PubMed Health⌕ Search

Biomedical subjects

L Jani

Publications and source records attributed to L Jani.

At least 19 recordsLinked to original sources
PubMed1996

Follow-up (6-9 years) results of the uncemented CLS Spotorno stem.

The aseptic loosening rate in uncemented hip endoprostheses, especially the stem, is one of the most discussed problems among hip surgeons within the last few years. The first generation of uncemented stems had an essentially higher loosening rate compared with cemented stems. Although there are many reasons for this disappointing fact, the type of primary fixation and polyethylene wear are the two main ones. We reviewed 145 sequential uncemented CLS Spotorno stems, which achieved their primary fixation and bony in- or ongrowth predominantly in the metaphyseal region. The mean age of the patients was 54.9 years (range 37-76 years), and average follow-up was 7.8 years. The evaluation included both clinical (Merle d'Aubigne and Harris Hip Score) and radiographic parameters (plain X-rays). The medium-term follow-up showed a survival rate of 96.7% and good functional score results in more than 90%. Special attention was paid to the so-called thigh pain phenomenon which, despite current views, was found to be unexpectedly low (only one case). Although these results are encouraging, a further long-term follow-up of more than 10 years will have to show whether or not comparable results to cemented stems can be realised.

Adult↗
PubMed1996

Uncemented total hip replacement and thigh pain.

We reviewed 145 consecutive patients who had total hip replacements using uncemented CLS Spotorno femoral stems which achieve primary fixation with bony ingrowth which occurs later mainly in the metaphyseal region. The mean age was 54.9 years and average follow up 7.8 years. The Merle d'Aubigne and Harris hip scores were used for evaluation, together with plain radiographs. Current medium term follow up showed a survival rate of 96.7% and a good functional score in more than 90%. Special attention was paid to postoperative thigh pain which occurred in only one patient. These results are encouraging, but a follow up of more than 10 years is required before comparable results to cemented stems can be claimed.

Adult↗
PubMed1995

[Juvenile bone cysts. Relative value and therapy results of cortisone injections].

Seventy-one children and adolescents with unicameral bone cysts were treated between 1982 and 1992. Fifty-one percent were in the proximal humerus, 34% in the femur, 10% in the tibia, and only 5% in other sites. Until 1986 biopsies were routinely done. Since then, only selected cases have been biopsied because of uncertainty in the radiological diagnosis. In 70% the diagnosis was a pathological fracture as a result of the cyst. Cortisone injections were introduced in 1982. It replaced currettage and bone grafting, which was the routine treatment until then. Ninety-two percent of the cysts healed or healed with residuals according to the Neer classification. Additional osteosynthesis was done in pathological fractures of the femoral neck. The results are achieved with little morbidity, and low cost which justifies continuation of this treatment protocol.

Adolescent↗
PubMed1994

[Short donation intervals in preoperative autologous blood donation in the concept of autologous transfusion].

Homologous transfusion is associated with infectious and immunological risks. Preoperative autologous deposit reduces homologous transfusion requirements considerably. Usually donations are carried out at weekly intervals. In this study we investigated the effect of shorter donation intervals on erythropoiesis and perioperative transfusion requirements. METHODS. A total of 40 consecutive patients scheduled for hip arthroplasty and taking part in an autologous donation programme were randomly assigned to two groups: group I gave blood on days 0, 3, 7 (and 14), group II at weekly intervals. The aim was deposit of three blood units of 450 ml. A patient was deferred if hemoglobin concentration prior to donation fell below 11 g/dl, and in this case 100 mg Fe 2+ three times daily was prescribed. Blood was stored with CP-DA-1 anticoagulant. Surgery was performed between day 28 and 35. A perioperative hemoglobin concentration lower than 9 g/dl was considered a transfusion trigger. RESULTS. Group I was made up of 21 patients (10 women, 11 men, aged 39-69 years) who gave blood at short intervals, and group II of 19 patients (10 women, 9 men, aged 37-77 years) who gave blood at weekly intervals. General data, calculated blood volume and erythrocyte mass prior to donation were comparable. Each patient donated three units. Four patients had to be deferred once, one in group I, three in group II. The hemoglobin concentration in group I decreased from 13.9 +/- 1.2 g/dl (mean +/- SD) to 13.3 +/- 1.0 g/dl prior the operation, in group II from 13.5 +/- 1.3 g/dl to 12.5 +/- 1.1 g/dl. Preoperatively the hemoglobin concentrations differed significantly (P < 0.05), as did calculated erythrocyte mass (1633 versus 1474 ml, P < 0.05). Reticulocytes increased from 46 x 10(3)/microliters (median) to a maximum of 94 x 10(3)/microliters on day 7 in group I, and from 44 x 10(3)/microliters to 108 x 10(3)/microliters in group II on day 14. Serum ferritin decreased from 122 micrograms/l (median) to 82 micrograms/l in group I, and from 140 micrograms/l to 77 micrograms/l in group II. These parameters did not differ statistically between the two groups. Intra- and postoperative blood loss amounted to 2175 ml (median) in group I versus 1430 ml in group II (P < 0.05). The perioperative hemoglobin concentration was similar in the two groups. Homologous transfusion requirements were similar in the two groups (1 unit in group I, vs 3 units in one patient and 1 unit in two patients in group II). CONCLUSIONS. Short donation intervals resulted in a higher preoperative erythrocyte mass after similar preoperative deposit, and significantly higher blood loss was tolerated with similar homologous transfusion volume.

