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Biomedical subjects

J Bruns

Publications and source records attributed to J Bruns.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Long-term results after gluing of osteochondral fragments and osteochondrosis dissecans].

Long-term results after surgical treatment of osteochondritis dissecans of the talar dome and joint knee are dependent on the stage of cartilage damage, the age at operation and on the surgical technique. In cases of osteochondritis dissecans of the talar dome the only loosening of a refixed osteochondral fragment was seen after glueing with acrylate. Using the classification of Arcq in 59.6% an excellent and in 18.3% a good result was observed in cases of osteochondritis dissecans at the femoral condyles. In regard to the development of osteoarthritis in 56% no signs of osteoarthritis were visible. Worst results were obtained in knee joints in which acrylate glue was used for refixation of the osteochondral fragments. In conclusion we recommend the use of fibrin glue for refixation of osteochondral fragments in cases of osteochondritis dissecans even when early mobilisation follows the operation. Because of the long-lasting resorption and barrier effect to ingrowing tissue the use of cyanoacrylate should be avoided.

Adolescent↗
PubMed1993

Pressure distribution at the knee joint. Influence of varus and valgus deviation without and with ligament dissection.

Traumata or repetitive microtraumata, malalignment with varus or valgus deviation, or chronic joint instability are discussed in the aetiology of osteoarthritis and osteochondritis dissecans of the knee. 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. Consequently, the patterns of pressure distribution at the femoral condyles of weight-bearing knee joints were investigated in a cadaveric biostatic model. The pressure in the articular joint space was evaluated with pressure-sensitive films of the knee in different joint positions in the coronal plane (10 degrees varus, 10 degrees valgus, and neutral position) without and with medial collateral ligament (MCL), lateral CL (LCL), MCL + anterior cruciate ligament (ACL) or LCL + ACL ligament division. Results demonstrated that the location of the contact area and the peak pressure depended on the joint position and stage of ligamentous division. Without ligament division, a maximum peak pressure was observed at the medial condyle in the neutral and varus positions. Only in the valgus position did the lateral condyle show a higher peak of pressure than the medial condyle. Ligament division of the LCL and LCL + ACL resulted in an increase of peak pressure at the medial condyle, particularly in the varus position. Division of the MCL and MCL + ACL ligament complex reduced the differences between the medial and lateral condyle. In the valgus position, the peak pressure was significantly higher at the lateral condyle. The absolute maximum peak pressure was measured in the varus position at the medial condyle after division of the LCL and ACL.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadaver↗
PubMed1993

Pigmented villonodular synovitis in children. A case report.

Pigmented villonodular synovitis (PVS) is a rare disease of the synovial layer in joints, seen particularly in children. Early diagnosis allows treatment with resection of the affected synovial tissue, avoiding secondary osteoarthritic lesions of the normally unaffected joint structures. In this article, symptoms, clinical findings, and the diagnosis procedure are reported in a rare case of diffuse PVS in an 11-year-old girl. Diagnostic procedures are of differing value, and it seems that the most important factor is suspicion of this disease even in children. Since preoperative verification of the histological diagnosis is impossible, early invasive investigation such as arthroscopy are recommended to confirm the histological character of the lesion. Arthrotomy or arthroscopy followed by total synovectomy is recommended as the surgical treatment of first choice. Our patient was treated by total synovectomy via an arthrotomy of the affected knee joint after histological diagnosis has been confirmed by arthroscopic excision and histological analysis. Follow-up examinations 4 and 6 months postoperatively revealed no signs of recurrence.

Child↗
PubMed1993

[Results of surgical therapy of bacterial sacroiliitis with primary arthrodesis].

Surgical treatment of pyogenic infections of the sacroiliac joint is indicated in cases of ineffective conservative treatment, abscess formation, septicemia, and neurological deficits. Between 1983 and 1990 in nine patients surgical treatment was performed for pyogenic sacroiliitis under this criteria. The surgical procedure included joint debridement, primary arthrodesis of the sacroiliac joint using a autologous bone graft, antibiotic therapy and postoperative immobilisation. Follow-up examination of 8 patients in average 47 months postoperatively revealed excellent functional and roentgenological results in 6 patients. Two patients suffered only from mild low-back pain, none of the eight patients demonstrated signs of a recurrent infection, one patient died due to complications of a long-lasting preoperative septicemia. Regarding these postoperative follow-up results surgical therapy including primary sacroiliac arthrodesis should be early considered, because this treatment has a low complication rate and the surgical technique is easy to perform and results are excellent or good in most of the patients.

Abscess↗
PubMed1993

[Ultrasound imaging of the elbow joint. Loose joint bodies and osteochondrosis dissecans].

