Biomedical subjects
Publications and source records attributed to J Buchholz.
The clinical and operative findings of an isolated rupture of the biceps femoris tendon are described. The immediate suture and the initial postoperative treatment with a knee brace limiting extension to 20 degrees and flexion to 70 degrees resulted in a free range of motion and full activity of the biceps femoris.
The endotoxins of bacteria are lipopolysaccharides which are released in the central nervous system during bacterial meningitis. Endotoxin titers in cerebrospinal fluid correspond to the appearance of severe neurological symptoms like seizures and coma. The pathogenic mechanism, however, by which endotoxins disturb neuronal function, is unclear. The functional deficit may originate either from direct alteration of neuronal excitability or from indirect effects mediated by glial cells. Therefore, we investigated the effects of lipopolysaccharides on electrophysiological properties of cortical neurons and astrocytes in separate cell cultures. Membrane potential, resistance and membrane currents of neurons were unaffected. By contrast, astrocytes depolarized markedly in a dose dependent manner (concentration range 1.0-10.0 micrograms/ml). The depolarization was Na+ dependent and amiloride sensitive (250 microM), both indicating an activation of an electrogenic sodium dependent transport system like the Na+/Ca2+ exchanger as a source of the depolarization. These results suggest that endotoxin induced neurological deficits are not caused by direct effects on neurons, but may result from an impaired glial cell function.
In a retrospective review 78 compartmental syndromes, treated between 1980 and 1988, were analyzed. The mean follow-up was 42 months. 43 patients (53%) suffered an traffic accident. Direct trauma forces predominated (66 patients). The functional results after crush injuries had been worser than after contusion injuries or direct trauma forces. The functional results depended from the posttraumatic interval of decompression. The later the fasciotomy the worser the functional results had been. A wide fascial decompression is necessary. Two cases of rebound compartmental syndromes after unilateral fasciotomy reveal the skin as an important limiting factor in severe cases of compartmental syndrome.
Free transplantation of the latissimus dorsi muscle has become the treatment of choice in extensive soft-tissue defects of the lower leg after trauma. However, neither the ability of the remaining muscles of the shoulder to compensate for the lost function nor the long-term effects of latissimus dorsi removal on the function of the shoulder have been objectively measured. Therefore, the postoperative shoulder function in 23 patients was compared after removal of the latissimus dorsi muscle with 23 control subjects. The evaluation included a questionnaire, physical examination, and instrumented muscle-testing (cybex system). No significant statistical differences in the function of the shoulders of all the patients and control subjects could be verified, with the exception that 16 patients exhibited weakness during isokinetic torque during extension of the shoulder in a 55 to 65 degree flexion (4.2 +/- 1.2%). The latissimus dorsi free flap can therefore be recommended as a procedure for soft-tissue coverage of extensive wounds resulting only in negligible loss of function and a slightly altered appearance of the shoulder-girdle.
To investigate the impact of age on function of vascular postjunctional alpha 2-adrenoceptors in tail arteries of F-344 rats aged 6 and 20 months, vasoconstrictor responses of isolated ring segments were studied. In both 6 and 20 months old animals, norepinephrine concentration response curves were significantly shifted to the right in the presence of the alpha 2-adrenoceptor antagonists idazoxan (300 nM) or rauwolscine (50 nM). Furthermore, in both age groups alpha 2-adrenoceptor agonists UK14304 (300 nM) or BHT920 (25 nM) produced significant enhancements in the vasoconstrictor response to the selective alpha 1-adrenoceptor agonist, methoxamine. Concentration response curves for norepinephrine and methoxamine were not different with age. These data verify the existence of postjunctional alpha 2-adrenoceptors and demonstrate that the function of these receptors does not change with age. This supports the proposition that overall vascular adrenergic function in blood vessels is maintained with advancing age.
