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Biomedical subjects

K Parsch

Publications and source records attributed to K Parsch.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Treatment of spastic club foot].

In 38 patients with spastic cerebral palsy, treatment was carried out for talipes equinovarus. There were 12 children with spastic hemiplegia, while 24 had diplegia or tetraplegia. Surgery was done with the goal of achieving plantigrade and muscle-balanced feet. In 24 feet of 19 children tibialis anterior transfer was performed, while tibialis posterior transfer was done in 20 feet of 19 patients. Without exception, additional surgery was performed on the triceps surae (30 x ATLs and 16 Vulpius operations); medial arthrolysis was also necessary in 6 cases. The clinical results were assessed by the senior author in the weekly neuro-orthopedic clinic an average of 3.2 years after surgery. An additional questionnaire was sent to all patients' families asking for their subjective assessment of the surgery performed. Figures were collected for 30 patients with 38 treated feet. The results were evaluated according to Kling's criteria. We saw good and very good results in 75% of the patients (4 feet very good, 23 feet good), while 25% of the patients (9 feet in 7 patients) showed poor results with over-corrections and calcaneo-valgus foot as the main problem. The best results were seen in spastic hemiplegia and the poorest in patients with severe tetraplegia and total body involvement.

Achilles Tendon↗
PubMed1992

[The painful hip joint in the child: differential diagnosis and therapy of coxitis fugax, Perthes disease and septic coxitis].

The differential diagnosis of a painful hip joint in children is important. Transient synovitis is frequently seen in children from 3 to 7 years of age with a short history of limping. The joint effusion is visualized by ultrasound. Radiograms and laboratory data are negative. Therapy consists of short term bed rest supported by an oral antiphlogistic drug. Children with Legg-Calve-Perthes disease complain about knee or hip pain in an early stage. X-ray documentation in the a.p and axial view are mandatory as well as ultrasound visualization of the accompanying effusion. Healing of the capital femural epiphysis is aided by weight relief and improved head containment. This may need from one to three years according to the age of the child and the amount of head involvement. More than half of the children's hips with Perthes disease surgical help to achieve a satisfactory result. Hip pain is overwhelming in cases of septic arthritis of the hip joint. This is the most important help to differentiate septic coxitis from transient synovitis or Perthes disease. Rapidly rising values of red cell sedimentation and c-reactive protein are important for early diagnosis. Septic effusions are visualized by ultrasound. X-ray changes are absent in the beginning and are seen only in delayed cases. Early arthrotomy with scrupulous rinsing of the joint, followed by parenteral antibiotic treatment, is the treatment of choice.

Arthritis, Infectious↗
PubMed1991

Origin and treatment of fractures in spina bifida.

Children with spina bifida cystica have a high risk of fracturing their paraplegic legs. During the last fifteen years we observed 261 fractures and epiphyseal injuries in 173 children out of 1,400 (12.2%) patients with spina bifida. The increased risk of fracture seems to be due to reduced muscle activity in the paralysed limb with insufficient axial loading of the legs. A large proportion of fractures occurs after orthopedic interventions. Fractures are less common after urologic or neurosurgical procedures. Breaks are extremely frequent after operations in association with cast immobilization. Early standing and short immobilization times are the best defence mechanisms against fractures. If plasters are needed postoperatively one should preferably use the "Max and Moritz" standing cast. Fractures in spina bifida children heal quickly as compared to those in non-paralyzed children. In 30% excessive callus is seen. Immobilization for fracture care can be done in a standing cast even in the very early phase of treatment. In spite of the swelling and elevated temperature axial loading in the standing cast should continue. Splints and braces can be used instead of the plaster cast. By any means, the vicious circle of Fracture-Plaster-Fracture-Plaster should be avoided. Repeated stress on the growth plate causes a mechanism of loosening. The most common site is the distal tibia and femur, less often loosenings occur in the proximal tibia and proximal femur. Epiphyseal loosening is a nosological entity seen in spina bifida and also in congenital absence of sensation. Distal tibial epiphyseal loosening is frequently seen in adolescents who have learned to walk only after muscle balancing procedures in the hips.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Mixed chemodectoma-ganglioneuroma of the conus medullaris region.

Report of a 33-year-old man with a year-long history of low-back pain radiating into the left leg. Neurologic examination upon admission to the hospital revealed a spinal compression syndrome at the level L5. Laminectomy at L 4/5 revealed an encapsulated intradural tumor measuring 4 X 2.5 X 2.5 cm. The tumor was attached to the dorsal root L 4 and extended downward to the conus region. Light and electron microscopy revealed features mostly consistent with a mixed chemodectoma and ganglioneuroma.

