Biomedical subjects

Silke Aldrian

Publications and source records attributed to Silke Aldrian.

8 recordsLinked to original sources

PubMed2006

Occult scaphoid fractures: comparison of multidetector CT and MR imaging--initial experience.

PURPOSE: To compare the diagnostic performance of multidetector computed tomography (CT) and magnetic resonance (MR) imaging in patients clinically suspected of having a scaphoid fracture and who had normal initial radiographs, with radiographs obtained 6 weeks after trauma as the reference standard. MATERIALS AND METHODS: The ethics committee approved the study, and all patients gave written informed consent. Twenty-nine patients (17 male, 12 female; age range, 17-62 years; mean age, 34 years +/- 13) underwent multidetector CT and MR imaging within 6 days after trauma. CT data were obtained with 0.5-mm collimation. For image review, 0.7-mm-thick multiplanar reformations were performed in transverse, coronal, and sagittal planes relative to the wrist. The 1.0-T MR examination consisted of coronal and transverse short inversion time inversion-recovery, coronal and transverse T1-weighted spin-echo, and coronal volume-rendered T2-weighted gradient-echo sequences. Two radiologists analyzed the CT and MR images. A binomial test was used to evaluate the significance of the differences between MR imaging and CT in detection of scaphoid fractures and cortical involvement (P < .05). RESULTS: The 6-week follow-up radiographs depicted a scaphoid fracture in 11 (38%) patients. Eight patients had a cortical fracture, while three patients had only a bandlike lucency within the trabecular portion of the scaphoid. MR imaging depicted all 11 fractures but only three [corrected] cortical fractures. Multidetector CT depicted all eight cortical fractures but failed to depict trabecular fractures. No false-positive fractures were seen on MR or CT images. Differences between MR imaging and CT were not significant for the detection of scaphoid fractures (P = .25) but were significant for cortical involvement (P = .03). CONCLUSION: Multidetector CT is highly accurate in depicting occult cortical scaphoid fractures but appears inferior to MR imaging in depicting solely trabecular injury. MR imaging is inferior to multidetector CT in depicting cortical involvement.

Adolescent↗

PubMed2005

Geriatric polytrauma.

BACKGROUND: compared to a younger population, the treatment of geriatric trauma victims is known to be associated with a higher mortality and morbidity. The objectives of this study are to assess the clinical course and outcome of multitrauma patients aged 65 years and over. In addition, a direct comparison between the geriatric trauma patients and the younger collective is performed. METHOD: our study includes all multitrauma patients treated between 1992 and 2001 at a major urban trauma center. The major issues of this analysis are: injury severity, injury pattern, preclinical hemodynamics and intubation rate, operative treatment, ventilation time, outcome as well as incidence of multiorgan failure (MOF) and adult respiratory distress syndrome (ARDS). Out of these results, adults over 65 years of age (group B, n = 45) are compared to the younger group, ranging from 16 to 64 years of age (group A, n = 369). RESULTS: The preclinical intubation rate was comparable in both groups (A: 73.2%, B: 68.9%). Significantly more cases of group B were primarily shocked (A: 29.0%, B: 48.9%). The mean ISS was comparable in both groups (A: 34.0; B: 32.1). The younger group showed a significantly higher incidence of spine injuries (A: 21.1%; B: 6.7%). The number of emergency procedures (A: 24.2%; B: 24.4%) and operations during the first 24 hours (A: 70.2%; B: 60.0%) was comparable in both groups. The older group showed a lower number of reconstructive operations (A: 57.6%; B: 35.6%). Geriatric trauma patients had a longer ventilation time compared to their younger counterparts (A: 13.0 days, B: 20.0 days). During ICU-therapy, the ARDS rate was comparable (A: 16.0%, B: 15.6%). In contrast, the incidence of MOF was significantly higher in group B (A: 7.1%; B: 17.8%). The older group showed a significantly higher mortality rate (A: 26.8%; B: 53.3%) as well as early mortality during the first 24 hours after admission (A: 16.3%, B: 31.11%). CONCLUSION: Despite similarity in injury severity and a comparable injury pattern, elderly multitrauma patients initially presented a higher rate of hemodynamic instability, had to be ventilated longer and had a higher mortality.

