Trapezius-transfer for shoulder paralysis: 6 patients with brachial plexus injuries followed for 1 year.
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Brachial Plexus↗
Biomedical subjects
F Gossé
Publications and source records attributed to F Gossé.
The value of scintigraphy in the diagnosis of pseudarthrosis after spinal fusion surgery.
The utility of planar bone scintigraphy was evaluated for discerning bony union after spinal fusion surgery, especially in cases of clinically and radiologically suggested pseudarthrosis. Between 1991 and 1996, the authors performed bone scintigraphy on 42 patients (21 women, 21 men; mean age, 42 years) after spinal fusion surgery (32 posterolateral, 10 combined) and just before their admission to the hospital for material removal. The fusions consisted of 29 lumbosacral, 6 thoracolumbar, 3 lumbar, 2 thoracolumbosacral, 1 thoracic, and 1 cervical. The mean fusion spanned four segments, and the mean time between spinal fusion and material removal was 27 months. The scintigraphy was performed using the tracer Tc-99m. Based on the scintigraphy data, the radiologist suspected pseudarthrosis in five patients (12%), and the condition was confirmed in four patients during operation (10%), two diagnosed and two undiagnosed. The accuracy of the method was 88%; sensitivity, 50%, specificity, 93%; positive predictive value, 40%; and negative predictive value, 95%. The sensitivity and positive predictive value of bone scintigraphy are low for possible instability after spinal fusion. The method is not sufficient to reliably diagnose pseudarthrosis after spondylodesis.
Adult↗
Follow-up results 17 years after resection arthroplasty of the great toe.
Resection arthroplasty of the first metatarsophalangeal joint is a well-known operation. The follow-up results more than 17 years after arthroplasty for hallux valgus are reported and discussed. Between 1971 and 1980, 335 resection arthroplasties were performed on 205 patients. The sole indication for resection arthroplasty of the great toe in this study was hallux valgus. The technique involved removal of the proximal one-third of the phalanx with interposition of a capsular flap, occasionally including temporary Kirschner wire fixation. After 17.6 years on average, 102 patients were re-examined clinically and radiographically. Questionnaire assessment revealed a significantly prolonged walking distance, and 70% of the patients were pain-free at follow-up investigation, whereas 67% suffered from severe pain before the operation. Clinical evaluation showed diminished weight-bearing of the great toe during walking and a reduced range of motion of the resected first metatarsophalangeal joint. Radiographic shortening of the proximal phalanx was 37%. The average hallux valgus angle was 23 degrees at follow-up and 34 degrees prior to surgery. The unacceptably high rate of hallux valgus relapse, especially due to a high intermetatarsal angle, emphasizes the unsatisfactory long-term results of the resection arthroplasty. We now recommend this operation for older patients only, and a differentiated approach using reconstructive procedures according to the clinical and radiographical situation for younger patients.
Adolescent↗
Preventive administration of ornithine alpha-ketoglutarate improves intestinal mucosal repair after transient ischemia in rats.
OBJECTIVES: To investigate whether the preventive enteral administration of a polyamine precursor, such as ornithine alpha-ketoglutaiate (OKG), has a beneficial effect on the repair process of the intestinal mucosa after transient mesenteric vascular occlusion. DESIGN: A controlled laboratory study. SETTING: A research laboratory facility at the Research Institute for Digestive Cancer. SUBJECTS: Male Wistar rats, weighing 330 to 350 g, housed individually in plastic cages under standardized conditions (23 degrees C, 73 degrees F, 60% relative humidity, 12-hr light and 12-hr dark cycles). INTERVENTIONS: Intragastrically, 1.5 or 17 hrs before surgery, animals received either distilled water (water group), or an amino acid solution of either OKG (1 g/kg) or L-lysine (0.68 g/kg) in distilled water under isonitrogenous conditions. Intestinal ischemia was produced in anesthetized rats by occluding the superior mesenteric artery for 90 mins with a microbulldog clamp. At the end of the ischemic period, the clamp was removed, allowing reperfusion, and the abdomen was closed. MEASUREMENTS AND MAIN RESULTS: At 0, 4, and 24 hrs after ischemia/reperfusion, the midjejuno-ileum was resected. Intestinal morphology, polyamine content, and hydrolase activities were determined. In all groups at the end of the ischemic period, the villi were dismantled with preservation of the crypts. Rats treated with OKG exhibited a restoration of short villi by 4 hrs after ischemia/reperfusion. In other groups, the villi remained extensively denuded. By 24 hrs, only rats treated with OKG showed a complete recovery of normal mucosal architecture. The amount of the polyamines, putrescine, and spermidine were significantly enhanced by 4 hrs after ischemia/reperfusion in the mucosa of rats treated with OKG, as compared with the two other groups. At a functional level, sucrase and aminopeptidase activities remained significantly higher by 4 hrs of ischemia/reperfusion in rats treated with OKG as compared with rats receiving water or lysine. By 24 hrs, hydrolase activities were normalized in rats treated with OKG, whereas an important deficit in hydrolase activities remained in rats receiving either water or lysine. CONCLUSIONS: OKG administration to rats did not prevent ischemic damage of the intestinal mucosa, but it accelerated the repair of the mucosa during reperfusion. OKG favored the restitution of normal villus architecture and the functional recovery of the intestinal mucosa. We hypothesized that OKG-triggered metabolites might mediate the restitution process and contribute to the healing of the intestinal mucosa by minimizing cell injury and by promoting the replacement of injured cells.
