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Biomedical subjects

M Bircher

Publications and source records attributed to M Bircher.

17 recordsLinked to original sources
PubMed1998

Rapid prototyping for orthopaedic surgery.

The revision of an orthopaedic procedure can present surgeons with the challenge of a complex reconstructive process. Orthopaedic surgery can also face considerable challenges in cases presenting extensive primary injuries with multiple bone fragmentation, as well as in cases presenting bone deformities. Radiographs are used routinely for orthopaedic surgical planning, yet they provide inadequate information on the precise three-dimensional extent of bone defects. Three-dimensional reconstructions from X-ray computed tomography offer superior visualization but are not portable for consultation or readily available in the operating theatre for guidance during a procedure. A physical model manufactured from X-ray computed tomography data can offer surgeons a clear understanding of complex anatomical detail, by providing an intuitive physical relationship between patient and model. Rapid prototyping was used for the construction of an anatomical model in a case presenting with a complex shoulder injury. The model provided a definitive interpretation of joint pathology and enabled a full assessment of the degree of injury.

Adult↗
PubMed1991

Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw.

We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients' mobility at final review. There was no difference in failure of proximal fixation: cut-out occurred in three cases with the DHS, and twice with the Gamma nail. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery. In the absence of these complications, union was seen by six months in both groups.

Aged↗
PubMed1988

Assessment of the outcome of low back surgery.

We aimed to develop a better understanding and method of rating the success or failure of low back surgery by studying 185 patients prospectively. Identical pre-operative and postoperative assessment by an independent observer included pain, disability, physical impairment, psychological distress and illness behaviour. Outcome was assessed by the patient, by the observer and by return to work. There was 96% follow-up at two years. Correlation co-efficients varied considerably between the various measures of outcome, both patient and observer appearing to base their assessment mainly on postoperative status rather than on any change produced by surgery. The observer was influenced most by postoperative pain, disability and physical impairment. Patients were influenced most by residual physical impairment, type of surgery and proportional change in disability. Return to work was moderately influenced by postoperative disability and to a larger extent by social and work-related factors. We developed a simple formula to judge overall success or failure which accurately reproduced the combined assessment of patient and observer. If surgical audit is to be meaningful it must be based on an improved understanding of how the outcome of surgery should be assessed.

Activities of Daily Living↗
PubMed1986

A concept of illness tested as an improved basis for surgical decisions in low-back disorders.

In previous studies a model of illness based on analysis of the relationship between the different elements of illness at one pont in time was developed. This study prospectively tested this model and a number of associated hypotheses in 185 patients who had various types of surgery for low-back disorders: 49 had chemonucleolysis; 91, first-time disc operations; 20, fusions; and 25, repeat operations. Identical pre- and postoperative evaluations were performed with 96% of patients independently reviewed at an average of 26 months after surgery. The authors analyzed how physical and psychologic factors interacted to affect the outcome of surgery and attempted to explain other conflicting reports of how either physical or psychologic factors determined surgical outcome. It was found that physical outcome was almost entirely determined by physical factors, ie, accuracy of diagnosis of a surgically treatable lesion, operative findings, surgical procedure, and avoidance of complications. The most important psychologic disturbances were distress and abnormal illness behavior that could affect surgical outcome indirectly if inappropriate illness behavior led to inappropriate surgery and also directly affected subjective judgments of pain or disability--by patient or observer. Return to work was strongly influenced by additional occupational factors. All the main hypotheses were confirmed and this model or concept of illness is proposed as the basis for a fundamental reconsideration of clinical management and surgical decisions in low-back disorders.

Adult↗
PubMed1984

Symptoms and signs: physical disease or illness behaviour?

The amount of treatment received by 380 patients with backache was found to have been influenced more by their distress and illness behaviour than by the actual physical disease. Patients showing a large amount of inappropriate illness behaviour had received significantly more treatment (p less than 0.001). The symptoms and signs of illness behaviour need to be clearly distinguished from those of physical disease, and better assessment of illness behaviour is essential if everyday clinical practice is to fulfil the ideal of treating patients as well as diseases.

Adult↗
PubMed1978

The microvibrations of the body, an index for examination stress.

Changes of whole-body microvibrations (MV) were quantitatively analyzed in 123 voluntary subjects during two examination situations and compared with the results obtained during the ensuing vacation. The force oscillations in the three space directions were measured during quiet bipedal standing and simultaneously recorded as a time function with the rectified and integrated force-time function (= rectified impulse). The rectified impulses related to body weight were used as a measure for the MV. Immediately before the examinations, all the subjects showed high values. These decreased significantly in the control measurement if the subjects passed the exams, but remained relatively high in the subjects who failed. In all three measurements, smokers and candidates who took tranquilizers before the exams show higher MV values than do the other subjects. Females are less tense than males, a difference particularly significant in the vertical (z) direction. The rectified impulse in this direction correlates positively with the estimated cardiac output. Body weight and body length show a positive correlation with the MV values in the horizontal forward-backward (x) and vertical (z) direction. The measurement of the whole-body MV enables quantitative evaluation of the complex load due to an examination situation. The hypothesis that different types of stress or personality affect given directions in space requires further investigation.

Adult↗
PubMedDate not supplied

Surgical complications and implications of external fixation of pelvic fractures.

The application of a pelvic external fixator can be a vital stage in the management of patients with severe pelvic fractures, either as part of the resuscitation phase or as definitive treatment. This paper shows the complication rate of pelvic external fixation to be 47 per cent. This high rate increases the morbidity associated with the fracture, and may also interfere with the definitive management. The majority of complications were associated with pin placement and the pin-bone interface. An understanding of the principles of external fixation and knowledge of the correct methods of application should reduce this complication rate.

Adolescent↗
PubMedDate not supplied

[Psychotherapy in old age - experiences with individual therapy in geriatric and geronto-psychiatric patients].

Individual psychotherapy with the old is being described and analyzed on the basis of treatment experiences with 48 geriatric and gerontopsychiatric patients aged 80 to 96. Furthermore conditions of successfully integrating psychotherapists in the team of geriatric hospital are examined. Special problems in treating the chronically and terminally ill are dealt with and resulting therapeutical aims are discussed.

Aged↗