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Biomedical subjects

C Carstens

Publications and source records attributed to C Carstens.

At least 19 recordsLinked to original sources
PubMed1992

[Myelomeningocele--what can be done? Aids for evaluating rehabilitation from the orthopedic viewpoint].

Shortly before or shortly after the delivery of a child suffering from congenital paraplegia (myelomeningocele or spina bifida) the obstetrician is obliged to give advice as to what will follow after neurosurgical closure of the cele and shunting of the hydrocephalus. The parents' understanding of therapy and integration of the patient is developed to assess and utilise the future chances of the disabled child. Integration of children with congenital paraplegia is performed by an interdisciplinary team of therapists. However, the obstetrician's advice is of great value in preparing the parents for their decision for or against total care post partum. They must in fact be fully aware of the chances, that the disabled child actually has with regard to integration in life, and of what can be done in this respect. Besides the neurological, paediatric and urological care, it is the task of the orthopaedist to preserve or even to improve verticalization and mobility in paraplegic patients. In this manner he exercises an influence on the quality of life of the disabled children and on their social integration. Improvement and further development of physiological orthoses for walking enable even children suffering from a thoracic level of paralysis to walk independently and to achieve integration into society. Orthopaedic aspects of integration must be part of the information given to the parents by the obstetrician, so that they may be able to assess in what way their disabled children can participate in the future at various levels of everyday life.

Child↗
PubMed1992

Aortography in children with myelomeningocele and lumbar kyphosis.

In 21 children with myelomeningocele who underwent kyphectomy for congenital kyphosis of the lumbar spine, aortography revealed no case in which the aorta followed the spinal curvature. Many anomalies of the intercostal and segmental arteries were demonstrated which were only in part associated with deformities of the respective vertebral bodies. The kidneys, which were frequently malformed, often lay within the kyphosis and were therefore at risk of operative damage. We conclude that the aorta is not at risk and that aortography is not usually necessary before kyphectomy, except in patients who have undergone prior abdominal surgery. Non-invasive methods (ultrasound, CT or MRI) should be used to detect malpositions and malformations of the kidneys.

Aorta, Abdominal↗
PubMed1991

The stump capping procedure to prevent or treat terminal osseous overgrowth.

Terminal overgrowth in transverse deficiencies and in amputations, particularly of the humerus and tibia necessitate serial trimming procedures or re-amputation. Capping using an autogenous bone graft or a titanium and polyethylene endoprosthetic cap provides a satisfactory way of avoiding these re-amputations and allowing end-bearing.

Amputation, Surgical↗
PubMed1991

Results of orthotic treatment in children with myelomeningocele.

The level of paralysis in children with myelomeningocele is not necessarily the only factor determining whether they will be able to walk. If children, even with a high level of paralysis, have an appropriate motivation to walk they should be enabled to do so by surgically correcting their hip and knee flexion contraction and/or high degree of scoliosis. 106 children with spina bifida were provided with walking orthosis and were examined concerning their walking speed, walking distance, stepping distance, and how long they used their orthosis. We found that hip and knee flexion contraction as well as scoliosis substantially influenced their mobility. Therefore those handicaps should be surgically corrected if patients show an appropriate motivation to walk.

Adolescent↗
PubMed1990

Stability of the Millon Adolescent Personality Inventory in an incarcerated delinquent population.

Clinical use of the Millon Adolescent Personality Inventory (MAPI) depends on computerized interpretation of the pattern of scale score elevations in the profile beyond certain cutoff scores rather than the elevations of single scales. There has been no reported work on the stability of the scale scores or the stability of the 2-point codes in a delinquent population. The MAPI was administered to 46 incarcerated male juvenile delinquents and was readministered after a period of 2 to 4 weeks. The test-retest correlations of the base-rate scale scores ranged from .33 to .89 with a mean of .74, which compare favorably to Millon's (1982) standardization sample. However, only 41% of the 2-point codes were judged to be congruent between administrations. The poor congruence of the 2-point codes across administrations raises doubts about interpretive statements based on these codes.

Adolescent↗
PubMed1988

Human KRAS oncogene expression in meningioma.

Expression of 16 oncogenes was investigated in a series of human meningiomas showing a normal chromosome complement or the characteristic monosomy 22 but no structural aberrations detectable by banding analysis. By dot hybridization, the only expressed sequence detected was KRAS. The expression was elevated approximately 6--8-fold in comparison to matrix tissue (meninges) and to fibroblasts of the corresponding patient. Northern blot analysis displayed the typical banding pattern and an 8--10-fold overexpression. DNA analysis did not reveal gene amplification or major rearrangements in the KRAS gene structure.

Blotting, Northern↗
PubMed1988

[Surgical therapy of severe knee flexion and hip flexion contractures in caudal regression syndrome].

