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Biomedical subjects

H Reinhardt

Publications and source records attributed to H Reinhardt.

At least 19 recordsLinked to original sources
PubMed1998

Pulmonary artery growth after systemic-to-pulmonary shunt in children with a univentricular heart and a hypoplastic pulmonary artery bed. Implications for Fontan surgery.

The aim of the study was to investigate the developmental pattern of hypoplastic pulmonary artery (p.a.) bed augmented by systemic-to-pulmonary shunt in children with univentricular heart scheduled for Fontan surgery. For the study, a highly selected patient cohort was chosen (12 patients aged between 5 and 19 years; mean 9.5 years) with comparable initial morphological conditions of univentricular heart and hypoplastic p.a. bed, who after mandatory systemic-to-pulmonary shunt underwent Fontan procedure at time of normalization of pulmonary artery size. Further selection criteria were: normal pulmonary vascular resistance at time of Fontan procedure, competent a-v valve(s), and globally unimpaired ventricular function. All patients were grouped according to the preoperative pulmonary flow index (Qpi; L/min/m2 b.s.a.) measured immediately before Fontan operation: Group A: 1.5-2.5; B: 3.0-4.0; C: 4.0-5.0; D: > 6.0, and their cardio-pulmonary hemodynamic situation (Hb, SAsat%, Qp/Qs, PAP, Rp/Rs, EDVP, FS%, ventricular diastolic compliance (VC = EDVP/Qpi + Qsi) as well as the pulmonary artery size and area using standard (Nakata-index, McGoon-ratio) and a self designed computer assisted planimetric area calculation (PPAAI; cm2/m2 b.s.a.) analysed. Each patient underwent 1-3 shunt procedures, the mean shunt patency period for groups A, B, C and D was 12, 8.6, 5.3, and 4.5 years, respectively. The mean Nakata-index (283, 297, 324, 405 in groups A-D) and the McGoon-ratio (2.0, 2.2, 2.8, 3.3 in groups A-D) correlated with the Qp index, reflecting flow dependent development of pulmonary artery bed. No correlation was found between Qpi and PPAAI (47, 40, 41 and 47 in group A-D). The VC/Qp relation showed an inversely proportional pattern with values 2.3, 1.0, 0.8, 0.7 for corresponding groups A-D, the lowest VC in group A correlated with polyglobulic status (Hb- values; g/dl): 21.3 in A vs 19.8, 18.0 and 16.5 in B-D) and mean arterial SAsat-values (77% in A vs 83%, 84% and 89% in B-D). In conclusion, in our highly selected patient cohort, the development of p.a. size was strongly flow-dependent, and patients with restrictive pulmonary flow needed an approximately threefold longer time period to normalize their p.a. size compared to those with excessive flow. In patients with restrictive pulmonary flow, the Nakata-index underestimated the degree of development of the pulmonary artery system, probably due to the distortion of the proximal p.a. segment. In consequence, in these patients the normalization of the p.a. bed and thus suitability for the Fontan procedure probably occurred much earlier. Based on our observations and those of others, in patients with excessive flow the normalization of p.a. bed, provided it occurs within 3-4 years, seems not necessarily to be associated with a deterioration of ventricular function.

Adolescent↗
PubMed1998

[Quality assurance in inpatient surgical care in the Saxony-Anhalt area. Results of 3 years].

Quality assurance in surgery has a long tradition. In the last twenty years, especially externe quality assurance was very important. Pioneers of this development were Schega and Scheibe and the East German working group for quality assurance in surgery. After preparations of Scheibe in some federal countries, global measures could be started. In 1993, also in Sachsen-Anhalt we started externe quality assurance in surgery with the diagnosis gallstone disease and cholecystitis. The experiences and results of a 3-year period will be shown.

Cholecystectomy, Laparoscopic↗
PubMed1996

[Computer-assisted surgery of the paranasal sinuses with an opto-electronic stereotaxic system].

