Patients' own ability to assess activity of their rheumatoid arthritis.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
A Wild
Publications and source records attributed to A Wild.
Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis.
Treatment of slipped capital femoral epiphysis (SCFE) is still controversial. Agreement has not yet been reached on the appropriate time to perform surgery, the necessity of repositioning manoeuvres, the type of implants for stabilisation, or the need for prophylactic treatment of the contralateral side. In this retrospective study, we present 29 patients with unstable (acute and acute-on-chronic) SCFE treated by internal fixation of the epiphysis with three or four Kirschner wires both therapeutically on the affected side and prophylactically on the not (yet) affected side. After hardware removal and mean follow-up of 3.5 years, radiological and clinical examination of hip function was carried out. X-ray in two planes showed no incidence of any slip progression. Applying the score used by Heyman and Herndon, 18 results (62.1%) were classified as excellent, nine (31.1%) as good, one (3.4%) as fair, and one (3.4%) as poor. The rate of severe complications such as chondrolysis and avascular necrosis of the femoral head was low in our series (0% and 6.8%, respectively). This form of therapeutic management shows good clinical results with low complication rates. The slip can be efficiently stabilised, progression is reliably prevented, and remodelling of the joint gives the patient good overall hip function. We see no indication for emergency surgery.
Adolescent↗
[Surgical therapy for spondylolysis and spondylolisthesis].
The therapy for spondylolysis and spondylolisthesis is challenging in view of the large variety of treatment options. A general, standardized therapeutic concept has still not been established. Adequate therapy depends on different parameters and personal experience. Beside direct repair surgery of spondylolysis and low grade spondylolisthesis, dorsal, ventral and combined dorsoventral surgery, with or without instrumentation, are indicated depending on patients age and severity of the slip. Complications such as pseudarthrosis and progression of the slip develop in a given percentage of cases, but these are not significantly correlated with clinical symptoms. Decompression is necessary in high grade slippage with neurologic impairment, especially paresis. Reposition is associated with a higher risk of neurologic complications. Fusion in situ without instrumentation, even in moderate and severe spondylolisthesis, shows good clinical results with high fusion rates and without the increased risk of progression and pseudarthrosis. In many cases, it is an effective, safe and economic therapeutic option.
Adolescent↗
[Bone harvesting from the iliac crest].
BACKGROUND: Autogenous bone grafts from the iliac crest are frequently harvested for autologous bone transplantation. Although an autologous bone transplant does improve the local bone healing potency, significant donor site morbidity must be considered. METHODS: In this study we elucidate special bone harvesting techniques from the iliac crest and review the literature related to clinical significance of donor site morbidity. Furthermore, our own experiences are compared and discussed critically with relevant data of other investigators. RESULTS: The increasing number of scientific publications which focus on bone harvesting techniques and related complications in recent years indicate the high interest and relevance of this issue. There is a tendency to alternatives such as biomaterials as bone substitutes, whereas the role of growth factors and cell therapeutics in the treatment of bony defects are still being evaluated in clinical studies. CONCLUSION: Although autologous, heterotopic bone transplantation is still the gold standard in the treatment of bony defects, there is a tendency towards the application of biomaterials, stem cells, and growth factors. Conscientious observation of relevant anatomic considerations during bone harvesting procedures may help to avoid complications.
Adolescent↗
Surgical treatment of congenital pseudarthrosis of the clavicle: a report of three cases and review of the literature.
Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology with predominance of the right side. Our therapeutic concept is discussed with special reference to surgical therapy, histopathological findings and the most recent literature. Two girls and one boy, aged 4, 6, and 8 years, presenting with congenital pseudarthrosis of the clavicle were surgically treated between 1994 and 2000. A resection of the pseudarthrosis and internal fixation with a small reconstruction plate was performed. A bone graft from the iliac crest was used for restoration of clavicular length. Histological examination revealed a false joint with the ends of the clavicle covered by hyaline cartilage. The patients showed radiographic healing after 12 weeks. At follow-up (mean 44 months), all patients showed excellent clinical and radiological results without functional impairment. The clinical features and histological examination of the resected pseudarthroses clearly proved the diagnosis of a true congenital pseudarthrosis of the clavicle. According to our clinical and radiological results and considering the recent literature, we recommend surgical therapy with resection, bone grafting, and osteosynthesis with a reconstruction plate around the age of 4 - 6 years.
