Spinous process-plasty following lumbar laminectomy as a contributing factor to spine stability

A 10-year retrospective study of 41 consecutive patients who underwent spinous process-plasty is presented. We carried out laminectomy of the lumbar spine in cases of spinal stenosis, dorsomedial herniated disc and recurrent disc herniation with firm scars (traumatic and tumour cases are not included). To forestall the development of laminectomy's negative effects on spine stability, we initiated the spinous processes' reconstruction. Two groups of patients who underwent laminectomy form the basis of this presentation, one group with spinous process-plasty (41 patients) and the other (11 patients) without it. On postoperative neutral and dynamic X-ray films we paid attention to horizontal displacements larger than 3 mm and to negative intervertebral angular displacement. Considering such criteria, only 3.8% of those with spinous process-plasty developed a radiographic instability in contrast to 25% of patients without spinous process-plasty. These results support the use of this technique, which provides postlaminectomy lumbar spine stability.     

Reconstruction of bony defects using the Ilizarov “bone transport” technique

Summary Ilizarov's method of percutaneous transosseous osteosynthesis allows management of complex skeletal deformities using elastic external fixation, atraumatic corticotomy and gradual adaptations between bony fragments. One particular application, useful in the reconstruction of bony defects, is the lift or bone transport technique, in which in fact internal lengthening is carried out. Using some of their first cases as illustrations, the authors describe the technique and its potential problems.     

Demonstration of the 5-flap technique

Summary Demonstration of the 5-flap technique which is double opposed Z-plasty and Y – V advancement is presented. A 4×4 gauze serves to demonstrate this technique.The authors dedicate this paper to the dear memory of their teacher, the late Prof. Zvi Neuman, who passed away untimely on March 22, 1977     

Premature craniosynostosis a retrospective analysis of a series of 52 cases

Summary A retrospective analysis of a consecutive series of 52 cases with premature craniosynostosis is presented.Excellent functional, cosmetic, and social results could be achieved by resection of prematurely fused sutures and the creation of artificial growth sutures. Pronounced skull deformities have been corrected using the basket handle, the visor plasty, and the T-bone techniques or a combination of several of these skull form correction techniques. The surgical correction of the skull base by the frontal advancement technique in combination with orbitotomy was only necessary in 2 of our cases and could have been considered in 2 additional cases viewed retrospectively.Our results support the hypothesis that the primary cause of skull deformity is the premature closure of vault sutures and not a primary deformity of the skull base.     

Diagnostic value of automatically interpreted oculopneumoplethysmography

The diagnostic value of the Gee-oculopneumoplethysmography test for the detection of hemodynamically significant carotid artery obstructions has frequently been questioned due to the rather low agreement with arteriography. The kappa-corrected diagnostic accuracy of this test has been reported to be in the range between 0.54 and 0.68. These values indicate a fair to good agreement with arteriography. One of the causes for this rather low agreement is the variability in the interpretation of oculopneumoplethysmography recordings. Automatic analysis of oculopneumoplethysmography recordings might minimize the risks of misinterpretation and might improve the clinical significance of the Gee-oculopneumoplethysmography test. By assessing the signals of a conventional Gee-oculopneumoplethysmography apparatus in a personal computer, this automatic analysis has been realized. In a clinical study (population of 85 patients) the diagnostic value of automatic analysis of oculopneumoplethysmography recordings has been evaluated. The automatically interpreted Gee-oculopneumoplethysmography test had a kappa-corrected diagnostic accuracy of 0.71 on a per side base and of 0.76 on a per patient base.     

Computer assisted quantification of vasospasm on angiograms

Summary We describe a new computer-based, automated method for the assessment of in vivo cerebral vasospasm. Arterial diameter measurements were performed on post-processed digital substraction angiographic images, using pixel as the unit. Vasospasm which was difficult to detect by visual inspection could be measured by the stenosis quantification program. A computer-assisted method such as we describe might decrease the risk of subjective errors.     

