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Biomedical subjects

L Perlick

Publications and source records attributed to L Perlick.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Non-Hodgkin lymphoma as differential spondylodiscitis diagnosis].

This case presents the history of a 56-year-old patient suffering from low back pain for a period of several weeks. The radiological und histopathological examination showed hints for a spondylodiscitis of the fifth lumbar vertebra. Due to a progressive destruction of the fifth vertebra a ventral stabilisation was performed. Again the histological examination showed the characteristics of an unspecific spodylodiscitis. The last biopsy, taken during the explantation of the fixateur interne showed a high malignant lymphoma. A course of chemotherapy was started following the CHOP-Protocol accompanied by radiotherapy. This case demonstrates that meticulous clinical examination as well as advanced radiological techniques can fail in rare differential diagnosis of spondylodiscitis.

Diagnosis, Differential↗
PubMed2000

[Secondary hypertrophic osteoarthropathy. Differential diagnosis of post-traumatic ossification of the interosseous crural membrane].

The case of a 48-year-old patient is presented, suffering from persisting pain in the right lower leg for more than a year following a distortion of the ankle. The patient was known to have a history of severe asthmatic disease. Conventional X-rays showed a periostitis of the lower tibia and fibula. To exclude a malignant process, an open biopsy was performed. Neither tumor nor any histological signs of chronic inflammation were found. The patient claimed to have a similar pain in the contralateral lower leg 5 months after initial biopsy. X-rays again showed signs of a periostitis of the tibia and fibula. Furthermore, an increase in isotopes in this area was found in a performed bone scan. Diagnosis of osteoarthropathia hypertrophicans was confirmed 2 years after onset of the first symptoms. Pathogenetic variables both of the primary and secondary forms of hypertrophic osteoarthropathy (HOA) are as yet not completely clarified. Secondary hypertrophic osteoarthropathy (SHOA) may be defined as a syndrome of the long bones with clubbing of the fingers and toes, and occurs in the process of chronic lung and mediastinal disease. We conclude that HAO detection may contribute to early detection of lung disease, especially bronchopulmonary cancer, before it becomes clinically and radiographically manifest.

Diagnosis, Differential↗
PubMed2000

The three-dimensional ultrasound evaluation of the rotator cuff--an experimental study.

OBJECTIVE: An accurate sonographic diagnosis of rotator cuff lesions significantly depends on image quality and on the experience of the operator. The present study was performed to determine whether the use of three dimensional (3D) sonography further increases the diagnostic yield of ultrasound. METHODS: In an experimental study 22 artificial rotator cuff lesions (seven full thickness and 15 partial thickness tears) of cadaveric shoulder joints were evaluated by ultrasound with two and three dimensional imaging in a water basin. RESULTS: With 3D ultrasound, rotator cuff lesions were more often correctly diagnosed (sensitivity of 77%) than with conventional 2D sonography (sensitivity of 64%). Specificity was 85 and 69%, respectively. In partial thickness tears in particular, 3D imaging was the superior method reaching a sensitivity and specificity of 73 and 77%, respectively, compared to 53 and 61%, respectively, with 2D ultrasound. With 2D and 3D ultrasound eight and 11 out of 13 tendons, respectively, were correctly diagnosed as intact confirmed by histopathological examination. CONCLUSION: Although the results of an experimental study may not reflect the clinical situation, 3D ultrasound appears to facilitate diagnosis of partial thickness rotator cuff tears.

Humans↗
PubMed2000

[Desmoplastic fibroma of the fibula. A difficult clinical, radiological and histological diagnosis].

Desmoplastic fibroma of bone is a rare benign tumor that is made up of wavy fibroblasts and abundant collagenous tissue. The case of a 18-year-old patient is presented with a two months history of weightbearing pain in the left knee. Neither native x-ray, CT nor MRI could detect the kind of tumor. The histological findings lead finally to the diagnosis of a desmoplastic fibroma. Wide resection prevented recurrence of the tumor for 8 1/2 years until now. Considering the semi-malignant character of the desmoplastic fibroma and the recurrence rate marginal or wide resection for the primary treatment is recommended. The superior imaging quality of MRI facilitates preoperative planning.

Adolescent↗
PubMed2000

[Three-dimensional ultrasound evaluation of the rotator cuff. Preliminary results of clinical application].

