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Biomedical subjects

K Kunze

Publications and source records attributed to K Kunze.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Osteosynthesis of subtrochanteric femoral fractures with the dynamic condyle screw].

The dynamic condyle screw was originally designed for osteosynthesis of distal femoral fractures. Because of more favourable biomechanical facilities compared with the condyle plate we have been used the implant since 1987. This investigation is based on 40 patients with pertrochanteric, subtrochanteric as well as proximal diaphyseal fractures. The majority of the patients were mobilized early and reached full weight bearing latest after 3 months according to the fracture type. The most severe complications appeared with subtrochanteric fractures with lack of medial cortical support. There was a broken plate in 2 cases and a secondary spongiosa plastic was necessary in 3 cases to ensure bony consolidation. As the point of this investigation we will see a wider indication for primary spongiosa plastic and early secondary spongiosa plastic.

Adult↗
PubMed1992

Multimodal tests of cerebrovascular reactivity in migraine: a transcranial Doppler study.

Altered cerebral vasoreactivity (CVR) has been implicated in migraine. To test this hypothesis, we studied CVR as measured by transcranial Doppler ultrasound (TCD) in 11 migraineurs and 12 healthy controls of similar age. Mean flow velocities (MFV) in the middle cerebral artery (MCA) were recorded during a cognitive and two motor tasks. MFV in the posterior cerebral artery (PCA) were measured during photic stimulation and observation of complex images. The increase of MFV in the MCA during the cognitive task was greater in migraineurs than in controls (9.1% vs 5.0%; P = 0.06). The increase of MFV in both tests for PCA reactivity was significantly greater in migraineurs than in controls: 17.4% vs 9.9% for photic stimulation (P less than 0.05) and 20.3% vs 10.2% for observation of complex images (P less than 0.05). Owing to overlap of individual results, the discriminative value of both tests was unsatisfactory. The variability of flow velocities as measured by standard deviations of MFV was significantly greater in migraineurs than in controls during all tests of PCA vasoreactivity. Differences in CVR between migraineurs and normal controls may be detected by TCD testing, in particular in the PCA territory. For individual diagnostic purposes, CVR tests proved to be insufficient.

Adult↗
PubMed1992

Turn and phase counts of individual motor unit potentials: correlation and reliability.

Different turn algorithms are used for quantitative motor unit potential (MUP) analysis. To compare their retest reliability, 420 myopathic and neuropathic MUPs were recorded twice and the turn count of the first registration was correlated with that of the second. Reliability was best for the algorithm according to Willison as compared to the conventionally used algorithms based on amplitude criteria for 2 or 3 successive relative extrema. As demonstrated by discriminant analysis, an amplitude limit of 25 microV yielded more useful turn counts than a limit of 50 microV if myopathic MUPs had to be discriminated from normal MUPs. For this discrimination the turn count was superior to the phase count which did not further improve the discriminant model. This was different for the discrimination between normal and neuropathic MUPs. In this case, both parameters measured partly independent features of the MUP and had to be considered together.

Adult↗
PubMed1992

The mechanism of the interaction between amiodarone and warfarin in humans.

Amiodarone decreased the total body clearance of both (R)- and (S)-warfarin in normal subjects but did not change volumes of distribution. Warfarin excretion products were quantified and clearance and formation clearance values calculated. Amiodarone and metabolites inhibited the reduction of (R)-warfarin to (R,S)-warfarin alcohol-1 and the oxidation of both (R)- and (S)-warfarin to phenolic metabolites. Inhibition of warfarin hydroxylation by amiodarone in human liver microsomes was compared with the in vivo results. In agreement, the in vitro data indicates that amiodarone is a general inhibitor of the cytochrome P450 catalyzed oxidation of both enantiomers of warfarin, but the metabolism of (S)-warfarin is more strongly inhibited than that of (R)-warfarin. These data suggest that the enhanced anticoagulant effect observed when amiodarone and warfarin are coadministered is attributable to inhibition of P4502C9, the isozyme of P-450 primarily responsible for the conversion of (S)-warfarin to its major metabolite, (S)-7-hydroxywarfarin.

Adult↗
PubMed1992

Treatment of ruptures of the symphysis and iliosacral joint in pediatric patients.

The three osseous parts of the human pelvis form a continuous structure because of the symphysis and both iliosacral joints that-owing to their mobility-make possible a shock-absorption of vertical forces. The goal in the treatment of ruptures of the symphysis and/or of the sacroiliac joints is the restoration of functioning joints. Especially in the adolescent, a stiffening of these joints has to be avoided. Therefore, we treat ruptures of the pelvic joints with an overbridging banding that preserves the function of shock absorption. Due to utilisation of a banding, made up of polydioxanone, another operation to remove internal fixation material is not necessary. Rupture of the symphysis or iliosacral joint in the pediatric patient is very rare. Only three among the 67 patients whom we operated on because of a rupture of the symphysis or iliosacral joints between 1984 and 1990 were children. These were an eleven-year-old girl and a nine-year-old boy, who had suffered a rupture of the symphysis, and an eight-year-old boy with a disrupted iliosacral joint. In these children a banding with PDS suture was performed. At a follow-up examination, the children were free from pain and did not feel restricted in their daily routine or their physical activities.

