[The talometatarsal-index ("TMT-Index") : A valuable X-ray parameter for differentiating between normal feet and planovalgus deformity in children and adolescents]

INTRODUCTION

The development of the shape of the shape from childhood to adulthood is a complex continuum. Deviations from this process occur frequently and, especially in asymptomatic patients, do not always include the need for therapeutic intervention. In the current S2-guideline on the juvenile flexible flatfoot, established x‑ray parameters for assessing the flatfoot deformity were judged to be sensitive, whereby no statement was made regarding the value of the parameters among themselves. The aim of the present work is to assess the talometatarsal Index (TMTInd) in comparison to established angle measurements.

METHODS

Twenty-two feet with and 22 feet without planovalgus deformity (age: 10-14 years) were investigated. Established radiological parameters (lateral view: talocalcaneal angle (TC-lat), calcaneal pitch angle (Calc-B), Costa-Bartani angle (Costa-B), talometatarsal‑I angle (TMTI-lat); dorsoplantar view: talometatarsal-I-basis angle (TMTIB), talonavicular coverage (TNG), calcaneal metatarsal- V angle (Calc-MTV), talocalcaneal angle (TC-dp), and talometatarsal‑I angle (TMTI-dp)) were measured on standardized X‑ray images and compared with the values of the TMTInd.

RESULTS

All parameters other than Calc-MTV, TC-dp, TC-lat and Calc‑B, showed a statistically significant difference between normal and planovalgus feet, although for almost all values measured (apart from TMTI-lat and TMTInd) there was a large overlap area (>10°) between the two groups. The comparison of TMTInd to all other parameters showed the highest discrimination factor (area-under-the-curve) for the TMTInd in the distinction between the groups.

CONCLUSION

Compared to conventional radiological parameters, the TMTInd shows the highest validity in the distinction between normal and planovalgus feet and can provide valuable information in clinical decision-making with regard to therapy specification.

[Hindfoot-centred X-ray technique for the evaluation of cavovarus deformity : A proposal for the optimization of radiologic delineation]

In surgical correction of cavovarus deformity bony hindfoot procedures are required in most cases. For treatment planning X‑rays in two or more planes are usually used. In conventional X‑ray-techniques the hindfoot and ankle joint are presented in a more or less outward rotated position. Moreover, the peritalar complex is not delineated in the most corrected position. Therefore, the frequently used talus-metatarsal-I-angle (Meary angle) cannot be measured correctly. By application of the Coleman block test and additional adjustment of the malrotation in the lateral view, the peritalar complex and ankle joint can be evaluated in the corrected and "hindfoot-centred" position. Also, the frequently seen anterior ankle impingement can be observed precisely. Planning of osteotomies or corrective peritalar fusions is supported thereby. Some treatment examples are presented.

[Anatomic lateral ankle ligament reconstruction with the semitendinosus graft]

OBJECTIVE

Stabilization of severe anterolateral rotatory instability of the ankle joint.

INDICATIONS

Major ankle instability, rerupture after ligament reconstruction, generalized ligament laxity.

CONTRAINDICATIONS

Minor instabilities, degenerative joint disease, underlying complex deformities like cavovarus.

SURGICAL TECHNIQUE

Insufficient lateral ankle ligaments are replaced by an autologous semitendinosus graft. Three small incisions are used to position the graft anatomically under direct view with two fibular bone tunnels and bony fixation with interference screws.

POSTOPERATIVE MANAGEMENT

Early functional treatment with weight-bearing as tolerated in a walker.

RESULTS

In all, 22 patients have been treated with the described technique with good stabilization in all cases. Two complications were observed: Too short graft in one patient and postoperative suture granuloma in another case.

