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Biomedical subjects

A Werner

Publications and source records attributed to A Werner.

At least 37 records · Page 2Linked to original sources

Dietary P regulates phosphate transporter expression, phosphatase activity, and effluent P partitioning in trout culture.

Phosphate utilization by fish is an important issue because of its critical roles in fish growth and aquatic environmental pollution. High dietary phosphorus (P) levels typically decrease the efficiency of P utilization, thereby increasing the amount of P excreted as metabolic waste in effluents emanating from rainbow trout aquaculture. In mammals, vitamin D3 is a known regulator of P utilization but in fish, its regulatory role is unclear. Moreover, the effects of dietary P and vitamin D3 on expression of enzymatic and transport systems potentially involved in phosphate utilization are little known. We therefore monitored production of effluent P, levels of plasma vitamin D3 metabolites, as well as expression of phosphatases and the sodium phosphate cotransporter (NaPi2) in trout fed semipu diets that varied in dietary P and vitamin D3 levels. Mean soluble P concentrations varied markedly with dietary P but not with vitamin D3, and constituted 40-70% of total effluent P production by trout. Particulate P concentrations accounted for 25-50% of effluent P production, but did not vary with dietary P or vitamin D3. P in settleable wastes accounted for <10% of effluent P. The stronger effect of dietary P on effluent P levels is paralleled by its striking effects on phosphatases and NaPi2. The mRNA abundance of the intestinal and renal sodium phosphate transporters increased in fish fed low dietary P; vitamin D3 had no effect. Low-P diets reduced plasma phosphate concentrations. Intracellular phytase activity increased but brushborder alkaline phosphatase activity decreased in the intestine, pyloric caeca, and gills of trout fed diets containing low dietary P. Vitamin D3 had no effect on enzyme activities. Moreover, plasma concentrations of 25-hydroxyvitamin D3 and of 1,25-dihydroxyvitamin D3 were unaffected by dietary P and vitamin D3 levels. The major regulator of P metabolism, and ultimately of levels of P in the effluent from trout culture, is dietary P.

6-Phytase↗

Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients.

This prospective study evaluated the use of multi-slice CT (MSCT) for detection of clinically suspected left-sided colonic diverticulitis with regard to diagnosis, complications and alternative diagnoses. One hundred twenty patients with clinically suspected acute left-colonic diverticulitis underwent MSCT of the lower abdomen with IV contrast after rectal application of iodic contrast. The MSCT results were compared with histopathological and intraoperative findings or other radiological or endoscopic methods and clinical outcome. Acute diverticulitis was proven in 67 of the 120 (55.8%) patients, which was detected by MSCT with an accuracy of 98% (sensitivity 97%, specificity 98%). Contained perforation or abscess formation were detected with an accuracy of 96% (sensitivity 100%, specificity 91%) and 98% (sensitivity 100%, specificity 97%), respectively. In 31 of 120 (25.8%) patients diagnoses other than diverticulitis caused abdominal pain, which was correctly diagnosed by MSCT in 71%. The MSCT as well as other concurrently performed diagnostic methods showed normal findings and no causes for the patients symptoms in 22 of the 120 (18.4%) patients. Multi-slice CT is reliable in detecting diverticulitis, including extracolic complications, and often reveals other diagnoses; therefore, MSCT is recommended as standard diagnostic procedure in suspected acute diverticulitis.

Acute Disease↗

[Intraarticular pathology of atraumatic shoulder dislocations. An arthroscopic study].