Composition and calcium binding of proteinpolysaccharides of calf nasal septum and scapula

Proteinpolysaccharide (PP-L) of resting and ossifying zones of calf scapular cartilage and of calf nasal septum cartilage was extracted with aqueous 0.15 M KCl and fractionated into a series of products: PP-L3, PP-L4, PP-L5, PP-L6. An additional proteinpolysaccharide fraction, PP-L2, was extracted from the cartilage residues with hydroxylamine. Differences in chemical composition among corresponding proteinpolysaccharides obtained from the three cartilage sources were, in general, small. The calcium binding capacity of the PP-L, PP-L2, and PP-L3 samples, as measured by equlibrium dialysis, appeared to reflect principally their uronic acid and exchangeable sulfate contents. Application of a cation exchange technique indicated that PP-L from resting and ossifying zones of scapular cartilage had similar affinities for tracer quantities of calcium. However, the affinity of PP-L from both zones of scapular cartilage for tracer quantities of calcium was greater than that of PP-L from nasal septum. The data obtained from this study do not indicate sufficient differences between the chemical composition and calcium affinity of proteinpolysaccharides from resting and ossifying scapular cartilage to account for the calcium uptake in the ossifying zone.This work was supported by the U.S. Atomic Energy Commission and by U.S. Public Health Service Special Fellowship (QTS), 1-F3-GM-16, 179–01.     

HA-coated hip implants: A 10 year follow-up

Summary We started using HA-coated hip prostheses on May 1997 and our personal experience reaches to date 2075 HA hips of which 1898 were primary hips. This study was based upon a consecutive series of 134 consecutive HA cases implanted from May '87 until December '88, at the Clinique Médico-Chirurgicale of Bruay-Labuissière, France. No patient was lost to follow up. 26 patients deceased and of the 104 remaining cases, 58 complete dossiers were available for addressing clinical and radiological scored results. Within the 58 over 10 year cases cohort, mean age was 56 years. Main aetiology was osteoarthritis in 81% and necrosis in 17%, 1 case was a revision one. Femoral component was HA Omnifit stem in all the cases, fitted with Arc 2f cup. No case of loosening nor any mechanical failure was observed within this over 10 yr of FU series, since 4 reoperations were related to 2 stiffnesses and 2 recurrent dislocations with neither retrieval of acetabular nor femoral component.As regards radiographic findings, femoral lysis over 10 yr was none in 48%, limited to neck area in 28%, proximally extended in 24%, as no case of distal lysis was observed. 88% of cups had no lysis at 10 yr of FU. All our 58 10 yr+ cases belonged to the ingrowth confirmed group. Mean values of HHS scores were preoperatively 33.34 ± 12.46 out of 100 pts preoperatively up to 97.6 pts at 10 year. Thus results were excellent in 86%, good in 9%, fair in 5%, and poor in 0%. Mean values according to Merle d'Aubigne score (MDA) were 7.98 ± 1.74 pts out of 18 preoperatively up to 16.90 pts at 10 yr, leading to 84% of excellent, 11% of good, 5% of fair and 0% of poor results.When considering the cumulative survival analysis since 1987, the results at 10 year, based upon the 1922 primary cases reaches 0.9889 ± 0.0061 when considering all types of failures (Mechanical loosening + Clinical failure + Radiological failure). While considering a 10 year follow-up period as a major milestone in terms of hip results, the results of this series may look very encouraging and lead us to remain confident in bioactive coatings.     

34. Akute und chronische Pankreatitis. Morphologische Grundlagen

Zusammenfassung Die akute Pankreatitis zeigt mit der jauchigen Nekrose und der Vielfalt der Fettgewebsnekrosen ein eindrucksvolles Bild. Dennoch sind einige Teilaspekte wenig bekannt und für das Verständnis der Krankheit wichtig, z. B. die häufige Aussparung des Kerns der Drüse. Die anatomischen Äquivalente von Schock, Schmerz, Ileus werden erläutert, auf das Krankheitsbild Pankreatitis ohne Pankreatitis wird kurz eingegangen. Als Komplikationen werden die Chronifizierung und die Pseudocysten dargestellt. Die chronische Pankreatitis bis zur ausgebrannten Drüse mit Stein, Diabetes und möglicherweise Carcinom wird in ihrer Entstehung anatomisch gezeigt.

