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Biomedical subjects

U König

Publications and source records attributed to U König.

At least 19 recordsLinked to original sources
PubMed2001

[Evidence-based medicine in internal guideline development in a general hospital--the Park-Clinic EbM-Project].

Evidence-based medicine (EbM) is despite its historical roots still a young concept that is quite relevant in everyday work, but yet little used. The first hospital specific approach to implement EbM into the health care system and daily clinical practice in Germany is recorded in the project of the Park-Klinik Weissensee (Berlin). Implementation and execution of EbM into daily routine should be reached through five steps which should result in better quality of treatment of the patients: 1. EbM-Training for hospital staff; 2. EbM-Search (= access to electronic databases and EbM-information); 3. Guideline-Committee (= hospital committee for the development of clinical practice guidelines); 4. EbM-Recommendation (= use of EbM-information in discharge letters) and, finally 5. EbM-Events (= vocational trainings for hospital physicians and general practitioners). Although project duration is yet quiet short, first results allow to look into the future with confidence. At the same time it can be recognized how long and difficult the way for all participants will be to reach evidence-based information and communication. The "Park-Klinik EbM-Project" can make an important contribution to health care services research in Germany.

Education, Continuing↗
PubMed2001

[Psychiatric illness from a multi-generational perspective: results of a longitudinal study with children and grandchildren of hospitalized depressed patients].

In a longitudinal empirical study data from three generations were gathered: Generation 1: formerly depressive patients, who had been treated as inpatients; generation 2: children of these patients; generation 3: grandchildren of the former patients. The first investigation of the children was carried out in the seventies, the follow-up-assessment of children and grandchildren was done in 1996. In the follow-up-study the meanwhile grown-up children of the depressive patients showed to a high degree psychic disturbances and were in treatment because of these problems. The majority of the grandchildren showed no relevant deviations. The severity of the depressive illness (in generation 1) and the psychopathological status of the former inpatient's spouse proved to be relevant prognostic factors with regard to the long-term development and resilience of children and grandchildren.

Adolescent↗
PubMed2000

[Superior labrum pathology in the athlete].

Since their first description several years ago, superior glenoid labral lesions have increasingly been blamed for shoulder problems associated with sports. Originally merely describing arthroscopically visible upper labral/biceps abnormalities, the current understanding is that often clinical problems such as impingement pain or even rotator cuff disease can be secondary to these lesions, especially in overhead athletes. Impingement in these cases is caused by superior shoulder instability originating from an unstable biceps insertion that is present for example in SLAP (superior labrum from anterior to posterior) lesions. Additional problems such as internal or posterosuperior impingement that are often found simultaneously in these patients are pathomorphologically located in the same anatomical region and therefore make exact diagnosis and thus treatment more complex. Magnetic resonance imaging with intra-articular contrast enhancement and particularly arthroscopy are the primary tools for exact diagnosis and classification of superior labral/biceps pathology. Therapeutically, lesions with unstable biceps origin (SLAP types 2 and 4) require operative refixation, as we have seen in our 50 cases in the last 4 years, in order to reestablish the stabilising effect of the biceps tendon for the shoulder joint. The arthroscopic technique for repair of these lesions using different devices of implantable suture anchors is presented. Long-term pain-free shoulder function in competitive athletes, throwers in particular, thus requires anatomical reconstruction of the originally unstable biceps, which is the causal therapy for these lesions.

Arthroscopy↗
PubMed1999

Repetitive hemodilution in chronic obstructive pulmonary disease and pulmonary hypertension: effects on pulmonary hemodynamics, gas exchange, and exercise capacity.

