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  • breast cancer  (1,228)
  • Arbeitsmedizin
  • Rehabilitation
  • Strömungsmechanik
  • Springer  (1,392)
  • Sage Publications  (11)
  • Bundesarbeitsgemeinschaft für Rehabilitation
  • 1
    Keywords: Medicine ; Human Physiology ; Neurosciences ; Pathology ; Rehabilitation ; Sports Medicine ; Biomedicine ; Neurosciences ; Human Physiology ; Pathology ; Sports Medicine ; Rehabilitation ; Biomedicine general ; Springer eBooks
    Description / Table of Contents: Historical perspectives in understanding traumatic brain injury and in situating disruption in CBF in the pathotrajectory of head trauma -- Situating Cerebral Blood Flow in the Pathotrajectory of Head Trauma -- Modeling of traumatic brain injury and its implications in studying the pathology of repeated mild impacts to the head -- The presence of venous damage and microbleeds in traumatic brain injury and the potential future role of angiographic and perfusion magnetic resonance imaging -- Situating the Endothelin System in the pathotrajectory of TBI-induced changes in haemodynamics -- Age and Sex Differences in Cerebral Blood Flow and Autoregulation after Pediatric Traumatic Brain Injury -- New Frontiers in Clinical Trials Aimed at Improving Outcome Following Traumatic Brain Injury
    Abstract: 〈p〉Traumatic brain injury (TBI) has caught the ear of the general public in the last few years in the context of injuries seen both in athletes and the military.℗ Despite TBI being situated as a critical problem in society for multiple decades, the underlying pathotrajectory of TBI has only recently been truly appreciated.℗ Only recently has TBI research begun to develop better models of TBI that more closely recapitulate the human condition, make new advances in our ability to image pathophysiological sequelae in the brain following TBI, place a greater emphasis on studying the vascular dysfunction that accompanies head trauma, and, very recently, explore a new understanding of how age and sex can alter outcome to brain injury.〈/p〉〈p〉While this book was developed to satisfy a wide audience, from patient to caregiver, basic scientist to clinical scientist, the overall goal is to present the most current information known about head trauma and to expose areas where we may be deficient in understanding the nuances of TBI.℗ ℗ In particular, focus will be placed on the largest gap in our knowledg途the influence of cerebral blood flow (CBF) and metabolism in outcome following injury. This volume explores such varied concepts as the influence of CBF in the pathotrajectory of TBI, modeling TBI as a means to understand underlying pathological states associated with brain injury victims, disrupted vasculature following head trauma and advanced imaging techniques, vasoreactive substances underlying disrupted blood flow, the role of age and sex on injury outcome, and the latest pre-clinical rationale for focusing on CBF and strategies to improve blood flow as a means to improve outcome in patients suffering the effects of TBI.℗ Taken together, the information contained in ́€œCerebral Blood Flow, Metabolism, and Head Traumဝ is designed to both educate and illuminate anyone associated with TBI, with the hopes of stimulating future research.〈/p〉
    Pages: : digital.
    ISBN: 9781461441489
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  • 2
    Keywords: Medicine ; Rehabilitation ; Medicine & Public Health ; Rehabilitation ; Rehabilitation Medicine ; Springer eBooks
    Description / Table of Contents: 〈p〉Pr©♭face -- Imagerie IRM du plexus brachial normale et pathologique -- M©♭thodes d€™éxploration ©♭lectrophysiologique du plexus brachial -- Nouvelles ©♭chelles d́€™©♭valuation clinique des atteintes du syst©·me nerveux p©♭riph©♭rique -- Paralysie traumatique du plexus brachial de l€™ádulte℗ : prise en charge chirurgicale initiale -- Paralysie du plexus brachial obst©♭trical. Actualit©♭s et perspectives -- Chirurgie palliative dans les s©♭quelles de l©♭sions du plexus brachial chez l€™ádulte -- Faisabilit©♭ de l€™éxploration du d©♭fil©♭ cervico-thoracobrachial sous endoscopie℗ : ©♭tude cadav©♭rique -- Prise en charge r©♭©♭ducative. Quoi de neuf℗ ? -- L€™áppareillage dans les l©♭sions du plexus brachial de l€™ádulte -- Traitement du d©♭s©♭quilibre musculaire du plexus brachial -- Prise en charge de la douleur dans les l©♭sions du plexus brachial -- Particularit©♭s de l€™éxpertise dans les suites d€™úne atteinte traumatique du plexus brachial.〈/p〉
    Abstract: 〈p〉Cet ouvrage traite de la prise en charge des traumatismes du plexus brachial chez l€™ádulte et l€™énfant. Les auteurs font une mise © jour des m©♭thodes actuelles d́€™©♭valuation clinique, iconographique et ©♭lectrophysiologique ainsi que des techniques chirurgicales pr©♭conis©♭es en fonction du stade et du type de l©♭sion. 〈/p〉〈p〉℗ 〈/p〉〈p〉Les traitements ©♭voluent ; les proc©♭dures de r©♭©♭ducation, d€™áppareillage et de prise en charge de la douleur sont ©♭troitement li©♭es au traitement chirurgical. Les d©♭marches r©♭adaptatives et r©♭paratrices sont ©♭labor©♭es en fonction du projet de vie du patient.〈/p〉〈p〉℗ 〈/p〉〈p〉Cet ouvrage s€™ádresse aux praticiens chirurgiens, m©♭decins ou param©♭dicaux qui souhaitent mettre © jour leurs connaissances dans ce domaine.〈/p〉
    ISBN: 9782817803340
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  • 3
    Keywords: Medicine ; Neurology ; Pain Medicine ; Rehabilitation ; Psychology, clinical ; Medicine & Public Health ; Pain Medicine ; Health Psychology ; Rehabilitation ; Neurology ; Springer eBooks
    ISBN: 9781441916518
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  • 4
    Keywords: Medicine ; Human Physiology ; Neurosciences ; Neurology ; Rehabilitation ; Biomedicine ; Neurosciences ; Human Physiology ; Neurology ; Rehabilitation Medicine ; Springer eBooks
    Description / Table of Contents: Modulation of motor cortical connections through timed stimulation: animal studies -- Connection between premotor and motor cortices in primates -- Excitability of intracortical circuits in the primary motor cortex -- Effects of cortical stimulation on cortical functional connectivity: Imaging studies -- Accessing cortical connectivity using TMS -- Connections between cortical areas during grasping and modulation by brain stimulation -- Modulation of functional connectivity with transcranial direct current stimulation -- Cortical connections to motor cortex and their modulation in behavioural tasks (e.g. posterior parietal cortex, premotor cortex) -- The functional role of interhemispheric interactions in human motor control -- Functional modulation of primary motor cortex during action selection -- Enhancement of normal cortical functions through brain stimulation -- Movement disorders -- Stroke -- Multiple sclerosis -- Spinal cord injury -- Psychiatric diseases
    Abstract: 〈p〉The study and modulation of cortical connections is a rapidly growing area in neuroscience.℗ This unique book by prominent researchers in the field covers recent advances in this area.℗ The first section of the book describes studies of cortical connections, modulation of cortical connectivity and changes in cortical connections with activities such as motor learning and grasping in primates. ℗ The second section covers the use of non-invasive brain stimulation to study and modulate cortical connectivity in humans.℗ The last section describes changes in brain connectivity in neurological and psychiatric diseases, and potential new treatments that manipulate brain connectivity.℗ This book provides an up-to-date view of the study of cortical connectivity, and covers its role in both fundamental neuroscience and potential clinical applications.〈/p〉
    Pages: VIII, 365 p. 63 illus., 37 illus. in color. : digital.