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Fundamental morphological aspects of acute and chronic pancreatitis

Summary Acute pancreatitis presents an impressive picture, with autodigestic necrosis and various types of necrosis of fat tissue. Nevertheless, some side aspects are little known, although they are important to the understanding of the disease, e.g. the frequent sparing of the kernel of the gland. The anatomical equivalents of shock, pain, ileus are exvlained, and the syndrome of pancreatitis without pancreatitis will be briefly discussed. The complications of progression to a chronic state and of pseudocysts will be shown. The development of chronic pancreatitis leading to the burnt out gland with stones, diabetes and possibly carcinoma will be shown anatomically.

     

Reduction mammoplasty: General approach and basic considerations

Reduction mammoplasties must take into consideration volume, mammary base, and forward projection in establishing criteria for a standard breast. Any reduction procedure involves the mammary gland or mass, the skin, and the nipple-areola complex.Since 1969, we have used a dermal vault technique on over 1,200 patients with satisfactory results. It produces a short, well-situated scar, a pleasing form, ideal residual mammary volume, and good stability.     

Primary bladder neck obstruction

Summary Primary bladder neck obstruction is not uncommon in young and middle age men. The symptoms are confounding and routine urologic investigation including cystometry, uroflow, voiding cystourethrography and cystourethroscopy often leads to an erroneous diagnosis of psychogenic voiding dysfunction, neurogenic bladder or prostatitis. An accurate diagnosis can be obtained by the simultaneous measurement of detrusor pressure and uroflow, preferably accompanied by radiographic visualization of the lower urinary tract during micturition. Treatment with bladder neck incision is usually curative, but often results in retrograde ejaculation.     

Surgical implications of “fixed points”: A new concept in plastic surgery

The dynamic study of surface anatomy brings to light the existence of fixed points. This new concept allows us to better understand the difficult problem of skin excess and the crumpled appearance sometimes seen after liposuction. Understanding this phenomenon will avoid unaesthetic or nonfunctional results of plastic surgery.     

Cranioplasty of an extremely large cranial defect caused by transitional meningioma with a knitted polypropylen-polyester prothesis “Codubix”

Summary The authors report a case of transitional cell meningioma of the convexity which destroyed a large portion of the calvarium and invaded subcutaneous tissue. The tumour was totally removed and a large cranial defect/430 cm² in size/ was filled with a polypropyleno-polyester knitted prothesis Codubix with an excellent result.The problems of chronioplastic closure of such an unusually large skull defect and the advantages of the use of the material Codubix are discussed.     

Cerebral reperfusion in brain death of a newborn. Case report

A case of sudden infant death after 15 minutes of successful resusciation of cardiovascular function is presented. While apnoic cranial nerve areflexia and electrocerebral silence persisted, angiography and transcranial Doppler sonography demonstrated nearly normal cerebral perfusion, which even increased day by day inspite of the persistence of other signs of brain death. The phenomenon cerebral reperfusion is concluded to be compatible with the diagnosis of brain death.     

Absorptiometry and “osteoporosis”: problems

connecting the dots between diverse clinical and other matters and an updated bone physiology reveals relationships that could modify some ideas about the roles and uses of absorptiometry in osteoporosis work. Herein, absorptiometry means that part of clinical densitometry that depends on X-ray absorption by bone and other tissues, thus excluding ultrasound methods and magnetic resonance imaging. The modifications concern, in part, some limitations of bone mineral density data, the kinds of physiological information that absorptiometry can and cannot provide, the relative importance of bone mass and whole-bone strength, how to define and study bone health and osteoporosis, and two kinds of osteoporotic fractures. As those modifications concern important national health care issues, they deserve answers based on hard evidence. Identifying those modifications might help others to evaluate them.     

The distribution of extracellular matrix vesicles in healing of rat tibial bone three days after intramedullary injury

Summary The distribution of extracellular matrix vesicles on the third day of bone healing was studied by morphometric analysis of transmission electron micrographs. Detection and grouping of the vesicles was performed according to type, diameter, and distance from the calcified front. The different types were selected as follows: vesicles with electron-lucent contents (empty), vesicles with amorphous electron-opaque contents (amorphic), vesicles containing crystalline depositions (crystal), and vesicles containing crystalline structures with ruptured membranes (rupture). The majority of vesicles were between 0.07 µm and 0.12 m in diameter and were located at less than 3 m from the calcified front. The distribution of the empty, amorphic, crystal, and rupture vesicles was 23.2%, 74%, 2.5%, and 0.3% respectively. Their sequence of arrangement according to diameter was as follows: empty, amorphic, crystal, and rupture, the empty vesicles constituting the smallest and the rupture the largest type. Distances from the calcified front were similar for the empty, amorphic, and crystal vesicles, while the rupture type was located nearest to the front. The present observations support the widely acknowledged hypothesis on the role of extracellular matrix vesicles in mineralization. It is thought that the secretion of empty vesicles from the cell is followed by intravscular accumulation of amorphous Ca and Pi to form a hydroxyapatite crystal that, in turn, ruptures the vesicle's membrane. The maturation process is accompanied by an increase of the vesicular diameter and its approximation to the calcifying front.     

