Arnold Soren

Pathogenesis, clinic, and treatment of ganglion.

SummaryIn clarification of various theories on the pathogenesis of the ganglion, histopathologic examinations indicate that the ganglion develops from connective tissue by myxoid degeneration and disintegration of collagen fibers. Increasing amounts of mucinous fluid accumulate by the progressive liquefaction of collagen fibers and are surrounded by densifying collagen bundles which form a delimiting capsule. In view of the inadequacy of conservative treatment and the shortcomings of excision, the subcutaneous (s.c.) discission of the ganglion with a tenotome is recommended. Of 184 patients treated in this way, 151 displayed full healing, six underwent a successful repetition of the procedure, nine underwent an excision of the recurrent ganglion, and 18 rejected further treatment.ZusammenfassungZur Klärung der verschiedenen Theorien fiber die Pathogense der Ganglien erwiesen histopathologische Untersuchungen, daß das Ganglion aus Bindegewebe durch Zerfall and myxoide Degeneration von Kollagenfasern mit Ansammlung schleimiger Flüssigkeit and Verdichtung der umgebenden Kollagenbündel entsteht. Als Behandlung wird die subcutane (s.c.) Diszission des Ganglion empfohlen. Von 184 derartig behandelten Patienten boten 151 vollständige Heilung dar, sechs unterzogen sich einer erfolgreichen Wiederholung des Verfahrens, neun machten eine sekundäre Exzision mit und 18 lehnten eine weitere Behandlung ab.

On the etiology of congenital malformation of the meniscus

SummaryIn order to explain the occurrence of malformed meniscus in man, dissections were carried out in various vertebrates; they revealed that menisci shaped like a plate, disc, or ring are physiological components of the knee joint in several vertebrates. Microscopic examinations of tissue sections through the knee joints of human embryos revealed that the meniscus develops from an intermediate mesodermal blastema, which has the shape of a thick plate in the early embryonic period. The occurrence of a malformed meniscus in man may be explained by persistence of a very early embryonic stage and also possibly by reversal to a phylogenetic shape.

Contracture of the shoulder joint

The movements of the shoulder joint may sometimes be markedley limited due to posttraumatic or inflammatory changes in the shoulder joint or in adjacent organs, a condition designated as contracture of the shoulder joint or frozen shoulder. The routine treatment consists of positioning the arm as often as possible in abduction, and of diligent active and passive mobilization exercises. In those patients who started the treatment after a long delay so that the articular as well as the periarticular tissues were very shrunken, manipulation of the shoulder joint was carried out under general anesthesia this led to the return of full motion of the joint in the great majority of these patients. However, in those patients who did not benefit by manipulation, surgical revision of the joint and of periarticular structures was carried out for excision of all scarified tissues. The result was restoration of the mobility of the joint to an adequate although not total range.

Kinetics of Salicylates in Blood and Joint Fluid

Samples of blood and joint fluid from 30 patients who had taken buffered acetylsalicylic acid were examined for concentrations of total salicylates (TSA), acetylsalicylate (ASA) and salicylate (SA). The data were arranged in groups according to diagnosis of the joint disease. Analysis of the data did not show significant difference in the kinetics of TSA into blood. In groups the time to first appearance of 0.3 mg/l averaged 6.3 min for TSA; these values averaged 7.7 min for ASA and 10.9 min for SA. Close to maximum concentrations in blood averaged 18.9 mg/l for TSA, 3.3 mg/l for ASA, and 23.3 mg/l for SA. The time for first appearance of 0.3 mg/l of total salicylates in joint fluid ranged from 10 to 34 min with an average of 18.1 min; the values of ASA averaged 19.4 min and those of SA 21.9 min. The maximum concentration in joint fluid averaged 15.7 mg/l for TSA, 2.5 mg/l for ASA, and 14.5 mg/l for SA. Transport of salicylates from blood to joint fluid showed a pattern consistent with the type of joint disease. Support was found for the hypothesis that diffusion was the major factor in the movement of salicylates from blood to joint fluid.

Microscopic comparison of the synovial changes in posttraumatic synovitis and osteoarthritis.

The similarity of the histopathologic changes in posttraumatic synovitis and osteoarthritis suggests that similar etiologic agents, possibly macro- and microtraumata, were pathogenetic factors in common.

Spondylolisthesis and related disorders. A correlative study of 105 patients.

A close relation exists among the alterations in the lumbosacral spine designated as spondylolysis, isthmic spondylolisthesis, degenerative spondylolisthesis, and prespondylolisthesis. While the former two conditions are probably caused by faulty development and subsequent minor traumata or repeated stresses, the third condition is caused by degenerative changes associated with anatomic variations; the fourth condition is a static insufficiency leading to faulty alignment. In 105 patients, the initial preferred management of these conditions was conservative. Thirty-four patients who developed persistent symptoms of spinal instability and/or intractable neurologic deficits were treated surgically. The results were generally successful.

Surgical correction of hallux valgus

SummarySurgical treatment of hallux valgus was carried out by a procedure which comprises lengthening of extensor tendons, interposition of a capsular flap, and attachment of the periosteocapsular cover with distributed tension in addition to the routine excision of a sufficiently large portion of the first phalanx and metatarsal head. Impairment of function and persistent pain were considered more important in the indication for operation of hallux valgus than the cosmetic demands. Of 142 patients operated upon, 117 patients displayed a satisfactory result applying morphologic and functional criteria.ZusammenfassungDie chirurgische Behandlung des Hallux valgus wurde durch eine Methode ausgeführt, welche Verlängerung der Extensorsehnen, Zwischenlagerung eines Kapsellappens, Anheftung eines Periost-Kapsel-Lappens mit verteilter Spannung zusdtzlich zur üblichen Entfernung eines genügend großen Anteiles von Grundphalanx und Metatarsalkopf umfaßte. Beeinträchtigung der Funktion und andauernde Schmerzhaftigkeit wurden für die Indikation zur Operation maßgebender als die kosmetischen Belange erachtet. Von 142 derartig operierten Patienten boten 117 Patienten ein zufriedenstellendes Resultat unter Zugrundelegung morphologischer und funktioneller Maßstäbe.