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  • Electronic Resource  (165)
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  • 2000-2004  (165)
  • Apoptosis  (93)
  • Complications  (72)
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  • Electronic Resource  (165)
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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
    Pathologic significance of tumor progression in locally recurrent rectal cancer (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 775-781 
    Details
    ISSN: 1530-0358
    Keywords: Locally recurrent rectal cancer ; Survival ; Prognostic factor ; Angiogenesis ; Apoptosis ; PCNA labeling index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: It has recently been demonstrated that the tumor growth rate is a stronger determinant of survival than the extent of the growth in local recurrence of rectal cancer. We studied which factors controlled the tumor growth rate using modern immunohistochemical methods. METHODS: In 51 patients who underwent extended resection for this condition, paraffin-embedded specimens were examined for 1) tumor angiogenesis by CD31 staining and microvessel counting, 2) apoptosis by terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling staining, and 3) cellular proliferative activity using anti-proliferative cell nuclear antigen antibody. The results were compared with carcinoembryonic antigen doubling time and survival. RESULTS: The five-year survival rate was 20 percent. The postoperative carcinoembryonic antigen doubling time, which was the strongest predictor of survival, correlated highly with proliferative cell nuclear antigen labeling index, but did not correlate with the apoptotic index or microvessel counts. CONCLUSION: Our study shows that cancer cell proliferation rather than apoptosis or angiogenesis is a major determinant of tumor growth rate and survival in patients with locally recurrent rectal cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02238013
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  • 3
    Electronic Resource
    Electronic Resource
    Apoptosis and its regulation in flat-type early colorectal carcinoma (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. S23 
    Details
    ISSN: 1530-0358
    Keywords: Apoptosis ; Flat-type carcinoma ; Colorectal neoplasms ; p53 ; p21 (WAF1/CIP1) ; Bax
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to investigate the relationship among apoptotic cell death, proliferative activity, and the expression of apoptosis-regulating proteins (p53, p21 (WAF1/CIP1), and bax) in flat-type early colorectal carcinoma and to compare these factors with those in polypoid-type early colorectal carcinoma. METHODS: Formalin-fixed, paraffin-embedded tissues of 11 flat-type early colorectal carcinomas and 17 polypoid-type early carcinomas were studied. The histologic diagnosis was either well-differentiated adenocarcinoma or carcinoma in adenoma, and the depth of invasion was limited to mucosa or submucosa. Apoptotic cells were detected by terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling method, and proliferative activity was determined by Ki-67 immunohistochemistry using monoclonal antibody MIB-1. Apoptosis-regulating proteins were determined by immunohistochemistry using antibody DO-7 (p53), Cip1 (p21 (WAF1/CIP1)), and Bax (bax). RESULTS: There was no significant difference in terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling index between flat-type early colorectal carcinoma and polypoid-type early carcinoma, at 1.9vs. 1.1, respectively. In flat-type carcinoma terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling index in the p53 protein overexpression group was significantly smaller than that in the p53 protein-negative group (P〈0.05). The Ki-67 labeling index/terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling index ratio in the p53 protein overexpression group was significantly higher than that in the p53 protein-negative group (P〈0.05). In polypoid-type carcinoma, the terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling index and Ki67/terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling index ratio showed no significant difference between the p53 protein overexpression group and p53 protein-negative group. CONCLUSION: p53-dependent apoptosis may contribute to the development of flat-type early colorectal carcinoma. Apoptosis and its regulation in flat-type early colorectal carcinoma may differ from those in polypoid-type carcinoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237222
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  • 4
    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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  • 5
    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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  • 6
    Electronic Resource
    Electronic Resource
    Angiogenesis, proliferation, and apoptosis in anal high-grade squamous intraepithelial lesions (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 346-352 
    Details
    ISSN: 1530-0358
    Keywords: Anus ; High-grade squamous intraepithelial lesion ; Carcinoma ; Proliferation ; Apoptosis ; Microvessel density
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Management of anal high-grade squamous intraepithelial lesions is controversial. Anal and cervical high-grade squamous intraepithelial lesions are similar in that they occur in transitional squamous epithelium, are associated with human papilloma virus infection, and have increased incidence in the immunocompromised population. Ablation of cervical high-grade squamous intraepithelial lesions is preferred, but similar ablation or excision of anal high-grade squamous intraepithelial lesions may compromise bowel control; thus, there is a need to define the malignant potential of anal high-grade squamous intraepithelial lesions. METHODS: We analyzed 50 paraffin sections of normal anoderm, anal low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and anal squamous-cell carcinoma. Microvessels were detected immunohistochemically with von Willebrand factor and counted manually along the epithelial-stromal junction. Proliferation and apoptosis were determined in the epithelial cells with MIB-1 antibody immunostaining and the terminal deoxynucleotidyl transferase-mediated digoxigenin-11-dUTP nick end labeling, respectively. RESULTS: Microvascular density was significantly greater in anal high-grade squamous intraepithelial lesions (mean, 0.50 vessels/cm)vs. normal anoderm (mean, 0.21 vessels/cm;P=0.0017, Mann-WhitneyU test). The proliferative percentages were greater in low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and squamous-cell carcinoma (mean, 20.4, 21.8, and 23.6 percent)vs. normal anoderm (mean, 14.4 percent), although not significantly (P=0.06, Kruskal-Wallis statistic). Although the mean proliferative proportions were similar in low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions, the apoptotic proportion was lower for high-grade squamous intraepithelial lesions than low-grade squamous intraepithelial lesions (10.13vs. 19.96 percent, respectively;P=NS, Mann-WhitneyU test). CONCLUSIONS: Angiogenesis, increased proliferation, and decreased apoptosis occur in anal high-grade squamous intraepithelial lesions as they do in the cervix before the development of malignancy. These biologic markers support the importance of anal high-grade squamous intraepithelial lesions as a potential premalignant lesion warranting surgical intervention.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02258300
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  • 7
    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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  • 8
    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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  • 9
    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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  • 10
    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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  • 11
    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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  • 12
    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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  • 13
    Electronic Resource
    Electronic Resource
    Apoptosis in rectal cancer (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1227-1236 
    Details
    ISSN: 1530-0358
    Keywords: Rectal cancer ; Apoptosis ; p53 ; bcl-2 ; Prognosis ; Recurrence ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to evaluate the prognostic value of the apoptotic index for recurrence and disease-free survival after curative surgery for rectal cancer, particularly in relation to clinicopathologic variables, p53− and bcl-2 expression. METHODS: Formalin-fixed, paraffin-embedded tissue samples of rectal carcinomas resected curatively within a five-year period were used (N=160). Apoptotic cells with fragmented DNA were detected by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphatase-biotin nick-end-labeling method. The ratio of apoptotic tumor cells (in percent) was classified into low apoptotic index (less than 10 percent) and high apoptotic index (10 percent or more). Immunohistochemical analysis was performed using monoclonal antibodies (DO-1 for p53 and clone 124 for bcl-2). Statistics included univariate and multivariate analysis, and survival was calculated using the Kaplan-Meier method. RESULTS: Seventy-five percent of tumors showed a low apoptotic index, and 25 percent had a high apoptotic index. No correlation was found between apoptotic index and International Union Against Cancer stage (P〉0.05). However, significant correlations were documented with histologic differentiation (mean apoptotic index, 5.74 percent in moderatelyvs. 3.98 percent in poorly differentiated carcinomas; P=0.0173), lymph node involvement (mean apoptotic index, 6.11 percent in pN1vs. 3.72 percent in pN2; P=0.0074), p53 status (mean apoptotic index, 6.26 percent in p53−vs. 4.42 percent in p53+; P=0.0085), and bcl-2 expression (mean apoptotic index, 5.13 percent in bcl-2−vs. 6.51 percent in bcl-2+; P=0.0418). Tumors of the lower rectum had a lower apoptotic index than those of the upper rectum (P=0.0277). Neither univariate nor multivariate analysis assessed apoptotic index as predictor of prognosis: Recurrence rates did not differ between tumors related to apoptotic index (22 percent with low apoptotic indexvs. 15 percent with high apoptotic index; P〉0.05), and no significant differences were found regarding survival (P〉0.05). On multivariate analysis, International Union Against Cancer stage (P=0.0002), p53 (P=0.0002), gender (P=0.0136), and bcl-2 (P=0.0243) were independent predictors of recurrence. These variables, except for bcl-2, were also independently related to disease-free survival. CONCLUSIONS: Reflecting tumor biology, apoptotic index as single variable showed no prognostic significance, whereas p53 was an independent predictor for both recurrence and survival, and bcl-2 was independently related to recurrence, but not to survival. Clinically, International Union Against Cancer stage and gender were independent prognostic factors after curative surgery for rectal cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237426
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  • 14
    Electronic Resource
    Electronic Resource
    Prognostic Significance of Fas and Fas Ligand System-Associated Apoptosis in Gastric Cancer (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 750-757 
    Details
    ISSN: 1534-4681
    Keywords: Gastric cancer ; Apoptosis ; Fas ; Fas ligand ; Cytotoxic T lymphocyte.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Previous studies indicate that gastric carcinomas express Fas ligand and downregulate Fas to escape from the host immune attack; however, the prognostic importance of Fas/FasL expression in this tumor is yet to be evaluated. Methods: Specimens from 87 gastric carcinoma patients of different stages treated in a defined period with curative intent were evaluated for apoptosis, Fas, FasL, and CD8 expression using an immunohistochemical method. Results: The percentage of terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive apoptotic cells expressed as apoptotic index (AI) was higher in 43 patients when the cut-off value was set at the median value. There were no significant correlations between AI and clinicopathologic parameters. Thirty-nine patients showed a high number of CD81 cells within cancer nests. Positive FasL and Fas expression was seen in 53 and 72 patients, respectively. CD8 and FasL expressions were related only to patients’ age. Fas expression had significant correlations with tumor invasion and Lauren classification. There were significant direct correlations between AI and number of nest CD81 cells and between AI and grade of Fas expression. Apoptotic index, pT stage, CD8 expression, and Fas expression were identified as independent prognostic factors. Conclusions: Spontaneous apoptosis in gastric carcinoma may be an independent prognosticator for survival and is significantly influenced by tumor Fas expression and number of nest CD81 cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0750-1
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  • 15
    Electronic Resource
    Electronic Resource
    A model chemosensitivity test examining apoptosis in small specimens of gastric cancer (2000)
    Springer
    Gastric cancer 3 (2000), S. 39-44 
    Details
    ISSN: 1436-3305
    Keywords: Key words Chemosensitivity ; Apoptosis ; TUNEL ; Gastric cancer ; Small specimen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Because chemosensitivity tests usually require a large amount of tissue, they are not used routinely in patients with unresectable gastric cancer. The aim of this study was to investigate whether apoptosis can be used as a sensitivity assay for chemosensitivity in small gastric cancer specimens. Methods. Apoptosis, detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick labeling (TUNEL), was investigated in small specimens of the MKN-1, MKN-45, and TMK-1 human gastric cancer cell lines as a marker of chemosensitivity following exposure to antineoplastic agents. Results. Doxorubicin (DXR), SN-38 (active metabolite of irinotecan), and paclitaxel (Taxol) induced DNA fragmentation in MKN-45 and TMK-1 cells, but not in MKN-1. In contrast, neither 5-fluorouracil (5-FU) nor cisplatin (CDDP) induced DNA fragmentation in any of the three cell lines. Small pieces cut from tumors implanted in nude mice were exposed to the antineoplastic agents in culture medium for 24 h, and the percentage of TUNEL-positive cancer cells (TUNEL positivity) was examined. TUNEL positivity in all three cancers increased after exposure to DXR, SN-38, and Taxol, but not after exposure to CDDP or 5-FU. MKN-45 showed the highest TUNEL positivity with SN-38 and Taxol, and TMK-1 TUNEL positivity was highest with DXR. MKN-45 and TMK-1 were the most sensitive to these three antineoplastic agents in vitro, while MKN-1, with the lowest TUNEL positivity, was the least sensitive to these three antineoplastic agents. TUNEL positivity after exposure to Taxol correlated with the antitumor effects of this compound in an animal model. Conclusion. These results suggest that, in small gastric cancer specimens where apoptosis is implicated, TUNEL positivity may be applicable to a chemosensitivity test.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00011688
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  • 16
    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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  • 17
    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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  • 18
