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Biomedical subjects

K Szepesi

Publications and source records attributed to K Szepesi.

At least 19 recordsLinked to original sources
PubMed1997

Experimental studies for the surgical correction and fixation of dorsal spine deformities.

One of the specific features of the scoliosis operations with a posterior approach is that both the correction of the deformity and then the maintaining of the corrected situation are carried out with the help of the implants. With the currently applied systems based on the CD principle it is still difficult to control the rotational component of the scoliotic curve. To complement the systems based on the CD principle, we have developed an implant family whose application makes the correction of the dorsal deformity generally simplier and derotation more effective. Our method is based on the application of such hooks which, linked to the longitudinal rods and hooked on both transverse processes of the instrumented vertebrae, transmit the concerted forces exerting their influence in the direction of the correction. Depending on their symmetrical relations, the hooks are capable of tilting in the frontal plane and derotating in the horizontal plane simultaneously, in the direction of our choice. The stability and applicability of the hooks were tested in implants into cadavers, and then the intimate relations of the implants were examined by means of radiological tests and dissection on instrumented specimens. On the basis of our results, the implants can already be used in clinical practice.

Cadaver↗
PubMed1997

Therapeutic value of continuous passive motion after anterior cruciate replacement.

The aim of this study is the evaluation of the therapeutic value of continuous passive motion after ACL replacement. After 41 ACL reconstruction in 13 cases only active motion, in 28 cases active motion and CPM were used postoperatively. Stability, the range of motion and complications were evaluated at the time of discharge, 3 and 6 months after the operation. The flexion-extension in the CPM group was significantly greater at the time of discharge, but this difference was practically eliminated in 6 months after the operation. There were not any other significant difference between the two groups. The CPM gives only a little advantage in the rehabilitation after the ACL replacement.

Adult↗
PubMed1997

Idiopathic scoliosis--new surgical methods or search for the reasons.

Idiopathic scoliosis (IS) is a deformity of the spine whose aetiology is unknown despite of extensive clinical and basic research work. The significance of this disease lies in the consequences of a spine deformity (deformation of the chest, compromise of the cardio-pulmonar function, compression of the neurological elements, severe somatic and psychological sufferings). According to statistical data, one third of the idiopathic scoliotic cases progress and need surgical intervention. Cotrel and Dubousset introduced the three dimensional correction surgical method for the treatment of spine deformities in 1983 (CD method). The authors report on the application of the CD method for the treatment of IS from 1991 to date. After the operation of 36 patients they give an account of good results and report on the modifications of the surgical technique on the basis of their experiences. Aware of the late consequences of the surgical treatment of IS the authors started with the investigation of the aetiology of the disease in order to introduce a causal treatment. As for the aetiological background of IS, data on the role of heritable factors were relevant only. They gave a hint to start with studies aimed at the investigation of genetic determinants of the syndrome. I aberration of chromosome #10 [karyotype: inv(10)(p11q26)]. In one of the cases there was a multiple familial occurrence of the syndrome coupled with the same anomaly of the karyotype. The probands' father and grandfather all had the same pattern of scoliotic deformity and the same aberrant karyotype of chromosome #10 was found both in the proband and his father. Preparation of genomial DNA from peripheral blood of the patients was started. Fragment length polymorphism (RFLP) examination with PCR technique using oligonucleotide primers specific for chromosome #10 and for regulatory genes of left-right body assymetry is underway.

Chromosome Aberrations↗
PubMed1997

Efficacy of prevention of thromboembolic complications with LMW-heparin in experiment.

