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Biomedical subjects

D Burkhardt

Publications and source records attributed to D Burkhardt.

At least 19 recordsLinked to original sources
PubMed2006

Transcranial grey-scale sonography of subdural haematoma in adults.

AIM: Transcranial high-resolution grey-scale sonography reliably allows diagnosis and monitoring of subdural haematoma (SDH) and extra-cerebral intracranial fluid collections in infants but has not been evaluated thoroughly in adults up to now. Because of rapid development of ultrasound systems, the depiction of intracerebral haemorrhage (ICH) has now become feasible. The presented study evaluated the sonographic appearance of SDH in adults. METHOD: We performed transcranial grey-scale sonography (TGS) in 25 consecutive patients with SDH confirmed by cranial computed tomography (CCT) or MRI. According to paediatric TGS, the dural border of the arachnoid was depicted as a highly echogenic membrane, and the distance between the skull and the echogenic membrane was measured. SDH was measured by CCT/MRI and by TGS in corresponding axial planes. The rate of identification of SDH in TGS was evaluated, and the extent of SDH as assessed by CCT/MRI and TGS was compared. RESULTS: TGS reliably detected SDH in 22 of the 25 patients with confirmed SDH (88 %). In the remaining 3 patients, the temporal bone window was insufficient for TGS investigation. Extent of SDH measured by CCT and TGS correlated linearly (r= 0.849). CONCLUSION: TGS allows imaging of SDH in patients with CCT/MRI confirmed SDH, and the extent of SDH correlates significantly between TGS and CCT/MRI. Therefore, TGS may be a possible alternative to serial CCT imaging in monitoring SDH, since in contrast to CCT, TGS is a non-invasive bedside method. So far, TGS is not suitable for the diagnosis of SDH.

Adult↗
PubMed2003

Topographical analysis of the structural, biochemical and dynamic biomechanical properties of cartilage in an ovine model of osteoarthritis.

OBJECTIVE: The relationship between the topographical variations in the structural, biochemical and dynamic biomechanical properties of articular cartilage (AC) before and 6 months after meniscectomy has not been previously reported but is clearly relevant to our understanding of the role of mechanical factors on the pathogenesis of osteoarthritis (OA). The objective of this study was to address this deficiency using an ovine model of OA induced by bilateral lateral meniscectomy. DESIGN: The dynamic effective shear modulus (G*) and phase lag were determined ex vivo at 26 individual locations over the medial and lateral tibial plateaux of non-operated and meniscectomized ovine joints 6 months after surgery using a novel hand-held dynamic indentation probe. AC thickness was measured with a needle penetration probe. The AC from the same topographical locations as indented was then analysed for sulfated glycosaminoglycans (S-GAG) as a measure of proteoglycan (PG) levels, collagen and water content. Histological evaluation of the collagen organization using quantitative analysis of birefringence intensity was performed on stained tissue sections from the same topographical locations of each animal. RESULTS: It was demonstrated that the AC of the entire lateral tibial compartment of the meniscectomized joints underwent significant local degenerative and compensatory changes as indicated by a decreased G* and an increase in phase lag and water content. This was accompanied by a decrease in PG content of the AC of the middle and inner regions. While the AC of the outer region of the lateral meniscectomized compartment showed a marked increase in PG content and a more than two-fold increase in thickness, these tissues were also found to be structurally inferior, as indicated by a decreased G* and abnormal collagen birefringence intensity. The AC thickness was elevated at all locations of the lateral and medial tibial plateau of the meniscectomized joints. Strong and significant correlations between the biomechanical and biochemical data were established for a number of the parameters examined, especially between collagen content and G*, collagen content and AC thickness, and G* and AC thickness. An inverse correlation between S-GAG content and G* was only apparent in non-operated control tissues, whereas correlations between collagen and water content, water content and G*, and water content and thickness were evident for AC of the meniscectomized tibial plateaux. Less striking changes were noted in the medial compartment where the intact meniscus remained in place. However, elevated PG content, thicker AC together with slight changes in G* suggested an early hypertrophic response in these tissues. CONCLUSION: This study has highlighted the variable response of AC in different topographical regions of meniscectomized joints to the altered mechanical stresses introduced by this surgical procedure. The AC at the joint margins, while thicker and richer in PG, was found to be biomechanically softer (lower shear modulus) than normal AC, and because of this, would be expected to undergo degenerative changes with time leading to the onset of OA.

