bluuebunny/crossref_metadata_2025 huggingface dataset:
Die Geschlechtlichkeit des Menschen
Authors: Garlipp P. , Brüggemann B. R.
Published: March 2018

Biologische Studien konnten den Einfluss von Geschlechtshormonen auf die Feinstruktur und Funktion des Gehirns nachweisen. Geschlechtstypische Unterschiede hinsichtlich verschiedener Verhaltens- und Erlebensweisen können jedoch nicht einfach auf hormonelle Einflüsse auf das Gehirn zurückgeführt werden, da sich psychische und soziokulturelle Faktoren ebenso auf die Morphologie und Physiologie des Gehirns auswirken. Soziologische Theorien können andererseits nicht ohne Rückgriff auf psychologische oder biologische Theorien erklären, warum nur ein Teil der Menschen, die pathogenen psychosozialen Bedingungen ausgesetzt sind, tatsächlich eine psychische Störung entwickeln, und warum andere Personen trotz Fehlen dieser Bedingungen psychisch erkranken. Für das Verständnis verschiedener psychischer Störungen erweist sich der Bezug auf die Geschlechtlichkeit des Menschen unter Berücksichtigung biologischer, psychologischer und soziokultureller Konzepte als paradigmatisch. Am Beispiel des Lesch-Nyhan-Syndroms und der Geschlechterverteilung depressiver Störungen wird die Bedeutung der Geschlechtlichkeit des Menschen für das Verständnis psychischer Störungen aufgezeigt.
Psychopharmaka und Polypharmazie
Authors: Buchmann J. , Reis O. , Häßler F.
Published: March 2018

Geistige Behinderung ist keine Krankheit, aber Menschen mit geistiger Behinderung weisen ein erhöhtes Risiko auf, sowohl somatisch als auch psychisch zu erkranken. Die Prävalenzraten für psychische Störungen liegen bei leicht geistig Behinderten zwischen 33 und 57% und bei mittelschwer bis schwer geistig Behinderten zwischen 42 und 64%. Aggressives Verhalten weisen dabei 30 bis 55% und speziell selbstverletzendes Verhalten (SVV) 10 bis 20% aller institutionalisierten Betroffenen auf. Nach einer Metaanalyse liegen die typischen Prävalenzraten für Psychopharmaka und/oder Antikonvulsiva in Großeinrichtungen zwischen 44 und 60%. In Betreuungseinrichtungen dreier Bundesländer wurden das Auftreten von Verhaltensstörungen und die daraus resultierende Psychopharmakatherapie untersucht. Insgesamt gingen die Daten von 279 geistig behinderten Bewohnern (18 bis 79 Jahre, Durchschnitt 41,9 Jahre; weiblich 175, männlich 104) in die Auswertung ein. Diese Daten wurden mit einer aktuellen Analyse der Medikation (Januar 2005) von 188 therapierten Bewohnern des Michaelshofes in Rostock verglichen.
Zur Geschichte der Neurochirurgie
Authors: Krüger J.
Published: March 2018

Eine kurze Übersicht über die Geschichte der Neurochirurgie wird dargestellt. Von der Pionierzeit in der zweiten Hälfte des 19. Jahrhunderts über die Gründerzeit (1920-1969) bis zum Beginn der Mikroneuroneurochirurgie, die wir als die gegenwärtige Zeit bezeichnen. Als Geburtsland der Neurochirurgie gilt Groß Britannien, wo 1879 durch W. Macewen in Glasgow der erste intrakranielle Tumor, in London 1884 durch R. Godlee und A.H. Bennett unter spektakulären Umständen ein Gliom und 1887 erstmals ein Spinaltumor von V. Horsley entfernt wurden.

Zu Beginn des 20. Jahrhunderts war es in Amerika (Boston) H. Cushing, der die Neurochirurgie mit geringer postoperativer Letalität als selbstständiges Fach etablieren konnte. In Deutschland waren zwar wichtige Anfänge, vor allem durch F. Krause und O. Foerster sowie ab 1936 Tönnis zu verzeichnen, aber die Entwicklung zur Eigenständigkeit ist erst nach dem 2. Weltkrieg möglich geworden.
Das Lee Silverman Voice Treatment (LSVT)
Authors: Pichler K.
Published: March 2018

Das Lee Silverman Voice Treatment (LSVT) ist ein in Deutschland noch recht unbekanntes intensives Therapiekonzept, das speziell zur Behandlung der Sprech- und Stimmproblematik bei M. Parkinson entwickelt wurde. Behandlungsfokus liegt auf der Stimme und vor allem auf einer erhöhten Sprechlautstärke, die als Trigger für Kraft und Koordination in allen Subsystemen des Sprechens fungiert, so dass sich neben der Stimmfunktion auch unter anderem Verständlichkeit und Schlucksymptomatik nachweisbar verbessern. Um den Therapietransfer in die Alltagssprache zu stabilisieren, findet ein sensorisches Wahrnehmungstraining in Bezug auf Krafteinsatz und Lautstärke besondere Berücksichtigung. LSVT ist bei Parkinsonpatienten die erste Sprechtherapie, deren Wirksamkeit durch zahlreiche Kurz- und Langzeitstudien eindrucksvoll belegt ist.
Erster epileptischer Anfall
Authors: Schmidt D.
Published: March 2018

Nach der vorliegenden Evidenzlage treten im Durchschnitt bei einem von drei Patienten nach dem ersten unprovozierten epileptischen Anfall weitere Anfälle auf, meist innerhalb der nächsten 12 Monate. Die individuelle Beurteilung basiert auf den Gegebenheiten des Einzelfalls. Hierzu gehören die sichere Diagnose des epileptischen Anfalls oder des Epilepsiesyndroms, die Kenntnis von Risikofaktoren für Anfallsrezidive und die Evaluierung der Nutzen-Risiko Balance der Behandlung nach dem ersten Anfall. Unstrittig ist, dass die sofortige wie die verzögerte Antiepileptikatherapie die Wahrscheinlichkeit weiterer Anfälle senkt. Die sofortige Behandlung verbessert aber weder die Langzeitprognose der Epilepsie noch wird die Mortalität gesenkt oder die Lebensqualität gesteigert. Die Entscheidung zur Behandlung bereits nach dem ersten Anfall (und nicht erst bei weiteren Anfällen) muss daher individuell nach ausführlicher medizinischer Information des Patienten erfolgen unter Berücksichtigung des Wunsches des Patienten oder seiner Angehörigen, des individuellen Rezidivrisikos und der Konsequenzen eines weiteren Anfalls.
Kompensatorischer Konsum und Kaufsucht bei Jugendlichen
Authors: Lange E.
Published: March 2018