    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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  • 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
    Morphogenesis of nonpolypoid colorectal adenomas and early carcinomas assessed by cell proliferation and apoptosis (2000)
    Springer
    Virchows Archiv 437 (2000), S. 17-24 
    Details
    ISSN: 1432-2307
    Keywords: Key words Colon ; Nonpolypoid adenoma ; Apoptosis ; Proliferation ; Morphogenesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Nonpolypoid neoplasms, as well as ordinary polypoid tumours, are occasionally found in the colorectum. To clarify whether cell kinetic status affects the macroscopic morphology of colorectal neoplasms, we investigated proliferative indices (PI), apoptotic indices (AI), and the expression of apoptosis-related gene products. We examined 110 colorectal neoplasms comprised of 36 polypoid, 38 flat elevated and 36 depressed tumours. According to WHO’s criteria these tumours consisted of 61 adenomas with low grade dysplasia (LGD), 30 adenomas with high grade dysplasia (HGD) and 19 carcinomas with submucosal invasion. Apoptotic cells were detected by TUNEL staining. Proliferating cells and apoptosis-related gene products were assessed by immunohistochemistry for Ki-67, p53, Bcl-2, and Bax antigens. AI were closely associated with macroscopic morphology in adenomas but not in carcinomas. PI were relatively constant among the three macroscopic types in adenomas and carcinomas. Median AI values of polypoid, flat elevated and depressed tumours were 1.8%, 2.1% and 4.6% for adenomas with LGD, 0.8%, 2.4% and 6.2% for adenomas with HGD and 2.9%, 4.0% and 3.6% for carcinomas, respectively. Overall PI were significantly higher in carcinomas than in adenomas with LGD, whereas AI were not different. Although the incidence of expression was significantly higher in carcinomas for p53 and in adenomas for Bcl-2 than the others, the expression of apoptosis-related gene products (p53, Bcl-2 and Bax) was similar among polypoid, flat elevated and depressed tumours. Macroscopic morphology of colorectal adenomas is determined by the apoptosis not by proliferation, and high apoptosis found in depressed adenomas implies their low net growth.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000198
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  • 21
    Electronic Resource
    Electronic Resource
    Regulation of proliferation and apoptosis in sporadic and hereditary medullary thyroid carcinomas and their putative precursor lesions (2000)
    Springer
    Virchows Archiv 437 (2000), S. 256-263 
    Details
    ISSN: 1432-2307
    Keywords: Keywords Medullary thyroid carcinoma ; MEN2 ; Proliferation ; Apoptosis ; bcl ; p53
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  C-cell hyperplasia (CCH) and medullary thyroid carcinoma (MTC) in patients affected by germline mutations of the RET oncogene represent an exceptional opportunity to study the regulation of proliferation and apoptosis during tumour initiation and progression. In 56 specimens [CCH, n=1; MTC with CCH, n=26; MTC, n=20; lymph-node metastasis (LNM), n=9] from 46 patients [multiple endocrine neoplasia type 2a (MEN2a), n=24; MEN2b, n=2; familiar MTC (FMTC), n=4; sporadic MTC, n=16] and 3 cases of non-neoplastic CCH, proliferation activity (MIB1), the rate of apoptosis [dUTP nick end labelling (TUNEL)] and expression of p53, bcl-2, bcl-x and bax were investigated and compared with clinical data. In MEN-associated CCH and small MTC, bcl-2 was strongly expressed, bcl-x was moderately expressed and bax was only weakly expressed. Advanced tumours and LNM did show a more heterogeneous bcl-2 staining accompanied by an increased bax expression and accelerated proliferation. The rate of apoptosis was extremely low in all investigated tumours. P53 was detectable in three patients with rapidly growing and extensively metastasising MTC. No somatic p53 mutations were found. Hereditary MTC with germline RET mutations at codon 918 (MEN2b) and codon 634 revealed a bias towards a higher proliferation activity at a younger age and are more frequently accompanied by LNM. CCH and MTC are characterised with a preponderance of bcl-2 as a factor blocking the programmed cell death. While MTC, in general, is a slowly growing tumour, a minority of tumours do progress rapidly with high proliferation. The factors leading to an accelerated tumour progression do not seem to take their effect via the regulation of apoptosis. Certain alterations of RET are supposed to have a direct or indirect implication on proliferation and, because of this, an effect on the clinical course.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000233
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  • 22
    Electronic Resource
    Electronic Resource
    Effects of genistein and synergistic action in combination with eicosapentaenoic acid on the growth of breast cancer cell lines (2000)
    Springer
    Journal of cancer research and clinical oncology 126 (2000), S. 448-454 
    Details
    ISSN: 1432-1335
    Keywords: Key words Genistein ; Eicosapentaenoic acid ; Apoptosis ; Bax ; Bcl-xL ; Caspase-3
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Genistein, a prominent isoflavone in soy products, produced dose- and time-dependent in vitro growth inhibition at high concentrations (at least 185 μM) with an IC50 of 7.0–274.2 μM after 72 h incubation in four breast cancer cell lines (DD-762, Sm-MT, MCF-7 and MDA-MB-231) and one breast epithelial cell line (HBL-100) of human and animal origin; it stimulated estrogen-receptor-positive MCF-7 cells at low concentrations (3.7 nM–37 μM). Genistein-exposed cells underwent apoptosis, confirmed by G2/M arrest followed by the appearance of a sub-G1 fraction in cell-cycle progression, and by a characteristic cell ultrastructure. The apoptosis cascade was due to up-regulation of Bax protein, down-regulation of Bcl-XL protein, and activation of caspase-3. Genistein acted in synergism with eicosapentaenoic acid (EPA), a fish oil component, on human breast cancer MCF-7 cells (genistein 〉 93.2 μM and EPA 〉 210.9 μM) and on MDA-MB-231 cells (genistein 〉 176.1 μM and EPA 〉 609.3 μM). Dietary intake of genistein in combination with EPA may be beneficial for breast cancer control.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050012
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  • 23
    Electronic Resource
    Electronic Resource
    Expression of the angiogenic factor thymidine phosphorylase in human astrocytic tumors (2000)
    Springer
    Journal of cancer research and clinical oncology 126 (2000), S. 145-152 
    Details
    ISSN: 1432-1335
    Keywords: Key words Angiogenesis ; Apoptosis ; Glioma ; Thymidine phosphorylase ; Vascular endothelial growth factor ; AbbreviationsTP thymidine phosphorylase ; GBM glioblastoma ; AA anaplastic astrocytoma ; LGA low-grade astrocytoma ; VEGF vascular endothelial growth factor ; RT-PCR reverse transcriptase/polymerase chain reaction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Thymidine phosphorylase (TP) has been implicated as a potent angiogenic factor and a prognostic factor in various human solid tumors. We investigated the expression of TP in a series of human astrocytic tumors using immunohistochemistry, enzyme-linked immunosorbent assay, and reverse transcriptase/polymerase chain reaction (RT-PCR) analysis. A total of 63 astrocytic tumors [27 glioblastomas (GBM), 19 anaplastic astrocytomas (AA), 17 low-grade astrocytomas (LGA)] and 5 normal brain tissues were immunohistochemically stained with antibodies to TP, vascular endothelial growth factor (VEGF), p53, MIB-1, and factor-VIII-related antigen. They were also evaluated for the degree of apoptosis by a ApopTag kit. Ten tumors (5 GBM, 2 AA, 3 LGA) and 3 normal brain tissues were evaluated for their expression of VEGF and TP by RT-PCR analysis. TP was constantly localized in the cytoplasm of astrocytic tumor cells, less intensely in the cytoplasm of vascular endothelial cells, but not in the normal brain. Some of the TP-positive cells were of macrophage origin, but most positive cells were the tumor cells themselves. Vascular density, MIB-1 positivity, p53 positivity, VEGF expression, and the apoptotic index were significantly higher in the TP-positive tumors than in TP-negative tumors. There was a significant correlation between TP and VEGF mRNA expression. In a limited number of glioblastoma cases, the apoptotic index was significantly higher in TP-positive glioblastomas than in TP-negative glioblastomas. In human astrocytic tumors, TP was expressed in the tumor, macrophage, and endothelial cells. TP was a potent angiogenic factor closely associated with cell proliferation and tumor apoptosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050024
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  • 24
    Electronic Resource
    Electronic Resource
    Cycloprodigiosin hydrochloride, a H+/Cl− symporter, induces apoptosis in human breast cancer cell lines (2000)
    Springer
    Journal of cancer research and clinical oncology 126 (2000), S. 191-197 
    Details
    ISSN: 1432-1335
    Keywords: Key words Cycloprodigiosin hydrochloride ; Breast cancer ; Apoptosis ; Intracellular acidification ; Bcl-2
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of cycloprodigiosin hydrochloride (cPrG · HCl), a H+/Cl− symporter, on five human breast cancer cell lines (KPL-1, T-47D, MCF-7, MKL-F, and MDA-MB-231), a human breast epithelial cell line (HBL-100), and a human fibroblast cell line (WI-38–40) was examined. cPrG · HCl inhibited the growth of all five breast cancer cell lines (IC50: 0.46–0.62 μM) and slightly inhibited HBL-100 and WI-38–40 cell growth (IC50: 1.75 μM and 2.26 μM respectively). cPrG · HCl treatment in KPL-1 cells increased the pH of acidic organelles, decreased intracellular pH, and caused apoptosis, which was confirmed by the appearance of a sub-G1 population by flow cytometry and DNA fragmentation. In addition, cPrG · HCl-induced apoptosis was strongly suppressed by imidazole, a cell-permeable base, suggesting that intracellular acidification was essential for the apoptosis. Further, cPrG · HCl treatment up-regulated Bax and Bak expression, down-regulated Bcl-2 expression, and activated caspase-3. Therefore, the intracellular acidification by cPrG · HCl treatment suppressed the growth of human breast cancer cell lines by inducing apoptosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050032
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  • 25
    Electronic Resource
    Electronic Resource
    Cell-cycle arrest and p53-independent induction of apoptosis in vitro by the new anticancer drugs 5-FdUrd-P-FdCydOct and dCydPam-P-FdUrd in DU-145 human prostate cancer cells (2000)
    Springer
    Journal of cancer research and clinical oncology 126 (2000), S. 247-256 
    Details
    ISSN: 1432-1335
    Keywords: Key words 5-Fluorodeoxyuridine ; Heterodinucleoside dimers ; Prodrugs ; Prostate cancer ; Cytotoxicity ; Cell cycle ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Purpose: Current therapies have limited impact on the progression of metastatic hormone-refractory prostate cancer. Therefore, we investigated the utility of new heterodinucleoside phosphate dimers of 5-fluorodeoxyuridine (5-FdUrd) in p53-mutated and androgen-independent DU-145 human prostate tumour cells. Methods: The effects of the dimers were assessed in vitro by a cell proliferation assay for cytotoxicity, flow cytometry for cell cycle distribution, confocal laser scanning microscopy for the detection of apoptotic bodies, poly(ADP-ribose) polymerase cleavage for caspase 3 activity and by a thymidylate synthetase assay. Results: The new dimers N 4-palmitoyl-2′-deoxycytidylyl-(3′→5′)-5-fluoro-2′-deoxyuridine (dCydPam-P-FdUrd) and 2′-deoxy-5-fluorouridylyl-(3′→5′)-2′-deoxy-5-fluoro-N 4-octadecylcytidine (5-FdUrd-P-FdCydOct) caused marked cytotoxicity with IC50 values of 3–4 μM. 5-FdUrd-P-FdCydOct at 200 μM was capable of eradicating 100% of tumour cells whereas 10% of the cells were resistant to 5-FdUrd. Cytotoxicity was caused by a dramatic S-phase arrest, resulting in an increase of this cell population from 34% to 85% with 5-FdUrd-P-FdCydOct and to 81% with dCydPam-P-FdUrd. S-phase arrest was followed by apoptosis, as shown by 85% of the cells staining positive for Apo 2.7 antibody, a six- to eight-fold increased caspase 3 activity and DNA fragmentation. Thymidylate synthase activity was inhibited by 50% at 0.6–0.7 μM dimer concentration. The dimers were hydrolysed in vitro by phosphodiesterase I and human serum to the corresponding nucleosides and nucleoside monophosphates. Conclusions: The new dimers dCydPam-P-FdUrd and 5-FdUrd-P-FdCydOct are effective prodrugs of 5-FdUrd and have potential value for the treatment of p53-mutated and hormone-independent human prostate carcinomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050339
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  • 26
    Electronic Resource
    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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  • 27
    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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  • 28
    Electronic Resource
    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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  • 29
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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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050667
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  • 30
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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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  • 31
    Electronic Resource
    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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  • 32
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    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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  • 33
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    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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  • 34
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    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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  • 35
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    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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  • 36
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    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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  • 37
    Electronic Resource
    Electronic Resource
    Apoptose bei multipler Sklerose Ätiopathogenetische Relevanz und Perspektiven für neue therapeutische Strategien (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 767-773 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Multiple Sklerose ; Apoptose ; Immunpathogenese ; CD95 ; TNF ; Keywords Multiple sclerosis ; Apoptosis ; Immunopathogenesis ; CD95 ; TNF
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Apoptosis, or programmed cell death, is a physiological cell suicide program mainly leading to selective elimination of useless cells. This mechanism is important for the homeostasis of the immune system and presumably plays a two-sided role in the pathogenesis of multiple sclerosis (MS). On the one hand, evidence has been provided that impaired apoptosis might result in increased numbers or persistence of activated myelin-specific T cells, thus inducing the pathophysiologic processes in MS. On the other hand, local tissue damage might involve apoptosis of glial and neuronal cells and lead to the clinical symptoms. Here, an overview is presented on the current knowledge of the role of apoptosis in the pathogenesis of MS, and implications for related therapeutic strategies are discussed.
