PubMed Health⌕ Search

Biomedical subjects

H Gruber

Publications and source records attributed to H Gruber.

At least 19 recordsLinked to original sources
PubMed2003

Computer assisted learning in medicine: a long-term evaluation of the 'Practical Training Programme Dermatology 2000'.

In recent years, numerous computer assisted learning (CAL) programmes based on new teaching methods, as for example the principles of cognitive apprenticeship and problem based learning, have euphorically been developed for various medical fields. However, many of these programmes failed due to either low acceptance, economic inefficiency, or, most seriously, problems with the implementation and evaluation in medical curricula. In 1999, the practical training course 'Dermatology 2000', an interactive multimedia programme for dermatological education, was developed and completely integrated into the regular dermatological curriculum of five German medical schools. The formative evaluation of an implemented relational database revealed contemporary information about the programme's quantity of use. So far, 3050 students have participated in 6557 lessons. The evaluation of two online questionnaires showed a high learner acceptance regarding the programme's instructional design, ergonomics, and didactical presentation and, after completion of Dermatology 2000, an increased interest in medical education software. A comparison of the objective learning outcome illustrated that Dermatology 2000 students (n = 31) not only outperformed non-participants (n = 7) but also showed a (10%) lower rate of errors in a conventional knowledge test. Additionally, single-case studies demonstrated the increased ability of participating students to apply the acquired knowledge to diagnostic problems. We conclude that the implementation of CAL in present medical curricula can contribute to reformations of medical education. The instructional design of Dermatology 2000 is well accepted and suitable to provide both theoretic biomedical knowledge and clinical skills.

Computer-Assisted Instruction↗
PubMed2002

[Stress fractures in athletes].

Stress fractures may pose a diagnostic dilemma for radiologists since they are sometimes difficult to demonstrate on plain films and may simulate a tumour. They were first described in military personnel and professional athletes. Recently, there is an increasing incidence in the general population due to increasing sportive activities. Stress fractures occur most often in the lower extremities, especially in the tibia, the tarsal bone, the metatarsal bone, the femur and the fibula. In the upper extremities, they are commonly found in the humerus, the radius and the ulna. Some fractures of the lower extremities appear to be specific for particular sports, for example, fractures of the tibia affect mostly distance runners. Whereas stress fractures of the upper extremities are generally associated with upper limb-dominated sports. A correct diagnosis requires a careful clinical evaluation. The initial plain radiography may be normal. Further radiological evaluation could be performed by means of computerised tomography, magnetic resonance imaging and bone scanning. The latter two techniques are especially helpful for establishing a correct initial diagnosis.

Arm Injuries↗
PubMed2002

[Art therapy: development and evaluation of an observation instrument to systematically analyze patients' paintings from oncology and rheumatology].

INTRODUCTION: Art therapies have been established methods in oncology for many years. To what extent patients' pictures can be systematically described, and what connections to various illnesses are possibly thereby revealed, has been discussed in various specialized medical fields for over a hundred years. The following paper first presents insight into the present stand of research and then presents the results of the study. QUESTION: Are systematic analyses of pictures possible with the use of the instrument we have developed? Are pictorial differences evident within the researched group? METHOD: A previously developed instrument was submitted for expert questioning for the purpose of the study. The instrument that had been modified on the basis of these results could then be used in the study to interpret 162 pictures. Four different raters, three of whom were acquainted with neither the patients nor the pictures, interpreted these pictures independently of one another. RESULTS: The evaluation of the expert interpretations shows that this newly developed instrument is suitable for the differentiated description of patients' pictures. First important indications were drawn in regard to the pictorial differences between the two examined groups of cancer patients and patients with chronic polyarthritis. CONCLUSION: Systematic picture analyses are possible. A further analysis of the expert interpretations is necessary to clarify questions raised by the pictorial differences found in the various diagnostic groups.

Adult↗
PubMed2001

New, simple, ultrasound-guided infiltration of the pudendal nerve: topographic basics.

