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Biomedical subjects

H Zippel

Publications and source records attributed to H Zippel.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of the efficacy and safety of intravenously administered dexketoprofen trometamol and ketoprofen in the management of pain after orthopaedic surgery: A multicentre, double-blind, randomised, parallel-group clinical trial.

OBJECTIVE: This study aimed to evaluate the analgesic efficacy and tolerability of dexketoprofen trometamol, a nonsteroidal anti-inflammatory drug, in comparison with that of racemic ketoprofen (both administered by intravenous infusion), in patients with postoperative pain. METHODS: This was a multicentre, randomised, double-blind, parallel-group study. 252 patients with moderate to severe pain following hip or knee replacement surgery performed under general anaesthesia were randomly assigned to receive either dexketoprofen trometamol 50 mg or ketoprofen 100 mg, both administered by intravenous infusion every 8 hours over 2 days. A level of > or =40 mm on a 100 mm visual analogue scale (VAS) for pain was required for inclusion in the study. Pain intensity on the VAS at different time-points after the administration of the first dose was assessed and the sum of pain intensity differences (SAPID(0-8 h)) was calculated as the primary efficacy variable. The use of rescue medication, maximum pain intensity difference (PID(max)), time to PID(max) and safety were also evaluated. RESULTS: The mean (+/- SE) adjusted SAPID(0-8 h) scores in the per-protocol population were 310.9 +/- 19.2 and 326.3 +/- 19.0 mm x h after dexketoprofen trometamol and ketoprofen treatment, respectively. The 95% CI for the difference between treatments (-59.1 to 28.3) was fully included within the range of equivalence of +/-65.3 mm x h. There were no significant differences with regard to secondary variables. The need for rescue analgesia was high in both groups; 81.3% of patients receiving dexketoprofen trometamol treatment and 87.1% receiving ketoprofen treatment required rescue analgesia. The time to achieve PID(max) was 284.7 and 308.5 min after dexketoprofen and ketoprofen, respectively. Treatment- related adverse events were experienced by 16% of patients in the dexketoprofen trometamol group compared with 21.3% in the ketoprofen group. Most patients were concomitantly treated with low-molecular-weight heparin (94.4%), and no haemorrhagic events related to the surgical procedure were reported. No adverse events related to renal function were detected during the study. CONCLUSION: The two medications were equivalent in terms of analgesic activity in the management of postoperative pain after orthopaedic surgery. The high use of rescue analgesics indicates a need for a multimodal approach to analgesia in this type of surgery. Dexketoprofen trometamol appeared to show a trend towards a better tolerability profile compared with the racemic compound.

Adult↗
PubMed2003

Effects of fondaparinux compared with dalteparin, enoxaparin and unfractionated heparin on human osteoblasts.

The objective of the this study was to examine the effects of fondaparinux, a synthetic anticoagulant substance similar to heparin, on osteoblasts compared with previously used heparins. Its effects have been shown in clinical trials to be highly effective in thromboembolism prophylaxis. Unfractionated heparin (UFH), dalteparin, enoxaparin and fondaparinux were added to osteoblast cultures in the therapeutic range and two decimal powers above and below it in each case. The results showed that the mitochondrial activity and protein synthesis of osteoblasts treated with fondaparinux were significantly higher than in the other groups. Similar effects could be demonstrated for the matrix collagen type II content and calcification. In contrast enoxaparin, dalteparin and UFH lead to a significant decrease of matrix collagen type II content and calcification in concentrations equal or higher than the therapeutic one. No inhibitory in-vitro effects of fondaparinux on human osteoblasts could be demonstrated within the concentration range investigated (0.01-100 microg/ml). We conclude that fondaparinux can be used to avoid the heparin-related negative influence on osteoblast-dependent fracture healing and endoprosthetic implant integration.

Aged↗
PubMed2001

Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group.

