[Surgical techniques in dislocations, cartilage and tendon injuries: refresher course].
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Athletic Injuries↗
Biomedical subjects
H Resch
Publications and source records attributed to H Resch.
Radiation studies on B cell differentiation marker CD24/SCLC Cluster-4 antigen expressing and non-expressing lung cancer cell lines and mouse fibroblasts.
A correlation between CD24 expression and higher intrinsic radiation sensitivity has been described in B-lineage acute lymphoblastic leukaemia (B-ALL). We recently identified the SCLC surface antigen Cluster-4 (CL-4) to be identical to the B cell differentiation marker CD24, except for one amino acid residue. The CD24/CL-4 antigen is highly expressed on SCLC, but rarely on NSCLC cells. In order to investigate the influence of the expression of CD24/CL-4 on the radiation sensitivity in a non-leukaemic cell system, sublines of the human SCLC H249 cell line transfected with mutated ras oncogene, and differing in their CD24/CL-4 expression, were studied. In addition, we stably transfected the NSCLC A125 cell line and the mouse fibroblast NIH3T3 cell line with the CL-4 cDNA. The differential expression of CD24/CL-4 on the cells had no influence on morphology, proliferation and cloning efficiency. Radiation studies were done with cells in exponential growth phase. In the highly resistant NSCLC A125 cells no difference in radioresponsiveness was observed between CD24/CL-4 expressing and non-expressing cells. In the rather radiosensitive cells, similar responses to radiation were observed between CD24/CL-4 expressing and non-expressing SCLC H249-ras cells, whereas the CL-4 transfected NIH3T3 mouse fibroblasts showed a substantially higher radioresistance than the CD24/CL-4 non-expressing control cells. In conclusion, the correlation between CD24/CL-4 expression and radiation sensitivity is controversial and depends on the cell type.
3T3 Cells↗
Risk of vertebral fractures in men: relationship to mineral density of the vertebral body.
OBJECTIVE: Vertebral fracture is the most frequent manifestation of osteoporosis in women. Because there is a lack of information about bone density and the occurrence of fractures in men with osteoporosis, we evaluated the relationship between vertebral fractures and spinal bone mineral density (BMD) to determine if there is a threshold of BMD below which fractures are likely to occur. SUBJECTS AND METHODS: Radiographs of the spine and BMD measurements of the lumbar spine as measured by quantitative CT were obtained in 201 men 21-86 years old (mean age, 68 +/- 4 years) who were referred consecutively for osteoporosis screening. Radiographs were interpreted for the presence or absence of vertebral fractures. The probability of fractures was determined after classifying the patients into subgroups according to their quantitative CT values. The relationship of spinal bone mass to spinal fracture was examined by both logistic regression and receiver operating characteristic (ROC) analysis. RESULTS: Seventy-one patients were classified as having definite vertebral compression fractures. Spinal BMD was 132 +/- 34 mg/ml for the 130 men without vertebral fractures and 75 +/- 22 mg/ml for the 71 men with vertebral fractures (p < .001). The number of fractures per patient and the BMD were negatively correlated (r = -0.71, p < 0.0001). When a BMD of 100 mg/ml was given as a fracture threshold, 15% of the patients without fractures were below this value and 14% of the patients with fractures were above this threshold. Quantifying the overlap between values from patients with and without fractures by ROC analysis, the value of 100 mg/ml gave a sensitivity of 86%. Logistic regression showed 105 mg/ml as the most discriminate value, resulting in a sensitivity of 90%. Logistic regression analysis of the predicted fracture probability also indicated that age does not significantly influence the regression curve. CONCLUSION: We found that direct quantitative CT measurement of the BMD of the vertebral body is a highly efficient approach to distinguish men without vertebral fractures from those with fractures. Thus, a fracture-threshold concept could provide a quantitative criterion to identify men at high risk for vertebral fractures.
Adult↗
Dietary vitamin D intake in patients with Crohn's disease.