Bone Transplantation↗
[Prospective screw misplacement analysis after conventional and navigated pedicle screw implantation].
BACKGROUND: [corrected] The aim of this prospective study was (1) to evaluate the accuracy of pedicle screw placement using Computer - Assisted Orthopedic - Surgery (CAOS) in comparison to conventionelly image intensifier controlled pedicle screw instrumentation, (2) to compare our results with data from literature and (3) report our experiences with this technique. PATIENTS AND METHODS: Between 11/00 and 11/01 sixteen patients planned for spine surgery were subsequently recruited. Pedicle screw instrumentation was done in each patient as well with computer aided surgery (CAOS, SurgiGate-System, Medivision, Stratec Medical, Swiss) as also with image intensifier control, allowing for intraindividual comparison. Evaluation of pedicle screw placement was carried out with postoperative computed tomography (CT) or magnetic resonance imaging (MRI). RESULTS: 33 of altogether 36 pedicle screws inserted with Computer-Assistance (CAOS) were correctly placed (91,7%), however only 17 of altogether 24 pedicle screws inserted under image intensifier control (70,8%). The difference of frequency of screw misplacement between Computer-aided and image intensifier controlled instrumentation was statistically significant (p<0.05; chi-square test). CONCLUSION: Computer assisted surgery reduces significantly the misplacement rate of pedicle screws and remains for experienced spine surgeons an important support in the operative treatment of complex spinal deformities in future. Additionally it can be expected that Computer-Navigation will also spread out in the field of minimal-invasive spinal surgery, e.g. the kyphoplasty. The use of this technique supports beside the medical-technical knowledge an improved three-dimensional orientation in the education of spine surgeons.
Artificial Intelligence↗
[Retransfusion of unwashed drainage blood after total hip and knee arthroplasty].
The method of retransfusion of drainage blood as known from the literature was investigated in a prospectiv study regarding effectivness and rate of side effects. 200 patients who underwent total hip and knee arthroplasty were investigated concerning hemoglobin, hematocrit, amount and quality of the retransfused drainage blood, the amount of autologous and homologous transfusions as well as complications and costs. 100 of these patients were selected as the control group. The amount of the retransfused drainage blood after hip arthroplasty amounted an average of 387 +/- 194 ml and after knee arthroplasty 595 +/- 250 ml. The retransfused blood had an average hemoglobin of 5,2 +/- 0,9mmol/l with a hematocrit of 0,24 0,05. No complications directly associated to the retransfusion were found. The need of transfusion was reduced for patients with knee arthroplasty about 30% and for hip arthroplasty about 25%. The retransfusion of unwashed drainage blood is a sufficient method to reduce perioperative homologous blood transfusion in patients with arthroplasty of hip and knee. Substantial complications were not observed, so that this method seems to be save enough for clinical usage. The method is easy to handle and usable without special technical devices. The autologous retransfusion of drainage blood can contribute to lower costs in patients treatement.
Aged↗
[Multiple endocrine neoplasia type 1. Surgical therapy of primary hyperparathyroidism].
Primary hyperparathyroidism (pHPT) occurs in about 90% of patients with multiple endocrine neoplasia type 1 (MEN1). In contrast to sporadic pHPT, multiple gland disease is most common in MEN1. The appropriate surgical approach is still controversial. The aim of this study was to analyze the results of surgical therapy of pHPT in patients with genetically confirmed MEN1. In an observational study, preoperative data, operative procedures, long-term results, and a possible genotype-phenotype correlation were analyzed in patients with pHPT and genetically confirmed MEN1. According to our results, tPTX+T (total parathyroidectomy+thymectomy+autotransplantation) seems to be a more favorable surgical approach in patients with MEN1 pHPT than sDE (selective gland exstirpation) and stPTX (subtotal parathyroidectromy) without cervical thymectomy, because recurrences or persistence of the disease are rare. A prospective randomized trial is needed to compare stPTX including cervical thymectomy vs tPTX+T. A genotype-phenotype correlation could not be identified.
