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Biomedical subjects

T Fritz

Publications and source records attributed to T Fritz.

At least 19 recordsLinked to original sources
PubMed2006

[Escalating management of progressive neuropathic cancer pain].

The management of tumor-related pain, particularly that which is neuropathic in origin, is both difficult and challenging. According to WHO guidelines, opioids are the first-line analgesics in case of severe tumor-related pain syndromes. Some patients receiving continuous opioid therapy rapidly require increase of the opioid dose. In this case it can be necessary to extend the analgesic regime and to either apply interventional procedures or change the opioid or the route of administration. The case presented is remarkable regarding the severity and persistent nature of the patient's pain despite a variety of commonly employed treatments.

Analgesics, Opioid↗
PubMed2005

An unusual presentation of giant cell arteritis.

A 77-year-old-man with giant cell arteritis who developed bitemporal scalp ulcerations is described. Since 1946 when Cooke et al. reported the first case of scalp necrosis there were approximately 55 cases published. Scalp ulceration is a rare complication of giant cell arteritis and occurs mainly in elderly persons, particularly women. About half of all patients were presented to dermatologists. Most of the patients (70%) had other serious complications of giant cell arteritis: blindness, gangrene of the tongue and nasal septum necrosis. Seventy percent of the cases were confirmed by a temporal artery biopsy. The necrosis were of varying extent and uni- or bilateral. Although, in most cases necrosis has been located bilaterally as in the presented case. Scalp healing was complete nearly in all patients by conservative treatment within a year. Scalp ulceration is a potentially reversible complication of giant cell arteritis which indicates extensive vessel involvement and adequate coricosteroid therapy is required and essential.

Aged↗
PubMed2004

Correct interpretation of spectral interference measurements of weakly absorbing films of micrometer thickness.

We present analytical equations based on thin-film optics with which to extract the thickness of weakly absorbing films from spectral interference measurements, using only the observed constant interference frequency. It is shown that the assumption of a constant index of refraction n for the analysis of interference frequency omega 0 introduces significant errors into the thickness calculation. Instead, the first derivative of n with respect to the energy, n', has to be included as well to yield the correct film thickness, even for small values of n'. The equations presented can be used as constraints in appropriate numerical methods to improve the film thickness iteratively.

Journal Article↗
PubMed2003

Individual and common antigen-recognition sites of liver-derived T cells in patients with autoimmune hepatitis.

Autoimmune hepatitis (AIH) is characterized by dense T-cell infiltrations in the liver tissue, but little is known how T cells influence the pathogenesis. To address this question, the distribution of T-cell receptor variable beta-chain (TCR Vbeta) transcripts of peripheral blood and liver-infiltrating T cells from previously untreated patients with newly diagnosed acute exacerbated AIH was investigated. Furthermore, the lengths and sequences of complementary-determining region 3 (CDR3) were studied. Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis and CDR3 spectratyping revealed multiple clonal expansions of liver-infiltrating T cells but not peripheral T cells within various TCR Vbeta families. Further analysis of overexpressed TCR Vbeta transcripts using TCR beta-chain-joining element (TCR Jbeta)-specific primers in a nested PCR showed characteristic Vbeta/Jbeta combinations. Subsequent sequencing of CDR3 regions from PCR products confirmed the clonality of T-cell expansions and the usage of common and individual CDR3 motifs. In conclusion, the clonality of expanded T cells within the liver tissue during early clinical manifestation of untreated AIH indicated that autoantigen-specific T cells accumulate at the inflammation site. Individual and common CDR3 motifs argued for predominant epitopes that were recognized by liver-infiltrating T cells in AIH patients.

Adult↗
PubMed2003

Perioperative changes in cerebral ischemic markers in the cerebrospinal fluid after preoperative nimodipine treatment.

BACKGROUND: Elderly patients with previous organ damage are at risk for minor neurologic deficits after major surgery. Spinal catheter analgesia is used whenever possible in this group and enables regular cerebrospinal fluid (CSF) sampling. Nimodipine, a calcium blocker, may have neuroprotective effects. We examined whether preoperative treatment with nimodipine affects ischemic markers in the CSF during extracranial surgery. METHODS: We performed a prospective, randomized, placebo-controlled, double-blind study in patients (ASA III or IV, 65-85 years) that underwent elective implantation surgery of the hip joint with intrathecal catheter anesthesia. Starting 15 h before surgery, patients received either 30 microg x kg(-1) h(-1) of nimodipine (n = 20) or 0.9% saline solution (placebo, n = 23) as a central venous infusion. The concentrations of neuron-specific enolase, hypoxanthine, creatine-kinase, lactate and pH in the CSF were determined before and immediately after surgery as well as 6 and 24 h after surgery. RESULTS: Before surgery, the baseline CSF pH was normal in all patients. Immediately after surgery it fell significantly to 7.08 +/- 0.29 in the placebo group and non-significantly to 7.27 +/- 0.38 in the treatment group; all values were normalized at 6 and 24 h after surgery in both groups. In the placebo group, lactate levels rose significantly from 1.48 +/- 0.28 mmol l(-1) before surgery to 1.77 +/- 0.27 mmol l(-1) immediately after surgery, and to 2.03 +/- 0.32 mmol l(-1) 24 h after surgery. In the treatment group, lactate concentrations remained stable up to 6 h after surgery (1.55-1.62 mmol l-1), while an increase to 2.10 +/- 0.48 mmol l(-1) was observed 24 h after the operation. Neuron-specific enolase, hypo-xanthine and creatine-kinase showed no change in either group. CONCLUSION: In conclusion, preoperative nimodipine treatment reduced intraoperative CSF acidosis and delayed surgery-related increases in lactate concentration in the CSF by several hours in elderly, comorbid patients at risk for minor postoperative neurologic deficits.

