Biomedical subjects

H Mau

Publications and source records attributed to H Mau.

158 records · Page 9Linked to original sources

PubMedDate not supplied

[Unexpected and undesirable treatment results].

The most frequent causes of unexpected and undesired results of treatment are due to insufficient information of the patient, furthermore, apart from technical deficiencies, to insufficient attention and experience of the physician, and to erroneous evaluation of the situation, especially with measuring out a dose of treatment-"medicus curat". On the other hand "natura sanat" comprises spontaneous healing. It's reactions of adaptation to functional stress are just partially known and, therefore, cannot be controlled safely. With insufficient incorporation of the cybernetic systems of the tissues into our planning of operations counter-reactions have to be expected, resulting in unphysiological, "unsound" operative procedures. They are characterised by relative frequent recurrences. The chances to reduce unexpected and undesired results in the "curative" and "sanative" sector are outlined. The personal experience remains most important.

Adaptation, Physiological↗

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["Sound" surgical concepts and problematic indications in orthopedics].

With sound operative procedures we try to approach the operative goal as closely as possible not only technically by control of the primary operation. We have also to consider the less regulable reactions of the postoperative functional adaptation of the locomotor system when planning an operation. With this in mind we ought to reevaluate our indications and operative methods not the least from a forensic point of view. Some sound and unsound procedures are discussed with the sole intertrochanteric osteotomy for treatment of acetabular dysplasia in childhood as a negative example, because of it's-physiological-tendency towards revalgisation.

Adolescent↗

PubMedDate not supplied

[Secondary flattening of the acetabular roof in children].

The primary "idiopathic" shallow acetabuli within the classical complex of CDH are confronted with the rare secondary "symptomatic" dysplasias of the acetabular roof. They are encountered mainly in connection with neuromuscular diseases and bad static conditions about the hip-joint. Nine cases with secondary flattening of the acetabular roof of unknown aetiology are presented, probably partially due to CDH, in connection with slight cerebral disturbances, mental and physical retardation, hypotonia of the muscles, with general constitutional laxity of joints as well as with acquired local loosening of the joint capsule due to treatment, and with insufficiency of the hip-abductors. As with the classical CDH one may observe in those cases a lateralization of the femoral head in the absence of an interposition in the joint; increasing subluxations due to joint instability with increasing shallow acetabuli may start from infancy, many years prior to puberty. If conservative treatment--not prolonged--fails and the findings are deteriorating acetabuloplasty is indicated prior to intertrochanteric adduction osteotomy during the growth-period.

Acetabulum↗

PubMedDate not supplied

[Arthropathy of the shoulder joint in syringomyelia].

Based on 4 long time observations of syringomyelitic arthropathy and the literature, the clinical and roentgenological picture, the differential diagnosis, the course and the limited chances of treatment are discussed. As to diagnosis initial shoulder pain, pseudophlegmoneous swelling of the shoulder, rupture of the long tendon of the biceps muscle and bone appositions at the medialcaudal portion of the humeral neck-head area and at the lower margin of the acetabulum are emphasized as well as small destructions of the greater tubercle, prior to extensive bone resorption. As to therapy a reserved indication towards synovectomy and refixation of the long biceps tendon is recommended, especially towards bigger interventions. Following decrease of inflammatory processes, on the other hand, guided exercises for support of functional adaptation of the destroyed joint elements are favoured.

Arthritis↗

PubMedDate not supplied

[Specification of corresponding growth laws of Hueter-Volkmann and Pauwels (growth deformities) and their relation to deformities caused by loading].

Intermittent pressure within the limits of physiological stress and strain stimulates the growth plates of a healthy bone (Pauwels), whereas a constant pathological strong pressure does inhibit the enchondral longitudinal growth (Hueter-Volkmann). An active change of direction of growth is induced if the pressure is exerted excentrically: growth deformities. In the presence of a diseased weak bone asymmetrical pressure leads to passive bending of bone: weight bearing deformities. An attempt is made to support these distinctions by experimental and clinical observations.

Arthrogryposis↗

PubMedDate not supplied

[Scoliosis as a concomitant disease of syringomyelia].