BACKGROUND: A basic problem common to all systems for computer-assisted surgery (CAS) is the exact registration and referencing, that is, the transfer of preoperative image data to the intraoperative pathology. A system for computer-assisted ENT surgery should provide high precision as well as noninvasive registration and referencing. We present a system designed for such use in paranasal sinus surgery that is based on optical digitizing with several custom-made self-localizing surgical instruments. METHODS AND RESULTS: The system tracks the correct alignment of the head during CT data acquisition and continuously throughout surgery. A transformation matrix and a plane equation of the CT scan are used to match points of the object space to the image space detecting fiducial markers on the CT scans by an automatic algorithm. For position measurements a special reference frame and surgical instruments were developed and equipped with infrared light-emitting diodes that could be detected in real time. Measurements for repositioning of the reference system in a model and during real operations demonstrated a mean error ranging from 0.69 to 1.01 mm and from 0.76 to 1.67 mm respectively. Clinical experience with the application of the system for 15 patients who underwent surgery for different paranasal sinus pathologies is reported. CONCLUSIONS: Results suggest that the non-invasive reference system and the locatable surgical tools may be effective, accurate and useful for computer-assisted identification of intranasal structures. Such systems may contribute to further improvement of minimal invasive intranasal sinus surgery.

Equipment Design↗
PubMed1995

Optically-navigable operating microscope for image-guided surgery.

In computer-assisted surgery (CAS), optical digitizing is state-of-the-art. Unfortunately standard navigation instruments, e.g. small, LED-equipped pointers are frequently shadowed by the operating microscope when the camera-array is ceiling- or rack-mounted. Thus, for microsurgery, a navigation module consisting of a reference panel mounted onto the housing of the microscope and an object distance measuring unit attached in front of the objective lens was developed. By means of this navigation module the microscope can be located in space with an accuracy of +/- 1-2 mm. Focusing errors due to the high depth of view of modern microscopes and individual refraction anomalies are eliminated by laser distance measurement. This device has been clinically tested since September 1994 and a typical case is reported.

Humans↗
PubMed1993

[Mortality in childhood--a study of pediatric fatalities in the Magdeburg district].

In the present study the causes of the cases of infant mortality (1 to 16 years of age) in the Magdeburg district in the period from 1982-1989 are analysed. The causes of death are shown according to age, sex and diagnosis groups, using autopsy-documents and data from the district of Magdeburg. The order of diagnosis starts with accidents with 40%, followed by malignant neoplasm and congenital anomalies with 13% and 13.1%, respectively, and diseases of the nervous system and of the sense organs with 9.9%. Conclusion are drawn for the reduction of the infant mortality rate.

Adolescent↗
PubMed1992

Significant lateralisation of supratentorial ICP after blunt head trauma.

After blunt head trauma simultaneous left and right hemispheric intracranial pressure (ICP) monitoring revealed a pressure gradient of about 30 mmHg persisting until the 5th day after the accident equilibrating thereafter. ICP was elevated over the radiologically more compressed hemisphere. The supratentorial space seems to allow considerable interhemispheric pressure gradients. As a consequence epidural ICP monitoring should be performed over the hemisphere with signs of greater compression.

Brain Edema↗
PubMed1992

[The strategy in decision making for the development of an orthodontic consultation system].

The high increase of information mainly because of new exact methods of examination makes it necessary to search for new possibilities of data storage, data processing and data analyzing. Orthodontic cases retrospectively assessed are taken as a knowledge-based system, and the individual case is classified by objective criteria metrically determinable as well as subjective criteria. After classification a plan of treatment can be elaborated.

Computer Systems↗
PubMed1991

[Catamnestic study of school children with behavioral disorders].

