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1.
Handchir Mikrochir Plast Chir ; 52(2): 151-158, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-31724136

RESUMO

Human skin is an efficient barrier that protects the organism from noxious substances. Wounds destroy this barrier. Wound healing is a phased physiological regeneration of the destroyed tissue that ideally leads to occlusion of a wound, in particular by regeneration of connective tissue and capillaries. The Wnt signaling pathway is a highly conserved signal transduction cascade across the animal kingdom that controls basic cellular interactions in multicellular organisms. Accordingly, through the Wnt signaling path many processes, e. g. as the balance between proliferation and differentiation or apoptosis, coordinated. Wnt signaling is activated by a wound and participates in each subsequent phase of the healing process, beginning with inflammatory control and programmed cell death, to the mobilization of stem cells within the wound. Endogenous Wnt signaling is an attractive therapeutic approach to assist in the repair of skin wounds, as the complex mechanisms of the Wnt signaling pathway have become increasingly understood over the years. This review summarizes current data to clarify the role of Wnt signaling in the wound healing process of the skin.


Assuntos
Dermatopatias , Via de Sinalização Wnt , Animais , Diferenciação Celular , Humanos , Pele , Cicatrização
3.
Anaesthesist ; 68(12): 859-868, 2019 12.
Artigo em Alemão | MEDLINE | ID: mdl-31720727

RESUMO

Transparency in healthcare has been demanded and promoted for years. The aim of such transparency is disclosure of relationships and interests, so that patients can draw their own conclusions regarding the economic relations of their treating physician. Furthermore, transparency measures aim to prevent illegitimate payments. Overall, transparency should keep healthcare free from non-medical considerations, which may stand in contrast to the patient's wellbeing. Part of this strategy is the legislation aimed at fighting corruption in healthcare passed 13 April 2016, the so-called Anticorruption Act.


Assuntos
Assistência à Saúde/normas , Ética Médica , Fraude/legislação & jurisprudência , Humanos
4.
Laryngorhinootologie ; 98(5): 325-332, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31618775

RESUMO

BACKGROUND: The body dysmorphic disorder (BDD) is considered to be a sub-form of somatoform disorders. BDD can express itself in a delirious experience, an excessive evaluation and employment of the external appearance, in particular the face. Preliminary results suggest that individuals with BDD do not benefit from plastic surgery, so that aesthetic surgery often results in aggravation of their symptoms. Thus, the identification of signs for a BDD is crucial, whether a patient should be operated plastically-aesthetically. This overview explains the often difficult diagnostics of the BDD by summarizing the current literature on its screening. STUDY DESIGN: Systematic overview METHODS: An electronic search was conducted in the German and English-language literature in order to identify all screening instruments for the BDD. The specific development RESULTS: Six different screening instruments were identified for the BDD. Only two of these were evaluated in a cosmetic setting: the "Body Dysmorphic Disorder Questionnaire Dermatology Version" (BDDQ-DV) and the "Dysmorphic Concern Questionnaire" (DCQ). The influence on the subjective results after a plastic-aesthetic procedure was measured only for the DCQ. CONCLUSION: The limited availability of validated screening instruments for BDD in plastic surgery is markedly in contrast to the supposedly high prevalence of the disease of 2.4 %. Among the currently used screening tools, the BDDQ-DV and the DCQ appear to be most suitable. Further research efforts are needed to establish better screening methods for the BDD in the plastic surgical patient population and to examine the effects of BDD on treatment results.


