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  • 1
    Electronic Resource
    Electronic Resource
    Effects and biotransformation of 4-dimethylaminophenol in man and dog (1983)
    Springer
    Archives of toxicology 53 (1983), S. 275-288 
    Details
    ISSN: 1432-0738
    Keywords: 4-Dimethylaminophenol ; Ferrihemoglobin ; Metabolism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The cyanide antidote 4-dimethylaminophenol · HCl (DMAP) was administered orally, i.v., or i.m. to man and dog. Ferrihemoglobin formation and changes of several parameters in human blood were investigated to obtain information on damage to liver, kidney, muscle, and red blood cells; in addition, the metabolism of DMAP was studied. In dogs, the initial rate of ferrihemoglobin production (DMAP, 3.25 mg/kg i.v. or i.m., 15 mg/kg orally) amounted to 28%, 3.5%, and 2% of the total hemoglobin per min; the corresponding values for man were 9%, 2%, and 2% per min. The dogs behaved normally while CPK increased after i.m. injection. In man, only i.m. injection of DMAP (3.25 mg/kg) was followed by increases in LDH, GOT, and CPK of 110, 260, and 490%, resp.; while total bilirubin, conjugated bilirubin, and iron concentration rose by 270,120, and 50%, respectively. Bilirubin and iron concentration increased also after DMAP i.v. (3.25 mg/kg) or when it was taken orally (600 or 900 mg). The lactate concentration was not influenced while the pyruvate concentration increased by 50%. DMAP produced hemolysis in vitro. Generally, the values determined in vivo approached the starting level within 1 week. Intramuscular injection of DMAP induced reversible subjective and objective symptoms, e.g., local pain, swollen buttock, fever reaction. The urine showed no pathological changes. About 54% of DMAP taken orally was excreted as metabolites in the urine, 41% as glucuronide, 7% as sulfate, and 6% as thioethers. After i.v. administration the total of metabolites was somewhat higher, and the thioether proportion was 15%. The results indicate that DMAP is readily absorbed after oral administration but undergoes significant first pass effect in the liver. Therefore, the 4-fold i.v. dose must be administered orally to achieve the same ferrihemoglobin formation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00294993
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  • 2
    Electronic Resource
    Electronic Resource
    Effects of amyl nitrite on circulation, respiration and blood homoeostasis in cyanide poisoning (1988)
    Springer
    Archives of toxicology 62 (1988), S. 161-166 
    Details
    ISSN: 1432-0738
    Keywords: Amyl nitrite ; Ferrihaemoglobin ; Cyanide ; Circulation ; Blood gases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effects of intravenously (i.v.) administered or inhaled amyl nitrite (AN) were followed under chloralose anaesthesia in intact and cyanide-poisoned, spontaneously breathing beagles. The i.v. doses of AN were 0.03 and 0.15 mmol/kg and the i.v. dose of KCN was 0.06 mmol/kg. AN was inhaled in a closed system at 0.15 mmol/kg without previous poisoning and, in addition, at 0.074 mmol/kg (two ampoules at 0.3 ml AN) during artificial ventilation after poisoning with 0.045 mmol KCN/kg i.v., Mean arterial pressure decreased by 15 and 40 mmHg, respectively, after i.v. injection of AN, associated with bradycardia and lowered peripheral blood flow. Respiratory minute volume rose by 65% with the higher dose. Arterial pO2 decreased by 20 mmHg while pCO2 rose by 6 mmHg. Within 30 min of injection, these changes were only partially reversible. Similar results were obtained following inhalation of AN in a closed system. Lactic acidosis and lowering of pH were produced by the i.v. route, but not by inhalation. Total haemoglobin increased. The lethality of KCN was abolished with AN doses that produced 10–30% ferrihaemoglobin. Artificial ventilation and simultaneous inhalation of AN after poisoning with lethal doses of KCN turned out to be ineffective therapeutic measures. The findings are compared with those of other papers dealing with cyanide poisoning and AN. It is pointed out that, for the present, there is no experimental proof for another antidotal mechanism of action of AN than ferrihaemoglobin formation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00570134
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  • 3
    Electronic Resource
    Electronic Resource