PURPOSE: We report the topographic relationship of the pudendal nerve to the accompanying pudendal vessels and the ischial spine and provide the basics for an ultrasonographic depiction of these structures. METHODS: Twenty-nine female and 29 male adult human cadavers were positioned prone to expose the deep gluteal region. In 58 left and 58 right pelves the course of the pudendal nerve and vessels at the ischial spine were evaluated and analyzed statistically (n = 116). RESULTS: Multitrunked pudendal nerves were found in 40.5 percent with a left-vs.-right ratio of 1:1.5. The diameters of the single-trunked nerves ranged from 1.3 to 6.8 (mean 3.6 +/- 1.1) mm. In 75.9 percent the pudendal nerve was found medial to the accompanying internal pudendal artery. The distance to the artery ranged from 17.2 mm medial to 8 mm lateral (mean, 3.4 mm medial +/- 4.1 mm). The distance to the tip of the ischial spine ranged from 13.4 mm medial to 7.4 mm lateral (mean, 2.1 mm medial +/- 3.7 mm). CONCLUSIONS: The knowledge of the close spatial relationship between the pudendal nerve and the internal pudendal artery is important for any infiltration technique and even surgical release. It demands real-time, visually controlled infiltration techniques, such as with ultrasound.

Aged↗
PubMed2001

New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique.

PURPOSE: Anesthetic infiltration of the pudendal nerve at the ischial spine can relieve perineal pain in cases of compression or distention. The aim of our study was to look for a real-time, visually controlled infiltration technique using ultrasound. METHODS: Fifty-three volunteers were examined in a prone position using a 3.5-MHz curved-array probe in color-coded Doppler mode. The deep gluteal region was scanned in two perpendicular planes, longitudinal and transverse to the internal pudendal artery. RESULTS: On the transverse planes the ischial spine, the sacrospinous ligament, and the internal pudendal artery were depicted in all but two cases. In 47.2 percent of the cases one trunk of the pudendal nerve was detected directly. Nerves consisting of more than one trunk were not found. The thickness of the nerve ranged between 3.5 and 7 mm. CONCLUSIONS: In almost one-half of the cases a direct ultrasound-guided infiltration of the pudendal nerve is possible. In the remaining cases the nerve can be detected and blocked indirectly, using the ischial spine or the internal pudendal artery as a landmark.

Adolescent↗
PubMed2001

The precision of ultrasound imaging and its relevance for carpal tunnel syndrome.

The carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy in human. The diagnosis is based on symptoms and on physical examination and is supported by nerve conduction tests. The aim of this study was to evaluate the precision and the valence of ultrasound (US) for CTS. An anatomic study was performed on 40 wrists of 20 unfixed human cadavers. The carpal tunnel and its important structures and contents were imaged and measured by ultrasound (7.5-MHz high resolution probe). The dorsopalmar diameter (DPD), the radioulnar diameter (RUD), the perimeter (P) and the cross-sectional area (A) were determined for the carpal canal and for the median nerve. These US images and measurements were directly compared with anatomic cross-sections gained from the same wrists at the same level. Our results showed that ultrasound is a very precise method to display the anatomy of the carpal tunnel and of the median nerve and thus the conditions of the median nerve. Significant differences could not be detected for each of these parameters either for the carpal tunnel or the median nerve. (Ultrasound: cross-sectional area of carpal tunnel: 162.4 +/- 29.3 mm2 and of the median nerve: 9.2 +/- 2.4 mm2; anatomy: cross-sectional area of carpal tunnel: 168.4 +/- 31.2 mm2 and of median nerve: 9.4 +/- 2.2 mm2).

Aged↗
PubMed2001

The different growth zones of the fetal foot.

Previous publications revealed no reliable data or models concerning the three-dimensional ontogenesis of the lower extremity. Using the method of plastination-histology in combination with 3D-computer-reconstructions we were able to produce exact, virtual 3D-specimens of 19 healthy fetal feet. The fetuses were aged between 9 to 38 weeks of gestation and age-dependently related to four defined age-groups. We compared these feet with the help of a new geometrical method. Thus, we obtained a kind of "slow-motion-picture" of the undisturbed three-dimensional development of the fetal foot. Our results show that the human fetal foot has a desultory mode of growth and that growth priorities within the foot-skeleton change dependent upon age and region. Though the growth of the fetal foot-skeleton is desultory, it is not disconnected. The result of this peculiar mode of growth is to create the foot arches and thus seems to be functionally-oriented toward the human foot's specific purposes.

