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  • 1
    Electronic Resource
    Electronic Resource
    Development of a new modular titanium femoral prosthesis consisting of a head and shaft component. Indications, operation and optimization of the tapered socket connection (1999)
    Springer
    European journal of orthopaedic surgery & traumatology 9 (1999), S. 13-18 
    Details
    ISSN: 1432-1068
    Keywords: Modular femoral prosthesis ; Fretting ; Taper socket ; Cementless
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les auteurs décrivent une nouvelle prothèse fémorale modulaire associant une prothèse conventionnelle et un clou centro-médullaire. La prothèse est constituée d’une pièce céphalique et d’une partie diaphysaire fixées ensemble par un cône morse. Chaque pièce est modulaire selon les besoins en longueur et en diamètre. L’antéversion de la pièce céphalique est libre. Les pièces diaphysaires ont une courbure sagittale anatomique et sont creuses, permettant l’utilisation d’un guide centro-médullaire. Les pièces diaphysaires longues peuvent être verrouillées. Les pièces céphalique et diaphysaire sont en alliage de titane et la pièce diaphysaire a une surface grenaillée dans sa partie proximale. Le cône morse a été optimisé par l’adjonction d’une rainure qui a diminué l’usure par abrasion lors des tests de fatigue. Aucun démontage de la jonction intraprothétique et aucune fracture dé tige n’a été rencontrée lors de c es tests. La technique opératoire n’offre aucune particularité. Cent vingtquatre prothèses ont été implantées depuis 1990, principalement pour des fractures du col fémoral et des changements de prothèses totales de hanche. Les résultats cliniques sont en cours d’investigation. D’autres indications plus rares ont été choisies : pseudarthrose per-trochantérienne, fracture sur coxarthrose, chirurgie métastatique. Cette prothèse permet un ancrage diaphysaire stable dans les pertes de substance de l’extrémité supérieure du fémur, et autorise ainsi la repousse osseuse dans cette zone, spontanée ou après greffe osseuse, et la fixation proximale secondaire. L’optimisation du cône morse a permis de diminuer de façon considérable l’usure par abrasion. La modularité de la prothèse permet de s’adapter à toutes les morphologies et toutes les situations cliniques.
    Notes: Summary The development and clinical indications of a new modular femoral endoprosthesis consisting of a head and shaft component is discribed. Components are available in different lengths and diameters and therefore can be joined individually depending on the patients anatomy and surgery required. Both parts are joined by a unique optimized taper socket with a groove, avoiding fretting and corosion. Fatigue tests showed no loosening of the tapered connection and no prosthesis fracture. The advantage of this new modular prosthesis is diaphyseal stabilization, if necessairy by two distal interlocking screwes. Indications are revisions, pertrochanteric femoral and neoplastic fractures if cementless bridging of boney defects in the calcar region must be achieved. Further indications are femoral neck fraktures and coxarthrosis if stable diaphyseal fixation is required. The material and surface structure as well as the philosophie of the distal fixation are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02427763
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  • 2
    Electronic Resource
    Electronic Resource
    Incidence and mortality of severe sepsis in surgical intensive care patients: the influence of patient gender on disease process and outcome (2000)
    Springer
    Intensive care medicine 26 (2000), S. 167-172 
    Details
    ISSN: 1432-1238
    Keywords: Key words Severe sepsis ; Septic shock ; Gender ; Clinical study ; Intensive care therapy ; Mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Laboratory studies demonstrated significant detrimental effects of male sex-steroids (testosterone) on immune functions following hemorrhagic shock and soft-tissue trauma. Moreover, better survival of female mice subjected to severe sepsis was observed when compared to male animals. The aims of the present study were to evaluate whether or not gender differences regarding incidence and mortality of severe sepsis do exist in surgical intensive care patients and to elucidate the influence of patient age on incidence and mortality of severe sepsis/septic shock.