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Biomedical subjects

K Ludwig

Publications and source records attributed to K Ludwig.

At least 109 records · Page 6Linked to original sources
PubMed1998

CT scanning of the paranasal sinuses: axial helical CT with reconstruction in the coronal direction versus coronal helical CT.

Paranasal sinuses of 52 patients with sinusitis, tumours or fibrous dysplasia were scanned. Axially acquired spiral data were obtained and reconstructed coronally. Four radiologists compared the two sets of images. They evaluated the diagnostic quality for visualization of the ostiomeatal unit, infundibulum, infraorbital canal, inflammatory disease, fine osseous lamellae and presence of amalgam or step artefacts. Two test phantoms were scanned for both techniques and lens dose was measured. Statistical significant differences in the diagnostic quality of the representation of the fine osseous structures in the paranasal sinuses, attributable to step artefacts were found in the coronally reconstructed images (p < 0.001). However, there was no amalgam and almost no motion artefacts in the reconstructed images. Interobserver correlation was r = 0.953 versus 0.956 for inflammatory disease, r = 0.816 versus 0.852 for artefacts, and r = 0.596 versus 0.547 for fine osseous lamellae in coronally acquired or axially acquired and reconstructed images, respectively. Lens dose was measured between 11.8 mGy and 13.8 mGy for axially acquired and reconstructed images. The advantage of axially acquired, coronally reconstructed images is the absence of artefacts attributable to amalgam and fewer motion artefacts. Axially acquired, coronally reconstructed images are inferior to coronal helical CT images, because of step artefacts, when it comes to evaluating the resolution of fine osseous structures. Nevertheless, reconstructed images are suitable as a investigatory procedure for patients with inflammatory disease who cannot maintain the prone position.

Adult↗
PubMed1998

[Breast reconstruction-plasty. A modification of the Strömbeck-Wise technique].

We report about 7 patients with an modification of Strömbeck-Wise-technique in reduction mammoplasty. The average weight of reduced breast tissue was about 650 g per side. The experience of this method shows an procedure without complications, with good plastic results and an successful intraoperative symmetry adaptation.

Adult↗
PubMed1998

[Microcystic adenoma of the pancreas--a case report].

A 65-year-old female patient with microcystic adenoma of the pancreatic head is reported. Under suspicion of a malignant pancreatic tumour a kephalic duodenopancreatectomy (Kausch-Whipple) was performed. Diagnosis, therapy, prognosis and pathological anatomical aspects of benign microcystic adenoma are discussed.

Adenoma↗
PubMed1998

[Diagnosis and therapy of traumatic injury of the pancreas].

Traumatic injuries of the pancreas are with 3 to 12% of all abdominal traumas an uncommon finding. Intraabdominal combined injuries and unspecific symptoms make an early detection often difficult. In the present study we report on 25 cases (4.7%) with pancreatic trauma out of 529 abdominal injuries that were treated between 1973 and 1996. In 68% of the cases, we detected simple gland lesions with an A.A.S.T.-score I-III (American Association for the Surgery of Trauma). In 32% of the cases, we found extended ruptures of the head of the gland (score IV and V). These patients presented severe therapeutic problems. 98% of our patients had combined intraabdominal injuries. With respect to imaging techniques, CT-scan and ERCP were the most sensitive procedures. Our therapeutic management included in 14 of the cases external drainage after debridement, 6 pancreatic head--and 3 left resections. 2 patients had to undergo a duodenopancreatectomy. The morbidity in our study was 33% (8 patients), whereas septic complications were most often encountered. The clinical mortality was 24% (6 patients). Based on our results, simple drainage after selective debridement may be sufficient for simple gland contusions. For the treatment of severe damages of the pancreatic head, including lesions of the pancreatic or bile duct or duodenum, adequate resection methods are recommended. An early diagnosis is mandatory facilitated by regular employment of CT-scanning and ERCP techniques.

Abdominal Injuries↗
PubMed1998

[Gallbladder carcinoma--an unexpected finding after laparoscopic cholecystectomy].