    ISBN: 9783642327674
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  • 5
    Keywords: Medicine ; Orthopedics ; Orthopedic surgery ; Rehabilitation ; Sports Medicine ; Endoscopic surgery ; Medicine & Public Health ; Surgical Orthopedics ; Sports Medicine ; Orthopedics ; Conservative Orthopedics ; Rehabilitation Medicine ; Minimally Invasive Surgery ; Springer eBooks
    Pages: : digital
    ISBN: 9780857296092
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  • 6
    Unknown
    London : Springer
    Keywords: Medicine ; Internal Medicine ; Physical Therapy ; Rehabilitation ; Rheumatology ; Medicine & Public Health ; Rheumatology ; Internal Medicine ; Physiotherapy ; Rehabilitation Medicine ; Springer eBooks
    Pages: : digital
    ISBN: 9781848820937
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  • 7
    Keywords: Medicine ; Radiology, Medical ; Orthopedics ; Orthopedic surgery ; Rehabilitation ; Physical Therapy ; Sports Medicine ; Medicine & Public Health ; Surgical Orthopedics ; Orthopedics ; Sports Medicine ; Imaging / Radiology ; Rehabilitation ; Physiotherapy ; Springer eBooks
    Pages: : digital
    ISBN: 9783642227691
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  • 8
    Keywords: Medicine ; Radiology, Medical ; Internal Medicine ; Neurology ; Neurosurgery ; Psychiatry ; Rehabilitation ; Medicine & Public Health ; Neurology ; Rehabilitation ; Internal Medicine ; Neurosurgery ; Psychiatry ; Neuroradiology ; Springer eBooks
    Pages: : digital.
    ISBN: 9781447124405
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  • 9
    Keywords: Medicine ; Neurology ; Pain Medicine ; Rehabilitation ; Medicine & Public Health ; Neurology ; Rehabilitation ; Pain Medicine ; Springer eBooks
    Pages: : digital.
    ISBN: 9788847024632
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  • 10
    Keywords: Medicine ; Anesthesiology ; Rehabilitation ; Surgery ; Medicine & Public Health ; Plastic Surgery ; Surgery ; Rehabilitation ; Anesthesiology ; Oral and Maxillofacial Surgery ; Springer eBooks
    Pages: : digital
    ISBN: 9781848821163
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  • 11
    Keywords: Medicine ; Neurology ; Physical Therapy ; Rehabilitation ; Medicine & Public Health ; Neurology ; Rehabilitation Medicine ; Physiotherapy ; Springer eBooks
    Pages: : digital
    Edition: 2012.
    ISBN: 9781447122777
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  • 12
    Keywords: Medicine ; Human Physiology ; Orthopedics ; Rehabilitation ; Sports Medicine ; Medicine & Public Health ; Sports Medicine ; Orthopedics ; Human Physiology ; Rehabilitation ; Springer eBooks
    Edition: 3rd ed. 2012.
    ISBN: 9781461411505
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  • 13
    Keywords: Medicine ; Maternal and infant welfare ; Rehabilitation ; Early childhood education ; Social work ; Developmental psychology ; Medicine & Public Health ; Maternal and Child Health ; Child and School Psychology ; Childhood Education ; Rehabilitation ; Social work ; Springer eBooks
    Pages: : digital.
    ISBN: 9781461423355
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  • 14
    Keywords: Medicine ; Dermatology ; Rehabilitation ; Surgery ; Medicine & Public Health ; Surgery ; Plastic Surgery ; Dermatology ; Rehabilitation ; Springer eBooks
    Pages: : digital.
    ISBN: 9783709103159
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  • 15
    Keywords: Medicine ; Neurosciences ; Anesthesiology ; Critical care medicine ; Neurology ; Neurosurgery ; Rehabilitation ; Medicine & Public Health ; Neurology ; Neurosurgery ; Anesthesiology ; Intensive / Critical Care Medicine ; Rehabilitation Medicine ; Neurosciences ; Springer eBooks
    Pages: XVI, 170 p. : digital.
    ISBN: 9782817801278
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  • 16
    Keywords: Medicine ; Radiology, Medical ; Radiotherapy ; Oncology ; Head / surgery ; Rehabilitation ; Medicine & Public Health ; Radiotherapy ; Oncology ; Imaging / Radiology ; Head and Neck Surgery ; Rehabilitation ; Springer eBooks
    Pages: : digital
    ISBN: 9788847018068
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  • 17
    Keywords: Medicine ; Orthopedics ; Rehabilitation ; Sports Medicine ; Medicine & Public Health ; Orthopedics ; Sports Medicine ; Rehabilitation ; Springer eBooks
    Pages: : digital
    ISBN: 9788847017023
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  • 18
    Keywords: Medicine ; Nursing ; Otorhinolaryngology ; Rehabilitation ; Speech pathology ; Applied psychology ; Medicine & Public Health ; Speech pathology ; Otorhinolaryngology ; Nursing ; Rehabilitation ; Psychotherapy and Counseling ; Education (general) ; Springer eBooks
    Pages: : digital
    ISBN: 9788847018037
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  • 19
    Keywords: Medicine ; Radiology, Medical ; Radiotherapy ; Oncology ; Cancer / Surgery ; Psychotherapy ; Rehabilitation ; Medicine & Public Health ; Oncology ; Surgical Oncology ; Imaging / Radiology ; Radiotherapy ; Rehabilitation ; Psychotherapy ; Springer eBooks
    ISBN: 9782817802251
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  • 20
    Keywords: Medicine ; Neurology ; Rehabilitation ; Medicine & Public Health ; Rehabilitation Medicine ; Neurology ; Springer eBooks
    Pages: : digital
    ISBN: 9782817802206
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  • 21
    Keywords: Medicine ; Gynecology ; Neurology ; Rehabilitation ; Urology ; Medicine & Public Health ; Urology/Andrology ; Gynecology ; Neurology ; Rehabilitation Medicine ; Springer eBooks
    Pages: : digital
    ISBN: 9783642035807
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  • 22
    Keywords: Medicine ; Orthopedics ; Rehabilitation ; Medicine & Public Health ; Orthopedics ; Rehabilitation ; Medicine/Public Health, general ; Springer eBooks
    Pages: : digital
    ISBN: 9783642171772
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  • 23
    Unknown
    London : Springer
    Keywords: Medicine ; Internal Medicine ; Cardiology ; Rehabilitation ; Heart / Surgery ; Medicine & Public Health ; Cardiology ; Rehabilitation ; Cardiac Surgery ; Internal Medicine ; Springer eBooks
    Pages: : digital
    ISBN: 9781848827943
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  • 24
    Keywords: Medicine ; Orthopedics ; Orthopedic surgery ; Rehabilitation ; Medicine & Public Health ; Orthopedics ; Surgical Orthopedics ; Rehabilitation Medicine ; Springer eBooks
    Pages: : digital
    ISBN: 9783642008979
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  • 25
    Keywords: Medicine ; Neurology ; Orthopedics ; Rehabilitation ; Medicine & Public Health ; Rehabilitation ; Orthopedics ; Neurology ; Springer eBooks
    Pages: : digital
    ISBN: 9788847014787
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  • 26
    Keywords: Medicine ; Neurology ; Rehabilitation ; Medicine & Public Health ; Rehabilitation Medicine ; Neurology ; Springer eBooks
