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Bad Münster am Stein-Ebernburg, Germany

Background: The anterior cruciate ligament (ACL) greatly influences joint kinematics. In particular, the complex structure of the ACL enables functional stabilization of the knee joint.Biomechanics of the intact ACL: The main task of the anterior cruciate ligament is to stabilize against anterior tibial translation (ATT) as well as the preservation of rotational stability. These two stabilization tasks can be examined using the Lachman and the pivot–shift tests. While stabilization of the knee joint against ATT can be assigned to the anteromedial fibers of the ACL in flexion, the posterolateral fibers are responsible for rotation stabilization in near extension.Kinematics after ACL insufficiency: Following rupture of the anterior cruciate ligament, there is mainly a combination of anterior instability with increased anterior tibial translation and rotation instability. The degree of instability after partial ACL ruptures depends on the extent of the affected fibers. Existing ACL insufficiency has far-reaching effects on knee joint kinematics. In addition to increased load on the medial and lateral collateral ligaments and the posterior horn of the meniscus, increased translational and rotational instability leads to a shift of the main stress points in the knee joint and, thus, to an overload of certain areas of the cartilage.Kinematics of ACL reconstruction: The recovery of the kinematics of the knee joint by ACL reconstruction depends of the anatomical reconstruction of the complex ACL fiber structure and ACL insertion. Increased consideration of the anteromedial and posterolateral bundle portions of the ACL leads to improved stability of the knee joint. © 2015, Springer-Verlag Berlin Heidelberg. Source

Olalekan A.O.,University of Tubingen | Olalekan A.O.,Ladoke Akintola University of Technology | Schaumburg F.,Universitatsklinik Munster | Nurjadi D.,University of Tubingen | And 6 more authors.
International Journal of Antimicrobial Agents

Nasal colonisation with Staphylococcus aureus is a risk factor for invasive infection in human immunodeficiency virus (HIV)-positive individuals. This study aimed to characterise colonising S. aureus from regions with a high HIV prevalence. Single nasal swabs were taken from a total of 374 HIV-positive and 370 healthy individuals. Overall, 202 S. aureus carriers were detected. Compared with healthy individuals, HIV-positive subjects were more likely to be S. aureus nasal carriers (33% vs. 21%; P = 0.0001). Isolates from HIV-positive individuals were more often resistant to meticillin (16% vs. 8%; P = 0.13), chloramphenicol (47% vs. 16%; P < 0.0001), sulfamethoxazole/trimethoprim (SXT) (90% vs. 55%; P < 0.0001) and ciprofloxacin (18% vs. 0%; P < 0.0001). Strains belonging to the spa clonal complexes 3772/ST25 and 064/ST8 were significantly more often isolated from HIV-positive individuals and exhibited greater resistance to ciprofloxacin, SXT and chloramphenicol (spa-CC 3772) or to meticillin (spa-CC 064), respectively. Panton-Valentine leukocidin gene content was high overall and was equally distributed between isolates from HIV-positive and healthy individuals (33% vs. 30%). Genotypic characteristics of colonising isolates were similar to those reported to cause invasive infection in Nigeria. The HIV pandemic contributes to the evolution of antimicrobial resistance in S. aureus. Measures to contain antimicrobial resistance of S. aureus in Nigeria must target risk groups such as HIV-positive individuals. © 2012 Elsevier B.V. and the International Society of Chemotherapy. Source

Background: In medical ethics there is broad agreement that patients should be empowered to make autonomous decisions about their health and that objective, detailed information promotes these decisions. According to German law patients have a right of access to their own medical records. Objectives: Which advantages and disadvantages does the access to records have for doctors and patients in psychiatry? Which requirements should be met to make access reasonable for patients? Material and methods: This article presents an analysis of the legal situation and the state of research, evaluation of empirical studies, discussion of features of psychiatry, its language and patients as well as their influence on access to medical records. Results: Psychiatrists are sometimes concerned about patient access to medical records and some psychiatric patients feel upset or uncomfortable after having inspected their records. The misunderstanding and stigmatization of psychiatric terms, the vulnerability of psychiatric patients and the nature of psychiatric disorders, the description of which affects fundamental aspects of personality, all play a role in this. In addition, in having access to their records patients use a source of information that was originally written for other addressees. Information content and language are not adapted to their needs. Possible solutions could involve improvements in patient education and (stylistic) changes in writing records. © 2015, Springer-Verlag Berlin Heidelberg. Source

