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Biomedical subjects

W Puhl

Publications and source records attributed to W Puhl.

At least 163 records · Page 9Linked to original sources
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[Surgical treatment and prognosis factors in spinal metastases of breast cancer].

AIM: The aim of this study was the evaluation of surgical therapy results and prognosis factors in patients with spinal metastases of breast cancer. METHODS: 55 patients with spinal metastases of breast cancer who were treated surgically were retrospectively evaluated. In 11 patients the cervical, in 27 patients the thoracic and in 17 patients the lumbar spine was affected. RESULTS: Postoperatively, 45 patients (81.8 %) described a reduction in pain and 5 patients (50 %) reported a neurological improvement. Perioperative complications appeared in 27 patients (49.1 %), 2 patients died. For the entire group, the mean postoperative survival was 27.2 +/- 28.6 months and the median survival 16.2 months. In patients with solitary metastasis the univariate analysis did not show a significantly longer postoperative survival than in patients with additional visceral metastases (p = 0.0659), but patients with solitary metastasis showed a significantly longer survival than those with multiple osseous and/or visceral metastases (p = 0.0325). In the univariate analysis, the classification of the primary tumour, the duration of symptoms, the localisation of the metastases, the patient's age and the kind of surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior treatment with intralesional resection of the affected vertebra and vertebral body replacement) did not show a significant influence on the postoperative survival. The multivariate analysis did not show a significant prognostic influence for the potentially prognostic factors, however, solitary and multiple metastasis showed the highest statistical influence for the prognosis (p = 0.1187), followed by the classification of the primary tumour (p = 0.1243). CONCLUSION: Pain reduction and neurological improvement can be reached by a stabilisation of the diseased spinal region. Patients with spinal metastases due to breast cancer showed a relatively long postoperative median and mean survival. Therefore, the preoperative evaluation of extent of the disease and the therapy concept should be individually adapted. The surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior approach with vertebrectomy and vertebral body replacement) does not significantly influence the survival.

Adult↗
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[Osteoporosis--a neglected issue in orthopaedics? Results of a survey amongst German orthopaedic surgeons].

AIM: Patients with fragility fractures have a significantly increased risk of sustaining additional fractures. Therefore one should consider avoidance of further fractures as the primary treatment principle. Since orthopaedic surgeons manage most of fragility fractures, but might not be well attuned to osteoporosis itself, it was the aim of the Bone and Joint Decade (BJD) and the International Osteoporosis Foundation (IOF) to survey orthopaedic surgeons in order to assess their knowledge of prevention, diagnosis, and treatment of osteoporosis. MATERIAL AND METHODS: The multinational survey questionnaire was developed by a working group of national project co-ordinators in France, Germany, Italy, Spain, the United Kingdom, and New Zealand and based to some extent on an American survey. Following translation into the national language it was distributed in 2002 to the members of the orthopaedic societies to assess the management of prevention, diagnosis, and therapy of osteoporosis and fragility fractures, comparing both different health-care systems and different working environments. 5 700 questionnaires were distributed in Germany with a 20 percent response rate. RESULTS: As the main result of the German survey -- independent of the working environment -- a substantial deficit concerning training and knowledge about the management of prevention, diagnosis, and treatment of osteoporosis and fragility fractures was seen. In addition, the majority of participants requested educational opportunities to become qualified for a better disease control. CONCLUSION: In order to satisfy the increasing need for adequate management of prevention, diagnosis, and therapy of osteoporosis and fragility fractures, structured educational opportunities have to be offered to the German orthopaedic community. In the mean time first steps have been initiated: training courses to qualify as "Osteologe DVO" and the "White Book Osteoporosis", which was initiated by BJD and IOF and developed by several German medical societies and patient organisations it is based on the German DVO guidelines providing an evidence-based and structured overview concerning all relevant aspects of osteoporosis and fragility fractures.

Attitude of Health Personnel↗
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[Predictors of tibial head transposition in the therapy of varus knee osteoarthritis].

PURPOSE: The aim of this study was to find predictors for the clinical outcome in patients who underwent a high tibial osteotomy (HTO). METHOD: Between 1984 and 1996 a high tibial valgus osteotomy was performed in 155 patients with genu varum. 133 HTO patients were available for follow-up at an average postoperative time of 9.3 +/- 3.0 years. The degree of osteoarthritis was evaluated by radiological (Kellgren) and arthroscopic scoring systems (Outerbridge). Survival time of HTO was estimated using Kaplan-Meier survivorship analysis. RESULTS: The survival rate of HTO was 95 % after 5 years and 77 % after 10 years. In the medial compartment of knee joints with a preoperative Outerbridge stage III/IV or Kellgren stage III/IV the survival rate of HTO was significantly lower when compared to stages 0/I/II (p < 0.05). Age, sex, tibial malalignment and severity of osteoarthritis in the lateral compartment had no influence on survival rates. The pre-postoperative comparison of radiologically visible signs of osteoarthritis showed mainly either no (46.5 %) or only small (50.5 %) progression. We found that patients who underwent a HTO had good and very good clinical outcomes. CONCLUSION: We identified severity of preoperative radiological osteoarthritis and intraoperative chondromalacia as predictors of survival rate.

