[The clinical importance of pelvic injuries].
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Acetabulum↗
Biomedical subjects
A Meissner
Publications and source records attributed to A Meissner.
[Developments in osteosynthesis of proximal femoral fractures--rational change in therapy based on clinical results and experiences].
MATERIAL AND METHODS: In the Department of Traumatology and Reconstructive Surgery of Steglitz Medical Center, Berlin, a total of 1,323 patients with proximal femoral fractures were treated between 1978 and 1992. 988 patients were female and 335 male, age range 18-99 years, mean age 74 years. 479 fractures were classified as medial femoral neck fractures and 205 as lateral femoral neck fractures, further 461 pertrochanteric and 178 subtrochanteric fractures were seen. Based upon computerized data--especially regarding lethality and complication rates--the evolution of fracture treatment is outlined. RESULTS: The average lethality of hospitalized patients was 6%, this primarily due to old age and thus especially concerning patients treated with bipolar prosthesis. On the other hand we found a marked methodic dependent peak in lethality, reaching a maximum of 19% in conservatively treated patients. Therefore conservative treatment was exclusively chosen for the limited number of young patients with medial femoral neck fractures showing minimal or no displacement and good impaction. Total infection rate was 0.8%. The rate of local complications was highest with Ender nailing (21.6%). In pertrochanteric fractures this method is therefore no longer utilized and replaced by the DHS. CONCLUSIONS: In older patients with medial femoral neck fractures the therapeutic standard today is the bipolar prosthesis, in younger patients osteosynthesis. In lateral femoral neck fractures as well as pertrochanteric fractures the most suitable osteosynthesis is the DHS, in subtrochanteric fractures the condylar plate. Whenever possible osteosynthesis should be preferred to total hip arthroplasty if patient condition and hip joint integrity allow this treatment. The more stable and biological procedure of osteosynthesis should be preferred.
Adolescent↗
Identification of Bacteroides forsythus in subgingival plaque from patients with advanced periodontitis.
Bacteroides forsythus has been associated with destructive adult periodontitis. Up to now, detailed analysis by classical means was hampered by the fastidious nature of the organism. There is hope that the application of molecular detection methods such as indirect immunofluorescence or in situ hybridization (ISH) will allow for more rapid and accurate identification. Here we describe a B. forsythus-specific probe (BFV530), complementary to 16S rRNA, which correctly identified all B. forsythus isolates as confirmed by biochemical, protein, or fatty acid analysis. To assess whether this probe might be suitable for direct identification of B. forsythus in clinical specimens, a total of 92 subgingival plaque samples were analyzed. Fifty-five specimens were tested in parallel by culture, light microscopy, and filter hybridization. Unfortunately, the overall agreement between results of filter hybridization and conventional methods was 70.9% only. We therefore examined 37 new specimens by ISH and indirect immunofluorescence by using fluorescently labeled probe BFV530 or B. forsythus-specific monoclonal antibody 116BF1.2 (kindly provided by R. Gmür, Zurich, Switzerland), respectively. Agreement between these methods was 100%, indicating that ISH with probe BFV530 might be used to accurately identify B. forsythus directly in subgingival plaque samples.
Adult↗
[Concentration of ciprofloxacin in bone tissue].
After the administration of a 200 mg i.v. dose, the concentration of ciprofloxacin in bone and serum of 20 patients with coxarthrosis was determined before implantation of a total hip-joint endoprosthesis. Samples were taken from the cortical bone and cancellous bone either 1 hour, 2 hours, 3 hours, 4 to 5 hours, or 13 to 19 hours after administration. Blood samples for the determination of serum concentration were also taken at these times. The bone samples were extracted three times in phosphoric acid (10 mmol/l) at 4 degrees C for 20 hours, the volume of phosphoric acid being ten times that of the bone sample. The ciprofloxacin concentration was determined by high-performance liquid chromatography and fluorescence detection. The bone concentration was referred to bone volume by assuming a bone density of 1.9 g/l. The mean bone concentrations in cancellous and cortical bone after ciprofloxacin administration were, respectively, 2.16 mg/l and 1.42 mg/l after 1 hour; 0.82 mg/l and 0.56 mg/l after 2 hours; 2.50 mg/l and 1.04 mg/l after 3 hours; 1.16 mg/l and 0.42 mg/1 after 4-5 hours; and 0.27 mg/l and 0.15 mg/l after 13-19 hours. Ciprofloxacin quickly penetrated the bone. The ratio of areas under the curve (AUC) from bone to serum was 2.24 for cancellous and 0.99 for cortical bone. In 16 out of 19 bone samples, the ciprofloxacin concentration measured was higher than the MIC90 for Staphylococcus aureus.
