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  • Digitale Medien  (131)
  • 2000-2004  (131)
  • Complications  (72)
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  • Digitale Medien  (131)
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  • 1
    Digitale Medien
    Digitale Medien
    Laparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 61-65 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Laparoscopic colectomy ; Laparotomy ; Postoperative ileus ; Complications ; Nasogastric tube ; Colectomy ; Colorectal surgery
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: The aim of this study was to compare the length of postoperative ileus in patients undergoing colectomy by either laparotomy or laparoscopy. METHODS: A total of 166 patients were studied. These patients were divided into two groups: Group 1, in which colectomy was done laparoscopically, and Group 2, consisting of patients undergoing laparotomy. Both groups contained 83 patients who were matched for disease severity, indications for surgery, and procedure. Indications for surgery included sigmoid diverticulitis in 12 (14 percent) patients, polyps in 22 (27 percent), Crohn's disease in 21 (25 percent), colorectal cancer in 11 (13 percent), stoma reversal in 8 (10 percent), rectal prolapse in 3 (4 percent), and other indications in 6 (7 percent) in each group. Operations were colectomy with anastomosis (42 ileocolic, 26 colorectal, 6 colocolic, 4 ileorectal, and 2 ileal J pouch) or without anastomosis (3 abdominoperineal resections) performed by the same surgeons during the same time period (January 1993 to October 1996). The nasogastric tube was removed from all patients immediately after surgery in both groups. All patients received a clear liquid diet on the first postoperative day, followed by a regular diet as tolerated. The nasogastric tube was reinserted if two or more episodes of emesis of more than 200 ml occurred in the absence of bowel movement. Patients were discharged from the hospital when tolerating a regular diet without evidence of ileus. Statistical analysis was performed using unpairedt-test and Fisher's exact probability test. RESULTS: The male-to-female ratio was 38 to 45 in both groups. A total of 10 (12 percent) and 23 (28 percent) patients in Group 1 and Group 2 had emesis (P=0.02), and the rate of nasogastric tube reinsertion was 5 (6 percent) and 13 (16 percent), respectively (P〉0.05). There were significant differences between Groups 1 and 2 relative to the lengths of ileus (3.5±1.3vs. 5.4±1.7 days, respectively;P〈0.001), hospitalization (6.6±3.3vs. 8.1±2.5 days, respectively;P〈0.002), and operative time (170±60vs. 114±46 minutes, respectively;P〈0.001). The morbidity rate was 16 (19.2 percent) and 18 (21.6 percent) in the laparoscopy and laparotomy groups, respectively. CONCLUSIONS: Although early oral intake is safe and can be tolerated by 84 percent of patients after colectomy by laparotomy, laparoscopic colectomy reduced the lengths of both postoperative ileus and hospitalization.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02237245
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  • 2
    Digitale Medien
    Digitale Medien
    Closedvs. open hemorrhoidectomy—Is there any difference? (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 31-34 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Hemorrhoidectomy ; Postoperative pain ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: The aim of this study was to compare closed (Ferguson) hemorrhoidectomy to open (Milligan-Morgan) hemorrhoidectomy regarding postoperative conditions, complications, and long-term results. METHOD: This was a randomized study of 77 patients with second-degree or third-degree hemorrhoids suitable for hemorrhoidectomy. In 39 patients the Milligan-Morgan procedure was used, and in 38 patients the Ferguson procedure was used. Details of operations, postoperative complications, and length of postoperative stay were recorded. Pain was assessed from a visual analog scale and by registration of postoperative analgesic medication. Follow-up was done at three weeks, six weeks, and by visit or telephone interview after at least a year. RESULTS: No statistically significant differences were found between the two methods regarding complications, pain, or postoperative stay. There were four reoperations for bleeding, all after Milligan-Morgan operations. At follow-up after three weeks 86 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. Of the Milligan-Morgan patients, only 18 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent. One patient had a superficial wound infection. After one year more than 10 percent in each group had recurrent hemorrhoids with symptoms. CONCLUSION: Both methods are fairly efficient treatment for hemorrhoids, without serious draw-backs. The closed method has no advantage in postoperative pain reduction, but wounds heal faster, and the risk of wound dehiscence seems exaggerated.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02237240
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  • 3
    Digitale Medien
    Digitale Medien
    ras p21 isoprenylation inhibition induces flat colon tumors in Wistar rats (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 70-75 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Pravastatin ; ras p21 isoprenylation ; Colon carcinogenesis ; Flat colon tumor ; Azoxymethane ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: The effect of pravastatin, an inhibitor ofras p21 isoprenylation, on the gross type of colon tumors induced by azoxymethane was investigated in Wistar rats. METHODS: Rats received ten weekly subcutaneous injections of 7.4 mg/kg body weight of azoxymethane and intraperitoneal injections of 10 or 20 mg/kg body weight of pravastatin every other day until the end of the experiment at Week 45. RESULTS: Administration of pravastatin at both dosages had no significant effect on the incidence of colon tumors but significantly increased the incidence of rats with adenomas only. In contrast to the elevated adenomas in control rats, flat adenomas were significantly more prevalent in rats given pravastatin. Pravastatin at both doses significantly decreased the labeling index, but not the apoptotic index, of elevated adenomas, whereas it significantly decreased the labeling index but increased the apoptotic index of flat adenomas. Administration of pravastatin at both dosages also significantly decreased the amounts of membrane-associatedras p21 in colon tumors. CONCLUSIONS: These findings suggest that theras oncogene may be closely related to the development of adenocarcinomas from adenomas and the development of elevated or polypoid tumors of the colon.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02237247
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  • 4
    Digitale Medien
    Digitale Medien
    Audit of single-stage proctocolectomy for Crohn's disease (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 249-256 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Single-stage proctocolectomy ; Crohn's disease ; Complications ; Delayed perineal wound healing ; Stomal complications ; Long-term results ; Recurrence ; Risk factor for recurrence
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: This study was undertaken to review our overall experience of single-stage proctocolectomy for Crohn's disease. METHODS: One hundred three patients who underwent single-stage proctocolectomy for Crohn's disease between 1958 and 1997 were reviewed. Factors affecting the incidence of recurrence were examined using a multivariate analysis. RESULTS: Principal indications for proctocolectomy were chronic colitis (49 percent), acute colitis (37 percent), and anorectal disease (14 percent). The commonest postoperative complication was delayed perineal wound healing (n=36; 35 percent), followed by intra-abdominal sepsis (17 percent) and stomal complications (15 percent). In 23 patients the perineal wound healed between three and six months after proctocolectomy, whereas in 13 patients the wound remained unhealed for more than six months. There were two hospital deaths (2 percent) caused by sepsis. The 5-year, 10-year, and 15-year cumulative reoperation rates for small-bowel recurrence were 13, 17, and 25 percent, respectively, after a median follow-up of 18.6 years. From a multivariate analysis, factors affecting reoperation rate for recurrence were gender (male; hazard ratio 2.4vs. female;P=0.03) and age at operation (≤30 years; hazard ratio 2.6vs. 〉30 years;P=0.04). The following factors did not affect the reoperation rate: duration of symptoms, smoking habits, associated perforating disease, coexisting small-bowel disease, postoperative complications, and medical treatment. CONCLUSIONS: Proctocolectomy for Crohn's disease is associated with a high incidence of complications, particularly delayed perineal wound healing. Proctocolectomy carries a low recurrence rate in the long term. However, young male patients are at high risk of recurrence.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02236990
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  • 5
    Digitale Medien
    Digitale Medien
    Femoral neuropathy: An infrequently reported postoperative complication (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 419-422 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Neuropathy ; Femoral nerve ; Colectomy ; Complications ; Retractors
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Postoperative femoral neuropathy is an uncommon complication of abdominal surgery. We present four cases occurring after colectomy at our institution and discuss the diagnosis and treatment.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02258312
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  • 6
    Digitale Medien
    Digitale Medien
    Safety and efficacy of dynamic graciloplasty for fecal incontinence (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 743-751 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Fecal incontinence ; Dynamic graciloplasty ; Neurostimulation ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: Dynamic graciloplasty has been used for intractable fecal incontinence, and good results have been reported. The aim of this study was to assess prospectively the safety and efficacy of dynamic graciloplasty for intractable fecal incontinence in a prospective, multicenter trial. METHODS: A total of 123 adults were treated with dynamic graciloplasty at 20 institutions. Continence was assessed preoperatively and postoperatively by use of 14-day diaries. RESULTS: There was one treatment-related death. One hundred eighty-nine adverse events occurred in 91 patients (74 percent). Forty-nine patients (40 percent) required one or more operations to treat complications. One hundred seventy (90 percent) events were resolved. Sixty-three percent of patients without pre-existing stomas recorded a 50 percent or greater decrease in incontinent events 12 months after dynamic graciloplasty, and an additional 11 percent experienced lesser degrees of improvement. Twenty-six percent were not improved, worsened, or exited. In patients with pre-existing stomas, 33 percent achieved successful outcomes at 12 months. This number increased to 60 percent at 18 months. Seventy-eight percent of patients had increased enema retention time, and mean anal canal pressures improved significantly at 12 months. Significant changes in quality of life were also observed. CONCLUSIONS: Objective improvement can be demonstrated in the majority of patients with end-stage fecal incontinence treated with dynamic graciloplasty. Reduction in incontinence episodes can be correlated with improved quality of life. Adverse events are frequently encountered, but most resolve with treatment.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02238008
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  • 7
    Digitale Medien
    Digitale Medien
    A Prospective Analysis of the Cephalic Vein Cutdown Approach for Chronic Indwelling Central Venous Access in 100 Consecutive Cancer Patients (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 496-502 
    Details
    ISSN: 1534-4681
    Schlagwort(e): Cephalic vein ; Subclavian vein ; Central venous access ; Implanted port ; Tunneled catheter ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Background: Chronic indwelling central venous access devices (CICVAD) generally are placed by the percutaneous subclavian vein approach. The cephalic vein cutdown approach is used only infrequently. Although the technique has been well described, few prospective data are available on the cephalic vein cutdown approach. Methods: From September 9, 1998, to July 20, 1999, the cephalic vein cutdown approach was attempted in 100 consecutive cancer patients taken to the operating room with the intention of placing CICVAD. Median patient age was 54.5 years (range 18–88), with 46 men and 54 women. Twenty-five patients had gastrointestinal malignancies, 17 had breast cancer, 15 had lymphoma, 13 had lung cancer, 12 had leukemia, 5 had multiple myeloma, and 13 had other malignancies. Patients were followed prospectively for immediate and long-term outcome. Results: CICVAD placement via the cephalic vein cutdown approach was successful in 82 patients; the remaining 18 patients required conversion to a percutaneous subclavian vein approach. The reasons for inability to place CICVAD via cephalic vein cutdown approach were a cephalic vein that was too small (10 patients), an absent cephalic vein (7 patients), and inability to traverse the angle of insertion of the cephalic vein into the subclavian vein (1 patient). There were 56 subcutaneous ports and 26 tunneled catheters. Median operating time was 44 minutes (range, 26–79 minutes). No postoperative pneumothorax occurred. Median catheter duration was 198 days (range, 0–513 days). Long-term complications included catheter-related bacteremia (6%), site infection (2%), deep venous thrombosis (5%), port pocket hematoma (1%), and superior vena cava stricture (1%). Thirty-seven percent of patients have died since CICVAD placement. Twenty-nine percent of the CICVADs have been removed. Conclusions: The cephalic vein cutdown approach was successful in 82% of patients. This approach is a safe and useful alternative to the percutaneous subclavian vein approach.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s10434-000-0496-9
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  • 8
    Digitale Medien
    Digitale Medien
    Use of a gracilis muscle flap to facilitate delayed ileal pouch-anal anastomosis (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1628-1631 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Gracilis muscle flap ; Ileal pouch-anal anastomosis ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Failure of an ileal pouch-anal anastomosis may result in unsuccessful completion of the anastomosis or removal of an ischemic pouch. We report a technique for preservation of the muscular wall of the rectum after mucosal dissection, which allowed a successful delayed pull-through.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02236752
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  • 9
    Digitale Medien
    Digitale Medien
    Effect of previous surgery on abdominal opening time (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1749-1753 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Adhesions ; Operative technique ; Complications ; Economics
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: The purpose of this study was to document prospectively the time required to gain access to the abdomen to perform a planned procedure in patients with and without previous surgery. METHODS: Patients were obtained from the consecutive cases of 11 surgeons at three colorectal surgery centers. Opening time (skin incision to retractor placement) was measured and recorded in the operating room by the circulating nurse or by an independent researcher. Demographic data including the number and type of previous operations and the presence and severity of adhesions were recorded by the staff surgeon. A comparison of opening times between patients with and without previous abdominal operations was conducted. RESULTS: One hundred ninety-eight patients had abdominal operations. Fifty-five percent had previous abdominal procedures. Patients with prior surgery required a mean of 21 minutes to open their abdomens, whereas patients without prior surgery required a mean of 6 minutes (P〈0.01). The median times were 17 and 6 minutes, respectively. Eighty-three percent of patients with prior surgery had adhesions, whereas only 7 percent of patients had adhesions on their initial operation. Patients with prior surgery also had higher grade adhesions (P〈0.001). Irrespective of previous surgery, comparing patients with adhesions with those without, patients with adhesions required a mean of 22 minutes to open, whereas the lack of adhesions resulted in a mean opening time of 6 minutes. CONCLUSIONS: Previous surgery and the presence of adhesions add significant time to opening the abdomen.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02236862
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  • 10
    Digitale Medien
    Digitale Medien
    Lumbar osteomyelitis and epidural abscess complicating recurrent pilonidal cyst (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1015-1017 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Pilonidal cyst ; Lumbar osteomyelis ; Epidural abscess ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: This study was conducted to report the rare presentation of lumbar osteomyelitis and epidural abscess as a complication of a pilonidal cyst. METHODS: A case report is presented. RESULTS: We describe the rare case of a male patient with diabetes with a recurring pilonidal cyst who developed a lumbar osteomyelitis and epidural abscess three weeks after pilonidal cyst excision with epidural anesthesia, with a fatal outcome despite emergency treatment. CONCLUSIONS: Life-threatening complications should be kept in mind in high-risk patients with repetitive surgery and neurologic involvement.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02237370
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  • 11
    Digitale Medien
    Digitale Medien
    Erfahrungen mit der Osteosynthese bei Fersenbeinfrakturen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S442 
    Details
    ISSN: 1436-6274
    Schlagwort(e): Schlüsselwörter Intraartikuläre Fersenbeinfraktur ; Klassifikation ; Weichteilschaden ; Komplikationen ; Ergebnisse ; Keywords Intraarticular calcaneal fracture ; Classification ; Soft tissue lesions ; Complications ; Results
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Even now, the diagnosis of a dislocated intraarticular calcaneal fracture means a handicap for many patients. A bilateral fracture usually means the end of professional life – especially in the case of any job involving physical work. Because the functional outcome after an intraarticular calcaneal fracture is determined by the degree to which restoration of the different articular surfaces, and of the height, length and width of the affected calcaneus is achieved, operative treatment has become much more frequent in recent years. Discussion continues on the operative treatment of high comminuted fractures. The available studies are not comparable, differing as they do in the classification systems and criteria of outcome used and the postoperative check-up schedules followed. Despite some progress towards standardization of the operative procedure in the last 10 years, especially with respect to soft tissue treatment and the types of implants used, several questions remain to be answered. Our own experience is reported.
    Notizen: Zusammenfassung Die Diagnose einer intraartikulären dislozierten Fersenbeinfraktur bedeutet auch heute noch für viele Patienten eine Einschränkung der künftigen Belastbarkeit, bei beidseitiger Betroffenheit in der Regel das Ausscheiden aus einem körperlich belasteten Beruf. Da sich das funktionelle Ergebnis der Fersenbeinfraktur im Wesentlichen durch die Wiederherstellung der Gelenkflächen, Höhe, Länge und Breite sowie Achsen des Fersenbeins beeinflussen lässt, hat die operative Rekonstruktion in den letzten Jahren deutlich zugenommen. Die Diskussion über die operative Versorgung von Fersenbeinfrakturen ist insbesondere bei Trümmerfrakturen noch nicht als abgeschlossen zu betrachten. Die vorliegende Fülle von Studien ist bezüglich der Klassifikation, der Nachuntersuchungskriterien und der Nachuntersuchungszeiträume nur schwer zu vergleichen. Trotz einer seit nun mehr als über einem Jahrzehnt perfektionierten und zunehmend standardisierten Operationstechnik bleiben noch viele Fragen zu beantworten. Über Schwierigkeiten bei der operativen Versorgung wird berichtet.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00014967
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  • 12
    Digitale Medien
    Digitale Medien
    Aktuelle Behandlungsstrategien bei distalen Unterarmfrakturen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S205 
    Details
    ISSN: 1436-6274
    Schlagwort(e): Schlüsselwörter Distale Unterarmfrakturen ; Konservative Therapie ; Operative Therapie ; Risiken ; Komplikationen ; Keywords Distal fractures of lower arm ; Conservative therapy ; Operative therapy ; Risks ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract The treatment of distal fractures of the lower arm can be conservative or operative. The immediate aims of any treatment are anatomical realignment and the avoidance of trophic impairments, with the ultimate objective of unrestricted function of the hand and wrist. A graduated treatment scheme based on the ASIF classification is necessary to do justice to the different forms of fracture that can occur. The majority of injuries can still be successfully treated by conservative means; operative treatment becomes more important when there are signs of unusually high levels of instability or joint involvement. The authors’ own patient population is presented in this paper: in these patients fixation with Kirschner wires has proved to be the most successful of the operative procedures used, followed by palmar plate fixation with or without cancellous bone plasty, and for C-type fractures according to the ASIF classification or when there ¶is severe soft-tissue damage, application of ¶a fixateur externe spanning the joint has proved best. Treatment strategy, risks, complications and results are presented.
    Notizen: Zusammenfassung Die Behandlung distaler Unterarmfrakturen kann konservativ oder operativ erfolgen. Ziel jeder Behandlung sind die anatomische Reposition und Retention sowie die Vermeidung trophischer Störungen mit dem Fernziel einer unbeeinträchtigten Funktion der Hand und des Handgelenks. In Anlehnung an die AO-Klassifikation ist ein stufenförmiges Behandlungsschema notwendig, um den verschiedenen Frakturformen gerecht zu werden. Ein Großteil der Verletzungen kann nach wie vor erfolgreich konservativ behandelt werden, bei Zeichen einer erhöhten Instabilität oder einer Gelenkbeteiligung rückt die operative Behandlung zunehmend in den Vordergrund. Im eigenen, dargestellten Krankengut hat sich bei den operativen Verfahren schwerpunktmäßig die Kirschner-Draht-Osteosynthese bewährt, nachfolgend die palmare Plattenosteosynthese mit oder ohne Spongiosaplastik und bei Frakturen der C-Typen nach AO und bei höhergradigem Weichteilschaden die gelenkübergreifende Fixateur-externe-Anordnung. Behandlungsstrategie, Risiken, Komplikationen und Ergebnisse werden dargestellt.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00014888
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  • 13
    Digitale Medien
    Digitale Medien
    Spezielle Probleme bei Wirbelfrakturen mit Querschnittlähmung (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S500 
    Details
    ISSN: 1436-6274
    Schlagwort(e): Schlüsselwörter Hoffnung ; Selbstständigkeit ; Komplikationen ; Gangschulung ; Keywords Hope ; Independence ; Complications ; Mobility training
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract In the treatment of paraplegic patients ¶there is a definite discrepancy between the ideas and wishes of the patients and the approaches and objectives of the physiotherapists. The greatest concern of the person affected is recovery of the ability to walk, while the main emphases of physiotherapy primarily involve avoiding complications of paralysis and achieving the highest possible degree of independence. One aid used in teaching partially paralysed patients to walk again is the walking belt, which complements the neurophysiological treatment methods very well. Mobility training with completely paralysed patients is obviously restricted owing to the lack of function. Sources of problems include relapsing shoulder pain and marked spasticity, which limit the results that can be achieved by way of rehabilitation medicine. With the support of an electronic measuring system the threat of pressure sores can be successfully combated.
    Notizen: Zusammenfassung In der Behandlung Querschnittgelähmter besteht zwischen den Vorstellungen und Wünschen der Patienten und den Gesichtspunkten und Zielen der Physiotherapie eine deutliche Diskrepanz. Der Betroffene erhofft sich v. a. das Wiedererlangen seiner Gehfähigkeit, die Schwerpunkte der Physiotherapie liegen in erster Linie auf der Vermeidung lähmungsbedingter Komplikationen und dem Erreichen maximaler Selbstständigkeit. Gangschulung wird bei inkomplett Gelähmten u. a. mit Hilfe des Laufbands durchgeführt, das eine hervorragende Ergänzung der neurophysiologischen Behandlungstechniken darstellt. Das Gehtraining mit komplett Gelähmten reduziert sich naturgemäß aus Mangel an funktionellen Einsatzmöglichkeiten. Unter anderem können rezidivierende Schulterschmerzen und starke Spastik Probleme darstellen und sich limitierend auf das Rehabilitationsergebnis auswirken. Der Dekubitusgefahr wird, unterstützt durch ein elektronisches Messsystem, erfolgreich entgegengewirkt.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00014982
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  • 14
    Digitale Medien
    Digitale Medien
    Development of the bones and synovial joints in the rat model of the VATER association (2000)
    Springer
    Journal of orthopaedic science 5 (2000), S. 390-396 
    Details
    ISSN: 1436-2023
    Schlagwort(e): Key words Adriamycin ; Rat ; Embryo ; VATER association ; Synovial joint ; Bones ; Limbs ; Vertebra ; Sirenomelia
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The adriamycin-induced rat model of the Vertebral, Anorectal, Tracheo-Esophageal, Radial and Renal (VATER) association produces a variety of vertebral, rib, and limb abnormalities. This study was designed to document accurately the nature of these abnormalities and to determine whether synovial joints are affected. Fetuses from pregnant Sprague Dawley rats that had received intraperitoneal injections of 1.75 mg/kg of adriamycin on days 6–9 or 10–13 of gestation were harvested. Double-stained skeletal preparations and histological sections were examined for vertebral, rib, and limb anomalies. The incidence of anomalies was high in the group treated on gestational days (GD) 6–9, while it was low in the GD 10–13 group. The length and thickness of the long bones were reduced, with bowing and reduction in their endochondral ossification. Sirenomelia occurred in the group treated on GD 6–9, and was often associated with a short tail and anal atresia. The joint cavities, and intra-articular structures such as menisci and the cruciate ligaments developed normally from the mesenchymal interzone. These data indicate that adriamycin inhibits skeletal growth and differentiation without any interference in the differentiation of the mesenchymal interzone, thus producing normal synovial joints.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s007760050015
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  • 15
    Digitale Medien
    Digitale Medien
    Management intraoperativer Komplikationen bei der Applikation stentgestützter Aortenprothesen (2000)
    Springer
    Gefässchirurgie 5 (2000), S. 232-240 
    Details
    ISSN: 1434-3932
    Schlagwort(e): Schlüsselwörter Endovaskuläre Operationen ; Stents ; Aortenstentprothese ; Bauchaortenaneurysma ; Komplikationen ; Keywords Endovascular surgery ; Stents ; Aortic stent prostheses ; Aneurysm ; Abdominal aorta ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract  Intraoperative complications can be divided into three categories on the basis of the time of their occurrence: Group I – Problems associated with access; group II: introduction of the endovascular stent (a: release of the main segment, b: anchoring the second limb); and group III: incidence of primary endoleaks. The objective of the present study was to describe the management of these complications. In a group of 130 patients undergoing endovascular treatment of aneurysms of the abdominal aorta, a total of 31 complications occurred in 26 patients (20.0%). The most frequently encountered complication in each group and its respective management was as follows: Group I: Correction was performed using dilatation and retroperitoneal stretching as well as surgical shortening of the external iliac artery with interposition; group IIa: overstenting the renal arteries was corrected either by conversion or tugging at the endograft; group IIb: the guide wire or docking system could not be placed. Such cases were managed either through conversion or use of fresh systems; group III: such complications were treated with repeated stent placement, postoperative coil embolizations, or conversion. The endovascular therapy of aortic aneurysms is associated with intraoperative complications in 20% of cases. Adequate management helps to keep both morbidity and mortality rates low.
