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PROBLEM The success rate of high-energy extracorporal shock wave therapy in the treatment of non-unions in comparison to the "golden standard" surgery is still unclear. METHOD In a prospective study, 3000 impulses with an energy density of 0.6 mJ/mm2 were applied with an experimental device to the pseudarthrosis in 52 patients. RESULTS The mean duration of pseudarthrosis was 13 months. A mean of 2.5 surgical interventions had already been performed. Bony union was achieved in 52% of our patients after an average of 3.3 months. Failures especially were found in the atrophic type of pseudarthrosis as well as in congenital bone disorders like fibrous dysplasia or osteogenesis imperfecta. No serious complications were observed. CONCLUSIONS Even after numerous surgical interventions high-energy extracorporal shock wave therapy as a noninvasive method for the treatment of bony non-unions showed a fair success rate. A higher success rate can be expected by strict selection criteria.

Aim of the study Has extracorporal shockwave therapy in chronic golfer's elbow comparable results as in tennis elbow? Method 30 patients for extracorporal shockwave therapy who suffered from chronic medial epicondylitis (group I) and 30 patients with persistent tennis elbow (group II) received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. The final follow-up examination was done after 24 weeks. Results Significant differences in relief of pain and improvement of function were observed in favour of group II. Good or excellent outcome was found in only 27% for the epicondylitis humeri ulnaris, but in 60% for epicondylitis humeri radialis. Conclusion The indication for extracorporeal shock-wave therapy in medial epicondylitis must be questioned.

Background The prevalence of coronary vessel wall alterations in the general population is not known. Therefore, the aim of our study was to determine the prevalence of coronary artery disease in persons in whom the underlying disease was not related to coronary artery disease and could therefore be regarded as a near normal population. Methods We included 331 consecutive patients (173 men, 158 women, aged between 40 and 70 years) who were referred for catheter ablation of an accessory pathway (67·4% ) or atrioventricular-node modification (32·6%) and who underwent coronary angiography as part of their routine baseline evaluation before radiofrequency current application. Most of the patients (79%) of this cohort were free of symptoms of coronary artery disease. Based on visual inspection of coronary angiograms in multiple projections, patients were classified to have one-, two- or three-vessel disease if stenoses greater than 50% of lumen diameter were present. In addition, diffuse vessel wall alterations were assessed using two different score systems. Results The prevalence of coronary artery disease in this near normal population was 7·3%, with a significant difference in coronary asymptomatic (3·8%) vs symptomatic patients (17·1%). Mean levels of total cholesterol and other risk factors were not significantly different in patients with coronary artery disease compared to those without. But levels of low-density lipoprotein (LDL) cholesterol and lipoprotein(a) were significantly higher and high-density (HDL) cholesterol lower in patients with a stenosis or extent score higher than zero compared to a score of zero. The values of all vessel scores evaluating the extent of critical and diffuse coronary vessel alterations were very low in patients affected with coronary artery disease, indicating a low degree of diffuse alteration of the vessel wall. Conclusions The prevalence of coronary artery disease with at least one critical stenosis in subjects aged 40–70 years with an average cholesterol level of 238±42mg.dl−1is 7·3%.

Wir berichten im folgenden uber einen 52jahrigen Patienten, der sich bei einer bestehenden koronaren Herzkrankheit in einer auswartigen Klinik fur Herz- und Gefaschirurgie einer 4fach-ACVB-Operation unterzogen hat. Bei gleichzeitig bestehender peripherer arterieller Verschluskrankheit rechts fuhrend (Stadium IIb–III) mit langstreckigem Verschlus der A. femoralis superficialis erfolgte in gleicher Sitzung die Implantation eines femoropoplitealen Bypasses mit supraglenuidalem Anschlus rechts. 4 Monate postoperativ stellte sich der Patient in unserer Klinik vor und berichtete von einer deutlich abgenommenen Gehstrecke und Schmerzen im rechten Bein. Die von uns durchgefuhrte DSA zeigte die Ausbildung einer postoperativen arteriovenosen (A.V.-)Fistel nach femoropoplitealen Bypass. Ursache hierfur war die distale Anastomisierung des angelegten Bypasses mit der V. poplitea. Es erfolgte in unserem Hause eine Dissektionsligatur im Bereich des Bypasses distal und eine Reanastomosierung der Gefas-prothese auf die A. poplitea im 1. Segment, die intraoperative Angiographie zeigte jetzt korrekte Verhaltnisse.

