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Weigl M, Bartl C, Suttner S, Rauh M, Seelbach-Göbel B, Köninger A. Monozentrische Evaluation der Frühgeburtenrate im ersten Lockdown der SARS-CoV-2-Pandemie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Osteoporosis is still an underdiagnosed and insufficiently therapied widespread disease in Germany. Of the estimated 7 million osteoporosis patients only 1.5 million receive a guideline conform diagnosis and even less receive appropriate treatment. Some 90 % of patients are provided with analgesics but only 10 % receive an effective therapy, although efficacious, well-tested and affordable medications are available. In addition, approximately one half of the patients terminate treatment after only 1 year although according to the results of recent studies the duration of therapy should be at least 3-5 years. In view of the increasing average life expectancy, a consistent management for prevention of fractures associated with osteoporosis is always most important for society, even if only for reasons of costs. Achievement of this target depends on four circumstances: clarification of the origin of osteoporosis and fractures (bone consciousness), prophylaxis of bone loss and fractures (primary prevention), consistent guideline conform diagnostics and therapy (secondary and tertiary prevention) and cooperation of all disciplines in medicine (bone is everybody's business). This article describes the current state of diagnostics (bone density measurement with dual X-ray absorptiometry, FRAX®), prophylaxis of fractures (screening program) and therapy (use of economic and effective medications with low side effects). Novel medications are already undergoing clinical testing and a "healing" of bone reduction with restoration of the normal bone structure is to be expected.
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Affiliation(s)
- R Bartl
- Osteoporosezentrum am Dom, Kaufingerstr. 15, 80331, München, Deutschland.
| | - C Bartl
- Osteoporosezentrum am Dom, Kaufingerstr. 15, 80331, München, Deutschland
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Stengel D, Bartl C. Distale Radiusfrakturen – Evidence is Shlevidence. Unfallchirurg 2016; 119:706-7. [DOI: 10.1007/s00113-016-0220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The article "Evidence based medicine: what it is and what it isn't" published in the BMJ in 1996, is regarded as the foundation of the evidence-based medicine (EbM) movement. Approximately 5 years later David L. Sackett, one of the leaders of the movement, requested all experts to voluntarily abandon their position to make way for young researchers and fresh ideas. Since the term was first coined and the establishment of organizations and platforms fostering the idea, EbM has polarized clinicians and scientists around the world. Clinical and methodological developments during recent years have, however, overtaken the original principles of EbM. This review highlights the core concepts of EbM which have remained unchanged and valid for the current practice of trauma and orthopedic surgery and where revision is needed.
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Affiliation(s)
- D Stengel
- Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland.
| | - S Kirschner
- St. Vincentius-Kliniken gAG, Steinhäuserstraße 18, 76135, Karlsruhe, Deutschland
| | - A Ekkernkamp
- Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland
| | - C Bartl
- Ärztehaus Nymphenburg, Rosa-Bavarese-Str. 1, 80639, München, Deutschland
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Gülke J, Gulkin D, Wachter N, Knöferl M, Bartl C, Mentzel M. Dynamic aspects during the cylinder grip--flexion sequence of the finger joints analyzed using a sensor glove. J Hand Surg Eur Vol 2013; 38:178-82. [PMID: 22526512 DOI: 10.1177/1753193412444399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to assess whether there is a universal pattern of movement of the finger joints while performing a cylinder grip. A sensor glove was used to record the finger joint motion of 48 participants. Our observations showed that when examining the fingers, flexion motion began either at the metacarpophalangeal (MP) or proximal interphalangeal (PIP) joints, with the distal interphalangeal (DIP) joints always last to move (p = 0.0052). The sequence of the joints at the end of the gripping motion was different than at the beginning. Here, the only statistically significant observation was that the DIP joints fully flexed only once the MP joints had flexed fully. Apart from that, it was completely variable which joint reached its final position first or last. The analysis also revealed that synchronization of four identical joints (i.e. the four PIP joints) was significantly higher than synchronization of the 12 finger joints. Although synchronization was already high at the beginning of the flexion motion, it increased significantly by the time the joints completed their movement.
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Affiliation(s)
- J Gülke
- Clinic of Traumatology, Hand, Plastic and Reconstructive Surgery, University of Ulm, Germany.
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Bartl R, Bartl C, Gradinger R. [Drug-induced osteopathies. Drugs, pathogenesis, forms, diagnosis, prevention and therapy]. Orthopade 2010; 38:1245-60; quiz 1261. [PMID: 19888565 DOI: 10.1007/s00132-009-1436-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A number of drugs can have "side effects" on bone metabolism and formation, causing bone atrophy, impaired mineralisation, as well as osteonecrosis. In both clinical and general practitioner settings, these forms of bone damage have been hitherto considered as adverse drug side effects and have received insufficient attention; moreover, they have not been the subject of patient information. Preventive measures are not instigated prior to initiation of medication and even after onset of bone damage, therapeutic strategies are poorly implemented. Even fracture healing with its complex, staged course can be both positively and negatively influenced by a number of drugs and these effects require monitoring. Recommendations regarding practical screening and therapy of drug-induced osteopathies are presented.