AIM OF THE STUDY: According to the literature, atraumatic shoulder dislocations occur without or only minor trauma,self-reduction and no or little pain. Little is known about intraarticular pathology in this entity. It was the purpose of our study to evaluate such findings. METHODS: During a 2-year period,226 patients had surgery for shoulder dislocation.28 patients met the criteria for atraumatic dislocation as above (group A). Patients with bony pathology or recurrent microtrauma were excluded. All had been treated with a rehabilitation program without success.28 consecutive patients with surgery after posttraumatic dislocation served as a control group (group B). At the beginning of the surgery,arthroscopy was performed in all patients and the intraarticular findings were recorded. For the capsulo-labral pathology,we determined 3 types: type I had capsular elongation or scarring and included so called "non-Bankart-lesions"; type II had classic "Bankart"-lesions and type III more complex capsulo-labral lesions like e.g. "ALSPA"-lesions. RESULTS: The mean age in group A was 27.6 y and 26.2 y in group B.12 patients in group A and 5 in group B were female. The average no.of dislocations was 10 (1-30) or 9 (1-28), respectively. In group A we saw type I lesions in 11 patients (39.3%), type II lesions in 9 (32.1%) and type III lesions in 8 (28.6%) patients. In group B we found type I lesions in 8 (28.6%), type II lesions in 4 (14.3%) and type III lesions in 16 (57.1%) patients.Hill-Sachs lesions were found in 22 (78.6%) and 23 (82.1%) of the patients, respectively.Also, we saw chondral glenoid damage, cuff lesions and SLAP-lesions in both groups. CONCLUSION: The above mentioned criteria for atraumatic shoulder dislocation do not exclude intraarticular pathology comparable to posttraumatic cases, at least for patients, who do not respond to a conservative treatment. Besides the etiology, the given pathology must be considered for therapy.

Adult↗

[Detection of prostate carcinomas with T1-weighted dynamic contrast-enhanced MRI. Value of two-compartment model].

AIM: The suitability of dynamic parameters of the two-compartment model for detecting prostate carcinomas and its correlation with tumor microvascular density were evaluated. METHODS: The study included 43 patients with biopsy-proven prostate carcinoma: 28 were examined by 1.0-T MRI (Turbo-FLASH) and 15 by 1.5-T MRI (FLASH) with infusion of 0.1 mmol/kg Gd-DTPA. Signal time curves were parametrized with an open two-compartment model in amplitude and exchange rate constants (k(ep)). The microvascular density of resected prostate carcinomas was determined. RESULTS: The microvascular density in the tumors was significantly higher than in the adjacent healthy prostate tissue and correlated in both sequences with k(ep). Prostate carcinomas of the peripheral zone were demarcated by amplitude and k(ep). In the Turbo-FLASH sequence there was a significant difference between the tumor tissue and healthy peripheral zone in terms of k(ep) and in the FLASH sequence in terms of amplitude. CONCLUSION: Prostate carcinomas can be visualized with dynamic T1-weighted MR sequences using a two-compartment model. Moreover, the parameter k(ep) reveals the microvascular density in the tumor and can thus provide valuable clinical information for characterizing the tumors.

Biopsy↗

[Tendinitis of the long head of biceps tendon associated with lesions of the "biceps reflection pulley"].

UNLABELLED: In some patients with persistent pain around the Long Head of Biceps Tendon (LHB), lesions of the "biceps reflection pulley", associated with biceps tendinitis, can be found. The aim of this study is to describe the anatomy of the reflection pulley and the arthroscopic appearance of the pulley lesion. Therapeutic options will be discussed. METHOD: The results of a former histo-anatomic study done by the authors in 13 cadaver shoulders are compared with the intra-operative findings in patients with persistent tendinitis of the LHB together with a lesion of the reflection pulley and signs of LHB instability. Intra-operative findings from patients with either posttraumatic anterior instability or calcific tendinitis served as control. RESULTS: The superior glenohumeral ligament (SGHL) together with the coraco-humeral ligament (CHL) and fibers from the subscapularis and supraspinatus tendons form a stabilizing reflection pulley for the LHB in the rotator cuff interval. Arthroscopy shows an association between a lesion of this pulley and persistent LHB-tendinitis. Pulley lesions can occur as isolated ligamentous pathology or together with a partial detachment of rotator cuff tendons. CONCLUSION: In patients with therapy-resistant pain around the LHB, lesions of the reflection pulley need to be excluded beside more common causes of biceps problems. Arthroscopy is a reliable tool to assess these lesions. Therapy should address the definite pathology.

