[Show abstract][Hide abstract] ABSTRACT: Cranial migration of shoulder hemiarthroplasties due to rotator cuff insufficiency typically requires conversion into a reverse total shoulder arthroplasty. This study was conducted to analyze differences between the height and offset of six implants designed to enable conversion of a hemiarthroplasty into a reverse system.
Archives of Orthopaedic and Trauma Surgery 11/2014; · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: The present prospective study investigated the influence of the static ulnar variance on the success of arthroscopic debridement of degenerative TFCC lesions. Patients and Methods: 10 patients with an ulnar positive variance ("Ulna+") and 12 patients with ulnar neutral or ulnar negative variance ("Ulna-/0") were examined preoperatively (U0), as well as at 2 (U2) and 6 (U6) months after arthroscopic debridement of degenerative TFCC le-sions and compared with each other. After the U2 investigation due to persistent complaints in 9 of 10 patients with an ulnar positive variance there was a need for further surgery, consisting of ulnar shortening osteotomy (USO). The following parameters were recorded in each case: pain at rest and with load, the summed wrist range of motion - consisting of extension and flexion, radial and ulnar deviation, pronation and supina-tion - compared to the contralateral side, the strength of the affected hand compared to the contralateral side, the Mayo modified wrist score (MMWS), the Krimmer score and the DASH score. Preoperatively there were no significant differences between the 2 cohorts "Ulna+" and "Ulna-/0" except for the characteristic "pain at rest". Results: At 2 months postoperatively (U2), the results in the cohort "Ulna+" remained at a significantly or tendentially poorer level compared to the cohort "Ulna-/0". The subsequent surgical treatment of the subgroup "Ulna+" with USO led to almost complete approximation of the results at 6 months postoperatively (U6). In addition to this, with time (U6) within each subgroup there were tendential or significant improvements of all characteristics compared to the preoperative situation (U0). At U6 four of 22 patients were -unable to work. Conclusion: Degenerative lesions of the TFCC can be treated successfully by arthroscopic debridement in cases of ulnar negative and ulnar neutral variance. Patients with ulnar positive variance and persistent complaints after debridement of the TFCC can be treated successfully with a secondary ulnar shortening osteotomy.
[Show abstract][Hide abstract] ABSTRACT: We compared a dermoglandular rotation flap (DGR) in the upper inner, lower inner, and upper outer quadrant regarding similar aesthetic results, patient satisfaction, and comfort after breast-conserving therapy with standard segmentectomy (SE). Between 2003 and 2011, 69 patients were treated with breast-conserving surgery using DGR for cancers with high tumor-to-breast volume ratios or skin resection in the three above mentioned quadrants; 161 patients with tumors in the same quadrants were treated with SE. The outcome of the procedures was assessed at least 7 months after completed radiation therapy using a patient and breast surgeon questionnaire and the BCCT.core software. Symmetry, visibility of the scars, the position of the nipple-areola complex, and the appearance of the treated breast were each assessed on a scale from 1 to 4 by an expert panel and by the patients. Univariate and multivariate analysis were used to evaluate the relationship between patient-, tumor-, and treatment-dependent factors and patient satisfaction. 94.2% of the patients with rotation flaps and 83.5% of the patients with lumpectomy were very satisfied with the cosmetic appearance of their breast. Younger patient age was significantly associated with a lower degree of satisfaction. DGR provides good cosmetic results compared with SE and shows high patient satisfaction despite longer scarring and higher median resection volume.
International journal of breast cancer. 01/2014; 2014:152451.
