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Biomedical subjects

P Ritschl

Publications and source records attributed to P Ritschl.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Fibrous dysplasia: its appearance in the magnetic resonance tomogram].

Eleven patients with proven fibrous dysplasia of the skeleton (FD) were examined using magnetic resonance imaging (MRI). Almost constantly T1-weighted hypointense, T2-weighted hyperintense (cystic) as well as T1- and T2-weighted hypointense (fibrous) areas within the lesion could be demonstrated, the latter of which always exhibited either moderate or marked enhancement following intravenous application of Gd-DTPA, resulting in a typical appearance. Furthermore, T1- and T2-weighted hyperintense areas within the lesion were seen in many patients due to focal hemorrhage. No linear time correlation between the clinical symptom pain and focal areas of hemorrhage as shown by MRI, could be established.

Adult↗
PubMed1989

[Management of the administration of leucovorin calcium in high-dose methotrexate therapy].

At the Orthopaedic University Hospital Vienna, neoadjuvant chemotherapy with high-dose methotrexate (MTX) has been applied since 1975 in patients with osteosarcoma. Since 1977 the hospital has been a participant in the Cooperative German-Austrian Study on Osteosarcoma (COSS, 77, 80, 82, 85, 86). Therapeutic results and incidence of side effects are reviewed at regular intervals. Over a 2-year period (1/86 to 12/87), a total of 1999 g MTX were given to 15 patients in 102 therapeutic cycles. In patients treated with MTX in our hospital, only minor intolerance phenomena occurred, owing to careful leucovorin monitoring. Intoxications of up to grade III (modified WHO-score) have been seen in only a few patients. The management of the administration of leucovorin (leucovorin calcium, calcium folinate, INN; citrovorum factor) which is directly dependent on the serum level of MTX, is exactly shown in the discussion.

Adult↗
PubMed1988

Fibrous metaphyseal defects--determination of their origin and natural history using a radiomorphological study.

The radiomorphological appearance of fibrous metaphyseal defects (FMDs) is demonstrated by long-term follow-up studies. A characteristic radiomorphological course rather than a typical single appearance can be established. These findings correlate well with the duration of these tumor-like lesions; therefore, the radiological findings allow conclusions to be made about the age of a fibrous metaphyseal defect. In addition, the characteristic locations of FMDs will be explained in respect of their origins at insertions of tendons and ligaments.

Adolescent↗
PubMed1988

[Vascular surgical reconstructions in orthopedic tumor operations].

The surgical treatment of bone tumors today results more and more in a radical resection therapy. The major vessels are often included in the tumor mass and therefore they have to be resected and reconstructed. Between 1981-1986 30 patients of the Orthopaedic University Clinic in Vienna were treated with tumor resection. The arterial and/or venous reconstruction was done in cooperation with the I. Department of Surgery of the University of Vienna. In 73% of the cases rotation plasty of the knee was performed, in 10% a local tumor resection and in 7% a tumor resection and reconstruction by a tumor endoprosthesis (KMFTR-system). Three patients underwent partial pelvic resection, hemipelvectomy and rotation plasty of the hip respectively.

Adolescent↗
PubMed1987

[Compatibility and toxicity of methotrexate in the treatment of bone tumors].

Chemotherapeutical treatment with high dose methotrexate (HD-MTX) of osteogenic sarcoma has been performed at the Orthopaedic University Clinic of Vienna since 1975. In accordance with the cooperative study for osteosarcoma (Coss) which has been in use in Germany and Austria since 1977, HD-MTX has been used in larger quantity beside other cytostatic drugs. The total of 4259 g MTX has been applied to 36 patients who were suffering from malignant bone tumors. We report about the toxicity and compatibility of MTX. Within 231 cycles of treatment in 8 cases a high toxicity (grade IV after modified WHO-Score) was found. One patient died in consequence of the chemotherapy by fungal infection.

Bone Neoplasms↗
PubMed1987

[Treatment strategy of malignant bone tumors of the spine].

