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Biomedical subjects

J Franke

Publications and source records attributed to J Franke.

228 records · Page 13Linked to original sources
PubMedDate not supplied

[Health-economic considerations for the use of BMP-2 for spinal surgery in Germany].

INTRODUCTION: BMP-2 can replace autogenous bone grafting in lumbar one-level anterior lumbar interbody fusions (ALIF). The current G-DRG system does not reimburse the upfront price of 2,970 euro per BMP-2 application for hospitals in Germany. The purpose of the current study was to create a health economic model to evaluate the financial savings for health care providers (hospitals) and health care payers (health care insurance) that can be achieved by the use of BMP-2 in spine surgery. METHODS: A previously published pooled data analysis was used in which BMP-2 showed significant improvements in the treatment after ALIF surgery compared to autogenous bone grafting, including earlier return to work time and reduced revision rates. These medical findings were transformed into economic data based on the regulations of the German health system of 2005. RESULTS: The significantly shorter return to work time under BMP-2 treatment generates important financial savings for health care insurances offsetting the upfront prize of 2,970 euro for BMP-2. Savings for hospitals are mainly related to shorter surgery time due to the absence of the bone grafting procedure and faster discharge of the patient. CONCLUSIONS: The combination of improved medical outcome by BMP-2 treatment for the patient and net savings for the entire health care system in Germany represents a "dominant" strategy from a health economic perspective. This implicates that BMP-2 in ALIF procedures is to be recommended from a health economic point of view for the German health care system.

Bone Morphogenetic Protein 2↗
PubMedDate not supplied

[Perthes disease--results of a containment-oriented therapy concept].

INTRODUCTION: In a retrospective study a treatment concept for Perthes' disease dependent on the containment was applied. PATIENTS/METHODS: 49 hips of 41 children (9 female, 32 male) were treated between 01. 01. 1990 and 31. 12. 1995. In our concept of treatment a varus femoral osteotomy was performed in 28 cases with not contained hips or less than 4/5 coverage of the femoral head (X-ray/MRI). The other 21 well contained hips with 4/5 coverage or more were treated conservatively with physiotherapy and in case of joint effusion and pain additionally with the use of crutches (partial weight bearing) and anti-inflammatory medication. The average age in the non-operative group at the time of first investigation was 4 years and 9 months (3 y./1 m. to 7 y./1 m.) and 6 years and 3 months (4 y/2 m. to 10 y/0 m.) at our last examination (mean follow up 17.7 months, range of 6 to 72 months). At the time of indication for a varus femoral osteotomy the patients had an average age 6 years and 1 month (3 y./6 m. to 10 y./2 m.), the mean age at the last postoperative examination was 7 years and 11 months (4 y./8 m. to 12 y./5 m.) with an average follow up of 21.5 months (6 to 77 months). RESULTS: For the conservatively treated children we achieved good results (still well contained hips with 4/5 coverage, no decrease of function, no increase of pain) in 85.7% (18 of 21 cases). In 85.7% (24 of 28 cases) we found good results (well contained hips, increase of coverage, no decrease of function, no increase of pain) in the operation group. CONCLUSIONS: The presented concept of therapy in Perthes' disease was practicable for all patients and included the possibility of decision for operative or non-operative treatment. In both groups we achieved good results in 85.7% of the cases.

Child↗
PubMedDate not supplied

[Initial experiences with subcutaneous Harrington distraction without spondylodesis in scoliosis].

We report on a special method in the treatment of scoliosis using subcutaneous Harrington-distraction without spondylodesis. We operated 14 patients in all who were between 7 and 12 years old, in average 10 2/12 years Indication is made if scoliosis is extremely progressive, if Cobb's measure is above 50 degrees, after unsuccessful conservative treatment also including orthosis and physiotherapy, or if patients appeared to late in our department. In this technique only two incisions to make are necessary to place the Harrington roots to the cranial and caudal end of the scoliosis curve. The Harrington root can be 'needled' in subcutaneously. When in times of further growth the amount of correction gets noticeably lost the cranial hook could be tightened or the Harrington root could be changed easily. We need an orthosis (Cheneau or Milwaukee) for after treatment until in a final operation with spinal fusion is made. This method has showed good results although we had to cope with a bad prognostic starting position.

Adolescent↗
PubMedDate not supplied

[Ultrasound hip joint screening in newborn infants. Correlation of anamnestic risk factors and hip dysplasia].

BACKGROUND: Congenital dysplasia of the hip (CDH) is the most frequent inborn deformity of the locomotor apparatus. Hereditary, pelvic respectively breech presentation or abdominal delivery, premature as well as post-term birth and twin pregnancy are considered to be anamnestic risk factors for congenital dysplasia of the hip. The results of ultrasound hip screening from July 87 until December 94 are presented with special regard to the correlation of these risk factors and the occurrence of pathologic hips. PATIENTS: 19 different orthopaedic surgeons examined the hips of 3739 newborns (female: 1837-49.1%; male: 1902-50.9%) by ultrasound (screening). 96% of the examinations were performed within a period of 5 days after birth, in a few cases the babies were up to 19 days old. METHOD: The ultrasound examinations, the assessment of the echograms and classification into types of hip were performed according to Graf's technique. Two types of ultrasonographs were used: SL-1, Siemens--5 MHz scanner; LSC 7500, Picker--7.5 MHz scanner). All investigations were assessed retrospectively over the period of time with the help of documentation forms (data of newborn baby, case history, clinical and sonographical findings, kind of therapy and procedure) and statistically checked (program SPSS 7.5, Chi-Quadrate-Test, logistic regression). RESULTS: In 239 children (6.4%) we found hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). For the entire group we achieved the following types of hips (right/left side): Ia--214 (5.7%)/224 (6.0%); Ib--2069 (55.3%)/2008 (53.7%); IIa (> or = 55 degrees)--1318 (35.3%)/1322 (35.4%); IIa (< 55 degrees)--65 (1.7%)/74 (2.0%); IIc--45 (1.2%)/71 (1.9%); D--18 (0.5%)/30 (0.8%); IIIa--8 (0.2%)/7 (0.2%); IIIb--1 (< 0.1%)/2 (0.1%); IV--1 (< 0.1%)/1 (< 0.1%). With regard to the risk factors the distribution was as follows: hereditary--302 babies (8.1%), pelvic respectively breech presentation--149 (4%), abdominal delivery--359 (6.5%), premature birth--188 (5.0%), post-term birth--164 (4.4%), twin pregnancy--73 (2%). CONCLUSIONS: In newborn babies with cases of hip dysplasia in their family (heredity) and pelvic respectively breech presentation at birth we found a significant higher rate (p < 0.05) of hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). Also, for girls and the left hip a significant higher rate was achieved. A correlation of the other mentioned risk factors abdominal delivery, premature and post-term birth as well as twin pregnancy was not evident.