Animals↗
PubMed2002

Decremental intravenous pulse propagation during extrastimulus pacing: relevance for catheter ablation of focal atrial fibrillation.

We report a case study demonstrating delayed circumferential intrapulmonary-venous conduction characteristics during coronary sinus extrastimulus pacing. This phenomenon allowed the unmasking and discrimination of a localized left atrial to PV breakthrough from secondarily activated PV muscle in a common left-sided PV ostium. Thus, this pacing manoeuvre may serve to guide RF delivery in the treatment of focal AF.

Atrial Fibrillation↗
PubMed2001

A novel microassay for the quantitation of the sulfated glycosaminoglycan content of histological sections: its application to determine the effects of Diacerhein on cartilage in an ovine model of osteoarthritis.

OBJECTIVE: A new micro-histological method of assessing the sulfated glycosaminoglycan (S-GAG) content in unstained histological sections of articular cartilage was developed and used to study the effects of orally administered Diacerhein (DIA) on joint cartilage in an ovine model of osteoarthritis (OA). METHODS: Twenty adult, age-matched Merino wethers were subjected to bilateral lateral meniscectomy, while 10 served as non-operated controls (NOC groups). Half of the operated sheep (N=10) remained untreated (MEN groups), while the other 10 animals were given DIA (25 mg/kg orally) daily for 3 months, then 50 mg/kg daily for a further 6 months (DIA groups). Five animals each of the DIA, MEN and NOC groups, respectively, were sacrificed at 3 months post-operatively, and the remainder 6 months later. For the present study only one knee joint of each animal was used for histological processing. The tissues studied were from the lateral femoral condyles (LFC) and lateral tibial plateaux (LTP). Each of these joint regions was further subdivided into inner (I), middle (M), and outer (O) zones. Unstained histological sections from these AC regions and zones were then analysed for S-GAG content using the following procedure. Images of each section of 6 microm thickness were acquired using a flatbed scanner and the area determined with an image analysis software program. The sections were then transferred to wells of a microtiter plate, digested with papain and the S-GAG content quantitated using a modification of the 1,9-dimethylmethylene blue dye binding assay. The data was represented as microg S-GAG/mm(3)of each tissue section. These data were also compared with toluidine blue stained sections from the same paraffin blocks. RESULTS: The results obtained showed that the area of histological sections could be very accurately determined by computer assisted image analysis using a 10 mmx10 mm calibration grid. Cartilage sections of areas ranging from 1 mm(2)up to 25 mm(2)were analysed for S-GAG content with this simple technique. There was a linear relationship between section thickness (2-10 microm) and S-GAG content per unit area (R(2)=0.993). Sections of 6 microm thickness were found to be optimal. S-GAG analyses of serial sections from tibial and femoral articular cartilage (I, M and O zones) revealed an average coefficient of variation of 7.0+/-2.3% (range 4.9-10.2%) confirming the accuracy and reproducibility of this assay method. A separate experiment showed that no significant losses of S-GAG occurred during the histological sample processing. The different regions and zones of the knee joint AC in the six experimental groups revealed variable levels of S-GAG which did not necessarily correlate with the histochemical distribution of toluidine blue staining. The major S-GAG changes occurred in the middle (lesion zone) and outer zones (hypertrophic zone) of both the LFC and LTP of the MEN groups. In the lesion (M) zone the S-GAG content was reduced while in the O zone levels were increased at both 3 and 6 months post-surgery. In animals receiving Diacerhein S-GAG levels in the M zone were lower than or equivalent to those of non-drug treated OA or non-operated controls for both joint regions at 3 and 6 months. While the hypertrophic response in the outer zone of the LFC, as assessed by S-GAG content, was enhanced by drug treatment, the cartilage of the outer zones of the LTP was not affected by drug treatment. CONCLUSION: The results of this study have demonstrated that the S-GAG (and therefore proteoglycan [PG]) content in different cartilage zones of OA joints can be readily quantitated by direct biochemical analysis of unstained histological sections. By this means subtle changes in PG distribution in different cartilage zones, which were not evident using traditional histochemical staining methods, could be readily detected.