    Notizen: Zusammenfassung  Intraoperative Komplikationen können je nach Zeitpunkt des Ereignisses in 3 Gruppen definiert werden: Gruppe I – Zugangsprobleme, Gruppe II – Einbringen des endovaskulären Stents (a: Absetzen des Hauptteils, b: Andocken des 2. Schenkels), Gruppe III – Inzidenz primärer Endoleaks. Zielsetzung dieser retrospektiven Studie war es, das Management zur Behebung dieser Komplikationen darzustellen. Von 130 Patienten mit endovaskulärer Ausschaltung eines Aortenaneurysmas traten bei 26 Patienten 31 intraoperative Komplikationen auf (20,0%). Die führenden Komplikationen in jeder Gruppe sowie das daraus resultierende Management waren: Gruppe I: Die Korrektur erfolgte durch Dilatation, retroperitoneale Streckung, Kürzungsoperation der A. iliaca externa und Interponat. Gruppe II a: Bei Überstentung der Nierenarterien erfolgte die Konversion oder Zug am Endograft. Gruppe II b: Führungsdraht oder Andocksystem können nicht platziert werden. Die Behebung erfolgte durch Konversion und Anwendung neuer Systeme. Gruppe III: Hier wurden erneute Stentplazierungen, postoperativer Coil-Embolisationen und Konversionen durchgeführt. Die endovaskuläre Therapie aortaler Aneurysmen birgt eine Rate intraoperativer Schwierigkeiten von 20%. In 3,8% der Fälle musste eine Konversion durchgeführt werden. Durch adäquates Management konnten die Letalität (1/26) und Morbidität jedoch gering gehalten werden.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00010600
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  • 16
    Digitale Medien
    Digitale Medien
    Induction of adenocarcinoma containing myoepithelial cells in rat submandibular gland by 7,12-dimethylbenz(a)anthracene (2000)
    Springer
    Virchows Archiv 437 (2000), S. 314-324 
    Details
    ISSN: 1432-2307
    Schlagwort(e): Keywords 7 ; 12-dimethylbenz(a)anthracene ; Rat ; Submandibular gland ; Adenocarcinoma Myoepithelial cell
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  In an attempt to induce adenocarcinoma containing myoepithelial cells (MECs) in the rat submandibular gland, we injected 7,12-dimethylbenz(a)anthracene (DMBA) dissolved in acetone into the glands of rat pups at the age of 10 days. In both male and female pups, the glands, including their developing terminal secretory units, contained far greater numbers of cells positive for proliferating cell nuclear antigen (PCNA) than did adult glands. A single administration of 1% DMBA (0.05 ml/130 g b.w.) did not produce adenocarcinoma, but did induce occasional sarcomas, such as rhabdomyosarcoma and fibrosarcoma, in 2 months. Most glands regenerated with minimal scar formation. Microscopically, these glands were atypical in that they contained increased numbers of PCNA-positive cells, underdeveloped granular ducts, and striated ducts surrounded by MECs positive for alpha smooth muscle actin (αSMA). Though these features were also observed in the regenerated glands after acetone injection, the number of PCNA-positive cells was relatively high in the glands of DMBA-treated females, especially in the terminal secretory unit. The second DMBA injection at 10 weeks of age produced adenocarcinoma made up of αSMA-positive MECs and keratin 19-positive duct cells. Such MEC-associated adenocarcinoma was induced in the glands of more than half the female but not the male animals. Replacement of either of the double DMBA treatments with acetone, or DMBA treatment, single or double, of adult glands did not produce adenocarcinoma, but did produce sarcoma and squamous cell carcinoma. These results suggest that (1) at least two genetic mutations are necessary for induction of adenocarcinoma with MECs in the rat submandibular gland, (2) the mutation is efficiently introduced to pup glands whose terminal secretory units exhibit extreme proliferative activity, and (3) the second mutation is difficult to introduce in male glands, whose proliferative activity is relatively low, and/or transformed cells need some female hormone after the mutation to propagate.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004280000223
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  • 17
    Digitale Medien
    Digitale Medien
    Myocardial enzyme activities in plasma after whole-heart irradiation in rats (2000)
    Springer
    Journal of cancer research and clinical oncology 126 (2000), S. 27-32 
    Details
    ISSN: 1432-1335
    Schlagwort(e): Key words Heart irradiation ; Plasma enzyme levels ; Myocardial enzyme levels ; Rat ; AbbreviationsCK creatine kinase ; LDH lactate de-hydrogenase ; AST aspartate aminotransferase ; ALT alanine aminotransferase ; α-HBDHα-hydroxybutyrate dehydrogenase
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Plasma levels of myocardial enzymes present after local heart irradiation were studied in a rat model. The purpose was to investigate whether, within days after irradiation, these enzyme levels change to such an extent that they may be helpful in assessing the severity of cardiac damage after radiotherapy. Therefore, activities of creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and α-hydroxybutyrate dehydrogenase (α-HBDH) were determined in the plasma and left ventricular myocardium of rats following local heart irradiation with a single dose of 20 Gy. A dose of 20 Gy is known to cause irreversible cardiac damage and to reduce survival times of the animals. Cardiac enzyme assays were performed directly after and twice daily for up to 2 weeks after radiation. Plasma CK, LDH, AST and α-HBDH levels were increased between 2 h and 24 h after irradiation. Plasma ALT levels remained unchanged. Myocardial enzyme levels, measured between 24 h and 16 days after radiation, did not differ between irradiated and control animals, although acute (first 12 h) reductions were observed in the irradiated group. The elevated enzyme levels in plasma appeared to correlate with the acutely reduced myocardial enzyme levels. Although irradiation with a dose of 20 Gy induced acute rises of cardiac enzyme levels in plasma, it is doubtful that fractionated radiation, as applied clinically for treatment of solid tumors, will induce plasma enzyme elevations that are large enough to indicate the extent of cardiac damage occurring acutely or chronically.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00008461
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  • 18
    Digitale Medien
    Digitale Medien
    Risiken bei Sectio caesarea und vaginaler Geburt (2000)
    Springer
    Der Gynäkologe 33 (2000), S. 872-881 
    Details
    ISSN: 1433-0393
    Schlagwort(e): Schlüsselwörter Sectio caesarea ; Notsectio ; Geburt ; Schwangerschaft ; Müttersterblichkeit ; Letalität ; Morbidität ; Komplikationen ; Keywords Cesarean section ; Emergency cesarean ; Birth ; Pregnancy ; Maternal mortality ; Lethality ; Morbidity ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract The rate of cesarean section now exceeds 20% and continues to increase. This effect is enhanced by the almost negligible surgery-dependent risks. Maternal mortality in Central Europe has evidenced a sharp decline to approximately 10–20 deaths per 100,000 live births. Cesarean mortality due solely to surgical and/or anesthesiological intervention has also decreased considerably in the past 20 years. Nevertheless, vaginal birth entails a lower risk per se for the mother. Thus, the letality rate for vaginal birth is lower by a factor of 5–10 excluding pregnancy-dependent risks. Primary cesarean section exhibits a 1.7-fold lower risk of letality in comparison to secondary cesarean section. The main causes of death continue to be hemorrhages and thromboembolism. The mortality rate due to cesarean section continues to remain higher than that for vaginal birth. The rate of severe blood loss is significantly higher. The risk of deep vein thrombosis is about ten times greater than for vaginal birth with concomitantly increased risk for a pulmonary embolism as well as post-thrombotic syndrome. Perioperative prophylactic treatment with antibiotics was able to reduce the morbidity rate due to infection by more than 50%, but endometritis and wound infection continues to occur 10–15 times more frequently than during vaginal birth. In summary, maternal risk during pregnancy and birth – be it vaginal or cesarean – has been further reduced considerably. Nevertheless, cesarean section constitutes a surgical intervention entailing significantly higher rates of morbidity and mortality in comparison to vaginal birth.
    Notizen: Zusammenfassung Die Sectiorate hat die 20%-Grenze überschritten und steigt unvermindert an. Begünstigt wird dieser Effekt durch die schon fast vernachlässigbaren operationsbedingten Risiken; die maternale Mortalität verzeichnet in Mitteleuropa einen starken Rückgang auf ca. 10–20 Todesfälle bezogen auf 100.000 Lebendgeburten. Auch die reine operations- bzw. anästhesiebedingte Sectioletalität hat sich in den letzten 20 Jahren deutlich vermindert. Nichtsdestotrotz geht die vaginale Geburt mit einem für die Mutter per se niedrigeren Risiko einher. So liegt die Letalität bei vaginaler Geburt um den Faktor 5–10 niedriger bei Ausschluss gestationsbedingter Risiken. Die primäre Sectio weist gegenüber der sekundären Sectio ein 1,7fach vermindertes Letalitätsrisiko auf. Haupttodesursachen sind weiterhin die Hämorrhagie und Thrombembolien. Aber auch die sectiobedingte Morbidität liegt weiterhin über der einer vaginalen Geburt. Die Rate an stärkeren Blutverlusten ist signifikant höher. Das Risiko einer tiefen Venenthrombose liegt rund 10fach über dem einer vaginalen Geburt mit ebenfalls erhöhtem Risiko für eine Lungenembolie sowie einem postthrombotischen Syndrom. Zwar konnte durch die perioperative Antibiotikaprophylaxe die Infektmorbidität um mehr als 50% gesenkt werden, doch ist die Endometritis und die Wundinfektion nach Sectio noch rund 10- bis 15-mal häufiger als bei vaginaler Geburt.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001290050656
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  • 19
    Digitale Medien
    Digitale Medien
    Doppelbilder durch Doppel-IOL (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 781-783 
    Details
    ISSN: 1433-0423
    Schlagwort(e): Schlüsselwörter Katarakt-Chirurgie ; Komplikationen ; IOL-Luxation ; Doppel IOL ; Doppelbilder ; Keywords Cataract surgery ; Complications ; Intraocular lens dislocation ; Double intraocular lens implant ; Double vision
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract An 80-year-old man had intraoperative loss of an intraocular lens (IOL) in the vitreous and simultaneous implantation of an anterior chamber lens. For the first 3 years his course was uncomplicated, but after this time he noted monocular double vision. The IOL in the vitreous had moved into the optic axis of the eye. The case presented here underlines the possibility of complications occurring even years after surgery due to an IOL left behind in the vitreous. The double IOL implant technique should be reserved for very few selected indications.
    Notizen: Zusammenfassung Bei einem 80-jährigen Patienten war nach intraoperativer Luxation einer intraokularen Linse (IOL) in den Glaskörper (GK) eine zweite IOL in die Vorderkammer implantiert worden. Nach zunächst komplikationslosem Verlauf, bemerkte der Patient 3 Jahre später monokulare Doppelbilder, offensichtlich durch eine Mobilisierung der IOL im GK in die optische Achse. Der beschriebene Fall zeigt, dass Komplikationen einer in den GK luxierten IOL auch nach längerer Zeit noch auftreten können. Die Doppelimplantationstechnik sollte ganz wenigen Ausnahmefällen vorbehalten werden.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003470070028
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  • 20
    Digitale Medien
    Digitale Medien
    Bilaterale simultane LASIK Pro und Kontra (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 881-884 
    Details
    ISSN: 1433-0423
    Schlagwort(e): Schlüsselwörter LASIK ; einzeitige und zweizeitige Operation ; Kostenaspekt ; Komplikationen ; Keywords LASIK ; Simultaneous and sequential operation ; Cost effectiveness ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Until recently simultaneous bilateral laser in situ keratomileusis (LASIK) was regarded as contraindicated in Germany. However, the procedure was sporadically performed, because it offers patient comfort and is more cost effective than sequential LASIK. Even though the complication rate is below the calculated rate of 0.01%, bilateral complications may have catastrophic effects on the patient. In addition, there is the theoretical disadvantage that the results from the first eye cannot be used for the second eye. However, this effect has yet to be clinically proven.
    Notizen: Zusammenfassung Seit September 2000 wird in Deutschland die bilaterale simultane Laser-in-situ-Keratomileusis (LASIK) nicht mehr als ungerechtfertigt angesehen. Bereits zuvor wurde sie vereinzelt durchgeführt, da sie dem Patienten einen höheren Komfort bietet und kostengünstiger ist als ein zweizeitiges Vorgehen. Auch wenn die Komplikationsrate sehr gering ist und sicherlich unter der rechnerischen Komplikationsrate von 0,01% liegt, können beidseitige Komplikationen katastrophale Auswirkungen für den Patienten haben. Zudem besteht der theoretische Nachteil der schlechteren Vorhersagbarkeit für das zweitbehandelte Auge. Dieser Effekt konnte bisher klinisch nicht nachgewiesen werden.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003470070014
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  • 21
    Digitale Medien
    Digitale Medien
    Operative Behandlung von Verletzungen des thorakolumbalen Übergangs Teil 2: Operation und röntgenologische Befunde (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 1032-1047 
    Details
    ISSN: 1433-044X
    Schlagwort(e): Schlüsselwörter Arbeitsgemeinschaft “Wirbelsäule” der DGU ; Prospektive multizentrische Studie ; Thorakolumbale Wirbelsäule ; Wirbelsäulenverletzung ; Operative Behandlung ; Operative Zugänge zur Wirbelsäule ; Dorsale Stabilisierung ; Kombinierte Stabilisierung ; Ventrale Stabilisierung ; Fusionsoperation ; Fixateur interne ; Spinalkanaldekompression ; Komplikationen ; Schraubenfehllagen ; Grund-Deckplatten-Winkel ; Segmentale Kyphose ; Körperwinkel ; Sagittaler Index ; CT der Wirbelsäule ; Keywords Working group “spine” of the German Trauma Society, prospective multicenter study ; Thoracolumbar spine ; Fractures and dislocations of the spine ; Injuries of the spine ; Operative treatment ; Posterior surgery ; Combined surgery ; Anterior surgery ; Spinal fusion ; Internal fixator ; Decompression of the spinal canal ; Complications ; Misplaced pedicle screws ; Segmental kyphosis angle ; Wedge angle ; Sagittal index ; Computertomography of the spine
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary The authors report on a prospective multicenter study with regard to the operative treatment of acute fractures and dislocations of the thoracolumbar spine (T10–L2). The study should analyze the operative methods currently used and determine the results in a large representative collective. This investigation was realized by the working group “spine” of the German Trauma Society. Between September 1994 and December 1996, 682 patients treated in 18 different traumatology centers in Germany and Austria were included. Part 2 describes the details of the operative methods and measured data in standard radiographs and CT scans of the spine. Of the patients, 448 (65.7%) were treated with posterior, 197 (28.9%) with combined posterior-anterior, and 37 (5.4%) with anterior surgery alone. In 72% of the posterior operations, the instrumentation was combined with transpedicular bone grafting. The combined procedures were performed as one-stage operations in 38.1%. A significantly longer average operative time (4:14 h) was noted in combined cases compared to the posterior (P〈0.001) or anterior (P〈0.05) procedures. The average blood loss was comparable in both posterior and anterior groups. During combined surgery the blood loss was significantly higher (P〈0.001; P〈0.05). The longest intraoperative fluoroscopy time (average 4:08 min) was noticed in posterior surgery with a significant difference compared to the anterior group. In almost every case a “Fixateur interne” (eight different types of internal fixators) was used for posterior stabilization. For anterior instrumentation, fixed angle implants (plate or rod systems) were mainly preferred (n=22) compared to non-fixed angle plate systems (n=12). A decompression of the spinal canal (indirect by reduction or direct by surgical means) was performed in 70.8% of the neurologically intact patients (Frankel/ASIA E) and in 82.6% of those with neurologic deficit (Frankel/ASIA grade A–D). An intraoperative myelography was added in 22% of all patients. The authors found a significant correlation between the amount of canal compromise in preoperative CT scans and the neurologic deficit in Frankel/ASIA grades. The wedge angle and sagittal index measured on lateral radiographs improved from −17.0° and 0.63 (preoperative) to −6.3° and 0.86 (postoperative). A significantly (P〈0.01) stronger deformity was noted preoperatively in the combined group compared to the posterior one. The segmental kyphosis angle improved by 11.3° (8.8° with inclusion of the two adjacent intervertebral disc spaces). A significantly better operative correction of the kyphotic deformity was found in the combined group. In 101 (14.8%) patients, intra- or postoperative complications were noticed, 41 (6.0%) required reoperation. There was no significant difference between the three treatment groups. Of the 2264 pedicle screws, 139 (6.1%) were found to be misplaced. This number included all screws, which were judged to be not placed in an optimal direction or location. In seven (1.0%) patients the false placement of screws was judged as a complication, four (0.6%) of them required revision. The multicenter study determines the actual incidence of thoracolumbar fractures and dislocations with associated injuries and describes the current standard of operative treatment. The efforts and prospects of different surgical methods could be demonstrated considering certain related risks. The follow-up of the population is still in progress and the late results remain for future publication.
    Notizen: Zusammenfassung Die Autoren berichten über eine prospektive multizentrische Studie zur operativen Behandlung frischer Verletzungen des thorakolumbalen Übergangs (Th10 bis L2). Die Studie soll die derzeitigen Behandlungsmethoden und ihre Ergebnisse an einem großen Kollektiv repräsentativ analysieren und wird von der Arbeitsgemeinschaft “Wirbelsäule” der Deutschen Gesellschaft für Unfallchirurgie (DGU) erarbeitet. An 18 unfallchirurgischen Kliniken in Deutschland und Österreich wurden von September 1994 bis Dezember 1996 insgesamt 682 Patienten prospektiv erfasst. Die Nachuntersuchung der Patienten ist z. Z. noch nicht abgeschlossen. Im Teil 1 (Epidemiologie) wurden Studiendesign und epidemiologische Daten des Kollektivs dargestellt. Der vorliegende Teil 2 schildert die Details der Operationen sowie Messdaten der konventionellen Röntgenuntersuchungen und Computertomographien (CT); 448 (65,7%) Patienten wurden von dorsal, 197 (28,9%) kombiniert dorsoventral und 37 (5,4%) isoliert von ventral operiert; 72% der 448 von dorsal stabilisierten Patienten erhielten eine transpedikuläre Spongiosaplastik. Die kombinierten dorsoventralen Eingriffe wurden bei 75 (38,1%) Verletzten einzeitig und bei 122 (61,9%) zweizeitig durchgeführt. Die durchschnittliche Operationszeit war bei kombiniertem Eingriff mit 4:14 h signifikant länger als bei dorsalem (p〈0,001) oder ventralem (p〈0,05). Der durchschnittliche Blutverlust war bei dorsalem und ventralen Vorgehen vergleichbar hoch und signifikant geringer als bei kombinierter Operation (p〈0,001 bzw 〈0,05). Die intraoperative Durchleuchtungszeit war mit 4:08 min bei dorsaler Behandlung am längsten und signifikant (p〈0,005) länger als bei ventraler. Als dorsales Implantat wurde fast ausnahmslos ein Fixateur interne verwendet (8 verschiedene Modelle). Bei den ventralen Eingriffen kamen überwiegend winkelstabile Platten- oder Stabsysteme (n=22) und seltener winkelinstabile Platten (n=12) zum Einsatz. Der Spinalkanal wurde bei 82,6% der Patienten mit neurologischem Defizit und bei 70,8% derjenigen ohne Ausfallserscheinungen direkt mit Eröffnung des Spinalkanals oder indirekt mit Hilfe des Instrumentariums dekomprimiert. Eine intraoperative Myelographie wurde bei 22% der Patienten für notwendig gehalten. Wir fanden eine statistisch signifikante Korrelation zwischen dem Ausmaß der neurologischen Beeinträchtigung und der Einengung des Spinalkanals im präoperativen CT. Der im seitlichen Röntgenbild ermittelte Körperwinkel des betroffenen Wirbels und der sagittale Index betrugen im Gesamtkollektiv präoperativ im Mittel −17,0° und 0,63; postoperativ lagen die Werte bei −6,3° und 0,86. Eine signifikant (p〈0,01) stärkere Verformung des Wirbelkörpers bestand präoperativ in der kombinierten gegenüber der dorsalen Gruppe. Der segmentale Kyphosewinkel GDW 1 wurde von prä- zu postoperativ durchschnittlich um 11,3° und der GDW 2 um 8,8° lordosiert. Die signifikant (p〈0,005) größte Korrektur wurde bei den kombiniert Behandelten erzielt. Bei insgesamt 101 (14,8%) Patienten wurden intra- oder postoperative Komplikationen beobachtet, davon 41 (6,0%) revisionspflichtige. Die 3 Behandlungsgruppen wiesen unterschiedliche Komplikationsraten auf, der Unterschied war jedoch nicht signifikant (χ2-Test). Die Rate von Fehllagen transpedikulärer Schrauben betrug 139 von 2264 (6,1%) Schrauben; jede nicht optimal plazierte Schraube wurde dabei als Fehllage dokumentiert. Bei 7 (1,0%) Patienten wurde eine Schraubenfehllage als Komplikation gewertet und 4 (0,6%) von diesen wurden deswegen revidiert. Die Sammelstudie ermöglicht eine aktuelle Standortbestimmung für Verletzungshäufigkeiten und -muster sowie die verschiedenen, heute angewendeten Operationsmethoden. Mit der multizentrischen Studie konnten erstmals der operative Aufwand sowie Möglichkeiten und Risiken der verschiedenen Behandlungsformen dargestellt werden. Weiterführende Ergebnisse sind von den noch andauernden klinischen und radiologischen Nachuntersuchungen zu erwarten.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001130050667
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  • 22
    Digitale Medien
    Digitale Medien
    Zur Implantatpositionierung bei der Epiphysiolysis capitis femoris Folgen des schlechten Verlaufs und Konsequenzen (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 820-825 
    Details
    ISSN: 1433-044X
    Schlagwort(e): Schlüsselwörter Implantatpositionierung ; Epiphysiolysis capitis femoris ; Komplikationen ; Behandlungskonsequenzen ; Keywords Implant position ; Slipped capital femoral epiphysis ; Complications ; Consequences of treatment
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Which consequences can be ascribed to the intraarticular position of devices in the operative treatment of a slipped capital femoral epiphysis? Which steps are to define as a standard of a careful procedure? The clinical and radiological results of five cases of a pin or nail penetration after the operative treatment of a slipped capital femoral epiphysis are described, a possible connection of causalities is investigated. The intraarticular position of devices in most cases goes along with an unfortunate clinical outcome and leads to a higher risk of developing chondrolysis. Because of the radiologic overprojection with the femoral head it is possible to oversee the malposition of the pin. Any operative treatment of a slipped capital femoral epiphysis requires a careful intraoperative X-ray examination combined with documentation. With this procedure the bad results of an intraarticular implant position must be ascribed to the reminding risk of a fateful development.
    Notizen: Zusammenfassung Welche Folgen bei der operativen Behandlung der Epiphysioslysis capitis femoris sind einer intraartikulären Implantatlage zuzurechnen, und welche Maßnahmen sind als Sorgfaltsmaßstab zu definieren? Anhand von 5 Fällen mit intraartikulärer Implantatlage nach der operativen Behandlung einer Epiphysiolysis capitis femoris werden die klinischen und radiologischen Folgen aufgezeigt und ein möglicher Kausalzusammenhang anhand der Literatur untersucht. Die intraartikuläre Implantatlage geht meistens mit einem ungünstigen klinischen Ergebnis einher und führt zu einer erheblichen Risikoerhöhung für das Auftreten einer Chondrolyse. Durch Überlagerung mit dem Femurkopf kann sich die Fehlposition des Implantates der radiologischen Diagnostik entziehen. Jede operative Behandlung der Epiphysiolysis capitis femoris erfordert eine sorgfältige intraoperative Durchleuchtungskontrolle, eine entsprechende Dokumentation ist zu empfehlen. Bei einem solchen Vorgehen sind die Folgen einer intraartikulären Position des Implantats als Restrisiko dem schicksalshaften Verlauf zuzurechnen.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001130050627
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  • 23
    Digitale Medien
    Digitale Medien
    Behandlungsergebnisse nach primärer und sekundärer Radiusköpfchenresektion (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 437-443 
    Details
    ISSN: 1433-044X
    Schlagwort(e): Schlüsselwörter Radiusköpfchenfraktur ; Primäre Resektion ; Osteosynthese ; Sekundäre Resektion ; Komplikationen ; Keywords Radial head fracture ; Primary resection ; Osteosynthesis ; Secondary resection ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Apart from comminuted fractures of the radial head the indication for resection of the radial head is discussed controversially. To evaluate our own results, the hospital notes of 113 patients treated between 1.1.1984–31.12.1994 in our clinic by posttraumatic primary or secondary radial head resection were examined retrospectively. 79 patients were controlled by clinical and radiological examination with an average follow-up of 37,8 months. We examined at 46 patients the influence of additional lesions of the elbow joint on the functional outcome. In 33 patients follow up was done with special regard to the time of resection. Poor results due to the score from Radin and Riseborough especially followed secondary radial head resection (〉14 days after trauma) and in case of additional elbow lesions. We could not observe problems of the wrist joint after radial head resection as described by other authors. According to our own experience primary resection is recommended in case of doubtful reconstruction of the radial head. In these fracture types radial head resection should not be seen as an alternative treatment because of the worse results following secondary resection.
