Long-term recurrence rate in anterior shoulder instability after Bankart repair based on the on- and off-track concept

BACKGROUND Since its first proposal, the concept of on- and off-track lesions in anterior shoulder instability has gained clinical relevance as a tool to predict the failure rate of arthroscopic Bankart repair. Current literature only reports either short-term follow-up or long-term results of small sample sizes. The aim of this study was to provide a long-term evaluation of recurrent instability following arthroscopic Bankart repair in a large cohort using the on-track vs. off-track concept as a predictor for failure. METHODS We retrospectively analyzed 271 patients who underwent primary arthroscopic Bankart repair for anterior shoulder instability between 1998 and 2007. All patients with a minimum follow-up of 78 months and a preoperative computed tomographic (CT) or magnetic resonance imaging (MRI) scan were included into the study. Preoperative CT and/or MRI scans were used to determine the glenoid track and width of Hill-Sachs lesion. Recurrence of instability was defined as presence of instability symptoms (dislocation, subluxation, and/or apprehension) or revision surgery (stabilization procedure) and was assessed as the primary outcome parameter. RESULTS The glenoid track of 163 shoulders was assessed (female n = 51, male n = 112) with a mean follow-up of 124 months (99.4-145.6, standard deviation = 2.5) and a mean age of 24 years (20-34.). An off-track Hill-Sachs lesion was found in 77 cases (47%), and in 86 cases (53 %) it was on-track. The rate of recurrent instability in the off-track group was 74% (n = 57) compared with 27% (n = 23) in the on-track group (P < .001). The overall rate of revision surgery due to instability was 29% (n = 48) after a mean time of 50.9 months (±42.8) following Bankart repair. The rate of revision surgery in the off-track group was 48% (n = 37) after a mean of 53.5 months (±42.0) vs. 13% (n = 11) after 42.3 months (±46.3) in the on-track group (P < .001). CONCLUSION This study shows that the on- and off-track concept helps to distinguish patients for whom an isolated arthroscopic Bankart repair yields long-term benefits. Because of the high rate of recurrent instability in the off-track group, an off-track lesion should be treated surgically in such a way that the off-track lesion is converted into an on-track lesion

Produktivität, Narbendichte und Vegetation einer Kurzrasenweide

Productivity, sward structure and floristic diversity of a continuous grazed pasture on organic permanent grassland were determined in 2015. Daily pasture growth reached less than 50 kg dry matter per hectare in May and stayed low due to unfavorable weather conditions in 2015 (cold spring, dry and hot summer). Forage quality was quite high (> 6,5 MJ NEL/kg dm) most of the grazing season. Tiller density was moderate during summer but increased after sufficient rain in late summer. Perennial ryegrass, Kentucky bluegrass and white clover were the dominant plant species and yielded more the 85 % of dry matter

Akute Gefäßerkrankungen in der Gastroenterologie

Zusammenfassung: Vaskulär-gastroenterologische Notfälle zählen zu den häufigen Krankheitsbildern auf internistischen und chirurgischen Notfallstationen. Die klinischen Konsequenzen reichen von trivialen bis zu lebensbedrohlichen Situationen. Nur eine frühzeitige Erkennung der Symptomenkomplexe und die Anwendung der adäquaten diagnostischen Mittel führen zur korrekten Diagnosestellung mit nachfolgend - möglicherweise lebensrettender - Therapie. Um die hohen Mortalitätsraten der akuten Mesenterialischämien (50%), aortoenterischen Fisteln (30-40%), Aneurysmen viszeraler Arterien (10-100%) sowie des Budd-Chiari-Syndroms weiter senken zu können, gewinnen neue Strategien mit endovaskulärem Therapieansatz zunehmend an Bedeutung und ersetzen teilweise über viele Jahrzehnte etablierte Diagnose- und Therapiealgorithmen. Diese Übersichtsarbeit soll einen Überblick über aktuelle Diagnostik- und Therapiekonzepte häufiger vaskulär-gastroenterologischer Notfälle verschaffe

