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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    European journal of orthopaedic surgery & traumatology 6 (1996), S. 115-117 
    ISSN: 1432-1068
    Keywords: Superficial wound infection ; Ceftriaxone ; Out-patient therapy ; Infection superficielle ; Ceftriaxone ; Traitement ambulatoire
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les auteurs ont effectué une étude prospective pour déterminer l'efficacité du traitement ambulatoire des infections postopératoires superficielles, chez des patients porteurs d'implants orthopédiques, avec une coût-efficacité de cette technique comparée avec le traitement en hospitalisation. L'étude a proté sur 25 patients opérés d'une arthroplastie totale de hanche ou de genou de première intention, ou d'une vis-plaque DHS pour fracture trochantérieenne. Les infections superficielles ont été séparées en bénignes, modérées et sévères, et la durée d'administration de l'antibiotique dépendait de la gravité de l'infection. Il n'y a eu aucun échec dans cett série. L'économie totale réalisée a été estimée à 3..840 livres sterling. Les auterus recommandent le traitement ambulatoire par ceftriaxone pour les infections superficielles des interventions orthopédiques implants.
    Notes: Abstract We undertook a prospective open, non-randomised study to determine the efficacy of out-patient treatment of postoperative superficial wound infection, in patients with orthopaedic implants using single daily IM injection of ceftriaxone and to examine the cost effectiveness when compared with inpatient management. The study comprised of 25 patients who have had primary total hip or knee replacements or Dynamic Hip Screw fixation for an intertrochantric fracture. The superficial wound infections were categorised into mild, moderate and severe according to the classification described in this article and the length of administration of antibiotic varied according to the severity of infection. There were no failures in the study. It was estimated that an overall cost savings of £33.840 could be achieved. We recommend that superficial wound infection in association with major orthopaedic operations using implants can be managed with ceftriaxone as an out-patient.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0932
    Keywords: Key words Lumbar vertebrae ; Anatomical dimensions ; Spine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The precise dimensions of the lumbar vertebrae and discs are critical for the production of appropriate spinal implants. Unfortunately, existing databases of vertebral and intervertebral dimensions are limited either in accuracy, study population or parameters recorded. The objective of this study is to provide a large and accurate database of lumbar spinal characteristics from 126 digitised computed tomographic (CT) images, reviewed using the Picture Archiving Communication System (PACS) coupled with its internal measuring instrumentation. These CT images were obtained from patients with low back pain attending the spinal clinic at the Hammersmith Hospitals NHS Trust. Measurements of various aspects of vertebral dimensions and geometry were recorded, including vertebral and intervertebral disc height. The results from this study indicated that the depth and width of the vertebral endplate increased from the third to the fifth lumbar vertebra. Anterior vertebral height remained the same from the third to the fifth vertebra, but the posterior vertebral height decreased. Mean disc height in the lower lumbar segments was 11.6 ± 1.8 mm for the L3/4 disc, 11.3 ± 2.1 mm for the L4/5, and 10.7 ± 2.1 mm for the L5/S1 level. The average circumference of the lower endplate of the fourth lumbar vertebra was 141 mm and the average surface area was 1492 mm2. An increasing pedicle width from a mean of 9.6 ± 2.2 mm at L3 through to 16.2 ± 2.8 mm at L5 was noted. A comprehensive database of vertebral and intervertebral dimensions was generated from 378 lumbar vertebrae from 126 patients measured with a precise digital technique. These results are invaluable in establishing an anthropometric model of the human lumbar spine, and provide useful data for anatomical research. In addition this is important information for the scientific planning of spinal surgery and for the design of spinal implants.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European spine journal 2 (1993), S. 96-98 
    ISSN: 1432-0932
    Keywords: Débit sanguin ; Plateau vertébral ; Nutrition discale ; Blood flow ; Endplate ; Disc nutrition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Measurements of blood flow were made in the endplate and disc of the vertebrae in adult sheep. In anaesthetised animals, radioactively labelled microspheres were injected into the left ventricle and blood withdrawn from the brachial artery. The lumbar spine was then removed and sectioned to measure microsphere deposition. Blood flow in the bony endplate was found to be 4.22±0.59 ml/min 100g, and flow of 0.57±0.29 ml/min 100g was also measured in regions of the disc adjoining the endplate. No significant flow was recorded in the central region of the disc. This work has clinical significance in relation to spinal infections and also to the pathogenesis of degenerative disc disease.
