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Double exposure holography using a pulsed ruby laser system has been applied to investigations of tympanic membrane vibrations. As could be proved in experiments on human temporal bone preparations this method turned out to be capable of investigating vibrational unsymmetry and phase-opposition of different parts of the tympanic membrane. Alterations of the vibration pattern due to pathological changes of the mechanical properties of the middle ear can also be detected using this technique. This provides in principle the possibility of a differential diagnosis of these dysfunctions without opening the tympanic cavity. For investigations in living man a special closed acoustic system for sound application and holographic recording through the outer ear canal has been developed. First results o n patients with regular and pathologically altered status of the middle ear are described. [ABSTRACT FROM AUTHOR]

Physical fitness is defined as an individual's ability to be physically active. The main components are cardiorespiratory fitness (CRF), muscle strength, and flexibility. Regardless of physical activity level, physical fitness is an important determinant of morbidity and mortality.The aim of the current study was to describe the physical fitness assessment methodology in the German National Cohort (NAKO) and to present initial descriptive results in a subsample of the cohort.In the NAKO, hand grip strength (GS) and CRF as physical fitness components were assessed at baseline using a hand dynamometer and a submaximal bicycle ergometer test, respectively. Maximum oxygen uptake (VO 2max ) was estimated as a result of the bicycle ergometer test. The results of a total of 99,068 GS measurements and 3094 CRF measurements are based on a data set at halftime of the NAKO baseline survey (age 20-73 years, 47% men).Males showed higher values of physical fitness compared to women (males: GS = 47.8 kg, VO 2max  = 36.4 ml·min -1  · kg -1 ; females: GS = 29.9 kg, VO 2max  = 32.3 ml · min -1  · kg -1 ). GS declined from the age of 50 onwards, whereas VO 2max levels decreased continuously between the age groups of 20-29 and ≥60 years. GS and VO 2max showed a linear positive association after adjustment for body weight (males β = 0.21; females β = 0.35).These results indicate that the physical fitness measured in the NAKO are comparable to other population-based studies. Future analyses in this study will focus on examining the independent relations of GS and CRF with risk of morbidity and mortality.

Objective: This study describes (i) the procedure of obtaining patients' consent for secondary data usage, (ii) the complexity of integrating data from multiple sources, and (iii) the correspondence among patients' self-reports, physician reports, routine data, hospital discharge diagnosis, and cause-of-death coding regarding stroke., Methods: Data from the first follow-up (N=3 186) of the population-based Study of Health in Pomerania (SHIP) were used. These data were combined with secondary data from the Greifswald University Hospital, the association of statutory health insurance physicians Mecklenburg-Western Pomerania, physician reports, and death certificates., Results: Consent for using health-related information from all data sources in question was obtained from more than 90% of the SHIP participants. Follow-up data from at least one source were available for 2 747 (86%) participants. For 92 participants information about the occurrence of stroke was found in at least one data source. In 59 cases the event appeared in only one data source, in 24 cases the event was found in 2 sources, and for 9 participants 3 data sources reported on the event., Conclusion: Participants of a population-based cohort are highly willing to give consent for using their health-related information from secondary data sources. Yet, data integration is challenging due to considerable differences in data type, structure and coverage., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The objective of the KORA-Age research consortium is to assess the determinants and consequences of multimorbidity in the elderly and to look into reasons for successful aging in the general public., Patients and Methods: In the KORA-Age cohort study 9,197 persons were included who where born in the year 1943 or before and participants of previous KORA cohort studies conducted between 1984 and 2001 (KORA: Cooperative Health Research in the Region of Augsburg). The randomized intervention study KORINNA (Coronary infarct follow-up treatment in the elderly) tested a nurse-based case management program with 338 patients with myocardial infarct and included an evaluation in health economics., Results: A total of 2,734 deaths were registered, 4,565 participants submitted a postal health status questionnaire and 4,127 participants were interviewed by telephone (response 76.2% and 68.9% respectively). A gender and age-stratified random sample of the cohort consisting of 1,079 persons took part in a physical examination (response 53.8%)., Conclusion: The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.

