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D Stiefel

Publications and source records attributed to D Stiefel.

11 recordsLinked to original sources
PubMed2005

Amniotic fluid brain-specific proteins are biomarkers for spinal cord injury in experimental myelomeningocele.

Myelomeningocele (MMC), the most severe form of spina bifida (SB), causes neurological deficit. Injury to the spinal cord is thought to begin in utero. We investigated whether brain-specific proteins (BSPs) would enable us to monitor the development of MMC-related tissue damage during pregnancy in an animal model with naturally occurring SB (curly tail/loop tail mouse; n = 256). Amniotic fluid levels of neurofilament heavy chain (NfH), glial acidic fibrillary protein (GFAP) and S100B were measured by standard ELISA techniques. The amniotic fluid levels of all BSPs were similar in SB and control mice on embryonic day (E) 12.5 and 14.5, whereas a significant increase was observed for GFAP in SB mice on E16.5. Levels of all BSPs were significantly increased in SB mice on E18.5. The rapid increase in GFAP, paralleled by a moderate increase in NfH and S100B, suggests that spinal cord damage starts to accelerate around E16.5. The macroscopic size of the MMC was related to NfH level on E16.5 and E18.5, suggesting that axonal degeneration is most severe in large MMC. Amniotic fluid BSP measurements may provide important information for balancing the risks and benefits to mother and child of in utero surgery for MMC.

Amniotic Fluid↗
PubMed2001

Fractures of the neck of the radius in children. Early experience with intramedullary pinning.

The treatment of fractures of the neck of the radius in children is difficult, particularly if the angulation of the fracture exceeds 60 degrees. Since 1994 we have used closed reduction and stabilisation with an intramedullary Kirschner wire in patients with grade-IV fractures according to the classification of Judet et al. In a retrospective analysis of a two-year period (1994 to 1996), 324 children with fractures of the elbow were treated in our department. Of these, 29 (9%) had a fracture of the neck of the radius; six were grade-IV injuries (1.9%). Five of the latter had an excellent postoperative result with normal movement of the elbow and forearm. One patient with a poor result had a concomitant dislocation of the elbow. Our results suggest that closed reduction and intramedullary pinning of grade-IV fractures allows adequate stabilisation while healing occurs.

Bone Nails↗
PubMed2000

Posttraumatic dural sinus thrombosis in children.

Posttraumatic dural sinus thrombosis (DST) in children has rarely been described in the literature. Over a period of two years (1994-1996) we treated 131 children (n=131) with minor or severe head injury requiring a cranial computed tomography (CT) scan. DST was found in eight patients (6.1%), five with mild and three with severe cranial trauma. Diagnosis was suspected either because of a skull fracture crossing over a dural sinus or because of a hyperdensity at a dural sinus in the noncontrast CT scan. Enhanced CT scan was used to confirm DST. No specific symptoms related to DST were observed. DST was managed conservatively in all patients and recovery was uneventful. Recanalization of the sinus was documented to occur within three weeks to six months in six children. One patient showed a residual clot after five months and another did not have a follow-up CT scan. Based on our data we conclude that neither surgical nor medical intervention is indicated in traumatic DST in children.

Adolescent↗
PubMed2000

Pitfalls in therapy of upside-down stomach.

The upside-down stomach (UDS) is a special form of gastric organoaxial volvulus in a supradiaphragmatic hernial sac. The authors report five cases treated between 1979 and 1998, and seek to point out possible problems and pitfalls in the surgical management of this uncommon anomaly. Retrospective analysis of these cases shows that brachyesophagus as described is not a problem in UDS, as the esophagus is of normal length. The hiatus, on the other hand, is always very large and needs proper narrowing, which may be achieved through a transabdominal approach more easily than through a transthoracic access. A common esophago-aortal hiatus is often present. In conclusion, the authors recommend a hiatal repair and gastropexy, i.e. fundophrenopexy and corpoventropexy along the esophageal axis to prevent recurrent gastric herniation or torsion. Transabdominal access should be chosen since brachyesophagus is not expected. Beware of a common hiatus when preparing the hiatal crura. An antireflux procedure is not necessary as gastro-esophageal reflux usually resolves spontaneously after hiatal repair and gastropexy.

Digestive System Surgical Procedures↗
PubMed1998

Acute appendicitis in neonates: complication or morbus sui generis?

Neonatal appendicitis (NA) is very rare and is associated with a very high perforation rate. Three cases treated at our hospital since 1969 are presented. All of them had a perforated appendix; two represented a complication of an underlying disease, i.e., Hirschsprung's disease and cystic fibrosis, respectively. These diseases should always be ruled out actively in cases of NA. If an underlying disease is not found, NA might be an isolated form of necrotizing enterocolitis limited to the appendix. Histology cannot distinguish between a simple appendicitis and a localized form of NEC, so NA must be regarded as a complication of an underlying disease as well as a morbus sui generis.

