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Biomedical subjects

R Krauspe

Publications and source records attributed to R Krauspe.

89 records · Page 5Linked to original sources
PubMedDate not supplied

[Advantages of biomatrices in chondrogenesis of pluripotent mesenchymal stem].

AIM: The autologous in vitro expansion of chondrocytes is a new method for the treatment of localized cartilage defect zones in humans. In the past several investigators have shown the occurrence of mesenchymal stem cells (MSC) in human bone marrow, periosteum and somite mesoderm. Moreover it has been shown that these progenitor cells are able to differentiate into chondral tissue under special in vitro conditions. The following study shows current possibilities and borders of a chondrogenetic stem cell therapy. Furthermore advantages and disadvantages of different cellular biomatrix carriers are described, cartilage tissue engineering-related problems are discussed and possible solutions were pointed out. METHODS: A literature investigation served for evaluation of the present clinical and experimental data. Furthermore our own cell culture experiences were considered. RESULTS: Until now there exists no clinical concept using the potential of MSC for cartilage tissue engineering. Reasons are the lack of biomechanical and histological stability and handling problems of the cultivated cartilage tissue, especially the difficulties to fix and secure the transplant in the cartilage defect zones in situ. CONCLUSION: The systematic investigation of biomatrices by chondrogenic progenitor cell culture systems may lead to important data for the evaluation of the chondrogenic potency biomatrices.

Cell Differentiation↗
PubMedDate not supplied

[One- or two-step instrumentation for thoracolumbar scoliosis due to myelomeningocele?].

AIM: This investigation evaluates patients with MMC who underwent a two-stage anterior-posterior correction and stabilisation of thoracolumbar scoliosis due to myelomeningocele. The data were compared with the few reported series of one-stage versus two-stage surgery in the literature. METHOD: From 1.7.1992 to 30.6.1995, 11 consecutive patients with severe thoracolumbar scoliosis due to myelomenigocele were admitted at our hospital. The mean age at operation was 12 years nine months (range nine years nine to 14 years six months). All patients underwent a two-stage anterior and posterior spinal instrumentation. The patients were pre- and postoperatively evaluated. RESULTS: All patients were followed for a mean of 4 years 11 months (range 42 months to 88 months) from the time of the second stage procedure. Preoperatively the mean scoliosis angle was 82 degrees (range 55 degrees to 110 degrees ), this was reduced to a mean of 31 degrees (range 8 degrees - 70 degrees ), at final follow-up, the correction had deteriorated slightly to a mean of 35 degrees (range 12 degrees - 80 degrees ). No patient had increased neurological deficit or showed other major complications, i. e., infection, sepsis due to immunologic disorders at the time of the operation. CONCLUSION: We believe that with the two-stage anterior and posterior instrumentation an effective correction of the scoliosis can be achieved. Compared to other studies this report confirms the low morbidity rate and emphasise the good results of a two staged procedure.

Adolescent↗
PubMedDate not supplied

[Kyphoscoliosis in Wiedemann-Rautenstrauch-syndrome (neonatal progeroid syndrome)].

AIM: The Wiedemann-Rautenstrauch syndrome (neonatal progeroid syndrome, WR syndrome) is a rare autosomal recessive disorder including premature aging already at birth. Most of the patients show an aged face, a craniofacial dysmorphism, decreased subcutaneous fat tissue, a significant developmental delay, and have a short life expectation. We present the second patient described in literature reaching an age of 16 years. Furthermore this patient developed a progressive scoliosis during childhood which to our knowledge has not been reported before among individuals affected by Wiedemann-Rautenstrauch syndrome. The pathogenetic features of the spinal deformity are discussed and the operative management is described. METHOD: The patient underwent a three-stage correction of her spinal deformity (anterior thoracic and lumbar release and posterior release, correction of the deformity with instrumentation and fusion) supported by Halo traction and physiotherapy. RESULTS: At the latest follow-up 12 months postoperatively the patient showed a stable correction from 78 degrees to 38 degrees in the frontal plane with physiologic sagittal alignment both clinically and radiologically. CONCLUSION: The scoliosis of our patient with Wiedemann-Rautenstrauch syndrome showed radiologically and clinically the characteristics of a neuromuscular curve. Since the curve showed a significant progression and high rigidity operative correction and fusion was indicated. We recommend a staged operative management to minimize the high risks of the operations and possible complications from cardiological and respiratory dysfunction associated with WR syndrome.

Adolescent↗
PubMedDate not supplied

[Osteonecrosis and HELLP-Syndrome].

