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Biomedical subjects

R Forst

Publications and source records attributed to R Forst.

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

[Treatment of infected total hip endoprostheses].

In total hip arthroplasty the most serious complication besides aseptic loosening is infection. The results observed in 42 cases of infected hip arthroplasties are presented. In contrast to early superficial infection, deep infection following total hip replacement is difficult to treat. Depending on the general condition of the patient, a well-defined, adequate treatment is required. In patients at vital risk the provocation of a permanent fistula can be recommended as an alternative method in preference to revision arthroplasty.

Aged↗
PubMed1988

[Axillary blockade of the brachial plexus. A prospective evaluation of 1133 cases of plexus catheter anesthesia].

UNLABELLED: The results of 1133 axillary catheter brachial blocks are reported. Effectiveness and side-effects were monitored in a prospective manner over a period of 1 year. METHOD: The puncture was performed with an 18-gauge plastic cannula fitted with a solid steel stylet. The stylet has a 45 degrees, short bevel with rounded edges. When puncturing the axillary neurovascular sheath, no attempt was made to elicit paresthesias with the needle. A distinct "click" and very easy advancement of the plastic cannula were signs of being well inside the neurovascular sheath. To confirm the correct positioning, 0.5-3 ml refrigerated saline solution were injected. If no paresthesias could be produced, a new puncture was performed using a nerve stimulator. The plastic cannula was fixed to the skin. For long-lasting operations or if postoperative analgesia or sympatholysis was required, a more flexible catheter was introduced through the plastic cannula. As an initial dose 40 ml 1% mepivacaine was injected via the cannula. If there was an insufficient block after 20 min, another 20 ml 1% mepivacaine was given. For long-lasting operations, 40 ml 1% mepivacaine was injected every 2 h. RESULTS: Surgery was completed in 72% of patients; 24% required some form of supplementation including 17.2% of patients who received a "top-up" after 20 min (Table 1). In 3.8% of cases the technique was considered to be a complete failure, meaning that patients needed some type of general anesthesia including the use of i.v. ketamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Axilla↗
PubMed1985

[7 MHz real-time sonography of the skeletal musculature in Duchenne muscular dystrophy].

The lumbar paravertebral musculature, the M. quadriceps femoris and M. triceps surae of boys suffering from Duchenne's muscular dystrophy of different clinical progression, were examined via sonography. The sonographic incisions were made at fixed levels. The sonographic findings were compared with those of healthy boys. The sonographic findings showed - depending on the clinical stage of Duchenne's muscular dystrophy - typical reflex patterns of different intensity determined by lipomatosis and fibrosis of the skeletal musculature, correlating with the clinical stage, and hence musclesonography is an important diagnostic element in the observation of the course and in therapy planning in Duchenne's muscular dystrophy. The 7-MHz transducer has an advantage over the low-frequency transducers mostly in use, because the image quality is substantially superior.

Adolescent↗
PubMed1984

Shaving of the lumbar disk space--a new technique in lumbar nucleotomy.

A complete curettage of the intervertebral space using the common surgical instruments (forceps, sharp spoons) is not possible during nucleotomy because of the anatomic site and the shape of the instruments. An alternative technique--called "shaving"--is described, which enables a faster, more effective, and less traumatizing removal of free-floating, pulpy residue in the intervertebral space.

Humans↗
PubMed1983

Nucleoscope. Instrumentarium for endoscopy of the intervertebral disc space.

Basing on preliminary endoscopic examinations to present the intervertebral disc interspace using a common arthroscope in operations performed for lumbar disc prolapses, a special endoscopic instrumentarium (nucleoscope Hausmann-Forst) was developed allowing detailed and riskless views into the intervertebral disc interspace.

Arthroscopes↗
PubMed1979

[Course of alcoholic predelirium during treatment with piracetam: results of serial psychometric tests (author's transl)].

Thirty-six male alcoholics in a mild predelirial state were studied with a series of psychometric tests (reaction time to light and sound, reaction to multiple sequential stimuli, apprehension and tachistoscopic appreciation test, achievement and concentration test analogous to the Pauli test). The degree of psychometrically determined abnormalities pointed to serious cerebral lesions even in the mild predelirial stage and exceeded the expectations gained from clinical impression. The disorders decreased in the course of treatment but were present for at least another three days. Additional treatment with piracetam (Normabrain, Nootrop, 9 g/d intravenously) in eighteen patients significantly improved the results of the achievement and concentration tests, while there was no or only slight improvement in the other tests.

Adult↗
PubMed1977

A psychometric evaluation of the acute tremulous state.

The acute alcohol withdrawal state (tremulous state), with mainly vegetative symptoms and without evident loss of conciousness or confusion, was evaluated as to functional psychopathological disturbances aiming to present a complete and objective record of the clinical findings and to establish a control of the course and drug treatment. We tried to meet the inherent inability to cooperate by using proven and also new test devices (flicker fusion, simple reaction time on light and tone, reaction on multiple serial stimuli, visual motor coordination, tachistoscopic perception and memory test, test of concentration and sustained performance with simple arithmetical calculation by analogy with the Pauli test) to circumvent the difficulties arising when patients have to answer long questionnaires. The tests enabled a measurement of the disturbances as objective as possible and proved to have a discriminating sensitivity for different functions. The correlations between the results were found to be similar for alcoholics and controls. tthe degree of the established functional cerebral and cerebellar defects which was revealed was more severe than expected in this mild stage of withdrawal.