Aged↗
PubMed2001

[National Diabetes Registry. A teaching pedagogical instrument for quality assurance].

The National Diabetes Registry of Sweden presents results from its third year of registration. Quality of care data from more than 41,000 patients with diabetes treated at medical and children's departments as well as primary health care centers are compared with national goals concerning metabolic and blood pressure control, and information is provided concerning the prevalence of lipid treatment, nephropathy, smoking etc. The national HbA1c goal of 6.5% is reached by 30% of patients treated at medical departments and by 50% in primary health care. Concerning patients with onset before 30 years of age, this goal is reached by 25%, which indicates that the national goal is difficult to reach and that individual goals must be set for individual patients.

Adolescent↗
PubMed2001

Effects of imidazoline antihypertensive drugs on sympathetic tone and noradrenaline release in the prefrontal cortex.

1. The aim of the present study was to compare the effects of the centrally acting antihypertensive drugs rilmenidine, moxonidine, clonidine and guanabenz on sympathetic tone with their effects on noradrenaline release in the cerebral cortex. In particular, the hypothesis was tested that rilmenidine and moxonidine, due to their high affinity for sympatho-inhibitory imidazoline I(1) receptors and low affinity for alpha(2)-adrenoceptors, lower sympathetic tone without causing an alpha(2)-adrenoceptor-mediated inhibition of cerebrocortical noradrenaline release. 2. In rats anaesthetized with urethane, blood pressure and heart rate were measured and the concentration of noradrenaline in arterial blood plasma was determined. The release of noradrenaline in the medial prefrontal cortex was estimated by microdialysis. Intravenous administration of rilmenidine (30, 100, 300 and 1000 microg kg(-1)), moxonidine (10, 30, 100 and 300 microg kg(-1)), clonidine (1, 3, 10 and 30 microg kg(-1)) and guanabenz (1, 3, 10 and 30 microg kg(-1)) led to dose-dependent hypotension and bradycardia; the plasma noradrenaline concentration also decreased. After the two highest doses, all four drugs lowered noradrenaline release in the prefrontal cortex. At doses eliciting equal hypotensive and sympatho-inhibitory responses, rilmenidine and moxonidine inhibited cerebral cortical noradrenaline release at least as much as clonidine and guanabenz. 3. The results show that rilmenidine and moxonidine lower cerebrocortical noradrenaline release at doses similar to those which cause sympatho-inhibition. This effect was probably due to an alpha(2)-adrenoceptor-mediated inhibition of the firing of locus coeruleus neurons and, in addition, to presynaptic inhibition of noradrenaline release at the level of the axon terminals in the cortex. The results argue against the hypothesis that rilmenidine and moxonidine, due to their selectivity for sympatho-inhibitory I(1) imidazoline receptors, do not suppress noradrenergic neurons in the central nervous system.

Animals↗
PubMed2001

Walking for exercise - immediate effect on blood glucose levels in type 2 diabetes.

OBJECTIVE: To determine the immediate effect of walking on blood glucose levels in patients with type 2 diabetes. DESIGN: Participating patients walked for half an hour on one occasion and on another day they remained physically inactive for half an hour. Blood glucose was measured before and after walking and resting. SETTING: Krokom in the north of Sweden. PATIENTS: Thirty-nine persons with type 2 diabetes, aged 63 (SD 8.5). MAIN OUTCOME MEASURES: Difference of blood glucose levels before and after walking and resting respectively. RESULTS: Post-walk glycaemic levels were reduced by 2.2 mmol/l (SD 1.5). No significant reduction could be observed after a period of physical rest. CONCLUSION: Walking can be safely employed in groups or individually as an introduction to low-intensity exercise and as a demonstration of its blood glucose lowering effect in type 2 diabetes.

Aged↗
PubMed2000

[Trans-scaphoid perilunar dislocation of the wrist (de Quervain) as a rare complication of electric injury].

We describe the case of a 67-year-old man with an electricity inflicted injury in the left hand and a transscaphoidal perilunear dislocation of the opposite right hand. On admission, the injury was missed on the standard ap-radiogram of the right hand, so the operative reconstruction was delayed. Later on, the lunate showed aseptic necrosis and wrist collapse as consequence.

Aged↗
PubMed2000

Teaching model for intraoperative spinal sonography in spinal fractures. An experimental study.