    Notizen: Zusammenfassung Abgesehen von Trümmerfrakturen wird die Indikationsstellung zur Radiusköpfchenresektion kontrovers diskutiert. Zur Evaluation eigener Ergebnisse führten wir eine retrospektive Untersuchung der 113 Patienten durch, die von 1.1.1984–31.12.1994 mittels primärer oder sekundärer posttraumatischer Radiusköpfchenresektion behandelt wurden. Nach einem durchschnittlichen postoperativen Intervall von 37,8 Monaten konnten insgesamt 79 Patienten klinisch und radiologisch nachuntersucht werden. Bei 46 Patienten wurde die Auswirkung der Begleitverletzungen auf das Endergebnis untersucht. Bei 33 Patienten erfolgte die Nachuntersuchung unter besonderer Berücksichtigung des Resektionszeitpunktes. Schlechte Behandlungsergebnisse nach den Kriterien des Scores von Radin und Riseborough resultierten besonders häufig nach sekundärer Radiusköpfchenresektion (〉 14 Tage nach Trauma) und bei Begleitverletzungen des Ellenbogengelenks. Die Berichte anderer Autoren über negative Langzeitfolgen auf das Handgelenk können wir nicht bestätigen. Nach unseren Erfahrungen sollte daher bei zweifelhaften Rekonstruktionsversuchen die primäre Radiusköpfchenresektion bevorzugt werden, die aufgrund der eindeutig schlechteren Resultate nach sekundärer Resektion nicht als Option für mißlungene Erhaltungsversuche des Radiusköpfchens betrachtet werden darf.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001130050563
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  • 24
    Digitale Medien
    Digitale Medien
    Perforation eines mucocelenartig transformierten Hartmannstumpfs (2000)
    Springer
    Der Chirurg 71 (2000), S. 572-574 
    Details
    ISSN: 1433-0385
    Schlagwort(e): Keywords: Mucocele ; Ileostomy ; Complications ; Hartmann procedure. ; Schlüsselwörter: Mucocele ; Ileostoma ; Komplikationen ; Hartmannstumpf.
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Zusammenfassung. Wir berichten über eine 53 jährige Patientin, bei der 22 Jahre nach Anlage eines Ileostomas wegen eines Morbus Crohn eine Stenose im distalen Colonsegment (Hartmannstumpf) zu einer mucocelenartigen Transformation und nachfolgenden Ruptur geführt hat. Über die Ruptur eines stillgelegten Colonabschnitts nach Anlage eines Ileostomas wurde bisher offenbar noch nicht berichtet.
    Notizen: Abstract. We report an unusual complication in a 53-year-old woman following ileostomy for Crohn's disease 22 years previously. A stenosis of the distal colonic segment was the reason for the formation and subsequent rupture of a huge colonic mucocele. To our knowledge, this is the first report of a ruptured mucocele of colonic origin after ileostomy.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001040050859
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  • 25
    Digitale Medien
    Digitale Medien
    Patient reports of complications of bone marrow transplantation (2000)
    Springer
    Supportive care in cancer 8 (2000), S. 33-39 
    Details
    ISSN: 1433-7339
    Schlagwort(e): Key words Marrow transplantation ; Complications ; Oral mucositis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  In recent years, significant improvements have been made in the management of neutropenia and thrombocytopenia and other potentially life-threatening complications of ablative chemotherapy. While these complications are of particular concern to physicians, patients receiving ablative therapy for bone marrow or blood stem cell transplants are often troubled by other side effects such as nausea, vomiting, diarrhea and mouth sores. The purpose of the study was to gain a better understanding of patients' experiences while undergoing a transplant. The same professional medical interviewer conducted in-depth interviews with 38 subjects (10 men, 28 women; mean age 46.9 years) who had received ablative therapy for bone marrow and/or peripheral blood stem cell transplants. Participants were consecutively identified through physician and patient referrals, cancer and BMT patient support groups, and newspaper advertisements. Twenty-eight patients (74%) received autologous stem cell transplants and 10 patients (26%) received allogeneic transplants. Participants reported mouth sores, nausea and vomiting, diarrhea, and fatigue as the most troubling side effects of their transplants. Mouth sores were selected as the single most debilitating side effect (42%), followed by nausea and vomiting (13%). Many patients mentioned that mouth sores made it difficult or impossible to eat (n=23), swallow (n=21), drink (n=17), and/or talk (n=8). Twenty patients reported pain in the mouth, throat, and/or esophagus. Two-thirds (66%) of patients reported receiving opioid analgesics, most frequently morphine, to relieve oral pain. For many, opioids caused incapacitating side effects, including hallucinations, a feeling of loss of control and a decrease in mental acuity. Patients receiving ablative chemotherapy identify oral mucositis as a significant cause of suffering and morbidity. Effective interventions to alleviate this complication are urgently needed.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s005209900095
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  • 26
    Digitale Medien
    Digitale Medien
    Heilungsverlauf und Komplikationen nach Augenmuskeloperationen (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 22-26 
    Details
    ISSN: 1433-0423
    Schlagwort(e): Schlüsselwörter Augenmuskeloperation ; Komplikationen ; Heilungsverlauf ; Key words Eye muscle surgery ; Complications ; Healing process
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Background: Varying reports on the incidence of operative and postoperative complications following eye muscle surgery have been published. The purpose of this study was to quantify complications after various types of eye muscle surgery as well as minor pathological changes of the anterior and posterior segment. Patients and methods: This prospective study included all patients who underwent eye muscle surgery at the Department of Strabismology and Neuroophthalmology, Giessen, from January to May 1998. Five hundred eyes of 377 patients aged 2–82 years were included. The spectrum of procedures comprised: recessions, resections, tucks, R&R procedures, transpositions, bimedial retroequatorial myopexies, and revisions of rectus and oblique muscles. All patients were examined 1 day preoperatively and 1 day, 1 week, and 3 months postoperatively. Any complications and even minor pathological changes of the anterior and posterior segment were documented. Some changes were assessed by means of a score (0–3). Results: One day postoperatively, 30% of eyes had inflammatory pseudoptosis, most of them mild. Conjunctival swelling and injection were frequently mild and moderate, after 1 week mostly mild. Conjunctival irritation was more pronounced following resection than tucking. Punctate epithelial keratopathy was noted in 1.6% of cases (first postoperative day), dellen in 4.3% (first postoperative week). Three months postoperatively, 14.3% of eyes had biomicroscopically visible conjunctival folds and 91.3% had minimal conjunctival scars. None of the patients had a scleral perforation or other serious complication. Conclusions: Eye muscle surgery rarely entails complications. Revisions due to organic pathological changes are extremely rare. Possible development of dellen requires check-up 4–7 days postoperatively. Tucking of rectus muscles causes less conjunctival irritation than resection.
    Notizen: Hintergrund: Zur Inzidenz operativer und postoperativer Komplikationen bei Augenmuskeloperationen liegen unterschiedliche Mitteilungen vor. Ziel der vorliegenden Studie war es, sowohl Komplikationen als auch geringfügige pathologische Veränderungen des vorderen und hinteren Augenabschnittes nach unterschiedlichen Augenmuskeloperationen zu quantifizieren. Patienten und Methode: Es wurden prospektiv alle Patienten erfaßt, bei denen im Zeitraum Januar bis Mai 1998 an der Augenklinik für Schielbehandlung und Neuroophthalmologie Gießen eine Augenmuskeloperation durchgeführt wurde. In die Studie konnten 500 Augen von 377 Patienten im Alter von 2 bis 82 Jahren einbezogen werden. Das Spektrum der durchgeführten Eingriffe umfaßte Rücklagerungen, Resektionen, Faltungen, kombinierte Operationen, Transpositionen, Fadenoperationen und Revisionsoperationen an allen geraden und schrägen Augenmuskeln. Die Patienten wurden am Tag vor der Operation und postoperativ am ersten Tag, nach einer Woche und nach drei Monaten untersucht. Alle Komplikationen des vorderen und hinteren Augenabschnittes wurden dokumentiert und quantitativ erfaßt, teilweise erfolgte eine Gradeinteilung (0–3). Ergebnisse: Am ersten postoperativen Tag war bei 30% der Augen eine zumeist diskrete Lidschwellung auffällig. Die Bindehautschwellung und -injektion waren meist gering bis mäßig, nach einer Woche häufig nur noch gering. Der Reizzustand der Bindehaut war geringer nach Faltung als nach Resektion eines horizontalen M. rectus. Bei den Hornhautveränderungen dominierte am ersten postoperativen Tag eine Epitheliopathie (1,6%), nach 1 Woche standen diskrete Fuchs'sche Dellen (4,3%) im Vordergrund, die unter lokaler Therapie abheilten. Mikroskopisch erkennbare Bindehautfalten wurden überwiegend zur 3-Monats-Kontrolle (14,3%) dokumentiert, ebenso Bindehautnarben (91,3%), die i.d.R. sehr gering waren. Perforationen oder schwerwiegende Komplikationen kamen nicht vor. Schlußfolgerungen: Eine Augenmuskeloperation ist ein komplikationsarmer Eingriff, der nur selten einen erneuten Eingriff wegen organischer pathologischer Veränderungen erfordert. Zur Erkennung von Fuchs'schen Dellen ist eine Kontrolluntersuchung 4–7 Tage postoperativ wichtig. Faltung eines horizontalen M. rectus führt zu weniger Bindehautreiz als Resektion.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003470050005
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  • 27
    Digitale Medien
    Digitale Medien
    Okuläres vernarbendes Pemphigoid Retrospektive Analyse von Risikofaktoren und Komplikationen (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 113-120 
    Details
    ISSN: 1433-0423
    Schlagwort(e): Schlüsselwörter Okuläres vernarbendes Pemphigoid ; Therapie ; Komplikationen ; Glaukom ; Key words Ocular cicatricial pemphigoid ; Therapy ; Complications ; Glaucoma
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: 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.
    Notizen: 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.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003470050021
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  • 28
    Digitale Medien
    Digitale Medien
    Qualitätssicherung in der gynäkologischen Endoskopie (2000)
    Springer
    Der Gynäkologe 33 (2000), S. 213-219 
    Details
    ISSN: 1433-0393
    Schlagwort(e): Schlüsselwörter Qualitätssicherung ; Endoskopie ; Komplikationen ; Key words Quality control ; Endoscopy ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Due to the expanding use of laparoscopic surgery in gynecology, the necessity for evaluation of results was raised. With the intention of quality control in gynecological endoscopy, the gynecological department of the Evangelisches Diakonie-Krankenhaus in Bremen has developed, in cooperation with the Institute for Artificial Intelligence at the University of Bremen and on behalf of the German Society for Gynecological Endoscopy, the quality control program “German Gynecological Endoscopy Complication Register”. In 1997, 20 German endoscopic centers took part in the prospective observational study. A total number of 17,745 cases were reported. Altogether 20,050 endoscopic procedures were performed, 8020 hysteroscopies and 12030 laparoscopies. The complication rate for hysteroscopies amounted to 7.0‰ and that of laparoscopies to 9.6‰. The quality control program of the German Society for Gynecological Endoscopy is a unique tool, comparable to the “German Perinatology Study”. It allows to compare individual hospital profiles, an option that is necessary to gain the best possible results in terms of quality in gynecological surgery in the long term.
    Notizen: Zusammenfassung Mit dem Ziel der Qualitätsverbesserung in der gynäkologischen Endoskopie hat die Frauenklinik des Evangelischen Diakonie-Krankenhauses in Bremen im Auftrag der Arbeitsgemeinschaft der Gynäkologischen Endoskopie (AGE) zusammen mit dem KI-Labor der Universität Bremen das Qualitätssicherungs-Programm “Komplikationsregister gynäkologische Endoskopie” entwickelt. Es ermöglicht dem Anwender die differenzierte Betrachtung der durchgeführten Operationen von den Indikationsstellung bis zum Therapieerfolg. Im Jahre 1997 haben 20 endoskopisch tätige Institutionen an der prospektiven Dokumentation der gynäkologisch-endoskopischen Operationen teilgenommen. Bei insgesamt 17.745 Patientinnen wurden 20.050 Eingriffe erfasst, darunter 8020 Hysteroskopien und 12.030 Laparoskopien. Die Komplikationsrate der Hysteroskopien betrug 7,0‰, die der Laparoskopien 9,6‰. Mit dem Qualitätssicherungs-Programm der AGE steht heute ein Instrument zur Verfügung, das vergleichbar der Perinatologiestudie die Daten in Form von vergleichenden Klinikprofilen liefern kann, die notwendig sind, um im Zusammenhang mit endoskopischen Operationen langfristig die bestmögliche Ergebnisqualität zu erzielen.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001290050537
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  • 29
    Digitale Medien
    Digitale Medien
    Neurologische Komplikationen nach Organtransplantation (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 249-258 
    Details
    ISSN: 1433-0407
    Schlagwort(e): Schlüsselwörter Organtransplantation ; Immunsuppression ; Neurotoxizität ; ZNS-Infektionen ; Komplikationen ; Key words Organ transplantation ; Complications ; Immunosuppression ; Neurotoxicity ; CNS infection
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Following organ transplantation, 30–60% of patients develop neurologic complications which can be classified as pre-existing deficits due to the underlying disease, complications during surgery, metabolic encephalopathies, neurotoxicity of immunosuppressant agents, opportunistic CNS infections, and secondary malignomas as indirect side effects of immunosuppression. While encephalopathies, seizures, or CNS infection can occur in all types of transplantation, some specific neurological complications exist for different types of organ transplantation. In this review, the clinical symptoms and treatment of both the common neurological complications as well as the particular neurological syndromes after liver, heart, and bone marrow transplantation are discussed.
    Notizen: Zusammenfassung Nach Organtransplantation entwicklen 30–60% der Patienten neurologische Komplikationen, die eingeteilt werden können in vorbestehende Störungen im Rahmen der Grunderkrankung, intraoperative Komplikationen, metabolische Enzephalopathien, neurotoxische Nebenwirkungen der verschiedenen Immunsuppressiva sowie opportunistische ZNS-Infektionen und sekundäre Malignome als indirekte Folge der Immunsuppression. Differentialdiagnostisch relevant ist, dass einerseits Enzephalopathien, Anfälle oder ZNS-Infektionen bei allen Transplantationen auftreten können, andererseits für einzelne Organtransplantationen bestimmte neurologische Komplikationen typisch sind. In dieser Übersicht werden die allgemeinen neurologischen Komplikationen mit klinischen Leitsymptomen und Therapie sowie die spezifischen neurologischen Krankheitsbilder nach Leber-, Herz- und Knochenmarktransplantation vorgestellt.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001150050554
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  • 30
    Digitale Medien
    Digitale Medien
    Management von Komplikationen nach prothetischer Stimmrehabilitation (2000)
    Springer
    HNO 48 (2000), S. 508-516 
    Details
    ISSN: 1433-0458
    Schlagwort(e): Schlüsselwörter Stimmprothese ; Komplikationen ; Laryngektomie ; Tracheoösophageale Fistel ; Keywords Voice prosthesis ; Complications ; Total laryngectomy ; Tracheoesophageal fistula
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract The growing popularity of prosthetic voice restoration after total laryngectomy confronts ENT specialists with an increasing number of prosthesis-related complications. The ENT specialist should be familiar with the management of these complications in order to maintain the patients speech and social rehabilitation. In a retrospective study on 108 consecutive patients, complications were encountered in 30%. The incidence was not related to the factors age or primary vs. secondary insertion of the prosthesis. Complications consisted of formation of granulation tissue (15,7%), shunt dilatation (5,5%), loss of prosthesis (3,7%), local cellulitis (2,8%), extrusion (1,9%), ingrowth of prosthesis (1,9%) and formation of excessive scar tissue with dislocation of prosthesis (0,9%). Permanent removal of the prosthesis due to complications was necessary in 3 cases (2,8%). Therapeutic measures for the management of complications are described and evaluated. The treatment of complications was well tolerated by all patients and led to satisfying results in most cases. Our observations show that prosthetic voice rehabilitation is associated with various difficulties and complications, but that these can be handled quite easily and successfully in the majority of cases.
    Notizen: Zusammenfassung Die wachsende Beliebtheit der prothetischen Stimmrehabilitation nach Laryngektomie konfrontiert den HNO-Arzt immer häufiger mit stimmprothesenbedingten Komplikationen. Als solcher sollte man daher die Komplikationen der Stimmprothesenversorgung kennen und deren Management beherrschen, um die kommunikative und soziale Rehabilitation des Patienten nicht zu gefährden. Die retrospektive Untersuchung von 108 Stimmprothesenträgern erbrachte eine Komplikationshäufigkeit von 30%. Eine Abhängigkeit der Komplikationsinzidenz vom Alter des Patienten oder vom Faktor primäre / sekundäre Protheseneinlage gab es dabei nicht. Häufigste Komplikation war die Entwicklung von Granulationsgewebe (15.7%), gefolgt von Shunterweiterung (5,5%), Prothesenverlust (3,7%), lokalen Infektionen (2,8%), Abstoßung (1,9%), eingewachsener Prothese (1,9%), narbiger Shuntwandverdickung mit Prothesendislokation (0,9%). In nur 3 Fällen (2,8%) mußte die Stimmprothese aufgrund verschiedener Komplikationen wieder entfernt werden. Die erforderlichen therapeutischen Maßnahmen waren für die Patienten wenig belastend und führten in fast allen Fällen zu befriedigenden Ergebnissen. Diese Beobachtungen zeigen, daß die prothetische Stimmrehabilitation zwar nicht ohne Komplikationen und Schwierigkeiten ist, diese jedoch in weitaus der Mehrzahl der Fälle medizinisch leicht zu beherrschen und daher zumutbar sind.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001060050607
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  • 31
    Digitale Medien
    Digitale Medien
    Die stabile und instabile pertrochantäre Femurfraktur Differenzierte Indikationsstellung für die dynamische Hüftschraube (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 741-748 
    Details
    ISSN: 1433-044X
    Schlagwort(e): Schlüsselwörter Pertrochantäre Fraktur ; Dynamische Hüftschraube ; Instabile Frakturen ; Komplikationen ; Keywords Trochanteric fracture ; Dynamic hip screw (DHS) ; Instable fractures ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract The aim of all surgical procedures in the treatment of trochanteric fractures in elderly and even geriatric patients is achievement of initial stability. We examined in a clinical trial whether primary stability was achieved in all types of trochanteric fractures following osteosynthesis with the Dynamic Hip Scres (DHS). From 1994 to 1996, 122 patients with trochanteric fractures had osteosynthesis by dynamic hip screw. Patient records were evaluated and all data got registered with a standardized protocoll; clinical and radiological outcome was analysed after an average period of 1,9 years after injury according to the Traumatic Hip Rating Score. 22% of all patients died meantimes, 51,6% of the remaining 95 patients could get examined. The average age was 75,5 years, the patient population showed an increased preoperative morbidity (2,5 points) according to ASA-Score. 81% showed progressive osteoporosis. According to the AO-classification 47% stable fractures (type A-1) and 53% instable trochanteric fractures (type A-2 and A-3) occured. Surgery lasted 77 minutes average in osteosynthesis of stable fractures. The duration of 108 minutes in instable fractures was significantly higher, as well as the blood loss was 43% increased in these complex fractures. Complications closely associated to the osteosynthesis appeared only in instable fractures (7%). Also common complications (24,6%) predominated with 15,6% in tpy A-2 and A-3 fractures versus 9% in type A-1 fractures; mortality was also different with 5,7% versus 1,6%. Assesment of the functional outcome according to THRS showed a significant deterioration of 20 points in 71% of all patients compared with the preoperative score. The results show that dynamic hip screw osteosynthesis in instable trochanteric fractures is associated to a higher incidence of complications. While the dynamic hip screw still represents the standard implant in stable fractures of the trochanteric regio, beeing aware of improved intramedullary implants regarding biomechanical features and surgical technique, the results justify to critical consider the use of DHS for osteosynthesis in instable fractures of the trochanteric region.
    Notizen: Zusammenfassung Bei der operativen Versorgung petrochantärer Femurfrakturen im geriatrischen Krankengut stellt eine sofort übungs- und belastungsstabile Osteosynthese das Therapieziel dar. In einer klinischen Studie wurde vergleichend untersucht, ob dieses Ziel mit der DHS (dynamische Hüftschraube) bei allen pertrochantären Frakturtypen erreicht werden kann. Von 1994–1996 wurden 122 pertrochantäre Frakturen mit der DHS behandelt. Neben der Auswertung durch standardisierte Datenerhebungsprotokolle wurden die Patienten durchschnittlich 1,9 Jahre nach Trauma radiologisch und klinisch nach dem “Traumatic hip rating score” nachuntersucht; 22% waren verstorben, von den verbliebenen 95 Patienten konnten 51,6% nachkontrolliert werden. Bei einem Altersdurchschnitt von 75,5 Jahren lag mit dem ASA-Score von durchschnittlich 2,5 Punkten eine hohe präoperative Morbidität vor; 81% der Fälle wiesen eine fortgeschrittene Osteoporose auf. Nach der AO-Klassifikation handelte es sich um 47% stabile (Typ A1) und 53% instabile (Typ A2 und A3) Frakturen. Die mittlere Operationszeit war bei den instabilen im Vergleich zu den stabilen pertrochantären Frakturen mit 108 gegenüber 77 min signifikant höher, der Blutverlust um 43% größer. Direkt mit der Osteosynthese assoziierte Komplikationen betrafen ausschließlich instabile Frakturen (7%). Allgemeine Komplikationen (24,6%) überwogen ebenfalls mit 15,6% in der Gruppe der Typ A2 und A3 gegenüber der Typ-A1-Frakturen, was sich auch in einer entsprechend höheren Klinikletalität mit 5,7% gegenüber 1,6% ausdrückt. Bei der Bewertung des funktionellen Nachuntersuchungsergebnisses mit dem THRS wiesen 71% der Patienten im Vergleich zum präoperativen Ausgangswert eine deutliche Verschlechterung um durchschnittlich 20 Punkte auf. Die Osteosynthese instabiler pertrochantärer Femurfrakturen durch die DHS ist mit einer höheren Komplikationsrate belastet. Während die DHS für die stabilen Frakturen das Standardverfahren darstellt muss die Osteosynthese instabiler Frakturen vor dem Hintergrund neuerer, operationstechnisch und biomechanisch verbesserter intramedullärer Implantate kritisch betrachtet werden.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001130050613
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  • 32
    Digitale Medien
    Digitale Medien
    Unaufgebohrter Humerusnagel (UHN) (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 277-283 
    Details
    ISSN: 1436-6274
    Schlagwort(e): Schlüsselwörter ; Humerusschaftfraktur ; Intramedulläre Marknagelosteosynthese ; UHN ; Komplikationen ; Behandlungsergebnisse ; Keywords ; Fracture of the humeral diaphysis ; Humerus nail ; UHN ; Complications ; Results
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: In a retrospective study, 115 fractures of the humeral diaphysis were evaluated, and 94 of the patients were treated by surgical operations. In 64 patients we used an unreamed humerus nail (UHN) to stabilize the fractures of the humerus diaphysis. All patients with an UHN were followed up. Having analysed the system-specific and general complications and the functional, subjective and radiological results we can recommend the UHN for the treatment of both fractures and pseudarthrosis of the humeral diaphysis.