Die folgenden Fragen sollen in diesem Beitrag beantwortet werden: Was wird unter kompensatorischem Konsum und Kaufsucht verstanden? Wie erhebt man kompensatorischen Konsum und Kaufsucht? Welches Ausmaß haben diese beiden Konsummuster in Deutschland erreicht und wie haben sie sich in den letzten Jahren verändert? Unter welchen Bedingungen treten diese Konsummuster auf? Was lässt sich präventiv gegen diese abweichenden Konsummuster unternehmen?

Grundlage ist eine im Jahr 2002 in Deutschland durchgeführte repräsentative Untersuchung von insgesamt 845 Jugendlichen im Alter zwischen 15 und 24 Jahren zu ihren Konsummustern, speziell auch zum kompensatorischen Konsum und zur Kaufsucht, die von der DFG finanziert wurde. Darüber hinaus gehen die Daten einer vergleichbaren Studie aus dem Jahr 1996 mit ein, bei der allerdings nur die Altersgruppe der 15 bis 20-jährigen Jugendlichen erhoben wurde, sowie die Ergebnisse eines Präventionsprojekts aus den Jahren 1997 bis 1998, das bei Jugendlichen in Verbänden (Pfadfinder), in Heimen und Häusern der offenen Tür durchgeführt wurde.
Metastasiertes kolorektales Karzinom: Perspektive in der Antiangiogenese
Authors: Henning Peter
Published: March 2018

Aflibercept ist ein Angiogenesehemmer, der aufgrund seiner Struktur die Tumorangiogenese besonders effektiv blockiert und bei progredienten Patienten mit metastasiertem kolorektalen Karzinom einen signifikanten überlebensvorteil erreichte – selbst bei jenen, die bereits anti-angiogen vorbehandelt waren.
Pazopanib beim fortgeschrittenen Nierenzellkarzinom: Die Tauglichkeit im Alltag entscheidet die individuelle Therapie
Authors: Kretzschmar Alexander
Published: March 2018

Bei der systemischen Therapie des fortgeschrittenen Nierenzellkarzinoms (mRCC) können Arzt und Patient inzwischen unter mehreren Möglichkeiten wählen. Bei etwa vergleichbaren Wirksamkeitsdaten kommt hier der Alltagstauglichkeit eine große Bedeutung zu. Nach den Erfahrungen von Prof. Stefan Siemer, Homburg/Saar, ermöglicht hier Pazopanib (Votrient®) eine gute individuelle Therapiesteuerung.
Fortgeschrittenes malignes Melanom: Erstmals signifikante Verlängerung des Gesamtüberlebens möglich
Authors: Bubenzer Rainer
Published: March 2018

Dr. Richard Pazdur, Direktor der Onkologika-Abteilung des Zentrums für Arzneimittelforschung der FDA gab sich bei der US-Zulassung (1) des Antikörpers Ipilimumab (Yervoy®) ungewohnt euphorisch. „Das fortgeschrittene Melanom ist eine verheerende Erkrankung mit nur wenigen Behandlungsoptionen, von denen keine bisher das Leben der Betroffenen verlängern konnte. Ipilimumab ist die erste jemals von der FDA zugelassene Therapie, deren Verwendung eindeutig zu einer nachweisbaren Lebensverlängerung bei Patienten mit metastasierendem Melanom führt.” Nach der EUZulassung steht der Antikörper jetzt auch in Deutschland zur Verfügung.
Geriatrische Onkologie: Vergangenheit, Gegenwart und Zukunft – eine Zeitbombe
Authors: Henning Peter
Published: March 2018

Die Bevölkerung altert in zunehmendem Maße in fast allen Ländern der Welt (1), dementsprechend steigt auch der Anteil von alten Krebspatienten mit schweren Komorbiditäten. Diese Patienten werden jedoch sehr oft von klinischen Studien ausgeschlossen. Dementsprechend gering ist das Wissen um Toleranz und Behandlungsergebnisse in dieser Patientengruppe, die jedoch für jeden Behandler und Patienten hoch-relevant ist. Eine brisante Entwicklung.
Metastasiertes, kastrationsresistentes Prostatakarzinom: Phase-II-Studie mit Tasquinimod erfolgreich
Authors: Kretzschmar Alexander
Published: March 2018

Tasquinimod (TASQ, ABR-215050) ist ein Molekül mit einem neuartigen Wirkmechanismus, das immunsuppressive und gefäßneubildende Mechanismen unterdrückt, aber die Wundheilung nicht beeinflussen soll. Zielsubstanz ist das Protein S100A9, dem eine hohe Aussagekraft beim Prostatakarzinom zugeschrieben wird. Nach einer erfolgreichen Phase-II-Studie wird die Substanz jetzt in einer Phase-III-Studie untersucht.
Lokal begrenztes und fortgeschrittenes Prostatakarzinom: Bei Hochrisikopatienten Radiatio plus Androgendeprivationstherapie
Authors: Kretzschmar Alexander
Published: March 2018