BACKGROUND: In 25 % of patients who develope gestosis a Hemolysis- Elevated- Liver-enzymes-and- Low- Platelet-count-Syndrome (HELLP-Syndrome) may occur, which is characterized by activation of the coagulation mechanism and bone marrow alterations. Besides this therapeutical steroid application and an elevated age of primigravidity are responsible for an increased osteonecrosis risk in women, too. Because of anatomical and biomechanical reasons the highest incidence of pregnancy-associated osteonecrosis are the subchondral areas of the femoral epiphysial head. PATIENTS/METHODS: In this investigation data of pathogenesis, diagnostic work up and therapy in HELLP-associated osteonecrosis are reviewed and discussed based on a case report. We report of a 37-year old HELLP-patient showing bilateral femoral head osteonecrosis, who sustained a proximal femur fracture after bone marrow core decompression surgery. RESULTS/CONCLUSIONS: In pregnant patients with joint or bone associated pain an early MRI screening is recommended to detect osteonecrosis at early stages. This allows for therapeutic procedures which may be successful at early stages. If steroids are applicated for HELLP-treatment, the risk of osteonecrosis is elevated. DISCUSSION: Only early stages of osteonecrosis can be treated curatively. Sometimes it can be difficult to differentiate between early osteonecrosis stages, a bone marrow edema syndrome and a transient osteoporosis.

Adult↗
PubMedDate not supplied

Joint preserving surgery for osteonecrosis and osteochondral defects after chemotherapy in childhood.

BACKGROUND: As a complication of chemotherapy/corticosteroids for the treatment of acute lymphoblastic leukemia (ALL) and other malignancies during childhood, avascular osteonecrosis appears in up to 30 % of the patients. Weight-bearing joints are involved in over 90 % of the cases. Total joint replacement is often necessary to restore function. Yet, endoprostheses in young patients again bare the risk of later complications and the need for several revision surgeries. In this report, joint preserving surgical strategies will be discussed. PATIENTS: Three hips and eleven knee joints in 8 patients (4 male, 4 female) were operated on for symptomatic ON and/or osteochondral defects (OCD) after chemotherapy. Four of the patients underwent surgery in more than one joint. The average age at the time of surgery was 18 years (range 14 - 26). The procedures included retrograde drilling (core decompression), bone grafting, implantation of collagen sponges with autologous bone marrow aspirate, osteochondral autograft transplantation and transplantation of periosteal flaps. Two hip joints underwent total joint replacement. Average follow up was 25 months. RESULTS: After an average follow up of 2 years, all patients were satisfied with the functional results after the last follow up with pain free walking for a minimum of 60 minutes. No night pain was reported. One patient complained about intermittent periods of dysaesthesia around the bone harvest area at the iliac crest. CONCLUSIONS: The aim of surgery for ON and OCD after chemotherapy should be the reduction of pain and preservation of the joint to bypass the risks of joint replacement in young patients, although total joint replacement may become indicated in endstage degeneration of the involved joint.

Adolescent↗
PubMedDate not supplied

[Occurrence of a segmental kyphosis after laminectomy of C2 for an aneurysmatic bone cysts--course and treatment strategy].

HISTORY: A 9-year-old girl suffered from an enlarging tumor in the lamina of the axis. After resection of the aneurysmatic bone cyst via laminectomy of C2 an anterior plate-fusion of C2/3 was done. Instead of a correctly placed ventral cervical plate, an adjacent instability of the level C3/4 with kyphosis and subluxation of the facet joints was seen at follow-up. COURSE OF TREATMENT: After reposition over a hypomochlion retention was achieved with a halo body-jacket. Two weeks later the level C3/4 was stabilized by posterior instrumentation. After almost two years the patient has no complaints and the radiological controls show correctly placed instrumentation and increasing bony fusion at the levels C2/3 and C3/4. CONCLUSION: Especially in children and adolescents laminectomy of a cervical vertebra often leads to kyphotic deformities. When using a posterior approach for surgery of intraspinal lesions or in case of tumors of the dorsal elements of the spine, the laminae and posterior structures should be preserved or, respectively, reconstructed for restoration of traction and tension mechanisms. This is of essential relevance for biomechanical stability and maintenance of the sagittal profile of the spine.

Bone Cysts, Aneurysmal↗
PubMedDate not supplied

[Computer-assisted periacetabular triple osteotomy for treatment of dysplasia of the hip].