In search for the reasons of vitamin D deficiency in Crohn's disease (CD), dietary records were evaluated over 7 days in 30 uninformed out-patients with CD (but no current flare-up) by the help of food tables and compared with those of 30 age- and sex-matched healthy controls. The study was undertaken in December. The nutritional status (height-weight index) was similar in both groups. The dietary vitamin D intake was as low in patient with CD (1.0 microgram/d; 0.5-1.3) as in the controls (1.1; 0.4-1.6) whereas the recommended daily intake is 5 micrograms/d. Vitamin D intake correlated with serum 25-hydroxyvitamin D (25-OHD) levels in patients with low 25-OHD levels (tau = 0.45, p = 0.04). Bone mineral content (BMC)-measured by single photon absorptiometry on the radius- was decreased in 9 patients (31%) with CD. Patients with CD tended to have a lower sun exposure in summer (p = 0.10), which also correlated with BMC (p = 0.03). Hence, a specific diet with a high vitamin D content, or vitamin D supplementation is recommended in patients with CD to overcome the negative effects of low sun exposure on bone mineral density.
Adult↗
[Spontaneous tendon ruptures. Etiology, pathogenesis and therapy].
Spontaneous tendon ruptures are ascribed to recurrent microtrauma resulting from continuous mechanical loading in a critical zone, to muscular imbalance combined with poor coordination as a result of inappropriate training, and also to deteriorating circulation with increasing age. Ruptures of the rotator cuff occur more frequently with increasing age, and the size of the rupture also correlates with age. The frequency of the complaint in men, the predominant involvement of the dominant shoulder, and also the above-average occurrence in occupations involving strenuous physical work indicate that degenerative change plays a role. In about 50% of patients presenting with a ruptured rotator cuff, the genesis is clearly traumatic. A trauma will almost always be the cause of an isolated rupture of the subscapularis tendon. The choice of reconstruction technique for a ruptured rotator cuff depends on the patient's age and level of activity in daily life. In the case of young patients, further surgical measures to repair the defect are indicated following failure of primary suture of the tendon, but in older patients subacromial debridement alone is considered the appropriate procedure. Rupture of the long head of the biceps tendon is usually a sequela of a rotator cuff rupture and the resulting loss of protective cover. Isolated ruptures of the long head of the biceps tendon are much rarer. They tend to occur in middle-aged patients and are usually the result of a relatively minor trauma. Ruptures of the distal biceps tendon are also relatively rare (3%) and are always of traumatic origin. There is no absolute indication for surgical intervention for a ruptured long head of the biceps tendon. Surgical repair is essential in the case of rupture of the distal biceps tendon. Transosseous reinsertion at the tuberosity of the radius is the recommended method of repair. Today's frequent cases of rupture of the Achilles tendon in the framework of sports activities are ascribed to inappropriate training procedures in combination with poor muscular coordination. An exogenous cause is the administration of local injections for pain relief in the form of a so-called tendon anesthetic. Today an increasingly important role is assigned to functional therapy with ultrasound support, although suturing the tendon is still the intervention of choice to meet the high functional demands imposed in the framework of top-level sports.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Prevention of bone mineral loss in patients with Crohn's disease by long-term oral vitamin D supplementation.
OBJECTIVE: To determine whether long-term dietary supplementation with low doses of vitamin D helps to prevent bone loss and the development of osteoporosis or osteomalacia in out-patients with Crohn's disease. DESIGN: A randomized controlled study. SETTING: The out-patient clinic of a tertiary centre (university hospital). PATIENTS: Seventy-five out-patients (31 men and 44 women, aged 16-77 years) with Crohn's disease. INTERVENTIONS: All patients were randomly assigned to receive either an oral supplement of 1000 IU/day vitamin D for 1 year or no supplement. Bone mineral density, assessed in the distal part of the nondominant forearm using single photon absorptiometry, and serum levels of 25-hydroxyvitamin D, assessed using a competitive protein binding assay, were measured before and after the period of dietary supplementation. MAIN OUTCOME MEASURE: Relative change of bone mineral density. RESULTS: Serum levels of 25-hydroxyvitamin D increased in 57% of patients who received a supplement (compared with 37% of control patients). Bone mineral density decreased significantly in control patients [median -7%, interquartile range -12.6-(+0.4%)] but not in patients who received a supplement [median -0.2%, interquartile range -3.8-(+14%); P < 0.005]. Increases in bone mineral density were especially prevalent among patients who received the supplement and had normal serum levels of 25-hydroxyvitamin D (68%), whereas increases occurred in only 18% of patients with low serum levels of 25-hydroxyvitamin D (P = 0.008). Patients without an intestinal resection and receiving the vitamin D supplement had a marginally greater increase in bone mineral content than patients who had undergone a resection (P = 0.05). CONCLUSION: Long-term oral vitamin D supplementation seems to be an efficient means of preventing bone loss in patients with Crohn's disease and could be recommended, especially for patients at high risk of osteoporosis.
