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  • 1
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Präzision ; Variationskoeffizient ; DEXA ; Osteoporose ; Polyarthritis ; Key words Precision ; coefficient of variation ; DEXA ; osteoporosis ; rheumatoid arthritis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Precision of osteodensitometric measurements using dual energy X-ray absorptiometry (DEXA) depends on various known factors, such as positioning, aortic calcification or vertebral fractures. The purpose of this study was to investigate the influence of various diseases or bone density on the reproducibility of measurements in the lumbar spine and the proximal femur.  Measurements in the LWS p.a., LWS lat. and at Ward‘s triangle were made in a total of 100 patients. The subjects were repositioned between measurements. In order to be able to determine the influence of various diseases, four groups of 25 patients each were formed: three with the diagnosis osteoarthrosis, osteoporosis and rheumatoid arthritis and one control group. The mean percentual difference and coefficient of variation were calculated as the measure for reproducibility.  Mean percentual differences of 0.18 to 2.6% were found in the four groups at the three measurements sites. After calculation of coefficient of variation, a value between 1.2 and 2.7% was found for LWS p.a., between 7.1 and 15.7% for LWS lat. and between 4.1 and 9.9% at Ward‘s triangle. It was also conspicuous that the difference in coefficient of variation in osteoporosis patients was nearly double that in the control group in all measured areas. Conclusion: Lateral lumbar spinal measurements using DEXA cannot presently be recommended. LWS p.a. measurements and, with limitations, measurements at Ward‘s triangle have good precision and could be used for course documentation of bone density.
    Notes: Zusammenfassung Die Präzision osteodensitometrischer Messungen mit der dual energy X-ray absorptiometry (DEXA) hängt von verschiedenen bekannten Faktoren, wie Lagerung, Aortenverkalkung oder Wirbelkörperfrakturen ab. Ziel der Untersuchung war, den Einfluß verschiedener Erkrankungen bzw. der Knochendichte auf die Reproduzierbarkeit der Messungen an der Lendenwirbelsäule und am Femur zu überprüfen.  Insgesamt wurden 100 Patienten an der LWS p.a., LWS lat. und am Ward‘schen Dreieck doppelt gemessen, wobei zwischen den Messungen neu positioniert wurde. Um den Einfluß unterschiedlicher Erkrankungen festzustellen zu können, wurden zusätzlich 4 Gruppen à 25 Patienten mit den Diagnosen: Arthrose, Osteoporose und chronische Polyarthritis im Vergleich zur Kontrollgruppe gebildet. Als Maß für die Reproduzierbarkeit wurde jeweils die mittlere prozentuale Differenz und der Variationskoeffizient der beiden Messungen berechnet.  In den vier Gruppen ergaben sich an den drei Meßorten mittlere prozentuale Differenzen von 0,18 bis 2,6%. Nach Berechnung der Variationskoeffizienten fand sich für die LWS p.a. ein Wert zwischen 1,2 und 2,7% für die LWS lat. zwischen 7,1 und 15,7% und am Ward‘schen Dreieck zwischen 4,1 und 9,9%. Auffällig war zudem ein nahezu doppelt so hoher Variationskoeffizient der Patienten mit Osteoporose im Vergleich zur Kontrollgruppe an allen gemessenen Regionen. Ergebnis: Die laterale LWS-Messung beim DEXA-Verfahren ist derzeit nicht zu empfehlen. Die LWS p.a.-Messung und mit Einschränkung auch die Messung am Ward‘schen Dreieck können bei guter Präzision zur Verlaufsdokumentation der Knochendichte herangezogen werden.
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  • 2
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Diclofenac ; in vitro ; Osteoblasten ; stromale Knochenmarkzellen ; Hüftprothektik ; Key words Diclofenac ; in-vitro ; osteoblasts ; bone marrow cells ; hip arthroplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Introduction: Results of animal experiments have demonstrated that the osseous integration of non-cemented prostheses can, at the very least temporarily, be impaired by the application of non-steroidal antiphlogistic agents (such as diclofenac). It is the objective of this study to examine whether there is a direct influence of diclofenac used in usual clinical dosages (3 times 50 mg daily) on bone cells and their progenitor cells which would explain the observed slow integration of the prostheses. Methods: To investigate this, cultivated human in vitro osteoblasts and stromal bone marrow cells were incubated with increasing doses of the medications. Our study focused on the effect of diclofenac application on proliferation and functional metabolism in both cell lines. The measurable maximal plasma concentration 2h after the application of one tablet Voltaren 50® reached 1.6μg/ml. This correlated with diclofenac concentrations between 1 and 10 ml found in our experiments. The detected values were correlated to the control group (0 μg/ml diclofenac). Results: The drug effect upon osteoblasts was higher than on progenitor cells. The proliferation of in vitro stromal bone marrow cells, compared to untreated cells, was found to be decreased. We observed a decrease to 82% at a diclofenac concentration of 1 μg/ml, Osteoblasts exhibited a decrease to 97,5% at the same concentration. The DNA synthesis increased to 118% in stromal bone marrow cells, in osteoblasts to 144%. In contrast, we detected a neglectible decrease to 92% in the collagen synthesis of osteoblasts compared to untreated cells. The synthesis of osteocalcin by osteoblasts increased to 119%. The alkaline phosphatase activity was found to be decreased to 88% in stromal bone marrow cells and increased in osteoblasts to 111%. Conclusion: Temporary inhibiting effects on osseous integration in non-cemented prosthesis by diclofenac could be caused by a disturbance in the anabolic bone metabolism, exhibited by an increase of osteoblastic osteocalcin expression. Osteocalcin as a known negative regulator of the osteoneogenesis is most likely inhibiting the collagen matrix deposition.
