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C Wurnig

Publications and source records attributed to C Wurnig.

At least 19 recordsLinked to original sources
PubMed2002

Ultrasonographic investigation of the atlanto-occipital articulation in the horse.

The purpose of this study was to evaluate ultrasonographic imaging as a means of easy and noninvasive diagnosis of articular and periarticular structures of the atlanto-occipital articulation in the horse; and to find a safe approach to the atlanto-occipital joint. Ultrasonographic investigations were performed on 6 healthy horses and 16 specimens from horses humanely destroyed age 2-17 years (mean 9.56 years). Preliminary examinations included anatomical studies and preparation of cross-sections. On 4 horse specimens, puncture of the atlanto-occipital joint under ultrasonographic guidance was performed and a new lateral approach undertaken. For ultrasonographic investigations, the neck was divided into 4 zones according to anatomical and clinical modalities: 1) insertion of the funiculus nuchae; 2) tuberculum dorsale of the atlas; 3) atlanto-occipital joint and 4) region above the foramen alare. Each zone was examined in transverse and longitudinal planes proceeding from cranial to caudal. Ultrasonography was found to be useful for soft tissue imaging of this region and was performed down to the atlanto-occipital joint of which the joint surfaces, joint capsule and collateral ligament could be delineated in both planes. We conclude that ultrasonography of the neck is a useful technique, representing an easy to use and safe method. However, further studies are indicated which should be performed on live subjects.

Animals↗
PubMed2001

[Overuse and trauma in sports--clinical symptoms in the context of modern imaging techniques].

New insights in the fields of pathology and diagnostic radiology of sports injuries show that the borders between overuse syndromes and trauma are blurred. Techniques of diagnostic imaging are increasingly important for an objective documentation of morphologic changes of the musculoskeletal system. Typical sports-related syndromes exist and their clinical diagnosis is not always easy because pain cannot be located exactly.

Athletic Injuries↗
PubMed2000

[Shoulder impingement].

The impingement syndrome is a common disorder of the shoulder girdle. The causes for this syndrome may be anatomic changes in the coracoacromial arch, also within the ultrastructural regions, on the one hand, or changes in the biomechanics which have developed for various reasons, on the other. Diagnosis is based on roentgenograms using the appropriate technique. In large-scale-studies, sonography has proved to be an extremely sensitive screening method for differential diagnosis of rupture of the rotator cuff. Magnetic resonance imaging might gain in value in the diagnosis of impingement as regards differential diagnosis of rupture of the rotator cuff because this technique--when employed appropriately--allows exact viewing of the soft tissue and the anterior part of the acromion. In the majority of cases conservative treatment is the method of choice. Methods of treatment are sonography, galvanization, and application of heat. Physiotherapy should not be initiated until pain relief has been achieved by other measures. Infiltration therapy is of considerable value in the management of pain due to impingement. Application of cortisone into the subacromial space must also be considered critically. As regards conservative therapy, only few evidence-based publications provide information on the effectiveness of different treatment regimens. Surgical therapy is only indicated in cases of pain resistant to the conservative therapy for a certain period. Furthermore, only an outlet impingement can be treated successfully by surgical decompression. The surgeon decides on the surgical method--open surgery or arthroscopy. Of course, arthroscopic methods are less invasive; however, up to now the superiority of one of the surgical methods over the other could not yet be proven by mid-term clinical results. Other surgical methods such as wedge osteotomy in the region of the spina scapulae are still in the experimental stage. By surgical and conservatives methods, good and even excellent results can be achieved in about 80% of the cases. The question remains as to why 20% of the patients show unsatisfactory results. One explanation might be that factors such as pathologic changes of the muscular balance and an altered microstructure of the tendons of the rotator cuff are rarely taken into consideration and Neer's concept of decompression is overestimated. Further research will be required in the field of biomechanics but clinical research on treatment concepts should also be undertaken to develop more differentiated strategies of treatment.

