Zur Frage der operativen Behandlung der Tuberkulose der grofsen Gelenke der Extremitäten und speziell der Resektion derselben

Ohne Zusammenfassung (Mit 11 Abbildungen und 6 Skizzen.)     

Über den Mechanismus der Darmberstung unter der Wirkung der Bauchpresse

Ohne Zusammenfassung (Mit 4 Abbildungen.)     

Klinische Wertigkeit der Rekonstruktionsverfahren der 3D-CT-Angiographie in der Gefäßdiagnostik

Technological advances in spiral CT scanners and their workstations have changed the common perception of computed tomography in vessel imaging. The less invasive character of CTA examination compared to intraarterial DSA can transform this method into the which is viable clinically to increase diagnostic utility. However, the 2D axial images do not optimally communicate the 3D nature of the anatomy and pathology involved. The option to render 3D angiogram-like images can be combined with the diagnostic exploitation of the volume data information. The choice of the rendering technique to create 3D images from the data set greatly affects the quality and efficacy of CTA data. The commonly used rendering techniques are surface shaded display (SSD) and maximum intensity projection (MIP). Volume rendering (VR) as a relatively new modality may have the potential to replace the other rendering techniques. For critical image evaluation it is important to know the basic principles, advantages, disadvantages and limitations of these algorithms.     

Ästhetische Gesichtspunkte der Chirurgie der Fingerendglieder

Ohne Zusammenfassung     

Lageveränderungen der rechten Niere in der Differentialdiagnose der chronisch-rezidivierenden Appendicitis

Ohne Zusammenfassung Mit 1 Textabbildung in 3 Einzeldarstellungen     

Zur Mechanik der Ringbrüche der Schädelbasis und der Verletzungen der oberen Halswirbelsäule

Zusammenfassung Bei Ringbrüchen der Schädelbasis kann es sich um Impressions- oder Traktionsfrakturen handeln. Impressionsfrakturen können beim Fall aus der Höhe und Aufschlag auf die Beine oder das Gesäß, Gewalteinwirkungen gegen die Scheitelgegend aber auch bei solchen gegen die Schädelbasis eintreten. Traktionsfrakturen sind die Folge einer Schleuderung des Kopfes nach hinten oben (Beugung und Zerrung) und können bei Gewalteinwirkungen gegen das Gesicht oder gegen den Rumpf, hier besonders gegen den Rücken, auftreten. Die Unterscheidung, ob eine Impressions- oder eine Traktionsfraktur vorliegt, wird nach dem Verhalten der Bruchkanten (Knochenquerschnitt) getroffen. Nach Gewalteinwirkungen gegen den Rücken, aber auch von der Seite gegen den Rumpf kann es zu einem Abriß des Bandapparates zwischen Hinterhaupt und den oberen Halswirbeln kommen, ohne daß Frakturen an der Insertionsstelle der Bänder aufzutreten brauchen. Abrisse des Dens epistrophei als indirekte Verletzungen treten vorzugsweise bei seitlich oder von hinten seitlich gegen den Körper ansetzenden Traumata auf. Rupturen der basalen Hirnarterien brauchen sich nicht in der Umgebung des Skeletschadens zu finden, sondern können durch Fortleitung der Zugwirkung auch an anderen Stellen hervorgerufen werden. Ein Locus minoris resistentiae gegenüber kräftigen Zerrungen ist der Übergang von der Pons zur Medulla oblongata.Mit 7 Textabbildungen (13 Einzelbilder)     

Grundlagen und Probleme der intertrochanteren Adduktions-Detorsionsosteotomie bei der Behandlung der Hüftdysplasie

Ohne ZusammenfassungMit 10 Textabbildungen (20 Einzelbilder)Herrn Professor Dr. G. A. Wollenberg zum 85. und Herrn Professor Dr. M. Brandes zum 80. Geburtstag gewidmet.     

Qualitätsmanagement aus der Sicht der Krankenhausleitung

Background

Within the framework of patient care quality assurance and therefore quality management are of decisive significance. In this context it is questionable whether quality management has the same importance for all players.

Quality management

In contrast to medical and nursing personnel who are more concerned with the perspective of the discipline with the aim of therapeutic validation with full responsibility for quality, the perspective of the hospital management is more comprehensive and includes the complete hospital, the system. The management perspective is therefore correspondingly different.

Problem

The different perspectives often lead to misunderstandings, for example between department heads and hospital management. The frequently observed lack of willingness to accept change also leads to tension between system (hospital management) and faculty management (medical and nursing personnel) and reduces performance, even for the quality management.

Conclusion

By the implementation of integratively effective multiprofessional hospital performance management (HPM) the quality management can be improved. Medical and nursing personnel should also be actively involved in the optimization as this problem can only be solved in an interdisciplinary and multiprofessional manner and also results in changes in internal behavior which in turn have an effect on the quality of results in hospitals.     

