PubMed Health⌕ Search

Biomedical subjects

S Andereya

Publications and source records attributed to S Andereya.

14 recordsLinked to original sources
PubMed2006

[Surgical management of spondylodiscitis. An analysis of 78 cases].

Spondylodiscitis is a rare bacterial infection of the spine with an inflammatory, destructive course. To obtain further information on the therapeutic management and clinical course of spondylodiscitis, we retrospectively investigated 78 patients after surgical intervention. Mean age was 64 years (+/-4.6 years; range 21-80 years), the mean length of stay 49 days (+/-8.2 days; 3-121 days) including 24 days (+/-4.7 days; 0-112 days) in ICU. In hospital mortality was 9%. The cervical spine was affected in 10%, the thoracic spine in 35% and the lumbar/sacral spine in 55% of patients. Abscess formation occurred in 65% and destruction of the vertebral body in 74%. A total of 75% of patients presented with neurological deficits which could be improved by surgical intervention in 82% of cases. 24 patients were treated by ventral debridement and stabilization alone, 20 patients with a combined dorsoventral method. Most patients (n=34) were stabilized via dorsal bridging instrumentation without ventral debridement of the focus. Of this group, 23 patients were initially scheduled for secondary ventral debridement but complete healing was achieved prior to this, so further surgical therapy was unnecessary. Successful cure was obtained in 92% of cases. Based on our findings, we favor a split surgical approach: initially with dorsal internal fixation only. Abscesses can be drained percutaneously. Ventral debridement and stabilization is only recommended if insufficient stability can be obtained by dorsal fixation alone, as shown by the persistence of infection or pain.

Adult↗
PubMed2006

[Liver laceration following a kick in a soccer game].

Severe intraabdominal injuries in soccer are very rare. We present the case of an 18 year old soccer player who suffered from a grad IV liver laceration following a kick during a soccer game. After primary explorative laparatomy and liver packing in a hospital nearby the patient was transferred to our clinic. Following CT scan the injury was treated by suture of liver parencym lacerations, argon laser coagulation and pile duct repair. In soccer severe intraabdominal injuries should be expected following players collision at high velocity or kicking with the foot or the knee.

Adolescent↗
PubMed2005

Comparison of modern marker proteins in serum and synovial fluid in patients with advanced osteoarthrosis and rheumatoid arthritis.

Numerous studies have focused on the significance of modern marker proteins in the synovial fluid of the knee joint and in the serum both, for osteoarthritis (OA) and rheumatoid arthritis (RA). The relationship between the serum concentrations and the concentrations in the synovial fluid is still unclear. Synovial fluid and serum samples were obtained from 13 patients with advanced OA and from 8 patients with severe RA and concentrations of MMP-1, MMP-3, MMP-13, TIMP-1, COMP and MIA/CD-RAP were determined. All values were normalized against the total protein concentrations. Serum concentrations of MMP-13 in the RA-group were statistically higher than the synovial values (P<0.05). MMP-13 was the only marker protein that revealed distinct higher levels in the serum than in the synovial fluid. The study design allows only conclusions about advanced stages of RA and OA. Longitudinal investigations may provide further information about the value of MMP-13 as a potential marker to monitor the course of RA and OA.

Aged↗
PubMed2003

Reactive knee and ankle joint arthritis: abnormal manifestation of Legionella pneumophila.

This case report demonstrates that active legionellosis is not always characterised by pulmonary symptoms and specific radiomorphological findings. Whereas the initial clinical presentation, as described in the literature, includes fever, cough, expectoration, extrapulmonary organ changes or typical laboratory findings, atypical manifestations such as reactive arthritis must be considered.

Adult↗
PubMed2003

[Serious complication after subcutaneous injection of heparin for prophylaxis of thromboembolism. Case report].