    Ferrihaemoglobin formation by amyl nitrite and sodium nitrite in different species in vivo and in vitro (1988)
    Springer
    Archives of toxicology 62 (1988), S. 152-160 
    Details
    ISSN: 1432-0738
    Keywords: Amyl nitrite ; Sodium nitrite ; Ferrihaemoglobin ; Oxygen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The ferrihaemoglobin (HbFe3+) formation by amyl nitrite (AN) or sodium nitrite (NaNO2) was studied in different species including man, in vivo and in vitro. In in vivo studies AN was administered intravenously (i.v.), intramuscularly (i.m.), by inhalation, or orally. NaNO2 was injected i.v. AN i.v. produced HbFe3+ much more rapidly than NaNO2 in dogs, cats, rabbits, and rats. In dogs, i.m. injection of AN was followed by a very slow linear increase in the HbFe3+ content. Inhalation of AN did not lead to HbFe3+ formation in dogs unless it was rebreathed in a closed (bag) or not completely open (gas mask) system. HbFe3+ was produced by oral AN in dogs, the effect being enhanced by addition of DMSO. Inhalation of AN by human volunteers in a gas mask and from ampoules crushed close to the nose did not induce haemoglobin oxidation to a practically significant extent, but it was associated with headache, tiredness, dizziness, and a fall in blood pressure. In in vitro studies, in contrast to NaNO2, AN produced HbFe3+ instantaneously in erythrocytes of various species and in purified human haemoglobin. AN 1 mol yielded 2 mol Fe3+. Only 20% of the oxygen released during the oxidation of haemoglobin by AN or NaNO2 was recovered. In 0.2 M phosphate buffer, pH 7.4, 0.01 mol O2/mol AN was consumed. CO2 was released in the presence of AN, but not of NaNO2, from blood, plasma, and 0.02 M NaHCO3 solution. The ratio (lactate)/(pyruvate) decreased when HbFe3+ was formed by AN or NaNO2.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00570133
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  • 4
    Electronic Resource
    Electronic Resource
    Fraktur und Weichteilschaden (1998)
    Springer
    Der Chirurg 69 (1998), S. 684-700 
    Details
    ISSN: 1433-0385
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050477
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  • 5
    Electronic Resource
    Electronic Resource
    Vergleich eines durchleuchtungsfreien mechanischen Zielsystems und einer Freihandtechnik für die Plazierung von distalen Verriegelungsschrauben von Tibianägeln (1997)
    Springer
    Der Chirurg 68 (1997), S. 1194-1201 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Interlocking nail ; Tibia ; Distal interlocking ; Distal aiming device ; Free-hand technique ; Radiolucent drill. ; Schlüsselwörter: Verriegelungsnagel ; Tibia ; distale Verriegelung ; röntgenstrahlenunabhängiges ; distales Zielgerät ; Freihandtechnik ; strahlentransparentes Winkelgetriebe
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Seit kurzem stehen röntgendurchleuchtungsunabhängige, mechanische Zielsysteme für die distale Verriegelung von ungeschlitzten Tibiamarknägeln zur Verfügung, die die insertionsbedingte Nageldeformation kompensieren. Vergleichende Untersuchungen über Vor- und Nachteile dieser Systeme sind bisher noch nicht durchgeführt worden. Die vorliegende Studie untersuchte Operationsdauer, Länge der Durchleuchtungszeit und Präzision der Schraubenplazierung mit einem strahlenunabhängigen, mechanischen Zielsystem und einer Freihandtechnik (strahlentransparentes Winkelgetriebe). Von einem mit beiden Techniken unerfahrenen Chirurgen wurden am Frakturmodell der Tibia (Schrägosteotomie) an humanen Ganzkörperpräparaten im Rechts-Links-Vergleich Unterschenkelmarknagelungen mit statischer Verriegelung durchgeführt. Für das distale Zielgerät bzw. für die Freihandtechnik betrug die Gesamtoperationszeit 25,4 ± 11,3 vs. 30,9 ± 14,3 min (p = 0,029), die distale Verriegelungszeit 16,7 ± 8,6 vs. 21,9 ± 10,5 min (p = 0,004), die gesamte Durchleuchtungszeit 9 ± 5 vs. 93 ± 34 s (p 〈 0,0001), die Durchleuchtungszeit für die distale Verriegelung 0 vs. 88 ± 33 s (p 〈 0,0001), und die Bolzendestruktion −0,7 ± 5,2 vs. 26,8 ± 31,6 μm (p = 0,001). Die Versagerquote betrug in beiden Gruppen je 1,6 % (1 von 60 Schrauben). Beide Techniken können von einem unerfahrenen Chirurgen gleich schnell erlernt werden. Der Hauptvorteil des röntgenstrahlenfreien, mechanischen distalen Zielgerätes ist die Vermeidung von Röntgenstrahlen während der distalen Verriegelung und die präzisere Schraubenplazierung mit einer geringeren insertionsbedingten Implantatbeschädigung.
