[West Nile fever with meningeal involvement].
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Arbovirus Infections↗
Biomedical subjects
D Kohn
Publications and source records attributed to D Kohn.
[Advances in planned parenthood].
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Contraceptive Agents↗
Preoperative ultrasonographic mapping of calcium deposits facilitates localization during arthroscopic surgery for calcifying tendinitis of the rotator cuff.
Calcifying tendinitis is a relatively common disorder of the rotator cuff. For symptomatic patients, excision of the calcium deposits offers reliable pain relief. The arthroscopic technique is demanding. Arthroscopic localization of the deposit is frequently demanding. The technique described in this article facilitates the localization of calcium deposits based on preoperative ultrasonography. Knowing the exact topography of the deposit relative to the visible landmarks allows the surgeon to localize the site of the deposit from the intra-articular view. Probing the rotator cuff with a spinal needle and looking for calcific material at the tip of the needle is an important step in verifying the location of the deposit.
Arthroscopy↗
Benign giant-cell tumor of the patellar ligament.
We report the symptoms, clinical findings, and treatment of a patient with an extra-articular benign giant-cell tumor of the patellar ligament. Between the years 1966 and 1996 no similar case has been found to be documented by a Medline search. On palpation, a soft, mobile lesion, the size of a pigeon's egg, was felt in the lateral region of the patellar ligament. There was no set of laboratory values to determine the diagnosis. In addition, there were no typical findings in diagnostic imaging procedures and it seems that the most important fact is that the clinician is aware of this type of synovial tumor. A clear diagnosis is only possible by means of a pathological investigation. The choice of therapy for giant-cell tumors is local excision. Arthroscopy is recommended exclusively for the diagnosis and therapy of a localized intra-articular giant-cell tumor.
Adult↗
[Significance of the hypoechoic area around the long biceps tendon in shoulder sonography--underlying pathology].
OBJECTIVE: The objective was to evaluate the sonographic sign of a hypoechoic area ("halo-sign") around the long biceps tendon as an equivalent of intraarticular effusion. METHODS: Part 1: Ten patients scheduled for shoulder arthroscopy underwent ultrasonography immediately before surgery. If there was no hypoechoic area around the long biceps tendon 30 ml of NaCl-solution (0.9%) were injected into the joint. After repetitive passive motion the patient underwent a second ultrasonography. Part 2: Ten consecutive patients with a hypoechoic area around the long biceps tendon underwent shoulder arthroscopy. During this procedure they were examined for intraarticular effusion. Patients with rheumatoid disease were excluded from the study. RESULTS: Part 1: In 9 of 10 patients a hypoechoic area around the long biceps tendon was induced by injection into the joint. The area was 1.07 +/- 0.13 cm2. In one case we could not induce the described phenomenon. Part 2: In all patients with a hypoechoic area around the long biceps tendon an intraarticular effusion was found at arthroscopy. CONCLUSION: A hypoechoic area around the long biceps tendon correlates with fluid in the synovial sheet and indicates effusion within the glenohumeral joint.
Arthroscopy↗
[High tibial osteotomy--primary stability of several implants].
INTRODUCTION: High tibial osteotomy in varus knee has been performed for a long time. Several newer operation techniques have been established in recent years. We tested the primary stability of several of these techniques in vitro. MATERIAL AND METHODS: 10 human cadaveric fresh-frozen specimens were tested with a mean age of 61 years (range 50-72 years), and weight of 65 to 78 kg. The following implants were tested: One-third-tubular plate with cortical screw (AO, Synthes), blade plate with screws (Giebel's plate, Link), bone staples (osteotomy staples, Krackow staples, Smith & Nephew), external fixateur (Orthofix). The specimens were fixed in metal cylinders and then loaded in two different apparati: Shear forces were applied to the osteotomy site by hanging weights parallel to the osteotomy plane in a static-loading frame, and axial forces were applied by a materials testing machine (Zwick). Load displacement was recorded by inductive displacement transducers. RESULTS: The highest stability was achieved by the external fixateurs and the bone staples. Giebel's plate and the one third tubular plate were less stable. Receipt of the medial corticalis was decisive for primary stability of the implants. CONCLUSION: The clinical significance of the results is limited by the relevance of the protocol, which for practical reasons did not account for the soft tissue situation around the knee. Thus, primary stability of the tested devices was generally comparable as long as they were correctly implanted. It was found, that lateral distance of the osteotomized bone should not exceed 3 mm. If the medial cortical is sawed, another medial implant is necessary to ensure sufficient primary stability.
Aged↗
[Improved radiological imaging of acetabular screw socket].
