Biomedical subjects

F Gohlke

Publications and source records attributed to F Gohlke.

At least 19 recordsLinked to original sources

PubMed2003

[Anatomy of the glenoid labrum].

Most instabilities or pain syndromes are associated with injuries or morphologic changes in the glenoid labrum complex or long head of the biceps tendon origin. The first anatomic descriptions go back to Fick in 1910 and since then many authors have described the anatomy of these structures. It was Snyder who introduced the term SLAP lesions, classifying superior, anterior, posterior labrum changes into four grades. It is still unclear whether all of the described and arthroscopically observed changes are due to a post-traumatic, acquired lesion or whether anatomic variations can be present as well. In order to elucidate this problem, 36 cadaver shoulder joints were inspected macroscopically and sectioned for microscopic evaluation. Here the glenoid could be divided into an superior and an anterior- superior area demonstrating a wide variety of morphologic labral glenoid changes, while the dorsal and inferior sectors of the glenoid showed a relatively uniform anatomy of a firm labrum-glenoid bond. Four types of biceps tendon attachments could be identified similar to the description given by Vangsness. In addition, a variety of anterior-superior changes could be found. The sublabral hole as described by Esch in the clinical setting was found to be a physiologic variant. Precise knowledge of the anatomic morphology of the normal glenoid in its variations seems to be necessary to understand variants and allow for distinguishing between physiologic anatomic variants and pathoanatomic changes in imaging and the clinical setting.

Aged↗

PubMed2003

Ultrasonographic appearance of os acromiale.

AIM: Ossa acromiale are rare anatomical conditions and have been evaluated with plain radiographs, CT- and MRI-scans, but not with ultrasound. The purpose of this study was to evaluate the appearance and the characteristics of os acromiale with ultrasound. METHODS: 25 patients with unilateral radiologically prediagnosed os acromiale had bilateral examination with ultrasound. Recorded details were bilateral appearance, the width of the non-ossified space and the shape of the bony margins of the os acromiale. As a control group 25 patients without radiological appearance of os acromiale had identical ultrasound examination. RESULTS: The os acromiale could be identified in all 25 patients (100%) with radiologically confirmed os acromiale. In 12 patients an os acromiale could be identified on the contralateral side (48%). The average width of the non ossified space was 4.3 mm (2.5 to 7.6 mm). Three different sonographic types of bony margins of the os acromiale and the acromion exist: Type I with flat bony margins; Type II with marginal osteophytes and Type III with inverted bony margins. In the control group no os acromiale could be identified. CONCLUSION: With ultrasonographic assessment, os acromiale can be accurately identified in each case. Three differently shaped bony margins exist. Ultrasound can give additional information about the os acromiale if radiological assessment is unclear because of superimposing bones.

Acromion↗

PubMed2003

[Tendinitis of the long head of biceps tendon associated with lesions of the "biceps reflection pulley"].

UNLABELLED: In some patients with persistent pain around the Long Head of Biceps Tendon (LHB), lesions of the "biceps reflection pulley", associated with biceps tendinitis, can be found. The aim of this study is to describe the anatomy of the reflection pulley and the arthroscopic appearance of the pulley lesion. Therapeutic options will be discussed. METHOD: The results of a former histo-anatomic study done by the authors in 13 cadaver shoulders are compared with the intra-operative findings in patients with persistent tendinitis of the LHB together with a lesion of the reflection pulley and signs of LHB instability. Intra-operative findings from patients with either posttraumatic anterior instability or calcific tendinitis served as control. RESULTS: The superior glenohumeral ligament (SGHL) together with the coraco-humeral ligament (CHL) and fibers from the subscapularis and supraspinatus tendons form a stabilizing reflection pulley for the LHB in the rotator cuff interval. Arthroscopy shows an association between a lesion of this pulley and persistent LHB-tendinitis. Pulley lesions can occur as isolated ligamentous pathology or together with a partial detachment of rotator cuff tendons. CONCLUSION: In patients with therapy-resistant pain around the LHB, lesions of the reflection pulley need to be excluded beside more common causes of biceps problems. Arthroscopy is a reliable tool to assess these lesions. Therapy should address the definite pathology.

Adult↗

PubMed2002

[Kapandji intramedullary wire osteosynthesis in proximal humeral fractures].

