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Biomedical subjects

E Brug

Publications and source records attributed to E Brug.

At least 19 recordsLinked to original sources
PubMed1992

[Resorbable antibiotic delivery systems in local treatment of chronic osteitis--polyglycolic acid/poly-L-lactide as drug carrier. Experimental studies in vitro].

Resorbable polyglycolic acid (PGA)- and poly-L-lactic acid (PLLA) cylinders were investigated in vitro to explore their properties as an antibiotic deposit (Ciprobay, Bayer Leverkusen) with prolonged release. PGA cylinders sized 3.2 x 5 mm, 4.5 x 5 mm and 4.5 x 7 mm respectively were shaped in monofil and polyfil technique. The Ciprofloxacin concentration varied from 0.5 mg to 5.0 mg of each cylinder. The cylinders were eluated in phosphate buffer, pH-value of 7.4, at 37 degrees C. The daily antibiotic release was measured by high performance liquid chromatography. Best combinations we could find demonstrated an initial delivery of Ciprofloxacin in vitro of 67 mg/l. The average daily release was about 16 mg/l during the first 36 days. After complete hydrolysis of the PGA carriers the recovery of Ciprofloxacin reached up to 6.5% and 11.6% respectively. For 40 bioactive cylinders (size phi 3.5 mm x 5 mm, containing 4 mg Ciprofloxacin) were eluated with phosphate buffer (pH 7.4 at 37 degrees C) respectively fresh human blood plasma and tested under various conditions. A gentamicin-polymethylmetacrylate (PMMA) chain (Septopal, E. Merck, Darmstadt) was exposed to equal test conditions for comparison. The quantities of released Ciprofloxacin and Gentamicin were analysed by a microbiological method (bioassay). Initially released rates of Ciprofloxacin were measured very high (up to 180 mg/l) but decreased rapidly within the first 5 days (4.2-22.5 mg/l). The release of Gentamicin produces an initial sharp decrease in concentration during the first 3 days (from 227.5 mg/l to 77.5 mg/l); this is then followed by an almost constant release over a long period of time (about 20 mg/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Ciprofloxacin↗
PubMed1992

Ciprofloxacin-impregnated poly-L-lactic acid drug carrier. New aspects of a resorbable drug delivery system in local antimicrobial treatment of bone infections.

Resorbable poly-L-lactic acid (PLLA) cylinders (3.5 mm diameter, 5 mm in length) carrying 6% of weight ciprofloxacin (Ciprobay, Bayer AG, Leverkusen, FRG) were investigated in vitro to explore their properties as a slow-release antibiotic deposit. Forty bioactive cylinders stored in test tubes were covered with phosphate buffer (pH 7.4 at 37 degrees C) and 40 with fresh human blood plasma and tested under various conditions. For comparison a gentamicin-polymethylmethacrylate (PMMA) chain (Septopal, E. Merck, Darmstadt, FRG) was exposed to similar test conditions. The quantities of ciprofloxacin and gentamicin released were analysed by a microbiological method (bioassay). The concentrations of ciprofloxacin released were analysed by a microbiological method (bioassay). The concentrations of ciprofloxacin released from 40 cylinder were initially very high (up to 180 mg/l) but they decreased rapidly within the first 5 days (4.2-22.5 mg/l). Early release of gentamicin reached up to 227.5 mg/l but dropped to of 22 mg/l on the 14th day. Complete degradation of the PLLA-cylinders was not seen in the observed period of 92 days. The mean loss of mass was 8.4%. The recovery of incorporated ciprofloxacin was 6.5% on average.

Biological Assay↗
PubMed1992

[The treatment concept and results of peri-/sub-prosthetic fractures].

The treatment of choice in ipsilateral femoral shaft fractures in patients with hip prosthesis depends on the location of the fracture lines and the observation of loosening of the prosthesis. Either a change of prosthesis, if necessary in combination with refixation of the greater trochanter or simple open reduction with internal fixation (ASIF) along with autologous and/or homologus spongiosa are the used techniques. The rate of complications in peri- or subprothetic fractures is high. Lack of motion in hip and knee joint occurs frequently.

Adult↗
PubMed1991

[Therapeutic concept and results of treatment of subcutaneous extensor tendon rupture of the finger end joint].

This study covers treatment and after-treatment of 95 extensor tendon injuries of the DIP-joint in 94 patients over a period of 3 years. Tendon injuries were classified into 4 types according to Suckert et al. and the final results were evaluated using a modified Riedeberger and Zeumer scale. In recent subcutaneous tendon injuries conservative therapy is indicated, depending on the primary extension deficit (less than 20 degrees = modified Stack splint, greater than 20 degrees = Mommsen plaster of Paris or special dressing). Chip fractures should be stabilized by pull-out suture.

Adolescent↗
PubMed1991

[Bundle nailing of forearm fractures. Indications and results].

