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Biomedical subjects

A Grosse

Publications and source records attributed to A Grosse.

At least 37 records · Page 2Linked to original sources
PubMed1992

[The time requirement for endoscopic diagnosis and therapy: results of a multicenter study].

For evaluation of the time requirements for endoscopic diagnostic and therapeutic procedures data of 13,321 patients gathered from 155 endoscopic units were collected. Time requirements were calculated for preparation of the procedure, examination and after-care of patients and instruments. The data indicate, that time requirement is significantly influenced by the special procedure. Therefore, calculation of the time requirement of an individual unit needs exact consideration of the frequency of different procedures. Only cleaning of instruments by washing machines could be shown to reduce time requirement. Education of endoscopists was demonstrated to be time intensive. Age (exemption children) sex of patients and video-endoscopy did not effect duration of procedures.

Adolescent↗
PubMed1992

[Therapy of choledocholithiasis using extracorporeal shock wave lithotripsy and adjuvant surgical endoscopy].

Extracorporeal shock wave lithotripsy of extra- and intrahepatic bile duct stones is indicated after failure of conventional operative endoscopic procedures including mechanical lithotripsy. An overview of the current literature (12 centers, 568 patients) indicates that this novel procedure has attracted international acceptance. It was applied in elderly patients (means = 65 years) with solitary (37.5%) or multiple (62.5%) concrements. Clearance of the bile ducts was achieved in 71.6% after 1.3 to 3.0 lithotripsy sessions (1900-4000 shocks) if additional endoscopic sphincterotomy was performed. Without sphincterotomy 61% of patients were treated successfully. The most frequent side effects were macrohematuria (6.9%), hemobilia (6.2%) cholangitis (4.5%) and pancreatitis (1.3%). A lethality of 0-3.6% (means = 0.6%) was reported. The current results demonstrate that therapy of extra- and intrahepatic bile duct stones with extracorporeal shock wave lithotripsy is effective, safe and provides high therapeutic comfort.

Aged↗
PubMed1991

[Extrasystoles during extracorporeal biliary shockwave lithotripsy. Their incidence and clinical significance].

Incidence and clinical significance of cardiac side effects of extracorporeal shock-wave lithotripsy (ESWL) were prospectively analysed for 85 patients (26 men, 59 women; mean age 44 [17-81] years) with cholecystolithiasis (n = 70) or choledocholithiasis (n = 15). 24-hour ECG monitoring was undertaken on the day of treatment. Additionally, during ESWL cardiac rhythm and blood pressure were monitored. ESWL was performed with an electromagnetic lithotriptor under light anaesthesia with intravenous diazepam (10 mg) and pethidine (75-100 mg). There were no superventricular premature systoles in any of the patients during treatment. In 15 patients with occasional ventricular premature systoles (VPS) (6-81 per 23 hours) in the 24-hour ECG the number of VPS increased during the one-hour ESWL procedure significantly to 6-55 (P less than 0.05). 14 of these patients had an unremarkable cardiac history. Changing the lithotriptor coupling angle failed to suppress the VPS in only two patients. In these two it was necessary to trigger the shock wave with the ECG. Blood pressure rose markedly (up to 220 mm Hg systolic) during ESWL in only three patients, known hypertensives. But this rise was easily controlled with nifedipine, 10 mg sublingually. These data demonstrate that ESWL is a safe alternative to operative treatment, even in the presence of existing cardiac disease. Nonetheless, precautions should be taken in case there are complications.

Adolescent↗
PubMed1991

Electromagnetically generated extracorporeal shock wave lithotripsy and adjuvant combined oral litholysis for therapy of symptomatic gallbladder stones.

A prospective study was conducted to evaluate effectivity, problems and adverse effects of extracorporeal shock wave lithotripsy (ESWL) using a newly developed electromagnetic biliary lithotriptor (Lithostar Plus, Siemens, Erlangen, FRG) for the treatment of selected patients presenting with symptomatic cholecystolithiasis. In addition to generally accepted criteria for the selection of patients, gallbladder contractility was established and pigment stones were excluded by computed tomography (CT). 80 out of 486 patients (63 females, 17 males, mean age 36, range 17-76 years) were selected for ESWL using a standardized diagnostic program. 62 out of 80 patients participating in the study had solitary concrements (diameter 23.3 +/- 6.4 mm) while in 18 patients 2 or 3 stones (diameter below 10 mm) were observed. Stone fragmentation was achieved after an average of 1.35 treatment sessions (range 1-3) in 78 (97.5%) patients. No clinically relevant adverse effects were observed. Immediately after ESWL, ultrasound revealed misleading results with regard to stone fragmentation. 98.7% of patients (n = 77) were seen for follow-up investigations 3, 6 and 9 months after ESWL, and 82% at 12 months. A total of 40 (53%) patients became free of stones. Subgroup analysis showed that 68% of the patients were free of stones (stone diameter 10-20 mm), 54% (20-30 mm) and 33% (multiple stones), respectively. We therefore conclude that ESWL should be restricted to highly selected patients presenting with small (10-20 mm) solitary concrements.

