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  • Electronic Resource  (320)
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  • 2000-2004  (320)
  • Magnetic resonance imaging  (158)
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  • Electronic Resource  (320)
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  • 1
    Electronic Resource
    Electronic Resource
    Analysis of the Anatomic Changes in the Thoracic Cage After a Lung Resection Using Magnetic Resonance Imaging (2000)
    Springer
    Surgery today 30 (2000), S. 879-885 
    Details
    ISSN: 1436-2813
    Keywords: Key words Lung lobectomy ; Magnetic resonance imaging ; Left ventricular geometry ; Mediastinum ; Diaphragm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The thoracic cage after a lung resection is filled by the remaining lobes, the elevated diaphragm, the diminished thoracic cage, and by mediastinal shifting. The changes in the thorax after a lung resection were quantified using magnetic resonance imaging. The study group consisted of 39 patients who had undergone a lobectomy, four who had undergone a pneumonectomy, and 14 controls. The left ventricular angle, ascending aortic angle, mediastinal shift, longitudinal length of the thoracic cage, the distance between the thoracic apex and the level of the aortic valve, and diaphragmatic elevation were all measured. After a right lower lobectomy, the mediastinum shifted more rightward than after a right upper lobectomy. The diaphragm became more greatly elevated after a right upper lobectomy than after a right lower lobectomy. When a chest wall resection was added to a right upper lobectomy, the mediastinal anatomical changes decreased. After a left upper lobectomy, the degree of mediastinal shifting was greater than after a left lower lobectomy. A left upper lobectomy shifted the mediastinum at the level of the right atrium. This method is easily reproducible and was found to be effective for quantifying the changes in the thorax after a lung resection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950070038
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  • 2
    Electronic Resource
    Electronic Resource
    Age as a determinant of severity of dental fluorosis in children residing in areas with 0.5 and 2.5 mg fluoride per liter in drinking water (2000)
    Springer
    Clinical oral investigations 4 (2000), S. 157-161 
    Details
    ISSN: 1436-3771
    Keywords: Key words Age ; Children ; Dental fluorosis ; Severity ; Tooth eruption
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The purpose of this study was to investigate the influence of age on the severity of dental fluorosis in children exposed to drinking water with either low or high fluoride concentrations. The children selected for this study were aged 10–14 years, with 28 permanent teeth and at least 1 tooth pair with fluorosis. The children were permanent residents of districts in western Uganda with either 0.5 mg (n=33) or 2.5 mg fluoride/l in drinking water (n=186). All vestibular tooth surfaces were examined for fluorosis using the modified Thylstrup and Fejerskov (TF) index. In the high fluoride community, the proportion of teeth per child with TF scores ≥4, and ≥5 was significantly higher among children aged 13–14 years compared to those aged 10–12 years. Children’s chronological age correlated positively and significantly with the median TF scores for all teeth, including early erupting (first molars and incisors) and late erupting teeth (canines, premolars and second molars). In linear regression analyses, the median TF score for all teeth, as well as for early erupting and late erupting teeth, increased significantly with age. On the other hand, in the low fluoride community there was no significant association between age and the severity of fluorosis. This study showed a significant increase in the severity of fluorosis with increasing age in a high fluoride community, whereas no change in severity with age was observed in a low fluoride community.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010677
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  • 3
    Electronic Resource
    Electronic Resource
    Diagnostisches und therapeutisches Management von Begleitverletzungen beim komplexen Beckentrauma (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 28-38 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Beckenverletzung ; Begleitverletzung ; Diagnostik ; Therapie ; Algorithmus ; Keywords ; Pelvic trauma ; Concomitant lesions ; Diagnosis ; Therapy ; Algorithm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The injuries that typically accompany pelvic fractures are lesions of the urogenital tract, the lumbosacral plexus, and the retroperitoneal and intra-abdominal organs. The prognosis depends heavily on early recognition of the abdominal- and retroperitoneal injuries, which are frequently a primary threat to vital functions. Missing these injuries would be very serious, as the mortality with early diagnosis and adequate treatment is normally low; according to the results reported in the literature, delayed therapy leads to increasing mortality rates of up to 80%. Experience in trauma centres has shown that for complete ascertainment of accompanying injuries it is necessary to perform a systematic diagnosis according to a fixed algorithm. The treatment of the concomitant injuries accompanying a complex pelvic trauma is fundamentally different from the treatment of patients with isolated injuries. A high survival rate with a low postoperative complication rate cannot be achieved except with specialist surgical management tailored to the primary life-threatening lesions. After determination and recording of the injury pattern a therapy concept must be made at once. A trauma algorithm can be helpful when treatment is selected. Step-by-step treatment with several operative phases alternating with recovery and stabilization periods under intensive care conditions has proved worthwhile.
    Notes: Typische Begleitverletzungen von Beckenfrakturen sind Verletzungen des Urogenitaltrakts, des Plexus lumbosacralis und intraabdominaler Organe. Entscheidend für die Prognose ist das rechtzeitige Erkennen v. a. der häufig primär vital gefährdenden Abdominal- und Retroperitonealverletzungen. Das Übersehen dieser Verletzungen ist besonders tragisch, da bei rechtzeitiger Diagnostik und adäquater Versorgung die Letalitätsrate in der Regel gering ist; bei verzögerter Therapie resultieren nach den Angaben in der Literatur Letalitätsraten bis zu 80%. Die Erfahrung in Traumazentren hat gezeigt, dass zur vollständigen Erfassung der Begleitverletzungen die systematische Diagnostik nach einem festgelegten Algorithmus erfolgen sollte. Die Behandlung der Begleitverletzungen im Rahmen eines komplexen Beckentraumas unterscheidet sich prinzipiell von der bei Monoverletzten. Voraussetzung für eine hohe Überlebensrate mit geringer postoperativer Komplikationsrate ist ein prioritätenorientiertes chirurgisches Vorgehen. Nach Erfassung des Verletzungsmusters muss bereits initial ein Therapiekonzept erstellt werden. Zur Entscheidungsfindung kann ein Traumaalgorithmus herangezogen werden. Es hat sich eine abgestufte Versorgung mit mehreren operativen Phasen und zwischengeschalteten Erholungs- und Stabilisierungsphasen unter Intensivbedingungen bewährt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390050088
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  • 4
    Electronic Resource
    Electronic Resource
    Komplexverletzung des Schultergürtels (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 240-248 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Komplexe Schultergürtelverletzung ; Diagnostik ; Therapie ; Interdisziplinäres ¶Management ; Keywords ; Complex shoulder girdle trauma ; Diagnosis ; Therapy ; Interdisciplinary management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The particular injury pattern of complex joint trauma means that a standardized operative procedure would be difficult to devise and an individual therapy plant is therefore essential for each patient. One of the main problems consists in the recognition and adequate treatment of associated vascular and neural lesions. The treatment of a complex joint trauma makes extremely high demands on the trauma-team in terms of both diagnostis and therapy and is an interdisciplinary challenge. On the basis of a detailed literature search and evaluation of the procedures we have adopted in sample cases, we suggest an algorithm for interdisciplinary management of severe combination injuries of the shoulder region.
    Notes: Die Problematik des komplexen Gelenktraumas besteht darin, dass aufgrund des besonderen Verletzungsmusters ein standardisiertes operatives Vorgehen erschwert und deshalb ein individuelles Therapiekonzept essenziell ist. Ein Hauptproblem besteht in ¶der Erkennung und der adäquaten Behandlung assoziierter Gefäß- und Nervenläsionen. Die Behandlung eines komplexen Gelenktraumas stellt höchste diagnostische und therapeutische Ansprüche an das Traumateam und bedeutet eine interdisziplinäre Herausforderung. Aufgrund einer eingehenden Literaturrecherche und der Auswertung des eigenen Vorgehens anhand exemplarisch ausgewählter Fälle wird versucht, einen Algorithmus der interdisziplinären Komplexversorgung schwerer Kombinationsverletzungen der Schulterregion zu erstellen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/
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  • 5
    Electronic Resource
    Electronic Resource
    Was man über die kindliche Fraktur des Ellbogengelenks wissen sollte (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S51 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Ellbogenverletzungen ; Wachstumsalter ; Diagnostik ; Therapie ; Key words ; Ellbow joint injuries ; Adolescence ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Fractures and dislocations of the elbow are some of the most common injuries in childhood and adolescence. The majority occur in the course of sport and play, for example as the result of falling from apparatus used in gymnastics or a bike, or falling while engaging in such popular sports as in-line-skating or skateboarding. Elbow injuries can be divided into dislocations of the joint alone and fractures, of the distal humerus or the proximal radius and ulna, or combinations of both dislocation and fracture. In addition, a differentiation is made between extra- and intraarticular fracture types, the latter being seen as either partial or complete joint lesions.
    Notes: Zusammenfassung Luxationen und/oder Frakturen am Ellbogen gehören zu den häufigsten Verletzungen im Wachstumsalter überhaupt. Sie entstehen überwiegend bei Sport und Spiel, z. B. durch Sturz von einem Turngerät, von Zweirädern oder während der Ausübung moderner Sportarten wie In-line-Skating, Rollschuhlauf und Skateboardfahren. Bei den Verletzungen werden reine Luxationen von Frakturen entweder am körperfernen Oberarmende oder an den gelenkbildenden Anteilen von Radius und Ulna unterschieden. Ein weiteres Unterscheidungsmerkmal ist die Abgrenzung extraartikulärer von intraartikulären Frakturformen, wobei letztere entweder als partielle oder komplette Bruchform imponieren.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014924
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  • 6
    Electronic Resource
    Electronic Resource
    Stumpfe Schultergelenkverletzungen und ihre Begutachtung (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S186 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Schultergürtel ; Stumpfe Verletzungen ; Rotatorenmanschettenruptur ; Schulterluxation ; Therapie ; Keywords Shoulder girdle ; Blunt injuries ; Rupture of rotator cuff ; Shoulder dislocation ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract It is difficult to assess blunt injuries in the region of the shoulder girdle because of the overlying acute and chronic processes. In assessments of rotator cuff ruptures in particular, in over 50% of cases the rupture could be explained by a degenerative process. This makes the assessment difficult, and also the decision as to whether or not the injury is due to an occupational accident. The diagnostic procedures applied should exclude a degenerative aetiology immediately after an accident in all cases. Rupture of the rotator cuff is often associated with an impingement syndrome and leads to corresponding symptoms in the subacromial space. Treatment of a rotator cuff rupture always involves a diagnostic arthroscopy as the first step, after which a reconstruction can be undertaken, either by way of the anterolateral approach after Neer or, in many cases, arthroscopically. Reconstruction of the rotator cuff must include outward mobilization of the muscles and a secure, mostly transosseous suture. Transference of a pedunculated tendon is indicated for large defects in the rotator cuff. In the case of dislocation of the shoulder with subsequent shoulder instability degenerative change and any possible multidirectional instability should be defined. Unidirectional instability with a demonstrable Bankart lesion has a good prognosis when surgery is performed without delay. In view of the high recurrence rate early treatment is indicated especially in young persons and in patients with a high activity level. Following detection of the Bankart lesion an arthroscopic procedure with refixation of the capsule–labrum complex is the method of choice.
    Notes: Zusammenfassung Stumpfe Verletzungen im Bereich des Schultergürtels sind aufgrund einer Überlagerung akuter und chronischer Prozesse schwer beurteilbar. Insbesondere bei der Beurteilung der Rotatorenmanschettenruptur ist diese nachweislich in über 50% der Fälle auf dem Boden eines degenerativen Prozesses begründet. Dies macht die Begutachtung und die Abgrenzung eines Arbeitsunfalls schwierig. Die Diagnostik sollte auf jeden Fall unmittelbar nach einem Unfall eine degenerative Genese abgrenzen. Zusätzlich muss die Schmerzsymptomatik gezielt untersucht und von vertebragenen Beschwerden abgegrenzt werden. Die Rotatorenmanschettenruptur geht häufig mit einem Impingementsyndrom einher und führt zu entsprechenden Beschwerden im Subakromialraum. Die Behandlung der Rotatorenmanschettenruptur beinhaltet immer im ersten Schritt ¶eine diagnostische Arthroskopie, anschließend kann entweder über den anterolateralen Zugang nach Neer oder in vielen Fällen auch arthroskopisch eine Rekonstruktion vorgenommen werden. Die Rekonstruktion der Rotatorenmanschette muss eine ausgiebige Mobilisation der Muskulatur und eine ¶sichere, meist transossäre Naht beinhalten. Der gestielte Sehnentransfer ist bei großen Defekten der Rotatorenmanschette angezeigt. Bei der Schulterluxation mit anschließender Schulterinstabilität sind ebenfalls ¶eine degenerative Veränderung und eine mögliche multidirektionale Instabilität abzugrenzen. Bei unidirektionaler Instabilität mit nachweisbarer Bankart-Läsion ist die Prognose bei unmittelbarer operativer Versorgung gut. Gerade beim jungen Menschen und bei Patienten mit hohem Aktivitätsniveau ist aufgrund der hohen Reluxationsrate ein frühes Vorgehen angezeigt. Nach Nachweis der Bankart-Läsion ist ein arthroskopisches Vorgehen mit Refixation des Kapsel-Labrum-Komplexes die Methode der Wahl.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014885
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  • 7
    Electronic Resource
    Electronic Resource
    Psychische Beeinträchtigungen als Unfallfolgen aus ärztlicher Sicht (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S456 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Trauma ; Akute Belastungsstörung ; Posttraumatische Belastungsstörung ; Therapie ; Medizinische Begutachtung ; Keywords Trauma ; Acute stress disorder ; Posttraumatic stress disorder ; Therapy ; Medico-legal expertise
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract ‘Psychopathology after trauma’ mostly refers to cognitive or affective impairment after direct or indirect damage to brain tissue. Patients who have suffered a whiplash injury of the cervical spine, even without direct trauma to brain tissue, also often complain of cognitive or affective dysfunction for prolonged periods after the injury. Even more difficult to evaluate is psychopathology arising in the aftermath of severely distressing events, such as major disastrous accidents, natural catastrophes or assault. The medical expert must be aware of a variety of posttraumatic psychiatric disorders with different courses and symptoms and must be able to distinguish these from endogenous or merely coincident psychiatric disorders. In this paper, we outline the relevant diagnoses and diagnostic criteria, with special refrence to posttraumatic stress disorder (PTSD). It should be emphasized that while acute stress disorder is common after stressful experiences, PTSD is most likely to develop in the presence of personality traits or a concurrent psychiatric illness predisposing to the disorder. The nature of the trauma sustained is significant: for example, trauma inflicted by human aggression causes PTSD significantly more often than similar injuries suffered as the result of a motor vehicle accident. Finally, therapeutic strategies for posttraumatic disorders are briefly reviewed.
    Notes: Zusammenfassung Mit posttraumatischen psychischen Störungen sind in der Regel kognitive oder affektive Beeinträchtigungen in der Folge direkter oder indirekter Hirngewebeschäden gemeint. Aber auch Patienten mit Halswirbelsäulenschleudertrauma beklagen häufig und über lange Zeit kognitive oder affektive Störungen ohne Nachweis einer Hirnschädigung. Noch problematischer sind psychische Störungen in der Folge erheblich belastender Ereignisse, wie Unfälle katastrophalen Ausmaßes, Naturkatastrophen oder Überfällen, zu beurteilen. Dem ärztlichen Gutachter obliegt die Aufgabe, eine Reihe posttraumatischer Störungen, die sich hinsichtlich des Verlaufs und der Symptome unterscheiden, zu kennen und von anlagebedingten oder koinzidierenden psychischen Störungen zu differenzieren. In der vorliegenden Arbeit werden die relevanten Diagnosen ¶und diagnostischen Kriterien mit besonderer Behandlung der posttraumatischen Belastungsstörung (PTSD) besprochen. Hervorzuheben ist, dass es nach erheblich belastenden Erlebnissen recht häufig zu akuten Belastungsreaktionen kommt, während die PTSD in der Regel dann auftritt, wenn eine besondere persönliche Disposition oder psychiatrische Komorbidität vorliegen. Ferner kommt der Art des belastenden Erlebnisses Bedeutung zu. So wird eine PTSD häufiger nach Ausbrüchen menschlicher Aggression als nach z. B. Verkehrsunfällen gefunden. Abschließend wird ein kurzer Überblick über therapeutische Möglichkeiten bei posttraumatischen Störungen gegeben.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014970
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  • 8
    Electronic Resource
    Electronic Resource
    Arthroskopische Behandlung der traumatischen Schulterinstabilität (akut – chronisch) (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S400 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Schulterinstabilität ; Arthroskopische Stabilisierung ; Therapiestrategie ; Akut ; Chronisch ; Keywords Instability of the shoulder ; Arthroscopic repair ; Therapy ; Acute ; Chronic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Traumatic instability of the shoulder has to be distinguished from instability due to capsular hyperlaxity if a stable shoulder and good functional results are to be achieved after surgery. Physical examination, radiological studies and arthroscopy are the most important diagnostic tools for this distinction. On the basis of our own experience and the results reported in the literature, we propose a strategy of patient selection for an arthroscopic stabilizing procedure. This procedure is indicated for first-time, traumatic dislocation and for chronic instability with a history of fewer than five recurrences without hyperlaxity.
    Notes: Zusammenfassung Die traumatische Schulterinstabilität muss von der Instabilität aufgrund hyperlaxer Kapsel-Band-Strukturen unterschieden werden, um dem therapeutischen Ziel einer stabilen und in ihrer Funktion nicht gestörten Schulter nahe zu kommen. Hierzu sind die klinische, radiologische und arthroskopische Diagnostik entscheidend. Auch der Enstehungsmechanismus und die Häufigkeit der Luxationen müssen berücksichtigt werden. Aufgrund der bisher gemachten Erfahrung und den in der Literatur verfügbaren Ergebnissen entstand eine Therapiestrategie der traumatischen Schulterinstabilität, die in Abhängigkeit von der präoperativen Reluxationsrate, den anatomischen Gegebenheiten und dem Anspruch des Patienten eine Selektion für oder wider eine arthroskopische Stabilisierungsoperation vorschlägt. Die Indikation zu diesem Eingriff sehen wir bei der traumatischen Erstluxation und der rezidivierenden traumatischen Schulterinstabilität ohne Hyperlaxität, wenn weniger als 5 Rezidive in der Anamnese zu erheben sind.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014955
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  • 9
    Electronic Resource
    Electronic Resource
    Die ausgedehnte venös-aneurysmatische Malformation der V. poplitea (2000)
    Springer
    Gefässchirurgie 5 (2000), S. 188-191 
    Details
    ISSN: 1434-3932
    Keywords: Schlüsselwörter Venöses Poplitealaneurysma ; Differentialdiagnose ; Knieschmerz ; Therapie ; Keywords Popliteal venous aneurysm ; Differential diagnosis ; Knee pain ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract  A rare cause of painful swelling of the knee cavity can be an aneurysm of the popliteal vein. Only 28 cases are reported in the literature. We treated a 20-year-old male patient who underwent three arthroscopies, one operation and one MRI; finally, phlebography detected a popliteal vein aneurysm and a malformation of the deep venous system of the popliteal and proximal calf veins. To avoid the threat of pulmonary embolism a resection of the aneurysm with interposition of a venous autograft was performed. Twelve months after the operation the patient is free of symptoms with a patent autograft.
    Notes: Zusammenfassung  Eine seltene Ursache schmerzhafter Schwellungen in der Kniekehle kann ein Aneurysma der V. poplitea sein. Bisher wurden 28 Fälle dieser Fehlbildung in der Weltliteratur beschrieben. Wir sahen einen 20-jährigen männlichen Patienten, bei dem nach 3 Arthroskopien, einer Arthrotomie und einer MRT durch eine Phlebographie ein venöses Aneurysma der V. poplitea mit venös-aneurysmatischer Malformation der proximalen Unterschenkelvenen festgestellt wurde. Um eine potentiell tödliche Lungenembolie zu vermeiden, erfolgte die Resektion mit Interposition der kontralateralen gedoppelten V. saphena magna. 12 Monate nach der Operation hat der Patient bei duplexsonographisch gutem Flow im Interponat keine Beschwerden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010592
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  • 10
    Electronic Resource
    Electronic Resource
    Gelenkfortsatzfrakturen (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S110 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Unterkiefer ; Gelenkfortsatzfrakturen ; Diagnostik ; Therapie ; Key words ; Mandible ; Condylar neck fracture ; Diagnostic ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Among mandibular fractures, those of the condylar neck hold a special position due to the exceptional anatomical situation. Computer assisted tomography and magnetic resonance tomography have improved diagnostic evaluation. Indication for surgical treatment is given in cases of severely displaced or dislocated fractures. In surgical management, the preauricular, submandibular, retromandibular, and oral approach have been established. For sufficient fixation of fragments, procedures rendering a functional stability, like osteosynthesis with lag screw or by miniplating, are required.
    Notes: Zusammenfassung Die Gelenkfortsatzfrakturen nehmen aufgrund der besonderen anatomischen Situation eine Sonderstellung innerhalb der Unterkieferfrakturen ein. Die Computertomographie und das MRT haben die Diagnostik wesentlich verbessert. Die Indikation zur operativen Behandlung besteht bei stark dislozierten oder luxierten Frakturen. Als operativer Zugang sind der präaurikuläre-, sub- bzw. perimandibuläre, retromandibuläre und orale Zugang etabliert. Zur Fixation der Fragmente sollten ausschließlich funktionsstabile Verfahren, wie die Miniplatte oder Zugschraube verwendet werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014531
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  • 11
    Electronic Resource
    Electronic Resource
    Malignes Melanom der Kopf-Hals-Region (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S177 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Malignes Melanom ; Inzidenz ; Diagnostik ; Therapie ; Key words ; Malignant melanoma ; Incidence ; Diagnostic procedure ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Malignant melanoma is one of the most frequent malignancies of the skin. This is particularly true of malignant melanoma in juveniles. Its incidence has more than doubled from the 1970s to the mid-1990s. Presently, 15 new cases are recorded per 100,000 inhabitants a year in Germany. At Fachklinik Hornheide, a tumor center specializing in skin neoplasm with patients being referred from all over Germany, the number of melanoma patients treated per year has been approximately 500–¶550 for the past 10 years. In the present study, the state-of-the-art therapy for primary melanoma and treatment of the regional lymph node system is discussed. The radical treatment formerly advocated with wide tumor resection plus radical neck dissection is no longer justified for this immunogenic malignant tumor caused by endogenic as well as exogenic factors. “Sentinel lymph node” imaging by means of radioactive substances for diagnosing possible melanoma metastases in adjacent lymph nodes has changed the therapeutical concept. Tumor staging by means of ultrasound, CT, MRT, or PET allows the differentiation of tumors without distant metastases and a favorable prognosis, from melanomas which have to be considered as generalized disease. In addition to surgical resection of the tumor and neck dissection for removal of lymph nodes, adjuvant immunotherapy with interferon-α is capable of prolonging survival without a recurrence. Palliative chemotherapy or immunotherapy are valuable options for cases with generalized melanoma. Vaccination with a melanoma-associated antigen or dendritic cells is at an experimental stage and may become part of future treatment strategies.
