[Idiopathic scoliosis--therapy with the Cheneau corset. Results of treatment of 69 patients with advanced scoliosis].
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Adolescent↗
Biomedical subjects
J Heisel
Publications and source records attributed to J Heisel.
The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments.
STUDY DESIGN: A retrospective study was performed of 182 revisions on failed back surgery syndrome from the years 1965 to 1990. OBJECTIVE: To analyze the reasons for failure of primary discectomy, the outcome of the revisions, and factors that influenced those outcomes. SUMMARY OF BACKGROUND DATA: The reported reintervention rates after lumbar discectomy range from 5% to 33% depending on the type of surgical procedure. The authors' former investigations reported a revision rate of 10.8% in evaluating 1500 lumbar discectomies. METHODS: Because the documentation was standardized, detailed data of all patients were available. To gain further information concerning the long-term results a questionnaire was used. Computer processing and statistical tests were performed. RESULTS: One hundred eighty-two revisions were performed on 136 patients. Forty-four patients (34%) were revised multiple times. Generally, recurrent or uninfluenced sciatic pain and neurologic deficiency or lumbar instability led to reintervention. Recurrent lumbar disc herniation mainly was found at the first reintervention. In multiple revision patients the rate of epidural fibrosis and instability increased to greater than 60%. In 80% of the patients the results were satisfactory in short-term evaluation, decreasing to 22% in long-term follow up (2-27 years). CONCLUSIONS: Laminectomy performed in primary surgery could be detected as the only factor leading to a higher rate of revisions. A trend toward poor results after recurrent disc surgery seems to be fateful because of the development of epidural fibrosis and instability. In severe discotomy syndrome, a spinal fusion seems to be more successful than multiple fibrinolyses.
Back↗
Demonstration of interleukin-1beta and interleukin-6 in cells of synovial fluids by flow cytometry.
Cytokine levels are increased in the synovial fluid of affected joints from patients with inflammatory joint diseases. The aim of our study was therefore to determine if and to what extent immmunologically defined subpopulations of mononuclear cells (MNC) in the synovial fluid are responsible for the increased levels of interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) in affected joints. Lipopolysaccharide (LPS) stimulated peripheral MNC were used as positive controls. While soluble IL-1beta (median 167 pg/ml) and IL-6 (median 508 pg/ml) levels were significantly elevated in the synovial fluids tested, IL-1beta and IL-6 were demonstrated by flow cytometry in only a small subpopulation (<=11%) of mononuclear synovial fluid cells in 7/13 patients. Our results suggest that elevated IL-1beta and IL-6 levels in the synovial fluid of inflammatory joints are derived mainly from cells in the synovial membrane and only to a minor extent from cells in the synovial fluid itself.
Arthritis, Reactive↗
[Synovectomy of the knee joint in rheumatoid arthritis. Follow-up studies].
A total of 156 synovectomies were performed to treat recurrent swelling of the knee joints in 148 patients with rheumatic diseases. The late results observed in 112 patients (72%) re-examined after an average follow-up period of 6.2 years are discussed. The subjective and objective findings in patients undergoing early surgery proved to be superior to those seen after late synovectomy. Also in comparison with a group of patients submitted to synoviorthosis, surgical synovectomy, in particular when carried out at an early stage, showed more favorable results. For this reason, should conservative treatment fail, and recurrent swelling of the knee joints persist, early surgical intervention ist recommended.
Arthritis, Rheumatoid↗
Is surface cooling effective for tissue preservation in free-flap surgery?
Effective tissue cooling can extend the period of safe ischemia. To determine whether the technique of surface cooling could produce an effectively low core temperature (4 degrees to 10 degrees C) in the flap core in a reasonable amount of time, bovine muscle/subcutaneous fat flaps, weighing 400, 800, and 2000 g, were brought to 37 degrees C and then surface cooled. Temperatures were then recorded every 5 min. All flaps were able to attain 4 degrees C in the core; the average times for the 400, 800, and 2000 g flaps to reach 4 degrees C were 136, 153, and 194 min, respectively. Although a clear inverse relationship existed between flap weight and effectiveness of core cooling, even relatively large flaps (2000 g) could still achieve sufficiently low core temperatures from surface cooling well within tolerable warm ischemia time. Concern for ischemia time generally should not interfere with efficient, orderly, free-flap surgery.
