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  • 1
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Luxation des Akromioklavikulargelenks ; Ergebnis von operativer und konservativer Therapie ; Key words Sprains of the acromioclavicular joint ; Surgical treatment ; Conservative treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Eighty-five patients with grade 2 or grade 3 sprains of the acromioclavicular (AC) joint were evaluated clinically and radiographically 32 months after injury. Group I included 34 patients with grade 2 sprains (Tossy II) and group II included 51 patients with grade 3 injuries (Tossy III). In group I, 15 patients were treated surgically (group I a) and 19 patients were treated conservatively (group I b), while in group II, 41 patients were treated surgically (group II a) and 10 patients were treated conservatively (group II b). At surgery open reduction and transarticular fixation of the AC joint with Kirschner wires was performed. Conservative treatment included the initial use of a sling or a knapsack bandage and early performance of range-of-motion exercises. Shoulder function was assessed according to the score devised by Constant and Murley. In both groups, 97 of 100 possible points (minimum 72, maximum 100) were obtained after conservative and after surgical treatment. Nine of 10 patients (90%) with grade 3 sprains (group IIb) had more pronounced displacement and increased mobility of the lateral end of the clavicle after conservating treatment. After surgery, dislocation and increased horizontal, mobility of the lateral end of the clavicle occurred in 18 (44%) of 41 patients with grade 3 sprains (group II a P〈0.0001). However, these findings did not correlate with the functional outcome. At follow-up there was a significant increase in degenerative changes seen on radio-graphs (P〈0.035) in all patients. Again these findings did not correlate with the functional outcome. More degenerative radiological changes were observed in patients who had undergone surgery (P〈0.003). Patients with grade 2 sprains were more frequently restricted in sporting activity after surgery (P〈0.05). Patients with grade 3 sprains who were treated surgically complained of pain more frequently (P〈0.01), and they returned to work later than patients who were treated conservatively after grade 3 sprains. An additional rehabilitation program guided by a physiotherapist seemed to have no impact on the functional outcome. A total of 56 patients were treated by surgery. Among these patients 11 complications occurred, requiring five additional surgical procedures. Among 29 conservatively treated patients, only in 1 patient did subacromially located arthritic changes of the AC joint have to be removed.
    Notes: Die funktionelle Untersuchung mittels des Score nach Constant und Murley ergab durchschnittlich 97 von 100 möglichen Punkten (Minimum 72, Maximum 100) in beiden Gruppen, sowohl nach konservativer als auch nach operativer Therapie. Bei der Nachuntersuchung wiesen 9 von 10 konservativ (90%) behandelten Patienten nach drittgradiger AC-Luxation ein positives Klaviertastenphänomen und eine vermehrte Horizontalverschieblichkeit der Klavikula im Gegensatz zu 18 (44%) von 41 operierten Patienten auf (p〈0,0001). Allerdings wurde dadurch das funktionelle Ergebnis nicht beeinflußt. Weiters kam es in beiden Gruppen unabhängig vom Therapieverfahren zu einer deutlichen Zunahme der degenerativen radiologischen Veränderungen (p〈0,035), aber ebenfalls ohne Einfluß auf das gute funktionelle Ergebnis. Die operierten Patienten wiesen dabei mehr radiologische Veränderungen auf als die nicht operierten Patienten (p〈0,003). In Gruppe I waren die operierten Patienten öfter in der Sportausübung eingeschränkt, als die konservativ behandelten (p〈0,05). Operierte Patienten in Gruppe II klagten häufiger über Schmerzen (p〈0,01) und waren länger im Krankenstand (p〈0,001) als die konservativ behandelte Vergleichsgruppe. Die Durchführung einer Physikotherapie hatte keinen Einfluß auf das funktionelle Ergebnis. Bei 11 von 56 operativ behandelten Patienten kam es zu Komplikationen, welche bei 5 Patienten einen weiteren chirurgischen Eingriff notwendig machten. Von den 29 konservativ behandelten Patienten mußten bei 1 Patienten subakromial gelegene arthrotische Veränderungen des AC-Gelenks mittels subakromialer Dekompression entfernt werden.