Objectives To determine the late complications and consequences for renal function, vitamin and acid-base metabolism after application of the Mainz Pouch I (MZP-I) technique in children and young adults. Patients and methods To November 1994, the MZP-I procedure was carried out in 463 patients at our institution, 91 of whom were children and adolescents (≤20 years old) using bladder augmentation in 21 and a continent cutaneous stoma in 70. A minimum follow-up of 1 year was possible in 87 patients or 163 renal units (RUs) with a mean of 5.5 years (range 1–10.5). Results At the last examination, 23 of 55 (42%) pre-operatively dilated RUs had improved, 131 of the 163 RUs (80%) were stable and nine RUs (5.5%) showed a slight clinical asymptomatic increase in the upper tract dilatation. Through an extraperitoneal flank incision, 11% of the RUs which developed stenosis at the ureterocolic anastomosis were successfully reimplanted (16% in patients with neurogenic disorders, 17% with pre-operative irradiation and 5% in the remaining patients). Two of 32 patients with an intussuscepted and invaginated ileal nipple required re-operation due to incontinence, but none of the patients with an appendiceal stoma were incontinent. Open revision of a stomal stenosis was performed in three and endoscopic treatment in nine patients. In 54 patients, the levels of vitamins A, B1 , B2 , B6 , E, folic and bile acid were within normal ranges. There was no significant decrease in vitamin B12 levels after operation. In none of the patients with normal pre-operative creatinine values had the levels increased and none developed severe acidosis or bowel neoplasm. Conclusion The MZP-I is recommended as a technique for bladder augmentation or continent urinary diversion in children and young adults, with an acceptable complication rate which offers long-term protection of the upper urinary tract.

We report a controlled, prospective study to investigate the effect of treatment by low-energy extracorporeal shock waves on pain in tennis elbow. We assigned at random 100 patients who had had symptoms for more than 12 months to two groups to receive low-energy shock-wave therapy. Group I received a total of 3000 impulses of 0.08 mJ/mm2 and group II, the control group, 30 impulses. The patients were reviewed after 3, 6 and 24 weeks. There was significant alleviation of pain and improvement of function after treatment in group I in which there was a good or excellent outcome in 48% and an acceptable result in 42% at the final review, compared with 6% and 24%, respectively, in group II.

Summary Over a period of 4 years we performed a prospective randomized trial on 100 patients in order to compare the effects of low-energy extracorporal shock-wave therapy (ESWT) in the treatment of painful heel (chronic plantar fasciitis). Patients in group I were treated three times at weekly intervals with 1000 impulses of 0.08 mJ/mm 2 given around the heel spur. Group II received treatment three times with 10 impulses of the same energy density at weekly intervals. Follow-up examinations were done at 12 and 52 weeks, respectively. The main outcomes assessed were reduction in severity of pressure pain, period of pain-free walking, and patient satisfaction. At 12 weeks, 16 of 50 patients in group I were almost or completely pain free, compared to one in group II. The period of pain-free walking increased by 141% in group I, compared to 33% in group II. The subjective assessment showed 10 excellent and 18 good results in group I compared to no excellent and eight good or fair results in group II. Twenty-six patients in group I were satisfied with the treatment compared to six in group II. Several patients had additional treatment after the 12-week assessment. At one year, 20% of group I patients had received combined conservative therapy, and 4% had had an operation, whereas 58% of group II had had combined therapy and 32% had had surgery. At the one-year follow-up there was still a difference in outcome in favour of group I, with 29 patients satisfied in group I versus 18 in group II. We conclude that three treatments with 1000 impulses of low-energy shock waves at 12 and 52 weeks provides an effective therapy for chronic plantar fasciitis.

