Biomedical subjects

R H Wittenberg

Publications and source records attributed to R H Wittenberg.

43 records · Page 3Linked to original sources

PubMedDate not supplied

[Calcifying subacromial syndrome--clinical and ultrasound outcome of non-surgical therapy].

PURPOSE: The aim of this study is to analyse the mid-term clinical and sonographical results of non-operative therapy of calcifying tendinitis. METHODS: Retrospectively the anamnestical, clinical and sonographical results after various non-operative treatment of patients with calcifying tendinitis were reviewed. For this purpose 159 patients with 178 calcifying deposits in the rotator cuff were evaluated on an average of 60 months after their first examination in our clinic (mean age: 49.2 years; sex ratio: 58% women). RESULTS: During a mean symptomatic period of 49 months, an average of 4.2 different therapeutic modalities were applied. After this time 70% of all patients showed an excellent or good result. With regard to the age-correlated Constant-Score 85% of all patients had more than 81 points, i.e. a good result. The mid-term results on a visual analogous scale from 10 (pain) to 0 (no pain) showed a decrease from 7.7 to 2.2 and this correlated with the shoulder function scores (Constant-/Patte-Score, r -0.8). After an average of 104 months 82% of the hydroxyapatite deposits could not be diagnosed by sonography (7.5 MHz.) anymore. CONCLUSION: In the treatment of calcifying tendinitis the conservative methods achieve good and excellent results in 70%. Patients should be treated with analgetics, subacromial injections, physiotherapy and ice therapy up to a period of twelve months, above all with small deposits and radiologic resorptive stadiums. The results of this study should be compared with any invasive regimen.

Adult↗

PubMedDate not supplied

[Biomechanical studies of bisegmental lumbosacral stabilization using the internal fixator or PMMA-simulated fusion].

The implantation of fixation devices increases the primary stability after surgery significantly. Little is known about the comparison of flexibility of instrumented and posterolateral fusions or the lumbosacral distractions spondylodesis (LSDS). The purpose of the study was to compare the flexibility of instrumented and posterolateral fusions or LSDS after simulation with polymethylmethacrylate (PMMA). Dynamic testing from 0-16 Nm in flexion/compression and 0-900 N in compression was performed on 14 lumbosacral spines. The spines were tested intact, after laminectomy, instrumentation with an internal fixateur L5-S1, and simulation of posterolateral fusion L4-S1 or LSDS and thereafter a pseudoarthrosis was simulated. The laminectomy resulted in a significant increase of flexibility and posterior distraction in flexion and compression. The stabilization with an internal fixateur or PMMA simulation for posterolateral fusion or LSDS resulted in a significant decrease of the flexibility. Creation of a unilateral pseudoarthrosis did not effect the flexibility. The instrumented fusion as well as the PMMA simulated bony posterolateral fusion and LSDS resulted in this model in a significant stabilization of the laminectomy. After unilateral fusion the flexibility was not significantly increased.

Aged↗

PubMedDate not supplied

[Is epidural injection treatment with hypertonic saline solution in intervertebral disk displacement useful? (The effect of NaCl solution on intervertebral disk tissue)].

The effect of sodium chloride solution on disc tissue was investigated in vitro. Tissue material was obtained from 19 discectomies. The specimens were incubated in aqua ad injectionem and in different sodium chloride solutions and weighted regularly during a maximum of 24 hours. Following the incubation periods the specimens were examined histologically. After one hour the surgical specimens showed a weight increase of 290% for aqua bidest., 170% for 0.9% NaCl and 100% for 5.85% NaCl and 10% NaCl. Disc tissue obtained from six autopsies was also examined under the same conditions. The weight increase in nucleus pulposus and anulus fibrosus tissue was less than in the disc tissue obtained from surgery. The weight increase in anulus fibrosus tissue was less than in nucleus pulposus tissue. In vitro incubation of disc tissue in a hypermolar sodium chloride solution always resulted in a weight increase. Successful therapy could not be explained by shrinkage of disc tissue treated with hypermolar sodium chloride.