Bei Hochrisikopatienten mit einem lokal begrenzten Prostatakarzinom (T2) oder lokal fortgeschrittenen Prostatakarzinom (T3-T4) ist eine Androgendeprivationstherapie plus Radiatio einer reinen Androgendeprivationstherapie hinsichtlich des Gesamtüberlebens sowie des Tumor-assoziierten überlebens signifikant überlegen. Dies zeigt eine aktuelle, hochrangig publizierte Vergleichsstudie. Die Radiatio wirkte sich nicht negativ auf die Lebensqualität der Studienteilnehmer aus.
F-18-FDG-PET bei Schilddrüsen-Autonomien
Authors: Voth E. , Wienhard K. , Wagner R. , Schicha H. , Börner Anne-Rose
Published: March 2018

Ziel: Die Schilddrüsenautonomie im lodmangelgebiet beruht in der Mehrzahl der Fälle auf konstitutiven, funktionsaktivierenden Mutationen des Thyreotropin-(TSH-)Rezeptors. Diese Studie evaluiert F-18-Fluoro-Deoxy-Glukose-(F-18-FDG-)PET der Schilddrüse bei Patienten mit funktionell relevanter Autonomie der Schilddrüse. Methoden: 20 Patienten mit fokaler und 10 Patienten mit disseminierter Autonomie der Schilddrüse wurden am Tag vor geplanter Radioiod-Therapie mit FDG-PET untersucht. 20 Patienten mit Kopf/Halstumoren und normaler Schilddrüsenfunktion dienten als Kontrollgruppe. Ergebnisse: Die F-18-FDG-Aufnahme in die Schilddrüse war signifikant höher bei Patienten mit funktionell relevanter Autonomie im Vergleich zu den Kontrollen. Fokale Autonomien zeichneten sich ausnahmslos durch einen intensiven, fokal gesteigerten Glukose-Uptake aus, während disseminierte Autonomien ein variables Muster globaler Steigerungen des Glukose-Uptakes zeigten. Schlußfolgerung: Funktionelle Autonomien der Schilddrüse zeigen einen gleichzeitig gesteigerten Glukose- und lodstoffwechsel als Folge der konstitutiven Mutation des TSH-Rezeptors, wobei das Ausmaß beider Veränderungen positiv korreliert.
Zweizeitige Radioiodtherapie benigner Schilddrüsenerkrankungen während eines stationären Aufenthaltes – Beobachtungen an 100 Patienten
Authors: Khandani A. , Schicha H.
Published: March 2018

Ziel: Eine zweizeitige Radioiodtherapie (RITh) während eines stationären Aufenthaltes ist gelegentlich bei Patienten mit gutartigen Schilddrüsenerkrankungen erforderlich, wenn ungewöhnlich starke Abweichungen zum vorher durchgeführten Radioiodtest auftreten. In dieser Studie wurden die Parameter (Uptake und Halbwertszeit u. a.) im Test mit denen der 1. und 2. RITh verglichen. Methode: Es wurden 100 Patienten erfaßt, die zwischen Juni 1992 und März 1994 in unserer Klinik eine zweizeitige RITh erhielten. Anhand der täglich gemessenen Aktivitäten wurden Uptake, Halbwertszeit und die Energiedosis bei der 1. und 2. RITh berechnet und miteinander verglichen. Ergebnisse: Eine zweizeitige RITh war bei etwa 10% der Patienten erforderlich. Dabei zeigte sich eine Verminderung des maximalen 1-131-Uptake bei der 1. Therapie gegenüber dem Test und bei der 2. gegenüber der 1. Therapie. Dagegen spielte eine Veränderung der effektiven thyreoidalen Halbwertszeit keine entscheidende Rolle. Schlußfolgerung: Der Wert des Radioiodtests zur »Dosisbestimmung« wird unterstrichen. Die vorliegenden Daten hinsichtlich der Verminderung des maximalen 1-131 -Uptake bei einer 2. RITh (Stunning) können bei der Dosisberechnung berücksichtigt werden.
A Rare Case of Polyostotic Fibrous Dysplasia Assessed by Bone Scintigraphy with Tc-99m Methylene Diphosphonate (MDP)
Authors: Ardemagni A. , Bestetti A. , Tagliabue L. , Del Sole A. , Conte A. , Tarolo G. L. , Di Leo C.
Published: March 2018

A 66-year-old man affected by polyostotic form of fibrous dysplasia in consequence of worsening of lower extremity bone pain aggravated by walking and concomitant increase of serum alkaline phosphatase and osteocalcin, was subjected first to a radionuclide study. Bone scan demonstrated a pathological uptake of the radiotracer in the craniofacial bones, right scapula, left and right posterior ribs, right hemipelvis and lower extremities confirming the diagnosis but establishing especially the extent of bone involvement, greater than expected on the basis of symptoms and X-ray findings, underlying the importance of nuclear medicine imaging in the assessment and follow-up of this rare disease.
Radionuclide esophageal transit test to detect esophageal disorders in patients with mitra valve prolapse
Authors: Tsai Shih-Chuan , Hsieh Jih-Fang , Ho Yung-Jen , Ding Hueisch-Jy , Kao Chia-Hung
Published: March 2018

Aim: The origin of chest discomfort in patients with mitral valve prolapse (MVP) is controversial. Our aim was to prospectively determine the incidence of esophageal disorders in MVP patients with or without chest pain. Methods: Twenty-five MVP patients with chest pain (group A) and 25 MVP patients without chest pain (group B) underwent evaluation of esophageal motility. None of the total of 50 MVP patients had significant coronary artery disease on cardiac catheterization. Esophageal motility including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (Rl) was analyzed by the radionuclide esophageal transit test (RETT). Results: In comparison with 25 age and sex-matched healthy volunteers, the results showed that: (1) 19 patients in group A (76%) had abnormal RETT findings (48% of cases with prolonged MTT, 44% of cases with higher RF, and 60% of cases with higher Rl); (2) 3 patients in group B (12%) had abnormal RETT findings (8% of cases with prolonged MTT, 4% of cases with higher RF, and 8% of cases with higher Rl). In addition, mean values of MTT, RF, and Rl in group A patients were significantly higher than in group B patients and healthy volunteers. Conclusion: We found that the chest pain in some MVP patients may be related to abnormal esophageal motility, based on the evidence from a simple and noninvasive RETT.
Positronen-Emissions-Tomographie und Knochenszintigraphie einer »osteoklastischen« Metastase
Authors: Roubaie Z. Al , Kirsch C.-M. , Chapot C.
Published: March 2018