Children (28 boys, 24 girls) with an average age of 10.1 years (range 2–17) who underwent 63 sessions of extracorporeal shock wave lithotripsy for 64 urinary stones (57 renal, 7 ureteral) between 1...

A 38-year-old patient with a grade 3 testicular varicocele was treated by antegrade scrotal sclerotherapy. Although performed technically accurate, antegrade sclerotherapy led to a haemorrhagic infarction of the testis by complete occlusion of venous drainage. The testis had to be removed. This complication has not been described yet and patients should be informed about this rare event.

Semifinished produced electrical steels have advantageous properties, especially high magnetic induction values, combined with less expensive technologies compared with fully finished materials. We present the results of some new developments on the basis of technically produced hot band which was further treated both on a technical and laboratory scale.

This paper presents an outline of the phenomenological theory of sedimentation-consolidation processes. In one space dimension, this theory leads to an initial-boundary value problem (IBVP) of a hyperbolic-parabolic degenerate partial differential equation. A brief account of recent existence and uniqueness results for this IBVP is given. The predictive power of the phenomenological theory is illustrated by two comparisons of numerical with experimental results.

Has extracorporal shockwave therapy in chronic golfer's elbow comparable results as in tennis elbow?30 patients for extracorporal shockwave therapy who suffered from chronic medial epicondylitis (group I) and 30 patients with persistent tennis elbow (group II) received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. The final follow-up examination was done after 24 weeks.Significant differences in relief of pain and improvement of function were observed in favour of group II. Good or excellent outcome was found in only 27% for the epicondylitis humeri ulnaris, but in 60% for epicondylitis humeri radialis.The indication for extracorporeal shock-wave therapy in medial epicondylitis must be questioned.

A 38-year-old patient with a grade 3 testicular varicocele was treated by antegrade scrotal sclerotherapy. Although performed technically accurate, antegrade sclerotherapy led to a haemorrhagic infarction of the testis by complete occlusion of venous drainage. The testis had to be removed. This complication has not been described yet and patients should be informed about this rare event.

Sedimentation processes are employed in a variety of industrial applications in which a suspension, a mixture of a fluid and fine solid particles, is separated into its solid and liquid components under the influence of gravity. In the mining industry, large vessels, so-called thickeners of up to 100 m in diameter and 6 m in depth with a slightly conical bottom, are used for the settling of the suspension and for the consolidation of the sediment. In a continuous thickener, the control operations (feeding of fresh suspension, discharge of the concentrated sediment at the bottom and overflow of the supernatant clear liquid) take place continuously. Fig. 1 shows a schematic cross-section of a continuous thickener [14].

Since the beginning of the 1990s scientific investigations on the use of extracorporeal shock wave therapy (ESWT) in the field of orthopedics have been carried out at the Orthopedic Department of the University of Mainz. Prospective studies demonstrated beneficial effects in chronic lateral humeral epicondylitis (tennis elbow), and in calcifying tendinitis of the shoulder in more than 50% of the cases. Additional indications for which positive results of prospective studies have been published during the past 2 years are plantar calcaneodynea and pseudoarthrosis. On the basis of the results achieved, it may be concluded that, for specific indications, extracorporeal shock wave therapy may now be taken out of the clinical testing stage and introduced into routine practice.

The success rate of high-energy extracorporal shock wave therapy in the treatment of non-unions in comparison to the "golden standard" surgery is still unclear.In a prospective study, 3000 impulses with an energy density of 0.6 mJ/mm2 were applied with an experimental device to the pseudarthrosis in 52 patients.The mean duration of pseudarthrosis was 13 months. A mean of 2.5 surgical interventions had already been performed. Bony union was achieved in 52% of our patients after an average of 3.3 months. Failures especially were found in the atrophic type of pseudarthrosis as well as in congenital bone disorders like fibrous dysplasia or osteogenesis imperfecta. No serious complications were observed.Even after numerous surgical interventions high-energy extracorporal shock wave therapy as a noninvasive method for the treatment of bony non-unions showed a fair success rate. A higher success rate can be expected by strict selection criteria.

