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51.
Abstract Chorea is a rare complication of polycythaemia vera. Polycythaemic chorea occurs predominantly in females and usually in generalised
form. We present a 66-year-old woman with acute onset hemichorea-ballism with no vascular pathology in the basal ganglia region.
A clear relationship was observed between the onset of chorea and worsening of haematological parameters in the patient. After
repeated phlebotomies the patient's clinical status was improved. Polycythaemic chorea must be considered, especially in the
elderly, as early diagnosis leads to effective treatment and prevention of complications. 相似文献
52.
53.
Emir Q. Haxhija Prof. Dr. Johannes M. Mayr Wolfgang Grechenig Michael E. Höllwarth 《Operative Orthopadie und Traumatologie》2006,18(2):120-134
OBJECTIVE: Surgical reduction and retention of apophyseal avulsion injuries at the medial epicondyle to prevent joint instability, lasting malalignment, or pseudarthrosis. INDICATIONS: Absolute: intraarticular apophyseal dislocation of the medial epicondyle, complete lesion of the ulnar nerve. Relative: dislocation of the apophysis (> 4 mm) in children > 5 years of age; the need for intervention increases in children as the degree of dislocation, age, and athletic activity increase. CONTRAINDICATIONS: Dislocation of the medial epicondyle (< or = 4 mm) in children < 5 years of age, provided the fragment location is not intraarticular. SURGICAL TECHNIQUE: Open reduction of the apophysis through a medial approach. Identification of the ulnar nerve. In young children or with small fragments fixation with Kirschner wire. Screw fixation in older children or for larger fragments. POSTOPERATIVE MANAGEMENT: Long upper-arm plaster cast until wound healing is achieved. Subsequently, upper-arm plaster cast for 3 weeks. Removal of Kirschner wires after 4-6 weeks, screw removal after 8-12 weeks. Physiotherapy only if marked reduction of elbow mobility is found 6 weeks after cast removal. RESULTS: From January 1, 1994 to December 31, 2003, 25 children with an average age of 12 years suffering from medial epicondylar avulsion fractures were operated on using open reduction and Kirschner wire fixation. An average of 3 years after the injury 14 of these children underwent follow-up examination using a procedure that took subjective, clinical and radiologic parameters into account. Two children showed a slight reduction in overall strength of the injured extremity when compared with the contralateral extremity. One child had a flexion deficit of 10 degrees, all other children showed movement limitations of < or = 5 degrees compared to the contralateral extremity. In all the cases available to follow-up, there was a slight increase in valgus alignment of the elbow joint compared with the uninjured side (3 degrees on average). All fractures consolidated within 6 weeks. 相似文献
54.
55.
W. Nörenberg Ernst Schöffel Bela Szabo Klaus Starke 《Naunyn-Schmiedeberg's archives of pharmacology》1997,356(2):159-165
The aim of the study was to subclassify the soma-dendritic α2-autoreceptors in the locus coeruleus (LC) of the rat by means of antagonists. To this end, the frequency of spontaneous action
potentials was recorded extracellularly from single LC neurones in brain slices. The neurones fired spontaneously at an average
rate of 1 Hz. The selective α2-adrenoceptor agonist 5-bromo-6-(2-imidazolin-2-ylamino)-quinoxaline (UK 14,304) and noradrenaline decreased the action potential
discharge with IC50 values of 5 and 510 nM, respectively. The concentration-inhibition curves of UK 14,304 and noradrenaline were shifted to the
right by phentolamine (0.15 μM) and rauwolscine (0.15 μM) but not by prazosin (1 μM). Apparent K
d values of phentolamine were 17 nM (against UK 14,304) and 20 nM (against noradrenaline). Apparent K
d values of rauwolscine were 47 nM (against UK 14,304) and 70 nM (against noradrenaline). (+)-Oxaprotiline (1 μM) suppressed
the firing of the neurones within 10 to 33 min. In the continued presence of oxaprotiline, phentolamine and rauwolscine restored
firing with EC50 values of 120 and 250 nM, respectively. Prazosin (1 μM) again was ineffective. All three antagonist affinity estimates –
against UK 14,304, exogenous noradrenaline and endogenous noradrenaline (that accumulates in the extracellular space in the
presence of oxaprotiline) – yield an affinity order phentolamine > rauwolscine >> prazosin, prazosin being ineffective even
at a concentration of 1 μM. These findings identify the soma-dendritic α2-autoreceptors of the LC as the rat variant of the α2A/D-adrenoceptor, i.e. α2D. Not only presynaptic but also soma-dendritic α2-autoreceptors may at least predominantly be α2A/D throughout the nervous system.
Received: 3 March 1997 / Accepted: 21 April 1997 相似文献
56.
K. Reynen U. Röber W.G. Daniel R. Henßge S. Schüler 《Clinical research in cardiology》1998,87(5):331-335
Zusammenfassung Zahlen zur H?ufigkeit von Herztumoren im operativen Krankengut liegen bisher für die Bundesrepublik Deutschland nicht vor.
Um einen entsprechenden überblick für das Jahr 1996 zu erhalten, wurde allen 77 herzchirurgischen Zentren der Bundesrepublik
Deutschland ein standardisierter Fragebogen zugesandt.
