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11.
12.
Boerhaave’s syndrome: Primary repair vs. esophageal resection—Case reports and meta-analysis of the literature 总被引:3,自引:0,他引:3
Otto Kollmar M.D. Werner Lindemann M.D. Sven Richter M.D. Ingo Steffen M.D. Georg Pistorius M.D. Martin K. Schilling M.D. 《Journal of gastrointestinal surgery》2003,7(6):726-734
Boerhaave’s syndrome is a life-threatening disease with a high mortality. With regard to the heterogeneity of treatment strategies,
no comparative studies exist and recommendations remain controversial. Seventeen cases of Boerhaave’s syndrome operated on
between 1989 and 2000 at our hospital were reviewed retrospectively to compare the time period between perforation and diagnosis,
and the morbidity and mortality among the different treatment options. In addition, we conducted a meta-analysis of the literature
including all series containing five or more patients and compared the findings with our own data. Our patients with a perforation
history of less than 12 hours showed significantly fewer signs of sepsis compared to patients with a history of more than
12 hours. In a comparison of patients with primary repair vs. patients treated with esophageal resection or an exclusion operation,
no differences were found. In the literature, patients with a long period of perforation (more than 24 hours) were treated
more often with an esophageal resection than patients with primary repair. In cases of Boerhaave’s syndrome, primary suturing
of the esophageal perforation should be reserved only for those patients presenting within 12 hours after perforation. In
all other cases, depending on the extent of the tissue damage, a two-stage esophageal resection with cervical esophagostomy
and gastrostomy is recommended as the safest treatment. 相似文献
13.
Helmut Seidel Barbara Harazin Kristina Pavlas Christine Sroka Jörg Richter Ralph Blüthner Udo Erdmann Jan Grzesik Barbara Hinz Reinhard Rothe 《International archives of occupational and environmental health》1988,61(1-2):95-106
Summary This study was carried out in order: (1) to examine the effects of isolated and combined prolonged exposures to noise and whole-body vibration on hearing, vision and subjectively experienced strain, and (2) to check the combined effects with repeated exposures. Six male subjects were exposed twice to noise (N) at 92 dBA, whole-body vibration (V) in the Z-axis at 4 Hz and 1.0 ms–2 rms, and noise and vibration (NV) for 90 min with each condition. Temporary threshold shifts of hearing (TTS) and their integrals (ITTS) were measured at 4, 6, 10, and 12 kHz. Visual acuity was examined by means of a very sensitive test. Cross-modality matching (CMM) of the handgrip force was used to judge the subjectively experienced strain. NV induced a clear tendency of higher TTS and ITTS than N, with several significant differences most pronounced at 10 kHz. With repeated exposures, the effect of NV decreased, while the reactions to N and V remained unchanged. The individual reactions to NV differed. The influence of the duration of exposures on vision depended on the condition; N caused time-dependent changes, whereas V did not. CMM-data increased with the duration of the exposure during V and NV. N was generally judged to be more straining than V; NV caused higher strain than V during the first 30 min of exposure only. Correlations between different effects suggest certain links between them. Additionally, less motivation — daily obtained by a questionnaire — often correlated with higher ITTS during N and NV. The results also illustrate the combined effects on the individual susceptibility, repetition of exposure, the kind of response, and, possibly, the actual psychic state.Abbreviations CMM
cross-modality matching
- MVC
maximum voluntary contraction force
- N
exposure condition: noise level 92dBA, no whole-body vibration
- NV
exposure condition: combined exposure to noise with a level of 92 dBA and wholebody vibration with 4 Hz, 1 ms–2 rms
- V
exposure condition: whole-body vibration with 4 Hz, 1 ms–2 rms
- TTS
temporary threshold shift
- ITTS
integral of temporary threshold shift
- WBV
whole-body vibration in the common sense
This work was done in the Temporary International Research Team on Combined Effects of Noise and Vibration of the Council of Mutual Economic Assistance of the Socialist Countries. The authors gratefully acknowledge the help and assistance of L.-M. Brumm, Y. Bening, M. Godau, G. Weber, and R. Vizcaino. 相似文献
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15.
