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Biomedical subjects

R Kohler

Publications and source records attributed to R Kohler.

At least 19 recordsLinked to original sources
PubMed1992

[Neurological complications of surgery for spinal deformities].

The aim of this study was to precisely analyse the physio-pathogenic mechanisms, bring to light the risk factors, and find a more practical way of proceeding in spinal surgery. Out of 667 spinal instrumentation surgical operations carried out between 1980-1989, we found 33 (4.8 per cent) neurological complications and have divided them into 2 groups: 7 peripheral complications, 26 cord and central complications. After further analysis, especially of the cord complications (2.5 per cent), we were able to pick out the factors which influence the rate of neurological complications and their evolution: secondary aetiology and the kyphotic composition of spinal deformation, and above all the notion of cord at risk. The delay of cord complications and especially the relation between the severity of the neurological syndrome and its evolution is extremely important. Somesthesic evoked potential monitoring confirmed that per operative diagnosis of a cord injury is possible. The steps to take when confronted with neurological complications, depend on the results of many examinations: pre and post-operative neurological evaluations electrophysiological exploration of the cord and neuro radiological explorations (myelography, scanner and IRM). This helps to complete aetiology and eliminate mechanical causes, which are the only positive indications of iterative surgery. The problems of instrumentation removal in emergency and the legal-medical aspect brought on by this type of complication are discussed.

Humans↗
PubMed1991

[Treatment of congenital dislocation of the hip].

In most cases congenital dislocation of the hip is detected at birth or during the first weeks of life. Forced abduction by means of breeches or wrappage or with Pavlik harness has replaced continuous traction which is useful after 6 months. These measures must be applied according to strict rules, but they do not prevent the occurrence of complications, including post-reductional osteochondritis. Their pros and cons therefore must be weighed with extreme care.

Hip Dislocation, Congenital↗
PubMed1991

Osteoid osteoma: CT-guided percutaneous treatment.

Seven patients with presumed osteoid osteoma were treated with percutaneous destruction or drill resection with computed tomographic (CT) guidance. The diagnosis of osteoid osteoma was made on the basis of findings in the clinical history and results at plain radiography, bone scintigraphy, and CT. In four patients, histologic confirmation was obtained. Hospital stay lasted from 1 to 3 days. After 11-38 months of follow-up examinations, all patients were asymptomatic. The authors report this simple procedure as an alternative to the more traditional open surgery technique.

Adolescent↗
PubMed1990

Massive bone allografts in children.

A group of ten children and adolescents with malignant bone tumours (eight osteosarcomas, two Ewing's tumours) were treated with chemotherapy and resection with allograft reconstruction. Intercalary grafts were used in three cases and terminal osteoarticular grafts at the knee in seven. The mean follow up was 22 months. Functional results were satisfactory, but there were some complications related to the graft. Although these are early results, we believe that the method is justified and is preferable to the use of an endoprosthesis, particularly in children.

Adolescent↗
PubMed1990

New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases.

Three hundred fifty-nine consecutive patients with community-acquired pneumonia admitted to university, community, and VA hospitals underwent a standardized evaluation, including specialized tests for Legionella spp. and Chlamydia pneumoniae (TWAR). The most common underlying illnesses were immunosuppression (36.3%), chronic obstructive pulmonary disease (32.4%), and malignancy (28.4%). The most frequent etiologic agents were Streptococcus pneumoniae (15.3%) and Hemophilus influenzae (10.9%). Surprisingly, Legionella spp. and C. pneumoniae were the third and fourth most frequent etiologies at 6.7% and 6.1%, respectively. Aerobic gram-negative pneumonias were relatively uncommon causes of pneumonia despite the fact that empiric broad-spectrum combination antibiotic therapy is so often directed at this subgroup. In 32.9%, the etiology was undetermined. Antibiotic administration before admission was significantly associated with undetermined etiology (p = 0.0003). There were no distinctive clinical features found to be diagnostic for any etiologic agent, although high fever occurred more frequently in Legionnaires' disease. Clinical manifestations for C. pneumoniae were generally mild, although 38% of patients had mental status changes. Mortality was highest for Staphylococcus aureus (50%) and lowest for C. pneumoniae (4.5%) and Mycoplasma pneumoniae (0%). We document that specialized laboratory testing for C. pneumoniae and Legionella spp. should be more widely used rather than reserved for cases not responding to standard therapy. Furthermore, realization that C. pneumoniae and Legionella spp. are common etiologies for community-acquired pneumonia should affect empiric antibiotic prescription.