[Show abstract][Hide abstract] ABSTRACT: The haemolytic uraemic syndrome (HUS) is the most frequent cause of acute renal failure in childhood. We investigated L-arginine/NO pathway in 12 children with typical HUS and 12 age-matched healthy control subjects. Nitrite and nitrate, the major NO metabolites in plasma and urine, asymmetric dimethylarginine (ADMA) in plasma and urine, and dimethylamine (DMA) in urine were determined by GC-MS and GC-MS/MS techniques. Urinary measurements were corrected for creatinine excretion. Plasma nitrate was significantly higher in HUS patients compared to healthy controls (P = 0.021), whereas urine nitrate was borderline lower in HUS patients compared to healthy controls (P = 0.24). ADMA plasma concentrations were insignificantly lower, but urine ADMA levels were significantly lower in the HUS patients (P = 0.019). Urinary DMA was not significantly elevated. In HUS patients, nitrate (R = 0.91) but not nitrite, L-arginine, or ADMA concentrations in plasma correlated with free haemoglobin concentration. Our results suggest that both NO production and ADMA synthesis are decreased in children with typical HUS. We hypothesize that in the circulation of children with HUS a vicious circle between the L-arginine/NO pathway and free haemoglobin-mediated oxidative stress exists. Disruption of this vicious circle by drugs that release NO and/or sulphydryl groups-containing drugs may offer new therapeutic options in HUS.
Oxidative Medicine and Cellular Longevity 01/2014; 2014:203512.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: In a retrospective radiological study, the authors aimed to detect the influence of fracture morphology on the union rate of ulnar styloid fractures associated with distal radial fractures. MATERIALS AND METHODS: Eighty-two out of 101 ulnar styloid fractures were included in the final statistical analysis. Initially, they were grouped into six different morphological types based on a novel classification system. They were also classified as per the established Fernández and Frykman classification systems. Furthermore, the initial ulnar styloid displacement was measured in conventional anteroposterior radiographs. Union of the ulnar styloid fracture was evaluated after at least 6 months of follow-up. RESULTS: The current investigators demonstrated that the various ulnar styloid fracture patterns have no significant predictive value for ulnar styloid union. In contrast, it could be attested, that an initial fragment dislocation of greater than 2.4 mm in the conventional AP radiographs has a significantly lower chance of successful union (p = 0.022). CONCLUSION: Initial displacement of the ulnar styloid should be measured in each distal radial fracture with a concomitant ulnar styloid fracture. This could be useful to inform the decision regarding surgical fixation of the ulnar styloid fragment in patients with an unstable distal radioulnar joint (DRUJ) or persistent symptoms at the ulnar aspect of the wrist.
[Show abstract][Hide abstract] ABSTRACT: Chronic liver diseases are characterized by inflammatory and fibrotic liver injuries that often result in liver cirrhosis with its associated complications such as portal hypertension and hepatocellular carcinoma. Liver biopsy still represents the reference standard for fibrosis staging, although transient elastography is increasingly used for non-invasive monitoring of fibrosis progression. However, this method is not generally available and is associated with technical limitations emphasizing the need for serological biomarkers staging of liver fibrosis. The enhanced liver fibrosis (ELF) score was shown to accurately predict significant liver fibrosis in different liver diseases, although extracellular matrix components detected by this score may not only mirror the extent of liver fibrosis but also inflammatory processes.
In this prospective biopsy-controlled study we evaluated the utility of the ELF score in comparison to transient elastography to predict different stages of fibrosis in 102 patients with chronic liver diseases.
Both techniques revealed similar area under receiver operating characteristic curve values for prediction of advanced fibrosis stages. Compared to transient elastography, the ELF score showed a broader overlap between low and moderate fibrosis stages and a stronger correlation with inflammatory liver injury.
Both the ELF score as well as transient elastography allowed for high quality fibrosis staging. However, the ELF score was less discriminative in low and moderate fibrosis stages and appeared more strongly influenced by inflammatory liver injury. This should be considered when making clinical interpretations on the basis of ELF score values.
PLoS ONE 12/2012; 7(12):e51906. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Two hundred distal radial fractures, with a mean follow up of 20 months (range 6-49), were divided into three groups according to the presence and healing status of an ulnar styloid fracture. The patients underwent both clinical and radiological examination and completed two different questionnaires. One hundred and one, of 200 distal radial fractures, were associated with an ulnar styloid fracture. Forty-six of these developed an ulnar styloid nonunion. The authors encountered significantly higher pain scores (ulnar sided pain p = 0.012), a higher rate of DRUJ instability (p = 0.032), a greater loss of motion and grip strength (p = 0.001), and a poorer clinical outcome in cases with an ulnar styloid fracture, but no differences were apparent when those with healed ulnar styloid fractures or ulnar styloid nonunions were compared (p > 0.05). The investigators propose that the incidence of ulnocarpal complaints following distal radial fracture depends on the presence but not the healing status of an ulnar styloid fracture.
