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Biomedical subjects

L Jani

Publications and source records attributed to L Jani.

101 records · Page 6Linked to original sources
PubMedDate not supplied

[Heparin-induced thrombocytopenia after elective hip joint replacement with postoperative prevention of thromboembolism with low-molecular-weight heparin].

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a severe side effect of the prophylaxis of venous thromboembolism with unfractionated heparin. The aim of the present study is to gain more information on the incidence of HIT during prophylaxis of venous thromboembolism with low-molecular-weight heparin in elective hip surgery. METHODS: 586 consecutive patients were included into the prospective study, who were admitted to hospital for elective hip replacement. The incidence of thrombocytopenia, clinically manifest venous thromboembolism and of the heparin-induced IgG antibodies were analysed during prophylaxis with low molecular-weight heparin. Patients received once daily subcutaneously low molecular-weight heparin for a mean of 28 days postoperatively. Platelet counts and clinical examinations for the presence of venous thromboembolism were done at days 0, 2, 7 (+/- 1) and 12 (+/- 2). Heparin-induced IgG antibodies were determined before and after a 12 (+/- 2) days prophylaxis with low molecular-weight heparin in 265 of 586 patients randomly. Patients were reexamined for thromboembolic complications after 3 and 6 months. The clinical suspicion of thromboembolic complication was documented objectively. RESULTS: None of the patients developed a decrease of platelets of < 50% of the initial value. Ten of 265 patients had elevated IgG antibodies against heparin/platelet factor 4 before prophylaxis (3.8%). After the 12 (+/- 2) days prophylaxis 13 of 265 patients had elevated IgG antibodies (4.9%). C14 serotonin assay was positive in 0 of 10 patients before treatment and in 3 of 19 patients at day 12 (+/- 2). Ten patients developed venous thromboembolism postoperatively (8 x deep venous thrombosis, 2 x pulmonary embolism, no fatal embolism). Only 1/19 patients with elevated antiheparin IgG titres developed venous thromboembolism. The C14 serotonin assay was negative in this patient. Two patients died in the postoperative phase due to underlying cardiovascular diseases. CONCLUSIONS: In patients with elective hip replacement prophylaxis of venous thromboembolism with low molecular-weight heparin was associated with a very low incidence of HIT, and hence screening for HIT antibodies is not required.

Aged↗
PubMedDate not supplied

[Osseointegration of a laser-structured titanium hemispheric acetabulum in the animal experiment].

Eight hemispherical titanium-cups with a new laser structured surface had been implanted in sheeps. Duration of implantation was eight weeks and one year. Analysis and evaluation of the results were done by post-operative x-rays, x-rays of the specimen, macroradiography, microradiography, fluorescencemicroscopy and histology. A quantitative analysis of the bony ingrowth was performed with a computer-aided system. The 8 weeks-cups showed an osseointegration rate of 28.8%, the one year group of 52.1% of the available surface. Bony ingrowth of the laserstructured titanium surface is possible. The laserstructured titanium surface can be used for the cementless fixation of implants.

Acetabulum↗
PubMedDate not supplied

[Clinical and radiological isthmus reconstruction in lumbar spondylolysis and minimal spondylolisthesis].

Treatment of spondylolysis and minor form of spondylolisthesis in childhood is usually conservative and includes physical therapy, a temporary reduction in sport activities or the use of an orthosis. Persisting pain despite conservative therapy, neurological symptoms and progressive sliding on x-ray may indicate surgical treatment. We report about the results in 25 patients operated by direct repair of the isthmus between 1982 and 1990 in the Orthopaedic Hospital in Mannheim. In 75% of the cases the special hook-screw by Morscher was used. The other patients were operated according to the original method described by Buck or by the Scott procedure with wire fixation. The clinical and radiological results were available in all patients by a mean follow-up of 8.9 years (4-12 years). All juvenile patients had good or very good clinical results. Within the adult group half of the patients had fair or worse clinical results. Only in 3 out of 14 cases we found bony consolidation of both arches. In 6 cases the x-ray showed pseudoarthrosis on both sides. In 3 of these patients spondylodesis had to be performed. Because of the bad results of direct repair in adult patients, we looked for further criteria, which are necessary to achieve good clinical and radiological results. In addition of the age, the condition of the disc is important. In adolescent patients (more than 16 years old) we documented a degeneration of the disc by NMR or by intraoperative discography.