    Notes: Zusammenfassung Einleitung: Nichtsteroidale Antiphlogistika (NSAR, z.B. Diclofenac) können das knöcherne Einwachsen nicht zementierter Prothesen zumindest vorübergehend beeinträchtigen. Es wird untersucht, ob ein direkter Einfluß von Diclofenac, in üblicher klinischer Dosierung (3×50 mg), bzw. der dadurch maximal erreichbaren Plasmakonzentration auf Knochenzellen und ihre Progenitoren besteht. Methoden: In-vitro kultivierte humane Osteoblasten und stromale Knochenmarkzellen wurden mit steigenden Medikamentendosierungen inkubiert und deren Wirkung auf das Proliferationsverhalten sowie Funktionsstoffwechsel gemessen. Die, durch Einnahme eines Dragees Voltaren 50®(Diclofenac) im Mittel nach 2 Stunden meßbare maximale Plasmakonzentration beträgt 1,6 μg/ml (26). Dies entspricht Diclofenackonzentrationen von etwa 1 μg/ml in unseren Experimenten. Die ermittelten Werte werden auf die Kontrollgruppe (0 μg/ml Diclofenac) bezogen. Ergebnisse: Die Wirkung von Diclofenac auf Osteoblasten ist bei allen Versuchen ausgeprägter als auf Vorläuferzellen. Die Proliferation stromaler Knochenmarkzellen wird bei Diclofenackonzentrationen von 1μg/ml auf 82%, bei Osteoblasten auf 97,5% reduziert. Die DNA-Synthese stromaler Knochenmarkzellen erhöht sich bei 1 μg/ml Diclofenac auf 118%, bei Osteoblasten auf 144%. Die Kollagensynthese der Osteoblasten wird auf 92% gesenkt. Die Osteocalcinsynthese der Osteoblasten steigt auf 119%. Die Aktivität der Alkalischen Phosphatase sinkt bei stromalen Knochenmarkzellen auf 88%, bei Osteoblasten steigt sie auf 111%. Schlußfolgerungen: Die zumindest während der Medikamentengabe verminderte Implantat-Knochen-Haftung könnte in einer Störung des anabolen Knochenstoffwechsels begründet sein, was sich in einer signifikanten Zunahme der spezifischen Osteocalcinexpression zeigt. Osteocalcin inhibiert als Negativ-Regulator der Osteogenese vermutlich die kollagene Matrixablage.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0827
    Keywords: Key words: Heterotopic osteoblast-like cells — Colony formation — Differentiation — Alkaline phosphatase — Osteocalcin.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine , Physics
    Notes: Abstract. In this study, a characterization of human bone-forming cells responsible for heterotopic ossification was carried out in vitro. The biological and biochemical cell characteristics of the heterotopic osteoblast-like (HOB) cells were compared with those of orthotopic osteoblast-like (OB) cells from normal bone and stromal bone marrow cells believed to contain a subpopulation of osteogenic precursor cells. We found that HOB's from the spongiosa of heterotopic ossification required less time until the beginning of migration and the achievement of confluence in vitro compared with OBs from femoral shaft spongiosa. The fraction of mitotically active cells assessed by a clonogenic assay was higher as well in HOB cells. The in vitro studies of mitogenesis and the efficiency of colony formation of osteogenic cells indicate that with increasing differentiation and relative age they become more dependent on growth factors in the medium, otherwise the morphology of osteoblast-like cells changes and they pass irreversibly into the postmitotic stage of the cell cycle. The activity of the alkaline phosphatase is distinctly higher in the HOB than in the OB cells, HOB cells exhibit a lower level of osteocalcin expression compared with OB cells. No significant difference was found between OB and HOB cells in the amount of procollagen of type I sequestered by the cells. After 30 days, HOB and OB cells formed a mineralized matrix on exposure to 2 mM β-glycerophosphate. Since HOBs were isolated from heterotopic bone that had developed within 3–6 months after hip surgery, the differences in cellular behavior compared with OBs may be attributed to the relatively young age of HOB cells.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Archives of orthopaedic and trauma surgery 115 (1996), S. 28-32 
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Thirty-four Achilles tendons were explanted post-mortem. The explantation took place less than 24 h after death. The tendons were examined by means of ultrasonography and after explantation assessed histologically and biomechanically. In the sonograms 19 changes in echogenicity were noted. Changes in form with an increase in the diameter of the tendon of up to 10 mm (compared with the contralateral side) were found in 6 tendons. The changes in echogenicity and form were found most frequently 2–4 cm from the insertion of the tendon at the oscalcis. At a speed of 5 mm/min, the average force needed until rupture occurred was calculated as 27.6 N/mm2. The tear was located on average 29.7 mm from the bony insertion of the tendon at the calcaneus. Histologically, necroses could by found most frequently in all regions of the tendon, followed by scars and fissures. When there were differences of more than 25% in tensile strength between the right and left sides, there was a histological change in the weaker tendon at the site of the tear. Sonographic changes in form pointed to histological lesions in this region. Changes in the echogenicity led to the detection of degenerative changes of the tendon, but they have to be analysed carefully, as they are prone to artefacts. There was not statistically relevant correlation either with regard to tensile strength or to the site of the rupture for sonographically proven changes in the area of the rupture. However, when there was a sonographically abnormal finding in the course of a tendon, the tendon tore at an earlier point than those exhibiting no abnormality. Sonography proved to be a useful method in the detection of degenerative lesions of tendons. A direct influence on the biomechanics of the tendon could not be found.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Archives of orthopaedic and trauma surgery 119 (1999), S. 205-207 