The Journal of hand surgery, European volume. 12/2012;
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: The intention of this study is to analyze the impact of the single parameters NT, PAPP-A and free β-hCG used in combined first trimester screening and to determine their contribution in the risk assessment. METHODS: A retrospective risk assessment on the advanced first trimester screening (AFS) algorithm was made to determine the effect of a particular parameter while the remaining ones were fixed for calculation. Afterward data were recalculated by the AFS module. Test performance was measured by receiver operating characteristics (ROC) curves and their area under curve (AUC). RESULTS: Among the 14,862 cases are 14,748 healthy fetuses, 86 with trisomy 21, 22 with trisomy 18 and 6 with trisomy 13. Some settings obtain at default cut-off a very high sensitivity. However, a lack of specificity, as a high false-positive rate, too. The ROC analysis was best for NT, followed by PAPP-A. Free β-hCG showed the lowest AUC. Combining PAPP-A and free β-hCG offered a better AUC than each parameter alone. Best test performance was obtained by including all three parameters. DISCUSSION: A detection rate of 69 % for testing NT discretely is in order with present study data. PAPP-A is following and free β-hCG is not useful with a test positive rate of about a third. The detection rate of the biochemical parameters combined is higher than for NT alone, but results in a five times higher punctuation rate. All parameters together in the AFS provide the best test performance. The impact of each parameter NT, PAPP-A and free-β-hCG in a combined test strategy is nearly a third. Thus, every single parameter is needed to provide a high detection rate for all of the trisomies and minimize the number of unnecessary invasive diagnostics.
Archives of Gynecology 10/2012; · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Immunohistological methods indicated a rapid onset of cellular defence shortly after seeding of mammary adenocarcinoma cells into the lungs of F344 rats. The purpose of the present study was to monitor natural killer (NK) cell-mediated effects on tumour cell clearance in vivo, in this model of lung metastasis using dynamic positron-emission tomography (dPET). MADB106 breast cancer cells were labelled with 2'-[(18)F]-2'-deoxy-D-glucose (FDG) then injected intravenously, after the F344 rats had been anaesthetized and placed in a PET scanner. NK cell-depleted and sham-treated control rats were investigated in parallel. The radioactivity per region of interest (ROI) over the lungs peaked at 60 s past injection and was followed by a slow decline over the observation time of 40 min in both groups. Statistical analysis using a linear mixed model revealed that release of radioactivity from tumour cells or tumour cell disintegration was significantly slower in animals after depletion of NK cells compared with controls. There was no significant tumour cell homing in organs other than the lungs. Early kinetics of tumour cells after injection were defined. PET with FDG was shown to be an adequate method to further investigate novel options for using cellular host defence mechanisms in cancer patients.
In vivo (Athens, Greece) 03/2012; 26(2):191-5. · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fibrosis and steatosis are major histopathological alterations in chronic liver diseases. Despite various shortcomings, disease severity is generally determined by liver biopsy, emphasizing the need for simple noninvasive methods for assessing disease activity. Because hepatocyte cell death is considered a crucial pathogenic factor, we prospectively evaluated the utility of serum biomarkers of cell death to predict different stages of fibrosis and steatosis in 121 patients with chronic liver disease. We compared the M30 enzyme-linked immunosorbent assay (ELISA), which detects a caspase-cleaved cytokeratin-18 (CK-18) fragment and thereby apoptotic cell death, with the M65 ELISA, which detects both caspase-cleaved and uncleaved CK-18 and thereby overall cell death. Both biomarkers significantly discriminated patients with different fibrosis stages from healthy controls. However, whereas both markers differentiated low or moderate from advanced fibrosis, only the M65 antigen could discriminate even lower stages of fibrosis. The M65 assay also performed better in distinguishing low (≤10%) and higher (>10%) grades of steatosis. In a subgroup of patients, we evaluated the biomarkers for their power to predict nonalcoholic steatohepatitis (NASH). Importantly, both markers accurately differentiated healthy controls or simple steatosis from NASH. However, only serum levels of M65 antigen could differentiate simple steatosis from healthy controls. CONCLUSION: Cell death biomarkers are potentially useful to predict fibrosis, steatosis, or NASH. Compared with the widely used apoptosis marker M30, the M65 assay had a better diagnostic performance and even differentiated between lower fibrosis stages as well as between healthy individuals and patients with simple steatosis.