Animals↗
Sixteen-years' experience with ceramic hip prostheses.
The introduction of alumina ceramic combined with the self-locking principle by surface increase has many followers. There is no manufacturing company in the world that does not produce self-locking hip prostheses with ceramic components. Despite increased interim results with conventional prostheses by improved cement technique, the self-locking principle with wear resistant ceramic components is better, at least in young, active patients.
Adolescent↗
[Results of hip joint replacement with ceramics partial endoprostheses].
Report about our 5 years experience with cementless and cemented partial ceramic hip prostheses in altogether 58 cases. Indication, in old age, mostly in case of fresh or elder femoral neck fracture; in younger age, chiefly in case of partial femoral head necrosis and preserved cartilage of acetabulum. Typical complication of this type of prosthesis: early luxation, especially in case of acetabular dysplasia, which, therefore, has to be regarded as contraindication for hemiarthroplasty. Satisfying subjective and objective middle-term-results in older age. Failure of arthroplasty with necessity of later implantation of acetabular component only in two cases of osteoporotic bone destruction. In younger age, the results weren't that satisfying. Because of higher activity and strain there was a higher rate of wear of acetabular cartilage; twice, we had to perform later implantation of ceramic socket, up to now.
Adolescent↗
[Metabolic diseases of bones. Catamnestic study of the incidence and kind of problems in surgical treatment].
By a catamnestic study at Orthopedic Department of Homburg/Saar University Clinic 156 courses of variant constitutional diseases of bone (1965-1986) were recorded. The frequencies of primary spontaneous fractures, fracture healing-disturbances, refractures and pseudarthroses after operative management of bone lesions or correction-osteotomies were of special interest. While there was no increased rate of traumatic or spontaneous lesions or prolongated healing-rate in case of Rickets and M. Ollier, those complications with need of osteosynthetic measures were more often due to M. Paget and M. Jaffé-Lichtenstein. As expected, osteogenesis imperfecta represented the highest rate of osseous lesions; an uneven situation was found among multiple/generalized epi- and metaphyseal dysplasias.
Adolescent↗
[Technic and results of covered ankle joint arthrodesis with autocompression angle plates].
In 1973, Mittelmeier introduced a new technique of arthrodesis of the ankle joint by internal osteosynthesis using an autocompression plate with additional compression screwing of fibula to tibia and talus in order to avoid the disadvantages of previous operative methods of arthrodesis by bone splinting or external fixation (longer cast immobilisation, handicap by external fixator, danger of bone hole osteomyelitis a.o.). Regarding this new technique, the fibula works as a petiolated well vascular bone chip which bridges the joint. Representation of the special operative technique of covered autocompression arthrodesis of the upper ankle joint rsp. - in case of special indication - the combined arthrodesis of the upper and lower ankle joint. Representation of our casuistry of 43 patients who underwent this operation. With the exception of one case (osteomyelitis recidivation with following pseudarthrosis) a fast bony consolidation of the arthrodesis was achieved. In the meantime the osteosynthesis material is removed in 35 cases. One third of the patients gets along with conventional shoes.
Adult↗
[Intra- and postoperative fractures in alloarthroplastic knee replacement].
In contrast to aseptic and septic loosening intra- and postoperative fractures of the femur rsp. the tibia represent rare complications of total knee replacement. Between 1971 und 1986 we implanted altogether 163 knee prostheses; 7 times (6 patients) happened a fracture of the femur or the tibia (3 times intra-, 4 times postoperatively). Those complications are described by special case reports. Intraoperative fractures are mainly referred to not very subtle operative technique. Concerning postoperative fractures prosthesis specific factors and non specific circumstances have to be differentiated.
Adolescent↗
[Indications for and results of primary and secondary radial head resection].
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Adolescent↗
[Animal experiment studies of callus formation by hydroxyapatite injection].
Hydroxy-apatite may be suspended well in liquid high-molecular gelatine. This renders possible an application by local injection. By means of experimental animal investigations in 64 rabbits it could be proved, that hydroxy-apatite stimulates osteogenesis and local callus formation when being injected at artificial bone defects. Gelatine on its own without any HA-grains only leads to a callus-free bridging of the bone defect. In case of an injection of the HA-suspensions to muscular soft tissue, no stimulation of the osteogenesis could be proved. It has to be concluded, that hydroxy-apatite stimulates osteogenesis. To achieve this effect, a direct contact to osteogenetic cells is necessary.