¶Design: Data base review of prospectively collected data from surgical intensive care patients.¶Setting: Surgical intensive care unit of the department of surgery of a university hospital.¶Patients: Prospectively collected data of 4218 intensive care patients (2709 male, 1509 female).¶Results: Significantly fewer female patients were referred to the intensive care unit (6.6 % vs 10.8 % of all patients; P 〈 0.05) leading to a significantly smaller proportion of female intensive care patients (35.8 % vs 64.2 %). No gender differences regarding number of failing organs or surgical procedure (exception vascular surgery) were observed in patients with and without severe sepsis/septic shock, indicating that the patients studied are comparable regarding general health prior to admission to SICU. Among all female patients referred to SICU only 7.6 % developed severe sepsis/septic shock, while 10.4 % of all male patients suffered from severe sepsis or septic shock (P 〈 0.05). This gender difference results from a significantly lower incidence of severe sepsis/septic shock in female patients between 60 and 79 years. No gender difference regarding mortality rates of severe sepsis/septic shock was observed (men 64.9 %, women 65.5 %).¶Conclusions: Our results indicate a significantly smaller number of female patients requiring intensive care as well as a significantly lower incidence of severe sepsis/septic shock in female intensive care patients. Mortality from severe sepsis/septic shock, however, is not affected by gender.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050041
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  • 3
    Electronic Resource
    Electronic Resource
    Versorgung der per- bis subtrochantären Femurfraktur durch Gammanagel und modulare Hüftprothese Differentialindikation und Ergebnisse (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 444-451 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Gammanagel ; Modulare Hüftprothese ; Pertrochantäre Femurfraktur ; Koxarthrose ; Keywords Gamma nail ; Modular hip prostheses ; Trochanteric fracture ; Osteoarthrosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary From January 1997 to August 1998 all stabel and nonstabel trochanteric femoral fractures (n=72) were treated routinely by gamma nail using the correct operative technique. Patients showing additional osteoarthritis of the hip in radiographs hip replacement was performed by a cementless modular femoral hip prostheses from January 1996 to August 1998 (n=28). Follow up period was 6 to 18 months. Operation time and blood loss were higher using the prostheses. However complications and letality (〈5%) were not different during postoperativ course. In each group three operative technical complications occured. Using a modified Harris Hip Score (without range of motion, contractions) the score was decreased non significant comparing both groups first of all in unstabel fractures until follow up. In each group one revision (loosening of prostheses, excessive shortening of femoral neck) was necessary. Using the correct operative technique, the gamma nail prooved to be a save device with good outcome. Outcome using modular prostheses is comparable to gamma nail. Therefore the use of modular prostheses is justified in case of osteoarthrosis and in some cases of very unstable fracture.
    Notes: Zusammenfassung In der Zeit vom 1.1.1997 bis 1.8.1998 wurden alle stabilen und instabilen per- bis subtrochantären Femurfrakturen (n=72) routinemäßig durch einen Gammanagel (GN) unter Anwendung der korrekten Operationstechnik stabilisiert. Ausgenommen waren Patienten, die radiologisch eindeutige Koxarthrosezeichen hatten. In dieser Vergleichsgruppe (n=28) wurde der Gelenkersatz durch eine zementfreie, modulare Hüftprothese (MHP) durchgeführt und die Patienten im Zeitraum vom 1.1.96 bis 1.8.98 ebenfalls prospektiv erfaßt. Die Nachuntersuchung erfolgte nach 6–18 Monaten. Trotz längerer Operationszeit und höherem Blutverlust in der MHP Gruppe bestand kein Unterschied an Komplikationen und Letalität (〈5%) während des stationären Aufenthalts. In jeder Gruppe waren drei operationstechnische Komplikationen nachweisbar. Unter Verwendung eines modifizierten Harris-Hip-Scores (ohne Bewegungsumfang, Deformität) zeigten beide Gruppen eine nicht signifikant unterschiedliche Abnahme der Punktzahl vor allem bei den instabilen Frakturen zum Zeitpunkt der Nachuntersuchung. In jeder Gruppe mußte ein Patient (Sinterung im Frakturbereich, Prothesenlockerung) revidiert werden. Unter Anwendung der korrekten Operationstechnik ist der GN ein sicheres Implantat. Die MHP zeigt gleich gute Ergebnisse mit gleicher Letalität, so daß der Einsatz bei Koxarthrose und in ausgewählten Fällen auch bei hochgradig instabilen Frakturen gerechtfertigt ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050564
