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Biomedical subjects

H Resch

Publications and source records attributed to H Resch.

At least 37 records · Page 2Linked to original sources
PubMed2000

Ultrasound and X-ray-based bone densitometry in patients with anorexia nervosa.

In 20 patients (mean age 23+/-5 years) with anorexia nervosa (AN), bone mass was evaluated by broadband ultrasound attenuation (BUA) of the calcaneus, peripheral quantitative computed tomography (pQCT) of the distal radius, and dual X-ray absorptiometry (DXA) of the lumbar spine and the hip. Compared with 20 age- and sex- matched healthy controls, patients with AN showed marked osteopenia at all measuring sites. Values of BUA (33.0+/-9 dB/MHz vs. 51.0+/-5.7 dB/MHz; P<0.0001) and of BMD of all regions of the hip (e.g., femoral neck: 0.71+/-0.13 g/cm(2) versus 0.89+/-0.07 g/cm(2); P<0.001), lumbar spine (0.82+/-0.15 g/cm(2) versus 1.24+/-0.06 g/cm(2); P<0.003) and total BMD of the peripheral radius (303.2+/-75 g/cm(3) versus 369.4+/-53.2 g/cm(3), P<0.001) were significantly reduced. Calculating a Z-score we found the most prominent differences between AN and controls by BUA of the calcaneus (-3.2+/-1.6), followed by DXA at the lumbar spine (-2.9+/-2.2) and the hip (femoral neck -2.1+/-1.7) and by pQCT at the distal radius (total BMD -1.2+/-2.0). There were highly significant correlations between BUA of the calcaneus and BMD of the femoral neck (r = 0.78, P<0.0001) and lumbar spine (r = 0.75, P<0.0001) as well as between BMD values of the femoral neck and lumbar spine (r = 0.95; P<0.0001). In addition, there were significant correlations (P<0.001) between body mass index (BMI) and the three different measuring sites and between the duration of the disease and BUA (r = 0.5, P<0.05). Our data suggest that BUA of the calcaneus is a valuable tool in the management of osteoporosis. Being a fast, radiation-free investigation method of good acceptance, it may be well suited for an assessment of the skeletal status in patients with AN.

Absorptiometry, Photon↗
PubMed2000

Peripheral quantitative CT of the forearm: scanner cross-calibration using patient data.

Bone density measurements by peripheral quantitative CT (pQCT) of the distal radius in 87 women (age 38.4 +/- 12.3 years) were obtained on a both a Stratec XCT 900 and an updated version XCT 1400. Axial area, and total and trabecular bone mineral density (BMD) results from both scanners were compared for all patients using linear regression analysis. To achieve scanner calibration we used the intercept and slope of the patients' correlations. The correlations of the patients' values were good for area (r = 0.83) as well as total BMD (r = 0.90) and excellent for trabecular BMD (r = 0.97). The cross-calibration approach in our study provided compatibility of pQCT for trabecular and total ROIs, the clinically mostly utilized volumes of measurement.

Adult↗
PubMed2000

Transfer of the pectoralis major muscle for the treatment of irreparable rupture of the subscapularis tendon.

BACKGROUND: The clinical diagnosis of a tear of the subscapularis tendon is difficult, and the resulting delays frequently cause a major time-lapse before repair is attempted. Diagnostic delay often means that surgical repair is no longer possible. In twelve patients who had an irreparable tear of the subscapularis tendon, the superior one-half to two-thirds of the tendon of the pectoralis major muscle was used as a substitute for the subscapularis tendon. In order to adapt the orientation of the transferred muscle to that of the subscapularis, it was routed behind the conjoined tendon of the coracobrachialis muscle and the short head of the biceps to the lesser tuberosity. METHODS: The operations were performed between May 1993 and June 1997. The average age of the twelve patients was sixty-five years old (range, forty-nine to eighty-one years old). Eight patients had an isolated rupture of the subscapularis tendon, and four had a concomitant lesion in the form of either a partial or a complete rupture of the supraspinatus tendon. The dominant symptoms were anterior shoulder pain and weakness that had responded poorly to nonoperative therapy. Four patients also had signs of recurrent anterior instability. RESULTS: After an average follow-up interval of twenty-eight months (range, twenty-four to fifty-four months), nine of the twelve patients assessed the final result as excellent or good; three, as fair; and none, as poor. Pain was reduced, with the score improving from an average of 1.7 points (of a maximum of 15 points) preoperatively to an average of 9.6 points postoperatively. The patients' subjective functional evaluation improved from an average score of 20 points preoperatively to an average of 63 points postoperatively. The average functional rating with use of the Constant and Murley score increased from 26.9 to 67.1 percent of normal. All four preoperatively unstable shoulders were stable at the time of the latest follow-up. CONCLUSIONS: This repair technique can be recommended as a reconstructive procedure for elderly patients who have an irreparable tear of the subscapularis tendon.