Absorptiometry, Photon↗
Pharmacokinetic profile of a new fluoride preparation: sustained-release monofluorophosphate.
The pharmacokinetic profiles of a sustained-release monofluorophosphate (MFP-SR) preparation (76 mg) and of plain MFP (76 mg) were compared in six osteoporotic females. These studies were performed in a randomized, crossover, double-blind design to select a preparation that would result in therapeutic serum levels while avoiding high serum peak values. Following a single dose of 76 mg MFP-SR, the serum fluoride levels remained within the accepted therapeutic range (5-10 microM/liter) for 24 hours. In contrast, following a single dose of 76 mg plain MFP, serum fluoride levels exhibited a wide circadian fluctuation and serum levels approximately threefold higher than those of the MFP-SR preparation (9.5 +/- 1.6 vs 3.5 +/- 0.8 microM/liter, P < 0.005). Compared with plain MFP, the sustained-release MFP had a significantly lower peak concentration (Cmax MFP-SR: 10.6 +/- 3 vs CmaxMFP: 18.9 +/- 5 microM/liter, P < 0.005) and a significantly longer absorption lag time (TmaxMFP-SR 7.3 +/- 1.6 vs TmaxMFP: 3.0 +/- 0.6 h, P < 0.05). Twenty-four-hour urinary fluoride excretion after ingestion of plain or SR fluoride was significantly increased from pretreatment values documenting absorption with either MFP formulation. Our results show that the use of sustained-release MFP preparation that we tested prevents the development of high peak levels associated with the use of plain MFP preparations. Furthermore, a single dose of MFP-SR resulted in serum fluoride levels within the accepted range of 5-10 microM/liter for 24 hours.
Aged↗
[Evidence of fluoride-induced effects on the calcaneus by measurements of broadband ultrasound attenuation (BUA)].
We measured broadband ultrasound attenuation (BUA) of the calcaneus as well as radial (RBD) and spinal bone density (SBD) in normal and osteoporotic females (n = 188) both before treatment and after long-term fluoride therapy. RBD was measured using single photon absorptiometry of the non-dominant distal forearm (SPA) and spinal bone density (SBD) was assessed using quantitative CT (QCT). In untreated osteoporotic patients (n = 62), BUA as well as the other densitometric methods showed significantly lower values (p < 0.05) when compared to age matched controls (n = 75). Females with osteoporosis and long-term treatment with fluoride (n = 51) had both significantly higher BUA values and higher spinal bone density when compared to women with untreated osteoporosis. BUA and SBD were correlated in the entire group (r = 0.5, r < 0.0001) as well as in the subgroups of untreated (r = 0.48, p < 0.001) and fluoride-treated patients with osteoporosis (r = 0.4, p < 0.05). These results suggest that BUA provides further evidence of an osteogenic response to fluoride at peripheral weight-bearing skeletal sites such as the calcaneus.
Absorptiometry, Photon↗
Influence of sex and age on biochemical bone metabolism parameters.
