Die subtalare Arthrorise mit dem Kalix®-Implantat in der Therapie des symptomatischen kindlichen Pes planovalgus - Eine Vergleichsstudie mit der extraartikulären Arthrodese nach Grice-Green

Wir präsentieren die Ergebnisse von 42 Operationen bei kindlichem Pes plano-valgus, die als Arthrorise mit dem Kalix-Implantat oder als Arthrodese nach Grice-Green durchgeführt wurden. Bei 70% der Patienten lag eine ICP vor. Die Auswertung erfolgte klinisch, radiologisch, podoskopisch und pedobarografisch. Die Arthrodese zeigte in 75% gute Ergebnisse. Nach 28,6% aller Arthrorisen musste das Implantat wieder entfernt werden. Schmerzen und Luxationen waren die Probleme. Daher erreichte die Arthrorise nur in 36,9% der Fälle ein gutes Er-gebnis. Die ICP-Patienten schnitten schlechter ab als die idiopathischen und nicht paralytischen Patienten. Wir empfehlen den Einsatz der Arthrorise für idiopathische und nicht paralytische Pes planovalgi mit einem Implantat mit ge-ringer Luxationstendenz. Bei durch ICP bedingten Fehlstellungen wird weiterhin der Einsatz der Methode nach Grice-Green empfohlen. We present the results of 42 surgical interventions for the therapy of pes planovalgus of the child, being done by arthroereisis with the Kalix-implant or by arthrodesis according to Grice-Green. In 70% cerebral palsy was the basic diagnosis. The evaluation was done clinically, radiographically, by podoscope and by pedobarography. The arthrodesis showed good results in 75%. 28.6% of the Kalix-implants had to be removed because of pain or luxation. The arthroereisis therefore showed good results in only 36.9%. The cerebral palsy patients had poorer results then the other patients. We recommend the arthroereisis for idiopathic or non paralytic pes planovalgi with a safe implant. Grice-Green would be the better choice for cerebral palsy patients

Early Affective Processing in Patients with Acute Posttraumatic Stress Disorder: Magnetoencephalographic Correlates

Background: In chronic PTSD, a preattentive neural alarm system responds rapidly to emotional information, leading to increased prefrontal cortex (PFC) activation at early processing stages (<100 ms). Enhanced PFC responses are followed by a reduction in occipito-temporal activity during later processing stages. However, it remains unknown if this neuronal pattern is a result of a long lasting mental disorder or if it represents changes in brain function as direct consequences of severe trauma.Methodology: The present study investigates early fear network activity in acutely traumatized patients with PTSD. It focuses on the question whether dysfunctions previously observed in chronic PTSD patients are already present shortly after trauma exposure. We recorded neuromagnetic activity towards emotional pictures in seven acutely traumatized PTSD patients between one and seven weeks after trauma exposure and compared brain responses to a balanced healthy control sample. Inverse modelling served for mapping sources of differential activation in the brain.Principal Findings: Compared to the control group, acutely traumatized PTSD patients showed an enhanced PFC response to high-arousing pictures between 60 to 80 ms. This rapid prefrontal hypervigilance towards arousing pictorial stimuli was sustained during 120–300 ms, where it was accompanied by a reduced affective modulation of occipito-temporal neural processing.Conclusions: Our findings indicate that the hypervigilance-avoidance pattern seen in chronic PTSD is not necessarily a product of an endured mental disorder, but arises as an almost immediate result of severe traumatisation. Thus, traumatic experiences can influence emotion processing strongly, leading to long-lasting changes in trauma network activation and expediting a chronic manifestation of maladaptive cognitive and behavioral symptoms