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Biomedical subjects

A Werner

Publications and source records attributed to A Werner.

At least 343 records · Page 19Linked to original sources
PubMedDate not supplied

[Medical-insurance aspects of atlantoaxial instability in children].

INTRODUCTION: An os odontoideum is mostly diagnosed coincidentally on the basis of neurological symptoms or painful movement of the cervical spine. Diagnostic work-up and therapy are currently subjects of controversial discussion in the literature. CASE: Our report is about an eleven-year-old boy with an unknown os odontoideum, who developed neurological symptoms with tetraparesis after a fall from 1.5 m height. Conventional X-ray examination resulted in the diagnosis of a suspected dens fracture, MRI showed atlanto-axial instability and an os odontoideum with significant dural sack compression but no signs of acute bony or ligamentous lesion. CONCLUSION: Because of the importance concerning not only medical but also legal/insurance aspects, a possible coincidental finding of an os odontoideum versus a dens fracture must be included in the differential diagnosis. In the case of an os odontoideum without instability in children, conservative therapy is justified after due enlightenment regarding possible risks. In the event of neurological symptoms and/or persistent instability the authors advocate early surgical stabilization even in patients with little infirmity, particularly in view of the possible consequences.

Accidental Falls↗
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[Self-training versus conventional physiotherapy in subacromial impingement syndrome].

AIM: This prospective, randomized study was aimed to compare the effect of a standardized self-training versus standard physiotherapist-supervised exercises in the non-operative treatment of shoulder impingement syndrome types Neer I and II. METHOD: 40 patients with subacromial impingement I/II were randomized to two groups. Group 1 performed a mostly isometric self-training after instruction by a physiotherapist, group 2 received prescriptions for physiotherapy and "strengthening exercises for the rotator cuff". Follow up was performed after 6 and 12 weeks with the use of the constant score (unpondered). Patient satisfaction with the treatment was controlled by VAS (1 - 6). RESULT: After 12 weeks, patients of group 1 had performed the exercises 5 x/week for 15 minutes. Patients of group 2 had received 30 sessions in average. Patients of group 1 improved from a mean of 59 points (39.5 - 86) to a mean of 68 points (37 - 88) after 6 and 75 points (65 - 90) after 12 weeks. Patients of group 2 improved from 60.5 points (41 - 83) to 67 points (39.5 - 92) and 72 points (43 - 93), respectively. Patient satisfaction was higher in the self-training group (1.9 : 2.8). CONCLUSION: Strengthening of the centering muscles around the humeral head leads to good results in the non-operative treatment of subacromial impingement. Self-training after instruction showed no difference to physiotherapist-supervised exercises in the non-operative treatment of subacromial impingement.

Adult↗
PubMedDate not supplied

[Primary synovial chondromatosis of the shoulder].

AIM: To demonstrate the various patterns of primary synovial chondromatosis (PSC) around the shoulder and to discuss a therapeutic algorithm. METHOD: In this retrospective study, 6 patients with histologically proven PSC were operated on. The diagnosis was based on clinical examination, plain X-rays, ultrasonography and MRI in 5/6 patients. Also, a histological examination was done in all cases. According to the localisation of the disease, surgery was done by endoscopy alone, endoscopy together with open surgery or direct open surgery. RESULTS: In one case each, we saw an isolated disease of the subacromial bursa or the gleno-humeral joint. In two cases, we found an intraarticular affection together with the biceps tendon sheath. The other two patients showed a massive periarticular deposition of loose bodies together with a defect of the rotator cuff. All patients with intraarticular disease (5/6) showed different stages of chondromalacia. In 5 of 6 patients all bodies could be removed at surgery. At follow-up after 36 months the patients subjectively rated the result as satisfactory to excellent. In the patients with total removal of the bodies, no recurrences were seen on plain X-ray or ultrasonography. CONCLUSION: PSC around the shoulder appears with a variable pattern. According to the possible late complications described in the literature (i. e., secondary osteoarthritis, involvement of the rotator cuff and secondary malignant transformation), we find operative treatment justified. Surgery addressing removal of loose bodies and partial synovectomy allows good results. The operative approach (endoscopy or open surgery) is related to the localisation and severity of the condition.

Adult↗
PubMedDate not supplied

[Advantages of biomatrices in chondrogenesis of pluripotent mesenchymal stem].

AIM: The autologous in vitro expansion of chondrocytes is a new method for the treatment of localized cartilage defect zones in humans. In the past several investigators have shown the occurrence of mesenchymal stem cells (MSC) in human bone marrow, periosteum and somite mesoderm. Moreover it has been shown that these progenitor cells are able to differentiate into chondral tissue under special in vitro conditions. The following study shows current possibilities and borders of a chondrogenetic stem cell therapy. Furthermore advantages and disadvantages of different cellular biomatrix carriers are described, cartilage tissue engineering-related problems are discussed and possible solutions were pointed out. METHODS: A literature investigation served for evaluation of the present clinical and experimental data. Furthermore our own cell culture experiences were considered. RESULTS: Until now there exists no clinical concept using the potential of MSC for cartilage tissue engineering. Reasons are the lack of biomechanical and histological stability and handling problems of the cultivated cartilage tissue, especially the difficulties to fix and secure the transplant in the cartilage defect zones in situ. CONCLUSION: The systematic investigation of biomatrices by chondrogenic progenitor cell culture systems may lead to important data for the evaluation of the chondrogenic potency biomatrices.

