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Biomedical subjects

Y Gotfried

Publications and source records attributed to Y Gotfried.

12 recordsLinked to original sources
PubMed2004

The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures.

Pertrochanteric hip fractures still are a major orthopaedic challenge, and those that are unstable have the poorest prognosis. Fracture collapse is one of the postoperative complications reported in association with these fractures. My objective was to evaluate possible causes for pertrochanteric hip fracture collapse. Twenty-four patients with documented postoperative fracture collapse were evaluated retrospectively. The findings showed unequivocally that in all patients, this complication followed fracture of the lateral wall and resulted in protracted period of disability until fracture healing. The importance of the integrity of the lateral wall for event-free fracture healing clearly is indicated, and fracture of the lateral wall should be avoided in any fixation procedure. The presence of the lateral wall on the preoperative radiograph should be a major factor in determining the internal fixation device used for fracture stabilization. In unstable pertrochanteric hip fractures, the traditional description of the posteromedial fracture part as the most important prognostic factor should be revised to include the structural description of the lateral wall. Special caution should be taken when drilling at the base of this often delicate structure.

Aged↗
PubMed2002

Percutaneous compression plating for intertrochanteric hip fractures: treatment rationale.

Percutaneous compression plating was developed after thorough consideration of each stage in the surgical procedure for intertrochanteric fractures and the ways in which they might be improved. This system represents a minimally invasive method of fracture stabilization and fixation, providing enhanced rotational stability and bone sparing, which reduces both peri- and postoperative complications including cut outs and fracture collapse.

Aged↗
PubMed2001

Immune response and resistance to infectious bursal disease virus of chicken lines selected for high or low antibody response to Escherichia coli.

Two experimental broiler lines were developed by divergent selection for high (HH) and low (LL) antibody response to Escherichia coli. Antibody response of these lines to immunization with a commercial vaccine (whole inactivated virus, WIV) against infectious bursal disease virus (IBDV) or with proteins VP2 and VP3 of that virus, and their resistance to challenge with a virulent IBDV, were tested. The study was performed with 213 male and female chicks from the tenth generation of the HH and LL lines. At 15 d of age, after disappearance of maternal antibodies, chicks from each line were randomly divided into four groups and injected with WIV, VP2, VP3, or adjuvant alone as a negative control. Chicks were bled 18 d postinjection, and antibody titers were determined by ELISA. Ten days later, the chicks were challenged with a virulent strain of the virus and killed after 10 d; the ratio of bursa of Fabricius to 100 g BW was determined for each bird. Significant differences in antibody titers were found among immunized and control chicks. Chicks from the HH line exhibited significantly higher antibody titers than LL chicks in response to WIV and VP2 vaccines but not to VP3 vaccine. Following challenge, bursa weight (relative to BW) of HH and LL chicks vaccinated with WIV and VP2 was significantly higher (P < 0.01) than that of chicks vaccinated with VP3 or the challenged unvaccinated control. No difference was found in this parameter between the latter two groups. Possible explanations for the differences in the line response to VP2 and VP3 are discussed.

Animals↗
PubMed1994

[The Oswestry peduncular screw system used in 108 patients. Oswestry experiences].

Authors report on the control examinations of 108 patients on a peduncular system, known since 1986 and applied successfully in the operative treatment of various diseases of the lumbosacral spine. The results of healing of 69 patients in whom the fusion of the lumbosacral spine was performed because of long standing low-back pains are analysed. They describe also other possibilities given by the peduncular system, among others the correction and stabilization of the lumbar kyphosis in Becterew's disease, the postlaminectomy kyphosis and the lumbar scoliosis of adults. Cases of trauma and tumor in which this method of stabilization was also successfully used are also mentioned.

Adult↗
PubMed1991

The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure.