Tunnerhoff H.-G.,Praxis fur Hand und Fuchirurgie | Langer M.,Universitatsklinik Munster
Handchirurgie Mikrochirurgie Plastische Chirurgie

Accurately performed anatomic and biomechanical studies as well as clinical experience during the last years have widened our knowledge about function and pathology of the distal radioulnar joint (DRUJ) making a differentiated treatment possible. In cases of trauma a rupture of the ulnar part of the triangular fibrocartilaginous complex (TFCC) frequently occurs. An overview is given on the development of different arthroscopic techniques for repair and the state of the art is presented. The ulnar part of the TFCC is constituted of the superficial part which is less important for stability and the deep part which is anchored to the fovea of the ulnar head. This deep part is the most important stabiliser of the DRUJ. Each of these parts may rupture separately or both of them may rupture at the same time. Keystones for diagnosis are clinical examination and arthroscopy. On clinical examination instability of the DRUJ is to be evaluated by comparing it to the contralateral side. Furthermore, the degree of instability should be estimated. Extraarticular associated lesions must also be assessed clinically. On arthroscopy the TFCC may be evaluated from the radiocarpal joint as well as from its undersurface, from the DRUJ. In cases of avulsion from the fovea, an anatomic reconstruction with reinsertion of the deep part to the bone is indicated and may be performed successfully according to the published studies and our own experience. If a severe instability is found on clinical examination it is to be supposed that more stabilising structures - then only the radioulnar ligaments - are affected and reinsertion of the deep fibres to the fovea may not be sufficient. © 2014 Georg Thieme Verlag KG Stuttgart. Source

Socie G.,Service dHematologie Greffe de Moelle | Socie G.,Paris West University Nanterre La Defense | Schmoor C.,Clinical Trials Center Universitatsklinikum Freiburg | Bethge W.A.,University Hospital of Tuebingen | And 19 more authors.

Previous randomized graft-versus-host disease (GVHD)-prophylaxis trials have failed to demonstrate reduced incidence and severity of chronic GVHD (cGVHD). Here we reanalyzed and updated a randomized phase 3 trial comparing standard GVHD prophylaxis with or without pretransplantation ATG-Fresenius (ATG-F) in 201 adult patients receiving myeloablative conditioning before transplantation from unrelated donors. The cumulative incidence of extensive cGVHD after 3 years was 12.2% in the ATG-F group versus 45.0% in the control group (P < . 0001). The 3-year cumulative incidence of relapse and of nonrelapse mortality was 32.6% and 19.4% in the ATG-F group and 28.2% and 33.5% in the control group (hazard ratio [HR] = 1.21, P = . 47, and HR = 0.68, P = . 18), respectively. This nonsignificant reduction in nonrelapse mortality without increased relapse risk led to an overall survival rate after 3 years of 55.2% in the ATG-F group and 43.3% in the control group (HR = 0.84, P = . 39, nonsignificant). The HR for receiving immunosuppressive therapy (IST) was 0.31 after ATG-F (P < . 0001), and the 3-year probability of survival free of IST was 52.9% and 16.9% in the ATG-F versus control, respectively. The addition of ATG-F to standard cyclosporine, methotrexate GVHD prophylaxis lowers the incidence and severity of cGVHD, and the risk of receiving IST without raising the relapse rate. ATG-F prophylaxis reduces cGVHD morbidity. © 2011 by The American Society of Hematology. Source

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