Chi-Square Distribution↗
[How reliable are data from 3d-gait analysis].
AIM: The aim of the present study was to collect preliminary data to determine the test-retest reliability in healthy subjects using 3-dimensional computerised gait analysis. METHOD: Ten healthy subjects (6 females, 4 males) were tested using a 3-dimensional computerized gait analysis system (VICON 512, Oxford Metrics). There were two trials within a 2-hour period in which kinetic, kinematic and time-distance data were collected. Markers were removed after the first trial and reapplied for the second trial and Pearson's correlation coefficients were calculated. RESULTS: The correlation coefficients were all positive and high for time-distance (r = 0.86-0.99), sagittal plane kinematics (r = 0.86-0.98) and power (r = 0.90-0.98) parameters, indicating excellent reliability of these measures. Correlation coefficients for frontal and transverse plane kinematics were lower (r = 0.59-0.89). The lowest correlation coefficient values were obtained for transverse plane measures at the hip joint indicating poor reliability of this measure in healthy subjects. CONCLUSION: The results suggest excellent test-retest reliability using 3-dimensional computerized gait analysis, especially in the sagittal plane. Therefore this method is a very valuable tool in the analysis as well as in the outcome evaluation of conservative and operative procedures in movement disorders
Adult↗
[Variations of superficial nerves at the pelvis considering orthopaedic surgical approaches].
PROBLEM: Intraoperative injuries of vessels and nerves are common risks and repeatedly described in orthopaedic pelvic surgery. Especially in pelvic osteotomies or bone harvesting procedures subcutaneous nerves are at risk for damage. In this study we elucidated the variations of subcutaneous nerves by anatomic preparation exposure with regard to the anterior and posterior spines. METHODS: To investigate the different anatomic variations the iliohypogastrical, lateral cutaneous, subcostal and the cluneal nerves of 10 human cadavers were prepared and exposed bilaterally at the anterior, lateral and posterior pelvic region. For determination of anatomically important reference points the distance of these structures to the anterior superior spine was measured and compared with present datas in literature with respect to the ilioinguinal (Letournel) and iliofemoral (Smith- Petersen) approach. RESULTS: We found a high variability of superficial pelvic nerves. Our findings differ somehow with datas of recent papers. CONCLUSION: The findings of our study stress the importance of basic knowledge and thorough preparation in surgical procedures at the pelvis including harvesting bone grafts to minimize donor site morbidity.
Bone Transplantation↗
[Growth behaviour of human mononuclear cells derived from bone marrow and cord blood on a collagen carrier for osteogenic regeneration].
UNLABELLED: We investigated the biocompatibility and osteogenetic potency of a porcine collagen I/III carrier in a human bone marrow and cord blood cell culture system. METHODS: Human mesenchymal mononuclear cells were isolated from cord blood and iliac crest bone marrow and cultivated in various cell densities on a semipermeable porcine collagen I/III carrier. After 14 days of in vitro cultivation both cultures were subjected to osteogenic stimulation by dexamethasone, ascorbic acid and beta-glycerol phosphate (DAG) until day 40. Semiquantitative immunochemical evaluation based on osteoblastic and progenitor cell markers was then done. RESULTS: With regard to the minimal local cell density required for growth and osteogenic differentiation, cord blood derived progenitor cells showed lower tolerance in comparison with bone marrow derived cells. For both cell culture systems three-dimensional growth and calcification within the collagen fibres were seen after osteogenic stimulation. CONCLUSION: Human cord blood and bone marrow derived mesenchymal stem cell are capable of differentiating into osteoblasts after incubation with a collagen I/III biomaterial.
Animals↗
Magnetic resonance imaging after reduction for congenital dislocation of the hip.
