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  • 1
    Electronic Resource
    Electronic Resource
    A comparison of sevoflurane to halothane in paediatric surgical patients: results of a multicentre international study (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 6 (1996), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Induction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with nitrous oxide/oxygen and sevoflurane or halothane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement laryngospasm, bronchospasm, increased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P= 0.037) and rapid emergence times (10.3 min vs 13.9 min, P= 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Postoperatively, 46% of the children in the halothane group developed nausea and or vomiting versus 31% in the sevoflurane group (P= 0.002). Two children in the halothane group developed cardiac dysrhythmia and were dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an uneventful recovery. Mean maximum inorganic fluoride concentration was 18.3 μM˙l−1. The fluoride concentrations peaked within one h of termination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of choice for the anaesthetic management of children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1460-9592.1996.tb00452.x
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  • 2
    Electronic Resource
    Electronic Resource
    Three-dimensional location of ribosomal protein BL2 from Bacillus stearothermophilus, a key component of the peptidyl transferase center
    Amsterdam : Elsevier
    FEBS Letters 233 (1988), S. 119-123 
    Details
    ISSN: 0014-5793
    Keywords: Immunoelectron microscopy ; Peptidyl transferase center ; Ribosomal protein BL2 ; Ribosomal topography
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
    URL: http://linkinghub.elsevier.com/retrieve/pii/0014-5793(88)81367-X
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  • 3
    Electronic Resource
    Electronic Resource
    Endocrine stress reaction to surgery in brain-dead organ donors (1996)
    Springer
    Transplant international 9 (1996), S. 102-108 
    Details
    ISSN: 1432-2277
    Keywords: Brain death, endocrine stress ; Donor, endocrine stress ; Stress hormones, brain death ; Endocrine stress, brain death
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We studied the course of plasma levels of the stress markers adrenocorticotropic hormone (ACTH), cortisol, human growth hormone (h-GH), β-endorphin, and prolactin during retrieval surgery in eleven brain-dead organ donors scheduled for multiple organ explantation. Donors were divided into two groups according to hemodynamic stability. Hormones demonstrated a great variability in plasma levels and in the pattern of reaction, revealing a different degree of remaining pituitary function. β-Endorphin was the only stress hormone that showed a response to surgical stimuli in six patients. Only three of them developed a concomitant rise in ACTH. Cortisol, prolactin, and h-GH plasma levels did not change during the observation period. In the three cases with a slight elevation in ACTH, no subsequent change in cortisol was detectable. β-Endorphin showed greater variability and a tendency to higher levels in the group presenting with a higher arterial pressure, which resulted in a significant difference (P〈0.005) when distributions were compared using the Mann-Whitney U-test. No correlation was found between hypotensive episodes and deficiencies of other stress hormones. We conclude that pituitary function varies considerably in brain-dead organ donors without demonstrating a correlation to the onset of hypotension. Thus, we feel no need for a substitution treatment with any of the hormones investigated prior to organ explantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00336386
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  • 4
    Electronic Resource
    Electronic Resource
    Langzeitergebnisse nach konservativer oder operativer Therapie der vorderen Kreuzbandruptur (1996)
    Springer
    Der Unfallchirurg 99 (1996), S. 964-969 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Vordere Kreuzbandruptur ; Konservative Therapie ; Operative Therapie ; Key words Anterior cruciate ligament reconstruction ; Conservative treatment ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: The treatment of anterior cruciate ligament (ACL) rupture continues to be a controversial subject. This study was undertaken to compare long-term results of different therapy regimens A total of 52 patients (mean age: 34.7±3.2 years) who underwent ACL reconstruction using the central one third of the patellar tendon and 32 patients (mean age: 38.3±5.2 years) treated conservatively were evaluated 5–7 years clinically, radiologically and with respect to their sports activities. In all, 25% of the patients operated on subjectively rated their knees as ``excellent'', 40.4% as ``very good'', 22.2% ``good'', 12.5% ``fair'' and 0% as ``poor''. The ratings for the conservatively treated group were: 12.9%, 19.4%, 29%, 25.8% and 12.5%, respectively. The results of the OAK score were significantly better for the surgically treated group (87.5±7.1 points compared with 77.1±13.4). An increasing number of degenerative changes were found on radiographs in both groups at follow-up as compared with their pre-injury status.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050081