Assuntos
Transtornos Dismórficos Corporais , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Transtornos Dismórficos Corporais/diagnóstico , Estética , Humanos , Inquéritos e Questionários
5.
Handchir Mikrochir Plast Chir ; 51(2): 111-118, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30763978

RESUMO

BACKGROUND: Due to the loss of the natural skin barrier function with reduced immune competence as a result of a plasma loss and the numerous intensive care interventions, burn patients are particularly at risk for infection. STUDY DESIGN: systematic review METHODS: A systematic review of German and English literature between 1990 and 2018 analyzes the epidemiological and diagnostic aspects as well as the therapeutic use of antibiotics in infections of burn patients in clinical trials. RESULTS: A total number of 53 randomized controlled clinical trials met the inclusion criteria. Various types / forms of application of antibiotic prophylaxis in burn wounds were investigated: topically, systemically (generally), systemically (perioperatively), nonabsorbable antibiotics (= selective intestinal decontamination), locally (inhaled) and all forms of administration versus control. Early postburn prophylaxis was studied in low-severity patients (six studies) and severe burn patients (seven studies). Antimicrobial prophylaxis has shown no effectiveness in the prevention of toxic shock syndrome in low grade burns, but can be useful in patients with severe burns in need for mechanical ventilation. Perioperative prophylaxis has been studied in ten studies. CONCLUSION: The benefit of long-term systemic antibiotic prophylaxis in the majority of burn patients is not evident. Mild infections in stable clinical conditions should be closely monitored, while in severe infections, international sepsis guidelines and the Tarragona principle are recommended.


Assuntos
Antibacterianos , Antibioticoprofilaxia , Queimaduras , Infecções Bacterianas/prevenção & controle , Queimaduras/complicações , Queimaduras/tratamento farmacológico , Humanos
6.
Handchir Mikrochir Plast Chir ; 51(4): 309-318, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30278469

RESUMO

The development and homeostasis of multicellular organisms depends on a complex cellular interaction between proliferation, migration, differentiation, adhesion, and cell death. Wnt signaling pathways coordinate these different cellular responses. Wnt signaling plays a role as a regulatory pathway in the osteogenic differentiation of mesenchymal stem cells. The Wnt signaling pathway is an attractive therapeutic target with the potential to directly modulate stem cells responsible for the regeneration of skeletal tissue. Recent studies indicate that Wnt ligands are capable of promoting bone growth, suggesting that Wnt factors could be used to stimulate bone healing in osteogenic disorders.


Assuntos
Osso e Ossos , Células-Tronco Mesenquimais , Osteogênese , Via de Sinalização Wnt , Osso e Ossos/metabolismo , Diferenciação Celular , Proteínas Wnt
7.
Handchir Mikrochir Plast Chir ; 49(6): 415-422, 2017 12.
Artigo em Alemão | MEDLINE | ID: mdl-28763813

RESUMO

BACKGROUND: The body dysmorphic disorder (BDD) is considered to be a sub-form of somatoform disorders. BDD can express itself in a delirious experience, an excessive evaluation and employment of the external appearance, in particular the face. Preliminary results suggest that individuals with BDD do not benefit from plastic surgery, so that aesthetic surgery often results in aggravation of their symptoms. Thus, the identification of signs for a BDD is crucial, whether a patient should be operated plastically-aesthetically. This overview explains the often difficult diagnostics of the BDD by summarizing the current literature on its screening. STUDY DESIGN: Systematic overview METHODS: An electronic search was conducted in the German and English-language literature in order to identify all screening instruments for the BDD. The specific development and validation processes are assessed whether the screening instruments have a positive predictive value for the BDD. RESULTS: Six different screening instruments were identified for the BDD. Only two of these were evaluated in a cosmetic setting: the "Body Dysmorphic Disorder Questionnaire Dermatology Version" (BDDQ-DV) and the "Dysmorphic Concern Questionnaire" (DCQ). The influence on the subjective results after a plastic-aesthetic procedure was measured only for the DCQ. CONCLUSION: The limited availability of validated screening instruments for BDD in plastic surgery is markedly in contrast to the supposedly high prevalence of the disease of 2.4 %. Among the currently used screening tools, the BDDQ-DV and the DCQ appear to be most suitable. Further research efforts are needed to establish better screening methods for the BDD in the plastic surgical patient population and to examine the effects of BDD on treatment results.


