Biomedical subjects

J Grifka

Publications and source records attributed to J Grifka.

107 records · Page 6Linked to original sources

PubMedDate not supplied

[Extracorporeal single dose and radiographic dosage in image-controlled and fluoroscopic navigated pedicle screw implantation].

AIM: Goal of the current study was to compare radiation dose and fluoroscopy time of fluoroscopic computer assisted pedicle screw implantation versus the conventional technique. METHOD: For each of 10 specimens two pedicle screws were placed using conventional technique (group 1) and two screws were inserted with fluoroscopic navigation system (group 2) contralateraly. RESULTS: For implantation of two pedicle screws the mean radiation dose was 0.041 mSv in group 1 and 0.029 mSv in group 2. Fluoroscopy time was 34 seconds in group 1 and 25 seconds in group 2. The differences of radiation dose and fluoroscopy time for group 1 and 2 were statistically significant (radiation dose p = 0.00044, fluoroscopy time p = 0.00039). CONCLUSION: We achieved significantly lower radiation dose and fluoroscopy time with fluoroscopic computer assisted pedicle screw implantation compared with the conventional technique. Concerning exposure to radiation for patients and personnel fluoroscopic navigated screw insertion is to favour.

Body Burden↗

PubMedDate not supplied

[Postoperative autologous retransfusion of collected shed blood after total knee arthroplasty with the cell saver].

AIM: The purpose of this study was to examine if it is possible to reduce transfusion of blood units by collecting shed blood with the Cell Saver for autologous retransfusion in total knee arthroplasty (TKA). METHOD: In 186 patients drainage blood was collected over a 6-h period after total knee arthroplasty with a Cell Saver system in order to make retransfusions if necessary. A tourniquet was used routinely throughout the operation. No preoperative blood donation was performed. In 19 patients preoperative haemoglobin levels were below 12 g/dL (group A, anaemic patients). In the other 167 patients (group B) the preoperative haemoglobin levels were higher. RESULTS: 4 patients (21 %) in group A received a homologous blood transfusion. Only 1 patient (0.6 %) in group B received one unit of erythrocyte concentrate (difference statistically significant, P < 0.001). In group A 8 patients (42 %) received 284 ml (145-621 ml) Cell-Saver concentrate on average, 38 patients (23 %) in group B received 358 mL (147-776 ml) Cell-Saver concentrate on average. CONCLUSION: With a risk lower than 1 % for patients without anaemia to get a homologous blood transfusion one can do without the more expensive preoperative blood donation in total knee arthroplasty if a tourniquet is used for the operation and a Cell Saver is used for facultative retransfusion of drainage blood.

Aged↗

PubMedDate not supplied

[Stability of pedicle screws in comparison to anterior vertebral body screws after kyphoplasty augmentation].

AIM: Aim of the study was to compare stability of pedicle screws and ventral implanted screws after insertion in soft or cured kyphoplasty cement. METHODS: Pedicle screws were inserted in a total of 40 thoracolumbar vertebrae of 10 different formalin-fixed human specimens: each 10 pedicle screws were implanted in soft (group 1) and cured cement (group 2), each 10 ventral screws were placed in soft (group 3) and cured (group 4) cement. Pedicle screws were then evaluated for biomechanical axial pullout resistance. RESULTS: Mean pull-out force was 452 N (range 60-1 125 N) in group 1, 367 N (range 112-840 N) in group 2, 364 N (range 65-875 N) in group 3 and 271 N (range 35-625 N) in group 4. CONCLUSION: Implantation of pedicle screws and ventral implanted screws in soft and cured kyphoplasty cement is a sufficient method. We achieved more stability with pedicle screws compared with ventral implanted screws in soft and cured cement. No significant difference was seen.

Bone Cements↗

PubMedDate not supplied

[First results after implantation of a pyrocarbon-endoprosthesis in patients with degenerative arthritis].

AIM: Evaluation of an unconstrained pyrocarbon prosthesis (Ascension) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand. METHODS: In this study 10 patients (13 implants), that were treated with this type of prosthesis between February 2002 and January 2005 were clinically and radiologically studied. RESULTS: All but one patient were satisfied with the postoperative situation and would agree to another operation. A significant pain reduction was observed. The average ROM was 58 degrees. Five patients demonstrated a free extension, two patients had a swan neck deformity, which could be actively compensated for, and the remaining six patients had an extension deficit of 30-45 degrees. The average flexion was 76 degrees (+/-12 degrees). X-ray examination was unremarkable in eight patients with a regular position of the endoprosthesis. However, in five patients significant radiolucent lines (>or=1 mm) were observed. So far, a luxation of the prosthesis has not occurred and all implants are still in-situ. However, a dorsal tenoarthrolysis had to be performed in 3 patients. CONCLUSION: The results of this study show a high rate of patient satisfaction with a significant pain reduction. A missing osteointegration may be an explanation for the radiological results. The prosthesis has to be closely monitored in the future. Long-term results with a higher number of patients are necessary. A central registry for finger implants is recommended.