Age-related changes in bone metabolism are of interest in the pathogenesis of postmenopausal and senile osteoporosis; however, data in the literature give conflicting results. Thus, the aim of our study was to measure serum levels of osteocalcin, a specific biochemical parameter of bone formation, as well as serum levels of midregional parathyroid hormone (PTH) and alkaline phosphatase in healthy males and females of various age groups. We studied 155 healthy subjects (91 females, 64 males, mean age: 43 years, age range: 20-81 years). Serum levels of osteocalcin, alkaline phosphatase and PTH increased with age and were significantly higher in the postmenopausal than in the premenopausal females (osteocalcin: 8.7 +/- 0.4 vs. 6.5 +/- 0.3 ng/ml, p < 0.0001; alkaline phosphatase: 126 +/- 7 vs. 89 +/- 5 U/l, p < 0.0003; PTH: 111 +/- 10 vs. 61 +/- 9 pmol/l, p < 0.0001). In contrast, serum levels of osteocalcin, alkaline phosphatase and PTH were similar in the male subjects above or below the age of 50 years (osteocalcin: 6.5 +/- 0.5 vs. 7.2 +/- 0.4 ng/ml, non significant; alkaline phosphatase: 104 +/- 8 vs. 105 +/- 5 U/l, non significant; PTH: 59.6 +/- 6 vs. 61 +/- 5 pmol/l, non significant. Serum calcitonin levels were significantly lower in postmenopausal women and men above 50 years of age. Our data suggest different age-related alterations in bone metabolism in males and females. The increased levels of osteocalcin, alkaline phosphatase and PTH in postmenopausal females give evidence of increased bone turnover in these subjects. In healthy men bone-specific markers remained unchanged, indicating no relationship between bone turnover and age.
Adult↗
Evidence that fluoride therapy increases trabecular bone density in a peripheral skeletal site.
We measured the spinal bone density (SBD) and femoral condyle bone density (FCD) in normal and osteoporotic females (n = 219) both before and during fluoride therapy. SBD and FCD in untreated osteoporotics were significantly lower (P < 0.05) than those in the age-matched controls. SBD and FCD were correlated in the untreated (r = 0.62; P < 0.0001) as well as in the fluoride-treated osteoporotics (r = 0.42; P < 0.0001). SBD and FCD were significantly increased (P < 0.05) in response to fluoride therapy. The average rates of increase in FCD and SBD were similar (1.3 +/- 1.3 vs. 1.24 +/- 1.4 mg/cc.month). We conclude that the osteogenic action of fluoride is not limited to the axial skeleton. An increase in trabecular bone density also occurs at peripheral weight-bearing sites such as the femoral condyle.
Aged↗
Spirometry, blood gas analysis and ultrasonography of the diaphragm after Winnie's interscalene brachial plexus block.
Ten patients with healthy lungs were subjected to radiology, sonography, spirometry and blood gas analysis before and after an interscalene brachial plexus block prior to shoulder surgery. Winnie's interscalene block induced ipsilateral hemidiaphragmatic paresis that was confirmed by radiology and sonography. Changes in forced expiratory vital capacity (FVC), forced expiratory volume (FEV1) and peak expiratory flow rate (PEFR) were significant and PaO2 declined by an average of 1.3 kPa. These changes should not cause further clinical symptoms in sitting patients with unaffected lungs. In patients with pulmonary disease, this method of nerve block should be limited to cases for which there is a clear indication.
Adult↗
[Prognosis of epidural hematoma: is emergency burr hole trepanation in craniocerebral trauma still justified today?].
We made a retrospective study of the records of 80 patients with epidural haematoma, to investigate whether delay between injury and surgery and neurological status upon admission affect outcome after 3-6 months. Outcome was classified on a four-grade scale, grade 1 meaning full recovery and grade 4, death. Overall mortality was 13%. Patients operated on within 7 h after injury made a full recovery in 52%, and mortality in this group was 6%. Patients operated on between 7 h and 14 h after injury made a full recovery in 20%; mortality was 16%. Among the patients who were not comatose on admission a good outcome was achieved in 55% and mortality was 3%. The outcome in patients who were comatose on admission was rated grade 1 in 15% and grade 4 in 25%. The proportion of comatose patients and the mortality were higher in patients transferred from general hospitals. Textbook signs of epidural haematoma are not reliable aids to diagnosis and localization; for example a lucid interval occurred in only 58% of our patients. It is concluded that emergency burr hole trepanation might improve the outcome in patients showing signs of brain stem dysfunction after head injury, but prior computed tomography is necessary to guide such an intervention at the district hospital level.