AIM: Besides general risks, reorienting periacetabular osteotomies include the risks of over- or under-correction. Therefore, intraoperative computer-assisted control of the pelvic fragment may allow for precise reorientation of the acetabulum in all planes. METHODS: The advantages and problems of a computer assisted periacetabular osteotomy are demonstrated in a 19 year old female with spastic paresis and severe secondary dysplasia of the hip over a postoperative follow up period of 2 years. Because of progressive subluxation of the left femoral head with initial degenerative changes of the hip joint a pelvic triple osteotomy as described by Tönnis and an intertrochanteric derotation-varus osteotomy were performed. The intraoperative control of the acetabular position was optimized by CT based navigation. To compare and evaluate the pre- and postoperative clinical and functional outcome, X-rays, CT scans and a gait analysis were applied. RESULTS: The computer assisted orthopedic surgery (CAOS) technique allows for precise intraoperative control following reorientation of the acetabular fragment in all three planes. The pre- and postoperative clinical and radiological findings were compared and the result was classified as good. CONCLUSION: Although the costs and logistics for pelvic osteotomies are increased by CAOS technology, the authors favor this technique for corrective surgery of complex acetabular deformities, although individual parameters need to be considered in each patient.

Acetabulum↗
PubMedDate not supplied

[Correction of forearm deformities in children with multiple cartilaginous osteochondromas].

AIM: Deformity of the forearm with shortening and bowing is common in children with multiple cartilaginous osteochondromas. The objective of this study was to evaluate the benefit of ulnar lengthening using an external fixateur in these patients. METHOD: 9 patients (10 cases) underwent surgery of the forearm between 1995 and 2001 and were evaluated using a standard protocol. The mean follow-up was 33.6 months, the mean age at operation 8.9 years. All patients were treated with ulnar lengthening, in 6 cases combined with an excision of the osteochondromas. RESULTS: Four out of ten patients did show an improvement in postoperative forearm rotation, two deteriorated and 4 presented unchanged. Wrist motion improved in 7 patients and remained unchanged in 3. The postoperative radial articular angle showed an improvement in 6, the carpal slip in 9 of the patients. The preoperative radial head dislocation in one patient remained unchanged postoperatively. CONCLUSION: The authors advocate this therapeutic concept for the correction of forearm deformity in multiple hereditary osteochondromas to prevent a progression of the deformity and to establish carpal stability. A significant improvement of forearm and wrist function could not be reached.

Bone Lengthening↗
PubMedDate not supplied

[Preoperative halo-traction in severe paralytic scoliosis].

AIM: During the past decades the treatment of severe paralytic scoliosis has developed towards surgical treatment. However there is controversial discussion about the need of pre-operative Halo-traction. The aim of this study was to built two groups of patients -- one group with and another one without pre-operative Halo-traction -- and to compare the results after surgical correction of scoliotic deformity with data from literature. METHOD: Between 2000-2003 twenty-five patients with severe neuromuscular spine deformity were treated surgically. Eight patients had preoperative Halo-traction, seventeen patients underwent directly operative correction and instrumentation. The evaluation included the pre- and postoperative X-rays as well those after Halo-traction before surgery. RESULTS: In the group without Halo-traction the scoliotic angle according to Cobb was reduced from 77 degrees to 33 degrees on average (mean correction of 44 degrees [57 %]). In the group with Halo-traction scoliosis was reduced from 85 degrees to 33 degrees on average (mean correction of 52 degrees [61 %]). CONCLUSION: The preoperative Halo-traction in patients with severe neuromuscular scoliosis indeed leads to radiologically higher correction, but this is not significant (p = 0.19) and only in single cases clinically relevant. In our point of view except from specific indications Halo-traction should not be applied in general as a standard procedure.

Adolescent↗
PubMedDate not supplied

[Complex reconstruction of subluxated and dislocated hip joints in spastically handicapped children].

QUESTION: Will surgical reconstruction of subluxated or dislocated hip joints in children with cerebral palsy lead to stable reduction and painless hips? Is there any positive influence on psychomotoric development of the children and on trunk and pelvic symmetry as well as on daily hygienic care after successful reduction of unstable hip joints in spastic children? MATERIALS AND METHODS: Thirty hip joints in 26 children with cerebral palsy were operated applying the same complex reconstruction method of the hip joint. Fifteen of these children with 17 operated hip joints fulfilled a minimum follow up period of 3 years were evaluated continuously in this study. The parents and physiotherapists answered a questionnaire, all patients were examined clinically and pelvic anteroposterior and lateral radiographs were obtained. RESULTS: The mean age at surgery was 6 years, the minimum follow up 3 years (3-10 years). All hip joints were preoperatively decentered, 6 subluxated, 11 complete dislocated. At follow-up 15 of 17 were persistently reduced. The postoperative results were graded by the parents as excellent and good in eleven, satisfying in four and in two patients as poor. The radiographic evaluation showed an significant improvement of the CE-, AC- and neck shaft angle. CONCLUSION: Reconstruction of decentered hips will lead to stable reduction and painless hips at least in mid term follow-up. Symmetrically centered hip joints are mandatory for a pelvic and spinal symmetry and may contribute for an optimal of psychomotoric development.

