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Biomedical subjects

H Troeger

Publications and source records attributed to H Troeger.

At least 19 recordsLinked to original sources

Restitution of single-cell defects in the mouse colon epithelium differs from that of cultured cells.

Integrity of colon epithelium is of crucial importance and, as small defects occur constantly, rapid repair (restitution) is essential. To investigate the mechanism of restitution, single-cell lesions were induced in mouse colonic surface epithelia by iontophoretic injection of Ca2+. Closure of the resulting defects was monitored using confocal laser scanning microscopy (CLSM), and functional sealing by electrophysiological techniques. Restitution was evaluated as the time constant tau of the exponential decrease in conductance of an induced leak and amounted to 0.28 min under control conditions. After 4 min, the leak was completely sealed. Repair was thus considerably faster than in previously investigated HT-29/B6 cells (tau=5.73 min). As in cultured cells, cytochalasin D delayed restitution in native colon epithelia (tau=0.69 min), indicating the involvement of actin in the healing process; however, no accumulation of actin surrounding the lesion was detected. Long-term incubation of epithelia with IFN-gamma alone or in combination with TNF-alpha increased tau to 0.49 and 0.59 min, respectively. In contrast to cultured cells, TNF-alpha alone did not affect restitution. A brief (<10 min) exposure to the sterile filtered supernatant of hemolytic E. coli O4 cultures did not affect the morphology of the epithelium, but delayed restitution. In CLSM studies, defects were still clearly visible 4 min after the onset of lesion induction. The supernatant of a nonhemolytic E. coli O4 mutant did not exhibit this effect. In conclusion, single-cell defects in native colon cause functional leaks that seal faster than in cell cultures. Proinflammatory cytokines and pathogenic bacteria delay restitution. This suggests a key role of very small lesions at the onset of pathogenic processes in the intestine.

Actins↗

[Fibular nerve compression due to an unusual cause. A case report].

There are many factors causing a compression of the fibular nerve accompanied by a loss of function. We describe an unknown cause: a chronic low-grade infection after implantation of a knee endoprosthesis. Perforation of the capsule of the knee joint followed by discharge of polyethylene particles originating from the endoprosthesis. A granuloma developed which resulted in a compression of the peroneal nerve with sensomotor disabilities. Preoperatively we were not able to define the dignity of the tumour. Neurolysis was performed followed by excision of the tumour. The infection was treated by long term antibiotics without removal of the endoprosthesis. Histological examination revealed the definitive diagnosis.

Aged↗

Enhanced 11beta-hydroxysteroid dehydrogenase type 1 activity in stress adaptation in the guinea pig.

The 11beta-hydroxysteroid dehydrogenases (11beta-HSDs) convert cortisol to its inactive metabolite cortisone and vice versa. 11beta-HSD type 1 (11beta-HSD-1) functions as a reductase in vivo, regulating intracellular cortisol levels and its access to the glucocorticoid receptor. In contrast, 11beta-HSD-2 only mediates oxidation of natural glucocorticoids, and protects the mineralocorticoid receptor from high cortisol concentrations. We investigated the in vivo and in vitro effects of ACTH on the recently characterized 11beta-HSDs in guinea pig liver and kidney. Tissue slices of untreated guinea pigs were incubated with (3)H-labelled cortisol or cortisone and ACTH(1-24) (10(-10) and 10(-9) mol/l). The 11beta-HSD activities in liver and kidney slices were not influenced by in vitro incubation with ACTH(1-24). In addition, guinea pigs were treated with ACTH(1-24) or saline injections s.c. for 3 days. Liver and kidney tissue slices of these animals were incubated with (3)H-labelled cortisol or cortisone. In vivo ACTH treatment significantly increased reductase and decreased oxidase activity in liver and kidney. Furthermore, 11beta-HSD-1 activity assessed by measurement of the urinary ratio of (tetrahydrocortisol (THF)+5alphaTHF)/(tetrahydrocortisone) was significantly increased after ACTH treatment compared with the control group. Plasma levels of cortisol, cortisone, progesterone, 17-hydroxyprogesterone and androstenedione increased significantly following in vivo ACTH treatment. The enhanced reductase activity of the hepatic and renal 11beta-HSD-1 is apparently caused by cortisol or other ACTH-dependent steroids rather than by ACTH itself. This may be an important fine regulation of the glucocorticoid tonus for stress adaptation in every organ, e.g. enhanced gluconeogenesis in liver.

