Biomedical subjects
Publications and source records attributed to H Zilch.
Soft-tissue calcifications in the hands may often be a sign of a systemical disease. The calcification then appears as a secondary manifestation of this disease. In that case, operative treatment ought to be a part of the overall treatment of the primary disease. When operating on fingers, the surgeon must pay attention not to compromise blood supply.
Closed traumatic lesions of the extensor tendon hood of a longfinger at the metacarpophalangeal joint are rare. Surgical treatment was done in 6 cases during the last 10 years in our department; in 5 cases the dorsoradial part, in one case the dorsoulnar part of the hood was injured. The tear extended longitudinal or diagonal through the transverse fibers of the hood. Respecting the accident mechanism there have been reported tangential forces at the extensor tendon hood and forced ulnar deviation in the bended metacarpophalangeal joint. A jerky dislocation of the extensor tendon to the ulnar side of the metacarpophalangeal head during increased bending of the metacarpophalangeal joint, sometimes with ulnar abduction of the longfinger, leads usually to the diagnosis. Misdiagnoses of cases sent to our department were: "trigger finger" and "recurrent dislocation of the metacarpophalangeal joint". Once the presurgical diagnosis was "rupture of the extensor tendon" because of a permanent extension deficit in 30 degree position of the metacarpophalangeal joint. Treatment is always surgical with suture of the hood and immobilization of the metacarpophalangeal joint in extension position for 4 weeks. Conservative treatment can not heal up a tear of the extensor tendon hood.
The Sauvé-Kapandji procedure comprises distal radioulnar arthrodesis with screwing of the caput ulnae at the basis of the radius after the correction of the radioulnar length discrepancy. Therefore the best indications are posttraumatic changes of the distal radioulnar joint. At the same time a distal ulnar segment resection about 12 mm in length is necessary to restore forearm rotation, producing an iatrogenic pseudarthrosis. The proximal ulnar segment functionally assimilates to a rotating joint, as could be shown by X-rays. Between 1988 and 1993 this procedure was performed in 12 patients. Follow-up after an average of 38.2 months showed improvements in forearm rotation of 84% for pronation and 60% for supination. All patients had significant pain relief. Grip strength also improved, by 55%. No patient got worse postoperatively as measured by the score of Gartland and Werley. Neither non-union of the distal radioulnar joint fusion nor bony regeneration across the resected ulnar segment was seen. The good results are the consequence of adherence to a rigorous indication: no preexisting arthrosis at the radiocarpal joint.
This is the first description of a dislocation of the polyethyleninlay from the cup of a cementless hip prosthesis. Due to a fall of the patient 8 months after the implantation an unspecific complaint arised. In spite of detailed diagnostic no reason could have been found. During the renewed operation we saw the dislocated inlay by mechanical anchorage of the cup and the shaft. Retrospective there were made suggestions how the described complication could be recognized earlier.
A series of substituted 2,3-dihydrothiazolo[2,3-a]isoindol-5(9bH)-ones and related compounds 1-73 were synthesized and evaluated for their ability to inhibit reverse transcriptase (RT) of the human immune deficiency virus 1 (HIV-1) and replication of HIV-1 in MT2 cells. The antiviral activity of these compounds depends on the stereoselective configuration of the substituent in position 9b. Structure-activity studies were done within these series of compounds to determine the optimum substituents for antiviral activity. The most potent inhibitors were found in the class of 2,3-dihydrothiazolo[2,3-a]isoindol-5(9bH)-ones bearing a phenyl ring system in position 9b optionally substituted with one or two methyl groups or a chlorine atom in position 8. The most active analogues (R)-(+)-1, (R)-(+)-6, (R)-(+)-13, (R)-(+)-26, and (R)-(+)-53 inhibit the HIV-1 RT with an IC50 between 16 and 300 nM and an IC50 between 10 and 392 nM in MT2 cells, respectively.
The structural features of a new class of non-nucleoside HIV-1 reverse transcriptase inhibitors (3) are presented. Comparison of the structural and electronic properties with those of TIBO (1) and Nevirapine (2) yields a common three-dimensional model. This model permits the improvement of the lead compound 3 by chemical modification (5,6). Additionally, two new types of inhibitors (4, 7) with similar biological activity can be derived from this model. The structure of the new compounds, including their absolute configuration, are determined by X-ray crystallography.
In an attempt to assess the structural requirements of hexahydro-sila-difenidol for potency and selectivity, a series of analogues modified in the amino group and the phenyl ring were investigated for their affinity to muscarinic M1-(rabbit vas deferens), M2- (guinea-pig atria) and M3- (guinea-pig ileum) receptors. All compounds were competitive antagonists in the three tissues. Their affinities to the three muscarinic receptor subtypes differed by more than two orders of magnitude and the observed receptor selectivities were not associated with high affinity. The pyrrolidino and hexamethyleneimino analogues, compounds substituted in the phenyl ring with a methoxy group or a chlorine atom as well as p-fluoro-hexahydro-difenidol displayed the same affinity profile as the parent compound, hexahydro-sila-difenidol: M1 approximately M3 greater than M2. A different selectivity pattern was observed for p-fluoro-hexahydro-sila-difenidol: M3 greater than M1 greater than M2. This compound exhibited its highest affinity for M3-receptors in guinea-pig ileum (pA2 = 7.84), intermediate affinity for M1-receptors in rabbit vas deferens (pA2 = 6.68) and lowest affinity for the M2-receptors in guinea-pig atria (pA2 = 6.01). This receptor selectivity profile of p-fluoro-hexahydro-sila-difenidol was confirmed in ganglia (M1), atria (M2) and ileum (M3) of the rat. Furthermore, dose ratios obtained with either pirenzepine (M1) or hexahydrosila-difenidol (M2 and M3) and the p-fluoro analogue used in combination suggested that the antagonism was additive, implying mutual competition with a single population of muscarinic receptor subtypes. These results indicate that p-fluoro-hexahydro-sila-difenidol represents a valuable tool for characterization of muscarinic receptor subtypes.
