Ossifikation bei chronischer Achillessehnentendinose: Ein dritter Unterschenkelknochen

Zusammenfassung: Die Ossifikation der Achillessehne stellt eine seltene Komplikation der chronischen Achillessehnentendinose dar. Der vorliegende Fallbericht zeigt bei einem 59-jährigen Patienten nach Achillessehnenverlängerung bei Klumpfuß in der frühen Kindheit eine rekordverdächtige Ossifikation von 10cm Länge. Bei chronischen Beschwerden und erhöhtem Frakturrisiko orientiert sich die Therapiewahl an operativ rekonstruktiven Kriterie

Sprunggelenkprothese bei Valgusarthrose

Zusammenfassung: Die Arthrose des oberen Sprunggelenks (OSG) ist häufig mit einer Fehlstellung verbunden, dabei ist die Valgusarthrose seltener als die Varusarthrose. Die Ursachen für eine Valgusarthrose sind eine mediale Bandinstabilität, ein Pes planovalgus und posttraumatische Fehlstellungen z.B. nach Fibulafraktur oder Stauchung des lateralen Tibiaplateaus. Damit eine OSG-Prothese kurz- wie auch langfristig korrekt und schmerzfrei funktionieren kann, muss die Biomechanik entsprechend den Prinzipien der mechanischen Achse, deren Wichtigkeit in der Orthopädie allgemein akzeptiert ist, wiederhergestellt werden. Richtlinien sind dabei (1) ein anteriorer tibiotalarer Winkel von etwa 90° und (2) eine neutrale Rückfußstellung. Diese wird vorzugsweise mit der Rückfußaufnahme nach Saltzman gemessen. Dabei ist zu beachten, dass der normale Rückfuß in einer Neutralstellung bis 1-2° Varusposition und nicht wie bisher angenommen in einer Valgusstellung ist. Je nach Ausmaß und Lokalisation der Valgusdeformität werden in unterschiedlicher Reihenfolge (1) die OSG-Prothese implantiert, (2) supra- und (3) inframalleoläre Korrekturosteotomien/-Arthrodesen, (4) eine mediale Bandplastik, (5) eine Fibulaosteotomie (6) mit eventueller Rekonstruktion der Syndesmose durchgeführ

Chronische Instabilität des oberen Sprunggelenks

Zusammenfassung: Die chronische Sprunggelenkinstabilität ist eine typische Pathologie im Sport und entwickelt sich bei 20 bis 40% der Sportler nach erlittener akuter Sprunggelenkdistorsion. Man unterscheidet zwischen einer lateralen und medialen Sprunggelenkinstabilität, wobei die Kombination beider als Rotationsinstabilität des oberen Sprunggelenks bezeichnet wird. Des Weiteren kann pathophysiologisch eine mechanische oder funktionelle Sprunggelenkinstabilität unterschieden werden, die sich durch eine strukturelle Bandläsion bzw. durch eine Schwächung der neuromuskulären Kontrolle manifestiert. Durch die erschwerte Diagnose und eine komplexe Therapie, die oft eine operative Rekonstruktion bedingt, stellt die chronische Sprunggelenkinstabilität für den behandelnden Arzt eine vielschichtige Entität dar. Die vorliegende Übersichtsarbeit erörtert Pathomechanismen, Möglichkeiten der Diagnostik, Indikationen zur konservativen und operativen Therapie sowie potenzielle Langzeitschäden wie die posttraumatisch-ligamentäre Sprunggelenksarthros

Diagnostic examination of the child with urolithiasis or nephrocalcinosis

Urolithiasis and nephrocalcinosis are more frequent in children then currently anticipated, but still remain under- or misdiagnosed in a significant proportion of patients, since symptoms and signs may be subtle or misleading. All children with colicky abdominal pain or macroscopic hematuria should be examined thoroughly for urolithiasis. Also, other, more general, abdominal manifestations can be the first symptoms of renal stones. The patients and their family histories, as well as physical examination, are important initial steps for diagnostic evaluation. Thereafter, diagnostic imaging should be aimed at the location of calculi but also at identification of urinary tract anomalies or acute obstruction due to stone disease. This can often be accomplished by ultrasound examination alone, but sometimes radiological methods such as plain abdominal films or more sensitive non-enhanced computed tomography are necessary. Since metabolic causes are frequent in children, diagnostic evaluation should be meticulous so that metabolic disorders that cause recurrent urolithiasis or even renal failure, such as the primary hyperoxalurias and others, can be ruled out. The stone is not the disease itself; it is only one serious sign! Therefore, thorough and early diagnostic examination is mandatory for every infant and child with the first stone event, or with nephrocalcinosis

