Between 1974 and 1991, 100 equinovarus deformities in 65 patients with myelomeningocele have been primary operated at the authors clinic. Aim of our treatment was a plantigrade position of the foot, to give the possibility of an orthetic supply. 75% of our patients reached this result after the first operation, 25% had to be operated once more. The incision was done in the way of Cincinnati. According to the level and type of paralysis the operative treatment had to be adapted. We could reach good results of treatment in group 1 (thoracal to L2) with 64% of plantigrade feed as well as in group 3 (L5 to sacral) with 61%. Group 2 (L4 to L5) was worse with 32%. Within all types of paralysis there was a better result while doing a tenotomy. Paralysed muscles should be cut, innervated muscles should be extended to keep the function. Important is the reconstruction of a balance of the muscles. While you have a forefoot varus, a plentiful medial release is necessary. After the operation a cast was given for 8 to 12 weeks, followed by special shoes and nightly storage in stales. Corresponding to the treatment of idiopathic equinovarus deformity the beginning of therapy should be started after birth and should be completed while the child begins to verticalize.

Adolescent↗

PubMedDate not supplied

Experimental in vitro and in vivo studies of epithelium formation on biomaterials seeded with isolated respiratory cells.

Extensive tracheal defects after intensive care medicine, trauma, or large resections in tumor surgery remain a major challenge in plastic and reconstructive surgery. Defects that cannot be satisfactorily treated by complicated and costly reconstructive techniques reveal a need for an alloplastic tracheal replacement. Recent experimental and clinical studies in the development of alloplastic tracheal prostheses proved that the lack of an epithelial lining on the luminal surfaces and inadequate biophysical properties and shapes of the prostheses were the main causes for failure of these prostheses. In this study a cell-seeding technique has been used. Adhesion, spreading, and differentiation of seeded mucosa cells on biomaterials in vitro were observed by scanning electron microscopy (SEM). Chemical properties and surface structure of the material influenced the differentiation process. Epithelium formation of incorporated tracheal prostheses was tested in animal experiments. Isolated respiratory cells were seeded into implanted tubular prostheses of porous polyurethane or expanded polytetrafluorethylene. Light microscopy and SEM showed the tendency of epithelium formation on the surface of the lumen. Vigorous cell layers, predominantly as multiple cell layers of squamous epithelium, were observed. Ciliated or mucus cells were not detected. It can be stated that the epithelium formation on incorporated porous implants is possible. Further studies of the stability and the differentiation process of the epithelium on such implants is needed before an introduction of tracheal replacements into the clinical practice can be considered.

Biocompatible Materials↗

PubMedDate not supplied

The combined use of transluminal angioplasty and selective clot lysis.

14 cases of transluminal angioplasty and selective clot lysis are reported. One patient removed the catheter before successful lysis and one lost his leg after an almost complete lysis due to advanced necrosis. Treatment was successful in the other 12 cases with complete or partial thrombolysis. Remaining clots were either smashed by catheter and/or successfully treated by oral fibrinolytic therapy. The injected dose of streptokinase was 5,000 U/h after an initial dose of 20,000 U in one hand injection. The duration of infusions was 6-72 hours. A total dose of 60,000-520,000 U streptokinase was adopted. Intraarterial infusion therapy was followed by long-term low-grade fibrinolytic treatment with oral penthosan polysulphate. Four bleedings at the puncture site, one epistaxis and a bleeding at the site of a recently extracted tooth were seen. Only one infusion was stopped due to moderate bleeding and without any drawback.

Angioplasty, Balloon↗

PubMedDate not supplied

[Cryomedical apparatus].

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Cataract Extraction↗