Adolescent↗
[The value of sonography in ruptures of the rotator cuff].
In 375 patients ultrasonography of the rotator cuff was carried out before operation. All the patients underwent acromioplasty, either alone or with additional repair of a full-thickness tear. The ultrasound findings were then compared with the intraoperative findings. Two hundred and seventy-two tears of the rotator cuff were seen on ultrasonography, and in 262 cases this was confirmed at operation. In 103 patients no rupture was diagnosed by ultrasound, but in 26 of these cases a full-thickness tear was detected on operation. These figures yield sensitivity of 91%, specificity of 89% and accuracy of 90%; the positive predictive value was 96%, the negative predictive value 75%. In most cases of incorrect evaluation the size of the tears was underestimated by ultrasonography.
Adult↗
The influence of partial gastrectomy on biochemical parameters of bone metabolism and bone density.
Since it has been suggested that gastric resections are followed by changes in bone metabolism, the aim of our study was to determine the biochemical parameters of bone metabolism and radial and lumbar bone density in 15 male ulcus patients treated by partial gastrectomy (Billroth II). Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography was statistically significantly lower (P less than 0.04) in the patient group, whereas the peripheral bone mass of the distal part of the nondominant forearm measured by single-photon absorptiometry showed no statistically significant difference. In addition, a marked increase in alkaline phosphatase (P less than 0.002) and urinary excretion of hydroxyproline (P less than 0.003) was found in gastrectomy group, whereas the 25-hydroxy-vitamin D levels were found to be significantly decreased (P less than 0.04). Osteocalcin, a biochemical marker for osteoblast activity, and the carboxy-terminal propeptide of type I procollagen (PICP), a marker of collagen formation, were slightly but not significantly higher in gastrectomy-treated patients. The serum parathyroid hormone levels were similar in both groups. As none of the patients had any radiologic evidence of osteopenia, the changes in biochemical parameters of bone metabolism and bone mass in patients who had undergone partial gastrectomy could be a marker of latent bone loss.
Absorptiometry, Photon↗
Bone mass and biochemical parameters of bone metabolism in men with spinal osteoporosis.
With advancing age both sexes have an increased incidence of osteoporotic fractures, although fractures are more common in women than in men. Whereas in women several potential risk factors have been identified, less is known about osteoporosis in men. A total of 27 Austrian men (mean age: 65 +/- 2 years) with atraumatic spine fractures were studied. In all patients, medical history gave no evidence of disease or medications causing osteoporosis. Peripheral bone mass was determined by single-photonabsorptiometry on the distal non-dominant forearm; lumbal bone density was measured by quantitative computed tomography. Serum levels of calcium, phosphate, alkaline phosphatase, osteocalcin, testosterone, estrogen, parathyroid hormone and 25-hydroxy-vitamin D as well as 2-h-urinary-OH proline and calcium excretion were measured. All data were compared with those of an age and sex matched control group consisting of 19 healthy males. A significant difference in mean peripheral and axial bone mass (SPA: P less than 0.004; QCT: P less than 0.0001) was observed between osteoporotic men and controls. When compared to controls, serum levels of alkaline phosphatase (P less than 0.012), urinary OH proline (P less than 0.05) and urinary calcium excretion (P less than 0.003) were significantly higher in the osteoporotic males. Additionally, there was a significant positive correlation between serum alkaline phosphatase and urinary OH proline excretion (r = 0.32; P less than 0.04) in the osteoporotics. All other biochemical parameters showed no significant differences. Our results may lead to the assumption that osteopenia in men is related to increased bone turnover.
Aged↗
The spine deformity index in osteoporosis is not related to bone mineral and ultrasound measurements.
