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Biomedical subjects

M Kligman

Publications and source records attributed to M Kligman.

At least 19 recordsLinked to original sources
PubMed1999

Strain differences in neointimal hyperplasia in the rat.

We performed an initial screen of 11 rat strains by use of a standard balloon injury to the left iliac artery to observe whether genetically determined differences existed in the development of neointimal hyperplasia. Neointimal hyperplasia was assayed 8 weeks after the vascular injury on coded microscopic sections. Statistically significant differences in the percentages of the vascular wall cross-sectional areas composed of intima (percentage intima) secondary to neointimal hyperplasia were noted among the different rat strains (P<0.02), with the Brown-Norway (BN), Dark Agouti, and Milan normotensive strain rats having the highest and the spontaneously hypertensive rats (SHR) having the lowest percentages of intima. In a separate experiment, F1 hybrids of SHRxBN strains and parental BN and SHR underwent the vascular injury, and the parental strains again showed a statistically significant difference from one another in the mean percentage of intima (P<0. 0001). The F1 hybrids showed an average percentage of intima intermediate between those of the parental strains. The average lumen size of the injured BN vessels were significantly smaller than that of the noninjured control vessels (P=0.044), but this significance disappeared when the circular areas of these vessels were calculated without taking neointimal growth into consideration (P=0.649). These results provide the groundwork for a genetic linkage analysis to identify the genes that influence the development of neointimal hyperplasia after vascular injury.

Analysis of Variance↗
PubMed1999

Conservative versus surgical treatment for femoral fracture after total or hemiarthroplasty of hip.

This retrospective study compared internal fixation of a femoral fracture following total or hemiarthroplasty of hip with conservative treatment. Sixteen patients were included in the study and classified according to Johannsen. Seven of these patients were treated conservatively by skeletal traction (group A), while the remaining nine patients underwent internal fixation by Mennen plate in conjunction with bone graft (group B). All patients were followed for at least 2 years and evaluated clinically and radiographically using the Mayo Clinic score. The results of group B were superior to those of group A for fracture lines located proximally or extending distally to the tip of the prosthesis. Furthermore, two patients from group A in whom conservative treatment had failed underwent internal fixation, improving their final outcome. Regarding fracture distal to the tip of the prosthesis, there was no significant difference in final outcome between the groups. Our conclusion is that Mennen plate fixation should be considered the treatment of choice in femoral fracture around the tip of a prosthesis, and Mennen plate fixation for fracture distal to the tip should remain as a good option, especially for patients who would like to reduce the length of postoperative hospitalization.

Aged↗
PubMed1999

Cementless coated and noncoated Mathys acetabular cups: radiographic and histologic evaluation.

This study evaluated 185 cementless Mathys coated and uncoated acetabular cups inserted for total hip replacement since September 1984. All of the cups were high-density polyethylene. Sixty were uncoated (group A), 96 were coated with hydroxyapatite (group B), and 29 were coated with titanium (group C). Cup survival was assessed clinically, histologically, and radiographically, and a computer-assisted EBRA method was used to evaluate cup migration. After a mean follow-up of 8 years, five cups in group A that had previously shown migration were revised as a result of aseptic loosening, while no loosening of hip sockets occurred in groups B and C. These results suggest that Mathys cups should be used only if coated with hydroxyapatite or titanium. Furthermore, the histologic evaluation in four cups from groups B and C revealed normal bone formation without inflammation or fibrotic tissue around the cups, promising long-term survival.

Acetabulum↗
PubMed1999

Humeral fracture following shoulder arthroplasty.

Fracture of the humeral shaft after total or hemiarthroplasty of the shoulder occurs infrequently but has serious consequences. This article reports on five patients with ipsilateral humeral fractures following shoulder hemiarthroplasty who were treated either conservatively or surgically. Fractures in the three patients treated conservatively healed on average by 7 months. The results were satisfactory in one patient and unsatisfactory in two patients. Both of these patients complained of pain and limitation of shoulder motion. Fractures in the two patients treated by open reduction and Mennen plate fixation healed on average by 2 months, resulting in a better outcome for these patients treated surgically.

