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Biomedical subjects

M Geijer

Publications and source records attributed to M Geijer.

10 recordsLinked to original sources
PubMed2000

Ectopic metaplastic ossification after sternotomy.

Ectopic ossification is a rare complication after a major operation. We report a case of cutaneous infection and metaplastic ossification in an 80-year-old man who underwent coronary artery bypass grafting 4 years earlier. Computed tomographic scan demonstrated a partial pseudarthrosis of the corpus sterni. The infected part of the sternal scar was excised and sternal wires were removed. Eight months later, the wound has healed without complications and the cutaneous ossification is unaltered.

Aged↗
PubMed1999

Early results with osseointegrated proximal interphalangeal joint prostheses.

Osseointegrated endoprostheses were used in 22 proximal interphalangeal joint replacements in 12 patients between 1993 and 1995. Indications for surgery were joint destruction due to rheumatoid arthritis (13 joints), primary osteoarthrosis (7 joints), posttraumatic arthrosis (1 joint), and psoriatic arthritis (1 joint). The prostheses consisted of 2 screw-shaped titanium fixtures with a flexible silicone spacer. The 1-stage surgical procedure included joint resection and cancellous bone grafting from the iliac crest before insertion of the titanium fixtures. At a follow-up examination 27 months (range, 12-37 months) after surgery, the average active range of motion was 56 degrees (20 degrees to 80 degrees) with an extension lag of 11 degrees (-5 degrees to 45 degrees), corresponding to an average arc of motion of from 11 degrees to 67 degrees flexion. Radiographs indicated that 41 of 44 fixtures were osseointegrated. Four of the 22 joint mechanisms showed fracture of the silicone spacer; deformation of the silicone was noted in an additional 27%. Patient satisfaction was high (20 of 22 joints), with significantly improved range of motion and hand function, increased grip strength, good pain relief, and satisfactory appearance. The results of this study indicate good early clinical findings using osseointegrated implants for proximal interphalangeal joint replacement but also show the need for further development regarding the durability of the flexible silicone joint spacer.

Adult↗
PubMed1999

Osseointegrated silicone implants. 18 patients with 57 MCP joints followed for 2 years.

20 patients were operated on consecutively with osseointegrated MCP joint prostheses in 64 joints at our department between September 1993 and February 1995. The one-stage procedure included joint resection and cancellous bone grafting from the iliac crest before insertion of screw-shaped titanium fixtures, connected with a flexible silicone spacer. 18 patients (57 joints) were clinically and radiographically examined at median 28 (18-37) months postoperatively. Indications for surgery were joint destruction due to chronic arthritis in 17 patients (56 joints), and posttraumatic arthrosis in 1 patient (1 joint). Postoperative median range of motion was 40 (15-85) degrees, with an extension deficit of 30 (-20-70) degrees. 16 patients were satisfied, and had good pain relief and substantially improved postoperative hand function, evaluated with the standardized Sollerman hand function test. Radiographic osseointegration was obtained in 112 of 114 titanium fixtures (98%), but fracture of the silicone spacer was observed in 14 implants (25%). We conclude that osseointegration of longitudinal titanium fixtures in the bone marrow canal is possible in a one-stage procedure, but our findings show the need for a new, more durable joint spacer.

Adult↗
PubMed1998

The role of CT in the diagnosis of sacro-iliitis.

OBJECTIVE: Ankylosing spondylitis is a progressive, debilitating disease in which early diagnosis and early treatment can improve the prognosis. Radiographic confirmation is essential for diagnosis but conventional radiography has not proved useful, particularly in the early course of the disease. The aims of this study were to correlate the findings at conventional radiography with those at CT, and to correlate the duration of clinical symptoms with the radiological findings. MATERIAL AND METHODS: Forty patients with clinical sacro-iliitis and 13 controls were evaluated by means of conventional radiography and CT. RESULTS: Conventional radiography was positive in 10/40 patients and CT in 30/40 patients. Conventional radiography was positive in only 2/14 patients with a symptom duration of less than 2 years while CT was positive in 10/14 such patients. CONCLUSION: The study demonstrated a considerably higher sensitivity in CT than in conventional radiography in detecting the subtle changes necessary for the radiological diagnosis of sacro-iliitis, particularly in cases of short duration. CT allows an early start to be made in treatment with a consequently improved prognosis. The use of conventional radiography cannot be recommended because its low sensitivity delays diagnosis in many instances.