Abortion, Induced↗
PubMed2000

Flow cytometric analysis of intracellular IFN-gamma, IL-4 and IL-10 in CD3(+)4(+) T-cells from rat spleen.

The application of multi-parameter flow cytometry for the assessment of T-cell and cytokine functioning has been used by several groups for studying human and mouse samples, although little has been reported for the rat. Here we report the optimisation of immunofluorescent staining for cell surface and intracellular antigens using three-colour flow cytometric analysis to measure the frequency of rat CD3(+)4(+) T-cells that produce IFN-gamma, IL-4 and IL-10. In vitro stimulation of IFN-gamma production required incubation of splenocytes with PMA and ionomycin in the presence of the protein transport inhibitor brefeldin A for 6 h. Three stimulation protocols for IL-4 and IL-10 production were evaluated. In vitro priming of splenic T-cells with antibodies against CD3 and CD28 and recombinant cytokines (IL-2 and IL-4) for 5 days followed by restimulation with PMA and ionomycin was required to stimulate cells to produce either IL-4 or IL-10. Brefeldin A was found to be a more suitable protein transport inhibitor than monensin. This method will be useful for analysing the nature of individual rat cytokine-producing cells in a variety of experimental model systems.

Animals↗
PubMed2000

Morphometric and functional results after CO(2) laser welding of nerve coaptations.

BACKGROUND AND OBJECTIVE: Several reports describe nerve coaptations by laser welding in combination with stay sutures and bonding material. This study was undertaken to obtain functional and morphologic information by using a nerve coaptation technique by epineurial CO(2) laser welding only. STUDY DESIGN/MATERIALS AND METHODS: The sciatic nerves of 24 rats were transected and epineurially coapted with the CO(2) laser at 60 mW or with microsutures as a control. Walking track analysis were carried out to evaluate the functional recovery, and the nerves were harvested for histology after 6 months of regeneration. RESULTS: None of the 24 nerves showed dehiscence of the coaptations, and all showed good nerve fiber regeneration. Better results were obtained for the functional evaluation of the sciatic function index (P < 0.02) and the toe spread index (P < 0.04) from the laser nerve coaptations. Likewise, the morphologic evaluations of the fiber density (P < 0.04) and area fraction (P < 0.002) were better in the laser group. CONCLUSION: CO(2) laser welded nerve coaptations are as successful as their sutured counterparts and may become a promising alternative in clinical practice.

Animals↗
PubMed2000

Hydrolysed casein diet protects BB rats from developing diabetes by promoting islet neogenesis.

Feeding diabetes-prone BioBreeding (BBdp) rats a hydrolysed-casein (HC)-based semi-purified diet results in two-to-three-fold fewer diabetes cases compared with feeding cereal-based diets such as NIH-07 (NIH). We showed previously that young NIH-fed BBdp rats had decreased islet area at a time when classic insulitis was minimal. Rats fed an HC diet maintained near normal islet area followed 3-4 weeks later by a deviation of the pancreas cytokine pattern from Th1 to Th2/Th3. This finding raised the possibility that BBdp rats were more susceptible to diet-induced changes in islet homeostasis. To investigate this possibility further, BBdp rats were fed an NIH or HC diet from days 23 to 45. Bouin's fixed sections of pancreas were stained with H & E or antibodies for insulin and glucagon. Cell proliferation nuclear antigen (PCNA) was used as a marker of cell proliferation and cells were stained for putative markers of islet neogenesis, cytokeratin 20 (CK20) and Bcl-2. Apoptotic bodies were recognized by morphological features and by TUNEL-positive staining. BBdp rats fed an HC diet had a significantly higher beta-cell fraction than rats fed NIH, whereas alpha-cell fraction and beta-cell size were not affected by diet or rat type. Apoptotic bodies of beta-cells were rare and unaffected by diet. The number of PCNA(+)beta-cells was not affected by diet. CK20 expression was localized in the ductular system and at the periphery of islets in rats aged 7 and 45 days. There were more CK20(+)islets in BBdp rats fed NIH than in those fed HC but the CK20 area fraction was unaffected by diet. Bcl-2 expression was scattered among ducts and central acinar cells. The number of extra-islet insulin(+)and glucagon(+)clusters (<four cells) was significantly higher in animals fed the HC diet compared with those fed NIH. Most of the insulin(+)clusters were also homeodomain-containing transcription factor pancreas duodenum homeobox gene-1 (PDX-1) positive. Glucagon(+)/PDX-1(+)clusters were rarely found. These data are consistent with a shift in pancreas homeostasis that maintains islet cell mass by increased islet neogenesis, a process that was enhanced in animals fed a diabetes-retardant diet.

