Biomedical subjects

R Wirbel

Publications and source records attributed to R Wirbel.

11 recordsLinked to original sources

PubMed2006

[Treatment of hypertrophic non union of the distal tibial shaft with percutaneously inserted locking plate Initial report on experience in 4 cases].

Hypertrophic nonunions of the distal, dia-/metaphyseal tibial shaft are still considered to be a problematic challenge. The use of a locking plate system (LCP) as an alternative treatment option was evaluated in these nonunions. This retrospective, nonrandomized study included four male patients (mean age 52.5 years) with hypertrophic nonunions of the distal dia-/metaphyseal tibial shaft treated with a locking compression plate (LCP) by percutaneous technique. The following parameters were evaluated: fracture type (AO), primary fracture care, operation technique of the nonunion, healing of the nonunion, ability to work, complications, and clinical result (function of the upper ankle joint). Primarily, there were 3 cases of open fractures. Three fractures were located in the dia-/metaphyseal region and primarily treated with an unreamed tibial nail (UTN), while 1 open metaphyseal fracture was treated with an external fixator. The mean interval between injury and operation of the nonunion was 9.1 (4.4-12) months. All nonunions healed within 3 (2-4) months. The mean clinical and radiological follow-up was 11.5 (9-14) months. All patients were able to work within an average of 2.3 months. The function of the upper ankle joint was unrestricted in 3 cases, and in 1 case there was a mild functional deficit. The use of an interlocking plate for the management of hypertrophic nonunions of the distal tibial shaft represents a reliable, new treatment option.

Bone Plates↗

PubMed2006

[Misinterpretation of anterior pelvic ring fractures in the elderly].

Clinical outcome following pelvic ring fractures of AO/OTA type-A in the elderly is often unsatisfying because the posterior pelvic ring fracture is underdiagnosed and patients with type B fractures were conservatively treated like patients with type A fractures. This so-called "A-B" problem was systematically analyzed in our patients with pelvic ring fractures. 183 patients were treated with pelvic ring fractures. Primarily, the injuries were classified as follows: 81 type A, 38 type B, and 64 type C. The diagnosis was changed from type A to type B injury in seven patients. Parameters of investigation included fracture type, duration of symptoms, treatment, and outcome score according to the German Multicenter Study Group Pelvis. Persistent pain in the sacral area over an average of 2 (1-6) weeks was found in all patients. The CT scan revealed in all patients a transalar sacral impression fracture in the sense of an internal rotationally unstable injury of type AO/OTA B 2.1. The treatment consisted in a supra-acetabular external fixator for an average of 3 weeks. After 4 weeks the mean pelvis outcome score was 9 (7-10) points. In cases of persistent pain for more than 2 weeks after transpubic pelvic ring fractures in the elderly further investigation by CT scan should be recommended to exclude a concomitant sacral fracture, which then could be safely treated by a supra-acetabular external fixator.

Age Factors↗

PubMed2003

[Results of femoral shaft fractures in childhood in relation to different treatment modalities].

The clinical and radiological results of femoral shaft fractures in childhood were evaluated and compared in relation to different treatment modalities. One hundred and one children (mean age 5+/-0,4 years) were treated between 1990 to 1999. 38% of the patients were treated conservatively (mean age 2,2+/-0,5 years), 32% of the patients (mean age 6+/-0,5 years) were treated by external fixation, 17% were treated with elastic stable intramedullary nailing (ESIN, mean age 5,6+/-0,8 years) and 12% underwent other internal fixation procedures. The duration of hospital stay was significantly longer in the conservative treatment group (18+/-1,6 days) than in the external fixator (12+/-1,2 days) as well as in the ESIN group (8+/-0,9 days). Radiological controls revealed a significantly better reduction of the fracture by operative procedures (external fixator,ESIN) as compared to conservative management. Complications, i.e. secondary dislocation or infection, occurred in 25% of patients in the external fixator group,6% of the ESIN patients, and in 10% of the conservatively treated patients. Late complications,i.e.weight bearing dependent pain or hypertrophic scarring,were developed in both the conservative treatment group (4%) and in the external fixator group (19%); however,no late complications were seen in the ESIN group. While each method examined is known to be suitable for treatment of femoral shaft fractures in childhood,each has defined indications. Also there is a limited possibility of fracture reduction in conservative treatment this method is indicated in younger children (<4 years) where spontaneous bone remodelling is likely. For older children the ESIN method showed a low rate of complications and demonstrates the best long term results. When ESIN is not possible because of local soft tissue damage,additional injuries,or in complex fractures, the external fixator proved to be an alternative treatment for femoral shaft fractures.