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  • 5
    Electronic Resource
    Electronic Resource
    Mittel- bis langfristige Ergebnisse nach arthroskopisch assistierter Behandlung der Schienbeinkopffrakturen (1999)
    Springer
    Arthroskopie 12 (1999), S. 121-124 
    Details
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Tibiakopffraktur ; Arthroskopie ; Bildwandlerkontrollierte Reposition ; Operative Rekonstruktion ; Key words Tibial plateau fracture ; Arthroscopy ; Imaging intensifier-controlled procedure ; Operative reconstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Of 23 patients operated following tibial plateau fracture we personally examined 19 clinically and radiographically. All patients had undergone an arthroscopically assisted, imaging intensifier-controlled procedure. Early operative reconstruction (2.8 days) was carried out in all patients (15 monotrauma, 4 polytrauma). Fractures were classified according to the AO system (3 B1, 5 B2, 8 B3, 1 C2, 2 C3). Isolated screw fixation was performed in 13 and additional butress plating in 6 patients. There were no significant intraoperative or immediate posteroperative complications. Reoperation was carried out due to secondary meniscus lesion (1), loose bodies (1), arthrofibrosis ( 1) and malalignment (1). Classification of posttraumatic osteoarthritis was graded according to Fairbank’s classification I (n 7), II (n 5), III (n 2). Malalignment was 0–5° in 5 patients and more than 5° in one patient. Arthroscopically-assisted procedures and simultaneous control by imaging intensifier is recommended in the management of tibial plateau fractures classified in group B, according to AO.
    Notes: Von 23 operativ – arthroskopisch-BV-kontrollierten – behandelten Tibiakopffrakturen wurden 19 mit einem Follow-up von 6 Jahren persönlich klinisch und radiologisch nachkontrolliert. Die operative Rekonstruktion erfolgt in allen Fällen (15 Monotraumen – 4 Mehrfach- bzw. Polytraumen) frühzeitig im Durchschnitt 2,8 Tage nach dem Unfall. Die Osteosynthese der Frakturen (3 B1, 5 B2, 8 B3, 1 C2 und 2 C3-Frakturen) erfolgte nach den Richtlinien der AO – Imprimathebung, Rekonstruktion der Gelenkfläche und interne Stabilisierung. Es gelangten dabei die islolierte Verschraubung in 13 und die additive Plattenosteosynthese in 6 Fällen zur Anwendung. Eine intraoperative sowie unmittelbar postoperative Komplikation im Sinn einer neurovaskulären Schädigung eines Kompartmentsyndroms oder eines Infekts fand sich in keinem der Fälle. Die 4 Reoperationen waren erforderlich wegen Reruptur des lateralen Meniskus (1), freier Gelenkkörper (1), Bewegungseinschränkung (1) und einer Achsenkorrektur wegen Valgusfehlstellung über 5°. Die Klassifikation der osteoarthrotischen posttraumatischen Veränderung erfolgte nach Fairbanks. Dabei fanden sich in 7 Fällen Veränderungen von Grad I, in 5 Fällen von Grad II und in 2 Fällen vom Grad III. Eine Achsenfehlstellung konnte bis maximal 5° bei 5 Patienten und 〉 5° bei 1 Patienten nachgewiesen werden. Die arthroskopisch BV-kontrollierte assistierte Behandlung der Tibiakopffraktur ist besonders für das Management der B-Frakturen geeignet, wobei die korrekte Wiederherstellung der Beinachse sowie die stufenlose Rekonstruktion des Gelenkplateaus Voraussetzung für das Erreichen eines guten Ergebnisses sind.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001420050085
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  • 6
    Electronic Resource
    Electronic Resource
    Point-of-Care-Testing – das Intensivlaboratorium (1999)
    Springer
    Der Anaesthesist 48 (1999), S. 3-8 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Point-of-Care-Testing (POCT) ; Turn-Around-Time ; Zentrallabor ; Intensivstation ; Notfallaufnahme ; Key words Point-of-Care-Testing (POCT) ; Turn-Around-Time ; Central Laboratory ; Intensive Care Unit ; Emergency Room
