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Biomedical subjects

D P König

Publications and source records attributed to D P König.

At least 19 recordsLinked to original sources
PubMed2006

[Dynamic ultrasound examination of the shoulder of golf players].

Although golf is becoming popular it can result in injury, usually from overuse and from poor technique. The shoulder is a commonly affected site, with the lead shoulder (or the left shoulder in the right-handed golfer) vulnerable to injury. With this study we tried to figure out any hyperlaxity of the lead shoulder using ultrasonography. 33 golf-players were investigated by questionnaire, clinical examination and dynamic ultrasonography. Neither clinically nor by using ultrasonography hyperlaxity of the shoulder was found. Nevertheless hyperlaxity followed by secondary impingement should be considered.

Adolescent↗
PubMed2005

[Intradiscal electrothermal therapy (IDET)].

Low back pain is a major physical and socioeconomic problem. A significant percentage is attributable to internal disc disruption (IDD). The management of IDD has been limited to conservative treatment or to operative treatment. Intradiscal electrothermal therapy (IDET) is a new minimal-invasive therapy. In carefully selected patients, it could be an effective treatment alternative. Further studies with long-term follow-up are necessary.

Electric Stimulation Therapy↗
PubMed2005

[Isokinetic testing of the shoulder of handball players].

Aim of the study was to evaluate an isokinetic profile testing handball players to describe muscular imbalance. 30 athletes (15 male and 15 female) were measured at the Cybex 6000 test-unit for concentric internal and external rotation. Both shoulders, throwing arm (dominant shoulder) and the opposite shoulder were tested by speeds at 60 degrees/s and 180 degrees/s. There were sex specific differences which are also found in other sports. But these contrary data are not useful to define effective training concepts for handball-players with shoulder problems. From our point of view isokinetic testing of the shoulder joint in handball players can not reach any sufficient result. From our point of view there is no reason for using isokinetic testing to evaluate shoulder problems.

Adult↗
PubMed2004

Iatrogenic paraplegia in spinal surgery.

INTRODUCTION: Paraplegia as a result of a surgical spinal procedure is a rare complication. The risk cannot be precisely quantified due to the lack of current data. The aim of this study was to record a sufficiently large number of major spinal operations, especially extended methods in scoliosis surgery. Hereby, a reliable statement regarding the risk of severe neurological complications with these surgical techniques should be possible. First, a retrospective analysis of patients from a German spine centre (spinal fusion) and a survey of 17 German centres of spinal surgery were conducted for the retrospective acquisition of severe iatrogenic neurological complications. MATERIALS AND METHODS: The study included 1194 patients who underwent a spinal fusion during the period 1992-2002. The incidents of postoperative paraplegia are described in detail, and case studies done. Possible causes, methods of intraoperative monitoring and options of therapy are discussed according to research in relevant publications. Additionally, severe neurological complications of 3115 spinal operations were recorded in a standardised survey conducted throughout major German spinal centres. RESULTS: Of the 1194 patients surveyed, 7 (0.59%) experienced a postsurgical complete or incomplete paraplegia. In 3 of the recorded cases, the cause could be identified. The survey of 3115 scoliosis surgeries showed that iatrogenic paraplegia occurred with a frequency of 0.55%. The risks associated with short spinal fusions (0.14%), cervical discectomies (0.07%) and lumbar discectomies (0.03%) are considerably less. CONCLUSION: Operative treatment of scoliosis with a high degree of correction carries a risk of neurological complications of about 0.5%. Mechanical as well as ischaemic damage to the spinal cord can be detected early by means of consistent intraoperative neuromonitoring.

Adolescent↗
PubMed2004

[Special aspects of implant-associated infection in orthopedic surgery. From the pathophysiology to custom-tailored prevention strategies].

One of the most important risk factors in orthopedic surgery is implant-associated infection. Adhesion and colonization mediated implant infections are extremely resistant to antibiotics and host defences and frequently persist until the biomaterial or foreign body is removed, which is standard therapy. Tissue damage caused by surgery and foreign body implantation increases the susceptibility to infections, activates host defences and stimulates the generation of inflammatory mediators including radicals that are further aggravated by bacterial activity and toxins. Nearly one third of implant-related infections can be prevented by strictly following established infection control guidelines. However, a significant number of implant-associated infections remains. The escape of bacteria from host defence and antibiotic therapy makes the development of infection-resistant materials as anti-microbial drug delivery systems feasible. This concept consists of the sustained delivery of antimicrobial drugs into the local microenvironment of implants avoiding systemic side effects exceeding usual systemic concentrations by magnitudes of order.

Anti-Bacterial Agents↗
PubMed2004

[Minimally invasive approaches to hip and knee joints for total joint replacement].