Aminopeptidases↗
Trapezius transfer after brachial plexus palsy. Indications, difficulties and complications.
Most brachial plexus palsies are due to trauma, often resulting from motorcycle accidents. When nerve repair and physiotherapy are unsuccessful, muscle transfer may be considered. Paralysis of the deltoid and supraspinatus muscles can be addressed by transfer of the trapezius. Between March 1994 and June 1997 we treated 38 patients with brachial plexus palsy by trapezius transfer and reviewed 31 of these (7 women, 24 men) after a mean follow-up of 23.8 months (12 to 39), reporting the clinical and radiological results and subjective assessment. The mean age of the patients was 29 years (18 to 46). The operations had been performed according to the method of Saha described in 1967, involving transfer of the acromion with the insertion of the trapezius to the proximal humerus, and immobilisation in an abduction support for six weeks. Rehabilitation started on the first postoperative day with active exercises for the elbow, hand and fingers, and electrical stimulation of the transferred trapezius. All 31 patients had improved function with a decrease in multidirectional instability of the shoulder. The average increase in active abduction was from 7.3 degrees (0 to 45) to 39 degrees (25 to 80) at the latest review. The mean forward flexion increased from 20 degrees (0 to 85) to 44 degrees (20 to 90). Twenty-nine of the 31 were satisfied with the improvement in stability and function. Trapezius transfer for brachial plexus palsy involving the shoulder improves function and stability with clear subjective benefits.
Adolescent↗
Suppression of preneoplastic changes in the intestine of rats fed low levels of polyamines.
Administration for 7 days of an enteral diet that is naturally deficient in polyamines strikingly reduces the preneoplastic changes observed in the intestines of adult Wistar rats previously treated with the carcinogen 1,2-dimethylhydrazine. On the contrary, supplementing the enteral diet with spermidine favors preneoplastic development. The effects of the low-polyamine diet included a 40% decline in the putrescine content of the intestinal mucosa, a significant decrease in the turnover rate of the epithelial cells from the crypts to villus tip in the ileum, and a 2-fold reduction in the number of abnormal colonic crypts. The experimental data support the view that it might be of interest to control the dietary intake of polyamines in the clinical management of cancer patients.
1,2-Dimethylhydrazine↗
[Trapezius transfer in deltoid paralysis].
