Ammonia losses estimated by an open collector from urea applied to sugarcane straw

The quantification of ammonia (NH3) losses from sugarcane straw fertilized with urea can be performed with collectors that recover the NH3 in acid-treated absorbers. Thus, the use of an open NH3 collector with a polytetrafluoroethylene (PTFE)-wrapped absorber is an interesting option since its cost is low, handling easy and microclimatic conditions irrelevant. The aim of this study was to evaluate the efficiency of an open collector for quantifying NH3-N volatilized from urea applied over the sugarcane straw. The experiment was carried out in a sugarcane field located near Piracicaba, São Paulo, Brazil. The NH3-N losses were estimated using a semi-open static collector calibrated with 15N (reference method) and an open collector with an absorber wrapped in PTFE film. Urea was applied to the soil surface in treatments corresponding to rates of 50, 100, 150 and 200 kg ha-1 N. Applying urea-N fertilizer on sugarcane straw resulted in losses NH3-N up to 24 % of the applied rate. The amount of volatile NH3-N measured in the open and the semi-open static collector did not differ. The effectiveness of the collection system varied non-linearly, with an average value of 58.4 % for the range of 100 to 200 kg ha-1 of urea-N. The open collector showed significant potential for use; however, further research is needed to verify the suitability of the proposed method.

Background minimization issues for next generation hard X-ray focusing telescopes

The hard X-ray band (10 - 100 keV) has been only observed so far by collimated and coded aperture mask instruments, with a sensitivity and an angular resolution lower than two orders of magnitude as respects the current X-ray focusing telescopes operating below 10 - 15 keV. The technological advance in X-ray mirrors and detection systems is now able to extend the X-ray focusing technique to the hard X-ray domain, filling the gap in terms of observational performances and providing a totally new deep view on some of the most energetic phenomena of the Universe. In order to reach a sensitivity of 1 muCrab in the 10 - 40 keV energy range, a great care in the background minimization is required, a common issue for all the hard X-ray focusing telescopes. In the present PhD thesis, a comprehensive analysis of the space radiation environment, the payload design and the resulting prompt X-ray background level is presented, with the aim of driving the feasibility study of the shielding system and assessing the scientific requirements of the future hard X-ray missions. A Geant4 based multi-mission background simulator, BoGEMMS, is developed to be applied to any high energy mission for which the shielding and instruments performances are required. It allows to interactively create a virtual model of the telescope and expose it to the space radiation environment, tracking the particles along their path and filtering the simulated background counts as a real observation in space. Its flexibility is exploited to evaluate the background spectra of the Simbol-X and NHXM mission, as well as the soft proton scattering by the X-ray optics and the selection of the best shielding configuration. Altough the Simbol-X and NHXM missions are the case studies of the background analysis, the obtained results can be generalized to any future hard X-ray telescope. For this reason, a simplified, ideal payload model is also used to select the major sources of background in LEO. All the results are original contributions to the assessment studies of the cited missions, as part of the background groups activities.

Aufbau und Betrieb einer schnellen Kalorimeterelektronik für ein Experiment zur Messung der Paritätsverletzung in der elastischen Elektronenstreuung

