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P Kehr

Publications and source records attributed to P Kehr.

At least 19 recordsLinked to original sources
PubMed2005

[Clear-cell sarcoma of tendons and aponeuroses: three case reports].

Clear-cell sarcoma (CCS) of tendons and aponeuroses is a rare malignant tumor representing about 1% of soft tissue tumors. Preferentially observed in young adults in the second or third decade, the tumor generally develops in the limbs. Only 2% of SCC of tendons and aponeuroses have been reported in children less than 10 years of age. This slowly progressive tumor usually forms a painless mass. The tumor increases in size followed by metastatic dissemination to lymph nodes and the lungs. The prognosis is related to tumor size. At the present time, the recognized limit is greater than 5 cm. Early diagnosis must be achieved to enable effective treatment by carcinological surgical resection. We report the three cases of CCS of tendons and aponeuroses observed at the Strasbourg University hospital over a 35-year period. Each case had a special clinical presentation. The first patient, treated in 1967, presented tumor bone lysis on the plain x-ray, an observation rarely reported in the literature. In the second patient, treated in 2002, the tumor was discovered after trauma. This patient developed skin ulceration associated with paraplegia secondary to metastatic thoracic cord compression. The third case occurred in a 12-year-old girl, treated in 2002.

Adult↗
PubMed2004

Repair of distal biceps tendon ruptures using a suture anchor and an anterior approach.

In a prospective study, eight consecutive patients with nine ruptures of the distal biceps tendon underwent repair through a single incision. All patients were satisfied with their clinical results and had full ranges of elbow and forearm motion. There were no radial nerve injuries and no radio-ulnar synostoses. Isokinetic testing, after correction for dominance, demonstrated a 6% strength deficit, but 7% higher endurance in the repaired extremity for the flexion-concentric test, and no strength deficit and 13% higher endurance for supination. The improved endurance is probably explained by initial reduced effort due to apprehension which minimized subsequent fatigue.

Adult↗
PubMed1998

[Long-term survival rate of tibial osteotomies for valgus gonarthrosis].

PURPOSE OF THE STUDY: High tibial osteotomy (HTO) is a routine procedure for medial gonarthrosis. Mid-term results are known to be satisfactory, but they deteriorate with longer follow-up. The authors present a long term survival analysis of 109 out of 111 consecutive HTO with a minimal potential follow-up of ten years. MATERIAL AND METHODS: 111 patients were consecutively operated on for isolated primary varus gonarthrosis between 1977 and 1985: 57 men and 54 women, with a mean age of 53 years (range, 27 to 79 years). X-ray measurements were done on stance, hip-ankle view. Global axial deformation was defined as the angle between mechanical axes of femur and tibia. The respective part of congenital and degenerative tibial deformation was assessed according to Dejour. The angle between femoral and tibial bicondylar lines, representing lateral instability, was added to the tibial degenerative deformation to represent the total degenerative deformation. The goal of correction was a 3 to 7 degree mechanical valgus angulation. At the time of bone healing, 82 patients (74 per cent) had an optimal correction. Two patients were excluded from the follow-up study because of a severe complication (1 bacterial arthritis and 1 tibia non union) which could interfere with the long term result. The 109 remaining patients were followed for a minimal period of 1 year (mean: 8.4 years). GUEPAR pain grading and the occurrence of a revision were prospectively analyzed. 57 non reoperated patients could be re-examined at a mean maximal follow-up of 13.5 years (range, 10 to 18 years). Failure was defined as either the occurrence of a grade 2 or 3. GUEPAR pain during the whole follow-up, or a clinical or functional Knee Society score < 80 points at final follow-up, or revision. Failure and revision rates were calculated according to Kaplan and Meier. RESULTS: 11 patients were reoperated on before final examination (10 per cent): 2 medial unicondylar and 9 total knee prostheses. At final follow-up, the mean clinical and functional scores were respectively 87.0 points (range, 24 to 100 points) and 86.3 (range, 45 to 100 points). The cumulative failure rate was 33 per cent after 10 years and 54 per cent after 15 years; the respective revision rates were 9 per cent and 19 per cent. A pre-operative total degenerative deformation superior to 3 degrees led to a 3.5 fold increased failure rate (p < 0.000,1). A pre-operative medial joint space narrowing over the half of the normal, lateral one led to a 2.2 fold increased failure rate (p = 0.014). An optimal post-operative correction led to a 3.2 fold decreased failure rate (p = 0.000,1). For a given total degenerative deformation, patients with a congenital deformation superior to 5 degrees had a significant lower failure rate (p < 0.000,1). No factor significantly influenced the revision rate. DISCUSSION: Ideal patients for HTO, with an expected survival rate of 100 per cent after 13 years, have moderate degenerative changes and a congenital deformation superior to 5 degrees. Patients with advanced degenerative changes and no congenital deformation experienced a 35 per cent failure rate after 10 years. In this population, unicondylar replacement should be considered as a valuable alternative.

Adult↗
PubMed1997

[Proximal tibial meniscal slope: a comparison with the bone slope].

