128. Ketakutät und Komplikationen bei Leberrupturen

Zusammenfassung Klinische Erfahrungen mit 44 Verbundosteosynthesen, davon bei 41 Femurfrakturen zeigten, daß es in 11 Fallen zu frakturspezifischen Komplikationen wie Implantatbrüchen, Pseudarthrosen etc. kam. Die Ursache scheint in einer verzögerten Bruchheilung infolge Implantation des Knochenzementes in den Frakturbereich zu liegen. Die Indikation zur Verbundosteosynthese bleibt beschränkt auf pathologische Frakturen and auf Patienten in schlechtem Allgemeinzustand zur Verbesserung ihrer Pflegefähigkeit.     

Localization and detection of visual stimuli in monkeys with pulvinar lesions

Summary Since the pulvinar receives a major ascending projection of the superior colliculus, pulvinar lesions might produce behavioral impairments resembling those that follow colliculus lesions. To test this possibility, we examined the effect of pulvinar lesions in monkeys on the localization and detection of brief light flashes, a task in which monkeys with colliculus lesions are severely impaired. Some of the pulvinar-lesioned monkeys showed localization impairments similar to those in monkeys with colliculus lesions. However, histological analyses of the lesions suggested that these deficits were related not to the pulvinar damage per se, but rather to interruption of corticotectal fibers that pass through the pulvinar. We conclude that the pulvinar is not critical for the ability to locate and detect brief visual stimuli.Supported by research grants MH 26489 from the National Institute of Mental Health and EY02254 from the National Eye Institute     

Effects of kainic acid and radiofrequency lesions of the pulvinar on visual discrimination in the monkey

Monkeys with thermocoagulation or kainic acid lesions of the pulvinar and unoperated control monkeys were tested in two tasks: pattern discrimination retention and color discrimination learning in which the stimuli were located at the response sites or were separated spatially from them (S-R separation). The monkeys with kainic acid pulvinar lesions were mildly impaired in retention of the pattern discrimination, but were unimpaired in the color discrimination tasks with or without the S-R separation. The monkeys with thermocoagulation lesions, like monkeys with superior colliculus lesions in a prior study, were severely impaired in performing one of the color discrimination tasks with S-R separation. These findings suggest that: (a) the inferior pulvinar, unlike the superior colliculus, does not contribute to the performance of discriminations involving S-R separation; and (b) corticotectal projections traversing the pulvinar and destroyed by the thermocoagulation lesions are crucial to the performance of discriminations involving S-R separation. The results of an earlier experiment also suggested that interruption of corticotectal fibers passing through the pulvinar impairs performance in another task sensitive to superior colliculus lesions — spatial localization of light flashes. Thus, corticotectal projections may be crucial for the contribution of the colliculus to performance in a variety of visual tasks.     

Interventionelle Behandlung der Mitralklappeninsuffizienz mit dem MitraClip®-Verfahren

The interventional treatment of mitral valve regurgitation by the MitraClip® procedure has grown rapidly in Germany and Europe during the past years. Apparently, the MitraClip® procedure has the potential to treat high risk patients with secondary mitral valve regurgitation and poor left ventricular function. Furthermore, patients with primary mitral valve regurgitation may be treated successfully by the MitraClip® procedure in case of high surgical risk or advanced age. At the same time it has been emphasized that the MitraClip® interventional treatment is still at an early stage of clinical development. The largest clinical experience with the MitraClip® procedure so far is probably present in some German cardiovascular centers, which here summarize their recommendations on the current indications and procedural steps of the MitraClip® treatment. These recommendations of the AGIK and ALKK may present a basis for future development of interventional treatment of mitral valve regurgitation by the MitraClip® procedure.     

Improving left ventricular contraction by stimulation during the absolute refractory period. Cardiac contractility modulation

Cardiac contractility modulating (CCM) signals are nonexcitatory signals applied during the absolute refractory period and have been shown to enhance the strength of left ventricular contraction in studies performed in animals and humans with heart failure. In patients with congestive heart failure, improvement of exercise tolerance and quality of life have been shown. Recent studies from myocardial biopsies demonstrate that CCM treatment normalizes expression of many genes that are abnormally expressed in heart failure, including proteins involved with calcium cycling. These findings suggest that CCM might be an alternative or even additional electrical treatment option for patients with heart failure and normal QRS duration delivered by a pacemaker, e.g., a rechargeable device without any antibradycardiac or antitachycardiac function.     

