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Biomedical subjects

R Kayser

Publications and source records attributed to R Kayser.

At least 19 recordsLinked to original sources
PubMed2006

Brown-Séquard syndrome caused by a high velocity gunshot injury: a case report.

STUDY DESIGN: Case report. OBJECTIVE: To present an unusual traumatic neurologic pathology caused by gunshot injury. SETTING: Spine unit of Department of Trauma and Orthopaedic Surgery, University Medical School, Charité - Campus Benjamin Franklin, Berlin, Germany. METHOD AND RESULT: A 35-year-old male sustained a gunshot injury from a machine gun. The projectile caused a fracture of the left pedicle of Th10. The spinal cord was indirectly damaged by cavitation that caused a Brown-Séquard syndrome (BSS). After a microscopically assisted posterior revision at T9/10 with removal of bullet and bone fragments from the spinal canal and debridement of the bullet cavity via extended fenestrectomy the patient gained his motor function back. The sensory deficit remained unchanged. CONCLUSION: BSS can be caused by bullet-related injury of the spinal canal with no direct damage of neural structures. The initial treatment is always based on the total injury pattern. Possible spinal cord injuries are only clarified after restitution of vital functions. Decompression of neural structures in shotgun injury is indicated in incomplete paraplegia, injury of intra-abdominal hollow organs or high velocity bullet wounds. Through debridement and decompression of neural structures and chronic damage caused by foreign body granulomas can be prevented. Secondary destabilization of the spine should be avoided.

Adult↗
PubMed2006

[Direct osteosynthesis of instable Gehweiler Type III atlas fractures. Presentation of a dorsoventral osteosynthesis of instable atlas fractures while maintaining function].

This retrospective study evaluates eight patients with unstable fractures of the atlas vertebra, treated operatively in the Central Clinic Bad Berka between January 1995 and December 2001. In all cases, we were confronted with unstable and dislocated type III fractures according to Gehweiler, caused by an injured transverse ligament. Mean age was 34 years (range 20-49) in two women and six men. We introduce a new technique of direct reconstruction of the atlas vertebra. This technique leads to a stable ring construct that allows compression osteosynthesis of the fracture. Spinal fusion can be avoided, as can postoperative immobilization, since sufficient stability for functional postoperative treatment is achievable. The follow-up control 38 months (range 6-75) after surgery showed solid bony fusion in all cases, in one case after revision surgery. All patients showed good functional results, there was no need for analgesics and all patients could be reintegrated into their former occupation.

Bone Screws↗
PubMed2006

[Instability of the upper cervical spine due to rheumatism].

Rheumatic manifestation at the cervical spine occurs in more than 50% of all cases in the natural course of this disease. The first cervical manifestation takes place in the upper cervical spine. The initial involvement of the C1/C2 segment leads to atlantodental subluxation. Progressive destruction can result in vertical instability, which is characterized by cranial subluxation of the odontoid process with the danger of resulting stenosis and cervical myelopathy. The goal of diagnosis has to be the early recognition of these changes to establish an effective treatment protocol. Persistent pain, neurological deficits, and progressive radiological signs for instability are indications for operative stabilizing procedures. These procedures avoid progressive destruction and improve the prognosis regarding pain decrease, regression of neurological deficits, and life expectancy.

Aged↗
PubMed2006

[Functional disorders and functional diseases in the region of the upper cervical spine particularly regarding the cervical joints. Current status and clinical relevance].

Functional disorders of the upper cervical spine may be responsible for or the primary cause of persistent complaints following an injury or illness. Functional disorders involving the cervical joints, especially C0/C1 and C1/2 but also the C2/3 junction are of particular clinical relevance. Range of motion assessment is extremely important for the diagnosis of joint disorders. Hypomobility or "blockade" can be diagnosed using special examination techniques that, in many cases, can be extended for direct manual therapy. Periarticular structures involved in these dysfunctional processes, especially muscles and fasciae, must also be examined and treated. Clinical manifestations may include locally restricted muscle extensibility (e.g., trigger points, tension or muscle shortening) with zones of radiating pain as well as referred problems distal to the primary lesion. Functional disorders in the region of the upper cervical spine may be accompanied by various types of reflexive compensatory problems. Although they must be diagnosed separately, these disorders frequently respond to the manual therapy techniques used to treat the underlying functional problem. Even if the exact correlations to functional medicine cannot be scientifically demonstrated in every case, functional assessment and treatment techniques are, in our view, a useful addition to the armamentarium for orthopedic diagnosis and treatment.

