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Biomedical subjects

J Bruns

Publications and source records attributed to J Bruns.

At least 37 records · Page 2Linked to original sources
PubMed1997

Internal hemipelvectomy and endoprosthetic pelvic replacement: long-term follow-up results.

We report on our experiences with internal hemipelvectomy followed by an implantation of a endoprosthetic pelvic replacement (EPR) performed in 15 patients over a period of 15 years. Our primary aim was to determine the implications for this procedure because of its high rate of complications. Due to the malignant character of the disease and the biomechanical stress on the anatomical region, the demands on the surgeon are high. The most important factor is a sufficiently wide resection of the primary tumour because most are chondrosarcomata which do not respond to other therapies. In addition, the malignant character of the tumour has the greatest influence on the long-term results. Internal hemipelvectomy and endoprosthetic pelvic replacement are accompanied by a high rate of operative and postoperative complications Nevertheless, nearly full anatomical and functional reconstruction can be obtained provided a medium level of function is accepted. Follow-up results of the remaining six still living patients were evaluated by means of three different scoring systems. All patients had only a medium score but emphasised subjective acceptance of the endoprosthetic pelvic replacement even when removal was necessary later on. Because of the lower functional outcome of alternative operative procedures such as pseudarthroses and arthrodeses and problems with the replantation of autoclaved autografts or implantation of an allograft, internal hemipelvectomy combined with endoprosthetic pelvic replacement is the treatment of choice for these specific acetabular lesions, provided a complete resection is feasible. Otherwise, an external hemipelvectomy is necessary because even alternative limb-salvaging procedures must incorporate the same complete resection of the tumour. In cases of metastatic lesions, internal hemipelvectomy and endoprosthetic pelvic replacement are indicated relatively because of the systemic character of the disease. The procedure should be considered only when resection of a solitary metastasis enables a cure and/or prolongation of life with an improved quality of life.

Adult↗
PubMed1997

Cartilage-flow phenomenon and evidence for it in perichondrial grafting.

The cartilage-flow phenomenon has been frequently described but not in connection with transplantation procedures for treatment of cartilage lesions. Consequently, we examined this particular phenomenon in an experimental sheep model originally set up to study the use of perichondrial grafts for repair of full-thickness cartilage lesions. Osteochondral lesions were made in nonweight-bearing and weight-bearing areas of knee joints in 36 sheep. The defects were filled with autologous rib perichondrial grafts and secured by either collagen sponges or fibrin glue (n = 24 animals). Defects without perichondrial grafts served as controls (n = 12 animals). Following 1 week of immobilisation of the operated leg, the plaster was removed, and animals were allowed to move freely. Animals were killed after 2, 4, 12 and 16 weeks. Grafts including rims of original surrounding cartilage and bone were removed and investigated by means of macroscopy, histology and micromorphology, including scanning electron microscopy and analysis under polarized light. Cartilage flow was observed in all specimens by 4 weeks after drilling the defects, independent of the weight-bearing condition. These flow formations exhibited a bending of the collagen fibres centrally into the defects, reduction of metachromasia, cell cluster formation and areas of reduced cell density. Time-dependent flow formations were observed related to the weight-bearing condition and whether or not the defects had been grafted. In grafted, non-weight-bearing defects further cartilage flow was stopped 8 weeks after transplantation by the growing perichondrial transplants, which had filled the defects completely. In contrast, control defects exhibited further flow formations in both areas. The same was observed in grafted defects in the weight-bearing area. In defects without complete filling as not enough spontaneously growing fibrous tissue had arisen from the bottom of the defects, two different observations were made: either the defects exhibited a fungiform mass of fibrous tissue that had overgrown the lateral flow formations, or the central mass of fibrous tissue was overgrown by the lateral flow formations. In conclusion, cartilage flow seems to be a mechanically induced phenomenon at the rims of cartilage lesions that contributes little to the reduction of size of large osteochondral defects. There was no evidence for new cartilage proliferation or production of cartilaginous matrix at the rims of the lesions.

Animals↗
PubMed1997

Arthrolysis of the shoulder for ruptures of the rotator cuff.

Complete repair of tears of the rotator cuff may be difficult, but with superior arthrolysis by the Apoil-Dautry technique the lesion in the cuff is not treated. We report 17 patients who had this procedure for large cuff defects. The outcome is directly related to the duration of symptoms, and we only had good results in a few patients, although intensive physiotherapy improves function. A wide debridement is needed, followed by intensive physiotherapy for the deltoid and shoulder stabilising muscles. We recommended that this technique should be used in elderly patients who will put less demand on their shoulders.

Aged↗
PubMed1996

[Reversed musculus biceps femoris flap for covering a defect of the distal thigh].

