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Biomedical subjects

M Pritsch

Publications and source records attributed to M Pritsch.

17 recordsLinked to original sources

The snapping biceps femoris syndrome.

Snapping of tendons is a well-described entity in the literature, occurring mostly in athletes around the hip, ankle, shoulder, and elbow, but rarely the knee. A case of snapping of the biceps femoris tendon (BFT) in a patient with a painful knee and no history of trauma is described. An abnormal anterior insertion of the BFT was found to be the cause of the pain and snapping. Surgical treatment, reinsertion of the tendon in its anatomic position, completely corrected the abnormality, whereas conservative treatment failed.

Adult

Cyclic-alternating versus response-oriented chemotherapy in small-cell lung cancer: a German multicenter randomized trial of 321 patients.

To test whether alternating chemotherapy is a favorable treatment modality in small-cell lung cancer (SCLC), 334 patients were randomized to receive either fixed cyclic-alternating treatment with ifosfamide/etoposide (IE), cyclophosphamide, doxorubicin, and vincristine (CAV), or response-oriented treatment with IE therapy up to maximal response and subsequently an immediate switch to CAV. In both arms, six cycles were given in 3-week intervals. After chemotherapy, patients with limited-stage disease received chest irradiation with 45 Gy. Prophylactic cranial irradiation with 30 Gy was applied to all complete responders. No maintenance therapy was given to patients with complete response. Minimum follow-up was 2 years. Of 321 assessable patients, the overall response rate was 70% for cyclic alternating and 77% for response-oriented treatment. Complete remission (CR) rates were 26% versus 26%. The median survival times were 9.7 months for cyclic-alternating versus 10.7 months for response-oriented treatment; the 2-year survival rates were 11% versus 9%. In limited-stage disease (LD) patients, there was a median survival of 12.5 months versus 12.3 months and a 2-year survival rate of 21% versus 18%. In extensive-stage disease (ED) patients, median survival was 8.5 versus 9.1 months, and the 2-year survival rate 3% versus 4%. From these results, we conclude that the cyclic-alternating treatment according to the hypothesis of Goldie et al has no advantage in comparison to a sequential treatment strategy with an immediate switch to a second-line protocol at the time no further response to first-line therapy is seen. Our major aim in the treatment of SCLC is to administer an active regimen at any time during the course of treatment regardless of whether sequential or alternating therapy is used.

Adult

Osteochondritis of the first metatarsal sesamoids.

Osteochondritis of the sesamoids of the hallux is an infrequently presenting condition of uncertain etiology. The diagnosis is usually established by the typical clinical presentation, fragmentation of the affected sesamoid seen on the axial-view radiogram and increased uptake on the 99mTc bone scan. The condition is usually refractory to conservative treatment and is best treated by excision of the affected sesamoid.

Adult

Villonodular synovitis of the shoulder in the elderly.

Villonodular synovitis of the shoulder developed in two elderly patients. Huge soft tissue mass, marked joint effusion, and radiographs demonstrating severe osteoarthritic changes characterized these patients. Localized shoulder muscle atrophy accounts for residual painfree limitation of active shoulder motion following synovectomy of the shoulder joint.

Aged

Arthroscopic treatment of osteochondral lesions of the talus.

In a study of twenty-four patients (twenty-four ankles) with a symptomatic osteochondral lesion of the talus, eighteen of the lesions were found to be associated with trauma. The lesions were evaluated both radiographically and by arthroscopy. The method of treatment was determined at arthroscopy by observing the nature of the articular cartilage overlying the lesion. The cartilage was graded from I to III based on its appearance. It was found that a lesion can progress from grade I to grade III while under observation. There was a lack of correlation between the radiographic appearance and the findings at arthroscopy. The results after an average length of follow-up of thirty months (range, twenty to forty-four months) indicated that osteochondral lesions over which the cartilage is intact (grade I) are best treated by simple restriction of sports activities. Lesions in which the overlying cartilage is soft (grade II) can be treated through the arthroscope by drilling and those in which the overlying cartilage is frayed (grade III) can be treated through the arthroscope by curettage, with minimum morbidity and good results.