    Notes: Zusammenfassung Das maligne Melanom gehört, insbesondere in jugendlichen Altersgruppen, zu den häufigsten malignen Tumoren der Haut. Seine Inzidenz hat sich von den 70er Jahren bis zur Mitte der 90er mit etwa 15 Fällen/¶100.000 Einwohnern und Jahr mehr als verdoppelt. In der Fachklinik Hornheide, einer Tumorklinik der Haut mit bundesweiten Zuweisungen, hat sich dagegen im letzten Jahrzehnt die Zahl der behandelten Patienten auf etwa 500–550 Fälle pro Jahr stabilisiert. Die vorliegende Arbeit soll den aktuellen Standard der Therapie der Primärtumoren und der regionären Lymphabflussregion darstellen. Dabei soll vermittelt werden, dass das frühere radikale Behandlungskonzept mit großflächigen lokalen Tumorresektionen und einer radikalen Ausräumung aller Lymphknotenstationen des Halses diesem immunogenen bösartigen Tumor, dessen Entwicklung teils endogenen und teils exogenen Faktoren unterliegt, nicht mehr gerechtfertigt ist. Schon im Bereich der Diagnostik der fraglichen lymphogenen Metastasierung des Melanoms hat die Darstellung des „sentinel-lymph-node“ mit radioaktivem Material eine Änderung des Therapiekonzepts erzwungen. Das Tumorstaging mit Hilfe der Sonographie, der CT-, der MRT- und PET-Untersuchungen vermag prognostisch günstige Tumoren ohne Nachweis von Fernmetastasen von solchen Melanomen zu unterscheiden, die als generalisierte Erkrankung zu bewerten sind. Neben der operativen Entfernung des Tumors und der Ausräumung der Lymphknotenstationen des Halses ist in bestimmten Stadien die adjuvante Immuntherapie mit Interferon α geeignet, das rezidivfreie Überleben zu verlängern. Bei einer Generalisierung besteht die Option einer palliativen Chemo- oder Immunochemotherapie. Experimentelle Behandlungsansätze überprüfen den Einsatz von Vakzinierungsstrategien mit melanomassoziierten Antigenen und dendritischen Zellen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014539
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  • 12
    Electronic Resource
    Electronic Resource
    Röntgendiagnostik in der Mund-, Kiefer-, Gesichtschirurgie (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S270 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Röntgendiagnostik ; Panoramaschichtaufnahme ; Strahlenexposition ; Computertomographie ; Kernspintomographie ; Key words ; X-ray diagnostics ; Panoramic X-ray ; Radiation exposure ; Computed tomography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A vital X-ray imaging technique in oral and craniomaxillofacial surgery is the panoramic X-ray. Due to its variety of special projections, including imaging of the transversal level and low exposure to radiation, it is suitable for answering many clinical questions and for diagnostics of various findings. It has become possible to minimize the necessary doses by further development of technology and devices, as well as of X-ray films and by new detection systems, such as sensors or screens. In some clinical cases, the diagnostic deficiencies of conventional imaging techniques make computed tomography (CT) and magnetic resonance (MR) imaging indispensable. Although MR is particularly suitable for soft tissue imaging, it has also become helpful in finding cortical changes by shorter measuring times. In certain cases, e. g., changes to bone metabolism, differentiated methods of nuclear medicine make image-aided analysis of function possible.
    Notes: Zusammenfassung Zentrale Aufnahmeart in der Röntgendiagnostik der Mund-, Kiefer- und Gesichtschirurgie ist die Panoramaschichtaufnahme. Mit ihren zahlreichen Spezialprojektionen einschließlich der Abbildung der Transversalebene ist sie für die Abklärung zahlreicher Fragestellungen mit geringer Strahlenexposition geeignet. Die Verringerung des Dosisbedarfs ist weiterhin durch Fortentwicklungen der Gerätetechnik, der Röntgenfilme und durch neue Detektionssysteme wie z. B. Sensoren oder Speicherfolien möglich geworden. Diagnostische Unzulänglichkeiten der konventionellen Aufnahmearten machen bei zahlreichen klinischen Fragestellungen der Mund-, Kiefer- und Gesichtschirurgie eine Bildgebung mittels Computertomographie und Kernspintomographie unumgänglich. Obgleich die Kernspintomographie v. a. für die Weichteildiagnostik vorrangig geeignet ist, erlaubt sie mittlerweile, aufgrund der Verkürzung der Messzeiten, auch Veränderungen der Kortikalis abzubilden. Bei bestimmten Fragestellungen, wie z. B. Veränderungen des Knochenmetabolismus, ermöglichen differenzierte nuklearmedizinische Verfahren eine abbildungsunterstützte Funktionsanalyse.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014549
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  • 13
    Electronic Resource
    Electronic Resource
    Characterization of Wue-1, a novel monoclonal antibody that stimulates the growth of plasmacytoma cell lines (2000)
    Springer
    Virchows Archiv 437 (2000), S. 372-379 
    Details
    ISSN: 1432-2307
    Keywords: Keywords Monoclonal antibody ; Lymphoma ; Myeloma ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A new monoclonal antibody, Wue-1, which specifically recognizes normal and malignant plasma cells, is characterized. Biochemical studies showed that monoclonal antibodies (mAbs) recognize a protein of 94 kDa. Using triple-staining flow cytometry and double-labeling immunohistochemical techniques, two populations of plasma cells, i.e. lymphoplasmocytoid plasma cells located in the germinal center of lymphoid organs and reticular plasma cells at the paracortex or medullary cords of secondary lymphoid tissues, were distinguished. Wue-1 is expressed when B-cell markers become lost and secretory activity with plasma cell morphology appears. Cell surface markers were identified on normal plasma cells and compared with their malignant counterpart in vivo. Terminal plasma–cellular differentiation of malignant low- and high-grade B-cell lymphoma and anaplastic plasmacytoma, otherwise difficult to identify with conventional B-cell markers on tissue sections or fluorescence-activated cell sorter analyses, were detectable by Wue-1. In cell culture, Wue-1 enhanced the proliferation of myeloma cell lines but not normal plasma cells in a dose-dependent manner. Since Wue-1-induced proliferation was increased by interleukin (IL)-6, Wue-1 recognizes a so far unidentified antigen with functional properties. Therefore, Wue-1 represents a useful new tool for therapy and for the in vivo and in vitro studying of B-cell lymphomas and the mechanisms of B-cell differentiation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000258
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  • 14
    Electronic Resource
    Electronic Resource
    Radiologic anatomy of the spinal dorsal horn at the cervical level (anatomic-MRI correlations) (2000)
    Springer
    Surgical and radiologic anatomy 22 (2000), S. 81-88 
    Details
    ISSN: 1279-8517
    Keywords: Spinal cord ; Dorsal horn ; Magnetic resonance imaging ; Radiologic anatomy ; Dorsal root entry zone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The spinal dorsal horn is known for its important functional role in the field of transmission and modulation of sensory afferents. Because of this, the dorsal horn represents a target for numerous analgesic and antispastic procedures. Thus, it would be interesting to develop imaging dedicated to this spinal structure. The purpose of this study was to investigate the radiologic anatomy of the cervical dorsal horn by magnetic resonance imaging (MRI) (1.5T). The first step consisted in the validation of the anatomic information provided by MRI on 5 human cadavers. A spin-echo sequence (T2, 2000/45) enabled the demonstration of good correlations between histologic sections and axial MRI slices performed at the corresponding cervical levels. The second step was the 〈〈in vivo〈〈 exploration of 20 subjects, aiming at the development of a gradient echo sequence (T2*) with a conventional MRI unit, compatible with a routine clinical examination. The dorsal horn was clearly identified in 77% of the axial slices performed (n = 300). The angle between the dorsal horn axis and the sagittal plane was measured as from 25.5˚ at C2 to 40˚ at C8 segments. The results of this anatomico-radiologic study of the cervical dorsal horn suggest that preoperative MRI could be useful to design the surgical approach to this structure, as performed during cervical microsurgical drezotomy (DREZ = dorsal root entry zone) for the treatment of selected cases of chronic pain or disabling spasticity in the upper limbs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00276-000-0081-8
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  • 15
    Electronic Resource
    Electronic Resource
    Pneumocolography and virtual colonoscopy: its clinical place and development (2000)
    Springer
    Techniques in coloproctology 4 (2000), S. 129-131 
    Details
    ISSN: 1128-045X
    Keywords: Key words Colonscopy ; CT scanning ; Magnetic resonance imaging ; Virtual colonoscopy ; Pneumocolography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Colonoscopy is an invasive technique, frequently incomplete and often poorly tolerated in elderly patients. New, less invasive modalities are being developed to diagnose moderate-sized adenomatous polyps and colorectal caners which involve pneumo- or hydrocolography with high-resolution surface imaging, either by CT or MR scanning. This approach has recently been supplemented by complex image post-processing to provide a form of virtual colonoscopy which takes account of projected colonic direction and which can map for mucosal anomalies. It remains to be seen how sensitive these newer techniques are and whether defined algorithms for colonic representation can be agreed upon which will prove both accurate and cost-effective both in symptomatic and screening populations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101510070002
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  • 16
    Electronic Resource
    Electronic Resource
    Is there a brainstem generator of chronic daily headache? (2000)
    Springer
    The journal of headache and pain 1 (2000), S. 67-71 
    Details
    ISSN: 1129-2377
    Keywords: Key words Chronic daily headache ; Migraine ; Magnetic resonance imaging ; Red nucleus ; Substantia nigra ; Image processing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Using BOLD-fMRI we have previously documented activation of the red nucleus (RN) and substantia nigra (SN) during spontaneously and visually activated migraine headache. These observations prompted us to study brainstem function in chronic daily headache patients using high-resolution magnetic resonance imaging (MRI) techniques. Seventeen chronic daily headache (CDH) patients, ten episodic migraine (EM) patients and fifteen controls (N) were imaged with a 3 tesla MRI system. For each subject, the relaxation rates R2, R2* and R2' were obtained for RN and SN. There was a significant decrease in R2' and R2* values for RN and SN in CDH compared to N and EM groups (p 〈 0.05), but no significant difference between the N and EM groups. A decrease in R2' and R2* indicates reduced deoxyhemoglobin and hence persistent activation of the RN and SN in CDH patients most likely secondary to ongoing headache at the time of study. The imaging data provide objective evidence of disturbed central nervous system function in CDH.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101940070045
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  • 17
    Electronic Resource
    Electronic Resource
    Sleep apnea in childhood migraine (2000)
    Springer
    The journal of headache and pain 1 (2000), S. 169-172 
    Details
    ISSN: 1129-2377
    Keywords: Key words Migraine ; Sleep ; Sleep apnea ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In our previous study we found a high prevalence of disordered sleep breathing in migraine children vs. controls. Since no quantitative studies about sleep respiratory disorders have been carried out in migraine children, we performed a polysomnographic (PSG) study in 10 migraine patients (7 boys, 3 girls; mean age 8.11 years, range, 5.8–14.5) attending the Headache Center of our department, to evaluate the presence of sleep apnea. Mothers completed a headache diary and a sleep diary for at least 1 month and filled out a sleep questionnaire. PSG data showed a normal sleep architecture in 3 cases, an insomnia pattern in 2, a reduction of slow wave sleep in 3 and a reduction of REM sleep in 2. Respiratory analysis revealed that 2 of 10 patients had obstructive sleep apnea. These 2 patients presented habitual snoring and associated sleep disturbances such as restless sleep and hypnic jerks. Sleep apnea may be a subtle and often undiagnosed symptom in several migraine patients. The report of habitual snoring associated with other sleep disturbances such as restless sleep and other parasomnias may be a sign of sleep apnea in migraine children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101940070039
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  • 18
    Electronic Resource
    Electronic Resource
    HLA in migraine and coeliac children (2000)
    Springer
    The journal of headache and pain 1 (2000), S. S173 
    Details
    ISSN: 1129-2377
    Keywords: Key words Coeliac disease ; Headache ; Children ; HLA antigens
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The linkage between HLA antigens and disease susceptibility has been investigated in several diseases. Two different mechanisms are known to act in the relation between the HLA system and headache: linkage and association of alleles. Among neurological disorders associated with coeliac disease (CD) we focused on headache in 1997. From a group of 70 coeliac children, we studied 10 children with headache (3 boys and 7 girls). For each subject we evaluated clinical history and HLA antigens. The incidence of headache was not different with respect to the prevalence of headache in the general population. The HLA setting is not different between the 2 groups examined. However, we highlight 2 cases for the particular HLA setting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101940070014
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  • 19
    Electronic Resource
    Electronic Resource
    Subependymoma of the lateral ventricles (2000)
    Springer
    Neurosurgical review 23 (2000), S. 98-103 
    Details
    ISSN: 1437-2320
    Keywords: Key words Computed tomography ; Magnetic resonance imaging ; Lateral ventricle ; Subependymoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Four subependymomas of the lateral ventricle were reviewed with regard to clinical presentation, neuroimaging features, treatment, histopathological features, and long-term follow-up. There were two male and two female patients ranging in age from 27 to 60 years (mean 48.3 years). While two patients presented with symptoms and signs of raised intracranial pressure, two others were found incidentally during neuroimaging investigations to have intraventricular tumors. Neuroimaging characteristics of these tumors included no paraventricular extension, iso- or hypodensity with minimal enhancement on computerized tomography (CT), or iso- or hypointensity on T1-weighted and hyperintensity on T2-weighted magnetic resonance images (MRI). The usual finding on MRI was of no or scarce contrast enhancement, but one case showed heterogeneous enhancement. Three patients underwent total resection of the tumor and one underwent partial resection. No patients received postoperative radiation therapy. All patients have been doing well 4.8 to 15.4 years (mean 8.8 years), after surgery. Although there are no absolutely specific features to distinguish these tumors from other intraventricular tumors preoperatively, subependymoma should be kept in mind for differential diagnosis, as this tumor may safely be removed without sacrificing contiguous normal tissue and with good long-term results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101430050008
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  • 20
    Electronic Resource
    Electronic Resource
    Preoperative staging of rectal cancer (2000)
    Springer
    International journal of colorectal disease 15 (2000), S. 9-20 
    Details
    ISSN: 1432-1262
    Keywords: Keywords Rectal cancer staging ; Computed tomography ; Endorectal sonography ; Magnetic resonance imaging ; Systematic review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  With the widespread introduction of preoperative radiotherapy for rectal cancer and the development of transanal endoscopic microsurgery for selected early lesions, preoperative radiological staging of these tumours has taken on increasing importance. This study is a systematic review to evaluate computed tomography (CT), endorectal sonography (ES) and magnetic resonance imaging (MRI) as preoperative staging modalities in rectal cancer. A Medline-based search identifying studies using CT, ES, or MRI in preoperative staging of rectal cancer between 1980 and 1998 was undertaken. The list of papers was supplemented by extensive cross-checking of citation lists. Studies were included if they met predetermined criteria. Data from the accepted studies were entered into pooled tables comparing radiological and pathological staging results for each modality both in determining bowel wall penetration and involvement of lymph nodes. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were determined for the pooled results. Eighty-three studies from 78 papers including 4897 patients met the inclusion criteria. In determining the wall penetration of the tumour the values for sensitivity for CT, ES, MRI and MRI with endorectal coil were 78%, 93%, 86% and 89%; for specificity 63%, 78%, 77% and 79%; and for accuracy 73%, 87%, 82% and 84%, respectively. In determining the nodal involvement by tumour the sensitivity values for CT, ES, MRI and MRI with endorectal coil 52%, 71%, 65% and 82%; for specificity 78%, 76%, 80% and 83%; and for accuracy 66%, 74%, 74% and 82%, respectively. MRI with an endorectal coil is the single investigation that most accurately predicts pathological stage in rectal cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050002
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  • 21
    Electronic Resource
    Electronic Resource
    Kinder psychisch kranker Eltern Forschungsperspektiven am Beispiel von Kindern depressiver Eltern (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 164-172 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Psychisch kranke Eltern ; Depressive Eltern ; Entwicklungsbedingungen ; Psychosoziale Bedingungen ; Kinder ; Forschungsprobleme ; Forschungsaufgaben ; Forschungskriterien ; Key words Parents with psychiatric disorders ; Depressive parents ; Developmental conditions ; Psychosocial condition ; Children ; Research problems ; Research tasks ; Research criteria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Children of psychiatrically ill parents represent a risk group that has received growing attention during the last years. The risk for this group to develop a psychiatric illness is markedly increased due to genetic and psychosocial factors. The development of effective preventive concepts requires a thorough knowledge of the psychosocial factors. In this paper, deficits and problems of research in psychosocial transmission mechanisms are discussed taking the example of children of depressive parents. Conclusions from this exemplary considerations may serve as guidelines for future research. The authors suggest that the focus be rather placed on coping strategies and developmental psychopathology. Further, research criteria are formulated that refer to theoretical models as well as to study design.
    Notes: Zusammenfassung Kinder psychisch kranker Eltern stellen in psychiatrischer Hinsicht eine Risikogruppe dar, die in den letzten Jahren zunehmend in den Blickpunkt gerückt ist. Die Wahrscheinlichkeit für psychische Erkrankungen ist bei dieser Gruppe aufgrund von genetischen und psychosozialen Faktoren deutlich erhöht. Die Entwicklung von effektiven Präventionskonzepten setzt eine genaue Kenntnis der psychosozialen Faktoren voraus. In der vorliegenden Arbeit werden Defizite und Probleme bei der Erforschung der psychosozialen Transmissionsmechanismen am Beispiel der Kinder von depressiven Eltern diskutiert, und es werden Schlussfolgerungen herausgearbeitet, an denen sich die künftige Forschung orientieren sollte. Es wird vorgeschlagen, bewältigungsorientierte und entwicklungspsychopathologische Konzepte stärker zu berücksichtigen; darüber hinaus werden Forschungskriterien formuliert, die sich sowohl auf die theoretischen Modelle ebenso wie auf die Untersuchungsdesigns beziehen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050025
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  • 22
    Electronic Resource
    Electronic Resource
    Tibiale Torsionsfehler (2000)
    Springer
    Der Orthopäde 29 (2000), S. 802-807 
    Details
    ISSN: 1433-0431
    Keywords: Schlüsselwörter Unterschenkel ; Torsion ; Tibiatorsion ; Untersuchung ; Therapie ; Kind ; Adoleszente ; Bein ; Entwicklung ; Osteotomie ; Keywords Tibia ; Torsion ; Adolescence ; Child ; Osteotomy ; Diagnosis ; Therapy ; Developmental ; Leg
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Tibial torsion defects are usually not clinically evident and, hence, are often overlooked. Clinical examination and CT scan have proved to be the best ways of measuring static tibial torsion, whereas dynamic measurements are usually performed in the clinic and the “gait laboratory.” Only few studies have determined there to be a connection between a torsion defect in the lower leg and expected pathological conditions of the knee and ankle joints. However, patellofemoral instability, Osgood-Schlatter disease, osteochondrosis dissecans are increasingly being found in cases of increased external tibial torsion and arthrosis in reduced torsion. Although spontaneous correction may occur in certain cases, in others the only way to correct the condition is by employing physiologic torsion. Conservative treatment methods such as bandages or ortheses have been shown to not have any effect on torsion; thus, surgical treatment is the only successful way to correct a pathologic angle of rotation of the tibia. For this, supramalleolar osteotomy with fixation using Kirscher wires and plaster or an external fixator are the most common treatments.
    Notes: Zusammenfassung Tibiale Torsionsfehler sind meistens klinisch nicht sehr evident und werden deshalb häufig übersehen. Zur Messung der statischen Tibiatorsion hat sich am besten die klinische Untersuchung und das CT bewährt, während für die dynamische Messung die Klinik und das Ganglabor zum Einsatz kommen. Es gibt nur wenige Studien, die einen Zusammenhang zwischen einem Torsionsfehler des Unterschenkels (US) und zu erwartenden Pathologien des Knie- und Sprunggelenks nachweisen. Immerhin wurden vermehrt patellofemorale Instabilitäten, Morbus Osgood-Schlatter, Osteochondrosis dissecans bei erhöhter Tibiaaußentorsion und Arthrose bei veminderter Torsion nachgewiesen. Während die Korrektur nach Frakturen in gewissen Fällen spontan erfolgen kann, ist bei andern Ursachen keine Korrektur außer der physiologischen Torsion zu erwarten. Konservative Maßnahmen wie Bandagen oder Orthesen haben nachgewiesenerrmaßen keinen Effekt auf die Torsion, sodass bei pathologischem Drehwinkel der Tibia nur die operative Korrektur zum Erfolg führt. Diese wird meistens in Form einer supramlleolären Osteotomie mit Fixation durch Kirscher-Drähte und Gips oder durch einen Fixateur externe durchgeführt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001320050529
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  • 23
    Electronic Resource
    Electronic Resource
    91 dB Hörverlust – die Schwelle zum “Cochlear Implant”? (2000)
    Springer
    HNO 48 (2000), S. 828-831 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Cochlear Implant ; Resthörige Kinder ; Indikation ; Bildung ; Keywords Cochlear implant ; Children ; Indication ; Education ; Residual hearing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background and objective. Recent indications for cochlear implant in children are bilateral total cochlear deafness and an age of 2 or more. Reports on successful implantations in adults with residual hearing pose the question of whether this indication might be expanded to children with residual hearing. Patients/Methods. In a retrospective analysis of 106 hearing-impaired children with binaural amplification, we were able to ask parents in 90 cases about their children's education. The pure-tone average of the frequencies of 1–4 kHz was correlated to education. Results. The results showed that all children except one with a pure-tone average of ≤90 dB could successfully attend regular school or kindergarten. However, those with a pure-tone average of ≥91 dB had to be educated in special units for children with impaired hearing. Conclusions. Our results indicate that amplification in children with profound hearing loss (pure-tone average ≥91 dB) is not sufficiently effective to enable them to attend regular schools or kindergarten. We conclude that the only chance to integrate these children into the world of hearing might be cochlear implantation.
    Notes: Zusammenfassung Hintergrund und Fragestellung. Die derzeit gültigen Richtlinien zur Indikation eines “Cochlear Implants” (CI) bei Kindern sind eine beidseitige cochleäre Taubheit sowie ein Lebensalter von über 2 Jahren. Berichte über die guten Hörerfolge nach Implantation von resthörigen, nicht tauben Erwachsenen werfen die Frage nach dieser Indikationserweiterung auch bei Kindern auf. Ziel unserer Arbeit war es, die Effizienz der Hörgeräteversorgung von schwerhörigen Kindern an Hand des Bildungsweges zu beurteilen um daraus Schlüsse zur Indikationserweiterung für ein CI zu ziehen. Patienten/Methodik. In einer retrospektiven Analyse von 106 beidseitig schwerhörigen, mit Hörgeräten versorgten Kindern konnte der Bildungsweg durch Befragung der Eltern in 90 Fällen erhoben werden. Ergebnisse. Durch Ermittlung der mittleren Hörschwelle in den Frequenzen 1–4 kHz und Vergleich mit dem Bildungsweg konnte gezeigt werden, dass nahezu alle Kinder (bis auf eines) mit einer Hörschwelle ≤90 dB Regelschulen oder -kindergärten mit Erfolg besuchen konnten. Alle Kinder mit einer Hörschwelle ≥91 dB mussten spezielle Einrichtungen für Hörbehinderte besuchen. Schlussfolgerungen. Da nach unseren Ergebnissen schwerhörige Kinder mit einer mittleren Hörschwelle ≥91 dB trotz Hörgeräteversorgung nicht in der Lage sind, Regelschulen oder -Kindergärten erfolgreich zu besuchen, schließen wir daraus, dass das Hauptziel einer Versorgung, nämlich der Erwerb einer ausreichenden Sprachkompetenz und -Produktion, nur durch ein CI erreicht werden kann.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050669
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  • 24
    Electronic Resource
    Electronic Resource
    Ambulante Rehabilitation nach Cochlear-Implant-Versorgung (2000)
    Springer
    HNO 48 (2000), S. 832-838 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Cochlear Implant ; Ambulante Rehabilitation ; Kinder ; Erwachsene ; Ergebnisse ; Keywords Cochlear implant ; Outpatient rehabilitation ; Cost effectiveness ; Results ; Children ; Adults
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background and objective. This study compares the results of the outpatient-based program of the Cochlear Implant Center Ruhr with inpatient-based rehabilitation, which is almost exclusively performed in Germany. Patients/methods. The Department of Otorhinolaryngology at the University of Essen in Germany provided 52 patients with either 22- or 24-channel Nucleus cochlear implants from March 1996 to July 1999. Almost all patients (n=49) were rehabilitated on an outpatient basis, which is the standard in many cochlear implant centers outside Germany. Results. The longest follow-up period at the University of Essen Department of Otorhinolaryngology was 36 months. Minor complications occurred in 10% of the patients. After 24 months, the first three implanted patients were able to discriminate 100% of numbers and over 60% of syllables in the Freiburg speech discrimination test. The patients who developed an understanding of open speech were able to discriminate 31 words per minute with cochlear implant and without lipreading after 24 months. Children were seen to double their Schmid-Giovannini scores at 6 months postimplantation. Conclusions. The Essen outpatient-based cochlear implant program demonstrates results in speech development and speech understanding equal to those of centers providing inpatient rehabilitation. A special advantage is continuous rehabilitation with professionals known to the child for several years. In children especially, exhaustive commuting reduces school attendance and is a burden on the accompanying guardians. As an inpatient, however, the child is torn from his familiar environment. Parents with several children have particular difficulties in accompanying their child and indeed this may not always be possible.