Adult↗

PubMedDate not supplied

[The mobile segment above fusion].

The question is, if a possible concentration of stress in the segment adjacent to the fusion level might result in disc degeneration. Two series of patients have been evaluated: One group of 70 patients underwent a posterolateral fusion without instruments and the other group of 69 patients underwent a posterolateral instrumented fusion. The follow-up was in average 5.7 years resp. 4.6 years. The operations were divided in monosegmental, floating and polysegmental fusions. In the total group, 10% of the non-instrumented and 28% of the instrumented patients had an osteoarthritis of the facet joints, 10% resp. 23% were unstable and in 9% resp. 1% a disc resorption occurred. There have been no statistical differences in the both polysegemental groups, but this was the case for all osteoarthritis and instabilities in the monosegmental fusions. It is supposed that the changes in kinematics together with material related alterations of elasticity led to higher stress concentration in case of instrumentation.

Biomechanical Phenomena↗

PubMedDate not supplied

[Results of dorsal lumbosacral distraction spondylodesis without implant in previously surgically treated back patients].

Lumbosacral fusions of the L4/5 and L5/S1 segment were performed in 168 patients with a tricortical iliac crest bone graft between the spinal processes L4 and S1 and two posterolateral fusions (LSDS). At follow-up five or more years after surgery, 46 of 55 patients with prior back surgery had a solid bony fusion. Pain was reduced in 94% of the failed back patients; 61.8% were satisfied with the result. On a ten-point scale from no (0) up to unacceptable (10) pain, the degree of back-pain decreased five years after fusion from 9.1 to 4.9 points, while the leg pain was reduced from 8.5 to 4.3. During surgery and the early postoperative period four major complications occurred in 168 patients. Twice the dura was perforated and two graft luxations were seen. No deep wound infections and no nerve root lesions were seen after surgery. The average blood loss was substituted by 2.4 erythrocyte concentrates. The lumbosacral distraction spondylodesis is a fusion of the two lower lumbar segments with satisfactory clinical and radiological results and a low complication rate. In patients with a failed back syndrome the pain in most cases decreased. The fact that 38.2% of the patients are unsatisfied with the result is most likely due to the severe scar tissue following prior surgery.

Adult↗

PubMedDate not supplied

[Experimental studies of change in the center of rotation of the moveable segment after intervertebral disk removal].

The in vitro effect of nucleus pulposus removal from human lumbar FSU's was investigated in a special test apparatus. Instability was determined by ROM, loss of disc height and displacement of the center of rotation. Disc height showed a decrease of 3.2 mm under axial load (700N). ROM increased up to 70%. The center of rotation demonstrated a distinct displacement in extension and lateral bending.

Biomechanical Phenomena↗

PubMedDate not supplied

[Prostaglandin and leukotriene release of synovial tissue in various joint diseases].

Synovial tissue from 37 patients suffering from osteoarthritis, chondrocalcinosis, active and inactive rheumatoid arthritis was investigated. The tissue was obtained during knee surgery and immediately incubated in tyrode solution. PGE2, 6-keto-PGF1 alpha, LTB4 and LTC4 were measured by radioimmunoassay. Calcium ionophore A 23187 stimulated the eicosanoid release significantly. This effect was more pronounced with LT than with PG. In the four different joint diseases there was no significant difference in the PG release. The LTC4 release was significantly lower in inactive rheumatoid arthritis as compared to the other joint diseases. For LTB4 this effect was significant only when compared to osteoarthritis. Indomethacin 10(-5) and 10(-7)mol/l inhibited the PG release from synovial tissue in all joint diseases significantly (p less than 0.05), there was no significant effect on the LT release. LT as well as PG are pro-inflammatory mediators. Non-steroidal anti-inflammatory drugs inhibit only the PG release. The remaining LT synthesis might thus be partially responsible for the lack of efficacy of these drugs in some patients.

Adult↗