Adolescent↗

PubMed2005

[Hand injury in polytrauma].

BACKGROUND: The aim of this study was to evaluate forearm and hand injuries in multitrauma patients and to compare this group of patients to the overall multitrauma population. PATIENTS AND METHODS: Out of a prospectively gathered polytrauma data base a retrospective analysis, including demographics, injury severity, injury pattern and treatment of forearm and hand injuries was performed. RESULTS: Out of 386 patients (G) that had been entered in our polytrauma data base, 26 had forearm and hand injuries (H). The mean age of group (H) was 36.4 years (G: 40.3 years, p = 0.220), the mean ISS of this population was 28,3 (G: 34.5, p = 0.003). Mostly fractures of the radius (50.0%), the metacarpus (53.8%) and the carpus (50.0%) were diagnosed. Surgical interventions of hand- and forearm injuries were done in 15 cases within 24 hours, 4 patients were treated after 24 hours. CONCLUSION: Multiple trauma patients with hand- and forearm injuries showed a statistically significant decreased injury severity and were younger compared to the overall multitrauma population.

Abbreviated Injury Scale↗

PubMed2005

Clinical results of computer-navigated anterior cruciate ligament reconstructions.

Growing participation in sports activities over recent years has increased the number of anterior cruciate ligaments (ACL) injuries. Thus, more surgeons became active in this field, leading to a high incidence of transplant failure. In the past 2 1/2 years, 235 patients were treated through navigated ACL reconstruction with semitendinosus-gracilis tendon (STG) autograft. One hundred patients who returned for the follow-up examinations were evaluated. In all cases without concurring injuries, the clinical outcome was excellent or very good. Postoperative radiological examination showed correct positioning of the EndoButton (Smith and Nephew, Mansfield, Mass.) and the Suture Plate (B. Braun-Aesculap, Tuttlingen, Germany) in all patients. The subjective and objective stability assessment did not show any significant difference to the uninjured opposite side.

Adolescent↗

PubMed2003

[Psychopathologic deficits after polytrauma in childhood and adolescence].

PURPOSE: The aim of this report was to evaluate psychological deficits following polytrauma in childhood and adolescence as well as to detect psychological vulnerable phases during the treatment period. METHODS: From 9/92 to 12/98, 41 polytrauma patients (18a or younger) were treated at the University of Vienna Medical School, Trauma Center. Out of the 28 survivors, patients with head injuries and congenital neurological deficits were excluded, leaving 10 young patients that were eligible for psychological testing after a mean follow-up of 3.4 years (range, 1 to 7 years). Besides catamnesis and diagnostic interviews, an evaluation of cognitive functions as well as personality tests were performed. RESULTS: The diagnostic interviews revealed mild psychiatric symptoms in 2/10 patients, but the cognitive functions did not show any deficits compared to normal values. The personality tests presented stress-avoiding strategies and an increased anxiety sensitivity in 2/10 patients. The catamnesis constantly revealed 2 vulnerable phases in all patients: 1. the transfer from the intensive care unit to the normal ward, 2. the retransfer to the domestic field after a long hospital stay. CONCLUSIONS: The present report suggests that the long-term psychological outcome following polytrauma in childhood and adolescence may be good, without any major disorders. The described critical phases during treatment demonstrate that psychological support in the young, severely injured patient should start very early on at the intensive care unit.

Adaptation, Psychological↗

PubMed2003

Fixation of femoral fractures in multiple-injury patients with combined chest and head injuries.

BACKGROUND: The purpose of the present paper was to study the effects of a femoral shaft fracture and its early stabilization on the morbidity, mortality, and outcome of multiple-injury patients with combined blunt head and chest trauma. The clinical course of patients was analysed using a prospectively gathered data base. METHODS: Out of 352 multitrauma patients, from September 1992 to June 2000, we identified 28 patients with combined blunt chest and head trauma (abbreviated injury scale >/= 2) and a femoral fracture as the study group. A total of 120 patients with combined chest and head trauma but without femoral fracture formed the control group. Parameters examined included injury severity, injury pattern, haemodynamics at admission, mortality, duration of ventilation, length of stay in intensive care unit, and outcome. RESULTS: There were no significant differences regarding the demographics and injury severity (injury severity score) between the two groups. No significant differences were found in terms of mortality, duration of ventilation\intensive care unit stay and outcome. Injury severity (P < 0.0001), age (P = 0.0153), and haemodynamics at admission (P = 0.0036) were shown to have a significant effect on mortality and outcome. Injury severity (P < 0.0001) and age (P = 0.017) had a significant effect on the duration of ventilation\intensive care unit stay. CONCLUSIONS: The present study suggests that a femoral shaft fracture and its early stabilization in a multitrauma patient with combined chest and head injury do not adversely affect mortality and outcome and supports aggressive surgical management for these patients.