Animals↗
PubMed2000

Case report: human neonatus with spina bifida, clubfoot, situs inversus totalis and cerebral deformities: sequence or accident?

An unreported coincidence of malformations has been studied by anatomical dissection in a mature male fetus. Auxiliary, this fetus was examined by computed tomography and the skeletal malformations were three-dimensionally reconstructed. The organs of the thorax as well as of the abdomen showed a visceral inversion. In the lumbar region, a hyperkyphosis was detected in addition to a split-notochord. A hydrocephalus internus with enlarged lateral ventricles and an agenesis of the corpus callosum were apparent. The lower extremities were dystrophic with both showing a talipes equinovarus-deformation. Following the case report, we discuss if this is coincidental or manifestations in consequence of one defect.

Abnormalities, Multiple↗
PubMed2000

The sensitivity of the nipple-areola complex: an anatomic study.

Although preservation of the sensitivity of the nipple and areola is an important goal in breast surgery, only scant and contradictory information about the course and distribution of the supplying nerves is found in the literature. The existing controversy might be due to the difficulty in dissecting the thin nerves and to frequent anatomic variations that bias the results if only a small number of cadavers are dissected. We dissected 28 female cadavers and found that the nipple and areola were always innervated by the lateral and anterior cutaneous branches of the 3rd, 4th, and 5th intercostal nerves. The most constant innervation pattern was by the 4th lateral cutaneous branch (79 percent) and by the 3rd and 4th anterior cutaneous branches (57 percent). The anterior cutaneous branches took a superficial course within the subcutaneous tissue and terminated at the medial areolar border in all dissected breasts. The lateral cutaneous branches took a deep course within the pectoral fascia and reached the nipple from its posterior surface in 93 percent of the dissected breasts. In 7 percent of the dissected breasts, the lateral cutaneous branches took a superficial course within the subcutaneous fat and reached the nipple from the lateral side. These findings suggest that the nerves innervating the nipple and areola are best protected if resections at the base of the breast and skin incisions at the medial areolar border are avoided.

Female↗
PubMed1999

External oblique abdominal muscle: a new look on its blood supply and innervation.

Numerous reports have discussed the use of the external oblique abdominal muscle as a pedicled or a free flap for defect coverage. A detailed description of the supplying vessels and nerves is a prerequisite for successful tissue transfer but so far is not available in the literature. A study of the arteries and nerves supplying the external oblique abdominal muscle was carried out in 42 cadavers after injection of a mixture of latex and bariumsulfate. In seven fresh cadavers the motor branches were identified with the Karnovsky technique. Three different groups of arteries were identified as the nurturing vessels. The cranial part of the muscle is supplied by two branches of the intercostal arteries. While the lateral branches run on the outer surface of the muscle together with the nerves, the anterior branches enter the muscle from its inner surface. The caudal part of the muscle derives its main blood supply from one or two branches of the deep circumflex iliac artery (94.7%) or the iliolumbar artery (5.3%). The external oblique abdominal muscle is innervated by motor branches of the lateral cutaneous branches of the anterior spinal nerves in a segmental pattern. With the exception of the subcostal nerve the motor branches enter the outer surface of the muscle digitation arising from the rib above. The results show that the cranial half of the external oblique abdominal muscle has a strictly segmental blood and nerve supply while the caudal half of the muscle derives its main blood supply from one artery but still shows a segmental innervation.

Abdominal Muscles↗
PubMed1999

[Gorham-Stout idiopathic osteolysis--a local osteoclastic hyperactivity?].

