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Ziel dieser Arbeit ist es, einen Uberblick uber die wichtigsten Lidfehlstellungen zu geben und deren Behandlungsoptionen aufzuzeigen. Die praoperative Evaluierung, Atiologie und Formen der Blepharoptosis und des Ek- und Entropiums werden dargestellt und anhand von Literatur und aus eigener Erfahrung Behandlungsoptionen vorgestellt. Erst durch die Kenntnis der Atiologie und der zugrundeliegenden Pathogenese der verschiedenen Lidfehlstellungen kann eine optimale Therapieoption gewahlt und damit die besten Ergebnisse erzielt werden.

Objective. To investigate diagnostic accuracy in patient histories involving nonspecific complaints and the extent to which characteristics of physicians and structural properties of patient histories are associated with accuracy. Methods. Six histories of patients presenting to the emergency department (ED) with nonspecific complaints were provided to 112 physicians: 36 ED physicians, 50 internists, and 26 family practitioners. Physicians listed the 3 most likely diagnoses for each history and indicated which cue(s) they considered crucial. Four weeks later, a subset of 20 physicians diagnosed the same 6 histories again. For each history, experts had previously determined the correct diagnoses and the diagnostic cues. Results. Accuracy ranged from 14% to 64% correct diagnoses (correct diagnosis listed as the most likely) and from 29% to 87% correct differential diagnoses (correct diagnosis listed in the differential). Acute care physicians (ED physicians and internists) included the correct diagnosis in the differential in, on average, 3.4 histories, relative to 2.6 for the family practitioners ( P = 0.001, d = .75). Diagnostic performance was fairly reliable (r = .61, P < 0.001). Clinical experience was negatively correlated with diagnostic accuracy ( r = –.25, P = 0.008). Two structural properties of patient histories—cue consensus and cue substitutability—were significantly associated with diagnostic accuracy, whereas case difficulty was not. Finally, prevalence of diagnosis also proved significantly correlated with accuracy. Conclusions. Average diagnostic accuracy in cases with nonspecific complaints far exceeds chance performance, and accuracy varies with medical specialty. Analyzing cue properties in patient histories can help shed light on determinants of diagnostic performance and thus suggest ways to enhance physicians’ ability to accurately diagnose cases with nonspecific complaints.

Background: Micro-structural changes associated with ultra high molecular weight polyethylene particle (UHMWPE) induced osteolysis, the most frequent cause of aseptic loosening, have been intensively investigated in the mammalian calvarian model by histomorphometry and micro-computed tomography. However, little is known regarding the serological changes that occur during this process. Methods: Serological parameters for bone metabolism [calcium, phosphate, osteocalcin (OCN), deoxypyridinoline (DPD)/creatinine, alkaline phosphatase, osteoprotegerin and receptor activator of nuclear factor-κB] were analyzed in this animal model for particle induced osteolysis. Ten C57BL/6 mice were divided at random into sham operated and UHM-WPE implanted groups. Blood and urine samples were collected prior to and at 14 days after surgery. Results: Implantation of UHMWPE lead to a significant decrease in bone volume (p=0.027). Both groups (sham/UHMWPE) showed a significant increase in calcium (p=0.004/p=0.027) and phosphate (p=0.001/p=0.001), without correlation to particle implantation. Significantly higher concentrations of DPD/creatinine (p=0.034) and OCN (p=0.022) were found after implantation of UHM-WPE. In addition, parameters could not be correlated to particle induced osteolysis. Conclusions: DPD can be regarded as a valuable parameter for detecting UHMWPE induced osteolysis in the calvarian model. Further studies of serum parameters should focus on the clinical relevance in aseptic prosthetic loosening. Clin Chem Lab Med 2010;48:1641–6.

There is still iodine deficiency in many populations, which justifies efforts to increase this trace element in food such as milk, eggs and meat by fortifying compound animal feeds with extra iodine. The iodine requirement of growing pigs is in the order of 100–200 μg/kg feed (as a supplement) and the effects of this dosage range or higher on pork iodine concentration should be determined including the action of relevant iodine antagonists in feed, e.g., rapeseed. In three experiments on a total of 208 pigs [Pietrain × (Landrace × Large White)] the iodine concentration of meat (m. longissimus) – 71 samples –, blood serum – 100 samples – and of the thyroid – 100 samples – was analysed by intracoupled plasma-MS. In Experiment 1, 4 × 10 pigs received diets without or with rapeseed cake (0 and 3.2 mmol glucosinolates/kg diet) either with 125 or with 250 μg iodine/kg. In Experiment 2, the three groups with 46 pigs each were fed high iodine diets (1200 μg supplementary iodine/kg) without or with 100 or 150 g solvent extracted rapeseed meal/kg diet (0; 0.8 and 1.2 mmol glucosinolates/kg). In Experiment 3, 3 × 10 pigs received either 600 μg iodine/kg feed (1) or the 5-fold dosage (600 + 2400 μg iodine/kg diet) administered 7 days (2) or 18 days (3) before slaughtering. The group means of pork iodine content were in the relatively small range from 3 to 16 μg/kg, which contrasted to the enormously varying dosage range from 125 to 3000 μg iodine/kg diet. There was a certain iodine dosage effect in Experiment 3 when – in comparison to the control – a 3-fold higher meat iodine concentration resulted from a 5-fold higher diet iodine concentration. In Experiment 1 with the low iodine offer, rapeseed cake with glucosinolates decreased the serum iodine level whereas in Experiment 2 this did not happen due to higher iodine fed and lower glucosinolates exposure. The thyroid iodine reflected the dietary iodine better than blood serum iodine and the serum better than muscle. However, in Experiment 2, 1200 μg iodine/kg diet produced only half the serum iodine concentration than half as much dietary iodine in Experiment 3 (600 μg iodine/kg diet), which may result from rapid elimination of blood iodine and a higher urinary excretion by longer duration of feed withdrawal before blood sampling. The muscle of pigs has to be classified as a low iodine food. Thus, there are no possibilities to concentrate this trace element reproducibly in amounts relevant for human nutrition in pork.

Background Tibial head depression fractures demand a high level of fracture stabilization to prevent a secondary loss of reduction after surgery. Elderly individuals are at an increased risk of developing these fractures, and biomechanical investigations of the fractures are rare. Therefore, the aim of this study was to systematically analyze different types of osteosyntheses in combination with two commonly used bone substitutes. Methods Lateral tibial head depression fractures were created in synthetic bones. After reduction, the fractures were stabilized with eight different treatment options of osteosynthesis alone or in combination with a bone substitute. Two screws, 4 screws and a lateral buttress plate were investigated. As a bone substitute, two common clinically used calcium phosphate cements, Norian® Drillable and ChronOS™ Inject, were applied. Displacement of the articular fracture fragment (mm) during cyclic loading, stiffness (N/mm) and maximum load (N) in Load-to-Failure tests were measured. Results The three different osteosyntheses (Group 1: 2 screws, group 2: 4 screws, group 3: plate) alone revealed a significantly higher displacement compared to the control group (Group 7: ChronOS™ Inject only) (Group 1, 7 [p