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Larvae and adults of the aphid Myzus persicae (Sulz.), reared on a synthetic diet, gain higher weight if their diet contains ATP (1.11 μ M). The numbers of larvae born on diets with ATP are higher (20%) than on diets without ATP. The longer aphids were fed on the ATP-diet the more their weight increased compared with larvae on a diet without ATP. Generally ATP seems to balance the synthetic diet in whatever physiological way it may be. Since phloem sap contains a high level of ATP, it is suggested that ATP may also be of great importance under natural conditions on the host-plants. [ABSTRACT FROM AUTHOR]

Knowledge of normal anatomy and kinematics of the glenohumeral joint as well as analysis of the pathoanatomic changes that occur during the course of the disease is the condition for successful patient management. This review article critically discusses the most relevant geometrical variables. Systematically, normal anatomy, pathologic anatomy, and the implications for prosthetic design and implantation are presented. The most important aspects concerning the size and shape of the glenoid, the inclination of the articular surface in the horizontal and frontal planes, as well as the geometry of the scapular neck are discussed. The accumulated knowledge is of immediate practical use and might stimulate researchers and manufacturers to develop more adequate glenoid components.

Injuries to the shoulder and shoulder-girdle represent a demanding diagnostic and therapeutic challenge. The complex and minimally constrained anatomic construction of the joints is critical. Although a large majority of the injuries are relatively trivial it is essential to recognize critical lesions that deserve intensive investigation and appropriate treatment. In view of the severity of the consequences of particular injury patterns this article focuses on fractures of the proximal humerus, gleno-humeral dislocations and on acute ruptures of the rotator cuff. In particular, attention will be drawn on fractures with avascular head fragment, primarily undisplaced fractures of the anatomic neck, unrecognized posterior dislocation and on under diagnosed acute ruptures of the rotator cuff. The key issue for a secure diagnosis are a precise physical examination and an adequate conventional radiologic investigation. Both aspects are discussed with practically relevant suggestions.

The diagnosis of rotator cuff tears may be based on clinical examination and MRI. The aim of this study was to define the relative value of these methods. Clinical and MRI diagnoses of 88 shoulders were compared with the intraoperative findings. The correct diagnosis of a posterosuperior rotator cuff rupture was made in 79% of the cases by clinical examination and in 91% of the cases by MRI. For the subscapularis tendon clinical examination corresponded to the intraoperative findings in 73% of the cases versus 59% for MRI. MRI was superior to clinical examination in diagnosing a posterosuperior rotator cuff rupture. For the evaluation of ruptures of the subscapularis tendon, clinical examination was more reliable than MRI. Diagnosis of rotator cuff rupture can most often be obtained by a simple physical examination.

Painful stiffness of the shoulder is an ill-defined||| clinical entity that is difficult to assess and delicate to treat. The||| nomenclature used is broad and includes terms such as frozen shoulder, adhesive||| capsulitis, focal algodystrophy, stiff shoulder, contracted shoulder, and||| others. Apart from its idiopathic form, the disease can be initiated by trauma,||| infection, tumour, radiation, systemic and local metabolic disturbances.||| Pathoanatomically, the common denominator is an inflammatory vascular||| proliferation followed by thickening, scarring, and retraction of the joint||| capsule. The inflammatory process often starts at the rotator interval and may||| extend to the subacromial space. Clinical diagnosis is based on history and||| physical examination. Generally the onset of pain precedes the perception of a||| reduced range of motion by weeks or months. In early stages of the disease, the||| inflammatory type of pain dominates, i.e., the patient's main complaint ist||| pain at night. In the later stage, range of motion gradually decreases.||| Patients do not often complain about reduced motion, probably because of its||| slow onset. Treatment options are a combination of mobilisation exercises with||| intra-articular steroids, hydraulic distension of the joint capsule,||| manipulation under anaesthesia, arthroscopic and/or open arthrolysis. The||| appropriate choice of protocol is just as important as its correct timing. In||| the inflammatory phase, aggressive treatment protocols are probably||| contraindicated. Complications of invasive protocols are rare but deleterious||| and therefore have to be taken into consideration. New anti-anglogenetic agents||| may enhance functional results and shorten the rehabilitation||| phase.