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  • 4
    Electronic Resource
    Electronic Resource
    A rare case of osteoporotic spine fracture associated with epidural lipomatosis causing paraplegia following long-term cortisone therapy (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 484-486 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cushing´s syndrome is frequently associated with osteoporosis. Therefore, the incidence of osteoporotic spine fractures is significant. They are a rare cause of paraplegic syndromes. Additionally, epidural lipomatosis may occur in those patients. The combination of both fracture and lipomatosis may cause neurological deficit. A case of a young patient suffering from drug-induced Cushing’s syndrome is reported. She developed progressive paraplegia. Radiographs demonstrated kyphosis of the thoracic spine from T7 to T9 and pathologic fractures. Urgent operation was planned to stabilize and decompress the spinal cord in the area of the kyphosis. Fortunately, magnetic resonance imaging (MRI) was conducted first. It confirmed pathologic fractures of T7–9 but also showed massive epidural fat extending from the level of T1 to T9. As suspected, laminectomy alone in the area of the fracture proved to be insufficient, as shown by myelography during operation. For treatment of paraplegia in this case of symptomatic epidural lipomatosis, an expanded laminectomy was necessary to remove all the epidural fat. Having undergone this procedure, the patient is now recovering from paraplegia. Our experience suggests that care should be taken before operative treatment of patients with pathological fractures in combination with Cushing’s syndrome. In addition to vertebral fractures, epidural lipomatosis has to be taken into consideration. Those patients with neurological deficits have to be treated by an extensive laminectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004029900086
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  • 5
    Electronic Resource
    Electronic Resource
    408. Veränderungen der nahrungsstimulierten Mikrozirkulation des Magen-Darmtraktes nach proximal selektiver und trunculärer Vagotomie (1983)
    Springer
    Langenbeck's archives of surgery 361 (1983), S. 933-933 
    Details
    ISSN: 1435-2451
    Keywords: Gastrointestinal blood flow ; Gastrin ; Food ; Vagotomies ; Gastrointestinale Durchblutung ; Gastrin ; Futterstimulation ; Vagotomien
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In Narkose wurde nach intragastraler Futtergabe bei Kontrollhunden sowie 4 Wochen nach proximal selektiver (PSV) oder trunculärer Vagotomie mit Pyloroplastik (TV) Serum Gastrin radioimmunologisch und die gastrointestinale Durchblutung mittels Microspheres bestimmt. Nach PSV war die Durchblutung 60 min postprandial nicht mehr, nach TV noch in Antrummucosa und Bulbus duodeni stimulierbar. Zwischen der Hypergastrinämie nach PSV und TV bestand kein Unterschied. In der gastralen Phase scheint der N. vagus — gastrinunabhängig — den größten Stimulus auf die gastrointestinale Durchblutung mit Ausnahme von Antrummucosa und Bulbus duodeni auszuüben.
    Notes: Summary Dogs that had undergone proximal selective vagotomy (PSV) or truncal vagotomy and pyloroplast (TV) 4 weeks before and control animals received food intragastrally while anaesthetized. Serum gastrin was determined by radioimmunoassay, microcirculation by microspheres. After PSV blood flow no longer increased 60 min postprandially, and after TV blood flow increased only in the antral mucosa and the duodenal bulb. There was no difference between the hypergastrinemia following PSV and that after TV. In the gastral phase the vagal nerve seems to exert the strongest stimulus on the gastrointestinal blood flow, exept in the antral mucosa and duodenal bulb; this stimulus is not dependent on gastrin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01276234
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