[Prevention--a fall helmet for the hip].
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Accidental Falls↗
Biomedical subjects
C Wilhelm
Publications and source records attributed to C Wilhelm.
Fatal sepsis caused by Corynebacterium amycolatum in a premature infant.
Corynebacterium amycolatum has not been reported as a cause of human infections up to now, but usually the bacterium is misidentified in clinical specimens as Corynebacterium xerosis. We report the first case of neonatal sepsis due to Corynebacterium amycolatum with a fatal outcome in a premature infant.
Corynebacterium↗
Intrauterine insemination for treatment of male infertility.
Intrauterine inseminations (IUI) have been performed since the beginning of this century for treatment of infertility. Despite its widespread use the clinical value of this technique remains unclear. Today, indications for IUI include male factor, cervical factor, immunological and unexplained infertility and infertility due to ejaculatory disorders. IUI is superior to intravaginal (IVI) or intracervical insemination (ICI). Before insemination, semen has to be processed using one of the established sperm preparation techniques. Different techniques seem to be equally effective in preparing a highly concentrated sperm fraction with progressively motile, morphologically normal sperm. Ovarian stimulation further improves pregnancy rates achieved by insemination. Human menopausal gonadotropin (HMG) stimulation seems to be superior to clomiphene citrate stimulation. Among other factors, timing and number of inseminations are crucial when influencing the outcome of IUI treatment.
Female↗
Tamm-Horsfall protein as a marker of tubular maturation.
Tamm-Horsfall protein (THP), a glycoprotein with a molecular weight of 95 kilodaltons, is produced and secreted in the ascending loop of Henle. To evaluate the measurement of THP in the assessment of fetal renal development and function, we stained fetal kidney sections for THP and measured THP concentrations in 129 amniotic fluid samples from healthy pregnancies, together with other parameters such as transferrin, albumin, alpha 1- and beta 2-microglobulin. After the 16th week of gestation THP could be detected immunohistochemically in the distal tubular cells, but was not consistently detected by sandwich enzyme immunoassay until after the 20th week of gestation (detection limit 50 ng/ml). Between the 15th and 19th week of gestation THP was only detected occasionally, but after the 20th week of gestation the concentration increased significantly reaching levels of 0.4-4 mg/l at term. The THP concentration was lower in samples taken directly before birth than in the corresponding first urine after birth, indicating that THP is produced from the fetal kidney only and does not pass the placental barrier. This pattern was different from other proteins studied. Transferrin and albumin were significantly lower in the first urine voided, microglobulins remained unchanged, and the creatinine concentration increased. This indicates that maternal to fetal exchange or transport is likely for most of the other proteins. Measurement of THP concentrations, in addition to other proteins in the amniotic fluid, can improve fetal renal assessment, but because the range of THP concentrations is wide accurate predictions are still not possible.
Alpha-Globulins↗
[Thrombomodulin is a marker of microvascular, but not for macrovascular endothelial cell damage].
UNLABELLED: Plasma levels of thrombomodulin are increased in diseases associated with microangiopathia. The target of this study was to examine whether plasma thrombomodulin is also influenced by macroangiopathia. There was no variation of plasma thrombomodulin in a sample of 183 diabetic patients with or without peripheral arterio-occlusive disease of the lower limbs. In a second sample of 33 patients with peripheral arteriosclerosis of the lower limbs, without any indication of diabetes, plasma levels of thrombomodulin were not significantly increased compared to a control group. Since thrombomodulin is also found in thrombocytes, we analysed whether plasma thrombomodulin levels were influenced by platelet activation. Neither platelet activation after hyperthermal limb perfusion not the PGE1-treatment showed any effect on plasma thrombomodulin level. CONCLUSION: Thrombomodulin is a marker for microvascular but not for macrovascular endothelial cell damage.
Adult↗
FDDI information management system for centralizing interactive, computerized multimedia clinical experiences in pediatric rheumatology/Immunology.
This paper describes the design, authoring, and development of interactive, computerized, multimedia clinical simulations in pediatric rheumatology/immunology and related musculoskeletal diseases, the development and implementation of a high speed information management system for their centralized storage and distribution, and analytical methods for evaluating the total system's educational impact on medical students and pediatric residents. An FDDI fiber optic network with client/server/host architecture is the core. The server houses digitized audio, still-image video clips and text files. A host station houses the DB2/2 database containing case-associated labels and information. Cases can be accessed from any workstation via a customized interface in AVA/2 written specifically for this application. OS/2 Presentation Manager controls, written in C, are incorporated into the interface. This interface allows SQL searches and retrievals of cases and case materials. In addition to providing user-directed clinical experiences, this centralized information management system provides designated faculty with the ability to add audio notes and visual pointers to image files. Users may browse through case materials, mark selected ones and download them for utilization in lectures or for editing and converting into 35mm slides.
Allergy and Immunology↗
Therapeutic strategies in cervical pregnancy.