We report the case of a 30-year-old female patient, who had suffered a grade III open femur fracture in a motor vehicle accident 14 weeks prior to being transferred to the trauma department of the University Hospital in Bonn. Upon admission to our unit, posttraumatic osteitis, an unstable fracture following compression plating, and a soft tissue defect of the anterolateral distal thigh were discovered. Following removal of the hardware and stabilization of the fracture with external fixation, the infection was brought under control. Because the patient refused the time-consuming segmental transport utilizing the callus distraction technique, local muscle transfer and shortening of the femur were carried out. The most lateral of the hamstring muscles, the biceps femoris, was used as a distally based muscle flap utilizing a delay technique. With the help of a reversed biceps femoris flap, the soft tissue defect was closed, the infection subsided and the fracture healed. The surgical technique is outlined.

Adult↗
PubMed1996

Muscular involvement in Behçet's disease: case report and review of the literature.

Acute necrotizing myositis is described in a 22-yr-old man with clinically diagnosed Behçet's disease. Light microscopic examination revealed a prominently granulocytic-monocytic infiltration of the muscle with severe necrosis. An infectious (bacterial, fungal or parasitic) etiology could be excluded by specific staining techniques and by immunohistochemistry. Vascular deposition of immune complexes was detected by direct immunofluorescence. Electron microscopy revealed severe structural damage and phagocytosis of muscle fibers. In the endomysium, leukocytes and occasional erythrocytes were found. Virus-like particles were not seen. The relevant literature on muscular involvement in Behçet's disease is reviewed. It is suggested that two different stages of inflammation occur in Behçet's disease. In the acute stage it presents as a granulocytic-monocytic necrotizing reaction developing from a neutrophil-mediated vasculitis. In the later phase lymphocytic infiltrations predominate. Despite the rare involvement of muscles the diagnosis of Behçet's disease should be considered particularly in younger patients presenting with muscular symptoms like pain and swelling pre-dominantly of the lower extremities.

Adult↗
PubMed1996

The stabilizing effect of orthotic devices on plantar flexion/dorsal extension and horizontal rotation of the ankle joint. An experimental cadaveric investigation.

The mechanical stabilizing effect of nine different orthotic devices on physiological and pathological plantar flexion/dorsal extension and horizontal rotation of the ankle joint subjected to artificial lateral ligament lesions was investigated in 20 cadaveric ankle joints under standardized conditions using an experimental apparatus. All of the braces tested significantly reduced plantar flexion/dorsal extension, as well as internal/external/external horizontal rotation, under the experimental conditions. In so far as these results can be transposed into a clinical setting, our data favour that bracing significantly reduces the instability. But, other criteria, such as the stabilizing effect on talar tilt and anterior drawer sign, the price and the convenience of wearing such devices have to be taken into consideration when choosing the optimal brace.

Analysis of Variance↗
PubMed1996

[Secondary osteosarcoma in Paget disease].

The incidence of Paget's disease in Germany is about 3%. Up to 10% of all affected individuals develop secondary osteosarcomas in the affected bone areas. Compared to primary osteosarcoma patients with Paget's sarcoma differ in regard to age, tumor localisation, therapy, prognosis and radiological symptoms. The following case report describes clinical features, therapy and the typical radiological findings.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[De Anquin disease or spinous engagement syndrome].

We report on a rare disorder called de Anquin's disease or spinous engagement or impingement syndrome. Low back pain in this specific syndrome probably combined with sciatica is caused by a hypertrophic spinous process in combination with a spina bifida occulta of an underlying vertebra which leads to compression of the neural structures beneath. Mostly the enlarged spinous process is seen at the level L5 and the spina bifida occulta at the level S1. Between 1981 and 1993 six patients were treated surgically after long-lasting periods of conservative therapy by resection of the hypertrophic spinous process combined with revision of the nerve roots and division of adhaesions. All patients had been reexamined clinically and radiologically. Up to now three of six patients are free of all symptoms, pain diminished in two others. The back pain situation is unchanged in only one patient.

Adult↗
PubMed1994

The in vitro influence of different culture conditions on the potential of sheep rib perichondrium to form hyaline-like cartilage. Evaluation of gluing materials used for in vivo graft fixation.

The effectiveness of autologous rib perichondrium for repair of full-thickness hyaline cartilage defects has been shown experimentally and clinically in various reports. The purpose of this study was to examine the behaviour of sheep rib perichondrial tissue under in vitro conditions and the influence of different culture matrices in order to evaluate possible stimulating effects. Rib perichondrium was obtained from sheep used for an experimental in vivo trial. After removal of adjacent cartilage remnants the tissue was divided and specimens cultured for 14 days in different ways. Explants cultured on collagen sponges (group A), fibrin glue (group B) and cellulose acetate filter (group C) were examined histologically, histochemically, histomorphometrically and autoradiographically. Clear differentiation of perichondrial cells towards a chondrocyte-like cell shape, particularly in the proliferation zone, was noticed on all matrices. These cells synthesized new matrix substances comparable to the ground substance normally present in hyaline cartilage. Morphometric comparison of tissue differentiation on different culture matrices revealed no significant differences in proliferation rates.

Animals↗
PubMed1994

Pressure distribution in the knee joint. Influence of flexion with and without ligament dissection.

