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Biomedical subjects

D Kohn

Publications and source records attributed to D Kohn.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Intravenous iron-dextran in the elderly].

127 of 1000 patients treated during the first 2 years of this department's operation were found to be anemic. In 69 of them iron deficiency was diagnosed and 54 of them were treated with intravenous iron-dextran (Imferon). It had to be stopped because of adverse effects in 11 of them; 1 of them had a nonfatal anaphylactoid reaction, 4 women, 75-84 years old, are presented to demonstrate the indications for intravenous iron therapy. Oral administration is the treatment of choice in ambulatory patients. However, when as in the cases presented it fails, because of failure-to-thrive, intolerance to the oral preparation or noncompliance, intravenous iron is indicated.

Administration, Oral↗
PubMed1990

[Meniscus replacement using Hoffa's infrapatellar fat bodies--initial clinical results].

Between December 1986 and July 1988 a replacement of the absent medial meniscus was taken by means of the infrapatellar adipose body in seven patients. A replacement of the anterior cruciate ligament by means of the middle one third of the patellofemoral ligament was taken too. This operation was done for reconstruction of the synergism between the anterior cruciate ligament and the posterior horn of the medial meniscus. All patients are controlled in our special knee outpatient service. There were no complication postoperatively and on all seven patients a control arthroscopy was performed twelve months postoperatively. The subjective results are very satisfying because of the restoration of knee stability. The arthroscopic controls of the meniscal replacements, however, showed a reduction in size of the transplants after one year, the tissue was weak and not identical to that of a normal meniscus. Autologous strong tissue, e.g. quadriceps tendon, may have better presuppositions for meniscal replacement.

Adipose Tissue↗
PubMed1990

[Meniscus transplantation and anterior cruciate ligament replacement--results 2-4 years postoperative].

23 transplantations of meniscus combined with replacement of the anterior cruciate ligament were performed from May 1984 to December 1986 at the Department of Orthopaedics of the University of Munich ('Klinikum Grosshadern'). Clinical follow-ups were coupled with arthroscopic follow-ups on the average 10 months postoperatively in 19 patients with transplantation of the medial meniscus of the knee joint. In 17 cases a lyophilised meniscus was transplanted and in 6 cases a deep-freeze allogenous meniscus. There were no operation-specific complications in either group. Both the lyophilised meniscus transplants and the deep-frozen ones underwent a reduction in size during the observation period. Whereas good to excellent results were generally obtained with the deep-frozen transplants, the results seen in the lyophilised transplants were less satisfactory due to reduction in size partly down to regenerate size. The treatment results were of course positively influenced due to the contributory effect of the regained stability; in the patients with meniscus transplants the preoperative Lysholm score was 72 +/- 14 points, on the average 36 weeks postoperatively 82 +/- 15 points. However, clinical and arthroscopic findings showed that no clinically, immunologically and morphologically satisfactory meniscus replacement has become available to date.

Adult↗
PubMed1990

Mycobacterium avium-intracellulare infections after allogeneic bone marrow transplantation in children.

Serious infections caused by the Mycobacterium avium-intracellulare (MAI) complex have been increasingly recognized in patients with acquired immunodeficiency syndrome (AIDS). Allogeneic bone marrow transplant recipients are prone to infections caused by a wide spectrum of organisms. However, infection with MAI has been reported only once in an allogeneic bone marrow transplant setting. We describe two allogeneic bone marrow transplant recipients with severe combined immunodeficiency syndrome (SCID) in whom MAI infections occurred. Thus, MAI must be added to the list of infectious pathogens that can infect allogeneic bone marrow transplantation (BMT) recipients. Aggressive multidrug antituberculosis therapy may be of benefit in such patients.

Bone Marrow Transplantation↗
PubMed1990

Epidermal Langerhans' cells in elderly patients with decubital ulcers.