Die A4-Kollaboration am Mainzer Mikrotron MAMI erforscht die Struktur des Protons mit Hilfe der elastischen Streuung polarisierter Elektronen an unpolarisiertem Wasserstoff. Bei longitudinaler Polarisation wird die paritätsverletzende Asymmetrie im Wirkungsquerschnitt gemessen, die Aufschluss über den Strangeness-Beitrag zu den Vektor-Formfaktoren des Protons gibt. Insbesondere wurde eine Messung für Rückwärtsstreuwinkel bei einer Elektronenstrahlenergie von 319 MeV durchgeführt, die zusammen mit einem unter Vorwärtsstreuung bei gleichem Impulsübertrag bestimmten Wert die Separation der magnetischen und elektrischen Strangeness-Formfaktoren erlaubt. Im Rahmen der vorliegenden Arbeit wurde ein Elektroniksystem zur Energiemessung und Histogrammierung der auftretenden Einzelereignisse aufgebaut, das eine vernetzte Struktur aus 1022 Einzelkanälen besitzt und zur Verarbeitung einer Gesamtereignisrate von 100 MHz ausgelegt wurde. Für den experimentellen Betrieb wurden für alle Kanäle erforderliche Qualitäts-prüfungen und Eichmessungen vorgenommen. Die volle Funktionsfähigkeit des Systems zur Durchführung eines Zählratenexperiments für die paritätsverletzende Asymmetrie im Bereich von 10^{-6} wurde demonstriert. Um den bei rückwärtigen Streuwinkeln dominierenden inelastischen Untergrund an Photonen in den Spektren zu reduzieren, wurde das System außerdem um ein Taggersystem für Elektronen erweitert. Das Ergebnis einer vorläufigen Analyse für die paritätsverletzende Asymmetrie im Streuquerschnitt von longitudinal polarisierten Elektronen an unpolarisierten Protonen unter Rückwärtsstreuung bei einem Viererimpulsübertrag Q^2 = 0.23 GeV^2/c^2 beträgt A{PV}=(-16.37 +- 0.93 {stat} +- 0.69 {syst}) ppm. Für die Differenz der gemessenen Asymmetrie A{PV} und der theoretischen Vorhersage ohne Strangeness A{0}=(-16.27 +- 1.22) ppm ergibt sich A{S}= A{PV} - A{0} = (-0.10+-1.68) ppm. Mit dem bereits vorliegenden Wert der Vorwärtsstreuung von A{PV} = (-5.59+- 0.57 {stat} +- 0.29 {syst}) ppm kann ein Wert für den magnetischen bzw. elektrischen Formfaktor von G{M}^s = -0.01+- 0.15 bzw. G{E}^s = 0.034 +- 0.050 ermittelt werden.

Der Austausch von Stickstoffmonoxid zwischen Boden und Atmosphäre unter besonderer Berücksichtigung des Bodenwassergehaltes

Stickstoffmonoxid (NO) ist als reaktives Spurengas eine wichtige Komponente atmosphärenchemischer Prozesse und hat somit einen bedeutenden Einfluss auf die Zusammensetzung der Atmosphäre. Eine Hauptquelle des Spurengases stellen bodenmikrobiologische Prozesse dar, deren regionaler und globaler Anteil weiterhin mit größeren Unsicherheiten geschätzt wird. Ursache für die schwere Abschätzbarkeit der NO-Freisetzung aus Böden ist die hohe räumliche Variabilität der steuernden Faktoren. Als einer der wichtigsten Faktoren, die die Freisetzung von NO aus Böden regeln, gilt der Bodenwassergehalt. Ziel der vorliegenden Arbeit ist es, den Zusammenhang zwischen NO-Freisetzung, Bodenwassergehalt, den Bodeneigenschaften und den Standortbedingungen zu untersuchen und diesen möglichst zu quantifizieren. Dazu sind Bodenproben unterschiedlicher Landnutzungen in einem kleineren Wassereinzugsgebiet im Rheingau im Labor, unter kontrollierten Bedingungen, untersucht. Der charakteristische Zusammenhang zwischen Bodenfeuchte und NO-Freisetzung, die sogenannte Bodenfeuchtekurve, kann demnach weitestgehend auf die gemessenen Bodenmerkmale der untersuchten Proben zurückgeführt werden. Anhand der Bodenmerkmale kann die Bodenfeuchtekurve zufriedenstellend vorhergesagt werden. Dabei zeigt vor allem der Humusgehalt der Böden einen dominierenden Einfluss. Er ist die Variable, die die Unterschiede der Böden beim Zusammenhang zwischen Bodenfeuchte und NO-Freisetzung am besten und hinreichend erklären kann. Zur Konstruktion der Bodenfeuchtekurve müssen die optimale Bodenfeuchte und die dabei herrschende Freisetzung, sowie die obere Bodenfeuchte, bei der keine NO-Freisetzung mehr stattfindet, bekannt sein. Diese charakteristischen Punkte lassen sich durch lineare Regressionsmodelle gut aus den Bodeneigenschaften ableiten. Auf räumlicher Ebene werden die Bodeneigenschaften durch die standörtlichen Bedingungen geprägt, die wiederum Ausdruck der landschaftlichen Ausstattung sind. In der Kulturlandschaft kann der Mensch aufgrund seiner Landnutzungsansprüche als der dominierende Faktor angesehen werden. Die Landnutzung orientiert sich an den landschaftlichen Bedingungen und bestimmt in hohem Maße wichtige Bodeneigenschaften, die zu den erklärenden Merkmalen bei der Beziehung zwischen Bodenwassergehalt und NO-Freisetzung gehören. Die in erster Linie wirtschaftlich orientierten Kartenwerke Bodenschätzung, Weinbergsbodenkartierung und forstliche Standortkartierung sind dementsprechend geeignete Grundlagen, um eine Regionalisierung der Landschaft in - bezüglich der NO-Freisetzung - weitgehend homogene Flächen durchführen zu können. Eine hierauf beruhende Regionalisierung ist dazu geeignet, die räumliche Variabilität der NO-Freisetzung in räumlich sinnvoller Auflösung besser abschätzen zu können.

