Biomedical subjects

H Osterman

Publications and source records attributed to H Osterman.

At least 19 recordsLinked to original sources

PubMed2000

Reoperations after lumbar disc surgery: a population-based study of regional and interspecialty variations.

STUDY DESIGN: A follow-up study using nationwide administrative databases. OBJECTIVES: To explore rates of reoperation after lumbar disc surgery and their regional and interspecialty variations. SUMMARY OF BACKGROUND DATA: In many Western countries, rates of lumbar disc surgery display significant geographic variations suggesting varying treatment criteria among operating surgeons. Few population-based studies have explored the risk of reoperation after disc surgery, and regional or interspecialty variations in the reoperations are unknown. METHODS: Patients who underwent lumbar spine surgery from January 1, 1987 through December 31, 1995, were identified in the Finnish Hospital Discharge Register. Data on the patients' initial disc operations, subsequent operations, and cause-of-death records were linked using personal identification codes. The Kaplan-Meier method and proportional hazard model were used to analyze risks of reoperation after initial surgery, according to hospital catchment area rates of disc surgery and for neurosurgical and orthopedic patients of university hospitals. RESULTS: 12.3% of 25,359 surgical patients with herniated lumbar discs underwent subsequent lumbar operations corresponding to the cumulative risk of 18.9% in the 9-year follow-up. Reoperation rates increased during the study period with the recent patient cohorts exhibiting risks. The reoperation risk showed a systematic geographic variation: the higher the regional disc surgery rate, the higher the reoperation risk. Overall, neurosurgical patients had a higher reoperation risk than orthopedic patients (relative risk [RR]: 1.57, 95% confidence interval [CI]: 1.17-2.10), but this was not a uniform finding. CONCLUSIONS: The reoperation risk after disc surgery increased during the study period and was higher in hospital catchment areas with higher overall discectomy rates. The reoperation risks varied among the university hospitals but tended to be higher for neurosurgical rather than for orthopedic patients.

Adult↗

PubMed1997

The process of amputation and rehabilitation.

The process of rehabilitation of the amputee begins before any surgical intervention. It embodies a team concept with the patient at the core. Evaluation of the appropriate amputation level involves a number of parameters and input from all the team members. Goals are modified as the rehabilitation progresses. The involvement of family and/or significant other is crucial for a positive outcome. Whether or not the patient is a prosthetic candidate, the rehabilitation process is designed to achieve maximum independence, and an improved quality of life.

Amputation, Surgical↗

PubMed1996

Evidence for insufficient chondrocytic differentiation during repair of full-thickness defects of articular cartilage.

The main objective of this study was to characterize the cellular phenotypes in the repair tissue of full-thickness defects of articular cartilage by histologic and molecular biologic techniques. Healing of the defects in the articular cartilage of the knee joints of 12 rabbits was analyzed at days 3, 7, 14, 28 and 50 using histology and Northern analysis of mRNA levels for type I, II and III collagens and osteonectin. The cellular source of each mRNA was determined by in situ hybridization. Two novel cDNA clones for rabbit type II and III collagen mRNAs were constructed to obtain species-specific hybridization probes. The repair tissue of full-thickness defects consisted of two types of tissue. At the bottom of the defect, bone-derived cells with high levels of type I collagen and osteonectin mRNA were actively producing new osteoid, while superficially a slow transition from a fibrin clot into undifferentiated mesenchyme with cells containing type III collagen mRNA was observed. This tissue subsequently became fibrocartilaginous, with small groups of cells turning on the transcription of the type II collagen gene and acquiring a phenotype typical for hyaline cartilage. The data suggest that small clusters of cells in the repair tissue of full-thickness articular cartilage defects are capable of turning on an apparently correct chondrocytic phenotype. The low transcription level of the type II collagen gene suggests, however, that insufficient amounts of fundamentally important regulatory factors or progenitor cells are present in the repair tissue. In the future, such factors should be administrable into the joint by novel therapeutic means.

