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Long-term damage in the hip, knee and ankle joints of football players has been thoroughly discussed in the literature. Compared with outfield players, however, goalkeepers sustain injuries to the upper extremities five times more often. There is a lack of studies on long-term functional damage to the wrist and finger joints of football goalkeepers. Repetitive micro-traumas and injuries lead to degenerative diseases in goalkeepers after 20 years of playing recreational soccer. The personal histories, injury histories and clinical examination findings of the wrist and finger joints of 27 goalkeepers were compared with the findings obtained in a control group of outfield players. Goalkeepers were significantly more restricted in finger movement (p 0.05) and experienced more pain and swelling (p 0.05) as well as higher levels of instability (p 0.05) in the wrist and finger joints than outfield players. Medical history and clinical findings indicate deficits in the hands of soccer goalkeepers and a high prevalence of joint and ligament injuries sustained to the fingers over the course of their sports activity. This necessitates specific strategies in the future to prevent injuries and long-term posttraumatic deficits. Folgeschäden an den Hüft-, Knie- und oberen Sprunggelenken von Fußballspielern wurden in der Literatur bereits eingehend untersucht. Im Gegensatz zum Feldspieler ist beim Torwart die obere Extremität 5-fach häufiger von Verletzungen betroffen. Klinische Studien zu Langzeitfolgeschäden auf die Finger- und Handgelenke im Rahmen der Torwarttätigkeit wurden bislang noch nicht publiziert. Repetitive Mikrotraumata und Verletzungen führen beim Amateurtorwart nach mehr als 20 Jahren aktiven Sports zu posttraumatischen und degenerativen Veränderungen. 27 Fußballtorhüter mit über 20 Jahren Torwarttätigkeit im Amateurbereich wurden anamnestisch und klinisch auf Folgeschäden an den Hand- und Fingergelenken untersucht. Die Ergebnisse wurden mit denen einer Gruppe von 27 Feldspielern verglichen. Die Torwartgruppe zeigte im Vergleich zur Kontrollgruppe signifikant häufiger Beeinträchtigungen wie Schmerzen, Instabilitätsgefühle, Bewegungseinschränkungen und Blockierungen an den Finger- und Handgelenken (p 0,05*). Bei der klinischen Untersuchung zeigten sich signifikant häufiger Schwellungen, Achsfehlstellungen, Druckschmerz, Seitenbandinstabilitäten und ein pathologisches Gelenkspiel an den Hand- und Fingergelenken (p 0,05*). 20 Jahre Torwarttätigkeit zeigte bei Amateurspielern anamnestische und klinische Zeichen posttraumatischer und degenerativer Veränderungen und Einschränkungen an den Hand- und Fingergelenken. Weitere Studien zur Korrelation mit radiologischen Daten sind erforderlich.

ZusammenfassungFußball wird als beliebteste Sportart weltweit von einer Großzahl von Verletzungen begleitet. Zu den seltenen Verletzungen, mit zum Teil schwerwiegenden Folgen, zählen Schädelhirntraumen, deren Verletzungsmechanismen im Fußball multifaktoriell sind. Der Ball gehört im Rahmen des Kopfballspiels zu den seltenen Auslösern einer Kopfverletzung im Fußball. Kurz-, mittel- und langfristige Folgen von Kopfbällen im Fußball sind insgesamt nur unzureichend untersucht und es sind kaum praktische Fallbeispiele mit schwerwiegenden Folgen bekannt. Das seit dem November 2015 bestehende Kopfballverbot im Juniorenfußball der USA ist unter Berücksichtigung der Angst und des hohen Risikos für Schädelhirntraumen bei den beliebtesten amerikanischen Sportarten wie American Football oder Eishockey für den US-Sport im Allgemeinen nachvollziehbar, jedoch sollte diese Entscheidung zum Kopfballverbot im Fußball aufgrund fehlender wissenschaftlicher Daten und anderen Erfahrungen aus der Praxis in Europa nicht ungeprüft übernommen werden. Vielmehr sind andere Präventionsmaßnahmen für Schädelhirntraumen und weitere Verletzungen im Juniorenfußball notwendig und wozu die Anpassung der Ballgrößen für Juniorenfußballer gehört und bereits Alltag ist. Das Regelwerk so zu ändern, dass der Kopfball im Juniorenfußball gänzlich abgeschafft wird, ist nach Meinung der Autoren deswegen nicht zwingend erforderlich. Weitere Studien sind hier für eine Vereinheitlichung des weltweiten Fußballsports notwendig.