Synthese und Charakterisierung von Polymethylmethacrylat (PMMA)-Silika-Komposit-Partikeln und fluorierten Nanopartikeln unter Verwendung des Miniemulsionsprozesses

In der vorliegenden Dissertation wurden zwei verschiedene Fragestellungen bearbeitet. Zum einen wurde im Rahmen des Schwerpunktprojektes „Kolloidverfahrenstechnik“ und in Zusammenarbeit mit der Arbeitsgruppe von Prof. Dr. Heike Schuchmann vom KIT in Karlsruhe die Verkapselung von Silika-Nanopartikeln in eine PMMA-Hülle durch Miniemulsionspolymerisation entwickelt und der Aufskalierungsprozess unter Verwendung von Hochdruckhomogenisatoren vorangetrieben. Zum anderen wurden verschiedene fluorierte Nanopartikel durch den Miniemulsionsprozess generiert und ihr Verhalten in Zellen untersucht.rnSilika-Partikel konnten durch Miniemulsionspolymerisation in zwei unterschiedlichen Prozessen erfolgreich verkapselt werden. Bei der ersten Methode wurden zunächst modifizierte Silika-Partikel in einer MMA-Monomerphase dispergiert und anschließend durch den normalen Miniemulsionsprozess Silika-beladene Tröpfchen generiert. Diese konnten zu Komposit-Partikeln polymerisiert werden. Bei der Verkapselung durch den Fission/Fusion Prozess wurden die hydrophobisierten Silika-Partikel durch Fission und Fusion Prozesse in schon vorhandene Monomertröpfchen eingebracht, welche hinterher polymerisiert wurden. Um hydrophiles Silika in einem hydrophoben Monomer zu dispergieren, musste zunächst eine Modifizierung der Silika-Partikel stattfinden. Dies geschah unter anderem über eine chemische Anbindung von 3-Methacryloxypropyltri-methoxysilan an der Oberfläche der Silika-Partikel. Des Weiteren wurden die hydrophilen Silika-Partikel durch Adsorption von CTMA-Cl physikalisch modifiziert. Unter anderem durch die Variation des Verkapselungsprozesses, der Silika-Menge, der Tensidart und –menge und der Comonomere konnten Komposit-Partikel mit unterschiedlichen Morphologien, Größen, und Füllgraden erhalten werden.rnFluorierte Nanopartikel wurden erfolgreich über den Prozess der Miniemulsionspolymerisation synthetisiert. Als Monomere dienten dabei fluorierte Acrylate, fluorierte Methacrylate und fluoriertes Styrol. Es war möglich aus jeder dieser drei Gruppen an Monomeren fluorierte Nanopartikel herzustellen. Für genauere Untersuchungen wurden 2,3,4,5,6-Pentafluorstyrol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-Heptadecafluorodecyl-methacrylat und 1H,1H,2H,2H-Perfluorodecylacrylat als Monomere ausgewählt. Als Hydrophob zur Unterdrückung der Ostwaldreifung wurde Perfluromethyldecalin eingesetzt. Die stabilsten Miniemulsionen wurden wiederum mit den ionischen Tensid SDS generiert. Mit steigendem Gehalt an SDS gelöst in der kontinuierlichen Phase, wurde eine Verkleinerung der Partikelgröße festgestellt. Neben den Homopolymerpartikeln wurden auch Copolymerpartikel mit Acrylsäure erfolgreich synthetisiert. Zudem wurde noch das Verhalten der fluorierten Partikel in Zellen überprüft. Die fluorierten Partikel wiesen ein nicht toxisches Verhalten vor. Die Adsorption von Proteinen aus Humanem Serum wurde über ITC Messungen untersucht. rnSomit konnte gezeigt werden, dass die Technik der Miniemulsionspolymerisation eine abwechslungsreiche und effektive Methode ist, um Hybridnanopartikel mit verschiedenen Morphologien und oberflächenfunktionalisierte Nanopartikel erfolgreich zu generieren.rn

