Mittelfristige Ergebnisse der Vastus-medialis-obliquus-Plastik bei lateraler Patellaluxation

Zusammenfassung: In Langzeitergebnissen nach traditionellen Operationsverfahren distalen Realignements für Patellaluxationen wie z.B. der Tuberositasosteotomie wird eine hohe Rate an Femoropatellararthrosen gefunden, sodass ein operatives Vorgehen noch heute kontrovers diskutiert wird. In der Literatur scheinen die Verfahren mit dynamischem proximalem Realignement eine geringere Arthroserate, aber bisweilen höhere Reluxationsrate aufzuweisen. Unlängst wurde der M.vastus medialis obliquus (VMO) in anatomischen und biomechanischen Studien als eine der entscheidenden proximalen stabilisierenden Strukturen bei lateralen Patellaluxationen identifiziert. Zwischen 1994 und 2003 wurden 28Patienten (Durchschnittsalter 21,5Jahre) mit einer VMO-Plastik bei lateraler Patellaluxation operativ versorgt. Die Technik wurde für die meisten Ätiologien einer femoropatellären Instabilität angewandt. Bei dieser proximalen Weichteilkorrektur wird die sehnige Einstrahlung des VMO von der Patella abgelöst. Anschließend wird die Sehne 10-15mm distalisierend an der Patella über MITEK-Anker reinseriert. Postoperativ ist eine Vollbelastung in Streckung möglich. Ein aktives Auftrainieren des Vastus medialis beginnt 6Wochen nach der Operation. 27Patienten wurden klinisch und radiologisch im Jahre 2004 nachkontrolliert, durchschnittlich 5Jahre nach der Operation. 83% gaben ein exzellentes oder gutes Resultat an, 10% waren zufrieden und 7% unzufrieden. Der durchschnittliche Lysholm-Knie-Score betrug 83,1Punkte. Zwei Patienten erlitten eine Reluxation (7%). Die postoperativen Röntgenbilder zeigten eine signifikante Verbesserung des Kongruenzwinkels auch noch nach vielen Jahren. In 89% der Fälle wurde keine oder eine nur geringe Femoropatellararthrose beobachtet. Die präsentierten Fünfjahresergebnisse sind bezüglich Patientenzufriedenheit mit anderen Verfahren proximalen und distalen Realignements vergleichbar. Die Reluxationsrate ist unterdurchschnittlich. Die bisherige niedrige Rate an Femoropatellararthrose nach durchschnittlich 5Jahren erscheint im Vergleich mit den Arthroseraten des rigiden, distalen Realignements hinsichtlich zukünftiger Langzeitergebnisse vielversprechend und wird auf den minimalen Eingriff in das physiologische Gelenkspiel und auf die Wiederherstellung der verletzten Anatomie zurückgeführt. Die Idee der proximalen dynamischen Stabilisierung und das Angreifen am Ursprung der Pathologie wird in den Erkenntnissen aktueller anatomischer und biomechanischer Untersuchungen bestätigt, was diese relativ guten Ergebnisse erklären mag. Über- und Unterkorrekturen der Weichteile können zurzeit kompensiert werden. Die oben genannten traditionellen und rigideren Operationsmethoden erlauben eine solche Kompensation nicht in diesem Ausmaß und können so zu präarthrotischer Überbelastung des medialen Femoropatellar- und Femorotibialgelenks führe

Terrestrial land cover shapes fish diversity in major subtropical rivers

Freshwater biodiversity is critically affected by human modifications of terrestrial land use and land cover (LULC). Yet, knowledge of the spatial extent and magnitude of LULC-aquatic biodiversity linkages is still surprisingly limited, impeding the implementation of optimal management strategies. Here, we compiled fish diversity data across a 160,000-km² subtropical river catchment in Thailand characterized by exceptional biodiversity yet intense anthropogenic alterations, and attributed fish species richness and community composition to contemporary terrestrial LULC across the catchment. We estimated a spatial range of LULC effects extending up to about 20 km upstream from sampling sites, and explained nearly 60% of the variance in the observed species richness, associated with major LULC categories including croplands, forest, and urban areas. We find that integrating both spatial range and magnitudes of LULC effects is needed to accurately predict fish species richness. Further, projected LULC changes showcase future gains and losses of fish species richness across the river network and offer a scalable basis for riverine biodiversity conservation and land management, allowing for potential mitigation of biodiversity loss in highly diverse yet data-deficient tropical to sub-tropical riverine habitats

Immunopotentiating reconstituted influenza virus virosome vaccine delivery system for immunization against hepatitis A.

