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Biomedical subjects

W Puhl

Publications and source records attributed to W Puhl.

At least 73 records · Page 4Linked to original sources
PubMed1995

Measurement of femoral anteversion by magnetic resonance imaging--evaluation of a new technique in children and adolescents.

Anteversion of the femoral neck was measured by magnetic resonance imaging (MRI) in 19 children (37 hips) preoperatively before femoral rotation osteotomies. The results of this new technique were compared with values for anteversion obtained by computed-tomographic (CT) scanning and ultrasound. In order to determine the correlation between the three different methods and to assess their reliability, the measurements were performed independently by two observers at different times. There was a high correlation (Pearson's correlation coefficient) between MRI results and CT scan (r = 0.77) as well as MRI and sonography (r = 0.81), although the mean anteversion angles obtained by computerized tomography (34.0 degrees, range 5-82 degrees) and ultrasound (25.6 degrees, 10-40 degrees) were larger than the MRI values (23.2 degrees, 0-65 degrees), which can be explained by the different measurement techniques. Mean inter-rater as well as intra-rater reliability was high for MRI (r = 0.97 and r = 0.97) and CT (r = 0.99 and r = 0.96) but slightly less for sonography (r = 0.88 and r = 0.88). MRI is a novel method for evaluating femoral anteversion that does not require ionizing radiation, allows a precise anatomical measurement and reliable results. MRI is recommended for preoperative planning of pediatric femoral rotation osteotomy cases.

Adolescent↗
PubMed1994

Thermal side effects of fiber-guided XeCl excimer laser drilling of cartilage.

We examined thermal effects during ablation of human joint cartilage using two XeCl excimer lasers with pulse durations of approximately 20 ns and 60 ns. An increase in radiant exposure or repetition rate caused a rise in tissue temperature up to 82 degrees C at a 100-microns distance. With increasing distance from the crater edge, the temperature dropped exponentially. Radiant exposures higher than 1.8 J/cm2 and repetition rates above 20 Hz lead to a formation of hot gaseous products escaping from the laser crater. When osteoarthritic cartilage is irradiated, these gases spread inside the tissue causing a temperature rise of > 50 degrees C at a distance of 1 mm from the crater edge. In the contact mode, we found a linear rise of ablation rate with increasing repetition rate both in air or saline. But ablation rates in saline were only half the rates achieved in air. Both phenomenons can be explained by additional thermal effects of excimer lasers working in the range of higher repetition rates and pulse energies.

Cartilage, Articular↗
PubMed1994

The importance of sonography in the diagnosis of septic complications following spinal surgery.

The detection of infection after surgery on the thoracic and lumbar spine is difficult due to the anatomical circumstances. Clinical symptoms, laboratory findings, and most radiological techniques are of limited diagnostic value. Among other benefits, sonography offers the advantage of early postoperative examination, even with metal implants in the operated area. In a retrospective study, 27 patients with clinically suspicious wounds were evaluated by sonography in the postoperative follow-up; all cases were verified by puncture and/or operative revision. Eleven cases turned out to be hematomas, and 16 cases were found to be infections. Accumulations of fluid, however, could not be differentiated by the established sonomorphological criteria such as internal echo structures, septation, demarcation from the environment, and reaction of the surrounding tissue. Ultrasonically guided transcutaneous needle aspiration biopsy served to differentiate the local findings and to establish the diagnosis and therefore is required as an obligatory method of investigation.

Adult↗
PubMed1994

Metabolic and hemodynamic changes during isokinetic muscle training. A controlled clinical trial.

Twenty-one healthy males aged 20-36 years were examined for hemodynamic and metabolic parameters such as heart rate, oxygenation, lactate, blood pressure, under isokinetic and ergometric loadings. The healthy volunteers were tested by increased loads and constant times with an identical isokinetic and ergometric power. The important results are: Heart frequency and blood pressure are higher under isokinetic than under ergometric conditions. Oxygenation is equal in both tests. The lactate values show for the isokinetic maximal and for the ergometric submaximal loadings. The definitive factor for this variation is the relation between force and velocity. The higher tension of the muscles and the higher activity of the fast-twitch fibers seem to be responsible for the increasing of sympathicotonia. The clinical impact of this controlled study is: 1. Isokinetic testing might be dangerous for patients with cardiac diseases or circulatory disturbances. 2. Isokinetic training programs have to pay attention to joint and internal diseases at the same level. 3. During the first isokinetic test all precautions for a possible emergency case have to be taken.

Adult↗
PubMed1994

[The importance of neuromuscular coordination for athletic stress of the knee joint after anterior cruciate ligament injuries. A gait and locomotion analysis with EMG on treadmill].

