Biomedical subjects

M Weber

Publications and source records attributed to M Weber.

At least 991 records · Page 55Linked to original sources

PubMedDate not supplied

[The Holt-Oram syndrome. Review of the literature and current orthopedic treatment concepts].

PROBLEM: The clinical manifestation of the Holt-Oram-syndrome (HOS) shows congenital heart-disease and anomalies of the upper limb. The inheritance of this syndrome is autosomal dominant. The question arise, as to whether a contemporary orthopedic concept of treatment could developed based on own experiences and data from the literature. METHODS: We revised data from five patients with HOS treated at the Clinic for Orthopaedics of the University of Heidelberg. The review of the literature revealed a comprehensive and detailed picture of the clinical syndrome and, furthermore, information in respect to a comparative analysis of methods of treatments. RESULTS: Our patients showed characteristic cardiac anomalies, i.e. atrio and ventricular septal defects, and persisting Botall's duct (three cases). The types of malformation of the upper limb corresponded with those found in the literature. Furthermore the indication for amputation of rudimentary or hypoplastic fingers in the Heidelberg clinic was in accordance with the clinical treatments described worldwide. CONCLUSION: The type of treatment of the clubhand in cases with HOS depends on (1) the age and (2) the pattern and degree of accompanying malformations of the upper limb. For patients with aplasia of the thumb or amputation of a rudimental one we recommend pollicisation of the index finger to improve its function.

Child↗

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[Significance of revision of the occupational illness legislation for evaluating intervertebral disk damage].

QUESTION: Are there any radiological criterions which are able to indicate the profession related disease No. 2108? METHODS: The medical documents and x-rays of the whole spine of 390 back pain patients who applied for a profession related disease of the spine were evaluated. Those patients who fulfilled the professional claims for acknowledgement of the profession related disease were compared to those who didn't fulfill these conditions. RESULTS: Concerning the segmental alterations of the cervical and the lumbal spine specific allocation frequencies were found. The dominance of L3/4 in the comparison group was conspicuous. Looking at the allocation frequencies of the cervical and lumbal disc alterations in view of affection heaviness it was obvious, that the predominating slight alterations mainly were located in the central parts of the cervical and the lumbal spine whereas bad alterations mainly were found in the lower parts. Regarding this matter test and comparison groups behaved the same way. Looking at the allocation frequencies concerning single respectively multiple alterations it was found that in the comparison group single respectively bisegmentale alterations could be recognized even in duplicate than in the test group in which the multiple alterations were dominant. The comparison of the cervical and the lumbal spine regarding chondrotic? spondylotic, slight and bad alterations in all mentioned features the next deeper located segment was affected particularly in the test group. Therefore a distal shift of the chondrotic alterations could be recognized. In case of the spondylotic affections it was the other way round: a cranial shift was conspicuous. CONCLUSION: After doing heavy labour for years only a few isolated multiple affections of the lumbal spine are found. On the strength of this fact the proof of exclusively in the lumbal spine located alterations doesn't allow the acknowledgement of a profession related disease. However, a distal shift of osteochondrotic alterations respectively a cranial shift of spondylotic affections in the lumbal spine is suspicous for being job-related. L3/4 takes a very special place in the differential diagnosis of profession related disease of the spine. In the test group this part of the lumbal spine showed bad alterations much more frequent. The affection of L3/4 pleads against a considerable participation of mechanical influences and therefore against a profession related disease. Singular or bisegmental disc affections are out of question for being a profession related disease because these alterations are seen much more frequent in the comparison than in the test group.

Adult↗

PubMedDate not supplied

[Roentgen criteria and radiologic results of the Hofer-Imhof (H-I) threaded acetabulum cup in first time implantation].

