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G Pap

Publications and source records attributed to G Pap.

At least 37 records · Page 2Linked to original sources
PubMed1999

Detailed analysis of proprioception in normal and ACL-deficient knees.

We assessed proprioception using threshold levels for the perception of knee movement at slow angular velocities (0.1 degrees/s to 0.85 degrees/s) in 20 patients with unilateral tears of the anterior cruciate ligament (ACL) and 15 age-related control subjects. Failure to detect movement was also analysed. The threshold levels of detection did not differ between the damaged and undamaged knees in the patients or between the patients and the control group. Failure to appreciate movement, however, was significantly greater in knees with ACL loss compared with the undamaged knees of patients and the control group. Our findings show a proprioceptive deficit in the absence of the ACL. Measurements of threshold levels of detection of passive movement alone are not suitable for the evaluation of proprioceptive loss in ACL deficiency; assessment of failure to appreciate movement is essential.

Adult↗
PubMed1999

[Experiences with the GSB (Geschwend-Scheier-Bähler) III total endoprosthesis in the elbow joint].

Studies on the results with elbow prostheses published in the seventies reported on marked problems such as high loosening rates and instabilities of the joints. However, enormous progresses in elbow replacements have been made in the meantime. Therefore, we analyzed the results of the GSB III-elbow-prostheses that were implanted in our department for 9 years. Between January 1, 1987 and April 1995 at our department 34 total elbow replacements were performed in 32 patients. In this study, we reviewed 25 patients with elbow replacements both clinically and radiologically. The clinical outcome was rated according to the score of INGLIS and PELLICI. The mean follow-up time was 3.7 years. Our follow up examination revealed a total complication rate of 22%. Septic prosthesis loosening with explantation of the prostheses occurred in 3 patients resulting in a prosthesis survival-rate of 88%. However, clinical assessment revealed 80% excellent or good results. While the range of motion could only be improved to a small degree, a marked reduction of the preoperative pain could be achieved. Patients were satisfied with the outcome of the operation in 97%. Although the results of total elbow arthroplasties cannot be compared with those of hip or knee arthroplasties, in selected patients with rheumatoid arthritis and osteoathrosis the use of elbow replacements proved to be a successful procedure with satisfactory results. The implantation of elbow prostheses should mainly be considered when debilitating pain, strongly limited range of motion and instability of the joint are the main problems.

Arthritis, Rheumatoid↗
PubMed1999

[New findings in orthopedic pathology].

The term orthopedic pathology refers to bone- and joint-affecting diseases which are important for the orthopedic surgeon. In the report presented here, emphasis is placed on the membrane-associated proteolysis, which is essential for the degradation of the extracellular matrix. Matrix-degrading processes play a role not only in arthrosis but also in rheumatoid arthritis. Moreover, they are strongly associated with the problem of loosening of protheses, which is of utmost importance for the orthopedic surgeon. In these processes, major roles are played by the plasminogen activator system, plasmin, different matrix metalloproteinases, including the membrane type matrix metalloproteases and different cathepsins. A deeper insight into the function of these proteins and their influence on the matrix degradation in joint diseases will open the way for new diagnostic and therapeutic strategies. Investigations into a large number of chondrosarcomas have shown that for this type of bone lesions, urokinase plasminogen activator and cathepsin B are prognostic parameters that are independent of the differentiation grade. Also, in this context, investigations into the membrane-bound proteases will be of great practical and diagnostic value.

Arthroplasty, Replacement↗
PubMed1999

Membrane-type-1 matrix metalloproteinase is abundantly expressed in fibroblasts and osteoclasts at the bone-implant interface of aseptically loosened joint arthroplasties in situ.