Fragestellung: Verschiedene Studien zeigen einen Konzentrationsabfall und eine physiologische Leistungsminderung des medizinischen Personals in der Nacht. In dieser Studie soll die Frage geklart werden, ob sich dies auf die Prozess- und Ergebnisqualitat auswirkt. Methodik: Von 1226 prospektiv im Schockraum eines uberregionalen Traumazentrums erfassten Patienten wurden 420 schwerverletzte Patienten in diese Studie eingeschlossen (Beobachtungszeitraum: 76 Monate). Einschlusskriterien waren ein ISS ≥ 16 und das Eintreffen des Patienten im Schockraum in den Zeitraumen „TAG“ (8:00–16:59 Uhr) oder „NACHT“ (21:00–5:59 Uhr). Basis der Dokumentation war das TraumaRegister der DGU. Daruber hinaus wurden weitere 350 Variablen zur Beschreibung der Praklinik, des Schockraumverlaufs und der Intensivtherapie erhoben. Als Proxyvariablen fur die Prozessqualitat der Schockraumtherapie wurden die Interventionszeiten herangezogen. Die Daten wurden von Studienassistenten im 24-Stunden-Dienst erhoben. Ergebnisse: Die Studienpopulation teilt sich in 268 Patienten am Tag und 152 Patienten in der Nacht auf. Die in der Nacht eintreffenden Patienten sind schwerer verletzt: ISS 34,9 (± 16,4) vs. 31,1 (± 14,2), p = 0,015 und junger: 33,3 (± 16,6) vs. 43,6 (± 22,3) Jahre, p 0,775. In Bezug auf die Prozessqualitat unterscheiden sich die beiden Gruppen weder in der benotigten Zeit fur einzelne Interventionen wie z. B. die benotigte Zeit fur einen arteriellen Zugang: NACHT 4,5 (± 3,7) vs. TAG 5,0 (± 3,7) min, p = 0,116 oder zur Extremitatenstabilisierung: 3,8 (± 3,7) vs. 3,4 (± 3,1) min, p = 0,922, noch in anderen Parametern wie z. B. der Zeit bis zum CT: 26,9 (± 11,2) vs. 26,6 (± 14,5) min, p = 0,520. Hinsichtlich der Ergebnisqualitat zeigte sich kein Unterschied im Outcome. So starben 17,8 % der NACHT-Patienten (RISC-Prognose: 23,8 %; SMR: 0,74) wahrend ihres Krankenhausaufenthalts, verglichen mit 18,3 % der TAG-Patienten (RISC-Prognose: 24,0 %; SMR: 0,77), p = 0,894. Auch der Vergleich der Glasgow Outcome Scale offenbarte keinen Unterschied: NACHT 3,8 (± 1,5) vs. TAG 3,8 (± 1,6), p = 0,491. Schlussfolgerung: Es ist wohl evident, dass die Leistungsfahigkeit des medizinischen Personals nachts reduziert ist. Jedoch konnen wir diesen Effekt anhand unserer Studienpopulation nicht verifizieren. Insofern war sowohl die Prozess- als auch die Ergebnisqualitat – unabhangig von der Ankunftszeit des Patienten – auf einem konstanten Niveau. Es ist vorstellbar, dass die Masnahmen zur Qualitatssicherung und die Standardisierung der Behandlung hierauf einen positiven Einfluss nahmen.

Background and study aims: A variety of factors (needle type, needle passes, tumor location, cytological assessment, etc.) may influence the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) from pancreatic tumors. Whereas most published studies report a diagnostic accuracy of > 80 % for EUS-FNAC, the results in routine settings are often considerably lower. This retrospective study aimed to define the effect of switching microscopic assessment from a standard pathology department to a highly specialized institute of cytology. Patients and methods: A total of 63 patients underwent EUS-FNAC of solid or semisolid pancreatic masses. Specimens of the first consecutive 20 cases (Phase 1) were assessed by the local department of pathology. Then in Phase 2, involving another 43 subsequent cases, a specialized cytology laboratory examined all aspirates. All EUS-FNACs were performed in the same manner, using a 22-gauge needle. After cytological evaluation, all patients either underwent surgery or were followed up for at least 6 months. Results: Of the tumors, 56 were solid and 7 semisolid; the mean size was 30 mm. Sensitivity (sens.), specificity (spec.), positive predictive value (PPV), and negative predictive value (NPV) of EUS-FNAC were 38.5 % (95 %CI [confidence interval] 13.9 – 68.4 %), 100 % (59.0 – 100 %), 100 % (47.8 – 100 %), and 46.7 % (21.3 – 73.4 %) during Phase 1 versus 91.4 % (95 %CI 76.9 – 98.2 %), 100 % (63.1 – 100 %), 100 % (89.1 – 100 %), and 72.7 % (39.0 – 94.0 %) during Phase 2. Conclusion: These results emphasize the considerable impact of a dedicated cytological evaluation on the results of EUS-FNAC.

