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Biomedical subjects

A Rüter

Publications and source records attributed to A Rüter.

At least 37 records · Page 2Linked to original sources
PubMed2000

Spinal cord injury without radiographic abnormalities in children and adolescents: case report of a severe cervical spine lesion and review of literature.

The biomechanics of the child's and juvenile's spine is responsible for the commonly encountered closed spinal trauma with significant neurological injury but without bony or ligament injury (particularly of the cervical spine). The ligamentous laxity and hypermobility of the young bony cervical and thoracic spine predispose to spinal cord injury without radiographic abnormalities. We report a 16-year-old girl with typical features of this type of injury after a "flic-flac" sports injury. We conclude that children and adolescents who have neurological deficits without positive radiographic findings require appropriate diagnostic screening, monitoring, and often a prolonged therapy. The sometimes changing neurological deficits should never be ignored or dismissed as psychogenic affection.

Adolescent↗
PubMed2000

The unreamed tibia nail. Multicenter study of the AO/ASIF. Osteosynthesefragen/Association for the Study of Internal Fixation.

In the last 10 years, traumatologists have become more aware of the importance of blood supply to fracture fragments for both the healing of fractures and prevention of infection. Due to our experience with fractures having severely disrupted periosteal blood supply, we are looking more critically at intramedullary reamed nailing as a treatment option. This research was a result of our increased knowledge of the interplay between periosteal and endosteal blood supply.

Adolescent↗
PubMed2000

[Does low intensity, pulsed ultrasound speed healing of scaphoid fractures?].

Since pulsed low-intensity ultrasound (frequency: 1.5 MHz, pulsed by 1 kHz, signal burst width: 200 microseconds, intensity: 30 mW/cm2) has been proven to stimulate fracture healing both clinically and experimentally, our question was whether this therapy also accelerates healing of fresh stable scaphoid fractures. Addressing this question, we did the following prospective randomized clinical trial. Regarding the results of former clinical fresh fracture studies by Heckman and Kristiansen, we postulated that low intensity ultrasound accelerates healing by about 30%. Based on this thesis, we calculated that 30 patients divided into two groups would be necessary to show significant differences between the standard treatment (treated by casting) and an adjunctive ultrasound treatment (treated by casting and additional daily 20 minutes ultrasound treatment) if present. Diagnosis and healing was assessed by CT scans every two weeks. CT's were analyzed by two independent radiologists and one hand surgeon. Furthermore, areas of cancellous bone bridging in correlation to the diameter of the scaphoid was measured in each CT scan. The results showed ultrasounded fractures healing in 43.2 +/- 10.9 days versus 62 +/- 19.2 days in the control group (p < 0.01). Trabecular bridging six weeks after injury showed 81.2% +/- 10.4% healed in the ultrasound-stimulated fractures versus 54.6% +/- 29% in the control (p < 0.05). Our study results confirm those of Heckman and Kristiansen and show a similar acceleration of bone healing. Low intensity ultrasound is successful in accelerating the healing of fresh scaphoid fractures.

Adult↗
PubMed1999

[Dislocation of the elbow joint--therapy and treatment outcome].

At our hospital, closed dislocations of the elbow without neurovascular or osseous lesion are treated conservatively after successful reduction in the absence of a tendency to redislocation. Indications for surgery are irreducible dislocations and those with a tendency to redislocation as well as open soft tissue injuries, neurovascular and osseous concomitant injuries. During a period of 10 years 113 patients were treated according to this strategy. Of these patients, 46 had simple dislocations of the elbow and 67 suffered from dislocations with osseous lesions. In 95 patients follow-ups could be performed after a mean period of 55 months. In more than 75% of cases good or excellent functional results were documented; unfavourable results were seen only in patients with osseous lesions. Nearly all of the patients had a stable elbow joint at the end of therapy.

Adolescent↗
PubMed1999

[Pseudarthrosis].

