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  • Articles: DFG German National Licenses  (4,312)
  • 2000-2004  (653)
  • 1945-1949  (3,659)
  • Chemistry  (4,140)
  • Immunohistochemistry  (100)
  • Complications
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  • Articles: DFG German National Licenses  (4,312)
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  • 1
    Electronic Resource
    Electronic Resource
    Laparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 61-65 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopic colectomy ; Laparotomy ; Postoperative ileus ; Complications ; Nasogastric tube ; Colectomy ; Colorectal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to compare the length of postoperative ileus in patients undergoing colectomy by either laparotomy or laparoscopy. METHODS: A total of 166 patients were studied. These patients were divided into two groups: Group 1, in which colectomy was done laparoscopically, and Group 2, consisting of patients undergoing laparotomy. Both groups contained 83 patients who were matched for disease severity, indications for surgery, and procedure. Indications for surgery included sigmoid diverticulitis in 12 (14 percent) patients, polyps in 22 (27 percent), Crohn's disease in 21 (25 percent), colorectal cancer in 11 (13 percent), stoma reversal in 8 (10 percent), rectal prolapse in 3 (4 percent), and other indications in 6 (7 percent) in each group. Operations were colectomy with anastomosis (42 ileocolic, 26 colorectal, 6 colocolic, 4 ileorectal, and 2 ileal J pouch) or without anastomosis (3 abdominoperineal resections) performed by the same surgeons during the same time period (January 1993 to October 1996). The nasogastric tube was removed from all patients immediately after surgery in both groups. All patients received a clear liquid diet on the first postoperative day, followed by a regular diet as tolerated. The nasogastric tube was reinserted if two or more episodes of emesis of more than 200 ml occurred in the absence of bowel movement. Patients were discharged from the hospital when tolerating a regular diet without evidence of ileus. Statistical analysis was performed using unpairedt-test and Fisher's exact probability test. RESULTS: The male-to-female ratio was 38 to 45 in both groups. A total of 10 (12 percent) and 23 (28 percent) patients in Group 1 and Group 2 had emesis (P=0.02), and the rate of nasogastric tube reinsertion was 5 (6 percent) and 13 (16 percent), respectively (P〉0.05). There were significant differences between Groups 1 and 2 relative to the lengths of ileus (3.5±1.3vs. 5.4±1.7 days, respectively;P〈0.001), hospitalization (6.6±3.3vs. 8.1±2.5 days, respectively;P〈0.002), and operative time (170±60vs. 114±46 minutes, respectively;P〈0.001). The morbidity rate was 16 (19.2 percent) and 18 (21.6 percent) in the laparoscopy and laparotomy groups, respectively. CONCLUSIONS: Although early oral intake is safe and can be tolerated by 84 percent of patients after colectomy by laparotomy, laparoscopic colectomy reduced the lengths of both postoperative ileus and hospitalization.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237245
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  • 2
    Electronic Resource
    Electronic Resource
    Immunohistochemical localization of cathepsin D in colorectal tumors (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 396-401 
    Details
    ISSN: 1530-0358
    Keywords: Colorectal carcinoma ; Cathepsin D ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Although it has been suggested that cathepsin D, a lysosomal protease, is involved in tumor invasion and metastasis in human colorectal cancers, conflicting studies have also been reported recently. In addition, this issue has been only rarely studied in human colorectal tumors by use of immunohistochemical methods. The aim of the study presented here was to clarify not only the correlation between cathepsin D expression and tumor invasion or metastasis but also the correlation between the intracellular immunostaining pattern of cathepsin D and tumor invasion and metastasis in human colorectal tumors. METHODS: Thirty-four primary colorectal adenocarcinomas and 24 adenomas were immunostained by use of an anticathepsin D antibody. Both the incidence and the immunostaining patterns of cathepsin D were investigated in all tissue samples. RESULTS: Three different immunostaining patterns,i.e., supranuclear, basal, and diffuse, were observed in samples containing cathepsin D. Although the incidence of cathepsin D-positive carcinomas was not correlated with tumor progression, invasion, or metastasis, the immunostaining pattern was significantly correlated with lymphatic invasion. CONCLUSIONS: The results of this study suggest that abnormal cathepsin D immunostaining patterns (basal or diffuse) can be used to predict a potential for lymphatic invasion in colorectal carcinoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02258308
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  • 3
    Electronic Resource
    Electronic Resource
    Closedvs. open hemorrhoidectomy—Is there any difference? (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 31-34 
    Details
    ISSN: 1530-0358
    Keywords: Hemorrhoidectomy ; Postoperative pain ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to compare closed (Ferguson) hemorrhoidectomy to open (Milligan-Morgan) hemorrhoidectomy regarding postoperative conditions, complications, and long-term results. METHOD: This was a randomized study of 77 patients with second-degree or third-degree hemorrhoids suitable for hemorrhoidectomy. In 39 patients the Milligan-Morgan procedure was used, and in 38 patients the Ferguson procedure was used. Details of operations, postoperative complications, and length of postoperative stay were recorded. Pain was assessed from a visual analog scale and by registration of postoperative analgesic medication. Follow-up was done at three weeks, six weeks, and by visit or telephone interview after at least a year. RESULTS: No statistically significant differences were found between the two methods regarding complications, pain, or postoperative stay. There were four reoperations for bleeding, all after Milligan-Morgan operations. At follow-up after three weeks 86 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. Of the Milligan-Morgan patients, only 18 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent. One patient had a superficial wound infection. After one year more than 10 percent in each group had recurrent hemorrhoids with symptoms. CONCLUSION: Both methods are fairly efficient treatment for hemorrhoids, without serious draw-backs. The closed method has no advantage in postoperative pain reduction, but wounds heal faster, and the risk of wound dehiscence seems exaggerated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237240
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  • 4
    Electronic Resource
    Electronic Resource
    Audit of single-stage proctocolectomy for Crohn's disease (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 249-256 
    Details
    ISSN: 1530-0358
    Keywords: Single-stage proctocolectomy ; Crohn's disease ; Complications ; Delayed perineal wound healing ; Stomal complications ; Long-term results ; Recurrence ; Risk factor for recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was undertaken to review our overall experience of single-stage proctocolectomy for Crohn's disease. METHODS: One hundred three patients who underwent single-stage proctocolectomy for Crohn's disease between 1958 and 1997 were reviewed. Factors affecting the incidence of recurrence were examined using a multivariate analysis. RESULTS: Principal indications for proctocolectomy were chronic colitis (49 percent), acute colitis (37 percent), and anorectal disease (14 percent). The commonest postoperative complication was delayed perineal wound healing (n=36; 35 percent), followed by intra-abdominal sepsis (17 percent) and stomal complications (15 percent). In 23 patients the perineal wound healed between three and six months after proctocolectomy, whereas in 13 patients the wound remained unhealed for more than six months. There were two hospital deaths (2 percent) caused by sepsis. The 5-year, 10-year, and 15-year cumulative reoperation rates for small-bowel recurrence were 13, 17, and 25 percent, respectively, after a median follow-up of 18.6 years. From a multivariate analysis, factors affecting reoperation rate for recurrence were gender (male; hazard ratio 2.4vs. female;P=0.03) and age at operation (≤30 years; hazard ratio 2.6vs. 〉30 years;P=0.04). The following factors did not affect the reoperation rate: duration of symptoms, smoking habits, associated perforating disease, coexisting small-bowel disease, postoperative complications, and medical treatment. CONCLUSIONS: Proctocolectomy for Crohn's disease is associated with a high incidence of complications, particularly delayed perineal wound healing. Proctocolectomy carries a low recurrence rate in the long term. However, young male patients are at high risk of recurrence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236990
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  • 5
    Electronic Resource
    Electronic Resource
    Femoral neuropathy: An infrequently reported postoperative complication (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 419-422 
    Details
    ISSN: 1530-0358
    Keywords: Neuropathy ; Femoral nerve ; Colectomy ; Complications ; Retractors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Postoperative femoral neuropathy is an uncommon complication of abdominal surgery. We present four cases occurring after colectomy at our institution and discuss the diagnosis and treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02258312
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  • 6
    Electronic Resource
    Electronic Resource
    Safety and efficacy of dynamic graciloplasty for fecal incontinence (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 743-751 
    Details
    ISSN: 1530-0358
    Keywords: Fecal incontinence ; Dynamic graciloplasty ; Neurostimulation ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Dynamic graciloplasty has been used for intractable fecal incontinence, and good results have been reported. The aim of this study was to assess prospectively the safety and efficacy of dynamic graciloplasty for intractable fecal incontinence in a prospective, multicenter trial. METHODS: A total of 123 adults were treated with dynamic graciloplasty at 20 institutions. Continence was assessed preoperatively and postoperatively by use of 14-day diaries. RESULTS: There was one treatment-related death. One hundred eighty-nine adverse events occurred in 91 patients (74 percent). Forty-nine patients (40 percent) required one or more operations to treat complications. One hundred seventy (90 percent) events were resolved. Sixty-three percent of patients without pre-existing stomas recorded a 50 percent or greater decrease in incontinent events 12 months after dynamic graciloplasty, and an additional 11 percent experienced lesser degrees of improvement. Twenty-six percent were not improved, worsened, or exited. In patients with pre-existing stomas, 33 percent achieved successful outcomes at 12 months. This number increased to 60 percent at 18 months. Seventy-eight percent of patients had increased enema retention time, and mean anal canal pressures improved significantly at 12 months. Significant changes in quality of life were also observed. CONCLUSIONS: Objective improvement can be demonstrated in the majority of patients with end-stage fecal incontinence treated with dynamic graciloplasty. Reduction in incontinence episodes can be correlated with improved quality of life. Adverse events are frequently encountered, but most resolve with treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02238008
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  • 7
    Electronic Resource
    Electronic Resource
    A Prospective Analysis of the Cephalic Vein Cutdown Approach for Chronic Indwelling Central Venous Access in 100 Consecutive Cancer Patients (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 496-502 
    Details
    ISSN: 1534-4681
    Keywords: Cephalic vein ; Subclavian vein ; Central venous access ; Implanted port ; Tunneled catheter ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Chronic indwelling central venous access devices (CICVAD) generally are placed by the percutaneous subclavian vein approach. The cephalic vein cutdown approach is used only infrequently. Although the technique has been well described, few prospective data are available on the cephalic vein cutdown approach. Methods: From September 9, 1998, to July 20, 1999, the cephalic vein cutdown approach was attempted in 100 consecutive cancer patients taken to the operating room with the intention of placing CICVAD. Median patient age was 54.5 years (range 18–88), with 46 men and 54 women. Twenty-five patients had gastrointestinal malignancies, 17 had breast cancer, 15 had lymphoma, 13 had lung cancer, 12 had leukemia, 5 had multiple myeloma, and 13 had other malignancies. Patients were followed prospectively for immediate and long-term outcome. Results: CICVAD placement via the cephalic vein cutdown approach was successful in 82 patients; the remaining 18 patients required conversion to a percutaneous subclavian vein approach. The reasons for inability to place CICVAD via cephalic vein cutdown approach were a cephalic vein that was too small (10 patients), an absent cephalic vein (7 patients), and inability to traverse the angle of insertion of the cephalic vein into the subclavian vein (1 patient). There were 56 subcutaneous ports and 26 tunneled catheters. Median operating time was 44 minutes (range, 26–79 minutes). No postoperative pneumothorax occurred. Median catheter duration was 198 days (range, 0–513 days). Long-term complications included catheter-related bacteremia (6%), site infection (2%), deep venous thrombosis (5%), port pocket hematoma (1%), and superior vena cava stricture (1%). Thirty-seven percent of patients have died since CICVAD placement. Twenty-nine percent of the CICVADs have been removed. Conclusions: The cephalic vein cutdown approach was successful in 82% of patients. This approach is a safe and useful alternative to the percutaneous subclavian vein approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0496-9
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  • 8
    Electronic Resource
    Electronic Resource
    Sentinel Node Biopsies in Melanoma Patients: A Protocol for Accurate, Efficient, and Cost-Effective Analysis by Preselection for Immunohistochemistry on the Basis of Tyr-PCR (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 51-54 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Sentinel node analysis ; Tyrosinase RT-PCR ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Immunohistochemistry (IHC) of serial sectioning is considered the gold standard for detection of melanoma activity in sentinel node (SN) biopsies. However, this is cost and labor intensive. In contrast, tyrosinase reverse transcription-polymerase chain reaction (RT-PCR) is simple and quick, but it is hampered by its extreme sensitivity. This study was performed to test whether a strategy that combines the two methods, using tyrosinase RT-PCR to preselect nodes for IHC, could be accurate and cost effective. Methods: In 36 patients, SNs were identified by scintigraphy and patent blue uptake. Of each SN, one cross section was analyzed first by hematoxylin and eosin staining. Next, all nodes were examined by serial sectioning and IHC of one-half and tyrosinase RT-PCR of the other. Before comparison, all results were documented in a blinded manner. Material costs and workload estimates were noted per SN. Results: Fifty-five SNs were retrieved from the 36 patients. Hematoxylin and eosin staining of the first cross section revealed tumor positivity in 3 patients (6 SN). Tyrosinase RT-PCR was positive in 11 of the remaining 33 patients (19 of 49 SN). Of these same 11 patients, only 5 were shown to have tumor-positive SNs by using IHC on serial sections (7 SN). All these nodes had been positive for tyrosinase on PCR. For IHC, an average of 40 sections were prepared and examined per SN at a cost of $200(U.S.)/SN. In contrast, routine tyrosinase RT-PCR costs $37(U.S.)/SN, and takes 5% of the time necessary for IHC. A strategy including hematoxylin and eosin staining on the first cross section, followed by tyrosinase RT-PCR on half of each negative (half) node, could preselect nodes to be taken through serial sectioning. In these series, such a strategy would have prevented serial sectioning and IHC of 30 SN from 22 patients. Apart from a considerable gain in efficiency, this would have reduced material costs by a minimum of $6000 (U.S.). This iscrepancy would be even higher if work intensity of analysts and pathologists were considered. Conclusions: In routine analysis of SN biopsies in melanoma patients, tyrosinase RT-PCR can be used effectively to preselect nodes for further IHC of serial sections. This method seems both time and cost effective.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0051-8
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  • 9
    Electronic Resource
    Electronic Resource
    Use of a gracilis muscle flap to facilitate delayed ileal pouch-anal anastomosis (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1628-1631 
    Details
    ISSN: 1530-0358
    Keywords: Gracilis muscle flap ; Ileal pouch-anal anastomosis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Failure of an ileal pouch-anal anastomosis may result in unsuccessful completion of the anastomosis or removal of an ischemic pouch. We report a technique for preservation of the muscular wall of the rectum after mucosal dissection, which allowed a successful delayed pull-through.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236752
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  • 10
    Electronic Resource
    Electronic Resource
    Effect of previous surgery on abdominal opening time (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1749-1753 
    Details
    ISSN: 1530-0358
    Keywords: Adhesions ; Operative technique ; Complications ; Economics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The purpose of this study was to document prospectively the time required to gain access to the abdomen to perform a planned procedure in patients with and without previous surgery. METHODS: Patients were obtained from the consecutive cases of 11 surgeons at three colorectal surgery centers. Opening time (skin incision to retractor placement) was measured and recorded in the operating room by the circulating nurse or by an independent researcher. Demographic data including the number and type of previous operations and the presence and severity of adhesions were recorded by the staff surgeon. A comparison of opening times between patients with and without previous abdominal operations was conducted. RESULTS: One hundred ninety-eight patients had abdominal operations. Fifty-five percent had previous abdominal procedures. Patients with prior surgery required a mean of 21 minutes to open their abdomens, whereas patients without prior surgery required a mean of 6 minutes (P〈0.01). The median times were 17 and 6 minutes, respectively. Eighty-three percent of patients with prior surgery had adhesions, whereas only 7 percent of patients had adhesions on their initial operation. Patients with prior surgery also had higher grade adhesions (P〈0.001). Irrespective of previous surgery, comparing patients with adhesions with those without, patients with adhesions required a mean of 22 minutes to open, whereas the lack of adhesions resulted in a mean opening time of 6 minutes. CONCLUSIONS: Previous surgery and the presence of adhesions add significant time to opening the abdomen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236862
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  • 11
    Electronic Resource
    Electronic Resource
    Lumbar osteomyelitis and epidural abscess complicating recurrent pilonidal cyst (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1015-1017 
    Details
    ISSN: 1530-0358
    Keywords: Pilonidal cyst ; Lumbar osteomyelis ; Epidural abscess ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was conducted to report the rare presentation of lumbar osteomyelitis and epidural abscess as a complication of a pilonidal cyst. METHODS: A case report is presented. RESULTS: We describe the rare case of a male patient with diabetes with a recurring pilonidal cyst who developed a lumbar osteomyelitis and epidural abscess three weeks after pilonidal cyst excision with epidural anesthesia, with a fatal outcome despite emergency treatment. CONCLUSIONS: Life-threatening complications should be kept in mind in high-risk patients with repetitive surgery and neurologic involvement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237370
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  • 12
    Electronic Resource
    Electronic Resource
    Micrometastasis in lymph nodes of mucosal gastric cancer (2000)
    Springer
    Gastric cancer 3 (2000), S. 91-96 
    Details
    ISSN: 1436-3305
    Keywords: Key words Mucosal gastric cancer ; Micrometastasis ; Cytokeratin ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Endoscopic mucosal resection is frequently used in the treatment of mucosal gastric cancer. Micrometastasis in the lymph nodes of mucosal gastric cancer remains unclear. Methods. We examined 2526 lymph nodes from 84 patients with mucosal gastric cancer. Two consecutive sections were prepared, for simultaneous staining with hematoxylin and eosin and immunostaining with CAM 5.2 monoclonal antibody against cytokeratin (CK), respectively. A clinicopathological comparison was made between patients with and without lymph node involvement. Results. Lymph node involvement was detected in 45 of 2526 (1.8%) lymph nodes. The incidence of nodal involvement was significantly increased, from 1.2% (1/84 patients) with hematoxylin and eosin staining, to 19% (16/84 patients) with CK immunostaining. Although no significant difference was found, micrometastasis to lymph nodes was more frequently detected in tumors larger than 1.0 cm (15/72 patients, 21%) than in those less than or equal to 1.0 cm (1/12 patients; 8%, P = 0.307). However, discrete CK-positive cancer cells or clusters of CK-positive cancer cells were detected only in tumors larger than 2 cm. Conclusion. Because mucosal gastric cancer of more than 1.0 cm in superficial diameter may indicate a risk of micrometastasis to lymph nodes, endoscopic mucosal resection is not recommended for these patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00011702
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  • 13
    Electronic Resource
    Electronic Resource
    Immunohistochemical investigation of a pulmonary surfactant in fatal mechanical asphyxia (2000)
    Springer
    International journal of legal medicine 113 (2000), S. 268-271 
    Details
    ISSN: 1437-1596
    Keywords: Key words Surfactant-associated protein A ; Immunohistochemistry ; Asphyxia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract We evaluated the usefulness of pulmonary surfactant protein A (SP-A) as a practical diagnostic marker of fatal mechanical asphyxia in forensic autopsy cases. ¶A total of 27 cases of asphyxia were examined histologically and immunohistochemically and compared with a control group consisting of 16 cases of poisoning (n = 9) and peracute death (n = 7). Both groups showed histological findings of local atelectasis and local emphysema, congestion, intra-alveolar and interstitial edema in most cases and pulmonary hemorrhages in some cases. The mechanical asphyxia group showed a significantly increased intensity of SP-A staining in the intra-alveolar space accompanied by many massive aggregates in approximately 60% of cases, which was not found in the control group. These structures may be interpreted as aggregates of pulmonary surfactant released from the alveolar wall due to enhanced secretion caused by strong forced breathing or over-excitement of the autonomic nervous system by mechanical asphyxia. The results of our investigation suggest the practical usefulness of the immunohistochemical detection of SP-A in distinguishing mechanical asphyxia from other types of hypoxia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004149900109
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  • 14
    Electronic Resource
    Electronic Resource
    The time course of the vascular response to human brain injury – an immunohistochemical study (2000)
    Springer
    International journal of legal medicine 113 (2000), S. 288-292 
    Details
    ISSN: 1437-1596
    Keywords: Key words Brain injury ; Cortical contusion ; Vascular ¶reaction ; Immunohistochemistry ; Wound age
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract In a total of 104 individuals who had sustained traumatic brain injury (TBI), the time-dependent vascular response was investigated at the injured cortical area during the first 30 weeks after the trauma. The immunohistochemical staining of the cerebral blood vessels was performed with antibodies against laminin, type IV collagen, tenascin, thrombomodulin and factor VIII associated antigen. Compared to the immunoreactivity in unaltered control tissue, a significantly increased vascular expression could be detected in cortical contusions after a postinfliction interval of at least 3 h for factor VIII, after 1.6 days for tenascin or after 6.8 days for thrombomodulin, whereas the immunostaining for laminin and type IV collagen was regularly positive even in the vascular endothelium of uninjured brain tissue.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004149900126
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  • 15
    Electronic Resource
    Electronic Resource
    Erfahrungen mit der Osteosynthese bei Fersenbeinfrakturen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S442 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Intraartikuläre Fersenbeinfraktur ; Klassifikation ; Weichteilschaden ; Komplikationen ; Ergebnisse ; Keywords Intraarticular calcaneal fracture ; Classification ; Soft tissue lesions ; Complications ; Results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Even now, the diagnosis of a dislocated intraarticular calcaneal fracture means a handicap for many patients. A bilateral fracture usually means the end of professional life – especially in the case of any job involving physical work. Because the functional outcome after an intraarticular calcaneal fracture is determined by the degree to which restoration of the different articular surfaces, and of the height, length and width of the affected calcaneus is achieved, operative treatment has become much more frequent in recent years. Discussion continues on the operative treatment of high comminuted fractures. The available studies are not comparable, differing as they do in the classification systems and criteria of outcome used and the postoperative check-up schedules followed. Despite some progress towards standardization of the operative procedure in the last 10 years, especially with respect to soft tissue treatment and the types of implants used, several questions remain to be answered. Our own experience is reported.
    Notes: Zusammenfassung Die Diagnose einer intraartikulären dislozierten Fersenbeinfraktur bedeutet auch heute noch für viele Patienten eine Einschränkung der künftigen Belastbarkeit, bei beidseitiger Betroffenheit in der Regel das Ausscheiden aus einem körperlich belasteten Beruf. Da sich das funktionelle Ergebnis der Fersenbeinfraktur im Wesentlichen durch die Wiederherstellung der Gelenkflächen, Höhe, Länge und Breite sowie Achsen des Fersenbeins beeinflussen lässt, hat die operative Rekonstruktion in den letzten Jahren deutlich zugenommen. Die Diskussion über die operative Versorgung von Fersenbeinfrakturen ist insbesondere bei Trümmerfrakturen noch nicht als abgeschlossen zu betrachten. Die vorliegende Fülle von Studien ist bezüglich der Klassifikation, der Nachuntersuchungskriterien und der Nachuntersuchungszeiträume nur schwer zu vergleichen. Trotz einer seit nun mehr als über einem Jahrzehnt perfektionierten und zunehmend standardisierten Operationstechnik bleiben noch viele Fragen zu beantworten. Über Schwierigkeiten bei der operativen Versorgung wird berichtet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014967
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  • 16
    Electronic Resource
    Electronic Resource
    Aktuelle Behandlungsstrategien bei distalen Unterarmfrakturen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S205 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Distale Unterarmfrakturen ; Konservative Therapie ; Operative Therapie ; Risiken ; Komplikationen ; Keywords Distal fractures of lower arm ; Conservative therapy ; Operative therapy ; Risks ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The treatment of distal fractures of the lower arm can be conservative or operative. The immediate aims of any treatment are anatomical realignment and the avoidance of trophic impairments, with the ultimate objective of unrestricted function of the hand and wrist. A graduated treatment scheme based on the ASIF classification is necessary to do justice to the different forms of fracture that can occur. The majority of injuries can still be successfully treated by conservative means; operative treatment becomes more important when there are signs of unusually high levels of instability or joint involvement. The authors’ own patient population is presented in this paper: in these patients fixation with Kirschner wires has proved to be the most successful of the operative procedures used, followed by palmar plate fixation with or without cancellous bone plasty, and for C-type fractures according to the ASIF classification or when there ¶is severe soft-tissue damage, application of ¶a fixateur externe spanning the joint has proved best. Treatment strategy, risks, complications and results are presented.