Subcutaneous application of low-dose heparin before and after surgery is a routine procedure to avoid thromboembolic complications. Advances in development of anticoagulants, reduction of intervals between applications, modern injection tools,and training of the personnel have already reduced the incidence of severe complications. However, the case presented shows impressively that a life-threatening complication is still possible and has to be kept in mind in perioperative thrombosis prophylaxis. After postoperative subcutaneous injection of low-dose-heparin in the right lower abdominal wall, a 76-year-old female patient suffered from an extensive,hemodynamically active hematoma located in the M.rectus abdominis as a sequela of perforating the A. epigastrica superficialis. Consequently hypovolemic shock led to cardiopulmonary circulatory arrest. After immediate resuscitation, surgical hemostasis was performed and the hematoma was removed. Post-interventional stabilization of circulation and wound healing were trouble free.

Aged↗
PubMed2003

[Sigmoid colon perforation with local peritonitis caused by indirect trauma--case report and review of the literature].

Injuries to the sigmoid occur either as acute or protracted events. In the first case, enteral contents discharge into the abdominal cavity and a generalized, fecal, life-threatening peritonitis with a bad prognosis develops. In the protracted form, the rupture is covered by peritoneum and adherent organs before perforation. The ensuing abscess formation may lead to perforation into contiguous visceral organs or the cutis. Frequently an intestinal or cutaneous fistula results. The trigger for a sigmoid perforation can be a spontaneous rupture in an already vulnerable intestine. Common precursory diseases are diverticulitis, colitis, carcinomas, and necroses. Also, elevated intestinal pressure invoked by increased bearing down or coproliths may cause disruption. Diagnostic procedures such as rectoscopy and rectal contrast instillation are frequent idiopathic causes of traumatic injuries to the sigmoid. Perforating injuries of the abdominal cavity by stabbing, gunshot, or impalement may affect the sigmoid and open its lumen. Foreign bodies often lead to traumatic injuries of the rectosigmoid junction. In contrast, indirect trauma as a cause of sigmoid perforation, which is described in the following case, is very rare. A 62-year-old woman,who had a cholecystectomy and adhesive strangulation of intestine in her history, was admitted to our clinic after falling down stairs and landing on her bottom. She suffered a sigmoid rupture and peritonitis. Laparotomy and suturing of the sigmoid defect were performed.

Accidental Falls↗
PubMed2002

[Coracoid pseudarthrosis caused by anterior shoulder dislocation with concomitant coracoid fracture].

Fractures of the coracoid process are rare and represent only 2-5% of all fractures of the scapula. The most frequent cause of a coracoid fracture is direct trauma, but indirect trauma may also lead to a fracture of this kind. Avulsion injuries as part of an acromioclavicular dislocation are the most frequent forms of trauma. For the rare cases of an anterior shoulder dislocation with concomitant coracoid fracture, two different mechanism are discussed. One cause of the coracoid fracture could be direct impact of the dislocated head of the humerus on the coracoid process, another may be the occurrence of a sudden strong pull of the muscles inserting at the coracoid process during shoulder dislocation.In the majority of cases, conservative treatment with six weeks of immobilization is appropriate. If a pseudarthrosis occurs and there is persistent pain, we recommend the operative fixation of the distal coracoid fragment by insertion of cancellous bone graft taken from the iliac crest and stabilization with a cannulated AO titanium small fragment screw and PDS cord.

Adult↗
PubMed2001

[Value of human recombinant osteogenetic proteins as bone replacement materials in lumbar spondylodesis. Results of an animal experiment study].