Assuntos
Transtornos Dismórficos Corporais , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Transtornos Dismórficos Corporais/diagnóstico , Estética , Humanos , Inquéritos e Questionários
9.
J Hand Surg Eur Vol ; 41(1): 94-101, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26115684

RESUMO

Carpal stability has traditionally been defined as dependent on the articular congruity of joint surfaces, the static stability maintained by intact ligaments, and the dynamic stability caused by muscle contractions resulting in a compression of joint surfaces. In the past decade, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. The proprioception of the wrist originates from afferent signals elicited by sensory end organs (mechanoreceptors) in ligaments and joint capsules that elicit spinal reflexes for immediate joint stability, as well as higher order neuromuscular influx to the cerebellum and sensorimotor cortices for planning and executing joint control. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities by delineating the sensory innervation and the neuromuscular control of the carpus, as well as descriptions of clinical applications of proprioception in carpal instabilities.


Assuntos
Articulações do Carpo/inervação , Articulações do Carpo/fisiopatologia , Instabilidade Articular/fisiopatologia , Articulações do Carpo/cirurgia , Humanos , Instabilidade Articular/terapia , Ligamentos Articulares/inervação , Ligamentos Articulares/fisiopatologia , Ligamentos Articulares/cirurgia , Mecanorreceptores/fisiologia , Procedimentos Ortopédicos , Aparelhos Ortopédicos , Modalidades de Fisioterapia , Propriocepção/fisiologia , Reflexo/fisiologia , Articulação do Punho/inervação , Articulação do Punho/fisiologia
10.
J Hand Surg Eur Vol ; 41(5): 527-33, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26685153

RESUMO

The morphological structure of the seven components of triangular fibrocartilage complexes of 11 cadaver wrists of elderly people was assessed microscopically, after staining with Hematoxylin-Eosin and Elastica van Gieson. The articular disc consisted of tight interlaced fibrocartilage without blood vessels except in its ulnar part. Volar and dorsal radioulnar ligaments showed densely parallel collagen bundles. The subsheath of the extensor carpi ulnaris muscle, the ulnotriquetral and ulnolunate ligament showed mainly mixed tight and loose parallel tissue. The ulnolunate ligament contained tighter parallel collagen bundles and clearly less elastic fibres than the ulnotriquetral ligament. The ulnocarpal meniscoid had an irregular morphological composition and loose connective tissue predominated. The structure of the articular disc indicates a buffering function. The tight structure of radioulnar and ulnolunate ligaments reflects a central stabilizing role, whereas the ulnotriquetral ligament and ulnocarpal meniscoid have less stabilizing functions.


Assuntos
Fibrocartilagem Triangular/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Coloração e Rotulagem
11.
Handchir Mikrochir Plast Chir ; 44(3): 147-54, 2012 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-22833068

RESUMO

BACKGROUND: This study analyses the outcome of a transosseous suture fixation for the ulnar collateral ligament (UCL) of the thumb, which is performed completely internally. METHODS: 60 patients with distal rupture of the UCL of the thumb were surgically treated with a transosseous suture technique. Patients with ligament tears surgically treated within 14 days after injury were included in Group 1 (n=33); patients with delayed surgical treatment (>14 days after injury) in Group 2 (n=13). Group 3 (n=14) contained patients with avulsion fractures. Subjective, functional, and radiological outcomes were evaluated after at least 24 months, and up to an average of 68 months after surgery. Statistical analysis was performed using the Kruskal-Wallis test, Mann-Whitney test, chi-square test, and Wilcoxon test. RESULTS: No significant differences were seen for the disability of the arm, shoulder and hand (DASH) scores among the groups. The average DASH score was 2.4±3 points in Group 1, 4.6±9 points in Group 2 and 5±8 points in Group 3. The visual and verbal pain analogue scales showed significant differences between Groups 1 and 2 at (p=0.02) and after exertion (p=0.03). Significant differences were seen for the flexion of the interphalangeal joint in Group 1 (p=0.004) and the radial abduction of the thumb in Group 3 (p=0.001), as compared to the contralateral hand. Furthermore, significant differences were obtained for the pinch strength between the thumb and the ring finger in Group 1 (p=0.03) and 3 (p=0.04), as well as pinch (p=0.02) and key strength (p=0.03) of the little finger in Group 1, again compared to the contralateral hand. Group 3 (p<0.001) showed significantly more radiological bony alterations at the distal UCL insertion than the other groups. CONCLUSIONS: This study shows good to very good subjective, functional, and radiological results in all 3 groups. Therefore, we recommend this transosseous suture fixation as an affordable, practicable technique for the treatment of acute rupture of the UCL of the thumb with and without avulsion fractures.


