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Biomedical subjects

G Muhr

Publications and source records attributed to G Muhr.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Thoracic injuries associated with acute traumatic paraplegia of the upper and middle thoracic spine].

AIM: The aim of this study was to analyse the number of thoracic injuries associated with acute traumatic paraplegia of the upper and middle thoracic spine and review the early management in respect to treatment standards. METHODS: Using a prospective study protocol, data were sampled and analyzed from 12 December 2000 to 31 March 2002 at a level 1 trauma center. RESULTS: Twenty-two consecutive patients were included in the study. Sixteen suffered severe chest traumata. Lung contusion was diagnosed in 81%, followed by haemopneumothorax (75%) and fracture of the bony chest (75%). Intubation was performed 12 times in all. Chest drainage was performed in 14 patients. The mean duration of artificial ventilation was 20 days (range 2-93) and of intensive care treatment 25 days (range 2-93). Five patients died. CONCLUSIONS: Acute traumatic paraplegia of the upper and middle thoracic spine caused by high energy trauma is highly associated with severe chest trauma. Therefore, respiratory impairment must be kept in mind during the early treatment. If respiratory failure becomes more evident, emergency procedures such as intubation and chest drainage have to be performed. Secondary transfer should be avoided.

Accidental Falls↗
PubMed2005

[Application of low intensity, pulsed ultrasound on distraction osteogenesis of the humerus. Case report].

Low intensity pulsed ultrasound accelerates fracture healing both clinically and experimentally. Based on recently published animal studies, an improvement in regenerative bone maturation after distraction osteogenesis due to low intensity, pulsed ultrasound is also expected. We report on an 18 year-old female patient suffering from an acquired shortening of the right upper arm of 10 cm after humeral osteitis as a baby. The patient was admitted to hospital for corticotomy and distraction osteogenesis at the afflicted humerus. Due to the published experimental results in animals which indicate an improvement in bone regeneration during callotasis with the additional application of low intensity, pulsed ultrasound, we decided to try this procedure. The calculated distraction consolidation index was 21 days/cm, which is below the mean of 30 days/cm reported in the literature for humeral lengthening by distraction osteogenesis. The calculated healing index according to Paley was 0.7 months/cm in our patient. Compared to reference data, in which a range of from 0.87 months/cm to 1.5 months/cm is reported, our patient showed an accelerated maturation of distraction callus. The duration of treatment of the patient was clearly shortened by the additional application of low intensity, pulsed ultrasound. If distraction osteogenesis is correctly indicated, the early use of low intensity, pulsed ultrasound should be considered, since an acceleration of callus formation with consecutive shortening of treatment time could be attained while wearing an external fixator, leading to a decrease in cumulative complications, such as pin tract infections. Further studies from our research group regarding this topic will follow.

Adult↗
PubMed2005

[Surgical treatment of a displaced femoral head fracture with a cement-free dual-headed prosthesis using a minimally invasive approach. Clinical and radiographic outcome].

One hundred patients treated with a cementless bipolar prosthesis for a displaced subcapital hip fracture were prospectively evaluated for clinical and radiographic outcome. All patients were operated via a minimally invasive approach; in every case we implanted a Zweymuller stem. There were 77 women and 33 men with a mean age of 80 years (29-98 years). The mean duration of the operation was 29 min (20-95 min). Full weight bearing on crutches was allowed 1 day after the operation. The mean follow-up was 2.5 years (6 months to 7 years). Two years after the operation there were 40% of the remaining 65 patients who scored between 90 and 100 on the Harris hip score, 23% between 80 and 89, 20% between 70 and 79, and 17% below 70. No patient complained about thigh pain and up to now there has been no need for femoral revision due to loosening. There was no infection or nerve lesion. In three patients there was a luxation of the prosthesis which could be reduced by closed means. Radiographs from 81 patients showed stress shielding in 97.5% mainly in Gruen zones 1 and 7. Radiolucent lines in two or more Gruen zones were found in two patients. These findings suggest that the noncemented, pressfit, grit-blasted bipolar prosthesis demonstrated similar stability and radiographic results to cemented bipolar prostheses. Stress shielding was common but did not influence longevity of the implant. We did not find any signs of protrusion. Especially in older patients with a history of cardiac disease, the noncemented bipolar prosthesis is a rational alternative to avoid intra- and postoperative complications despite the higher costs for the implant. The minimally invasive approach helps to reduce operation time and intraoperative blood loss.