Cell Differentiation↗
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Joint preserving surgery for osteonecrosis and osteochondral defects after chemotherapy in childhood.

BACKGROUND: As a complication of chemotherapy/corticosteroids for the treatment of acute lymphoblastic leukemia (ALL) and other malignancies during childhood, avascular osteonecrosis appears in up to 30 % of the patients. Weight-bearing joints are involved in over 90 % of the cases. Total joint replacement is often necessary to restore function. Yet, endoprostheses in young patients again bare the risk of later complications and the need for several revision surgeries. In this report, joint preserving surgical strategies will be discussed. PATIENTS: Three hips and eleven knee joints in 8 patients (4 male, 4 female) were operated on for symptomatic ON and/or osteochondral defects (OCD) after chemotherapy. Four of the patients underwent surgery in more than one joint. The average age at the time of surgery was 18 years (range 14 - 26). The procedures included retrograde drilling (core decompression), bone grafting, implantation of collagen sponges with autologous bone marrow aspirate, osteochondral autograft transplantation and transplantation of periosteal flaps. Two hip joints underwent total joint replacement. Average follow up was 25 months. RESULTS: After an average follow up of 2 years, all patients were satisfied with the functional results after the last follow up with pain free walking for a minimum of 60 minutes. No night pain was reported. One patient complained about intermittent periods of dysaesthesia around the bone harvest area at the iliac crest. CONCLUSIONS: The aim of surgery for ON and OCD after chemotherapy should be the reduction of pain and preservation of the joint to bypass the risks of joint replacement in young patients, although total joint replacement may become indicated in endstage degeneration of the involved joint.

Adolescent↗
PubMedDate not supplied

[Long-term results (5 - 13 years) after surgical local repair and deltoid muscle flap for massive rotator cuff tears].

AIM: The functional long-term results of reconstructions of massive rotator cuff tears (Bateman IV) were evaluated and analyzed. METHODS: 38 patients (6 female/32 male) had a clinical and sonographical assessment and an evaluation of the Constant score after a follow-up of 81 (60 - 160) months. Operative procedures were direct transosseous refixation in 16, local tendon shifts in 17 and deltoid flaps in 5 patients. RESULTS: The average age and sex related Constant score was 77 %. The 5 patients with the deltoid flap achieved a Constant score of 60 %, all had a sonographically detected re-tear and 4 of them rated their result as only moderate. 25/33 patients with reconstruction (76 %) rated their result as good or excellent, 5 (15 %) as satisfactory, 1 (3 %) as moderate and 2 (6 %) as poor. 12 (36 %) of the 33 patients met the sonographic criteria of a re-tear. These patients had a Constant score of 71 %, whereas 21 (64 %) patients with intact reconstruction achieved a score of 85 %. CONCLUSION: The reconstruction of massive rotator cuff tears achieves good clinical long-term results if the tendons remain intact. But even with a recurrent defect, the results have been better than in patients treated with a deltoid flap. In massive rotator cuff tears a thorough selection of the operative procedure regarding atrophy and fatty infiltration of the rotator cuff muscles as well as the tendon retraction and quality is mandatory.

Adult↗
PubMedDate not supplied

Primary synovial chondromatosis of the elbow.

Very few cases of primary synovial chondromatosis of the elbow have been reported in the literature. This is a study concerning the late outcome of primary synovial chondromatosis in the elbows of 12 patients, 10 men and 2 women, with a mean follow-up of 16 years 10 months. The average age at the time of the initial complaint was 29 years. The histories of 10 patients revealed elbow strain as a consequence of work-related activities. Surgery included removal of loose bodies and partial synovectomy in all patients. A moderate to severe osteoarthritis was found preoperatively in 5 of 12 patients and during follow-up in 7 of 10 patients. The degree of osteoarthritis deteriorated after surgery in 5 of these cases, depending on patient age, length of presurgical history, length of follow-up, and strenuous activities. However, the functional deficiencies were usually moderate and had little significance with respect to the activities of daily living. No recurrence of primary synovial chondromatosis was found.

Activities of Daily Living↗
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Colostrum management in calves: effects of drenching vs. bottle feeding.