The Hofer-Imhof cup consists of a parabola-shaped titanium acetabular component with flat threads. These flat threads are designed to be self-cutting and allow accurate insertion without incarceration, even in sclerotic bone. In a prospective study conducted from May 1988 to July 1989, 143 Hofer-Imhof cups were implanted. Radiographic assessment included initial bone contact, cup position, fixation on osteophytes, presence of any radiolucencies or sclerosis, cup migration and bone ingrowth. Initial prosthesis fit was evaluated with a 20 degrees caudally angled anteroposterior X-ray for accurate demonstration of the threads. 119 of the Hofer-Imhof cups (83.2%) were available for radiographic follow-up at a mean of 65 months (min. 37 mo., max. 95 mo.). One cup required revision after 23 months due to infection. The cups had an average inclination of 47 degrees, and complete bone contact was evident in 86.6% on the postoperative X-ray. In 8.4% of the cups, some threads were not in contact with bone at the edge of the acetabulum. At final follow-up, 82.4% had complete bone ingrowth without any evidence of radiolucency (type I), 15.1% had near-complete bone ingrowth with minimal radiolucencies (type II), and 2.5% had predominantly fibrous fixation (type III). One cup (0.8%) showed excessive migration. The technique of anchorage using a flat thread, minimal bone resection as a result of the parabolic shape and the sandblasted titanium surface are the characteristic features of the Hofer-Imhof threaded cup and produce good medium-term results in primary hip arthroplasty.

Acetabulum↗

PubMedDate not supplied

[Mobility of patients with coxarthrosis].

The common methods of evaluating walking capacity of patients with osteoarthritis of the hip reported in literature are all inaccurate and are based on symptoms. It has been proved, that these informations are to uncertain and therefore have to be replaced by objective criterias. A method of assessment was developed which can easily be applied in clinical routine without great apparative means. With a pedometer and a stopwatch the time can be measured which the patient needs to pass a distance of 30 meters as quick as possible (MAX 30). Similarly the maximal walking distance (MAX DIST) is evaluated as well as the average walking distance (MEDIAN). It could be shown, that walking capacity is not dependent on the amount of degenerative changes, duration of hip disease and hip motion. Walking capacity is negatively influenced by pain, muscle atrophy and lack of training. Patients with osteoarthritis of the hip are able to walk on average 3 km without interruption, thereby they develop a speed of 4 km/h on average. So they are not much slower than healthy subjects. The two must important aims of conservative treatment of hip disease must be alleviation of pain and improvement of muscular strength. Main indication criterium for hip replacement is walking capacity, not the radiological assessed amount of degenerative changes.

Adult↗

PubMedDate not supplied

[Expert evaluation in bony injuries of the spine].

The conventional way of appreciating working capacity is no longer satisfying considering the improved diagnostic tools with increasing frequency of various deformities, instability and ankylosis and their combinations. As in the evaluation of peripheral joint function a concept is proposed, which is based on the structural changes in the motion segments. The concept is practicable in all parts of the vertebral column and allows a differentiated judgement within the usual percentages.

Disability Evaluation↗

PubMedDate not supplied

[Development and assessment of so-called rotator cuff ruptures].

The following conclusions can be drawn from our investigations: We could not find out isolated ruptures of the supraspinatus tendon, which were caused exclusively by injury. Mostly ruptures of the rotatory cuff develop spontaneously, the basic degenerative changes involve also the shoulder joint and the acromioclavicular joint. The term rupture of rotatory cuff is misleading, because it signals to the patient the existence of aftermath of injuries and for the most part the rupture is not found in the tendons of the rotatory muscles but in the supraspinatus tendon. The degenerative cuff defects with spontaneous ruptures must be differentiated in medical certificate from the rare rotatory cuff ruptures, which are caused by injury alone. Seldom exogenous mechanical stress may lead to an enlargement of a preexistent rupture with symptoms and clinical signs, which occur for the first time. On the promises, that an adequate injury has occurred, that roentgenographic changes deteriorated within 3 months after the injury and a degenerative defect of rotatory cuff with clinical relevance can be excluded for the time before the injury, the damage of the shoulder has to be accepted by the insurance as an injury after accident. In the most times occasional causes with inadequate injuries to the shoulder are brought up, to assert an old degenerative defect of the shoulder as an aftermath of injury. There are no interrelations between intraoperative findings and mechanism of injury. The anamnestic statement of the patient concerning earlier diseases and injuries are often unreliable.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗

PubMedDate not supplied

[Pathological rupture of the distal biceps tendon after long-term androgen substitution].