Implementation of a VLSI amplifier interfaced with biomedical sensors for ultra wide band data transmission

This thesis presents a CMOS Amplifier with High Common Mode rejection designed in UMC 130nm technology. The goal is to achieve a high amplification factor for a wide range of biological signals (with frequencies in the range of 10Hz-1KHz) and to reject the common-mode noise signal. It is here presented a Data Acquisition System, composed of a Delta-Sigma-like Modulator and an antenna, that is the core of a portable low-complexity radio system; the amplifier is designed in order to interface the data acquisition system with a sensor that acquires the electrical signal. The Modulator asynchronously acquires and samples human muscle activity, by sending a Quasi-Digital pattern that encodes the acquired signal. There is only a minor loss of information translating the muscle activity using this pattern, compared to an encoding technique which uses astandard digital signal via Impulse-Radio Ultra-Wide Band (IR-UWB). The biological signals, needed for Electromyographic analysis, have an amplitude of 10-100μV and need to be highly amplified and separated from the overwhelming 50mV common mode noise signal. Various tests of the firmness of the concept are presented, as well the proof that the design works even with different sensors, such as Radiation measurement for Dosimetry studies.

Ease of Application of Medical Compression-stocking Systems for the Treatment of Venous Ulcers

OBJECTIVE: To evaluate the ease of application of two-piece, graduated, compression systems for the treatment of venous ulcers. METHODS: Four kits used to provide limb compression in the management of venous ulcers were evaluated. These have been proven to be non-inferior to various types of bandages in clinical trials. The interface pressure exerted above the ankle by the under-stocking and the complete compression system and the force required to pull the over-stocking off were assessed in vitro. Ease of application of the four kits was evaluated in four sessions by five nurses who put stockings on their own legs in a blinded manner. They expressed their assessment of the stockings using a series of visual analogue scales (VASs). RESULTS: The Sigvaris Ulcer X((R)) kit provided a mean interface pressure of 46 mmHg and required a force in the range of 60-90 N to remove it. The Mediven((R)) ulcer kit exerted the same pressure but required force in the range of 150-190 N to remove it. Two kits (SurePress((R)) Comfort and VenoTrain((R)) Ulcertec) exerted a mean pressure of only 25 mmHg and needed a force in the range of 100-160 N to remove them. Nurses judged the Ulcer X and SurePress kits easiest to apply. Application of the VenoTrain kit was found slightly more difficult. The Mediven kit was judged to be difficult to use. CONCLUSIONS: Comparison of ease of application of compression-stocking kits in normal legs revealed marked differences between them. Only one system exerted a high pressure and was easy to apply. Direct comparison of these compression kits in leg-ulcer patients is required to assess whether our laboratory findings correlate with patient compliance and ulcer healing.