Vorgestellt wird der Fall eines 66jährigen Patienten mit einem Bronchialkarzinom und einer Rippenmetastase, die beim PET-Staging durch einen deutlich erhöhten 18F-FDG-Uptake entdeckt wurde. Die Knochenszintigraphie mit “mTc-DPD zeigte einen Aktivitätsdefekt im Bereich dieser Rippe. Hier handelte es sich um einen schnell wachsenden Prozeß ohne Einwirkung auf eine osteoblastische Aktivität.
Individuelle Verlaufskontrolle der TSHRezeptor- Antikörper-Titer zur Einschätzung der Prognose eines M. Basedow
Authors: Holle L.-H. , Schroth H.-J. , Garth H. , Rink Th.
Published: March 2018

Ziel: Diese retrospektive Studie soll weiteren Aufschluß über den bislang kontrovers diskutierten Stellenwert einer Verlaufskontrolle von TSH-Rezeptor-Antikörper (TRAK)-Titern zur Beurteilung der Prognose eines M. Basedow geben. Methode: Die Ergebnisse von 1480 in-vitro- Untersuchungen an 36 Patienten (292 w, 54 m) im Alter von 9 bis 91 Jahren mit gesichertem M. Basedow bilden die Grundlage der Arbeit. Die TRAK-Spiegel wurden im Gesamtkollektiv, in der Gruppe aller unbehandelten Patienten, sowie in 182 individuellen Verläufen mit den jeweiligen fT3-, fT4- und basalen TSH-Werten verglichen. Ergebnisse: Die TRAK-Titer waren auch bei gleicher Funktionslage individuell sehr unterschiedlich. Bei den persistierenden Funktionsstörungen variierten sie initial zwischen 6 und 482 U/l (formaler Normbereich >15 U/l), so daß sich bei globaler Betrachtung der Kollektive keine Korrelation zwischen dem TRAK-Spiegel und dem Grad der Dysfunktion fand. Im individuellen Verlauf zeigten sich allerdings klare Zusammenhänge zwischen der weiteren Krankheitsentwicklung und den Veränderungen der TRAK. Als Grenzwert zur Trennung des Kollektivs mit fortbestehender bzw. rezidivierender Fehlfunktion und der Gruppe der Remissionen erwies sich ein Abfall des individuellen TRAK-Titers auf unter 50% des Ausgangswertes als günstig, der in 94% aller Remissionen nachweisbar war. Bei 90% aller Rezidive fanden sich entweder persistierend hohe TRAK-Titer (Abfall um weniger als 50% des Ausgangswertes), oder es kam zum erneuten TRAK-Anstieg. Der positive prädiktive Wert der Methode beträgt 97%, der negative prädiktive Wert liegt bei 58%. Schlußfolgerung: Bei der Verlaufskontrolle von TRAK zur Beurteilung der Prognose eines M. Basedow kommt es weniger auf die absoluten Titer, als vielmehr auf die relativen zeitlichen Veränderungen an. Im Falle persistierend hoher TRAK ist von einer fehlenden Spontanremission bzw. einem bevorstehenden Rezidiv auszugehen.
Inkorporationsmessungen bei Angehörigen von Radioiodtherapiepatienten nach Therapie benigner Erkrankungen der Schilddrüse
Authors: Hänscheid H. , Schelper L.-F. , Körber C. , Reiners C. , Laßmann M.
Published: March 2018

Ziel: Patienten exhalieren 1-131 nach Radioiodtherapie. Ziel der vorliegenden Studie ist die Bestimmung der von Angehörigen von Radio- iodtherapiepatienten nach Entlassung aus der Therapiestation inkorporierten Aktivität und der daraus resultierenden Schilddrüsendosis.

Methoden: Bei 31 Angehörigen von Radioiodtherapiepatienten wurde die Schilddrüsenaktivität mittels der Schilddrüsensonde eines Ganzkörperzählers gemessen und daraus Dosiswerte bestimmt.

Ergebnisse: Bei 11 der 31 Messungen wurde keine Aktivität oberhalb der Nachweisgrenze von 13 Bq festgestellt. Im Mittel wurde bei den restlichen Personen 104 Bq gemessen, entsprechend einer daraus resultierenden mittleren Schilddrüsendosis von 0,2 mSv (Maximalwert: 2 mSv). Schlußfolgerung: Die Zufuhr von 1-131 bei Angehörigen von Radioiodtherapiepatienten nach deren Entlassung ist gering und führte in keinem Fall zu einer effektiven Dosis von mehr als 1 mSv.
Effect of Clamp Type on Type II External Fixator Stiffness
Authors: Wotton H. M. , Kraus K. H.
Published: March 2018

In order to investigate the effects of two clamp types on type II external fixator stiffness, models using wooden dowels were constructed and mechanically tested. Kirschner-Ehmer clamps were compared to Securos clamps in four-pin type II external fixator configurations. Increasing axial loads were applied and displacement at a gap in the centre of the model measured. Linear regression and comparison of the slope of the regression lines before yield, after yield, and throughout 700N assessed model performance. The resulting load displacement curves were linear. There was no difference in model stiffness before yield, but was greater with models constructed with Securos clamps after yield and overall. The mean relative stiffness of the models constructed with the Kirschner-Ehmer type clamps were 320 ± 53.8 Newtons/mm, and with models constructed with Securos type clamps were 425 ± 74.8 Newtons/mm. Utilizing Securos clamps resulted in significantly (p<0.05) greater frame stiffness that is attributable to higher load at yield and greater stiffness after yield. Increasing resistance to rotational moments at the clamp/connecting bar junction should result in less stress imparted to the bone/pin interface, decreasing strain and decreasing pin loosening.

