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Biomedical subjects

G Muhr

Publications and source records attributed to G Muhr.

At least 235 records · Page 13Linked to original sources
PubMed1992

[Primary humerus head replacement in dislocated proximal humeral fracture. Indications, technique, results].

Displaced three- and four-part fractures of the humeral head detached from their blood supply are at high risk for a poor functional outcome after internal fixation. Primary prosthetic replacement can restore the pretraumatic anatomy, and early function is possible. Head replacement within 2 weeks after trauma, reapproximation of the tuberosities, and reconstruction of the rotator cuff tear establishes early stability and good functional results in up to 80%.

Aged↗
PubMed1992

[A cellular quantitative immune deficiency in chronic post-traumatic osteomyelitis].

The specific cellular host defence in patients with chronic post-traumatic bone infection was analyzed in a prospective study. The study included 120 patients with chronic post-traumatic osteomyelitis and 60 healthy volunteers. The number of CD-5, CD-4, CD-8, natural killer cells and the CD-4/CD-8 ratio were significantly decreased. The immunodeficiency seems to be trauma-induced and reinflammation seems to be due to other immunodeficient factors. The potential key role of a defect in cytokines is discussed.

Adolescent↗
PubMed1992

[Antibiotic-containing collagen sponge in therapy of osteitis].

In 1988, we treated 47 patients with acute or chronic osteitis by means of a new industrial collagenous sponge containing gentamicin (Sulmycin Implant) as an adjuvant measure. The local surgical management was standard: total excision of all avascular or infected soft tissue and bone, stabilization of pseudarthrosis, the improvement of local circulation and the condition of the soft tissue by means of local or free flaps before autologous bone grafting and antibiotics administered according to the test results. In cases of instability AO external fixation was used. One or two Sulmycin Implants (10 x 10 cm) containing 130 or 260 mg gentamicin were placed in the remaining small cavities or in the transplanted autologous spongy bone. Gentamicin was measured in the wound exsudate for 3-5 days; during this time we found bactericidal concentration in these exsudates. The wounds healed in 44 patients, but we had a persistent fistula in 3 patients (6.3%). We see collagen-gentamicin sponges as being very useful in the treatment of osteitis. It seems to reduce delayed bone transplantation in infected areas.

Bone Transplantation↗
PubMed1992

[Complications after surgical management of scaphoid pseudarthroses].

The Matti-Russe technique yields a 95% success rate in treating scaphoid non-unions diagnosed in the first years after trauma and without osteoarthrosis of the radiocarpal joint. Between October 1981 and December 1989, 215 patients were treated by Matti-Russe procedure at the University Hospital of "Bergmannsheil" Bochum. In ten cases, this operation did not lead to osseous consolidation. The results are presented and discussed.

Bone Transplantation↗
PubMed1991

[Axis-related spontaneous correction after tibial fractures in childhood].

In the Department of Surgery at the Bergmannsheil University Hospital, a total of 50 children with measurable post-traumatic deformity of the axis after fracture of the lower limb were examined. Clinical and radiological monitoring was carried out 6 years after their accidents, which they had sustained at the age of 3-15 years. The real degree of axis deformity remaining was determined mathematically, and the correction tendency was analysed in three dimensions and projected graphically using sum vectors. This showed better results in the correction of axis deformations of the lower limb visualized on a-p X-ray photographs as varus or valgus than of deformations seen as ante- and recurvation of lateral X-ray photographs. The excentric arrangement of muscles in the dorsal part of the lower limb could be one reason for this. All 50 patients experienced a reliable spontaneous correction of the axis deformity with no complications of stimulatory growth disturbance with showing good functional results. Shaft fractures of the lower limb in children are generally treated conservatively, operative treatment being indicated only in the case of severe lesions of the soft tissue and in adolescent patients.

Adolescent↗
PubMed1991

[Primacy of soft tissue reconstruction in complicated tibial fracture--a new concept].

