Biomedical subjects

M Krismer

Publications and source records attributed to M Krismer.

68 records · Page 4Linked to original sources

PubMed1992

Listeria monocytogenes infection in prosthetic joints.

Listeria monocytogenes is increasingly recognised as a cause of prosthetic joint infection. These infections tend to be more insidious and indolent in contrast to similar infections with Staphylococcus aureus. They can occur in patients who are immunocompromised due to malignancy or other illness or in nonimmunocompromised elderly patients. Listeria infections should not be treated with cephalosporins and prolonged antimicrobial treatment is generally advised for prosthetic joint infections. We noted a high affinity of L. monocytogenes for foreign bodies. Three of twenty-seven cases 11%) of listeriosis under the period of investigation were associated with foreign bodies (hip prosthesis, knee prosthesis and arterial graft).

Aged↗

PubMed1992

Scoliosis correction by Cotrel-Dubousset instrumentation. The effect of derotation and three dimensional correction.

In 30 patients undergoing Cotrel-Dubousset instrumentation, computerized tomography was performed before and after surgery. The RAsag-angle was measured for each vertebral level. Coronal and sagittal translation were evaluated in the same computerized tomographic scans by means of a new method. Based on the hooks used, various sections of the spine were defined. In these sections relative rotation as well as relative sagittal and frontal translation were calculated by an algorithm comparing the most severely rotated or translated vertebra with the mean value of both end vertebrae. Significant correction of rotation did not occur in any of these sections. A significant increase of kyphosis, however, could be demonstrated in all thoracic sections. Above the second intermediate hook combined correction of all three parameters was achieved. Below this hook correction occurred almost independently in the frontal and sagittal planes.

Adolescent↗

PubMed1992

[The hip in infantile cerebral palsy, natural developmental course and treatment concepts].

Classification of cerebral palsy according to the topographical distribution of clinical phenomena permits determination of a prognosis of the natural history of CP and the probability of hip problems to some extent. In 55 patients with CP, 101 muscle release operations were performed between 1971 and 1988. Preoperatively, the diagnosis was established by the neuropediatrician, function was evaluated according to the Rancho-los-amigos system, and the X-rays of the hip were assessed according to Reimers. For the postoperative evaluation patients were grouped according to neurologic diagnosis: hemiplegia (4), diplegia (19), total body involvement (31). Patients with hemiplegia had no functional or radiological changes as a result of the operation. In diplegia functional deterioration was seen in 4 cases (21%); in 3 cases (16%) this meant loss of the ability to walk. The migration percentage was improved from 48% to 39% on average. In 19 cerebral palsy patients with total body involvement surgery was considered to be indicated on the basis of a suspected dislocation of the hip. No functional changes occurred as a result of surgery. Hip dislocation was successfully prevented in 90% of the cases. The migration percentage was improved from 73% to 33%. In another 12 patients with total body involvement, adductor and iliopsoas release was performed to allow better hygiene and care and for pain relief. These goals were achieved; neither the Rancho-Los-Amigos function classification system nor X-rays were used to evaluate the results.

Cerebral Palsy↗

PubMed1991

Aseptic loosening of straight- and curved-stem Müller femoral prostheses.

Out of 1099 Müller total hip prostheses with straight and curved stems consecutively implanted between 1980 and 1984, those performed in as homogeneous a group as possible of patients under the age of 70 years were selected for the present retrospective study. There were 158 straight femoral stems with cementless RM acetabular cups, 105 straight stems with cemented Müller acetabular cups, and 158 curved stems with cemented Müller acetabular cups, and their results over a mean follow-up period of 5.8 +/- 1.24 years were compared. Six (3.7%) curved and 5 (1.9%) straight-stem prostheses were exchanged due to aseptic loosening; 26 (16.3%) curved and 54 (20.1%) straight-stem prostheses were "at risk" or loose at the time of follow-up. Survival curves show a worse result for straight stems after 6 years; within a follow-up period of 6-8 years there was significantly more radiological loosening in straight stems than in curved. Loosening in straight stems is assumed to develop mainly as a physiological reaction to the presence of bone cement particles.

