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Biomedical subjects

K P Schulitz

Publications and source records attributed to K P Schulitz.

At least 19 recordsLinked to original sources
PubMed2000

Clinical evaluation and computed tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in the lumbar spine.

STUDY DESIGN: An examination of the accuracy of percutaneous pedicle screw placement in the lumbar spine. Using computed tomography scan analysis after implant removal, the screw tracts could be analyzed regarding the degree and direction of screw dislocation. OBJECTIVES: To investigate the misplacement rate and related clinical complications of percutaneous pedicle screw insertion in the lumbar spine. SUMMARY OF BACKGROUND DATA: The feasibility of the external fixation test has been investigated in several studies. Although pedicle screw misplacement has been reported as one of the main complications, there are no reliable data on the misplacement rate for this difficult surgical procedure. METHODS: In this study, 51 consecutive patients with suspected segmental instability were investigated after external transpedicular screw insertion for the external fixation test. Computed tomography scans of all instrumented pedicles from L2 to S1 were performed after screw removal. The screw tracts were analyzed, and the direction and degree of the pedicle violations were noted. In addition, the screw and pedicle angles were measured. RESULTS: Of 408 percutaneously inserted pedicle screws, only 27 screws (6.6%) were misplaced. There were 19 medial pedicle violations, 6 lateral cortical defects, and only 1 cranial and 1 caudal displacement. With respect to the spinal level, S1 showed the highest misplacement rate, with 11 screw dislocations (12%). After surgery, found two nerve root injuries were found. Only one of the injuries (L4) was related to the malposition of a screw. CONCLUSIONS: This study has shown that percutaneous insertion of pedicle screws in the lumbar spine is a safe and reliable technique. Despite the low misplacement rate of only 6.6%, it should be kept in mind that the surgical procedure is technically demanding and should be performed only by experienced spine surgeons.

Adult↗
PubMed1999

Miniarthroscopy of metacarpophalangeal joints in rheumatoid arthritis. Rating of diagnostic value in synovitis staging and efficiency of synovial biopsy.

OBJECTIVE: To evaluate miniarthroscopy (MA) (needle arthroscopy) of involved joints in rheumatoid arthritis (RA) in the early detection and staging of synovitis and its application in visual guided synovial biopsies. METHODS: 1.0 and 1.9 mm (0 degree/30 degrees) arthroscopes were used in a 2 portal technique. MA performance was developed and evaluated first on hand cadavers (n = 20) and then transferred to metacarpophalangeal (MCP) joints under local anesthesia conditions. Joints of 20 patients with RA with different disease activity and duration were scoped and rated according to scores adapted from arthroscopy of other joints. RESULTS: In 20/20 cases MA provided visualizing and magnification of intraarticular features of MCP joints in RA and allowed grading of synovial alterations, chondromalacia, and bony alterations. Synovial surface changes, thickness, and fibrosis were related to disease duration, as was damage to cartilage and bone. The degree of acute inflammatory reactions like vascularity and hyperemia varied independently of chronic changes; synovial proliferation was reflected to some extent by C-reactive protein. In 2 patients with early RA, synovitis criteria were found macroscopically and histologically. In 18/20 joints, biopsies were taken under visual control; in the other 2, progression of disease (Larsen score >3) limited arthroscopy to 1.0 scope imaging only. Sampling sizes were sufficient for histologic and molecular analysis. CONCLUSION: The developed standardized procedure of MCP arthroscopy is minimally invasive, practicable, and well tolerated by patients, and may allow synovitis monitoring, staging, and biopsy in patients with early as well as chronic arthritis.

Adult↗
PubMed1999

[Postoperative, appositional ossifications after lumbar laminectomy].

QUESTION: Post-laminectomy segmental hypermobility as well as appositional ossification were suggested by many authors to contribute to the unsatisfactory long-term results of laminectomy. The aim of this study was to find out whether segmental instability, among other factors, influences the degree of appositional ossification following laminectomy. METHODS: 55 out of 72 patients operated upon by laminectomy or hemilaminectomy for degenerative lumbar spinal stenosis were examined by radiography after an average follow-up period of 5.2 years. Appositional ossification at the site of surgery was evaluated in relation to lumbar instability, the number of segments undergoing laminectomy, and whether simultaneous fusion was done. Instability was determined by measuring angulation and translation using lateral flexion and extension views of the lumbar spine, whereas new-bone formation was best evaluated on antero-posterior radiographs. RESULTS: 94% of the patients had appositional ossification at the site of laminectomy. Patients undergoing simultaneous fusion with laminectomy had a significantly lower amount of appositional ossification compared to patients undergoing laminectomy without segmental fusion. Radiographically measured segmental instability, the number of segments undergoing laminectomy, age, and sex of the patients did not influence the extent of ossification. CONCLUSIONS: Postoperative appositional ossification at the posterior site of resection are seen regularly following laminectomy. The extent of appositional ossification does correlate with lumbar fusions, but does not correlate with the extent of radiographically measured lumbar instability, the number of segments undergoing laminectomy, or the age and sex of the patients. CLINICAL RELEVANCE: Simultaneous lumbar fusion with laminectomy is proved to be associated with less appositional ossification. Therefore lumbar fusion should be considered when planning surgery for spinal stenosis.