    Notes: Zusammenfassung Hintergrund und Fragestellung. In dieser Arbeit werden die Ergebnisse der ambulanten Rehabilitation nach Cochlear-Implant-Versorgung mit denen der stationären Rehabilitation verglichen, die bisher in Deutschland fast ausschließlich durchgeführt wird. Von März 1996 bis Juli 1999 wurden an der Universitäts-Hals-Nasen-Ohren-Klinik Essen 52 taube oder an Taubheit grenzende Patienten mit einem 22-kanaligen bzw. 24-kanaligen Nucleuscochlear-Implant versorgt. Fast alle Patienten (n=49) konnten wohnortnah ambulant rehabilitiert werden, wie dies dem internationalen Standard entspricht. Ergebnisse. Der längste bisherige Nachbeobachtungszeitraum an der Universitäts-Hals-Nasen-Ohren-Klinik Essen sind 36 Monate. Nach 2 Jahren wurden von den 3 am längsten nachbeobachteten Patienten 100% der Zahlen und über 60% der Einsilber im Freiburger Sprachtest verstanden. Im “speech tracking” erreichten Patienten mit CI und ohne Lippenabsehen nach 24 Monaten 31 Wörter/min. Die Kinder zeigten 6 Monate nach Implantation eine Verdopplung des Scores im Test nach Schmid-Giovannini. Schlussfolgerungen. Das Essener Modell zeigt, dass eine ambulante Rehabilitation nach CI zu vergleichbaren Ergebnissen in der Sprachentwicklung und im Sprachverstehen führt, wie sie von anderen Zentren vorgelegt wurden, in denen fast ausschließlich stationär rehabilitiert wird. Besonders bei Kindern bedeuten lange Anfahrtswege mit einwöchigem stätionärem Aufenthalt Schulausfälle und eine Belastung für die begleitenden Eltern und Familienangehörigen zu Hause, sowie erhebliche Fahrtkosten. Stationäre Aufenthalte zur Rehabilitation reißen zudem das Kind aus seiner gewohnten Umgebung und sind für Eltern mit mehreren Kindern oft unmöglich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050670
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  • 25
    Electronic Resource
    Electronic Resource
    Angeborene Erkrankungen des Hörvermögens bei Kindern Teil 1: Erworbene Hörstörungen (2000)
    Springer
    HNO 48 (2000), S. 879-886 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Hörstörung ; Prävalenz ; Konnatale Hörstörungen ; Erworbene Hörstörungen ; Progredienz ; Infektionen ; Kinder ; Keywords Hearing loss ; Prevalence ; Connatal hearing loss ; Acquired hearing loss ; Progressive hearing loss ; Infections ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The results of international investigations on connatally acquired hearing loss are compared with the data of the German Registry on Childhood Hearing Loss (4058 cases). The connatal hearing disorders have shown a notable change in the last years regarding to aetiology and prevalence. In contrast to countries of the third world in developed nations the prevalence of permanent childhood hearing loss has been reduced down to 1 in 1.000 births. The results let assume a prevalence of approximately 1:1.200 births in Germany. For instance the number of rubella embryopathia decreased effectively. In contrast CMV infections and alcohol fetopathia are playing an increasing role. In the patients of the German Registry on Childhood Hearing Loss the percentage of certainly progressive hearing loss is 10.3 within the 4058 children with permanent hearing impairment. Diagnostic procedures first of all for the early diagnosis of CMV but also of toxoplasmosis are considerable because these infections may result in treatable hearing loss. Also consequent hearing tests are demanded in children with alcohol fetopathia.
    Notes: Zusammenfassung Im vorliegenden Beitrag werden die Daten internationaler Studien zu angeborenen erworbenen Hörstörungen mit den Ergebnissen aus 4058 Fällen im Deutschen Zentralregister für kindliche Hörstörungen (DZH) verglichen und ausgewertet. Die angeborenen Erkrankungen des Hörvermögens haben innerhalb der letzten Jahre bezüglich Ätiologie und Prävalenz einen deutlichen Wandel erlebt. Im Gegensatz zu Ländern der 3. Welt ist die Prävalenz permanenter kindlicher Hörstörungen in den westlichen Industrienationen auf ca. 1:1.000 gesunken. In Deutschland liegt die Prävalenz nach ersten Ergebnissen des DZH bei ca. 1,2:1.000. So ist beispielsweise der Anteil der Rötelnembryopathien stark zurückgegangen. Dagegen spielen heute die Zytomegalievirus-(CMV)-Infektion und die Alkoholfetopathie eine größere Rolle. Im Patientenkollektiv des DZH mit 4058 permanent hörgestörten Kindern beträgt der Anteil gesichert progredienter Verläufe 10,3%. Diagnostische Verfahren, vor allem zur Früherkennung von CMV und Toxoplasmose, gewinnen zunehmend an Bedeutung. Ebenso ist eine konsequente Hördiagnostik auch bei Kindern mit Alkoholfetopathie zu fordern.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050684
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    Electronic Resource
    Kraniomandibuläre Dysfunktion Eine Standortbestimmung (2000)
    Springer
    Manuelle Medizin 38 (2000), S. 335-341 
    Details
    ISSN: 1433-0466
    Keywords: Schlüsselwörter Kiefergelenk ; Kraniomandibuläre Dysfunktion (CMD) ; Kraniozervikale Dysfunktion (CCE) ; Kraniosakrale Dysfunktion (CSD) ; Diagnostik ; Therapie ; Keywords Temporomandibular joint ; Craniomandibular disorder ; Craniocervical disorder ; Craniosacral disorder ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Evaluating the current understanding of craniomandibular disorders means attempting to discern structures among the dysfunctions of this functional disturbance rather than recording the multitude of different forms. Most dentists understand the functioning and dysfunctions of the craniomandibular system (CMS) while most orthopedists have knowledge in the functioning and dysfunctions of the craniocervical systems (CCS), and some are well trained in the disturbances of the craniosacral system (CSS). In clinical practice, however, the specific data and the structural and functional connections are not provided by associative connections. Therefore the figure at the end of the article will help those lacking substantial experience to keep in view the variety of disorders, recognize the inner structure of the dysfunction, consult with colleagues, and begin effective therapeutic procedures.
    Notes: Zusammenfassung Eine bewertende Standortbestimmung zum Thema kraniomandibuläre Dysfunktion vorzunehmen bedeutet nicht, dass versucht wird, die facettenreichen vielgestaltigen Formen von Funktionsstörungen vollständig nachzuzeichnen, sondern vielmehr, das Krankheitsbild – anhand vereinfachter Denkmodelle – durchgängig zu strukturieren. Die meisten Zahnärzte haben Kenntisse über die Funktionen und Dysfunktionen des kraniomandibulären Systems (CMS). Dagegen kennen sich die meisten Orthopäden und Physiotherapeuten gut mit den Funktionen und Dysfunktionen des kraniozervikalen Systems (CCS) aus, etliche auch mit dem kraniosakralen System (CSS). Es sind aber eher die Einzeldaten, die strukturellen und funktionellen Zusammenhänge, die oft nicht durch Assoziationsketten strukturiert sind. Eine tabellarische Übersicht soll deshalb dem noch nicht so Erfahrenen helfen, den Überblick zu behalten und die innere Struktur der Funktionsstörungen zu erkennen, Kollegen gezielt hinzuziehen und die Therapie sinnvoll einzuleiten.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003370070005
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  • 27
    Electronic Resource
    Electronic Resource
    Tufted Angioma Fallbeschreibung und Besprechung der aktuellen Therapieoptionen (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 475-478 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Tufted Angioma ; Büschelartiges Hämangiom ; Kutane Tumoren ; Therapie ; Key words Tufted angioma ; Hemangioma ; Cutaneous tumor ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Case report: A 16-month-old girl was admitted with a 6-month history of multiple redishblue plaques on the right abdomen. These proved to have increased in size and number daturing a 1.5-year follow-up. Histologically (including histochemistry and electron microscopy), these skin changes were classified as tufted angioma. Tufted angioma is a rare, often multiple benign tumor. Half of the tumors reported develop in children 5 years and younger. The exclusion of malignant tumors (leukemia, lymphoma, neuroblastoma) is important. A punch biopsy is not very traumatic. A subsequent histological examination is highly sensitive and specific. Therapy: There are a few active therapeutic options with rather severel side effects.
    Notes: Zusammenfassung Fallbericht: Bei einem Mädchen im Alter von 16 Monaten traten seit einem halben Jahr am rechten Abdomen multiple, disseminierte rötliche bis bläulich-bräunliche infiltrierte Plaques auf, die innerhalb des 1,5-jährigen Beobachtungszeitraums weiter an Größe und Anzahl zunahmen. Mittels konventioneller Histologie, Immunhistologie und Elektronenmikroskopie sicherten wird die Diagnose eines Tufted Angioma. Das Tufted Angioma ist ein sehr seltener, häufig multipel vorkommender Tumor gutartigen Charakters. Die Hälfte der berichteten Tumoren entwickelte sich innerhalb der ersten 5 Lebensjahre. Deshalb ist der differenzialdiagnostische Ausschluss eines malignen Geschehens (Leukämie, Lymphome, Neuroblastom) von außerordentlicher Bedeutung. Hierzu ist eine Stanzbiopsie ideal geeignet, da sie einfach durchführbar und nur gering traumatisch ist. Die nachfolgende Histologie hat eine hohe Sensitivität und Spezifität. Therapie: Die aktiven therapeutischen Möglichkeiten müssen eher als eingeschränkt und nebenwirkungsreich gewertet werden. Eine spontane Rückbildung ist möglich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050578
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  • 28
    Electronic Resource
    Electronic Resource
    Okuläres vernarbendes Pemphigoid Retrospektive Analyse von Risikofaktoren und Komplikationen (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 113-120 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter Okuläres vernarbendes Pemphigoid ; Therapie ; Komplikationen ; Glaukom ; Key words Ocular cicatricial pemphigoid ; Therapy ; Complications ; Glaucoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Cicatricial pemphigoid (CP) is a rare autoimmune disease characterized by subepidermal blistering and progressive cicatrization affecting the skin and mucosa. Ocular involvement occurs in approximately 70% of the patients. Methods: The course of the disease, complications and putative risk factors in patients with ocular cicatricial pemphigoid (OCP) treated at the Departments of Ophthalmology and Dermatology were analyzed retrospectively from 1986 to 1998. Results: Eighteen of 28 patients (64%) with CP demonstrated ocular involvement. The mean age of patients with OCP was 73 years; 61% were female. At the time of referral to our hospital, all patients had reached advanced stage III (83%) or IV (17%) of OCP. In 38% of patients vision was already reduced to 〈20/200 at first presentation. Twenty-eight percent of patients additionally suffered from glaucoma. Two patients exhibited life-threatening extraocular manifestations of CP (larynx stricture, esophagus stricture). Conjunctival or mucosal biopsies were performed in 15 patients with OCP and showed typical immunodeposits at the basement membrane zone in 12/15 patients. Therapy with dapsone (12 patients), oral steroids (11 patients), azathioprine (5 patients), cyclophosphamide (4 patients), colchicine (2 patients) and methotrexate (1 patient) was used concomitantly or consecutively. Complications of OCP including entropion, recurrent epithelial erosions, corneal ulcers, keratitis, and corneal perforations required multiple surgical interventions such as entropion surgery (8 patients), tarsorrhaphy (3 patients), mucous membrane grafting (1 patient), amniotic membrane transplantation (1 patient), tectonic keratoplasty (1 patient), keratoprosthesis (1 patient) and enucleation (1 patient). Despite control of the inflammatory process, further visual loss occurred in 53% of eyes. Reading visual acuity could only be maintained in 35% of eyes. Discussion: Early diagnosis and therapy can prevent ocular complications of OCP. This study indicates that advanced stages of the disease often result in irreversible visual loss despite institution of immunosuppressive therapy. Whether or not the high association of OCP with glaucoma and/or anti-glaucomatous treatment in our patients represents part of the underlying disease process or plays a role in the pathogenesis of OCP must still be clarified.
    Notes: Zusammenfassung Das vernarbende Pemphigoid (cicatricial pemphigoid, CP) ist eine seltene, mit subepidermaler Blasenbildung und Vernarbung einhergehende Autoimmunerkrankung, die sich an Haut und Schleimhaut manifestiert. Eine Augenbeteiligung liegt bei etwa 70% der Patienten vor. Methode: Retrospektiv wurden Krankheitsverlauf, klinische Komplikationen und mögliche Risikofaktoren von Patienten der Augen- und Hautklinik mit vernarbendem Pemphigoid von 1986–1998 untersucht. Ergebnisse: 18/28 Patienten (64%) mit CP hatten eine okuläre Beteiligung. Das Durchschnittsalter der Patienten mit okulärem vernarbendem Pemphigoid betrug 73 Jahre, 61% der Patienten waren weiblich. Bereits bei Erstvorstellung in unserer Klinik bestand bei allen Patienten ein Krankheitsstadium III (83%) oder IV (17%), mit einem Visus 〈0.1 in 38% der Augen. Bei 28% der Patienten wurde zusätzlich ein Glaukom diagnostiziert. Zwei Patienten zeigten eine lebensgefährliche extraokuläre Schleimhautbeteiligung (Larynx- bzw. Ösophagusstriktur). Bei 15 Patienten mit okulärem vernarbendem Pemphigoid wurde eine Bindehaut- bzw. Schleimhautbiopsie aus dem Mund oder Nasen-Rachen-Raum durchgeführt, welche die Verdachtsdiagnose bei 12/15 Patienten immunhistologisch sicherte. Eine Therapie mit Dapson (12 Patienten), oraler Kortikosteroidgabe (11 Patienten), Azathioprin (5 Patienten), Cyclophosphamid (4 Patienten), Colchizin (2 Patienten) und Methotrexat (1 Patient) wurde in Folge oder Kombination eingesetzt. Komplikationen wie Lidfehlstellungen, rezidivierende Epitheldefekte, Hornhautulzera, Keratitiden und Hornhaut-Perforationen erforderten multiple operative Eingriffe wie Entropium-Operation (8 Patienten), Tarsorrhaphie (3 Patienten), Kryoepilation (2 Patienten), Mundschleimhaut-Transplantat (1 Patient), Amniontransplantat (1 Patient), tektonische Keratoplastik (1 Patient), Keratoprothese (1 Patient) und Enukleation (1 Patient). Trotz befriedigender Kontrolle des okulären vernarbenden Pemphigoids kam es bei 53% der Augen zum weiteren Visusabfall. Ein Lesevisus konnte nur in 35% der Augen erhalten werden. Schlußfolgerung: Wahrscheinlich kann die Früherkennung und rechtzeitige Behandlung des okulären vernarbenden Pemphigoids okuläre Komplikationen verhindern. Diese Studie zeigt, daß trotz immunsuppressiver Therapie in Spätstadien häufig ein irreversibler Visusverlust resultiert. Es bleibt zu untersuchen, ob die auffällig hohe Assoziation von okulärem vernarbendem Pemphigoid zu Glaukom bzw. antiglaukomatöser Therapie in unserem Patientenkollektiv als Folge der Grunderkrankung oder als pathogenetischer Faktor zu werten ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050021
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  • 29
    Electronic Resource
    Electronic Resource
    Mikroangiographische Darstellung der Gefäßversorgung des medialen Kollateralbandes am Kniegelenk (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 208-214 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Kniegelenkverletzung ; Mediales Kollateralband ; Ruptur ; Gefäßversorgung ; Therapie ; Key words Knee injury ; Medial collateral ligament ; Rupture ; Vascularization ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Because the vascularization of ligaments is an important factor in ligament healing we wanted to examine the vascularization status of the medial collateral ligament of the knee. The type of vascularization was examined by mikroangiographie of 21 postmortem preparations. We could observe a vascularization from the proximal end of the ligament by one or two major vessels in all cases. These vessels were mostly localized in the ventral third of the ligament. From the proximal to the distal part of the ligament we found a decreasing density of blood vessels. We could not observe vessel free ligament areas. Due to this vascularization status we would advise the differentiation of two ligament areas respecting the following therapy. Because of the good vascularization in the proximal part of the ligament we can accept good conditions concerning complete healing after a non-operative treatment and an operative therapy by suture or refixation. In the case of interligamentous and distal ruptures operative reconstruction by sutures often is difficult and a conservative therapy leads to a high rate of poor results. Therefore we advise fibrin bonding in these ligament areas if a surgical procedure is indicated because of the high risk of vessel strangulation after suture.
    Notes: Zusammenfassung Da die Durchblutungsverhältnisse bei Bandrupturen einen wesentlichen Parameter insbesondere bezüglich der Erfolgsaussichten einer chirurgischen Versorgung darstellen, sollte in der vorliegenden Arbeit die Vaskularisation des Knieinnenbandes dargestellt werden. Die spezielle Durchblutungssituation wurde mittels Mikroangiographie an 21 Leichenpräparaten untersucht. Es zeigte sich dabei eine Versorgung von proximal durch 1 oder 2 Hauptgefäßstämme, die bevorzugt in den ventralen Bandanteilen verliefen. Die Gefäßdichte nahm von proximal nach distal sowie von ventral nach dorsal ab. Gefäßfreie Bandabschnitte waren nicht nachweisbar. Aufgrund des proximalen Versorgungstyps kann im proximalen Bandanteil im Vergleich zum distalen Abschnitt mit günstigeren Heilungsvoraussetzungen sowohl nach operativer als auch nach konservativer Therapie gerechnet werden. Dies entspricht den klinischen Erfahrungen. Prognostisch ungünstiger einzustufen sind interligamentäre und distale Bandverletzungen, die insbesondere nach konservativer Behandlung h6auml;ufig unbefriedigende Resultate zeigen. Angesichts der geringeren Vaskularisation der distalen Bandanteile würden wir hier die Bandrekonstruktion mittels Fibrinklebung empfehlen, die eine atraumatische Wiederherstellung ohne die Gefahr der nahtbedingten Gefäßstrangulation erlaubt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050524
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  • 30
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    Electronic Resource
    Diagnostik und Therapie von Pseudotumoren der Orbita (2000)
    Springer
    HNO 48 (2000), S. 665-670 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Pseudotumor orbitae ; Histopathologie ; Therapie ; Rhinochirurgische Zugänge ; Keywords Pseudotumor orbitae ; Histopathology ; Therapy ; Rhinosurgical approaches
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that can be divided histopathologically into three basic types: granulomatous, lymphoid, and sclerosing. Between 1995 and 1998, 12 patients with pseudotumor orbitae were treated in the ENT Department of the University of Saarland. Histopathological examination showed granulomatous type of pseudotumor in six, lymphoid in three, and sclerosing in three patients. In seven cases the pseudotumor orbitae were medially located and in four cases laterally. In one patient nearly all orbital structures were infiltrated. Diagnostic biopsy was taken endonasally in six cases, via medial orbitotomy in two cases, and via lateral orbitotomy in four cases. Due to their good delimitation lymphoid and sclerosing tumors were extracted completely during diagnostic biopsy and patients were free of complaints after a few weeks. The six patients with granulomatous pseudotumor were treated primarily with steroids after the diagnosis had been definitely confirmed by histology. In three of those six cases a second course of steroid therapy had to be given, with positive results in two cases. Follow-up was between 6 and 28 months (mean 16 months). There were no postoperative complications. The clinical and radiographic presentation of the pseudotumors can vary greatly. Therefore, the differential diagnosis of specific infections or neoplasms can only be established through diagnostic biopsy. Different rhinosurgical approaches provide clear biopsy results and in some cases the pseudotumor is even completely removed.
    Notes: Zusammenfassung Der Pseudotumor der Orbita ist ein unspezifischer entzündlicher Prozess dessen Genese unbekannt ist und der histologisch in 3 Gruppen unterteilt wird: der granulomatöse, lymphoide und sklerosierende Typ. Zwischen 1995 und 1998 haben wir 12 Patienten mit einem Pseudotumor der Orbita behandelt. Es handelte sich dabei um Fälle vom granulomatösen (n=6), lymphoiden (n=3) und sklerosierenden (n=3) Typ. Bei 7 Patienten war der Pseudotumor im medialen Bereich der Orbita und in 4 Fällen im lateralen Bereich lokalisiert. Bei einer Patientin lag eine diffuse Infiltration annähernd aller orbitalen Strukturen vor. Die Probebiopsie wurde in 6 Fällen endonasal, in 2 Fällen über eine mediale Orbitotomie und bei 4 Patienten über eine laterale Orbitotomie durchgeführt. Die gut abgrenzbaren lymphoiden (n=3) und sklerosierenden (n=3) Pseudotumoren konnten im Rahmen der Probebiopsie komplett entfernt werden, so dass die Patienten nach wenigen Wochen beschwerdefrei waren. Bei den 6 Patienten mit einem granulomatösen Pseudotumor wurde nach der definitiven Histologie eine primäre Kortikosteroidtherapie durchgeführt. In 3 der 6 Fälle kam es dadurch zu einem Rückgang der Beschwerden mit kompletter Ausheilung. Bei den restlichen 3 Patienten war eine erneute Kortisontherapie erforderlich wobei diese nur in 2 Fällen erfolgreich war. Der Nachbeobachtungszeitraum betrug 6–28 (Mittel 16) Monate. Postoperative Komplikationen traten nicht auf. Die klinische Symptomatik und die radiologische Darstellung der Pseudotumoren kann sehr variabel sein, so dass nur durch eine Probebiopsie eine genaue Differenzierung von spezifischen Infektionen und malignen Raumforderungen möglich ist. Die rhinochirurgischen Zugänge erlauben eine sichere Biopsie und in einigen Fällen auch eine komplette Entfernung des Pseudotumors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050636
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  • 31
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    Electronic Resource
    Psychische Belastung, Informiertheit und Behandlungserwartung von Eltern mit einem Cochlear Implant versorgten Kind (2000)
    Springer
    HNO 48 (2000), S. 675-683 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Cochlear Implant ; Kinder ; Eltern ; Psychische Belastung ; Erwartungshaltung ; Keywords Cochlear Implant ; Children ; Parents ; Psychosocial stress ; Expectations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Established knowledge. It is known that parents of hard-of-hearing children suffer from an increase in psychosocial stress. Scientific question. How does the psychosocial situation of parents with children who have cochlear implants change during rehabilitation? Aim of study. It was the aim of this study to demonstrate how parents evaluate retrospectively their own psychological well-being during the process of rehabilitation. Methods and results. We interviewed 87 parents by questionnaire which were mailed to them. Fifty-seven mothers and 46 fathers responded (59% return rate). Parents reported a significant increase in stress, as perceived by themselves, after the time of diagnosis. Of the parents, 25% continued to suffer from psychic stress during rehabilitation as could be demonstrated by the SCL-90-R questionnaire criteria. The expectations by parents were realistic prior to implantation but thereafter increased significantly with time. Conclusions. The psychological state of parents during the critical phase, after a diagnosis of deafness has been made for their child, has to be considered. Even after an initial phase of shock, parents seemed to be stressed to an extent that required therapeutic intervention.
