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Biomedical subjects

R Grass

Publications and source records attributed to R Grass.

31 records · Page 2Linked to original sources
PubMed2002

[Allogenic transplantation of femoral condyle after traumatic injury].

A 21-year-old man experienced an open knee injury with a subtotal loss of the medial part of the distal femur. After an initial debridement of the wound we performed 48 hours post injury an allogeneic transplantation of the condyle of the femur. The wound healed by first intention and no signs of rejection were noted. The bone transplant hadn't been treated specifically prior to the transplantation and the patient didn't receive any immunodepressive drugs. 18 months later, the patient is able to flex the knee joint up to 120 degrees and to extend it completely. The overall result is excellent.

Adult↗
PubMed2001

Apolipoprotein E epsilon 4 is associated with rapid progression of multiple sclerosis.

OBJECTIVE: The apolipoprotein E (APOE) polymorphism is known to impact on various neurologic disorders and has differential effects on the immune system and on CNS repair. Previous findings concerning a possible modulation of the clinical course of MS have been inconsistent, however. METHODS: In a cross-sectional study, the authors investigated 374 patients with clinically definite MS and a disease duration of at least 3 years and related their clinical and demographic findings to the allelic polymorphism of the APOE gene. The genotype distribution of patients with MS was compared with a cohort of 389 asymptomatic, randomly selected elderly volunteers. RESULTS: The authors found no significant differences in the distribution of genotypes between patients with MS and controls. However, patients with MS with the epsilon4 allele (n = 85) had a significantly higher progression index of disability (0.46 +/- 0.4 versus 0.33 +/- 0.26; p < 0.004) and a worse ranked MS severity score (5.1 +/- 1.9 versus 5.7 +/- 1.7; p = 0.05) than their non-epsilon4 counterparts, despite significantly more frequent long-term immunotherapy in epsilon4 carriers (74% versus 58%; p < 0.007). The annual relapse rate in epsilon4 carriers (0.87 +/- 0.56) was significantly higher than in patients with MS without an epsilon4 allele (0.71 +/- 0.47; p = 0.03). CONCLUSIONS: These results suggest no effect of the APOE genotype on susceptibility to MS, but indicate an association of the APOE epsilon4 allele with a more severe course of the disease.

Adult↗
PubMed2000

[Fatal aorto-esophageal fistula as a late complication of traumatic aortic rupture].

We report on a case of a 23 years old man who was polytraumatized in a car accident. He survived with excellent clinical outcome, but 113 days after the accident he collapsed, massive bleeding out of the mouth started and the patient died within a few minutes. A gastric ulcer bleeding was assumed, but autopsy showed the break-in of a posttraumatic aortic aneurysm into the esophagus. The difficulties of in time diagnosis of thoracic aorta lesions are discussed.

Adult↗
PubMed2000

[Injuries of the pelvic girdle. The pathway to exact diagnosis: which imaging methods are indicated? Synopsis of information].

Synopsis in diagnosis of pelvic ring fractures begins with the help of our senses while taking the history, inspecting and palpating the patient. It is continued with urological, gynecological and neurological assessment of the whole extent of peripelvineal injury. The picture is completed by ultrasonography, standard X-rays and special views, two- and three-dimensional CT and finally MRI. To minimize radiation damage to the patient and to lower the costs for radiologic assessment the standard ap view of the pelvis has to be analysed carefully to avoid numerous special views. Horizontal lines drawn perpendicular to the L5-Sacrum-Symphysis axis are helpful in discriminating rotational and translational instability, quantifying the extent of dislocation and controlling the quality of reduction and internal fixation. In order to avoid missing fractures of the os sacrum, the arcuate lines have to be inspected carefully.

Diagnostic Imaging↗
PubMed2000

[Injuries of the inferior tibiofibular syndesmosis].