BACKGROUND: In cor pulmonale associated with severe chronic obstructive pulmonary disease (COPD), disturbances of pulmonary microcirculation may contribute significantly to hypoxemia, pulmonary hypertension, and exercise intolerance. OBJECTIVE: It was tested whether reduction of blood viscosity induced by repetitive hemodilution might improve pulmonary hemodynamics and oxygen uptake. METHODS: Seven patients with stable COPD (forced expiratory volume in 1 s 33 +/- 3 % of predicted, means +/- SE) and pulmonary hypertension were phlebotomized 5-6 times over a period of 3 months with substitution of 6% hydroxyethyl starch (molecular weight 40, 000). This resulted in a stepwise reduction of the hematocrit from 53.3 +/- 2.6 to 45.8 +/- 3.1% and a reduction of whole blood viscosity from 9.8 +/- 0.6 to 8.8 +/- 0.7 mPa x s at a shear rate of 2.0 s-1. Before and after the treatment period, patients underwent cardiopulmonary exercise testing and right heart catheterization. RESULTS: Mean pulmonary artery pressure (PAm) decreased from 30 +/- 3 to 22 +/- 2 mm Hg and arterial oxygen partial pressure (PaO2) increased from 63.2 +/- 2.2 to 71.8 +/- 3.7 mm Hg at rest. During peak exercise, PAm decreased from 59 +/- 7 to 53 +/- 7 mm Hg and PaO2 increased from 54.0 +/- 5.7 to 63.2 +/- 2.4 mm Hg after hemodilution. Peak oxygen consumption rose from 573 +/- 84 to 750 +/- 59 ml x min-1, corresponding to an increase in cardiac index from 4.25 +/- 0.5 to 5.88 +/- 0.76 liters x min-1 x m-2. Pulmonary vascular resistance fell from 345 +/- 53 to 194 +/- 32 dyn x s x cm-5. The patients' peak exercise capacity increased from 9.2 +/- 2. 0 before to 13.5 +/- 3.2 kJ at the end of the study (p < 0.05 for all differences, paired t test). CONCLUSION: The findings suggest that a prolonged improvement of pulmonary microcirculation by reducing blood viscosity may improve pulmonary gas exchange, central hemodynamics, and exercise tolerance in patients with severe COPD and pulmonary hypertension.

Aged↗
PubMed1998

[Arthroscopic shoulder stabilization. Differentiated treatment strategy with Suretac, Fastak, Holmium: YAG-laser and electrosurgery].

The goal for arthroscopic stabilization of anterior glenohumeral instability is to achieve an outcome equivalent to or better than open procedures. A number of arthroscopic procedures have been advocated to reestablish continuity of the inferior glenohumeral ligament complex (IGHLC) with the glenoid. Implantable suture anchors were developed to avoid the problems associated with arthroscopic staple capsulorrhaphy like iatrogenic injury of the glenoid or humeral surface, loosening and migration of the staple. Several transosseous techniques include the need for an accessory posterior incision, the possibility of neurovascular injury (Suprascapular or axillary nerve), and the loosening of the repair after typing over the fascia of the infraspinatus posteriorly. The preferred techniques are cannulated, absorbable fixation device (Suretac) and easy implantable suture anchors made of titanium (Fastak). Even in the hands of experienced arthroscopists, unacceptably high recurrence rates for arthroscopic shoulder stabilization have been reported, due to the steep learning curve for both technical performance and patient selection. Our experience suggests, that if proper selection criteria are employed, normal patients and overhead-athletes may benefit from the advantages of an arthroscopic repair without accepting an increased risk for recurrence. We performed a prospective analysis of 105 shoulders, who underwent arthroscopic stabilization with Suretac or Fastak between 4/96 and 7/98. 48 shoulders were available for followup at least one year. The redislocation rate was 6.25% (3 shoulders) and the rate of subluxation without dislocation also was 6.25%, but none of the shoulders required a second open stabilization. The reason for redislocation or subluxation were 5/6 traumatic injuries, participating in contact sports or in one case a generalized ligamentous laxity. In combination with the LACS-Procedure or the Electro thermally assisted capsular shift (ETACS) not only the capsular detachment but also the capsular redundancy may be adressed and a lower failure rate can be expected.

Arthroscopy↗
PubMed1997

Sheath pulling immediately after PTCA: comparison of two different deployment techniques for the hemostatic puncture closure device: a prospective, randomized study.

Sheath pulling immediately after percutaneous transluminal coronary angioplasty (PTCA) increases patients' comfort, decreases burden for the medical staff, and may reduce hospital costs by shortening the length of stay. Immediate sheath pulling in anticoagulated patients with a low risk of bleeding complications is feasible using hemostatic devices. For the hemostatic puncture closing device (HPCD), published data regarding sheath pulling in patients immediately after PTCA is limited. Furthermore, no study addressed the question whether the recommended deployment time (DT) of 30 min can be reduced to a few minutes. We, therefore, performed a prospective study, randomizing 140 patients to a DT of 5 and 30 min, respectively. There were no statistical differences in gender, age, height, weight, or cardiovascular risk factors between the two groups. Blood pressures measured invasively immediately before sheath removal were comparable. Activated coagulation time just prior to sheath removal was 227 +/- 52 sec in the DT-5 group and 223 +/- 37 sec in the DT-30 group. After deployment, 74% of the DT-5 patients and 71% of the DT-30 patients showed immediate and complete hemostasis. The remaining patients showed only little oozing with complete hemostasis at the time of the final device removal. Hematoma size after 24 hr was 6.2 +/- 4.4 cm2 for DT-5 and 6.8 +/- 8.2 cm2 for DT-30 patients. There was no statistical difference between both groups. No severe bleeding or major complications were observed in either group. Thus, the use of a collagen system with an intra-arterial anchor (HPCD) is effective and safe when sheaths are pulled immediately after PTCA. The reduction of deployment time from 30 to 5 min is not related to an increased risk of bleeding or other vascular complications; patients can be transferred much faster to the ward, therefore reducing the burden on the personnel in the catheterization laboratory and increasing patients' comfort by allowing them to return to their rooms without a sheath.

