Determinants and constraints of feather growth

During the periodic moult of the plumage of birds, a fast regrowth of feathers would shorten the time of reduced plumage functionality. However, it has long been known that feather growth-rate is limited and that long feathers take disproportionally longer to grow than small feathers, which has severe consequences on moult duration and the completeness of moult in large birds. The reasons for the limitations of feather-growth must be related to the size and/or functions of the feather follicle, but are largely unknown. Here we measured the size of the feather follicle (taking calamus width as a proxy) and related it to parameters of feather growth (feather growth-rate by mass and by length) and feather structure (feather length, mass, massiveness [mass of feather material per mm feather-length]). We used three independent datasets which allowed for interspecific analyses, and for intraspecific comparisons of differently structured feathers within the framework of biological scaling. We found that the cross-sectional area of the calamus (as a proxy of feather follicle size) was directly proportional to feather growth-rate by mass. Hence, factors acting at a two-dimensional scale (possibly nutrient supply to the growing feather) determines feather growth rate by mass, rather than the linear arrangement of stem cells (in a circular configuration) as had previously been assumed. Feather follicle size was correlated with both feather length and massiveness, hence it seems to be adapted to some extent to feather structure. Feather growth-rate by length was dependent on both the feather material produced per unit time (growth-rate by mass) and the amount of material deposited per unit feather-length. Follicle size not only determines feather growth-rate by mass, but also directly the structural design (shape, number of barbs, etc.) of a feather. Therefore, feather growth-rate is severely constrained by the requirements imposed by the structural feather design.

Acute and Chronic Lead Exposure in Four Avian Scavenger Species in Switzerland

Despite irrefutable evidence of its negative impact on animal behaviour and physiology, lethal and sublethal lead poisoning of wildlife is still persistent and widespread. For scavenging birds, ingestion of ammunition, or fragments thereof, is the major exposure route. In this study, we examined the occurrence of lead in four avian scavengers of Switzerland and how it differs between species, regions, and age of the bird. We measured lead concentration in liver and bone of the two main alpine avian scavengers (golden eagle Aquila chrysaetos and bearded vulture Gypaetus barbatus) over the entire area of the Swiss Alps and two of the main avian scavengers occurring in the lowlands of Switzerland (red kite Milvus milvus and common raven Corvus corax). Of those four species, only the bearded vulture is an obligate scavenger. We found that lead burdens in the two alpine avian scavengers were higher than those found for the same species elsewhere in Europe or North America and reached levels compatible with acute poisoning, whereas lead burdens of the two lowland avian scavengers seemed to be lower. Several golden eagles, but only one red kite with abnormally high bone lead concentrations were found. In all four species, a substantial proportion of birds had elevated levels which presumably represent recent (liver lead levels) or past (bone lead levels) uptake of sublethal doses of lead.

Surgical dislocation of the adult hip

Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided. We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. It combines aspects of approaches which have been reported previously and consists of an anterior dislocation through a posterior approach with a ‘trochanteric flip’ osteotomy. The external rotator muscles are not divided and the medial femoral circumflex artery is protected by the intact obturator externus. We report our experience using this approach in 213 hips over a period of seven years and include 19 patients who underwent simultaneous intertrochanteric osteotomy. The perfusion of the femoral head was verified intraoperatively and, to date, none has subsequently developed avascular necrosis. There is little morbidity associated with the technique and it allows the treatment of a variety of conditions, which may not respond well to other methods including arthroscopy. Surgical dislocation gives new insight into the pathogenesis of some hip disorders and the possibility of preserving the hip with techniques such as transplantation of cartilage.

Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis

Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided. We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. It combines aspects of approaches which have been reported previously and consists of an anterior dislocation through a posterior approach with a 'trochanteric flip' osteotomy. The external rotator muscles are not divided and the medial femoral circumflex artery is protected by the intact obturator externus. We report our experience using this approach in 213 hips over a period of seven years and include 19 patients who underwent simultaneous intertrochanteric osteotomy. The perfusion of the femoral head was verified intraoperatively and, to date, none has subsequently developed avascular necrosis. There is little morbidity associated with the technique and it allows the treatment of a variety of conditions, which may not respond well to other methods including arthroscopy. Surgical dislocation gives new insight into the pathogenesis of some hip disorders and the possibility of preserving the hip with techniques such as transplantation of cartilage.

Anatomy of the medial femoral circumflex artery and its surgical implications

The primary source for the blood supply of the head of the femur is the deep branch of the medial femoral circumflex artery (MFCA). In posterior approaches to the hip and pelvis the short external rotators are often divided. This can damage the deep branch and interfere with perfusion of the head.

We describe the anatomy of the MFCA and its branches based on dissections of 24 cadaver hips after injection of neoprene-latex into the femoral or internal iliac arteries.