Adult↗
PubMed2005

[Pigmented villonodular synovitis of the knee joint].

Pigmented villonodular synovitis is a rare proliferative disorder of the synovial membrane most frequently found in the knee. The etiopathology of the disease is still not understood. Present terminology differentiates between a localized (LPVNS) and a diffuse (DPVNS) form. Currently, MRI is the diagnostic imaging technique of choice. The localized form (LPVNS) can be cured definitely in almost all cases by partial arthroscopic synovectomy, whereas the treatment of the diffuse form (DPVNS) is discussed controversially concerning an arthroscopic or total synovectomy by open arthrotomy. We report a case rarely found in the literature of a patient suffering from a diffuse form of PVNS localized in the right knee joint. In this case PVNS acted as a locally aggressive and destructive lesion of immense extent invading femoral, tibial and fibular bone and the whole extending muscular system. We performed a radical synovectomy by open arthrotomy. By implanting a tumor prosthesis we prevented progression of the disease. Apart from adequate diagnosis, we recommend complete and aggressive resection of the affected tissue by performing an open arthrotomy.

Arthroplasty, Replacement, Knee↗
PubMed2005

[Avulsion fractures of the lower pole of the patella].

Fractures of the lower pole of the patella are rare and occur typically in children. In these types of fractures an extensive sleeve of cartilage is pulled off with a small bony fragment. The so-called sleeve fractures are often overlooked in plain radiographs. We describe the operative treatment and outcomes in two patients with sleeve fractures, one receiving early and one delayed treatment.A 12-year-old boy (case 1) sustained an indirect injury to the left knee while playing ball. Clinical examination showed a lag of active extension of the left knee without decrease in passive range of motion. At 9 years of age, a 12-year-old girl (case 2) sustained a direct blunt trauma to her right knee while playing ball. The lesion of the lower pole of the patella was not diagnosed in time. During the following 3 years a lag of extension of the right knee developed.The sleeve fracture diagnosed early was treated by open reduction and internal fixation with transosseous suturing. At the 6-month follow-up the knee had regained full range of motion. The sleeve fracture diagnosed late showed a nonunion of the patella resulting in a lag of extension. Even after 3 years a shortening osteotomy of the patella resulted in full range of motion of the right knee.

Arthroplasty, Replacement, Knee↗
PubMed2005

[Iliopsoas tendinitis--rare cause of pain following implantation of a total hip endoprosthesis].

Pain following implantation of a total hip endoprosthesis is described in the literature with an incidence of 1-17.6%, depending on the type of prosthesis. The underlying causes are numerous; the primary reasons for such pain are septic and nonseptic loosening of the prosthesis, periarticular heterotopic ossifications, or trochanteric bursitis. Less common reasons are muscular hernia, squeezing of the joint capsule, distal nerve lesions, stress fractures, compartment syndromes, or neoplasia.One can find only a few reports about tendinitis of the iliopsoas muscle as a cause for pain following implantation of an endoprosthesis in total hip arthroplasty. We now report about a female patient with therapy-resistant pain after total hip replacement, caused by tendinitis of the iliopsoas muscle. We introduce the transpositioning of this tendon from the lesser trochanter to the proximal anterior femur and bony refixation with a PDS cord as a new operative treatment.

Arthroplasty, Replacement, Hip↗
PubMed2005

[Prospective randomized trial of a modified standard multislice CT protocol for the evaluation of multiple trauma patients].