Arthroscopy↗
PubMed2000

[In Process Citation]

The impingement syndrome is a common disorder of the||| shoulder girdle. The causes for this syndrome may be anatomic changes in the||| coracoacromial arch, also within the ultrastructural regions, on the one hand,||| or changes in the biomechanics which have developed for various reasons, on the||| other. Diagnosis is based on roentgenograms using the appropriate technique. In||| large-scale-studies, sonography has proved to be an extremely sensitive||| screening method for differential diagnosis of rupture of the rotator cuff.||| Magnetic resonance imaging might gain in value in the diagnosis of impingement||| as regards differential diagnosis of rupture of the rotator cuff because this||| technique--when employed appropriately--allows exact viewing of the soft tissue||| and the anterior part of the acromion. In the majority of cases conservative||| treatment is the method of choice. Methods of treatment are sonography,||| galvanization, and application of heat. Physiotherapy should not be initiated||| until pain relief has been achieved by other measures. Infiltration therapy is||| of considerable value in the management of pain due to impingement. Application||| of cortisone into the subacromial space must also be considered critically. As||| regards conservative therapy, only few evidence-based publications provide||| information on the effectiveness of different treatment regimens. Surgical||| therapy is only indicated in cases of pain resistant to the conservative||| therapy for a certain period. Furthermore, only an outlet impingement can be||| treated successfully by surgical decompression. The surgeon decides on the||| surgical method--open surgery or arthroscopy. Of course, arthroscopic methods||| are less invasive; however, up to now the superiority of one of the surgical||| methods over the other could not yet be proven by mid-term clinical results.||| Other surgical methods such as wedge osteotomy in the region of the spina||| scapulae are still in the experimental stage. By surgical and conservatives||| methods, good and even excellent results can be achieved in about 80% of the||| cases. The question remains as to why 20% of the patients show unsatisfactory||| results. One explanation might be that factors such as pathologic changes of||| the muscular balance and an altered microstructure of the tendons of the||| rotator cuff are rarely taken into consideration and Neer's concept of||| decompression is overestimated. Further research will be required in the field||| of biomechanics but clinical research on treatment concepts should also be||| undertaken to develop more differentiated strategies of||| treatment.

Journal Article↗
PubMed1999

The postoperative shoulder.

Because disability and pain may persist or recur after shoulder surgery, visualization of the postoperative shoulder before further treatment is of great interest. Postoperative status is reevaluated most frequently after rotator cuff repair, capsulorrhaphy in patients with chronic instability, and acromioplasty, where postoperative symptoms are clinically difficult to distinguish from rerupture or inadequate surgical results. Postoperative evaluation or follow-up after surgical treatment of tumors or surgical repair of shoulder injuries are other potential indications. Whereas surgical procedures for osseous components primarily will be evaluated by plain film radiographs, magnetic resonance imaging is a valuable tool for other sites of surgical treatment, such as soft-tissue components, with further potential indication for magnetic resonance arthrography. This article focuses on normal and abnormal postoperative findings in the shoulder, with emphasis of magnetic resonance imaging, and discusses specific findings based on magnetic resonance arthrography.

Acromion↗
PubMed1999

Six-year results of a cementless stem with prophylaxis against heterotopic bone.

The hypothesis of a possibly diminished bony ingrowth revealed by the development of radiolucency or a radiodense line with time around a cementless femoral stem subsequent to indomethacin administration for prevention of heterotopic ossification was investigated. Eighty prospective patients with indomethacin prophylaxis were compared with 82 patients without indomethacin prophylaxis chosen retrospectively. The same cementless implant was used in all cases, and patients were observed clinically and radiologically for a minimum of 6 years. The mean postoperative Harris hip score at 6 years was 91 versus 88 points, respectively, and there were significantly more excellent results (Harris hip score > 90) in the indomethacin group. None of the patients underwent revision surgery. Radiologic signs such as loss of bone density and radiodense lines were observed around the shoulder of the prosthesis in a similar percentage in both groups. Significant subsidence of the stem was observed in one instance in the indomethacin group and in three instances in the control group. The results of this study are a strong indication that indomethacin does not influence the development of radiolucency or other radiologic changes around a cementless stem after 6 years.

Adult↗
PubMed1997

Osteoarthrosis after the Max Lange procedure for unstable shoulders.