Anwendungsmöglichkeiten der Bisphosphonate in der Endoprothetik

The use of bisphosphonates in joint arthroplasty is the latest field of application for these agents. The mechanism of action of bisphosphonates suggests that they may optimize long-term survival of the implant. Most important is their potency in suppressing periprosthetic osteolysis due to the inflammatory foreign body reaction of wear debris, to decrease periprosthetic osteopenia caused by stress-shielding and to improve the osseointegration of cementless metal implants. The present review provides the latest information on definite and presumed mechanisms of action of bisphosphonates and their clinical importance.     

Zur Frage der Entstehung der Gelenkmäuse

Ohne Zusammenfassung     

Ergebnisse der chirurgischen Behandlung der Lungenabszesse mit besonderer Berücksichtigung der Paraffinplombe

Ohne Zusammenfassung     

Rolle der löslichen Guanylatzyklase im Modell der Herztransplantation in der Ratte

It is known that the nitric oxide (NO)/soluble guanylate cyclase (sGC)/cyclic-GMP pathway is an important key mechanism to protect the heart from ischemia/reperfusion injury; however, this pathway is disrupted in several cardiovascular diseases as a result of decreased NO bioavailability and increased NO-insensitive forms of sGC. Cinaciguat preferentially activates these NO-insensitive, oxidized forms of sGC. We assessed the hypothesis that targeting NO-unresponsive sGC would protect the graft against ischemia/reperfusion injury in a rat heart transplantation model. Prior to explantation, the donor Lewis rats received methylcellulose (1?%) vehicle or cinaciguat 10 mg/kg body weight. The hearts were excised, stored in cold preservation solution and heterotopically transplanted. We evaluated in vivo left ventricular (LV) function of the graft. After transplantation, decreased LV systolic pressure (77 ± 3 vs. 123 ± 13 mmHg, p < 0.05), dP/dt_max (1703 ± 162 vs. 3350 ± 444 mmHg, p < 0.05) and dP/dt_min (995 ± 110 vs. 1925 ± 332 mmHg, p < 0.05) were significantly increased by cinaciguat. Coronary blood flow was significantly higher in the cinaciguat group compared with the control group. Additionally, cinaciguat increased ATP levels (1.9 ± 0.4 vs. 6.6 ± 0.8 µmol/g, p < 0.05) and improved energy charge potential. After transplantation, increased c?jun mRNA expression was downregulated, whereas superoxide dismutase-1 and cytochrome C oxidase mRNA levels were upregulated by cinaciguat. Cinaciguat also significantly decreased myocardial DNA strand breaks induced by ischemia/reperfusion during transplantation and reduced cardiomyocyte death in a cellular model of oxidative stress. By interacting with NO-unresponsive sGC, cinaciguat enhances the protective effects of the NO-cGMP pathway at different steps of signal transduction after global myocardial ischemia/reperfusion. Its clinical use as preconditioning agent could be a novel approach in cardiac surgery.     

Übergewicht in der Ätiologie der Gonarthrose

Problem

Osteoarthritis of the knee joint is one of the important and highly functionally impairing diseases of the musculoskeletal system in adults. The spectrum of causes of knee arthritis is broad. Obesity is one of the main causes in the etiology of osteoarthritis of the knee. In particular, knowledge of the cause and effect relationship between obesity and knee osteoarthritis are important in the assessment of claims of occupational disease BK 2112 (knee osteoarthritis due to long-term kneeing).

Objective and methods

This article is based on a literature review of cohort studies with regard to the question whether obesity is a risk factor in the etiology of osteoarthritis of the knee.

Results

A total of 26 cohort studies were identified. Based on the proven cohort studies it can be shown that a significant association exists between obesity and physical occurrence of osteoarthritis of the knee joint. Compared with normal weight subjects the risk of occurrence of the disease is doubled in obese subjects per category of overweight (overweight 25-30 kg/m², obese over 30 kg/m²). A dose-response relationship with respect to the degree of obesity is clearly demonstrated.

Conclusion

Obesity plays a significant role in the etiology of primary osteoarthritis of the knee joint.

     

Veränderungen der Muskarinrezeptoren der alternden Harnblase

The prevalence of the overactive bladder syndrome (OAB) increases with age. Unfortunately, treatment of the condition is still unsatisfactory. Since muscarinic receptor antagonists are the only effective drug treatment to date, it is logical to assume that muscarinic receptors play an important role in the pathogenesis of OAB. Muscarinic receptors are involved in both the normal and overactive detrusor contraction, and age-dependent changes in muscarinic receptor functions have been found in both animals and human detrusors. In animals as well as humans, two components of detrusor contraction have been demonstrated, the dominating one mediated by muscarinic receptors and the other by ATP (atropine-resistant component). The muscarinic receptor-mediated component decreases with age, and the ATP (purinergic) part increases. However, the clinical consequence of this is unclear, since no major age-dependent changes in the efficacy of antimuscarinic agents in the treatment of OAB have been demonstrated.     

Zur Technik der Radikaloperation der Nabelbrüche

Ohne Zusammenfassung