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Biomedical subjects

H J Refior

Publications and source records attributed to H J Refior.

At least 55 records · Page 3Linked to original sources
PubMed2000

Tripled semitendinosus anterior cruciate ligament reconstruction with Endobutton fixation: a 2-3-year follow-up study of 35 patients.

We evaluated the clinical outcome of tripled semitendinosus tendon ACL reconstruction with femoral Endobutton (Acufex, Smith&Nephew, Andover, MA) and tibial Suture Washer (Acufex, Smith&Nephew, Andover, MA) (n 29) or post screw fixation (n 6) in 35 patients on an average of 28 (20-37) months after surgery. On the basis of IKDC criteria, 22 patients showed a normal or nearly normal knee function and 25 patients had a KT 1000 maximal manual side-to-side difference of < or =5 mm at follow-up. Subjectively, 28 patients graded their knee function as normal or nearly normal. The average Lysholm score was 88 points, average OAK score 90 points and average modified HSS score 93 points. 19 patients reached their preinjury level of activity at follow-up. The postoperative Lachman test was < or =1+ in 24 patients and 24 patients also showed an absent pivot shift. Significant bone tunnel enlargement occurred in 26 patients on the femoral side and in 23 patients on the tibial side. We found no correlation between bone tunnel enlargement and clinical outcome. The clinical outcome of tripled semitendinosus tendon ACL reconstruction with Endobutton fixation on the femoral side was not entirely satisfactory. The procedure was associated with a high incidence of bone tunnel enlargement in this series.

Activities of Daily Living↗
PubMed2000

Partial rupture of the distal biceps tendon.

Partial rupture of the distal biceps tendon is a relatively rare event, and various degrees of partial tendon tears have been reported. In the current study four patients with partial atraumatic distal biceps tendon tears (mean age, 59 years; range, 40-82 years) are reported. In all four patients, a common clinical pattern emerged. Pain at the insertion of the distal biceps tendon in the radius unrelated to any traumatic event was the main symptom. In all patients the diagnosis was based on magnetic resonance imaging or computed tomography imaging. In three of four patients the partial rupture of the tendon caused a significant bursalike lesion. The typical appearance was a partially ruptured biceps tendon, with contrast enhancement signaling the degree of degeneration, tenosynovitis, and soft tissue swelling extending along the tendon semicircular to the proximal radius. In three patients, conservative treatment was successful. Only one patient needed surgery, with reinsertion of the tendon resulting in total functional recovery.

Adult↗
PubMed2000

Extracorporeal shock wave application for chronic plantar fasciitis associated with heel spurs: prediction of outcome by magnetic resonance imaging.

OBJECTIVE: To clarify morphologic features associated with the clinical outcome of extracorporeal shock wave application (ESWA) in chronic plantar fasciitis. METHODS: In this prospective study 43 patients (48 heels) with chronic courses of plantar fasciitis were clinically examined before and after repetitive low energy ESWA. Standard radiographs of the affected heels were obtained before ESWA to document the existence of a calcaneal heel spur. Magnetic resonance imaging (MRI) was performed before ESWA to evaluate abnormalities of the plantar fascia, the surrounding soft tissue structures, and bone marrow edema of the calcaneus. RESULTS: After ESWA (mean followup 19.3 mo), clinical evaluation of all 48 heels revealed a statistically significant decrease in the mean visual analog scale score from 74.5 to 25.4. Using the Roles and Maudsley score (RM), an established scoring system for categorizing results of treatment following ESWA for patients with plantar fasciitis, patients could be divided into 2 groups, i.e., satisfactory clinical outcome of ESWA (grades 1 and 2 by RM scale; n = 36 heels) and unsatisfactory outcome (grades 3 and 4 by RM scale; n = 12 heels). While thickness of plantar aponeurosis, soft tissue signal intensity changes, and soft tissue contrast medium uptake did not correlate with clinical outcome, the presence of a calcaneal bone marrow edema was highly predictive for satisfactory clinical outcome (positive predictive value 0.94, sensitivity 0.89, specificity 0.8). CONCLUSION: This study indicates that in patients with chronic plantar fasciitis, the presence of calcaneal bone marrow edema on pretherapeutic MRI is a good predictive variable for a satisfactory clinical outcome of ESWA.