For operative treatment of proximal humeral fractures minimal invasive techniques reduce the risk of iatrogenic damage of blood supply and periarticular scarring. Reported preliminary results are encouraging. We present our experience achieved with an intramedullary wire fixation adapted from a report of Kapandji in 1989. Between 3/95 and 6/00 29 patients were treated with this technique at our institution. All received early functional treatment. 14 patients (average mean age 56 years at time of trauma) who had a minimum follow up of 24 months (mean 36.4 months) and therefore allowed a preliminary conclusion regarding avascular head necrosis (AVN) were reexamined by use of the Constant Score and x-ray. We examined three unstable 2-part, four 3-part and seven 4-part fractures (5 of them valgus-impacted). The mean Constant Score at follow up was 70 points (31-86 points). We saw one total collapse of the humeral head because of AVN. In one patient the distal end of the wires led to a skin irritation and had to be shortened. We observed no secondary fragment displacement or non-unions. In our hands, this technique offers good results, even in valgus-impacted 4-part fractures of the elderly and allows internal fixation in little displaced but unstable fractures with the benefit of early functional treatment instead of longer immobilization. Based on the experience with intramedullary wiring the previously performed technique using threading wires was abandoned and the indication for primary arthroplasty considerably influenced.

Adult↗

PubMed2001

Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis.

OBJECTIVE: To examine the significance of power Doppler sonography (PDS) in the diagnosis of synovial hypertrophy of the knee joint by verifying and comparing the PDS findings with histopathologic findings of synovial membrane vascularity. METHODS: The knee joints of 23 patients who were undergoing arthroplasty of the knee joint because of osteoarthritis or rheumatoid arthritis were examined with ultrasound before arthroplasty. The vascularity of the synovial membrane was classified semiquantitatively using PDS. A sample of synovial tissue was obtained during the arthroplasty, and the vascularity of the synovial tissue was evaluated by immunohistochemistry (factor VIII) and was graded qualitatively by a pathologist who was unaware of the PDS findings. The visual qualitative grading by the examiner was controlled by analyzing PDS images and histologic samples using a digital image evaluation system. RESULTS: The correlation between the qualitative PDS results and the qualitative grading of the vascularity by the pathologist was 0.89 by Spearman's rho (P < 0.01). The Pearson correlation coefficient between the digital analysis of the PDS images and the digital analysis of the tissue sections was 0.81 (P < 0.01). Digital image analysis and qualitative grading by the examiner had a correlation of 0.89 by Spearman's p (P < 0.01) for the PDS images. The correlation between the qualitative estimation of vascularity by the pathologist and the digital image analysis was 0.88 by Spearman's rho (P < 0.01). CONCLUSION: In the present study, PDS proved to be a reliable diagnostic method for qualitative grading of the vascularity of the synovial tissue. In clinical practice, PDS allows further differentiation of the hypertrophic synovium.

Adult↗

PubMed2001

[Atraumatic locked posterior-inferior shoulder luxation in a child].

We report a rare case of recurrent atraumatic posterior-inferior dislocation of the shoulder in an eight year old girl. After closed reduction of the locked dislocation and conservative treatment three further dislocations occurred. Because of the recurrence of locked dislocations and functional impairment arthroscopy including partial synovectomy was performed. Postoperative rehabilitation included the use of a brace in handshake position for six weeks and strengthening exercises. Within a clinical followup of 24 months the shoulder remained stable without loss of function but atraumatic posterior-inferior dislocation of the contralateral shoulder occured. The bilateral involvement indicates a predisposing factor, predominantly gross capsular laxity, of this rare form of instability.

Arthroscopy↗

PubMed2001

[MRI of the shoulder. Degenerative changes and rotator cuff tears].

MRI currently offers the best imaging information for the diagnosis of subacromial pain syndrome, rotator cuff tears and osteoarthritis of the shoulder. The excellent anatomical and tissue specific imaging allows a detailed evaluation of the rotator cuff as well as the adjacent bony structures. If the cause of subacromial pain can not be determined despite extensive clinical, sonographical and radiological examination, MRI is indicated if there is a suspected pathology of the bony structures or the glenohumeral joint that could influence the further therapeutic procedures. In addition, MRI evaluation of muscular atrophy has become an important factor for determining appropriate therapy, particularly in cases of massive rotator cuff tears.

Acromion↗

PubMed2000

[Recommendations for diagnosis and expert assessment of traumatic rotator cuff lesions].

