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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  50. Kongress der Deutschen Gesellschaft für Handchirurgie; 20091008-20091010; Tübingen; DOC09dgh63 /20091005/
    Publication Date: 2009-10-06
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
    ISSN: 1432-1076
    Keywords: Key words Haemophilus influenzae type b  ;   Combination vaccine  ;  Immunological memory
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The lack of an adequate immune response to the major polysaccharide of the Haemophilus influenzae type b (Hib) capsule (polyribosyl ribitol phosphate) (PRP) in very young infants (〈 18 months) can be overcome by conjugating PRP to a T-cell dependent carrier protein. We studied whether administration of a tetanus-PRP conjugate vaccine reconstituted with a diphtheria-tetanus-acellular pertussis-hepatitis B (DTPa-HBV) vaccine as a three dose primary course at 3, 4 and 5 months of age induced PRP-specific immunological memory, by examining the anti-PRP response to a dose of unconjugated PRP given with the DTPa-HBV booster approximately 1 year later. The unconjugated PRP elicited protective anti-PRP antibody levels (≥ 0.15 μg/ml) in all but 3 of the 369 vaccinees, including 13 infants who failed to demonstrate a measurable immune response after the primary course. In a sub-cohort of 54 subjects all had anti-PRP levels ≥ 0.5 μg/ml within 7–14 days of the booster showing a rapid anamnestic type response. Both primary and booster responses were predominantly IgG1 indicating a T-cell dependent response. The DTPa-HBV components elicited protective anti-diphtheria, anti-tetanus and anti-HBs antibody levels in ≥ 98.5% of vaccinees, and immune responses to each of the acellular pertussis vaccine components in 92.3%–97.3% of subjects. Conclusion The tetanus-PRP conjugate vaccine not only elicited a good primary humoral response, but also induced immunological memory so that the infants were able to mount a large and rapid immune response to subsequent exposure to plain PRP, indicating that protection against circulating wild-type Hib had been generated. Successful induction of immunological memory occurred even when there was no measurable humoral anti-PRP response to the primary course. Tetanus-PRP conjugate vaccine can be used in combination with DTPa-HBV vaccine, when administered separately or as a single injection in the same syringe, in primary immunisation schedules at 3, 4 and 5 months of age.
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  • 3
    ISSN: 1432-1076
    Keywords: Key wordsHaemophilus influenzae type b ; Acellular pertussis ; Vaccination ; PRP-tetanus ; Diphtheria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract With an increasing number of new vaccines available for routine childhood immunization, combination vaccines are needed in order to maintain or achieve a high compliance with recommended immunization programmes. In a prospective, randomized, comparative, multi-centre study, 822 healthy infants were enrolled to receive three doses of either a candidate or a commercially available Haemophilus influenzae type b (Hib) vaccine concomitantly with diphtheria-, tetanus- acellular pertussis (DTaP) vaccine. Study subjects were randomly allocated to one of the following groups: (1) separate, or (2) mixed injection of DTaP and candidate Hib vaccine, or (3) separate injection of DTaP and commercial Hib vaccine. One year later the first 189 study subjects received either separate or mixed injections of the same Hib and DTaP vaccines as booster doses. Evaluation of reactogenicity was based on diary cards completed by parents. Immunogenicity was documented by measuring IgG antibody concentrations in serum samples taken before and 4 weeks after primary and booster vaccination. No serious adverse events occurred and most local and systemic reactions were mild to moderate. Booster doses were more reactogenic than primary doses with all groups. Antibody concentrations against pertussis antigens were similar to those seen with DTaP alone. All but one subject had protective antibody concentrations against diphtheria and tetanus. Primary immune response to the Hib vaccine was significantly lower in the group receiving the mixed Hib-DTaP vaccine, however, ≥95% of vaccinees had anti-Hib antibody concentrations ≥0.15 μg/ml and there was a marked booster response (〉100-fold) in all groups. Conclusions Mixing DTaP and Hib vaccines for primary immunization caused a decrease in anti-Hib antibody response, although after primary immunization as after booster doses, all subjects showed antibody concentrations considered to be protective for invasive Hib disease. Mixing of the vaccines did not result in increased reactogenicity.
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  • 4
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Certaines tumeurs malignes osseuses sélectionnées avec attention relèvent de nos jours d'une résection radicale en bloc complétée par la chimiothérapie. Des autogreffes osseuses bien vascularisées peuvent être employées pour procéder à la reconstruction d'un segment de squelette réséqué. Ces greffes présentent outre les mêmes avantages que les greffes non vascularisées le fait que leur viabilité est conservée. Le péroné constitue le greffon osseux de choix. La technique chirurgicale suivie par les auteurs ainsi que les avantages et la limitation des indications des greffes osseuses vascularisées sont étudiées et discutées dans l'article.