    Pages: : digital
    ISBN: 9782817801094
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  • 27
    Keywords: Medicine ; Oncology ; Rehabilitation ; Quality of Life ; Quality of Life / Research ; Medicine & Public Health ; Oncology ; Rehabilitation Medicine ; Quality of Life Research ; Springer eBooks
    Pages: : digital
    ISBN: 9782287795015
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  • 28
    Keywords: Medicine ; Pediatrics ; Rehabilitation ; Psychology, clinical ; Developmental psychology ; Medicine & Public Health ; Rehabilitation Medicine ; Neuropsychology ; Developmental psychology ; Clinical Psychology ; Pediatrics ; Springer eBooks
    Pages: : digital
    ISBN: 9788847015753
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  • 29
    Keywords: Medicine ; Rehabilitation ; Psychology, clinical ; Medicine & Public Health ; Rehabilitation ; Neuropsychology ; Springer eBooks
    Pages: : digital
    ISBN: 9782817800349
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  • 30
    Keywords: Medicine ; Rehabilitation ; Speech pathology ; Curriculum planning ; Medicine & Public Health ; Rehabilitation Medicine ; Speech pathology ; Curriculum Studies ; Springer eBooks
    Pages: : digital
    ISBN: 9788847014152
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  • 31
    Keywords: Medicine ; Emergency Medicine ; Critical care medicine ; Pneumology ; Neurology ; Rehabilitation ; Medicine & Public Health ; Pneumology/Respiratory System ; Intensive / Critical Care Medicine ; Emergency Medicine ; Rehabilitation Medicine ; Neurology ; Springer eBooks
    Pages: : digital
    ISBN: 9788847015487
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  • 32
    Keywords: Medicine ; Orthopedic surgery ; Rehabilitation ; Sports Medicine ; Trauma ; Medicine & Public Health ; Sports Medicine ; Surgical Orthopedics ; Traumatic Surgery ; Rehabilitation ; Medicine/Public Health, general ; Springer eBooks
    Pages: : digital
    ISBN: 9782817800073
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  • 33
    Keywords: Medicine ; Family medicine ; Radiology, Medical ; Neurology ; Rehabilitation ; Medicine & Public Health ; General Practice / Family Medicine ; Neurology ; Neuroradiology ; Rehabilitation Medicine ; Springer eBooks
    Pages: : digital
    ISBN: 9782817800417
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  • 34
    Electronic Resource
    Electronic Resource
    Springer
    Der Gynäkologe 33 (2000), S. 494-502 
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Mammakarzinom ; Zervixkarzinom ; Korpuskarzinom ; Ovarialkarzinom ; Rehabilitation ; Keywords Oncology ; Rehabilitation ; Gynaecological carcinomas ; Physiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract In Germany about 41% of malignant neoplasies of women are carcinomas of mamma, cervix, Corpus uteri and ovary. Therapy of these malignomas consists of surgery, radio-, chemo- or hormonotherapy. Apart from therapeutic effects primary therapy may have negative effects in different physical, psychical and social aspects. These side effects are the concern of stationary oncological rehabilitation. Interdisciplinary cooperation makes it possible to consider the individual requirements of the patient.
    Notes: Zusammenfassung In Deutschland machen das Mamma-, Zervix-, Korpus- und Ovarialkarzinom ca. 41% der malignen Neoplasien bei der Frau aus. Die Behandlung dieser Malignome beinhaltet Operation, Strahlen-, Chemo- oder Hormontherapie. Neben der therapeutischen Wirkung kann es bei den Patientinnen durch die Primärbehandlung auch zu unterschiedlich ausgeprägten Beeinträchtigungen im physischen, psychischen oder sozialen Bereich kommen. An dieser Stelle greift die stationäre onkologische Rehabilitation an, die in interdisziplinärer Zusammenarbeit die individuellen Bedürfnisse der Patientinnen berücksichtigt.
    Type of Medium: Electronic Resource
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  • 35
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Schizophrenie ; Kognitive Therapie ; Kognitive Funktionsstörungen ; Strategieaufbau ; Bewältigung ; Key words Schizophrenia ; Information processing ; Cognitive therapy ; Strategy building ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A critical review of current approaches and principles of cognitive remediation strategies in rehabilitation of schizophrenia is given. Selection of cognitive functions targeted in compensatory training programs could be based on results of neuropsychological predictor research on social and vocational functioning in community and neuropsychological rate limiting factors in rehabilitation. Methodological flaws in data base, missing of task analysis of more complex skills like social perception, social skills and interpersonal problem solving and the lack of evaluation of training generalization on work performance are discussed. Finally the cognitive remediation program developed in the Department of General Psychiatry and Psychotherapy/University of Freiburg, Germany is proposed. The components focused on training in attention, memory, and executive function (decision making, planning). Compensatory strategy building, and computer-mediated automatization are integrated in a group settting.
    Notes: Zusammenfassung In dieser Übersicht werden die aktuellen Trainingsverfahren der spezifischen Rehabilitation kognitiver Funktionsstörungen schizophrener Patienten sowie Kriterien für die Auswahl der Trainingsziele dargestellt. Neuere Arbeiten zur differentiellen Bedeutung für die Prädiktion sozialen und beruflichen Funktionsniveaus sowie für das Rehabilitationspotential können gegenwärtig die Auswahl kognitiver Trainingsziele empirisch legitimieren. Die aktuelle empirische Befundlage wird kritisch diskutiert: fehlende Analyse des kognitiven Anforderungsprofils sozialen und beruflichen Funktionierens, sozialer Wahrnehmung, interpersonellen Problemlösens (task analysis); mangelndes Wissen über Transfervoraussetzungen und ihre Wirkmechanismen sowie über setting-Aspekte, fehlende Regeln für eine Integration in einen verhaltenstherapeutischen Gesamtbehandlungsplan; methodische Mängel: Einfluss von Testwiederholungseffekten, zu kleine Stichproben (power-Defizite: Übersehen statistisch signifikanter Effekte), fehlende a-Adjustierung trotz multiplen Testens und unzureichender Einbezug der Effektgeneralisierung auf rehabilitativ bedeutsame Alltagskontexte. Abschließend wird ein computerunterstütztes Bewältigungstraining in der Gruppe zur Ausweitung des Rehabilitationspotentials vorgestellt, das an der Psychiatrischen Univ.-Klinik Freiburg entwickelt und gegenwärtig an der Abteilung für Klinische und Sozialpsychiatrie, Klinikum Karlsbad Langensteinbach (Ltd. Arzt: Dr. M. Clauß) erprobt wird. Das Training ist strategieorientiert und fokussiert die Bereiche Aufmerksamkeit, verbales Kurz- und Langzeitgedächtnis sowie Handlungsplanung und -organisation/exekutive Funktionen.