Carbon↗

PubMedDate not supplied

[Is there evidence in evidence-based medicine? A comparison of common gradation systems and critical evaluation].

AIM: Evidence-based medicine is still discussed controversially. The current literature offers a huge amount of tables, recommendations and modifications for the levels of evidence and degrees of recommendations. The scientist who is critical of new techniques and who wants to continue his education might be confused by the different recommendations. Unfortunately, the gradation of the recommendations is not always cited which has led to the controversially held discussion about evidence-based medicine. It was, therefore, the aim of the current article to present the most often used gradations and to discuss them critically. METHOD: In the current study we performed an analysis of the currently used recommendations and gradations in evidence-based medicine and discussed them critically. RESULTS: The great number of the available divisions to evidence-based medicine are often technical and partially differ considerably. An unambiguous assignment of the evidence classes and of recommendation degrees can only succeed if the source is indicated clearly. CONCLUSION: As far as the authors are concerned, the confusing status of evidence-based medicine makes one gradation necessary, which should be accepted and used worldwide.

Evidence-Based Medicine↗

PubMedDate not supplied

[The lumbar ligamentum flavum. Anatomic characteristics with reference to microdiscotomy].

One important step in lumbar discotomy is the safe penetration and exact partial removal of the Lig. flavum. This is a crucial prerequisite for the selective and gentle removal of prolapsed and sequestrated intervertebral disc tissue. Extensive lancing of the Lig. flavum should be avoided, to minimize intraoperative and postoperative complications, such as injuries to the nerves and the Dura mater, instabilities, bleeding and scarring. As there has up to now been insufficient information on the anatomy of the Lig. flavum especially regarding microdiscotomy, an analysis of the Ligg. flava L2/L3 to L5/S1, guided by this aim, was carried out on 36 corpses kept in formaline (16 f, 20 m; 52-78 y). Preparations showed the lumbar Ligg. flava to be embodied in the Foramina interarcualia in a characteristic configuration. There also proved to be defined insertion areas on the laminae of the vertebral arches, which must be taken into consideration during the operative exposure. The Lig. flavum rises from the cranial vertebral arch from the ventral surface of the lamina (6.8 mm) whilst the insertion area on the caudal lamina covers the dorsal and the ventral surface. The extent at the ventral surface is 2.2 mm in average. Taking the insertion proportions into account we would suggest the Lig. flavum to be divided as follows: Pars interspinalis, which clearly differs from the Lig. interspinale (and from the M. interspinalis), and which houses venous anastomoses in its dorsal, ridge-shaped extension. Pars interlaminaris, which starts at the laminae and constitutes the target area for flavotomy in its lateral section, and Pars capsularis, which merges into the capsular structures of the facets. In all levels examined, there proved to be dorso-ventrally a typical change in the direction of the course of the fibres in the Pars interlaminaris. Whilst the direction of the fibres dorsally is oriented cranio-medially to caudo-laterally at an angle between 15 degrees and 30 degrees to the median line, the ventral fibres of the Lig. flavum are strictly aligned cranio-caudally. The changes in the directions of the fibres are continuous with the fibres being very closely intertwined, without there being any spatium at all. The texture of the Lig. flavum is, therefore, a mirror image of that of the autochthonuous muscular system of the back, even if the overlapping angle area is considerably smaller. The different segment levels show a segment-specific thickness profile. The analysis has provided anatomic information about the Ligg. flava L2/L3 to L5/S1. These data represent important prerequisites for a selective, gentle and safe intraoperative procedure for discotomy.

Aged↗

PubMedDate not supplied

[Sonographic studies of the lateral ligament of the proximal ankle joint in recent ligament rupture and chronic ligamental instability].

For diagnosis of instability in case of ruptures of the lateral ankle joint ligaments a special ultrasound examination technique was established. In 41 patients with acute ruptures and 8 patients with chronic instabilities a prospective preoperative sonographic instability-testing was performed and compared to intraoperative result. A sensitivity of 0.96 for injuries of the lig. fib. tal. ant. and 0.79 for the lig. fib. calc. proves the exactness of this method. This technique is easy to perform and the result can be documented. This examination is accepted by the patients.

Ankle Injuries↗

PubMedDate not supplied

[Ultrasound morphologic criteria in evaluating meniscus changes--an experimental study].

