Autologe Verfahren zur Therapie von Gefäßinfektionen

The development of a deep infection following vascular reconstructive surgery is the most demanding situation encountered in vascular surgery and requires diagnostic investigations that will vary with the hospital concerned and a targeted, early and aggressive attack on the infection both systemically and locally; in addition, local reconstruction carried out with autologous materials in association with sutures that are absorbed over the medium term – also referred to as autologous reconstruction – is helpful in many cases. A range of autologous reconstruction procedures is available for application at all sites of infection, allowing adequate and effective treatment. In most cases these can ensure a secure blood flow situation, win time, and keep the patient alive and conserve his or her extremity. The main priority is to combat the infection and make it possible to keep the patient alive and the extremity affected intact. When the stage of deep infection has been reached even recovery of the initial status once the infection is cured can be regarded as a success. After an appropriate time it is always possible to reoperate on the basis of the principles of vascular surgery.     

Rolle der Winkelstabilität bei der intramedullären Stabilisierung

Zusammenfassung Winkelstabile Plattenfixateur-interne-Systeme haben in den letzten 20 Jahren zunehmend an Bedeutung gewonnen. Die aus der Winkelstabilität resultierende flächenhafte Krafteinleitung und gleichmäßigere Kraftverteilung führen zu einer besseren Knochenbruchheilung insbesondere im metaphysischen Bereich und bei Osteoporose. Bei Marknagelsystemen ist die Winkelstabilität bislang nur partiell verwirklicht. Der vorgestellte winkelstabile Tibiamarknagel realisiert an jedem einzelnen Bolzen eine Winkelstabilität mit dem einliegenden intramedullären Kraftträger. Von Februar 2002–August 2004 wurden 21 Patienten mit ihm behandelt. In 13 Fällen wurden Frakturen stabilisiert, 6 Patienten hatten Fehlstellungen, 2 Patienten Pseudarthrosen. Zum Nachuntersuchungszeitpunkt waren alle Behandlungen abgeschlossen. Postoperative Komplikationen traten nicht auf. In allen Fällen wurde eine vollständige Durchbauung erreicht. In 6 Fällen fand sich radiologisch eine verzögerte Knochenbruchheilung. Die ersten klinischen Erfahrungen mit dem winkelstabilen Tibiamarknagel zeigen, dass dieser aufgrund der höheren Primärstabilität insbesondere im metaphysären Knochenbereich mit kurzen Fragmenten sowie bei Osteoporose Vorteile gegenüber anderen nichtwinkelstabilen oder nur partiell winkelstabilen Marknagelsystemen erbringt. Die verzögerten Knochenbruchheilungen bedürfen weiterer klinischer und biomechanischer Untersuchungen.     

Auditory event-related potentials and cognitive function of preterm children at five years of age.

OBJECTIVE: In our previous study, auditory event-related potentials (AERPs) in preterm 1-year-old children had a positive deflection at 150-350 ms that correlated positively with their 2-year neurodevelopmental outcome. In a study of the same subjects at age 5, our aim was to assess AERPs and their relationship to neuropsychological test results. METHODS: Preterm small (SGA, n=13), appropriate for gestational age (AGA, n=15), and control (n=13) children were assessed with an Easy paradigm presenting a large frequency change accompanied with occasional novel sounds, and a Challenging paradigm presenting small frequency and duration changes with a rapid rate. The preterm children underwent neurocognitive tests. RESULTS: Easy paradigm. The P1 response to frequency deviant was smaller and MMN larger in the preterm than in the control children. Challenging paradigm. The P1 response to standard, frequency, and duration deviants was smaller in the preterm than in the control children. The N2 response to frequency deviant was larger in the preterm than in the control children. AGA and SGA children had similar AERPs. The P1, N2, and MMN amplitudes correlated with verbal IQ and NEPSY language subtests. CONCLUSIONS: Small P1 response(s) appears to be typical for preterm children. SIGNIFICANCE: Small P1 response in preterm children may suggest altered primary auditory processing.     

Hydatid disease presenting as an intrascrotal mass in a child.

A thirteen-year-old boy with the preliminary diagnosis of hydrocele of the cord who underwent surgery is presented. Ultimate diagnosis of hydatid disease was established by surgical exploration and histopathologic examination of the specimen. Although it is a rare occurrence, hydatid disease should be considered as a diagnostic possibility in endemic areas.     

Lithium but not cholinergic ligands influence guanylate cyclase activity in intact human lymphocytes

The presence of guanylate cyclase in intact circulating human lymphocytes and the sensitivity of this enzyme to stimulation by sodium nitroprusside could be confirmed. However, in contrast to other observations all attempts failed to stimulate the enzyme by cholinergic agonists, despite the use of M1 as well as M2 selective agonists. These findings do not support the assumption that cholinergic recognition sites on human lymphocytes described by many groups are part of a functioning muscarinic transducing mechanism. While several other neuroreceptor agonists were also unable to affect lymphocyte guanylate cyclase activity, lithium was found to potently inhibit the stimulation of guanylate cyclase by sodium nitroprusside at an intracellular concentration close to the therapeutic plasma levels. It is suggested that the effects of lithium on guanylate cyclase activity in human lymphocytes could be related to a possible mechanism of action of lithium in affective disorders.     

Fetus in fetu or giant epignathus protruding from the mouth.

A huge and extremely organoid mass, protruding from the mouth of a newborn and causing respiratory embarrassment, was resected. It was difficult to make a clear distinction whether this mass was fetus in fetu or a highly organoid epignathus dealing with the findings obtained from its gross and histological examination of the mass.     

Licensing and control authority batch release of influenza vaccine in Germany in accordance with EEC regulations

The epidemiological situation calls for almost yearly changes in the antigenic composition of influenza vaccine, thus necessitating fresh licensing procedures. Since the time for bringing a new vaccine onto the market should be relatively short, the following work of all parties involved must be done expeditiously: 1) WHO recommendations on new virus strains and their subsequent adaptation by the EEC (February/March); 2) Distribution of the new virus strains to the International Reference Centers for Influenza in the UK and USA (February/ March); the centers later issue reference materials for the determination of the haemagglutinin antigen concentration (April/May); 3) Production and testing of seed virus by manufacturers, as well as validation of the producer's inactivation process for the new virus strains (May/June); 4) Licensing of the vaccines by the National Control Authority (Paul-Ehrlich-Institute) (June/July); in the case of previously licensed products, the procedure is limited essentially to the approval of the detailed protocol of production and tests on the new virus strains, clinical studies not being required before licensing because of a lack of time; 5) Paul-Ehrlich-Institute's test for batch release, according to Directive 89/342/EEC, besides protocol approval, conducts material testing of the endotoxin and antigen content of each vaccine lot; the assay for the antigen quantification is especially laborious and sometimes must be repeated because of test invalidity.