    Notizen: In einer retrospektiv durchgeführten Studie wurden 115 Humerusschaftfrakturen ausgewertet. Operativ wurden 94 Patienten, davon 64 mit einem unaufgebohrten Humerusnagel (UHN), versorgt. Die mit einem UHN behandelten Patienten wurden nachuntersucht. Nach Auswertung der systemspezifischen und allgemeinen Komplikationen sowie der funktionellen, subjektiven und radiologischen Ergebnisse kann der UHN sowohl zur Behandlung der frischen Humerusschaftfraktur als auch zur Versorgung von Humerusschaftpseudarthrosen empfohlen werden.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s100390000318
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  • 33
    Digitale Medien
    Digitale Medien
    Wann ist die arthroskopische Diagnostik und Therapie am Ellbogengelenk beim Trauma angezeigt? (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S81 
    Details
    ISSN: 1436-6274
    Schlagwort(e): Schlüsselwörter ; Arthroskopie ; Ellbogengelenk ; Trauma ; Minimalinvasive Osteosynthese ; KomplikationenArthroscopy ; Elbow joint ; Injury ; Osteosynthesis ; Complications ; Key words ; Arthroskopie ; Ellbogengelenk ; Trauma ; Minimalinvasive Osteosynthese ; KomplikationenArthroscopy ; Elbow joint ; Injury ; Osteosynthesis ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Elbow arthroscopy, unlike arthroscopy of the knee or shoulder, is technically a very demanding procedure that is associated with a high risk of complications owing to the surrouding neurovascular structures. In the case of trauma the arthroscopic approach is even more difficult because of the altered anatomy. In addition, the time available for the performance of any surgical procedures is very much limited by the immediate onset of periarticular swelling with fluid loss caused by the damage to the joint capsule that is present in most cases. Arthroscopy of the elbow should not therefore be considered to be indicated in acute trauma except in isolated cases and after very careful consideration of the risks and benefits for the patient. This procedure cannot be generally recommended as a standard method of examining or treating freshly sustained injuries.On the other hand, elbow arthroscopy can be very helpful in the case of posttraumatic functional deficiencies or such pathologic findings as loose bodies after osteochondral fractures, adhesions and intraarticular scars, while little or no improvement can be expected for vague joint symptoms or posttraumatic arthrosis. As there is a relatively high risk of neurological complications the patient needs to be given quite comprehensive information in an intensive preoperative session. Diagnostic arthroscopy is hardly ever indicated in a trauma case because of the excellent results yielded by modern noninvasive imaging methods, such as ultrasound, X-ray, computed tomography and MRI.
    Notizen: Zusammenfassung Im Gegensatz zur Arthroskopie des Knie- oder Schultergelenks ist die Arthroskopie des Ellbogengelenks mit erheblichen technischen Schwierigkeiten und entsprechend hohen Komplikationsrisiken verbunden. Beim Trauma ist die Arthroskopie zudem aufgrund der veränderten anatomischen Verhältnisse noch weit komplizierter. Die Operationszeit ist wegen der rasch auftretenden periartikulären Schwellung infolge der meist bestehenden Gelenkkapselläsionen deutlich limitiert. Die Indikation zur Arthroskopie sollte daher nur im Einzelfall unter sorgfältiger Abwägung der Risiken und der zu erwartenden Vorteile gestellt werden. Eine generelle Empfehlung für dieses Verfahren bei frischen Verletzungen kann nicht ausgesprochen werden. Sinnvoll ist der Einsatz dagegen bei einigen posttraumatischen Veränderungen, z. B. freien Gelenkkörpern nach osteochondralen Frakturen oder Arthrolysen bei intraartikulären Vernarbungen, während bei „unklaren Gelenkbeschwerden“ oder posttraumatischer Arthrose kaum Verbesserungen zu erwarten sind. Wegen des relativ hohen Risikos neurologischer Komplikationen ist eine intensive präoperative Aufklärung der Patienten erforderlich. Eine diagnostische Arthroskopie beim Trauma ist bei der Aussagekraft der modernen nichtinvasiven Untersuchungsverfahren kaum noch angezeigt.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00014932
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  • 34
    Digitale Medien
    Digitale Medien
    Indikationsstellung und Verfahrenswahl bei Beckenringverletzungen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 39-45 
    Details
    ISSN: 1436-6274
    Schlagwort(e): Schlüsselwörter ; Beckenringfrakturen ; Klassifikation ; Behandlungsverfahren ; Komplikationen ; Ergebnisse ; Keywords ; Pelvic ring fractures ; Classification ; Treatment ; Complications ; Results
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Injuries of the pelvis are caused by high-energy trauma, and concomitant injuries are therefore often found. Many patients with such pelvic injuries have multiple injuries. Accurate diagnosis and classification are both fundamental to adequate therapy. Especially in the presence of complex pelvic trauma and in polytraumatised patients priority-oriented and fast procedures are essential. Type B and C instabilities require operative treatment. In emergency cases with unstable pelvic fractures external fixation has proved successful. For definitive treatment with internal stabilisation different internal fixation procedures with screws and plates selected with reference to the features of the injury are needed. The operative stabilisation of the pelvic ring demands particular care, because various main vessels and nerves are adjacent to the injury site. Ultimately, the results of treatment depend heavily on the quality of anatomical restoration of the pelvic ring.
    Notizen: Beckenverletzungen entstehen aufgrund hoher lokaler Gewalteinwirkung und sind deswegen häufig mit Begleitverletzungen kombiniert. Bei vielen beckenverletzten Patienten liegt ein Polytrauma vor. Grundlage einer adäquaten Therapie von Verletzungen des Beckenrings sind eine exakte Diagnostik und Klassifikation. Vor allem beim komplexen Beckentrauma und beim Vorliegen eines Polytraumas ist ein rasches und an Prioritäten orientiertes Vorgehen entscheidend. Instabilitäten vom Typ B und C erfordern eine operative Stabilisierung. Dabei steht in der Notfallbehandlung des instabilen Beckenrings die externe Stabilisierung im Vordergrund. Beim Übergang auf interne Fixationsverfahren haben sich abhängig von der Verletzungsmorphologie verschiedene Schrauben- und Plattenmontagen bewährt. Die operative Stabilisierung des Beckenrings erfordert wegen der engen Nachbarschaft zu verschiedenen Gefäß- und Nervenbahnen besondere Sorgfalt. Das Endergebnis hängt dabei ganz wesentlich davon ab, wie gut die Wiederherstellung der anatomischen Form des Beckenrings gelungen ist.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s100390050089
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  • 35
    Digitale Medien
    Digitale Medien
    Verletzungen des thorakolumbalen Übergangs (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 162-166 
    Details
    ISSN: 1436-6274
    Schlagwort(e): Schlüsselwörter ; Thorakolumbale Frakturen ; Transpedikuläre Spondylodese ; Spongiosaplastik ; Komplikationen ; Keywords ; Thoracolumbar fractures ; Transpedicular spondylodesis ; Bone grafting ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Spinal fractures are located predominantly at the thoracolumbar junction. After conservative treatment, for unstable fractures operative procedures were established during the last 20 years. Using implants with angular stability, dorsal transpedicular fixation yields good clinical results even compared with those of combined dorsoventral procedures. Transpedicular bone grafting is controversial as resorption frequently occurs; it has given disappointing results in fracture types in which definitive segmental fusion is unavoidable, so that combined dorso-ventral stabilization is necessary in such cases. The most frequent complications of dorsal instrumentation are the result of badly positioned transpedicular screws.
    Notizen: Die Verletzungen des thorakolumbalen Übergangs stellen die Mehrzahl der Frakturen der Wirbelsäule dar. Nach der konservativen Therapie hat sich in den letzten beiden Jahrzehnten die operative Versorgung instabiler Frakturen etabliert. Die dorsale transpedikuläre Spondylodese unter Verwendung winkelstabiler Implantate stellt ein Verfahren dar, mit dem sich auch im Vergleich zu aufwändigen dorsoventralen Rekonstruktionen bei den meisten Frakturen gute klinische Resultate erzielen lassen. Der additionellen transpedikulären intrakorporalen Spongiosaplastik wird aufgrund der zu beobachtenden Resorption des Transplantats zunehmend geringere Bedeutung beigemessen. Auch bei Frakturtypen, bei denen eine definitive Fusion angestrebt werden sollte, hat die transpedikuläre interkorporale Knochentransplantation enttäuscht, sodass in derartigen Fällen nach primärer dorsaler Stabilisierung sekundär die Fusion von ventral erfolgen sollte. Die häufigsten Komplikationen bei der dorsalen transpedikulären Spondylodese sind auf Fehllagen der transpedikulären Schrauben zurückzuführen.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00010931
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  • 36
    Digitale Medien
    Digitale Medien
    Decreased expression of vascular endothelial growth factor in glomeruli of puromycin aminonucleoside nephrosis (2000)
    Springer
    Clinical and experimental nephrology 4 (2000), S. 29-33 
    Details
    ISSN: 1437-7799
    Schlagwort(e): Key words VEGF ; Glomeruli ; Ribonuclease protection assay ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Background. Vascular endothelial growth factor (VEGF) is a selective endothelial growth factor which potently enhances microvascular permeability. In the kidney, VEGF mRNA is known to be highly expressed in visceral epithelial cells in glomeruli. However, the physiological role of VEGF in glomerular function and its involvement in the pathogenesis of proteinuria are not clear. The present studies were designed to determine whether altered expression of VEGF mRNA was observed in the course of puromycin aminonucleoside (PAN) nephrosis in rats (a model of human minimal change nephrosis). Methods. The message level of VEGF in isolated glomeruli of PAN nephrosis rats was measured using a ribonuclease protection assay. Results. VEGF expression began to decrease 4 days after PAN injection and could not be detected in the nephrotic stage of PAN nephrosis (on days 8 and 16). In the remission of stage of PAN nephrosis (on day 28), mRNA was restored to the control level. Conclusions. According to our results, a functional defect in the VEGF expression of visceral epithelial cells was observed in PAN nephrosis. VEGF could be a functional marker of visceral epithelial cells, and the loss of normal expression of VEGF after damage to visceral epithelial cells could affect glomerular endothelial cell function in PAN nephrosis.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s101570050058
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  • 37
    Digitale Medien
    Digitale Medien
    Apoptosis in murine duodenum during embryonic development (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 485-487 
    Details
    ISSN: 1437-9813
    Schlagwort(e): Key words Duodenum ; Apoptosis ; Fetus ; Rat ; Duodenal atresia
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Duodenum is thought to go through a solid-core stage followed by recanalization during its development. This study investigates the role of apoptosis in normal duodenal development, especially during widening of the lumen, and hence, the possible role of apoptosis in duodenal atresia (DA). Twenty-four time-mated Sprague-Dawley rats were killed from day 13 to day 20 of gestation. Duodenums of 3 fetuses were chosen randomly from each rat and processed. Apoptosis was determined by the terminal deoxytransferase-mediated biotin dUTP nick-end labeling (TUNEL) technique (ApopTag). Apoptosis count and cross-sectional areas were measured with an image analyzer (MetaMorph). The number of apoptotic cells per unit area duodenum peaked on day 15 for the mucosal/submucosal layer and on day 14 for the muscular/mesenchymal layer. The maximal number of apoptotic cells per cross-section of duodenum was between 7 and 8. The cross-sectional areas of the duodenal wall and lumen increased exponentially between day 17 and day 19 while duodenal-wall thickness remained relatively constant throughout duodenal development. The localization, timing, and intensity of apoptosis do not suggest that apoptosis is responsible for the widening of the duodenal lumen; enlargement of the lumen is related to the increase in duodenal circumference. Apoptosis thus may not be involved in the pathogenesis of DA.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003830000408
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  • 38
    Digitale Medien
    Digitale Medien
    Organ-specific distribution of major histocompatibility antigens in rats (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 285-292 
    Details
    ISSN: 1437-9813
    Schlagwort(e): Key words Major histocompatibility complex (MHC) ; Rat ; Immunohistochemistry ; Distribution
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  The present study systematically investigated the expression and distribution of the major histocompatibility complex (MHC) classes I and II in the rat. About 150 native tissue probes from eight adult Lewis rats were taken, representative for most organs, tissues, and the vascular system. MHC expression was analyzed by two monoclonal antibodies (mAb) generated against the non-polymorphic determinants of rat MHC class I (Ox-18) and class II (Ox-6). Immunoreactivities were compared to those of different endothelial (HIS52, TLD-3A12, Ox-43, REHA-1 antigen), histiocytic (ED1, ED2), B-cell (RLN-9D3), and T-cell (MRC Ox-52) markers. A nonspecific mAb (MR12/53) served as a negative control. Pretested concentrations on various tissues and the alkaline phosphatase-anti-alkaline phosphatase technique allowed semiquantitative evaluation of serial cryostat tissue sections. MHC class I expression was detected on most immunocompetent cells. Endothelial cells were stained heterogeneously along the vascular system and the organ-specific microcirculation. Furthermore, some organs showed staining of parenchymal cells. MHC class II was found on all immunocompetent cells positive for the B-cell marker and about 15% of cells positive for the histiocytic markers. Besides the well-known expression of MHC class II in the outer zone of the renal proximal tubule, further organ-specific cell forms were found positive. In conclusion, the present study outlines tissue-specific distribution of MHC I/II and implies that each organ carries a variable immunologic burden that needs to be considered for any transplantation model.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003830050746
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  • 39
    Digitale Medien
    Digitale Medien
    Proliferation, zonal maturation, and steroid production of fetal adrenal transplants in adrenalectomized rats (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 293-296 
    Details
    ISSN: 1437-9813
    Schlagwort(e): Key words Fetal transplantation ; Proliferation ; Adrenal glands ; Addisonian crisis ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  The present study investigated the histologic maturation, proliferative capacity, and steroid production of fetal adrenal transplants (Tx) in adrenalectomized rats. A pair of fetal adrenal glands (18–20 days of gestation) was transplanted into the omentum of syngeneic Lewis rats (n=45). Four weeks later, in 5 animals the grafts were excised for morphologic evaluation. Proliferation was investigated by immunohistochemical staining for KI-67 protein and quantified by the proliferation index (PI = positive cells/100 counts). All other hosts (Tx; n = 40) underwent bilateral adrenalectomy (AE) to induce Addisonian crisis. Postoperatively, survival and concentrations of potassium, sodium, aldosterone, and corticosterone were recorded for 6 months. These data were compared to controls (C = only AE; n = 30) and a sham group (S; n = 10). At the end of the study period all surviving hosts were killed for histologic examination of grafts. At 4 weeks post-Tx the adrenal grafts demonstrated a distinct zona glomerulosa and frequent proliferation with a PI of 0.084, comparable to normal control (0.092). Following AE survival was significantly prolonged in Tx (86% vs 12% of C, P 〈 0.05). Control animals developed severe hyponatremia and hyperkalemia, whereas in Tx only transient signs of Addisonian crisis were recorded. Levels of aldosterone dropped within 7 days in the Tx and C groups, but returned to normal for Tx within 8 weeks. Corticosterone levels of Tx animals fell to 25% within week, but steadily increased to 70% by the end of the study. At 6 months, grafts revealed a mature adrenocortical structure with little proliferative activity, which was comparable to controls. In a syngeneic rat model fetal adrenal transplants thus mature and proliferate to provide sufficient steroid production for adrenalectomized hosts.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003830050747
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  • 40
    Digitale Medien
    Digitale Medien
    Antenatal dexamethasone administration inhibits smooth-muscle-cell DNA synthesis in pulmonary-arterial media in nitrofen-induced congenital diaphragmatic hernia in rats (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 414-416 
    Details
    ISSN: 1437-9813
    Schlagwort(e): Key words Congenital diaphragmatic hernia ; Hypoplastic lung ; Bromodeoxyuridine (BrdU) ; Antenatal glucocorticoids ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  The aim of this study was to investigate the effect of antenatal glucocorticoid therapy on smooth-muscle-cell (SMC) DNA synthesis in the pulmonary arteries (PA) in a nitrofen-induced congenital diaphragmatic hernia (CDH) rat model following nitrofen administration on day 9.5 of gestation. Antenatal dexamethasone (DEX) was given intraperitoneally on days 18.5 and 19.5 of gestation. Bromodeoxyuridine (BrdU) was injected via a jugular vein into the dam 1 h before the fetuses were killed by cesarean section at term. The fetuses were divided into three groups: group I (n = 10): normal controls; group II (n = 10): nitrofen-induced CDH; group III (n = 10): nitrofen-induced CDH with antenatal DEX treatment. Immunostaining of the lungs with anti-BrdU antibody was obtained by a standard avidin-biotin complex method. The number of immunopositive cells in the PA media and adventitia were counted using an image analyzer and analyzed statistically. The number of BrdU-immunopositive cells in the media was significantly increased in group II (16.83 ± 3.01) compared to groups I (9.16 ± 2.20) and III (6.83 ± 1.70) (P 〈 0.01). There was no significant difference between groups I and III. The number of BrdU-immunopositive cells in the adventitia was not significantly different between the three groups. Antenatal DEX treatment inhibits SMC DNA synthesis in PA media in CDH lungs. This may be a possible mechanism by which antenatal DEX prevents structural PA changes in nitrofen-induced CDH in rats.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003839900336
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  • 41
    Digitale Medien
    Digitale Medien
    Infantile acute pancreatitis after mumps vaccination simulating an acute abdomen (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 488-489 
    Details
    ISSN: 1437-9813
    Schlagwort(e): Key words Pancreatitis ; Childhood ; Mumps vaccination ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  We describe an extremely rare case of acute pancreatitis presenting as an acute abdomen that appeared as a complication of mumps vaccination in a young child. A laparotomy performed because of suspected perforated appendicitis proved unnecessary in retrospect. No similar case in infancy and early childhood has been reported to date.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003830000417
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  • 42
    Digitale Medien
    Digitale Medien
    Patient perception of magnetic resonance arthrography (2000)
    Springer
    Skeletal radiology 29 (2000), S. 265-269 
    Details
    ISSN: 1432-2161
    Schlagwort(e): Key words MR arthrography ; Joint injection ; Gadolinium (intra-articular) ; Pain-rating scores ; Arthrogram ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Objective. Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging alone. The purpose of this study was to evaluate patients’ perception of the fear and discomfort, and to assess their overall acceptance of the intra-articular gadolinium injection. Design and patients. Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most commonly associated with the procedure including ”pain”, ”needles”, ”complications”, and ”discovery of results that would lead to surgery”. In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked to rate their perception of pain. Results. While many patients expressed fear of ”pain” and ”needles”, after having undergone the injection their overall pain rating score was low. Only 6% actually found gadolinium arthrography more painful than expected. Conclusion. Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002560050605
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  • 43
    Digitale Medien
    Digitale Medien
    Rapid chondrolysis after an intra-articular leak of bone cement in treatment of a benign acetabular subchondral cyst: an unusual complication of percutaneous injection of acrylic cement (2000)
    Springer
    Skeletal radiology 29 (2000), S. 275-278 
    Details
    ISSN: 1432-2161
    Schlagwort(e): Key words Bone subchondral cyst ; Acetabulum ; Interventional radiology ; Complications ; Methylmethacrylate ; Chondrolysis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Percutaneous injection of methylmethacrylate is now increasingly employed to treat bone lesions, both malignant and benign. However, the risks of this procedure are still to be fully established. In this report, we describe a case of rapid chondrolysis appearing after the intra-articular leakage of cement during injection of an acetabular subchondral cyst, resulting in hip replacement. Although the mechanism of such chondrolysis is unknown, this event suggests a chondrolytic effect of the acrylic cement. Thus, it is essential to systematically search for the presence of an intra-articular passage before injecting bone cement into a peri-articular cyst. This unusual complication highlights the need for rigorous evaluation of the benefits and risks of percutaneous injection of acrylic cement in the treatment of benign lesions, especially close to an articulation.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002560050607
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  • 44
    Digitale Medien
    Digitale Medien
    Long-term small bowel allograft function induced by short-term FK 506 application is associated with split tolerance (2000)
    Springer
    Transplant international 13 (2000), S. S532 
    Details
    ISSN: 1432-2277
    Schlagwort(e): Key words Small bowel transplantation ; Split tolerance ; FK 506 ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Functional long-term allograft survival after experimental small bowel transplantation (SBT) is limited by chronic rejection. Initial application of high-dose FK 506 has been shown to induce stable long-term graft function. In order to examine whether this long-term function is associated with donor-specific tolerance, we analyzed the functional status of recipient T cells in vivo and in vitro. One-step orthotopic SBT was performed in the allogeneic Brown Norway (BN)-to-Lewis rat strain combination. FK 506 was given daily at a dose of 2 mg/kg from days 0–5 in the rejection model and from days 0–9 in the long-term functional model. Mean survival time in the rejection model was 98 ± 2.8 days. Histological examination of these small bowel allografts disclosed signs of chronic rejection. In contrast, all animals of the long-term functional model survived long term ( 〉 250 days) without clinical signs of chronic rejection. The latter model, furthermore, produced evidence of donor-specific tolerance. Whereas heterotopic Dark Agouti (DA) hearts were rejected regularly within 7 days, BN hearts survived indefinitely ( 〉 70 days). In vitro, mixed leukocyte reactivity of CD4 + T cells was similarly strong against donor (BN) antigens as against third-party (DA) antigens. The split tolerance revealed by our in vivo and in vitro results enabled acceptance of both the small bowel allograft without signs of chronic rejection and of donor-specific heart allografts.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001470050396
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  • 45
    Digitale Medien
    Digitale Medien
    Heart valve dysfunction resulting from cellular rejection in a novel heterotopic transplantation rat model (2000)
    Springer
    Transplant international 13 (2000), S. S528 
    Details
    ISSN: 1432-2277
    Schlagwort(e): Key words Implantation model ; Aortic valves ; Valve dysfunction ; Rejection ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Structural failure of heart valve allografts may be related to technical factors or immunological reactions. To circumvent nonimmunological factors a new rat implantation model was developed to study whether alloreactivity results in histopathological changes and valve dysfunction. Syngeneic (WAG-WAG, DA-DA) and allogeneic (WAG-BN, WAG-DA) transplantation was carried out using this new technique, and the function of explanted valves was assessed 21 days later by retrograde comptence testing. Additionally, grafts were examined using standard histological and immunohistochemical techniques. There was no leakage during retrograde injection in nine of tem syngeneic and two of ten allogeneic grafts. Microscopically, syngeneic valves appeared normal without fibrosis or intimal thickening, although CD8+ lymphocytes and macrophages were found in necrotic myocardial rim and adventitia. In contrast, allogeneic valves were deformed and noncellular, with extensive infiltration of CD4+, CD8+ and CD68+ cells in adventitia and media. Absence of fibrosis and intimal thickening in syngeneic transplanted valves indicated circumvention of nonimmunological factors. Allogeneic valve transplantation induces cellular infiltration in the graft with subsequent graft failure.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001470050395
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  • 46
    Digitale Medien
    Digitale Medien
    Hypoxia-reoxygenation differentially stimulates stress-activated protein kinases in primary-cultured rat hepatocytes (2000)
    Springer
    Transplant international 13 (2000), S. S597 
    Details
    ISSN: 1432-2277
    Schlagwort(e): Key words Hypoxia-reoxygenation ; JNK1/SAPK1 ; Rat ; Hepatocytes
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Organ injury after ischemia and reperfusion (I/R) remains one of the most important limiting factors in liver surgery and transplantation. Oxygen-free radical (OFR) generation is considered a major cause of this damage. JNK1/SAPK1, a member of MAPK family, regulates cell adaptation to stressful conditions. The aim of this study was to determine if hypoxia-reoxygenation (H/R) can activate JNK1/SAPK1 and if OFR are involved in this activation. Primary cultured rat hepatocytes isolated from other liver cells and blood flow were submitted to warm and cold H/R phases mimicking surgical and transplant conditions. JNK1/SAPK1 was activated by both warm and cold H/R. Deferoxamine (1 mM), di-phenyleneiodonium (50 μM) and N-acetylcysteine (10 mM) significantly inhibited this kinase activation.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001470050410
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  • 47
    Digitale Medien
    Digitale Medien
    D3 Lymph Node Dissection in Gastric Cancer: Evaluation of Postoperative Mortality and Complications (2000)
    Springer
    Surgery today 30 (2000), S. 700-705 
    Details
    ISSN: 1436-2813
    Schlagwort(e): Key words Gastric cancer ; Lymph node dissection ; Mortality ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Since November 1995 we have been performing a D3 lymph node dissection in patients undergoing an operation for gastric cancer with a curative intent. The aim of the present study was to evaluate whether this procedure results in an increased postoperative mortality or complication rate in a Western population. Between November 1995 and August 1997 the postoperative courses of 76 patients were retrospectively assessed (45.3 lymph nodes per patient, lymph node ratio: 0.16). The patient outcome was compared with data from a historic control group of patients (n = 383) in whom the newly established D2 dissection was studied in our department. Regarding the demographic, clinical, and tumor-pathologic data, and the choice of resection and reconstructive procedures, the two groups differed only slightly. The postoperative mortality of 1% was lower (vs 6.8%) while the overall complication rate of 34% (vs 32.1%) was identical. In particular, no anastomotic leakage (vs 9.4%) and fewer nonsurgical complications (17.1% vs 27.9%) occurred. The reoperation rate was 1% vs 9.7%. However, in 6% of the patients drainage tubes had to be inserted under computed tomographic guidance. The average hospital stay remained unchanged (21.9 vs 20.7 days). A D3 dissection was shown to be feasible while demonstrating no disadvantages in the patients when compared with the D2 procedure.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s005950070080
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  • 48
    Digitale Medien
    Digitale Medien
    Real-time monitoring of nitric oxide in ischemia-reperfusion rat kidney (2000)
    Springer
    Urological research 28 (2000), S. 141-146 
    Details
    ISSN: 1434-0879
    Schlagwort(e): Key words Kidney ; Nitric oxide ; Ischemia-reperfusion injury ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract In this study we attempted to clarify the release of nitric oxide (NO) and its role in the ischemia-reperfusion rat kidney. After right nephrectomy, male Wistar rats were divided into four groups: one sham operated and three groups who underwent ischemia (30 min) and reperfusion of the left renal artery. Thirty minutes prior to ischemia-reperfusion, two groups were injected intraperitoneally with 10 and 30 mg/kg of NG-nitro-l-arginine methylester (L-NAME). Real-time monitoring of blood flow and NO release in the rat kidney was measured with a laser Doppler flowmeter and an NO-selective electrode, respectively. Serum creatinine and blood urea nitrogen (BUN) levels were measured 1 and 7 days after the induction of ischemia-reperfusion. Clamping of the renal artery decreased blood flow to 1–5% of the basal level measured before clamping. After removal of the clip, the blood flow of the 30 mg/kg L-NAME rats was significantly lower than that of the controls. Immediately following the clipping of the renal artery, NO release rapidly increased. After removing the clip, NO release immediately returned to three-quarters of the basal level. Serum creatinine and BUN levels of the ischemia-reperfusion rats were slightly but not significantly higher and those of 30 mg L-NAME rats were significantly higher than those of the control or ischemia-reperfusion rats 1 day and 7 days after ischemia-reperfusion. Our data suggest that NO acts as a cytoprotective agent in ischemia-reperfusion injury of the rat kidney.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002400050153
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  • 49
    Digitale Medien
    Digitale Medien
    Systemic treatment with epidermal growth factor but not insulin-like growth factor I decreases the involution of the prostate in castrated rats (2000)
    Springer
    Urological research 28 (2000), S. 75-81 
    Details
    ISSN: 1434-0879
    Schlagwort(e): Key words Castration ; Epidermal growth factor ; Insulin-like growth factor I ; Prostate ; Testosterone ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Epidermal growth factor (EGF) and insulin-like growth factor I (IGF-I) are strong inducers of proliferation to prostate cells cultured in serum-free medium. Accordingly we wanted to study the growth of the prostate gland in castrated rats after treatment with EGF, IGF-I and testosterone. Castrated Wistar rats were treated with growth factors (EGF 35 μg/rat per day; IGF-I 350 μg/rat per day) or testosterone (2 mg/rat per day) for 3 days either immediately after or 10 days after castration. Prostate tissue was examined by stereological and immunohistochemical techniques and by enzyme-linked immunosorbent assay (ELISA). Treatment with EGF inhibited the involution of the prostate (P 〈 0.05), whereas treatment with IGF-I did not affect the prostate involution as compared to castrated controls. EGF treatment significantly increased the endogenous rat EGF in the ventral prostate, but cellular proliferation was not affected. Testosterone treatment increased the weight of the prostate, by increase of all tissue components of the prostate, and significantly increased cellular proliferation. Systemic administration of EGF but not IGF-I decreased the involution of the rat prostate induced by castration. Compared with testosterone, the effects of EGF treatment on the prostate involution were moderate, and the effects of EGF were not related to cellular proliferation.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002400050141
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  • 50
    Digitale Medien
    Digitale Medien
    Effect of aging on bladder function and the response to outlet obstruction in female rats (2000)
    Springer
    Urological research 28 (2000), S. 33-37 
    Details
    ISSN: 1434-0879
    Schlagwort(e): Key words Bladder ; Rat ; Aging ; Obstruction ; Cystometrics
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Bladder dysfunction in the aging population is a significant problem. However the concomitant presence of other diseases in many patients can make it difficult to distinguish between changes in bladder function and other influences. The present study was designed to study, in aging rats, bladder function and the effect of partial bladder outlet obstruction (BOO) on bladder function. Cystometrics were performed in awake, female Fischer 344 rats of four age groups (6, 12, 18 and 24 months) following subcutaneous implantation of a mediport catheter. Cystometric evaluations were carried out in control rats or those subject to three weeks of BOO. Bladder compliance significantly decreased with aging, which reflected an increase in threshold pressure without changes in bladder capacity. Partial BOO caused development of severe bladder instability. Following BOO, bladder capacity and compliance were significantly increased in all age groups. Threshold pressure was lower in obstructed animals, except for 6-month rats. Younger animals were able to generate a higher contraction pressure to compensate for the BOO, whereas older animals did not. Using an awake model of cystometric measurement, we have demonstrated that aging, by itself can affect bladder function. Furthermore, aged animals respond differently to BOO than younger animals. These results demonstrate that both aging and disease can contribute to bladder dysfunction, and suggest that treatment of bladder dysfunction may require a combination of therapies targeted to multiple etiologies.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002400050007
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  • 51
    Digitale Medien
    Digitale Medien
    Differentialindikation zentraler und peripherer Leitungsanästhesien (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 495-504 
    Details
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter Regionalanästhesie ; Spinalanästhesie ; Epiduralanästhesie ; periphere Nervenblockaden ; Komplikationen ; Keywords Regional anesthesia ; Spinal anesthesia ; Epidural anesthesia ; Nerve blocks ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Serious neurological complications caused by spinal hematoma or abscess following central neuraxial block have been reported more often during the last years. In contrast, severe complications are extremely rare associated with peripheral nerve blocks. Concerned about the safety of spinal and epidural anesthesia, we encourage the use of peripheral regional techniques for procedures on the lower extremity and especially for postoperative regional analgesia. Motor block due to lumbar epidural anesthesia using high concentrations of local anesthetic makes spinal hematoma or abscess difficult to recognize. Therefore, low concentrations of local anesthestic should be used for postoperative epidural analgesia. Any increase in motor block following neuraxial blockade should raise the suspicion of a spinal compression (e.g. hematoma or abscess). Other symptoms are back pain, radicular pain or paresthesia and incontinence. Disastrous neurological injuries can only be prevented by immediate diagnosis (MR, CT or myelography) and therapy (surgical decompression).
