Biomedical subjects

B Landsleitner

Publications and source records attributed to B Landsleitner.

At least 19 recordsLinked to original sources

PubMed2001

[Is mini-screw osteosynthesis a suitable procedure in surgical treatment of intra-articular distal phalanx fractures?].

In a retrospective clinical study, the results of operative treatment of intraarticular fractures of the distal phalanx were studied. From February 1992 to December 1998, 75 patients were treated operatively, 47 were examined. 14 patients were treated with Lengemann wire and temporary transfixation of the DIP joint, 25 patients were treated with screw fixation and in eight patients another procedure (wire suture, Kirschner wire, "Hakendraht", combination of screw and wire) was used. All patients had little or no pain. All patients had no or only little limitation in activities of daily living. Two patients after screw fixation had serious limitations. Four patients after Lengemann wire fixation had an extension lag in the DIP joint of up to 10 degrees, four patients between 11 and 20 degrees and one patient 25 degrees. 19 patients after screw fixation had an extension lag of the DIP joint of up to 10 degrees, five patients between 11 and 20 degrees and one patient of 25 degrees. Arthrosis of the DIP joint was seen in five patients after Lengemann wire fixation and in two patients after screw fixation. Screw fixation in the treatment of intraarticular fractures of the distal phalanx is a good, but demanding procedure with the potential for exact reconstruction of the joint surface, since implant removal is not necessary.

Bone Screws↗

PubMed2001

[Experiences with the STT (scapho-trapezio-trapezoid) arthrodesis. A retrospective evaluation].

From 1992 until 1998, 98 fusions of the scapho-trapezio-trapezoid joint on 97 patients were performed in our clinic. The indications were dissociation of the scapho-lunate joint (n = 32), necrosis of the lunate stage III/IV (Lichtman classification) (n = 39), and idiopathic arthrosis of the scapho-trapezio-trapezoid joint (n = 27). 87 patients with 88 procedures were reviewed after an average follow-up period of three years. The review included a clinical examination with determination of a traditional wrist-score and a DASH questionnaire, X-rays of the wrist and CT of the carpal bones. The results in the wristscore were on average 74 of maximal 100 points. The DASH-score was on average 29. The best results were in the group with arthrosis of the scapho-trapezio-trapezoid joint. The results in the groups with scapho-lunate dissociation and necrosis of the lunate were also good. The rate of non-union was within an acceptable level with 7.7%. In the examined group, five patients underwent fusion of the wrist for persisting pain after scapho-trapezio-trapezoid arthrodesis. The examination of the radiological investigations in the reviewed group demonstrated, that CT shows arthritic degeneration in patients where the conventional X-ray does not. In conclusion, scapho-trapezio-trapezoid arthrodesis is a valid therapeutic method in the above mentioned indications. However, the question how early arthritic degeneration will affect long-term results remains unanswered for the moment.

Adolescent↗

PubMed2000

[Patient-oriented anesthesia] .

Goals of this study were to quantify patients' preferences for anaesthesia care and to identify what they know about various tasks of an anaesthetist. On the day before surgery, 122 patients scheduled for elective procedures were interviewed using a structured questionnaire. A reliable pain relieve and unawareness as well as stable vital functions have priority in patients' preferences. Patients are also concerned with good postoperative pain relieve and the avoidance of nausea and vomiting. Not important are short preoperative soberness, rapid awakening and initial wide awakeness. Not informed about typical tasks of an anaesthetist are 28-51% of the patients. In order to obtain maximum patient satisfaction, a thorough education plus further continuous training are the essential items for a patient orientated health care management in anaesthesia, along with good medical and technical equipment. The wide spectrum of tasks of an anaesthetist must be better represented in order to strengthen the position of anaesthesia in the competition for rare resources. A postoperative visit, which is judged of 77% of the patients as important, offers a beginning.

Adult↗

PubMed2000

Awareness during laryngoscopy and intubation: quantitating incidence following induction of balanced anesthesia with etomidate and cisatracurium as detected with the isolated forearm technique.

