Neue Gesichtspunkte zur Behandlung der kompletten und isolierten diaphysären Unterarmfrakturen im Kindesalter

From 1984 to 1992 153 children were treated at the pediatric surgical department of the University of Mainz, of whom 19 had fractures of the radius, 9 of the ulna and 125 had a combination of both in the diaphysis of the forearm. Factors like patient's age, type of fracture and therapeutic methods were analyzed. One hundred and forty-one children were treated conservatively, 12 by operation. One hundred and one of these patients were healthy, when discharged (about 8 weeks after accident). Follow-up was possible in 69 cases. We found that occasional a remaining dislocation angle does not impair function: in 65 cases the result was “good” and “very good”, but only “moderate” in 4 cases. These 4 children had been treated conservatively by reposition and plaster cast; 2 of these 4 children showed bone reconstruction without dislocation. Twenty-two of the 56 X-ray follow-up's showed persisting dislocation. To prevent functional problems (2 of our cases) it is essential to obtain a very exact reposition of diaphyseal forearm fractures. Therefore we would recommand a more generous indication for operation, preferably using elastic-stable Nancy pins.     

Simultane Bestimmung von CA 125 im Tumorcytosol und im Serum bei Patientinnen mit Ovarialtumoren

Ohne Zusammenfassung     

Nasal administration of naloxone for detection of opiate dependence.

In clinical trials, nasally applied naloxone was used to identify opiate dependence in humans for the first time. Withdrawal distress was recorded, and pupillary response, pulse rate and blood pressure measured. A significant increase in withdrawal distress and pupillary dilation was observed after nasal administration of 1mg (1mg/400 microliters) naloxone in all subjects who also showed opiate-positive urine samples. In control subjects, no reaction to naloxone was observed. It may be concluded that the nasal route for naloxone administration is as effective as the parenteral route. This test is sensitive enough to identify the physically-dependent opiate user and might have a role in emergency medicine and withdrawal treatment.     

Resektion der Vena jugularis interna bei infizierter Thrombose Management einer seltenen Komplikation nach Polychemotherapie bei metastasiertem, testikul?rem Keimzelltumor

Zusammenfassung Für die Therapie bei infizierten Thrombosen der großen Halsvenen und zentralen Venen gibt es kein standardisiertes therapeutisches Vorgehen. Sowohl konservative als auch aggressive, invasive Therapiestrategien werden beschrieben. Wir präsentieren den Fall einer septischen Thrombose der rechten V. jugularis interna nach einliegendem zentralem Venenkatheter bei einem immunsupprimierten Patienten nach Polychemotherapie wegen eines metastasierten Seminoms des rechten Hodens. Nach konservativem Therapieversuch mit intravenöser antibiotischer Therapie und therapeutischer Heparinisierung wurde wegen des sich verschlechternden septischen Zustandsbildes des Patienten die Indikation zur chirurgischen Intervention gestellt. Intraoperativ war eine Thrombektomie unmöglich, sodass eine vollständige Resektion der rechten V. jugularis interna durchgeführt wurde. Der postoperative Verlauf war komplikationslos. Der histopathologische Befund zeigte eine putride Thrombophlebitis mit ausgeprägter Periphlebitis; die kulturellen Untersuchungen aus dem Wundgebiet und Blutkulturen wiesen übereinstimmend Staphylococcus aureus nach. Vor allem der immunsupprimierte Patient mit Neutropenie und Thrombopenie erfordert ein aggressives chirurgisches Vorgehen zur sicheren und schnellen Befundsanierung. Abstract There is no therapeutic standard for the treatment of septic thrombosis of the central veins. We present a case of septic thrombosis of the right internal jugular vein. The immunocompromised patient had a central venous line for polychemotherapy of metastasized seminoma of the right testis. After conservative therapy with antibiotics and therapeutic heparinization the septic status of the patient worsened rapidly and surgical intervention was planned. Intraoperatively, thrombectomy was not feasible and complete resection of the right internal jugular vein became necessary. Postoperative reconvalescence was uneventful. Histopathological findings showed purulent suppurative thrombophlebitis and marked periphlebitis, mirobiology revealed staph. aureus both in the catheter insertion site and in blood cultures. Especially in immunocompromised patients with severe granulo- and thrombocytopenia, surgery may be attributed with less danger for the patient than prolongued septicemia.     

The feasibility of sensitization studies using fewer test animals

The possibility of reducing the number of animals in sensitization studies (maximization method) is discussed on the basis of results from 20 sensitization tests. It appears that the number of test animals in sensitization studies may be reduced to ten treated animals and five control animals without prejudice to the quality of the test.     

Stimulated pressure response of the ileocolonic junctional zone and its use as a continence mechanism in a canine model

Summary Mechanisms for maintaining passive continence in the efferent limb of urinary diversions include compression of tissue, peristalsis, equilibration of pressure and use of valves. Motor activity and pressure in the ileum, ileocecal valve (ICV) and the colon were evaluated in dogs. Spontaneous activity and pressure were compared with stimulated pressure response and activity. Stimulation was performed at the pelvic nerve and the small nerves in the mesenterium, as well as direct neurostimulation of the bowel. Resting pressure at the ICV was 12.7±0.4 cmH₂O rising to 26.4±2.2 cmH₂O during spontaneous depolarization. Stimulation of the pelvic nerve resulted in increased colonic motor activity with unchanged pressure. Electric stimulation of small mesenterical nerves to the ICV increased pressure in the ICV to 35.0±4.1 cmH₂O, while direct myoelectric stimulation of the ICV zone increased the intraluminal pressure to 75.0±3.2 cmH₂O. Termination of the electric stimulation was followed by a slow decrease of pressure to the resting level a period of 30–45 s. Maintaining continence at the ICV with long-term constant or intermittent stimulation seems feasible.     

Ureteral stents — materials and new forms

Summary Three different types of polymers are currently used for self-retained ureteral stents: thermoplastic materials such as polyurethanes, and thermoset elastomers such as silicone and hydrogels. Polyurethane stents are easy to form and have high drainage capacity, whereas silicone shows the best biocompatibility but a lower drainage efficacy than the former. A mock urinary system consisting of a collecting system and a 9-F tube was used to evaluate the flow characteristics of various double-pigtail stents in cases of urinary obstruction. For simulation of an unobstructed urinary system a human urogenital system was used. Inner flow polyurethane stents showed the best drainage as compared with inner flow silicone and outer flow ESWL stents in an obstructed ureter, whereas ESWL stents maintained the best flow in an unobstructed ureter or in respect to conventional stents with obstructed sideports.     

LSECtin interacts with filovirus glycoproteins and the spike protein of SARS coronavirus

Cellular attachment factors like the C-type lectins DC-SIGN and DC-SIGNR (collectively referred to as DC-SIGN/R) can augment viral infection and might promote viral dissemination in and between hosts. The lectin LSECtin is encoded in the same chromosomal locus as DC-SIGN/R and is coexpressed with DC-SIGNR on sinusoidal endothelial cells in liver and lymphnodes. Here, we show that LSECtin enhances infection driven by filovirus glycoproteins (GP) and the S protein of SARS coronavirus, but does not interact with human immunodeficiency virus type-1 and hepatitis C virus envelope proteins. Ligand binding to LSECtin was inhibited by EGTA but not by mannan, suggesting that LSECtin unlike DC-SIGN/R does not recognize high-mannose glycans on viral GPs. Finally, we demonstrate that LSECtin is N-linked glycosylated and that glycosylation is required for cell surface expression. In summary, we identified LSECtin as an attachment factor that in conjunction with DC-SIGNR might concentrate viral pathogens in liver and lymph nodes.