[Show abstract][Hide abstract] ABSTRACT: A novel screening method for fetal aneuploidies was developed, in which nuchal translucency (NT), pregnancy-associated plasma protein-A (PAPP-A), and free-β human chorionic gonadotropin (free-β hCG) are placed into a three-dimensional scatter plot. Likelihood ratios are directly inferred from the ratio of already observed healthy and diseased fetuses. This method is called 'Three-dimensional Advanced First trimester Screening' (AFS-3D). It was aimed to develop and test a new algorithm based on the results of previous studies.
A new static-sized sphere model was developed. Several scaling factors of the axes and the optional application of the modifications 'simulation' (SIM) and 'empty sphere positive' were tested on 15,227 data sets. An additional examination was performed on a second collective (n = 458).
The application of the new AFS-3D model with static-sized spheres, a re-sampled ∆NT axis by a scaling factor of 0.125, and the application of SIM and Empty Box Positive resulted in a marked improvement of the test performance (area under curve, AUC = 0.9668). Analogous results (AUC = 0.9807) were found for the second test collective.
This novel approach is promising and should be tested on a larger, independent collective.
[Show abstract][Hide abstract] ABSTRACT: Fat cells are fragile cells with a short life span outside the body. Ways to reduce cell death in a biochemical way are almost unknown due to scarce information on the type of cellular death that is induced in fat tissue. This study was designed to investigate the apoptotic pathways of fat tissue in a permanent perfusion bioreactor system with the Hannover preservation solution and the Eurocollins solution in fat flaps of rats. In Lewis rats, the inguinal adipofascial flaps were elevated bilaterally and placed in a bioreactor at 37°C. To detect caspases 3, 8, 9 and 12, immunofluorescence stains of fat tissue specimen were analysed at several time points after preservation of flaps were placed in Hannover solution and Eurocollins solution for 10 days. An additional visual assessment of viability by a calcein based life/dead test was performed. It revealed a superior viability of the adipose tissue preserved in Hannover solution. Immunofluorescence staining demonstrated that apoptotic pathways via mitochondria, endoplasmatic reticulum and death receptors were activated, as Caspases 8, 9 and 12 were detected. Caspase 3 as an effector in the common apoptotic pathway was detected as well. Adipose tissue preserved at 37°C ex vivo in a bioreactor system undergoes apoptosis. Immunofluorescence examination of the fat tissue preserved ex vivo revealed that apoptotic pathways via mitochondria, endoplasmatic reticulum and death receptors are being activated. Significantly less activation of Caspase 3, 8, 9 and 12 in flaps preserved in Hannover solution in comparison to Eurocollins was found, supporting the anti apoptotic characteristics of Hannover solution. Based on these findings, further research to modify the apoptotic pathways to ameliorate viability of fat tissue can be performed.