Exhaled breath analysis in childhood rheumatic disorders--a longitudinal study

We aimed to evaluate the fraction of exhaled nitric oxide (FENO50) and deaerated exhaled breath condensate pH (dEBCpH) as non-invasive markers of subclinical airway inflammation in pediatric patients with rheumatologic disorders. We determined FENO50 and dEBCpH in a prospective study spanning at least 12 months, comprising 85 pediatric patients with rheumatologic disorders, including juvenile idiopathic arthritis (JIA, n  =  63), chronic recurrent multifocal osteomyelitis (CRMO, n  =  6), systemic lupus erythematosus (SLE, n  =  3), juvenile dermatomyositis (JDM, n  =  1) and other rheumatic disorders (n  =  12). dEBCpH was determined once in a group of children without evidence of rheumatologic or pulmonary disease (controls, n  =  90). Findings were correlated with results of pulmonary function tests. Atopic sensitization was assessed by RAST or skin prick test in 76 patients. Atopic sensitization was detected in 34% (26/76) of patients. Neither FENO50 nor dEBCpH correlated with disease activity, but intermediately (20-35 ppb) or highly elevated (>35 ppb) levels were observed at least once in 26 patients (31%), 19 of whom had atopic sensitization. Median dEBCpH did not differ between cases and controls (8.05 versus 8.02; p  =  0.48). Median dEBCpH decreased slightly over the study period (p  =  0.02), whereas FENO50 values did not change significantly (p  =  0.89). There were several patients with significantly abnormal dEBCpH values that could not be readily explained by diagnosis, higher disease activity, medications, or atopic sensitization. Thus, there were no consistent abnormalities in FENO50 or dEBCpH in this cohort of Caucasian patients with relatively stable rheumatologic disorders, but there were some patients with abnormal values of unknown significance.

[Diagnosis and treatment of tarsal coalitions and synostoses in children and adolescents]

The majority of tarsal coalitions are located in the calcaneonavicular and talocalcaneal regions and other locations are rare. Complete early ossified synostoses are found not only in major limb deficiencies but also in otherwise normal feet. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are the most important imaging techniques especially for preoperative planning. Early resection is advisable in calcaneonavicular coalitions as soon as it is detected in childhood and adolescence. Indications for or against resection or limited tarsal fusion are much more difficult in talocalcaneal coalition. The patient's complaints, extension and location of the coalition, additional malalignment and especially patient age are some of the factors that should be considered carefully. Results of surgical resection are not always satisfactory with a long-lasting rehabilitation especially in older children or adolescents and the necessity for secondary procedures can never be ruled out. In cases of malalignment corrective tarsal osteotomy can be considered as a simultaneous or staged procedure. An overview with special emphasis on surgical options is presented with typical examples as well as rare conditions and a review of important literature from recent years is included.

[A case of bilateral isolated talonavicular synostosis in childhood--observations of tarsal joint function and functional adaptation of the proximal ankle joint]

A rare case of bilateral isolated coalition of the talonavicular joint with ball and socket ankle joint is presented. Range of motion of the subtalar joint and hindfoot mobility were measured intraoperatively. The following conclusions may be drawn on development and function of the ankle joint complex: Isolated talonavicular synostosis in the growing foot results in marked impairment of subtalar range of motion. The development of a ball and socket ankle joint may be caused thereby, if tarsal hypomobility becomes effective at an early stage of growth.

Toxicité aiguë comparée du phénol et d'une série de chlorophénols sur des organismes aquatiques et terrestres

Les chlorophénols sont des composés chimiques couramment utilisés dans de nombreuses applications industrielles et donc retrouvés dans l'environnement.

L'objectif de ce travail est d'abord de comparer la toxicité aiguë du phénol et de cinq dérivés chlorés vis à vis de trois organismes : un protozoaire d'eau douce Colpidium campylum, un végétal terrestre Vicia lens et un mammifère, la souris. Afin d'avoir une comparaison plus large, nos résultats expérimentaux ont été confrontés avec des données relevées dans la littérature sur neuf autres espèces de l'environnement.

À l'exception des mammifères pour lesquels le 2,4 dichlorophénol et le 2,4,6 trichlorophénol sont les moins dangereux, il apparaît que la toxicité est étroitement liée avec le degré de substitution en chlore du noyau phénolique. Plus le nombre d'atomes de chlore est élevé, plus la toxicité est importante.

Cette étude montre d'autre part que dix organismes, parmi les douze étudiés, répondent de façon semblable vis à vis des chlorophénols. Seuls le rat et la souris présentent une sensibilité différente. Cependant, le pentachlorophénol s'avère être le composé le plus dangereux dans tous les cas.

[Ultrasound diagnosis of congenital foot deformities]

Assessment of tarsometatarsal skeletal malalignment in congenital foot deformities such as clubfoot and vertical talus is possible with ultrasound. Sonography can be useful in deciding on the therapeutic concept and evaluating therapeutic effects.

