Biomedical subjects
Publications and source records attributed to M Sager.
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In patients suffering from, or with a history of, reflex sympathetic dystrophy (RSD), there is always a risk of exacerbation or reactivation of this disease after surgery or trauma. The use of calcitonin in the treatment of this type of disorder is well established. Starting in 1984, 18 patients with clinical symptoms of RSD or a history of this disease were given daily prophylactic treatment with salmon calcitonin (100 IU subcutaneously or as a spray). Ten of the patients underwent orthopaedic surgery and 8 received conservative treatment following trauma. The mean duration of prophylactic treatment was 4 days before and 23 days after surgery or trauma. Only one recurrence was observed (3 per cent). For comparison, a retrospective analysis of a group with the same inclusion criteria who underwent surgery or received conservative treatment after trauma, without prophylactic administration of calcitonin showed a recurrence of the underlying disease 28 per cent of the cases. It is therefore possible to recommend prophylactic administration of calcitonin, to patients with a history of RSD who are about to undergo orthopaedic surgery or conservative treatment following trauma.
Based on a case report regarding a patient with a tenosynovial tumor in the calcaneal spur area, we present a compilation of the differential diagnoses in the event of heel pain. The diagnostic procedure is dealt with peripherally. As to the various therapeutic possibilities, we refer to the literature.
Early diagnosis and medical as well as physical therapy are necessary to successfully treat reflex sympathetic dystrophy. Psychological support and guidance of the patient are also a must. Due to wide individual differences it is not possible to recommend any single therapy as the sole treatment. The choice of treatment must be selected not only according to disease stages but also taking the individual factors of each patient inter account. Therefore, therapy must often be modified during the course of treatment. As a result a favorable out-course can be expected in most cases. Today severe physical disabilities secondary to sympathetic reflex dystrophy is quite rarely encountered.
1. In intensively operated dog breeding kennels bacterial infections are very significant in perinatal mortality. 2. Staph. aureus, Streptococci (type G) and also beta-haemolytic E. coli were transmitted intra-uterine or by the infected genital tract to the puppies. In many cases they are the cause of septicaemic death of the puppies. 3. A second important cause of infection is subclinical mastitis of the bitch, leading to septicaemic death of newborn puppies. 4. Prophylactic hygienic measures make possible a prognosis concerning the risk of perinatal death. This includes examinations of the dog and the bitch ante coitum, bacteriological examination of the genital tract of the bitch, and a bacteriological examination of the milk before the date of birth. 5. Prophylactic hygienic measures in combination with antibiotic treatment of the bitch or the puppies could reduce the losses of puppies to less than 10%.
We reviewed malpractice data from the state of Wisconsin for 1983 and 1984 to determine the frequency and the outcome of malpractice litigation by the elderly. Research data were obtained from court dockets filed with Wisconsin's Patients Compensation Panel and from 281 attorneys who provided the age for 431 claimants. The results showed that 10.0% of malpractice suits in Wisconsin were filed by the elderly during the study years. When we compared the frequency of litigation with the use of the health care system (number of hospitalizations and inpatient days), the elderly were significantly less likely than younger persons to initiate malpractice litigation despite greater exposure to potential negligence. However, once a malpractice suit was filed, there was no significant difference between older and younger litigants in the disposition of the case or in the likelihood of being the prevailing party when a finding or award was made. These findings suggest that the elderly are less likely to file malpractice claims against health care providers than would be expected given their use of the health care system. This finding may be related to social, economic, and legal barriers to malpractice litigation by older adults.
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INTRODUCTION: It is well known that cytokines are involved in the induction of intervertebral disc and articular cartilage destruction. Therapeutic proteins are of great potential as locally produced drugs after transfer of their cognate genes to the sites of interest. METHODS: Chondrocytic cells from bovine os coccygis and discal chondrocytes from 6 wistar rats were isolated and cultured in vitro. The bacterial beta-galactosidase (LacZ) gene and the cDNA of the human interleukin-1 receptor antagonist (IL-1ra) were introduced into the cells by retrovirus mediated gene transfer. LacZ activity was determined by Xgal staining, IL-1ra protein was determined by ELISA. RESULTS: Our study confirms that isolation and cultivation of bovine chondrocytic end plate cells and of rat discal cells in possible. Transfer of both LacZ and of the IL-1ra cDNA to cultured cells was successfull. DISCUSSION: The introduction of exogenous therapeutical genes into cells from the intervertebral disc and the end plate opens the possibility for a local gene therapy of IVD degeneration. This therapy has the potential to be specific, effective and appropriate to the chronicity of the disease.