AIM: Accurate sonographic diagnosis of rotator cuff lesions mainly depends on image quality and on the experience of the examiner. The present study was performed to determine whether the use of three dimensional (3D) sonography further increases the diagnostic yield of ultrasound examinations. METHOD: In a prospective study 25 patients who later underwent shoulder surgery of the rotator cuff were examined pre-operatively by ultrasound with two and three dimensional ultrasound. RESULTS: With three dimensional ultrasound rotator cuff lesions were more often correctly diagnosed (sensitivity of 100%) than with conventional 2D sonography (sensitivity of 91.7%). Specificity with both methods was 84.6% predictive value 92% and 88% respectively. In partial thickness tears, false-negative results were twice as common with 2D imaging. CONCLUSION: Although our results are preliminary and have to be verified in a larger study, three dimensional ultrasound appears to facilitate diagnosing of rotator cuff lesions and partial thickness tears, in particular.

Female↗
PubMed2000

[N. thoracicus longus lesion--a rare injury in weight lifting].

The case of long thoracic mononeuropathy associated with sport participation a presented. The diagnosis was confirmed with electromyography. It is suggested that the athletic activity caused a stretch injury to the long thoracic nerve. Degenerative changes and infections were excluded. Conservative management, consisting of range of motion exercises for the shoulder and strengthening of the serratus anterior muscle, resulted in a forable outcome. The 12 month follow-up showed only slight changes in EMG and clinical examination.

Adult↗
PubMed1999

[Three-dimensional ultrasonography and intraoperative navigation:a new application of ultrasonograms in osteotomy of the proximal femur].

AIM: As precise operative control is difficult to achieve, the accuracy of femoral osteotomies can only be estimated. Therefore, a computer-assisted ultrasound navigation system was developed in order to apply an on-line control for femoral osteotomies. METHOD: Three ultrasound emitters were fixed on a triangle. The exact position of triangles could be determined by measuring the time the ultrasound beam takes to reach microphones positioned in a frame. With a reference triangle fixed distally to the osteotomy and a second triangle fixed on the surgical chisel the exact correction angle can be determined three-dimensionally. RESULTS: A high degree of accuracy was found in both laboratory trials and in simulation trials using pig femurs. The deviation of measured values compared to a laser beam control was less than 0.5 degrees. CONCLUSION: The system was introduced into our operating theatre as an optimised control device that can provide excellent support to the surgical procedure.

Animals↗
PubMed1998

[High energy shock wave treatment of the painful heel spur].

Extracorporal shock wave application (ESWA) has been used in the treatment of stones located in kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of the ESWA on the treatment of soft tissue disorders. The aim of this study was to explore the effect of high energy extracorporal shock waves in patients with painful calcaneus spurs. 83 patients who underwent medicophysical treatment without benefit were treated with 3000 impulses of 0.30 mj/mm2. Follow-ups after 12 weeks and 12 months showed that 51 of 83 patients became pain-free and 20 patients improved from the treatment. The results are showing the benefit of the high energy extracorporal shock wave application in the treatment of chronic plantar fasciitis.

Calcaneus↗
PubMed1996

Open wedge high tibial osteotomy using fractioned drill osteotomy: a surgical modification that lowers the complication rate.

We investigated retrospectively 132 cases of open wedge high tibial osteotomy using an external fixation device, concentrating on the rate of neurological complications. One group of patients underwent surgery according to the conventional technique (n = 89). The rate of transient neurological complications was 15.7%; 7 months after surgery the rate of persistent deficits was 12.4%. For the second group (n = 43) a modified surgical technique was used that lowered the complication rate significantly (transient deficits 14%, persistent deficits 4.7%). In the modified technique the osteotomy is not performed in the conventional way using an oscillating saw but through consecutive drill holes of increasing diameter followed by osteoclasis. The lower complication rate in the second group is mainly due to the less extensive approach that leads to a smaller number of postoperative tibialis anterior syndromes (type B lesion). No differences were found with type C lesions (extension deficit of D1). No complete peroneal nerve palsy (type A) occurred in either group. We conclude that the reduction of neurological complications in group 2 is related to the less extensive approach of the proposed technique.

Adult↗
PubMed1996

[Shockwave treatment of therapy refractory soft tissue pain].

