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  • 1
    Electronic Resource
    Electronic Resource
    Tendon of the normal supraspinatus muscle: correlations between MR imaging and histology (1995)
    Springer
    Surgical and radiologic anatomy 17 (1995), S. 329-334 
    Details
    ISSN: 1279-8517
    Keywords: Shoulder ; Supraspinatus ; Histology ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Le but du travail était d'essayer de préciser la nature des modifications de signal observées en IRM dans le tendon du m. supra-épineux en dehors de toute pathologie de l'épaule, et dûes, selon certains auteurs, à un artefact lié à l'IRM. Cinq tendons macroscopiquement normaux de m. supra-épineux ont été prélevés chez 4 patients jeunes (14 à 28 ans), 30 mn maximun après l'arrêt cardiaque, après autorisation du comité d'éthique. Ces tendons ont été examinés en IRM dans le plan frontal oblique suivant l'axe du muscle avec une antenne de surface de 4 cm de diamètre en utilisant une séquence écho de spin T2, puis ont été analysés en histologie en utilisant le même plan de coupe. Vingt-cinq sujets témoins (18 à 34 ans) ont été examinés en IRM avec la même séquence écho de spin T2. Tous les tendons de m. supra-épineux examinés possédaient un signal noir avec des zones de signal intermédiaire sur le premier écho de la séquence. Il existait une parfaite corrélation entre l'aspect en IRM des 5 tendons prélevés et leur description en histologie. Trois aspects histologiques ont été décrit: dégénérescence fibrillaire, dystrophie fibreuse, transformation éosinophile du collagène tendineux. Tous les tendons examinés chez les volontaires sains présentaient, au premier écho, des images hétérogènes; au second écho, l'hyposignal était homogène et franc. La bonne corrélation obtenue permet de suggérer que les modifications du signal du tendon du m. supra-épineux ne sont pas en rapport avec un artéfact décrit en IRM mais sont liés à une détérioration précoce de ce tendon, vraisemblablement liée à l'importance des contraintes mécaniques qu'il subit.
    Notes: Summary The aim of this study was to attempt to specify the nature of the signal modifications observed in MRI in the supraspinatus tendon apart from any pathology of the shoulder, and due, according to certain authors, to an artefact associated with MRI. Five macroscopically normal supraspinatus tendons were removed from 4 young subjects (14–28 years), 30 min after cardiac arrest, with the authorisation of the ethical committee. These tendons were examined by MRI in the frontal oblique plane along the axis of the muscle with a surface coil of 4 cm diameter, using a T2-weighted spin-echo sequence, and then studied histologically using the same plane of section. 22 control subjects (18–24 years) were examined by MRI with the same T2-weighted spinecho sequence. All the tendons examined possessed a dark signal with zones of intermediate signal on the first echo of the sequence. There was a complete correlation between the MRI appearances of the 5 tendons and their histologic description. Three histologic appearances were described: fibrillary degeneration, fibrous dystrophy, and eosinophil transformation of the tendinous collagen. All the tendons examined in healthy volunteers exhibited hetereogenic images at the first echo; in the second echo the hyposignal was uniform and obvious. The good correlation obtained suggests that modifications of the tendon signal from the supraspinatus m. are not related to an artefact described in MRI, but are linked with premature degeneration of this tendon, probably associated with the severity of the mechanical constraints to which it is subject.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01795192
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  • 2
    Electronic Resource
    Electronic Resource
    Anatomy of the prostatic nerves (1994)
    Springer
    Surgical and radiologic anatomy 16 (1994), S. 23-29 
    Details
    ISSN: 1279-8517
    Keywords: Anatomy ; Prostatic innervation ; Computer reconstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La prostate d'un enfant de 10 ans, a été sectionnée au microtome en 4 300 coupes. Les nerfs ont été colorés avec un anticorps monoclonal anti PS 100 et toutes les informations ont été recueillies sur un programme informatisé. L'innervation de la prostate est très abondante, les fibres nerveuses de la prostate craniale (zone centrale) suivent une voie parallèle à la face antérieure des vésicules séminales, vers la prostate caudale. La zone péri-urétrale est richement innervée par des nerfs venant de la périphérie, la prostate caudale contient aussi de nombreuses fibres nerveuses de taille variable. Nous avons identifié un grand nombre de nerfs le long de la face antérieure des vésicules séminales et entourant les faces latérales de la capsule prostatique, elles pénètrent la capsule prostatique et toute la circonférence de la prostate caudale. La capsule prostatique est couverte par de nombreuses fibres nerveuses et des ganglions qui forment un véritable réseau nerveux péri prostatique. L'urètre est innervé par de nombreuses fibres de plus de 30 µm de diamètre.
