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Zusammenfassung: Die orthopädischen Therapieoptionen zur Versorgung des Rheumatikers sind in den letzten Jahren maßgeblich fortentwickelt worden. Neben den konservativen Behandlungsmethoden der Orthopädie mit speziellen Schienen und Hilfsmitteln sowie lokalen Injektionen im Gelenk- und Sehnenbereich wird das Therapiespektrum wesentlich von den operativen Interventionsmöglichkeiten geprägt. Grundsätzlich können hierbei gelenkerhaltende, gelenkersetzende und gelenkversteifende Eingriffe unterschieden werden. Aufgrund apparativer Möglichkeiten und ausgefeilter technischer Vorgehensweisen haben sich auch bei Rheumatikern minimal-invasive Techniken zunehmend etabliert. Dadurch konnte die postoperative Morbidität deutlich reduziert werden. Zu den vorrangigen orthopädischen Therapiezielen gehören die Funktionsverbesserung und Schmerzreduktion sowie die Prävention der erneuten lokalen Entzündungssymptomatik. Unter diesen Therapiemaximen hat die Arthrodese nur noch in einzelnen Bereichen Bedeutung. Gelenkerhaltende und -ersetzende Maßnahmen stehen heute ganz im Vordergrund und werden in diesem Beitrag für den internistischen Rheumatologen dargestellt.

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We have performed a controlled, randomised study to analyse the effects of low-energy shock-wave therapy (ESWT) on function and pain in tendinitis of the supraspinatus without calcification. There were 20 patients in the treatment group and 20 in the control group. The former group received 6000 impulses (energy flux density, 0.11 mJ/mm2) in three sessions after local anaesthesia. The control group had 6000 impulses of sham ESWT after local anaesthesia.The patients were examined at six and 12 weeks after treatment by an independent observer who evaluated the Constant score and level of pain. We found an increase in function and a reduction of pain in both groups (p = 0.001). Statistical analysis showed no difference between the groups for the Constant score and for pain. We therefore do not recommend ESWT for the treatment of tendinitis of supraspinatus.

We describe an experimental approach that combines multidimensional NMR experiments with a steadily renewed source of laser-polarized129Xe. Using a continuous flow system to circulate the gas mixture, gas phase NMR signals of laser-polarized129Xe can be observed with an enhancement of three to four orders of magnitude compared to the equilibrium129Xe NMR signal. Due to the fact that the gas flow recovers the nonequilibrium129Xe nuclear spin polarization in 0.2 to 4 s, signal accumulation on the time scale of seconds is feasible, allowing previously inaccessible phase cycling and signal manipulation. Several possible applications of MRI of laser-polarized129Xe under continuous flow conditions are presented here. The spin density images of capillary tubes demonstrate the feasibility of imaging under continuous flow. Dynamic displacement profiles, measured by a pulsed gradient spin echo experiment, show entry flow properties of the gas passing through a constriction under laminar flow conditions. Further, dynamic displacement profiles of129Xe, flowing through polyurethane foams with different densities and pore sizes, are presented.

In this paper we describe the construction of an apparatus for optical pumping of ¹²⁹Xe in a circulating gas system connected to a probe for static high-field NMR. The optimal working conditions for the optical pumping under flow are explored, yielding a continuous gas flow with a steady-state spin-polarization of about 2%. It is shown that on various types of high surface area materials a steady-state of adsorbed laser-polarized xenon can be reached with polarizations of about 0.3%. NMR spectroscopy of this layer is greatly facilitated due to the renewable magnetization under the continuous-flow conditions allowing unprecedented fast detection of two-dimensional NMR experiments with laser-polarized Xe. The steady-state spin-polarization of adsorbed ¹²⁹Xe gives rise to cross-relaxation to surface nuclei such as ¹H and ²⁹Si. A direct spin-polarization-induced nuclear Overhauser effect (SPINOE) to heteronuclei is observed with an enhancement factor of about 20−30. A method is presented for simple modulation of the spin-polarization direction in the fringe field of the high-field magnet; this is exploited to obtain difference SPINOE spectra to highlight only the surface nuclei. Furthermore, a transfer via cross-polarization (CP) from adsorbed Xe to surface protons is demonstrated to select surface groups with reduced mobility compared to SPINOE detection.