Common variable immunodeficiency (CVID) is the most common primary antibody deficient syndrome in adults. Among the broad spectrum of clinical manifestations are recurrent infections, allergies, autoimmune, tumour, pulmonary, liver and gastrointestinal diseases. Here we report the case of a 45-year-old male patient, who has been suffering from ulcerative colitis - likewise recognised as a CVID-associated disease - for many years. He was admitted to our clinic with a rapid progressive reduction of his general condition and a loss of weight. Diagnostic work-up revealed adenocarcinoma of the stomach as well as an undifferentiated neuroendocrine carinoma of the colorectum at the rectosigmoidal junction. Curative resection of the distal stomach and proctolcolectomy were performed. To date, the pathogenesis of the association of many diseases with CVID is still ambiguous. Yet, there is no doubt about the significantly higher incidence of e.g., inflammatory bowel disease or gastric cancer in patients with CVID. Our case highlights that in patients with CVID and obscure deterioration of their general health condition a careful search for especially malignant complications is mandatory although to date there are no precise recommendations for screening.

Mesenteric, inflammatory veno-occlusive disease is an entity of unknown incidence and aetiology. Inflammation and necrosis of mesenteric veins leads to severe ischaemic damage of an intestinal segment. The clinical and endoscopic presentation can be ambiguous. However, modern multiphasic contrast-enhanced computed tomography allows early diagnosis, when characteristic features are considered. As local resection is the only known cure with minimal risk of recurrent disease, knowledge of this rare disease entity can spare our patients a risky delay of resection and erroneous therapeutic approaches.

BACKGROUND: There is abundant literature on the treatment of Achilles tendon rupture; however data on sports and recreational activities after this injury is scarce. PATIENTS AND METHODS: 71 patients were assessed in a prospective cross-sectional study after an average of 3 years after Achilles tendon rupture. 44 patients were treated non-operatively, using a functional algorithm, and 23 patients were treated operatively. Outcome parameters were the AOFAS-Score and the SF-36 Score. The strength of plantar-flexion was measured using the Isomed 2000 system, the structural integrity of the tendon was assessed sonografically. RESULTS: Patients treated operatively had a higher complication rate than patients treated non-operatively (p = 0.05). Re-rupture rate was identically in both groups. No difference was noted between the two groups for the AOFAS score (92 vs. 90). Moreover the SF-36 score did not show any significant difference between the groups. However, if compared to the age-adjusted normative population significant lower scores were achieved. A significant reduction in practicing sports was detected, as well as a reduction of plantar flexion of the affected foot (p = 0.04). CONCLUSION: Except for complication rate no significant difference could be detected between the groups. Thus operative treatment in the recreational athlete should only be considered, if no adaptation of the ends of the tendon is diagnosed during the initial or repeated ultrasound. Regardless of the therapeutic intervention chosen an Achilles tendon rupture leads to marked changes in sports- and recreational activities.

History and clinical findings A slightly confused and apathic 78-year-old woman presented in a deteriorating general condition and unspecific symptoms with (diarrhea, vomiting, nausea). Investigations Laboratory tests revealed megalocytic anemia with vitamin B12 deficiency. As a cause, atrophic gastritis was suspected. Esophagogastroduodenoscopy with multiple "gastric mapping" biopsies revealed diffuse infiltration by an adenocarcinoma in 12 out of 14 gastric biopsy sites. Surprisingly, this malignant tissue was identified by immunohistochemistry as a diffuse infiltration by an as yet unrecognized breast cancer. Immunohistochemically identical infiltrations were identified in the cecum by colonoscopy. Treatment and course Subsequent mammography identified a retromammilar primary tumor in the right breast. Because of the patient's poor general condition merely palliative therapy with oral tamoxifen was initiated. Conclusion The correct diagnosis and appropriate therapy of gastric and coecal metastases secondary to an as yet unrecognized breast cancer were rendered possible only by additional immunohistochemical testing with specific antibodies against the estrogen receptor, cytoceratin (CK) 20 and 7 and E-cadherin.

Objectives To investigate the interaction of serum leptin, IGF-1, estradiol and cortisol in salvia as well as IL-6 with nutritional composition in female athletes (swimming) according to the training protocol (competition (C), sprint (S), recreation (R), endurance (E)). Design/methods In 23 young (10-19 years old) female athletes (Bavarian swimming competition) in different training stages nutritional protocols were evaluated using standardized questionnaires. Body composition was measured by using analysis of bioimpedance. Estradiol, IGF-1, leptin and IL-6 in serum were measured by ELISA. To obtain circadian profiles of cortisol salvia probes were sampled at 4 h intervals and cortisol in saliva was measured. Results Daily intake of kilocalories varied significantly and was highest during R with the highest percentage of nutritional fat intake (37.3%) when compared to C (28.1%, p=0.001). BMI was associated with leptin in all training stages and IL-6 in R, C and E. Leptin, IGF-1 and cortisol in salvia were dependent on training stages while serum levels of estradiol were not. Nutritional fat intake (p=0.07 in R) as well as serum levels of IGF-1 (p=0.014 in E) were significantly associated with estradiol but not with serum leptin levels or salivary cortisol. Conclusions In female athletes nutritional composition has an impact on serum hormones (leptin, IGF-1 as well as estradiol) and may be also on cytokines (IL-6). Leptin, IGF-1 and salivary cortisol levels represent the intensity of physical training and possibly overtraining. In our female athletes no findings indicative of female athlete triad could be demonstrated.