[Show abstract][Hide abstract] ABSTRACT: Asymmetric dimethylarginine (ADMA) systemic concentrations are elevated in hypercholesterolemic adults and contribute to nitric oxide (NO) dependent endothelial dysfunction. Decreased activity of the key ADMA-hydrolyzing enzyme dimethylarginine dimethylaminohydrolase (DDAH) may be involved. Yet, the ADMA/DDAH/NO pathway has not been investigated in childhood hypercholesterolemia. We studied 64 children with hypercholesterolemia type II (HCh-II) and 54 normocholesterolemic (NCh) children (mean ± SD; age, years: 11.1 ± 3.5 vs. 11.9 ± 4.6). Plasma and urine ADMA was measured by GC-MS/MS. Dimethylamine (DMA), the ADMA metabolite, creatinine, nitrite and nitrate in urine were measured by GC-MS. The DMA/ADMA molar ratio in urine was calculated to estimate whole body DDAH activity. ADMA plasma concentration (mean ± SD; nM: 571 ± 85 vs. 542 ± 110, P = 0.17) and ADMA urinary excretion rate (mean ± SD: 7.1 ± 2 versus 7.2 ± 3 μmol/mmol creatinine, P = 0.6) were similar in HCh-II and NCh children. Both DMA excretion rate [median (25th-75th percentile): 56.3 (46.4-109.1) vs. 45.2 (22.2-65.5) μmol/mmol creatinine, P = 0.0004] and DMA/ADMA molar ratio [median (25th-75th percentile): 9.2 (6.0-16.3) vs. 5.4 (3.8-9.4), P = 0.0004] were slightly but statistically significantly increased in HCh-II children compared to NCh children. Plasma and urinary nitrite and nitrate were similar in both groups. In HCh-II whole body DDAH activity is elevated as compared to NCh. HCh-II children treated with drugs for hypercholesterolemia had lower plasma ADMA levels than untreated HCh-II or NCh children, presumably via increased DDAH activity. Differences between treated and untreated HCh-II children were not due to differences in age. In conclusion, HCh-II children do not have elevated ADMA plasma levels, largely due to an apparent increase in DDAH activity. While this would tend to limit development of endothelial dysfunction, it is not clear whether this might be medication-induced or represent a primary change in HCh-II children.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the impact of gestational age on energy metabolism in human umbilical vein endothelial cells (HUVECs) of preterm and term neonates.
Activities of respiratory chain (RC) complexes I-V, citrate synthase (CS), overall mitochondrial fatty acid oxidation (FAO), carnitine palmitoyltransferase 2 (CPT2), glycolytic enzymes as well as energy-rich phosphates in HUVECs from uncomplicated term and preterm pregnancies were measured. Neonatal acylcarnitine profiles were analyzed postpartum.
Activities of RC complexes II+III, IV, V, and CS were higher in HUVECs from immature pregnancies. Overall FAO did not change, whereas CPT2 activity was higher in term neonates. RC complexes II-V and CS correlated inversely to gestational age, as well as CPT2 activity within the term cohort. Phosphofructokinase activity increased with maturation; lactate dehydrogenase and hexokinase as well as energy-rich phosphates remained constant. In blood, long-chain acylcarnitines were higher in term neonates.
Gestational age-dependent differences of energy-providing pathways in HUVECs were shown. Alterations of RC complexes with gestational age may be an adaptive process to cope with metabolic stress during birth; reduced oxidative phosphorylation and high glycolytic activity make HUVECs less susceptible to peripartum hypoxic damage. We hypothesize that HUVECs of premature neonates are metabolically maladapted to birth, which may be responsible for perinatal complications.
Journal of Perinatal Medicine 08/2011; 39(5):587-93. · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Is the time to diagnosis and to start antibiotic therapy a major factor contributing to the outcome in geriatric patients?
In 2006, a program for documentation and improvement for diagnostic and therapeutic procedures in patients with community-acquired pneumonia was introduced in German hospitals. The analyses were performed centrally by an independent board.
Tertiary geriatric department with 70 beds for acute care and rehabilitation in a hospital, also including a department of neurology and neurological rehabilitation.