    Type of Medium: Electronic Resource
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  • 36
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Stroke Unit ; Schlaganfalltherapie ; Frührehabilitation ; Integratives Behandlungskonzept ; Keywords Stroke Unit ; Acute treatment ; Rehabilitation ; Integrative treatment concept
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The experiences of a rural stroke unit since 1997 are reported. A special referral concept was developed with the emergency services and hospitals of the region. As a result, 35% of patients arrived in the stroke unit within 3 hours after onset of stroke symptoms. This corresponds with the data from larger cities. The major peculiarity of the Günzburg Stroke Unit is that, after emergency diagnostic and therapeutic procedures, 41% of the patients with mainly internistic problems were transferred to another regional hospital and only 40% were admitted to the inpatient stroke unit. Moreover, among these were an above-average proportion of patients with intracerebral hemorrhage (24% of the inpatients in 1998), and complete acute treatment and rehabilitation were carried out in the same hospital according to an integrative treatment concept. Since 1997, the average hospitalization duration decreased from 11.4 days to 5.9 days and the number of patients per month increased to an average of 22.3. The total hospitalization duration – including inpatient rehabilitation – was 33.9 days. All in all, a comparably good stroke treatment thus is possible outside urban regions.
    Notes: Zusammenfassung Die Erfahrungen einer seit 1997 bestehenden Stroke Unit im überwiegend ländlichen Raum werden berichtet. Im Rahmen eines speziellen Zuweisungskonzeptes erreichten 35% der Patienten die Klinik innerhalb von 3 h nach Symptombeginn, was den Angaben aus Ballungszentren entspricht. Wesentliche Besonderheit der Günzburger Stroke Unit ist, dass nach der “präklinischen” Notfalldiagnostik und -therapie 41% der Patienten mit im Vordergrund stehenden internistischen Problemen in die umliegenden Krankenhäuser eingewiesen und nur 40% auf der Stroke Unit aufgenommen wurden. Darüber hinaus wurden relativ viele Patienten mit intrazerebralen Blutungen (24% der stationären Patienten im Jahr 1998) versorgt, und entsprechend einem integrierten Konzept erfolgte die Akutversorgung und Frührehabilitation im Hause. Seit 1997 konnte die durchschnittliche Verweildauer auf der Stroke Unit von zunächst 11,4 auf 5,9 Tage verkürzt werden bei gleichzeitigem Anstieg der Fallzahl auf 22,3 Patienten/Monat. Die Gesamtverweildauer einschließlich Frührehabilitation lag bei 33,9 Tagen. Die Erfahrungen belegen, dass auch außerhalb von Ballungszentren eine gut vergleichbare Schlaganfallversorgung möglich ist.
    Type of Medium: Electronic Resource
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  • 37
    ISSN: 1433-7347
    Keywords: Key words Anterior cruciate ¶ligament ; Screening examination ; Rehabilitation ; Knee injuries
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract This report describes the development and current use of decision-making criteria for returning patients to high-level physical activity with nonoperative management of anterior cruciate ligament ruptures, and presents the results of treatment for patients who met our criteria as candidates for nonoperative rehabilitation and attempted to return to high-level physical activity with nonoperative management. The screening examination consists of four one-legged hop tests, the incidence of knee giving-way, a self-report functional survey, and a self-report global knee function rating. We screened 93 consecutive patients with acute unilateral anterior cruciate ligament rupture, classifying them as either candidates (n = 39, 42%) or noncandidates (n = 54, 58%) for nonoperative management. Of the 39 rehabilitation candidates 28 chose nonoperative management and returned to preinjury activity levels, 22 of whom (79%) returned to preinjury activity levels without further episodes of instability or a reduction in functional status. No patient sustained additional articular or meniscal damage as a result of rehabilitation or return to activity. The decision-making scheme described in this study shows promise in determining who can safely postpone surgical reconstruction and temporarily return to physically demanding activities. Continued study to refine and further validate the decision-making scheme is recommended.
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  • 38
    ISSN: 1433-7347
    Keywords: Key words Knee injury ; Patellar dislocation ; Isokinetic testing ; Muscle performance ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Eighty-two patients (50 women, 32 men) underwent isokinetic muscle testing on average 13 years after a conservatively treated unilateral primary patellar dislocation. Three study groups were formed according to the natural history of recovery: group A (n = 32), patients with only primary conservative treatment; group B (n = 34) patients with conservative (group B1; ¶n = 24) or surgical (group B2; n = 10) treatment of redislocations; group C (n = 16) patients with other residual complaints (anterior knee, pain subluxations) requiring surgery. The Cybex 6000 dynamometer system was used as the testing machine for quadriceps and hamstrings muscles, with proportional deficits of peak torque as the test parameter. Isokinetic testing revealed both quadriceps and hamstring muscle atrophy even after long-term recovery from injury. There were statistically significant differences between the three study groups at both tested speeds of quadriceps muscles ¶(60 rad/s, P 〈 0.002; 180 rad/s, ¶P 〈 0.009). Groups B1 and B2 presented similar results. The muscle performance findings are probably due to more than one factor: primary immobilization, poor outcome, patellofemoral degeneration, redislocations, and residual knee complaints followed by surgery and deficiency in motor control of thigh muscle had – together or separately – an effect on muscle performance.
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  • 39
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Intensivmedizin ; Lebensqualität ; Polytrauma ; Langzeitergebnisse ; Rehabilitation ; Keywords Quality of life ; Intensive care ; Multiple trauma ; Long-term outcome ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Introduction. Long-term treatment in surgical intensive care units (SICU) subjects the patient to a high degree of somatic, psychological, and social stress. The aim of this study was to determine their outcome in terms of quality of life and health status. Methods. All patients from a 4-year period in a SICU with a length of stay (LOS) of 30 days or more were included. All survivors were interviewed and examined after 35±14 months; they also completed several questionnaires (Munich Inventory for Quality of Life and Health Status, POMS, and Spitzer Quality of Life Index). Results. One hundred one patients fulfilled the inclusion criteria, and 46 survived until follow-up. Forty-one (89%) could be traced and examined. Male:female ratio was 31:10, age 42±17 years, and LOS 51±19 days, Diagnoses on admittance were multiple trauma (n=32) and other (n=9). When classifying patients according to physical impairment, one third each showed no, mediocre, or severe limitations. Subjective appraisal of quality of life and well-being was sufficient for about half the patients in every test. Trauma victims experienced more severe impairment of quality of life. There were no differences between sex, age, or time until follow-up. Conclusion. After prolonged SICU treatment, about half of the patients report limitations in their quality of life as a result of their illness and the subsequent treatment. Some patients, in particular after trauma, exhibit striking psychosocial problems despite satisfactory somatic treatment results. These problems can be positively addressed in rehabilitative efforts.