    Notes: Zusammenfassung Die Behandlung distaler Unterarmfrakturen kann konservativ oder operativ erfolgen. Ziel jeder Behandlung sind die anatomische Reposition und Retention sowie die Vermeidung trophischer Störungen mit dem Fernziel einer unbeeinträchtigten Funktion der Hand und des Handgelenks. In Anlehnung an die AO-Klassifikation ist ein stufenförmiges Behandlungsschema notwendig, um den verschiedenen Frakturformen gerecht zu werden. Ein Großteil der Verletzungen kann nach wie vor erfolgreich konservativ behandelt werden, bei Zeichen einer erhöhten Instabilität oder einer Gelenkbeteiligung rückt die operative Behandlung zunehmend in den Vordergrund. Im eigenen, dargestellten Krankengut hat sich bei den operativen Verfahren schwerpunktmäßig die Kirschner-Draht-Osteosynthese bewährt, nachfolgend die palmare Plattenosteosynthese mit oder ohne Spongiosaplastik und bei Frakturen der C-Typen nach AO und bei höhergradigem Weichteilschaden die gelenkübergreifende Fixateur-externe-Anordnung. Behandlungsstrategie, Risiken, Komplikationen und Ergebnisse werden dargestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014888
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  • 17
    Electronic Resource
    Electronic Resource
    Spezielle Probleme bei Wirbelfrakturen mit Querschnittlähmung (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S500 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Hoffnung ; Selbstständigkeit ; Komplikationen ; Gangschulung ; Keywords Hope ; Independence ; Complications ; Mobility training
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract In the treatment of paraplegic patients ¶there is a definite discrepancy between the ideas and wishes of the patients and the approaches and objectives of the physiotherapists. The greatest concern of the person affected is recovery of the ability to walk, while the main emphases of physiotherapy primarily involve avoiding complications of paralysis and achieving the highest possible degree of independence. One aid used in teaching partially paralysed patients to walk again is the walking belt, which complements the neurophysiological treatment methods very well. Mobility training with completely paralysed patients is obviously restricted owing to the lack of function. Sources of problems include relapsing shoulder pain and marked spasticity, which limit the results that can be achieved by way of rehabilitation medicine. With the support of an electronic measuring system the threat of pressure sores can be successfully combated.
    Notes: Zusammenfassung In der Behandlung Querschnittgelähmter besteht zwischen den Vorstellungen und Wünschen der Patienten und den Gesichtspunkten und Zielen der Physiotherapie eine deutliche Diskrepanz. Der Betroffene erhofft sich v. a. das Wiedererlangen seiner Gehfähigkeit, die Schwerpunkte der Physiotherapie liegen in erster Linie auf der Vermeidung lähmungsbedingter Komplikationen und dem Erreichen maximaler Selbstständigkeit. Gangschulung wird bei inkomplett Gelähmten u. a. mit Hilfe des Laufbands durchgeführt, das eine hervorragende Ergänzung der neurophysiologischen Behandlungstechniken darstellt. Das Gehtraining mit komplett Gelähmten reduziert sich naturgemäß aus Mangel an funktionellen Einsatzmöglichkeiten. Unter anderem können rezidivierende Schulterschmerzen und starke Spastik Probleme darstellen und sich limitierend auf das Rehabilitationsergebnis auswirken. Der Dekubitusgefahr wird, unterstützt durch ein elektronisches Messsystem, erfolgreich entgegengewirkt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014982
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  • 18
    Electronic Resource
    Electronic Resource
    Clinical significance of disordered beta-catenin expression pattern in human gastric cancers (2000)
    Springer
    Gastric cancer 3 (2000), S. 193-201 
    Details
    ISSN: 1436-3305
    Keywords: Key words Gastric cancer ; Beta-catenin ; E-cadherin ; Immunohistochemistry ; Western blot
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Background. Beta-catenin plays two distinct roles, in intercellular adhesion by E-cadherin, and in transcriptional activation via TCF/LEF. Theoretically, the former role is tumor-suppressive, while the latter is oncogenic. We investigated the involvement of beta-catenin in the histogenesis and clinical outcome of gastric cancers. Methods. The expression pattern of beta-catenin was evaluated in stomach and lymph nodes from 82 patients with gastric cancer by immunohistochemistry and Western blot. Its association with E-cadherin expression and clinicopathological factors, including histological type and postoperative survival, was examined. Results. Beta-catenin expression was classified into two patterns, normal (23.2%; 19 patients) and disordered (76.8%; 63 patients), the latter being subclassified as overexpressed (7.3%; 6 patients) and reduced (69.5%; 57 patients). A disordered beta-catenin expression pattern was significantly correlated with diffuse type adenocarcinoma and deep tumor infiltration (P = 0.0154), but was not associated with lymph node metastasis (P = 0.7877). E-cadherin was always expressed at the cell membrane, and disordered beta-catenin expression was significantly associated with reduced E-cadherin expression (P 〈 0.0001). On univariate analysis, the beta-catenin pattern, as well as depth of invasion and lymph node metastasis, was associated with postoperative prognosis; however, only lymph node metastasis was an independent prognostic factor on multivariate analysis. Interestingly, different disordered patterns of beta-catenin expression, both overexpressed and reduced, were associated with E-cadherin reduction and poorer postoperative survival. Conclusion. Although disordered patterns of beta-catenin expression varied in gastric cancers, they were consistently associated with cancer progression.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00011717
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  • 19
    Electronic Resource
    Electronic Resource
    Management intraoperativer Komplikationen bei der Applikation stentgestützter Aortenprothesen (2000)
    Springer
    Gefässchirurgie 5 (2000), S. 232-240 
    Details
    ISSN: 1434-3932
    Keywords: Schlüsselwörter Endovaskuläre Operationen ; Stents ; Aortenstentprothese ; Bauchaortenaneurysma ; Komplikationen ; Keywords Endovascular surgery ; Stents ; Aortic stent prostheses ; Aneurysm ; Abdominal aorta ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract  Intraoperative complications can be divided into three categories on the basis of the time of their occurrence: Group I – Problems associated with access; group II: introduction of the endovascular stent (a: release of the main segment, b: anchoring the second limb); and group III: incidence of primary endoleaks. The objective of the present study was to describe the management of these complications. In a group of 130 patients undergoing endovascular treatment of aneurysms of the abdominal aorta, a total of 31 complications occurred in 26 patients (20.0%). The most frequently encountered complication in each group and its respective management was as follows: Group I: Correction was performed using dilatation and retroperitoneal stretching as well as surgical shortening of the external iliac artery with interposition; group IIa: overstenting the renal arteries was corrected either by conversion or tugging at the endograft; group IIb: the guide wire or docking system could not be placed. Such cases were managed either through conversion or use of fresh systems; group III: such complications were treated with repeated stent placement, postoperative coil embolizations, or conversion. The endovascular therapy of aortic aneurysms is associated with intraoperative complications in 20% of cases. Adequate management helps to keep both morbidity and mortality rates low.
    Notes: Zusammenfassung  Intraoperative Komplikationen können je nach Zeitpunkt des Ereignisses in 3 Gruppen definiert werden: Gruppe I – Zugangsprobleme, Gruppe II – Einbringen des endovaskulären Stents (a: Absetzen des Hauptteils, b: Andocken des 2. Schenkels), Gruppe III – Inzidenz primärer Endoleaks. Zielsetzung dieser retrospektiven Studie war es, das Management zur Behebung dieser Komplikationen darzustellen. Von 130 Patienten mit endovaskulärer Ausschaltung eines Aortenaneurysmas traten bei 26 Patienten 31 intraoperative Komplikationen auf (20,0%). Die führenden Komplikationen in jeder Gruppe sowie das daraus resultierende Management waren: Gruppe I: Die Korrektur erfolgte durch Dilatation, retroperitoneale Streckung, Kürzungsoperation der A. iliaca externa und Interponat. Gruppe II a: Bei Überstentung der Nierenarterien erfolgte die Konversion oder Zug am Endograft. Gruppe II b: Führungsdraht oder Andocksystem können nicht platziert werden. Die Behebung erfolgte durch Konversion und Anwendung neuer Systeme. Gruppe III: Hier wurden erneute Stentplazierungen, postoperativer Coil-Embolisationen und Konversionen durchgeführt. Die endovaskuläre Therapie aortaler Aneurysmen birgt eine Rate intraoperativer Schwierigkeiten von 20%. In 3,8% der Fälle musste eine Konversion durchgeführt werden. Durch adäquates Management konnten die Letalität (1/26) und Morbidität jedoch gering gehalten werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010600
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  • 20
    Electronic Resource
    Electronic Resource
    Histological study on pN upgrading of oral cancer (2000)
    Springer
    Virchows Archiv 437 (2000), S. 116-121 
    Details
    ISSN: 1432-2307
    Keywords: Key words Oral cancer ; pN upgrading ; Immunohistochemistry ; Micrometastasis ; Semiserial sectioning
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The International Union Against Cancer (UICC) does not define the number of sections required from each regional lymph node to record pTNM classification. This study was designed to clarify the incidence of occult metastasis and to assess the pN upgrading of patients with oral cancer. Ultimately, this study led to a proposal for appropriate semiserial sectioning guidelines. Five hundred fifty-four nonmetastatic cervical lymph nodes taken from 73 patients with oral cancer were subjected to hematoxylin-eosin (HE) staining and keratin immunohistochemistry. Micrometastases, defined as foci ≤3 mm, were detected in 29 sites of 23 lymph nodes (4.2%) of 16 patients (21.9%). In 9 patients (12.3%) pN upgrading was needed: in 6 from pN0 to pN1, in 1 from pN0 to pN2b, and in 2 from pN1 to pN2b. The remaining 13 lymph nodes with occult metastasis were found in 5 pN2b and 2 pN2c patients, resulting in no pN upgrading. Occult metastasis was also detected in 6 small lymph nodes ≤5 mm in diameter. The average minor axis of the micrometastasis was 1.36±0.85 mm. We propose that the lymph nodes should be cut and examined at 1-mm intervals to detect micrometastatic foci and to evaluate the pN classification accurately.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000199
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  • 21
    Electronic Resource
    Electronic Resource
    In situ reverse-transcriptase polymerase chain reaction demonstration of the EWS/FLI-1 fusion transcript in Ewing’s sarcomas and peripheral primitive neuroectodermal tumors (2000)
    Springer
    Virchows Archiv 437 (2000), S. 234-240 
    Details
    ISSN: 1432-2307
    Keywords: Keywords Small round cell tumors ; Ewing’s sarcoma ; Translocation ; Immunohistochemistry ; Differential diagnosis ; RT-PCR
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  It is now widely accepted that the EWS/FLI-1 fusion transcript is associated with tumors of the Ewing family. To test whether it is possible to detect the fusion transcript by means of combining polymerase chain reaction (PCR) methodology and immunohistochemistry, we investigated tumors of the Ewing family using in situ reverse transcriptase (RT)-PCR. We were able to demonstrate the t(11;22) fusion transcript in five of six cases of Ewing’s sarcoma and four of four peripheral primitive neuroectodermal tumors. These results were confirmed using fluorescence in situ hybridization in seven tumor samples. In situ RT-PCR-labeled fusion transcripts were found in virtually all tumor cells within a given sample, indicating that each cell possessed the t(11;22) transcript. We conclude from these results that in situ RT-PCR can be used for the rapid detection of EWS/FLI-1 fusion transcripts in biopsy material. The findings also suggest that all cells of the tumors of the Ewing family carry the EWS/FLI-1 fusion transcript.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000252
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  • 22
    Electronic Resource
    Electronic Resource
    Detection of gonadotropin-releasing hormone receptor in normal human pituitary cells and pituitary adenomas using immunohistochemistry (2000)
    Springer
    Virchows Archiv 437 (2000), S. 264-269 
    Details
    ISSN: 1432-2307
    Keywords: Keywords Gonadotropin-releasing hormone receptor ; Pituitary gland ; Immunohistochemistry ; Colocalization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Gonadotropin-releasing hormone (GnRH), which is a well-known regulator of gonadotroph function, has recently been considered to be a paracrine factor involved in the control of somatotroph, lactotroph, and corticotroph cells. GnRH action is initiated by binding to a specific cell surface receptor, the gonadotropin-releasing hormone receptor (GnRHR), which is expressed by follicle-stimulating hormone/luteinizing hormone (FSH/LH) cells. Using in situ hybridization techniques, GnRHR messenger ribonucleic acid (mRNA) has recently been detected in normal human anterior pituitary gland and in various pituitary adenomas, including FSH/LH-cell, growth hormone (GH)-cell, adrenocorticotropic hormone (ACTH)-cell, and null-cell adenomas. However, immunohistochemical studies indicating the specific cell distribution of GnRHR in normal pituitary cells have never been reported. The aim of the present investigation was to evaluate the immunohistochemical expression of GnRHR in different types of normal pituitary cells and related tumors. Using double-label immunohistochemical techniques on formalin-fixed and paraffin-embedded tissues and specific antibodies directed against pituitary hormones and GnRHR, we found GnRHR immunoreactivity not only in FSH/LH cells, but also in GH- and thyroid-stimulating hormone (TSH) cells. GnRHR was detected in FSH/LH-cell, GH-cell, mixed GH- and prolactin (PRL)-cell, and α-subunit (α-SU)/null-cell adenomas. The findings of this study suggest that the interaction between GnRH and GnRHR may play a role in paracrine/autocrine regulation of different types of normal pituitary cells and pituitary adenomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000247
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  • 23
    Electronic Resource
    Electronic Resource
    CD99 immunoreactivity in gastrointestinal and pulmonary neuroendocrine tumours (2000)
    Springer
    Virchows Archiv 437 (2000), S. 270-274 
    Details
    ISSN: 1432-2307
    Keywords: Keywords CD99 antigen ; Neuroendocrine tumours ; Immunohistochemistry ; Cell-to-cell adhesion ; Proliferative activity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Although considered a specific marker for Ewing’s sarcoma/peripheral neuroectodermal tumour, the MIC2 gene product (CD99) has been immunolocalised in a variety of human tumours. The present study evaluated immunohistochemically the prevalence of CD99 expression in a series of 68 neuroendocrine tumours of different gastrointestinal and pulmonary sites. We now report on membrane and/or granular cytoplasmic immunoreactivity in 25% of these tumours, independent of their anatomical sites. In lung neuroendocrine tumours, CD99 was preferentially confined to typical carcinoids (P=0.009). A statistically significant relationship was observed between the number of CD99 positive cells but not the immunostaining patterns and the presence of local invasion and/or distant metastases (P〈0.001). Moreover, there was a tendency for CD99-reactive tumours to show a reduced proliferative activity expressed by a Ki67 index of 2% (P=0.119). The number of CD99 immunoreactive cells or patterns of immunoreactivity did not correlate with the presence of associated clinical syndrome or particular hormonal immunostaining. Although the molecular basis underlying CD99 expression in neuroendocrine tumours is still poorly understood, our data suggest that CD99 may be involved in cell-to-cell adhesion of neuroendocrine tumour cells and in downregulation of their proliferative activity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000240
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  • 24
    Electronic Resource
    Electronic Resource
    Solitary fibrous tumour of the adrenal gland associated with pregnancy (2000)
    Springer
    Virchows Archiv 437 (2000), S. 445-449 
    Details
    ISSN: 1432-2307
    Keywords: Keywords Solitary fibrous tumour ; Adrenal gland ; Pregnancy ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Solitary fibrous tumour (SFT), first described as a pleural lesion, has been reported in several extrathoracic sites over the past 10 years. We describe a SFT of the left adrenal gland incidentally discovered in a 23-year-old, 22-week pregnant woman and characterised by a rapid growth during the third trimester of pregnancy. Elevated serum and urinary levels of cortisol and elevated blood levels of delta 4 androstendione and 17-OH progesterone were observed. After spontaneous delivery, the patient underwent laparoscopic resectioning of the mass and of the left adrenal gland from which the tumour was apparently originating. The kidney was not involved, and no other abdominal tumours were found. Histological and immunohistochemical features were typical of SFT of pleura and other locations. Only one case of adrenal SFT is on record, and the adrenal gland is to be added to the long list of extrathoracic locations of SFT. The association with pregnancy was a previously unrecognised event in SFT. The focal expression of progesterone receptors in the tumour cells may be related to pregnancy. This observation prompted an analysis of steroid hormone receptors in SFT of classical sites (pleura). Two of five cases had focal progesterone receptors too, a finding which deserves further investigations in a much larger series of SFTs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000268
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  • 25
    Electronic Resource
    Electronic Resource
    A case of anaplastic lymphoma kinase-positive anaplastic large cell lymphoma presenting with spontaneous splenic rupture: an extremely unusual presentation (2000)
    Springer
    Virchows Archiv 437 (2000), S. 459-464 
    Details
    ISSN: 1432-2307
    Keywords: Keywords Non-Hodgkin’s lymphoma ; Immunohistochemistry ; ALK1 ; T-cell lymphoma ; Splenic rupture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In a 22-year-old male with a 10-day history of fever, painful swelling in the left groin, and abdominal complaints, emergency surgery was performed because of spontaneous splenic rupture. At histology, a cellular infiltrate of intermediate-sized atypical lymphocytes was seen in the splenic white pulp, staining for T-cell markers. In addition, CD30 and anaplastic lymphoma kinase 1 (ALK) were diffusely positive, thus, representing a case of anaplastic large cell lymphoma (ALCL), T-cell, ALK-positive, small cell monomorphic variant. ALK-positive ALCL patients generally bear a much better prognosis than patients with T-cell lymphomas, unspecified, or ALK-negative ALCL. Therefore, besides the very unusual clinical presentation, this case highlights the importance of immunostaining for CD30 and ALK in all T-cell lymphomas. This report is the first extensive description of ALK-positive ALCL involvement of the spleen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000251
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  • 26
    Electronic Resource
    Electronic Resource
    Dopamine D1-D5 receptor protein immunohistochemistry in dog pial arteries (2000)
    Springer
    The journal of headache and pain 1 (2000), S. 163-168 
    Details
    ISSN: 1129-2377
    Keywords: Key words Dopamine receptors ; Pial arteries ; Immunohistochemistry ; Prejunctional receptors ; Post-junctional receptors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The localization of dopamine D1-D5 receptor protein was investigated in different sized dog pial arteries. This was done to further understand the pathophysiology of cerebrovascular dopaminergic system in migraine. The study was performed in sections of dog brain including the pia-arachnoid membrane, which were processed for indirect immunohistochemistry using antibodies raised against dopamine D1-D5 receptor protein. A faint dopamine D1 receptor protein immunoreactivity was observed in smooth muscle of the tunica media of different sized pial arteries. Dopamine D2 receptor protein immunoreactivity was located in the adventitia and adventitia-media border of pial arteries. In the same area tyrosine hydroxylase immunoreactive nerve fibers were found. No dopamine D3 receptor immunoreactivity was detectable in dog pial arteries. A faint dopamine D4 receptor protein immunoreactivity was observed in dog pial arteries, with a localization similar to that of D2 receptor protein. A moderate dopamine D5 receptor protein immunostaining was observed in smooth muscle of the tunica media. These findings indicate that dog pial arteries express dopamine D1-like (D1 and D5) and D2-like (D2 and D4) receptor subtypes and display, respectively, a muscular (post-junctional) and probably prejunctional localization. These results, the first analysis of dopamine D1-D5 receptor subtype distribution in the cerebrovascular tree, suggest that dopamine is involved in the regulation of cerebral circulation. These finding may help evaluate the role of cerebrovascular dopaminergic mechanisms in the pathogenesis of migraine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101940070038
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  • 27
    Electronic Resource
    Electronic Resource
    Excitatory amino acids, monoamine, and nitric oxide synthase systems in organotypic cultures: biochemical and immunohistochemical analysis (2000)
    Springer
    Amino acids 19 (2000), S. 33-43 
    Details
    ISSN: 1438-2199
    Keywords: Keywords: Amino acids ; Basal ganglia ; Dopamine ; Nitric oxide ; Excitatory amino acids ; Organotypic culture ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary. The nigrostriatal and mesolimbic systems of the rat have been re-constructed using the organotypic culture model, whereby neonatal brain tissue is grown in vitro for approximately one month. The nigrostriatal cultures consisted of tissue from the substantia nigra, dorsal striatum and frontoparietal cortex; while the mesolimbic cultures included the ventral tegmental area, ventral striatum and cingulate cortex. The cultures were grown at 35°C in normal atmosphere, using a tube-roller device placed in a cell incubator and changing the medium every 3–4 days. The in vitro development was evaluated with an inverted microscope equipped with a variable relief contrast function. Samples were taken directly from the medium in the culture tube and analysed for several amino acids with HPLC. After a month the cultures were fixed and processed for immunohistochemistry. High levels of glutamate and aspartate were observed every time the medium was changed, but the levels rapidly decreased reaching a steady state after approximately 24 h. A decrease in the levels was also observed along development, reaching stable values (∼2 μM and ∼0.12 μM for glutamate and aspartate, respectively) at approximately two weeks, but only when the cultures showed an apparently healthy development. The levels were approximately 10 times higher in deteriorating or apparently damaged cultures. Glutamine levels were in the mM range and remained stable along the entire experiment. No differences were observed among nigrostriatal and mesolimbic cultures. Immunohistochemistry confirmed the impressions obtained from microscopic and biochemical analysis along the in vitro development, revealing apparently healthy neuronal systems with characteristics similar to those observed in vivo, when tyrosine hydroxylase and nitric oxide synthase, markers for dopamine and nitric oxide containing neurons, respectively, were analysed. In the substantia nigra, nitric oxide synthase-positive networks surrounded tyrosine hydroxylase-positive neurons, while in the striatum nitric oxide synthase dendrites were surrounded by tyrosine hydroxylase-positive nerve terminals, suggesting a reciprocal interaction among dopamine and nitric oxide containing neurons. Thus, the organotypic model appears to capture many of the neurochemical and morphological features seen in vivo, providing a valuable model for studying in detail the neurocircuitries of the brain.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007260070031
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  • 28
    Electronic Resource
    Electronic Resource
    Neurotrophic factors influence upregulation of constitutive isoform of heme oxygenase and cellular stress response in the spinal cord following trauma (2000)
    Springer
    Amino acids 19 (2000), S. 351-361 
    Details
    ISSN: 1438-2199
    Keywords: Keywords: Amino acids ; Spinal cord injury ; Heme oxygenase ; Heat shock protein ; Carbon monoxide ; Growth factors ; BDNF ; IGF-1 ; Immunohistochemistry ; Cell injury ; Spinal cord edema
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary. The influence of brain derived neurotrophic factor (BDNF) or insulin like growth factor-1 (IGF-1) on spinal cord trauma induced carbon monoxide (CO) production and cellular stress response was examined using immunostaining of the constitutive isoform of the hemeoxygenase (HO-2) enzyme and the heat shock protein (HSP 72 kD) expression in a rat model. Subjection of rats to a 5 h spinal trauma inflicted by an incision into the right dorsal horn at T10–11 segment markedly upregulated the HO-2 and HSP expression in the adjacent spinal cord segments (T9 and T12). Pretreatment with BDNF or IGF-1 significantly attenuated the trauma induced HSP expression. The upregulation of HO-2 was also considerably reduced. These results show that BDNF and IGF-1 attenuate cellular stress response and production of CO following spinal cord injury which seems to be the key factors in neurotrophins induced neuroprotection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007260070066
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  • 29
    Electronic Resource
    Electronic Resource
    Expression of extracellular matrix proteins in the fetal rat gastric mucosa (2000)
    Springer
    Anatomy and embryology 201 (2000), S. 149-156 
