[Hip prosthesis implantation--only good long-term results count!].
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Aged↗
Biomedical subjects
W Dick
Publications and source records attributed to W Dick.
In situ detection of 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue.
Growing evidence suggests that intracellular vitamin D receptors are present in skeletal muscle tissue mediating vitamin D hormone response. The aim of the work reported here was to investigate the in situ expression of 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue. Intraoperative periarticular muscle biopsies were taken from 20 female orthopaedic patients (17 middle-aged and elderly patients receiving total hip arthroplasty due to osteoarthritis of the hip or an osteoporotic hip fracture and 3 young patients who received back surgery). The immunohistological distribution of the vitamin D3 receptor was investigated using a monoclonal rat antibody to the receptor (Clone Nr. 9A7). The receptor-positive nuclei were quantified by counting 500 nuclei per biopsy. Strong intranuclear immunostaining of the vitamin D receptor was detected in human muscle cells. Biopsies of hip patients had significantly fewer receptor-positive nuclei compared to those of back surgery patients (Mann-Whitney U-test: p = 0.0025). VDR expression (number of antigen-positive nuclei) was significantly correlated with age (coefficient of correlation = 0.46; p = 0.005), but not with 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D levels. The data clearly demonstrate presence of nuclear 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle. To our knowledge this is the first in situ detection of the receptor in human skeletal muscle. The difference in the expression of the receptor between hip and spinal muscle biopsies might be explained by age or location. Further research is needed in order to evaluate whether vitamin D3 receptor expression in human skeletal muscle is age-dependent and varies between different muscles.
Adult↗
Self-reported exercise before age 40: influence on quantitative skeletal ultrasound and fall risk in the elderly.
OBJECTIVES: To compare musculoskeletal factors with bone structure, as measured by quantitative ultrasound (QUS) at the calcaneus, and their potential to predict fall risk in geriatric inpatients. DESIGN: Longitudinal. SETTING: Two geriatric hospitals in Switzerland. PARTICIPANTS: A total of 134 of 207 long-stay geriatric patients (96 women, 38 men) who were able to perform the timed up and go (TUG) test. INTERVENTIONS: Five musculoskeletal tests: 2 functional tests (TUG, for mobility; functional reach test, for balance), and 3 muscle strength tests (knee flexor, knee extensor, grip). Falls were monitored prospectively in a subgroup of 94 mobile subjects of 1 geriatric hospital throughout each individual length of stay (median, 31.4wk: interquartile range, 16-56.4wk). MAIN OUTCOME MEASUREMENTS: Functional and strength tests, mobility status, and self-reported exercise before age 40 were musculoskeletal factors to be compared with QUS. RESULTS: QUS was higher in mobile subjects without walking aid (p < .0001) and correlated significantly with muscle strength (knee flexor: r = .36; knee extensor: r = .30) and functional tests (TUG: r = -.25; functional reach: r = .16). Women who reported regular exercise before age 40 had higher QUS (p = .01) and fewer falls (p = .01). Falls were less frequent in subjects with walking aid (p = .03). No single musculoskeletal test, but rather a combination of demographic variables, musculoskeletal factors, and QUS could predict 76% of total variation of fall risk. CONCLUSION: This study showed the important impact of current mobility and muscle strength status on bone structure, as measured by QUS at the calcaneus. In addition, a beneficial effect of former exercise on QUS and fall risk at advanced age could be documented in women. Both findings support life-long engagement in exercise, which might be particularly meaningful for women.
Accidental Falls↗
Quantitative analysis of gene expression in human articular cartilage from normal and osteoarthritic joints.
OBJECTIVE: To quantify the expression of genes encoding extracellular matrix (ECM) proteins in human cartilage from normal and osteoarthritic (OA) joints. DESIGN: Human cartilage samples were classified as control (CTR) or OA according to clinical evaluation and assessed histologically and biochemically to confirm the diagnosis. mRNAs encoding collagen types I, II and X, aggrecan, versican, osteopontin and osteocalcin were quantified by real-time reverse transcription-PCR assays and normalized to a reference mRNA (GAPDH). RESULTS: RNA from native cartilage could be reproducibly and efficiently amplified by real-time PCR only if isolated using purification membranes. Primers and fluorescent probes for real-time PCR, endowed with comparable (<6% difference from GAPDH) and high (>91%) amplification efficiencies, were designed and validated for the selected ECM genes. The expression of most genes under investigation displayed large variations and was not significantly different in CTR and OA cartilage. Only osteopontin mRNA levels were significantly higher in OA than CTR specimens. mRNA ratios of collagen type II to I and of aggrecan to versican, defined as indexes of chondrocyte differentiation, were less variable within each population than the single genes and markedly higher (27.0 and 7.6-fold, respectively) in CTR than OA cartilage, with high statistical significance (P = 0.00013 and P = 0.00007, respectively). CONCLUSIONS: Our results provide evidence that gene patterns related to chondrocyte differentiation discriminate between CTR and OA human cartilage with higher sensitivity than single ECM genes. The method described here has the potential to improve understanding of the progression of OA and could become a valuable diagnostic tool.