Adult↗
PubMed1999

Castor oil decreases pain during extracorporeal shock wave application.

In a prospective single-blind study the contact media ultrasound gel, vaseline and castor oil were examined for their effect on surface pain caused by extracorporeal shock waves used for tendinosis calcarea (n = 25), radiohumeral epicondylitis (n = 23) and plantar heel spur (n = 12). A total of 60 patients was divided into six groups. Using a Compact S shockwave source (Dornier MedTech), an energy flux density up to 0.12 mJ/mm2 was applied three times within 3 weeks. Independent of the diagnosis, there was a statistically significant influence of the contact medium on the intensity of application pain. In this comparison castor oil was best. For the diagnosis of tendinosis calcarea and plantar heel spur, castor oil was significantly better than the other two contact media, while for epicondylitis there was no significant difference. Castor oil was found to have an advantage over ultrasound jelly and vaseline in all indications used with regard to application pain. The positive effect of castor oil can be explained by its cavitation-free quality.

Castor Oil↗
PubMed1999

Phenol as an adjuvant for local control in the treatment of giant cell tumour of the bone.

AIMS: Intralesional treatment of giant cell tumour (GCT) of the bone may result in a high rate of local recurrence. The introduction of local adjuvant therapy, such as cementation or phenolization, has lead to a significant reduction in recurrence rates. Due to the combined use of phenol and cementation in most studies, the effect of phenol alone is described in this study. METHODS: Twenty primary and nine recurrent surgical procedures in 26 patients with GCT of the bone with a median follow-up of 61 months were reviewed retrospectively. The mean age was 33.5 years (range 13.5-76.5 years). Eighteen curettages and 11 resections were performed. For the curettages, a large bone window was cut followed by high speed burring and bone graft reconstruction. In 11 of 18 curettages and three of 12 resections, phenol was additionally applied. RESULTS: Four patients showed pulmonary metastasis. Three of these four cases also experienced local recurrences. Three patients died due to metastatic disease. In total, five patients developed local recurrence (17.2%); three in the first 2 years and one after 4 years. Four of 18 curettages recurred (22.2%), compared to one of 11 resections (9.1%). Only one of 11 patients (9.1%) treated with curettage and adjuvant phenol recurred, whereas three of seven patients (42.9%) treated with curettage alone recurred. CONCLUSION: Phenolization is an effective and safe local adjuvant therapy for GCT. We did not observe any significant differences in recurrence rates for curettage, phenolization and bone grafting compared to most published results using cryosurgery or cementation alone. We recommend adjuvant phenolization in the treatment of GCT of the bone after careful curettage in applicable cases, regardless of whether additional cementation is used.

Adolescent↗
PubMed1999

Fibromatosis of the plantar fascia: diagnosis and indications for surgical treatment.

Plantar fibromatosis is a rare, benign lesion involving the plantar aponeurosis. Eleven patients (13 feet) underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy. Clinical results were evaluated retrospectively. There were no differences among the subgroups in postoperative complications. Two primary fasciectomies did not recur. Three of six revised fasciectomies, seven of nine wide excisions, and six of seven local excisions recurred. Our results indicate that recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection.

Adult↗
PubMed1999

Anterior debridement, fusion, and extrafocal stabilization in the treatment of osteomyelitis of the spine.

To simplify and shorten the rehabilitation after anterior debridement and fusion in pyogenic and tuberculous osteomyelitis of the spine, the role of additional extrafocal dorsal transpedicular instrumentation was studied. Thirty-three (10 female, 23 male) patients were followed up in a prospective study and controlled with an average follow-up period of 22.1 months after the operation with clinical and neurologic check-up, blood test, and serial radiographs. Solid bony fusion and healing of the infection was achieved in all patients. Preoperative deformities could be corrected, and there were no life-threatening complications. Dorsal extrafocal stabilization offered the advantage of braceless rehabilitation without adding unpredictable risks.