Adolescent↗
PubMedDate not supplied

[Pyogenic spondylitis in the interarticular portion of the vertebral arch. Case report on primary dorsal spondylitis].

The manifestation of a pyogenic spondylitis only in the dorsal part of a spinal segment is very rare and causes even more diagnostic problems than the typically anterior located spondylitis. We are reporting on a patient with known isthmic spondylolisthesis who developed the inflammatory process primarily in the intervertebral joint and in the interarticular portion. For a few months the cause of his complaints was thought to be due to spondylolisthesis till radiological adn laboratory methods lead to the correct diagnosis and adequate therapy.

Abscess↗
PubMedDate not supplied

[Conservative treatment of hip dysplasia/hip dislocation in infancy].

In the last two decades, considerable progress has been made in the conservative treatment of dislocation. As our ability increases to detect hips at risk due to instability or decentration in the course of screening newborns, it ought to be possible to make this treatment increasingly simpler and less problematic.

Casts, Surgical↗
PubMedDate not supplied

[Harrington's operative treatment of scoliosis in combination with segmental transverse stabilization with Luque cerclage (the Harrington-Luque operation). Early results of the first 31 personal cases].

Early postoperative results in 31 cases of scolioses of varying etiology using the new combination of Harrington's distraction system together with Luque's segmental wiring are presented. Starting from an average preoperative COBB angle of 70 degrees (40 degrees-120 degrees), postoperative average correction to 35 degrees (15 degrees-80 degrees) could be achieved. This represents an average correction of 49.7% (28%-73%). One deep wound infection (cleared by removal of the material) and one transient monoradicular nerve irritation complicated the follow-up in total. The superior stability of the Harrington-Luque-combination (detailed description of the operative procedure) allows the reduction of the postoperative time of external splinting to only 6 months. The Technique described can be estimated as a considerable improvement of the classical Harrington-operation and has already replaced it in our department.

Adolescent↗
PubMedDate not supplied

[Gliding polyethylene-PMMA combination as "wear model"].

The situation, described in this casuistry, shows the fatal consequences of the huge amount of wear particles from the PE-PMMA-components of a total hip prosthesis. The prosthesis had been implanted in Russia. It was made of a PE-ball fixed to a titanium stem and a socket, which had been molded intraoperatively in situ. The combination of PMMA and PE in the bearing surface caused an extreme osteolysis in the proximal femur and the acetabulum and the loosening of the cup and the stem within only a few months.

Aged↗
PubMedDate not supplied

[Reproducibility of radiologic markers of osteoarthritis. Evaluating a score for radiologic classification of degenerative changes in osteoarthritis of the knee joint].

INTRODUCTION: The radiological assessment of osteoarthritis of the knee joint in longitudinal studies is usually performed with established classifications. It is disadvantageous that these features are always combined to describe a certain stage of the disease, even though they can develop independently. METHODS: A german score based on a publication by Scott et al. (1993) was designed. At first 100 X-ray series of knees were evaluated using the Jäger & Wirth, the Kellgren & Lawrence classification and the point score. Six observers then evaluated 200 anonymised radiographs of knee joints twice within 3 months. RESULTS: The most reliable criteria for the inter-observer reliancy were medial osteophytes, medial joint-line narrowing, patella osteophytes and chondrocalcinosis. At least 4 out of 6 observers had a high match in these criteria. The reproducability of most of the individual radiographic features was good, with a higher level of orthopaedic training resulting in a higher consistency of the score. DISCUSSION: A certain level of orthopaedic training is necessary for consistent results. The main focus of the score will be less the daily routine assessment of radiographs of the knee joint, but more the scientific assessment of radiographic progression of osteoarthritis in longitudinal studies.

Humans↗
PubMedDate not supplied

[A new standard method for experimental for measuring cement coat strength in endoprosthesis implantation].

The distribution of bone cement around an endoprosthesis influences its stability over the long term. We have developed a new method for the experimental measurement of the cement mantle thickness of an endoprosthesis. The use of this computer-aided procedure is described in a hip prosthesis. Transverse sections of a human femur containing a cemented stem were prepared, recorded with a CCD camera and the images fed into a computer. The image-processing software differentiated the metal and bone cement on the basis of the different colours. Radial lines were drawn from the calculated centre of gravity of the stem, and the cement thickness was measured automatically along these lines. In our experiment, the accuracy of the method was 0.2 mm. This method of measuring the thickness of the cement mantle is accurate, rapid and practical.

Arthroplasty, Replacement, Hip↗