PURPOSE: To evaluate whether modification of a standard multislice CT (MSCT) protocol might improve the diagnostic work flow in patients with multiple trauma without relevant loss of image quality. MATERIALS AND METHODS: Between September 2002 and September 2003, 80 multiple trauma patients underwent 4-slice CT encompassing head, thorax, abdomen/pelvis and spine. All patients were randomly assigned to either protocol A or B: Protocol A included serial scanning of the head (collimation 1 mm, 350/380 mAs/120 kV) and spiral scans of thorax, abdomen/pelvis and spine (collimation 2.5 mm, 220 mAs/120 kV) with gantry angulation and arm elevation; protocol B included spiral scanning of all body regions (collimation 2.5 mm, 300/150 mAs/120 kV) without gantry angulation or arm elevation. Time intervals, radiation exposure and results of the initial and final analysis were documented. RESULTS: In the investigated 64 male and 16 female patients (mean age 41.7 years), 88.7 % of the 407 pathologic findings were correctly identified on the initial images. Protocol B revealed a significant decrease in scan time (6.4 vs. 16.8 min., p < 0.001), time in the CT examination room (22.9 vs. 32.8 min.; p < 0.001), time until initial (25.3 vs. 35.8 min.; p < 0.001) and final image analysis (93.7 vs. 112.9 min; p < 0.005). No significant difference was found for patient transport time and image reconstruction time. Protocol B has a significantly lower effective radiation dose compared to protocol A (10.2 vs. 12.7 mSv, p < 0.001). CONCLUSIONS: Applying a modified MSCT protocol without gantry angulation and arm elevation can significantly decrease radiation exposure and examination time in multiple trauma patients without relevant loss of diagnostic image information and, consequently, has the potential of improving the diagnostic process and prognosis in multiple trauma patients.

Adult↗
PubMed2005

[Evaluation of multiple trauma victims with 16-row multidetector CT (MDCT): a time analysis].

PURPOSE: Description and time analysis of a 16-row MDCT protocol in the evaluation of multiple trauma patients considering transport, time of scanning, patient positioning, image reconstruction, and image interpretation. MATERIALS AND METHODS: Between May and December 2004, 60 multiple trauma patients underwent 16-row MDCT (Sensation, Siemens, Erlangen, Germany). The protocol included serial scanning of the head, spiral scanning of the cervical spine and contrast-enhanced spiral scanning of the thorax/abdomen with multiplanar reformations (MPR) of the thoracic/lumbar spine and the pelvis. All time intervals including transport, patient positioning, scanning, duration of MPR, total time in the examination room, and time to first and final image interpretation were prospectively evaluated. Furthermore, patient characteristics, trauma profiles, and mortality rates were recorded. RESULTS: 46 male and 14 female patients (mean age 43.6 years) were enrolled in the study. Time analysis of 16-row MDCT revealed the following results (mean time standard deviation): Emergency room treatment and transport 19.2 +/- 6.7 min, patient positioning 16.5 +/- 6.5 min, scan duration 8.0 +/- 3.3 min, total time in examination room 24.5 +/- 7.2 min, image reconstruction including MPR 32.0 +/- 16.4 min, and time of first (16.4 +/- 4.7 min) and final image interpretation (82.5 +/- 30.4 min). Trauma profiles revealed thoracic injuries in 35/60 patients (58.3 %), head injuries in 23/60 patients (38.3 %), abdominal injuries in 15/60 patients (25.0 %), injuries of the cervical (9/60 patients, 15.0 %), thoracic (12/60 patients, 20.0 %), and lumbar spine (19/60 patients, 31.7 %), pelvic injuries in 13/60 patients (21.7 %), and injuries of extremities in 39/60 patients (65.0 %). The mortality rate was 21.7 %. CONCLUSION: MDCT provides fast and all-inclusive imaging of multiple trauma patients. With the use of 16-row MDCT technology scanning times of 8 minutes are realistic and first image interpretation can be performed 16 minutes after arrival of the patient in the examination room and 35 minutes after admission in the emergency room, respectively. The duration of all procedures done in the examination room is strongly influenced by positioning maneuvers, whereas final image interpretation depends on image reconstructions including MPR. Beside technical improvements, these circumstances provide the potential to further accelerate the diagnostic process in multiple trauma victims.