AIM OF THE STUDY: The aim of this study was to evaluate the response of the femoral head to intraosseous pressure increases and to document blood flow of periarticular soft tissue after infusion of vasoactive substances. Beside that the value and imagery of native MRI after induced intraosseous pressure increase should be estimated for early detection of femoral head necrosis. METHODS: The alteration of intraosseous pressure and peripheral blood flow of the femoral head of beagle dogs was examined after administration of bradykinin as a vasoactive substance followed by subsequent magnetic resonance imaging (MRI). Bradykinin was injected into the arteriae circumflexae femoris lateralis and medialis of six beagle dogs. The administrations were made using a standard protocol with simultaneous measurement of venous blood flow and intraosseous pressure distribution in the epiphysis of the femoral head. Bradykinin was applied in regular time intervals followed by MRI. RESULTS: At a mean epiphyseal pressure 14.66 mmHg (sigma: 2.42) in the femoral head, a mean flow of 91.6 ml/min (sigma: 16.08) was measured in the vena femoralis. After an administration of a defined concentration of bradykinin an increased epiphyseal pressure was recorded in the measured area. An average increase blood flow of the vena femoralis was observed at the beginning of the bradykinin-injection, followed by a circulatory volume reduction. The post-experimental MRIs showed massive oedema in the femoral musculature after bradykinin-application, however without osseous signal alterations in T1- or STIR-weighted images. CONCLUSION AND CLINICAL RELEVANCE: Our results indicate that acute intraosseous pressure increases are not accompanied by signal alterations in MRI. Obviously more extensive pressure induced lesions are necessary for detectable signal alterations, as these have already been demonstrated in patients with diagnosed femoral head necrosis.
OBJECTIVE: To present an alternative surgical technique for the repair of soft palate defects in dogs. ANIMAL POPULATION: Three Foxhound cross dogs. METHODS: Bilateral buccal mucosal flaps, based at the palatoglossal arches, were raised. One flap was rotated so that the mucosal side created the floor of the nasopharynx. The second flap was rotated so that the mucosal side formed the roof of the oropharynx. The mucosa of the remnant of the soft palate and the pharyngeal walls was incised and the flaps sutured to these free mucosal edges. The caudal ends of the two flaps were sutured to each other. RESULTS: Complete closure of the soft palate defect was obtained in all three dogs. The dogs were monitored for between 1.5 and 3 years postoperatively, and no long-term problems were encountered. CONCLUSIONS: This surgical technique resulted in an excellent functional separation of the oropharynx and nasopharynx and allowed reconstruction of a large bilateral soft palate defect. CLINICAL RELEVANCE: By using the buccal mucosal flaps, as described in this report, a tension-free closure of large soft palate defects can be obtained, thereby eliminating a major cause of failure of this type of reconstructive surgery.
A case of degenerative spondylopathy in chondrocalcinosis (pseudospondylo-discitis) is presented. The incidence of vertebral involvement in chondrocalcinosis reported in the literature is reviewed. In approximately 4-10% of all cases of chondrocalcinosis the vertebral column is involved as well. Especially in elderly patients, a differential diagnosis based on clinical, radiological and laboratory findings must include infectious spondylodiscitis. In the presence of additional degenerative spondylolisthesis, as well as radiculopathy and/or symptoms of spinal stenosis, surgery is often performed. However, there are cases reported in which improvement occurs after spontaneous vertebral fusion without surgical intervention. If any vertebral change is detected that is suggestive of chondrocalcinosis, even in asymptomatic patients, it is recommended to obtain radiographs of other joints, for example, the knee and wrist, which are frequently also involved in chondrocalcinosis.