Journalliteratur

Ohne Zusammenfassung     

Sammelbericht über Luxationen aus dem Jahre 1919

Ohne Zusammenfassung     

Sammelreferat über Heilgymnastik und Massage aus dem Jahre 1920.

Ohne Zusammenfassung     

Non-surgical salvage of thrombosed arterio-venous fistulae: a case series and review of the literature

Attempts to salvage thrombosed hemodialysis arterio-venous fistulae (AVF) using interventional techniques are not universally performed. Patients often require temporary dialysis catheters pending creation of a new vascular access. We determined the long-term outcome of interventional (non-surgical) repair of completely thrombosed AVF in 49 consecutive accesses (22 radio-cephalic, 1 radio-basilic, 19 brachio-cephalic, and 7 brachio-basilic) referred for an intervention within 48 hours of thrombosis. Subjects were 65% male (32), with mean +/- SD age 63.7 +/- 13.5 years (range 33-91), 51% African-American (25), 47% Caucasian (23) and 65% had diabetes (32). Overall, 96% (47/49) of thrombosed AVF were salvaged with complications observed in four cases (two extravasations of contrast; two radial artery emboli), with no serious long-term sequelae. Interventional procedures included 34 venous angioplasties, 11 venous angioplasties with stenting and two combined venous and arterial angioplasties. The primary and secondary patency rates for all salvaged AVF were 50.5 +/- 8.7%, 72.5 +/- 7.8% at 1 year, and 43.3 +/- 10%, 55.4 +/- 12.7% at 2 years, respectively. The median estimate to first intervention after the declot procedure was 14.7 months. The median estimate for continued function exceeded 23.1 months. There was no significant statistical difference in the primary (p = 0.73) and secondary patency rates (p = 0.057) for forearm vs. upper arm AVF. We conclude that interventional repairs should routinely be employed to salvage newly thrombosed AVF. The vast majority of these individuals can avoid receiving dialysis catheters or placement of a new dialysis vascular access.     

Rapid onset of lung involvement in progressive systemic sclerosis.

Lung involvement in progressive systemic sclerosis (PSS) is common but usually is of chronic onset late in the course. Skin changes usually antedate pulmonary findings. Presentation of PSS with rapid development of pulmonary interstitial fibrosis, without skin changes, has not previously been described. Such a case is discussed here and the radiologic and pathologic findings and course of pulmonary PSS are reviewed.     

Beitrag zur Lehre von den kongenitalen Dyskeratosen

Ohne Zusammenfassung     

Ureteroileal anastomotic leaks: percutaneous treatment

Interventional techniques are increasingly important in patient care. We present new uses of these techniques in each of three patients who had rapidly deteriorating clinical status due to an anastomotic leak following the creation of a ureteroileal conduit. To divert urine flow and to promote healing, large bore nephrostomy tubes were placed percutaneously. Silastic ureteral stents were placed from above to help divert flow of urine, and to prevent the formation of strictures. The procedures, the nephrostomy tubes, and the stents were all well tolerated, and the clinical status of the patients improved rapidly. These three patients left the hospital with tubes and stents in place, and complete healing occurred without complications in one to three months. Following removal of the nephrostomy tubes and stents, all patients had good preservation of renal function and normal loopograms.     

Current use of low-osmolality contrast agents: results of a survey

Members of the Society of Cardiovascular and Interventional Radiology and the Society of Uroradiology were surveyed to assess both current practice and determinants of use of low-osmolality contrast agents (LOCA). Of 715 questionnaires mailed, 229 were returned (32%). Many indicated that the responses referred to the practice of a group, rather than to an individual. Two thirds of the responses indicated that the choice of agent was made by the radiologist alone; one third shared the decision with administrators. Approximately 40% of respondents use written guidelines, but this percentage was higher when administrators were involved in the decision. Almost all (99%) obtained written informed consent--one third for all procedures that use contrast material and two thirds for angiographic studies only. Four percent noted the availability of LOCA in obtaining consent. Overall, LOCA were used for most angiographic procedures by 38% and for most IV studies by only 9% of respondents. All used them for at least some angiographic studies, and all but 2% used them for some IV studies. The major indications for use in both angiographic and IV studies were a prior major (but not minor) reaction and renal dysfunction. Anticipated patient discomfort also was important for intraarterial use. LOCA were used most often for peripheral and pulmonary arteriography. When LOCA were used, nonionic agents were preferred to low-osmolality ionic dimeric contrast agents for coronary angiography and venography, but this preference was essentially reversed for peripheral arteriography. This survey suggests that IV use of LOCA is much less frequent than intraarterial use and that use is individualized to certain risk factors and certain examinations. Guidelines for use are often in place, but this is clearly not universal. The importance of informed consent for use of contrast agents and of the appropriate role for LOCA remains unsettled.     

Observations on the ultrastructure and function of the so-called “microfold” or “membraneous” cells (M cells) by means of peroxidase as a tracer

Summary 79 NMRI mice and Wistar rats were used for ultrastructural investigations of the sequential uptake of horseradish peroxidase (HRP) by M cells. In addition the ultrastructure of the so-called tuft-cells was reported.HRP, a foreign protein antigen, was applied either by injection (Owen 1977), or by stomach tube. After variable exposure times (5 min to 3 h) segments of the distal small intestine, containing Peyer's patches, mesenteric lymph nodes and liver tissue were removed. After fixation, they were reacted with H₂O₂-3,3-diaminobenzidine tetrachloride and were examined by light and electron microscopy for HRP reaction products. The uptake of HRP mainly occurs through the M cells in the dome epithelium of Peyer's patches with a continual transport of the antigenic material into lymphoid cells, macrophages, and dendritic reticulum cells. In the 3 h specimens a few single HRP-positive lymphoid cells can be observed within the efferent lymphatics of Peyer's patches. In addition, a continual uptake of HRP by necrobiotic enterocytes was observed. It has also been shown that after 3 h HRP is located inside the Kupffer cells of the liver. These findings also support the presumption that antigenic material can be transmitted via the portal circulation. However, definite, quantitatively and permanently recorded uptake of HRP by brush border cells was not be observed.To exclude a toxic effect of the applied HRP on the enterocytic epithelium additional resorptive-physiological investigations were performed using the in vivo-perfusion-recirculation method and in vitro-accumulation of L-phenylalanine.This study was supported by a grant from Deutsche Forschungsgemeinschaft (Ot 53/4-6)