[Chondrosarcoma--an easily treatable tumor?].
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Adolescent↗
Biomedical subjects
B Wippermann
Publications and source records attributed to B Wippermann.
Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients.
Early recognition of blunt abdominal trauma in patients with multiple injuries and in shock is of utmost importance and calls for a rapid screening method. The reliability of diagnostic ultrasonography in detecting hemoperitoneum in patients with multiple trauma was evaluated prospectively. From 1986 to 1990, 291 patients with severe multiple injuries (ISS greater than 20, mean ISS 31.2) were included in the study. Laparotomy was performed on 117 patients (40%). Initial ultrasound (US) findings showed a sensitivity, specificity, and accuracy of 89%, 97%, and 94%, respectively, in detecting intra-abdominal injuries requiring surgical repair. The positive and negative predictive values were 94% and 95%, respectively. A standardized management of frequent repeat US studies can even improve on these numbers. In our department ultrasonography has replaced diagnostic peritoneal lavage (DPL) as the diagnostic study of first choice. Diagnostic peritoneal lavage is reserved for selected cases only.
Abdominal Injuries↗
[Primary sonographic diagnosis and follow-up of muscular and tendon injuries of the lower extremity].
Ultrasound examination has become an important diagnostic method in muscle and tendon injuries. In addition dynamic ultrasound examination allows evaluation of the course of healing from various aspects. Starting with the sonoanatomy, the pathologic ultrasound patterns typical for injuries to muscle and to Achilles, patellar and quadriceps tendons are demonstrated. As complement to clinical examination, ultrasonography enables appropriate adaptation of the therapy concept to the course of healing. In the hands of experienced operators, ultrasound examination has reached a high level of sensitivity and specificity in these injuries and can justifiably be routinely performed.
Achilles Tendon↗
[Results of treatment of compartment syndrome of the upper arm].
Only a small number of cases of compartment syndrome in the upper arm has been reported in the literature. The authors have reviewed 14 patients with 14 cases of compartment syndrome treated at their institution from 1980 to 1988. In the majority of cases in this series, compartment syndrome was caused by blunt, high-energy trauma. There were 9 patients with multiple trauma, 7 of whom were motor cyclists, and fracture of the upper arm was present in most of these. In 5 patients scapulothoracic dissociation with disruption of the neurovascular bundle of the upper extremity concerned was present. In this series, 2 patients died of their injuries and three arms had to be amputated. At final follow-up after an average of 45 months (range 11-91 months) the functional result was dependent mainly on the severity of the associated injuries. Patients with isolated compartment syndrome had full recovery of upper limb function.
Adolescent↗
[Functional therapy in treatment of fractures and joint injuries].
Full and timely restoration of the function of an injured segment of the locomotor system is the treatment goal for all fractures and joint injuries. Functional aspects therefore have to be considered, when operative or conservative forms of treatment are chosen for a particular injury. We define a treatment as purely functional if the involved limb is either not immobilized at all or whenever the immobilization is incomplete and for a limited time only. At least partial function of the involved segment is therefore restored during the treatment. Purely functional treatment ist most applicable for stable fractures. Stable can be defined as the property of biological tissues to withstand physiological loads. Many joint injuries such as AC separation, ankle ligament rupture, Achilles tendon rupture, and isolated rupture of the medial collateral ligaments of the knee can also be treated functionally.
Braces↗
[Rupture of the fibular ligament of the upper ankle joint].
A prospective randomized trial was performed to compare conservative functional treatment and operative functional treatment for rupture of the lateral ankle ligament. On the basis of the results observed 1 and 2 years after injury, primary functional therapy with a orthetic support appeared to be the method of choice. In a 100-point clinical check-up scale we were not able to find any statistical differences between the treatments. This type of conservative treatment gives a high degree of mechanical stability, a shorter time off work and the ability to take a full, active part in sports within 3 months in all cases. Operative treatment is indicated only in cases of dislocation of the foot and ankle, ankle ligament rupture with additional osteochondral talus fracture, and second-stage injuries or reruptures.
Adult↗
[Management of sonography in blunt abdominal trauma].