NMR signals of surface nuclei of solids may be enhanced by the transfer of spin polarization from laser-polarized noble gases. Until now such experiments have not been feasible under conditions of magic angle spinning. In the present contribution it is shown that laser-polarized129Xe can be inserted into a spinning rotor under continuous-flow conditions using helium as a carrier gas. Effective adsorption of xenon on the sample occurs at temperatures of about 163–173 K making possible the observation of a spin polarization induced nuclear Overhauser effect (SPINOE) from the laser-polarized129Xe to surface1H nuclei of SiO2(AEROSIL300). This technique opens the way to selectively enhancedhigh-resolutionmultinuclear surface NMR experiments.

In cases of congenital varus deformity of the proximal femur, the screening of hip dysplasia can lead to misinterpretations. The false-positive ultrasound result is caused by the superiorly displaced greater trochanter in hips with coxa vara, which narrows the scan window. In this paper three typical patients are presented to demonstrate that the use of additional non-standard views cannot exclude hip dysplasia in all cases. Hence, such patients with femoral abnormalities and doubtful sonographic findings should be further evaluated by arthrography or magnetic resonance imaging to rule out additional hip dysplasia.

A total of 113 patients, excluding those with tumor, spondylitis, and idiopathic scoliosis, underwent anterior lumbar interbody fusion (ALIF) with autologous iliac crest graft between 1984 and 1991 at our department. The proportion of these who were failed back patients was higher than that reported in the literature. Evaluation of functional outcome was feasible in 80 patients, utilizing Oswestry and Marburg scores, which were closely intercorrelated. The overall results yielded an improvement in the Oswestry score of 35.7 percentage points. A subset of 52 patients who were evaluated twice, showed the same results at an average of 6.6 years as they did at 2.3 years following surgery. Functional results showed a weak correlation with postoperative height loss of the intervertebral space. Influencing factors for the functional result were: postoperative compensation claim, age, and obesity. Of the professional people involved, 19.4% did not return to any occupation. Patients satisfied with the result had significantly greater functional improvement. Younger patients with additional dorsal distraction prior to ALIF for reduction of severe spondylolisthesis fared better than patients with ALIF alone. The rate of complications was low and did not contribute to the postoperative functional result. On the basis of these results further prospective studies have been designed and are currently underway.

Thirty cementless femoral stems of six different types of hip endoprostheses were impanted in femurs taken at autopsy and underwent static loading and afterwards dynamic loading of 50000 cycles to simulate walking during the early months after implantation. After that, the static load tests were performed again. During both static load series a certain amount of micromotion between stem and implantation bed occurred in the frontal and sagittal planes and also during rotation. The six prostheses exhibited clearly differing results. The influence of dynamic load on the extent of micromotion was small.

It has been reported1 that children with Mongolism demonstrate an idiosyncrasy to atropine with a significantly increased rate of pupillary dilatation after conjunctival instillation. One possible explanation of this hypersensitivity may be that in Mongolism there is a diminished availability of some natural antagonist to atropine. Now one such substance is serotonin which has been shown to have an action in pharmacological opposition to atropine in rabbit intestine2 and guinea pig ileum.3 Moreover, we have found that in Mongolism there is a decreased urinary excretion of 5-hydroxyindoleacetic acid,4 the end-product of serotonin. The mean seven-hour excretion of 5-HIAA after an oral dose of 250 mg/kg. dl-tryptophan was 47μg/kg. for 16 children with Mongolism as opposed to 66.0μg/kg. for 13 normal controls. While these differences are probably not significant by the Aspin Welch Test5 (p = <0.1 and >0.05), a similar trend was shown in another

The title thiatriazines, e.g. (III), (VI), (IX), (X) and (XIII), are prepared via condensation of the cyanimides (I) and (IV) with the sulfodiimide (II).

Sulfimides, Sulfoximides and Sulfodiimides are polyfunctional compounds with nucleophilic/basic nitrogen and acidic hydrogen adjacent to sulfur. From these Mannich-type-reaction products 1 were prepared. For example, amidomethylation on nitrogen was achieved either directly via three-component condensation (pathway (a) or, after conversion of the S-Imide into the sodium salt by treatment with N-chloromethyl-amides (pathway (b)). With highly reactive methylene-iminium halides pathway (b) provided N-aminomethylated sulfoximides, the stability of which mainly depends on the substituents on sulfur. Surprisingly stable, however, are their monoquaternary salts. These are of pharmaceutical interest with respect to anticholinergic and antihistamine activity, which was found in this series and will briefly be discussed. Of similar interest but spasmolytically less active are C-Mannich-bases of type 2 as well as N-aminoalkylated sulfodiimides 3, which were synthesized by different reaction routes.