To improve the technique of intraoperative sonography of the spinal canal, a teaching model of the thoracolumbar spine was developed. It allows to simulate the typical spinal stenosis of a vertebral fracture and the sonographic procedure to detect and measure such a lesion. Moreover, partial laminectomy and modification of a fixateur interne set-up, which are preconditions for successful sonography, can be simulated. Independent of the surgical qualification, a high precision in sonographic localisation and measurement of the spinal canal stenosis was achieved by the training. The results could be validated in the cadaveric model. Thus, sonographic expertise acquired with the teaching model proved to be reliable in the clinical situation.

Cadaver↗
PubMed1999

[In Process Citation]

To optimise the microsurgical training in our clinic we organized a permanent possibility to practice microsurgical techniques of vascular anastomosis. This includes step-wise education by means of plastic materials, human placenta and the rat model. The most important role in this concept is played by the placenta. It supplies a realistic simulation of different in vivo situations concerning microvascular anastomosis. As to availability, handling and costs the placenta is superior to animal models and has replaced them almost completely in our educational concept.

Journal Article↗
PubMed1999

[The struggle with the ego: the assessment center in the selection of physicians-in-chief].

The assessment center (AC), which played an important role in the recruitment of officers at the beginning of the century, nowadays is used in the business for the selection of managers. Also in the medical institutions the AC is of increasing significance, since the accentuation of economic aspects have led to a change in the qualities expected of a physician in chief. Usually the AC in the classic form is not applied; more often, hospitals take advantage of professional counselors who obviously use the basic elements of the AC. Physicians who are concerned are recommended to study the essence of the AC.

Ego↗
PubMed1999

[The subacromial shoulder dislocation].

We report on a case of subacromial shoulder dislocation, which resulted from a combination of a cranial glenoid fracture and an acromial fracture. The patient sustained this rare injury while playing handball. The whole implication of the injury was revealed only after extensive workup with CT scan of the shoulder. After reduction of the shoulder dislocation, the glenoid fracture was stabilized by osteosynthesis. The postoperative results showed anatomical reconstruction of the glenoid joint surface. After completion of therapy, the patient has achieved good functional results with a full range of motion (abduction 180 degrees ) and has been able to work full-time again.

Acromioclavicular Joint↗
PubMed1999

Prospective randomized comparison of gliding nail and gamma nail in the therapy of trochanteric fractures.

In a prospective randomized study, we compared the new intramedullary implant of the gliding nail to the gamma nail in the fixation of 80 unstable trochanteric fractures in elderly patients. The preconditions of both groups were comparable. We found no differences concerning the operation time, blood loss, period of stationary treatment or social situation. Also, the anatomic reconstruction and the long-term function according to the Merle d'Aubigne score were comparable. Regarding postoperative complications, the gliding nail showed a minor tendency of cutting out; this we attribute to the special design of the dynamic blade and regard it as the most favourable advantage of this new implant.

Aged↗
PubMed1999

Combined Kirschner wire fixation in the treatment of Colles fracture. A prospective, controlled trial.

For surgical treatment of the unstable Colles fracture we developed a new form of osteosynthesis, which consists in a modification of the dynamic Kirschner wire fixation described by Kapandji. It allows early motion without the typical risk of palmar dislocation noted with the Kapandji method. We prefer this method in elderly patients with reduced bone quality. The analysis of a collective of 110 fractures including a clinical and radiological follow-up examination of 72 patients revealed good anatomical reconstruction of the distal radius. The loss of motion was minimal on average and consistent with a good wrist function. Major restrictions resulted from stress-dependent pain as a consequence of posttraumatic arthritis or algodystrophy. A minor loss of reduction by dorsal impaction was observed in the follow-up evaluation, but it had no functional relevance. The most frequent complication was paraesthesia within the area of the superficial radial nerve. According to the NYOH score the following results were achieved: excellent 35%, good 50%, fair 10%, poor 5%.

Bone Wires↗
PubMed1999

The classic nail in the therapy of trochanteric fractures.A prospective, controlled study.

In a prospective controlled study we analysed the classic nail, a new intramedullary implant for the fixation of peritrochanteric fractures. By means of lateral bending of 4 degrees, unreamed implantation is generally possible. Our collective of 85 patients was characterized by elderly mean age (82.3 years), a predominance of female patients (4.3 : 1), a minor trauma aetiology without relevant additional injuries, and a high rate of concomitant disease (92%). Only 31A-type femur fractures were treated, with a low specific complication rate of 13%, whereby operative revision was necessary in only two patients (3%). A good anatomic reconstruction and full weight-bearing with the osteosynthesis was achieved in the majority of patients. No secondary shaft fractures and only one case of cutting out was observed. The mortality (30 days: 18%, 6 months: 25%) as well as the high rate of unspecific complications (20%) were caused by the patients' multiple morbidity. Deficits in the Merle d'Aubigne score at follow-up after 6 months can be interpreted within the same context. Nevertheless, 85% could return to their former social environment and only 15% became dependent on a nursing institution in connection with the fracture treatment.

Aged↗