Hepatitis A virus (HAV) was purified from MRC-5 human diploid cell cultures, inactivated with formalin, and evaluated for safety and immunogenicity in humans. Three vaccine formulations were produced: (a) a fluid preparation containing inactivated HAV, (b) inactivated HAV adsorbed to Al(OH)3, and (c) inactivated HAV coupled to novel immunopotentiating reconstituted influenza virosomes (IRIV). IRIV were prepared by combining phosphatidylcholine, phosphatidylethanolamine, phospholipids originating from the influenza virus envelope, influenza virus hemagglutinin, and neuraminidase. The HAV-IRIV appeared as unilamellar vesicles with a diameter of approximately 150 nm when viewed by transmission electron microscopy. Upon intramuscular injection, the alum-adsorbed vaccine was associated with significantly (P < 0.01) more local adverse reactions than either the fluid or IRIV formulations. 14 d after a single dose of vaccine, all the recipients of the IRIV formulation seroconverted (> or = 20 mIU/ml) versus 30 and 44% for those who received the fluid and alum-adsorbed vaccines, respectively (P < 0.001). The geometric mean anti-HAV antibody titer achieved after immunization with the IRIV-HAV vaccine was also significantly higher (P < 0.005) compared with the other two vaccines

Thermophysical Properties of Te-based II-VI Semiconductors: Reduced Algorithms for Thermal Diffusivity Determination

This paper presents methodologies for measuring the thermal diffusivity using the difference between temperatures measured at two, essentially independent, locations. A heat pulse is applied for an arbitrary time to one region of the sample; either the inner core or the outer wall. Temperature changes are then monitored versus time. The thermal diffusivity is calculated from the temperature difference versus time. No initial conditions are used directly in the final results

[Medium-term results after m. vastus medialis obliquus-plasty for lateral patellar dislocation]

Progressive retropatellar arthrosis is often seen in dated rigid distal realignment (i.e. osteotomy of tuberositas) at long-term follow-ups. Therefore, operations for lateral dislocation of the patella are still discussed controversially. Dynamic, proximal realignments seem to have lower rates of arthrosis but higher rates of redislocation. Recently, in anatomic and biomechanic studies, the m. vastus medialis obliquus (vmo) was found to be one of the most important proximal restraints to lateral dislocation of the patella.A total of 28 patients (mean age 21.5 years) were treated between 1994 and 2003 with a plasty of the vmo for lateral patellar dislocation. The technique was performed for most etiologies of femoropatellar instability.For this proximal soft tissue technique, the muscle tendon is detached from its patellar insertion. Subsequently, the tendon is reinserted at the patella 10-15 mm more distally and fixed with Mitek anchors. Full weight bearing in extension is possible immediately after surgery. An active vastus medialis training is started after 6 weeks.Of the patients, 27 were evaluated clinically and radiologically in 2004 (a mean of 5 years postoperatively). A total of 83% of the patients estimated the result to be good or excellent, 10% were satisfied and 7% were discontent. The mean Lysholm-Knee-Score was 83.1 points. Two patients suffered a patella redislocation (7%). A statistically significant improvement of the congruence angle was noted in the radiographs, even in medium-term controls. In 89% of the cases no or only little retropatellar arthrosis was observed. These 5 year results are comparable to those of other techniques for distal or proximal realignments. The rate of redislocation was below average. Compared to the rate of retropatellar arthrosis in long-term results of rigid distal realignment, our patients demonstrated a relative low rate after 5 years. We attribute this to the minimal interference in physiological joint mechanics and to the restored anatomy. In terms of future long-term results, our findings are promising. The idea of a proximal dynamic stabilization and the causal operative approach at the origin of pathology using vmo-plasty was confirmed in recent anatomic and biomechanic studies. Over or under correction of soft tissues could be adapted. More rigid techniques of distal realignment do not allow an adaptation to this extent and can lead to prearthrotic hyperpression in the medial femoropatellar and femorotibial joints