In 6 patients with loose bodies due to osteochondritis dissecans, trauma or chondromatosis at the elbow, an additional ultrasonic examination was performed. In all cases loose bodies as well as the osteochondral lesion at the radial head and trochlea humeri were seen. Ultrasonic examination of the elbow is recommended in addition to the mandatory x-ray examination. However, sonography enables reduction of x-ray exposure because additional x-ray tomography can be avoided.

Adolescent↗
PubMed1993

[Osteochondrosis dissecans of the knee and sports].

Osteochondritis dissecans (O.d.) of the knee is a common disease, but the aetiological factors are still controversial. With a follow-up examination of 97 surgically treated patients (109 lesions) we looked for the influence of preoperative sports activities as a possible aetiological factor. Most of the patients complained first symptoms at puberty age between 10 and 15 years, girls with a mean age of 12.4 years and boys with a mean age of 15 years. Because of that, humoral factors are supposed to have influence on the onset of this lesion. Also patients with O.d. of the knee demonstrated a high rate of sports activities and/or trauma prior to the onset of symptoms. There was also a good correlation between lesions at the medial condyle with varus malalignment. Additionally, in most of the patients a high grade of general ligament laxity could be observed at the follow-up examination. It seems that biomechanical factors have an important aetiological influence on the initiation of O.d. at the knee. At the date of follow-up examination all patients reported on a minor sports activity in comparison to sports activities prior to the onset of symptoms. The amount of postoperative sports activities depends on the level of the resulting Lysholm score and on the grade of osteoarthritis.

Adolescent↗
PubMed1993

Renal hemodynamics and cardiovascular reactivity in the prehypertensive stage.

To examine whether sympathetic nervous activation has an impact on renal circulation in subjects at risk for high blood pressure, we assessed renal hemodynamics and cardiovascular response to mental stress in 40 healthy young white males, 12 normotensive subjects without and 14 with familial hypertension, and 14 with borderline hypertension. The response of systolic and diastolic blood pressure to mental stress was assessed while each patient performed a mental arithmetic task; this was taken as the parameter for the activation of the sympathetic nervous system. Renal plasma flow was measured by para-aminohippuric acid clearance under steady-state conditions. In parallel, glomerular filtration rate as a parameter for functional impairment of the kidneys was determined by creatinine clearance, and filtration fraction was also calculated. Patients with borderline hypertension were characterized by a reduced renal blood flow and increased filtration fraction in comparison with both normotensive groups. The increase in systolic blood pressure during mental stress was more pronounced in borderline hypertensives. We observed no significant difference in renal hemodynamics and cardiovascular response to mental stress between normotensives with and without a family history of hypertension. In the total population, cardiovascular response to mental stress was correlated with renal hemodynamics: The greater the increase in systolic blood pressure during mental stress, the lower was the renal plasma flow and the greater the filtration fraction. Thus, renal plasma flow was found to be already reduced and filtration fraction increased before sustained hypertension developed. Because this pattern in renal hemodynamics was related to cardiovascular response to mental stress, our data suggest that sympathetic activation already appeared to affect renal hemodynamics at the onset of essential hypertension.

Adult↗
PubMed1993

[Autologous transplantation of rib perichondrium in treatment of deep cartilage defects of the knee joint of sheep. Morphologic comparison of two resorbable fixation methods].

The purpose of this study was to examine the fate of autologous perichondrial grafts after transplantation into cartilage lesions in weight-bearing joints, with reference to different fixation methods and different regimens of postoperative functional treatment. Full-thickness osteochondral lesions were drilled in the articular surface of knee joints in 36 sheep. The defects were filled with autologous rib perichondrial grafts, which were secured by either collagen sponges (group A; n = 12 animals) or fibrin glue (group B; n = 12 animals). Defects not filled with perichondrial grafts served as controls (group C; n = 12 animals). Following 1 week of immobilization of the treated leg, the plaster was removed and the animals were allowed to move freely. Animals were sacrificed after 4, 8, 12 and 16 weeks. The grafts were removed and investigated histologically. In contrast to weight-bearing areas and control defects, hyaline-like cartilage formation could be noted in non-weight-bearing areas after 4 weeks. This newly formed cartilage revealed strong metachromasie following staining with acidic toluidine-blue and reacted positively with PAS, indicating de novo synthesis of proteoglycans and glycoproteins. Enzyme-histochemistry for alkaline and acid phosphatase activity showed positive reactivity only at the base of the transplants. Quantitatively, hyalin-like cartilage was achieved in 40/48 transplants from the non-weight-bearing area (20/24 transplants fixated with collagen sponge (group A); and 20/24 fixated with fibrin glue (group B). In control defects only fibrous scar tissue was detectable. In transplants from the weight-bearing area only 7/48 (24 of group A and B each) a differentiation into hyalin-like cartilage was visible.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Osteochondrosis dissecans tali. Results of surgical therapy].