Adult↗
PubMed2006

[Injuries to the craniocervical junction].

Injuries to the upper cervical spine (C0-C2) play a major role in surgical treatment of traumatic sequelae in the entire cervical spine. Even though the number of such operations has increased in recent years, there are no clear treatment recommendations for most types of cervical spine injuries. In view of the wide range of injury types and the correspondingly large number of treatment options, this review focuses mainly on the following types of injuries: C0 fractures, occipital condyle fractures (OCF), atlanto-occipital dislocation (AOD), atlas fractures, atlantoaxial dislocation (AAD), and axis fractures. Important aspects of the mechanisms of injury, clinical signs and symptoms, diagnostic procedures, and treatment options are discussed. Special emphasis is placed on comparatively reviewing the different treatment options discussed in the literature. A summary in table form is presented at the end of each chapter for quick reference.

Adolescent↗
PubMed2006

[Rare pathological alterations of the upper cervical spine requiring surgical treatment].

Because of its unique anatomy, specific diseases and lesions arise in the upper cervical spine, which differ widely from the rest of the spine. During the last two decades standardised diagnostic and therapeutic algorithms have been defined for most of the craniocervical pathologies often occurring in combination with an underlying disease requiring surgical intervention as well. On the other hand there are some very rare phathological alterations: about 20% of the patients suffering from neurofibromatosis type I develop spinal deformities. These are mostly found in the thoracic and lumbar spine (dystrophic/non-dystrophic type). In rare cases the dystrophic neurofibromatosis type I involves the upper cervical spine leading to bizarre deformities endangering the spinal cord. An aggressive, timely and combined operative therapy is necessary. Patients with Down syndrome should be investigated regularly for affections of the upper cervical spine. Though only in about 1% of all patients with Down syndrome do instabilities require surgical intervention, the upper cervical spine should be screened on a regular basis, since neurological changes due to the pathognomy of the underlying disease often remain undetected for a long time. The operative therapy of the instable os odontoideum in Down syndrome follows the general principles of this pathoanatomical variation. Even though the Klippel-Feil syndrome is generally not linked with neuropathological findings, rare associated deformities of the upper cervical spine should be excluded by proper diagnostic procedures.

Adolescent↗
PubMed2005

Ultrasonography as a reliable diagnostic tool in old quadriceps tendon ruptures: a prospective multicentre study.

Quadriceps tendon rupture is an uncommon injury. In the majority of cases, predispositions as recurrent microtrauma or degenerative changes are present. The diagnosis of acute quadriceps tendon ruptures can usually be made by clinical examination. Ultrasonography has been shown as a reliable, inexpensive and easily available diagnostic tool to confirm the diagnosis. In this study, we evaluated the clinical value of ultrasonography for establishing diagnosis of old quadriceps tendon ruptures. In the prospective time period of 6 years (01/1998-12/2003), the delayed diagnosis of quadriceps tendon rupture was established in six patients with seven cases of old ruptures (one bilateral rupture). The mean age was 50.2 (SD+/-16.9) years in one woman and five men. The mean interval from trauma until diagnosis was 15.2 (SD+/-7.1; range 8-24) weeks. In all cases, ultrasonography represented a reliable and sensitive tool for establishing diagnosis of old quadriceps tendon rupture. We therefore recommend the use of ultrasonography in the diagnostic work up of cases with knee trauma and potential involvement of tendon injuries.

Adult↗
PubMed2005

[Management of spine injuries in polytraumatized patients].

The management of spine injuries in polytraumatized patients remains a great challenge for the diagnostic procedures and institution of appropriate treatment by integrating spinal trauma treatment into the whole treatment concept as well as following the treatment steps for the injured spine itself. The established concept of "damage control" and criteria regarding the optimal time and manner for operative treatment of the injured spine in the polytrauma setting is presented and discussed.

