Biomedical subjects
Publications and source records attributed to J Heine.
We still do not know enough about the natural course of untreated idiopathic scoliosis although more knowledge would be desirable from the point of view of deciding on adequate conservative treatment or operative therapy. We present the natural course of 110 cases of marked scoliosis and 135 cases of slight, untreated scoliosis with respect to age, sex and localization of the curve. The results are compared to those of other authors.
Fourty-three cases with metastatic spinal cord compression were reviewed post-operatively to clarify the usefulness of the procedures concerning restoration of neurological function, and pain relief. Only patients with pathological spinal instability and neurological sequelae were included. Posterior decompression and stabilization was performed in all but six patients. All but four patients (91%) reported decrease of pain symptoms. Amelioration of neurological function was achieved in 58%. Re-establishment of walking ability was obtained in 57%. Post-surgery life expectancy averaged 11 months. In patients with widespread metastatic disease and/or multi-level instability of the spine restriction to palliative dorsal procedures is sensible. Post-operative ancillary treatment is necessary.
UNLABELLED: Inflammatory bowel disease (IBD) is associated with an increase in colon and rectal carcinoma. Immunosuppression after transplantation increases the incidence of certain types of tumors. PURPOSE: We reviewed the postoperative course of IBD patients who had undergone hepatic transplantation for primary sclerosing cholangitis to see whether there was an increase in the rate of colorectal neoplasms. METHODS: The charts of 44 patients from two institutions who had undergone a hepatic transplant for primary sclerosing cholangitis were reviewed. Of these 44 patients, 33 had IBD (32 chronic ulcerative colitis, 1 Crohn's). Of these 33 patients, 2 had previously undergone total colectomy/proctectomy and 4 died in the perioperative period. The remaining 27 patients had all undergone colonoscopic evaluation just prior to transplant. Postoperatively all patients were given prednisone, cyclosporine, and azathioprine. Minimum follow-up was 12 months; mean follow-up was 39 months. RESULTS: Three of the 27 patients (11.1 percent) developed early colorectal neoplasms (2 cancers, 1 large villous adenoma with severe dysplasia) at 9, 12, and 13 months post-transplant. All three patients were successfully treated with a total colectomy/proctectomy or resection of any remaining colon. These 3 patients had a mean 19-year history of IBD (range, 9-27 years), while the 24 patients without tumors had a mean 18-year history of IBD (range, 6-39 years). CONCLUSION: There is a subset of transplant patients with primary sclerosing cholangitis and IBD who rapidly develop colorectal neoplasms. Frequent surveillance is recommended for IBD patients in the post-transplant period.
50 patients with metastatic disease of the spine underwent dorsal decompression and stabilization with the Cotrel-Dubousset-Instrumentation from 1987 to 1991. Indications for surgical treatment were neurologic deficit, spinal instability, and/or pain resistant to medical or radiation treatment. No external orthotics were used postoperatively. Pain was relieved dramatically in 45 patients. Among 25 patients suffering from neurologic deficit preoperatively, 13 improved, 15 remained unchanged, whereas 2 developed an incomplete, transient paraplegia. 15 (7) patients were alive after 1 (2) years. Postoperative complications were frequent, but there were only 2 failures of the stabilization device requiring reoperation.
In this study we examined the feasibility of rebuilding a stable stapes superstructure for a new articulated ossicular chain by using bioactive ceramics. Dense hydroxylapatite and ceravital were tested in guinea pigs. The ceramic prosthesis was placed on the remnants of the footplate to create a bony connection without touching the tympanic membrane, thereby protecting it from relative movements. The implants were explanted together with the stapes footplate at six weeks and three months, respectively. Histologically, bony connections were found between all ceramic implants and the remnants of the crura even at six weeks and became more pronounced after three months.
Benign and primary malignant tumors of the spine require a ventral procedure to remove the tumor and to stabilize the spine. Experience in the last years has shown that sole laminectomy in children can no longer be recommended. An instrumentation of the spine to prevent kyphosis must be performed. The rate of pseudarthrosis was of course, high when the kyphosis was treated by an exclusive dorsal instrumentation. In patients with severe kyphosis a combined procedure with ventral and dorsal operation is necessary. Solitary metastases of cancer of the prostate, breast, and the thyroid gland show a better prognosis than metastases of cancer of the lung or the stomach. Thus metastases of the first group which also show a dependency on hormones, should be operated on by a ventral procedure, independent of the location of the tumor. In cases of multiple metastases and bad condition of the patient a ventral operation is not indicated. In these cases, a dorsal procedure with decompression and stabilization allows mobility of the patients until only few days before death. An implantation of instrumentations that include a transpedicular screwing can result in spreading of the tumor to the neighboring vertebrae. Therefore, this kind of operation should be the "ultima ratio".
A nine-year-old boy suffered an evulsion of the optic nerve as a result of being hit on the left eye with a stick. The anterior segment showed only superficial injury. Possible causes of optic nerve evulsion are discussed.