Hackethal developed the nailing procedure named after him in 1959. The rationale of Hackethal nailing is an elastic jamming, which can only be achieved by obeying four rules: jamming of the nails in the cortical window, jamming then in the waist of the medullary cavity, spreading the bunch of nails in the metaphysis and filling up the conus of the medullary cavity with short nails. We confined Hackethal nailing to closed and first-degree open fractures of the 2nd-5th sixth of the shaft of the forearm. If closed reduction and nailing were impossible, we performed a plate fixation (AO), in second- or third-degree open fractures we treated with fixators (Orthofix). In a 13-year period we performed Hackethal bundle nailing in 65 patients with 115 fractures. In 54% patients surgery was performed within the first 8 hours following admission. We used two or three nails passing the fracture and one short nail. Except for 1 case, in which we needed a plaster of Paris, we achieved rational stability. On average, the nails were removed after 11.5 months. The healing and complication rates were assessed by follow-up examination of 49 patients. The results were excellent and good in 71.5% patients, satisfactory 11.4% and poor in 17.1%. Complications consisted of a 2.1% infection rate (osteitis), 3.1% non-union, 2.1% with a synostosis, 1% refracture (during removal of the nails) and 3.1% migration of nails, combined with tendon rupture. We have seen 1 case with metallosis. In conclusion with our confined spectrum of indications Hackethal nailing is a low-risk method, which leads to a rational stability and early bone healing.

Adult↗
PubMed1991

[Traumatically-induced thrombosis of the distal ulnar artery. Case report and review of the literature].

The authors report on a patient who fell and struck his right hypothenar against a sharp edge. He had immediate pain and reduced circulation in his ring and little fingers. The neurological findings revealed paraesthesia in the two ulnar fingers and loss of abduction strength in the little finger. Treatment was at first conservative, but the symptoms persisted. Four weeks after injury, the patient was referred to our unit. Doppler ultrasound and angiography of the brachial artery were performed, showing an occlusion of the ulnar artery just distal to the space of Guyon. Operative revision was carried out and a 20 mm thrombus removed. Recovery was then uneventful, and all previous symptoms disappeared. A review of the literature is presented and typical symptoms, diagnostic and therapeutic approaches discussed. The need for an early diagnosis and operative revision is demonstrated.

Angiography↗
PubMed1991

[Injury of the pelvic ring and abdominal trauma].

Fractures and disruptions of the pelvic ring are usually found in multiply injured patients and exacerbate the life-threatening character of the concomitant injuries. The main prognostic factors are haemorrhagic complications, abdominal trauma and associated injuries of the urogenital tract. All patients admitted to the Department of Surgery of the University of Münster between July 1985 to December 1989 were analysed with particular reference to pelvic ring instability and the accompanying pelvic and abdominal lesions. Of 27 patients with unstable displaced lesions of the pelvic ring, 9 were female (33.3%) and 18 male (66.7%); the average age was 35.1 years. Multiple trauma was present in 25 patients (92.6%). Associated pelvic or abdominal injuries were found in 15 cases (55.6%) [multiple entries]. In 9 patients (33.3%) there were lesions of the urogenital tract. Injuries to pelvic blood vessels were diagnosed in 3 patients (11.1%). In 2 patients (7.4%) there were lesions of the perineum. A ruptured spleen was found in 4 patients (14.8%), lesions of the liver in 3 patients (11.1%), lacerations of the mesentery in 2 patients (7.4%). Bleeding into the mesentery, lacerations of serosa of the sigmoid colon and contusion of the pancreas were each seen in 1 case (3.7%). In 12 patients (44.4%) laparotomy was performed: The mortality in this series was 22.2% (6 patients). The authors propose a procedure for immediate diagnosis of these associated pelvic and abdominal injuries. The key factor for a favourable outcome is the differentiation between intraabdominal and retroperitoneal bleeding. A treatment algorithm is described. The value of laparotomy, interventional radiology and primary anterior stabilization of the pelvic ring with an external frame is discussed.

Abdominal Injuries↗
PubMed1991

[Heterotopic ossifications from the trauma surgery viewpoint].

A heterotopic ossification is a non-neoplastic bone formation located in the soft tissues (so-called myositis ossificans). Important aspects of this condition, which is not uncommon after trauma or surgical procedures, are discussed from the trauma surgeon's viewpoint. The results of treatment of heterotopic ossifications are frequently unsatisfactory. Therefore, the importance of preventive measures is emphasized.

Fracture Fixation, Internal↗
PubMed1991

[A return to callus healing using dynamic osteosynthesis procedures. Principles, indications, complications, x-ray diagnosis of interlocking nailing and dynamic monofixators in comparison with conventional bone plates].

A disproportionately high rate of complications such as osteomyelitis, nonunion and refracture after plating have brought about a change in our understanding of the process of fracture healing. Locked nailing and dynamic external Monofixators, however, avoid fracture exposure obviate the necessity of arranging fragments and aim at callus healing of fractures. Fracture hematoma and axial micromovements of these dynamic stabilizing devices are two of the yet known elements to promote callus production.

Bone Nails↗
PubMed1990

A target device for placement of implants in the thoracolumbar pedicles.

Posterior spinal instrumentation with the placement of intrapedicular implants has become an important technique. We have designed a hand-held target device to facilitate the open or percutaneous location and penetration of the thoracolumbar pedicles. A cylindrical pin guide incorporates two metal rings and can be moved under image intensifier control until the rings are superimposed to show correct alignment. The radiation dosage for the surgeon is minimal; the device allowed accurate placement of 106 consecutive pedicle screws.