One rare case of so-called massive idiopathic osteolysis Gorham-Stout is presented. In a 77-year-old female patient the whole right femoral head and neck of femur was resorbed within 2.5 month following trauma. As a histologic cause for the osteolysis, a marked stimulation of osteoclasts on the spongiosa, especially intracortically, was observed. The course and the clinical findings are described, and the pathogenesis and treatment are discussed in comparison with the present literature. The results suggest that an early antiresorptive therapy (calcitonin, bisphosphonates) could stop the progressive osteolytic changes.

Aged↗
PubMed1999

Chemical stability of silicone oil in the human eye after prolonged clinical use.

OBJECTIVE: To investigate the assumption that silicone oil is chemically stable in the human eye after prolonged clinical use as a vitreous substitute. DESIGN: Experimental study. MATERIAL: Samples of silicone oil recovered from the vitreous cavities of 25 consecutive patients up to 26 months (mean, 9.2 months) after implantation and 4 different batches of original highly purified silicone oil with a kinematic viscosity of 5000 mPa.s were analyzed. Visible silicone oil emulsification was present in 18 of the 25 eyes. INTERVENTION: Gas chromatography/mass spectroscopy (GC/MS) was used to detect and characterize low-molecular weight components (LMWC). Gel permeation chromatography (GPC) was used to determine the molecular weight distribution of the silicone oils. Functional groups of the silicone oils were quantified and characterized by infrared (IR) spectroscopy and 1H nuclear magnetic resonance (1H NMR) spectroscopy. MAIN OUTCOME MEASURES: The sample oils explanted from the eyes were compared to the original oils with regard to LMWC, molecular weight distribution, and type and amount of functional groups. RESULTS: The GC/MS chromatograms showed no peaks indicative of LMWC in any of the 25 sample oils explanted from the eyes or any of the original oils. In the GPC chromatograms, the peak position occurred at the same retention times with identical signal shape in all original and sample oils, indicating that the molecular weight and the molecular weight distribution did not change after prolonged implantation. The IR spectroscopy and 1H NMR spectroscopy showed characteristic absorption bands at 1260 cm(-1) related to symmetric deformation vibration of the Si-CH3 group and at 800 cm(-1) related to the Si-(CH3)2 group. This was identical for all sample and original oils. CONCLUSIONS: Highly purified 5000-mPa.s silicone oils, used as prolonged retinal tamponades in patients with proliferative vitreoretinopathy, proliferative diabetic retinopathy, and tractional retinal detachment after central retinal vein occlusion, are chemically stable in the human eye and do not undergo chemical modification. The LMWC do not play a substantial role in the variations of oil emulsification.

Adult↗
PubMed1999

The nerve of Henle: an anatomic and immunohistochemical study.

The topography of the nerve of Henle was reviewed. Fifty-two human cadaveric upper extremities were studied. In 30 (58%) the nerve was well defined; in 22 (42%) its origin from the ulnar nerve was unidentifiable. The palmar cutaneous branch of the ulnar nerve separated from the ulnar nerve 5 to 11 cm distal to the medial epicondyle of the humerus to divide into its terminal branches in the distal forearm. Four patterns were detected: ulnar, radioulnar, vessel-related, and radial. These shared a consistent vascular branch, which sent 2 branches to the ulnar artery just proximal to the distal ulnar tunnel. Using a tyrosine hydroxylase antibody-based immunohistochemistry technique the nerve was shown to carry sympathetic fibers. Motor fibers were ruled out with Karnovsky's stain, which was used in combination with the tyrosine hydroxylase method in 10 specimens.

Adult↗
PubMed1999

regA, a Volvox gene that plays a central role in germ-soma differentiation, encodes a novel regulatory protein.

Volvox has two cell types: mortal somatic cells and immortal germ cells. Here we describe the transposon-tagging, cloning and characterization of regA, which plays a central role as a master regulatory gene in Volvox germ-soma differentiation by suppressing reproductive activities in somatic cells. The 12.5 kb regA transcription unit generates a 6,725 nucleotide mRNA that appears at the beginning of somatic cell differentiation, and that encodes a 111 kDa RegA protein that localizes to the nucleus, and has an unusual abundance of alanine, glutamine and proline. This is a compositional feature shared by functional domains of many 'active' repressors. These findings are consistent with the hypothesis that RegA acts in somatic cells to repress transcription of genes required for growth and reproduction, including 13 genes whose products are required for chloroplast biogenesis.

Algal Proteins↗