We evaluated the radiological pelvic diameter after the bernese periacetabular osteotomy (PAO) and its influence on the modality of birth. Out of 93 woman, 17 had a total of 28 babies after PAO; 18 children were delivered spontaneously and 10 by caesarean section. The rate of section (36 %) was twice as high after PAO as in a normal population. In 50 % the indication to perform a section was made because the obstetrician anticipated problems during delivering after PAO. The average weight of birth was 3348 g +/- 285 g in the spontaneous delivery group, 3475 g +/- 356 g in the section group. The weight of birth didn't correlate neither with the duration of delivery nor with the indication to perform a section. The 17 woman who had a baby after PAO didn't show a significant change of the radiological diameters of the pelvis: pelvic entrance (before PAO 15. 4 cm, after PAO 15.7 cm), mid-pelvis (before PAO 11.8 cm, after PAO 11.8 cm) and pelvic outlet (before PAO 14.2 cm, after PAO 13.7 cm). We found that the PAO does not influence the anatomical diameters of the birth canal and therefore is not an indication for a section.

20 arthrodeses in 19 patients were followed up for an average of 39 months (12-69 months). All arthrodeses were fused. In one patient a fibular pseudarthrosis was encountered. All arthrodeses healed in a correct position but one that consolidated with a pes equinus of 3 degrees . The average AOFAS (American Orthopedic Foot and Ankle Society) hindfoot score reached 78.5 points (40-86 points). A marked reduction of symptoms and satisfactory function were reported postoperatively by all patients. All would be willing to undergo surgery again.

BackgroundSymptoms associated with pes planovalgus or flatfeet occur frequently, even though some people with a flatfoot deformity remain asymptomatic. Pes planovalgus is proposed to be associated with foot/ankle pain and poor function. Concurrently, the multifactorial weakness of the tibialis posterior muscle and its tendon can lead to a flattening of the longitudinal arch of the foot. Those affected can experience functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment and foot orthoses are considered to be the first line approach. Furthermore, strengthening of arch and ankle stabilising muscles are thought to contribute to active compensation of the deformity leading to stress relief of soft tissue structures. There is only limited evidence concerning the numerous therapy approaches, and so far, no data are available showing functional benefits that accompany these interventions.MethodsAfter clinical diagnosis and clarification of inclusion criteria (e.g., age 40–70, current complaint of foot and ankle pain more than three months, posterior tibial tendon dysfunction stage I & II, longitudinal arch flattening verified by radiography), sixty participants with posterior tibial tendon dysfunction associated complaints will be included in the study and will be randomly assigned to one of three different intervention groups: (i) foot orthoses only (FOO), (ii) foot orthoses and eccentric exercise (FOE), or (iii) sham foot orthoses only (FOS). Participants in the FOO and FOE groups will be allocated individualised foot orthoses, the latter combined with eccentric exercise for ankle stabilisation and strengthening of the tibialis posterior muscle. Participants in the FOS group will be allocated sham foot orthoses only. During the intervention period of 12 weeks, all participants will be encouraged to follow an educational program for dosed foot load management (e.g., to stop activity if they experience increasing pain). Functional impairment will be evaluated pre- and post-intervention by the Foot Function Index. Further outcome measures include the Pain Disability Index, Visual Analogue Scale for pain, SF-12, kinematic data from 3D-movement analysis and neuromuscular activity during level and downstairs walking. Measuring outcomes pre- and post-intervention will allow the calculation of intervention effects by 3×3 Analysis of Variance (ANOVA) with repeated measures.DiscussionThe purpose of this randomised trial is to evaluate the therapeutic benefit of three different non-surgical treatment regimens in participants with posterior tibial tendon dysfunction and accompanying pes planovalgus. Furthermore, the analysis of changes in gait mechanics and neuromuscular control will contribute to an enhanced understanding of functional changes and eventually optimise conservative management strategies for these patients.Trial registrationClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT01839669