Infrared Parallaxes of Young Field Brown Dwarfs and Connections to Directly Imaged Gas-Giant Exoplanets

We have measured high-precision infrared parallaxes with the Canada-France-Hawaii Telescope for a large sample of candidate young (approximate to 10-100 Myr) and intermediate-age (approximate to 100-600 Myr) ultracool dwarfs, with spectral types ranging from M8 to T2.5. These objects are compelling benchmarks for substellar evolution and ultracool atmospheres at lower surface gravities (i.e., masses) than most of the field population. We find that the absolute magnitudes of our young sample can be systematically offset from ordinary (older) field dwarfs, with the young late-M objects being brighter and the young/dusty mid-L (L3-L6.5) objects being fainter, especially at J band. Thus, we conclude the "underluminosity" of the young planetary-mass companions HR 8799b and 2MASS J1207-39b compared to field dwarfs is also manifested in young free-floating brown dwarfs, though the effect is not as extreme. At the same time, some young objects over the full spectral type range of our sample are similar to field objects, and thus a simple correspondence between youth and magnitude offset relative to the field population appears to be lacking. Comparing the kinematics of our sample to nearby stellar associations and moving groups, we identify several new moving group members, including the first free-floating L dwarf in the AB Dor moving group, 2MASS J0355+11. Altogether, the effects of surface gravity (age) and dust content on the magnitudes and colors of substellar objects appear to be degenerate. (C) 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

Minimum ten year results of total hip arthroplasty with the acetabular reinforcement ring in avascular osteonecrosis

Total hip arthroplasty (THA) still carries a higher failure rate in patients with avascular necrosis of the femoral head (AVN) than in a similar patient population with THA for other reasons. This is particularly true for the acetabular component. One of the major factors accounting for this is the compromised acetabular bone quality with structural defects subsequent to collapsing of the femoral head in high-grade AVN. In this study we implanted an acetabular reinforcement ring with hook (ARRH), which had been used successfully for other indications with acetabular bone stock deficiency, in 32 consecutive THA's in 29 patients with AVN. Five patients died during the observation period of causes unrelated to the surgery, one patient was lost to follow-up and one patient could not be followed up due to chronic illness, leaving 25 hips (23 patients) with a minimum follow-up of ten years (mean: 11.8; range: 10-15). The mean Merle d'Aubigne score increased significantly from 7.7 preoperatively to 16.6 postoperatively (p < 0.001). One revision was performed for aseptic stem loosening. Of the unrevised hips, one acetabular component was classified as definitively loose. The cumulative 12-year survivorship for THA with ARRH in AVN was 95.2% (confidence interval: 86.1-100%) for both components, 100% for the cup and 95.2% for the stem (86.1-100%).

Characterization of water-soluble organic compounds in ambient aerosol using ultrahigh-resolution elctrospray ionization fourier transform ion cyclotron resonance mass spectrometry.

Atmospheric aerosol water-soluble organic compounds (WSOC) exist in a complex mixture of thousands of organic compounds which may have a significant influence on the climate-relevant properties of the atmospheric aerosol. To understand the potential influences, the ambient aerosol was collected at a nonurban mountainous site near Steamboat Springs, CO. The WSOC fraction was analyzed using positive and negative electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry. Approximately 2400 and 4000 molecular formulas were identified from the detected positive and negative ions, respectively. The formulas contained carbon (C), hydrogen (H), oxygen (O), nitrogen (N), and sulfur (S) atoms over the mass range of 100-800 Da in both ionization modes. The number range of double bond equivalents (DBE), the mean O:C, H:C, and oxidation state of carbon for the positive ions were 0 – 18, 0.25 ± 0.15, 1.39 ± 0.29, and -0.89 ± 0.23, respectively. Comparatively, the negative ion values were 0 – 14, 0.53 ± 0.20, 1.48 ± 0.30, and -0.41 ± 0.45, respectively. Overall, the positive ion molecular formulas were less oxygenated than negative ions as seen with the lower O:C and OSc values. Molecular formulas of the positive ions classified as aliphatic, olefinic, and aromatic compound classes based on the aromaticity index values. Aliphatic compounds were the CHNO and CHO formulas that had mean DBE values of about 5 and 3, respectively. However, a majority of the CHOS, CHNOS, and CHS formulas were defined as olefinic compounds and had mean DBE values of about 12, 13, and 10, respectively. Overall, more than half of the assigned molecular formulas contained sulfur and were olefinic to aromatic compounds with a DBE range of 7-18. Source of the unsaturated sulfur containing compounds is currently unknown. Several nitrogen containing compounds were in common with the field and laboratory studies of the biomass burning aerosol and aged secondary organic aerosol products of the limonene ozonolysis.