Aged↗

PubMed1991

Uncoated polyethylene RM acetabular component versus Müller cemented acetabular component. A 4- to 8-year follow-up study.

Comparable patient populations with 160 uncoated RM acetabular cups and 263 cemented Müller standard acetabular cups were submitted to survival-time analysis in a retrospective study with a mean follow-up of 5.3 years for the RM cup and 6.1 years for the Müller cup. After 7-8 years 12% of the RM cups and 4% of the Müller cups had been exchanged, 40% and 15% respectively were loose. The poor performance of the RM cups is ascribed to additional external polyethylene wear, which leads to the formation of granulomas and destroys the weight-bearing osseous structures. Similar granulomas also develop on the proximal stem and thus endanger the same.

Aged↗

PubMed1991

[Intermediate results of kinematic knee prosthesis].

A retrospective study of 88 of 117 kinematic total knee prostheses was carried out at the Department of Orthopaedics, University Clinic, Innsbruck. In 71 cases the clinical and functional score of the knee Society was applied. Radiographs were taken under fluoroscopic control. In 3 cases, the need for revision surgery was already obvious. A slight varus angle of 2.1 degrees became apparent. Flexion contracture showed a correlation with the inclination of the femoral component. Radiolucencies of the tibial component showed up in cases with a reduced tibial angle. Radiolucencies of the patella component correlated with lateral subluxation.

Aged↗

PubMed1990

[Pelvic tilt in neuromuscular diseases].

On the basis of a study of the literature and observations in 53 of our own patients, we attempted to establish the cause and best treatment for neuropathic oblique pelvis. In addition, we tried to find out if certain kinds of neurologic dysfunctions coincide with certain kinds of oblique pelvis. It is highly probable that this pelvis malformation is the result of neuropathic spinal deformity. Severe oblique pelvis and scoliosis can be related to the severity of the neurologic dysfunction. Hip dislocation is not the reason for oblique pelvis. It can be assumed that hip dislocation, on the one hand, and oblique pelvis and scoliosis on the other can influence each other. To correct oblique pelvis, the neuropathic spinal deformity must be corrected. Anterior and posterior fusion, including the lumbosacral junction, give the best results.

Adolescent↗

PubMed1990

[The Luque-Galveston operation in the treatment of neuropathic pelvic tilt].

A series of 17 patients with neuromuscular pelvic obliquity underwent Luque-Galveston instrumentation. None of these patients had an increased neurologic deficit. One intraoperative death occurred due to pulmonary air embolism. It was possible to follow up 13 patients for an average of 2.7 years. The average correction achieved was from 97.6 degree to 38.8 degree for pronounce unbalanced lumbar or thoracolumbar curves: the correction loss averaged 3.6%. Combination with anterior correction or fusion in 38% is believed to be the factor that enabled us to reduce the incidence of pseudarthrosis and implant failure.

Adolescent↗

PubMed1990

[Indications for and results of surgical scoliosis therapy using VDS instrumentation (ventral derotation spondylodesis)].

The complications of 97 patients who were operated with anterior spinal instrumentation were frequent, but insignificant. 22 of these patients with lumbar and thoracolumbar curves in whom the VDS instrumentation was used were reviewed. A 79% correction was obtained in the coronal plane. Loss of correction was 11% in the first year and further 2% at 56 months average follow up. In the sagittal plane a mild tendency to increased kyphosis was found. A permanent "adding on" phenomenon occurred in one case. The VDS-instrumentation appears the apparatus of choice for treatment of thoracolumbar and lumbar scoliosis, other indications are discussed.

Adolescent↗

PubMed1989

[Antibiotic therapy in hip endoprosthesis surgery].