Aged↗
PubMed1999

Ceramide triggers p53-dependent apoptosis in genetically defined fibrosarcoma tumour cells.

p53 mutations are among the most common genetic alterations in human cancer and are frequently described in intrinsic or acquired radio- and chemotherapy resistance. Radiation-induced cell kill is not only mediated by DNA damage but also by the activation of signal transduction cascades generated at the plasma membrane like the sphingomyelin pathway. We used genetically defined wild-type p53 or p53-deficient mouse fibrosarcoma cells to investigate the p53-dependence of tumour response upon activation of the sphingomyelin pathway. Treatment of the tumour cells with neutral sphingomyelinase drastically reduced the amount of wild-type p53 fibrosarcoma cell proliferation over 72 h in a clear dose-response (0.2-1.0 U ml(-1) nSMase). Sphingomyelinase had no effect on cell proliferation in tumour cells lacking p53. Similarly, cell proliferation was abolished by C2-ceramide (5-20 microM) only in wild-type p53 cells. FACS-analysis revealed that C2-ceramide induced massive p53-dependent apoptosis (40-50% after 12-24 h) and cell cycle analysis showed a transient G1 arrest in p53-deficient tumour cells 12-24 h after C2-ceramide exposure. These results suggest that ceramide-induced apoptosis in tumour cells can be dependent on the status of p53 and imply that p53 is also important for stress-induced apoptotic signal transduction cascades generated at the plasma membrane.

Animals↗
PubMed1998

[Lumbar bone density. Risk factor for vertebral fractures in women].

BACKGROUND AND OBJECTIVE: The direct connections between a reduction in bone density and an increase in the incidence of fractures with increasing age is well known. When interpreting bone density measurements the attending physician is confronted with an overlap of false-positive and false-negative parameters, as is also the case with biochemical data. Aim of this study was to determine, in addition to bone density, a fracture threshold, i.e. a value for bone density with maximal sensitivity and specificity, in a representative cohort of women. PATIENTS AND METHODS: 534 healthy women (mean age 60.9 +/- 8.07, range 40-83 years), seen in an out-patient osteological clinic between 1993 and 1996 were included. After full biochemical investigation to exclude a metabolic bone disease, bone density (LBD) of the lumbar vertebrae 1-5 and the number of vertebral body fractures were documented, together with age and menopausal status. LBD was measured by quantitative computed tomography (qCT), results being analysed with the Wilcoxon 2-sample test and logistic regression and assessed by receiver operating characteristics (ROC) analysis. RESULTS: None of the women with a qCT value over 111 mg/cc had evidence of vertebral fractures. Those with values under 60 mg/cc had at least one vertebral fracture (defined as at least 15% reduction in vertebral body height). There was a highly significant negative correlation between age and LBD (r = -0.56; P < 0.0001), as well as between LBD and the number of fractured vertebrae (r = -0.58, P < 0.0001). But there was no longer any correlation between age and number of vertebral body fractures once allowance was made for LBD (r = 0.001, not significant). The least overlap of false-positive and false-negative values was at an LBD with qCT values of 102 mg/cc. CONCLUSIONS: LBD is the determining variable for fracture risk independent of age. Despite an overlap of false-positive and false-negative LBD values, the probability of fractures can be predicted from bone mineral content.

Adult↗
PubMed1998

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed1998

Immunophenotypic characteristics of monocytes in elderly subjects.

