One hundred years of orthopedics in the Netherlands. VIII. Pediatric orthopedics

Orthopaedic disorders in children differ in type from those in adults: most frequent are congenital anomalies and disorders of growth and development. The special nature and relative rarity of these conditions justify the separate development of this branch of the discipline. Fractures almost always heal normally after closed reduction and immobilization in a plaster cast; fractures close to epiphyseal discs and in joints require special attention. Slipping of the upper femoral epiphysis necessitates surgical fixation of the epiphysis. Benign bone tumours occur relatively often and mostly require no surgical intervention. The prognosis of solid malignant bone tumours has improved since the introduction of (neo)adjuvant chemotherapy and limb-sparing surgery. In case of difference in leg length, the length of both legs is predicted with the aid of roentgenological measurements. Inhibition of the growth of the longer leg gives rise to fewer complications than lengthening of the short leg. The essence of the treatment of growth disorders due to abnormal ossification of the cartilage is to monitor the natural repair process and to intervene if permanent malformation threatens.     

Ambulatory operations in orthopedics

Outpatient surgery in orthopedics, which ist becoming increasingly popular and is promoted by present-day health care legislation, is associated with a whole range of ifs and buts. Patient-related factors, including age, readiness and ability to cooperate, and home care, need just as much consideration as physician-related factors (experience of the surgeon, anesthesist und surgical team). Architectural and equipment-related facilities need to be investigated. Not every intervention that is theoretically possible on an outpatient basis can be recommended--for example if intensive aftercare, which is better performed on an inpatient basis, should be necessary. The usual postoperative risks (e.g. thrombosis) must be taken into account, and in such cases, proper care must be guaranteed.     

Systemic enzyme therapy in orthopedics and traumatology

In 57 patients the preparations of systemic enzyme therapy vobenzim and flogenzim were applied during conservative or operative treatment of locomotor system injuries. Anti-edema, antiinflammatory and analgetic action of preparations was established.     

Legal grounds for patient information in orthopedics

Neuroimaging is playing an increasing role in research of affective disorders, with investigators examining both volumetric changes of specific brain structures and vascular changes within white and gray matter. Recent studies have attempted to make clinical correlations between neuroimaging changes in unipolar and bipolar mood disorders. In this review, we focus particularly on those changes that are clinically meaningful. We conclude that there is enough evidence to begin to evaluate inclusion of neuroimaging findings in our mood disorder classification system. To this end, we propose two new mood disorder subtypes, vascular depression and vascular mania. Directions for future research in neuroimaging are then discussed.     

Bone and joint tuberculosis in the field of orthopedics

In Japan the number of patients with bone and joint tuberculosis has been dramatically decreasing since the beginning of 1980's. The number of patients was 1626 in 1978 according to statistics of tuberculosis patient in Japan. This was only 2.02% of new tuberculosis patients of Japan in 1978. Since that time the number of patients with bone and joint tuberculosis, in Japan, has been in steady decline. The number was only 675 patients in 1996. This was only 1.34% of new tuberculosis patients. The rate of new infections also decreased. Recently due to the development of computed tomography, magnetic resonance imaging and so on, patients with bone and joint tuberculosis can be diagnosed early, with great certainty. Curettage of infected focus and bone grafting via anterior approach has resulted in consistently improved results. While there are many reports of about the operative treatment with spinal instruments for spinal tuberculosis, artificial materials must be implanted with great care.     