The outcome in 119 patients who were operated on with a conventional standard lumbar discectomy procedure was retrospectively compared with that in 299 patients who were operated on with a microsurgical discectomy technique developed in Homburg/Saar, Federal Republic of Germany by the senior author (W.C.). All patients in this consecutive series had "virgin" lumbar radiculopathy evaluated and operated upon by two experienced surgeons at one institution. Determination of the final outcome was made objectively by an impartial third party using identical criteria for both groups, and with a patient self-evaluation form. The study looked at various pertinent aspects of the treatment course and at final outcome. The results in the microsurgical group were significantly favorable: fewer levels were explored: there was less operative blood loss and a decreased incidence of deep venous thrombosis, urinary tract infections, pulmonary emboli, and bladder catheterization; the time to full ambulation, discharge, and return to work was faster: and there was a decrease in change of occupation and a greater percentage of satisfactory final outcomes, as measured both objectively and subjectively. A description of the microsurgical technique used in this study, which differs significantly from existing microdisectomy techniques, is presented. The authors conclude that the microsurgical disectomy technique presented in this study is a safe and effective approach to the treatment of lumbar radiculopathy.

Adolescent↗
PubMed1987

Histological characteristics of acute rejection in vascularized allografts of bone.

Using a genetically defined rat model for the heterotopic transplantation of a vascularized knee in the rat, histological and histochemical studies of acute rejection in vascularized allografts of bone were carried out. The graft consisted of the knee joint with the distal end of the femur, the proximal part of the tibia, the cartilaginous growth plates, the articular cartilage, and a minimum cuff of muscle, which was transferred to a location under the abdominal skin. A total of 160 transplants, including vascularized and non-vascularized isografts, vascularized and non-vascularized allografts that were transplanted across a strong histocompatibility barrier, and vascularized allografts of bone that were transplanted across a weak histocompatibility barrier, were studied by light microscopy at intervals for as long as twelve weeks after transplantation. Vascularized allografts of bone that were transplanted across a strong histocompatibility barrier showed evidence of rapid rejection, similar to that after transplantation of allografts of visceral organs. This was manifested at one week by necrosis of osteocytes, cessation of microcirculatory flow, massive extravasation of red cells, and deposition of fibrin in the marrow. The large vessels demonstrated changes that were characteristic of vascular rejection. Allografts that were transplanted across a weak histocompatibility barrier showed a more gradual, less intense process of rejection that allowed observation of the evolution of the process. In these grafts, the osteoblasts and marrow in the primary spongiosa of the metaphysis were early targets of rejection, as indicated by necrosis of osteoblasts, extravasation of red blood cells, and deposition of fibrin in the marrow spaces. Loss of osteoblasts from the surfaces of osteoid as well as from bone on spicules of calcified cartilage resulted in the cessation of new-bone formation. Calcification of the longitudinal septa between the lowermost hypertrophic chondrocytes was decreased. However, the proliferation and maturation of chondrocytes in the zone of proliferating chondrocytes and in the upper hypertrophic zone continued and resulted in the formation of a thickened growth plate. The loss of osteocytes in other areas of the graft occurred later and only in the areas where the microcirculation had been lost. These data suggest that ischemic damage, which is probably secondary to an immune-related vascular compromise, is a significant factor in the failure of grafts. In the grafts that were transplanted across a weak histocompatibility barrier, the growth of new bone and revascularization by the host occurred by twelve weeks.

Animals↗
PubMed1987

Staged salvage reconstruction of grade-IV and V spondylolisthesis.

Sixteen patients who had Grade-IV or V spondylolisthesis underwent a staged reconstruction for the salvage of a failed result of previous procedures. The indications for operation were incapacitating pain, radicular pain, pseudoclaudication, or the inability to stand upright. All patients had shown progression of the deformity after the previous surgery. At an average length of follow-up of fifty-two months, all patients had resumed normal activities and were free of the pain and symptoms of spinal stenosis. The complications included delayed union in six patients and a traumatic pseudarthrosis in one patient. In all of these patients a solid fusion was obtained after additional surgery. In five patients, neuropathy of the fifth lumbar-nerve root developed after surgery; it resolved in three patients. From this work, it is concluded that staged reconstructive surgery is feasible in patients who have Grade-IV or V spondylolisthesis with incapacitating pain and deformity that interfere with normal function. The benefits outweighed the risks in this very select group of patients.