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The formation of heterotopic ossifications after total hip endoprosthesis implantation is a well-known complication. During the postoperative course laboratory parameters are subject to partial change due to the development of heterotopic ossifications. However, these changes occur relatively late at a time when the application of prophylactic precautions is usually already decided. Any meaningful prophylactic treatment, however, has to be initiated immediately after surgery. In a prospective study we assessed the postoperative C-reactive protein (CRP) levels in 95 patients twice after total hip replacement surgery. The initial assessment took place on the 1st day following surgery and again between the 5th and 7th day. All patients received three doses of 50 mg diclofenac daily for 7 days starting on the 1st postoperative day. Average CRP values on the 1st postoperative day were 6.33 ± 2.28 mg/dl for ossification grade Brooker 0, 7.04 ± 1.8 mg/l for Brooker 1 and 7.65 ± 3.7 mg/dl for Brooker grades 2–4. At the time of the second CRP assessment (postoperative day 5–7), CRP values in the groups of patients showing ossifications were higher. Whereas patients without ossifications (A) exhibited an average level of 4.22 ± 3.13 mg/dl, in patients with ossification grade 1 (B) CRP was 5.57 ± 2.78 mg/dl and in the group with ossification grades 2–4 (C) was 6.38 ± 4.48 mg/dl. The differences between group A on the one hand and the combined groups B and C values on the other were significant (P = 0.036). We are able to assert that after total hip replacement, significantly higher CRP levels can be recorded immediately after surgery in those patients who will eventually develop heterotopic ossifications, as compared with those who do not. Hence, the postoperative rise of CRP levels should be introduced as a further risk factor for the formation of heterotopic ossifications since its recording at such an early stage still allows for the timely initiation of prophylactic treatment.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Archives of orthopaedic and trauma surgery 119 (1999), S. 445-449 
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 94 patients 112 knees were examined after high tibial osteotomy for varus and valgus gonarthrosis. Preoperatively, there were 71 varus and 23 valgus deformities. The mean follow-up period was 9.0 years (range 2–21 years). Concerning the pain on walking and the pain at rest, we noted good an excellent results in 73% and 65%, respectively. The radiological evaluation showed an improvement or a persistence of the stage of arthrosis in 69.5% of the reviewed cases. The results according to the HSS score as an objective parameter showed in over 50% an improvement of the patients’ situation. The data were subjected to multivariate statistical analysis in which three of four evaluated risk factors were found to be associated with the duration of pain-free survival: certain preoperative injuries, preoperative meniscopathies and a deterioration of the stage of arthrosis (P 〈 0.05). There was no significance for weight in excess of 10% above the normal body mass index (BMI) limits. However, in a Kaplan-Meier survival analysis this parameter could be determined as a significant factor for a reduced pain-free survival interval (P 〈 0.05): patients with a BMI of more than 10% above normal limits had a pain-free peroid of 5.07 years, whereas those with a BMI of less than 10% had a pain-free period of 7.80 years.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This prospective study involves 644 patients who received ossification prophylaxis by means of the drug diclofenac after implantation (87.5%) or revision (12.5%) of a total hip endoprosthesis between August 1992 and June 1994. One hundred patients (15.5%) stopped the treatment because of side-effects of the drug, and medication was stopped when gastrointestinal troubles occurred. The follow-up examination after 6 months revealed ossification of HO degree 1 according to Brooker in 13.8% of cases, of degree 2 in 4.8%, and of degree 3 in 1.4% of cases. Severe HO of degree 4 was not observed at all, and 80% of the patients exhibited no ossification what ever. Thus, in comparison to our own studies and to the literature, diclofenac must be regarded as an extremely effective drug for the prevention of ossification.
