Biomedical subjects

D Sabo

Publications and source records attributed to D Sabo.

At least 37 records · Page 2Linked to original sources

PubMed2000

[Pathological fracture in primary malignant bone tumors].

Retrospective analysis of 30 patients with pathological fracture out of 336 patients with primary malignant bone tumors should demonstrate the influence a pathologic fracture and the form of surgical therapy have on the survival rate. In 25 out of 30 patients a fracture led to diagnosis of the disease. Pathological fractures occurred cumulatively by malignant fibrous histiocytoma of the bone and in tumor stages IIb and III. Surgery was performed on 26 out of 30 patients (12 ablative therapies, 14 reconstructive therapies). The mortality risk for patients with pathological fractures was more than double the risk for patients without pathological fractures (P = 0.0062). When performed correctly, reconstructive therapy does not influence the survival rate.

Adolescent↗

PubMed2000

Men's health studies: origins and trends.

This article provides a brief outline of the development of men's health studies in the United States. Research on men's health is discussed within critical feminist theories that highlight the reciprocality of gender relations as well as power differences between men and women and among male subgroups. A relational theory of gender and health is used to identify both positive-gendered and negative-gendered health synergies that influence the health processes and outcomes of men and women. Several examples of gendered health synergies are presented to illustrate key concepts. Finally, some directions for future research and advocacy with reference to men's health are outlined.

Adolescent↗

PubMed2000

Influence of extracorporeal irradiation on the reintegration of autologous grafts of bone and joint. Study in a canine model.

We studied the effects of irradiation on the reintegration of autologous osteoarticular grafts over a period of 24 weeks in a canine model. In 16 foxhounds the medial femoral condyle was resected, irradiated and immediately replanted. In the control group resection and replantation were performed without irradiation. Reintegration was assessed by macroscopic analysis, histology, radiography and gait analysis. Reintegration was equal at 12 weeks, but significantly inferior in the irradiated group after 24 weeks with delayed bone remodelling. The articular cartilage showed modest degeneration. Conventional radiography and histology showed corresponding changes. Limb function was adequate but the gait was inferior in the treated group.

Animals↗

PubMed1999

[Intraoperative extracorporeal irradiation and replantation (EIR) in the treatment of primary malignant bone tumors].

In 6 patients with primary malignant bone tumors (4 Ewing, 1 recurrent Adamantinoma, 1 maligne Haemangioperizytoma) the local therapy was performed as intraoperative extracorporeal irradiation and replantation. During the follow-up 10 (6-24) months no local recurrence in the replanted segment occurred. One recurrence occurred in the host bed; in two cases the replanted segment had to be removed because of severe infection. The other cases showed good functional and radiological results. These clinical findings and the reports in the literature seem to allow the application of the intraoperative extracorporeal irradiation and replantation procedure for defect reconstruction in cases of chemo- and radiotherapy-sensitive bone tumors.

Adolescent↗

PubMed1998

[Surgical management of skeletal metastases of the extremities].

Operations on skeletal metastases of the extremities represent the most frequent surgical treatment in orthopedic oncology. From 1970 to 1997, 340 patients were operated on in 383 surgical procedures in the Orthopedic Department of the University of Heidelberg. Carcinoma of the breast and renal cell carcinoma were the most common primary tumors. Operations concerned mainly the femur with acetabulum (55%) and the humerus with glenoid (25%). A pathologic fracture occurred in 51%. While in these cases surgical treatment is absolutely necessary, it is contraindicated in preterminal patients. In imminent fractures or peripheral compression syndromes, the indication is relative and has to be justified on a multidisciplinary basis. Marginal resection of the tumor is allowed because of the limited life expectancy of most patients. Only in patients with solitary metastases and a better prognosis the resection of metastasis margin can be more extensive. Intensification of local therapy by adjuvant irradiation is indicated in an R2 situation, depending on the patient's prognosis. An analysis of our cases from 1994 to 1996 exemplifies the increasing use of modular tumor endoprostheses (52%). In meta-diaphyseal and diaphyseal cases, cement-augmented osteosynthesis is mainly used (34%). The application of these established reconstruction techniques after metastasis resection in cases with adjuvant radiotherapy assures a pain-free extremity capable of weight bearing.

