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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Orthopäde 27 (1998), S. 542-555 
    ISSN: 1433-0431
    Keywords: Key words Posterior shoulder instability • Voluntary shoulder instability • Posterior capsular shift • Glenoidosteotomy • Posterior bone block • Biofeedback ; Schlüsselwörter Hintere Schultergelenkinstabiliät • Willkürliche Schulterinstabilität • Posteriorer Kapselshift • Glenoidosteotomie • Dorsale Spananlagerung • Biofeedback
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die posteriore Schulterinstabilität stellt ein wesentlich schwierigeres diagnostisches und therapeutisches Problem dar als die anteriore. Zum einen verbergen sich dahinter ätiologisch und pathogenetisch grundsätzlich verschiedene Krankheitsbilder, die auch in Form von Mischbildern ineinander übergehen können. Zum anderen gibt es aufgrund der geringeren Inzidenz nur wenige und sehr heterogene retrospektive Studien bezüglich der therapeutischen Möglichkeiten. Grundsätzlich muß man traumatische und atraumatische Formen strikt voneinander trennen. Bei den rein traumatischen Formen handelt es sich um Luxationsimpressionsfrakturen des Humeruskopfes. Die Therapie dieser Luxationen ist abhängig von der Größe des Defekts, der Chronizität und dem funktionellen Anspruch des Patienten. Je nach Defektgröße kommt hier die geschlossene Reposition mit anschließender Ruhigstellung, die offene Reposition evtl. kombiniert mit Transposition des Tuberculum minus (McLaughlin), die retrograde Defektanhebung mit Spongiosaunterfütterung, die Drehosteotomie oder der endoprothetische Humeruskopfersatz in Frage. Die nicht traumatische rezidivierende hintere Instabilität ist primär konservativ zu behandeln. Muskelkoordination und Kräftigung der kopfzentrierenden und scapulaführenden Muskulatur nach Analyse des Luxationsmechanismus sind die Therapie der Wahl. Vor der Indikation zu operativen Maßnahmen ist das Ausschließen zugrundeliegender psychopathologischer Störungen essentiell. Bei den operativen Maßnahmen scheinen dorsale Kapselshiftoperationen den früher durchgeführten Knochenblockappositionen und Glenoidosteotomien überlegen zu sein. Die letztgenannten knöchernen Eingriffe sind dann indiziert, wenn als Luxationsursache eindeutig Störungen der Glenoidgeometrie in Frage kommen, sollten in der Regel aber auch mit Kapselshiftoperationen kombiniert werden.
    Notes: Summary The posterior instability of the shoulder is a more difficult diagnostic and therapeutic challenge than the anterior instability. There are many etiologies and causes of posterior instability. Most studies in the literature are retrospective and yield a great variation in therapeutic recommendations. Generally it has to be separated in traumatic and atraumatic instabilities. Most of the traumatic dislocations are impaction fractures of the humeral head against the dorsal glenoid. Therapy is depending on the size of the humeral defect, the duration of dislocation and the functional demand of the patient. Therapeutic possibilities are closed reduction and fixation with a cast, open reduction and the transfer of the lower tubercule (McLaughlin's procedure), lifting of the defect and supporting with cancellous bone, subcapital rotational osteotomy or arthroplasty. The therapy of choice for atraumatic instability is a individualized rehabilitation program with strengthening and balancing of rotatator cuff muscles and scapular stabilizers. Psychologic abnormalities and emotional problems have to be recognized prior to any operative procedure. These patients are no operative candidates. Operative treatment of choice is the posterior capsular shift adressing the causative redundancy or laxity of the postero-inferior capsule. Posterior bony procedures as glenoid osteotomy or bone block transfers are indicated, if the pathologic geometry of the glenoid is primarily responsible for posterior instability. It is strongly recommended to combine them with a capsular shift to adress the secondary capsular redundancy.
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 48 (1999), S. 108-115 
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Anästhesie ; Ambulante Patienten ; Präoperative Untersuchungen ; Routineuntersuchungen ; Key words Anaesthesia ; Outpatient anaesthesia ; Preoperative diagnostic ; Routine screening investigations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The volume of preoperative screening investigations for outpatient anaesthesia ranges from few, selectively ordered investigations to extensive routine diagnostic procedures. It seem appropriate to reevaluate benefit and efficacy of routine preoperative assessment programs. The purpose of preoperative diagnostic is to assess the risk of anaesthesia and surgery for the patient. As shown by a number of studies, preoperative screening investigations seldom disclose new pathological findings of clinical relevance. Abnormal laboratory results in otherwise healthy patients rarely alter the anaesthetic management of the patient and are not related to perioperative complications. Extensive use of costly diagnostic procedures considerably increases health care budgets. A more selective approach to order preoperative investigations promises considerable savings. To achieve costeffective evalulation an efficient organisation of properative assessment must be established to avoid costly delay and on-day-of-surgery-cancellations. There is no medicolegal obligation to perform routine diagnostic testing. The anaesthetist must be sufficiently informed in time to assess the perioperative risk of the patient and to alter anaesthetic management as necessary. According to the presented studies a clinical history and a thorough physical examination represent an effective method of screening for the presence of disease. Careful medical history evaluation and physical examination can avoid extensive investigations in apparently healthy individuals and the latter should only be ordered if indicated.