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Affiliation(s)
- R Bartl
- Bayerisches Osteoporosezentrum, Medizinische Klinik und Poliklinik III, Klinikum München-Grosshadern, Ludwig-Maximilians-Universität München, München, Deutschland.
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Abstract
Isolated subscapularis tendon tears are rare and often of traumatic origin. Despite specific clinical tests and exact radiological tools (ultrasound, magnetic resonance imaging), these tendon ruptures are often overlooked. For restoration of normal biomechanical joint function, immediate operative reconstruction is recommended. Tears of the upper subscapularis and partial articular-side tendon can be safely managed arthroscopically. The biceps tendon is often involved, and adequate treatment with tenotomy or tenodesis must be given to prevent postoperative pain. Complete subscapularis tendon avulsions should be reconstructed with an open repair technique. Immediate surgical management provides better results than delayed repair.
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Affiliation(s)
- C Bartl
- Abteilung für Sportorthopädie, Technische Universität München, Connollystr. 32, 80809 München, Deutschland.
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Imhoff AB, Bartl C. Die arthroskopische Rotatorenmanschettenrekonstruktion. Arthroskopie 2007. [DOI: 10.1007/s00142-006-0377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Liener UC, Sauerland S, Knöferl MW, Bartl C, Riepl C, Kinzl L, Gebhard F. [Emergency surgery for chest injuries in the multiply injured: a systematic review]. Unfallchirurg 2006; 109:447-52. [PMID: 16773318 DOI: 10.1007/s00113-005-1048-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Severe chest injuries are still associated with significant morbidity and mortality. This systematic review assesses the early operative management of severe chest trauma in multi injured patients with special regard to the priority of the operative therapy. METHODS Clinical trials were systematically sought and collected (MEDLINE, Cochrane and hand searches). Of 618 abstracts, 46 articles were selected for detailed appraisal and were classified into evidence levels (1 to 5 according to the Oxford system). RESULTS Penetrating chest injuries in haemodynamically instable patients require emergency operative therapy. A thoracotomy is also indicated in excessive chest tube output (>1500 ml). An aortic rupture can be treated either by open suture or-in borderline patients-by endovascular stenting. In selected haemodynamically stable patients delayed treatment is also possible. Lesions of the tracheobronchial system should be treated urgently with primary surgical repair. Diaphragmatic ruptures should be closed urgently. Surgical stabilisation of rib fractures with an associated flail chest reduces the ventilator days and the length of intensive care unit stay. CONCLUSION A large part of early surgery for chest injuries is justified because it averts immediate threats to life (level 1c evidence). No randomised and only a few controlled trials have examined the relative value of the different surgical options so far. Long-term data are lacking especially on the safety of endovascular stenting.
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Affiliation(s)
- U C Liener
- Abteilung für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinik, Steinhövelstrasse 9, 89075 Ulm.
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Dietz SO, Bartl C, Magosch P, Lichtenberg S, Habermeyer P. Intra-articular volume assessment in glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 2006; 14:189-92. [PMID: 16133443 DOI: 10.1007/s00167-005-0661-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 02/13/2005] [Indexed: 10/25/2022]
Abstract
It is commonly claimed that instability of the shoulder is associated with an enlarged joint volume. The purpose of our study was to assess the intra-articular volume in acute and chronic glenohumeral dislocation. Sixty-seven patients were examined by intra-articular infusion of saline solution. Three groups could be formed. Group 1 (n = 51) consisted of patients with first time traumatic dislocation, group 2 (n = 8) of cases with recurrent post-traumatic dislocation. The patients of group 3 (n = 8) suffered from impingement syndrome and served as the control group. The joint volume was correlated to the body surface area (BSA). We found a strong correlation between height, sex and intra-articular joint volume. There was no statistically significant difference in joint volume correlated to BSA between the three groups. There is no statistically significant difference in joint volume correlated to BSA in patients with traumatic anterior instability, chronic instability and individuals without glenohumeral instability.
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Affiliation(s)
- S O Dietz
- Department of Shoulder and Elbow Surgery, ATOS-Praxisklinik, Heidelberg, Germany.
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Scheibel M, Bartl C, Magosch P, Lichtenberg S, Habermeyer P. Osteochondral autologous transplantation for the treatment of full-thickness articular cartilage defects of the shoulder. ACTA ACUST UNITED AC 2004; 86:991-7. [PMID: 15446525 DOI: 10.1302/0301-620x.86b7.14941] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed eight osteochondral autologous transplantations from the knee joint to the shoulder. All patients (six men, two women; mean age 43.1 years) were documented prospectively. In each patient the stage of the osteochondral lesion was Outerbridge grade IV with a mean size of the affected area of 150 mm2. All patients were assessed by using the Constant score for the shoulder and the Lysholm score for the knee. Standard radiographs, magnetic resonance imaging and second-look arthroscopy were used to assess the presence of glenohumeral osteoarthritis and the integrity of the grafts. After a mean of 32.6 months (8 to 47), the mean Constant score increased significantly. Magnetic resonance imaging revealed good osseointegration of the osteochondral plugs and congruent articular cartilage at the transplantation site in all but one patient. Second-look arthroscopy performed in two cases revealed a macroscopically good integration of the autograft with an intact articular surface. Osteochondral autologous transplantation in the shoulder appears to offer good clinical results for treating full-thickness osteochondral lesions of the glenohumeral joint. However, our study suggests that the development of osteoarthritis and the progression of pre-existing osteoarthritic changes cannot be altered by this technique.
