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Biomedical subjects

H O Dustmann

Publications and source records attributed to H O Dustmann.

44 records · Page 3Linked to original sources
PubMedDate not supplied

[Etiology and pathogenesis of epiphyseal necrosis in childhood as exemplified with the hip].

In many cases the etiology of juvenile necrosis of the femoral head has not been unequivocally explained. Essentially, however, it is due to reduced arterial blood flow, although venous congestion also has to be considered. Epiphyseal necrosis is frequently a result of known underlying diseases. These include, for example, both specific and nonspecific forms of coxitis and rheumatic coxitis, hormonal dysfunctions, metabolic disorders such as mucopolysaccharidosis, blood diseases (e.g. hemophilia, sickle cell anemia), leukosis, and tumors and necrosis following cortisone and cytostatic therapy. The following four factors may directly or indirectly cause arterial vascular damage and thus necrosis: 1) primarily exogenous and 2) primarily endogenous factors, 3) genetic, and 4) skeletal maturation factors. These etiological factors are described in detail and discussed. Epiphyseal deformation occurs in a strict sequence of five phases, which are described. It should be emphasized that while necrotic bone tissue is being gradually resorbed, deposits of new bone matrix are already accumulating on dead trabecula and will subsequently form new bone fibre. In other word, a gradual substitution takes place. Two important clinical facts derive from this. First, epiphyseal crash is not due to the load of the body's weight. Since active resorption takes place, there is no justification for weight-relieving therapy in the basic therapeutic concept for Perthes' disease. Second, in light of our studies, surgical containment therapy appears to be the most suitable form of treatment if performed at the right time, i.e. in the golden period of remodelling, depending on the patient's age, the extent of necrosis and the degree of dislocation. Where stringent criteria are fulfilled we perform a three-dimensional intertrochanteric osteotomy, i.e. an extension-derotation reduction osteotomy.

Child↗
PubMedDate not supplied

[Experiences with cement-free implantation of the Zweymüller/Endler and Zweymüller total hip joint endoprosthesis. Indications, results, complications and modification of periarticular ossification by diphosphonate (ethylidene-1-hydroxy-1,1-diphosphonate)].

In the last six years the authors have implanted 340 hip joint prostheses of the Zweymüller/Endler or Zweymüller type in 285 patients from the lateral transgluteal approach. Approximately one-third of these patients (111) had previously undergone surgery on the hip joint in question. Intraoperative complications included four cases of elongation of the leg due to implantation of an over-long prosthesis shaft. Four of the shafts implanted were too small and in two cases subsequently loosened. In two patients a divulsion of the trochanter major occurred and there were two cases of cracking of the calcar femoris with involvement of the trochanter minor. There were also two cases of shaft divulsion at the level of the prosthesis tip. Postoperative complications included periarticular ossifications in 41 cases. There were 11 cases of phlebothrombosis and six of pneumonia. Superficial hematomas developed in the wound region in four cases. In addition, there were two cases of shaft and one of acetabular loosening, as well as three prosthesis dislocations. Between October and December 1987, a total of 232 of these patients were examined and the results rated according to Merl d'Aubigne's classification: 166 (71%) were classified as very good or good, 49 (21%) as satisfactory, and 17 (7%) as unsatisfactory. The most common postoperative complication was periarticular ossification, seen in 41 cases. Even though this is not a serious complication and the periarticular ossifications did not necessarily result in severe limitation of movement, a major functional loss as compared to the preoperative findings was seen in the patients with severe ossification (IIIrd degree) at the examination 12 months postoperatively. By giving EHDP, since November 1984, it has proved possible to reduce the incidence of periarticular ossifications from 28 to 12%. In the last 24 months even better results have been achieved by administration of EHDP unter function-scintigraphic control. According to the author's results the Zweymüller/Endler and Zweymüller systems satisfy the requirements for a cement-free total hip replacement since, on the one hand, intraoperative and postoperative complications are slight and, on the other, a good functional result is achieved. The Zweymüller prosthesis has proved particularly suitable for hip joints operated on previously.

Adult↗
PubMedDate not supplied

[Ultrasonography of the spine in infancy].

QUESTION: Based on a standardized technic and reliable attachment of the presented structures the suitability of spinal sonography as a screening-method in newborns and infants should be estimated. METHODS: Enabled by the comparison of sonographic transverse and sagittal plains with identical anatomic sections of an infant corpse the anatomic structures of an healthy spine were associated, which was verified in the clinical use later on. RESULTS: Exemplary photographs of a collective of 50 newborns and infants reproduce the presentation of the spine found in the preparation of the corpse. The technical practicability of such an examination in clinical use was confirmed herein and it became clear that the application of this method is limited from the 6.-8. months of living on because of the increasing ossification which involves a reduction of the image quality. The deviations from the spine presentation in normal relations were shown by some ultrasound examples of malformed spines (spinal dysraphism, hemivertebrae). CONCLUSION: Reproducible attachment of the structures obviously seen with ultrasound and the clear demarcation of deformations as well as the simply practicable examination make evident the suitability of spinal sonography in newborns and infants as a noninvasive screening for the exclusion of spine malformations.

Female↗
PubMedDate not supplied

[Experiences with Wagner's hip joint cup endoprosthesis. Indication, results complications].

In the last 5 years the authors have installed Wagner hip joint cup prostheses in 260 patients. Of these, 211 were implanted with an iliofemoral approach after Smith-Petersen, severing the pelvitrochanterian musculature, and 49 with a lateral approach after Watson-Jones, modified after Harris, with temporary ablation of the trochanter major. Altogether, 160 of the patients thus treated were followed up 3, 6, 18, 24, 30 and 36 months after surgery. The most common postoperative complication, found in 36% of those examined, was periarticular calcification, which was rated as severe in 5%, moderate in 15% and slight in 16%. Even though the periarticular ossifications did not necessarily lead to severe restrictions of movement, the patients with severe and moderate calcifications who were examined after 3 years were found to have a reduction of function of approx. 24% in flexion and extension, approx. 50% in abduction and adduction and approx. 57% in internal and external rotation compared with preoperative findings. In contrast, patients with no significant periarticular ossifications were found to have a definite improvement in motility 3 years after surgery as compared to their preoperative conditions. Further important complications were 2 infections, 3 fractures of the neck of the femur, 3 slipped prostheses and 23 cases of loosening of the prosthesis. The number of loosened prostheses (9% of those examined) represents a marked increase as compared to the loosening rate with conventional total hip replacements.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