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Biomedical subjects

B Greitemann

Publications and source records attributed to B Greitemann.

At least 19 recordsLinked to original sources
PubMed2006

[Long-term efficiency of orthopedic rehabilitation in chronic back pain--the integrative orthopedic psychosomatic concept (IopKo)].

UNLABELLED: Chronic diseases of the musculoskeletal system rank first as causes of early retirement in Germany. Therefore orthopaedic rehabilitation has to identify patients with work-related problems and to promote return to work through differential treatment and vocational counselling. In the framework of the IopKo-Project such measures were developed and evaluated. These measures encompass: (1) an intensive and multiprofessional diagnostic pathway which allows early detection and treatment of mental disorders and job related problems; (2) homogeneous treatment groups based on multiprofessional diagnostics; (3) differential treatments, among these a multidisciplinary programme for patients with chronic low back pain or high risk of chronification (Rückenfit); (4) interactive training modules which mediate principles of performance and disability expertise, the legal bases of retirement pensioning, and measures to support occupational rehabilitation; and (5) a work hardening training programme. METHOD: To evaluate the effects of these measures in comparison to a control group with usual care, a prospective longitudinal study was conducted. A total of 307 patients were assigned to the multidisciplinary in-patient treatment programme, whereas 176 patients in the control group had a standard rehabilitation programme. RESULTS: The results show positive moderate and strong effects in the intervention group concerning function, pain, psychic strains as well as the number of sick days and return to work rates 10 months after discharge. The effects in the intervention group exceeded the effects achieved in the control group. PATIENTS WITH HIGH RISK OF CHRONIFICATION: Beside the full sample, a subgroup of patients with chronic pain or high risk of chronification was analyzed, who had received a multidisciplinary functional restoration treatment. Also for this subgroup we found moderate and strong effects of treatment for function, psychic strains and sick days superior to those in the control group. CONCLUSION: By this study we were able to show that orthopedic rehabilitation in a multimodal and multidisciplinary setting with a focus on activating and motivating therapy can have sustainable positive effects on pain, function and psychic well-being as well as on economic parameters. We interpret these persistent and superior effects in the treatment group (1) as a result of multiprofessional diagnosis and assignment which helps to subdivide the inhomogeneous group of patients with unspecific back pain into more homogeneous and thus more effective subgroups, (2) as a result of increased motivation by closed treatment groups, (3) as a result of intense and multilevel counselling of work related problems, (4) as a result of work hardening modules, and (5) as a result of direct and efficient treatment of psychic strains. The results also demonstrate the significance of inpatient rehabilitation, which will be efficient if differential treatment - adequate to the problems of the patient - is offered.

Adult↗
PubMed2005

[Occupational orientation in medical rehabilitation and measures for participation in the professional life].

Return-to-work and protection of work-related participation is stated as a primary objective of rehabilitation by the statutory pension insurance institutes. A general continuous management of work-related participation in rehabilitation is a prerequisite for optimal results in view of stay in work and return to work. This means an extended vocational orientation in medical rehabilitation, individualized occupational rehabilitation according to need and capacity in connection with closer linkages between medical and occupational rehabilitation. In the course of the "Rehabilitation Sciences" research funding programme and beyond it, quite a few research projects and scientific activities aimed at development, testing and evaluation of -new screenings and diagnostic instruments with better findings of vocational related needs in medical and occupational rehabilitation, -specific methods of therapy and models for treatment settings with immediate reference to the work related restriction and capacity, as well as -models of the organization and forms of cooperation between medical and occupational rehabilitation. This paper reviews the projects and findings in these research fields in relation to the requirements for an increase of general continuous vocational orientation in rehabilitation.

Biomedical Research↗
PubMed2001

[Gender-specific aspects in chronic low back pain rehabilitation].