Administration, Oral↗
PubMed1991

[Interlocking central medullary nailing of recent femoral and tibial fractures. Statistical study apropos of 835 cases].

Kuntscher's conventional closed intra-medullary nailing represents a good procedure in the treatment of diaphyseal fractures of the femur and the tibia but had a very restricted area (the midshaft) of indications. Thanks to the interlocking technic which consists in the fixation of the nail to the bone by means of transfixing screws either in a static or in a dynamic procedure, the method can be extended to fractures localised between both epiphysis of the long bones. After a first period between 1974 and 1983 of development of the method summarized in a first statistic, a second study was performed between 1984 and 1989 in the Center of Traumatology of Strasbourg with 837 cases of fresh fractures of the femur (385) and the tibia (397) treated by locked intra-medullary nailing. In two third of the cases the procedure was static and in one third it was dynamic. Full weight bearing was allowed in a mean period of 60 days. On the femur (371 closed and 65 open fractures), we had noted 8 infections out of which 2 deep infections (0.45%), 5 non unions, 25 moderate malunions in varus and 18 in valgus. On the tibia (267 closed and 132 open fractures) we had observed 15 deep infections (3.7%) out of which 9 (2.2%) after open fractures, 15 non unions (3.7%), 22 compartment syndroms, 6 mal unions in varus and 54 malunions in valgus greater than 5 degrees out of which 15 greater than 10 degrees.

Adult↗
PubMed1991

[Screw fixation of fractures of the odontoid process].

In the year 1981, J. Böhler completed for the first time a screw fixation for unstable fractures of the odontoid process of the axis. This surgical technique preserves the anatomy and the physiology of the articulation between the atlas and the axis, as a guarantee for a good functional recovery. It is not a very difficult technique when performed by a trained surgeon with a very good X-ray image intensification for the per-operative control. We have treated 32 unstable fractures of the odontoid process without any neurological complication per- or post-operatively. We had a follow-up on only 29 cases. In 19 cases the fracture healed in leading to a good bone union, complete mobility and no residual pain. Seven patients complained of residual pain or a limitation in cervical movement, because of the association with other cervical fractures, an age superior of 70 years, or a major initial instability. In 2 cases the authors noted a non-union and a secondary displacement because of technical faults at the beginning of their experience. These good results determined the authors to prefer the direct screw fixation for the unstable fractures of the odontoid process, to the posterior arthrodesis which leads to functional limitations.

Adolescent↗
PubMed1991

Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the femur.

Thirty-seven fractures of the distal part of the femur in thirty-five patients were treated with interlocking intramedullary nailing. All fractures were nailed by a closed technique after any intercondylar extension of the fracture had been managed by reduction and stabilization with percutaneous lag-screws. Patients who had an isolated condylar fracture or a severely comminuted intercondylar fracture were treated with other types of implants. There were thirty extra-articular (type-A) fractures and seven intra-articular (type-C1 and type-C2) fractures. Postoperatively, early mobilization exercises and weight-bearing were begun. At an average duration of follow-up of 20.5 months (range, fifteen to twenty-six months), all thirty-seven fractures had healed. There were no malunions of either the supracondylar or the intercondylar fractures. Complications were infrequent and included chronic irritation from the distal screws in three patients and delayed union in one; the latter healed with two centimeters of shortening after bone-grafting. There were no infections. The functional results were assessed with the modified knee-rating system of The Hospital for Special Surgery. Thirteen knees (35 per cent) had an excellent result; twenty-two (59 per cent), a good result; and two (5 per cent), a fair result. The results correlated with the age of the patient and the presence of an intra-articular fracture. We concluded that closed interlocking intramedullary nailing is an excellent technique for both supracondylar and simple intercondylar fractures in which closed reduction and percutaneous fixation of the articular fracture is possible.

Adult↗
PubMed1990

[Esophageal varices: is bleeding predictable?].

