Biomedical subjects
Publications and source records attributed to N Pallua.
This paper describes a procedure for lengthening the first metacarpal bone in hypoplasia of the thumb by microvascular transplantation of the distal part of metatarsal bone with its epiphysis. This method is a promising alternative to pollicization of the index finger.
A new form of correction of hypoplasia of the thumb is presented in a case of grade 3 thumb hypoplasia. The distal half of the second metatarsal together with its epiphyseal plate was used to lengthen the first metacarpal bone and improve thumb function. This method represents a promising alternative to pollicization in this type of thumb hypoplasia.
Injuries and tattooing caused by gunpowder explosions may lead to permanent cosmetic disfigurement when they are not treated properly. One must distinguish between early and late treatment and recognize that early correct treatment prevents the development of many problems for both the doctor and the patient. It is essential to emphasize the importance of adequate dermabrasion of the tattooing, preferably within the first 6 h after injury or at the absolute maximum 72 h. When the injury is too old or the tattoos are too deep the minipunch technique has worked well.
From 1981 to 1990 110 scaphoid non-unions were operated on in our clinic. The period from 1986 to 1990 was followed up. During this time, 45 cases were surgically treated: 27 by Matti-Russe plasty, 11 by Herbert screw, and 7 by vascularized radial bone graft. The following criteria were compared: 1. Radiological signs of healing; 2. Period of immobilization; 3. Clinical results. The shortest period of immobilization and best wrist function was observed in patients treated by Herbert screw.
Candida sepsis is a very serious complication in severely burned patients. This mainly affects patients whose immune system is weakened by illness and/or by drugs. Often diagnosis is difficult because candida sepsis occurs after an initial infection, but therapy is always difficult. Good fungicidal drugs are available, but their side effects limit their effectivity. Two severely burned patients who were suffering from a gram-negative sepsis confirmed by clinical and laboratory data developed candida sepsis. Conventional therapy failed, and both patients suffered from renal failure with constantly high candida-latex-antigen titre. By means of the liposomal encapsulated amphotericin B, which has the same fungicidal effect as amphotericin B, but without its limiting side effects, both, patients could be saved. The kidneys functioned as normal again, the laboratory findings were normal when the patients were discharged.
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In the FRG one person every ten is more than 70-years old; the average life expectancy, often underestimated, is about 11 years for the 70-years old and 6 years for 80-years old. The modern approach to coronary disease has broadened the indications for coronary artery bypass grafting in the elderly. The present report, studying 152 patients more than 70-years old, suggests the usefulness of a myocardial revascularization in the elderly; it remains to define the relative contraindications (renal failure, high LVEDP, valve replacement). However, the symptomatic improvement we could achieve (95.45%) seems to be a good result, considering the low CABG-related postoperative lethality (1.9%). The trend of our results regardless of 5 years survival is also encouraging (85.1%).
After 685 reconstructive vascular operations (1982-1984) on account of arterial occlusive disease in the supra-aortic arteries as well as in the aorto-iliac and femoro-popliteal segments there occurred 9 deep infections (1.31%); most infected by-passes were extra-anatomical type. In 2 cases an aseptic by-pass was performed; in 4 cases an open local treatment was performed (early broad splitting of the soft tissues and laying open the entire infected graft, surgical wound debridement and local application of antiseptic solution); in 3 cases there was no other possibility than to remove the implant and amputate the leg. Each of the 2 methods described has its specific indications: the aseptic by-pass has to be performed in retroperitoneal and inguinal infections; the open local treatment has to be performed in cases of extra-anatomical by-passes and operations in the femoro-popliteal-cruralis or supra-aortic region. The correct use of these 2 treatment modalities, with their specific indications, allows a conservative management of deep tissue infections.
Aseptic bypass graft and graft-preserving open local treatment have proved to be the two suitable procedures for therapy of infected grafts in vascular surgery (stage III Szilagyi). 18 deep wound infections in vascular surgery were treated 1982-1986; rate of infection was 1.2%. The infection was successfully treated with preservation of life and limb in 66.7%. Amputation was unavoidable in 5 patients (27.8%). 2 patients (11.1%) died. By applying the above-discussed principles of management the results could be drastically improved.
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124 axillofemoral bypass grafts were performed in 105 high risk patients with chronic aortoiliac occlusive disease (1970-1983). Graft thrombosis occurred in 49.35% of 77 unilateral grafts, mostly as early occlusion, whereas in cases of 20 axillobifemoral bypass procedures the incidence of graft thrombosis was 35.0%. By graft thrombectomy, if necessary combined with reconstruction of the femoropopliteal artery segment, and graft exchange the patency rates could be improved in both groups. After 5 years of patency rate was 52.57% in the unilateral and 81.48% in the bifemoral group. In both groups the patency times of every second graft could be prolonged respectively for 16 and 18.8 months. On the whole considering the bifemoral procedure was superior to the unilateral. Considering the high rate of graft thrombosis and the poor long term results, esp. in cases of unilateral grafts, the initial euphoria of using the axillofemoral bypass was not justified. Therefore nowadays the indication for axillofemoral bypass is handled more strictly: high risk patient without any other possibilities to avoid amputation.