Bone Neoplasms↗

PubMed1998

Periprosthetic mineralization around cementless total hip endoprosthesis: longitudinal study and cross-sectional study on titanium threaded acetabular cup and cementless Spotorno stem with DEXA.

In a prospective longitudinal study over 2 years and a separate cross-sectional study more than 5 years after operation, we analyzed periprosthetic bone mineral density (BMD) after cementless total hip arthroplasty (THA) (press-fit cementless Spotorno stem, Mecron threaded acetabular cup) by dual-energy X-ray absorptiometry (DEXA). BMD was analyzed in a longitudinal prospective study (n = 53 patients: 29 women, 24 men) and in a separate cross-sectional study (n = 23 patients: 13 women, 10 men) with good clinical outcome (Merle d' Aubigne score > 12). Regions of interest were defined according to Gruen (ROI 1-7) and as netto average ROI (NETAVG I) for the periprosthetic femur, and according to De Lee and Charnley (ROI I-III) and as NETAVG II for the periprosthetic acetabulum. BMD during follow-up was compared with immediate postoperative values of the affected limb. Mean precision error (CV%) was 2.6 +/- 0.5% for ROI 1-7 and 1.3 +/- 0.9% for ROI I-III. BMD significantly decreased in the periprosthetic femur and acetabulum during the first 3 months after operation. At the femur, BMD (NETAVG I) for women and men, respectively, was 92.4% and 87.5% at 6 months, then 89.4% and 96.2% at 2 years. ROIs around the proximal stem showed the lowest absolute values and decreased most during follow-up (to 79.9% ROI 1 and 68.2% ROI 7, respectively). Mineralization around the cup (NETAVG II), respectively, amounted to 81.1%, 82.6% at 6 months, then 80.1% and 93.8% at 2 years. The medially placed ROI II demineralized most (respectively, 72.1% and 76.7%). More than 5 years after THA, BMD in the femur showed little change, but decreased significantly to 76.4% and 79.1%, respectively, around the cup (NETAVG II). DEXA is a useful method for analyzing changes of mineralization around cup and stem of cementless THA. The results reflect the different stress on the periprosthetic bone after implantation of THA in defined ROIs, supporting earlier reported good clinical results of the Spotorno stem and increased loosening rate of threaded acetabular cups after 5 years.

Absorptiometry, Photon↗

PubMed1997

Quantitative assessment of callus distraction using dual energy X-ray absorptiometry.

Bone mineralisation during and after limb lengthening procedures on the femur or tibia using unilateral fixators has been monitored quantitatively using dual energy X-ray absorptiometry (DEXA). We measured the bone mineral density (BMD) prospectively in the newly formed callus, in the bone adjacent to the callus and in the proximal femur. In twenty-one patients we showed a typical course with a peak value at 4-6 weeks after beginning distraction and a minimum value at maximum distraction. In the consolidation period the BMD in the distraction gap increased until the fixator was removed. The BMD in the regenerated bone increased faster in the regions of interest (ROI) opposite the fixator compared to those near it. Dynamisation caused more homogeneous regeneration equalising VBMD in the different ROIs. The BMD in the proximal femur of the leg which was operated on decreased to 67% and in the opposite leg to 87% of the preoperative value. DEXA provides a precise and quantitative assessment of callus and bone mineralisation during limb lengthening and helps in understanding what is happening during these procedures.

Absorptiometry, Photon↗

PubMed1997

Middle-term results of threaded acetabular cups. High failure rates five years after surgery.

We report our results using three different threaded acetabular components (Mecring A, Mecring B and Weill) in 715 hips with a follow-up of between one and ten years (median: 99.1, 56.5, 38.3 months, respectively). All cups were implanted with one type of cementless stem. The clinical results were good or acceptable in about 70% of the hips, but signs of loosening with radiolucency and/or migration were found in 10.1%. Radiological evidence of loosening did not correlate significantly with the clinical outcome. Pain was not a reliable indicator of loosening and its absence sometimes allowed severe osteolysis to develop. Twenty-five hips were revised (3.5%) for aseptic loosening of the acetabular component. Kaplan-Meier estimates of the cumulative rate of failure showed a rapid increase five years after the initial operation, but no significant correlation with gender, age or weight. The high rate of failure indicates that further use of these acetabular components cannot be recommended. Annual radiographs are required to assess osteolysis even if the patients are free from pain.

