Biomedical subjects

M G Ehrlich

Publications and source records attributed to M G Ehrlich.

79 records · Page 5Linked to original sources

PubMedDate not supplied

Congenital intraspinal lipomas: clinical presentation and response to treatment.

A retrospective review of 29 patients with surgically treated intraspinal lipomas was conducted in a determination of their manner of presentation and response to treatment. The average age at the time of diagnosis for the entire group was 12.8 years. Only five patients were neurologically normal by clinical examination at the time of diagnosis, and these five patients were all less than 6 months old. Orthopedic intervention was judged successful in each of the 11 foot-procedures done after surgery on the lipoma, but in only two of the five foot procedures done before such surgery. We conclude that consideration of intraspinal lipoma is worthwhile in several circumstances, including pediatric foot deformities.

Adolescent↗

PubMedDate not supplied

Combined biochemical and clinical investigation of chemonucleolysis failures.

To attempt to understand the etiology of failures of chemonucleolysis, biochemical analyses were performed on intervertebral disk material to determine if the enzyme had actually digested the nucleus pulposus proteoglycans. This information was then correlated with the clinical laboratory data to see if a pattern evolved for the failures. Nine chymopapain treated disks, 6 untreated herniated disks and 6 lumbar disks from scoliotic patients were obtained at surgery. The results indicated that 6 out of 9 patients treated with chymopapain had a marked reduction in the proteoglycan (hexosamine) content of their disk compared to the untreated controls. There was a significant inverse correlation of intrinsic lysosomal enzymes and hexosamine content in those cases where the chymopapain failed to destroy the proteoglycan. The other 3 patients, however, had hexosamine levels virtually identical to those disks not treated with chymopapain. The clinical evaluation, consisting of preoperative myelograms, diskograms, the surgeon's observations at laminectomy and evaluation of the postoperative regimen did not explain the failures. This study suggests that the chymopapain failures are not the result of inactivity of the enzyme or failure to digest the nuclear material in at least 6 of the 9 cases. However, there were 3 patients where either the enzyme was not reaching the nuclear material or it was inactive.

Chymopapain↗

PubMedDate not supplied

Effect of repetitive impulsive loading on the knee joints of rabbits.

To simulate the forces from hopping, the right foot of adult rabbits was subjected to 1 1/2 the animal's body weight 40 times a minute for 20-40 minutes per day. During these brief periods of repetitive impulsive loading the legs were held in short-leg splints to eliminate the natural shock-absorbing mechanism associated with ankle dorsiflexion and calve muscle stretching. Under these conditions subchondral bone stiffening occurred and was associated with the earliest metabolic changes of cartilage damage. When bone stiffening returned to normal the effect on the cartilage did not completely disappear, although these effects diminished. The results suggested that subchondral bone stiffening accompanies the earliest metabolic changes in osteoarthrosic chondrocytes and suggests that trabecular microfracture may occur very early in this sequence of events.

Animals↗

PubMedDate not supplied

Correlation between ultrasound imaging and mechanical and physical properties of lengthened bone: an experimental study in a canine model.

The right tibias of 16 adult mongrel dogs were lengthened 2.5 cm using a uniplanar lengthening device (Orthofix). After the animals were killed in groups of 4 at 3, 6, 9, and 12 weeks postlengthening, ultrasound imaging and mechanical and physical testing was performed. There was a direct relationship between the percentage of intact cortices on ultrasound imaging and the mechanical and physical properties of lengthened bone. However, once 80-90% of all the cortices regained their continuity, the strength of the lengthened bone was only 50-60% that of the control. Ultrasound imaging, therefore, may be useful in predicting the mechanical and physical properties of lengthened bone in the early phases of limb lengthening. Once all the cortices become continuous, however, another method for assessment of the mechanical properties of lengthened bone should be used.

Animals↗

PubMedDate not supplied

Management of the completely stiff pediatric knee.

The purpose of this study was to ascertain whether aggressive surgical treatment of ankylosed knees, followed by immediate continuous passive motion (CPM), can restore acceptable function in children. A retrospective analysis was performed on five children operated on for severely contracted knees. In all cases, extensive intraarticular pathology was present, and lysis of adhesions, tendon lengthenings, and capsular releases were performed in each case. Cruciate ligament release, drilling of subchondral bone, and patellectomy or meniscectomy or both also were performed in certain cases. Surgery was followed by immediate CPM for 6 weeks. Knee motion improved significantly from a preoperative mean of 7 degrees (range, 0-20 degrees) to 63 degrees (range, 15-90 degrees) at final follow-up, and all patients were satisfied with the result. The mean follow-up interval was 4.6 years. The regenerative properties of articular cartilage as well as the physis in the skeletally immature may permit a radically different approach from that accepted in adults. Such an approach can spare the native joint and restore acceptable function.

Adolescent↗

PubMedDate not supplied

Long-term patient-oriented outcome study of a modified Evans procedure.

More than 50 surgical procedures have been described for treatment of chronic lateral ankle instability. Anatomic repairs have come into favor in the recent literature based on short-term studies, which have used objective measures for outcome. A long-term (range, 7-20 years; average, 12.6) patient-oriented outcome analysis was performed on 20 patients that underwent a modified Evans procedure for chronic lateral ankle instability by the senior author over a 13-year period. There was a 91% follow-up on all located patients (20 of 22). All patients had mechanical and functional instability, and all had failed conservative therapy. A questionnaire, based on the outcomes questionnaire developed by the American Academy of Orthopaedic Surgeons was used to determine functional stability. The patient's ability to perform recreational or competitive sporting activities at specific time intervals were also assessed (preinjury, 1 year postoperatively, present time). Overall result was considered satisfactory if five criteria were met: patents (a) were happy with the outcome of surgery, (b) were able to perform desired level of activities, (c) had functional stability, (d) were pain free performing desired level activities, (e) would undergo procedure again. The entire cohort demonstrated satisfactory results in 19 (95%) of 20 respondents at 1 year and 17 (85%) at present time. Grouping patients into competitive (12 cases) and recreational (eight cases) athletes demonstrated six of 12, and seven of eight reached their preinjury level (p = 0.074). In this study, we showed that surgical reconstruction using a modified Evans procedure is a reliable and effective treatment for chronic lateral instability. This procedure has proved to stand the test of time, as demonstrated by a patient-oriented outcome analysis. The elite athlete may be better served by a procedure using the principles of anatomic rather than augmented repair; however, the long-term data to our knowledge has yet to be published.

Adolescent↗

PubMedDate not supplied

Idiopathic subluxation of the radial head.

Idiopathic subluxation of the radial head is a different entity from congenital dislocation. The former is always painful, with marked loss of rotation. The radius articulates with the capitellum and the radial head is concave, possibly representing a lesser stage of dislocation. There also may be a correlation with true posterior dislocation. Since it successfully alleviates pain in this condition, radial head resection is often advisable. However, the operation should be delayed until growth is complete and the danger of disruption of the distal radioulnar joint is avoidable.

Adolescent↗