Biomedical subjects
Publications and source records attributed to M Sparmann.
The inflammation of the wrist occurs very early in Rheumatoid arthritis. In cases of wrist deviation the biomechanics of the hole hand are affected. Carpal collapse will severely influence the range of motion (ROM) of the fingers. Operative techniques of how to maintain hand function are discussed. There are different procedures available - partial arthrodesis, arthrodesis and arthroplasty.
The function of the wrist is frequently considerably impaired by early destruction in patients with rheumatoid arthritis. The aim of endoprosthetic arthroplasty is to restore functional use and provide freedom from pain. In our study a newly developed, uncemented wrist prosthesis was implanted in 30 patients (24 women and 6 men) with advanced destruction of the wrist. This wrist prosthesis is a hydroxyapatite-coated cobalt-chrome prosthesis with a titanium coating of the articular surfaces. The radial component has an articular surface inclination of 10 degrees toward the ulna, and the carpal component, which is anchored with its tip in the distal carpal bones and third metacarpal bone, has a double articular surface with a radial inclination of 10 degrees. At the 18-month follow-up visit, the following parameters were examined: x-ray, grip strength, range of motion, and the patient's subjective satisfaction. Good improvement of function was found in 92% of the patients; 87% were free of pain. Eighty-eight percent of the patients rated the outcome of surgery as good. If the indication is accurately diagnosed, this wrist prosthesis can markedly improve function, which in turn leads to high patient acceptance. Various salvage procedures remain open because of the minimal loss of bone stock and the uncemented implantation of the prosthesis.
RATIONALE AND OBJECTIVES: To examine the ability to image fractures of the body and hook of the hamate bone in conventional X-rays and high-resolution computed tomography (HR-CT). MATERIALS AND METHODS: In an in vitro experiment using 18 cadaver hands, the hamate bone was fractured at different places. Before and after fracture, conventional X-rays were taken in different planes (anteroposterior, lateral, oblique, and carpal tunnel), and HR-CT was performed with 2-mm layer thickness in the axial, sagittal, and coronal plane. RESULTS: Taking into account all the conventional X-ray projections applied, the in vivo experiment revealed a sensitivity of 72.2%, a specificity of 88.8%, and an accuracy of 80.5%. For the HR-CT, the sensitivity was 100%, the specificity was 94.4%, and the accuracy was 97.2%. CONCLUSIONS: Fractures of the body and hook of the hamate cannot always be detected with certainty in the conventional X-ray image, even if different projectional planes are used. The HR-CT is the imaging procedure of choice for further clarification, and an axial or sagittal plane should be selected.
OBJECTIVE: To study the expression of the cysteine proteinases cathepsin B and L and their most potent inhibitor cystatin C in the synovial membrane of patients with rheumatoid arthritis (RA) and osteoarthritis (OA) on both the messenger RNA (mRNA) level and the protein level. METHODS: The expression of both cysteine proteinases and cystatin C was investigated in synovial tissue from 15 RA and 11 OA patients and compared with the expression of matrix metalloproteinase 1 (MMP-1; collagenase), MMP-3 (stromelysin), and tissue inhibitor of metalloproteinases 1 (TIMP-1). Expression of mRNA was analyzed by semiquantitative reverse transcriptase-polymerase chain reaction. Protein expression was evaluated by immunohistochemistry. The results were correlated with the histologic evidence of inflammatory activity. RESULTS: A significantly more pronounced expression of MMP mRNA was observed in RA synovium compared with OA. In contrast, the mRNA expression of cysteine proteinases, as well as TIMP-1 and cystatin C, did not differ between the patient groups. However, the protein expression of both MMP and cysteine proteinases was significantly more prominent in RA synovial lining compared with OA, whereas cystatin C and TIMP-1 protein were expressed equally. CONCLUSION: The data indicate a more pronounced expression of MMP mRNA compared with cysteine proteinases in RA. The higher levels of cathepsin B and L proteins in RA synovial lining cells compared with OA are consistent with previous studies that assert a post-transcriptional up-regulation of these enzymes in RA.
Pronounced osteoporosis of and surrounding the acetabulum commonly leads to early loosening of endoprosthetic hip replacements following implantation. Large osseous defects in the subimplant bed are the result and the reason why multiple revisions of loosened acetabular cups have to be performed so often in rheumatic surgery. The defects extend from the cranial to the central; ventral and dorsal anchorage losses may occur in addition to this. The anchorage of a new implant must be adapted to the individual circumstances. The new implant must be selected in accordance with point of surgical access, the patient's general status and osseous regenerationability. In the optimum case, osseous buildup of lost anatomical structures is the preferred method. If this is not possible, special implants, mostly custom-made prostheses, have to be incorporated. However, the survival time of the implants is much shorter than in patients with degenerative diseases.
To date, every attempt to bridge neural defects with nerve prostheses has failed. Silicone tubes,polyglactides, caprolactones and other compounds containing polyglactin have not solved the basic problems of nerve regeneration. The profound rejection responses to foreign matter cause destruction of the ultrastructural units that are imperative for the regeneration of neurites. Positive results obtained with animal experiments have not withstood clinical testing since inferior regenerative performance can occur despite obstructed regenerative pathways.