QUESTION: Is the long-standing use of androgenes able to cause tendon lesions with pathological tendon ruptures? METHOD: In a case of a rupture of the distal biceps tendon after long-standing testosterone-substitution it is tried to show the connection between the use of androgenes and pathological tendon rupture by the help of the patients treatment documents, the X-rays and sonograms, the histological findings and the results of the clinical examination. RESULTS: For the first time a case with a rupture of the distal biceps tendon after long-standing testosterone-substitution for the support of a genital transformation is described. Since other tendon damaging factors could be excluded the suspicion of tendon alteration caused by androgenes is obvious. CONCLUSION: Looking at tendon ruptures of professionals and even amateur sportsmen the possible connection between long-standing use of androgenes and tendon damage has to be considered.

Adult↗

PubMedDate not supplied

[A new punch technique of cartilage-bone tissue for morphological studies in orthopedics].

A new technique is presented for the analysis of tissues which allows an exact, detailed comparison of light and electron microscopy. For this purpose, the previous techniques required the cutting of tissue pieces from the original tissue compound and the preparation of drawings as a rough localisation of the tissue pieces removed for analysis. Due to the processes of cutting and drawing, only an approximate localisation of the tissue investigated by electron microscopy was practicable. Specifically, the exact analysis of fetal cartilage-bone-tissue was mostly not possible due to the complicate arrangement of both tissue components. Therefore, the assessment of electron microscopic analyses was severely limited. The new technique, presented in this study, is characterised by a removal of punches 1 mm in diameter from the original tissue for electron microscopy. The remaining tissue with its exact defined punch-punctures is prepared for standard histology. Thus, the specific advantage of this new method is the precise attribution of the punched tissue to the original tissue group. Human fetal cartilage-bone-tissue has been used to demonstrate this punch-technique and the specific light- and electron microscopic preparations.

Bone and Bones↗

PubMedDate not supplied

[The treatment of hip dysplasia or dislocation with Fettweis' immobilization cast].

To verify the success of the cast immobilisation in a squatting position in the treatment of dysplasia and dislocation of the hip 41 children were reviewed whereby lapses up to 13 years had to be considered. In 9 hips the cast immobilisation leaded to an unsatisfactory result so that the joints had to be revised operatively. In the remaining 48 hips 31 (65%) were cured, 15 (31%) showed a light, 2 (4%) a grave remaining dysplasia. One hip joint showed an ischemic necrosis of the femoral head which corresponds to a rate of necrosis of 2.1%. As the concerned patient was treated with spreader pants in spite of the high grade of luxation of her hip it more likely that this avascular necrosis is caused by the preceding treatment and not by the cast immobilisation itself. Factors with negative effects on the result or bad prognostic signs respectively, were poor initial findings and reluxation during cast immobilization. The start of therapy had no noticeable influence on the result. On the other hand this factor was very important for the permanence of treatment. In hips with remaining dysplasia very often a clinical hypermobility was found. A positive Trendelenburg-sign was seen in the hip with defect-healed avascular necrosis of the femoral head and furthermore in 2 other hips with evident remaining dysplasia of the acetabulum. In comparison to other methods, the cast immobilisation according to Fettweis shows a low rate of avascular necrosis of the femoral head and a forced supplementary development of the dysplastic acetabulum. Because of its wide range of indication and its small rate of complications the Fettweis plaster cast is a very reliable method for the treatment of dysplasia and dislocation of the hip in infancy and early childhood.

Adolescent↗

PubMedDate not supplied

[Legal assessment of fractures and ruptures of the pelvis].