    Details
    ISSN: 1432-0568
    Keywords: Key words Cell differentiation ; Cell proliferation ; Collagen ; Fetal development ; Fibronectin ; Immunohistochemistry ; Keratin ; Laminin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  At gestational day 16 the epithelium of the rat stomach consists of a stratified layer of undifferentiated cells, and two days later glandular structures appear. The present study was carried out to identify extracellular matrix proteins that could be involved in the epithelial cell proliferation and differentiation processes that occur in the fetal rat stomach during this period. For comparative purposes the expression of the same components in the adult gastric mucosa was examined. Pregnant Sprague-Dawley rats received an intraperitoneal injection of 5-bromo-2’-deoxyuridine to label proliferating cells. One, 3.5, or 6 h post-injection the stomachs were excised and immediately frozen. The specimens were sectioned and stained with hematoxylin and eosin or for 5-bromo-2’-deoxyuridine, cytokeratin no. 8, H,K-ATPase, and the extracellular matrix proteins fibronectin, laminin, and collagens type I and IV. A stratified layer of proliferating cells was observed in the epithelium of the fetal stomachs, while in adult stomachs proliferating cells were detected in the isthmus/neck region of the glands. Cytokeratin, an epithelial cell marker, was sparse at gestational day 16 but abundant both at gestational day 18 and in the isthmus/neck region of gastric glands of the adult stomach. The parietal cell marker H,K-ATPase could not be detected in the fetal stomachs during this period. Fibronectin was observed in the stroma of both fetal and adult stomachs. Collagen type I could only be detected in the stroma close to the oesophagus at gestational day 16. Two days later, collagen type I was abundant in the lamina propria, the submucosa and in the serosa of the fetal stomachs. In adult tissue collagen type I was detected in the surface epithelium, the submucosa and in the serosa of the stomach. Collagen type IV and laminin were expressed in the lamina propria, the basement membranes around blood vessels, muscle cells, and nerve bundles, as well as in the serosa of both 16- and 18-day-old fetal and adult rat stomachs. In conclusion, a high cell proliferation rate was observed in the epithelium at both gestational days 16 and 18. The increased expression of cytokeratin observed during this period indicates that the epithelial character of the embryonic cells becomes more distinct, while the remarkable change in the expression of collagen type I might reflect an important role of collagen type I in the development of the gastric epithelium.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008236
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  • 30
    Electronic Resource
    Electronic Resource
    Mandibular deformities in parathyroid hormone-related protein (PTHrP) deficient mice: possible involvement of masseter muscle (2000)
    Springer
    Anatomy and embryology 202 (2000), S. 85-93 
    Details
    ISSN: 1432-0568
    Keywords: Key words Intramembranous ossification ; Immunohistochemistry ; Muscle fiber type
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Previous studies using parathyroid hormone-related protein (PTHrP) null mutant mice have indicated severe abnormalities in the endochondral ossification, suggesting that PTHrP affects chondrocyte differentiation. In this study, we found in newborn PTHrP-deficient mice some deformities in the mandible that is formed via intramembranous ossification. The mandibular ramus was bent downwards and a prominent bone crest to which the deep layer of masseter muscle was tendinously attached was observed in the mandibular body. Transmission electron microscopic studies showed that active bone formation was progressing along the tendon fibers of the masseter muscle. The examination of 3-D reconstruction models indicated that the mandibular ramus was bent at the site of muscle attachment, which was shifted in the direction of the muscle fibers. Muscle fiber type analysis using myosin ATPase staining showed that the masseter muscle in the newborn PTHrP-deficient mice contained numerous type 2B fibers, demonstrating premature maturation of this muscle. Based on these findings, we speculated that premature maturation of the masseter muscle leads, probably due to increased tensile forces, to accelerated bone crest formation and subsequent bending of the mandibular ramus. These results further suggest that PTHrP is involved in the regulation of muscle development in normal animals.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004290000100
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  • 31
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    Electronic Resource
    Organ-specific expression of the intestinal epithelium-related antigen A33, a cell surface target for antibody-based imaging and treatment in gastrointestinal cancer (2000)
    Springer
    Cancer chemotherapy and pharmacology 46 (2000), S. S27 
    Details
    ISSN: 1432-0843
    Keywords: Key words Monoclonal antibody ; A33 ; Gastric cancer ; Immunohistochemistry ; Tumor targeting
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Murine monoclonal antibody A33 (mA33) was developed by the Memorial Sloan-Kettering Cancer Center and by the New York Branch of the Ludwig Institute for Cancer Research. It is an immunoglobulin (Ig)G2a antibody that detects a protease- and neuraminidase-resistant, periodate-sensitive epitope. Serological analysis of the antigen showed that it is expressed in a few colorectal cancer cell lines and a pancreatic cancer cell line, but is basically not reactive with other types of cell line. Normal fibroblasts and normal kidney cell lines reacted negatively to mA33. Immunohistochemical study of normal tissues identified the large and small intestinal mucosa as the principal site of A33 expression. Tests in tumor samples demonstrated that only tumors of the gastrointestinal tract are consistently A33 positive. A33 is found in 95% of primary and metastatic colorectal cancers, with uniform expression throughout the tumors in most cases. A33 is also detected in 63% of gastric cancers, with uniform expression in 45% of cases. Eighty-three percent of intestinal-type gastric cancers were positive for A33, and about 50% of the diffuse-type and mucinous cancers were mA33 positive. A33 was expressed in 50% of the pancreatic cancers but with marked heterogeneity. Other epithelial cancers, sarcomas, neuroectodermal tumors, and lymphoid neoplasms were generally A33 negative. A33 is the first example of a constitutively expressed, organ-specific epithelial membrane antigen permitting highly specific tumor targeting in patients with gastrointestinal cancer. Encouraged by the success of the biodistribution and imaging characteristic studies performed at Memorial Sloan-Kettering Cancer Center by the New York Branch of the Ludwig Institute in colorectal cancers, a new clinical study of humanized monoclonal antibody huA33 against A33 antigen-positive gastric cancers has been initiated in Japan.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014045
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  • 32
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    Electronic Resource
    Heat shock protein 72 expression in chondrosarcoma correlates with differentiation (2000)
    Springer
    Journal of cancer research and clinical oncology 126 (2000), S. 667-670 
    Details
    ISSN: 1432-1335
    Keywords: Key words Chondrosarcoma ; Heat shock protein ; Differentiation ; Diagnosis ; Immunohistochemistry ; Chondroma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: Heat shock proteins (hsp) are involved in tumor immunity, and a correlation with survival, occurrence of metastases, and drug resistance has been reported. It was the aim of this study to investigate the expression of heat shock proteins in chondrosarcomas and chondromas. Methods: Hsp expression was investigated immunohistochemically on paraffin-embedded sections of 37 consecutive patients (24 male and 13 female, mean age 48 years) with chondrosarcoma and of ten patients (six male, four female, mean age 36 years) with chondroma. Results: Chondromas showed a positive staining for hsp27 in 100%, for hsp60 in 30%, for hsp72 in 80%, for hsp73 in 80%, and for hsp90 in 90%. In chondrosarcoma a decreased expression was found for hsp27 (62% positive, P 〈 0.05) and hsp72 (43% positive, P 〈 0.05), whereas no significant difference to chondromas was detected in the expression of hsp60 (49% positive), hsp73 and hsp90 (73% and 81% positive, respectively). In addition, hsp72 expression showed a correlation with differentiation of the tumors (P 〈 0.05); the lowest hsp72 expression was found in G3 chondrosarcomas (only 13% positive). No correlation with respect to differentiation was found for the expression of the other hsps. Conclusions: This study shows a different expression of hsps in chondrosarcomas and chondromas. Together with the correlation of hsp72 expression with low differentiation, this finding could lead to new experimental and diagnostic strategies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320000167
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  • 33
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    Electronic Resource
    Risiken bei Sectio caesarea und vaginaler Geburt (2000)
    Springer
    Der Gynäkologe 33 (2000), S. 872-881 
    Details
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Sectio caesarea ; Notsectio ; Geburt ; Schwangerschaft ; Müttersterblichkeit ; Letalität ; Morbidität ; Komplikationen ; Keywords Cesarean section ; Emergency cesarean ; Birth ; Pregnancy ; Maternal mortality ; Lethality ; Morbidity ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The rate of cesarean section now exceeds 20% and continues to increase. This effect is enhanced by the almost negligible surgery-dependent risks. Maternal mortality in Central Europe has evidenced a sharp decline to approximately 10–20 deaths per 100,000 live births. Cesarean mortality due solely to surgical and/or anesthesiological intervention has also decreased considerably in the past 20 years. Nevertheless, vaginal birth entails a lower risk per se for the mother. Thus, the letality rate for vaginal birth is lower by a factor of 5–10 excluding pregnancy-dependent risks. Primary cesarean section exhibits a 1.7-fold lower risk of letality in comparison to secondary cesarean section. The main causes of death continue to be hemorrhages and thromboembolism. The mortality rate due to cesarean section continues to remain higher than that for vaginal birth. The rate of severe blood loss is significantly higher. The risk of deep vein thrombosis is about ten times greater than for vaginal birth with concomitantly increased risk for a pulmonary embolism as well as post-thrombotic syndrome. Perioperative prophylactic treatment with antibiotics was able to reduce the morbidity rate due to infection by more than 50%, but endometritis and wound infection continues to occur 10–15 times more frequently than during vaginal birth. In summary, maternal risk during pregnancy and birth – be it vaginal or cesarean – has been further reduced considerably. Nevertheless, cesarean section constitutes a surgical intervention entailing significantly higher rates of morbidity and mortality in comparison to vaginal birth.
    Notes: Zusammenfassung Die Sectiorate hat die 20%-Grenze überschritten und steigt unvermindert an. Begünstigt wird dieser Effekt durch die schon fast vernachlässigbaren operationsbedingten Risiken; die maternale Mortalität verzeichnet in Mitteleuropa einen starken Rückgang auf ca. 10–20 Todesfälle bezogen auf 100.000 Lebendgeburten. Auch die reine operations- bzw. anästhesiebedingte Sectioletalität hat sich in den letzten 20 Jahren deutlich vermindert. Nichtsdestotrotz geht die vaginale Geburt mit einem für die Mutter per se niedrigeren Risiko einher. So liegt die Letalität bei vaginaler Geburt um den Faktor 5–10 niedriger bei Ausschluss gestationsbedingter Risiken. Die primäre Sectio weist gegenüber der sekundären Sectio ein 1,7fach vermindertes Letalitätsrisiko auf. Haupttodesursachen sind weiterhin die Hämorrhagie und Thrombembolien. Aber auch die sectiobedingte Morbidität liegt weiterhin über der einer vaginalen Geburt. Die Rate an stärkeren Blutverlusten ist signifikant höher. Das Risiko einer tiefen Venenthrombose liegt rund 10fach über dem einer vaginalen Geburt mit ebenfalls erhöhtem Risiko für eine Lungenembolie sowie einem postthrombotischen Syndrom. Zwar konnte durch die perioperative Antibiotikaprophylaxe die Infektmorbidität um mehr als 50% gesenkt werden, doch ist die Endometritis und die Wundinfektion nach Sectio noch rund 10- bis 15-mal häufiger als bei vaginaler Geburt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001290050656
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  • 34
    Electronic Resource
    Electronic Resource
    Doppelbilder durch Doppel-IOL (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 781-783 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter Katarakt-Chirurgie ; Komplikationen ; IOL-Luxation ; Doppel IOL ; Doppelbilder ; Keywords Cataract surgery ; Complications ; Intraocular lens dislocation ; Double intraocular lens implant ; Double vision
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract An 80-year-old man had intraoperative loss of an intraocular lens (IOL) in the vitreous and simultaneous implantation of an anterior chamber lens. For the first 3 years his course was uncomplicated, but after this time he noted monocular double vision. The IOL in the vitreous had moved into the optic axis of the eye. The case presented here underlines the possibility of complications occurring even years after surgery due to an IOL left behind in the vitreous. The double IOL implant technique should be reserved for very few selected indications.
    Notes: Zusammenfassung Bei einem 80-jährigen Patienten war nach intraoperativer Luxation einer intraokularen Linse (IOL) in den Glaskörper (GK) eine zweite IOL in die Vorderkammer implantiert worden. Nach zunächst komplikationslosem Verlauf, bemerkte der Patient 3 Jahre später monokulare Doppelbilder, offensichtlich durch eine Mobilisierung der IOL im GK in die optische Achse. Der beschriebene Fall zeigt, dass Komplikationen einer in den GK luxierten IOL auch nach längerer Zeit noch auftreten können. Die Doppelimplantationstechnik sollte ganz wenigen Ausnahmefällen vorbehalten werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470070028
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  • 35
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    Electronic Resource
    Bilaterale simultane LASIK Pro und Kontra (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 881-884 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter LASIK ; einzeitige und zweizeitige Operation ; Kostenaspekt ; Komplikationen ; Keywords LASIK ; Simultaneous and sequential operation ; Cost effectiveness ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Until recently simultaneous bilateral laser in situ keratomileusis (LASIK) was regarded as contraindicated in Germany. However, the procedure was sporadically performed, because it offers patient comfort and is more cost effective than sequential LASIK. Even though the complication rate is below the calculated rate of 0.01%, bilateral complications may have catastrophic effects on the patient. In addition, there is the theoretical disadvantage that the results from the first eye cannot be used for the second eye. However, this effect has yet to be clinically proven.
    Notes: Zusammenfassung Seit September 2000 wird in Deutschland die bilaterale simultane Laser-in-situ-Keratomileusis (LASIK) nicht mehr als ungerechtfertigt angesehen. Bereits zuvor wurde sie vereinzelt durchgeführt, da sie dem Patienten einen höheren Komfort bietet und kostengünstiger ist als ein zweizeitiges Vorgehen. Auch wenn die Komplikationsrate sehr gering ist und sicherlich unter der rechnerischen Komplikationsrate von 0,01% liegt, können beidseitige Komplikationen katastrophale Auswirkungen für den Patienten haben. Zudem besteht der theoretische Nachteil der schlechteren Vorhersagbarkeit für das zweitbehandelte Auge. Dieser Effekt konnte bisher klinisch nicht nachgewiesen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470070014
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  • 36
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    Electronic Resource
    Operative Behandlung von Verletzungen des thorakolumbalen Übergangs Teil 2: Operation und röntgenologische Befunde (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 1032-1047 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Arbeitsgemeinschaft “Wirbelsäule” der DGU ; Prospektive multizentrische Studie ; Thorakolumbale Wirbelsäule ; Wirbelsäulenverletzung ; Operative Behandlung ; Operative Zugänge zur Wirbelsäule ; Dorsale Stabilisierung ; Kombinierte Stabilisierung ; Ventrale Stabilisierung ; Fusionsoperation ; Fixateur interne ; Spinalkanaldekompression ; Komplikationen ; Schraubenfehllagen ; Grund-Deckplatten-Winkel ; Segmentale Kyphose ; Körperwinkel ; Sagittaler Index ; CT der Wirbelsäule ; Keywords Working group “spine” of the German Trauma Society, prospective multicenter study ; Thoracolumbar spine ; Fractures and dislocations of the spine ; Injuries of the spine ; Operative treatment ; Posterior surgery ; Combined surgery ; Anterior surgery ; Spinal fusion ; Internal fixator ; Decompression of the spinal canal ; Complications ; Misplaced pedicle screws ; Segmental kyphosis angle ; Wedge angle ; Sagittal index ; Computertomography of the spine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The authors report on a prospective multicenter study with regard to the operative treatment of acute fractures and dislocations of the thoracolumbar spine (T10–L2). The study should analyze the operative methods currently used and determine the results in a large representative collective. This investigation was realized by the working group “spine” of the German Trauma Society. Between September 1994 and December 1996, 682 patients treated in 18 different traumatology centers in Germany and Austria were included. Part 2 describes the details of the operative methods and measured data in standard radiographs and CT scans of the spine. Of the patients, 448 (65.7%) were treated with posterior, 197 (28.9%) with combined posterior-anterior, and 37 (5.4%) with anterior surgery alone. In 72% of the posterior operations, the instrumentation was combined with transpedicular bone grafting. The combined procedures were performed as one-stage operations in 38.1%. A significantly longer average operative time (4:14 h) was noted in combined cases compared to the posterior (P〈0.001) or anterior (P〈0.05) procedures. The average blood loss was comparable in both posterior and anterior groups. During combined surgery the blood loss was significantly higher (P〈0.001; P〈0.05). The longest intraoperative fluoroscopy time (average 4:08 min) was noticed in posterior surgery with a significant difference compared to the anterior group. In almost every case a “Fixateur interne” (eight different types of internal fixators) was used for posterior stabilization. For anterior instrumentation, fixed angle implants (plate or rod systems) were mainly preferred (n=22) compared to non-fixed angle plate systems (n=12). A decompression of the spinal canal (indirect by reduction or direct by surgical means) was performed in 70.8% of the neurologically intact patients (Frankel/ASIA E) and in 82.6% of those with neurologic deficit (Frankel/ASIA grade A–D). An intraoperative myelography was added in 22% of all patients. The authors found a significant correlation between the amount of canal compromise in preoperative CT scans and the neurologic deficit in Frankel/ASIA grades. The wedge angle and sagittal index measured on lateral radiographs improved from −17.0° and 0.63 (preoperative) to −6.3° and 0.86 (postoperative). A significantly (P〈0.01) stronger deformity was noted preoperatively in the combined group compared to the posterior one. The segmental kyphosis angle improved by 11.3° (8.8° with inclusion of the two adjacent intervertebral disc spaces). A significantly better operative correction of the kyphotic deformity was found in the combined group. In 101 (14.8%) patients, intra- or postoperative complications were noticed, 41 (6.0%) required reoperation. There was no significant difference between the three treatment groups. Of the 2264 pedicle screws, 139 (6.1%) were found to be misplaced. This number included all screws, which were judged to be not placed in an optimal direction or location. In seven (1.0%) patients the false placement of screws was judged as a complication, four (0.6%) of them required revision. The multicenter study determines the actual incidence of thoracolumbar fractures and dislocations with associated injuries and describes the current standard of operative treatment. The efforts and prospects of different surgical methods could be demonstrated considering certain related risks. The follow-up of the population is still in progress and the late results remain for future publication.
    Notes: Zusammenfassung Die Autoren berichten über eine prospektive multizentrische Studie zur operativen Behandlung frischer Verletzungen des thorakolumbalen Übergangs (Th10 bis L2). Die Studie soll die derzeitigen Behandlungsmethoden und ihre Ergebnisse an einem großen Kollektiv repräsentativ analysieren und wird von der Arbeitsgemeinschaft “Wirbelsäule” der Deutschen Gesellschaft für Unfallchirurgie (DGU) erarbeitet. An 18 unfallchirurgischen Kliniken in Deutschland und Österreich wurden von September 1994 bis Dezember 1996 insgesamt 682 Patienten prospektiv erfasst. Die Nachuntersuchung der Patienten ist z. Z. noch nicht abgeschlossen. Im Teil 1 (Epidemiologie) wurden Studiendesign und epidemiologische Daten des Kollektivs dargestellt. Der vorliegende Teil 2 schildert die Details der Operationen sowie Messdaten der konventionellen Röntgenuntersuchungen und Computertomographien (CT); 448 (65,7%) Patienten wurden von dorsal, 197 (28,9%) kombiniert dorsoventral und 37 (5,4%) isoliert von ventral operiert; 72% der 448 von dorsal stabilisierten Patienten erhielten eine transpedikuläre Spongiosaplastik. Die kombinierten dorsoventralen Eingriffe wurden bei 75 (38,1%) Verletzten einzeitig und bei 122 (61,9%) zweizeitig durchgeführt. Die durchschnittliche Operationszeit war bei kombiniertem Eingriff mit 4:14 h signifikant länger als bei dorsalem (p〈0,001) oder ventralem (p〈0,05). Der durchschnittliche Blutverlust war bei dorsalem und ventralen Vorgehen vergleichbar hoch und signifikant geringer als bei kombinierter Operation (p〈0,001 bzw 〈0,05). Die intraoperative Durchleuchtungszeit war mit 4:08 min bei dorsaler Behandlung am längsten und signifikant (p〈0,005) länger als bei ventraler. Als dorsales Implantat wurde fast ausnahmslos ein Fixateur interne verwendet (8 verschiedene Modelle). Bei den ventralen Eingriffen kamen überwiegend winkelstabile Platten- oder Stabsysteme (n=22) und seltener winkelinstabile Platten (n=12) zum Einsatz. Der Spinalkanal wurde bei 82,6% der Patienten mit neurologischem Defizit und bei 70,8% derjenigen ohne Ausfallserscheinungen direkt mit Eröffnung des Spinalkanals oder indirekt mit Hilfe des Instrumentariums dekomprimiert. Eine intraoperative Myelographie wurde bei 22% der Patienten für notwendig gehalten. Wir fanden eine statistisch signifikante Korrelation zwischen dem Ausmaß der neurologischen Beeinträchtigung und der Einengung des Spinalkanals im präoperativen CT. Der im seitlichen Röntgenbild ermittelte Körperwinkel des betroffenen Wirbels und der sagittale Index betrugen im Gesamtkollektiv präoperativ im Mittel −17,0° und 0,63; postoperativ lagen die Werte bei −6,3° und 0,86. Eine signifikant (p〈0,01) stärkere Verformung des Wirbelkörpers bestand präoperativ in der kombinierten gegenüber der dorsalen Gruppe. Der segmentale Kyphosewinkel GDW 1 wurde von prä- zu postoperativ durchschnittlich um 11,3° und der GDW 2 um 8,8° lordosiert. Die signifikant (p〈0,005) größte Korrektur wurde bei den kombiniert Behandelten erzielt. Bei insgesamt 101 (14,8%) Patienten wurden intra- oder postoperative Komplikationen beobachtet, davon 41 (6,0%) revisionspflichtige. Die 3 Behandlungsgruppen wiesen unterschiedliche Komplikationsraten auf, der Unterschied war jedoch nicht signifikant (χ2-Test). Die Rate von Fehllagen transpedikulärer Schrauben betrug 139 von 2264 (6,1%) Schrauben; jede nicht optimal plazierte Schraube wurde dabei als Fehllage dokumentiert. Bei 7 (1,0%) Patienten wurde eine Schraubenfehllage als Komplikation gewertet und 4 (0,6%) von diesen wurden deswegen revidiert. Die Sammelstudie ermöglicht eine aktuelle Standortbestimmung für Verletzungshäufigkeiten und -muster sowie die verschiedenen, heute angewendeten Operationsmethoden. Mit der multizentrischen Studie konnten erstmals der operative Aufwand sowie Möglichkeiten und Risiken der verschiedenen Behandlungsformen dargestellt werden. Weiterführende Ergebnisse sind von den noch andauernden klinischen und radiologischen Nachuntersuchungen zu erwarten.
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    URL: http://dx.doi.org/10.1007/s001130050667
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  • 37
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    Electronic Resource
    Zur Implantatpositionierung bei der Epiphysiolysis capitis femoris Folgen des schlechten Verlaufs und Konsequenzen (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 820-825 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Implantatpositionierung ; Epiphysiolysis capitis femoris ; Komplikationen ; Behandlungskonsequenzen ; Keywords Implant position ; Slipped capital femoral epiphysis ; Complications ; Consequences of treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Which consequences can be ascribed to the intraarticular position of devices in the operative treatment of a slipped capital femoral epiphysis? Which steps are to define as a standard of a careful procedure? The clinical and radiological results of five cases of a pin or nail penetration after the operative treatment of a slipped capital femoral epiphysis are described, a possible connection of causalities is investigated. The intraarticular position of devices in most cases goes along with an unfortunate clinical outcome and leads to a higher risk of developing chondrolysis. Because of the radiologic overprojection with the femoral head it is possible to oversee the malposition of the pin. Any operative treatment of a slipped capital femoral epiphysis requires a careful intraoperative X-ray examination combined with documentation. With this procedure the bad results of an intraarticular implant position must be ascribed to the reminding risk of a fateful development.