Adolescent↗

PubMed2001

[Pathological fracture in osteofibrous dysplasia].

Osteofibrous dysplasia Campanacci is a rare tumor-like lesion mostly presented in the meta-epiphyseal region of the tibia. Different options exist about the treatment modalities. The rare case of a 4 1/2-year-old girl suffering from a pathologic fracture of the tibia shaft due to a osteofibrous dysplasia is presented. The fracture was stabilized by intramedullary nailing using elastic titanium rods. During this procedure a biopsy of the lesion confirmed the radiological suspected diagnosis of an osteofibrous dysplasia. The implant was removed after ten months when fracture and lesion were healed. The treatment options and the differential diagnoses are discussed by review of the literature.

Bone Cysts↗

PubMed1999

[Not Available].

Explore the source record for details and available documents.

Journal Article↗

PubMed1998

Tetraploidization is a physiological enhancer of wound healing.

To investigate the role of chromosomal alterations in the process of wound healing on the cellular level, we analyzed biopsies from well-healing (10) and chronic defect (8) wounds. Classical chromosome preparation and fluorescence in situ hybridization were performed with cultured cells and smear preparations. Results from both techniques showed an unusual high rate of tetraploid cells (4 n) in granulation tissue of well-healing wounds (6.5-60%), whereas we found only a low amount of tetraploid cells (from 0 to 5.5%) in chronic wounds. In fibroblast control cultures, there was a percentage of 2-5.5%. In chromosome preparations, we noticed an increased number of nonclonal structural and numerical chromosome aberrations in both well-healing and chronic wounds. Our data show clearly that especially tetraploidization is a typical phenomenon in the well-healing wound, where it apparently supports the healing process.

Cells, Cultured↗

PubMed1998

[Quantitative determination of cell composition of human granulation tissue by fluorescence activated cell sorting (FAC)].

Granulation tissue of normal and non-healing human wounds showed a similar distribution pattern of the cell populations investigated by FACS analysis, whereas only non-healing wounds revealed a reduced density of cells and intercellular matrix. Thus, supporting the thesis that impaired wound healing is not caused by changes of the cellular distribution pattern of granulation tissue, but possibly by lessened cell function.

Cell Count↗

PubMed1997

[Pathological fractures].

Pathological fractures are defined as fractures that occur in patients with weakened bone due to systemic and local diseases. If osteoporosis is excluded, the frequency amounts to 5% of all fractures treated. The main diagnostic aim is to observe the pathological nature of the fracture and to perform interdisciplinary, causal therapy. For this, diagnostic and therapeutic algorithms are demonstrated, arranged according to osteopathies, constitution anomalies, myelogenous and inflammatory bone diseases, primary and secondary bone tumors and posttraumatic/postoperative disorders. These algorithms should help the trauma and orthopedic surgeon to select the proper conservative and operative therapy and to use all resection and reconstruction possibilities, such as osteosynthesis, alloarthroplasty and bone transplantation.

Algorithms↗

PubMed1996

Bilateral vertebral artery lesion after dislocating cervical spine trauma. A case report.

