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Biomedical subjects

G U Exner

Publications and source records attributed to G U Exner.

17 recordsLinked to original sources

[Rickets due to vitamin D deficiency--a reminder].

Vitamin D deficiency, because of prophylactic supplementation, has become a rare disorder in Switzerland and therefore is usually not considered in the clinical routine. In the few cases we could diagnose, the affected children either have been of East-Mediterranean origin with insufficient nutrition and vitamin supplementation, or were raised in families who, for philosophical or other reasons, refuse any "non-biological" measure including vitamin supplementation. For the orthopedic surgeon the challenging task is to screen out of the many children presented with physiologic gait "disturbance", bow-legs or flat feet the few children with true disorders. An important point is the history of vitamin D prophylaxis; in selected cases X-ray and laboratory findings are indicated. Finally the response to the treatment with vitamin D will confirm the diagnosis of rickets due to vitamin D deficiency.

Bone and Bones

[Complex disorders of radius and ulna in childhood].

Treatment of congenital or acquired disturbances of the radius or ulna always requires recognition of the complex biomechanics of the forearm. In particular trauma, seemingly restricted to one of the bones, should caution against concomitant lesions to the other bone. The typical example is unfortunately the often missed dislocation of the capitulum radii in Monteggia-type lesions. Additional examples are deranged growth of the distal epiphysis of the radius after a fracture of the ulna, in association with multiple osteochondromas and of the proximal epiphysis of the radius in presumptively congenital dislocation of the capitum radii. Lesions encountered in children have to be analyzed carefully with respect to dynamics of maldevelopment. Corrections that have implications for neighbouring articulations should be undertaken with the intent to fully exploit the potential for remodelling by forthcoming growth processes.

Adolescent

[Hip diseases in children].

In the orthopedic practice, the hip joint is of special importance at all ages. For the general practitioner and the pediatrician are those disorders of the hip of high importance, for which early diagnosis and initiation of treatment is critical for prognosis. The following disorders should be looked for in priority, if symptoms indicate a possible affection of hip: congenital dysplasia and dislocation of the hip, coxitis, slipped capital femoral epiphysis, and tumors. One should always be aware that especially in children disease of the hip need not necessarily present with symptoms directly located within the region of the hip. Especially the child often complains only about knee or vague leg pain, while having a disorder of the hip; therefore, the cause of any pain should always also be looked for proximal to the structure, where the pain may be localized by the patient.

Bone Neoplasms

[Early diagnosis of hip dysplasia--arguments for a general ultrasonographic screening].

We propose a systematically performed ultrasonographic screening of the infant's hip in Switzerland. This demand is based on shorter treatment of dysplastic or dislocated hips, if the diagnosis is established before the age of three months. In addition, the costs of treatment are remarkably reduced if treatment can begin at an early age. In order to avoid late surgery causing high costs, an early treatment of the dysplastic hip is indispensable.

Costs and Cost Analysis

["Congenital" dislocation of the radial head. A bilateral case developing around the age of ten].

Dislocation of the head of the radius has important repercussions on pronation-supination, elbow stability and on the wrist joint. In the absence of a history of trauma, this anomaly is generally considered to be "congenital". Few authors have described the progressive acquisition of this dislocation during growth. The case of a 20 year old man is presented, corresponding to initial subluxation which gradually evolved towards dislocation of the head of the radius at about the age of 11 years. This type of dislocation appears to be related to abnormal growth of the proximal radial epiphysis, responsible for repercussions on the humero-radial articular relations and on the anatomy of the upper extremity of the radius. The patient was treated by ulnar osteotomy at the age of 17 years according to Hirayama's technique, when he was probably already too old. Surgical correction of the subluxation of the head of the radius at an earlier age would probably have been preferable.

Age Factors

[Experiencing and coping with the diagnosis and therapy of a malignant bone tumor and the survival time afterwards].

