Biomedical subjects
Publications and source records attributed to W Puhl.
The extra-abdominal aggressive fibromatosis is a locally aggressive non-metastasizing fibroproliferative tumor of the locomotive system with an extremely high recurrence rate. By means of a case report the treatment possibilities are discussed. The recommended treatment of choice is a wide resection where possible. The indications for radio-, chemo- or hormone therapy are presented.
The aim of the operative treatment of the hallux valgus deformity is to correct the medial luxation of the first metatarsal head out of the sesamoid complex, the restoration of a congruent joint, the patient after treatment should be painfree. 82 patients were available for an independent clinical and radiological review. The median follow up was 32 months. The evaluation of the results are based on objective and subjective assessment of the patients as well as on radiographic criteria, such as hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal bone, subluxation, lateral positioning of the osteotomized MT I-head and position of the sesamoid complex. Depending on the degree of "lateralisation" of the sesamoid complex seven groups were defined: 0/0, 1/0, 1/1, 2/1, 2/2. 2/3, 3/3 following Appel. Following objective criteria 61% of the patients were evaluated excellent or good, following subjective criteria 77% were evaluated excellent or good. Isolated parallel shifting seems to be sufficient in mild forms of hallux valgus (sesamoid complex group 2/2 or less), while the severe subluxation in the metatarsophalangeal joint (sesamoid complex group 2/3, 3/3) requires an additional lateral wedge osteotomy.
In a retrospective study we analysed the effect of caudal epidural anesthesia combined with general anesthesia on requirement for intraoperative narcotics and postoperative analgesics in children undergoing surgical release of congenital clubfoot. In 20 children (mean age at day of surgery 4,7 months) general anesthesia was supplemented by caudal epidural anesthesia, controls (20 children, mean age 4,3 months) received general anesthesia only. Compared to controls, the amount of narcotics was significantly reduced in the caudal epidural group (1,1 Vol% compared to 1,6 Vol% Isofluran). As well the use of analgesics in the postoperative phase was decreased from 112,5 mg to 56,3 mg Paracetamol. The children in the caudal epidural group recovered from anesthesia more comfortably. No complications occurred in either group. Our results show, that general anesthesia combined with caudal epidural anesthesia is more suitable for surgical release of congenital clubfoot than the exclusive use of general anesthesia.
A concept for treating progressive muscular dystrophy type Duchenne is presented. It aims at the improvement of quality of life by surgery of the lower extremities. 60 Duchenne patients were treated by a standard operating regime. The different stages of the disease required different postoperative rehabilitation measures.
An analysis of 93 unconstrained totalcondylar knee prostheses showed good to excellent results. There was no significant difference between cemented and uncemented knee replacement. The advantages of unlinked totalcondylar knees are: --the minor bone resection, which enables a sure fixation of a new prosthesis or an arthrodesis in case of loosening, --the stabilisation by the natural ligaments leading to a reduced force transmission in comparison to linked prostheses. If knee replacement is necessary the total condylar surface replacement should be the knee endoprosthesis of first choice.
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About one year after Harrington-Spondylodesis in 29 patients scintigraphy was performed in order to find non-unions. Scintigraphy is more successful in this question and can be recommended in routine-diagnostics.
From 1984 to 1988 20 revisions for aseptic or septic loosening of knee prosthesis were performed. In 12 case there was an aseptic- and in 8 cases a septic loosening of the prosthesis. Most revision surgery for loosening of knee replacement needs reconstruction of bone stock. In loosening of unconstrained knee prostheses (uni-, totalcondylar knees) it was possible to insert a total condylar knee for revision surgery. Partially gross deviations had to be corrected, but in all cases a good alignment and ligamentous stability were effected. In septic loosening we had good experience with the two stage procedure. We temporarily implanted a gentamycine-PMMA-Spacer to avoid soft tissue contracture and to inhibit fusion of the cancellous bone. Arthodesis after knee replacement is difficult to manage, because the sclerotic bone of the site the prosthesis doesn't easily fuse.
Acute hematogenous osteomyelitis of the os ischii is a rare disease. Involvement of the acetabulum in a 4-month old girl with concomitant developmental dysplasia of the ipsilateral hip caused a dislocation of the hip joint due to synovitis. Arthroscopic joint lavage, antibiotic treatment and reduction of the hip in a pavlik-harness led to a satisfactory result.
