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  • 1
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    German Medical Science; Düsseldorf, Köln
    In:  Kooperative Versorgung - Vernetzte Forschung - Ubiquitäre Information; 49. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 19. Jahrestagung der Schweizerischen Gesellschaft für Medizinische Informatik (SGMI) und Jahrestagung 2004 des Arbeitskreises Medizinische Informatik (ÖAKMI) der Österreichischen Computer Gesellschaft (OCG) und der Österreichischen Gesellschaft für Biomedizinische Technik (ÖGBMT); 20040926-20040930; Innsbruck; DOC04gmds140 /20040914/
    Publication Date: 2004-09-14
    Keywords: ddc: 610
    Language: English
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  • 2
    ISSN: 1433-0385
    Keywords: Keywords: Per- and subtrochanteric fracture – Gamma nail – Mobility – Complication. ; Schlüsselwörter: Per- und subtrochantäre Fraktur – Gammanagel – Mobilisation – Komplikation.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Einleitung: Ziel dieser retrospektiven Studie ist es, den Einfluß von Alter, Begleiterkrankungen, Frakturform, Operationszeitpunkt, Wahl des Implantats (kurzer oder langer Gammanagel) und Operationsverfahren auf Mobilisationsgrad, radiologischen Heilungsverlauf und mögliche Komplikationen nach operativer Stabilisierung von per- und subtrochantären Oberschenkelbrüchen mittels Gammanagel zu analysieren. Patienten und Methoden: Von 1992 bis 1997 wurden 96 Patienten mit isolierter per- oder subtrochantärer Oberschenkelfraktur mittels Gammanagel (Howmedica) operiert. Das Durchschnittsalter der Patienten zum Zeitpunkt der Verletzung betrug 72,5 (27–101) Jahre. 27 Patienten waren Männer, und 69 waren Frauen. Die Operation erfolgte durchschnittlich 1,19 (0–10) Tage nach dem Unfall. Die postoperativen Kontrollen erfolgten nach 3, 6 und 12 Monaten. Hierbei wurden jeweils Röntgenaufnahmen des Oberschenkels mit Hüftgelenk in 2 Ebenen durchgeführt und der Mobilisationsgrad der Patienten beurteilt. Ergebnisse: Begleiterkrankungen, Operationszeitpunkt, Frakturtyp, Operationsverfahren und Wahl des Implantats (kurzer oder langer Gammanagel) hatten keinen Einfluß auf den Grad der Mobilisation, auf den radiologischen Heilungsverlauf oder auf aufgetretene Komplikationen. Ältere Patienten ( 〉 70 Jahre) waren schlechter mobilisierbar (p 〈 0,001). Ein Jahr nach dem Unfall waren 97 % der Frakturen radiologisch geheilt. Bei 15 Patienten (18 %) kam es zu technischen Komplikationen bei der Verwendung des Gammanagels. Schlußfolgerungen: Per- und subtrochantäre Oberschenkelfrakturen können mit Hilfe des Gammanagels bei richtiger Handhabung stabil versorgt und die Patienten frühzeitig mobilisiert werden.
    Notes: Abstract. Background: From 1992 through 1997 96 patients with per- or subtrochanteric femur fractures were treated with a Gamma nail. We retrospectively evaluated the influence of patient age, additional diseases, type of fracture, time of operation, type of implant (short/long Gamma nail) and surgical approach (open/closed reduction) on the mobility of the patients, healing of the fractures on radiographs, and possible complications. Patients and methods: The average patient age was 72.5 years (range 27 to 101). There were 27 male and 69 female patients. Surgery was performed 1.19 (0–10) days after injury. At 3, 6, and 12 months after surgery radiographs of the involved hip joint and femur were obtained and the degree of mobility was assessed. Results: Additional diseases, type of fracture, time of operation, type of implant (short/long Gamma nail) and surgical approach (open/closed reduction) did not influence mobility of the patients, healing of the fractures on radiographs or rate of complications. It was more difficult to mobilize older patients (P 〈 0.001). After 1 year 97 % of all fractures had healed on radiographs. In 15 patients (18 %) complications occurred due to technical errors using the Gamma nail. Discussion: With the Gamma nail stable osteosynthesis of per- and subtrochanteric femur fractures is obtained independently of the fracture classification. Patients can be mobilized immediately. Technical errors must be avoided.
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  • 3
    ISSN: 1365-2842
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Investigations concerning normal and pathological anatomy of the temporomandibular joint (TMJ) have shown that pathological reactions such as deviations of the shape of the condyle, disc thinnings, disc perforations and osteoarthrotic changes are fairly common, particularly in the elderly population. Autopsy studies of the TMJ describe pathological findings respective to their location in different age groups, but most authors describe their findings for removed joints of one side only. The specific aim of this study was therefore to investigate the intra-individual relationships between the degenerative changes and deviations concerning the articular surfaces of the TMJs and the topographical distributions of these findings. In this investigation both joints of 22 edentulous individuals between 58 and 95 years of age were studied. Correlations were found between the right and left joints with respect to the anatomical location of the pathological findings.
