PubMed Health⌕ Search

Biomedical subjects

P Zangger

Publications and source records attributed to P Zangger.

At least 19 recordsLinked to original sources
PubMed1998

Musculoskeletal surgery in psoriatic arthritis.

OBJECTIVE: To determine the probability that patients with psoriatic arthritis (PsA) will require musculoskeletal surgery. To identify factors predictive of surgery in patients with PsA. To determine the clinical outcome of patients with PsA who underwent surgery compared to patients who did not. METHODS: The database of the Psoriatic Arthritis Clinic was searched to identify individuals who had undergone musculoskeletal surgery. Biological and clinical data such as erythrocyte sedimentation rate (ESR), rheumatoid factor, clinical pattern, nail changes, functional class, number of inflamed joints, and radiological damage, as well as health scores such as Arthritis Impact Measurement Scale 2 (AIMS-2), SF-36, and Health Assessment Questionnaire (HAQ) were available for these patients. Patients who had surgery were compared to those who did not. RESULTS: Out of 444 patients with confirmed PsA, 31 had musculoskeletal surgery (6.98%). This probability increased with the duration of PsA. Surgery patients had their first operation at an average of 13.9 years (range 1-46) after onset of joint disease. Age at onset of PsA, clinical pattern, constancy of clinical pattern over time, rheumatoid factor, functional class, symmetry, nail changes, and the time separating the onset of skin disease and the onset of joint disease were not significantly different at the 0.05 confidence level. Patients who had surgery had significantly more radiological damage (p < 0.001) and more actively inflamed joints (p < 0.02) at first assessment than patients who did not. AIMS2, SF-36, and HAQ scores at final review were not statistically different across both groups. CONCLUSION: In our patients the probability of having musculoskeletal surgery for PsA was 7%. It increased with disease duration. Patients had their first surgery after an average of 13 years. The number of actively inflamed joints and the extent of radiological damage at first assessment were highly predictive of subsequent surgery: patients with the highest numbers of severely affected joints, both clinically and radiologically, were more likely to have surgery. "Baseline characteristics" such as ESR, rheumatoid factor, functional class, clinical pattern, nail changes, and symmetry were not predictive of subsequent orthopedic surgery.

Adult↗
PubMed1996

[Use of laser in arthroscopy of the ankle. Indications, method, first results].

As in the knee joint, lasers can be used during ankle arthroscopy for their resective and ablative properties. Reports on arthroscopic treatment of degenerative and post-traumatic disorder of the ankle by conventional techniques are encouraging. We have used laser in ankle arthroscopy in three main situations: (1) When exuberant scar tissue from previous capsulo-ligamentous damage (e.g. after ankle sprain) symptomatically restricts range of motion and causes pain (ankle impingement). Laser is used in this case at middle energy, as a resector. (2) In the presence of cartilaginous lesions, as in osteoarthritis, flake fractures or osteoarthritis, flake fractures or osteochondrosis dissecans. Here laser is used at lower energy to reshape the cartilaginous surface without resective effect ("welding"). (3) When impaired range of motion is due to osteophytic rims, mainly at the anterior tibia, resulting from previous capsular lesions. Laser is then used at high energy to cut excessive bone. A series of 16 patients underwent ankle arthroscopy at our clinic, mainly for post-traumatic disorders, including impingement, osteochondrosis dissecans and osteoarthritis. The most frequently encountered intraarticular findings were impingement by post-traumatic synovitis and scar tissue of the anterio-lateral and postero-lateral compartments, with or without an osteophytic rim of the distal anterior tibial border. Scar tissue, synovitis and osteophytes were debrided in half of the patients purely mechanically (with arthroscopic scissors or shaver) and in the other half with the holmium laser. The results are encouraging; 50% of patients had no symptoms at all at follow-up (9.5 months on average), and another 38% were satisfied with a significant improvement. In two cases, no improvement at all occurred: one patient complained of persistent pain with lack of objective findings and is believed to have developed "insurance neurosis." The other had severe postinfectious osteoarthritis that was operated too late in the course to influence pain positively. Concerning the clinical, functional and subjective follow-up results there was no relevant difference between the two groups. We recommend ankle arthroscopy to treat post-traumatic impingement syndromes of the antero-lateral, antero-medial and postero-lateral compartments of the ankle joint; the use of lasers seems to have a slightly better analgetic effect, allows an easier approach than is the case with shavers or other bulky arthroscopic resectors, and allows shaping of convex resection surfaces, which cannot be performed with a shaver.

