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Biomedical subjects

C Gerber

Publications and source records attributed to C Gerber.

At least 37 records · Page 2Linked to original sources
PubMed1998

Patient-controlled interscalene analgesia with ropivacaine after major shoulder surgery: PCIA vs PCA.

We have compared the efficacy of patient-controlled interscalene analgesia (PCIA) using ropivacaine with patient-controlled analgesia (PCA) using nicomorphine in 60 patients (n = 30 in each group), in a prospective, randomized study. In both groups, all patients received interscalene block with 0.75% ropivacaine before induction of anaesthesia. Six hours after interscalene block, patients in group PCIA received continuous infusion of 0.2% ropivacaine at a rate of 5 ml h-1 with a bolus dose of 3 or 4 ml and a lockout time of 20 min; patients in group PCA received continuous infusion of nicomorphine 0.5 mg h-1 and a bolus dose of 2 or 3 mg with a lockout time of 20 min. Control of pain was significantly better from 12 to 48 h after operation (except at 42 h) in group PCIA. Nausea and pruritus occurred significantly more frequently in group PCA. Patient satisfaction was greater in group PCIA. We conclude that the use of 0.2% ropivacaine using PCIA was an efficient way of managing pain after major shoulder surgery and compared favourably with PCA nicomorphine in terms of pain relief, side effects and patient satisfaction.

Adolescent↗
PubMed1998

Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging.

RATIONALE AND OBJECTIVES: The purpose of this study was to establish a magnetic resonance (MR) imaging standard for quantification of the muscles of the rotator cuff. METHODS: Parasagittal T1-weighted turbo spin-echo images of the shoulder were obtained in 70 asymptomatic subjects (35 women, 35 men; age range: 21-70 years, mean: 45 years). Standardized cross-sectional areas (rotator cuff muscle areas divided by the area of the supraspinatus fossa) and standardized signal intensities (related to signal intensities of the teres major muscle) were measured and compared with 30 patients with different stages of rotator cuff tears and 10 patients with glenohumeral instability. In addition, a so-called tangent sign was evaluated with the hypothesis that a healthy supraspinatus muscle crosses a line (tangent) drawn through the superior borders of the scapular spine and the superior margin of the coracoid. RESULTS: Cross-sectional areas of the muscles of the rotator cuff were variable in asymptomatic subjects. Cross-sectional areas (but not signal intensities) did discriminate patients with different stages of rotator cuff tears from asymptomatic subjects. The tangent sign was negative in all asymptomatic subjects but positive in four and nine of 10 patients with medium and large rotator cuff tears, respectively. CONCLUSIONS: A method for quantification of the muscles of the rotator cuff using MR imaging is presented. Cross-sectional areas can be used for quantification of the muscles of the rotator cuff. The tangent sign is a useful MR sign for atrophy of the supraspinatus muscle.

Adult↗
PubMed1998

Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography.

OBJECTIVE: The purpose of this study was to assess the diagnostic role of MR arthrography in patients with tendinopathy or rupture of the long biceps tendon. MATERIALS AND METHODS: MR arthrograms of 42 consecutive patients with arthroscopic or surgical confirmation of diagnosis (16 normal biceps tendons, 19 with tendinopathy, and seven with ruptures) were analyzed independently by two radiologists. Visibility of the biceps tendon, caliber changes, contour irregularities, and signal intensities were assessed separately in the parasagittal and axial planes. In addition, the two radiologists made an overall evaluation of abnormalities of the biceps tendon using both MR imaging planes. RESULTS: The most reliable MR findings for tendinopathy were caliber changes (sensitivity was 59% for observer 1 and 82% for observer 2; specificity was 88% and 64%, respectively) and signal abnormalities (sensitivity, 77% and 88%, respectively; specificity, 75% and 43%, respectively) in the parasagittal plane. Absence of visualization of the tendon in the parasagittal plane was a reliable sign for rupture (sensitivity, 86% and 86%, respectively; specificity, 94% and 87%, respectively). The overall sensitivity for detecting abnormalities (tendinopathy or rupture) was 92% for observer 1 and 89% for observer 2. Specificity was 56% and 81%, respectively. CONCLUSION: MR findings of tendinopathy and rupture of the biceps tendon are subtle. However, the combination of several MR criteria in two imaging planes makes a reasonably accurate diagnosis possible. The biceps tendon should not only be assessed in the bicipital sulcus on axial images but also on parasagittal images.