Adult↗
PubMed1999

Surgical treatment of osseous metastases in patients with renal cell carcinoma.

Forty-five patients who underwent surgical treatment for osseous metastases secondary to renal cell carcinoma between 1980 and 1998 were reviewed. The diagnosis was confirmed histologically in all patients. The mean age of the 34 men was 61.5 +/- 9 years and of the 11 women 55.2 +/- 17.6 years. The most common locations of the metastases were the spine (15 patients), the pelvis (eight patients), and the femur (11 patients). In 21 patients, the renal cell carcinoma was diagnosed when the osseous metastasis was detected. The time from diagnosis of the primary tumor to metastasis in the remaining patients ranged from 0 to 23 years (mean, 3 +/- 5 years). At presentation, 19 patients had a singular lesion. Nine patients had multiple osseous metastases and 17 patients had additional visceral involvement. In seven patients, a wide or radical resection was done; in 35 patients, a palliative procedure was done; and in three patients, only a diagnostic procedure was done. For the whole group, the survival was 49% after 1 year, 39% after 2 years, and 15% after 5 years. Only the extent of the disease and the latency period between primary tumor diagnosis and first detection of osseous metastasis could be identified as independent factors of survival. Nine patients with solitary metastasis to the bone more than 12 months after resection of the primary tumor showed a 5-year survival of 54%.

Adult↗
PubMed1999

In vivo assessment of synovial microcirculation and leukocyte-endothelial cell interaction in mouse antigen-induced arthritis.

OBJECTIVE: The microcirculation and leukocyte-endothelial cell interaction in synovial tissue of an inflamed joint are known to play a crucial role in the pathogenesis of rheumatoid arthritis. The aim of this study was to characterize the in vivo changes in the microvasculature and in leukocyte-endothelial cell interactions in the mouse synovial tissue using intravital fluorescence microscopy in three stages of antigen-induced arthritis. The expression of E- and P-selectin and ICAM-1 were also studied using immunohistochemistry. METHODS: Antigen-induced arthritis (AiA) was produced in Balb/c mice. The severity of arthritis at three different phases was quantified using a clinical and histological score. For the intravital fluorescence microscopy measurements, the patella tendon was partially resected for visualization of the intraarticular synovial tissue of the knee joint. The number of rolling and adherent leukocytes, functional capillary density (FCD) and RBC velocity were quantitatively measured in synovial microvessels. Expression of ICAM-1, E- and P-selectin was assessed by immunohistochemistry. RESULTS: There was a significant increase in the leukocyte rolling fraction in postcapillary venules in the acute phase of AiA (from 0.26 +/- 0.05 in controls to 0.45 +/- 0.04 8 d after AiA induction). The number of leukocytes adherent to the endothelium was significantly elevated in all phases of arthritis (from 121 +/- 27 in controls to 376 +/- 62 mm2 63 d after AiA-induction). Functional capillary density was significantly enhanced in the acute (332 +/- 15 cm/cm2) and intermediate phases (320 +/- 15 cm/cm2) compared to control values (227 +/- 15 cm/cm2). Arthritis resulted in a distinct increase in the expression of ICAM-1 on the synovial endothelium in all phases of AiA. E- and P-selectin expression were detected only in the acute phase. CONCLUSION: Our model provides new insights into the microcirculatory changes which occur in the synovial tissue of an arthritic joint.

Animals↗
PubMed1998

[Prognosis of skeletal metastases].

Surgical resection of osseous metastases is becoming more and more important in obtaining longer overall survival in carcinoma patients. In 228 cases surgically treated at our institution between 1980 and 1993, the survival was 49% after 1 year, 32% after 2 years, 22% after 3 years and, finally, 11% after 5 years. Retrospectively evaluated, breast and thyroid carcinoma proved to be of positive prognostic influence and lung cancer of negative significance. As a main significant parameter, further extraosseous metastases were evaluated. The prognostic influence of the number of osseous lesions could only be demonstrated in breast and renal cell carcinoma without involvement of further organs. Age and location of the skeletal lesions proved to be of no prognostic influence. Based on these prognostic parameters, three subgroups of patients with worse, median and good long-term survival could be defined. In conclusion, the indication and amount of surgery can be based on these prognostic factors, leading to a decrease in morbidity and hospitalization time in patients with limited survival.