A total of 158 tibial shaft fractures with soft tissue injuries were treated from 1986 to 1990. In cases with type III open fractures, early reconstructive procedures with local or free flaps were carried out after radical debridement. After 12 months 95% of these fractures had healed. Postoperative infection occurred only in 4 (2.5%) of these 158 tibial shaft fractures with soft tissue damage. Before 1986, without these principles, the infection rate of type III open fractures was 17%.

Fracture Fixation↗
PubMed1991

[Aggressive volume therapy for prevention of acute renal failure in multiple trauma patients].

Immediate fluid resuscitation is of the utmost importance for patients with multiple trauma. Evaluation of this form of treatment for the prevention of acute renal failure was the purpose of this study. Of 262 patients with multiple trauma, 112 were in shock on admission. The patients were treated with large volumes of Ringer's lactate and sodium bicarbonate until urine production was 60-100 ml/h. Hemoglobin and electrolytes were substituted according to the laboratory findings. There were 32 patients who developed renal complications, such as bacteriuria (13), hematuria (7), reduction of renal function (3), and acute renal failure (9). The renal failure did not develop during the first 24-48 h but during treatment in the intensive care unit, mostly in the course of multiple organ failure. Death supervened in 35 of the 262 patients (13.5%). Thus, immediate rapid fluid replacement with large volumes of crystalloid solutions can prevent acute renal failure.

Blood Volume↗
PubMed1991

[Post-traumatic correction osteotomy of the distal forearm. Which factors modify the results?].

Post-traumatic deformities are a typical complication of fractures of the distal radius, occurring in about 20% of cases. They are associated with ulno-carpal pain and malfunction of the wrist. Different indications for surgery are given and various operative techniques are recommended. Between 1972 and 1987 a total of 108 patients with post-traumatic disorders following fractures of the distal radius underwent surgical treatment by one of three different procedures: isolated correction of the distal radius, combined correction of the radius und ulna, isolated correction of the ulna (distal resection, shortening osteotomy, hemiresection arthroplasty). 92 (85.2%) followed-up for an average of 9 years postoperatively was possible in 92 (85.2%) of the patients. The functional results were evaluated according to Lidström's system. Excellent and good results were found in 64 (69.6%), fair results in 22 (23.9%), and poor results in 6 (6.5%) of the patients studied. The best results were seen mainly in cases with a short time lapse between trauma and corrective surgery. Distal resection of the ulna has not been performed since 1986 because of poor results and wrist instability. Following isolated correction of radius or ulna, in some patients axial malalignment of the distal radius by about 10 degrees and/or length differences of 2-3 mm with persisting pain or malfunction were seen. In summary, we recommend the combined correction procedure in patients with painful deformities, not more than 6-9 months after the injury. The range of indications should be determined by individual aspects, such as profession, age, activity, discomfort and radiological findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroplasty↗
PubMed1991

[Increasing compartment pressure in tibial intramedullary nailing. A phenomenon inherent in the therapy?].

At the Department of Surgery of the Bergmannsheil Hospital, a total of 58 patients treated with intramedullary nailing were reviewed with reference to the condition of the soft tissue. During intra- and postoperative treatment a bilateral fasciotomy was required in 8 patients. The subfascial pressure in the deep flexor compartment measured in 11 patients during secondary closed placement of intramedullary nails showed a slight increase of pressure in the deep flexor compartment from 8 mmHg to 40 mmHg after extension of the leg positioned on the operating table. After reduction the pressure increased significantly, from 50 mmHg to 80 mmHg. The postoperative pressure measured after 20 min was less than 50 mmHg in 9 patients. In 2 patients with manifest compartment syndrome (compartment pressure greater than 50 mmHg) immediate fasciotomy was required. Besides commonly known traumatic effects, parameters inherent in the therapy caused an increase in compartment pressure were critically reviewed with reference to their clinical relevance. The reasons for an increase in compartment pressure during closed placement of intramedullary nails in the lower leg are high position of the leg (hydrostatic effect), stretching of the soft tissue by reduction (decrease of volume), and possibly hematoma with outflow into the deep flexor compartment (increase of content).