BACKGROUND: Reliable concentric reduction of the femoral head and subsequent retention in a centred position are indispensable preconditions for the remodelling of the acetabulum in developmental dysplasia of the hip (DDH) and to prevent damage to the hip joint, i.e. avascular necrosis. The objective of this study is to evaluate the necessity of verifying the reduced position of the articulation in the plaster cast. METHOD: MRI was carried out in 15 infants with 21 unstable hip joints after reduction under arthrographic control and fixation in a plaster cast in the 'human' position with the hips flexed above 90 degrees and abducted to 50 degrees or 60 degrees. When the reduction was found to be inadequate-the hip still partially or completely dislocated-the plaster cast was removed, reduction repeated, a new cast applied, and MRI carried out again. RESULTS: After primary reduction, 1 of 21 hips was dislocated, and 2 showed unsatisfactory reduction. Three hip joints out of 21 (14.3%) were not fixed in the plaster cast in the optimal centred position. CONCLUSION: In view of the number of inadequate reductions in plaster casts, we recommend verifying the position of the hip joint by MRI. This MRI documentation should be established as a standard examination post-reduction.
Casts, Surgical↗
Prevalence of multiple endocrine neoplasia type 1 in young patients with apparently sporadic primary hyperparathyroidism or pancreaticoduodenal endocrine tumours.
BACKGROUND: The appropriate treatment for a sporadic endocrine tumour may be different from those that present as part of the multiple endocrine neoplasia type 1 (MEN1) syndrome. As primary hyperparathyroidism (pHPT) and pancreaticoduodenal endocrine tumours (PETs) are the most common organ manifestations of MEN1, the prevalence of germline mutations in the MEN1 gene was determined in young patients with apparently sporadic pHPT or PETs. METHODS: Eighteen of 705 patients with pHPT and 11 of 93 patients with PETs operated on between 1987 and 2001 had no family history of MEN1, only one organ manifestation and were aged 40 years or less at the time of diagnosis. Fifteen patients with pHPT and eight with PETs agreed to MEN1 gene mutation analysis, which was performed by single-strand conformational variant analysis and direct DNA sequencing. RESULTS: Two of 15 patients (13.3 (95 per cent confidence interval (c.i.) 1.6 to 40.4) per cent) with apparently sporadic pHPT had a MEN1 germline mutation. Both mutations were found in patients with pHPT due to multiglandular disease, whereas the remaining 13 patients had a solitary adenoma. None of the eight patients with PETs carried a MEN1 germline mutation. CONCLUSION: Sporadic pHPT due to multiglandular disease in patients younger than 40 years may represent the first organ manifestation of MEN1 despite a negative family history.
Adolescent↗
[Nonoperative treatment in Legg-Calvé-Perthes disease].
There is still discussion about the indication for and modalities about treatment of Perthes'disease. The main objective of treatment in Perthes'disease is prevention of deformation and malalignment of the hip joint. Most important for the evaluation of any therapy is the long term outcome, therefore we present this retrospective study on nonoperative treatment of perthes disease with orthoses compared to the natural history. 54 Patients with 59 involved hips, treated between 1945-1975 were clinically and radiologically evaluated. We divided the patients into two subgroups: Group 1 with nonoperative therapy. Group 2 with no therapy. The outcome shows correlation of the results with the degree of malalignment and necrosis. There was no statistically significant correlation between the two groups, but a slightly better outcome in the non-operative group compared to the natural history. The use of orthosis may be justified if there is improvement of the containment and reduction of the femoral head, otherwise surgical treatment like pelvic- and hip osteotomies to realign the hip joint should be considered.
Adolescent↗
[Ultrasonographic evaluation of the rotator cuff after shoulder arthroplasty].
AIM: Ultrasonography of the rotator cuff tendons is a standard imaging technique. Although increasing numbers of shoulder arthroplasty are performed, there is no available data concerning the use of ultrasound after shoulder replacement. Our experimental study was performed to analyse the value of ultrasonography after shoulder arthroplasty a) in an ex-vivo-setting and b) in a retrospective analysis of our patients after shoulder hemiprothesis. METHOD: After defrosting, anatomic modular humeral head replacement was performed in four fresh-frozen specimens with intact rotator cuffs. The supraspinatus and subscapularis tendons of each specimen were either detached to simulate a cuff defect or reattached anatomically (four times per specimen). Two experienced examiners then performed ultrasonography to evaluate the two tendons to be either intact or deficient. In a retrospective study, 22 patients with 25 hemiprotheses of the shoulder underwent clinical and sonographic examination. For documentation of the clinical findings, the Constant score was used. RESULTS: In the cadaver study, the reliability of the method was slightly higher for the subscapularis tendon (13 correct, 3 false results) than for the supraspinatus tendon (12 correct, 4 false results). In our patients, rotator cuff defects and effusions around the biceps tendon and in the subdeltoid bursa could be detected. Normal sonograms correlated with good clinical results. CONCLUSION: In the cadaver study, we found a good reproducibility of in-vivo conditions. We believe that ultrasonography is beneficial in follow-up evaluation after shoulder arthroplasty.
