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Biomedical subjects

F Gohlke

Publications and source records attributed to F Gohlke.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1997

Inflammatory infiltrate and interleukin-8 expression in the synovium of psoriatic arthritis--an immunohistochemical and mRNA analysis.

Psoriatic arthritis is an inflammatory arthropathy that ultimately can lead to joint destruction. In this study, we investigated the immunophenotypes of the inflammatory cells and the expression of interleukin-8 (IL-8), which is the hallmark chemoattractant cytokine of psoriasis in synovial membranes from patients exhibiting active psoriatic synovitis (n = 9). The tissue samples were examined by immunohistochemistry, Western blot analysis and in situ hybridisation. The inflammatory infiltrate consisted predominantly of CD3+ T lymphocytes, with a higher proportion of CD4+ than CD8+ T lymphocytes in six cases. CD3+ T lymphocytes were focally distributed near small blood vessels and the enlarged synovial intima. CD1+ interdigitating reticulum cells were not detected. CD22+ B lymphocytes and plasma cells were found in small aggregates without KiM4+ follicular dendritic cells. KiM8+ macrophages were located in the synovial intima and were distributed in a diffuse pattern near the synovial lining cells. CD15+ neutrophil granulocytes were detected in four cases. They were preferentially located in the vicinity of blood vessels and the synovial intima. IL-8 was found at a high level in the synovial lining cells and to a lesser extent in cells located in the perivascular areas. Immunofluorescence double staining showed IL-8 to be expressed in KiM8+ multinucleated giant cells, KiM8+ macrophages and CD3+ T lymphocytes. IL-8 receptor A was demonstrated in the synovial lining and in macrophages and lymphocytes. IL-8 was detected by immunoblot analysis of the synovial tissue at 8.4 kD. Employing in situ hybridisation, IL-8 mRNA was strongly and preferentially expressed in the synovial intima, as well as in macrophages and lymphocytes. The immunophenotype of the psoriatic arthritis inflammatory cells shows great similarity to the inflammatory infiltrate found in the synovial tissue of patients with rheumatoid arthritis. The preferential expression of IL-8 and IL-8 mRNA in the enlarged synovial intima and in lymphocytes and macrophages suggests that IL-8 exerts its action through activated mononuclear cells and T lymphocytes. It seems to play a role in regulating leucocyte traffic into the enlarged synovial intima and may contribute to the aggressive synovitis of patients with psoriatic arthritis.

Adult↗
PubMed1996

Immunohistochemical analysis of proliferating and antigen-presenting cells in rheumatoid synovial tissue.

We analysed the proliferative activity of synovial lining cells (SLCs), the distribution of proliferating B and T lymphocytes and the relationship of proliferating B and T lymphocytes to the pattern of antigen-presenting cells (APCs) within the rheumatoid synovial tissue (n = 21). The immunohistochemical detection of the proliferation-associated antigen Ki67 revealed low proliferative activity of SCL with and without expression of the Kim 8 (CD68) antigen. Ki67-positive B lymphocytes could be observed within secondary follicles (2/21), in small follicular dendritic reticulum cell (FDC)-containing follicle-like aggregates (7/21) and near the enlarged synovial intima (6/21). Ki67-positive T lymphocytes could be detected in T-lymphocyte aggregates (8/21), in the vicinity of blood vessels (18/21) and within the enlarged synovial intima (15/21). Semiquantitative analysis showed a strong correlation between the numbers of Ki67-positive B lymphocytes and FDCs and between the numbers of Ki67-positive T lymphocytes and interdigitating dendritic reticulum cells (IDC). There were significant differences in the number of Ki 67-positive B and T lymphocytes, IDCs and FDCs between the two groups of rheumatoid arthritis (RA) patients with different local clinical activity. These findings demonstrate a low proliferation of SLCs with and without expression of the monocyte-specific antigen Kim 8 and imply that B and T lymphocyte proliferation occurs in the presence of FDCs and IDCs. These results indicate that the RA synovial tissue is a site for antigen-dependent proliferation and maturation of B and T lymphocytes. The atypical pattern of FDC distribution within the rheumatoid synovial tissue "dysmorphic follicle" may be regarded as morphological substrate for a dysmaturation compartment of B lymphocytes leading to pathogenetic autoimmune phenomena in RA patients.

