Of vulcan ears, human ears and 'earprints'.
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Adaptation, Physiological↗
Biomedical subjects
D Kistler
Publications and source records attributed to D Kistler.
Primary intracerebellar osteosarcoma arising within an epidermoid cyst.
The authors report a case of a primary extraskeletal osteosarcoma arising within an epidermoid cyst in the parenchyma of the cerebellum in a 64-year-old woman. On initial presentation, the tumor involved the midline cerebellum without attachment to the surrounding dura mater or calvarium. Complete medical and radiologic evaluation failed to reveal a primary skeletal or other extraskeletal osteosarcoma. To our knowledge, this is the first reported case of a primary extraskeletal osteosarcoma within the cerebellum. Osteosarcoma as a primary brain tumor is exceedingly rare, and only three cases (all occurring within the cerebral hemispheres) have been reported previously. The histogenesis of primary sarcomas of the brain is not evident. The associated finding of an epidermoid cyst suggests the tumor originated from a teratoma.
Cerebellar Diseases↗
Venous stenosis and occlusion in hemodialysis shunts: follow-up results of stent placement in 65 patients.
PURPOSE: To provide follow-up data on the use of self-expanding stents in hemodialysis fistulas to improve the technical success of balloon angioplasty. MATERIALS AND METHODS: Ninety-two self-expanding vascular stents were placed in 65 patients (29 men and 36 women 25-79 years of age; mean, 57.6 years) with failing hemodialysis fistulas or shunts. RESULTS: Stent placement was successful in all patients, but rethrombosis of the shunt occurred in six patients (10%) within 1 week. There were 96 episodes of reobstruction. In 87 cases, percutaneous or combined surgical and percutaneous repeat intervention was performed. The cumulative shunt function rate was 88% after 6 months, 86% after 1 year, and 77% after 2 years. CONCLUSION: Stent placement in hemodialysis fistulas helps treat lesions that cannot be adequately treated with percutaneous transluminal angioplasty (PTA) alone but has a follow-up patency rate similar to that of PTA. Standard central venous stents have a better patency rate than after PTA.
Adult↗
[Treatment of stenosed or occluded hemodialysis shunts. Results of percutaneous angioplasty and combined radiologic-surgical therapy].
The results of all recanalisations of stenosed and occluded haemodialysis shunts over a period of three years are reported; there were 112 percutaneous angioplasties and 40 combined radiological-surgical procedures. In 13% of cases a metallic endoprosthesis (wall stent) and in 3% Simpson's atherectomy catheter was used. The functional results were retrospectively evaluated for all 152 interventions which involved 60 orthoptic Brescia-Cimino shunts and 19 PTFE prostheses. In addition, the primary and total functions of the treated shunts were calculated. Cumulative function rate (percentage at a given time of effective shunts) for Brescia-Cimino shunts at one year was 80% and after two years 68.5%; for the PTFE prosthesis the corresponding figures were 83.8 and 75.5% respectively. The average number of interventions per patient was 2.3 with a range of 1-7. Total functional rate of all shunts following the first percutaneous procedure after one year was 78.2%, for combined radiological-surgical procedures for the treatment of acute thromboses it was 68%. Comparison with the results of surgical treatment reported in the literature confirms the effectiveness of percutaneous or combined treatment of stenosed or acutely occluded haemodialysis shunts. The outstanding advantage of radiological intervention is its repeatability.
Angioplasty, Balloon↗
[Percutaneous vascular endoprotheses for occlusions or stenoses of hemodialysis shunts].
In ten patients (four men and six women, mean age 51.7 [26-79] years), with six occlusions and five stenoses of a haemodialysis shunt or shunt-draining subclavian vein, a self-expanding intravascular stent was implanted percutaneously after balloon-dilatation. The implantation was successful in 9 of 11 instances, but the shunt thrombosed in two within 24 hours (in one of the patients, with antithrombin III deficiency, the shunt had to be abandoned). After an average observation period of 7.8 (1-14) months, ten shunts have remained open and suitable for dialysis. A further stent had to be implanted in one of the patients because of stenosis distal to the first stent. In three patients intima hyperplasia within the stent necessitated percutaneous balloon dilatation and/or atherectomy.
Adult↗
A chair for patients with burns of the back.
