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Biomedical subjects

R Eisele

Publications and source records attributed to R Eisele.

At least 19 recordsLinked to original sources
PubMed2005

[Value of arthroscopy in the treatment of upper ankle arthritis].

OBJECTIVE: The purpose of this retrospective study was to evaluate arthroscopy in upper ankle osteoarthritis. METHODS: In the period from 1988 to 1997, 358 arthroscopies of the upper ankle joint were performed in 178 cases due to arthritis. Of 132 accessible patients, 124 replied to our questionnaire: 90 (73%) of the responders underwent clinical examination 94 (37-152) months following the initial arthroscopy and were graded according to the score of Evanski and Waugh. All arthroscopies were performed under fluid filling using anterolateral and anteromedial approaches. In only five cases was the posterior compartment additionally investigated. Generally, neither tourniquet nor mechanical joint distraction were applied. RESULTS: Of a total of 12 (6.7%) complications, only 3 (1.7%) hematomas needed surgical revision. One hematoma was due to an arteriovenous fistula treated by double ligation. All complications including five hypesthesias were temporary and subsided spontaneously. The 124 patients of the questionnaire group assessed the result of arthroscopic surgery as excellent in 11%, good in 46%, fair in 22%, and poor in 21%. Of all patients, 22% required further surgery of the upper ankle: in 9% further arthroscopy, in 3% arthrodesis, and in 10% microsurgical denervation. The total range of motion increased from 10/0/40 degrees (extension/flexion) preoperatively to 15/0/44 degrees at the follow-up examination. The Evanski score improved significantly (p<0.001) from 41 to 76 points. CONCLUSION: Due to minimal invasiveness and low risk of complications, arthroscopy is recommended for the following indications of upper ankle osteoarthritis: focal arthrosis, limited range of motion caused by osteophytes, soft tissue impingement, corpora libera, and synovitis. Severity and extent of upper ankle arthritis, range of motion, pain, local bone and soft tissue quality as well as the age, physical activity and compliance of the patient concerned are decisive for the individual therapeutic protocol. Alternative surgical techniques in upper ankle osteoarthritis are assessed such as denervation, distraction arthroplasty, correction osteotomy, ankle arthrodesis and total ankle replacement.

Adolescent↗
PubMed2005

The obesity epidemic in young men is not confined to low social classes--a time series of 18-year-old German men at medical examination for military service with different educational attainment.

OBJECTIVE: Obesity prevalence is increasing worldwide and obesity is associated with low education. To assess if the overall increase of obesity prevalence is due to increasing obesity prevalence among low educated strata only. DESIGN: Data on n=1,883,783 males in their 19th year of life seen at physical examinations due to general conscription in Germany from 1989 to 1998. MEASUREMENTS: Stature and weight were measured in underpants and obesity defined as body mass index > 30 kg/m(2). RESULTS: From 1989 to 1998 an increase of body mass index values >70th percentile was observed. Overall obesity prevalence increased from 3.4% (95% CI 3.3-3.5) to 5.7% (95% CI 5.6-5.8). During the whole observation period, the prevalence of obesity was inversely related to educational level. The increase of obesity prevalence, however, was unrelated to educational level: for education less than 10 y from 4.9% (95% CI 4.7-5.0) to 7.7% (95% CI 7.5-7.9), for education of 10 y from 2.6% (95% CI 2.5-2.7) to 5.3% (95% CI 5.1-5.5) and for education of more than 10 y from 1.6% (95% CI 1.4-1.8) to 3.4% (95%CI 3.2-3.5). CONCLUSION: Prevalence of obesity increased among recruits of all educational levels, suggesting that preventive measures against obesity have to target all educational levels.

Adult↗
PubMed2004

[Reconstruction of visceral arteries with homografts in excision of the pancreas].

BACKGROUND: At present, surgical treatment with R(0) resection offers the only chance of cure for patients suffering from pancreatic cancer. Carcinomas of the pancreas are frequently diagnosed at an inoperable stage because of local tumor progression by vessel wall infiltration. In a small series of patients, efforts have been made to increase curative resection rates for advanced pancreatic cancer by excision and reconstruction of the involved visceral arteries. Whether this provides clinical benefit remains uncertain. METHODS: Since 2001 we have been employing "en bloc" tumor resection for advanced pancreatic carcinomas with extended infiltration of visceral vessels. Technical experience was gained previously by performing portal vein resection as well as arterial excision and reconstruction by direct anastomosis in the presence of malignant wall infiltration. A total of ten patients underwent vascular reconstruction by arterial homograft interposition. In six of ten cases, combined extended reconstructions of the hepatic and superior mesenteric arteries were performed. One patient died during the perioperative course due to fulminant bleeding. One patient developed severe diarrhea. During a 3- to 18-month follow-up, one case of liver metastasis and one case of local tumor recurrence were documented. CONCLUSIONS: In selective cases, operability and R(0) resection can be achieved in advanced pancreatic cancer by performing extended resection procedures with vascular reconstruction using arterial homografts. Vascular substitution of visceral arteries can be conducted without ischemic disturbances of the small bowel and liver. Only a few perioperative complications were observed.