BACKGROUND: Risedronate increases bone mineral density in elderly women, but whether it prevents hip fracture is not known. METHODS: We studied 5445 women 70 to 79 years old who had osteoporosis (indicated by a T score for bone mineral density at the femoral neck that was more than 4 SD below the mean peak value in young adults [-4] or lower than -3 plus a nonskeletal risk factor for hip fracture, such as poor gait or a propensity to fall) and 3886 women at least 80 years old who had at least one nonskeletal risk factor for hip fracture or low bone mineral density at the femoral neck (T score, lower than -4 or lower than -3 plus a hip-axis length of 11.1 cm or greater). The women were randomly assigned to receive treatment with oral risedronate (2.5 or 5.0 mg daily) or placebo for three years. The primary end point was the occurrence of hip fracture. RESULTS: Overall, the incidence of hip fracture among all the women assigned to risedronate was 2.8 percent, as compared with 3.9 percent among those assigned to placebo (relative risk, 0.7; 95 percent confidence interval, 0.6 to 0.9; P=0.02). In the group of women with osteoporosis (those 70 to 79 years old), the incidence of hip fracture among those assigned to risedronate was 1.9 percent, as compared with 3.2 percent among those assigned to placebo (relative risk, 0.6; 95 percent confidence interval, 0.4 to 0.9; P=0.009). In the group of women selected primarily on the basis of nonskeletal risk factors (those at least 80 years of age), the incidence of hip fracture was 4.2 percent among those assigned to risedronate and 5.1 percent among those assigned to placebo (P=0.35). CONCLUSIONS: Risedronate significantly reduces the risk of hip fracture among elderly women with confirmed osteoporosis but not among elderly women selected primarily on the basis of risk factors other than low bone mineral density.

Aged↗
PubMed2000

Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine.

STUDY DESIGN: A comparative study on the position of pedicle screws in patients treated surgically with and without computer assistance. OBJECTIVES: To evaluate the accuracy of computer-assisted pedicle screw installation, and to evaluate its clinical benefit as compared with conventional pedicle screw installation techniques. SUMMARY OF BACKGROUND DATA: In vitro and clinical studies have documented a significant rate of misplaced screws in the thoracolumbar area. Neurologic complications are recognized problems caused by screw misplacement. METHODS: Patients treated surgically with computer assistance were compared with a historical control group of patients treated surgically with conventional techniques in the same hospital and by the same surgical team. All screw positions were measured with a postoperative magnetic resonance tomography, and cortical effractions were categorized in 2-mm increments. Patients' charts also were reviewed to assess individual neurologic outcomes. RESULTS: The control cohort was composed of 100 patients, with 544 screws from T5 to S1. The computer-assisted cohort was composed of 50 patients, with 294 screws from T2 to S1. In the control cohort, 461 of 544 screws (85%) were found completely within their pedicles as compared with 278 of 294 screws (95%) correctly placed in the computer-assisted group (P < 0.0001). All 16 screws incorrectly placed with computer assistance were found 0.1 mm to 2 mm from the pedicle cortex. In the control cohort, 68 screws were found 0.1 mm to 2 mm, 10 screws 2.1 mm to 4 mm, and 5 screws more than 4 mm from the pedicle cortex. Seven patients in the control cohort were surgically retreated because of postoperative neurologic deficits, whereas no patients in the computer-assisted group were surgically retreated. CONCLUSIONS: Computer assistance can decrease the incidence of incorrectly positioned pedicle screws.

Bone Screws↗
PubMed2000

Subtrochanteric corrective osteotomy for the endoprosthetic treatment of high hip dislocation. Treatment and mid-term results with a cementless straight stem.

Total hip arthroplasty is problematical in the case of high dislocation. To reposition the hip, a femoral shortening osteotomy is necessary in order to prevent damage to the neurovascular structures. This paper describes the implantation of a cementless straight stem in 15 patients using a simple technique with a simultaneous, derotating and shortening osteotomy. Femur fractures, pseudoarthroses, stem loosening, paresis and deep infections were not found. One socket loosening was revised. Fourteen patients had good or very good results in the Merle d'Aubigne score after a median of 4.3 (range 2-5.6) years of follow-up. The surgical technique described enables the initial stable fixation of a standard prosthesis without additional osteosynthesis. Additional advantages include a shorter duration of surgery, a lower complication rate and a more rapid consolidation of the osteotomy.

Adolescent↗
PubMed2000

[Chondrocyte transplantation in PGLA/polydioxanone fleece].