In most cases the genesis of brachial plexus palsy is traumatic, often because of bike accidents. If physiotherapy and neurosurgical procedures such as nerve repair do not have the desired outcome, muscle transfer operations are possible. The results of our favored transfer of the trapezius muscle to compensate paralysis of the deltoid muscle will be presented. Preoperatively radiological, clinical and electromyographic examinations are necessary. Our results are based upon the clinical and radiological check ups and the subjective assessment of the patients. Thirty-one patients (7 female, 24 male) underwent a trapezius transfer between March 1994 and December 1996. The average age was 29 years (range 18-46 years). We performed the operations using a modification of Saha's technique. With the patient in lateral decubitus position and protection of the opposite plexus, a sagital skin incision is the first step, followed by the preparation of trapezius and deltoid muscle as well as the bony parts of the shoulder (acromion, clavicle, scapular spine). The deltoid origin is cut from the lateral third of the clavicle, the acromion and the lateral half of the scapular spine. The next step is transection of the roof of the acromion and the lateral clavicle. After elevation of the remaining trapezius insertions from the clavicle and scapular spine, the proximal humerus is exposured by splitting the partly detached deltoid muscle longitudinally. Then the acromion fragment and humerus are prepared for the bone-to-bone contact. In 90 degrees of abduction the acromion fragment with its trapezius insertion is transferred and fixed to the humerus with two 4.5-mm screws. Finally the deltoid is sutured on the top of the trapezius and the skin is closed over two suction drains. Postoperatively we immobilize the operated arm in an abduction support for 6 weeks. The physiotherapy program starts on the first postoperative day with active training of elbow, hand and fingers and electrostimulation of the transferred trapezius muscle. Six weeks after the procedure we take an X-ray and start with progressive adduction of the arm. The preoperative subluxation of the humeral head was abolished in all cases. We achieved an average increase of active abduction from 7.3 degrees (range 0-45 degrees) preoperatively to 39.2 degrees (range 25 degrees-80 degrees) 1 year after the operation; the increase of forward flexion was from 20 degrees (range 0 degrees-85 degrees) to 43 degrees (range 20 degrees-90 degrees). All patients were satisfied with the improvement of stability and function of the operated shoulder. Finally we can conclude that the trapezius transfer for flail shoulder gives a satisfactory outcome regarding shoulder function and stability as well as the subjective situation of the patients.
Adolescent↗
[Effect of surgical technique on meniscus transplants. A histological, animal experiment study].
After transplantation, a meniscus undergoes alterations in mechanical loading, which causes changes in its histological structure. We studied the degenerative effects on meniscus and tibial cartilage resulting from variations in the congruity or the isometric fixation of medial meniscus transplants. In three groups of five sheep each, the menisci were transplanted in three different ways, using the same operative approach. The menisci were evaluated 24 weeks after operation. In group 1, the meniscus was totally detached from its base at the capsule and refixed without changes in the congruity or isometry. This group provided the basic data. In group 2, the contralateral medial meniscus was turned upside down and transplanted. The reattachment was performed according to isometric conditions. With this technique the congruity of the tibial and femoral surface was modified. In group 3, the medial meniscus was reimplanted by choosing defined non-isometric fixation points for the anterior and posterior meniscal ligaments without changing the position of the corpus. For evaluation, the morphological alterations of meniscus and tibial cartilage were assessed by the Jackson score. The more distinct changes of the meniscus were assessed histologically by three criteria: surface cells, surface fibers and changes in the meniscus center. The highest degree of degenerative changes occurred in group 3 (score 4.5); however, considerable changes were also found in group 2 (score 3.5). Incongruous or non-isometric placement of a meniscal graft will lead to degeneration and failure of the graft.
Animals↗
[Robot-assisted knee endoprosthesis].
With the development of powerful computer systems, computer-assisted medical diagnosis and therapy have become common over the last 10 years. Even in the surgical field, computer- and robotic-assisted techniques are becoming practical but are not yet used on a daily basis. In the orthopaedic field, computer and robotic assistance is used in planning and performing demanding three-dimensional osteotomies, setting pedicle screws in the spine and milling the femoral medullary canal in total hip replacement. This article introduces a computer- and robotic-assisted system for performing arthroplasty in total knee replacement procedures.
Computer Simulation↗
[After-care regimen after muscle replacement operations in brachial plexus lesions].
Following augmentation of the upper extremity muscles necessitated by damage to the brachial plexus, special post-operative care programs are required to provide the patient with the best possible results. Proper care requires cooperation between the orthopedic surgeon, physical therapists and nurses. Only then can postoperative rehabilitation and functional control of the extremity improve. We describe interdisciplinary postoperative care programs for augmentation of the deltoid muscle with trapezius transfer, arthrodesis of the glenohumeral joint, biceps augmentation with the latissimus dorsi transfer, Steindler flexorplasty and augmentation of flexors/extensors muscles in the hand.
Adult↗
Enteral supplementation with ornithine alpha ketoglutarate improves the early adaptive response to resection.