Since it is very difficult to arrive at a complete picture of the very varied effects of fractures and ruptures in the pelvic region, the few studies that have so far dealt with the assessment of injuries to the pelvic girdle have been unable to develop any uniform guidelines. An analysis of the clinical, radiological and in particular CT studies that have been published to date shows that there is a well-defined relationship between clinical and radiological symptomatology. This allows cases to be assessed expertly and objectively. Where there are unstable pelvic girdle fractures, follow-up examinations can use the extent of symphyseal diastasis and the dislocation of one or both halves of the pelvis in relation to the sacrum as a yardstick to assess the effects of injury on the posterior pelvic girdle and their consequences - effects which would otherwise be difficult to detect. Only where there are symphyseal diastases of more than 15 mm with degenerative alterations of the sacroiliac joint and permanent dislocation of one half of the pelvis does an impairment of earning capacity of 20% apply. Impairment-of-earning-capacity rates of 30-40% are appropriate in cases with completely unstable pelvic girdle fractures involving dislocation of both halves of the pelvis and posttraumatic arthritis in the sacroiliac joints. All other pelvic girdle or iliac wing fractures qualify for a maximum 10% reduction in earning capacity, even if the symphysis has become rigid.

Disability Evaluation↗

PubMedDate not supplied

[Infectious damage to the intervertebral disk--before and following discotomy].

Bad results after discotomy for treatment of herniated lumbar disc are caused either by postoperative complications or by preoperative diagnostic errors. Very often other degenerative changes of the "Bewegungssegment" are involved and misunderstood. But also septic lesions of the intervertebral disc following pyogenic hematogenous osteomyelitis of the spine are confused with degenerative lesions. They are even treated operatively as a ruptured intervertebral disc. When pyogenic osteomyelitis may no longer by overlooked after discotomy due to her progression, she is misinterpreted as discitis following removal of intervertebral disc. Only 9 of 97 verified patients with vertebral osteomyelitis suffered from true postoperative infection of the intervertebral space after removal of a herniated disc. In 14 patients the signs of hematogenous osteomyelitis of the spine have been missed or have been explained by degenerative changes of the spine. In none of the patients the wrong diagnosis was perioperatively revised. The common confusion of osteomyelitis and degenerative disc changes can be explained by several reasons: the predilection of lumbar spine and the similarity of local signs of both diseases, the unknown or underestimated frequence of radicular lesions in osteomyelitis of the spine and the difficulties to assess osteomyelitis in early stages by X-ray examination and the frequency of accessory degenerative changes. It may be supposed that many of the reported disc space inflammations after diagnostic or therapeutic means have not been caused by these manipulations but have given occasion for them.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[The radicular and pseudoradicular syndrome of infectious spondylitis and its differential diagnostic significance].

Infectious spondylitis is now the most common form of hematogenous osteomyelitis. In 37% of patients followed up it causes root irritation without peripheral paralysis, and radicular and pseudoradicular syndromes. Accounting for 8.2% of the cases, incomplete paraplegias are not as rare as is usually assumed. In certain sections of the spine infectious spondylitis is encountered very frequently (T7/8, T9/10, L3/4, and L4/5). The distribution pattern of the paralyses does not correspond to the frequency of the spondylitis in the individual segments of the spine. Radicular syndromes are more common in the lumbar spine, incomplete paraplegias in the thoracic spine. The neurologic risk depends on the patient's age: while very low in children, it is distinctly higher in patients aged over 70. Only the paraplegia risk is dependent on the extent of vertebral destruction. This in turn depends on the time that elapses until diagnosis. Almost all cases of spondylitis are still diagnosed unnecessarily late. Radicular and pseudoradicular symptoms accelerate diagnosis of spondylitis. Inflammatory and mechanical factors cause the radicular and pseudoradicular syndromes. Detection by radiologic examination is not usually possible. As regards formal pathogenesis, degenerative and inflammatory vertebragenous syndromes are indistinguishable, and spondylitis can only be clinically recognized from its general symptoms. No signs of paralysis occurred in any of the patients in whom spondylitis had been diagnosed in good time. Therefore, spondylitis diagnosis must also be improved in order to prevent neurologic complications.