    Notizen: Zusammenfassung In den letzten Jahren wird vermehrt über schwerwiegende neurologische Komplikationen durch spinale Hämatome und Abszesse nach rückenmarksnahen Regionalanästhesien berichtet. Vor diesen Hintergrund werden die verschiedenen Regionalanästhesietechniken für die untere Extremität und ihre Komplikationen gegenübergestellt, denn die komplikationsärmeren peripheren Leitungsanästhesien bieten sich im Bereich der unteren Extremität als Alternative zur Spinal- oder Epiduralanästhesie an. Es wird empfohlen, zur postoperativen Schmerztherapie lumbale Epiduralanalgesien soweit möglich durch periphere Leitungsblockaden zu ersetzen. Kontinuierliche Blockaden, z.B. im Bereich des N. femoralis eignen sich auch zur postoperativen Schmerztherapie. Bei der postoperativen lumbalen Katheter-Epiduralanalgesie erschweren hohe Lokalanästhetika-Konzentrationen mit ausgeprägter motorischer Blockade die Diagnose intraspinaler Raumforderungen. Zur postoperativen Epiduralanalgesie sind Lokalanästhetika daher nur in niedriger Konzentration einzusetzen. Bis zum Ausschluss des Gegenteils begründet nach rückenmarksnaher Regionalanästhesie jede Zunahme der motorischen Blockade den Verdacht auf eine spinale Raumforderung (z.B. Hämatom oder Abszess). Weitere Kardinalsymptome sind Rückenschmerzen, Wurzelkompressionsschmerzen und Inkontinenz. Nur die sofortige Diagnose (MR, CT oder Myelographie) und Therapie (ggf. operative Entlastung) kann katastrophale neurologische Schäden verhindern.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001010070089
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  • 52
    Digitale Medien
    Digitale Medien
    Auswirkungen von Luftbläschen in der Infusionsspritze auf die Funktion von Spritzenpumpen (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 1018-1023 
    Details
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter Infusionssysteme ; Spritzenpumpen ; Luft ; Fehlerquellen ; Gefahren ; Keywords Syringe pumps ; Air ; Infusion line occlusion ; Drug delivery ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Application of highly concentrated short-acting vasoactive drugs in the critically ill patient requires precisely working syringe pump systems for continuous intravenous drug delivery. We performed a bench study to investigate the consequences of small amounts of air entrapped within a 50-ml infusion syringe. In particular we studied the effect of entrapped air on drug delivery after moderate vertical displacement of the pump by 50 cm (e. g. in preparation for transport) and the effect on the time required to trigger the pressure alarm after occlusion of the infusion line. At a flow rate of 1 ml/h, lowering the syringe pump prolonged the zero-drug delivery time from (mean±SD) 4.1±0.8 min (without air) to 6.2±0.9 (with 1 ml air) and to 13.1±0.9 min (with 2 ml of air, p〈0.001 for all comparisons). Entrapping of 2 ml of air within the syringe resulted in a 2.6-fold prolongation of the occlusion alarm time after accidental occlusion of the infusion line and a 3-fold increase of the resulting infusion bolus after occlusion. Enclosed air within infusion syringes considerably affects the syringe compliance. It increases the susceptibility of constant drug delivery to vertical displacement of syringe pumps and impairs the occlusion alarm function. Therefore, any air in syringe of infusion pump systems should be carefully removed. To avoid infusion boluses of short-acting vasoactive drugs after accidental occlusions, the occluded infusion line should be released to ambient pressure first.
    Notizen: Zusammenfassung Werden hochdosierte kreislaufwirksame Pharmaka mit kurzer Halbwertszeit bei niedrigen Flussraten appliziert (z. B. bei Neugeborenen oder in der Kinder-Herzchirurgie), so ist eine konstante Zufuhr des Medikaments für die hämodynamische Stabilität eine unabdingbare Voraussetzung. Wir untersuchten in einem experimentellen Modell den Einfluss von geringen Luftmengen in 50-ml-Infusionsspritzen auf die Konstanz der Flussrate und die Alarmfunktion in 2 klinisch relevanten Situationen: relative Niveauänderungen zwischen Spritzenpumpe und Patient (etwa bei Transport oder Umlagern) und akzidentieller Verschluss (etwa Abknicken) einer Infusionsleitung. Nach Absenken der Spritzenpumpe um 50 cm gegenüber dem Ausgangsniveau verlängerte sich die Zeit unterbrochener Medikamentzufuhr (wegen hydrostatischer, retrograder Aspiration) von 4,1 min ohne Lufteinschluss auf 6,2 min bei 1 ml und auf 13,1 min bei 2 ml Lufteinschluss. Bei akzidentiellem Verschluss verlängerte sich die Zeit bis zum Okklusionsalarm bei 2 ml Lufteinschluss um das 2,6fache auf über 1 h, der resultierende Bolus nach Aufheben des Verschlusses verdreifachte sich. Daher sollten bei der Zufuhr hochkonzentrierter Vasoaktiva nicht nur relative Lageveränderungen zwischen System und Patient vermieden, sondern jegliche eingeschlossene Luft konsequent evakuiert werden. Dies gilt gleichermassen für alle über dasselbe Katheterlumen infundierenden Perfusoren. Bei Erkennen eines Verschlusses ist es sinnvoll, das okkludierte Infusionssystem vom Patienten zu trennen und den Druckentlastungsbolus zu verwerfen, bevor der Verschluss aufgehoben wird.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001010070016
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  • 53
    Digitale Medien
    Digitale Medien
    Ciaglia Blue Rhino: Ein weiterentwickeltes Verfahren der perkutanen Dilatationstracheotomie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 202-206 
    Details
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter Perkutane Dilatationstracheotomie ; Ciaglia Blue Rhino ; Komplikationen ; Key words Percutaneous dilatational tracheostomy ; Ciaglia Blue Rhino ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Objective: Elective tracheostomy has become an established treatment modality in modern intensive care medicine, and the number of percutaneously performed tracheostomies is steadily increasing. The Ciaglia Blue Rhino (CBR) represents another percutaneous technique in which the tracheostoma is formed by one-step dilation. Our study presents the technique itself and the early clinical experiences. Methods: In 20 adult patients on long-term ventilation, CBR was done. After puncture of the trachea in typical manner, dilation of the tracheostoma was achieved in one single step by means of a curved dilator with a special hydrophilic coating. Then, the tracheostomy tube was inserted over a curved loading dilator. Practicability and safety were determined as well as gas exchange during the procedure by means of arterial blood gas samples. Results: As a result of the dilator’s hydrophilic coating, dilation of the tracheostoma was rapidly achieved within 152±22 s, virtually free from resistance of the trachea or the cervical tissues. Complications such as bleeding, aspiration or postoperative infection of the stoma were not noted in any of our patients. Fractures of isolated tracheal cartilage rings were seen in 5 patients, however, no therapeutic intervention was necessary. In terms of perioperative gas exchange, pre- and postoperative levels of FiO2, PaO2, PaCO2 and the oxygenation index (PaO2/FiO2) did not change significantly. Conclusions: Based on our early clinical experience, Ciaglia Blue Rhino represents a new method that may combine the typical advantages of each of the other techniques for percutaneous tracheostomy (i.e. Ciaglia, Griggs, Fantoni) in one single technique. This method is distinguished by a high level of safety and practicability. However, further comparative trials need to be done before a definitive judgement can be made.
    Notizen: Zusammenfassung Fragestellung: Die elektive Tracheotomie stellt in der modernen Intensivmedizin einen festen Bestandteil der Beatmungstherapie dar und wird zunehmend perkutan durchgeführt. Mit der Ciaglia Blue Rhino (CBR) steht nunmehr eine weitere perkutane Technik zur Verfügung, bei der zur Anlage des Tracheostomas nur noch ein einziger Dilatationsschritt erforderlich ist. Ziel der vorliegenden Untersuchung war es, die Technik der CBR und erste klinische Ergebnisse vorzustellen. Methodik: Bei 20 langzeitbeatmeten, erwachsenen Intensivpatienten wurde eine CBR durchgeführt. Nach Punktion der Trachea in typischer Weise erfolgt die Dilatation des Tracheostomas in einem Schritt mittels eines gebogenen Dilatators, der über eine spezielle hydrophile Beschichtung verfügt. Anschließend wird die Trachealkanüle über einen Führungsstab eingeführt. Neben Praktikabilität und Komplikationen der Technik wurde deren Einfluß auf den perioperativen Gasaustausch mittels Blutgasanalysen untersucht. Ergebnisse: Aufgrund der hydrophilen Beschichtung des Dilatators und der damit verbundenen nahezu widerstandslosen Bougierung gelang die Anlage des Tracheostomas im Mittel in 152±22 s. Akut interventionsbedürftige Komplikationen wie Blutungen, Aspiration oder eine postoperative Infektion des Tracheostomas wurden nicht beobachtet. Bei 5 Patienten kam es zu einer Fraktur einzelner Trachealspangen, die jedoch keine therapeutische Konsequenz hatte. Hinsichtlich des perioperativen Gasaustauschs ergaben sich keine Signifikanzen hinsichtlich der prä- und postoperativen Höhen von FiO2, paO2, paCO2 und des Oxygenierungsindex (paO2/FiO2). Schlussfolgerung: Die Ciaglia Blue Rhino-Technik könnte aufgrund dieser ersten klinischen Erfahrungen ein Verfahren darstellen, das die jeweiligen Vorteile der anderen perkutanen Tracheotomietechniken nach Ciaglia, Griggs und Fantoni in sich vereint. Diese weiterentwickelte Technik zeichnet sich durch hohe Praktikabilität und eine sehr rasche und sichere Durchführbarkeit aus. Zur endgültigen Bewertung dieses Verfahrens auch im Hinblick auf Spätkomplikationen müssen jedoch detaillierte Vergleichsstudien folgen.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001010050815
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  • 54
    Digitale Medien
    Digitale Medien
    Die Larynxmaske bei Adenotonsillektomie bei Kindern Gefährliche Spielerei oder medizinischer Fortschritt? (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 706-712 
    Details
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter AT ; TE ; Larynxmaske ; Technik ; Komplikationen ; Keywords Adenotomy ; Tonsillectomy ; Laryngeal mask ; Technique ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Anaesthesia both for adenotomy (AT) and for tonsillectomy (TE) frequently presents a challenge. On one hand, children scheduled for adenotomy often have upper airway infections and are thus at risk of laryngo- and bronchospasm; on the other hand the ENT surgeon and the anaesthetist have to share the “workspace” in the patient's mouth. Since the succinyl choline debate in the early 1990s, the question of the best muscle relaxant has gone hand in hand with that of the most appropriate means of securing the airway. The concept of the laryngeal mask as airway was initially greeted with scepticism. Following several years' use of the mask for this purpose in AT and TE in young children, we report our experience and summarise the literature on this topic. The laryngeal mask represents a safe alternative to intubation, provided there is close cooperation with the ENT surgeon.
    Notizen: Zusammenfassung Die Narkosen zur Adenotomie, aber auch zur Tonsillektomie stellen für Anästhesisten immer wieder große Herausforderungen dar. Zum einen haben die Kinder, die zur Adenotomie anstehen, häufig Infekte der oberen Luftwege und sind damit laryngo- und bronchospasmusgefährdet, zum anderen müssen sich HNO-Arzt und Anästhesist den “Arbeitsraum” im Mund teilen. Seit der Succinylcholindebatte der frühen 90er-Jahre stellte sich mit der Frage nach dem geeigneten Muskelrelaxans die Frage nach der geeigneten Atemwegssicherung. Der Anwendung der Larynxmaske als Airway bei AT und TE wurde zunächst mit Skepsis begegnet. Nach langjähriger Anwendung der Larynxmaske zur Atemwegssicherung bei AT und TE im Kleinkindesalter wird hier nicht nur über Ergebnisse und langjährige Erfahrungen berichtet, sondern auch die Literatur zu diesem Thema zusammengefasst. Daraus ergibt sich, dass die Larynxmaske bei AT und TE eine sichere Alternative zur Intubation darstellt. Voraussetzung dazu ist jedoch eine gute Kooperation mit dem HNO-Arzt.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001010070064
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  • 55
    Digitale Medien
    Digitale Medien
    Pneumothorax bei der Vertikalen Infraklavikulären Blockade des Plexus brachialis Fallbericht einer seltenen Komplikation (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 901-904 
    Details
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter Vertikale Infraklavikuläre Blockade ; Pneumothorax ; Komplikation ; Plexus brachialis ; VIP ; Keywords Vertical infraclavicular blockade ; Pneumothorax ; Complications ; Brachial plexus ; VIP
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract A 50 year old female patient received anaesthesia of the arm by the vertical infraclavicular blockade of the plexus brachialis (VIP). Postoperatively an ipsilateral pneumothorax occured complicated by pleural effusion and a contralateral bronchopneumonia, which resolved completely after treatment. The blockade of the plexus was performed correctly, failures in determining the correct point of needle insertion could be excluded. Therefore a pneumothorax has to be regarded as a specific complication of the VIP, which might occur despite correct technique, and requires that the patient be informed of this eventuality. Nevertheless, the VIP is an important method due to its high success rate concerning blockade of the musculocutaneous nerve and tolerance of tourniquet. The risk of a pneumothorax is about 0.2 to 0.7%.
    Notizen: Zusammenfassung Bei einer 50-jährigen Patientin wurde im Rahmen einer elektiven Operation an der Hand die Anästhesie durch die Vertikale Infraklavikuläre Plexus-brachialis Blockade (VIP) nach Kilka durchgeführt. Postoperativ kam es zum Auftreten eines ipsilateralen Pneumothorax, welcher durch einen Pleuraerguss und eine kontralaterale Bronchopneumonie kompliziert wurde. Unter invasiver Behandlung der Patientin kam es bezüglich aller Komplikationen zur restitutio ad integrum. Die Durchführung der Anästhesie war lege artis entsprechend der Erstbeschreibung, Fehler bei der Bestimmung der Punktionsstelle konnten mit größtmöglicher Wahrscheinlichkeit ausgeschlossen werden. Ein Pneumothorax bei der Vertikalen Infraklavikulären Plexus-brachialis Blockade stellt auch bei korrekter Durchführung unter Vermeidung von beschriebenen Kardinalfehlern ein methodenspezifisches und somit aufklärungspflichtiges Risiko dar. Der VIP ist dennoch eine wichtige Ergänzung der herkömmlichen Methoden zur Blockade des Plexus brachialis, da er sich durch eine hohe Erfolgsrate speziell im Bereich des N. musculocutaneus und in der Toleranz eines Tourniquets auszeichnet. Nach den bisherigen Erfahrungen ist von einem Pneumothoraxrisiko von 0,2–0,7% auszugehen.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001010070044
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  • 56
    Digitale Medien
    Digitale Medien
    Kombinierte Anästhesie mit Epiduralkatheter Eine retrospektive Analyse des perioperativen Verlaufs bei Patienten mit radikalen Prostatektomien (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 949-959 
    Details
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter Kombinierte Anästhesie ; Thorakale Epiduralanästhesie ; Lumbale Epiduralanästhesie ; Prostatektomie ; Schmerztherapie ; Komplikationen ; Keywords Combined anaesthesia ; Thoracic epidural anaesthesia ; Lumbar epidural anaesthesia ; Prostatectomy ; Pain management ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. Patients were divided in those who received: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA)+GA or, 3. thoracic epidural anaesthesia (TEA)+GA. General anaesthesia was performed as balanced anaesthesia, and epidural administered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8–12 ml/h. In terms of intra- and postoperative numbers of tachycardic and hypertensive episodes, a reduced stress response was observed under epidural anaesthesia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointestinal motility was found earlier ([h] GA: 50.6±11.1/ LEA: 39.3±13.6/ TEA:33.8±13.0). Furthermore, a trend to rarer phases of postoperative vomiting and a significant decrease of in hospital stay of about one day ([d] GA: 12.4±5.8/ LEA: 11.1±3.1/ TEA: 11.5±3.8) was observed. The duration of personnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9±43.5/ LEA: 238.2±41.8/ TEA: 227.0±46.2), but ICU stay was shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.