Prevention of radiochemotherapy-induced toxicity with amifostine in patients with malignant orbital tumors involving the lacrimal gland: a pilot study

BACKGROUND: To use amifostine concurrently with radiochemotherapy (CT-RT) or radiotherapy (RT) alone in order to prevent dry eye syndrome in patients with malignancies located in the fronto-orbital region. METHODS: Five patients (2 males, 3 females) with diagnosed malignancies (Non-Hodgkin B-cell Lymphoma, neuroendocrine carcinoma) involving the lacrimal gland, in which either combined CT-RT or local RT were indicated, were prophylactically treated with amifostine (500 mg sc). Single RT fraction dose, total dose and treatment duration were individually adjusted to the patient's need. Acute and late adverse effects were recorded using the RTOG score. Subjective and objective dry eye assessment was performed for the post-treatment control of lacrimal gland function. RESULTS: All patients have completed CT-RT or RT as indicated. The median total duration of RT was 29 days (range, 23 - 39 days) and the median total RT dose was 40 Gy (range, 36 - 60 Gy). Median lacrimal gland exposure was 35.9 Gy (range, 16.8 - 42.6 Gy). Very good partial or complete tumor remission was achieved in all patients. The treatment was well tolerated without major toxic reactions. Post-treatment control did not reveal in any patient either subjective or objective signs of a dry eye syndrome. CONCLUSION: The addition of amifostine to RT/CT-RT of patients with tumors localized in orbital region was found to be associated with absence of dry eye syndrome.

Individualization of 5-fluorocytosine therapy

Using a convenient and fast HPLC procedure we determined serum concentrations of the fungistatic agent 5-fluorocytosine (5-FC) in 375 samples from 60 patients treated with this drug. The mean trough concentration (n = 127) was 64.3 mg/l (range: 11.8-208.0 mg/l), the mean peak concentration (n = 122) was 99.9 mg/l (range: 25.6-263.8 mg/l), the mean nonpeak/nontrough concentration (n = 126) was 80.1 mg/l (range: 10.5-268.0 mg/l). Totally 134 (35.7%) samples were outside the therapeutic range (25-100 mg/l), 108 (28.8%) being too high, 26 (6.9%) being too low. Forty-four (73%) patients showed 5-FC serum concentrations outside the therapeutic range at least once during the treatment course. In a prospective study we performed 65 dosage predictions on 30 patients by use of a 3-point method previously developed for aminoglycoside dosage adaptation. The mean absolute prediction error of the dosage adaptation was +0.7 mg/l (range: -26.0 to +28.0 mg/l). The root mean square prediction error was 10.7 mg/l. The mean predicted concentration (65.3 mg/l) agreed very well with the mean measured concentration (64.6 mg/l). The frequency distribution of 5-FC serum concentrations indicates that 5-FC monitoring is important. The applied pharmacokinetic method allows individual adaptations of 5-FC dosage with a clinically acceptable prediction error.