    Notes: Zusammenfassung Die Bandbreite präoperativer Untersuchungen bei Patienten mit ambulanter Anästhesie variiert von wenigen, nur selektiv angeforderten Untersuchungen hin bis zu einem umfassenden Routineuntersuchungsprogramm. Nicht zuletzt aufgrund finanzieller Erwägungen erscheint es sinnvoll, den Nutzen und die Effektivität von routinemäßig durchgeführten Untersuchungen erneut kritisch zu bewerten. Durch präoperative Diagnostik sollen Zustände erkannt werden, die ein relevantes perioperatives Risiko darstellen. Präoperative Screeninguntersuchungen decken aber nur selten relevante pathologische Veränderungen auf. Pathologische Befunde lassen außerdem häufig therapeutische Konsequenzen vermissen und stehen in keinem Zusammenhang mit perioperativen Komplikationen. Vielmehr zeigt sich, daß das perioperative Risiko von ambulanten Patienten gut durch eine ausführliche Anamnese und sorgfältige körperliche Untersuchung abgeschätzt werden kann. Unter diesen Voraussetzungen erscheint es den Autoren gerechtfertigt, auf standardisierte Untersuchungsprogramme bei ambulanten Patienten zu verzichten und sich nach den Erfordernissen des Einzelfalls zu richten.
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  • 3
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Stereoisomerie ; Muskelrelaxanzien ; Cisatracurium ; kardiovaskuläre Effekte ; Key words Stereoisomerie ; Muscle relaxant ; Cisatracurium ; Cardiovascular effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Cisatracurium – one of the ten stereoisomers of atracurium – is an intermediate long-acting non-depolarizing neuromuscular blocking agent. Cardiovascular reactions have been described after administration of cisatracurium or vecuronium in surgical patients. Methods. After approval by our institutional review board, 62 patients (ASA I–II) were randomly assigned to three groups to either receive 3×ED95 or 5×ED95 of cisatracurium or 3×ED90 of vecuronium prior to intubation as a bolus. After oral premedication with 2 mg lormetazepam anaesthesia was induced with thiopental (4–12 mg/kg) and maintained with O2/N2O and isoflurane (1.5%–2%). Six minutes after administration of thiopental, patients received the muscle relaxant. Six minutes later 0.1–0.2 mg fentanyl was given and the trachea was intubated. Heart rate (HR) and blood pressure (BP) were monitored every minute. Changes of heart rate or blood pressure 〉20% compared to baseline were defined as clinically significant. Results. After application of the study drug, median values of blood pressure and heart rate were stable. For each muscle relaxant, there were several patients who had statistically significant cardiovascular changes. After 3×ED95 cisatracurium, 3 of 21 patients exhibited haemodynamic changes 〉20% (2 exhibited hypotension and 1 tachycardia), while in the high-dose cisatracurium group 2 of 21 patients demonstrated a tachycardia that was predetermined to be statistically but not clinically significant. In the vecuronium group, 2 of 20 patients sustained statistically significant hypotension and 1 patient had statistically significant tachycardia. The frequency of all individual cardiovascular changes after the application of the muscle relaxant was not dose-dependent. Conclusion. After the administration of cisatracurium in two different doses (3×ED95 and 5×ED95) or vecuronium (3×ED90) only minor cardiovascular changes were observed. Both drugs proved to be safe for use during induction of anaesthesia in patients ASA I–II. With regard to its cardiovascular effects, cisatracurium shares with vecuronium the requirements of an ideal muscle relaxant.