In patients with big, tumorous changes in the vertebral bodies, conservative measures like radiotherapy, medical therapy, and external support measures are often no longer applicable. As a result of the instability of the spinal column, most of the patients are bedridden and in great pain. Signs of root compression occur frequently, as do incipient or incomplete transverse lesions. On the one hand, these signs result from tumor growth and on the other from collapse of the vertebral bodies with kyphosis and fragment dislocation in the spinal canal. In these patients the procedure of choice is "ventral" tumor removal, decompression of the spinal cord and roots, followed by stabilization. By the "dorsal" operative method, it is not possible to overcome the major cause of the instability and pain. On the basis of the results obtained in 100 "ventral" resections of the vertebral bodies, the treatment strategy is presented, ranging from the preliminary examination to the postoperative period.

Combined Modality Therapy↗
PubMed1986

Fractures of the proximal femur in patients with total hip endoprostheses.

Between October 1982 and October 1983 three patients were admitted to the Orthopedic Clinic of the University of Vienna who had suffered complicated fractures of the proximal femur, with concomitant loosening of previously implanted total hip endoprostheses. To replace them we used the KMFTR Endoprosthesis. The Kotz Modular Femur and Tibia Reconstruction Endoprosthesis was originally developed for the surgical management of bone tumors. The implantation followed the principle of intramedullary splinting and transfer of force. Fragments of bone adhering to the surrounding muscles were positioned around the endoprosthesis and the periosteum was carefully reconstructed. After a follow-up period of 1 year on the average the patients were very content with the results and were essentially not restricted in their scope of activities. Walking capacity and mobility were satisfying at last checkup. Radiographically, a consolidation of the femur with solid bony incorporation and a firm fit of the prosthesis were observed.

Aged↗
PubMed1986

A modular femur-tibia reconstruction system.

A 26 piece modular system for the reconstruction of the bones of the lower extremity from the femoral head to the distal third of the tibia is described. This modular system can be implanted without cement and allows for the intraoperative determination of the amount of resection necessary. The implant material is the well-known cast, Co-Cr-Mo alloy Vitallium. From 1982 to the end of 1985, 52 patients were treated with this cementless tumor endoprosthesis of the Kotz Modular Femur-Tibia Reconstruction System (KMFTR) at the University of Vienna, Department of Orthopedics. The locations of the tumors were: proximal femur (28), distal femur (17), and proximal tibia (7). In two cases a total femur was implanted and in another patient a total knee. Indications for the resection of the bone segments and joints concerned included primary bone tumors, metastases, and loosening of conventional endoprostheses and tumor resection endoprostheses. Twenty-one patients with an average follow up of 20.4 months and a minimum follow up of 1 year were evaluated according to Enneking's criteria. Eight patients had proximal femoral replacement. The results were excellent in two, good in five, and fair in one. Eleven patients had undergone replacement surgery in the knee joint area. The overall rating showed five excellent results, four good and two fair. One patient with a total femoral replacement had multiple bone metastases with polytopic pain and was no longer available for regular assessment. Another patient with a total knee replacement suffered a rupture of the patellar ligament after 10 months and had to be revised. Radiologically we have observed excellent bone incorporation of the prosthesis in 15 of 25 evaluated patients. Ten cases showed no changes in radiologic features as compared to the initial findings. These were patients with short follow up periods. Although complications did occur in these major surgical interventions, the final results were very satisfactory and the patients were subjectively content with the operation.

Adolescent↗
PubMed1985

Plasminogen activator activity in bone metastases of prostatic carcinomas as compared to primary tumors.

The plasminogen activator content of extracts of 14 prostatic carcinomas and the respective bone metastases was determined and found to be at an average 1.5 times higher in the extracts from bone metastases than in the primary tumors. Furthermore, the relative contribution of the two known types of plasminogen activators, urokinase-type (u-PA) and tissue-type (t-PA), was evaluated using specific antibodies. About 70% of the plasminogen activator activity in the primary tumors was inhibited by anti-urokinase IgG, whereas the same antibody nearly completely inhibited the plasminogen activator activity in extracts from bone metastases. Using antibodies against t-PA about 30% of the plasminogen activator activity could be quenched in extracts of primary tumors but less than 10% in extracts of bone metastases. Further studies revealed that the increased amount of u-PA in extracts of bone metastases is not caused by different extractability but is also reflected by a relative increase in the amount of u-PA demonstrable by immune histochemical techniques using anti-urokinase IgG. Upon purification, the predominant plasminogen activator from extracts of bone metastases could also be identified physicochemically as urokinase.