Beschrieben wird die erfolgreiche Anwendung eines neuen Knochenersatzmaterials fur die variable lokale Antibiose. Ein Patient erlitt offene Unterschenkelbruche und eine offene Ellenbogenluxation durch den Tsunami 2004. Durch ein kombiniertes Vorgehen mit Debridement, systemischer als auch lokaler Antibiose konnte die Stumpflange der Unterschenkel weitestgehend konserviert werden, obwohl eine offene Markraumphlegmone im Verlauf der Behandlung auftrat. Die Infektion beider Tibiamarkhohlen durch einen multiresistenten Pseudomonas-aeruginosa-Stamm, Escherichia coli und Enterococcus faecium konnte erfolgreich mit dem Knochenersatzmaterial PerOssal®, beladen mit Vancomycin und einer systemischen Antibiose mittels Vancomycin, Meropenem und Ceftazidim saniert werden. Durch den Erhalt der Stumpflange an beiden Unterschenkeln konnte der Patient mit erhaltener Kniefunktion gut prothetisch versorgt werden. Er war schon 6 Monate nach dem Unfall wieder vollzeitarbeitsfahig und selbststandig mobil. A seriously injured tsunami victim with complicated osteomyelitis is presented. The patient was treated with a new resorbable bone substitute, which can be loaded with different antibiotics. The successful treatment is illustrated by the clinical, radiological and histological features. Bilateral open fractures of the lower leg with open elbow fracture led to a bilateral amputation of the lower legs and the right arm because of a beginning sepsis. The following intramedullary osteitis with multiresistant Pseudomonas aeruginosa, Escherichia coli and Enterococcus faecium was treated with the bone substitute PerOssal® combined with systemic and local application of vancomycin and systemic application of ceftazidime and meropenem. This case report illustrates the concept of an additional local antibiotic treatment of osteomyelitis by a bone substitute also functioning as a drug delivery system.

A 65-year-old woman with dermatomyositis for which she had been treated for ten years with prednisone (latterly 15 mg daily) suddenly experienced severe pain in the left thoracolumbar region. Cardiovascular, pulmonary and vertebral causes of the pain were excluded. But serological tests indicated inflammatory disease and the haemoglobin concentration was low (10.4 g/dl). Left pleural effusions were repeatedly aspirated and some haemorrhagic fluid obtained (haematocrit 0.31 in blood, 0.28 in the pleural effusion). Five days after admission her cardiovascular status became unstable and she developed respiratory failure (haemoglobin 7.6 g/dl). Chest radiograph showed increased pleural effusion. Subsequent thoracotomy revealed a left coagulothorax which was removed and flushed. During this procedure severe bleeding occurred from a covered perforation of the descending aorta, 1.5 x 1.5 cm in size. Although the aortic wall was thin, there was no aneurysm but arteriosclerotic changes and an external erosion near an abscessing mediastinitis, originating from a chronic purulent pleuritis and bronchopneumonia. The severe blood loss caused circulatory failure from which the patient could not be resuscitated.

In a 52-year-old female patient and a 50-year-old patient with a malign tumor of the right distal femur (stage IIIb) respectively the left distal tibia (stage Ia according to Enneking), the extremely rare primary leiomyosarcoma of the bone was diagnosed. The mortality of the primary leiomyosarcoma of the bone is 50%, the mean survival time after diagnosis is 3.4 years. Diagnosis of a primary leiomyosarcoma of the bone is only possible after a secondary leiomyosarcoma has been excluded as well as by histopathological including immunohistochemical examination. The operative procedure is the therapy of choice. A neoadjuvant and/or adjuvant radio- or chemotherapy can be useful.

The extreme stress on the long head of the biceps tendon is defined by its specific anatomical situation with near contact to the rotator cuff, to the sulcus intertubercularis and to the acromion. We took 74 specimens from cadavera and studied the macromorphological and cross-sectional anatomy to analyze changes preceding rupture of the biceps tendon. Degenerative tendon alterations with disorganized collagen fibers and large mucoid deposits occurred especially at the distal sulcus bicipitalis and near the origin of the tendon at the superior part of the glenoid labrum. The found degenerative histological alterations are possibly precursor of tendon rupture near to the distal sulcus or precursor of the so called "SLAP"-lesions.