    Notes: Zusammenfassung Welche Folgen bei der operativen Behandlung der Epiphysioslysis capitis femoris sind einer intraartikulären Implantatlage zuzurechnen, und welche Maßnahmen sind als Sorgfaltsmaßstab zu definieren? Anhand von 5 Fällen mit intraartikulärer Implantatlage nach der operativen Behandlung einer Epiphysiolysis capitis femoris werden die klinischen und radiologischen Folgen aufgezeigt und ein möglicher Kausalzusammenhang anhand der Literatur untersucht. Die intraartikuläre Implantatlage geht meistens mit einem ungünstigen klinischen Ergebnis einher und führt zu einer erheblichen Risikoerhöhung für das Auftreten einer Chondrolyse. Durch Überlagerung mit dem Femurkopf kann sich die Fehlposition des Implantates der radiologischen Diagnostik entziehen. Jede operative Behandlung der Epiphysiolysis capitis femoris erfordert eine sorgfältige intraoperative Durchleuchtungskontrolle, eine entsprechende Dokumentation ist zu empfehlen. Bei einem solchen Vorgehen sind die Folgen einer intraartikulären Position des Implantats als Restrisiko dem schicksalshaften Verlauf zuzurechnen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050627
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  • 38
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    Electronic Resource
    Behandlungsergebnisse nach primärer und sekundärer Radiusköpfchenresektion (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 437-443 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Radiusköpfchenfraktur ; Primäre Resektion ; Osteosynthese ; Sekundäre Resektion ; Komplikationen ; Keywords Radial head fracture ; Primary resection ; Osteosynthesis ; Secondary resection ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Apart from comminuted fractures of the radial head the indication for resection of the radial head is discussed controversially. To evaluate our own results, the hospital notes of 113 patients treated between 1.1.1984–31.12.1994 in our clinic by posttraumatic primary or secondary radial head resection were examined retrospectively. 79 patients were controlled by clinical and radiological examination with an average follow-up of 37,8 months. We examined at 46 patients the influence of additional lesions of the elbow joint on the functional outcome. In 33 patients follow up was done with special regard to the time of resection. Poor results due to the score from Radin and Riseborough especially followed secondary radial head resection (〉14 days after trauma) and in case of additional elbow lesions. We could not observe problems of the wrist joint after radial head resection as described by other authors. According to our own experience primary resection is recommended in case of doubtful reconstruction of the radial head. In these fracture types radial head resection should not be seen as an alternative treatment because of the worse results following secondary resection.
    Notes: Zusammenfassung Abgesehen von Trümmerfrakturen wird die Indikationsstellung zur Radiusköpfchenresektion kontrovers diskutiert. Zur Evaluation eigener Ergebnisse führten wir eine retrospektive Untersuchung der 113 Patienten durch, die von 1.1.1984–31.12.1994 mittels primärer oder sekundärer posttraumatischer Radiusköpfchenresektion behandelt wurden. Nach einem durchschnittlichen postoperativen Intervall von 37,8 Monaten konnten insgesamt 79 Patienten klinisch und radiologisch nachuntersucht werden. Bei 46 Patienten wurde die Auswirkung der Begleitverletzungen auf das Endergebnis untersucht. Bei 33 Patienten erfolgte die Nachuntersuchung unter besonderer Berücksichtigung des Resektionszeitpunktes. Schlechte Behandlungsergebnisse nach den Kriterien des Scores von Radin und Riseborough resultierten besonders häufig nach sekundärer Radiusköpfchenresektion (〉 14 Tage nach Trauma) und bei Begleitverletzungen des Ellenbogengelenks. Die Berichte anderer Autoren über negative Langzeitfolgen auf das Handgelenk können wir nicht bestätigen. Nach unseren Erfahrungen sollte daher bei zweifelhaften Rekonstruktionsversuchen die primäre Radiusköpfchenresektion bevorzugt werden, die aufgrund der eindeutig schlechteren Resultate nach sekundärer Resektion nicht als Option für mißlungene Erhaltungsversuche des Radiusköpfchens betrachtet werden darf.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050563
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  • 39
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    Electronic Resource
    Identifizierung eines Nasenrachenkarzinoms mit Hilfe der EBV-Diagnostik (2000)
    Springer
    HNO 48 (2000), S. 314-317 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter ; Nasenrachenkarzinom ; Epstein-Barr-Virus ; Immunhistologie ; Polymerasekettenreaktion ; Keywords ; Nasopharyngeal carcinoma ; Epstein-Barr virus ; Immunohistochemistry ; Polymerase chain reaction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract We report the case of a 36-year-old women who was found to have a malignant tumor extending from the side of her right nasal cavity to the nasopharynx. Magnetic resonance imaging and computed tomography were not able to define the primary site of the tumor. Histologic evaluation demonstrated an undifferentiated squamous cell carcinoma. Because of the different treatment concepts for carcinomas of the nasal cavity and nasopharynx, we tried to identify the primary site by diagnosing Epstein-Barr virus (EBV) infection, which is associated with carcinoma of the nasopharynx. By using immunohistochemistry and polymerase chain reaction EBV could be identified in the cells of the carcinoma. This showed that the primary site of the tumor was located in the nasopharynx and resulted in the patient being treated with simultaneous radiochemotherapy.
    Notes: Zusammenfassung Eine 36 Jahre alte Patientin stellte sich mit einem ausgedehnten Tumor der rechten Nasenhöhle und des rechten Nasenrachens vor. Die histologische Untersuchung ergab ein undifferenziertes Plattenepithelkarzinom. Sowohl mit Hilfe der computertomographischen, als auch der kernspintomographischen Befunde, war keine eindeutige Bestimmung der Primärtumorregion möglich. Anhand der bekannten Assoziation zwischen Karzinomen des Nasenrachens und Epstein-Barr Virus (EBV) wurde versucht, die Primärlokalisation des Tumors zu klären. Immunhistologisch und durch „polymerase chain reaction” war es möglich, eine EBV-Infektion im Tumor nachzuweisen. Die Primärlokalisation des Tumors wurde damit dem Nasenrachen zugeordnet und die entsprechende Therapie für diese Lokalisation in Form einer simultanen Radiochemotherapie eingeleitet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050572
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  • 40
    Electronic Resource
    Electronic Resource
    Perforation eines mucocelenartig transformierten Hartmannstumpfs (2000)
    Springer
    Der Chirurg 71 (2000), S. 572-574 
    Details
    ISSN: 1433-0385
    Keywords: Keywords: Mucocele ; Ileostomy ; Complications ; Hartmann procedure. ; Schlüsselwörter: Mucocele ; Ileostoma ; Komplikationen ; Hartmannstumpf.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Wir berichten über eine 53 jährige Patientin, bei der 22 Jahre nach Anlage eines Ileostomas wegen eines Morbus Crohn eine Stenose im distalen Colonsegment (Hartmannstumpf) zu einer mucocelenartigen Transformation und nachfolgenden Ruptur geführt hat. Über die Ruptur eines stillgelegten Colonabschnitts nach Anlage eines Ileostomas wurde bisher offenbar noch nicht berichtet.
    Notes: Abstract. We report an unusual complication in a 53-year-old woman following ileostomy for Crohn's disease 22 years previously. A stenosis of the distal colonic segment was the reason for the formation and subsequent rupture of a huge colonic mucocele. To our knowledge, this is the first report of a ruptured mucocele of colonic origin after ileostomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050859
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  • 41
    Electronic Resource
    Electronic Resource
    Patient reports of complications of bone marrow transplantation (2000)
    Springer
    Supportive care in cancer 8 (2000), S. 33-39 
    Details
    ISSN: 1433-7339
    Keywords: Key words Marrow transplantation ; Complications ; Oral mucositis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In recent years, significant improvements have been made in the management of neutropenia and thrombocytopenia and other potentially life-threatening complications of ablative chemotherapy. While these complications are of particular concern to physicians, patients receiving ablative therapy for bone marrow or blood stem cell transplants are often troubled by other side effects such as nausea, vomiting, diarrhea and mouth sores. The purpose of the study was to gain a better understanding of patients' experiences while undergoing a transplant. The same professional medical interviewer conducted in-depth interviews with 38 subjects (10 men, 28 women; mean age 46.9 years) who had received ablative therapy for bone marrow and/or peripheral blood stem cell transplants. Participants were consecutively identified through physician and patient referrals, cancer and BMT patient support groups, and newspaper advertisements. Twenty-eight patients (74%) received autologous stem cell transplants and 10 patients (26%) received allogeneic transplants. Participants reported mouth sores, nausea and vomiting, diarrhea, and fatigue as the most troubling side effects of their transplants. Mouth sores were selected as the single most debilitating side effect (42%), followed by nausea and vomiting (13%). Many patients mentioned that mouth sores made it difficult or impossible to eat (n=23), swallow (n=21), drink (n=17), and/or talk (n=8). Twenty patients reported pain in the mouth, throat, and/or esophagus. Two-thirds (66%) of patients reported receiving opioid analgesics, most frequently morphine, to relieve oral pain. For many, opioids caused incapacitating side effects, including hallucinations, a feeling of loss of control and a decrease in mental acuity. Patients receiving ablative chemotherapy identify oral mucositis as a significant cause of suffering and morbidity. Effective interventions to alleviate this complication are urgently needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005209900095
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  • 42
    Electronic Resource
    Electronic Resource
    Heilungsverlauf und Komplikationen nach Augenmuskeloperationen (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 22-26 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter Augenmuskeloperation ; Komplikationen ; Heilungsverlauf ; Key words Eye muscle surgery ; Complications ; Healing process
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Background: Varying reports on the incidence of operative and postoperative complications following eye muscle surgery have been published. The purpose of this study was to quantify complications after various types of eye muscle surgery as well as minor pathological changes of the anterior and posterior segment. Patients and methods: This prospective study included all patients who underwent eye muscle surgery at the Department of Strabismology and Neuroophthalmology, Giessen, from January to May 1998. Five hundred eyes of 377 patients aged 2–82 years were included. The spectrum of procedures comprised: recessions, resections, tucks, R&R procedures, transpositions, bimedial retroequatorial myopexies, and revisions of rectus and oblique muscles. All patients were examined 1 day preoperatively and 1 day, 1 week, and 3 months postoperatively. Any complications and even minor pathological changes of the anterior and posterior segment were documented. Some changes were assessed by means of a score (0–3). Results: One day postoperatively, 30% of eyes had inflammatory pseudoptosis, most of them mild. Conjunctival swelling and injection were frequently mild and moderate, after 1 week mostly mild. Conjunctival irritation was more pronounced following resection than tucking. Punctate epithelial keratopathy was noted in 1.6% of cases (first postoperative day), dellen in 4.3% (first postoperative week). Three months postoperatively, 14.3% of eyes had biomicroscopically visible conjunctival folds and 91.3% had minimal conjunctival scars. None of the patients had a scleral perforation or other serious complication. Conclusions: Eye muscle surgery rarely entails complications. Revisions due to organic pathological changes are extremely rare. Possible development of dellen requires check-up 4–7 days postoperatively. Tucking of rectus muscles causes less conjunctival irritation than resection.
    Notes: Hintergrund: Zur Inzidenz operativer und postoperativer Komplikationen bei Augenmuskeloperationen liegen unterschiedliche Mitteilungen vor. Ziel der vorliegenden Studie war es, sowohl Komplikationen als auch geringfügige pathologische Veränderungen des vorderen und hinteren Augenabschnittes nach unterschiedlichen Augenmuskeloperationen zu quantifizieren. Patienten und Methode: Es wurden prospektiv alle Patienten erfaßt, bei denen im Zeitraum Januar bis Mai 1998 an der Augenklinik für Schielbehandlung und Neuroophthalmologie Gießen eine Augenmuskeloperation durchgeführt wurde. In die Studie konnten 500 Augen von 377 Patienten im Alter von 2 bis 82 Jahren einbezogen werden. Das Spektrum der durchgeführten Eingriffe umfaßte Rücklagerungen, Resektionen, Faltungen, kombinierte Operationen, Transpositionen, Fadenoperationen und Revisionsoperationen an allen geraden und schrägen Augenmuskeln. Die Patienten wurden am Tag vor der Operation und postoperativ am ersten Tag, nach einer Woche und nach drei Monaten untersucht. Alle Komplikationen des vorderen und hinteren Augenabschnittes wurden dokumentiert und quantitativ erfaßt, teilweise erfolgte eine Gradeinteilung (0–3). Ergebnisse: Am ersten postoperativen Tag war bei 30% der Augen eine zumeist diskrete Lidschwellung auffällig. Die Bindehautschwellung und -injektion waren meist gering bis mäßig, nach einer Woche häufig nur noch gering. Der Reizzustand der Bindehaut war geringer nach Faltung als nach Resektion eines horizontalen M. rectus. Bei den Hornhautveränderungen dominierte am ersten postoperativen Tag eine Epitheliopathie (1,6%), nach 1 Woche standen diskrete Fuchs'sche Dellen (4,3%) im Vordergrund, die unter lokaler Therapie abheilten. Mikroskopisch erkennbare Bindehautfalten wurden überwiegend zur 3-Monats-Kontrolle (14,3%) dokumentiert, ebenso Bindehautnarben (91,3%), die i.d.R. sehr gering waren. Perforationen oder schwerwiegende Komplikationen kamen nicht vor. Schlußfolgerungen: Eine Augenmuskeloperation ist ein komplikationsarmer Eingriff, der nur selten einen erneuten Eingriff wegen organischer pathologischer Veränderungen erfordert. Zur Erkennung von Fuchs'schen Dellen ist eine Kontrolluntersuchung 4–7 Tage postoperativ wichtig. Faltung eines horizontalen M. rectus führt zu weniger Bindehautreiz als Resektion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050005
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  • 43
    Electronic Resource
    Electronic Resource
    Okuläres vernarbendes Pemphigoid Retrospektive Analyse von Risikofaktoren und Komplikationen (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 113-120 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter Okuläres vernarbendes Pemphigoid ; Therapie ; Komplikationen ; Glaukom ; Key words Ocular cicatricial pemphigoid ; Therapy ; Complications ; Glaucoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Cicatricial pemphigoid (CP) is a rare autoimmune disease characterized by subepidermal blistering and progressive cicatrization affecting the skin and mucosa. Ocular involvement occurs in approximately 70% of the patients. Methods: The course of the disease, complications and putative risk factors in patients with ocular cicatricial pemphigoid (OCP) treated at the Departments of Ophthalmology and Dermatology were analyzed retrospectively from 1986 to 1998. Results: Eighteen of 28 patients (64%) with CP demonstrated ocular involvement. The mean age of patients with OCP was 73 years; 61% were female. At the time of referral to our hospital, all patients had reached advanced stage III (83%) or IV (17%) of OCP. In 38% of patients vision was already reduced to 〈20/200 at first presentation. Twenty-eight percent of patients additionally suffered from glaucoma. Two patients exhibited life-threatening extraocular manifestations of CP (larynx stricture, esophagus stricture). Conjunctival or mucosal biopsies were performed in 15 patients with OCP and showed typical immunodeposits at the basement membrane zone in 12/15 patients. Therapy with dapsone (12 patients), oral steroids (11 patients), azathioprine (5 patients), cyclophosphamide (4 patients), colchicine (2 patients) and methotrexate (1 patient) was used concomitantly or consecutively. Complications of OCP including entropion, recurrent epithelial erosions, corneal ulcers, keratitis, and corneal perforations required multiple surgical interventions such as entropion surgery (8 patients), tarsorrhaphy (3 patients), mucous membrane grafting (1 patient), amniotic membrane transplantation (1 patient), tectonic keratoplasty (1 patient), keratoprosthesis (1 patient) and enucleation (1 patient). Despite control of the inflammatory process, further visual loss occurred in 53% of eyes. Reading visual acuity could only be maintained in 35% of eyes. Discussion: Early diagnosis and therapy can prevent ocular complications of OCP. This study indicates that advanced stages of the disease often result in irreversible visual loss despite institution of immunosuppressive therapy. Whether or not the high association of OCP with glaucoma and/or anti-glaucomatous treatment in our patients represents part of the underlying disease process or plays a role in the pathogenesis of OCP must still be clarified.
    Notes: Zusammenfassung Das vernarbende Pemphigoid (cicatricial pemphigoid, CP) ist eine seltene, mit subepidermaler Blasenbildung und Vernarbung einhergehende Autoimmunerkrankung, die sich an Haut und Schleimhaut manifestiert. Eine Augenbeteiligung liegt bei etwa 70% der Patienten vor. Methode: Retrospektiv wurden Krankheitsverlauf, klinische Komplikationen und mögliche Risikofaktoren von Patienten der Augen- und Hautklinik mit vernarbendem Pemphigoid von 1986–1998 untersucht. Ergebnisse: 18/28 Patienten (64%) mit CP hatten eine okuläre Beteiligung. Das Durchschnittsalter der Patienten mit okulärem vernarbendem Pemphigoid betrug 73 Jahre, 61% der Patienten waren weiblich. Bereits bei Erstvorstellung in unserer Klinik bestand bei allen Patienten ein Krankheitsstadium III (83%) oder IV (17%), mit einem Visus 〈0.1 in 38% der Augen. Bei 28% der Patienten wurde zusätzlich ein Glaukom diagnostiziert. Zwei Patienten zeigten eine lebensgefährliche extraokuläre Schleimhautbeteiligung (Larynx- bzw. Ösophagusstriktur). Bei 15 Patienten mit okulärem vernarbendem Pemphigoid wurde eine Bindehaut- bzw. Schleimhautbiopsie aus dem Mund oder Nasen-Rachen-Raum durchgeführt, welche die Verdachtsdiagnose bei 12/15 Patienten immunhistologisch sicherte. Eine Therapie mit Dapson (12 Patienten), oraler Kortikosteroidgabe (11 Patienten), Azathioprin (5 Patienten), Cyclophosphamid (4 Patienten), Colchizin (2 Patienten) und Methotrexat (1 Patient) wurde in Folge oder Kombination eingesetzt. Komplikationen wie Lidfehlstellungen, rezidivierende Epitheldefekte, Hornhautulzera, Keratitiden und Hornhaut-Perforationen erforderten multiple operative Eingriffe wie Entropium-Operation (8 Patienten), Tarsorrhaphie (3 Patienten), Kryoepilation (2 Patienten), Mundschleimhaut-Transplantat (1 Patient), Amniontransplantat (1 Patient), tektonische Keratoplastik (1 Patient), Keratoprothese (1 Patient) und Enukleation (1 Patient). Trotz befriedigender Kontrolle des okulären vernarbenden Pemphigoids kam es bei 53% der Augen zum weiteren Visusabfall. Ein Lesevisus konnte nur in 35% der Augen erhalten werden. Schlußfolgerung: Wahrscheinlich kann die Früherkennung und rechtzeitige Behandlung des okulären vernarbenden Pemphigoids okuläre Komplikationen verhindern. Diese Studie zeigt, daß trotz immunsuppressiver Therapie in Spätstadien häufig ein irreversibler Visusverlust resultiert. Es bleibt zu untersuchen, ob die auffällig hohe Assoziation von okulärem vernarbendem Pemphigoid zu Glaukom bzw. antiglaukomatöser Therapie in unserem Patientenkollektiv als Folge der Grunderkrankung oder als pathogenetischer Faktor zu werten ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050021
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  • 44
    Electronic Resource
    Electronic Resource
    Qualitätssicherung in der gynäkologischen Endoskopie (2000)
    Springer
    Der Gynäkologe 33 (2000), S. 213-219 
    Details
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Qualitätssicherung ; Endoskopie ; Komplikationen ; Key words Quality control ; Endoscopy ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Due to the expanding use of laparoscopic surgery in gynecology, the necessity for evaluation of results was raised. With the intention of quality control in gynecological endoscopy, the gynecological department of the Evangelisches Diakonie-Krankenhaus in Bremen has developed, in cooperation with the Institute for Artificial Intelligence at the University of Bremen and on behalf of the German Society for Gynecological Endoscopy, the quality control program “German Gynecological Endoscopy Complication Register”. In 1997, 20 German endoscopic centers took part in the prospective observational study. A total number of 17,745 cases were reported. Altogether 20,050 endoscopic procedures were performed, 8020 hysteroscopies and 12030 laparoscopies. The complication rate for hysteroscopies amounted to 7.0‰ and that of laparoscopies to 9.6‰. The quality control program of the German Society for Gynecological Endoscopy is a unique tool, comparable to the “German Perinatology Study”. It allows to compare individual hospital profiles, an option that is necessary to gain the best possible results in terms of quality in gynecological surgery in the long term.
    Notes: Zusammenfassung Mit dem Ziel der Qualitätsverbesserung in der gynäkologischen Endoskopie hat die Frauenklinik des Evangelischen Diakonie-Krankenhauses in Bremen im Auftrag der Arbeitsgemeinschaft der Gynäkologischen Endoskopie (AGE) zusammen mit dem KI-Labor der Universität Bremen das Qualitätssicherungs-Programm “Komplikationsregister gynäkologische Endoskopie” entwickelt. Es ermöglicht dem Anwender die differenzierte Betrachtung der durchgeführten Operationen von den Indikationsstellung bis zum Therapieerfolg. Im Jahre 1997 haben 20 endoskopisch tätige Institutionen an der prospektiven Dokumentation der gynäkologisch-endoskopischen Operationen teilgenommen. Bei insgesamt 17.745 Patientinnen wurden 20.050 Eingriffe erfasst, darunter 8020 Hysteroskopien und 12.030 Laparoskopien. Die Komplikationsrate der Hysteroskopien betrug 7,0‰, die der Laparoskopien 9,6‰. Mit dem Qualitätssicherungs-Programm der AGE steht heute ein Instrument zur Verfügung, das vergleichbar der Perinatologiestudie die Daten in Form von vergleichenden Klinikprofilen liefern kann, die notwendig sind, um im Zusammenhang mit endoskopischen Operationen langfristig die bestmögliche Ergebnisqualität zu erzielen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001290050537
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  • 45
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    Electronic Resource
    Neurologische Komplikationen nach Organtransplantation (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 249-258 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Organtransplantation ; Immunsuppression ; Neurotoxizität ; ZNS-Infektionen ; Komplikationen ; Key words Organ transplantation ; Complications ; Immunosuppression ; Neurotoxicity ; CNS infection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Following organ transplantation, 30–60% of patients develop neurologic complications which can be classified as pre-existing deficits due to the underlying disease, complications during surgery, metabolic encephalopathies, neurotoxicity of immunosuppressant agents, opportunistic CNS infections, and secondary malignomas as indirect side effects of immunosuppression. While encephalopathies, seizures, or CNS infection can occur in all types of transplantation, some specific neurological complications exist for different types of organ transplantation. In this review, the clinical symptoms and treatment of both the common neurological complications as well as the particular neurological syndromes after liver, heart, and bone marrow transplantation are discussed.
    Notes: Zusammenfassung Nach Organtransplantation entwicklen 30–60% der Patienten neurologische Komplikationen, die eingeteilt werden können in vorbestehende Störungen im Rahmen der Grunderkrankung, intraoperative Komplikationen, metabolische Enzephalopathien, neurotoxische Nebenwirkungen der verschiedenen Immunsuppressiva sowie opportunistische ZNS-Infektionen und sekundäre Malignome als indirekte Folge der Immunsuppression. Differentialdiagnostisch relevant ist, dass einerseits Enzephalopathien, Anfälle oder ZNS-Infektionen bei allen Transplantationen auftreten können, andererseits für einzelne Organtransplantationen bestimmte neurologische Komplikationen typisch sind. In dieser Übersicht werden die allgemeinen neurologischen Komplikationen mit klinischen Leitsymptomen und Therapie sowie die spezifischen neurologischen Krankheitsbilder nach Leber-, Herz- und Knochenmarktransplantation vorgestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050554
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  • 46
    Electronic Resource
    Electronic Resource
    Management von Komplikationen nach prothetischer Stimmrehabilitation (2000)
    Springer
    HNO 48 (2000), S. 508-516 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Stimmprothese ; Komplikationen ; Laryngektomie ; Tracheoösophageale Fistel ; Keywords Voice prosthesis ; Complications ; Total laryngectomy ; Tracheoesophageal fistula
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The growing popularity of prosthetic voice restoration after total laryngectomy confronts ENT specialists with an increasing number of prosthesis-related complications. The ENT specialist should be familiar with the management of these complications in order to maintain the patients speech and social rehabilitation. In a retrospective study on 108 consecutive patients, complications were encountered in 30%. The incidence was not related to the factors age or primary vs. secondary insertion of the prosthesis. Complications consisted of formation of granulation tissue (15,7%), shunt dilatation (5,5%), loss of prosthesis (3,7%), local cellulitis (2,8%), extrusion (1,9%), ingrowth of prosthesis (1,9%) and formation of excessive scar tissue with dislocation of prosthesis (0,9%). Permanent removal of the prosthesis due to complications was necessary in 3 cases (2,8%). Therapeutic measures for the management of complications are described and evaluated. The treatment of complications was well tolerated by all patients and led to satisfying results in most cases. Our observations show that prosthetic voice rehabilitation is associated with various difficulties and complications, but that these can be handled quite easily and successfully in the majority of cases.