BACKGROUND: Polyamine synthesis or uptake, or both, might be an important event that initiates the adaptive hyperplasia seen in the intestinal remnant after partial small bowel resection. AIM: The ability of an enteral diet supplemented with the ornithine salt: ornithine alpha ketoglutarate (OKG), a precursor for polyamine synthesis, to modulate the adaptive response of the remnant ileum after jejunectomy was evaluated. METHODS: Adult Wistar rats underwent a resection of the proximal 50% of the small intestine. Controls underwent a single transection. The rats were fed intragastrically with a nutritive mixture supplemented either with casein hydrolysate or with OKG (1 g/kg). The isoenergetic and isonitrogeneous diets was given continuously for seven days. RESULTS: Villus and crypt hyperplasia was observed in the remnant ileum compared with transfected controls. OKG supplementation started after resection a further increase in villus height. After resection, OKG supplementation increased significantly the putrescine content and the amount of ornithine decarboxylase mRNA. A twofold to threefold increase of sucrase activity was measured in the resected animals compared with the transected rats. In contrast, the amount of sucrase mRNA was significantly lower in the ileum of the resected rats and OKG supplementation initiated a further drop in the amount of sucrase mRNA without pronounced changes in enzyme activity. CONCLUSIONS: The adaptive hypertrophy seen after resection can be accelerated by supplementing the diet with ornithine (OKG) a precursor of polyamine synthesis. In the remnant ileum, the reduced amount of sucrase mRNA, despite the increased level of sucrase activity, suggests a post-translational control of sucrase expression.
Adaptation, Biological↗
A new oscillating saw for robotic aided surgery.
In this paper a brief description of a computer and robotic aided surgery system is given with a detailed overview of the necessity to develop special tools for robotic surgery. The application range of this robotic system has been specially focused on the orthopaedics field and, more particularly, on the execution of osteotomies. It was therefore necessary to develop a new saw device which would meet medical and--from the robot system point of view--mechanical as well as functional requirements. After describing the device which was developed on the basis of these requirements, a detailed comparative study of off-the-shelf oscillating saws and the new device is given at the end of the paper.
Equipment Design↗
Ultrasound for diagnosis of apophyseal injuries.
Avulsion injuries of the apophysis is a problem in young athletes. A correct diagnosis is necessary for establishing the appropriate treatment and the rehabilitation program. However, it is often difficult to distinguish between a simple muscle strain and an avulsion fracture. The X-ray examination is helpful only when an ossification center of the apophysis exists. Ultrasonography is considered the suitable diagnostic tool for these cases. From June 1988 to June 1993, 243 young athletes were seen with an anamnestic and clinically suspected apophyseal injury of the lower extremity. In all cases X-ray examination and ultrasound examination were performed. In 80 cases the diagnosis was confirmed by X-ray examination and in 97 by ultrasonography. Four criteria were defined for the sonographic examination: (a) a hypoechogenic zone, (b) increased distance to the apophysis, (c) dislocation of the apophysis, and (d) mobility of the apophysis on dynamic examination. These criteria are correlated to (a) edema, (b) lysis, (c) avulsion, and (d) unstable avulsion of the apophysis. Ultrasonography is a proven technique for the detection of apophyseal injuries. In comparison to X-ray examination, it has the advantages of no radiation exposure, early detection even without ossification center, and dynamic examination.
Adolescent↗
[Primary arthrodesis of the knee joint].
Because of progressive development in the field of knee arthroplasty, currently there are fewer indications for primary knee arthrodesis. Primary knee arthrodesis is indicated in acute or chronic infections in which conservative treatment has failed, monoarticular arthritis in young patients if total knee replacement is not suitable, unstable knee joints caused by poliomyelitis or other neuromuscular disease, neuropathic joint disease, in salvage of the extremities with tumors of the distal femur and proximal tibia, and to obtain length in femur dysplasia. The operation technique with a modified Charnley compression fixator is described. Fifteen patients (100%) treated by this double-frame fixator have had a solid arthrodesis 13.6 weeks after surgery. We found 5 pin infections and had to reset 2 Steinmann pins.
Adult↗
[The relevance of perioperative coagulation parameters to indications for blood transfusion. A retrospective analysis of 300 liver transplantations].