OBJECTIVE: To investigate the distribution pattern of membrane-type-1 matrix metalloproteinase (MT1-MMP) within the synovial-like interface membranes of failed prosthetic joints. METHODS: Interface tissue around loose arthroplasties containing both fibrous membrane and attached bone was obtained from 6 patients at revision surgery. In situ hybridization with digoxigenin labeled RNA probes was applied to investigate MT1-MMP expression in paraffin sections of the samples. In addition, double labeling using immunohistochemistry was performed to characterize MT1-MMP producing cells. RESULTS: Apart from being present in fibroblasts, MT1-MMP was also found expressed in osteoclasts at sites of bone resorption. Our results revealed no expression of MT1-MMP at parts of the membrane that originally had been located next to the prosthesis. In contrast, abundant staining for MT1-MMP was observed at sites attached to bone. MT1-MMP mRNA expression was more intense at those sites of bone resorption covered by a thicker interface membrane. CONCLUSION: These results indicate a role for MT1-MMP not only in matrix degradation by fibroblasts but also in osteoclast mediated bone resorption. Given the ability of MT1-MMP to activate MMP2 and MMP13, they suggest also that osteoclasts might contribute to matrix degradation by activating these MMP. This could be of potential interest not only for other conditions in which bone resorption by fibroproliferative tissue plays a role, but also to design novel strategies to prevent loosening of prosthetic joints.

Arthroplasty, Replacement↗
PubMed1998

[Influence of retropatellar arthrosis on the proprioceptive ability of patients with gonarthrosis].

Degenerative changes of the retropatellar articular surface contribute to a great extent to functional disability in patients with osteoarthritic knees. Therefore, in the present study we examined the influence of retropatellar osteoarthritis (OA) on proprioception in patients with knee OA. Comparison of movement sense determined by threshold levels for the perception of knee motion was performed in 10 patients with severe, in 10 patients with moderate, and in 9 patients with mild retropatellar OA. In addition, detection failures occurring during movement sense measurements were analysed. At correct movement detections, threshold levels did not differ between the three groups of patients regardless the extent of retropatellar OA. In contrast, analysis of detection failures occurring during movement sense measurements revealed significantly higher failure rates with greater severity of retropatellar OA. In conclusion, our study gives evidence for increased proprioceptive deficits with greater severity of retropatellar articular surface damage. Hereby, analysis of detection failures occurring during movement sense measurements proved to be a feasible tool for the assessment of proprioceptive deficits.

Humans↗
PubMed1998

[Measuring knee joint kinesthesis for determining proprioceptive deficits in varus gonarthrosis].

Studying knee osteoarthrosis proprioceptive deficits play a growing role. However, the methods for the detection of these deficits using joint position sense measurements have been criticized recently. Therefore, we developed a new method for the measurement of knee-joint kinaesthesia. At 5 different angular velocities of passive knee movement both movement and stop detection were tested. Tests were performed both in 25 patients with osteoarthrosis of the knee and in a control group of 20 age related normal subjects. In addition to the measurements of movement detection and stop-detection thresholds, a specific detection-failure analysis was performed in our study. In addition to a significant improvement of proprioceptive abilities with increasing angular velocities, detection failure analysis brought about significant differences between patients with knee osteoarthrosis and normal subjects yielding a significant proprioceptive deficit in osteoarthrosis of the knee. In contrast, in case of correct movement detection or stop-detection there were no significant differences in the detection-threshold values between normal and ostheoarthrotic knees. In conclusion, both the lack of differences in detection thresholds between the arthrosis and the control-groups and the increased detection failure rates in arthrosis patients gave evidence for these proprioceptive differences being a result of central nervous dysregulation in knee osteoarthrosis.

Humans↗
PubMed1998

Development of osteoarthritis in the knee joints of Wistar rats after strenuous running exercise in a running wheel by intracranial self-stimulation.