Abscess↗

PubMedDate not supplied

[The history of orthopedics in Freiburg].

During the 19th century orthopedic medicine in Germany developed uniformly. The starting point was almost always the foundation of a private institute, which was then taken over by state/communal or confessional/charitable bodies, and in some cases universities. In Freiburg, however, orthopedics developed very differently. From the very beginning it was a clinical and academic discipline within the university. Orthopedic medicine was practised systematically at Freiburg Surgical Clinic from about 1835 on, and it was at this time that the first lectures in Orthopedics were given. Freiburg also has one of the oldest university orthopedic institutes. The founding of an Extraordinary Chair of Orthopedic Medicine is due to the efforts of the pathologist Aschoff and the surgeon Kraske. Besides Carl Friedrich Hecker, the special development of orthopedics in Freiburg may be attributed to the work of Georg Friedrich Louis Stromeyer. It is to him that orthopedics--in Freiburg and elsewhere--owes a debt not only for introducing surgical procedures, but first and foremost for its establishment as a scientific discipline. The remarkably early rise of orthopedics in Freiburg was followed, after World War I, by a decline brought about by economic conditions and university policy. Its consequences were so far-reaching that the Chair of Orthopedic Medicine in Freiburg was not refounded until 1970- the last in Germany. Until that time orthopedics remained dependent on the judgment or indulgence of the directors of the surgical clinic, who regarded orthopedics as a conservative discipline, or at best as a branch of limb surgery.

Germany↗

PubMedDate not supplied

[Growth disorders of the acetabular roof after acetabuloplasty in congenital hip dysplasia].

PURPOSE: The aim of this long-term study was to evaluate whether the Lance acetabuloplasty for congenital dysplasia of the hip causes a growth disturbance of the acetabular roof during or after puberty. METHOD: 71 hips of 58 patients were followed clinically and radiologically over a maximum time of 16 years after the operative procedure of a Lance acetabuloplasty. The average age of the patients at the time of operation was 2.8 years (1-6 years). In order to assess the growth of the acetabulum in the early and long-term postoperative phase quantitative parameters (acetabular index of Hilgenreiner, CE angle of Wiberg, ACM angle of Idelberger) as well as qualitative parameters (disturbance of the ossification of the acetabulum and the femoral head) were determined in standardized X-rays of the pelvis, done routinely 6 months, 3 years, 5 years, 8 years and at an average of 11 years as the last follow-up examination after the operation. The assessment of these metrical parameters were carried out in accordance to the classification of the study-group "hip dysplasia" of the DGOT (normal--slight pathological--serious pathological) respecting the different age-groups and degrees of dysplasia. RESULTS: Although in the early postoperative phase the acetabular roof showed a positive development (65% of the CE angles could be considered normal 3 years after operation), the further growth of the acetabulum was disturbed in the period of puberty (8 years after operation only 33% of the CE angles could be considered normal, 51% were extremely pathological). And also in the last X-ray control after an average follow-up time of 11 years a significant retardation of the acetabular roof was seen in 51% of all cases. CONCLUSION: The Lance acetabuloplasty seems to damage the Ossa acetabuli, which are as centers of ossification the essential anatomic structures for the growth of the acetabular rim in adolescence. CLINICAL RELEVANCE: Other procedures such as the Salter osteotomy are to be preferred for the therapy of hip dysplasia.

Acetabulum↗

PubMedDate not supplied

[Percutaneous CT-controlled puncture and drainage of spondylodiscitis--a minimally invasive method].