The manuscript features the different minimally invasive approaches to the hip for joint replacement. These include medial, anterior, anterolateral, and posterior approaches. The concept of minimally invasive hip arthroplasty makes sense if it is an integral part of a larger concept to lower postoperative morbidity. Besides minimal soft tissue trauma, this concept involves preoperative patient education, preemptive analgesia, and postoperative physiotherapy. It is our belief that minimal incision techniques for the hip are not suited for all patients and all surgeons. The different minimally invasive approaches to the knee joint for implantation of a knee arthroplasty are described and discussed. There have been no studies published yet that fulfill EBM criteria. The data so far show that minimally invasive approaches and implantation techniques for total knee replacements lead to quicker rehabilitation of patients.

Arthroplasty, Replacement, Hip↗
PubMed2004

[The minimally invasive unicompartmental knee system "Preservation"First clinical results and analysis of complications].

The Preservation uni knee system is a minimally invasive procedure for implantation of a unicompartmental knee prosthesis. The early results show that the rehabilitation process is quick; the postoperative pain and blood loss is less than after conventional knee arthroplasty. Still there are some pitfalls. The implantation of the tibial mobile-bearing component requires a sound operative technique; otherwise complications will occur. The combination of the available navigation system with the Preservation uni will improve operative accuracy.

Aged↗
PubMed2004

[Injuries and muscle tightness in soccer].

Soccer is one of the most popular sports worldwide. Due to its characteristic many injuries are expected. Muscular tightness is postulated as an intrinsic risk factor for the developement of a muscle injury. Muscle flexibility testing can identify soccer players at risk for musculoskeletal lesions. One-hundred-and-seventeen male amateur soccer players aged 4 to 29 were examined for former injuries and muscular flexibility by using Janda's "functional muscular diagnostic". Muscle injuries and ankle lesions predominated among the injuries. The "functional muscular diagnostic" is suitable for screening muscular flexibility in soccer players. You found comprehensive muscular tightness among the soccer players. The value of stretching for preventing exercise-related muscle injury is still unclear.

Adolescent↗
PubMed2003

[Development of physical and sports activity in patients before and after implantation of a total knee endoprosthesis. A prospective study of 40 patients].

AIM: The aim of this prospective study was to analyse the development of activities of daily living (ADL) as well as sports activities in patients suffering from osteoarthritis of the knee and undergoing total knee replacement. 40 patients with 42 operated knee joints were included in this study. METHOD: 38 patients (40 knee replacements) recieved a PFC endoprosthesis, 2 patients recieved a GSB endoprosthesis. In 28 cases (71%) we found generalized degenerative joint changes, in 7 cases (17%) a varus deformity and in 2 cases (5%) a valgus deformity. Post-traumatic osteoarthritis was seen in 3 cases (7%). We used the PFC endoprosthesis in patients with stable ligaments, in unstable joints we used the GSB endoprosthesis. Patients were reviewed clinically and radiographically and answered a questionnaire with special reference to ADL (walking, gymnastics, bicycling, homework, swimming, gardening). For evaluation of the results we used the Ranawat & Shine score. Pain was determined with the VAS (visual analogue pain scale). RESULTS: The activity level increased from preoperatively 62.5% up to 91.5% 2 years postoperatively. This was mainly due to walking and gymnastics. Overall sports activities decreased. There was a high uncertainty regarding activities due to patients' lack of knowledge about possible postoperative load capacity of the new joint. The average score according to Ranawat & Shine increased from preoperative 56.98 to 75.89 points out of 100. Most significantly we found an improvement in the pain rating. There was an improvement of 73% under resting and of 81% under activity conditions. CONCLUSION: With this prospective study we can demonstrate the benefit for patients undergoing knee replacement surgery with respect to activities of daily living and especially pain reduction.

Activities of Daily Living↗
PubMed2003

[Treatment course in endoprosthetic knee replacement--a systematic insurance cost calculation exemplified by a concrete example].

In view of the planned introduction of the DRG system in Germany, this paper gives the reader a guideline on how to analyse costs and productivity of medical procedures. Total knee replacement was chosen because it is one of the standard operations in orthopedic surgery with existing special calculations for this type of operation. By using the example of a total knee replacement, productivity phases are used and their costs are estimated. With these phases the clinician is able to analyse the efficiency of his department and a benchmarking is possible. Nevertheless, we should not forget that although cost reduction in hospitals is essential the patients' health is the main aim of treatment.

Arthroplasty, Replacement, Knee↗
PubMed2003

[Possibility of sonographic early diagnosis of heterotopic ossifications after total hip-replacement].