    Notes: Zusammenfassung Fragestellung. Die Langzeitbehandlung auf Intensivstationen (ICU) bedeutet eine erhebliche somatische, psychische und soziale Belastung für die Patienten. Um die Ergebnisse im Langzeitverlauf beurteilen zu können, wurden nach der Entlassung Lebensqualität und Gesundheitszustand von Überlebenden untersucht. Methodik. Alle Patienten, die während eines 4 Jahres Zeitraumes auf einer operativen ICU mindestens 30 Tage in Behandlung gewesen waren, wurden in die Untersuchung eingeschlossen. Die Überlebenden wurden 35±14 Monate nach der Entlassung körperlich untersucht und ausführlich befragt. Zur Anwendung kamen außerdem Selbst- und Fremdbeurteilungsskalen (Münchner Inventar für Lebensqualität und Gesundheit, POMS, Spitzer Quality-of-life-Index). Ergebnisse. 101 Patienten wurden mindestens 30 Tage behandelt. Die Mortalität bis zur Nachuntersuchung betrug 55%. Von den 46 verbleibenden Patienten konnten 41 (89%) untersucht werden (m/w=31/10; Alter 41,6±17,2 Jahre; Liegedauer 51±19 Tage; Diagnosen: Trauma n=32, andere n=9). Je ein Drittel der Patienten zeigten keine, mittlere oder schwere körperliche Beeinträchtigungen. Lebensqualität und Gesundheit wurden von ca. der Hälfte, unabhängig vom Testverfahren, als zufriedenstellend beurteilt. Traumapatienten waren in allen Bereichen stärker belastet. Es zeigte sich keine Abhängigkeit von Alter, Geschlecht und Zeitraum bis zur Nachuntersuchung. Schlussfolgerungen. Patienten nach Langzeitintensivbehandlung weisen etwa zur Hälfte deutliche Einschränkungen ihrer Lebensqualität auch als Folge der Erkrankung oder Behandlung auf. Besonders Traumapatienten geben trotz somatisch zufriedenstellender Behandlungsergebnisse erhebliche Probleme im psychosozialen Bereich an, die rehabilitativen Maßnahmen zugänglich sind.
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  • 40
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Vordere Kreuzbandruptur ; Lig.-patellae-Transplantat ; Rehabilitation ; Physiotherapie ; Krafttraining ; Keywords Anterior cruciate ligament ; Rehabilitation ; Physiotherapie ; Muscle strengthening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: In a prospective randomized study, all 133 consecutive ACL ruptures, operated by two experienced surgeons in 1997, were assessed in terms of the benefit derived from four different rehabilitation programs. In all cases an arthroscopically assisted autogenous bone-patellar tendon–bone technique was used. The following four rehabilitation programs were compared: (1) a simple home-based program; (2) home-based program plus physiotherapy for a period of 12 weeks postoperatively; (3) home-based program plus a muscle strengthening program for a period of 3 months, starting 3 months postoperatively; and (4) home-based program plus physiotherapy plus muscle strengthening program (as detailed in 1 and 3 above). Clinical assessments and controls were conducted at 6 and 12 weeks. At 6 months, in addition, an isometric muscle strength measurement (MedX) concerning extension and flexion, comparing the affected leg with the unaffected leg, was applied. The results of these assessments are consistently the same in all four groups: 6 months postoperatively, loss of muscle strength in extension was 50%. No apparent benefit could be detected from either physiotherapy or muscle strengthening or from the combined application of those methods as compared to the home-based program. In conclusion, our investigation shows that a simple home program, supervised by the surgeon, leads to highly satisfactory results in virtually all cases.
    Notes: In einer prospektiven, randomisierten Studie wurden alle 133, während des Jahrs 1997 mittels autologem Lig.-patellae-Transplantat durch 2 erfahrene Chirurgen versorgten vorderen Kreuzbandrupturen in 4 verschieden intensive postoperative Rehabilitationsgruppen eingeteilt. Anhand von protokollierten Verlaufskontrollen nach 6 Wochen, 3 Monaten und 6 Monaten wurde die Effizienz der 4 Rehabilitationsprogramme überprüft. Zusätzlich zum einfachen, durch den Operateur kontrollierten Heimprogramm verordnete Physiotherapiesitzungen vermochten den Frühverlauf nicht zur verbessern. Vergleichende, isometrische Kraftmessungen des operierten gegenüber dem unverletzten Bein (MedX) zeigten in allen 4 Gruppen eine Kraftdifferenz von ungefähr 50% bezüglich der Extension nach 6 Monaten. Auch ein intensives Krafttraining im Zeitraum 3–6 Monate postoperativ vermochte das Kraftdefizit am operierten Bein nicht zu verkleinern. Aufgrund unserer Untersuchungsergebnisse von 4 verschiedenen Rehabilitationsprogrammen nach vorderer Kreuzbandrekonstruktion mit autologem Lig.-patellae-Transplantat, arthroskopisch assistiert, erachten wir in der Regel ein einfaches, vorzugsweise durch den Operateur kontrolliertes Nachbehandlungsschema, in Eigentherapie als Heimprogramm absolviert, zum fristgerechten Erreichen eines guten Operationsresultats für ausreichend.
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  • 41
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    Springer
    Arthroskopie 13 (2000), S. 186-190 
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Revisionseingriffe ; Rotatorenmanschettenläsion ; Ultraschall ; Rehabilitation ; Keywords Revision operations ; Rotator cuff tears ; Ultrasound ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Twenty-four consecutive patients (14 male, 10 female, average age 58 years, 40–73 years) were included in the study during their stationary rehabilitation program. They were examined clinically and by ultrasound an average of 32 days (18–50 days) after operation. Anamnestic and clinical findings did not reveal a clear suspicion of a re-tear. All of the patients showed considerable morphologic and structural sonographic alterations of the rotator cuff. Reliable sonographic signs concomitant with a tear were seen in 18 patients, in 16 cases within the supraspinous muscle. We found 8 type II, 11 type III, and 6 type IV images. Only two of the patients undergoing a revision operation due to a subcutaneous necrosis had changes of blood patterns. Whereas the sonographic criteria for primary tears of the rotator cuff are well defined, re-tears pose real diagnostic problems, especially in case of lack of an earlier postoperative control. Only the lack of sonographic imaging of the rotator cuff compared to earlier postoperative sonographic findings allows a reliable diagnosis of a re-tear, because other pathologic alterations of form and echogenicity are common preoperatively. Owing to this, we recommend an early postoperative ultrasound control as a basic finding, enabling a sufficient control in the further course of rehabilitation.
    Notes: In der Anschlussheilbehandlung nach Eingriffen an der Rotatorenmanschette wurden 24 konsekutive Patienten [14 Männer, 10 Frauen, Durchschnittsalter 58 Jahre (40– 73 Jahre)] durchschnittlich 32 Tage (18–50 Tage) postoperativ klinisch und sonographisch untersucht. Anamnestisch und klinisch waren keine eindeutigen Hinweise auf Rezidivläsionen zu finden. Alle Patienten zeigten erhebliche morphologische und strukturelle Ultraschallveränderungen der Rotatorenmanschette. Sichere sonographische Rupturzeichen fanden sich bei 18 Patienten, davon 16-mal im Bereich des M. supraspinatus. Typ-II-Bilder wurden 8-mal, Typ-III-Bilder 11-mal und Typ-IV-Bilder 6-mal gefunden. Nur jene 2 Patienten, die aufgrund einer subkutanen Nekrosebildung revidiert werden mussten, zeigten Auffälligkeiten der Laborwerte. Während die sonographischen Kriterien für die Diagnose einer primären Rotatorenmanschettenruptur klar definiert sind, stellen Rerupturen den Untersucher vor erhebliche Probleme, insbesondere, wenn frühere postoperative Vergleichsbefunde fehlen. Nur die im Vergleich zu Vorbefunden fehlende sonographische Darstellung der Rotatorenmanschette erlaubt die sichere Diagnose einer Reruptur, da in der Regel bereits präoperativ pathologische Veränderungen der Form und Echogenität der Rotatorenmanschette häufig sind. Daher ist eine frühe postoperative Ultraschalluntersuchung als Basisbefund zu empfehlen, um eine Verlaufskontrolle zu ermöglichen.