Adolescent↗
PubMed1986

Facet joint changes after chemonucleolysis-induced disc space narrowing.

Changes on facet joint articular cartilage biology after chymopapain-induced disc height loss were determined in adult mongrel dogs. Disc height decreased to 50% at 2 weeks and returned to 80% at 6 months. The biochemistry and histology of the involved-level facet joints were followed at 2 weeks, 6 weeks, 3 months and 6 months after the injection. X-ray study showed a narrowing of the joint space and overlap of the facet joints at 6 weeks and at 3 months. Some return toward normal appearance was noted at 6 months. There was a loss of Safranin-O stain at 6 weeks, which persisted at 3 months, although some cells showed increased Safranin-O staining in the surrounding matrix. This was further improved at 6 months. The water content was unchanged early, but had decreased significantly at 6 weeks. The hexuronic acid content, already dropping at 2 weeks, was significantly lower at 6 weeks, at 3 months, and at 6 months. However, by 6 months, it had increased, compared with the 3-month value. Synthesis of proteoglycan was depressed only at 6 weeks. Similar changes were found in the facet cartilage in the joints above and below the last injected disc level. Results of this study would suggest that there is a cause-and-effect relationship between disc pathology and facet pathology and this can affect adjacent disc facet-joint biology. The initial facet lesion described appears to be potentially reversible, but a long-term disc height decrease might be expected to cause irreversible osteoarthritic-like changes in the adjacent facet joint.

Animals↗
PubMed1986

Lumbar spine osteolysis: an entity caused by spinal instability.

Presented is a new entity in the spectrum of complications following spinal decompression. It occurs in patients with spinal instability after decompression. Thereafter, instability accelerates, leading to a rapid clinical and radiologic deterioration. The presenting symptoms are back pain and lower extremity weakness, resembling spinal stenosis. Erythrocyte sedimentation rate and temperature remain normal. Radiologically, a distinct form of progressing osteolysis is present. This entity may present a difficult diagnostic problem and is usually diagnosed erroneously as a destructive osteomyelitis. Craig needle biopsy results are normal. Treatment consists of stabilization rather than antibiotic therapy and debridement. It is apparent that patients with spinal instability are to be considered "at risk" as further decompression may accelerate the instability, resulting in progressive osteolysis.

Aged↗
PubMedDate not supplied

Percutaneous compression plating of intertrochanteric hip fractures.

OBJECTIVE: To present the principles of a surgical technique for percutaneous compression plating of intertrochanteric hip fractures and to report the clinical results of treatment using this method. DESIGN: Retrospective. SETTING: University hospital. PATIENTS: Ninety-eight intertrochanteric hip fractures in ninety-seven patients with a minimum follow-up of twelve months. MAIN OUTCOME MEASURES: Radiographic and clinical evidence of functional outcome and complications including fracture collapse and implant failure. RESULTS: Mean perioperative blood loss was 92.4 milliliters (range 14 to 245 milliliters), and the mean postoperative hospital stay was 8.7 days (range 4 to 20 days). Complications included two minor wound hematomas and one soft tissue infection. Radiographically, one fracture with a varus deformity of 8 degrees and two fractures had minor screw pullout that did not affect the final results. No collapses, screw cutouts, or head penetrations were seen. Three patients required reoperation: one for avascular necrosis after a fracture at the base of the neck and two, after fracture healing, for trochanteric bursitis requiring plate removal. All surviving patients (80 of 98; 82 percent) had uneventful fracture healing with union achieved by six months in all patients. CONCLUSIONS: Use of the percutaneous compression plating for intertrochanteric hip fractures resulted in reduced complications, event-free fracture healing, and improved rehabilitation.

Aged↗