    Notizen: Zusamenfassung Patienten, die sich einer radikalen Prostatektomie (rPE) einschließlich retroperitonealer Lymphadenektomie (rLA) unterziehen, haben aufgrund ihres Alters und ihrer Begleiterkrankungen ein erhöhtes perioperativen Risiko. Ziel dieser Untersuchung war es, den intra- und postoperativen Verlauf der standardisierten Operation rPE+rLA unter verschiedenen Anästhesieregimen zu analysieren. Krankenakten von 433 Patienten, die sich zwischen 1994 und 1999 in unserer Einrichtung einer rPE+rLA unterzogen, wurden retrospektiv ausgewertet. Die Patienten wurden nach dem durchgeführten Anästhesieverfahren eingeteilt: 1. Allgemeinanästhesie (AA), 2. Kombination lumbale Epiduralanästhesie (LEA)+AA, 3. thorakale Epiduralanästhesie (TEA)+AA. Für die intra- und postoperative Katheteranalgesie wurden Bupivacain 0,25% oder Ropivacain 0,2%, 8–12 ml/h verwendet. Die Allgemeinanästhesie wurde als balancierte Anästhesie durchgeführt. Diese retrospektive Erhebung zeigt unter epiduraler Analgesie, gemessen an Tachykardien und hypertensiven Episoden, eine reduzierte intra- und postoperative Stressantwort, kürzere Extubationszeiten, früheres Wiedereinsetzen der gastrointestinalen Motilität ([h] AA: 50,6±11,1/ LEA: 39,3±13,6/ TEA:33,8±13,0), tendenziell selteneres Erbrechen und eine um einen Tag verkürzte Krankenhausverweildauer ([d] AA: 12,4±5,8/ LEA: 11,1±3,1/ TEA: 11,5±3,8). Dabei war unter TEA die Dauer der Anästhesiepräsenz im OP-Bereich vergleichbar mit AA ([min] AA: 222,9±43,5/ LEA: 238,2±41,8/ TEA: 227,0±46,2), und der Wachstationsaufenthalt verkürzt. Daneben war unter TEA die Anzahl der auffälligen postoperativen Thoraxröntgenbefunde reduziert. Zum Erreichen einer der TEA vergleichbaren Analgesie mussten unter LEA häufiger sensomotorische Blockaden, saO2-Abfälle und tendenziell eine höhere Anzahl kardialer Komplikationen in Kauf genommen werden. Gemessen an den von uns erhobenen Parametern stellt damit die Kombination einer Allgemeinanästhesie, insbesondere mit thorakaler Epiduralanalgesie ein sicheres und auch betriebswirtschaftlich effizientes anästhesiologisches Vorgehen bei radikalen Prostatektomien dar.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001010070030
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  • 57
    Digitale Medien
    Digitale Medien
    Morphological analysis of peripheral nerve regenerated by means of vein grafts filled with fresh skeletal muscle (2000)
    Springer
    Anatomy and embryology 201 (2000), S. 475-482 
    Details
    ISSN: 1432-0568
    Schlagwort(e): Key words Nerve repair ; Nerve fiber regeneration ; Sciatic nerve ; Muscle-vein-combined graft ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Clinical data have shown that a vein segment filled with fresh skeletal muscle can be considered a good autologous grafting conduit for the repair of peripheral nerve lesions. In this study, the long-term morphological organization of rat sciatic nerve fibers regenerated along a muscle-vein-combined graft conduit is further analysed by light and electron microscopy. Regenerated nerve fibers were organized into fascicles of various sizes that were clearly delimited by perineurial-like shells made by long and thin cytoplasmic processes of perineurial-like bipolar cells and by densely packed collagen fibrils. Grafted skeletal muscle fibers were still detectable among nerve fiber fascicles. However, in spite of the persistence of skeletal muscle along the graft, regenerated nerve fibers showed a good morphological pattern of regeneration, providing further evidence that the muscle-vein-combined grafting technique represents an effective surgical alternative to the classical fresh nerve autograft for the repair of peripheral nerve defects.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004290050334
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  • 58
    Digitale Medien
    Digitale Medien
    Immunocytochemical distribution of the GABAB receptor splice variants GABAB R1a and R1b in the rat CNS and dorsal root ganglia (2000)
    Springer
    Anatomy and embryology 201 (2000), S. 1-13 
    Details
    ISSN: 1432-0568
    Schlagwort(e): Key words GABAB receptor ; CNS ; Dorsal root ganglia ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  The anatomical distribution of the GABAB receptor (GBR) splice variants GBR1a and 1b in the CNS has not previously been studied. In the present study, distribution of the splice variants was mapped using immunohistochemistry. Polyclonal antibodies against splice variant unique epitopes were raised in rabbits. Affinity purified antibodies were used according to routine immunohistochemical procedures in sections from the rat CNS or dorsal root ganglia (DRG). The staining intensity was high in the cerebral cortex but lower in basal ganglia and the hippocampus. In the cerebellum, there was a marked difference in the distribution of GBR1a- and 1b-like immunoreactivity (LI). GBR1a-LI was preferentially localised in the granule cell layer whilst GBR1b-LI was mostly found in Purkinje cells and in the molecular layer. Cell bodies of the deep cerebellar nuclei stained for the GBR1a antibody while terminals surrounding the cell bodies were strongly labelled with the GBR1b antibody. A similar pre- vs postsynaptic pattern was seen in several nuclei ventral or caudal to the cerebellum (e.g. the cochlear nucleus, the facial nucleus, the spinal cord) but not in regions rostral to the cerebellum. In the spinal cord, strong labelling for both antibodies was seen in the dorsal horn. The GBR1b but not the GBR1a antibody stained tanycytes in the epithelium of the 3rd ventricle and in the central canal at the brain stem level. DRG neurons were positive for both the GBR1a and 1b antibody, but the former stained the cells much more intensely. Satellite cells were labelled with the GBR1b antibody. The most important aspect of these findings is that in some nuclei, GBR1b may mediate inhibition of transmitter release while in the same regions, GBR1a may mediate postsynaptic inhibition. Further, the observations support previous findings that GBR1b is the predominant splice variant in Purkinje cells.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00008224
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  • 59
    Digitale Medien
    Digitale Medien
    NK1, NK2 and NK3 tachykinin receptor localization and tachykinin distribution in the ileum of the mouse (2000)
    Springer
    Anatomy and embryology 202 (2000), S. 247-255 
    Details
    ISSN: 1432-0568
    Schlagwort(e): Key words Enteric neurons ; Interstitial cells of Cajal ; Smooth muscle cells ; Guinea-pig ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Tachykinin receptors NK1r, NK2r and NK3r bind tachykinins with different affinities and share pharmacological and molecular differences among animal species. NK1r, NK2r, NK3r and tachykinin (SP/NKA) distribution was studied by immunohistochemistry in the ileum of mouse since no data are available for this species. The results were then compared to those obtained in the rat and guinea pig either by us or by others to ascertain interspecies similarities and/or differences. NK1r- and NK3r-immunoreactivity (IR) were detected in neurons and NK1r-IR in the interstitial cells of Cajal at the deep muscular plexus. At variance with rat and guinea pig, NK1r-IR was also found in the myoid cells of the villi, while NK2r-IR was never detected in nerve varicosities. This latter datum suggests that the NK2r does not play a presynaptic role in the mouse. Unexpectedly, a high NK2r-IR and the presence of NK3r-IR were observed at the inner portion of the circular muscle layer in the mouse as well as in the rat and guinea pig, demonstrating a subregional distribution of these receptors. Tachykinin distribution did not show noticeable species-related differences. The present findings show species-related differences in the tachykinin receptor distribution that might be related to a different tachykinin controlof intestinal motility.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004290000106
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  • 60
    Digitale Medien
    Digitale Medien
    Systemic hypothermia following spinal cord compression injury in the rat: an immunohistochemical study on MAP 2 with special reference to dendrite changes (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 546-552 
    Details
    ISSN: 1432-0533
    Schlagwort(e): Key words Hypothermia ; Immunohistochemistry ; Microtubule-associated protein 2 (MAP2) ; Rat ; Spinal cord injury
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Systemic hypothermia has been shown to exert neuroprotective effects in experimental ischemic CNS models caused by vascular occlusions. The present study addresses the question as to whether systemic hypothermia has similar neuroprotective qualities following severe spinal cord compression trauma using microtubule-associated protein 2 (MAP2) immunohistochemistry combined with the avidin-biotin-peroxidase complex method as marker to identify neuronal and dendritic lesions. Fifteen rats were randomized into three equally sized groups. One group sustained thoracic laminectomy, the others severe spinal cord compression trauma of the T8-9 segment. The control group contained laminectomized animals submitted to a hypothermic procedure in which the esophageal temperature was reduced from 38 °C to 30 °C. The two trauma groups were either submitted to the same hypothermic procedure or kept normothermic during the corresponding time. All animals were sacrificed 24 h following the surgical procedure. The MAP2 immunostaining in the normothermic trauma group indicated marked reductions in MAP2 antigen in the cranial and caudal peri-injury zones (T7 and T10, respectively). This reduction was much less pronounced in the hypothermic trauma group. In fact, the MAP2 antigen was present in almost equally sized areas in both the hypothermic groups independent of previous laminectomy alone or the addition of trauma. Our study thus indicates that hypothermia has a neuroprotective effect on dendrites of rat spinal cords subjected to compression trauma.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004010000206
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  • 61
    Digitale Medien
    Digitale Medien
    Changes of Fas and Fas ligand immunoreactivity after compression trauma to rat spinal cord (2000)
    Springer
    Acta neuropathologica 100 (2000), S. 75-81 
    Details
    ISSN: 1432-0533
    Schlagwort(e): Key words Fas ; Fas ligand ; Rat ; Spinal cord ; Trauma
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract This immunohistochemical study evaluated Fas and Fas ligand (FasL) in the rat nervous system and their changes in the spinal cord subjected to compression. Normal spinal cord showed a low level of Fas and FasL immunoreactivity in the white matter except in the corticospinal tracts. Fas and FasL immunoreactivity seemed to be located in axons and their myelin sheaths. Other regions of the nervous system did not show immunoreactivity to Fas and FasL. Moderate and severe compression injury of the spinal cord resulted in a reduction of Fas and FasL immunoreactivity in the white matter of injured T8–9 segments at 4 h and a complete loss at 1 day after trauma. This was seen even in the remaining white matter. In contrast, increased immunoreactivity to Fas and FasL was present in the cranial T7, caudal T10 (moderate injury) and T12 (severe injury) segments at day 4 with most intense staining were seen at day 9 after trauma. Increased Fas and FasL immunoreactivity may have pathophysiological implications for the development of secondary injuries after trauma to the spinal cord. Fas-FasL interactions may for instance be involved in apoptosis of oligodendrocytes which occurs as a delayed phenomenon after trauma to the spinal cord. The integrity of myelin sheaths may in this way be jeopardized by apoptosis of oligodendrocytes.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004010051195
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  • 62
    Digitale Medien
    Digitale Medien
    Maximum tolerated doses of methotrexate and 7-hydroxy-methotrexate in a model of acute toxicity in rats (2000)
    Springer
    Cancer chemotherapy and pharmacology 46 (2000), S. 69-73 
    Details
    ISSN: 1432-0843
    Schlagwort(e): Key words 7-Hydroxymethotrexate ; Methotrexate ; Maximum tolerated dose ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Purpose: After more than 50 years of methotrexate (MTX) treatment of acute lymphoblastic leukaemia (ALL), it is currently believed that as long as dose escalations are followed by adequate leucovorin rescue guided by monitoring MTX serum concentrations, hydration and urinary alkalinization, high-dose MTX (HD-MTX) can be tolerated without life-threatening toxicity. However, our recent experimental animal studies of the major metabolite of MTX, 7-OH-MTX, indicate that this concept may have some limitations. Animals with levels of 7-OH-MTX of 1 mM, which is below the levels routinely found in patients on HD-MTX, demonstrate intolerable toxicity and some animals die within 8 h. Electron microscopy indicates that endothelial cell and platelet functions are perturbed. Since animal data are lacking, and interspecies differences not known, we wanted to investigate the maximum tolerated doses of MTX and 7-OH-MTX in a rat model of short-term effects. The maximum tolerated dose was chosen instead of LD50 for reasons of animal welfare. Methods: We infused MTX and 7-OH-MTX into anaesthetized male Wistar rats and monitored the animals for 8 h. The drugs were given as a bolus plus continuous infusion. The dose-finding ranges were 1.8–11.3 g/kg MTX and 0.1–1.2 g/kg 7-OH-MTX. Results: The maximum tolerated dose was between 3 and 5 g/kg for MTX and lower than 0.1 g/kg for 7-OH-MTX. The mean serum concentrations of MTX and 7-OH-MTX in animals that did not survive the 8-h period were 21.9 and 1.6 mM, respectively. The animals that received the highest MTX or 7-OH-MTX doses and concentrations died after sudden reductions in heart rate and blood pressure. Conclusions: We demonstrated a lower maximum tolerated dose of 7-OH-MTX than of MTX in rats after 8 h. The 7-OH-MTX concentrations were in the therapeutic range after HD-MTX. If the rat/human interspecies differences are not large, our data may indicate that HD-MTX regimens should not be further dose intensified, due not so much to the effects of MTX as to those of 7-OH-MTX.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002800000111
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  • 63
    Digitale Medien
    Digitale Medien
    A polymorphism of the rat T-cell receptor β-chain variable gene 13 (BV13S1) correlates with the frequency of BV13S1-positive CD4 cells (2000)
    Springer
    Immunogenetics 51 (2000), S. 296-305 
    Details
    ISSN: 1432-1211
    Schlagwort(e): Key words Vβ13 ; CD4/CD8 ratio ; Rat ; Tcrb ; Polymorphism
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Biologie , Medizin
    Notizen: Abstract. Three rat BV13S1 alleles (T-cell receptor β-chain variable gene 13) were characterized by new BV13S1-allele specific monoclonal antibodies (18B1 and 17D5) and sequence analysis of expressed and genomic BV13S1. Two alleles were functional and designated BV13S1A1 present in strains LEW, BUF, PVG, and BV13S1A2 present in BN and WF. Their products differed by six amino acids, two of them in complementarity-determing region (CDR)1 and one in CDR2. A third nonfunctional allele, BV13S1A3P, was found in strains F344 and DA. Apart from a single nucleotide insertion, it was identical to BV13S1A2. All 12 rat strains tested showed association of TCRBC1 with BV8S2/4 alleles but not with the BV13S1 alleles, which may reflect a different gene order of the rat BV compared to mouse. BV13S1A1-encoded T-cell receptors (TCRs) which bind both monoclonal antibody (mAb) 18B1 and mAb 17D5 are over-represented in the CD4 lymphocyte subset. BV13S1A2-encoded TCRs which are stained by mAb 18B1 but not by mAb 17D5 show a slight CD8-biased expression. Preferential usage of BV13S1A1-positive TCRs by CD4 but not by CD8 cells in (LEW×WF)F1 hybrids and cosegregation of BV13SA1 and increased frequency of BV13S1 TCR-positive CD4 cells in a (LEW×BN)×BN backcross suggest structural differences of the two allelic products as the reason for their contrasting CD4/CD8 subset bias.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002510050623
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  • 64
    Digitale Medien
    Digitale Medien
    Lasertherapie in der Dermatologie und Ästhetischen Medizin Nebenwirkungen, Komplikationen und Behandlungsfehler (2000)
    Springer
    Der Hautarzt 51 (2000), S. 463-473 
    Details
    ISSN: 1432-1173
    Schlagwort(e): Schlüsselwörter Laser ; Nebenwirkungen ; Komplikationen ; Behandlungsfehler ; Keywords Laser ; Side effects ; Complications ; Treatment faults
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Many different laser systems are used in dermatology. To wisely choose the correct laser for a given problem, one must be aware of both the spectrum of disorders for which each laser is suited and the potential side effects. We compare the side effect and complication profiles of the common laser systems pointing out their possibilities and limitations. Typical treatment errors will be pointed out. Dermatological training, extensive experience in laser therapy and compliance with quality guidelines are prerequisites for safe and successful treatment.
    Notizen: Zusammenfassung In der Dermatologie werden unterschiedliche Lasersysteme eingesetzt. Für die Anwender ist nicht nur das jeweilige Behandlungsspektrum von Bedeutung, sondern auch welche unerwünschten Reaktionen im Rahmen einer Laserbehandlung auftreten können. Das Nebenwirkungs- und Komplikationsprofil der gängigen Geräte wird in der vorliegenden Arbeit vorgestellt und verglichen, und deren Möglichkeiten und Grenzen werden dargestellt. Typische Behandlungsfehler werden aufgezeigt. Eine dermatologische Facharztausbildung, umfangreiche lasertherapeutische Erfahrungen sowie die Einhaltung und Erfüllung von definierten Qualitätsrichtlinien sind Voraussetzungen für ein sicheres Behandlungsergebnis.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001050051155
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  • 65
    Digitale Medien
    Digitale Medien
    Osteochondroma: MR imaging of tumor-related complications (2000)
    Springer
    European radiology 10 (2000), S. 832-840 
    Details
    ISSN: 1432-1084
    Schlagwort(e): Key words: Osteochondroma ; Complications ; Chondrosarcoma ; Bone tumors ; MRI
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Osteochondromas can be complicated by mechanical irritation, compression or injury of adjacent structures, fracture, malignant transformation, and postoperative recurrence. Magnetic resonance imaging represents the most valuable imaging modality in symptomatic cases, because it can demonstrate typical features of associated soft tissue pathology, which can be differentiated from malignant transformation. Reactive bursae formation presents as an overlying fluid collection with peripheral contrast enhancement. Dislocation, deformation, and signal alterations of adjacent soft tissue structures can be observed in different impingement syndromes caused by osteochondromas. Magnetic resonance imaging provides excellent demonstration of arterial and venous compromise and represents the method of choice in cases with compression of spinal cord, nerve roots, or peripheral nerves, depicting changes in size, position, and signal intensity of the affected neural structures. Malignant transformation as the most worrisome complication occurs in approximately 1 % of solitary and 5–25 % of multiple osteochondromas. Magnetic resonance imaging is the most accurate method in measuring cartilage cap thickness, which represents an important criterion for differentiation of osteochondromas and exostotic (low-grade) chondrosarcomas. Cartilage cap thickness exceeding 2 cm in adults and 3 cm in children should raise the suspicion for malignant transformation. Finally, MR imaging can detect postoperative recurrence by depiction of a recurrent mass presenting typical morphological features of a cartilage-forming lesion.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003300051014
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  • 66
    Digitale Medien
    Digitale Medien
    Constitutive NF-κB activity is modulated via neuron-astroglia interaction (2000)
    Springer
    Experimental brain research 130 (2000), S. 100-104 
    Details
    ISSN: 1432-1106
    Schlagwort(e): Key words NF-κB ; p65 ; Hippocampal neurons ; Glia ; Astrocytes ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  NF-κB is found in many neuronal cell types in different states of activity. This study aimed to define which conditions induce constitutive NF-κB activity in cultured hippocampal neurons using activity-specific antibody staining. In co-culture with astroglia, hippocampal neurons were devoid of activated NF-κB. In these co-cultures, NF-κB could not be activated via kainate or glutamate. In contrast, separating neurons from the glial compartment resulted in a time-dependent increase of activated neuronal NF-κB. In this line, activation of NF-κB by kainate or glutamate is very effective in freshly separated cultures, but inhibited when the cultures are reassembled after stimulation. These findings suggests that a neuronal-glial interaction may regulate gene expression via NF-κB.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002210050011
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  • 67
    Digitale Medien
    Digitale Medien
    Localization of endothelin receptors in bleomycin-induced pulmonary fibrosis in the rat (2000)
    Springer
    Histochemistry and cell biology 122 (2000), S. 507-517 
    Details
    ISSN: 1432-119X
    Schlagwort(e): Endothelin-A receptor ; Endothelin-B receptor ; Rat ; Pulmonary fibrosis ; Immunohistochemistry ; Quantitative PCR
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Biologie , Medizin
    Notizen: AbstractPulmonary fibrosis is characterized by excessive extracellular matrix deposition with concomitant loss of gas exchange units, and endothelin-1 (ET-1) has been implicated in its pathogenesis. Increased levels of ET-1 from tissues and bronchoalveolar lavage have been reported in patients with pulmonary fibrosis and in animal models after intratracheal bleomycin. We characterized the cellular distribution of alveolar ET receptors by immunohistochemistry in bleomycin-induced pulmonary fibrosis in the rat and determined the regulation by bleomycin of ET receptor mRNA expression in isolated alveolar macrophages and rat lung fibroblasts. We found significant increases in the numbers of fibroblasts and macrophages at day 7 compared to day 28 and control animals. ETB receptor immunoreactivity was observed on fibroblasts and invading monocytes. Isolated fibroblasts expressed both ETA and ETB receptor mRNA, and ETA receptor mRNA was upregulated by bleomycin. Isolated resident alveolar macrophages expressed neither ETA nor ETB receptor mRNA which were also not induced by bleomycin. We conclude that, while ETB receptor stimulation of fibroblasts and monocytes recruited during bleomycin-induced lung injury exerts antagonistic effects on fibroblast collagen synthesis, the observed increase in the number of fibroblasts in vivo and upregulation of fibroblast ETA receptor mRNA by bleomycin in vitro point to a predominance of the profibrotic effects of ET receptor engagement.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s00418-004-0708-7
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  • 68
    Digitale Medien
    Digitale Medien
    Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip (2000)
    Springer
    European radiology 10 (2000), S. 1329-1331 
    Details
    ISSN: 1432-1084
    Schlagwort(e): Key words: Central venous catheters ; Venous obstruction ; Vena cava ; Interventional procedure ; Catheters and catheterization ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003300000361
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  • 69
    Digitale Medien
    Digitale Medien
    Risikofaktoren für das Auftreten von lokalen Komplikationen beim Erysipel (2000)
    Springer
    Der Hautarzt 51 (2000), S. 14-18 
    Details
    ISSN: 1432-1173
    Schlagwort(e): Schlüsselwörter ; Erysipel ; Komplikationen ; Diabetes mellitus ; Hepatopathien ; Nephropathien ; Key words ; Erysipelas ; Complications ; Diabetes mellitus ; Hepatopathy ; Nephropathy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Background and objective: A complicated course of erysipelas is not uncommon. Bullous, haemorrhagic, necrotic and purulent lesions may be encountered. Today no reliable data exist as to which constitutional factors renders a patient at risk for developing complicated erysipelas though several risk factors, particularly diabetes mellitus, are often suggested. Based on the analysis of patients with erysipelas at the Department of Dermatology in Graz, factors determining the risk for complicated erysipelas should be identified. Patients/Methods: In a retrospective case-control study clinical data sheets of 766 in- patients treated at the department were evaluated with respect to the course of the erysipelas and with respect to potential risk factors. Results: General risk factors for local complications were location at the lower extremities, pre-existing hepatic or renal disease, hyperuricaemia, and diabetes mellitus. Hepatic and renal disease and – to a lesser extent – diabetes particularly predisposed for bullous and haemorrhagic lesions, while vascular occlusive disease enhanced the risk for ne- crotic lesions. Conclusions: Location and hepatic and renal disease are the most important risk factors, while diabetes is probably of less significance than previously suggested.