Adenocarcinoma↗
PubMed2004

[Stationary thromboprophylaxis in casualty surgery. Relevance of postoperative mobility and preexisting risk factors].

The presented thromboprophylactic concept includes weight bearing and ankle motion as well as breathing therapy and drug prophylaxis (antiphlogistics, analgesic drugs, heparin). Routinely performed ultrasound screening of the deep veins (legs and pelvis) before release showed a low DVT incidence of 2.5% in a prospective clinical observation of 841 inpatients. Obesity, venous insufficiency, and a history of previous thromboembolic events were associated with a significantly increased risk of thrombosis (relative risk 4.1, 4,9, and 5.8, respectively) The duration of immobilization also had a relevant influence indicating that early postoperative physiotherapy in traumatology and orthopedic surgery has a widely underestimated thromboprophylactic effect.

Adolescent↗
PubMed2003

Guidelines for the intramuscular positioning of EMG electrodes in the semispinalis capitis and cervicis muscles.

The objective of the study was to establish guidelines for the application of fine-wire or needle electrodes in the semispinalis cervicis and semispinalis capitis muscles. First of all, measured data for the puncture angle and puncture depth of each muscle were determined in CT scans. Using a regression approach, a model relation of these data with the neck circumference was established. This made it possible to accurately determine the puncture angle and puncture depth on the basis of the known neck circumference. In a further step, the neck muscles of seven human cadavers were punctured with wires in order to check the workability of these guidelines. At the same time, the wires' positions in relation to important structures (nerves, vessels) were studied. Both muscles can be punctured with a high degree of reliability. However, when puncturing the semispinalis cervicis muscle, one has to pass through a layer that contains vessels, nevertheless the risk of injury is regarded as very small. The technique enables intramuscular EMG measurements of the two muscles in manifold clinical problems.

Electrodes↗
PubMed2001

[Severe complications of Staphylococcus aureus infection in the child].

Life threatening complications can be caused by staphylococcal infection, even if they appear as a simple pustulosis, via hamatogenous dissemination. On the other hand the bacteria is able to penetrate the skin without pre-existing skin lesions and reach the adjacent soft tissue, as was the case with a 9 year old boy who had a contusion of the left shoulder and a consecutive life threatening septicemia.

Abscess↗
PubMed2001

[Ambulatory prevention of thrombosis in traumatology].

There are no guidelines for the use of heparin in the prophylaxis of deep vein thrombosis in outpatients. In a prospective clinical investigation in 1996 and 1997, 1321 outpatients after trauma of the lower extremities were screened by duplex-color-coded-ultrasound in order to detect deep vein thrombosis. There were two separate groups: group A with drug prophylaxis of deep vein thrombosis (n = 723) and group B (n = 598) without. The classification A or B was mainly related to the ability of weight bearing (at least 20 kp) and of ankle mobility (at least 20 degrees). Patients who did not achieve both criteria were classified in group A and were treated with heparin until they attained a higher level of activity (B). Group A showed 30 deep vein thrombosis while group B had no thromboembolic complications. We conclude that outpatients achieving a level of activity close to a physiological situation will show no thromboembolic complications.

Adolescent↗
PubMed2001

Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine.

The dorsal approach is increasingly preferred in the surgical treatment of vertebral fractures. However, the access and the implant's position cause muscle loss, which can lead to instability and a reduced capacity for rehabilitation. Morphological factors (bones, intervertebral discs) are typically blamed for chronic pain syndromes in the literature, while less importance is attached to functional factors (muscles). The objective of this study was therefore to investigate the isolated influence of dorsal spinal instrumentation on the back muscles by means of electromyography (EMG). A total of 32 patients with conditions after dorsal spondylodesis following the fracture of a vertebral body and 32 subjects with healthy backs were enrolled in this study. The EMG signal was recorded in three different muscle groups during isometric extension exercise. The evaluation was performed by comparing the mean rectified amplitudes of the three muscle groups in the patients and controls. The patients had significantly lower amplitudes in the multifidus muscle (MF) and significantly higher amplitudes in the iliocostal muscle (IL). Patients with severe pain were found to have lower electric muscle potentials in all investigated muscle groups than patients with mild pain. The muscle damage which was established in the multifidus muscle is compensated by increased activity in the iliocostal muscle. On the basis of anatomical considerations, the damage pattern can be identified as having been caused by surgery. It is extremely unlikely that trauma is the cause.

