Biomedical subjects

M Pfahler

Publications and source records attributed to M Pfahler.

29 records · Page 2Linked to original sources

PubMed1994

Diagnosis of osteomyelitis. Accuracy and limitations of antigranulocyte antibody imaging compared to three-phase bone scan.

Thirty-seven patients with suspected osteomyelitis in conjunction with diabetic gangrene (N = 14, group 1), arthroplasty (N = 8, group 2), and various diseases (N = 15, group 3) were examined. Three-phase bone scans, followed by granulocyte imaging using I-123 labeled anti-NCA 95 monoclonal antibodies, were performed to evaluate and compare the diagnostic accuracy of both procedures. Final diagnosis was established histologically, bacteriologically, or by both methods either through the clinical course or by long-term follow-up in patients in group 1. Osteomyelitis was proven in 17 out of the 37 patients. Bone and antigranulocyte imaging demonstrated positive results in all patients with osteomyelitis (sensitivity 100% for each method). No signs of skeletal infection were found in 20 patients. Fifteen of these patients had no antigranulocyte antibody accumulation, resulting in 75% specificity. Ten patients without infection had normal three-phase bone imaging results (specificity 50%). Antigranulocyte imaging results were negative in 6 out of 10 patients without osteomyelitis in groups 2 and 3 whose bone imaging results were questionable. However, because of identical bone and granulocyte imaging results, no increase of diagnostic accuracy could be obtained by additional granulocyte imaging in patients with diabetic gangrene. Final diagnoses of false-positive antigranulocyte studies were aseptic osteonecrosis (N = 2), loosening of prostheses, gouty arthritis, and pain after arthrolysis. In summary, antigranulocyte antibody imaging offered high sensitivity and acceptable specificity for the diagnosis of osteomyelitis. Diagnostic accuracy can be improved through the adjuvant use of antigranulocyte imaging for patients with suspected osteomyelitis, especially when radiographic and scintigraphic results are questionable or unreliable.

Adult↗

PubMed1991

[The methods and place of digital subtraction arthrography of the hip in detecting endoprosthesis loosening].

Digital subtraction arthrography (DSAr) of the operated hip is presented and compared to nuclide bone scan and plain radiograph. Surgical proof was obtained in 47 patients. In the evaluation DSAr proved to be superior to nuclide bone scan and plain radiograph. DSAr had the best predictive value in the diagnosis of loosening of a prosthesis. In contrast to conventional arthrography there is a better differentiation between the contrast medium, the prosthesis, the acrylic cement and the bone by using DSAr. In addition DSAr presents the advantage of postprocessing, especially pixel shift.

Aged↗

PubMed1984

[Long-term sclerosing therapy of bleeding esophageal varices. A prospective course study].

Longterm sclerotherapy by flexible endoscopy was done in 109 patients with acute bleeding from oesophageal varices in a prospective follow-up study. The severity of the liver disease was classified according to Child (Pugh's modification) at the beginning of treatment. Patients were followed-up for at least 12 months with a maximum of 44 months. The one-year survival rate for all patients was 67%. Child-A patients (100%) and child-B patients (84%) had a significantly better survival than Child-C patients (36%; P less than 0.001). The rate of haemorrhage per patient-month was significantly lower (P less than 0.001) in Child-A patients (0.4%) and Child-B patients (2.4%) than in Child-C patients (8.5%). After initial sclerosing of 8 weeks' duration the rate of recurrent haemorrhage was only 1.3% per patient-month. There was a significant difference (P less than 0.005) between Child-A patients (0.2%) and Child-B and -C patients (2%). The data show that Child-Pugh's classification permits a high prognostic accuracy in predicting results of sclerotherapy. Child-A and -B patients are suitable candidates for longterm sclerotherapy whereas Child-C patients show a clearly increased risk of recurrent bleeding during the early phase of treatment and have a markedly reduced survival rate.

Esophageal and Gastric Varices↗

PubMed1982

Esophageal function after sclerotherapy of bleeding varices.