    Notes: Zusammenfassung In einer randomisierten, doppelblinden Studie wurden bei insgesamt 62 Patienten (ASA I–II) die Veränderungen von Blutdruck und Herzfrequenz nach Bolusapplikation von Cisatracurium (0,15 mg/kg oder 0,25 mg/kg) im Vergleich zu Vecuronium (0,15 mg/kg) untersucht. Die Narkoseinduktion erfolgte mit Thiopental (4–12 mg/kg) und wurde mit N 2 O/O 2 sowie Isofluran (1,5–2,5 Vol.-%) aufrechterhalten. Sechs Minuten nach Thiopental erhielten die Patienten binnen 5–10 s das jeweilige Relaxans. Blutdruck und Herzfrequenz wurden minütlich registriert und Abweichungen 〉20% des Ruhewerts als individuell bedeutsam gewertet. Nach Applikation der jeweiligen Prüfsubstanz zeigte sich in allen drei Patientengruppen eine Stabilität von Blutdruck und Herzfrequenz. Die maximalen individuellen Veränderungen der hämodynamischen Parameter (auch 〈/ 〉20%) blieben stets im physiologischen Bereich. Eine statistische Signifikanz oder Dosisabhängigkeit der hämodynamischen Veränderungen nach der jeweiligen Prüfsubstanz konnte nicht nachgewiesen werden. Hinsichtlich der hämodynamischen Stabilität zeigte Cisatracurium vergleichbare Eigenschaften wie Vecuronium.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 47 (1998), S. 788-802 
    ISSN: 1432-055X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 5
    Electronic Resource
    Electronic Resource
    s.l. : American Chemical Society
    Langmuir 11 (1995), S. 186-190 
    ISSN: 1520-5827
    Source: ACS Legacy Archives
    Topics: Chemistry and Pharmacology
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  • 6
    Electronic Resource
    Electronic Resource
    College Park, Md. : American Institute of Physics (AIP)
    The Journal of Chemical Physics 104 (1996), S. 7338-7343 
    ISSN: 1089-7690
    Source: AIP Digital Archive
    Topics: Physics , Chemistry and Pharmacology
    Notes: The Si(100) and (111) surfaces have generally been classified as relatively inert toward molecular hydrogen adsorption. In the present work, we show using surface second harmonic generation that the sticking probability increases dramatically for slightly misoriented substrates, which are of interest in many integrated circuit applications. At temperatures lower than 30–50 K below where desorption becomes significant, defect sites serve as adsorption conduits from which hydrogen atoms diffuse onto the rest of the surface. The adsorption rate therefore has the activation energy of surface diffusion, found to be 0.78 eV on Si(100) and 1.50 eV on Si(111). The small energy barrier and pre-exponential factor (∼10−11 cm2/s) for diffusion on (100) seem to result from the need to break Si–Si dimer-pair bonds prior to hopping of an H atom. At higher temperatures, the adsorption mechanism changes, and H2 sticks to both surfaces with a fairly large probability near 0.1. © 1996 American Institute of Physics.
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  • 7
    ISSN: 1432-1351
    Keywords: Key words Fly ; Chemoreception ; Taste hairs ; Receptor site ; Lactose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract Receptor cell responses in the largest labellar (LL) and tarsal (D) taste hairs of the housefly Musca domestica were investigated electrophysiologically using the tip-recording technique. In LL hairs, test series with lactose in concentrations of 12.5–400 mmol · l−1 yielded a threshold concentration around 12 mmol · l−1 and a calculated concentration eliciting half-maximal response of around 40 mmol · l−1, the maximal response varying between 18 and 30 impulses/300 ms. D hairs are more sensitive towards lactose, indicated by a slightly lower threshold and a by 60% higher response to 400 mmol · l−1 lactose. The high variation in the relative stimulating effectiveness of lactose and sucrose and experiments with sugar mixtures imply that these sugars bind to different receptor sites without noticeable cross affinity. A comparison of the concentration response characteristics for sucrose and lactose in LL and D hairs suggests that sucrose can combine with more than one site type, expressed in different proportions in both hair types. Results obtained with p-nitrophenyl-β-galactoside as stimulus indicate that a β-galactoside link is not sufficient for a substance to interact specifically with the lactose binding site. The exceptional lactose sensitivity of the sugar cell in M. domestica is discussed in the context of food acquirement and digestion.
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  • 8
    Electronic Resource
    Electronic Resource
    College Park, Md. : American Institute of Physics (AIP)
    The Journal of Chemical Physics 104 (1996), S. 2557-2565 
    ISSN: 1089-7690
    Source: AIP Digital Archive
    Topics: Physics , Chemistry and Pharmacology
    Notes: For diffusion-controlled reactions in three dimensions, continuum mechanics provides a quantitative relation between the steady-state reaction rate constant k and the diffusion coefficient D. However, this approach fails in two dimensions, where no steady-state solution exists on an infinite domain. Using both Monte Carlo methods and analytical techniques, we show that previous attempts to circumvent this problem fail under real laboratory conditions, where fractional coverages often exceed 10−3. Instead, we have developed a rigorous and general relation between k and D for all coverages on a square lattice for the reaction A+A→A2. For short times or high coverages, the relation k=πD/γ holds exactly, where γ denotes the two-dimensional packing fraction. For lower coverages, however, k depends on time in both constant-coverage (adsorption allowed) and transient-coverage (adsorption forbidden) regimes. In both cases, k decreases in response to the evolution of nonrandom adsorbate configurations on the surface. These results indicate that diffusion-limited surface reactions may be identified unambiguously in the laboratory and also provide a quantitative link between diffusion parameters and experimentally determined recombination rate parameters. Practical experimental methods highlighting such effects are outlined. © 1996 American Institute of Physics.
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