    Notes: Zusammenfassung Apoptose, auch programmierter Zelltod genannt, stellt einen physiologischen Prozess zur selektiven Eliminierung vor allem von unerwünschten körpereigenen Zellen dar. Dieser für die Homöostase des Immunsystems wichtige Mechanismus nimmt wahrscheinlich eine ambivalente Schlüsselrolle in der Ätiopathogenese der multiplen Sklerose (MS) ein. So existieren Hinweise dafür, dass bei der MS eine eingeschränkte Apoptose zur pathologischen Existenz und Persistenz aktivierter myelinspezifischer T-Zellen führt, die wiederum für die charakteristische intrazerebrale Entzündung verantwortlich gemacht werden. Gleichzeitig deuten aktuelle Arbeiten aber darauf hin, dass auf der Endstrecke der entzündlichen Reaktion der apoptotische Untergang von Glia- und evtl. auch Nervenzellen zur Gewebeschädigung und somit entscheidend zur klinischen Symptomatik beitragen. Ziel dieser Übersicht ist die Zusammenstellung der bislang gewonnenen Erkenntnisse zur Bedeutung von Apoptose für die Pathogenese der MS und eines Ausblicks auf mögliche apoptoseorientierte Therapiestrategien.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050664
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  • 38
    Electronic Resource
    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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  • 39
    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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  • 40
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    Electronic Resource
    Molekulargenetische und zellbiologische Grundlagen der Entstehung von malignen Tumoren (2000)
    Springer
    Der Urologe 39 (2000), S. 214-221 
    Details
    ISSN: 1433-0563
    Keywords: Schlüsselwörter Krebs ; Karzinogenese ; Zellzyklus ; Protoonkogene ; Tumorsupressorgene ; DNA-Reparaturgene ; Apoptose ; Telomere ; Key words Multi-step carcinogenesis ; Cell cycle ; Proto-oncogene ; Tumor suppressor gene ; DNA repair gene ; Apoptosis ; Telomeres
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The development of cancer is one of the most intensively studied areas of medical research resulting in an immense quantity of data. Therefore, the purpose of this article is to give an overview of the basic principles of cancer development. Key words such as multi-step carcinogenesis, cell cycle, proto-oncogene, tumor suppressor gene, DNA repair gene, apoptosis and telomeres are explained and described in examples. This paper aims to connect recent information of molecular and cellular biology in an overview of cancer origin and development.
    Notes: Zusammenfassung Die Entstehung von Tumoren und die Entwicklung von entsprechenden Modellen gehört zu den sehr intensiv untersuchten Fragestellungen medizinischer Forschung mit einer schier unerschöpflichen Datenflut. Ziel dieses Artikels ist daher die möglichst anschauliche und daher sicher vereinfachende Darstellung grundlegender Prinzipien der Krebsentstehung. Es werden Begriffe wie Mehrschrittkarzinogenese, Zellzyklus, Protoonkogene, Tumorsupressorgene, DNA-Reparaturgene, Apoptose und Telomere in Zusammenhang gebracht und anhand von Beispielen erklärt. Dieser Artikel soll damit zum Verständnis der Zusammenhänge der Molekular- und Zellbiologie bei der Krebsentstehung beitragen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001200050344
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  • 41
    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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  • 42
    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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    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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  • 44
    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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  • 45
    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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  • 46
    Electronic Resource
    Electronic Resource
    Glycine attenuates apoptotic cell death in uranyl acetate-induced acute renal failure in rats (2000)
    Springer
    Clinical and experimental nephrology 4 (2000), S. 24-28 
    Details
    ISSN: 1437-7799
    Keywords: Key words Uranyl acetate ; ARF ; Glycine ; Apoptosis ; Tubular damage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Although uranyl acetate (UA) is known to induce apoptosis in renal tubular cells, the pathophysiological role of apoptotic cell death in UA-induced acute renal failure (ARF) is not clear. In this study, we examined whether glycine, which is known to provide protection against nephrotoxic acute renal failure, attenuated tubular damage in UA-induced ARF in rats, and, if so, whether the attenuation of tubular damage was associated with reduced apoptotic cell death. Methods. Sprague-Dawley rats were allocated to three groups; normal controls, UA-treated, and UA plus glycine-treated. Acute renal failure was induced by the intravenous injection of UA (5 mg/kg). UA plus glycine-treated rats were given glycine at 1 g/kg, i.v. over 3 min at the same time as the UA injection. Serum creatinine concentration (Scr) and tubular damage score were examined 5 days after UA administration. Apoptosis was evaluated by counting the number of terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)-positive cells in the outer stripe of the outer medulla. Results. Glycine significantly decreased the UA-induced increases in Scr (3.73 ± 0.31 vs 2.74 ± 0.11 mg/dl; P 〈 0.05) and the tubular damage score (3.83 ± 0.13 vs 2.58 ± 0.01; P 〈 0.01). UA significantly increased the number of TUNEL-positive cells in the outer stripe of the outer medulla (0.16 ± 0.04 vs 7.45 ± 0.46/high power field at ×400 magnification; P 〈 0.01 vs normal control value). Glycine infusion significantly lessened the number of TUNEL-positive cells (5.84 ± 0.31/ high power field at ×400 magnification; P 〈 0.01 vs UA-treated rats). A significant correlation was found between the number of TUNEL-positive cells and the tubular damage score (r = 0.93; P 〈 0.01). Conclusion. Glycine ameliorated the severity of UA-induced ARF and the degree of apoptotic cell death. This finding suggested that the protective effect of glycine in UA-induced ARF may be mediated, at least in part, through a reduction of apoptosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101570050057
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  • 47
    Electronic Resource
    Electronic Resource
    The contribution of the adriamycin-induced rat model of the VATER association to our understanding of congenital abnormalities and their embryogenesis (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 465-472 
    Details
    ISSN: 1437-9813
    Keywords: Key words Adriamycin ; Apoptosis ; Embryogenesis ; Esophageal atresia ; Notochord ; VATER association
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The adriamycin-induced rat model of the VATER association has provided a means of studying the morphogenesis of a variety of major congenital structural abnormalities similar to those seen in humans with the VATER association. Most interest has been centered on the foregut, where the model has clarified some aspects of the development of esophageal atresia (EA), tracheal agenesis, and other communicating bronchopulmonary foregut malformations. It has demonstrated aberrations in the nerve supply to the esophagus in EA and allowed the study of tracheomalacia. A relationship between an abnormal notochord, foregut abnormalities, and vertebral defects has been shown, and the model has reignited interest in the role of the notochord as a regional organizer of axial development. The normal temporospatial characteristics of apoptosis during fore- and hindgut development is disturbed in this model, resulting in abnormal morphology. The indications are that this model will continue to clarify the processes that lead to many of the structural congenital abnormalities that are seen in infants born with the VATER association.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000426
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  • 48
    Electronic Resource
    Electronic Resource
    Apoptosis in murine duodenum during embryonic development (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 485-487 
    Details
    ISSN: 1437-9813
    Keywords: Key words Duodenum ; Apoptosis ; Fetus ; Rat ; Duodenal atresia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Duodenum is thought to go through a solid-core stage followed by recanalization during its development. This study investigates the role of apoptosis in normal duodenal development, especially during widening of the lumen, and hence, the possible role of apoptosis in duodenal atresia (DA). Twenty-four time-mated Sprague-Dawley rats were killed from day 13 to day 20 of gestation. Duodenums of 3 fetuses were chosen randomly from each rat and processed. Apoptosis was determined by the terminal deoxytransferase-mediated biotin dUTP nick-end labeling (TUNEL) technique (ApopTag). Apoptosis count and cross-sectional areas were measured with an image analyzer (MetaMorph). The number of apoptotic cells per unit area duodenum peaked on day 15 for the mucosal/submucosal layer and on day 14 for the muscular/mesenchymal layer. The maximal number of apoptotic cells per cross-section of duodenum was between 7 and 8. The cross-sectional areas of the duodenal wall and lumen increased exponentially between day 17 and day 19 while duodenal-wall thickness remained relatively constant throughout duodenal development. The localization, timing, and intensity of apoptosis do not suggest that apoptosis is responsible for the widening of the duodenal lumen; enlargement of the lumen is related to the increase in duodenal circumference. Apoptosis thus may not be involved in the pathogenesis of DA.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000408
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  • 49
    Electronic Resource
    Electronic Resource
    Induction of apoptosis and manganese superoxide dismutase gene by photodynamic therapy in cervical carcinoma cell lines (2000)
    Springer
    International journal of clinical oncology 5 (2000), S. 97-103 
    Details
    ISSN: 1437-7772
    Keywords: Key words Photodynamic therapy ; Cervical cancer ; Apoptosis ; MnSOD ; Gene induction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Photodynamic therapy (PDT) is a cancer treatment modality in which systemic administration of a tumor-localizing photosensitizer is followed by irradiation of the tumor with visible light. Although PDT is undergoing clinical trials for various cancers, the mechanisms of its action are not fully understood. To investigate the mechanism of cell death by PDT, we performed in-vitro PDT, using Photofrin II as a photosensitizer, in two human cervical carcinoma cell lines, HeLa and CaSki. Methods. Cells were incubated with Photofrin II for 24 h, followed by illumination, using a YAG-OPO laser. Cell survivability after PDT was evaluated by an MTT assay. Cytotoxicity was assayed by measuring the release of lactate dehydrogenase (LDH) into the supernatant. DNA of the PDT-treated cells was electrophoresed in an agarose gel to determine fragmentation. In situ detection of apoptosis in the PDT-treated cells was performed by identification of the 3′-OH ends of DNA. In addition, induction of manganese superoxide dismutase mRNA (MnSOD) was analyzed in the PDT-treated cells. Results. The CaSki cells were more sensitive to this PDT treatment than were the HeLa cells. DNA fragmentation was observed with less than 5 μg/ml of Photofrin II in both cell lines, whereas PDT-induced cell membrane destruction, determined by LDH release, was observed only at 10 μg/ml. The MnSOD mRNA was induced in the HeLa cells in the early hours after PDT with a non-lethal dose of Photofrin II, but was reduced with a high dose, whereas the CaSki cells did not show any induction of the MnSOD gene by PDT. Conclusion. The present results suggest that PDT induces cell death by a mechanism involving membrane destruction and apoptosis. Differences in cell susceptibilities to PDT may depend upon a protective mechanism, such as MnSOD gene induction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101470050098
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  • 50
    Electronic Resource
    Electronic Resource
    An analysis of the therapeutic efficacy of protracted infusion of low-dose 5-fluorouracil and cisplatin in advanced gastric cancer (2000)
    Springer
    Journal of infection and chemotherapy 6 (2000), S. 222-228 
    Details
    ISSN: 1437-7780
    Keywords: Key words Gastric cancer ; Low-dose FP ; Pharmacokinetics ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To analyze the clinical efficacy of a protracted infusion of low-dose 5-fluorouracil (5-FU) and cisplatin (CDDP), a phase II study was performed in 36 patients with advanced gastric cancer. The treatment schedule of the low-dose administration of 5-FU and CDDP (FP) was a continuous infusion of 5-FU (250 mg/m2) for 28 consecu-tive days and a drip infusion of CDDP (3.5 mg/m2) for 5 consecutive days, followed by a 2-day interval each week in one cycle. The overall response rate was 47.2%. Of importance, the improvement in quality of life assessed by performance status (PS) and oral intake was 13.9% and 33.3%, respectively. The toxicity in low-dose FP treatment was less than grade 2, including gastrointestinal toxicities and bone marrow suppression, and this was tolerable during the treatment. The median survival time (MST) and 1-year survival rate were 8 months and 36.2%, respectively. In a pharmacokinetic analysis following the protracted infusion of low-dose FP, the plasma concentrations of 5-FU and CDDP were increased to about 120–130 ng/ml and 0.3–0.5 μg/ml on day 21 after the treatment, respectively. The plasma concentrations of 5-FU and CDDP were not significantly different between responders and non-responders. The tumor response to low-dose FP treatment was associated with the induction of apoptotic cell death and with the overexpression of apoptosis-related genes, such as Bax and Bcl-Xs, in cancer cells. These results indicate that the protracted infusion of low-dose FP could be a useful regimen for patients with advanced gastric cancer, in terms of the high response rate and low toxi-city, possibly leading to the prolongation of survival and improvement in the quality of life.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101560070007
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  • 51
    Electronic Resource
    Electronic Resource
    BCG (bacille Calmette-Guérin)-activated lymphocytes (BAK cells) induce apoptosis in urinary bladder carcinoma cell line T24 in vitro (2000)
    Springer
    International journal of clinical oncology 5 (2000), S. 253-261 
    Details
    ISSN: 1437-7772