Langerhans' cells in the sacral epidermis 8-10 cm from the lesion of elderly patients (mean age 74 years) with decubital ulcers were studied ultrastructurally and compared with the patients' own normal epidermis from the upper leg, with age-matched normal controls, and with young normal controls (mean age 43 years). High percentages of Langerhans' cells (ranging between 30 and 50%) without dendrites were found in patient epidermis from the sacral region near the lesion and similar percentages in normal skin from the patients' upper leg. In both elderly and young controls, Langerhans' cells without dendrites found in the epidermis of the upper leg were fewer, ranging between 13 and 33%. The density of Langerhans' cells in adjacent sites of the same epidermis was non-homogeneous, being in the range of 0.56-1.19% in patient sacral epidermis, 0.69-1.31% in patient normal leg epidermis, 0.63-4.17% in leg epidermis of the elderly controls, and 0.63-3.94% in leg epidermis of the young controls. The majority of the Langerhans' cells in both patients and controls were located near the basal cell layer and in the mid-epidermis. The percentage of Langerhans' cells found in patient sacral epidermis (0.84 +/- 0.08%) and in their leg epidermis (0.87 +/- 0.15%) was significantly lower than in the elderly controls (1.91 +/- 0.30%) and young controls (1.84 +/- 0.24%). The low percentage of Langerhans' cells in the epidermis of patients with decubital ulcers may affect the healing process of the lesions.

Adult↗
PubMed1990

Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide purged marrows for children with acute non-lymphoblastic leukemia in second remission.

Although autologous bone marrow transplantation (ABMT) following purging with 4-hydroperoxycyclophosphamide (4HC) has been effective for some adults with acute non-lymphoblastic leukemia (ANLL), there are few data on ABMT for children. We have performed ABMT for 13 patients (median age, 5 years) with ANLL in second remission. Bone marrow was treated ex vivo with 4HC to kill residual leukemic cells. In order to enhance the anti-leukemic effect of 4HC, exogenous red blood cells were eliminated from the marrow/4HC mixture. All patients were conditioned for transplantation with busulfan (16 mg/kg) and cyclophosphamide (200 mg/kg), followed by infusion of the 4HC treated marrow. Eleven of 13 patients had complete hematologic reconstitution; there were no transplant-related deaths. Five patients relapsed at 2, 4, 5, 6 and 6 months post-BMT. Eight patients are disease-free survivors; the median time for survival is 24 months, with a projected disease-free survival of 61%. ABMT is a safe and efficacious treatment modality for children with ANLL in second remission. Our results suggest that the disease-free survival for pediatric patients may be superior to that seen in adults.

Actuarial Analysis↗
PubMed1990

[Value of diagnostic measures in soft tissue diseases and soft tissue lesions of the shoulder joint].

Calcifying tendinitis, acute tendinitis, frozen shoulder, rotator cuff rupture, subluxation of the gleno-humeral joint and injury of the biceps tendon are commonly classed under the blanket term "peri-arthropathy of the shoulder". It is now possible to make a precise diagnosis of these shoulder disorders by means of a clinical examination supported by X-ray examination, ultrasonography, arthrography, computed tomography (CT), magnetic resonance imaging (MRI) and arthroscopy. Calcifying tendinitis is diagnosed by consideration of the patient's history, followed by clinical examination and X-ray examination. Acute tendinitis is a clinical diagnosis, as is frozen shoulder. Ruptures of the rotator cuff can be detected by ultrasonography, which is a screening method; such ruptures can also be detected by arthrography. The localization and extent of the defect are best estimated by arthroscopy. Shoulder instability is another clinical diagnosis. Bony defects of the humeral head (Hill-Sachs lesion) or the glenoid rim are revealed by computed tomography (CT). CT arthrography reveals the presence of any Broca-Hartman lesion in the anterior inferior part of the anterior capsular mechanism. Rupture, subluxation or luxation of the biceps tendon are diagnosed either by clinical examination or by arthroscopy. Knowledge of the sensitivity, specificity and accuracy of the diagnostic procedures makes it possible to carry them out in a standardized, logical sequence. Arthroscopy allows a decidedly more accurate diagnosis than any of the other methods, but as it is an invasive procedure it should be kept until last when diagnosis of disorders of the gleno-humeral joint is required.