    Notes: Summary. Recently, radiation-independent aiming devices for the tibia which compensate for insertion-related implant deformation have been developed, but the benefits of such systems have not been determined. This study prospectively evaluated the duration of the nailing procedure, the length of radiation time, and the accuracy of interlocking screw placement with a radiation-independent distal aiming system and the free-hand technique. In an oblique cadaveric tibial fracture, a surgeon inexperienced with either technique performed a statically locked intramedullary nailing. For the aiming system and free-hand technique respectively, the total operation time was 25.4 ± 11.3 vs 30.9 ± 14.3 min (P = 0.029), the distal locking time was 16.7 ± 8.6 vs 21.9 ± 10.5 min (P = 0.004), the total fluoroscopy time was 9 ± 5 vs 93 ± 34 s (P 〈 0.0001), the distal locking fluorscopy time was 0 versus 88 ± 33 s (P 〈 0.0001), and the screw destruction was −0.7 ± 5.2 vs 26.8 ± 31.6 μm (P = 0.001). The failure rate was 1.6 % (1 of 60 screws) in both groups. These results suggest that aiming devices can eliminate the need for radiation during distal interlocking screw placement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050345
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  • 6
    Electronic Resource
    Electronic Resource
    Acute effects of the heavy metal antidotes DMPS and DMSA on circulation, respiration, and blood homoeostasis in dogs (1993)
    Springer
    Archives of toxicology 67 (1993), S. 428-434 
    Details
    ISSN: 1432-0738
    Keywords: DMPS ; DMSA ; Thiols ; Ferrihaemoglobin ; Blood gases ; Circulation ; Respiration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The heavy metal antidotes sodium-2,3-dimercaptopropane-1-sulfonate (DMPS) and meso-2,3-dimercaptosuccinic acid (DMSA) were investigated in anaesthetized dogs for their effects on a variety of physiological variables and parameters. In addition, the influence of both dithiols on oxygen consumption and ferrihaemoglobin production was studied in blood and red blood cells in vitro. DMPS (15 and 75 mg/kg i.v.) did not affect respiration, central venous pressure, left ventricular pressure or cardiac output and showed only marginal, statistically non-significant effects on aortic and effective perfusion pressure. In contrast to the slight, non-significant changes due to DMPS (15 mg/kg i.v.), an equimolar dose of DMSA (12 mg/kg i. v.) led to a slight transient decrease in femoral blood pressure with strong reflex tachycardia and increase in blood flow. The higher DMPS dose (75 mg/kg i.v.), however, caused marked decreases in femoral blood pressure and blood flow, strong changes in blood gases and pH, and lactacidosis. Most of the physiological variables and parameters did not return to the initial level by 60 min. The R-spike of the electrocardiogram decreased, and the T-wave increased. Experiments on the denervated hind leg indicate that DMPS may be a direct vasodilator. The fall of blood pressure due to DMPS was markedly reduced when 30% ferrihaemoglobin had been formed by 4-dimethylaminophenol. HCl (DMAP). The highest DMPS dose (150 mg/kg i.v.) provoked circulatory failure and respiratory arrest. Artificial ventilation with room air restored spontaneous respiration, but one of three animals did not survive this dose for more than 90 min. DMPS and DMSA reacted with oxygen. In phosphate buffer, pH 7.4,1 mol O2 appears to be taken up by 2 mol DMPS. The consumption of O2 by DMPS was less in samples of human and canine blood or erythrocyte suspensions than in buffer solution. DMPS caused a greater loss of oxygen than DMSA. DMPS and DMSA alone did not produce ferrihaemoglobin, but the ferrihaemoglobin content of erythrocyte suspensions increased over the time when DMPS was added in the presence of 30% ferrihaemoglobin. Such an action was not observed at the same ferrihaemoglobin content in vivo.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01977405
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  • 7
    Electronic Resource
    Electronic Resource
    Fractures of the odontoid process in small children: biomechanical analysis and report of three cases (1996)
    Springer
    European spine journal 5 (1996), S. 63-70 
    Details
    ISSN: 1432-0932
    Keywords: Odontoid fracture in children ; Synchondrosis ; Operative treatment ; Follow-up ; Biomechanics ; Child seat restraint