Cerebral Palsy↗
PubMedDate not supplied

[Multifocal osteonecrosis in children and adolescents after polychemotherapy].

Adequate treatment protocols provide excellent results in management of lymphoma, leukemia and other malignancies in children. With improved survival rates, therapy related sequaela like osteonecrosis (avascular necrosis of bone, AVN) have become a matter of increasing concern. From 1982 to 1992 121 patients were treated for acute lymphocytic leukemia, acute myelocytic leukemia, Hodgkin's Lymphoma, Non-Hodgkin's Lymphoma and Langerhanscell-histiocytosis. All patients were treated with multiagent regimes that included low-dose steroid therapy. 23 patients died, but 64 patients could be evaluated 4 to 14 years after chemotherapy. If the patient complained of bone or joint pain or other clinical findings were suspicious for bony lesions, radiological evaluation was made to get prove of AVN. Six out of 64 patients developed AVN at 17 different sites. Four patients had multifocal AVN. The interval between induction chemotherapy and onset of symptoms was at average 12 months. The average cumulative steroid dosage was 4.25 g. AVN did not relate to sex, diagnosis or a single agent, but did relate to age. There were no cases of AVN in patients younger than 10 years of age. Four patients required surgical intervention. AVN after polychemotherapy was only seen in patients over the age of 10 years. AVN developed at an average of 12 months after induction chemotherapy during the maintenance dose phase. Therefore careful clinical monitoring of patients receiving polychemotherapy is indicated and if indicated radiological evaluation for early detection of AVN to prevent further morbidity is necessary.

Adolescent↗
PubMedDate not supplied

[Splint treatment of Perthes disease].

In Perthes' disease the necessity of any treatment and its management has to be considered carefully. Good results are reported after treatment with various splints as well as after surgery. According to Imhäuser we prefer a position for the hip joint in the splint in 30 degrees flexion, abduction and external rotation respectively. In this position the lowest intraarticular pressure was measured. If deterioration of the containment develops while using a splint, we recommend surgical treatment.

Child↗
PubMedDate not supplied

[Arterial blood flow in congenital idiopathic clubfoot].

A doppler ultrasound study investigated vascularity in congenital idiopathic clubfeet (talipes equinovarus, (TEV) pretreated only by casting and physiotherapy. The studies were performed on 40 TEV (27 patients) aged 4-72 months (average 15.1). In 12 unilateral cases of TEV, the opposite normal foot and 74 normal feet of 37 healthy children aged 3-35 months (average 8.7) were used as controls. Dorsalis pedis (DP), posterior tibial (PT), and peroneal (P) pulses were recorded by an unidirectional 8 MHZ continuous wave technique. At rest, DP pulses and PT pulses were present in all investigated TEVs. P pulse was absent in only one case of TEV. In the group of controls DP pulse was absent in one case and P pulse was absent in an other case of normal foot with contralateral TEV. All the other pulses in normal feet were present at physiological location. We propose that a vascular etiology for the origin of congenital idiopathic clubfoot, as reported in literature, is unlikely. The influence of postnatal casting in TEV on the vascular arterial condition is slight or even absent. Doppler assessment is readily available, noninvasive, and a reproducible mean of monitoring vascular integrity in clubfeet. Relating to vascular complications after surgery, perhaps caused by a preextant arterial anomaly, doppler assessment is indicated routinely in syndromes of multiple malformations with clubfoot deformity before surgical treatment. In congenital idiopathic clubfeet it is not necessary as a routine check.

Arteries↗
PubMedDate not supplied

[Remodeling of the acetabulum after experimental hip joint dislocation--an animal experiment study of the rabbit].

