Biomedical subjects
Publications and source records attributed to J Löhnert.
Treatment with autologous chondrocyte transplantation (ACT) leads to regeneration of hyaline cartilage. Since September 1996, 52 patients have been treated. Eleven patients were screened clinically and by MRI 18 months later. The biopsy specimen from the transplanted area showed formation of hyaline cartilage.
To ascertain the efficiency of different techniques of arthroscopic therapy for gonarthritis and establish the relevance of the extent of chondromalacia, clinical and experimental studies were performed. In principle, the process of chondromalacia determines the course of the disease. Treatment of additional meniscus lesions temporarily leads to better clinical results, but after only a few months the symptoms caused by the arthritic process reappear. Compared with the temporary relief of complaints after debridement and lavage, smoothing with a xenon chloride excimer laser in grade II chondromalacia leads to statistically significantly better clinical results. Scanning electron microscopic studies confirm the extremely good smoothing. These studies permit clear statements as to the various methods of treatment and their application in the different grades of chondromalacia, thus leading to differentiated arthroscopic treatment of degenerative gonarthritis.
We analysed sonographic (n = 19) and CT (n = 15) findings in 19 patients with intrapancreatic metastases (solitary: n = 8, multiple: n = 11) from solid tumours. The diagnosis was confirmed either histologically (n = 5) or by the follow-up showing decrease of the size of the lesion due to chemotherapy (n = 3) or progression without specific therapy (n = 11). Clinically or serologically organ-related symptoms were found in 5 cases, whereas the rest of the patients were free of symptoms. Sonographically the metastases appeared hypoechogeneic compared to normal pancreatic parenchyma. In 15 cases CT at the time of sonographic investigation demonstrated hypodense intrapancreatic lesions (8/15) or bulging of the organ contour without differences in density (2/15). In some patients (5/15) sonographically detected metastases measuring less than 2 cm were not discovered via CT. In a patient with known malignancy multiple intrapancreatic lesions must be considered as metastases. Differential diagnosis includes diffusely growing pancreatic carcinoma, haemorrhagic necrotising pancreatitis and focal infiltrates due to malignant lymphoma.
A new operative technique in arthroscopic treatment of chondromalacia using ultraviolet laser systems is introduced. The postoperative results are evaluated in a prospective and randomized clinical trial. One hundred and forty patients stage II or III chondromalacia according to Outerbridge were randomly assigned to arthroscopic operation using either laser or mechanical instruments. After a 6-month follow-up period the clinical results were compared, guided by a specially designed modification of the Lysholm scoring scale. In the short-term follow-up laser surgery gave superior results in regard to reducing pain (P less than 0.05) and leading to a lower incidence of reactive synovitis (P less than 0.01). No difference was found in respect of disability and functional impairment. Our results lead to the conclusion that arthroscopic laser application seems to be a successful procedure in the treatment of degenerative cartilage disorders, providing precise ablation of tissue without significant thermal damage to the remaining cartilage.
Following arthroscopic meniscectomy a 41-year old patient developed an external synovial fistula in the area of the central joint approach with a communication to the deep intrapatellar bursa. Anatomical preparations performed on 20 knee joints revealed extraordinary variations in the dimension of the infrapatellar bursa with a mean longitudinal diameter of 24 mm and a transversal diameter of 38 mm. The distance between bursa and the distal margin of the patella measured 15 to 39 mm. These topographic conditions lead to the assumption that the bursa is exposed to iatrogenic lesion by placing a central joint approach. Therefore a proximal incision is recommended for the central portal to avoid a lesion of the bursa with the potential risk of a postoperative fistula formation.
In a review of the literature, intra- and postoperative complications in arthroscopic surgery of the knee joint are analyzed on the basis of 167,210 reported cases. Depending on the variable criteria and definitions, the respective studies are based upon the individual complication rates differ greatly between 0.8 and 17.7%. The incidence of serious complications was less than 1%. Factor analysis proved the following variables to be correlated with the incidence of complications: age and sex, kind and etiology of joint lesion, kind of operative procedure performed, duration of operation, and experience of the surgeon. Compared to arthrotomy, arthroscopic surgery is associated with reduced morbidity and a low complication rate.
In a clinical study the postoperative results of 3,500 arthroscopic operations on the knee joint were analyzed with a follow-up period of 1 year. At the time of examination 55.3% of patients were symptom-free, 33.8% had definite relief of symptoms and in 10.9% the symptoms were unchanged or progressive. The results of the different procedures performed varied widely, with the best results being obtained after meniscectomy. The average postoperative hospitalization was 3.5 days. Arthroscopy is a procedure with a low morbidity. Rehabilitation in the immediate postoperative period is accelerated due to reduced pain and functional impairment.
Arthroscopic laser synovectomy consists of a mechanical abrasion of the superficial layers followed by a laser devitalization of the basal synovium. The Neodymium-YAG-laser is suitable for this purpose because of its depth of penetration in tissue and the transmission through quartz flexible fibers. In histological in-vivo-studies laser induced changes in the deep synovial layers could be verified. After a total of 50 arthroscopic laser procedures the clinical results of the first 15 laser synovectomies are analyzed in a follow-up period of 6 months. Compared to the preoperative condition the arthroscopic operation resulted in a significant improvement. A reduced hemorrhage is a specific advantage of this technique. Arthroscopic laser synovectomy is as effective as conventional open capsulosynovectomy preserving the advantages of arthroscopic surgery, a reduced morbidity, a low functional impairment and short rehabilitation periods.