The improved radiological representation of the cementless acetabular screw-socket at two levels is of fundamental importance for the postoperative determination of position as well as for the judgement of an aseptic loosening. To improve the radiological representation two special radiographic techniques in the anterior-posterior as well as in the axial view have been examined on a human preparation of pelvis and have been scrutinized on a great number of clinical patients. The a.-p. radiography with twenty degrees cranio-caudal prone view in the sagittal plane and the axial radiography with forty-five degrees caudo-cranial prone view in the coronal plane shows the best and fewest overlayed representation of the screw-socket. The position of inclination and anteversion could have been directly determined out of these two radiographs. Malpositions of the screw-socket, especially with regard to the anteversion are easily identifiable due to the special axial radiographic technique. Overprojection of adjoining bone areas, which were possible should be considered at the judgment of the implant-bone-contact. Radiographic technical and positioning problems were not observed in patients. Out of these examinations the a.-p. radiography with twenty degrees cranio-caudal prone view in the sagittal plane and the axial radiography with forty-five degrees caudo-cranial prone view in the coronal plane could be recommended to the radiological diagnosis after implantations of hip prosthesis.
Acetabulum↗
[Intertrochanteric flexion osteotomy and allo-arthroplasty in femur head necrosis. A comparative retrospective study].
Intertrochanteric flexion osteotomy and total hip arthroplasty are the most frequent operative treatments of advanced osteonecrosis of the femoral head in adults. In a retrospective study the postoperative results of intertrochanteric osteotomy and total hip arthroplasty were determined in 68 cases. The evaluation was based on the modified Harris-Hip-Score, the clinical examination and the radiological classification of the ARCO. The patients after osteotomy showed significantly worse subjective results. After osteotomy an increase of the stage of osteonecrosis was found in 73% of the patients. There was no correlation between clinical result and radiological stage of osteonecrosis. In spite of a better preoperative situation the results after osteotomy compared to hip arthroplasty were disappointing in many cases. The postoperative result did not depend on the preoperative stage of the osteonecrosis. The new classification system of the ARCO, which includes the very important MRI, proved to be very suitable and practicable. Based on our results it seems to be reasonable, to restrict the indication for intertrochanteric flexion osteotomy to cases of low stage osteonecrosis and carry out cementless total hip arthroplasty primarily in all others.
Adolescent↗
[Dislocation of total hip endoprosthesis with special reference to various techniques].
1238 primary total hip replacements for arthritis were performed in our hospital from 1980 until 1988. 26 dislocations (2.1%) were registered during this period. No differences became obvious regarding age, sex, type of prosthesis and different concepts of postoperative treatment. After the posterior approach dislocations occurred in 18 (3.1%) of the cases, 8 dislocations (1.2%) were found after the transgluteal approach. The dislocation rate was significantly higher for the posterior approach. Derotation braces were not able to decrease the risk of redislocation. Most of the dislocations happened during the first postoperative week. The most frequent occasions were rotation of the operated leg while lying in bed and deep sitting positions. Performing the posterior approach for primary total hip arthroplasty the surgeon has to realize the higher dislocation rate.
Aged↗
[Comparison of knee ligament scores and rating systems].
The results of the treatment of knee instabilities are evaluated by different scoring systems including subjective and/or objective criteria. Because of their number and their different criteria a comparison between the scoring systems is still a problem. The aim of this study was to analyze 14 different scoring-systems and prove the comparison of the commonly used rating scales. 116 patients with anterior or anterior-medial knee instabilities were followed up at least 2 years postoperatively. The evaluation was performed according to the criteria of the used rating-scales. The Lysholm I scoring system showed the highest mean total score (92 points). The scales that gave the highest correlation were the Cincinnati and ARPEGE scoring system (r = 0.97). The Lysholm I Scale and the Barrack Scale correlated least well (r = 0.711). This study documents that a transfer of results from one scoring system to another is not possible. A comparison between these scoring systems is only possible after adjusting the total points, the quality and the quantity of each criterion and component of the scoring system. This can done by using a standardized rating scale like the IKDC-score.
Activities of Daily Living↗
[Basic equipment for arthroscopic knee surgery].
Five hundred arthroscopic operations were carried out with a 10-part hand-operated instrument set since January 1984. The most frequent operation was meniscectomy (84%), followed by removal of free bodies (18%) and division of plicae (7%). In four cases, there were instrument-dependent complications. By simulation of the surgical work on the joint in a suitable model, undesired, automatic movements of various instruments could be demonstrated. They depended on the respective principle of construction. The reliable grasping of meniscus tissue and free bodies was often a critical phase of the operation. Traction experiments on meniscus preparations showed that the arthroscopic forceps offered are frequently not equivalent to conventional surgical clamps. Instrument breaks were reconstructed in bending experiments. With some materials, a few bending cycles were sufficient in order to bring about the break. The experience obtained in our operations as well as in the laboratory experiments mentioned are described. Criteria for selection and use of hand-operated instruments for arthroscopic knee surgery are enunciated.
Arthroscopes↗
[Material properties of meniscus tissue and the effect of the menisci on the compression behavior of the knee joint].
Specimens of meniscus tissue were taken from different locations of the medial and lateral meniscus. They were tested to failure in the tensometer and force elongation diagrams were recorded. 28 meniscus specimens (14 medial, 14 lateral) gained at autopsy were available for testing. The posterior third of the medial meniscus and the middle third of the lateral meniscus were the strongest and stiffest parts of the meniscus. Yet local differences within one meniscus were only subtle. One clinical significance of these data is, that for replacement of the medial and lateral meniscus the same homogeneous material can be employed. Six tests under compression were carried out using six knee specimens gained at autopsy. Knee compression tests yielded different results after radial cutting of the meniscus, whereas partial meniscectomy had no effect on deformation and hysteresis. These biomechanical results support the concept of partial meniscectomy and preservation of the meniscal periphery. But they cannot be related to the problem of possible degenerative arthritis after partial meniscectomy.