Adult↗
The role of ankle arthroscopy in the treatment strategies of osteochondritis dissecans lesions of the talus.
Thirty-six cases of osteochondritis dissecans (OD) of the talus were diagnosed among 413 ankle arthroscopies performed within a period of six years. In 52.8% of the cases the OD was found on the medial and in 41.7% on the lateral talus. 53.3% of the lateral OD presented stage III and IV lesions while only 26.3% of the medial OD were to be graded stage III and IV. Patients with grade I and II lesions had mostly excellent outcome scores between 90 and 100. However, four patients with medial OD at less severe stages who were treated surgically, showed a particularly unfavorable outcome with scores between 11 and 36. All these patients needed either ankle arthrodesis or total ankle joint replacement. For stage II and III medial lesions, our experience has led to a more conservative approach due to the unfavorable outcome of surgical treatment observed in these patients. Despite the usefulness of MRI in the diagnosis of OD of the talus, arthroscopy has been proven to represent a very helpful diagnostic tool in assessing extent and in particular stability and integrity of the osteochondritic lesion. Apart from enabling the various minimally invasive surgical treatment options, ankle arthroscopy should be performed in all patients with OD of the talus in order to help define the treatment strategy and avoid unnecessary surgery on stable lesions.
Adult↗
[Advanced emergency life support measures in resuscitation. Guidelines of the European Resuscitation Council 1998].
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Emergency Treatment↗
[Trauma patients--establishing comparable data sets].
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Databases, Factual↗
[Research--publications--impact factor--"industry-method" corruption. Thoughts on a German phenomenon].
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Bibliometrics↗
Total hip arthroplasty after arthrodesis of the hip joint.
The results of 15 conversions of a hip arthrodesis into a total hip arthroplasty performed in the years 1980-1995 are reported. Fifteen patients (8 men, 7 women) underwent total hip arthroplasty 30.9 (range 2-61) years after spontaneous or operative fusion of a hip joint. The primary indications of the conversion were low-back pain (n = 10), knee pain (n = 2) and hip problems (n = 3). At follow-up examination 5.4 (range 2-13.3) years postoperatively, the Harris Hip Score averaged 86.0 (range 70.1-99.0). Six patients were pain-free, 7 had less pain, 2 felt no improvement of pain. All patients confirmed that they would undergo the operation again. The Trendelenburg sign was negative or mild in 8 patients and moderate to severe in 7. Aseptic loosening of 2 stems (1 cemented, 1 cementless) and 2 deep infections required revision surgery. We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. However, full function with no pain and a negative Trendelenburg sign could be obtained in only 20% (3/15) of the cases.
Adult↗
Ventilation volumes with different self-inflating bags with reference to the ERC guidelines for airway management: comparison of two compression techniques.
The 1998 ERC-guidelines for airway-management recommend an tidal volume of 400-600 ml for adults undergoing CPR. As commercially available self-inflating bags were designed to meet former recommendations (800-1200 ml) we investigated how to meet the latest recommendations with these bags. We combined the head of a training manikin (Laerdal Medical) and a standard lung (VTTL; Michigan Instrument), adjusted to a physiological compliance and resistance. Volume was measured with a Wright spirometer (BOC). Seven self-inflating bags were investigated. Tests were carried out by ten people (five female and five male) for 5 min each using two different techniques. Technique 1: standard ventilation with one hand without compression of the self-inflating bag against the rescuers knee. Technique 2: modified open palm technique with total squeezing of the self-inflating bag by compression against the rescuers knee. The average tidal volumes for technique 1 ranged from 438 to 604 ml. Applying technique 2 the volumes ranged from 888 to 1192 ml. The latest recommendations were met using a single hand technique without compression against the rescuers knee for all seven bags tested. The modified open palm technique produced larger tidal volumes which were more in line with previous recommendations.
Cardiopulmonary Resuscitation↗
Alternative methods of mechanical cardiopulmonary resuscitation.
Due to the relative ineffectiveness of standard resuscitation techniques, alternative methods have been explored for many years. The aim of new methods is to improve haemodynamics and increase survival rates. In spite of some encouraging haemodynamic results, all but one study failed to show an increase in long-term survival rates with an alternative method in a convincingly large group of patients (hospital discharge without neurological damage, and 1-year survival). In this study active compression-decompression resuscitation (ACD-CPR) increased long-term survival compared to standard-CPR. The results from certain individual studies, which showed a significant increase in short-term survival rate, could not be reproduced in other trials. This may be attributed in part to the fact that the alternative methods are not significantly superior, but also due to logistical and statistical problems in the conduct of the studies and differences in application within and between the study sites. ACD-CPR has been the most studied method amongst the alternatives and can be recommended for patients with asystole in centres with special training and where outcome quality is regularly verified and evaluated.