Anterior cruciate ligament (ACL) injuries are considered of high prevalence in sports medicine and are of socio-economical relevance. Indications for operative treatment and the ability for physical activity after ACL injuries are discussed controversially. Although it is known that the ACL has neurosensory functions, no test system has been developed which takes this biological function into account. The first goal of this study was to determine the neurosensory function after ACL reconstruction, and the second goal was to develop predictive markers for functional results after surgery. 20 healthy athletes (10 male, 10 female) (control group) and twenty ACL deficient patients (10 male, 10 female) (study group) were included in a prospective, controlled study. Electromyograms (EMG) were performed under defined load conditions of the knee. Important results of our study are: 1. Previously described parameters can be reproduced with EMG techniques. Their validity was proved. Typical contraction patterns (m. quadriceps, hamstrings, m. gastrocnemius) for defined load conditions can be recorded. 2. Statistically significant differences can be shown between the control group and the study group as well as between the two legs (injured/noninjured) of the same patient in the study group. 3. The results suggest that the diminished innervation of the m. biceps femoris and m. gastrocnemius in down-ramp-running as an important parameter for ACL deficiency. 4. Distinct differences of innervation patterns of the muscles, which stabilise the knee in downramp walking suggest that despite a subjective stability, altered load conditions may result. Innervation patterns seem to vary from individual to individual. 5. Concluding from our findings, we suggest that clinical methods should be developed to allow a patient-specific assessment of physical activity.

Adult↗
PubMed1994

[Standardized analysis of acetabulum cup migration in hip endoprosthesis using digital image processing].

Measurement of the migration of the acetabular component following total hip replacement seems to be a useful method of early detection of aseptic loosening. The methods used so far for migration analysis are either too time-consuming or too elaborate in terms of the technical equipment required, and are therefore not suitable for use in day-to-day clinical practice. Analysis software based on the methods described by Nunn and Sutherland was developed with the aid of digitized conventional radiographs of the pelvis. It allows a planar migration measurement including cup inclination following manual marking of only five reference points on a computer screen. A correction for projection enlargement and rotational malpositioning of the patient is performed. All results are stored in a data bank and automatically compared with those recorded at previous follow-ups. Five different acetabular cups were analysed by a conventional and by a digital method for calculation of intra-observer variability. The standard deviation (SD) for horizontal and vertical migration was 0.2-0.4 mm and that for inclination angle 0.8-1.4 degrees with digital evaluation. For manual measurement the SD was 0.4-0.8 mm for migration and 0.8-1.2 degrees for inclination. A pelvis phantom was measured in nine different positions (neutral, 5 degrees and 10 degrees cranial and caudal inclination, 5 degrees and 10 degrees rotation to each side). Four different acetabular cup design were examined, each of which yielded a series of nine measurements. Within these series the SD for biplanar distances varied between 0.1 mm and 1.2 mm and for inclination between 1.1 degree and 2.3 degrees. Intra-observer variability was negligible.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1993

The development of juxta-articular osteoporosis after synovectomy of the knee. A prospective study by double photon absorptiometry.

In a prospective study 9 patients, who were going to have a synovectomy for rheumatoid arthritis of the knee, underwent dual photon absorptiometry before, and at intervals after, operation. This determined the degree of juxta-articular osteoporosis quantitatively. The density was compared to a control group with normal knees. The follow up measurements showed an improvement in the juxta-articular bone mineral content after the 6th month. This demonstrates that bone densitometry is an objective indicator of the development of juxta-articular osteoporosis in inflammatory joint disease.

Absorptiometry, Photon↗
PubMed1993

Intra-articular sodium hyaluronate in osteoarthritis of the knee: a multicenter, double-blind study.

The efficacy and the safety of intra-articular injections of sodium hyaluronate were studied in patients with osteoarthritis of the knee in a randomized multicenter double-blind study. Two hundred and nine patients received five injections of either 25 mg hyaluronate/2.5 ml (verum, N = 102) or 0.25 mg hyaluronate/2.5 ml (control, N = 107) at weekly intervals. Seven patients in each group were excluded from the protocol-correct efficacy analysis. The Lequesne Index, the first main criterion, showed a significant superiority of the verum-treated patients after the third injection up to the final follow-up examination 9 weeks after the last injection (MANOVA, P < 0.025). The consumption of paracetamol was defined as a complementary main criterion that did not reveal significant differences between the treatment groups. Most of the individual secondary endpoints demonstrated a much better response to the active treatment without reaching the significance level in the intergroup comparisons for the single time-points. Side-effects were confined to local reactions of minor severity and short duration in four patients (six events) of the verum group and in five patients of the control group. Clinical chemistry and hematology remained essentially unchanged.

Adjuvants, Immunologic↗
PubMed1993

[In vitro toxicity tests of bioceramics and bone transplants in fibroblast culture].

