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  • 1
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter Hämorrhagischer Schock ; Leukozytenadhäsion ; Lebermikrozirkulation ; Intravitalmikroskopie ; Key words Haemorrhagic shock ; Leukocyte adhesion ; Hepatic microcirculation ; Intravital microscopy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Deferoxamine is known to reduce the iron-dependent generation of toxic oxygen- derived radicals during reperfusion of ischaemic tissue. The present study investigates the antioxidative properties of a deferoxamin-conjugated hydroxyethyl starch solution and its effects on the hepatic microcirculation in a haemorrhagic-shock rat model. Methods: Anaesthetized Sprague-Dawley rats were tracheotomized, prepared for invasive haemodynamic monitoring, and subject to haemorrhagic shock (MAP=40 mmHg during 60 min). The animals were resuscitated blood-free with lactated Ringer’s (RILA, n=10), gelatine (GELA, n=10), hydroxyethyl starch (HES, n=10), or deferoxamine-conjugated HES (DFO, n=8) solution (MAP≥70 mmHg). After 1 h of resuscitation the hepatic microcirculation was investigated by intravital microsscopy, the glutathione concentration was measured in liver homogenate, and the thiobarbituric acid reactive substances (TBARS) were determined as markers of lipid peroxidation. Results: Resuscitation resulted in restoration of MAP to ≥70 mmHg within a short time. The volume required to stabilise the arterial pressure during 1 h of resuscitation was significantly less in the DFO group compared with HES, GELA, and RILA. Significantly higher glutathione levels in liver homogenate as well as decreased TBARS levels were observed in the DFO group. The shock-induced increase of leukocyte adhesion in liver sinusoids was significantly attenuated by DFO. Conclusion: DFO significantly attenuates shock-induced oxidative stress, thereby reducing the early inflammatory reaction and improving the hepatic microcirculation.
    Notizen: Zusammenfassung Fragestellung: Die Synthese der während der Reperfusion ischämischen Gewebes aus der Haber-Weiss-Reaktion Fe-abhängig hervorgehenden toxischen Sauerstoffradikale kann durch Deferoxamin, einen potenten Fe-Chelator, verringert werden. Die vorliegende Studie untersucht eine Deferoxamin-konjugierte Hydroxyethylstärkelösung auf ihre antioxidativen Eigenschaften und Auswirkungen auf die hepatische Mikrozirkulation am hämorrhagischen Schockmodell der Ratte. Methodik: Sprague-Dawley-Ratten wurden in Pentobarbitalanästhesie tracheotomiert, für ein invasives hämodynamisches Monitoring präpariert und einem hämorrhagischen Schock unterzogen (MAP=40 mm Hg während 60 min). Die blutfreie Volumentherapie wurde entweder mit Ringerlaktat (RILA; n=10), Gelatinelösung (GELA; n=10), Hydroxyethylstärke (HES; n=10) oder mit Deferoxamin-konjugierter Hydroxyethylstärkelösung (DFO; n=8) durchgeführt (MAP≥70 mm Hg). Eine Studie nach Beginn der Volumentherapie wurde die Mikrozirkulation der Leber intravitalmikroskopisch untersucht und die Glutathionkonzentration im Leberhomogenat sowie die Thiobarbitursäure-reaktiven Substanzen als Marker der Lipidperoxidation gemessen. Ergebnisse: Mit jeder der verwendeten Volumenersatzlösungen konnte der MAP innerhalb kurzer Zeit auf ≥70 mm Hg angehoben werden. In der mit DFO behandelten Gruppe konnte eine signifikant geringere Abnahme an reduziertem Glutathion im Lebergewebe sowie eine geringere Zunahme der Lipidperoxidation als Zeichen des verminderten oxidativen Stresses beobachtet werden. Die schockinduzierte verstärkte Leukozytenadhäsion in Lebersinusoiden wurde durch DFO signifikant vermindert. Schlußfolgerung: DFO vermindert signifikant den schockinduzierten oxidativen Streß, schwächt damit die frühe Entzündungsreaktion ab und bewirkt eine Verbesserung der Lebermikrozirkulation.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 2
    ISSN: 1615-3146
    Schlagwort(e): Key words Classification ; Children's fractures ; Fractures of the epiphyseal plate ; Localisation ; Morphology ; Displacement ; “Spontaneous” corrrection
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract It is absolutely necessary to classify children's fractures for quality controls and clinical research. It is not possible that a classification of children's fractures will follow hierarchies, such as the prognosis of growth, the kind of treatment, the severity of the lesion, the patient's age, as well as medical expenditures and different techniques of therapy. The prognosis of growth is dependent on the patient's age and the localisation of the fracture in the bone and in the skeleton. The kind of treatment is dependent on the extent of displacement as well as on the localisation in the bone. Thus, a classification of children's fractures can only be characterized by the localisation of the fracture and the morphology. In addition, a parameter of “tolerable displacement” should be involved in the classification – as a sign for the possibility of spontaneous correction of displacements by further growth. From the morphological/functional point of view, the epiphyseal plate injuries should be differentiated into a metaphyseal part without proliferation but with mineralisation potential, and an epiphyseal part with proliferation but without mineralisation potential. From this aspect of functional morphology the epiphyseal separation – as a lesion in the metaphyseal part of the physis – belongs to the metaphyseal fractures (so to speak, it is the most peripheral shaft fracture), and the epiphyseal fracture – as a lesion in the epiphyseal part of the physis – belongs to the joint fractures. The localisation is differentiated into 4 main segments: upper arm, forearm, femur, and lower leg. In the segment itself, a subdivision is made into proximal, middle, and distal, with proximal and distal being further differentiated in metaphysis and epiphysis. In addition, it is possible to differentiate between radial and ulnar and tibial and fibular. The morphology is differentiated into typical fractures of the epiphysis, the metaphysis and the shaft fractures as well as avulsion fractures of ligaments, avulsion fractures of muscles and flake fractures. Exceptions in the consequent classification of morphology are only made at the distal end of the humerus and at the neck of the femur. the parameter of “tolerable displacement” showes up already known “ spontaneous corrections” of displacements in the joints, the metaphysis and the epiphysis. The proposed classification should be used in prospective clinical studies to evaluate the prognosis of growth and the results of different therapeutic approaches.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 3
    ISSN: 1615-3146
    Schlagwort(e): Key Words Radial head ; Radial neck ; Minimally invasive technique ; Percutaneous osteosynthesis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Integrity of soft tissues plays a major role in the final outcome of fractures of the proximal radius. Numerous minimally invasive operative techniques were developed to avoid additional trauma during surgical procedure. An overview over the literature is given in the present paper. We report a modified technique of Kapandji for percutaneous reduction and stabilization of displaced radial neck and radial head fractures in children. Functional results in 5 cases were good, and the children had no complaints. In one case with a luxation of the elbow and a fracture of the lateral epicondyle of humerus persitent rotation deficit was oberseved. The modified percutaneous method described here demonstrates an alternative procedure to reduce and stabilize displaced radial head and radial neck fractures. In contrast to open reduction this method avoids impairment of the anular ligament and joint capsule. Associated complex injuries of the elbow with soft tissue trauma, however, may lead to unsatisfactory functional results despite minimal operative technique and anatomic reduction.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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