Assuntos
Ligamentos Colaterais/lesões , Fraturas Intra-Articulares/cirurgia , Articulação Metacarpofalângica/lesões , Articulação Metacarpofalângica/cirurgia , Técnicas de Sutura , Polegar/lesões , Adulto , Parafusos Ósseos , Ligamentos Colaterais/cirurgia , Terapia Combinada , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Ruptura , Polegar/cirurgia , Estudos de Tempo e Movimento
12.
Unfallchirurg ; 115(1): 38-46, 2012 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-20737132

RESUMO

BACKGROUND: The purpose of this study was to investigate the outcome after K-wire pinning of distal radius fractures with a minimum follow-up period of 5 years. PATIENTS AND METHODS: A total of 189 patients with an isolated fracture of the distal radius were treated between 1998 and 2002 and 100 were evaluated at an average of 5.6 years after the surgery. At the final follow-up examination all patients were assessed clinically and bilateral radiographs were taken. RESULTS: Of the patients 37 had an A type fracture, 8 a B type and 55 a C type according to the AO classification and 86% achieved good to excellent results based on the Gartland and Werley and Disability of Arm, Shoulder, Hand (DASH) scores. Patients were divided in to two groups. Group A included patients with fractures with a primary palmar inclination greater than -20° (range -20° to 10°) and group B with fractures with a primary palmar inclination less than -20° (range -45° to -20°). Secondary loss of reduction was significant higher in group B compared to group A (group B: 8.3°, group A: 1.6°, p <0.05). In 8 out of 11 patients of group B an osteoporosis was found. Functionally no difference was detected between the two groups. Radial shortening of over 4 mm resulted in a significant reduction (36%) of prosupination and supination. No other influence of the radiological results on the functional or subjective outcome was found. Superficial infection of the K-wire occurred in 6 cases, whereas early K-wire removal was performed in 2 cases, 8 patients complained of dysesthesia in the area of the superficial radial nerve and 5 patients developed an early stage of the complex regional pain syndrome. CONCLUSION: K-wire pinning cannot be routinely recommended. However, in cases of A2, A3 and C1 fractures, a primary dorsal dislocation of less than -20° and in patients without low bone mineral density, K-wire pinning leads to a high rate of radiological, functional good results.


Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Radiografia , Recuperação de Função Fisiológica , Resultado do Tratamento
13.
Z Orthop Unfall ; 149(5): e45-67, 2011 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-21984430

RESUMO

Injuries to the lateral ankle ligaments are the most common sports injuries. Determination of their severity and exclusion of relevant accompanying injuries requires a subtle clinical and a focussed radiological assessment. Treatment is non-operative and functional in the majority of cases. Consequent application of orthoses limiting supination and proprioceptive training are essential to avoid chronic instability. With recurrent ankle sprains one has to distinguish between functional and mechanical instability. The latter can be treated successfully with anatomic reconstruction and ligamentoplasty in more than 80 % of cases. Extraanatomic tenodeses should be reserved for cases of combined ankle and subtalar instability. Isolated injuries to the medial collateral ligaments are rare. Therefore, osseous injuries or underlying deformities have to be excluded. Isolated deltoid ligament ruptures may be treated non-operatively. Unstable injuries to the distal tibiofibular syndesmosis resulting in a manifest or latent diastasis are treated with open reduction and fixation with two tibiofibular set screws. Anatomic reduction of the distal fibula into the tibial groove is of utmost prognostic relevance and therefore should be reliably proved with either intraoperative 3D fluoroscopy or postoperative CT scanning. For chronic syndesmotic instability an anatomic ligamentoplasty using half the peroneus longus tendon is recommended.


Assuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos em Atletas/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Articulares/lesões , Traumatismos do Tornozelo/diagnóstico , Traumatismos em Atletas/diagnóstico , Fíbula/lesões , Fíbula/patologia , Fíbula/cirurgia , Fluoroscopia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Instabilidade Articular/diagnóstico , Ligamentos Laterais do Tornozelo/patologia , Ligamentos Laterais do Tornozelo/cirurgia , Ligamentos Articulares/patologia , Ligamentos Articulares/cirurgia , Imagem por Ressonância Magnética , Modalidades de Fisioterapia , Complicações Pós-Operatórias/reabilitação , Recidiva , Entorses e Distensões/diagnóstico , Entorses e Distensões/cirurgia , Tíbia/lesões , Tíbia/patologia , Tíbia/cirurgia , Tomografia Computadorizada por Raios X
14.
Z Orthop Unfall ; 149(5): 560-7, 2011 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-21594818

RESUMO

BACKGROUND: This study analyses the outcome of a transosseous suture fixation for the ulnar collateral ligament (UCL) of the thumb, which is performed completely internally. METHODS: 60 patients with distal rupture of the UCL of the thumb were surgically treated with a transosseous suture technique. Patients with ligament tears surgically treated within 14 days after injury were included in Group 1 (n = 33); patients with delayed surgical treatment (> 14 days after injury) in Group 2 (n = 13). Group 3 (n = 14) contained patients with avulsion fractures. Subjective, functional, and radiological outcomes were evaluated after at least 24 months, and up to an average of 68 months after surgery. Statistical analysis was performed using the Kruskal-Wallis test, Mann-Whitney test, chi-square test, and Wilcoxon test. RESULTS: No significant differences were seen for the disability of the arm, shoulder and hand (DASH) scores among the groups. The average DASH score was 2.4 ± 3 points in Group 1, 4.6 ± 9 points in Group 2 and 5 ± 8 points in Group 3. The visual and verbal pain analogue scales showed significant differences between Groups 1 and 2 at (p = 0.02) and after exertion (p = 0.03). Significant differences were seen for the flexion of the interphalangeal joint in Group 1 (p = 0.004) and the radial abduction of the thumb in Group 3 (p = 0.001), as compared to the contralateral hand. Furthermore, significant differences were obtained for the pinch strength between the thumb and the ring finger in Group 1 (p = 0.03) and 3 (p = 0.04), as well as pinch (p = 0.02) and key strength (p = 0.03) of the little finger in Group 1, again compared to the contralateral hand. Group 3 (p < 0.001) showed significantly more radiological bony alterations at the distal UCL insertion than the other groups. CONCLUSIONS: This study shows good to very good subjective, functional, and radiological results in all three groups. Therefore, we recommend this transosseous suture fixation as an affordable, practicable technique for the treatment of acute rupture of the UCL of the thumb with and without avulsion fractures.


Assuntos
Ligamentos Colaterais/lesões , Ligamentos Colaterais/cirurgia , Microcirurgia/métodos , Complicações Pós-Operatórias/etiologia , Âncoras de Sutura , Técnicas de Sutura , Polegar/lesões , Polegar/cirurgia , Adulto , Parafusos Ósseos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Força de Pinça/fisiologia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Ruptura
15.
Arch Orthop Trauma Surg ; 130(3): 313-9, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18839193