Gender-specific Aspects in Chronic Low Back Pain Rehabilitation. Little is known about gender differences in utilisation, outcomes and evaluation of orthopaedic rehabilitation for chronic low back pain. The purpose of this article is to review and analyse the literature on rehabilitation and recovery of men and women with chronic back pain. In Western societies, chronic back pain is one of the most common causes for utilising medical rehabilitation services. In general no significant gender differences in the prevalences of back pain are found, but men are more sick-listed and early retired due to musculoskeletal diseases. Also, more men than women participate in medical rehabilitation programmes. National and international studies pinpoint the fact that differences exist between women and men with regard to participating in an orthopaedic rehabilitation programme. Additionally there is some evidence that different physical and psychological therapy services have different effects on health status of women and men. Mixed results are available regarding gender differences concerning the outcomes of rehabilitation programmes. Rehabilitation activities after discharge from in-patient programmes and these being performed within the home setting are primary indicators of recovery. Gender differences have been identified regarding various types of activities, apparently because especially family roles interfere with activity. Further research must be conducted so as to increase the understanding of women's and men's experiences relative to orthopaedic diseases and orthopaedic rehabilitation services.

Adult↗
PubMed2001

["Zest for life instead of strain of illness" - implementation and evaluation of a programme activating chronic back pain patients in a rehabilitation clinic].

"Zest for Life Instead of Strain of Illness" - Implementation and Evaluation of a Programme Activating Chronic Back Pain Patients in a Rehabilitation Clinic.A group training was developed for chronic back pain patients in a rehabilitation clinic to enhance coping, to activate internal and external resources, and to make transfer to everyday life easier. The training consists of 12 either physiotherapeutic or psychologically oriented sessions. The training was evaluated in a longitudinal, quasi-experimental control-group design. Patients of the intervention group (n = 144) and control group (n = 157) rated the usefulness of the rehabilitation for private and working life at the end of the in-patient phase (t1) and three month later (t2). They also evaluated selected elements of the rehabilitation (t2). Results show that the anticipated usefulness of the rehabilitation was rated higher at the end of the stay than three months later. This indicates frustration after returning to everyday life. Patients of the intervention group rated the transfer possibilities to working life higher than the control group. They also are more satisfied with the psychological parts of the rehabilitation. After minor revisions, such as strengthening the topic of employment, the training now is implemented in the clinic for all patients with chronic back pain.

Adaptation, Psychological↗
PubMed1995

Long term results of uncemented Judet hip endoprostheses.

We reviewed 94 patients in whom 113 Judet uncemented total hip endoprostheses had been inserted; 83 had a mean follow up of 10.8 years (range 6 to 13 years). The Merle dAubigne and Harris hip scores were used for clinical evaluation. In the long term follow up, severe or moderate pain was present in 38.6% of hips. Radiographs were studied and radiolucent lines, and other evidence of loosening, were recorded. Twenty hips (24.1%) showed radiological signs of loosening of the acetabular cup and a displacement of more than 5 mm in 37.3%. The loosening rate of femoral stems was 32.5%, but only 8.4% showed subsidence. The cumulative survival rate at 6 years was 84.1%, decreasing to 55.1% after the eleventh year. Complications and other aspects of the outcome are discussed. Our results were on the whole not satisfactory and we cannot recommend this type of uncemented endoprosthesis for routine total hip replacement.

Adult↗
PubMed1995

[The diabetic foot].

Foot disease in patients with diabetes mellitus is multifactorial and results from a combination of peripheral neuropathy, vascular compromise and superimposed infection. Foot complications in diabetic patients are common and account for more hospital days than any other aspects of their disease. Therefore, familiarity with the spectrum of findings in the different imaging modalities appears essential. Radiographically, significant changes include Charcot joints of the tarsus (destructive type) and bone absorption of the forefoot (mutilating type). In diabetic foot problems, magnetic resonance imaging and leukocyte scintigraphy appear to be the most effective tools for detection of osteomyelitis, and a negative study makes osteomyelitis unlikely. However, the findings of both techniques in active, noninfected neuropathic osteoarthropathy may be indistinguishable from those of osteomyelitis.

Arthropathy, Neurogenic↗
PubMed1994

[Amputation in geriatric patients].

The incidence of amputation rises dramatically in old age. Trauma and tumors are uncommon reasons in this age group, however; 90% of amputations in such patients are performed for occlusive disease. These patients are distinguished from all other amputees by their multiple morbidity, which must be borne in mind at all stages, from the decision to operate to rehabilitation. This paper briefly indicates the points that are important for an optimal result of rehabilitation, starting with selection of the amputation level and extending through to provision of the prosthesis and mobilization. The paper ends with a presentation and discussion of the results of rehabilitation in 90 patients aged over 70.