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  • 42
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Knietrauma ; Propriozeption ; Neuromuskuläre Veränderungen ; Koordination ; Rehabilitation ; Keywords Knee trauma ; Proprioception ; Neuromuscular alterations ; Coordination ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Despite some alterations of receptor thresholds after knee trauma and surgical treatment joint receptors provide the prerequisites for correct proprioception. The peripheral afferent pathway, the spinal and central stimulus processing and the peripheral efferent pathway are intact. Alterated peripheral sensory perception is caused by the knee trauma induced change of proprioception. A reduction of absolute torque, active range of movement, modified muscle selection and delay in neuromuscular latency time are observed. Postoperative exercise should enable the patient to gather positive sensory experience enclose to activities of daily living.
    Notes: Nach Knietraumen und operativer Versorgung sind die Voraussetzungen zur korrekten Propriozeption gegeben. Der peripher-afferente Schenkel, die spinale und zentrale Reizverarbeitung sowie der peripher-efferente Schenkel sind nach Kniebinnentraumen und -operationen intakt. Veränderte peripher-sensorische Wahrnehmungen (Afferenzen) sind durch das Knietrauma bedingt. Es kommt zu einer Reduktion des absoluten Krafteinsatzes und der aktiven Beweglichkeit, zu einer Veränderung der Muskelselektion sowie zu Verlängerungen neuromuskulärer Reaktionszeiten. Postoperative Übungen müssen es dem Patienten ermöglichen, alltagsnahe positive sensorische Erfahrungen zu sammeln.
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  • 43
    ISSN: 1614-7456
    Keywords: Rehabilitation ; Robotics ; User interface ; Simulation ; Haptics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science
    Notes: Abstract Advances in software, computing, control architectures, and design practice have led to rehabilitation robots with high-bandwidth, bidirectional user interfaces that allow people to interact with mechatronic systems in highly realistic, cognitively and biomechanically coupled scenarios. Immersive and graphic interfaces to real-time systems such as robots require, robust control environments and high-speed computing to provide safe, human-scale motions and interfaces with sufficient quality to be usable in functional environments. This paper illustrates some emerging applications in rehabilitation, spanning assistive technology, simulation/design aids, and smart therapy devices. Examples will be drawn laregly from work done at the VA Palo Alto Rehabilitation R&D Center.
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  • 44
    ISSN: 1614-7456
    Keywords: Rehabilitation ; Robotics ; Independence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science
    Notes: Abstract The Handy 1 was developed in 1987 by Mike Topping to assist an 11-year-old boy with cerebral palsy to eat unaided. The system is the most successful low-cost, commercially available robotic system in the world to date, and is capable of assisting the most severely disabled with several everyday functions such as eating, drinking, washing, teeth-cleaning, shaving, and make-up application. This paper charts the development of the system, gives an overview of some individual Handy 1 studies, and also looks at the development of the robotic aid to independent living (RAIL) system funded by the European Commission BIOMED II program.
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  • 45
    ISSN: 0044-281X
    Keywords: Schlüsselwörter Neue Medien ; Telematik ; Tele-Reha ; Telemedizin ; Rehabilitation ; Geriatrie ; Altenhilfe ; Key words Telematics ; telerehabilitation ; telemedicine ; rehabilitation ; geriatrics ; health services for the aged
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Modern telecommunication technology (telematics) has the potential to improve the quality of life for elders with physical and mental impairments as well as for their care giving relatives. Videophones, internet resources, and multimedia computers can be used for networking them together with social workers, nurse practitioners, physicians and therapeutic staff in service-centers. This can be viewed as a unique opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Some studies already showed its applicability and feasibility, but there are still no larger trials showing that maintenance or enhancement of autonomy can be achieved effectively by using new technologies.    This article reviews the literature on telematics in geriatrics and presents data of a tele-rehabilitation project (“TeleReha”, conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients (N=13, mean age 72 yrs), care giving relatives (N=8), and geriatric professionals. Networking was established using ISDN technology with videophones or PC-based videoconferencing systems. Results showed that participants regard telecommunication devices as a valuable resource for their informational and communicational needs. Use of telecommunication systems was inversely related to physical mobility. Having access to professional service and counselling was rated highly important but also the opportunity to establish reliable contacts with non-professionals (relatives, other participants). Despite experienced technical problems, use of telecommunication systems was evaluated more positively in the post-test as compared to the pre-test.    In summary, current experience suggests that telematics can be used efficiently by geriatric patients and by relatives and professionals caring for them. However, evidence for a medically and economically effective use is still scarce. A lack of structural and organizational concepts for geriatric telematics initiatives can be identified which in part may be due to the fact that the considerable potentials of telematics applications are still largely unrecognized by geriatricians.
    Notes: Zusammenfassung Die Darstellung der modernen Kommunikations- und Informationstechnologie in den Medien verspricht auch älteren Menschen eine Chance zur Verbesserung der Lebensqualität. Mit „Neuen Medien” wie Bildtelefon oder PC, dem Internet und der elektronischen Post können geriatrische Patienten mit Beratungseinrichtungen, Ärzten, Therapeuten oder Pflegekräften, aber auch ihren eigenen Angehörigen oder Selbsthilfeeinrichtungen so vernetzt werden, dass sie bildgestützt kommunizieren und Informationen elektronisch erhalten oder übermitteln können. In der vorliegenden Arbeit wird untersucht, ob Versorgungsstrukturen in der Altersmedizin und Altenhilfe durch moderne Informations- und Kommunikationstechnologie („Telematik”) sinnvoll ergänzt oder sogar substituiert werden können. Trotz einer Vielzahl von Untersuchungen zur Telemedizin und zu Telematikanwendungen existieren nur wenige Studien, die eine Eignung für geriatrisch-rehabilitative Belange belegen. Eigene Anwendungserfahrungen aus einem geriatrischen Telematik-Projekt („TeleReha”) am Evangelischen Geriatriezentrum Berlin, in dem geriatrische Patienten und deren Angehörige mit professionellen Kräften aus dem Geriatriezentrum unter der Maßgabe des Erhalts eines Rehabilitationserfolges vernetzt wurden, zeigen aber, dass Telematik-gestützte Dienste von geriatrischen Patienten und deren Angehörigen als eine wertvolle zusätzliche Ressource angesehen werden, wenn sie mit einem qualifizierten Dienstleistungskonzept einhergehen. Abschließend werden die Potentiale, aber auch die Probleme von Telematikanwendungen in der Geriatrie diskutiert. Obwohl sich ein Bedarf beim geriatrischen Klientel identifizieren lässt, fehlt es in der Geriatrie noch an Initiativen, die notwendigen Konzepte und tragfähige Strukturen zu entwickeln. Das beachtliche Potential der telematischen Anwendungen für Geriatrie und Altenhilfe wird noch zu wenig beachtet. Gerade die Geriatrie kann und muss hier ihre spezifische Expertise einbringen, über die andere Disziplinen nicht gleichermaßen verfügen.