STUDY DESIGN: This case report illustrates the problems associated with diagnosis and management of vertebral artery injuries resulting from dislocating cervical spine trauma. OBJECTIVES: Treatment involved the principles of anterior stabilization of dislocating cervical spine fracture as well as the diagnostic procedures and therapeutic modalities appropriate for vertebral artery lesions. SUMMARY OF BACKGROUND DATA: Because vertebral artery injuries with cervical spine trauma are rarely symptomatic, they can easily be overlooked. Bilateral or dominant vertebral artery occlusion, however, may cause fatal ischemic damage to the brain stem and cerebellum. METHODS: Cervical spine dislocation was stabilized immediately after admission using internal fixation by ventral plate and corticocancellous bone graft. Immediate angiography was performed when brain stem neurologic dysfunction manifested 36 hours after surgery. The patient was treated with anticoagulation, osmotherapy, and controlled hypertension. RESULTS: A fatal outcome resulted in this case of dominant left vertebral artery occlusion. Necropsy even revealed bilateral vertebral artery damage at the level of the osseous lesion. CONCLUSIONS: The possibility of the complication of a vertebral artery lesion should be kept in mind when examining patients with cervical spine trauma, especially in patients with fracture-dislocation. Immediate identification by vertebral angiography, magnetic resonance imaging, or thin-slice computed tomography scan is necessary for optimal management of this injury.

Adult↗

PubMed1984

Lectin-binding spectra in the hyperplastic human tonsil. Effect of formalin fixation and paraffin embedding on lectin affinity of tissue components.

In order to determine the effect of routine fixation on the lectin affinity of tissue structures, we used unconjugated lectins and an indirect immunoalkaline-phosphatase method for frozen sections, and the peroxidase-anti-peroxidase method for paraffin-embedded, formalin-fixed tissue sections. Fourteen hyperplastic human tonsils were used, and the results of the binding spectra of each lectin were compared. In general, the binding spectrum detected in the paraffin sections was part of the broader range of affinity obtained in the frozen sections. The lectin receptors on the cell surface were especially affected by formalin fixation. On the other hand, the paraffin sections, because of their superior morphology, showed a better localization of the cytoplasmic reaction product and discriminated the cell types more accurately. Thus, the two tissue preparations are rather complementary. In the tonsil peanut agglutinin (PNA) and periodic acid/Concanavalin A (PA/Con A) proved to be suitable tools for distinguishing exactly between the crypt and the surface epithelium. Ulex europaeus agglutinin I (UEA) is a reliable endothelial marker with a strong affinity to the crypt epithelium. In the frozen sections, PNA regularly stained follicular-centre cells on their cell surface. PNA, Helix pomatia agglutinin (HPA), soybean agglutinin (SBA) and Con A stained the histiocytic population, especially PNA which additionally stained an "asteroid" histiocyte. This cell probably corresponds to the antigen-presenting histiocyte of the T-system.

Alkaline Phosphatase↗

PubMed1984

Lymphoepithelial carcinoma (Schmincke type) as a derivate of the tonsillar crypt epithelium.

Ten tumours of tonsillar or epipharyngeal localization showing the histological picture of "lymphoepithelial carcinoma" (Schmincke 1921) were examined immunohistochemically using Peanut lectin, Ulex europaeus lectin-I and an antiserum to S-100 protein. The findings suggest a close relationship of this type of carcinoma to the normal tonsillar crypt epithelium. The majority of tumour cells are UEA-I-positive and PNL-negative, as is the crypt epithelium, while oral mucosa is both PNL- and to a lesser extent UEA-I-reactive. Tumour areas expressing this pattern contain a large number of asteroid-shaped PNL-positive histiocytes and arachnoid-shaped histiocytes reacting with anti-S-100 protein; both cell types being probably identical and representing typical elements of the normal tonsillar crypt epithelium. Consequently, the WHO-term "nasopharyngeal carcinoma, undifferentiated type" seems to be inadequate for this type of tumour.

Carcinoma, Squamous Cell↗