Surgical treatment with arthrotomic revision, removal of the subchondral sclerosis, and autologous bone transplantation with restoration of the cartilage layer resulted in good results in nearly 70%. This could be demonstrated in a follow-up examination in 26 of 38 surgically treated patients. The outcome is dependent on the patient's age at the onset of symptoms and the stage of the cartilage lesions. In adolescents, the results are better than in adults and better in cases without or with only mild cartilage lesions. The most important etiological factors seem to be biomechanical factors such as a sprained ankle--even without ligament ruptures. Osteoarthritis of the ankle joint is not a common sequela, and it occurs in only mild degrees in adult patients.

Adolescent↗
PubMed1992

Osteochondrosis dissecans of the talus. Comparison of results of surgical treatment in adolescents and adults.

Clinical results in two groups of patients treated for osteochondrosis dissecans tali were examined in a follow-up examination: adolescents up to age 16 years versus adults. Thirteen patients were reexamined in each group. Clinical comparison revealed distinct differences between the groups. In adolescents there were eight excellent and three good results, only one fair, and one poor result. In contrast, adults demonstrated excellent results in only two and good results in five patients; five patients showed fair results and one a poor outcome. No signs of osteoarthrosis were detected in adolescents whereas in four adult patients slight radiological signs of osteoarthritis were visible. In both groups clinical and radiological results were better when the cartilage layer at the talar dome was found to be intact at the time of surgical intervention. Detectable cartilage damage at the time of operation was accompanied by a worse result at the time of follow-up examination. In conclusion, adolescents without any signs of joint locking or loose body formation should first be treated conservatively. The older the patient the shorter the period of nonsurgical treatment should be. In cases of increasing stages, joint locking, or formation of loose bodies surgical intervention is recommended.

Adolescent↗
PubMed1992

Autologous rib perichondrial grafts in experimentally induced osteochondral lesions in the sheep-knee joint: morphological results.

The purpose of the present study was to examine the fate of autologous perichondrial grafts after transplantation into cartilage lesions in weight-bearing joints. Osteochondral lesions were made in the articular surface of knee joints in 36 sheep. The defects were filled with autologous rib perichondrial grafts which were secured by either collagen sponges (12 animals) or fibrin glue (12 animals). Defects without perichondrial grafts served as controls (12 animals). Following 1 week of immobilization of the operated leg, the plaster was removed and the animals were allowed to move freely. Animals were sacrificed after 4, 8, 12 and 16 weeks. The grafts were removed and investigated histologically. In contrast to weight-bearing areas and control defects, hyaline-like cartilage formation was seen in non-weight-bearing areas after 4 weeks. This newly formed cartilage revealed strong metachromasia following staining with acidic toluidine blue and reacted positively with periodic acid-Schiff, indicating de novo synthesis of proteoglycans and glycoproteins. Scanning electron microscopy and examinations with polarized light confirmed a hyaline cartilage-like architecture for the surface area as well as for the fibre orientation of the whole graft. Enzyme histochemistry for alkaline and acid phosphatase activity showed positive reactivity only at the base of the transplants.

Animals↗
PubMed1992

Mechanical ankle stabilisation due to the use of orthotic devices and peroneal muscle strength. An experimental investigation.

The mechanical stabilising effect of different orthotic devices and artificially applied muscular strength to the peroneal muscles is tested in cadaveric ankle joints and in vivo. Both orthotic devices as well as muscular strengths of 150 N applied to the peroneal muscles can produce a significant reduction in mechanical ankle instability. However, none of these methods alone can stabilise the ankle joint in such way to completely normalise the talar tilt and anterior drawer sign that is found in stable ankle joints. In contrast to that, clinical results in the treatment of sprained ankles with the application of an orthosis, additional muscular strengthening is the best treatment to achieve a sufficient mechanical ankle stability during the period of ligament healing. Additional factors influencing the mechanical ankle stability are supposed.

Ankle Joint↗
PubMed1992

[Etiopathogenetic aspects of medial osteochondrosis dissecans tali].