    Notes: Zusammenfassung Die wachsende Beliebtheit der prothetischen Stimmrehabilitation nach Laryngektomie konfrontiert den HNO-Arzt immer häufiger mit stimmprothesenbedingten Komplikationen. Als solcher sollte man daher die Komplikationen der Stimmprothesenversorgung kennen und deren Management beherrschen, um die kommunikative und soziale Rehabilitation des Patienten nicht zu gefährden. Die retrospektive Untersuchung von 108 Stimmprothesenträgern erbrachte eine Komplikationshäufigkeit von 30%. Eine Abhängigkeit der Komplikationsinzidenz vom Alter des Patienten oder vom Faktor primäre / sekundäre Protheseneinlage gab es dabei nicht. Häufigste Komplikation war die Entwicklung von Granulationsgewebe (15.7%), gefolgt von Shunterweiterung (5,5%), Prothesenverlust (3,7%), lokalen Infektionen (2,8%), Abstoßung (1,9%), eingewachsener Prothese (1,9%), narbiger Shuntwandverdickung mit Prothesendislokation (0,9%). In nur 3 Fällen (2,8%) mußte die Stimmprothese aufgrund verschiedener Komplikationen wieder entfernt werden. Die erforderlichen therapeutischen Maßnahmen waren für die Patienten wenig belastend und führten in fast allen Fällen zu befriedigenden Ergebnissen. Diese Beobachtungen zeigen, daß die prothetische Stimmrehabilitation zwar nicht ohne Komplikationen und Schwierigkeiten ist, diese jedoch in weitaus der Mehrzahl der Fälle medizinisch leicht zu beherrschen und daher zumutbar sind.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050607
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  • 47
    Electronic Resource
    Electronic Resource
    Die stabile und instabile pertrochantäre Femurfraktur Differenzierte Indikationsstellung für die dynamische Hüftschraube (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 741-748 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Pertrochantäre Fraktur ; Dynamische Hüftschraube ; Instabile Frakturen ; Komplikationen ; Keywords Trochanteric fracture ; Dynamic hip screw (DHS) ; Instable fractures ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The aim of all surgical procedures in the treatment of trochanteric fractures in elderly and even geriatric patients is achievement of initial stability. We examined in a clinical trial whether primary stability was achieved in all types of trochanteric fractures following osteosynthesis with the Dynamic Hip Scres (DHS). From 1994 to 1996, 122 patients with trochanteric fractures had osteosynthesis by dynamic hip screw. Patient records were evaluated and all data got registered with a standardized protocoll; clinical and radiological outcome was analysed after an average period of 1,9 years after injury according to the Traumatic Hip Rating Score. 22% of all patients died meantimes, 51,6% of the remaining 95 patients could get examined. The average age was 75,5 years, the patient population showed an increased preoperative morbidity (2,5 points) according to ASA-Score. 81% showed progressive osteoporosis. According to the AO-classification 47% stable fractures (type A-1) and 53% instable trochanteric fractures (type A-2 and A-3) occured. Surgery lasted 77 minutes average in osteosynthesis of stable fractures. The duration of 108 minutes in instable fractures was significantly higher, as well as the blood loss was 43% increased in these complex fractures. Complications closely associated to the osteosynthesis appeared only in instable fractures (7%). Also common complications (24,6%) predominated with 15,6% in tpy A-2 and A-3 fractures versus 9% in type A-1 fractures; mortality was also different with 5,7% versus 1,6%. Assesment of the functional outcome according to THRS showed a significant deterioration of 20 points in 71% of all patients compared with the preoperative score. The results show that dynamic hip screw osteosynthesis in instable trochanteric fractures is associated to a higher incidence of complications. While the dynamic hip screw still represents the standard implant in stable fractures of the trochanteric regio, beeing aware of improved intramedullary implants regarding biomechanical features and surgical technique, the results justify to critical consider the use of DHS for osteosynthesis in instable fractures of the trochanteric region.
    Notes: Zusammenfassung Bei der operativen Versorgung petrochantärer Femurfrakturen im geriatrischen Krankengut stellt eine sofort übungs- und belastungsstabile Osteosynthese das Therapieziel dar. In einer klinischen Studie wurde vergleichend untersucht, ob dieses Ziel mit der DHS (dynamische Hüftschraube) bei allen pertrochantären Frakturtypen erreicht werden kann. Von 1994–1996 wurden 122 pertrochantäre Frakturen mit der DHS behandelt. Neben der Auswertung durch standardisierte Datenerhebungsprotokolle wurden die Patienten durchschnittlich 1,9 Jahre nach Trauma radiologisch und klinisch nach dem “Traumatic hip rating score” nachuntersucht; 22% waren verstorben, von den verbliebenen 95 Patienten konnten 51,6% nachkontrolliert werden. Bei einem Altersdurchschnitt von 75,5 Jahren lag mit dem ASA-Score von durchschnittlich 2,5 Punkten eine hohe präoperative Morbidität vor; 81% der Fälle wiesen eine fortgeschrittene Osteoporose auf. Nach der AO-Klassifikation handelte es sich um 47% stabile (Typ A1) und 53% instabile (Typ A2 und A3) Frakturen. Die mittlere Operationszeit war bei den instabilen im Vergleich zu den stabilen pertrochantären Frakturen mit 108 gegenüber 77 min signifikant höher, der Blutverlust um 43% größer. Direkt mit der Osteosynthese assoziierte Komplikationen betrafen ausschließlich instabile Frakturen (7%). Allgemeine Komplikationen (24,6%) überwogen ebenfalls mit 15,6% in der Gruppe der Typ A2 und A3 gegenüber der Typ-A1-Frakturen, was sich auch in einer entsprechend höheren Klinikletalität mit 5,7% gegenüber 1,6% ausdrückt. Bei der Bewertung des funktionellen Nachuntersuchungsergebnisses mit dem THRS wiesen 71% der Patienten im Vergleich zum präoperativen Ausgangswert eine deutliche Verschlechterung um durchschnittlich 20 Punkte auf. Die Osteosynthese instabiler pertrochantärer Femurfrakturen durch die DHS ist mit einer höheren Komplikationsrate belastet. Während die DHS für die stabilen Frakturen das Standardverfahren darstellt muss die Osteosynthese instabiler Frakturen vor dem Hintergrund neuerer, operationstechnisch und biomechanisch verbesserter intramedullärer Implantate kritisch betrachtet werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050613
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  • 48
    Electronic Resource
    Electronic Resource
    Unaufgebohrter Humerusnagel (UHN) (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 277-283 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Humerusschaftfraktur ; Intramedulläre Marknagelosteosynthese ; UHN ; Komplikationen ; Behandlungsergebnisse ; Keywords ; Fracture of the humeral diaphysis ; Humerus nail ; UHN ; Complications ; Results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: In a retrospective study, 115 fractures of the humeral diaphysis were evaluated, and 94 of the patients were treated by surgical operations. In 64 patients we used an unreamed humerus nail (UHN) to stabilize the fractures of the humerus diaphysis. All patients with an UHN were followed up. Having analysed the system-specific and general complications and the functional, subjective and radiological results we can recommend the UHN for the treatment of both fractures and pseudarthrosis of the humeral diaphysis.
    Notes: In einer retrospektiv durchgeführten Studie wurden 115 Humerusschaftfrakturen ausgewertet. Operativ wurden 94 Patienten, davon 64 mit einem unaufgebohrten Humerusnagel (UHN), versorgt. Die mit einem UHN behandelten Patienten wurden nachuntersucht. Nach Auswertung der systemspezifischen und allgemeinen Komplikationen sowie der funktionellen, subjektiven und radiologischen Ergebnisse kann der UHN sowohl zur Behandlung der frischen Humerusschaftfraktur als auch zur Versorgung von Humerusschaftpseudarthrosen empfohlen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390000318
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  • 49
    Electronic Resource
    Electronic Resource
    Wann ist die arthroskopische Diagnostik und Therapie am Ellbogengelenk beim Trauma angezeigt? (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S81 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Arthroskopie ; Ellbogengelenk ; Trauma ; Minimalinvasive Osteosynthese ; KomplikationenArthroscopy ; Elbow joint ; Injury ; Osteosynthesis ; Complications ; Key words ; Arthroskopie ; Ellbogengelenk ; Trauma ; Minimalinvasive Osteosynthese ; KomplikationenArthroscopy ; Elbow joint ; Injury ; Osteosynthesis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Elbow arthroscopy, unlike arthroscopy of the knee or shoulder, is technically a very demanding procedure that is associated with a high risk of complications owing to the surrouding neurovascular structures. In the case of trauma the arthroscopic approach is even more difficult because of the altered anatomy. In addition, the time available for the performance of any surgical procedures is very much limited by the immediate onset of periarticular swelling with fluid loss caused by the damage to the joint capsule that is present in most cases. Arthroscopy of the elbow should not therefore be considered to be indicated in acute trauma except in isolated cases and after very careful consideration of the risks and benefits for the patient. This procedure cannot be generally recommended as a standard method of examining or treating freshly sustained injuries.On the other hand, elbow arthroscopy can be very helpful in the case of posttraumatic functional deficiencies or such pathologic findings as loose bodies after osteochondral fractures, adhesions and intraarticular scars, while little or no improvement can be expected for vague joint symptoms or posttraumatic arthrosis. As there is a relatively high risk of neurological complications the patient needs to be given quite comprehensive information in an intensive preoperative session. Diagnostic arthroscopy is hardly ever indicated in a trauma case because of the excellent results yielded by modern noninvasive imaging methods, such as ultrasound, X-ray, computed tomography and MRI.
    Notes: Zusammenfassung Im Gegensatz zur Arthroskopie des Knie- oder Schultergelenks ist die Arthroskopie des Ellbogengelenks mit erheblichen technischen Schwierigkeiten und entsprechend hohen Komplikationsrisiken verbunden. Beim Trauma ist die Arthroskopie zudem aufgrund der veränderten anatomischen Verhältnisse noch weit komplizierter. Die Operationszeit ist wegen der rasch auftretenden periartikulären Schwellung infolge der meist bestehenden Gelenkkapselläsionen deutlich limitiert. Die Indikation zur Arthroskopie sollte daher nur im Einzelfall unter sorgfältiger Abwägung der Risiken und der zu erwartenden Vorteile gestellt werden. Eine generelle Empfehlung für dieses Verfahren bei frischen Verletzungen kann nicht ausgesprochen werden. Sinnvoll ist der Einsatz dagegen bei einigen posttraumatischen Veränderungen, z. B. freien Gelenkkörpern nach osteochondralen Frakturen oder Arthrolysen bei intraartikulären Vernarbungen, während bei „unklaren Gelenkbeschwerden“ oder posttraumatischer Arthrose kaum Verbesserungen zu erwarten sind. Wegen des relativ hohen Risikos neurologischer Komplikationen ist eine intensive präoperative Aufklärung der Patienten erforderlich. Eine diagnostische Arthroskopie beim Trauma ist bei der Aussagekraft der modernen nichtinvasiven Untersuchungsverfahren kaum noch angezeigt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014932
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  • 50
    Electronic Resource
    Electronic Resource
    Indikationsstellung und Verfahrenswahl bei Beckenringverletzungen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 39-45 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Beckenringfrakturen ; Klassifikation ; Behandlungsverfahren ; Komplikationen ; Ergebnisse ; Keywords ; Pelvic ring fractures ; Classification ; Treatment ; Complications ; Results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Injuries of the pelvis are caused by high-energy trauma, and concomitant injuries are therefore often found. Many patients with such pelvic injuries have multiple injuries. Accurate diagnosis and classification are both fundamental to adequate therapy. Especially in the presence of complex pelvic trauma and in polytraumatised patients priority-oriented and fast procedures are essential. Type B and C instabilities require operative treatment. In emergency cases with unstable pelvic fractures external fixation has proved successful. For definitive treatment with internal stabilisation different internal fixation procedures with screws and plates selected with reference to the features of the injury are needed. The operative stabilisation of the pelvic ring demands particular care, because various main vessels and nerves are adjacent to the injury site. Ultimately, the results of treatment depend heavily on the quality of anatomical restoration of the pelvic ring.
    Notes: Beckenverletzungen entstehen aufgrund hoher lokaler Gewalteinwirkung und sind deswegen häufig mit Begleitverletzungen kombiniert. Bei vielen beckenverletzten Patienten liegt ein Polytrauma vor. Grundlage einer adäquaten Therapie von Verletzungen des Beckenrings sind eine exakte Diagnostik und Klassifikation. Vor allem beim komplexen Beckentrauma und beim Vorliegen eines Polytraumas ist ein rasches und an Prioritäten orientiertes Vorgehen entscheidend. Instabilitäten vom Typ B und C erfordern eine operative Stabilisierung. Dabei steht in der Notfallbehandlung des instabilen Beckenrings die externe Stabilisierung im Vordergrund. Beim Übergang auf interne Fixationsverfahren haben sich abhängig von der Verletzungsmorphologie verschiedene Schrauben- und Plattenmontagen bewährt. Die operative Stabilisierung des Beckenrings erfordert wegen der engen Nachbarschaft zu verschiedenen Gefäß- und Nervenbahnen besondere Sorgfalt. Das Endergebnis hängt dabei ganz wesentlich davon ab, wie gut die Wiederherstellung der anatomischen Form des Beckenrings gelungen ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390050089
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  • 51
    Electronic Resource
    Electronic Resource
    Verletzungen des thorakolumbalen Übergangs (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 162-166 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Thorakolumbale Frakturen ; Transpedikuläre Spondylodese ; Spongiosaplastik ; Komplikationen ; Keywords ; Thoracolumbar fractures ; Transpedicular spondylodesis ; Bone grafting ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Spinal fractures are located predominantly at the thoracolumbar junction. After conservative treatment, for unstable fractures operative procedures were established during the last 20 years. Using implants with angular stability, dorsal transpedicular fixation yields good clinical results even compared with those of combined dorsoventral procedures. Transpedicular bone grafting is controversial as resorption frequently occurs; it has given disappointing results in fracture types in which definitive segmental fusion is unavoidable, so that combined dorso-ventral stabilization is necessary in such cases. The most frequent complications of dorsal instrumentation are the result of badly positioned transpedicular screws.
    Notes: Die Verletzungen des thorakolumbalen Übergangs stellen die Mehrzahl der Frakturen der Wirbelsäule dar. Nach der konservativen Therapie hat sich in den letzten beiden Jahrzehnten die operative Versorgung instabiler Frakturen etabliert. Die dorsale transpedikuläre Spondylodese unter Verwendung winkelstabiler Implantate stellt ein Verfahren dar, mit dem sich auch im Vergleich zu aufwändigen dorsoventralen Rekonstruktionen bei den meisten Frakturen gute klinische Resultate erzielen lassen. Der additionellen transpedikulären intrakorporalen Spongiosaplastik wird aufgrund der zu beobachtenden Resorption des Transplantats zunehmend geringere Bedeutung beigemessen. Auch bei Frakturtypen, bei denen eine definitive Fusion angestrebt werden sollte, hat die transpedikuläre interkorporale Knochentransplantation enttäuscht, sodass in derartigen Fällen nach primärer dorsaler Stabilisierung sekundär die Fusion von ventral erfolgen sollte. Die häufigsten Komplikationen bei der dorsalen transpedikulären Spondylodese sind auf Fehllagen der transpedikulären Schrauben zurückzuführen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010931
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  • 52
    Electronic Resource
    Electronic Resource
    Immunohistochemical investigations on the course of astroglial GFAP expression following human brain injury (2000)
    Springer
    International journal of legal medicine 113 (2000), S. 70-75 
    Details
    ISSN: 1437-1596
    Keywords: Key words Brain injury ; Cortical contusion ; GFAP ¶expression ; Immunohistochemistry ; Wound age
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract The course of GFAP expression by astrocytes has been immunohistochemically investigated during the first 30 weeks after human brain injury. In order to provide reliable data for a forensic wound age estimation, a quantitative morphometric analysis was performed considering the different topographic regions of the cortex as well as of the white matter. Compared to the GFAP immunoreactivity in unaltered control tissue, significantly increased numbers of GFAP positive astroglial cells could be detected adjacent to the cortical contusion from 1 day up to 4 weeks after brain injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007711
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  • 53
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    Electronic Resource
    Demonstration of morphine in ganglion cells of the hippocampus from victims of heroin overdose by means of anti-morphine antiserum (2000)
    Springer
    International journal of legal medicine 113 (2000), S. 117-120 
    Details
    ISSN: 1437-1596
    Keywords: Key words Ganglion cells ; Hippocampus ; Immunohistochemistry ; Mean optical density (MOD) ; Morphine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract To investigate the topography of morphine distribution in the human brain, a method has been developed to detect morphine immunohistochemically. In this study hippocampus tissue from victims of heroin overdose (blood morphine concentrations 220 ng/g–1500 ng/g; 6-MAM positive urine sample), known for its high concentration of μ-opiate receptors was used. The immunohistochemical staining was performed with an anti-morphine antiserum originally developed for radio-immuno-assays. In comparison with control specimens from cases of sudden death without morphine exposition or a history of heroin abuse, the brains from victims of heroin overdose showed selectively stained ganglion cells, axons and dendrites, suggesting a massive concentration of morphine in the neuronal structures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004140050012
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  • 54
    Electronic Resource
    Electronic Resource
    Immunohistochemical localization of mitogen-activated protein kinase (MAPK) family and morphological changes in rat heart after ischemia-reperfusion injury (2000)
    Springer
    Medical electron microscopy 33 (2000), S. 74-81 
    Details
    ISSN: 1437-773X
    Keywords: Key words Mitogen-activated protein kinase (MAPK) ; Ischemia reperfusion injury ; Heart ; Ultrastructure ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The mitogen-activated protein kinase (MAPK) family is considered to be activated by stress, but the role of the MAPK family is still unknown in cardiac pathology. In the present study, not only the localization of MAPKs such as the extracellular responsive kinase (ERK), c-jun N-terminal kinase (JNK), and p38 MAPK (p38), but also ultrastructural changes were investigated in the ischemia-reperfusion model of Wistar rats. At 5, 10, 30, 60, and 180 min reperfusion after 30 min ischemia by occluding the coronary artery, the expression of these MAPKs was increased in blood vessels and cardiomyocytes by Western blotting and immunohistochemical methods. In addition, after ischemia reperfusion, various ultrastructural changes such as decreased glycogen granules, mitochondrial swelling, and myolysis were observed in the blood vessels and cardiomyocytes. These results suggest that protein kinases may regulate numerous biological processes, including the regulation of contraction and ion transport.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007950070005
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  • 55
    Electronic Resource
    Electronic Resource
    An immunohistochemical and ultrastructural study of a follicle-stimulating hormone-secreting gonadotroph adenoma occurring in a 10-year-old girl (2000)
    Springer
    Medical electron microscopy 33 (2000), S. 25-31 
    Details
    ISSN: 1437-773X
    Keywords: Key words Gonadotroph adenoma ; FSH ; Childhood ; Ultrastructure ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Female gonadotroph adenomas with endocrinological symptoms are uncommon. Six cases of such adenomas have been reported in the literature: two were girls who presented with precocious puberty and four were premenopausal women with accompanying multiple ovarian cysts. We describe here a 10-year-old Japanese girl with a gonadotroph macroadenoma and present detailed morphological findings of the tumor. The patient's chief complaints were nausea, abdominal distention, and abdominal pain. Abdominopelvic ultrasonography and magnetic resonance imaging (MRI) revealed bilateral multiple ovarian cysts. Endocrinological assays showed elevated serum follicle-stimulating hormone (FSH) (33.7 mIU/ml) and estradiol (3840 pg/ml). MRI of the head showed a large pituitary tumor. Two transsphenoidal operations and subsequent radiation therapy were performed. Immunohistochemically, more than half the tumor cells were positive for anti-FSH-β monoclonal antibody. Ultrastructurally, the tumor cells exhibited a fairly uniform picture of rounded cells. Their nuclei were slightly irregular and contained heterochromatin, and their cytoplasm contained many round, dense core granules, measuring 140–260 nm in diameter, together with well-developed organelles. An in vitro study showed that the tumor cells in primary culture produced FSH (1089.0 mIU/ml). To our knowledge, this is the first immunohistochemical and ultrastructural study of an FSH-secreting gonadotroph adenoma occurring in childhood.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007950000004
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  • 56
    Electronic Resource
    Electronic Resource
    Mesangial myofibroblastic transformation in steroid-dependent minimal change nephrotic syndrome (2000)
    Springer
    Medical electron microscopy 33 (2000), S. 102-107 
    Details
    ISSN: 1437-773X
    Keywords: Key words Minimal change nephrotic syndrome ; α-Smooth muscle actin ; Vimentin ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Patients with minimal change nephrotic syndrome (MCNS) occasionally show frequent relapses with proteinuria after cessation of steroid treatment, even though no significant pathological abnormalities are found in the glomeruli, compared with those in nonrelapsed and good-prognosis cases of MCNS. To resolve this contradiction, we immunohistochemically and ultrastructurally examined a biopsied renal tissue of a patient who showed glomerular features of MCNS and frequent clinical relapses. Immunohistochemistry demonstrated the overexpression of α-smooth muscle actin (ASMA) and vimentin in glomerular mesangial cells despite no mesangial cell proliferation, compared with nine nonrelapsed cases of MCNS. These facts may be an important clue to the investigation of the pathogenesis of steroid-dependent MCNS with frequent relapses. Furthermore, the immunohistochemical examination of ASMA and vimentin may be useful to detect mesangial myofibroblastic transformation that is not demonstrated in conventional light microscopy and immunofluorescence study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007950070009
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  • 57
    Electronic Resource
    Electronic Resource
    Structural immaturity of the pylorus muscle in infantile hypertrophic pyloric stenosis (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 282-284 
    Details
    ISSN: 1437-9813
    Keywords: Key words Desmin ; Infantile hypertrophic pyloric stenosis ; Immunohistochemistry ; Fetus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Recent reports indicate that extracellular matrix and cytoskeleton plasmalemmal elements are altered in infantile hypertrophic pyloric stenosis (IHPS). Desmin is a cytoskeletal protein that is important for the organization and function of muscular fibers. It has been found to be increased in the smooth muscle in chronic intestinal pseudo-obstruction and in skeletal muscle in some forms of myopathies as well as in unexplained hypertrophic cardiomyopathies. The aim of this study was to analyze the expression of desmin in IHPS. Full-thickness muscle-biopsy specimens were obtained from 8 IHPS patients (age range 23 to 41 days) at pyloromyotomy, from 8 age-matched controls without evidence of gastrointestinal (GI) disease at autopsy, and from 2 stillborns who died at 27 and 30 weeks of gestation without evidence of GI disease. Indirect immunohistochemistry was performed using the avidin-biotin-peroxidase complex method with anti-desmin and visualized by development with 3-diaminobenzidine tetrahydrochloride. Pyloric muscle in IHPS demonstrated strong desmin immunoreactivity. The expression of desmin was also strong in the muscular layers of fetal pylorus. In the age-matched controls absent or weak desmin immunoreactivity was seen in the pyloric muscle layer. The increased amount of desmin in hypertrophied pyloric muscle in IHPS may result in inco-ordination of contraction and relaxation of the pylorus, thus causing motility dysfunction. The similar pattern of desmin expression in IHPS and fetal pylorus suggests that the organization of intermediate filaments in IHPS is in a fetal stage of development.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050745
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  • 58
    Electronic Resource
    Electronic Resource
    Organ-specific distribution of major histocompatibility antigens in rats (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 285-292 
    Details
    ISSN: 1437-9813
    Keywords: Key words Major histocompatibility complex (MHC) ; Rat ; Immunohistochemistry ; Distribution
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The present study systematically investigated the expression and distribution of the major histocompatibility complex (MHC) classes I and II in the rat. About 150 native tissue probes from eight adult Lewis rats were taken, representative for most organs, tissues, and the vascular system. MHC expression was analyzed by two monoclonal antibodies (mAb) generated against the non-polymorphic determinants of rat MHC class I (Ox-18) and class II (Ox-6). Immunoreactivities were compared to those of different endothelial (HIS52, TLD-3A12, Ox-43, REHA-1 antigen), histiocytic (ED1, ED2), B-cell (RLN-9D3), and T-cell (MRC Ox-52) markers. A nonspecific mAb (MR12/53) served as a negative control. Pretested concentrations on various tissues and the alkaline phosphatase-anti-alkaline phosphatase technique allowed semiquantitative evaluation of serial cryostat tissue sections. MHC class I expression was detected on most immunocompetent cells. Endothelial cells were stained heterogeneously along the vascular system and the organ-specific microcirculation. Furthermore, some organs showed staining of parenchymal cells. MHC class II was found on all immunocompetent cells positive for the B-cell marker and about 15% of cells positive for the histiocytic markers. Besides the well-known expression of MHC class II in the outer zone of the renal proximal tubule, further organ-specific cell forms were found positive. In conclusion, the present study outlines tissue-specific distribution of MHC I/II and implies that each organ carries a variable immunologic burden that needs to be considered for any transplantation model.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050746
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  • 59
    Electronic Resource
    Electronic Resource
    Appearance of denuded hepatic stellate cells and their subsequent myofibroblast-like transformation during the early stage of biliary fibrosis in the rat (2000)
    Springer
    Medical electron microscopy 33 (2000), S. 217-230 
    Details
    ISSN: 1437-773X
