PubMed Health⌕ Search

Biomedical subjects

L Wiesner

Publications and source records attributed to L Wiesner.

28 records · Page 2Linked to original sources
PubMed1988

[Chronic pancreatitis: natural history and development in relation to alcoholism].

42 cases of chronic pancreatitis treated between 1976 and 1986, presenting 0.2% of all patients seen at the surgical clinic in the same period, have been reviewed. 37 patients (88%) were alcoholics and the prevalence of males was 83%. -Study of dietary habits showed a very high alcohol intake of 135.3 g alcohol per day, contrasting with the control group's alcohol consumption of 44.9 g per day. Alcohol intake calculated per life of patient with chronic pancreatitis represented 850.4 kg, whereas the control group consumed 344.1 kg (beer and wine). -Patients with chronic pancreatitis had started excessive alcohol consumption at an average age of 18 +/- 2 years and continued for an average of 18.0 +/- 1 years. These data correspond to zone A, i.e. Southern Europe. The evolution was analyzed with regard to persistence or cessation of alcoholism. Repeated attacks of chronic pancreatitis were seen in both groups. Patients abstaining from alcohol had only one attack during an average period of 10 years. Painful recurrences after surgery seem to be more frequent with persistent alcoholism (4 out of 5 patients), whereas in 15 patients without alcoholism they were observed only 3 times. -This shows that alcoholism remains the main factor in the natural history and evolution of chronic pancreatitis.

Adult↗
PubMedDate not supplied

[Segmental hypermobility of the spine before and following discectomy].

In 145 patients with open dissectomies (virgin back) preoperative functional x-rays (flexion/extension) were available. 80 patients out of this group could be used for additional postoperative functional x-rays. The mean follow-up was 28 +/- 18 months. The segmental mobility was measured using the translation in the z- and the angular rotation about the x-axis (methods of Morgan/ King and Dupuis et al.). The patients were divided in 3 groups in respect to the level of operation. For each patient 3 segments (L3/4 to L5/S1) were analyzed. Segmental hypermobility was defined with a translation of more than 4 mm respectively a rotation of more than 18 degrees (ROM flexion/extension). In patients operated at the level of L4/5 (n = 62) segmental hypermobility was found in 12.9% at L3/4, in 8.1% at L4/5 and in 17.7% at L5/S1. Patients with a discectomy at the level of L5/S1 (n = 79) showed preoperative hypermobility in 10.1% at L3/4, in 15.1% at L4/5 and in 12.6% at L5/S1. In postoperative x-rays patients with discectomy at L4/5 (n = 34) showed no significant differences after operation, neither in translation nor in rotation. In the L5/S1-discectomy group (n = 45) the mobility for rotation at the level L4/5 increased significantly from 6.7 degrees to 10.2 degrees and in the level L5/S1 from 5.2 degrees to 8.4 degrees. There was no significant difference for the translation in all 3 segments. In both discectomy groups the number of segments with hypermobility didn't change significantly after operation.

Adult↗
PubMedDate not supplied

[Early diagnosis of postoperative discitis].

This study demonstrates that infection of the retro- and intradiscal space is probable, when the temperature rises above over 37 degrees and CRP exceeds 2.0 mcg/ml 5 days postoperatively. MRI of 4 patients confirmed a retrodiscal infection that was indicated by a hyperintense band shaped structure in PS-sequences and which was space occupying with respect to the dural sac. Discitis was demonstrated by intradiscal hyperintensity in STIR images and by enhancement in T1 weighted images following the application of Gadolinium DTPHA. Diagnosis is simplified by comparison of pre- and postoperative MR-examination. Infection can be cured by treatment with antibiotics (Tobramycin and Clindamycin) bedrest and plaster cast.

Blood Sedimentation↗
PubMedDate not supplied

[Accuracy of pedicle screws following instrumented dorsal fusion of the lumbar spine].

We evaluated the placement of pedicle screws (N = 131) in 30 patients after lumbar dorsal spinal fusion. Postoperatively all patients were examined by CT. 39.9% of all screws penetrated the cortex of the vertebra. Of special interest were those implants which led to medial penetration of the pedicle, which is of potential hazard to the neural structure within the nerve root canal. 28.5% of all screws showed a medial deviation. In our study, a penetration of more than 6 mm coincided with a high risk for nerve root damage. In 2 patients there was proven damage to a nerve root due to screw placement. In another 3 patients coherence was likely to exist. The technique of transpedicular screw fixation for spinal fusion is highly demanding and should be performed only by experienced surgeons after a clear indication and after a trial of intense conservative therapy.

Bone Screws↗
PubMedDate not supplied

[The mobile segment above fusion].

The question is, if a possible concentration of stress in the segment adjacent to the fusion level might result in disc degeneration. Two series of patients have been evaluated: One group of 70 patients underwent a posterolateral fusion without instruments and the other group of 69 patients underwent a posterolateral instrumented fusion. The follow-up was in average 5.7 years resp. 4.6 years. The operations were divided in monosegmental, floating and polysegmental fusions. In the total group, 10% of the non-instrumented and 28% of the instrumented patients had an osteoarthritis of the facet joints, 10% resp. 23% were unstable and in 9% resp. 1% a disc resorption occurred. There have been no statistical differences in the both polysegemental groups, but this was the case for all osteoarthritis and instabilities in the monosegmental fusions. It is supposed that the changes in kinematics together with material related alterations of elasticity led to higher stress concentration in case of instrumentation.

Biomechanical Phenomena↗
PubMedDate not supplied

[Foraminal and extraforaminal lumbar disk herniations].

Between 1985 and 1989, a total of 40 intraforaminal and extraforaminal disc herniations were treated, either conservatively or surgically. Lasègue was observed in 28%, pain on femoralis extension in 22% and paralysis in 57%. The computer discogram was the most sensitive imaging method, with a sensitivity of 97%. The corresponding values for computerized tomography and NMI were 82% and 85%, respectively. Nine patients were treated by chemonucleolysis, 19 underwent surgery as a primary procedure and three following failure of chemonucleolysis. One patient underwent surgery a second time, the first operation having failed. The authors report on the indications for various surgical procedures.

Adult↗
PubMedDate not supplied

[External fixators in temporary spinal stabilization. Radiographic anatomy of the lumbar pedicles].

External spinal fixation is used in cases where fusion is indicated and for reducing the number of stiffened segments in lumbar sacral pain. Owing to the percutaneous implantation, only the pedicle oval is available for localizing the screw in a-p X-rays. Cadaver studies have shown that the root of the arch and the halo are not identical and that unless one relies on the midpoint of the halo the pedicle may be perforated medially. rate, with markedly enhanced fusion of the lumbar spine following external spinal fixation.

External Fixators↗