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Biomedical subjects

R J Wirbel

Publications and source records attributed to R J Wirbel.

At least 19 recordsLinked to original sources
PubMed1999

Megaprosthetic replacement of the pelvis: function in 17 cases.

Between 1980 and 1997, we treated 39 patients (mean age 39 (16-66) years, 24 men) with megaprosthetic replacement of a large bone defect (> 10 cm) of the pelvis. The bone resection was necessary in 38 cases due to malignant bone and soft tissue tumors and in 1 case due to hydatid disease. Polyacetal hemipelvic replacement was performed in 29 cases, CAD hemipelvic replacement in 8 cases, and a saddle prosthesis was inserted in 2 cases. All patients were followed clinically and radiographically. The mean follow-up was 58 (15-110) months. 20 patients have died of their tumor. 10 local infections occurred, in 2 cases necessitating hemipelvectomy. Hip dislocation occurred in 6 cases. 13 of the remaining 17 survivors had good or excellent clinical results according to the Enneking evaluation (MSTS). In 6 of the 17 survivors, radiographs revealed implant loosening.

Adolescent↗
PubMed1999

Conservative surgery for chondrosarcoma of the first metacarpal bone.

A rare case of a chondrosarcoma of the first metacarpal bone is presented. The lesion was radiographically interpreted initially as an enchondroma and treated conventionally by curettage and cancellous autologous bone grafting. After final histology, a low-grade chondrosarcoma was reported. A resection of the entire first metacarpal bone was performed, followed by reconstruction using an autologous corticocancellous bone graft and plate fixation, creating arthrodeses of the adjacent joints. Although isolated enchondromas are considered to have no malignant potential, histological examination is essential to rule out malignancy. A preoperative biopsy should be recommended in lesions suspected to be chondromas. Chondrosarcomas are rarely located in bones of the hand, where they are usually treated by amputation. With the case presented we wish to advocate that cases of low-grade, intraosseous chondrosarcoma (stage IA) can be treated by conservative surgery, especially when it is located in the thumb.

Adult↗
PubMed1998

Blunt rupture of the right hemi-diaphragm with complete dislocation of the right hepatic lobe: report of a case.

We present herein a case of blunt rupture of the right hemidiaphragm occurring with complete intrathoracic dislocation of the right hepatic lobe in a polytraumatized patient. The initial chest X-ray was interpreted as right-sided hemothorax, and a thoracic drainage tube was accidentally placed into the liver. A computed tomography scan subsequently revealed diaphragmantic rupture with intrathoracic liver dislocation. It was possible to reposition the liver, and the extended dorsal diaphragmatic rupture was closed primarily through an abdominal approach. The problems associated with the diagnosis and operative treatment of fresh right-sided blunt traumatic diaphragmatic ruptures are discussed following this case report.

Adult↗
PubMed1998

Treatment of severe injuries caused by attempted suicide: pattern of injury and influence of the psychiatric disorder on the postoperative course.

OBJECTIVE: To assess the influence of psychiatric disorders on the treatment and postoperative course of patients severely injured as a result of attempted suicide. DESIGN: Retrospective case study. SETTING: University hospital, Germany. SUBJECTS: 36 patients who had multiple injuries after attempting suicide during the five year period 1991-95. INTERVENTIONS: Operative and psychiatric treatment. MAIN OUTCOME MEASURE: Functional results assessed with the Trauma Outcome Profile (TOP) score, psychiatric state, and risk of further suicide attempts. RESULTS: 30 of the 36 patients attempted suicide by jumping from a height, and the most common injuries were fractures of the spine (n = 33) and lower limbs (n = 43). All patients had a psychiatric disorder, and 18 had previously attempted suicide at least once though had inflicted only minor injuries. 29 of the 36 were receiving psychiatric care at the time of the suicide attempt. Five patients died. 27 of the 31 survivors were available for follow up and 26 of them had good or excellent functional results. 30 of the 31 underwent psychiatric assessment (one refused) and none was judged to be at risk of a further attempt. CONCLUSIONS: The functional results were better than we expected. The psychological effect of severe injuries and a long hospital stay seems to reduce the risk of a further attempt, so all treatment (both surgical and psychiatric) is worthwhile.

Adult↗
PubMed1998

[Primary malignant tumors of the sacrum].

The oncological and functional results of 16 patients with primary malignant sacral tumors (12 chordomas, 3 chondrosarcomas, 1 fibrosarcoma) during the past decade are reported. Dorsal approach was used in 10 cases, ventral or combined ventrodorsal procedure in 5 cases; in 1 case only biopsy was taken. Amputation of rectum with colostomy was necessary in 9 cases, ileosacral stabilization in 2 cases. Eight patients died, 5 of the disease and 3 of complications, with a mean survival time of 25.8 months. Local recurrence occurred in 4, distant metastases in 3 cases. Six of the 8 survivors--mean survival is 59 (21-112) months--showed good or excellent functional results according to the Enneking score system. Local complications, mostly wound healing problems, were observed in 9 (56%), neurological disorders in respect of the resected sacral nerve roots in 11 (68%) cases. The oncological and functional results after resection of primary malignant sacral tumors, especially of chordomas, justify radical surgical procedures sacrificing the sacral nerve roots.

Chondrosarcoma↗
PubMed1997

[Osseous echinococcosis].

Hydatid disease is caused by the parasitic tapeworm Echinococcus. The larval stage of this parasite can thrive in many parts of the body, most frequently in the liver. Primary bone location is very rare, accounting for less than 2% of all hydatid lesions. We report on a case of left-sided extended pelvic infestation. The destruction of the hip joint, os pubis, large parts of the ileum and the femoral head made pelvic resection and prosthetic replacement necessary. Recurrence of a hydatid cyst 5 years later in the left groin originating from the proximal femur was treated with second femoral resection and new total hip replacement. Because of instability, the primarily inserted polyacetal pelvic replacement had to be exchanged for a custom-made device fabricated with the aid of computer-aided design (CAD) techniques. This surgical procedure was combined with chemotherapy (mebendazole). The necessity of radical resection in osseus hydatid disease is discussed.