Adolescent

Surgical treatment of ligamentous instability after total knee arthroplasty.

During the period of January 1, 1972 through October 31, 1982 seven knees in seven patients had ligamentous reconstructions for instability following total knee arthroplasty. The type of ligamentous instability included severe medial instability in six and a combined severe medial and mild lateral instability in one patient. The surgical technique utilized to reconstruct the ligaments included proximal and distal advancement of the medial collateral ligament. In five of the seven, additional soft tissue surgery was combined with tightening of the medial collateral ligament. Unfortunately, ligamentous reconstruction failed to restore stability to the knee in any of the seven patients. Four patients required revision total knee arthroplasty. Instability of the knee necessitated full-time support with a brace and the seventh patient manages his instability without a brace. Ligamentous reconstruction without component revision is inappropriate in the treatment of the unstable knee following total knee arthroplasty.

Adult

Ankle arthroscopy.

Arthroscopic assessment of the ankle joint can be an important diagnostic aid for intra-articular pathologic conditions. The major portals of entry are anteromedial and anterolateral. In one patient with loose bodies of the ankle, the authors successfully localized the loose bodies and determined the status of the articular surface by arthroscopy. In a second patient with pain and a roentgenogram suggestive of an osteochondral fracture, arthroscopic evaluation determined that the articular surface was intact, and the patient was successfully treated non-surgically. Precise indications for arthroscopy of the ankle have not yet been determined, but its role will certainly be less extensive in the ankle than in the knee.

Adult

Recurrent dislocation of the shoulder and the Putti Platt operation.

Recurrent dislocation of the shoulder has long been recognized, and more than 100 techniques for repair of the injury are described. This survey describes 113 patients who suffered from recurrent anterior dislocation of the shoulder and were operated upon in accordance with the Putti Platt technique. The most significant preoperative finding was inadequate immobilization after the primary dislocation (62% of the patients). Postoperative recurrence was uncommon (1%) and a relative increased limitation of motion in the postoperative period improved gradually to almost a full range of movement.

Adolescent

Efficacy of ceftriaxone and gentamicin in an abscess model.

The therapeutic efficacy of ceftriaxone and gentamicin was investigated in a foreign body induced abscess model in the rat by implanting a dialysis tube contaminated with Klebsiella pneumoniae into the subcutaneous tissue. Animals were treated for four days with ceftriaxone, gentamicin, and their combination starting immediately following or 48 h after the implantation. Peak free ceftriaxone and gentamicin abscess fluid levels were 4.3 and 2.6 mcg/ml, which were 7.3% and 37.5% of peak blood levels respectively. Both agents persisted longer in abscess fluid than in blood. Ceftriaxone inhibited the development of abscess formation when administered shortly after the implantation of the contaminated foreign body whereas gentamicin alone was without beneficial effect. When administered after 48 h ceftriaxone was less effective than immediately after implantation and gentamicin was again without any therapeutic effect. The effect of the combination of ceftriaxone and gentamicin was slightly better than ceftriaxone alone. Low oxygen tension may be an explanation for the lack of bactericidal effect of gentamicin. Ceftriaxone may be more suitable for the therapy of closed space infections caused by susceptible microorganisms than gentamicin.

Abscess

Manipulation and external fixation of metacarpal fractures.

We have developed a method of manipulation and external fixation of metacarpal fractures using Kirschner wires bonded with acrylic resin. This simple procedure requires no special instruments and it facilitates accurate reduction and stable fixation of the fracture while allowing free movement of the hand. Access to the wound is unhampered in open fractures. Thirty-six fractures were treated by this technique. All healed within five weeks, during which time free movement of the hand was encouraged. There were no complications.

Acrylic Resins