Daten von 65 der 77 Herzzentren (=84%) waren schlie?lich verfügbar: 187 Patienten waren wegen Myxomen, lediglich 44 wegen
nichtmyxomat?sen Tumoren, davon 28 wegen malignen prim?ren oder sekund?ren Herztumoren, operiert worden. Im Jahr 1996 waren
somit 0,32% (231/72 763) der Eingriffe mit Herz-Lungen-Maschine (erfa?t 72 763 von insgesamt 87 372) wegen eines Herztumors
vorgenommen worden. Ausgehend von diesen operativen Daten liegt die Inzidenz ausschlie?lich der prim?ren Tumoren des Herzens
zumindest bei 3 Tumoren pro 1 Million Einwohner pro Jahr (253 Tumoren/81,814 Millionen Einwohner). Wenn auch kleine Tumoren
asymptomatisch und unentdeckt bleiben k?nnen, wird heute doch die Mehrzahl prim?rer kardialer Tumoren durch Echokardiographie,
Computer- und Kernspintomographie bereits zu Lebzeiten des Patienten diagnostiziert, und diese Patienten werden in aller Regel
einer Operation zugeführt.
Somit werden gut 0,3% aller Eingriffe mit Herz-Lungen-Maschine in Deutschland wegen Herztumoren durchgeführt, wobei es sich
weit überwiegend um Myxome handelt.
Eingegangen: 23. September 1997, Akzeptiert: 11. Februar 1998 相似文献
57.
A. Heinig S. H. Heywang-Köbrunner P. Viehweg D. Lampe J. Buchmann R. P. Spielmann 《Der Radiologe》1997,37(9):710-717
Summary
Early recognition of recurrence and work-up of clinically indeterminate lesions may be impaired after reconstruction with
silicone implants due to superimposition of the implant or to scarring. This study was undertaken to evaluate the use of contrast-enhanced
MRI in patients with silicone implant after breast cancer. Contrast-enhanded MRI was offered to 169 patients. Comparative
two- to three-view mammography was also performed in 169 patients, as well as comparative sonography in 144 patients. Conventional
imaging and clinical examination detected only 8/13 recurrences, whereas 12/13 were detected by MRI. One recurrence had been
visible as a strongly enhancing 2-mm dot in a previous examination (2 years before), but was not called. It was therefore
counted as false negative. In addition, multicentricity was detected by MRI alone in two of three cases. MRI correctly diagnosed
scar tissue in all cases with indeterminate findings. However, due to false-positive calls caused by enhancing granulomas
specificity could not be improved. Contrast-enhanded MRI allowed decisive additional information in our study group and improved
the sensitivity significantly (concerning all diagnoses). Contrast-enhanded MRI is recommended in patients with diagnostic
problems or high risk of recurrence after silicone implants.
相似文献
58.
Doing it right the first time: quality improvement and the contaminant blood culture. 总被引:5,自引:3,他引:2
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F I Weinbaum S Lavie M Danek D Sixsmith G F Heinrich S S Mills 《Journal of clinical microbiology》1997,35(3):563-565
The aim of the project was to determine whether the rate of contaminant blood cultures could be reduced by using a team of dedicated phlebotomists. Comparisons were made between adult patients requiring blood cultures for suspected bacteremia on medical and surgical units before and after the introduction and withdrawal of a dedicated blood culture team. The results showed that a significant reduction in the contaminant blood culture rate was achieved by the blood culture team (P < 0.001; chi(2) test). Therefore, in our experience, the rate of contaminant blood cultures can be reduced in a teaching hospital by using a team of dedicated phlebotomists. Calculations made with our data and those published by others suggest that cost savings from reducing false-positive blood cultures are greater than the cost of the blood culture team. 相似文献
59.
Wolfgang Söllner Gerlinde Mairinger Martina Zingg-Schir Peter Fritsch 《Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete》1996,47(3):200-205
Zusammenfassung
Bei 205 Melanompatienten im Stadium I und II wurden das Ausma? der psychosozialen Belastung und der sozialen Unterstützung
sowie die Einstellung der Patienten zu unterstützenden Gespr?chsangeboten erhoben. 59% der Patienten fanden zus?tzliche unterstützende
Gespr?che mit dem behandelnden Dermatologen, 20% mit einem Psychotherapeuten sinnvoll. Patienten, die starke Angst vor einem
Fortschreiten des Tumors ?u?erten und die sich über die Erkrankung nicht ausreichend aufgekl?rt fühlten, wünschten Gespr?che
mit dem behandelnden Arzt. Patienten, die sich psychosozial st?rker belastet fühlten und sozial weniger Unterstützung durch
ihr soziales Umfeld angaben, befürworteten Unterstützung durch einen Psychotherapeuten. Auch eine ungünstige Prognose scheint
das Interesse an psychotherapeutischer Unterstützung zu verst?rken.
Eingegangen am 13. Januar 1995 Angenommen am 23. August 1995 相似文献
60.
Mikael Hellström Bo Jacobsson Ulf Jodal Jan Winberg Anders Odén 《Pediatric nephrology (Berlin, Germany)》1987,1(3):269-275
This study presents the result of 12–21 years' follow-up in a group of children with neonatal urinary tract infection (onset within 1 month after birth) in whom early renal growth retardation was noted without concomitant classical renal scarring. In all cases the neonatal infection was diagnosed and treated within a few days of onset and the patients were closely supervised thereafter. Renal length, parenchymal thickness and area were measured at urography. At first follow-up (22 children, mean age 4.1 years) a significant reduction of renal parenchymal thickness was noted. Long-term follow-up (18 patients, mean age 17 years) demonstrated a normalization of renal size in the entire group, although less complete in the subgroup with reflux. There were two major findings in the present study. Firstly, renal growth retardation was seen after neonatal infection, both with and without reflux. Secondly, normalization of renal size in previously small kidneys was demonstrated, suggesting that growth retardation can be a reversible phenomenon. The tendency for such normalization was slightly more marked in children without reflux. Reduction of parenchymal thickness without calyceal deformity, therefore, does not necessarily mean irreversible damage, and differentiation between permanent scarring and temporary growth retardation can thus only be made at later follow-up, possibly not until after puberty. The demonstration of renal growth retardation in spite of early diagnosis and treatment emphasizes the great vulnerability of the kidney in the newborn. 相似文献