Painful stiffness of the shoulder is an ill-defined clinical entity that is difficult to assess and delicate to treat. The nomenclature used is broad and includes terms such as frozen shoulder, adhesive capsulitis, focal algodystrophy, stiff shoulder, contracted shoulder, and others. Apart from its idiopathic form, the disease can be initiated by trauma, infection, tumour, radiation, systemic and local metabolic disturbances. Pathoanatomically, the common denominator is an inflammatory vascular proliferation followed by thickening, scarring, and retraction of the joint capsule. The inflammatory process often starts at the rotator interval and may extend to the subacromial space. Clinical diagnosis is based on history and physical examination. Generally the onset of pain precedes the perception of a reduced range of motion by weeks or months. In early stages of the disease, the inflammatory type of pain dominates, i.e., the patient's main complaint ist pain at night. In the later stage, range of motion gradually decreases. Patients do not often complain about reduced motion, probably because of its slow onset. Treatment options are a combination of mobilisation exercises with intra-articular steroids, hydraulic distension of the joint capsule, manipulation under anaesthesia, arthroscopic and/or open arthrolysis. The appropriate choice of protocol is just as important as its correct timing. In the inflammatory phase, aggressive treatment protocols are probably contraindicated. Complications of invasive protocols are rare but deleterious and therefore have to be taken into consideration. New anti-anglogenetic agents may enhance functional results and shorten the rehabilitation phase.

From 1986 to 1994 18 patients with 19 IIIB open tibial fractures were treated following similar therapeutic management. This included early and radical primary debridement, early and wherever possible immediate internal fixation of the bone and coverage with a local muscle flap (hemisoleus or gastrocnemius). At the time of follow-up all fractures had consolidated clinically as well as radiographically. The mean time to bony union was 7 months (3-20). Twelve patients did not have any severe pain and were able to walk for more than 4 km. The time to return to work averaged 8 months. In 2 cases a permanent disability of 50% was established. Fourteen of 18 patients were satisfied with the function of the leg. On the other hand, 9 didn't like the aesthetic appearance and were inhibited because of it. The following complications occurred within a period of 2 years: non-union (3), flap necrosis (2), osteomyelitis (2), delayed union (4). The mean number of reoperations was 3 (0-8). In no case did an amputation have to be performed.

In this article we report a case of an early postoperative compartment syndrome of the anterior tibial compartment with complete sensomotoric palsy of the peroneal nerve after arthroscopic-assisted replacement of the anterior cruciate ligament (ACL) of the knee. The tourniquet pressure was 360 mm Hg and operation time was 1.75 h. After the operation the leg was bandaged to avoid swelling of the leg and as antithrombotic prophylaxis. Analgesic therapy was by continuous epidural bupivacaine infusion. Increasing pain of the lower leg was suppressed by additional analgesia. Due to persistent pain despite regular analgesia, the patient was sent to a main hospital on the 3rd postoperative day, where an extremely painful and swollen anterior tibial compartment with intracompartmental pressure of over 100 mm Hg was found. The compartment was released immediately. Despite the appearance of severe muscle damage, no extensive débridement was done. At the second examination, at 48 h, there was minimal perfusion of the muscles without contraction and islands of ischemic necrosis. Clinically, there was complete palsy of the dorsiflexors of the foot. The case shows the danger of a compartment syndrome when tourniquet of the limb, arthroscopy and a firm bandage are combined. Continuous epidural analgesia masks the classic symptoms of compartment syndrome.