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  • 46
    ISSN: 1615-6722
    Keywords: Schlüsselwörter Koronare Herzerkrankung ; Perkutane transluminale Koronarangioplastie (PTCA) ; Angina pectoris ; Lebensqualität ; Anschlußheilbehandlung ; Key words Coronary artery disease ; Percutaneous transluminal coronary angioplasty (PTCA) ; angina pectoris ; Quality of life ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: Quality control becomes increasingly important in interventional cardiology. Since in most health care systems, clinical treatment of patients who underwent percutaneous transluminal coronary angioplasty (PTCA) is left to general practitioners, important information on the clinical long-term outcome is lost for the cardiologic centers. Aim of this study was to evaluate the clinical status of these patients 4 years after treatment with a PTCA at our institution. Patients and Methods: Inclusion criterion was the treatment with a PTCA within July 1, 1989 to June 30, 1991 (549 Patients). A questionnaire was sent to all patients (45±7 months after PTCA). Four time-points were defined: before PTCA (T1), directly after PTCA (T2), 3 months after PTCA (T3) and actual status (T4). Results: Questionnaires of 500/549 (91,1%) patients could be analyzed. One-hundred and fifteen patients (23%) had to undergo reinterventions: 69 (13.8%) had a re-PTCA and 46 (9.2%) patients an operative revascularization. At T4, 11.2% patients still had disturbing angina. Within the study period 35 patients (7%) died. Two-hundred and nineteen patients attended a rehabilitation institution. At T4, the amount of patients with little angina was not different comparing patients with/without the attendance of a rehabilitation institution (60.7% vs 66.4% p = 0.29). The rate of new pensioners after PTCA (n = 114 [22.8%] was higher in the group of patients who attended a rehabilitation (68 patients [13.6%] with vs 48 patients [9.2%] without attendance, p = 0.0036). The attendance of a rehabilitation institution, however, had positive effects on changes of the life stile and eating habits. Conclusions: This retrospective inquiry was found to be a useful tool (response rate 91.1%) for quality control in interventional cardiology. Important information concerning the quality of the interventions (low reintervention rate) and the long-term outcome of our patients (low rate with severe angina at T4) could be aquired.
    Notes: Zusammenfassung Hintergrund: Die Qualitätskontrolle gewinnt in der interventionellen Kardiologie zunehmend an Bedeutung. Da aber die Nachbetreuung von Patienten, die mit einer perkutanen transluminalen Koronarangioplastie (PTCA) behandelt wurden, meist durch die jeweiligen Hausärzte durchgeführt wird, gehen dem kardiologischen Zentrum wichtige Informationen hinsichtlich des klinischen Langzeitverlaufs verloren. Ziel dieser retrospektiven Studie war daher, den klinischen Status dieser Patienten vier Jahre nach der Behandlung mit einer PTCA an unserer Institution zu untersuchen. Patienten und Methode: Einschlußkriterium war die Behandlung mit einer PTCA im Zeitraum vom 1.7.1989 bis 30.6.1991 (549 Patienten). Zur Erhebung der Langzeitergebnisse (45±7 Monate nach PTCA) wurde den Patienten ein Fragebogen zugesandt. Vier Erhebungszeitpunkte wurden definiert: vor PTCA (T1), direkt nach PTCA (T2), drei Monate nach PTCA (T3) und zum Erhebungszeitpunkt (T4). Ergebnisse: Fragebögen von 500/549 (91,1%) Patienten kamen zur Auswertung. 115 (23%) Patienten mußten sich einer Reintervention unterziehen (PTCA: 69 Patienten [13,8%], aortokoronare Venen-Bypass-(ACVB-)Operation: 46 Patienten [9,2%]). Zu T4 hatten 11,2% Patienten stärkere Angina-pectoris-Beschwerden. 35 Patienten (7%) waren im Erhebungszeitraum verstorben. 219 Patienten (52%) nahmen an einer Anschlußheilbehandlung teil. Zu T4 waren diese Patienten nicht häufiger beschwerdefrei als Patienten ohne Anschlußheilbehandlung (60,7% vs. 66,4%, p = 0,29). Der Anteil der nach Intervention neu berenteten Patienten (n = 114 [22,8%] war in der Gruppe mit Anschlußheilbehandlung höher (68 Patienten [13,6%] mit Anschlußheilbehandlung vs. 46 Patienten [9,2%] ohne Anschlußheilbehandlung, p = 0,0036). Positiven Einfluß hatte die Teilnahme an einer Anschlußheilbehandlung auf Änderungen des Lebensstils und der Eßgewohnheiten. Schlußfolgerung: Diese retrospektive Befragung erwies sich als sinnvoll (Antwortrate 91,1%), um Daten zur Qualitätskontrolle zu erheben. Wichtige Informationen sowohl hinsichtlich der Qualität der Koronarinterventionen (niedrige Reinterventionsrate) als auch hinsichtlich des klinischen Langzeitverlaufs (niedriger Anteil von Patienten mit schwerer Symptomatik nach vier Jahren) konnten hierdurch gewonnen werden.
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  • 47
    ISSN: 1573-7217
    Keywords: bone metastases ; breast cancer ; clinical course ; localization of metastases ; prognosis ; therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although metastasis is a frequent event in breast cancer patients, insight into the clinical course, prognosis and therapy with respect to the site of the first metastases has been poor and contradictory in former investigations. Follow-up data from 648 patients with metastatic breast cancer were statistically analyzed. Patients with bone metastases at first relapse had better overall survival (median 71 vs. 48 months; p〈0.001) and survival after first metastases (median 24 vs 12 months; p〈0.001) than patients with visceral metastases at first relapse. Bone was the site of first metastasis in 46%, and 71% of patients with metastatic breast cancer developed bone metastases. The localization of the second metastatic site was of prognostic relevance in patients with first visceral metastases, but not in patients with first bone metastases. The presence of osseous metastases correlated significantly with estrogen and progesterone receptor positivity, tumor grading I/II and S-phase fraction 〈5%. The better prognosis of patients with bone metastases is not determined exclusively by hormone receptor status. The disease is significantly more stable in patients with first bone metastases than in those with first visceral metastases.
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  • 48
    ISSN: 1573-7217
    Keywords: breast cancer ; cellular immunity ; β2-microglobulin ; sIL-2r ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The association of known prognostic factors with immune cell counts and β2-microglobulin and soluble IL-2 receptor (sIL-2r) serum levels as markers of activation of the immune system was investigated in breastcancer. Methods: Two hundred thirty five operated stage I and II breast cancer patients to receive adjuvant treatment in IBSCG trials were assessed in a cross-sectional study immediately before the first treatment. Leukocytes, lymphocytes and lymphocyte subset counts, β2-microglobulin and sIL-2r serum levels were assessed as immunological parameters. Prognostic factors were tumor load, receptor status, patient characteristics, and contextual factors of the immune assessment (such as time of the day, time since surgery, type of surgery, concomitant medication, co-morbidity). Results: In an operated early stage breast cancer patient population, tumor load was not associated with immune cell counts, β2-microglobulin, or sIL-2r before adjuvant treatment. There was a pattern of association of prognostically favorable factors such as estrogen receptor (ER) positive tumor and older age with higher NK cell counts or with β2-microglobulin or sIL-2r. In addition, immune cell counts and the markers of activation of the immune system were affected by several contextual factors, such as diurnal variability, time since surgery, type of surgery, and the intake of concomitant medication. Conclusions: The association of NK cell counts and β2-microglobulin or sIL-2r serum levels with prognostically favorable factors such as ER positive tumor and older age supports the assumption that the immune system plays a role in the course of early breast cancer. The exact nature of this role requires furtherstudy.