Traumatic rotator cuff lesions are a very rare condition. However, this article represents a comprehensive survey according to current knowledge on anatomy, biomechanics, and pathogenesis of rotator cuff pathology. Because of the relatively high prevalence of degenerative changes with increasing age, including partial and complete rotator cuff tears, it may be difficult to demonstrate the causality of an acute traumatic rotator cuff tear. Therefore, a catalogue of potential adequate and inadequate trauma mechanisms is proposed. Emphasis is also placed on posttraumatic diagnostic steps following persistent rotator cuff deficient shoulder function (e.g., ultrasound, MRI). From a legal aspect (e.g., private accident insurance, workers compensation claim), different minor and major criteria are defined, which could help experts to judge the causality of posttraumatic rotator cuff deficiency. These criteria mainly refer to distinct details concerning patients' history, trauma mechanism, primary clinical appearance, and diagnostic findings.

Diagnosis, Differential↗

PubMed2000

[Biomechanics of the shoulder].

The shoulder joint takes a special position among all the other joints of the human body because of its special requirements of stability and mobility. Knowledge of the biomechanics of the shoulder joint forms the basis for the development of modern concepts of reconstructive surgery and arthroplasty. Most of the biomechanical findings are the result of research performed on cadaver shoulders using increasingly sophisticated methods of measurement. These studies elucidate the interaction of the static and dynamic factors which contribute to the delicate balance of the glenohumeral joint. Recently performed research is increasingly being focussed on more detailed analyses of muscle forces and stress distribution in the subchondral bone and periarticular soft tissues. The efficiency of the computer systems now available has enabled the development of complex, virtual shoulder models and three-dimensional finite element analyses. In the future a pure mechanical understanding has to be modified to extend to a concept which includes more data obtained from living subjects, especially with regard to muscle activity under varying loads and neuromuscular feedback systems which currently are difficult to assess.

Biomechanical Phenomena↗

PubMed2000

Results of posterior cruciate-retaining unconstrained total knee arthroplasty after proximal tibial osteotomy for osteoarthritis. A prospective cohort study.

The purpose of the study was to investigate the results of posterior cruciate ligament (PCL)-retaining total knee arthroplasty (TKA) after previous proximal closed wedge tibial osteotomy for degenerative arthritis according to the technique recommended by Coventry and Insall. Thirty-five patients with previous proximal tibial osteotomy were matched to 35 patients without previous osteotomy according to age, sex, and Knee Society patient category. TKA after osteotomy was technically more difficult, often requiring a more extensive exposure. Complications were similar in the two groups, but an extended hematoma was more common in patients with previous osteotomies (2 patients) than in those with primary arthroplasty (1 patient). Knee Society scores were significantly lower in those with previous osteotomy, primarily because of decreased anteroposterior stability and pain. No significant differences were found in function scores, range of motion, or alignment. However, overall results of this PCL-retaining unconstrained TKA did not match those reported after PCL-substituting TKA.

Adult↗

PubMed2000

Balance sheets of knee and functional scores 5 years after total knee arthroplasty for osteoarthritis: a source for patient information.

To improve patient information on the results of total knee arthroplasty (TKA) for osteoarthritis, 253 primary TKAs of a prospective study with a mean follow-up of 5.3 years were analyzed. The increase or decrease of the individual variables of the Knee Society knee and function score and the percentage of operated knees in which these variables increased were determined. Improvement in pain rating had the largest increase of all variables, contributing 60% to the knee score increase. Pain improved in 95% of the knees. Alignment improved in about 90% of knees and accounted for 25% of knee score increase. Improvement in level walking contributed more to increase of function score than better stair-climbing abilities. Level walking improved in 80% of knees and stair climbing in 55%. Pain is the most rewarding indication for TKA, followed by deformity and poor walking ability. Key words: total knee arthroplasty, knee score, functional score, patient information.

Aged↗

PubMed2000

[Arthrography, ultrasound and MRI in rotator cuff lesions: a comparison of methods in partial lesions and small complete ruptures].

PURPOSE: To evaluate the accuracy of arthrography, ultrasound and MR imaging in rotator cuff disease. METHODS: 40 patients suffering from subacromial impingement syndrome for at least three months and who were selected for surgery, underwent ultrasound, double-contrast arthrography and MR imaging. Patient preselection focused on partial and small complete tears. RESULTS: 13/26 surgically confirmed tears were partial tears (articular surface: 10, bursal surface: 2, intra-substance tearing: 1). Arthrography, ultrasound and MR imaging yield a sensitivity for complete tears of 91%, 69% and 92% with a specificity of 100%, 93% and 93%. For partial tears sensitivity was 50%, 69% and 69% with a specificity of 100%, 79% and 86%. Concerning evaluation of localisation, extent and correct classification ultrasound was correct in 17/26 cases, MR in 21/26 cases. CONCLUSION: Arthrography is not helpful in detecting partial tears. Ultrasound and MR imaging yield comparable accuracy. MR imaging has advantages concerning better evaluation of extent, location and classification as well as for the detection of associated pathologies.