PURPOSE: Little is known about the remodeling potential of the acetabulum after dislocation and relocation of the hip joint. Most clinical data rely on radiographic measurements in a clinical setting, with only few singular reports on histologic changes at the time of surgery. This study was undertaken to examine the remodeling potential of the rabbit acetabulum after different length of hip dislocation and to gain insight into the histology of the remodeling process involved. METHOD: The right knee joint was immobilized in 28 matched New Zealand white rabbits, causing dislocation of the associated hip joint. Assessment of the joint status was made by serial X-rays in a reproducible standardized way, allowing measurement of the Acetabular Index (AI). The untreated left hip joints served as controls in the histologic sections and also allowed to develop an age matched scale of normal acetabular development for radiographic assessment. Dislocation was unsuccessful in 2 rabbits, 9 animals were sacrificed with the joint dislocated, and in 13 animals a closed reduction was performed and maintained in a Petrie type position for 10 days. Reduction was unsuccessful in 4 cases. The reduced group was sacrificed after 4 to 12 weeks, the point of harvesting being determined by no further change in the serial standardized radiographic measurements of the AI. All surgical procedures were done under the supervision of a veterinary surgeon and followed an approved protocol. RESULTS: In the time observed, the normal values of the Acetabular Index drop from 30 degrees to 20 degrees over a time of 3 months. In animals with a dislocated hip the AI increased to 40 degrees, which was completely reversible and reached normal values in 4 weeks, if reposition was done at this time (group A). Later reposition did improve the AI, but compared to normal age matched values, the AI remained elevated (> 30 degrees), demonstrating a residual dysplasia (group B). The histologic sections of the control left joints showed normal hyaline cartilage with physiologic vertical stacking of the cartilage zones. In the dislocated group the vertical stacking was lost, with chondrocytes demonstrating a fibro-cartilaginous metaplasia. There was hypocellularity with loss of nuclear staining. These changes were completely reversed in the group A, but remained in group B. CONCLUSIONS: This study demonstrates that an early reduction will not only allow for a normalisation of the radiographic values, but that the histologic changes as they develop during dislocation can completely be reversed. Long standing dislocation will lead to a permanent tissue metaplasia similar to the one seen in compression testing of joint cartilage, therefore loosing the potential for remodeling. Similar processes may occur in the human situation and the findings here underline the necessity for early reduction to allow for a complete remodeling of the hip joint.

Acetabulum↗
PubMedDate not supplied

[Hallux varus congenitus].

INTRODUCTION: The congenital hallux varus is a rare hereditary deformity of the big toe, which often is combined either with polydactylia or with systemic deformities of the skeleton. The congenital hallux varus can be easily diagnosed clinically. The X-ray shows the ossified bony elements and provides information about the shape and number of the digits as well as their axial deviation. An operative treatment is required. So far a standardized surgical technique has not been accepted for all types of hallux varus. METHODS: The correction of the bony structures and soft tissues is planned by means of preoperative scetches. The amount of correction depends on the degree of the deformity. As consequence of the reorientation of the first ray a soft tissue flap has to be planned and prepared for wound closure which otherwise would need larger grafts. RESULTS: Based on this series the clinical and radiological appearance of the congenital hallux varus are discussed. The operative treatment is explained step by step illustrated by photographs as well as planing scetches. Our procedures are compared to other operative methods reported in the literature. CONCLUSIONS: There are no diagnostic problems with the hallux varus deformity. For therapy surgery is mandatory and recommended between 9 and 24 months of age. For microsurgical preparation and correction of the deformity planning of all surgical steps and alternatives is advocated, this allows for good functional and cosmetic results.

Child, Preschool↗
PubMedDate not supplied

Osteogenic progenitor cell potency after high-dose chemotherapy (COSS-96).

BACKGROUND: Since the first trial of chemotherapy in patients with osteosarcoma the survival rate has gradually improved. For more than two decades, most osteosarcoma patients from Germany, Austria and Switzerland have been treated according to the protocols of the Cooperative Osteosarcoma Study Group (COSS). The uniform treatment concept of a high-dose polychemotherapy pre- and postoperatively improved the survival rate of these patients significantly. One severe side-effect of COSS chemotherapy is multiple osteonecrosis. PATIENTS AND METHODS: In this study the osteogenic stem cell potency of three different tissue types was elucidated after COSS-96 chemotherapy (high-risk arm). Mononuclear cells were obtained from the periosteum, cartilage and bone marrow of a 17-year-old female with a chondroblastic osteosarcoma. The cells were cultivated for 4 weeks in standard medium and stimulated for osteogenic differentiation after the second passage with dexamethasone, glycerolphosphate and ascorbine acid. Two weeks later, the cell cultures were analysed with respect to cell morphology and immunochemical stainings. RESULTS: All cells cultures showed an osteoblastic regeneration potential measured by osteocalcin (OC), osteopontin (OP) and alkaline phosphatase (ALP) expression. Compared to other donor tissues and localizations, the fibula periosteum showed significantly higher osteoblast rates in vitro, whereas collagen II, CD34 and CD45 were not expressed in any culture. CONCLUSION: The results of this study demonstrate the survival of mesenchymal progenitor cells in bone marrow during COSS-96 polychemotherapy, which allows for an osteogenic regeneration in vitro and potentially in vivo.

Adolescent↗