The extinction risk of a population is determined by its demographic properties, the environmental conditions to which it is exposed, and its genetic potential to cope with and adapt to its environment. All these factors may have stochastic as well as directional components. The present chapter reviews several types of models concerned with the vulnerability of small populations to demographic stochasticity and to random and directional changes of the environment. In particular, the influence of mutation and genetic variability on the persistence time of a population is explored, critical rates for environmental change are estimated beyond which extinction on time scales of tens to a few thousand generations is virtually certain, and the extinction risks caused by the above mentioned factors are compared.

Fifty patients who suffered from persistent tennis elbow for more than 12 months, and were referred for surgical treatment, were assigned at random to 2 groups of low-energy extracorporal shock wave therapy. Group I received a total of 3000 impulses of 0.08 mJ/mm2; group II (controls) 30 impulses of 0.08 mJ/mm2. Follow up was after 3 and 12 weeks. We found no significant differences between the 2 groups before treatment, there was but significant relief of pain and improvement of function in group I with good or excellent outcome in 56% at the last evaluation.

The range and type of ventrodorsal motion between two adjacent vertebra (L3-S1) was analyzed on isolated vertebral columns of 13 German Shepherd Dogs. All except one were neurologically normal dogs. The movement from maximal flexion to maximal extension was divided into 5 degree steps. For each step, the center of motion was determined on laterolateral radiographs. It could be shown that mobility between two adjacent vertebra within the lumbar spine increases towards the lumbosacral region with the highest mobility in this joint. In the cranial portion of the lumbar spine, rotation and ventrodorsal (parallel) displacement between two adjacent vertebra was seen. Rotation dominated in the lumbosacral joint in 11 dogs, whereas parallel displacement was mainly seen in 2 dogs. Further studies on pathologic and surgically modified vertebral columns are necessary to clarify the significance of these findings in the pathogenesis of lumbosacral instability and cauda equina compression in the German Shepherd Dog.

Between October 1990 and March 1991, 8 patients with cystic lesions in the region of the posterior bladder wall, the seminal vesicles and the prostate were examined by MRI. In all cases there was accurate characterisation of the lesion and of its anatomy. In 3 patients with abnormalities in the retrovesical space there was very good agreement with the operative findings. 4 patients were treated conservatively. In these patients there was good agreement with the findings on cystoscopy, CT and sonography.

In the dog congenital or acquired stenosis of the lumbosacral region is commonly encountered. In humans the lumbosacral junction is the most often affected part of the vertebral column. Lumbosacral instability, one possible etiology for stenosis of the vertebral canal plays an important role in man. This study summarizes the functional anatomy and some important geometric and kinematic considerations necessary for the understanding of the motion (flexion-extension) between two adjacent vertebra.

The purpose of our studies was to investigate experimentally the dose-dependent effects of extracorporeal shock waves on tendon and bone and to unveil therapeutic possibilities in tendinopathies and pseudarthroses. In animal experiments, both positive and negative influences were exerted by shock waves, depending on the initial situation and on the power of the applied shock waves. In prospective clinical trials positive effects were found in the treatment of persistent tennis elbow, plantar fasciitis, calcifying tendinitis, and pseudarthrosis. Our data show that extracorporeal shock waves may provide analgesic, resorptive and osteo-inductive reactions with nearly no side effects. However, the high cost of apparatus and staff prevents a routine application. Extracorporeal shock waves thus remain a last alternative before the indication is made for an operative procedure.

Age hardenable martensitic Iron—Manganese—Nickel alloys were neutronographically investigated in order to explain the age hardening effect occurring during the heat treatment. The formation of coherent precipitations of an ordering phase within the matrix proved to be the reason for the occurring hardness increase. Aushartbare martensitische Eisen—Mangan—Nickel-Legierungen wurden neutronografisch untersucht, um den wahrend einer Warmebehandlung auftretenden Ausharteeffekt zu klaren. Es konnte nachgewiesen werden, das die auftretende Hartesteigerung durch die Bildung von koharenten Ausscheidungen einer Ordnungsphase innerhalb der Matrix verursacht wird.