Fractional flow reserve and complex coronary pathologic conditions.

Fractional flow reserve (FFR) is a well-validated index for assessing the physiologic significance of a coronary stenosis in most clinical conditions encountered in today's catheterisation laboratory. The aim of this paper is to provide a short overview of the theoretical background of the coronary pressure-derived FFR index and its clinical applicability in guiding complex coronary intervention procedures.     

Differences in CMV-Specific T-Cell Levels and Long-Term Susceptibility to CMV Infection after Kidney, Heart and Lung Transplantation

Patients after kidney, heart and lung transplantation differ in their immunosuppressive drug regimens and in susceptibility to infectious complications with cytomegalovirus (CMV). In this study, CMV-specific T-cell responses were characterized in long-term transplant recipients and associated with the frequency of infectious complications. CMV-reactive CD4 T cells from 50 healthy controls, 68 renal, 14 heart and 24 lung transplant recipients were flow cytometrically quantified by the induction of cytokines after specific stimulation. Moreover, the immunosuppressive effect of calcineurin inhibitors on specific T-cell reactivity was quantified in vitro and compared with responses in vivo. Median CMV-specific T-cell frequencies in long-term renal (1.48%; range 0.06-17.26%) and heart transplant recipients (0.90%; 0.13-12.49%) did not differ from controls (1.82%; 0.26-21.00%). In contrast, CMV-specific T-cell levels were significantly lower in lung transplant recipients (0.50%; <0.05-4.98%) and showed a significant correlation with the frequency of infectious episodes (r =-0.57, p = 0.005). The differences within the groups were associated with increasing dosages of immunosuppressive drugs, as exemplified for calcineurin inhibitors that dose dependently reduced specific T-cell reactivity in vitro. In conclusion, monitoring CMV-specific CD4 T cells may serve as a measure for long-term disease susceptibility and may contribute to an improved management of CMV complications after lung transplantation.     

Effects of angle and laminectomy on triangulated pedicle screws

We aimed to demonstrate the effect of angle and laminectomy on paired pedicle screws to determine whether a 90 degrees screw angle is optimal as has been previously suggested. According to the angle between right and left screws, 28 calf vertebrae were divided into three groups and instrumented as follows: Group I: 60 degrees screw angle; Group II: 90 degrees angle; Group III: 60 degrees angle with laminectomy. The screws were connected using rods and cross-fixators and tested to peak pullout force. Triangulated pedicle screws provided 76.5% more pullout strength than single screws. Most of the specimens failed through loss of convergence angle (toggling of screws on the rods) and subsequent uni- or bilateral screw pullout. Mean+/-SD peak loads were: Group I: 2071+/-622 N; Group II: 1753+/-497 N; Group III: 2186+/-587 N. The differences were not significant (p>0.05). 90 degrees triangulation was not associated with a superior pullout performance versus conventional 60 degrees triangulation, suggesting that achieving additional triangulation angle is not necessary to obtain increased pullout strength. Laminectomy did not alter the effect of triangulation on fixation strength.     

Gewaltforschung zum Thema „häusliche Gewalt“ aus kriminologischer Sicht

Domestic violence continues to be a subject of public interest and media presence, especially when it involves spectacular cases ranging from abuse of children to fatal violence in the family. Although domestic violence has been the subject of scientific research for the last three decades, there is still no clear evidence of prevalence and etiology of this particular kind of violence. Since the introduction of the German Violence Protection Act which came into force in January 2002, domestic violence has been met with severe societal and legal sanctions. The consequences for culprits are not only theoretical but also include an increase in criminal proceedings and improved civil court protection. Therefore medical staff, particularly legal medicine, is more than ever confronted with the need to standardize documentation of injuries resulting from domestic violence. In addition, legal medical specialists are often confronted with the victims’ personal and social problems. This paper gives an insight into the historical background and recent law reforms which have created legal sanctions and protection against domestic violence.     

Über Kombinationswirkungen

Naunyn-Schmiedeberg's Archives of Pharmacology -     

Ruptur der langen Bizepssehne und operative Therapiestrategien

Zusammenfassung Die Ruptur der langen Bizepssehne beruht auf ihrer anatomischen Disposition und, bedingt durch die biomechanische Belastung, zu 90% auf degenerativen Veränderungen. In der Regel finden sich begleitende Verschleißschäden anderer Strukturen des Schultergelenks wie der Rotatorenmanschette. Es wird ein Überblick über die Häufigkeit und den Entstehungsmechanismus von Rupturen der langen Bizepssehne sowie gängige operative Behandlungskonzepte gegeben. Die Rolle und das anatomisch-funktionelle Prinzip der Sehne des Caput longum im komplexen dynamischen System des Schultergelenks werden erläutert. Eingang finden die klinische Symptomatik, Beschreibungen sowie Wertungen apparativer diagnostischer Verfahren. Der Stand derzeit etablierter Operationstechniken wird unter Darstellung von Vor- und Nachteilen beleuchtet und diskutiert. Des Weiteren werden die selbst favorisierte Methode und die gesammelten Erfahrungen dargestellt.