Extracorporal shock-wave application (ESWA) has been used in the treatment of stones located in the kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of ESWA in the treatment of soft-tissue disorders and tendinosis calcarea. To date, the exact mechanism is unknown. Local hyperemia following damage or afferent inhibition is discussed. The possibilities and indications of ESWA with respect to several syndromes are presented. The results show the benefit of ESWA in the treatment of chronic soft-tissue disorders without severe side effects. Some patients showed small subcutaneous hematomas and erosion of the skin when energies about 20 mJ were used. Forty-seven of 84 of the patients obtained complete relief; 24 patients showed a marked reduction in their complaints. In only 13 of 84 cases was the treatment unsuccessful.

Adult↗
PubMedDate not supplied

[Surgical outcome of single segment ventral fusion with plate osteosynthesis in therapy refractory chronic cervico-brachialgia].

INTRODUCTION: In anterior cervical stabilization, collapses of the grafted bone with resulting localized kyphosis and graft dislocation has been reported. It was the aim of this clinical trial to evaluate the benefit of additional plating while taking specific implant-related complications into account. METHODS: The results of single level anterior cervical spinal fusion were evaluated. In 44 patients suffering from chronic cervical radicular pain with degenerative changes, arthrodesis with iliac-crest bone and plate fixation was performed. Apart from clinical parameters, the pre- and postoperative segmental kyphosis and cervical lordosis were evaluated. RESULTS: The total cervical alignment increased from 15.4 degrees to 18.5 degrees while the alignment of the fused segment increased from 2.6 degrees to 7.7 degrees. Postoperative decrease of correction did not occur. Bony fusion was confirmed in 95% after 12 months and 100% aller 36 months. Our results show that patients had more relief from radicular pain (80%) than from unspecific neck pain (66%). DISCUSSION: In single level anterior cervical fusion, additional plating successfully prevents dislocation of the bone graft and postoperative kyphosis. The clinical results and pseudarthrosis rate do not differ from studies without plating. Long. term follow-up studies are necessary to show the benefit of the reduced postoperative kyphosis.

Bone Plates↗
PubMedDate not supplied

[Non-cerebrovascular complication in chirotherapy manipulation of the cervical vertebrae].

PURPOSE: Chirotherapy is a popular and successful management option for reversible functional disorders of the cervical spine. Though rarely observed, complications do occur, mainly involving the cerebrovascular system. By means of the here described case and a literature survey, we aim to highlight non-cerebrovascular complications of chirotherapeutic cervical spine manipulation. RESULTS: A 43-year-old male initially consulted an ENT specialist, suffering from tinnitus aurium and loss of hearing ability. His hearing significantly increased after intravenous drug therapy, but the tinnitus remained. During chiropractic manipulation of the cervical spine by an orthopaedic surgeon for the tinnitus, the patient described severe neck pain following a clearly audible clicking sound. Scans of the cervical spine prior to and after manipulation showed an intracapsular/intraosseus oedema of the facet joints C2/C3 with lesion of the nerve root C3, most probably induced by chirotherapy. CONCLUSION: Although complications after chiropractic manipulation are extremely rare, treatment of the spine, especially the cervical spine, is not wholly harmless. An adequate history taking followed by clinical and radiographic patient evaluation is necessary to keep the risk of iatrogenic trauma at a minimum. Above all, the chiropractic manipulation of the cervical spine belongs in the hands of a qualified and experienced medical practitioner.

Adult↗
PubMedDate not supplied

[Histomorphology versus three-dimensional ultrasound morphology of the rotator cuff].

AIM: Sonographic evaluation is a reliable method for the detection of rotator cuff tears. However, the diagnostic value of the different echogenic patterns of the rotator cuff, especially in elderly patients, has led to a controversial discussion. The present study elucidates whether three-dimensional ultrasound can increase the diagnostic significance of different sonographic echogenicity patterns of tendons compared to histopathological tissue degeneration. METHOD: To evaluate the sonographic appearance of tendons in elderly patients, the sonographic echogenicity of 33 rotator cuff specimens with macroscopic absence of rotator cuff lesions was classified in three groups and compared with the histopathological morphology. RESULTS: The sonographic appearance of the degenerated rotator cuff in elder patients correlates with a reduced sonographic echogenicity. The two-dimensional ultrasound evaluation of the rotator cuff led to a sensitivity of 84.0%, a specificity of 42.9%, a positive predictive value of 63.6%, a negative predictive value of 69.2%, and an accuracy of 65.2%. The three-dimensional ultrasound evaluation of the rotator cuff led to a sensitivity of 91.6%, a specificity of 50.0%, a positive predictive value of 66.6%, a negative predictive value of 84.6% and an accuracy of 71.%, respectively. CONCLUSION: As a high incidence of false positive results has to be taken into consideration, neither the two-dimensional, nor the three-dimensional ultrasound evaluation seems to lead to a reliable correlation.