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract After successful centralization of laboratory analyses since more than 30 years, advances in biosensors, microprocessors, measurement of undiluted whole blood and miniaturization of laboratory analyzers are leading nowadays more and more to a re-decentralization in the laboratory medicine. Point-of-care-testing (POCT), which is defined as any laboratory test performed outside central or decentralized laboratories, is becoming more and more popular. The theoretical advantages of POCT are faster turn-around-times (TAT), more rapid medical decisions, avoidance of sample identification and sample transport problems and the need of only small specimen volumes. These advantages are frequently mentioned, but are not associated with a clear clinical benefit. The disadvantages of POCT such as incorrect handling and/or maintenance of the analyzers by non-trained clinical staff, inadequate or even absent calibrations and/or quality controls, lack of cost-effectiveness because of an increased number of analyzers and more expensive reagents, insufficient documentation and difficult comparability of the obtained POCT-results with routine laboratory results, are strongly evident. According to the authors’ opinion the decision for the establishing of POCT has only to be made in a close co-operation between physicians and laboratorians in order to vouch for necessity and high quality of the analyses. Taking the local situation into consideration (24-h-central laboratory, etc.) the spectrum of parameters measured by means of POCT should be rigorously restricted to the vital functions. Such analytes should be: hemoglobin or hematocrit, activated whole blood clotting time, blood gases, sodium, potassium, ionized calcium, glucose, creatinine, ammonia and lactate.
    Notes: Zusammenfassung Nach erfolgreicher Zentralisierung der Laboranalytik seit mehr als 30 Jahren, führen Fortschritte bei Biosensoren, Mikroprozessoren, Messung in unverdünntem Vollblut und die Verkleinerung von Laboranalysen heute wieder immer mehr zu einer neuerlichen Re-Dezentralisierung in der Labormedizin. Das Point-Of-Care-Testing (POCT) wird nahe dem Patienten außerhalb von zentralen oder dezentralen Laboratorien durchgeführt. Die theoretischen Vorteile des POCT sind schnellere Turn-Around-Times (TAT), schnellere medizinische Entscheidungen, Vermeidung von Probenidentifizierungs- und Probentransportproblemen sowie die Notwendigkeit von nur kleinen Probenmengen. Diese Vorteile werden zwar oft hervorgehoben, gehen jedoch nicht mit einem klar erkennbaren klinischen Nutzen einher. Die Nachteile des POCT wie unsachgemäße Handhabung und/ oder Wartung der Analysengeräte durch das ungeschulte Stationspersonal, mangelnde oder fehlende Kalibration und/oder Qualitätskontrolle, Kosten durch Vorhaltung mehrerer Geräte und teurerer Reagenzien, insuffiziente Dokumentation und schwierige Vergleichbarkeit zwischen den POCT-Ergebnissen und den Routinelaborergebnissen, sind ebenfalls augenscheinlich. Nach Meinung der Autoren sollte die Entscheidung zur Etablierung eines POCT nur in engster Kooperation zwischen Klinikern und Labormedizinern erfolgen, um Sinnhaftigkeit und hohe Qualität der Analysen zu gewährleisten. Unter Berücksichtigung der lokalen Situation (24 h-Zentrallabor, etc.) sollte sich das Parameterspektrum des POCT streng auf vitale Funktionen beschränken. Die dafür notwendigen Analyte sollten sein: Hämoglobin oder Hämatokrit, Aktivierte Vollblut-Gerinnungszeit, Blutgase, Natrium, Kalium, ionisiertes Kalzium, Glukose, Ammoniak und Laktat.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050661
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  • 7
    Electronic Resource
    Electronic Resource
    Effects of porcine somatotropin on the chemical body composition and fat quality in growing-finishing pigs (1997)
    Springer
    European journal of nutrition 36 (1997), S. 294-298 
    Details
    ISSN: 1436-6215
    Keywords: Body composition ; fat ; growth ; somatotropin ; pig ; Körperzusammensetzung ; Fett ; Wachstum ; Somatotropin -Schwein
    Source: Springer Online Journal Archives 1860-2000
    Topics: Agriculture, Forestry, Horticulture, Fishery, Domestic Science, Nutrition , Medicine
    Description / Table of Contents: Zusammenfassung An 78 männlichen Kastraten und weiblichen Schweinen der Kreuzung Pietrain x (Deutsches Edelschwein x Deutsche Landrasse) wurden Untersuchungen zum Einfluß einer porcinen Somatotropin (pST)-Behandlung während des Wachstums auf die chemische Körperzusammensetzung der Tiere, das Adipozyten-Wachstum und das Fettsäure-Profil des Rückenspecks untersucht. Die intramuskulären Injektionen (1 oder 3 mg pST) wurden täglich ab durchschnittlich 65 kg Lebendgewicht bis zum Schlachten verabreicht. Nach der pST-Behandlung wurden bei den Kastraten in allen untersuchten Merkmalen signifikante Unterschiede festgestellt, während sich bei den weiblichen Tieren nur leichte Reaktionen zeigten. Das pST verursachte eine Zunahme des Wasserund Proteingehaltes bei gleichzeitiger Reduzierung des Lipidgehaltes besonders in den fettreichen Körperteilen der Tiere. Im Rückenspeck war der Gehalt an ungesättigten Fettsäuren erhöht und der Fettzelldurchmesser erniedrigt.