Child↗
PubMed1992

[Vertebrobasilar ischemia. Value of Doppler ultrasound in the acute phase].

We prospectively studied patients with acute vertebrobasilar ischaemia to assess the value of Doppler ultrasound compared to cerebral angiography during initial evaluation. Doppler ultrasound was diagnostic in 11 of 14 patients (79%). Transcranial ultrasonic examination yielded important information in addition to extracranial findings in 8 of 11 patients. Depending on the underlying vascular pathology, Doppler ultrasound proved to be a useful screening instrument to support acute management of vertebrobasilar ischaemia. With regard to clinical symptoms and ultrasonic findings, practical consequences for diagnostic evaluation are proposed.

Blood Flow Velocity↗
PubMed1991

Cerebral potentials evoked by painful, laser stimuli in patients with syringomyelia.

Brief cutaneous heat stimuli generated by a CO2 laser were used to elicit late somatosensory evoked cerebral potentials (SEPc) in 10 patients with syringomyelia. For comparison, early and late cerebral potentials in response to electrical nerve stimuli (SEPn) were recorded in the same session. In 8 patients with localized impairment of pain and temperature sensitivity we found complete absence of SEPc after stimulation of the affected area; in another patient with similar sensory deficits, the SEPc was grossly attenuated and delayed. In 1 patient with intact pain sensitivity but absent temperature sensitivity, a well defined SEPc could be recorded. Both early cortical SEPn and late SEPn in response to conventional nerve stimuli were normal in all patients and thus did not differentiate control and affected areas. These data indicate that alteration of SEPc correlates with altered pain sensitivity in patients with a circumscribed spinal lesion. SEPc may thus be used as a neurophysiological test in the assessment of hypalgesic dermatomes.

Brain↗
PubMed1991

Ultralate cerebral potentials in a patient with hereditary motor and sensory neuropathy type I indicate preserved C-fibre function.

Late and ultralate cerebral potentials in response to cutaneous heat (CO2 laser pulses) and electrical nerve stimuli were studied in a patient with hereditary motor and sensory neuropathy type I who showed severe impairment of myelinated nerve fibre function. Cerebral potentials in response to electrical stimuli were absent (tibial nerve) or small (median nerve). With the laser pulses applied to the foot only ultralate, but no late potentials were observed, indicating intact C-fibres, but disturbed A delta-fibres. Laser stimulation of the hand resulted in both late and ultralate components, indicating at least partly preserved A delta-fibre function. The results document the usefulness of laser stimuli in the assessment of small nerve fibre function.

Adult↗
PubMed1991

[Reconstruction of an acetabulum by implantation of a reconstruction prosthesis].

The problem of the "missing acetabulum" in central dislocation of the hip was solved in the case under report by means of a bone transplant from the ala of the ilium. After the bone had healed, a vital and solid acetabulum had been obtained, so that a repeated central dislocation is most unlikely--both as a result of this fact and because of the insertion of an Eichler ring.

Acetabulum↗
PubMed1990

Polyneuropathy associated with chronic hypoxaemia: prevalence in patients with chronic obstructive pulmonary disease.

The prevalence of clinical and electrophysiological signs of peripheral nerve disease was evaluated in 151 patients with chronic obstructive pulmonary disease. Patients with concomitant disorders affecting the peripheral nervous system were excluded. Thirty patients had clinical signs of a mild sensorimotor and distal neuropathy and 13 additional patients had only electrophysiological abnormalities. The rate and the severity of the neuropathy correlated with the severity of chronic hypoxaemia. Three out of 20 patients with mild hypoxaemia (PaO2 less than 15 mm Hg below normal) had polyneuropathy as compared with 15 out of 36 with severe hypoxaemia (PaO2 more than 30 mm Hg below normal (rates different at the 10% level)). PaO2 and age were the only variables discriminating between patients with and without peripheral neuropathy.

Aged↗
PubMed1990

[Management of subtrochanteric femoral fractures with the dynamic condylar screw].

The 95-degree angled condylar screw (DCS) has been proven to be a valuable implant in the operative repair of comminuted and two-level fractures of the subtrochanteric region. Technically, it is easier to insert than the 95-degree angled condylar plate providing higher stability and the possibility of corrections even after insertion.

Bone Screws↗
PubMed1990

Transcranial Doppler evaluation of common and classic migraine. Part I. Ultrasonic features during the headache-free period.