Aged↗
PubMed1993

Treatment of congenital elevation of the scapula. 10 (2-18) year follow-up of 37 cases of Sprengel's deformity.

We studied retrospectively and partially prospectively all 37 cases of Sprengel's disease who were treated between 1970 and 1990, 23 of whom were operated on. Many of the patients were severely handicapped by abnormal shoulder abduction and elevation. Neurological deficits were not found. 34 of our cases had other congenital malformations. Several operative techniques were used. In cases with only cosmetic problems we now prefer resection of part of the superior angle. In cases with impaired function we prefer the Woodward-procedure.

Adolescent↗
PubMed1992

White blood cell scintigraphy with monoclonal antibodies in the study of the infected endoprosthesis.

Forty-three patients with suspected infection of a hip or a knee prosthesis were studied with white blood cell scintigraphy (WBC), using technetium-99m (n = 37) or iodine-123 (n = 6) labelled monoclonal mouse antibody (MoAb). Previously, all patients had undergone skeletal scintigraphy, which was performed as a three-phase study in 33 cases. The final diagnosis was established by open surgery, histology and culture in 37 cases, by puncture and culture in 3 cases, and by clinical follow-up of at least 6 months in 3 cases. Eighteen prostheses were infected, 25 uninfected. The delayed phase of skeletal scintigraphy had a sensitivity of 92%, a specificity of 24% and an accuracy of 48% in the detection of infection. The perfusion and blood pool activity of the three-phase bone scan had a sensitivity of 67%, a specificity of 71% and an accuracy of 70%. The diagnostic value of WBC was sensitivity 89%, specificity 84% and accuracy 86%. WBC with 99m-Tc-MoAb is easy to perform and always available. Its diagnostic accuracy is similar to conventional WBC scintigraphy with either indium-111 or technetium-99m.

Adult↗
PubMed1992

Inflammatory reactions in primary osteoarthritis of the hip and total hip prosthesis loosening.

In 14 patients [9 with loosened total hip arthroplasty (THA), 5 with primary osteoarthritis], the inflammatory cell infiltrate was characterized in cryostat tissue sections using antibodies against subsets of macrophages and lymphocytes. In all patients the abundance of a mature type macrophage (25F9+) was observed, whereas 27E10+ macrophages, characteristic of acute inflammatory reactions, were not seen in primary osteoarthritis but were found in 4 out of 9 patients with THA loosening. The RM3/1 + macrophage phenotype was seen in some of both sets of patients (osteoarthritis 4/5; THA loosening 4/9). The markers MRP8 and MRP14 typical of immature macrophages, were found in all patients with osteoarthritis and in some (4/9 and 8/9 respectively) of those with THA loosening. IOT4+ T-helper cells were only present in 1/5 5 patients with osteoarthritis and in 2/9 patients with THA loosening. IOT8+ T-suppressor lymphocytes were more frequently present (in 4/5 and 5/9 respectively). The data reveal remarkable differences between the two groups of patients. While the inflammatory infiltrate in patients with osteoarthritis lacks the characteristics of acute inflammation, in patients THA loosening the inflammatory process seems to be determined by periods of acute reactions. The occasional presence particularly of T-helper cells suggests that the inflammatory process is less T-cell but rather macrophage-driven.

CD4-CD8 Ratio↗
PubMedDate not supplied

[Ambulatory diagnosis and therapy of gonarthrosis].

AIM OF STUDY: To develop recommendations for appropriate diagnostic procedures and conservative treatment of knee osteoarthritis in outpatients. MATERIAL AND METHODS: Following a consensus conference and expert reviews basic recommendations were developed. RESULTS: While standardized radiographic assessment is mandatory, MRI investigation should be restricted to problems apart from osteoarthritis. Indications for physical therapy, bracing and pharmaco-treatment depend on the severity of the disease. Guidelines for intraarticular injections are presented. CONCLUSION: Effective treatment of knee osteoarthritis must be based on available recommendations and guidelines.

Ambulatory Care↗
PubMedDate not supplied

[Multidisciplinary orthopedic rehabilitation program in patients with chronic back pain and need for changing job situation -- long-term effects of a multimodal, multidisciplinary program with activation and job development].