    Keywords: Key words BAK cells ; T24 cells ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. We previously reported the basic characteristics of BCG (bacille Calmette-Guérin)-activated killer (BAK) cells, which exhibited antitumor effects against the bladder cancer cell line T24. Our study suggested that both BCG and BAK cells were responsible for the inhibition of tumor cell proliferation; however, the basic mechanism of BCG or BAK cells in this inhibition was not clear. We here report the antitumor effects of BAK cells, which correlated with the induction of apoptosis in T24 cells. Methods. Lymphocytes were cultured with BCG to examine 3H-thymidine uptake, and the subpopulation was evaluated by immunocytometry. T24 cells were then cultured with BAK cells for the analysis of 3H-thymidine uptake and apoptosis induction by DNA electrophoresis; pathology study, and cell-cycle analysis were also done. Culture supernatants of BAK and T24 cells were also investigated to detect interferon-γ (IFN-γ), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Results. The 3H-thymidine uptake study of lymphocytes showed that BCG activated the lymphocytes. Evaluation by immunocytometry revealed that CD4+ and CD8+ T cells were induced by BCG. The 3H-thymidine uptake study of T24 cells revealed that BAK cells inhibited tumor cell proliferation. DNA electrophoresis, the morphological study, and cell-cycle analysis by immunocytometry demonstrated that apoptosis in T24 cells was induced when they were cultured with BAK cells. IFN-γ, IL-6, and TNF-α were detected in the culture supernatants of BAK and T24 cells. Conclusions. Cytokine production and the induction of apoptosis may, together, be the major mechanisms of the antitumor action seen when BAK cells were employed against T24 cells; BAK cells could be employed as clinical effectors against bladder cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00012046
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  • 52
    Electronic Resource
    Electronic Resource
    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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  • 53
    Electronic Resource
    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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  • 54
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    Electronic Resource
    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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  • 55
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    Electronic Resource
    Caspase inhibition protects from liver injury following ischemia and reperfusion in rats (2000)
    Springer
    Transplant international 13 (2000), S. S568 
    Details
    ISSN: 1432-2277
    Keywords: Key words Normothermic liver ischemia ; Apoptosis ; Caspases ; Rats
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Normothermic ischemia and reperfusion of the liver results in microcirculatory failure followed by necrosis and cell death. Recently, another type of cell death, apoptosis or programmed cell death, was found to be activated during the early phase of reperfusion after liver ischemia. Caspases are cysteine proteinases specifically involved in the initiation and execution phases of apoptosis. The aim of this study was to demonstrate that inhibition of apoptosis by a specific inhibitor of caspases might protect the liver against ischemia/reperfusion injury. Rats were divided into three groups: group 1, control, PBS administration; group 2, Z-Asp-cmk (Z-Asp-2,6-dichlorobenzoyl-oxymethylketone) treatment; group 3, sham-operated control animals. Z-Asp-cmk (0.5 mg Z-Asp-cmk dissolved in 300 μl PBS solution containing 1 % DMSO) was injected intravenously, 2 min prior to induction of 120 min ischemia. Survival rates were compared and serum activities of aspartate aminotransferases and alanine aminotransferases were assessed in the blood collected from the suprahepatic vena cava. Histology of the liver was assessed 6 h after the end of ischemia. Apoptosis was detected by the terminal deoxynucleotidyl transferase-mediated dUTP-FITC nick end-labeling method (TUNEL method) and by electrophoresis for analysis of DNA fragmentation. Caspase activity was determined by measuring hydrolysis of the CPP32-like substrate Ac-DEVD-pNA and absorption of paranitroaniline. Z-Asp-cmk treatment significantly increased 7-day survival (95 %) compared with that in nontreated rats (30 %, P 〈 0.001). Serum activities of aminotransferases and the extent of liver congestion and necrosis were significantly (P 〈 0.001) decreased after treatment with Z-Asp-cmk. TUNEL-positive cells were detected 3–6 h after reperfusion in the control group. In Z-Asp-cmk pretreated rats, a dramatic decrease in the number of TUNEL-positive cells was observed. Analysis of DNA fragmentation of freshly isolated hepatocytes confirmed these results. Caspase activity was increased 3–6 h after reperfusion in the control group, but significantly (P 〈 0.001) decreased after treatment with Z-Asp-cmk. These findings demonstrate that liver injury following ischemia and reperfusion can be prevented by inhibition of caspases. Caspase inhibitors may have important implications for therapy in liver disease and after liver transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050405
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  • 56
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    Electronic Resource
    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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    Apoptotic cell death and fertility in three unilateral cryptorchid rat models (2000)
    Springer
    Urological research 28 (2000), S. 332-337 
    Details
    ISSN: 1434-0879
    Keywords: Key words Cryptorchidism ; Contralateral descended testis ; Apoptosis ; Fertility ; Rat model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Three rat strains have been studied, using a sensitive apoptotic detection method for germ-cell degeneration, to resolve the controversy regarding the effect of cryptorchidism on the contralateral descended testis (CDT). Sprague Dawley and Buffalo rats were made cryptorchid by operation at 20–22 days of age, while trans-scrotal (T-S) rats were a congenitally unilateral cryptorchid strain. Sham operated rats or normal T-S littermates were used as controls. Experiments were performed over a period ranging from 2 weeks to 18 months. Testis weight was assayed, as was the detection of apoptosis by agarose gel laddering and immunohistochemistry by using the TUNEL method. Labeled cells in 150 cross-sectioned testis tubules were counted on the TUNEL stained slides and the mean number of labeled cells per tubule was calculated. Paternity studies on Sprague Dawley and T-S rats were carried out at 12 and 24 weeks of age to assess fertility by the resultant number of pregnancies and litter sizes. Both Sprague Dawley and T-S rat models showed a biphasic distribution of apoptosis levels. This biphasic distribution was not observed in Buffalo rats as they were only studied at later time points (12–20 weeks). A significant effect on either testis weight or apoptosis in the CDT compared with the control descended testis (P ≥ 0.1) has not been found in these three cryptorchid models, and the present results are discussed with reference to observations of other researchers in rodents and humans. While the cryptorchid testis showed a high level of labeled apoptotic cells per tubule in all rat strains, fertility was not affected and remained the same as controls at 12 and 24 weeks. There was, however, a marked strain difference in fertility in T-S as compared with Sprague Dawley rats. After 24 weeks of cryptorchidism, both control and cryptorchid T-S rats had a 44% pregnancy incidence compared with a 90% pregnancy incidence in Sprague Dawley rats. In addition, litter size in T-S control and cryptorchid rats were small compared with those of Sprague Dawley rats at 12 and 24 weeks.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002400000121
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    Renal tubular apoptosis after complete ureteral obstruction in the presence of hyperoxaluria (2000)
    Springer
    Urological research 28 (2000), S. 220-222 
    Details
    ISSN: 1434-0879
    Keywords: Key words Kidney ; Ureter ; Urinary obstruction ; Hydronephrosis ; Hyperoxaluria ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hyperoxaluria is a well-known cause of renal stone disease and in vitro studies have shown that oxalate crystals have a stimulatory effect on apoptosis of renal tubular epithelial cells. Total and partial ureteral obstruction also have an accelerating effect on apoptosis of renal tubular epithelial cells. The aim of the present study was to investigate the apoptotic effect of unilateral ureteral obstruction in the presence of hyperoxaluria on the rat kidney. Twenty-eight male Wistar rats were divided into four groups, with seven rats in each. The groups were named G1 (control), G2 (hyperoxaluric), G3 (obstructive) and G4 (hyperoxaluric + obstructive). G2 and G4 rats were given 1% ethylene glycol (a precursor for oxalates) in their drinking water. G1 and G2 rats underwent sham operation, while left proximal ureteral ligation with a 5-zero silk suture was performed on G3 and G4 animals. The rats were sacrificed 2 weeks after the operation; left nephrectomy was then performed. We searched for the apoptotic cells by direct immuno-peroxidase detection of digoxigenin-labeled genomic DNA. The mean ± SD values of the apoptotic cell count was 0.86 ± 0.90 in G1 and 4.33 ± 3.81 in G2. The values for G3 and G4 were 30.17 ± 16.85 and 302.67 ± 184.45, respectively. We found a statistically significant difference between all groups (P 〈 0.001). When compared with the control group (G1), the mean apoptotic cell count was fivefold that of G2 and 35- and 351-fold those of G3 and G4, respectively. Our study demonstrated that hyperoxaluria with complete ureteral obstruction induces an excessive level of apoptosis, which is responsible for renal damage, and that ureteral obstruction is a more important factor for apoptosis than hyperoxaluria. Considering these data, we also believe that research studies for medical preventive measures must be considered for patients with ureteral obstruction and/or hyperoxaluria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002400000128
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    Neuronal nuclear DNA fragmentation in the aged canine brain: apoptosis or nuclear DNA fragility? (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 402-408 
    Details
    ISSN: 1432-0533
    Keywords: Key words Ageing ; Dog brain ; Apoptosis ; DNA ¶fragmentation ; TUNEL method
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neuronal DNA fragmentation, as revealed with the method of in situ end-labeling of nuclear DNA fragmentation (TUNEL), has been reported in both the canine and human brains in normal ageing, and in some human age-related neurodegenerative diseases. These results have suggested that apoptosis plays an important role in age-related neuronal loss. It is not clear, however, whether the TUNEL method is highly specific for apoptosis, as DNA fragmentation also occurs in the late stages o necrosis. In this study we have examined 27 dogs aged from ¶8 to 18 years, to investigate the occurrence of nuclear DNA fragmentation. An autolysis index based on current histological criteria was assigned to each animal to evaluate the effects of autolysis on nuclear DNA integrity. Our results have shown that neuronal nuclear DNA fragmentation is frequent in aged dogs, although it is not accompanied by apoptotic morphology. Yet, a positive relation between TUNEL labelling and the degree of tissue autolysis was observed. In contrast, no TUNEL labelling was detected in young control dogs despite autolysis indices being similar to those in aged dogs. Taken together, these results suggest that neuronal nuclear DNA fragmentation is an age-related phenomenon, not due to apoptosis, whenever other factors render neuronal DNA more susceptible to autolytic fragmentation. We confirm the effect of autolysis in a subpopulation of neurons in the aged canine brain, inducing nuclear DNA fragmentation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010051142
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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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    N-[4-(3-Ethoxy-2-hydropropoxy)phenyl] acrylamide selectively induces apoptosis of cerebellar granule cells in vivo and in vitro in rats (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 337-344 
    Details
    ISSN: 1432-0533
    Keywords: Key words Cerebellar selective injury ; Acrylamide ; Granule cell degeneration ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Oral administration of N-[4-(3-ethoxy-2-hydropropoxy)phenyl] acrylamide (EHA) induced selective granule cell destruction in the granular layer of the cerebellar cortex together with neurological signs, such as delayed righting reflex, gait or truncal ataxia, and convulsion. Neuropathologically, it caused multifocal granule cell destruction with nuclear pyknosis and spongiosis of the neuropile in the granular layer. Other neurons, including Purkinje cells, were spared. Ultrastructurally, damaged granule cells showed aggregation of nuclear chromatin and cytoplasmic edema, but cytoplasmic organelles were preserved. The brain uptake index of 14C-labeled EHA was similar to that of H2O. When EHA was added to rat cerebellar tissue cultures, only the granule cells showed nuclear pyknosis, aggregation of nuclear chromatin, and karyorrhexis with cytoplasmic swelling. These granule cells were positive for DNA fragmentation by the TUNEL method. These results suggest that EHA permeates the blood vessel wall and directly affects the cerebellar granule cells, resulting in selective granule cell apoptosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010051133
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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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    Apoptosis of perineurial cells in sensory perineuritis (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 317-320 
    Details
    ISSN: 1432-0533
    Keywords: Key words Perineuritis ; Neuropathy ; Nerve biopsy ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 71-year-old man presented a 6-month history of progressive paresthesia of all four limbs. Sural nerve biopsy specimens showed dense mononuclear infiltrates in the perineurium and subperineurium, indicating sensory perineuritis. One section revealed disruption of the perineurial barrier. Perforin and granzyme B were present in the infiltrates, and apoptosis of perineurial cells was indicated by a terminal deoxynucleotidyl-transferase-mediated dUTP-digoxigenin nick end-labeling (TUNEL) method. These findings suggest T cell-mediated apoptosis of the perineurium and nerve injury caused by perineurial damage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007444
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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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    Soluble Fas levels in patients with systemic sclerosis (2000)
    Springer
    Archives of dermatological research 292 (2000), S. 522-523 
    Details
    ISSN: 1432-069X
    Keywords: Key words Serum soluble Fas ; Systemic sclerosis ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004030000170
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    15-Hydroxyeicosatrienoic acid (15-HETrE) suppresses epidermal hyperproliferation via the modulation of nuclear transcription factor (AP-1) and apoptosis (2000)
    Springer
    Archives of dermatological research 292 (2000), S. 397-403 
    Details
    ISSN: 1432-069X
