Mehrere internationale Leitlinien zur Therapie und Prophylaxe der Glukokortikoid-induzierten Osteoporose (GIO) sind verfügbar. Die Unterschiede in den verschiedenen Empfehlungen sind nachvollziehbar, wenn man die zum jeweiligen Publikationsdatum vorliegenden wissenschaftlichen Daten berücksichtigt. Einige neue Erkenntnisse zur postmenopausalen Osteoporose fließen in rezentere Leitlinien zur GIO ein. Nach Bearbeitung aktueller Leitlinien und rezenter Literatur zu diesem Thema hat sich der Arbeitskreis Osteologie der österreichischen Gesellschaft für Rheumatologie und Rehabilitation (ÖGR) entschlossen, nationale Empfehlungen zur Prophylaxe und Therapie der GIO zu geben.

Untreated severe kyphoscoliosis is rarely observed nowadays. In affected patients dislocation of inner organs with functional impairment may occur [1] [2]. We present the unusual case of a patient with severe kyphoscoliosis who developed extensive esophageal ulceration.

The effect of rapid altitude changes on middle ear pressures has not been extensively studied. With the increasing popularity of recreational skydiving, there is an increased risk of barotrauma from rapid altitude changes in jumpers. During a skydive a jumper falls 13,500 - 15,000 feet within 3 - 7 minutes. Additionally, similar pressure changes can occur with commercial airline travel. This study assessed the effect of altitude change on middle ear pressure in skydivers by comparing: 1) changes in pressure before and after a jump 2) pressures in those who attempted equalization versus not and 3) pressure changes in those who developed middle ear symptoms versus those who did not.

Representatives of the Antarctic food web (krill, cephalopod, fish, penguin, seal) of the area around Elephant Island and from the Weddell Sea were analysed for the most recalcitrant organochlorine compounds. Due to sorption of the compounds to sinking particles and accumulation in sediments, two benthic fish species (Gobionotothen gibberifrons, Chaenocephalus aceratus) feeding on benthos invertebrates and fish reflected significantly increasing concentrations within a decade (1987-1996), while a benthopelagic species (Champsocephalus gunnari) feeding on krill did not. In the pelagic food chain, lipid normalised concentrations of all compounds increased from Antarctic krill to fish proving that biomagnification of highly lipophilic pollutants (log octanol-water partition coefficient>5) occurs in water-breathing animals. As top predators Weddell and southern elephant seals (Leptonychotes weddellii, Mirounga leonina) biomagnified the persistent organic pollutants relative to krill 30-160 fold with the exception of hexachlorobenzene, the levels of which were lower than in fish indicating its intense specific elimination.

Organochlorine compounds were analysed in three fish species of different feeding types from the area of Elephant Island in the Antarctic. In 1996, hexachlorobenzene (HCB) (means: 15-20 ng/g lipid), p,p'-DDE (5-13 ng/g lipid) and mirex (1-7 ng/g lipid) predominated, while PCBs were minor components (PCB 153: 0.4-2 ng/g lipid). Concentration patterns were species-dependent: PCB 180, PCB 153, mirex, nonachlor III, trans-nonachlor and the toxaphene compound B8-1413 were highest in the bottom invertebrate feeder Gobionotothen gibberifrons and lowest in the krill feeder Champsocephalus gunnari. Levels of p,p'-DDE, PCB 138 and heptachloro-1'-methyl-1,2'-bipyrrole (Q1), a natural bioaccumulative product, were highest in the fish feeder Chaenocephalus aceratus, whereas HCB was present in about equal concentrations in all species. Most compounds were taken up preferentially via the benthic food chain, the chlorinated bipyrrole via the pelagic food chain and HCB from the water. In antarctic fish, biomagnification was generally more important than bioconcentration. Between 1987 and 1996, most persistent organic pollutant (POP) levels showed significant increases in the benthos feeder and the fish feeder, while they remained nearly constant or increased less in the krill feeder. Hence, the former species represent indicator species for changing POP levels in Antarctica. Ratios (1996/1987) of average concentrations in G. gibberifrons were: PCB 138 0.7, HCB 0.8, B8-1413 1.5, PCB 180 1.7, PCB 153 1.8, p,p'-DDE 2.0, nonachlor III 2.9, trans-nonachlor 3.3, mirex 6.7. By comparison with trends in the northern hemisphere it is concluded that global distribution of HCB is close to equilibrium. Changing levels of other POPs reflect global redistribution and increasing transfer to antarctic waters probably due to recent usage in the southern hemisphere and climate changes.

