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R Kayser

Publications and source records attributed to R Kayser.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Heparin-induced thrombocytopenia as a complication of postoperative prevention of thromboembolism with unfractionated heparin/low molecular weight heparin after hip and knee prosthesis implantation].

AIM: With this prospective study we analysed the occurrence of a heparin-induced thrombocytopenia type II (hit type II) using unfractioned heparin (UFH) or low-molecular-weight heparin (LMWH) as postoperative thrombosis prophylaxis after primary total hip or knee replacements. Furthermore the postoperative course of the platelet count with UFH and LMWH was investigated. MATERIAL AND METHODS: In a prospective study we looked at the platelet count of 504 primary endoprothesis patients until the 9. postoperative day. 252 patients got UFH (3-mal 5000 IE Liquemin), 252 patients got LMWH (Clexane 40 opd) as thrombosis prophylaxis. RESULTS: 5 patients of the UFH-group developed a HIT type II (incidence 2%; 95%-confidence interval 0.7-4.5) after 9.8 (7-16) days. Within the LMWH-group we saw just one case (incidence 0.4%; 95%-confidence interval 0-2.1). The drop of the platelet count was on average 64% (40.9-81.6). Within the 498 patients without a HIT type II just 2 patients had a drop of the platelet count between the 5. and 9. postoperative day of more than 15% referring to the preoperative value (24% and 33%). CONCLUSION: The incidence of a HIT type II after the use LMWH seems to be lesser than after the use of UFH. The postoperative platelet count shows a typical course after a total joint replacement. With deviations of that a HIT type II must be excluded.

Aged↗
PubMed2002

[Spondylodiscitis in childhood].

Spondylitis is a rare disease in childhood and atypical symptoms frequently retard the diagnosis. From 1968 to 1988, 25 children with a diagnosis of spondylitis were treated in our orthopedic hospital. Anamneses, clinical symptoms, roentgenograms, and differential diagnoses are described for these cases. Spondylodiskitis represents a mild course of the disease in childhood. Tuberculous spondylitis was not present in any of the cases. The prognosis of childhood spondylitis is favorable, and surgical interventions were not necessary in our patients. Spondylitis healed with an ankylosis of one segment of the spine without essential disturbance of spinal function.

Age Factors↗
PubMed2001

Effects of preventative footwear on foot pressure as determined by pedobarography in diabetic patients: a prospective study.

AIMS: This study analysed the effects of specially manufactured insoles on foot pressures in diabetic patients during a 1-year prospective observation period. METHODS: We studied 81 type 2 diabetic patients without foot lesions. Using pedobarography three different regions of interest were examined: maximum peak pressure (MPP) of the total foot area, heel region and head of metatarsal bone I-III. Eighteen patients with high risk pressure (MPP of total foot 474 +/- 183 kPa; heel region 278 +/- 147 kPa, metatarsal 389 +/- 222 kPa) received optimal insole support. Sixty-three patients as a control group (MMP of total foot 367.7 +/- 157 kPa; heel 263.1 +/- 127 kPa, metatarsal 339.9 +/- 171 kPa) received conventional footwear. RESULTS: After insole support a 30% pressure reduction of total foot MMP (474 +/- 183 kPa vs. 290 +/- 106 kPa) was achieved in the treatment group. After 6 months (324 +/- 127 kPa) and 1 year (380 +/- 190 kPa) a pressure reduction was found. Between the 6- and 12-month controls plantar pressures again increased. In the control group a significant increase of all peak pressures occurred. CONCLUSIONS: Early insole support is successful in reducing plantar pressure. A repeated adjustment should be performed every 6 months to prevent foot pressure increases. The comparison of foot pressure development between the two groups showed constant levels in the treatment group. In the control group a marked increase of the pressure values was found. Identification and subsequent support of patients with high ulceration risk may help to reduce the high amputation rate.

Aged↗
PubMed2001

[Diskography findings and results of percutaneous laser disk decompression (PLDD)].

AIM: The aim of our study was to find a correlation between discographic findings and the clinical outcome of patients treated by PLDD. METHOD: At our clinic a total of 444 patients was treated by PLDD from 1992 until 1998. Of these, 100 patients were included into this study by chance. All patients had discography. We analysed the discographic results and correlated them with the objective and subjective outcome after PLDD. RESULTS: Best clinical results were found in the group of discographic stages 7 and 8 according to Krämer. In cases of epidural leak of contrast medium and in cases of total degeneration, the clinical results were significantly poor (stages 6 and 9). CONCLUSION: In cases of ruptured posterior longitudinal ligament, i.e., epidural leak of contrast medium in discography, PLDD is not indicated. The indication for an operation first of all depends on the clinical symptoms but the success of the operation depends on the discographic findings.