Amino Acid Sequence↗

PubMed1996

Control of the residual tibia in transtibial amputation.

Eight transtibial amputees had localized unremitting discomfort and pain in the distal anterior residual limb during prosthetic wear while weightbearing. Modification of the prosthetic socket did not change this pain. It was not consistent with "phantom limb" or causalgia/reflex sympathetic dystrophy-type etiologies. Thirteen randomly selected, pain-free, transtibial amputees were selected for comparison. The subjects in both groups used similar total-contact, "patellar tendon-bearing" prosthetic sockets fabricated and aligned with similar technique. The angles formed between the femur and tibia, femur and prosthetic socket, and tibia and socket were measured. Significant differences were found at each angle measurement between those patients who experienced pain and those who did not. The variable of tibia length had no effect. We conclude that bone alignment within the transtibial total-contact prosthetic socket may be partially dependent on surgical technique and not solely on prosthetic socket configuration.

Amputation, Surgical↗

PubMed1996

Experimental lumbar spondylolisthesis in growing rabbits.

Lumbosacral spondylolisthesis was provoked experimentally in growing rabbits by means of a bilateral facet joint resection at the L7-S1 segment. The effects of additional immobilization of the L6-L7 segment with bone cement and of severing the lumbosacral disc on the development of the olisthesis were tested. A mean ventral slip of 21% was seen after the facet joint resection. The slip resembled the spondylolisthesis seen in humans in wedging of the olisthetic vertebra, sacral rounding, and increased sagittal rotation. Combining the facet joint resection with immobilization of the L6-L7 segment resulted in a mean slip of 15%. Morphologic features of the slip were like those seen after a plain facet joint resection. A different result was seen after facet joint resection was combined with severing of the lumbosacral disc. The mean slip was only 6%, and sacral rounding was a prominent feature. This experiment shows that an upright posture of the spine is not a prerequisite for the development of spondylolisthesis. A bilateral facet joint resection in a growing rabbit results in a human like spondylolisthesis. This model may help further experimental studies concerning the changes in the olisthetic disc.

Animals↗

PubMed1995

Syme ankle disarticulation in peripheral vascular disease and diabetic foot infection: the one-stage versus two-stage procedure.

A prospective randomized trial compared performing a Syme ankle disarticulation using a one-stage versus Wagner's two-stage technique. Surgery was performed at two University Medical Centers where patients underwent amputation surgery for gangrene or nonsalvageable diabetic foot infection. Those undergoing surgery subsequent to trauma or congenital anomaly were eliminated. Initially, 21 patients were randomized into one-stage and two-stage surgery. The randomization was stopped for ethical reasons when the results of both procedures appeared to be similar. The next 22 consecutive patients underwent 23 Syme ankle disarticulations in one-stage surgery. Selection of amputation level was based on clinical examination, transcutaneous oximetry as a measure of vascular inflow, serum albumin as a measure of tissue nutrition, and total lymphocyte count as a measure of immunocompetence. As a total group, 31 of 44 amputations progressed to amputation wound healing and prosthetic limb fitting. In the randomized group, 9 of 13 one-stage and 5 of 8 two-stage surgeries healed. In the subsequent consecutive group, 17 of 23 healed. In all, 26 of 36 one-stage and 5 of 8 two-stage surgeries healed successfully. We concluded from this study that Syme ankle disarticulation may be performed as safely in one stage as in two stages in properly selected patients and, therefore, recommend the one-stage Syme ankle disarticulation in those patients suitable for this level amputation.

Adult↗

PubMed1995

Amputations in the diabetic foot.

Foot amputation in the diabetic population can help maintain a patient's independent ambulation and function. Such surgery requires diligence of the surgeon and a watchful eye for the development of early and long-term complications. Careful adherence to the listed healing parameters can assist the surgeon in achieving healing rates of above 90%.

Amputation, Surgical↗

PubMed1993

The MacIntosh lateral substitution reconstruction for anterior cruciate deficiency.