UNLABELLED: Six patients who had been treated for osteosarcoma of the lower extremity report their experience and how they mastered diagnosis and therapy as well as the time thereafter. They give information regarding especially the following points: psychological stress during different phases of their disease, aspects of the information they received during treatment, how they felt during therapy and how and where they have received support, wishes, etc. RESULTS: In order to master the disease as well as the sequelae they need sufficient time and opportunities to express their feelings to others and sufficient understandable informations about examinations, therapy and prognosis. There are large variations in how the individual patient responds to the threat by the disease. The whole period of time with repeated hospitalizations that extends over about one year in retrospect has been judged to be very burdening. Most of the patients feel to be strongly challenged during chemotherapy; physically, they are reduced, are oversensitive and need sensitivity and support by the persons taking care of them. The informations given by the patients allow us to improve treatment and support of patients in the future.

Adaptation, Psychological

[Reconstruction of large segmental defects of the lower extremities following resection of malignant and locally aggressive bone tumors].

The chances to be cured from a primary malignant musculoskeletal tumor have improved dramatically during the last two decades with the introduction of adjuvant chemotherapy. The cure rate e.g. for osteosarcomas and Ewing sarcomas has improved in this period from about 20% to 75%. Furthermore instead of amputations for local tumor control local resections have become possible in most cases when the rules of oncologic surgery for such tumors beginning with the biopsy are strictly followed. With the improved long term survival of patients afflicted by musculoskeletal malignancies the demands upon reconstructions after large resections have significantly increased. Techniques actually available for different localizations of tumors of the femur and tibia with trends for 'more biologic' procedures with arthrodeses and massive allografts are demonstrated besides new endoprosthetic material.

Adolescent

Fibular aplasia. Early surgical correction in two cases.

Two infants with bilateral fibular aplasia are described. They were operated on at 1 1/2 years and 8 months respectively in order to obtain a stable axial position of the foot beneath the tibia. The procedures consisted of soft tissue releases together with angulation osteotomies of the tibiae in one, and splitting the distal tibial epiphysis in the other. Both patients are now able to walk well barefoot or in custom-made shoes; no orthotic devices are needed. This type of conservative approach should be considered rather than amputation in selected cases.

Fibula

Loss and recovery of trabecular bone in the distal radius following fracture--immobilization of the upper limb in children.

Computed tomography of the human radius is performed using a special purpose scanning device which incorporates a radionuclide (125I) as radiation source. Parameters decribing the trabecular bone and the compact bone are determined at a distal and a diaphyseal measuring site respectively. Using this measurement technique changes in bone mineralization in the radius were studied in a group of 23 children following immobilization of an upper limb for fracture healing. An immobilization period of between three to six weeks resulted in a reduction of the relevant parameter value of up to 44% (mean 16%) in the distal part of the radius, whereas no significant change could be seen in the diaphyseal part of the same bone. Rapid remineralization of trabecular bone is indicated by the increase of the corresponding parameter value at a rate of up to several percent per week. However, in some of the patients studied complete normalization was not attained during the first six months following cast removal.

Bone Regeneration

Bone densitometry using computed tomography. Part I: selective determination of trabecular bone density and other bone mineral parameters. Normal values in children and adults.

Gamma-ray computed tomography (gamma-ray CT), using a special purpose scanner, enables in-vivo quantitative analysis of bone mineralization. Trabecular bone density (TBD), the relative amount of compact bone (bone density, BD) and the total absorption (TA) for a cross-section of the radius are determined from measurements of local linear absorption coefficients. A preliminary study of normal children (n = 49) and adults (n = 34) indicated that TBD is independent of age and sex in the age range 4 to 40 years. DB remains constant throughout childhood but increases after puberty in both women and men. TA is higher for adults than for children, and also higher for men than for women. A correlation between TA and parameters relating to body size indicates a relationship between body weight and bone mass.

Adolescent

Bone densitometry using computed tomography. Part II: increased trabecular bone density in children with chronic renal failure.