The infiltrating intramuscular hemangioma has a high recurrence rate in case of incomplete resection. NMR is presently the most suitable diagnostic procedure to secure the diagnosis and to demonstrate the extent of infiltrative growth of this relatively rare soft tissue tumor. The case of an infiltrating hemangioma of the thigh in a 9 year old girl is presented, highlighting diagnostic and different treatment modalities.
UNLABELLED: The DXA-technique is a well established method to study bone mineral density (BMD). Until now there are no reliable reference data based on the male population of Germany. QUESTION: Are the data base, given by the manufacturer transferable to the male population in Germany? METHODS: So a cross sectional study based on 715 healthy males with German ethnic background (age 20-89) was carried out. Comparison was made to the ap spine reference data of northern Europe. RESULTS: The peak bone mass was 1,26 +/- 0,17 g/cm2 at the age of 20-24 years. After that the BMD decreases to the sixth decade (1,09 +/- 0,18 g/cm2), further on there is an increase to 1,18 +/- 0,21 g/cm2 in the ninth decade. CONCLUSION: Looking at a comparable Swedish study there are no significant differences, looking at a Finnish study there are statistically significant differences in the sixth decade (t = 3,246) and seventh decade (t = 2,413). The results of our study complete the data base until now, but one should be careful to transfer the data base provided by the manufacturer.
OBJECTIVE: To imitate the in vivo joint situation and to allow cell interactions, a co-culture system of human osteoarthritic chondrocytes and synovial fibroblasts from a single joint was established and characterized with or without stimulation by IL-1 beta. METHODS: Culture settings included chondrocytes in alginate alone, synovial fibroblasts in monolayer alone and a co-culture of both. Proteoglycan (PG) synthesis was measured by 35S-incorporation, PG content by a dimethylmethylene blue assay, DNA content by a fluorometric assay, and prostaglandin-E2 and IL-1 beta release by ELISA. RESULTS: In co-culture PG synthesis by chondrocytes was significantly reduced in the presence of IL-1 beta (1 ng/ml) compared to controls. PG content of chondrocyte cultures was reduced for controls and IL-1 beta treated co-cultures. Synovial fibroblasts in co-culture did not show significant change of PG synthesis or content when compared to cells in mono-cell culture. PG release into the medium was relatively high in co-cultures. IL-1 beta significantly decreased the proliferation rate of chondrocytes in co-cultures and slightly increased prostaglandin-E2 release. CONCLUSIONS: Co-culturing of osteoarthritic chondrocytes and synovial fibroblasts from a single human joint allows interactions between both entities and may offer a useful tool to study the effects of mediators or new drugs under more in vivo like conditions compared to mono-cell cultures.
The positive effect of moderate physical activity on cardiovascular system, psychological condition, immune reactions and joint biology are wellknown. They seem to facilitate pain control and to stimulate the metabolism of skeletal tissue and joints also in elder patients with rheumatoid arthritis if certain prerequisites are considered. The possible influence of physical activity on the natural course of the disease has not yet been investigated. The recommended type and extent of sports activity therefore have to be carefully selected with regard to the pathogenesis of the disease and their inflammatory changes as well as the patients individual medical conditions.
Axial-free knee prostheses have proved their worth in the treatment of arthritic knees. Normal axial alignment and physiological ligamentous guidance can be accomplished by this type of prosthesis, even in cases of severe deformity and instability. In addition, unconstrained prostheses show some important advantages in comparison to constrained prostheses.
Missing pathognomonic clinical and radiological signs, an early diagnosis of hip joint synovitis is often impossible. Ultrasonography and arthroscopy of the hip joint are useful methods to accomplish recognition and exact description of chronic inflammatory hip joint diseases. These new diagnostic methods enable an early adequate treatment. Until today synovectomy of the hip joint is still a rare surgical procedure. Reasons are the difficulties in diagnosis of the synovitis and the insufficient radicality of synovectomy if the femoral head is not luxated temporarily. The semi-arthroscopic synovectomy of the hip joint allows a radical removal of the synovial membrane even in the fossa acetabuli, avoiding the inherent risks of a luxation of the femoral head.