The immunogenicity of a novel A (H1N1) vaccine in HIV-infected children

Background

In October 2009, the United Kingdom Department of Health recommended vaccination of high-risk groups, including children with HIV, with a novel, oil-in-water AS03_B adjuvanted Influenza A (H1N1) vaccine (Pandemrix™). There were no published data available regarding the immunogenicity of this vaccine in such children.

Objectives

This study evaluated the immunogenicity of the adjuvanted Influenza A (H1N1) vaccine in HIV-infected children immunised according to national recommendations and assessed the impact of vaccination on individual CD4 counts and HIV viral loads.

Methods

HIV-infected children attending outpatient appointments between 01 November and 31 December 2009 were offered two doses of H1N1 vaccine three weeks apart and a blood test before and 3 weeks after the second dose of vaccine. Serum antibody responses were determined by a haemagglutination inhibition (HAI) assay using standard methods.

Results

Of the 39 children recruited for vaccination, 31 (median age 11.2, range 3.0-17.9 years) received both doses of vaccine and provided pre- and post-vaccination blood samples. Eight children (26%) had baseline HAI titres ≥1:32. After vaccination, 29 children (94%, 95% CI, 78.6-99.2%) had HAI titres ≥1:32 (seroprotection), of whom 27 (87.1%, 95% CI, 70.1-96.4%) had also had a four-fold rise in titres (seroconversion). In the univariate analysis, post-vaccination geometric mean titres (GMTs) were higher among the 21 children receiving highly active anti-retroviral therapy compared with the 10 treatment-naïve children (GMT 406 [95% CI 218-757] vs. 128 [49-336]; P = 0.035), but this was no longer statistically significant when adjusted for prevaccine GMTs. There was no significant impact of vaccination on CD4+ T cell count or HIV viral load.

Conclusion

The AS03_B-adjuvanted pandemic Influenza A (H1N1) vaccine is highly immunogenic and appears to be safe in HIV-infected children.     

Intravascular misplacement of an extravascular closure system: StarClose

Closure devices for closing femoral arteries following catheterization procedures are routinely used. They reduce time of immobilization and decrease complications such as bleeding and aneurysm formation. We report of a new vascular closure device (StarClose, marketed by Abbott) that was misplaced in the femoral artery with subsequent vascular stenosis and need for surgical removal and plastic reconstruction.     

Evolution of graft morphology and function after recellularization of decellularized rat livers

Decellularization of livers is a well‐established procedure. Data on different reseeding techniques or the functional evolution and reorganization processes of repopulated grafts remains limited. A proprietary, customized bioreactor was established to repopulate decellularized rat livers (n = 21) with primary rat hepatocytes (150 × 10⁶ cells) via the hepatic artery and to subsequently evaluate graft morphology and function during 7 days of ex vivo perfusion. Grafts were analysed at 1 h, 6 h, 12 h, 24 h, 3 days, 5 days and 7 days after recellularization (all n = 3) by immunohistological evaluation, hepatocyte‐related enzyme (aspartate transaminase, alanine transaminase and lactate dehydrogenase) and albumin measurement in the perfusate. This appears to be the first available protocol for repopulation of rat livers via the hepatic artery. Within the first 24 h after repopulation, the hepatocytes seemed to migrate out of the vascular network and form clusters in the parenchymal space around the vessels. Graft function increased for the first 24 h after repopulation with a significantly higher function compared to standard two‐dimensional culture after 24 h. Thereafter, graft function constantly decreased with significantly lower values after 6 days and 7 days of perfusion, although histologically viable hepatocytes were found even after this period. The data suggests that, owing to a constant loss of function, repopulated grafts should potentially be implanted as soon as cell engraftment and graft re‐organization are completed. Copyright © 2016 John Wiley & Sons, Ltd.