In Lower Saxony (LS), 81,853 patients were treated between 2006-2009 in our geriatric department (GD). In LS, 55.3% of the population was male, while 45.2% of the patients in the GD were male (p=0.063). Throughout an age of 79 years, the distribution was equal; however in the age groups 80-89 years (LS vs GD: 32.3 vs 47.6%) and >90 years (LS vs GD: 10.2 vs 15.5%, p<0.001) there were a higher proportion of male patients in the GD. The proportion of male nursing home patients was 46.8% vs 24.3%, hospital or rehabilitation unit 6.2% vs 40.5%, and status of confinement to bed was 47% vs 35.1% (LS vs GD, p<0.001). Delirium caused by pneumonia occurred in 24.4% vs 9.3% and a status of chronic delirium (dementia) was assessed by 75.6% vs. 90.7% of all cases (LS vs GD, p=0.021). The distribution about the risk classes 1/2/3 of the CRB-65 score was 14.9/76.9/8.2% in LS and 3.6/89.3/7.1% in the GD (p=0.011). The time to starting antibiotics (no therapy, <4, 4-8, and >8 h) was 2.2/83.0/7.6/7.2% in LS and 15.4/47.4/10.3/26.9% in GD patients (p<0.001). Overall mortality rates did not differ significantly (LS 14.6% vs GD 11.9%, p=0.53).
Patients in the GD were older and more functionally dependent. The distribution of the risk index CRB-65 shows that these patients were at higher risk, were more often cognitively impaired (not caused by pneumonia), and time to starting antibiotics was longer. However, none of these differences had an influence on total mortality. The results are limited by the number of patients, potential differences of the treatment groups, and the quality of data in general as a result of a quality improvement program.
[Show abstract][Hide abstract] ABSTRACT: FragestellungIst die Zeit zwischen Diagnosestellung und Beginn der antibiotischen Therapie ein relevanter Outcomefaktor für geriatrische
MethodikSeit 2006 besteht verpflichtend eine externe Qualitätssicherung für Patienten mit ambulant erworbener Pneumonie, die hier
vergleichend analysiert wird.
SettingGeriatrische Fachabteilung für Akut- und rehabilitative Geriatrie mit 70 Betten.
ErgebnisseVon 2006 bis 2009 wurden in Niedersachsen (NDS) 81.853 Patienten aus diesem Anlass behandelt, in der Klinik für Geriatrie
(GER) 84. Der Anteil Männer betrug 55,3 vs. 45,2% (NDS vs. GER, p=0,063). Die Altersgruppen bis 79 verteilen sich gleich,
ungleich dagegen die 80–89-Jährigen (32,3 vs. 47,6%) und über 90-Jährigen (10,2 vs. 15,5%, jeweils NIE vs. GER, p<0,001).
Der Anteil an Pflegeheimbewohnern differiert mit 46,8 vs. 24,3% und für Krankenhaus-/Rehaabteilung mit 6,2 vs. 40,5% sowie
Bettlägerigkeit 47 vs. 35,1% (jeweils NIE vs. GER, p<0,001). Delirium trat pneumoniebedingt/nicht pneumoniebedingt in NIE
zu 24,4/75,6 und GER 9,3/90,7% auf (p=0,021). Die Verteilung der CRB-65-Risikoklassen 1/2/3 war für NIE 14,9/76,9/8,2 und
für GER 3,6/89,3/7,1% (p=0,011). Die Verteilung der Zeitfenster für die Antibiotikatherapie (keine, bis 4, zwischen 4–8 sowie
>8h) betrug für NIE 2,2/83,0/7,6/7,2 und für GER 15,4/47,4/10,3/26,9% (p <0,001). Die Gesamtmortalität betrug 14,6 vs. 11,9%
(NIE vs. GER, p=0,53).
SchlussfolgerungDie Patienten in der Geriatrie sind älter und funktionell eingeschränkter als die des Gesamtkollektivs, sind nach CRB-65-Index
schwerer betroffen (häufiger nicht pneumoniebedingt kognitiv eingeschränkt) und haben ein verlängertes Zeitintervall bis zur
ersten Antibiotikagabe, ohne dass dies einen Einfluss auf die Mortalität hat. Potenzielle Limitationen in der Interpretation
der Ergebnisse bestehen in der geringen Fallzahl und der Kollektivzusammensetzung.