11-beta-Hydroxysteroid Dehydrogenases↗

Recovery after carpal tunnel syndrome operation: the influence of the opposite hand, if operated on in the same session.

In a clinical, retrospectively randomised study, we compared the results of the operation for a carpal tunnel syndrome when one side only or both sides were simultaneously assessed in one session. Of the 125 patients examined, 47.2% had both hands operated on in one session, 52.8% had only one hand operated on in one session or both hands in two sessions. We found the bilateral simultaneous operation to be associated with better results concerning earlier return to work, earlier relief of symptoms and better patient satisfaction than the operation on one side only. These are explained by the necessity of using both hands for daily activities and thus a guaranteed functional follow-up treatment after the bilateral operation. In conclusion, we propose operating on both hands simultaneously whenever possible, even if the opposite hand presents with only a slight CTS, which would otherwise not be considered for operation yet.

Carpal Tunnel Syndrome↗

[An alternative for defect coverage of the dorsal side of the finger with a pedicled flap].

We present a flap to cover defects of the dorsum of the digits with donor site at the midhand. It may be used by leek of the donor sites of established alternatives i.e. cross-finger flap or an island flap. The flap can size up to 8 x 2 cm, its pedicle is formed by the Vasa perforantia distales of the webspace 2-4. It is inset into the primary defect by rotation of 180 degrees and reaches easily defects beyond the PIP joints.

Accidents, Occupational↗

[Malignant course of pigmented villonodular synovitis of the flexor tendon sheath of the small finger--case report and review of the literature].

The case of a 55-year-old patient is described, presenting the clinical sign of a chronic infection of the tendon sheath. Upon incision a mass of brown synovial tumor was found. The X-ray showed a circumscript bone erosion. MRI demonstrated tumor involvement of all flexor tendons up to the forearm. Under radiation the tumor initially was diminished. Half a year later, pulmonary metastases were found. The destruction of the whole skeleton of the hand led to a forearm amputation. Later, a metastasis was found in the tongue. The patient died with the clinical signs of pulmonary insufficiency. Autopsy showed diffuse pulmonary metastases. This case is discussed together with other rare cases of malignant pigmented villonodular synovialitis arising from joints and tendon sheaths.

Cell Transformation, Neoplastic↗

Wrist arthroscopy without distraction. A technique to visualise instability of the wrist after a ligamentous tear.

We describe a technique for arthroscopy of the wrist which is carried out without traction and with the arm lying horizontally on the operating table. The wrist is not immobilised, which makes it possible to assess the extent of instability after a ligamentous tear. In a prospective study of 30 patients we compared this technique with conventional wrist arthroscopy, performing the new method first followed by conventional arthroscopy. The advantages are that the horizontal position of the arm allows the surgeon to proceed directly from arthroscopic diagnosis to treatment, and that no change of position is required for fluoroscopy. In terms of diagnostic sensitivity, we found our technique matched that of conventional arthroscopy. We had no difficulty in carrying out minor surgical procedures such as debridement and suturing.

Adult↗

Increased surface expression of CD18 and CD11b in leukocytes after tourniquet ischemia during elective hand surgery.