Animals↗
PubMed2001

The effects of orally administered diacerein on cartilage and subchondral bone in an ovine model of osteoarthritis.

OBJECTIVE: An ovine model of osteoarthritis (OA) induced by bilateral lateral meniscectomy (BLM) was used to evaluate in vivo effects of the slow acting antiarthritic drug diacerein (DIA) on degenerative changes in cartilage and subchondral bone of the operated joints. METHODS: Twenty of 30 adult age matched Merino wethers were subjected to BLM in the knee joints and the remainder served as non-operated controls (NOC). Half of the BLM group (n = 10) were given DIA (25 mg/kg orally) daily for 3 mo, then 50 mg/kg daily for a further 6 mo. The remainder of the meniscectomized (MEN) group served as OA controls. Five DIA, 5 MEN, and 5 NOC animals were sacrificed at 3 mo and the remainder at 9 mo postsurgery. One knee joint of each animal was used for bone mineral density (BMD) studies. Osteochondral slabs from the lateral femoral condyle and lateral tibial plateau were cut from the contralateral joint and were processed for histological and histomorphometric examination to assess the cartilage and subchondral bone changes. RESULTS: No significant difference was observed in the modified Mankin scores for cartilage from the DIA and MEN groups at 3 or 9 mo. However, in animals treated with DIA, the thickness of cartilage (p = 0.05) and subchondral bone (p = 0.05) in the lesion (middle) zone of the lateral tibial plateau were decreased relative to the corresponding zone of the MEN group at 3 mo (p = 0.05). At 9 mo subchondral bone thickness in this zone remained the same as NOC but BMD, which included both subchondral and trabecular bone, was significantly increased relative to the NOC group (p = 0.01). In contrast, the subchondral bone thickness of the outer zone of lateral tibial plateau and lateral femoral condyle of both MEN and DIA groups increased after 9 mo, while BMD remained the same as in the NOC. CONCLUSION: DIA treatment of meniscectomized animals mediated selective responses of cartilage and subchondral bone to the altered mechanical stresses induced across the joints by this procedure. While subchondral bone thickness in tibial lesion sites was reduced, cartilage and bone proliferation at the outer joint margins, a region where osteophyte formation occurred, were enhanced, suggesting that DIA supported the processes of repair and endochondral ossification.

Administration, Oral↗
PubMed2000

Spinal biomechanics and aging are major determinants of the proteoglycan metabolism of intervertebral disc cells.

STUDY DESIGN: The proteoglycan metabolism of ovine disc nucleus pulposus and anulus fibrosus cells was investigated in relation to age, spinal level, and intrinsic spinal biomechanical properties. OBJECTIVE: To evaluate the hypothesis that with aging loss of proteoglycans from the lumbosacral disc exceeds that from upper lumbar discs because of its proximity to a rigid segment, the sacrum. SUMMARY OF BACKGROUND DATA: The proteoglycan and associated water of the disc decreases with aging. METHODS: Proteoglycans were extracted directly from the disc tissues using 4 M GuHCl and examined by composite agarose polyacrylamide gel electrophoresis. Disc cells were cultured in alginate beads, and their metabolic activity was assessed by 3H-thymidine incorporation into DNA and by bioreduction of a cell proliferation dye. Newly synthesized proteoglycans were radiolabeled with 35S, and their molecular weight distributions and ability to aggregate with hyaluronan were determined by Sephacryl S1000 gel chromatography. Resident proteoglycans extracted from disc tissues with 4 M GuHCl were similarly evaluated. A group of adult animals also were studied biomechanically to evaluate the range of spinal motion (L4/L5 to L7/S1). RESULTS: In contrast to the neonatal proteoglycan samples, the biosynthesis of proteoglycans by nucleus pulposus cells of adult discs increased progressively toward the sacrum. This correlated with increased metabolic activity. Analysis of the resident proteoglycans by composite agarose polyacrylamide gel electrophoresis indicated that although the aggrecan-1 population was present almost exclusively in the neonatal group, it was the aggrecan-2 population that predominated in the adult discs, and it became progressively more heterogeneous with aging and proximity of the disc to the sacrum. CONCLUSIONS: The proteoglycans of the lumbosacral disc of adult animals turned over faster than proteoglycans of adjacent lumbar discs. The reduced proteoglycan content and ability to aggregate, particularly in the nucleus pulposus of lumbosacral discs, indicated that proteoglycan catabolism exceeded the rate of biosynthesis. These events in the lumbosacral disc are thought to be determined mechanically by its proximity to the sacrum.