Abdominal Injuries↗
PubMed2005

[The televisit system in patients care after discharge in clinical use--first experiences].

The televisite is a form of application of telemedicine, that allows a communication between the patient and the family doctor or specialist in the clinic after discharging of hospital. Pioneers for the use of telematic projects have been up to now wide states like the USA, Canada, Norway or Australia to provide, guarantee and maintain by the means of telemedical solutions medical care in geographic regions hardly reachable and of little medical attention. In central Europe and Germany telemedicine is gaining in significance on the one hand because of increasing importance of the cost factor and resulting pressure on the public health system and on the other hand because of the rising demand of the patients for optimised medical care. It specially represents a new form of treatment in patients care after dischargement of hospital. In the year of 2002 a prospective randomised two-armed study was initiated including patients after operative intervention by arthroplasty in posttraumatic contracture of the elbow. The system of the Televisite is used for 6 weeks after dischargement and patients had been controlled ambulant after 6 months including a physical examination. The functional outcome will be scored, the duration of stay in hospital measured, the arising costs for treatment calculated and the satisfaction of the patients in handling the Televisite surveyed. Over this first results showed a shortened stay in hospital together with lowered costs in medical treatment on the one hand and on the other no difference in functional outcome could be found in comparison to the control group by additionally high grade of satisfaction with the new system.

Home Care Services↗
PubMed2004

[Periprosthetic supracondylar femoral fractures: LISS or retrograde intramedullary nailing? Problems with the use of minimally invasive technique].

Retrograde intramedullary locking nailing as well as the LIS system are propagated as minimally invasive treatment options for distal femoral fractures following total knee arthroplasty. In a retrospective study, we reviewed the clinical results after operative treatment of 18 periprosthetic supracondylar femoral fractures. The fracture was stabilized with the less invasive stabilization system (LISS) in nine patients (average age: 80.3 years) and with a retrograde intramedullary locking nail in the remaining nine patients (average age: 76.8 years). The mean follow-up was 18.2 months (6-35 months). We did not find significant differences concerning the operation time (nailing 99.8 min vs 102.3 min with the LISS) or the length of stay in the hospital (nailing 10.6 days vs 12.7 days with the LISS). In one patient of the nailing group we found a valgus malalignment of 18 degrees. Seven patients in each group were satisfied with the clinical results. In one patient of the LISS group a revision due to an infection was necessary. In one patient of the nailing group a reosteosynthesis had to be performed. To sum up, both systems are useful tools in the treatment of dislocated periprosthetic fractures and both systems are not without any problems. However, under special consideration of the complications we found in our study, the LISS seems to be a better alternative in osteoporotic bone with a small distal fragment. The choice of the optimal implant should therefore depend on the type of fracture and knee arthroplasty, the type of bone, and the experience of the surgeon.

Activities of Daily Living↗
PubMed2004

[Open pelvic fracture. Treatment strategy and results for 12 patients].