Since ageing is accompanied by various alterations of the immune system, the aim of the present study was to investigate the effect of age on the expression of surface markers in peripheral blood monocytes. We studied 28 healthy young subjects and 28 elderly subjects fulfilling the criteria of the SENIEUR protocol. Peripheral blood mononuclear cells were isolated and the expression of various surface markers was analysed by double colour flow cytometry. The mean fluorescence intensity of the intercellular adhesion molecule- (CD54), CD29, CD45RO and CD32 was increased significantly in CD14+ cells of elderly people when compared with the young subjects. No significant differences were found in the expression of CD11a, CD11b, CD15, CD26, CD27, CD33, CD45RA, CD45RB, CD49d, HLA-DR and CD65. In summary, we demonstrated significant increase in four monocyte surface markers in subjects of old age; this finding may be related to certain immune phenomena observed in ageing subjects such as auto-immunity.

Adult↗
PubMed1998

Evidence that tamoxifen preserves bone density in late postmenopausal women with breast cancer.

Tamoxifen, which is used for treating breast cancer, exhibits estrogenic and antiestrogenic characteristics, depending on the tissue. In the human breast it acts as an antiestrogen, whereas estrogenic effects have been reported on endometrium and bone. The purpose of this study was to determine whether tamoxifen (TAM) prevents bone loss in elderly, postmenopausal women. Bone mineral density of the lumbar spine (SBD) was measured in elderly women (at least 10 years after menopause) 5 years after stage I or II breast cancer (n = 111). The results showed that SBD in untreated patients (n = 74) was significantly lower (p < 0.05) than SBD in patients (n = 37) treated with TAM over 5 years. In a subgroup of patients (n = 24) with positive estrogen receptor status, changes in SBD 12 months after discontinuation of 5-year TAM therapy were measured and compared with the changes of extended TAM treatment over a sixth year. Twelve months after withdrawal of 5-year TAM medication (n = 11) bone density decreased significantly (- 4.8+/-2.5%; p > 0.05), whereas in the group of women (n = 13) receiving extended TAM medication (20 mg) for an additional 12 months, SBD ( + 1.9+/-3.5 %) was maintained during the observation period, and was significantly higher when compared with the group of untreated patients (p <0.05). We conclude that tamoxifen has a preventive effect on trabecular bone loss at the lumbar spine, when compared to age-matched data and to untreated women with breast cancer in the late menopause. Our data give evidence of benefits to bone density provided by prolonged administration in patients after breast cancer and at risk of osteoporosis.

Aged↗
PubMed1998

A randomized, prospective study of operative and non-operative treatment of injuries of the fibular collateral ligaments of the ankle.

One hundred and forty-six adults who had an isolated injury of the fibular collateral ligaments of the ankle were randomized to be managed operatively or non-operatively. Disruption of the ligaments was diagnosed by means of a physical examination and on the basis of stress radiographs of the ankle made with use of a specially designed device to hold the leg. Operative treatment, performed in seventy-three patients, consisted of suture repair of the disrupted ligaments within seventy-two hours after the injury, followed by immobilization of the ankle in a below-the-knee plaster cast for six weeks. Non-operative treatment, used for seventy-three patients, consisted of the use of an ankle orthosis for six weeks. After a minimum of two years of follow-up, we could detect no significant differences, with the numbers available, between the two groups with regard to the functional result or the degree of joint laxity that was evident on stress radiographs. The non-operative group lost a mean of 1.6 weeks from work, and the operative group lost a mean of 7.0 weeks. We concluded that non-operative treatment of an injury of the fibular collateral ligaments of the ankle yields results that are comparable with those of operative repair and is associated with a shorter period of recovery.

Adolescent↗
PubMed1998

[Osteosynthesis of proximal humerus fractures].

Only 5% of adult fractures are fractures of the proximal humerus. In 80% of these fractures one can expect a good result, because they are generally nondisplaced, stable and allow early mobilization. However, the other 20% of these fractures present not only problems with reduction and adequate fixation but also the risk of humeral head necrosis and painful shoulder ankylosis. The operative treatment of displaced fractures of the proximal humerus has changed during the last few years. Minimal osteosynthesis takes into consideration the great extend and the biological aspects of these fractures and provides sufficient stability for early functional therapy. The Neer-classification has proved very useful for both, the indication for and the choice of an operative procedure.

Adult↗
PubMed1997

Serum fluoride and serum osteocalcin levels in response to a novel sustained-release monofluorophosphate preparation: comparison with plain monofluorophosphate.