    Notizen: Zusammenfassung Hintergrund und Fragestellung: Im Zuge eines Erysipels treten immer wieder Lokalkomplikationen (Blasen, Hämorrhagien, Nekrosen, Abszesse) auf. Derzeit gibt es keine verlässlichen Daten darüber, aufgrund welcher Merkmale ein Patient als komplikationsgefährdet einzustufen ist, wobei aber verschiedene Risikofaktoren, insbesondere Diabetes mellitus, vermutet werden. Anhand des Patientenguts der Grazer Hautklinik sollten klinische Risikofaktoren für einen komplizierten Erysipelverlauf erhoben werden. Patienten/Methodik: In einer retrospektiven Fall-Kontroll-Studie wurden von 766 Patienten, die in den Jahren 1986–1995 wegen eines Erysipels stationär behandelt worden waren, klinische Daten hinsichtlich Erysipelverlauf und möglicher Risikofaktoren erhoben und statistisch ausgewertet. Ergebnisse: Das Risiko eines komplizierten Erysipelverlaufs wird allgemein durch Lokalisation am Bein, durch Leber- und Nierenerkrankungen, Hyperurikämie und durch einen Diabetes mellitus erhöht. Lebererkrankungen und – in geringerem Maße Diabetes – disponieren speziell zu bullösen und hämorrhagischen Verläufen, eine periphere arterielle Verschlusskrankheit zu nekrotischen Läsionen. Schlussfolgerungen: Betroffene Körperregion sowie Leber- und Nierenerkrankungen scheinen die wichtigsten Risikofaktoren zu sein, während der Diabetes mellitus möglicherweise eine geringere Rolle spielt, als bisher angenommen.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001050050004
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  • 70
    Digitale Medien
    Digitale Medien
    Sleep-related breathing disorders following discharge from intensive care (2000)
    Springer
    Intensive care medicine 26 (2000), S. 426-433 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Outcomes ; Hypoxaemia ; Sleep-related breathing disorders ; Obstructive sleep apnoea ; Central sleep apnoea ; Mechanical ventilation ; Complications ; Intensive care
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objectives: To determine the incidence of sleep-related breathing disorders and nocturnal hypoxaemia in patients discharged from ICU following prolonged mechanical ventilation.¶Design: Prospective, consecutive patient observational study.¶Setting: The medical and surgical wards of a University Hospital.¶Patients and participants: Fifteen consecutive, adult patients discharged from the ICU who had received more than 48 h of mechanical ventilation were studied. Ten healthy volunteers acted as controls.¶Measurements and results: Overnight, multi-channel pneumographic studies were performed on all patients and controls. Chest and abdominal wall movement, air flow, oxygen saturation and snoring were continuously recorded. Data was analysed by both visual inspection of the traces and by computer-based algorithms. An apnoea/hypopnoea index was calculated for each patient and volunteer. Volunteers had an apnoea/hypopnoea index of less than 5 and had no episodes of nocturnal oxygen desaturation (SaO2 〈 90 %). Despite oxygen therapy 13/15 patients had episodes of desaturation and 9/15 spent more than 2 h with an SaO2 〈 90 %. Eleven patients had an abnormal apnoea/hypopnoea index (range 5–34 events/h). Four patients had predominantly obstructive events while 7 primarily had hypopnoeas.¶Conclusions: Significant overnight oxygen desaturation is common in patients discharged from ICU who have received prolonged mechanical ventilation. This group also has a significant incidence of sleep-related breathing disorders and this mechanism is likely to be important in the pathogenesis of the hypoxaemia.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340051177
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  • 71
    Digitale Medien
    Digitale Medien
    Translaryngeal tracheostomy: two modified techniques versus the basic technique – early experience in 75 critically ill adults (2000)
    Springer
    Intensive care medicine 26 (2000), S. 457-461 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Tracheostomy: percutaneous, translaryngeal ; Complications ; Oxygenation ; Intensive care medicine
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objectives: Elective tracheostomy is an established procedure in the management of ICU patients on long-term ventilation. In addition, percutaneous tracheostomy techniques are increasingly being used. In 1997, Fantoni's translaryngeal technique (TLT), another minimally invasive procedure, was introduced. While clinical studies of TLT showed that the technique is safe and can be performed rapidly, technical difficulties which sometimes led to prolonged operating times were also noted. Our study compared the basic TLT technique to a modified TLT approach and to TLT performed with the manufacturer's new, improved “Straight Cannula” set. Twenty-five patients were enrolled in each group, and the advantages and disadvantages of the respective techniques were evaluated.¶Setting: Surgical ICU of a university hospital.¶Patients: Seventy-five adult, surgical intensive care patients.¶Measurements and results: Average operating times with the modified TLT techniques were significantly shorter, 4 and 5 min respectively, as compared to 11 min for the basic TLT technique. Initially, use of the new, improved TLT set resulted in a complete passage of the tracheal cannula in two patients; uneventful Griggs's tracheostomy was performed instead. Regardless of the technique used, no other perioperative complications were noted and the perioperative gas exchange remained unaffected by the tracheostomy procedure.¶Conclusions: The modified TLT procedures are safer and more readily performed than the basic technique. Difficulty in the retrograde passage of the guide wire was seen only occasionally with the modified techniques. Based on our data we conclude that the modified techniques are superior to the basic technique and represent significant progress in TLT.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340051181
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  • 72
    Digitale Medien
    Digitale Medien
    Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia (2000)
    Springer
    Intensive care medicine 26 (2000), S. 942-949 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Ventilator-associated pneumonia ; Cardiac surgery ; Children ; Pediatric intensive care ; Complications ; Extubation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective: This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children.¶Methods: Cohort study in a pediatric intensive care unit of a tertiary referral center. All patients who had cardiac operations during a 22-month period and who survived surgery were eligible (n = 272, median age 1.3 years). Primary outcome was time to successful extubation. Primary variable of interest was VAP. Surgical procedures were classified according to complexity. Cox proportional hazards models were calculated to adjust for confounding. Potential confounders comprised other known risk factors for delayed extubation.¶Results: Median time to extubation was 3 days. VAP occurred in 26 patients (9.6 %). The rate of VAP was not associated with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P = 0.23). The adjusted analysis revealed as further factors associated with delayed extubation: other respiratory complications (n = 28, chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic support (n = 48, 17.6 %), and the need for secondary surgery (n = 51, 18.8 %; e. g., re-operation, secondary closure of thorax). Older age promoted early extubation. The median delay of extubation attributable to VAP was 3.7 days (hazards ratio HR = 0.29, 95 % CI 0.18–0.49), exceeding the effect size of secondary surgery (HR = 0.48) and other respiratory complications (HR = 0.50).¶Conclusion: VAP accounts for a major delay of extubation in pediatric cardiac surgery.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340051285
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  • 73
    Digitale Medien
    Digitale Medien
    Operative or endovascular treatment of ruptured intracranial vertebral artery aneurysms? (2000)
    Springer
    Neuroradiology 42 (2000), S. 685-691 
    Details
    ISSN: 1432-1920
    Schlagwort(e): Key words Aneurysm, vertebral artery ; Haemorrhage, subarachnoid ; Surgery ; Embolisation ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Our purpose was to evaluate the surgical and endovascular treatment outcomes of ruptured intracranial vertebral artery aneurysms (RIVAA). The outcomes of 44 patients with RIVAA treated between 1983 and 1998 surgically (26), endovascularly (20) or both (2) were evaluated. The aneurysms were clipped in 24 patients, and clipped and wrapped in two. We treated 20 by the endovascular approach, 12 with Guglielmi detachable coils (GDC), and eight by parent-vessel occlusion using detachable balloons. Three patients had endovascular treatment after a failed or inadequate surgical attempt. Post-treatment follow-up was 17–183 months (mean 101 months) for surgically treated patients. For the GDC-treated group angiographic follow-up was carried at 8–49 months (mean 19 months). The condition of seven (27 %) of the surgically treated patients worsened due to procedure-related complications, compared with 10 % in the endovascular treatment group. Of the patients initially presenting with Hunt and Hess grade IV or V, three of five (60 %) died who were treated surgically and two of eight (25 %) who were treated endovascularly. A good outcome was achieved in 17 surgically treated patients (85 % of the survivors) and in 16 of the endovascular group (89 % of the survivors). This present “same-site” report on treatment of a specific abnormality, RIVAA, treated surgically or by an endovascular approach indicates that especially in poorer Hunt and Hess grade patients, the latter may offer a clinical outcome as good as that of surgery, although long-term efficacy of GDC treatment is still to be determined.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002340000378
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  • 74
    Digitale Medien
    Digitale Medien
    Resistance to growth hormone and insulin-like growth factor-I in acidotic rats (2000)
    Springer
    Pediatric nephrology 14 (2000), S. 720-725 
    Details
    ISSN: 1432-198X
    Schlagwort(e): Key words Metabolic acidosis ; Growth ; Growth hormone ; Insulin-like growth factor-I ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Growth impairment induced by chronic metabolic acidosis is associated with an abnormal growth hormone (GH)/insulin-like growth factor-I (IGF-I) axis. To examine the potentially beneficial effects of IGF-I on acidosis-induced growth impairment and the influence of GH and IGF-I treatment on the GH/IGF-I axis, three groups of acidotic young rats (untreated, AC, n=12; treated with recombinant human GH, GH, n=8; treated with recombinant human IGF-I, IGF-I, n=8) were studied, and compared with nonacidotic rats fed ad libitum (C, n=9)) or pair-fed with the AC group (PF, n=12). After 14 days of acidosis and 7 days of treatment, growth rate, hepatic abundance of 4.7-kilobase (kb) and 1.2-kb GH receptor transcripts and 7.5-kb and 1.8- to 0.8-kb IGF-I transcripts, serum GH-binding protein (GHBP), and IGF-I concentrations (mean±SEM) were analyzed. Significant decreases of 4.7-kb GH receptor [26±2 vs. 49±6 arbitrary densitometry units (ADU)] and 7.5 kb IGF-I (41±3 vs. 104±10 ADU) transcripts and low serum GHBP (25±1 vs. 32±1 ng/ml) and IGF-I (279±50 vs. 366±6 nmol/l) levels were found in the AC compared with the C rats. The majority of these alterations were also observed in PF rats. Compared with acidotic untreated rats, GH and IGF-I therapy produced no improvement in growth rate. GH treatment normalized the levels of IGF-I mRNA, aggravated the acidosis-related inhibition of the GH receptor gene, and did not modify the serum levels of GHBP and IGF-I. In contrast, IGF-I administration depressed the hepatic expression of all GH and IGF-I transcripts and normalized serum IGF-I concentrations. Our results confirm that sustained metabolic acidosis alters the GH/IGF-I axis, in part because of associated malnutrition, and induced growth retardation that is resistant to GH therapy. Our study also shows that administration of IGF-I does not accelerate the growth of acidotic rats, suggesting a peripheral mechanism, at the level of target tissues, is responsible for the resistance to the growth-promoting actions of GH and IGF-I.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00013425
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  • 75
    Digitale Medien
    Digitale Medien
    Apoptosis parallels ceramide content in the developing rat kidney (2000)
    Springer
    Pediatric nephrology 15 (2000), S. 188-191 
    Details
    ISSN: 1432-198X
    Schlagwort(e): Key words Apoptosis ; Ceramide ; Development ; Kidney ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Ceramide is emerging as an important hydrophobic sphingolipid involved in cell differentiation and apoptosis. Since apoptosis plays a significant role in cellular remodeling during renal morphogenesis, we measured ceramide content and apoptosis in the fetal (18 days gestation), neonatal (3, 7, and 14 days postnatal), and adult rat kidney. In addition, to determine whether developmental changes in ceramide content are tissue-specific, we compared renal ceramide content with that in lung and liver. Ceramide was measured by the diacylglycerol kinase assay, and apoptosis was determined by the TUNEL technique. Renal ceramide content fell over 100-fold from the fetus to the 7th postnatal day. Renal apoptosis paralleled ceramide content, with a greater than 300-fold decrease in apoptosis from fetal to adult life. Ceramide content of the lung and liver was significantly less than that of the kidney, and changed less with maturation. We conclude that maturational changes in ceramide content are tissue-specific, and that the high rate of apoptosis in the developing kidney may be related to the elevated ceramide content.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004670000444
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  • 76
    Digitale Medien
    Digitale Medien
    Pediatric biopsy of a single native kidney (2000)
    Springer
    Pediatric nephrology 15 (2000), S. 66-69 
    Details
    ISSN: 1432-198X
    Schlagwort(e): Key words Biopsy ; Kidney ; Complications ; Percutaneous ; Internet ; e-mail
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Technological improvements have reduced the frequency of complications in children receiving a percutaneous renal biopsy. No study has systematically compared the safety of open and percutaneous kidney biopsy. Yet many nephrologists consider a single native kidney an absolute contraindication to percutaneous biopsy. We have established an international registry of single native kidney biopsies in children and we now report our early results. Eight biopsies are included. Seven patients had percutaneous biopsies and one an open biopsy. None of the patients had major complications, and adequate tissue was obtained from all. Our limited experience indicates that the presence of a single native kidney is not an absolute indication for an open approach. We encourage our colleagues to report to the international registry in order to further document the safety of percutaneous biopsy of the single native kidney in children.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004670000417
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  • 77
    Digitale Medien
    Digitale Medien
    Environmental modulation of the response to amphetamine: dissociation between changes in behavior and changes in dopamine and glutamate overflow in the rat striatal complex (2000)
    Springer
    Psychopharmacology 151 (2000), S. 166-174 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Keywords Novelty ; Context ; Environment ; Stress ; 6-OHDA ; Rotational behavior ; Striatum ; Nucleus accumbens shell ; Caudate ; Amphetamine ; Dopamine ; Glutamate ; Aspartate ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Rationale: We have previously shown that environmental novelty enhances the behavioral activating effects of amphetamine and amphetamine-induced expression of the immediate early gene c-fos in the striatal complex, particularly in the most caudal portion of the caudate. In contrast, we found no effect of novelty on the ability of amphetamine to induce dopamine (DA) overflow in the rostral caudate or in the core of the nucleus accumbens. Objectives: The twofold aim of the present study was to determine the effect of environmental novelty on (1) amphetamine-induced DA overflow in the shell of the nucleus accumbens and in the caudal portions of the caudate, and (2) glutamate and aspartate overflow in the caudal portions of the caudate. Methods: Two groups of rats with a unilateral 6-hydroxydopamine lesion of the mesostriatal dopaminergic system received amphetamine (0.5 mg/kg, i.v.) in physically identical cages. For one group, the cages were also the home environment, whereas, for the other group, they were a completely novel environment. In vivo microdialysis was used to estimate DA, glutamate, and aspartate concentrations. Results: Environmental novelty enhanced amphetamine-induced rotational behavior (experiments 1–3) but did not alter amphetamine-induced DA overflow in either the shell of the nucleus accumbens (experiment 1) or the caudate (experiment 2). In addition, the ability of environmental novelty to enhance amphetamine-induced behavioral activation was not associated with changes in glutamate or aspartate efflux in the caudate (experiment 3). Conclusions: The present data indicate that the psychomotor activating effects of amphetamine can be modulated by environmental context independent of its primary neuropharmacological actions in the striatal complex.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002139900359
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  • 78
    Digitale Medien
    Digitale Medien
    Human interferon-α increases immobility in the forced swimming test in rats (2000)
    Springer
    Psychopharmacology 148 (2000), S. 106-110 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Key words Interferon ; Depression ; Forced swimming test ; Locomotor activity ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Objectives: We examined the immobility of the forced swimming test induced in an animal model by human interferon (IFN), which has often been reported to induce depression in clinical use. Methods: In the present study, we examined the effects of human IFNs on results of the forced swimming test in rats. Results: Single intravenous (IV) administration of human IFN-α (6×104 IU/kg), but not of human IFN-β or -γ, significantly increased immobility time in the forced swimming test in rats. Repeated administration of human IFN-α (6×103 IU/kg) also significantly increased the immobility time. On the other hand, none of the rat IFNs (rat IFN-α, -β and -γ, 6×104 IU/kg, IV) changed the immobility time. Neither human IFNs nor rat IFNs changed the locomotor activity of rats. Conclusions: These findings suggest that human IFN-α has a greater potential for inducing increase of the immobility in the rat forced swimming test than human IFN-β and -γ, and that the effect of human IFN-α might not be mediated through IFN-α/β receptors.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002130050031
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  • 79
    Digitale Medien
    Digitale Medien
    Selective mu and delta, but not kappa, opiate receptor antagonists inhibit the habituation of novelty-induced hypoalgesia in the rat (2000)
    Springer
    Psychopharmacology 148 (2000), S. 99-105 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Key words Opiate receptor ; Antinociception ; Habituation ; Novelty ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Rationale: There is now extensive evidence demonstrating that exposure to novel stimuli induces hypoalgesia and that this effect habituates over repeated exposure to the stimuli. Moreover, it has been shown that administration of the nonselective opiate receptor antagonist naloxone can attenuate the rate of habituation of novelty-induced hypoalgesia. Objectives: The present experiments were conducted to determine the relative influence of different opiate receptor subtypes in the attenuation of the habituation of novelty-induced hypoalgesia. Methods: In experiments 1–3, different groups of male, Wistar rats (275–300 g) were administered vehicle, 0.5, 1.0 or 2.0-nmol doses of the µ-selective antagonist Cys2-Tyr3-Orn5-Pen7-amide (CTOP), the δ-receptor selective antagonist naltrindole, or the κ-selective antagonist nor-binaltorphimine (nor-BNI). In experiment 4, animals were administered vehicle, 5, 25 or 75-nmol doses of nor-BNI. All injections were delivered to the right lateral ventricle 30 min prior to exposure to a novel hot-plate apparatus (48.5°C), once a day for eight consecutive days. Results: Paw-lick latencies in vehicle-treated animals were long during the initial exposures and declined over repeated tests, suggesting the habituation of novelty-induced hypoalgesia. The rate of habituation was significantly attenuated by administration of 1.0-nmol and 2.0-nmol doses of CTOP, by a 2.0-nmol dose of naltrindole, but was unaffected by all doses of nor-BNI. Conclusions: These results support the involvement of the µ and δ, but not the κ, opiate receptor subtypes in the habituation of novelty-induced hypoalgesia.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002130050030
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  • 80
    Digitale Medien
    Digitale Medien
    Acute exposure to saccharin reduces morphine analgesia in the rat: evidence for involvement of N-methyl-d-aspartate and peripheral opioid receptors (2000)
    Springer
    Psychopharmacology 149 (2000), S. 56-62 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Key words Morphine ; Opioid receptor ; NMDA ; Tolerance ; Rat ; Tail flick
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Rationale: Pairings of a sweet taste and injection of morphine result in a learned avoidance of that taste and learned analgesic tolerance. This avoidance is mediated by the drug’s peripheral effect, while learned tolerance involves activation of N-methyl-d-aspartate (NMDA) receptors. Exposure to a sweet taste also reduces morphine analgesia. We studied whether this taste-mediated reduction was reversed by an NMDA or peripheral opioid receptor antagonist. Objectives: To determine whether an intraoral infusion of saccharin would modulate morphine analgesia in rats, and to study the contribution of NMDA as well as peripheral opioid receptors to this modulation. Methods: Six experiments used the rat’s tail-flick response to study the effect of an intraoral infusion of a sodium saccharin solution on morphine analgesia, and the effects of the quaternary opioid receptor antagonist methylnaltrexone as well as the non-competitive NMDA receptor antagonist MK-801 on this modulation of analgesia. Results: An intraoral infusion of saccharin reduced the analgesic effects of an intraperitoneal (i.p.) injection of morphine across a range of doses (experiment 1a), which was not attributable to an influence on tail-skin temperature (experiment 1b). This reduction was mediated by opioid receptors in the periphery and activation of NMDA receptors because morphine analgesia was reinstated by an i.p. injection of either methylnaltrexone (experiment 2a) or MK-801 (experiment 3a), which was not due to the effect of methylnaltrexone (experiment 2b) or MK-801 (experiment 3b) on morphine analgesia in the absence of saccharin. Conclusions: These results document evidence for an antagonism of morphine analgesia by actions of the drug at peripheral opioid receptors and excitatory amino-acid activity at NMDA receptors. They are discussed with reference to the aversive motivational effects of peripheral opioid receptors and pain facilitatory circuits.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002139900337
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  • 81
    Digitale Medien
    Digitale Medien
    Opiate withdrawal-induced place aversion lasts for up to 16 weeks (2000)
    Springer
    Psychopharmacology 149 (2000), S. 115-120 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Key words Opiate ; Withdrawal ; Place aversion ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Rationale: Administration of low doses of opiate antagonists to morphine-dependent rats produces an aversive response as measured by a conditioned place aversion, but the time course of such a learned aversion is largely unknown. Objectives: The purpose of this experiment was to examine the time course for the expression of a place aversion to opiate withdrawal. Methods: Morphine-dependent rats were tested in a three-chamber place- aversion apparatus. The conditioning phase consisted of three pairings of either naloxone (15 µg/kg s.c.) or vehicle with two compartments, with the most similar time allotments during the preconditioning test. During the testing phase, rats were again allowed to explore the entire apparatus. Different groups were tested at 24 h, 1 week, 2 weeks, 4 weeks, 8 weeks, and 16 weeks post-conditioning (morphine-free tests). Results: A robust place aversion was recorded at every time point tested, including at 16 weeks. In previously published work, placebo-pelleted rats tested with naloxone at the same dose failed to show a place aversion and nondependent rats showed a stable lack of aversion at tests up to 56 days. Dependent animals without naloxone also failed to show a place aversion at any of those time points. Conclusions: In the absence of any active intervention, the place aversion produced by opiate withdrawal is very long lasting and provides a model for protracted abstinence that may be useful for delineating the neurobiological substrate for vulnerability to relapse.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002139900358
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  • 82
    Digitale Medien
    Digitale Medien
    Role of dopamine in prepulse inhibition of acoustic startle (2000)
    Springer
    Psychopharmacology 149 (2000), S. 181-188 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Key words Acoustic startle response ; Prepulse inhibition ; Sensorimotor gating ; Schizophrenia ; Dopamine ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Rationale: Prepulse inhibition of acoustic startle is the reduction in startle response to an intense auditory stimulus when this stimulus is immediately preceded by a weaker prestimulus. Prepulse inhibition occurs normally in humans and experimental animals, but schizophrenic persons often exhibit a marked impairment in this measure. Previous studies have shown that dopamine (DA)-dependent neuronal mechanisms are involved in the modulation of prepulse inhibition. Objective: Experiments were conducted in rats to elucidate further the involvement of DA-ergic mechanisms in prepulse inhibition. Results: In line with previous studies, the indirect DA agonist, amphetamine, was shown to decrease prepulse inhibition. A close reverse relationship over time between DA overflow in the nucleus accumbens and prepulse inhibition was obtained using a technique allowing concomitant measurement of these parameters in awake, freely moving rats. This effect was more pronounced in amphetamine-treated rats compared to rats treated with equimolar doses of cocaine, which increased DA overflow without affecting prepulse inhibition. In other experiments, the combined treatment with subthreshold doses of the selective DA D1 agonist, SKF 38393, and the selective DA D2 agonist, quinpirole, was also shown to decrease prepulse inhibition. Finally, the selective DA D2 antagonist, raclopride, was shown to enhance prepulse inhibition. Conclusions: In line with previous studies, it is concluded that DA neurotransmission is involved in the modulation of prepulse inhibition and that the ventral part of the mesostriatal DA system may serve an important role in this modulation. Furthermore, the possibility is discussed that the discrepant results on prepulse inhibition obtained with amphetamine and cocaine may disclose functionally relevant differences in their mechanisms of action, and that the enhancement of prepulse inhibition induced by some antipsychotics in rats may reflect their propensity to induce adverse mental effects in humans.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002130000369
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  • 83
    Digitale Medien
    Digitale Medien
    Prefrontal dopamine is directly involved in the anxiogenic interoceptive cue of pentylenetetrazol but not in the interoceptive cue of chlordiazepoxide in the rat (2000)
    Springer
    Psychopharmacology 149 (2000), S. 366-376 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Key words Prefrontal cortex ; Dopamine ; Anxiety ; Drug discrimination ; Pentylenetetrazol ; Chlordiazepoxide ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Rationale: The prefrontal cortical (PFC) dopamine (DA) system has been implicated in anxiety-related behavioral changes, but direct, unequivocal support for this idea is sparse. Objectives: The present aim was to study the functional significance of prefrontal DA using the pentylenetetrazol (PTZ) discrimination model of anxiety. A comparison was made with its role in the cue of the anxiolytic drug chlordiazepoxide (CDP). Methods: Two groups of rats were trained to discriminate either PTZ (20 mg/kg, s.c.) or CDP (10 mg/kg, i.p.) from saline using an operant drug discrimination procedure. After prolonged training, half of each group was used to assess biochemical changes induced by both drugs in different sub areas of the PFC. For the remaining rats, discrimination training continued and generalization tests with PTZ and CDP were performed. Rats were then provided with bilateral guide cannulae aimed at the ventromedial (vm) PFC, and the effects of local infusions of DAergic drugs on discriminative performance were evaluated. Results: CDP did not affect PFC DA activity, but PTZ increased the DOPAC/DA ratio in the vmPFC selectively. Generalization tests showed that the cues of PTZ and CDP were dose dependent. In PTZ-trained rats, infusions of the DA receptor antagonist cis-flupenthixol into the vmPFC blocked the PTZ cue dose dependently, whereas the agonist apomorphine partially generalized to this cue. In CDP-trained rats, neither drug antagonized or generalized to the CDP cue, showing that PFC DA is not critically involved in the CDP cue and that local pharmacological manipulations of PFC DA do not affect discriminative abilities per se. Conclusions: The DAergic innervation of the PFC is directly involved in the behavioral effects of PTZ, suggesting a role for it in anxiety.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002130000390