Experimental data and clinical experience with ultrasonography have demonstrated good results in the evaluation of internal derangements of the knee. But the value of ultrasound of the menisci still is controversial. The following investigations compare sonography with histologic results. In a water bath 64 cadaveric menisci were examined with a 5 MHz phased array sector scan. Pathologic conditions like natural or artificial tears, meniscal degeneration and crystal deposition diseases gave different echoes. In cases of vertical meniscal tears, a sharp and bright line-echo is seen on the screen. Due to this consistent reflexion, different types of meniscal tears cannot be differentiated by ultrasound. Severe degrees of meniscal soft tissue degeneration, proven histologically, were shown as hypoechoic areas. Following this experimental results, sonography is a useful modality in the diagnosis of meniscal disorders.

Adult↗

PubMedDate not supplied

[Basic problems in the treatment with functional knee orthoses].

An indication for functional knee-orthoses is given especially with ACL-insufficiency and after ACL-operations. Analyses of biomechanical examinations demonstrate difficulties in realizing the joint movement of the knee in detail and imitating it with knee-orthoses. An anamnestic investigation and clinical examination of sportsmen and -women, using functional knee-orthoses due to ACL-insufficiency (24 Lenox-Hill, 25 C.Ti., 38 Donjoy), demonstrate problems in practical usage of these orthoses. Problems especially arise from dislocation of the orthoses' joints and a deficient protection against anterior tibial translation. Thus leading to evident giving-way events though using a knee brace in 68% of these cases. In the tested knee-orthotic-devices problems in usage are independent of the kind of mechanical joints of the orthoses. The clinical examination should prove an application of the orthosis without pressure and only little distal dislocation.

Adult↗

PubMedDate not supplied

[Characteristics of an intervertebral disk herniation in spondylolisthesis].

Treatment of intervertebral disc herniation associated with spondylolisthesis is not different from common procedures concerning indication for surgery and surgical technique as far as sciatica is not related to retrolisthetic soft tissue or the posterior edge of the vertebral body. In a case of a disc herniation L5/S1 and an olisthesis grade I with radicular pain L5 a microdiscectomy of the prolapse and parts of the retrolisthetic soft tissue was performed. An immediate reintervention was necessary due to postoperative symptoms of paralysis. Derangement of the retrolisthetic soft tissue was found to cause the increased L5-symptoms.

Adult↗

PubMedDate not supplied

[Follow-up following Lelièvre's method of metatarsal head resection].

From 1975 to 1987 on 107 cases of severe deformities of the forefoot a resection of the metatarsal heads according to the method of Lelièvre was performed. As to the success of this method special features of this operation and especially the requirements of postoperative treatment will be explained. Possible complications of healing will be detailed. The procedure of resecting the heads of the metatarsal bones according to Lelièvre seems to be recommendable in order to prevent immovability, especially in case of advanced inflammable alterations of the joints in the forefoot.

Follow-Up Studies↗

PubMedDate not supplied

[Torsion effects of shoe soles. A biomechanical viewpoint].

Requirements concerning the location of the top of shoe-sole rolls are formulated on the basis of the physiological sequence of movements in the step, the aim being to ensure a functionally correct sequence of movements, corresponding to the condition to be treated. Special attention should be paid to adverse torsion effects caused by inappropriate positioning of the rolls, since the torsion has negative effect on the gait pattern.

Ankle Joint↗

PubMedDate not supplied

[Analysis of orthopedic specialty knowledge and comparison of 2 written test methods].

QUESTION: What about the knowledge of specific orthopaedic subjects in medical education as tested with mc-questions and open-ended questions? METHOD: 524 medical students were evaluated by a questionnaire survey to determine the state of orthopaedic knowledge in different periods of medical education. With the same questionnaire the use of two different types of written tests of knowledge (multiple choice questions and open-ended questions) has been tested and the results have been compared. The students participating in the orthopaedical practical (6th clinical semester) have been tested before and after the practical, given as pretest and posttest. RESULTS: The results show that the orthopaedic knowledge corresponds to the educational level so that during medical formation, there is a gradual knowledge gain. Comparison of the results of the pretest and the posttest reveals that the highest knowledge gain occurred during the orthopaedic practical. For all groups candidates performed better in mc-questions than in open-ended questions. Likewise in all groups, open-ended questions were found to be more difficult than the mc-questions. CONCLUSIONS: To summarize it may be concluded that there is a gradual orthopaedical knowledge gain during medical formation. It was found that students gain a considerable part of their technical knowledge during the practicals. Both mc-questions and open-ended questions are useful to measure this knowledge gain where there are hints that open-ended questions give a more accurate assessment of the actual knowledge. The pre- and posttest setting can provide both teachers and students with feedback regarding the realization and acquisition of instructional contents.

Curriculum↗

PubMedDate not supplied

Efficacy of lumiracoxib in osteoarthritis: a review of nine studies.