The author presents a case of tuberculous chorioretinitis in a patient with miliary tuberculosis. Miliary tuberculosis with ocular involvement has become rare, because with modern chemotherapy miliary spread can usually be prevented. The chorioretinal changes, which in this case were completely reversible, are described and illustrated with fundus photos and angiograms.
The natural history of scoliosis, or lateral curvature of the spine, was followed up in 135 patients (111 girls, 24 boys) for a total average period of 52.4 months. We observed patients with a curvature of between 5 degrees and 30 degrees none of whom had been treated specifically as orthotics or with electrical stimulation or by surgery. Two groups of patients with progressive curvature were differentiated: 1) in 62.2% of the patients the curvature progressed by more than 5 degrees during the entire observation period; 2) in 36% of the patients we found an increase in curvature by more than 5 degrees within one year. Another result of our study was that idiopathic scoliosis is particularly dangerous in young patients with a "0" Risser sign. Thoracic curvatures and double major curvatures were more liable to progress than lumbar and thoracolumbar curvatures. Even a small angle of curvature in young patients must be taken seriously.
A case of ocular melanosis with a 24-year follow-up is presented. On the basis of the course and the results of histologic findings (conjunctival biopsy) it was classified as benign acquired melanosis with pronounced junctional activity. The constantly changing clinical appearance, ranging from a deep black conjunctiva to ultimately white tissue, is described and discussed.
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The current report summarizes our experience with 77 patients with cancer of the pancreas treated over 3.5 years. Patients were not assigned to a definite group of therapy, but through the availability of different drugs and different types of treatment several comparable groups have evolved. All patients have received radiofrequency hyperthermia and chemotherapy, but in addition, some have received selective immune stimulation with one of two low-molecular-weight compounds. The data show that radiofrequency hyperthermia permits the use of a lower dose of chemotherapy, with an apparent response to treatment. This response is enhanced significantly by the addition of selective immune stimulation. A further, more rigorously defined study will be undertaken to confirm this data.
Human albumin 5% (HA), frequently used in paediatric anaesthesia as a human plasma substitute, could be replaced by hydroxyethyl starch 6% (HES) 40,000/0.5 provided its use would not entail any disadvantages but rather advantages instead. This problem was studied by examining 30 children (mean body weight 32.5 kg) in general anaesthesia. During about 3 hours of surgery the patients lost up to 15 per cent (approx. 400 ml) of blood volume. In a randomised study the blood loss was compensated either via HA or HES with 14 ml/kg body weight each, respectively. Blood pressure and pulse rate remained within the normal range. Haemodilution was represented by a drop in the erythrocyte count to about 3 million/microliter, haematocrit (HCT) to about 30% and haemoglobin to approx. 10 g/100 ml. Slight metabolic acidosis (Bodansky unit = -4 mmol/l) was found to be statistically not significant (= n.s.) with both methods, as was the difference in serum albumin and during serum electrophoresis. Serum [Na+] was reduced in those children who had been treated with HES, to 137.33 +/- 33.30 mmol/l; however, in those children who received HA with low sodium content (statistically significant difference = s.s.) the corresponding level was 134.15 +/- 2.36 mmol/l. Serum creatinine rose in each case from 60 to 80 mmol/l (s.s.), renal function being slightly impaired probably due to the anaesthesia and surgery. The value according to Quick's test and the partial thromboplastin time (PTT) remained in the normal range both with HA and HES treatment (in each case over 70% and below 25s, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
The Schnöllner operation for reduction of spondylolisthesis was performed through a transversal incision. After removal of the disc, two pedunculus screws with two different threads are inserted. Over these screws the reduction is performed against a slotted sacral plate. The operations were performed at the following levels: 48 at L5-S1, seven at L4-L5, and two at both levels. 70.8% of the patients had preoperative lumboischialgia, 23.3% lumbalgia. Postoperatively, 92.1% were without pain. Twenty-seven patients had preoperative sensory disturbances, while only five had such disorders five years after operation. New sensory disturbances occurred after operation in 11 patients, seven of these persisted. Before operation, 27 patients had pareses of the foot and toe extensors; after operation, ten of them. Paresis occurred in 12 cases, of which three persisted. In 13 cases the reposition was complete, in 17 cases the displacement after operation ranged from 11% to 30%. The lumbosacral angle was markedly diminished.
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We recently treated a patient with right ventricular myxoma and a clinical picture of pulmonary embolism and tricuspid valve obstruction who had successful removal of the tumor through the tricuspid valve via a right atriotomy.
Tracheal and conjunctival infections with Cryptosporidium were established in pigs by inoculation of oocysts into the trachea and onto the conjunctival sacs. The protozoa were found attached to epithelial cells by an electron-dense band and a folded, vacuolated feeder organelle. They were situated in a parasitophorous vacuole surrounded by a double-layered membrane covered by glycocalyx. Trophozoites, schizonts, merozoites, macrogametes and oocysts could be demonstrated. In addition to normal stages of the life-cycle, degenerate stages were found. The infections with Cryptosporidium were characterized by focal destruction and loss of epithelial cells. Numerous intraepithelial lymphocytes were associated with affected foci, as were infiltrations with lymphocytes, monocytes, and macrophages.