Female↗
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[Total hip arthroplasty in congenital dysplasia of the hip: follow-up of a small-dimensioned, cemented straight stem].

AIM: The aim of this study is to report the survival and mid-term results including patient-relevant outcome measures with a small-sized cemented stem (CDH-stem) for the treatment of coxarthrosis secondary to developmental dysplasia of the hip. METHOD: 33 total hip replacements were performed with the CDH stem, 29 of which (88 %) were included in the follow-up after an average of 7.6 years. According to the classification system of Hartofilakidis et al., 10 hips were classified as type 1, 15 as type 2, and 3 as type 3. Survival was predicted using Kaplan-Meier survivorship analysis with revision as the end point. Results were assessed using the Harris hip score, as well as the WOMAC and SF-36 as patient-relevant outcome measures. RESULTS: Survival at thirteen years was predicted to be 92.4 % for the stem and 87.6 % for the varying acetabular implants used. At the time of the final follow-up, the average Harris hip score was 82.45 points. The global WOMAC index averaged 2.1, the average SF-36 score was 66.2 points. CONCLUSIONS: The data support the use of a small-sized cemented stem in small femora for total replacement of the dysplastic hip. To the best of our knowledge, this is the first study utilising the well validated WOMAC and SF-36 as patient-relevant outcome measures in this subgroup of patients.

Aged↗
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[Can follow-up scintigraphy be a decision aid for therapy choice in Perthes disease?].

In the period from 1988 to 1982 91 patients with M. Legg-Calvé-Perthes received orthopaedic treatment. In 51 cases surgical treatment for femoral head containment by intertrochanteric derotation varus osteotomy was performed. 40 patients were treated conservatively. Most cases received a Thomas-splint to eliminate weightbearing on the affected hip, some used crutches. Out of this group we present 6 cases that showed during the time of their first examination the radiologic stages 1 and 2 according to Waldenström. At the time when the M. Perthes was diagnosed these patients received a radionuclide bone scan, which was repeated of the average 6 months later to aid in the choice of therapy. Two other cases are presented for comparison, who received the first bone scan in the Perthes stage 2 and 3 according to Waldenström (fragmentation stage) showing an activity defect and were then operated with a derotation varus osteotomy after the follow-up bone scan had not shown revascularisation. All patients that had a complete revascularisation in the follow-up bone scan during the fragmentation stage had a good final result after conservative treatment. For other cases, where the bone scan in the fragmentation stage shows a persisting lack of epiphysis perfusion, it is recommended to decide for surgical treatment with derotational varus osteotomy, since the development of "head-at-risk" signs is likely, which will not resolve after later surgery.

Child↗
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[Overview of clinical and experimental use of hyaluronic acid in gonarthrosis].

AIM: The aim of this survey is to review the clinical and experimental background for the use of hyaluronan (HA) in the therapy of gonarthrosis. MATERIALS AND METHODS: Clinical and experimental studies were analysed following a medline literature-research. To determine the clinical efficiency of HA only randomised and controlled studies were taken into account. As a result of this analysis the current knowledge for the clinical and experimental use of HA is portrayed. RESULTS: Numerous controlled, randomised studies showed beneficial effects for pain relief and joint function after i.art.injection with HA. Placebo, NSAIDs and steroids were used as control medications. The effect of HA was significantly better compared to placebo, and similar or superior in comparison to other verums (NSAIDs, steroids). After completion of HA-therapy a long lasting effect compared to steroids was shown. Review of the literature reveals side-effect rates for HA-therapy similar to those for placebos. In various experimental studies a clear working mechanism could not be identified, especially reasons for the long lasting effects are still unknown. However, some studies showed an anti-inflammatory effect in inflamed joints and in stimulated culture-conditions. A stimulating effect of the HA-production by synoviocytes after administration of HA was shown. Further studies will have to demonstrate the cellular effects in vitro and in animal models in detail. CONCLUSION: HA is therefore classified as a "symptom slow acting drug for osteoarthritis" because a "structure-modifying (chondroprotective) effect" has not been proven yet.

Animals↗
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[Incidence of joint-specific risk factors in patients with advanced cox- and gonarthroses in the Ulm Osteoarthrosis Study].

