Biomedical subjects
T Bauer
Publications and source records attributed to T Bauer.
[Heterotopic hand replantation following radical tumor resection in the elbow region. Functional results 15 months after surgery].
BACKGROUND: In a 28-year-old male who had suffered an olecranon fracture, delayed diagnosis was made of epithelioid sarcoma in the left upper extremity. Radical tumor resection was carried out which included removal of the entire elbow joint. MATERIAL AND METHODS: The amputated hand with the distal one-third of the forearm was replanted at the upper arm. It was important to ensure that all tendinous structures of the forearm were attached to the three muscles of the upper arm and the nerves of the distal forearm with the nerves of the upper arm, which are incongruent in diameter with the former. Details of the operation are given below. RESULTS: The anatomic peculiarities involved in this form of replantation, the early intensive therapy, reintegration of the replanted hand in the body scheme, and the usability of such a shortened extremity are described and the extremely good functional results documented in numbers and figures.
[Results of reimplantation for infected total knee arthroplasty: 107 cases].
PURPOSE OF THE STUDY: The purpose of this study was to assess the results of reimplantations of total knee arthroplasties complicated by infection. Outcome was assessed in terms of eradicated infection and function. MATERIAL AND METHODS: This retrospective multicentric study included 107 cases of infected total knee arthroplasties treated by changing the implants. Seventy-seven patients had a two-stage revision and thirty had a one-stage procedure. Patients were reviewed with a minimal 2-year and an average 52-month follow-up. RESULTS: Revision arthroplasty (one- or two-stage) eradicated infection in two out of three patients. With a two-year follow-up, revision arthroplasty was successful in 77% of patients without any sepsis risk factor, in 65% of patients with one risk factor and in 33% of patients with at least two risk factors. After reimplantation for total knee arthroplasty infection, overall function outcome was good (KS knee score: 74.8 after two-stage revision and 75.5 after one-stage revision, NS). After two-stage procedures, the knee outcome was excellent in one-third of patients, good in another third and fair or poor in the final third. After one-stage reimplantation, 40% of the knees had an excellent outcome, 30% a good outcome and 30% a fair or poor outcome. Regarding functional outcome, overall results were fair (KS function score 62.5 for one-stage and two-stage revisions). Functional outcome was fair or poor in 42% of patients with a two-stage procedure and in 55% of patients with a one-stage revision (NS). DISCUSSION: Our study was unable to disclose any difference between one-stage and two-stage revision for eradicating infection. Unfavorable systemic and local conditions decreased the rate of success after revision total knee arthroplasty for infection. Length of infection before reimplantation, number of surgical procedures and bacterial virulence or resistance were not, in our series, predicting factors for failure of septic revision total knee arthroplasty. No difference was found for the clinical and functional results between one-stage and two-stage procedures. Functional outcome was fair or poor for half of the patients after septic revision total knee arthroplsty. The use of an external device between the two procedures for two-stage revision significantly decreased the functional outcome compared with the use of a spacer. Articulated spacers did not offered any advantage compared with a static spacer for functional outcome.
[CAPNETZ: Competence network for community acquired pneumonia in Germany].
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Preoperative embolization of cervical spine osteoblastomas: report of three cases.
Our aim was to describe the technique and clinical results of preoperative embolization of cervical spine osteoblastomas. We treated 3 patients with these tumors with transarterial embolization and subsequent surgical excision. In all 3 patients, distal access to the tumor-supplying vessels was gained with a microcatheter and embolization was performed with polyvinyl alcohol particles. No complications occurred. Surgical resection was performed in all patients without relevant bleeding. The postoperative course was uneventful in all patients. Preoperative embolization is a valuable adjunct to the surgical treatment of osteoblastomas of the cervical spine.
[Prospective study assessing quality-of-life after hemiarthroplasty for hip fracture].
