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Biomedical subjects

J Heine

Publications and source records attributed to J Heine.

At least 73 records · Page 4Linked to original sources
PubMed1998

Revision resurfacing knee arthroplasty for aseptic loosening.

This re-investigation presents our experience with revision resurfacing knee arthroplasty caused by aseptic failure. The evaluation of the results should elucidate the benefit of revision, its complications as well as the impact of the implant type used. The study involved 36 patients whose primary resurfacing knee prostheses failed by aseptic loosening. The rather elderly patients (average 68.3 years) underwent revision 6 years later on average. In 30 cases (83.3%), arthroplasty could be repeated with resurfacing implants, whereas the use of hinge prostheses was unavoidable in 6 knees (16.7%). After an average of 7 years later, 30 knees were re-investigated according to the Hospital for Special Surgery (HSS) scoring system. Results were compared with the HSS values prior to revision. Complications and revised implant survivorship were reported chronologically. The revision knees had a 80% incidence of improved HSS score. In 73.3% the outcome was graded as good or even excellent. In contrast, scoring values before revision were dissatisfying without exception. The early complication rate after operation was 25%. Persisting pain, instability and limited mobility led to repeated revision in two cases and arthrodesis of one of the knees. The outcome of revision after 7 years revealed a remarkable early complication rate. Nevertheless, good or excellent results could be scored after implantation of PFC, PFC-modular, TC and TCIII prostheses.

Adult↗
PubMed1998

Effect of lung allograft ischaemia duration on postreperfusion graft function and postoperative course.

Lung transplantation is limited by the effects of ischaemia. Previous clinical studies related graft ischaemia duration to post-operative pulmonary function in the ICU, morbidity, and overall survival. This report describes the intraoperative pulmonary allograft function immediately after reperfusion. 23 lung transplantations (15 bilateral, 8 single) were analysed. Donor selection and organ procurement were identical. After pulmonary vasodilation with prostacyclin, allografts were flush-perfused with cold modified Euro-Collins solution. Mean duration of lung ischaemia was 255.1 +/- 35.1 min (190-314 min). Ischaemia times did not differ with respect to the recipient's disease or the use of extracorporeal circulation. After reperfusion, oxygenation indices deteriorated in 73.9% of patients compared with the native lungs (313.4 +/- 163.5 vs 427.2 +/- 96.1, p = 0.006). Linear regression analysis and subgroup analysis both revealed a significant influence of the duration of allograft ischaemia on early transplant function. Ischaemia of more than 4 hours resulted in an acceptable but significantly lower PaO2 (254.9 +/- 143.3 mmHg vs 463.0 +/- 149.2 mmHg, p = 0.011). However, mean time until extubation and time spent in the ICU were not affected. It is concluded that flush-perfusion of the lung with modified Euro-Collins solution provides reliable preservation of lung function up to four hours. Longer ischaemia, up to six hours, is followed by an acceptable but progressively reduced early transplant function.

Adult↗
PubMed1998

Remifentanil, fentanyl, and alfentanil have no influence on the respiratory burst of human neutrophils in vitro.

BACKGROUND: Anaesthetic agents inhibit certain functions of human neutrophils. The respiratory burst (RB) enzyme in the plasma membrane of neutrophils leads to the production of superoxide anion. The oxygen radicals are responsible for killing phagocytised micro-organisms. We investigated the in vitro influence of remifentanil, fentanyl, and alfentanil on the respiratory burst of human neutrophils. METHODS: For the flow-cytometric evaluation, leukocytes were obtained as supernatant following sedimentation and were incubated with the tested drugs. The concentrations in vitro were adjusted to conform to the plasma concentrations reported for anaesthesia and also to 10-fold higher concentrations. The RB was measured by intracellular oxidation of dihydrorhodamine to fluorescent rhodamine after induction of phorbol-myristate-acetate (PMA), Escherichia coli (E. coli) or priming by tumour necrosis factor alpha followed by stimulation of n-formyl-methionyl-leucyl-phenylalanine (TNF-alpha/FMLP). In order to exclude prestimulation of the neutrophil granulocytes, negative controls were carried out. Propidium iodide (PI) was added for viability discrimination immediately prior to flow cytometry measurement. RESULTS: Regardless of the triggering agents chosen (PMA, E. coli, TNF-alpha/FMLP), remifentanil, fentanyl, and alfentanil had no significant effect on the neutrophils' respiratory burst even in concentrations which were higher than those encountered during in vivo conditions. CONCLUSION: With respect to peri- and postoperative risk of infection, anaesthetics and analgetics with no inhibiting effect on neutrophil function should be used. These results show that remifentanil, fentanyl, and alfentanil do not influence the neutrophils' respiratory burst in vitro.