The transplantation of chondrogenic cells in a supportive carrier structure proved to be a promising alternative for the treatment of cartilage defects. In the study presented we focused on the transplantation of allogeneic chondrocytes in a biodegradable polymer scaffold (PGLA/Polydioxanon) in articular cartilage defects in a rabbit defect model. Isolated allogeneic chondrocytes embedded in a PGLA polymer scaffold were transplanted into osteochondrogenic defects of the patellar groove and compared with empty defects and transplants of polymer scaffolds without cells. The histological and histochemical analysis was performed after 4 and 12 weeks. The transplant integration and the architecture of the newly formed cartilage were evaluated with a semiquantitative score. After 4 weeks the development of a hyaline-like cartilage tissue of the cell-polymer-transplants was observed, after 12 weeks the defects were nearly completely filled with hyaline-like cartilage. The biodegradation of the polymer construct did not affect the histological structure of the transplant area. Defects of the groups with empty defect and polymer transplants without cells revealed no or insufficient healing indices. The study demonstrated that biodegradable polymers served as suitable carriers for the chondrocyte transplantation, which is due to the in-vitro establishment of a semi-solid cartilage transplant and the resulting effective transplant fixation into the defect. In-vivo the polymer cell transplants seem to provide a supportive microenvironment for the development of hyaline cartilage. The controlled release of morphogenic factors or bioactive molecules and the use of pluripotent mesenchymal progenitor cells opens new perspectives for the optimization of cartilage repair procedures.

Animals↗
PubMed2000

Localized pigmented villonodular synovitis of the knee joint: neoplasm or reactive granuloma? A review of 18 cases.

OBJECTIVE: The localized form of pigmented villonodular synovitis of the knee joint is a rare disease with limited alteration of the synovial membrane, the pathogenesis of which is the subject of controversial discussion. METHODS: Eighteen cases have been documented in our hospital since 1976. All of the patients had additional cartilage or meniscus damage. Treatment consisted of excision of the lesion and the adjacent synovial membrane, as well as therapy of the additional damage. RESULTS: The patients who had received such therapy were followed for 3-9 yr, without any clinical, sonographic or magnetic resonance tomographic signs of recurrence. In addition to the lack of a tendency towards recurrence, none of the cases displayed any further characteristics of the diffuse form of villonodular synovitis, such as invasiveness or malignant transformation. CONCLUSIONS: We therefore suggest that pigmented villonodular synovitis of the knee joint should be classified more strictly than before into a potentially neoplastic (diffuse) form and a reactive granulomatous (local) form. From the cases observed, we conclude that degenerative joint lesions may be the cause of the reactive granulomatous form.

Adolescent↗
PubMed1997

Surgical management of severe spondylolisthesis in children and adolescents. Anterior fusion in situ versus anterior spondylodesis with posterior transpedicular instrumentation and reduction.

STUDY DESIGN: A clinical and radiologic retrospective follow-up examination of patients treated surgically for severe juvenile spondylolisthesis. OBJECTIVE: To compare two different surgical techniques in the management of severe (degree of slip > 30%) juvenile spondylolisthesis (anterior spondylodesis in situ versus combined anterior spondylodesis and posterior transpedicular instrumentation including reduction of the slipping vertebra) to determine if the advantages of the repositioning of the slipping vertebra and a decreased number of pseudarthroses because of the transpedicular instrumentation lead to clinical improvement despite showing better alignment radiologically. METHODS: This study included 59 children and adolescents with severe spondylolisthesis of L5 who were treated surgically at the authors' orthopedic department between 1980 and 1992. Twenty-nine children received anterior spondylodesis (AS group), and 30 children received, in addition, a posterior reduction and transpedicular instrumentation (posteroanterior spondylodesis, PAS group). RESULTS: Distribution of age, gender, preoperative clinical symptoms, and preoperative radiologic classification of the spondylolisthesis were comparable in both groups (average degree of slip for the AS group, 66%; that for the PAS group, 75%; angle of slip, 28 degrees and 36 degrees, respectively; sacral inclination, 31 degrees and 25 degrees, respectively). The postoperative follow-up period of the AS group lasted 125 +/- 22 months, considerably longer than that of the PAS group at 67 +/- 20 months. At the time of the follow-up assessment, the PAS group showed a reduced rate of pseudarthrosis (7% versus 24%), a reduced degree of slip (36% versus 59%), and a reduced lumbosacral kyphosis (14 degrees versus 26 degrees) in comparison with the AS group. The transpedicular instrumentation decreased the fusion time of osseous consolidation of the spondylodesis markedly (7 months versus 17 months, on average). Adverse effects and rate of complications were equal in both groups. The results failed to show any differences in favor of either of the two surgical techniques used either subjectively to the patient or objectively by means of clinical examination. CONCLUSION: Anterior spondylodesis including posterior instrumentation and reduction was superior to the simple anterior fusion in situ for normalization of the lumbosacral profile and osseous consolidation of the spondylodesis. This result was not reflected in the clinical evaluation.

