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Articles by Andreas Paech
Total Records ( 7 ) for Andreas Paech
  Andreas Paech
  Although digital imaging techniques are also available for ultrasound imaging with most of the modern machines, only contrast optimization is regularly used. The possible improvement in image quality by digital reprocessing with different filtering techniques was assessed. An independent sonography specialist assessed the shoulder of a healthy test person. Previously described and frequently used standard setup slices were used for this study. A video print was generated after every standard setup, the images were then reprocessed. The resulting edited sonographic images were investigated and judged by 5 experienced sonologists. Several combinations of sonographic views and digital enhancement techniques significantly improved image quality. In conclusion digital reprocessing can improve the quality of images in ultrasound studies of the healthy shoulder.
  Stefan Farke , Andreas Paech , Michael Duchrow , Tobias Bethge , Thilo Wedel , Buko Lindner , Uwe J. Roblick , Hans-Peter Bruch and Rainer Broll
  In times of reduced financial margins, resterialization of surgical meshes is a possibility to economise their use. To test whether re-sterilization of polypropylene meshes (initially gas-sterilized) by steam autoclaving is advisable we analyzed resterilized specimens on structural alterations and the release of cytotoxic substances. Gas-sterilized (non-resterilized) and resterilized (121°C, 20 min) nonabsorbable PROLENE (Ethicon, Germany) meshes (1 cm2) incubated 48 h under cell culture conditions were imaged using scanning electron microscopy. Potential release of substances from original and resterilized meshes was analyzed on lyophilisates using mass spectrometry. Toxicity of lyophilisates was tested on cultures of primary fibroblasts by estimation of proliferation and apoptotic index. Original meshes showed a smooth surface. Filaments of resterilized meshes exhibited tears and crevices of variable depth. After incubation under cell culture conditions, filaments of non-resterilized and especially resterilized meshes revealed tears and crevices. Dots of variable size have formed on the surface. Mass spectrograms of resterilized meshes demonstrated release of polymer molecules with a mass difference of 44 amu. Finally, apoptotic index of fibroblasts incubated with lyophilisates of resterilized meshes was significantly elevated. Re-sterilization of polypropylene meshes leads to distinct material defects on filament`s surface and a release of substances which causes apoptosis in human fibroblasts. For this reason, re-sterilization of polypropylene meshes should be avoided.
  Andreas Paech , Arndt P. Schulz , Johannes Kiene , M.M. Kaiser and Christian Jurgens
  The biomechanical inlay testing of a newly developed modular cemented acetabular component system is under investigation. The aim of this study, was to determine how strong the bondage of the inlay with the metal shell is in in-vitro testing. A Cementable Metal-Cup (C-MIC) was crafted in the commonly used sizes. Its material (cobalt-chromium-molybdenum alloy) was configured to the needs of cementation. For biomechanical inlay testing standard test methods for determining the axial disassembly force of a modular acetabular device were used. Push in/out and Torsion as well as lever-out inlay tests were performed. The mean maximal push-out force for the 28mm inlay was: 1.140 kN; for the 32mm test inlay was 2.483 kN. Mean results for the lever-out torque for test inlay 28 mm were 14.40 Nm, for the test inlay with 32 mm it was 45.93 Nm. The test results for the torsion tests: Inlay 28 mm: 17.545 Nm and 53.252 Nm for test Inlay 32 mm. The results of these biomechanical experiments have proven a high stability for the anchorage of the inlays in this newly developed C-MIC-cup.
  Andreas Paech , Felix Renken , Arndt P. Schulz , Roman Nasshut , Christian Juergens and Michael E. Wenzl
  In Total Hip Arthroplasty (THA) there is so far no device on the market that enables surgeons to use a cemented acetabular component with the possibility of different inlays. We present an acetabular metal backed shell that has been specifically developed for this purpose. Basis of our approach was to gain all profits from the cement-less method of hip replacement where, after press-fit fixation of the metal-cup, a great variety of inlays can be attached. Polyethylene, ceramic- or snap-inlays-even with different geometries (straight or asymmetric) - can be combined with different head-diameters (28/32/36 mm). The presented modular cementable acetabular component system (C-MIC), newly developed and utility patented in collaboration with ESKA Implants GmbH (Luebeck, Germany), combines the advantages of both methods.
  Martin M. Kaiser , Martina Kohl , Kianusch Tafazzoli , Andreas Paech , Arndt P. Schulz and Lucas M. Wessel
  For omphaloceles, specially giant ones, different approaches of abdominal wall repair exist. Serious complications can follow staged repair as well as primary closure. We performed a delayed direct closure under stable conditions. Eight patients (gestational age: 26-37 weeks, birth weight: 710-3240 g) with omphalo-celes of different sizes were treated prospectively. The hernial sac was protected by a sterile dressing and gentle upward traction was performed without sedation or anaesthesia. This allowed spontaneous reduction of herniated viscera and liver, before the defect was closed. Seven defects were closed on day 2-14. No serious complications were observed. At follow-up 15-34 months cosmetic results were excellent without ventral hernia. One re-laparotomy for ileus due to adhesions was necessary. The preterm infant with 730 g birth weight died of severe intracranial haemorrhage before the defect could be closed. Present treatment proved to be safe and reliable, even in two giant omphaloceles. Multiple operative procedures as well as prosthetic material were avoided. No infection or abdominal-compartment syndrome occurred. Cosmetic results were very good, no secondary ventral hernia or other long-term complications developed.
  Martin M. Kaiser , B. Lange , Arndt P. Schulz , Andreas Paech and Lucas M. Wessel
  The aim of this study is to describe the technique and first results of treatment of metacarpal fractures of children and adolescents with a new method. Fractures of the second to fifth metacarpal bone were treated with only one Elastic Stable Intramedullary Nail (ESIN) and followed prospectively. These patients were reviewed at a mean follow-up time of 9 months. Patientís satisfaction was very high, especially because of almost no postoperative pain and lack of immobilization This method offers an effective and safe alternative in the treatment of closed displaced fractures of the 2nd to 5th metacarpus without significant complications.
  Stefan Farke , Boris Jansen-Winkeln , Christian Franke , Andreas Paech , Albert Jagle , Ernst Kraas and Frank Fischer
  Laparoscopic surgery is the gold standard for the treatment of symptomatic gall stones. However, it remains unclear when an open surgical or a laparoscopic approach is more appropriate in difficult acute or rare cases. The tactical concept in the decision making is presented. Between June 1990 and December 2001, 7303 patients underwent a cholecystectomy, 6942 operations were completed minimally invasive. There were 990 (13.6%) with acute cholecystitis and 47 (0,6%) with malignant disease of the gallbladder. A conversion was required in 1.66% of all operations and in 10.61% for acute cholecystitis. The total rate of complications was 4.2% without significant differences between acute or chronic cholecystitis. In the study period there were 47 patients with malignancies of the gallbladder. The 5-years, survival rate depended on the stage of the tumour and the operation carried out. The clinical suspicion of malignancy is usually associated with an advanced stage. In these cases open laparotomy is the access of choice. Early tumours are frequently incidentalomas that laparoscopic surgery alone can be sufficient to cure. In summary, laparoscopic resection can be considered safe even for difficult indications. A standardised surgical approach and an experienced team is most important.
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