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Biomedical subjects

V Vécsei

Publications and source records attributed to V Vécsei.

At least 73 records · Page 4Linked to original sources
PubMed1997

The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique.

A prospective clinical trial from January 1994 to February 1996 evaluated the efficacy of a vacuum sealing technique in dealing with sacral pressure ulcers, acute traumatic soft tissue defects and infected soft tissue defects following rigid stabilization of lower extremity fractures in 45 patients. Polyvinyl foam under negative pressure generates an area of high contact forces at the wound/foam interface. This situation appears to facilitate granulation tissue production while maintaining a relatively clean wound bed. In 84% (38/45) of the patients the use of the vacuum sealing technique following irrigation and debridement decreased the dimensions of the initial wound, thus facilitating healing time and the eradication of any pre-existing infection. Wound closure by granulation, secondary closure, or split thickness skin grafting was achieved in 35 wounds. The vacuum sealing technique is an effective option in the management of infected wounds.

Adult↗
PubMed1997

Occult fractures of the scaphoid. The diagnostic usefulness and indirect economic repercussions of radiography versus magnetic resonance scanning.

Scaphoid fractures that are not visible on initial radiographs are notoriously difficult to diagnose. This prospective study compared four-view plain radiography at an average of 14 days after injury, with high-definition macroradiography and magnetic resonance imaging at presentation. Initial magnetic resonance imaging was superior to repeat scaphoid radiography for the confirmation or exclusion of fractures as well as for the detection of associated wrist injuries. Macroradiography was unsuitable for screening for occult scaphoid fractures.

Adolescent↗
PubMed1997

Diagnosis of lateral ankle ligament injuries. Comparison between talar tilt, MRI and operative findings in 112 athletes.

We evaluated the reliability of the radiographic talar tilt test by MRI examinations in 112 athletes with injuries to the lateral ligaments of the ankle. 25 athletes with a talar tilt > 15 degrees were treated operatively. Intraoperative findings and the talar tilt test were compared with MR imaging results. Our results suggest that MRI is a reliable method for diagnosing injuries of the lateral ankle ligaments. The talar tilt test cannot evaluate the specific pathology of lateral ankle ligaments, but it was reliable in indicating complete double-ligament ruptures (anterior talofibular and calcaneo-fibular ligaments), when talar tilt was 15 degrees or more than on the uninjured side.

Adolescent↗
PubMed1997

[Vienna Shoulder Score (VSS) and Vienna Shoulder Formula (VSF) for follow-up and assessment of shoulder and shoulder girdle injuries].

The Vienna Shoulder Score (VSS) was screened by two groups of patients for use in medical expertises and follow-up examinations. One group (n = 157) consisted of patients with healed clavicular bone fractures, the other group (n = 130) consisted of healthy individuals. The study proved that the VSS is a useful, exact and fast method of shoulder evaluation after injuries to the shoulder and shoulder girdle. The side dominance is of no influence to the outcome of the VSS. The Vienna Shoulder Formula (VSF) helps to equalize the age factor in shoulder examinations.

Activities of Daily Living↗
PubMed1996

[Meniscus lesions after isolated anterior cruciate ligament rupture].

In this retrospective study the meniscal status of 34 patients with untreated complete anterior cruciate ligament (ACL) tears is reported. The anterior cruciate ligament injury was initially documented by examination under anesthesia and arthroscopy. Treatment in all cases consisted of a standard protocol of early rehabilitation and bracing. The mean follow-up was 7.3 years. Twenty-two (65%) patients showed signs of meniscal pathology at an average of 2.5 years after the ACL injury during the follow-up period. Rearthroscopy was performed and showed a higher incidence of medial meniscus tears (53%) than lesions of the lateral meniscus (41%). The most common tear of the medial meniscus was the bucket-handle type, followed by the flap tear and the single longitudinal split of the posterior horn. Secondary reconstruction of the ACL was necessary in 18 patients (82%) complaining of symptoms indicative of permanent anterior instability of the knee. The remaining 4 patients had rearthroscopy 3.5 years after the ACL injury and a partial meniscectomy and ACL reconstruction was performed. 12 patients (35%) had no symptoms or signs of joint instability or meniscal pathology during the follow-up period, but discontinued their sporting activities. This study indicates the increasing incidence of meniscal tears during ACL insufficiency. We recommend that patients with ruptures of the anterior cruciate ligament should be investigated for meniscal tears and that early ligament reconstruction of the knee and meniscal repair or partial meniscectomy should be considered simultaneously.

Adolescent↗
PubMed1996

Load sharing in augmented anterior cruciate ligament repair: a mathematical analysis based on in vitro measurements.

