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Biomedical subjects

J Grifka

Publications and source records attributed to J Grifka.

At least 73 records · Page 4Linked to original sources
PubMed2003

[Tissue toxicity of local anesthetics. An in vivo trial].

AIM: Local anesthetics are often administered intra-articularly after knee surgery. The aim of this study was to determine differences in irritancy of local anesthetics in an in vivo test performed on the chorioallantoic membrane of hen's eggs (HET-CAM test) to evaluate the specific irritation score. METHOD: After incubation for 9 days, the chorioallantoic membrane was prepared and then exposed to different local anesthetics (Naropin, Scandicain,Carbostesin,Xyloneural). RESULTS: We found no irritating values for the tested substances. No vascular injuries of the chorioallantoic membrane could be detected. Therefore, the irritation score was measured according to the standard protocol with an irritation score=0. CONCLUSION: Our results show that local anesthetics often used in clinics do not provoke severe vascular injuries as a sign of tissue toxicity. Therefore, the customary concentrations can be recommended for clinical use.

Allantois↗
PubMed2003

Prosthetic joint infections with osteomyelitis due to Candida albicans.

We report the case of a 78-year-old woman who suffered from a severe soft tissue and bone infection of her left knee 3 years after a total knee-joint replacement without loosening of her endoprosthesis. Cultures from joint aspiration and tissue specimen identified Staphylococcus aureus and Candida albicans. Direct microscopic examination of vital spongy bone and fibrous tissue revealed microabscesses and seeds of yeasts inside the fatty marrow and interface. After removal of the prosthesis several soft tissue and bone specimens were taken during planned re-operations. The histological examination showed no morphological changing, no reduction or extinction of the yeast cells under fluconazole therapy with a dosage of 6 mg kg(-1) body weight (400 mg daily). Curing of the fungal infection with eradication of the yeasts in the bony specimens was achieved with higher doses of 12 mg kg(-1) body weight (800 mg day(-1)) over a 2 month regimen in combination with repeated surgical debridements.

Aged↗
PubMed2003

[Useability of an image based nagivation system in reconstruction of leg alignment in total knee arthroplasty - results of a propsective study].

Accurate leg alignment is one important factor for long term survival in total knee arthroplasty (TKA). The aim of this study was to determine the accuracy of a CT-based navigation system in restoration of the leg axis. 80 TKA (P.F.C.-Sigma--DePuy) were implanted either using a CT-based navigation-system or the conventional technique. There were no significant differences between the groups according to the preoperative leg deformity. Accuracy of implantation was determined on postoperative long-leg coronal and lateral x-rays. A postoperative leg axis between 3 degrees varus and 3 degrees valgus was obtained in 35/40 patients (88%) in the computer assisted and 28/40 patients (70%) in the conventional operated group. A higher precision in the sagittal plane was seen for the tibial (computer assisted: 3.9 +/- 2.2 vs. conventional TKA 1.3 +/- 5.8) and the femoral component (computer assisted: 3.5 +/- 2.3 vs. conventional TKA 6.9 +/- 3.6). The use of the CT-based VectorVision-System allows a significant improvement in the accuracy of implantation in TKA. The CT-based module has the advantage of a precise preoperative planning and a useful documentation and control tool for each important step. On the other hand there are additional costs and time consuming logistics.

Adult↗
PubMed2002

[Development and trial use of multistep diagnosis of musculoskeletal disorders during a routine physical examination at the workplace].

Musculoskeletal disorders represent the main cause for absenteeism. To determine the disorders exactly, a multistep inventory of examinations was developed. The method of diagnostics may be an indicator of the quality of occupational medical management. It may improve the availability of health data related to working conditions and may increase the chances of goal-oriented prevention in the field of working conditions as well as in the field of behavior. In addition, the standardized recording of data provides an opportunity for evaluation in epidemiological studies, which may be organized as longitudinal studies to look for the development of musculoskeletal disorders over time.

Humans↗
PubMed2002

[Office workplace at a computer monitor from an occupational-orthopedic view].

Typical back problems as well as complaints in the shoulder-arm-hand system are increasing as the volume of sedentary office work at the computer screen rises. Various legal rules precisely define preventive measures. However, basic orthopedic-biomechanical principles are not being taken into consideration. Orthopedists as well as occupational physicians are equally challenged to enforce those legal guidelines by beginning to raise awareness of the principles and thus contributing towards improvement of working conditions.

Computer Terminals↗
PubMed2002

[Differential therapy for the rheumatoid shoulder].