Adult↗
PubMed1991

[A comparison of autologous transfusion procedures in hip surgery].

The risks associated with transfusion can be minimized with autologous blood. The efficiency of preoperative deposit, preoperative hemodilution and intra- and postoperative autotransfusion in reducing homologous transfusions has been demonstrated. There seem to be few studies, however, that compared the different methods of autologous transfusion. This study was designed to evaluate the comparative efficiency of these methods. PATIENTS AND METHODS. Sixty-four patients scheduled for total hip arthroplasty were randomly divided into four groups: group I--preoperative autologous deposit: group II--preoperative hemodilution; group III--intra- and postoperative autotransfusion; group IV--control. Preoperative autologous donations were stored in CPDA-1 buffer. Three units of 450 ml were requested. A predonation hemoglobin (Hb) concentration of 11 g dl was required. Surgery was carried out in the 5th week after the first donation. Preoperative hemodilution to Hb 9 g/dl was carried out after induction of anesthesia and initial circulatory stabilization. A cell separator was used for intra- and postoperative autotransfusion. Postoperative autotransfusion of drainage blood was continued until 6 h after the beginning of the operation. Polygeline was used for volume resuscitation. If the Hb concentration fell below 9 g/dl in the operating room and intensive care unit or below 10 g/dl in the general ward, autologous blood or homologous packed red cells were transfused. Autologous blood collected with the cell separator was retransfused at the end of the operation and after the autotransfusion period irrespective of the actual Hb concentration. RESULTS. The general data of the patients, blood loss, and Hb concentration at the beginning of the study and postoperatively were comparable in the four groups. Homologous transfusion requirements amounted to 0 (0-1250) ml (median, range) packed red cells in group I (preoperative deposit). 500 (0-2000) ml in group II (hemodilution), 125 (0-1000) ml in group III (autotransfusion) and to 500 (0-1500) ml in group IV (control). In group I 14 of 16 patients, in group II 1 of 16, in group III 8 of 16 patients, in group IV 5 of 15 patients did not require homologous transfusion. The difference between group I and IV was significant (p = 0.004 and p = 0.003). Global coagulation tests, antithrombin III, and total serum protein were comparable in the four groups. DISCUSSION. The efficiency of preoperative hemodilution to reduce homologous transfusion requirements is limited]. In the present study, as in two other recent studies, hemodilution did not reduce homologous transfusion requirements. Autotransfusion with a cell separator can save approximately 50% of the erythrocytes lost during hip arthroplasty and 70% of the drainage loss. The homologous transfusion requirements for the autotransfused group reported here were less than in the control group; the difference, however, was not statistically significant. Patients participating in preoperative autologous deposit did not require homologous blood for hip arthroplasty in 62%-70% of cases in other investigations; in the present study 88% of the patients did not require homologous blood. CONCLUSION. Under the conditions studied, preoperative autologous deposit was the most efficient method of autologous transfusion for hip arthroplasty. It should be employed primarily.

Adult↗
PubMed1991

[Bacterial spondylitis caused by Haemophilus aphrophilus].

Four weeks after a slight scratch a 43-year-old man noted a severe back pain. Physical examination gave suspicion of a bacterial spondylitis. From the biopsy of the involved vertebral body Haemophilus aphrophilus was isolated under aerobic growth conditions.

Adult↗
PubMed1990

[Femur head necrosis in childhood].

The natural history of avascular necrosis of the femoral head in children and adolescents shows significant differences compared to the course of this disease in adults. Depending on the remaining growth potential, even extensive damage of the femoral head can regenerate, as long as the epiphyseal growth plate is not involved in the process. Otherwise, the deformity will increase with time. Current knowledge on the etiology, natural history, diagnosis and treatment is described on Perthes' disease and other possible causes of avascular necrosis, such as CDH, epiphyseolysis of the femoral head, femoral neck fracture and some uncommon diseases.

Adolescent↗
PubMed1989

Results of screw osteosynthesis in spondylolysis and low-grade spondylolisthesis.