Background: The free radial forearm flap is state of the art for a phalloplasty in female-to-male transsexuals. Alternatives are the free fibula flap or the pedicled groin flap., Method: In a retrospective study, 269 phalloplasties performed between 1993 and 2009 were analysed for success rates and complications. The operative technique for the radial forearm flap in 2 designs and the groin flap penile reconstruction are described., Results: Indications for penile reconstruction were transsexualism in 96.3%. We used 135 radial forearm flaps, 119 groin flap reconstructions, 2 fibula, one scapula and 2 pedicled randomised flaps. Of the radial forearm flaps, 10 flaps had a thrombosis (3 arterial, 4 venous, 3 combined) on postoperative day 0, 1 (n=5), 4, 4, 5 and 24. Six revisions were successful; 4 flaps failed (3%). 12 flaps (9%) showed a partial or superficial necrosis which required an operative revision., Conclusion: The radial forearm flap can be performed in various designs. If the patient wishes a glans plasty the Gottlieb design is favoured. In obese patients with a short forearm the Chang design is recommended as it provides a sufficient pedicle length for anastomosis without a venous interpositional graft. The radial forearm flap has a high success rate, but late thromboses and partial necrosis are particular problems. Surgically, we recommend a trapezoid design, a skin graft if there is any sign of tension, a subfascial dissection and sufficient subcutaneous veins for drainage of the ulnar urethra. The groin flap penile reconstruction is a rare alternative for patients who wish a larger bulk, refuse to accept a stigmatising scar on the forearm and whose priority is not voiding while standing., (© Georg Thieme Verlag KG Stuttgart · New York.)

In breast reconstruction with autologous tissue the DIEP flap has become the gold standard in recent years. The superior gluteal artery perforator (s-GAP) flap is an alternative harvested from the buttock. We present our experience with the s-GAP flap and discuss its role in breast reconstruction. All s-GAP flaps performed for breast reconstruction in the Department of Plastic and Hand Surgery, Behandlungszentrum Vogtareuth from June 2002 until February 2007 were retrospectively analysed. Out of 59 flaps 4 flaps failed, the success rate was 94 %. Partial or fat necrosis occurred in 2 cases. The s-GAP flap served as a safe reconstructive alternative to the DIEP flap. Advantages of the s-GAP flap are reliable perforators, the safe vascular supply and the firm fat structure which facilitates the breast reconstruction. The donor site morbidity is minimal, the gluteal muscles stay intact and the scar is easy to hide in the underwear. Disadvantages are a demanding preparation with a prolonged operating time compared to the DIEP flap. The s-GAP flap is a reliable and safe option for autologeous breast reconstruction. It is the method of choice for staged bilateral breast reconstruction or if the DIEP flap is not available, particularly in the thin patient.

Background: In the event of exposed hardware from reconstructive surgery, it must be decided whether to retain or remove it prior to plastic surgical soft-tissue reconstruction to ensure long-term freedom from infection and stable wound closure., Material and Methods: Treatment options and results in the literature are reviewed. A treatment algorithm is proposed under consideration of our personal experience., Results and Conclusion: Hardware used in spine surgery is commonly left in situ until bony consolidation has been achieved. The indications for hardware removal depend on length of exposure or infection, implant failure, and location. Osteosynthetic devices in the extremities may be removed and replaced by external fixators or immobilisation. Removal of prostheses requires complex second-stage reimplantation or arthrodesis. A treatment algorithm is suggested that might ease the decision whether exposed hardware can remain or requires removal before reconstruction of soft-tissue defects.

Aim: The purpose of this study was to identify risk groups for low dental care utilisation and to highlight adequate determinants for necessary action., Methods: The database was the "Study of Health in Pomerania" (SHIP), a cross-sectional sample drawn from the adult population (20 - 79 years) in a northeast region of Germany. 4310 of 7008 randomly selected inhabitants participated in the examinations (response rate 68.8 %). The use of dental care in the last year was analysed using logistic regression according to the conceptual model by Andersen and Newman., Results: Multivariate analysis revealed that participation in the bonus scheme system of the statutory sickness funds (OR = 8.2) and participation in the bonus system of the private health insurance companies (OR = 2.6) as "enabling resources" predicted dental care use in the last year. "Objektive need" (OR = 1.02) is weaker associated with dental care utilisation than "subjective need", for instance the attitude towards need of regular dental checkups. Presence of own teeth is a significant predictor for dental care utilization (OR = 3.3), whereas edentulous persons, those with complete denture prosthesis, don't think about possible oral problems and don't visit the dentist at least once a year. Among "predisposing factors" only gender and education were significant determinats for dental care utilization., Conclusions: The conclusions concerning the significant influence of subjective need and promotional impact of the bonus scheme are important for health care. Financial incentives and motivation for regular prevention should be continued and upgraded. Measures to improve preventive dental care utilization should focus on persons with low educational levels and on men with inadequate dental care utilisation. The mental anchorage of the term "oral health" rather than the conventional term "dental health" is important, so that edentulous persons become conscious of regular prevention pointers to maintain a high quality of life.