    Notes: Summary The entire prostate of a 10 year old boy was cut with a microtome into 4300 serial slices. The nerves were stained using a monoclonal antibody called anti PS 100. All information was recorded using a computer reconstruction programme. The prostatic nerve supply is very abundant. The nerve fibers of the cranial prostate (central zone) follow a pathway parallel to the anterior surface of the seminal vesicles going towards the caudal prostate. The periurethral zone is widely innervated by nerves arising from the periphery. The caudal prostate also contains many nerve fibers of variable size. We identified many nerve fibers along the anterior surface of the seminal vesicles and surrounding the lateral aspect of the prostatic capsule. They penetrate the capsule and the whole circumference of the caudal prostate. The prostatic capsule is covered by numerous nerve fibers and ganglia, which form a true periprostatic nerve network. The urethra is supplied by numerous thick fibers of more than 30 µm in diameter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01627917
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  • 3
    Electronic Resource
    Electronic Resource
    The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation (1995)
    Springer
    Intensive care medicine 21 (1995), S. 365-383 
    Details
    ISSN: 1432-1238
    Keywords: Ventilator-associated pneumonia ; Colonization ; Aspiration defense mechanisms ; Inflammatory response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ventilator-associated pneumonia (VAP) is an infection of the lung parenchyma developing in patients on mechanical ventilation for more than 48 h. VAP is associated with a remarkably constant spectrum of pathogenic bacteria, most of which are aerobic Gramnegative bacilli (AGNB) and, to a lesser extentStaphyloccus aureus. Most authorities agree that VAP develops as a result of aspiration of secretions contaminated with pathogenic organisms, which appear to be endogenously acquired. These pathogens gain access to the distal airways by mechanical reflux and aspiration of contaminated gastric contents and also by repetitive inoculation of contaminated upper airway secretions into the distal tracheobronchial tree. Persistence of these organisms in the upper airways involves their successful colonization of available surfaces. Although exogenous acquisition can occur from the environment, the rapidity at which critically ill patients acquire AGNB in the upper airways in conjunction with the low rate of AGNB colonization of health-care workers exposed to the same environment favors the presence of endogenous proximate sources of AGNB and altered upper airway surfaces that are rendered receptive. Proximate sources of AGNB remain unclear, but potential sites harboring AGNB prior to illness include the upper gastrointestinal tract, subgingival dental plaque, and the periodontal spaces. Following illness or antibiotic therapy, competitive pressures within the oropharynx favor AGNB adherence to epithelial cells, which lead to oropharyngeal colonization. Similar dynamic changes in contiguous structures (oropharynx, trachea, sinuses, and the upper gastrointestinal tract) lead to the transcolonization of these structures with pathogenic bacteria. Following local colonization or infection, these structures serve as reservoirs of AGNB capable of inoculating the lower airways. As the oropharynx becomes colonized with AGNB, contaminated oropharyngeal secretions reach the trachea, endotracheal tube, and ventilator circuit. Contaminated secretions pooled above the endotracheal tube cuff gain access to the trachea and inner lumen of the endotracheal tube by traversing endotracheal tube cuff folds. Amorphic particulate deposits containing AGNB form along the endotracheal tube and are capable of being propelled into the distal airways by ventilator-generated airflow or by tubing manipulation. Bacteria embedded within this type of amorphous matrix are particularly difficult for the host to clear. If host defenses fail to clear the inoculum, then bacterial proliferation occurs, and the host inflammatory response progresses to bronchopneumonia. By understanding the mechanisms involved in the pathogenesis of VAP, new strategies may be developed to prevent this significant complication of mechanical ventilation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01705418
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  • 4
    Electronic Resource
    Electronic Resource
    The pathogenesis of ventilator-associated pneumonia: II. The lower respiratory tract (1995)
    Springer
    Intensive care medicine 21 (1995), S. 452-461 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01707417
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  • 5
    Electronic Resource
    Electronic Resource
    The role of gallium-67 scintigraphy in diagnosing sources of fever in ventilated patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 395-403 
    Details
    ISSN: 1432-1238
    Keywords: Key words Fever ; Mechanical ventilation ; Nosocomial infection ; Fibroproliferation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the diagnostic value of gallium-67 scintigraphy in febrile ventilated patients by correlating the findings of 67Ga scintigraphy to sources of fever and pulmonary density, as determined by a comprehensive protocolized diagnostic evaluation. Design: Prospective observational study. Patients: Thirty-two intubated patients on mechanical ventilation for ≥3 days with fiver (≥38.3°C) and a new or progressive density on chest radiograph. Twenty patients (21 tests) had adult respiratory distress syndrome (ARDS). Intervention: Diagnostic evaluation for fever included bronchoscopy with protected specimen brushing and (protected) bronchoalveolar lavage (BAL); computed tomography (CT) of sinuses; cultures of blood, urine, and central lines; and CT of the abdomen in high-risk patients. Measurements and results: Uptake of 67Ga was reported as either focal or diffuse pulmonary uptake and extrapulmonary uptake. The combined causes of fever were pneumonia (9), fibroproliferation of late ARDS (7), abdominal process (4), sinusitis (4), urinary tract infection (3), and others (6). Causes of the pulmonary densities were pneumonia (9), ARDS (13), atelectasis (7), congestive heart failure (3), and empyema (1). Marked and diffuse pulmonary uptake was found only in patients with ARDS; however, it was not useful in discriminating those patients with pulmonary fibroproliferation as the sole cause of fever (p=0.167) from those with infection. 67Ga scintigraphy was inadequate for detecting pneumonia but valuable in identifying extrapulmonary sites of infection in patients with ARDS (p=0.021). Conclusions: 67Ga scintigraphy should be considered only as an adjunct diagnostic test in the febrile, ventilated patient who has no obvious source of fever, despite a negative evaluation that includes testing for pneumonia, sinusitis, and urinary tract infection, conditions that are rarely detected by 67Ga scintigraphy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712154