Adult↗
PubMed1996

Evidence for an overlap syndrome of autoimmune hepatitis and primary sclerosing cholangitis.

BACKGROUND/AIMS: Autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis are chronic liver diseases with probable autoimmune background. Overlapping features have been described for primary biliary cirrhosis and autoimmune hepatitis. In contrast, there have been only a few case reports on an overlap of autoimmune hepatitis and primary sclerosing cholangitis. METHODS: We describe three male patients with clinical and histological overlapping features of primary sclerosing cholangitis and autoimmune hepatitis. RESULTS: All initially asymptomatic patients had elevated levels of aminotransferases, alkaline phosphatase, gamma-glutamyltranspeptidase and IgG. Anti-nuclear antibodies and/or smooth muscle antibodies were positive and anti-neutrophil cytoplasmic antibodies were detected in all patients. Retrograde endoscopic cholangiography showed bile-duct strictures characteristic for primary sclerosing cholangitis. Histopathology showed necro-inflammatory activity of portal tracts with bridging necrosis in all patients at the time of first diagnosis. Aminotransferase levels and the necro-inflammatory activity responded well to immunosuppressive treatment. Predominant periductular fibrosis as a typical histopathological feature of primary sclerosing cirrhosis was seen to develop in all patients. Cholestatic serum parameters remained elevated and periductular fibrosis as endoscopic bile duct changes progressed despite immunosuppression. CONCLUSIONS: We suggest that these patients present an overlap syndrome of autoimmune hepatitis and primary sclerosing cholangitis as they fulfill the diagnostic criteria for both conditions.

Adolescent↗
PubMed1995

[Tubulointerstitial nephritis-uveitis syndrome (TINU syndrome)].

For 10 weeks a 25-year-old man had been suffering from tiredness, fatigue, nausea and a 16 kg weight loss. Erythrocyte sedimentation rate (83/133 mm), serum C-reactive protein (5.5 mg/dl) and creatinine (5.05 mg/dl) were all elevated. He also had proteinuria (1120 mg daily), sterile leukocytosis and a creatinine clearance of 10 ml/min. Renal biopsy showed interstitial nephritis and bone marrow biopsy revealed non-caseous epithelioid-cell granulomas. 14 days after admission he developed acute iritis in the right eye. Other causes having been excluded, the diagnosis of tubulo-intestinal nephritis with uveitis (TINU syndrome) was made. The clinical symptoms and laboratory findings improved within a few days of the start of glucocorticoid treatment (initially, 100 mg prednisone daily, reduced to 5 mg within 30 days). The patient was discharged after 8 days in good general condition.

Acute Disease↗
PubMed1995

[Therapy refractory atypical polyarthritis and cryoglobulinemia in a patient with colon carcinoma and palliative intestinal bypass. Differential diagnosis: carcinoma-polyarthritis or bypass arthritis].

The case of a 63 year old woman with mesenteric recurrence of a colonic carcinoma and infiltration of the duodenum is reported. To bypass duodenal stenosis a duodenojejunostomy was performed. Three months later the patient developed severe atypical polyarthritis which led to hospitalization. The arthritis affected large and small joints in an asymmetrical pattern. Fever and Raynaud's phenomenon of both hands accompanied the arthritis. Elevated sedimentation rate, acute phase proteins, cryoglobulinemia and immune complexes were remarkable laboratory findings. Rheumatoid factor was absent. In the subsequent course the polyarthritis was refractory to steroids and nonsteroidal anti-inflammatory drugs. Only treatment with broad-spectrum antibiotics ameliorated the arthritis. Postenteric reactive arthritis, septic arthritis and metastatic arthritis could be excluded. Although the patient had a family history of rheumatoid arthritis and a HLA-type DR4 the diagnosis of rheumatoid arthritis was not very likely since distal interphalangeal joints were affected, rheumatoid factor was absent and antibiotic therapy was successful. The case serves to discuss carcinoma-polyarthritis and bypass-arthritis as the main differential diagnosis.

Adenocarcinoma↗
PubMed1993

The influence of variations of the coracoacromial arch on the development of rotator cuff tears.