The incidence of isolated distal tibiofibular syndesmotic ruptures in acute ankle sprains lies between 1% and 11%. These injuries are frequently overseen or misdiagnosed as anterolateral rotational instability of the ankle and often become apparent through protracted courses. Although the pathomechanics and extent of syndesmotic injuries have been systematically described by Lauge-Hansen and Weber, no generally accepted guidelines exist as to when these complex injuries are to be treated surgically to ensure sufficient and stable healing of the syndesmosis besides correct alignment of the distal fibula. So far, systematic follow-up regarding syndesmotic injuries in ankle fractures is missing, although it has long been recognized that tibiofibular diastasis secondary to chronic syndesmotic instability leads to external rotation of the talus. In combination with a valgus position of the talus, this instability leads to a decrease in the contact area which results in posttraumatic arthritic changes. This paper reviews the standard diagnostic and therapeutic procedures for acute syndesmotic ruptures in fracture dislocations of the ankle. Among the few corrective procedures advocated for chronic syndesmotic insufficiency are tibiofibular arthrodesis, synthetic ligament substitutes, and tenodesis with the peroneus brevis tendon. A sufficient reconstruction must restore the stability of the ankle mortise and alignment of the fibula in the tibiofibular incisura to ensure limitation of talar rotation. Therefore, a tenodesis was developed which substitutes the three important ligaments of the syndesmotic complex. The Casting procedure for chronic syndesmotic insufficiency was modified with reconstruction of the interosseous tibiofibular ligament in addition to the anterior and posterior tibiofibular ligaments. The resulting three-point fixation of the distal fibula appears more anatomically, physiologically, and biomechanically advantageous. The operative procedure is given in detail. Distal tibiofibular syndesmosis. Persistent instability of the distal syndesmosis. Ankle fractures. Syndesmotic screw.

Ankle Injuries↗
PubMed1999

[Arthrodesis - non-union of the ankle. Arthrodesis failed].

Non-unions after fracture dislocation of the ankle joint are extremely rare with predominantly operative treatment. In contrast, after fractures of the tibial plafond (pilon fractures) infections are seen in the literature in 37 % and non-unions are seen in 27 % after open reduction and internal fixation, requiring secondary ankle arthrodesis in about one quarter of all cases. In contrast to aseptic non-union or arthrosis, which can be salvaged with screw arthrodesis, with prevailing infection and severe osteoporosis external fixation (either one- or two-sided) is the treatment of choice. In isolated non-unions of the malleoli, either plate osteosynthesis with 3.5 low-contact dynamic compression plate or tension banding with autologous bone graft interposition, or alternatively sliding graft technique, is performed with good results.

Ankle Injuries↗
PubMed1998

Internal fixation of supracondylar femoral fractures: comparative biomechanical performance of the 95-degree blade plate and two retrograde nails.

OBJECTIVE: The biomechanical stability of supracondylar femoral fractures fixed with a condylar blade plate (plate), a Green Seligson Henry nail (GSHN), or a new retrograde unreamed supracondylar femoral nail (new nail) based on the AO unreamed femoral nail were compared. DESIGN: A standardized simulated comminuted supracondylar femoral fracture (segmental defect) in fresh frozen paired cadaveric femora was stabilized with one of the implants. The interfragmentary fracture site stiffness in three directions and axial strength of the fixator-bone construct were compared (pairwise). RESULTS: The plate versus the new nail was (a) axially 10 percent as stiff and 50 percent as strong (ultimate strength), (b) as stiff in A/P bending, and (c) five times more stiff in torsion. Varus angle at failure under axial load was significantly greater for the plate than for the new nail. There were no statistical differences in axial stiffness and ultimate strength between the new nail and the GSHN, but the new nail was 50 percent and 30 percent as stiff in A/P bending and torsion, respectively. The magnitude of deformation at failure under axial loading was similar. CONCLUSIONS: In fixation of extraarticular comminuted supracondylar distal femur fractures, results indicate that (a) the new nail provides equal or greater stability than does the plate, except when large torsional loads are anticipated, and (b) the new nail provides stability equal to the GSHN for axial loading and lesser stability against off-axis loads. As is evident in this and other studies, intramedullary implants are less torsionally stiff than are plates. The torsional stiffness of the new nail is expected to be sufficient because it is comparable to many available nails, and low torsional moments are expected for healing femoral supracondylar fractures.

Biomechanical Phenomena↗
PubMed1998

[Minimally invasive method for treatment of supra-diacondylar femoral fractures].

The "gold standard" treatment modality for extra-articular and combined intra-, extra-articular fracture of the distal femur is the condylar blade plate (CP). Large exposure of the distal femur with unavoidable iatrogenic trauma to the soft tissue surrounding the fracture site and perhaps the lack of stiffness of the eccentric lateral cortical location of the CP has been suggested to play a role in the high rate of infections and pseudarthrosis reported in the literature. In an effort to overcome some of the difficulties with the condylar blade plate and to reduce complications, an unreamed, titanium, solid nail, locked proximally with two locking screws and distally with a screw and twisted blade was developed (DFN). The nail was designed for minimal invasive reduction through a small median parapatellar arthrotomy of the articular fracture (percutaneous screw) and of the supracondylar fracture. The DFN is a modular system sharing many components and almost all instrumentation with the AO-UFN and it is expected that the nail is much better in axial stiffness and strength than the condylar blade plate. The treatment of supracondylar femoral fractures should be improved by providing early weight bearing and accelerated fracture healing with a reduced incidence of delayed unions and infections.