PURPOSE: Is there an absolute operative indication for the abscess-forming spondylodiscitis or is a curing also possible with minimal invasive procedures? METHOD: In a retrospective study over a period from 1986 to 1993, 40 patients with a spondylodiscitis of the thoracic and lumbar spine were treated and then followed up over two years in our Department of Orthopedic Surgery. Using a CT-controlled method of minimal invasive punction and drainage of the abscessed forms of spondylodiscitis, it was to be settled whether these therapeutic procedures result in a normalization of the biochemical inflammatory parameters (CRP) and in a normalization of the CT--as well as MRI-findings. RESULTS: 7 of the 40 patients had a spondylodiscitis with a local abscess, further 7 patients had a gravidation abscess. 92.5% of the cases were treated conservatively and minimal invasively, respectively. In 11 patients the minimal invasive procedure was used in addition to conservative therapy. 3 cases had to be operated on. A recurrence of the spondylodiscitis was seen in 1 patient; complications (n = 2; 1 x pneumonia, 1 x venous thrombosis) occurred in 5% of all patients. CONCLUSION: Minimal invasive therapy with CT-controlled punction or drainage may be a good alternative to the operative intervention in the predominantly old and multimorbid patients with abscessed forms of spondylodiscitis. The risk is minimized, the immobilizing period was 8.7 weeks on average.

Abscess↗

PubMedDate not supplied

Sodium chloride transport of normal and dietary enlarged rat cecum in vitro.

Sodium chloride transport across isolated cecum mucosa was investigated in normal rats and rats with adaptive cecum growth induced by dietary polyethylene glycol (PEG). The normal cecum absorbed Cl in excess of Na with a small short-circuit current (ISC). Dietary adaptation led to large equivalent increments of Na and Cl net absorption without adequate ISC change. Inhibitor studies (mucosal amiloride 10(-3) and 10(-4) M; mucosal 4, 4-diisothiocyanatostilbene-2,2-disulfonic acid 5 x 10(-5) M; serosal furosemide 10(-3) M; serosal ouabain 10(-3) M) suggested that normal cecal NaCl absorption involves electroneutral Na/H and Cl/HCO3 exchange at the apical and Na-K-ATPase-mediated exit across the basolateral cell membrane. Dietary adaptation stimulates the loosely coupled antiports and possibly activates a small serosally located NaCl cotransport. Comparative histology showed flattening of all tissue layers and widening of crypts in PEG animals. Crypt widening may facilitate ion access to underutilized transport sites and, at least in part, explain the increased absorption of the enlarged cecum.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗

PubMedDate not supplied

Acute reversible cerebral arteritis associated with parenteral ephedrine use.

Cerebrovascular disorders in association with licit or illicit drugs have rarely been reported. We report a first case of stroke associated with the parenteral use of ephedrine. A 44-year-old woman underwent spinal anaesthesia for varicose vein surgery. She was usually treated with propranolol and occasionally with phenoxazoline. During anaesthesia, ephedrine was administered by the venous route because of arterial hypotension. She developed intracranial hypertension and focal cerebral deficits related to multiple haemorrhagic cerebral infarcts associated with a reversible beading appearance on angiography consistent with the diagnosis of acute cerebral arteritis. The role of ephedrine in this case is discussed beside other causes of acute cerebral arteritis.

Adult↗

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Human peripheral blood eosinophils express and release interleukin-8.

Eosinophils can synthesize various cytokines. We demonstrate that interleukin-8 (IL-8) mRNA and protein are constitutively expressed by freshly isolated resting human eosinophils. Most of the patients with bronchial asthma or atopic dermatitis show evidence for up-regulated IL-8 protein expression in eosinophils but not in neutrophils, suggesting that an eosinophil-specific cytokine may act in these patients. To investigate whether the intracellular IL-8 can be released, eosinophils were stimulated by different cytokines and platelet-activating factor (PAF). Priming with granulocyte/macrophage-colory-stimulating factor and a subsequent 25-min stimulation with RANTES or PAF resulted in release of IL-8 from highly purified human eosinophils in vitro.

Asthma↗