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  • 84
    Digitale Medien
    Digitale Medien
    In vivo estimates of efficacy at 5-HT1A receptors: effects of EEDQ on the ability of agonists to produce lower-lip retraction in rats (2000)
    Springer
    Psychopharmacology 149 (2000), S. 377-387 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Key words 5-HT1A agonist ; Intrinsic activity ; Efficacy ; Irreversible antagonism ; Lower-lip retraction ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Rationale: Maximal responses are often used as a measure of intrinsic activity or efficacy, but cannot be directly equated to efficacy. Using irreversible antagonists, estimates of efficacy can be obtained that may be less dependent on specific conditions. Objectives: To characterize the intrinsic activity of serotonin (5-HT)1A agonists by examining the effects of an irreversible antagonist on their ability to produce 5-HT1A receptor-mediated responses. Methods: The effects of N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ) on the ability of 5-HT1A agonists to produce lower-lip retraction (LLR) in rats were studied. Results: In the absence of EEDQ, each 5-HT1A agonist produced full effects, the rank order of potency being: S 14506 〉 8-OH-DPAT 〉 buspirone 〉 ipsapirone. EEDQ decreased the number of 5-HT1A binding sites and shifted the dose–response curves (DRCs) of each agonist either to the right or, at higher EEDQ doses, to the right and downward. The manner in which these shifts occurred, however, differed among the compounds. For each agonist, all DRCs obtained after different doses of EEDQ were fitted to models proposed by Furchgott and Black and Leff, and the results indicated the following rank order of efficacy: ipsapirone 〈 buspirone ≈ 8-OH-DPAT 〈 S 14506. 5-HT1A agonist-induced LLR appears to be mediated by 5-HT1A receptors, because the 5-HT1A antagonist, WAY 100635, shifted the agonist DRCs to the right in a parallel and dose-related manner, with pA2 values ranging from 7.8 to 8.1. Moreover, pretreatment with WAY 100635 protected against the antagonist activity of EEDQ. Conclusions: The results suggest that the effects of EEDQ on the ability of 5-HT1A agonists to produce LLR in rats may be useful to obtain estimates of their apparent efficacy at 5-HT1A receptors.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002130000374
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  • 85
    Digitale Medien
    Digitale Medien
    Duodenal duplication cyst identified with MRCP (2000)
    Springer
    European radiology 10 (2000), S. 1277-1279 
    Details
    ISSN: 1432-1084
    Schlagwort(e): Key words: Duodenum ; Congenital anomalies ; Duodenal duplication ; Imaging ; Duodenal duplication ; Complications ; Treatment
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. We report a case of a stalked cystic duodenal duplication. The lesion, hyperintense on T2-weighted GRE images, maintained the signal intensity after oral administration of a negative contrast agent (Lumirem, Guerbet, Aulnay-Sous-Bois, France), confirming its independence from the duodenal lumen. To our knowledge, this is the first demonstration of duodenal duplication by means of MR cholangiopancreatography.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003309900286
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  • 86
    Digitale Medien
    Digitale Medien
    Late complication following percutaneous cholecystostomy: retained abdominal wall gallstone (2000)
    Springer
    European radiology 10 (2000), S. 1284-1286 
    Details
    ISSN: 1432-1084
    Schlagwort(e): Key words: Percutaneous cholecystostomy ; Complications ; Gallstone ; Abdominal wall imaging ; Ultrasonography
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. A case of recurrent abdominal wall abscess following percutaneous cholecystostomy (PC) is presented. Transperitoneal PC was performed in an 82-year-old female with calculous cholecystitis. Symptoms resolved and the catheter was removed 29 days later. The patient came back 5 months later with a superficial abscess that was drained and 8 months post PC with a fistula discharging clear fluid. Ultrasonography revealed the tract adjacent to an area of inflammation containing a calculus, whereas CT failed to depict the stone. Subsequent surgery confirmed US findings. To our knowledge, this is the first report of a dislodged bile stone following percutaneous cholecystostomy.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003309900309
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  • 87
    Digitale Medien
    Digitale Medien
    Complications following anterior approaches to the cervical spine (2000)
    Springer
    European journal of orthopaedic surgery & traumatology 10 (2000), S. 177-181 
    Details
    ISSN: 1432-1068
    Schlagwort(e): Cervical spine ; Anterior approach ; Complications ; Dysphagia ; hoarseness
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The authors present a retrospective study of 535 consecutive anterior approaches to the cervical spine back to 5 years. The data were analyzed for post-operative complications. This surgical procedure has been commonly used for more than 40 years, but the post-operative complications due to the anterior approach itself were presented with few accompanying statistics, with various and contradictory results. Injury to nearly all of the structures has been reported in the literature, the more frequent problems are hoarseness and dysphagia; other complications include perforation of the oesophagus, hematomas, vascular injury⋯ Analysis of this data allows to understand better the specific problems related to this surgical approach, and to suggest precautions at each stage of the course of exposure of cervical vertebrae.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01682311
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  • 88
    Digitale Medien
    Digitale Medien
    Perinatal indomethacin treatment and neonatal complications in preterm infants (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 153-155 
    Details
    ISSN: 1432-1076
    Schlagwort(e): Key words Indomethacin ; Premature infants ; Antenatal ; Postnatal ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract To evaluate the incidence of neonatal complications among infants exposed to indomethacin antenatally, postnatally or both ante-and postnatally (combined), the records of 240 infants of gestational ages between 23 to 32 weeks were analysed retrospectively. Antenatal indomethacin treatment for longer than 2 days with a daily or cumulative dosage ≥150 mg correlated with a significantly higher incidence of grade I-II intraventricular haemorrhage. Combined exposure, cumulative antenatal exposure ≥150 mg and duration of antenatal exposure of more than 2 days was associated with necrotising enterocolitis and a cumulative exposure with sepsis. There was no independent association between indomethacin exposure and pneumothorax, bronchopulmonary dysplasia or respiratory distress syndrome. Conclusion Preterm infants with exposure to antenatal indomethacin might be at increased risk of grade I and II intraventricular haemorrhage and those with both ante- and postnatal exposure at an increased risk of necrotising enterocolitis and sepsis.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004310050040
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  • 89
    Digitale Medien
    Digitale Medien
    The results of anterior fusion and Cotrel-Dubousset-Hopf instrumentation in idiopathic scoliosis (2000)
    Springer
    European spine journal 9 (2000), S. 505-515 
    Details
    ISSN: 1432-0932
    Schlagwort(e): Key words Idiopathic scoliosis ; Anterior instrumentation ; Surgical treatment ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Anterior instrumentation for the correction of scoliotic curves has recently been gaining in popularity. The problems of high mortality and morbidity that were associated with the employment of anterior instrumentation in the first years it was used have now been overcome. Efforts are now being concentrated on increasing the correction rates in the frontal plane and decreasing the kyphotic effect in the sagittal plane. The anterior Cotrel-Dubousset-Hopf (CDH) system is a recently developed instrumentation that has been claimed to decrease the kyphotic effect through the use of double rods. This study aimed to investigate the impact of the anterior CDH system on idiopathic scoliotic curves in frontal and sagittal planes. To this end, 26 idiopathic scoliosis patients treated with the CDH system were followed for a mean period of 32.8 ± 5.3 months. In the frontal plane, Cobb angles of major and secondary curves were measured, and postoperative and final correction rates determined. In the sagittal plane, sagittal contours of both the instrumented region and the thoracic and lumbar regions were measured, and their preoperative, postoperative and final control values were determined. In addition to clinical examination, lateral trunk shift (LT), shift of head (SH) and shift of stable vertebra (SS) were measured in vertebral units (VU), on the preoperative and postoperative radiographs in order to evaluate the effect of the system on trunk balance. It was established that in patients with single flexible thoracolumbar and lumbar curves and those with rigid thoracic curves, the correction rates obtained in the frontal plane were respectively 79.4 ± 14.8%, 68.0 ± 9.4% and 61.5 ± 8.0%, with statistical significance. Their final corrections at the last control were 76.3 ± 17.4%, 56.9 ± 9.1% and 52.3 ± 8.3%, respectively. Although the corrections in the lumbar rigid curves were relatively low, they were still statistically significant. Taking all the patients together, the mean preoperative Cobb angle of the major curves of 67.2°± 20.2° improved to a mean of 28.6°± 21.0°, which was a statistically significant difference (P 〈 0.05), giving a mean correction rate of 61.2 ± 20.3%. The mean correction loss of major curves in the frontal plane in all patients was 6.0°± 3.8° and the mean final correction rate was 52.6 ± 23.2%. In the sagittal plane, there was a favorable kyphotic effect on the thoracic region of patients with hypokyphosis and lordosis pattern, whilst in patients with kyphotic pattern, this effect was minimal. In patients with a single flexible lumbar curve, kyphotic effect was not observed except in two patients. In these two patients, it was thought that excessive compression force may have been used. As to the patients with a rigid lumbar curve, there was a slight decrease in lumbar lordosis. No postoperative complaints were made about imbalance, and the mean overall correction in LT values was 60.1 ± 21.7%. While preoperatively, the SH and SS values of all patients were over 0.5 VU, postoperatively, 12 patients (46.2%) were completely balanced (SH = 0 VU, SS = 0 VU) and 8 patients (30.8%) were balanced (0 VU 〈 SH and SS 〈 0.5 VU). The remaining six patients, whose balance values were corrected with statistical significance but were still over 0.5 VU, were found to be the ones with rigid lumbar curves. Implant failure and systemic complications were not noted in the follow-up period. In view of these findings, it was determined that CDH instrumentation achieves significant correction rates in the frontal and sagittal planes, particularly in single flexible lumbar, thoracolumbar and thoracic rigid curves. It was found that the kyphotic effect was minimized with a double rod system. Significant clinical and radiological corrections were achieved in balance values, without any imbalance and decompensation problems.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s005860000176
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  • 90
    Digitale Medien
    Digitale Medien
    Repeated dose (28 days) oral toxicity study of flutamide in rats, based on the draft protocol for the `Enhanced OECD Test Guideline 407' for screening for endocrine-disrupting chemicals (2000)
    Springer
    Archives of toxicology 74 (2000), S. 127-132 
    Details
    ISSN: 1432-0738
    Schlagwort(e): Key words Flutamide ; Androgen antagonist ; Rat ; Enhanced OECD Test Guideline 407 ; Endocrine disrupters
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract In association with the international validation project to establish a test protocol for the `Enhanced OECD Test Guideline 407', we performed a preliminary 28-day, repeated-dose toxicity study of flutamide, a non-steroidal androgen antagonist, and assessed the sensitivity of a list of parameters for detecting endocrine-related effects of endocrine-disrupting chemicals (EDCs). Seven-week-old CD(SD)IGS rats were divided into four groups, each consisting of 10 males and 10 females, and administered flutamide once daily by oral gavage at doses of 0 (control), 0.25, 1 and 4 mg/kg body weight/day. Male rats were killed 1 day after the 28th administration. Female rats were killed on the day they entered the diestrus stage in the estrous cycle following the last treatment. Male rats receiving flutamide at dose levels of 1 and 4 mg/kg showed lobular atrophy of the mammary gland and a decrease in epididymal weight. In addition, 4 mg/kg flutamide-treated males exhibited raised serum testosterone and estradiol levels and decreased weight of the accessory sex glands. In females, a slight prolongation of the estrous cycle was also observed in the 4 mg/kg flutamide-treated group. No dose-related changes could be detected by haematology, serum biochemistry and sperm analysis. Thus, among the parameters tested in the present experimental system, the weight of endocrine-linked organs and their histopathological assessment, serum hormone levels, and estrous cycle stage allowed the detection of endocrine-related effects of flutamide.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002040050664
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  • 91
    Digitale Medien
    Digitale Medien
    Changes in serum α2u-globulin levels in male rats given diethylstilbestrol and applicability to a screening test for endocrine-disrupting chemicals (2000)
    Springer
    Archives of toxicology 74 (2000), S. 48-53 
    Details
    ISSN: 1432-0738
    Schlagwort(e): Key wordsα2u-Globulin ; Diethylstilbestrol ; Endocrine disrupter ; Rat ; Screening
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract α2u-Globulin (AUG) is a major rat urinary protein, which has a molecular weight of 16 kDa (kidney type) or 19 kDa (native type). The biosynthesis of this protein is under multi-hormonal regulation. In this study, we investigated changes in serum AUG level and their association with changes in the reproductive organs of male rats after the administration of the estrogenic chemical, diethylstilbestrol (DES) at doses ranging from 0.01 mg/kg per day to 100 mg/kg per day by gavage for 14 days. Our aim was to establish basic data for the development of a new screening method for endocrine disrupting chemicals based on serum AUG levels. DES treatment decreased the weight of testes in a dose-dependent manner; and was accompanied by atrophic histopathological changes in testes. Testis weights were significantly decreased by the group given 1 mg/kg per day DES; however, histopathological abnormalities were found in the group given 0.1 mg/kg per day DES. In four of five animals in the group given 1 mg/kg per day there was no significant decrease in testis weight and only a slight or moderate degeneration of the pachytene spermatocytes. Despite these findings, serum AUG levels in this group decreased markedly, while the serum AUG level markedly decreased even in the animals with no histopathological change in the 1 mg/kg per day or 0.1 mg/kg per day groups with no histopathological change also showed decreased serum AUG level. These results suggest that the serum AUG level may be a sensitive parameter for detecting the activity of estrogenic chemicals in intact male rats. Although a uterotropic assay has been proposed for immature female or ovariectomized female rats and is currently undergoing validation studies internationally, there is no screening method for estrogenic chemicals in intact male animals. More data on AUG changes by treatment with other estrogenic chemicals are needed in order to determine the sensitivity and specificity of this response to estrogens. Nonetheless, an AUG-based screening test for estrogenic chemicals may be useful owing to its applicability to conventional toxicity studies and an apparently higher sensitivity of this parameter compared to organ weight change or histology of testis in intact male rats and applicability to conventional toxicity studies.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002040050651
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  • 92
    Digitale Medien
    Digitale Medien
    Increasing chronic subdural hematoma after endoscopic III ventriculostomy (2000)
    Springer
    Child's nervous system 16 (2000), S. 402-405 
    Details
    ISSN: 1433-0350
    Schlagwort(e): Keywords Endoscopic III ventriculostomy ; Overdrainage ; Chronic SDH ; Shunt ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Object: Endoscopic III ventriculostomy (ETV) is an effective and a rather safe treatment for noncommunicating hydrocephalus secondary to aqueductal stenosis and other obstructive pathologies. Though not devoid of risk, ETV is increasingly replacing shunt operations, and it prevents related complications, including overdrainage. Methods: We report a rare case of a large chronic subdural hematoma (ChSDH) after ETV in a patient with aqueductal stenosis. Three weeks after he was shunted elsewhere, he presented to us with clinical symptoms of intracranial hypotension and overdrainage. ETV was performed and the shunt removed uneventfully. On routine postoperative MRI a few weeks later, a large ChSDH was noted, the patient being totally asymptomatic. Since the ChSDH grew significantly, causing a mass effect on the follow-up MRI, it was finally drained. Large and increasing ChSDHs have previously been reported secondary to overdrainage after shunt placement, but not after ETV. Conclusions: We conclude that though rare, a ChSDH may evolve even after ETV, if there is a substantial decrease in previously elevated intracranial pressure.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s003810000298
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  • 93
    Digitale Medien
    Digitale Medien
    Evolution of living donor liver transplantation in adults: a single center experience (2000)
    Springer
    Transplant international 13 (2000), S. S134 
    Details
    ISSN: 1432-2277
    Schlagwort(e): Key words Liver transplantation ; Living donor ; Adult patient ; Right lobe graft ; Small-for-size graft ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001470050300
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  • 94
    Digitale Medien
    Digitale Medien
    Incidence and clinical characteristics of posttransplant lymphoproliferative disorders: report from a single center (2000)
    Springer
    Transplant international 13 (2000), S. S382 
    Details
    ISSN: 1432-2277
    Schlagwort(e): Key words Transplantation ; Complications ; PTLD
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract In the period 1973–1998, among 2 139 allograft recipients treated with standard immunosuppression, posttransplant lymphoproliferative disorders (PTLD) developed in 19 patients (0.9 %): one plasmacytic hyperplasia, two polymorphic PTLD, one myeloma, and 15 lymphomas. PTLD developed 1 year after transplantation (tx) in 14 patients. Five patients were diagnosed at autopsy, 2 were lost to follow up, 3 died before therapy could be instituted, and 1 patient has just started chemotherapy. Of the 8 evaluable patients, 2 received acyclovir and are alive in complete remission (CR) and 6 received chemotherapy ± surgery. Of these 6, 4 died of lymphoma and/or infection, 1 died of unrelated causes in CR, and 1 is alive in CR. PTLD is a severe complication of tx, usually running an aggressive course which may preclude prompt diagnosis and treatment. Nevertheless, therapy is feasible and must be tailored on the histologic subtype. Seventy-four percent of patients were diagnosed with late-onset PTLD stressing the need for long-term follow up.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001470050367
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  • 95
    Digitale Medien
    Digitale Medien
    The T-type calcium channel blocker mibefradil reduced interstitial and perivascular fibrosis and improved hemodynamic parameters in myocardial infarction-induced cardiac failure in rats (2000)
    Springer
    Virchows Archiv 436 (2000), S. 147-157 
    Details
    ISSN: 1432-2307
    Schlagwort(e): Key words T-type calcium channel blockade ; Mibefradil ; Myocardial infarction ; Cardiac remodeling ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Fibrillar collagen accumulates within the interstitium and around coronary arteries following cardiac failure and is responsible for abnormal myocardial stiffness and reduced coronary performance associated with impaired cardiac function. The aim of the study was to determine the effects of long-term treatment with the T-type calcium channel antagonist mibefradil on myocardial remodeling and cardiac function after chronic myocardial infarction (MI). MI was induced by permanent ligation of the left coronary artery in male Wistar rats. Animals were assigned to sham-operated, placebo-treated or mibefradil-treated (10 mg/kg per day p.o.) MI groups. Treatment with mibefradil was started either 7 days before, 24 h after, or 7 days after ligation and continued for 6 weeks after MI. At this time point, mean arterial blood pressure (MAP), heart rate (HR), left ventricular end-diastolic pressure (LVEDP) and cardiac contractility (dP/dtmax) were measured in conscious rats. Morphometric parameters were determined in picrosirius red-stained hearts: total heart weight (THW), interstitial and perivascular collagen volume fraction (ICVF, PCVF), myocardial infarct size (IS), vascular perimeter (VP), inner vascular diameter (IVD) and media thickness (MT). Six weeks after MI, MAP and dP/dtmax were decreased, and LVEDP was increased in placebo-treated animals. In mibefradil-treated animals whose treatment started 7 days before or 24 h after MI, MAP and dP/dtmax were higher, and LVEDP was lower than in placebo-treated controls. THW, ICVF, PCVF and MT were higher in placebo-treated animals. Mibefradil treatment resulted in higher ICVF and IS, higher VP and IVD (when started 7 days before MI) and lower PCVF and MT (when started 7 days before or 24 h after MI) than were observed in placebo-treated controls. Chronic treatment with mibefradil reduced interstitial and perivascular fibrosis and improved cardiac function in MI-induced heart failure in rats. Cardiac remodeling was best prevented when treatment was begun before the ischemic event.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00008215
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  • 96
    Digitale Medien
    Digitale Medien
    Sex differences in the discriminative stimulus effects of m-chlorophenylpiperazine and ethanol withdrawal (2000)
    Springer
    Psychopharmacology 149 (2000), S. 170-175 
    Details
    ISSN: 1432-2072
    Schlagwort(e): Key words  m-Chlorophenylpiperazine ; Drug discrimination ; Ethanol withdrawal ; Anxiety ; 17β-estradiol ; Sex difference ; Rat
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Rationale: The serotonergic system plays a role in regulation of anxiety and ethanol withdrawal (EW). Nevertheless, few studies have assessed sex differences in serotonergic effects on EW. Objectives: This study examined sex differences in the anxiogenic stimu-li induced by a serotonin (5-HT)1b/2 agonist, meta- chlorophenylpiperazine (mCPP), prior to ethanol and during EW. Methods: Gonadectomized or sham-operated adult male and female rats and 17β-estradiol (2.5 mg, 21-day release, s.c.) -replaced ovariectomized (OVX) rats were trained to discriminate mCPP (1.2 mg/kg, i.p.) from saline in a two-lever choice task for food. Latency to the first lever press and mCPP lever selection were measured following mCPP (0–1.2 mg/kg). Rats then received chronic ethanol-containing liquid diet (6.5%) for 10 days and were tested for mCPP lever selection 12 h and 36 h after removal of ethanol. Results: Fewer sham female and β-estradiol-replaced OVX rats selected the mCPP lever than male or OVX rats, and showed an increased initiation latency after mCPP injection. During EW (12 h and 36 h), fewer sham female and β-estradiol-replaced OVX rats responded on the mCPP-lever after saline injection as well as after mCPP challenge than male or OVX rats. Castration did not alter any response of male rats to mCPP. Conclusions: (1) mCPP discrimination is a useful measure of EW in male and female rats; and (2) sham female and β-estradiol-replaced OVX rats are less sensitive to the discriminative stimulus prior to and during EW, but more sensitive to impaired behavioral initiation induced by mCPP than male or OVX rats.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002139900353
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  • 97
    Digitale Medien
    Digitale Medien
    Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees (2000)
    Springer
    Knee surgery, sports traumatology, arthroscopy 8 (2000), S. 196-206 
    Details
    ISSN: 1433-7347
    Schlagwort(e): Keywords Anterior cruciate ; ligament ; Immediate motion ; Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin , Sportwissenschaft
    Notizen: Abstract We prospectively determined the effectiveness of an immediate knee motion and early intervention program to prevent permanent motion limitations in a consecutive series of patients who had anterior cruciate ligament autogenous patellar tendon reconstruction for isolated rupture (219 knees) or combined with other procedures (224 knees). The subjects were placed into either a progressive or delayed rehabilitation program and were followed for at least 12 months postoperatively. At follow-up a normal range of motion (0° to at least 135°) was found in 436 knees (98%), and mild losses of extension (–5°) were found in 7 knees. Twenty-three knees (5%) required interventions; 9 had extension casts, 9 had gentle manipulations under anesthesia, 3 had arthroscopic débridements, and 2 had continuous epidural anesthetic and inpatient therapy. All of these 23 knees regained full motion. The 7 patients with mild losses of extension had refused treatment intervention. The 0% incidence rate of permanent arthrofibrosis, and 0.7% reoperation rate for knee motion limitations, demonstrated the effectiveness of our program.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001670000126
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  • 98
    Digitale Medien
    Digitale Medien
    The dynamic infusion test in rats (2000)
    Springer
    Child's nervous system 16 (2000), S. 451-456 
    Details
    ISSN: 1433-0350
    Schlagwort(e): Keywords Intracranial pressure ; CSF dynamics ; Infusion test ; Rat ; H-Tx rat ; Outflow resistance
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract  Although the hydrocephalic H-Tx rat is a widely used model, data on the cerebrospinal fluid (CSF) dynamics in hydrocephalic rats are rare or – as the pressure volume index (PVI) – not available. We used hydrocephalic and nonhydrocephalic H-Tx rats, a stock with a high percentage of inherited hydrocephalus, for the evaluation of such data. In addition, a new, simple mathematical algorithm (”dynamic infusion test”), which has not formerly been used in animal experiments, was used as a pathophysiological model of CSF dynamics. Compared with classical methods for evaluation of these data, the dynamic infusion test gives a deeper insight into the relation between ICP and CSF dynamics. It was found that the resistance to outflow (ROF) in hydrocephalic rats was at least twice that in nonhydrocephalic rats. The PVI measured was similar in hydrocephalic and nonhydrocephalic animals, but clearly higher than the values reported in the literature. This may be attributable to the fact that the classically used bolus test, in contrast to the ”dynamic infusion test”, is representative only for the CSF compartment which is directly exposed to the bolus application.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00007290
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  • 99
    Digitale Medien
    Digitale Medien
    Two Cases of Fulminant Mycoplasma pneumoniae Pneumonia within 4 Months (2000)
    Springer
    Infection 28 (2000), S. 180-183 
    Details
    ISSN: 1439-0973
    Schlagwort(e): Key WordsMycoplasma pneumoniae ; Pneumonia ; Complications ; Immunoblot
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary We report the clinical course and diagnostic findings in two patients with life-threatening Mycoplasma pneumoniae (MP) pneumonia who were treated in the same hospital in the course of only 4 months. The patients were previously healthy adults, aged 31 and 37 years, respectively. In both of them severe complications occurred which coincided with the acute MP respiratory infection.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s150100050077
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  • 100
    Digitale Medien
    Digitale Medien
    Hospitalization for Primary Varicella-Zoster Virus Infection and Its Complications in Patients from Southern Israel (2000)
    Springer
    Infection 28 (2000), S. 200-204 
    Details
    ISSN: 1439-0973
    Schlagwort(e): Key Words Varicella ; Hospitalization ; Complications ; Bedouins ; Jews
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Background: We conducted this study to determine the impact of chickenpox on two different ethnic populations in southern Israel: Jews and Bedouins. Methods: Hospital records of 113 patients discharged from the Soroka Medical Center with the diagnosis of varicella during a 4.5-year period were reviewed. Results: Mean age was 9.2 years and the average hospital stay was 5.4 days. Bacterial skin or soft tissue infections were the most common complications (30%), followed by pneumonia (17%) and central nervous system complications (11.5%). There were no fatal cases throughout the study period. The calculated hospitalization rate for varicella was one in every 319 cases. Major differences between Jews and Bedouins included an older mean age of Bedouin patients (13.9 years versus 4.5 years); higher hospitalization rate (relative risk [R.R.]: 2.8, 95% confidence interval: 1.9–4.2), and higher risk for complicated varicella (R.R.: 2.1, 95% confidence interval: 1.3–3.4). Conclusion: Hospitalization of patients with varicella in southern Israel is common and varicella infection in Bedouins is associated with greater morbidity compared with that in Jews in southern Israel.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s150100070035
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