Problemstellung: Das Curriculum zur Ausbildung „Sportmedizin” wird an deutschen Universitaten sehr heterogen betrieben. Effizienz und Akzeptanz dieser Ausbildung sind unbekannt. Zudem machen gewandelte Sinnmuster des Sports - Erlebnis, Spas, Gesundheit und Wohlbefinden statt reiner Leistungsorientierung - einen Neuentwurf des sportmedizinischen Curriculums wahrend des Studiums hin zu einer praxisorientierteren Ausbildung notwendig. So entstand in Anlehnung an die Richtlinien der Bayerischen Landesarztekammer ein neues Konzept zur sportmedizinischen Ausbildung. Hauptaugenmerk liegt neben der interdisziplinar angebotenen Vorlesungsreihe auf einer sportpraktischen Ausbildung. Methodik: Mittels Fragebogen erfolgte die Evaluation von Akzeptanz und Effizienz der Veranstaltung. Die Stichprobe umfasste 90 Teilnehmer: 58 Manner und 32 Frauen. Ergebnisse: Das interdisziplinare Themenangebot der Vorlesung wurde sehr positiv bewertet. Den meisten Vortragen der Veranstaltung wurde ein groser Nutzwert fur die spatere Tatigkeit beigemessen. Die Sportpraxisausbildung wird als wesentlicher Bestandteil der Sportmedizinerausbildung gesehen. Der „Spasfaktor” spielt eine zentrale Rolle. Organisation und Durchfuhrung der Veranstaltung wurden gleichermasen positiv bewertet. Diskussion: Die Evaluation eines neuen Lehrkonzepts der Sportmedizin zeigt den Erfolg der Revision des Curriculums „Sportmedizin” hin zu einer interdisziplinaren, praxisorientierten Ausbildung, um den Anforderungen der Sportmedizin bei gewandelten Sinnmustern des Sports in unserer Zeit gerecht zu werden. Abstract Introduction: Education in Sports Medicine is offered heterogeneously in German medical schools. Efficacy and acceptance among medical students are unknown. The self-image of sports has changed from a traditional, competition-oriented way to adventure, entertainment, wellness and health. Therefore changes of our curricula to a practical oriented way of teaching are required. In this regard a new curriculum was developed. The main focus, besides an interdisciplinary class in sports medicine was to offer practical education in sports to the students. Methods: Efficacy and acceptance of the class were evaluated using a questionnaire. 90 medical students (58 male, 32 female) were included into the study. Results: The interdisciplinary topics of the class were graded positively. Most of the presentations were regarded as very useful for the future practice. Empathy and commitment of the professor were keystones to good scores. The “fun-factor” was the key for the success of the practical assignment. Practical training was regarded as fundamental for a sports medicine class. Discussion: Evaluation of the new concept as well as a discussion of the current practice to teach sports medicine at medical school confirm the need of a more practical oriented education, in order to meet the requirements of sports medicine in a time with changing self image of sports.

On the basis of three patients with bone and soft tissue sarcoma,we would like to illustrate the necessity of a well working inter-disciplinary cooperation of radiologists, internal oncologists, radiation therapists, orthopaedic surgeons and plastic surgeons. Functional extremity preservation in sarcoma patients can be achieved by a good interdisciplinary management without im-pairing the total prognosis of the patients. Patients with sarcoma should be treated in centres in which all specialised divisions are experienced and well trained in the treatment of tumour patients. Only then can a promising approach be achieved.

Percutaneous high speed large core biopsy (LCB) using a 14-gauge-needle, supported by sonographic procedures, is a safe and reliable method for the diagnosis of benign and malignant breast lesions in daily practice. All malignant diagnoses (B5)--comprising 44 % (267/604) of cases--were confirmed by subsequent surgical biopsy. This indicates a positive predictive value of 100 %. Evidence for uncertain dignity in LCB (categories B3 and B4) was found in 3 % of our cases (20/604), requiring open breast surgery for further clarification. This is strongly supported by the fact that 22 % of B3 and 82 % of B4 cases were identified as carcinomas in subsequent surgery. In 9 % of our cases (53/604), histology was only questionably representative (category B1) without cancer in the follow-up. In the B2-category--which comprised nearly 44 % of all cases (n = 263)--the positive predictive value ranged at 2 %. For clinical investigation, mammography, breast ultrasound and LCB the sensitivity were at 79 %, 92 %, 92 % and 98 %, respectively. The specificity of clinical findings, mammography, breast ultrasound and LCB ranged at 88 %, 67 %, 79 % and 99 %, respectively. The combination of the 3 methods: clinical findings, mammography and breast ultrasound (leading to a "total diagnostic score" provided a sensitivity and specificity of 97 % and 52 %. LCB revealed an excellent specificity of 99 %. Therefore, large core biopsy takes up a definite and reliable place in procedures of breast diagnostics, thereby preventing a high number of unnecessary open surgical interventions.