Adolescent↗
PubMed2001

The effect of partial and full weight-bearing on venous return in the lower limb.

We studied the effect of full and partial weight-bearing on venous peak velocity in the legs of 73 subjects. We used colourflow Duplex ultrasound to determine the minimal amount of weight-bearing required to produce the same venous peak velocity as full weight-bearing. We found that the venous peak velocity remains the same in the femoral vein during partial weight-bearing (196 N and above). This is important for postoperative physiotherapy and thromboprophylaxis. The median peak velocity was 30 cm/s. This corresponds to an amplification factor of four in relation to the individual resting level (peak velocity). In addition, we found that partial weight-bearing at 196 N can reliably be reproduced. The median value of partial weight-bearing after a three-day training programme was 206 N.

Blood Flow Velocity↗
PubMed2001

[Body height, body weight and body mass index of German military recruits. Historical retrospect and current status].

Surveys of conscripts give a chance to pursue the somatic development and the nourishment situation of young men over long times. At the beginning a historical view is given of the organization and methodological basis of medical examinations of German recruits since the introduction of the general conscription at the beginning of the 19th century. Secular changes of the body height are sketched out for selected regions of Germany until the middle of the 20th century. Data of the body weight hardly exist for this time. Until now the greatest continuous documentation of data for body height and body weight is available for West Germany since 1957 and for East Germany between 1973 and the reunion in 1989. The body height of German conscripts has nearly permanently increased since 1957 and reached in 1994 a maximum with 180.0 cm. In general East German conscripts have body height data which are smaller on an average than those of West German conscripts. But in the last years a catch-up in body height could be seen. The body weight of German conscripts also shows an increase apart from some short-time exceptions. The data of West German conscripts are also higher than those of the East German conscripts. Until the reunion the West-East-differences could partly be due to the different mustering age. But the differences also continue in the nineties despite the now identical mustering age. The Body Mass Index (BMI) of the German conscripts (calculated from the average values of body height and body weight) is characterized by increments in the last years. This indicates greater changes in body weight than in body height. The BMI also shows marked West-East-differences. There is no uniform tendency in differences between urban and country side regions for body height and body weight. On the other hand until now differences between selected professional groups are existing. Especially the over-proportional increase of the number of conscripts in the higher body-weight-classes requires a further continuous analysis of the available mustering data.

Adolescent↗
PubMed2000

[Outcome quality of treatment for chronic low back pain under primary care conditions].

BACKGROUND: Little is known about the outcome quality of treatment for chronic low back pain under primary care conditions in Germany. METHODS: All physicians (2100) of middle Franconia, a region of Bavaria with 1.6 million inhabitants, involved in outpatient management were asked to include consecutively patients who suffered from low back pain of at least 4 weeks duration without decreasing intensity. Before and after a 6-month interval patients documented the following outcome data in a questionnaire: pain intensity during the last 24 hours (numerical rating scale), pain-dependent disability (Brief Pain Inventory, German version), health-related quality of life (SF-36, German version), depression (Allgemeine Depressionsskala), pain chronification state (Mainz Pain Staging System) and the days of inability to work within 3 months before start and end of the interval. Treatment of patients was not standardized and included the natural spectrum of non-surgical therapies for low back pain except multimodal pain therapy programs. RESULTS: Thirty-five physicians participated in the study. "Before and after" data of 157 patients (43+/-12 years) could be analysed. Initially 20% were classified in pain chronification state I, 57% in state II and 23% in state III. The pain intensity, pain-dependent disability, depression and quality of life improved significantly but mean differences and effect sizes were small (p<0.41). Less than one third of patients improved by 30% or more from baseline or by one step in the chronification state of pain. Days off work did not change significantly. Predictors for positive therapy response could not be identified. CONCLUSIONS: Monodisciplinary treatment procedures are not sufficient to ameliorate problems of patients in advanced chronification states of back pain.

English Abstract↗
PubMed2000

[Outcome-quality of treatment for headache on primary care conditions].