Prior to the clinical use of synthetic bone substitutes and allogenic bone transplants, potential toxicity resulting from various different manufacturing, storage, and sterilisation techniques should be excluded. In order to develop a reliable and reproducible in vitro model for the investigation of possible tissue reactions after implantation of biomaterials, we modified an established animal fibroblast culture technique used to test chemical agents for acute unspecific cytotoxicity. Subcultivation of human fibroblasts produces stable monolayer cultures with the aid of which, standardised, accurate and reproducible evaluation of toxic effects, as well as the direct visualisation of fibroblast ingrowth into porous implant material, is possible. Gamma-irradiated synthetic implants and bovine hydroxyapatite failed to show any substantial cytotoxicity. In contrast, ethylene oxide sterilised implant material, as well as fresh untreated trabecular bone showed a significant toxic effect in comparison with cryopreserved and autoclaved trabecular bone.

Animals↗
PubMed1992

Ultrasonographic evaluation of Legg-Calve-Perthes disease based on sonoanatomic criteria and the application of new measuring techniques.

This study attempts an ultrasonographic classification of Legg-Calve-Perthes disease according to sonoanatomic and sonometric criteria. Four stages, similar to standard radiological staging, could reproducibly be found in 29 patients with unilateral disease. The stages could be significantly differentiated according to descriptive sonoanatomic criteria and partially newly introduced sonographic measurements, including epiphysis-metaphysis-index and acetabulum-epiphysis-distance. Sonographic evaluation of Perthes hips is a simple and standardised procedure, which can serve to stage and monitor the course of the disease and hence reduce the amount of X-ray exposure and treatment costs.

Child↗
PubMed1992

[Supinator tunnel syndrome--a differential diagnosis of so-called tennis elbow].

The increasing activity in sport lead especially in untrained persons to overstress of the elbow joint. Often one tends to diagnose a epicondlylits humeri radialis i.E. tennis elbow. In 1873, Runge (16) first described what we now call epicondylitis humeri radialis, i.e. what Morris (10) 1882 called "Tennis elbow." Its etiology is still under discussion, and the diagnosis of tennis elbow necessitates exact and detailed differential diagnostic efforts. In the work presented, we describe one major differential diagnosis, the posterior interosseous nerve syndrome or supinator entrapment syndrome. With sketches and anatomical preparations we describe the course of the radial nerve around the elbow joint and of its ramus profundus within the supinator muscle pouch. Listing representative causes of this syndrome, we also comment on clinical aspects and our surgical method of choice. We have interviewed and reexamined 6 of our patients suffering from a so called therapy-resistant epicondylitis humeri radialis. Due to their clinical picture all six had been operated for posterior interosseous nerve syndrome/supinator muscle entrapment syndrome. We present our results including neurophysiological evaluations. In relapsing, therapy resistant and diagnostically untypical humeral radial epicondylitis, a posterior interosseous nerve syndrome should be considered. After clinical and electromyographic examination a revision of the supinator channel is justified in selected cases.

Adult↗
PubMed1991

Pustular osteoarthropathy and its differential diagnosis.

A combination of costo-sterno-clavicular hyperostosis and palmo-plantar pustulosis, sometimes with hyperostotic spondylosis and spondylarthritis, is called pustular osteoarthropathy. In the Western hemisphere 40 cases have been reported and in the Far East the condition occurs more commonly. Five cases are described. Diagnosis is difficult because the skin lesions can occur before the costo-sterno-clavicular hyperostoses. The clinical condition is discussed together with the differential diagnosis. Pustular osteoarthropathy seems to be an enthesopathy and the palmoplantar pustulosis is interpreted as a form of psoriasis.

Adult↗
PubMed1990

[Congenital or acquired cleft of the tibial and fibular sesamoid bone of the phalanges of the hallux in a young athlete?].

Splitting of the medial sesamoid bone of the first metatarsophalangeae is relatively frequent, whereas splitting of the tibial and fibular sesamoid bone occurs rarely (6). Differential diagnosis must consider (in respect of pathogenesis) both a fracture if there is an adequate trauma, and a stress fracture. Diagnosis is discussed on the basis of an available case report and compared with the reports published in the literature.

Adult↗
PubMed1989

[Figure skating in high performance sports].

A top performance figure skater is compleled to expose his postural and locomotor system to maximum stress. To achieve the high level of performance that is expected from him, his training schedule must be most exacting. Parallel to this there is an enhanced risk of a sports accident and of damage to health conditioned by sports activities. We report on the results of a study conducted with 67 active and former top performance figure skaters in respect of joint mobility of the lower extremities, sports injuries and damage caused by sports. The type and rate of incidence of sports injuries and sports damage are described and compared with epidemiological data of the average population, the hobby figure skater, and related types of sports.

Adolescent↗
PubMed1988

Semiarthroscopic synovectomy of the hip.

A new surgical procedure, semiarthroscopic synovectomy of the hip is described. The operation enables a radical synovectomy to be performed without the risk of necrosis of the femoral head from temporary luxation. The early results have been encouraging and the method appears to offer a low-risk alternative to conventional radical synovectomy.

Acetabulum↗