Background. A biomechanical cadaver study was performed to test the stability and strength of screw osteosynthesis of surgical neck fractures of the humerus.Methods. After bone density measurement, 64 cadaver proximal humerus bones were bent to create a subcapital fracture. The fracture was then stabilized by means of screw osteosynthesis randomly assigned to subgroups of screw positioning, size of screw, and stress test (torsion/bending).Results. Two screws applied laterally and parallel were 34.2% more stable than the normal arrangement. Bone density had a dominant role with regard to maximal bending and torsion force, but no significance was found with respect to additional screws through the major tuberculum or diameter of screws.Conclusion. Two of the smaller 4.5-mm cannulated screws should be applied parallel from the lateral direction. Only range-of-motion exercises that produce a bending stress should be considered early after surgery, avoiding axial stress.

BACKGROUND AND AIMS:Sildenafil blocks phosphodiesterase type 5 which degrades nitric oxide (NO) stimulated 3'5'-cyclic monophosphate (cGMP), thereby relaxing smooth muscle cells in various organs. We used sildenafil as a tool to investigate the role of the NO-cGMP pathway in the oesophagus of healthy volunteers and patients with hypercontractile oesophageal motility disorders.METHODS:Six healthy male volunteers participated in a randomised double blind study on two separate days before and one hour after oral intake of either sildenafil 50 mg or placebo. Oesophageal manometry was performed to determine vector volume of the lower oesophageal sphincter (LOS) and pressure amplitudes of the oesophageal body. Four of the volunteers underwent 12 hour ambulatory oesophageal manometry on two separate days, once with sildenafil 50 mg and once with placebo. An activity index for spontaneous swallowing was calculated for every hour of the study. Eleven patients with hypercontractile oesophageal motility disorders took part in an open study of the effect of 50 mg sildenafil on manometric features of their disorder and on the clinical response to sildenafil taken as required.RESULTS:In healthy subjects, sildenafil significantly reduced LOS pressure vector volume and pressure amplitudes in the distal half of the oesophageal body. In three of four subjects the inhibitory effect of sildenafil lasted at least eight hours. In nine of 11 patients, manometric improvement after sildenafil was observed but only four had an improvement in oesophageal symptoms with sildenafil taken as required. Two of these four patients however experienced side effects and did not want to continue treatment.CONCLUSIONS:Sildenafil lowers LOS pressure and propulsive forces in the body of the oesophagus of healthy subjects as well as in patients with nutcracker oesophagus, hypertensive LOS, and achalasia. The effect of sildenafil on the oesophageal body may last for up to eight hours in healthy volunteers. A subset of patients with hypertensive LOS or nutcracker oesophagus may benefit from sildenafil but side effects are a limiting factor.

Elimination kinetics of tetra-, penta- and hexachlorobiphenyls (IUPAC Nos. 44, 52, 87, 95, 101, 153) were investigated by laboratory experiments in three species of different phyla: Nereis diversicolor (Polychaeta), Palaemon longirostris (Crustacea) and Platichthys flesus (Pisces). Half-lives were species-specific and structure-dependent. Palaemon longirostris eliminated all components fastest. N. diversicolor was faster than Platichthys flesus except for components 95 and 153. Contrary to the fish species, the two invertebrates contained significant amounts of polar transformation products of No. 52, which had been applied as 14C labelled. Therefore, the faster elimination by Palaemon longirostris and N. diversicolor was assumed to be generally due to increased biotransformation. Elimination was in accordance with polychlorinated biphenyl (PCB) residue patterns obtained from field samples of the species. Congeners with vicinal H atoms in m,p positions were under-represented in Palaemon longirostris and so were congeners with ⩾7 Cl in N. diversicolor, while the PCB residue pattern in Platichthys flesus was similar to that of Clophen A60. By comparing percentages of the experimental congeners in ΣPCB and their elimination half-lives in the three species, it was revealed that residue patterns were also influenced by species-dependent uptake, e.g. feeding habits. Extractable organic matter-based ΣPCB levels increased with trophic levels of the three species.

