Biomedical subjects
Publications and source records attributed to W Rauschning.
The CT appearance of the pterygopalatine fossa is described in detail. Anatomic and CT sections were compared in cadavers and patients in axial and coronal CT planes to identify the osseous configuration and vascular and neural contents of the fossa. The normal fat, soft-tissue, and osseous margins are altered by neoplasms in the fossa. CT is an effective technique to evaluate the fossa and contiguous area.
In rabbits, repeated passive forcible exercising of immobilized hip, knee, ankle, or elbow joints produced muscle necrosis within a few days. Within two to five weeks, heterotopic cartilage and bone formation occurred in the soft tissues around the joint and in the area of damaged muscle. The changes were morphologically and radiographically similar to those observed in human myositis ossificans. The incidence of these changes was correlated with the duration of immobilization and the frequency of manipulation. Ossification occurred especially in muscle attachments to bone. Denervation, administration of diazepam, or narcosis during manipulation did not prevent the development of heterotopic bone. Treatment by passive manipulation, immobilization, crushing the muscles, or repeated injections of autogenous blood into the muscles did not induce significant calcification. Heterotopic bone formed as a consequence of repeated forcible distention of previously immobilized soft tissues.
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Thirty popliteal cysts, classified on the basis of clinical arthrographic findings as 12 idiopathic and 18 symptomatic lesions, were examined by light and scanning microscopy. The histopathology varied considerably and did not allow a valid distinction between the two types of cysts. Nevertheless, careful histopathologic examination of surgically removed popliteal cysts is advisable for exclusion of malignancy and for consideration of the presenting symptom as part of an inflammatory arthritic disorder.
The authors describe the results obtained in fifteen athletes suffering from recurrent monolateral subluxation of the patella by a new technique which should represent a considerable improvement over existing methods, both in surgical and rehabilitation phases. The treatment consists of: a) a surgical stage comprising extensive lateral mobilisation by section of the lateral capsule and the external alar ligament, extensive manual detachment of the vastus lateralis muscle, and osteotomy performed obliquely to the frontal plane with antero-medial transposition of the tibial tuberosity to realign the extensor apparatus; b) a post-operative stage characterised by immediate mobilisation of the knee without the application of a plaster cast. The aim of this method is to eliminate above all the instability caused by recurrent subluxation of the patella, to cancel out any abnormal stress exerted on the femoral condyle by the patella, to normalize the extensor apparatus, to bring about the regression of any incipient chondromalacic lesions, and to prevent femoro-patellar arthrosis by restoring the anatomical and functional equilibrium of the femoro-patellar joint. The clinical and radiographic results determined by follow up examinations performed between one year and two and a half years after the operation were so satisfactory that the authors extended the method to recurrent subluxations in non-athletes.
Oblique resection of the lateral end of the clavicle and transfer of the coracoacromial ligament into the medullary cavity of the clavicle according to Weaver and Dunn had been performed in 12 fresh and 5 old type 3 separations of the AC-joint. At follow-up 1--5 years after the operation all patients had stable and painless shoulders. Heavy work and competitive sports had been resumed. The functional and cosmetic results were excellent. Stress radiographs showed good alignment and stability. The muscle strength, recorded with an isokinetic technique, was normal in the shoulder and slightly lowered in the elbow.
Large cryosections (up to 45 x 15 cm) have been made from an entire rat or hamster or from a large human organ such as a cross section of a leg obtained from amputation operations. The quality of the sections was found to be sufficient for a histochemical and a X-ray microanalytical characterization of individual cells in the tissues of interest. When histochemical stainings were applied on sections from a human leg, different muscle groups were analysed simultaneously for pathological changes and at the same time bone tissue, nerves and blood vessels could be investigated. It was possible to study pathological changes in relation to histochemical muscle fibre type and describe the dispersion of changes within a certain muscle. Analytical scanning electron microscopy (X-ray microanalysis) was useful for the description of the elemental composition of different organs on longitudinal sections of small animals and of different muscle fibres in the leg cross sections. The X-ray emission could be related to histochemical muscle fibre type and other parameters such as the degree of fibre atrophy.
Efficient irrigation during arthroscopy mainly depends on the patency of the outflow cannula. By inserting the cannula into the posteromedial recess of the knee joint good drainage is obtained.
The clinical symptoms and signs of 16 patients presenting with swelling and tenderness of the calf indicative of deep venous thrombosis are reported. Phlebography disclosed no venous obstruction in any case. Arthrography revealed dissecting or ruptured popliteal cysts in all patients. The differential diagnosis and the underlying disorders of the knee joint are discussed.
The anatomy and function of the opening between the knee joint cavity and gastrocnemio-semimembranosus bursa was studied in 120 necropsy specimens of knee joints both by conventional knife dissection and by a newly modified technique of serial cryosectioning of undecalcified joints frozen at various angles of flexion. The communication invariably took the shape of a transverse slit separating the capsule from the undersurface of the gastrocnemius tendon. On flexion it opened as the pull from the semimembranosus tendon and the medial meniscus widened the gap. On extension the communication was closed by compression by the overlying tendons. A functional closing action was invariably demonstrated, whereas no unidirectional valve mechanism was found.