Aged↗
PubMed1998

Revision arthroplasty of femoral cortex defect using a noncemented stem, Mennen plate, and bone graft.

Twelve patients who underwent total hip replacement complicated by aseptic loosening with severe bone loss were included in this study. Two patients had aseptic loosening of the second revision, six of the third revision, and the remaining four patients of the fourth revision total hip replacement. In all patients, the radiographs revealed an extremely thin cortex around the stem of the prosthesis and almost complete disappearance of one cortex. All patients were treated by revision total hip replacement in conjunction with Mennen plate fixation and allograft bone support. The allograft bone support included three cortical struts and nine massive bone grafts that used cement as a strew. The results were satisfactory in 10 patients in respect to functional activity, pain and radiographic evaluation. In two patients who underwent their fifth revision, the results were unsatisfactory but better than before the operation. Mennen plate fixation provides a sufficient and easy technique for aseptic loosening of total hip replacement with severe bone loss. By preserving the periosteal blood supply, the time required for bone graft incorporation is shortened, resulting in an early final outcome.

Aged↗
PubMed1998

Glenoid fracture: conservative treatment versus surgical treatment.

Glenoid fossa fractures are rare. The indication for conservative or surgical treatment is controversial, especially because of limited reports in the literature. Many authors prefer conservative treatment for most types of glenoid fractures to the alternate surgical treatment, but long-term follow-up is rarely reported. We report on four patients with displaced, intra-articular glenoid fossa, who were treated either surgically or conservatively. After an average 7-year follow-up, clinical and radiographic results were satisfactory in all patients. Based on the literature and our limited experience, we recommend that conservative treatment be considered as a good option for displaced intra-articular glenoid fossa fracture.

Adult↗
PubMed1998

Urografin injection demonstrated soft tissue ganglion communication with an intraosseous ganglion cyst.

Intraosseous ganglion cysts rarely occur in the hand or wrist. We present a case of a soft tissue ganglion cyst that communicated with the intraosseous ganglion of the scaphoid. Typical diagnostic studies include radiography, computed tomography, and magnetic resonance imaging. The diagnosis was made in this case by injection of Urografin into the soft tissue ganglion. The patient underwent excision of both ganglion cysts, resulting in a satisfactory outcome.

Adult↗
PubMed1998

Femoral bone reconstruction in revision total hip replacement.

Twelve patients who had undergone total hip replacement complicated by aseptic loosening with severe bone loss were included in this study. Eight of these patients had aseptic loosening of more than the second revision and the remaining four patients of the fourth revision total hip replacement. In all patients, the radiographs revealed an extremely thin cortex around the stem of the prosthesis and almost disappearance of one cortex. All patients were treated by revision total hip replacement in conjunction with Mennen plate fixation and bone graft support. The results were satisfactory in ten patients in respect to functional activity, pain, and radiographic evaluation. In two patients who underwent their fifth revision, the results were unsatisfactory but better than that before the operation. Our conclusion is that Mennen plate fixation provides a sufficient and easy operative technique for the correction of aseptic loosening of total hip prostheses accompanied by severe bone loss.

Activities of Daily Living↗
PubMed1997

[Magnetic resonance imaging for suspected femoral neck fractures].

Painful hip as a result of injury, with or without a history of trauma, is a common reason for referring elderly patients to the emergency room. The diagnosis of femoral neck fracture requires the combination of a physical examination, X-rays, and in problematic cases, a bone scan. However, even this combination does not always provide a diagnosis. We present 50 patients with painful hip who complained of limp and reduced hip joint motion, but had no evidence of fracture, either on X-ray or bone scan. After conservative treatment, 5 patients with no history of trauma underwent hemiarthroplasty of the hip for displaced subcapital fracture. In addition, we present a case of subcapital fracture which was diagnosed only by MRI, in whom both X-rays and bone scan were considered normal.

Aged↗
PubMed1997

[Recurrent chronic multifocal bone infection].