RESUMO

HYPOTHESIS: Subtalar instability is thought to be one of the possible causes for chronic functional instability of the foot and ankle. The purpose of this study was to determine the extent of ligament injury that is followed by subtalar instability and to depict consecutive pathologic joint motion. METHODS: Twelve fresh human cadaver lower legs were investigated with respect to pathologic motion and mobility of the subtalar joint in a modified spinal column simulator after arthrodesis of the talocrural articulation and selective sectioning of the lateral ligaments of the subtalar joint. In order to simulate several injury mechanisms, ligaments were dissected starting anteriorly in group one (n = 6) and posteriorly in group two (n = 6). RESULTS: Dissection of the bifurcate ligament in group one resulted in a significant increase in plantar- and dorsiflexion, dissection of the inferior extensor retinaculum resulted in a significant increase in eversion and inversion. Additional dissection of the lateral talocalcaneal ligament resulted in a significant increase in internal and external rotation. Dissection of the calcaneofibular ligament in group two was followed by significant kinematic changes regarding all degrees of motion in the subtalar joint. CONCLUSIONS: The calcaneofibular ligament plays a key role in lateral stabilisation of the subtalar joint. Therefore, ligaments of the subtalar joint should be included in surgical repair.


Assuntos
Instabilidade Articular/fisiopatologia , Ligamentos Articulares/lesões , Articulação Talocalcânea , Artrodese , Fenômenos Biomecânicos , Cadáver , Humanos , Rotação
16.
J Hand Surg Eur Vol ; 34(3): 351-7, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19282403

RESUMO

Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should provide sufficient collateral blood flow from adjacent regions in some patients. Since blood supply is available from the palmar circulation, a dorsal approach to the scaphoid bone is possible.


Assuntos
Osso Escafoide/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Cadáver , Circulação Colateral , Feminino , Humanos , Masculino , Osso Escafoide/patologia
17.
Unfallchirurg ; 109(10): 837-44, 2006 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-16969651

RESUMO

BACKGROUND: The purpose of the present study was to investigate the influence of the radiological parameters on the functional outcome of patients with a fracture of the distal radius and to find out to which extent a deformity can be tolerated. PATIENTS AND METHODS: A total of 344 patients with an isolated fracture of the distal radius were treated during a 3-year period; 211 of them were evaluated at an average of 16 months after the accident according to the score of Gartland and Werley as modified by Sarmiento. Furthermore, we developed our own score for evaluating the influence of radiological parameters on the functional outcome. RESULTS: According to the AO classification, there were 20 patients with an A2, 71 an A3, 11 a B, 35 a C1, 44 a C2, and 30 a C3 fracture. Of 211 patients, 28 (13%) had a step-off in the articular surface of over 1 mm, resulting in a 24% reduction of the range of motion compared to the non-injured wrist (p<0.05). Patients with a radial shortening of more than 3 mm (n=12) had a 21% reduction of pro- and supination compared to the non-injured side (p<0.05). The radial tilt and the palmar inclination did not have a direct influence on the functional outcome. Patients treated with K-wire pinning and with an initial palmar inclination of less then -15 degrees had a significantly higher secondary loss of palmar inclination of 9 degrees compared to all others (p<0.05) at the final follow-up. CONCLUSION: The main radiological factors influencing the functional outcome of fractures of the distal radius are radial shortening and a step-off in the articular surface.


Assuntos
Avaliação de Resultados em Cuidados de Saúde/métodos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Adolescente , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Radiografia , Fraturas do Rádio/epidemiologia , Estatística como Assunto , Resultado do Tratamento
18.
Handchir Mikrochir Plast Chir ; 37(4): 267-75, 2005 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-16149036

