1. Three random linear copolymers composed of two or three of the amino acids d-tyrosine, d-glutamic acid, d-alanine and d-lysine, and a branched multichain copolymer with a poly-d-lysine backbone and polymeric side chains of d-tyrosine and d-glutamic acid, were found to be non-antigenic in rabbits, by precipitin and passive cutaneous anaphylaxis, and in guinea pigs, by delayed hypersensitivity tests. The corresponding four copolymers of l-amino acids were shown to be antigenic by all the three criteria. 2. No immunological cross-reactions were observed between the polypeptides composed of d-amino acids and the corresponding l-amino acid copolymers. 3. Similarly, an azobenzenearsonic acid conjugate of poly-d-tyrosine was shown to be non-antigenic in guinea pigs, in contrast with an analogous conjugate of poly-l-tyrosine. Animals sensitized with the conjugate of poly-l-tyrosine did not exhibit delayed skin reactions, when cross-tested with the d-conjugate. 4. A linear polymer composed of d-tyrosine, l-glutamic acid and l-alanine was found to be immunogenic and to cross-react with the corresponding polymer composed exclusively of d-amino acids.

Alanine↗

PubMed1965

Preparation and characterization of poly-DL-alanyl rabbit gamma-globulin.

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Animals↗

PubMed1964

Antigenicity of some new synthetic polypeptides and polypeptidyl gelatins.

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Antigens↗

PubMedDate not supplied

Simpson-Golabi-Behmel syndrome with severe cardiac arrhythmias.

We report on a family with 2 affected males with the X-linked Simpson-Golabi-Behmel (SGB) syndrome. The propositus was a 33-year-old man with pre- and postnatal overgrowth, "coarse" face with hypertelorism, broad nose, wide mouth, malposition of teeth, submucous cleft, accessory nipples, broad hands with hypoplastic index finger nails, and operated left postaxial hexadactyly. From the age of 26 years he suffered from severe tachyarrhythmias, requiring recurrent defibrillations. The brother of the propositus was macrosomic at birth and had a similar facial appearance. In addition he had a pyloric stenosis and a 3/6 systolic murmur. He died at age 4 months. Cardiac defects and conduction disturbances are major components of the SBG syndrome and can be responsible for death in early infancy and perhaps for cardiac arrest in the adult.

Abnormalities, Multiple↗

PubMedDate not supplied

Performance of two clinical decision rules for knee radiography.

We designed a prospective observational study to attempt to validate two recently described clinical decision rules for knee radiography. Consecutive patients aged > or = 15 yr with acute knee injuries occurring less than 1 wk prior to presentation were included for study. Patients with distracting conditions, open knee injuries, or previous surgery were excluded. Each patient was assessed for 7 historical and 15 physical examination criteria that were recorded on a standardized data collection instrument. Radiographs were ordered at the discretion of the attending physician and were read by two board-certified radiologists. When radiographs were not ordered, structured telephone follow-up was performed after 3 wk. The main outcome parameter was the presence or absence of a clinically significant fracture. There were 351 patients in the study; 26 (7%) had knee fractures. Fractures were significantly associated with an increased prevalence for two of the three criteria in the rule derived by Bauer: inability to weight bear immediately or in the emergency department (ED; 76.9% of patients with a fracture vs. 29.8% of patients without a fracture) and effusion (53.8% vs. 28.9%, respectively). Ecchymosis was not significantly associated with fracture (19.2% with fracture vs. 9% with no fracture). Use of the Bauer rule would have led to a radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 48.9%). Fractures were associated with a significantly increased prevalence for three of the five criteria in the decision rule proposed by Stiell: isolated patella tenderness (30.8% with fracture vs. 14.5% with no fracture), inability to flex the knee to 90 degrees (42.3% vs. 19.7%, respectively), and inability to weight bear immediately and in the ED (57.7% vs. 18.8%, respectively). Age > or = 55 yr (23.1% vs. 12.0%, respectively) and fibula head tenderness (11.5% vs. 5.5%, respectively) were not significantly associated with fracture. Use of the Stiell rule would have led to radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 49.8%). We conclude that neither clinical decision rule is 100% sensitive. Further refinement will be necessary to identify all patients with knee fractures.