PURPOSE OF THE STUDY: We conducted a prospective multicentric study of 203 consecutive patients who underwent hemi-arthroplasty for femoral neck fracture between May 1999 and August 2001. The purpose of the study was to assess quality-of-life among these patients one year after their surgery. MATERIAL AND METHODS: Mean patient age was 79.6 +/- 8.6 years; 71.2% were women. Most fractures were Garden type III and IV (87.4%) and 90.9% were recent (< 21 d). The hemiarthroplasty was performed with the Intermedia implant via a posterolateral approach in 73.9% of patients with acetabular reaming for 13.7%; a skirted head was used in only 20.8%. The Robinson score (19/26 < or = 6.89) for joint motion, lifestyle, degree of osteoporosis (Singh score), and history (ASA score), as well as a psychomotor indicator (Hodkinson score) were noted preoperatively. Quality-of-life was measured at one year in the same patients using the Postel Merle d'Aubigne (PMA) score and a quality-of-life score. RESULTS: Among the 203 patients, 38 (18.7%) were lost to follow-up and 37 died (18.2%). Eleven posterior dislocations (5.4%) were noted and four were reduced orthopedically. The PMA score was 84.7% satisfactory results (excellent, very good, good). Preoperatively 58.8% of the patients were independent and 7% were in nursing homes; one year postoperatively, these proportions were 54% and 4.8%. There was a significant difference in the PMA score between two populations defined by the preoperative Robinson score less than or greater than 20. Outcome was better for patients with a Robinson score > 20 pre-operatively. For these two populations, change in lifestyle was highly significant one year postoperatively. However, for the overall population, changes in lifestyle and joint motion were not significantly different between the pre- and postoperative evaluations. Paradoxically, 29.1% of the patients who were dependent preoperatively were not one year after surgery, which indicates that certain patients also had a better quality-of-life after their hemiarthroplasty. CONCLUSION: Mortality after fracture of the femoral neck remains high (18.2% at one year). There were no infections requiring revision in this series, but there were eleven cases of dislocation (5.4%). The difference in joint motion and quality-of-life between the pre- and postoperative assessment was not significant for the whole population, but one third of the patients who were independent preoperatively were not at last follow-up.
[Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature].
PURPOSE OF THE STUDY: Fracture of the anterior tibial tubercle is exceptional in adolescents. The purpose of this work was to better understand the circumstances of such fractures, identify potential complications, and assess outcome of different therapeutic options. MATERIAL AND METHOD: This was a retrospective analysis of a consecutive series of 22 children with avulsion fracture of the anterior tibial tubercle. The circumstances of the fracture were noted. The Ogden classification was used to establish the radiological type. Associated lesions were also noted as were any complications. Two types of treatment were given: orthopedic or surgical (several types). The functional outcome was assessed at last follow-up. RESULTS: Mean age at fracture of the anterior tibial tubercle was 13 years (range 12-16) in 14 boys and 7 girls. It occurred after a jump or reception after a jump in 22 of the children. Five patients presented symptomatic homo- or contralateral anterior tibial apophysitis before the accident. The fracture was not displaced (type IA) in ten patients and was treated orthopedically. In twelve patients, the fracture was displaced (type IB, II, or III) and required osteosynthesis. Immobilization was maintained for four weeks on average (range 3-7). Associated lesions were observed in half of the twelve displaced fractures, with five cases of patellar ligament avulsion and three cases of meniscal injury. There were no complications with type IA fractures. For the twelve displaced fractures, complications were observed in seven children: hematoma (n = 2), infrapatellar hypoesthesia (n = 2), complete rupture of the patellar ligament 38 months after surgery (n = 1), recurvatum with leg length discrepancy (n = 1), and stiff knee (n = 1). Mean follow-up was two years (range 9 months-8 years). The functional outcome was excellent in all patients with a non-displaced fracture and in seven of the twelve patients who underwent surgical treatment. DISCUSSION: Non-displaced fracture of the anterior tibial tubercle I children (type IA) should be considered as a separate entity responding very well to orthopedic treatment. The other cases of displaced fracture generally require surgery which enables an assessment of often associated lesions. The prognosis of displaced fractures of the anterior tibial tubercle is more sever due to the associated lesions and potential complications. We describe the second case of recurvatum and leg length discrepancy following fracture of the anterior tibial tubercle. CONCLUSION: Displaced fracture of the anterior tibial tubercle in adolescents is often associated with soft tissue injury (patellar ligament, menisci). Surgery is indispensable and provides good functional results.