[Ultrasound diagnosis of the posterior tibial tendon]

Standardized sonographic delineation of the posterior tibial tendon using high-frequency ultrasonography with quantitative evaluation of the transverse section may confirm or exclude the clinical suspicion of posterior tibial tendon dysfunction and can serve as a complement to magnetic resonance imaging.

[Clinical pedographic radiological findings after basal valgus osteotomy of metatarsal 1--a prospective study]

AIM

This study investigated the influence of valgusizing base wedge osteotomy of metatarsal 1 (MT 1) subsequently on the entire forefoot.

METHOD

Pre- and post-operatively 22 cases were investigated between 1998 and 2000 both clinically and radiologically with pedographic analysis in 20 of these cases.

RESULTS

According to the Kitaoka Score we could establish preoperative 37 and postoperative 72 out of 100 possible points. Following the MT 1-base wedge osteotomy with a distal soft-tissue procedure, the central forefoot region (MT 2/3) showed reduced pressure-induced pain, unchanged callus development, and reduced maximum load pressure. When the Plus-Index (MT 1 longer than MT 2) could be preserved in the valugusizing MT 1-base wege osteotomy, the metatarsalgia in the central forefoot region not only improved generally, but also the maximum loading pressure was clearly reduced. In cases with a post-operative Minus-Index (MT 1 shorter than MT 2), as well as in those Plus-Index cases undergoing a Keller procedure in the valgusizing base wedge osteotomy, the elevated pressure values in the central forefoot region persisted.

CONCLUSION

In valgusizing MT 1-base wege osteotomy with preservation of the Plus-Index (MT 1 longer MT 2), metatarsalgia can be improved and the maximum loading pressure in the central forefoot can be reduced.

Localization of surface immunogenic protein on group B streptococcus

The localization and accessibility of the group B streptococcus (GBS) surface immunogenic protein (Sip) at the surface of intact GBS cells were studied by flow cytometric assay and immunogold electron microscopy. Antibodies present in pooled sera collected from mice after immunization with purified recombinant Sip efficiently recognized native Sip at the surfaces of the different GBS strains tested, which included representatives of all nine serotypes. Examination of GBS cells by immunogold electron microscopy revealed that the Sip-specific antibodies attached preferentially to polar sites and the septal region. This result confirmed that Sip is exposed at the intact-cell surface, but it also suggests that its distribution is restricted to certain regions of the cell.

Identification of group B streptococcal Sip protein, which elicits cross-protective immunity

A protein of group B streptococci (GBS), named Sip for surface immunogenic protein, which is distinct from previously described surface proteins, was identified after immunological screening of a genomic library. Immunoblots using a Sip-specific monoclonal antibody indicated that a protein band with an approximate molecular mass of 53 kDa which did not vary in size was present in every GBS strain tested. Representatives of all nine GBS serotypes were included in the panel of strains. Cloning and sequencing of the sip gene revealed an open reading frame of 1,305 nucleotides coding for a polypeptide of 434 amino acid residues, with a calculated pI of 6. 84 and molecular mass of 45.5 kDa. Comparison of the nucleotide sequences from six different strains confirmed with 98% identity that the sip gene is highly conserved among GBS isolates. N-terminal amino acid sequencing also indicated the presence of a 25-amino-acid signal peptide which is cleaved in the mature protein. More importantly, immunization with the recombinant Sip protein efficiently protected CD-1 mice against deadly challenges with six GBS strains of serotypes Ia/c, Ib, II/R, III, V, and VI. The data presented in this study suggest that this highly conserved protein induces cross-protective immunity against GBS infections and emphasize its potential as a universal vaccine candidate.

Candidate Neisseria meningitidis NspA vaccine

The highly conserved NspA protein has been found in the outer membrane of every Neisseria meningitidis strain tested so far. Two monoclonal antibodies (MAbs) directed against this protein were used to demonstrate that biologically important epitopes of the NspA protein are exposed at the surface of serologically distinct meningococcal strains. Analysis of sera collected from mice that survived a deadly meningococcal challenge following immunization with recombinant NspA protein (rNspA) revealed the presence of cross-reactive antibodies which efficiently attached to and killed the four serogroup B strains tested. These data are additional proof that the NspA protein is exposed at the surface of intact meningococcal cells, which is an important characteristic for a vaccine candidate.