Adult↗
PubMed1998

Hemarthrosis as a major complication after arthroscopic subcutaneous lateral retinacular release: a prospective study.

The use of arthroscopic lateral release and medial imbrication of the vastus medialis obliquus for recurrent dislocation of the patella was evaluated prospectively in 31 patients. Patients were examined clinically as well as radiologically; the average length of follow-up was 34.4 months. Seventy-one percent of the patients were satisfied with the operative result. Seven patients experienced redislocation of the patella. Postoperative effusion occurred in 13 (42%) patients, with 4 patients requiring aspiration and 3 patients requiring open revision because of hemarthrosis. Seven patients developed a long-lasting stiffness of the joint following a 3-week period of immobilization with a dorsal plaster splint of the whole leg.

Adult↗
PubMed1997

Transfer of genes to chondrocytic cells of the lumbar spine. Proposal for a treatment strategy of spinal disorders by local gene therapy.

STUDY DESIGN: In the current study, chondrocytic cells from bovine intervertebral end plates were cultivated in vitro and modified genetically. OBJECTIVE: The authors intended to perform isolation and cultivation of cells from bovine end plates of the spine. They also intended to show, in principle, the feasibility of introducing exogenous genes into chondrocytic cells from bovine intervertebral end plates by way of retroviral vectors. SUMMARY OF BACKGROUND DATA: The involvement of cytokines in the destruction of articular cartilage is established. It appears possible that similar mechanisms may play a role in intervertebral disc degeneration and other spinal disorders. Conventional medication and surgery of intervertebral disc degeneration addresses neither the pathophysiology nor the chronicity of the disease. Therapeutic proteins carry great potential as locally produced drugs after transfer of their cognate genes to the sites of interest. METHODS: Vertebral end plate tissue was obtained from bovine os coccygis. Chondrocytic cells were isolated and cultured in vitro. The bacterial beta-galactosidase (LacZ) gene and, alternatively, the complementary DNA (DNA copy of the mRNA) of the human interleukin-1 receptor antagonist were introduced into the isolated cells by retrovirus mediated gene transfer. beta-galactosidase activity was determined by staining, and interleukin-1 receptor antagonist protein was quantitated by enzyme-linked immunosorbent assay. RESULTS: Isolation and cultivation of chondrocytic end plate cells is possible. Native cells continue to grow in culture for more than 2 months. Transfer of the beta-galactosidase gene to cultured cells resulted in approximately 1% beta-galactosidase positive cells. Transfer of the interleukin-1 receptor antagonist complementary DNA resulted in the production of 24 ng/ml/10(6) cells interleukin-1 receptor antagonist protein in 48 hours. CONCLUSIONS: The introduction of exogenous therapeutic genes into cells from the intervertebral end plate opens the possibility for a local gene-based treatment of intervertebral disc degeneration. This approach avoids some of the shortcomings of conventional drug- and surgery-based treatments and has the potential to be specific, effective, and appropriate to the chronicity of the disease.

Animals↗
PubMed1997

Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis. Comparison of four procedures.

STUDY DESIGN: A study to analyze the changes of the spinal deformity during the growth period, with regard to different operations for spinal tuberculosis in children. OBJECTIVES: To quantify the changes in the kyphotic angle and the growth ratio of the fusion bloc during spinal growth for different fusion techniques. SUMMARY OF BACKGROUND DATA: Most of the publications dealing with spinal tuberculosis in children focused on the clinical outcome with regard to different conservative and operative treatments. There is little reliable information concerning the growth of the solidly fused kyphotic bone bloc and its influence on the changes of the kyphotic deformity after different operative procedures. METHODS: The study included 117 children operated on for spinal tuberculosis at the age of 2-6 years at the Ruttonjee Sanatorium in Hong Kong during the 1950s and 1960s. Lateral radiographs obtained postoperatively and 5 and 10 years after the operation were analyzed for the growth changes of the solidly fused bone bloc. These results were compared with the different operation techniques (e.g., anterior fusion, posterior fusion, combined anterior and posterior fusion, and anterior debridement without fusion). RESULTS: The patients treated by anterior fusion showed the worst results with respect to the kyphotic angle. This was especially true when the lesion was located in the thoracic spine and several segments were involved. Regarding the growth ratio of the fusion bloc, only the combined fusion and the anterior debridement guaranteed an equal growth of the anterior and posterior height. CONCLUSIONS: Radical anterior surgery for spinal tuberculosis destroys the anterior growth and limits the capacity for spinal remodeling. Therefore, it should be avoided, if it is not absolutely necessary, for the healing of the infection or the primary correction of the tuberculous deformity.