Alfentanil↗
PubMed1998

Long-term results after Mitchell osteotomy in children and adolescents with hallux valgus.

The current study elucidates the quality of long-term results after hallux valgus correction by Mitchell osteotomy in children and adolescents. Eight female and 1 male hallux valgus patient with a total of 16 bunion deformities underwent a Mitchell procedure in the period 1970 to 1985, and were reinvestigated in December 1994 (at an average of 16 years later). Their ages at operation ranged from 9 to 20 years (average 16 years). Patients' data were subdivided into subjective and objective criteria. Subjective parameters such as pain, shoe fitting, mobility and cosmesis were assessed by interview. Objective data were obtained from reports, radiographs and physical examination. Owing to the lack of established and recommended scores, we developed our own evaluation pattern. Overall outcome was judged as good in 69%, satisfying in 12% and dissatisfying in 19% by both patients and surgeon. In our experience, Mitchell osteotomy is an appropriate method for young hallux valgus patients, especially in forefeet with rigid malformation or moderately severe hallux valgus and metatarsus primus varus. Extensive metatarsal shortening should be excluded preoperatively in order to avoid postoperative metatarsalgia.

Adolescent↗
PubMed1997

[Extracorporeal shockwave therapy in orthopedics. Positive results in tennis elbow and tendinosis calcarea of the shoulder].

Since the beginning of the 1990s scientific investigations on the use of extracorporeal shock wave therapy (ESWT) in the field of orthopedics have been carried out at the Orthopedic Department of the University of Mainz. Prospective studies demonstrated beneficial effects in chronic lateral humeral epicondylitis (tennis elbow), and in calcifying tendinitis of the shoulder in more than 50% of the cases. Additional indications for which positive results of prospective studies have been published during the past 2 years are plantar calcaneodynea and pseudoarthrosis. On the basis of the results achieved, it may be concluded that, for specific indications, extracorporeal shock wave therapy may now be taken out of the clinical testing stage and introduced into routine practice.

Calcinosis↗
PubMed1997

Inhibition of neutrophil respiratory burst and chemotaxis in vitro by thiopentone but not methohexitone.

Administration of high-dose barbiturates may be used as an appropriate adjunctive treatment for control of intracranial pressure. The thiobarbiturate, thiopentone, has been reported to increase the rate of nosocomial pulmonary infection. This may be a substance-related effect of thiobarbiturates and it may be clinically important in barbiturate-sedated patients with severe head injury. Thus, the effects of the dose-response relationship of two commonly used barbiturates (thiopentone and methohexitone) on two vital aspects of neutrophil function were tested. We studied the production of superoxide anion during the respiratory burst by means of a flow cytometric method, and we assessed N-formyl-methionyleucylphenylalanine-induced neutrophil chemotaxis using the results produced by specific migration. The concentrations of thiopentone and methohexitone tested in vitro were adjusted to conform to the plasma concentrations reported for anesthesia and also to 10-fold higher concentrations. Only thiopentone dose dependently decreased respiratory burst and N-formyl-methionyleucylphenylalanine-induced chemotaxis. Methohexitone produced minimal effects in both concentrations. It was demonstrated that thiopentone had a direct effect on the intracellular respiratory burst oxidase enzyme system. The postulated free radical scavenging capacity of thiopentone was ruled out.

Journal Article↗
PubMed1997

[Effect of remifentanil on respiratory burst of human neutrophilic granulocytes in vitro].

Recovery chances for severely ill patients have been significantly improved by the progress of intensive care medicine. The success of any therapy, however, is still jeopardized by postoperative infections and septic complications. In the early stage of bacterial infections polymorphonuclear leukocytes (PMNL) play a decisive role. After PMNL activation, the production of oxygen radicals during the respiratory burst (RB) denature the phagocytosed micro-organisms. Remifentanil is a new opioid which has been safely administered to various patient groups and shows pharmacokinetic advantages in comparison to the already established opioids. As some intravenous anaesthetics can influence PMNL functions, we analysed, by flow cytometry, the in vitro influence of clinically relevant remifentanil concentrations on the respiratory burst. In our study remifentanil had no influence on the respiratory burst of human PMNL in vitro, regardless of the RB triggering agents chosen.

