Biomedical subjects
Publications and source records attributed to A Reichelt.
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Haemangiosarcoma of bone is a very rare primary tumour with a variable history and differing radiographic and histological appearances. In some cases the lesion has similar features to the so-called "adamantinoma of long bones" in which the histogenesis is also unknown. Such a lesion is described which occurred in the shaft of the right humerus of a 31-year-old man. Radiographically a centrally located area of osteolysis was seen without marginal sclerosis, but with erosion of the bony cortex. A biopsy was performed 16 months after the first radiographic examination and showed malignant tumour tissue which was difficult to classify histomorphologically. Several different neoplasms such as Ewing's sarcoma, myeloma, liposarcoma, malignant fibrous histiocytoma or a bone metastasis were suggested. Finally, a haemangiosarcoma or so-called "adamantinoma of long bones" was considered. The tumour was completely removed by en-bloc resection. Careful histomorphological investigation of the tumour tissue by means of light microscopy, cytology and electronmicroscopy showed a vascular pattern characteristic of a haemangiosarcoma. Using cytophotometric DNA measurements of the tumour cells, the lesion could be classified as being of low-grade malignancy. This is confirmed since there has now been a 4-year follow up with no local recurrence or metastasis. There are many similarities between a well-differentiated haemangiosarcoma and an "adamantinoma of long bones". The differential diagnosis and the histogenesis of the latter lesion is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of lymphangioma of the 11th and 12th thoracic vertebral body with considerable diagnostic difficulties is reported. The course of the disease could be followed roentgenographically for six years backwards. The diagnosis is confirmed by lymphangiography: lymphographic contrast medium can be demonstrated within the vertebral spongiosa. In the last months, an osteolysis of the right 11th rib was observed, being in the immediate neighbourhood of the vertebral lesion. The probable pathogenesis, the clinical presentation, and the therapeutic possibilities are discussed.
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Vertebral biopsies were performed in 28 patients, 17 males and 11 females, because of vertebral body and disc changes between June 1978 and May 1982. In two patients biopsy was performed in two segments. Punctures were done in local and superficial anaesthesia of the vertebral body periosteum during continuous fluoroscopy control using Jamshidi's instrumentation. Aspiration and tissue cylinders were evaluated histologically and bacteriologically. There were no complications among the 8 thoracic and 22 lumbar biopsies. A histologic diagnosis could be established in 22 cases (78.6%): plasmocytoma (n = 2), spontaneous deformation of the spine in osteoporosis (n = 3), Scheuermann's disease (n = 1), specific (n = 2) and nonspecific (n = 14) spondylitis. Demonstration of bacteria was possible in 5 out of the 16 cases of spondylitis (31.25%): in two cases tubercle bacilli were demonstrated and once each salmonella group B, Haemophilus aphrophilus and coagulase-negative staphylococci. Only in 6 cases a diagnosis could not be established from the biopsy material.
Between the years 1949 and 1968 75 children with unilateral idiopathic LCPD were treated nonoperatively in the Orthopedic University Clinic of Freiburg. In the follow-up 1981 the pelvic teardrop distances were determined and the quotient of the measurement's results of the sick and healthy sides were named "tear drop distance quotient" (TDDQ). We compared this TDDQ with the clinical and radiological end result.
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Ruptures of the rotator cuff are more frequent than generally assumed. Out of 25 patients with ruptures of the rotator cuff treated surgically, 17 were seen at follow-up investigations at least 6 months later. The procedure was successful in most cases. Should severe pains persist despite regular conservative treatment for 6--8 weeks, disturbing night rest of sports and working performance, and has the rupture been demonstrated by arthrography, surgical reconstruction should not be delayed as partial shoulder immobility diminishes postoperative results considerably. Long-term follow-up physiotherapy is a prerequisite for a lasting success.