A 5-point programme preventing deep infection following total hip replacement is presented. All of the single-stage procedures (3948) were subjected to analysis. An infection rate after total hip replacement of 0.07% in the first half year and long-term follow-up results of 1.29% were found using a laminar air flow system without prophylactic antibiotics. One-stage reimplantation was performed in combination with local administration of antibiotics, followed by a postoperative regimen of alternating administration of 2 antimicrobial drugs for the treatment of deep periprosthetic infection. Over a follow-up period of one to 9 years there was no evidence of recurrence of infection in 80% of cases.

Bacterial Infections↗

PubMed1989

[The surgical treatment of kyphosis with special reference to ventral bone span support].

Eighty-three patients with kyphosis of different etiology underwent operative correction. The results obtained in 65 of these patients after an average follow-up of 5.2 years are reported. The operative treatment produced regression of neurologic deficit in 63%, and most patients were relieved of their disabling preoperative pain. There were 3 cases of pseudoarthrosis and instrumentation failure. The four stages of operative treatment of kyphosis consist of: mobilizing osteotomy, correction, anterior and/or posterior fusion, stabilization without fusion (tumor). The indications for surgery and the choice of surgical technique are discussed. The importance of anterior fusion is emphasized.

Adult↗

PubMedDate not supplied

[Intermediate results with Swanson's hallux implant].

Fifty Swanson single stemmed metatarsophalangeal silastic great toe prostheses in 38 patients inserted between 1974 and 1984 in the Orthopaedic University Clinic of Innsbruck were reviewed. The authors compare results of hallux valgus correction and of hallux rigidus correction by the Swanson prostheses and conclude, that implant arthroplasty should not be performed to correct hallux valgus, but is an excellent procedure in the treatment of hallux rigidus, if the hallux valgus angle is not higher than 18 degrees.

Adult↗

PubMedDate not supplied

[Mc Bride's operation with and without additional basic osteotomy of the 1st metatarsal].

Follow-up of Mc Bride procedure in treatment of Hallux valgus or Mc Bride procedure combined with a proximal osteotomy of the first metatarsal was done in 151 patients by means of a retrospective study. According to the above mentioned methods the patients were divided into two groups. The second group showed better clinical and radiological results, whereas in the patients' estimation the two groups showed equally good results.

Adult↗

PubMedDate not supplied

Videotape preparation of patients before hip replacement surgery reduces stress.

OBJECTIVE: Elective surgery represents a considerable source of stress for the patient. Many attempts have been made to prepare patients before surgery with the aim of reducing stress and improving outcome. This study used a novel approach to fulfill this aim by showing a videotape of a patient undergoing total hip replacement surgery, covering the time period from hospital admission to discharge, that strictly keeps to the patient's perspective. METHODS: Before elective total hip replacement surgery, 100 patients were randomly assigned to a control group or a preparation group; the latter group was shown the videotape on the evening before surgery. Anxiety and pain were evaluated daily for 5 days, beginning with the preoperative day, by means of the State-Trait Anxiety Inventory and a visual analog scale. Intraoperative heart rate and blood pressure, as well as postoperative intake of analgesics and sedatives, were recorded. Urinary levels of cortisol, epinephrine, and norepinephrine were determined in 12-hour samples collected at night for 5 nights, beginning with the preoperative night. RESULTS: Compared with the control group, the preparation group showed significantly less anxiety on the morning before surgery and the mornings of the first 2 postoperative days, and significantly fewer of them had an intraoperative systolic blood pressure increase of more than 15%. The pain ratings did not differ significantly between the two groups, but the prepared patients needed less analgesic medication after surgery. Prepared patients had significantly lower cortisol excretion during the preoperative night and the first 2 postoperative nights. Excretion of catecholamines did not differ significantly between groups. CONCLUSIONS: We conclude that use of the videotape decreased anxiety and stress, measured in terms of urinary cortisol excretion and intraoperative systolic blood pressure increase, in patients undergoing hip replacement surgery and prepared them to cope better with postoperative pain.

Adaptation, Psychological↗