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Back Injuries↗
The serratus anterior osteocutaneous free flap.
Microvascular transfer of the rib as an osteocutaneous or osseous free flap based on the thoracic branch of the thoracodorsal artery is described. A review of the literature revealed various patterns of rib vascularization in different areas of the body from the periosteum and the endosteal vessels. Reversing the blood flow in the transcortical vessels of the rib is reported to be possible. Injection studies showed a reliable connection between the thoracic branch of the thoracodorsal artery and the endosteal vessels of the sixth and seventh ribs at the origin of the anterior serratus muscle. This approach to free rib transfer has proved to be quick, easy, and reliable in various clinical applications.
Adult↗
Increased survival rates by topical treatment of burns with cerium nitrate.
In experiments on mice we were able to show that the negative effects attributed to burn toxins could almost completely be prevented by one single early treatment of the burned skin with a 0.04 M solution of cerium nitrate [Ce(NO3)3]. The survival rate was 10% for animals which were grafted with burned skin. Treatment with Ce(NO3)3 increased the survival rate to 74%. A reflection of this protective effect was the prevention of the burn-induced disturbance of the acceptor control ratio in isolated liver cell mitochondria. Repeated use of Ce(NO3)3 showed adverse effects due to an increased absorption. An effective treatment of burns with Ce(NO3)3 is without problems and can be done in any hospital.
Absorption↗
[Combined surgical-radiologic procedure in occlusion of a hemodialysis shunt].
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Angioplasty, Balloon↗
[Pathogen spectrum and pathways of infection at an intensive care burn unit].
Coagulase-negative staphylococci have gained increasing importance in burns, whereas interest is no longer focussed on Pseudomonas bacteria. By means of microbiological analysis of swabs taken from patients, environment and staff, we trailed the routes of infection in an intensive-care unit for burns. Analysis of patients: In 27 out of 11 patients the same biotype of Staphylococcus epidermidis could be identified; 22 of these occurred in swabs from wounds. The phagotypification of Staphylococcus aureus showed the same phagotype in 28 out of 41 swabs taken from infected wounds of 10 patients. The pathogen mostly caused the destruction of already healed grafts in a later phase of the treatment. Further microbiological analysis showed a severe infestation of the patients by enterococci. Analysis of environment: Here, greatly increased counts of coagulase-negative staphylococci of the same lysotype as in the patients could be demonstrated. Analysis of staff: The naso-pharyngeal area is of minor importance in the spreading of germs, whereas that of protective clothing and especially the hands should be considered to be more crucial. Regular environmental tests enable rapid detection of hygienic errors so that appropriate countermeasures can be taken.
Adolescent↗
[Burns. Primary management and clinical therapy].
Following the saving of the patient in addition to the cool-water therapy an adequate infusion therapy with Ringerlactate should be initiated immediately. For the transport the wounds should only be covered sterile; in case of inhalation trauma early intubation. Adults with burns of more than 15% TBA (children already at 5%) as well as with burns of hands and face require an immediate transfer into a burncenter. After cleansing of the wounds in the hospital estimation of the burn depth and decision of treatment. Deep burns of hand and face should be necreted and covered within the first 72 hours if possible. For the remaining deep burns one should try a primary excision too or in case of a bad general condition a delayed primary excision after tanning. Up to the moment of operation one should choose between an open, half open or closed treatment. The covering of the necrectomized areas is done temporary with alloplastic material or xeogenic or allogenic skin respectively. Definitive covering can only be achieved by autogenic split skin or intermingled skin grafting. New possibilities are offered by "in vitro" grown keratinocytes.
Adult↗
Computer-assisted infusion and nutrition planning in an intensive care burn unit.
The paper describes a computer-assisted infusion and nutrition programme, running on an IBM-compatible PC/XT or PC/AT, for a surgical intensive care unit specializing in burn treatment. Using inputs of patient and laboratory data relevant to infusion planning, the programme generates a schedule for balanced enteral or parenteral nutrition of adult and adolescent patients from the age of 14 upwards. Potential side effects and metabolic complications in nutrition therapy are minimized. Graphics provide a rapid status check on individual parameters whenever required.
Body Weight↗
Intermingled skin grafts with in vitro cultured keratinocytes--experiments with rats.
