Biomedical subjects

M Jülke

Publications and source records attributed to M Jülke.

8 recordsLinked to original sources

PubMed1998

[Lifting osteotomy of the acromion as a new principle in treatment of impingement syndrome, especially in correlation with reconstruction of large rotator cuff lesions].

There are many different causes leading to impingement lesions of the shoulder (e.g., architecture of the acromion, arthritis of the acromioclavicular joint, bursitis subacromialis, chronic instability). There are also different ways of treating it. Neer described his technique of anterior acromioplasty in 1972. With this technique there is sometimes a limitation in the amount of resection possible because of the anatomical findings (i.e., very curved or small acromion). We developed a new technique: the lift-up osteotomy of the acromion (LOA). This technique allows us to gain as much subacromial space as needed (e.g., for large anterior deltoid flaps). Osteotomy of the acromion gives an excellent view of the rotator cuff. Even large lesions can easily be repaired. After the cuff repair is done, the acromion is refixed with two canulated screws. So far, we have used this LOA technique in more than 100 patients in impingement operations, cuff repairs and anterior deltoid flaps all with good results.

Acromion↗

PubMed1996

[Reconstruction of chronic symptomatic acromioclavicular joint dislocation (Rockwood III-V) using the modified Weaver-Dunn method. 24 operated patients (1988-95), surgical technique, results].

In literature there is a great controversy about the treatment of acute acromio-clavicular (AC) joint dislocations. Nevertheless some patients continue to suffer from chronic pain due to the persistent instability of the AC-joint. This can even lead to an impingement syndrome, going as far as tearing the rotator cuff. In 1972 Weaver and Dunn described a new procedure for the treatment of instable AC-joints. From 1988 to 1995 we used a modified version of this technique on 24 patients suffering from chronic AC-joint dislocation (Rockwood III-V). After the resection of the AC-joint and the preparation of the coraco-acromial ligament, we transposed the acromial end of this ligament together with a small piece of bone from the acromion tip to the lateral end of the clavicle. The results of this modified method were excellent. All patients had no pain anymore, regained a full shoulder movement, could participate in sport again and returned to work after an average of 3.3 months. This new procedure seems to be the treatment of choice for chronically instable AC-joint dislocations.

Acromioclavicular Joint↗

PubMed1995

Thoracoscopic mediastinal lymph node dissection: an experimental study in pigs.

Thoracoscopic lobectomy is feasible and can be performed correctly in terms of anatomy. Its application in bronchial carcinoma is often criticized, partly because of incomplete mediastinal lymph node dissection (MLD). We therefore developed the technique and studied the completeness of MLD in an animal experiment. Ten pigs were anesthetized and intubated with a double-lumen tube and the left lung was excluded from ventilation. Four trocars were inserted. Using a modified endo-Babcock clamp for traction we resected all ipsilateral tracheobronchial, pretracheal and paratracheal and paraesophageal lymph nodes (LNs) as well as nodes in the aortopulmonary window. An average of 19 +/- 5 mediastinal LNs were removed. Macroscopic control through a thoracotomy did not show any residual LNs at the site of operation. Complete resection of all ipsilateral LNs in the paratracheal and paraesophageal region as well as the aortopulmonary window can be performed thoracoscopically in pigs. This may offer further perspectives in the thoracoscopic treatment of bronchial carcinoma.

Animals↗

PubMed1995

[The anterolateral deltoid muscle flap-plasty: the procedure of choice in large rotator cuff defects].

We analysed the results of shoulder reconstruction using an anterolateral deltoid muscle flap plasty in 101 patients with large rotator cuff lesions. This method was first described in Apoil and Augereau in 1985. We modified and extended their technique. Regular follow-up examinations were possible in 100 patients (27 females, 73 males, age 61.3 +/- 8.7 years). One patient died of sepsis of unknown aetiology during the hospital stay. All patients suffered from severe pain and sleepless nights prior to the operation. They also had long histories of unsuccessful and frustrating treatment. The rotator cuff lesions found intraoperatively were at least 5 x 5 cm in size. We used an anterolateral deltoid muscle flap to reconstruct these large defects. Physical therapy was started on the 1 postoperative day and was continued for about 6 months (6.8 +/- 2.6 months). The average hospital stay was 10.9 +/- 5.3 days. After the treatment 90% of all patients were subjectively satisfied or very satisfied with the result, while 12% had moderate and 5% unsatisfactory results. No pain was felt at all by 75% of the patients, and 21% showed decidedly less pain. Severe pain attacks were found in only 4% of the patients, but their pain was less intense than preoperatively. The shoulder function improved significantly, and 72% recovered their strength completely. Most of the patients were able to work after 6 months. The overall result was good to very good in 83%. This high percentage of good shoulder function and patient satisfaction makes this the operation technique of choice for large rotator cuff lesions.