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    International orthopaedics 23 (1999), S. 104-106 
    ISSN: 1432-5195
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé  Le but de cette étude est de déterminer prospectivement la densité osseuse préopératoire et de la comparer avec les résultats de la densité postopératoire après l’implantation d’une prothése de hanche controlaterale. La densité osseuse de 45 malades (x=54 années) a été mesurée avec la méthode DEXA à la hanche non operée, une semaine, 3 et 6 mois après l’implantation d’une prothese. Nos résultats montrent une réduction de la densité osseuse par l’immobilisation entre −3 et −5,9% (x=−3,9%). Cette différence diminue dans les prochains trois mois à une valeur de −2.5%, qui n’etait plus significative. L’évaluation préopérative montrait une différence de −4.5% en faveur de la hanche qui n’était pas atteinte (12 hanches).
    Notes: Abstract  It was the aim of this study to examine bone mineral density changes in the non-operated contralateral femur of patients undergoing total hip replacement. Bone density in the contralateral femur of 45 patients with an average age of 54 years was measured with the aid of the DEXA technique at one week, 3 and 6 months after total hip replacement. Within the first 3 months there was an average reduction of bone density of 3.9% (3.0%–5.9%). After a further 3 months the average difference was 2.5%.
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  • 9
    ISSN: 1432-5195
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé. L’implantation d’une prothèse de la hanche a pour conséquence une diminution de la densité osseuse du fémur autour de la prothèse. Selon la littérature ce procéssus dépend surtout de la forme de la prothèse et de la durée de l’implantation. La densité osseuse de 27 malades a été mésurée avec la méthode DEXA en moyenne 21 mois après l’implantation d’une prothèse sur mesure de la hanche. Nos résultats montrent une réduction de la densité osseuse entre 5 (ROI 1) et 21% (ROI 7), surtout au calcar proximal. La réduction de la densité osseuse ne dépendait pas de la durée de l’implantation. En comparaison avec la littérature ces résultats, surtout la diminution très restreinte au ROI 7, sont en faveur d’une forme individuelle d’une prothèse de la hanche.
    Notes: Summary. Implantation of a total hip replacement leads to resorption of bone, especially in the upper femoral shaft and this depends mainly on the design of the stem, and also on the survival time of the implant. Density of the periprosthetic bone was examined with the DEXA method in both femurs in 27 patients at a mean of 21 months after implantation of uncemented custom-made femoral stems. A loss of bone density between 5% and 21% was found which was independent of the survival time of the implant. The maximum decrease was at the upper medial part of the calcar. The negligible loss of bone density, compared to other reports, favours the use of a computer tomography assisted custom-made femoral stem.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    International orthopaedics 21 (1997), S. 133-136 
    ISSN: 1432-5195
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé. On décrit le cas d’un patient atteint d’exostoses ostéocartilagineuses multiples avec dégénérescence maligne d’un ostéochondrome pelvien en chondrosarcome. On passe ensuite en revue 94 autres cas décrits par d’autres auteurs. L’incidence de la dégénérescence de la maladie ostéogénique exostosante est de 15%, l’âge moyen des patients étant de 31 ans. Les hommes sont deux fois plus touchés que les femmes. Plus de 85% des tumeurs étaient situées sur la partie proximale de l’humérus, sur le tronc ou sur la partie proximale du fémur. Le laps de temps entre le premier symptôme et l’établissement du diagnostic était en moyenne de deux ans et quatre mois. Une augmentation de taille était le symptôme majeur. Dans 9 cas sur 10, l’histologie révélait un chondrosarcome. Malgré les traitements à visées curatives, un patient sur deux faisait deux récidives en moyenne. Chez 10% des patients des métastases étaient détectées. Un patient sur quatre avait une survie postopératoire de plus de 5 ans. Suit une discussion sur les déductions diagnostiques et thérapeutiques.
    Notes: Summary. A patient is reported who had multiple cartilaginous exostoses with malignant transformation of a pelvic osteochondroma.
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