Background: Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly increased during recent years, so too have the indications for these procedures expanded., Material and Methods: We retrospectively report the results of 42 free flaps for upper extremity reconstruction in 35 severely burned patients using 13 different free flaps. This experience has enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures., Results: In high voltage injuries (n = 17) early free flap coverage (< 21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominately the forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3 to 6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous or fascial flaps was the preferred method. The elbow and the dorsum of the hand underwent defect coverage in most circumstances. For the reconstruction of complex or large defects (n = 6) combined "chimeric" flaps, preexpansion of free flaps, or the combination of a free and local flap were used. Overall, the flap failure rate was 12 % (n = 5). Interestingly, there was a relationship between flap failure rate and timing of the procedure. Four out of five flap failures occurred within 5 to 21 days after trauma, all five flap failures occurred between five days and six weeks. No flap failure was seen during secondary reconstruction., Conclusion: Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom-tailored reconstructive solutions for limb salvage. Even if our flap failures all occurred during the first six weeks it should not be forgotten that this type of coverage is the only alternative to amputation in selective cases.

The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). In 38 patients PRC was performed for a stage II SNAC- (n = 29) or SLAC-wrist (n = 9) between June 1994 and March 2002. Postoperative examination included range of motion and grip strength. Pain was assessed using a visual analogue scale (VAS 0 - 100). The DASH questionnaire (disability of the arm, shoulder and hand) was used to evaluate the disabilities in activities of daily living (ADL). Thirty patients (79 %) with a mean age of 39 years (23 - 59) were evaluated with a mean follow-up of 27 months (6 - 100). Mean extension and flexion of the wrist reached 75 degree which was 57 % of the contralateral hand. Mean radial and ulnar deviation was 33 degree corresponding with 52 % of the contralateral hand. The average grip strength was 50 % of the unaffected side. The postoperative DASH score was 27.4. Pain with strenuous activity was reduced by 40 %, resting pain by 77 %. Three patients showed radiological signs of a radiocapitate arthrosis, one patient needed conversion into a complete wrist arthrodesis. Our results are in concordance with the literature. However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.

Purpose: Epidemiological studies show a "North-South" gradient in drinking patterns in Germany, with the South-Eastern regions consuming more alcohol. Hence, patterns of alcohol consumption as well as at-risk drinking were evaluated in West Pomerania using a representative sample. In addition, the average daily quantities and the proportions of at-risk drinking were compared with representative data for Germany (Federal German Health and Examination Survey 1998 [FGHES])., Methods: A representative random sample of the Pomeranian population (4,310 persons) was analysed. The response rate was 68.8 %. The amount and frequency of alcohol consumption was surveyed with a standardized questionnaire. Prevalence rates for at- risk drinking (> or = 30 g ethanol per day for men, > or = 20 g ethanol per day for woman), indications of abuse / dependence, and episodes of heavy drinking (number of days with 5 and more drinks consumed per day) are presented. To identify socio-economic correlates of high-risk drinking multiple logistic regression modelling was used. Alcohol consumption was evaluated via a frequency-quantity-measure and by using the "Luebeck Alcohol Dependence and Abuse Screening Test" (LAST)., Results: Average daily consumption of pure alcohol was about 11.8 g per day, 18.5 g per day for men and 5.8 g per day for women. The consumed quantities exceeded the levels calculated with the FGHES about 1.5 g, 1.8 g for men and 1.2 g for women. Prevalence of risk drinking and harmful alcohol use in Pomerania is higher than the FGHES as well. At-risk drinking was especially associated with age. In women, belonging to a higher social class at-risk drinking was higher, whereas in men of the lower social class consumption rates were higher. The highest alcohol consumption was observed among middle-aged men and women., Conclusions: The results suggest that alcohol consumption on a high level as well as high-risk drinking is a common phenomenon in the north-eastern part of Germany. Public health measures are indicated for this region. Such intervention projects should focus on population groups with higher alcohol intake.

