Biomedical subjects

E J Müller

Publications and source records attributed to E J Müller.

At least 19 recordsLinked to original sources

PubMed2006

[Surgical management of spondylodiscitis. An analysis of 78 cases].

Spondylodiscitis is a rare bacterial infection of the spine with an inflammatory, destructive course. To obtain further information on the therapeutic management and clinical course of spondylodiscitis, we retrospectively investigated 78 patients after surgical intervention. Mean age was 64 years (+/-4.6 years; range 21-80 years), the mean length of stay 49 days (+/-8.2 days; 3-121 days) including 24 days (+/-4.7 days; 0-112 days) in ICU. In hospital mortality was 9%. The cervical spine was affected in 10%, the thoracic spine in 35% and the lumbar/sacral spine in 55% of patients. Abscess formation occurred in 65% and destruction of the vertebral body in 74%. A total of 75% of patients presented with neurological deficits which could be improved by surgical intervention in 82% of cases. 24 patients were treated by ventral debridement and stabilization alone, 20 patients with a combined dorsoventral method. Most patients (n=34) were stabilized via dorsal bridging instrumentation without ventral debridement of the focus. Of this group, 23 patients were initially scheduled for secondary ventral debridement but complete healing was achieved prior to this, so further surgical therapy was unnecessary. Successful cure was obtained in 92% of cases. Based on our findings, we favor a split surgical approach: initially with dorsal internal fixation only. Abscesses can be drained percutaneously. Ventral debridement and stabilization is only recommended if insufficient stability can be obtained by dorsal fixation alone, as shown by the persistence of infection or pain.

Adult↗

PubMed2006

[Avascular necrosis of the capitate in athletes].

The possibility of osteonecrosis of the carpal bones should always be considered when athletes present with pain of unknown origin in the hand and wrist, in particular, if they are participating in sports such as gymnastics or weight-lifting that involve extreme loading of the wrist with axial compression and microtrauma. This sort of extreme loading of the wrist combined with a constitutionally "weak" blood supply to the individual carpal bones may lead to the formation of osteo-necrotic zones. A treatment method that can produce excellent results, depending on the pathomorphology, is available in the form of vascularized bone grafting.

Adult↗

PubMed2004

[Periprosthetic supracondylar femoral fractures: LISS or retrograde intramedullary nailing? Problems with the use of minimally invasive technique].

Retrograde intramedullary locking nailing as well as the LIS system are propagated as minimally invasive treatment options for distal femoral fractures following total knee arthroplasty. In a retrospective study, we reviewed the clinical results after operative treatment of 18 periprosthetic supracondylar femoral fractures. The fracture was stabilized with the less invasive stabilization system (LISS) in nine patients (average age: 80.3 years) and with a retrograde intramedullary locking nail in the remaining nine patients (average age: 76.8 years). The mean follow-up was 18.2 months (6-35 months). We did not find significant differences concerning the operation time (nailing 99.8 min vs 102.3 min with the LISS) or the length of stay in the hospital (nailing 10.6 days vs 12.7 days with the LISS). In one patient of the nailing group we found a valgus malalignment of 18 degrees. Seven patients in each group were satisfied with the clinical results. In one patient of the LISS group a revision due to an infection was necessary. In one patient of the nailing group a reosteosynthesis had to be performed. To sum up, both systems are useful tools in the treatment of dislocated periprosthetic fractures and both systems are not without any problems. However, under special consideration of the complications we found in our study, the LISS seems to be a better alternative in osteoporotic bone with a small distal fragment. The choice of the optimal implant should therefore depend on the type of fracture and knee arthroplasty, the type of bone, and the experience of the surgeon.

Activities of Daily Living↗

PubMed2004

[Osteomyelitis of the spine].

Spinal infections are rare, occurring most often in elderly patients with urinary tract infections or diabetes. With the increasing number of patients with immune suppression, and also the increasing number of immigrants in the population, spinal infections are seen more frequently, especially in young adults. Typically spinal infections are monomicrobial, Staphylococcus aureus being the most common organism. Hematogenous spread of bacteria through the arterial paravertebral collateral vessels into the subchondral bone marrow of the vertebral bodies is the most common source of infection. Clinical presentation is often nonspecific. Important diagnostic measurements are laboratory studies, radiological evaluation including MR image scans, and CT-guided percutaneous biopsy of the lesion for microbiological studies. The management of spinal infections consists of antimicrobial therapy over 6-8 weeks. Surgical intervention is indicated in neurologically compromised patients for spinal instability and abscesses.