Adult↗

[Ultrasonographic evaluation of the rotator cuff after shoulder arthroplasty].

AIM: Ultrasonography of the rotator cuff tendons is a standard imaging technique. Although increasing numbers of shoulder arthroplasty are performed, there is no available data concerning the use of ultrasound after shoulder replacement. Our experimental study was performed to analyse the value of ultrasonography after shoulder arthroplasty a) in an ex-vivo-setting and b) in a retrospective analysis of our patients after shoulder hemiprothesis. METHOD: After defrosting, anatomic modular humeral head replacement was performed in four fresh-frozen specimens with intact rotator cuffs. The supraspinatus and subscapularis tendons of each specimen were either detached to simulate a cuff defect or reattached anatomically (four times per specimen). Two experienced examiners then performed ultrasonography to evaluate the two tendons to be either intact or deficient. In a retrospective study, 22 patients with 25 hemiprotheses of the shoulder underwent clinical and sonographic examination. For documentation of the clinical findings, the Constant score was used. RESULTS: In the cadaver study, the reliability of the method was slightly higher for the subscapularis tendon (13 correct, 3 false results) than for the supraspinatus tendon (12 correct, 4 false results). In our patients, rotator cuff defects and effusions around the biceps tendon and in the subdeltoid bursa could be detected. Normal sonograms correlated with good clinical results. CONCLUSION: In the cadaver study, we found a good reproducibility of in-vivo conditions. We believe that ultrasonography is beneficial in follow-up evaluation after shoulder arthroplasty.

Arthroplasty↗

Characterization of a type IIb sodium-phosphate cotransporter from zebrafish (Danio rerio) kidney.

Zebrafish (Danio rerio) express two isoforms of the type IIb Na-dependent P(i) cotransporter (NaPi). Type NaPi-IIb1 has previously been cloned and characterized. Here, we report the cloning of the NaPi-IIb2 transcript from zebrafish kidney, its localization, and its functional characterization. RT-PCR with renal RNA and degenerate NaPi-IIb-specific primers resulted in a specific fragment. 3'-Rapid amplification of cDNA ends yielded a product that contained typical NaPi-IIb characteristics such as a cysteine-rich COOH terminus and a PDZ (PSD95- Dlg-zona occludens-1) binding motif. Several approaches were unsuccessful at cloning the 5' end of the transcript; products lacked an in-frame start codon. The missing information was obtained from an EST (GenBank accession number ). The combined clone displayed a high degree of homology with published type IIb cotransporter sequences. Specific antibodies were raised against a COOH-terminal epitope of both NaPi-IIb1 and NaPi-IIb2 isoforms. Immunohistochemical mapping revealed apical expression of both isoforms in zebrafish renal and intestinal epithelia, as well as in bile ducts. The novel clone was expressed in oocytes, and function was assayed by the two-electrode voltage-clamp technique. The function of the new NaPi-IIb2 clone was found to be significantly different from NaPi-IIb1 despite strong structural similarities. NaPi-IIb2 was found to be strongly voltage sensitive, with higher affinities for both sodium and phosphate than NaPi-IIb1. Also, NaPi-IIb2 was significantly less sensitive to external pH than NaPi-IIb1. The strong structural similarity but divergent function makes these zebrafish transporters ideal models for the molecular mapping of functionally important regions in the type II NaPi-cotransporter family.

Amino Acid Sequence↗

The value of ultrasound after shoulder arthroplasty.