Posterolateral approach to the displaced posterior malleolus: functional outcome and local morbidity

BACKGROUND: Stable anatomical reconstruction of the joint surface in ankle fractures is essential to successful recovery. However, the functional outcome of fractures involving the posterior tibial plafond is often poor. We describe the morbidity and functional outcome for plate fixation of the displaced posterior malleolus using a posterolateral approach. MATERIALS AND METHODS: The posterolateral approach was used for osteosynthesis of the posterior malleolus in 45 consecutive patients (median age 54 years) with AO/Muller-classification type 44-A3 (n = 1), 44-B3 (n = 35), 44-C1 (n = 7), and 44-C2 (n = 2) ankle fractures. Thirty-three of the patients suffered complete fracture dislocation. Functional outcome at followup was measured using the modified Weber protocol and the standardized AAOS foot and ankle questionnaire. Radiological evaluation employed standardized anterior-posterior and lateral views. RESULTS: The fragment comprised a median of 24% (range, 10% to 48%) of the articular surface. Postoperative soft tissue problems were encountered in five patients (11%), one of whom required revision surgery. Two patients (4%) developed Stage I complex regional pain syndrome. Clinical and radiological followup at 25 months disclosed no secondary displacement of the fixed fragment. The median foot and ankle score was 93 (range, 58 to 100), shoe comfort score was 77 (range, 0 to 100). A median score of 7 (range, 5 to 16) was documented using the modified Weber protocol. CONCLUSION: The posterolateral approach allowed good exposure and stable fixation of a displaced posterior malleolar fragment with few local complications. The anatomical repositioning and stable fixation led to good functional and subjective outcome.

Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series

HYPOTHESIS: This study addresses the outcome after osteosynthesis or hemiarthroplasty, using a cohort of patients that was enrolled in a previous prospective study on humeral head perfusion and was consequently treated using a common conceptual approach. MATERIALS AND METHODS: Between 1998 and 2001, 98 patients with 100 fractures of the proximal humerus were treated surgically by a single surgeon with open reduction and internal fixation (ORIF) (51/100, group A, median age 54 years; range, 21-88) or with hemiarthroplasty (49/100, group B, median age 66 years; range, 38-87). Seventy-six of 98 patients were available for re-evaluation at a mean follow-up of five years (3.3-7.3) using the Constant-Murley score (CMS), the Subjective Shoulder Value (SSV), and conventional radiographs. RESULTS: The median total CMS was 77 (range, 37-98) for group A and 70 (range, 39-84) for group B. The median SSV was 92 (range, 40-100) for group A and 90 (range, 40-100) for group B. Avascular necrosis occured in 6/40 fractures treated with ORIF. CONCLUSION: Osteosynthesis and hemiarthroplasty yield similar functional results and comparable patient satisfaction following the applied decision making process in this selected patient cohort. Osteosynthesis with preservation of the humeral head is worth considering when adequate reduction and stable conditions for revascularization can be obtained. In patients with osteopenic bone and/or comminuted fractures, hemiarthroplasty is a viable alternative. LEVEL OF EVIDENCE: Level 2; Prospective non-randomized comparison study.

Arthroscopically assisted removal of intraosseous ganglion cysts of the distal tibia

Intraosseous ganglia of the distal tibia are rare. We evaluated the feasibility of surgically treating these lesions with an arthroscopically assisted technique. Five patients with symptomatic distal tibial ganglia underwent surgical curettage and excision with this technique. All patients underwent débridement of the chondral lesion and hypertrophied synovial lining when present, probing of the portal to the ganglion, and subsequently thorough curettage with bone grafting performed through a cortical window made from a separate small incision. Biopsy confirmed the diagnosis in all patients. All patients had eventual relief of symptoms with good integration of bone graft at final followup. There were no recurrences at a minimum followup of 19 months (mean, 38.6 months; range, 19-69 months). Mean time for return to full function was 15.4 weeks (range, 8-17 weeks). There were no intraoperative or postoperative complications. The mean American Orthopaedic Foot and Ankle Society scores increased from 73 points (range, 67-77 points) preoperatively to 94 points (range, 90-100 points) postoperatively. Arthroscopically assisted surgical treatment of ganglia of the distal tibia in the appropriate patient is a reasonably simple technique that relieves symptoms and helps the patient to regain normal gait and full function with no recurrence (in our small series). LEVEL OF EVIDENCE: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.