Anti-Bacterial Agents↗

PubMed2004

Role of subtilisin-like convertases in cadherin processing or the conundrum to stall cadherin function by convertase inhibitors in cancer therapy.

Cadherins are a family of intercellular adhesion receptors. Produced as inactive precursors, they become functional adhesion molecules after proteolytic cleavage by subtilisin-like pro-protein convertases (PCs). Owing to their activation and assembly into multiprotein adhesion complexes at sites of cell contacts, adhesion-competent cadherins are prerequisite for tissue integrity. In recent years evidence has accumulated that intercellular junctions not only provide mechanical linkage, but in addition are potent modulators of signalling cascades. This infers a biological role to intercellular adhesion complexes that is significantly more complex and powerful. Currently, the broad implications of disturbances in somatic tissue adhesion components are only just beginning to emerge. Prominent examples of adhesion defects include autoimmune diseases, or tumour invasion and metastasis and malignant transformation. This review reports on our current knowledge of cadherin function and their maturation by pro-protein convertases, and puts special emphasis on the consequences of pro-protein convertase inhibition for epithelial tissue homeostasis.

Animals↗

PubMed2003

[10-year results of bone marrow stimulating therapy in the treatment of osteochondritis dissecans of the talus].

The optimal operative therapy for the treatment of osteochondritis dissecans tali is still controversial. Beside bone marrow-stimulating techniques like abrasion arthroplasty, drilling and microfracturing, new techniques like autologous osteochondral transplantation and autologous chondrocyte transplantation are increasingly used. This study reviewed the clinical, radiological and subjective long-term outcome of bone marrow-stimulating therapy for 45 ankles with an osteochondritis dissecans tali stage 3 or 4 according to the classification by Berndt and Harty. All ankles were treated by the removal of the dissecate and abrasion of the subchondral bone. In 67%, an additional antegrade drilling of the defect was performed. The average maximum size of the lesion was 1.1 cm. At follow-up examination, 10.4 years (7.1-13.5 years) postoperatively, the average AOFAS-score was 91 points (66-100 points). Using the score of Mazur, the outcome of 28 ankles (62%) was rated excellent, 12 ankles (27%) were rated good and five ankles (11%) fair or poor. Progressive osteoarthritic changes, according to the classification of van Dijk, were seen in seven ankles (16%). Reoperations were necessary in eight cases (18%). Obesity, age older than 40 years and preoperative osteoarthritic changes had a significant negative impact on the clinical outcome. Bone marrow stimulating therapy is an inexpensive, low invasive therapy and a good therapeutic option at least for small Berndt/Harty stage 3 and 4 ODT lesions. Autologous chondrocyte transplantation and osteochondral autografts yield encouraging 2- and 4-year results, but still have to prove their superiority in long-term follow-up studies.

Adolescent↗

PubMed2003

[The postoperative control CT after a fracture of the acetabulum. A useful quality control measure or an unnecessary exposure to radiation?].

Fractures of the acetabulum are severe injuries of the hip joint. Exact preoperative management is necessary to make possible an anatomical reconstruction. Postoperative quality control is done best with computed tomography. Is the higher radiation exposure caused by this routine examination justified?During the 5 years from 1995 to 1999, a total of 154 patients with fractures of the acetabulum were examined postoperatively at our clinic using CT to control reconstruction, implant position and the remaining free fragments in the joint. Thirteen of these patients (8.4%) had to be re-operated after postoperative CT control. The causes of the re-operation were four cases of an intra-articular implant position, three of free fragments remaining in the joint, and in 6 patients showed inadequate reconstruction. The mean radiation exposure was 25 mGy per patient. The low mean age of the patients and the long lasting consequences of a probably unrecognised complication, justify routine, postoperative CT control, even though the radiation exposure is about 10 mGy higher than the conventional radiological diagnosis. The use of CT diagnosis as a routine postoperative measure is an appropriate control procedure that allows an objective assessment of the quality of the result for the patient as well as for the surgeon.

Acetabulum↗

PubMed2003

[Patellectomy after trauma: is there a correlation between the timing and the clinical outcome].