Hemorrhage of oesophageal varices is still a life-threatening complication of portal hypertension. Parameters to identify patients being on risk to bleed are on demand for prophylactic therapy. Recent studies showed that bleeders present with larger varices, red color sign of the variceal wall and higher intravariceal hydrostatic pressure than patients without previous hemorrhage. Advanced liver disease (Child C) is an additional risk factor. The clinical value of the parameters appears to be decreased by a significant overlap of the findings obtained in bleeders and non-bleeders. However, patients with small varices, low variceal pressure (less than 12 mmHg) and fair condition are considered to be not on risk to bleed from varices. An additional clinical value of the parameters is provided by the potency to define patients more accurately for future clinical studies.

Esophageal and Gastric Varices↗
PubMed1990

Electromagnetically generated extracorporeal shockwaves for fragmentation of extra-and intrahepatic bile duct stones: indications, success and problems during a 15 months clinical experience.

Electromagnetically generated extracorporeal shock waves (without waterbath) were applied after intravenous premedication with 10-15 mg diazepam and 100 mg tramadol in the treatment of 33 patients (aged 32 to 91 years) with multiple intrahepatic stones (n = 4) or huge common bile duct stones (n = 29, 18-30 mm in diameter), which could not be removed by conventional endoscopy. Stone disintegration was achieved in 70% of common bile duct stones and in all intrahepatic concrements after 800-7500 discharges, which were applied during one (n = 21), two (n = 6) or three sessions (n = 6). Apart from mild fleabite-like petechiae at the side of shock wave transmission no other side effects were observed for a total of 51 procedures. We believe electromagnetically generated shock waves are safe, easy to apply, and relatively effective in the therapy of common bile duct and intrahepatic stones.

Adult↗
PubMed1990

Pressure responses of hypertensive patients treated with thiazides, beta blockers and clonidine during a psychological experimental stress situation.

A total of 61 hypertensive patients treated during more than six months with antihypertensive drugs and showing a satisfactory evolution and normal basal arterial pressure values were studied. Patients were subjected to a psychological stress test in order to evaluate the effectiveness of the pharmacological treatment during and after an emotional situation. Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were measured in three instances: before (I), during (II) and after the test (III). Patients were divided in two groups: a) moderate hypertensive subjects (N = 38) treated with thiazides and beta-blockers and b) severe hypertensive subjects (N = 23) treated with the same drugs plus clonidine. A group of 26 normotensive subjects was used as control. Reactivity was determined comparing SAP and DAP values in instances I and II, whereas the recovery phase was evaluated by comparing instances I and III. SAP and DAP reactivity were highest in severe hypertensive patients and lowest in normal subjects. SAP and DAP recovery was partial in severe hypertensive subjects and complete in the other two groups. All reactivity and recovery differences were statistically significant. These results suggest that antihypertensives treatment that normalized basal arterial pressure values in these patients was not sufficiently effective to protect them during a psychological stress situation.

Adrenergic beta-Antagonists↗
PubMed1989

Electromagnetically generated extracorporeal shock waves for gallstone lithotripsy: in vitro experiments and clinical relevance.

First generation shock wave sources have been proved to disintegrate gallstones effectively, but they require the immersion of the patient's body in a tank of water. A recently developed second generation shock wave source (Siemens-Lithostar, Erlangen, FRG) generates shock waves electromagnetically. It presents several novel features. In particular the waterbath can be omitted and due to lower shock wave pressure general anaesthesia is not required. In vitro studies showed that 36 out of 38 gallstones (11-30 mm in diameter) could be disintegrated. Two concrements resisting lithotripsy were pure white cholesterol stones. Independent of shape, size, and composition (cholesterol or pigment) the maximum diameter of remaining fragments after lithotripsy was between 1 and 8 mm. For sufficient disintegration precise focusing (+/- 1 cm) of the stones and maximum power of the shock wave generator were required.

Cholelithiasis↗
PubMed1986

The treatment of noninfected pseudarthrosis of the femur and tibia with locked intramedullary nailing.