Contractile behaviour of the human pyelo-ureteral musculature

Summary In normal proximal and distal pyeloureteral human strips and in pathological reflux or obstructive segments the influence of repetitive electrical stimulation at frequencies between 0.01 and 200 Hz on their contractile behaviour was studied. Between 0.01 and 1 Hz baseline tone and maximum amplitude of contraction were dependent on stimulation frequencies, but some strips showed an irregular response pattern. At frequencies between 1 and 200 Hz half of the strips showed a typical on and off contraction (at the beginning and end of the stimulus period respectively) separated by a plateau. We consider the off reaction to be a response to an ionic displacement at the end of the stimulus. Spontaneous activity was mostly observed in Tyrode solution and in calix and pyelum. Transmural nerve stimulation did not change the contraction patterns.     

209. Die Behandlung der nichtinfizierten Schaftpseudarthrosen

Zusammenfassung Während bei der reaktiven, elefantenfußartigen Form eine stabile Osteosynthese die Heilung zur Folge hat, sind beim reaktionslosen atrophischen Poeudarthrosetyp zusätzlich zur stabilen Osteosynthese eine Dekortikation und eine Spongiosaplastik notwendig.Im Film werden beide Pseudarthrosetypen an der Tibia mit einer Platte stabilisiert, und zwar einer Zuggurtungsplatte für die elefantenfußartige und einer Neutralisationsplatte für die atrophische Pseudarthrose. Im letzteren Fall erfolgt nach Dekortikation und Spongiosaplastik zusätzlich ein Längenausgleich der um 2,5 cm verkürzten Tibia. Technik der Behandlung der Pseudarthrosen sowie der Verlängerung werden im Schema und in den einzelnen Operationsphasen ausführlich dargestellt.

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The treatment of non-infected pseudarthroses of the tibia

Summary The elephant foot type of reactive pseudarthrosis heals after rigid internal fixation, but the atrophic, non-reactive type requires decortication and an autogenous cancellous bone graft in addition.The film shows stabilization of the tibia with a plate in both types; a tension band plate is used in the case of elephant foot type pseudarthrosis and a neutralizing plate in the atrophic case. In the latter case the tibia has shortened by 2.5 cm, and this is corrected after decortication and the autogenous bone graft are complete. The techniques to be used in the treatment of pseudarthroses and that of lengthening are illustrated in detail, both in diagrams and at various stages of the operation.

     

121. Modifizierte Technik der „Ersatzklappen”-Operation an der V. poplitea bei postthrombotischem Syndrom

Zusammenfassung Die Technik der Ersatzklappen-Operation an der V. poplitea bei postthrombotischem Syndrom wurde vom Initiator durch die Verwendung einer 24cm langen Silicone-Sehne modifiziert. Die Silicone-Sehne wird zwischen A. und V. poplitea durchgezogen, ihr mediales Ende an die Gracilissehne und ihr laterales Ende um die Bicepssehne vernäht. Bei 31 durchgeführten Operationen konnte klinisch und phlebographisch bei allen eine regelrechte Ersatzklappen-Funktion und eine Besserung der venösen Hämodynamik des Beines festgestellt werden.     

Evaluation of urodynamic studies by computer

Summary In an attempt to simplify urodynamic evaluation, the data obtained from cystometry, urethral profile and flowmetry were analysed using the ICS recommendations for standardization and terminology. All studies were compiled from check lists feasible for computation. The aim was to establish standards and typical changes for the normal bladder and pathological states to enable automatic readout of computed data. The results did, in fact, show typical changes but failed to establish standard measurements suitable for completely computed diagnoses.