    Abstract: Resumen En pacientes seleccionados de tumores óseos malignos localizados se puede realizar la resección en bloque con quimioterapia adyuvante, y es posible utilizar autoinjertos vascularizados de hueso para la reconstrucción secundaria del defecto óseo. La técnica del autoinjerto óseo vascularizado ha sido desarrollada en un esfuerzo por evitar los problemas de la revascularización de los injertos óseos convencionales. Los injertos óseos vascularizados poseen las ventajas de los no vascularizados, y todas las ventajas de la conservación de su viabilidad. Los injertos vascularizados, siendo independientes de la vecina vascularidad del lecho recipiente, parecen tolerar bien la irradiación y son resistentes a la infección. El peroné es generalmente el hueso más adecuado para servir como donante. Debido al estado vascular de la extremidad, no siempre es posible utilizar un injerto óseo vascularizado para la reconstrucción. El papel primordial del cirujano debe ser el de resecar el tumor maligno con márgenes adecuados de tejido normal, tanto de tejidos blandos como de hueso. Este objetivo no debe verse comprometido por tratar de preservar vasos que puedan permitir la reconstrucción con un injerto óseo vascularizado. En este artículo se discuten los aspectos de nuestra técnica quirúrgica y las ventajas y limitaciones de los injertos óseos vascularizados.
    Notes: Abstract In selected patients with localized malignant bone tumors, radical en bloc resection with adjuvant chemotherapy is now performed. Vascularized bone autografts can be used for secondary reconstruction of the bone defect. These grafts have the advantages of the nonvascularized ones, as well as the advantages of preserved viability. The fibula is usually the most suitable donor bone. Our surgical technique and the advantages and limitations of vascularized bone grafts are discussed.
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  • 5
    ISSN: 1432-5195
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Chez un patient jeune, présentant à la fois une lésion du plexus brachial par étirement, avec avulsion radiculaire, et un traumatisme jambier sévère, avec perte de substance tibiale de 13 cm, osseuse et des parties molles, une reconstruction microchirurgicale de la jambe a été pratiquée par transfert vascularisé de la diaphyse du cubitus, et des tissus mous du bord cubital de l'avant-bras. La consolidation osseuse finale fut obtenue après un an. La récupération fonctionnelle du membre inférieur fut complète.
    Notes: Summary We present the case of a young man with 13 cm of bone and soft-tissue loss in the tibia and a severe traction injury of the brachial plexus. A free vascularised composite transfer of the bone and soft tissues of the ulnar side of the forearm was undertaken to reconstruct the defect. Bony union was achieved after a year and was followed by complete functional recovery of the lower limb.
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  • 6
    ISSN: 1432-1238
    Keywords: Infants ; Continuous SvO2 ; Cardiac surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Continuous mixed venous oxygen saturation SvO2c was measured in 16 infants immediately after cardiac surgery. A polyurethane 4F, dual channel catheter (Opticath, Modell U440, Oximetrix) with fiberoptic filaments was introduced into the pulmonary artery during cardiothoracic surgery. The catheters were left in place for an average of 67.5 h (range 27 h – 125 h) and there were no catheter-related complications. Correlation between continuous in vivo SvO2 values and in vitro values was satisfactory (r=0.85), whereas a correlation between SvO2c and arterial oxygen saturation (SaO2) was not found (r=0.07). The sampled arterial lactate values were inversely correlated to the simultaneously measured SvO2c, but the corelation coefficient was only r=-0.4. There was an inverse correlation between SvO2c and arteriovenous oxygen content difference (Ca−vDO2c) (r=-0.82), and a marked inverse correlation to the calculated oxygen utilization ratio (r=-0.97). Therefore SvO2c continuously reflects the overall balance between oxygen consumption and delivery, but the use of SvO2 as a predictor of blood lactate levels is unreliable. A further purpose of the present study was to demonstrate the clinical applications and to show the usefulness of SvO2c-monitoring; particularly as a surveillance and early warning system, as a guide for assessing therapy and its relevance in interpreting other monitored parameters. In our opinion continuous SvO2 measurement is a reliable and valuable indicator of cardiopulmonary function in the immediate post-operative period, even in infants with complicated repair of cardiac malformations.
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  • 7
    ISSN: 1619-7089
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In rat the uptake of colloids by the femur and tibia is dependent on bone plasma flow even if other factors modulate the relationship. We warn Nuclear Medicine scientists against the use of colloid uptake measurement as a marker of the bone macrophagic population, especially in situations associated with modified bone plasma flow.
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  • 8
    ISSN: 1432-1971
    Keywords: Color Doppler ; Perforated mitral leaflet ; Infant ; Mitral regurgitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Color-coded two-dimensional (2D) echocardiography confirmed the presence of severe congenital mitral regurgitation in an 8-month-old infant. Intraoperative inspection revealed an isolated perforation in the anterior leaflet.
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