Massive insulin secretion in response to anaerobic exercise in exercise-induced hyperinsulinism.
Exercise-induced hyperinsulinism (EIHI) is a recently described entity characterised by recurrent episodes of hypoglycaemia induced by physical exercise. The index patient for this disorder and a matched control were subjected to aerobic and anaerobic exercise tests on a cycle ergometer. Aerobic exercise was performed at an intensity of 60% of the respective 4 mmol/l lactate threshold (40 min). Anaerobic exercise with an intensity corresponding to 130% VO2max lead to exertion within 2-3 min and elicited comparable maximal lactate levels in both subjects (10-11 mmol/l). The patient experienced a massive increase in insulin from 34 to 649 mU/l after the anaerobic test, and a lower increase in insulin from 27 to 79 mU/l during the aerobic test. Insulin concentration remained unchanged during both tests in the control. Epinephrine increased in the EIHI patient, which was probably a counterregulatory response to hypoglycaemia. The activity of lactate dehydrogenase of the index patient in isolated leukocytes as well as the response to inhibition of oxamate was normal. The hypothesis of abnormal transport or metabolism of lactate/pyruvate in the beta-cells of patients with EIHI was further supported by the parallel increase of lactate and insulin in this study elicited in particular by anaerobic exercise.
[S3-guideline on ambulant acquired pneumonia and deep airway infections].
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Drop foot after high tibial osteotomy: a prospective study of aetiological factors.
Drop foot is not uncommon after high tibial osteotomy for genu varum. The authors report their results of a prospective study of 16 patients operated on between May 1990 and May 1991. All patients had medial femoro-tibial osteoarthritis with a constitutional genu varum. They all had a subtraction valgus high tibial osteotomy fixed by a blade plate. The experimental protocol included clinical review, antero-lateral compartment pressure measurements, intra- and post-operative electromyography, assessment of the post-operative drainage, serum estimation of muscle enzymes and post-operative arteriography. From their own results and a literature review, the authors consider successively the different aetiological factors for post-operative drop foot. Certain deficits occur due to direct trauma on the nerve during high osteotomy of the fibula, by local high pressure due to poor haemostasis or ineffective drainage. In addition, there are several related phenomena. The pneumatic tourniquet sensitises the nerve to trauma, and stretching of the nerve during correction of the deformation depends on the local anatomical factors and their marked variation. In order to diminish the frequency of these post-operative complications, the authors suggest limiting the surgical approach, and limiting as far as possible the traumatic manoeuvres on the nerve by using a tibial resection jig, which allows correction without forced manoeuvres. Finally, the authors discuss the benefits of using a pneumatic tourniquet.
tBuP(NH2)2--a reactive synthon for the synthesis of molecular imidophosphinates of group 13 metals.
Reactions of tBuP(NH(2))(2) with Group 13 trialkyls MR(3) (M=Al, Ga, In; R=Me, tBu) were investigated in detail. According to variable-temperature (VT) NMR investigations, the reaction proceeds stepwise with the initial formation of aminophosphane adducts, which subsequently react to give iminophosphorane adducts and finally the heterocyclic metallonitridophosphinates. BP86/TZVPP (DFT) calculations were performed to verify this reaction pathway, to elucidate the influence of the central Group 13 element on the stability of the reaction intermediates and the heterocycles, as well as to assess the thermodynamics of their formation. The relative stability of free and complexed aminophosphane RP(NH(2))(2) and iminophosphorane R(H(2)N)(H)P=NH (adducts) with P(III) and P(V) centers was studied in more detail with DFT and MP2 methods. In addition, the influence of the substituent R was investigated by variation of R from H to Me, tBu, F, and NH(2). In general, the aminophosphane form was found to be favored for the free ligand, however, upon complexation with MR(3) (M=Al, Ga; R=alkyl) both forms are almost equal in energy.