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  • 4
    ISSN: 1435-1285
    Keywords: Schlüsselwörter Angeborene Herzfehler – Kind – pulmonale Hypertonie – Stickstoffmonoxid ; Key words Congenital heart disease – children – pulmonary hypertension – nitric oxide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary We assessed the effect of oxygen, nitric oxide (NO) and prostanoids (prostacyclin and iloprost) on pulmonary hemodynamics and plasma levels of vasoactive mediators in children with pulmonary hypertension (PH). It is not known whether the hemodynamic response during acute vasodilator testing correlates with changes in plasma levels of endothelin-1 (ET-1), cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP). In this retrospective analysis 14 children at a median age of 4 years and 3 months [1.8 months–13 years] with a median pulmonary resistance to perfusion of 10.1 [2.1–37.7]. Wood-Units×m2 were studied. Diagnoses included PH due to congenital heart disease (AVSD n=5; VSD n=2; PDA n=1) or unknown causes (n=6). The ratios of pulmonary/systemic pressure (Pp/Ps) and of pulmonary/systemic resistance (Rp/Rs) were recorded a) at baseline, b) during oxygen (FiO2=1.0) and c) while on NO (80ppm max., at FiO2 = 0.23). In 13 out of 14 children prostanoids were given additionally: 7 received prostacyclin (i.v.) and 6 were given iloprost which was nebulized. ET-1, cGMP and cAMP were measured in blood samples taken from the pulmonary vein or left ventricle at baseline, during increased FiO2, during NO inhalation and while on prostanoids. Pulmonary vasodilation in response to oxygen was found in 2/14 patients. 4/14 patients responded to NO and 2/7 to prostacyclin i.v. Increased FiO2 was not associated with changes in plasma concentrations of ET-1, cGMP or cAMP. NO inhalation was followed by an increase in cGMP levels from 10.9 [5.5–55.4] nM/L to 21.3 [6.4–76.3] nM/L independent from the individual hemodynamic response. Oxygen and NO identify most children with reactive pulmonary vasculature. cGMP plasma levels do not correlate with individual hemodynamic responses to NO.
    Notes: Zusammenfassung Bei Patienten mit pulmonaler Hypertension im Kindesalter ist die Überprüfung der Reaktionsfähigkeit des pulmonalen Gefäßbettes auf vasodilatierende Substanzen von großer Bedeutung für die therapeutische Strategie. Nicht bekannt ist, ob das Ausmaß der messbaren hämodynamischen Veränderungen während der Applikation vasoaktiver Substanzen mit der Fähigkeit der pulmonalen Zirkulation zur Bildung vasoaktiver Mediatoren korreliert. Ziel der vorliegenden retrospektiven Untersuchung war es daher, die eigenen Erfahrungen mit der Gabe von Sauerstoff, Stickstoffmonoxid (NO) und Prostanoiden (Prostazyklin bzw. Iloprost) zur Überprüfung der pulmonalen Gefäßreagibilität zu analysieren und die Veränderung der Plasmaspiegel von Endothelin-1 (ET-1), zyklischem Guanosin-Monophosphat (cGMP) und zyklischem Adenosin-Monophosphat (cAMP) bei Patienten mit pulmonaler Hypertension zu untersuchen. Die Untersuchung erfolgte an 14 Patienten mit einem mittleren Alter von 4 Jahren und 3 Monaten [1,8 Monate–13 Jahre], die eine pulmonale Hypertension bei kongenitalen Vitien (AVSD n=5; VSD n=2; PDA n=1) oder unklarer Ursache (n=6) aufwiesen. Die diagnostische Herzkatheteruntersuchung wurde in Intubationsnarkose durchgeführt. Der mittlere pulmonale Perfusionswiderstand betrug 10,1 [2,1–37,7] Wood-Einheiten×m2. Das Verhältnis des pulmonalen/systemischen Blutdrucks (Pp/Ps) und des pulmonalen/systemischen Perfusionswiderstands (Rp/Rs) wurden a) unter Normoventilation (FiO2=0,21), b) während Sauerstoffbeatmung (FiO2=1,0) und c) während Gabe von NO (80ppm max., FiO2=0,23) ermittelt. Bei 13 von 14 Patienten wurde zusätzlich Prostanoide verabreicht: 7 Patienten erhielten Prostazyklin (i.v.) und bei 6 Patienten wurde Iloprost als Aerosol appliziert. Die Plasmaspiegel von ET-1, cGMP und cAMP wurden in Blutproben bestimmt, die nach dem jeweiligen Untersuchungsschritt aus der Vena pulmonalis oder dem linken Ventrikel entnommen wurden.    Eine pulmonale Vasodilatation während Sauerstoffgabe wurde bei 2/14 Patienten beobachtet. 4/14 Patienten reagierten unter NO und 2/7 während Prostazyklingabe mit einer selektiven pulmonalen Vasodilatation. Die Gabe von Prostazyklin bzw. von Iloprost führte bei 5/13 Patienten zu einer systemischen Blutdruckerniedrigung, die das Ausmaß der pulmonalen Blutdrucksenkung übertraf. Während Sauerstoffbeatmung kam es nicht zu einer Änderung der Plasmaspiegel für ET-1, cGMP oder cAMP. Unter NO-Inhalation konnte ein Anstieg der cGMP-Plasmaspiegel von 10,9 [5,5–55,4] nM/L auf 21,3 [6,4–76,3] nM/L beobachtet werden. Dieser Anstieg der messbaren cGMP Plasmakonzentrationen war unabhängig von der individuellen hämodynamischen Reaktion während der Untersuchung. Durch Gabe von Sauerstoff und NO kann die Mehrzahl der Kinder mit pulmonaler Hypertension identifiziert werden, die ein reagibles pulmonales Gefäßbett aufweisen. Änderungen der cGMP-Plasmaspiegel unter NO korrelieren nicht mit der hämodynamischen Reaktion.
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  • 5