In a clinical follow-up study the postoperative results after arthroscopic meniscectomies are compared to conventional arthrotomies. 200 selected patients, half treated arthroscopically and half by open meniscectomy are reviewed after a postoperative period of 1.5-4 years. Each patient in the arthrotomy-group is matched with a patient in the endoscopic collective by age, sex and type of meniscus lesion. Ligamentous instability was an excluding criteria. The mean hospital stay in the arthroscopic group is 4.9 days compared to 12.3 days in the arthrotomy-group. At follow-up 46% of the arthroscopically treated patients are free of symptoms, in 49% the operation resulted in a significant relief of symptoms, whereas 5% have unsatisfactory results. In the arthrotomy-group 38% have excellent, 54% good and 8% unsatisfactory results. The total amounts of remission with 95% and 91.5% in both collectives are comparable. Using a modified Larson-scoring-scale to record the symptomatic results in the longer term we found a mean score of 91.3 points in the arthroscopic and of 89.4 points in the arthrotomy-group. Apart from the operative technique a partial meniscectomy results in a mean score of 91.9 points compared to 88.5 points at total meniscectomies. The presence of degenerative changes seems to influence the postoperative result negatively. The advantages of endoscopic surgery include a decreased hospitalisation and a shorter sick leave, whereas the long-term results do not differ significantly from conventional menisectomy. Referring to the progress of degenerative changes a partial meniscectomy should be preferred to a total meniscectomy to prevent the cartilage from degeneration and arthrosis.
The topographic relation of the popliteus bursa to the peripheral rim of the lateral meniscus is described with particular attention to the arthroscopic appearance. The arthroscopic findings are compared to sections of knee joints obtained after amputation. As a constant result we found a peripheral separation of the lateral meniscus in the posterior part which extends for 2-3 cm. In consequence of these physiological defects in the superior and inferior attachments to the joint capsule the popliteus bursa communicates with the central part of the joint cavity on the femoral and in the majority of cases on the tibial level of the lateral meniscus. These anatomical conditions which appear arthroscopically as a peripheral longitudinal tear might be confounded with a traumatic or degenerative lesion of the lateral meniscus.
In a clinical follow-up study the postoperative results of 234 meniscus lesions treated by partial arthroscopic meniscectomy are analysed. After a period of 3-12 months 43% of cases were completely free of symptoms, in 50% the operation resulted in a significant relief of symptoms whereas 7% of the patients had unsatisfactory results. Serious intra- and postoperative complications did not occur. Compared to open meniscectomies the hospital stay is considerably shorter with an average duration of 4.7 days. The postoperative short-term result seems not to be related to the presence of degenerative changes. In 89% of cases with a severe chondromalacia an isolated arthroscopic meniscectomy gave an excellent or good result.
Case of unusual diffuse segmental lipomatosis of a part of the small bowel is reported. Other cases from the literature are compared to various pathological deposits of fat in the intestine. Aetiology, clinical signs, diagnosis and differential diagnosis, as well as surgical treatment, are discussed.
In 35 patients with non-toxic goitre, surgically resected thyroid tissue was hydrolyzed with Pronase under anaerobic conditions in the presence of methylmercaptoimidazole. Total iodine, PBI, L-thyroxine (T4-RIA and T4 (D)) as well as triiodothyronine (T3-RIA) were determined in the tissue hydrolysates. The data obtained were compared with T4/T3 ratios in the serum, TRH test and thyroidal 131I uptake before operation. The total iodine, amounted to 112.6 +/- 14.6 ug/g tissue. The T4/T3 ratio was 11.37 +/- 1.80. Using this procedure of tissue hydrolysis and RIA assays for iodothyronines, the yield for T4 and T3 is considerably higher than the one obtained with previous methods. As in animal experiments, evidence was given for human goitre that T3 is predominantly produced first in the case of decreased T4 production. Second in the case of iodine deficiency, and third in cases of increased TSH response after TRH. Patients with a large amount of iodine and T4 in their thyroids have a much smaller increase in serum TSH after TRH than do subjects with a much lower thyroidal T4 concentration. This occurs even though the thyroid hormone levels in serum in these groups are not different. No correlation between thyroidal T4/T3 ratio and serum T4/T3 ration could be demonstrated even under extreme conditions. This finding favors the assumption of a predominant extrathyroidal regulation for T4/T3 ratio in serum.
Ulcerative colitis may occur on several forms. Toxic megacolon is roentgenologically characterized by dilatation usually in the area of transverse colon and toxic symptoms. At the first appearance of these symptoms the patient should be treated or operated upon. Under normal circumstances the roentgenological diagnosis may be obtained only by a full erect or a left lateral decubitus film of the abdomen. A barium enema could lead to performation of the colon, peritonitis or provocation of toxic megacolon. In doubtful cases the examination should be performed with water-solubel contrast media (i. e. Gastrografin, Propyliodon etc.) The therapeutical internal and surgical possibilities are discussed.
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