Cor triatriatum associated with partial anomalous pulmonary venous connection to the coronary sinus: Echocardiographic and angiocardiographic features

Summary An infant girl is described who had cor triatriatum and partial anomalous pulmonary venous connection of the left pulmonary veins to the coronary sinus, the first report of this combination of lesions. The infant also had a Dandy-Walker malformation and multiple facial and intrathoracic hemangiomas. The cardiac diagnosis was made by two-dimensional echocardiography. Cardiac catheterization and angiography confirmed the findings and also demonstrated a persistent left superior vena cava draining to the coronary sinus. The infant underwent successful surgical repair. Partial anomalous pulmonary venous connection and left superior vena cava not infrequently are associated with cor triatriatum. Although two-dimensional echocardiography is sensitive for the detection of cor triatriatum, preoperative cardiac catheterization is necessary to identify unequivocally systemic and pulmonary venous connections.     

Is the Swiss Society for Social and Preventive Medicine what it should be? An invitation to a discussion

Ohne Zusammenfassung     

Intracoronary thrombolysis: Organizational prerequisites,technique, and results

Reestablishing myocardial perfusion during evolving myocardial infarction may limit the ultimate extent of infarction if viable myocardial tissue is present when recanalization of the occluded vessel is achieved. This will result in improved left ventricular function and decreased mortality. In addition to their therapeutic benefits, recanalization procedures have contributed greatly to our knowledge of acute myocardial infarction. It has been demonstrated that myocardial infarction most often occurs after thrombotic occlusion of a coronary artery. This has settled a controversy that has preoccupied cardiologists for decades. Selective intracoronary administration of fibrinolytic agents is followed by recanalization in approximately 80% of cases. Therapeutic failures are attributable to occlusion caused by other factors, to inactivation of streptokinase by high antibody concentrations, and to insufficient concentrations of streptokinase at the thrombus as a results of unfavorable flow conditions. This study is dedicated to Prof. Dr. Med. Horst Schmutzler on the occasion of his 60th birthday.     

Reproduktionsmedizin

Since the introduction of in vitro fertilization in 1978, reproductive medicine and its associated scientific fields have developed rapidly. In Germany, progress in this field is impeded by the German Embryo Protection Act. Exemplary are the prohibition of embryo selection and the ban on genetic testing of the pre-implantation embryo. Nevertheless, infertility treatment outcome has to be optimized within the framework of this law, with the aim of making treatment more efficient, lowering the incidence of multiple gestations, making ovarian hyperstimulation safer, as well as reducing the financial costs for the couple.     

Medizinische Beurteilungskriterien zu bandscheibenbedingten Berufskrankheiten der Lendenwirbelsäule (I)

Occupational diseases Nos. 2108 and 2110 correspond to intervertebral disc-related diseases of the lumbar spine from many years of carrying or lifting heavy loads, occupations in extreme postures of full flexion or oscillation of the whole body when seated, and which compel the cessation of all activities which are or could be the cause for the origin, exacerbation or recurrence of the disease. These occupational diseases came into force at the start of 1993, but there have been considerable problems in their implementation. The present Part I of the contribution is the result of the work of an interdisciplinary study group and contains medical criteria for the assessment of possibly strain-related clinical characteristics and the evaluation of other possible causes. Part II is to be published in Volume 4/2005 and will deal with questions related to forced cessation and to the assessment of the loss of earning ability. Agreement was reached in many areas related to the assessment of occupational claims. This should allow for evidence-based decision making in the future for the occupational diseases Nos. 2108 and 2110.     

Mikrofrakturierung bei fokalem Knorpelschaden

The microfracture technique and spongiolization using Pridie drilling are the most commonly used and highly cost-efficient operative therapies for restoration of cartilage in Germany. Microfracturing can be performed arthroscopically in various joints including the knee, ankle, elbow, and shoulder joint. Specifically designed instruments are recommended for this procedure. Steadman recently reported excellent results in a series of 72 patients undergoing microfracturing with a mean follow-up of 11 years showing consistent and long-term reduction of weight-bearing pain and swelling as well as improvement of daily activities. Ideal indications for this easy arthroscopic procedure of microfracture treatment include focal lesions up to 4 cm². Some studies have demonstrated that microfracturing results not merely in the formation of fibrocartilage but also in the induction of hyaline cartilage with superior properties.     

Multimodal—was ist das überhaupt?

In chronic pain syndromes multimodal treatment has proved its efficacy. However, multimodal treatment does not mean randomly combining different interventions in a potpourri of methods. Multimodal treatment must closely follow a well-proved conceptual framework. Those concepts may be well illustrated by therapy of back pain. The most elaborate model for understanding the transition from acute to chronic pain is fear avoidance. Based on this model chronic pain status is understood as a learned consequence, which resulted from patients’ anxious avoidance of body movements. In these cases, treatment of a physical pathology is not the main aim of therapy but rather functional restoration. Those multimodal programs meanwhile have demonstrated their effectiveness. However, good results not only depend on recognition of imperative elements in therapy but also on adhering to essential principles (avoidance of negative anticipation, adequate information with assurance techniques, no training of avoidance, recognition of elements of fear therapy).     