Arthrography↗

PubMed2000

[Resection of the head of the ulna in patients with rheumatoid arthritis].

PURPOSE: The purpose of the study was to investigate value and effect of distal ulna resection (Darrach procedure) on the wrist in rheumatoid arthritis. CLINICAL MATERIAL: From 1985 to 1995, resection of the distal ulna was performed in 47 patients (54 hands) with rheumatoid arthritis. 38 patients (6 men, 32 women, 43 hands) had an average clinical and radiological follow up of 4.7 years (range 3 to 13 years). RESULTS: 15 of the cases with rheumatoid arthritis were pain-free, 19 complained about pain after severe stress, seven complained about pain after mild stress and two about continuous pain. 85% of the patients had a range of motion (pro- and supination) of more than 120 degrees. 75% of the patients had a good or very good wrist function. In 32 cases, the patients were absolutely satisfied with the operative outcome, in five cases, they had expected more improvement. Six reported, that there was no change due to the operation. CONCLUSION: The results demonstrate that the main indication for the resection of the distal ulna is rheumatoid arthritis. This operation does not influence the progress of rheumatoid arthritis. Preoperative radiological changes (Larsen's classification) have the main prognostic value. In Larsen's II and higher, a partial arthrodesis is recommended.

Adult↗

PubMed2000

[In Process Citation]

The shoulder joint takes a special position among all the||| other joints of the human body because of its special requirements of stability||| and mobility. Knowledge of the biomechanics of the shoulder joint forms the||| basis for the development of modern concepts of reconstructive surgery and||| arthroplasty. Most of the biomechanical findings are the result of research||| performed on cadaver shoulders using increasingly sophisticated methods of||| measurement. These studies elucidate the interaction of the static and dynamic||| factors which contribute to the delicate balance of the glenohumeral joint.||| Recently performed research is increasingly being focussed on more detailed||| analyses of muscle forces and stress distribution in the subchondral bone and||| periarticular soft tissues. The efficiency of the computer systems now||| available has enabled the development of complex, virtual shoulder models and||| three-dimensional finite element analyses. In the future a pure mechanical||| understanding has to be modified to extend to a concept which includes more||| data obtained from living subjects, especially with regard to muscle activity||| under varying loads and neuromuscular feedback systems which currently are||| difficult to assess.

Journal Article↗

PubMed1998

[Histopathological findings in the proprioception of the shoulder joint].

Purpose of this study was the evaluation of distribution and morphology of mechanoreceptors in the glenohumeral joint capsule and rotator cuff in comparison to the coracoacromial ligament by means of specific immunfluorescence microscopy. The complemente joint capsules, rotator cuffs and coracoacromial ligaments of three fresh cadaver shoulder were harvesed. Serial cryostate sections were taken and alternately incubated with antiserum against neurofilament, lamin or myelin of peripheral nerves. The antibody-reaction was visualized with fluorescin lg-G. The nerve endings were photographed and computer-aided 3-dimensional reconstructions were performed. Three types of corpuscular and free nerve endings of different morphology were found in different distributions: whereas the Ruffini corpuscles were much more frequent in the coracoacromial ligament and rotator cuff, Pacini endings were predominantly found in the joint capsule. Generally corpuscular nerve endings were more frequent in the coracoacromial ligament and the rotator cuff than in the antero-inferior capsule and the number of corpuscles increased from medial to lateral within the anterior and inferior parts of the capsule. The dense ligamentous tissue was almost aneural whereas the periarticular fatty or loose connective tissue contained nerve fibres and nerve endings. In view of the results of other experimental and clinical studies the high frequency of Ruffini and Pacini endings in the rotator cuff and coracoacromial ligament suggest, that both are involved in the neurosensory control of glenohumeral stability and subacromial impingement. In contrast our findings in the joint capsule do not clearly prove, that those joint receptors predominantly maintain joint stability.

Acromioclavicular Joint↗

PubMed1997

Autoimmune findings resembling connective tissue disease in a patient with Castleman's disease.