    Keywords: Key words Docosahexaenoic acid (DHA) ; 15-hydroxyeicosatrienoic acid (15-HETrE) ; AP-1 ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this study was to ascertain whether the antiproliferative effect of 15-hydroxyeicosatrienoic acid (15-HETrE), a monohydroxy fatty acid generated from dihomo-Á-linolenic acid, in an experimentally induced guinea pig hyperproliferative model involves alterations in nuclear transcription factor (AP-1) and apoptosis. The topical application of docosahexaenoic acid (DHA) to normal guinea pig skin elicited a severe hyperplasia which was accompanied by the suppression of AP-1 expression in a time-dependent manner. Since apoptosis is pivotal in tissue turnover, the expression of two apoptotic proteins (Bcl-2 and caspase-3) after DHA and 15-HETrE treatment was explored. DHA-induced hyperproliferation enhanced the expression of Bcl-2 (an antiapoptotic protein) but inhibited the expression of caspase-3 (an apoptotic protein). 15-HETrE, on the other hand, reversed the DHA-induced epidermal hyperplasia, and upregulated epidermal AP-1 expression. These events paralleled the suppression of Bcl-2 and the elevation of caspase-3. Taken together, these results suggest that the antiproliferative effect of 15-HETrE may, at least in part, be via the modulation of AP-1 and apoptosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004030000139
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    Critical role of nitric oxide for proliferation and apoptosis of bone-marrow cells under septic conditions (2000)
    Springer
    Annals of hematology 79 (2000), S. 249-254 
    Details
    ISSN: 1432-0584
    Keywords: Nitric oxide ; Bone marrow ; Proliferation ; Apoptosis ; Sepsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: α , interferon γ and interleukin-1β for 48 h. The basal proliferation rate of the cells remained unchanged, but granulocyte–macrophage colony stimulating factor-induced proliferation was suppressed and the percentage of apoptotic cells significantly raised. Levels of nitrite in the culture supernatants were inversely correlated with the suppression of proliferation, but directly correlated with apoptosis. The NO synthesis inhibitor N-methyl-arginine inhibited the suppression of proliferation as well as the induction of apoptosis and NO synthesis. Our results indicate that NO is a negative feedback regulator of cell turnover in sepsis, which limits growth-factor-induced proliferation and induces apoptosis of bone marrow cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050588
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    Altered expression of insulin-like growth factor -1 and insulin like growth factor binding proteins-2 and 5 in the mouse mutant Hypodactyly (Hd) correlates with sites of apoptotic activity (2000)
    Springer
    Anatomy and embryology 202 (2000), S. 1-11 
    Details
    ISSN: 1432-0568
    Keywords: Key words Mouse ; Gene expression ; Insulin-like growth factor (IGF) ; IGF binding protein (IGFBP) ; Hypodactyly (Hd) ; Limb bud ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Insulin-like growth factor-I (IGF-I) mediated signalling has been implicated to be of significant importance during vertebrate embryonic development. IGF-I signalling has also been shown to be modulated by a number of IGF binding proteins that are thought to act as either agonists or antagonists of IGF activity. IGF-I has been implicated in a number of cellular processes, including cell division and programmed cell death (apoptosis). We have used the mouse mutant Hypodactyly (Hd) as a tool to determine the role of IGF-I and two key IGF binding proteins (IGFBP-2 and IGFBP-5) during embryonic development. The Hd mutant is a good model with which to study developmental cascades, since it has a distinct phenotype in the limb where cellular and molecular circuits have been thoroughly investigated. The distinctive pointed limb buds observed in Hd mutant embryos have been shown to be the result of a massive increase in apoptosis. We show that all three genes, IGF-1, IGFBP-2 and IGFBP-5, display restricted expression patterns during limb development. Indeed, IGFBP-5 shows a remarkable similarity to the expression of Engrailed-1, which is the vertebrate homologue of the Drosophila selector gene Engrailed. We show that there is downregulation in the expression of IGFBP-2 in the entire apical ectodermal ridge (AER) in homozygous Hd/Hd limb buds, whereas IGFBP-5 is downregulated in specific regions in the mutant AER. IGF-I expression is downregulated in Hd limb buds in regions undergoing high levels of cell death, consistent with its proposed role as an anti-apoptotic factor, while IGFBP-5 is found at higher levels in regions of cell death, consistent with reports of its association with apoptosis in adult tissues. We propose that these three components of the IGF axis could be involved in the manifestation of the mutant phenotype in Hypodactyly, and that this is probably a result of their ability to regulate cell survival and cell death.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008239
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    Overexpression of HSP70 prevents ultraviolet B-induced apoptosis of a human melanoma cell line (2000)
    Springer
    Archives of dermatological research 292 (2000), S. 482-487 
    Details
    ISSN: 1432-069X
    Keywords: Keywords HSP70 ; Human melanoma cells ; Ultraviolet B ; Apoptosis ; Caspase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The heat shock response is a highly conserved reaction common to all cells and organisms. It has been reported that hyperthermic treatment can induce the expression of the heat shock protein (HSP) and can protect cells from ultraviolet (UV) B radiation. In this study, we evaluated the effects of induced HSP70 on resistance to UV radiation. G361 amelanotic human melanoma cells were irradiated with increasing doses of UVB. UVB irradiation caused apoptotic cell death in these cells. Following transfection with MFG.hsp70.puro plasmid, the expression of HSP70 was determined. Compared to control vector-transfected cells, hsp70-transfected cells showed significantly elevated levels of HSP70 and were highly resistant to UVB irradiation. In order to investigate the effects of HSP70 on the apoptotic pathway, the changes in caspase-3 and PARP were analyzed. Following UVB irradiation, activation of caspase-3 and cleavage of PARP were observed in control vector-transfected cells, and the changes in these molecules were inhibited in the hsp70-transfected cells. These results suggest that UVB-induced apoptosis of melanoma cells is accompanied by caspase-3 activation and PARP cleavage, which can be prevented by an overexpression of HSP70.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004030000173
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    Expression of IFNγ, coexpression of TNFα and matrix metalloproteinases and apoptosis of T lymphocytes and macrophages in granuloma annulare (2000)
    Springer
    Archives of dermatological research 292 (2000), S. 384-390 
    Details
    ISSN: 1432-069X
    Keywords: Key words Granuloma annulare ; Cytokine ; Apoptosis ; Lymphocytes ; Macrophages
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Granuloma annulare, a prototype noninfectious granulomatous dermatitis, is morphologically characterized by a necrobiotic core surrounded by a cellular infiltrate. Because of many morphological similarities to tuberculosis, granuloma annulare has been suggested to represent a delayed-type hypersensitivity (Th1) reaction in the course of which inflammatory cells elicit matrix degradation. In the present study we (1) investigated the expression of interferon-Á as the most important Th1-associated cytokine, (2) sought in situ evidence for the coexpression of the proinflammatory cytokine tumor necrosis factor-· and cytokine-regulated matrix metalloproteinases 2 (gelatinase A) and 9 (gelatinase B), and (3) sought to determine whether shrunken cells seen within necrobiotic areas of granuloma annulare are apoptotic cells. In situ hybridization combined with immunofluorescence showed that large numbers of infiltrating CD3+ lymphocytes express interferon-Á. Application of catalyzed signal amplification in immunodetection revealed that the vast majority of CD3+ lymphocytes and CD68+ macrophages contained tumor necrosis factor-·. Immunohistochemistry demonstrated that macrophages producing tumor necrosis factor-· coexpress matrix metalloproteinases 2 and 9. In situ end-labeling combined with immunofluorescence detected few apoptotic T cells in perivascular regions and numerous apoptotic macrophages within necrobiotic areas. These results suggest that in granuloma annulare interferon-Á+ Th-1 lymphocytes may cause a delayed-type hypersensitivity reaction whereby macrophages are differentiated to aggressive effector cells expressing tumor necrosis factor-α and matrix metalloproteinases. In parallel, activation-induced apoptosis in lymphocytes and macrophages may serve to restrict the destructive potential of the inflammatory cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004030000150
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    Bcl-2 transfected HaCaT keratinocytes resist apoptotic signals of ceramides, tumor necrosis factor α and 1α,25-dihydroxyvitamin D3 (2000)
    Springer
    Archives of dermatological research 292 (2000), S. 455-462 
    Details
    ISSN: 1432-069X
    Keywords: Key words Ceramide ; 1α,25-Dihydroxyvitamin D3 ; TNFα ; Apoptosis ; Bcl-2
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract During the last few years increasing evidence has shown that sphingolipid metabolites are highly bioactive compounds that play important roles in cellular regulation. The induction of ceramide signalling in primary human keratinocytes and HaCaT keratinocytes has recently been demonstrated using 1·,25-dihydroxyvitamin D3. The data obtained indicate that approximately one-third of the proapoptotic effect of 1·,25-dihydroxyvitamin D3 is mediated by an intracellular ceramide increase induced via tumor necrosis factor · expression and autocrine stimulation of sphingomyelin hydrolysis. In the present study the role of bcl-2 in this process was investigated. HaCaT keratinocytes were transfected with bcl-2 and the effects of C2-ceramide, tumor necrosis factor · and 1·,25-dihydroxyvitamin D3 on HaCaT keratinocytes stably overexpressing bcl-2 were determined. Apoptosis was measured by detection of soluble DNA-histone complexes using the ELISA technique. In situ analysis of apoptotic cells was also carried out by detecting phosphatidylserine flip using the annexin V method and by detecting DNA fragmentation using the TUNEL assay. The results obtained showed that apoptosis induced by C2-ceramide, tumor necrosis factor · or 1·,25-dihydroxyvitamin D3 occurred in a vector-transfected clone but not in a bcl-2-transfected HaCaT clone. This indicates the important role of bcl-2 in the regulation of ceramide-mediated signalling pathways in human keratinocytes and supports the involvement of ceramide as a signalling molecule in 1α,25-dihydroxyvitamin D3-induced biological responses.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004030000158
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    Overexpression of bcl-2 in transient abnormal myelopoiesis associated with Down syndrome (2000)
    Springer
    Annals of hematology 79 (2000), S. 319-321 
    Details
    ISSN: 1432-0584
    Keywords: Key words Down syndrome ; Transient abnormal myelopoiesis ; Apoptosis ; bcl-2
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Transient abnormal myelopoiesis (TAM) is a haematological complication found in Down syndrome. To determine the mechanisms of sustained proliferation of TAM cells, we studied the expression of apoptosis-related proteins, such as bcl-2, Fas (APO-1/CD95) and p-53, in peripheral blood cells from a new-born infant with Down syndrome and TAM. Using flow cytometry, peripheral blood mononuclear cells (PBMCs), consisting mostly of blast cells, showed marked expression of bcl-2 protein but not of Fas or p-53 products. DNA gel electrophoresis of PBMCs, cultured in the absence of serum factors, revealed no marked fragmentation. Our findings suggest that bcl-2 overexpression may be associated with prolonged cell survival of TAM cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002779900138
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    Induction of apoptosis using 2′,2′difluorodeoxycytidine (gemcitabine) in combination with antimetabolites or anthracyclines on malignant lymphatic and myeloid cells. Antagonism or synergism depends on incubation schedule and origin of neoplastic cells (2000)
    Springer
    Annals of hematology 79 (2000), S. 485-492 
    Details
    ISSN: 1432-0584
    Keywords: Key words Gemcitabine ; Apoptosis ; Chronic lymphocytic leukemia ; Acute myeloid leukemia ; Cell lines ; HPLC
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Induction of apoptosis in vitro using gemcitabine (dFdC) in combination with cladribine (2-CdA) and other cytotoxic drugs on malignant mononuclear cells (MNCs) of patients with acute myeloid leukemia (AML, n=20) and chronic lymphocytic leukemia (CLL, n=20) in myeloid (HL60, HEL) and lymphatic cell lines (HUT78, JURKAT) was investigated using different incubation conditions (simultaneous and consecutive). Furthermore, the influence of dFdC on the level of intracellular metabolites of 2-CdA was studied using high-performance liquid chromatography (HPLC). Apoptosis was evaluated using flow cytometry with 7-aminoactinomycin D. In MNCs of patients with CLL, dFdC+2-CdA showed an antagonistic effect when applied simultaneously. This antagonism was reduced by consecutive application. The combination of dFdC with doxorubicin was synergistic, independent of incubation schedule. In blasts from newly diagnosed patients with de novo AML, all drug combinations (dFdC+2-CdA, doxorubicin, or cytosine arabinoside) were antagonistic by simultaneous incubation. Reduced antagonism or even synergism was shown (P〈0.001) by consecutive incubation. The simultaneous combination of dFdC with 2-CdA in all tested cell lines resulted in a competitive inhibition on the rate of apoptosis. By changing the incubation period to a consecutive schedule, the antagonism was diminished or synergism of apoptosis was measured (P〈0.001). Using similar incubation conditions, these experiments were supported by HPLC measurement of intracellular metabolites of 2-CdA influenced by dFdC application. In conclusion, we demonstrated that the efficacy of dFdC in vitro in combination with other cytotoxic drugs depends on the incubation condition and on the origin of neoplastic cells (lymphatic vs myeloid). The data suggest that simultaneous combination therapy with purine and pyrimidine analogues may not improve the clinical efficacy of one or the other drug administered alone.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770000181
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    Identification of okadaic-acid-induced genes by mRNA differential display in glioma cells (2000)
    Springer
    Journal of biomedical science 7 (2000), S. 152-159 
    Details
    ISSN: 1423-0127
    Keywords: Apoptosis ; Differential display ; Glioma ; Okadaic acid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract To identify novel genes associated with apoptosis in glioma cells, we treated T98G glioma cells with okadaic acid (OA). Differential display using 15 random primers was performed on RNA extracted from these cells. Upregulated bands were excised from polyacrylamide gels and cloned. Northern blots were used to confirm RNA expression in T98G cells. 18 RNA fragments corresponding to the untranslated region of genes were identified and sequenced. Three unknown gene fragments were used to screen a fetal brain cDNA library resulting in three complete cDNA sequences. The three sequences corresponded to a human gene homologous to the yeast translation initiation factor Sui-1, a cAMP-regulated phosphoprotein, ARPP-16/19, and a novel gene designated O48. Transcription of Sui-1 increased in response to all stress factors tested, whereas ARPP only responded to OA. 2-kb and 4-kb O48 RNA species were identified. OA and stress factors increased 2-kb expression while K252a (protein kinase inhibitor) increased 4-kb expression. Differential display is effective for identifying genes associated with apoptosis. Novel genes may be identified by further analysis of the gene fragments identified in this study. The function of O48 is unknown.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02256622
