Biomedical subjects

M Wiese

Publications and source records attributed to M Wiese.

115 records · Page 7Linked to original sources

PubMedDate not supplied

[Computer-assisted navigated cup placement of different cup types in hip arthroplasty--a randomised controlled trial].

AIM: The position of the acetabular implant has a great influence on the outcome of total hip arthroplasty. The acetabular implants differ in their characteristics during insertion. In order to control the influence of the implant in different axes, 80 implantations of acetabular component were performed under computer-assisted control by a surogate navigation system. METHOD: Within a prospective randomised study, 70 total hip replacements were performed by one surgeon using two different uncemented implants (PPF screw cup/Hedrocel pressfit cup). The position of the cup was measured at different times during surgery and was compared to 10 cemented PE cup placements. RESULTS: During the milling procedure the anteversion of the two uncemented cups differed significantly (p = 0.026). The standard deviation of anteversion during implantation different significantly relating to the cup type: press-fit cup 3.86 degrees, screw cup 2.1 degrees and cemented PE cups 0,84 degrees. The inclination was less susceptible. CONCLUSION: The cup design of uncemented acetabular implants influences the outcome of surgery. In our trial a spherical press-fit cup showed a greater variability than the screw-cup. The CAS system can be used as a tool to minimise these effects.

Acetabulum↗

PubMedDate not supplied

[Occupational diseases of the spine].

Since 1993 occupational influences of the spine are included into the German workman's compensation law (Berufskrankheitenverordnung). Because it is difficult to differentiate degenerative from occupational disc diseases only 3 % of the proposals have been accepted in the last years. Unfortunately most of the epidemiologic studies only consider morphologic changes of the spine but not discogenic diseases. More efforts have to be made to prevent spine diseases in the working place by exercises and back training. Our results of medical opinions in 256 cases of occupational spine diseases are presented and analysed.

Adult↗

PubMedDate not supplied

[Mid-term clinical results of in-patient conservative treatment of cervicobrachialgia syndromes].

AIM: The aim of this study was to evaluate the mid-term results of an in-patient conservative therapy regimen for discogenic cervicobrachialgia. METHODS: A retrospective follow-up of 100 patients after an average of 4.01 years with clinical examination and a questionnaire was performed. RESULTS: The subjective outcome rating for pain on a scale from 0 (pain-free) to 10 (maximum imaginable pain) was reduced from 7.91 at beginning of the therapy to 3.19 at the end of the therapy and to 1.5 at follow-up (p < 0.005). Duration of pain, reductions of motion and palsy improved significantly. The patients' appraisal of required surgical therapy could be reduced from 26 % at beginning to 2 % at the end of the therapy. CONCLUSION: The intensive conservative in-patient treatment for discogenic cervicobrachialgia shows a high satisfaction of the treated patients even after a follow-up of four years. The natural course of the disease shows a rapid and stable remission after wearing off the acute or subacute complaints.

Brachial Plexus Neuritis↗

PubMedDate not supplied

[Cup placement in hip replacement surgery -- A comparison of free-hand and computer assisted cup placement in total hip arthroplasty -- a multi-center study].

AIM: The purpose of the current study was to determine the accuracy of free hand and computer-assisted (CAS) cup placement. MATERIAL AND METHODS: Between June 1985 and August 2001, 105 free-hand and from March to November 1999 80 total hip arthroplasties under computer assistance were implanted in the above mentioned centers. To determine the accuracy of the cups, the inclination and anteversion angles were measured. In all cases the cup position was measured with a CT-investigation of the pelvis. Statistical analysis was performed with the F-test. RESULTS: With regard to the inclination and anteversion angles the variability of the cup position was significantly higher in the group of free hand implanted cups. In the CAS group we could not find any "extreme" positions. CONCLUSION: Using computer-assisted surgery a significantly higher reproducible cup position can be obtained. Long time survey may present a lowering of the rate of early and late complications caused by better prostheses alignment in the follow up.

Adult↗

PubMedDate not supplied

[Medical and cost efficiency of autologous blood donation in total hip or knee replacement].

AIM: Preoperative autologous blood donation before joint replacement has become standard practice. However, this procedure is discussed controversially regarding medical benefit and cost-effectiveness. METHOD: In a retrospective study the data of 994 patients scheduled for hip (THR) or knee arthroplasty (TKR) between 1/2000 and 9/2002 were analysed. RESULTS: Altogether 612 patients donated autologous blood (61.6 %). 50.2 % of the patients got blood transfusions during surgery or in the course of their hospitalisation. Donors received blood units more often than non-donors (55.2 vs. 41.9 %). On average 1.4 +/- 1.7 blood units were given during or after THR and 0.8 +/- 1.1 units during or after TKR. Clear predispositions for an increased use of blood transfusions were cemented endoprosthesis, old age (> 70 years) as well as exclusive general anaesthesia. Since 57.8 % of the blood units were wasted, the additional expenses (only laboratory and material costs were calculated) for each retransfused autologous blood unit were calculated to be 28.76. CONCLUSION: Besides saving homologous blood, autologous blood donation causes mainly an increased probability of giving transfusions and higher costs. Therefore autologous blood donation should be indicated more critically, especially in younger patients and knee replacements.