BACKGROUND: Little is known about the outcome-quality of treatment for headache on primary care conditions in Germany. METHODS: All physicians (2100) of middle franconia, a bavarian greater district with 1,6 Mio. inhabitants, involved in outpatient management were asked to include consecutively patients in the study which suffer from migraine (at least 2 attacks/month) and/or tension type headache (at least 8 days/month) of at least 4 weeks duration. Before and after a 6 months interval patients documented the following outcome data in a questionnaire: pain intensity during the last attack (numeric rating scale), pain dependent disability (Brief Pain Inventory, German version), health related quality of life (SF-36, German version) and depressivity (Allgemeine Depressionsskala). The pain chronification state (Mainz Pain Staging System) has been assessed by the physician. Therapy was not standardized and included the natural spectrum of medicamental and non-medicamental therapy of headache. Agreement of therapy with recommendations of the "Arzneimittelkommission der Deutschen Aerzteschaft" has been assessed. RESULTS: 24 physicians participated in the study. Pre-post-data of 80 patients (46+/-14 y) could be analysed. Initially 67% were classified in pain chronification state I, 27% in state II and 6% in state III. Medicamental therapy agreed with recommendations in approximately 50% of patients, non-medicamental therapy has been used rarely. The pain intensity, pain dependent disability, depression and quality of life improved significantly. 45% and 55% of patients improved in at least 2 of 6 outcome-parameters by 30% of baseline value or by half standard deviation of the corresponding pre-post-differences, respectively. The latter outcome-measure reflects a medium effect size. CONCLUSIONS: On primary care conditions about 50% of patients suffering from migraine and/or tension type headache (predominantly low chronification stae) perceive a therapy effect that corresponds to a medium effect size.

English Abstract↗
PubMed1999

[Structure quality in outpatient care of chronic pain patients].

BACKGROUND: Outcome quality of medical treatment depends on structure quality of the treatment facility. In the present study we tried evaluate structural parameters of outpatient treatment facilities relating to management of headache, low back pain and cancer pain. METHODS: 109 outpatient treatment facilities (104 offices, 3 outpatient departments of hospitals, 2 pain ambulances of hospitals) in middle franconia, one of the larger Bavarian administrative division (population: 1,6 Mio.), have been evaluated by questionnaires. Questions examined certain structural conditions of the treatment facility as compared to german guidelines for outpatient treatment of pain patients ("Schmerztherapievereinbarung"). RESULTS: Only one treatment facility worked within an interdisciplinary setting. Less than 25% (median) of total patients of an outpatient treatment facility suffered from acute or chronic headache, low back pain or cancer pain. 38% of physicians participated regularly on pain conferences. Established methods for diagnosis and documentation of patients suffering from chronic headache, chronic back pain and cancer pain were regularly used by 16%, 12% and 10% of physicians, respectively. Regular interdisciplinary cooperation in the management of patients with chronic headache, chronic back pain and cancer pain was indicated by 28%, 24% and 41% of physicians, respectively. However, personal discussion of patient related problems took place in less than 5% of physicians. Although a considerable number of different therapies (included as standard therapy for outpatient management of chronic pain in the "Schmerztherapievereinbarung") can be applied in each outpatient treatment facility (median:5), psychological therapy for management of chronic headache, chronic back pain and cancer pain was used regularly by 5%, 2% and 7% of physicians, respectively. Scoring of all examined structural parameters provides a measure for the quality of the parameters of a certain outpatient treatment facility as compared to that of an optimal outpatient facility for pain treatment (quality score=100%). However, 75% of examined outpatient treatment facilities reached quality scores only up to 43%. CONCLUSIONS: There are considerable structural deficits in outpatient treatment facilities involved in management of patients suffering from chronic headache, chronic back pain and cancer pain. Realisation of standards according to the "Schmerztherapievereinbarung" needs organisation of an interdisciplinary network between the different specialties necessary for pain management. Interdisciplinary cooperation should be supported by the official organization of the medical self-government in Germany--the Kassenärztliche Vereinigung--which has to assure optimal conditions for outpatient treatments.

English Abstract↗
PubMed1998

[Prevention of thrombosis with physical therapy in trauma surgery. Possibilities and value of individual measures].

Patients in traumatology need additional physiotherapy to prevent deep vein thrombosis. There is still a 4% risk of deep vein thrombosis in outpatients receiving already low molecular weight heparin prophylaxis [9]. However, there are no prospective studies with a high number of patients to prove effectiveness of the presented physiotherapeutic tools, even if the hypothesis "achieving physiological-like conditions" sounds positive and some authors postulate that physiotherapy would be equal to drug prophylaxis of deep vein thrombosis.

Humans↗