Three long-time and two ore three respectively shorter observations of scoliotics with syringomyelia are presented and the pertinent literature is discussed including the complex etiopathogenesis. An attempt is made to describe the concomitant scoliosis. The older the patients with syringomyelia so more frequently scolioses appear, up to about two thirds of all cases, resembling a deformity due to paralysis: Dorsal kyphoscoliosis with lumbar countercurve and lordosis, tendency towards a list of the trunk, eventually rapid progression not only in the growing age but also in adulthood. The scoliosis may preceed the neurologic symptoms for years as well as follow later. Spontaneous fusion of the curves may occur by broad based flat bony appositions to the vertebrae with round prominences as well, aetiologically probably due to syringomyelia: "dystrophic". Since the spinal cord of these cases is more ore less pre-damaged and does react very sensible to progression of the scoliosis, in this phase mainly laminectomy for decompression is indicated whereas treatment otherwise is administered with the help of a Milwaukee brace. If one decides exceptionally to perform a fusion operation the application of any essentional distraction force and contusion is to be avoided.

Adolescent↗

PubMedDate not supplied

[Pathogenesis and treatment of pes adductus].

Based on the literature and our own 143 patients the etiopathogenesis and treatment of metatarsus varus are discussed. The exact scientific proof is still lacking, whether there does exist, besides of the congenital mostly severer metatarsus varus, a slight exogen postnatal form with spontaneous healing, without or with a preceding permanent prone position of the infants. A fixed adductus position of the forefoot represents the indication for stepwise correction of the deformity by means of a plaster cast and additional wedging. It is necessary to produce a slight overcorrection including the typical valgus heel. Afterwards we are striving for strengthening of the foot abductors in order to gain an equilibrium of the musculature as in the treatment of club feet. Our own techniques of correction are demonstrated as well as the results.

Casts, Surgical↗

PubMedDate not supplied

[Familial hip dysplasia with short acetabular roofs].

A longtime observation of a mother and her three children with too short but not flattened acetabular roofs as contrasted with shallow acetabuli is presented, probably on a hereditary basis. The development of these short roofs from acetabular dysplasia may be recognized towards the end of the first decade of life at the latest. The short roof as such seems to be little amenable to conservative treatment. Adduction osteotomies, if necessary, later are preferable to the acetabuloplasties aiming more at improvement of a shallow than a short acetabulum, with the exception of Chiari's osteotomy.

Acetabulum↗

PubMedDate not supplied

[Results of the follow-up of Ludloff open hip repositions and closed repositions in congenital hip dislocations].

Three combinations of therapy of CDH (closed and open reduction, with and without foregoing so called "functional" conservative treatment, and with and without retention in the frog position) have been evaluated among 82 children with 100 dislocated hips. They had been operated on 71 times by Ludloffs open reduction and 29 times by gentle closed reduction in anaesthesia. If following a test-x-ray in 130 degrees flexion of the hips and 50 degrees of abduction no spontaneous reduction occurs, an attempt at careful closed reduction under anaesthesia seems to be justified. If it is not successful with lack of a deep position of the head, an immediate open reduction after Ludloff with retention in hip flexion of about 130 degrees and slight abduction was in our hands less frequently followed by an avascular necrosis of the femoral head than following conservative treatment. The latter and the inhuman frog position are according to our statistics probably more responsible for the avascular necroses than the open reduction as such. Every treatment of CDH has to be evaluated in regard to the frequency of irreversible avascular necrosis of the femoral head.

Casts, Surgical↗

PubMedDate not supplied

[Chondrolysis with protrusion and stiffness of the hip in puberty].

With reference to 5 recently observed cases, and after a review of the literature, the rare and hitherto inadequately clarified complex of stiffness of the hip in puberty is considered. The primary condition--chondrolysis, not necrosis of the head--is typified by destruction with subsequent layered fibrosis of the tissue at the cartilage/bone transition point, mainly at the head of the femur and the acetabulum. The clinical picture is an independent one, accompanied by synovitis and in severe cases leading to fibrous ankylosis. It is not only seen in females with deep and protruding acetabuli, beginning usually between the ages of 10 and 16; it also occurs as a complication of femoral head epiphysiolysis in boys and occasionally also after trauma and inflammations in the hip region. In severe cases the treatment of these events, which even occur occasionally on the "healthy" side, is unsatisfactory. Early relaxation surgery still seems to be the most effective treatment, by reducing the pressure on the base of the acetabulum which probably occurs in these cases. All treatment should be performed in carefully timed and measured stages, "sneaking up" on the irritation.