Adult↗
PubMed1988

CORFs (comprehensive outpatient rehabilitation facilities): an emerging healthcare system for brain-injured patients.

This paper follows the development of Comprehensive Outpatient Rehabilitation Facilities (CORFs) as they emerged from the Day Hospital concept to a new healthcare delivery system. The structure, requirements for stature, reimbursement considerations and potential problems associated with CORFs are discussed. Issues relating to the care of patients with brain injuries are presented and an innovative model of an institute that individualizes a program of techniques to arouse comatose patients and trains and supports families during the process of arousal from coma, are described. The paper goes on to explore the problems and potentials for CORFs to serve as a cost effective, efficient health service delivery system for brain-injured patients with long-term rehabilitative needs.

Brain Injuries↗
PubMedDate not supplied

[Functional postoperative treatment of internally fixed ankle fractures with a flexible arthrodesis boot (Variostabil)].

AIM: Postoperative treatment following osteosynthesis of ankle fractures in a flexible arthrodesis boot (Variostabil) aims at fast restoration of the function of the injured extremity while allowing early full weight bearing. This treatment regimen was validated in a clinical and experimental study. METHODS: (1) In the clinical study part, 56 patients with internally fixed ankle fractures received after treatment with the arthrodesis boot for 6 weeks. (2) In the experimental study part, the intravascular pressure was recorded in a foot vein of 8 healthy volunteers during knee bends. RESULTS: (1) No implant failure or secondary dislocation was seen due to the after treatment. All patients rated subjective comfort and mobility as excellent. 90.5 % had a good to excellent functional result with the Philips Score. (2) Wearing the arthrodesis boot effected significantly faster venous outflow (25.8 +/- 15.2 vs. 11.3 +/- 6.0 mmHg/sec, p < 0.05) and higher pressure amplitude (53.6 +/- 12.0 vs. 26.5 +/- 9.6 mmHg) during knee bends, compared to a below-the-knee plaster cast. CONCLUSIONS: The flexible arthrodesis boot offers safe protection of ankle fractures combined with superior functional performance (undisturbed gait, training of the ankle joint, high patient comfort and mobility, accelerated venous outflow) as compared to cast immobilization.

Adolescent↗
PubMedDate not supplied

Improved intramedullary nail interlocking in osteoporotic bone.

OBJECTIVE: Intramedullary nail locking bolts often fail to gain purchase or cut out in osteoporotic bone. The biomechanical stability of a bladelike device that lowers intraosseous stress levels by distributing the load over a greater volume of bone was compared with conventional locking bolts in osteoporotic bone. METHODS: Standardized simulated comminuted supracondylar femoral fractures (segmental defect) in fresh-frozen paired osteoporotic (bone mineral density <200 milligrams per cubic centimeter) human cadaveric femurs were stabilized with a retrograde unreamed distal femoral nail and distally interlocked with conventional locking bolts or a bladelike device. The distal portions of the fixator-bone constructs were tested under axial load, and the stiffness and strength were compared (pairwise). RESULTS: Interlocking with a bladelike device was 41 percent stiffer (p = 0.01) and 20 percent stronger (p = 0.02) than that with conventional locking bolts. All posttesting radiographs showed compaction of the cancellous bone distal to the interlocking devices. Even after nail displacements of twelve millimeters, only a few locking bolts were plastically deformed and no bladelike device showed gross plastic deformation. CONCLUSION: This study showed the biomechanical benefits of increasing the bone-implant interface surface for improving the acute stiffness and strength of fracture fixation in osteoporotic cancellous bone. The fixator-bone construct withstood higher forces before failure in these fragile bones.

Aged↗
PubMedDate not supplied

Immunoglobulins in acute, parainfectious, disseminated encephalo-myelitis.

Acute, parainfectious, disseminated encephalo-myelitis (ADEM) is usually treated with corticosteroids. Intravenous immunoglobulins have not been applied to patients with ADEM. This article describes a 22-year old woman who developed progressive paraparesis, ascending sensory dysfunction, and urinary incontinence one week after tonsillitis. Guillain-Barré syndrome was diagnosed initially, and intravenous immunoglobulins (0.4 g/kg daily) were begun. Symptoms deteriorated after the first and second applications, but after the third application the patient's sensory level declined. After the fourth application, the deterioration of symptoms stopped and cerebrospinal fluid (CSF) abnormalities improved. Because of diffuse spinal cord swelling, intramedullary edema, and hyperintense white and grey matter lesions in the basal ganglia and the corpus callosum on MRI scans, the diagnosis was corrected to ADEM. It is concluded that initial administration of intravenous immunoglobulins might be of therapeutic value in patients with ADEM.

Adult↗