AIM OF THE STUDY: Is there a correlation between the timing of patellectomy after trauma in crush injuries and the clinical outcome? METHODS: Retrospective analysis of 21 patients who had undergone patellectomy after trauma. RESULTS: In 12 patients (57.1%) a primary patellectomy was performed within 4 weeks after the fracture; in the remaining 9 (42.9%) patients the procedure was performed after an average of 21 months (range 2-72). Nineteen patients could be followed up after 9.3 years (range 3-18). In 10 of these, patellectomy had been performed primarily. The HSS Knee Score was 68.4 points (range 39-83) on average for all patients. For patients with a primary patellectomy the score was 71 points (range 54-83), while for patients in whom the patellectomy was performed secondarily the score was 63.8 points (range 39-77). The evaluated ROM was 113.6 degrees for all patients; in the primary group ROM was 122.5 degrees (range 65-145 degrees ), and in the secondary group it was 103 degrees (range 85-145 degrees ). The difference was not statistically significant for either parameter. CONCLUSION: Primary reconstruction of the patella is recommended in multifragmentary fractures; if the outcome is poor, however, patellectomy should be considered early.

Adolescent↗

PubMed2003

[Importance of the cross-sectional area of the spinal canal in thoracolumbar and lumbar fractures. Is there any correlation between the degree of stenosis and neurological deficit?].

A relationship between traumatic spinal canal stenosis and the degree of neurological deficit is known for the cervical spine. However, this has not been proven for the thoracolumbar and lumbar spine. During a period of 4 years, from 1996 to 1999, 1168 patients with a spinal injury were treated at our department, 473 of these by operation. Thirty-five were examined in a separate group. They showed a single fracture of the thoracolumbar and lumbar spine with stenosis of the spinal canal. All fractures were single burst fractures after blunt trauma. All patients were conscious and fully oriented at the time of admission and a thorough neurological examination could be performed. The fractures were diagnosed by conventional X-ray in two views and computed tomography (CT). Using the transverse CT scans in horizontal view, the sagittal diameter was measured and the degree of stenosis calculated in percent at the level of the fracture and one below and above. The group included 25 male and 10 female patients, with a mean age of 38 years (range: 17-61 years). Of the 35 patients, 19 (54.3%) showed neurological deficits after spinal cord injury,and 16 (45.7%) were without any neurological complications at the time of first admission to the hospital. There was no correlation between the extent of spinal canal stenosis and the degree of the neurological deficit. One patient with stenosis of 20% suffered from neurological dysfunction, others with stenosis up to 80% were without spinal cord injury. The average stenosis of the spinal canal was 49.6% in cases with cord injury and 46.3% in patients without neurological dysfunction. No correlation and no predisposing anatomical structures could be found between stenosis and neurological deficit.

Adolescent↗

PubMed2003

Arthrodesis of the shoulder after septic arthritis. Long-term results.

We analysed the long-term results of arthrodesis of the shoulder after infection in 15 patients. At the time of operation, 14 cultures were positive for Staphylococcus aureus. The mean follow-up was 8.3 years (3 to 14) and 90% of the patients were satisfied with the outcome. There were complications in five patients (33%); in three there was nonunion with loosening of the implant. One patient had a sound bony union but with a persistent sinus six years after arthrodesis and another had a sinus which healed after the metal was removed. Four of these five patients (80%) were heavy smokers (> 20 cigarettes/day). Cancellous bone grafting did not affect the incidence of complications. The mean age of the patients with complications was 58.6 v 48.6 years for those without (p = 0.2808; not significant). Those with complications had had more previous operations (6.4 v 2.5, p < 0.05). Antibiotics, as determined by the bacteriological cultures, were administered for six weeks. The complication rate was higher in patients with active sepsis but the younger the patient and the fewer number of previous operations (< 50 years, < four previous operations), the better was the outcome. Considering the rate of complications, we recommend early surgery in these patients.

Activities of Daily Living↗

PubMed2002

Burst fracture of the fifth lumbar vertebra: results of posterior internal fixation and transpedicular bone grafting.