Axial stiffness in models of bilateral external fixators using Kirschner-Ehmer type clamps versus Securos clamps were compared. The stiffness of fixators constructed with Securos clamps was greater overall and at high loads due to a more secure fixation pin/connecting bar junction. Increased fixator stiffness would result in less stress at the bone/pin interface and may contribute to less pin loosening.
A Method of Quantifying Microangiograms
Authors: Wilson J. W. , Arighi Mimi
Published: March 2018

A method is proposed which can quantify the vascularity depicted in microangiograms. Total vascular area depicted in the microangiogram is measured using an image analyser. Vessel diameters and frequency are determined using standard stereological methods. Using the incidence of measured vessel diameters, the measured vascular area, and minimal mathematical manipulation, a distribution curve of possible vascular volumes can be constructed. When combined with sample volume, statistical data relevant to vessel diameters and volumes can be derived. This calculation is not meant as a substitute to stereological methods for quantifying vascularity using thin sections, only as a quantitative adjunct to microangiograms and descriptive microangiography.

A method is proposed which can provide statistical data relevant to vessel diameters and volumes depicted in microangiograms.
Screw Torque and Bone Plate Fixation to Equine Cadaver Longbones
Authors: McKee S. L. , Field J. R.
Published: March 2018

The purpose of the study was to determine what contribution an individual surgeon, their gender and the location of screw application within the bone makes to the perceived optimal applied screw torque (Mopt) for bone plate fixation to equine cadaver longbones. Five surgeons were required to apply a 4.5 mm broad dynamic compression plate, using 4.5 mm fully-threaded cortical bone screws, to the lateral diaphysis of an equine third metacarpal bone.

Consideration of within (repetition) and between individual differences was significant (P = 0.010, P = 0.0001) as was gender (P = 0.0001) with male surgeons applying higher levels of torque. There did not appear to be a contribution to variability by location (P = 0.065). Regression analysis of Mopt and cortical thickness showed no linear relationship between these parameters (R2 = 0.088), allowing the conclusion that cortical thickness did not influence the perceived optimal applied screw torque.

Screw torque was also measured at point-of-failure (Mmax) showing no relationship to location.

This study examined the contribution of variation within and between individual surgeons, their gender and the location of screw application in the bone on the perceived optimal applied screw torque for bone plate fixation to equine cadaver longbones.

Significant differences were seen within (repetition) and between individuals. When individuals were grouped according to gender significant differences also arose (males applying greater levels of torque than females). The results suggest, that for mature equine longbone fracture repair the use of a torque-limiting device may be a consideration in order to standardize bone plate fixation.
Total Hip Replacement in Three Ponies - A Feasibility Study
Authors: Squire K.R.E. , Toombs J. P. , Sickle D.C. , Blevins W.E. , Clarke R.B. , Fessier J.F.
Published: March 2018

Total hip replacement (THR) using two different human implant designs was performed in three ponies. Pony # 1 sustained a fracture of the ipsilateral femur and was euthanatized 40 hours after implantation of a human selfcentering hip. The same implant, with a modified femoral prosthesis, was used in pony # 2. It luxated initially at 26 hours, was surgically reduced after changing to a smaller diameter acetabular component, and reluxated at day 23 when the pony was euthanatized. A modified femoral component with a press-fit, screw-fixated acetabular prosthesis was inserted in pony # 3. This pony was maintained for 232 days and sustained over 400,000 cycles on the prosthesis by being exercised daily on a mechanical walker. We conclude that THR is feasible in ponies and small horses and would allow this size of animal to be used as a research model for hip replacement in heavy human beings.

Total hip replacement (THR) was evaluated in three ponies as a model for studying THR problems in humans and for the management of coxofemo-ral disease in small Equidae. A modified cemented human femoral component, with a press-fit acetabular component, was maintained in one pony for 232 days, sustained over 400,000 cycles, and established the feasibility of THR in this species.
Foreign Body Granulomatous Response to Particulate Bony Debris
Authors: Ish-Shalom Z. , Misselevich I. , Mendes D. G. , Boss J. H.
Published: March 2018

Archival material was retrieved in order to histologically assess the body’s response to micron-sized, necrotic bony particles. Specimens were obtained from (1) human bone grafts in a subcutaneous or muscular pouch of athymic nude mice, (2) a massive bone allograft replacing a patient’s humerus, (3) rabbits’ healing tibial cortical bone defects littered with finely dispersed bony particles, (4) periprosthetic tissues of patient’s aseptically loosened artificial joints and (5) interfacial membranes of intramedullary nails used for fixation of patients’ fractured long bones. Necrotic bony debris was found to induce a giant celled granulomatous reaction. In sections of undecalcified samples stained by the von Kossa method, small calcific particles were observed to be present within polykaryonic macrophages (foreign body giant cells) and surrounded by mononuclear macrophages. It is concluded that a foreign body-type giant celled granulation tissue participates in the degradation of micron-sized, necrotic bony detritus, whether the disintegrating bone is of the xeno-, alio- or autogenic provenance.

Histological examination of von Kossa-stained sections, of undecalcified specimens, revealed a giant celled granulomatous response to bony debris. Irrespective of whether or not the disintegrating bone was of auto-, alio- or xenogeneic provenance, micron-sized bony particles were found to be phagocytosed by polykaryonic macrophages of the granulation tissue.
Biomechanical Evaluation of the Suitability of Monofilament Nylon Fishing and Leader Line for Extra-articular Stabilisation of the Canine Cruciate-deficient Stifle
Authors: Roe S. C. , Caporn T. M.
Published: March 2018

The use of monofilament nylon line for extra-articular stabilisation of the cruciate deficient canine stifle is widespread in veterinary surgery. The purpose of this study was twofold: 1) to examine the mechanical behaviour of two forms of monofilament line - standard nylon fishing line (NFL) and nylon leader line (NLL) - when sterilised by steam or ethylene oxide and formed into loops approximating their use in the clinical situation; 2) to compare the mechanical performance of the canine fabellar attachment site to the steel hooks used in the first part of the study.