STUDY OBJECTIVE: To measure the incidence of awareness during induction of anesthesia with etomidate and fentanyl, and to model its frequency as a function of dose of etomidate. DESIGN: Prospective cohort study. SETTING: Anesthesia department of a university hospital. PATIENTS: 30 ASA physical status I, II, and III patients undergoing elective general surgery. INTERVENTIONS: Patients were assigned to one of three groups of etomidate (0.2 mg/kg, 0.3 mg/kg, 0.4 mg/kg) and received fentanyl (2 microg/kg) and 2 x ED(95) of cisatracurium (0.1 mg/kg). Neuromuscular block was monitored with a peripheral nerve stimulator. Intubation was performed after maximum T(1)-depression. To identify awareness, the isolated forearm technique (IFT) was used. The IFT was performed by prompting the patient every 20 seconds. Only a verified response was considered a positive IFT response. Anesthesia was maintained with isoflurane in oxygen/air and fentanyl. MEASUREMENTS AND MAIN RESULTS: Maximum neuromuscular block occurred after 352 +/- 96 seconds and intubation was performed 424 +/- 86 seconds after loss of consciousness (LOC). Awareness was dose dependent: 80% of patients receiving 0.2 mg/kg etomidate, 70% of patients receiving 0.3 mg/kg etomidate, and 20% of patients receiving 0.4 mg/kg etomidate had a positive IFT response. Awareness occurred in one patient 3 minutes after LOC, in 65% during laryngoscopy, and in 30% within the following 120 seconds. One patient had explicit recall without finding awareness unpleasant. Hemodynamic parameters did not differ between patients with a positive or a negative IFT response. CONCLUSIONS: The incidence of awareness during bolus induction can be modeled as dose dependent. However, when combining a short-acting induction drug and a delayed-onset neuromuscular blocker, the continuous infusion of the hypnotic drug may prevent awareness during induction.

Adult↗

PubMed2000

[Non-traumatically-induced paralysis of the ramus profundus nervi radialis. Aspects of a rare disease picture].

Both radial tunnel syndrome and posterior interosseous nerve compression syndrome are caused by compression of the posterior interosseous nerve. Posterior interosseous nerve (PIN) compression syndrome is a rare condition--less than 10 percent of our cases of PIN-compression showed signs of palsy--and must be differentiated from tendinous lesions. From 1992 to 1997, we decompressed the PIN using an anterior approach in nine cases because of palsy without a history of trauma. Only one patient was lost to follow-up. Our study indicates that the results of operative decompression of the PIN depend on the time interval between first symptoms of palsy and operation. On the other hand, some cases of posterior interosseous nerve compression syndrome show spontaneous recovery. We recommend operative decompression of the PIN if incomplete palsy worsens or if complete palsy persists for more than 12 weeks.

Adult↗

PubMed2000

[Fractures near the base of the first metacarpal bone--clinical outcome of 21 patients].

Fractures of the base of the first metacarpal are particularly common. The present examination was carried out in order to find out a correlation between the clinical outcome and the type of the fracture, the quality of reduction, the surgical procedure, and the extent of osteoarthrosis. From February 1992 to August 1997, 24 patients with Bennett fracture-dislocation, Rolando fracture und extraarticular fracture--eight patients in each group--were treated operatively. After a median interval of 33 months, 21 patients were reviewed. The evaluation was done using a new score with subjective (pain and utility) and objective (strength and range of motion) parameters. The "DASH score" was also used. Excellent results were found in the intra- and the extraarticular fractures. The extent of palmar abduction was 98% and 86% of the contralateral side in Bennett and Rolando fractures, 90% in extraarticular fractures. Key pinch was 93%, 77%, and 90% of the contralateral side (Bennett, Rolando and extraarticular fractures). This means 97, 85, and 87 points in the new score and 100, 93, and 85 points in the DASH score. The results after intraarticular fractures did not correlate with the type of treatment. Osteoarthrosis was found to correlate with the quality of reduction of the fracture, but remained asymptomatic. Intraarticular fractures have no worse prognosis. Nevertheless, exact reduction, either by the open or closed method, should be the aim of treatment.

Adolescent↗

PubMed1999

[Treatment outcome after surgical arthrodesis].