Understanding the pathophysiology of non-union is a prerequisite for successful treatment of this disorder. Fracture healing may be impeded by mechanical or biological factors as well as a combination of these. A thorough evaluation of each individual case before surgery is necessary to prevent either undertreatment or overtreatment. The whole spectrum of methods of internal fixation may be utilized for stabilization. To optimize the biological component, classic methods such as decortication and cancellous autograft may be employed. It is too early yet to determine if alternative techniques (e.g. ultrasound) will successfully replace these long-standing options. In any case, these newer modalities cannot supplant the need for skeletal stabilization. For infected pseudarthroses the first step is eradication of infection, after which measures can be taken to unite the fracture. Callus distraction has opened new and safe ways to treat large bone defects.

Biomechanical Phenomena↗
PubMed1999

[Ultrasound therapy for nonunions. Three case reports].

Despite of the good results of operative treatment disorders of fracture healing are still a challenge for surgeons. In some cases all endeavours are frustrating and bone does not heal. Low intensity pulsed ultrasound (frequency: 1.5 MHz, pulsed by 1 KHz, signal burst width: 200 musec, intensity: 30 mW/cm2) offers the opportunity of an alternative treatment. In contrast to magnetic field therapy, electric stimulation or use of extracorporal shock waves this therapy is judged positively all over the literature. Within an own series of 76 cases at present time we can show a 86% healing rate under defined conditions. Within this paper we present three case reports, which clearly show the efficiency of low intensity pulsed ultrasound.

Female↗
PubMed1999

[Treatment of acromioclavicular joint separations. Central Kirschner- wire and PDS-augmentation].

Beside the basic question wether a separation of the acromioclavicular joint should be treated operatively or not, the method of operation is discussed in particular. For that reason we investigated our own method of a temporary transfixation of the joint by a centrally drilled K-wire combined with a PDS-augmentation of the coracoclavicular and a suture of the acromioclavicular ligament. Follow up examinations were possible in 57 out of 82 patients which were operated during 5 years. Patients subjective rating and objective follow up and sonographically evaluated joint conditions were scored together. Looking for the range of motion of the shoulder only 5.5% of the patients had a reduction of more than 20 degrees. Out of 12 complications in particular three infections only resulted satisfying by influencing the subjective rating negatively. In 28.1% of patients no durable anatomic reconstruction of the joint was achieved. Score achieved by these patients was significantly lower compared to those with a lasting anatomic reconstruction of the acromioclavicular joint. In conclusion the results confirm our operative regime for separations of the acromioclavicular joint. In literature survey the here described method of operation belongs to the better ones without showing a clear advantage. Nevertheless the method should be modified to decrease the rate of subluxations.

Acromioclavicular Joint↗
PubMed1999

[Late results after fracture of the femoral head].

The dislocation fracture of the femoral head is the result of high speed trauma. Most of the patients have additional injuries. The prognosis of this kind of fracture of the femoral head depends on the type of fracture, the additional injuries and the age of the patients. The diagnosis and the specific treatment are most important, since most of the patients with this injury are of a younger age. The reposition of the fracture has to be performed within 6 hours. In our opinion, this should be done by surgery if possible. For the operation some routine pelvic X-rays and a CT of the pelvis should be prepared. The therapy depends on the type of fracture. In patients with Type I and II fractures the broken head fragments should be refixed by only taking out small parts of bone which are not elementary for the pressure zone of the femoral head. Younger patients with Type III fractures should always receive the possibility of a screw fixation of the neck of femur, whereas total hip replacement should generally be achieved in the older patient. An exact reconstruction of the dorsal acetabulum must be performed in Pipkin Type IV fractures. The usual approach for Type I-III fractures is the ventrolateral Smith-Peterson and lateral Watson-Jones, for Type IV fractures, the dorsal Kocher-Langenbeck approach. We suggest indometacine as a prophylaxis for ossifications due to high tissue damage. Several scores for the evaluation and documentation of the outcome of this kind of fracture are useful: the clinical results according to Merle d'Aubigne, social status scored by the Karnofsky Index and X-ray results using Brooker and Helfet to classify the heterotopic ossification and post traumatic joint changes.

