Zur operativen Behandlung der Trichterbrust nach Brunner

Zusammenfassung Während die reinen Lösungsverfahren nur im Kleinkindesalter erfolgversprechend sind, werden heute im Adoleszentenalter vorwiegend die sog. Extensionsverfahren geübt. Die Resektionsmethoden sind weitgehend verlassen. Die freie Transplantation des resezierten Trichters nach Drehung um 180° stellt einen recht erheblichen Eingriff dar, der bisweilen mit der Gefahr der Sternumnekrose und möglicherweise auch mit einer Störung der Hämatopoese im Sternalmark belastet ist. Die sog. gestielte Umwendplastik nach Jung vermeidet zwar die Nerkosegefahr, ohne aber den Eingriff zu verkleinern. Diese Methode dürfte nur für ganz wenige Fälle mit ganz exorbitanter Trichterbildung vorbehalten sein. Uns scheint auch bei hochgradigen Trichterbrustdeformitäten die von Brunner angegebene Technik die eleganteste zu sein, weil sie bei gutem Aufrichtungsergebnis die geringste Belastung für den Patienten darstellt.Mit 4 Textabbildungen (8 Einzelbilder)Meinem Vater zum 80. Geburtstag.     

Quantitative structure-activity relationship of 5-(X-benzyl)-2,4-diaminopyrimidines inhibiting bovine liver dihydrofolate reductase.

The inhibitory effect for a set of 23 5-(X-benzyl)-2,4-diaminopyrimidines acting on bovine liver dihydrofolate reductase (DHFR) had led to the following quantitative structure-activity relationship (QSAR): log 1/C = 0.62pi3 + 0.33epsilon sigma + 4.99, where r = 0.931 and s = 0.146. C in this expression is the molar concentration of inhibitor producing 50% inhibition, pi3 is the hydrophobic parameter for substituents on the 3 position of the phenyl moiety, and epsilon sigma is the the sum of the Hammett sigma constants for the 3, 4, and 5 substituents of the phenyl ring.     

Toxikologische untersuchungen über triphenylphosphat,trixylenylphosphate und triarylphosphate aus mischungen homologer phenole

Zusammenfassung Untersuchungen an Hühnern und Katzen dienten der weiteren Aufklärung von Struktur-Wirkung-Beziehungen bei Triarylphosphaten, nachdem früher gezeigt worden war, daß beim Trikresylphosphat das Ausmaß der charakteristischen Lähmungen in bestimmter Weise vom Orthokresolgehalt abhängt.Technische Triarylphosphate, deren Aromatenanteil ganz oder teilweise aus Phenol und/oder Xylenolen besteht, wirken paralytisch, wenn sie noch Orthokresyl enthalten. Wahrscheinlich können aber auch Xylenylreste mit orthoständigen Methylgruppen ähnliche Effekte erzeugen, da reine Triester aus 2,3- und 2,4-Dimethylphenol noch schwach lähmen und technische Mischtriarylphosphate mit rund 1,5% Orthokresol gleich stark wirken wie Trikresylphosphate mit rund 3% Orthokresol.Die Wirkung von Triphenylphosphat beim Menschen ist direkt nicht bekannt und kann aus Tierversuchen z. Z. nicht beurteilt werden; enthalten technische Präparate aber Orthokresyl, so ist Lähmungswirkung im Prinzip noch möglich.Pyrophosphorsäureester sind sehr wahrscheinlich an der paralytischen Wirkung von technischen Triarylphosphaten nicht beteiligt. Tetraorthokresylpyrophosphat ist ein ähnliches Parasympathicomimeticum wieTetraäthylpyrophosphat (TEPP), erzeugt aber bei Hühnern keine Lähmungen.     

Proctalgia Fugax in Patients with the Irritable Bowel, Peptic Ulcer, or Inflammatory Bowel Disease

One hundred forty-eight patients with gastrointestinal disease, 50 patients with the irritable bowel syndrome (IBS) and 49 each with peptic ulcer and inflammatory bowel disease, were interviewed to determine if they had proctalgia fugax (PF) and if the symptom was associated with the IBS. One-third of the patients had PF. It occurred in 51% of females and 12% of males (p less than 0.001). When corrected for sex, PF was no more prevalent in IBS than in peptic ulcer or inflammatory bowel disease. Only two of six previously described IBS symptoms were more prevalent in the PF patients. Attacks occurred in the day in 94%, and one-third of sufferers related them to defecation. The pain was localized in the anus in 90%, occurred less than five times a year in 51%, and lasted less than 1 min in 57%. In most, activity was not interrupted by this pain and only 20% had ever reported it to a physician. PF is very common among patients with abdominal symptoms, but is not related to the IBS. Since it is infrequent, benign, and transient, PF is usually not mentioned to the physician.     