AIM: The sonographic early diagnosis of heterotopic ossifications after total hip replacement. MATERIAL AND METHOD: 53 patients were sonographically and radiologically examined after a total hip-replacement. RESULTS. In the sonographic exam,positive findings were shown in 49.1% (n=26) one week, 66% (n=35) three weeks,73.6% (n=39) six weeks and 77.3% (n=41) twelve weeks after surgery. 88.5% of patients showing positive results in the sonographic exam carried out one week after surgery, later on showed positive x-ray findings (p<0.001). Of the three-week positive x-ray findings (n=19), 78.9% had condensations in the sonographic exam (p<0.001). CONCLUSIONS: Sonographic imaging after hip-replacement seems to be a sensitive and specific method which allows an early diagnosis of ossifications one week after surgery in 2/3 of patients. In this context a therapy concept which helps avoiding the development ossifications would be welcome.

Arthroplasty, Replacement, Hip↗
PubMed2003

Cryosurgery in long bones with new miniature cryoprobe: an experimental in vivo study of the cryosurgical temperature field in sheep.

AIM: The aim of this in vivo study was to determine whether new miniature cryoprobes provide adequate tissue cooling in long bones by measuring the field of temperature under various conditions. METHODS: Freezings were performed in femoral and tibial bones of 10 sheep under general anaesthesia. Applying one cryoprobe, temperatures of -75 degrees C resp. -51 degrees C could be reached within 0.75 cm resp. 1.00 cm of the probe. RESULTS: Histological examinations revealed compact bone and marrow necroses along the isotherm in all 10 sheep. Using two cryoprobes simultaneously, a mean temperature decrease to -71 degrees C between the two cryoprobes was achieved thanks to the synergistic freezing effect. Looking at consecutive freezes, it was apparent that with similar cryoprobe end temperatures, the temperature dropped faster if the number of freezing cycles was increased. CONCLUSION: In conclusion, it was seen that despite its small diameter, the new miniature cryoprobe delivers adequate in vivo tissue cooling in long tubular bones. Employing the synergistic freezing effect by using two or more cryoprobes simultaneously, efficient in vivo freezing of larger bone segments is also possible. Thus, cryosurgery with the new miniature probes can provide a valuable complement to conventional resection of long tubular bones, and offers a viable alternative to surgical treatment of neoplastic diseases of the skeletal system.

Animals↗
PubMed2003

Pharmacokinetics of the antimicrobial agents rifampicin and miconazole released from a loaded central venous catheter.

The time course of rifampicin and miconazole concentrations after insertion of a polyurethane catheter loaded with these antibiotics were studied. Data from controlled release experiments in vitro were used, and the concentration time courses of the antimicrobials in serum were calculated by pharmacokinetic simulations. Systemic therapy using typical dosages (rifampicin 600 mg/day iv, miconazole 3 x 200 mg/day iv) results in rifampicin concentrations between 54 and 8424 microg/L, and miconazole concentrations between 3567 and 4676 microg/L. After insertion of a polyurethane catheter loaded with these antibiotics, the maximal concentrations after catheter placement were determined as 6 microg/L at 10.7h for rifampicin, and 13 microg/L at 28.6 h for miconazole. Assuming that the total amount of antibiotics incorporated in the catheter matrix were bioavailable ('worst case'), the resulting maximal concentrations calculated by simulation are 10 microg/L for rifampicin and 65 microg/L for miconazole. Maximal concentrations of rifampicin or miconazole resulting from the insertion of a polyurethane catheter loaded with these antibiotics are, therefore, far below the concentrations resulting from a systemic therapy with the same antimicrobial agents. Even in the worst case, the danger of selecting resistant bacterial strains seems remote because the systemic drug levels are magnitudes of order below subinhibitory concentrations.

Biological Availability↗
PubMed2002

[Autologous chondrocyte transplantation--progress or misleading development in high-tech medicine?].

Autologous chondrocyte transplantation (ACT) is a recently developed procedure for repairing chondral defects of the knee. An analysis of the literature provides no evidence so far for regular regeneration of hyaline cartilage, and no randomized controlled studies are available showing a long-term efficacy. Therefore, controlled randomized studies are urgently needed. At present, ACT cannot be recommended for extended application in clinical practice.

Animals↗
PubMed2002

[Treatment outcome after surgical management of osseous breast carcinoma metastases. Preventive stabilization vs. management after pathological fracture].