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Although local muscle flaps of the lower leg are often used, the functional problems that arise after these reconstructive procedures have not yet been adequately studied. Twenty patients who had undergone a local muscle flap of the lower leg 3 years earlier were studied using a isokinetic muscle test. The isokinetic muscle strength profile during flexion of the foot was reduced by up to 21 +/- 16% after transfer of the m. gastrocnemius and by up to 31 +/- 20% after transfer of the m. soleus at a angular velocity of 120 degrees. The isokinetic muscle strength profile during pronation and supination of the foot at an angular velocity of 120 degrees was reduced by up to 89 +/- 32% after transfer of the m. soleus. Statistically, compound tibia fractures without a local flap for soft tissue therapy showed significantly better results. In view of this functional loss, the use of local muscle flaps, particularly the transfer of the m. soleus, should be restricted in younger patients, and alternative techniques (free flaps) should be used.
A total of 146 patients with 150 closed metacarpal fractures were treated between 1980 and 1981, and 109 patients with 113 metacarpal fractures (75%) were followed up (follow up 7.3 years). After conservative treatment, the functional results were good to excellent in 92.7%, while 5.8% had satisfactory and 1.5% poor functional results. After operative treatment 81.5% had good or excellent functional results, 14.8% satisfactory results and 3.7%, poor functional results. The radiological result did not correspond with the functional result. Angulation of the Ist-IVth metacarpal bones by up to 20 degrees of the Vth metacarpal bone by up to 50 degrees, and even shortening by up to 8 mm had no detrimental influence on the functional results. Axial rotational deviation of the Vth metacarpal bone by up to 15 degrees was tolerated. Joint fractures with a 1 mm step could also be treated by conservatively means.
Combinations of fractures or dislocations with vascular damage of the leg have a high incidence of amputation or severe functional deficit. With this type of lesion 22 patients were treated at "Bergmannsheil" from 1986 to 1991. Using a pre-, intra- and postoperative protocol, the amputation rate decreased to 18%. More than 80% of the patients had a good function of their leg with only minor joint restrictions.
Stimulation-evoked norepinephrine release from the rat tail artery increases with age; therefore, the sensitivity of prejunctional alpha-2 adrenergic receptors to antagonists and agonists was compared in perfused tail arteries from Fischer-344 rats, aged 6 and 20 months. The increase in endogenous fractional norepinephrine release produced by blockade of alpha-2 adrenergic receptors with submaximal concentrations of either yohimbine or idazoxan was significantly greater in 6-month-old animals as compared to 20 months; however, the effect of a maximal concentration of idazoxan was not significantly different. Inhibition of norepinephrine release by the alpha-2 receptor agonist UK14304 was reduced in 20-month-old animals compared to 6 months. In contrast, there were no age-related differences in inhibition of contractile responses to nerve stimulation by the prejunctionally acting dopamine D2 agonist, N-0923. These data suggest that age-related changes in the sensitivity of prejunctional alpha-2 receptors to agonists and antagonists may not reflect any fundamental alteration in the function of this receptor system, but may be related to competition between alpha-2 agonists or antagonists and increased biophase concentrations of norepinephrine. This conclusion is supported by lack of an age-related change in function of prejunctional dopamine D2 receptors. Persistence of age-related increases in norepinephrine release when alpha-2 adrenergic receptors are fully blocked may reflect an alteration in other fundamental mechanisms that control norepinephrine release.
The Matti-Russe technique yields a 95% success rate in treating scaphoid non-unions diagnosed in the first years after trauma and without osteoarthrosis of the radiocarpal joint. Between October 1981 and December 1989, 215 patients were treated by Matti-Russe procedure at the University Hospital of "Bergmannsheil" Bochum. In ten cases, this operation did not lead to osseous consolidation. The results are presented and discussed.
Fifteen patients with an aneurysma spurium of the femoral artery due to coronary angiography had to be operated from March, 1988 till April, 1990. Contrary to our expectations we did not find a culmination of risk factors or relevant arteriosclerosis of the legs in these patients. It were the "young vessels" that were not able to compensate the defects from catheters and locks. In view of two cases of aneurysm rupture with hemorrhage, we consider the aneurysma spurium as an urgent indication for surgery. Only the complete exploration of the vessel permits an exact localization of the aneurysm and possible further defects and thus prevents the development of a secondary aneurysm.