RESUMO

PURPOSE/BACKGROUND: Compression of peripheral nerves is a well known complication of articular synovial cysts. The peroneal nerve is the most common site of intraneural ganglia (pseudocysts) originating from the proximal tibiofibular joint. The neurological deficit associated with these cysts is often severe due to delayed diagnostic and surgical treatment. Therefore, recurrence is very often seen and recovery is incomplete. MATERIAL AND METHODS: We report a case of a 60-year-old man with peroneal nerve palsy caused by recurrent proximal tibiofibular joint ganglion. RESULTS: Within the context of the current literature, clinical symptoms, diagnostics, differential diagnosis with regard to imaging methods, neurology, pathology and the broader spectrum of operative and non-operative treatment are discussed. The cyst was completely resected, but a recurrent cyst developed eight years later. At reoperation, a communication of the cyst with the tibiofibular joint was demonstrated. Despite complete resection of the cyst and ligation of the ganglion stem, a routine postoperative MRI disclosed a second recurrence of the cyst nine months later. On the last clinical examination, twelve years after onset of the symptoms, a complete paresis of the peroneal nerve was seen. CONCLUSION: This entity needs careful, prompt preoperative evaluation to avoid neurological damage. Surgical treatment includes microsurgical decompression and complete resection of the cyst and also ligation of the ganglion stem. Early diagnosis and treatment is required to ensure recovery.


Assuntos
Cistos Glanglionares/complicações , Articulação do Joelho , Neuropatias Fibulares/etiologia , Diagnóstico Diferencial , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/diagnóstico por imagem , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/diagnóstico , Modalidades de Fisioterapia , Radiografia , Recidiva , Reoperação , Fatores de Tempo , Ultrassonografia
19.
Unfallchirurgie ; 21(1): 1-7, 1995 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-7709490

RESUMO

Six different polyglycolide and poly(-L-lactide) rods were tested biomechanically: native, in vitro and in vivo. They were Biofix-C and Biofix-CG rods and 4 poly(-L-lactide) rods with a molecular weight between 70,000 and 700,000. Their flexual strength and elasticity module were determined by the 3-point flexion test. A total of 70 pins were implanted in the soft tissue and intramedullary to splint tibial osteotomies of 30 rabbits. The Biofix rods' flexural strength was high. There was no difference due to coating (346 to 402 N/mm2). In vitro experiments showed a rapid loss strength by 75 and 90%, equivalent to 2 to 3 weeks' implantation. The initial strength of the lactide pins was about 60% lower than that of the polyglycolid rods. The stability of the former after implantation decreased at a lower rate, with 25% of the initial strength being retained after 14 weeks. The histological findings were commensurate with the loss of flexural strength.


Assuntos
Materiais Biocompatíveis , Fixação Interna de Fraturas/instrumentação , Poliésteres , Ácido Poliglicólico , Próteses e Implantes , Animais , Fenômenos Biomecânicos , Osso e Ossos/patologia , Tecido Conjuntivo/patologia , Feminino , Reação a Corpo Estranho/patologia , Consolidação da Fratura/fisiologia , Masculino , Coelhos
20.
Ophthalmologe ; 89(4): 283-7, 1992 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-1304200

RESUMO

Plasma formation with nanosecond and picosecond Nd:YAG laser pulses was investigated as a function of laser pulse energy to find possibilities for a spatial reduction of the laser effects. The threshold for plasma formation (optical breakdown) in distilled water is 200 microJ for ns pulses and 15 microJ for ps pulses. At a pulse energy of 1 mJ, the plasma length is 80 microns for ns pulses and 250 microns for ps pulses. For the same pulse energy, ps plasmas are on average three times larger than ns plasmas. The plasma length is approximately proportional to the cube root of the laser pulse energy for both ns and ps laser pulses. The decrease in the breakdown threshold achieved by using ps pulses renders photodisruption with a smaller pulse energy (in the microJ range) possible, and therefore a reduction in the side effects. The results are compared with the "moving breakdown" model.


Assuntos
Iris/cirurgia , Terapia a Laser/instrumentação , Cápsula do Cristalino/cirurgia , Epitélio Posterior/lesões , Temperatura Alta/efeitos adversos , Humanos , Iris/fisiopatologia , Cápsula do Cristalino/fisiopatologia , Modelos Anatômicos
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