The objective was to examine whether the administration of colostrum by a drencher is a safe method to achieve satisfying immunoglobulin concentrations in newborn Holstein Friesian (HF)-calves. Twenty-one calves were fed 1 h postnatum with 2 l colostrum from their dam using a nipple bottle (group I); 15 calves were drenched with 4 l colostrum from their dam 1 h postnatum (group II). Thereafter, all calves were fed milk replacer exclusively. Serum concentration of total immunoglobulin [analysed by Sandwich-enzyme-linked immunosorbent assay (ELISA)] 24 h postnatum was higher in drenched calves (25.2 g/l; 12.8/52.2; median and 10/90 percentiles) compared with bottle-fed calves (14.1 g/l; 9.2/24.7). To characterize the kinetics of immunoglobulin absorption, 17 blood samples were taken frequently within 72 h postnatum using a jugular catheter in five calves fed 2 l colostrum by nipple bottle and five calves drenched with 4 l colostrum 1 h postnatum. A slightly delayed increase of serum immunoglobulin concentration (approximately 3 h) was obvious in drenched calves compared with bottle-fed calves, but drenched calves reached significantly higher immunoglobulin concentrations compared with bottle-fed calves. It is concluded that the proper application of colostrum by a drencher is a useful method for adequate colostral supply in newborn calves. The failure of the oesophageal groove reflex in drenched calves caused no clinical consequences.

Animals↗
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R4 peptide-pDNA nanoparticle coated HepB vaccine microparticles: sedimentation, partitioning, and spray freeze dry bioprocesses.

Broad therapeutic application of nucleic acid micro- and nanoparticles will require bioprocesses capable of achieving high loads of structurally intact and functionality active DNA. Here we report condensation of pDNA into nanoparticles by sedimentation through R4 peptide and partitioning at a hydrophobic interface. > or = 90% coating efficiency onto microparticles is achieved via this combined bioprocess with the pDNA retaining 85-90% intact supercoil after bioprocessing. SEM analyses of the microparticles produced therefrom reveals bound pDNA and R4 peptide nanoparticles. HPLC and chemical analyses afford quantification of the particle-associated pDNA and R4 peptide along with lactose, raffinose, or trehalose carbohydrate stabilizer, surface coatings uniformly applied by spray freeze-drying. Administration of these particles by gene gun demonstrates delivery to the nucleus of expressive nanoparticles and into rodents and pigs pronounced immunogenicity even after bioprocessing and accelerated degradation. These data support the discovery of a robust bioprocess platform for preparing macromolecule bound bioparticles with potential relevance beyond simple preparation of bioactive DNA vaccine.

Coated Materials, Biocompatible↗
PubMedDate not supplied

The stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. A histoanatomic study.

A histoanatomic study of the rotator cuff interval was done in 13 cadaveric specimens to investigate the relation of its ligamentous structures to the long head of the biceps tendon, with a special focus on revealing a stabilizing function. After macroscopic evaluation, the lateral half of the rotator cuff interval capsule was cut into three sections: medial, middle, and lateral. These sections were embedded in methacrylate, and then serial sections were made and stained for polarized light microscopy. The superior glenohumeral ligament was seen to form a fold having the macroscopic appearance of a U-shaped anterior suspension sling for the long head of the biceps tendon. Microscopic evaluation revealed an important role of the fasciculus obliquus in the roof of this sling. Fibers of the supraspinatus tendon join the posterosuperior part of the sling. The subscapularis tendon is not involved in this suspensory mechanism. As a result of these observations, we determined that the superior glenohumeral ligament and the fasciculus obliquus are the most important ligamentous reinforcements of a stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. Their histologic appearance indicates they function to protect the long head of the biceps against anterior shearing stress. A lesion of this sling might lead to anterior instability of the biceps tendon.

Adult↗
PubMedDate not supplied

[The effect of temperature on preservation of swine articular cartilage--an NMR study].

The influence of temperature on stored porcine articular cartilage was studied and the factors underlying degradation identified. For these investigations, specimens measuring 18 mm in diameter were punched out of the articularis humeri of juvenile pigs. These samples were investigated by MR microimaging immediately after preparation, and after storage for three days at +4 degrees C and -18 degrees C. Five smaller (3 mm) cylindrical specimens were then obtained and compared with one another using MR-spectroscopy, relaxometry and biochemical assays. From the experiments we conclude that all analytical methods--with the exception of MR microimaging--are capable of detecting changes in cartilage, and that it is not advisable to keep cartilage frozen, since marked changes, presumably at the cellular level, occur. Storage at +4 degrees C also requires the use of preserving chemicals, as otherwise, the polymers of the extracellular matrix degrade.

Animals↗
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Psychiatric services in a rural general hospital.

Rural areas face severe problems related to the inadequate distribution of psychiatrists. This paper describes a model of inpatient psychiatric care in a rural general hospital which has successfully overcome many of the constraints of the rural setting using a four member psychiatric consultation team. Using the medical community and its resources as the basis for care, a strong emphasis is also placed on continuing education for care providers. Important factors in the system include allowing all physicians to admit and care for psychiatric patients and the use of the emergency room physicians as interim admitting doctors when patients have no family physician. Other factors in the program are discussed. Problem areas have included continuity of care and treatment of certain types of patients. The results of the project have been an increase in the number of psychiatric patients admitted (140 to 268 per year) and a decrease in the number of patients sent to the state institution. Consultations requested on non-psychiatric patients, including children have increased from thirty-five to sixty-seven per year. Most patients now remain in the care of their own physicians throughout a mental illness episode. Cooperation between community practitioners and the center staff has improved. With increased skill, center and community physicians have shown greater self sufficiency in working with hospitalized patients and their families.

Adolescent↗