Equipment Design↗
PubMed1990

[Tuberculosis of the hand].

Skeletal tuberculosis of the hand has become rare. The authors report a 27-year-old female patient with tuberculous osteomyelitis of the middle phalanx of the left ring finger without occupational exposure of the hand and with positive chest roentgenogram. The case shows the diagnostic difficulties of the uncommon manifestation of skeletal tuberculosis in the short tubular bones of the hand. By means of a review of the literature the differential diagnosis, the course and necessary treatment are discussed.

Adult↗
PubMed1990

[Indications for interlocking nailing].

For closed diaphyseal fractures of femur and tibia in adults, medullary nailing with interlocking nails has become the treatment of choice. Their use has been extended to certain intraarticular fractures in combination with shaft fractures, compound fractures with low-grade wound contamination, malunion, non-union and pathologic fractures. Locked nailing should be performed as a closed procedure, and callus bone healing should be expected. Fracture hematoma, drill debris and preservation of periosteal circulation are of particular relevance in achieving this. Dynamization by removal of the locking screw(s) opposite the fracture site accelerates the transformation and ossification of early fixation callus.

Bone Nails↗
PubMed1990

[Principles of secondary soft tissue reconstruction after open fractures of the tibia].

Course and prognosis of open lower leg fractures are significantly influenced by the concomitant soft tissue injury. Selection and timing of therapeutic procedures determine the final outcome. Fracture stabilisation takes priority. Early soft tissue coverage should be achieved by local cutaneous or fasciocutaneous flaps. Exposed bone can be covered by transposed local musculature. Especially in the distal third as well as in extensive soft tissue loss the microsurgical transplantation of free flaps is advantageous. Tissue expansion can provide skin for secondary replacement of instable scars.

Cicatrix↗
PubMed1990

[Differential diagnosis of distortion of the elbow joint].

Distortion of the elbow joint often means a vague diagnosis describing a traumatized joint with no radiological changes, or it means a transient diagnosis until sophisticated examinations can demonstrate what the injury really is. In adults there are only a few injuries that cannot be shown by radiography. In children, however, radiography of the elbow joint is more difficult due to the inhomogeneity during growth. Contrary to adults, fractures misdiagnosed in radiography often result in significant reduction of joint function.

Adolescent↗
PubMed1989

[Use of unilateral external fixation in pediatric femur shaft fracture within the scope of polytrauma].

Femoral fractures in children are mostly managed conservatively. The recommended methods are overhead traction, 90/90 degree traction on a special table (Weber) and skeletal traction in a Thomas splint or on a Brown's frame. This treatment proves cumbersome in most multiply injured children, especially in those with head injury. Due to uncooperative behaviour the fracture is difficult to hold in an acceptable position. Therefore, operative treatment has been favoured by several authors in the past. Over a period of 8 years, 167 adolescent multiple trauma victims were treated in our institution, 48% of whom had sustained femoral fractures. Since June 1985 such fractures have been stabilized with the unilateral De Bastiani external fixator as the primary and definitive treatment. Our first series consists of ten children (eight male, two female) with a total of eleven fractures, aged 3.2-15 years, mean age 8.1 years. Nine fractures were closed and two compound. Nine fractures were fixed on the day of injury and two 2 days after injury. Depending on the patient's age and the level of the fracture, controlled overriding of 10-15 mm was performed to compensate for expected overgrowth. All fractures healed in an average time of 11 weeks. Free hip and knee movement was achieved in all cases 6 weeks after removal of frame. Neither refracture nor deep infection was seen in any of these patients. Compared with internal fixation, use of this device is less invasive and requires a very short operating time. The fixator can be removed as an outpatient procedure with no need for an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Insertion of distal screws in interlocking nailing using a new free-hand control device].

While it is technically easy to introduce the proximal screw in interlocking nailing, the torsion of the nail being driven into the medullary canal can make distal locking more difficult. There are two approaches to the insertion of the distal screws: the c-arm-mounted device and the free-hand technique. The Grosse-Kempf c-arm device was introduced in 1978, but it requires modification of the fluoroscopy unit and is time consuming. The free-hand technique has certain disadvantages because of involuntary movement during the change from aiming to drilling. Furthermore, the bulky power drill makes monitoring of the path of the drill bit impossible, and the radiation time can be considerable. A new free-hand distal aiming device for the interlocking nail was therefore designed in our department. The main objectives were to provide a simple, yet precise instrument with few parts that would allow monitoring of the direction during process of penetrating the nail hole. The device consists of two metal rings on both ends of an X-ray translucent cylinder with a central 4-mm hole in it. A pin with a sharp tip (diameter 4 mm, length 160 mm) is inserted through the hole. Using the image intensifier, the device is then placed so that the sharp tip of the pin points to the bone. The device is moved until the two metal rings are superimposed on each other and give the impression of one ring with the nail hole in the middle. On the screen the pin then appears as a dot inside the nail hole.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Nails↗