Adult↗
PubMed1997

A large family with subtelomeric translocation t(18;21)(q23;q22.1) and molecular breakpoint in the Down syndrome critical region.

We describe a 17-month-old infant with clinical features of Down syndrome and a normal karyotype by standard chromosomal analysis, her two uncles aged 28 and 30 years, respectively, with reduced intelligence and unusual appearance but not apparent Down syndrome, and a severely retarded 6-year-old girl with dysmorphy and epilepsy from the same family. Cytogenetic studies of patients and normal intervening relatives had been carried out at different institutions with normal results. Fluorescence in situ hybridization using whole chromosome painting and unique-copy probes (cosmids) and high-resolution banding revealed a familial subtelomeric translocation of chromosomes 18 and 21, resulting in partial trisomy 21 in the infant and her two uncles, and partial monosomy 21 in the 6-year-old girl. Cytogenetic breakpoints were located in bands 18q23 and 21q22.1, respectively. The molecular breakpoint on chromosome 21 was located between D21S211 (proximal) and D21S1283 (distal) and thus maps within the Down syndrome critical region.

Adult↗
PubMed1997

Microwave CO2 plasma-initiated vapour phase graft polymerization of acrylic acid onto polytetrafluoroethylene for immobilization of human thrombomodulin.

The functionalization of polytetrafluoroethylene (PTFE) for human thrombomodulin (hTM) binding has been achieved by CO2 plasma activation and subsequent vapour phase graft polymerization of acrylic acid (AA). The PTFE surfaces after CO2 plasma treatment, AA grafting and hTM immobilization were characterized by attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy, X-ray photoelectron spectroscopy (XPS) and electron spin resonance (ESR) spectroscopy, as well as by zeta potential and wetting measurements to quantitatively control each step of modification. The activity of immobilized hTM was estimated by the protein C activation test.

Acrylates↗
PubMed1996

[Sequential therapy concept in choledocholithiasis].

Of 4023 Patients with gallstone disease, 124 were treated for common bile duct stones by endoscopy (ERC/EPT). Stone clearance was completed in 81% of the patients. Due to a morbidity of 5.9% and a mortality of 0.6%, the concept of preoperative ERC followed by laparoscopic cholecystectomy seems to reduce risk for the patients.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1994

Highly polymorphic repeat marker within the beta-amyloid precursor protein gene.

We have identified a polymorphic compound dinucleotide repeat sequence in intron 1 of the beta-amyloid precursor protein (APP) gene on chromosome 21. Using polymerase chain reaction (PCR) amplification of the locus, designated APPivs1, we detected 13 alleles in the CEPH family members (heterozygosity = 0.69). Lod score analysis showed complete linkage of the marker to the loci D21S210 and D21221.

Alleles↗
PubMed1994

[Psychosocial problems of adolescents and adults with congenital heart defects].

Despite successful medical treatment and hemodynamic good results after surgical correction, relevant psychosocial problems occur in adult patients with congenital heart disease. 146 patients in Germany with simple but also with complex congenital heart defects were examined by means of a questionnaire to look into these problems. Although most of the patients belonged to Ability Index I or Ability Index II of J. Somerville, almost 60% felt not healthy and impaired. The level of education was above average. 98% had attended a regular school, 23% a secondary school, and 15% had attended university. The congenital heart disease negatively affected the choice of occupation for 25% of the patients, but only 8.6% had difficulties when they applied for a job. The majority of patients was employed and satisfied with their occupation. Most of them were working in physically less demanding jobs. Sporting activities were widespread, although half of the patients felt impaired by the congenital heart disease when performing sports. All patients had some kind of health insurance. Most of them were enrolled in the common public health insurance plan. The insurers paid for almost all expenses caused by the congenital heart disease. More than 30% were not accepted by life insurance companies. Only 1.4% were members of a self-help-group for congenital heart disease. The knowledge of these occurring problems may help to improve the treatment of adult patients with congenital heart disease and, moreover, infants and adolescent patients who still have to reach adulthood may later benefit from this information.

Activities of Daily Living↗
PubMed1993

A linkage map of human chromosome 21:43 PCR markers at average intervals of 2.5 cM.