AIM OF STUDY: To determine the prevalence of joint specific risk factors in patients with different patterns of advanced hip and knee osteoarthritis (OA). METHODS: We performed a cross-sectional multicenter study in four orthopaedic hospitals in the southwest of Germany. A detailed medical history (date and nature of trauma, conservative and surgical treatment of congenital or acquired joint disorders known as secondary causes of OA) and radiographic evaluation (sequelae of hip dysplasia, slipped capital femoral epiphysis or other malformations) was obtained in 809 patients with advanced hip (n = 420) or knee (n = 389) osteoarthritis, which required unilateral total joint replacement. According to the presence or absence of joint specific risk factors, patients were classified as having secondary or primary (idiopathic) OA. RESULTS: In 41.7% (25.5%) of patients with hip OA and 33.4% (11.1%) of patients with knee OA some predisposing abnormality of the operated (or contralateral) joint could be observed. In hip OA the underlying pathological conditions were mainly hip dysplasia (25.0% in the operated joint and 14.8% in the non-operated joint) and slipped capital femoral epiphysis (7.1% and 14.8%), while knee OA was most often associated with a history of severe trauma (28.6% and 8.3%) CONCLUSION: While there is a lack of comparable investigations in patients with advanced knee OA, the presented data is somewhat contradictory to earlier reports of the prevalence of identified underlying risk factors in patients with hip OA. The reported differences, however, might be attributed to different methodological approaches and could also resemble recent changes in the multifactorial ethiopathologic concept of OA.

Aged↗
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[Diagnosis and therapy of spinal stenosis in the elderly].

PROBLEM: Spinal stenosis is a common and increasing problem in the elderly population and a diagnostic and therapeutic challenge. METHODS: An overview of etiology, epidemiology, diagnostics and therapy is given based on a literature review of the years 1978-1998 and experiences since 1985. RESULTS: Dealing with spinal stenosis we have to distinguish concerning diagnostics and therapy between cervical and lumbar spinal stenosis. The cardinal symptom of the lumbar spinal stenosis is the claudicatio spinalis and of the cervical spinal stenosis the cervical myelopathy occasionally combined with radiculopathy. The first therapeutic step should be the conservative therapy in nearly all cases, the only exception is a severe cervical myelopathy where an operation is indicated. In case of persistent or progressive symptoms under a sufficient conservative therapy, operative therapy is indicated. The different possible therapy decisions will be based on flow-charts. CONCLUSION: Whereas in lumbar spinal stenosis the indication for operative therapy should be considered with reservation, in cervical spinal stenosis with myelopathy operative therapy should be considered at an early stage.

Aged↗
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[Use of ultrasonography in the diagnosis of infections in the locomotor apparatus--possibilities and limitations].

Significance of sonography in the detection of soft tissue infections is unclear and discussed controversial in literature. In a retrospective study sonograms of 40 hematomas and 23 infections were evaluated to examine the possibility of detecting infections by means of sonography alone. Accumulation of fluid, however, could not be differentiated by the established sonomorphological criteria. Especially in postoperative infections with unclear clinical pattern no differentiation between hematoma and abscess could be made. Only ultrasonically guided transcutaneous needle aspiration biopsy can prove the character of sonographic findings.

Abscess↗
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[Reproducibility in the roentgenological assessment of coxarthritis].

The "German Society of Orthopaedic Surgery and Traumatology (DGOT)" is trying to support the application of standardized and reproducible criteria in diagnosis and therapy of osteoarthritis. As radiographs are a primary measure of outcome at present, the objective of this study was to investigate the reproducibility of radiologic assessment in hip osteoarthritis using different radiographic variables. 3 investigators read 100 hip joints on 50 pelvis radiographs at two time-points for the presence and severity of individual radiographic features: joint space narrowing (JSN), osteophytes, sklerosis, subchondral cysts and deformity of the femoral head. Additionally the summary grade of Kellgren and Lawrence (1963) and Scott et al (1992) was assessed. Intra- and inter-rater-reliability were calculated by intra-class-correlation-co-efficient (ICC). The results regarding intra- and inter-rater-reliability show excellent values for superior JSN, femoral head deformity and the summary score. The radiologic assessment of medial JSN, osteophytes and acetabular sklerosis depends on the level of the investigator's experience. Perifoveal osteophytes and subchondral cysts do not seem to be have sufficient reproducibility. The results of our investigation show, that a reliable radiological classification of the severity of hip osteoarthritis is possible by assessment of certain individual radiographic features or a summary grade.

Adult↗
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[Arthrosis].

Explore the source record for details and available documents.

Humans↗
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[Standardization of roentgen diagnosis in coxarthrosis and gonarthrosis in clinical studies. Recommendations of the 1st Working Circle of the DGOT (Connective Tissue Research and Arthrosis Deformans)].