It was found that NLL loops were not affected by sterilisation and had higher failure loads and stiffness than NFL loops. Further testing of 27-kilo - gram-test (kgt) and 36 kgt steam-sterilised NFL and NLL found that of the materials tested, NLL 27 kgt was most suitable as an extra-articular stabiliser of the canine stifle. The performance of the fabellar attachment site was superior to the steel hooks when cycled to 50 N and inferior when cycled to 100 N.

The suitability of monofilament nylon fishing line (NFL) and monofilament nylon leader line (NLL) for use as lateral fabel-lotibial sutures (LFTS) in canine cranial cruciate ligament repair was investigated. In vitro testing of loops of the materials was performed with steel hook and fabellar attachment points. Twenty-seven-kilogram test NLL was found to be the most suitable nylon line from which to construct an LFTS.
Lumbar Meningioma in a Dog
Authors: Miller C. W. , Smith-Maxie L. L. , Bateman K. E. , Duignan P. J. , Auger J. M.
Published: March 2018

Lameness may be the only detectable clinical sign in spinal meningiomas. An unusually young dog was diagnosed with lumbar meningioma whereas it had been referred for further evaluation of a previously treated partial anterior cruciate ligament rupture. Comparative aspects with the human counterpart are presented, showing prospects for improvement of treatment in the veterinary field.
Avulsion Fractures of the Femoral Head: Internal Fixation Using a Ventral Approach to the Hip Joint
Authors: Montavon P. M. , L’Eplattenier H. F.
Published: March 2018

Avulsion fractures of the femoral head are encountered in conjunction with craniodorsal luxations of the hip joint and cannot be treated conservatively without risking either reluxation of the joint or considerable cartilage damage resulting in degenerative joint disease. Fixation of the fragment is possible by inserting a Kirschner wire and a lag screw from the articular surface, making sure the implants are well countersunk. A ventromedial approach to the hip joint allows good visibility of the joint surface and easy reduction of the fracture without severing the round ligament. The surgical technique described was used on three cases and combines a ventromedial approach to the hip joint with fixation of the fracture with a Kirschner wire and a lag screw inserted from the joint surface, and has the advantages of enabling good reconstruction of the joint surface as well as maintaining postoperative joint stability. Both these factors considerably reduce the development of degenerative joint disease and improve the prognosis for recovery of full limb function.

A surgical technique for treatment of avulsion fractures of the femoral head is described. It combines a ventromedial approach to the hip joint with fixation of the fracture with a Kirschner wire and a lag screw inserted from the joint surface.
Comparison of Carbon Dioxide Laser Modalities for Removal of Polymethylmethacrylate Cement
Authors: Rochat M. C. , Bartels K. E. , Payton M. E. , Hoffman R. J. , Schafer St. A. , Dickey D. , Lange D. N.
Published: March 2018

Polymethylmethacrylate (PMMA) cement is routinely used in a number of surgical procedures performed on human beings and animals. As the use of PMMA increases in veterinary medicine, the need for its removal during “revision” surgeries also increases. Common indications for removal of PMMA are infection, aseptic loosening, and fracture of the cement. Polymethylmethacrylate cement is often applied in areas of the body where typical mechanical methods of removal are dangerous or impossible. Cement placed near the spinal canal for the treatment of caudal cervical malformation-malarticulation syndrome or deep within the femoral medullary canal for total hip prostheses are examples. The ability to safely and easily remove cement should lower intraoperative complication rates associated with revision surgeries.

The vaporization efficiency for removal of PMMA cement for three carbon dioxide laser modalities (continuous wave only, with Swift-Lase™ attachment, and with Fiberlase™ wave guide) were determined, as well as heat transferred to periosteal surface during PMMA cement vaporization, and gross pathology to the cortical bone at the maximum vaporization efficiency power. Cefazolin sodium was added to half of the samples to determine if the ablation ablation rate of PMMA would be affected. The C02 laser with wave guide was the most efficient modality for vaporization at 25 watts, and produced significantly less heat transfer to the periosteal surface than the heat of polymerization of the PMMA cement. Cefazolin sodium appeared to slightly decrease the vaporization efficiency, and all of the lasers produced gross and histologic lesions to the bone.

Three laser types were compared for their ability to efficiently and safely remove polymethylmethacrylate (PMMA) cement. Vaporization rates were determined. The most efficient wattage for each laser modality was used to compare the heat transferred during PMMA removal as well as the pathology created by application of each laser modality to the cortical bone. The CO2 laser with wave guide at 25 watts was the most efficient modality for vaporization of PMMA cement, and produced significantly less heat transfer to the periosteal surface than the CO2 laser and the CO2 laser with Swift-Lase™.
Collateral Ligament Prosthesis for Stabilization of Transverse Subchondral Fracture of Metatarsus III/IV in a Calf
Authors: Schawalder P. , Steiner A. , Hirsbrunner G.
Published: March 2018

The successful use of a collateral ligament prosthesis for stabilization of a transverse subchondral fracture of metatarsus III/IV in a newborn calf is reported. The proximal metaphysis of the right metatarsus III/IV was displaced medially with the medial collateral ligaments ruptured. On the medial side the periosteum was intact, whereas it was detached on the lateral side. The fracture was reduced and the collateral ligaments and the periosteum were reattached on the lateral side of the proximal metatarsus III/IV using titanium alloy staples. On the medial side a braided polypropylene yarn prosthesis, including the ruptured collateral ligaments was attached to the os tarsale II/III and the proximal metatarsus III/IV, using titanium alloy staples. The minimal internal stabilization was reinforced by a full limb fibreglass cast.

Seven months after the operation clinical and radiographic follow-up examination revealed complete healing of the fracture without signs of ankylosis of the tarsometatarsal joint. The calf did not show any signs of lameness and axial alignment of the fractured bone in the frontal and sagittal plane was excellent.