Aged↗
[Additive effects of milrinone and dobutamine in severe heart failure].
The hemodynamic effects of dobutamine, milrinone, and a combination of both drugs were compared intra-individually in 14 patients with severe heart failure (NYHA III: n = 9; NYHA IV: n = 5). Dobutamine (maximum dose: 9 micrograms/kg/min) and milrinone (0.5 micrograms/kg/min) each induced a comparable increase in stroke volume index (21 to 29 resp. 21 to 30 ml/m2; mean values; p less than 0.001) and reduction in pulmonary capillary wedge pressure (29 to 22 resp. 28 to 21 mm Hg; p less than 0.001), as well as in systemic (1846 to 1218 resp. 1858 to 1276 dyn s/cm5; p less than 0.001) and pulmonary vascular (301 to 195 resp. 293 to 216 dyn s/cm5; p less than 0.001) resistances. The heart rate rose significantly after dobutamine (92 to 107 min-1; p less than 0.05), but did not change after milrinone (94 to 95 min-1; ns). Neither drug had a significant effect on systemic arterial pressures. The combination of milrinone and dobutamine induced a further significant rise in stroke volume index (37 ml/m2; p less than 0.01) when compared to either drug alone. The combination also caused an additional fall in pulmonary capillary wedge pressure (14 mm Hg; p less than 0.01), as well as in systemic (799 dyn s/cm5; p less than 0.001) and pulmonary (133 dyn s/cm5; p less than 0.001) vascular resistances. When compared to dobutamine alone, the combined therapy did not significantly change the heart rate and systemic arterial pressures. The combined administration of a beta-adrenergic agonist and a phosphodiesterase inhibitor induces beneficial hemodynamic effects.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Pharmacokinetics of oral isosorbide-5-mononitrate in patients with ischemic heart failure.
This study compared the pharmacokinetics of orally administered isosorbide-5-mononitrate (20 mg) in patients with and without signs of ischemic heart failure after acute myocardial infarction. The central venous pressure was used as a parameter of global myocardial function and to separate 17 patients into two groups with normal (group I: CVP less than 6 cmH2O; Killip class I; n = 9) and elevated (group II: CVP greater than or equal to 6 cmH2O; Killip class II-III; n = 8) pressure. As compared to subjects with normal CVP patients with hemodynamic impairment showed a markedly lower peak concentration of isosorbide-5-mononitrate levels (475 +/- 32 vs 663 +/- 38 ngml-1; p less than 0.01; mean +/- SEM) which occurred delayed (32 +/- 6 vs 55 +/- 9 s; p less than 0.05). Reduced cardiac function also resulted in a prolonged elimination of isosorbide-5-mononitrate as was suggested by the diminished elimination rate constant (0.14 +/- 0.01 vs 0.18 +/- 0.01 h-1; p less than 0.05). Thus, in patients with ischemic heart failure cardiac performance influences both the absorption and apparent elimination phase of oral isosorbide-5-mononitrate.
Absorption↗
Proto-oncogene expression in cultured synovial fibroblasts of patients with rheumatoid arthritis.
Total RNA was isolated from cultured synovial fibroblasts of nine patients with rheumatoid arthritis and two controls (cruciate ligament ruptures). RNA was dot-blotted and hybridized with nine different, cloned cellular or viral oncogene probes. None of the proto-oncogenes showed a significant difference of expression in cultured fibroblasts from patients with rheumatoid arthritis when compared to the expression of control fibroblasts.
Arthritis, Rheumatoid↗
[Measuring electric impedance of organs--methodologic principles].
Ischemia causes changes in organ tissue (e.g. during operation or transplantation) which may finally lead to irreversible injury, so that the organ can no longer be resuscitated. To the extent that these changes affect the electrical properties of the tissue they are manifested in the impedance spectrum. As an example, the course of impedance of a HTK-protected porcine liver is presented in the frequency range of 0.1 Hz to 10 MHz, which includes two dispersion--alpha- and beta-dispersion. Using a suitable electrical equivalent circuit analogue to the structure of the liver, the behavior of the alpha- and beta-dispersion is explained on the basis of gap junction closure and narrowing of the extracellular space due to cell swelling.