Adolescent↗

PubMedDate not supplied

Do functional deficits result from radial head resection?

The treatment of comminuted fractures of the radial head with primary or secondary head resection is controversial. To assess the outcome of patients after radial head resection, a retrospective study with clinical and radiologic follow-up including isokinetic testing was performed. Between 1981 and 1992, 151 patients underwent radial head resection for comminuted fractures. Fifty-nine patients were operated on during the first 2 weeks after injury (primary treatment), 47 patients were operated on between 3 weeks and 6 months after injury (early secondary), and 45 patients were operated on more than 6 months after injury (late secondary). Follow-up examinations of 108 patients were conducted at an average of 6 years after operation. In 64% of the patients only the radial head was fractured. In 26% of the patients the fracture was combined with a dislocation of the elbow. Results on the clinical and isokinetic tests were better for patients treated with primary resection than for patients treated with secondary resection. Of the patients treated with primary resection, 45% were subject to no restrictions in daily life and 64% had no limits at work.

Adult↗

PubMedDate not supplied

[Treatment modalities in infected knee alloarthroplasties].

PURPOSE: The purpose of this study was to present and to evaluate different treatment options in the infected knee alloarthroplasty. METHODS: We followed 47 infected knee alloarthroplasties with a mean follow-up of 62 months which were surgically treated by different techniques. There were 20 cases with early infection (< or = 12 months) and 27 cases with late infections (> 12 months). RESULTS: In 10 patients a two stage exchange of the implant were undertaken. In 6 of those 10 cases the infection could be successfully treated. 30 patients underwent an arthrodesis, two of those after an unsuccessful exchange procedure. In this group only in two patients the infection was not managed successfully. 28 of the patients with an arthrodesis showed a good result of the fusion side. One case was only debrided and in 8 cases bony and soft tissue damage lead to amputation. The HSS-score showed an excellent results in 5.3%, a good result in 21%, a fair result in 26.3% and a poor results in 47.4% of the cases. Comparable distribution was documented with the Hungerford-score. Patients with a stable and painless fusion showed a comparable functional outcome to those patients with a new replacement. CONCLUSION: Revision of an infected knee implant is best managed by a two stage procedure and can lead to a good functional result. Fusion is indicated in cases with bad bony and soft tissue situation. A solid arthrodesis gives a painfree and stable extremity.

Adolescent↗

PubMedDate not supplied

[Value of alignment osteotomy of the proximal tibia in the endoprosthesis period].

AIM OF THE STUDY: To evaluate the value of high tibial osteotomy in times of growing numbers of endoprostheses we compared our personal with other results of this method as well as of the unilateral sledge prosthesis. MATERIAL AND METHODS: Between 1972 and 1993 the high tibial osteotomy as described by Coventry was performed in 105 patients. 98 patients could be examined clinically-radiologically and evaluated with a questionnaire. The indication for surgery was given in patients with unilateral arthrosis without affection of the retropatellar joint and without significant ligamentous instability. The varus deviation was in no case more than 10 degrees. The average follow-up for the clinical-radiologic examination was 9.4 years. RESULTS: 77 patients (78.6%) were satisfied with the outcome of the surgery. Here it was seen that neither age nor pain or instability had an influence on this judgement. The walking distance on the other hand had a significant influence. Stair climbing and range of motion were significantly important as well. 23 patients gave the judgement "excellent", 31 "good", 36 "satisfactory" and 8 patients were "not satisfied". A significant influence of patient age on the judgement could not be proven. The division in the Japanese Score showed "good" results in 14%, "moderate" in 81% and "poor" in 5%. 13 knee joints (13.3%) were absolutely pain-free and in 67 cases (68.4%) there were a definite pain reduction. A significant correlation between the preoperative axis deviation and pain could not be found. An average flexion of 97.5 degree and an extension deficit of 3.3 degree on average was seen. A significant difference of range of motion dependent on age groups could not be found. In 42 knees (42.9%) the lateral ligaments were clinically stable, in 35 cases (35.7%) there was a first degree lateral stress gap and in 21 cases (21.4%) there was a second degree lateral instability. A significant correlation between the instability and age or pain could not be proven. 13 revision surgeries including 9 endoprosthesis implantations were performed. CLINICAL RELEVANCE: The study showed a high level of satisfaction with an exact surgical indication. When seeing the growing number of implanted uni- or tricompartmental endoprostheses the procedure of tibial osteotomy can be suggested for patients with unilateral arthrosis without retropatellar arthrosis, with an axis deviation less than 15 degrees, with unaffected cartilage of the contralateral compartment and without ligamentous insufficiency independent of patient age.