To study the effect of sclerotherapy of varices on esophageal function, the motility of the tubular esophagus and of the lower esophageal sphincter (LES) were recorded in 19 patients after 7 to 13 sclerotherapy sessions and in 15 healthy volunteers. In addition, esophageal functional scintigraphy (EFS) was performed in the patient group. Compared with the volunteers the patients had lower contraction amplitudes in the distal esophagus (30.5 +/- 17.5 mm Hg versus 43.6 +/- 9.1 mm Hg, p less than 0.01) and a higher percentage of non-propulsive simultaneous contractions (NPC) in the distal (33.4 +/- 23.2% versus 9.0 +/- 8.6%, p less than 0.005) and mid-esophagus (15.0 +/- 8.2% versus 8.3 +/- 8.1%, p less than 0.05). There was a negative correlation between the percentage of NPC in the distal and mid-esophagus and radionuclide transit (rs - 0.53, p less than 0.02). Three of 19 patients had a positive reflux index by EFS. The LES tone was only slightly lower in the patients than in the controls (10.7 +/- 3.2 mm Hg versus 13.4 +/- 3.6 mm Hg, p less than 0.05). Our findings indicate that sclerotherapy of esophageal varices may lead to a reduced peristaltic esophageal motility with an impaired transport function. This could contribute to the development of dysphagia or esophagitis.

Adolescent↗

PubMedDate not supplied

Hemiarthroplasty versus total shoulder prosthesis: results of cemented glenoid components.

In this retrospective study, we compared the results of 705 total shoulder arthroplasties (TSAs) with 469 hemiarthroplasties (HSAs), all having been performed with the Aequalis shoulder prosthesis. Each group, both TSA and HSA, was comparable by age (mean, 63.9 years) and sex (853 men and 321 women). Each group had comparable dominance and preoperative Constant scores (mean, 29 points). The length of follow-up averaged 43 months (range, 24-110 months) in both groups. The postoperative functional outcome and subjective assessment demonstrated the superiority of TSA over HSA independent of age or rotator cuff status (Constant score, 65.7 vs 56.3 points). The analysis of the radiographs showed a disturbing 68% of cases with radiolucent lines developing around the glenoid component and their subsequent progression with time. We saw an adverse effect on functional outcome by the presence of these radiolucent lines. This review would suggest that TSA is superior to HSA in most cases with chronic pathologic entities. HSA remains a satisfactory solution in specific cases. In the future, we need to optimize the designs of the glenoid implant and develop a better implantation technique to avoid the problems associated with glenoid replacement.

Adolescent↗

PubMedDate not supplied

The role of the bicipital groove in tendopathy of the long biceps tendon.

Long biceps tendon disease is often underrated but plays an important role in anterior shoulder pain. We studied prospectively the anatomy of the bicipital groove and its relationship to clinical symptoms. Sixty-seven consecutive patients were investigated by mutual ultrasonography and radiographs of the intertubercular groove. All images were scrutinized for biceps tendon status (ultrasonography) and groove anatomy (radiography). Thirty-seven patients (21 male, 16 female, average age 48 years) had chronic anterior shoulder pain, and 30 patients (16 male, 14 female, average age 46 years) served as a control group. In 28 shoulders we found sonographic signs of tendovaginitis, and in 14 we found degenerative changes. The mean age of patients with pathologic conditions of the long biceps tendon was 40 years, significantly lower than that of the complete study group. The x-ray films revealed a great variation in the medial and total opening angle of the groove, whereas width, depth, and humeral head diameter showed sex-related differences. Radiologic signs of groove degeneration correlated in 43.6% with biceps tendon disease on the sonogram. Our study revealed statistically significant correlations between groove anatomy and long biceps tendon disease, which should be considered more while shoulder problems are evaluated.

Adult↗

PubMedDate not supplied

[Analgesic effect of low energy extracorporeal shock waves in tendinosis calcarea, epicondylitis humeri radialis and plantar fasciitis].

PURPOSE OF THE STUDY: Is there a pain reduction at the application site after extracorporeal shockwave application for tendinitis calcarea, epicondylitis radialis and plantar fasziitis? METHODS: In a prospective study 85 patients were observed. Shockwave application was performed three or five times using low energies (0.09-0.18 ml/mm2). Before and after shockwave application pain was evaluated using SF-36 score and Visual Analog Scale (VAS). RESULTS: After 5 months for all three indications a significant improvement of the pain situation could be reached. Patients with plantar fasziitis demonstrated the highest decrease of pain, followed by tendinosis calcarea and epicondylitis radialis. The number of applications had no influence to the clinical result of the ESWT. RELEVANCE: In the present study the analgetic effect of ESWT after repeated low-energy application was described for the standard indications.

Adolescent↗

PubMedDate not supplied

[Complete rotator cuff rupture--differential surgical techniques and intermediate-term results].