Adolescent↗
PubMed1998

[Traumatologic emergency in the shock department. Analysis of the spectrum and temporal aspects of diagnostic imaging].

UNLABELLED: With a prospective assessment of 140 emergency-room patients, we registered the conventional radiological examinations (CR), ultrasound (US) and computer tomographies (CT), including the duration of the examinations, transportation and diagnostic free time. RESULTS: CR: 98.6% (average 8.5 radiographs per patient), US 78.6%, CT 67.8%. DURATION: CR average 20.3 min (range 1-80 min), US average 6.5 min (range 2-15 min), CT average 16.9 min (range 12-135 min). The entire time spent in the primary diagnostic work-up, including CT: average 79.4 min (only CR and US average 49.1 min). Diagnostic free time, including CT: average 31.9 min, without CT average 19.2 min. Time for transportation and repositioning: average 14.5 min. When a CT is indicated, the radiological diagnostic work-up will increase as a result of waiting and transportation. The patient also suffers because of more repositioning procedures.

Adolescent↗
PubMed1998

Value of serum thyroglobulin measurement in patients operating on for well differentiated thyroid carcinoma.

OBJECTIVE: To study the clinical relevance of measurements of serum thyroglobulin in patients undergoing total thyroidectomy for well differentiated thyroid cancer. DESIGN: Prospective study. SETTING: University hospital, Sweden. SUBJECTS: 194 patients operated on for well differentiated thyroid cancer from 1 January 1978 to 31 December 1992. INTERVENTIONS: All patients underwent total thyroidectomy by a standard technique, and were prospectively followed up at regular intervals by clinical examination and measurement of the serum thyroglobulin concentration. RESULTS: Six patients whose thyroglobulin concentrations after operation were low or undetectable had gradual increases leading to detection of recurrences that could be treated successfully. Six patients had gradual increases without detectable recurrences. In 12 patients thyroglobulin concentrations remained high after operation with no signs of thyroid tissue remaining, which we interpreted as persistence of the disease. No recurrence was found without an appreciable rise in the thyroglobulin concentration. Thyroglobulin antibodies were found in 81 (42%). CONCLUSION: Measurement of the serum thyroglobulin concentration is a valuable addition to the follow up of patients operated on for highly differentiated thyroid cancer. In many cases it is the first sign of recurrent disease, thereby facilitating early and successful treatment.

Adenocarcinoma, Follicular↗
PubMed1997

[Reconstruction of complex acetabular fractures using the extensile kocher-langenbeck approach (modified maryland approach).].

GOAL OF SURGERY: Approach to the essential bony parts of the pelvis which can be adapted to the fracture pattern and which causes minimal soft tissue damage. It allows exposure of the posterior and anterior columns and the roof of the acetabulum. INDICATIONS: Complex acetabular fractures such as 2-column fractures, T-fractures, displaced transverse fractures with posterior rim fragment, fractures of 1 column. CONTRAINDICATIONS: Fractures which can be approached through smaller incisions, preexisting lesions of the superior gluteal artery, arterial occlusive diseases, particularly of the pelvis. PREOPERATIVE WORK UP: Radiographs of the pelvis in anterior-posterior and two oblique news. Special radiographs and CT. POSITIONING AND ANAESTHESIA: Lateral decubitus with free draping of the leg. Endotracheal anaesthesia. Cell saver optional. SURGICAL TECHNIQUE: T-shaped skin incision and gradual extension of the Kocher-Langenbeck approach depending on the fracture pattern. First extensile step: Transverse division of the fascia lata and osteotomy of the greater trochanter. Second extensile step: Osteotomy of part of the iliac crest and exposure of the outer and inner cortex of the iliac wing. POSTOPERATIVE MANAGEMENT: Operated leg rests in a foam padded splint. Careful wound drainage, routine low dose radiation or indomethacin to prevent heterotopic ossification. CPM starting the 2nd postoperative day, mobilization starting the 2nd or 3rd day with partial weight bearing of 15 kg. Full weight bearing depends on fracture type and consolidation. POSSIBLE COMPLICATIONS: Delayed wound healing with risk of infection. Injury to the superior gluteal artery with danger of necrosis of the abductor muscles. Injury through stretching of the sciatic nerve. Injury of the lateral femorocutaneous nerve. RESULTS: Seven patients with complex acetabular fractures were operated between June 1993 and January 1994. Use of the 1st extensile step was sufficient in 3 patients and 3 times all 4 steps were used. Postoperative necrosis of fatty tissue necessitated 2 revisions. All fractures consolidated. During the follow-up examination 1 case of heterotopic ossification was seen (Brooker grade II). Using the classification of Merle D'Aubigné we had 1 excellent, very good, 2 good and 1 satisfactory result.