Thirty-four patients were followed for a mean of 14.4 years after the Max Lange operation for instability of the shoulder. This procedure consists of an anterior capsulorraphy with lateralisation of the subscapularis tendon and the insertion of a bone block at the inferior and anterior part of the glenoid. The Rowe score showed 87% good and excellent results. External rotation and abduction were significantly limited as compared to the normal side. Radiographs revealed osteoarthrosis in 47%. Double contrast computed tomography in 18 cases showed a bony defect in the anterior and inferior part of the humeral head in 12 who had significantly limited external rotation as compared to those without the defect. Lateralisation of the subscapularis tendon with limitation of external rotation may lead to increased contact stress and shear forces at the anterior rim of the glenoid which contributes to the development of osteoarthrosis.

Follow-Up Studies↗
PubMed1997

Short term prophylaxis against heterotopic bone after cementless hip replacement.

The aim of the current study was to reveal whether 7 days of indomethacin treatment sufficiently prevents heterotopic ossification after cementless total hip arthroplasty. One group received indomethacin for 14 days (n = 102), and the second for 7 days (n = 99) after cementless total hip arthroplasty. At followup 1 year postoperatively, the average Harris Hip Score was 91 points in the 14-day treatment group and 89 points in the 7-day treatment group. The incidence of heterotopic ossification as outlined by Brooker was similar in both groups. Ninety-six patients in the 14-day treatment group had heterotopic ossification Grades 0 or 1, and 6 patients had Grade II heterotopic ossification; whereas in the 7-day treatment group, 95 patients had Grades 0 or 1 heterotopic ossification and 4 patients had Grade II ossification. None of the patients had Grades III or IV heterotopic ossification. In the 14-day treatment group, headache, dizziness, or gastritic disorders develop in 10 patients, and in the 7-day treatment group, 7 patients had these effects. This study shows that treatment with 100 mg indomethacin daily for 7 days is not significantly different than 14 days of treatment for the prevention of formation of severe heterotopic ossification after cementless hip arthroplasty.

Adult↗
PubMed1997

Stress fracture of the ulna in a female table tennis tournament player.

A stress fracture of the diaphyseal ulna occurred in a 19-year-old female competitive table tennis player with a history of secondary amenorrhea. Stress fractures are one of more common problems occurring in vigorous sports. Stress fractures of the ulna can result from any repeated forearm flexor muscle activity. In our case stress was caused by increased athletic activity by additional training twice a day six times a week starting eighth weeks before first signs of pain and by rhythmic repeated submaximal work load in a new job additional to training. Physical training is often associated with menstrual irregularity. Hormonal factors were known for six months. Spontaneous onset of pain in women and previous history of amenorrhea should include stress fractures as differential diagnosis.

Adult↗
PubMed1996

[Osteomyelitis. Clinical aspects, diagnosis and therapy].

In this paper the basic features of acute, subacute and chronic types of osteomyelitis, skeletal tuberculosis and some special forms of osteomyelitis are described. The diagnosis of osteomyelitis is established using clinical signs and symptoms, culture studies, laboratory studies and radiological signs. The common conservative and surgical treatments are discussed. In the treatment of posttraumatic/postoperative osteitis severe problems are encountered as a result of an increasing number of orthopaedic traumatologic surgical techniques using a variety of implants and because of a generally increasing occurrence of multiresistant strains. Thanks to modern treatment and the increased use of antibiotics, a considerable decrease in morbidity and mortality is observed. Despite this improved prognosis, an established infection remains one of the most challenging problems for the orthopaedic surgeon.

Chronic Disease↗
PubMed1996

Prevention of chemotherapy-induced anemia by the use of erythropoietin in patients with primary malignant bone tumors (a double-blind, randomized, phase III study).