Adult↗
PubMed2001

[Significance and incidence of type II heparin-induced thrombocytopenia. A prospective study].

AIM: The incidence of heparin-induced thrombocytopenia (HIT type II) as a consequence of postoperative thrombosis prophylaxis after hip or knee prosthesis was investigated in this study. Furthermore the platelets count was postoperatively analysed in patients without HIT II. PATIENTS AND METHODS: Patients with knee and hip prosthesis were included in a prospective study during an 8 months period. All patients received 3 x 5,000 Liquemin (Hoffmann-LaRoche) from the day of the operation until discharge. In cases with a platelet count drop of more than 40% and in patients with clinically manifest thrombosis or embolism a HIT type II test was initiated. RESULTS: 5 of 252 patients included in this study developed a HIT type II. The platelet count drop was on average 65.7% (40.9-81.6). One patient died of a lung embolism (lethality 20%). Four patients were treated with Hirudin and 1 patient with Danaproid-Natrium. There was no drop of the platelet count between the 5th and 7th postoperative day of more than 15% in the other patients without HIT type II. CONCLUSION: In operative departments not enough attention is paid to HIT type II. Knowing the risks with an appropriate monitoring HIT type II can be early detected. Under these conditions the advantages of a heparin prophylaxis outweigh the risk of developing a HIT type II with it's life threatening sequelae.

Aged↗
PubMed2001

[Value of ultrasound in diagnosis of bursopathies in the area of the Achilles tendon].

AIM: The goal of this study was to check the usefulness of ultrasonography as a diagnostic tool for a bursitis in the area of the Achilles tendon. Furthermore, we assessed the shape and size of the retrocalcaneal bursa of normal subjects. METHOD: The ultrasonograms of 28 patients with a bursitis at the Achilles tendon were analysed. In addition, we sonographically examined the region of interest in 10 normal subjects (20 Achilles tendons). We used a 5 and/or a 7.5 MHz linear transducer. The examination was done in both standard planes. RESULTS: The examination of 10 normal subjects could not reliably demonstrate a bursa in the expected location of the subachillic bursa or the subcutaneous calcaneal bursa in a single case. We could, however, depict a subachillic bursitis (echofree to hypoechoic) in 22 patients. A subcutaneous calcaneal bursitis was found in 7 cases. CONCLUSIONS: The retrocalcaneal and subcutaneous calcaneal bursa is not demonstrable by ultrasonography in healthy people. Exsudation and proliferation of the bursa, however, facilitate the detection by ultrasound. Taking that into consideration, the sign of the bursitis is not the enlargement but the fact that the bursa is demonstrable at all by ultrasonography. In the case of the peritendinitis of the achilles tendon a concurrent bursitis should be looked for. During operative explorations an existing bursitis has to be removed. Ultrasonography is the method of choice for the diagnostic evaluation of a bursitis in the area of the achilles tendon.

Achilles Tendon↗
PubMed2001

[Ultrasonography of the Osgood-Schlatter disease].

AIM: The aim of our study was to asses the value of ultrasound in the diagnosis of M. Osgood-Schlatter. The results of the primary ultrasound examination were compared with the use of X-ray. METHOD: 15 patients were included in our study (average age 11 - 17 years, 8 female, 7male). All patients get an X-ray of the knee in two or three images. There was a reference-group of 10 patients with 20 joints (average age 11 - 14 years). RESULTS: We observed typical sonographic images in different stages of M. Osgood-Schlatter. The changes depended on the duration of the disease. In every case we found a thickness of the patellar tendon of more than 1 mm (stage I and II), a bursitis infrapatellaris (stage II) and a fragmentation of the cortical bone of the apophysis (stage II). In cases of stage III disease a thickness of the patellar tendon of less than 1 mm was to be seen. In healthy people the average thickness of the patella tendon was 4.8 mm (3.5 - 5.7 mm). The maximal difference between the left and the right side was 0.4 mm. CONCLUSIONS: With the use ultrasound in cases of M. Osgood-Schlatter a reduced exposure of children to X-ray is possible. Ultrasound examination is a clear and easy way to diagnose the disease correctly and evaluate its course and cure.

Adolescent↗
PubMed2001

Comparative investigations on COD-removal in sequencing batch reactors and continuous flow plants.