UNLABELLED: AIM OF THE STUDY, METHOD: The advantages of a prophylactic care of fracture-endangered, osseous metastasis of the mammary cancer stand opposite to the perioperative risk and to conservative alternatives. As a pathologic fracture cannot surely be excluded while performing a conservative proceeding, a retrospective trial was set up to compare the results of treatment after a pathologic fracture (n = 35) with those undergoing a prophylactic attendance (n = 44). RESULTS: The intraoperative, cardio-pulmonary complications were distributed in balance totally amounting to 20.3% (n = 16). Intraoperative complications concerning surgical procedure (n = 3) exclusively occurred within the fracture group. Generally, postoperative complications arose in 20.3% (n = 16) of all cases, in which the patients belonging to the fracture group were increasingly afflicted [28.6% (n = 11/35) vs. 11.4% (n = 5/44); p < 0.02]. While there were no differences between both groups concerning the postoperative, surgery-technical complications, significantly more patients (91.8% [n = 40/44]) of the prophylactic-care group achieved a complete postoperative usability of the operated area than in the fracture-group [74.3% (n = 26/35)] (p < 0.05). The average survival time tended to be longer within the prophylactic-care group [19.3 +/- 15.6 month (prophylactic-care group) vs. 15.0 +/- 16.9 month (fracture group)]. CONCLUSIONS: The prophylactic treatment of fracture endangered, osseous metastasis of the mammary cancer leads to reduction of the general, postoperative complications compared to the patients with a pathologic fracture. Further, those patients have a better chance to recover full mobility after surgery. Considering the long survival time after the incidence of osseous metastasis at the mammary cancer a prophylactic treatment represents the method of first choice compared with the conservative treatment which persistently contains the risk of fracturing.

Adult↗
PubMed2002

[Development of ultrasonography in a radiological university department from 1994 to 2001].

BACKGROUND: In 1994, 5 % of a total of 25 718 examinations and 7 % of all 4630 B-mode sonograms performed in the Radiology Department, University of Cologne was classified as not indicated. In light of these results, the health care policy guidelines for sonographic indications have been amended. PURPOSE: The aim of this study was to establish the current rate of non-indicated sonographic examinations performed in routine diagnostics by radiology departments at university hospitals, to determine the reasons for such over-diagnosis and identify which regulatory mechanisms can be implemented to prevent his. METHOD: We counted the number of 1) B-mode and 2) color-flow Doppler ultrasound imaging procedures carried out in patients who had had no change in symptoms within the previous 4 weeks or who were scheduled without reference to an existing sonogram (double examinations). 3) The reasons for over-diagnosis were analyzed. 4) The 1994 survey was repeated in 2000 with an identical protocol and 5) additionally, a modified survey of the diagnostic questions was conducted. RESULTS: 1) Out of 4,119 patients presenting for the first time to receive a B-mode sonogram, 443 prior sonograms (11 %), 305 CT scans (7 %) and 57 MRI scans (1 %) were documented. 2) Double sonograms were carried out in 6 % of the 1,118 patients presenting for the first time for color-flow Doppler ultrasounds and in 16 % of the 651 patients assigned to receive catheter angiographies with arterial color-flow Doppler. 2) 41 out of 55 (75 %) prior sonograms from non-university settings stated by 94 surgery patients were listed in the medical records. 36 out of 43 (84 %) prior sonograms from the university hospital were repeated in the same patients despite the fact that the medical report with the findings was available. None of the 48 sonograms indicated to confirm a plausible finding yielded any information that was additionally relevant to therapy. 4) In the period April - June, 2000, 12 % of all 15,921 tests and interventions, 26 % of 3,569 B-mode sonograms and 58 % of 1,033 abdominal sonograms performed in adults were classified as having not been indicated. 5) Staging and follow-up were stated as the most common reasons that a sonography was carried out in 46 % of the 1,017 adults who were given B-mode sonograms conducted from Jan - Mar, 2000 and comprised 62 % of the 410 sonograms classified as not or probably not medically indicated. CONCLUSION: The results showed that a multidisciplinary consensus was required to establish the diagnostic value of sonographic procedures. Therefore, this research group drafted a hospital-internal interdisciplinary guideline for "abdominal transcutaneous B-mode sonography in oncological questions".

Diagnostic Imaging↗
PubMed2001

Treatment of staphylococcal implant infection with rifampicin-ciprofloxacin in stable implants.

Infection following total joint replacement remains a problem that has not been solved so far. The treatment options include removal of the implant and a delayed reconstruction or a direct exchange operation. Among patients with stable implants and short duration of infection as well as in patients who for certain reasons are inoperable, antibiotic therapy with a combination of rifampicin-ciprofloxacin may be a reasonable treatment option for curing staphyloccocal infection without removal of the implant. A case study of a Staphylococcus epidermidis (coagulase-negative) infection following delayed revision total knee replacement after septic loosening of a knee arthroplasty and its successful conservative treatment with rifampicin-ciprofloxacin is described. Alternative rifampicin combinations are discussed with respect to recently developed pharmacodynamical and pharmacokinetical findings of biofilm active drugs.

Anti-Bacterial Agents↗