Complex fractures of the proximal humerus are uncommon injuries and a therapeutic challenge to the orthopaedic surgeon. Successful treatment requires proper evaluation of the patient and analysis of standardized high-quality radiographs. The trauma series of radiographs (including true anteroposterior and lateral views in the scapular plane, and axillary view) is essential for accurate fracture assessment. Generally, joint-preserving reconstructive techniques are emphasized, aiming at restoration of the anatomy of the proximal humerus. In young individuals with excellent quality of the bone fragments, careful techniques of reduction and fixation, avoiding additional surgical devascularization, should be performed, even in case of possible impairment of the vascular supply to the humeral head. In elderly individuals with osteoporotic bone and limited compliance throughout aftercare, humeral head replacement may be indicated less restrictively. In the latter group hemiarthoplasty generally can be expected to result in painfree shoulders. However, recovery of function and range of motion are much less predictable.

Complex injuries of the shoulder require differentiated management. Interestingly there is a relative lag of warranted information on this subject. Generally the different lesions are discussed separately. However it is not acceptable to simply add the standard diagnostic and therapeutic measures, because major tactic, strategic and rehabilitation incompatibilities could occur. Diagnostic and therapeutic difficulties are frequent for the following injuries: complex proximal humerus dislocation fractures, dislocation fractures with associated lesions of the rotator cuff, posterior dislocation fractures, peri- and intraarticular segmental fractures and fractures or dislocations associated with major neurovascular lesions. Increased awareness of the most relevant diagnostic and therapeutic aspects should contribute to optimize treatment protocols.

From May 1992 to September 1995, 38 patients with recurrent anterior shoulder instability underwent arthroscopic stabilization. The arthroscopic stabilization was performed by capsular shifting and labral refixation using Mitek anchors, based on the Wolf procedure. Immediately after operation active assisted shoulder mobilization was initiated (elevation 60 degrees, external rotation 20 degrees less than contralateral shoulder). After a mean follow-up of 24 months (12-42 months) 30 patients were evaluated by means of the Rowe Score. Excellent and good results were achieved in 90% (n = 27) of patients and 80% had no restriction in sports activities. In 4 of the patients (13%) redislocation occurred. Analysis of the recurrence revealed no adequate trauma in two patients with preoperative multidirectional laxity. One had a trauma and the fourth showed no compliance in the early postoperative period. Compared to the open Bankart operation the described procedure shows a slightly higher rate of redislocations. However, the approach is less invasive and the subscapularis tendon with its proprioception remains intact.

Operative treatment of fractures in osteoporotic bone using standard techniques such as are applied in normal bone leads to special problems. The major difficulty is the limited anchorage of any implant in osteoporotic bone. To improve the stability of an implant in osteoporotic bone the following techniques are applicable, either singly or in combination: impaction, long-distance splinting, large-area surface buttressing, osteotomy, and the use of bone cement as a spacer and to improve the purchase of screws. The different techniques are discussed and examples of their application are presented.

A general equation is provided for the nutritional budgets of both morphal stages of third-instar larva of the green-peach aphid Myzus persicae (Sulz.), fed on an artificial diet. Uptake of food and oxygen is related to: 1) gain in (fresh) weight, 2) amount of excrement, 3) carbon dioxide respired, and 4) water lost by transpiration (Table 4).Aphids fed holidicly exhibit a respiratory quotient of 1.0 during food uptake, thus using mainly carbohydrates during respiration. Hence, based upon quantitative chemical analysis of the excrement, an equation for an amino acid or glucose budget can be formulated (Table 5). The energy budget can then be calculated from these equations (Table 6). The water budget (Table 7) of the aphids is derived from the equation of the general budget. These values confirm that the alatiform morphs differ from their apteriform sisters in the efficiency of their nutritional budgets.

In the years 1980-1986 there were provided 159 operations under narcosis at the clinic for maxillo-facial surgery in the district hospital Zwickau. The aim was the complex oral rehabilitation with handicapped people. In connection with this there were diaguized 10.4% complications of the narcosis and 4.3% complications of the operation. In accordance with other authors there are demands for a pre- and postoperative concept.