    Notes: Zusammenfassung Bisheriges Wissen zum Thema. Eine generell erhöhte psychosoziale Belastung der Eltern hörbehinderter Kinder ist aus der Literatur bekannt. Wissenschaftliche Fragestellung. Wie verändert sich die psychosoziale Situation der Eltern von mit einem Cochlear Implant (CI) versorgten Kindern im zeitlichen Verlauf der Rehabilitation? Ziel der Arbeit. Ziel war es darzustellen, wie die Eltern ihr eigenes psychisches Befinden während der Rehabilitation ihres Kindes retrospektiv einschätzen. Methoden und Arbeitsergebnisse. 87 Elternpaare wurden getrennt in einer postalischen Fragebogenerhebung befragt; 57 Mütter und 46 Väter antworteten (59% Rücklauf). Die Eltern gaben ab dem Zeitpunkt der Diagnosestellung eine subjektiv deutlich erhöhte Belastung an. 25% der Eltern waren auch im weiteren Verlauf der Rehabilitation anhand der Beurteilungskriterien des SCL-90-R in einem klinisch relevanten Ausmaß psychisch belastet. Die Erwartung der Eltern vor der Implantation war realistisch und stieg im Verlauf der Rehabilitation statistisch signifikant an. Schlussfolgerungen. Die starke psychische Belastung in der Selbsteinschätzung der Eltern von CI-Kindern in der Phase der Diagnosestellung bestätigt die Theorie und klinische Praxis, dass die Eltern in dieser kritischen Phase besonderer Betreuung bedürfen. Auch über die Phase des initialen Schocks hinaus scheinen die Eltern in einem Ausmaß psychisch belastet zu sein, welches eine gezielte zusätzliche psychologische Betreuung der Eltern erforderlich machen könnte.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050638
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  • 32
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    Electronic Resource
    Hydroa vacciniformis Klinik, Differenzialdiagnosen und therapeutische Möglichkeiten der seltenen Photodermatose am Beispiel einer Kasuistik (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 895-899 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hydroa vacciniformis ; Klinik ; Differenzialdiagnosen ; Verlauf ; Therapie ; Keywords Hydroa vacciniformis ; Clinical features ; Differential diagnoses ; Course ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Case report. This case of a 6 year old boy presents hydroa vacciniformis, a rare skin disease in children which may also affect the eyes and is caused by UVA exposure. It presents as hemorrhagic small blisters in sun exposed areas that heal with a tendency to scarring, usually with recurrent onset at the beginning of the sunny season until adult age. Differential diagnosis. As possible differential diagnoses polymorphic light eruption, erythropoetic protoporphyria and photodermatitis due to external or systemic photosensitizers must be excluded. In rare cases congenital erythropoetic porphyria, hepatic erythropoetic porphyria, Epstein-Barr virus infection, lymphomatoid papulosis and angiocentric cutaneous T-cell lymphoma may cause the clinical symptoms of hydroa vacciniformis. Therapy. Appropriate therapy consists in protection of skin and eyes against direct and indirect UV radiation, especially UVA-radiation.
    Notes: Zusammenfassung Fallbericht. Anhand der Kasuistik eines 6-jährigen Jungen wird die Hydroa vacciniformis, eine seltene, durch UVA-Exposition ausgelöste Dermatose mit möglicher Augenbeteiligung bei Kindern, vorgestellt. In lichtexponierten Bereichen treten zu Beginn der lichtreichen Jahreszeit rezidivierend bis zum Erwachsenenalter akut zahlreiche hämorrhagische Bläschen auf, die narbig abheilen. Differenzialdiagnose. Differenzialdiagnostisch müssen eine polymorphe Lichtdermatose, eine erythropoetische Protophorphyrie und eine Photodermatose durch exogene bzw. systemische Photosensibilisatoren ausgeschlossen werden. In seltenen Fällen können eine Porphyria erythropoetica congenita, eine hepatoerythropoetische Porphyrie, eine Infektion durch Epstein-Barr-Virus, eine lymphomatoide Papulose und ein angiozentrisches kutanes T-Zell-Lymphom klinisch ähnliche Symptome verursachen. Therapie. Die effektive Therapie besteht im Schutz vor direkter und indirekter UV-Exposition für Haut und Augen, insbesondere im UVA-Bereich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050666
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  • 33
    Electronic Resource
    Electronic Resource
    Büschelartiges Hämangiom (“tufted angioma”) des Unterarms Fallbericht und Literaturübersicht (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 832-836 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hämangiom ; Büschelartiges Hämangiom ; Diagnostik ; Therapie ; Keywords Haemangioma ; Tufted angioma ; Vascular lesion ; Diagnostic ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: Tufted angioma represents a benign vascular lesion of the skin. The knowledge of this distinctive entity is important in distinction of clinically more aggressive and malignant neoplasms respectively. Case report. We report a 8-months-old girl who developed a deep seated tufted haemangioma on her right forearm. Sonography and MRI showed a good vascularized tumor with interseptal spreading. Histological examination of the incisional biopsy revealed a cellular capillary haemangioma with morphological features of rare tufted haemangioma. Discussion. Characteristic morphological features of tufted haemangioma allow accurate diagnosis and differential diagnosis to clinically more aggressive and malignant neoplasms of skin and soft tissues, wheras radiological methods are rather unspecific and do not distinguish reliably between these vascular lesions. It is of special clinical importance that tufted haemangioma represents an enlarging but biologically benign vascular neoplasm.
    Notes: Zusammenfassung Hintergrund: Das büschelartige Hämangiom (“tufted angioma”) ist ein benigner vaskulärer Tumor der Haut, dessen Kenntnis in der Differenzialdiagnose zu aggressiveren und malignen Tumoren wichtig ist. Fallbericht. Es wird über ein 8 Monate altes Mädchen mit diesem Tumor im Unterarmbereich berichtet. Sonographie und Magnetresonanztomographie zeigten einen gut vaskularisierten Weichgewebetumor, bei dem aufgrund interseptaler Ausbreitung ein maligner Prozess nicht ausgeschlossen werden konnte. Die Histologie der Inzisionsbiopsie ergab ein zellreiches kapillares Hämangiom, dessen morphologische Veränderungen eine Einordnung als ein seltenes büschelartiges Hämangiom erlaubten. Diskussion. Eine Abgrenzung des büschelartigen Hämangioms gegenüber aggressiveren und malignen vaskulären Läsionen der Haut ist aufgrund des typischen histologischen Bilds möglich, während eine Differenzierung mit Hilfe bildgebender Verfahren nicht gelingt.
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    URL: http://dx.doi.org/10.1007/s001120050651
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    Cholezystolithiasis bei Kindern und Jugendlichen Einfluss von Adipositas und anderen Risikofaktoren (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 600-604 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Epidemiologie ; Cholezystolithiasis ; Kinder ; Sonographie ; Risikofaktoren ; Key words Epidemiology ; Cholecystolithiasis ; Children ; Ultrasound ; Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Objective. To assess the prevalence of and risk factors (e. g., obesity and positive family history) for the development of cholecystolithiasis in a non-selected collective of children and adolescents. Design and participants. A series of 482 children and adolescents aged 6–18 years underwent upper abdominal diagnostic ultrasound examinations as part of a whole-community investigation (response rate: 78%) for Echinococcus multilocularis in a town in southern Germany. Results. Gallbladder stones were identified in three of 482 children, corresponding to a prevalence of 0.6%. None of the three children was overweight at the time of the examination. Additional risk factors (pronounced weight reduction and Wilson's disease) were present in one study subject. Conclusions. Findings of the present study do not confirm the significance of obesity as a risk factor for cholecystolithiasis in children and adolescents.
    Notes: Zusammenfassung Fragestellung. Ziel der Studie war es, Häufigkeit und Risikofaktoren der Cholezystolithiasis, insbesondere Adipositas und familiäre Belastung, an einem unselektierten Kollektiv von Kindern und Jugendlichen zu untersuchen. Methode und Studienkollektiv. Ein Studienkollektiv von 482 Kindern einer Gemeinde in Süddeutschland zwischen 6 und 18 Jahren wurde in einer Vollerhebung (Responserate: 78%) im Rahmen einer Screeninguntersuchung zu Echinococcus multilocularis sonographisch untersucht. Ergebnisse. Bei 3 von 482 Kindern, entsprechend einer Prävalenz von 0,6%, wurden Gallenblasensteine festgestellt. Keines der 3 Kinder war zum Zeitpunkt der Untersuchung übergewichtig. Als weitere Risikofaktoren fanden sich bei einem Studienteilnehmer eine starke Gewichtsreduktion sowie ein M. Wilson. Schlussfolgerungen. Adipositas konnte bei Kindern und Jugendlichen in der vorliegenden Studie nicht als Risikofaktor für die Cholezystolithiasis bestätigt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050602
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    Rezidivierende paraneoplastische Zerebellopathie und limbische Enzephalitis Fallbericht bei einer Patientin mit Mammakarzinom (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 295-298 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Paraneoplastische zerebelläre Degeneration ; Opsoklonus-Myoklonus-Syndrom ; Limbische Enzephalitis ; Therapie ; Prognose ; Key words Paraneoplastic cerebellar degeneration ; Opsoclonus-myoclonus syndrome ; Limbic encephalitis ; Therapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Paraneoplastic neurological syndromes are rare diseases that occur in relation to cancer. Supporting the hypothesis of an autoimmune mechanism, specific antineuronal antibodies have sometimes been detected. The current possibilities for treatment are limited. A female patient, aged 57, suffering from a breast cancer, developed a severe paraneoplastic cerebellar syndrome and limbic encephalitis within a few weeks. It is possible that the impressive partial remission that occurred during the ensuing 6 months was not due to therapy. Although the patient was still bound to a wheelchair, discharge from hospital was possible because she was still able to perform daily tasks by herself. A recurrence of the cerebellar symptoms with mild alterations of mental status occurred 2 months later but again showed a good remission.
    Notes: Zusammenfassung Paraneoplastische neurologische Syndrome sind seltene Erkrankungen in Assoziation mit einem Tumor, die bei vermutetem Autoimmunmechanismus mit antineuronalen Antikörpern einhergehen können und deren Verlauf therapeutisch nur bedingt beeinflussbar ist. Berichtet wird von einer 57-jährigen Patientin mit Mammakarzinom, die in engem zeitlichen Rahmen sowohl eine schwere paraneoplastische Zerebellopathie als auch eine limbische Enzephalitis entwickelte. In unklarem Zusammenhang zur Therapie kam es innerhalb von 6 Monaten zu einer vergleichsweisen guten Rückbildung beider Syndrome, so dass zwar noch eine partielle Rollstuhlpflichtigkeit bestand, bei weitgehender Selbständigkeit aber eine Entlassung nach Hause möglich war. Ein Rezidiv 2 Monate später mit im Vordergrund stehender zerebellärer Symptomatik verlief ebenfalls günstig.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050560
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    Die isolierte Zungenbeinfraktur (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 996-998 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Zungenbeinfraktur ; Diagnostik ; Therapie ; Keywords Hyoid bone fracture ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract We present a rare case of isolated hyoid bone fracture caused by direct trauma. We will describe the mechanism of injury, how to find diagnosis and our treatment.
    Notes: Zusammenfassung Wir berichten über den seltenen Fall einer isolierten Zungenbeinfraktur bei einem Jugendlichen durch ein direktes Trauma. Erörtert werden Unfallmechanismus sowie Diagnostik und Therapie.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050658
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    Beatmung in Bauchlage bei einem 5-jährigen Kind nach Polytrauma Effektive Therapie persistierender Atelektasen (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 787-790 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Thoraxtrauma ; Atelektasen ; Pädiatrie ; Bauchlage ; Keywords Thoracic trauma ; Atelectasis ; Children ; Prone position
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract We report on the ventilation in prone position in a 5-year-old traumatized child with severe thoracic and abdominal injuries (lung contusion, rib fractures, rupture of liver and spleen). Under continuous analgosedation, the young patient was ventilated in prone position for 6 h, since acute lung injury and atelectasis persisted despite various therapeutic measures (artifical ventilation in the pressure controlled mode, fiberoptic bronchoscopy, reexpansion maneuver). After initiation of the prone position, we observed a rapid increase i narterial oxygenation, which persisted in the following period. The hemodynamic situation remained stable. The complete disappearance of atelectasis was demonstrated radiologically after supine repositioning. After cessation of analgosedation, the extubation was performed 2 days later. Furthermore, we found no side effects of the prone position on the injured abdomen, and the liver function improved rapidly. Although there is a lack of experience with ventilation in prone position in pediatric intensive care, our report might be a recommendation for the indication of this technique in children.
    Notes: Zusammenfassung In dieser Kasuistik wird über die erfolgreiche Anwendung der Beatmung in Bauchlage bei einem 5-jährigen Mädchen berichtet, welches von einem Pkw überrollt worden war und sich Thorax- und Abdominalverletzungen (Rippenserienfraktur, Lungenkontusion, Leber- und Milzeinrisse) zugezogen hatte. Wegen des akuten Lungenversagens mit persistierenden Atelektasen, die durch wiederholte fiberoptische Bronchiallavagen und durch Reexpansionsmanöver nicht zu beheben waren, wurde der Entschluss zur 6-stündigen Lagerung auf den Bauch gefasst, obwohl über den Effekt dieser Lagerungsmaßnahme bei traumatisierten Kindern wenig bekannt ist und zu möglichen negativen Auswirkungen auf das schwerverletzte Abdomen eine Informationen vorliegen. Die Beatmung in Bauchlage führte zur raschen Verbesserung des pulmonalen Gesaustausches, die hämodynamische Situation wurde nicht beeinflusst. Die radiologische Kontrolle nach Rücklagerung zeigte eine vollständigen Rückgang der Atelektasen; die kleine Patientin konnte bald darauf extubiert werden. Weder laborchemisch noch klinisch wurde ein schädigender Einfluss auf das verletzte Abdomen gefunden. Die Beatmung in Bauchlage hat sich als Routineverfahren bei der Behandlung des Lungenversagens des Erwachsenen etabliert; nach der hier beschriebenen Erfahrung ist diese Maßnahme auch bei traumatisierten Kindern in Betracht zu ziehen, insbesondere wenn andere Maßnahmen nicht ausreichend sind.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050618
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    Der vergrößerte ventrikuläre Sacculus beim Larynxkarzinom – ein erhöhtes tumorchirurgisches Risiko (2000)
    Springer
    HNO 48 (2000), S. 689-692 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Larynxkarzinom ; Sacculus laryngis ; Therapie ; Keywords Laryngeal carcinoma ; Sacculus laryngis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The case of a 60-year-old female patient with a supraglottic larynx carcinoma (T3N2CM0) and bilateral enlargement of the laryngeal sacculus is presented. On one side, the sacculus opened atypically into the left vestibular fold. The sacculus is a physiologic part of the roof of Morgagni's ventricle, the size of which can vary greatly. These canal-like structures can be the point of origin of cysts, laryngoceles, mucoceles, and pyoceles. Laryngoceles are present in about 5% of larynx carcinomas; their cause is not precisely known. Frequently, a computer tomogram suggests the coincidence of larynx carcinoma and laryngoceles or a large laryngeal sacculus. In oral panendoscopy, these ventricular distensions are difficult to detect even using 70° rigid endoscopes. A planned supraglottic partial resection must take into account early tumor growth along the preformed canals in the preepiglottic space. In this patient, a laryngectomy was performed due to the bilateral involvement of the vocal process and the anterior commissure.
    Notes: Zusammenfassung Es wird der Fall einer 60-jährigen Patientin mit einem supraglottischen Larynxkarzinoms (T3 N2c M0) und beidseitiger Vergrößerung des Sacculus laryngis vorgestellt. Einseitig mündete der Sacculus untypisch auf der linken Taschenfalte. Der Sacculus laryngis ist eine physiologische Ausstülpung des Daches des Morgagni-Ventrikels, dessen Größe sehr variieren kann. Diese gangartigen Strukturen können Ausgangsort von Zysten, Laryngozelen, Mukozelen und von Pyozelen sein. In ca 5% von Larynxkarzinomen liegen Laryngozelen vor, wobei der disponierende Faktor nicht genau bekannt ist. Oftmals ist der Verdacht der Koinzidenz von Larynxkarzinom und Laryngozele oder großem Sacculus laryngis in der Computertomographie zu stellen. In der Panendoskopie sind diese Erweiterungen der Ventrikel auch mit starren Winkeloptiken schwer zu sehen. Bei geplanter supraglottischer Teilresektion muss man an ein frühes Tumorwachstum entlang der präformierten Gänge in den präepiglottischen Raum denken. Bei der Patientin wurde bei beidseitiger Beteiligung der Processus vocales und der vorderen Kommissur eine Laryngektomie durchgeführt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050640
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    Omeprazol in der Kinderheilkunde (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 113-117 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter ; Kinder ; Säuglinge ; Protonenpumpenhemmer ; Omeprazol ; Pharmakologie ; Gastroösophageale Refluxkrankheit ; Ösophagitis ; Helicobacter-pylori-Infektion ; Ulkus ; Key words ; Children ; Infants ; Omeprazole ; Gastroesophageal reflux disease ; Esophagitis ; Pharmacology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Proton pump inhibitors (omeprazole, lansoprazole, and pantoprazole) have revolutionized the therapy of peptic disease of the upper gastrointestinal tract and reduced the indications for surgical intervention. These substances inhibit the H+/K+-ATPase in the parietal cells with an acid suppressing potency that is much higher than that of H2-receptor-antagonists. The first proton pump inhibitor, omeprazole, has been introduced ten years ago. Since then, sufficient experience with this drug in children has accumulated. Omeprazole is released for children aged one year or older. A new formulation makes the drug applicable in tube fed patients. The main indications for the use of omeprazole are endoscopically verified peptic esophagitis and gastric and duodenal ulcerations of different etiologies. In the treatment of Helicobacter pylori-infection a sufficient acid suppression is essential for the efficacy of the antibiotics. The recommended pediatric dose ranges between 0,7–1,4 mg/kg bodyweight and day. However, some children with ulcerative esophagitis may need daily doses up to 3.5 mg/kg. Healing of the esophageal mucosa should be monitored by endoscopy. After remission, doses can often be reduced for maintenance therapy. Side effects are rare and do not seem to increase with higher doses. Possibly interactions with other medications, i.e. antiepileptic drugs, may occur. A long-term therapy lasting more than 6 months in a child should be monitored by an experienced pediatric gastroenterologist.
    Notes: Zusammenfassung Protonenpumpeninhibitoren (Omeprazol, Lansoprazol, Pantoprazol) haben die Therapie peptischer Erkrankungen im oberen Gastrointestinaltrakt revolutioniert und die Indikation für chirurgische Therapiemaßnahmen deutlich eingeschränkt. Diese Substanzen hemmen die H+-/K+-ATPase in den Parietalzellen und haben eine sehr viel stärkere säuresuppressive Wirkung als H2-Rezeptor-Antagonisten. Mit dem ersten Vertreter dieser Substanzklasse, Omeprazol, liegen nach 10jähriger Anwendung inzwischen ausreichend Erfahrungen bei Kindern vor. Die Substanz ist für Kinder ab dem 1. Lebensjahr zugelassen und in einer neuen Darreichungsform auch bei Sondenernährung anwendbar. Die wichtigsten Indikationen für den Einsatz von Omeprazol sind eine endoskopisch gesicherte peptische Ösophagitis und Ulzerationen verschiedener Genese im Magen und Duodenum. Für eine effektive Therapie der Helicobacter-pylori-Infektion ist die ausreichende Säuresuppression essentiell für die Wirksamkeit der eingesetzten Antibiotika. Die therapeutische Dosis liegt zwischen 0,7 und 1,4 mg/kg KG und Tag, in Einzelfällen werden zur Abheilung einer Refluxösophagitis bis zu 3,5 mg/kg und Tag benötigt. Die Abheilung erosiver und ulzeröser Läsionen muß endoskopisch kontrolliert werden. Für die Erhaltungstherapie nach Abheilung sind niedrigere Dosen angemessen. Bei kurzfristiger Anwendung sind Nebenwirkungen selten und scheinen nicht dosisabhängig zu sein. Potentielle Wechselwirkungen mit anderen Medikamenten, besonders Antikonvulsiva, müssen beachtet werden. Eine Langzeittherapie bei Kindern über Monate oder Jahre muß gut überwacht werden und gehört in die Hand eines damit erfahrenen Kindergastroenterologen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050020
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    Stellenwert von Hydrodistension und Blasentraining (2000)
    Springer
    Der Urologe 39 (2000), S. 539-541 
    Details
    ISSN: 1433-0563
    Keywords: Schlüsselwörter Interstitielle Zystitis ; Blasendehnung ; Hydrodistension ; Blasentraining ; Keywords Interstitial cystitis ; Bladder distension ; Bladder training ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Although hydrodistension of the bladder is generally considered standard therapy for interstitial cystitis, scientific data are largely lacking. With the mechanism of action unknown, prospective studies non-existent and the therapeutic effect at best very short-lived, hydrodistension cannot be regarded as a therapeutic standard concept with scientifically validated efficacy. The value of behavioral therapy and bladder training is equally unclear; success can only be anticipated in the very rare subset of patients without pain.
    Notes: Zusammenfassung Obwohl die Hydrodistension der Harnblase ein häufig angewendetes Konzept in der Behandlung der intestitiellen Zystitis (IC) darstellt, ist die wissenschaftliche Datenlage zur therapeutischen Blasendehnung spärlich. Bei ungeklärtem Wirkungsmechanismus, fehlenden prospektiven und kontrollierten Studien und bestenfalls kurzfristiger Effektivität kann die Hydrodistension nicht als therapeutisches Standardkonzept mit wissenschaftlich nachgewiesenem Behandlungserfolg angesehen werden und besitzt eher den Stellenwert eines Heilversuchs. Die Wertigkeit von Blasentraining oder ähnlichen Miktonsverhaltensmodifikationen bei der IC bleibt ebenfalls unklar, ein gewisser Effekt kann allenfalls für die vergleichsweise kleine Untergruppe von IC-Patienten ohne Schmerzkomponente erwartet werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001200050405
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    Optionen einer kausalen Therapie der männlichen Infertilität (2000)
    Springer
    Der Gynäkologe 33 (2000), S. 104-112 
    Details
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Männliche Infertilität ; Therapie ; Medikamente ; Spermatogenese ; Oligozoospermie ; Asthenozoospermie ; Key words Male infertility ; Therapy ; Drugs ; Spermatogenesis ; Oligozoospermia ; Asthenozoospermia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Causal treatment regimens of proven effectiveness in controlled studies are only available for cases of male infertility resulting from hypogonadotropic hypogonadism. Drug treatment of retrograde ejaculation is also effective but has so far not been tested in double-blind, placebo-controlled randomized studies. The results of immunosuppressive therapy in cases of immunological male infertility are still controversial . In addition, antiphlogistic and antibiotic treatment of chronic male genital tract infections has not been shown to improve male fertility. Inconsistent results have been obtained with empirical therapy – e.g., with kallikein, tamoxifen, clomiphene, pentoxifylline, mast cell blockers, testolacton, vitamin E, captopril, alpha receptor blockers, glutathione, indometacin, interferon alpha, growth hormone, zinc salts, ketoprofen, mesterone or testosterone undecanoate – or the studies performed are not sufficient to allow a final judgement. Recent studies have indicated a possible impairment of sperm function by pure FSH, while GnrH and FSH have no influence on spermatogenesis in normogonadotropic men.
    Notes: Zusammenfassung Kausale medikamentöse Therapieregime mit in kontrollierten Studien zweifelsfrei nachgewiesener Wirksamkeit stehen nur bei männlicher Infertilität als Folge des hypogonadotropen Hypogonadismus zu Verfügung. Eine medikamentöse Therapie der retrograden Ejakulation ist ebenfalls effektiv, wurde aber bisher nicht durch doppelblinde, placebokontrollierte, randomisierte Studien ü,berprü,ft. Auch immunsuppressive Therapien bei Nachweis von Spermatozoenantikörpern werden bezüglich ihrer klinischen Wirksamkeit uneinheitlich bewertet. Gleiches trifft auf die Gabe von Antibiotika bei chronisch-entzündlichen Veränderungen oder asymptomatischen Infektionen des Urogenitaltraktes zu. Im Gegensatz dazu sind die Angaben bei empirischer Therapie mit z. B. Kallikrein, Tamoxifen, Clomiphen, Pentoxifyllin, Mastzellblockern, Testolakton, Vitamin E, Captopril, α-Rezeptorenblockern, Glutathion, Indometacin, Interferon-α, Wachtumshormon, Zinksalzen, Ketoprofen, Mesterolon oder Testosteronundecanoat entweder widersprüchlich oder die vorgelegten Studien reichen für eine abschließende Bewertung noch nicht aus. Neuere Studien weisen möglicherweise auf eine Beeinflussung von Spermatozoenfunktionen durch pures FSH hin. Dahingegen haben GnRH und FSH bei normogonadotropen Männern keinen Einfluss auf die Spermatogenese.
