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Biomedical subjects

S Klima

Publications and source records attributed to S Klima.

14 recordsLinked to original sources
PubMed2006

[Reconstruction of the ligamentum cruciatum anterius during the performance of unicondylar knee arthroplasty by minimally invasive surgery. A salvage procedure for monocondylar arthrosis and downfall of the anterior cruciate ligament].

Opinions differ on unicompartmental knee replacement for treatment of unicompartmental ostearthritis of the knee. There is general agreement that well-functioning cruciate ligaments are necessary if use of this prosthesis is to be successful. Especially for younger people who are still working and who have advanced medial arthritis and lacking or inadequate anterior cruciate ligament, this therapy has its limitations. To exploit the advantages of unicondylar replacement in such patients, we combined this joint replacement operation with reconstruction of the anterior cruciate ligament using the semitendinosus/gracilis tendon and applying a transfix technique in 7 cases. The mean Knee Society Score was recorded preoperatively and after 12 and 28 months of follow-up. Long-term results are not yet available, but after this operation method average Knee Society Scores of 164.1 were recorded at 28 months, and all these patients were able to return to work after their rehabilitation. Thus, the short-term follow-up documents the efficacity of the treatment and benefit to the patients.

Anterior Cruciate Ligament↗
PubMed2005

[Multimedia preoperative patient information].

Due to heavy workloads and shortage of staff, doctors often find it difficult to explain operations to their patients with the legally required detail and timing (in Germany, 24 h preop). This is however mandatory for obtaining informed consent. We developed a computer program that generates films explaining 24 common orthopedic operations and blood transfusion. They explain the operation, early postoperative phase, and benefits and risks to the patient. At our clinic, this program is used in daily routine and precedes the actual doctor-patient conversation for informed consent. We asked 300 patients about their satisfaction with the newly developed program. The multimedia presentation gives the patient more time, enough detail and clarity, and the chance to repeat parts of the film. For the doctor, it saves time. The time gap required in Germany between explanation and operation is thus easily adhered to. In case of legal problems, the film can be used for evidence. The use of this multimedia presentation to help in getting informed consent is improving workflow considerably.

Computer-Assisted Instruction↗
PubMed2000

Correcting tritium concentrations in water vapor monitored with silica gel.

A correction is needed to calculate the activity concentration of airborne tritium oxide when dried silica gel is used as the collector. A tracer study using tritiated water with silica gel showed that the concentration of tritium in desorbed water is lower than that in adsorbed water by a fraction that increases with the amount of adsorbed water. The hypothesis was tested that adsorbed tritiated water is diluted by isotopic exchange with both non-tritiated water and hydroxyl groups within the silica gel matrix. The extent of dilution was measured from 4% to 14% adsorbed water, which is typical of moisture on field collectors for monitoring airborne tritium oxide. For this range of percent adsorbed water, the inferred percent exchangeable water in the silica gel under study was 6.3 +/- 0.1%. This value compares to the silica gel weight loss of 5.3% after heating to 1,050 degrees C. An explanation of the difference between 6.3% and 5.3% is proposed. The contribution of the HTO/H2O vapor pressure isotope effect was considered in calculating isotopic exchange. A curve is presented for correcting the measured tritium concentration in the distillate from the silica gel as a function of the amount of adsorbed water. The tritium tracer procedure is recommended for determining the percent exchangeable water in other silica gels to correct tritium measurements of water vapor collected by them.

Humans↗
PubMed1999

[Results of routine intraoperative cholangiography].

Most bile duct injuries result from an incorrect interpretation of bile duct anatomy. In 500 laparoscopic cholecystectomies we used a modified technique of cholecystcholangiography. This method is very easy and needs only 5 minutes. We found variants of bile duct anatomy in 74 cases and occult bile duct stones in 20 patients. We recommend this method which decreases the risk of bile duct injuries and gives the opportunity to approximate the golden standard of conventional cholecystectomy.

Cholangiography↗
PubMed1998

[Importance of appendix stump management in laparoscopic appendectomy].

