Functional cineangiography in the diagnosis of arterial occlusive diseases of the lower extremities

An analysis of cineangiograms of lower extremity arteries of 225 patients with occlusive lesions of the abdominal aorta and lower extremity arteries has been made. Symptoms detected by cineangiography are described which allow to judge on stenotic lesions of the arteries with greater reliability than by the data of serial angiography. Quantitative analysis of cineangiograms has been performed with the determination of time of blood flow along arterial segments.     

Possibilities for early detection of arthroses using imaging procedures

Today early detection of osteoarthrosis (OA) must imply the recognition of initial changes of articular cartilage before radiological signs appear. A noninvasive imaging technique must meet the demands of imaging the articular cartilage layer with high contrast and surface irregularities (fibrillation) and changes within the substance. This can only be achieved by magnetic resonance imaging (MRI) with optimized conditions (3D-gradient echo sequence). In 80 patients, 62% of them without radiological signs of OA, articular cartilage of the knee joint was prospectively (70 patients) and retrospectively (10 patients) investigated with MRI and compared with the arthroscopic findings. Normal cartilage could be distinguished from pathological conditions with a specificity of more than 90% when evaluating surface morphology, signal homogeneity and, above all, signal intensity (40 patients). Full-thickness defects were identified in all cases. Cartilage fibrillation of differing depths (grades 1-3) could not be differentiated with a sufficient degree of reliability and requires a more subtle evaluation method by means of improved software. Thus, the noninvasive recognition of early pathological changes of articular cartilage in patients without radiological signs of OA has become possible.     

肢体闭合性皮肤撕脱伤的早期诊治

目的 探讨闭合性皮肤撕脱伤的早期诊断和治疗。方法 回顾我院1991年10月至2001年12月收治的76例肢体碾压伤中7例肢体闭合性皮肤撕脱伤患者的诊断过程，采用带蒂的保留真皮下血管网皮肤与全厚或中厚皮结合的网格状皮肤原位回植方法修复创而。结果 7例患者中有6例手术治疗后皮肤全部成活，1例经穿刺放血保守治疗成功。结论 汽车车轮碾过肢体后没有造成皮肤伤口时，应高度怀疑肢体闭合性皮肤撕脱伤，手术治疗效果满意。     

Biochemical and molecular biologic aspects of early detection of human arthroses

New insights into the biochemical and cell-biological alterations occurring in articular cartilage during the early phase of osteoarthrosis (OA) have been gained in the past decade by analysing experimentally induced osteoarthrosis in animals, mostly dogs and rabbits, while early phases of OA in humans so far have escaped diagnostic evaluation. Before the beginning of surface fibrillation loss of proteoglycans from the cartilage matrix could already be detected, as could activation of the synthesis of proteoglycans, collagens and degradative enzymes in chondrocytes. The discovery of a variety of new proteoglycans, glycoproteins and collagens in hyaline cartilage has created new experimental possibilities of identifying specifically different types and stages of degradative alterations in articular cartilage. For the analysis of proteoglycans and collagens a number of biochemical, immunological and molecular biological methods have been developed that allow analysis of cartilage samples from animal experiments - arthroscopic as well as operation probes. In this article we present examples of such studies showing sepharose elution profiles of proteoglycans from normal and OA cartilage, types I, II, and VI collagen expression in articular chondrocytes by immunofluorescence, as well as type X collagen synthesis by cultured arthrotic chondrocytes by metabolic labelling and gel electrophoresis.     

Drug therapy of arthroses

Osteoarthritis (OA) is one of the most common diseases requiring treatment. A clear clinical and pathophysiological understanding of the disease is required before treating a patient with OA. Drug therapy of patients with OA is mainly divided into two groups: a group receiving symptomatic therapy and a group receiving drugs intended to modify or improve the disease. Symptomatic therapy includes pure analgesics as well as non-steroidal antirheumatic drugs and muscle relaxants. Their use depends on the activity as well as on the form of clinical manifestation (activated/decompensated disease). If there are signs of severe activation, intra-articular steroids, orgotein or even synoviorthesis with yttrium are administered as local therapy. All of these therapies are used in the sense of trouble shooters, as they cannot alter the course of the disease in the long run. The disease-modifying substances have well been investigated in vitro and in animal models. Furthermore, some clinical trials have shown evidence for the usefulness of these substances in the therapy of OA.     

Physical therapy of arthroses

The physical therapy of arthrosis as a symptomatic and stage-oriented therapy is illustrated in a review. All of the various therapeutic procedures are discussed regarding their effectiveness and applicability in the different stages. There have been some changes within the last few decades and treatments have been introduced with more or less success. Mild thermotherapy of active arthrosis, suggested earlier, has been replaced by cryotherapy, which is more effective. Peloid therapy has now also been introduced into this cryotherapy, which only used to be applied as a type of heat therapy. Naturally, most of the new developments are in the field of electrotherapy. Nevertheless, the newer types have not led to any significant improvement in therapeutic success compared with "classical" electrotherapy (diadynamic, Tr?bert ultrastimulation, interferential current). The only remarkable innovation seems to be therapy with low-frequency magnetic fields, although the basic means of the working mechanism have not been thoroughly investigated. Regarding the most recent publications, laser therapy has not shown complete proof of its effectiveness. Passive physical therapy of arthrosis only shows persistent success when it is combined with a careful amount of physical therapy.     