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    URL: http://dx.doi.org/10.1007/s001290050018
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    Der benigne tenosynoviale Riesenzelltumor im Bereich des oberen Sprunggelenks Seltene Differentialdiagnose eines Weichteiltumors am Fuß (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 479-481 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Riesenzelltumor ; Sprunggelenk ; Differentialdiagnose ; Therapie ; Keywords Giant cell tumor ; Ankle joint ; Differentialdiagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The giant cell synovialoma is a benign neoplasia classically located in the fingers. It mostly rises from tendon sheaths, sometimes from the synovia. Other locations than the fingers are rare. Making a differential diagnosis to lipomas, gangliomas or even malignant soft tissue tumors can be very difficult especially in rare locations. We report the case of a 21 years old man suffering from a giant cell synovialoma in the area of the right ankle joint. The clinical, radiological and patho-morphological findings are documented. The tumor was excised totally, other foci were not found. The problems of making the right diagnosis are described.
    Notes: Zusammenfassung Bei dem tenosynovialen Riesenzelltumor handelt es sich um eine benigne Neoplasie, die klassischerweise im Bereich der Finger zu finden ist. Dort geht sie in der Regel von Sehnenscheiden aus, seltener aus der Synovialis hervor. Gerade bei den seltenen und atypischen Lokalisationen kann die differentialdiagnostische Abgrenzung gegenüber Lipomen, Ganglien oder malignen Weichteiltumoren schwierig sein. Es wird über einen 21jährigen Patienten mit einem Riesenzellsynovialom im Bereich des linken Innenknöchels berichtet. Die klinischen, radiologischen und pathologisch-anatomischen Befunde werden dokumentiert. Der Tumor wurde in toto reseziert, andere Herde konnten nicht gefunden werden. Die Problematik der richtigen diagnostischen Einordnung wird dargestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050569
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    Progressive posthämorrhagische Ventrikelerweiterung des Frühgeborenen Inzidenz, Prognose und Therapie (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 1072-1077 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Posthämorrhagische Ventrikelerweiterung ; Frühgeborene ; Therapie ; Keywords Posthemorrhagic ; Hydrocephalus ; Preterm ; Infant ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background. 35% of preterm infants with intraventricular hemorrhage develop ventricular dilatation. The posthemorrhagic ventricular dilatation can persist, be transient or be progressive. Finally 1–2% of all very low birthweight (VLBW 〈1500 g) infants require shunt placement for the treatment of the posthemorrhagic hydrocephalus. Outcome. The neurodevelopmental outcome is extremely poor in children surviving progressive posthemorrhagic ventricular dilatation. Therapy. There are no uniform guidelines for the treatment of preterm infants with progressive posthemorrhagic ventricular dilatation. Randomised multicenter trials demonstrated, that inhibition of cerebrospinal fluid production with acetazolamide and furosemide or early cerebrospinal fluid tapping did not reduce the need for shunt placement and may worsen the outcome or can be associated with adverse side-effects. Preterm infants with posthemorrhagic ventricular dilatation should be treated by standard therapy with uniform guidelines for cerebrospinal fluid tapping and shunt placement.
    Notes: Zusammenfassung Hintergrund. 35% der Frühgeborenen entwickeln nach einer intraventrikulären Blutung eine Ventrikelerweiterung. Die posthämorrhagische Ventrikelerweiterung kann persistieren, transient oder progressiv sein. Letztlich entwickeln 1–2% der Frühgeborenen mit einem Geburtsgewicht 〈1500 g einen shuntpflichtigen posthämorrhagischen Hydrozephalus. Prognose. Die Prognose von Frühgeborenen mit progressiver posthämorrhagischer Ventrikelerweiterung ist hinsichtlich Mortalität und neurologischer Morbidität noch sehr ungünstig. Therapie. Bisher gibt es keine einheitlichen Therapierichtlinien für Frühgeborene mit progressiver posthämorrhagischer Ventrikelerweiterung. Multizenterstudien zeigten, dass die medikamentöse Hemmung der Liquorproduktion mit Azetazolamid und Lasix oder frühzeitige serielle Liquorpunktionen die Shuntpflichtigkeit nicht vermindern und den Verlauf und die Prognose sogar ungünstig beeinflussen. Die Erkenntnisse aus diesen Studien mahnen zur Vorsicht. Frühgeborene mit posthämorrhagischer Ventrikelerweiterung sollten außerhalb von Studien möglichst konservativ und zurückhaltend mit einheitlichen Kriterien für Liquorpunktion und Shuntimplantation behandelt werden.
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    URL: http://dx.doi.org/10.1007/s001120050696
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    Electronic Resource
    Therapie des Kleinwuchses mit Wachstumshormon Entwicklungen 10 Jahre nach der Einführung von rekombinantem Wachstumshormon (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 746-761 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Wachstumshormon ; Kleinwuchs ; Therapie ; Demographie ; Pharmakoepidemiologie ; KIGS [Kabi] Pharmacia & Upjohn International Growth Study) ; Key words Growth hormone ; Short stature ; Therapy ; Demography ; Pharmaco-epidemiology ; KIGS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Recombinant growth hormone (rGH) therapy in the treatment of children with short stature was introduced 10 years ago, and experience has shown that progress in implementing this mode of therapy depends increasingly on analyses of large pharmaco-epidemiological studies. These studies prove that the diagnosis of growth hormone deficiency, whatever the cause or pathogenetic form, is the most frequent indication for GH therapy. The remaining problems are timely and precise diagnosis, and the best possible and individual therapy aiming at the projected height and taking safety and costs into account. We are closer to solving these problems today than ever before. Apart from this, the use of GH in treating short stature in Turner syndrome and renal insufficiency has led to its acceptance as a suitable therapy for these patients. Height improvement in a number of other growth disorders is, in certain cases, also possible through GH therapy. In the light of current experience, GH therapy can thus be attempted on a rational basis in individual cases. This form of treatment clearly holds wider possibilities and its implementation is likely to go beyond short stature in the future.
    Notes: Zusammenfassung 10 Jahre nach der Einführung von rekombinantem Wachstumshormon (WH) in die Therapie kleinwüchsiger Kinder werden unsere Erfahrungen zunehmend auch durch Analyse umfangreicher pharmako-epidemiologischer Beobachtungen geprägt. Wachstumshormonmangel: Diese zeigen, daß der Wachstumshormonmangel in seinen unterschiedlichen Ursachen und pathogenetischen Erscheinungsformen nach wie vor die häufigste Indikation für WH darstellt. Die Probleme bestehen weiterhin in der rechtzeitigen und rationellen Diagnostik und in der Optimierung und Individualisierung der Therapie zum Erreichen der Wachstumsziele unter ökonomischen Gesichtspunkten und bei gleichzeitiger therapeutischer Sicherheit. Diese Probleme sind für den WH-Mangel heute lösbar. Weitere Indikationen: Ferner zeigt sich, daß auch der Kleinwuchs beim Ullrich-Turner-Syndrom und bei der Niereninsuffizienz, für welche WH zugelassen ist, erfolgreich behandelt werden kann. Bei einer Vielzahl anderer Wachstumsstörungen ist die Möglichkeit zur Größenverbesserung im Einzelfall gegeben. Vor dem Hintergrund heutiger Erfahrungen kann ein individueller Heilversuch so auf eine rationale Basis gestellt werden. Zukunftsperspektiven: In Zukunft wird das breite Wirkpotential von Wachstumshormon über die Indikation des Kleinwuchses hinaus ausgeschöpft werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050633
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    Electronic Resource
    Tarsaltunnelsyndrom (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 341-343 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Tarsaltunnelsyndrom ; Ätiologie ; Trauma ; Diagnose ; Therapie ; Keywords ; Tarsal tunnel syndrome ; Aetiology ; Trauma ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: In this paper we describe the tarsal tunnel syndrome with reference to our own experience in 10 cases and the literature. Compared with the numerous injuries involving the ankle and foot, the diagnosis of tarsal tunnel syndrome is rare. In the case of a painful foot of unknown aetiology, the differential diagnosis should therefore include tarsal tunnel syndrome. Our presentation discusses the aetiology and pathology of the tarsal tunnel syndrome, and particularly that caused by trauma. We also describe an effective therapeutic approach based on surgical decompression.
    Notes: Anhand der Literatur und eigenen Erfahrungen von 10 Operationen wird das Tarsaltunnelsyndrom dargestellt. Gemessen an der Vielzahl der Traumen im Sprunggelenk- und Fersenbeinbereich wird die Diagnose selten gestellt. Bei unklaren Fußschmerzen sollte daher differenzialdiagnostisch ein Tarsaltunnelsyndrom in Erwägung gezogen werden. Es wird auf die Ätiologie, die Pathologie sowie auf den Zusammenhang zu Traumen eingegangen und die effektive Therapie durch operative Dekompression beschrieben.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390000310
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  • 46
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    Electronic Resource
    Kreuzbandriß beim Kind (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S136 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Vordere Kreuzbandverletzung ; Kinder ; Rekonstruktion ; Indikation ; Key words ; ACL lesion ; Children ; Reconstruction ; Indications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract For ACL lesions in children near to the end of the growth phase the treatment can be treated identical to that in adults. For younger children (8–12 years) the treatment must be conservative, combined with controls at short intervals. Behaviour during sport should be modified. If instability is experienced in activities of daily life or during sport a reconstruction of the ACL should be done using a central tibial transepiphyseal hamstring reconstruction with a femoral over-the-top position to avoid possible growth disturbances.
    Notes: Zusammenfassung Kreuzbandverletzungen bei Kindern, die nahe ihres Wachstumsabschlusses sind (14. bis 17. Lebensjahr) können wie Kreuzbandverletzungen von Erwachsenen behandelt werden. Kreuzbandverletzungen bei Kindern, die 13 Jahre und jünger sind, sollten zunächst abwartend behandelt werden (Kniebandage, Koordinationstraining, Belastungsreduzierung). Stellt sich im täglichen Leben oder bei sportlicher Belastung eine Instabilität im Sinne eines Giving way heraus, so sollte das Kreuzband rekonstruiert werden. Dabei ist es nach allen vorliegenden Daten unbedenklich, die Tibia zentral mit einem 8-mm-Bohrloch zu durchbohren und ein ligamentäres Transplantat durchzuziehen. Femoral ist es aus Sicherheitsgründen eher sinnvoll, statt einer transossären Bohrung die Over-the-top-Position zu wählen. Auch andere, rein epiphysäre Verankerungsmethoden (Semitendinosusplastik mit transossärer Drahtfixation) sind möglich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014871
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  • 47
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    Electronic Resource
    Schultergelenknahe Oberarmfrakturen einschließlich Endoprothetik (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S180 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Humeruskopffraktur ; Diagnostik ; Therapie ; Keywords Fracture of the head of the humerus ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Fractures of the head of the humerus present a challenge both at the stages of diagnosis and treatment. Fortunately, 70–80% ¶of all fractures of the humeral head can be treated conservatively because they are not dislocated. When dislocation is present detailed understanding of the morphology of such fractures and purposeful application of internal fixation techniques are essential for the achievement of good shoulder function. Every step of the treatment is aimed at stability of the joint with its components as close as possible to their original anatomical positions. This can generally be managed with minimally invasive approaches and/or with the bone fragments preserved. We regard depression fractures of the humeral head (〉 45%) in active, older patients –¶who are frequently affected – as a primary indication for a shoulder replacement. Four-fragment fractures with displacement of the head fragment in an older, physically active patient can also occasionally be an indication for primary joint replacement. Both for conservatively treated and for operatively treated fractures of the humeral head a customized schedule of follow-up treatment should be applied, to avoid the precipitation of secondary frozen shoulder by too-passive behaviour. On the other hand, neither should the follow-up treatment programme lead to a secondary dislocation. For restoration of the function it is therefore absolutely essential that the trauma surgeon monitor the treatments applied.
    Notes: Zusammenfassung Humeruskopffrakturen stellen eine Herausforderung an die Diagnostik und die Therapie dar. Glücklicherweise können 70–80% davon konservativ behandelt werden, da sie nicht disloziert sind. Im Fall der Dislokation sind ein differenziertes Verständnis der Frakturmorphologie und der zielgerichtete Einsatz osteosynthetischer Techniken unabdingbare Voraussetzung einer guten Schulterfunktion. Ziel jedweder Behandlungsmaßnahme ist das Erreichen einer stabilen Situation in möglichst anatomiegerechter Position. Dies kann überwiegend mit minimalinvasiven Zugängen bzw. unter Schonung der Knochenfragmente erreicht werden. Besonders im Fall der Humeruskopfimpressionsfrakturen (〉 45%) beim häufig betroffenen älteren, aktiven Patienten sehen wir eine primäre Indikation zur Schulterendoprothese. Ebenso stellen die 4-Fragment-Frakturen mit Verschiebung des Kopffragments bei älteren, biologisch aktiven Patienten eine gelegentliche Indikation zum primären Gelenkersatz dar. Sowohl für die konservativ als auch für die operativ behandelten Humeruskopffrakturen sollte ein differenziertes Nachbehandlungsschema Anwendung finden, um nicht durch zu passives Verhalten eine sekundäre Schultersteife zu initiieren. Auf der anderen Seite sollte ein Nachbehandlungsprogramm auch nicht zur sekundären Dislokation führen. Die unfallchirurgische Kontrolle der Behandlungsmaßnahmen ist daher zwingende Voraussetzung einer bestmöglichen Wiederherstellung der Funktion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014884
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  • 48
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    Electronic Resource
    Arbeitsunfall und psychische Gesundheitsschäden (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S450 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Psychisches Trauma ; Psychische Störungen ; Versicherungsschutz ; Kausalität ; Heilverfahrenssteuerung ; Therapie ; Begutachtung ; Keywords Psychological trauma ; Psychological disorders ; Insurance cover ; Legal causality ; Case management ; Therapy ; Expert reviewing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Accident insurance agencies are confronted with an increasing number of cases in which psychological damage occurs immediately at the time of the traumatic events, or in their aftermath. This article reviews the stipulations governing insurance cover and benefits and the legal principles of causality issues in the case of psychological traumas and disorders resulting from such incidents. Insurance agencies face special challenges for case mangagement, since there are no well-established procedures for physicians and hospitals to follow in such cases. Irrespective of the often difficult causality and liability issues, immediate therapy should be given absolute priority. More attention should be paid to psychological damage, with the aims of improving methods of medical rehabilitation and establishing guidelines for expert review in such cases.
    Notes: Zusammenfassung Die Unfallversicherungsträger sind mit einer zunehmenden Zahl von Fällen konfrontiert, bei denen psychische Gesundheitsschäden unmittelbar bei dem Unfallereignis auftreten oder sich nachfolgend entwickeln. Der Beitrag gibt einen Überblick über Grundsätze des Versicherungsschutzes und Kausalitätsfragen bei psychischen Traumen und psychischen Störungen als Folge eines Versicherungsfalls. Für die Unfallversicherungsträger ergeben sich besondere Anforderungen an die Steuerung des Heilverfahrens, da nicht auf das für organische Verletzungen etablierte System besonderer Heilverfahrensarten, wie z. B. das Durchgangsarztverfahren, zurückgegriffen werden kann. Unter allen Umständen hat die Therapie unbedingten Vorrang, unabhängig von der kausalrechtlichen Fragestellung nach dem zuständigen Leistungsträger. Psychischen Gesundheitsschäden ist vermehrt Aufmerksamkeit zu schenken mit dem Ziel, geeignete Maßnahmen der medizinischen Rehabilitation weiterzuentwickeln und Konventionen für die Begutachtung zu schaffen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014969
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  • 49
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    Electronic Resource
    Kreuzbandriß beim Kind (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S138 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Vorderes Kreuzband ; Kind ; Wachstumsfuge ; Fehlwachstum ; Key words ; Anterior cruciate ligament ; Children ; Growth plate ; Growth disturbance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Lesions of the anterior and posterior cruciate ligaments are relatively rare in childhood and adolescence; in this age group they need even more consistent and aggressive treatment than in adults as far as conservation of the menisci and definitive stabilization are concerned. Virtually no cases in which serious growth disturbance has arisen following transepiphyseal drilling are known from the literature. Thus, cruciate ligament suturing should also not be done in children, because the long-term efficacy has not been confirmed. The operative procedure is presented in detail and is related to bone age. Early transepiphyseal drilling is permissible.
    Notes: Zusammenfassung Ligamentäre Kreuzbandverletzung beim Kind und im Adoleszentenalter sind relativ selten, sie bedürfen im Vergleich zum Erwachsenen ¶einer noch konsequenteren und aggressiven Behandlung bezüglich Meniskuserhalt und definitiver Stabilisierung. In der Literatur sind praktisch keine Fälle bekannt, bei denen es tatsächlich zu einem gravierenden Fehlwachstum nach transepiphysärer Bohrung gekommen ist. Insofern sollte auch die Kreuzbandnaht beim Kind wegen der nicht bewiesenen Langzeiteffizienz unterlassen werden. Das Vorgehen im Einzelnen in Bezug zum Skelettalter wird dargestellt. Frühzeitige transepiphysäre Bohrungen sind erlaubt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014872
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  • 50
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    Electronic Resource
    Frakturen und Luxationen am proximalen Unterarm (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S194 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Fraktur ; Luxation ; Radiusköpfchen ; Olekranon ; Processus coronoideus ; Behandlung ; Keywords Fracture ; Dislocation ; Radial head ; Olecranon ; Coronoid process ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Because of its central location, the elbow joint is considered the most important joint within the upper extremity from the viewpoint of function. Trauma to osseous and ligamentous structures of the proximal forearm confronts trauma surgeons and orthopedic specialists with numerous diagnostic and therapeutic challenges. Conditions following elbow trauma are often accompanied by chronic pain and diminished range of motion, leading to functional deficits of the entire arm. There is now practically no doubt that primary osteosynthesis, anatomical joint reconstruction and early onset of functional treatment are essential for a good ¶final outcome. With our expanding knowledge of the anatomical and biomechanical condtions in the proximal lower arm in the last few decades the basic principles of therapy have also changed, and current standards of treatment for proximal forearm trauma are presented in this paper with reference to the relevant literature.