The authors used an antithrombotic agent (Nadroparin Calcium) with anti-Xa effect in their experiments to prevent thromboembolic complications in the model of endoprosthetic replacement of the hip joint in mongrel dogs. 10 experimental animals (Group I.) were given doses of 100 A Xa ICU/kg/bwt of Nadroparin Calcium subcutaneously 4 hours prior to the operation and also once a day until the 3rd postoperative day; between the 4th and 10th postoperative days doses of 150 A Xa ICU/kg/bwt Nadroparin Calcium were given. The 10 control animals (Group II.) did not receive anticoagulant treatment. In both groups platelet count, activated partial thromboplastin times (APTT), prothrombin and fibrinogen levels as well as activated factor X inhibition (F Xa) were measured prior to surgery and also until the 14th postoperative day. No changes in APTT and prothrombin levels were detected during the experiment, however platelet count and fibrinogen levels as well as the extent of F Xa inhibition showed significant and different changes in groups I. and II. The Group I. which had received thromboembolic prophylaxis did not develop deep venous thrombosis or pulmonary embolism, but the control group did. Based on their investigations, the authors concluded that they had been able to achieve F Xa inhibition by giving the above mentioned doses of Nadroparin Calcium which was enough to prevent thromboembolic complications in their model experiment of implanting hip endoprosthesis.

Animals↗
PubMed1996

Pemberton's pericapsular osteotomy for the treatment of acetabular dysplasia.

We present the results of 80 Pemberton procedures carried out between 1977 and 1990. The patient age at the time of operation ranged between 2 and 12 years, and follow-up was between 1 and 15 years. Before Pemberton's operation, conservative treatment, closed and open reduction, and derotation femoral osteotomy were used. Pemberton's operation was combined with intertrochanteric femoral osteotomy in 30 cases. The mean values of the acetabular and center edge angle of Wiberg showed postoperative improvement of 19 and 17 degrees, respectively; whereas at follow-up, improvement was 20 and 23 degrees, respectively. Radiologically, 79% of the cases met Severin's classification grade I-II criteria. Clinically, 81% were classified as excellent and good. The results were closely correlated with ischemic necrosis due to preoperative treatment. Only patients belonging to groups II-IV of Kalamchi and MacEwen, plus one patient operated on at relatively old age (12 years), were found radiologically to be in Severin's groups III and IV. The results among patients operated on before age 7 were more favorable than those of patients operated on at an older age.

Acetabulum↗
PubMed1995

Preliminary results of early open reduction by an anterior approach for congenital dislocation of the hip.

We report the results of 113 early open reductions of congenitally dislocated hips using a technique we have developed. Surgery is followed by functional postoperative treatment with a Pavlik harness or abduction splint. The age of the patients and the follow-up period ranged from 6 to 24 months and 2 to 12 years, respectively. Radiologic results corresponded to Severin grades I and II in 98%. Severe ischemic necrosis was not observed. Secondary surgery (femoral derotation osteotomy and/or Pemberton's operation) was performed in 21% of the cases. Reduction at a young age resulted in fewer secondary procedures. Good results were attributed to postoperative treatment: Abandoning rigid fixation prevented soft tissue stretching, which may endanger blood supply to the joint. This treatment ensures concentric reduction and allows early and spontaneous joint mobilization in a functional position. These factors stimulate further joint development.

Braces↗
PubMed1994

[Results of combined surgical operations in the management of congenital hip dislocation].

The results of 51 different combined operations for the treatment of CDH after the age of two years performed between 1980 and 1989 are presented. The age of the patients at the time of the operation ranged from 2 to 12 (mean 4.5 years. Follow-up was 2-12 (meean 6) years. Preoperatively 19 hips were untreated. Primary surgery included reduction alone in 6 cases, together with femoral osteotomy in 28 cases, reduction combined with Pemberton's operation in 1, and reduction supplemented by both correction techniques in 16 cases. Secondary acetabular correction was later necessary only in 14 cases (27%), thus in 63% of all cases. Radiologycally, the results were of Severin's grade I and II in 64% of the whole series, but in 88% in the 2-3-years-old group. The results in the different surgical groups correlated primarily with the incidence of avascular necrosis and not with the extent of surgery.

Age Factors↗
PubMed1994

[Results of early surgical reduction of congenital hip dislocation].