Adult↗
PubMed1998

[Clinical examination of the shoulder].

The clinical examination is decisive in the diagnosis of shoulder pathologies. This examination should be exact and systematic and in relation with the anatomical structures. With patient history, the clinical examination allows in over 90% of the cases a correct diagnosis. Complementary exams such as standard X-rays, CT-Scan, MRI and neurological examinations serve to confirm the diagnosis and to allow precise surgical planning.

Diagnostic Imaging↗
PubMed1998

[Classification and therapy of the unstable shoulder].

Instability of the shoulder can be classified as uni- or multidirectional with or without general hyperlaxity. Instability of a shoulder without hyperlaxity is often caused by a single traumatic event for the unidirectional instability and by two or several different events for the rarer multidirectional instability. The diagnosis of unidirectional instability is made with a positive apprehension test. For multidirectional instabilities, the anterior and posterior apprehension tests are positive. The treatment consists of surgical repair of the labrum-capsule complex for both the uni- and the multidirectional instabilities without hyperlaxity. For shoulders with a concomitant hyperlaxity, uni- or multidirectional instability is often caused by only minor trauma. Hyperlaxity itself is not a disease but represents a risk factor of instability. The typical feature of hyperlaxity is the positive "sulcus sign". Unidirectional instability with hyperlaxity is characterised by a positive apprehension test combined with a positive sulcus sign. Multidirectionally unstable shoulders with hyperlaxity have a positive anterior and posterior apprehension test as well as a positive sulcus sign. The unidirectional instability with hyperlaxity is best treated surgically whereas conservative treatment is recommended for the multidirectional instability with hyperlaxity. The voluntary instability without loss of control of position of the shoulder is not a real instability and has an excellent prognosis without treatment.

Chronic Disease↗
PubMed1997

Evidence for the activation of myeloperoxidase by f-Meth-Leu-Phe prior to its release from neutrophil granulocytes.

Activity and release of myeloperoxidase (MPO) was measured in heparinized whole blood samples after activation of neutrophil granulocytes by the chemoattractant N-formyl-methionyl-leucyl-phenylalanine (fMLP) using two different methods: (i) by determination of the amount of MPO released into the blood plasma using a MPO enzyme-immunoassay, and (ii) simultaneously, by measuring the remaining activity within the neutrophils by flow cytometry using the Bayer Technicon H3. Although a part of MPO was released immediately after addition of fMLP, remaining MPO activity within the neutrophils surprisingly increased during the first minutes after incubation. Subsequently, MPO activity dropped due to a continuous release of MPO. In addition to fMLP, granulocyte-macrophage colony stimulating factor (GM-CSF) enhanced MPO activity in neutrophils. These results indicate that MPO is present in resting granulocytes in an inactive or only partially active form and is activated by fMLP and GM-CSF.

Adult↗
PubMed1997

Tendon transfers for the treatment of irreparable rotator cuff defects.

Certain defects of the rotator cuff musculotendinous units cannot be repaired. If restoration of strength is an important treatment goal, then tendon transfers must be considered for palliation. In this article, the anatomical and physiological bases for tendon transfers are discussed, and currently known results with this form of treatment are reviewed.

Humans↗
PubMed1997

Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia.

BACKGROUND: The authors compared patient-controlled interscalene analgesia (PCIA) with local anesthetics with intravenous patient-controlled analgesia (PCA) with opioids to manage postoperative pain after major shoulder surgery. METHODS: Forty patients scheduled for elective major shoulder surgery were prospectively randomized to receive either PCIA or PCA. Before surgery, all patients had an interscalene block. In the PCIA group, a catheter was introduced within the interscalene sheath. Six hours after the initial block, patients received for 48 h either a continuous infusion of 0.15% bupivacaine through the interscalene catheter at a rate of 5 ml/h plus a bolus of 3 or 4 ml with a lock-time of 20 min (group PCLA) or a continuous intravenous infusion of nicomorphine at a rate of 0.5 mg/h plus a bolus of 2 or 3 mg with a lock-time of 20 min (group PCA). Pain relief was regularly assessed using a visual analog scale, side effects were noted, and the patients were asked to rate their satisfaction at the end of the study. RESULTS: Pain relief was significantly better controlled in the PCIA group at t = 12 and 18 h (P < 0.05). Vomiting and pruritus were 0 versus 25% and 0 versus 25% for the PCIA and PCA groups, respectively (P < 0.05). Patient satisfaction was greater in the PCIA group (P < 0.05). Time of first bolus administration and paracetamol supplement were similar in both groups. CONCLUSIONS: The use of the PCIA technique was uncomplicated and provided better pain relief than PCA during the first 18 h after operation. The incidence of side effects such as vomiting and pruritus was significantly decreased with the use of PCIA, and patient satisfaction was superior in the PCIA group.