    ISSN: 1365-2222
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background Children with a shunted hydrocephalus are at highest risk for developing an immediate type allergy to latex. Limited data are available for preventive or therapeutical approaches.Objective To evaluate the effectiveness of latex avoidance, with special regard to status of sensitization and compliance.Methods In 1995, 131 children with a shunted hydrocephalus were screened for sensitization to latex by skin prick test and determination of specific IgE. Patients and parents were instructed on latex-avoiding strategies. Hospital physicians, family doctors and dentists were advised to perform further surgical and other medical interventions under latex-free conditions.In 2000, 100 of these 131 patients were re-evaluated according to the same testing procedures. Special attention was directed at the extent prophylaxis had been performed.Results In 1995, 30/100 patients re-evaluable in 2000 proved sensitized to latex, 70 had negative testing results. In 2000, 64/70 patients were still negative, six had meanwhile developed latex-specific IgE. Seven out of thirty subjects with former positive testing had changes within the same RAST-class, 20 showed a decline of at least one RAST-class, whereas in three cases an increase of latex-specific IgE was found. However, only 34 patients, mainly those being already sensitized, had thoroughly followed both medical and private prophylaxis. Within this group, 16 subjects (47.1%) had improved and another nine (26.5%) were still negative. Only three (8.8%) already previously sensitized patients presented with a further increase of latex-specific IgE. Medical prevention contributed more to the outcome than home prevention. No statistically significant correlation with latex-avoidance was observed, however, in previously unsensitized subjects. Underlying disease, atopy, number of operations, and age did not prove as significant variables.Conclusion Secondary prevention results in a decrease of specific IgE in latex-sensitized patients with hydrocephalus. This is due to medical more than home prophylaxis. Sensitization obviously occurs mainly in early childhood, thus primary prevention remains to be the main target.
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  • 6
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  A multicentre, centrally randomized, open-labelled study with temozolomide and interferon (IFN)-α2b was carried out to study the therapeutic effect in patients with metastatic melanoma stage IV.Objectives  The response rate, efficacy, side-effects, reasons for discontinuation of therapy and survival rate of 47 patients treated with temozolomide in combination with two different dosing regimens of IFN-α2b were documented.Patients/methods  Twenty-nine male and 18 female patients (mean age 57·6 years, range 34–74) were centrally randomized to two different arms: 20 patients received a treatment schedule with temozolomide 150 mg m−2 on days 1–5 orally every 28 days in combination with IFN-α2b 10 MIU m−2 every other day and 27 patients received temozolomide 150 mg m−2 on days 1–5 every 28 days in combination with IFN-α2b in a fixed dose of 10 MIU every other day.Results  We observed an overall response rate of 27·6% comprising five complete remissions (10·6%: one patient group A, four patients group B), in two of these five patients at the last follow-up in the study (4·3%, both in group B); and eight partial remissions (17%: six patients in group A, two patients in group B), in three of these eight patients at the last follow-up in the study (6·4%, two patients in group A, one patient in group B). Three patients showed stable disease (6·4%: one patient in group A, two patients in group B). Mean survival was 14·5 months [95% confidence interval (CI) 10–19] with no significant differences between treatment groups. However, there was a significant correlation with response after three cycles (log rank test, P 〈 0·03). Within the 32 patients who completed at least three cycles of therapy, seven patients (three in group A and four in group B) with a partial or complete response showed a significantly better mean survival of 30·6 months (95% CI 19·1–42) compared with 25 patients who did not respond (13·7 months 95% CI 9·2–18·3). In total, patients with at least one complete remission showed the longest survival (37·1 months 95% CI 26·3–47·9), followed by patients with at least one partial response (17·4 95% CI 10·9–23·9). Major side-effects of the treatment were nausea, vomiting, headache, leucopenia, thrombopenia, elevation of liver function parameters and neurological symptoms. In five patients, the side-effects led to a discontinuation of treatment: neurological symptoms (two patients), sepsis (one patient), brain haemorrhage (one patient) and exanthema (one patient). There were no treatment-related deaths.Conclusions  The combination of temozolomide and IFN-α2b can easily be administered and shows tolerable toxicity. When an objective response occurs after three cycles, it indicates a significant survival advantage.