Analgesics, Opioid↗
PubMed1996

Low-energy extracorporal shock wave therapy for persistent tennis elbow.

Fifty patients who suffered from persistent tennis elbow for more than 12 months, and were referred for surgical treatment, were assigned at random to 2 groups of low-energy extracorporal shock wave therapy. Group I received a total of 3000 impulses of 0.08 mJ/mm2; group II (controls) 30 impulses of 0.08 mJ/mm2. Follow up was after 3 and 12 weeks. We found no significant differences between the 2 groups before treatment, there was but significant relief of pain and improvement of function in group I with good or excellent outcome in 56% at the last evaluation.

Adult↗
PubMed1996

Flow cytometry evaluation of the in vitro influence of four i.v. anaesthetics on respiratory burst of neutrophils.

Exposure of neutrophils to anaesthetic agents may alter their functional characteristics and in patients undergoing long-term sedation this may be clinically relevant. We have investigated the in vitro influence of propofol, thiopentone, methohexitone and midazolam on phorbol 12-myristate 13-acetate (PMA)-induced respiratory burst of neutrophils by the intracellular oxidative transformation of dihydrorhodamine-123 to the fluorescent dye rhodamine-123 via flow cytometry. We tested in vitro concentrations similar to sedating, anaesthetic, 10-fold sedating and 10-fold anaesthetic plasma concentrations. All drugs showed similar inhibition of respiratory burst at sedating concentrations (1-6%). At anaesthetic concentrations, propofol produced significantly higher mean inhibition (7.3%) compared with thiopentone (4.5%) and methohexitone (0.9%). At 10-fold anaesthetic concentrations inhibition of respiratory burst by propofol was almost complete (90.8%) and significantly higher than that by thiopentone (29.2%) and methohexitone (1.8%). Methohexitone and midazolam had only minimal effects at all concentrations. The effect of the solvent of propofol (10% Intralipid) was similar to that of propofol. Thus suppression of respiratory burst of neutrophils by propofol may be caused by this lipid carrier.

Anesthetics, Intravenous↗
PubMed1996

Analgesic effect of extracorporeal shock-wave therapy on chronic tennis elbow.

We report a controlled, prospective study to investigate the effect of treatment by low-energy extracorporeal shock waves on pain in tennis elbow. We assigned at random 100 patients who had had symptoms for more than 12 months to two groups to receive low-energy shock-wave therapy. Group I received a total of 3000 impulses of 0.08 mJ/mm2 and group II, the control group, 30 impulses. The patients were reviewed after 3, 6 and 24 weeks. There was significant alleviation of pain and improvement of function after treatment in group I in which there was a good or excellent outcome in 48% and an acceptable result in 42% at the final review, compared with 6% and 24%, respectively, in group II.

Adult↗
PubMed1995

Biochemical bone markers compared with bone density measurement by dual energy X-ray absorptiometry.

In contrast to medical imaging, the biochemical markers allow a more frequent determination and are not as invasive as histomorphometric methods. We investigated biochemical markers of type I collagen compared with bone density measurements in 85 females between 41 and 89 years of age (median: 57 years). The bone density measurements were performed by dual energy X-ray absorptiometry (DXA) on the lumbar spine (L1-4). The bone density measurements were stated as a percentage of the norm. All patients were divided into three groups: I = <80%; II = 80-130%; III = >120%. Based on this classification the median concentration of the I-carboxyterminal propeptide of type I collagen in serum (S-PICP) as an anabolic marker of type-I collagen increased significantly with rising bone density: I 65.0 micrograms/liter (interquartile range: 52.1-78.0 micrograms/liter); II 85.9 micrograms/liter (52.1-115.5 micrograms/liter); III 81.4 micrograms/liter (62.0-101.0 micrograms/liter);P < 0.05. The concentration of urinary pyridinolines (U-PYR) as a marker for degradation of type I collagen decreased. The I-carboxyterminal telopeptide (S-ICTP) and osteocalcin (S-BGP) did not change. The multivariate regression analysis showed no relationship between between bone density and biochemical bone markers. Only the age significantly correlated negatively with bone density measurement. For a better assessment of type I collagen metabolism we created a "b-quotient" by dividing the sum of S-PICP and S-BGP by U-PYR. The median b-quotient increased significantly: I 1.55 (0.97-2.04); II 2.09 (1.57-2.86): III 2.46 (1.58-3.22); P < 0.05. Changes in bone metabolism cannot be identified by the determination of a single marker. However, the improved biochemical diagnostic measurement using the b-quotient may provide early information about the progression of a metabolic disorder within the interval of imaging.