Analgesia, Patient-Controlled↗
PubMed1996

[Assessment of shoulder pain in athletes].

The shoulder joint, the most movable joint in our body, is exposed to a considerable load during many sporting activities. The shoulder can be injured and limited in its function not only by direct and indirect trauma but also by repetitive load. Sports with body contact may cause bruises, glenohumeral and acromio-clavicular dislocations or strains of the rotator cuff. Any repetitive microtrauma, particularly those involving sporting activities requiring repetitive overhead use of the arm, may develop lesions of tendons, glenohumeral instabilities or impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim and may be frequently the cause of shoulder pain in athletes. After an introduction to the anatomy of the shoulder and an illustration of the biomechanics of throwing, we explain shoulder pains in the athlete caused by tendon lesions, joint instability and by neurovascular shoulder problems with the typical patient history, the clinical signs, physical and imaging studies in detail. Among the typical lesion of tendons we are describing the impingement syndrome of the supraspinatus tendon, the lesions of the biceps tendon and the impingement of the lower surface of the cuff on the postero-superior glenoid labrum. As glenohumeral instability we describe the anterior, posterior, and inferior instability and the multidirectional instability as well. As neurovascular shoulder problems we describe anatomy, function, patient history, etiology, clinical signs, physical examination, differential diagnosis, therapy, and prognosis of lesions of the nervi suprascapularis, axillaris, thoracicus longus, musculocutaneus, and accessorius as well as lesions of the plexus brachialis and in the thoracic outlet syndrome.

Acromioclavicular Joint↗
PubMed1996

Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder.

The recognized options for the treatment of chronic locked posterior dislocation of the shoulder are dependent on the size of the anteromedial defect of the humeral head. Transfer of the lesser tuberosity with its attached subscapularis tendon into the defect is recommended for defects that are smaller than approximately 40 per cent of the joint surface. Prosthetic replacement is preferred for larger defects. Four consecutive patients who had a chronic locked posterior dislocation of the glenohumeral joint associated with a defect of the humeral head that was at least 40 per cent of the articular surface were managed with reconstruction of the shape of the humeral head with use of an allogeneic segment of the femoral head. Stability was restored and maintained in each patient at an average of sixty-eight months (range, sixty to seventy-six months) after the procedure. Three patients reported little or no pain and no or slight functional restrictions in the activities of daily living, and they considered the result to be satisfactory. The fourth patient had mild pain and moderate-to-severe dysfunction secondary to avascular necrosis of the remaining portion of the humeral head after a symptom-free period of six years.

Activities of Daily Living↗
PubMed1996

Isolated rupture of the subscapularis tendon.

Sixteen consecutive patients were managed operatively for repair of an isolated traumatic rupture of the subscapularis tendon in the absence of avulsion of the lesser tuberosity. All of the patients were men. The diagnosis was made for each patient on the basis of the clinical examination and was confirmed by imaging studies and operative exploration. The operative treatment consisted of mobilization of the subscapularis after exploration and protection of the axillary nerve, transosseous reinsertion of the tendon to a trough created at the lesser tuberosity, closure of the rotator interval, and protection of the shoulder for six weeks postoperatively. The average duration of follow-up was forty-three months (range, twenty-four to eighty-four months). Thirteen patients subjectively rated the result as excellent or good. The average functional score of the shoulder, as assessed according to the system of Constant, was 82 per cent of the average age and gender-matched normal value. Active flexion was normal in twelve patients, was decreased by 15 degrees or less in three, and was severely limited in one patient. The capacity of the patients to work in their original occupations had increased from an average of 59 per cent of full capacity preoperatively to an average of 95 per cent postoperatively (p = 0.006). Operative treatment proved to be economically sound within the Swiss National Accident Insurance system. The quality of the result did not depend on the capacity for work at the time of the operation, on the type of work in which the patient was engaged, on the state of the biceps, or on the duration of follow-up. Conversely, the results were less successful when there was an increased delay from the time of the injury to the time of the operative repair.

Adult↗