OBJECTIVE: To quantify the stress on a reinserted anterior cruciate ligament (ACL) we studied the load sharing between the ACL and a 3.7 mm polyethylene terephthalate (PET) band in 10 knees of fresh human cadavers. DESIGN: The load sharing between the Marshall sutures-ACL complex and the PET band and between the ACL and the PET band was calculated by means of a mathematical model. BACKGROUND: Augmentation of a reinserted ACL with a synthetic band is an accepted treatment for a ruptured ACL. METHODS: After transsecting the ACL at its femoral origin and reinserting it with four sutures using the Marshall technique we augmented it with the PET band. The augmentation device was inserted by the through-the-condyle (TTC) procedure and attached without preload to the femoral and the tibial condyle with 4 mm staples. Then the length of the ACL, the lengths of the Marshall sutures, the partial lengths and the angles between the different directions, and the adherence-friction force of the PET band were measured. RESULTS: In the beginning the Marshall sutures-ACL complex takes over 40% of an externally applied load and the PET band 60%. After the hypothetical ACL healing phase the PET band takes over 27% and the ACL 73% of the load. CONCLUSIONS: An external force of 40 N acting on the knee will therefore lead to an elongation of the Marshall sutures-ACL complex and result in movement of the proximal end of the ACL away from the femoral condyle of at least 0.5 mm, which is highly undesirable in the early postoperative healing phase.

Journal Article↗
PubMed1996

Tracheobronchial ruptures in children.

Tracheobronchial ruptures in children after blunt trauma are rare, with an incidence at our clinic of 0.17% of juvenile thoracic injuries in the years 1985 to 1994. The symptoms are variable, and these injuries frequently occur in conjunction with other thoracic injuries, leading to delays in diagnosis. Diagnosis, conservative and operative treatment, and late complications are discussed by presenting four different cases of children with lesions of the tracheobronchial tree after blunt trauma.

Adolescent↗
PubMed1996

Anterior instability of the knee despite an intensive rehabilitation program.

To investigate if an intensive rehabilitation program has a positive influence on the late course of an old, isolated anterior cruciate ligament rupture, patients were evaluated at an average of 8 years after injury. Seventy-five percent had acquired the injury during sporting activities. After diagnostic arthroscopy, which was done at an average of 163 days after the injury, the patients immediately were assigned to an intensive rehabilitation program. At the followup examination, none of the patients had an excellent result as determined by the Swiss Knee Group Score; 6 patients had a good result; 13 had a fair result; and 8 had a bad result. Fourteen patients had a partial meniscectomy during the followup period, and 4 had positive signs for meniscal lesions at the followup examination. In 52% of the patients gonarthrosis had advanced 2 stages, and in 26% it had advanced 3 stages. There was a significant correlation between worsening of gonarthrosis and previous meniscectomy, poor evaluation scores, and clinical signs of instability. Even an intensive rehabilitation program cannot prevent secondary lesions of the meniscus with ensuing joint degeneration. Thus, immediate operative reconstruction of old ruptured anterior cruciate ligaments is recommended.

Adolescent↗
PubMed1996

Magnetic resonance imaging of occult scaphoid fractures.

Occult fractures of the scaphoid bone occur frequently and may lead to nonunions. In a prospective blind study, we performed magnetic resonance imaging (MRI) examinations on 32 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected, but could not be confirmed on the original set of two routine and four scaphoid view radiographs. The MRI examinations were performed an average time of 2.8 days after the trauma. This prospective study proved that MRI is able to diagnose occult scaphoid fractures without delay and without the use of radioactive diagnostic means. Sensitivity and specificity of MRI were 100%. This conventional method could save $7,200 (US) per 100,000 inhabitants in providing an immediate and correct diagnosis and avoiding unnecessary cast immobilization. Additional injuries that may be misdiagnosed by conventional radiographs are also detected with a specificity and sensitivity of 100%.

Adolescent↗
PubMed1996

[Biocompatibility of polyethylene terephthalate--PET--(Trevira strong)--an in vivo study of the sheep knee].

The anterior cruciate ligament was transected at the femoral origin in the right stifle joint of 25 sheep. The ligaments were re-inserted using the Marshall technique, and reinforced with a 3 mm band made of polyethylene terephthalate--PET--(Trevira hochfest) using the through-the-condyle (TTC) procedure, and re-attached--with a preload of 20 N--to the femoral and tibial condyle with two 4 mm staples. To assess the biocompatibility of the augmentation band, the synovial fluid was analysed for total protein and glucose concentration 2, 6, 24, and 56 weeks after implantation, and a total and differential cell count performed. No significant differences were found before and after implantation of the PET band. No pathological increase in the total protein concentration occurred after implantation (normal range: > 3.0 g/dl), and no significant differences vs. the preoperative analysis were found. No synovitis-signalling decrease in the glucose concentration (normal range: > 40 mg/dl) was observed. The preoperative glucose concentration of 87 +/- 12.84 mg/dl showed no significant difference from the postoperative concentration of 95 +/- 13.58 mg/dl. The cytological examination revealed no increase in the leucocyte counts (normal range: 3 leucocytes/HPF). Neither free nor phagocytosed wear particles were seen.

Animals↗
PubMed1996

[Traumatic rupture of the inferior thyroid artery].