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Odontoid “fractures” in young children typically involve the cartilaginous plate (synchondrosis) that separates the odontoid process from the body of the axis; 58 cases have been described in the literature. We report two cases in which 2-year-old children were involved as backseat passengers in head-on motor vehicle accidents, both were restrained by four-point child's seat harnesses. A biomechanical investigation was carried out using simulation in a real car crash test with a child dummy. This revealed that head-on collisions with a speed absorption of at least 40 km/h are the typical mechanism of injury in children under the age of 3 years involved in motor vehicle accidents. Shearing force is all that is necessary to explain the dens fracture. Both children were immediately symptomatic, and the diagnosis was obvious on radiographs. Neither child had neurological deficit, which correlates well with the literature, where neurological injuries were found only in conjunction with head injuries. After closed reduction, both cases were initially trated conservatively with halo and plaster vest for 12 weeks. In one case, in which the anterior dislocation was less than the diameter of the odontoid shaft, eventless healing occurred. In our second case, despite an anatomic reduction, the odontoid fracture failed to unite. After a temporary posterior fixation of C1/C2 we reamed the synchondrosis from anterior and performed autogenous bone grafting. The posterior fixation wire was removed after 5 months. In contrast to the literature, we do not recommend a permanent posterior fusion of C1/C2. Our two young patients were both followed-up for more than 3 years. Clinical and radiological examination at final follow-up was normal with no signs of atypical growth of the odontoid. In cases of major dislocation with greater instability we recommend primary open reduction and osteosynthesis with appropriate implants. This was done in a third case: a $$1{\raise0.5ex\hbox{$\scriptstyle 1$}\kern-0.1em/\kern-0.15em\lower0.25ex\hbox{$\scriptstyle 2$}}$$ -year-old boy who fell down the stairs and sustained a head injury and an unstable lesion of the odontoid with subtotal paraplegia. The odontoid was fixed with two screws.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00307830
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  • 8
    Electronic Resource
    Electronic Resource
    Whiplash-type neck distortion in restrained car drivers: frequency, causes and long-term results (2000)
    Springer
    European spine journal 9 (2000), S. 109-117 
    Details
    ISSN: 1432-0932
    Keywords: Key words Car accident ; Whiplash-type neck distortion ; Duration of complaints ; Injury mechanism ; Prognostic factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract An analysis was made of 1176 whiplash-type neck distortions taken from a total of 3838 restrained car driver incident reports. The percentage of whiplash-type neck distortion among injured drivers increased from less than 10% in 1985 to over 30% in 1997. Most occurred in head-on crashes or crashes with multiple collisions; only 15% occurred in rear-end collisions. More than 1,000 questionnaires were sent to the injured to find out about the duration and type of complaints caused by their cervical spine injury. Although only 138 (12%) returned the questionnaire, which may not be a representative sample, a further analysis was carried out. Of the 138, 121 (88%) indicated that they had suffered or were still suffering from their symptoms. The percentages of the various complaints were as follows: pain (74%), tension (6%) and stiffness (5%) in the head (27%), neck (55%) and shoulder (8%). The duration of the complaints was longest after multiple collisions and when the onset of complaints was longer than 24 h after trauma. Women and elderly persons predominated slightly in the group with longer duration of complaints. A correlation between the severity of the accompanying injuries and duration of complaints was found. Lack of adequate follow-up for patients with less severe injuries posed considerable difficulties for this retrospective study. In order to better evaluate this problem, prospective studies are necessary, with documentation including diagnosis, treatments, complaint duration and type.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005860050220
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  • 9
    Electronic Resource
    Electronic Resource
    Complex knee trauma (1997)
    Springer
    Der Orthopäde 26 (1997), S. 1037-1045 
    Details
    ISSN: 1433-0431
    Keywords: Key words Tibial plateau fractures • Distal femur fracture • Intraarticular fracture • Osteosynthesis • Fracture-dislocation • Dislocation • External fixation ; Schlüsselwörter Tibiakopffraktur • Distale Femurfraktur • Gelenkfrakturen • Osteosynthese • Luxationen • Offene Frakturen • Fixateur externe
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Juxta- und intraartikuläre Doppelfrakturen, Gelenkfrakturen mit schwerem Weichteilschaden und Knieluxationen mit Begleitverletzungen werden als Komplextrauma des Kniegelenks definiert. Diese Verletzungen weisen eine hohe Komplikationsrate und eine schlechte Prognose auf. Sie erfordern ein spezielles Management und spezielle Versorgungsstrategien. In der Frakturbehandlung sollten heute Verfahren mit reduzierter Invasivität eingesetzt werden: perkutane Repositions- und Osteosynthesetechniken, eingeschobene Platten, Hybridfixationen. Bei Knieluxationen sollte der Zentralpfeiler mit den Kreuzbändern rekonstruiert werden, wobei augmentierte Nähte bzw. Bandplastiken zu bevorzugen sind.