In a previous study we found that sustained-release monofluorophosphate (MFP-SR), a novel, sustained-release MFP preparation, acutely maintained the basal therapeutic serum fluoride levels without causing the high serum peak levels associated with plain MFP administration. The objective of the present study was to determine (a) whether chronic MFP-SR administration would provide therapeutic serum fluoride levels, and (b) whether treatment with this new preparation would result in an increase in bone formation similar to that achieved with plain MFP. Bone formation was assessed by serum osteocalcin (OC) determination. We studied 17 postmenopausal women older than 60 years and suffering from primary osteoporosis. All had received a minimum of 6 months of continuous treatment with plain MFP at a dose of 152 mg/day (76 mg b.i.d.). Upon entering the study, the subjects were randomized, in a double-masked protocol, to receive either MFP-SR (76 mg b.i.d.) (n = 9) or placebo (n = 8) for 2 months, after which all subjects returned to the original plain MFP regimen. Serum fluoride and serum OC levels were determined monthly for 3 months. At the beginning of the study serum fluoride levels were in the accepted therapeutic range (5-10 microM) in all patients. Serum fluoride levels were maintained in the patients switched to MFP-SR. In contrast, serum fluoride levels decreased significantly (p < 0.005) in the placebo-treated control subjects and returned to therapeutic levels upon switching back to plain MFP. Similarly, serum OC levels remained elevated in the subjects switched to MFP-SR but dropped significantly (p < 0.001) in the placebo-treated group. Our results demonstrate that chronic MFP-SR administration, at a dose of 152 mg/day, results in maintenance of therapeutic serum fluoride levels and in stimulation of bone formation. Because we have previously reported that high, supratherapeutic post-absorptive serum fluoride levels are avoided by MFP-SR administration, this novel preparation may prevent side effects associated with plain MFP by reducing the amount of fluoride deposited in bone.

Aged↗
PubMed1997

Arthroscopic extra-articular Bankart repair for the treatment of recurrent anterior shoulder dislocation.

This study describes a new arthroscopic procedure for the stabilization of recurrent anterior shoulder dislocations. The technique involves two important features. The first is the anterior inferior transmuscular approach through the subscapularis muscle, which permits self-locking implants to be inserted into the anterior inferior third of the glenoid rim so that they oppose the direction of pull of the capsule. This approach was studied on 79 cadaveric shoulders before clinical application. The second feature is the extracapsular (extra-articular) location of the self-locking implants, which permits a superomedial capsular shift as required. The technique offers a high degree of capsular stability. Of a total of 318 patients undergoing this procedure, the first 100 shoulders (98 patients) were evaluated postoperatively at an average of 35 months (range, 18 to 62 months). The diagnosis in all cases was traumatic recurrent anterior shoulder dislocation. Repair of the capsule was performed initially with screws and later with absorbable tacks. The overall recurrence rate was 9% (9 shoulders). Excluding the first 30 shoulders to take account of the learning curve, the recurrence rate for the subsequent 70 shoulders was only 5.7%. Limitation of external rotation at 0 degrees abduction averaged 6.7 degrees and 6.1 degrees at 90 degrees abduction for all shoulders; 61% of participants in overhead sports and 70% of participants in contact sports resumed their preinjury activities. The recurrence rate for patients involved in overhead sports was 10% and for collision sports it was 14%. There were no recurrences in the case of patients whose sports involve minimum risk to the shoulder (cycling, jogging). Most recurrences were observed in patients with lax shoulders and small Bankart lesions.

Adolescent↗
PubMed1997

Percutaneous fixation of three- and four-part fractures of the proximal humerus.

Untreated 3- and 4-part fractures of the proximal humerus have a poor functional outcome. Open operation increases the risk of avascular necrosis and percutaneous reduction and fixation may be preferable. We report 27 patients, 9 with 3-part and 18 with 4-part fractures, treated by percutaneous reduction and screw fixation. Thirteen of the 4-part fractures were of the valgus type with no significant lateral displacement of the articular segment, and five showed significant shift. Instruments were introduced into the fracture through small incisions so that the fragments could be manoeuvred under the control of an image intensifier, taking advantage of ligamentotaxis as far as possible. A good reduction was achieved in most cases. The average follow-up was 24 months (18 to 47). All the 3-part fractures showed good to very good functional results, with an average Constant score of 91% (84% to 100%), and no signs of avascular necrosis. Good radiological results were achieved in 4-part fractures when impacted in valgus except for one patient with partial avascular necrosis of the head. In those with lateral displacement of the head, revision to a prosthesis was required in one patient because of avascular necrosis and in another because of secondary redisplacement of the fracture. Avascular necrosis was seen in 11% of 4-part fractures. The average Constant score in patients with 4-part fractures who did not need further operation was 87% (75% to 100%).