Adenocarcinoma↗
PubMed1984

[Tissue plasminogen activator activity in early prostatic cancer and in bone metastases of prostatic cancer].

Most malignant cells exhibit increased plasminogen activator activity which, in turn, leads to the formation of the fibrinolytically active enzyme, plasmin. Since solid tumours in man are surrounded by a fibrin network, the fibrinolytic activity of the tumour may influence tumour growth and metastasis. In the present study plasminogen activator activity, as assessed in purified extracts, was compared in benign hyperplasia of the prostate (group A, n = 6), non-metastasizing+ prostatic carcinoma (group B, n = 26), and in prostatic carcinoma with bone metastasis (group C, n = 10). Plasminogen activator activity was significantly higher in prostatic carcinoma than in hyperplasia, but there was no significant difference in plasminogen activator activity between prostate carcinoma with or without bone metastasis. However, plasminogen activator activity in the bone metastasis cells was significantly higher than in the primary tumour. If a positive correlation between fibrinolytic activity of the tumour and the metastasizing capacity were postulated, particular importance could be attached to bone metastasis in prostatic cancer.

Bone Neoplasms↗
PubMedDate not supplied

Embolization of bone metastases.

PURPOSE: To assess the effectiveness and clinical usefulness of transcatheter embolization of bone metastases. PATIENTS AND METHODS: The procedures and outcome of 61 transcatheter embolization procedures performed in 51 patients with hypervascular skeletal metastases were retrospectively evaluated. Results from computed tomography, magnetic resonance imaging, and diagnostic angiography, performed before and after embolization, were reviewed. RESULTS: All embolizations were technically and clinically successful. Major blood loss during surgery was prevented in 32 cases; the size of viable tumor tissue in large, unresectable bone metastases was reduced before radiation or chemotherapy in 17 cases; and otherwise untreatable skeletal pain was decreased in 11 cases. Heavy bleeding from a metastasis was controlled in one case. The complications were temporary paresis of a lower extremity in three patients, cardiac arrest in one patients, and unintentional embolization of synthetic tissue adhesive in one patient. Median survival time was 28 months (range, 3-59 months). CONCLUSION: Transcatheter embolization is effective and reliable in the treatment of bone metastases.

Bone Neoplasms↗
PubMedDate not supplied

[The modified Ludloff osteotomy for correction of severe metatarsus primus varus with hallux valgus deformity].

AIM: The present study investigates the clinical and radiological mid-term results of the modified Ludloff osteotomy, a proximal metatarsal osteotomy for surgical correction of severe metatarsus primus varus with hallux valgus deformity. METHOD: 70 feet in 67 patients from 25 to 78 years (average age 56 years) were included in this prospective study. The patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal interphalangeal score, which was used preoperatively and at an average follow-up of 37 +/- 6 months. Weight-bearing foot radiographs were analysed according to AOFAS guidelines and statistical evaluation was made with the Wilcoxon signed-rank test. RESULTS: The average AOFAS score improved significantly (p < 0.0001) from 55.2 +/- 15.2 points preoperatively to 86.6 +/- 15.2 points at follow-up. Preoperatively, all patients complained of pain (20.2 +/- 9.6 points) which had improved significantly (p < 0.0001) at the latest follow-up (37.3 +/- 5.7 points). The average hallux valgus angle (HVA) was 37 +/- 8 degrees preoperatively and improved significantly to 12 +/- 11 degrees at follow-up (p = 0.0001). The intermetatarsal angle (IMA) improved significantly from 18 +/- 2 degrees preoperatively to 8 degrees +/- 4 degrees after 37 +/- 6 months (p = 0.0002). The sesamoid position improved significantly from preoperative to follow-up (p = 0.0003). Radiographic evaluation of the patients indicated that all examined osteotomies had healed after 37 +/- 6 months. CONCLUSION: This prospective investigation at intermediate follow-up using currently available outcome measures suggests that the Ludloff osteotomy is a suitable procedure for the surgical correction of severe metatarsus primus varus (IMA > 15 degrees ) with hallux valgus deformity.