Voluntary hyperventilation for 20 min causes haemoconcentration and an increase of white blood cell and thrombocyte numbers. In this study, we investigated whether these changes depend on the changes of blood gases or on the muscle work of breathing. A group of 12 healthy medical students breathed 36 l.min-1 of air, or air with 5% CO2 for a period of 20 min. The partial pressure of CO2 decreased by 21.4 mmHg (2.85 kPa; P < 0.001) with air and by 4.1 mmHg (0.55 kPa; P < 0.005) with CO2 enriched air. This was accompanied by haemoconcentration of 8.9% with air (P < 0.01) and of 1.6% with CO2 enriched air (P < 0.05), an increase in the lymphocyte count of 42% with air (P < 0.001) and no change with CO2 enriched air, and an increase of the platelet number of 8.4% with air (P < 0.01) and no change with CO2 enriched air. The number of neutrophil granulocytes did not change during the experiments, but 75 min after deep breathing of air, band-formed neutrophils had increased by 82% (P < 0.025), whereas they were unchanged 75 min after the experiment with CO2 enriched air. Adrenaline and noradrenaline increased by 360% and 151% during the experiment with air, but remained unchanged with CO2 enriched air. It was concluded that the changes in the white blood cell and platelet counts and of the plasma catecholamine concentrations during and after voluntary hyperventilation for 20 min were consequences of marked hypocapnic alkalosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Zusammenfassung Nach Berner periazetabulärer Osteotomie (PAO) wurden am eigenen Krankengut die Geburtsmodalität untersucht und Messungen des knöchernen Geburtskanals durchgeführt. Von 93 Frauen, die mittels Fragebogen erreicht wurden, hatten 17 nach der PAO insgesamt 28 Kinder geboren; 18 Kinder wurden spontan und 10 Kinder per Sectio geboren. Die Sectiorate nach PAO war mit 36 % doppelt so hoch wie in der ¹Normal-populationª, wobei die Indikation in 50 % der Fälle vom behandelnden Gynäkologen ausschlieûlich oder vornehmlich mit der stattgefundenen PAO begründet wurde. Das mittlere Geburtsgewicht bei den Spontangeburten betrug 3348 285 g, bei den Sectiogeburten 3475 356 g. Es korrelierte weder mit der Geburtsdauer noch mit der Indikation zur Sectio. Bei der Ausmessung der Beckenröntgenbilder der 17 Frauen mit Geburten nach PAO konnte keine signifikante Veränderung des transversalen Durchmessers am Beckeneingang (vor PAO 15,4 cm, nach PAO 15,7 cm), in der Beckenmitte (vor PAO 11,8 cm, nach PAO 11,8 cm) sowie am Beckenausgang (vor PAO 14,2 cm, nach PAO 13,7 cm) festgestellt werden. Damit beeinfluût die PAO die Geometrie des Geburtskanals nicht und stellt keine Indikation zur Sectio dar. Schlüsselwörter Periazetabuläre Osteotomie · Beckeninnenmasse · Geburtsmodalität nach PAO Die Berner periazetabuläre Osteotomie (PAO) hat eine Verbesserung von Ueberdachung und Kongruenz des dysplastischen Hüftgelenks zum Ziel; sie wurde 1984 inauguriert [3] und hat seither eine weite Verbreitung erfahren [8, 13]. Wegen der hohen Inzidenz der Hüft-dysplasie beim weiblichen Geschlecht [14] erfolgt der Eingriff bei einer groûen Zahl von jungen Frauen im gebährfähi-gen Alter. Mit Ausnahme der sphäri-schen Osteotomien kann es bei anderen Beckenosteotomien zu einer Verände-rung des transversalen Durchmessers am Beckeneingang, in der Beckenmitte oder am Beckenausgang kommen [5±7, 9, 17]. Die Berner PAO hat grundsätzlich keinen Einfluû auf diese Masse und verändert somit die Geometrie des Geburtskanals nicht [3, 9]. Gründe hierfür sind die vergleichsweise geringe Gröûe des azetabulären Fragments und der unversehrt belassene hintere Beckenpfeiler. Ziel dieser Studie war es, die Geburtsmodalitäten nach durchgeführter Beckenosteotomie am eigenen Krankengut zu erfassen und die Indikationen einer allfälligen Kaiserschnittentbindung zu überprüfen. Methodik 93 Patientinnen, bei welchen zwischen 1984 und 1996 eine PAO erfolgte, haben einen Fragebogen beantwortet in welchem Anzahl der Geburten insgesamt, Anzahl der Geburten nach PAO, Dauer der Schwangerschaft, Dauer der Geburt, Geburtsmodus, Lage des Kindes, Geburtskomplikationen, Geburtsgewicht des Kindes sowie die Indikation für eine eventuelle Sectio erfragt wurden. Alle Frauen, welche nach PAO geboren hatten, wurden zusätzlich telefonisch interviewt. Ebenso wurden die Gynäkologen der Frauen mit Kaiserschnittentbindung persönlich befragt. Die Röntgenbilder (orthograde Beckenübersichtsaufnahmen) aller Frauen, welche nach PAO geboren hatten, wurden standardisiert ausgemessen [2] (Abb. 1). Der Verg...