Adolescent↗
PubMed1993

[Surgical limb lengthening--experiences and results].

This paper describes the experiences and results in 172 operative lengthening procedures on 134 patients, performed in the Orthopaedic Department of Charité Hospital in Berlin. The bone length increase was on an average 8.5 cm (min.: 1 cm, max.: 20 cm), this gives altogether a bone increase of over 14 meters. Patients are differentiated in groups of age, indication, localization, mode of procedure (callus-distraction, epiphysealdistraction) and in regard to the used external fixation devices. Authors present their own model of wire fixed external fixateur (so called "Berlin type-external fixateur"), a modification of the original Ilizarov-device. Importance of procedure-planning and time-balance as well as the high rates of complications (146 complications = 84.8%) are discussed.

Adolescent↗
PubMed1990

[Femoro-tibial torsion in patellar instability. A contribution to the pathogenesis of recurrent and habitual patellar dislocations].

Examination of femoro-tibial torsion in patellar instability. A contribution to pathogenesis of recurrent and habitual dislocation of patella. In a CT-study are examined the angle of tibial torsion, femoral antetorsion, femoro-tibial rotation and tibio-femoral index as well as the habitual step angle by direct measurement in 40 patients with recurrent in habitual dislocation of the patella and in 10 normal persons. In comparison to the control group the femoral antetorsion and the femoro-tibial rotation in the pathological group were significantly increased. Results are discussed in regard of pathogenesis and operative treatment of patella dislocation.

Adolescent↗
PubMed1989

Biomechanics of the SB Charité lumbar intervertebral disc endoprosthesis.

The SB Charité intervertebral disc prostheses consist of two metal end-plates and an interposed polyethylene slide core. These were subjected to static and dynamic testing in a servohydraulic test rig. When embedded in polypropylene, the prostheses were found to function adequately under a high static load, and under a lighter dynamic load for a long time. When tested in a cadaveric vertebral segment, a large end-plate surface area proved to be of critical importance in preventing collapse of the prosthesis into the vertebral body.

Biomechanical Phenomena↗
PubMed1989

[The value of spinal CT in the planning of spinal surgery].

The diagnostic information gained by spinal CT for the planning of surgery of spinal disease is discussed under clinical aspects. For discogenic disease CT has replaced myelography in significance and as primary investigation, except for unclear complaints, that cannot be attributed to a specific segment. Here myelography still is the prime investigation. With CT degenerative peripheral appendages turned out to be significant for secondary stenosis syndromes of the spinal canal. In future it seems advisable, to differentiate between the facultatively pathogenetic important dorsal spondylosis and ventro-lateral spondylosis, which is unimportant for the spinal complaints. If surgical correction of congenital spinal malformations is considered, apparent or silent dysraphia must be ruled out in order to prevent neurological complications. Here CT can improve diagnostic safety significantly. For the resection of tumourous or inflammatory destructions CT provides an excellent means for preoperative statements on the necessary resection area, the size of the graft and the strength of adjacent soft tissues for the graft, the required stabilisation instruments, possible effects on adjacent organs, lumen reduction of the spinal canal, and the appropriate surgical entrance. The exploration of traumatic conditions of the spinal column by CT is of value especially for a detailed preoperative investigation, since it facilitates a quantification of the destruction of the vertebral body and the arches, the condition of the posterior body surface and the stenosis of the spinal canal.

Humans↗
PubMed1987

[Pathophysiologic aspects of inflammatory and degenerative joint diseases].

Authors describe the physiological particularities of components of articular system (cartilage, synovialis, synovia, subchondral bone, ligamentous and neuromuscular apparatus). The essential resultant pathophysiological pattern in rheumatoid arthritis and osteoarthritis are demonstrated. Differences between temporary attendant synovitis in osteoarthritis and rheumatoid arthritis are pointed out.

Arthritis↗