Lumiracoxib is a cyclooxygenase-2 selective inhibitor in development for the treatment of osteoarthritis (OA), rheumatoid arthritis and acute pain. We reviewed nine clinical studies of 1-52 weeks' duration demonstrating the efficacy of lumiracoxib in OA. Male and female patients aged > or = 18 years with primary OA of the hand, hip or knee received lumiracoxib, placebo or active comparators (diclofenac, celecoxib or rofecoxib). Lumiracoxib provided consistent reductions in OA pain intensity and improvements in the patient's global assessment of disease activity and functional status (assessed using the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire or the Australian/Canadian OA Hand Index). These results were superior to placebo and similar to the active comparators tested. In addition, lumiracoxib was consistently superior to placebo and generally similar to active comparators in terms of the new Outcome Measures in Clinical Trials and Osteoarthritis Research Society International criteria. These were used to provide a single measure of response to treatment, taking into account pain, the patient's global assessment of disease activity and functional status.

Diclofenac↗

PubMedDate not supplied

Molecular evidence for local denervation of paraspinal muscles in failed-back surgery/postdiscotomy syndrome.

A study was performed to analyze whether local denervation of the medial branch of the dorsal ramus of the lumbar spinal nerve occurs in a patient with postoperative failed-back surgery syndrome/postdiscotomy syndrome (FBSS/PDS). We investigated the effect of the loss of innervation of the multifidus muscle on neuronal nitrite oxide synthetase (n-NOS) and endothelial nitrite oxide synthetase (e-NOS) applying realtime RT-PCR and immunohistochemistry. Our study demonstrates a substantial reduction of n-NOS expression, supporting the view that local denervation of the multifidus is involved in the pathology of FBSS. No regulation of e-NOS was detectable. Interestingly, this change is region-specific and does not occur throughout the entire multifidus segment. This result supports the hypothesis that local denervation of the multifidus muscle is involved in the pathology of FBSS/ PDS.

Aged↗

PubMedDate not supplied

Low density of CD1+ cells in the synovial tissue of patients with rheumatoid arthritis.

OBJECTIVE: CD1 molecules present microbial and self glycolipid antigens to a defined T cell subset with features of natural killer cells. CD1 molecules are up-regulated by inflammatory stimuli such as GM-CSF, and we would expect to find increased CD1 expression in the synovium of patients with rheumatoid arthritis (RA) as compared to osteoarthritis (OA). This study was initiated to compare the density of CD1a+, CD1b+, and CD1c+ synovial cells in RA and OA patients. METHODS: Expression of CD1a+, CD1b+, and CD1c+ molecules in synovial tissue was assessed by semiquantitative immunohistochemistry. For comparison, serological, functional, and typical immunohistochemical markers of inflammation were detected. RESULTS: Although patients with RA as compared to OA had highly significantly increased signs of inflammation, the density of CD1a+, CD1b+, and CD1c+ synovial cells was similar This was also true for the density of CD1+ cells in relation to that of activated CD163+ macrophages. There was a high correlation between the densities of CD1a,b,c positive cells, which suggests the existence of similar regulatory pathways. In a combined analysis of RA and OA patients, there existed a negative association between prior NSAID therapy and the density of CD1a+, CD1b+, and CD1c+ synoviocytes in relation to CD163+ macrophages. This is interesting because a similar immunosuppressive aspect of NSAID has never been shown before and this might represent a hitherto unrecognized immunosuppressive aspect of NSAID. CONCLUSION: Considering the high synovial inflammation in patients with RA, the densities of CD1a+, CD1b+, and CD1c+ synovial cells were low compared to patients with OA. Further studies in RA patients are needed to clarify whether a defect in CD1 regulation may exist. Such a defect may lead to an insufficient immune response against microbial glycolipids, which would support smoldering or repeated inadequately responded infection.

Adult↗

PubMedDate not supplied

[Epiduroscopy with access via the sacral canal. Some constructional equipment requirements from the anatomic and biomechanical viewpoint].

To ensure optimal mechanical functioning of the vertebral column, intact symmetry of its bony and muscular elements is mandatory. With this in mind, the need to reduce the invasiveness of spinal surgery is even greater than that applying to surgery in general. To avoid bony or muscular damage during surgery, in particular in the case of the segments L4/L5 and L5/S1-which are particularly prone to intervertebral disc rupture-laser discotomy procedures, with introduction of instruments via the sacral canal during epiduroscopy are presently being developed. Preliminary experiments on human corpses have demonstrated the practicability of the technique, but specially designed instruments have yet to be developed for use in patients. In an attempt to define the conditions of important for the design of the instrument, we have carried out a morphometric analysis of 100 sacral bones (56 females; 44 males). The configuration of the sacral canal is described in quantitative terms, and the results used to determine the diameters and curvatures of the instruments needed for laser discotomy.

Aged↗