Investigations on enhanced COD removal from municipal wastewater were performed over a period of 2.5 years, comparing three different types of reactor. The main idea was to determine the influence of the mixing characteristics of the reactor on the treatment processes and the effluent quality. Therefore three pilot plants (a completely mixed reactor, a cascade of three reactors and a SBR) were operated under equal conditions (wastewater, hydraulic load, temperature, sludge age) in parallel to each other. Investigations were carried out at different sludge ages. It could be shown that within one sludge age the CODf removal efficiency increased, when mixing characteristics came closer to the plug flow and it also increased with higher temperatures. A significant correlation was observed between the COD removal efficiency and the sludge load. The higher the sludge load was the greater the CODf concentration in the effluent. Especially the SBR reactor showed an excellent performance under the given operating conditions. Dynamic simulation calculations were carried out, to investigate whether the influence of the type of reactor on the COD-elimination could be described theoretically by combining growth kinetics and the mixing characteristics of the individual reactors. The results showed that performance was better when mixing characteristics came closer to plug flow.

Biometry↗
PubMed2000

Vertebral collapse and normal peripheral blood cell count at the onset of acute lymphatic leukemia in childhood.

Acute lymphatic leukemia presenting with bone pain and spine involvement is a recognized clinicopathologic complex that can mimic a wide range of orthopaedic conditions. Bone pain as the presenting complaint is common, with a reported incidence of 27% to 50%. Radiologic abnormalities associated with leukemia in children has been described previously. In the literature, the incidence of spinal involvement is controversial, but there is agreement that the spine is less commonly involved than are the long bones. At the onset of the disease, only 10% of children have normal peripheral blood counts. If the patient has spinal involvement and a normal leukocyte count, the diagnosis is often unclear. Only three of these patients have been described in the literature; this article adds one more patient with acute lymphatic leukemia with back pain as the main symptom, vertebral collapse, and a normal peripheral blood cell count at the time of initial presentation. It illustrates that delay in diagnosis frequently occurs, with the classic features of the disease being uniformly absent.

Blood Cell Count↗
PubMed2000

[Autologous lateral patellar transplant as a reserve method for managing large osteochondral defects of the knee joint in young adults].

Between 1995 and 1997, five patients were operated on with a large osteochondral defect of the femoral condyle using the lateral third of the patella. The age of the four male and one female ranged from 18 to 23 years. Initially all of them suffered from an osteochondrosis dissecans which was located at the typical site on the medial condyle of the femur, in the maximal weight bearing region. The follow-up study was 14 to 35 months and showed an improvement from 35 points preoperatively to 89 points postoperatively based on the Cincinnati knee score. All patients returned to there previous profession as well as mild sports activity. The postoperative examination did not show any retropatellar problems and there were no radiological signs of the femoropatellar joint osteoarthritis. For the operative treatment of large chondral defects at the femoral condyle autologous osteochondral transplantation using the lateral third of the patella seems to be a successful alternative.

Adolescent↗
PubMed1999

[Ultrasonography as a diagnostic tool in cases of quadriceps tendon rupture].

AIM: Determination of the reliability of ultrasonography as a diagnostic tool for rupture of the quadriceps tendon and for follow-up after surgical repair. METHOD: 11 patients (12 tendons) with a clinical suspicion of quadriceps tendon rupture were studied with ultrasonography in two planes. RESULTS: In 9 cases we were able to confirm the results of the clinical examination using ultrasonography. In 2 cases we did not find a rupture of the quadriceps tendons ultrasonographically. Within the postoperative follow-up, the homogeneity and echogeneity normalised after the sixth week. CONCLUSION: Using ultrasonography we are able to clearly diagnose ruptures of the quadriceps tendon and objectively assess the postoperative follow-up.

Adult↗
PubMed1999

[Diagnostic ultrasonography of the sternoclavicular joint].

PURPOSE: To evaluate the value of ultrasonography in the diagnosis of swelling and lesions of the sternoclavicular joint (SCG). MATERIAL AND METHODS: We analysed the sonograms of 20 SCG of 18 patients with pain and swelling of the SCG. Ultrasonography was performed just after the clinical examination, using a 7.5 MHz linear scanner. RESULTS: All examinations of the SCG produced distinct and clear sonographical findings. We showed that luxations of the SCG as well as tumors and local inflammation can be identified. CONCLUSION: Ultrasonographic examination is a noninvasive, time sparing and economical diagnostic tool for clarifying the differential diagnosis of lesions of the SCG and establish may a therapy regimen.

Diagnosis, Differential↗
PubMed1999

[Bilateral and simultaneous quadriceps tendon rupture in secondary hyperparathyroidism. A case report].

A case of bilateral simultaneous rupture of the quadriceps tendon without significant trauma is presented. Generally there is an association with chronic metabolic disorders, such as chronic renal failure and secondary hyperparathyreoidism, as well as hormonal diseases. The ruptures appeared in a 34-year-old man with chronic renal failure and severe secondary hyperparathyreoidism. Etiology, diagnostic procedures and treatment in comparison with the international literature are described. We discuss the value of ultrasound screening as a diagnostical and follow-up tool.