BACKGROUND: Patients undergoing chemotherapy for treatment of malignancy frequently experience clinically significant anemia. Myelosuppressive chemotherapy impairs erythropoiesis, which may not fully recover between treatment cycles. Recombinant human erythropoietin (rHuEPO) has been effectively introduced in anemic patients suffering from chronic renal failure. The present study was designed to assess, first, whether rHuEPO treatment decreases transfusion requirements in chemotherapy-induced anemia and, second, whether high-dose rHuEPO application is safe. STUDY DESIGN AND METHODS: Thirty consecutive anemic patients (hemoglobin <11 g/dl) receiving combination chemotherapy for primary malignant bone tumors were studied in a prospective, double-blind, randomized, Phase III trial. Patients received chemotherapy according to one of two German protocols, depending on histologic diagnosis. All subjects enrolled were randomly assigned either to receive 600 IU of rHuEPO per kg of body weight intravenously twice a week or to receive a placebo during chemotherapy. To obtain comparable data, an observation period of 20 weeks was chosen. Twenty-nine patients fulfilled the criteria and were eligible for statistical evaluation. RESULTS: Transfusion requirements were significantly decreased from Week 8 of therapy (p<0.05) in the treatment group. Therapeutic benefits were even more evident with continuation of therapy (Week 12, p = 0.03; Week 16, p = 0.016; Week 20, p = 0.002). The blood required was 2.1 units of red cells in the treatment group and 8.4 units of red cells in the placebo group. All patients tolerated rHuEPO with no serious side effects. CONCLUSION: These findings suggest that rHuEPO is an effective and well-tolerated therapeutic option for decreasing the transfusion requirements in chemotherapy-induced anemia.

Adolescent↗
PubMed1994

Impaired erythropoietin responsiveness in anaemic rheumatoid arthritis patients: potential relation to immune mechanisms.

1. Serum levels of erythropoietin and the immune parameters tumour necrosis factor-alpha, soluble interleukin-2 receptor, interleukin-2, interleukin-6 and interferon-gamma were measured in patients with rheumatoid arthritis. 2. Out of 69 patients, 44 had anaemia with serum haemoglobin concentrations of 10.8 (SD 1.2) g/dl. In these patients erythropoietin levels were significantly higher than in non-anaemic patients [51.97 (SD 23.9) versus 26.06 (SD 11.9) m-units/ml; P < 0.0001; control patients: 18.1 (SD 13.8) m-units/ml]. Mean soluble interleukin-2 receptor activity was elevated in all patients with rheumatoid arthritis [1324 (SD 715) units/ml; control patients: 480 (SD 75) units/ml; P < 0.001] and was significantly higher in the anaemic group than in the non-anaemic group [1562 (SD 662) versus 696 (SD 402) units/ml; P < 0.0001]. The serum activity of soluble interleukin-2 receptor showed an inverse correlation with haemoglobin (r = 0.79; P < 0.0001) and a positive correlation with erythropoietin (r = 0.70, P < 0.0001). 3. Elevated serum tumour necrosis factor-alpha levels were found in 19 anaemic patients [20.6 (SD 9.1) pg/ml]. Concentrations of tumour necrosis factor-alpha in serum showed an inverse correlation with haemoglobin (r = 0.57, P < 0.001) and a positive correlation with erythropoietin (r = 0.46, P < 0.05). Interleukin-6 was detected in seven anaemic patients [21 (SD 14) pg/ml] and interleukin-2 activity in three anaemic patients (12, 16 and 14 units/ml, respectively). Interferon-gamma was not detected in any of the patients investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Increased serum concentrations of adhesion molecules after coronary angioplasty.

1. Reocclusion is still a significant complication after percutaneous transluminal coronary angioplasty. The injury of coronary arteries resulting from PTCA plays an important role in the pathophysiology of both abrupt closure and late restenosis after an initially successful procedure. Cytokines play a pivotal role in the accumulation of circulating blood cells at the endothelium and are known to regulate their interaction with the vessel wall. 2. To obtain further information about this interaction, serum concentrations of soluble endothelial leukocyte adhesion molecule 1 (sELAM-1), leucocyte endothelial cell adhesion molecule 1 (sL-selectin), intercellular adhesion molecule 1 (sICAM-1), interleukin 2 receptor (sIL-2R) and interleukin 8 (IL-8) detected by enzyme-linked immunosorbent assay were monitored in 30 consecutive patients referred for elective PTCA. Fifteen patients who underwent elective coronary angiography without PTCA served as controls. 3. All patients underwent successful first PTCA. Within 24 h the serum concentrations of sELAM-1 increased gradually from 21.7 (SD 7.1) to 48.2 (SD 8.6) ng/ml (P < 0.01); levels of sL-selectin rose from 982.1 (SD 128.7) to 1541.3 (SD 104.6) ng/ml after 48 h (P < 0.01). Serum levels of IL-8 remained stable initially, but peaked at the end of the observation time of 72 h (9.4, SD 3.8, versus 16.1, SD 4.9 ng/ml; P < 0.05). A positive correlation was found between the number of dilatations and the rise in these parameters (P < 0.01). No significant changes were found in the serum concentrations of sICAM-1 and sIL-2R after PTCA or in any of the parameters in patients after coronary angiography. 4. We conclude that PTCA induces a significant rise in the concentration of certain adhesion molecules in serum. Thus, we provide preliminary data on the potential role of cytokines for blood cell-endothelium interaction after PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Indomethacin for prevention of ectopic ossification in cementless hip arthroplasties. A prospective 1-year study of 100 cases.