Adult↗
PubMedDate not supplied

[Duchenne muscular dystrophy--contracture preventive operations of the lower extremities with special reference to anesthesiologic aspects].

So far there is no causal treatment for Duchenne muscular dystrophy up to now, it has been proven, however, that its course can be considerably improved by an early contracture-prophylactic operation of both lower limbs--mostly between age 4 and 6 years--as well as by a surgical stabilization of the spine before any progressive scoliosis appears, that is at the very beginning of the wheel-chair stage: Walking and standing ability can be prolonged for several years and a significant scoliosis can be avoided. A decisive prolongation of life can be achieved by treating the fatal respiratory insufficiency with timely started mechanical ventilation. Our first experiences have shown, that there is no proven justification for a reserved attitude against early lower limb surgery in view of modern anaesthesia. Malignant hyperthermia-reaction and hyperkalaemia are the known anaesthetic rise factors of operations in Duchenne muscular dystrophy. However, we could exclude virtually these rises by choosing the right anaesthesia and by a comprehensive monitoring routine. If need be, malignant hyperthermia can be treated effectively by using the obligatory antidote (Dantrolene). In view of an expected causal treatment in future, early detection of Duchenne muscular dystrophy by newborn screening ("CK-Test") as well as a comprehensive stage-depending treatment programme (early surgery/mechanical ventilation) are nowadays of outstanding importance.

Anesthesia, General↗
PubMedDate not supplied

[Real-time sonography of the infant hip joint in the early diagnosis of congenital hip dysplasia].

The ultrasonic examination of infant hip joint means a great advantage in early diagnosis of congenital hip dysplasia. The sonographic type classification by Graf enables the experienced examiner to make up a differentiated diagnostic-therapeutic concept as early as possible. Therapeutic omissions just as well as exaggerated therapeutic measures can be avoided. Consequently the prognosis of hip joint dysplasia is considerably improved by ultrasonic examination of new-born hip joints.

Diagnosis, Differential↗
PubMedDate not supplied

[Characteristics in the treatment of scoliosis in muscular diseases].

INTRODUCTION: Patients suffering from the most frequent muscle disorders Duchenne muscular dystrophy (DMD) and spinal muscular atrophies (SMA), who ceased walking respectively are confined from the outset to the wheel-chair, are developing commonly a progressive scoliosis (collapsing spine) due to an increasing muscle weakness. Basing on the pelvic obliquity these scolioses are leading first of all to problems in sitting as well as difficulties in trunk and head control. Along with the increasing weakness of respiratory muscles these phenomena entail a restrictive respiratory insufficiency. CONSERVATIVE TREATMENT: An effective conservative treatment is not available for these scolioses. The use of a corset, however, can only be taken into consideration as a compromise, either for very young patients or those who refused an operation respectively who have reached an inoperable stage. The exclusive use of so-called "anatomic sitting supports" in the wheel-chair in order to treat or prevent a progressive scoliosis in DMD or SMA is absolutely to be rejected. They should only be applied for very young patients with SMA type II as a transitional solution until a corset or better an surgical stabilisation of the spine will be effected, or as a palliative measure in late stages. SURGICAL TREATMENT: Only the early as possible performed surgical stabilisation of the spine using adequate instrumentation (Luque, CD or modifications), enabling an early mobilization without corset or cast, is the most effective treatment of these scoliosis. Patients with DMD or SMA type III should be stabilized after loss of walking ability and definitive confinement to wheel-chair, if the curve is more than 20 degrees-30 degrees Cobb and progressive and forced vital capacity (FVC) is > 35%. The instrumentation should be applied between D3 or D4 and sacrum. The bony fusion mass should include the lumbar and lumbosacral region. The unfused instrumentation with the telescope-rod after Naumann is a good solution for patients with SMA type II and progressive curves already in the early childhood from ca. 5 years of age. First of all surgical spinal stabilisation improves the sitting comfort. Over and above this the improved cosmetic appearance should not be underestimated for the psychological condition of these patients. Additionally it is proved, that surgical stabilisation of the spine prolongs the life expectancy of patients with DMD. Furthermore stabilization of lung function can be achieved for both DMD and SMA patients in comparison to the natural history of these diseases. Altogether a decisive improvement of quality of life can be reached for all these patients.

Adolescent↗
PubMedDate not supplied

[Multi-segmental fusion of scoliosis in Duchenne's muscular dystrophy].

Operations in scoliosis in patients suffering from an advanced stage of Duchenne muscular dystrophy are associated with a higher risk due to the extent of the curves, the respiratory insufficiency and frequent cardiomyopathia. Progressive scolioses in 20 wheelchair patients with an age between 10.5-18.3 years (mean 14.6 years) were treated by CDI. The mean preoperative angle in this group was 70.6 degrees, the postoperative angle 31.2 degrees (mean correction 39.4 degrees or 55.8%). The preoperative lordosis of the lumbar spine (mean angle 4.1 degrees) was corrected to 17.8 degrees postoperatively. The average intraoperative blood loss (2300 ccm) was evident more compared with idiopathic scoliosis. One neurologic complication (postoperative disturbance of bladder function) was observed. Nowadays early surgical correction and stabilization (Cobb angle > 20 degrees) has to be recommended as the treatment of choice for scolioses in Duchenne muscular dystrophy using multisegmental instrumentation methods to enable rapid mobilisation and a postoperative care without brace or cast. This conception allows a prophylactic operation including the following targets: prolongation of life expectancy, improvement of sitting position and prevention of rapid deterioration of lung function including assisted mechanical ventilation in late stages.

Adolescent↗