Animals↗
Morton's intermetatarsal neuroma: morphology and histological substrate.
Twenty-three biopsies from patients with the typical symptoms of intermetatarsal neuroma (so-called Morton's metatarsalgia) were compared histologically and semi-quantitatively with 25 plantar nerves from the intermetatarsal space III/IV gained at autopsies from cases where no problems in the forefoot had been recorded. The histomorphological examination of the nerves from autopsies revealed the same findings as were found in the biopsies. Thus, qualitatively, the nerves from patients could not be distinguished from those gained at autopsy. The only difference was the diameter of the resected nerves: semi-quantitative analysis of the nerves showed that the 17 thinnest ones were all from autopsies and the five thickest ones from biopsies of symptomatic patients. At medium diameters, however, there was wide overlap of the two groups. The study yielded a specificity of the swelling of 80 % and a sensitivity of 78%. From these results it must be concluded that diagnostic MRIs or ultrasonography, are unnecessary for decision-making about operative treatment and are not superior to exploratory local anaesthesia. Since histomorphological findings in intermetatarsal neuroma (so far accepted as the gold standard for confirmation of that diagnosis) were the same as findings in autopsied (normal) specimens, the value of postoperative histological examination is questioned. It merely proved that the nerve has been resected.
Adult↗
No influence of osteoarthritis of the hand on phalangeal osteography in elderly women.
We investigate the influence of hand osteoarthritis on skeletal quantitative ultrasound (QUS) measurement through the proximal phalanges in female geriatric inpatients. In a cross-sectional study, bone status was assessed with QUS at the distal metaphysis of the first phalanges of fingers II-V. Thirty-three of 101 female geriatric inpatients met the clinical criteria of the American College of Rheumatology for osteoarthritis of the hands (median age: 85 years) and were compared to 68 female inpatients without swellings of the small finger joints (median age: 88 years). Amplitude-dependent speed of sound at the distal metaphysis, the electronic signal of the ultrasonic wave after crossing the phalanx (graphic trace), and the thickness of the each phalanx were measured and compared between the two groups by a phalangeal QUS device (DBM-Sonic 1200). There were no significant differences between the phalangeal QUS readings of both groups. The only statistically significant difference was observed in the comparison of the small finger thickness with a lower value in the osteoarthritis group (p = 0.02). These findings suggest that at the metaphyseal level of phalanges, the degenerative process of osteoarthritis doesn't influence the QUS assessment. This could be explained by the finger thickness at metaphyseal level, which was not increased in patients with osteoarthritis compared with control subjects, at least as detected by the applied finger ultrasound method.
Aged↗
[Hemodynamic effects of a ventriculo-cisternal perfusion of bupivacaine].
OBJECTIVES: The cardiotoxic properties of bupivacain have been well documented under in-vitro, as well as under in-vivo conditions. A further mechanism of cardiovascular impairment by bupivacaine via the central nervous system gained investigational interest in animal studies. The aim of our study was to demonstrate the effect of a ventriculocisternal perfusion of bupivacain on systemic hemodynamic variables and their reversibility by wash-out with mock-CSF. METHODS: After obtaining animal investional committee consent, nine anaesthetized and relaxed pigs were prepared for a ventriculocisternal perfusion (VCP). Hemodynamic data were obtained by invasive blood pressure measurements in the high and low pressure system as well as cardiac output (thermodilution technique), intracranial pressure and electrocardiogram. Systemic vascular resistance and stroke volume were calculated using standard formulas. A second group of three animals were exposed to an intravenous infusion of the same dose of bupivacain over the same period of time to rule out direct cardiac effects. After instrumentation baseline data were obtained (K0 1) under VCP with mock-CSF for 30 minutes. The mock-CSF was replaced by 0.05% bupivacaine in mock-CSF and VCP was continued with 3 ml.h-1 for 20 minutes. After administration of 500 micrograms bupivacaine data were collected (BU). The bupivacaine solution was replaced by mock-CSF and after twenty minutes hemodynamic measurement were repeated (K02). RESULTS: The intravenous administration of 500 micrograms bupivacaine had no effect on all measured variables. VCP of the same dose resulted in significant increase in heart rate, systolic, diastolic and mean arterial blood pressures. Left and right heart filling pressures as well as systemic vascular resistance were not affected while the stroke volume decreased. After continuation of VCP with mock-CSF hemodynamic changes were reversed. DISCUSSION: Our results demonstrate that bupivacaine initiates an indirect cardiovascular stimulating effect of a VCP with 500 micrograms of bupivacaine via the central nervous system. The intravenous administration of the same dose had no effect. The centrally mediated cardiovascular effect of bupivacaine was reversed by wash-out with mock-CSF. The cardiovascular stimulation observed in this animal experiment may be of clinical relevance as a potential sign of toxic effects of bupivacaine on the CNS.