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  • 49
    ISSN: 1573-7217
    Keywords: breast cancer ; bcg-1 ; L19 ; L34 ; MAGE-like ; MLN70 ; subtractive hybridization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A number of approaches have been used to identify genes important in breast cancer. In one approach the genes already shown to be involved in other tumors, such as p53 and Her2neu, were examined. A second approach examined genes detected through genetic screening of families with a high incidence of breast cancer, for example, BRCA-1 and BRCA-2. We used a third approach, subtractive hybridization, to identify and clone genes that were preferentially expressed in breast cancer cells compared to normal mammary epithelium. Instead of analyzing breast cancer cell lines, we examined fresh human breast cancer specimens. By subtracting normal mammary epithelial cDNA from breast cancer cDNA, we were able to clone several genes overexpressed in breast cancer. Two of these genes, L19 and MLN70, were previously reported to be overexpressed in breast cancer. Three of these genes, L19, L34, and MLN70, were localized to a region on chromosome 17 where Her2/neu and BRCA-1 are found. In addition, we isolated a gene we call breast cancer associated gene-1 that was expressed almost exclusively in fresh breast cancer tissue and not in normal mammary epithelium or breast cancer cell lines. We were unable to detect expression of breast cancer associated gene-1 in cell lines from melanoma, renal cell carcinoma, lymphoma, or leukemia. The full-length sequence from two separate breast cancer specimens revealed one amino acid difference compared to the sequence from normal breast epithelial tissue. Further studies are necessary to determine whether these genes contribute to breast cancer development or can be used as therapeutic targets.
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  • 50
    ISSN: 1573-7217
    Keywords: axillary lymphnode metastasis ; breast cancer ; 111In-pentetreotide ; receptor autoradiography ; somatostatin receptors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We conducted a prospective analysis of somatostatin receptor scintigraphy using 111In radiolabeled pentetreotide, a somatostatin analog, in patients with breast cancer in the aim to visualize the primary tumor and axillary or parasternal metastatic extension because some malignant breast tumors express somatostatin receptors (SS-R) in 50%, approximately. An analysis of SS-R was performed by autoradiography. Patients and methods.Thirteen patients with clinically suspected breast tumors (T1, T2), and at least one palpable axillary node (N1) were included. In vivo planar scintigrams were acquired 1, 4, and 24 h after subcutaneous, then after intravenous injections (24 h delay between injections). Improved 111In-pentetreotide uptake in invaded nodes after subcutaneous injection was hypothesized. Ex vivo scintigrams of surgical specimens were also acquired immediately after tumor resection and axillary dissection. Pathological examination and receptor autoradiography were performed on all surgical specimens. Results.Among 11 pathologically proven malignant tumors (9 ductal and 2 lobular carcinomas), only four were scintigraphically visible although six expressed SS-R receptors in vitro. Among six pathologically proven malignant nodes, four expressed SS-R, including two visualized scintigraphically. Scintigrams acquired after subcutaneous injections were less sensitive than after intravenous injections. There were no false positive. False negatives occurred in cases with small tumors with low-density or heterogeneously distributed SS-R. There was no significant difference by histological type or prognostic factors. Conclusion.Somatostatin receptor scintigraphy does not appear to be sensitive enough to evaluate axillary node extension of breast cancer or even to confirm the presence of tumoral tissue, and this whatever the administration route for 111In-pentetreotide.
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  • 51
    ISSN: 1573-7217
    Keywords: ataxia telangiectasia ; ATM ; breast cancer ; mutation screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Based upon the results of several epidemiologic studies, it has been suggested that women who are carriers for a mutation in the ataxia telangiectasia-mutated (ATM) gene are susceptible for the development of breast cancer. Therefore, 37 consecutive breast cancer patients were screened for the presence of a germline ATM mutation using a non-isotopic RNase cleavage-based assay (NIRCA). This paper reports the first use of NIRCA for detection of ATM mutations in breast cancer patients. Using this assay, no ATM mutations were found in our patient population. This result is similar to the findings of other studies that have employed approaches complementary to NIRCA.
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  • 52
    ISSN: 1573-7217
    Keywords: breast cancer ; p21WAF1/CIP1 ; p53 ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract p21WAF1/CIP1 is transcriptionally activated by wt p53 and inhibits G1 associated cyclins, a major mechanism by which p53 inhibits cellular proliferation. Archival breast cancers (798) with a median follow-up of 16.3 years were used to explore the prognostic value of p2l immunohistochemical analyses. p21 immunostaining was detected in the majority (726/798: 91%) of breast cancers as well as adjacent in situ carcinomas (125/170: 74%), hyperplastic lesions (140/349: 40%) and normal breast epithelium adjacent to carcinoma (3/89: 3%). Complete immunonegativity was observed in only 9% of invasive cancers and was associated with p53 immunopositivity (p〈0.05). Univariate analysis of all patients showed that p21 negativity was associated with a longer disease specific survival (relative risk (RR) 1.5). Node positive p21 – patients also showed a longer disease free and disease specific survival as compared to tumor p21+ patients. In node negative patients, p53 positivity but not p21 alone, was significantly associated with a shortened disease free survival (RR = 1.6). Node negative patients who were p53 + p21−, in particular had the shortest disease free survival compared to other p53, p21 subgroups (i.e., p21 negativity was associated with a worse outcome). Multivariate analysis of lymph node negative patients (n〉300) demonstrated that tumor size and tumor grade were independently predictive of outcome, whereas neither p53 nor p21 were significant. For node positive patients, p21 positivity (p=0.05), p53 positivity (p=0.03), a higher number of positive nodes, larger tumor size, steroid receptor negativity, high proliferation rate, and erbB-2 expression were each independently associated with poor outcome. In summary, p21 negativity was inversely correlated with p53 immunopositivity in the majority of cases. p21 negative tumor patients had an improved outcome if they were node positive, whereas p21 status was not significantly associated with survival in node negative patients. This observation may be due to the reported ‘uncoupling of S phase and mitosis’ associated with a loss of p21 expression which may result in enhanced sensitivity to chemotherapy.
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    ISSN: 1573-7217
    Keywords: breast cancer ; intravenous digital subtraction angiography ; axillary lymph node metastasis ; neovascularization of lymph nodes ; microvascular density ; antibody to platelet/endothelial cell adhesion molecule
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Accurate predication of axillary node status by non-invasive diagnostic method would be of great value in cases of breast cancer. There have been few reports advocating digital subtraction angiography (DSA) as specifically advantageous for the detection of lymph node metastasis. IV (intravenous)-DSA was carried out on 42 patients with breast carcinoma using a DSA system with a matrix of 1024 × 1024×pixels. When a mass became stained in the axilla, it was considered to be metastatic. An immunohistochemical technique with JC70 antibody to platelet/endothelial cell adhesion molecules was used to evaluate the microvascular density (MVD) of the axillary lymph nodes. IV-DSA achieved a 76.2% sensitivity, 85.7% specificity, and 81.0% accuracy. The average MVD with JC70 antibody was 97.7 ± 44.4 in metastatic and 62.9 ± 23.6 in nonmetastatic nodes. MVD was significantly higher in the cancerous than in the noncancerous regions within lymph nodes. The MVD was 105 ± 38.4 in DSA-N(+) cases and was 57.8 ± 21.9 in DSA-N(−) cases, and the difference was statistically significant. In conclusion, IV-DSA is a useful diagnostic modality for detection of axillary lymph node metastasis. This new modality predicts lymph node status by assessing the neovascularization of the lymph node.
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