The carcinoma of the gallbladder can be found mostly in a late stage. We have to expect a incidental carcinoma of the gallbladder in 1-2% after conventional cholecystectomy. We report 9 cases of unexpected carcinoma of the gallbladder after 1700 laparoscopic cholecystectomies. The time of survival were--dependent on tumor stage--2 to 36 month. We outline special items of this disease within the context of minimal-invasiv surgery.

Adenocarcinoma↗
PubMed1998

[The employment schedule act--effects on the young surgeon].

Since 1. 1. 96, new regulations of working hours have been introduced in our hospital with regard to emergency service and compensation through leisure time. The average payment was reduced by 23% for surgeons on call. By this means, three additional surgeons could be employed. For every resident in training there is now less time for his residency than before. Sufficient surgical residency requires enough time on the ward and in the operating room. Thus, other conditions for residency programs are necessary to avoid unfulfilled tasks being pushed into the pre-existing area of non-documented working hours. Research and any scientific activity take place in leisure time.

Curriculum↗
PubMed1998

[Intraoperative routine cholangiography in laparoscopic cholecystectomy].

In the present study of 1000 patients undergoing laparoscopic cholecystectomy we report the results of intraoperative routine cholangiography (IOC). IOC was feasible in 89.2% of the patients and presented a complete depiction of the extrahepatic bile system in 98.1%. Anatomic variations of the bile system which subsequently affected the operative management were found in 12.6% by IOC. In conclusion we recommend that using IOC anatomic variations of the bile system can be visualised and therefore accidental injuries avoided.

Adolescent↗
PubMed1997

[Effect of selenium administration on various laboratory parameters in patients with acute pancreatitis].

BACKGROUND: Recent studies presented evidence that activation of oxygen derived free radicals occurs in patients with acute pancreatitis. The purpose of this study was to evaluate the effect of sodium selenite as a possible antioxidant therapy in acute pancreatitis. PATIENTS AND METHOD: 16 patients with moderate form of acute pancreatitis received a high dose of sodium selenite. Selenium in serum and whole blood, zinc, copper, manganese, superoxid dismutase (SOD), glutathione peroxidase (Gpx) and malondialdehyde (MDA) were determined (before selenium substitution, 3 days later, 8 days later, before demission). No selenium deficiency could be detected before selenium substitution. RESULT: The selenium therapy caused a significant increase in selenium, a moderate increase in activity of Gpx, a significant decrease in activity of MDA, whereas SOD remained unchanged. CONCLUSION: Concerning the particular point of view of "deficiency management", there is no need of selenium substitution in patients with a moderate form of acute pancreatitis in our region. The highly normal selenium concentration we established by our therapy is possibly connected with a decrease of the oxidative stress in acute pancreatitis. More clinical follow-up studies with more patients, who have different grades of severity of the acute pancreatitis, and besides that a control group of patients without selenium substitution, are necessary for evaluating the clinical relevance of our results.

Acute Disease↗
PubMed1997

Fragmin in unstable angina pectoris or in non-Q-wave acute myocardial infarction (the FRIC study). Fragmin in Unstable Coronary Artery Disease.

The safety and efficacy of weight-adjusted, low-molecular-weight heparin (dalteparin) was compared with that of unfractionated heparin during 6 days of treatment in 1,482 patients with unstable angina or non-Q-wave myocardial infarction. Dalteparin, at a lower dose, was compared with placebo during the following 39 days. No significant outcome difference was found between the 2 treatment regimens in the unblinded phase (days 1-6). Between days 6-45 the rates of death, myocardial infarction, and recurrence of angina were comparable between the active treatment and placebo groups. The results suggest that twice-daily administration of subcutaneous dalteparin may be an effective and safe alternative to unfractionated heparin during the acute phase of unstable coronary artery disease. Prolonged treatment with dalteparin at a lower once-daily dose did not confer any additional benefit over aspirin (75-165 mg) alone.