OBJECTIVE: This study was undertaken to evaluate whether sonography is a useful tool in the diagnosis of soft tissue disorders as a possible cause for discomfort and/or pain after shoulder arthroplasty. DESIGN AND PATIENTS: Static and dynamic ultrasound examinations were performed in the standard sectional planes on 22 patients with 25 hemiprostheses and the results were correlated with the clinical outcome. The stability was determined in the transverse and frontal planes and the clinical results were evaluated according to the Constant and Swanson scores. RESULTS: Several pathological changes were detected: rotator cuff lesions, subdeltoid bursitis, changes around the long biceps tendon as well as an increase in intra-articular volume due to effusion and/or synovitis. The correlation of sonographic and clinical results demonstrated that patients with an excellent clinical result showed no or only a few pathological findings on sonography compared with those with a moderate or poor result. CONCLUSION: Pathological changes of the periarticular tissue in the direct neighbourhood of the implant can be detected by sonography, which can be recommended as a valuable examination technique to evaluate the soft tissue in patients after shoulder arthroplasty.

Adult↗

New advanced operational regime on the W7-AS stellarator.

A promising new plasma operational regime on the Wendelstein stellarator W7-AS has been discovered. It is extant above a threshold density and characterized by flat density profiles, high energy and low impurity confinement times, and edge-localized radiation. Impurity accumulation is avoided. Quasistationary discharges with line-averaged densities n(e) to 4 x 10(20) m(-3), radiation levels to 90%, and partial plasma detachment at the divertor target plates can be simultaneously realized. Energy confinement is up to twice that of a standard scaling. At B(t) = 0.9 T, an average beta value of 3.1% is achieved. The high n(e) values allow demonstration of electron Bernstein wave heating using linear mode conversion.

Journal Article↗

[Kapandji intramedullary wire osteosynthesis in proximal humeral fractures].

For operative treatment of proximal humeral fractures minimal invasive techniques reduce the risk of iatrogenic damage of blood supply and periarticular scarring. Reported preliminary results are encouraging. We present our experience achieved with an intramedullary wire fixation adapted from a report of Kapandji in 1989. Between 3/95 and 6/00 29 patients were treated with this technique at our institution. All received early functional treatment. 14 patients (average mean age 56 years at time of trauma) who had a minimum follow up of 24 months (mean 36.4 months) and therefore allowed a preliminary conclusion regarding avascular head necrosis (AVN) were reexamined by use of the Constant Score and x-ray. We examined three unstable 2-part, four 3-part and seven 4-part fractures (5 of them valgus-impacted). The mean Constant Score at follow up was 70 points (31-86 points). We saw one total collapse of the humeral head because of AVN. In one patient the distal end of the wires led to a skin irritation and had to be shortened. We observed no secondary fragment displacement or non-unions. In our hands, this technique offers good results, even in valgus-impacted 4-part fractures of the elderly and allows internal fixation in little displaced but unstable fractures with the benefit of early functional treatment instead of longer immobilization. Based on the experience with intramedullary wiring the previously performed technique using threading wires was abandoned and the indication for primary arthroplasty considerably influenced.

Adult↗

[Use of a newly developed piezoelectrically driven drilling machine for MR-guided bone biopsies].

PURPOSE: Development and clinical testing of an MR-compatible bone biopsy system, to enable the sample collection from osteosclerotic or subcortical lesions for histological investigation under MR control. MATERIALS AND METHODS: A piezoelectrically driven drilling machine was constructed and tested in connection with an MR-compatible bone biopsy set in a vertical open MR scanner (0.5 T) on a phantom and 10 patients with ambiguous bone lesions. Images were obtained using T(1)-weighted spin-echo sequences and, in case of real-time imaging, a fast spoiled gradient-echo sequence. RESULTS: The influence of the enabled motor (RF-interference) leads to a reduction of the signal to noise ratio of the images, but can be minimised by appropriate measures. The observed slight field distorsions do not affect the image quality during real time acquisition in a substantial manner. No complications occurred. The extracted biopsy material was sufficient and of good quality. CONCLUSIONS: In spite of slightly restricted image quality, the described drilling machine combined with the bone biopsy set is well suited for MR-guided bone biopsies, which require the application of a motor driven drill. Its application within an interventional MR scanner is safe and its handling simple and manageable.