Multicentric angiofollicular lymphnode hyperplasia (multicentric Castleman's disease) may be associated with acute phase reaction and several autoimmune features. Since lymphadenopathy is a common feature in connective tissue disease, a clear distinction between the different disease entities may be difficult. We describe a 26-year-old male patient with predominant cervical lymphadenopathy, hepatosplenomegaly and polyserositis, diagnosed as collagen disease. He showed several autoimmune features including autoimmune haemolytic anaemia, cryoglobulinaemia, positive antinuclear and anti smooth muscle antibodies, serum immune complexes and a sensorimotor polyneuropathy. Under immunosuppressive therapy with prednisolone and azathioprine, only partial remission was achieved. Repeated lymph node biopsy together with the clinical features led to the diagnosis of multicentric Castleman's disease in this patient nine years later. Interleukin-6 (IL-6) seems to play an important role in the pathogenesis of clinical and serum biochemical features in patients with Castleman's disease.

Adult↗

PubMed1997

Endothelial cells are the major source of sICAM-1 in rheumatoid synovial tissue.

The objective of this research was to investigate the cellular source of soluble ICAM-1 (siCAM-1) from rheumatoid synovial tissue (RS) and its relation to sICAM-1 in synovial fluid (SF) and serum, and to study the expression of ICAM-1 in isolated cells of RS. sICAM-1 was determined by using the enzyme-linked immunosorbent assay (ELISA) and Western blot analysis in supernatants from RS cultured for short periods (n = 19), in SF (n = 7) and in serum (n = 19). ICAM-1 expression, vascularization and inflammatory infiltration (CD3, CD68, CD22) were characterized immunohistochemically in cytospin preparations (n = 18), cryosections (n = 18) and in conventionally stained paraffin sections (n = 19) of RS. The degree of RS vascularization was analysed morphometrically in immunohistochemically stained cryosections (factor VIII related antigen). We found 90-kD sICAM-1 in supernatants of cultured cells, in SF and in sera. sICAM-1 in cellular supernatant correlated significantly (P < 0.01) with SF sICAM-1. The amount of sICAM in cellular supernatants showed no correlation to the score of inflammatory infiltration, but correlated significantly (P < 0.001) with the vascularization index of RS. The percentage of ICAM-1-expressing cells correlated significantly (P < 0.001) with the percentage of CD68-positive macrophages, but not with CD3- and CD22-positive lymphocytes. Macrophages, multinucleated giant cells and endothelial cells exhibited a higher expression of ICAM-1 as compared to lymphocytes and fibroblasts. The differential expression of ICAM-1 on infiltrating leucocytes and resident cells of RS indicates a functional role of ICAM-1 in the local inflammatory process. SF sICAM-1 originated in RS, but serum sICAM-1 did not. Shedding of sICAM-1 by RS was independent of inflammatory infiltration, but depended on the degree of vascularization, indicating that endothelial cells are the major source of sICAM-1 in RS.

Adult↗

PubMed1997

[Prospective observational study of surgical therapy of renal hyperparathyroidism].

A prospective long-term follow-up study in patients who had had surgical therapy for renal hyperparathyroidism was launched to investigate the results of surgical treatment and to evaluate possible correlations between preoperative laboratory values and the course of symptoms. From August 1987 to December 1995, 79 patients underwent surgery for renal hyperparathyroidism. It was the first neck exploration for 72 patients. Total parathyroidectomy with autotransplantation to a forearm was our preferred procedure (n = 67). The postoperative course of all patients is know. We carried out one to nine reexaminations (median 4) in 74 of 79 patients. The follow-up period ranged from 1 month to 5 years with a median of 18 months. After the operation transient hypocalcaemia occurred in 84.4% of patients. Postoperative hypocalcaemia correlated negatively with the preoperative levels of alkaline phosphatase and intact parathyroid hormone. Within the first month after surgery 60% of the preoperatively affected patients completely recovered from pruritus, whereas the skeletal syndrome took longer to disappear. One year after surgery 75% of the patients with pruritus and 79% of those with skeletal syndrome had became asymptomatic. After total parathyroidectomy with autotransplantation, patients with preoperatively elevated concentrations of alkaline phosphatase (> 200 U/I) experienced faster relief from joint pain than patients with preoperatively normal concentrations (P = 0.0297). To date 4.5% of the patients developed recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Morbidity of surgery for renal hyperparathyroidism is influenced by patients' risk factors. Postoperative hypocalcaemia correlates negatively with the grade of renal osteopathy at the time of operation. Preoperative concentrations of alkaline phosphatase influence the rapidity of the relief from joint pain.

Adult↗