Burst fractures of the fifth lumbar vertebra are rare, and there are only a few reports on this subject, which is characterised by its unique anatomical and biomechanical features. This retrospective analysis reports on ten patients whose fractures of L5 were stabilised with a short internal fixator in combination with a posterior fusion as well as transpedicular bone grafting. The average follow-up period was 22 months. Radiometric data were surveyed and compared to the functional results. The height of the fractured vertebra remained nearly unchanged throughout the course. Loss of lordosis of 4 degrees in the upper disc space and 4 degrees in the lower disc space were observed postoperatively. At the time of follow-up, the values of segmental lumbar lordosis were significantly below the preoperative level. The narrowing of the neural canal was reduced from 57% to 28% with the surgical intervention. However, there was no correlation between the functional and the radiological outcome. Neurological deficits were documented in two patients, which declined during the course. There were no severe postoperative complications. The results of the present study demonstrate that the described surgical procedure in fractures of the fifth lumbar vertebra does not promote an anatomic restoration of the fractured vertebra, nor of the segmental lordosis. However, the clinical results do not correlate with the radiological outcome. Nonoperative treatment with early mobilisation without external support seems to be the treatment of choice.

Adolescent↗

PubMed2002

[Coracoid pseudarthrosis caused by anterior shoulder dislocation with concomitant coracoid fracture].

Fractures of the coracoid process are rare and represent only 2-5% of all fractures of the scapula. The most frequent cause of a coracoid fracture is direct trauma, but indirect trauma may also lead to a fracture of this kind. Avulsion injuries as part of an acromioclavicular dislocation are the most frequent forms of trauma. For the rare cases of an anterior shoulder dislocation with concomitant coracoid fracture, two different mechanism are discussed. One cause of the coracoid fracture could be direct impact of the dislocated head of the humerus on the coracoid process, another may be the occurrence of a sudden strong pull of the muscles inserting at the coracoid process during shoulder dislocation.In the majority of cases, conservative treatment with six weeks of immobilization is appropriate. If a pseudarthrosis occurs and there is persistent pain, we recommend the operative fixation of the distal coracoid fragment by insertion of cancellous bone graft taken from the iliac crest and stabilization with a cannulated AO titanium small fragment screw and PDS cord.

Adult↗

PubMed2001

[Supracondylar femoral fractures in knee endoprostheses. Stabilizing with retrograde interlocking nail].

The treatment of supracondylar fractures of the femur in total knee arthroplasty is still challenging, and a variety of methods has been recommended. In a retrospective analysis, we reviewed six patients (average age: 70.5 years) with this type of fracture that had been stabilized with a retrograde intramedullary locking nail [Green-Seligson-Henry (GSH) nail]. The fracture had occurred 34.5 months after implantation of total knee arthroplasty. The average time of the operation was 97.16 min. There were no intra- or postoperative complications. All patients could be followed up at 17.3 months on average. Fracture healing was uneventful in all six cases. The postoperative range of motion was similar to the prefracture level in five patients. One patient demonstrated a loss of extension (10 degrees) associated with a valgus malalignment of 10 degrees. According to our experience, retrograde intramedullary nailing of supracondylar fractures in total knee arthroplasty is a promising alternative, which allows closed reduction and preservation of the soft tissue envelope. Immediate mobilization with partial weight bearing is possible, and the rate of complications is low.

Aged↗

PubMed2001

Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion.

Up to 15% of all fractures involve the clavicle. Nonunion of the clavicle is a rare complication after conservative treatment. It mainly presents as pain at the fracture site and a limited range of motion of the shoulder. The purpose of this study is to define a certain type of fracture of the clavicle that is predisposed to malunion and therefore should be treated surgically after failure of conservative treatment. Thirty-nine patients with delayed or malunion of the clavicle were analyzed. There were 13 women and 26 men. The average age of the male patients was 36.4 years (range 20-59 years) and of the female patients, 43.6 years (range 18-55 years). The mean follow-up period was 2.3 years (range 6 months to 4.2 years). All of them were treated surgically. There were 33 Allman I fractures and 6 Allman II fractures. Of the Allman I fractures, 30 (91%) were shortened by at least 2 cm. Allman I fractures were treated using a reconstruction plate or a dynamic compression plate in combination with bone grafting. The time of operation after fracture ranged from 6 weeks to 8.5 years (average 9.8 months). Pain at the fracture site was the leading symptom in all patients. At 6 months after the operation, 38 patients were free of pain with an unlimited range of motion of the shoulder. One patient (2.6%) complained of a slight weakness on the operated site. One fracture failed to unite (2.6%) and had to be replated. There were no refractures, infections, vessel or nerve lesions. To conclude, in Allman I fractures with a shortening of more than 2 cm, we recommend operative treatment in symptomatic patients if there are no signs of callus formation after 6 weeks.

Adolescent↗

PubMed2001

[Complications in the use of the halo fixator].