AIM Bilateral foot injuries are not uncommon. Operative treatment usually requires partial weight bearing over several weeks. This is a challenge for physiotherapy especially for ambulation training. We describe a new rehabilitation aid allowing for bilateral limited weight bearing during ambulation. METHODS Ambulation training was initiated in the early postoperative period using the Regensburg ambulation aid. A lift system allows for exact limitation of weight bearing on both sides controlled by balances integrated into the floor. Using a rail system a 15 m free walking distance is available. This study included 10 patients with bilateral foot fractures. The functional outcome was assessed using the AOFAS score and quality of life with the SF-36 score. Plain X-rays were used to evaluate loss of correction. The control group consisted of 20 patients where ambulation training was discontinued for at least 6 weeks postoperatively. RESULTS The system is very safe, during the entire period no complication was recorded. Acceptance among the patients was extremely high. Worries about unwanted weight bearing could be reduced. Patients mobilized with early ambulation training showed a better compensation of gait if compared to the control group. Secondary problems in the knee, hip or spine, as well as muscular deficiencies had a significantly lower incidence. No loss of correction could be seen in either of the two groups. CONCLUSION The presented ambulation aid is a significant contribution to the physiotherapy of bilateral foot injuries.

Surgical procedures designed to treat focal chondral lesions by regenerating the cartilage surface have been evolving in the last few years. Selecting the proper treatment algorithm for a particular chondral defect depends on careful patient evaluation, including the defect morphology (e.g. defect size, depth) and the recognition of comorbidities such as ligamentous instability, deficient menisci, or misalignment of the mechanical limb axis or extensor mechanism. These comorbidities may need to be treated in conjunction with symptomatic chondral injuries to achieve the desired outcome. Among the various surgical treatment options for focal articular lesions, this article focuses on marrow stimulating techniques and osteochondral transplantation.

Virtual colonoscopy provides a computer-simulated endoluminal perspective of the air-filled, distended colon using modern CT scanning (spiral CT). According to recent studies the sensitivity and specificity of this technique are high for adenomatous polyps > or = 10 mm. A 67-year-old patient was admitted to our hospital because of diarrhoea and constipation, associated with abdominal pain in the lower right abdomen. Prior to admission the patient had undergone virtual colonoscopy in a specialised radiological practice which had detected no abnormalities apart from colonic diverticulosis. However, conventional video-colonoscopy revealed a subtotal circular malignant stenosis in the region of the right colonic flexure. A poorly differentiated adenocarcinoma was diagnosed histologically. Staging showed peritoneal carcinosis with infiltration of the right ureter and lymphangiosis carcinomatosa of the pectoral lobe of the left lung. After right hemicolectomy because of metastasised carcinoma of the ascending colon (pT4pN1pM1) we started palliative chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin. The risk of misdiagnosis by virtual colonoscopy is clearly increased in patients with subtotal tumour stenosis of the ascending colon. Conventional video-colonoscopy remains the gold standard for the diagnosis of colorectal carcinoma.

Studienziel: Die sportmedizinische Ausbildung wird an deutschen Universitaten sehr heterogen betrieben. Gewandelte Sinnmuster des Sports - Erlebnis, Spas, Gesundheit und Wohlbefinden statt reiner Leistungsorientierung - machen einen Neuentwurf des sportmedizinischen Curriculums wahrend des Studiums hin zu einer praxisorientierteren Ausbildung notwendig. Als erster Schritt sollten in einer Fragebogenaktion Einstellung und Motivation der Studenten evaluiert werden. Methode: Die Erhebung erfolgte mittels selbst entworfener Fragebogen. Hierbei waren Mehrfachantworten sowie freie Kommentare moglich. Ergebnisse: Die Stichprobe umfasste 150 Teilnehmer, davon nahmen 90 an der Sportmedizinausbildung teil. Als Hauptmotivation gaben die meisten die Erlangung der „Zusatzbezeichnung”, gefolgt von Interesse an. Studenten, die nicht an dem Kurs teilnahmen, fuhrten vor allem Zeitmangel gefolgt von Desinteresse und fehlender Praxisrelevanz an. 80 % der Studenten, die sich fur Sportmedizin interessieren, gaben an, selber aktiv Sport zu treiben. 66 % der mannlichen, aber nur 38 % der weiblichen Studenten schatzen sich selbst als sportlich ein. 66 % der Studenten geben an bereits mit Sportverletzungen konfrontiert worden zu sein. 90 % der Befragten halten eine sportpraktisch ausgerichtete Ausbildung fur absolut sinnvoll. Schlussfolgerung: Die Evaluation der studentischen Motivation, der Vorkenntnisse sowie eine Bestandsaufnahme der gegenwartigen Lehrpraxis der Sportmedizin in Deutschland unterstreichen die Notwendigkeit einer Revision des Curriculums Sportmedizin hin zu einer mehr praxisorientierten Ausbildung. Aim: Education in sports medicine is offered heterogeneously in German medical schools. The self-image of sports has changed from a traditional, competition-oriented way to adventure, entertainment, wellness and health. Therefore, changes of our curricula to a practical-oriented way of teaching are required. In a first step the motivations and expectations of the students have to be evaluated. Methods: 90 students enrolled in a sports medicine class were evaluated using a questionnaire and compared to 60 students not participating in the sports medicine class. Results: The main motivation for the students to sign in was the future possibility to subspecialize in sports medicine, followed by interest in the subject. The main reasons not to participate were the time factor followed by lack of interest. 80 % of the students were regularly practising sports. 66 % commented on having been involved in sports trauma. 90 % of the students believe that practical-oriented education is absolutely necessary. Conclusion: Evaluation of the students motivation, knowledge as well as a discussion of the current practice to teach sports medicine at medical school confirm the need for modification of our curricula to a more practical-oriented education.