AIM OF STUDY: Recommendations of standardized radiographic assessment in clinical and epidemiological studies on patients with hip and knee osteoarthritis. METHODS: Survey of published studies and results of consensus conferences regarding reproducibility of radiographic assessment and standardization procedures. CLINICAL RELEVANCE: With the proposed guidelines a standardized and reproducible radiographic assessment of patients with hip and ankle osteoarthritis in clinical and epidemiological studies is possible. The recommended procedures can be supplemented by additional techniques.

Cross-Sectional Studies↗
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[Reproducibility of radiologic diagnosis in gonarthrosis].

AIM OF STUDY: Ongoing efforts of the "German Society of Orthopaedic Surgery and Traumatology" (DGOT) to standardize diagnosis and therapy of osteoarthritis, necessitated this study, where the reproducibility of different radiographic features of knee-OA was assessed. METHODS: Three readers graded 100 antero-posterior and lateral knee radiographs for selected features (femorotibial osteophytes, joint space narrowing, sclerosis and chondrocalcinosis; patellofemoral osteophytes) and an overall-score (Kellgren and Lawrence, 1963) at two time points 3 months apart. Intra- and inter-observer-reliability were calculated by intra-class correlation-coefficient (ICC). RESULTS: Osteophytes in the femorotibial as well as in the patellofemoral joint could be assessed with a high intra- and inter-observer-reliability. While for joint space narrowing intra-observer-reliability is excellent, the inter-observer-reliability is less satisfactory, and subchondral sclerosis as well as chondrocalcinosis showed even less reproducibility. The Kellgren-Lawrence global score proofed to be highly reproducible. CONCLUSION: Based on the results of this examination, we can recommend a reliable radiographic classification of knee osteoarthritis by grading of relevant individual features (osteophytes and joint space narrowing) and overall assessment.

Follow-Up Studies↗
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[Do calcium and zinc ions influence matrix molecule synthesis of chondrocytes?].

The experiments described here tested the effect of various calcium (Ca) and Zinc (Zn) concentrations on cell proliferation and matrix molecule synthesis of fetal and adult bovine chondrocytes in monolayer cultures. Levels of Ca < 0.2 mM in a culture medium or the addition of Zn (0.1-50 microM) selectively promoted the production of collagen but did not affect significantly synthesis of proteoglycans. No change in proliferation of fetal and adult chondrocytes could be observed. In contrast 10 mM Ca promoted the hypertrophic differentiation of chondrocytes (e.g. expression of collagen type X). The results are related to calcium channel configurations in chondrocytes in the discussion.

Animals↗
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[Femoral anteversion: significance of clinical methods and imaging techniques in the diagnosis in children and adolescents].

In order to investigate the correlation between different methods of AV-determination and to assess their reliability, we compared the results of clinical and sonographic examination with computed tomography and magnetic resonance imaging in 21 children (41 hips) preoperatively. The mean anteversion angles obtained by computed tomography (34.0 degrees +/- 13.7 degrees) appeared larger than the clinical (27.7 degrees +/- 8.5 degrees), sonographic (25.6 degrees +/- 8.0 degrees) and MRI-values (23.2 degrees +/- 12.8 degrees), which can be explained by the different measurement techniques. The inter-rater as well as intra-rater reliability was high in MRI (Pearson's correlation coefficient r = 0.97 and r = 0.97) and CT (r = 0.99 and r = 0.96) but slightly less in sonography (r = 0.88 and r = 0.88) and clinical investigation (r = 0.47 and r = 0.77). For routine use in screening of femoral anteversion clinical and sonographic methods are sufficiently accurate. But in determining the exact amount of torsion preoperatively and in planning of rotation osteotomies in children MRI and CT determination are superior. As magnetic resonance imaging requires no radiation dosage, shows non-ossified cartilaginous structures and proved its high reliability, it could replace other techniques in the future for that purpose.

Adolescent↗
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[Fluorescence spectroscopy in selective percutaneous nucleotomy using the excimer laser--experimental studies].

Our intention was to test fluorescence spectroscopy as a possibility for selective laser ablation. In an experimental setup a XeCl excimer laser (308 nm) with pulse energies between 5 and 50 mJ was used for fluorescence excitation in 20 human and 100 pig vertebral segments. Tissue fluorescence was detected via a quartz fiber bundle and analyzed by a polychromator and optical multichannel analyzer. Both low and high energy levels led to a broad band fluorescence of nucleus pulposus, intervertebral muscle, spinal cord and vertebral end plate and a typical fluorescence of anulus fibrosus with peak maxima at 385 and 435 nm. Tissue fluorescence was independent of surrounding medium (with air and normal saline used) and excitation energy. Borderlines between different tissues could be clearly indicated in all cases. Using intensity rations at 350, 385 and 435 nm (I1 = I350/I385, I2 = I385/I435) tissue discrimination was possible in all cases. This results demonstrate, that discrimination between intervertebral disc and surrounding tissue is possible and could be used for selective percutaneous laser nucleotomy in the near future.

Animals↗