Ankle Injuries↗
PubMed1993

Spontaneous ruptures of flexor tendons secondary to extreme DISI deformity of the lunate in a rheumatoid wrist. A case report.

Spontaneous flexor tendon ruptures in rheumatoid arthritis are associated with flexor tenosynovitis and/or with attrition due to bony prominences in the carpal tunnel. The commonest bony prominence observed is the distal pole of a rotated scaphoid. We are reporting the case of an eighty-year-old woman with long-standing rheumatoid arthritis who presented with the inability to actively flex both the interphalangeal and the metacarpophalangeal joints of the right index finger, with preservation of passive motion. There was also loss of active flexion of the interphalangeal joint of the right thumb. Roentgenograms revealed a marked dorsal intercalated segment instability (DISI) pattern in both wrists associated with advanced joint destruction and collapse. Surgical exploration revealed total rupture of the FDS and FDP of the index finger and of the FPL, as well as partial rupture of the flexor tendons of the long finger. Rupture of the FPL was found to be due to attrition on the relatively common finding of a prominent and malrotated scaphoid. Ruptures of the flexor tendons of the index and long fingers appeared to be caused by a markedly prominent palmar protrusion of the lunate. Surgical repair was undertaken, including correction of the DISI deformity and reconstruction of carpal height by radiolunate fusion from a palmar approach. In addition the tubercle of the scaphoid was resected, and the FDS tendon of the ring finger was transferred to the distal stump of the FDP of the index finger; the FPL tendon was not reconstructed as arthrodesis of the interphalangeal joint of the thumb was planned at a later date.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Hospital management and short-term outcome of the severely injured: Lausanne experience].

Several physiological and anatomical methods of scoring severely injured patients have been developed since the 1970s, based on very large series of patients. In this study, 59 patients are assessed by the ISS (Injury Severity Score) and the RTS (Revised Trauma Score). The mean ISS is 28, and the mean RTS is 6; the overall evolution shows a 42.4% mortality. Analysis by the TRISS method shows 12 out of 18 "unexpected" deaths, the majority of which can be explained by the fact that the ISS underestimates severe neurological trauma, and that the RTS is not consistently obtained in the early patient notes in our emergency care system.

Adolescent↗
PubMed1991

[Analysis of health care needs and evaluation five years after severe brain injuries].

Five years after severe head injury with persistent and extensive deficits of brain functions and loss of working capacity, an assessment and analysis of demand was performed with 31 patients and their relatives. The main impairments consist in the severe changes of personality and in cognitive deficits; they contrast with the spare physical handicaps. A main demand of the relatives are local family groups which are still lacking in many parts of the country.

Activities of Daily Living↗
PubMed1990

Adjusted hypervolemic hemodilution in acute ischemic stroke.

We prospectively randomized 47 patients with acute ischemic stroke of the middle cerebral artery of less than 24 hours' duration to either adjusted hypervolemic hemodilution or control treatment and followed them up for 90 days. Rapid hemodilution to a target hematocrit of 30-35% as monitored with bedside determinations was achieved by using infusions of dextran 40, venesections, and infusions of additional crystalloid solution when necessary. There was no difference in the death rate between the two treatment groups. Of these 47 patients, 37 (19 in the hemodilution group and 18 in the control group) could be followed up for the entire study period of 3 months. The relative improvement in neurologic function from day 1 to days 8, 21, and 90 was significantly better in the hemodilution group than in the control group. In accordance, special tests for fine motor control of the paretic arm disclosed better performance in the hemodilution group. The frequency of patients with severe disability was significantly lower in the hemodilution group on days 8 and 21. Plasma viscosity (measured in 11 patients) was not affected by infusions of dextran 40. Vigorous hypervolemic hemodilution in patients with acute ischemic stroke is well tolerated and improves early neurologic outcome with an effect lasting at least 3 months.

Aged↗
PubMed1989

[Rehabilitation of polytraumatized brain-injured patients].