Hexachlorocyclohexanes (HCHs) were determined simultaneously in air and seawater during two cruises across the Atlantic Ocean between the Arctic Ocean (Ny-Alesund/ Svalbard, 79 degrees N; 12 degrees E) and the Antarctic Continent (Neumayer Station/ Ekstroem Ice Shelf, 70 degrees S; 8.2 degrees W) in 1999/ 2000. The concentrations of alpha-HCH and gamma-HCH in air and surface waters of the Arctic exceeded those in Antarctica by 1-2 orders of magnitude. The gaseous concentrations of gamma-HCH were highest above the North Sea and between 20 degrees N and 30 degrees S. Fugacity fractions were used to estimate the direction of the air-sea gas exchange. These showed for alpha-HCH thatthe measured concentrations in both phases were close to equilibrium in the North Atlantic (78 degrees N-40 degrees N), slightly undersaturated between 30 degrees N and 10 degrees S and again close to equilibrium between 20 degrees S and 50 degrees S. Y-HCH has reached phase equilibrium in the North Atlantic as alpha-HCH, but the surface waters of the tropical and southern Atlantic were strongly undersaturated with y-HCH, especially between 30 degrees N and 20 degrees S. These findings are significantly different from two earlier estimates around 1990 as a result of global emission changes within the past decade. Therefore, we investigated the time trend of the HCHs in the surface waters of the Atlantic between 50 degrees N and 60 degrees S on the basis of archived samples taken in 1987-1997 and those from 1999. A decrease of alpha-HCH by a factor of approximately 4 is observed at all sampling locations. No decrease of gamma-HCH occurred between 30 degrees N and 30 degrees S, but there was a decrease in the North Atlantic, North Sea, and in the South Atlantic south of 40 degrees S. The constant level of gamma-HCH in the tropical Atlantic confirms the conclusion that the tropical Atlantic acts as a sink for y-HCH at present time. The measured alpha-HCH seawater concentrations were compared with results from a global multimedia fate and transport model. Whereas the time trend over 13 years and the latitudinal gradient were well reproduced by the model, the absolute levels were too high by a factor of 4.5. This may be explained by the zonal averaging employed in the model as well as uncertain emissions and degradation rates.

BACKGROUND AND AIMS: In our previous studies, we showed that glucagon inhibits cholinergic motor activities in the gastric antrum through postganglionic cholinergic motor neurons.However, the exact physiological roles of it have not yet been elucidated.The purpose of this study was to investigate the effects of glucagon on contractions and relaxations of the pyloric ring and antro-pyloro-duodenal coordinative contractions.SUB-JECTS AND METHODS: Experiments were performed on conscious dogs.In the gastric antrum, pyloric ring, and duodenum, the contractile activities were measured by means of strain gauge force transducers.RESULTS: 1) During migrating motor contractions (phase 3), relaxations of the pyloric ring (i.e.pyloric ring opening) were obviously observed at the same time as when intense phasic contractions occured in the antrum.In contrast, when phasic contractions were observed in the pyloric ring (i.e.pyloric ring closure), bursts of contractions occured in the duodenum.2) In the pyloric ring, glucagon (20-50ILglkg, drip infusion for 5 minutes) did not affect contractions, but strongly inhibited relaxations.At the same time, it significantly inhibited phasic contractions in the antrum, and did not affect these contractions in the duodenum.3) During the interdigestive quiescent phase, administration of erythromycin (0.15mglkg, drip infusion for 10 minutes) induced phase 3-like contractions with negative deflection of the pyloric ring, synchronized with strong contractions of the antrum, which were similar to spontaneous phase 3 contractions.Glucagon strongly inhibited relaxations in the pyloric ring, but never affected contractions.CONCLUSION: These results probably suggests that glucagon itself inhibits duodeno-gastric refluxes after bursts of contractions in the duodenum induced by glucagon, by means of inhibition of pyloric ring relaxations.

