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Biomedical subjects

B Romanus

Publications and source records attributed to B Romanus.

At least 19 recordsLinked to original sources
PubMed2000

Congenital pseudarthrosis of the tibia: history, etiology, classification, and epidemiologic data.

Congenital pseudarthrosis of the tibia is a rare disease with a variable history. The pseudarthrosis is usually not present at birth (and therefore is not truly congenital) but occurs during the first decade of life. Paget in 1891 was the first to describe a case. The etiology is unknown. Neurofibromatosis plays a role in approximately 50% of patients. In the others, hereditary and mechanical factors are debated. Various (morphologic) classification systems have been proposed (Andersen, Boyd, Crawford). Because the appearance changes during the course of the disease, all classification systems have limited value: the determining factor is the stage of the disease at which it was classified. Because of the rarity of the disease and the variability of its history, the European Pediatric Orthopaedic Society decided to carry out a multicenter study on this disease. This paper presents the epidemiologic data on the patients involved. Data have been gathered on 340 patients from 13 countries. Two hundred patients were male (58.8%), 140 were female (41.2%). The right side was affected in 165 patients (48.5%) and the left side in 172 (50.6%); 3 patients had bilateral disease. Symptoms of neurofibromatosis were present in 54.7%. Histologic examinations in 192 patients showed a nonspecific appearance in 45.3%; in 15.6% the ultrastructure resembled fibrous dysplasia, and in 39% there was histologic evidence of neurofibromatosis. Most of the lesions were initially localized in the middle or distal third of the tibia. In 29% the localization changed during the course of the disease.

Child↗
PubMed2000

The fibula in congenital pseudoarthrosis of the tibia: the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

Fibular involvement in congenital pseudoarthrosis of the tibia (CPT) can be either a rare isolated pathology or is in association with the tibial changes. Out of 282 patients with CPT who had complete radiographic work-up, 62% (almost two thirds) demonstrated fibular pathology: 36% had true fibular pseudoarthrosis and the rest, i.e., 26% had fibular hypoplasia or dysplastic fibula. Neurofibromatosis was found in 62% of the patients with fibular pathology. The typical radiological features of tibial pseudoarthrosis are often missing in patients with fibular pathology. It is most probably because fibular changes precede the tibial involvement. In 250 patients with tibial surgical treatment, the highest rate of fusion occurred in patients with fibular involvement compared with those with normal fibula.

Child↗
PubMed2000

Treatment approaches for congenital pseudarthrosis of tibia: results of the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

This study was designed to analyze the different therapeutic methods used by European Paediatric Orthopaedic Society members from 13 countries for congenital pseudarthrosis of tibia. The treatment data of 340 patients who underwent 1287 procedures for this condition were analyzed. The essential findings were that the method of choice needed to approach the biological problem with the aims of: (1) resecting the pseudarthrosis to provide stability, the basic requirement for bony consolidation; (2) correcting length discrepancy and axial deformity; (3) achieving fusion; and (4) solving the additional problems around the main deformity such as alignment, leg length discrepancy and ankle valgus. The Ilizarov technique emerged as being the optimal method, having the highest rate of fusion (75.5%) of pseudarthrosis and rate of success in correction of the additional deformities. There was also consensus that surgery should be avoided before the third year of life.

Adolescent↗
PubMed2000

Free vascular fibular transfer in congenital pseudoarthrosis of the tibia: results of the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

This paper presents a review of the literature, describes the principal author's (B.R.) personal experience and provides the results of the European Paediatric Orthopaedic Society (EPOS) multicenter study. The objective is to evaluate the present status and future role of free vascular fibular transfer in treating congenital pseudoarthrosis of the tibia. Variables such as the selection of cases, age at operation, technical surgical details and postoperative results will be considered. The data on the EPOS study were incomplete at the time of writing, but the considerable amount of information already amassed is a valuable contribution to this updated report.

Child↗
PubMed2000

Functional results at the end of skeletal growth in 30 patients affected by congenital pseudoarthrosis of the tibia.