In vitro cultured autogenic keratinocytes were used instead of autogenic skin islets in intermingled skin grafts on rats. According to the observations made with the original method, the allogenic epidermis is being rejected. The cultured keratinocytes start to grow out in circles, eventually covering the remaining allodermis in the form of a multilayered, well-differentiated epidermis. The prospects of these findings for possible future clinical applications are discussed.
Animals↗
Cytogenetic investigations of the allodermis after intermingled skin grafting.
In most instances intermingled skin transplants done according to the method developed in the PR China are not subject to a generalized rejection. During the healing process there is an integration of the allodermis instead, which eventually becomes covered by outgrowing auto-epidermal cells. To investigate the fate of allogenic cells experiments were done with intermingled skin grafts, using male Wistar rats as recipients and female DA-rats as donors. By studying karyotype analysis of cells growing out from intermingled skin biopsies the presence of viable allogenic cells was demonstrated on days 53 and 111 post-transplantation. It was concluded that the intermingled skin forms a cellular mosaic with different portions of autogenic and allogenic cells.
Animals↗
Distribution of lymphocytes in intermingled skin grafts.
Chinese intermingled skin grafts of allogenic material interspersed with small autogenic islets heal permanently with no signs of a rejection reaction. A study of the T-helper and T-suppressor cells in the region of the autogenic islets and the remaining allodermis revealed a distinctly greater frequency of these cells in the islets, with marked massing of the cells between the autoepithelium and the autodermis. Histologically it could be shown, that the Langerhans' cells grow over the allodermis together with the epithelium, although compared with the autogenic islets their number in the newly formed epidermis remained reduced.
Humans↗
Fournier's gangrene in hypersensitivity vasculitis.
Fournier's gangrene in IgE positive hypersensitivity vasculitis demands concurrent high dose immunosuppression, radical surgery and intensive treatment of septic sequelae. Even extended autologous skin grafting is possible with immunosuppression. A case of fulminant necrotizing infection of the genitalia, perineum and abdominal wall during the acute generalization phase of IgE positive hypersensitivity vasculitis is described. Apart from the radical surgical approach, medical treatment demands a different strategy than in classical Fournier's gangrene. The favorable outcome in a 21-year-old man after several months of intensive care could be realized only by close cooperation of internal specialists, urologists and plastic surgeons.
Adult↗
Frequency resolution in children.
The auditory frequency resolving ability of preschool children, school-aged children, and adults was assessed in a standard forced-choice masking experiment. Thresholds for pure-tone signals at 500 Hz, 2000 Hz, and 4000 Hz were obtained in two masking conditions. In one condition, the masker was a 4000-Hz-wide band of noise centered at the signal frequency; in the other, there was a notch in the noise spectrum, approximately one-half octave wide and 50 dB deep, centered at the signal frequency. Frequency resolving ability was inferred from the difference in signal threshold between the two masking conditions. The adaptive forced-choice psychophysical procedure was embedded in a video game in order to obtain rigorous psychophysical data within the attentional limits of young children. This procedure produced data from children as young as 3 years old that were qualitatively indistinguishable from adult data. However, the threshold estimates from the children were more variable from run to run than were the estimates obtained from adults. The mean data from this experiment suggest that frequency resolving ability improves at all frequencies with increasing age.
Adult↗
Venous stenoses in dialysis shunts: treatment with self-expanding metallic stents.
A flexible, self-expanding metallic endoprosthesis was employed for the treatment of venous outflow stenoses in four patients with a polytetrafluoroethylene shunt and two patients with a Brescia-Cimino shunt. The stenoses had led to shunt occlusion in five patients and to flow impairment in one. In the occluded shunts, thrombectomy and subsequent balloon angioplasty were performed in four patients, and percutaneous recanalization with angioplasty was performed in one. One shunt with decreasing flow was percutaneously dilated. Since the underlying stenoses recurred in four patients after 24 hours and did not respond sufficiently to angioplasty in two patients, up to four stents were placed in the venous segments. Thrombosis of the stents occurred in two patients after 24 hours and in one after 6 weeks and was successfully recanalized with thrombectomy in two. At 2-6 months follow-up, the stents and the shunts were patent in five patients. In three of these patients, intima hyperplasia, associated with narrowing of the stent lumen in two, was noted within 4 months after stent placement.
Adult↗