This article presents treatment priorities for open pelvic fracture and the results of 12 patients. In a retrospective study we analyzed 12 patients treated at a level 1 trauma center between 1994 and 1998 of whom eight were male and four female with an average age of 29.6 years. Six type C (6 x III degrees open) and six type B (4 x II degrees and 2 x III degrees open) were identified. On average, 15 EKs were necessary within the first 12 h of treatment (type C=17, type B=13). All type C fractures underwent emergency stabilization with the pelvic C-clamp. Early laparotomy was performed in 60%. Perineal laceration was identified in 58%, followed by nerve and plexus lesions in 42%, injuries of the genitourinary tract in 33%, and lesions of the fecal stream in 25%. Altogether, there were more peripelvic injuries associated with type C fracture than with type B (12 vs 8). On average, there were 27 second-look operations necessary with 3-.2 operations per patient. The average stay in the ICU was 82 days (80-360); 25% died. Control of hemorrhage is fundamental; therefore, emergency stabilization of the pelvis is essential followed by surgical procedures. Early surgical definitive stabilization of the fracture decreases septic complications. Such complex injuries should be treated at specialized trauma centers.

Adult↗
PubMed2004

[Influence of local application of basic fibroblast growth factor on resistance to local infection after standardized closed soft tissue trauma. An experimental study in rats].

The aim of the study was to obtain information on the importance/influence of local application of an angiogenic potent growth factor (bFGF) on local infection resistance after soft tissue trauma.A paired comparison of infection rates was carried out on Sprague-Dawley rats after standardized, closed soft tissue trauma and local, percutaneous bacterial inoculation of different concentrations (2 x 10(4)-2 x 10(7)), whereby the lower leg was treated with 1, 10, and 100 ng bFGF (n=16 each) and without bFGF (n=16). Statistical evaluation of the differences between the infection rates of both groups was performed using the two-sided Fisher's exact test ( p<0.05). For the group without bFGF application, the infection rate was 25%. In the groups with 1, 10, and 100 ng bFGF application, the infection rates were 50%, 69%, and 81%. The difference in the infection rates for the groups in which 10 and 100 ng bFGF were applied was highly significant ( p=0.032/ p=0.004) compared with the group without bFGF. If these initial results are confirmed for other angiogenic potent growth factors, then the local application of growth factors to stimulate wound and bone healing will need to be reconsidered and preceded by a very strict evaluation of the risks and benefits.

Animals↗
PubMed2004

[Osteomyelitis of the spine].

Spinal infections are rare, occurring most often in elderly patients with urinary tract infections or diabetes. With the increasing number of patients with immune suppression, and also the increasing number of immigrants in the population, spinal infections are seen more frequently, especially in young adults. Typically spinal infections are monomicrobial, Staphylococcus aureus being the most common organism. Hematogenous spread of bacteria through the arterial paravertebral collateral vessels into the subchondral bone marrow of the vertebral bodies is the most common source of infection. Clinical presentation is often nonspecific. Important diagnostic measurements are laboratory studies, radiological evaluation including MR image scans, and CT-guided percutaneous biopsy of the lesion for microbiological studies. The management of spinal infections consists of antimicrobial therapy over 6-8 weeks. Surgical intervention is indicated in neurologically compromised patients for spinal instability and abscesses.

Anti-Bacterial Agents↗
PubMed2004

[Animal models of osteomyelitis].

Despite new approaches in biochemical testing, radiologic and nuclear medicine and advances in surgical techniques, the problem of diagnosis and therapy of acute and chronic osteitis has not been finally solved. Clinical research on osteitis is problematic as there are many variables influencing the inflammatory process and a wide spectrum in therapeutic options exists, hampering research under defined conditions. Consequently, there was an early need for animal models. In vivo experimental settings were established to gain reproducible and reliable results under standardized conditions on the pathogenesis and therapy of osteitis. In this article, an overview of the hitherto established experimental animal models and the results of osteitis research on these models is given.

Animals↗
PubMed2004

[Pathophysiology of posttraumatic osteitis].

Over the last few decades, significant reduction of post-traumatic infections could be attained by establishing novel surgical techniques and tactics, by adapting surgical decisions to the risk of infection, by employing chemotherapeutic agents, and by developing new implants. Here a novel understanding of the pathophysiologic mechanisms of post-traumatic and postoperative osteomyelitis were directive. Nevertheless, post-traumatic infections later cause significant physical and economic sequelae. This article sums up the fundamental pathophysiological mechanisms of post-traumatic infection. New ideas about post-traumatic prevention and therapy of osteomyelitis are discussed.