Adult↗
PubMed2005

Sonographic imaging of the distal biceps tendon -- an experimental and clinical study.

AIM: With this study we aimed to determine the reliability of ultrasound imaging in depicting the normal anatomy of the distal biceps tendon in human cadaver specimens and to provide an accurate visualisation of ruptures of the distal biceps tendon in healthy volunteers. METHOD: The distal biceps tendons of six whole-arm human cadaver specimens were investigated. The tendons were subsequently marked with a biopsy needle and re-examined. In addition, ultrasound imaging of the distal biceps tendon was performed in 25 healthy volunteers (50 sonograms). All examinations were carried out using linear ultrasonic transducers of various frequencies (5 - 13.5 MHz). The sonographic images were submitted to two experienced examiners for analysis. RESULTS: Positive identification of the tendon was achieved in all cases. The best results were achieved using 7.5 MHz transducers. Our study also suggests that the medial longitudinal scan and the articular transversal scan are a definite prerequisite for a correct diagnosis in the region of the distal biceps tendon. The dynamic examination is very useful to visualise the tendon with sufficient accuracy. CONCLUSION: Based on this study, ultrasound imaging is recommended as the method of choice for visualisation of the distal biceps tendon if performed with the necessary accuracy.

Adult↗
PubMed2005

Proximal focal femoral deficiency -- a rare entity in the sonographic differential diagnosis of developmental dysplasia of the hip,.

In the present study, we will describe the differential diagnosis of the rare hip anomaly of proximal focal femoral deficiency (PFFD), based on an analysis of 12,488 ultrasound images of the hips of 6244 neonates, examined in our orthopaedic clinics between 1988 and 1998. The clinical manifestations and ultrasound features of PFFD will be characterised and compared with those of the normal, the mildly dysplastic, and the severely dysplastic hip. Two cases of PFFD (0.032 %) were detected during the investigation period. Both neonates had been referred to the orthopaedic clinic for further evaluation after the initial ultrasound findings suggested an anomaly in the coxal-femoral region. Correct identification of anatomical structures in the acetabular region (acetabular labrum and lower edge of the ilium) was not possible, but the iliac line, femoral head, and greater trochanter could be reliably visualised. Because of these findings, a deformity in the coxal-femoral region was suspected, and further diagnosis was recommended. PFFD was subsequently diagnosed, and specific treatment was initiated. PFFD should be suspected in any neonate with suspicious clinical findings and failure of ultrasound to clearly visualise anatomical landmarks in the region of the acetabulum (acetabular labrum, lower edge of the ilium, cartilage-bone interface) despite the use of a sufficient imaging technique. Radiographs should then be obtained to confirm or refute the tentative diagnosis. Infants with PFFD can then receive proper treatment without unnecessary therapeutic trial and error.

Diagnosis, Differential↗
PubMed2005

[Validity of ultrasound examinations of disorders of the shoulder joint].