After head injury, motor deficits (paralysis, spasticity, ataxia) dominate together with cognitive and personality disturbances. Optimal positioning and physiotherapy is important in early treatment to prevent complications later, due to spasticity. Memory and learning deficits can be compensated for with alternate cognitive strategies. Restoration of function after severe cognitive deficits takes a minimum of one year. Personality changes are disruptive to the rehabilitation process and to family reintegration. Therefore an intensive support system for the family is needed.

Brain Damage, Chronic↗
PubMed1988

[Sedation].

Explore the source record for details and available documents.

Aged↗
PubMed1985

'Fusimotor set': new evidence for alpha-independent control of gamma-motoneurones during movement in the awake cat.

The discharge activity of single muscle spindle receptors was recorded in freely moving cats. Large changes in responsiveness to length variations was observed in different types of movement. In separate stimulations on anaesthetised cats, the activity of the gamma-fusimotor neurones responsible for these changes was reconstructed. The results suggested that fusimotor action on a given spindle afferent during the movements studied was not rigidly alpha-linked, but 'set' by the CNS to steady levels, and that it could switch from largely static (gamma s) to largely dynamic (gamma d) according to the motor tasks performed.

Animals↗
PubMed1984

The effect of dorsal root transection on the efferent motor pattern in the cat's hindlimb during locomotion.

Mesencephalic cats can walk on a treadmill if the midbrain locomotor region is stimulated. The motor pattern of different hindlimb muscles is similar to that of th intact cat. The present experiments in the mesencephalic preparation test if the complex motor pattern in one hindlimb is causally dependent on the afferent signals arising in the same limb during walking. The electromyographical activity and the movement pattern during locomotion were compared before and after transecting all dorsal root fibres originating from one hindlimb. Flexor and extensor muscles at different joints may retain their general pattern after the dorsal root transection. This applies also to muscles such as the knee flexors, which have a short and early flexor burst and a second burst during the extension phase, and the short toe dorsiflexor , which has an early burst in the transition between flexor and extensor activity. After the dorsal root transection the pattern of activity may become more variable and it can even break down altogether. The present results demonstrate that the central nervous system devoid of phasic afferent inflow from one hindlimb can produce a complex motor output to this limb rather than a motor pattern degraded to a simple alternation between flexors and extensors.

Adaptation, Physiological↗
PubMed1981

The effect of 4-aminopyridine on the spinal locomotor rhythm induced by L-DOPA.

In high spinal curarized cats rhythmic motor output similar to locomotion ('fictive locomotion') of all 4 limbs was obtained after intravenous application of the noradrenergic precursor, L-DOPA, and nialamide combined with 4-aminopyridine (4-AP). The activity was recorded from muscle nerves. In the presence of 4-AP, which enhances transmission at various excitatory and inhibitory synapses, reduced amounts of DOPA were sufficient to evoke fictive locomotion. 4-AP alone did not elicit locomotion. The burst rate increased up to 6 Hz with the amount of 4-AP given (0.5-50 mg/kg). The cyclic frequency of high spinal cats exhibiting either fictive locomotion or walking on a treadmill was accelerated by 4-AP. After a supplementary transection of the spinal cord at the upper lumbar level both fore- and hindlimbs generally continued to show fictive locomotion with similar frequencies. In the presence of high doses of clonidine (alpha-receptor-activator, greater than 4 mg/kg), the locomotor pattern was replaced by regular (2 Hz) synchronous discharges in all flexors and extensors.

4-Aminopyridine↗
PubMed1979

On the central generation of locomotion in the low spinal cat.

A central network of neurones in the spinal cord has been shown to produce a rhythmic motor output similar to locomotion after suppression of all afferent inflow. The experiments were performed mainly in acute spinal cats (th. 12), which had received DOPA i.v. and the monoamine oxidase inhibitor Nialamide. In some preparations all dorsal roots supplying the spinal cord were transected, in others phasic afferent activity was suppressed by curarization. The activity was recorded as neurograms from nerve filaments or as electromyograms. It is concluded that: 1. alternating activity between flexors and extensors of foot, ankel, knee, and hip of one limb can still occur 2. the duration of the flexor discharges vary less with the cycle duration than the extensor discharges 3. different flexor muscles may retain individual patterns 4. the activity at different joints can be dissociated 5. there is at least one network for each limb. 6. the coordination between the two hindlimbs can be alternating as in walking or be more closely spaced as in galloping 7. alternating activity in the ankle remains even when only segments L6, L7 and S1 are intact.