Bone Remodeling↗
PubMed1997

Recurrent dislocation of the patella and the Goldthwait operation.

In this study 17 patients with recurrent dislocation of the patella were followed up 10 years after their Goldthwait operation. The subjective and clinical findings were excellent or good in 70%. X-radiographs indicated osteoarthritis of the femoropatellar joint in 60%. Concerning the aetiopathological factors, we found an increased external torsion of the afflicted extremity (measured by computed tomography).

Adolescent↗
PubMed1997

Comparison of surgical procedures for degenerative lumbar spinal stenosis: a meta-analysis of the literature from 1975 to 1995.

Therapy for spinal stenosis remains difficult. The possibilities for conservative management are limited and not satisfactory in the more severe cases. Various surgical procedures are possible, such as decompression, decompression and fusion without instrumentation and decompression and fusion with instrumentation. The aim of our meta-analysis was to compare the postoperative results of these three surgical techniques in the literature and, thus, to establish a treatment of choice for degenerative lumbar spinal stenosis. Via Medline, 30 articles met the inclusion criteria for our study, leading to a total number of 1668 cases being included in the meta-analysis. The evaluation was made according to our own definition of outcomes, based on criteria most commonly used in the studies reviewed. We found that in patients suffering degenerative spinal stenosis for up to 8 years, decompression without fusion showed the best results. For a duration of symptoms of 15 years or more, decompression with instrumented fusion had the best results. Analysing all postoperative outcomes, decompression is the surgical procedure with the highest rate of success and the fewest complications, followed by decompression with instrumented fusion. In surgery for degenerative lumbar spinal stenosis, decompression and fusion without instrumentation was the least successful procedure. As patients suffering from a degenerative spinal stenosis often are elderly, operations are risky and place a strain on them. This review of the literature shows that the least invasive surgical procedure can obtain the best results if the correct diagnosis is made and if the operation is carried out within the first years of the disease.

Adult↗
PubMed1996

Neurophysiologic changes in lumbar nerve root inflammation in the rat after treatment with cytokine inhibitors. Evidence for a role of interleukin-1.

STUDY DESIGN: The present study was designed to evaluate the effect of cytokine inhibitors in experimental allergic radiculitis. OBJECTIVE: Evaluation of the effect of cytokine inhibitors in experimental allergic radiculitis. SUMMARY OF BACKGROUND DATA: A number of cytokines are known to be involved in hyperalgesia and may play a role in radiculitis. Corticosteroids and other cytokine inhibitors antagonize their effects. METHODS: Experimental allergic radiculitis was induced in rats by injection of bovine myelin from the peripheral nervous system. The sham group subsequently received saline injections; the treatment groups received either prednisolone or interleukin-1 receptor antagonist. Treatment effect was assessed on the basis of motor performance and neurophysiologic parameters. RESULTS: Treatment ameliorated the symptoms of experimental allergic radiculitis. Prednisolone appeared to be somewhat more effective than interleukin-1 receptor antagonist. CONCLUSIONS: Because interleukin-1 receptor antagonist specifically blocks the effects of interleukin-1 at its receptors, the present results imply that interleukin-1 is a causal factor in the model of experimental radiculitis used. Its specificity and apparent lack of side effects make interleukin-1 receptor antagonist an attractive candidate treatment for the human disease.

Animals↗
PubMed1996

Jacques Calvé.

Jacques Calvé was born August 18, 1875, In Paris, France, and died on March 10, 1954. His main interest in medicine was the treatment of tuberculosis of the spine. Therefore, he established a very differentiated plan for the treatment of the Pott's disease. Calvé was also one of the pioneers in the radiologic evaluation of the skeletal system. He was among the first to describe the osteonecrosis of the hip and its radiological features-with his name still a part of the disease name today: the Morbus Legg-Calvé-Perthes. Furthermore, he was the first to describe the radiologic image of histiocytosis X of the vertebral body, but he interpreted it as a special form of tuberculosis of the spine. It was years later that the correct diagnosis of this particular radiologic change was found. This paper provides a short account of Jacques Calvé's life as a medical scientist.