BackgroundIs the time to diagnosis and to start antibiotic therapy a major factor contributing to the outcome in geriatric patients?
MethodsIn 2006, a program for documentation and improvement for diagnostic and therapeutic procedures in patients with community-acquired
pneumonia was introduced in German hospitals. The analyses were performed centrally by an independent board.
SettingTertiary geriatric department with 70beds for acute care and rehabilitation in a hospital, also including a department of
neurology and neurological rehabilitation.
ResultsIn Lower Saxony (LS), 81,853 patients were treated between 2006–2009 in our geriatric department (GD). In LS, 55.3% of the
population was male, while 45.2% of the patients in the GD were male (p=0.063). Throughout an age of 79years, the distribution
was equal; however in the age groups 80–89years (LS vs GD: 32.3 vs 47.6%) and >90years (LS vs GD: 10.2 vs 15.5%, p<0.001)
there were a higher proportion of male patients in the GD. The proportion of male nursing home patients was 46.8% vs 24.3%,
hospital or rehabilitation unit 6.2% vs 40.5%, and status of confinement to bed was 47% vs 35.1% (LS vs GD, p<0.001). Delirium
caused by pneumonia occurred in 24.4% vs 9.3% and a status of chronic delirium (dementia) was assessed by 75.6% vs. 90.7%
of all cases (LS vs GD, p=0.021). The distribution about the risk classes 1/2/3 of the CRB-65 score was 14.9/76.9/8.2% in
LS and 3.6/89.3/7.1% in the GD (p=0.011). The time to starting antibiotics (no therapy, <4, 4–8, and >8 h) was 2.2/83.0/7.6/7.2%
in LS and 15.4/47.4/10.3/26.9% in GD patients (p<0.001). Overall mortality rates did not differ significantly (LS 14.6% vs
GD 11.9%, p=0.53).
ConclusionsPatients in the GD were older and more functionally dependent. The distribution of the risk index CRB-65 shows that these
patients were at higher risk, were more often cognitively impaired (not caused by pneumonia), and time to starting antibiotics
was longer. However, none of these differences had an influence on total mortality. The results are limited by the number
of patients, potential differences of the treatment groups, and the quality of data in general as a result of a quality improvement
[Show abstract][Hide abstract] ABSTRACT: Plasma concentration of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthesis from L-arginine and a cardiovascular risk factor, was found to be elevated in plasma of homocysteinemic adults. Enhanced cardiovascular risk due to homocystinuria and impaired renal function has been found in patients with phenylketonuria (PKU) on protein-restricted diet. However, it is still unknown whether ADMA synthesis is also elevated in children with homocystinuria due to cystathionine beta-synthase deficiency (classical homocystinuria), and whether ADMA may play a role in phenylketonuria in childhood. In the present study, we investigated the status of the L-arginine/NO pathway in six young patients with homocystinuria, in 52 young phenylketonuria patients on natural protein-restricted diet, and in age- and gender-matched healthy children serving as controls. ADMA in plasma and urine was determined by GC-MS/MS. The NO metabolites nitrate and nitrite in plasma and urine, and urinary dimethylamine (DMA), the dimethylarginine dimethylaminohydrolase (DDAH) metabolite of ADMA, were measured by GC-MS. Unlike urine ADMA excretion, plasma ADMA concentration in patients with homocystinuria was significantly higher than in controls (660±158 vs. 475±77 nM, P=0.035). DMA excretion rate was considerably higher in children with homocystinuria as compared to controls (62.2±24.5 vs. 6.5±2.9 μmol/mmol creatinine, P=0.068), indicating enhanced DDAH activity in this disease. In contrast and unexpectedly, phenylketonuria patients had significantly lower ADMA plasma concentrations compared to controls (512±136 vs. 585±125 nM, P=0.009). Phenylketonuria patients and controls had similar L-arginine/ADMA molar ratios in plasma. Urinary nitrite excretion was significantly higher in phenylketonuria as compared to healthy controls (1.7±1.7 vs. 0.7±1.2 μmol/mmol creatinine, P=0.003). Our study shows that the L-arginine/NO pathway is differently altered in children with phenylketonuria and homocystinuria. Analogous to hyperhomocysteinemic adults, elevated ADMA plasma concentrations could be a cardiovascular risk factor in children with homocystinuria. In phenylketonuria, the L-arginine/NO pathway seems not be altered. Delineation of the role of ADMA in childhood phenylketonuria and homocystinuria demands further investigation.