Adult↗

PubMedDate not supplied

[Proprioceptive capacities of the knee joint with and without endoprosthesis].

PURPOSE OF THE STUDY: To compare the proprioceptive abilities of total knee arthroplasty patients and a control group. METHOD: In a knee arthroplasty patient group of 28 and in 25 healthy volunteers the proprioceptive function was examined. To measure the proprioceptive function the motion analysis system with reflecting markers was chosen. In each patient 16 measurements from different starting points in different joint positions with and without visual controlling were performed. RESULTS: The results demonstrated significant differences between the patients and volunteers independent of the starting point, the joint position and the visual controlling. Also the comparison with the 30 and 60 degree position showed significant differences. In the patient group were not shown significant values comparing the starting position, the visual controlling and the comparison with the healthy leg. CLINICAL RELEVANCE: Knee arthroplasty conducts to loss of proprioception in the operated and healthy leg. Visual controlling can not solve these problems. The worst results were achieved in 60 degrees position. The starting position can not influence the results.

Aged↗

PubMedDate not supplied

[The physician's professional responsibilities, especially the responsibility for patient education].

AIM OF THE STUDY: With increasing numbers of disputs between patient and doctor the interest in correct enlightenment is rising. MATERIALS AND METHODS: A review of literature is performed to find out the different duties of patient and especially of doctor to enlighten. RESULTS: The medical profession has certain duties, not fulfilling or fulfilling of these duties results in patients claims. In addition to the duties to treat and to coordinate, there is the duty to enlighten of which there are two forms. They are called therapeutic enlightenment and informed consent. The therapeutic enlightenment should aid the collaboration of the patient in order to maximize the medical success of the treatment. The informed consent shall serve to give the patient all information about possible or necessary treatment, so that one can make a self-informed decision between treatment and non-treatment. The last form consists not only clarification about procedure but also the unavoidable risks. Because of the right of informed consent the doctor is obligated to explain the choices among possible similar treatments. CONCLUSION: The knowledge for correct enlighten can reduce the number of disputes between patient and doctor.

Humans↗

PubMedDate not supplied

[Does the type of prosthesis have an effect on the development of periarticular ossification?].

We checked up the hip operations that were done by the same surgeon in the years 1974-76 and 1984-86. For this examination we had 115 Müller Charnley prosthesis and 75 anatomically straight stems type SF. The heterotopic ossifications were classified according to Arcq. The aim was to find out if the form and type of the femoral stem, the changing of the leg length and of the CCD-angle, the post operative CCD-angle and the number of blood transfusion influences the dimension of heterotopic ossifications. The groups with higher amount of periarticular ossification (Arcq grade 2 and 3) are generally smaller. In the case of SF prostheses the ossifications raised when the CCD angle difference also raised. But the Müller/Charnley prostheses showed quite the contrary. Though there was no significance in this manner. Although in the other controlled factors there were no significant differences. The difference that was found between the two types of prosthesis was equalized with another factor: Low-dose heparin. This was the only significant influence on heterotopic ossification.

Aged↗