Endoprothesenlockerungen

The life time of hip endoprostheses is in part limited by aseptic loosening. The aim of this study was to produce a digital system for recording shaft loosening in such endoprostheses using acceleration sensors. Four identical prosthetic shafts were each set with 3.2-axial acceleration sensors and placed in artificial femurs. In order to simulate a firm fit, one prosthesis was fixed with bone cement; a loose fit was fixed with a surrounding silicon shell 0.5 mm thick. Simulation of the transition from firm to loose in the other two prostheses was attained by the distal 2/3 or 1/3 being cemented, with the rest surrounded by a silicone shell. A weak oscillation was initiated via a damped falling weight. Using a fast Fourier transformation it was possible to make a global evaluation of the measurement curves. A wavelet transformation could be used to differentiate firm or loose prostheses. A third order Daubechies filter recognized the deviation in the main oscillation, made visible by an increase in amplitude. The results encourage the development of an implantable, telemetrically functioning total system which would allow digital quality assurance when integrated into the endoprosthesis.     

Vom Konzept zur Praxis – Aktuelles in der Luftrettung

The 2006, annual meeting of the senior physicians and emergency medical technicians of the German Air Rescue Service (Deutschen Rettungsflugwacht, DRF) was titled “From Concept to Practice”. The themes of security in the air rescue services and the current practice of cardiopulmonary respiration were discussed. In addition, different concepts and networks for treating patients with acute coronary syndrome or severe trauma were presented. The training of emergency technicians and quality assessment using the database of the whole TeamDRF was explained. New helicopter stations as well as long-range transport using normal aviation by the TeamDRF were presented.     

Single-center experience with primary orthotopic liver transplantation with FK 506 immunosuppression.

OBJECTIVE: The efficacy for primary orthotopic liver transplantation of a new immunosuppressive agent, FK 506 (tacrolimus, Prograf, Fujisawa USA, Deerfield, IL), was determined. SUMMARY BACKGROUND DATA: After 3 years of preclinical research, a clinical trial of FK 506 for orthotopic liver transplantation was begun in February 1989, first as a rescue therapy for patients with intractable rejection with conventional immunosuppression, then as a primary drug. METHODS: Between August 1989 and December 1993, 1391 recipients (1188 adult and 203 pediatric) of primary liver allografts were treated with FK 506 from the outset. Results from these patients were analyzed and compared with those of 1212 historical control patients (971 adult and 241 pediatric) given cyclosporine-based immunosuppression. RESULTS: Actuarial survival at 4 years was 86.2% with FK 506 versus 65.5% with cyclosporine in the pediatric patients (p < 0.0000) and 71.4% versus 65.5% in the adults (p < 0.0005). The need for retransplantation was reduced significantly for FK 506 patients. Four-year graft survival was 77.0% with FK 506 versus 48.4% with cyclosporine in the pediatric patients (p < 0.0000), and 61.9% with FK 506 versus 51.4% with cyclosporine in the adult recipients (p < 0.0000). Regression analysis revealed that reduction in mortality or graft loss from uncontrollable rejection, sepsis, technical failure, and recurrent original liver disease were responsible for the improved results with FK 506 therapy. CONCLUSIONS: FK 506 is a potent and superior immunosuppressive agent for orthotopic liver transplantation.     

Psychosoziale Rehabilitation von Kindern und Jugendlichen mit körperlicher und/oder psychischer Erkrankung

The guidelines regarding medical rehabilitation have changed. When applying for medical rehabilitation, the International Classification of Functioning (ICF) must be used for young adults with somatic and/or psychiatric diseases. The ICF is an appropriate tool to assess the outcome of rehabilitation in children and adolescents. Nowadays the ICF is used in rehabilitation hospitals; in former times the Functional Independence Measure (FIM) was used. The different criteria of the ICF such as personal factors, environmental factors, body function and structure (impairment), activities (limitation) and participation (restriction) are explained. A case report is presented which shows the outcome of rehabilitation according to FIM and ICF in graphic form.     

Percutaneous isolated liver perfusion for treatment of hepatic malignancy: preliminary report.

Chemotherapy for primary or metastatic hepatic malignancy is limited by poor tumor response and dose-related systemic toxicity. As an alternative to chemotherapy infusion by vein or by the hepatic artery, the authors have developed a percutaneous technique of isolated liver perfusion that allows the regional delivery of high-dose chemotherapy to the liver with little systemic toxicity. After placement of a hepatic artery infusion catheter, an 18-F double-balloon catheter is placed into the inferior vena cava through the opposite femoral vein. Balloons are inflated above and below the hepatic veins, thus isolating hepatic venous outflow. The effluent passes through fenestrations in the catheter and is pumped through charcoal hemoperfusion filters where the drug is removed. The filtered blood is returned to the patient through the internal jugular vein. Fifteen treatments have been conducted in eight patients in a phase I dose-escalation study with use of 5-fluorouracil (5-FU). While it is premature to assess tumor response to isolated liver perfusion, the data demonstrate that the procedure is safe and is tolerated by patients. Pharmacokinetic studies show a 5-FU extraction of up to 85%, with minimal drug leakage into the systemic circulation. This technique shows potential for improving liver tumor response while decreasing systemic toxicity.     

Notfälle bei extrapyramidalen Erkrankungen

Zusammenfassung Extrapyramidalen Störungen liegen zwar meist chronische Erkrankungen zugrunde, jedoch kommt es unter Umständen auch zum akuten Auftreten oder zu einer dramatischen Verschlechterung bis hin zu lebensbedrohlichen Zuständen. So kann ein Infekt, Medikamentenentzug oder eine Exikkose bei Parkinson-Patienten eine akinetische Krise auslösen. Auch akute, therapieassoziierte Psychosen mit Halluzinationen, Verwirrtheits- und Unruhezuständen können beim Parkinson-Patienten eine Notfallbehandlung erforderlich machen. Akute medikamenteninduzierte Dystonien treten nach einer Latenz von Stunden bis Tagen nach der Therapie mit Neuroleptika auf. Diese Frühdyskinesien können mit i.v.-Gabe von Anticholinergika effektiv behandelt werden. Seltene Folge einer Neuroleptikatherapie ist das maligne neuroleptische Syndrom, das mit Hyperthermie, Rigor und Bewusstseinsveränderungen einhergeht und zur kardiopulmonalen Dekompensation führen kann. Auch hier ist eine rasche Diagnosestellung entscheidend.     

Schlaganfallverbund Essen

Modern stroke care is now comparable to the care for cardiac ischemia. Although there are 100 stroke units in Germany, only a few patients can be treated with all the options available with evidence-based medicine. The stroke network in Essen is based on a concept, which optimizes all elements of stroke care, from the acute onset to rehabilitation. The Essen manual on stroke summarizes all results of the local round table talks. Logistics for acute situations, recommendations for prehospital care, and requirements at admission are explained in detail. With networks for stroke, patient care can be optimized and costs can be saved.