From 1984 to 1989 78 patients over the age of 60 years were operated on acute appendicitis. Compared to appendicitis in younger people these older patients showed 3 times longer an interval between the first appearance of symptoms and their contact to the doctor, or surgical treatment. As result of this longer period appeared the high perforation rate 53.8%. In this group of patients with perforation the complication rate was 4 times higher than the intraoperative and histologically confirmed acute appendicitis. From these facts results a mortality rate of 4%. In the retrospective evaluation was also seen that there was no conclusion between the laboratory parameters, the physical symptoms and the degree of the inflammation of the evidence of perforation with local or diffused peritonitis. The inclusion of appendicitis in the differential diagnosis of acute abdominal pain in older people offers the chance of an earlier surgical treatment, so reducing the risk of postoperative complication and mortality.
The effect of age on prejunctional modulation of norepinephrine release was studied in tail arteries isolated from Fischer-344 rats, age 6 to 27 months. Tail arteries were perfused in vitro, and norepinephrine released during adrenergic nerve stimulation was collected and analyzed by high-pressure liquid chromatography with electrochemical detection. There was no progressive change with age in norepinephrine content in the tail artery, although content at 6 months was significantly less than 12 months. The most significant finding was a decline with age in the effect of the alpha-2 adrenergic antagonist yohimbine to increase norepinephrine release, suggesting an age- related fall in the effectiveness of prejunctional alpha-2 adrenoceptor activation. In the absence of drugs there was an age-related increase in fractional norepinephrine release, and an age-related increase in the effect of deoxycorticosterone and cocaine was also seen. The increased effect of deoxycorticosterone and cocaine appears to be related to increased norepinephrine levels in the junctional cleft as opposed to an age-related increase in the activity of catecholamine metabolism and uptake. These results suggest that the age-related increase in fractional norepinephrine release may be due, in part, to a decline in negative feedback mediated by prejunctional alpha-2 adrenergic receptors.
Biopsy of the liver with the Tru-cut needle was done as a routine diagnostic procedure during gallbladder surgery in 166 cases. The data of history, ultrasonography and laboratory were compared with the microscopic liver findings. Preoperatively in 89% of the cases there was an indication for liver biopsy. In 11% of the cases, where there was no indication for preoperative biopsy, we found severe changes in liver histology. Therefore we recommend liver biopsy during gallbladder surgery as a routine procedure.
By analysis the results of thoracoscopy in 57 patients suffering from pleural effusion of unknown cause in the Surgical Department of Marienhospital Herne, it is clear that we can reach the exact diagnosis in 98% of these patients by this examination, which can be done in local anaesthesia with little complications. In the same time the histological examination of the tissue and the cytological examination of the effusion make the diagnosis sure and in the same time improved the complaints of the patients by removing of effusion.
In a group of 44 healthy probands, the change in bile-duct size after ingestion of a gastric stimulant in the early stage of the regulation was examined. From an empty diameter of 5.62 mm, a statistically significant reduction to 4.00 mm was found after 5 min, followed by a further slight reduction to 3.86 mm after 10 min and to 3.57 mm after 20 min. The physiological basis is the influence of cholecystokinin on the ductus hepatocholedochus and the sphincter of Oddi. This eliminates the long examination and observation intervals typical of radiological diagnostics and justifies early functional sonographic investigation of the bile duct during abdominal sonography, which does not involve an additional time investment.
The administration of glucose to rats for 48 h resulted in an increase in the duration of anesthesia produced by intraperitoneal injection of pentobarbital. The effect of this glucose treatment on hepatic glycogen and on microsomal protein, cytochrome P450 (P450), cholesterol, lipid and phospholipid content, as well as on the spectral binding of hexobarbital and methadone to microsomal P450, was examined. The glucose treatment appeared to have no effect on microsomal protein or P450 content. The binding of hexobarbital and methadone by P450 produced a type 1 spectrum in both control and glucose-treated animals. The glucose treatment resulted in a decrease in the spectral dissociation constant (Ks) and in the maximal spectral binding (delta Amax) of hexobarbital to P450 while with methadone there was an increase in Ks and a decrease in delta Amax. Total lipid, phosphatidylcholine and phosphatidylethanolamine were increased in the microsomal fractions from glucose-treated animals. The changes in the parameters for drug binding to microsomal P450 probably relate to the increased lipid content of the microsomes although changes in the proportion of P450 isoenzymes could be involved. The previously observed decrease in the microsomal metabolism of hexobarbital and methadone following glucose treatment may be due to decreased binding of these compounds to microsomal P450.