The influence of excessive running load on the development of knee osteoarthritis (OA) was investigated in male Wistar rats. Running exercises were performed in a running wheel using intracranial self-stimulation to motivate Wistar rats to run daily distances of 500 m at 5 days/week. Hereby, ten rats ran a distance of 15 km within three weeks while a further ten rats run a total of 30 km within six weeks. Thirteen Wistar rats without running exercises served as controls. Complete knee joint sections of all rats were evaluated histologically using MANKINs grading system with categorization of the findings into non, mild moderate, and severe osteoarthritis. In addition, immunoreactivity of the chondrocytes to MMP-3 as an important cartilage degrading enzyme in OA was assessed by immunostaining with monoclonal MMP-3 IgG antibodies. Histological assessment of the knee joint sections revealed a significant increase in osteoarthritic changes with higher running load. While in rats with 15 km running all but two knee joints showed mild OA, moderate OA was the predominant finding in rats with 30 km running. In contrast, no OA was found in the controls. Immunostaining for MMP-3 revealed a significant increase in immunoreactivity of the chondrocytes to MMP-3 with higher running load, indicating a running load-depending production of this cartilage-degrading enzyme in the course of increasing OA. Compared to 47.4% immunoreactive chondrocytes to MMP-3 in the controls, this ratio rose to 70.4% in rats with 15 km running and even up to 89.9% in rats with 30 km running. In conclusion, in Wistar rats, excessive running load leads to marked, running distance-depending osteoarthritic changes which are caused, at least in part, by an increase in MMP-3 production rising with greater running distance. Within this exercise model of OA, intracranial self-stimulation is an effective method to motivate Wistar rats to extremely excessive running in a running wheel. This model offers a wide range of further approaches to studying different processes of the development of OA.

Animals↗
PubMed1998

[Changes in proprioceptive capacities of the shoulder joint in ventral shoulder instability. A comparative study before and after arthroscopic labrum refixation].

Measurements of movement sense determined by threshold levels for the perception of motion of the shoulder were performed in 10 patients with unilateral posttraumatic shoulder instabilities, in 30 patients who underwent arthroscopic labrum repair for recurrent anterior shoulder instability, and in 15 age-related controls. In patients with anterior shoulder instabilities threshold levels for the perception of motion were higher. In addition, movement sense measurements revealed a marked, but time dependent improve of proprioceptive abilities in patients who underwent arthroscopic labrum repair. While in the shoulders of patients with an postoperative period shorter than 18 months elevated threshold levels for the perception of motion still could be observed, after a postoperative period of 18 moths or more movement sense was not different from normal, uninjured shoulders. In conclusion, our study gives evidence for a proprioceptive deficit with anterior shoulder instability which improves significantly after arthroscopic labrum repair. The restitution of proprioceptive abilities, however, seems to be a time dependent process.

Adult↗
PubMed1998

[Outcome in therapy of hand infections--are there differences between East and West Germany?].

In 564 patients treated at the University of Magdeburg Medical School, we evaluated the timing of surgical intervention and the use of systemic antibiotics and their influence on recovery and treatment results. Special attention was paid to the question if there are any differences between East- and West-German treatment results. While early surgical intervention and radical débridement are the most important factors for complete recovery, differences in the availability and use of antibiotics did not play a significant role in results.

Adolescent↗
PubMed1998

[Long-term outcome of Putti-Platt operation in recurrent traumatic ventral shoulder dislocations].

In the present study, we reviewed 25 patients who had been treated by Putti-Platt procedure for recurrent traumatic anterior shoulder dislocations between 1988 and 1991. The average follow up time was 6.8 years. Redislocations occurred in nine cases (36%), five of these patients had to undergo a second shoulder reconstruction. Clinical examination with exclusion of the reoperated patients revealed signs of instability in further six patients. Six patients showed decreases in external rotation of more than 40 degrees compared with the nonoperated shoulder. According to the Rowe-score, results were judged as excellent or good only in 55% while they had to be estimated as poor in 30%. At follow up, 13 patients still suffered from limitations in their shoulder functions, only six out of 15 patients were able to return to their sporting activities postoperatively. Thus, the Putti-Platt procedure revealed rather disappointing long-term results and cannot be recommended.