In 34 female patients suffering from osteoporotic vertebral compression fractures, the spine deformity index (SDIM) was determined, according to the method of Minne et al (1988), to reflect the radiological severity of established osteoporosis. Peripheral (single-photon absorptiometry (SPA) of the non-dominant distal forearm) and axial (quantitative computed tomography (QCT) of the lumbar spine) bone mineral measurements, as well as the broadband ultrasound attenuation of the os calcis, were performed in the osteoporotic patients and in a control group of 20 age-matched women. No correlation could be found between bone mineral measurements and radiological severity of osteoporosis, expressed as SDIM. All three densitometry methods showed clearly reduced values in patients with vertebral crush fractures. Correlations established in the control group between peripheral and axial bone mass (SPA versus QCT) could no longer be found in the osteoporotic group, thus indicating changes in bone mineral density of the spine after the occurrence of osteoporotic fractures. Our data show that SDIM is an additional parameter of osteoporotic change in the spine, independent from bone mass measurements. In the management of osteoporotic patients, quantitative radiological methods (i.e. SDIM) in addition to densitometry might be of value for grading and monitoring the progress of disease.
Absorptiometry, Photon↗
[Arthroscopic and percutaneous bone screw techniques with a new screw system].
A new screwdriver is presented with which small titanium screws can be introduced into a joint under arthroscopic guidance. The screws are centrally cannulated, 2.7 mm thick (thread diameter), and available with and without a washer (5 mm in diameter, serrated and convex, flexible but not removable). The screwdriver has a special screw-holding device which allows the screw to be grasped and released making it possible to remove a screw already implanted in the joint at an earlier time. This arthroscopic screwing system has been used in 81 cases to date. In 59 patients with shoulder instability, arthroscopic refixation of the detached labrum-capsule complex was performed. In the first 32 of these cases an intra-articular screwing technique was used and in the following 27 cases an extra-articular screwing technique was applied. In addition, in 9 patients a fractured and displaced greater tuberosity was reduced and fixated percutaneously under the guidance of an image intensifier by means of this screwdriver. Other fields of application were the knee joint (type III fracture of the intercondylar eminence in 5 patients) and the ankle (displaced fracture of the talus in 2 patients and osteochondritis dissecans in 1). Complications were seen only in the patients with shoulder instability who were treated by the intra-articular screwing technique (screw loosening in 4 patients). This was the reason why the intra-articular technique was replaced by the extra-articular method. Since that time no further complications caused by the screws have been seen. Redislocation of the shoulder joint occurred in 1 case 7 months after operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Arthroscopes↗
[Dislocation fractures of the shoulder. Special status and therapeutic concepts].
Shoulder dislocations associated with a displaced fracture of the humeral head or glenoid require different treatment than shoulder dislocations without fracture. If the humeral head is fractured, two possible complications must be considered:impairment of the subacromial gliding mechanism and insufficient blood supply to the humeral head. In glenoid fractures, instability may be induced. The degree of instability depends on the size of the fragment. In fractures of the humeral head, in particular of the greater tuberosity, we differentiate between the so-called en bloc fracture and the so-called supra-spinatus avulsion fracture. In "en bloc" fractures, one has to be aware that displacement of the fragment can occur not only in the superior direction but in the posterior direction as well. Posterior displacement is displayed radiologically by the "tangential" view. Both the duration of pain and range of motion depend on the amount of displacement of the fragment. Displacement exceeding 3 min in one direction should be reduced surgically in the active patient. For operative treatment of a displaced "en bloc" fracture, we recommend closed reduction and percutaneous screw fixation performed under regional anesthesia. "Supraspinatus avulsion fractures" ought to be treated like rotator cuff tears because there is no possibility of the small fragments healing due to their placement on the joint cartilage. In fracture dislocations, the blood supply of the humeral head is seriously jeopardized if the fracture is situated in the anatomical neck, whereas this is not the case in a fracture of the surgical neck. The number of displaced fragments allows a prediction concerning the survival of the articular segment of the humeral head.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