Adult↗
PubMed1978

[Surgical and apparative treatment of patients with meningomyelocele with special reference to their hip problems].

Children with thoracic lesions should have hip surgery done only if this is necessary for the child to be able to walk with braces. In lumbar lesions hip surgery and especially SHARRARD'S procedure of iliopsoas transfer is done to establish muscular balance. The amount of braces for walking can thus be reduced. In sacral lesions there is no place for hip surgery, as functional gain would not be expected.

Braces↗
PubMed1978

[Treatment of knee joint deformities in spina bifida].

182 cases of surgical treatment of knee deformities in children with spina bifida between 1968 and 1977 are reviewed. The most number of cases had very good or good success. 138 supracondylar osteotomies produced very good results in 18 cases; reosteotomy was necessary in 10 cases. EGGERs procedure in 26 cases made very good results and good results in 6 cases. Quadriceps-Z-plasty with anterior capsulotomy produced very good results in 11 cases, only one bad result here was produced by skin-breakdown.

Braces↗
PubMed1977

[Genu valgum after proximal tibial fracture in children (author's transl)].

Residual valgus deformity and overgrowth was found in 4 children out of 6 with proximal tibial metaphyseal fractures. Primary reduction of this minimally displaced fracture under general anaesthesia is advised. In case of an irreducable fracture open revision is suggested. In case of an established valgus of more then 20 degrees a tibial wedge osteotomy is necessary. Recurrence of the deformity is very common especially in young children.

Age Factors↗
PubMed1977

[Congenital rocker-bottom foot (author's transl)].

A report was made of 19 patients with rocker-bottom foot operated on during the last 10 years in the Orthopedic Hospital and Out-Patient Clinic of the University of Heidelberg. No additional bone anomalies were present in 6 cases. The remaining malformations occurred together with multiple contractures and in the context of spina bifida cystica. The various malformations of the foot were divided into three groups. This study is particularly concerned with therapy for rocker-bottom foot. Conservative measures are not suitable for types I and Ia while conservative therapy should be attempted in type II. The surgical procedure involves 4 steps: development of the calcancal part of the foot, repositioning of the navicular bone, new adjustment of the ankle and various stabilization measures including the Grice operation and transposition of various tendons. The surgical procedure and the results were discussed.

Achilles Tendon↗
PubMed1976

[Management of slipped epiphyses in renal osteodystrophy (author's transl)].

Epiphyseal slipping in uraemia differs strikingly from juvenile epiphyseal slipping with respect to pathology and therapy. Based on our own experience with the treatment of 8 uraemic children with epiphyseal slipping, an effort was made to establish the respective indications for conservative and surgical treatment. Mechanical stabilization of slipped epiphyses was achieved within a few weeks without any surgery and usually without parathyreoidectomy by vitamin D3 alone. The initial dose was 10,000 to 30,000 I.U./day, the total curative dose 1.8 to 5.6 millions I.U. Prolonged immobilization was unnecessary. Rising urinary calcium excretion was a valuable indicator of vitamin D intoxication even in advanced renal failure. In one case, pronounced metaphyseal deformations (distal femur, distal tibia) required surgical correction before the ability to walk normally was restored. - The following therapeutical approach is recommended: metabolic bone disease must be cured by vitamin D therapy with or without parathyreoidectomy. Osteotomy to correct metaphyseal deformities or coxa vara epiphysaria never should be performed before metabolic bone disease is healed.

Adolescent↗
PubMed1976

Prevention and treatment of knee problems in children with spina bifida.

The outcome of surgical treatment of flexion, valgus or extension knee deformities is reviewed in 114 spina-bifida children (164 knees) who received such treatment over the period 1968 to 1975. Eggers' procedure for 26 knees produced very good results in 21 cases and good results in four; supracondylar osteotomy in 128 knees produced very good results in 104 cases and good results in 16; and quadriceps Z-plasty with anterior capsulotomy in 10 knees produced very good results in nine cases.

Child↗
PubMed1976

[Long-term follow-up after arthrodesis of the hip-joint using cross-plates and pelvic osteotomy, particularly late complications. Results of follow-up for 4-8 years (author's transl)].

In two thirds of our patients there were no complications. All fractures could be healed after osteosynthesis or plaster. At least those patients who had tight pseudarthroses were relatively free from pain on weight-bearing. But 34% of our patients showed severe complications - pseudarthroses and post-operative fractures. The argument in favor of early mobilisation, the mainstay for the choice of this technique of arthrodesis, does not - as our long-term follow-up shows - carry conviction.

Adult↗