Endoluminal stent graft repair for acute and chronic type B aortic dissection and atherosclerotic aneurysm of the thoracic aorta: an interdisciplinary task

Objective: Endoluminal thoracic aortic stenting is a new therapeutic tool in reducing the operative trauma of the patient. However, the inherent risks of aortic stent grafting are perivascular leakage, stent dislocation, blunt rupture of the aorta, side branch occlusion and neurological sequelae. To reduce these risks, in our institution all stent implantations were performed in close collaboration with our fellow cardiologists under biplane X-ray control supported by simultaneous intravascular and transoesophageal ultrasound imaging. Methods: Between August 1999 and August 2001, endovascular stent graft repair was performed in 34 patients (27 male, seven female) with a mean age of 68.6±7 years (range 58–84). Indication for treatment was an acute Type B aortic dissection in six patients (18%), a symptomatic chronic Type B dissection in 12 patients (35%), a true aneurysm of the descending aorta in seven patients (21%) and an atherosclerotic contained rupture of the descending aorta in nine (26%) patients. Out of six acute type B dissections three patients (8.8%) and one patient (2.9%) out of the chronic dissection group were in severe haemorrhagic shock, ventilated and required high-dose adrenergic support. The others (30 patients, 88.3%) remained symptomatic despite maximum medical treatment. In a special case a combined surgical and endoluminal stent graft repair was performed. Individually manufactured Talent, Medtronic AVE (33), and Gore (1) stents were used. Follow-up examination was performed 1 week after implantation and repeated every 3 months (mean follow-up 8 months, range 1–24). Results: In all patients the aneurysm or the entry of the dissection could be excluded. The observed hospital mortality was 2.9% (one patient). No perivascular leakage, no stent dislocation, no neurological deficit or perfusion impairment was observed. All patients except four were extubated immediately after the procedure and discharged from hospital on postoperative day 2–3. The late procedure-related mortality was 5.8% (two patients) resulting in an overall mortality of 8.8% (three patients). Conclusion: Stent graft repair is a safe and feasible treatment option for selected patients, especially in emergency situations, if the aortic lesions can be clearly identified and localized. The use of biplane X-ray control combined with simultaneous intravascular and transoesophageal ultrasound imaging in an interdisciplinary approach enables a more precise targeting of the stent landing zone, resulting in low morbidity and mortality rates.     

Afferents to the cerebellar cortex of turtles studied by means of the horseradish peroxidase technique

Summary Origins of afferents to the cerebellar cortex from the brainstem were explored in turtles by means of the horseradish peroxidase (HRP) technique. Following relatively large injections involving all cortical layers, HRP label was observed in neural perikarya of the following structures: 1) contralateral reticular formation just lateral and ventral to the hypoglossal nucleus; 2) a few cells in the central gray of the cervical spinal cord; 3) neurons scattered in the dorsolateral, ventromedial and descending vestibular nuclei, mainly ipsilaterally; 4) a few solitary cells in the mesencephalic and medulalry tegmentum; 5) the nucleus isthmi magnocellularis caudalis on the ipsilateral side; 6) a group of small cells in the isthmic tectum; 7) the ipsilateral nucleus of the optic tract; 8) a prominent group of small cells in the isthmic region just rostral to the vestibular complex ipsilaterally. Most of these cells were localized within the so called nuclei gustatorius secundarius,-lemnisci lateralis and-isthmi parvocellularis. This parvocellular isthmic complex (PIC) was the only region containing labelled cells when small injections restricted to the molecular layer were achieved. We interpret the PIC as a source of climbing fibers, possibly corresponding to the mammalian inferior olive which migrates from the alar plate to its' ventral destination during ontogenesis. Connecting axons were sometimes homogeneously stained which permitted the tracing of connecting pathways. Contorted axon branches stained by anterograde HRP transport were found concentrated in cerebellar and superior vestibular nuclei and sparsely distributed in other vestibular nuclei.     

The significance of increased echogenicity in the detection and differentiation of pediatric disease

Increased renal echogenicity, by ultrasonography, is seen in various pathological conditions. Correlation of renal size with the pattern and distribution of the increased echogenicity, and the patient's age and clinical data will limit the differential diagnosis and suggest the appropriate radiographic follow-up studies, obviating the need for unnecessary procedures.