A genetic linkage map of human chromosome 21q (HC21q) containing 43 markers genotyped by the polymerase chain reaction in the CEPH pedigrees is presented. The markers placed on this map are highly polymorphic with an average heterozygosity of 61%. The average interval size of the markers localized at 1000:1 odds is 2.5 cM. The map has a total length of 65.5 cM, with male and female lengths of 47.7 and 83.3 cM, respectively. The genotypes used in the construction of this map were subjected to rigorous error checking, which is reflected in the shorter map length compared to previous maps; the estimated error rate in genotyping is less than 0.04%. As noted in previous linkage maps there is increased recombination in females on proximal HC 21q and in the male in a region near the telomere. This map of HC 21 represents a highly informative and dense meiotic linkage map and will be useful in linking disease phenotypes to loci on this chromosome.

Chromosome Mapping↗
PubMed1993

Cytogenetic, FISH and DNA studies in 11 individuals from a family with two siblings with dup(21q) Down syndrome.

A Spanish family has previously been described with two siblings with dup(21q) Down syndrome. The father has a normal karyotype. The mother has a microchromosome. Cytogenetic, fluorescence in situ hybridization and DNA studies have now been carried out on the family. Findings include that the mother has three different chromosome anomalies, viz. (1) a chromosome 22 with an unusual pericentromeric region that contains alphoid DNA from chromosomes 21/13 and chromosome 22, (2) an isochromosome 21p in the frequent cell line and (3) an isochromosome 21q in a rare second cell line. A possible explanation is that the mother developed from a zygote with trisomy 21 and that mitotic error in early development resulted in the formation of two cell lines with karyotypes of 47,XX,+i(21p) and 47,XX,+i(21q), respectively. The unusual chromosome 22 represents a hitherto undescribed chromosome anomaly and one possible explanation is a translocation of the short arms between chromosomes 21/13 and 22 in the ancestry of the family. The relationship between the unusual chromosome 22 and the isochromosome formation in the mother is not known. However, all three chromosome anomalies involve the alphoid DNA of chromosome 21/13, indicating that this is not a chance finding.

Centromere↗
PubMed1993

Follow-up using magnetic resonance imaging in adult patients after surgery for aortic coarctation.

Functional impairment, aneurysma formation, and restenosis are well known complications after surgery for coarctation of the aorta. In order to assess long-term results, 25 adults were studied by physical examination, exercise tests, and magnetic resonance imaging after an interval ranging from 1 to 28 years since surgery for coarctation. Fifteen patients had arterial hypertension at rest, five additional patients showed hypertension on exertion only. Magnetic resonance imaging showed pathological changes of the aorta in all patients. An aneurysm of the ascending aorta was seen in four patients, a circumscript aneurysm in the descending aorta at the site of surgery was found in three patients. Restenosis of the descending aorta occurred in three patients. In eight patients the left subclavian artery was distally displaced and dilated in eleven patients. In order to initiate appropriate treatment of specific complications such as restenosis, aneurysm, and arterial hypertension, regular checks are necessary in patients with surgery for aortic coarctation. In addition to clinical examination and exercise tests, magnetic resonance imaging is an effective noninvasive imaging method for follow-up.

Adolescent↗
PubMed1993

Application of molecular and cytogenetic techniques to the detection of a de novo unbalanced t(11q;21q) in a patient previously diagnosed as having monosomy 21.

The occurrence of complete autosomal monosomy in man is extremely rare and generally considered to be incompatible with life. Since the introduction of banding techniques in human cytogenetics, several cases of presumptive monosomy for chromosome 21 have nevertheless been reported. However, it has been suggested that most, if not all, of these cases may represent unbalanced translocations or other structural aberrations resulting in only partial monosomy 21. Here we described a patient in whom full monosomy 21 was initially diagnosed by routine karyotyping. Re-examination with a combination of high resolution banding technique, chromosome painting and DNA polymorphism analysis demonstrated the presence of an unbalanced translocation between the long arms of chromosome 11 and 21, respectively. Consequently, the case was re-classified as a partial monosomy for the proximal long arm of chromosome 21.

Chromosome Banding↗
PubMed1991

[A flip-flop model of the chloride channel complex explains the dysregulation of the chloride flow in the plasmalemma of cells in cystic fibrosis].

The basic defect in cystic fibrosis is the chloride impermeability of the plasmalemma in different cells. A candidate for the chloride channel, thought to be affected in the syndrome, is "Porin 31HL" recently described by us. The molecule is i) expressed in the plasmalemma of different cells, it has ii) a molecular mass of 31,000 Daltons, it shows iii) high conductance in artificial membranes and it can be iv) modified by 4,4'-Diisothiocyanatostilbene-2,2'-disulfonate. A porin in the outer membrane of cells should furthermore v) be regulated by modulators. All these characters of "Porin 31HL" correspond to those given in literature for chloride channels. The regulation of the channels can be explained by a two component flip flop model.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