Adolescent↗
PubMed1997

[Gray scale histographic analysis of the acetabular cartilage for quantifying hip ultrasound images].

AIM: Congenital dislocated hips are classified in ultrasound studies using the angle measuring system of Graf and evaluating the typical changes in acetabular form and structure. We attempted to quantify physiological and pathological changes in the acetabular cartilage using B-mode scan ultrasound studies. METHODS: Gray-level histograms were performed on 894 infant hips; 833 were classified by the Graf scheme as Type IIa and 61 as Type IIIa/b. We compared the histological structure of the cartilage of both the acetabulum and the head of the femur using objective parameters. RESULTS: We could show that gray-level histograms of the acetabular cartilage are an ideal way to study objectively ultrasound evaluations of the same area. Type IIa hips with histographically identified ossification zones show significantly higher healing rates than those without such areas. Type IIIb hips with histographically demonstrated pathological changes showed a significantly longer healing rate and a higher incidence of persistent dislocations that did Type IIa hips with normal cartilage. CONCLUSION: Structural changes in the acetabular cartilage can be evaluated not only qualitatively but also quantitatively to provide prognostic information in infants with congenially dislocated hips. Gray-level histograms nicely supplement ultrasound examination.

Acetabulum↗
PubMed1997

[Treatment of recurrent traumatic shoulder dislocations with coracoid transfer--Latarjet-Bristow operation].

We reviewed 31 patients with recurrent traumatic anterior shoulder dislocations, being operated with the Latarjet-Bristow procedure consecutively between March 1991 and March 1994. The average follow-up time was 31.2 months. According to the Rowe-score results were estimated as excellent in 45.1% and as good in 38.7%. New shoulder dislocations occurred in one case, resulting in a new shoulder dislocation rate of 3.2 per cent. Deficits in the external rotation of more than 5 degrees compared with the not operated side were seen in 15 patients. In two patients 7 respectively 9 months after the operation loosenings of the screws happened, but were without any effect on the functional outcome of the operation. The Latarjet-Bristow procedure proved to be a very safe method with a low redislocation rate, few complications and good functional results. Because of limitations in external rotation, however, this method should only be performed in cases in which an anatomic labrum reconstruction is hardly possible.

Adolescent↗
PubMed1992

A clinical evaluation of XPERT NCT (Reichert) for glaucoma screening by optometrists.

XPERT NCT advanced logic pneumotonometer (Reichert) was studied for its reliability and use in glaucoma screening. The evaluated 2400 NCT measurements on 300 eyes were compared to the results of Goldmann applanation tonometry (GAT) from the same eyes. Repeated NCT tonometry had no significant effect on IOP. Local anesthesia reduced mean NCT-GAT difference and standard deviation significantly (p < 0.05), i.e. feeling due to the diminished air pulse force provided by the instrument had still considerable influence on IOP. NCT-GAT regression was significant (p < 0.01). Mean IOP readings provided by NCT were four mmHg higher than GAT values. Although accuracy was not satisfactory for exact measuring, it was satisfactory for screening. The results suggested that four mmHg less than the mean IOP value seen on the display is acceptable for screening when the difference between the minimal and maximal individual readings on the display is less than 2SD i.e. six mmHg. In the case of a greater difference, the maximal value is to be replaced, as NCT tends to read higher values than GAT.

Glaucoma↗
PubMed1991

Does the lymph drainage from the head influence aqueous humour outflow and visual functions?

Effect of lymphoedema of the head on the central nervous system is known. Possible changes in intraocular pressure, tonogram, electroretinogram, visual functions and ophthalmologic state was studied in animal experiments and in patients following serious surgical impairment of the cervical lymph drainage. Lymph drainage from the orbit to the deep cervical lymphatics was established, while no ophthalmologic alteration was detected after surgery.

Animals↗