In laparoscopic appendectomy several variants of technique have been proposed. In a randomized prospective trial we compared three common techniques: 1. application of two endoloops, 2. application of two endoloops and additional manual stump sinking 3. application of endo-cutter. The study included 150 patients, 50 each per technique. The application of two endoloops with additional manual stump sinking as well as the cutter technique were associated with a low risk for complications. In contrast, appendectomy by two endoloops without stump sinking was associated with a higher risk for local complications. The manual stump sinking requires a high level of manual experience, whereas the cutter technique can be learned rapidly by surgical residents. Therefore, we recommend the cutter technique as standard procedure, because it allows laparoscopic appendectomy to be performed with high reliability by experienced surgeons as well as by novice surgical residents.

Appendectomy↗
PubMed1998

[New aspects of laparoscopic cholangiography].

Cholangiography does not prevent bile duct injury, but if performed properly, it can identify impending injury before hand. We present a modified form of laparoscopic cholecystcholangiography; only 5 min are required to perform this technique. Some 408 consecutive peroperative cholangiographies are analyzed. We recommend this method, which decreases the risk of bile duct injuries, reveals occult bile duct stones in 4.2%, and gives the opportunity to approximate the gold standard of cholecystectomies.

Bile Ducts↗
PubMed1997

[Bile duct injuries in laparoscopic cholecystectomy--assessment of current status].

The laparoscopic technique for cholecystectomy is associated with a increased rate of bile duct injuries. A conscientious preparation, the excessive application of electrocoagulation, anatomical variants and renunciation of cholangiography are reasons for injuries. The technique of operative treatment depends on type, range and location of injury.

Bile Ducts↗
PubMed1996

[Technique and significance of stump management for outcome of laparoscopic appendectomy].

We compared 140 appendectomies in a prospective study with regard to length of operation, stay in hospital and intra- and postoperative complications. We operated by four methods and made up four groups, 35 patients in each: (1) application of RODER-loop and manual stump-sinking; (2) application of RODER-loop without manual stump-sinking; (3) application of Endo-GIA; (4) conventional appendectomy according to McBurney. Intraoperative complications occurred mainly in laparoscopic appendectomy, while disturbances of wound-healing were observed mainly in conventional appendectomy. The analysis of postoperative complications in laparoscopic appendectomy showed the most complications in the second group (RODER-loop without stump-sinking), while using the Endo-GIA involved only a little risk. In a clear situs the laparoscopic appendectomy with the RODER-loop with manual stump-sinking is recommended; in cases with a difficult preparation or advanced appendicitis the application of the Endo-GIA is a safe technique with the best results.

Appendectomy↗
PubMed1989

Effects of short-term hypoxic hypoxia on the sodium and potassium homoeostasis in humans.

The effect of a short-term hypoxic hypoxia on the electrolyte metabolism has by now scarcely examined. Disposable results are not consistent. With the help of ionosensitive electrodes sodium and potassium concentrations in blood, serum, urine, and erythrocytes have been studied before and after a hypoxic hypoxia (PaO2) in healthy subjects. Blood and plasma concentrations of sodium and potassium were unchanged. Natriuria and kaliuresis increased under the hypoxia exposure. Intraerythrocytic potassium concentration decreased significantly. Possible causes and the diagnostic value are discussed.

Altitude↗
PubMedDate not supplied

[Wristing -- a new opportunity in digital migration analysis of uncemented total hip arthroplasty].

AIM: The aim of this study was to evaluate a computer program (Wristing) for digital migration analysis in hip endoprotheses and to assess the most accurate landmarks in hip-alone radiographs. METHOD: Conventional radiographs of 52 patients with a minimum follow-up period of seven years and five consecutive radiographs were digitised and different landmarks were compared. The parameters with the greatest accuracy were analysed to calculate inter- and intra-observer variability in 30 radiographs. Digital and manual measurement techniques were compared with each other. RESULTS: The obtained accuracy (95 % confidence interval) was 1.7 to 2.2 mm and 2.8 degrees to 3.2 degrees for the most accurate landmarks. The intra-observer variability was 0.12-0.3 mm; 0.28 degrees and the inter-observer variability ranged from 0.14 to 0.45 mm and 0.5 degrees to 0.53 degrees . In comparison to the migration measurement with pencil and ruler (precision: 0.24-0.67 mm; 0.57-0.74 degrees ) the new software (precision: 0.12-0.3 mm; 0.28 degrees ) was associated with a superior accuracy (t test: p < 0.001). CONCLUSION: With the program "Wristing" migration in hip-alone radiographs could be recorded with high precision. The integrated sketch, zooming and the current possibility of comparing radiographs and patient data with previous follow-ups and examples leads to a high inter- and intra-observer accuracy and is very useful in day-to-day clinical practice.

