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Biomedical subjects

H M Sommer

Publications and source records attributed to H M Sommer.

At least 19 recordsLinked to original sources
PubMed1999

Accuracy of blind versus fluoroscopically guided caudal epidural injection.

STUDY DESIGN: A prospective observational study of a case series of patients with low back pain referred for epidural injection of corticosteroid. OBJECTIVES: To evaluate the accuracy of caudal epidural injections performed without the use of fluoroscopic guidance and to determine the value of specific clinical tests performed during the procedure in predicting successful epidural needle placement. SUMMARY OF BACKGROUND DATA: Epidural injection of corticosteroid is one of many treatments currently used in the nonsurgical management of low back pain. The face validity of many studies evaluating the efficacy of epidural corticosteroid injections has been criticized for use of a blind technique. Although there currently is no consensus in the spine literature as to whether epidural injection of corticosteroid (by any technique) is effective, it is imperative first to establish the accuracy of the technique being used. METHODS: A total of 54 consecutive patients underwent fluoroscopically guided caudal epidural injections. Needle insertion was performed blindly (without the use of fluoroscopic guidance), and the success of needle placement was predicted according to the presence of palpable landmarks, palpation of subcutaneous airflow, and the subjective impression that the needle was in a satisfactory position. These clinical criteria then were compared with the position of the needle as seen under fluoroscopy and the spread of radio-opaque contrast in the epidural space after the procedure. RESULTS: Successful injection placement on the first attempt occurred in 74.1% of the patients. Results were improved when anatomic landmarks were identified easily (87.5%) and no air was palpable subcutaneously over the sacrum when injected through the needle (82.9%). The combination of these two signs predicted a successful injection in 91.3% of attempts. CONCLUSIONS: Caudal epidural injection is performed ideally with fluoroscopic guidance as the gold standard for accurate drug placement. If fluoroscopic guidance is unavailable, impractical, or contraindicated, the presence of readily palpable anatomic landmarks at the sacral hiatus and the absence of palpable subcutaneous airflow over the sacrum significantly increase the operator's confidence in the likelihood of an accurate injection even before any products are administered into the epidural space.

Adult↗
PubMed1998

Examination of reproducibility in microbiological degradation experiments.

Experimental data indicate that certain microbiological degradation experiments have a limited reproducibility. Nine identical batch experiments were carried out on 3 different days to examine reproducibility. A pure culture, isolated from soil, grew with toluene as the only carbon and energy source. Toluene was degraded under aerobic conditions at a constant temperature of 28 degrees C. The experiments were modelled by a Monod model--extended to meet the air/liquid system, and the parameter values were estimated using a statistical nonlinear estimation procedure. Model reduction analysis resulted in a simpler model without the biomass decay term. In order to test for model reduction and reproducibility of parameter estimates, a likelihood ratio test was employed. The limited reproducibility for these experiments implied that all 9 batch experiments could not be described by the same set of parameter values. However, experiments carried out the same day (within the same run) were more uniform than experiments carried out on different days (between runs), and a common set of parameter estimates could be accepted for experiments within runs, but not for experiments from different runs. The limited reproducibility may be caused by variability in the preculture, or more precisely, variations in the physiological state of the bacteria in the precultures just before used as inoculum.

Biodegradation, Environmental↗
PubMed1996

Sensory nerve conduction studies of the L-1/L-2 Dorsal rami.