BACKGROUND The relative resistance to arteriosclerosis of the internal thoracic artery is clinically valid. The aim of this study was to evaluate the graduation of intima and media fibrosis in ITA parts and to determine the extent of atherosclerosis using immunohistochemical methods related to patients' risk factors. METHODS 227 distal ITA segments from 144 male and 83 female patients were examined. Mean age was 66.7 +/- 9.03 years. HE and Elastica van Gieson staining was performed to detect intima-/mediafibrosis. POPULATION insulin-dependent diabetes mellitus (idDM; n = 35), non-insulin-dependent diabetes mellitus (nidDM; n = 32), irradiation of the chest due to cancer (n = 27), control group with isolated hyperlipidemia, hypertension, peripheral vascular disease (n = 133). 12 ITA segments of each group were examined immunohistochemically using CD34, CD68, Tenascin, Collagen III, Collagen IV. RESULTS Histomorphological examinations using HE and Elastica van Gieson stainings showed for idDM-ITAs no fibrosis in 57 %, slight fibrosis in 34 %, medium in 6 %, no severe, for nidDM-ITAs no fibrosis in 63 %, slight 31 %, medium 3 %, severe 3 %, for ITAs after irradiation: no fibrosis in 37 %, slight in 62 %, no medium or severe fibrosis. Compared to the control group there was no statistically significant difference in diabetic ITAs. Immunohistochemical examinations, scored on a 0 - 3 basis with 0 being the lowest (no reaction), 3 the highest (severe reaction), showed mostly no or slight reaction to CD34, CD68, Tenascin, and Collagen III for intima and media, with comparable results for diabetic or "irradiated" ITAs to those of the control group. The most distinct reaction (medium= 2), was detected for Collagen IV, a marker which outlines basement membranes of endothelia and smooth muscle cells of the vessel wall, but without differences between the four groups. No severe reactions were observed. CONCLUSIONS The relative resistance of ITA to arteriosclerosis could be demonstrated in 227 ITA segments. Immunohistochemistry supports histomorphological findings. The influence of diabetes mellitus and irradiation remains irrelevant.

Der im Fruhjahr 2015 geschlossene erste Kooperationsvertrag zwischen der DGOU und der Orthopaedic Research Society (ORS) hatte das Ziel, die Internationalisierung der DGOU weiter voranzutreiben. Die Aktivitaten des letzten Jahres und die hieraus entstandenen Folgeprojekte belegen, dass es hierdurch tatsachlich zu einer erheblichen Vertiefung der Zusammenarbeit beider Gesellschaften gekommen ist. Mit den folgenden Ausfuhrungen sollen wesentliche Aspekte der Kooperation vorgestellt werden.

Degeneration of the intervertebral disc is a common disease in the adults, especially at advanced age. A causal therapy is not known, but the progress in new therapeutic strategies, for example in tissue engineering, shows new possibilities. The goal of our study was to develop a new animal model that stimulates a load induced degeneration of the disc. We used the New Zealand rabbit, because morphology is similar to the human intervertebral disc. The degeneration was induced by axial compression of the disc L4 - L5 with an external fixateur. After different loading intervals, the animals were sacrified and the discs examined by radiology, histology, apoptosis and biomechanical testing. Radiography showed a significant decrease of the disc thickness in all loaded groups. Morphologically the intervertebral discs of loaded rabbits showed degenerative changes which were comparable to those in humans. A significantly increased number of dead cells in the annulus occurred after 14 and 28 days loading compared to the controls. The bending stress measured as the load to failure was not significantly different between the unloaded discs and the 28 days loaded discs. The results show that our animal modell can create degeneration. Four weeks compression leads to significant degeneration. Degeneration of the discs persisted in animals that were allowed a recovery time of 28 days after 28 days of loading.