    Notes: Résumé Des mesures du débit sanguin ont été réalisés au niveau des plateaux vertébraux et des disques chez le mouton adulte. Chez les animaux anesthésiés, des microagrégats ont été injectées dans le ventricule gauche et le sang a été prélevé au niveau de l'artère brachiale. Le rachis lombaire a été ensuite prélevé et découpé afin de mesurer la quantité de microagrégats déposée. Le débit sanguin au niveau des plateaux a été chiffré à 4.22±0.59 ml/mn/100g; un débit de 0.57±0.29 ml/mn/100g a été également relevé dans les zones discales adjacentes aux plateaux. Aucun débit significatif n'a été enregistré au niveau de la zone centrale du disque. Ce travail trouve son intérêt clinique dans les infections rachidiennes et aussi dans la pathogénie des affections discales dégénératives.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    International orthopaedics 11 (1987), S. 249-254 
    ISSN: 1432-5195
    Keywords: Cervical spondylosis ; Computed tomography ; Myelography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Neuf cas d'arthrose cervicale, à l'origine de symptômes sévères et prolongés, ont été étudiés par myélographie couplée à un examen tomodensitométrique en utilisant la même injection de produit de contraste. Dans tous les cas existaient des signes radiologiques de cervicarthrose et les patients étaient programmés pour un abord antérieur du rachis cervical en vue d'une arthrodèse intersomatique. Tous avaient un bilan clinique, électromyographique et radiographique complet avant l'examen tomodensitométrique. L'examen électromyographique a permis dans trois cas de mettre en évidence l'atteinte de plusieurs étages. De même l'examen radiographique a toujours montré une atteinte pluriétagée. La myélographie a visualisé une compression du sac dural dans trois cas sur cinq mais sans jamais révéler l'absence d'injection d'une racine nerveuse. Lorsque la myélographie était couplée à un examen tomodensitométrique les renseignements étaient plus précis: atteinte des articulations de Lushka et interapophysaires, existence d'une compression centrale et/ou latérale. Dans trois cas les constatations opératoires ont confirmé les données de la tomodensitométrie alors que la myélographie seule n'avait pas montré la présence d'importants ostéophytes.
    Notes: Summary Nine patients with severe and prolonged signs and symptoms due to cervical spondylosis had myelography followed by a CT Scan using the same injection of intrathecal contrast. All patients had radiographic changes of cervical spine degeneration and were being considered for exploration and fusion of the anterior cervical spine. All patients had a full clinical evaluation, EMG studies and plain radiographs taken prior to their CT Scan. EMG readings showed several levels of compression in three patients but did not indicate a single level in any. Plain radiography showed multiple level involvement in every patient. Myelography indicated significant indentation in three of five patients with clinical signs but did not demonstrate root cut off in any case. CT Myelography indicated the degree of Lushka and facet joint involvement, indentation, exit foramen encroachment, and the degree of spinal stenosis at the involved segment. In three patients, the findings at operation correlated closely with the CT Scans. Myelography failed to indicate the presence of significant osteophytes in these two cases.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    International orthopaedics 10 (1986), S. 53-62 
    ISSN: 1432-5195
    Keywords: Fibrous dysplasia ; Albright syndrome ; McCune-Albright syndrome ; Weil-Albright syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Présentation de 13 malades atteints de dysplasie fibreuse, 4 formes mono-osseuses et 9 poly-osseuses dont une comportant le syndrome de Weil-Albright classique et une autre pouvant comporter ce syndrome chez un jeune garçon. Tandis que les formes mono-osseuses surviennent chez l'adulte et peuvent être traitées chirurgicalement, les atteintes poly-osseuses apparaissent chez l'enfant et le nourrisson et posent de difficiles problèmes thérapeutiques. Un bilan squelettique est indispensable pour porter un diagnostic correct et entreprendre un traitement, il sera réalisé de préférence par une scintigraphie de l'ensemble du corps plutôt que par un examen radiologique complet du squelette. La biopsie est particulièrement indiquée dans les formes mono-osseuses. L'évolution des formes poly-osseuses de la dysplasie fibreuse est imprévisible et dépend en partie du potentiel ostéogénique qui ne peut être évalué et également de la chirurgie. Le syndrome de Weil-Albright et ses variantes ne sont pas plus graves que les formes poly-osseuses. Le traitement orthopédique s'adresse aux fractures pathologiques et vise à prévenir ou à corriger les déformations, tout particulièrement les coxa-vara. L'enclouage centro-médullaire renforce habituellement de façon satisfaisante les lésions diaphysaires ou métaphysaires du fémur ou du tibia, mais le matériel devra être retiré ou échangé jusqu'à la fin de l'adolescence. Les lésions étendues de l'extrémité supérieure du fémur peuvent nécessiter une chirurgie plus aggressive. L'atteinte du bassin et la destruction de la hanche sont au delà des possibilités chirurgicales et nécessitent le recours à l'appareillage externe.