Arthroscopy↗
PubMed1990

Arthroscopic evaluation of anterior cruciate ligament reconstruction using a free patellar tendon autograft. A prospective, randomized study.

In a prospective study, follow-up arthroscopy was performed (with the informed consent of the patient) after anterior cruciate ligament reconstruction using a free patellar tendon autograft. Nineteen of 21 consecutive patients agreed to arthroscopy. Time between operation and arthroscopy ranged from six to 25 months (average, 15 months) and was distributed at random among the patients. In evaluating knee stability and functional performance, the arthroscopic findings were disappointing. The Lysholm score improved from 68 +/- 8 points preoperatively to 84 +/- 8 points postoperatively. KT-1000 measurement on the day before follow-up arthroscopy showed only a slightly increased anterior laxity of 6.2 mm compared to 4.7 mm on the uninjured side. When the arthroscopic results were graded from 0 (ruptured) to 3 (excellent), four patients had a Grade 3 result, ten patients had a Grade 2 (moderate) result, and five patients had a Grade 1 (poor) result. No graft was ruptured. These findings indicate that, in the majority of patients, reconstruction of the anterior cruciate ligament using a free patellar tendon autograft will not result in an arthroscopically normal substitute for the anterior cruciate ligament.

Adult↗
PubMed1989

Meniscus suture techniques: a comparative biomechanical cadaver study.

The primary stability of four common meniscus suture techniques was tested on human cadaver menisci. The test series was carried out under standard conditions (25 degrees C, 100% air humidity) using the Instron 1122 Tensometer. The tearing stress of different sutures was reproducible in different specimens dependent only on the suture technique. Knot-end techniques gave inferior results (tearing stress, 24 +/- 9 N) compared with arthroscopic techniques using a loop placed on the meniscus surface (tearing stress, 89 +/- 4 N). When an open meniscus repair is performed, a vertical stitching technique (tearing stress, 105 +/- 4 N) should be the preferred method. Horizontal sutures are weaker (tearing stress, 44 +/- 18 N).

Adult↗
PubMed1989

[Basic principles of after care following autoplastic reconstruction of the cruciate ligament].

Since 1984 we avoided immobilization after reconstruction of the anterior and/or posterior cruciate ligament. Principles of kinematics were taken in consideration during aftertreatment. Results were very satisfactory in anterior cruciate ligament reconstruction. Subjective assessment of knee function (Lysholm score), objective measurement of anterior-posterior knee stability (KT-1000 arthrometer) and clinical follow-up results were good without immobilization.--This cannot be said for the posterior cruciate ligament, because the number of patients was too small. Our current concept of rehabilitation after reconstruction of the posterior cruciate ligament may yet serve as a reasonable but still unproven approach to the problem.

Athletic Injuries↗
PubMed1988

Unsuccessful arthroscopic treatment of pyarthrosis following anterior cruciate ligament reconstruction.

Postoperative purulent infection developed in the knee of a patient who had undergone anterior cruciate ligament reconstruction. Initially, arthroscopic lavage and debridement was performed, but was unsuccessful because the infection had spread into the soft tissues of the former surgical wound. Open debridement had to be performed to control the periarticular infection. It is important to stress that the extent of the infection has to be considered when instituting a method of treatment. It should be possible to clinically diagnose this extraarticular infection.

Adult↗
PubMed1988

[Knee arthroplasty in osseous ankylosis. A case report].

We report on the successfully performed arthroplasty of a knee joint in a 19-year-old female patient in whom a bony ankylosis in malalignment had occurred following an infection. The deciding factor for performing the arthroplasty was not only the patients wish to regain mobility in the knee joint, but also the existing possibility of postoperative mobilization of the joint on a CPM-machine in combination with analgesia by means of a peridural catheter.

Adolescent↗