To study vascular abnormalities in migraine, transcranial Doppler (TCD) was used for evaluation of 100 consecutive patients with either common or classic migraine during the headache-free period. We insonated the basal cerebral arteries and the internal carotid artery (ICA) in the neck. Particular ultrasonic features in migraineurs included intracranial elevations of mean flow velocity (MFV) above 3 standard deviations of normal values in 16%, probably reflecting increased vasotonus. Marked asymmetry of MFV in corresponding intracranial arteries was found in 12%, and could represent "asymmetrical" vascular tone. Characteristic vascular bruits of low frequency and sometimes harmonic quality were detected in 56%. When compared to TCD findings in 40 young controls, MFV were significantly higher in all intracranial arteries in migraineurs, but not in the cervical ICA. Marked differences were also found for incidence of MFV elevations and vascular bruits (p less than 0.0001). Vascular reactivity in response to eye closing as measured by flow changes in the posterior cerebral artery (visually evoked flow) was significantly greater in migraineurs than in controls (%MFV change, 14.1 +/- 5.4 vs 11.4 +/- 4.8; p = 0.004). TCD features did not discriminate common from classic migraine. Taken together, our results support the view of intracranial vascular abnormality in migraineurs reflecting, in particular, a narrower and more reactive arterial tree. The value of TCD in the differential diagnosis of "vascular headache" and in the study of migraine pathophysiology will have to be determined in the future.

Adult↗
PubMed1990

Transcranial Doppler evaluation of common and classic migraine. Part II. Ultrasonic features during attacks.

Transcranial Doppler (TCD) examinations were performed in 13 patients with common and 5 patients with classic migraine during attacks and compared to TCD findings during the headache-free period. Two distinct patterns of flow changes were detected to distinguish common from classic migraine on the basis of TCD findings. During attacks, patients with common migraine exhibited reduction of flow velocities associated with an increase of pulse wave amplitudes. Vascular bruits that were heard during the headache-free interval often disappeared. Opposite changes were found in attacks of classic migraine during the headache phase with increase of flow velocities, decrease of pulsatility and more prominent or newly appearing bruits. These findings were often diffuse and did not appear to correlate with side of headache or side of neurological aura. Uniform changes occurred in the cervical internal carotid artery and the basal cerebral arteries in either form of migraine. We propose that these changes represent caliber fluctuations of the large arteries, suggesting vasodilatation during attacks of common migraine and vasoconstriction during attacks of classic migraine. We do not intend to imply a casual role of these preliminary findings in migraine pathogenesis, but we suggest that TCD be used in combination with other methods to study vascular changes in migrainous disorders.

Acute Disease↗
PubMed1990

[The epidemiology and importance of metaplasia and dysplasia of the urinary bladder mucosa in autopsy material from a middle-size industrial city (study of Görlitz)].

This study had been conducted for the purpose of obtaining information on incidence and biological significance of metaplasia and dysplasia of the urinary bladder. Therefore, postmortem investigations were made of 1,117 urinary bladders, using optical light microscopy and mapping. They were related to a medium-size industrial town with an autopsy frequency of 98%. Metaplasia (58%) and dysplasia (13%) are no rare urinary bladder findings and occur particularly to individuals in somewhat advanced age, with no significant sex-related difference. Urocystitis was recorded from over 50% of all cases reviewed. More strongly pronounced inflammatory processes appeared to be risk factors for higher severity of dysplasia. Inconspicuous as well as metaplastic von Brunn's nests or squamous and glandular metaplasia without atypical cells should not be considered precarcinomas. However, atypical cells in terms of dysplasia were recordable from a small number of these metaplasias. Precancerous importance might be attributed to few of them, particularly in male patients with dysplastic squamous cell metaplasia. No reliable information, however, was available on premature development of dysplasia in lower age groups which would have meant a long-drawn process of carcinogenesis.

Adult↗
PubMed1990

[Femoral shaft fractures in the growth period--results following the end of the growing period].

Between 1960 and 1987 we treated 270 children for fractures of the femoral shaft. 195 could be followed up two times clinically and radiologically. The age at the time of accident is decreasing, might be a sign of battered-child syndrome. Boys were two times more afflicted than girls. Normally we use overhead extension or Weber-Bock-extension for 4-6 weeks and a pelvis leg cast for the same time afterwards. If the extension is not sufficient one reduction trial is allowed, the second one should give way the operation in the following complications: axial shift of more than 20 degrees, rotational aberration of more than 15 degrees and fragment deviation in more fragment fractures. The torsion was measured using Rippstein's method. 17 patients showed a difference between the angles of antetorsion of more than 10 degrees after being 18 years of age (only 2 of them were operated). Length growing was also measured and more confirmed in the only extended fractures. Both parameters showed better results, when both "detorsional thrusts" came after the accident. So the indication for an operative proceeding should be more liberal after the 7th and more often after the 12th year of age.

Bone Nails↗