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the relevant conditions for safe free flap transfers. The authors retrospectively studied the data from 150 patients who received free flaps at a single institution. Many parameters were analyzed to reveal if there was a correlation with respect to surgical or medical complications. Regarding safety of free tissue transfer, we found a worse prognosis in flaps where a revision of the microanastomosis had to be performed. Platelet count and leukocyte count had an impact on the prognosis. Patients older than 60 years did not have an increased rate of surgical complications. Apart from active osteomyelitis, the presence of comorbid conditions did not significantly impair the outcome of flap transfer, although smoking and diabetes correlated with minor surgical complications like wound breakdown or hematoma, respectively. Besides one case of lethal heart failure of an octogenarian patient, no severe medical complications occurred in this series of patients. Microvascular free tissue transfer is not significantly impaired by age and most comorbidities. Osteomyelitis as well as elevated leukocytes and lowered platelets may increase the complication rate and worsen the surgical prognosis. Smoking and diabetes might prolong the hospital course of the patients.
Journal of Reconstructive Microsurgery 02/2011; 27(2):127-32. · 1.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: cryotherapy and compression as integral part of the RICE regimen are thought to improve treatment outcome after sport injuries. Using standardized cryotherapy and compression perioperatively has been reported with conflicting clinical results. The impact of combined cryotherapy and compression is compared to standard care among patients undergoing wrist arthroscopy.
fifty-six patients undergoing wrist arthroscopy were assessed, 54 patients were randomized to either Cryo/Cuff (3 × 10 min twice daily) or standard care over 3 weeks. Follow-up clinical visits were at postoperative days 1, 8, and 21. One patient in each group was lost during follow-up. Fifty-two patients were analyzed. Statistics were performed as Intention-to-treat analysis. Outcome parameters were pain, three-dimensional volume of the wrist, range of motion, and DASH score.
the Cryo/Cuffgroup had a 49% reduction in pain level (VAS 3.5 ± 0.4 vs. VAS 1.8 ± 0.2 on the 21st postoperative day) when compared to a reduction of 41% in the control group (VAS 5.1 ± 0.6 preoperatively vs. VAS 3.0 ± 0.5 on the 21st postoperative day). Swelling and range of motion were not as significantly different between the two groups as were DASH scores (DASH-score Cryo/Cuff group preoperatively 37.3 ± 3.5 and postoperatively 36.9 ± 3.5; DASH-score control group preoperatively 42.8 ± 4.3 and postoperatively 41.9 ± 4.9). The CONSORT score reached 17 out of 22.
there was no significant effect of additional home-based combined cryotherapy and compression using the Cryo/Cuff wrist bandage, following wrist arthroscopy regarding pain, swelling, range of motion, and subjective impairment assessed using the DASH score over 3 weeks in comparison with the control group.
[Show abstract][Hide abstract] ABSTRACT: To investigate the role of cytoskeletal components in canine distemper virus (CDV) replication, various agents were used that interfere with turnover of actin filaments and microtubules. Only inhibition of actin filaments significantly reduced viral infectivity. Analysis of the intracellular localization of the viral matrix (M) protein revealed that it aligned along actin filaments. Treatment with actin filament-disrupting drugs led to a marked intracellular redistribution of M protein during infection as well as transfection. In contrast, the localization of the CDV fusion (F) protein was not significantly changed during transfection. Thus, a M protein-actin filament interaction appears to be important for generation of infectious CDV.
Archives of Virology 09/2010; 155(9):1503-8. · 2.28 Impact Factor