[Emergency free microvascular flap transfer for repair of a pharyngeal defect manifesting as carotid artery erosion hemorrhage].
We report on a case of an emergency free flap cover of a pharyngeal defect which was made necessary by aggressive digestive salivatory and radiation effects 3 weeks after neck-dissection and laser ablation of an epidermoid left tonsil carcinoma. Life threatening intraoral bleeding resulted from the erosion of branches of the external carotid artery. After management of the bleeding, massive blood transfusions and restoration of the patient's general condition, a sandwich patch cover of the transmural pharyngeal defect was achieved using a microvascular lateral arm flap. This aimed at preventing further digestive effects and bacterial colonisation of the neurovascular structures at the carotid triangle. Unfortunately, due to external mechanical forces, the flap became avascular and thus necrotic at the eighth postoperative day; however, until the successful replacement by a myocutaneous latissimus dorsi flap it remained water-tight and fulfilled its sealing task.
[Extensive hydatid disease of the femur: a case report].
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Primary melanocytic lesions of the CNS: report of five cases.
Primary melanocytic tumours of the central nervous system (CNS) form a rare entity which is histologically and clinically distinct from metastatic cutaneous or retinal malignant melanoma. They can be classified into diffuse melanocytosis (diffuse melanosis), malignant melanoma and benign melanocytoma with a small number of intermediate variants. In this paper, 5 cases treated neurosurgically in our department for spinal or cerebral primary CNS malignant melanoma are reported. Primary tumors and further metastases were ruled out. Radiological, histological and clinical features are discussed. Compared to metastatic disease, primary CNS malignant melanoma shows a more benign clinical course with long-term tumour control and a good quality of life. A review of the literature which mainly consists of individual case reports, confirms this assessment. Although therapeutic experience for primary melanocytic lesions of the CNS is based on a small number of published cases, prognosis seems highly dependent on complete tumour resection. Adjuvant radiation seems to be of additional therapeutic benefit. Except for meningeosis melanomatosa chemotherapy must be regarded as experimental. Unfortunately, a standardised therapy concept is still lacking.
Novel retractor for endoscopic and microsurgical spinal interventions.
Retractors play an important role in surgery, especially using endoscopic techniques like microendoscopic discectomy. As a consequence of the minimally invasive approach the working space is frequently very restricted. All currently available systems still use tubular retractors with limitations regarding flexibility, stability and accessible working space. This paper discusses the technical aspects of a newly designed circular retractor system for endoscopic and microsurgical spinal interventions (SpineGate) and presents first clinical results in a series of 20 consecutive patients. The autoclavable system consists of a circular base plate and several valves varying in length. The variable fixation of the valves from different directions within the 360 degrees geometry of the base plate allows a continuously adjustable working space, depending on the individual anatomy. An additional fixation device is not necessary. The retractor is suitable for microendoscopic and microsurgical techniques. It is easy and safe to handle. The retractor system was successfully used in all cases without complications or instrumental malfunctions. All patients experienced good to excellent relief of their preoperative symptoms.
Validation of predictive rules and indices of severity for community acquired pneumonia.