A standardized management of sonography in blunt abdominal trauma has replaced peritoneal lavage in our department. The sonographic evaluation is performed simultaneously with additional diagnostic and therapeutic procedures in the emergency room. The primary goal is the exclusion of intraabdominal bleeding. The management and the results of the diagnostic procedure are presented with reference to a consecutive series of 314 patients with blunt abdominal trauma or polytrauma. In 71 patients, laparotomy was performed because the sonographic findings were felt to indicate it. Only in two cases was the sonographic assessment incorrect (false-positive). Frequent sonographic and clinical controls are required especially when sonography cannot totally exclude intraabdominal bleeding during the initial assessment. If any discrepancies between negative or uncertain sonographic and suspect clinical findings remain, further high-tech diagnostic methods or exploratory laparotomy become necessary.
Abdominal Injuries↗
[Therapy of fresh fibular ligament ruptures].
In a prospective, random study carried out at the Casualty Clinic of the University Hospital of Hannover from 15 April 1986 to 31 July 1986, 200 patients were randomly selected from four treatment groups, according to treatment: operative-immobilized (group A, n = 52), operative-functional (group B, n = 50), conservative-immobilized (group C, n = 48) and conservative-functional (group D, n = 50). Follow-up examinations were made in 92.5% of patients after 3 months and 64% after 12 months. At the 3-month and 1-year follow-ups, no statistically significant differences were found in the total evaluation (100-point checklist) Moderately significant instability (6 degrees -10 degrees talar tilt and 6-10 mm anterior talar dislocation) in the conservative groups C and D was observed only in the clinical-radiological instability test. This statistically significant difference is, however, only evident in stress tenographically confirmed dual-ligament lesions. No functional physiological differences can be found after 12 months; on average, the period of incapacitation is 3 weeks shorter than with primary functional treatment, but so far there are no long-term results. Until late results are available, we conclude that conservative treatment, even for professional athletes, can be recommended as the procedure most free of risk and most economical; if at all, operative therapy should only be carried out when the instability is very serious.
Ankle Injuries↗
Accuracy and reproducibility of a quantitative electrophoresis of plasma lipoproteins: interlaboratory comparison and verification by ultracentrifugation.
Fifty-three samples of sera from normal subjects and from patients with type IIa, IIb and IV hyperlipoproteinemia were shipped from Hannover to the collaborative laboratories in Vienna and Mannheim, which participated in the quantification of their lipoprotein fractions based on polyanion precipitation of electrophoretically separated lipoproteins followed by densitometric measurement of alpha-, prebeta- and beta-lipoproteins. Total serum cholesterol and cholesterol calculated from quantified lipoprotein fractions were highly correlated, the correlation coefficients ranged between r = 0.93-0.98. Furthermore, we found a high concordance comparing the beta-, and prebeta- and alpha-cholesterol with data obtained from lipoprotein fractionation and subsequent cholesterol measurement by ultracentrifugation. The obtained correlation coefficients were always higher than r = 0.91. High accuracy and reproducibility of the quantitative lipoprotein electrophoresis justify its recommendation for wide use in the field of clinical chemistry.
Cholesterol↗
[Sensorimotor potential of the intact and injured anterior and posterior cruciate ligaments--a neurophysiological study in an animal model].
AIM: This neurophysiological study is intended to investigate the sensomotor potential of the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) which may provide joint stabilization via a ligamentomuscular reflex arch. In addition, the role of ligamentous injury on the sensomotor potential has been investigated. METHOD: The sensomotor potential was investigated using 24 knee joints in a sheep model under in-vivo conditions. The cruciate ligaments were mechanically loaded and the muscular activities of the hamstrings and the quadriceps were recorded simultaneously via electromyography. Injury to the ligaments was simulated by defined mechanical elongation of the ACL and PCL to failure. RESULTS: The results confirm the hypothesis of the existence of a ligamentomuscular reflex loop between ligamentary mechanoreceptors and the joint-stabilizing muscles. Mechanical loading of the ACL triggered mainly the activity of the hamstrings, whereas loading of the PCL led to the activation of the quadriceps. The rate of elongation which caused disturbances to the sensomotor potential was significantly smaller as compared to the elongation to failure. CONCLUSION: The cruciate ligaments provide dynamic joint stabilization via a ligamentomuscular reflex arch. It was demonstrated that the sensomotor potential of both structures is significantly more susceptible to ligament injury than the biomechanical potential.
Animals↗