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  • 2
    ISSN: 1433-0474
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Skelettfehlbildungen und Herzfehler sind Leitsymptome des autosomal dominant erblichen Holt-Oram-Syndroms. Bei vollständiger Penetranz kann der Ausprägungsgrad der klinischen Symptome innerhalb einer Familie jedoch sehr unterschiedlich sein und zu diagnostischen Schwierigkeiten führen. Anhand von 13 eigenen Patienten mit Holt-Oram-Syndrom im Alter 1–35 Jahren wird das klinische Spektrum dargestellt. Es reicht von - meist asymmetrischen - Phokomelien der oberen Extremität bis zu isolierten Thenarhypoplasie als Minimalsymptom der Erkrankung. Eltern eines scheinbar sporadischen Falles sollten gezielt daraufhin untersucht werden, um das Wiederholungsrisiko für weitere Kinder bestimmen zu können.
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  • 3
    ISSN: 1365-2842
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The lack of easily measurable, objective physiological activity parameters of the masseter and temporalis muscle during jaw movements in humans has led to the consideration to revise data of surface electromyographies (EMGs) by applying a computerized quantification method. The aim of this follow-up analysis was to get quantitative data out of EMG-records of an earlier study. These records were obtained with two different splints, splint 1 providing an anterior front-canine guidance and splint 2 providing bilateral balanced occlusion. Utilizing a computer aided integration method led to numeric results which statistically proves the prediction of the previous investigation. Applying the integration method, the EMG raw signal was transformed into area-values which enabled a statistical work up of the data. Wilcoxon test statistics shows a significant (P〈0·05) lower muscle activity in patients wearing dentures providing anterior front-canine guidance compared to those with balanced occlusion. It is concluded that the neuromuscular activity of the elevator muscles is highly reproducible and that the neuromuscular function is similar in edentulous subjects to that found in people with natural teeth. Furthermore, the study statistically proves earlier visual data that all those subjects, whose muscle activities were observed with anterior guidance (splint 1) compared to bilateral balanced occlusion (splint 2) showed significantly lower values with regard to subjects wearing splint 2.
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  • 4
    ISSN: 1420-9071
    Keywords: Borg's scale ; extracellular metabolic regulation ; metabolic control ; motor control ; motor learning ; psychophysiological feedback ; RPE-scale ; teleoanticipation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract Efferent motor signals to skeletal muscles concern not only the space/time pattern of motion, but also the setting of muscular performance and through this the control of the current metabolic rate. For an optimal adjustment of metabolic rate during heavy exercise — e.g. in athletic competitions — a feedback control system must exist, including a programmer that takes into consideration a finishing point (teleoanticipation). The presented experiments, using Borg's scale, indicate the existence and functioning of a system for optimal adjustment of performance during heavy exercise and the relevance of teleoanticipatory effects. Thus motor learning includes not only somatosensory control, but also metabolic control. With regard to migratory birds, such metabolic control would have to operate in the individual as well as in the migrating flock as a whole.
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  • 5
    ISSN: 0942-0940
    Keywords: Glioblastoma ; survival ; surgery ; radiotheraphy ; chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Purpose Comparison of the effect of different therapeutic modalities on survival time of patients with glioblastoma multiforme operated on during the last decade (1980–1990). Patients and methods The records of 157 consecutive patients with the histological diagnosis of glioblastoma multiforme were analysed for survival with respect to age of patients, extent of surgery, influence of re-operation and adjuvant postoperative treatment. The latter included fractionated radiotherapy, chemotherapy (BCNU, CCNU with Vincristine) and photodynamic therapy (PDT). Results Analysis of variance showed a significant effect for survival after macroscopically radical surgery (p=0.005), postoperative radiotherapy (p〈 0.001), chemotherapy (p〈 0.01). Low age (p〈 0.05) and a postoperative Karnofsky performance score (KPS) ⩾60 (p〈 0.001) had a positive influence; the site of tumour and pre-operative presence of seizures had no significant influence (p 〉 0.1) on survival time. Conclusion We conclude that the current adequate management of glioblastoma multiforme should include surgical resection followed by adjuvant treatment such as radiotherapy and chemotherapy.