The course of the deep branch of the MFCA was constant in its extracapsular segment. In all cases there was a trochanteric branch at the proximal border of quadratus femoris spreading on to the lateral aspect of the greater trochanter. This branch marks the level of the tendon of obturator externus, which is crossed posteriorly by the deep branch of the MFCA. As the deep branch travels superiorly, it crosses anterior to the conjoint tendon of gemellus inferior, obturator internus and gemellus superior. It then perforates the joint capsule at the level of gemellus superior. In its intracapsular segment it runs along the posterosuperior aspect of the neck of the femur dividing into two to four subsynovial retinacular vessels. We demonstrated that obturator externus protected the deep branch of the MFCA from being disrupted or stretched during dislocation of the hip in any direction after serial release of all other soft-tissue attachments of the proximal femur, including a complete circumferential capsulotomy.

Precise knowledge of the extracapsular anatomy of the MFCA and its surrounding structures will help to avoid iatrogenic avascular necrosis of the head of the femur in reconstructive surgery of the hip and fixation of acetabular fractures through the posterior approach.

Anatomy of the medial femoral circumflex artery and its surgical implications

The primary source for the blood supply of the head of the femur is the deep branch of the medial femoral circumflex artery (MFCA). In posterior approaches to the hip and pelvis the short external rotators are often divided. This can damage the deep branch and interfere with perfusion of the head. We describe the anatomy of the MFCA and its branches based on dissections of 24 cadaver hips after injection of neoprene-latex into the femoral or internal iliac arteries. The course of the deep branch of the MFCA was constant in its extracapsular segment. In all cases there was a trochanteric branch at the proximal border of quadratus femoris spreading on to the lateral aspect of the greater trochanter. This branch marks the level of the tendon of obturator externus, which is crossed posteriorly by the deep branch of the MFCA. As the deep branch travels superiorly, it crosses anterior to the conjoint tendon of gemellus inferior, obturator internus and gemellus superior. It then perforates the joint capsule at the level of gemellus superior. In its intracapsular segment it runs along the posterosuperior aspect of the neck of the femur dividing into two to four subsynovial retinacular vessels. We demonstrated that obturator externus protected the deep branch of the MFCA from being disrupted or stretched during dislocation of the hip in any direction after serial release of all other soft-tissue attachments of the proximal femur, including a complete circumferential capsulotomy. Precise knowledge of the extracapsular anatomy of the MFCA and its surrounding structures will help to avoid iatrogenic avascular necrosis of the head of the femur in reconstructive surgery of the hip and fixation of acetabular fractures through the posterior approach.

[Can late sequelae of diabetes be avoided? Various critical observations]

Hyperglycemia plays a decisive role in development of diabetic retinopathy, nephropathy and neuropathy. Unfortunately, even modern antidiabetic means often fail to install normoglycemia or near normoglycemia. They also bear an important risk for hypoglycemia. What glucose levels (as measured by Hb-A1c) may be tolerated without consequences for the patient is unknown so far; therefore, we should presently still aim at lowering the blood glucose as often and as close to normal as possible and try to avoid severe hypoglycemias. Those who care for diabetics carry a high responsibility. The care diabetics should be improved as follows: Regular ophthalmologic controls could reduce occurrence of visual losses or blindness. Efficient lowering of hypertension prevents occurrence and progression of nephropathy. ACE-inhibitors turned out to be also useful in normotonic diabetics, because they prevent progression of nephropathy. Diabetics bearing a risk for lesions on the feet should be identified, instructed and treated adequately. This is the only way to reduce the rate of amputations. Risk factors for general arteriosclerosis should be efficiently treated or avoided, particularly in diabetics. In consideration of these factors, morbidity and mortality of diabetic patients could be influenced more efficiently. There is no justification for any defeatist attitude.

[Semiautomatic insulin injection equipment (pens)]

To the best of our knowledge, a good glycaemic control must be advised to avoid or delay the degenerative complications of diabetes, bearing in mind an increased risk of hypoglycaemias. Among other techniques, a treatment consisting of multiple injections (basal-bolus concept) is one way to achieve a good control. Although this form of treatment is rather restrictive (frequent blood glucose determinations), the use of pens makes it more acceptable. A fully informed and cooperative patient is a prerequisite before considering this particular type of insulin therapy which, however, is usually not very helpful for older diabetics. It is a misconception to think that every patient receiving insulin should do so with a pen, just as it is incorrect to recommend multiple injections for all type I diabetics. Whether such a therapeutic strategy is indicated should be established for each patient individually. In addition, the fashion for pens should not distract us from all the other problems associated with inadequate diabetic control, such as foot care and systematic blood pressure measurements.