Biomechanical factors influencing the patterns of pressure distribution at the articular surface and the subchondral bone are suggested to be most important in the pathogenesis of osteoarthritis and osteochondritis dissecans at the knee joint. Besides this, chronic joint instability is another important factor under discussion in the etiology of osteoarthritis of the knee. The patterns of pressure distribution on the femoral condyles of weight-bearing knee joints were investigated in a biostatic cadaver model. The pressure on the femoral condyles was evaluated using pressure-sensitive films with the knee in different physiological joint positions (extension, 15 degrees and 30 degrees flexion) with and without division of either the medial collateral ligament (MCL), the lateral collateral ligament (LCL), the MCL and the anterior cruciate ligament (ACL), or the LCL and the ACL. Results showed that the location of the contact area and peak pressure depended on the joint position and stage of ligament division. Without ligament division the maximum peak pressure was always observed on the medial condyle. Only after MCL and combined MCL + ACL division did the lateral condyle show in extension a higher peak pressure than the medial condyle. Division of the LCL and LCL + ACL resulted in an increase in peak pressure on the medial condyle, particularly in flexion. The highest peak pressure of all was measured in the 30 degrees flexion position on the medial condyle after division of the LCL. The lowest at all was found on the lateral condyle in 15 degrees flexion after LCL division. Additional ACL division resulted in only minor further changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1994

Synovial hemangioma--a rare benign synovial tumor. Report of four cases.

We report our clinical experiences in the diagnosis and treatment of four patients with synovial hemangiomata. Synovial hemangiomata are rare causes of recurrent, nonspecific joint complaints and occur most often at the knee joint. Nontraumatic joint swelling combined with recurrent, possibly hemorrhagic joint effusions must be considered signs of a synovial hemangioma. Although no preoperative diagnostic tool enables confirmation of the diagnosis, and MRI seems to be the diagnostic procedure of first choice, it is most important fact for the clinician to be aware of the existence of this disease. Early surgical treatment with excision of the tumor within wide margins of noninvolved normal synovial tissue as partial or total synovectomy is the therapy of choice and avoids degenerative changes as demonstrated with the four cases reported here.

Adult↗
PubMed1994

Morbus de Anquin or spinous engagement syndrome. A rare cause of low-back pain syndrome and sciatica.

We report on a rare disease called to Anquin's disease or spinous engagement or impingement syndrome. Low-back pain in this specific syndrome probably combined with sciatica is caused by a hypertrophic spinous process along with a spina bifida occulta of the underlying vertebra. Mostly, the enlarged spinous process is seen at L5 and the spina bifida occulta at S1. Conservative therapy consists of physiotherapy with postural exercises including improvement of lumbar flexion. If conservative treatment is unsuccessful, surgical treatment is indicated. Surgical therapy should include resection of the hypertrophic spinous process, probably combined with revision of the nerve roots and division of adhesions. Between 1981 and 1993 six patients were treated surgically after long-lasting periods of conservative therapy. All patients were re-examined clinically and radiologically after a mean follow-up period of 2.9 years. In all but one patient a distinct release from lumbar back pain and/or sciatica was observed. Regarding this, the most important fact in de Anquin's disease is to be aware of this specific syndrome. If low-back pain can be traced to a hypertrophic spinous process the first choice of therapy should be conservative. In unsuccessful cases simple surgical resection probably combined with division of the adhesion can lead to significant release from pain and is recommended.

Adult↗
PubMed1994

[Ultrasound imaging of soft tissue tumors of the extremities and para-articular soft tissue changes].

Valid preoperative imaging procedures are important in the diagnosis of soft-tissue tumours of the extremities due to their potential malignancy. The value of ultrasound regarding these tumours is still under controversial discussion. Hence, it was the aim of this retrospective study to examine the value of ultrasound in respect of these particular problems. Therefore, in 20 cases ultrasonography was compared with intraoperative findings and other imaging techniques. Finally ultrasonography is merely an "adjuvant" diagnostic procedure, because it does not precisely outline the anatomical topography is incomplete and differentiation from neural and vascular structures is not possible in all cases. In contrast, ultrasonographic description of the size of tumours demonstrates a good correlation when compared with intraoperative findings. In addition, ultrasound examination can help to improve preoperative diagnosis in cases when imaging with MRI and CT is disturbed due to already implanted metallic endoprosthetic components.

Adult↗
PubMed1994

[Etiopathogenetic aspects of osteochondrosis dissecans of the femoral condyles].

In an analysis of results from a biostatic examination on the pressure distribution at the weight-bearing femoral condyles under different conditions compared with results from a follow-up examination of patients with osteochondritis dissecans of the knee, we discuss the most likely etiology of this disease, namely mechanical induction. From this comparison it is deduced that the biomechanical impact is the most important factor for the initiation of osteochondritis dissecans at the femoral condyles.

Biomechanical Phenomena↗
PubMed1994

[Tertiary yaws--skeletal manifestations at the distal tibia].

We describe the case of a 16-year old male patient from African presenting tertiary yaws at the distal tibia. Clinical signs, biochemical results and the different diagnostic imaging methods are demonstrated. Differential diagnosis and therapy are described.

Adolescent↗