Up to now autologous spongiosa may be considered as the golden standard for the filling up of bone defects. Because of the limited quantity, complications at the extraction place and the increasing problems concerning infections when using homologous spongiosa the development of various bone replacement materials was intensified during the last years. The development of various osteogenetic proteins as well as experimental studies using these proteins represent a main point in science at present. It is expected that these substances will lead to a qualitative improvement and increase of bone healing. In the presented study influence of various osteogenetic substances to bone regeneration was examined at 30 breeding sheep after a ventral spine fusion of the segment L4/L5 by a dorsal approach. Bone defect filling was realized at each 10 animals with autologous spongiosa, Bio-Oss as well as the osteogenetic protein 1 (OP-1). To evaluate the progress and outcome of the segmental fusion during a post-operative period of 24 weeks x-ray controls were performed. In the 24th postoperative week after euthanasia of the experimental animals x-ray controls as well as computed and magnetic resonance tomographies were carried out. The results of 26 experimental animals could be analysed. The results were evaluated according to the criterias of an own score-system. Compared with autologous spongiosa OP-1 as a biomaterial for the fusion of spine-sections led to favorable radiologic results because of higher score values concerning the capability of fusion. Our experiences with Bio-Oss demonstrated lower osteogenetic potency after defect filling with this substance. Therefore we cannot recommend Bio-Oss as filling material for the fusion in spine surgery.

Animals↗
PubMedDate not supplied

[The cement-free modular revision prosthesis MRP-hip revision stem prosthesis in clinical follow-up].

INTRODUCTION: We present prospective medium-term results of the modular revision prostheses "MRP-TITANIUM". MATERIAL AND METHODS: 45 patients (n = 48 prostheses) were evaluated. The mean follow-up was 4.7 years (min.-max.: 1.0-9.0 years). Pre- and postoperatively the Harris hip score (differentiated to Paprosky I-III) was examined. 66.67 % of the cases had extensive bony defects (> or = Paprosky II b). By means of X-ray examinations, the stability of the prostheses, periprosthetic bone remodelling, the presence of radiolucent lines as well as bone defect regeneration were assessed postoperatively. RESULTS: The mean Harris hip score improved from 25.6 preoperative to 71.4 postoperative (p < or = 0.05). In 44 cases the X-ray showed stable fixation without secondary migration. In one case the stem (stand time 2.36 years) was revised due to secondary migration (> or = 5 mm). The survival rate (Kaplan-Meier) was 97 %. Bone transplantation with consecutive defect regeneration was (n = 30) complete in all cases. In six cases (12.5 %) a postoperative dislocation occurred with subsequent successful closed reposition four times (8.3 %). In two cases (4.2 %) an open reposition was done with correction of the antetorsion angle of the prostheses. CONCLUSION: The "MRP-TITANIUM modular revision prostheses" has proved to be reliable in cases of revision surgery with extensive bony defects. The failure rate was 2.1 % for 48 prospectively examined prostheses.

Aged↗
PubMedDate not supplied

[Meniscus replacement: current aspects in the field of tissue engineering].

Tissue engineering offers new opportunities for meniscus repair and replacement. In this field different approaches are being studied to genererate a meniscus subsitute by a combination of a matrix scaffold, cells and specific stimuli. MENISCUS REPLACEMENT BY ACELLUAR MATRICES: For meniscus replacement the matrix material has to meet high biomechanical demands. Besides implant geometry, the material properties and a secure intraarticular attachment are important preconditions for implant function. A collagen scaffold has already been applied clinically for partial meniscus replacement. Scaffolds made of synthetic, bioabsorbable polymers and small intestine submucosa have been employed in animal studies. Following implantation, matrices are invaded by cells and undergo a process of remodeling. Formation of fibrocartilage repair tissue has been observerd. The biomechanical quality of implants and their effect on cartilage preservation have to be studied further. CELLULAR SEEDING OF MATRICES FOR MENSICUS REPLACEMENT: Advanced biological and biomechanical implant quality might be achieved by seeding matrices with cells in vitro. However, the ideal type of cell for this purpose has not yet been identified. Autologous mensicus cells, articular chondrocytes and mesenchymal stem cells represent possible cellular sources. Additional stimuli, such as cytokines and mechanical forces, and techniques of genetic engineering might further contribute to enhance the quality of engineered tissue.

Biocompatible Materials↗
PubMedDate not supplied

[What factors influence the results of ACT when the indication limits are exceeded?].