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    Delta opioid peptide [D-Ala2,D-Leu5]enkephalin promotes cell survival (2000)
    Springer
    Journal of biomedical science 7 (2000), S. 195-199 
    Details
    ISSN: 1423-0127
    Keywords: Opioid ; Enkephalin ; DADLE ; Transplantation ; Hibernation ; Apoptosis ; Methamphetamine ; Dopamine ; Ischemia ; Reperfusion ; PC12 cells ; Neuroprotection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract By studying the hibernation in ground squirrels, a protein factor termed hibernation induction trigger (HIT) was found to induce hibernation in summer-active ground squirrels. Further purification of HIT yielded an 88-kD peptide that is enriched in winter hibernator. Partial sequence of the 88-kD protein indicates that it may be related to the inhibitor of metalloproteinase. Delta opioid [D-Ala2,D-Leu5]enkephalin (DADLE) also induced hibernation. HIT and DADLE were found to prolong survival of peripheral organs preserved en bloc or as a single preparation. These organs include the lung, the heart, liver and kidney. DADLE also promotes survival of neurons in the central nervous system. Methamphetamine (METH) is known to cause destruction of dopaminergic (DA) terminals in the brain. DADLE blocked and reversed the DA terminal damage induced by METH. DADLE acted against this effect of METH at least in part by attenuating the mRNA expressions of a tumor necrosis factor p53 and an immediate early gene c-fos. DADLE also blocked the neuronal damage induced by ischemia-reperfusion following a transient middle cerebral artery occlusion. In PC12 cells, DADLE blocked the cell death caused by serum deprivation in a naltrexone-sensitive manner. Thus, DADLE, and by extension the endogenous delta opioid peptides and delta opioid receptors, may play an important role in organ and neuronal survival. Here, critical developments concerning these fascinating cell protective properties of DADLE are reviewed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02255466
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    Differential apoptosis effects of primate lentiviral Vpr and Vpx in mammalian cells (2000)
    Springer
    Journal of biomedical science 7 (2000), S. 322-333 
    Details
    ISSN: 1423-0127
    Keywords: Apoptosis ; HIV ; SIV ; Vpr ; Vpx ; Bcl-2 ; Bax
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract The growth inhibitory effects of Vpr and Vpx are species-and cell type-dependent. HIV-1, HIV-2 and SIV Vpr are primarily cytostatic in mammalian cells and HIV-1 Vpr has been reported to induce apoptosis in human cells. Our previous studies have shown that HIV-1, HIV-2 and SIV Vpr and Vpx have differential cytostatic and cytotoxic effects in the yeast cells [Zhang et al.: Virology, 230:103–112; 1997]. Here, we further examined the apoptosis function of HIV-1 Vpr in different species of mammalian cells and investigated if other primate lentiviral Vpr and Vpx exert similar functions. Our results show that none of the primate lentiviral Vpr or Vpx we tested induces apoptosis in nonhuman species of mammalian cells. However, HIV-1 Vpr, but not HIV-2 or SIV Vpr and/or Vpx, induced apoptosis in different types of human cell lines. Further, the apoptotic effect of HIV-1 Vpr can be distinguished from that of the human interferon-γ, a known proapoptotic protein, that HIV-1 Vpr shows little to no paracrine and/or bystander effect. When coexpressed with Bcl-2 or Bcl-XL, the apoptotic effect of HIV-1 Vpr became markedly attenuated. These results indicate that the apoptotic effect of HIV-1 Vpr is species-dependent and is intracellularly modulated by the Bcl-2 family of proteins. Our study also suggests that the proapoptotic function of HIV-1 Vpr is developmentally associated with human but not nonhuman primate species.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02253252
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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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    DNA fragmentation, gliosis and histological hallmarks of Alzheimer’s disease (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 681-687 
    Details
    ISSN: 1432-0533
    Keywords: Key words Alzheimer’s disease ; Apoptosis ; β-Amyloid load ; Astrocytes ; Microglia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The extent of DNA fragmentation analysed using the TUNEL technique was evaluated in post-mortem human brain tissue. Twenty-four patients with clinical and histopathological diagnosis of Alzheimer’s disease (AD) and a short post-mortem delay were analysed. We report an increase in the count of TUNEL-labelled cells as the pathology of AD intensifies. Our results point out a significant correlation between neurofibrillary tangle and senile/neuritic plaque score and TUNEL-labelled cells. Patients with two copies of apolipoprotein (Apo) E ɛ4 allele had highest number of histopathological hallmarks lesions of AD, whereas the ApoE genotype did not significantly influence the density of TUNEL-positive cells. No significant correlation was found between β-amyloid protein load and TUNEL-labelled cells. There was no relationship between the age at death, age at onset, extent of astrogliosis or microgliosis and TUNEL-labelled cells in our material.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000228
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    Loss of dystrophin and some dystrophin-associated proteins with concomitant signs of apoptosis in rat leg muscle overworked in extension (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 618-626 
    Details
    ISSN: 1432-0533
    Keywords: Key words Skeletal muscle ; Eccentric exercise ; Apoptosis ; Dystrophin ; Dystrophin-associated proteins
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study investigated the basis for the high severity of damage to skeletal muscle due to eccentric exercise, i.e., to muscles generating force while lengthened. Fast and slow rat leg muscles maintained in an extended position were examined after 2–24 h of continuous stimulation. The treatment caused the injury to some regions of both muscles. Within the better preserved parts of the muscles, i.e., those without signs of necrotic processes, dystrophin, spectrin, and some of the dystrophin-associated proteins (β-dystroglycan, α-sarcoglycan, and γ-sarcoglycan) disappeared from sarcolemma of many fibers. The reduction or loss of dystrophin from the sarcolemma was more evident than that of other proteins examined, with sarcoglycans apparently being the most preserved. Several muscle fibers devoid of dystrophin contained apoptotic nuclei. Simultaneously, Bax, Bcl-2 and caspase-3 proteins appeared in many fibers. Our results indicate that a normal muscle overworking in an extended position undergoes the loss of several membrane skeletal proteins because of the excessive stress to the membrane cytoskeleton, which can lead to fiber death by either apoptosis or necrosis. This experimental model may represent a good model for mimicking the pathogenetic events in several muscular dystrophies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010000231
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    Apoptosis occurs in a new model of thermal brain injury (2000)
    Springer
    Journal of biomedical science 7 (2000), S. 459-465 
    Details
    ISSN: 1423-0127
    Keywords: Apoptosis ; Thermal brain injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract Apoptosis has been implicated recently as a prominent response of the brain to a variety of insults, such as ischemia and trauma. In this study, we demonstrate that apoptosis is a prominent part of the brain's response to a thermal insult. To examine the brain's response to a thermal insult, a new model of thermal brain injury in the laboratory rat was developed. Water heated to 60°C was passed over an area of thinned calvarium for 1 min. This resulted in an actual brain temperature of 47–48°C. A uniform area of 2,3,5-triphenyl-tetrazolium chloride pallor was demonstrated and pyknotic neurons were seen in the area of injury by hematoxylin-eosin staining. Apoptosis was demonstrated by the characteristic DNA fragmentation seen by agarose gel electrophoresis, ApopTag in situ staining and electron microscopy. The findings of apoptosis were localized to the area of thermal injury and were time dependent, starting 6 h after the insult and peaking approximately 18 h after the insult. This represents one of the first demonstrations that apoptosis occurs in the brain in response to a thermal injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02253361
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  • 84
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    Mitochondrial role in life and death of the cell (2000)
    Springer
    Journal of biomedical science 7 (2000), S. 2-15 
    Details
    ISSN: 1423-0127
    Keywords: Apoptosis ; Mitochondria ; Necrosis ; Oxidative stress ; Reactive oxygen species
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract Mitochondria are the major ATP producer of the mammalian cell. Moreover, mitochondria are also the main intracellular source and target of reactive oxygen species (ROS) that are continually generated as by-products of aerobic metabolism in human cells. A low level of ROS generated from the respiratory chain was recently proposed to take part in the signaling from mitochondria to the nucleus. Several structural characteristics of mitochondria and the mitochondrial genome enable them to sense and respond to extracellular and intracellular signals or stresses in order to sustain the life of the cell. It has been established that mitochondrial respiratory function declines with age, and that defects in the respiratory chain increase the production of ROS and free radicals in mitochondria. Within a certain concentration range, ROS may induce stress responses of the cell by altering the expression of a number of genes in order to uphold energy metabolism to rescue the cell. However, beyond this threshold, ROS may elicit apoptosis by induction of mitochondrial membrane permeability transition and release of cytochrome c. Intensive research in the past few years has established that mitochondria play a pivotal role in the early phase of apoptosis in mammalian cells. In this article, the role of mitochondria in the determination of life and death of the cell is reviewed on the basis of recent findings gathered from this and other laboratories.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02255913
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  • 85
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    p53 gene status modulates the chemosensitivity of non-small cell lung cancer cells (2000)
    Springer
    Journal of biomedical science 7 (2000), S. 64-70 
    Details
    ISSN: 1423-0127
    Keywords: p53 ; Chemosensitivity ; Cell cycle ; Apoptosis ; Non-small cell lung cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract This study examined the effects of p53 gene status on DNA damage-induced cell death and chemosensitivity to various chemotherapeutic agents in non-small cell lung cancer (NSCLC) cells. A mutant p53 gene was introduced into cells carrying the wild-type p53 gene and also vice versa to introduce the wild-type p53 gene into cells carrying the mutant p53 gene. Chemosensitivity and DNA damage-induced apoptosis in these cells were then examined. This study included five cell lines, NCI-H1437, NCI-H727, NCI-H441 and NCI-H1299 which carry a mutant p53 gene and NCI-H460 which carries a wild-type p53 gene. Mutant p53-carrying cells were transfected with the wild-type p53 gene, while mutant p53 genes were introduced into NCI-H460 cells. These p53 genes were individually mutated at amino acid residues 143, 175, 248 and 273. The representative cell line NCI-H1437 cells transfected with wild-type p53 gene (H1437/wtp53) showed a dramatic increase in susceptibility to three anticancer agents (7-fold to cisplatin, 21-fold to etoposide, and 20-fold to camptothecin) compared to untransfected or neotransfected H1437 cells. An increase in chemosensitivity was also observed in wild-type p53 transfectants of H727, H441, H1299 cells. The results of chemosensitivity were consistent with the observations on apoptotic cell death. H1437/wtp53 cells, but not H1437 parental cells, exhibited a characteristic feature of apoptotic cell death that generated oligonucleosomal-sized DNA fragments. In contrast, loss of chemosensitivity and lack of p53-mediated DNA degradation in response to anticancer agents were observed in H460 cells transfected with mutant p53. These observations suggest that the increase in chemosensitivity was attributable to wild-type p53 mediation of the process of apoptosis. In addition, our results also suggest that p53 gene status modulates the extent of chemosensitivity and the induction of apoptosis by different anticancer agents in NSCLC cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02255920
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  • 86
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    Decreased cisplatin/DNA adduct formation is associated with cisplatin resistance in human head and neck cancer cell lines (2000)
    Springer
    Cancer chemotherapy and pharmacology 46 (2000), S. 255-262 
    Details
    ISSN: 1432-0843
    Keywords: Key words Head and neck cancer ; Cisplatin ; Glutathione ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To evaluate the correlation between cisplatin sensitivity, intracellular glutathione, and platinum/DNA adduct formation (measured by atomic absorption spectroscopy) in a series of seven head and neck cancer cell lines, and to evaluate the effect of biochemical modulation of glutathione on platinum/DNA adduct formation and repair. Methods: Cisplatin/DNA adducts were measured by atomic absorption spectroscopy. Glutathione content was measured by enzymatic assay and was modulated with buthionine sulfoximine. Apoptosis was measured by double-labeled flow cytometry. Results: Intracellular glutathione concentration was strongly correlated with cisplatin resistance (P = 0.002, R 2=0.7). There was also a statistically significant inverse correlation between cisplatin/DNA adduct formation and the IC50 for cisplatin in these cell lines. (P=0.0004, R 2=0.67). In addition, resistant cells were able to repair approximately 70% of cisplatin/DNA adducts at 24 h, while sensitive cells repaired less than 28% of adducts in the same period. However, despite the positive correlation between cellular glutathione and cisplatin resistance, there was no direct correlation between intracellular glutathione concentration and platinum/DNA adduct formation. Further, depletion of intracellular glutathione by buthionine sulfoximine did not dramatically alter formation of cisplatin/DNA adducts even though it resulted in marked increase in cisplatin cytotoxicity and was associated with increased apoptosis. Conclusions: These results suggest that glutathione has multiple effects not directly related to formation of cisplatin/DNA adducts, but may also be an important determinant of the cell's ability to repair cisplatin-induced DNA damage and resist apoptosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002800000167
