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Biomedical subjects

C Kieser

Publications and source records attributed to C Kieser.

17 recordsLinked to original sources
PubMed2001

[Family consultation as a part of routine management in a psychiatric and psychotherapy department of the general hospital].

BACKGROUND: Covers two years experience of family visits (FV) as a routine fixture at a psychiatric ward in a General Hospital. PATIENTS AND METHODS: In the course of one year 98 visits took place involving a total of 481 contacts between therapists, patients, and relatives. 269 patients participated up to 10 times in FV. A total of 666 family members participated, the bulk of them partners, mothers and children. Each FV contact is restricted to 20 minutes, but can be repeated as often as desired. An ever recurrent theme is the question family members ask as to the causes of the patients condition and how they can expedite the healing process and ensure compliance. The 269 FV patients do not differ markedly from the other patients concerning age, sex, diagnosis and treatment time. CONCLUSION: FV are experienced by patients and relatives as positiv and enriching. For psychiatric workers an ideal way to learn the psychotherapeutic rudiments.

Caregivers↗
PubMed2000

[Ernst Vaubel M. D. German pioneer in the field of arthroscopy 1902-1989].

In Germany of the pre-war period Ernest Vaubel at Wiesbaden was the most eminent arthroscopist. He collaborated with the manufacturer Georg Wolf at Berlin and developed his own arthroscope, a jacobaeus-type thoracolaparoscope with a 45 degrees -optic and an in- and outflow connecting piece. The optic was definitely longer than the trocard and the electric bulb at the tip was in danger during manipulation in a narrow joint. Vaubel did a rather small series of arthroscopies from 1936 to 1939 at the University hospitals of Leipzig and Frankfurt, using local anaesthesia and air medium. 1938 he held a paper at the International Congress of Rheumatologists at Bath. In the same year he published a monograph titled "Die Arthroskopie", the first book of world literature on this issue. 1939 he left the Frankfurt university hospital and went in his own private practice. 1941-1944 he did military service as medical officer of the air force. After war he had not more facilities to practice arthroscopy. His ideas and his instrument were revived in the german speaking countries in the late fifties by the sports surgeons Gottwald Heiss at Stuttgart and Reinhold Suckert at Linz.

Arthroscopes↗
PubMed1998

Modified Elmslie-Trillat procedure for instability of the patella.

The purpose of this study was to determine whether or not the modified medial transfer of the ligamentum patellae in case of objective instability of the patella is an adequate therapy and if it is possible to improve the patellar congruence angle by this method. Between October 1987 and April 1993, 41 operations were performed in 37 patients with medialization of the medial third of the ligamentum patellae with the corresponding part of the tibial tubercule. Four patients needed a bilateral operation; the two interventions were not performed at the same time. Thirty-six operated knees (88%) were examined at a median clinical and radiological follow-up of 62.8 months (+/- 15.8 SD). For evaluation, the objective and subjective Turba score was used, and pre- and postoperative X-rays were compared. The patients' average age at the time of intervention was 23.2 years (+/- 7 years SD). The operation was performed 39 times for recurrent dislocation or subluxation, for patella alta with cartilage tissue damage, and for first time traumatic dislocation. The only postoperative complication was a temporary peroneal paresis. There were no redislocations seen at the follow-up. One patient with repeated subluxations underwent an additional lateral release combined with a repair of the medial retinaculum. In all other cases, the Turba score showed good or excellent results (subjective 1.9; objective 0.8), the patellar congruence angle was significantly improved (P < 0.001), and there were no medial subluxations. We conclude that the transfer of the medial third of the ligamentum patellae for objective instability of the patella is a minimally invasive and adequate technique to improve significantly a pathological patellar congruence angle.

Adolescent↗
PubMed1996

[Expenses and risk of artificial knee joint: a look backward to a 20-year clinical experience].

Costs and risks of implantation of prosthetic knee joints are analyzed in this retrospective study. From 1974-1993 514 primary and 34 revision arthroplasties were done in this hospital, all by the same surgeon. 98% of the patient protocols were available and analyzed, but no systematic follow-up was attempted. 82% of the patients were female; mean age at operation was 74 years. Joint destruction was caused by osteoarthritis in 75%, aseptic osteonecrosis in 10%, rheumatoid arthritis in 9% and posttraumatic arthritis in 3.5%. 75% of the patients were obese and had a body mass index > 25 kg/m2. Non-constrained unicompartmental type prostheses were used in 66%, the non-constrained multicompartmental type in 10% and the constrained total rotation knee (Engelbrecht) in 24%. Hospital mortality rate was 0.55% due to myocardial infarction and pulmonary embolism. 3 patients died of septic prosthetic joint infections 5, 7 and 71/2 years after surgery. Perioperative morbidity, typical of the age group above 70 years, was mainly due to cardiovascular and thromboembolic events and gastrointestinal bleeding. Early infection during the first postoperative year was encountered in 3 constrained total knees, but none in nonconstrained type. The calculated operative infection rate was 2.4% for the constrained type, zero for the non-constrained type, and 0.5% for the whole series. Late prosthetic infections occurred in 8 patients up to 12 years after surgery. In comparing non-constrained unicondylar and hinged types of joint replacement, the non-constrained sledge prosthesis involves considerably lower costs in terms of duration of surgery, hospital stay, blood loss, price of the implant, infection rate and difficulties of revision arthroplasty. Lower costs and risks favour the smaller unicondylar implant for use in localized degenerative or necrotic destruction, particularly of the medial compartment of the knee. Semi-constrained total condylar systems are used for more extensive degeneration without evident instability. The indication for hinged endoprostheses is restricted to revision arthroplasty and grossly unstable knees.