Animals↗
Influence of tissue acidification and halothane anesthesia on hepatic electrical and biochemical properties during ischemia.
In order to further corroborate the recent findings on liver ischemia after perfusion with solutions containing an additive of heptanol, that the intraischemic loss of cell-to-cell communication in protected livers can be detected by electrical impedance measurement (1), we tried to induce uncoupling in porcine liver by tissue acidification applying acidified protective solutions. Moreover, the effects of preischemic inhaling of high concentrations of the decoupling anesthetic halothane were examined in unprotected ischemic livers (2-5). Electrical impedance, biochemical analyses, and pH measurements were applied in parallel. In addition, typical time courses of impedance parameters of unprotected liver and skeletal muscle were compared, because the latter is devoid of gap junctions. In spite of overlapping side-effects of the respective uncoupling measure, the results suggest that the loss of cell-to-cell communication in the liver is associated with measureable effects on the electrical impedance.
Acid-Base Equilibrium↗
[Dose and time dependence of hemodynamic tolerance development during intravenous nitrate therapy in acute myocardial infarct].
Intravenous nitroglycerin therapy during acute myocardial infarction has beneficial effects on infarct size, infarct complications, and mortality. Numerous dosage formulas for the continuous administration of nitrates are currently used, although several studies have demonstrated the rapid development of tolerance during long-term treatment in patients with ischemic heart disease. The dose and dosage of a continuous nitrate application in the clinical setting of acute myocardial infarction has thus yet to be resolved. This study investigated the hemodynamic effects of a 60-h, low- (33 micrograms/min) vs high- (133 micrograms/min) dose intravenous nitroglycerin (NTG) infusion in 16 patients with uncomplicated acute myocardial infarction. In group I (33 micrograms/min NTG; n = 8) the initial nitrate effect on the pulmonary capillary pressure (PCP-control: 14 +/- 1.5; 4 h: 7 +/- 0.9; 60 h: 7 +/- 0.8; mean +/- SEM; all values in mm Hg) and mean pulmonary artery pressure (PAPM-control: 23 +/- 2.3; 4 h: 15 +/- 1.3; 60 h: 14 +/- 1.3) remained unchanged for 60 h. In group II (133 micrograms/min NTG; n = 8) an almost complete loss of the initial effect on PCP (control: 15 +/- 1.6; 4 h: 5 +/- 1.4; 60 h: 12 +/- 1.3) and PAPM (control: 25 +/- 2.0; 4 h: 14 +/- 1.8; 60 h: 20 +/- 1.3) was observed. In contrast to high-dose application the low-dose NTG-infusion induced comparable acute hemodynamic effects that were not attenuated by tolerance development.
Aged↗
Concentrations of ofloxacin in human bone and in cartilage.
Concentrations of ofloxacin were determined in bone, cartilage and serum of 23 patients (8 male, 15 female; age 29-85 years) who underwent total hip replacement for osteoarthritis. A single dose of 200 mg ofloxacin was infused over a period of 20 min. Blood specimens (total 89), bone (45), and cartilage specimens were taken up to 720 min after the infusion. Ofloxacin was determined by high performance liquid chromatography. Bone was extracted with buffer three times to obtain a complete extraction. An average bone density of 1.9 kg/l was assumed in order to convert concentrations from mg/kg to mg/l bone. Mean serum concentrations decreased from 7.2 +/- 2.6 (0 min) to 0.5 +/- 0.1 (720 min). Mean tissue concentrations (mg/l) at 98, 246 and 716 min after the end of infusion were, in cortical bone 0.64 +/- 0.29, 0.86 +/- 0.55 and 0.59 +/- 0.14; in cancellous bone, 1.70 +/- 0.72, 1.47 +/- 1.00 and 0.99 +/- 0.43, and in cartilage 1.38 +/- 1.05; 2.19 +/- 1.56 and 2.18 +/- 0.45. The half-life of ofloxacin in tissues was longer than in serum. No side effects were observed.
Adult↗
[Patellar and quadriceps tendon ruptures].