Acetabulum↗

PubMedDate not supplied

[Osteoid osteoma of the vertebral column].

The peculiarities of osteoid osteoma of the spine occurring most frequently during adolescence are pointed out and contrasted to the benigne osteoblastoma, based on 5 observations and on studies of the literature. The nidus is usually located excentrically and exceptionally even intrarticular. Two foci may occur side by side or one after another, and the adjacent vertebral end plates may be involved. Spontaneous subsiding of pain is possible. The dorsal portions of the lumbar spine are diseased occasionally under the clinician picture of tight hamstrings, most often, however, with a painful reactive scoliotic position of the spine with the concavity always to the involved side. Spontaneous pain and local joint tenderness do precede the x-ray manifestations for many months. The history of pain prior to diagnosis still exceeds one year in the average. The x-ray findings are extraordinary polymorphe. A high awareness of suspicion ought initiate repeated examinations with x-ray and scintigraph. Lack of pains and disappearance of the reactive malpositions of the trunk may be expected only after resection of the nidus. It's preoperative detection may cause considerable difficulties as well as the correct postoperative histological diagnosis in the absence of the relevant material. The most frequent misdiagnosis is low grade osteomyelitis which has been true with the authors who describes first the syndrome of tight hamstrings.

Adolescent↗

PubMedDate not supplied

[In osteogenesis imperfecta no intramedullary nailing and especially no bone plates in childhood].

This is a review of 24 patients with osteogenesis imperfecta of all age groups. 7 severe cases have been followed closely during growth for at least 10 years after multiple series of osteotomies with stabilisation by rodding and plating. The conclusion of the disappointing late results consists in that plating has to be abandoned completely during growth. The indication for rodding has to be restricted severely because of the necessity for replacement of the nails about every two year until cessation of growth. Special operative indications are outlined.

Adolescent↗

PubMedDate not supplied

[Incidence and development of noticeable hip findings (a dysplasia complex) in newborn and young infants].

Among 5338 infants in a DFG (German Research Association) priority program for prospective examination of pregnant women and neonates, asymmetry of the gluteal folds was found in approx. 12%. However this is of little diagnostic value for early diagnosis of hip dysplasia/luxation. The number of cases of restricted abduction found was even lower: in the period following birth it was 3.4%, from the 3rd to the 14th week. 12.7%. Ortolani's sign, including slightly positive and uncertain findings, was positive in 3.0% of the neonates; a hip dysplasia/luxation was diagnosed in 2.4% of the infants. The high percentage of suspected cases diagnosed, at 12.6%, is indicative of excessive diagnosis, even though this figure may already contain some oblique-presentation hips. Moreover, all the data are rendered relative by the differences in emphasis made by the 20 clinics taking part in the study; as a result the actual state and hence the uncertainty of early diagnosis of a hip dysplasia in practice are faithfully reflected. The results are compared with corresponding figures published by Barlow from a study of 9289 children.

Age Factors↗

PubMedDate not supplied

Associated malformations and chromosomal defects in congenital diaphragmatic hernia.

In order to determine the frequency of associated malformations and chromosomal defects in patients with congenital diaphragmatic hernia (CDH) our experiences with CDH during the last 8 years (1985-1993) were reviewed. During the study period, 33 fetuses (prenatal group) with CDH were examined at our level III ultrasound department. In the same period 11 neonates (postnatal group) were admitted to our pediatric surgical unit after postnatal diagnosis of a CDH. Those cases had not been suspicious for CDH during prenatal level I scan. In 24 (72.7%) of the cases with CDH seen prenatally, at least one or more extradiaphragmatic malformations could be detected. Most of them affected the cardiovascular, skeletal, genitourinary and nervous system. Six (18.1%) fetuses had chromosomal abnormalities, especially trisomy 18. In contrast to these findings just 4 of the 11 babies (36.3%) seen postnatally had associated malformations and all of them had a normal chromosome set. Survival rate of fetuses with CDH and associated anomalies (7.1%) was poor, in contrast to those with an isolated CDH (43.7%). Prenatal ultrasound investigations being suspect for CDH should encourage the clinician to make further diagnostical efforts. This includes detailed ultrasound examination and cytogenetic analysis. Associated malformations as well as chromosomal defects are often present in affected patients.

Abnormalities, Multiple↗