Acetabulum↗

PubMed1997

Clinical information system: a "gateway" to the 21st century.

This article describes the selection, design, and implementation of a clinical information system that includes order entry, results reporting, physical assessments, and critical care. The benefits of implementing this data management system such as cost savings, chart-as-you-go documentation, use of wireless technology, online quality improvement audits, and rapid data retrieval will be explained.

Decision Making, Organizational↗

PubMed1997

"Community health care: serving Colorado's uninsured"--a health policy legislative proposal.

The article presents a hypothetical legislative proposal titled "Community Health Care: Serving the Uninsured." Briefly stated, the purpose of this legislation is to encourage public and private initiatives to provide health care for the uninsured, the indigent, and the underinsured citizens of Colorado. Lessons learned from this project can facilitate APNs' understanding of the issues surrounding the development of health policy.

Colorado↗

PubMed1996

Bone quality in the lumbar spine in high-performance athletes.

Little is known about the influence of high-performance training on the bone quality of the lumbar spine, in particular, the effects on bone mineral density (BMD) in athletes with high weight-bearing demands on the spine. Measurements were therefore performed in internationally top-ranked high-performance athletes of different disciplines (weight lifters, boxers, and endurance-cyclists). The measurements were carried out by dual-energy X-ray absorptiometry, and the results compared with the measurements of 21 age-matched male controls. The BMD of the high-performance weight lifters was greater than that of the controls by 24% (0.252 g/cm2) on the AP view by 23% (0.200 g/cm2) on the lateral view (P < 0.01), while difference in BMD between the boxers and the controls was +17% (0.174 g/cm2) on the AP view and +19% (0.174 g/cm2) on the lateral view. The BMD of the lumbar spine in all endurance cyclists was lower than that in the controls (AP view -10%, 0.105 g/cm2; lateral view -8%, 0.067 g/cm2; P > 0.05). The results show that training program stressing axial loads of the skeleton may lead to a significant increase of BMD in the lumbar spine of young individuals. Other authors' findings that the BMD of endurance athletes may decrease are confirmed. Nevertheless the 10% BMD loss of cyclists was surprisingly high.

Absorptiometry, Photon↗

PubMed1996

Open wedge high tibial osteotomy using fractioned drill osteotomy: a surgical modification that lowers the complication rate.

We investigated retrospectively 132 cases of open wedge high tibial osteotomy using an external fixation device, concentrating on the rate of neurological complications. One group of patients underwent surgery according to the conventional technique (n = 89). The rate of transient neurological complications was 15.7%; 7 months after surgery the rate of persistent deficits was 12.4%. For the second group (n = 43) a modified surgical technique was used that lowered the complication rate significantly (transient deficits 14%, persistent deficits 4.7%). In the modified technique the osteotomy is not performed in the conventional way using an oscillating saw but through consecutive drill holes of increasing diameter followed by osteoclasis. The lower complication rate in the second group is mainly due to the less extensive approach that leads to a smaller number of postoperative tibialis anterior syndromes (type B lesion). No differences were found with type C lesions (extension deficit of D1). No complete peroneal nerve palsy (type A) occurred in either group. We conclude that the reduction of neurological complications in group 2 is related to the less extensive approach of the proposed technique.

Adult↗

PubMed1996

Juvenile progressive scoliosis and congenital horizontal gaze palsy.

Eleven articles reporting 39 patients with the combination of progressive scoliosis and familial congenital gaze palsy have now been published. This disorder appears to be caused by a malfunction of the normal equilibrial control mechanism related to the brainstem or the central nervous system. The scoliosis progresses when the children begin to walk. Even when they are treated with physiotherapy or brace, they often require early operation. We consider that progressive juvenile or infant scoliosis associated with familiar congenital horizontal gaze palsy constitutes a clinical entity. We report two sisters with congenital gaze palsy, in one of whom scoliosis of at least 70 degrees (Cobb) developed, and review and analyze all cases published until now.

Child, Preschool↗

PubMed1995

Fractioned drilling--a technique for wedge osteotomy of the knee.