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Affiliation(s)
- M Scheibel
- Department of Shoulder and Elbow Surgery, ATOS-Clinic Heidelberg, Bismarckplatz 915, 69115 Heidelberg, Germany
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Sillaber I, Ohl F, Bartl C, Panhuysen M, Henniger MSH, Holsboer F. Inbred mouse strains as models for the detection of genes relevant for the effects of antidepressants. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Until about 20 years ago osteoporosis was considered an inevitable disease of ageing. Now the situation has completely changed and osteoporosis is classified as a disorder which is easily diagnosed and treated in the early stages of its development that is,before a skeletal fracture has occurred. Two types of medication are available today for prophylaxis and therapy of osteoporosis: the antiresorptive and the osteoanabolic drugs whose efficacy has been demonstrated in large randomized clinical trials (RCTs). These drugs are effective not only in the early stages of osteoporosis i.e. for prevention, but also when fractures have already occurred, to reduce the risk of further skeletal fractures. However, in this setting only about 7% of patients in Germany are being treated although all are at significant risk of sustaining additional fractures. Consequently all patients with osteoporosis-related fractures should be thoroughly investigated during their hospitalisation and effective treatment instituted. In addition, treatment should be continued and monitored by the family doctor. The strategy for the administration of therapy for successful prevention of secondary fractures in osteoporosis is presented.
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Affiliation(s)
- R Bartl
- Bayerisches Osteoporosezentrum, Medizinische Klinik III, Klinikum der Universität München-Grosshadern.
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Abstract
Arthroscopic treatment of glenohumeral instability has become more common over the last years. Compared with open reconstruction which still is the gold standard in the treatment of glenohumeral instability the arthroscopic techniques show several advantages but also disadvantages that must be proved for every single case. Careful patient selection with regard of prognostic preoperative and intraoperative factors is substantial for successful treatment. When indicated using clinical, radiological and arthroscopic findings the results of arthroscopic stabilization could be improved over the last years and failure rates could be decreased.
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Affiliation(s)
- C Bartl
- Schulter- und Ellenbogenchirurgie, ATOS-Praxisklinik, Heidelberg, Germany
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Spanagel R, Almeida OF, Bartl C, Shippenberg TS. Endogenous kappa-opioid systems in opiate withdrawal: role in aversion and accompanying changes in mesolimbic dopamine release. Psychopharmacology (Berl) 1994; 115:121-7. [PMID: 7862883 DOI: 10.1007/bf02244761] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The kappa-opioid receptor antagonist nor-binaltorphimine (nor-BNI) was recently shown to potentiate certain overt withdrawal signs in morphine-dependent rats. The present study sought to further assess this phenomenon by examining the influence of nor-BNI treatment upon the conditioned place aversion associated with the naloxone-precipitated withdrawal syndrome. In addition, in vivo microdialysis studies were conducted in morphine-dependent rats to determine whether nor-BNI treatment can modify withdrawal-induced changes in basal dopamine (DA) release within the mesolimbic system. Rats were pretreated with either saline or a single dose of nor-BNI and then received ascending doses of morphine for 10 days. A withdrawal syndrome was then precipitated by the administration of naloxone (1 mg/kg SC). In rats which received chronic morphine injections, administration of naloxone produced a characteristic withdrawal syndrome and a marked aversion for an environment previously associated with naloxone-precipitated withdrawal. Nor-BNI treatment potentiated most overt signs of physical dependence. This treatment also resulted in a greater withdrawal-induced place aversion. Morphine-dependent rats exhibited a marked reduction in basal mesolimbic DA release. An even greater decrease in basal DA release was observed in nor-BNI treated rats. These results suggest that endogenous kappa-systems are important in the modulation of mesolimbic DA release and the accompanying place aversion which occurs during opiate withdrawal.
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Affiliation(s)
- R Spanagel
- Department of Neuroendocrinology, Max-Planck-Institute of Psychiatry, Munich, Germany
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Wilhartitz P, Grasserbauer M, Hiesböuck HG, Bartl C. Characterization of buried interfaces in electroplated bronze wires by SIMS. SURF INTERFACE ANAL 1987. [DOI: 10.1002/sia.740100602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wilhartitz P, Grasserbauer M, Hiesböck HG, Bartl C. Characterization of buried interfaces in metallic film-structures by sims. SURF INTERFACE ANAL 1986. [DOI: 10.1002/sia.740090310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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