Absorptiometry, Photon↗
PubMed1995

Extracorporal shock wave therapy for calcifying tendinitis of the shoulder.

During the past 2 years, 40 patients referred to the authors' hospital for persistent calcifying tendinitis of the shoulder were seen on prospective followup after undergoing a single extracorporal shock wave therapy. During a single therapy session, all patients received 1500 impulses of the energy density 0.28 mJ/mm2 in plexus anesthesia. Followup examinations were done at 6 and 24 weeks. In 62.5% of the patients partial or complete disintegration of the deposit was observed. Statistical analysis showed significant improvement both of subjective and objective criteria. According to the Constant score, 60% of the patients reached normal values, and 72.5% of the patients had no or only occasional discomfort. Only 6 patients (15%) reported no improvement at the 24-week followup.

Anesthesia, Conduction↗
PubMed1994

Metastatic instability at the proximal end of the femur. Comparison of endoprosthetic replacement and plate osteosynthesis.

A retrospective study was performed of the surgical treatment of metastatic lesions of the proximal femur in 50 patients. In 25 consecutive cases a megaprosthesis was implanted; compound plate osteosynthesis was performed in another 25 consecutive patients. Indications for surgical treatment were pathological fractures or, for prophylactic treatment, lesions of the femoral cortex exceeding 2.5 cm in diameter or affecting half the diameter of the bone or more. In all patients capable of walking preoperatively mobility was regained. Immediate full weight-bearing stability was obtained in all patients. Group analysis showed that the functional rating of the hip joint was unchanged, i.e., good or excellent, in all patients with compound osteosynthesis, compared to only 68% in the endoprosthesis group. Pain relief was excellent or good in 84% and 88% respectively. Dislocation of the tumor prosthesis occurred in 3 patients. Closed reduction was possible in 2 cases. Local recurrence was higher in the patients undergoing plate osteosynthesis, as was the frequency of tumor-related implant failure. Postoperative survival averaged 14.7 months and 12.1 months respectively.

Adult↗
PubMed1994

Operative management of epidural tumors of the spine.

Seventy-two patients with neoplastic involvement of the vertebral column were operated on between 1986 and 1991. In the course of 79 operations anterior decompression and stabilization alone were performed in 3 cases, while ventrodorsal spondylodesis was carried out in 10 individuals. The remainder of the patients underwent exclusively dorsal decompression and stabilization, mainly with the Cotrel-Dubousset instrumentation (CDI). No external spinal support was required following posterior fixation by CDI alone or in combination with ventral spondylodesis. Forty patients suffered from neurological deficits preoperatively, 20 of them being unable to walk, in most cases owing to severe vertebral collapse. Neurologic symptoms improved in 18 patients postoperatively. Median postoperative survival time averaged 11.5 months. In palliative surgery of the spine, posterior decompression and fixation using CDI permit most patients to retain ambulation without requiring external orthotics. The rate of postoperative complications is reduced by the introduction of CDI.

Adult↗
PubMed1994

[Toxic shock syndrome caused by Streptococcus pyogenes].

Necrotizing fasciitis and myositis due to Lancefield group A beta-haemolytic streptococcal infection is a medical emergency. Survival depends on aggressive early wound management as well as high-dose intravenous antibiotics. We report about a 28-year-old man with fulminant necrotizing fasciitis and myositis of his right arm, in whom many features of the toxic shock syndrome were present, including profound hypotension and renal failure. After extensive surgical debridement with amputation of his arm in combination with high-dose intravenous penicillin G the patient recovered from this serious infection.

Adult↗