The method of gamma-ray computed tomography (gamma-ray CT) bone densitometry described in the preceding article provides selective determination of trabecular bone density (TBD), the relative amount of compact bone (bone density, BD), and the total absorption (TA) within a bone cross section. Seven of nine children with chronic renal failure (CRF), and selected only on the basis of their serum creatinine value (greater than 5 mg/100 ml), had increased TBD values above the normal range, whereas the other bone mineral parameters were normal. Radiographic signs of secondary hyperparathyroidism (subperiosteal erosions, cysts) were reported in the five patients with the highest TBD values, whereas the subjective diagnosis of osteosclerosis reported in three of these five and in one other patient correlated less well with the TBD increases. However, this is the first report of an objective, non-invasive documentation of the radiological finding of osteosclerosis in CRF. It also explains why methods for bone mineral measurements used previously, such as a photon absorptiometry which provides only a parameter equivalent to TA, failed to reveal increases in bone mineral content in renal osteodystrophy even when signs of osteosclerosis were present. Thus, gamma-ray CT helps to document objectively the degree of osteosclerosis and its location.

Adolescent

Growth retardation and bone mineral status in children with coeliac disease recognized after the age of 3 years.

Growth data, clinical symptoms and bone mineral parameters were analyzed in 20 children with coeliac disease in whom the diagnosis was established by biopsy at age 3-13 years. Small stature and bone age retardation (greater than 2 SD) were present in 65% and 60%, respectively. Typical clinical symptoms of coeliac disease as found in the younger child were present in many cases, but 3 were completely asymptomatic except for severe growth retardation. Metacarpal diameters and cortical thickness were significantly decreased for chronological age but in most cases normal for bone age. Quantitative bone mineral analysis of the radius by computed tomography revealed normal values for height and weight in the 4 cases investigated. It is concluded that coeliac disease should always be considered in the differential diagnosis of retarded growth and bone age. "Osteoporosis" may occur in coeliac disease, but does not necessarily accompany growth failure. The analysis of metacarpal diameters and cortical thickness in the search of "osteoporosis" may result in false interpretation if not correlated to height and weight.

Adolescent

Treatment of cryptorchidism by intranasal synthetic luteinising-hormone releasing hormone. Results of a collaborative double-blind study.

The effect of intranasal luteinising-hormone releasing hormone (L.H.R.H.) in 84 boys with unilateral or bilateral cryptorchidism was evaluated in a double-blind controlled trial. Boys with retractile testes were not studied. L.H.R.H. caused no side-effects; plasma antibodies to L.H.R.H. were never demonstrated. Four weeks' therapy with intranasal L.H.R.H. administered in six doses daily (1.2 mg/day) led to complete descent in 38% of a total of 61 testes, an improved position in 28%, and no response in 19%; 15% of testes were never palpated. After placebo the position of 25% of testes was improved; there was no response in 75% of a total of 51 testes. The success-rate seemed to be independent of age, but was related to the initial testicular position, with complete descent in only 11% of testes not previously palpated compared with 48% of testes found in the inguinal region.

Administration, Intranasal

Influence of intermittent long-term stimulation on contractile, histochemical and metabolic properties of fibre populations in fast and slow rabbit muscles.

Slow (m.soleus) and fast (m.tibialis anterior) muscles of the rabbit were subjected to indirect long-term intermittent stimulation (3 weeks, 8 hrs daily) with a frequency pattern of 10 imp/sec. Whereas no changes were observed in case of the slow muscle, stimulation induced profound changes in the fast tibialis anterior muscle. These consisted in a rearrangement of the enzyme activity pattern of energy-supplying metabolism, e.g. decrease in glycogenolytic and glycolytic enzyme activities and severalfold increase in key enzymes of aerobic endoxidation of substrates in beta-oxidation and the citric acid cycle. Concomitant with the increase in aerobic oxidative capacity, there was an increased resistance to fatigue. Histochemical studies revealed a strong increase in mitochondria of all fibres. The bimodal distribution of fibre cross-sectional area in the normal tibialis anterior muscle was changed by stimulation into a more homogeneous population of fibres with a smaller cross-sectional area. Despite a 50% increase in time to peak of isometric twitch contraction no changes were observed in the fibre population with regard to myofibrillar ATPase reaction in quantitative evaluation of whole cross-sections of the muscles. The percentage of fibres histochemically classified as slow amounted to 2.8% and 3.1% in control and stimulated tibialis anterior muscle. Nevertheless the data suggest a transformation of the fibre population under the influence of long-term intermittent stimulation.