In a cadaveric biostatic model the pressure distribution at the weightbearing ankle has been investigated under different joint positions and stages of artificial lateral ligament dissection mimicking a supination trauma. The location of the transduced contact area, the size of these areas and amount of pressure were evaluated after application of axial load. The results showed that the location, size of contact area and the maximum transduced pressure were depending on the joint position and stage of ligament dissection. Interestingly the peak pressure was located at the medial talar rim even without lateral ligament dissection. The transduced pressure areas were located at that locations were osteochondral lesions are mostly observed. In regard to these results the etiology and pathogenesis of osteochondritis dissecans tali is discussed. It is thought that supination traumas as well as other biomechanical factors such as overweight and lax ankle ligaments have an important influence on the development of osteochondritis dissecans at least at the medial rim of the talus.

Ankle Joint↗
PubMed1992

[Legg-Calvé-Perthes disease. The value of MRT in its early diagnosis and the assessment of its course].

We report on the value of MRT in diagnosis and follow-up of Perthes' disease. 38 children who were clinically suspect of suffering from Perthes' disease were examined by conventional x-ray and MRT. 25 children were proven to have Perthes' disease, 12 of them in an early stage. During the onset of the disease MRT showed a higher sensitivity (58% vs 50%) and accuracy (74% vs 71%) than conventional x-ray while specificity was equal (83% for both). Additionally, MRT in combination with the still obligatory x-ray gave no false-positive results. In some cases, the diagnosis may be found up to 6 weeks earlier using MRT. Conservative therapeutic regimens obviously will not profit from this. Although excluding other diseases is certainly helpful, the value of MRT as a primary diagnostic procedure is limited. During follow-up, MRT helps to reduce the number of x-ray examinations since it can easily assess the containment of the hip and the bone marrow revitalisation. Scintigraphy, another valuable method to judge revitalisation, should remain limited to selected cases, as it requires significant amounts of radiation.

Adolescent↗
PubMed1992

[Fracture lines of the foot].

In follow-up examinations of 112 patients who had been diagnosed as having a sprained foot, bony lesions, confirmed by X-ray films, were found in 96 (85.7%) patients. Up to this time the fractures had not been found in 58 of them. The fractures were found to be distributed in a point-specific location, i.e., a precisely defined anatomical area in 43 cases (44.8%) and a linear presentation in 53 (55.2%). This linear grouping of bony injuries is seen to develop along the path of joints, bones and ligamental insertions that anatomically follow one another in a functional manner. The line-like pattern to these presentation permitted us to develop 3 line sets that could be attributed to specific mechanisms of injury. The lateral line (56.6%) specially follows a supination sprain to the foot. The medial line (20.8%) is seen to follow injuries that involved a blow along the longitudinal axis. The transverse line (22.6%) follows trauma involving the Chopart joint. Six diagrams are presented to illustrate the mechanisms of foot trauma, with their vectors of force and the corresponding injuries that may result. Radiological examples of several clinical cases are given to demonstrate these three fracture lines.

Adolescent↗
PubMed1992

[Tarsal tunnel syndrome after fibular ligament repair. A rare complication of surgical therapy of chronic instability of the ankle joint ligament].

A case of tarsal tunnel syndrome following a reconstructive procedure with repair of chronic ankle instability using periosteal flap is reported. Two pathogenetic factors have to be discussed as possible causes for this complication. Dissection of the medial retinaculum was performed. With this procedure the patient is complaints could be removed.

Adult↗
PubMed1992

The rib perichondrium. An anatomical study in sheep of a tissue used as transplant in the treatment of hyaline-cartilage defects.

Perichondrial tissue is of great importance as a transplant for the repair of hyaline-cartilage defects of synovial joints because of its potential to produce hyaline-like cartilage. The histological and histochemical character and fiber orientation of rib perichondrial grafts prior to a transplantation procedure for the repair of full-thickness hyaline-cartilage defects is analyzed in a sheep model. Compared to other descriptions of the rib perichondrium of other different species and humans, the perichondrial architecture of different origins demonstrates the same histological, histochemical character and fiber orientation. The three different layers of this tissue are: the outer fibrous layer, the central part called proliferation zone and the inner part towards the underlying rib called transition zone. The fibrous layer demonstrates a wave-like extracellular configuration and contains a few fibrocytes. The proliferation zone is only a few cell rows thick and contains single cells with an oval shape and longitudinal fibrocyte-like nucleus. Because of the potential of these cells to produce cartilage this layer is called proliferation or cambium layer. The transition zone contains more oval-shaped cells with rounded nuclei and demonstrates a more chondrocytic character. Some cells lie in groups of 2 and more cells like in chondrons. The extracellular matrix shows an increasing stain towards the rib cartilage indicating new cartilage production. The fiber orientation is longitudinal in the fibrous part and vertical in the transition zone. Between these layers, fibers deviate from the longitudinal to the vertical orientation corresponding to the light-microscopically visible proliferation zone.

Animals↗