Biomedical subjects
Publications and source records attributed to K Flock.
Lesions of the anterior cruciate ligaments may be demonstrated by MRI with an accuracy of 99%. Standardised technique with sagittal and coronal projections produces excellent results. Localisation of the site of rupture can be achieved in 95% of cases. MRI provides a valuable method for diagnosing lesions of the cruciate ligaments.
150 patients were examined via magnetic resonance (MR) after anterior cruciate (ACL) ligament reconstruction (76 patellar tendon grafts, 53 semitendinous tendon grafts and 21 sutures). The results of MR were compared with clinical tests (Lachman, pivot-shift and anterior drawer test), in 2 cases with the operative findings, and in one case with arthroscopy findings. In 91% of patients with a clinically stable knee we found a continuous low-intensity ligamental structure. 10 patients were examined twice or more between 8 days and 6 months after surgery. Ligamental structures of low signal intensity did not significantly change their MR characteristics. MR is a valuable noninvasive method for evaluating ligament reconstructions.
Intra-operative autologous blood transfusion (IAT) employing a cell separator has proved an effective and safe means of reducing the amount of homologous blood needed for major orthopedic operations. Homologous blood was required in only 15 or 26% of patients, who underwent cemented or uncemented total hip replacement. This is significantly less than in a control group without IAT, in which homologous blood was required in 65 and 71% respectively. In 33% of patients, who had an operation of the spine and in 35% of cases of revision total hip surgery homologous blood was necessary in addition to IAT. We feel, that preoperative blood donation is indicated in addition to IAT, in total hip revisions, major surgery of the spine, as well as in special situations when a total hip replacement is planned.
Although golf is an ideal form of exercise for all age groups, complete mastery of the specific movements involved is a prerequisite. The typical golfing injuries and and pathological sequelae are usually the results of faulty driving and hitting techniques. Apart from golfer's shoulder and golfer's elbow, complaints affecting the lumber spine predominate.
Low back pain is considered to be a symptom of a variety of changes and disorders affecting the lumbar spine, the sacrococcyx and pelvis, but it may also be a symptom of disorders affecting the neighboring organs. If these points are taken into account and an accurate diagnostic evaluation including such modern procedures as scintigraphy, CT and MR imaging, low back pain can now--in contrast to 50 years ago--be analysed, and often treated with considerable success. In many cases, conservative treatment proves possible. In the presence of relevant morphological findings, however, various surgical procedures, developed in particular in recent years, offer new possibilities.
Low back pain for which operative therapy is not indicated, can prove resistant to treatment even with the aggressive application of conservative measures and the use of suitable drugs. Here, local anesthesia can often have a decisive influence on pain. On account of possible complications, particular consideration must be given to pharmacological aspects. Moreover, certain minimum demands must be met by the equipment and personnel staffing of a pain clinic, and also the possibilities for monitoring the patient. Within the framework of an interdisciplinary pain clinic, the various blockade techniques employed for therapeutic local anesthesia provide suitable possibilities for combatting this type of pain.
Apart from disc prolapse, there is a range of other disorders associated with low back pain, for which, when all conservative efforts have failed, surgical treatment should be offered. It must be emphasized, however, that the indication for surgery needs to be rigorously applied, since the most common cause of failure of surgical therapy is an erroneous surgical indication. Here, the clarification of the cause of the pain and not the diagnosis per se is decisive. In particular in degenerative disorders of the lumbar spine in the elderly, the diagnoses established often have little pathological value. Unfortunately, in many cases the real cause of low back pain still cannot be clarified with certainty. Our experience to date, however, in particular with the use of modern implants, shows that, in cases of lumbar spinal stenosis especially, tumors and pronounced segmental instability, excellent results can be achieved with surgery.
The treatment of acute and chronic low back pain is a problem frequently encountered in the doctor's office. Selective drug therapy has a useful role to play within the framework of the overall therapeutic strategy. Indications and practical application of the major analgesic agents in various low back pain conditions are discussed.
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Explore the source record for details and available documents.
Clinical results from 50 patients with an osteoid-osteoma, show that night pain is considered one of the most important symptoms (90%). 88% responded to salicylic acid. The diagnosis can often be made from normal X-rays. Diagnostic problems are especially common in cases of rare, atypical localisations (spine, sacrum, clavicula, talus, calcaneus and the proximal part of the femur). The scintigraphy represents an unspecific but sensitive method of diagnosis in the early stages. The osteoid-osteoma is visible as a "hot spot" or, in the subperiosteal type, as a diffuse accumulation. Angiography is of great importance for preoperative localisation and differential diagnosis. Computer tomography is particularly valuable for localisation in the region of the spine. Magnetic resonance is an excellent method of examination. The three dimensional imaging allows an exact localisation, especially in atypical and difficult localisations. This will be the preferred method of the future, not least because there is no exposure to radiation.