Aging↗
PubMed2000

Immunolocalisation of BPTI-like serine proteinase inhibitory proteins in mast cells, chondrocytes and intervertebral disc fibrochondrocytes of ovine and bovine connective tissues. An immunohistochemical and biochemical study.

A polyclonal anti-bovine pancreatic trypsin inhibitor (BPTI) IgY was raised in chickens immunised with aprotinin. The anti-BPTI IgY was subsequently isolated from egg yolks and purified to homogeneity by affinity chromatography on immobilised aprotinin and by Superose 6 size exclusion fast protein liquid chromatography (FPLC). Immunoblotting with the chicken IgY demonstrated its specificity for BPTI; 3.9 ng BPTI could be detected by this technique. There was no crossreactivity against alpha1-proteinase inhibitor (human and sheep), inter-alpha-trypsin inhibitor (human and sheep), secretory leucocyte proteinase inhibitor or a range of serine proteinase inhibitory proteins (SPIs) isolated from plant sources (soybean and lima bean trypsin inhibitor, potato trypsin and chymotrypsin inhibitors) or serum SPIs (antithrombin-III, alpha2-macroglobulin). Immunoblotting using the anti-BPTI IgY identified the 6- to 12- and 58-kDa forms of endogenous ovine cartilage SPIs in cartilage extracts, confirming the interrelationship of the ovine cartilage SPIs with BPTI. BPTI-domain SPIs were immunolocalised within mast cells of ovine and bovine duodenum, lung and pancreas, and in ovine and bovine bronchial cartilage chondrocytes, chondrocytes of the superficial and intermediate zones of articular cartilage and in the fibrochondrocytes/chondrocytes of the nucleus

Animals↗
PubMed1999

D-Dimer formation during cardiac and noncardiac thoracic surgery.

UNLABELLED: The ability to make therapeutic decisions regarding excessive fibrinolysis in the perioperative period is limited by the lack of availability of a near site monitor of fibrinolysis. We investigated the use of a latex agglutination D-dimer assay to detect perioperative fibrinolysis in patients undergoing thoracic surgery with and without extracorporeal circulation. We studied 27 patients who underwent thoracic surgery requiring cardiopulmonary bypass (CPB; coronary artery bypass grafting, n = 12; valvular surgery, n = 15) and a cohort of 20 patients who underwent noncardiac thoracic surgical procedures not requiring CPB. The purpose of this investigation was to determine the relationship among alterations in the latex agglutination D-dimer assay, use of extracorporeal circulation, type of cardiac surgical procedure, and mediastinal and/or chest tube drainage (cardiac surgery only) in patients undergoing thoracic surgery. Perioperative D-dimer levels, measured by latex agglutination, had significant (P < or = 0.05) intragroup changes among patients undergoing cardiac surgery (requiring CPB) and the cohort of patients who underwent noncardiac thoracic surgery without CPB. Although intraoperative D-dimer levels were not increased in patients undergoing noncardiac thoracic surgery, postoperative levels were significantly (P < 0.05) increased (compared with preinduction). In cardiac surgery patients requiring CPB, intraoperative D-dimer formation was significantly (P < or = 0.05) increased but did not demonstrate any intragroup (coronary artery bypass grafting versus valvular surgery) differences. Finally, D-dimer levels were not associated with postoperative mediastinal and/or chest tube accumulative drainage measured at intervals up to 48 h postoperatively in patients undergoing cardiac surgery requiring CPB. Our study indicates that the latex agglutination D-dimer assay can detect excessive fibrinolysis perioperatively, and that extracorporeal circulation can significantly influence the pattern of D-dimer formation in patients undergoing thoracic surgery. IMPLICATIONS: We assessed the ability of a readily available D-dimer assay to detect excessive fibrinolysis in patients undergoing thoracic surgery with and without extracorporeal circulation. The findings demonstrate that the assay used in this investigation reflected variable amounts of fibrinolysis in patients undergoing both types of thoracic surgery.