    Notes: Zusammenfassung Das Ellbogengelenk ist aufgrund seiner zentralen Lage aus funktionellen Gesichtspunkten als das bedeutendste Gelenk der oberen Extremität anzusehen. Knöcherne und ligamentäre Verletzungen im Bereich des proximalen Unterarms konfrontieren den behandelnden Arzt mit einer Anzahl von diagnostischen und therapeutischen Problemen. Posttraumatische Zustände am Ellbogengelenk, die mit chronischer Schmerzsymtomatik und Bewegungseinschränkungen einhergehen, mindern zwangsläufig die Gebrauchsfähigkeit des gesamten Arms. Es besteht heute kaum noch ein Zweifel daran, dass in der Mehrzahl der Fälle eine primäre definitive osteosynthetische Versorgung mit exakter Rekonstruktion der Gelenkfläche für ein befriedigendes Resultat ebenso unverzichtbar ist wie ein frühzeitiger Beginn physiotherapeutischer Übungsmaßnahmen. Mit zunehmendem Verständnis der anatomischen und biomechanischen Besonderheiten des proximalen Unterarms vollzog sich in den letzten Dekaden ein entscheidender Wandel der therapeutischen Grundsätze, deren aktueller Stand in der vorliegenden Arbeit unter Berücksichtigung der relevanten Literatur vorgestellt wird.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014886
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  • 51
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    Electronic Resource
    Clinicopathological correlations in nephrotic children with IgA nephropathy (2000)
    Springer
    Clinical and experimental nephrology 4 (2000), S. 318-322 
    Details
    ISSN: 1437-7799
    Keywords: Key words IgA nephropathy ; Nephrotic syndrome ; Children ; Age at onset
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. The prognostic significance of nephrotic syndrome (NS) in children with IgA nephropathy (IgAN) is unclear. Methods. NS was found in eight children with IgAN (mean onset age, 9.3 years). The clinicopathological findings of these eight children were investigated. Results. Five patients presented with macroscopic hematuria, while the remaining three were discovered in a school urinary screening program or by chance urinalysis. Six patients developed NS at the onset, and two developed NS later in the course of IgAN. All patients were treated with corticosteroids. At the end of follow-up, heavy proteinuria persisted in four children, one of whom had renal dysfunction at the onset of NS and developed end-stage renal failure, and two of whom developed NS after the onset of IgAN. Proteinuria decreased to less than 1 g/day 3 months after NS in four patients, two of whom showed disappearance of proteinuria afterward. Renal biopsy specimens revealed mesangial proliferation and crescent formation in all patients. The degree of persisting proteinuria was correlated with the presence of glomerular sclerosis, fibrous crescents, tubulo-interstitial changes on light microscopy, and depositions of C3 on immunofluorescence microscopy. Conclusions. Children who developed NS after the onset of IgAN developed renal dysfunction; the prognosis of those who showed chronic histopathological changes on renal biopsy specimens was poor, even in these young children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101570070008
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  • 52
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    Electronic Resource
    Major injuries from “domestic” animals in children (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 589-591 
    Details
    ISSN: 1437-9813
    Keywords: Key words Domestic animals ; Children ; Injury ; Evaluation ; Prevention
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Domestic animals are a potential cause of serious injury to handlers and children. In developed countries dogs are the most common cause of such injuries, but in developing countries childhood injuries from domestic animals have not been given much attention. A retrospective analysis of major injuries from domestic animal attacks in children aged 12 years or less in a developing country showed 17 injuries in 16 children. The locations were the abdomen (6), head and neck (4), extremities (3), external genitalia (3), and back (1). A big-horned cow was the cause of injury in 11 patients, a donkey in 4 and a ram in 1. Children under 10 years were injured by provoked animals, mostly as bystanders, while older children were handlers. Four abdominal injuries were penetrating with evisceration and contusion of bowel and required a laparotomy. One blunt splenic injury was managed non operatively and one by partial splenectomy. Two head injuries were managed non operatively. All other injuries were examined and explored with the child under general anaesthesia. These injuries were debrided and closed primarily or closure was delayed when contamination was heavy or adequate debridement was limited by vital neighbouring structures. Broad-spectrum antibiotics and tetanus prophylaxis were given for all open wounds. The average duration of hospital stay was 7.3 days. Three patients had wound infections resulting in long hospitalizations. Two patients died (12.5%), 1 from a severe head injury and 1 from an overwhelming infection. The management of major injuries from domestic animals in children requires meticulous evaluation and examination during general anaesthesia to establish the extent of injury and avoid missed injuries. Prevention of these injuries requires public education about the proper and compassionate handling of domestic animals.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000419
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  • 53
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    Accurate localization of an insulinoma by preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 118-120 
    Details
    ISSN: 1437-9813
    Keywords: Key words Insulinoma ; Arterial stimulation ; Calcium ; Localization ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The role of pre- and intraoperative procedures for the localization of insulinomas has been extensively debated. We report a case of successful treatment using preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring. A 12-year-old boy with hypoglycemic attacks had a large insulinoma in the head of the pancreas on computed tomography. Preoperative selective angiography combined with arterial stimulation-venous sampling (ASVS) by intra-arterial injection of calcium revealed no other insulinomas in the body and tail of the pancreas. Elevation of serum glucose on intraoperative monitoring confirmed complete enucleation of the insulinoma. Preoperative ASVS can accurately localize an insulinoma, and may help to increase the success rate of surgery and avoid blind pancreatectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050036
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  • 54
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    Electronic Resource
    Chemokines: new target molecules in renal diseases (2000)
    Springer
    Clinical and experimental nephrology 4 (2000), S. 273-280 
    Details
    ISSN: 1437-7799
    Keywords: Key words Chemokine ; Chemokine receptor ; Kidney ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The presence of leukocytes in the diseased kidneys is a hallmark of almost any kind of renal disease. Activated leukocytes are implicated in playing a crucial role in the pathogenesis of renal diseases. Recent investigations of the pathophysiological roles of chemokines and their cognate receptors have shed light on the detailed molecular mechanisms of leukocyte trafficking and activation in the diseased kidneys. This study summarizes findings that: (1) chemokine/chemokine receptor systems may be essentially involved in the pathogenesis of phase-specific renal disorders, (2) the measurement of urinary levels of chemokines may be clinically useful for monitoring different disease phases and activities in human renal diseases, and (3) interventions in chemokine/chemokine receptor systems may have potential as particular immunotherapeutic strategies to combat specific phases of renal diseases. Further investigations of anti-chemokine therapies for renal diseases will be required before clinical application is feasible.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101570070001
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  • 55
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    Electronic Resource
    Pleuropulmonary blastoma: four cases (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 595-598 
    Details
    ISSN: 1437-9813
    Keywords: Key words Pleuropulmonary blastoma ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pleuropulmonary blastoma (PPB) is a rare malignant neoplasm affecting children. A retrospective review was carried out of patients diagnosed as having PPB at one institute over a period of 16 years. The presentation, diagnosis, treatment, and family history were studied. PPB usually presents with symptoms and signs of respiratory tract infection, and the diagnosis may be delayed. There are no distinguishing clinical features or imaging studies. The diagnosis is made on histologic examination of tumour material and is sometimes difficult to differentiate from benign cystic lung lesions. The treatment is primarily complete excision of the tumour, followed in some cases by intense chemotherapy. PPB is a strong predictor of the presence of tumours in close relatives. Four patients treated at our institute are discussed along with a review of the literature.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000359
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  • 56
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    Sigmoid volvulus in childhood: report of six cases (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 132-133 
    Details
    ISSN: 1437-9813
    Keywords: Key words Sigmoid volvulus ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sigmoid volvulus is a common cause of large-bowel obstruction in elderly individuals, but is quite rare in childhood. We report six cases in patients under 20 years of age. One had Hirschprung's disease. Gangrenous sigmoid colon was found in three cases and resection was performed. Sigmoidopexy (one case) and extraperitonealization (two cases) were performed for viable sigmoid colon. There were no recurrences after 5.7 years of follow-up.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830070001
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  • 57
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    Ultrasound-guided percutaneous sclerotherapy of hydatid liver cysts in children (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 346-350 
    Details
    ISSN: 1437-9813
    Keywords: Key words Echinococcosis ; Liver/interventional procedure ; Cyst/percutaneous drainage ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the efficacy of ultrasound (US) guided percutaneous sclerotherapy in the pediatric population, 14 hydatid liver cysts (HLC) in eight male patients whose ages ranged between 6 and 16 years (mean 9.9 years) were treated. The maximum diameter was 110 mm. Albendazole was administered orally to all patients for 1 week before percutaneous treatment and for 3–6 months after the procedure to prevent dissemination of the disease. Cyst puncture was performed with 20 G Chiba needles using US guidance. More than one-half of the estimated cyst volume was aspirated, then 20% hypertonic saline (7 cysts) or sterile 96% alcohol (7 cysts) equivalent to one-third of the estimated cyst volume was injected into the cavity and left for 5–15 min. Finally, all the fluid in the cavity was reaspirated. Catheterization was not performed. Follow-up US examinations were performed every month during the first 6 months and every 3 months thereafter. The follow-up period ranged between 6 and 51 months (mean 15 months). No major complications were seen during or after the procedures. Two cysts in two patients completely disappeared. Volumes of the 11 cysts in five patients who were followed for 6–21 months were markedly reduced (22%–64% of the initial volume) and thick septations and solid debris-like structures were seen within the cyst cavities. There was no significant change in 1 cyst. US-guided percutaneous sclerotherapy is thus a safe and effective treatment of HLC in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000356
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  • 58
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    Anorectal injuries in children (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 388-391 
    Details
    ISSN: 1437-9813
    Keywords: Key words Anorectal injury ; Children ; Diagnosis ; Morbidity ; Mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Anorectal injuries (ARI) are uncommon in children in civil practice. In developed countries the injuries are mainly due to sexual abuse and firearms. This report reviews the experience in tropical Africa. A retrospective study of children aged 12 years or less managed for ARI over 10 years was undertaken. There were seven children, four girls and three boys. Four injuries were due to blunt trauma and three to penetrating trauma. Six patients presented within 6 h of injury and one after 24 h. Five had rectal bleeding, which was associated with vaginal bleeding in one girl. One girl each had vaginal bleeding and vaginal discharge without rectal bleeding. Diagnosis was by rectal examination and proctoscopy. In three patients a laparotomy was necessary to exclude an intraperitoneal rectal injury (IRI); this was positive in one case. One patient with abdominal findings had a laparotomy as the primary procedure. Overall, five patients had rectal injuries (extraperitoneal 3, intraperitoneal 2), which were associated with an anal injury in three while one patient had only an anal injury. An IRI was missed at initial assessment in one girl. Associated injuries were to the vaginal wall (3), urethra (1) and head (1). IRIs were treated by repair and proximal colostomy. Extraperitoneal injuries were treated by colostomy and drainage; in two patients the injuries were accessible and were repaired. Anal and external-sphincter injuries were repaired in two cases. Vaginal lacerations were repaired and other associated injuries treated accordingly. Three patients had wound infections. Faecal continence was maintained in all patients who had anal and external-sphincter injuries. One girl died of peritonitis from a missed IRI. It is concluded that ARI remains uncommon in children. Morbidity and mortality can, however, be high. Meticulous rectal palpation and visualisation is necessary to avoid missing injuries.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000347
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    Venous patency after open central-venous cannulation (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 411-413 
    Details
    ISSN: 1437-9813
    Keywords: Key words Central venous catheters ; Children ; Ultrasound assessment of venous patency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the value of Doppler ultrasound scan (USS) assessment of internal jugular vein (IJV) patency after previous open central-venous cannulation (CVC), a prospective study of 66 consecutive children (median age 4.5 years; range 4 months–17 years) who had previously undergone open insertion of at least one indwelling IJV line and required further CVC for completion of therapy was undertaken. All underwent Doppler USS examination prior to surgery. Where patency of the previously cannulated vein was suggested ultrasonographically, the accuracy of this finding was confined at open surgical exploration. Initial CVCs were in situ for a median of 9 months (1 month–4 years) prior to removal. The median interval to repeated CVC was 11 months (3 weeks–45 months). In 79 Doppler USS, 70 (88.6%) veins appeared patent, 3 (4.2%) stenosed, and 6 (7.6%) obliterated. Of the 70 “USS patent” veins, 66 were explored. Patency was confirmed surgically in 59 (89.4%) and a new CVC successfully inserted. Seven (10.6%) apparently patent veins on USS were found to be obliterated at open exploration. Review of USS images in these cases suggested that enlarged collateral veins were usually responsible. Overall, successful recannulation was possible in 74.6% of all previously accessed veins. In children requiring repeated CVC, Doppler USS of neck veins is a valuable but not entirely reliable guide to the presence of underlying vessel patency and should be interpreted with caution. At least three-fourths of previously cannulated IJVs remain patent after catheter removal and can be reused for CVC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000355
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    Gastric wall erosion by an amebic liver abscess in a 3-year-old girl (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 429-430 
    Details
    ISSN: 1437-9813
    Keywords: Key words Amebic liver abscess ; Children ; Pediatric ; Stomach ; Rupture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The occurrence of an amebic liver abscess (ALA) rupturing into the stomach is reported. ALAs in children can have atypical presentations, resulting in delayed diagnosis and increased morbidity and mortality. Timely treatment is usually followed by complete recovery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003839900319
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  • 61
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    Peutz-Jeghers syndrome: is family screening needed? (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 437-439 
    Details
    ISSN: 1437-9813
    Keywords: Key words Peutz-Jeghers syndrome ; Intestinal polyposis ; Intussusception ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a 7-year-old boy, a small-bowel polyp was found intraoperatively as a lead point of an intussusception. Histologically, a hamartoma was found and the clinical work-up revealed Peutz-Jeghers syndrome (PJS). Additionally, all four asymptomatic siblings showed intestinal polyposis. All children in a family with PJS should be properly investigated. In case of an intussusception with a polyp in a critical location, a surgical procedure should follow.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003839900296
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  • 62
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    Congenital spigelian hernia and cryptorchidism: cause or coincidence? (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 433-436 
    Details
    ISSN: 1437-9813
    Keywords: Key words Hernia ; Spigelian hernia ; Children ; Cryptorchidism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Congenital spigelian hernia (SH) is very rare in the pediatric age group. This is a report of two cases of SH in 1-week and 3-month-old male infants. A review of the literature revealed only 35 cases of SH in children younger than 17 years of age, bringing the total including our 2 cases to 37. There were 25 males and 12 females, a ratio of 2.1:1. Their ages ranged from 6 days to 17 years (mean 4.52 years). The hernia was situated on the right side in 13, the left side in 19, and was bilateral in 4. In one case the side of the hernia was not mentioned. In 29 cases the hernia was spontaneous while in 5 it was caused by trauma. In 3 children the hernia developed postoperatively, in 2 following repair of a congenital diaphragmatic hernia and in 1 following excision of a mediastinal neuroblastoma. Two children presented with a strangulated SH. Eleven of the 35 previously reported children had associated conditions; in 5 there was an ipsilateral undescended testis (UDT). Our two infants with SH also had an ipsilateral UDT. The significance of this association is discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003839900292
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  • 63
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    Posttraumatic high-flow priapism: treatment with selective embolisation (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 454-456 
    Details
    ISSN: 1437-9813
    Keywords: Key words Priapism ; Children ; Arteries ; Fistula ; Embolisation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Priapism is an uncommon problem in childhood. Most of the reported cases are in boys with sickle-cell disease or leukaemia. It occurs as a result of venous outflow obstruction, resulting in engorgement of the corpora cavernosa, and is termed “low-flow” priapism. In a small group of children priapism is due to uncontrolled arterial inflow, usually as a result of direct trauma. The authors report a case of post-traumatic arterial priapism in a child, successfully treated with selective embolisation of the internal pudendal artery. Recognition of this distinct entity is important, as it carries a good prognosis when appropriately treated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003839900320
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  • 64
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    Anti-retroviral treatment in Nigeria: a review (2000)
    Springer
    Journal of infection and chemotherapy 6 (2000), S. 196-199 
    Details
    ISSN: 1437-7780
    Keywords: Key words Anti-retroviral ; Therapy ; Nigeria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Research studies in Nigeria have been done primarily in the areas of epidemiology, clinical practice, virology, and laboratory diagnosis. Therapy for infection with human immunodeficiency virus (HIV) types 1 and 2 has largely focussed on the treatment of the HIV disease (AIDS) rather than the infection. Therefore, opportunistic infections such as tuberculosis, diarrhea, Herpes zoster, and other skin conditions, and tumors (Kaposi's sarcoma) are essentially the targets for therapy. Two reasons are responsible for the dearth of data on anti-retroviral therapy in Nigeria: there was scepticism about zidovudine, the first anti-retroviral drug to be developed, because of its toxicity, and the subsequent reluctance of the Federal Government to allow it into the country. The other reason was the prohibitive cost, making it impossible for patients to afford. That notwithstanding, there have been several uncoordinated and unpublished clinical trials by hospitals in the private sector, as expected, without firm laboratory monitoring or back-up. This review discusses such attempts and the claims of traditional medicine practitioners, as well as pilot studies on private patients with the combination therapy of zidovudine and lamivudine, which agents were allowed into the country in the late 1990s. The patients showed appreciable rises in their CD4 counts, an indirect way of monitoring viral load. This finding was corroborated with results of clinical wellbeing, indicating that they benefitted from the administration of zidovudine and lamivudine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101560070002
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  • 65
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    Urea kinetics and other dialysis indices in children undergoing ambulatory peritoneal dialysis (2000)
    Springer
    Clinical and experimental nephrology 4 (2000), S. 225-230 
    Details
    ISSN: 1437-7799
    Keywords: Key words Peritoneal dialysis ; Dialysis index ; Urea kinetics ; Adequacy ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Peritoneal dialysis (PD) is an established treatment for children with end-stage renal failure. Creatinine clearance and urea kinetics are used to quantitate the dialysis treatment, but the means to assess the adequacy of dialysis in children are still controversial. Methods. We studied serum chemistry, dietary protein intake (DPI), protein catabolic rate (PCR), weekly urea clearance/body water (Kt/Vurea), weekly creatinine clearance (Ccr/week), clinical signs and symptoms during PD treatment, and peritoneal transport function in 17 children (4 to 18 years of age) with end-stage renal disease treated with PD. Fourteen children were on continuous ambulatory peritoneal dialysis (CAPD) and 3 were on automated peritoneal dialysis. Results. The mean values of the parameters tested were: blood urea nitrogen, 71 mg/dl; creatinine, 9.8 mg/dl; total protein, 6.4 g/dl; albumin, 4.0 g/dl; total Ccr, 70 l/week per 1.73 m2; DPI, 1.76 g/kg per day; PCR, 1.17 g/kg per day, and total Kt/Vurea, 2.28/week. The mean patient's clinical assessment score was 11.7, out of 15 and the mean doctor's clinical assessment score was 11.7, out of 14. The correlation between Kt/Vurea and creatinine clearance was 0.84 (P 〈 0.0001). Kt/Vurea and clinical assessment scores (patient's and doctor's scores) did not show a good correlation (r = 0.32; P = 0.228, and r = 0.47; P = 0.064, respectively). Peritoneal function seemed to be preserved after an average duration of 32 months on PD. Conclusions. These patients appeared to be fairly well dialyzed, judging from the values for the various dialysis indices obtained in this study and comparing them with adult indices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101570070026
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  • 66
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    Direct inguinal hernias in children: laparoscopic aspects (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 562-564 
    Details
    ISSN: 1437-9813
    Keywords: Key words Inguinal hernia ; Children ; Direct ; Recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Among 109 children treated laparoscopically for inguinal hernias, 5 had direct hernias, more than would normally be anticipated. Two of the hernias were recurrences of indirect hernias operated upon previously using the open technique. Direct hernias are easier to detect with the laparoscopic technique.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000431
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  • 67
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    Intestinal volvulus: aetiology, morbidity, and mortality in Nigerian children (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 50-52 
    Details
    ISSN: 1437-9813
    Keywords: Key words Intestinal volvulus ; Children ; Idiopathic ; Adhesion/bands ; Resection rate ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In developed countries, intestinal volvulus in children is most frequently due to malrotation. To review the experience in Nigeria, a retrospective analysis of 28 patients managed over 25 years at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, was undertaken. There were 22 boys and 6 girls with an age range of 4 days to 14 years (median 4 years). There were equal numbers over and less than 5 years of age. Vomiting (89%) and abdominal distension (79%) were the most prominent features. Thirteen children (46%) had fever, associated with bowel gangrene in 5, while 8 (29%) presented with severe dehydration and shock. A plain abdominal radiograph was the only investigation performed, but the features were not specific for volvulus. In 11 children (39%) the volvulus was idiopathic, in 9 (32%) due to adhesions or bands, in 5 (18%) to malrotation, and in 1 each a Meckel's diverticulum, internal herniation, and ventriculoperitoneal shunt. Twenty-three patients had a small-bowel, 4 sigmoid, and 1 caecal volvulus. The bowel resection rate for gangrene was 46% (small bowel 9, sigmoid 3, caecum 1). All patients with malrotation had Ladd's procedure performed. Wound infections occurred in 10 patients (36%), complete wound dehiscence in 1, and recurrence in 1 (idiopathic terminal ileal volvulus). The mortality was 21%, mostly from overwhelming infection (2 neonates, 11-year-old, 3 ≥ 5 years). Intestinal volvulus in our environment differs in aetiology from other reports. The resection rates are similar, however. This condition carries high morbidity and mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050013
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  • 68
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    Macrodystrophia lipomatosa with associated fibrolipomatous hamartoma of the median nerve (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 216-218 
    Details
    ISSN: 1437-9813
    Keywords: Key words Macrodystrophia lipomatosa ; Fibrolipomatous hamartoma ; Magnetic resonance imaging ; Median nerve
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Macrodystrophia lipomatosa (MDL) is a rare disease typically causing localized gigantism and is often associated with a fibrolipomatous hamartoma (FH) of the median or plantar nerve. A previously unreported case of MDL with associated FH of the median nerve is presented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050728
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  • 69
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    Management of pancreatic and duodenal injuries in pediatric patients (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 35-39 
    Details
    ISSN: 1437-9813
    Keywords: Key words Pancreatic trauma ; Duodenal trauma ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050009
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  • 70
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    Electronic Resource
    Imaging of plant-thorn synovitis (2000)
    Springer
    Skeletal radiology 29 (2000), S. 605-608 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Plant-thorn synovitis ; Monoarticular arthritis ; Elbow ; Magnetic resonance imaging ; Ultrasound ; Power Doppler
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We describe a case of plant-thorn synovitis of the elbow resulting from a thorn injury. This caused recurrent pain and swelling of the elbow over a 3-month period. A magnetic resonance imaging examination was initially requested to exclude septic arthritis, and demonstrated a joint effusion, synovitis, and a 2-cm linear opacity embedded in the synovium. Ultrasound was performed prior to surgery to confirm these findings and provide accurate localization of the thorn fragment, later removed at surgery. To our knowledge this is the first example of this condition that has been confirmed by radiological imaging prior to surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000244
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  • 71
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    Effect of low back posture on the morphology of the spinal canal (2000)
    Springer
    Skeletal radiology 29 (2000), S. 217-223 
    Details
    ISSN: 1432-2161
    Keywords: Key words Spinal canal ; Low back posture ; Morphologic change ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To define the possible mechanism of posture-dependent symptoms of spinal stenosis by measuring the effect of low back posture on morphologic changes of the intervertebral discs and spinal canal in healthy young people. Design.Twenty healthy young volunteers underwent magnetic resonance imaging while supine with their spine in neutral, flexed, extended, and right and left rotational positions. The axial MR images at the middle of the intervertebral discs of L3–4 and L4–5 were analyzed to measure the difference in the size and shape of the intervertebral discs and spinal canal in each posture. Results.  Extension or rotation decreased the sagittal diameters and cross-sectional areas of the dural sac and spinal canal and increased the thickness of the ligamentum flavum, whereas flexion had the opposite effects. The gap between the convex posterior disc margin and the anterior margin of the facet joint on each side, represented as the subarticular sagittal diameter, increased with flexion and decreased with extension or rotation. The direction of rotation did not result in asymmetry of the subarticular sagittal diameter, but right rotation caused thickening of the right ligamentum flavum, and vice versa. The shape and dimensions of the disc did not change significantly according to the positions of the low back. Conclusions.With extension or rotation, the thickness of the ligamentum flavum increased and the posterior margin of the intervertebral disc was approximated to the facet joint without any change in shape and size of the disc. These phenomena result in a decrease in the size of the spinal canal and dural sac in extension or rotation postures in young healthy people without disc degeneration, and may explain the posture-dependent symptom of spinal stenosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050596
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  • 72
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    Complete rupture of the distal semimembranosus tendon with secondary hamstring muscles atrophy: MR findings in two cases (2000)
    Springer
    Skeletal radiology 29 (2000), S. 362-364 
    Details
    ISSN: 1432-2161
    Keywords: Key words Hamstring muscles ; Semimenbranosus ; Tear ; mass ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Complete rupture of the hamstring muscles is a rare injury. The proximal musculo-tendinous junction is the most frequent site of rupture. We present two cases of complete rupture of the distal semimenbranosus tendon, which clinically presented as soft-tissue masses. MR imaging permitted the correct diagnosis. There has been only one other such case reported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000216
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  • 73
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    Solid aneurysmal bone cyst in the humerus (2000)
    Springer
    Skeletal radiology 29 (2000), S. 470-473 
    Details
    ISSN: 1432-2161
    Keywords: Key words Aneurysmal bone cyst ; Humerus ; Giant cell reparative granuloma ; Pathological fracture ; Radiography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report on a 69-year-old woman with a solid variant of aneurysmal bone cyst (solid ABC) in the left humerus with a pathological fracture. Radiographically, the lesion exhibited a relatively well-defined osteolytic lesion in the diaphysis of the left humerus. On magnetic resonance (MR) imaging, the medullary lesion exhibited a homogeneous signal intensity isointense with surrounding normal muscles on the T1-weighted images and a mixture of low and high signal intensity on the T2-weighted images. Contrast-enhanced T1-weighted images revealed diffuse enhancement of the entire lesion. The pathological study showed a proliferation of fibroblasts, histiocytes, chronic inflammatory cells and numerous multinucleated giant cells in a collagenous matrix. Abundant osteoid formation in the matrix was observed, but the cells were devoid of nuclear atypia. Aneurysmal cystic cavities were absent. A review of the English literature found 22 cases of solid ABC of the long bones.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000236
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  • 74
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    Juxta-articular hemangioma of long bone (2000)
    Springer
    Skeletal radiology 29 (2000), S. 535-537 
    Details
    ISSN: 1432-2161
    Keywords: Key words Computed tomography ; Intraosseous hemangioma ; Magnetic resonance imaging ; Epiphysis equivalent ; Tibia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report on a rare case of an intraosseous hemangioma involving the proximal tibia in a 70-year-old man. Radiographically, the lesion was a well-defined osteolytic lesion with marginal sclerosis. The CT images demonstrated a well-defined osteolytic lesion with partial cortical breakthrough. T1-weighted MR images showed a hypointense lesion, while T2-weighted images revealed hyperintense areas, with internal, hypointense septa. Gadolinium-enhanced T1-weighted images showed lattice-like enhancement of the lesion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000256
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  • 75
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    Subcutaneous and musculoskeletal sparganosis: imaging characteristics and pathologic correlation (2000)
    Springer
    Skeletal radiology 29 (2000), S. 402-408 
    Details
    ISSN: 1432-2161
    Keywords: Key words Soft tissue ; Magnetic resonance imaging ; Sparganosis ; Sparganosis ; magnetic resonance imaging ; Sparganosis ; ultrasonography ; Parasitic infection ; Sparganum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To document the imaging characteristics of subcutaneous and musculoskeletal sparganosis. Design and patients. Ten patients with musculoskeletal sparganosis were examined, with a variety of imaging modalities including MRI (n=6), ultrasonography (n=8), plain radiography (n=7) and CT (n=1). Pathologic correlation was carried out in all cases. Results. Nine lesions involved soft tissues, of which seven were in the thigh, two in the trunk and one involved a vertebral body. The majority of the lesions in soft tissue were confined to the subcutaneous layer but two extended deep into underlying muscles. Sonography revealed low-echoic serpiginous tubular tracts (8/8), and an intraluminal echogenic structure (4/8). MRI revealed multiple serpiginous tubular tracts and peripheral rim enhancement. Two patients showed perilesional soft tissue edema. Pathologically, the lesion consisted of a larva surrounded by three layers of inflammation: an inner epithelioid granulomatous cell layer, middle chronic inflammatory cell layers, and an outer fibrous layer. Conclusion. The study suggests that if serpiginous tubular tracts are seen at imaging studies, musculoskeletal sparganosis should be included in the differential diagnosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000206
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  • 76
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    Pectoralis major muscle and tendon tears: diagnosis and grading using magnetic resonance imaging (2000)
    Springer
    Skeletal radiology 29 (2000), S. 305-313 
    Details
    ISSN: 1432-2161
    Keywords: Key words Pectoralis major muscle ; Magnetic resonance imaging ; Tendons ; injuries ; Tendons ; magnetic resonance imaging ; Muscles ; injuries ; Muscles ; magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To assess the accuracy and utility of magnetic resonance (MR) imaging in the detection and grading of pectoralis major muscle and tendon tears. Design and patients. A retrospective review was carried out of 10 patients referred for MR imaging for suspected pectoralis muscle injury and possible operative therapy. The pectoralis muscle and tendon were imaged using thin (3–4 mm) axial sections with a variety of sequences combined for anatomical delineation (T1-weighted SE or PD SE) and fluid detection (T2-weighted SE, T2-weighted FSE with fat suppression, or STIR). Surgical correlation was available in six patients. Clinical follow-up was available in four patients treated by nonoperative therapy. Results. MR imaging identified five complete tears, four partial tears and one normal tendon. One complete and one partial tear were at the myotendinous junction. The remaining seven injuries were at the enthesis. Surgical correlation consisted of five complete tears and one partial tear. One complete and one partial tear were at the myotendinous junction with the remaining four complete tears at the enthesis. The MR interpretation and surgical findings were in agreement in all six cases. All four patients treated with nonoperative therapy demonstrated improvement at a clinical follow-up examination, with restoration of function and strength consistent with a healed prior partial injury. Conclusion. MR imaging is accurate and useful in detecting and grading tears involving the pectoralis major muscle and tendon, facilitating the identification of patients with complete tears who are candidates for operative therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000199
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    Imaging in isolated sacral tuberculosis: a review of 15 cases (2000)
    Springer
    Skeletal radiology 29 (2000), S. 392-396 
    Details
    ISSN: 1432-2161
    Keywords: Key words Sacral ; Tuberculosis ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To review imaging studies of isolated involvement of the sacrum due to tuberculosis and determine the role of imaging in the diagnosis and management of these patients. Design and patients. A retrospective analysis of 15 cases of isolated sacral tuberculosis imaged with MR imaging was performed. The CT images were also reviewed where available, and the various lesion characteristics were identified. We also reviewed the medical records in an attempt to determine the impact of the imaging studies on the management of these patients. Results. Fifteen patients (5 male, 10 female) presented with symptoms of 3–15 months’ duration. Chronic localized backache with muscle spasm was the commonest presenting symptom; discharging sinuses with abscess formation was found in six patients, five of whom were children. MR imaging of the sacrum revealed a hypointense marrow signal on T1-weighted images and hyperintense signal on T2-weighted images in 14 of 15 patients, the S2 vertebra being always involved. CT revealed osteolytic changes in the sacrum in all the five patients in whom CT was performed. All patients showed marked clinical improvement within 1 year of anti-tuberculous chemotherapy. Conclusion. Isolated tuberculosis of the sacrum is uncommon but should be suspected in patients presenting with chronic low backache or children with discharging sinuses/abscesses and showing sacral destruction on CT or MR imaging. MR imaging can identify cases and enables early institution of anti- tuberculous chemotherapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000229
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    Juxtacortical chondromyxoid fibroma arising in an apophysis (2000)
    Springer
    Skeletal radiology 29 (2000), S. 466-469 
    Details
    ISSN: 1432-2161
    Keywords: Key words Bone neoplasm ; Chondromyxoid fibroma ; Femur ; Apophysis ; Radiography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We present a rare case of juxtacortical chondromyxoid fibroma arising in the lesser trochanter of the right femur which corresponds to an apophysis. Radiography showed a well-defined expansive lesion with a sclerotic margin measuring 5×3.5 cm in diameter in the lesser trochanter. On spin echo T1-weighted images, the lesion revealed low signal intensity similar to muscle. On spin echo T2-weighted images, the lesion revealed high heterogeneous signal intensity, which after gadolinium injection showed heterogeneous enhancement. The inner margin of the cortex was intact and adjacent bone marrow was of normal signal intensity. The outer margin of the lesion was also clearly defined and extension into adjacent soft tissue beyond the exophytic cortical outgrowth was not evident.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000245
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    Familial occurrence of glenoid dysplasia: report of two cases in two consecutive generations (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 349-351 
    Details
    ISSN: 1434-3916
    Keywords: Key words Glenoid dysplasia ; Magnetic resonance imaging ; Multidirectional shoulder dislocation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Glenoid dysplasia is a rare abnormality of the shoulder. We report glenoid dysplasia in two consecutive generations: a boy and his father. Both suffered recurrent shoulder dislocations, and radiological examination revealed bilateral glenoid dysplasia. Our cases confirm dominant inheritance of this osseous malformation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050481
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    The treatment of pulled elbow: a prospective randomized study (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 336-337 
    Details
    ISSN: 1434-3916
    Keywords: Key words Pulled elbow ; Children ; Trauma ; Immobilization ; Nursemaid’s elbow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the effectiveness in decreasing recurrence of cast application after manual reduction of pulled elbow. Sixty-four children with pulled elbow were randomized into two treatment groups: Group A underwent manipulative reduction followed by splinting the elbow in a flexed and supinated position for 2 days; group B underwent manipulative reduction only. Both groups were examined 2, 5, and 10 days later. None of the 33 patients in group A had a pulled elbow at follow-up. Four (13%) of 31 patients in group B had a pulled elbow 2–5 days later. Immobilizing the elbow for 2 days after manipulative reduction improves the success of treatment of a pulled elbow.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050477
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  • 81
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    Kraniofaziale Fehlbildungen (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S068 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Kraniofaziale Fehlbildungen ; Deformationen des Hirn- und Gesichtsschädels ; Therapie ; Frontoorbitales Advancement ; Key words ; Craniofacial malformations ; Craniofacial skull deformations ; Therapy ; Frontoorbital advancement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Most craniofacial malformations result from a premature fusion of skull sutures. Depending on the scope of the sutures affected, the results are more or less distinct deformations of the facial and cranial skull with substantial negative effects on functional as well as esthetic aspects. The etiopathology is still unclear. Various therapies have been developed over the past 100 years. However, Tessier’s technique of fronto-orbital advancement has been an important milestone in the treatment of these malformations. Numerous adjustments have since perfected this operational technique. It is now possible to treat practically all skull malformations with the surgical techniques available today. At the same time, these techniques have also aided the advancements in tumor surgery and traumatology.