English Abstract↗
PubMed1997

[The Chopart dislocation. A frequently underestimated injury and its sequelae. A clinical study].

During a 7-year period (between July 1987 and June 1994) 19 patients were treated for Chopart dislocation. Seventeen patients were examined clinically 48 months following trauma. We found 1 excellent, 6 good, 6 mediocre, and 4 poor results. Only 4 patients were able to achieve their pre-accident level of work and no patients could return to sports at the same level. In our patients, Chopart dislocation had a negative social consequence both at the work place and in recreational activities. In long-term follow-up, the Chopart dislocation was the most debilitating injury even for polytrauma patients.

Adult↗
PubMed1997

Significance of corrective growth of opposite physes in the surgical correction of deformity following epiphyseal injury around the knee joint.

Deformation due to growth disturbance after epiphyseal fractures around the knee may involve more than the primarily injured epiphysis, as spontaneous corrective growth of the opposite epiphyseal plate can take place in an attempt to maintain overall alignment of the leg. As a result, there will be an inclination in the knee joint line if corrective osteotomy is only performed for the primary angulation. We report two cases of this complex deformity in which corrective osteotomies of both the distal femur and the proximal tibia were performed, resulting in correct alignment of the overall leg axis and knee joint axis.

Adolescent↗
PubMed1997

Tall-cell variant of papillary thyroid cancer: disregarded entity?

The tall-cell variant of papillary thyroid carcinoma (TCV) has been described as an aggressive tumor with a significantly higher incidence of recurrence and mortality than other forms of papillary carcinoma. In some series it has accounted for up to 10%, whereas in other series it has not been reported at all, indicating that there are difficulties identifying it. In a series of 162 consecutively treated patients with papillary thyroid carcinoma treated by total thyroidectomy according to a highly standardized procedure, all specimens were specifically examined by an international group of pathologists to establish the occurrence of TCV. All patients with TCV were studied with regard to local aggressiveness, the presence of metastases, iodine uptake, DNA pattern, thyroglobulin production, treatment (surgical and adjuvant), and outcome (follow-up 3-17 years, median 10 years). At primary histopathologic evaluation by the local pathologist, three patients were recorded as having TCV. At special evaluation by the expert group, eight more cases were found, giving a total of 11 patients in this series (7%). Five of them had extracapsular growth, and four were multifocal. Three had metastases at the time of admission. Seven tumors were diploid, one tetraploid, and three aneuploid. Of the three patients with primary distant metastases two died (8 and 24 months after operation), and one is still alive after 10 years. Four other patients developed recurrences, one of whom died from cardiac failure, but the others have so far been treated successfully. Two of these recurrences had no radioiodine uptake, and one had no rise in thyroglobulin concentrations; the other two had rising values that correlated with recurrence. The other four patients are alive without recurrence. It was concluded that identification of the TCV requires examination by an experienced pathologist. Moreover, it may have a higher incidence than is generally recognized. No reliable criteria for prognostic classification were identified. The results suggest that early identification and active treatment can lead to an outcome more favorable than has previously been described.

Aged↗