Adolescent↗
PubMed1991

[Arthrolysis of post-traumatic stiff elbow. Which factors influence the end result].

In a retrospective study of 59 patients the results obtained with elbow arthrolysis performed for the treatment of posttraumatic stiffness were analyzed. The intraoperative functional result was classified as excellent in all cases, while an average of 27 months after the operation the range of movement was decreased again to varying extents. This deficit correlated with the type of injury, timing of arthrolysis, duration of metal implants and timing and type of postoperative rehabilitation program. The relative increase in function was better after simple fractures, with 47%, than after fracture dislocations, with 35%. After arthrolysis within 3 months of onset of posttraumatic stiffness the range of improvement was 55%, compared with an increase of only 30% after 10 months' stiffness. When arthrolysis was combined with metal removal and the implants had been in place for longer than 9 months the increase achieved was only 15%. Patients mobilized on the 1st day postoperatively lost only 15% of their intraoperative function. If mobilization was delayed to between the 2nd and 5th days, 30% was lost. Changing splints for maximal joint flexion and extension at 4-h intervals resulted in a 35% loss of range of movement postoperatively. In contrast there was a loss of only 17% in the group with combined additional physiotherapy and continuous passive motion. The results show that the prognosis of elbow arthrolysis is determined by optimal operative planning and a meticulous rehabilitation program. The time to arthrolysis should be as short as possible, as should the time to removal of metal implants. The aim of the rehabilitation program is immediate postoperative mobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Immunostimulation with ibuprofen in chronic osteitis. An experimental study].

The present investigation shows that chronic posttraumatic osteitis is associated with markedly elevated prostaglandin E2 (PGE2) serum levels. Synthesis of PGE2 is inhibited by nonsteroidal antiinflammatory drugs, such as ibuprofen, which block cyclooxygenase. Osteitis patients showed significantly decreased PGE2 serum levels during treatment with ibuprofen (1200 mg/day). In addition, a significant increase in soluble interleucin-2 receptor serum levels was observed. PGE2 has significant immunosuppressive effects on cell-mediated immunity. On the other hand, soluble interleucin-2 receptor is a reliable indicator of immune system activation. Ibuprofen seems to be a potent immunostimulating agent for the treatment of chronic posttraumatic osteitis, which is characterized by depression of cell-mediated immunity.

Dinoprostone↗
PubMed1990

[Sonographic diagnosis in blunt thoracic trauma].

Chest sonography after blunt thoracic trauma allows the immediate institution of emergency treatment before X-ray examination. Especially in cases of hemothorax or/and hemopericardium, ultrasound is more specific and sensitive than conventional X-ray. A definite diagnosis of pneumothorax is possible when the typical sonographic findings are present: there is a strong line of reflexes along the chest wall, with complete extinction. Unilateral intensification of air-stipulated repeating echoes may be a sign of mantle pneumothorax. Ruptures of the diaphragm are usually recognizable on radiographic examination only when there is massive intrathoracic splanchnectopia. They are better recognized by ultrasound examination, so that iatrogenic complications caused by thoracocentesis can be avoided. Continued ultrasound check-ups are necessary to reveal any secondary appearance of pleural fluid and to monitor the effect of pleural drains. Ultrasound is also useful for guidance when pleural aspirations are performed. In 64 patients sonography showed hemothorax in 39 cases (radiographic: 13 certain, 9 uncertain), hemopericardium in 1 case, and rupture of the diaphragm in 1 case (radiography: no pathologic findings in either of the last 2). In 2 cases rupture of the diaphragm seemed possible on ultrasound but was excluded by later (ultrasound) controls, and in 2 cases with ultrasound findings suggestive of pneumothorax subsequent X-ray examination confirmed the diagnosis of mantle pneumothorax. At follow-up, 29 pathologic findings according to radiographic examination were recognized on ultrasonography as liquid or organized pleural effusions or pulmonary infiltrates. False-negative or false-positive findings (apart from two supposed diaphragmatic injuries) were not recorded with ultrasound.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Comparative studies on the ingrowth behavior and the bone adhesion of various implant materials. An animal experiment].