Adult↗
PubMed1998

Evaluation of imaging in loosening of hip arthroplasty in 326 consecutive cases.

Between 1989 and 1995, 326 hip arthroplasties were surgically revised in our clinic because of loosening. For evaluation of loosening, we used history, clinical examination, radiographs, bone scans and arthrography with digital subtraction technique. In 130 cases (40%), surgery was planned by plain radiographs. In 116 cases (89%) a correct diagnosis of loosened components was made. Of the 72 patients (22%) with an additional bone scan, 87% (63 patients) had a correct diagnosis. Fifty-four patients (17%) with different findings were examined by hip arthrography; in 83% (45 patients) the diagnosis was confirmed intraoperatively. In 93% (65 patients) of 70 patients (21%) with bone scans and arthrography, surgery confirmed the diagnosis. Sensitivity for loosening of the socket was 61% by bone scan and 85% by digital subtraction arthrography; specificity was 75% in each case. Sensitivity for loosening of the stem was 71% by bone scan and 65% by digital subtraction arthrography; specificity was 80% and 88%, respectively. Our results showed that in most cases of suspected loosening of total hip arthroplasties, analysis of plain radiograph series can lead to an accurate diagnosis in 85%-90%. In cases of uncertainty, we suggest the additional use of digital subtraction arthrography, which has a similarly high diagnostic quality. Because of the low sensitivity of nuclide bone scanning (about 60%) and its dependence on prosthetic material and fixation, we do not recommend primary scintigraphy. It can be helpful in problematic cases with additional questions like activity of ectopic bone formation.

Adult↗
PubMed1998

Magnetic resonance imaging in lateral epicondylitis of the elbow.

The purpose of the study was to determine the changes that might be detected using magnetic resonance imaging (MRI) on patients with chronic lateral epicondylitis of the elbow and to judge its value concerning the clinical treatment. Thirty-four patients with chronic lateral epicondylitis were included in a prospective study. All individuals underwent MRI of the elbow on a 0.2-T dedicated system. The MRI findings were interpreted by an independent radiologist without knowledge of the clinical findings. In 6 surgical cases an additional histological study was done. The biopsy of the extensor tendon was performed for correlation with the MRI. In 21 of 34 symptomatic patients, increased signal changes in T1- and T2-weighted images were seen. In a further 11 cases, the morphology and signal intensity were normal. The histopathological analysis of 6 surgical cases confirmed the preoperative MRI findings by showing either focal fibrous degenerative tendon tissue or microruptures of collagenous fibres. MRI in patients with chronic lateral epicondylitis can help to differentiate the disease and may be of use in clinical management, preoperative planning, and in the evaluation of the degree of degeneration at the common extensor tendon insertion.

Adult↗
PubMed1998

A novel model for the study of synovial microcirculation in the mouse knee joint in vivo.

A novel model for the investigation of the microcirculation in synovial tissue of the mouse knee joint is presented. The mouse knee joint was exposed on a specially designed plexiglass stage with a slight flexion. After partial resection of the skin, the patella tendon was cut transversally, which allowed for visualization of the "Hoffa's fatty body", an intraarticular fatty tissue containing synovial cells on the interior surface of the joint. An intravital fluorescence microscope was adjusted to observe the microcirculation of this intraarticular synovial tissue without opening of the joint capsula. For staining of the plasma, fluorescein isothiocyanate (FITC)-dextran was used, and for the staining of leukocytes rhodamine 6G was used. The tissue investigated presents with a high-density honeycomb-like capillary network, containing some postcapillary venules and a few arterioles. The following parameters were assessed off-line using a computer-assisted microcirculation analysis system: flow and diameter of arterioles and postcapillary venules, as well as functional capillary density. Moreover, leukocyte-endothelial cell interaction was quantified by counting the number of rolling cells and cells adhering to the endothelium in postcapillary venules. As an indication of endothelial leakage, macromolecular extravasation was also assessed. To validate the model, we investigated these parameters at three time points during an observation period of 60 min. There was no change in functional capillary density, nor in vessel diameter after 60 min of observation. Moreover, there was neither a change in the number of rolling cells, nor in the number of cells adhering to the endothelium nor in extravasation of FITC-dextran, thus indicating the stability of the preparation. The new model allows the quantitative analysis of the intraarticular microcirculation of the synovial fatty tissue in vivo. It provides insight into the dynamics of synovial microcirculation and leukocyte-endothelial cell interaction in acute or chronic joint inflammation.