Adult↗
[Stress relief of the hip joint by the Thomas splint].
The Thomas Splint is mainly administered to relieve weight from the hip joint. Theoretically the leg is bypassed by transmitting the body weight directly from the pelvis to the floor.--Load transmission via a Thomas Splint was measured with an orthosis strain gauged at the ischial interface area and at the foot plate. The results show, that about one half of the weight will bypass the joint through the orthosis. The Thomas splint ist unsuitable in cases when complete weight relief from the hip joint is necessary.--These results did not depend on whether the floor was flat or ascending, or whether stairs were climbed. The lateral bar never carried more then 25% of the force transmitted.
Adult↗
[Vascular injuries in acetabular implantation and acetabular replacement surgery--case report, literature review and anatomical study].
Severe intraoperative bleeding during revision hip arthroplasty in one of our patients was the motive of the work reported here. A review of the literature and an anatomical cadaver study were carried out. The distance between the acetabular fossa and the intrapelvic blood vessels was measured in 15 specimens. The risk for the obturator artery is particularly high. The distance between this vessel and the acetabulum is 2 mm (1-5 mm) only. An account of previous complications and the vascular anatomy as pointed out in our report may help to prevent severe bleeding complications in hip surgery.
Acetabulum↗
[Prosthesis for tumor of the hip joint (indications and results)].
Between 1972 and 1982 34 tumour prostheses (23 total replacements, 11 semitotal replacements) of various designs were implanted at the State Orthopedic Clinic in Munich-Harlaching and at the University Orthopedic Clinic in Grosshadern. The indications were primary and secondary malignant tumours, potentially malignant tumours, peritrochanteric pseudarthroses, and loosening of prostheses where bone conditions were poor. Since 1977 only the "Harlaching" femoral tumour prosthesis, a locally developed model, has been used. Its distinguishing feature is the modular or kit principle, which renders it possible to adapt the prosthesis and define its length accurately during surgery. On the basis of 13 long-term observations, in some cases extending over 8 years, it was established that this tumour prosthesis need not be regarded as merely a palliative intervention (this applies also to younger patients with a longer life expectancy); the slight and transitory complications and the relatively good long-term functional results are encouraging.
Bone Neoplasms↗
[Short technical contribution: video technic and sterility in arthroscopy].
A new sterilizable adapter for video cameras is presented, which makes it possible to provide perfect sterility when changing the arthroscopes.
Arthroscopes↗
[An in vitro model for producing femoral fractures and for the study of primary stability of cerclage].
PURPOSE: Intraoperative femoral fracture is a well recognized intraoperative complication of cementless total hip arthroplasty (THA). This study was designed to establish an in-vitro model for initiation of fractures of the femur in cementless THA and to assess the effect of fracture fixation by cerclage wiring using steel wire (Protasul). METHODS: Ten human femur specimens were studied. Longitudinal cracks were created by pressing a well fixed conical stem deeper into the femur in a material testing machine. RESULTS: The force necessary to propagate a longitudinal crack in the femur was 1915 N to 9288 N (median 6531 N). This forces are according to 3 to 15 times (median 11 times) body weight. There was no difference of force between left and right femurs from the same individual (U-test). The femoral cortex fractured in 5 cases ventrally, in 6 cases medially and in 1 case laterally. After monofile cerclage wire application the force required to press prosthesis 5 mm deeper into the medullary canal was 0.3 to 2.7 times body weight. After monofile cerclage wire application pressing in the prosthesis 30 mm needed 1.8 to 8.1 times body weight. CONCLUSIONS: During insertion of a conical stem the orthopaedic surgeon should look for fractures of the medial cortex of the femur which is the most frequent location for fractures. This in-vitro model provides a reproductable method for the initiation and propagation of longitudinal femoral fractures in press-fit noncemented THA system and to assess the effect of fracture fixation in the form of cerclage wiring.
Adult↗
Epidural vs. intramuscular oxymorphone analgesia after thoracotomy in dogs.
Oxymorphone was administered epidurally (0.1 mg/kg) or intramuscularly (IM) (0.2 mg/kg) to 16 dogs undergoing thoracotomy, to compare the analgesic effectiveness. Heart rate, respiratory rate, systolic and diastolic blood pressure, and pain score were measured hourly. Arterial blood gases were measured at hour 1. A single dose of oxymorphone injected epidurally provided analgesia for up to 10 hours, whereas the IM route provided a comparable effect for less than 2 hours. There were statistically significant increases in heart rate, and systolic and diastolic blood pressures at hour 2 in the dogs treated IM over the dogs treated epidurally. We conclude that epidurally administered oxymorphone is highly effective in alleviating pain after thoracotomy in dogs and provides longer lasting analgesia than the IM route.
Analgesia, Epidural↗