Free tissue transplantation in burn reconstruction presents a major challenge to reconstructive surgeons. The results of a retrospective analysis of 68 free flaps in 55 patients are reported. This experience facilitated the establishment of reconstructive principles and a decision-making algorithm for primary and secondary reconstruction of burned extremities. Fourty-two free flaps were used for primary reconstruction. The indications were predominantly extremity salvage.The safety of the microsurgical procedures is correlated with the timing of the reconstruction. The failure rate of the free flaps was 24% in primary reconstruction. Due to an increased post-traumatic thrombogenicity, the period between 5 and 21 days had the highest risk of flap failure (40%).Twenty-six flaps were used for secondary reconstruction, with a success rate of 100%. Due to their elasticity, adipo- and fasciocutaneous flaps provide a useful option for the release of contractures. The large variability demonstrated by the use of 19 different types of free flaps showed that the reconstruction of burned extremities requires a reconstructive concept individualized to each patient as well as sophisticated microsurgical techniques. This clearly demonstrates the importance of a close link between primary burn treatment and reconstructive plastic surgery.

Background and Objective: Diabetes mellitus and its sequelae such as the "diabetic foot" are increasing in incidence and pose a challenging medical and financial problem. Interdisciplinary teams have been formed to prevent and treat these problems, consisting of diabetic nurses and physicians, nutritionists, podiatrists, specialist shoemakers, general, orthopaedic and vascular surgeons. However, hardly mentioned in the literature are the surgical options offered by plastic and reconstructive surgeons. The aim of this study was to analyse the outcome of plastic surgical treatment for soft tissue defect coverage of the diabetic foot ulcer and to define the role of plastic and reconstructive surgery within an interdisciplinary treatment concept., Patients and Methods: In a retrospective cohort study the charts of 38 diabetic patients (female n = 14/male n = 24) with an average age of 68.6 years and with 45 defects on the foot or ankle were analysed regarding the patient profile, defect etiology and size, operative procedures, complications and outcome results., Results: Defect coverage was performed using 20 split skin grafts, 19 local flaps and 6 free flaps as well as 27 amputations. At the time of discharge 25 of 45 defects were closed (56 %), 15 patients had an amputation and in 3 cases a small defect remained. The success rate of defect coverage decreased with increasing comorbidity. Whereas 71 % of the defects were covered in ASA stage 2 patients, only 50 % of the defects could be covered in ASA stage 3 patients and only 33 % in ASA stage 4 patients., Conclusions: Despite a high complication rate, plastic surgical techniques in many cases prevented an amputation in this negatively preselected patient group. These results provide justification for plastic and reconstructive surgery being in any case part of an interdisciplinary treatment approach of the diabetic ulcer.

Aims: This study examined the role of social support in relation to the use of medical services in a north-eastern German population., Methods: A representative random sample of the Pomeranian population (4,310 persons) was analysed. The response rate was 68.8 %. Bivariate and multivariate associations between socio-economic variables, need (evaluated and perceived health status), social support and the number of consultations (general practitioners or internists) were assessed. The SF-12 and the MOS social support survey were used as standardised instruments., Results: Social supports showed no main effects on utilisation rates. Individuals living in a partnership showed lower levels of utilisation (median: 4.3 vs. 6.2). The combination of high morbidity and low social support or no partnership results in an increase in medical services utilisation., Conclusions: Social support treatments that target an appropriate use of the health care system can be a cost-effective measure in chronically ill patients.