    Notes: Zusammenfassung Kraniofaziale Fehlbildungen entstehen überwiegend durch die vorzeitige Verknöcherung von Schädelnähten. Je nach Nahtbefall resultieren daraus mehr oder weniger ausgeprägte Deformationen des Hirn- und Gesichtsschädels, die sowohl zu einer funktionellen als auch zu einer ästhetischen Beeinträchtigung führen. Die Ätiopathogenese ist noch weitgehend ungeklärt. In den vergangenen 100 Jahren wurden verschiedene Therapieansätze entwickelt, wobei Tessier mit der Technik des frontoorbitalen Advancements der entscheidende Fortschritt gelang. Aufbauend auf dieser Operationstechnik wurden bis heute zahlreiche Verbesserungen eingebracht. Mit den heutigen Operationstechniken ist es möglich, praktisch alle Schädelfehlbildungen zu therapieren. Gleichzeitig konnten durch diese Techniken auch Fortschritte in der Tumorchirurgie und der Traumatologie erzielt werden.
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  • 82
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    Gefäß- und Nervenmalformationen (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S076 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Gefäßmalformation ; Nervenmalformation ; Neurofibromatose ; Hämangiom ; Therapie ; Key words ; Vascular malformation ; Neural malformation ; Neurofibromatosis ; Hemangioma ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The presentation of vascular and neural malformations in an understandable terminology permits accurate diagnosis, proper treatment, individualized prognosis, and also stimulates studies of pathogenesis. The descriptive classification includes: NF 1 and NF 2; hemangiomas, low- and high-flow vascular malformations, combined malformations, and hypertrophy; and syndromes such as, Parkes Weber, Klippel-Trénaunay, Maffuci’s, and multiple dysplasia syndromes. Lymphatic malformations are abnormalities of lymphatic development. The list of treatment includes surgical and nonsurgical treatment. Not all vascular malformations can be successfully treated. Coping with NF is a challenge for both, affected individuals and health care professionals. NF is often associated with a myriad of anomalies that present a lot of problems for plastic surgery. In certain cases watchful waiting seems justified but not in cases of severe problems, giant growth, and local complications.
    Notes: Zusammenfassung Die Frage der Terminologie ist im Zusammenhang mit vaskulären und nervalen Malformationen besonders wichtig. Dies gilt nicht nur im Hinblick auf die Wahl des richtigen Therapieverfahrens, sondern auch im Hinblick auf die individuell ausgerichtete Prognose und natürlich auch zur Beantwortung der die Pathogenese betreffenden Fragen. Es ist klar, dass bei Besprechung der Neurofibromatose zunächst an die NF 1 und NF 2 gedacht wird, die Hämangiome werden entsprechend ihrer Durchblutung und auch im Hinblick auf die Kombination mit den so ¶genannten Hypertrophiesyndromen, die später im Text genannt werden, eingeteilt. Dass die Bezeichnung Lymphangiom impliziert, es handle sich um einen Tumor, mag nicht ganz richtig sein, da anscheinend die für Tumoren üblichen Mitosen vermisst werden. Interessant ist das therapeutische Spektrum und dies gilt für alle Malformationen der Gefäße und Nerven, aber ganz besonders natürlich für die Neurofibromatose und die Hämangiome. Mit der NF konfrontiert zu sein, bedeutet für den Patienten und das ärztliche Personal eine lebenslange Herausforderung, darüber hinaus ist die NF häufig mit einer Unzahl von Einzelproblemen vergesellschaftet, die für die plastische Chirurgie z. T. schwere oder nicht zu lösende Probleme darstellen. Die große Zahl an Therapievorschlägen zeigt, dass die Gefäßmalformationen zum einen sehr unterschiedliche Probleme zeigen, und zum anderen, dass es kaum ein Therapieverfahren gibt, welches keinen Wunsch offen lässt. Wichtig ist der Hinweis, dass schnell wachsende Hämangiome durchaus im Anfangsstadium entfernt werden sollten, zuwartende Haltung ist in bestimmten Fällen gerechtfertigt, aber nicht, wenn sich schwere Probleme, Riesenwachstum und lokale Komplikationen einstellen.
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    Tumorchirurgie (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S142 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Tumoren im Kopf-Hals-Bereich ; Therapie ; DÖSAK-Richtlinien ; Key words ; Tumors in the head and neck area ; Therapy ; DÖSAK guidelines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Surgery is still the primary therapeutic approach in treatment of tumors in the head and neck area, dating back to the early nineteenth century. More than 150 years ago, hemimaxillectomies and mandibular resections as well as hemiglossectomies were already performed by leading surgeons. The block principle we are now following dates back to Crile, who also established the principle of cervical lymph node dissection. Ablative oncologic surgery has always been closely linked with plastic and reconstructive surgery, rendering radical surgical interventions possible without disfiguring patients. The development of facial reconstructive surgery proceeded in stages, in the first instance as secondary reconstruction using tube pedicled flaps. The change to the concept of primary reconstruction occurred via arterialized skin flaps and myocutaneous flaps to the widely accepted and performed free tissue transfer. Free bone grafting, inaugurated earlier and still representing the majority of bone grafting, has been supplemented for certain reconstructive purposes by free vascularized bone transfer from various donor sites. Although the five-year-survival rate of carcinoma of the oral cavity has remained unchanged in the past 30 years, distinctive improvements in tumor surgery can be recorded. This is primarily based on improved diagnostics such as modern imaging techniques and the refinement of surgical techniques. The DÖSAK has worked out distinctive guidelines for effective ablative oncologic surgery. Surgical approaches offering wide exposure and carrying low morbidity play a decisive role in radical resections. For this reason, midfacial degloving offers an essential improvement for the resection of midface tumors, especially from an aesthetic point of view. Tumors situated deep behind the viscerocranium at the skull base can be clearly exposed either through a lateral approach following a temporary osteotomy of the mandibular ramus or a transmandibular, transmaxillar, or transfacial approach with minimal morbidity. Concerning the concept of neck dissection, radical techniques are more and more abandoned in favor of a more conservative procedure. Actual inquiries concerning present surgical procedures as to the surgical strategy in “No-neck” or marginal and segmental resection in mandibular adherent carcinomas demand scientific clarification.
    Notes: Zusammenfassung Im Zentrum der Behandlung von Tumoren im Kopf-Hals-Bereich steht immer noch die Chirurgie, deren Ansätze weit in das 19. Jahrhundert zurückreichen. Schon vor weit über 150 Jahren wurden durch wegweisende Chirurgen Halbseitenresektionen des Ober- und Unterkiefers sowie der Zunge durchgeführt. Das heute von uns verfolgte Blockprinzip geht auf Crile zurück, der auch die Prinzipien der Halslymphknotenausräumung festschrieb. Eng verknüpft mit der Tumorchirurgie war stets die plastische und rekonstruktive Chirurgie, die radikalchirurgische Eingriffe ohne Entstellung der Patienten erst ermöglichte. Die Entwicklung der wiederherstellenden Gesichtschirurgie verlief in Phasen, zunächst als sekundäre Rekonstruktion mittels Rundstiellappen. Der Wandel zur primären Wiederherstellung vollzog sich über arterialisierte Hautfettlappen und die Myokutanlappen bis zum heute aktuellen mikrovaskulär anastomosierten Gewebetransfer. Die schon früh inaugurierte und heute noch praktizierte freie Knochentransplantation wurde für spezielle Indikationen durch den mikrochirurgischen Knochentransfer aus verschiedenen Spenderregionen ergänzt. Obwohl die 5-Jahres-Überlebensraten für das Mundhöhlenkarzinom in den letzten ¶30 Jahren stagnieren, sind heute doch deutliche Fortschritte in der Tumorchirurgie zu verzeichnen. Diese beruhen zunächst auf einer verbesserten Diagnostik durch die modernen bildgebenden Verfahren und die Weiterentwicklung der Operationsverfahren. Für eine erfolgreiche Tumorchirurgie hat der DÖSAK klare Richtlinien erarbeitet. Für eine radikale Tumorresektion spielen übersichtliche und wenig destruierende Zugangswege eine entscheidende Rolle. So brachte für die Tumoren des Oberkiefers das Midfacial degloving eine wesentliche Verbesserung, insbesondere auch aus ästhetischer Sicht. Versteckt hinter dem Gesichtsschädel liegende Tumoren an der Schädelbasis lassen sich entweder über einen lateralen Zugang nach temporärer Osteotomie des Unterkieferasts oder transmandibulär, transmaxillär oder transfazial übersichtlich ohne Destruktionen darstellen. Bezüglich der Halslymphknotenausräumung ist eine Abkehr vom radikalen zum konservativen Vorgehen zu verzeichnen. Derzeit aktuelle chirurgische Fragen, wie das operative Vorgehen beim „N 0 -Hals“ oder Kastenresektion bzw. Kontinuitätsresektion des Unterkiefers bei der Mandibula adhärenten Karzinomen, bedürfen einer wissenschaftlichen Klärung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014535
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    Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis – an evaluation of 59 cases (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 245-251 
    Details
    ISSN: 1434-3916
    Keywords: Key words Spondylodiscitis ; Magnetic resonance imaging ; Computed tomography ; Diagnostic algorithm ; Therapeutic algorithm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fifty-nine patients with spondylodiscitis (SD) of the thoracic and/or lumbar spine were followed-up clinically and radiologically [X-ray, computed tomography (CT), magnetic resonance imaging (MRI)] over a mean time of 2.2 years (1–6.5 years). All patients without abscess formation (n = 35) were treated conservatively. Out of the group with abscess formation (n = 24) 6 patients were also treated conservatively, 11 were drained under CT control and 7 were operated. At time of diagnosis, “signs of florid inflammation” were seen in 60% of the roentgenograms, in 93% of the CTs and in all of the MRIs. The sensitivity to differentiate between SD with and without abscess formation was 85% by MRI and 69% by CT. “Signs of regressive inflammation” and “signs of increasing osseous consolidation”, essential facts for starting remobilization, could first be seen using CT 6 weeks after onset of therapy. Using MRI these signs were seen with a considerable delay at 12 weeks. Clinically, only 3 of the 59 analyzed patients developed recurrent SD. In conclusion, MRI is the radiological method of choice for establishing the diagnosis of SD, in particular with regard to differentiating between cases with and without abscess formations. In contrast, CT is superior for performing success control after treatment. Therapeutically, conservative, minimal-invasive and operative procedures are not rival but rather complementary.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050457
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    Working memory resources and children's reading comprehension (2000)
    Springer
    Reading and writing 13 (2000), S. 81-103 
    Details
    ISSN: 1573-0905
    Keywords: Children ; Reading comprehension ; Working memory
    Source: Springer Online Journal Archives 1860-2000
    Topics: Education
    Notes: Abstract Working memory capacity is described as a pool of limited resources that carry out processing and storage functions. Its role has been emphasised in adults' reading comprehension. The present study had two aims: First, to study the relationship between working memory capacity and reading comprehension in fourth-grade children. Second, to study the nature of the working memory resources involved in reading comprehension, i.e., are they specific or general?To test the first point, the predictive power of working memory capacity was compared with two reading-related basic skills, vocabulary and decoding skills. To test the second point, different working memory tasks were devised using verbal, numerical and spatial materials. All the tasks were administered to 48 fourth-grade children. The results showed that working memory capacity was a direct predictor of reading comprehension when contrasted with vocabulary and decoding skills. Moreover, it seemed that working memory would be better described as a system specialised for the processing of symbolic information in that only the verbal and in a lesser extent the numerical working memory tasks were significant predictors of reading comprehension. The spatial task did not correlate with reading comprehension. The reasons accounting for the predictive power of working memory tasks were discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008088230941
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    Gliomas of the optic nerve: histological, immunohistochemical (MIB-1 and p53), and MRI analysis (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 563-570 
    Details
    ISSN: 1432-0533
    Keywords: Key words Ki-67 labeling index ; Magnetic resonance imaging ; Optic nerve glioma ; p53 ; Pilocytic ¶astrocytoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gliomas of the optic nerve, although typically of pilocytic (WHO grade I) histology, can present within the spectrum of astrocytic neoplasia including glioblastoma (WHO grade IV). In certain cases, histologic features alone make the distinction between pilocytic and diffuse astrocytomas difficult. We reviewed 22 cases of optic nerve gliomas, 19 of which were pilocytic astrocytomas (PA), and 3 of which were diffuse, non-pilocytic astrocytomas. The cases were evaluated for their clinical course, radiographic appearance, histologic grade, and proliferation indices as detected by MIB-1 (Ki-67) and p53 antibodies. Of the 19 PA, 14 showed no tumor growth by magnetic resonance imaging, and had Ki-67 and p53 labeling indices (LI) of 〈 1%. The other 5 PA exhibited aggressive behavior manifest by marked diffuse infiltrative tumor growth causing death in 2 patients, 1 of whom was diagnosed with neurofibromatosis type 1 (immunoperoxidase and radiographs not available), and marked local growth with an average time to growth of 39.3 months, a Ki-67 LI of 2–3%, and a p53 LI of 〈 1% in three others. Three of the five aggressive PA histologically demonstrated a finely reticulated pattern, a pattern that appears as an exaggeration or expansion of the normal neuroglia of the optic nerve, and may simulate a diffuse low-grade astrocytoma. Two demonstrated the coarsely reticulated pattern, with the biphasic and microcystic pattern typical of PA. Three diffuse astrocytomas (2 anaplastic astrocytomas and 1 glioblastoma) originated clinically and radiographically from the optic nerve, and revealed a Ki-67 LI of 2–12%, a p53 LI of 2–8%, and an average time to growth of 8 months. We conclude that the majority of PA of the optic nerve are non-aggressive, stabilize radiographically, and have Ki-67 and p53 LI 〈 1%. However, a subpopulation of PA has a propensity for aggressive behavior, and are identified by a Ki-67 LI of 2–3% and a p53 LI of 〈 1%. Diffuse astrocytomas have both Ki-67 and p53 LI 〉 2%. Thus, in cases of aggressive optic nerve tumors in which the histologic review of biopsy material cannot confidently confirm the diagnosis of pilocytic or diffuse fibrillary glioma, a p53 LI of 〉 1% appears to favor the diagnosis of diffuse astrocytoma.
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    URL: http://dx.doi.org/10.1007/s004010051161
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    Das akute Rechtsherzversagen Ätiologie – Pathophysiologie – Diagnostik – Therapie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 788-809 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Rechtsherzfunktion ; Störung ; Ätiologie ; Pathophysiologie Diagnostik ; Therapie ; Keywords Impaired right ventricular function ; RV failure ; Diagnosis ; Monitoring ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Impaired right ventricular (RV) function may be caused by pulmonary hypertension or myocardial ischemia. It is characterized by a dilation of the RV, which is followed by an increase of wall tension and O2-consumption and a decrease of RV ejection fraction (RV ‘dysfunction’). If a drop of arterial pressure occurs this my precipitate RV failure and shock (RV ‘insufficiency’). Diagnosis of RV failure and monitoring of RV function is difficult. Sometimes, even a severe impairment of RV function goes undetected or is misinterpreted. Patients in the operating room or on intensive care units seem to be especially prone to RV dysfunction and failure. Since a causative therapy often is not readily available, adequate symptomatic therapy is of utmost importance. Four basic principles have to be considered: 1) Optimizing preload: The failing RV requires adequate filling for preservation of stroke volume. On the other hand, overdistension of the RV may result in RV ischemia, thereby further deteriorating RV function Hence, volume loading is important, but requires continuous monitoring. 2) Maintenance of aortic pressure: Vasopressors are indicated if there is a critical drop of coronary perfusion pressure. Norepinephrine presently is the drug of choice for this purpose. 3) Reduction of RV afterload: Whereas intravenous vasodilators are limited in their efficacy in dilating pulmonary vessels due to systemic side effects, inhaled vasodilators result in selective pulmonary vasodilation and may improve RV function. 4) Increase of RV contractility: In RV failure and shock, norepinephrine and epinephrine are the drugs of choice. Inodilators are well suited for reducing pulmonary vascular resistance due to their positive inotropic and vasodilating effects. Since systemic vasodilation may occur, these drugs must only be used in hemodynamically stable patients.
    Notes: Zusammenfassung Eine Störung der Rechtsherzfunktion entsteht meist als Folge einer pulmonalen Hypertension, seltener bei primärer Myokardischämie. Sie ist gekennzeichnet durch eine Dilatation des rechten Ventrikels mit Anstieg von Wandspannung und Sauerstoffverbrauch bei reduzierter Ejektionsfraktion (“Dysfunktion”). Kommt es zum Abfall von arteriellem Druck und koronarem Perfusionsdruck, kann dies ein Rechtsherzversagen mit Schock auslösen (“Insuffizienz”). Diagnostik und Monitoring des rechten Ventrikels sind schwierig. Selbst eine schwere Beeinträchtigung der rechtsventrikulären Pumpfunktion bleibt daher häufig unbemerkt oder wird fehlgedeutet. Patienten in der perioperativen Phase und auf Intensivstationen scheinen besonders häufig von dem Krankheitsbild betroffen zu sein. Da eine kausale Therapie des akuten Rechtsherzversagens nur selten möglich ist, kommt der symptomatischen Therapie besondere Bedeutung zu. Sie stützt sich auf vier Prinzipien: 1) Optimierung der Vorlast: Der insuffiziente rechte Ventrikel benötigt zur Aufrechterhaltung seines Schlagvolumens ein gute Füllung. Andererseits kann eine Überdehnung des rechten Ventrikels eine Myokardischämie induzieren und seine Funktion weiter verschlechtern. Eine adäquate Volumentherapie ist daher essenziell, muss jedoch unter engmaschigem hämodynamischem Monitoring erfolgen. 2) Aufrechterhaltung des Aortendrucks: Bei kritischem Abfall des arteriellen Drucks ist die Gabe von Vasopressoren indiziert, um den rechtskoronaren Perfusionsdruck zu erhöhen. Noradrenalin gilt derzeit wegen seiner zusätzlich positiv inotropen Wirkung als Mittel der Wahl. 3) Verminderung der rechtsventrikulären Nachlast: Während sich intravenöse Vasodilatatoren wegen systemischer Nebenwirkungen nur bedingt zur Therapie der pulmonalen Hypertension eignen, dilatieren inhalierte Vasodilatatoren die pulmonale Strombahn selektiv und verbessern so die Pumpfunktion des rechten Ventrikels. 4) Steigerung der rechtsventrikulären Kontraktilität: Mittel der Wahl bei Dekompensation und Schock sind Noradrenalin und Adrenalin. Inodilatatoren weisen neben einer positiv inotropen auch eine pulmonal vasodilatierende Wirkung auf und eignen sich daher ebenfalls zur Therapie der rechtsventrikulären Dysfunktion. Sie sollten jedoch wegen der damit verbundenen systemischen Vasodilatation nur bei kreislaufstabilen Patienten eingesetzt werden.