    Notes: Summary Seventy eight growing-finishing pigs (male castrates and females) of the cross-breed Pietrain x (Large White x German Landrace) were used to investigate the effects of pST treatment on the chemical composition of the body, the growth of adipocytes, and the fatty acid profile of the backfat. Intramuscular injections (1 or 3 mg pST) were administered daily from an average weight of 65 kg up to slaughter. After pST treatment significant changes in all studied characteristics were observed in barrows, whereas the females exhibited very small responses. The pST caused an increase of water and protein contents and a simultaneous decrease of lipid content especially in body parts rich in fat. Furthermore, the proportion of unsaturated fatty acids increased and the fat cell diameter decreased in the backfat.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01617801
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  • 8
    Electronic Resource
    Electronic Resource
    Effect of large volume replacement with balanced electrolyte solutions on extravascular lung water in surgical patients with sepsis syndrome (1989)
    Springer
    Intensive care medicine 15 (1989), S. 505-510 
    Details
    ISSN: 1432-1238
    Keywords: Extravascular lung water ; Fluid therapy ; Balanced electrolyte solutions ; Sepsis syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We investigated the effect of large volume replacement with balanced electrolyte solutions on extravascular lung water (EVLW) in 16 adult surgical patients with sepsis syndrome. Patients entered the study within the 24 h period following surgical interventions for acute necrotizing pancreatitis, intra-abdominal abscesses, and/or peritonitis. Sequential measurements (n=108) were made at intervals of 6–12 h over a 48 h period. There were no significant differences between initial and final values of thermal-dye EVLW (5.0±1.1 vs. 5.7±1.1 ml/kg), plasma colloid osmotic pressure (COP, 13.3±2.5 vs. 13.2±2.9 mmHg), pulmonary artery wedge pressure (PAWP, 9.2±3.0 vs. 10.8±3.0 mmHg), and COP-PAWP gradient (4.0±3.5 vs. 2.4±3.9 mmHg). All results expressed as (mean±SD). The EVLW did not correlate with plasma COP, PAWP, or COP-PAWP gradient. We conclude that large volume replacement with balanced electrolyte solutions with the secondary decrease in plasma COP and COP-PAWP gradient do not necessarily contribute to a substantial increase in EVLW. This study fails to show any causal relationship between decrease in plasma COP or COP-PAWP gradient and oedema formation in the lung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00273561
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  • 9
    Electronic Resource
    Electronic Resource
    Locked lateral patellar dislocation: a rare case of irreducible patellar dislocation requiring open reduction (1999)
    Springer
    Knee surgery, sports traumatology, arthroscopy 7 (1999), S. 352-355 
    Details
    ISSN: 1433-7347
    Keywords: Key words Irreducible ; Lateral ; patellar dislocation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Irreducible patellar dislocations are rare injuries, but those that do occur are mainly directed intra-articularly. In this case, a 53-year-old woman sustained a locked lateral patellar dislocation when falling from a chair. A preoperative CT-scan revealed bony avulsions at the insertion of the vastus medialis muscle, the medial retinaculum, and partial disruption of the ligamentum patellae from the apex patellae. Open reduction was necessary and the torn structures were reattached with anchor systems and sutures. Postoperative management included intensive physiotherapy. At 1 year after surgery, the patient was without swelling or pain and had a normal gait, but flexion was restricted to 120°. All postoperative radiographs showed the patella correctly placed in the femoral groove.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001670050179