Adenosine Triphosphatases

[Technique and tactics of biopsy including puncture].

The biopsy is the key for the exact diagnosis of bone and soft tissue sarcomas. However the biopsy implicates risks that eventually may significantly interfere with the prognosis. The steps of the biopsy can be differentiated in tactical and technical aspects. Tactical aspects include laboratory examinations (e.g. blood count, immunological, chemical tests) in order to establish the prebiopsy differential diagnosis, basic imaging procedures (bone scan, magnetic resonance imaging) and to discuss with the pathologist questions as which region of the tumor might be most informative, how should the material be preserved and whether a frozen section might be useful and allow for initiation of therapy as early as possible. Furthermore the site of the biopsy has to be carefully chosen, the compartments that need being passed through or opened up during biopsy must be considered. The technical aspects refer to the approach and tissue handling during the biopsy itself. Fine needle aspiration allows only for a cytologic, core biopsies for a histologic examination (however only of a small sample), while the open biopsy provides more material for more analyses. Any biopsy (open biopsy as well as percutaneous puncture) contaminates the path with tumor cells and increases the risk of systemic seeding. In order to keep these risks as small as possible the most careful technique and tissue handling is mandatory. The biopsy path has to be completely ('en bloc') resected later for local tumor control.

Adolescent

[Osteochondrosis dissecans of concave joint surfaces: roof of shoulder joint, tibial plateau, distal tibia].

Typically an osteochondrosis dissecans occurs in the region of a convex articular surface, the most frequently localisation observed being the medial femoral condyle. Only few cases of an osteochondrosis dissecans in concave articular surfaces have been reported; these involved the tibial plateau, the distal tibia and the proximal surface of the navicular bone. Two more cases with an osteochondrosis dissecans in the proximal and distal tibial epiphysis are reported and additionally a hitherto unreported localisation in the glenoid fossa of the scapula. True osteochondrosis must be differentiated from ossification variants.

Adolescent

[Fatigue fracture as a tumor-simulating lesion. Differential diagnostic delimitation using proton spin tomography].

Fatigue (stress) fractures are due to increased repetitive stresses. The onset of clinical symptoms and the pain characteristic usually are vague; furthermore the radiographic picture shows lesions of different age and therefore may mimic a pattern typical of bone tumors. While for malignant bone tumors early diagnosis, biopsy and initiation of the appropriate treatment is of importance, the biopsy of a fatigue fracture is not only unnecessary, but also may interfere with the healing process. The value of magnetic resonance imaging in the differential diagnosis between tumors and fatigue fractures has therefore been analysed. Five consecutive cases of fatigue fractures have been evaluated from the onset of symptoms for a mean of 19 month (range 3-45 month) of follow-up. The signal pattern with low intensity in the area of the lesion in T1- and T2-weighted images seen in 2 cases has lead to observe the process under immobilization of the affected limb, while because of an increase of the signal intensity from T1- to T2-weighted images as seen in almost all malignant bone tumors biopsy has been performed in 2 cases. In 1 cases no biopsy but close-meshed clinical examinations were performed although there was an increase of the signal. From these observations we conclude that the MRI in fatigue fractures may either show a 'chronic' type of reaction with low signal intensity allowing for the caution observation while in cases with the rather 'acute' reaction with increased signal biopsy usually cannot be avoided in order not to miss a malignant tumor.

Adolescent