Der Einsatz des Prophy-Jet®-Gerätes zur Schmelzpolitur nach der Bracketentfernung

Zusammenfassung In einer In-vitro-Studie wurde die Einsatzfähigkeit des Prophy-Jet-^®-Gerätes für die Schmelzpolitur nach Bracketentfernung untersucht. In die Studie wurden drei verschieden stark gefüllte orthodontische Kleber einbezogen: Concise^®, Genie^® und Mono Lok^®. Alle Proben wurden rasterelektronenoptisch untersucht und fotografisch dokumentiert in Vergrößerungen zwischen 20- und 10 000fach. Die Oberflächenanalyse ergab, daß das Prophy-Jet^®-Gerät allein zur Schmelzpolitur nach Bracketentfernung nicht ausreicht, um unter klinisch vertretbarem Zeitaufwand (1 Minute/Zahn) eine kunststofffreie Schmelzoberfläche zu erzielen. Nach konventioneller makroskopischer Vorreinigung mit Scalern oder rotierenden Hartmetallfinierern zeigten sich nach fünfsekündiger Prophy-Jet^®-Bestrahlung noch geringe Kleberreste. Nach zehnsekündiger Expositionsdauer waren beim Mono Lok^®-Adhäsiv keine Kleberreste mehr nachweisbar, beim Concise^®-bzw. Genie^®-Adhäsiv fanden sich noch vereinzelte geringe Kleberinseln. Das Prophy-Jet^®-Gerät erscheint zur Unterstützung der Schmelzpolitur nach Bracketentfernung sinnvoll; eine sorgfältige Vorreinigung mit Hand- oder rotierenden Instrumenten ist jedoch erforderlich, um eine weitgehende Adhäsivreduktion zu erreichen. Die konventionelle Gummi- und Bimssteinpolitur kann nach 20sekündiger Prophy-Jet^®-Bestrahlung entfallen.

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Summary The purpose of this in vitro investigation was to ascertain the effects of the Prophy-Jet^® air-powder abrasive system for enamel polishing after debonding. Three adhesives differing in filler content were included in this study: Concise^®, Genie^®, and Mono Lok^®. All specimens were examined by scanning electron microscopy and documented photographically at magnifications from 20 to 10 000. Surface analysis showed that using the Prophy-Jet^® exclusively is not sufficient to produce a clean and smooth enamel surface without residual adhesive after debonding and after one minute of exposure time, as might be justifiable in a clinical situation. After macroscopic conventional clean-up with scalers or rotary finishing instruments and five seconds of exposure time to the Prophy-Jet^® some occasional adhesive remnants could be located. After ten seconds of Prophy-Jet^® treatment all Mono Lok^®-adhesive was removed from the enamel surface; in the Concise^® and Genie^®-group few isolated adhesive remnants could be detected. The Prophy-Jet^® air-powder abrasive system was found to be efficient in supporting enamel polishing after debonding; but an accurate pretreatment with scalers or rotary finishing instruments is essential to achieve an extensive reduction of adhesive. Final polishing of the enamel surface with rubber wheels or prophy cup and pumice can be omitted after treatment with the Prophy-Jet^® for 20 seconds.

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Résumé Le but de ce travail était d'éxaminer à l'aide d'une étude in vitro, l'emploi du Prophy Jet^® pour le polissage de l'émail après l'arrachage des brackets. Dans l'étude on a analysé trois substances adhésives différentes: Concise^®, Genie^® et Mono Lok^®. Après avoir examiné les spécimens par le microscope électronique à balayage, on les a documentés à l'aide de photos d'un grossissement de 20 à 10 000. L'analyse de la surface montre que la seule application du Prophy Jet^® (après l'arrachage des brackets) ne suffit pas pour obtenir une surface d'émail sans substance adhésive en un temps clinique d'une minute par dent. Après prétraitement macroscopique selon la méthode conventionnelle (scaler ou instruments montés sur tour) il demeurait encore de petits restes de la substance adhésive après l'application du Prophy Jet^® pendant cinq secondes. Après une durée d'application de dix secondes, on ne pouvait pas déceler de restes de Mono Lok^®, tandis qu'il y avait sporadiquement des restes de Concise^® et Genie^®. Ces résultats indiquent, que le Prophy Jet^® est efficace pour le polissage de l'émail après l'arrachage des brackets, mais on a tout de même besoin d'un nettoyage précédent minutieux avec des instruments convenables (scaler ou instruments montés sur le tour) pour obtenir une réduction considérable de la substance adhésive. On peut renoncer au polissage conventionnel à l'aide de caoutchouc ou de la pierre ponce après l'application du Prophy Jet^® pendant 20 secondes.

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Vortrag auf der wissenschaftlichen Jahrestagung der Deutschen Gesellschaft für Kieferorthopädie 1985.