Adult↗
PubMed1997

[Ultrasound findings of the patellar tendon and its insertion sites].

PURPOSE: To examine the use of ultrasonography in the diagnosis of soft tissue lesions in and around the patellar tendon. MATERIAL AND METHODS: We analysed the sonograms of 87 patients with knee pain and patellar tendon lesions after clinical observation. We used a 7.5 MHz linear scanner. In cases of bone lesions, a roentgenologic examination was performed. RESULTS: The visualisation of pathologic findings of the patellar tendon such as focal or generalised thickenings, calcifications as well as partial or total ruptures is possible with ultrasound. We could classify six different sonopathologic stages of the jumper's knee syndrome. In addition patellar bursitis and aseptic necrosis of the patella and tibial tuberosity can be identified. CONCLUSIONS: Ultrasound examination is a noninvasive, time sparing and economical diagnostic tool to evaluate chronic patellar tendinitis, to plan therapy and to objectively assess the results of treatment.

Athletic Injuries↗
PubMed1987

[Quantitative studies of the elimination of Salmonellae by biological wastewater treatment].

The wastewater pretreatment plant of Braunschweig works as a conventional, one step activated sludge plant without primary settling tanks. There were about 37,000 m3 per day of effluent during our investigations. During some months daily quantitative determinations of salmonellae were performed in the raw wastewater, in the activated sludge, and in the effluent. The mean concentrations of salmonellae were in the raw wastewater 2 X 10(5)/l and in the effluent after 11h of aeration and then settling 2 X 10(4) cells/l. The concentrations of salmonellae varied about the factor 10(3) (limits 10(2) to 10(5)). A small peak in the spring, a big peak in the late summer, and a week pattern were observed. The most salmonellae were adsorbed to unsoluble flocs of sludge, about 30-35% of the salmonellae only were found freely in the water and from that about 60% were concentrated round the flocs. Therefore, one step of settling removes about 90% of all salmonellae. In generally terms, the settling seems to be the most important step of removal of salmonellae from wastewater. Furthermore, the rate of removal is depending of the concentration. High concentrations of salmonellae cause a strong reduction and conversely. An immediate removal of salmonellae was observed in about 60%, however, there was a propagation of salmonellae in 30% of all samples, especially under conditions of low aeration, in an anaerobic environment, respectively.

Abattoirs↗
PubMedDate not supplied

[First experience of intraoperative nerve root monitoring with the INS-1-device on the lumbosacral spine].

AIM: The goal of intraoperative nerve root monitoring on the lumbosacral spine is to minimize the risk of nerve root injuries during surgery by reducing the incidence of misplaced pedicle screws. In this study we hypothesized that the INS-1 device (Nuvasive) may provide more accurate information about screw placement. METHOD: The INS-1 device provides a means for intraoperative EMG stimulation through the inside of the pedicles or the implanted screws. The readings from relevant muscles serve as a monitoring technique to detect perforated pedicles and thus can be used to prevent or detect misplaced pedicle screws and reduce the risk of nerve root injuries. We controlled 58 patients with 334 implanted pedicle screws. RESULTS: Our first experience with 334 pedicle screws shows that nerve root injuries can be avoided by reducing the number of misplaced pedicle screws through additional intraoperative information gained by the INS-1 device. Thus we corrected 3.9 % of screws intraoperatively in cases without relevant information from fluoroscopic control. CONCLUSION: The INS-1 device is a helpful tool to obtain additional information on misplaced pedicle drill holes or already implanted screws in the lumbosacral spine.

Adult↗
PubMedDate not supplied

[The congenital dislocation of the hip joint in ultrasound examination--frequency, diagnosis and treatment].

BACKGROUND: A real congenital dislocation of the hip joint is very rare. Because of the severeness of the disease an immediate diagnosis and begin of treatment is required. PATIENTS: Between 1984 and 1995 clinical and sonographic screening examinations at 4177 newborns were performed at our hospital. METHODS: We analyzed our patients retrospectively and found out all cases of congenital dislocation of the hip joint. All these cases were classified and the results of treatment were determined. The clinical success of our strategy of treatment was described. RESULTS: Among the 4177 observed newborns 39 cases of congenital dislocation of the hip joint in 27 children were found. We diagnosed the hip type IIIa, IIIb and IV according to Graf in 28.2 and 9 cases respectively. After 12 month a complete healing rate of 95 percent was exhibited with the functional management strategy. Five percent of the affected joints showed a residual dysplasia. The rate of residual dysplasias was 2.5%. CONCLUSIONS: The good prognosis after our early treatment strategy severe congenital dislocation of the hip joint underlines the use of earliest therapy together with a hip screening program.

Germany↗