total remissions. In the late results patients with primary total remission showed the best functional results. This therapy is justified in nephrotic, proteinuric-hypertonic, purely proteinuric and proteinuric-haematuric forms of mesangioproliferative glomerulonephritis.

An autosomal dominant syndrome of radial hypoplasia, triphalangeal thumbs, hypospadias, and maxillary diastema

We describe a family in which eight persons (three males, five females) in three generations had a syndrome of bilateral and strikingly symmetrical triphalangeal thumbs and radial hypoplasia. The affected males also had a first-degree hypospadias and all affected family members had an anterior maxillary diastema. The syndrome was inherited in an autosomal dominant fashion.

Cellular immunity in glomerulonephritis

58 patients (25 with GN, 13 with PN, 10 with hypernephroma, and 10 healthy controls) were tested for t-cell activity against glomerular basement membrane antigen (GBMA), total renal antigen (TRA), hypernephroma antigen (HyA), HEP, and PPD by means of the electrophoretic mobility test described by Field and Caspary. Positive reactions to GMBA were demonstrated in 21 to 25 GN patients, and 2 of 13 PN patients. There was no reaction among the hypernephroma patients or the controls. Lymphocytes from all 10 hypernephroma patients, but only 1 of the other 37 patients tested, were sensitized against HyA. No conclusion may be drawn regarding the pathogenetic relevance of the findings, but attention is drawn to the diagnostic value of tests based on these results.