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    URL: http://dx.doi.org/10.1007/s001010070052
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    Erworbene Hemmkörperhämophilie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 34-42 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter ; Erworbene Hemmkörperhämophilie ; spontane Faktor-VIII-Inhibitoren ; spontane Faktor-IX-Inhibitoren ; Diagnose ; Therapie ; Key words ; Acquired haemophilia ; Spontaneous factor VIII inhibitors ; Spontaneous factor IX inhibitors ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Although autoantibodies against factor VIII or factor IX are a rare phenomenon, they are associated with a high risk of bleeding and high mortality. The condition, termed ac- quired haemophilia, occurs equally in both sexes and is most frequent in higher age groups. Patients typically present with severe bleedings in muscles and skin. In contrast to patients with congenital haemophilia and inhibitors, joint bleedings are very rare. In approximately half of all cases an associated disease state can be identified as the cause of autoantibody formation. An immediate and comprehensive diagnosis is essential for a rapid initiation of therapy. Equally important are a careful diagnostic differentiation between congenital and acquired factor deficiencies and the exclusion of non-specific inhibitors, which increase the occurrence of thrombolic events. The inhibitor titre, quantified using the Bethesda assay, is an important criterion for selecting the appropriate therapy. A wide range of treatment options is now available for the management of bleedings in patients with acquired haemophilia, namely porcine factor VIII, recombinant factor VIIa, prothrombin complex concentrates, and immunoadsorptions. In addition, immunosuppressive therapies are used to achieve permanent reduction or elimination of inhibitors.
    Notes: Zusammenfassung Autoantikörper gegen Faktor VIII oder Faktor IX sind ein zwar seltenes, aber mit hohem Blutungsrisiko und hoher Letalität verbundenes Phänomen. Diese als erworbene Hemmkörperhämophilie bezeichnete Erkrankung kommt bei beiden Geschlechtern gleich häufig vor und tritt gehäuft im hohen Lebensalter auf. Die Patienten fallen klinisch v. a. durch schwere Blutungen in Muskeln und Haut auf, wogegen Gelenkeinblutungen – im Gegensatz zur angeborenen Hämophilie mit Hemmkörpern – sehr selten auftreten. In etwa der Hälfte der Fälle kann eine assoziierte Grunderkrankung als Auslöser der Autoantikörperbildung identifiziert werden. Eine rasche und umfassende Diagnostik ist entscheidend für einen schnellen Therapiebeginn. Ebenso bedeutend ist eine sorgfältige differentialdiagnostische Abgrenzung gegen einen angeborenen oder erworbenen Faktorenmangel sowie der Ausschluß unspezifischer Inhibitoren, die vermehrt zu Thrombosen führen können. Wichtig für die Auswahl der geeigneten Therapieform ist der Inhibitortiter, gemessen im Bethesda-Assay. Für die Blutstillungstherapie steht heute mit porcinem Faktor VIII, rekombinantem Faktor VIIa, Prothrombinkomplexpräparaten und Immunadsorptionen ein breites Spektrum an Möglichkeiten zur Verfügung. Für eine dauerhafte Reduktion bzw. Elimination der Autoantikörper finden immunsuppressive Therapien Anwendung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050007
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  • 89
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    Electronic Resource
    Tropisetron zur Prophylaxe von postoperativem Erbrechen bei Kindern (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 275-278 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Tropisetron ; postoperatives Erbrechen ; Adenotonsillektomie ; Antiemetika ; Kinder ; Key words Tropisetron ; PONV ; Adenotonsillectomy ; Antiemetics ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: Postoperative nausea and vomiting (PONV) after tonsillectomy is a common problem in children. Tropisetron is a new 5HT3 receptor antagonist and is successfully used in paediatric patients receiving cancer therapy. The aim of the study was to assess efficacy and safety of a single intravenous dose of tropisetron for prevention of PONV in paediatric patients at risk for postoperative vomiting. Methods: In a randomised, double-blind, placebo-controlled trial, we studied 98 children aged 2–12 years undergoing tonsillectomy or adenotonsillectomy. Patients received placebo or tropisetron 0.1 mg (=0.1 ml)/kg body weight immediately after induction of anesthesia. A standard general anesthetic technique (Sevoflurane/N2O/O2 without neuromuscular blockers or opioids) was used. Perioperative vital signs, grade of sedation and episodes of postoperative nausea and vomiting were recorded. Results: No vomiting episodes occurred in 65.3% of the tropisetron treated patients compared to 34.7% of the placebo group (p=0.0024). Only 10.2% of the tropisetron treated patients vomited more than 3 times compared to 22.4% of the control patients (p=0.0004). The need for antiemetic rescue medication was significantly lower in the study group (10.4%) compared to 28.6% (p=0.025). No significant adverse effects of the study medication were shown. Conclusion: A single intravenous prophylactic dose of tropisetron effectively reduces the incidence of PONV during the first 24 postoperative hours after tonsillectomy and/or adenoidectomy. Because of the low incidence of adverse effects, the prophylactic use of tropisetron seems to be safe and justified in paediatric surgical patients at high risk for postoperative vomiting.
    Notes: Zusammenfassung Fragestellung: Erbrechen und Übelkeit nach Tonsillektomien bei Kindern sind ein häufiges Problem. Aufgrund der positiven Erfahrungen mit Tropisetron, einem neueren 5HT3 Rezeptor-Antagonisten bei Chemotherapien in der pädiatrischen Onkologie und mit anderen 5HT3 Rezeptor-Antagonisten in der Kinderchirurgie, prüften wir die Wirksamkeit und Sicherheit einer Einzeldosis Tropisetron zur Prävention von postoperativem Erbrechen bei chirurgischen Kindern mit erhöhtem Risiko für postoperatives Erbrechen. Methodik: Bei 98 Kindern im Alter von 2– 12 Jahren, die eine Tonsillektomie oder Adenotonsillektomie benötigten, führten wir eine randomisierte, doppelblinde, plazebokontrollierte Studie durch. Die Patienten erhielten Tropisetron oder Plazebo in einer Dosis von 0,1 mg (=0,1 ml)/kg KG i.v. unmittelbar nach der Narkoseeinleitung. Die Narkose erfolgte standardisiert mit Sevofluran/N2O/O2 ohne Einsatz von Opioiden und Muskelrelaxanzien. Vitalparameter, Sedationstiefe, das Auftreten von postoperativem Erbrechen und unerwünschte Wirkungen wurden aufgezeichnet. Ergebnisse: In der Tropisetrongruppe zeigten 65,3% der Kinder kein postoperatives Erbrechen, im Gegensatz zu nur 34,7% der Kinder in der Plazebogruppe (P=0,0024). Mehr als 3 Episoden von postoperativem Erbrechen zeigten nur 10,2% der Patienten in der Tropisetrongruppe im Vergleich zu 22,4% der Patienten der Kontrollgruppe (P=0,0004). Auch der Bedarf an antiemetischer Zusatzmedikation war in der Tropisetrongruppe mit 10,4% signifikant niedriger als in der Kontrollgruppe mit 28,6% (P=0,025). Bedeutsame Nebenwirkungen der Studienmedikation konnten nicht dokumentiert werden. Schlussfolgerungen: Eine prophylaktische intravenöse Einzelgabe von Tropisetron reduziert bei Kindern wirksam das Auftreten von postoperativem Erbrechen während der ersten 24 h nach einer Tonsillektomie oder Adenotonsillektomie. Die geringe Inzidenz von Nebenwirkungen rechtfertigt unserer Ansicht nach die prophylaktische Anwendung von Tropisetron bei Kindern nach Tonsillektomien.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050828
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  • 90
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    Electronic Resource
    Schädelhirntrauma und zerebrale Hypoxie Diagnostik – Monitoring – Therapie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 332-339 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Schädelhirntrauma ; zerebrale Hypoxie ; Diagnose ; Therapie ; Key words Brain damage ; Cerebral hypoxie ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The main reason for posttraumatic secondary brain damage is cerebral hypoxia. Both, severity and duration of hypoxia are crucial in determining wether irreversible cerebral infarction will occur or not. For the clinical routine, the diagnosis of hypoxia is indirectly made by low CPP, low jugularvenous oxygen saturation (SjO2) or low tissue PO2. To minimize misleading false negative SjO2, the CT-Approach for the side of monitorig and calculation of arterial-jugularvenous lactate content for detection of anaerobic metabolism is recommended. Targeted treatment of hypoxia according to the underlying cause is mandatory. Primary goal is to increase cellular oxygen delivery by correction of low arterial oxygen content and elevation of regional CBF. Within the autoregulatory range decreasing CPP causes vasodilation and increasing CPP vasoconstriction with increasing or decreasing cerebral blood volume respectively. Initially elevation of the lower autoregulatory threshold often requires CPP 70 mmHg. Targeted treatment of intracranial hypertension must avoid decreasing CPP. In the early postrautmatic phase prevention of cerebral hypoxia relies on management of CBF by means of CPP and cerebral vascular resistance. Thereafter targeted treatment of intracranial hypertension caused by cerebral edema and hypervolemia are increasingly important.
    Notes: Zusammenfassung Hauptursache der sekundären Hirnschädigung ist die zerebrale Hypoxie. Abhängig von Schweregrad und Dauer entsteht eine irreversible Hirngewebsschädigung. Zur Diagnose der Hypoxie dient unter klinischen Bedingungen die kontinuierliche Messung des zerebralen Perfusionsdrucks (CPP) in Verbindung mit der zerebrovenösen O2-Sättigung (SjO2) oder der O2-Partialdruckmessung im Hirngewebe. Zur Minimierung von SjO2-Fehlinterpretationen sollte nach CT-Approach punktiert und ein anaerober Hirnstoffwechsel durch Bestimmung der arterio-jugularvenösen Laktatkonzentrationsdifferenz (avDL) ausgeschlossen werden. Die Therapie der zerebralen Hypoxie sollte kausal erfolgen. Normalisierung des arteriellen O2-Gehalts und Steigerung der Hirndurchblutung (CBF) haben Prioritöt. Bei intakter Autoregulation der CBF wird ein CPP-Abfall durch Vasodilatation mit Zunahme des zerebralen Blutvolumens und ein CPP-Anstieg durch Vasokonstriktion mit Abnahme des CBV kompensiert. Die häufige posttraumatische Rechtsverschiebung der unteren Autoregulationsschwelle erfordert in der Initialphase mit dem höchsten Hypoxierisiko CPP-Werte 70 mmHg. Die Therapie des ICP 〉 20 mmHg erfolgt CPP-orientiert. Eine ICP-Senkung zu Lasten des CPP ist zu vermeiden. Initial nach SHT hat die individuelle Optimierung der CBF durch Sicherstellung eines adäquaten CPP und zerebrovaskulären Gefäßwiderstandes (CVR) Priorität. Nachfolgend gewinnen durch SjO2 und avDL- oder Gewebe-PO2-Messung kontrollierte Maßnahmen zur Modulation von CVR und CBV sowie die Hirnödemtherapie zunehmend an Bedeutung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050838
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  • 91
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    Electronic Resource
    Acute myelofibrosis: multifocal bone marrow infiltration detected by scintigraphy and magnetic resonance imaging (2000)
    Springer
    Annals of hematology 79 (2000), S. 275-278 
    Details
    ISSN: 1432-0584
    Keywords: Key words Acute myelofibrosis ; Acute megakaryoblastic leukemia ; Scintigraphy ; Magnetic resonance imaging ; Interferon gamma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Acute myelofibrosis is a rare, malignant hematological disorder of unknown etiology with an inevitably fatal outcome. Here we present the study of a 63-year-old Caucasian man with acute onset of pancytopenia. Repeated bone marrow biopsies showed dense fibrosis and hypoplastic hematopoiesis raising various differential diagnoses of malignant and nonmalignant conditions. Bone marrow scintigraphy and magnetic resonance imaging (MRI) showed areas suggesting neoplastic infiltration, mainly in both femurs and tibias. Histological examination of a surgical biopsy of the left tibia revealed acute megakaryoblastic leukemia. As the patient refused polychemotherapy, therapy with interferon gamma was initiated but discontinued prematurely because of intolerable side effects. The presented case therefore suggests that the combination of bone marrow scintigraphy and MRI is a valuable diagnostic tool in patients presenting with myelofibrosis of unknown origin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050593
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  • 92
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    Electronic Resource
    Therapy of B-cell lymphomas with monoclonal antibodies and radioimmunoconjugates: the Seattle experience (2000)
    Springer
    Annals of hematology 79 (2000), S. 175-182 
    Details
    ISSN: 1432-0584
    Keywords: Monoclonal antibody ; Radioimmunotherapy ; Lymphoma ; Therapy ; Review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050576
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  • 93
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    Electronic Resource
    Functional organization of the human masseter muscle (2000)
    Springer
    Surgical and radiologic anatomy 22 (2000), S. 181-190 
    Details
    ISSN: 1279-8517
    Keywords: Masseter muscle ; Architecture ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors carried out an anatomic and magnetic resonance imaging study of the architecture of the elevator muscles of the mandible in 169 cadavers. The aim of this study was to define the architectural organization of the human masseter muscle, temporalis and pterygoid muscles. Layered dissections and anatomic sections in different spatial planes showed that the masseter muscle exhibited a typical pennate structure consisting of a succession of alternating musculoaponeurotic layers. The muscle had three well-differentiated parts the superficial, intermediate and deep masseter muscles. The same pattern was constantly found 1) for the superficial masseter, two alternate musculoaponeurotic layers oriented at 60∘ in relation to the plane of occlusion, 2) for the intermediate masseter, a single musculo-aponeurotic layer oriented at 90∘ in relation to the occlusal plane, 3) for the deep masseter, three musculoaponeurotic layers whose general orientation was at 90∘ for the bounding layers and 110∘ for the intermediate layer. The MRI study confirmed the reality of this architectural arrangement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00276-000-0181-5
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  • 94
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    Electronic Resource
    Therapie des Lichen sclerosus et atrophicus vulvae mit dem CO2-Silk-touch-Laser (2000)
    Springer
    Der Hautarzt 51 (2000), S. 502-504 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Lichen sclerosus et atrophicus ; Therapie ; CO2 Laser ; Keywords Lichen sclerosus et atrophicus ; Therapy ; Carbon dioxide laser
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract A 50 year old woman with distinct lichen sclerosus et atrophicus was suffering from severe genital itching, dyspareunia and increasing urinary burning. Therapy attempts with topical glucosteroids and estrogens had been without effort. Treatment with CO2 laser in silk touch mode under insufflation anesthesia to an improvement of her skin lesions and a nearly complete remission of her symptoms.
    Notes: Zusammenfassung Wir berichten über eine 50jährige Frau mit einem ausgeprägten Lichen sclerosus et atrophicus vulvae. Die Patientin litt unter stärkstem genitalen Pruritus, einer Dyspareunie und zunehmenden, brennenden Schmerzen beim Wasserlassen. Therapieversuche mit glukokortikosteroid- und östrogenhaltigen Externa erbrachten keine Besserung. Eine Behandlung in Intubationsnarkose mit dem CO2-Laser im Silk-touch-Modus führte zu einer Besserung der Hautveränderungen und zu einer beinahe kompletten Remission der subjektiven Beschwerden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050051161
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  • 95
    Electronic Resource
    Electronic Resource
    Longitudinal growth in HIV-negative boys with haemophilia (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 575-578 
    Details
    ISSN: 1432-1076
    Keywords: Key words Haemophilia ; HIV-negative patients ; Children ; Growth ; Body mass index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract It has been shown that HIV-positive haemophilic children develop growth retardation. As not only the HIV infection but also other disease-related factors might compromise growth in these children, growth data were analysed in a longitudinal cross-sectional manner in 84 HIV-negative haemophilic patients from two university clinics. A total of 2–24 height and weight measurements (median 6) were recorded in each patient resulting in 683 single values collected between 1977–1995. Height SDS of all haemophilic boys was −0.31 ± 2.13 (mean ± SD, NS versus 0) and body mass index SDS was 0.21 ± 3.49 (mean SD, NS versus 0) at first measurement and remained unchanged throughout the observation period. Neither height nor body mass index differed with respect to the severity of haemophilia (mild/moderate/severe) or the study centre (Vienna/Prague). Conclusion Growth in HIV-negative patients with haemophilia is not affected in spite of the immunological abnormalities attributed to the substitution therapy or the bleeding episodes in the joints with the potential effect on the growth plate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310000447
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  • 96
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    Electronic Resource
    Preventive effect of 2 and 10 mg of sodium cromoglycate on exercise-induced bronchoconstriction (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 759-763 
    Details
    ISSN: 1432-1076
    Keywords: Key words Sodium cromoglycate ; Children ; Exercise-induced asthma ; Urinary eosinophil protein X excretion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This double-blind, randomised and cross-over study was designed to compare the preventive effect against exercise-induced bronchoconstriction (EIB), defined as the percentage decrease in FEV1≥15% after 6 min of exercise, of 2 mg and 10 mg of sodium cromoglycate (SCG), administered through a metered dose inhaler via spacer, in asthmatic children. Each of the 30 subject (age 11.6 ± 3.2 years) was tested on five occasions. For inclusion, EIB in test1 was required. In tests 2 to 5, all subjects inhaled 2 mg or 10 mg of SCG 20 min and 120 min before exercise in a randomised order. In order to assess excretion of eosinophil protein X (EPX) accompanying EIB, urine samples were collected before and after exercise. The mean percentage fall in FEV1 (±SD) in test 1 was 26.8 ± 9.8%. Inhalation of 2 mg and 10 mg of SCG 20 min before exercise provided a significant preventive effect in 83% and 77% and inhalation 120 min before exercise provided a preventive effect in 63% and 70%, respectively (n=30). Variance analysis did not reveal a statistically different absolute fall in FEV1 after exercise when both doses (120 min before exercise) were compared (P=0.356). In an unselected subgroup of 12 children, urinary EPX increased after the challenge without SCG premedication (test 1) (mean change: +48.7 μg/mmol creatinine, P=0.034), whereas no significant increase was found in case of SCG premedication (mean change in μg/mmol creatinine): 2 mg/20 min: +12.1; 2 mg/120 min: +8.5; 10 mg/20 min: −10.4 and 10 mg/120 min: −23.5; P 〉 0.1). Conclusion Administration of 10 mg of sodium cromoglycate is no more effective in preventing exercise-induced bronchoconstriction than 2 mg regardless of whether the medication is given 20 or 120 min before exercise. The preventive effect of sodium cromoglycate on exercise-induced bronchoconstriction in asthmatic children is associated with the inhibition of urinary eosinophil protein X excretion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008341
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  • 97
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    Electronic Resource
    Prospective evaluation of late effects after childhood cancer therapy with a follow-up over 9 years (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 750-758 
    Details
    ISSN: 1432-1076
    Keywords: Key words Long-term late effects ; Childhood ; Cancer ; Therapy ; Follow-up examinations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Intensive multimodality treatment has led to a remarkable improvement of prognosis in paediatric cancer patients, however, a great number of long-term survivors suffer from considerable tumour- or treatment-related late effects. Between January 1990 and December 1998, 223 consecutive survivors of childhood malignancies entered a prospective follow-up study designed to evaluate the frequency and severity of tumour- and/or therapy-related long-term sequelae. After cessation of therapy and subsequently once a year, all patients underwent a detailed examination programme including physical examination, laboratory tests, abdominal sonography, echocardiography, electrocardiography, electroencephalography, spirometry, audiometry, ophthalmological examination and endocrine stimulation tests. Median follow-up was 5 years (range 0.4 to 9.6 years). A total of 167 patients (75%) had at least one chronic medical problem of whom 80 needed permanent medical support. The organ systems most frequently affected were the nervous system in 39%, the endocrine system in 32%, the ears/eyes in 22%, the kidneys in 17%, and the liver in 12% of the patients. Some late effects (endocrine deficits, hearing loss, tubulopathy) were primarily diagnosed only several years after the end of oncological therapy. Conclusion The results of this study indicate that a considerable number of former paediatric cancer patients suffer from remarkable long-term side-effects. Since life quality is an important parameter of cancer survival, careful follow-up of long-term survivors is mandatory with the aim to reduce or even abrogate possible side-effects at the earliest time.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008340
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  • 98
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    Electronic Resource
    Rapid appearance and onset of action of insulin aspart in paediatric subjects with type 1 diabetes (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 483-488 
    Details
    ISSN: 1432-1076
    Keywords: Key words Insulin aspart ; Insulin analogue ; Type 1 diabetes ; Pharmacokinetics ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pharmacokinetics of the novel, rapid-acting insulin aspart were compared with those of soluble human insulin following subcutaneous administration in nine children (aged 6–12 years) and nine adolescents (aged 13–17 years) with stable type 1 diabetes. The study had a randomised, double-blind, two-period crossover design. Each patient received a single subcutaneous dose of insulin aspart or human insulin (0.15 IU/kg body weight) 5 min before breakfast and the plasma insulin and glucose concentrations were measured at intervals during the following 5 h. The pharmacokinetic profile of insulin aspart differed significantly from that of human insulin with a higher mean maximum serum insulin (Cmax ins), 881 ± 321 (SD) pmol/l versus 422 ± 193 pmol/l for human insulin (P 〈 0.001); and with a shorter median serum insulin t max ins, 40.0 min (interquartile range: 40–50 min) versus 75.0 min (interquartile range: 60–120 min) for human insulin, (P 〈 0.001). An age-related effect on Cmax ins and area under the curve (AUC0–5h ins) was observed with higher values in adolescents than in children for both insulin aspart and human insulin. Postprandial glycaemic control was improved with insulin aspart; the baseline-adjusted ΔCmax glu being lower for insulin aspart compared with human insulin (increase of 7.6 ± 5.1 versus 9.4 ± 4.4 mmol/l respectively, P 〈 0.05). The incidence of adverse events was similar for the two insulin types. Conclusion The more rapid onset of action of insulin aspart versus human insulin, previously observed in adults, is confirmed in a paediatric population with type 1 diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051315
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  • 99
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    Electronic Resource
    Schistosomiasis in German children (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 530-534 
    Details
    ISSN: 1432-1076
    Keywords: Key words Schistosomiasis ; Children ; Travellers ; Ultrasonography ; Immunodiagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Reports on schistosomiasis in children growing up in Europe are rare despite increased travel activity. We report on eight male and three female German children aged 50 months to 15 years with schistosomiasis. Six children were asymptomatic, whereas two presented with typical signs of Katayama fever. Persisting haematuria, headache with eosinophilia and pyelonephritis were observed in one child each. An exposure was reported for six of the children. Two were examined solely because schistosomiasis was diagnosed in a family member. All had antibodies against schistosomal antigens in at least two of three screening tests. However, schistosomal ova (Schistosoma haematobium) were detected in urine and faecal specimens from only three children. A tumour-like lesion of the bladder was found by ultrasound in only one of the children who also exhibited haematuria. Neither eosinophilia nor elevated IgE levels were constant findings. Six to 12 months after praziquantel treatment, parasitological and ultrasound checks were negative and levels of specific antibodies decreased. However, 2 years later, elevated antibody levels were detected in one girl without evidence of any new exposure. She became antibody-negative 1 year after a second course of treatment. Conclusion In contrast to residents of endemic areas, parasitological and ultrasound examinations seem to be inferior to immunodiagnostics in children from non-endemic areas at temporary risk for schistosomiasis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051326
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  • 100
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    Electronic Resource
    Cortical malformations: a frequent cause of epilepsy in children (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 555-562 
    Details
    ISSN: 1432-1076
    Keywords: Key words Epilepsy ; Cortical malformations ; Migration disorders ; Magnetic resonance imaging ; Brain development
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this review, a simplified scheme for classification of cortical malformations is introduced and illustrated based on the work of Barkovich et al. [8]. Detailed MRI studies identify cortical malformations as a major cause of epilepsy in children. Two aspects that are becoming increasingly important for the paediatrician are emphasised. First, knowledge of the genetic background of cortical malformations is necessary for appropriate genetic counselling. Although the majority of cortical malformations occur sporadically, recent studies have shown a familial pattern in specific epilepsy syndromes associated with cortical malformations. Second, the epilepsy becomes refractory to the common anti-epileptic drugs in many patients with cortical malformations so that epilepsy surgery should be considered. In this respect, the paediatrician can play a pivotal role in referring candidate patients for further specialised assessment. Conclusion The input of the paediatrician will become crucial to link clinical, genetic and neuro-imaging data in children with the great variety of possible cortical malformations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310000452
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