Nineteen patients with spondylolysis and low-degree spondylolisthesis were treated with bone grafting and osteosynthesis of the pars defect with the Morscher hook screw (16 cases) or with Buck's procedure (three cases). Eighteen patients had a follow-up examination. In the age-group 9-16 years (ten patients) there were 80% excellent or good results with fusion, whereas in the adult group (eight cases) the majority had poor results. It seems that the operative techniques which we applied are useful in juvenile patients; adults require a more reliable fixation.

Adolescent↗
PubMed1989

[The place of intra- and postoperative autotransfusion in the exchange of a hip endoprosthesis].

Intraoperative autologous transfusion with a cell separator is being employed to an increasing extent in orthopedic procedures associated with high blood loss, including surgery for exchange total hip arthroplasty. Postoperative loss of blood via drains after exchange total hip replacement is also considerable. To our knowledge, there are only unpublished reports on postoperative autotransfusion in this type of surgery. In this study the role of intra- and postoperative autotransfusion is investigated.

Aged↗
PubMed1988

[Congenital changes in the elbow joint].

Radio-ulnar synostosis is one of the congenital malformations of the elbow joint that can be severely disabling, especially if it is present bilaterally or there is marked hyperpronation. In the case of fixed pronation of 60 degrees or more corrective surgery is definitely indicated to reduce functional impairment. As yet, there is no standard operative procedure for restoration of useful supination/pronation function of the forearm. Derotational osteotomy at the site of synostosis seems to be the best procedure. As the postoperative aim we recommend fixed pronation at 15 degrees -35 degrees for the dominant hand and fixed supination at 15 degrees -30 degrees for the contralateral hand. Major derotational procedures should be performed in several stages to avoid neurovascular complications.

Elbow Joint↗
PubMed1987

[Spinal fractures in children and adolescents].

A follow-up study of more than hundred spinal fractures in children and adolescents pointed out that treatment and prognosis depends on the injury involving the growth-plate. In compression fractures without injury of the growth-plate spontaneous correction can be expected during further growth, especially if the wedge-shaped compression was in the sagittal plane alone. Spinal fractures with damage of the growth plate always result from a severe accident. These compound fractures, luxations and luxation-fractures require an exact repositioning and stable fixation to avoid growth disturbances such as progressive scoliosis and kyphosis originating from the unreduced fracture. Reposition and fixation can be managed by modern surgical methods more carefully, more exactly and with greater stability than with conservative methods. Furthermore surgical procedure allows removal of mechanical obstructions within the spinal channel. The origin, clinical appearance and treatment of apophyseal tearing out from the vertebral body are discussed.

Adolescent↗
PubMed1986

[Pediatric flatfoot].

In flexible flatfeet in children the transition from physiological to pathological is obscure. This is seldom the case in pediatric foot deformities and makes assessment of the therapy required all the more difficult. On the other hand, the results of follow-up examinations of treated and non-treated cases of flexible flatfeet suggest that the value of arch-support insoles, which used to be prescribed widely, is more than questionable. In addition to the usual age-related fall of the medial arch and the physiologically accentuated valgus position of the calcaneous in children of preschool age, free movement of the joints of the foot should be taken into consideration in examinations, and attention should be paid to active correction of flexible flatfeet, in the tiptoe position. On the basis of our present knowledge, therapy only appears to be necessary for severe flexible flatfeet, i.e., when the heel valgus is over 20 degrees and, at the same time, there is complete lack of a medial arch. When weight is placed on the insole, the lack of medial arch can be seem to be completely or even convexly twisted. In cases of severe flexible flatfeet, further diagnostic clarification is usually necessary, in particular roentgenological examinations in order to exclude the possibility of other foot deformities by means of differential diagnosis.

Adolescent↗
PubMed1983

Primary chronic osteomyelitis.

Plasma-cell osteomyelitis is a histological diagnosis and, in the opinion of some authors, is a disease entity which can be differentiated from the sclerosing osteomyelitis of Garré and Brodie's abscess. Our investigation of 12 patients with plasma-cell osteomyelitis leads us to a different conclusion. The radiological appearances are not specific and do not allow a definitive diagnosis of the type of osteomyelitis or the exclusion of other bone disorders. Although there were always an increased number of plasma cells in the specimens from our patients, there were frequently transitional appearances varying from sclerosing osteomyelitis to Brodie's abscess. For this reason, we suggest that the term "primary chronic osteomyelitis" should be used. This makes it possible to distinguish the condition from acute and secondary osteomyelitis as well as from other diseases, such as bone tumours. All our patients were treated by local resection of the osteomyelitis lesion and they all recovered uneventfully; there were no local recurrences.

Adolescent↗