Animals↗
[Acute slipped femur head epiphysis. Causes--surgical treatment--results].
The juvenile slipped capital femoral epiphysis depends on a dysendocrinia during puberal acceleration. The weakening of mechanical stability of the epiphyseal cartilage leads in most of the cases to a slow, only in some cases to an acute dorsocaudal slipping of the capital femoral epiphysis. Representation of our own patients of Orthopedic University Hospital D-Homburg/Saar with altogether 27 acute slipped capital femoral epiphyses during the years 1965-1981. The early operative stabilisation seems to be most important for a good prognosis (danger of development of femoral head necrosis). The opening of the hip joint during the operation by a ventral capsulotomy facilitates the reduction and decompresses the haematoma. In consideration of the mostly slow beginning, in many cases an ideal correction could not be achieved in most of the patients. In contrast to the osteosynthesis by screws the growth in length is less influenced by using a lamellar nail or Kirschner-wires. In cases of an acute slipped capital femoral epiphysis a first conservative treatment with subsequent correction osteotomy does not seem to be justifiable, because the danger of femoral head necrosis raises drastically. In case of opportune operation and correct technique good to fair functional results can be achieved.
Acute Disease↗
[Animal experiment histologic and biomechanical studies of tissue tolerance and adhesiveness of bone cement containing carbon fibers and apatite].
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Adhesiveness↗
[Implant changes in sliding endoprostheses].
Analysis of 6 failures of resurfacing gliding prostheses of the knee with necessary exchange operations. By this procedure of exchange of the loosened parts of the alloplasty, a good functional result could be achieved with the exception of one case. Importance of careful preoperative indication of gliding prostheses of the knee, where axis deviations of the leg as well as instability of the collateral ligaments should be particularly observed.
Arthritis, Rheumatoid↗
[Significance of early meniscectomy in the etiology of severe arthritis of the knee].
With reference to 3579 meniscectomies performed in our clinic during 18 years as well as to cases with severe knee damage treated by arthroplasty, arthrodesis or correction osteotomy and their aetiopathological analysis with regard to previously performed meniscectomies, the following conclusions are drawn: Earlier meniscectomies seem to occur relatively often (up to 20%) in clinical cases of severe destructive processes in the knee e.g. knee arthritis. With reference to 3579 meniscectomies performed in this period this number is very low (1.34%) and - under statistical aspects - therefore not essentially important. The analysis of the cases of our clinic operated on by means of plastics, arthrodesis or correction osteotomies showed, that an earlier meniscectomy was performed because of static axis faults. These axis deviations were the main reason not only for the meniscopathy but also for the further development of knee arthritis. Cases of severe knee arthritis, who could be referred to an earlier meniscectomy (traumatic lesion) without any deviation of the leg axis were very rare. The rarity of the development of a knee arthritis after meniscectomy seems to prove that evidently there is no disadvantage of the mainly performed total meniscectomy compared to the subtotal procedure.
Arthritis↗
[Causes, therapy and results of operative treatment of recent and old acromioclavicular joint dislocations].
Osteosynthesis with wires and cerclages is the operative technique of choice in case of recent or old breaking of acromio-clavicular joint. In case of an old lesion of the acromio-clavicular joint syndesmoplasty should be performed only if direct suture of the ligaments is no longer possible. The so-called "allo-ligament" proved to be a failure because of the high rate of infections. The "Kirschner wires" should have a thickness of at least 1.5 mm. To avoid stiffness of the operated shoulder there should be an early active functional treatment. The removal of the osteosynthesis material should be performed only after complete healing of the ligaments (3-4 months postoperatively).
Acromioclavicular Joint↗
[Causes of rearthrotomies of the knee joint].
Report on 178 rearthrotomies of the knee joint in 158 patients. Most of these rearthrotomies became necessary subsequent to meniscus operations. A review of the literature shows that these are mainly persisting or recurring complaints appearing usually under the overall pattern of "irritable knee". The principal causes were found to be leftover meniscus residues; on rarer occasions degenerative meniscus regenerates were found, or other causes such as floating cartilage, damaged cartilage of the patella, and instabilities of the condyles and of the ligaments.
Adolescent↗