In severe cases of caudal-regression syndrome one usually can find hip-flexion and knee-flexion-contractures, which can hardly be treated. We report about a new possibility of operative treatment. In this case we correct the contractures with a shortening of the proximal part of the femur and with a resection-arthrodesis of the knee-joint. The clinical result, which we obtained by this way, allows the orthotic management with an orthoprosthesis. The maintaining mobility of the hip joint and the sitting-comfort is very sufficient.

Braces↗
PubMed1988

[Pediatric traumatic hip joint dislocation--overview of the topic based on 9 personal, previously unpublished cases].

We report on 8 patients with 9 traumatic hip dislocations in childhood. The follow-up period was between 1 and 21 years. The majority of these rare injuries were caused by major, sometimes, however, by minor trauma. The best prognosis is given by an immediately performed closed reduction in the absence of bony injuries. Five of our patients had associated bony injuries (fractures of the femoral shaft, acetabular fractures). Two of our patients developed an avascular necrosis of the femoral head which needed further surgery; in one case we found a premature closure of the proximal femoral epiphyseal plate, a fourth patient developed premature osteoarthritis due to a concomitant acetabular fracture. Clinical and radiological examination of all other patients showed no residues of the former injury.

Acetabulum↗
PubMed1987

Enhanced expression of four cellular oncogenes in a human glioblastoma cell line.

Examination of a human glioblastoma cell line displaying a relatively stable karyotype and absence of both copies of chromosome #13 (HeRo) as well as of a SV-40 transformed subline (HeRo-SV) using analysis on the DNA and RNA level showed that both cell lines express high levels of abl, erb B, myc, and Ha-ras mRNA. Neither gene amplification nor gene rearrangement at the loci concerned nor abnormal transcription account for this activation of expression. The possible influence of the deleted sequences in the context of a suppressor gene hypothesis is discussed.

Cell Line↗
PubMedDate not supplied

[Development of paralytic scoliosis in myelomeningocele].

Among other things the probability of developing a scoliosis in myelomeningocele depends on the patients age, the neurological level of lesion and the localisation of the vertebral arch defect. This study tries to analyse the influence of these factors in 465 patients with MMC and paralytic scoliosis. The results show, that the patients age and the neurological level of lesion are the most important factors for the development of paralytic scoliosis. The statistical evaluation based on the data found permits the determination of regression lines, which allow an estimation of further progression of paralytic scoliosis with respect to the neurological level of lesion and the patients age. At levels of paralysis between Th 3 and Th 12 an average progression of 3.5 degrees per year can be expected. Between L 1 and L 3 the progression rate can be estimated to be 2.5 degrees per year. At levels of paralysis distal to L 3 one can expect to find no significant development of scoliosis. In cases, which exceed the prediction interval, additional intraspinal anomalies, i.e. syringomyelia, must be considered and further examinations including MRI are required.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of hip dislocation in patients with infantile cerebral palsy].

The results of 63 operations on 52 patients with cerebral palsy, which were performed between 1978 and 1988 to correct a subluxation or dislocation of the hip, were reviewed. The innominate pelvic osteotomy was preferably combined with intertrochanteric femoral osteotomy and soft tissue release. The average age at time of surgery was 7 years/2 months. Surgical intervention was indicated irrespective of the severity of neurologic involvement. The mean follow-up period is 3 years/4 months. The results show, that by a combinations of these surgical procedures a permanent stability of the hip joint can be achieved. Retrospectively the 5 cases of reluxation can be explained by insufficient surgical technique. The postoperative development of the CE-angle and the acetabular index reveal, that after adequate reduction of the femoral head the acetabulum is able to remodel its dysplasia. From a functional point of view actually patients with diplegia gained the most benefit from a stable hip joint, because they showed the most progress in motor activity. In tetraplegic patients the long-term success of these surgical procedures must be seen in the prevention of a painful hip in adult life, the maintenance of sitting-stability and the improvement of perineal care condition.

Adolescent↗
PubMedDate not supplied

[Fractures and epiphyseal injuries in children with myelomeningocele].

Between February 1971 and February 1988, 947 children with myelomeningocele were treated at the Model Center of Heidelberg University Orthopedic Clinic. In 82 of these children, a total of 224 osseous lesions were seen. Metaphyseal and diaphyseal fractures were far more common than epiphyseal lesions, among which epiphysiolysis dominated. Diagnostically important symptoms included swelling, local hyperthermia, and high temperature. Owing to the paralysis, pain is of no value in diagnosing fractures. Protruding periosteal detachments are a common feature of lesions, and if this special form of healing of such fractures is unknown they may cause problems in differential diagnosis. Fractures in children with spina bifida should be treated conservatively, except for fractures of the femoral neck and epiphyseal lesions, which are treated with transcutaneous Kirschner wiring. Immobilization in plaster, postoperatively and during treatment of the injury, is the most common cause of osseous lesions in spina bifida children. Immobilization in plaster should therefore be minimized.

Adolescent↗
PubMedDate not supplied

[Intraspinal anomalies in myelomeningocele].