Different results are reported following total wrist fusion. We performed 64 total wrist fusions due to posttraumatic or degenerative arthrosis of the wrist including Kienböck's disease. Clinical outcome was evaluated using the DASH-questionnaire. The mean DASH-function/symptom score was 45.6 points (0 points representing the best possible results and 100 points representing the worst possible result). In addition, 35 patients of this group were reexamined clinically and radiologically using a modified traditional wrist score. The preliminary results of the traditional wrist score and the DASH-score demonstrated a significant correlation (r = -0.71; p < 0.001) indicating the validity of the DASH-score. In conclusion, this study shows that wrist fusion results in significant pain reduction and improvement of function. However, complete pain relief cannot be expected for the majority of patients. The new AO wrist fusion plate is used in our standard technique of wrist fusion. In a further study, we will investigate the outcome of total wrist fusion in comparison with limited wrist fusion using the DASH-questionnaire and the wrist score.

Adult↗

PubMed1999

[Compression syndrome of the radial nerve in the area of the supinator groove. Experiences with 110 patients].

Both radial tunnel syndrome and posterior interosseous nerve (PIN) compression syndrome are caused by compression of the posterior interosseous nerve. There is a controversy about certain features of PIN compression especially with regard to diagnostic criteria and therapy as well as differentiation from tennis elbow. From 1992 to 1997, we operated 110 patients because of PIN compression. Diagnosis was based on clinical examination only. As a rule, we decompressed the PIN directly using an anterior approach. With regard to radial tunnel syndrome, we could review 69 from 103 operations with an average follow-up of 41 months. Using the criteria originally proposed by Roles and Maudsley, only 60% showed excellent or good results. The mean DASH score was 32. Recompression of the PIN by scarring was found in as much as 17% of patients and proved to be a serious complication of direct decompression of the PIN. Furthermore, 52% of our patients operated on because of PIN compression suffered from tennis elbow as well. We therefore believe that radial tunnel syndrome is a specific form of tennis elbow. From an anatomical point of view, the inseparable origin of the radial wrist extensors and supinator muscle seems to link tennis elbow and radial tunnel syndrome. To avoid recompression of the PIN by scarring, we have abandoned direct decompression and now routinely use Wilhelm's denervation procedure for the treatment of tennis elbow as well as radial tunnel syndrome. This procedure indirectly decompresses the PIN by cutting the superficial origin of the supinator muscle with consecutive relaxation of Frohse's arcade. Preliminary results are promising and show improvement of preoperative neurologic status by indirect decompression.

Adolescent↗

PubMed1998

[Graner operation in therapy of semilunar bone necrosis. Review of the literature and personal results].

Intercarpal arthrodesis with interposition of the capitate osteotomized in Graner's technique is performed in the treatment of stage III Kienböck's disease. Although clinical results are satisfactory, there are complications such as necrosis of the capitate, pseudarthrosis of the capitate, and arthrosis of the radiocarpal joint. From 1992 to 1995, twenty patients were treated for Kienböck's disease by Graner's technique in the Clinic of Hand Surgery II in Bad Neustadt/Saale. Seventeen patients were submitted to follow-up studies. The range of motion (extension/flexion) of the wrist was 55 degree. The grip strength was 67% of the other hand. Four patients continued to complain of pain. Necrosis of the capitate was found in four cases, pseudarthrosis in two cases, and arthrosis of the radiocarpal joint in five cases. Based on the poor X-ray results found in this review, the authors feels there is no indication for Graner's technique. They favor STT arthrodesis in stage III of Kienböck's disease.

Adult↗

PubMed1997

[Causes for reoperations after osteosyntheses of finger and mid-hand fractures].

31 patients reoperated after osteosynthesis of a metacarpal or a phalangeal fracture were reviewed over a period of three years. The cause of injury was in 18 cases a crush, in six cases a fall, in five cases a saw injury, and in two cases axial trauma. A postoperative plaster splint immobilisation over a period of at least three weeks was carried out in 29 cases. Reoperation was necessary in most of the cases because of a loss of range of motion and a nonunion. The complication rate was independent of the method of fixation, but did depend on the type of injury. Fractures associated with soft tissue injury were more likely to develop complications.

Finger Injuries↗

PubMed1992

[Measuring microcirculation after replantation and revascularization].