Twenty-five patients who had anterior cruciate deficient knees treated by the MacIntosh reconstruction operation were reviewed after 5 years, with particular reference to any changes occurring over time. Subjectively, the knees were improved and the results were even better after 5 years than after one year. This was considered to be due to a decrease in the restriction of flexion, and to the psychological and functional adaptation to the injured knee. In the knees operated on, the anterolateral instability increased significantly during the follow up from one year (mean 1.9 mm) to 5 years (3.0 mm), but the numerical value was still as good as in the intact knees (3.5 mm).

Adolescent↗

PubMed1993

Transcutaneous oxygen tension in the dysvascular foot with infection.

Eight adult insulin-requiring diabetics with peripheral vascular disease were admitted with foot infection and signs of systemic sepsis. Transcutaneous oxygen tension was measured at the foot and ankle prior to surgery. None of the values were sufficient to support wound healing. Four of the patients underwent open ray resection and four open midfoot amputation. After resolution of the local infections, transcutaneous oxygen tensions were repeated. Seven of the eight patients exhibited an appreciable increase in the value following decompression of the foot infection, sufficient to support wound healing.

Adult↗

PubMed1993

Amputations in the diabetic foot and ankle.

Scientific structured foot salvage clinics will provide surgeons with a large population of peripheral vascular insufficiency patients who may someday become candidates for salvage amputation at the foot or ankle level. This article presents the technology of functional amputation levels.

Amputation, Surgical↗

PubMed1993

Functional outcome of below-knee amputation in peripheral vascular insufficiency. A multicenter review.

A retrospective functional outcome study was performed on 299 patients treated with below-knee amputations for peripheral vascular disease during a three-year period in six Veterans Administration special amputee centers. Sixty-one percent of the patients were diabetic, and 25% were previously unilateral amputees. Surgery was performed with a long posterior flap in 92.3%, sagittal flaps in 20%, and guillotine open technique in 5.7%. Wound management was accomplished with rigid plaster dressings in 75.3%, pneumatic compression dressing in 14%, and soft dressings in 10.7%. At follow-up evaluation one to two years later, 36.1% had died. Thirteen percent suffered wound complications, with 6.7% requiring revision to a more proximal amputation level. Eighty-seven percent of community ambulators maintained their ambulatory status. A comparable percentage maintained their ability to walk with a prosthesis.

Amputation, Surgical↗

PubMed1992

Transcutaneous oxygen as a predictor of wound healing in amputations of the foot and ankle.

Thirty-eight amputations of the foot and ankle were performed in patients with peripheral vascular insufficiency over a 20-month period. Amputation level selection was based on clinical examination, a minimum ankle-brachial index of 0.5 as a measure of vascular supply, serum albumin of 3.0 gm/dl as a measure of tissue nutrition, and a total lymphocyte count of 1500 as a measure of immunocompetence. Transcutaneous oxygen tension was measured at the midfoot and ankle levels prior to surgery. Thirty-two of 38 patients (84.2%) healed their amputation wounds. When the transcutaneous oxygen tension was greater than 30 mm Hg, 24 of 26 patients (92.3%) healed. When the value was below 30 mm Hg, only eight of 12 patients healed. When the propensity to support wound healing is factored out, with patients having the metabolic capacity to heal an amputation wound in the foot and ankle, it appears that transcutaneous oxygen tension is an accurate measure of vascular inflow to support amputation wound healing.

Adult↗

PubMed1992

Multidisciplinary preoperative assessment and late function in dysvascular amputees.

During a three-year period, 95 adults were treated by lower-extremity amputations for peripheral vascular insufficiency. A multidisciplinary team for presurgical evaluation determined all to be potentially independent walkers with a prosthesis. Patients were graded for level of independent walking before amputation and again at a minimum two-year follow-up examination using a seven-level functional grading system. Seventy-six of 90 patients (84%) ambulated within one functional level of their preamputation status. This return to preamputation level of function was maintained whether comparing preamputation functional level or surgical amputation level. Prosthetic use increased and the use of walking aids decreased with increased functional ambulation levels, but did not correlate with surgical levels. Peripheral vascular insufficiency patients can maintain walking independence. Multidisciplinary presurgical evaluation helps selection of the amputation level and correct prosthetic limb fitting.