Subchondral fractures in calves have rarely been described. The case reported here deals with treatment of a subchondral fracture of metatarsus III/IV in a newborn calf. Open fracture reduction was followed by minimal internal stabilization, using a collateral ligament prosthesis, which was reinforced by external coaptation. Follow-up examination revealed complete healing of the fracture in good alignment.
Evaluation of Femoral Nerve Blockade for Postoperative Analgesia in Dogs Undergoing Stifle Arthrotomy
Authors: Riedesel D. , Cox K. R.
Published: March 2018

The efficacy of the femoral nerve block (FNB) in alleviating postoperative pain was evaluated in dogs undergoing stifle arthrotomy. The pre- and postoperative nerve blocks were compared to intraarticular administration of a local anaesthetic. Forty-eight dogs with a ruptured cranial cruciate ligament were randomly assigned to the following groups: Group A (n = 16) received a femoral perineural injection prior to surgery; eight dogs within this group were given 0.5% bupivacaine and eight dogs received 0.9% saline. Group B (n = 16) had a femoral perineural injection immediately after surgery; eight dogs received 0.5% bupivacaine and eight received 0.9% saline. Group C (n = 16) dogs were given 0.5% bupivacaine (n = 8) or 0.9% saline (n = 8) intraarticularly. Postoperative pain was evaluated using a visual analog scale and a numerical rating scale, including measurement of heart rate, respiratory rate and systolic pressure. The dogs were scored preoperatively and at zero to six and at 24 hours after the operation. A significant difference was not noted between groups during the time until the first dose of supplemental analgesia nor in the total dose of supplemental analgesia required. The duration of the operation was found to be negatively correlated with the duration of postoperative analgesic effect. There was not any significant difference between the groups in pain scores at any time.

Femoral nerve block (FNB) was evaluated for the control of postoperative pain in dogs undergoing stifle arthrotomy. FNB, using bupivacaine, was performed preoperatively and was compared to a postoperative FNB, and to saline controls. In addition, the efficacy of the FNB was compared to intra-articularly administered bupivacaine. Differences were not found between any groups in the alleviation of postoperative pain.
A Comparison of the Mechanical Properties of Two External Fixator Designs for Transarticular Stabilization of the Canine Hock
Authors: Pardo A. D. , Parrott M. B. , Wassermann J. F. , Wells K. L.
Published: March 2018

Biomechanical testing was performed on 20 canine tibiotarsal joints. The conventional transarticular external skeletal fixator (ESF) was applied to one rear limb while the alternative design using acrylic was applied to the contralateral rear limb. The mode of failure for all models was fracture of the phalanges at the point of fixation in the distal grip device.

The mean stiffness for the acrylic design was 58.5 N/mm and for the conventional ESF 44.8 N/mm. The mean maximum load to failure for the acrylic design was 490.7 N, compared to 405.1 N for the conventional ESF. The angle of deformation at maximum for the acrylic apparatus was 0.45 degrees compared to 2.36 degrees for the standard ESF. The mean energy absorbed to maximum load was 1.92 N-m for the acrylic design and for the conventional ESF 2.69 N-m. This study indicated that the acrylic design was superior in maintaining immobilization across the tibiotarsal joint, indicated by the angle of deformation (p = 0.002) and was structurally comparable in stiffness (p = 0.295), maximum strength (p = 0.438), and total energy absorbed to failure (p = 0.276).

The properties of an acrylic and a stainless steel external transarticular skeletal fixator were biomechanically evaluated. Biomechanical parameters evaluated included: maximum load to failure, stiffness, angle of deformation across the tibiotarsal joint, and energy absorbed to failure. The angle of deformation was less (p = 0.002) for the acrylic device. Based on this study, we conclude that the new acrylic design is structurally comparable to the conventional transarticular ESF and warrants clinical trials.
A Review of 116 Clinical Cases Treated with External Fixators
Authors: Franch J. , Cairó J. , Font J.
Published: March 2018

One hundred and sixteen clinical cases (113 dogs) in which the external skeletal fixation was applied as the primary method of stabilization were reviewed. The 116 clinical cases were divided into the following groups: open fractures (41 cases); gunshot fractures (8 cases); comminuted fractures (11 cases); fractures affecting immature animals (11 cases); trans-articular application of external fixators (16 cases); corrective osteotomies (4 cases) and “simple” fractures (25 cases). History and signs of the animal (breed, age and weight), location and treatment of the fracture, healing time and functional recovery were evaluated in each case and discussed for every group. The mean healing time in the different groups ranged from 4.6 wks (immature animal’s fractures) to 13 wks (gunshot fractures). With reference to the functional recovery, in 14 cases (12.1%) the results were poor, in 57 cases (49.1%) the results were good and in 45 cases (38.3%) the results were excellent. The main complications observed were delayed union, non-union and osteomyelitis.

One hundred and sixteen clinical cases of fractures (113 dogs) were treated with a »Meynard« external fixator. The cases were divided in 7 groups: open fractures, gunshot fractures, comminuted fractures, fractures affecting immature animals, trans-articular application of external fixators, corrective osteotomies and »simple« fractures. Each case is reviewed and a discussion is provided for each group.
Polyethylene Wear in Retrieved Canine Acetabular Components
Authors: Tompkins D. , Bhushan B. , Olmstead M. L. , Dyce J.
Published: March 2018

The aim of this pilot study was to define the mechanism and mode of polyethylene wear in acetabular components retrieved from seven dogs following therapeutic total hip replacement. The articular surface of each acetabular component was examined using contact profilometry and scanning electron microscopy (SEM). Peak-tovalley distance (P-V) and arithmetic average surface roughness (Ra) were calculated for each quadrant of the surface. Deformation of the regular profile of the machining lines was the least severe form of surface alteration. Randomly orientated scratches, fine tapered filaments, ripples, and coarse surface shredding were common SEM observations. Gouging of the convex surface of the cup was seen in two cases following failure of the polyethylenecement interface. Wear of the nonarticular acetabular rim suggested neck impingement in one case. P-V and Ra were significantly lower in the craniodorsal zone, compared to the average roughness of the other three quadrants (p < 0.05). Abrasion, adhesion and fatigue were the principal mechanisms of polyethylene wear, and were implicated in the production of polyethylene particulate debris. Meticulous removal of abrasive third bodies at the time of surgery, and correct orientation of the acetabular component, should reduce early and severe wear.