From a multicentric study on Congenital Pseudoarthrosis of the tibia (CPT) conducted on 340 patients, we evaluated the functional results on a group of thirty patients who were at the end of skeletal growth (age < or = 16 years). The prognosis of CPT is very much related to the radiologic classification. Crawford type 2 and Crawford type 4 pseudoarthrosis have a worse prognosis, with a lower percentage of fusion at the site of pseudoarthrosis. Crawford 4 patients have the worst functional results. Most of them showed a severe leg length discrepancy, needed a permanent brace, with an ankle joint function fair or poor. The presence of fibula pseudoarthrosis seems to be responsible for most of the worst functional results. The level of deformity caused by either the natural course of the disease or its treatment, is decisive in the evaluation of the functional results.

Adolescent↗
PubMed1997

Does a single device prevent further slipping of the epiphysis in children with slipped capital femoral epiphysis?

All 170 patients (212 hips) treated between 1946 and 1992 for slipped capital femoral epiphysis (SCFE) with fixation in situ with a single device were reviewed to evaluate the incidence of further slipping of the epiphysis after primary treatment. In 154 hips, a smooth device without anchorage in the epiphysis was used and in 58, a device anchored in the epiphysis. In 3 hips, further slipping of the epiphysis occurred after primary treatment with no obvious cause. In 10 hips, an obvious cause for further slipping of the epiphysis was found. These 10 hips were re-operated due to the loss of epiphyseal grip in 6 hips, unsatisfactory placement of the device in 1, while in the remaining 3 hips, the device was removed before physeal closure. Twenty-six hips (12.3%) were re-operated because the device had lost its epiphyseal grip before physeal closure, and in 25 of these hips the device was smooth and had no anchorage in the epiphysis. The conclusion of this study is that a single device with anchorage in the epiphysis is stable enough to prevent further slipping of the epiphysis in hips with SCFE.

Adolescent↗
PubMed1996

Foot pathology and risk factors for diabetic foot disease in elderly men.

We examined 3 groups of elderly men; men with diabetes and previous or present foot ulcers, men with diabetes, and men without diabetes. In the foot diseased group, diabetes duration was longer (18 +/- 11 vs 8 +/- 7 years), insulin treatment was more common (86% vs 7%), fasting blood glucose and HbA1c were significantly higher (10.5 +/- 4.0 mmol/1, 8.4% +/- 1.6%) than in the diabetic control group (8.3 +/- 3.4 mmol/l, 7.4 +/- 1.7%). Men in the foot diseased group were taller than men in the diabetic group and non-diabetic men (1.79 vs 1.74 m) but not more obese (BMI 26-27 kg/m2 in all three groups). Current or previous alcoholic problems were more common in the foot diseased group (32%) compared to the control diabetic group (9%) and the non-diabetic group (10%). Diabetic patients with known foot disease had more often callosities, absent hair growth, dry skin and redness, compared to the other groups. Psychosocial problems (alcohol and divorce), long standing diabetes duration and poor metabolic control seem to be of importance for the development of diabetic foot ulcers.

Aged↗
PubMed1996

Long-term clinical and radiological results of the Lord total hip prosthesis. A prospective study.

We enrolled 98 patients (107 hips) with a mean age of 47 years (SD 8.6) into a prospective study of the Madreporic Lord THR; 34 hips had primary and 73 secondary osteoarthritis. After ten years, the survival rate using revision as the endpoint for failure was 70% (+/-9) for the cup and 98% (+/-0.3) for the stem. The combined clinical and radiological survival rates were 46% (+/-11) and 81% (+/-10), respectively. Osteoporosis due to stress-shielding was observed in the proximal femur. Hips with radiologically dense bone postoperatively showed the most pronounced bone loss. We recommend continued radiological follow-up of patients with this type of implant to allow revision to be performed before there is severe bony destruction of the pelvis.

Acetabulum↗
PubMed1993

A qualitative and quantitative study of retrieved femoral heads in three different types of resurface hip arthroplasties.