In order to define the geometry of the coracoacromial arch in both its bony and soft parts and to bring it into relationship with rotator cuff tears, 54 cadaver shoulders (from subjects aged 47-90 years) were dissected and X-rayed (anteroposterior projection and supraspinatus outlet view). Partial rotator cuff tears were assessed additionally by transillumination and polarized microscopy. After transfixation of the coracoacromial arch with a polyurethane mould, sections were made along the coracoacromial ligament. The morphology of the acromion was described following the classification of Bigliani et al. [5]. Amongst other parameters, measurements were taken between the long axis of the scapula, the spina, and the acromion. In 19 of 22 cases, a traction osteophyte was associated with rotator cuff tears. In incomplete tears, spurs were completely encased within the ligament and did not impair the subacromial space. The number of rotator cuff tears was significantly increased in shoulders with "curved" acromia, flat acromial slope, and increased angle between the scapular plane and the spina (intact, mean 58 degrees; tears, mean 47 degrees). The morphology of the subacromial space was secondarily determined by this angle. In contrast to Bigliani et al. we were unable to find a "hooked" acromion. These results indicate that the combination of a flat and curved acromion or a position of the acromioclavicular joint above the cranial pole of the glenoid must be regarded as considerable risks for the development of rotator cuff tears. The concept of anterior acromioplasty is supported by our results.

Acromioclavicular Joint↗
PubMed1993

[Instability and impingement of the shoulder of the high performance athlete in overhead stress].

The present prospective study was performed on 89 competitive sportsmen (league players of handball, basketball, volleyball and water polo). The evaluation was based on information obtained from a review of training methods, a standardised anamnestic, physical and sonographic examination directed at pain, function, flexibility and all signs of impingement and instability of the shoulder counted in a score. The incidence of shoulder pain, which handicapped during training and play within the last 6 months was for water polo 60%, handball 40%, volleyball 25% and basketball 3.5%. Analysing these problems we found severe problems predominantly in handball, fewer in water polo or volleyball. According to data obtained from sports with throwing activity we found a high incidence of shoulder disorders. Using basketball players as a control group with less throwing activity our results would suggest that this mechanism seems to be the most important. The high incidence of severe disorders in handball players is additionally caused by traumatic injuries. Ultrasonography shows predominantly incomplete tears of the deep surface of the supraspinatus tendon near to the insertion with exception of the basketball players. Only in 5 shoulders (2.8%) we found the coincidence of clear signs of instability and subacromial pathology. The term "instability impingement" has not proved to be very helpful and has turned out to be far too diffuse to establish a diagnosis.

Acromioclavicular Joint↗
PubMed1993

[Tensile strength of various anchor systems in surgical correction of instability of the shoulder joint].

Commercially available fixation devices used for reattachment of capsuloligamentous tissue to the glenoid rim were tested until they failed in 42 human cadaveric shoulders, and compared to the tension strength of the standard Bankart procedure and that of the intact anterior capsule. The bone quality in the glenoid was measured by quantitative computed tomography, which allowed selective quantification of cortical and cancellous quantification of cortical and cancellous bone. The mean load at failure perpendicular to the bone surface varied from 90 to 115 N and was lower than in the standard Bankart procedure (127 N). All suture anchors demonstrated similar holding strength with the exception of an absorbable wedge (P < 0.05). Due to reduced mineral content in the inferior part of the glenoid, the fixation strength of all suture anchors was significantly decreased. In more than 20% a tension load of 100 N caused the suture anchor to pull out, but in general the fixation strength was limited by the suture attachment and the quality of the soft tissues. These data together with the first clinical results of 49 cases of anterior instability operated on between 1988 and 1992 allow the conclusion to be made that this modification will provide sufficient stability for early mobilization after surgical repair.

Adult↗
PubMed1993

[Intra-articular steroid therapy in treatment of chronic arthritis in childhood and adolescence].

OBJECTIVE: Steroids are among the most potent antirheumatic drugs, but carry unacceptable adverse effects during long-term systemic application. In children with pauciarthritis intra-articular steroids have been recommended. METHODS: We assessed the effect of intra-articular triamcinolone-hexacetonide in 16 joints of 12 children and adolescents with chronic arthritis unresponsive to non-steroidal anti-inflammatory agents. RESULTS: All joints improved and no side effects were observed by clinical and roentgenographic means. After a follow-up of 12 months after a single injection 9 joints were without arthritis and 3 joints showed minimal effusion without limitation of motion. In 4 joints arthritis reappeared after 1, 6, 7 and 7 months. CONCLUSION: Intra-articular steroid therapy is a highly effective alternative in the treatment of children and adolescents with chronic arthritis.