High tibial wedge osteotomies are often followed by transient neurological complications. From a retrospective study of 132 patients it appears that the incidence of this troublesome complication can be reduced after osteotomy with external fixation by using a technique of making consecutive drill holes of increasing diameter followed by osteoclasis. This reduction of neurological complications was most marked when a less extensive surgical approach was used.

Adult↗

PubMed1995

[Results of treatment after traumatic shoulder dislocation. Thoracic abduction plaster case or Desault dressing].

In 80 patients with primary traumatic shoulder dislocation treated at the Heidelberg Orthopaedic University Hospital we had a follow-up examination. We wanted to know about age and sex of the patients, the number of redislocations in correlation to time and way of fixation. We had 70% male and 30% female patients with 97.5% of anterior dislocation. The minimum age was 16 and the maximum 87 years with an average of 44 years. 48 patients had a Desault bandage for 2 weeks and 32 had a shoulder-arm plaster cast for 3 weeks. There was no difference between both ways of fixation. We also could not see any better results after more than a 3 weeks' fixation. The most important fact for redislocation is the age and activity of the patients. A young man has a very high risk of redislocation within the first year.

Adolescent↗

PubMed1995

Dexamethasone therapy for children with bacterial meningitis. Meningitis Study Group.

OBJECTIVE: To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae. DESIGN: This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year. SETTING: The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio. PATIENTS: Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year. INTERVENTIONS: Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission. MAIN OUTCOME MEASURES: Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later. MAIN RESULTS: One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups. CONCLUSION: All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis.

Ceftriaxone↗

PubMed1995

[Quantitative follow-up of callus distraction with dual-energy roentgen absorptiometry (DEXA)].

With dual-energy X-ray absorptiometry (DEXA), bone mineralization during and after limb-lengthening procedures with unilateral fixators can be monitored quantitatively and precisely with low radiation exposure. We measured prospectively the bone mineral density (BMD) in the newly formed callus, in the bone adjacent to the callus and in the proximal femur in 21 patients with leg lengthening of the femur and/or tibia with unilateral external fixators. Mineralization showed a typical course with a peak value of 0.365 +/- 0.196 g/cm2 (30.9% of the first value) at 6-8 weeks after the beginning of distraction and a minimum value at the time of maximum distraction. In the consolidation period BMD in the distraction gap increased to 1.020 +/- 0.234 g/cm2 (87%) at the time of fixation removal. BMD in the regenerated bone increased faster in regions of interest (ROIs) opposite the fixator compared to ROIs near it. Dynamization of the fixation device led to a 13% increase in mineralization velocity (VBMD). On the other hand, dynamization caused more homogeneous regeneration equalizing VBMD in the different ROIs as well. BMD in the proximal femur of the leg operated on decreased to 67% and in the contralateral leg to 87% of the preoperative value. We consider DEXA to provide a precise and quantitative assessment of callus and bone mineralization during limb lengthening with unilateral fixators. Since we are well aware of the limitation of the technique. DEXA helps to understand what is happening in limb-lengthening procedures by providing quantitative values.

Absorptiometry, Photon↗

PubMed1993

[Clinical and roentgenologic changes after fibula resections: causes, differential diagnostic aspects, consequences].

This study correlates the clinical and radiological development of twelve patients with resection of the fibula, with the results of experimental investigations, reporting on the loss of tension-banding and proportional weight-bearing after fibula resection. Five patients underwent segmental fibula resection because of tumour disease, seven patients by reason of harvesting an intercalary allograft. Five patients suffered from lower leg pain. Spindle-shaped thickenings of the tibial cortex could be confirmed by most x-rays, in one case the tibial shaft diameter increased up to 10%. Usually the rest of the fibula will become atrophic in grown-up patients; in children the fibula may restore completely if the preparation is performed by sparing the periosteum. Three patients suffered a stress fracture of the tibia. As pain and tibial stress fracture appeared mainly if the remaining fibula was less than 1/4th of the original fibula length, the distal part should be preserved longer if justifiable from an oncological point of view. The knowledge about basic biomechanical behaviour and the arising possibility of a stress fracture or other structural changing of the tibia after fibula resection is important for correct assessment of the postoperative clinical and radiological development.

Adolescent↗