Directional coronary atherectomy: experience in 310 patients

This article describes the acute and long-term clinical outcomes of 310 consecutive patients who underwent directional coronary atherectomy (DCA) for treatment of coronary artery disease. An overall procedural success rate of 95% was noted with a total major complication rate of 5%. Analyses of minimal luminal diameter (MLD) were performed pre- and post-procedure for 160 patients. Clinical follow-up including treadmill testing and/or clinical symptoms was obtained on 293 patients. Results of angiographic analyses corresponded with the Kuntz model suggesting that larger MLDs are associated with lower restenosis rates. The overall target vessel revascularization rate was 27.6%, with a mean post-procedure percent diameter stenosis of 16%. These results indicate that DCA is associated with acceptable clinical restenosis rates, complications and long-term outcome.     

Rapid killing of urothelial carcinoma-cells by wild-type p53

The effect of the tumor suppressor p53 on urothelial carcinoma cells was studied by transfecting six cell lines containing different mutations in the p53 gene with an expression construct for the wild-type protein. In all cell lines, the number of cell clones resistant to a neomycin analogue was strongly diminished when pCMVhup53 was cotransfected with the resistance plasmid pRSVneo as compared to cotransfection with either a plasmid vector, a p53 deletion and a mutant p53 expression vector. Cytochemical analysis showed that cells cotransfected with pCMVhup53 and an expression plasmid for beta-galactosidase disappeared during the second day after transfection. Thus, reexpression of wildtype p53 efficiently and rapidly kills urothelial carcinoma cells, independent of the different mutations in p53 they contain.     

Acute hand burns in children: management and long-term outcome based on a 10-year experience with 698 injured hands

OBJECTIVE: To document long-term results associated with an coordinated plan of care for acutely burned hands in children. SUMMARY AND BACKGROUND DATA: Optimal hand function is a crucial component of a high-quality survival after burn injury. This can be achieved only with a coordinated approach to the injuries. Long-term outcomes associated with such a plan of care have not been previously reported. METHODS: Over a 10-year period, 495 children with 698 acutely burned hands were managed at a regional pediatric burn facility; 219 children with 395 injured hands were followed in the authors' outpatient clinic for at least 1 year and an average of >5 years. The authors' approach to the acutely burned hand emphasizes ranging and splinting throughout the hospital stay, prompt sheet autograft wound closure as soon as practical, and the selective use of axial pin fixation and flaps. Long-term follow-up, hand therapy, and reconstructive surgery are emphasized. RESULTS: Normal functional results were seen in 97% of second-degree and 85% of third-degree injuries; in children with burns involving underlying tendon and bone, 70% could perform activities of daily living and 20% had normal function. Reconstructive hand surgery was required in 4.4% of second-degree burns, 32% of third-degree burns, and 65% of those with injuries involving underlying bone and tendon. CONCLUSIONS: When managed in a coordinated long-term program, the large majority of children with serious hand burns can be expected to have excellent functional results.     

Hirntumorresektionen in einem offenen 0,5 T-MRT Zweijährige Erfahrungen aus neuroradiologischer Sicht

After two years clinical experience using an open 0.5 T-MRI, which make it possible to control all steps of a brain tumor resection, the high expense in relation to the effect is proofed. In 80 MRI-guided brain tumor resections the indication, the degree of resection, the appearance of operative induced changes, complications and clinical state are analysed. The advantage of the method consists in safety of localisation and detection especially of intra-axial cerebral tumors, recording of intraoperative invisible tumor parts and saving eloquent areas during tumor resection. To have optimal results, all over the operation time, the participation of a special experienced radiologist is necessary. The best results are shown in treatment of low grade gliomas and tumors near eloquent areas.     

Macromorphology and histology of intramuscular hemorrhages in cases of drowning

In a prospective autopsy series of 39 cases of fatal drowning, the detailed dissection of the skeletal muscles of the neck, anterior / posterior trunk and the upper extremities in layers revealed intramuscular hemorrhages of different size and shape in 20 cases (51.3 %). Light microscopy examination showed a premortal (vital/agonal) type of muscular alteration in 7 (50 %) out of 14 macroscopical hemorrhage-positive cases. These hemorrhages and histological muscle alterations are attributed to agonal convulsions, hypercontraction and overexertion of the affected muscle groups. As long as no cutaneous or subcutaneous hematomas above the hemorrhages can be found, these autopsy findings (with special reference to histology) can serve as an additional criterion concerning the differentiation of drowning and another cause of death. Received: 31 July 1998 / Received in revised form: 31 August 1998     

Percutaneous endoscopic gastrostomy in burn patients

Background: Prolonged enteral feedings are required occasionally in seriously burned individuals. We have employed percutaneous endoscopic gastrostomy (PEG) in selected patients who require particularly prolonged access, thus prompting this review. Methods: The PEG procedure was performed under general anesthesia in combination with another surgical procedure using a variety of commercially available needle and guidewire kits in 14 patients. Results: These 14 patients had an average age of 55.2 ± 6.6 years and a burn involving 38 ± 8% of the body surface. Eleven of these patients had suffered an inhalation injury. The tubes were placed an average of 57 ± 10.5 days after injury through unburned and unharvested skin in four patients (28%), healed donor sites in five patients (35%), healed burn in one patient (1%), and grafted burn in four patients (28%). One patient, whose catheter was placed through a grafted fascial excision, developed moderate local wound erosion. Tubes were known to have been left in place as long as 155 days. However, most were removed in rehabilitation hospitals, and we were unable to determine how long most were left in place. We are unaware of any problems with the tubes occurring after discharge from the acute care setting. Conclusions: In selected patients, PEG can provide more comfortable access for prolonged enteral feedings than nasogastric tubes and can be placed with minimal morbidity. Received: 29 March 1998/Accepted: 1 August 1998     

Sympathetic contralateral vestibulopathy after unilateral zoster oticus

A unique case of initially right sided varicella zoster induced Ramsay-Hunt syndrome with complete vestibular loss is reported. The patient subsequently developed deficits of the left vestibule 5 months later. An autoimmune pathogenesis of the left vestibular failure rather than bilateral varicella zoster infection was suggested by the following data: (1) no evidence of vesicular eruptions on the left auricle and the virtual absence of antiviral antibodies after onset of bilateral vestibulopathy; (2) prompt response of the left vestibule to immunosuppressive therapy with corticosteroids; and (3) presence of atypical nervous tissue specific autoantibodies against a 45 kDa protein.     

Analysis of premature termination in inpatient psychosomatic rehabilitation based on epidemiologic data from two hospital companies

Premature termination of inpatient psychotherapy can have multiple, mostly negative, effects for patients, therapists, clinics, insurance companies, and employers, but research regarding inpatient settings is still deficient. The analysis of two sets of data of four different rehabilitation clinics from two different hospital companies (2699 and 2215 patients, respectively), aimed at possible predictors and outcomes of premature termination. We found ratios of premature termination of 8.3% and 14.7%, respectively. Especially young patients under 30 years of age and patients with eating and personality disorders were more likely to terminate inpatient treatment prematurely. Treatment outcome as rated by therapists was in significantly fewer cases among premature terminators than among successful terminators improved. The results seem to indicate, that assignment to inpatient psychotherapy can be optimized. For a better understanding of the process of premature termination more theory guided prospective and followup studies are necessary.