1. In an attempt to assess the structural requirements for the muscarinic receptor selectivity of hexahydro-diphenidol (hexahydro-difenidol) and hexahydro-sila-diphenidol (hexahydro-sila-difenidol), a series of structurally related C/Si pairs were investigated, along with atropine, pirenzepine and methoctramine, for their binding affinities in NB-OK 1 cells as well as in rat heart and pancreas. 2. The action of these antagonists at muscarinic receptors mediating negative inotropic responses in guinea-pig atria and ileal contractions has also been assessed. 3. Antagonist binding data indicated that NB-OK 1 cells (M1 type) as well as rat heart (cardiac type) and pancreas (glandular/smooth muscle type) possess different muscarinic receptor subtypes. 4. A highly significant correlation was found between the binding affinities of the antagonists to muscarinic receptors in rat heart and pancreas, respectively, and the affinities to muscarinic receptors in guinea-pig atria and ileum. This implies that the muscarinic binding sites in rat heart and the receptors in guinea-pig atria are essentially similar, but different from those in pancreas and ileum. 5. The antimuscarinic potency of hexahydro-diphenidol and hexahydro-sila-diphenidol at the three subtypes was influenced differently by structural modifications (e.g. quaternization). Different selectivity profiles for the antagonists were obtained, which makes these compounds useful tools to investigate further muscarinic receptor heterogeneity. Indeed, the tertiary analogues hexahydro-diphenidol (HHD) and hexahydro-sila-diphenidol (HHSiD) had an M1 = glandular/smooth muscle greater than cardiac selectivity profile, whereas the quaternary analogues HHD methiodide and HHSiD methiodide were M1 preferring (M1 greater than glandular/smooth muscle, cardiac).
Fibrin sealant presents a satisfactory possibility for reconstruction of the joint surface, especially in cases of little osteochondral fragments. Our experience in 16 patients is detailed. The patients average age was 23 years. 34 osteochondral fragments had been glued in these 16 cases, 10 times at the finger joints, 4 times at the caput radii and 2 times at the trochlea humeri. The patients, who had been operated on from June 1979 to December 1984 have been followed up at an average of 2,1 years after the fibrin gluing. This method can avoid an early arthrodesis or oversized osteosynthetic material.
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The Léri-Weill-syndrome is a very rare disease. The presence of Madelung's deformity is the important feature to distinguish this dyschondrosteosis from other system diseases of the skeleton combined with mesomelic dwarfism. Mesomelic dwarfism is mostly located in the lower extremity. If the deformity causes pain it is necessary to do a corrective osteotomy of the distal radius.
Following a survey of the literature regarding clinical examinations and experimental studies of local absorbable carrier for an antibiotic in treatment of osteitis, a study is presented concerning clinical experience with 46 patients treated with a cefotaxim-loaded fibrin sealant. In connection with simultaneous focal sanitation the clinical results were satisfying. When autogenous cancellous bone was added at the same time, only one surgical operation was necessary in some cases to show results equivalent to other methods. Postoperatively, the cefotaxim levels in the blood and in the wound drainage fluid were measured. The serum cefotaxim concentrations were low and only identifiable for a period of 36h, whereas the wound drainage fluid contained very highly effective antibacterial concentrations over a measured period of 3.5 days. The best results were seen in cases of hematogenic osteomyelitis. The disadvantage of this system is the quick release of the antibiotic by diffusion. Therefore, high concentrations can be obtained only for a short period of several days.
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This is an uncommon injury of the carpus showing a fracture of the os scaphoideum associated with a fracture of the os capitatum with rotation of the proximal fragment of the capitate of 180 degrees. Presentation of a case report.
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Fractures of the metacarpals II-V can normally be handled conservatively. After reposition under local anaesthetic plaster of Paris is applied for a duration of 3 to 4 weeks. Open fractures usually with accompanying injuries, should be stabilized operatively. The functional results of conservative treatment are very good. Slight sidewards deviation of up to 1/3 of the width of the shaft and shortening of up to 6 mm don't interfere with good hand function. Palmar deviation of the distal fragment of up to 35 degrees following subcapitular fractures does not reduce hand function.
After discussion of the importance of the palmar, dorsal and interosseous ligaments in cases of scapholunate subluxation, the radiologic signs of this carpal instability are described. Four cases with this instability were treated successfully by reconstruction of the dorsal ligaments. In three instances ligament reconstruction was performed with the split tendon of the extensor carpi radialis brevis passed through drill holes in the scaphoid and lunate similar to the method reported by Dobyns.