Forty-one patients with popliteal cysts were examined radiographically. All cysts consisted of a dilated gastrocnemio-semimembranosus bursa. A valve mechanism at the site of their communication with the joint was demonstrated by a specific radiographic technique in the majority of cases. The radiographic findings in popliteal cyst ruptures simulating deep venous thrombosis are described.
In 15 adult patients, undergoing surgery for symptomatic popliteal cysts of fairly long duration, the communication into the joint was closed by two different procedures: In the early series, Series A (8 patients), the opening was tightly sutured, and in Series B (7 patients) a new type of capsuloplasty was performed, using a proximally based flap from the gastrocnemius tendon for additional reinforcement. One minor postoperative complication occurred in Series A, whereas all patients in Series B made an uneventful recovery. The results were assessed clinically and arthrographically almost 2 years postoperatively. All patients were relieved of their popliteal symptoms. In Series A three clinically asymptomatic recurrences were found at arthrography. No recurrence occurred in Series B (the capsuloplasty series). A modified postero-medial approach facilitated access to the communication. Postoperative immobilization for 3 weeks promotes uneventful healing of the capsular repair. The importance of meticulous closure of the gap is emphasized, whereas radical excision of the cyst does not seem essential for the therapeutic result.
A young patient with tetraplegia resulting from an unstable and irreducible fracture dislocation of the lower cervical spine unexpectedly died from an intercurrent gastrointestinal hemorrhage. Following routine autopsy the whole, intact cervical spine was frozen in situ, tomographed in the lateral projection and sectioned through on a heavy duty cryomicrotome with use of a newly modified technique. Detailed analysis of 50 sections revealed, among other things, that a fragment from the lacerated intervertebral disc had become impinged between the body of a vertebra and the spinal cord constituting the hindrance to reduction. No obstacle to reduction was seen at the level of the facet joints.
Forty-one knee joints presenting with significant popliteal cysts were examined clinically and arthrographically. The fluid was aspirated from the cysts and replaced by contrast medium of low viscosity. On knee flexion the contrast fluid spontaneously passed over into the joint in 16 cases (no valve mechanism), in 7 small amounts of fluid were forced into the joint when the cysts were manually compressed, and in 18 no fluid passage to the joint was observed on manipulation (valve mechanism). When a valvular action was established, effusion in the joint was rare and the fluid from the cyst was usually viscous. The cysts with a valvular connection were significantly larger than those without a valve mechanism.
In a previous investigation of 41 patients presenting with distended popliteal cysts, a valvular mechanism was demonstrated in 25 cases by means of a specific arthrographic procedure. In the present study the clinical symptoms and signs from the popliteal space and from the joint were assessed and related to the presence or absence of a valvular mechanism. By arthroscopy or arthrotomy seventeen associated knee disorders were diagnosed, e.g., synovitis, osteoarthritis, and tears of a semilunar cartilage. Intraarticular symptoms and intrinsic joint diseases were significantly correlated to the absence of a valve mechanism. The presence of a valve mechanism was indicative of the absence of pathological findings in the joint.
Forty patients were re-examined between 6 months and 15 years (mean 4 years) after excision of a popliteal cyst. Forty-six operations had been performed, including one bilateral cyst and five recurrent cysts. The history was reviewed with respect to the preoperative symptoms, clinical and roentgenological signs, the operative and histopathological findings and the postoperative course. Fifteen operations were followed by wound healing complications or tense swelling of the calf simulating deep venous thrombosis. At clinical follow-up a reccurent cyst was found in 63 per cent of the knees. A simplified follow-up arthrography was performed in all knees, and revealed a cyst-like cavity in all but one knee. The majority of the recurrent cysts displayed irregularities of the wall that had not been seen in the preoperative arthrograms. Despite this high rate of recurrence most of the patients had fewer symptoms from the popliteal space at the time of follow-up than before the operation. as associated knee disorders were present in the majority of patients, popliteal cysts (Baker's cysts) should be regarded and, if possible, treated as secondary to the basic pathological condition of the joint. Only if the knee disorder is not curable and if the symptoms from the popliteal region are troublesome should excision of the cyst and tight closure of the communication with the joint be considered.
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To increase our understanding of the complex topographic relations between temporal bone structures and to facilitate the interpretation of their radiographic images, two techniques were developed. Plastic moulding of temporal bone specimens using polyester resin and silicone rubber substances providing detailed information and a three-dimensional survey of the structures. Carefully macerated temporal bone specimens are filled with plastic material under vacuum and the bone is then dissolved. The preparations, freed from irrelevant structures and embellished, allow metric evaluation of the different structures and their topographic relations. Automatic serial cryomicrotomy of fresh, deep-frozen temporal bones, using a commercial sledge-cryomicrotome. Photography of the cut surfaces of the specimen, usually at distance of 0.25 to 0.50 mm, allows natural-colour reproduction of minute detail, e.g. the melanin cell area in the cochlea, the smallest vessels on the ossicular surfaces, and the origin of the cochlear aqueduct at the basal turn of the cochlea. By correlating the photographs with images from the corresponding tomographic planes accurate information is obtained for interpretation of the radiographic images. A combination of the two techniques facilitates a detailed study and is a valuable aid in the teaching of temporal bone anatomy.