Ten cases of rupture of quadriceps tendon and seven cases of rupture of the patellar ligament were studied. All patients were reexamined. One must differentiate between rupture of the quadriceps tendon (tendon ruptures in elderly patients with degeneratively changed tendon in trivial trauma) and rupture of the patellar tendon (tendon rupture in younger patients with considerable trauma). All the patients were discussed with regard to accident mechanism, histology, underlying systemic and local diseases, therapy and results. There were good results in all patients with rupture of the patella tendon. In seven of the ten patients with quadriceps tendon rupture, we noted also good results. Three patients had residual pain and restricted motion and function of the knee. In two of these cases, diagnosis and reconstruction was delayed for months, the other patient had an infection of an implanted knee endoprosthesis in the injured knee.
Adult↗
Heptanol effects on protected livers.
Heptanol, an agent known for inducing closure of gap junctions in a variety of organs, was used to evaluate the influence of uncoupling on the electrical impedance of livers during ischemia. Heptanol was added to a modified HTK solution or to Belzer's UW-CSS solution. Livers of swine were then perfused for 8 min with either one of the solutions containing heptanol or a solution devoid of this additive. During the following ischemia the phase angle of impedance at 5 kHz, pH and different biochemical parameters were determined. Heptanol fundamentally changed the time course of impedance and made the otherwise characteristic fast increase of the phase angle of impedance disappear. Already early during ischemia the phase angle was raised in a dose-dependent manner up to even highest values at the beginning of the whole observation period in case of a fully developed effect. Heptanol also stimulated anaerobic energy turnover. The results suggest that, besides unspecific effects, heptanol induces uncoupling which is detectable by electrical impedance measurement.
Alcohols↗
Glycogen effects on energy state and passive electric properties of liver during protection.
In order to evaluate the importance of glycogen for the hepatic tolerance to ischemia, livers of swine fed a glucose-potassium solution for premedication were perfused with either Bretschneider's HTK-solution (histidine-tryptophan-ketoglutarate) or with Euro-Collins-solution (EC) prior to subsequent ischemia at 25 and 5 degrees C. During ischemia, in regular intervals or continuously, energy rich phosphates, lactate, intrahepatic pH and the electrical impedance of liver tissue were determined. The results were compared with corresponding data from swine which had starved for 48 h. Corresponding to the higher glycogen content, energy supply during ischemia was markedly improved by the premedication. Despite high amounts of glucose in the EC-solution, energy supply after glucose-potassium premedication was no better with EC-solution than with HTK-solution. Moreover, glucose uptake led to concomitant cellular water uptake. Electrical impedance measurements during ischemia mirrored improved energetical protection by the glucose-potassium premedication.
Acid-Base Equilibrium↗
[Diagnosis of ventricular septum rupture following acute myocardial infarct using a fiber-optic indwelling catheter].
Rupture of the ventricular septum is a rare complication of acute myocardial infarction. Time of diagnosis, hemodynamic condition, as well as duration and effectiveness of the preoperative treatment determine the clinical outcome after surgical repair. Since its introduction the bedside-applied Swan-Ganz catheter has maintained an important role for the rapid confirmation and quantitation of the infarct-induced ventricular septal rupture. We report on the clinical courses of two patients whose diagnoses were established by means of a fiberoptic-armed Swan-Ganz catheter. Accuracy of the measured oxygen saturation was controlled by in vitro gas analyses with heparinized blood samples. As compared to conventional methods the continuous in vivo oximetry by a fiber-optic system is a simple procedure which facilitates repeated shunt calculations during hemodynamic monitoring in critically ill patients.
Catheterization, Swan-Ganz↗
[Circulatory collapse caused by carbachol-containing eye drops].
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Aged↗
[Defibrination syndrome after snake bites].
A defibrination syndrome developed in two men (aged 51, and 29 years old) within two hours of having been bitten by vipers Echis carinatus and Agkistrodon halys, respectively. In both the syndrome was characterized by afibrinogenemia with prolongation of the thrombin time, presence of fibrin monomers and split products of fibrinogen. Haemorrhagic signs included oral mucosa bleeding and macrohematuria. Specific serum was administered 9 and 16 hours, respectively, after the bite and achieved normalization of all clotting values within 48 hours.
Adult↗
Ciprofloxacin concentration in bone tissue.
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Anti-Infective Agents↗