Intranasal immunization with gonococcal outer membrane preparations reduces the duration of vaginal colonization of mice by Neisseria gonorrhoeae

Nasal immunization was studied to determine if it could elicit an immune response capable of preventing vaginal colonization by Neisseria gonorrhoeae or of reducing its duration in the estradiol-treated mouse model. Nasal administration of gonococcal outer membrane (OM) preparations induced the development of systemic and vaginal immune responses that were directed mainly against a limited number of gonococcal OM proteins. The impact of nasal immunization on vaginal colonization by N. gonorrhoeae was evaluated by use of an experimental model, in which mice were treated with estradiol to prolong the infection. Bacterial clearance was significantly faster for mice immunized intranasally with N. gonorrhoeae OM preparations (4.0+/-2.5 days) than for control mice (8.5+/-4.3 days). The estradiol-treated mouse model may serve as a useful tool for the evaluation of potential gonococcal vaccine candidates.

Settlement preferences and early migration of the tropical sea cucumber Holothuria scabra

Settlement and post-settlement processes of the sea cucumber Holothuria scabra Jaeger were studied in the laboratory. Independent and paired choice experiments revealed that several substrates could induce metamorphosis into pentactulae, but that specific substrates favoured settlement. Leaves of seagrass Thalassia hemprichii, with or without their natural bio-film, yielded the highest settlement rates (4.8-10.5%). T. hemprichii was preferred as a settlement substrate over sand, crushed coral, several other plant species and artificial seagrass leaves with or without a bio-film. Only settlement on the seagrass, Enhalus acoroides, was similar to that recorded for T. hemprichii. In the absence of a substrate, the larvae delayed settlement for nearly 96 h and survival was less than 0.5%. Sand and crushed coral, either alone or together, induced settlement from <1.5% of the available larvae. The pentactulae found on sand, coral and in bare containers were 10-35% smaller than those on T. hemprichii leaves. Soluble extracts from T. hemprichii and E. acoroides successfully induced metamorphosis and settlement on clean plastic surfaces. Newly settled juveniles remained on the seagrass leaves for 4-5 weeks before migrating to sand at around 6 mm in length. Prior to this, the juveniles spent 4-5 days moving on and off the leaves. Once on the sand, the juveniles became deposit-feeders, but did not show the typical burrowing behaviour of older specimens until they reached around 11 mm in length. The larvae of H. scabra appear to actively select seagrass leaves, possibly through chemical detection. We hypothesise that larvae settling on seagrass have an increased chance of growth and survival because they are provided with a suitable substrate on which to grow, and a bridge to sand substrates as they become deposit-feeders.

[Standardized ultrasound diagnosis (13 MHz) of the tendon of the posterior tibial muscle--normal findings in probands with healthy feet]

OBJECTIVES

Tibialis posterior dysfunction is often diagnosed at a very late stage. However, the early diagnosis of tibialis posterior dysfunction is crucial for therapeutic aspects and especially for the operative prognosis. The morphological correlate of the tibialis posterior dysfunction consists of degenerative changes and thickening of the posterior tibial tendon [2, 9, 11]. By means of a high frequency linear array transducer, a standardized technique of examination as well as reference values of cross-sections of posterior tibial tendon are introduced.

MATERIAL AND METHODS

Investigating 51 healthy subjects (102 feet) without any foot deformities, standardized planes were defined by use of a 13 MHz linear array transducer in order to delineate the posterior tibial tendon. At exact anatomic landmarks, tendon diameters were measured using two longitudinal sections proximal and distal to the medial malleolus. Likewise, two diameters and the resulting roughly calculated cross-section of the tendon were determined, using two transverse sections at the level of the subtalar joint facet and the medial malleolus. The findings obtained by ultrasound in four female patients with the diagnosis of a tibialis posterior dysfunction confirmed during surgery are compared to the aforementioned 51 healthy subjects.

RESULTS

A healthy tendon appears homogeneous and echo-rich in orthogonal ultrasound and displays average areas of 18.4 sq.mm. (SD 5.9 sq.mm.) at the subtalar joint facet level and 19.2 sq.mm (SD 4.8 sq.mm.) at medial malleolus level in transverse sections. The corresponding areas obtained in patients with tibialis posterior dysfunction were clearly enlarged than in healthy subjects. In 85% of all feet examined at the level of the medial malleolus, the tendon is surrounded by a hypoechoic halo which has a size smaller than two times the cross-section of the flexor digitorum longus tendon.