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  • 7
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  The well-known active chlorine compound chloramine T (CAT) with broad-spectrum antimicrobial activity is in common therapeutic use for leg ulcers with purulent coatings; however, this treatment is painful. The tolerability of the less aggressive N-chlorotaurine (NCT), an endogenous compound also produced in vivo by stimulated human granulocytes, could be superior.Objectives  To assess the tolerability and efficacy of NCT in the cleaning of purulent coatings in chronic leg ulcers in comparison with CAT.Methods  In a double-blind, randomized phase IIb clinical study 40 patients were treated for a median of 7 days (range 3–14) with a 1% aqueous solution of either NCT (20 subjects) or CAT (20 subjects) by twice-daily application of dressings soaked in the test solutions. Criteria for evaluation of tolerability were intensity and duration of pain caused by the ulcer therapy and scores of tissue toxicity (necrosis, granulation tissue and re-epithelialization). Therapeutic efficacy was graded as scores of intensity of purulent coating of the ulcers.Results  The concentration tolerated in vitro by human epidermoid carcinoma cells was at least 10-fold higher for NCT (0·01%) compared with CAT (0·0001–0·001%). There was significantly less pain caused by NCT compared with CAT (P 〈 0·05) on days 1 and 4 and a trend for a shorter duration of pain (P = 0·093). The scores of intensity of coating improved without difference in both treatment groups, whereas granulation and re-epithelialization appeared earlier in the NCT group (P 〈 0·05). Non-quantitative microbiological cultures from ulcer smears revealed persistence of colonization by bacterial species in approximately half of both treatment groups.Conclusions  Both active chlorine compounds were helpful in reducing purulent coatings. Because of its lower toxicity and better tolerability, NCT is of advantage in the treatment of leg ulcers.
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  • 8
    ISSN: 1432-1238
    Keywords: Key words Tachyarrhythmias ; Surgical intensive care ; Case control study ; Incidence ; Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Incidence, types, and factors associated with new onset tachyarrhythmias (TA) in surgical intensive care patients.¶Design: Pairwise-matched case-controlled study. Setting: Surgical intensive care unit (ICU) with nine intensive care beds. Patients: During a 1-year period, all TA patients (n = 89) were included in the study. Control patients (n = 82) without TA were matched according to age, sex, and surgical region. Methods: TA workup included: 12-lead ECG, arterial blood gas, serum electrolyte (K+, Mg2+), and serum CK/CKMB isoenzyme analysis. Pre-existing cardiovascular and pulmonary disease, cardiovascular risk factors, preoperative regular medication, and admission SAPS were recorded in all patients. A multiple organ dysfunction syndrome (MODS) score, the presence or absence of SIRS or sepsis, and hemodynamics (MAP and CVP) before onset of TA were evaluated in TA patients, while in control patients highest MODSscore, the presence or absence of SIRS or sepsis, mean hemodynamic and laboratory values calculated from highest and lowest readings during ICU stay were used for statistical comparison. Logistic regression analysis was performed to identify variables multivariately associated with TA. Results: Eighty-nine (14.8 %) of 596 patients developed TA. Atrial fibrillation was most frequent (60.7 %). Presence of SIRS or sepsis (adj. OR = 36.45; 95 % CI: 11.5–115.5), high admission SAPS (adj. OR = 1.25/point; 95 % CI: 1.08–1.44), high CVP (adj. OR = 1.27/mmHg; 95 % CI: 1.09–1.48), and low arterial oxygen tension (adj. OR = 0.97/mmHg); 95 % CI: 0.95–0.99) were found to be significant predictors for development of TA. Conclusions: In surgical patients hypoxia, high cardiac filling pressures, a greater degree of physiologic derangement at admission, and the presence of SIRS and sepsis are independent risk factors for the development of TA.
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