PCBs, p,p'-DDE, HCB, alpha-HCH and gamma-HCH were analysed in Lanice conchilega from the French, Dutch and German coasts. The annelid exhibited a species-specific PCB pattern. It showed lower and higher chlorinated congeners in more balanced quantities than the polychaete Nereis diversicolor and also the bivalve Mytilus galloprovincialis used in the French mussel watch programme RNO. The PCB pattern in L. conchilega was influenced by the geographical location, probably by changes of the environmental PCB composition from SW to NE. Riverine influences could be distinguished from regional ones. Contributions of higher chlorinated PCB congeners increasing from western to eastern river-related positions are explained by fractionation of PCBs during atmospheric transport.Concentrations of PCBs and p,p'-DDE in L. conchilega based on extractable organic matter were highest in the Seine Bay indicating a substantial input of these pollutants by the river Seine. No enhanced PCB and p,p'-DDE values were measured in the German Eight. Levels of gamma-HCH and ratios of gamma-HCH/alpha-HCH were elevated near the mouths of Rance and Seine, which drain areas of intensive agriculture with apparent lindane application. Balanced levels of HCB point to fast atmospheric transport and homogenous deposition of this compound into the sea. - (C) 1998 Elsevier Science Ltd. All rights reserved.

Dissolved sterols were investigated in the autumnal Weddell Sea, where stratification is weak and global bottom water formation takes place. Among 25 compounds identified, the zoosterol cholest-5-en-3β-ol exhibited highest concentrations. 24-Methycholesta-5,22E-dien-3β-ol and cholesta-5,22E-dien-3β-ol followed next in abundance. Levels of cholest-5-en-3β-ol remained roughly unchanged throughout the water column. Phytosterol concentrations decreased by a factor of 20 towards the bottom, but displayed a similar pattern. In general, the distribution of dissolved sterols was neither correlated to oceanographic features nor to biological ones, but reflected dissolution of particles with different sinking rates. Low levels in newly formed bottom water are consistent with extensive degradation in source waters on the shelf. From geographical and seasonal comparisons a degradation half-life of three weeks was estimated for phytosterols in surface waters. This half-life is slightly shorter than reported earlier in a warm oligotrophic ocean. Newly formed bottom water does not contribute significantly to sterol export into adjacent oceans.

Various antarctic fish species, particularly Chaenocephalus aceratus, Champsocephalus gunnari and Gobionotothen gibberifrons, from 1987 and 1991 were analysed for 10 nonpolar xenobiotic compounds. Concentrations expressed on the basis of extractable organic matter (EOM) were nearly identical in liver and adipose tissue. They were also independent of fish weight. Concentrations of HCB, which were as high as in Limanda limanda of the North Sea (20 ng/g EOM), are interpreted as results of cold condensation. p,p'-DDE, trans-nonachlor and PCB congeners 153, 138, 180 ranged one to two orders of magnitude lower than in North Sea fish. In addition, nonachlor III, octachlorobornane and mirex were roughly quantified. A residual compound comparable in concentration to octachlorobornane and not yet described in the literature was tentatively identified. From chromatographic and mass spectrometric data the elemental composition C10H3OCl7 was derived, p,p'-DDE and the three PCB congeners increased in Antarctica between 1987 and 1991 due to global redistribution. Copyright (C) 1996 Elsevier Science Ltd

Contaminated allograft donor tissue represents a potential source of infection unique to keratoplasty. We prospectively studied perilimbal cultures of drowning victims over 30 months to determine if the ocular surface flora of drowning victims was unique. Twenty-eight donor eyes were cultured from 14 drowning victims. Ninety-three percent of limbal cultures were positive for one or more organisms, compared to results of a previous study of surface contamination of donor globes in which 65% were found to be culture positive. Fifty-seven percent (16 of 28) of donor eyes grew at least one streptococcal species, while 46% (13 of 28) grew two or more streptococcal species. A previous study identified streptococcal species in 7.9% of perilimbal cultures from nondrowning donor eyes, which demonstrates the unique effect of drowning on the ocular flora. The incidence of gram-negative isolates was also markedly higher in drowning victims, compared to previous studies of donor globes. This prospective study has shown that the ocular surface flora of drowning victims harbors markedly increased numbers of streptococcal species as well as gram-negative organisms. These findings demand careful globe decontamination, and emphasize the need for appropriate antibiotic coverage in corneal storage media.

Lindquist, Thomas D. M.D., Ph.D.; Allen, Kim; Weber, Kurt; Oiland, Donna Author Information