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  • 6
    ISSN: 1432-1971
    Keywords: Idiopathic cardiomyopathy ; Cardiac dysrhythmias ; Sudden cardiac death
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To assess the incidence and prognostic significance of cardiac dysrhythmias in children with idiopathic dilated or hypertrophic cardiomyopathy, the clinical course of 59 patients was retrospectively reviewed over a period of 27 years. Dilated cardiomyopathy (DCM) was diagnosed in 28 patients and hypertrophic cardiomyopathy (HCM) in 31 patients. The mean age at the time of diagnosis was 2.8±0.7 years in DCM patients and 6.7±0.8 years in HCM patients. Mean follow-up time after diagnosis of cardiomyopathy was 4.1±1.0 years in DCM patients and 6.6±0.8 years in HCM patients. Clinically significant cardiac dysrhythmias were found in 17 of 59 patients (29%): 7 of 28 patients (25%) with DCM and 10 of 31 patients (32%) with HCM. The initial diagnosis of a cardiac dysrhythmia was made by standard electrocardiography in 12 of 17 patients (71%) and by 24-hour Holter monitoring in 5 of 17 patients (29%). Ventricular dysrhythmias were present in 5 of 7 patients with dilated cardiomyopathy and in 5 of 10 patients with hypertrophic cardiomyopathy. During the follow-up time, death occurred in 18 of 59 patients (31%): 8 of 59 patients (14%) died from congestive heart failure and 10 of 59 patients (17%) died suddenly. Among the sudden deaths were 4 of 28 patients (14%) with dilated cardiomyopathy and 6 of 31 patients (19%) with hypertrophic cardiomyopathy. Cardiac dysrhythmias had been documented in 6 of the 10 patients dying suddenly (3 of 4 patients with DCM and 3 of 6 patients with HCM). It is concluded that (1) cardiac dysrhythmias are not a rare finding in children with idiopathic dilated or hypertrophic cardiomyopathy, and (2) their occurrence is not a predictor for sudden death.
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Archives of women's mental health 1 (1998), S. 77-81 
    ISSN: 1435-1102
    Keywords: Keywords: Burden; stressful experience; childbirth; delivery.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background: Aims of this investigation were to study the subjective psychological and physical stressful experience of childbirth burden on a scale with 7 choises and to determine physical and psychosocial factors, which influence delivery experience. Methods: Information on sociodemographic data, physical and psychiatric anamnesis, as well as obstetrical and psychological variables were gained through a structured interview. This was carried out on 1250 women on the fifth postnatal day at the maternity ward. Results: According to the burden of childbirth score all 1250 women were divided into three subgroups. Group A (low burden, n = 433), group B (medium burden, n = 516) and group C (high burden, n = 301). The comparison between these three groups with respect to burden of childbirth revealed sig-nificant differences for length and mode of delivery, parity, pregnancy risk factors, gestational age at delivery, prior psychopharmacologic medication, occupational satisfaction, trait anxiety and depressive mood. The multiple logistic regression analysis between group A and group C showed that length of delivery had the strongest impact on burden of childbirth followed by depressive mood, elevated trait anxiety score, mode of delivery (emergency cesarean section and delivery by vacuum extraction provide significant higher burden scores than elective cesarean section and spontaneous delivery), and occupational satisfaction (higher occupational satisfaction correlates with low burden of childbirth). Conclusions: In summary, burden of childbirth assessed on the fifth postnatal day is a result of a complex interaction between physical and psychological factors, whereby physical stressors such as length of labor, emergency surgical delivery and affective alterations such as elevated trait anxiety, depressive mood, and job satisfaction seem to be of predominant relevance.
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