Die erschöpfende Reinigung von Aktin-Präparaten Zahl und Art der phosphathaltigen prosthetischen Gruppen von G- und F-Aktin

Exhaustive purification of actin preparations. Number and kind of phosphate containing prosthetic groups of G- and F-actin 1. 1. Previous investigations on the nucleoside phosphate content of G- and F-actin have all been carried out with unpurified or little purified protein preparations. It has never been tested whether the purification was complete or whether the purification itself inactivated the preparation. 2. 2. In F-actin solutions prepared according to Straub the content of adenine decreases by repeated ultracentrifugal sedimentation or Mg-precipitation according to Bárány to a constant level which is identical with both methods (16 μmoles/g protein). The adenine and phosphate content of the actin remains constant after the second purification procedure. Both procedures remove protein impurities present in the crude extract. 3. 3. The protein impurities are, however, not removed by repeated isoelectric precipitation of the crude unpolymerized Straub-extract. This procedure removes only contaminating phosphate and nucleoside phosphate of the crude extract. The actin polymerizes spontaneously during isoelectric precipitation. 4. 4. Ultracentrifugal sedimentation of F-actin, precipitation by MgCl2 or isolectric precipitation in presence of ATP do not inactivate the actin. The viscosity of F-actin, the ability for activating the ATP-ase of added L-myosin and the ATP-sensitivity of the resulting actomyosin remain constant even after repeating the purification procedure five times. 5. 5. Repeated isoelectric precipitation of actin in absence of ATP leads to an increasing loss of adenine phosphate and also to a stepwise decrease of Zν and ATP-sensitivity. 6. 6. In the nucleoside phosphate of purified F-actin the proportion of adenine to phosphate is 1:2 as in ADP. Paperchromatographic methods reveal in addition traces of AMP and ATP. 7. 7. G-actin and the contaminating proteins in the crude extracts contain also 16 μmoles adenine/g protein. 8. 8. From the content of adenosine phosphates bound to G- or F-actin (16 μmoles/g protein) the minimal molecular weight of the actin monomer is calculated as 62.000. 9. 9. The proportion adenine: phosphate and paperchromatographic methods show, that in the crude unpolymerized extract the protein-bound nucleoside-phosphate consists of 70–75% ATP and 25–30% ADP. Only 70–75% of the protein in the crude extract are able to polymerize. 10. 10. However, G-actin obtained from purified F-actin containing also 70–75% of its nucleoside phosphates as ATP does polymerize entirely. Thus whether or not ADP-G-actin polymerizes seems to depend on the history of the protein preparation. 11. 11. G-actin, whose ability for polymerization has been destroyed by X-rays, nevertheless activates the L-myosin-ATP-ase to a normal extent. The same holds for actin partly denatured by isoelectric precipitation in the absence of ATP. Thus, the ability of actin for polymerisation and its ability to activate the L-myosin-ATP-ase are independent properties. 12. 12. In phosphate or ATP containing solutions, purified F-actin ATP and inorganic phosphate reversibly (in addition to the tightly bound ADP). Howeever, actin is not phosphorylated in presence of ATP

Akute Gefäßerkrankungen in der Gastroenterologie

Acute gastroenterologic vascular emergencies are common situations in emergency departments and the clinical consequences range from trivial to life-threatening. Only the early recognition of these symptom patterns and prompt use of the appropriate diagnostic tools lead to a correct diagnosis with subsequent potentially life-saving treatment. To decrease the high mortality rate of acute mesenteric ischemia (50%), aorto-enteric fistula (30–40%), visceral artery aneurysms (10–100%) and Budd-Chiari syndrome new strategies with an endovascular approach are gaining importance and are partially replacing established diagnostic and therapeutic algorithms. This article provides a review of the diagnosis and therapy of these gastroenterologic emergency situations