The surface expression of beta2-integrins was investigated in leukocytes from patients undergoing ischemia induced by tourniquet application for elective hand surgery. Blood samples were obtained before initiation, at the end of ischemia, and after 15 minutes of reperfusion from ischemic and contralateral arms of five patients. Comparable expression of CD18, CD11a, CD11b, and CD11c could be detected by immunofluorescence in leukocytes from samples drawn from either arm before tourniquet application. In contrast, a significant increase in the expression of CD18 was detectable in monocytes, granulocytes, and lymphocytes from the ischemic arm compared with that in the nonischemic contralateral control, at the end of the ischemia time (80 +/- 16 minutes). A significantly increased expression of CD11b, but not CD11a or CD11c, determinants was also observed in granulocytes and monocytes. Concomitantly, a significant reduction in the percentages of granulocytes in samples from ischemic areas was detectable. After 15 minutes of reperfusion, differences in the expression of these adhesion molecules were no longer significant. The expression of the genes encoding interleukins IL-1alpha, IL-1beta, and IL-6 and tumor necrosis factor alpha (TNFalpha) proinflammatory cytokines was also studied by reverse polymerase chain reaction (rPCR) in peripheral blood mononuclear cells (PBMCs) obtained from the same samples in three patients. IL-1beta or IL-6 gene expression was never observed. Expression of IL-1alpha and TNFalpha genes, as detected in two patients, was not related with induction of ischemia. However, in these patients expression of one or both these genes was observed in samples derived from the ischemic but not the control arm after 15 minutes of reperfusion. These data document that overexpression of adhesion molecules and sequestration of leukocytes take place following short ischemia times, as routinely applied clinically for minor surgical procedures.

Adult↗

[Wrist impaction syndrome after distal radial or forearm fractures treated by ulnar osteotomy. Surgical techniques and results in 26 cases].

Twenty-six of 27 patients in whom an ulnar shortening osteotomy had been performed to treat ulnar impaction following distal radius (20 patients) or forearm (6 patients) fractures were evaluated at an average follow-up of 21 months. All but 3 patients were satisfied with the end-result and according to a modified Gartland-Werley score there were 1 excellent, 10 good, 10 fair and 5 poor results. This is distinctly inferior to other reports of mainly non-traumatic indications. Degenerative changes at the distal radioulnar joint were associated with fair and poor results and careful radiological examination of this joint is mandatory before ulnar shortening is performed in posttraumatic ulnar impaction syndrome. Bony union of the osteotomy was achieved at 12 to 16 weeks postoperatively except for 2 cases and there was no difference between transverse (13 cases) and oblique osteotomies (13 cases). We therefore prefer the technically easier transverse osteotomy and recommend the use of 3.5 dynamic compression plates for stabilisation which resulted in a low complication rate in our series and enables early active wrist mobilisation.

Adolescent↗

Ulnar shortening osteotomy in posttraumatic ulnar impaction syndrome.

Twenty-eight patients (average age 45 years) with posttraumatic ulnar impaction syndrome underwent ulnar shortening osteotomy of 3-15 mm. Contributing factors were malunited fractures of the distal radius in 20, diaphyseal fractures of the ulna and radius in 6, resection of the radial head and a traumatic tear of the triangular fibrocartilage in 1 patient each. Evaluation at an average follow-up of 20 months showed a high rate of satisfied patients (89%), but according to Chun's modification of the Gartland-Werley score there were 1 excellent (3.5%), 11 good (39.5%), 11 fair (39.5%) and 5 poor (17.5%) results. Degenerative changes of the distal radioulnar joint were associated with fair and poor results, and ulnar shortening osteotomy is only recommended in ulnocarpal impaction with an intact distal radioulnar joint. Osteotomy fixation with 3.5 mm dynamic compression plates enabled immediate postoperative mobilisation and resulted in a low complication rate. There was no advantage for the technically more demanding oblique as compared with a transverse osteotomy.

Adolescent↗

Acute median nerve compression at the distal forearm caused by a thrombosed aneurysm of an epineural vessel: case report.

The case of a patient with a 2-day history of symptoms suggesting acute carpal tunnel syndrome is presented. However, an urgent electroneurographic examination revealed median nerve compression at the forearm and magnetic resonance imaging confirmed compression by a mass proximal to the carpal tunnel. Surgical exploration showed a recently thrombosed aneurysm of an epineural vessel. Histological and, later, general and angiological investigations could not reveal the underlying cause of this aneurysm. Preoperative electrodiagnostic examination is recommended in acute peripheral nerve compression to prevent decompression at an incorrect site. If atypical nerve compression is suspected, magnetic resonance imaging may be indicated to detect localized nerve compression and its underlying cause.