Principles of psychoneuroendocrinology

We present the results of studies of an aqueous sample of a highly [15N,2H] enriched protein, the SH3 domain from Fyn. Measurements of 1H relaxation and interactions between H2O solvent and exchangeable protons are given, as well as a method for increasing the effective longitudinal relaxation of solvent exchangeable proton resonances. The long-range isotope shifts are measured, for 1H and 15N, which arise due to perdeuteration. Simulations, which employed a 7 or 8 spin relaxation matrix analysis, were compared to the experimental data from a time series of 2D NOESY datasets for some resonances. The agreement between experiment and simulation suggest that, with this 1H dilute sample, relatively long mixing times (up to 1.2 s) can be used to detect specific dipolar interactions between amide protons up to about 7A apart. A set of 155 inter-amide NOEs and 7 side chain NOEs were thus identified in a series of 3D HSQC-NOESY-HSQC experiments. These data, alone and in combination with previously collected restraints, were used to calculate sets of structures using X-PLOR. These results are compared to the available X-ray and NMR structures of the Fyn SH3 domain.     

The use of lasers in surgical orthopedics. A current review

An abundant, seven trans-membrane domain receptor related to the calcitonin receptor has been studied by a number of groups without identification of its ligand. A recent report claimed that the receptor was a type 1 CGRP receptor (Aiyar et al J. Biol. Chem. 271 11325-11329 (1996)). We have studied the equivalent rat sequence in transfected cells. When expressed in 293 cells the receptor interacts with CGRP and adrenomedullin with KD values of 1.2 nM for CGRP and 11 nM for adrenomedullin. Both ligands cause an elevation of intracellular cAMP with EC50 values of 4 nM and 20 nM respectively and these effects are inhibited by the antagonist CGRP8-37. The receptor is expressed at high levels in the pulmonary vascular endothelium. Both the pharmacological data and the localisation are consistent with the conclusion that the orphan receptor is a type J CGRP receptor. However, when expressed in COS-7 cells, no receptor activity could be demonstrated suggesting that 293 cells contain a factor necessary for functional receptor expression.     

One hundred years of orthopedics in the Netherlands. I. Introduction

One hundred years ago, on 1 May 1898, the Netherlands Orthopaedic Association was founded. This was prompted by the view that general surgeons paid insufficient attention to the treatment of the locomotor system; they were permitted to join the new association, however, at any rate until 1947. It was especially in the last 30 years that orthopaedic surgery underwent major changes. The most striking novelty was arthroplastic surgery. There have also been developments in the treatment of spinal abnormalities, rheumatological surgery, sports medicine, oncology and traumatology.     

The effects, limitations, and long-term dentofacial adaptations to treatment with the Herbst appliance

The purpose of this article is to summarize the existing scientific data with respect to the short- and long-term effects of the Herbst appliance on the occlusion and on the maxillo/mandibular complex. The article also discusses the treatment indications and possible treatment limitations. The Herbst method is most effective in the treatment of Class II malocclusions. Long-term stability seems to be dependent on a stable cuspal interdigitation. Marked mandibular morphological changes occur during therapy and sagittal condylar growth is increased. Posttreatment, most of the mandibular morphological changes revert and no long-term influence of Herbst treatment on mandibular growth can be verified. The appliance effect on the maxillary complex can be compared with that of a high-pull headgear. Without proper retention, however, this effect is of a temporary nature. Herbst treatment is especially indicated in the permanent dentition at or just after the pubertal peak of growth. Mixed dentition treatment is not recommended, as a stable cuspal interdigitation after therapy is difficult to achieve and relapses are prone to occur. In the nongrowing patient, the appliance should be used with great caution.     

Principles of antibiotic therapy

The primary development in the area of antibiotic treatment for surgical infections in the last 5 years has been the expanded clinical importance of beta-lactamases in the protection of Gram-negative organisms from previously active drugs. To counter this problem, a series of new antibiotic agents has been developed, including new cephalosporins, carbapenems, quinolones, and beta-lactamase inhibitors. This article describes the various beta-lactamases and their mechanisms of action, and details the activity of new antibiotic agents against resistant Gram-negative organisms. Recent information on the importance of combination therapy for patients with severe Gram-negative infections is reviewed. The use of optimized aminoglycoside dosing regimens, including once-a-day dosing, provides an additional strategy for treating serious Gram-negative infections.