Mycobacterium fortuitum NRRL B-8119 transformes sterols into 9 alpha-hydroxy-androsta-4-ene-3,17-dione (9OH-AD) at high efficieny. Cells strongly aggregate to the surface of the sterol particles forming stable agglomerates (“substrate immobilized cells”). Substrate uptake and product formation were studied as function of the size of the sterol particles. Using particle sizes comparable with the size of the mycobacterial cells (> 5μm) highest rates were found for both the substrate uptake and the product formation. After mechanical reinforcement of the contact between mycobacterial cells and the sterol substrate by co-grinding of the components, a significantly increased product formation was observed. Associated cells and cell-sterol agglomerates were investigated by freeze-fracture electron microscopy. The micrographs obtained demonstrate that cells of M. fortuitum are growing into the sterol microcrystallite. The uptake of the sterol substrate is assumed to take place via direct contact between cells and the substrate particles. To understand the transport mechanism a model is proposed that includes a flexible multicomponent mesophase (FMCM) which is placed between cells and particles and which mediates the sterol uptake. The putative FMCM is assumed to be composed of mycobacterial glycolipids, extracellular biolipids, synthetical detergents, sterol and water. 相似文献
16.
Treatment of a juvenile patient with a maxillary all-ceramic resin-bonded fixed partial denture: a case report. 总被引:1,自引:0,他引:1
Dietmar Weng Stefan Ries Ernst-Jürgen Richter 《Quintessence international, dental digest》2002,33(8):584-588
Treatment of juvenile patients with a missing maxillary incisor is difficult, because an implant cannot be placed until growth is completed. The other minimally invasive alternatives are also problematic: Removable dentures are rarely accepted by juvenile patients, and the conventional resin-bonded fixed partial denture often provides a poor esthetic result because the metal retainer causes the abutment teeth to lose their natural translucency and to become grayish. Moreover, the alveolar ridge defect makes it easy to identify the prosthesis in the pontic area. The present case report describes the prosthetic treatment of a juvenile patient who had lost a maxillary incisor to trauma. To avoid the disadvantages of conventional therapies, subepithelial connective tissue was grafted to reshape the alveolar ridge. The space was closed with an all-ceramic resin-bonded fixed partial denture. 相似文献
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18.
We present a new concept after Schultheis which is based on the results of experimental studies on cell cultures. Local chemoembolization in liver tumours including liver metastases is usually performed via the angiographic route. Embolisation of the most peripheral branches of the hepatic artery prevents early formation of collateral vessels. The method also comprises the additional infusion of cytostatic agents via the portal vein. The procedure is usually repeated after an interval of about four weeks. In this paper we will describe our method in liver metastases and present the preliminary results obtained from 19 patients treated to date. 相似文献
19.
20.
Dystonia is a common movement disorder which is thought to represent a disease of the basal ganglia. However, the pathogenesis of the idiopathic dystonias, i.e. the neuroanatomic and neurochemical basis, is still a mystery. Research in dystonia is complicated by the existence of various phenotypic and genotypic subtypes of idiopathic dystonia, probably related to heterogeneous dysfunctions.In neurological diseases in which no obvious neuronal degeneration can be found, such as in idiopathic dystonia, the identification of a primary defect is difficult, because of the large number of chemically distinct, but functionally interrelated, neurotransmitter systems in the brain.The variable response to pharmacological agents in patients with idiopathic dystonia supports the notion that the underlying biochemical dysfunctions vary in the subtypes of idiopathic dystonia. Hence, in basic research it is important to clearly define the involved type of dystonia.Animal models of dystonias were described as limited. However, over the last years, there has been considerable progress in the evaluation of animal models for different types of dystonia.Apart from animal models of symptomatic dystonia, genetic animal models with inherited dystonia which occurs in the absence of pathomorphological alterations in brain and spinal cord are described.This review will focus mainly on genetic animal models of different idiopathic dystonias and pathophysiological findings. In particular, in the case of the mutant dystonic (dt) rat, a model of generalized dystonia, and in the case of the genetically dystonic hamster (dtsz), a model of paroxysmal dystonic choreoathetosis has been used, as these show great promise in contributing to the identification of underlying mechanisms in idiopathic dystonias, although even a proper animal model will probably never be equivalent to a human disease.Several pathophysiological findings from animal models are in line with clinical observations in dystonic patients, indicating abnormalities not only in the basal ganglia and thalamic nuclei, but also in the cerebellum and brainstem. Through clinical studies and neurochemical data several similarities were found in the genetic animal models, although the current data indicates different defects in dystonic animals which is consistent with the notion that dystonia is a heterogenous disorder.Different supraspinal dysfunctions appear to lead to manifestation of dystonic movements and postures. In addition to increasing our understanding of the pathophysiology of idiopathic dystonia, animal models may help to improve therapeutic strategies for this movement disorder. 相似文献