    Keywords: Key wordsα-Smooth muscle actin ; Transforming growth factor-β1 ; Bile ductule ; Bile duct ligation ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the early in vivo response of hepatic stellate cells in biliary fibrosis, we examined rat livers during the first 7 days after bile duct ligation using light microscopy, immunohistochemistry, electron microscopy, and immunoelectron microscopy. At day 1 after bile duct ligation, α-smooth muscle actin-positive fibroblasts appeared and then increased in number around the proliferating bile ductules. With time, the destruction of the external limiting plate became accentuated because of the invasion of the proliferating bile ductules and periductural fibrosis. At day 7, stromal cells containing fat droplets appeared in the fibrous tissue adjacent to the periportal parenchyma; these are termed denuded hepatic stellate cells. In the fibrous tissue disconnected from the liver parenchyma, the denuded hepatic stellate cells were replaced by myofibroblast-like cells. Meanwhile, the expression of transforming growth factor-β1 on biliary epithelial cells increased. These results indicate the dual origin of myofibroblasts in experimental biliary fibrosis, the periductural and periductal fibroblasts in the initial stage, and the denuded hepatic stellate cells in the subsequent stage. These two types of stromal cells may undergo myofibroblastic transformation by the transforming growth factor-β1 secreted by the proliferating biliary epithelial cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007950000022
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  • 60
    Electronic Resource
    Electronic Resource
    Prognostic value of P-glycoprotein expression in bone and soft-tissue sarcoma (2000)
    Springer
    International journal of clinical oncology 5 (2000), S. 164-170 
    Details
    ISSN: 1437-7772
    Keywords: Key words P-glycoprotein ; Osteosarcoma ; Soft-tissue sarcoma ; Prognosis ; Immunohistochemistry ; RT-PCR
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. The purpose of this study was to investigate the correlation between P-glycoprotein status and outcome in adult patients with high-grade osteosarcomas and soft-tissue sarcomas. Methods. P-glycoprotein status was determined im-munohistochemically in specimens from 28 patients with osteosarcoma and 34 patients with soft-tissue sarcoma. The polyclonal antibody mdr(Ab-1) was used for either decalcified or undecalcified tissue samples which were formalin-fixed and paraffin-embedded. The expression of P-glycoprotein mRNA was also determined by the polymerase chain reaction in 23 fresh sarcoma specimens. P-glycoprotein status was analyzed in relation to the duration of event-free survival. Results. Positivity for P-glycoprotein was found in 29% of the osteosarcomas and 34% of the soft-tissue sarcomas. Consistent results were obtained at both the immunohistochemical and reverse transcriptase-polymerase chain reaction (RT-PCR) levels in 19 of 23 sarcomas (83%). In patients with osteosarcoma, the presence of increased levels of P-glycoprotein was significantly associated with a decreased probability of event-free survival after diagnosis (P = 0.022). In contrast, in patients with soft-tissue sarcoma there was no correlation between the level of P-glycoprotein and prognosis. Conclusions. In patients with high-grade osteosarcomas, the presence of increased levels of P-glycoprotein detected by polyclonal antibody mdr(Ab-1) was associated with a significantly increased risk of adverse events. This association was not found in patients with soft-tissue sarcomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00012032
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    Infantile acute pancreatitis after mumps vaccination simulating an acute abdomen (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 488-489 
    Details
    ISSN: 1437-9813
    Keywords: Key words Pancreatitis ; Childhood ; Mumps vaccination ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We describe an extremely rare case of acute pancreatitis presenting as an acute abdomen that appeared as a complication of mumps vaccination in a young child. A laparotomy performed because of suspected perforated appendicitis proved unnecessary in retrospect. No similar case in infancy and early childhood has been reported to date.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000417
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  • 62
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    Electronic Resource
    “Gut-feeling” or evidence-based approaches in the evaluation and treatment of human short-bowel syndrome (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 155-164 
    Details
    ISSN: 1437-9813
    Keywords: Key words Short-bowel syndrome ; Intestinal adaptation ; Sugar absorption test ; Gut hormones ; Electrophysiology ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Short bowel syndrome is the malabsorptive state that often follows extensive resection of the small intestine. Long-term survival without parenteral nutrition depends on the process of intestinal adaptation, through which the remaining small bowel gradually increases its absorptive capacity. The process of intestinal adaptation is almost exclusively luminal nutrient dependent. To date the clinical management of short bowel patients is mostly based on a “trial and error” regimen because human data and randomised trials using trophic substances are lacking due to the small number of patients annually present in pediatric surgical centres. We evaluate here the currently available as well as some more recently developed methods of measuring intestinal absorption and adaptation in short bowel patients. New techniques such as measurements of (1) intestinal permeability and carbohydrate absorption using the sugar absorption test, (2) gastrointestinal hormone production of gastrin, cholecystokinin and peptide YY, (3) transmural potential difference of the gastrointestinal tract using electrophysiology and (4) mucosal enzyme expression of lactase and sucrase-isomaltase using immunohistochemistry were evaluated. These new techniques are promising in monitoring the process of adaptation of the remaining intestine and evaluating the effect of therapeutic interventions in patients with short bowel syndrome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050713
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  • 63
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    Electronic Resource
    Patient perception of magnetic resonance arthrography (2000)
    Springer
    Skeletal radiology 29 (2000), S. 265-269 
    Details
    ISSN: 1432-2161
    Keywords: Key words MR arthrography ; Joint injection ; Gadolinium (intra-articular) ; Pain-rating scores ; Arthrogram ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging alone. The purpose of this study was to evaluate patients’ perception of the fear and discomfort, and to assess their overall acceptance of the intra-articular gadolinium injection. Design and patients. Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most commonly associated with the procedure including ”pain”, ”needles”, ”complications”, and ”discovery of results that would lead to surgery”. In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked to rate their perception of pain. Results. While many patients expressed fear of ”pain” and ”needles”, after having undergone the injection their overall pain rating score was low. Only 6% actually found gadolinium arthrography more painful than expected. Conclusion. Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050605
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    Variation among giant rice bodies: report of four cases and their clinicopathological features (2000)
    Springer
    Skeletal radiology 29 (2000), S. 525-529 
    Details
    ISSN: 1432-2161
    Keywords: Key words Giant rice body ; Ultrastructure ; Immunohistochemistry ; Histogenesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective: To report four cases of rice bodies (RBs) showing remarkable size variations and discuss their pathogenesis. Design and patients: Based on analysis of the clinical data, we speculate on the pathogenesis of RBs using immunohistochemical and ultrastructural methods. The patients comprised three men and one woman, three with RBs in the subacromial bursae and one in the wrist synovial sheath, aged 28 (woman), 44, 50 and 81 (wrist) years, respectively. Results: There were no particular differences in clinical data among the patients. T2-weighted MR imaging was very useful for diagnosis of the RBs, allowing their clear delineation from the bursal fluid. The RBs consisted of a layered protein- aceous substance with vague targetoid cut surfaces. Much fibrin and a lesser amount of collagen fibers were recognized together with various mononuclear cells, which were few in number and predominantly T cells. The bursae and synovial sheath had multiple fibrinoid spheroids at the luminal surface. Conclusion: Fibrinoid nodular deposits probably became detached, forming the nuclei of RBs and growing to a giant RB 65 mm in diameter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000258
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  • 65
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    Rapid chondrolysis after an intra-articular leak of bone cement in treatment of a benign acetabular subchondral cyst: an unusual complication of percutaneous injection of acrylic cement (2000)
    Springer
    Skeletal radiology 29 (2000), S. 275-278 
    Details
    ISSN: 1432-2161
    Keywords: Key words Bone subchondral cyst ; Acetabulum ; Interventional radiology ; Complications ; Methylmethacrylate ; Chondrolysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Percutaneous injection of methylmethacrylate is now increasingly employed to treat bone lesions, both malignant and benign. However, the risks of this procedure are still to be fully established. In this report, we describe a case of rapid chondrolysis appearing after the intra-articular leakage of cement during injection of an acetabular subchondral cyst, resulting in hip replacement. Although the mechanism of such chondrolysis is unknown, this event suggests a chondrolytic effect of the acrylic cement. Thus, it is essential to systematically search for the presence of an intra-articular passage before injecting bone cement into a peri-articular cyst. This unusual complication highlights the need for rigorous evaluation of the benefits and risks of percutaneous injection of acrylic cement in the treatment of benign lesions, especially close to an articulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050607
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  • 66
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    Peripheral papillary tumor of type-II pneumocytes: a rare neoplasm of undetermined malignant potential (2000)
    Springer
    Virchows Archiv 436 (2000), S. 289-295 
    Details
    ISSN: 1432-2307
    Keywords: Key words Unusual lung tumors ; Papillary adenoma ; Surfactant proteins ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Peripheral papillary adenomas of the lung are uncommon neoplasms (only ten cases have been described so far in the English literature) composed predominantly of type-II pneumocytes and generally considered benign. We describe here two additional cases of this lung tumor. In both cases histological examination revealed an encapsulated papillary neoplasm with invasion of the capsule and, in one case, invasion of the adjacent alveoli and visceral pleura too. The proliferative index (Ki67) was less than 2% and the epithelial cells were positive for cytokeratins, surfactant apoproteins (SP), and nuclear thyroid transcription factor-1 (TTF-1). Ultrastructurally, the epithelial cells showed the characteristic surface microvilli and cytoplasmic lamellar inclusions of type-II cells. Review of the literature has revealed two other cases of peripheral papillary adenoma of type-II pneumocytes with infiltrative features. Thus, we propose replacing the term peripheral papillary adenoma with peripheral papillary tumor of undetermined malignant potential.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050043
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  • 67
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    Differential expression of CD44s and CD44v3-10 in adenocarcinoma cells and reactive mesothelial cells in effusions (2000)
    Springer
    Virchows Archiv 436 (2000), S. 330-335 
    Details
    ISSN: 1432-2307
    Keywords: Key words Adenocarcinoma cell ; Mesothelial cells ; Effusions ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The detection of malignant cells in serous effusions obtained from patients diagnosed with cancer marks the presence of metastatic disease and is associated with a poor outcome. The purpose of this study was to evaluate the role of CD44s and CD44v isoforms in the distinction between mesothelial cells and malignant epithelial cells in effusions. Fifty-nine fresh pleural and peritoneal effusions were studied. These consisted of 41 specimens from patients with known gynecological neoplasms, 9 from patients diagnosed with breast adenocarcinoma, and 9 effusions from patients with various nongynecological malignancies or tumors of unknown origin. Forty-three effusions contained malignant/atypical epithelial cells, and 16 effusions were diagnosed as reactive. Three effusions contained exclusively malignant cells. Specimens were stained with anti-CD44s, v3, v5, v6, v7 and v3-10. The presence of staining in cancer cells, benign mesothelial cells and lymphocytes was evaluated. CD44s immunoreactivity was seen in 10 of 43 (23%) cases in malignant/atypical epithelial cells and in 53 of 56 (94%) cases in benign cells. In contrast, CD44v3-10 was seen in 23 of 43 (55%) cases in malignant/atypical epithelial cells and in 3 of 56 (6%) cases in benign cells. We advocate the use of CD44s and CD44v3-10 immunostaining in diagnostic evaluation of difficult serous effusions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050455
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    PE-35-related antigen expression and CD1a-positive lymphocytes in thymoma subtypes based on Müller-Hermelink classification (2000)
    Springer
    Virchows Archiv 436 (2000), S. 20-27 
    Details
    ISSN: 1432-2307
    Keywords: Key words PE-35 ; CD1a ; Immunohistochemistry ; Catalyzed signal amplification (CSA) ; Thymoma ; Thymic carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  PE-35 monoclonal antibody, detecting a cell-surface antigen of various types of carcinoma and normal epithelium, reacts exclusively with the medullary epithelium in the thymus; therefore, the antigen has been considered as a marker of medullary differentiation in thymomas. Using the catalyzed signal amplification method, which made it possible to apply PE-35 to routinely processed, archival tissues, we examined expression of this antigen, together with CD1a reactivity of lymphocytes, in 40 thymic epithelial tumors subclassified using the Mü1ler-Hermelink system. Medullary thymomas infiltrated with a small number of CD1a-negative lymphocytes were PE-35 positive, although many of the long spindle tumor cells were PE-35 negative. Mixed thymomas and predominantly cortical thymomas, both with prominent CD1a-positive lymphocytes, were also PE-35 positive, although some areas of the latter type were PE-35 negative. Cortical thymomas with decreased numbers of CD1a-positive lymphocytes were largely PE-35 negative. In well-differentiated thymic carcinomas with a few CD1a-positive lymphocytes, two cases were negative, but four cases were at least focally positive with PE-35. All high-grade thymic carcinomas infiltrated with some CD1a-negative lymphocytes were PE-35 positive. These results suggested that medullary thymoma generally possesses the medullary nature, although the latter tends to be lost in the long spindle tumor cells. Mixed and predominantly cortical thymomas may have mixed medullary phenotype and cortical function. Cortical thymoma and many well-differentiated thymic carcinomas may possess the cortical nature, while the large polygonal tumor cells tend to lose immature T-lymphocyte-retaining function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008194
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  • 69
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    Electronic Resource
    Highly sensitive diagnosis of amyloid and various amyloid syndromes using Congo red fluorescence (2000)
    Springer
    Virchows Archiv 436 (2000), S. 439-448 
    Details
    ISSN: 1432-2307
    Keywords: Key words Amyloid ; Classification ; Congo red fluorescence ; Early diagnosis ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In order to find how best to diagnose amyloid deposits as early as possible, the sensitivity of three different methods that can be applied to the diagnosis of amyloid in tissue sections have been compared: the Congo red staining method (CR), the combination of CR and immunocytochemistry (CRIC) and Congo red fluorescence (CRF). Tissue blocks were available from 25 patients, including 11 with immunohistochemically distinct and 3 with chemically undefined amyloid diseases. The results revealed (a) that CRF is more sensitive than either CR or CRIC, as shown qualitatively and quantitatively, (b) that CRF can therefore be utilized to track down even minute amyloid deposits, which can be missed by the other two methods; (c) that the specificity of CRF and CRIC is secured on double-stained sections by the demonstration of green birefringence (GB) of the CRF-marked and IC-marked areas; (d) that CRF can be performed on the spot by just changing the light source; and (e) that CRF is not hampered by the congruent IC chromogen overlay, which ensures the specific classification of the amyloid deposits as applied to different amyloid classes. In conclusion, CRF was demonstrated to be the most sensitive method for direct diagnosis of amyloid in tissue sections. This method can, therefore, allow the earliest diagnosis and classification of amyloid, which is a good basis for an amyloid class-specific therapy while organ damage is still minimal.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050471
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    Electronic Resource
    Bio-morphological events in the development of the human female mammary gland from fetal age to puberty (2000)
    Springer
    Virchows Archiv 436 (2000), S. 431-438 
    Details
    ISSN: 1432-2307
    Keywords: Key words Breast development ; Human breast ; Fetal breast ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Bio-morphological understanding of the developing human mammary glands may clarify some aspects of breast pathology, including cancer. In particular, some epidemiological data suggests that during fetal growth an altered intrauterine hormonal status, especially a change in estrogen status, could predispose to carcinogenesis. In an attempt to achieve new information on early breast growth, a series of developing human breasts have been analyzed, namely: 4 fetal breasts (28–32 weeks of gestational age), 7 infant breasts (7 h to 2 years) and 1 puberal breast (12 years). In addition to the morphological features, we studied the immunohistochemical expression of some markers involved in morphogenesis, such as MIB-1 for cell proliferation, bcl-2 for apoptosis control, CD34 for vasculogenesis, estrogen (ER) and progesterone (PR) receptors for hormonal profile, and smooth-muscle actin for myoepithelial differentiation. The results were as follows: (a) lobules, absent between 28 weeks and 2 days, were well evident at 2 years of age and at puberty; (b) myoepithelial cells appeared from 28 weeks onward and persisted later with no modification in quantity and distribution; (c) epithelial cell proliferation was constantly low; (d) in all breasts inner epithelial cells showed diffuse bcl-2 positivity, while basal myoepithelial-like cells were generally negative; (e) all breasts were well vascularized with two different patterns: periductal vascularization (PDV) and interductal vascularization (IDV), IDV being always present, whereas PDV was found only in infant breasts; (f) ER and PR were almost absent in fetal and infant breasts, while their expression was high in the epithelial cells of the puberal breast; (g) stromal cells had no hormonal receptors and were heterogeneous for proliferation and bcl-2 expression. Interestingly, two fetal breasts showed high proliferation and high ER expression, respectively, in their epithelial compartment. This could be the expression of an altered hormonal environment in utero, representing a basis for possible subsequent cancer initiation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050470
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  • 71
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    D3 Lymph Node Dissection in Gastric Cancer: Evaluation of Postoperative Mortality and Complications (2000)
    Springer
    Surgery today 30 (2000), S. 700-705 
    Details
    ISSN: 1436-2813
    Keywords: Key words Gastric cancer ; Lymph node dissection ; Mortality ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Since November 1995 we have been performing a D3 lymph node dissection in patients undergoing an operation for gastric cancer with a curative intent. The aim of the present study was to evaluate whether this procedure results in an increased postoperative mortality or complication rate in a Western population. Between November 1995 and August 1997 the postoperative courses of 76 patients were retrospectively assessed (45.3 lymph nodes per patient, lymph node ratio: 0.16). The patient outcome was compared with data from a historic control group of patients (n = 383) in whom the newly established D2 dissection was studied in our department. Regarding the demographic, clinical, and tumor-pathologic data, and the choice of resection and reconstructive procedures, the two groups differed only slightly. The postoperative mortality of 1% was lower (vs 6.8%) while the overall complication rate of 34% (vs 32.1%) was identical. In particular, no anastomotic leakage (vs 9.4%) and fewer nonsurgical complications (17.1% vs 27.9%) occurred. The reoperation rate was 1% vs 9.7%. However, in 6% of the patients drainage tubes had to be inserted under computed tomographic guidance. The average hospital stay remained unchanged (21.9 vs 20.7 days). A D3 dissection was shown to be feasible while demonstrating no disadvantages in the patients when compared with the D2 procedure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950070080
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    Correlation Between the Expression of Methionine Adenosyltransferase and the Stages of Human Colorectal Carcinoma (2000)
    Springer
    Surgery today 30 (2000), S. 706-710 
    Details
    ISSN: 1436-2813
    Keywords: Key words Methionine adenosyltransferase ; Colorectal adenocarcinoma ; Colon ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Methionine adenosyltransferase (MAT) catalyzes the synthesis of S-adenosylmethionine (AdoMet) from ATP and L-methionine. AdoMet is the major methyl donor in most transmethylation reactions in vivo, and it is also the propylamino donor in the biosynthesis of polyamines. In the present study, we assessed MAT activity in human colons with colorectal carcinoma and the values were compared with those of morphologically normal adjacent mucosa. Higher levels of MAT activity were observed in the colorectal carcinoma than in the normal colon. The ratio of MAT activity in tumor tissue versus normal tissue seemed to be correlated well will the stage of the colorectal tumor. Furthermore, immunoblot analysis showed that the high levels of MAT activity observed in colorectal carcinoma were due to the increased amounts of MAT protein. Immunohistochemical analysis revealed that MAT was most abundant in goblet cells, particularly in granules in the supranuclear area of these cells. In the colorectal carcinoma tissues, MAT was strongly stained in the cancerous cells and localized in granules in the supranuclear region. The results of this preliminary study suggest that determination of the relative ratio of MAT activity in both normal and tumor regions in human colorectal carcinoma could be a clinically useful tool for determining the stage of malignancy of colorectal carcinomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950070081
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  • 73
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    Electronic Resource
    Increased interleukin-8 (IL-8) expression is related to aseptic loosening of total hip replacement (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 328-332 
    Details
    ISSN: 1434-3916
    Keywords: Key words Interleukin-8 ; Aseptic loosening ; Total hip replacement ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aseptic loosening is an increasing problem in total hip replacement (THR). Chronic inflammatory reaction against implant wear particle results in collageno- and osteolysis, leading to loosening of the implant. Cytokines are known to play a major role in this particular inflammatory process [10]. The aim of the present study was to examine interleukin-8 (IL-8) in the synovial-like interface membrane (SLIM) and pseudocapsular tissue of THRs and to compare it to normal knee synovial membrane. Eleven patients suffering from aseptically loosened THRs were included. All the SLIM and pseudocapsular tissue samples were obtained during revision operations. Ten control samples of normal synovium were collected per arthroscopy from the superior recessus of the knee. For immunohistochemical IL-8 detection, polyclonal mouse anti-human immunoglobulin (Ig)G1 IL-8-primary antibody was used with the alkaline phosphatase anti-alkaline phosphatase (APAAP) method. Results were quantitated using the Vidas image analysis system. The highest count levels (mean ± SEM) were detected in SLIM tissue (386 ± 82 cells/mm2). The difference was statistically significant compared with pseudocapsular tissue (193 ± 36 cells/mm2) and control samples (18 ± 5 cells/mm2). Count levels in control tissue were on average 5% of the SLIM tissues values. The present study determines for the first time the cellular origin of IL-8 in aseptically loosened THRs and also quantitates the IL-8-producing cells in the periprosthetic tissue. The results reveal a high rise in IL-8 concentration in SLIM and in synovial tissues. This finding moves us one step forward in solving the complex network of multiple factors affecting loosening of hip implants.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050475
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    Ganglioglioma with a tanycytic ependymoma as the glial component (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 310-316 
    Details
    ISSN: 1432-0533
    Keywords: Key words Ganglioglioma ; Ependymoma (tanycytic variant) ; Neurofibrillary tangle ; Immunohistochemistry ; Ultrastructure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We studied a cystic ganglioglioma (GG) located in the right frontal lobe of the brain. Interestingly, the fibrillary spindle glial cells were often arranged in a fascicular pattern, and the generally uniform, round-to-oval delicate nuclei appeared to resemble those of ependymoma; and the neoplastic neurons often contained neurofibrillary tangles (NFTs). The glial component was positive for glial fibrillary acidic protein and occasionally contained granular or microvesicular structures positive for epithelial membrane antigen. Ultrastructural investigation revealed that the glial cells were ependymal in nature; intracytoplasmic lumina and intercellular microrosettes lined with cilia and microvilli, as well as long zonulae adherentes, were evident. In addition, chromogranin A-positive granular staining, neurosecretory-granule-like structures, and parallel arrays of microtubules were sometimes associated with the blood vessels. We considered the present case to be an unusual example of GG with an ependymoma, more precisely a tanycytic ependymoma, as the glial component; to our knowledge, the existence of ependymoma as the main glial component of this particular tumor has not been described before. The occurrence of NFTs, which has been reported in several cases of GG, was an additional, unusual feature.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007443
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  • 75
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    Differentialindikation zentraler und peripherer Leitungsanästhesien (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 495-504 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Regionalanästhesie ; Spinalanästhesie ; Epiduralanästhesie ; periphere Nervenblockaden ; Komplikationen ; Keywords Regional anesthesia ; Spinal anesthesia ; Epidural anesthesia ; Nerve blocks ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Serious neurological complications caused by spinal hematoma or abscess following central neuraxial block have been reported more often during the last years. In contrast, severe complications are extremely rare associated with peripheral nerve blocks. Concerned about the safety of spinal and epidural anesthesia, we encourage the use of peripheral regional techniques for procedures on the lower extremity and especially for postoperative regional analgesia. Motor block due to lumbar epidural anesthesia using high concentrations of local anesthetic makes spinal hematoma or abscess difficult to recognize. Therefore, low concentrations of local anesthestic should be used for postoperative epidural analgesia. Any increase in motor block following neuraxial blockade should raise the suspicion of a spinal compression (e.g. hematoma or abscess). Other symptoms are back pain, radicular pain or paresthesia and incontinence. Disastrous neurological injuries can only be prevented by immediate diagnosis (MR, CT or myelography) and therapy (surgical decompression).