Despite frequent involvement, the rheumatoid shoulder is neglected in operative treatment of the upper extremities. The slow course of omarthritis, the compensation mechanism of scapulothoracic motion and neighbouring joints as well as dominating disabilities of the lower extremities and the rheumatoid hand are possible explanations. The pattern of destruction of the rheumatoid shoulder is characterized by progressive joint and soft tissue deterioration. Soft tissue involvement determines the course of the shoulder joint. The subacromial space is a common and early site for rheumatoid involvement, often leading to bursitis, tenosynovitis of the biceps tendon and rotator cuff rupture. Sonography and MRI enable the early detection of subacromial and glenohumeral pathology before deterioration is visible radiologically. Surgical intervention in patients with rheumatoid arthritis of the shoulder is based on the degree of radiological destruction according to Larsen, the natural course of the shoulder joint and the soft-tissue condition. The goals of surgery are to relieve pain, increase motion and restore shoulder function. Surgery should be carried out early in the course of the disease, thus determining the long-term prognosis and the remaining surgical options. Depending on the pattern of destruction of the rheumatoid shoulder, the options for treatment can be divided into early and late procedures.Joint-preserving surgery is indicated in the early stages of radiological destruction according to Larsen classification O-III, whereas the late stages of destruction (Larsen IV-V) require reconstructive surgery. The introduction of arthroscopic and semiarthroscopic techniques has improved the acceptance of early synovectomy for the rheumatoid shoulder, but there is still a place for open synovectomy in patients with extensive soft-tissue repair and bone-remodelling procedures. Arthroscopic and open synovectomy are supplementary and noncompetitive surgical procedures for the rheumatoid shoulder. With proceeding bone and soft-tissue destruction corresponding to Larsen stage IV and V, synovectomy is not successful and reconstructive surgery is necessary. Resection-interposition-arthroplasty (RAIP) remains a controversial alternative to arthroplasty in young patients with sufficient bone stock and a reconstructable rotator cuff. The success of cup-replacement will additionally restrict the indications for RAIP. RIAP remains a possible salvage procedure after aseptic and septic loosening of shoulder arthroplasty. Glenohumeral replacement arthroplasty has become the procedure of choice in reconstructive surgery of the shoulder. The severity of soft-tissue and bone destruction determines the choice of shoulder prosthesis. Current modular shoulder systems with increased numbers of humeral-head stem combinations are calculated to achieve a better adjustment of the soft-tissue tension and to optimize the adaptation between head geometry and the natural shape of the glenoid.The surrounding soft-tissue structure, especially the condition of the rotator cuff, is very important for the functional recovery after shoulder arthroplasty. We prefer a hemiarthroplasty of the rheumatoid shoulder joint to avoid critical glenoid fixation. Patients with irreparable rotator cuff tears and severe glenohumeral arthritis remain a difficult challenge in shoulder surgery and the ideal procedure has not yet been found.Pain relief and a modest increase in active motion are the main goals in operative treatment. Bipolar shoulder arthroplasty represents an adequate alternative to currently favoured hemiarthroplasty in patients with cuff-deficient shoulders.

Arthritis, Rheumatoid↗
PubMed2002

Inhibition of cartilage destruction by double gene transfer of IL-1Ra and IL-10 involves the activin pathway.

The objective of the study was to determine the effects and the molecular background of interleukin-1 receptor antagonist (IL-1Ra) and vIL-10 double gene transfer into human synovial fibroblasts from patients with rheumatoid arthritis (RA) using the SCID mouse model for cartilage erosion in RA. RA synovial fibroblasts were transduced with retro- or adenoviruses encoding IL-1Ra and/or viral IL-10 (vIL-10). SCID mice were engrafted subcutaneously with IL-1Ra and vIL-10 transduced human rheumatoid synovial fibroblasts and normal cartilage. In parallel, gene expression analysis before and after gene transfer using RNA arbitrarily primed PCR in combination with cDNA array was performed. vIL-10 and IL-1Ra double gene transfer resulted in inhibition of cartilage invasion and degradation by RA synovial fibroblasts when compared with control transduced and non-transduced implants. Expression of key genes that were altered after double gene transfer were related to the activin pathway. The results demonstrate not only that virus-based gene transfer using a combination of two joint-protective genes is a feasible approach to inhibit cartilage degradation by activated RA synovial fibroblasts, but also that the underlying molecular effects include modulation of the activin pathway.

Actins↗
PubMed2001

[[Surgical intra-articular interventions in arthrosis].

The reconstruction of weight-bearing joint surfaces has long been a challenge for the orthopedic surgeon. The statistical rise in life expectancy, the spread of high-risk sports and leisure-time activities combined with high demands for painfree joint function even in older age as a factor for contemporary quality of life are the demographic factors of the bone and joint decade announced by the WHO. Osteoarthritis represents a multifactorial, irreversible, often heterogeneous joint disease with joint destruction as the inevitable consequence. Conventional and innovative intra-articular operative methods for the treatment of osteoarthritis are presented and discussed. Tissue engineering stands for vitalizing tissue modification by modification of cellular and humoral mechanisms. Thus, new therapy options for curing degenerative joint diseases will arise in the future. Autologous chondrocyte transplantation (ACT) represents one of the first clinically established methods. The paradigm of treating osteoarthritis by the orthopedic surgeon will be multimodal in the future. Innovative techniques in the biotechnological sector provide a promising horizon.