Adult↗
PubMed1999

Cytogenetic aberrations in myelodysplastic syndrome detected by comparative genomic hybridization and fluorescence in situ hybridization.

Conventional cytogenetics (CC) is proven as a diagnostic and prognostic factor in myelodysplastic syndrome (MDS). However, CC may be hampered by insufficient metaphase preparation and cannot analyze interphase nuclei. These problems are solved by using comparative genomic hybridization (CGH). The CGH was applied to samples from 45 patients with MDS, and the results were compared with CC and fluorescence in situ hybridization (FISH). The CC detected aberrations in 12 of 45 samples, including chromosomes 3 (n = 1), 5 (n = 9), 7 (n = 2),8(n = 1), 18(n = 1),21 (n = 1), X (n = 1), and Y(n = 2). In one patient, loss of B and C group chromosomes and a marker chromosome were seen. The CGH revealed chromosomal imbalances in 18 of 45 samples, including chromosomes 5 (n = 11), 7 (n = 2), 8 (n = 1), 18(n = 1), 20(n = 1), 21 (n = 1), X (n = 1), and Y (n = 2). All unbalanced aberrations found by CC were detected by CGH, too. In two patients, the CGH found additional aberrations and redefined the aberrations of the chromosomes of the B and C group in one sample. The FISH confirmed these aberrations. Additionally performed FISH for chromosomes 5, 7, and 8 gave normal findings in all patients found to be normal in CC and CGH. The CGH and FISH confirmed the results obtained by CC. All three techniques showed changes of chromosomes 5 and 7 as the most frequent aberrations, emphasizing the importance of these chromosomes in the development of MDS. Furthermore, the CC is proven as the basic technique for cytogenetic evaluation of MDS.

Adolescent↗
PubMed1999

Radiofrequency catheter ablation of symptomatic ventricular ectopic beats originating in the right outflow tract.

Ectopic activity originating in the right ventricular outflow tract is a frequent finding and may result in severe symptoms such as dyspnea, palpitations, and lack of physical capacity correlated with a low cardiac output. In 12 consecutive symptomatic and drug refractory patients, we performed a study with intracardiac mapping and ablation procedure. The origin of the ectopic beats was identified, and the ablation procedure was performed. Patients were examined by serial ECG, Holter ECG, bicycle ECG, echocardiography, and thoracic X ray. At baseline, the mean number of ectopic beats was 23,823 during Holter ECG. No other arrhythmias were present. Patients underwent basic electro-physiological study, mapping process, and ablation in a single procedure. Ablation was performed with a deflectable thermocoupled catheter with tip electrodes of 4 mm. Criteria for identification of the origin of the ectopic beats included pace mapping with 12 leads and earliest endocardial activation. One male patient suffered from myocarditis; the other 11 patients had no underlying structural heart disease. The mean age was 38 years. Ablation procedure with delivered temperature of 70 degrees C was successful in 11 of 12 patients eliminating the focus. The mean procedural time was 79 +/- 34 minutes; mean fluoroscopy time was 13.8 +/- 8.8 minutes; and mean number of applications was 4.4 +/- 2.8. No adverse effects occurred during a follow-up period of 10 months after ablation. The mean number of ectopic beats per 24 hours after ablation was 317 +/- 599 with a P value of 0.00024. The clinical symptoms improved in all but one patient. One patient had a recurrence after 2 months that could be successfully treated by a second procedure. In our experience, temperature guided radiofrequency catheter ablation is safe and effective for the treatment of patients with symptomatic ectopic activity of the right outflow tract. As long as we lack the experience of a greater patient cohort and a longer follow-up, only drug resistant and highly symptomatic patients should be selected.