A catamnestic study of disturbed pupils, who have been examined by a child neuropsychiatrist for admission to a balancing class, revealed that the accumulation of biological and psychosocial load factors presents a risk for persisting behavioural disturbance. Failure at school was prevented by a temporary stay in a balancing class, but psychic maldevelopment indicated by the high percentage of odd children in the disturbed population could not be precluded. The refore the life-long medical and special pedagogic care for these children beyond discharge from the balancing class is considered to be necessary.

Adolescent↗
PubMed1990

Anaplastic astrocytoma and glioblastoma: pion irradiation with the dynamic conformation technique at the Swiss Institute for Nuclear Research (SIN).

Clinical phase I/II studies have been performed at the Swiss Institute for Nuclear Research (SIN) since February 1982. Fifty-two out of 249 patients accepted for pion treatment by the end of 1986 were treated for malignant glioma with high dose pion irradiation. A substantial influence of their radioresistance was expected from increased radiation quality due to the contribution of high LET particles from pion capture, and by the possibility of target volume shaping and dose distribution related to the dynamic spot-scan conformation technique. The patients' treatment followed a dose escalation program with total doses from 2720-3420 cGy, fraction sizes from 170 to 205 cGy (90% isodose, minimum target dose), and treatment times from 4 to 5 weeks. 12/52 patients received an accelerated treatment with 3280 cGy in 14-22 days. 49/52 patients are eligible: 3 with astrocytoma of clinical aggressive behaviour, 14 with anaplastic astrocytoma (median age 42 years), and 32 patients with glioblastoma (median age 52 years). 8/49 patients had total/subtotal tumour resection, 19 patients a stereotactic biopsy. The patients were divided into three groups according to total dose, and a fourth group which received the accelerated treatment. There was no statistically significant difference in the median survival rate between the four groups, which was 13 months for the non-glioblastoma patients and 9 months for the glioblastoma patients. No radiation necrosis and no demyelination was found in 17 patients (6 recraniotomies, 11 autopsies). In 10/17 patients, clearly identifiable tumour cells were not demonstrated. NMR findings showed the tumour-surrounding oedema mostly stimulated by tumour necrosis and tumour progression. From these findings, further dose escalation programs, together with a shaping of the target volume close to the tumour, are not contraindicated.

Adult↗
PubMed1990

[Technical aspects of ultrasound aspiration].

Technical, metallurgical and ergonomic problems which were encountered during a three-year development period of a surgical ultrasonic aspirator are reported. The aim of the construction of a lighter, handier, piezo-driven handpiece with a durable titanium tip was achieved. A first version was extensively tested during more than 40 resections of brain tumours. A second prototype of a handpiece with an integrated aspiration and flushing facility will be soon evaluated clinically. Further applications and perspectives of ultrasonic aspiration are discussed.

Brain Neoplasms↗
PubMed1990

[Assessment of health status and current life style of patients with malignant neoplasms].

A review is given on the results of a study investigating the state of health and the psycho-social situation of 211 patients who underwent follow-up for malign neoplasm in the oncological Health Center of Magdeburg. In the course of a conversation the patients were questioned about social and other factors specific for their disease. For evaluating the psychic situation the questionnaire of Höck and Hess was used. The results of the study allowed to conclude that more than 50% of the patients showed psychoreactive disorders. Depending from age and sex as well as the diagnosis marked differences concerning the frequences of psychic peculiarities and the evaluation of the state of health were revealed. The results demonstrate that in addition to specific oncological knowledge the consideration of social and psychic factors is necessary for an optimum follow-up in order to recognize and prevent disorders in this field.

Adaptation, Psychological↗
PubMed1990

[State of oral health with children and adolescents aged 10 to under 15 years in relation to selected social factors].

The analysis of the state of oral health in pupils aged 10 to under 15 years showed a still high caries-morbidity. The mouth hygiene and the state of gingiva were good. Comparisons between pain patients, children dentistry patients and orthodontic patients showed best results in orthodontic patients. The state of oral health was found to be influenced by the profession of the parents, the number of brothers and sisters and the success at school.

Adolescent↗