We present a 9-year-old girl who had chronic recurrent multifocal osteomyelitis. The bones involved were: right clavicle, distal fibula (bilateral), left sacroiliac and right wrist. After 10 years of follow-up; she is asymptomatic but presents radiological evidence of lesions in the right clavicle and left sacroiliac joint. The diagnosis was made by exclusion criteria. The biopsy and results of cultures from various bones were negative 4 times. Although chronic recurrent multifocal osteomyelitis is rare, it should be considered in the differential diagnosis of acute or chronic osteomyelitis and neoplasma. Its recognition avoids unnecessary laboratory tests and antibiotic therapy.

Acute Disease↗
PubMed1997

[Glenoid fossa fracture].

4 patients with displaced intra-articular glenoid fossa were treated either surgically or conservatively. After an average follow-up of 7 years, the clinical and radiographic results were satisfactory in all. The 2 treated surgically required shorter follow-up than those treated conservatively. Conservative treatment should be considered a good option for displaced intra-articular glenoid fossa fracture.

Adult↗
PubMed1997

[Femoral fracture following total hip replacement].

Between January 1990 and May 1996 we performed 500 total hip replacements, 6 of which were complicated by ipsilateral femoral fracture. Treatment was either by skeletal traction or by internal fixation, with or without revision-total hip replacement. Results of surgical treatment were superior to those of conservative treatment. This study supports use of Mennen plate-fixation. Further studies are necessary for final evaluation of the efficacy of this method.

Bone Plates↗
PubMed1997

Posterior approach for radical excision of sacral chordoma.

Sacral chordoma is a rare primary malignant tumour of bone. Operations to excise these tumours are complex, time consuming and involve considerable blood loss. We describe the use of a posterior approach to excise chordomas from the sacrum of five patients without visceral involvement. This approach is less complex than combined approaches previously described. No distal recurrences had occurred at a mean followup of 5 years. One patient developed local recurrence and was successfully treated by wide local excision. Postoperative morbidity was low with regard to urinary and faecal continence problems. We recommend the use of Mersilene mesh to prevent herniation through the sacral defect.

Adult↗
PubMed1997

Posterior approach for glenoid fracture.

Intra-articular glenoid cavity fracture is very rare. We describe an original surgical technique for depressed intra-articular glenoid fracture used in three patients. The glenoid was exposed by the posterior approach. The anterior fragment was reduced by a hook through the joint cavity and an elevator device through the window, which was performed posteromedially to the glenoid. This approach provides excellent visualization of the glenoid cavity and mobilization of the anterior and posterior fragments.

Adult↗
PubMed1997

Mennen plate in hip and shoulder joint replacement.

Sixteen patients complicated by femoral fracture and aseptic loosening with severe bone loss and two patients complicated by humeral fracture after hip and shoulder joint replacement, respectively, were collected from the Carmel and Ichilov teaching hospitals. All patients underwent internal fixation with the Mennen plate or in conjunction with revision joint replacement, either for internal fixation or for bone graft support. The results were satisfactory in fifteen patients with respect to functional activity, pain, and the radiographic evaluation. In three patients who underwent their fourth revision, the results were unsatisfactory but were better than their preoperative status. Our conclusion is that Mennen plate fixation provides a sufficient and easy internal fixation technique for a fracture around or below the un-dislodged stem of hip and shoulder in joint replacement. In an unstable femoral fracture or in a case of aseptic loosenings with marked bone loss, we recommend Mennen plate fixation in conjunction with long stem revision total hip replacement and bone graft.

Aged↗
PubMed1996

[Total knee replacement].

The medical records of 319 patients who underwent 350 primary total knee replacements were analyzed retrospectively. The age range was 44-89 years (average 66). In all we used a Biomet ACG prosthesis and preserved the posterior cruciate ligament. Results, measured objectively with Knee Society scores, were satisfactory for all ages, especially the younger. However, even in older age groups subjective results were promising. We emphasize the importance of preserving the posterior cruciate ligament and its advantages for all age groups.

Adult↗