Cervical pregnancy is a rare condition associated with a high maternal morbidity rate. Standard recommendations for the management of this ectopic pregnancy are not available. This paper presents a case report and reviews the respective literature. In many cases hysterectomy was the ultimate solution. In order to avoid hysterectomy chemotherapy using methotrexate has been suggested. Local injections of prostaglandins or vasopressin have also been proposed. Based on data collected from the literature and our own experience it is concluded that the management of cervical pregnancy requires individualized therapeutic strategies to minimize the rate of hysterectomies.
Adult↗
Transvaginal sonography of myometrial invasion depth in endometrial cancer.
The myometrial invasion depth of endometrial cancer is an important prognostic factor. The preoperative assessment is decisive for the appropriate surgical treatment. In 96 patients with endometrial cancer, the myometrial invasion depth (greater than 50% or less than 50%) was measured preoperatively using transvaginal sonography (TVS). The sonographic results were compared to the histopathological findings. A sensitivity of 93% was obtained for invasion depths greater than 50%. The predictive value of an invasion depth less than 50% was 93% as well. In 16% of the cases the invasion depth was overestimated while, in only 3% it was underestimated. The diagnostic accuracy was 81%. Forty-five patients were examined preceding a diagnostic dilatation and curettage and fifty-one were examined following a diagnostic dilatation and curettage. The diagnostic accuracy in both groups was equivalent. Using transvaginal sonography, the spread of cancer to the cervix was observed in five of the seven cases in which it was postoperatively confirmed. TVS is a valuable, non-invasive diagnostic method for patients with endometrial cancer. When the TVS data are combined with results from other preoperative tests, the prognostic information obtained provides a useful basis in choosing the appropriate therapy.
Aged↗
[Selectivity of glomerular proteinuria and liver function in gestosis].
Proteinuria in preeclamptic women was qualitatively differentiated and in cases of pure glomerular proteinuria three groups according to the low-, medium- or high selectivity of glomerular proteinuria were formed. In these patients the incidence of liver dysfunction and severe proteinuria together with an increase in mean arterial blood pressure was investigated. The aim of this study was to find out if there is any connection between glomerular proteinuria of different selectivity and disturbed liver function. In patients with EPH-gestosis a pure glomerular proteinuria in SDS-PAA-disc electrophoresis of the urine was found. Together with the increase in glomerular selectivity an increase in quantitative urinary protein loss was found. In patients with high selective glomerular proteinuria the extent of proteinuria was about three times higher than in patients with low selectivity. In all patients a moderate elevation of the liver enzymes was found. In all patients disturbed liver function returned to normal within a few days after delivery. We conclude from these data that glomerular functional lesions pregnancy in patients with preexisting glomerulopathies or pregnancy induced renal dysfunction are accompanied in a high rate by moderate disorders of liver function.
Alanine Transaminase↗
[Prenatal diagnosis of congenital kidney and urinary tract malformations].
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Humans↗
Why do thylakoid membranes from higher plants form grana stacks?
Chloroplasts contain a system of membrane sacs, the thylakoids, some of which are stacked to form grana (singular, granum), whereas others float freely in the stroma. It is on the thylakoid membranes that the electron carriers necessary for photosynthesis reside. There has been continuous speculation and discussion about the function of the grana ever since Menke postulated their lamellar nature in 1939. On the basis of new insights into the biophysics of the two photosystems and the molecular organization of thylakoid membranes of algae that exhibit a different lateral heterogeneity from that of higher plants, we propose that the membrane stacking found in the chloroplasts of higher plants and green algae is just one way in which Nature implements a general principle, namely that of physically separating a slow (PS II) and a fast (PS I) photosystem.
Chlorophyta↗
Kinetics of pore size during irreversible electrical breakdown of lipid bilayer membranes.
The kinetics of pore formation followed by mechanical rupture of lipid bilayer membranes were investigated in detail by using the charge-pulse method. Membranes of various compositions were charged to a sufficiently high voltage to induce mechanical breakdown. The subsequent decrease of membrane voltage was used to calculate the conductance. During mechanical breakdown, which was probably caused by the widening of one single pore, the membrane conductance was a linear and not exponential function of time after the initial starting process. In a large number of experiments using various lipids and electrolytes, the characteristic opening process of the pore turned out to be independent of the actual membrane potential and electrolyte concentration. Our theoretical analysis of the pore formation suggested that the voltage-induced irreversible breakdown is due to a decrease in edge energy when the pore had formed. After initiation of the pore, the electrical contribution to surface tension is negligible. The time course of the increase of pore size shows that our model of the irreversible breakdown is in good agreement with mechanical properties of membranes reported elsewhere.
Biophysical Phenomena↗
[Doppler ultrasound in high grade multiple pregnancies].