PURPOSE OF THE STUDY: X-ray measurements of the proximal tibial slope only study bony structures, without considering cartilage and meniscil thickness. It is well known that the posterior horn of the meniscil is thicker than the anterior one, and this could decrease the bony postero-distal slope. The aim of this study was to measure the meniscal slope, including cartilage and meniscil, and to compare it to the usual bony slope. MATERIAL AND METHODS: 19 knee cadaver specimens without meniscal or chondral lesions were studied. Four metallic clamps were inserted at the most anterior or posterior part of the medial or lateral meniscosynovial border. Lateral plain X-ray was taken for each knee. The bony proximal tibial slope and the medial and lateral meniscal slopes were measured and compared for each knee. Paired Wilcoxon T-test and correlations were calculated with a 5 per cent significant limit. RESULTS: The mean paired difference between bony slope and medial or lateral meniscal slope was -6 degrees: the actual meniscal slope was less oblique than the bony slope, and it was almost perpendicular to the proximal tibial axis. There was a very significant correlation between bony and medial meniscal slopes. There was no correlation between bony and lateral meniscal slopes, nor between medial and lateral meniscal slopes. DISCUSSION: These results suggest that the proximal tibial meniscal slope, which is the mechanically active one, is less oblique than the usually measured bony slope. Medial meniscal slope and bony slopes are very strongly correlated for one given knee. But medial and lateral meniscal slopes can be very different for one given knee. CONCLUSION: These results could have an influence on the design of total or unicondylar knee replacements: the polyethylene slope of the tibial surface, which should reconstruct the natural articular design, should reproduce the meniscal, and not the bony slope. The medial and lateral slopes, should perhaps be individually reconstructed.

Arthroplasty, Replacement, Knee↗
PubMed1990

[Surgery for backache].

All types of lumbar pain are of course not an indication for surgery. However, an operation may bring relief from lymbodynia in given conditions, owing to the better knowledge of spinal physiopathology and to the evolution of the surgical technique. This is the case for intervertebral disk pathology, lesions of the posterior articular structures, lumbar canal stenosis, vertebral tumors or malunions, as well as for some cases of painful frontal or sagittal deviation of the spine. State-of-the art techniques utilize arthrodesis, often with a plate or CD-material osteosynthesis, but future surgery should be aimed at preserving motion.

Back Pain↗
PubMed1987

[Study by radioactive microspheres of bone microcirculation in aseptic osteonecrosis of the femoral head].

Thirty-two hips affected by aseptic necrosis, four of them post-traumatic and 12 contralateral hips thought to be healthy have been studied by combining superselective arteriography with the injection of radioactive microspheres. It has been possible to show that aseptic necrosis begins with a global ischaemia and is followed by an incomplete revascularisation leaving a necrotic area. On the border between the two areas hypervascularity produces a zone of fragility where microfractures develop with detachment of a sequestrum. The presumed opposite hip is almost always, even in traumatic lesions, the site of a hypovascularity which seems to suggest a predisposition to the lesion. There is a correlation between radiological and clinical worsening and the development of revascularisation in the femoral head.

Femur Head↗
PubMed1985

Sacral meningeal arteriovenous fistula fed by branches of the hypogastric arteries and drained through medullary veins.

The authors report a new case of intraspinal extra-medullary meningeal arteriovenous fistula draining through medullary veins. Discovered in a 33-year-old black man suffering from a cauda equina syndrome, this malformation suspected in myelography was confirmed by a selective angiographic procedure of both internal iliac arteries. This investigation specified the sacral site of the fistula as well as its feeding arteries from several branches of the left and right internal iliac arteries and its posterior and intra-meningeal venous medullary drainage. An embolization procedure followed by a surgical approach and a second embolization session brought a fair improvement to this young patient who could walk again. The acquired traumatic origin of the fistula is discussed for this patient who had been previously operated at his L5-S1 level.

Adult↗
PubMed1982

[Aneurysmal cyst of the clavicle : an uncommon lesion and a difficult diagnosis (author's transl)].

The authors describe a case of anevrysmal cyst of the clavicle seen in a five-year-old girl. Both clinical and radiological diagnosis proved impossible. Complementary investigations did not settle the question. surgical excision was decided on. In spite of an unfavorable macroscopic aspect, histological examination determined the nature of the tumor. The authors emphasize the great value of resorting to all branches of medical investigation when dealing with bone tumors. Before affirming a good prognosis, or, on the opposite, suggesting extensive and mutilating surgery, the utmost caution is required.

Bone Cysts↗
PubMed1981

[Radiation-induced sarcoma of the sixth cervical vertebra (author's transl)].

The authors report the case of a patient who suffered a sarcoma of the sixth cervical vertebra eleven years after a malpighian epithelioma of the pharynx had been treated and healed by local excision and radiotherapy. A radiation-induced sarcoma caused a tetraplegia. Laminectomy and plate fixation resulted in some recovery but the patient died three months later.

Cervical Vertebrae↗