Adipose Tissue↗
PubMed1998

Magnetic resonance imaging and knee stability following ACL reconstruction.

This study was undertaken to determine whether there is a correlation between magnetic resonance imaging (MRI) and clinical success after reconstruction of the anterior cruciate ligament (ACL). In a prospective study, 28 patients underwent clinical and MRI examination 3 to 5 years after ACL reconstruction with either the semitendinosus tendon (n = 15) or patellar ligament (n = 13). Knee stability was assessed both clinically and by KT-1000 arthrometer testing. Magnetic resonance imaging was performed with a 0.2-T dedicated system (Artoscan, Esaote, Italy) including sagittal and oblique coronal T1 and T2-weighted images. Magnetic resonance images were evaluated by two readers with regard to signal intensity and continuity of the ACL reconstruction and presence or absence of posterior cruciate ligament buckling. Knee stability and MRI evaluation were each summarized in a 6-point score. Statistical correlation was checked with the Spearman ranked correlation for testing non-normal distributed samples. Statistical testing of all patients' results together showed a significant correlation with a prediction value of 12%, indicating no significant correlation between clinical results and MRI evaluation. Separate statistical testing of the patellar ligament and semitendinosus patients' results showed no significant correlation in either group at all. Thus, no correlation between clinical stability and MRI could be established. Magnetic resonance images after ACL reconstruction using the techniques mentioned above should be interpreted with caution, as they may not relate to the clinical function of the ligament.

Adolescent↗
PubMed1998

[Influence of selective versus nonselective inhibitors of nitric oxide synthases on synovial microcirculation of the knee joint of the mouse in vivo].

Nitric oxide production by the inducible NO-synthase in the synovium and chondrocytes is known to be enhanced during chronic joint inflammation and aseptic loosening of joint prostheses. Due to the distinct side effects of non-selective NO-inhibitors on the macro- and microhemodynamics, we investigated the in vivo changes after selective (N-iminoethyl-L-lysine (NIL)) versus non-selective NO-synthase inhibition (NG-nitro-L-arginine methyl ester (L-NAME)) in the synovium of the mouse knee joint. Our results show a significant decrease in the functional capillary density and an increase in the leukocyte accumulation after L-NAME injection. In contrast, NIL did not alter the microhemodynamics or the leukocyte-endothelial cell interaction in the synovium, indicating its potential use for therapeutic selective inhibition of iNOS in joint inflammation.

Animals↗
PubMed1997

Surgical treatment for myeloma of the bone. A retrospective analysis of 22 cases.

In a retrospective study, 22 patients treated surgically for solitary or multiple myeloma between 1980 and 1993 were analysed. The main complaint was pain. A fracture was observed in 7 cases and motor-sensory impaired neurology due to spinal compression in 3. Apart from incisional biopsies, tumour resections, reductions (with and without stabilization by osteosynthesis) and endoprotheses were performed either at the extremities or on the spine. In addition, radiation and chemotherapy were included in the therapeutical concept. Early mobilization was achieved in all cases, and the 5-year survival rate (Kaplan-Meier method) was 48%. The results presented in this study demonstrate that a variety of surgical interventions can be of importance in the treatment of myeloma of the bone, ranging from biopsy or even curative resections in selected cases to endoprosthetic replacement. Thus, good functional results can be achieved and maintained over often long survival times.

Aged↗