Adult↗
PubMed1998

Analysis of hematologic diseases using conventional karyotyping, fluorescence in situ hybridization (FISH), and comparative genomic hybridization (CGH).

Comparative genomic hybridization (CGH) has been proven to be an important tool in interphase cytogenetics of solid tumors. Although, because of methodological implications, balanced aberrations are not detected by CGH, the technique has uncovered a variety of new and interesting imbalanced karyotype changes. However, only a few studies deal with its application to hematologic disorders, although this is a main topic of cytogenetics. The aim of our study was, therefore, to evaluate the usefulness of CGH in the examination of hematologic neoplasms. For this purpose, bone marrow aspirates of 33 patients with different hematologic disorders were examined with CGH and the results compared with conventional cytogenetics (CC) and fluorescence in situ hybridization (FISH). CGH showed chromosome changes in 8 of 33 cases. CC found balanced aberrations in 4 of 33 and unbalanced changes in 9 of 33 samples. Differences between CGH and CC in unbalanced aberrations were seen in four cases. In these samples, either the number of aberrant cells found by CC was low and, therefore, difficult to detect by CGH, or complex aberrations in different cell clones as seen in CC were lumped together as one karyotype by CGH. In one sample, CC was not capable of giving any results at all, whereas CGH showed trisomy 8. CGH was also helpful in defining the bands involved in the structural aberrations, which was difficult by CC in some cases because of the low quality of metaphase spreads. All results obtained by CGH were confirmed by FISH, whereas CC and FISH were discordant in one case. Although CGH was not able to detect all aberrations, it gave important additional information for the correct localization of the aberrations found in CC, and it was most helpful in samples not processed successfully in CC. These advantages would open up a new field of application for CGH not only for research, but also for diagnostic purposes.

Adult↗
PubMed1998

Clinical experience with antagonist-induced opiate withdrawal under anaesthesia.

AIMS: The study describes experience with antagonist-induced opiate withdrawal under anaesthesia in standard clinical conditions. DESIGN: The study was restricted to patients who had undergone failed withdrawal treatments with usual methods over the past months. No control group was used. SETTING AND PROCEDURE: The patients were selected after history-taking and examination. A multi-axial diagnosis was performed. They were then admitted to an inpatient treatment unit for addicted patients. On the second day they were put into neurological intensive care. There they were intubated, ventilated and anaesthetized with propofol for 6 hours. Shortly after induction of anaesthesia, naloxone and naltrexone were administered. A high amount of fluid was used to balance changes in water and electrolytes. After anaesthesia the patients were transferred back to the addiction ward and sedated with clonidine. The patients were then fully mobilized. On discharge 50 mg naltrexone were given daily. PARTICIPANTS: Eighty-eight patients were treated. They were long-term opiate users. Preference was given to methadone-substituted patients who were unable to rid themselves of methadone. MEASUREMENTS: The account given is based solely on clinical observations. FINDINGS: The first 14 patients were observed in detail and it is on them that this report is based. It was found that withdrawal from codeine and methadone can be shortened to approximately 2-3 days. No patient was in a condition to go home immediately after anaesthesia. Twelve patients showed significant symptoms on the day following anaesthesia. The majority of patients treated by this method will continue to suffer withdrawal symptoms for a few days after detoxification, after which time most can be treated in an outpatient setting. Dysfunction of the cardiovascular system, the lungs, the kidneys or other organs was not observed. Taking into account all the 88 patients, five had to stay in hospital for a longer period (up to 2 weeks) because of a prolonged withdrawal syndrome.

Anesthesia↗
PubMed1997

[Modification of the detection and stimulation behavior of active and passive fixed bipolar pacemaker electrodes by depot dexamethasone].