50 patients out of a total of 88 who underwent treatment using a halo-fixateur between 1987 and 1997 were available for a follow-up interview reviewing local complications and quality of life. Marginal discomfort was observed in 54% of patients, moderate complaints/transitory pain in 30%, prolonged and severe discomfort and pain in 16%. 62% of patients took no analgetics, 22% infrequently, and 16% continuously throughout treatment. In pin-tract infection local treatment was successful in 6 patients, in 3 patients the screws needed to be relocated. Complaints of dysphagia due to extended forced lordosis of the cervical spine could be corrected by adjusting the position of the halo ring in 3 out of 8 patients. 3 patients developed pressure sores which could be managed without surgical intervention. Proper fixation and placement of the pin-tracts are crucial in the application of the halo fixateur if complications are to be avoided. Superficial infections must be treated locally. If the infection persists immediate pin relocation and systemic antibiotic therapy have to be initiated.

Adolescent↗

PubMed2000

[Anterior screw fixation for odontoid fractures].

The results of anterior screw fixation of odontoid fractures in 28 patients are presented. There were 27 type II- and 1 type III-injuries. Non-union with persistent instability had to be notified in one patient (3.6 %), secondary posterior C1/2 fusion had to be performed. Incorrect positioning of the screws in the odontoid with penetration of the postero-lateral cortex occurred in 3 patients (10.7 %). Malpositioning of the odontoid after screw fixation was documented in 5 cases (17.9 %). Cardiopulmonary complications had to be treated in 5 patients (17.9 %), 4 patients (14.3 %) died in the postoperative period. 17 patients could be followed up. Only 3 patients (17.8 %) were free of symptoms. A significant limitation in ROM of axial rotation was seen in 44 % of the patients. With anterior screw fixation of the odontoid high fusion rates can be achieved, however the procedure is technically demanding. Regarding the functional outcome, there is no significant difference to other established treatment methods.

Adolescent↗

PubMed2000

[Intrathoracic displacement of the transverse colon as a late complication after abdominal knife stab wound. A case report].

The treatment of stab wounds of the abdomen is discussed controversely. The management of these wounds depends on a high degree on the clinical situation of the patient. Repeated physical examination, peritoneal lavage and laparotomy are recommended. The identification of an isolated diaphragmatic injury is worrisome because its subtle clinical presentation is often not alleviated by adjunctive tests. Delayed recognition of an incarcerated diaphragmatic hernia has a high mortality rate. We report about an 23 year old African male, who was injured by an intraabdominal stab wound. Initially he did not have any clinical problems, but after 6 months he was admitted to the hospital due to severe pulmonary complications. A diaphragmatic hernia with dislocation of the transverse colon into the left thorax was identified on x-rays. A thoracotomy as well as a laparotomy were performed to restore the anatomic conditions and to dose the hernia. After two weeks, the patient could leave the hospital without pulmonary complications. Under consideration of the literature we recommend exploratory laparotomy for stab wounds that penetrate the left side of the chest below the fourth intercostal space anteriorly, the sixth intercostal space laterally and the tip of the scapula posteriorly. The high mortality rate after a delayed recognition appears to justify an early operative approach.

Abdominal Injuries↗

PubMed2000

[Acute pseudo-obstruction of the colon as complication of hip surgery].

Pseudo-obstruction of the colon is characterized by a massive colonic dilatation without mechanical obstruction. It is rarely after hip surgery, however, untreated it may be complicated by a life threatening perforation of the colon. In a retrospective analysis we reviewed 11 patients (4 women, 7 men, mean age 75.2 years, range 67 to 86 years) with pseudo-obstruction of the colon after hip surgery in the years 1995 to 1998. In relation to all patients aged 65 years and older who underwent surgery of the hip, the prevalence was 1.06%. The leading clinical symptom was abdominal distension. On plain x-rays, dilatation of the colon measured 13.3 cm on average (9-16 cm). In two patients (18%) adequate application of drugs stimulating the gastro-intestinal motility was sufficient, whereas in 8 patients (73%) colonoscopic decompression had to be performed. In three of these, the procedure failed and because of persistent symptoms a cecostomy was performed. One patient underwent immediate laparotomy because of peritonitis. 2 patients (18%) died because of a complicated course. Non operative treatment should not exceed 24 hours, endoscopic decompression and tube placement is considered as the treatment of choice. In cases of failure of these procedures, perforation of the colon and/or peritonism, urgent laparotomy with open decompression by a cecostomy is essential.

Acute Disease↗