The article is based on the results obtained in 13 patients who were operated within a period of 25 months in 14 joints for calcareous tendinosis of the rotator cuff. The article concentrates on the technique of the minor and largely safe surgical procedure and describes the operative results obtained. Surgery should be performed in all cases where conservative treatment continued for 6 months has remained unsuccessful, the complaints in question being definitely attributable to the calcareous focus.
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This study is based on the evaluation of 250 arthrographies of the patellofemoral joint ("défilé" arthrographs in Ficat's terminology) which were performed because of clinical suspicion of chondropathia patellae and which could be controlled intraoperatively in 30 cases, as well as on examinations employing an etching paste as used in metallurgy and performed on 20 knee-joints of corpses. 46% of the arthrographies showed a ridge-shaped cartilaginous thickening which was not pre-modelled in the osseous structure and which separated the medial facette into a paramedian and a marginal segment and correlated with chondromalacia to a greater degree than patellar dysplasias or secondary osseous changes. This variant, which could not be detected by plain roentgenography, must be considered as a pre-arthrotic deformity on account of the high point-shaped pressure load on the ridge. The findings were fully confirmed by macroscopic examination of the postmortem material.
The present investigation of 84 operations effected because of Perthes' disease, was conducted with the aim of comparing and assessing two surgical methods. For this purpose, preoperative and postoperative measurements and statistical calculations were effected of the epiphyseal index, the radius quotient, the acetabular head index, the acetabular index, and the angle of the capitular epiphysis of the femur. The shape and kind of congruence was also included in the assessment. Fixation with Moore's pins or with Kirschner wires was conducted 28 times up to 1971. The patients remained in the clinic for an average period of six months with an average immobilization period of twelve weeks. Physiological congruence 1 was achieved in only 15% of the cases; deformed femoral heads were seen in 36% of the patients. The influence of the operation on the central positioning of the femoral head was only slight. 81% of the diseased hip joints showed an enlarged acetabular entrance. The angle of the capitular epiphysis of the femur showed average values near the boundary to the predysplasia range (19.8 degrees). Objective total assessment (Bauer and Jünger 1974) yielded 45% good or very good results and 37% poor results. Basing on these results this surgical method can no longer be recommended.
Follow-up examinations of 37 out of a total of 56 intertrochanteric varisational and partly derotational osteotomies after an average period of 62 months showed more favorable results in all respects. The in-patient treatment period was on the average 15 weeks when using Schanz' screws. In fixation with AO angular plates, the average hospitalization period was 8 weeks (including the second stay in the hospital for the removal of the metal). The regeneration period of the necrotic femoral head was 18 months, and was, therefore, 7 months shorter than after the spiking or nailing operation. Most of the operations took place in the beginning rehabilitation phase (stage 3a), resulting in a below-average regeneration period. Physiological congruence was achieved in 24% of the cases, and deformations of the femoral head were seen in only 19% of the patients. In 62% of the cases, good central positioning of the femoral head was achieved, whereas in 68% the entrance of the acetabulum was wider than on the contralateral, healthy side. The improved head/acetabulum ratio was also documented in a postoperative increase of the angle of the capitular epiphysis to almost 24 degrees. The objective total assessment yielded 68% very good and good results, whereas 19% of the results were considered poor. Basing on the favorable roentgenological and also clinical results which are mainly confirmed by literature references, this method can be considered as the method of choice according to the present state of knowledge.
The postoperative clinical course and late x-ray results after plastic reconstruction of the cruciate ligament with a meniscus. Presented here are the postoperative results after plastic reconstruction of the anterior cruciate ligament with the medial meniscus. The periods of observation cover up to 29 years. 14 patients were personally re-examined, 3 were accounted for after answering a questionnaire. Only 2 cases showed severe instability and 13 cases gonarthrosis of varying degree. 13 cases were satisfied with the results of the operation. 16 patients were able to maintain their occupations, 5 changed their professions. The majority of patients is involved in athletic activity of wide variety, 6 participate in competitive sports.
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