OBJECTIVE: This report describes a technique for performing sensory nerve conduction studies of the lateral cutaneous branches of the dorsal rami of the L-1/L-2 nerve roots for use in the evaluation of unilateral low back pain without lower limb referral. SUBJECTS: Eleven healthy adult volunteers (9 men and 2 women) ranging in age from 25 to 36 years with no current complaint of low back pain. DESIGN: Prospective determination of reference sensory nerve conduction values using a deep near nerve stimulation technique. RESULTS: Reproducible sensory nerve action potentials were evoked in all subjects. The mean distal onset latency was 3.5 +/- 0.7msec with a mean conduction velocity of 59.5 +/- 11m/ sec and a mean SNAP amplitude of 3.6 +/- 2.7 microV. The mean side-to-side difference in onset latency was 0.5 +/- 0.4msec. CONCLUSIONS: This study demonstrates a simple and reliable electrodiagnostic technique that may be useful in the evaluation of certain patients with unilateral low back pain. An onset latency of > 4.9msec (mean + 2 SD) or a side-to-side latency difference of > 1.3msec (mean + 2 SD) may represent a low back pain syndrome in which the cutaneous branches of the L-1 or L-2 dorsal rami have a primary role and which is possibly caused by entrapment of one of the cutaneous branches as it traverses the iliac crest in a fibro-osseous tunnel.

Action Potentials↗
PubMed1995

Proliferating cell nuclear antigen and Ki-67 immunohistochemistry of oligodendrogliomas with special reference to prognosis.

BACKGROUND: The biologic behavior of oligodendrogliomas is somewhat unpredictable. A supplementary prognostic factor is, therefore, desirable. METHODS: Thirty-two pure supratentorial oligodendrogliomas were investigated using proliferating cell nuclear antigen (PCNA) and Ki-67 immunohistochemical analyses. The correlation of PCNA and Ki-67 labeling index (LI) with prognosis were studied, and the correlation of LI with clinical data was evaluated. RESULTS: The PCNA LI had a range of 0-17% (mean, 5.27%; standard deviation [SD] = 4.65), and the Ki-67 LI had a range of 0-29% (mean, 4.19%; SD = 5.66). In general, the PCNA LI seemed to be higher than the Ki-67 LI. The mean survival time was 4.4 years, and 5- and 10-year survival rates were 38% and 19%, respectively. Ki-67 and PCNA staining indicated that patients with a high LI (> 3% and > 4%, respectively) had a significantly higher mortality, with mean survival time of 23.5 months and 26.2 months, respectively. No significant correlation between LI (or survival) and tumor size, cerebral localization, radiation, resection/biopsy, sex, age, or cytologic atypia was found. CONCLUSIONS: The use of Ki-67 and PCNA LI higher than 3% and 4%, respectively, appears reliable as prognostic factors when investigating pure supratentorial oligodendrogliomas.

Adolescent↗
PubMed1995

Effect of foot posture on the incidence of medial tibial stress syndrome.

This study reviewed the assessment of medial tibial stress syndrome (MTSS), a common lower limb overuse injury among athletes and dancers. The purpose of the study was twofold: 1) to determine whether abnormal foot alignment is positively correlated with a previous diagnosis of MTSS and 2) to assess the interrater reliability of the proposed methods. We therefore studied foot alignment retrospectively both qualitatively and quantitatively in both a closed and open kinetic chain manner. The specific measures evaluated were: 1) standing foot angle (SFA), 2) nonweight-bearing hindfoot angle, and 3) nonweight-bearing forefoot angle. Qualitative parameters were used for the non weight-bearing measures along the continuum: varus-neutral-valgus. The authors made their measurements independently and were blinded to the previous authors results. Case limbs (as defined as the symptomatic limb in a subject with the diagnosis of MTSS) were found to have a SFA < controls (P = 0.0001). Case limbs also tended towards having a higher incidence of hindfoot (P = 0.017) as well as forefoot (P = 0.08) varus alignment. We found that a SFA of < 140 degrees and a varus alignment of the hindfoot and/or forefoot, were predictive of a previous history of MTSS. These methods were found to be reliable and can be performed in an office setting without any special equipment.

Adolescent↗
PubMed1993

[Early functional conservative therapy of fresh fibular capsular ligament rupture from the socioeconomic viewpoint].