    Notes: Zusammenfassung In den letzten Jahren wird vermehrt über schwerwiegende neurologische Komplikationen durch spinale Hämatome und Abszesse nach rückenmarksnahen Regionalanästhesien berichtet. Vor diesen Hintergrund werden die verschiedenen Regionalanästhesietechniken für die untere Extremität und ihre Komplikationen gegenübergestellt, denn die komplikationsärmeren peripheren Leitungsanästhesien bieten sich im Bereich der unteren Extremität als Alternative zur Spinal- oder Epiduralanästhesie an. Es wird empfohlen, zur postoperativen Schmerztherapie lumbale Epiduralanalgesien soweit möglich durch periphere Leitungsblockaden zu ersetzen. Kontinuierliche Blockaden, z.B. im Bereich des N. femoralis eignen sich auch zur postoperativen Schmerztherapie. Bei der postoperativen lumbalen Katheter-Epiduralanalgesie erschweren hohe Lokalanästhetika-Konzentrationen mit ausgeprägter motorischer Blockade die Diagnose intraspinaler Raumforderungen. Zur postoperativen Epiduralanalgesie sind Lokalanästhetika daher nur in niedriger Konzentration einzusetzen. Bis zum Ausschluss des Gegenteils begründet nach rückenmarksnaher Regionalanästhesie jede Zunahme der motorischen Blockade den Verdacht auf eine spinale Raumforderung (z.B. Hämatom oder Abszess). Weitere Kardinalsymptome sind Rückenschmerzen, Wurzelkompressionsschmerzen und Inkontinenz. Nur die sofortige Diagnose (MR, CT oder Myelographie) und Therapie (ggf. operative Entlastung) kann katastrophale neurologische Schäden verhindern.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070089
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    Auswirkungen von Luftbläschen in der Infusionsspritze auf die Funktion von Spritzenpumpen (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 1018-1023 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Infusionssysteme ; Spritzenpumpen ; Luft ; Fehlerquellen ; Gefahren ; Keywords Syringe pumps ; Air ; Infusion line occlusion ; Drug delivery ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Application of highly concentrated short-acting vasoactive drugs in the critically ill patient requires precisely working syringe pump systems for continuous intravenous drug delivery. We performed a bench study to investigate the consequences of small amounts of air entrapped within a 50-ml infusion syringe. In particular we studied the effect of entrapped air on drug delivery after moderate vertical displacement of the pump by 50 cm (e. g. in preparation for transport) and the effect on the time required to trigger the pressure alarm after occlusion of the infusion line. At a flow rate of 1 ml/h, lowering the syringe pump prolonged the zero-drug delivery time from (mean±SD) 4.1±0.8 min (without air) to 6.2±0.9 (with 1 ml air) and to 13.1±0.9 min (with 2 ml of air, p〈0.001 for all comparisons). Entrapping of 2 ml of air within the syringe resulted in a 2.6-fold prolongation of the occlusion alarm time after accidental occlusion of the infusion line and a 3-fold increase of the resulting infusion bolus after occlusion. Enclosed air within infusion syringes considerably affects the syringe compliance. It increases the susceptibility of constant drug delivery to vertical displacement of syringe pumps and impairs the occlusion alarm function. Therefore, any air in syringe of infusion pump systems should be carefully removed. To avoid infusion boluses of short-acting vasoactive drugs after accidental occlusions, the occluded infusion line should be released to ambient pressure first.
    Notes: Zusammenfassung Werden hochdosierte kreislaufwirksame Pharmaka mit kurzer Halbwertszeit bei niedrigen Flussraten appliziert (z. B. bei Neugeborenen oder in der Kinder-Herzchirurgie), so ist eine konstante Zufuhr des Medikaments für die hämodynamische Stabilität eine unabdingbare Voraussetzung. Wir untersuchten in einem experimentellen Modell den Einfluss von geringen Luftmengen in 50-ml-Infusionsspritzen auf die Konstanz der Flussrate und die Alarmfunktion in 2 klinisch relevanten Situationen: relative Niveauänderungen zwischen Spritzenpumpe und Patient (etwa bei Transport oder Umlagern) und akzidentieller Verschluss (etwa Abknicken) einer Infusionsleitung. Nach Absenken der Spritzenpumpe um 50 cm gegenüber dem Ausgangsniveau verlängerte sich die Zeit unterbrochener Medikamentzufuhr (wegen hydrostatischer, retrograder Aspiration) von 4,1 min ohne Lufteinschluss auf 6,2 min bei 1 ml und auf 13,1 min bei 2 ml Lufteinschluss. Bei akzidentiellem Verschluss verlängerte sich die Zeit bis zum Okklusionsalarm bei 2 ml Lufteinschluss um das 2,6fache auf über 1 h, der resultierende Bolus nach Aufheben des Verschlusses verdreifachte sich. Daher sollten bei der Zufuhr hochkonzentrierter Vasoaktiva nicht nur relative Lageveränderungen zwischen System und Patient vermieden, sondern jegliche eingeschlossene Luft konsequent evakuiert werden. Dies gilt gleichermassen für alle über dasselbe Katheterlumen infundierenden Perfusoren. Bei Erkennen eines Verschlusses ist es sinnvoll, das okkludierte Infusionssystem vom Patienten zu trennen und den Druckentlastungsbolus zu verwerfen, bevor der Verschluss aufgehoben wird.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070016
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    α-Synuclein is expressed in a variety of brain tumors showing neuronal differentiation (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 154-160 
    Details
    ISSN: 1432-0533
    Keywords: Key wordsα-Synuclein ; Brain tumors ; Neuronal ¶differentiation ; Immunohistochemistry ; Neuronal marker
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract α-Synuclein is presynaptic nerve terminal protein and its immunoreactivity has been observed in such neurodegenerative structures as senile plaques of Alzheimer’s disease or Lewy bodies of Parkinson’s disease. The physiological role of α-synuclein is still unknown. It is speculated that α-synuclein may be expressed in brain tumors, especially in those showing neuronal differentiation. We examined the immunohistochemical localization of α-synuclein in 77 human brain tumors. α-Synuclein was widely distributed in the brain tumors showing neuronal differentiation. As a result, positive immunostaining for α-synuclein was observed in ganglioglioma, medulloblastoma, neuroblastoma, primitive neuroectodermal tumor, pineocytoma/pineoblastoma, and central neurocytoma. Compared with other neuronal markers, the positive ratio of α-synuclein was not as high as synaptophysin, microtubule-associacted protein 2, neuron-specific enolase and tau, but it was higher than neurofilament and chromogranin A. The expression of synaptophysin was diffusely observed in the cytoplasm, cellular processes and nucleus in tumors showing neuronal differentiation; however, the expression of α-synuclein was predominantly observed in the cytoplasm of the tumors as well as in the cellular processes. On the other hand, non-neuronal brain tumors such as astrocytic tumors or meningiomas were totally negative for α-synuclein. In conclusion, the appearance of an α-synuclein-positive structure was not limited to neurodegenerative diseases, but could also be detected in neoplastic cells showing neuronal differentiation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007419
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    Neuronal intranuclear hyaline inclusion disease with polyglutamine-immunoreactive inclusions (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 589-594 
    Details
    ISSN: 1432-0533
    Keywords: Key words Neuronal intranuclear inclusion ; Neurodegenerative diseases ; Polyglutamine ; Ubiquitin ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neuronal intranuclear hyaline inclusion disease (NIHID) is a group of neurodegenerative disorders characterized by the presence of intranuclear inclusions in neurons (NIs). We report here clinicopathological findings of a 25-year-old female patient who died after 13 years of a clinical course characterized by progressive gait disturbance and movement disorders. Histological examination revealed widespread NIs with neuronal loss in restricted regions; neuronal loss was severe in the subthalamic nucleus, internal pallidum, substantia nigra, Edinger-Westphal nucleus and Purkinje cell layer. Quantification of the NIs combined with a graded evaluation of neuronal loss revealed an overall tendency for more severe neuronal loss to be accompanied by a lower frequency of NIs. A morphological similarity to the nuclear inclusions recently identified in several CAG repeat diseases prompted us to examine the immunolocalization of ubiquitin and expanded polyglutamine stretches, which demonstrated the presence of ubiquitin at the periphery of most NIs. An expanded polyglutamine stretch was seen in the center of limited number of NIs. These findings indicate that abnormal fragments such as expanded polyglutamine regions are incorporated into the inclusion, aggregated in its center, and thereby metabolized by a ubiquitin-dependent proteolytic pathway. Although it remains to be elucidated how the formation of NIs is related to neuronal degeneration, our findings suggest that NIs are formed in the process of sequestering or degrading abnormal protein fragments and formation of NIs may not be immediately toxic to neurons.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010051166
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    Ubiquitinated filamentous inclusions in cerebellar dentate nucleus neurons in dentatorubral-pallidoluysian atrophy contain expanded polyglutamine stretches (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 615-618 
    Details
    ISSN: 1432-0533
    Keywords: Key words Dentatorubral-pallidoluysian atrophy ; Cerebellar dentate nucleus neuron ; Skein-like inclusion ; Polyglutamine ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We have recently reported that, in addition to the widespread occurrence of ubiquitinated neuronal intranuclear inclusions (NIIs), the restricted occurrence of ubiquitinated intracytoplasmic filamentous inclusions in the neurons of the cerebellar dentate nucleus (CDN) is a characteristic feature of dentatorubral-pallidoluysian atrophy (DRPLA). Interestingly, these neuronal intracytoplasmic filamentous inclusions (NIFIs) were morphologically indistinguishable from the skein-like inclusions (SLIs) described previously in the spinal anterior horn cells in amyotrophic lateral sclerosis (ALS). In the present study, we examined immunohistochemically the CDN in ten patients with clinicopathologically and genetically confirmed DRPLA and the spinal anterior horns in five patients with sporadic ALS, using a monoclonal antibody (1C2) directed against long polyglutamine stretches. In all of the patients with DRPLA, both the NIFIs and the NIIs were visualized clearly with 1C2. Conversely, in the patients with ALS all structures, including the SLIs, were completely negative. These findings indicate that in DRPLA, the NIFIs in the CDN are an alteration that is directly related to the causative gene abnormality (an expanded CAG repeat encoding polyglutamine) and that, from the molecular point of view, they are distinct from the SLIs in ALS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010051171
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    Ciaglia Blue Rhino: Ein weiterentwickeltes Verfahren der perkutanen Dilatationstracheotomie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 202-206 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Perkutane Dilatationstracheotomie ; Ciaglia Blue Rhino ; Komplikationen ; Key words Percutaneous dilatational tracheostomy ; Ciaglia Blue Rhino ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Objective: Elective tracheostomy has become an established treatment modality in modern intensive care medicine, and the number of percutaneously performed tracheostomies is steadily increasing. The Ciaglia Blue Rhino (CBR) represents another percutaneous technique in which the tracheostoma is formed by one-step dilation. Our study presents the technique itself and the early clinical experiences. Methods: In 20 adult patients on long-term ventilation, CBR was done. After puncture of the trachea in typical manner, dilation of the tracheostoma was achieved in one single step by means of a curved dilator with a special hydrophilic coating. Then, the tracheostomy tube was inserted over a curved loading dilator. Practicability and safety were determined as well as gas exchange during the procedure by means of arterial blood gas samples. Results: As a result of the dilator’s hydrophilic coating, dilation of the tracheostoma was rapidly achieved within 152±22 s, virtually free from resistance of the trachea or the cervical tissues. Complications such as bleeding, aspiration or postoperative infection of the stoma were not noted in any of our patients. Fractures of isolated tracheal cartilage rings were seen in 5 patients, however, no therapeutic intervention was necessary. In terms of perioperative gas exchange, pre- and postoperative levels of FiO2, PaO2, PaCO2 and the oxygenation index (PaO2/FiO2) did not change significantly. Conclusions: Based on our early clinical experience, Ciaglia Blue Rhino represents a new method that may combine the typical advantages of each of the other techniques for percutaneous tracheostomy (i.e. Ciaglia, Griggs, Fantoni) in one single technique. This method is distinguished by a high level of safety and practicability. However, further comparative trials need to be done before a definitive judgement can be made.
    Notes: Zusammenfassung Fragestellung: Die elektive Tracheotomie stellt in der modernen Intensivmedizin einen festen Bestandteil der Beatmungstherapie dar und wird zunehmend perkutan durchgeführt. Mit der Ciaglia Blue Rhino (CBR) steht nunmehr eine weitere perkutane Technik zur Verfügung, bei der zur Anlage des Tracheostomas nur noch ein einziger Dilatationsschritt erforderlich ist. Ziel der vorliegenden Untersuchung war es, die Technik der CBR und erste klinische Ergebnisse vorzustellen. Methodik: Bei 20 langzeitbeatmeten, erwachsenen Intensivpatienten wurde eine CBR durchgeführt. Nach Punktion der Trachea in typischer Weise erfolgt die Dilatation des Tracheostomas in einem Schritt mittels eines gebogenen Dilatators, der über eine spezielle hydrophile Beschichtung verfügt. Anschließend wird die Trachealkanüle über einen Führungsstab eingeführt. Neben Praktikabilität und Komplikationen der Technik wurde deren Einfluß auf den perioperativen Gasaustausch mittels Blutgasanalysen untersucht. Ergebnisse: Aufgrund der hydrophilen Beschichtung des Dilatators und der damit verbundenen nahezu widerstandslosen Bougierung gelang die Anlage des Tracheostomas im Mittel in 152±22 s. Akut interventionsbedürftige Komplikationen wie Blutungen, Aspiration oder eine postoperative Infektion des Tracheostomas wurden nicht beobachtet. Bei 5 Patienten kam es zu einer Fraktur einzelner Trachealspangen, die jedoch keine therapeutische Konsequenz hatte. Hinsichtlich des perioperativen Gasaustauschs ergaben sich keine Signifikanzen hinsichtlich der prä- und postoperativen Höhen von FiO2, paO2, paCO2 und des Oxygenierungsindex (paO2/FiO2). Schlussfolgerung: Die Ciaglia Blue Rhino-Technik könnte aufgrund dieser ersten klinischen Erfahrungen ein Verfahren darstellen, das die jeweiligen Vorteile der anderen perkutanen Tracheotomietechniken nach Ciaglia, Griggs und Fantoni in sich vereint. Diese weiterentwickelte Technik zeichnet sich durch hohe Praktikabilität und eine sehr rasche und sichere Durchführbarkeit aus. Zur endgültigen Bewertung dieses Verfahrens auch im Hinblick auf Spätkomplikationen müssen jedoch detaillierte Vergleichsstudien folgen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050815
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    Glial pathology in development of cerebellar dysplasia in the hereditary cerebellar vermis defect (CVD) rat (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 305-309 
    Details
    ISSN: 1432-0533
    Keywords: Key words Bergmann glia ; Cell migration ; Cerebellar ¶dysplasia ; Immunohistochemistry ; Mutant rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The cerebellar vermis defect (CVD) rat is a new neurological mutant characterized by a cerebellar vermis defect and dysplasia in the cerebellum, especially at the cerebellopontine junctions. In this study, the cytokinetics of glia in terms of the development of cerebellar dysplasia in the CVD rat was investigated using glial fibrillary acidic protein (GFAP) and vimentin immunohistochemistry. In the cerebellar hemispheres, dislocation of the Bergmann glia was observed from postnatal day 5 (P5) in lesions with abnormally aggregated external granule cells (EGCs). Rearranging Bergmann glia were often seen around the EGCs penetrating into the white matter. In the cerebellopontine junctional areas, Bergmann glia were induced after penetration of the Purkinje cells, identified with calbindin immunohistochemistry, and EGCs into the pons from P10. Bergmann fibers were frequently arranged perivascularly. In the clusters of Purkinje cells without EGC settlement in the pons, a small number of Bergmann fibers were observed and their alignment was completely disturbed. These findings suggest that morphological changes in the Bergmann glia depend on their contact with Purkinje cells, but that the orientation of their processes may be influenced by EGC settlement. These glial fibers in the CVD rat may play an important role in the aberrant migration of EGCs, resulting in the development of cerebellar dysplasia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007442
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    Simultaneous loss of hamartin and tuberin from the cerebrum, kidney and heart with tuberous sclerosis (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 503-510 
    Details
    ISSN: 1432-0533
    Keywords: Key words Hamartin ; Immunohistochemistry ; Tuberin ; Tuberous sclerosis ; Western blotting
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Tuberous sclerosis (TSC) is caused by a mutation in either the TSC1 or TSC2 gene. The clinical manifestations of mutations of the two genes are hardly distinguishable, for reasons as yet unknown. In this study, we examined the expression of the products of these genes, hamartin and tuberin, in control and TSC tissues. Western blotting disclosed that hamartin and tuberin are both abundant in the cerebral gray matter and that they have similar subcellular distributions and developmental patterns of expression. Immunohistochemical localizations of hamartin and tuberin were also similar, with high levels of expression being localized to the cerebral neurons and glial cells, renal uriniferous and collecting tubules, and cardiac muscles. In the cerebrum with TSC, both hamartin and tuberin were simultaneously reduced in the cortical tubers and subependymal giant cell astrocytomas, and from the normal-appearing cortex. The renal angiomyolipomas and cardiac rhabdomyomas also showed a loss of both the proteins. These results provide evidence for the co-localization and interaction of hamartin and tuberin in vivo, and suggest that a mutation in one TSC gene may secondarily affect the expression of the other in some TSC lesions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010051152
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    The formation of the chick ileal muscle layers as revealed by α-smooth muscle actin immunohistochemistry (2000)
    Springer
    Anatomy and embryology 201 (2000), S. 121-129 
    Details
    ISSN: 1432-0568
    Keywords: Key words α-Smooth muscle actin ; Chronological changes ; Smooth musculature ; Chick ; Ileum ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The genesis of intestinal smooth muscle layers was immunohistochemically investigated by use of an antibody to α-smooth muscle actin (α-SMA) in the developing chick ileum. Myoblast cells positive for α-SMA were already found in the presumptive circular muscle layer on E 8.5. On E 11.5 radially oriented muscle fibers were protruded from the outermost layer of the developing circular musculature and then formed a tuft-like aggregates. These radial muscle bundles were bent into an L-shape. The long distal extension of muscle bundles run parallel to the long axis of the ileal loop and developed into the longitudinal muscle layer. The obliquely oriented muscle fibers, locating at the intermuscular space of the muscularis propria, probably are to be considered a remnant of the short extension of radial muscle bundles. The muscularis mucosae was formed by the processes equivalent to the genesis of longitudinal muscle layer. On E 14.5 centripetally oriented muscle fibers emerged from the innermost layer of circular musculature. The long distal extension of centripetal fibers lay along the inner surface of developing circular musculature. On E 19.5 the longitudinal muscle layer of the muscularis mucosae was newly formed by separating from the circular musculature. The villous myoblast cells initially developed from the innermost layer of the muscularis mucosae on E 18.5, and were widely distributed in the lamina propria mucosae on E 20.5. Temporal and chronological pattern in expression of α-SMA was observed during the development of the chick intestinal smooth muscle. By E 14.5 the entire layer of the muscularis propria was intensely immunostained for α-SMA, but from E 15.5 onward the staining intensity gradually began to decrease from the outer half of the circular musculature. Finally, the immunoreactivity was localized in the inner layer of circular muscle and the longitudinal muscle layer. A possible functional role of this inner layer of circular muscle is discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008232
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    Die Larynxmaske bei Adenotonsillektomie bei Kindern Gefährliche Spielerei oder medizinischer Fortschritt? (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 706-712 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter AT ; TE ; Larynxmaske ; Technik ; Komplikationen ; Keywords Adenotomy ; Tonsillectomy ; Laryngeal mask ; Technique ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Anaesthesia both for adenotomy (AT) and for tonsillectomy (TE) frequently presents a challenge. On one hand, children scheduled for adenotomy often have upper airway infections and are thus at risk of laryngo- and bronchospasm; on the other hand the ENT surgeon and the anaesthetist have to share the “workspace” in the patient's mouth. Since the succinyl choline debate in the early 1990s, the question of the best muscle relaxant has gone hand in hand with that of the most appropriate means of securing the airway. The concept of the laryngeal mask as airway was initially greeted with scepticism. Following several years' use of the mask for this purpose in AT and TE in young children, we report our experience and summarise the literature on this topic. The laryngeal mask represents a safe alternative to intubation, provided there is close cooperation with the ENT surgeon.
    Notes: Zusammenfassung Die Narkosen zur Adenotomie, aber auch zur Tonsillektomie stellen für Anästhesisten immer wieder große Herausforderungen dar. Zum einen haben die Kinder, die zur Adenotomie anstehen, häufig Infekte der oberen Luftwege und sind damit laryngo- und bronchospasmusgefährdet, zum anderen müssen sich HNO-Arzt und Anästhesist den “Arbeitsraum” im Mund teilen. Seit der Succinylcholindebatte der frühen 90er-Jahre stellte sich mit der Frage nach dem geeigneten Muskelrelaxans die Frage nach der geeigneten Atemwegssicherung. Der Anwendung der Larynxmaske als Airway bei AT und TE wurde zunächst mit Skepsis begegnet. Nach langjähriger Anwendung der Larynxmaske zur Atemwegssicherung bei AT und TE im Kleinkindesalter wird hier nicht nur über Ergebnisse und langjährige Erfahrungen berichtet, sondern auch die Literatur zu diesem Thema zusammengefasst. Daraus ergibt sich, dass die Larynxmaske bei AT und TE eine sichere Alternative zur Intubation darstellt. Voraussetzung dazu ist jedoch eine gute Kooperation mit dem HNO-Arzt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070064
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    Pneumothorax bei der Vertikalen Infraklavikulären Blockade des Plexus brachialis Fallbericht einer seltenen Komplikation (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 901-904 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Vertikale Infraklavikuläre Blockade ; Pneumothorax ; Komplikation ; Plexus brachialis ; VIP ; Keywords Vertical infraclavicular blockade ; Pneumothorax ; Complications ; Brachial plexus ; VIP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract A 50 year old female patient received anaesthesia of the arm by the vertical infraclavicular blockade of the plexus brachialis (VIP). Postoperatively an ipsilateral pneumothorax occured complicated by pleural effusion and a contralateral bronchopneumonia, which resolved completely after treatment. The blockade of the plexus was performed correctly, failures in determining the correct point of needle insertion could be excluded. Therefore a pneumothorax has to be regarded as a specific complication of the VIP, which might occur despite correct technique, and requires that the patient be informed of this eventuality. Nevertheless, the VIP is an important method due to its high success rate concerning blockade of the musculocutaneous nerve and tolerance of tourniquet. The risk of a pneumothorax is about 0.2 to 0.7%.