France↗
PubMed1995

Haemodynamic changes in lumbar nerve root entrapment due to stenosis and/or herniated disc of the lumbar spinal canal--a magnetic resonance imaging study.

A prospective MRI study was carried out to assess the secondary changes in patients with stenosis and/or herniated disc of the lumbar spinal canal. The study covered 100 patients who had low back and leg pain due to such processes. Of these, 60 patients (group A) had a monoradicular pain pattern, average duration 2 months, due to a herniated lumbar disc. The remaining 40 patients (group B) had acute exacerbation of their chronic low back and leg pain, due to stenosis and herniated disc. As a control group, 5 asymptomatic volunteers with neither stenosis nor herniated disc on MRI were examined. All the patients and volunteers were examined by MRI with several sequences: partial saturation recovery with phase contrast PS (500/10), spin echo SE (500/20), short TI inversion recovery STIR (1900/135/30) and, for the dynamic study, field-gradient echo sequences FAST (50/15): 10 frames in 200 s. In all participants, Gd-DTPA was administered intravenously. In 8 of the patients of group B capillarisation in the protruded nucleus tissue was demonstrated on the PS sequence after Gd-DTPA administration. This tissue also showed decreased signal intensity on the STIR sequence. The capillarisation extended into the centre of the disc. Venous stasis could be verified in all of the 100 patients. An oedema could be verified in all patients of group A; in 20%, its size exceeded that of the herniated disc. In group B, an oedema was seen in only 12 patients. In the control group, no haemodynamic changes were seen. Using MRI, it is possible to define the border between herniated disc tissue and perifocal oedema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Magnetic stimulation as a diagnostic tool in cervical nerve root compression and compression-induced neuropathy.

Magnetic stimulation of motor cortex and cervical spinal cord was used to assess motor impairment in patients with either cervical nerve root compression or myelopathy. Evoked potentials were recorded from biceps brachii and abductor pollicis brevis. Our interest centered on whether the paresis resulting from root compression is accompanied by an increased latency of magnetically evoked muscle potentials and whether latency is increased in cases of cervical root compression or myelopathy in which no paresis occurs. Latency increase does appear to be a moderately good indicator of disturbed nerve conduction. In particular, prolonged latencies in cases of "subclinical" paresis could be used as an important diagnostic tool for the early detection of motor deficits in cervical compression radiculopathy and myelopathy.

Electrodiagnosis↗
PubMed1995

Sterilisation of canine anterior cruciate allografts by gamma irradiation in argon. Mechanical and neurohistological properties retained one year after transplantation.

Bone-ACL-bone allograft transplantation is a potential solution to the problem of reconstruction of the anterior cruciate ligament (ACL), but sterilisation by gamma irradiation or ethylene oxide causes degradation of the graft. We have studied the biomechanical and histological properties of deep-frozen canine bone-ACL-bone allografts sterilised by gamma irradiation (2.5 Mrad) under argon gas protection. Particular attention was paid to their collagen structure and neuroanatomy compared with those of non-irradiated allografts. We used 60 skeletally mature foxhounds. In 30 animals one ACL was replaced by an irradiated allograft and in the other 30 a non-irradiated graft was used. In both groups the graft was augmented by a Kennedy Ligament Augmentation Device. Examination of the allografts at 3, 6 and 12 months after implantation included mechanical testing, histology, collagen morphometry, neuroanatomical morphology (silver and gold chloride stain) and studies of the microvasculature (modified Spalteholz technique). At 12 months the irradiated ACL allografts failed at a mean maximum load of 718.3 N, 63.8% of the strength of the normal canine ACL. The non-irradiated allografts failed at 780.1 N, 69.1% of normal. All the allografts showed a well-orientated collagen structure one year after transplantation and there was no difference between the irradiated grafts and the others. The silver staining technique demonstrated Golgi tendon organs and free nerve endings within both groups of allografts. As in the normal ACL these structures were most commonly found near the surface of the graft and at its bony attachments. At 12 months the irradiated allografts showed slight hypervascularity compared with the non-irradiated grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Discitis after procedures on the intervertebral disc.