CONCLUSION AND CLINICAL RELEVANCE

Reference values of tendon thickness and of intratendinous echo-structures at reproducible landmarks facilitate delimitations from pathological tendon alterations. The exact delineation of intratendineal echoes by high frequency array transducers and standardized examination techniques that measure tendons size is a prerequisite to enable an early assessment and registration of degenerative alterations and thickening of the posterior tibial tendon.

Bactericidal and cross-protective activities of a monoclonal antibody directed against Neisseria meningitidis NspA outer membrane protein

The cross-bactericidal and cross-protective activities of a monoclonal antibody (MAb) named Me-7, which is directed against an antigenically highly conserved epitope on the meningococcal NspA protein, were studied. This MAb efficiently killed in vitro, in the presence of rabbit or human serum, 13 of 14 meningococcal strains tested, including 9 of 9, 2 of 3, and 2 of 2 strains of serotypes B, A, and C, respectively. MAb Me-7 also significantly reduced by more than 75% the levels of bacteremia recorded for mice challenged with 10 of 11 meningococcal strains tested. Analysis of the predicted amino acid sequence of the NspA protein from the meningococcal strain MCH88 (A:4:P1.10), which was not killed by MAb Me-7, indicated the presence of an additional glutamine residue at position 73, compared to the three other NspA sequences. The data presented in this study suggest that antibodies directed against this highly conserved outer membrane protein could protect against meningococcal infections.

A new modification of rotationplasty in a patient with proximal femoral focal deficiency Pappas type II

The application of rotationplasty type B III (Winkelmann) for a patient with proximal femoral focal deficiency (PFFD) Pappas type II in a 5-year-old patient is described. The advantages for prosthetic management are discussed in comparison with other surgical options.

Antigenic and molecular conservation of the gonococcal NspA protein

A low-molecular-weight protein named NspA (neisserial surface protein A) was recently identified in the outer membrane of all Neisseria meningitidis strains tested. Antibodies directed against this protein were shown to protect mice against an experimental meningococcal infection. Hybridization experiments clearly demonstrated that the nspA gene was also present in the genomes of the 15 Neisseria gonorrhoeae strains tested. Cloning and sequencing of the nspA gene of N. gonorrhoeae B2 revealed an open reading frame of 525 nucleotides coding for a polypeptide of 174 amino acid residues, with a calculated molecular weight of 18,316 and a pI of 10.21. Comparison of the predicted amino acid sequence of the NspA polypeptides from the gonococcal strains B2 and FA1090, together with that of the meningococcal strain 608B, revealed an identity of 93%, suggesting that the NspA protein is highly conserved among pathogenic Neisseria strains. The level of identity rose to 98% when only the two gonococcal predicted NspA polypeptides were compared. To evaluate the level of antigenic conservation of the gonococcal NspA protein, monoclonal antibodies (MAbs) were generated. Four of the seven NspA-specific MAbs described in this report recognized their corresponding epitope in 100% of the 51 N. gonorrhoeae strains tested. Radioimmunobinding assays clearly indicated that the gonococcal NspA protein is exposed at the surface of intact cells.

Heat shock response of Streptococcus pneumoniae: identification of immunoreactive stress proteins

In order to investigate whether pneumococcal heat shock proteins (HSPs) were major immunogens of humoral immune response, we first characterized the heat shock response of S. pneumoniae. Three HSPs, HSP62, HSP72 and HSP80, having an apparent molecular mass of 62, 72, and 80 kDa, respectively, were detected by labelling proteins synthesized with [35S]methionine after a shift from 37 degrees C to 45 degrees C and fluorography of SDS-polyacrylamide gels. Radioimmunoprecipitation and immunoblot analyses with mouse anti-pneumococcal sera revealed that HSP72 was a major immunogen. S. pneumoniae HSP62 was another antigen which was precipitated by some immune sera. Anti-HSP72 antibodies appeared after the first immunization with S. pneumoniae antigens and subsequent immunization elicited a booster response. Monoclonal antibodies (MAbs) to pneumococcal HSP72 were produced and their specificities defined. The epitopes reactive with four MAbs are highly conserved in S. pneumoniae since 20 out of 20 different strains were recognized by each individual MAb. Western blot analysis revealed cross-reactivities with few non-pneumococcal strains. By N-terminal sequence analysis, the S. pneumoniae HSP72 was found to belong to the heat shock protein 70 family. That HSP72 is an important highly conserved antigen in S. pneumoniae should provide a basis for further investigation of its physiological and potential pathogenic role.