Adolescent↗
PubMed1990

The Dwyer procedure in the treatment of idiopathic scoliosis. A 10-year follow-up review of 21 patients.

Despite the well-known Dwyer procedure, developed in 1969, comprehensive reports on its use, with long-term follow-up, are relatively scarce. The purposes of this study were to detect eventual late complications and to compare late results with postoperative angular curve correction. This article reports on 21 children operated on between October 1972 and October 1975 and reviewed with a minimum follow-up of 10 years (10 other patients were lost to follow-up after 5 years). Patients had idiopathic lumbar or thoracolumbar curves (average curve, 56 degrees). Results are discussed with a special reference to longitudinal observation. There is a great correction of the instrumented curve (postoperative, 5 degrees), but a loss of correction of 10 degrees is generally observed, prevented by a complete immediate correction or even hypercorrection. The upper curve, noninstrumented, also shows improvement (mean preoperative, 38 degrees; postoperative, 22 degrees; 10 years, 22 degrees) but re-equilibration cannot be predicted. Pseudarthrosis of one intervertebral space occurs frequently, and may cause failure of the cable with a loss of correction of 10-20 degrees. Kyphosis (or simple loss of lumbar lordosis) is commonly observed but should be balanced with correction of rotation. The following conclusions were made: morbidity is not severe, despite the advanced surgical technique. The technique is difficult and has a direct consequence on the quality of results; pseudarthrosis is a frequent complication, followed by important loss of correction; indications should be discussed carefully in idiopathic lumbar and thoracolumbar curves. It is still too early to advocate either anterior instrumentation of Zielke (VDS) or segmental posterior instrumentation (C. D. Luque) because of short-term follow-up.

Adolescent↗
PubMed1990

[Treatment of osteoid osteoma with percutaneous resection under computerized tomography control. Apropos of 5 cases].

Osteoid osteoma is a benign tumor requiring a surgical resection. An original technique is reported: the nidus was first located by computed tomography and then reached and resected through a small percutaneous approach. A special device, similar to those of knee arthroscopy or percutaneous discotomy has been designed. Five patients have been thus treated successfully (1 femoral neck, 1 trochanter, 1 femur, 2 tibias). Recent progress in radiology for management of bone tumors (scintigraphy, angiography) have given greater accuracy in the preoperative diagnosis of osteoid osteoma. It is thus possible to dispense with an histological proof in case of destruction of the nidus. However a new device is now designed to achieve true "en bloc" resection of the nidus.

Adolescent↗
PubMed1990

[Massive bone grafts in children (apropos of 10 cases)].

We studied 10 massive - 70 degrees C frozen dried allografts (7 terminal intermediate) in children between the ages of 9 and 16 with malignant tumors (8 primary osteogenic sarcomas and 2 Ewing sarcomas). A good response to chemotherapy was observed. The average follow-up is 2 years (7-36 months). Results showed 4 mechanical complications (2 plate failures, 2 graft fractures) and no deaths. The surgical procedure and postoperative management are discussed and compared to prosthetic reconstruction.

Adolescent↗
PubMed1990

[Developments in the treatment of osteosarcoma since 1979. Report of the statistics at the Centre Léon-Bérard].

Seventy-two patients with a localized osteosarcoma were treated between September 1979 and December 1987 by neoadjuvant chemotherapy, local surgery and post-operative chemotherapy. Chemotherapy regimens varied throughout the years but always comprised high dose methotrexate with leucovorin rescue and adriamycin pre-operatively for children under the age of 15, and ifosfamid and cis platinum in adults. Post-operative chemotherapy for bad responders (greater than 10% of residual malignant cells), was at first an association of adriamycin and cis platinum, and later of holoxan and cis platinum. Surgery changed from amputation to local conservative surgery (graft or prosthesis) which is now the most frequent surgery--61% of the patients are alive and disease-free at 5 years. Good responders to pre-operative chemotherapy have a much better prognosis (81% at 5 years) than bad responders (45%). There is no significant difference according to age or pre-operative chemotherapy regimen.