The expected direct and indirect costs following a fresh fibular rupture of the capsular ligament, and hence the socioeconomic burden on the patient, was investigated by a prospective randomised study comprising 120 males and females between 18 and 45 years of age. A comparison of three different conservative treatment methods A (immobilisation in a plaster cast for three weeks, followed by mobilisation with the aircast splint), B (mobilisation with the aircast splint) and C (Unna's paste dressing for two weeks with subsequent tape dressings and in each case immediate mobilisation) showed a significantly better stability after 6 months in the groups B (2.6 +/- 2.3) and C (3.6 +/- 3.8) than in A (4.8 +/- 3.5). The direct subsequent costs were also significantly lower in the groups B (DM 175.-) and C (DM 206.-) than in A (DM 340,-). Taking an average daily hospital care fee of DM 319.- (1991 in West Germany) as basis, the direct costs sequential to early functional treatment are the lowest also in comparison with surgical treatment in a hospital. The indirect sequential costs due to loss of working hours are mainly dependent on professionally conditioned physical stress but increase with the period of immobilisation after a fresh fibular rupture of the capsular ligament.

Adolescent↗
PubMed1989

Functional treatment of recent ruptures of the fibular ligament of the ankle.

A prospective randomised study was undertaken to compare the results of functional and operative treatment of recent ruptures of the fibular ligament of the ankle in 80 patients, aged from 18 to 45 years, with similar injuries. The best results were obtained from functional treatment and it is to be hoped that early movement and a stable ankle will avoid later osteoarthritis.

Adolescent↗
PubMed1989

[Subcutaneous muscle and tendon ruptures].

Reasons for subcutaneous ruptures of muscles and tendons are discussed from biomechanical and kinesiological points of view Experimental findings and clinical diagnostic procedures applied in muscle and tendon rupture are discussed. It is concluded that the aim of repair in the case of either muscle or tendon must be the reconstruction of their physiological length in order to avoid loss of muscle strength, which would increase the frequency of muscle and tendon injuries and cause a decline in sports performance. Therefore, surgical repair of complete muscle and tendon rupture has to be regarded as the therapy of choice especially in young patients and those engaged in competitive sport. It must be taken into account, however, that both surgical and non-surgical repair lead to the same weight-bearing capacity. Therefore, functional, non-surgical treatment must be preferred in the case of partial muscle and/or tendon rupture and in older patients.

Athletic Injuries↗
PubMed1988

[Central dysregulations as a cause of movement disorders in performance sports? An analysis of movement in sports with reference to functional anatomic and neurophysiologic viewpoints].

Typical orthopaedic findings and typical disturbances of movement in sports point to central dysregulation in motor disturbances in competitive sports compared with the ideal models set up under biomechanical aspects and from the viewpoint of sports practice. Neurophysiological data collected so far confirm this view. The central influence on movement is manifested by a change in peripheral proprioceptive properties, i.e. by a change in the pre-innervation of the musculature. If the musculature is subjected to high strain as in sports aiming at high performance levels, such changes produce an extremely high stretch tone in the phase of dynamic-eccentric muscular contraction resulting in functional reversal of two-joint muscles such as the M.rectus femoris and the M.gastrocnemius. This procedure is manifested in the region of system-immanent weak spots of the positional and locomotor system and, in the pelvic girdle region by tipping of the pelvis in ventral direction, with consecutive evasive shifts of the vertebral column and extremities.

Central Nervous System↗
PubMed1988

Patellar chondropathy and apicitis, and muscle imbalances of the lower extremities in competitive sports.

The jumping motion of 15 competitive basketball and volleyball players was tested until exhaustion in a cinematographic study. A stereotyped motion pattern was recognisable. The knee joint shows an evasive movement into a valgus and internal rotation position during the acceleration phase before take-off. Furthermore, the knee shows a brief stabilisation in overextension at heel strike. An imbalance of the muscles which stabilise the pelvis and the lower extremities can be regularly found in these athletes and could be a possible cause for this jump motion. It leads to a shortening of the hip flexors and adductors and of the knee extensors with the final evasive action of the knee joint. Though the anatomical condition of the joint is not directly observed, such a motion pattern must be the cause of additional shear forces and peak loads in the area of the patellofemoral joint and of the apex patellae. Clinical experience shows that an active correction of the evasive motion can be achieved by systematic physiotherapy. It ensures muscular balance of the pelvic region and lower extremities and thus lasting good results.