Adult↗
PubMed1992

A review of the complications of arthroscopic knee surgery.

Although fatalities following arthroscopic intervention are rare, complications do occur frequently. This article examines the most common complications, including instrument breakage and nervous lesions due to the tourniquet or positioning on the surgical table, discusses the various intraarticular media, and warns against the use of gas media under certain circumstances. The general surgical complications of thromboembolism, infection, and anesthetic problems are also discussed.

Arthritis, Infectious↗
PubMed1989

Lethal air embolism during arthroscopy. A case report.

We report a case of lethal air embolism during diagnostic arthroscopy using air to distend an acutely injured knee. Air had escaped from the joint through an intra-articular fracture and entered the venous system. During arthroscopy, pressure within the joint may be 5 to 10 times higher than venous pressure, so any medium may escape. We advise that the use of air, especially in freshly injured joints, should be abandoned in favour of saline or carbon dioxide.

Adult↗
PubMed1989

[Assessment and course of 110 patients with mono-arthritis].

This is a follow up study of 110 patients referred to the hospital because of mono-arthritis of unknown etiology. Patients with mechanical synovitis and infectious arthritis have been excluded from this study initially. From a total of 110 patients (100%) a diagnosis could be made in 49 patients (44.6%), namely in 24 (21.8%) by the initial very thorough work up or by the repeated examinations during the follow up period in 25 patients (22.8%). In 61 patients (55.4%) the cause of the disease remained unknown despite extensive investigations and follow up controls for many years. Of these 61 cases three (2.7%) developed polyarthritis and six (5.5%) oligoarthritis still of unknown origin. The rest, namely 52 (47.2%) remained mono-arthritis and are called mono-arthritis of unknown origin ("Arthritis unbekannter Ursache"). 67% of these 52 patients with mono-arthritis of unknown origin went into complete remission after one year and 80% after two years. 13 patients (11.8%) of the 110 developed rheumatoid arthritis within one month up to three years. Arthroscopy was important in making some diagnosis initially. Twelve patients had relief of symptoms after arthroscopy, ten of the group with mono-arthritis of unknown origin. 19 patients claimed that the initiating factor was a trauma to the joint.

Arthritis↗
PubMed1982

[Results of arthroscope studies of knee joint effusions of unknown origin].

174 knee joints with non-traumatic effusion have been examined by arthroscopy. In 71 cases synovial biopsy was performed. 43% of the knees had cartilaginous damage of the patella or tibiofemoral joint, 19% had an old meniscal and/or ligamentous tear and 33% a "non-specific" synovitis. The remaining 5% comprise 5 patients with pigmented villonodular synovitis, 3 patients with gout, one with synovial tuberculosis and one with a hemangioma of synovial membrane. Arthroscopy serves for early recognition of degeneration of hyalin cartilage and meniscal lesions, while synovial biopsies are also largely non-traumatic. Endoscopic evaluation of synovial membrane is more difficult. Mechanical irritation produces proliferation of synovial villi, while bacterial and rheumatoid inflammation leads to exudative and necrotic changes. The differences are obvious in marked inflammation but difficult to recognize in the beginning of any process. Arthroscopic and histological examination determines the etiology of synovitis only in pigmented villonodular synovitis and synovial tuberculosis. In the other forms of synovitis it is only possible to determine the stage and intensity of inflammation but not the etiology. The diagnosis of rheumatoid arthritis in particular is seldom secured by arthroscopy.

Arthritis↗
PubMed1976

[Arthroscopy of the knee joint].

The clinical usefulness of arthroscopies of the knee joint has been evaluated on the basis of 282 examinations. The procedures were performed under general anesthesia with sterility precautions as for arthrotomy. In nearly all cases, direct observation of articular surfaces, synovial membranes and the menisci of the ventral two thirds of the joint was possible. The dorsal recessus, the posterior third of medial meniscus, the posterior cruciate and Baker's cyst could not be inspected. The diagnostic accuracy of arthroscopy was compared with that of double contrast arthrography. The results are as follows: incipient degenerative lesions of articular cartilage, especially chondromalacia of patella, and dislocated bucket handle tears of menisci are more accurately diagnosed by arthroscopy. For other meniscal lesions double contrast arthrography provides better results. - Arthroscopy allows the taking of synovial biopsies in cases of chronic synovitis. However, the results of histological examination are rarely of decisive value, though undetected lesions of articular cartilage have been frequently brought to light.

Cartilage Diseases↗