Angina, Unstable↗
PubMed1997

Comparison of low-molecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in unstable coronary artery disease study (FRIC)

BACKGROUND: Low-molecular-weight heparin has a number of pharmacological and pharmacokinetic advantages over unfractionated heparin that make it potentially suitable, when used in combination with aspirin, for the treatment of unstable coronary artery disease. METHOD AND RESULTS: Patients with unstable angina or non-Q-wave myocardial infarction (1482) were included in the study, which had two phases. In an open, acute phase (days 1 to 6), patients were assigned either twice-daily weight-adjusted subcutaneous injections of dalteparin (120 i.u./kg) or dose-adjusted intravenous infusion of unfractionated heparin. In the double-blind, prolonged treatment phase (days 6 to 45), patients received subcutaneously either dalteparin (7500 i.u. once daily) or placebo. During the first 6 days, the rate of death, myocardial infarction, or recurrence of angina was 7.6% in the unfractionated heparin-treated patients and 9.3% in the dalteparin-treated patients (relative risk, 1.18; 95% confidence interval [CI], 0.84 to 1.66). The corresponding rates in the two treatment groups for the composite end point of death or myocardial infarction were 3.6% and 3.9%, respectively (relative risk, 1.07; 95% CI, 0.63 to 1.80). Revascularization procedures were undertaken in 5.3% and 4.8% of patients in unfractionated heparin and dalteparin groups, respectively (relative risk, 0.88; 95% CI, 0.57 to 1.35). Between days 6 and 45, the rate of death, myocardial infarction, or recurrence of angina was 12.3% in both the placebo and dalteparin groups (relative risk, 1.01; 95% CI, 0.74 to 1.38). The corresponding rates for death or myocardial infarction were 4.7% and 4.3% (relative risk, 0.92; 95% CI, 0.54 to 1.57). Revascularization procedures were undertaken in 14.2% and 14.3% of patients in the placebo and dalteparin groups, respectively. CONCLUSIONS: Our results add to previous evidence suggesting that the low-molecular-weight heparin dalteparin administered by twice-daily subcutaneous injection may be an alternative to unfractionated heparin in the acute treatment of unstable angina or non-Q-wave myocardial infarction. Prolonged treatment with dalteparin at a lower once-daily dose in our study did not confer any additional benefit over aspirin (75 to 165 mg) alone.

Adult↗
PubMed1997

Transient changes of the conformation of hemagglutinin of influenza virus at low pH detected by time-resolved circular dichroism spectroscopy.

Membrane fusion of influenza virus is mediated by a conformational change of the viral membrane protein hemagglutinin (HA) triggered by low pH. By near UV CD spectroscopy, which is sensitive to the arrangement and mobility of aromatic amino acids in proteins, we have monitored continuously with a time resolution of 5 s the kinetics of structural alterations of the ectodomain of HA isolated from different influenza virus strains (H1 (A/PR 8/34), H2 (A/Japan), and H3 (X31)). To establish a functional correlation to structural alterations of the HA ectodomain reflected by the CD, we have measured the kinetics of the virus-erythrocyte fusion and of the inactivation of fusion by low pH preincubation of viruses. At acidic pH we found a multiphasic behavior of the CD signal recorded at 283 nm. Upon lowering the pH we detected first an increase of the CD amplitude, which is associated with the formation of a fusion-competent state of HA. The initial increase was followed by a continuous decline of CD amplitude, which can be ascribed to a transformation into a fusion-inactivated conformation that is in its early phase reversible as found for A/Japan. The half-time of the different phases of the CD signal depended on the virus strain, the temperature, and the acidic pH. The results support recent hypotheses that the fusion-competent conformation is an intermediate of the fusion-inactivated structure of HA.

Circular Dichroism↗
PubMed1997

Outbreak of Escherichia coli O157:H7 infection in a large family.