From 1987 until 1992, 16 triplets and 2 quadruplets were studied by pulsed Doppler ultrasound between 17 and 36 weeks of gestation. A resistance index (RI) of the foetal aorta and umbilical artery above the 95th percentile was considered pathological. Elevated RI-values of the umbilical artery as compared to the A. cerebri media were indicative of circulatory centralisation. Intrauterine growth retardation (IUGR) was found in 9 (16%) foetuses, discordant growth occurred in 7 (39%) pregnancies. 41 (73%) of 56 foetuses survived in good health. Four of 7 foetuses with pathological Doppler findings died. The three survivors were markedly retarded. Four of 6 cases of intrauterine endangered foetuses were detected by Doppler sonography. The diagnosis of IUGR or discordant growth was based more frequently on pathological Doppler findings than on biometry and improved upon by combinations of both methods. Doppler sonography proved to be an important complementary method in the monitoring of high-grade multiple pregnancies.
Adolescent↗
[Comparison between argon and excimer laser angioplasty in patients with lesions of the femoral and popliteal arteries: clinical and angiography results after 1 year].
The aim of this study was to compare acute and long term results of thermic argon laser versus athermic XeCl-excimer laser for recanalization of femoropopliteal lesions in 43 patients with peripheral vascular disease stage IIb to IV according to Fontaine. The argon laser system was applied in 29 lesions (9 stenoses, 20 occlusions up to 31 cm length) and an excimer laser was used in 28 lesions (10 stenoses, 18 occlusions up to 30 cm length). In all cases balloon dilatation followed laser recanalization to achieve a sufficient primary result (< 25% stenosis rate). Primary success was obtained in 86% with both laser systems. After 1 year 62.5 of the recanalized vessels with excimer laser and 56% with argon laser were still patent. Neither acute nor long term results showed significant differences between both laser systems. Compared to the argon laser, the procedure with the excimer laser was of shorter duration which may be advantageous under routine conditions. After one year, combining the results of both systems, the reocclusion rates of stenoses amounted to 22%, the reocclusion rates of short distance occlusions to 35% and that of long occlusions more than 10 cm length to 71%. With regard to the high reocclusion rate after reopening of long occlusions the laser systems seem to be of advantage, compared to balloon angioplasty mainly in critical stenosis and short occlusions which cannot be passed with the guide-wire.
Angiography↗
Pathophysiology of polyhydramnios in twin transfusion syndrome.
In 3 cases of severe twin transfusion syndrome we demonstrate that the concentration of atrial natriuretic factor (ANF) in the cord blood of recipient twins is significantly elevated compared to that of donor twins. The discrepancy between recipient and donor concentration correlates with the volume of transfusion. The following pathophysiological mechanism for explaining polyhydramnios in recipient twins is proposed: chronic overload in recipient twins causes enhanced release of ANF from the fetal heart. Consequently, increased fetal urine production leads to polyhydramnios, which is additionally enhanced by inhibition of ADH release.
Adult↗
Intravascular ultrasound (IVUS) in patients with peripheral arterial occlusive disease (PAOD).
The new method of intravascular ultrasound (IVUS) permits an exact documentation of the pathomorphology of diseased arteries in a two-dimensional cross section image. Exact quantification of the vessel transverse diameters is achiveable. The different ultrasonic properties of fat, connective tissue and calcified tissue allow evaluation of intimal plaque composition. Thrombotic arterial occlusions can be detected. First experiences with IVUS prove, that this method is clearly superior to contrast arteriography and transcutaneous ultrasound, in terms of characterization and quantification of the extent of vessel wall disorders. Distinct structures, such as dissecting membranes or intimal flaps, which may escape arteriographic detection, are clearly visualized by IVUS. False adjustment of the physical parameters of the ultrasonic beam and non coaxial orientation of the ultrasound catheter within the vessel lead to false quantification of the transverse vessel diameters and to over- or underestimation of the echodensity and as a consequence of the intimal plaque composition. Simultaneous imaging of neighbouring arteries, veins or arterial branches allow longitudinal orientation within the vessel. Exact orientation however is only provided by simultaneous fluoroscopy. The present study demonstrates the value of IVUS as a guiding method of transcutaneous interventional procedures. The advantage could be an optimal selection of the recanalizing technique, appropriate to the arterial lesion. The result of interventional therapy can be documented immediately. Furthermore specific injuries of the vessel wall, leading to additional interventions and influencing short and long-term prognosis, can be imaged with high accuracy.
Angioplasty, Balloon↗
[Prenatal diagnosis of central nervous system malformations].
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Central Nervous System↗
[Ultrasound biometry of the fetal heart].
We report on biometric measurements of the fetal heart with the TM-technique; these measurements were carried out between the 20th and 40th gestational week. The right and left endsystolic atrial and ventricular diameters were, measured, as well as the diameters of the large vessels, i.e. aorta and pulmonary artery; finally, the septal thickness was determined. Our measurements show a linear progression of the diameters in question, the right-left ratio of the atria and ventricles was close to one, so was the ratio between aorta and pulmonary artery. Our results are compared, as far as possible, to the literature.
Anthropometry↗