Biomedical subjects
Publications and source records attributed to L Bernd.
A case of a highly malignant extraskeletal osteosarcoma is reported. Although biopsy is not considered necessary in cases of heterotopic calcification when the aetiology is known, malignancy should be suspected when the cause is questionable.
PURPOSE: The purpose of this study was to examine the accuracy of MR imaging of the healthy and the arthrotically altered articular hip cartilage with in vivo and in vitro separation of femoral head cartilage and acetabular cartilage. MATERIAL AND METHODS: Images of three animal cadaver hips, 8 dissected patient femoral heads and 18 hip joints of human corpses, all either with arthrosis stage I-III or artificial cartilage defects, were compared with their corresponding anatomic sections. Additional histomorphologic examinations of the arthrotic cartilages were conducted, and MR-Imaging of 20 healthy and 21 arthrotic patient hips was performed using a specific traction method. RESULTS: Using a T1-weighted 3-dimensional gradient-echo sequence and a traction of the hip joint, it was possible due to the low-signal imaging of the joint space to separate in vivo the high-signal femoral head cartilage from the high-signal acetabular cartilage. In horizontal position of the phase-encoding parameter, minimisation of the chemical-shift artifact, mainly in the ventro-lateral areas, was accomplished. MRI measurements of the articular cartilage widths showed significant correlations (p < 0.001) with the corresponding anatomic sections. At the same time the T1 3-dimensional gradient-echo sequence of the lateral femoral head with r = 0.94 showed the lowest deviations of the measurements. It was possible with MR imaging to distinguish four cartilage qualities. CONCLUSIONS: Using these MR-examinations, an improved imaging of early stage arthrotic cartilage defects is possible, and the status of the arthrotic hip cartilage with regard to intertrochanteric osteotomy can also be assessed.
Arterial embolization is an approved method in treating bleeding tumors of the urogenital tract. In orthopedic patients it has been applied for hypervascularized skeletal metastases of the pelvic, spine and long bones. Intraoperative blood loss with its known risks can be markedly reduced. Reduction of pain has also been reported. The good results in our series of 9 patients together with the low incidence of side effects suggest that arterial embolization is indicated on a large scale.
The chondromyxoid fibroma as a benign bone tumour is described. The difficult but extremely important differential diagnosis from chondrosarcoma is discussed, and the question of the existence of malignant chondromyxoid fibroma is examined. Cases of malignant chondromyxoid fibroma that have been reported in the literature are described and critically analysed. Experience with seven chondromyxoid fibromas and two tumours misdiagnosed as malignant chondromyxoid fibromas are described. In view of the clear definition of chondromyxoid fibroma and chondrosarcoma the term malignant chondromyxoid fibroma is not justified and should no longer be used.
Seven hundred and five radiographs of the knee were examined and 17.6% showed a so-called Haglund imprint on the patella. The incidence was the same in patients with chondromalacia and in a control group. There was no statistical difference regarding age, sex and body weight. Haglund's imprint is a variation from the normal and is of no diagnostic value.
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Shortly before or shortly after the delivery of a child suffering from congenital paraplegia (myelomeningocele or spina bifida) the obstetrician is obliged to give advice as to what will follow after neurosurgical closure of the cele and shunting of the hydrocephalus. The parents' understanding of therapy and integration of the patient is developed to assess and utilise the future chances of the disabled child. Integration of children with congenital paraplegia is performed by an interdisciplinary team of therapists. However, the obstetrician's advice is of great value in preparing the parents for their decision for or against total care post partum. They must in fact be fully aware of the chances, that the disabled child actually has with regard to integration in life, and of what can be done in this respect. Besides the neurological, paediatric and urological care, it is the task of the orthopaedist to preserve or even to improve verticalization and mobility in paraplegic patients. In this manner he exercises an influence on the quality of life of the disabled children and on their social integration. Improvement and further development of physiological orthoses for walking enable even children suffering from a thoracic level of paralysis to walk independently and to achieve integration into society. Orthopaedic aspects of integration must be part of the information given to the parents by the obstetrician, so that they may be able to assess in what way their disabled children can participate in the future at various levels of everyday life.
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Autologous stump capping is a procedure designed to prevent bony overgrowth in skeletally immature amputation stumps. All 19 capping procedures in the lower extremities were successful after an average follow-up of 7.3 years. All patients use their prostheses, and no secondary operations have been needed for stump problems. Of the 31 cap-plasties of the humerus, six required re-operation. The overall failure rate of 12% is low compared with the failure rate of re-amputation.
The clinical findings seen in chondromatosis (Henderson-Jones syndrome) and the treatment of this rare disease are presented. The etiology is also discussed. The authors suggest a therapy, drawing on their own experience in 40 patients with an average follow-up of 12.6 years and on numerous articles from the literature. They recommend total synovectomy with removal of loose bodies at an early stage to prevent mechanical destruction of articular cartilage.