The complication of chylopericardium following cardiac surgery is extremely rare. We report such a patient who had undergone a coronary artery bypass operation. The cause of chylopericardium in this patient appears to have been intraoperative injury to the tributaries of the thoracic duct. A conservative regimen with continuous drainage and a special diet containing medium chain triglycerides was all that was necessary for the management of this complication.
AIM: We performed a retrospective analysis of patients with soft tissue defects following total knee arthroplasty and therapy. Furthermore, we described the possibilities of covering soft tissue defects following knee arthroplasty. METHOD: In 5 patients, soft tissue defects following knee arthroplasty were covered with medial M. gastrocneminus flaps. Localisation and size of the defect, microbiology, risk factors, and interval between arthroplasty and the occurrence of the soft tissue defect were retrospectively analysed. RESULTS: On average, defects occurred 9 weeks after prosthesis implantation. In all cases, the soft tissue defect developed in the area of the incision. In 3 cases, wound infection was diagnosed. Four patients exhibited factors associated with wound-healing failure. No prosthesis was lost. CONCLUSION: The gastrocneminus muscle flap provides good quality coverage with small donor site defect, permits early mobilisation, and allows for fast rehabilitation. The risk of flap loss is minimal. Early and adequate defect coverage can reduce both prosthesis loss and amputation rates.
One of the prominent shortcomings of matrices for tissue engineering is their poor ability to support angiogenesis. We report here on experiments to enhance the angiogenic properties of collagen matrices. Our aim is to achieve this goal by covalently incorporating heparin into collagen matrices and by physically immobilizing angiogenic vascular endothelial growth factor (VEGF) to the heparin. The immobilization of heparin was performed with 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC) and N-hydroxysuccinimide (NHS). Carboxyl groups on the heparin are activated to succinimidyl esters, which react with amino functions on the collagen to zero length cross-links. This modification leads--in addition to the incorporation of heparin--to gross changes in in vitro degradation behavior and water-binding capacity. As a first approach to testing angiogenic capabilities, endothelial cells were exposed to nonmodified and heparinized collagen matrices. This exposure leads to an increase in endothelial cell proliferation. The increase can be further enhanced by loading the (heparinized) collagen matrices with VEGF. Evaluation of the angiogenic potential of heparinized matrices was further investigated by exposing them to the chorioallantoic membrane of chicken embryos and to the subcutaneous tissue of rats. Both approaches show that heparinized matrices have substantially increased angiogenic potential. In particular, the loading of heparinized matrices with VEGF invokes a further increase in angiogenic potential. It is apparent that the physical binding of VEGF to heparin allows for a release that is beneficial to angiogenesis. By varying the heparin and EDC/NHS concentrations during the modification process and by varying the loading with VEGF, the angiogenic potential as well as the degradation behavior can be adapted to obtain matrices that fulfill specific angiogenic requirements in the field of tissue engineering.
Forty-three patients with graft occlusion after aortofemoral bifurcation bypass surgery were analysed (1971-1986, 52 bypass branches, 75 graft occlusions). The late occlusion dominated with 73.1%. A poor run off was the main reason in 40.4%. A reduced inflow was responsible in 36.6%, especially caused by graft kinking. Bypass thrombectomy was performed in 56.7%, in 35.8% in combination with a distal reconstruction. Graft exchange was indicated in 39.6% but in 25.6% extraanatomical reconstruction was performed due to a high risk situation. Perioperative mortality rate measured 13.9%, not depending on the surgical procedures. Four times a major amputation was unavoidable. Therefore, in nine patients (= 20.9%) extremity or life could not be preserved. The rate of bifurcation graft occlusions can be reduced by technical improvement of the proximal anastomosis as to the mentioned guidelines.
During the period from 1970 to 1983 150 extra-anatomic bypass operations were carried out on 129 high risk patients revascularizing 157 extremities. There were 124 axillofemoral and 26 femorofemoral bypass grafts. In elective operations the mortality ranged from 4.9% for the axillofemoral bypass and 3.7% for the femorofemoral bypass. A five year postoperative follow-up showed a cumulative patency rate (according to life table method) of 80.21% for the femorofemoral bypass, 79.90% for the axillobifemoral bypass (Type IV) and 45.77% for the unilateral axillofemoral bypass (Type I and II). Considering the low operative mortality, the short operating time, the late results and the high late mortality independent of the surgical procedure, the femorofemoral bypass and in many ways also the axillobifemoral bypass represent suitable and effective methods of operation for high risk patients, whereas unilateral and bilateral axillofemoral grafts showed a high rate of graft thrombosis and poor long term results (Type I and III).