In the present study, a retrospective statistical analysis of laboratory data, clinical data, and perioperative blood requirements from 300 primary orthotopic liver transplantations (OLT) is described. METHODS. OLT was performed using established surgical techniques and total IV anaesthesia. Volume was substituted with red blood cells (RBC) and fresh frozen plasma (FFP) according to haemodynamic data, haemoglobin, and diuresis. Platelet counts, prothrombin time, activated partial thromboplastin time (aPTT), thrombin time, fibrinogen, and antithrombin III were registered but not used as indications for transfusions. Statistics were performed using regression analysis and analysis of variance. RESULTS. The mean intraoperative fluid requirement was 793 ml balanced salt solution, 7.1 units RBC, and 8.4 units FFP; pooled random donor platelets were given only once. During 24 h postoperatively, an average of 1.8 units RBC and 4.6 units FFP had to be transfused. Currently, 278 of the 300 patients (92.7%) are alive. There was no significant correlation between clotting data and intraoperative blood use; for postoperative transfusion rates, the preoperative aPTT and postoperative platelet counts had a significant correlation. Reviewing the basic diseases of the patients, there were significant differences in coagulation status, but no differences in transfusion rates. CONCLUSION. According to the data presented, indications for transfusions in OLT according to clotting data are not valid, since these data do not correlate with the blood requirement. In addition, strategies for pretreatment of patients such as preoperative plasmapheresis are no longer justified with respect to possible side effects.
Adult↗
Polyamines and the recovery of intestinal morphology and function after ischemic damage in rats.
We have followed the time-course of the morphological and functional recovery of intestinal mucosa after 90 min of mesenteric vascular occlusion. At the end of the ischemic period the villi were smashed, but crypts were preserved. Microvillous hydrolase activities showed a dramatic drop when compared with sham-operated controls. Reperfusion was followed by an immediate upsurge of ornithine decarboxylase activity and a significant (p < 0.01) enhancement of putrescine and N1-acetyl-spermidine concentrations, while spermidine and spermine concentrations in mucosal cells decreased. This indicated that, both, de novo synthesis and degradation rates of the polyamines were increased. Treatment with alpha-difluoromethyl-ornithine, a selective inactivator of ornithine decarboxylase prevented the accumulation of active enzyme, but did not prevent morphological healing. It delayed however the recovery of sucrase and aminopeptidase-specific activities. Our results suggest that in addition to de novo synthesis, other sources of polyamines are mobilized to an extent that growth at a normal rate is supported. This indicates that the presence of active ornithine decarboxylase enzyme is not a prerequisite for the restitution of intestinal integrity after ischemia. We suggest that in a situation of inadequate polyamine supply the restoration of vital processes (mucosal regeneration) has priority over the restoration of specific functions.
Animals↗
Comparison of different lipid substrates on intestinal adaptation in the rat.
The relative effects of medium chain (MCT) and long chain triglycerides (LCT) on intestinal morphology and functions were compared. Adult rats received intragastrically for 10 days an isoenergetic mixture containing either 50% MCT/50% LCT or 100% LCT. The other constituents of the diets were identical, and animals fed a standard diet orally were used as a reference group. Animals who were given the MCT/LCT diet showed a higher mucosal mass and protein content and increased villus length and crypt depth in the proximal part of the small intestine compared with the LCT and control diet groups. Administration of [3H] thymidine 12 hours before death resulted in a significant increase in the incorporation of the precursor into cellular DNA in the jejunum of rats given MCT. In rats given LCT as the only fat, the free fatty acid content of the microvillus membrane showed a 20 fold increase and at the same time there was a significant drop in the cholesterol content and in the cholesterol/protein ratio. Differences in the lipid composition of enterol diet or in the microvillus membrane did not effect adversely membrane bound hydrolase activities. These findings suggest that MCT in the diet confers advantages in addition to the provision of rapidly available energy.
Animals↗
[Post-traumatic recurrent hip joint dislocation].
Recurrent post-traumatic dislocation of the hip joint without an accompanying fracture is very rare. Delayed reduction and a too short immobilization periods seems to favor redislocation. One case is presented together with a discussion of the operative therapy and the intraoperative pathological-anatomical findings with respect to the literature.
Adult↗