OBJECTIVES: The objective of the present study was to assess the validity of ultrasound diagnosis of shoulder disorders in relation to examiner experience. METHODS: A total of 239 patients referred to us for shoulder arthroscopy from October 2001 to June 2004 were prospectively studied by ultrasound. The following ultrasound diagnoses were evaluated: total and partial rotator cuff tears, calcific tendinitis, biceps tendon injuries and subacromial bursitis. Examiner A established the ultrasound diagnoses and examiner B performed the surgery during week A, whereas examiner B did the examinations and examiner A operated in week B. The surgeon was blinded to the ultrasound results. Examiner A conducts ultrasound training seminars for DEGUM, the German Society of Ultrasound in Medicine, and has performed over 10,000 ultrasound examinations, with an average of roughly 150 examinations per year. Examiner B completed his ultrasound training some years ago and has performed roughly 1500 examinations (50 per year). The results were analysed in a time-independent and blinded manner by the co-author (H), who neither operated nor examined the patients. RESULTS: Ultrasound correctly identified 103 of 104 complete rotator cuff tears (sensitivity: 0.99--specificity: 0.99--accuracy: 98.7%). Both examiners achieved comparable results. Moreover, 41 of 52 partial rotator cuff tears were detected preoperatively (sensitivity: 0.79--specificity: 0.91--accuracy: 88.7%). Examiner A achieved a sensitivity of 0.92, a specificity of 0.95, and an accuracy of 94.7%. The corresponding rates for examiner B were: sensitivity 0.68, specificity 0.86, and accuracy 81.3%. 16 of 23 injuries of the long biceps tendon were identified correctly (4 of 8 dislocations and 12 of 15 tears: sensitivity 0.53; specificity 0.9; accuracy 95.3%). Examiner A achieved: sensitivity 0.58; specificity 0.99; accuracy 91.7% compared to examiner B: sensitivity 0.33; specificity 0.97; accuracy 95.3%. Both examiners correctly identified all 32 cases of calcific tendinitis (sensitivity 1.0; specificity 0.98; accuracy 98.3 % examiner A: 1.0--1.0--100% examiner B: 1.0--0.96--96.2%). 22 of 28 cases of subacromial bursitis were correctly diagnosed (sensitivity 0.79; specificity 0.98; accuracy 95.8% examiner A: 0.92--0.99--98.5% examiner B: 0.69--0.97--92.5%). CONCLUSIONS: Preoperative ultrasound examination of the shoulder permits a reliable diagnosis of complete rotator cuff tears and calcium deposits (calcific tendinitis). The method is less sensitive but sufficiently reliable for the diagnosis of partial rotator cuff tears and pathology of the long biceps tendon. Examiner experience plays an important role in these special cases. Permanent continuous training in the field of ultrasound diagnosis is a prerequisite for sufficient reliability of ultrasound diagnosis of shoulder disorders.

Arthroscopy↗
PubMed2005

Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging.

OBJECTIVES: The aim of this study was to determine whether ultrasound can correctly visualise partial ruptures of the proximal Achilles tendon. METHOD: This was a prospective study in which all chronic Achilles tendon injury patients seen at three centres in Germany from 1998 to 2003 were screened. All patients with clinical and/or sonographic signs of abnormalities in the region of the proximal third of the Achilles tendon and tendomuscular junction were included in the analysis. Each of these cases was evaluated by ultrasound following an assessment protocol. Patients with ambiguous ultrasound findings and/or clinical signs were additionally assessed by magnetic resonance imaging (MRI). RESULTS: Sonomorphologic changes suggestive of an abnormality in the proximal third of the Achilles tendon were detected in 13 out of 320 patients (4.2%) with recurring Achilles tendon complaints. Thirteen patients had clinical signs but no sonographic changes in the tendon. The sonographic diagnosis was correct in 19 cases. In six of the 26 cases studied, MRI was needed to establish the correct diagnosis of partial intratendinous rupture of the proximal Achilles tendon. Sensitivity was 0.5, specificity was 0.81, and the overall agreement of the ultrasound examination was 61.5%. All patients were asymptomatic at follow up at a mean of 14 months (range 12-17 months) after surgery. CONCLUSIONS: Ultrasound is a useful tool for evaluation of proximal Achilles tendon complaints. However, ultrasound is not sufficiently reliable for diagnosis of all pathologies, especially partial ruptures of the Achilles tendon. Thus, the definitive diagnosis must be established by MRI.

Achilles Tendon↗
PubMed2004

[Ultrasonographic visualization of a Baker-cyst as cause of a peroneal nerve palsy in a patient with rheumatoid arthritis].

With this report we present a patient with rheumatoid arthritis in whom a popliteal cyst could be diagnosed quickly and conclusively by ultrasonography as the possible reason for peroneal palsy. The sonographic investigation of the knee joint revealed an effusion. Within the popliteal fossa (dorsal longitudinal and transverse section) a cyst measuring 54 x 21 x 51 mm in a typical dorsomedial position in between the heads of the gastrocnemius muscles was found. Besides extensive synovectomy, we completely removed the cyst. The common peroneal nerve was entrapped by the Baker's cyst. The complete palsy of the nerve improved postoperatively (grade 4 according to Janda). Ultrasonography is an excellent diagnostic procedure for easy, quick, and reliable differential diagnostic evaluation of a swelling within the popliteal fossa region.