Authors report on the results of 118 early operative reductions, performed with their own method in the treatment of the congenital dislocation of the hip. Postoperative functional treatment with Pavlik's harness or abduction splint belongs to their method. Secondary operations were performed in 21 per cent: derotation femoral osteotomy and Pemberton's operation. The younger the patient was at the reduction the rarer was secondary operation necessary. The age of the patients was 6-24 months at the operation (in average 13 months) The follow-up time was 2-12 years (in average 6.1 years). The results corresponded radiologically to Severin's I + II grades (excellent and good) in 98 per cent. Clinically 98 per cent were excellent, 2 per cent fair. The good results are first of all attributed to their postoperative treatment: 1. They avoided the stiff plaster bandage and so no tension of the soft parts could develop, that would endanger the blood supply. In consequence ischaemic damage, belonging to Kalamchi's and Mac Ewen's group I was found only in a few cases. No damage belonging to the severe forms II-IV was observed 2. Their treatment: secures the central reduction and allows spontaneous joint movements in functional position: factors meaning the maximal stimulus of joint development. The condition of this postoperative treatment is the stability of reduction, secured by their special plasty of the capsule.

Age Factors↗
PubMed1993

[Surgical treatment of hip dislocations in children and damages caused by conservative treatment methods].

For the major requirements of the operative technique and other special problems of operation it is reasonable to discuss among the questions of the reduction of CHD the reoperations and the reconstructive surgery of hips, badly damaged by the conservative treatment, separately. We have analysed the results of 19 own cases with an average follow up of 6.3 years (3-12 years). The average age of the patients was 4.8 years. In 7 patients only conservative treatment was carried out previously, the others were also operated. The Roentgenogram revealed severe ischaemic necrosis in 10 hips. The dislocation could be reduced in every case, to the reduction however it was obligatory to add femoral osteotomy and correction of the acetabulum. The later operation was performed frequently in the second sitting. As a direct result of the operation a state, corresponding to the II. degree of Severin's radiological classification was always reached, in cases of severe ischaemic necrosis however the result later grew worse and at the follow up it corresponded only to the degrees III. and IV. (mediocre, poor). Thus the circulatory damage, suffered during the early treatment determined the late results. This was the reason that the result of the follow up examinations were better in patients in whom early surgery was performed than in patients with forced conservative treatment. The results summarized fall far behind the results of the group with primary surgery of the CHD. Without the operations described these patients would live as limping cripples, with these operations however we have improved their state significantly for the time until TEP can be performed.

Adult↗
PubMed1993

[Surgical-technical problems of triple pelvic osteotomy. Early results of the polygonal method].

Since the first description of the triple pelvic osteotomies papers reporting on the improvement of the operative technique were continuously published. This is explained by the more problematic details of the operation. Authors worked out to the technique of the polygonal triple pelvic osteotomy, published by Kotz, Dávid and Uyka, a new exposure that makes more simple, quick and safe the performance of the operation. The essential feature is that the os ischii is reached after the osteotomy of the trochanter major from a lateral exposure and so the field of operation can be widely surveyed. At the same time transposition can also be performed. The experiences gained in 12 operations are reported, 8 of which were made according to their own method (follow-up: 8-22 months, in average 15 months). The patients were 14-33 years old and their complaints disappeared in every case. Authors suggest the operation for the correction of the dysplastic acetabulum in young adults and also in puberty after the fusion of the Y cartilage if no subluxation exists. Minor articular deformity and mild arthrosis are not considered as a contraindication.

Adolescent↗
PubMed1993

[The KT 1000 arhtrometer in the comparative study of stability of knee joints operated on for instability].

In 1981 through 1989 authors performed 160 complex reconstruction operations for instability of the knee joint according to the basic principles of W. Müller, striving to restore all structures injured. 92 patients with 378 operations were controlled. The assessment of the results was based on the physical examination, the measurement of ligament laxity with the K 1000 arthrometer, the opinion of the patients, the level of their activity and Lysholm's functional point system was used. The stability of the knee could be restored in 73 per cent of the cases. The patients have thought the knees, found more stable with the arthrometer, really more stable. There was however no unambiguous relation between the knee stability and the level of activity of the patients. The most frequent complaint was pain, increased synovial fluid and the hindrance of squatting. The results were better if the patient had no previous operation in an other department and in those who did not need menisectomy, who had less operations, less body weight and better muscular force.

Adolescent↗
PubMed1993

[Experience with the implantation of porous coated hip endoprostheses and primary stability of implantation].