BACKGROUND: According to a recent review by Hüppe and Raspe effects of multidisciplinary treatment programs for patients with chronic low back pain in Germany seem to be rather weak and not to have persisting effects. Factors which could counteract possible benefits of treatment are, among others, psychic and job-related stresses and strains persisting after treatment. A multidisciplinary, in-patient treatment program for patients with chronic low back pain, therefore, was amended by multidisciplinary diagnosis and assignment and measures to support vocational solutions. METHOD: To evaluate the effects of the multidisciplinary program in comparison to a control group with the usual care, a prospective longitudinal study was conducted. 307 patients were assigned to the multidisciplinary in-patient treatment program, whereas 176 patients with comparable complaints had the standard rehabilitation program. Besides the full sample, we analyzed a subgroup of patients with chronic low back pain. RESULTS: We found positive moderate and strong effects in the intervention group concerning function, pain, psychic strains as well as the number of sick days and return to work rates 10 months after discharge. Effects in the intervention group exceeded the effects achieved in the control group. Beside the full sample, we analyzed a subgroup of patients with chronic low back pain, who received an intense activating group treatment. Also in this subgroup we found moderate and strong effects of treatment superior to those in the control group for function, psychic strains and sick days. CONCLUSION: We attribute these persisting and superior effects in the treatment group to an efficient treatment of occupational and psychic problems as well as to more homogeneous treatment groups attained by a multidisciplinary diagnosis and team-based assignment. They also show the significance of in-patient-treatment which is effective, when -- based on multidisciplinary diagnosis -- differential treatment groups can be formed.

Back Pain↗
PubMedDate not supplied

[Asymmetry of posture and truncal musculature following unilateral arm amputation--a clinical, electromyographic, posture analytical and photogrammetric study].

Unilateral upper limb amputation causes changes in statics of the spine. As a result asymmetrical posture of the spine, muscular asymmetries follow. In this study a population of upper limb amputees (above and below elbow amputees) is examined by clinical, electromyographical analysis and gait analysis. Upper limb amputations cause in correlation to weight loss a shift of the trunk to the side of the amputation, a scoliosis with a bowing to the side of the amputation, an elevation of the shoulder on the amputation side and a torsion of the trunk. Muscular asymmetries result from loss of function (muscles of the arm, M. latissimus, M. trapezius) and by shifting of the center of gravity. In order to get the center of gravity over the legs, the amputee compensates the loss of weight by shifting the upper trunk to the side of the amputation. As a result the shift of the segmental center of gravity at the lumber height to the side of the normal arm with muscular asymmetry in the erector trunci lumbalis results. As well we saw an overactivity of musculus glutaeus medius and resulting stress of the amputation sided hip joint. There was a remarkable difference between above and below elbow amputees caused by differences in weight loss. Muscular and static asymmetries in amputees who lost their arm only a short period before could be reduced by compensating the weight loss. Results for technical orthopaedic fitting and stress on gymnastic procedures to compensate these statistical problems are discussed.

Adult↗
PubMedDate not supplied

[Special case report: Gangrene of all 4 extremities caused by disseminated intravascular coagulation in pneumococcal sepsis].

The rare case of a child with gangrene of all extremities following intravascular coagulation in pneumococcus septicaemia is described. The two years old spanish girl showed a gangrene of all four extremities and accompanying celloid scars. The operative treatment, the orthopaedic technical fitting as well as the problems are discussed.

Amputation, Surgical↗
PubMedDate not supplied

[Charcot's elbow joint in syringomyelia].

Neuropathic arthropathy is a rare case in daily orthopedic practice. The case of a 43 year old technician is reported, who developed severe destruction of both elbow joints as a result of syringomyelia. The diagnostical problems as well as the therapeutical considerations are discussed.

Adult↗
PubMedDate not supplied

[Technical surgical possibilities for preserving an end-bearing knee exarticulation stump in skin necrosis].

Disarticulation of the knee results in an excellent end-bearing stump. Operative technique is easy, fast and gentle. The muscular balance in the femur is not disturbed. The shape of the stump provides excellent rotation control in the prosthesis. New socket designs and prosthetic knee mechanisms have eliminated the former cosmetic problems concerning this amputation level. Nevertheless--because of external rotation of the femur, poor skin quality or wound closure under tension skin necrosis can occur, most of the times concerning the lateral condyle region. Several operative possibilities to get a satisfactory wound closure while preserving the advantages of this stump are presented.

Artificial Limbs↗