Tissue reactions and percentage of mineralized bone in three different types of retrieved femoral head hip resurface prostheses were studied in undecalcified ground sections without removing the metal. All of the prostheses demonstrated soft tissue between the cement-implant and bone. There were some areas without soft tissue between bone and cement. This bone was often not normally stained, indicating a disturbed mineralization. The soft tissue layer in the cemented prostheses was observed in different stages of necrosis, while the uncemented prostheses demonstrated a thick collagen membrane. One of the cemented groups demonstrated a gradual decrease of mineralized bone towards the cement. The uncemented implants revealed normal bone qualitatively and quantitatively when the bone bordering the prosthesis was excluded. Too high interfacial stresses were probably a major failure mechanism, especially in the rapidly failed noncemented prostheses. Negative long-term effects of the cement on the bone may have contributed to failure in the cemented resurface arthroplasties.

Adult↗
PubMed1991

A comparison of quality of life before and after arthroplasty in patients who had arthrosis of the hip joint.

Quality of life before and one year after total hip arthroplasty was evaluated in fifty-six patients who had arthrosis of the hip joint. There were twenty-one men and thirty-five women, and the median age was sixty-five years (range, thirty to seventy-nine years). Before and after total hip arthroplasty, a functional assessment was done with the Charnley-Merle d'Aubigné scoring system. The patients assessed quality of life using the Nottingham Health Profile. In the comparison of quality of life before and after the arthroplasty, significant improvement was observed regarding pain (p less than 0.0001), energy (p less than 0.0001), sleep (p less than 0.0001), and social isolation (p = 0.001). Similarly, there was a significant reduction in the frequency of health-related problems pertaining to housework (p less than 0.0001), holidays (p less than 0.0001), hobbies (p = 0.0001), social life (p less than 0.0001), sexual function (p = 0.001), and family life (p = 0.0005), and among patients who were sixty-five years old or less and who worked at paid employment (p = 0.04). Quality of life after total hip arthroplasty was in close agreement with that of a healthy reference group of similar age and sex distribution. It was concluded that quality of life after total hip arthroplasty is improved considerably. The Nottingham Health Profile is a valuable tool in the evaluation of the result of, as well as the indicators for, total hip arthroplasty.

Activities of Daily Living↗
PubMed1988

Pitfalls of early diagnosis and treatment of congenital dislocation of the hip joint.

The efficiency of the routines for early diagnosis and treatment of congenital dislocation of the hip joint (CDH) practiced in the 1960s in the city of Göteborg were reviewed. Between 1961 and 1970 there were 65,875 live births in Göteborg. Eighty-five percent of the estimated number of cases of CDH were diagnosed during the first month of life. Of the children "missed" at the primary screening on the maternity wards, 75% (15/20) were premature babies and/or had been delivered during weekends. In all, 475 newborn children were judged to have unstable hips (dislocated or dislocatable hips), corresponding to an incidence of 7.2 per thousand live births. In 19 children, abduction treatment with braces commenced during the first 10 days of life failed to prevent dislocation. Eighteen of these children were treated primarily with a Frejka pillow and one with a von Rosen splint. A history of CDH among relatives was obtained in 47% of these 19 children including four of five children who had developed pathological hips after supplementary treatment with a hip spica cast and/or surgery. Radiological examination at the age of 1-4 months was helpful in revealing failure of early abduction treatment to prevent dislocation, which in most cases was difficult to detect by clinical examination at this early age.

Female↗
PubMed1988

Self-assessed disability in patients with arthrosis of the hip joint. Reliability of the Swedish version of the Nottingham Health Profile.

The study aimed to describe self-assessed disability, using the Nottingham Health Profile (NHP), in patients with arthrosis of the hip joint, to test the reliability of the Swedish version of the NHP, and to compare disability perceived by the patient with the Charnley/d'Aubignet score. The NHP was administered twice to 73 patients, waiting for total hip replacement. Pain, energy, sleep, and mobility were severely affected. The correlations between subjective and objective scores were, apart from pain, moderate. The two test administrations correlated highly. In conclusion, the NHP is a reliable instrument, which may provide valuable supplementary information in the assessment of disability.

