The in vitro effect of a fish oil-derived lipid emulsion (omega-3) on the superoxide anion production during the respiratory burst (RB) of human neutrophils was compared to a LCT lipid (Intralipid), and an LCT/MCT emulsion (Lipofundin MCT). The effects of two concentrations (60 and 600 micrograms/mL) were evaluated by rhodamine in a flow cytometer. The RB was induced either by stimulation with Escherichia coli (E. coli) or by priming with TNF-alpha and FMLP stimulation. The results (mean +/- SD%, P < 0.05) were compared to positive control responses (RB without lipids). omega-3 (60 micrograms/mL, -8.2 [9.3]%; 600 micrograms/mL, -9.6 [11.1]%) and LCT (600 micrograms/mL, -8.0 [9.3]%) significantly suppressed the RB after stimulation with E. coli. LCT/MCT increased the RB after E. coli (60 micrograms/mL, 15.7 [15.4]%; 600 micrograms/mL, 42.7 [21.4]%) as well as after TNF-alpha/FMLP stimulation (600 micrograms/mL, 27.4 [23.7]%). The in vitro influence of parenteral lipid emulsions on the superoxide anion production of human neutrophils is dependent on the length of the fatty acid molecule.

Drug Combinations↗

PubMedDate not supplied

[Late outcome after implantation of the PFC modular knee system].

AIM: The objective of the current, prospective study was the evaluation of long-term results after total knee arthroplasty with the PFC-Modular-knee system. METHOD: A total of 514 total knee arthroplasties were implanted between 1991 and 1994 in 248 female and 55 male patients. Their average age amounted to 62.4 years and 449 of them (87.4%) were re-investigated within the first half-year of 2000. Clinical and radiological data were evaluated according the recommendations of the American Knee Society. RESULTS: Late complications were observed in 6.5% of the cases. They consisted of prosthetic loosening (13 knees), patella problems (11 knees), instability (2 knees), periprosthetic fractures (2 knees), and one prosthesis fracture, 18 patients complained about a therapy-resistant, chronic pain syndrome. These findings lead to revision arthroplasty in 15 cases (3.3%). Preoperative American Knee Society Score values were on average 33, 35 an 17 points and improved to mean values of about 85, 79 and 5 points. Radiological signs of prosthetic loosening were observed in 12 cases (2.7%). CONCLUSION: Long-term results after total knee arthroplasty with the PFC-Modular-knee system showed a significant improvement in the patients' complaints and clinical findings at an average of 7.8 years postoperatively. Complication and revision rates of 6.5% and 3.3%, respectively, were low when compared with the international literature and--apart from this--decreased in the course of the observation time.

Aged↗

PubMedDate not supplied

[Results of the uncemented total hip arthroplasty in avascular necrosis of the femoral head].

AIM OF THE STUDY: The results from 56 patients with osteonecrosis of the femoral head who underwent 66 uncemented total hip replacements were analyzed and compared with current reports in the literature on cemented endoprosthesis. METHODS: In the retrospective study in 30 of those cases the Zweymüller and in 25 cases the HA-coated ABG prosthesis were used. In addition the results of 11 patients with a polyethylene Endler cup in combination with a Zweymüller stem are presented. The mean age at surgery was 48 years, the mean follow-up was 5.9 years. Clinical examination, registration of the Merle d'Aubigné score and a radiological examination were performed. RESULTS: The clinical results did not show any differences between the used prostheses. A more favourable outcome with regard to the Merle d'Aubigné score was demonstrated for the Zweymüller and ABG prostheses. No loosening of the stem was found. Revision as a consequence of aseptic loosening of the acetabular component was done in 7,5 % (27,3 % of the Endler cups and 8 % of the ABG cups). 20 % of the patients with an ABG prosthesis showed acetabular osteolysis of various degrees. This seems to be correlated with an increased polyethylene wear. CONCLUSION: Recent reports in the literature about a favourable outcome in uncemented total hip arthroplasty in osteonecrosis of the femoral head can be confirmed. The unsatisfactory results of the Endler cup indicate that established types of endoprostheses should be preferred.

Arthroplasty, Replacement, Hip↗

PubMedDate not supplied

[Musculoskeletal shock wave therapy--current database of clinical research].

During the past decade application of extracorporal shock waves became an established procedure for the treatment of various musculoskeletal diseases in Germany. Up to now the positive results of prospective randomised controlled trials have been published for the treatment of plantar fasciitis, lateral elbow epicondylitis (tennis elbow), and of calcifying tendinitis of the rotator cuff. Most recently, contradicting results of prospective randomised placebo-controlled trials with adequate sample size calculation have been reported. The goal of this review is to present information about the current clinical database on extracorporeal shock wave treatment (ESWT).

Calcinosis↗

PubMedDate not supplied

[Analysis of acetabular changes in Morbus Perthes disease with radiomorphometry].

AIM: Decreases in depth and irregularity are typical changes of the acetabulum in patients with Perthes disease and develop secondary to the femoral head involvement. Optimal timing of therapy plays an important role to prevent these secondary changes. The present study investigates the influence of the amount of femoral head involvement and the patients' age on the acetabulum and the outcome. METHODS: 66 patients with 76 affected hip joints were included in the study. 20 hips had a conservative therapy, 22 an operative therapy (IVO). 34 hip joints underwent a conservative therapy at first, followed by an operative intervention. The radiomorphometric analyses at the time of diagnosis, pre- and postoperatively and at follow-up were performed with epiphyseal ratio, acetabular ratio and acetabulum-head ratio. At the time of diagnosis the patients were classified with the Catterall classification, at follow-up with Mose classification. RESULTS: Independent from therapy there was a correlation of the parameters with Catterall classification over the whole course, i.e., the higher the Catterall group the worse the parameter at the time of diagnosis as well as at follow-up. Operatively treated patients with Catterall IV tended towards a worse result of the epiphyseal ratio whereas they achieved better results in the other parameters compared to conservatively treated patients. Catteral I and II patients achieved good results. CONCLUSION: Operative treatment of the higher Catterall groups seems to be more effective than conservative therapy. Secondary changes of the acetabulum develop in proportion to the amount of femoral head involvement.