STUDY DESIGN: Discitis after discectomy is frequently missed or detected too late because of false interpretation of postoperative complaints and examinations. Prospectively, the authors examined 31 patients after single-level discectomies. The results were compared with four clinical cases of postoperative infection. METHODS: From the first to tenth postoperative day, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and temperature were measured. On the fifth or sixth day, magnetic resonance examination was performed with and without administration of gadolinium diethylene triamine penta-acetic acid (Gd-DTPA). All patients were included in follow-up, which included radiographic and clinical examinations, for 3 years. RESULTS: Thirty of thirty-one patients had CRP values less than 2.5 micrograms/mL, ESR values less than 45 mm/hr, and temperatures less than or equal to 37.5 C. Magnetic resonance imaging showed normal postoperative features. Four patients with infection had increased levels of CRP, ESR, and temperature. Magnetic resonance imaging showed retrodiscal infection and spondylodiscitis. CONCLUSION: After discectomies, CRP, ESR, and temperature should be measured from the third day on. Pathologic values should initiate magnetic resonance examination. In cases of retrodiscal infection or discitis, conservative treatment with antibiotics is sufficient. In cases of retrodiscal abscess, operative intervention should be considered.

Adult↗
PubMed1994

Anterior cruciate ligament reconstruction using cryopreserved irradiated bone-ACL-bone-allograft transplants.

Bone-ACL-bone allograft transplantation has been investigated as a potential solution to reconstruction of the anterior cruciate ligament (ACL). To minimize disease transmission (e.g. the acquired immuno deficiency syndrome), bony and collagenous tissues should be sterilized. Recent animal studies indicate that gamma irradiation and ethylene oxide sterilization result in diminished histological and biomechanical properties. The purpose of the present study was biomechanical and histological determination of the fate of deep-frozen gamma-irradiated (2.5 Mrad) canine bone-ACL-bone allografts with argon gas protection. Particular attention was paid to collagenous and neuroanatomical morphology 3, 6 and 12 months after implantation, by comparison to a non-irradiated control group. Sixty skeletally mature foxhounds were operated on in this study, divided up in two groups of 30 dogs each. In group A animals the ACL was replaced by a deep-frozen (-80 degrees C) bone-ACL-bone LAD-augmented allograft subjected to 2.5 Mrad gamma irradiation with argon gas protection. The animals in group B received an LAD-augmented ACL-allograft transplant without gamma irradiation. All knees from both groups were evaluated 3, 6 and 12 months after implantation in regard to biomechanical properties, collagen morphology and routine histology (haematoxylin and eosin stain, polarization microscopy), neuroanatomical morphology (silver and gold chloride stain) and microvasculature (modified Spalteholz technique). The irradiated ACL allografts withstood a maximum load that was 63.8% (718.3 N) of the maximum load of normal ACLs after 12 months. By contrast, the non-irradiated allografts failed at 69.1% (780.1 N) of the maximum load of normal control ACLs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Isolated intraarticular plasty of the semitendinosus or combined intra- and extra-articular plasty in chronic anterior laxity of the knee].

MATERIAL AND METHODS: In a prospective study we examined 32 athletes with arthroscopic implantation of a double loop of semitendinosus tendon for intra-articular anterior cruciate ligament reconstruction combined with an iliotibial band tenodesis for extra-articular augmentation. They were compared to 26 athletes operated by isolated intra-articular semitendinosus reconstruction. RESULTS: The Lysholm-Score, clinical and radiological findings, KT-1000 stability values and isokinetic tests were evaluated monthly over a year. The data suggests that while both procedures under standardized rehabilitation conditions may obtain excellent functional results, adding the iliotibial band tenodesis to an intra-articular reconstruction significantly improves stability and muscular strength. Patients were able to resume all activities without a pivot shift following combined intra- and extra-articular stabilization.

Adult↗
PubMed1993

Long-term results after operation for funnel chest.

The cases of 36 out of 62 patients who underwent surgical correction of funnel chest deformity between 1978 and 1988 with an average follow-up of 7.6 years were reviewed. The mean age at which the Hegemann operation was performed was 14.1 years. Preoperative cardiorespiratory disorders were reported by 76% of patients, while 71% showed electrocardiographic and pulmonary alterations. Post-operatively, cardiorespiratory disorders were significantly reduced, but the electrocardiographic changes were not. The pre- and postoperative radiological and functional measurements of the chest deformity which allow an objective evaluation of the surgical result are described. Surgical treatment is indicated in most cases of funnel chest deformity, for cosmetic or psychological reasons. The long-term results were good or fair in 90% or more of our cases. We suggested that disfiguring scars with keloid formation cause less psychological distress than persistent congenital malformation of the chest.

Adolescent↗