Relationship between PPI and baseline startle response

Prepulse inhibition (PPI) of the startle response to a sudden noise is the reduction in startle observed when the noise is preceded shortly by a mild sensory event, which is often a tone. A part of the literature is based on the assumption that PPI is independent of the baseline startle. A simple model is presented and experimental validation provided. The model is based on the commonly accepted observation that the neuronal circuit of PPI differs from that of startle. But, by using a common output, the measures of both phenomena become linked to each other. But, how can we interpret the numerous experimental data showing PPI to be independent of the startle level? It is suggested that in a number of such cases the baseline startle would have been stabilized by a ceiling effect in the startle/PPI neuronal networks. Reducing the startle level, for example in a PPI evaluation procedure, may disclose properties of startle masked by this ceiling effect. Disclosure of habituation to the startle eliciting noise produced an increase of PPI along its initial measurements. Taken together, even if the neuronal process that sustains startle and PPI are distinct, separating them experimentally requires careful parametric methods and caution in the interpretation of the corresponding observations

Synthesis of high-quality libraries of long (150mer) oligonucleotides by a novel depurination controlled process

We have achieved the ability to synthesize thousands of unique, long oligonucleotides (150mers) in fmol amounts using parallel synthesis of DNA on microarrays. The sequence accuracy of the oligonucleotides in such large-scale syntheses has been limited by the yields and side reactions of the DNA synthesis process used. While there has been significant demand for libraries of long oligos (150mer and more), the yields in conventional DNA synthesis and the associated side reactions have previously limited the availability of oligonucleotide pools to lengths <100 nt. Using novel array based depurination assays, we show that the depurination side reaction is the limiting factor for the synthesis of libraries of long oligonucleotides on Agilent Technologies’ SurePrint® DNA microarray platform. We also demonstrate how depurination can be controlled and reduced by a novel detritylation process to enable the synthesis of high quality, long (150mer) oligonucleotide libraries and we report the characterization of synthesis efficiency for such libraries. Oligonucleotide libraries prepared with this method have changed the economics and availability of several existing applications (e.g. targeted resequencing, preparation of shRNA libraries, site-directed mutagenesis), and have the potential to enable even more novel applications (e.g. high-complexity synthetic biology)

MACI - a new era?

Full thickness articular cartilage defects have limited regenerative potential and are a significant source of pain and loss of knee function. Numerous treatment options exist, each with their own advantages and drawbacks. The goal of this review is to provide an overview of the problem of cartilage injury, a brief description of current treatment options and outcomes, and a discussion of the current principles and technique of Matrix-induced Autologous Chondrocyte Implantation (MACI). While early results of MACI have been promising, there is currently insufficient comparative and long-term outcome data to demonstrate superiority of this technique over other methods for cartilage repair

Studies in Dhāraṇī Literature II: Pragmatics of Dhāraṇīs

This article is one of a series that reassesses the dhāraṇī texts of Mahāyāna Buddhism. The article seeks to examine dhāraṇī texts by using the linguistic tools of pragmatics, especially historical pragmatics, to assist the understanding of their statements. Rather than the meaning of the term dhāraṇī as a subject term, the domain of truth-conditional semantics, this paper examines statements in texts labelled dhāraṇī. Pragmatics examines meaning in context, and the categories of speech acts developed by Searle has been especially helpful in mapping out differences within such texts and the formalization of statements across texts. The grammaticalization of specific speech elements, especially interjections, in the context of mantra-dhāraṇīs is also discussed