Adolescent↗

PubMed2003

Overexpression of Hsp27 in a human melanoma cell line: regulation of E-cadherin, MUC18/MCAM, and plasminogen activator (PA) system.

Hsp27 is considered a potential marker for cell differentiation in diverse tissues. Several aspects linked to the differentiation process and to the transition from high to low metastatic potential were analyzed in melanoma cells transfected with Hsp27. E-cadherin plays a central role in cell differentiation, migration, and normal development. Loss of expression or function of E-cadherin has been documented in a variety of human malignancies. We observed by fluorescence-activated cell sorter (FACS) as well as immunofluorescence (IF) analysis a pronounced expression of E-cadherin in Hsp27-transfected A375 melanoma cells compared with control melanoma cells. The expression of the adhesion molecule MUC18/MCAM correlates directly with the metastatic potential of melanoma cells. In contrast to wild-type and neotransfected melanoma cells, in Hsp27-transfected cells the expression of MUC18/MCAM could not be detected by FACS and IF analysis. The plasminogen activator (PA) system plays a central role in mediating extracellular proteolysis and also in nonproteolytic events such as cell adhesion, migration, and transmembrane signaling. Hsp27 transfectants revealed elevated messenger ribonucleic acid expression of the urokinase-type PA (uPA) and its inhibitor, PA inhibitor type 1, which might indicate a neutralization effect of the proteolytic activity of uPA. Control cells failed to express both these molecules. The influence of Hsp27 expression on uPA activity and the involvement of E-cadherin could be demonstrated by use of anti-E-cadherin-blocking antibody. Our data provide evidence for an inhibitory-regulatory role of Hsp27 in tumor progression as found in our system.

Antigens, CD↗

PubMed2002

Overexpression of Hsp27 affects the metastatic phenotype of human melanoma cells in vitro.

Overexpression of the small heat shock protein Hsp27 has been shown by us to inhibit the in vitro proliferation rate and to delay tumor development of a human melanoma cell line (A375) in nude mice. We hypothesized that Hsp27 may influence the neoplastic phenotype. In the present study Hsp27 transfectants from this cell line were analyzed for various cellular aspects associated with the metastatic process. We found that Hsp27-overexpressing clones exhibited an altered cellular morphology as compared with control transfected cells. The Hsp27-positive cells tended to develop an epithelial-like phenotype growing in clusters and were characterized by a loss of transcytoplasmic stressfibers. In parallel, Hsp27-expressing cells lost the ability to form colonies in soft agar. The invasive potential was studied in vitro by the use of a reconstituted extracellular matrix-coated filter (Matrigel). Compared with controls, Hsp27-overexpressing cells showed decreased cell invasiveness through Matrigel. A correlation between invasion and activation of matrix metalloproteinases (MMPs) has been shown in several cell models. Secretion of MMPs (MMP-2 and MMP-9) was studied by gelatin-substrate zymogram analysis, as well as by a sensitive gelatinase activity assay. The Hsp27-transfected A375 melanoma cell line showed decreased secretion of MMP-2 and MMP-9 as compared with the control transfected cells. Integrins are adhesion receptors and function in cell invasion by mediating cell movement on matrix molecules and by regulating the expression of MMPs. Both fluorescence-activated cell sorter analysis and immunofluorescence analysis revealed a loss of alpha(v)beta3 integrin in Hsp27-transfected cell colonies. Our results demonstrate that Hsp27 overexpression has a profound impact on several parameters regulating the invasive and metastatic potential of melanoma cells in vitro.

Actins↗