Activities of Daily Living↗
PubMed1986

Lowering of the patella secondary to anterior advancement of the tibial tubercle for the patellofemoral pain syndrome.

From a series of 72 patients treated with anterior advancement of the tibial tubercle for patellofemoral pain syndrome, secondary lowering of the patella was noted in eight. In all eight patients the results were poor following surgery, with severe disabling retro- and peripatellar pain and atrophy of the quadriceps muscle. We describe this complication and illustrate and discuss the biomechanical consequences. The shortening of the patellar ligament and lever arm of the ligament were determined from radiographs of the knee joints before and after surgery. A theoretical analysis was made of the compressive force in the patellofemoral joint in one of these patients. The Insall-Salvati index decreased from 0.88-1.25 (mean 1.07) preoperatively to 0.54-0.78 (mean 0.70) at follow-up, 1.0-2.5 years post-operatively. The lowering of the patella was correlated to a reduction of the lever arm of the patellar ligament in seven patients. The mechanism behind the lowering of the patella is obscure, but the reduced lever arm of the patellar ligament will increase the compressive force in the patellofemoral joint, and this might be one explanation of the poor results. Impaired congruity of the patellofemoral joint, increased tension in the patellar ligament, and increased pressure against the quadriceps tendon are other possible explanations.

Adult↗
PubMed1986

Accessory soleus muscle. A clinical and radiographic presentation of eleven cases.

When an accessory soleus muscle is present, it consists of a soft-tissue mass bulging medially between the distal part of the tibia and the Achilles tendon. It usually inserts with a separate tendon on the calcaneus anteromedial to the Achilles insertion, and may be a cause of pain on exercise. One may suspect a soft-tissue tumor, such as lipoma, hemangioma, and even sarcoma, but the anomalous muscle has a typical appearance on plain radiographs, and the appearance on computed tomography is diagnostic. If the patient is asymptomatic, no therapy is required, but if pain or other discomfort is provoked by exercise, exploration with fasciotomy or excision of the accessory muscle is recommended, as was done in six of our eleven patients who were seen between 1968 and 1985.

Adolescent↗
PubMed1985

Morphological and biochemical effects of sodium morrhuate on tendons.

The purpose of this study was to determine some of the morphological and biochemical effects of sodium morrhuate injections into intact rabbit patellar tendons and Achilles tendons. The effects of one, three, and five 100 microliters injections of sodium morrhuate on tendon circumference, cell content, collagen fibril diameter, collagen-proteoglycan relationships, water content, amino sugar content, and hydroxyproline content were investigated over periods of 1, 4, and 9 weeks. In general, sodium morrhuate injected tendons were larger in diameter and contained more cells, smaller collagen fibrils, increased water and amino sugar content, and reduced hydroxyproline content compared with their contralateral controls. As a sclerosing agent, sodium morrhuate appears to mimic the early stages of an injury-repair sequence when injected directly into intact tendons. Whether sodium morrhuate may hasten repair responses or improve joint laxity remains to be determined.

Achilles Tendon↗
PubMed1983

Surface replacement arthroplasty of the hip. Experience with the ICLH method.

Fifty-six ICLH-surface replacement arthroplasties of the hip were followed up prospectively for 1 to 6 years postoperatively, mean 2.5 years. Fifty-one hips had osteoarthritis and five rheumatoid arthritis. Pain, motion, walking ability, and function were considerably improved after surgery. It is our impression that the clinical results were equal to those obtained by conventional stemmed hip arthroplasties. Complications were recorded in nine hips, with femoral neck fracture in two, loosening of both components in two, and loosening of the acetabular component in five. Three of the failures occurred in the five hips with rheumatoid arthritis. The high failure rate is disturbing, and we now limit the indications for this procedure to patients with osteoarthritis, 40-60 years of age, and with good bone stock.

Adult↗