Arthroscopy↗
PubMed2001

[Biomechanical considerations on shoulder joint prosthesis implantation].

The biomechanical goals of prosthetic reconstruction of the shoulder are to restore the normal anatomy and range of motion, and to recreate the normal soft tissue balance of the static and dynamic stabilizers of the glenohumeral joint. An unconstrained prosthesis design best reproduces the physiological articulation and original anatomy of the shoulder. Humeral head components have been recently developed, which are adaptable to the variable anatomy of the proximal humerus (third generation design). A precise reconstruction of the three dimensional structure of the proximal humerus may lead to an improved functional outcome. However, there is still a lack of biomechanical data to support this concept. The optimal design of the glenoid component remains a challenge for future research. Specific issues including the choice of biomaterials, the optimum shape, radius of curvature, surface area of the articulation, component height and stem design remain under investigation. Although the prosthetic design represents an important factor in the success of glenohumeral arthroplasty, the surgical reconstruction of the soft tissues to recreate the normal soft tissue balance as well as postoperative rehabilitation determine the functional outcome.

Biomechanical Phenomena↗
PubMed1999

[Injection therapy in lumbar syndromes].

Injection therapy as part of orthopaedic pain treatment is of major importance in sciatica. It helps to differentiate unclear complaints and allows a break through of the vicious circle of pain and muscle spasm. Pharmacological principles and possible complications have to be observed. The different techniques need experience and manual training. The paper describes the various injection techniques in detail.

Bupivacaine↗
PubMed1999

[Medical training therapy in lumbar syndromes].

Chronic low back pain can be considered to be one of the most frequently treated and most costly diseases in modern industrial societies. Dysfunctions and imbalances of the spine-supporting muscles increase the risk of low back pain. Consequently preventive treatment and rehabilitation have to aim at preserving and restoring the full capacity of the spine-supporting muscles as well as training coordination and spine-friendly behaviour. In addition to various measures of pain therapy, physiotherapeutic treatment including neuro-physiotherapy, physical treatment (eg electrotherapy), balneotherapy and supportive behavioural training, medical rehabilitation therapy (MRT) ranks among the most effective ways of treating low back pain. MRT applies guidelines and methods of exercise methodology within medically indicated programmes of preventive treatment and rehabilitation. Various objectives of MRT are outlined with special regard to the stages of MRT treatment, emphasizing positive adaptation of the neuro-muscular system in the course of rehabilitation. Physicians are responsible for MRT diagnosis and control. Taking into account the base disorder and the progress of therapy physiotherapists and the physicians in charge determine MRT objectives and treatment strategies.

Adaptation, Physiological↗
PubMed1999

[Guidelines in orthopedics. Alliance of German Orthopedists. University Clinic of Orthopedics, Heidelberg].

Guidelines are systematically developed statements of the actual knowledge in order to assist doctors and patients by the decision of appropriate health care. Since 1998 the DGOT has published 22 well structured guidelines, 20 guidelines are under construction. The AWMF as the coordinator of guideline constructing of all scientific medical societies has published 629 guidelines since 1995. The publication of guidelines of the DGOT and the BVO is the first step for dissemination, next steps should be implementation und evaluation. Then it will be evident whether change in medical practice will occur.

Evidence-Based Medicine↗
PubMed1999

[Surgical approach in lumbar intervertebral disk displacement. Topographical principles and characteristics].

For the operative procedure in lumbar disc extrusion it is important to expose the prolapsed disc and sequestrum without disintegration of the musculature and branches of r. dorsalis nervi spinalis or provoking lesions in the spinal canal. A classification helps to determine exact description of localization of disc material in craniocaudal and mediolateral directions. It can be correlated with the interlaminar window as a structure seen in the operative procedure. A speculum helps to limit the exposure for an interlaminar as well as a lateral access, thus reaching the structures concerned in the spinal canal with minimal irritation of the surrounding tissues. For interlaminar access partial excision of the lig. flavum is sufficient. The extrusions in the foraminal region that can be exposed laterally from a medial skin incision, as well as from a paramedial are between m. multifidus and m. longissimus. In revision surgery, the upper laminar corner is advantageous for entering the spinal canal.

Diskectomy↗
PubMed1998

[Biomechanics of injury of the cervical spine].

Whiplash injuries of the cervical spine are of special medical and socio-economic importance. Biomechanical studies of the injury have proven, that a hypertranslation of the capito-cervical region takes place first, leading to ligamentous hyperdistension and ruptures, when exceeding elastic deformation, thus possibly resulting in mechanical disturbance and rotatory malpositioning. Diagnosis of so called "functional disorders" bears difficulties concerning objective tests for structural lesions. This demands the definition of diagnostic parameters and clinical signs, which also consider vegetative phenomena. This paper aims at a systematic clinical and radiological check. Adequate therapeutic means have to be concordant to prognosis. Therefore functional parameters should already determine differential diagnosis. This is based on technical feasibilities and needs future scientific efforts.

Biomechanical Phenomena↗