This study reports the results of MRI analysis of the spinal cord in 83 patients with myelomeningocele. 63 patients had a "tethered cord" or a "suspected tethered cord". In 14 cases we found a "hydro-/syringomyelia". In only 2 cases there were no pathological findings. The influence especially of the "tethered cord" and the "hydro-/syringomyelia" on the development of deformities of the locomotor apparatus is discussed. Concerning this problem the experience reported in the literature is not sufficient enough to make final statements. However, in cases of deterioration of the neurological status in patients with myelomeningocele the influence of intraspinal anomalies should be considered giving rise to further diagnostic examinations.

Adolescent↗
PubMedDate not supplied

[Hip joint problems in patients with Down's syndrome].

10 patients with Down's syndrome and hip disorders have been examined. Hip instability was present in 5 patients: habitual dislocations occurred in 2 patients, persistent subluxation was found in 2 patients and 1 patient had bilateral fixed hip dislocation. Hip instability usually occurs after the begin of walking and we suggest to perform regularly radiographic examinations on hip instability. Other hip disorders as slipped femoral capital epiphysis may be complicated by hip instability. Legg-Calvé-Perthes disease was found in 2 patients and slipped femoral capital epiphysis in 3 patients. 7 of the 10 patients underwent operative treatment. Subsequently a second or third operation was necessary in 2 patients because of an unexpected instability of the hip following the primary surgery. This was caused by the ligamentous laxity which is often found in Down's syndrome. An increased rate of infections is known in trisomy 21 and wound infections occurred in 2 of the 7 operated patients. Therefore we recommend to consider ligamentous laxity and susceptibility to infection in the treatment of hip disorders in Down's syndrome.

Adolescent↗
PubMedDate not supplied

[Results of surgical therapy of knee flexion contractures in patients with myelomeningocele].

This study reports the results of 98 operations for correcting knee-flexion-contractures, which were performed between 1972 and 1989 in 60 patients with myelomeningocele. 13 knees had hamstring lengthening and 85 knees had radical flexor release. In 4 patients, who had flexion-contractures of more than 50 degrees, the soft tissue release was combined with supracondylar extension osteotomy. 58 patients had additional hip-flexion-contractures and 39 patients had feet deformities. The average age at time of surgery was 8 years, 3 months. The average follow-up-period was 65 months with a minimum of 1 year and a maximum of 13 years. In 92 knees a permanent extension ability could be achieved. In 6 knees a recurrence of flexion-contracture occurred making a second surgery necessary. The main problem in the postoperative period were 13 skin necroses, which were seen mainly after an s-shaped incision. As a conclusion a perpendicular midline incision is recommended. After surgery 11 patients could be provided for the first time with an orthoses. In the remaining the upright body position or the erection of the orthoses could be improved.

Adolescent↗
PubMedDate not supplied

[How idiopathic is idiopathic scoliosis? Results of neurological studies with somatosensory evoked potentials (SSEP) in children and adolescents].

UNLABELLED: About 90% of all the scolioses are called "idiopathic". Various neurological diseases (for example poliomyelitis, etc.) are frequently accompanied by deformities of the spine. The so-called somatosensory evoked potentials are at our disposal being a very sensitive and a non-problematic neurological diagnostic tool. Formation of the question: Are there clinically non-detectable neurological changes demonstrable by use of evoked potentials in children with so-called idiopathic scoliosis? 45 non-operated patients suffering from scoliosis and 21 healthy children were examined clinically, neurologically, and by use of evoked potentials. RESULTS: 26/45 children with idiopathis scoliosis showed pathological evoked potentials (right-left-side-difference concerning latency and amplitudes of the potentials and generally delayed transmission from peripheral nerves to the somatosensory cortex), mostly concerning the lower extremities. 19/45 children showed normal evoked potentials (EP). There was no correlation between EP and direction respectively degree of the scoliosis. Neurological affections mostly located caudally of the cervical spine are to be discussed (for example protrusion of the intervertebral disc, dysrhaphic processes etc.).

Adolescent↗
PubMedDate not supplied

[Experiences with surgical therapy of scoliosis in patients with myelomeningocele].

This study reports about the experiences in surgical correction of scoliosis, which were performed between 1984 and 1989 in 32 children with myelomeningocele. The average age at time of surgery was 14 years, 1 month; the average degree of scoliosis was 96 degrees preoperatively. 6 different types of surgical techniques were used. In comparison the best results were obtained by a combination of ventral osteodiscectomy with or without instrumentation and dorsal CD-instrumentation; an improvement of 56% was found. Furthermore we sent questionnaires to all patients, who were operated more then one year ago. The majority of them judges the improved sitting stability of the trunk to be the greatest advantage. There is a high rate of postoperative complications. Beside one death, which occurred intraoperatively, especially pseudarthroses of the lumbosacral junction must be mentioned. These pseudarthroses and a to short selected area of fusion are the main reasons for the loss of correction, which was noticed after a mean follow-up period of 24.6 months. The necessity of postoperative bracing was not reduced by using CD-instrumentation.

Adolescent↗