AIM: The diagnostic procedures and management of calcifying bone lesions occurring in the sacrum. METHOD: A case report of a rare type of bone cyst at an unknown localisation including the differential diagnosis and management. RESULTS: Low back pain of a 41-year-old women was correlated with a calcifying bone formation of the sacrum on X-ray, demonstrating cystic, solid and exophytic components. On radionuclide bone scan, additional skeletal lesions were ruled out, the focus showed an increased uptake. An inflammatory process was excluded by lab studies. On computed tomography and magnetic resonance imaging, the calcifying bone formation was identified as surrounding the sacral canal, respecting the anatomical borders. Considering this anatomic region, a neurogenic tumor could be eliminated by the absence of neurological disorders, but the radiologic feature of this osseogenic process was not clear enough for classification. Hence, an incisional biopsy was essentially required. Describing the lesion as a bony cavity, the operating surgeon could macroscopically exclude an chordom a (known to be soft consistency). The histological work-up classified this tumor-like lesion as a calcifying solitary bone cyst (CSBC). A dorsal exostosis causing the complaint of the patient was resected. The patient became asymptomatic. CONCLUSION: For the first time, a calcifying solitary bone cyst located in the sacrum is described, By sole resection of a dorsal exostosis causing the complaint, an overtreatment of grave consequences was avoided.
AIM: The purpose of this study was to evaluate the clinical outcome of patients with metastatic tumors of the spine after surgical and non-surgical treatment. METHODS: The charts of 259 patients with metastatic tumors of the spine were reviewed retrospectively to define predictors of outcome. Our data included patient demographics, primary tumor, location of the metastatic tumor within the spine, indication for surgical or non-surgical treatment, type of surgical and non-surgical intervention, post-treatment outcome in terms of neurology, use of adjuvant radiation therapy or systemic therapy. RESULTS: The most frequent indication for surgical treatment was the combination of neurological deficit (ND), pathological vertebral fracture, and pain (50 %). Surgical intervention was performed by the posterior approach in 67 %, by the anterior approach in 13 %, and by an anterior/posterior approach in 10 %. The post-surgical outcome, depending on the type of surgical approach in terms of ND, was for the posterior approach 29 % improved, for the anterior approach 53 % improved, and for the anterior/posterior approach 15 % improved. DISCUSSION: Our data suggest that the indications for metastatic tumor surgery in the spine depend on the location of the metastatic tumor in the spine, clinical symptoms, and prognosis.
After a review of the history, clinical features, laboratory findings, imaging techniques and the treatment of coxitis fugax, the authors inform about 131 own cases. In this disease of the hip joint, which is most commonly encountered in childhood, differential diagnosis is of the utmost importance. In the present study, the initial diagnosis had to be changed in eleven cases affected with this condition, which is also referred to as "observation hip". The patients ultimately contracted severe diseases such as leukaemia, juvenile polyarthritis or Perthes' disease.
The leading symptom of Catel-Manzke syndrome is a characteristic deviation of index fingers. Further the patients suffer from symptoms of Pierre-Robin syndrome (micrognathia, glossoptosis, cleft palate). The survival of patients, mostly male, depends on the severeness of congenital malformation of the face skull. The rare disease is demonstrated and discussed by two own cases.
In the final stage of ankylosing spondylitis the spine will be completely fixed. With loss of mobility the patients suffering of ankylosing spondylitis are susceptible to spinal fractures. Predominantly the fractures occur in the lower part of the cervical spine, caused often by minor trauma. High fatality is at a 30% rate seen as severe consequence of these fractures. Conservative and operative treatment may be used. Severe fracture dislocation and progressive neurological deficiencies are recommended to be stabilized operatively. To avoid trauma of the spine in patients with ankylosing spondylitis preventive measures seem to be possible and should be employed.
Pierre Robins syndrome associated with symmetric hyperphalangia of the index fingers is called Catel-Manzke syndrome. Connate radial deviation of the index fingers is caused by an odd bone. The deformity is demonstrated by two personal cases. The deviation is progressive and because of increasing functional limitation the operative correction of the index fingers at the age of 2-3 years is advised. Surgical technique and success of treatment are presented.
The transient coxitis is the most common hip disease in the childhood. Etiology is unknown. Questioning the history you will often find an infection in the neck, nose, ear area. Clinical, radiological findings and serological testing are unspecific. In the arthrosonography normally you will find an effusion. The positive diagnosis of the transient coxitis is only possible by observing the mostly benign course of the disease. The treatment is bed rest and non weight bearing. The most important differential diagnosis is the Perthes disease. The principal aspects of the transient coxitis are described and discussed in literature and by own experience.
The purpose of the study was to examine the accuracy of MRI in distinguishing between the cartilage of the femoral head and the acetabulum in vivo. In 20 healthy and 41 arthrotic hips an MRI was performed, using a special traction on the hips. With T1-weighted 3-dimensional gradient-echo sequence it is possible to distinguish between the high-signal femoral head and acetabular cartilage by having a low signal of the joint space. In the horizontal position of the phase encoding parameters a reduction of the chemical-shift artefact can be achieved mainly in the ventro-lateral areas. In addition it is possible to discriminate between four qualities of cartilage. The extent and localisation of degenerative cartilage in the hip joint can influence the indication of osteotomies for the hip joint.