Contrôle de l’équilibre et port unilatéral d’une orthèse rigide de cheville. Partie I : effets sur des sujets sains évalués debout en unipédie

In order to assess the effects induced by wearing a rigid ankle orthosis, 14 healthy adults, without traumatic previous injuries at this level, were tested in a one-legged postural task. The subjects stood upright on a force platform and were required to remain still, eyes open. Ten trials lasting 32 s were recorded in a random order in two conditions: with a rigid orthosis model worn at the ankle level of the supporting leg (Thuasne, Ligastrap Immo^®) and with an elastic stocking. Balance strategies have been quantified by studying the centre of pressure (CP) trajectories, that is, the successive positions of the resultant reaction forces, and processed through a frequency analysis. The results indicate that slight decreases occur for the CP displacements intervening along the medio-lateral axis whereas statistically significant trends were found for those intervening along the anteroposterior one. This finding a priori suggests that wearing a rigid orthosis affects one-legged standing in healthy individuals but mainly along an axis not usually weakened by sprained ankles.     

Fehldiagnosen in der Gastroenterologie

Zum Thema Genaue Daten zu Art, H?ufigkeit sowie den medizinischen und sozio?konomischen Konsequenzen von Fehldiagnosen in der Gastroenterologie liegen nicht vor. Wie auch für die anderen Bereiche der Inneren Medizin ist jedoch zu vermuten, dass eine unvollst?ndige Anamnese, Fehler in der klinischen Erfassung der k?rperlichen Befunde, in diagnostischen Verfahren der Bildgebung, Labor- und Funktionsdiagnostik sowie der histologischen Beurteilung relevante Fehlerquellen darstellen. über diese vermeidbaren Fehler hinaus tragen trotz des raschen Fortschritts in der Medizin vorhandene Limitationen in unserem Verst?ndnis gastrointestinaler Erkrankungen, ihrer Klassifikation, Ursachen und Diagnostik durch ein unvollst?ndiges Erfassen von Erkrankungen und eine fehlerhafte Befundinterpretation zu Fehldiagnosen bei. Aus der Vielzahl gastroenterologischer Erkrankungen haben wir einige Krankheitsbilder zusammengestellt, bei denen Fehldiagnosen, die wir wegen ihrer H?ufigkeit oder Schwere für klinisch bedeutsam halten, aufgrund von Schwierigkeiten in der Differenzialdiagnose besonders leicht entstehen k?nnen.     

356. Die endoskopische subfasciale Discision der Perforansvenen (ESDP)

Zusammenfassung Der Ausschaltung insuffizienter Perforansvenen kommt bei der Behandlung der chronisch-venösen Insuffizienz und des venösen Ulcus cruris eine zentrale Bedeutung zu. Schwierigkeiten in der Lokalisationsdiagnostik und Wundheilungsstörungen beeinträchtigen den Erfolg bisher bekannter Therapieverfahren. Unsere Operationstechnik der ESDP ermöglicht dagegen eine sichere subfasciale Auffindung und selektive Durchtrennung der insuffizienten Perforansvenen. Es werden die Operationsschritte der ESDP und ihre anatomischen Grundlagen dargestellt. Mit Fallbeispielen wird der Erfolg des seit 1982 an 270 Patienten angewandten Operationsverfahrens belegt.     

Ex-vivo investigations on endoluminal laser therapy of varicosis – An optimization process

ObjectiveThis study was performed to compare the acute effects of different endoluminal heating procedures, by which obstruction of insufficient veins could be induced in an established standardized experimental ex-vivo model.MethodsThe model consists of the subcutaneous foot vein from recently slaughtered cows. Different energy sources (laser and radiofrequency), application devices and energy application parameters were compared in an iterative optimizing process. Following energy application the vein tissue was harvested and prepared for histology.ResultsBy means of the developed ex-vivo model reproducible conditions for the application of endoluminal thermal energy were enabled in each specimen. Radiofrequency-treated veins showed macroscopic shrinkage, contraction of vessels and induration of tissue. Histologically a circumferential and homogenous thickening of the vessel wall could be described. Dependent on the laser treatment protocol, in-situ dissection of the treated veins showed a broad spectrum of effects. These effects ranged from blood deposits in perivascular tissue and perivascular thermal lesions to transmural coagulated vein tissue inducing obstruction of the lumen.ConclusionThis standardized model is applicable to investigate acute effects of endoluminal treatment protocols. Changes in the protocol could be easily performed and investigated in order to develop optimized treatment protocols. These ex-vivo experiments indicate that endovenous laser treatment should be modified and needs treatment standardization to ensure a controlled homogenous circumferential thermal damage.     

鼠脑出血后海马内皮素-1变化与脑出血继发性损伤

目的:研究脑出血后脑内内皮素(ET-1)表达与脑出血灶周围组织水肿之间的关系。方法:采用脑内注射胶原酶建立大鼠脑出血模型,SD大鼠30只单纯随机分为注射胶原酶4,24,48,72h组及假手术组,通过免疫组化、彩色病理图像分析系统及干湿法观察脑出血后海马ET-1表达和脑出血灶周围脑组织水含量。结果:给大鼠尾壳核注射胶原酶0.5IU,4h后即可见直径约2.5mm的血肿,脑水含量即明显升高,24h达高峰;与此同时脑出血后4h海马CA1犤(37.6±7.3)个/切片犦、CA3区犤(41.3±3.7)个/切片犦的阳性细胞数较假手术组犤(18.3±4.0),(27.1±4.3)个/切片犦明显增加,24h犤(75.8±6.6),(88.4±9.6)个/切片犦最为显著,阳性细胞数及平均截面积除72h组外,明显高于对照组,均有统计学的显著性意义(t=2.306～5×106,P<0.01或P<0.05),72h后阳性细胞数已逐渐接近正常。结论:大鼠脑出血后脑内ET-1过度表达可能是血肿周围存在水肿和继发性缺血的重要因素之一。     

Embolization of vascular malformations

Often vascular malformations (VMs) can only be treated by multiple modalities. Alongside surgical interventions and laser therapy, embolization and sclerotherapy of such lesions have become mainstays of clinical management and sometimes represent the sole option for treating acute and life-threatening hemorrhages. In a total of 315 sessions, we embolized 133 patients with VMs of non-cerebral origin. Primary focus was placed on arteriovenous malformations (AVM). The outcome was classified as successful only when we were able to embolize the shunt level. For this purpose, liquid embolizing and sclerosing agents were applied alone or in combination with particle suspensions. Recurrence rates, especially for maxillofacial malformations, were dependent on disease spread, pretreatment status and patient age, and proved high overall. In practical terms, it was not possible to completely or permanently eliminate AVMs which had been long-standing or had received pretreatment by unsuitable methods. Embolization represents an indispensable part of every overall therapeutic concept for VM management. Acute hemorrhages are manageable in nearly all cases; in selected disease processes, a cure can be accomplished by embolization alone.