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  • 6
    Electronic Resource
    Electronic Resource
    The role of gallium-67 scintigraphy in diagnosing sources of fever in ventilated patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 395-403 
    Details
    ISSN: 1432-1238
    Keywords: Fever ; Mechanical ventilation ; Nosocomial infection ; Fibroproliferation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the diagnostic value of gallium-67 scintigraphy in febrile ventilated patents by correlating the findings of67Ga scintigraphy to sources of fever and pulmonary density, as determined by a comprehensive protocolized diagnostic evaluation. Design Prospective observational study. Patients Thirty-two intubated patients on mechanical ventilation for ≥3 days with fiver (≥38.3°C) and a new or progressive density on chest radiograph. Twenty patients (21 tests) had adult respiratory distress syndrome (ARDS). Intevention Diagnostic evaluation for fever included bronchoscopy with protected specimen brushing and (protected) bronchoalveolar lavage (BAL); computed tomography (CT) of sinuses; cultures of blood, urine, and central lines; and CT of the abdomen in high-risk patients. Measurements and results Uptake of67Ga was reported as either focal or diffused pulmonary uptake and extrapulmonary uptake. The combined causes of fever were pneumonia (9), fibroproliferation of late ARDS (7), abdominal process (4), sinusitis (4), urinary tract infection (3), and others (6). Causes of the pulmonary densities were pneumonia (9), ARDS (13), atelectasis (7), congestive heart failure (3), and empyema (1). Marked and diffused pulmonary uptake was found only in patients with ARDS; however, it was not useful in discriminating those patients with pulmonary fibroproliferation as the sole cause of fever (p=0.167) from those with infection.67Ga scintigraphy was inadequate for detecting pneumonia but valuable in identifying extrapulmonary sites of infection in patients with ARDS (p=0.021). Conclusions 67Ga scintigraphy should be considered only as an adjunct diagnostic test in the febrile, ventilaged patients who has no obvious source of fever, despite a negative evaluation that includes testing for pneumonia, sinusitis, and urinary tract infection, conditions that are rarely detected by67Ga scintigraphy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712154
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  • 7
    Electronic Resource
    Electronic Resource
    An Historical Review of Glucocorticoid Treatment in Sepsis. Disease Pathophysiology and the Design of Treatment Investigation (1999)
    Springer
    Sepsis 3 (1999), S. 21-38 
    Details
    ISSN: 1573-7411
    Keywords: Acute respiratory distress syndrome ; complications ; disease ; glucocorticoids ; glucocorticoid receptor ; infection ; sepsis ; syndrome ; transcription factors ; treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This review provides an historical perspective on events that have shaped our pathophysiological understanding of sepsis during this century and, as a result, have influenced the design of glucocorticoid treatment trials. A structured format to evaluate clinical investigation of glucocorticoid treatment in patients with sepsis is presented. From the early 1950s to the late 1980s, the methodological quality of randomized trials improved, while the science dictating the design of treatment protocols overlooked prior clinical observations and relied almost exclusively on the findings of an experimental model that misrepresented human sepsis. As a result, the daily glucocorticoid dose escalated up to 140 fold while the duration of treatment decreased to 24-hours or less. Bedside observation was the foundation for evaluating treatment response in the early studies, while in the later trials, survival was the principle outcome measure and these reports frequently did not include serial recordings of biological, clinical, and physiological variables over time. Today, we appreciate that excessive activation of the host defense response in patients with septic shock or acute respiratory distress syndrome (ARDS) may induce noncompensated glucocorticoid resistance in target organs, thereby negating the beneficial suppressive influence of an inadequately secreted endogenous cortisol. Recent studies have shown that a dysregulated host defense response is characterized by exaggerated and protracted immune cells activation of nuclear factor-kB and persistent elevation of biological markers (inflammatory cytokine levels, etc.) of disease activity over time. Within this new pathophysiological understanding of sepsis, prolonged treatment with increased doses of exogenous glucocorticoids may in theory modify the intracellular balance among activated transcription factors, and convert an initially dysregulated host defense response into a regulated one. Supporting evidence is provided by the results of recent controlled and uncontrolled studies of patients with septic shock and unresolving ARDS showing that prolonged glucocorticoid treatment was associated with a rapid, significant, and sustained reduction in circulating levels of markers of disease activity, and progressive physiological improvement. No other treatment intervention in sepsis or ARDS has yet provided this level of evidence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009870524359
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