[Realignment, fusion, and staple fixation of the chopart joint in neurogenic foot deformities.]

GOAL OF SURGERY

Restoration of a plantigrade foot in adolescents suffering from a neurogenic foot deformity with an important, irreversible malposition of the talocalcaneonavicular joint complex.

INDICATIONS

Severe, non reducible hindfoot deformity which cannot be corrected through soft tissue procedures alone. Important tarsal instability. Progressive forefoot deformities.

CONTRAINDICATIONS

Presence of supple club foot deformities. Severe deformities necessitating removal of a bone wedge. Important degenerative changes of the subtalar joint. Presence of skin infection or sores.

POSITIONING AND ANAESTHESIA

Supine with buttock of operated side slightly elevated. General or regional anaesthesia. Tourniquet at thigh.

SURGICAL TECHNIQUE

Two skin incisions, one overlying the talonavicular and the other the calcaneoucuboid joint. Subperiosteal dissection until both approaches meet. Arthrodesis of the calcaneoucuboid and talonavicular joints after resection of articular cartilage and correction of deformity. Temporary fixation with Kirschner wires, visual control of correction and permanent fixation with titanium staples. Long leg cast which is split immediately. Additional tendon surgery may be necessary

POSTOPERATIVE MANAGEMENT

Elevation of foot. Low molecular heparin. Well molded fibreglass cast after 2 weeks and heel added 2 weeks later. Orthopaedic shoes 10 to 12 weeks postoperatively.

POSSIBLE COMPLICATIONS

Injury of neurovascular structures. Pressure sores. Thrombophlebitis. Wound dehiscence, deep infection. Displacement or breakage of staples. Absence of bony fusion.

RESULTS

Between August 1990 and April 1993 the technique was performed 20 times in a total of 15 patients. Follow-up 14 to 36 months. A bony fusion occurred in all patients at 12 weeks. Eighteen times the functional result was good to satisfactory and these patients were free of pain. The following complications were observed: hindfoot varus (2), transient loss of sensation of foot (1), necrosis of the wound edges (2) and breakage of the staple (1).

Highly conserved Neisseria meningitidis surface protein confers protection against experimental infection

A new surface protein, named NspA, which is distinct from the previously described Neisseria meningitidis outer membrane proteins was identified. An NspA-specific mAb, named Me-1, reacted with 99% of the meningococcal strains tested indicating that the epitope recognized by this particular mAb is widely distributed and highly conserved. Western immunoblotting experiments indicated that mAb Me-1 is directed against a protein band with an approximate molecular mass of 22,000, but also recognized a minor protein band with an approximate molecular mass of 18,000. This mAb exhibited bactericidal activity against four meningococcal strains, two isolates of serogroup B, and one isolate from each serogroup A and C, and passively protected mice against an experimental infection. To further characterize the NspA protein and to evaluate the protective potential of recombinant NspA protein, the nspA gene was identified and cloned into a low copy expression vector. Nucleotide sequencing of the meningococcal insert revealed an ORF of 525 nucleotides coding for a polypeptide of 174 amino acid residues, with a predicted molecular weight of 18,404 and a isoelectric point of 9.93. Three injections of either 10 or 20 microg of the affinity-purified recombinant NspA protein efficiently protected 80% of the mice against a meningococcal deadly challenge comparatively to the 20% observed in the control groups. The fact that the NspA protein can elicit the production of bactericidal and protective antibodies emphasize its potential as a vaccine candidate.

Sonographic assessment of clubfoot deformity in young children

We report a new diagnostic imaging technique for talipes equinovarus. Sonographic assessment of the medial border of the foot offers insight into the center of tarsal malalignment at the talonavicular joint. Technique, observations, and interpretation of the findings are delineated and compared with current radiologic evaluation of talonavicular alignment according to the method of Simons in 38 cases. The TnCE-angle is introduced as a sonographic measure to quantify talonavicular malalignment in clubfeet. Sonographic results of clubfeet are compared with those of a group of 98 normal feet. The practical implications of the method as a means for planning and control of treatment in clubfoot deformity are discussed.