In a prospective series of 100 patients we investigated the effect of indomethacin for 6 weeks in the prophylaxis of ectopic bone formation in hip replacements with cementless fixation. Indomethacin prophylaxis reduced (P < 0.0001) ectopic bone formation compared to a retrospective control group of equal size. Side-effects occurred in one-fifth of the patients, but most of these could continue the medication for at least 4 weeks.

Bone Cements↗
PubMed1991

Long-term reaction of the osseous bed around silicone implants.

Between 1970 and 1987, 94 patients received 208 silicone implants at the Department of Orthopaedics, University Hospital, Vienna. Of these, 62.5% were clinically followed up. At follow-up after an average of 116 months, the implant bed was found to be intact in only 41% of cases; in all others we observed lyses around the implant and cysts even in bones at a distance from the operated joint. Histological findings obtained from revision arthroplasty showed a homogeneous picture with foreign-body granulation tissue. These changes were usually clinically inconspicuous and had little effect on patients' subjective well-being. Despite the low discomfort caused, however, the use of such implants in only recommended in critical and severe causes because of the progressive destruction of the osseous bed during the time the implant is in the body.

Adult↗
PubMed1991

Serum-erythropoietin concentration during acute cardiogenic pulmonary edema.

Reduced oxygen tension is regarded as the primary physiologic signal for the production of erythropoietin (EPO). There is little information available about early changes of EPO production in man due to severe hypoxia. The purpose of the present study was to examine the time course of EPO in serum of patients with acute cardiogenic pulmonary edema (ACPE). In 29 patients (seventy-five +/- six years, mean age +/- SEM) who were hospitalized within two hours after onset of symptoms of ACPE, serum EPO concentrations were monitored for up to seventy-two hours. At the moment of admission all patients showed significantly increased EPO concentrations of 121 +/- 64 mU/mL (mean +/- SEM) compared with a healthy population (15-35 mU/mL). Twenty-three patients who recovered within thirty minutes (group A) exhibited a quick return of their EPO serum levels to normal. The remaining 6 patients (group B) had a protracted clinical course and their EPO concentration showed a further increase up to the end of the observation period. The comparative monitoring of concentrations of alpha-1-proteinase inhibitor, antithrombin III, C-reactive protein, fibronectin, hapotoglobin, and transerrin in serum and plasma revealed no significant changes. Thus a major contribution of fluid shifts into or from the intravascular compartment to the observed changes in EPO concentration seems to be unlikely. The data suggest that the production and release of EPO in the kidneys due to altered oxygen delivery is a fast-responding mechanism.

Acute Disease↗
PubMed1991

Parosteal osteosarcoma. 2-23-year follow-up of 33 patients.

In a study of the working group for bone tumors of the German Orthopedic Society, 33 patients with a histologically confirmed parosteal osteosarcoma at reexamination underwent clinical and radiographic follow-up. Local recurrence occurred in all the cases after intralesional surgery and in 4 of 8 cases after marginal excision. The grade of differentiation was decisive for the prognosis. Despite intralesional surgery, the prognosis for Grade 1 tumors was good. Metastases developed in 1 of 23 patients with a Grade 1 tumor and in 4 of 9 patients with a Grade 2 tumor. The single patient with a Grade 3 tumor was treated with adjuvant chemotherapy and was free of disease after 5 years.

Adolescent↗