Acetabulum↗

PubMedDate not supplied

[Intra- and postoperative risk analysis after lumbar intervertebral disk operation].

PURPOSE: To evaluate the perioperative risks for lumbar disc surgery. MATERIALS AND METHODS: Over a 10-year period 558 patients (mean age 45, range from 18 to 83 years; 62.7% male, 37.2% female) underwent conventional lumbar disc nucleotomy (69.4% mono-, 27.3 bi-, and 3.3% tri-segmental) for the first (84.4%), second (12.3%), third (2.3%) or more (1.0%) time. Main levels operated were L4/L5 in 56.3% and L5/S1 in 35.3%. In 63.9% there was a preoperative motor deficit. Before the operation and until 3 months after the operation all complications were recorded. RESULTS: In 115 (20.6%) of our patients intra- and/or postoperative complications were observed. Of these 115 patients 33 (5.9%) had slight complications (i.e. urinary tract infection, GI tract disturbance, local irritation of the wound), 57 (10.2%) had moderate complications (i.e. respiratory tract infection, superficial wound infection, dural tear), and 25 (4.4%) suffered from severe complications (i.e. deep vein thrombosis, pulmonary embolism, increase of the neurological dysfunction, additional operation because of a complication). Only in severe complications the hospital stay was prolonged (from a mean of 21 days to a mean of 33 days, p < 0.05). Our analysis showed a doubling of the complication risk in patients older than 75 compared to patients younger than 40 years. Multiple regression analysis revealed significant influence of concomitant diseases like diabetes mellitus and hepatitis (p < 0.01). CONCLUSION: 25 or 4.4% of all our patients were confronted with severe complications. The indication for nucleotomy should be weighed especially careful in old patients with diabetes mellitus or hepatitis.

Adolescent↗

PubMedDate not supplied

[Long-term treatment outcome in ventral and combined ventrodorsal spondylodesis in the surgical therapy of scoliosis].

We report on 48 patients with a mean postoperative follow-up of 7.7 years. 9 patients underwent simple anterior derotation spondylodesis (VDS), 31 patients were additionally fused with posterior Harrington spondylodesis. In 7 of 8 patients the Dwyer compression spondylodesis (DCS) was completed with the Harrington instrumentation. 2 of 3 scoliosis were idiopathic, the residual cases were mainly neuromuscular. The primary curve (preoperative mean: 69.9 degrees) was initially corrected by 62.8% and sustained a loss of correction of 7.6 degrees resp. 10.9% during long-term follow-up. The long-term loss of correction was maximal after DCS showing 10.4 degrees (14.4%), on the average, and minimal after combined VDS and Harrington spondylodesis showing 6.9 degrees (9.3%). After simple VDS the long-term progression of the curve was 7.0 degrees (12.9%). In this group the initial correction was above-average high showing 76.4%. The main loss of correction occurred during the first 2 years after surgery. The long-term correction stability did not show significant differences between simple VDS and combined antero-posterior instrumentation. After anterior instrumentation of the primary curve the secondary cranial nerve spontaneously straightened up by 30%, on the average, and remained stable in the long-term. The anterior instrumentation of the spine lead to a mean loss of lordosis of 13.6 degrees which in the long-term additionally increased by 6.4 degrees due to the anterior epiphyseodesis effect. In 17 patients (42.5%) 24 fractures of the 3 mm-threaded VDS-compression rod occurred. In case of single rod fractures no higher loss of correction or differences in incidence of pain were observed in comparison to intact implants.

Adolescent↗

PubMedDate not supplied

[Comparison of the prognostic value of the Catterall and Herring classification in patients with Perthes disease].

QUESTION: Investigation of the predictive value of the Catterall- as compared to the Herring-classification in patients with Perthes disease. METHOD: A radiological follow-up study including 53 patients with a total of 59 affected hips was carried out. In the initial diagnosis the Catterall-, Waldenström- and Herring-stages were assessed. The epiphyseal ratio, the head-neck ratio and the lateral subluxation were measured and compared at the time of diagnosis, fragmentation stage and in a follow-up examination, which was carried out 4, 9 years after diagnosis on the average. The results of the follow-up examination were assessed using the Mose-classification and compared as well. In addition the two classifications were compared as to the necessity of an upgrading. RESULTS: Both classifications yielded similar descriptions of the radiomorphometric course. There was a good correlation between the results of Herring A and Catterall I, Herring B and Catterall II and III and Herring C and Catterall IV. Upgradings were necessary in the Herring- and the Catterall-classification in 21 cases, and 18 cases, respectively. CONCLUSION: The predictive values of both classifications are comparable.

Adolescent↗

PubMedDate not supplied

[Results of the surgical treatment of tuberculous spondylitis].

Between 1972 and 1992 91 patients with tuberculous spondylitis were treated in the orthopaedic departments of the Universities of Münster and Mainz. The age of the patients at the time of operation was 41 years and 7 months on the average. The tuberculous spondylitis was mostly located in the lower dorsal and upper lumbar spine. Indications for a surgical treatment were the acute spondylitis, the deformation of the spine and imminent or already existing neurological deficiencies. The number of removed vertebrae averaged between 2 and 7. For the ventral spondylodesis we mostly used iliac or tibial bone-grafts. The own results are discussed in relation to the literature, especially the different therapeutic regimes are regarded.

Adolescent↗