Aged↗

PubMed1992

[Inguinal hernia as a sequela of disordered bladder emptying?].

We examined 56 patients with hernias and 49 patients with other diseases prior to operation. They were all above 50 years of age. The urological screening examination included the patients history of the frequency of urination during night and day time, dysuria, the common risk factors (smoking, coughing, obstipation), obesity, a sonographic measurement of the prostate diameters, a sonographic evaluation of residual urine and the determination of the urinary flow rate. None of the above parameters showed a significant difference between the two groups. Surprisingly more than 60% of all men showed a pathological voiding function (either residual urine and/or a pathological flow rate). Our conclusions are: 1. Patients with inguinal hernias do not show a greater incidence of pathological bladder function than patients of the control group. The benign prostatic hypertrophy as a risk factor for the development of inguinal hernias is most questionable. 2. Because the results showed no significant difference between the two groups, a determination of residual urine prior to operation is not necessary. 3. More than 60% of the men above 50 years showed a pathological voiding function. We recommend a urological screening test for all men above 50 years of age during hospitalisation.

Aged↗

PubMed1989

[Degree of arteriosclerosis of the internal mammary artery and of the coronary arteries in 45-to-75-year-old men. An autopsy study].

In the last ten years the internal mammary artery (IMA) has, thanks to its higher patency rate, been increasingly used for revascularization of the coronary arteries in preference to the saphenous vein. However, uncertainty about atherosclerosis in the IMA has continued to be voiced, and to clarify the issue we investigated post mortem the IMA and left anterior descending (LAD) coronary artery in 48 male patients who died aged 45-75 years. Six segments of the IMA and 4 of the LAD, totalling 465 histologic cross sections, were estimated quantitatively. The result was unequivocal: the tendency to stenosing intimal sclerosis is much more marked in the coronary artery than in the IMA. The IMA is not immune to intimal thickening, but even in patients with severe coronary artery disease the degree of atherosclerosis in the IMA is not of functional relevance. This fact makes the IMA the vessel of choice for coronary bypass surgery.

Aged↗

PubMed1985

[Extra-aortic aneurysms. Analysis of 163 aneurysms in 142 patients].

163 extraaortic arterial aneurysms in 142 patients from autopsy and biopsy material were analyzed. The mean age of the autopsy cases was 71.3 years and of the biopsy cases 52.1 years. The mean age of all the cases was 61.3 years for men and 53.2 years for women. A predominance of the male sex was evident, with an overall ratio of 4:1. The majority of aneurysms were localized in the main arteries of the lower extremities below the aortic bifurcation. Among the etiologic factors, arteriosclerosis was by far the most important, whereas inflammatory disorders and degenerative lesions of the media (medionecrosis of Erdheim and Gsell, mucoid degeneration of media) were less frequently the reason for aneurysm formation. In contrast to the aorta, inflammatory alterations of the arteries which were responsible for aneurysm formation were usually caused by bacterial infections (mycotic aneurysms). In spite of the increasing nicotine consumption of the female population, an increase in female patients with arteriosclerotic aneurysms was not detected.

Aneurysm↗

PubMed1984

[Thoracic aortic aneurysm. Pathologico-anatomical analysis of 111 cases].

Only about 8% of all aortic aneurysms are localized in the thoracic segment. They are mainly due to degenerative diseases of the media (medianecrosis and mucoid degeneration); predominating in the ascending aorta, they possess a marked tendency to wall dissection. Their frequency decreases in the distal direction. On the other hand, arteriosclerotic aneurysms are rare in the proximal aortic segments and predominate more in the distal direction. Aneurysms due to inflammatory diseases are found mainly in the aortic arch and the descending thoracic aorta. About half of them are dissecting.

Aged↗