Afferent Pathways↗
PubMed1978

Effect of repetitive activation on the afterhyperpolarization in dorsal spinocerebellar tract neurones.

1. The changes in the afterhyperpolarization (a.h.p.) with repetitive activation have been studied in dorsal spinocerebellar tract cells of the cat using intracellular recording techniques. 2. The a.h.p. following a single spike was conditioned at different interspike intervals by a single preceding spike. In the majority of neurones the a.h.p. following a spike added approximately linearly with that generated by a preceding spike. 3. In other cells the a.h.p. following a spike was instead depressed by a preceding spike. THis depression was approximately constant at interspike intervals less than the a.h.p. duration (50-100 msec). Thereafter the a.h.p. slowly recovered during the next 100-300 msec. There was no associated decrease in the initial brief hyperpolarizing undershoot. 4. With shortlasting repetitive activation at high frequency (greater than 100 impulses/sec) the a.h.p, peak amplitude increased progressively with successive spikes (5-15 spikes). No change in the time constant of decay was observed. A good correspondence was found between the observed increase in peak amplitude of the a.h.p.s and that given by a theoretical linear superposition of the successive a.h.p.s. 5. Changes in the brief hyperpolarizing undershoot with repetitive activation is also described.

Action Potentials↗
PubMed1978

Firing behaviour of dorsal spinocerebellar tract neurones.

1. The repetitive discharge evoked by constant current injection from an intracellular micropipette has been studied in dorsal spinocerebellar tract cells of the cat. 2. The discharge frequency decreased with time, the decrease being more pronounced at high current intensities. Most of the frequency change occurred during the first ten intervals but the decrease continued slowly for several seconds. In some cells the frequency rose initially, the first interspike interval being larger than immediately succeeding ones. 3. The frequency-current (f/I) curves for the first interspike intervals were S-shaped, as found in spinal motoneurones. With successive intervals the lower leg of the f/I curve extended to higher frequencies, giving a progressive linearization of the f/I curves. In almost all cells this linearization was completed at 200 msec after current onset. 4. The experimental f/I curves were compared with the f/I curves obtained with a simple neurone model based on the properties of the postspike afterhyperpolarization. For the first interspike interval there was a good agreement between the experimental and calculated f/I curves of individual neurones up to frequencies of several hundred impulses per second. In the high frequency range, it was necessary to compensate for changes in initial postspike voltage trajectories caused by the injected current. Other aspects of the firing of real neurones, such as the progressive linearization of the f/I curves, the negative adaptation and the changes in the interspike voltage trajectories with increasing current were also reproduced by the neurone model. 5. It is concluded that the conductance process underlying the postspike afterhyperpolarization is a major factor in the regulation of repetitive firing in dorsal spinocerebellar tract neurones.

Action Potentials↗
PubMed1976

Central generation of locomotion in the spinal dogfish.

After a transection of the spinal cord a dogfish performs continuous swimming movements with a phase lag between adjacent segments. It is shown that the intersegmental coordination remains after an extensive dorsal root transection as well as after curarization. In the former case the motor activity was recorded electromyographically in several segments along the body, in the latter case the intersegmental coordination was evaluated by recording the efferent activity in different ventral roots along the body. It was concluded that a spinal central network can account for the phase lag observed between successive segments during swimming. It was also shown that the efferent activity from parts of the spinal cord with no dorsal roots intact could be influenced by peripheral stimuli such as pressure on the pelvic fins; this result suggests that some afferent fibres reach the spinal cord via the ventral roots.

Animals↗
PubMed1976

Muscle spindle control during locomotor movements generated by the deafferented spinal cord.

In acute spinalized (Th 12) cats, treated with DOPA, curarized or with all lumbosacral dorsal roots transected, stepping patterns were elicited in the hindlimbs by continuous electrical stimulation of the dorsal roots. Single primary endings in dorsal root filaments or single gamma and alpha efferents in muscle nerve filaments from flexors and extensors were recorded together with the efferent nerve activity to various hindlimb muscles. The experiments showed a clear coactivation of the intra- and extrafusal system to the same muscle. The alpha efferent discharges typically started with a very short first interspike interval. It is concluded that there exists a central spinal alpha-gamma-linkage for locomotion in the hindlimbs.

Animals↗