    Notes: Zusammenfassung Bei einer 50-jährigen Patientin wurde im Rahmen einer elektiven Operation an der Hand die Anästhesie durch die Vertikale Infraklavikuläre Plexus-brachialis Blockade (VIP) nach Kilka durchgeführt. Postoperativ kam es zum Auftreten eines ipsilateralen Pneumothorax, welcher durch einen Pleuraerguss und eine kontralaterale Bronchopneumonie kompliziert wurde. Unter invasiver Behandlung der Patientin kam es bezüglich aller Komplikationen zur restitutio ad integrum. Die Durchführung der Anästhesie war lege artis entsprechend der Erstbeschreibung, Fehler bei der Bestimmung der Punktionsstelle konnten mit größtmöglicher Wahrscheinlichkeit ausgeschlossen werden. Ein Pneumothorax bei der Vertikalen Infraklavikulären Plexus-brachialis Blockade stellt auch bei korrekter Durchführung unter Vermeidung von beschriebenen Kardinalfehlern ein methodenspezifisches und somit aufklärungspflichtiges Risiko dar. Der VIP ist dennoch eine wichtige Ergänzung der herkömmlichen Methoden zur Blockade des Plexus brachialis, da er sich durch eine hohe Erfolgsrate speziell im Bereich des N. musculocutaneus und in der Toleranz eines Tourniquets auszeichnet. Nach den bisherigen Erfahrungen ist von einem Pneumothoraxrisiko von 0,2–0,7% auszugehen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070044
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    Kombinierte Anästhesie mit Epiduralkatheter Eine retrospektive Analyse des perioperativen Verlaufs bei Patienten mit radikalen Prostatektomien (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 949-959 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Kombinierte Anästhesie ; Thorakale Epiduralanästhesie ; Lumbale Epiduralanästhesie ; Prostatektomie ; Schmerztherapie ; Komplikationen ; Keywords Combined anaesthesia ; Thoracic epidural anaesthesia ; Lumbar epidural anaesthesia ; Prostatectomy ; Pain management ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. Patients were divided in those who received: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA)+GA or, 3. thoracic epidural anaesthesia (TEA)+GA. General anaesthesia was performed as balanced anaesthesia, and epidural administered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8–12 ml/h. In terms of intra- and postoperative numbers of tachycardic and hypertensive episodes, a reduced stress response was observed under epidural anaesthesia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointestinal motility was found earlier ([h] GA: 50.6±11.1/ LEA: 39.3±13.6/ TEA:33.8±13.0). Furthermore, a trend to rarer phases of postoperative vomiting and a significant decrease of in hospital stay of about one day ([d] GA: 12.4±5.8/ LEA: 11.1±3.1/ TEA: 11.5±3.8) was observed. The duration of personnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9±43.5/ LEA: 238.2±41.8/ TEA: 227.0±46.2), but ICU stay was shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.
    Notes: Zusamenfassung Patienten, die sich einer radikalen Prostatektomie (rPE) einschließlich retroperitonealer Lymphadenektomie (rLA) unterziehen, haben aufgrund ihres Alters und ihrer Begleiterkrankungen ein erhöhtes perioperativen Risiko. Ziel dieser Untersuchung war es, den intra- und postoperativen Verlauf der standardisierten Operation rPE+rLA unter verschiedenen Anästhesieregimen zu analysieren. Krankenakten von 433 Patienten, die sich zwischen 1994 und 1999 in unserer Einrichtung einer rPE+rLA unterzogen, wurden retrospektiv ausgewertet. Die Patienten wurden nach dem durchgeführten Anästhesieverfahren eingeteilt: 1. Allgemeinanästhesie (AA), 2. Kombination lumbale Epiduralanästhesie (LEA)+AA, 3. thorakale Epiduralanästhesie (TEA)+AA. Für die intra- und postoperative Katheteranalgesie wurden Bupivacain 0,25% oder Ropivacain 0,2%, 8–12 ml/h verwendet. Die Allgemeinanästhesie wurde als balancierte Anästhesie durchgeführt. Diese retrospektive Erhebung zeigt unter epiduraler Analgesie, gemessen an Tachykardien und hypertensiven Episoden, eine reduzierte intra- und postoperative Stressantwort, kürzere Extubationszeiten, früheres Wiedereinsetzen der gastrointestinalen Motilität ([h] AA: 50,6±11,1/ LEA: 39,3±13,6/ TEA:33,8±13,0), tendenziell selteneres Erbrechen und eine um einen Tag verkürzte Krankenhausverweildauer ([d] AA: 12,4±5,8/ LEA: 11,1±3,1/ TEA: 11,5±3,8). Dabei war unter TEA die Dauer der Anästhesiepräsenz im OP-Bereich vergleichbar mit AA ([min] AA: 222,9±43,5/ LEA: 238,2±41,8/ TEA: 227,0±46,2), und der Wachstationsaufenthalt verkürzt. Daneben war unter TEA die Anzahl der auffälligen postoperativen Thoraxröntgenbefunde reduziert. Zum Erreichen einer der TEA vergleichbaren Analgesie mussten unter LEA häufiger sensomotorische Blockaden, saO2-Abfälle und tendenziell eine höhere Anzahl kardialer Komplikationen in Kauf genommen werden. Gemessen an den von uns erhobenen Parametern stellt damit die Kombination einer Allgemeinanästhesie, insbesondere mit thorakaler Epiduralanalgesie ein sicheres und auch betriebswirtschaftlich effizientes anästhesiologisches Vorgehen bei radikalen Prostatektomien dar.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070030
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  • 87
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    Expression of major bone extracellular matrix proteins during embryonic osteogenesis in rat mandibles (2000)
    Springer
    Anatomy and embryology 202 (2000), S. 31-37 
    Details
    ISSN: 1432-0568
    Keywords: Key words Bone ; Calcification ; Type I collagen ; Noncollagenous proteins ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  It is not known how bone proteins appear in the matrix before and after calcification during embryonic osteogenesis. The present study was designed to investigate expressions of the five major bone extracellular matrix proteins – i.e. type I collagen, osteonectin, osteopontin, bone sialoprotein and osteocalcin – during osteogenesis in rat embryonic mandibles immunohistochemically, and their involvement in calcification demonstrated by von Kossa staining. Wistar rat embryos 14 to 18 days post coitum were used. Osteogenesis was not seen in 14-day rat embryonic mandibles. Type I collagen was localized in the uncalcifed bone matrix in 15-day mandibles, where no other bone proteins showed immunoreactivity. Osteonectin, osteopontin, bone sialoprotein and osteocalcin appeared almost simultaneously in the calcified bone matrix of 16-day mandibles and accumulated continuously in 18-day mandibles. The present study suggested that type I collagen constitutes the basic framework of the bone matrix upon which the noncollagenous proteins are oriented to lead to calcification, whereas the noncollagenous proteins are deposited simultaneously by osteoblasts and are involved in calcification cooperatively.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008242
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  • 88
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    SM5-1: a new monoclonal antibody which is highly sensitive and specific for melanocytic lesions (2000)
    Springer
    Archives of dermatological research 292 (2000), S. 583-589 
    Details
    ISSN: 1432-069X
    Keywords: Keywords Melanoma ; Immunohistochemistry ; SM5-1 ; HMB-45 ; S100
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Antibodies such as HMB-45 and anti-S100 protein have been widely used as markers of malignant melanoma despite evidence that HMB-45 has a sensitivity of only 67–93% and S100 is nonspecific for melanoma. Using a subtractive immunization protocol in a mouse model of human melanoma, we have generated several monoclonal antibodies with putative specificity for melanoma. After initial screenings, the antibody SM5-1 was chosen because of its intriguing reactivity with melanocytic tumors in both frozen and paraffin sections. The immunohistochemical staining of SM5-1 was studied in paraffin-embedded specimens of 401 melanomas (n = 401; 250 primary melanomas, 151 metastases), melanocytic nevi of the skin (n = 16), nonmelanocytic neoplasms (n = 84). The results were compared with HMB-45 and anti-S100 staining. All antibodies reacted with nevi and 97–99% with primary melanomas. Whereas both SM5-1 and anti-S100 stained 96% (146/151) of melanoma metastases, HMB-45 correctly identified only 83% (126/151). All HMB-45-negative metastases were positive for SM5-1. Whereas neither SM5-1 nor HMB-45 stained any of 84 specimens from 40 different nonmelanocytic neoplasms, anti-S100 was positive in 21/84 (25%). While the staining pattern of SM5-1 was mostly homogeneous, small tumor areas in some metastases remained unstained. Staining with SM5-1 was also observed in perivascular dendritic cells, in plasma cells, some myofibroblasts and the secretion of eccrine sweat glands. Nonactivated epidermal melanocytes, keratinocytes, endothelial cells, smooth muscle cells and peripheral nerves were all negative for SM5-1. These results suggest that SM5-1 is highly specific, as well as sensitive, for melanocytic lesions and is useful in the immunohistochemical evaluation of melanoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004030000186
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  • 89
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    Fatal rupture of the spleen caused by infiltration of T-cell lymphoma (2000)
    Springer
    Annals of hematology 79 (2000), S. 158-160 
    Details
    ISSN: 1432-0584
    Keywords: Key words Splenic rupture ; T-cell lymphoma ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Pathological or spontaneous rupture of the spleen has been described in a variety of diseases affecting the spleen, with infections being cited as the cause in most cases. In hematological malignancies it is a rare event, despite the frequent involvement of the spleen in these diseases. It has, however, been described in patients with acute and chronic leukemia, Hodgkin's disease, non-Hodgkin's lymphoma of B-cell origin, mycosis fungoides, and so-called histiocytic lymphoma. Here, we present a fatal case of splenic rupture caused by infiltration of a peripheral T-cell lymphoma, unspecified according to the REAL classification. The importance of a correct diagnosis and fast surgery is emphasized.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050572
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  • 90
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    The consequences of the mutual recognition of measurement standards for international metrology (2000)
    Springer
    Accreditation and quality assurance 5 (2000), S. 409-413 
    Details
    ISSN: 1432-0517
    Keywords: Key words Metrology ; Comparisons ; Chemistry ; Standards
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract  After stressing the importance in the modern world of accurate and reproducible measurements, the actions taken by the Bureau International des Poids et Mesures to set up, together with the regional metrology organizations, a series of key comparisons are described. They are the technical foundation of a mutual recognition of national measurement standards arrangement prepared in conjunction with the National Metrology Institutes (NMIs). This arrangement also includes the recognition of calibration and measurement certificates issued by these institutes. Then, the consequences of this arrangement for trade are described. The case of chemical analysis is illustrated by the application of the Kyoto protocol on the reduction of greenhouse gases. But the global workload to be taken up by the International Committee of Weights and Measures, its Consultative Committee for Amount of Substance and the NMIs is huge.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007690000228
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  • 91
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    Corneal infection of herpes simplex virus type 2 – induced neuronal apoptosis in the brain stem of mice with expression of tumor suppressor gene (p53) and transcription factors (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 647-653 
    Details
    ISSN: 1432-0533
    Keywords: Key words HSV ; Immunohistochemistry ; Apoptosis ; p53 ; Transcription factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To understand the mechanism of neuronal apoptosis induced by herpes simplex virus (HSV) infection in vivo, the distribution of viral antigen, the appearance of apoptotic bodies, and the expressions of the tumor suppressor gene p53 and several transcription factors such as c-fos, c-jun and NF-κB were examined immunohistochemically and histopathologically after corneal infection of mice with HSV type 2 strain 186. Five days after HSV infection, viral antigen was diffusely detected in the corneal epithelium, the trigeminal ganglion and the pars caudalis of the spinal trigeminal nucleus. Neuronal apoptosis was observed in the brain stem ipsilateral to the HSV-infected side with the immunoreactivities of c-fos, c-jun, NF-κB and p53. Dual-labeling immunohistochemical studies revealed that almost all of the viral antigen-positive neurons and glia in the brain stem also showed p53 immunoreactivity. On the other hand, no neuronal apoptosis but only with the expression of c-jun was found in the trigeminal ganglion. Our results suggest that the different expression of transcription factors between the brain stem and the trigeminal ganglion may influence the neuronal apoptosis induced by HSV infection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000240
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  • 92
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    Glial cell line-derived neurotrophic factor-like immunoreactivity in the cerebella of normal subjects and patients with multiple system atrophy (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 131-137 
    Details
    ISSN: 1432-0533
    Keywords: Key words Glial cell line-derived neurotrophic factor ; Human cerebellum ; Immunohistochemistry ; Multiple system atrophy ; Purkinje cells
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Glial cell line-derived neurotrophic factor (GDNF) has a trophic effect on various types of neurons, including cerebellar Purkinje cells. To investigate the role of GDNF in the human cerebellum, we examined the cerebella of eight control cases and eight patients with multiple system atrophy (MSA) immunohistochemically using a polyclonal anti-GDNF antibody. The antibody recognized a single band of approximately 34 kDa on Western blot analysis of human cerebellar homogenates. In the cerebella from normal subjects, the neuronal somata and dendrites of the Purkinje cells were immunostained intensely, as were some axons, including torpedoes, immunolabeled in the granular layer. Many axons and a few oligodendrocytes were also immunopositive in the white matter, and weak immunoreactivity was detected in the granule cells and neurons in the cerebellar nuclei. In the cerebella from patients with MSA, the general immunostaining pattern was similar to that observed in the normal subjects. Most of the remaining Purkinje cells showed strong immunoreactivity, and abundant GDNF-positive granular structures or dense arborizations of GDNF-positive dendrites were found in some areas of the molecular layer. These data suggest that GDNF may be mainly produced and localized in the Purkinje cells of the human cerebellum, even in patients with MSA, and that the functional impairment of the Purkinje cells of MSA patients might cause a focal accumulation of GDNF in the dendrites of some of the surviving Purkinje cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010050004
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  • 93
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    Class III β-tubulin immunoreactive intranuclear inclusions in human ependymomas and gangliogliomas (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 427-434 
    Details
    ISSN: 1432-0533
    Keywords: Key words Ependymoma ; Ganglioglioma ; Immunohistochemistry ; Intranuclear inclusions ; Tubulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We have observed intranuclear inclusion bodies immunoreactive for the cytoskeletal protein class III β tubulin (C3βT) in neurons and ependymal cells of post-mortem human brain. The relationship of these inclusions, detected by light microscopy, to the intranuclear rodlets described by the classical microscopists is unknown. The present study was conducted to determine whether these proteinaceous inclusions (C3βT-NIIs) exist in the neoplastic counterparts of these cell types. Immunohistochemical staining for C3βT revealed intensely stained, predominantly rod-shaped intranuclear inclusions in a variable proportion of tumor cells in five of ten ependymomas. In addition, C3βT-NIIs were encountered in less than 1% of neuronal cells in two of five gangliogliomas. This study represents the first report of tubulin-containing intranuclear inclusions in brain tumors. The functional significance of these inclusions in normal human brain and in cerebral neuroepithelial neoplasms remains to be determined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000191
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  • 94
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    Systemic hypothermia following spinal cord compression injury in the rat: an immunohistochemical study on MAP 2 with special reference to dendrite changes (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 546-552 
    Details
    ISSN: 1432-0533
    Keywords: Key words Hypothermia ; Immunohistochemistry ; Microtubule-associated protein 2 (MAP2) ; Rat ; Spinal cord injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Systemic hypothermia has been shown to exert neuroprotective effects in experimental ischemic CNS models caused by vascular occlusions. The present study addresses the question as to whether systemic hypothermia has similar neuroprotective qualities following severe spinal cord compression trauma using microtubule-associated protein 2 (MAP2) immunohistochemistry combined with the avidin-biotin-peroxidase complex method as marker to identify neuronal and dendritic lesions. Fifteen rats were randomized into three equally sized groups. One group sustained thoracic laminectomy, the others severe spinal cord compression trauma of the T8-9 segment. The control group contained laminectomized animals submitted to a hypothermic procedure in which the esophageal temperature was reduced from 38 °C to 30 °C. The two trauma groups were either submitted to the same hypothermic procedure or kept normothermic during the corresponding time. All animals were sacrificed 24 h following the surgical procedure. The MAP2 immunostaining in the normothermic trauma group indicated marked reductions in MAP2 antigen in the cranial and caudal peri-injury zones (T7 and T10, respectively). This reduction was much less pronounced in the hypothermic trauma group. In fact, the MAP2 antigen was present in almost equally sized areas in both the hypothermic groups independent of previous laminectomy alone or the addition of trauma. Our study thus indicates that hypothermia has a neuroprotective effect on dendrites of rat spinal cords subjected to compression trauma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000206
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  • 95
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    Ectopic expression of telencephalin in brains with holoprosencephaly (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 506-512 
    Details
    ISSN: 1432-0533
    Keywords: Key words Telencephalin ; Holoprosencephaly ; Cerebral cortex ; Glomerular structure ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Telencephalin (TLN), a telencephalon-specific glycoprotein, is exclusively expressed in neurons of the mammalian telencephalon. In the normally developing human brain, TLN immunoreactivity appeared and increased from 35 gestational weeks (GW) in the temporal cortex, and reached adult level at 5 months of postnatal age, being strong in the molecular layer, and weak in the external and internal granular layers. TLN expression corresponded with the development of neuronal dendrites and synapses. In brains with holoprosencephaly TLN immunoreactivity was already strong from as early as 28 GW. Staining was weak in the molecular layer, but strong in the external sparse and middle cellular layers in most cases. Notably, TLN was abundant in the glomerular structures in the internal pyramidal and multiform layers of fetal brains with alobar holoprosencephaly, which disappeared with increasing age. These results indicate premature and ectopic development of the dendrites and synaptic network in holoprosencephaly.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000184
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  • 96
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    Developmental expression of myotonic dystrophy protein kinase in brain and its relevance to clinical phenotype (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 513-520 
    Details
    ISSN: 1432-0533
    Keywords: Key words Myotonic dystrophy ; Myotonic dystrophy protein kinase ; Immunohistochemistry ; Human brain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the pathophysiologic role of myotonic dystrophy protein kinase (DMPK) in the brain in myotonic dystrophy (MD), the developmental characteristics of DMPK immunoreactivity in the central nervous system and its alteration with disease were studied. Eleven patients’ brain with MD (5 congenital form, 6 adult form) were examined by immunohistochemistry using a specific antibody against synthetic DMPK peptides, anti-peptide DM1, and compared with 30 control brains, including 16 age-matched controls. In controls, DM1-immunoreactive neurons appeared in the early fetal frontal cortex and cerebellar granule cell layer, persisting through 29 weeks of gestation and then disappearing. In contrast, immunoreactive neurons continued to persist in the cerebral cortex and cerebellar granule cell layer of MD patients. When we counted DM1-immunoreactive neurons, the increase over controls was greater in the congenital form of MD than in the adult form, and was greater in the cerebrum than in the cerebellum in both forms of MD. DM1 immunostaining was predominantly nuclear, mirroring Western blotting of subcellular fractions. Differences in DM1 expression related to development and to the two forms of MD may be closely related to the pathogenesis of mental retardation in this disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000216
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  • 97
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    Phenotypic modulation of smooth muscle cells in human cerebral aneurysmal walls (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 475-480 
    Details
    ISSN: 1432-0533
    Keywords: Key words Cerebral aneurysm ; Immunohistochemistry ; Smooth muscle cell ; Phenotypic modulation ; Myosin heavy chain isoforms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We used immunohistochemical methods to analyze the phenotypes of smooth muscle cells (SMCs) in human cerebral arteries and aneurysmal walls. Thirty-two aneurysmal walls were studied; 31 aneurysmal walls were resected at operation and 1 aneurysm was obtained at autopsy. Seven control arteries were obtained at autopsy. Semiserial sections were subjected to immunohistochemical staining with antibodies to α-smooth muscle actin (α-SMA), desmin and smooth muscle myosin heavy chain isoforms: SM1, SM2 and SMemb. In control cerebral arteries, SMCs in the media were strongly immunostained for α-SMA, desmin, SM1 and SM2; immunoreactivity for SMemb was faint or weakly positive. SMCs in both non-ruptured and ruptured aneurysmal walls showed no staining for desmin; the expression of α-SMA was well preserved. Compared with control cerebral arteries, in 4 of 11 non-ruptured aneurysmal walls, the staining intensity of SMCs for SMemb was clearly increased. In ruptured aneurysmal walls, the expression of SM2 was lower than in control cerebral arteries and non-ruptured aneurysmal walls. Our study suggests that the phenotype of SMCs in aneurysmal walls is different from the contractile type in the media of normal cerebral arteries, at least partially changing to the synthetic type in some non-ruptured aneurysms. SMCs in ruptured aneurysmal walls may have lost both phenotypes before rupture. Phenotypic modulation of SMCs in the aneurysmal walls appears to be related to a remodeling of the aneurysmal wall and to a rupture mechanism.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000220
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  • 98
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    Long-term expression of heme oxygenase-1 (HO-1, HSP-32) following focal cerebral infarctions and traumatic brain injury in humans (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 377-384 
    Details
    ISSN: 1432-0533
    Keywords: Key words Heme oxygenase-1 ; Heat shock protein-32 ; Traumatic brain injury ; Cerebral infarction ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Extracellular heme derived from hemoglobin following hemorrhage or released from dying cells induces the expression of heme oxygenase-1 (HO-1, HSP-32) which metabolizes heme to the gaseous mediator carbon monoxide (CO), iron (Fe) and biliverdin. Biliverdin and its product bilirubin are powerful antioxidants. Thus, expression of HO-1 is considered to be a protective mechanism against oxidative stress and has been described in microglia, astrocytes and neurons following distinct experimental models of pathological alterations to the brain such as subarachnoidal hemorrhage, ischemia and traumatic brain injury (TBI) and in human neurodegenerative diseases. We have now analyzed the expression of HO-1 in human brains following TBI (n = 28; survival times: few minutes up to 6 months) and focal cerebral infarctions (FCI; n = 17; survival time: 〈 1 day up to months) by ¶immunohistochemistry. Follwing TBI, accumulation of ¶HO-1+ microglia/macrophages at the hemorrhagic lesion was detected as early as 6 h post trauma and was still pronounced after 6 months. In contrast, after FCI HO-1+ microglia/macrophages accumulated within focal hemorrhages only and were absent in non-hemorrhagic regions. Further, HO-1 was weakly expressed in astrocytes in the perifocal penumbra. In contrast to experimental data derived from rat focal ischemia, these results indicate a prolonged HO-1 expression in humans after brain injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000202
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  • 99
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    Allograft inflammatory factor-1 defines a distinct subset of infiltrating macrophages/microglial cells in rat and human gliomas (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 673-680 
    Details
    ISSN: 1432-0533
    Keywords: Key words Cell culture ; Cell line ; Glioma ; Calcium-binding proteins ; Microglia enzymology ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Allograft inflammatory factor-1 (AIF-1) is a Ca2+-binding peptide that constitutes a potential modulator of macrophage activation and function during the immune response of the brain. Peptides termed microglia response factor-1 or ionized calcium-binding adaptor molecule-1 have been reported to be identical with AIF-1. We have investigated the expression of AIF-1 in the rat C6 glioblastoma and 9L gliosarcoma tumor models and additionally assessed AIF-1 expression in a diverse range of human astrocytomas by immunohistochemistry. AIF-1 was expressed by activated microglial cells and a subset of infiltrating macrophages in areas of infiltrative tumor growth and in compact tumor areas in both rat and human gliomas. Double-labeling experiments in rats and humans characterized the nature and the functional status of AIF-1+ cells. AIF-1 expression was detected in cells expressing major histocompatibility complex class II molecules and in a subset of activated macrophages/microglial cells. All MRP-8+ cells coexpressed AIF-1. In humans, there was a strong correlation of AIF-1-expressing activated macrophages/microglial cells with tumor malignancy (P 〈 0.0001). These results suggest that AIF-1 defines a distinct subset of tumor-associated activated macrophages/ microglial cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000233
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  • 100
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    Electronic Resource
    Amyloid in a multiple sclerosis lesion is clearly of Aλ type (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 709-711 
    Details
    ISSN: 1432-0533
    Keywords: Key words Multiple sclerosis ; Aλ amyloid ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In rare multiple sclerosis cases amyloid is deposited in demyelinated plaques. In one such case amyloid was examined immunohistochemically with a panel of antibodies directed against different amyloid types. The amyloid was classified as the Aλ type produced by a local monoclonal B cell population.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000244
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