The use of porous coated cementless prosthesis, shows a worldwide spread in consequence of the advantages given by the "live" connection between the implant and the bone. Based on 40 implantations of prostheses of this type (Duraloc 1200 acetabulum, AML shaft) authors report on the technique of the implantation and the primary stability reached. In consequence of the formation, the variety of size and the properly usable instruments for implantation, the prostheses could be used for every kind of deformed, dysplastic hips and good primary stability was reached in every case operated.

Adult↗
PubMed1992

[Measuring the looseness of the knee joint by using the Kt 1000 arthrometer].

Authors measured the stability in the sagittal plane of the intact knee joints of 50 young men with the MEDmetric KT 1000 apparatus. The greatest movement during the measurements on 100 knees was observed in 25 degrees flexion and during the application of force 89N. In 70 degrees flexion the movement was only half of that observed in 25 degrees flexion. The difference of the average movements measured bilaterally was neither in active nor in passive experiments more than 0.5 mm. The difference between the average values of the compliance indexes on the left and right side was only 0.01 mm. In all measurements the frequency distribution of the differences between the two sides was essentially the same. The difference between the movements on the two sides did not exceed 2 mm-s in 90-100 percent of the cases.

Adult↗
PubMed1991

Results of surgical treatment of knee instabilities.

Between January 1, 1981 and January 5, 1987, 146 reconstructive operations for acute (39) and chronic (107) knee instabilities were performed. THe majority of the acute cases were anteromedial (24), and of the chronic instabilities, 33 were anteromedial, 14 anterolateral, and 53 combined anteromedial-anterolateral. In terms of suture, replacement, and reinforcement of the damaged structures of the acute cases, 32 were good, 6 fair, and 1 poor, while the reconstruction, according to Müller, for chronic instabilities produced good results in 34, fair in 59, and poor in 14. It is essential that such operations be performed by a trained surgical team. For success, precise knowledge of anatomy, exact examination, accurate diagnosis, adequate surgical techniques, and careful postoperative treatment are essential.

Adolescent↗
PubMed1991

Surgical treatment of pathologic fractures from metastatic tumors of long bones.

Surgical treatment of 74 cases of impending and established metastatic pathologic fractures were analyzed. On the basis of various reports, the incidence of bone lesions, bone-seeking primary tumors, lesion sites, diagnostic techniques and possibilities, as well as indications for and methods of surgical treatment, are surveyed. Surgical intervention is only one aspect of the different components of general treatment in bone metastases. An aggressive surgical procedure yields very satisfactory results in most cases, compared with those of conservative treatment.

Bone Neoplasms↗
PubMed1991

The effect of early anterior approach open reduction with functional postoperative treatment on the early development of the acetabulum in CDH.

Between 1980 and 1983, 30 anterior approach open reductions were performed on congenitally dislocated hips of 29 patients after unsuccessful conservative treatment; patients were between 6 and 18 months old. After the removal of the obstruction from the acetabulum, the reduction was performed with preservation of the limbus. Some part of the capsule was removed to constrict and tighten it and to prevent redislocation. This capsuloplasty demonstrates the success of a Pavlik harness and abduction splint postoperatively, without plaster fixation. The accelerated development of the acetabulum could be observed on radiograph by this functional treatment, compared to the control group treated with the usual hip spica postoperatively. The development of the acetabulum on the operated side almost equals the sound side within a year. If the operation was performed earlier, joint development would be quicker.

Acetabulum↗
PubMed1991

[The effect of early surgical reposition of congenital hip dislocation and functional postoperative treatment on the development of the acetabulum].

Authors performed early operative reduction from anterior exposure after unsuccessful conservative treatment on 30 hips of 29 patients in 1981 through 1983. The age of the patients was 6-18 months at the time of the operation. After the excision of the obstacle of the reduction with preservation of the limbus the capsule was closed tight so that it could prevent redislocation. This way it became possible to make functional after treatment without plaster fixation and using Pavlik's harness and abduction splint. It was found that the postoperative development of the acetabulum was accelerated and the development of the acetabular roof reached in average during one year the healthy one and the articular movements were free. The development of the joint was the quicker the younger the age was in which the operation was performed.

Acetabulum↗