Aged↗

PubMedDate not supplied

[Influence of the x-ray technique on evaluation of cup anteversion after total hip arthroplasty].

AIM: Total hip arthroplasty (THA) is a standard procedure in orthopaedic surgery. Planar radiography of the implant is routinely performed to ensure that the operation has achieved the desired result. This study investigates the influence of varying the X-ray beam on the analysis of the radiograph. METHOD: Twenty-three patients were analysed after implantation of a total hip replacement. Besides a CT scan of the pelvis, symphysis- and hip-centred radiographs were available. The cup anteversion was calculated using two published algorithms. The CT-based data were the gold standard. RESULTS: Our study revealed a significant major error in the analysis of the symphysis-centred radiographs when compared with the hip-centered radiographs. Widmer's algorithm showed a significant superiority over Pradhan's formula. CONCLUSION: The best approximation of the anteversion angle was achieved using Widmer's technique by centering the X-ray beam onto the hip.

Acetabulum↗

PubMedDate not supplied

Phase II clinical trial of combined natural interferon-beta plus recombinant interferon-gamma treatment of chronic hepatitis B.

BACKGROUND/AIMS: Alpha-interferon (IFN-alpha) is an effective treatment for chronic hepatitis B but only 25-40% of patients will profit from a long-term beneficial response to the currently recommended schedule of 3-6 MU given 3 times a week for 6 months. Clinical trials are therefore needed to investigate alternative modifications of interferon therapy, including combinations of different antivirals or immune modulators in order to improve the therapeutic approach to chronic hepatitis B infection. In a phase II trial we evaluated whether a combination of natural interferon-beta (nIFN-beta) with strong antiviral activity plus recombinant interferon-gamma (rIFN-gamma) with a predominantly immunomodulatory activity is able to increase the response rate compared to historical controls treated with IFN-alpha in a conventional regimen. METHODOLOGY: Forty patients with chronic hepatitis B were included in this trial of combined interferon therapy at a dosage of 6 MU nIFN-beta during week 1 followed by 3 MU for weeks 2-4 plus rIFN-gamma at a daily subcutaneous (s.c.) injection of 150 microg during the entire 4 weeks of the treatment period. Patients entered the trial on the basis of the following criteria: hepatitis B surface antigen (HBsAG), HBeAG and HBV-DNA positive for at least 6 months, HDV, EBV, CMV, anti-HIV negative, and chronic hepatitis proven on biopsy taken within 4 weeks of entry as well as 6 and/or 12 months after interferon therapy. The final diagnosis and classification of chronic hepatitis has been based on guidelines according to a revised classification of chronic hepatitis (Desmet 1994). The post-treatment follow-up was 12 months. RESULTS: The combined interferon therapy achieved complete responses with seroconversion from HBeAG to anti-HBe and a negative HBV-DNA (dot blot) test, as well as normalization of ALT activity in 15 patients, and partial response with negativation of HBV-DNA concomitant to a decrease in aminotransferase activity to near normal levels in 6 patients. Nineteen patients showed no response to viral markers but showed relief of clinical symptoms as well as pronounced decrease of serumtransaminase activity. Grading of liver biopsies demonstrated an improvement of histologic parameters after the interferon regimen in half of the evaluable patients (n=22). Histological response has been quantified by a reduction in the score of histological activity (HAI-index) from 12.6 before to 7.6 after interferon therapy, and in the inflammation and cellular degeneration score (ICD) from 9.9 to 5.2. Histological response, however, failed to show a consistent correlation with serologic response. This medium-dose combination of interferon-beta and interferon-gamma was tolerated very well by the patients, this good tolerability being explained by tachyphylaxis in response to daily interferon doses. No serious side effects or decompensation of liver function were observed during the 4-week period of therapy or the follow-up, despite the special clinical situation where 60% of the patients included in the study presented with histologically proven cirrhosis (35% of them with clinical manifestation of mildly decompensated cirrhosis). CONCLUSIONS: This short-term regimen of combined nIFN-beta + rIFN-gamma therapy in patients with chronic hepatitis B proved to be equieffective to long-term treatment with interferon-alpha and combines high clinical tolerability with good practicability, as it can be administered on an in-patient basis, ensuring close patient monitoring.

Adolescent↗