Anesthetics, Local↗
Pharmacokinetics and pharmacodynamics of hydroxyethyl starch in hypovolemic pigs; a comparison of peripheral and intraosseous infusion.
Intraosseous (i.o.) infusion is considered a useful technique for the administration of medications and fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of i.o. versus intravenous (i.v.) infusion of hydroxyethyl starch (HES 200/0.5) in hypovolemic pigs. Twenty-three pigs (8- to 9-week-old) were anaesthesized, instrumented and blood was withdrawn (25-30 ml/kg) to < 50 mmHg mean arterial pressure (MAP). The animals were left untreated in haemorrhage for 30 min. Relevant haemodynamic parameters were monitored and blood samples were collected for blood gas and HES concentration analysis. Infusion of HES via i.v. or i.o. line (20 ml/kg per h) carried out over a period of 30 min for volume resuscitation and measurements were taken every 5 min. Infusion was discontinued after 30 min and the animals were monitored for 1 h. Analysis of HES-pharmacokinetics and pharmacodynamics revealed no significant differences between i.o. and the i.v. administration. The results demonstrate i.o. infusion of HES to be a rapid and effective method for fluid resuscitation in hypovolemic shock.
Animals↗
Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities.
OBJECTIVE: To compare the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a questionnaire format of the Lequesne-Algofunctional Index in patients with OA of the lower extremities. METHODS: Longitudinal analysis of the instruments' responsiveness [standardized response mean (SRM), effect size (ES)] in ambulatory patients undergoing hip or knee arthroplasty. RESULTS: At six months 36, and at one year 40 out of 43 patients undergoing hip (N=30) or knee arthroplasty (N=13) could be examined. Both responsiveness statistics revealed the same order of responsiveness. For both indices and for both locations, the pain sections were more responsive than the function sections. However, the WOMAC scales and the WOMAC global index (hip at 12 months: SRM=2.4; knee at 12 months: SRM=2.0 ) were more responsive than the comparable Lequesne sections and Lequesne index (hip at 12 months: SRM=2.1; knee at 12 months: SRM=1.5). CONCLUSIONS: Although our results are based on a German version using a self-report format, the WOMAC scales appear to be more responsive than the Lequesne index in patients with OA of the lower extremities.
Adult↗
Stroke--a medical emergency.
Stroke is the third leading cause of death and number one cause of disability in industrialised countries. A number of new therapeutic approaches are currently in development for use in the acute phase of ischaemic stroke and all trials have, to date, demonstrated the importance of early diagnosis and subsequent initiation of treatment. It is well known that, for most patients, there is a long delay between the onset of symptoms and the start of treatment. A number of factors are responsible for this time delay: signs and symptoms often go unrecognised by patients, relatives, and bystanders and, unlike trauma or myocardial infarction, stroke is not given a high priority by medical staff. Studies into the pathophysiology of acute ischaemic stroke have indicated that treatment options are likely to be optimised when early signs of stroke are recognised and treatment is initiated within six hours of symptom onset. Although a small number of stroke patients are treated as emergencies and attended to by the emergency medical services within this time window, this number could easily be increased by intensified public and emergency personnel education. In the future, it is hoped that treatments which must be administered within the first few hours of acute stroke will be able to be initiated by the emergency medical services. In the same way that hospitals are notified and prepared in advance to receive trauma victims, early notification by the emergency medical services about stroke patients would enable stroke teams to be present at admission, thus improving the likelihood of a better outcome for patients.
Brain Ischemia↗
[High-frequency jet ventilation for placing tracheal stents--a case report].
Stenoses of the larynx and trachea may cause acute life-threatening situations. Surgical procedures in patients presenting this type of problem are a real challenge for the surgeon and the anaesthesiologist. Depending on the extent and the nature of the stenosis, the insertion of a stent may be the best therapeutic option. In this case, the high frequency jet ventilation offers certain advantages for the surgeon. Thanks to modern jet ventilators with automatic pressure monitoring and jet ventilation tubes with a separate lumen for pressure monitoring, the danger of barotrauma is considerably reduced, even in patients with a high-degree stenosis of the larynx and trachea. During insertion of a tracheal stent during jet ventilation, the complete cross-section of the trachea must at least be temporarily available to the surgeon. In addition, at the end of the operation the newly implanted stent should not be altered by manipulations necessary for artificial respiration. We describe a new method which uses tracheal jet ventilation for implanting a stent with only short interruptions of artificial ventilation. During recovery from anaesthesia, there is no risk of dislocating the newly placed stent.
Carcinoma, Adenoid Cystic↗