    Notes: Summary Four patients with monostotic and nine with polyostotic fibrous dysplasia of bone, including one with the classical Weil-Albright syndrome and a male child who may have had this syndrome, are presented. While monostotic forms affect adults and are amenable to curative surgery, polyostotic involvement may become evident in childhood and early infancy, and represent a difficult therapeutic problem. Screening of the skeleton is essential for proper diagnosis and treatment, and should be achieved by total body scan in preference to a complete radiological survey. Biopsy is of particular importance in monostotic cases. The course of polyostotic fibrous dysplasia of bone is not predictable and depends partly upon the unassessable osteogenic potential of the bone, and also on surgery. The Weil-Albright syndrome and its variants are no worse than polyostotic fibrous dysplasia. Orthopaedic treatment deals with pathological fractures and with the prevention and correction of deformities, particularly of coxa vara. Sufficient stability of diaphyseal and metaphyseal lesions of the femur and tibia can usually be provided by intramedullary fixation, which needs to be left, or exchanged, at least until the end of adolescence. Extensive lesions of the proximal femur make aggressive surgery necessary. Pelvic involvement and destruction of the hip joint preclude surgery and require the use of calipers.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Calcified tissue international 35 (1983), S. 508-511 
    ISSN: 1432-0827
    Keywords: Radionuclide uptake ; Skeletal blood flow ; Capillary permeability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine , Physics
    Notes: Summary The increased uptake of bone-seeking radionuclides following a fracture has been stated to be due to an increase in bone blood flow, resulting in an increase in capillary surface area available for exchange. This paper examines the relationship between the maximum instantaneous extraction of99mTc-MDP and blood flow in normal canine tibia. The findings, consistent with the model of capillary action proposed for muscle by Renkin and Crone, are applicable to bone. There is no evidence that in normal bone the surface area available for exchange responds to an increase in bone blood flow.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Calcified tissue international 36 (1984), S. 622-624 
    ISSN: 1432-0827
    Keywords: Sympathectomy ; Microspheres ; Bone blood flow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine , Physics
    Notes: Summary Several laboratories, including our own, have investigated the physiology of bone blood flow by perfusion of the tibia via the nutrient artery. Any damage caused to the nerve supply by cannulation of the artery might affect the results. The possible effect of such damage was investigated by measuring blood flow to the dog tibia using a microsphere technique, before and after sympathectomy. No effect was found and the tibial nutrient artery is therefore a suitable vessel for perfusion when estimating nutrient exchange in bone.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Archives of orthopaedic and trauma surgery 106 (1987), S. 381-384 
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Forty patients who underwent Wiltse's lateral mass fusion by two different surgeons for spondylolisthesis or degenerative disc disease have been independently reviewed. It was found at follow-up (mean 22 months ± S. D. 14 months) that factors that affected the final result were the age of the patient, the presence of preoperative nerve root symptoms, previous disc surgery, and incomplete fusion. The duration of symptoms, length of follow-up, preoperative spondylolysis, and the exent of the fusion did not appear to affect the result. This series confirms the previous reports that Wiltse's mass fusion is a good technique for relieving pain in the majority of patients.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Archives of orthopaedic and trauma surgery 105 (1986), S. 62-65 
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Da der Mineraltransport im Knochen von der Kapillardurchblutung in den Osteonen beeinflußt wird, haben gefäßaktive Substanzen orthopädische Bedeutung. Dieser Beitrag soll die Morphologie der Knochenkapillaren verdeutlichen und die Frage beantworten, ob Sympathomimetika die Häufigkeit durchströmter Kapillaren ändern können. Die quantitative Auswertung histologischer Serienschnitte von Mäuseknochen ergab keine signifikante Beeinflussung durch Phenylephrin. Im Hinblick auf elektronenmikroskopische Befunde scheinen postkapilläre Mechanismen den Blutfluß im Knochen zu regulieren.
    Notes: Summary Mineral transport to bone is dependant on an adequate blood supply. Thus, the role of vasoactive agents merits orthopaedic interest. This paper outlines the morphology of osteons and capillaries in cortical bone and discusses the possible morphological effects of systemic phenylephrine on mice tibiae. The frequency of dilated capillaries on histological serial sections did not significantly change. Hence, a postcapillary mechanism is likely to explain previous EM findings: i.e., an adrenaline-induced increase of the lumen diameter and perivascular cell edema.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Archives of orthopaedic and trauma surgery 104 (1985), S. 247-250 
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 21 Patienten mit zervikaler Spondylose wurden durchschnittlich 27 ± 15 Monate nach einer unkomplizierten vorderen Fusion der Halswirbelsäule untersucht. Röntgenologisch fand sich bei 14 Patienten eine vordere Instabilität des angrenzenden Segments. Ihr Auftreten korrelierte nicht mit dem Alter und Geschlecht des Patienten, mit der Fusionsstrecke oder mit dem postoperativen Zeitraum. Anhaltende oder wiederkehrende Schmerzen konnten ebenfalls in keinen Zusammenhang mit der Instabilität gebracht werden.
    Notes: Summary Twenty-one patients suffering from cervical spondylosis and peripheral symptoms underwent uncomplicated anterior interbody fusion of the cervical spine and were re-examined clinically and radiologically at 27 ± 15 months (mean ± SD) after the operation. Translatory displacement of the segment adjacent to the fusion level was noted in 14 patients. Its incidence could not be related to the age and sex of the patient, to extent of the fusion, or to post-operative time. Anterior slippage did not correlate with persistent or recurring pain.
    Type of Medium: Electronic Resource
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