Eighty-four patients were evaluated following replantation or revascularization. Extremity function in daily and professional life was altogether satisfactory. Microcirculation investigations in eight patients included thermography, laser-doppler-flowmetry and photoplethysmography. The rewarming period and postocclusive hyperemia after standardized cooling of the upper extremity were determined. In areas of hypesthesia, the rewarming period was clearly delayed. In addition, reactive hyperemia after occlusion of circulation was significantly reduced.

Amputation, Traumatic↗

PubMed1991

[A new method of transosseous pull-out wire fixation in ligamentous injuries of the metacarpophalangeal joint of the thumb].

Surgical repair is usually indicated for rupture of the ulnar collateral ligament of the MP-joint of the thumb. The pull-out wire technique is commonly used for repair of typically distal ligamentous ruptures or avulsion fractures at the base of the proximal phalanx. The method's disadvantages include skin or soft tissue necrosis beneath the button on the radial side of the thumb. When postoperative swelling subsides, the formerly taught wire loosens and so does the repair. Because of this inherent danger, a special steel sleeve which is drawn over the wire on the radial side of the thumb until bone contact is made was developed. Thus, a strong and unyielding fixation of the ulnar collateral ligament repair or avulsed bone chip is certain. The follow-up for 41 patients treated by this technical modification is presented; there were no complications, including wound infections.

Bone Wires↗

PubMed1990

[The etiology of ulnar nerve compression syndrome].

A retrospective investigation of the etiology of 132 patients with peripheral ulnar nerve compression was performed. Mainly there was external long-term pressure or compressive lesions near the nerve and disturbances of the osseous structures at the elbow and the wrist.

Female↗

PubMed1990

[Monitoring of an acute compartment syndrome of unusual etiology using MRI (magnetic resonance tomography) and MRS (magnetic resonance spectroscopy)].

The authors report on an acute compartment syndrome occurring symmetrically in the extensors of both forearms. The etiology of this unique compartment syndrome, not previously described, could be attributed to the inhalation of a propane-butane gas mixture, low in oxygen, while sleeping, in combination with external compression of both forearms, due to the patient's head lying on both forearms while sleeping. Ischemic damage to muscles was precisely located using non-invasive MRI (Magnetic Resonance Imaging). The extent of cellular damage due to ischemia after fasciotomy and healing by secondary intention was quantitatively assessed using non-invasive 31P-MRS (Phosphorus Magnetic Resonance Spectroscopy). The results correlate with the clinical and histological findings and indicate a bioenergetic regeneration of the ischemic skeletal muscle's cells.

Adult↗

PubMed1989

[Rupture of the palmar plate--conservative or surgical therapy].

Disruptions of the palmar plate are frequently overlooked injuries. As the palmar plate stabilises the PIP joint in combination with the collateral ligaments untreated injuries may result in severe complaints. Detailed anatomical and functional knowledge is therefore necessary to diagnose the degree of injury. In addition to ligamentous disruption osseous chips may occur and can be divided into four degrees (Hintringer 1987). By the study of results of 178 cases specific treatment has been established. Surgical intervention is indicated in the presence of an unstable PIP joint, subluxation or osseous chips grade 3 and 4 (Hintringer). The aim should be a painfree and stable joint. Small limitations in movement can be tolerated.

Adult↗

PubMed1984

[Apert syndrome--case report].

The Apert syndrome is a complex deformity. Blauth distinguishes three degrees of deformity in the hand; these are demonstrated in our patients. The functional results after operative treatment were satisfying.

Acrocephalosyndactylia↗

PubMed1984

[Epidermolysis bullosa hereditaria].

Two cases of epidermolysis bullosa hereditaria are presented. Their operative treatment is described. Distant flaps are necessary to bring resistant skin to the mechanically stressed areas of the hand. Specific after-care is essential to preserve the operative result.

Child↗

PubMed1983

[Fibromuscular dysplastic aneurysm of the palm and microsurgical therapy].

Until now fibromuscular dysplasia has only been described in centrally located arteries. We found this disease in the arteries of the palm. Because of the progressive course and the increasing pain the disease had to be treated surgically. After the necessary resection of the fibromuscular dysplastic aneurysm the vessel system of the palm can only be reconstructed by microsurgical interposition of a vein graft.

Adult↗