Antinematodal Agents↗
PubMed1997

[Right-sided diaphragmatic rupture with intrathoracic displacement of the entire right lobe of the liver].

A case of rupture of the right hemidiaphragm resulting from blunt trauma with complete intrathoracic dislocation of the right hepatic lobe in a multiple trauma patient is presented. After a primary chest X-ray study had been interpreted as showing right-sided hemothorax, the thoracic drainage tube was accidentally placed into the liver. CT revealed a diagnosis of diaphragmatic rupture with intrathoracic liver dislocation. The liver was replaced and the extended dorsal diaphragmatic rupture was closed primarily via an abdominal approach. Problems of diagnosis and operative procedure in rare cases of fresh right-sided blunt traumatic diaphragmatic ruptures are discussed. CT may be helpful in the differential diagnosis of pulmonary contusions, hemothorax and diaphragmatic disruptions with intrathoracic herniation of intra-abdominal organs.

Adult↗
PubMed1997

Osteochondrosis dissecans of the lateral femoral condyle before skeletal maturity.

Many surgical techniques are available for the treatment of osteochondrosis dissecans before skeletal maturity with variable success. In this paper we present a simple and safe surgical technique of bone grafting and temporary stabilization. The rare case of a 10-year-old boy, who suffered from a large developing osteochondrosis dissecans of the lateral femoral condyle, is reported. This patient was treated by retrograde autologous bone graft and fixation of the fragment with K-wires. After 4 weeks partial weight-bearing was possible. During 5 months the lesion healed well which could be demonstrated by x-ray and MRI. Consequently, the K-wires were removed. Because there is a high risk of osteoarthritis developing in the weight-bearing areas, especially in large lateral lesions, prophylactic stabilization and bone grafting is suggested. This can be performed successfully by the demonstrated simple technique.

Bone Transplantation↗
PubMed1997

[A method for nidus localization in osteoid osteomas].

A method for localization of the nidus of osteoid osteomas using CT-controlled needle placement and subperiosteal marking with methylene blue is demonstrated. Our clinical experience in 13 patients is reported. This method allows proper intraoperative localization of the nidus of osteoid osteomas without problems. Thus, osseous resection can be reduced and additional stabilization by internal fixation or defect filling by bone graft are not necessary.

Adolescent↗
PubMed1996

Case report: splenic hamartoma with hematologic disorders.

Hamartomas of the spleen are rare benign tumors usually detected as asymptomatic, incidental findings at laparotomy or autopsy. By review of the literature, there are only 16 well-documented cases of symptomatic splenic hamartomas associated with hematologic disorders. The authors report on an additional case of splenic hamartoma in a 34-year-old man with thrombocytopenia. Findings by ultrasonography and computed tomography suggested multiple confluent splenic lesions. Because of progressively increasing thrombocytopenia, elective splenectomy was performed. Final pathology confirmed diagnosis of multiple hamartomas of the red pulp. Platelet count returned to normal within 1 month postoperatively. Differential diagnosis, diagnostic procedures, and pathologic findings of splenic hamartomas will be discussed. Hamartomas should be kept in mind in the differential diagnosis of splenic tumors. Splenectomy is indicated in cases where malignancy cannot be excluded and in cases of associated hematologic disorders.

Adult↗
PubMed1996

[Primary malignant bone and soft tissue tumors of the pelvis--oncologic and functional outcome].

Surgical treatment of primary malignant bone and soft tissue tumors involving the innominate bone has to be considered an extensive procedure with high incidence of complications. It requires the knowledge of different techniques of resection and reconstruction of bone, joints, soft tissue and intrapelvic organs, as well as a multidisciplinary management. Therefore, it should be limited to specialized centers. The best oncological and functional results can be achieved by continuity resection and pelvic reconstruction in low grade malignant bone tumors [1-3].

Adult↗
PubMed1995

Hydatid disease of the pelvis and the femur. A case report.

We report a case of left-sided extended pelvic infestation of hydatid disease. The destruction of the hip joint, os pubis, larger parts of os ileum and the femoral head made pelvic resection and prosthetic replacement necessary. Recurrence of a hydatid cyst 5 years later in the left groin originating in the femur was treated with a second femoral resection and total hip replacement. Because of instability, the pelvic replacement also had to be changed to a custom-made CAD replacement. This surgical procedure was combined with chemotherapy by mebendazole. The need for radical resection in osseal hydatid disease is discussed.

Antinematodal Agents↗
PubMed1995

[Surgical therapy of bone metastases].

The surgical treatment of bone metastases is generally palliative. All operative procedures have to consider the mostly short life expectancy and therefore have to guarantee stability, early mobilization and short hospitalization. Surgery is absolutely indicated in patients with pathologic fractures of the long bones and innominate bone involving the hip joint, in patients with spinal lesions causing instability and progressive neural deficit and in patients with compression of peripheral nerves. Relative indications for surgery are given in cases where the risk of sustaining a pathologic fracture is high, in cases where spinal neurological deficit or root irritation can be expected, in patients where the tumor grows despite adequate irradiation or chemotherapy and finally in cases where open biopsy is useful to exclude primary malignant tumor or is necessary to define the further therapeutic management. As morbidity, hospitalization and complications increase in patients with pathologic fractures prophylactic stabilization is emphasized using well defined criteria. The standard surgical principles and techniques are presented and the results of 506 cases are reported.

Bone Neoplasms↗