Adolescent↗
PubMed1993

[Ultrasonographic appearance of the rotator cuff in elderly subjects].

Some special points must be taken into consideration when diagnosing complaints of the shoulder joint in older patients by means of sonography. Such patients not only have a higher incidence of systemic disease, but also--as we know from autopsies--a large percentage of rotator cuff tears. These changes--with the exception of small partial tears--can be recognized sonographically with a high degree of certainty. Prospective sonographic studies have provided us with information that the incidence of rotator cuff tears rises from 25% in patients in their fifties to 50% in patients in their seventies. These studies enabled us to explain the hitherto unknown clinical relevance of these changes. In general, the patients complained of little pain, but when large tears were present, there was usually a clear loss of function, which however was astonishingly well tolerated. These findings would call for caution in indicating complicated reconstructive surgery.

Aged↗
PubMed1991

[Surgical treatment of anterior shoulder instability].

Long-term results obtained with the procedures hitherto regarded as standard and new findings about the etiopathogenesis and biomechanics of shoulder instability allow the conclusion that there is no single technique that is suitable for all forms of instability. Rather, an optimal surgical treatment should be selected with regard to the particular pathologic anatomy. For the majority of anterior instabilities--most of which are traumatic in origin--lasting reattachment of the capsule ligamentous structures to the lower anterior glenoid rim without a change in the original anatomical conditions is indicated. This concept, first described by Perthes and made known by the publications of Bankart, has been incorporated into several operative procedures and has been subjected to various modifications and technical innovations, including adaptation for arthroscopic methods. In a small number of instabilities deformations of the bones articulating on each other in the joint are found. These should be compensated if they affect the biomechanics. Most instances of shoulder instability caused by constitutionally determined laxity of the capsule should be treated conservatively. Not until such measures have failed should an operation be carried out; depending on the extent and directions of the usually multi directional instability, different methods of tightening and strengthening of the capsule are required.

Biomechanical Phenomena↗
PubMedDate not supplied

[Follow-up studies after bicondylar superficial replacement of rheumatoid knee joint destruction].

This study documents prospectively the Knee Society knee- and function score of 28 patients with rheumatoid arthritis with 34 PFC unconstrained total knee arthroplasties from preoperative values on at yearly intervals. The average follow-up period was 3.4 years (range 2-5.5 y). At last follow-up over 80% of the knees were painfree. All but one patient could walk more than 500 m. Knee and function score increased significantly from 30.1 resp. 35.0 to 83.8 resp. 74.6 (P < 0.000001). Postoperatively the knee score rose soon to a constant level whereas the function score showed a continuous slow increase up to 5 years. We observed one deep venous thrombosis and one subluxation. At an intermediate follow-up rheumatoid knees are clinically and functionally successfully operated on using an unconstrained TKA. Pain relief is excellent. We recommend the use of a scoring system assessing knee and functional results separately.

Adult↗
PubMedDate not supplied

[Self-training versus conventional physiotherapy in subacromial impingement syndrome].

AIM: This prospective, randomized study was aimed to compare the effect of a standardized self-training versus standard physiotherapist-supervised exercises in the non-operative treatment of shoulder impingement syndrome types Neer I and II. METHOD: 40 patients with subacromial impingement I/II were randomized to two groups. Group 1 performed a mostly isometric self-training after instruction by a physiotherapist, group 2 received prescriptions for physiotherapy and "strengthening exercises for the rotator cuff". Follow up was performed after 6 and 12 weeks with the use of the constant score (unpondered). Patient satisfaction with the treatment was controlled by VAS (1 - 6). RESULT: After 12 weeks, patients of group 1 had performed the exercises 5 x/week for 15 minutes. Patients of group 2 had received 30 sessions in average. Patients of group 1 improved from a mean of 59 points (39.5 - 86) to a mean of 68 points (37 - 88) after 6 and 75 points (65 - 90) after 12 weeks. Patients of group 2 improved from 60.5 points (41 - 83) to 67 points (39.5 - 92) and 72 points (43 - 93), respectively. Patient satisfaction was higher in the self-training group (1.9 : 2.8). CONCLUSION: Strengthening of the centering muscles around the humeral head leads to good results in the non-operative treatment of subacromial impingement. Self-training after instruction showed no difference to physiotherapist-supervised exercises in the non-operative treatment of subacromial impingement.