PURPOSE: Examination of the ability to image fractures of the body and hook of the hamate bone in conventional X-rays and HR-CT. MATERIAL AND METHODS: In an in vitro experiment on 18 cadaver hands, the hamate bone was fractured at different localisations. Before and after fracture, conventional x-rays were taken in different projectional planes: a.-p., lateral, oblique and carpal tunnel view, as well as an HR-CT with 2 mm layer thickness in the axial, sagittal and coronal plane. In addition, 15 clinically verified hamate bone fractures (two body and 13 hook of hamate fractures) were reviewed retrospectively to assess the value of the imaging procedures that led to diagnosis. RESULTS: Taking into account all conventional x-ray projections applied, the in vitro experiment yielded a sensitivity of 72.2%, a specificity of 88.8% and an accuracy of 80.5%. For CT, the sensitivity was 100%, the specificity 94.4% and the accuracy 97.2%. In retrospective clinical evaluation, 60% of the existing fractures were identified in the conventional x-ray images. The remaining fractures were detected by additional procedures like scintigraphy, conventional tomography and CT. CONCLUSION: For the diagnosis of fractures of the body and hook of the hamate HR-CT is the imaging procedure of choice, in which case an axial or sagittal plane should be chosen.
We investigated the secretion of the matrix metalloproteinases, interstitial collagenase (matrix metalloproteinase-1), gelatinase A (matrix metalloproteinase-2) and stromelysin-1 (matrix metalloproteinase-3) in human synovial fibroblasts after stimulation with the neuropeptide substance P. Human synovial fibroblasts were stimulated with substance P or interleukin-1 beta (IL-1 beta). In the cell culture media gelatinase A, interstitial collagenase and stromelysin-1 were identified and their activities towards different substrates were determined. Substance P in synovial fibroblasts induced an increase in the overall matrix metalloproteinase activity towards the dinitrophenyl-labelled peptide by 85%, against an increase of 124% after stimulation with IL-1 beta. In case of substance P stimulation, the increase in activity reflects a significantly enhanced secretion of gelatinase A, whereas no significant increase of stromelysin-1 and collagenase secretion could be observed. The matrix metalloproteinase pattern showing the highest gelatinase A secretion was obtained after stimulation with substance P. This pattern was very pronounced and differed very clearly from the pattern seen after IL-1 beta stimulation which caused a significant rise in collagenase and stromelysin-1 activity. We assume that distinct stimulation pathways are involved and that the neuropeptide (substance P), which is always present in the inflamed joint, plays its own and separate role in proliferative processes leading to the cartilage destruction.
An experimental investigation was performed to examine the influence of ACTH on the long-term results of muscle regeneration after nerve repair. Twenty albino-rabbits ("White Russians") served as the animal model. The epi-perineural neurorrhaphy of the fibular nerve was carried out under microscopic control with 11x0 sutures. A computer-supported light-microscopic analysis of representative muscle-fiber diameters was performed for detection of nerve regeneration on the effector muscle of the peroneal nerve, the anterior tibial muscle, after 3, 4, 5 1/2, 7, and 8 months. In addition, the nerves were examined by light microscopy using not only standard techniques but also surgical immunohistological staining techniques (APAAP). The acceleration of nerve regeneration already described in the literature was confirmed by our investigations. However, the results observed after eight months were similar, regardless of the ACTH dosage applied. Muscle regeneration was not influenced by the injection of ACTH. It therefore does not appear justifiable to clinically apply ACTH for improvement of nerve and muscle regeneration.
The present contribution deals with the early rehabilitation outcomes achieved using total knee arthroplasties with major differences in design. Hinged and unhinged total knee replacements are compared for a total of 100 patients included in the prospective study (48 hinged prostheses, and 52 unhinged ones). Evaluation of the functional and subjective parameters included shows that major improvements in total scores had been achieved in both groups already after 5 weeks, even more pronounced after 10 weeks. With a number of differences found for the various criteria assessed, it in particular is the fact of early stability of the joint in using the hinged prostheses that entails speedy progress and a good rehabilitation outcome. Due consideration of the different early outcomes for the various parameters, hence, is imperative in pre-operative decision-making.
Twenty patients treated by surgery for Perthes' disease were studied between 4 and 9 years postoperatively. In the clinical investigation eight patients complained of persistent stress-induced pain. In nine patients flexion, extension, ab- and adduction of the hip joint was limited. In the MRI-study of ten hip joints a reduction of fatty marrow was seen in the femoral head. In 11 hip joints of patients complaining of persistent pain, a deformation of the femoral head (n = 2), a dysplasia of the femoral metaphysis (n = 2), and diaphysis (n = 4) or both (n = 2) were seen. In another five patients an additional dysplasia of the acetabulum was visualized. All these findings were diagnosed by X-ray studies as well. However, only by MRI were the extents of the postoperative defects of femoral spongiosa diagnosed in fifteen hip joints.