Arthritis, Rheumatoid↗
PubMed2003

[Value of ultrasound diagnosis in Legg-Calvé-Perthes disease].

Ultrasound examination of the hip joints in cases of the painful hip in childhood is routinely performed according to the advised standard sections of the German Society for Ultrasound in Medicine (DEGUM) at the special surgery of paediatric orthopaedics of the Orthopaedic University Clinic Magdeburg. Between 1993 and 2000 we performed 418 sonographic examinations of painful hip joints in 153 children. We identified 53 children (159 sonograms) with coxitis fugax, 47 children (188 sonograms) with Morbus Perthes, 28 children with epiphysiolysis capitis femoris, and three children with septic arthritis. In 15 cases (30 sonograms) no sonopathologic changes were observed. However, only in seven cases where ultrasound examination failed to reveal pathological changes, the cause of painful hip was identified by means of radiation depending X-ray or MRI. Sonograms of children with Morbus Perthes were further used to evaluate for stage differentiation and potential surgical treatment. Thus, we could show that ultrasound examination is a powerful tool for identifying the variety of underlying causes of painful hip in childhood and should be used as method-of-choice especially in children to avoid unnecessary radiation exposure.

Adolescent↗
PubMed2003

[Heparin induced thrombocytopenia type II after the use of low-molecular weight heparin. Case report and review of the literature].

INTRODUCTION: It has been suggested, that HIT-type-II can occur both after the use of low-molecular-weight and unfractionated heparin. The present study investigates the incidence of HIT-type-II after the use of low molecular weight heparin by reviewing the literature and describes one own case. CASE REPORT: We observed in a 72 year old female patient a HIT-type-II, who received low molecular weight heparin (Clexane 40 o.a.d) after the implantation of an endoprothesis as thrombosis prophylaxis. This occurred on the 9th postoperative day. One year later we performed a second endoprosthesis operation of the contralateral site without complications. With the known HIT-type-II, diagnosed the year before,we used hirudin (Refludan) for thrombosis prophylaxis. RESULT: A critical view on the international literature revealed only a few cases, where a HIT-type-II was caused by the use of low molecular weight heparin. The incidence seems to be much lower than correlated to the use of unfractionated heparin. CONCLUSION: It is possible to suffer from a HIT-type-II after low molecular weight heparin. This study confirms the suspicion that the incidence of a HIT-type-II after low molecular weight is lower than after unfractionated heparin. Therefore the further use of unfractioned heparin for thrombosis prophylaxis has to be questioned and low molecular-weight heparin should be preferred.

Adult↗
PubMed2002

[Freiburg intervention program for ambulatory therapy of obesity in childhood (FITOC)].

In this study we first try to answer the question, whether it is possible to make a successful treatment for obese children in an interdisciplinary program. Second it is asked whether a transfer of this program to further regions in Germany leads to comparable results. In FITOC children from the age of 8-11 years and over the 97. BMI-percentile are integrated in this program. The goals weight management, increased physical fitness and improvement of the cardiac risk profile are checked by weight, height, fasting blood serum, a standardized cycle ergometry and a medical measurement at the beginning, after treatment and at all check-ups. The recorded medical data show clearly that the intervention leads to a significant improvement in almost all checked parts. The successful treatment can be recorded after 8 months, likewise after 2.5 years as a long-term result. The further cornerstones of FITOC nutrition and psychology are not subject of this publication. In future the psychological part in FITOC will be evaluated by standardized inventories. The group from Düren has a success in therapy according to the definition of the program. Thereby it is shown that FITOC is extendable, if teams are trained intensively and the conditions are comparable. FITOC is able to treat obese children successfully over a long period of time. In consideration of the rising prevalence of obesity in childhood and the limited financial resources in health care this outpatient interdisciplinary program is an effective choice of treatment.

Child↗