Adolescent↗
PubMed1988

[Results of Salter's innominate osteotomy in residual hip dysplasia in children. Apropos of 60 cases].

Sixty Salter innominate osteotomies were analysed retrospectively with a mean post-operative follow-up of five years. The 53 children, suffering from congenital dislocation of the hip discovered at walking age, had initially been treated by Somerville-Petit conservative management. The results were assessed using the Severin classification and showed 80 per cent of good results (Severin groups Ia, Ib and IIa). The bad results were all due to errors of operative indications (failure to respect the Salter pre-requisites) or technical faults. Complications were uncommon. There were 11 pin extrusions, which led to the use of threaded pins to so as to gain sounder fixation of the osteotomy. An analysis of the characteristics of each hip allowed an assessment to be made of the effects of Salter osteotomy using several angular parameters, including Hilgenreiner's and Wiberg's angles. The description of a new parameter, the angle between the acetabulum and the epiphyseal line (acetabulo-epiphyseal line) and its normal values provides a new approach to the lower limit for the indications for operation on dysplastic hips. This parameter seems to be more discriminatory than Wiberg's angle in relation to dysplasia and makes it possible to determine a threshold of uncovering of the head that justifies surgical correction.

Adolescent↗
PubMed1986

[Measurement of femoral anteversion in children by ultrasonics].

After reviewing the anatomy of the frontal geometry of femur and values for femoral anteversion during growth, an ultrasound method is described for measurement of femoral anteversion. The principle underlying the technique is the use of a spirit level fixed to a bar probe and an effective contention in rotation of lower limbs, this ensuring validity of results even in infants. Analysis of findings in a preliminary series of 10 infants (20 hips), age range 2 to 16 years, with torsion anomalies of lower limbs, showed values obtained to be totally superimposable on those provided by a CT scan.

Adolescent↗
PubMed1979

[A new orthopedic apparatus for the treatment of congenital equinovarus clubfoot. The active-passive articulated splint. Critical study propos of 72 cases treated in our department].

The authors present a new equipment for orthopaedic assesment of club-foot. This "dynamic splint" aims to produce a self-correction of the deformity by the infant at time of each movement of his lower limb. With regard to 72 such deformities, concerning 47 children, they record the results after an average follow-up of more than 2 years. Criterions of results, clinical and chiefly radiological, more objectives, are classified into 3 parts : correction of varus of the foot, correction of adduction of the hind-foot, correction of equinus.

Child↗
PubMed1979

[Bone scanning in children: technic and indications. Apropos of 50 cases].

In children, radionuclide skeletal imaging with 99m Tc M. D.P. has been performed in 50 cases. Scans are done immediately, 20 minutes and three hours after injection. Osteomyelitis has been studied in 24 cases, Legg Perthes disease and benign bone tumors in the others. The scintigraphic patterns are very sensitive but not characteristic. However this exam seems to be essential in some orthopedic disorders of children.

Adolescent↗
PubMed1977

Detection of IgG antibodies to type-specific Pseudomonas aeruginosa lipopolysaccharides by solid-phase radioimmunoassay.

Previous studies have suggested that IgG serotype-specific antibodies are protective against infections with pseudomonas aeruginosa. In the present study, type-specific IgG antibodies to P. aeruginosa were detected by solid-phase radioimmunoassay in sera from 15 volunteers before and after vaccination with lipopolysaccharides from P. aeruginosa and from four patients with endocarditis due to P. aeruginosa. Significant type-specific increases in IgG antibody occurred after both vaccination and infection. The correlation coefficients comparing net counts per minute by solid-phase radioimmunoassay with hemagglutination titers in the 15 vaccinees were 0.940, 0.874, 0.792, 0.903, 0.882, 0.869, and 0.704 for serotypes 1--7, respectively.

Adult↗