[Sonographic diagnosis of the juvenile tarsus. Clinical application possibilities demonstrated by examples]

Radiologic assessment of foot deformities in young children is limited especially by the ossification status. Ultrasonography proved to be a useful diagnostic supplement e.g. in idiopathic talipes equinovarus, vertical talus, and tarsal coalitions. Effects of treatment and three-dimensional movements of the tarsal joint complex can be delineated. Sonographic assessment of tarsal alignment is applicable already in the first months of life. This study deals with first experiences in clinical application of this new diagnostic technique.

Analysis of protective and nonprotective monoclonal antibodies specific for Bordetella pertussis lipooligosaccharide

In this study, it has been determined that immunoglobulin G1 (IgG1) and IgG3 monoclonal antibodies directed to the lipooligosaccharide A of Bordetella pertussis were able to protect mice from fatal aerosol infection. No correlation was found between the bactericidal activity in vitro in the presence of complement and the protection in mice, since a bactericidal IgG3 did not elicit protection. In addition, no significant difference in protective capacity was observed with bactericidal and nonbactericidal IgG1 antibodies, indicating that bactericidal activity is not a requirement for protection mediated by certain anti-lipooligosaccharide A antibodies. A reduction in protection in C5-deficient mice was observed, suggesting a significant role for complement in certain host defense mechanisms against B. pertussis infection.

A combined bony and soft-tissue tarsal stabilization procedure (Grice-Schede) for hindfoot valgus in children with cerebral palsy

This study deals with a combined bony and soft-tissue procedure (Grice-Schede) for the treatment of pes (equino) planovalgus in children suffering from cerebral palsy. Results of 43 treated feet in 28 children were assessed clinically and radiologically at a mean follow-up time of 6.7 years (range from 0.6 years to 13.8 years). In all, 58.1% excellent or good results, 14.0% satisfactory and 27.9% poor results were found. The procedure can be recommended for patients with hemiplegic and diplegic conditions. It is not suited for patients with total body involvement.

Anti-idiotypic mimicry of a neutralizing epitope on the glycoprotein B complex of human cytomegalovirus

Experiments were carried out to investigate the ability of rabbit anti-idiotype antibodies (Ab2), directed against an anti-human cytomegalovirus monoclonal antibody (Ab1), to induce neutralizing antibodies specific for the immunodominant glycoprotein B viral complex. Mice immunized with Ab2 produced anti-Ab2 (Ab3) that was both antigen and idiotype specific with regard to Ab1. We conclude that the Ab2 antibodies mimicked a neutralizing epitope and acted as a network antigen for inducing a specific anti-human cytomegalovirus antibody response in this experimental system.

A novel approach to the laboratory diagnosis of Chlamydia trachomatis infections using monoclonal anti-idiotypic antibodies

We have developed a novel enzyme immunoassay (EIA) for the specific detection of Chlamydia trachomatis utilizing a monoclonal anti-idiotypic antibody to an antibody directed against a chlamydia specific epitope on 60 kDa heat-shock protein (HSP60). The basis of the assay is the inhibition of the binding of idiotype to anti-idiotype by antigen present in test samples. Two configurations of the assay were developed: a blocking EIA and a competition EIA. Greater sensitivity was observed using the competition EIA, with the assay detecting purified recombinant HSP60 and purified chlamydia in a concentration-dependent manner from 0.01 to 10 micrograms protein and from 0.5 to 12 micrograms total protein, respectively. The assay is highly specific and offers several potential advantages over currently available EIAs for the detection of this pathogen.

Monoclonal anti-idiotypes for the rapid detection of human cytomegalovirus

A novel enzyme-linked immunosorbent assay (ELISA) was developed for human cytomegalovirus (HCMV) utilizing a monoclonal anti-idiotype specific for CMVB1, an antibody to HCMV. Samples of HCMV were measured by their inhibition of the binding of CMVB1 to anti-idiotype. The ELISA detected HCMV in a concentration-dependent manner from 20 to 0.6 x 10(3) PFU/ml, with 50% inhibition at approx. 3 x 10(3) PFU/ml. These data demonstrate the potential of anti-idiotype antibodies as the basis of simple and rapid diagnostic tests for infectious agents.