Foreign-Body Reaction↗
PubMed2004

[Efficiency of low-intensity pulsed ultrasound on distraction osteogenesis in case of delayed callotasis -- clinical results].

AIM: Low-intensity pulsed ultrasound has been proven to accelerate fracture healing both clinically and experimentally. In this study the influence of low-intensity pulsed ultrasound during distraction-osteogenesis in case of delayed callotasis was investigated. METHOD: 20 patients could be included in this study. 16 patients initially were treated because of fractures of the lower leg, 2 because of fractures of the femur with resulting shortening of the afflicted limb. One patient suffered from chronic osteitis at the thigh and one from chronic osteitis at the upper arm without previous trauma. Because of delayed callotasis an adjunctive ultrasound treatment device was transcutaneously applied (frequency 1.5 MHz, signal burst width 200 microseconds, signal repetition frequency 1.0 kHz, intensity 30 mW/cm (2)) with the transducer placed at the distraction zone for 20 minutes daily. In all cases in-home treatment was performed. Evaluation was done by radiographic and sonographic controls of the distraction zone during examination of all patients at the outpatients' department every 3-4 weeks. RESULTS: Progress of callotasis was achieved in 15 out of 20 patients. Patients who were smokers during ultrasound therapy showed lower healing rates than those who never smoked. 2 patients suffering from osteitis of the tibia and missing callotasis had to be amputated. 3 other patients needed additional operative treatment including cancellous bone grafts because of missing new bone formation. Negative effects of low-intensity pulsed ultrasound during therapy could not be detected. CONCLUSION: We conclude that ultrasound treatment can accelerate bone maturation and formation in distraction osteogenesis, sometimes even in states of poor callotasis. It may provide a method of great promise in cases where delayed bone formation during distraction osteogenesis occurs.

Adult↗
PubMed2004

Qualitative and (semi)quantitative characterization of nasal and skin methicillin-resistant Staphylococcus aureus carriage of hospitalized patients.

The objective of this study was to systematically investigate the carriage pattern and load of newly identified methicillin-resistant Staphylococcus aureus (MRSA) colonized or infected patients before any decolonization took place. Cultures of wounds (38%), of sputum (16%) or throat (10%) and of urine (10%) most frequently gave the initial positive MRSA result. Samples from nose, forehead, neck, axilla, and groin were obtained to determine the extent of nasal and extranasal colonization. Fifty-six (69%) of the screened patients proved to be MRSA positive at one or more of these sample sites, and 53 (65%) were extranasal carriers. The proportions positive for cultures of the nares, forehead, groin, neck and axilla were 54%, 51%, 38%, 35%, and 28%, respectively. The most sensitive screening method (96% sensitivity) was to take a combination of cultures from the nares, forehead and groin. Out of the 56 patients (100% sensitivity) this combination revealed 10 more MRSA-carriers than testing the nose alone (79% sensitivity). But the number of study patients was relative small. Therefore we cannot give general recommendations for MRSA screening on the basis of these results. For our hospital we concluded to take a combination of three screening samples to detect MRSA-carriers. Beside the MRSA-carriage pattern we report about the quantitative whole-body colonization. Out of 41 patients colonized on the forehead, a median of 20 MRSA/24 cm2 was obtained on contact agar plates. On the neck (n = 28), an identical value was found. The median MRSA levels for the nose (n = 44), the groin (n = 31), and the axilla (n = 23) were 80, 50 and 50 cfu/swab streak. The MRSA load varied widely from 1 to more than 100 colonies per culture. Further studies must show whether the individual number of MRSA cultured from different body sites is relevant for transmission, for acquiring infections or for decolonization efficacy.

Bacteriological Techniques↗