A total of 40 surgical procedures were performed for bridging defects of the peronaeus nerve in 20 experimental animals (White Russian rabbits) with absorbable and non-absorbable suture materials. To investigate whether differences in the biological behaviour of suture materials may influence the formation of axons in the coaptation areas positively or negatively, the nerves were examined histologically and electrophysiologically and the regeneration process in the m. tibialis anterior, the reacting organ of the n. peronaeus, was assessed by histomorphometric quantification. Despite minor deviations in absolute values, significance tests and statistical evaluation with Wilcoxon's test revealed no significant differences among the groups. We could show that differences in biological behaviour of absorbable and non-absorbable suture materials are without influence on nerve regeneration in the proximal and distal coaptation areas and therefore without effect on the final results of nerve regeneration in defect areas.
An experimental study was performed in animals to investigate the effect of various coagulation techniques on the vascular system. Using a microsurgical procedure, the femoral vein of fifteen rabbits was exposed bilaterally and coagulated until the lumen was closed. Electro- and thermocoagulation systems were applied. The light microscopic examination showed endothelial alterations in the course of the vessel. Analyses with the scanning electron microscope were therefore also performed. Extensive endothelial damage could be detected regularly with monopolar currents; the results were not uniform with bipolar applications. The most favorable conditions were found when thermal coagulators had been used. Damage to the parallel arteries was not detectable to a significant degree in these cases. The toxic effect of the energy applied can be morphologically divided into three stages. It should be considered whether extensive endothelial damage leads to the formation of microthrombi and thus causes clinical complications.
Total RNA was isolated from cultured synovial fibroblasts of nine patients with rheumatoid arthritis and two controls (cruciate ligament ruptures). RNA was dot-blotted and hybridized with nine different, cloned cellular or viral oncogene probes. None of the proto-oncogenes showed a significant difference of expression in cultured fibroblasts from patients with rheumatoid arthritis when compared to the expression of control fibroblasts.
The development and introduction of microsurgical technique has made possible completely new concept of revascularisation surgery in femoral head necrosis. The bone graft described in this presentation is a pedicled one from the lateral ilium. In five femoral head necrosis a pedicled corticocancellous pelvic graft, supplied by the deep branch of the superior gluteal artery, was transplanted in the femoral head. In all cases it was possible to lift out the pelvic graft from the same side as the affected hip joint. Contrary to the medial iliac bone graft (deep circumflex iliac artery) the lateral iliac bone graft (deep branch of the superior gluteal artery) is inserted into the femoral head dorsally. Preoperatively and postoperatively performed selective angiographies are necessary and presented. In all cases an unimpeded perfusion could be shown three months postoperatively. Advantages and indications of the pedicled bone graft are discussed.
In congenital idiopathic club foot gross morphological changes cannot be assessed in muscle tissue by conventional histopathological techniques. Since, however, recent studies have indicated the presence of neuromuscular anomalies with preponderance of Type 1 fibres in this condition, we have performed histochemical, morphometric and electron microscopic examinations in muscle biopsies of 23 patients with congenital idiopathic club foot deformity. The age of the patients varied between 6 weeks and 12 years, respectively. Muscle biopsy was taken mainly from the flexor group of the affected leg(s) during the surgical correction of the anomaly. No gross pathological changes could be found by histochemical analysis. Morphometric study, however, disclosed abnormalities in the composition of the fibre types. The most prominent change was the percentual increase in Type 1 and decrease in Type 2 fibres in almost all the cases. Electron microscopically, only minor fine structural changes could be found. Since these changes could be assessed soon after birth just as in the later course, they cannot be regarded as the consequence of the abnormal position of the leg. More probably, Type 1 fibre predominance is related etiologically to the congenital club foot deformity.
A discussion is presented on the case of a 28-year-old motorcyclist who had an accident and got caught in the spoked wheel of her vehicle. The result was an extensive soft-tissue injury of the metatarsus and calcaneal part of the foot, a defect fracture of the calcaneus, an osseous disinsertion of the Achilles tendon, a lateral malleolus Weber type-A fracture, and a fracture of the second metatarsal bone. The primary treatment consisted in extensive débridement of the strongly contaminated soft parts and refixation of the Achilles tendon on the calcaneus with two osteosynthesis screws. The bruised skin flaps remaining were adapted in a tension-free manner. However, this was possible only in a considerable talipes equinus position. In the further course, the patient developed an extensive skin and soft-tissue necrosis over the calcaneal part of the foot. A neurovascularly pedicled forearm flap was freely grafted in order to maintain the load capacity of the calcaneal part of the foot, to prevent osteitis of the calcaneus, to correct the talipes eqinus position, and to achieve a resensibilization in the load zone of the sole. The healing result was good, and it was possible to achieve extensive correction of the talipes equinus position as well as prevention of calcaneus osteitis; the function of the Achilles tendon was also maintained. Moreover, there was satisfactory resensibilization of the calcaneal part of the foot, so that the patient can now walk in ready-made shoes with a fully molded arch support.
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