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  • 10
    Electronic Resource
    Electronic Resource
    Transplantatfixation bei der vorderen Kreuzbandrekonstruktion Metall- vs. bioresorbierbare Polyglykonatinterferenzschraube – Eine prospektive randomisierte Studie von 40 Patienten (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 468-474 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Vordere Kreuzbandplastik ; Interferenzschraube ; Bioresorbierbares Implantat ; Keywords Anterior cruciate ligament reconstruction ; Interference screw ; Bioabsorbable implants
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary To overcome some of the potential problems (e.g. hardware removal during revision surgery) of metall interference screws used for patellar tendon anterior cruciate ligament reconstruction, bioabsorbable screws have recently been introduced. Forty patients who underwent endoscopic ACL reconstruction using patella tendon autograft were included in the study, they were randomized intraoperatively to either Group A (femoral bone block fixation: polyglyconate screw; tibial: metall screw) or Group B (both bone blocks fixed with metall interference screws). The patients were evaluated clinically preoperatively as well as 6 weeks, 3 months 12 months and 24 months post op. Lysholm Score at 24 months was 98,1±2,3 for Group A and 97,7±3,0 for Group B. Tegner Score was 7,4±1,1 for Group A and 7,5±0,8 for Group B. Two years post op overall IKDC-Score for group A was 5,6% normal, 88,8% nearly normal and 5,6% abnormal. The result for group B was 11,1%, 77,8% and 11,1%, respectively. KT-1000 (at 89 N) at two years revealed a side to side difference of 1,5±0,3 mm (Group A) and 1,6±0,7 (Group B). The results of the two groups did not show significant differences at any stage of follow up. In our study polyglyconate interference screw fixation for patellar tendon grafts has not found to be associated with increased clinical complications. It provided equivalent fixation and clinical results compared to metall screws.
    Notes: Zusammenfassung Durch die Verwendung von resorbierbaren Interferenzschrauben zur Transplantatfixation bei vorderer Kreuzbandrekonstruktion sollen potentielle Nachteile von Metallschrauben vermieden werden. In einer prospektiv randomisierten Studie wurde bei 20 Personen (Gruppe A) der femorale Knochenblock eines Lig.-patellae-Knochen-Sehnen-Knochentransplantats mit einer resorbierbaren Polyglykonatschraube befestigt, bei 20 Personen der Kontrollgruppe (Gruppe B) mit einer Metallinterferenzschraube. Über einen Zeitraum von 2 Jahren wurden die Patienten klinisch und radiologisch nachuntersucht. Sowohl Tegner- (im Mittel 7,4±1,1 für Gruppe A bzw. 7,5±0,8 für Gruppe B bei Studienende) als auch Lysholm- (im Durchschnitt 98,1±2,3 für Gruppe A, 97,7±3,0 Gruppe B) und IKDC-Score (5,6% normal, 88,8% fast normal, 5,6% abnormal in Gruppe A bzw. 11,1% 77,8% und 11,1% in Gruppe B) zeigten einen ähnlichen Verlauf den gesamten Zeitraum über, es bestand zu keinem Zeitpunkt der Untersuchung ein signifikanter Unterschied zwischen beiden Gruppen. Anhand der Röntgenbilder konnte die Polyglykonatschraube bis 6 Wochen postoperativ identifiziert werden und war dann nicht mehr erkennbar. Abnorme radiologische Veränderungen (Osteolysen etc.) traten in beiden Gruppen nicht auf. Bei mit bioresorbierbaren Schrauben behandelten Patienten kam es zu keinen entzündlichen Abwehrreaktionen. Polyglykonatinterferenzschrauben eignen sich in gleicher Weise wie Metallimplantate zur Fixierung des autologen Lig.-patellae-Transplantats bei der vorderen Kreuzbandplastik.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050567
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