Aged↗
PubMedDate not supplied

[Orthopedic considerations of trichorhinophalangeal syndrome type II].

INTRODUCTION: The trichorhinophalangeal syndrome type II or Langer-Giedion syndrome is regarded as a rare abnormity that is marked by a number of clinical characteristics beside multiple cartilaginous exostoses. RESULTS: The deviation of the fingers within the scope of the TRPS II that is often reported in literature can not be found in the case at issue of a now 14 year old boy. The course of disease was complicated due to consecutive axis deviation of two large joints of the lower extremities being determined by the syndrome. Due to the marked exostoses in the area of the growth plate of the left knee joint a valgus deformity developed there. It was corrected with means of a temporary clamping of the growth plate. With the increasing valgus deformity of the right ankle causing a calcaneovalgus foot deformity the osteochondroma located at the distal fibula was also removed and a temporary clamping of the growth plate was carried out at the right medial malleolus. From earliest childhood repeating cartilaginous exostoses both at the extremities and the trunk attracted attention. Also strongly developed are the facial distinguishing marks which determine the typical shape of the face. CONCLUSION: By the case of a now 14 year old boy with severe orthopedic complications considerations are made concerning therapeutic principles due to the TRPS II.

Adolescent↗
PubMedDate not supplied

[Butterfly vertebrae and scoliosis: Alagille syndrome].

INTRODUCTION: Alagille syndrome is a dominantly inherited disorder affecting the liver (arteriohepatic dysplasia), the heart, the eyes and the face. Butterfly vertebrae in the thoracic and lumbar spine are detectable in 50 to 80 per cent of the patients; most of them remain asymptomatic. The management of progressive cholestasis in early childhood is the main aspect of therapy. CASE: A 14-year-old female patient with Alagille syndrome was referred to our hospital for examination of a right thoracic scoliosis. Magnetic resonance imaging verified butterfly deformity in thoracic vertebrae 2, 4, 6, 7, 8, 10, 11, and lumbar vertebra 3. Asymmetries of thoracic vertebrae 6, 8 and especially, 7 were responsible for the scoliosis. CONCLUSION: The highly variable expression of these typical characteristics in mildly affected patients can cause some difficulties. When diagnosing a scoliosis with asymmetric butterfly vertebrae, an Alagille syndrome should be considered, especially if the patient shows a liver dysfunction.

Adolescent↗
PubMedDate not supplied

[Extracorporal shock wave treatment of the achilles tendinitis: Experimental and preliminary clinical results].

OBJECTIVE: Various studies have shown the benefit of extracorporal shock wave therapy (ESWT) in the treatment of soft tissue pathologies. The aim of this prospective study was to compare the results of ESWT with the operative treatment for achilleus tendopathy. Furthermore mechanical effects of the shock waves on the achilleus tendon were analysed by an in-vitro model. METHOD: The achilleus tendons of common pigs treated with 1500 impulses twice using an energy varying from 0.23 - 0.54 mJ/mm (2) were histologically examined. The clinical results of two patient groups of which the first (n = 28) was treated with 2000 impulses (0.23 mJ/mm (2)) once and the second (n = 26) underwent surgery for achilleus tendopathy were compared. RESULTS: The in-vitro model demonstrated that an EFD of 0.42 and 0.54 mJ/mm (2) can lead to tendon lesions. One year follow-up showed good and excellent results in 69 % and satisfactory results in 15 % of the operated group and good and excellent results in 29 % and satisfactory results in 43 % of the ESWT group. We could show a time-dependent effect of the shock wave treatment on the clinical outcome. CONCLUSIONS: Follow-ups show acceptable results with little side effects when an energy flow density (EFD) under 0.23 mJ/mm (2) is used. ESWT offers a non-invasive therapeutic concept that can seriously be contemplated before operative treatment, but lower success rates in comparison to the operative results can be expected.

Achilles Tendon↗