    Notes: Summary Juxta- and intraarticular fractures of the knee (floating knee), intraarticular fractures with severe soft tissue damage and knee dislocations with vascular or soft tissue lesions are defined as complex knee trauma. A specific management protocol is required for these cases. Fractures should be treated with soft-tissue sparing minimal invasive reduction and fixation techniques to reduce the significant complication rate which is presently encountered. Percutaneous plate fixation, percutaneous screw osteosynthesis and hybrid fixation should be widely used in these cases. In knee dislocation, the central pivot with the two cruciate ligaments should be reconstructed using augmented repair or primary tendon grafting in every case, whereas the treatment of collateral ligament lesions depends on the specific injury type.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003359
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  • 10
    Electronic Resource
    Electronic Resource
    New developments in stabilization of dia- and metaphyseal long bone fractures (1997)
    Springer
    Der Orthopäde 26 (1997), S. 408-421 
    Details
    ISSN: 1433-0431
    Keywords: Key words Innovation • Intramedullary nail • Plate • Fixator • Minimally invasive plate osteosynthesis (MIPO) ; Schlüsselwörter Innovationen • Marknagel • Platte • Fixateur • Minimal-invasive Plattenosteosynthese (MIPO)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Nagel, Platte und Fixateur stellen zusammen mit Schrauben seit Jahrzehnten die wichtigsten Elemente zur Stabilisierung von dia- und metaphysären Frakturen dar. Diese Grundelemente sind auch heute noch präsent, allerdings haben in den letzten Jahren neue und wichtige Entwicklungen stattgefunden, die zusammen mit einem erweiterten Verständnis von Frakturheilung, Biologie, Metallurgie und Mechanik sowie Spezifizierung der Anwendung insgesamt zu verbesserten Möglichkeiten der Patientenversorgung geführt haben. Neben einem aktuellen Überblick zur Diskussion unreamed vs. reamed werden neue Trends, Techniken und Implantate aus Bereich der intramedullären Osteosynthese (retrograde Nagelung, Spiralklinge, FlexNagel Humerus, „distal aiming device“) beschrieben. Darüber hinaus werden neue Nagelzugangstechniken über Stichinzisionen und minimal-invasive perkutane Plattenosteosynthesetechniken (MIPO) für metaphysäre Frakturen am proximalen und distalen Femur sowie der proximalen Tibia beschrieben und dazu notwendige Techniken der Achsenkontrolle aufgezeigt.
    Notes: Summary Nail, plate and external fixator are since decades the most frequently and stabilizers for the surgical treatment of dia- and metaphyseal fractures. These elements are still present today. However, there were important changes in recent years. Together with better knowledge and understanding of fracture healing, fracture biology, implant metallurgy and mechanics and a more and more specified application of these techniques, this resulted in improved possibilities for the treatment of injured patients. Beside an overview about the current discussion of unreamed and reamed nail insertion new trends, techniques and nails are presented for the different long bones (retrograd nails, spiral blade, flex-nail humerus and a distal aiming device (DAD) for interlocking screws). In addition, new approach techniques for nailing (stab incision) and minimally invasive percutaneous plate osteosynthesis (MIPO) for metaphyseal fractures of the proximal and distal femur and proximal tibia are described including the necessary techniques for control of axes and rotation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003396
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