Polyethylene wear is inevitable following metal-on-polyethylene total hip replacement. In this study, the nature of polyethylene wear in retrieved canine acetabular components was defined, using contact profilometry and scanning electron microscopy. Abrasion, adhesion and fatigue were the principal mechanisms of wear, and were implicated in the production of polyethylene particulate debris.
A radiological study of the sesamoid bones and os meniscus of the cheetah (Acinonyxjubatus)
Authors: Groenewald H. B. , Wagner W. M. , Kirberger R. M.
Published: March 2018

A radiological study of the sesamoids was undertaken in differing numbers of joints from 10 cheetahs. Each sesamoid was described and measured. Sesamoids were not found in the elbow and tarsal joints. A sesamoid was found in the abductor digiti 1 longus muscle as well as paired sesamoids were found at the interosseous muscle insertions palmarly of digits #1–5 and plantarly of digits #2–5. There were significant differences between abaxial and axial lengths of some of these sesamoids and the palmar sesamoids were significantly shorter than their plantar counterparts. In the stifle, a patella, a popliteal and two gastrocnemius sesamoids were present. The lateral gastrocnemius sesamoid was significantly longer than the medial one and had a peculiar bilobed appearance. An os meniscus was constantly present in the cranial aspect of the medial meniscus. The shape of the sesamoids and the presence of an os meniscus in the cheetah differed from those seen in the domestic dog and cat and were ascribed to differences in form and function.

The radiological appearance of the sesamoids and os meniscus were described in adult cheetahs and compared to the domestic dog and cat. Possible anatomical and physiological factors influencing their appearance are postulated.
Evaluation of an intracapsular technique for the treatment of cranial cruciate ligament rupture
Authors: Roush J. K. , Hoskinson J. J. , McLaughlin R. M. , Geels J. J.
Published: March 2018

Treatment of cranial cruciate ligament (CCL) rupture using fascial replacement techniques have yielded good clinical results, with 85% to 93% of dogs returning to clinical soundness or intermittent lameness as evaluated by surgeons or owners, but have not been evaluated by force plate analysis long-term. The purpose of this study is to document the long-term clinical and radiographic outcome of dogs having CCL rupture stabilized with an underand- over fascial graft technique by owner assessment, clinical examination, force plate analysis, plain film radiography, and scintigraphy. Twenty dogs with previously repaired unilateral CCL rupture were used for the study. Although client satisfaction was high, force plate analysis revealed significantly lower vertical forces and impulses in the operated versus unoperated limbs. Radiographs and bone scans revealed significant bony changes and synovitis in the operated stifle relative to the unoperated stifle at a median of 17.5 months following repair. Lameness persists in dogs having undergone CCL repair using the under-and-over fascial graft technique; whether this lameness is secondary to progression of osteoarthritis or is a result of surgical repair is unknown.

The under-and-over fascial strip technique for stabilization of cranial cruciate ligament-deficient stifles has been evaluated using force plate analysis and nuclear scintigraphy. A median of 17.5 months following surgery, dogs are bearing less weight on the operated limbs as compared to the unoperated limbs. Significant synovitis and bony changes are present when compared to the unoperated limb as evaluated by scintigraphy. Despite these changes, clients are satisfied with the results of surgical repair.
The surgical treatment of traumatic stifle disruption in a cat
Authors: Rackard S. , Connery N. A.
Published: March 2018

A cat with multiple ligamentous injury of the stifle was surgically managed using a single trans-articular pin. The pin was removed after four weeks with the cat regaining adequate range of motion for normal activity over the following six weeks.
Synovial osteochondromatosis in the elbow joint of a Bengal tiger (Panthera tigris tigris)
Authors: Williams M. C. , Lambrechts N. E.
Published: March 2018

A 10-year-old Bengal tiger with a history of chronic thoracic limb lameness was presented for clinical evaluation. Radiographs of the elbows revealed extensive osteophyte formation in both joints and three ovoid mineralised densities in the right joint. Joint fluid analysis was consistent with a degenerative joint process. The joints were partially explored arthroscopically. A medial arthrotomy of the right joint allowed collection of synovial membrane samples which, when examined histopathologically, revealed the presence of cartilaginous nodules with central endochondral ossification within the synovial membrane. A diagnosis of synovial osteochondromatosis was made. This case is compared to other cases described in veterinary and human medical literature.

Clinical, radiological, and histopathological description of synovial osteochondromatosis in the elbow joint of a Bengal tiger.
The Utah paradigm of skeletal physiology: what is it?
Authors: Frost H. M.
Published: March 2018

An elegant design stratagem for an organ intended to carry loads for life without fracturing, rupturing or wearing out would make those loads determine the organ's strength. It seems load-bearing mammalian bones, joints, fascia, ligaments and tendons do exactly that. Physiologists begin to understand how they do it, and that led to the Utah paradigm of skeletal physiology. Those adaptations occur in two major steps. The first step creates the genetically predetermined newborn skeleton with its anatomical relationships and biologic machinery. The second step adds to the first one all postnatal adaptations to mechanical and other challenges that would affect an organ's strength, size, architecture and composition. During postnatal growth, increasing loads make tissue-level biologic mechanisms correspondingly increase the strength of such organs. Mechanical strain-dependent signals help to control that process, which muscle strength, muscle anatomy and neuromuscular physiology strongly influence. Its problems seem to cause or help to cause numerous skeletal and some extraskeletal disorders. A Table in the article lists examples of them.

This article summarizes salient features of the Utah paradigm, which includes both facts and some meanings inferred from them. Other times and people must resolve any questions about those meanings and about the devils that can lie in the details. Parenthetically, instead of the accuracy of the facts on which that paradigm stands, the above questions usually concern the different meanings people can infer from facts, and whether particular facts and ideas would be relevant to a particular issue.