Accidental Falls↗
PubMed1996

The tendon defect after anterior cruciate ligament reconstruction using the midthird patellar tendon--a problem for the patellofemoral joint?

Retrospective clinical and radiographic evaluation was performed on 41 patients seen at the Salzburg General Hospital Department of Traumatology on average 2 years following ACL reconstruction. In 26 patients (61%) clinical examination revealed pain trigger points over the donor site of the midthird patellar tendon and in the patellofemoral joint. Functional pain during kneeling activities was observed in 19 patients (46%). Objective measurement of the length of the patellar tendon in bilateral radiographs demonstrated exactly equal patellar tendon length in both knees in 11 patients (27%). The radiographs showed tendon shortening following harvesting of the midthird patellar tendon by 1-3 mm in 7 patients (17%), by 4-6 mm in 16 (39%), and by 6-9 mm in 7 (17%). Average length change in the patellar tendon on the donor side was -3 mm, representing a patellar tendon shortening of 9.8%. On the basis of the OAK score, however, good and very good results were recorded in 33 patients (80%). On the whole, these good overall results were compromised only be patellar tendon defect morbidity. In addition to the local scarring problems at the donor site, shortening of the patellar tendon was observed with changes to patella position and interference with the mechanics of the patellofemoral joint. Tendon shortening can be explained on the basis of cicatricial contraction in the process of autorepair to the tendon defect. The problems affecting the patellofemoral joint are inherent in the therapy and must be treated as a negative factor. In the case of patients whose work requires mainly a kneeling position and those who make significant functional demands of the extension system of the knee, a critical assessment is required of the use of the midthird patellar tendon for anterior cruciate ligament reconstruction.

Adult↗
PubMed1996

The antero-inferior (transmuscular) approach for arthroscopic repair of the Bankart lesion: an anatomic and clinical study.

In order to find a direct approach to the antero-inferior third of the glenoid rim, an anatomic study was performed on a total of 89 shoulders (48 cadavers). To obtain defined reference points for the anterior inferior third of the glenoid cavity, it was compared with the hour markings on a clock face. The 4:30 position on the right shoulder and the 7:30 position on the left shoulder were defined as the relevant reference points. The average distance between the palpable end of the coracoid process and the 4:30 and 7:30 positions was 19 mm. The average distance to the point of intersection of the musculocutaneous nerve with the medial margin of the conjoined tendon was more than 5 cm, and was never less than 2 cm. The average distance of the axillary nerve from the 4:30 position was 2.5 cm in the horizontal plane, with a minimum of 1.5 cm. Radially, the average distance of the axillary nerve was 1.7 cm, with a minimum of 1.3 cm. The anatomic study was followed by a clinical study of 264 patients. An antero-inferior portal located maximum 2 cm distal from the palpable coracoid tip was selected for the introduction of a trocar sheath and blunt trocar, passing through the subscapularis muscle to access the antero-inferior area of the glenoid rim. As additional protection for the musculocutaneous nerve, the direction of the trocar was adjusted during introduction. Reattachment of the labrum-capsule complex was performed extra-articularly. In all cases, at least one implant was located inferior to the 4:30 or 7:30 position. No neurovascular complications arose out of the choice of portal. Out of the 264 patients, the first 100 shoulders (98 patients) were followed-up after an average time of 35 months (18 to 62 months). The recurrence rate was 9%. Excluding the first 30 shoulders (30 patients) from the development phase of the technique, the recurrence rate is only 5.7%. The rate of return to overhead sports activities was 62% and to collision sports activities 70%.

Adult↗
PubMed1996

[Rupture of the rotator cuff].

The operative treatment of rotator cuff tears becomes more popular. New reliable diagnostic techniques improved operative procedures and as a very important fact the demanding of the patients to a normal function of the shoulder account for this development. Therefore every physician has to know exactly the reason, the clinical appearance and the course of this pathology. Beside conservative treatment, new operating techniques and the postoperative management will be shown.

Aged↗