Arthroplasty↗
Influence of different culture solutions on osteoblastic differentiation in cord blood and bone marrow derived progenitor cells.
Mesenchymal progenitor cells derived from cord blood (unrestringated somatic stem cells, USSC) and bone marrow (mesenchymal stem cells, MSC) are able to differentiate under defined culture conditions into at least bone, cartilage, adipose and muscle cells in vitro. The culture media and other in vitro conditions influence the osteogenic differentiation potency of both cell types. To increase and expand the number of osteoblasts in vitro an optimization of culture conditions is required. The aim of this study was to evaluate different culture media toward their osteogenic promoting capacity on human USSCs and MSCs in vitro. Immunohistochemical stainings against osteonectin (ON), osteopontin (OP) served as markers for an osteoblastic differentiation. Cellular morphology was analysed by light microscopy technique. We found significant differences between bone marrow and cord blood derived stem cells towards an osteoblastic differentiation. Considering the number of osteoblasts MesenCult seems to have advantages in bone marrow progenitor cells, whereas low glucose DMEM and HAMS-F12 promoted an osteoblastic differentiation in cord blood derived cells more than other tested media.
Cell Culture Techniques↗
The value of ultrasound after shoulder arthroplasty.
OBJECTIVE: This study was undertaken to evaluate whether sonography is a useful tool in the diagnosis of soft tissue disorders as a possible cause for discomfort and/or pain after shoulder arthroplasty. DESIGN AND PATIENTS: Static and dynamic ultrasound examinations were performed in the standard sectional planes on 22 patients with 25 hemiprostheses and the results were correlated with the clinical outcome. The stability was determined in the transverse and frontal planes and the clinical results were evaluated according to the Constant and Swanson scores. RESULTS: Several pathological changes were detected: rotator cuff lesions, subdeltoid bursitis, changes around the long biceps tendon as well as an increase in intra-articular volume due to effusion and/or synovitis. The correlation of sonographic and clinical results demonstrated that patients with an excellent clinical result showed no or only a few pathological findings on sonography compared with those with a moderate or poor result. CONCLUSION: Pathological changes of the periarticular tissue in the direct neighbourhood of the implant can be detected by sonography, which can be recommended as a valuable examination technique to evaluate the soft tissue in patients after shoulder arthroplasty.
Adult↗
[Acute low back pain with progressive sensorimotor paralysis. Differential diagnosis and therapy of acute decompression disease].
HISTORY AND CLINICAL FINDINGS: A 38-year-old man presented with acute low back pain and paraesthesia in dermatome S1. 4 hours before onset of symptoms he had finished the last of three scuba dives with a maximum depth of 30 m and a total diving time of 3 hours. No alcoholic beverages were taken during or before diving. The patient was complaining of local pain in the thoracic and lumbar spine and showed a 3/5 weakness of the big toe and impaired sensitivity in the S1 dermatome. 90 minutes later the patient developed a hemiparesis of the right side including hypaesthesia and additional meningism (stiff neck). INVESTIGATIONS: The X-rays of the thoracic and lumbar spine in two standard planes, cerebrospinal fluid examination, a cranial spiral-computer tomographie (CCT) and laboratory investigations showed no pathologic values. DIAGNOSIS: Acute decompression sickness (DCS) type II. TREATMENT AND COURSE: The patient received an intravenous infusion, antiinflammatory prophylaxis with dexamethasone and an immediate submission to hyperbaric oxygenation therapy. Complete recovery of neurological symptoms appeared after 4 decompression sessions in a hyperbaric chamber. CONCLUSIONS: In patients presenting low back pain as common symptoms the differential diagnosis needs to be worked out and DCS should be included especially if progressive neurologic deficits are present. Only emergency hyperbaric oxygen therapy can compromise a sufficient therapy of these patients.
Acute Disease↗