An outbreak of bloody and nonbloody diarrhoea caused by Escherichia coli O157:H7 including one case of haemolytic uraemic syndrome (HUS) and two cases of haemolytic anaemia, in five siblings (aged 2.5 to 11.3 years) and their playmate was investigated. Using sorbitol-MacConkey agar, colony blot hybridisation, and immunomagnetic separation, Shiga toxin 2-producing Escherichia coli O157:H7 was isolated from all children but the HUS patient; however, this patient had high immunoglobulin M antibody titres against Escherichia coli O157 lipopolysaccharide. Escherichia coli O157 isolates from all patients were indistinguishable in serotype, virulence properties, and genomic background, indicating that the same strain caused the infections. These data confirm the importance of person-to-person transmission.

Anemia, Hemolytic↗
PubMed1997

[Commercial teleradiology systems in Germany].

Teleradiologysystems can differ considerably in their features. The most important differences lie in the mode of image data acquisition, data transfer, data safety aspects and the possibilities of interaction between separate teleradiology units. A selection of commercially available teleradiologysystems is presented and compared.

Computer Systems↗
PubMed1997

Continuous plasma resin perfusion for detoxification of methotrexate.

UNLABELLED: Acute renal failure is a rare but very severe side-effect of methotrexate (MTX) treatment requiring extracorporeal detoxification. A new detoxification regime, consisting of a haemodiafiltration (HDF) and continuous plasma resin perfusion (PRP) over anion exchange resin column with high affinity for MTX, was used for treatment of MTX-induced acute renal failure in a 2-year-old boy with medulloblastoma. More than 99% of MTX was removed from plasma by perfusion over the resin column resulting in a marked decrease of MTX plasma half-life. No haematological complications occurred. CONCLUSION: The use of PRP alone or in combination with HDF is a new and effective treatment strategy for extracorporeal detoxification of MTX.

Acute Kidney Injury↗
PubMed1997

[Incidental gallbladder carcinoma--a report of experiences after 1,200 laparoscopic cholecystectomies].

Incidental carcinoma of the gallbladder can be found histologically in 1-2% of specimens after surgery of benign diseases of the hepatobiliary tract. We present our results of 7 cases of incidental gallbladder carcinoma in 1200 laparoscopic cholecystectomies. Surgical treatment and clinical outcome are reported. We tried to outline special items of this disease within the context of minimal-invasive surgery.

Aged↗
PubMed1997

[Value of intraoperative cholangiography in laparoscopic cholecystectomy].

By introduction of laparoscopic cholecystectomy, an increase of accidental common bile duct injuries up to 1.2% has been reported. In the present study of 325 cholecystectomies we evaluated whether mandatory intraoperative cholangiography (IOC) can reduce the rate of accidental bile duct injuries or, at least, identify them early in order to make an adequate repair possible. In addition 163 patients underwent preoperative intravenous cholangiography (IVC). Both imaging techniques were compared with regard to their sensitivity in the detection of anatomic variations and stones of the extrahepatic bile duct system. Our results demonstrated a great advantage of the IOC. The IOC was feasible in 98.1% of the cases and presented a complete depiction of the extrahepatic bile duct system in 99.3%. IVCs showed the biliary system in 91.4% of the cases but without visualization of the cystic duct in 51.5% and the hepatic confluence in 16%. Anatomic variations of the bile duct system which consecutively influenced the operative management were found in additional 27.6% exclusively by IOC. 71.4% of bile duct stones were not detected by IVC. The intraoperative time consumption of IOC was unimportant. The x-ray-load was clearly lower by a factor of 3.5. There was no complication after IOC. In comparison, 6.1% of patients demonstrated an anaphylactic reaction by IVC. One common duct injury (0.3%) was detected intraoperatively by IOC and at the same operation treated without postoperative complications. In conclusion, we recommend an IOC in addition to a thorough preoperative ultrasound-examination. By this technique intraoperatively identified stones of the common bile duct can be sufficiently treated by postoperative endoscopic extraction and anatomic variations of the bile duct system will be visualized and therefore accidental injuries will be avoided.

Adult↗