Biopsy, Needle↗

A new technique for the surgical management of deformities in the growing spine.

The Luque procedure was developed to correct the deformity without the need of bracing and maintaining that correction with growth. However many authors are disappointed by their results and the complications which appear in the management of infantile scoliosis with Luque trolley alone. Besides failed implants, pseudarthrosis, modest spinal growth and protuberant rods and wires, the major problem of the Luque systems is the high incidence of loss of correction by postoperative rotation. Therefore a new application technique is recommended. A standard posterior extraperiostal approach is chosen. Sublaminar titanium cables are passed at each level except the caudal lamina. Then the rods are precontoured in shape of the planed curve correction. We use a low profile titanium instrumentation with 5.0 mm diameter rods and 4.2 mm pedicle screws. In contrast to the conventional use of two antiparallel "L"-rods we recommend the use of one reversed "U"-rod securing the laminae with sublaminar titanium cables of the upper end vertebrae. For fixation of the lower spine a dual-opening pedicle screw system is used. Using a holding forceps the distal rods are introduced and fixed into the side opening of the screws then secured by sublaminar wires. In addition both single rods are stabilized by a low profile cross link bar. This technique allows to correct pelvic obliquity and a stable anchorage of two screws reduces risk of postoperatively rotation or caudal rod slippage due to gravity forces.

Adolescent↗

[Fracture analysis of a ceramic liner. Is in hip endoprosthesis replacement of ceramic on ceramic components with only one of the corresponding partners justified?].

The good biomechanical and tribological properties, together with the excellent biocompatibility, of ceramic-on-ceramic components, make them a preferential choice for total hip replacement surgery, at least in Europe. We report on a man admitted as an outpatient with painless grating in the hip one year after replacement of a ceramic femoral head, but not of the ceramic inlay. Clinical and radiological findings were indicative of a broken liner. This was confirmed during revision surgery, during which it was replaced by a polyethylene inlay; although the ceramic head appeared intact, it was replaced by a metal head. Inspection of the surface of the broken liner in the scanning electron microscope (SEM) revealed signs of material failure. We recommend careful inspection of ceramic-on-ceramic articulating components during total hip revision surgery and if there is any uncertainty, replacement of both so as to avoid premature failure.

Aged↗

[Normative data of the Biolfa(R) olfactory test].

OBJECTIVES: To evaluate the feasibility of the Biolfa(R) olfaction test and establish normative values. PATIENTS AND METHODS: The new Biolfa(R) olfaction test includes a quantitative test to measure the olfactory threshold of three substances in a concentration range from 1 to 9 and a semi-quantitative test to assess olfactory "acuteness" for eight substances. Substances used for this test entail non-significant trigeminal stimulation. A population of 28 women and 24 men without olfactory dysfunction were tested. RESULTS: The olfactory threshold obtained with the quantitative test ranged from 5.86 to 9.54 for women, and from 6.4 to 9.6 for men. Analysis of the thresholds identified with the semi-quantitative test enabled establishing normative values for recognition of the eight substances. These values were reported on a diagram to allow partial translation of each subject's olfactory "acuteness". Olfactory threshold and smell identification ability were statistically superior for women. CONCLUSION: The Biolfa(R) olfaction test is the first allowing determination of both the olfactory threshold and quantification of smell identification ability. Normative values were obtained in this study to detect disease states.

Feasibility Studies↗

Secondary intra-articular dislocation of a broken bioabsorbable interference screw after anterior cruciate ligament reconstruction.

We report a case of intra-articular migration of the proximal part of a broken polylactic acid screw from the tibial site of anterior cruciate ligament-reconstruction with quadrupled semi-tendinosus tendon. Five months after initially successful ACL surgery the patient felt a sudden locking of the knee without another injury. MRI showed intra-articular migration of one-half of the polylactic acid screw, and standard radiographs a widening of the proximal tibial tunnel. At revision arthroscopy the broken part was easily removed. The patient had full recovery. This case demonstrates the problem of "bioscrew" breakage in ACL surgery.