Monoclonal anti-idiotypes induce neutralizing antibodies to enterovirus 70 conformational epitopes

Monoclonal antibodies (MAbs) directed against the prototype enterovirus 70 (EV-70) strain J670/71 were generated and characterized in order to produce anti-idiotypic MAbs (MAb2s) for use as surrogate immunogens. Western immunoblot and radioimmunoprecipitation assays suggested that all the MAbs recognize conformational epitopes on the virion surface. An EV-70-neutralizing antibody, MAb/ev-12 (MAb1), was selected for the production of MAb2s. Five MAb2s were selected for their capacities to inhibit the interaction of MAb/ev-12 with EV-70 in dot immunobinding inhibition and immunofluorescence assays. In addition, these five MAb2s inhibited virus neutralization mediated by MAb/ev-12, suggesting that they recognize paratope-associated idiotopes. In competition enzyme immunosorbent assays, none of the five MAb2s recognized other neutralizing and nonneutralizing EV-70-specific MAbs, demonstrating that the MAb2s were specific for private idiotopes. Immunization with each of the MAb2s was carried out for the production of anti-anti-idiotypic antibodies (Ab3). All five MAb2s induced an immune response. Moreover, results suggested that they share idiotopes, since MAb2-MAb/ev-12 binding could be inhibited by homologous as well as heterologous Ab3s. Ab3 sera were shown to possess antibodies capable of immunoprecipitating 35S-labeled viral proteins in the same manner as MAb/ev-12. Nine of 15 mice immunized with MAb2s demonstrated Ab3 neutralizing activity specific for the prototype EV-70 strain, J670/71. The potential application of MAb2s to serve as surrogate immunogens for conformational epitopes is substantiated by the results presented in this report.

Epitope analysis of an immunodominant domain on the P1 protein of Haemophilus influenzae type b using synthetic peptides and anti-idiotypic antibodies

Synthetic peptides, anti-idiotypic antibodies (anti-Id) and human and murine monoclonal antibodies (mAbs) were used to further define a major antigenic domain on the outer membrane P1 protein (OMP) of Haemophilus influenzae type b (Hib). Synthetic peptides were elaborated from the known primary sequences of the P1 protein of prototype Hib strains MinnA (OMP subtype 1H) and 8358 (OMP subtype 6U). By peptide mapping, antibodies are categorized into three groups: A, B and C. A first epitope on the P1 from strain MinnA was identified by the reactivity of one set of murine anti-P1 mAbs with the two overlapping peptides 11H and 13H, corresponding to amino acid residues 384-412 and 400-437, respectively. On the basis of their reactivity with both peptides, these mAbs were designated as group A. Anti-Id obtained from mice immunized with two group A mAbs reacted specifically with all group A mAbs. A second epitope on the same P1 protein was identified by the reactivity of the peptide 13H with another distinct set of murine anti-P1 mAbs assigned to group B. This group of mAbs did not recognize the peptide 11H. Murine anti-Id which were prepared against one group B mAb inhibited the attachment of this mAb to outer membrane preparations, whereas the binding of the other group B mAbs was not affected, suggesting that these mAbs represent a heterologous group of mAbs. The epitope(s) recognized by two human anti-P1 mAbs was (were) distinct from the ones recognized by murine mAbs since no reactivity with the peptides was observed. Similarly, the binding of the two human mAbs to the P1 antigen was not inhibited by anti-Id raised against group A or B mAbs. Interestingly, an epitope on a different P1 protein recovered from strain 8358 was identified by the reactivity of group C murine mAbs with the peptide 13U, which occupies the same position on the P1 protein as 13H but differs from the latter by 10 amino acid residues. Our studies demonstrated the presence of several distinct surface-exposed B-cell epitopes within the antigenic domain which was defined previously on the P1 protein of Hib MinnA. Furthermore, we showed the immunodominance of this region on two different P1 proteins. None of the mAbs, however, had a bacteriolytic or protective activity against Hib strains. We suggest that the surface-exposed immunodominant region on the OMP P1 of Hib do not induce protective antibodies against Hib infection.