QUESTIONS: What is the mid term result of open rotator cuff repair? What are the criteria for a good surgical result? METHODS: Between February 1988 and December 1993 130 patients (135 shoulders) underwent surgery for rotator cuff repair. All surgical techniques were combined with a acromioplasty--transosseous refixation, transtendinous suture, isolated or combined transfers of tendons. The retrospective analysis consisted of clinical examination including the Constant score, X-rays and sonograms of the shoulder before and after surgery. RESULTS: 95 patients (98 shoulders) were controlled 4 years and 8 months after surgery by clinical, radiological and sonographical examination. 80% of all cases showed good or very good long term results by chiefly transosseous refixation alone or in combination with tendon transfer. Analysis of all data made it possible to create simple prognostic criteria. These criteria can help preoperatively to give an idea of the expected outcome. CONCLUSION: The best preoperative criteria for a prognostic good surgical result were an acromion-humeral head distance in the native true a.p.-X-ray of more than 7 mm, a rotator cuff defect of less than 2 x 3 cm and a passive free range of motion.

Adult↗

PubMedDate not supplied

Age-related changes of the glenoid labrum in normal shoulders.

A growing number of labral changes are described in the literature. The purpose of this study was to evaluate the glenoid and labrum of normal shoulders at different ages and characterize any apparent age-dependent changes. We analyzed 32 normal cadaveric shoulders with a mean age of 57 years (range, 18-89 years). There were 22 male and 10 female cadavers, with 14 right and 18 left specimens. The shoulders were studied macroscopically, histologically, and radiologically. The radiologic evaluation consisted of an analysis of the subchondral mineralization of the glenoid with the use of computed tomographic osteoabsorptiometry. Macroscopically, there were no statistically significant differences among the age groups. Histopathologically, the labrum showed a significant qualitative and quantitative increase (P <.01) in lesions across all regions with increasing age. In younger individuals, lesions at the 12-o'clock position were the most prevalent, with the incidence increasing with age. The anterosuperior position was the region with the next highest prevalence. This was also the area of the highest stress distribution on the glenoid. Our studies demonstrated clear histopathologic changes of the glenoid labrum that are significantly age-related at specific sites. The earliest changes are seen close to the area of highest stress distribution of the glenoid, which could explain the progressive labral changes with increasing age. Arthroscopically detected changes of the glenoid labrum should be evaluated in the context of age-related changes in normal shoulders.

Adolescent↗

PubMedDate not supplied

Long-term results of high tibial osteotomy for medial osteoarthritis of the knee.

We reviewed retrospectively the results in patients who had undergone one hundred and four high tibial lateral osteotomies. The operations were all performed between 1985 and 1993. Each one of fifty men and forty nine women demonstrated a varus deformity of the knee with a coexistent medial osteoarthritis. Results were reviewed in 49 patients (62 knees) with an average follow-up of 10.2 years (range 6-14 years). Of the remaining 42 patients, 8 were lost to follow-up, 10 had died, and 24 were subsequently treated with total knee arthroplasty at an average 4.7 years after having had a high tibial osteotomy. Clinical results were evaluated using the Hospital for Special Surgery Score (HSS) and the Knee Society Score. Radiographs were systematically analysed to evaluate osteoarthritis and leg axis. Forty four (90 per cent) of the forty nine patients stated the results met their expectations and given the same circumstances, they would have the operation once again. In these patients the knee score results were excellent. The same patients had excellent HSS and Knee Society Scores. Five patients (10 per cent) had a poor result and twenty four patients were treated later by total knee arthroplasty because of pain. The following factors set these patients apart from those with more favorable results: previous arthroscopic debridement, obesity, lateral knee osteoarthritis, insufficient valgus correction, and an age of more than 55 years. High tibial valgus osteotomy provides good pain relief and improved function in carefully selected patients. Our results support this conclusion.

Adult↗

PubMedDate not supplied

The influence of the implant size on the outcome of unconstrained total knee arthroplasty.

INTRODUCTION: The influence of implant size on the results in unconstrained total knee arthroplasty has never been investigated before. PATIENTS AND METHODS: 133 patients with unconstrained total knee arthroplasty were examined (HSS Score, Knee Society Score) with consideration of the different sizes of femoral and tibial components and the thicknesses of the tibial inlays. The medium follow up was 41.2 months (8 months to 74 months). RESULTS: Although the different component sizes gained different results, the differences were not significant. The combination of two component sizes did not lead to a significant change of the results. The results of the Knee Society Score seemed to become worse with thinner polyethylene tibial inlays although these differences were not significant. CONCLUSIONS: In conclusion, implant size had no significant influence on the outcome of total knee arthroplasty. The combination of two implant sizes showed no disadvantage.

Adult↗