Each of 36 mongrel dogs received implants of the following six materials: methyl methacrylate, carbon fibre composite, aluminium oxide-ceramic, titanium alloy, pure titanium and hydroxylapatite (HA). Test rods 7 mm in diameter were used to perform a push-out test, and discs with a diameter of 25 mm and a thickness of 5 mm were used for a plane traction test. The animals got a fluorochrome labelling and were harvested 8 weeks after operation. The results of the push-out test were a stability of 3.6 N/mm2 for HA and very low values for all the other materials, while the plane tension test showed a stability of 1.6 N/mm2 for the HA discs and values that were not even measurable for all the other materials. The interface of HA and the bone could not be separated by mechanical forces; usually the bone or the ceramic material fractured beneath the interface, so that the real stability of the interface must be rated very high. Light and fluorescence microscopy revealed a close bone connection for HA and only partial connections for the other materials. HA-coated materials may have a future in orthopaedics surgery.

Alloys↗
PubMed1990

[Quantitative immunohistological analysis of cell-mediated immunity in osteomyelitic bone tissue].

The present investigation allows an exact identification and quantification of cell populations involved in local cell-mediated immunity of osteomyelitic bone tissue. Determinations of systemic immunity carried out in osteomyelitis patients indicated the distribution of immunogenic cells in the osteomyelitic focus only indirectly. The method described combined with simultaneous determination of the systemic immunity and cell mediators can lead to a quantitative description of cell-mediated immunity and in turn to a better understanding of the interaction of cells and transmitters involved in osteomyelitis.

Adult↗
PubMed1990

[Continuous decompression. A new method in the treatment of juvenile bone cysts].

Venous obstruction in the bone is the true cause of a simple bone cyst. Scaglietti combined decompression with the injection of a corticosteroid into the cyst cavity, while Chigira used a multiple drill-hole method. We perforate the cyst wall and decompress continuously with cannulated screws for 12 months. Consolidation of a cyst cavity has been uniformly observed 9-11 months after drilling. Six patients have been treated, with excellent results and without any recurrences in the follow-up period of 24 months. Since the introduction of this simple method, resection and grafting of bone cysts in young people has been not necessary.

Adolescent↗
PubMed1990

[Prognostic parameters in acute lung failure (ARDS) in multi-trauma patients].

The data recorded in 10 multitrauma patients who died of respiratory insufficiency (ARDS) were retrospectively compared with corresponding data recorded in 10 patients with similar injury scores who survived. All 20 patients had had respirator therapy from the 1st day onward. The criteria for ARDS were: (1) death in respiratory insufficiency after trauma. (2) chest X-rays showing signs of ARDS, (3) continuous decrease in the Horowitz quotient, and (4) autopsy (50% of the patients). The goal was to find out which variables give the first indication that ARDS is developing. Leukocyte and serum fibrinogen levels proved to have no discriminatory value. The inspiratory oxygen concentration needed (FiO2) and the Horowitz quotient differed in a highly significant manner beginning on the 1st day after trauma. None of the survivors needed an FiO2 of over 0.28 by the 2nd posttraumatic day, while none of the ARDS patients needed less than 0.35. In survivors the Horowitz quotient increased up to physiological values on the 2nd day. A significantly higher PEEP from the 3rd posttraumatic day onward was needed in ARDS patients. The respiratory peak-pressure increased significantly from the 2nd posttraumatic day.

Adolescent↗