In a prospective, non-randomised study, two atrial steroid-eluting screw-in leads were evaluated (CapSureFix 4068, Medtronic, n = 17; Accufix II DEC 033-812, Telectronics, n = 16); in the same way, measurements were obtained of three steroid eluting ventricular electrodes (two screw-in leads: CapSureFix 4068, Medtronic, n = 11; Accufix II DEC 033-212, Telectronics, n = 20 and one tined lead Encor DEC 033-448, Telectronics, n = 18). Measurements were performed during implantation (= acute), 7 +/- 3 days after implantation (= subacute) and during follow-up at 3 and 6 months. After atrial implantation, there were no significant differences of the stimulation thresholds (Accufix II DEC: 0.76 +/- 0.23 V-CapSureFix: 0.75 +/- 0.16 V). During follow-up, a slight but not significant increase of the stimulation threshold was observed (Accufix II DEC: subacute 0.99 +/- 0.45 V; 3 months 0.79 +/- 0.43 V; 6 months: 0.84 +/- 0.45 V.-CapSureFix: subacute 0.76 +/- 0.18 V; 3 months 0.87 +/- 0.31 V; 6 months 0.88 +/- 0.32 V). The acute atrial thresholds were significantly lower in the right atrial appendage than in the right lateral wall, while there was no difference during measurements at 3 and 6 months (atrial appendage n = 20 acute 0.69 +/- 0.11 V; right lateral wall n = 13 acute 0.85 +/- 0.25 V). The ventricular Encor DEC and Accufix II DEC electrodes had similar thresholds at implantation, whereas the CapSureFix electrode showed significantly higher stimulation thresholds (Encor DEC 0.56 +/- 0.15 V; Accufix II DEC 0.53 +/- 0.13 V; CapSureFix 0.8 +/- 0.16 V). During follow-up the stimulation threshold increased significantly with each ventricular electrode (Encor DEC: subacute 0.71 +/- 0.22 V; 3 months 0.77 +/- 0.23 V; 6 months 0.8 +/- 0.28 V-Accufix II DEC: subacute 0.86 +/- 0.44 V; 3 months 0.8 +/- 0.25 V; 6 months 0.74 +/- 0.21 V-CapSureFix: subacute 0.92 +/- 0.17 V; 3 months 1.14 +/- 0.46 V; 6 months 1.12 +/- 0.32 V). With regard to the sensing of the intracardiac signals, no differences among the electrodes were detected at the atrial as well as the ventricular level. Subacutely all electrodes had a significant decrease of sensing level without changes after 3 and 6 months (atrium: CapSureFix acute 4.08 +/- 1.34 mV, subacute 3.09 +/- 0.88 mV, 3 months 2.91 +/- 1.02 mV, 6 months 3.0 +/- 1.22 mV; Accufix II DEC acute 4.34 +/- 1.49 mV, subacute 2.86 +/- 1.18 mV, 3 months 3.07 +/- 1.04 mV, 6 months 2.91 +/- 1.16 mV-ventricle: CapSureFix acute 11.55 +/- 4.5 mV, subacute 9.99 +/- 3.51 mV, 3 months 9.36 +/- 3.23 mV, 6 months 9.13 +/- 3.4 mV; Accufix II DEC acute 10.66 +/- 3.0 mV, subacute 7.49 +/- 4.04 mV, 3 months 7.25 +/- 3.64 mV, 6 months 7.52 +/- 4.1 mV; Encor DEC acute 11.65 +/- 3.9 mV, subacute 9.04 +/- 3.29 mV, 3 months 8.69 +/- 3.83 mV, 6 months 8.78 +/- 3.32 mV). The impedance of the Accufix II DEC electrode was significantly lower than the CapSureFix electrode at the time of implantation in the atrium. The ventricular electrodes with active fixation showed a decrease of impedance 7 days after implantation, which diminished during chronic follow-up. On the other hand, the Encor DEC electrode did not exhibit any change of impedance at the different times of determination. In summary, the dexamethasone depots prevented the rise of the stimulation threshold in all the atrial electrodes with active fixation. There remained a small increase of the stimulation threshold after ventricular implantation, which did not reach clinical significance. Thus, the energy saving output of 2.5 volt could be programmed in almost every patient.

Administration, Topical↗
PubMed1997

[The experiences of the Munich methadone outpatient clinics].