Acute Disease↗
PubMed1997

Fractures at the base of the skull in gunshots to the head.

The distribution of fractures at the base of the skull was investigated in 147 victims with lethal head shot wounds caused by handguns or small calibre low-velocity rifles. In individuals without an impact of the projectile at the base of the skull, bullets lodged in the head were found up to a calibre of 7.65 mm (pistol) or .38 special (revolver), respectively. In cases with a trajectory through the cranial fossae positive results were obtained up to 9 mm (pistol) or even .45 (revolver). Fractures in anterior parts of the base of the skull were a rather frequent finding (82% of the cases) and could also be observed in victims shot by low energy guns. Fracture lines in particular in all cranial fossae, however, indicate a comparatively high energy missile and were found in victims without a direct impact of the bullet at the base of the skull after the use of guns with a calibre of at least 7.65 mm. Severe fractures leading to a hinge-like mobility of the base of the skull point also to projectiles of rather high energy. On the other hand, such fractures were also found in a victim with a contact shot by a .22 rifle. Therefore, it must be emphasized that individual factors such as the constitution of the base of the skull, the path of the bullet, technical parameters of the gun and ammunition used are of great importance if conclusions are to be drawn on an unknown gun by evaluation of fractures at the base of the skull.

Adolescent↗
PubMed1997

[Intestinal foreign body with sigmoid perforation in an area of carcinomatous stenosis: incidental finding or etiology?].

Ingestion of a foreign body is a common incident. In most cases it rarely produces symptoms, but sometimes may cause severe complications such as abscess formation, obstruction or perforation. A definite diagnosis can be difficult to obtain for the following reasons: 1. the past history doesn't give any clue; 2. the symptoms are veiled by another intestinal disease; 3. radio opaquity of the foreign body is absent; 4. complications can mimic different symptoms inspite of their unique etiology. The following case reports a patient with an intestinal perforation, where a foreign body and a stenosis, caused by a sigma neoplasm, were simultaneously present. Histological findings showed that the foreign body, not the neoplasm, was causing the perforation, whereas for the underlying disease it only was an incidental finding.

Adenocarcinoma↗
PubMed1996

Cranial fractures and direction of fire in low velocity gunshots.

A total of 59 penetrating contact shot wounds to the head caused by handguns was investigated and a comparison was made between the magnitude and the number of fracture lines at the entrance and exist site of the vault and at the base of the skull. It was noted that in approximately 50% of the cases the extent of fractures at the entrance site exceeded those at the exit wound while in the remaining individuals no relevant differences or even greater exit fractures were found. Furthermore, no close correlation between the fracture patterns of the vault and at the base of the skull occurred indicating that differences in the magnitude and the number of entrance or exit fracture lines cannot provide reliable information on direction of fire. Additionally, no further conclusions on the gun used can be drawn from differences in the entrance and exit fracture patterns. It can only be assumed that the absence of fractures in the cranial fossae points to the use of small calibre handguns (< or = 7.65 mm) while a fragmentation of the skull can as a rule be expected after shots from guns with larger calibres (> 7.65 mm).

Adolescent↗
PubMed1995

Frequency of blood spatters on the shooting hand and of conjunctival petechiae following suicidal gunshots wounds to the head.

A total of 103 suicidal and 29 homicidal gunshot fatalities were evaluated. In 42% of the suicides, characteristic findings like blood spatters and/or powder soilings, could be found on the shooting hand by naked-eye inspection indicating the importance of an accurate examination of the deceased's hands at autopsy for a preliminary diagnosis. Petechial hemorrhages of the conjunctivae due to the gas pressure after discharge of the weapon were observed in 22% of those cases with contact shot wounds to the head/neck, but not in cases of distant shot injuries following the use of non-high velocity ammunition. Therefore, conjunctival petechiae can be regarded as an additional but optional sign of contact head shots in cases without alterations possibly influencing the development of conjunctival pin-point bleedings. The evidence of such findings can be of practical importance if the entrance shot wound cannot be examined for whatever reason.

Adolescent↗
PubMed1989

[Short-stop ammunition].

Now and again ammunition is offered emphasizing its "less deadly" or "not at all deadly" effects. On application, however, these types of ammunition contrary to the manufacturer's allegations turn out to be a real threat. On the one hand results can be rather harmful while on the other side at court a remonstration on the grounds of not knowing such outcome beforehand may be successful. Under these aspects construction and effects of a special small shot ammunition for revolvers (Speer 38/357 Shot Shells, manufactured by CCI), of the cartridge "Short-Stop", manufactured by MB Associates in San Ramon (California) and, in connexion with own casework, a "shock-defense" sort of ammunition, manufactured by Rauchalles (Offenburg, West Germany) are compared and discussed with respect to their construction and effects.

Adult↗