Adolescent↗
PubMed1996

Polyurethane versus silicone for endoprosthetic replacement of the metacarpophalangeal joints in rheumatoid arthritis.

In a prospective study 12 patients with rheumatoid arthritis underwent arthroplasty of four metacarpophalangeal joints. Two different implant materials were randomly used in each hand, polyurethane (Pellethane) or silicone (Silastic). Eleven patients with 44 (21 silicone; 23 polyurethane) implants were re-examined 4.5 years (range 3-5) postoperatively. No difference was found between the implant materials regarding pain, stability of the joint or recurrence of the ulnar drift. The mean range of motion was 41 degrees (range 20 degrees-70 degrees) in the polyurethane joints compared with 42 degrees (range 15 degrees-90 degrees) in the silicone joints. The extension deficit was more pronounced in the silicone (mean 11.4 degrees) than in the polyurethane (mean 5.8 degrees) joints, and clinical signs of synovitis around the implants were more common with the silicone arthroplasties. Radiographic analysis, performed with conventional radiography and computed tomography (CT) showed one implant fracture in each group. There was a more pronounced bone resorption around silicone implants, but more sclerosis around polyurethane implants. Bony spurs interfering with function of the implant were common with both materials.

Aged↗
PubMed1996

Intra-articular administration of polyclonal immunoglobulin G in rheumatoid arthritis. A double-blind, placebo-controlled pilot study.

The aim of our study was to assess local anti-inflammatory effects of high dose immunoglobulin G (IgG) in rheumatoid arthritis (RA). Eleven patients with definite RA, having flare-up of knee joint synovitis, were included in the study. Six received an intra-articular injection of 1 g of IgG in 10 ml saline and five received an intra-articular injection of 10 ml physiological saline alone. The effect of the treatment was evaluated clinically and by magnetic resonance imaging using gadolinium contrast enhancement. In one of the six patients that received intra-articular IgG and one of the five patients that received physiologic saline a modest decrease of synovial hypertrophy was noted. None of the patients experienced clinical signs of increased joint inflammation as a consequence of the treatment procedures. The results of this pilot, double-blind, placebo-controlled study do not support local administration of IgG as an anti-inflammatory treatment in patients with RA.

Arthritis, Rheumatoid↗
PubMed1990

Chest radiography in the intensive care unit. Indications for radiography and effects of selective archiving of films.

Consecutive chest radiographs (n = 2,303) in 601 patients in the intensive care units (ICU) were analyzed with regard to main disease and indication. Two thirds of the patients were transferred for routine post-operative treatment, 14 per cent mainly for cardiopulmonary insufficiency. The remainder were referred because of various clinical conditions. The main indications for chest radiography were routine radiographic follow-up and/or control of the position of catheters, tubes, drainages etc. (50%). Obvious clinical indications appeared in only about 1/4 of the patients. When the patients were discharged from the ICU all chest radiographs were analyzed with regard to their predicted future value. Films considered not worth storing were removed and stored in a separate archive (57%). During a 15-month follow-up period none of the removed films were requested, indicating that a substantial number of films can be sorted out continuously. The possibility to reduce and to 'clinically compress' the amount of data in a future digital picture archive is emphasized.

Humans↗
PubMedDate not supplied

Selective archiving of radiologic images.

The increasing number of radiographic images is a problem in most radiology departments. The problem will be emphasized with the introduction of digital acquisition and storage of radiographs. Changes in image management strategies will therefore become necessary. Such strategies will have great technologic and financial impact and will probably determine the applicability and success of digital radiography. Based on the experience that not all radiographs are equally important and on the assumption that not every image in a radiology archive can be maintained on-line, we investigated the effect of storing only selected, clinically informative radiographs; i.e., clinical data compression. In 165 routine examinations (77 barium enemas, 16 barium meals and 72 urographies) 2433 films were used (14.7 films per examination). We archived only the 461 films (19%) which were considered to be of future informative value. During a one-year follow-up period none of the 1972 removed films was requested. This indicates that a considerable number of films and a considerable amount of image data can be removed from the archive without affecting the clinical work.

Humans↗