Absorbable Implants↗

Treatment of congenital spondyloptosis in an 18-month-old patient with a 10-year follow-up.

STUDY DESIGN: Case report. OBJECTIVES: To present the case of a patient with congenital spondyloptosis treated and followed over 10 years. SUMMARY OF BACKGROUND DATA: The surgical management of spondyloptosis in children is variably reported in the literature. Some authors propose that posterior fusion in situ is a safe and reliable procedure, whereas others suggest that reduction of the slipped vertebra may prevent some of the adverse sequelae of in situ fusion, which include nonunion, bending of the fusion mass, and persistent lumbosacral deformity. Many investigators advocate a combined anterior and posterior fusion using instrumentation. METHODS: At the time of the first symptoms an 18-month-old boy with congenital spondyloptosis of L5-S1 was referred to the authors' institution. Because of the progression of pain, neurologic disturbance, mild foot deformity, muscle contractures, and lumbosacral kyphosis, surgical intervention was undertaken. Operative intervention began with a resection of the L5 lamina and wide bilateral L5 nerve root decompression. This was followed by anterior subtotal resection of L5 and interbody bone graft of the morcelized vertebral body for fusion from L5 to S1. The next step was reduction of the spondyloptosis and stabilization by posterior instrumentation L2-S1 with a sacral Cotrel-agraffe device. RESULTS: The procedure achieved almost complete reduction of the spondyloptosis with near-normal restoration of lumbar lordosis allowing more physiologic lumbar spinal biomechanics. There were no neurologic complications. After surgery there was no suggestion of back pain or gait disturbance and no progression of any deformity. CONCLUSION: In the treatment of severe congenital spondylolisthesis a staged procedure of decompression, reduction, and instrumented fusion is recommended for those cases in which intervention is indicated.

Decompression, Surgical↗

Microglia and the early phase of immune surveillance in the axotomized facial motor nucleus: impaired microglial activation and lymphocyte recruitment but no effect on neuronal survival or axonal regeneration in macrophage-colony stimulating factor-deficient mice.

Activation of microglia is among the first cellular changes in the injured CNS. However, little is known about their specific contribution to secondary damage or repair processes in neighboring neurons and nonneuronal cells or to the immune surveillance of the damaged tissue. Animal models with defective microglial response such as osteopetrosis provide an approach to explore these effects. Osteopetrosis (op) is an autosomal recessive mutation with a complete deficiency of the macrophage-colony stimulating factor (MCSF; CSF-1), an important mitogen for brain microglia. In the current study we examined the effects of this MCSF deficiency on the microglial reaction and the overall cellular response to nerve injury in the mouse axotomized facial motor nucleus. In the brain, MCSF receptor immunoreactivity was found only on microglia and was strongly up-regulated following injury. MCSF deficiency led to a failure of microglia to show a normal increase in early activation markers (thrombospondin, MCSF receptor, alpha M beta 2- and alpha 5 beta 1-integrins), to spread on the surface of axotomized motoneurons, and to proliferate after injury. Early recruitment of CD3(+) T-lymphocytes to the facial nucleus 24 hours after injury was reduced by 60%. In contrast, the neuronal and astrocyte response was not affected. There was a normal increase in the neuropeptides calcitonin gene-related peptide and galanin, neuronal c-JUN, and NADPH-diaphorase and a decrease in choline acetyltransferase and acetylcholinesterase. Astrocyte glial fibrillary acidic protein immunoreactivity also showed a normal increase. There was a normal influx of macrophages and granulocytes into the injured facial nerve. Synaptic stripping, neuronal survival, and speed of axonal regeneration were also not affected. The current results show a strong, selective effect of MCSF on the early activation of microglia and, indirectly, on lymphocyte recruitment. This early phase of microglial activation appears not to be involved in the process of repair following peripheral nerve injury. However, it is important in the initiation of inflammatory changes in the brain and in the interaction with the immune system.

Animals↗