We report a rare case of traumatic aneurysma of the inferior thyroid artery, which occurred after a minor life-threatening trauma. The lesion was diagnosed during an angiographical examination, performed because of hemodynamic instability of the patient. For therapy, the lesion was ligated and excised.

Aneurysm, False↗
PubMed1996

[Borderline indications for locked intramedullary nailing of femur and tibia].

The borderline indications of locked intramedullary nailing of the femur and the tibia, based on Küntscher nailing, are defined by the location of the fracture, the associated soft tissue injury, the appearance of infection and the patient's pulmonary status. From 1975 to 1995 at the Department of Traumatology, Vienna University School of Medicine, 551 patients with 559 femoral fractures and 536 patients with 548 tibial fractures were stabilized using locked intramedullary nailing. A total of 135 (24%) proximal femoral fractures were stabilized using intramedullary locking nails in 54 cases, and using long gamma nails in 81 cases. Ninety-one distal femoral fractures (16%) were stabilized in 82 cases with intramedullary locking nails and in 9 cases using retrograde nailing. In open fractures predominantly a reamed technique was used. Fifty-two of these fractures were femoral fractures and 101 were tibial fractures. Seventy-two femoral fractures (13%) were associated with compromised pulmonary function and polytrauma. Procedural changes from external fixation to the intramedullary locking nail technique were performed in 21 cases of femoral fractures and in 21 cases of tibial fractures. Six tibial fractures diagnosed as having compartment syndrome were treated using unreamed nailing and fasciotomy. The overall infection rate of femoral fractures was 1.7% and 1.9% for all tibial fractures; the nonunion rate of both femoral and tibial fractures was 0.5%. Because of the success rate observed in the treatment of borderline indications for locked intramedullary nailing of femoral and tibial fractures and the improvement in equipment, training and techniques, we have expanded the indications for treatment of these fractures by intramedullary nailing.

Adult↗
PubMed1996

[A simple method for removal of percutaneous endoscopically implanted gastrostomy tubes].

Percutaneous endoscopic gastrostomy (PEG) has become an accepted technique for providing longterm enteral nutrition. So far the PEG tubes have been removed by a second gastroscopy procedure. Extrusion of the PEG tube and fistula formation have been described as unusual complications. We report about 26 patients with severe brain injuries whose PEG tubes were removed percutaneously by applying constant traction force to the tubes. The soft internal bolsters collapsed and the PEG tubes could be pulled out through the gastrostomy site within 5-7 days. The gastrocutaneous fistulae closed spontaneously within 4 days. In one patient the internal bolster got caught in the external layer of the rectus muscle sheath and had to be removed through a small incision. There were no other complications and 21 patients rated their well-being as unimpaired. Thus we believe the "traction procedure" to be a simple, safe and cost-effective alternative to endoscopic removal of PEG catheters.

Adult↗
PubMed1996

[Gait analysis after intra-articular calcaneus fractures].

We retrospectively compared 20 patients with displaced intra-articular calcaneal fractures by clinical assessment and dynamic pedography. Eleven were treated operatively, 9 conservatively. The purpose was to identify differences in post-traumatic gait performance and to correlate the pedographic data to a clinical score to show its reliability. Twenty individuals without a history of foot injuries were used as a control group. Both groups had restricted motion in the subtalar joint, increased hindfoot and midfoot loading and decreased forefoot loading. Furthermore, they showed prolonged contact phases and an impaired ability to speed up gait during the toe-off phase. Load transfer from the hindfoot to the forefoot showed typical distribution patterns. The operatively treated group showed better functional results with fewer subjective complaints.

Adult↗
PubMed1995

[Results of surgical management of distal femur fractures with joint involvement].

Results of the treatment of 60 intraarticular distal fractures of the femur (AO classification: 33-B and 33-C fractures) are summarized. Frequencies of the different types of fractures were B1, 7; B2, 10; B3, 4; C1, 10; C2, 1; C3, 8. In 36 patients an isolated fracture, was present, in 9 patients, one additional injury, and in 16 patients there was more than one fracture or multiple trauma. We found 16.7% open fractures. Operation was possible within 24 h in 16 patients, in 21 patients between the 2nd and the 5th days, and in the rest after the 5th day. Check-ups took place an average of 46.4 months after the accident. The average age of the patients was 64.1 years (16-93). We encountered 3 cases of infection; we were able to treat 2 of these successfully, while 1 led to chronic osteomyelitis. Further complications were: loosening of implants (6 cases), non-union (1) fractures of plates (2), haematoma requiring operative treatment (1) refracture (1). All fractures resulted in osseous consolidation. Mobilization of patients was achieved an average of 12 days after operation. We evaluated the cases according to the Neer score. In 32 cases the result was excellent, in 18, average and in 4, unsatisfactory. Failure had to be recorded in 1 case. The combination of locking nails and lagscrews is an alternative method of osteosynthesis for distal femural fractures with an intra-articular component, provided strict selection criteria are applied.

Adolescent↗