AIM Our intention was to examine the value of ultrasonography in the case of spinal stenosis caused by bony fragments or a tumour. Pre- and postoperative computed tomographies were compared with intraoperative ultrasound images. METHOD Intraoperative sonography during spinal surgery was used after laminotomy or laminectomy in twenty patients with a stenosis of the spinal canal, caused by fragments or tumours. RESULTS The posterior vertebral wall as well as tumour-tissue and myelon can be well distinguished by sonography. The dural sheath remains sonographically visible as a white line between tumour-tissue and myelon even in the case of immense compression. Small bony fragments or herniated disc material are also visible in the spinal canal. Thin surgical instruments can be guided into their target region under ultrasonographic control. When the restored epidural space can be demonstrated sonographically, this proves complete decompression of the spinal cord. CONCLUSION Intraoperative ultrasound is an unrestricted repeatable real-time method for the surgeon to control the restoration and the width of the spinal canal. The extent of the operation depends on the results of the intraoperative sonography.

SummaryVascularized allotransplantation of knee joints under immunosuppression is a novel approach in orthopedic surgery. During the postoperative course immunosuppressive management depends on perfusion and viability of the graft. Aim: Evaluation of different diagnostic tools in regard to their usefulness and reliability to provide information about microvascularity and viability of vascularized knee joint allografts. Methods: Four patients with allogenic knee joint transplants were studied up to 26 months after transplantation with 3-phase bone scans and SPECT. The results were compared with duplex sonography, angiography, and histology. Results: Two cases without complications were characterized by adequate perfusion in duplex sonography, angiography and early bone scans. Late bone scans demonstrated increased bone metabolism of the transplant. Corresponding biopsy revealed viable bone cells. In one case with partial thrombosis and one case with complete thrombosis of the transplant vessels rapidly decreasing or missing perfusion was detected by duplex sonography, angiography, and bloodpool scintigraphy. Late bone scans showed reduced or absent bone metabolism. Biopsy demonstrated necrotic bone tissue. Due to the advantage of a tomographic technique SPECT allowed a more reliable assessment of graft viability as compared to planar imaging. Conclusion: Our findings confirm bone scintigraphy as a valuable diagnostic tool in patients with allogenic vascularized knee joint transplants. In contrast to other diagnostic approaches, scintigraphy provides reliable information on both viability and perfusion of the transplant within a single noninvasive clinical investigation.

In enger Verzahnung von Technik und Medizin erfasst und analysiert die Audi Accident Research Unit (AARU) Verkehrsunfaelle, an denen Audi-Fahrzeuge beteiligt sind. Abhaengig von der jeweiligen Unfallkonstellation besteht ein differierendes Verletzungsrisiko fuer Pkw-Insassen. Fuer die Einschaetzung einer Unfallschwere und dem daraus resultierenden Verletzungsrisiko ist es unzureichend, sich ausschliesslich an der Verformung des Unfallfahrzeuges zu orientieren. Moderne Systeme der passiven Sicherheit mindern die physikalischen Belastungen auf Pkw-Insassen. Bei richtigem Umgang beeintraechtigen diese Systeme, wie beispielsweise der Airbag, die Rettung von Unfallopfern nicht. (A) Titel in Englisch: The "entrapped" trauma of vehicle occupants as seen by the accident expert. "Audi" traffic accident research project AARU.

Osseous metastases to the hand are very rare. Only a single case of osseous metastasis of hepatocellular carcinoma to the hand has been reported in the literature to date. We report a case of osteolytic metastasis of the right first metacarpal as first manifestation of unresectable, alpha-fetoprotein-negative hepatocellular carcinoma (pT3, Nx, M1, UICC stage IVB, Okuda's stage I). The therapy consisted of R0-resection and hormonal therapy with tamoxifen 2 x 10 mg/d orally. Generally patients with metastatic cancer to the bones of the hand have a very poor prognosis.

Background Solitary intraparotid facial neurofibromas are extremely rare. These tumours arise from Schwann cells, in most cases as a manifestation of neurofibromatosis. In an intraparotid localisation, they can mimic other parotideal tumours. Due to their slow growth, they may be clinically inapparent for a long time. Case report We present the case of a patient with a right intraparotid neurofibroma originating from the facial nerve. He noted a slight facial weakness for the last three years and dullness over the preauricular area. On operation, all facial nerve branches were incorporated in the tumour mass. A total resection via monitoring technique of facial nerve function was performed. Postoperatively, the patient suffered from an incomplete facial palsy. Conclusion This case highlights particularly the importance of a concise diagnostic work-up of every facial palsy. Precise histological diagnosis is particularly essential because of the different biological behaviour of neurofibromas in contrast to neurinomas. With preoperative facial palsy the chance of facial nerve preservation decreases. Clinical and operative experience with parotid gland neurofibromas shows that recovery of facial nerve defects is mostly incomplete.