Equipment Design↗
PubMedDate not supplied

[Bilateral habitual fibula head dislocation].

Dislocation of the fibular head is rare. In most of the cases a trauma caused by sports activity, sometimes associated with a tibia fracture, is described. Only a few publications exist about habitual dislocation of the fibular head without history of trauma. This article reports a case of bilateral habitual anterolateral dislocation of the fibular head in a 17-year-old female. There was no information about a neurological or other disease and no sign of generalized ligamentous laxity. Because of marked symptoms with severe pain after each sensation of dislocation which appeared several times a day, the patient was treated by using a part of the biceps tendon for fixation of the reduced fibular head.

Adolescent↗
PubMedDate not supplied

[Magnetic resonance tomography in therapy follow-up after repositioning treatment of congenital hip dislocation].

INTRODUCTION: After treatment of infantile hip dislocation in terms of reduction and retention in plaster casts or splints a problem of therapy controlling exists. To assess if the femoral head is in correct position centered in the socket ultrasound is not possible, because one cannot achieve the necessary standard position. Computertomograms are associated with a hereditary taint of radiation and plain roentgenograms lack of presentation of the important cartilaginous structures. METHOD: To control infantile hips after open or closed reduction from 1990 until 1996, 43 examinations by MR imaging were performed in 34 children. RESULTS: In our series MRI was able to provide exact information about the position of the femoral head independently of its state of ossification. Also, a clearly visualisation of the different structures of the acetabular fossa, particular acetabulum, pulvinar, bony and cartilaginous acetabular rim and limbus was possible. Furthermore the MR images showed interpositioned soft tissue, intraarticular effusion and displayed cartilaginous parts of the acetabular rim. CONCLUSIONS: MRI is an exact method to assess the anatomical and pathological conditions of the childlike hip joint. Because of the disadvantages of CT and X-ray, MRI is superior in terms of controlling the results after treatment of infantile hip dislocation.

Acetabulum↗
PubMedDate not supplied

Our experiences with the early operative treatment of congenital clubfoot.

In operative clubfoot therapy, early operation plays an important role. Between 1975 and 1982, we operated on 55 children with 72 clubfeet: 56 posteroplantar releases in patients with an average age of 5.8 months, and 16 posteromedial releases in patients with an average age of 8.1 months. The average follow-up was 3.5 years. The results, based on an investigation scheme according to Henkel, were good and very good in 94%. Operative treatment is indicated after 3 to 4 months of intensive plaster treatment if there has been no further correction.

Age Factors↗
PubMedDate not supplied

RES function and liver microcirculation in the early stage of acute experimental pancreatitis.

BACKGROUND/AIMS: The reticuloendothelial system and in particular the Kupffer cells in the liver are important for eliminating antigens and toxic substances in many diseases including acute pancreatitis. Optimal Kupffer cell function is believed to depend on numerous factors including intact hepatic blood supply and microcirculation. The aim of the study was to evaluate whether hepatic microcirculation and Kupffer cell function are impaired in acute pancreatitis and whether enhancement of hepatic capillary blood flow leads to improved reticuloendothelial system function. METHODOLOGY: Acute pancreatitis was induced in rats by intraductal infusion of bile salt followed by i.v. cerulein hyperstimulation. Animals were randomized to receive either a selective endothelin-A receptor antagonist (ET-RA; LU-135252; 50 mg/kg) or saline. Sham-operated animals (intraductal and i.v. saline infusion) treated according to the same protocol served as controls. Liver phagocytic function was evaluated in 6 animals per group 6 and 24 hrs after acute pancreatitis induction and treatment using 99mTc-labeled Nanocoll and a scintillation camera technique. Another 6 animals of each group were used for intravital microscopic determination of hepatic capillary blood flow using fluorescein-labeled erythrocytes. RESULTS: Six hours after acute pancreatitis induction, hepatic capillary blood flow and nanocoll clearance were significantly decreased in saline-treated animals (compared to saline-treated healthy controls). Endothelin-A receptor antagonist significantly improved hepatic capillary blood flow and nanocoll clearance. This beneficial effect was no longer seen after 24 hrs when these parameters had spontaneously returned to values not significantly different from normal. CONCLUSIONS: Reticuloendothelial system function and hepatic capillary blood flow are impaired (only) in the early stage of this acute pancreatitis model. Endothelin-A receptor antagonist improves hepatic capillary blood flow at this stage. Enhancement of hepatic capillary blood flow is accompanied by normalization of nanocoll clearance, suggesting that hepatic microcirculation influences phagocytic Kupffer cell function early in acute pancreatitis.

Acute Disease↗