AIM: The present study evaluates the results of ACT at the knee joint with transgression of the usual spectrum of indications and points out the possible limits of the method. METHODS: In 20 of a total of 71 patients the indication limits of ACT were exceeded. The clinical follow-up over two years was related to the localisation, size, adjacent cartilage, previous and additional operations and the quality of the transplanted chondrocytes. RESULTS: The average patient age at time of operation was 41.1 years (24 to 55 years). The average defect size was 7.9 cm (2) (3.75 to 14 cm (2)). In the analysed group outside of the indication limits of ACT half of the patients showed good or excellent results at clinical follow-up after 2 years. 10 patients, however, assessed the clinical situation as fair or poor. Within this group 5 patients showed a minimum of two lesions. In 6 patients the treated defect was not completely surrounded by an adjacent cartilage shoulder. In 7 cases the meniscus at the site of the lesion had been partially removed in a previous operation and osteoarthrosis or kissing lesions were detected in 4 cases. The persistent good cell quality had no negative influence on the postoperative results. CONCLUSION: The results after ACT are influenced by the adjacent cartilage shoulder, kissing lesions, previous meniscectomy and osteoarthrosis. This may limit the indications of the method.

Adult↗
PubMedDate not supplied

[First clinical experiences with a novel 3D-collagen gel (CaReS) for the treatment of focal cartilage defects in the knee].

AIM: In this prospective study we present a novel technique of matrix-based chondrocyte transplantation for the treatment of focal cartilage defects. METHOD: 22 patients with chondral or osteochondral femoral defects were treated with 3D-collagen type-I gel seeded with autologous chondrocytes (CaReS). Overall handling of this novel method is described, and results after 2 years follow-up with regard to the ICRS-score are presented. RESULTS: 14 patients were treated because of a focal chondral lesion, in 8 cases subchondral bone had to be reestablished. The average defect size was 6 cm(2). In all cases cell-seeded matrix samples could be fixed with fibrin glue without any problems. The average surgery time was 69 min, length of the surgical approach was 8.2 cm. No surgery-specific problems had to be observed. A significant improvement in IKDC-score, functional score and overall rating after 3 or 6 months up to 2 years follow-up was detected. After 2 years post-OP 13 Patients were evaluated and matrix-based defect treatment by CaReS was rated good to excellent by 84.6 % of the patients. CONCLUSION: Defect treatment with cell-seeded 3D-collagen gel is easy to handle with a good clinical outcome after 2 years follow-up. Further investigations with higher patient number, longer follow-up time and histological and biomechanical sample analysis are needed in order to establish this method as an improvement of conventional ACT.

Adolescent↗
PubMedDate not supplied

[Cemented total knee arthroplasties].

INTRODUCTION: The aseptic loosening of cemented total knee arthroplasties is still an unsolved problem. In this regard, the hydrolysis resistance in the metal-to-bone cement interface is of major importance. MATERIAL AND METHODS: Cemented pre-treated tibia components coated by means of a silica/silane interlayer system of the model "Columbus PS" were dynamically loaded with the help of a knee-simulator similar to DIN ISO 14243. After loading, the components were microscopically analysed concerning debonding in the metal-to-bone cement interface as well as with regard to cement mantle defects. These data were matched with uncoated "Columbus PS" components. Unloaded coated and uncoated tibia components acted as a control. RESULTS: In comparison with uncoated tibia components, the pre-treated and coated ones yielded a highly significant reduction of cement defects (p < 0.01) as well as a significant reduction of debonding in the metal-to-bone cement interface (p < 0.05). CONCLUSION: By means of the silica/silane interlayer system for cemented tibia components, a hydrolytic debonding in the metal-to-bone cement interface with subsequent mechanical loosening and consecutive early cement mantle failure can be significantly reduced. This could lead to an increased long-term stability of the metal-to-bone cement compound with decreased aseptic loosening in clinical use.

Adhesiveness↗