Adult↗

[Osteosynthesis of the hand--indications, technique, results].

UNLABELLED: Between January 1st 1992 and December 31st 1993 140 non-complex (i.e. nerve, vascular, tendon injuries) fractures of the peripheral hand skeleton were operated at the Policlinic of the Kantonsspital Basel. In a retrospective study we analyzed results, complications and absence from work. We treated 110 male and 30 female patients with a mean age of 47 years. 45 fractures were treated by plate fixation, 45 by screw fixation, 53 times we applied k-wires and once a mini-fix-ex (AO-Prototype). Plate and screw fixation were performed with AO-mini-implants. 90% of our patients had an uneventful postoperative course. In spite of functional after-treatment we noted in 8.6% of the patients a relevant loss of movement leading to operative tenolysis in 7 patients. Fractures at the level of PIP were most frequently associated with loss of movement. Absence from work was 59 days in average (1-206)! CONCLUSIONS: Peripheral osteosynthesis of the hand (non-complex) are effectively treated on an out-patient basis. In spite of functional after-treatment about 10% of patients have a relevant postoperative reduction in motility. Absence from work is relatively long after operative treatment of peripheral hand fractures.

Adult↗

[AO external mini-fixateur for the hand bones. Surgical technique and initial experiences].

Fractures of the hand and fingers showing comminution or associated soft-tissue lesions are best treated with external fixation. In contrast to other systems, the new AO mini-external fixator enables less bulky unilateral fixation facilitating early mobilisation and the special design of the double clamps allows preliminary intraoperative stabilisation with only one wire in each fragment. Modular fixation makes free placement of the wires possible with accommodation of bone and soft tissue lesions. Twenty patients with hand injuries showed uneventful soft tissue healing and there were no cases of non-union in 19 metacarpal and phalangeal fractures.

Adolescent↗

[Infections of the hand].

The possibilities of hand injuries lead to the higher incidence of hand infections. The clinical signs of inflammation (pain, swelling, heat, loss of function and red colour) are found in near all cases. The start of pain and its localisation help to find quickly the layer of the inflammatory process. Bites, foreign bodies, puncture wounds and open wounds especially those acquired in slaughterhouse or agriculture are in most cases the predisposing conditions. Treatment of hand infections demands a consequent protocol consisting in: exact diagnostics including clinical picture, laboratory investigation, bacteriology and in some cases X-ray-examination; operative treatment including incision, irrigation, drainage, excision of necrosis and foreign bodies under the rules of hand surgery (i.g. blood--[without exsanguination] and painfree operation field, magnifying lenses, correct incision avoiding scar contractures); immobilisation (dressing or splinting) in intrinsic-plus-position while acute inflammation is going on, early movement combined with ergotherapy and physiotherapy after this. Use of antibiotics is indicated in septic cases or in cases of complications (sepsis, lymphangitis, osteomyelitis) in concordance with bacteriology but it cannot compensate mistakes in treatment. The most common infections are placed around and under nail (paronychia) and in the subcutaneous space of the distal phalanx (felon). They are treated by incision and spontaneous drainage. More severe are infections of tendon sheath, joint, web space and deep palmar space. If pus is present in such cases there is no place for conservative treatment but operative treatment under clinical conditions is imperative.

Anti-Bacterial Agents↗

[Tibial plateau fractures--indications for and results of surgical and of functional-conservative therapy].

56 patients with fractures of the tibial plateau were treated at the surgical department of the Wilhelm-Pieck-University Rostock between 1980 and 1987. 18 of these underwent on operative treatment, 38 patients were treated nonoperatively. Using a clinical and radiological follow-up on 35 of these patients the results after operative and functional-conservative treatment are shown and the indications for the different methods are concluded.

Adult↗