Sixty-six cases of noninfected nonunions (27 femoral and 39 tibial) were treated with an interlocking nail. In these cases, 92.6% of the femurs and 94.8% of the tibias healed after the first operation in a mean time of 15.4 and 13.0 weeks, respectively. Deep infection complicated five nailings (7.5%, two femur and three tibia), which included three patients with reactivation of latent osteomyelitis. All cases healed after debridement and use of gentamicin PMMA beads. In one case the nail had to be removed and replaced by an external fixator. Residual angulation between 5 degrees and 10 degrees occurred in three femurs and seven tibias. Shortening occurred in all patients and averaged 0.9 cm in the femur and 0.5 cm in the tibia. Of the patients treated for femoral nonunion, 92.5% achieved full hip flexion and 77.8% full knee flexion on final follow-up examination. In patients with tibial nonunions treated with a locked nail, 92.3% had normal knee flexion and 84.6% obtained normal ankle function. Interlocking nailing offers unique advantages to patients with femoral or tibial shaft pseudarthrosis. The technique allows early weight-bearing, range of motion of adjacent joints, and reliable rates of consolidation of the nonunions.

Adolescent↗
PubMed1986

Locked intramedullary nailing. Its application to femoral and tibial axial, rotational, lengthening, and shortening osteotomies.

Interlocking nailing is an alternative method of internal fixation following corrective osteotomies for malunions or after correction of leg length inequality. Of 13 osteotomies (six femoral, seven tibial) for angular or rotational malunion, all healed following dynamic locked nailing. Eleven were considered anatomic and two had mild residual deformity. One-stage femoral lengthening was performed in 17 patients. The preferred operative technique includes a long Z-shaped osteotomy, static interlocking nailing, primary cancellous bone grafts, and one or two supplemental screws at the osteotomy site to prevent shortening following dynamization. Thirteen complications developed following one-stage lengthening of the femur, which included significant loss of length in five patients, femoral nerve palsies in four patients, three deep infections, and one nonunion. Lengthening should not exceed 4.0 cm in the femur. The recommended technique of shortening osteotomy consists of resection of a cylindric segment of bone from the distal diaphyseal metaphyseal area. Shortening should not exceed 4.5 cm in the femur or 3.0 cm in the tibia. In ten patients who were shortened, all healed, but radiologic signs of union appeared very slowly in most cases.

Adolescent↗
PubMed1985

Testing the response of a cardiac output meter using an artificial circulatory system.

The variation in the response of a cardiac output flowmeter to several variables was investigated. An artificial circulatory system was constructed to give independent control of the variables. It was found that variations in the earlobe density, the amount of dye injected and the hematocrit value have little influence on the recorded flow which does, however, depend on the shape of the dilution curve. The values given by the instrument are too low for broad curves and too high for sharp ones, with an error of up to 25%.

Biomedical Engineering↗
PubMed1985

[Radiological aspects of cerebral and spinal cysticercosis. Apropos of 2 cases].

Two cases of neurocysticercosis are reported, one cerebral and the other spinal. Results of radiologic imaging of this affection, a rare parasitosis in occidental Europe, are discussed with emphasis on computed tomography findings. In fact, when perfect conditions can be established the CT scan provides data confirming the diagnosis of cerebral cysticercosis in most cases. However, this scan is insufficient for investigation of ventricular or cisternal forms when gas or positive contrast is sometimes necessary for visualization of parasitic cysts. Radiologic diagnosis of extra- and intra-medullary forms is based an myelography with water-soluble contrast completed by a scan.

Acute Disease↗
PubMed1985

Closed locked intramedullary nailing. Its application to comminuted fractures of the femur.

For many fractures of the femoral shaft, closed intramedullary nailing will not control rotation or telescoping of the fragments. Locked intramedullary nailing combines closed nailing with the percutaneous insertion of screws that interlock the bone and nail. This method permits static locking that controls rotation and telescoping and subsequently conversion to dynamic locking when weight-bearing is started after approximately twelve weeks. By providing greater stability, this method extends the indications for intramedullary nailing to severely comminuted, oblique, and spiral fractures as well as to fractures complicated by loss of bone and fractures in the proximal and distal ends of the femoral shaft. Of fifty-two patients with forty-nine severely comminuted fractures of the femoral shaft and three fractures that were complicated by loss of bone, forty-seven patients had uneventful consolidation of the fracture, with a mean time of 4.5 months for the severely comminuted fractures and seven months for the fractures that had a loss of bone. At follow-up, all forty-seven patients had normal motion of the hip, and forty-five had normal motion of the knee. Of the remaining five patients, four had a non-union that eventually healed (three after a second locked nailing and one after a third) and one had a septic non-union that eventually healed after removal of the nail and screws, débridement, and immobilization with an external fixator. Based on this experience, we concluded that this form of treatment has many advantages. The risk of infection and non-union is low, the incidence and severity of malunion are reduced, the hospital stay is short, and early mobilization of the patient is possible.

Adult↗