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  • 87
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    Anti-tumour activity of a panel of taxanes toward a cellular model of human cervical cancer (2000)
    Springer
    Cancer chemotherapy and pharmacology 45 (2000), S. 127-132 
    Details
    ISSN: 1432-0843
    Keywords: Key words Taxanes ; Cervical cancer ; Apoptosis ; Tubulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Using a model of human cervical cancer (ME-180 cells), the anti-tumour activity of paclitaxel was compared to that of docetaxel and IDN5109, a newly developed taxane. The growth inhibition effect of taxanes was assessed after 3 days of exposure. DNA analysis, the taxane-dependent modulation of the expression of the α and β subunits of tubulin and DNA fragmentation were assessed by flow cytometry. The presence of apoptosis was confirmed by morphological analysis using a laser scan cytometer. For the evaluation of “in vivo” anti-tumour activity, taxanes were administered to nude mice intravenously once daily, according to a q3/4d × 4 schedule. Docetaxel, IDN5109 and paclitaxel obtained “in vitro” IC50 values of 0.86, 1.4 and 2.4 nM, respectively. DNA analysis demonstrated a transient block at the G2/M phase of the cell cycle only after 12 h of culture in the presence of taxanes and an increase of nuclear fragmentation suggestive for apoptosis after additional 12 and 60 h of exposure. Morphological analysis confirmed the presence of apoptosis. Taxanes induced a down-modulation of the α subunit of tubulin in the G0/1 phase of the cell cycle, and an overexpression of the β subunit in the G2/M phase. A strong anti-tumour activity was obtained “in vivo” for nude mice xenografted using ME-180 cells (T/C=0% for all drugs). These data indicate that the three taxanes are strongly active both “in vitro” and “in vivo” toward ME-180 cells. Clinical studies are now needed to ascertain if the higher anti-tumour activity observed “in vitro” using docetaxel and IDN5109 yields a better clinical response in advanced cervical carcinoma with respect to paclitaxel.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002800050020
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    The role of caspase family protease, caspase-3 on cisplatin-induced apoptosis in cisplatin-resistant A431 cell line (2000)
    Springer
    Cancer chemotherapy and pharmacology 46 (2000), S. 241-245 
    Details
    ISSN: 1432-0843
    Keywords: Key words Caspase family protease ; Caspase-3 ; Cisplatin resistance ; Apoptosis ; A431
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: Cisplatin (cis-diamminedichloroplatinum(II), CDDP) has been reported to induce apoptosis in cancer cells, the mechanism of the apoptosis in cancer cells induced by CDDP is still unclear. Recent studies have revealed that caspase family of cystine proteases play an important role in the regulation of several apoptotic processes. In this study, whether apoptosis induced by CDDP could be mediated by the activation of caspase-3, a caspase family protease, was investigated. Methods: The CDDP-resistant subline A431/CDDP2 from the previously established human epidermoid carcinoma cell line A431 was used. The parent A431 cells (A431/P) and the A431/CDDP2 were exposed to CDDP with or without a caspase family protease inhibitor (Z-Asp-CH2-DCB), and cellular sensitivity to CDDP was determined. DNA fragmentation was then analyzed, and the caspase-3 protein levels determined by Western blotting following exposure of the cells to CDDP with or without Z-Asp-CH2-DCB. Results: In the A431/P cells, the cytotoxicity of CDDP was clearly reduced by Z-Asp-CH2-DCB compared with its cytotoxicity in A431/CDDP2 cells. Furthermore, quantitative analysis of DNA fragmentation revealed that Z-Asp-CH2-DCB inhibited DNA fragmentation induced by CDDP in A431/P cells, but not in A431/CDDP2 cells. Western blotting analysis demonstrated a marked reduction in procaspase-3 protein levels in A431/P cells treated with Z-Asp-CH2-DCB. In the A431/CDDP2 cells, procaspase-3 protein levels were no different with and without Z-Asp-CH2-DCB. Conclusions: These findings suggest that caspase-3 may mediate apoptosis induced by CDDP, and its induction could represent a novel approach to the effective treatment of malignant tumors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002800000145
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    Tumor apoptosis induced by epoxide-containing piperazines, a new class of anti-cancer agents (2000)
    Springer
    Cancer chemotherapy and pharmacology 45 (2000), S. 183-191 
    Details
    ISSN: 1432-0843
    Keywords: Key words Epoxide-containing piperazines ; Apoptosis ; Chemotherapeutics ; AbbreviationsNCO-700 Bis[ethyl(2R,3R)-3-[(S)-3-methyl-1-[4-(2,3,4-trimethoxyphenylmethyl)piperazin-1-ylcarbonyl]butylcarbamoyl]oxirane-2-carboxylate]- sulfate ; TOP-008 Bis[ethyl(2R,3R)-3-[(S)-3-methyl-1-[4(3-phenyl-2-propenyl)piperazin-1-ylcarbonyl]butyl- carbamoyl]oxirane-2-carboxylate]sulfate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: The overall purpose of this study was to determine the potential efficacy of epoxide-containing piperazines as a new class of anti-cancer agents. Two representative compounds, specifically NCO-700, a 4-trimethoxyphenyl-substituted epoxide-piperazine, and TOP-008, a 4-phenylpropenyl-substituted epoxide-piperazine were tested in cytotoxic assays with human breast and prostate cancer cell lines. A second objective was to determine if these two compounds had anti-cancer activity in vivo when tested against xenograft tumors in nude mice or human tumors grown under the kidney capsule in mice. A final objective of this study was to establish if NCO-700 and TOP-008 achieved cancer cell killing through an apoptotic mechanism. Methods: The anti-proliferative activity of NCO-700 and TOP-008 were tested in a 7 day cell-survival assay utilizing a number of well characterized breast (HS-578T, T47D, MCF-7) and prostate (DU-145, PC-3, LNCaP) cancer cell lines. In vivo studies with the two compounds were performed, in nude mice bearing DU-145 xenograft tumors, and in normal mice in which DU-145 prostate cancer cells and HS-578T breast cancer cells were grown as solid tumors in the subrenal capsules of the animals. Apoptotic cell death of cancer cells was determined by a number of established techniques that detect apoptosis, including the confocal laser microscopy of treated cells and mitochondrial leakage assays utilizing the cationic dye, JC-1. Finally, the activation of the caspase cascade, enzymes that carry out apoptosis in mammalian cells, was examined in treated cells by immunoblot assays. Results: NCO-700 and TOP-008 displayed cytotoxicity to HS-578T human breast cancer cells, with ED50 values in the 3–6 μM range. Cytotoxicity to androgen receptor-negative human prostate cancer cells (PC-3 and DU-145 cells) occurred with ED50 values in the 5–20 μM range. Cytotoxicity to hormone receptor-positive breast and prostate cancer cell lines occurred at 10 to 20-fold higher concentrations of the two compounds. When human prostate (DU-145) or breast cancer (HS-578T) cells were grown as solid tumors in the subrenal capsules of mice, significant anti-tumor activity of NCO-700 was observed at 20 mg/kg and 50 mg/kg body weight respectively, for prostate and breast tumors. In nude mice bearing DU-145 prostate tumor xenografts, 50 mg/kg doses of the two compounds either stopped (TOP-008) tumor growth or slowed (NCO-700) growth. The mechanism of cytotoxicity was shown to be through apoptosis, (a) by confocal microscopy studies revealing nuclear fragmentation, (b) by mitochondrial studies revealing disruption of the mitochondrial membrane and release of the cationic dye, JC-1, into the cytoplasm and (c) by protein immunoblot assays indicating that over a 6 h period, TOP-008 induced a significant accumulation of the pro-apoptotic protein, bak, in the mitochondrial fraction of HS-578T human breast cancer cells, accompanied by activation, at 2.5 h, of caspase-3. Conclusions: These studies indicated that the epoxide-containing piperazines, as exemplified by NCO-700 and TOP-008, were effective anti-cancer agents when tested in vitro and in vivo against human breast and prostate tumors. Our studies also indicated that TOP-008 induced the initiation of the caspase cascade leading to apoptosis. Previous toxicology studies in rodents and dogs, as well as a Phase I study in humans, showed NCO-700 to be a well-tolerated, non-toxic compound. Taken together with our current findings, these results suggest that this class of compounds has the potential to be relatively safe, new chemotherapeutic agents for refractory breast and prostate cancers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002800050028
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    Effects of gemcitabine on cell proliferation and apoptosis in non-small-cell lung cancer (NSCLC) cell lines (2000)
    Springer
    Cancer chemotherapy and pharmacology 46 (2000), S. 467-476 
    Details
    ISSN: 1432-0843
    Keywords: Key words Gemcitabine ; Non-small-cell lung cancer ; NSCLC ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We evaluated the antiproliferative and the proapoptotic ability of gemcitabine in three non-small-cell lung cancer (NSCLC) cell lines. NCI-H292 (mucoepidermoid carcinoma), NCI-CorL23 (large-cell carcinoma) and NCI-Colo699 (adenocarcinoma) cells were cultured with and without 0.5, 0.05 and 0.005 μM gemcitabine for 24, 48 and 72 h, respectively. Gemcitabine exerted a stronger and earlier antiproliferative and proapoptotic effect on H292 cells than on CorL23 or Colo699 cells. Fas receptor expression was increased in all three cell lines and was higher in Colo699 than in CorL23 cells. The incubation of NSCLC with anti-Fas agonistic monoclonal antibody (CH11) induced cell apoptosis in H292 cells, demonstrating that the Fas receptor was functionally active. Finally, gemcitabine and CH-11 exerted a synergistic effect on cell apoptosis in H292 cells. This study demonstrates that gemcitabine induces apoptosis in NSCLC and that this effect might be exerted by modulating functionally active Fas expression, and these effects of gemcitabine were stronger in H292 cells than in either CorL23 or Colo699 cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002800000183
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  • 91
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    Signaling events involved in anti-CD20-induced apoptosis of malignant human B cells (2000)
    Springer
    Cancer immunology immunotherapy 48 (2000), S. 673-683 
    Details
    ISSN: 1432-0851
    Keywords: Key words CD20 ; Apoptosis ; Mechanisms ; Lymphomas ; Immunotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Anti-CD20 monoclonal antibodies have been successfully employed in the clinical treatment of non-Hodgkin's lymphomas in both unmodified and radiolabeled forms. Previous publications have demonstrated that the antitumor effects of unmodified anti-CD20 mAb are mediated by several mechanisms including antibody-dependent cellular cytotoxicity, complement-mediated cell lysis, and induction of apoptosis by CD20 cross-linking. In this report, we demonstrate induction of apoptosis by three anti-CD20 monoclonal antibodies [1F5, anti-B1, and C2B8 (Rituximab)]. The magnitude of apoptosis induction was greater with the chimeric Rituximab antibody than with the murine 1F5 and anti-B1 antibodies. Apoptosis could be enhanced with any of the antibodies by cross-linking with secondary antibodies (or Fc-receptor-bearing accessory cells). The signaling events involved in anti-CD20-induced apoptosis were investigated, including activation of protein tyrosine kinases, increases in intracellular Ca2+ concentrations, caspase activation, and cleavage of caspase substrates. Our results indicate that anti-CD20-induced apoptosis can be attenuated by PP1, an inhibitor of protein tyrosine kinases Lck and Fyn, chelators of extracellular or intracellular Ca2+, and inhibitors of caspases, suggesting that anti-CD20-induced apoptosis may involve modulation of these signaling molecules. We also demonstrated that varying the expression of Bcl-2 did not affect the magnitude of anti-B1-induced apoptosis, possibly because of the sequestering effects of other Bcl-2 family members, such as Bad. These studies identify several of the signal-transduction events involved in the apoptosis of malignant B cells that transpire following ligation of CD20 by anti-CD20 antibodies in the presence of Fc-receptor-expressing cells or secondary goat anti-(mouse Ig) antibodies and which may contribute to the tumor regressions observed in mouse models and clinical trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002620050016
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    Noscapine inhibits tumor growth with little toxicity to normal tissues or inhibition of immune responses (2000)
    Springer
    Cancer immunology immunotherapy 49 (2000), S. 217-225 
    Details
    ISSN: 1432-0851
    Keywords: Key words Drug therapy ; T cells ; Apoptosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Noscapine, a phthalideisoquinoline alkaloid derived from opium, has been used as an oral anti-tussive agent and has shown very few toxic effects in animals or humans. Recently, we reported that noscapine binds stoichiometrically to tubulin and promotes microtubule polymerization. Noscapine causes growth arrest of tumor cells in mitosis and induces apoptosis of tumor cells in vitro. Previous experiments also showed that noscapine has potent antitumor activity in mice when administered parenterally or by gastric lavage. Here, we report that the anti-mitotic effect was specific to noscapine since closely related compounds did not inhibit the growth of a lymphoma cell line. In addition, noscapine was shown to be effective in reducing the growth of the lymphoma and increasing the survival of tumor-bearing mice when administered in the drinking water. It is noteworthy that, noscapine showed little or no toxicity to kidney, liver, heart, bone marrow, spleen or small intestine at tumor-suppressive doses. Furthermore, oral noscapine did not inhibit primary immune responses, which are critically dependent upon proliferation of lymphoid cells. Thus, our results indicate that noscapine has the potential to be an effective chemotherapeutic agent for the treatment of human cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002620000109
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    Lasertherapie in der Dermatologie und Ästhetischen Medizin Nebenwirkungen, Komplikationen und Behandlungsfehler (2000)
    Springer
    Der Hautarzt 51 (2000), S. 463-473 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Laser ; Nebenwirkungen ; Komplikationen ; Behandlungsfehler ; Keywords Laser ; Side effects ; Complications ; Treatment faults
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Many different laser systems are used in dermatology. To wisely choose the correct laser for a given problem, one must be aware of both the spectrum of disorders for which each laser is suited and the potential side effects. We compare the side effect and complication profiles of the common laser systems pointing out their possibilities and limitations. Typical treatment errors will be pointed out. Dermatological training, extensive experience in laser therapy and compliance with quality guidelines are prerequisites for safe and successful treatment.