Treatment of arthroses in the elderly patient

BACKGROUND: Elderly subjects with osteoarthritis are treated with analgesic drugs, non-steroidal antiinflammatory drugs (NSAID) and intra-articular corticosteroid injections as well as symptomatic slow acting drugs in osteoarthritis (Sy-SADOA). BASIC REGIMENS: Initial treatment for osteoarthritis pain should be paracetamol, followed by NSAID if necessary, especially in the elderly, because of their adverse effects. EFFICACY: Sy-SADOA are effective on pain and function with a persistent effect, allowing the reduction of analgesic and NSAID dosage.     

Functional morbidity of hyperthermic isolated regional perfusion of the extremities

Background: Isolated regional perfusion (IRP) of an extremity is a major operation. The therapeutic value for stage I melanoma is still controversial and is presently being investigated in a prospective, randomized study by the European Organization for Research and Treatment of Cancer. So far there are no reliable data available concerning the morbidity of IRP. Therefore, we performed a prospective, randomized study on this topic. Methods: In a prospective study, a group of 97 patients with a stage I melanoma localized on an arm or leg were randomized for IRP with melphalan followed by wide excision (WE) and fasciotomyor for WE only. Morbidity was evaluated on the basis of the following parameters: duration of hospitalization, postoperative pain, postoperative performance, and grade of perfusion toxicity. At 12-month follow-up, a physical diagnostic examination was performed to measure the mobility of the joints, and the circumference and volume of the treated and untreated extremities. Results: All the parameters, including the physical diagnostic examination, could be evaluated in 83 of the 97 patients (8 patients died of metastatic disease and 1 patient died of another disease before they could be investigated; 2 patients were in too poor physical condition due to metastases to be examined, and 3 patients were unable to participate for nonmedical reasons). Age and sex distribution were comparable in the various patient groups. Treatment mortality was 0%. There were no complications except for urine retention (one patient) and wound dehiscence (one patient). After IRP + WE of the lower limb, the period of hospitalization was an average of 1.9 days longer (p=0.01) than for WE on the limb only. This difference was absent for the arm. Naturally after perfusion, there was a significant difference in toxic reactions (edema and pain) between the IRP + WE patients and the WE-only patients. However, at 12-month follow-up, the difference in morbidity between IRP + WE and WE-only patients was no longer present: Morbidity of joints and circumference of the limb were the same. A number of subjective complaints were encountered fairly often after IRP + WE (e.g., pricking sensations or pain during changes in the weather), which can possibly be explained by fibrosis caused by perfusion. These complaints were not quantified further because they did not hinder the patients' functioning. Conclusions: In the long term, IRP with fasciotomy does not cause any additional morbidity. Immediately after the operation, there was more morbidity as a result of the perfusion, which caused a 2-day- longer period of hospitalization in the patients with lower-limb perfusion compared with those who underwent WE only. These findings are in contrast to those in the literature, in which 25% limitation of motion in the ankle joint after perfusion is mentioned. One explanation may be that we always performed fasciotomy after perfusion to prevent (sub)clinical compression syndrome and avoid late fibrosis.     

Functional recovery of tendons and nerves after early repair of electric burns of the extremities using cutaneous and myocutaneous flaps

A new operative treatment for the early repair of electric burn injuries by using cutaneous or myocutaneous flaps are recommended. The functional results of the burnt tendons and nerves were followed up. 174 operations among 134 cases were performed from 1964 to 1984, amputation rate were decreased to 9.7%. The percentage of functional recovery of the burnt tendons at wrist canal are 97.6% and which of the 21 burnt peripheral nerves are 80.9%.     

Technical orthopedic aspects of the treatment of arthroses

Technical orthopedic treatment of joint diseases still has a place in the treatment plan, although the role is supplementary and it is seldom the only form of therapy. Its most important tasks have to do with immobilization and stabilization, followed by shock absorption, decompression, and equalizing defective axial positioning and differences in leg length. Finally, orthopedic treatment plays an important role in joint diseases in the protection of the joint from cold and drafts. Deformed joints, malpositioning, atrophied soft tissue and poor circulation, however, require that the indications be weighted carefully. The various technical orthopedic possibilities are presented and discussed.     

Ultrasonic diagnosis of post-thrombotic disease of the lower extremities

On the basis of a rich experience and developed techniques of examination the authors claim that ultrasonic scanning is a highly informative and safe method for the diagnosis of postthrombotic disease of the lower limbs which yields all the necessary data on the condition of the deep main veins. With the introduction of this method into wide clinical practice the disease will be diagnosed in time, its stage and form determined, and the performance of phlebography, which is still necessary, will be less frequent.