Adult↗
PubMedDate not supplied

[Primary synovial chondromatosis of the shoulder].

AIM: To demonstrate the various patterns of primary synovial chondromatosis (PSC) around the shoulder and to discuss a therapeutic algorithm. METHOD: In this retrospective study, 6 patients with histologically proven PSC were operated on. The diagnosis was based on clinical examination, plain X-rays, ultrasonography and MRI in 5/6 patients. Also, a histological examination was done in all cases. According to the localisation of the disease, surgery was done by endoscopy alone, endoscopy together with open surgery or direct open surgery. RESULTS: In one case each, we saw an isolated disease of the subacromial bursa or the gleno-humeral joint. In two cases, we found an intraarticular affection together with the biceps tendon sheath. The other two patients showed a massive periarticular deposition of loose bodies together with a defect of the rotator cuff. All patients with intraarticular disease (5/6) showed different stages of chondromalacia. In 5 of 6 patients all bodies could be removed at surgery. At follow-up after 36 months the patients subjectively rated the result as satisfactory to excellent. In the patients with total removal of the bodies, no recurrences were seen on plain X-ray or ultrasonography. CONCLUSION: PSC around the shoulder appears with a variable pattern. According to the possible late complications described in the literature (i. e., secondary osteoarthritis, involvement of the rotator cuff and secondary malignant transformation), we find operative treatment justified. Surgery addressing removal of loose bodies and partial synovectomy allows good results. The operative approach (endoscopy or open surgery) is related to the localisation and severity of the condition.

Adult↗
PubMedDate not supplied

[Comparison between low-molecular and unfractionated heparin in the prevention of thrombosis in patients with total endoprosthetic replacement of hip and knee joint].

PURPOSE: Thrombosis-prophylaxies with heparins after total hip arthroplasty (THP) and total knee arthroplasty (TKA) is well accepted. The aim of this study was to compare the low molecular weight heparin (Enoxaparin) with PTT adjusted unfractionated heparin (Na-heparin). METHODS: In a prospective study of 226 patients after THA and TKA, we performed physical examination and ultrasound in compression and duplex technique one day before surgery and at the 7th and 14th day after surgery. 120 patients received Enoxaparin 1 x 40 mg per day in fixed dosage. 106 patients received Na-heparin 3 x 5000 IE. Since PTT did not reach 40 seconds, Na-heparin dosage was increased to 3 x 7500 IE. RESULTS: The overall thrombosis rate was 4% (n = 9), in the Enoxaparin group 2.9% for the 70 THA and 10% for the 50 TKA. Thrombosis occurred in the group of unfractionated heparin (PTT adjusted) in 1.8% after THA and in 2% after TKA. In TKA, there is statistical difference between the two heparin groups. CONCLUSION: In the thrombosis prophylaxis of TKA, PTT adjusted unfractionated heparin is superior to low molecular weight heparin in fixed dosage.

Aged↗
PubMedDate not supplied

[The stabilizing function of the glenohumeral joint capsule. Current aspects of the biomechanics of instability].

The purpose of the study was to determine the influence of rotation torques on superior-inferior and anterior-posterior translation in various degrees of abduction in the glenohumeral joint. 16 cadaveric shoulders were tested using a specifically designed four-degrees-of-freedom mounting apparatus and a 6-degrees-of-freedom tracking system which allowed of dynamic and static measurements by means of ultrasound (Zebris) Internal/external rotation torques and translation forces in the inferior-superior and anterior-posterior plane were applied in 0 degrees, 45 degrees, 75 degrees and 85 degrees of abduction. Shoulders were tested intact, vented, after severing of the acromion and coracoid (7 shoulders) and after subsequent division of the anterior capsule at the glenoid margin including a T-shaped incision (8 shoulders). Venting of the capsule resulted in a significant increase in ap-translation only in abduction of less than 45 degrees. Rotation torques and an abduction of more than 45 degrees effected a centering of the humeral head against translation-forces in the anterior-posterior and superior-inferior direction. The weakening of the anterior capsule by a T-shaped incision, in which circular fibers were also severed, significantly increased the anterior translation in comparison to that obtained after an incision along the glenoid margin.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromion↗