    Notes: Zusammenfassung In der Dermatologie werden unterschiedliche Lasersysteme eingesetzt. Für die Anwender ist nicht nur das jeweilige Behandlungsspektrum von Bedeutung, sondern auch welche unerwünschten Reaktionen im Rahmen einer Laserbehandlung auftreten können. Das Nebenwirkungs- und Komplikationsprofil der gängigen Geräte wird in der vorliegenden Arbeit vorgestellt und verglichen, und deren Möglichkeiten und Grenzen werden dargestellt. Typische Behandlungsfehler werden aufgezeigt. Eine dermatologische Facharztausbildung, umfangreiche lasertherapeutische Erfahrungen sowie die Einhaltung und Erfüllung von definierten Qualitätsrichtlinien sind Voraussetzungen für ein sicheres Behandlungsergebnis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050051155
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    Osteochondroma: MR imaging of tumor-related complications (2000)
    Springer
    European radiology 10 (2000), S. 832-840 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Osteochondroma ; Complications ; Chondrosarcoma ; Bone tumors ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Osteochondromas can be complicated by mechanical irritation, compression or injury of adjacent structures, fracture, malignant transformation, and postoperative recurrence. Magnetic resonance imaging represents the most valuable imaging modality in symptomatic cases, because it can demonstrate typical features of associated soft tissue pathology, which can be differentiated from malignant transformation. Reactive bursae formation presents as an overlying fluid collection with peripheral contrast enhancement. Dislocation, deformation, and signal alterations of adjacent soft tissue structures can be observed in different impingement syndromes caused by osteochondromas. Magnetic resonance imaging provides excellent demonstration of arterial and venous compromise and represents the method of choice in cases with compression of spinal cord, nerve roots, or peripheral nerves, depicting changes in size, position, and signal intensity of the affected neural structures. Malignant transformation as the most worrisome complication occurs in approximately 1 % of solitary and 5–25 % of multiple osteochondromas. Magnetic resonance imaging is the most accurate method in measuring cartilage cap thickness, which represents an important criterion for differentiation of osteochondromas and exostotic (low-grade) chondrosarcomas. Cartilage cap thickness exceeding 2 cm in adults and 3 cm in children should raise the suspicion for malignant transformation. Finally, MR imaging can detect postoperative recurrence by depiction of a recurrent mass presenting typical morphological features of a cartilage-forming lesion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300051014
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    Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip (2000)
    Springer
    European radiology 10 (2000), S. 1329-1331 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Central venous catheters ; Venous obstruction ; Vena cava ; Interventional procedure ; Catheters and catheterization ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300000361
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  • 96
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    Risikofaktoren für das Auftreten von lokalen Komplikationen beim Erysipel (2000)
    Springer
    Der Hautarzt 51 (2000), S. 14-18 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter ; Erysipel ; Komplikationen ; Diabetes mellitus ; Hepatopathien ; Nephropathien ; Key words ; Erysipelas ; Complications ; Diabetes mellitus ; Hepatopathy ; Nephropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background and objective: A complicated course of erysipelas is not uncommon. Bullous, haemorrhagic, necrotic and purulent lesions may be encountered. Today no reliable data exist as to which constitutional factors renders a patient at risk for developing complicated erysipelas though several risk factors, particularly diabetes mellitus, are often suggested. Based on the analysis of patients with erysipelas at the Department of Dermatology in Graz, factors determining the risk for complicated erysipelas should be identified. Patients/Methods: In a retrospective case-control study clinical data sheets of 766 in- patients treated at the department were evaluated with respect to the course of the erysipelas and with respect to potential risk factors. Results: General risk factors for local complications were location at the lower extremities, pre-existing hepatic or renal disease, hyperuricaemia, and diabetes mellitus. Hepatic and renal disease and – to a lesser extent – diabetes particularly predisposed for bullous and haemorrhagic lesions, while vascular occlusive disease enhanced the risk for ne- crotic lesions. Conclusions: Location and hepatic and renal disease are the most important risk factors, while diabetes is probably of less significance than previously suggested.
    Notes: Zusammenfassung Hintergrund und Fragestellung: Im Zuge eines Erysipels treten immer wieder Lokalkomplikationen (Blasen, Hämorrhagien, Nekrosen, Abszesse) auf. Derzeit gibt es keine verlässlichen Daten darüber, aufgrund welcher Merkmale ein Patient als komplikationsgefährdet einzustufen ist, wobei aber verschiedene Risikofaktoren, insbesondere Diabetes mellitus, vermutet werden. Anhand des Patientenguts der Grazer Hautklinik sollten klinische Risikofaktoren für einen komplizierten Erysipelverlauf erhoben werden. Patienten/Methodik: In einer retrospektiven Fall-Kontroll-Studie wurden von 766 Patienten, die in den Jahren 1986–1995 wegen eines Erysipels stationär behandelt worden waren, klinische Daten hinsichtlich Erysipelverlauf und möglicher Risikofaktoren erhoben und statistisch ausgewertet. Ergebnisse: Das Risiko eines komplizierten Erysipelverlaufs wird allgemein durch Lokalisation am Bein, durch Leber- und Nierenerkrankungen, Hyperurikämie und durch einen Diabetes mellitus erhöht. Lebererkrankungen und – in geringerem Maße Diabetes – disponieren speziell zu bullösen und hämorrhagischen Verläufen, eine periphere arterielle Verschlusskrankheit zu nekrotischen Läsionen. Schlussfolgerungen: Betroffene Körperregion sowie Leber- und Nierenerkrankungen scheinen die wichtigsten Risikofaktoren zu sein, während der Diabetes mellitus möglicherweise eine geringere Rolle spielt, als bisher angenommen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050050004
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  • 97
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    Electronic Resource
    Sleep-related breathing disorders following discharge from intensive care (2000)
    Springer
    Intensive care medicine 26 (2000), S. 426-433 
    Details
    ISSN: 1432-1238
    Keywords: Key words Outcomes ; Hypoxaemia ; Sleep-related breathing disorders ; Obstructive sleep apnoea ; Central sleep apnoea ; Mechanical ventilation ; Complications ; Intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To determine the incidence of sleep-related breathing disorders and nocturnal hypoxaemia in patients discharged from ICU following prolonged mechanical ventilation.¶Design: Prospective, consecutive patient observational study.¶Setting: The medical and surgical wards of a University Hospital.¶Patients and participants: Fifteen consecutive, adult patients discharged from the ICU who had received more than 48 h of mechanical ventilation were studied. Ten healthy volunteers acted as controls.¶Measurements and results: Overnight, multi-channel pneumographic studies were performed on all patients and controls. Chest and abdominal wall movement, air flow, oxygen saturation and snoring were continuously recorded. Data was analysed by both visual inspection of the traces and by computer-based algorithms. An apnoea/hypopnoea index was calculated for each patient and volunteer. Volunteers had an apnoea/hypopnoea index of less than 5 and had no episodes of nocturnal oxygen desaturation (SaO2 〈 90 %). Despite oxygen therapy 13/15 patients had episodes of desaturation and 9/15 spent more than 2 h with an SaO2 〈 90 %. Eleven patients had an abnormal apnoea/hypopnoea index (range 5–34 events/h). Four patients had predominantly obstructive events while 7 primarily had hypopnoeas.¶Conclusions: Significant overnight oxygen desaturation is common in patients discharged from ICU who have received prolonged mechanical ventilation. This group also has a significant incidence of sleep-related breathing disorders and this mechanism is likely to be important in the pathogenesis of the hypoxaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051177
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  • 98
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    Electronic Resource
    Translaryngeal tracheostomy: two modified techniques versus the basic technique – early experience in 75 critically ill adults (2000)
    Springer
    Intensive care medicine 26 (2000), S. 457-461 
    Details
    ISSN: 1432-1238
    Keywords: Key words Tracheostomy: percutaneous, translaryngeal ; Complications ; Oxygenation ; Intensive care medicine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: Elective tracheostomy is an established procedure in the management of ICU patients on long-term ventilation. In addition, percutaneous tracheostomy techniques are increasingly being used. In 1997, Fantoni's translaryngeal technique (TLT), another minimally invasive procedure, was introduced. While clinical studies of TLT showed that the technique is safe and can be performed rapidly, technical difficulties which sometimes led to prolonged operating times were also noted. Our study compared the basic TLT technique to a modified TLT approach and to TLT performed with the manufacturer's new, improved “Straight Cannula” set. Twenty-five patients were enrolled in each group, and the advantages and disadvantages of the respective techniques were evaluated.¶Setting: Surgical ICU of a university hospital.¶Patients: Seventy-five adult, surgical intensive care patients.¶Measurements and results: Average operating times with the modified TLT techniques were significantly shorter, 4 and 5 min respectively, as compared to 11 min for the basic TLT technique. Initially, use of the new, improved TLT set resulted in a complete passage of the tracheal cannula in two patients; uneventful Griggs's tracheostomy was performed instead. Regardless of the technique used, no other perioperative complications were noted and the perioperative gas exchange remained unaffected by the tracheostomy procedure.¶Conclusions: The modified TLT procedures are safer and more readily performed than the basic technique. Difficulty in the retrograde passage of the guide wire was seen only occasionally with the modified techniques. Based on our data we conclude that the modified techniques are superior to the basic technique and represent significant progress in TLT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051181
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  • 99
    Electronic Resource
    Electronic Resource
    Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia (2000)
    Springer
    Intensive care medicine 26 (2000), S. 942-949 
    Details
    ISSN: 1432-1238
    Keywords: Key words Ventilator-associated pneumonia ; Cardiac surgery ; Children ; Pediatric intensive care ; Complications ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children.¶Methods: Cohort study in a pediatric intensive care unit of a tertiary referral center. All patients who had cardiac operations during a 22-month period and who survived surgery were eligible (n = 272, median age 1.3 years). Primary outcome was time to successful extubation. Primary variable of interest was VAP. Surgical procedures were classified according to complexity. Cox proportional hazards models were calculated to adjust for confounding. Potential confounders comprised other known risk factors for delayed extubation.¶Results: Median time to extubation was 3 days. VAP occurred in 26 patients (9.6 %). The rate of VAP was not associated with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P = 0.23). The adjusted analysis revealed as further factors associated with delayed extubation: other respiratory complications (n = 28, chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic support (n = 48, 17.6 %), and the need for secondary surgery (n = 51, 18.8 %; e. g., re-operation, secondary closure of thorax). Older age promoted early extubation. The median delay of extubation attributable to VAP was 3.7 days (hazards ratio HR = 0.29, 95 % CI 0.18–0.49), exceeding the effect size of secondary surgery (HR = 0.48) and other respiratory complications (HR = 0.50).¶Conclusion: VAP accounts for a major delay of extubation in pediatric cardiac surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051285
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  • 100
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    Electronic Resource
    Operative or endovascular treatment of ruptured intracranial vertebral artery aneurysms? (2000)
    Springer
    Neuroradiology 42 (2000), S. 685-691 
    Details
    ISSN: 1432-1920
    Keywords: Key words Aneurysm, vertebral artery ; Haemorrhage, subarachnoid ; Surgery ; Embolisation ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Our purpose was to evaluate the surgical and endovascular treatment outcomes of ruptured intracranial vertebral artery aneurysms (RIVAA). The outcomes of 44 patients with RIVAA treated between 1983 and 1998 surgically (26), endovascularly (20) or both (2) were evaluated. The aneurysms were clipped in 24 patients, and clipped and wrapped in two. We treated 20 by the endovascular approach, 12 with Guglielmi detachable coils (GDC), and eight by parent-vessel occlusion using detachable balloons. Three patients had endovascular treatment after a failed or inadequate surgical attempt. Post-treatment follow-up was 17–183 months (mean 101 months) for surgically treated patients. For the GDC-treated group angiographic follow-up was carried at 8–49 months (mean 19 months). The condition of seven (27 %) of the surgically treated patients worsened due to procedure-related complications, compared with 10 % in the endovascular treatment group. Of the patients initially presenting with Hunt and Hess grade IV or V, three of five (60 %) died who were treated surgically and two of eight (25 %) who were treated endovascularly. A good outcome was achieved in 17 surgically treated patients (85 % of the survivors) and in 16 of the endovascular group (89 % of the survivors). This present “same-site” report on treatment of a specific abnormality, RIVAA, treated surgically or by an endovascular approach indicates that especially in poorer Hunt and Hess grade patients, the latter may offer a clinical outcome as good as that of surgery, although long-term efficacy of GDC treatment is still to be determined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000378
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