In 1994, two methadone outpatient treatment departments, providing a combined therapy of substitution and psychosocial care, were set up in Munich. Indication for treatment is established according to the guidelines for new treatment and diagnostic methods (NUB guidelines), focussing mainly on NUB 2.3, on account of the high psychiatric comorbidity. After 1 1/2 years a total of 102 addicts had received treatment. More than half of these patients were then hospitalized for detoxification. Substitution therapy enabled many of these patients to improve their work and home situations. A corresponding reduction in the use of drugs was also observed, especially in the case of opiates. The programme has therefore been successful similar to the results of the substitution study of Hamburg.

Adult↗
PubMed1996

Evaluation of laboratory coagulation and lytic parameters resulting from autologous whole blood transfusion during primary aortocoronary artery bypass grafting.

STUDY OBJECTIVE: To determine if autologous blood reinfusion influences overall hemostatic function following aortocoronary artery bypass graft (CABG) surgery, and if so, where the predominant area of this influence lies. DESIGN: Prospective, with control values on each patient. SETTING: Cardiac operating room of a major university-affiliated county hospital. PATIENTS: 20 patients undergoing elective CABG surgery. INTERVENTIONS: Following heparinization, and prior to cardiopulmonary bypass (CPB), venous blood (average 4.9 ml/kg) was removed via an indwelling internal jugular catheter into a preservative-free plastic transfer pack unit and stored without agitation at room temperature. This autologous whole blood was reinfused after systemic protamine reversal of heparin. Blood samples for analysis were drawn immediately before and 5 minutes after completion of the reinfusion. MEASUREMENTS AND MAIN RESULTS: Autologous blood reinfusion appears to be significantly related to increased hemoglobin, hematocrit, platelet count, fibrinogen, plasminogen, and antiplasmin levels. The prothrombin time and activated partial thromboplastin times decreased significantly, whereas activated clotting times and D-dimer levels were unchanged. Significant increases occurred in the following thromboelastography parameters: maximum amplitude, amplitude 60 minutes after the maximum amplitude, and whole blood clot lysis index. Reaction time and coagulation time were not statistically different from control values. CONCLUSIONS: Significant improvements in coagulation and lytic parameters occur following CPB after the infusion of autologous blood. These improvements in coagulation indices may be the result of the infused blood or hemoconcentration, which is also known to occur during this period. Additional control studies are needed to differentiate these effects.

Anticoagulants↗
PubMed1995

Comparison of chondroitin sulphate composition of femoral head articular cartilage from patients with femoral neck fractures and osteoarthritis and controls.

The glycosaminoglycan (GAG) and uronic acid (UA) composition of human hip articular cartilage from patients with femoral neck fractures [assumed osteoporosis (OP); n = 12], from patients with osteoarthritis (OA; n = 12) and from normal controls (n = 9) was determined. Full depth tissue samples from the control and OP groups were analysed from the superior, inferior, anterior and posterior regions, while the OA tissue was from cystic (tissue growing on top of cystic bone lesions) and osteophytic regions, from normal and fibrillated resident cartilage and from regions immediately adjacent to eburnated bone. The total sulphated GAG and UA content was reduced in the inferior region of control cartilage compared to the other regions and the values of all regions of the assumed OP group. Cystic regions and OA cartilage adjacent to the bone also showed lower GAG and UA levels than the other regions. The ratios of chondroitin 6-sulphate (C6S) to chondroitin 4-sulphate (C4S) indicated a similar pattern in the different regions of controls and the patient group with femoral neck fracture (OP group). The cystic and osteophytic cartilage of the OA group exhibited lower C6S/C4S ratios than any other region. The levels of dermatan sulphate (DS) in the cartilage of all regions of the OP and control groups were very similar and low, while the tissues of the OA group contained significantly higher amounts, particularly the cartilage from osteophytes. The previously presumed compositional similarity between normal aged and osteoporotic articular hip cartilage was essentially confirmed in a comparative analysis. Significant changes in GAG and UA composition of OA cartilage from distinct regions was also recorded.

Aged↗