Acetabulum↗
PubMedDate not supplied

[Osteoporosis--a neglected issue in orthopaedics? Results of a survey amongst German orthopaedic surgeons].

AIM: Patients with fragility fractures have a significantly increased risk of sustaining additional fractures. Therefore one should consider avoidance of further fractures as the primary treatment principle. Since orthopaedic surgeons manage most of fragility fractures, but might not be well attuned to osteoporosis itself, it was the aim of the Bone and Joint Decade (BJD) and the International Osteoporosis Foundation (IOF) to survey orthopaedic surgeons in order to assess their knowledge of prevention, diagnosis, and treatment of osteoporosis. MATERIAL AND METHODS: The multinational survey questionnaire was developed by a working group of national project co-ordinators in France, Germany, Italy, Spain, the United Kingdom, and New Zealand and based to some extent on an American survey. Following translation into the national language it was distributed in 2002 to the members of the orthopaedic societies to assess the management of prevention, diagnosis, and therapy of osteoporosis and fragility fractures, comparing both different health-care systems and different working environments. 5 700 questionnaires were distributed in Germany with a 20 percent response rate. RESULTS: As the main result of the German survey -- independent of the working environment -- a substantial deficit concerning training and knowledge about the management of prevention, diagnosis, and treatment of osteoporosis and fragility fractures was seen. In addition, the majority of participants requested educational opportunities to become qualified for a better disease control. CONCLUSION: In order to satisfy the increasing need for adequate management of prevention, diagnosis, and therapy of osteoporosis and fragility fractures, structured educational opportunities have to be offered to the German orthopaedic community. In the mean time first steps have been initiated: training courses to qualify as "Osteologe DVO" and the "White Book Osteoporosis", which was initiated by BJD and IOF and developed by several German medical societies and patient organisations it is based on the German DVO guidelines providing an evidence-based and structured overview concerning all relevant aspects of osteoporosis and fragility fractures.

Attitude of Health Personnel↗
PubMedDate not supplied

[Revision possibilities after failed unicompartmental knee arthroplasty--an analysis of 116 revisions].

AIM: A major advantage of the unicompartmental knee arthroplasty (UKA) is the quick rehabilitation, small traumatisation of tissue and the mostly uncomplicated revision to a total knee arthroplasty. The aim of the study is to examine whether the conversion to the total endoprosthesis, as is frequently is recommended at present in cases of defect of the sleigh system, is always necessary or whether a revision can have good chances of success with use of the unicondylar system under certain conditions. METHOD: 116 revisions were studied after unicompartmental knee arthroplasty at the first appearance of problems and during the follow-up of 45 months (range: 10-86 months) using the Knee Society Score and analyses of the various additional procedures as well as the anterior cruciate ligament substitute, the correction of slope etc. Revisions, with exchange of components or a conversion to a total arthroplasty, were included. RESULTS: In 60.3 % of all cases a revision could be performed within the unicompartmental knee system, with a mean score of 167.4 (range: 144-173). The outcome score corresponded to the outcome of primary UKA implantations and to conversion operations to total endoprosthesis in the literature (p < 0.05 Wilcoxon test). CONCLUSION: Under critical contemplation of the low case number and this short- to medium-term examination, individual revision solutions seem to have their entitlement within the unicondylar system as also do conversion operations to the TKA. Long-term results and larger case numbers are absolutely necessary prior to further judgment.

Adult↗