The cannulated 3.0 mm AO/ASIF screw with threaded washer is a new implant for scaphoid osteosynthesis. After insertion into the distal scaphoid pole, the washer serves as an intraosseous support for the head of the cannulated lag screw. From June 1997 to March 1998 the new implant was used in 28 male patients between 14 and 50 years of age. In fourteen patients, acute scaphoid fractures were operated on, including five transscaphoid perilunate fracture dislocations (Herbert type B2 and B4, respectively). Fourteen patients had scaphoid pseudarthroses, among those two re-pseudarthroses after prior surgery elsewhere. Using a palmar approach, the scaphoid was reduced. In pseudarthroses an iliac cortico-cancellous bone block was inserted, and the implants were inserted in a distal-to-proximal manner. In the fourteen acute fractures, follow-up assessment at a mean of 11 months revealed one pseudarthrosis (7%) and four screw removals (29%) for screw back-out after bony consolidation. In the fourteen pseudarthroses, follow-up assessment at a mean of ten months revealed one re-pseudarthrosis (7%) after a technical fault. It was treated by re-operation using the same implant, and healing was now uneventful. One screw removal became necessary after bony consolidation in another patient (7%). In conclusion, our preliminary results suggest that the new implant is suitable for stabilization of scaphoid pseudarthroses after insertion of an iliac crest bone graft. The complication rate in the treatment of acute fractures was inacceptably high.

From January 1995 to December 1995, 991 muskrats were examined for the occurrence and the regional prevalence of nematodes and trematodes. The muskrats were trapped in all parts of Lower Saxony. 77.2% of the studied population were less than one year old, 22.8% were older. The male to female ratio was 54.5% to 45.5%. One genus of nematodes, Trichuris spp., was found in the colon in 1.9% of the animals in the south of the investigated area. A species differentiation was not possible, as exclusively female parasites had been found. Additionally, two genera of trematodes (Echinostoma spp. and Quinqueserialis quinqueserialis) belonging to two different families were detected in 2.5% of the muskrats. In the north of the investigated area the prevalence was significantly higher than in the south. As to the echinostomatides, no species-differentiation was made because, according to KANEV (1985), many echinostomatides have not been described correctly in the past. Some echinostomatides cannot be differentiated until today. There was no statistically significant correlation between parasite infections and sex of the animals. Concerning Echinostoma spp. and Quinqueserialis quinqueserialis, a highly significant correlation was found between the age of the muskrats and the trematode-infections. Young animals were infected more often than older animals, none of the younger animals was infected with Trichuris spp.

Aim of the study was to examine the prevalence and regional distribution of Echinococcus multilocularis and other metacestodes and cestodes in muskrats in Lower Saxony, Germany. A total of 991 muskrats with similar numbers from all districts of the country were examined between January and December 1995. E. multilocularis metacestodes were found in 4.1% of the muskrats in the liver and other organs of the abdominal cavity. The majority of the E. multilocularis positive animals came from the south of Lower Saxony, where E. multilocularis is endemic, and single animals from the middle or the northern part of the country. All metacestodes found were fertile. Additionally, metacestodes from T. taeniaeformis were found in the livers of 42.3% of the muskrats, metacestodes from T. crassiceps were present in the abdominal cavity of 2.7%, T. polyacantha in 0.4% and T. martis in 3.4% of the animals. Adult cestodes of the family of the Anoplocephalidae were found in the small intestine of 1.5% of the muskrats. Due to autolysis a species differentiation of the latter was not possible.

The primary findings in 128 patients with malignancies of the nasal cavity and the paranasal sinuses were classified by 4 tumor classifications. The survival times and the rates of recurrences in relation to the stage of tumor were compared. Mostly cancers of advanced stages T3 and T4 with bad prognosis were treated: only 35% of the examined patients survived longer than 5 years. There was no obvious difference in the results of therapy in tumor cases T3 and T4 in relation to the different tumor classifications.

Therapeutic results from 134 cases with malignant tumors of the nasal cavity and paranasal sinuses are reported. Retrospective classification based on clinical and roentgenological findings was possible in 121 cases. 49 patients underwent primary radiation treatment by 60Co-teletherapy, 46 were exposed to postoperative irradiation. The mean 2-year survival rate considering all stages and all kinds of malignant tumors amounts to 52%, the 5-year survival rate to ca. 32%. The 5-year survival rate obtained by means of curative tumor doses was 59%. Recurrences of the tumor appeared in 58 cases (43%), most of them in the course of a year. The therapeutic control of local tumor disease and the possibilities of an early detection of recurrences, improved with the help of new diagnostic methods, must therefore be regarded as the essential problems. No generally approved clinical classification of tumors of the nasal cavity and paranasal sinuses is available as yet, and the comparison of therapeutic results from different authors thus is difficult.