BACKGROUND: A study was undertaken to validate the modified American Thoracic Society (ATS) rule and two British Thoracic Society (BTS) rules for the prediction of ICU admission and mortality of community acquired pneumonia and to provide a validation of these predictions on the basis of the pneumonia severity index (PSI). METHOD: Six hundred and ninety six consecutive patients (457 men (66%), mean (SD) age 67.8 (17.1) years, range 18-101) admitted to a tertiary care hospital were studied prospectively. Of these, 116 (16.7%) were admitted to the ICU. RESULTS: The modified ATS rule achieved a sensitivity of 69% (95% CI 50.7 to 77.2), specificity of 97% (95% CI 96.4 to 98.9), positive predictive value of 87% (95% CI 78.3 to 93.1), and negative predictive value of 94% (95% CI 91.8 to 95.8) in predicting admission to the ICU. The corresponding predictive indices for mortality were 94% (95% CI 82.5 to 98.7), 93% (95% CI 90.6 to 94.7), 49% (95% CI 38.2 to 59.7), and 99.5% (95% CI 98.5 to 99.9), respectively. These figures compared favourably with both the BTS rules. The BTS-CURB criteria achieved predictions of pneumonia severity and mortality comparable to the PSI. CONCLUSIONS: This study confirms the power of the modified ATS rule to predict severe pneumonia in individual patients. It may be incorporated into current guidelines for the assessment of pneumonia severity. The CURB criteria may be used as an alternative tool to PSI for the detection of low risk patients.
[Dynamic radiographic evaluation of the antero-inferior gleno-humeral ligament].
PURPOSE OF THE STUDY: The purpose of this work was to propose an objective radiographic evaluation of the antero-inferior gleno-humeral ligament for comparison with the clinical assessment proposed by Gagey. MATERIAL AND METHODS: A test radiogram was obtained from 32 healthy volunteers (15 men, 17 women, mean age, 29 years, age range 21-54 years) free of shoulder disease. The dynamic test image consisted in a strictly AP view of the shoulder in forced abduction in neutral rotation. The subjects were awake and in dorsal decubitus. Displacements of the scapulo-thoracic articulation were limited by a counter-force applied to the acromion, in accordance with the method described by Gagey. Bilateral images were obtained for comparison. Several angles were measured between the humeral shaft and the scapula to search for the most reliable and reproducible measurement. RESULTS: Three series of angles were measured between the axis of the humeral shaft and the scapula. The mean angle between the axis of the humeral shaft and line drawn from the lower rim of the glenoid cavity to the lateral border of the scapular tubercle was 130.3 degrees (range 110-148 degrees) on the dominant side and 131.5 degrees (108-148 degrees) on the non-dominant side; giving 38 degrees variability on the dominant side and 40 degrees variation on the non-dominant side and a standard deviation of 10.4 degrees on the dominant side and 11.5 degrees on the non-dominant side. The mean difference in gleno-humeral abduction was 3.8 degrees (range 0-14 degrees) between the dominant and non-dominant side. DISCUSSION: Among the different angles measured between the scapula and the humerus, the angle between the axis of the humeral shaft and the line drawn from the lower rim of the glenoid cavity to the lateral border of the scapular tubercle was the most reliable and reproducible. Inter-observer measurements were well correlated. We observed that the variability in the radiographic values of the scapulo-humeral angle was much greater than the clinical values described by Gagey who, finding very constant values during forced abduction, described "invariable" scapulo-humeral abduction of the shoulder. Our study demonstrates that scapulo-humeral abduction is not an invariable parameter. More interestingly, the difference in amplitude between the dominant and non-dominant sides showed very strong interindividual correlation. Interobserver variability was low and reproducibility was good. CONCLUSION: This dynamic radiographic test enables a precise quantified assessment of pure gleno-humeral abduction which depends on the antero-inferior gleno-humeral ligament. This test is reliable and reproducible. Variations in the length of the antero-inferior gleno-humeral ligament evaluated radiographically were greater than described clinically. We did not find any difference in pure gleno-humeral abduction greater than 14 degrees between the dominant and non-dominant sides in healthy subjects.
[Interstitial pulmonary disease in systemic scleroderma: diagnosis].
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