Adult↗
PubMed1987

The biomechanical and metabolic effects of a running regime on the Achilles tendon in the rat.

The Achilles tendons of 192 albino rats were subjected to biomechemical and metabolic testing after a defined running period and compared with a control group. After 2, 4, 8, 12 and 16 weeks, the cross-sectional area, ultimate tensile strength and oxygen uptake of the Achilles tendons were determined. Different reactions were demonstrated particularly after intensive training. These tendons showed an increase in cross-sectional area and a decrease of ultimate tensile strength when compared to the control group after 12 and 16 weeks of training. In contrast to these results the oxygen uptake was higher than in the control groups after 4 and 8 weeks of training. Alterations in the biomechanical and metabolic properties of tendon tissue occur at different times after the running regime.

Achilles Tendon↗
PubMed1987

[Conservative functional treatment of fibular capsule ligament rupture even in the performance athlete?].

In a prospective randomised study we examined 80 men and women of 18 to 45 years of age and 40 competitive sportsmen and sportswomen with fresh ruptures of the talofibular and calcaneofibular ligaments treated either surgically or conservatively by functional bracing. We controlled the results by anamnesis and by clinical and radiological follow-up. Conservative treatment leads to the same results after 3-8 months as surgical treatment (5 +/- 2 degrees of talar angulation). Functional conservative treatment results in earlier painless weight bearing in comparison to the surgical treatment which was, however, combined with three weeks immobilization directly after surgery. This proves the superiority of the early functional conservative treatment as long as there are no bony capsuloligamentous tears, osseocartilaginous lesions of the joint surface with splintered-off chips or "flakes" of cartilage ("flake fractures") or reruptures of a chronically unstable ankle joint. The similarly good results achieved in the group of 40 sportsmen and sportswomen by early functional conservative treatment do not justify operation of ruptures of the talofibular and calcaneofibular ligaments.

Adult↗
PubMed1984

3-0-demethyl fortimicin A: in vitro activity and interpretive zone standards for disk diffusion susceptibility tests.

The in vitro activity of 3-0-demethyl fortimicin A was compared to that of amikacin and tobramycin against 5,230 clinical isolates in four institutions. Amikacin and tobramycin were more active than 3-0-demethyl fortimicin A against Pseudomonas aeruginosa and Acinetobacter spp., but all three drugs had similar activity against the Enterobacteriaceae and Staphylococcus aureus. Additional tests with 335 representative gram-negative bacilli compared five different aminoglycosides, demonstrating differences with some isolates. Standardized disk diffusion tests were also performed with 30 micrograms 3-0-demethyl fortimicin A disks, according to the National Committee for Clinical Laboratory Standards. The following interpretive breakpoints are proposed: less than or equal to 11 mm for resistant (MIC greater than or equal to 32 micrograms/ml) and greater than or equal to 15 mm for susceptible (MIC less than or equal to 16 micrograms/ml).

Acinetobacter↗
PubMed1975

pH and bicarbonate excretion in the rat parotid gland as a function of salivary rate.

The bicarbonate concentration in rat parotid saliva increases with increasing flow rates and approximates plasma values at highest salivation. At lowest flow rates the bicarbonate concentration in the secretory fluid markedly exceeds the plasma levels. Intravenous administration of acetazolamide has no influence on the bicarbonate excretion of the parotid gland. Following retrograde application of acetazolamide into the gland duct the concentrations of both bicarbonate and sodium are elevated. The potassium concentrations in final saliva exceed 70 mEq/l at flow rates below 5 mul/min g gland weight. With increasing flow rates a precipitous decrease in potassium concentration below 10 mEq/l occurs. With further increase in flow rate the potassium concentration remains unchanged. The sodium concentrations increased with augmented salivation rate. At lowest flow rates the sodium concentrations showed an increase of modest degree. Our findings can best be explained by the existence of two independent ductular mechanism: a) bicarbonate reabsorption probably in the striated ducts of the parotid gland; b) secretion of potassium with concomitand secretion of bicarbonate in the main excretory duct.

Acetazolamide↗