Adult↗
PubMedDate not supplied

[Short-term outcome of Weil osteotomy in treatment of metatarsalgia].

INTRODUCTION: The aim of this retrospective study was to analyse the short term results after the Weil-procedure for the treatment for metatarsalgia in 30 consecutive patients. METHODS: 30 patients (69 osteotomies) after the Weil-procedure with an average age of 60 years (range 25 to 78 years) were analysed by clinical and radiological evaluation. The average follow up was 15 months (range 12 to 26 months). Analysis was performed using the patients' records, weight-bearing radiographs and a standardized questionnaire. RESULTS: Subjective evaluation revealed 23 very satisfied and satisfied patients. Based on the Lesser-Metatarsal-Interphalangeal-Scale the objective results showed 77.1 points on average. The results were excellent in 17 cases, good in 4, fair in 3 and unsatisfactory in 6 cases respectively. Recurrent metatarsalgia was noted in 5 cases, whereas no transfermetatarsalgia was observed. The average shortening was 4.4 mm. Subluxation of the metatarsophalangeal joint was corrected in 18 out of 22 cases. A restricted plantar flexion of the metatarsophalangeal joint was noted in 14 cases. 2 patients showed loss of movement. CONCLUSION: Our short-term results reveal that the Weil-osteotomy is a sufficient treatment for metatarsalgia. This technique is able to reestablish the alignment of the metatarsals and to correct luxation and subluxation of the metatarsophalangeal joint. Restricted plantarflexion of the metatarsophalangeal joint is a drawback, which may be avoided by intensive physiotherapy.

Adult↗
PubMedDate not supplied

[Keller-Brandes operation: long-term outcome in young patients with hallux valgus].

PURPOSE: Aim of this retrospective study was to analyse the long term results (10-16 years) after Keller-Brandes' operation for correction of hallux valgus in the younger patient. METHODS: From 1980 to 1986 fifty-one patients (77 feet) at the age of 40 years or younger at the time of surgery (19-40 years, [symbol: see text] 34 years), were operated according to a resection-arthroplasty at our institution. 24 patients (37 feet) were evaluated retrospectively after 10 to 16 years (median: 13 years) in respect to their clinical outcome. Radiological evaluation was performed preoperatively in 23 feet and in 34 feet at follow up. Analysis was performed using a standardized questionnaire based on the HMIS-Score of the American Foot and Ankle Society, an additional clinical score, weight-bearing radiographs, the patient's record and clinical investigation inclusive pedobarographic analysis. RESULTS: Seventy-six % of the patients revealed very good or good subjective overall results. The HMIS-Score revealed excellent or good results in only 57%. Cosmetic was rated very good or good in 64%, 70% of the patients were painfree. Average ROM of the MTP I-joint ranged from 25 degrees flexion to 45 degrees extension. Radiological analysis at follow up: hallux valgus angle-correction: 28 degrees to 19 degrees, no change of the intermetatarsal angle (11 degrees), proximal shift of sesamoids: 9.4 mm to 14.4 mm, neoarticulation gap: 0-2 mm in 23 feet and 3-5 mm in 11 feet, arthritis of IP-joint: 82%: none; 18%: moderate; correction of sesamoid position: 1.7 to 1.4. Metatarsalgia was observed in 27% (10 feet). CONCLUSION: Lateral weight transfer to the lesser metatarsal heads is caused by defunction of the great toe postoperatively which may lead to metatarsalgia (transfer-metatarsalgia). Besides pain relief younger patients require satisfying functional and cosmetic long-term results. To be capable of meeting these requirements, adequate joint preserving procedures like basal or distal metatarsal osteotomies conjuncted with soft tissue procedures should be preferred in respect to the grade of the deformity.

Adult↗