Adult↗

PubMed1991

Syme's two-stage amputation in insulin-requiring diabetics with gangrene of the forefoot.

Thirty-five insulin-requiring adult diabetic patients underwent 38 Syme's Two-Stage amputations for gangrene of the forefoot with nonreconstructible peripheral vascular insufficiency. All had a minimum Doppler ischemic index of 0.5, serum albumin of 3.0 gm/dl, and total lymphocyte count of 1500. Thirty-one (81.6%) eventually healed and were uneventfully fit with a prosthesis. Regional anesthesia was used in all of the patients, with 22 spinal and 16 ankle block anesthetics. Twenty-seven (71%) returned to their preamputation level of ambulatory function. Six (16%) had major, and fifteen (39%) minor complications following the first stage surgery. The results of this study support the use of the Syme's Two-Stage amputation in adult diabetic patients with gangrene of the forefoot requiring amputation.

Adult↗

PubMed1991

Preventing heel ulcers: a comparison of prophylactic body-support systems.

Five commercially available body-support systems used in the prevention of decubitus heel ulcers were objectively compared for their capacity to dissipate or decrease pressure concentration at the most prominent posterior aspect of the heel in bedridden, insensate patients. The Foot Drop Stop, a foam heel suspender, completely eliminated contact between the heel and the bed, and it was the most successful in decreasing pressure concentration. The space boot and foam heel protectors were far more successful than sheepskin rugs or polyester heel protectors, which provided little protection to the prominent heel.

Equipment and Supplies↗

PubMed1990

Tips of the trade #26. Treatment of amputation residual limb ulcers with a hydroactive dressing and continued weight bearing.

This paper discusses treatment methods for amputation residual limb (stump) ulcers and infected or failed-amputation wounds. Local wound care and abstinence from prosthetic limb use and weight bearing have been found effective in the treatment of decubitus ulcers, as has the use of occlusive hydroactive dressings such as DuoDERM (ConvaTec, Princeton, NJ). DuoDERM application and prosthetic socket modification have been found useful for the treatment of decubitus ulcers in ambulatory patients. The techniques of, and benefits obtained from, DuoDERM therapy are explored; we conclude that the relief of local wound pressure and shear forces obtained with this therapy generally enhances ambulation capacity.

Amputation Stumps↗

PubMed1989

A safe, pre-fabricated, immediate postoperative prosthetic limb system for rehabilitation of below-knee amputations.

Thirty-eight below-knee amputees were treated with a commercially available pneumatic prosthetic limb system, applied immediately postoperatively, that would allow immediate weight bearing following lower extremity amputation. Thirty-four limbs were amputated for peripheral vascular insufficiency and four were amputated due to trauma. Weight bearing was initiated an average of 4.7 days following surgery and patients were discharged with a non-removable temporary prosthesis at an average of 8.9 days. Thirty-three healed and were uneventfully fit with standard below-knee prosthetic limbs. Three required revision to the above-knee level. In a controlled setting, early weight bearing in the peripheral vascular insufficiency patient can be initiated with a low risk of local wound complication.

Adult↗

PubMed1989

Complications following midfoot amputation in neuropathic and dysvascular feet.

A review of 64 midfoot amputations performed between 1980 and 1985 revealed that complications occurred in 42% of the series. These included early wound dehiscence and late re-ulceration after the patient began walking again. By providing aggressive management and appropriate local revisions, 84% of the original group's limbs were salvaged at a functionally significant level. These findings underscore the fact that midfoot amputation requires diligent immediate and long-term follow-up if an acceptable success rate is to be achieved.

Amputation, Surgical↗