[Training programs for type 2 diabetes--where is the evidence?].
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Diabetes Mellitus, Type 2↗
Biomedical subjects
J E Müller
Publications and source records attributed to J E Müller.
Functional T lymphocytes infiltrate implanted polyvinyl alcohol foams during surgical wound closure therapy.
Vacuum-assisted closure involving the implantation of polyvinyl alcohol foam is a technique recently developed for the treatment of patients suffering from either wound infection or chronic wounds. This method has been shown to improve and accelerate wound healing. However, little is known about the cell populations that infiltrate the foam, and their potential role in resolving the infection and promoting granulation tissue formation. Our study demonstrates that wound-implanted foams are mainly infiltrated with granulocytes, but that mononuclear cells, including macrophages and minor populations of T, B and natural killer lymphocytes, are also present. We show that foam-infiltrating T cells, especially CD4(+) T cells, constitute a phenotypically and functionally heterogeneous population influenced by wound-infecting bacteria. Thus, T lymphocytes could play a role in wound cleansing. In addition, our data indicate that implanted polyvinyl alcohol foams might be suitable microenvironments for manipulating T cell-mediated immune responses in patients.
Adult↗
[Total intravenous anesthesia with methohexital-alfentanil or propofol-alfentanil in hypogastric laparotomy. Clinical aspects and the effects of stress reaction].
Total intravenous anaesthesia (TIVA) using a combination of a hypnotic and an analgesic agent is gaining increasing popularity as an alternative to balanced anaesthesia with volatile anaesthetics for abdominal surgery. Among the required characteristics of the drugs used in this technique are a good correlation between dose, plasma concentrations, and effect as well as rapid elimination from the circulation, allowing close control of anaesthetic depth. Two hypnotic drugs with similar pharmacokinetic and pharmacodynamic profiles are propofol and methohexitone, both of which can be employed as a component of a TIVA technique. Two TIVA combinations utilising either of these drugs with alfentanil were tested against isoflurane-nitrous oxide in a balanced regimen. METHODS. Twenty-seven healthy women undergoing hysterectomy for non-malignant diseases participated in the study after having given written consent. They were randomly allocated to receive either isoflurane (Iso), methohexital-alfentanil (M-A), or propofol-alfentanil (P-A). Blood samples for determination of cortisol, prolactin, catecholamines, glucose, lactate, non-esterified fatty acids, and pharmacon concentrations were drawn repeatedly from before induction until 360 min after surgery. Anaesthesia was induced in group Iso with fentanyl 0.1 mg and M 1.5 mg.kg-1 and maintained with Iso-N2O. In the TIVA groups M or P was given in a two-step infusion to load peripheral compartments and then maintain plasma concentrations within the hypnotic range. A was given as a continuous infusion in an identical dose (0.1 mg.kg-1 initial, 0.125 mg.kg-1.h-1 maintenance) in both groups. If signs of insufficient depth of anaesthesia occurred (heart rate or systolic blood pressure > 25% above baseline), then first A (0.5-1 mg), and if that was ineffective, then 50 mg hypnotic was administered. The A infusion was stopped 30 min before the end of surgery, and Iso or the hypnotic was stopped at skin closure. Recovery time was the time until the patients were able to give their birth date after stopping the Iso or hypnotic. RESULTS. The three groups were comparable with regard to age, weight, and duration of surgery. The total doses of M and P were 1,357 +/- 125 mg (mean +/- SEM) and 1,315 +/- 121 mg, respectively, and the total A doses were 20.7 +/- 2.5 mg (M-A) and 23.4 +/- 3.5 (P-A). The peak plasma concentrations were P 10.6 +/- 1.5 micrograms.ml-1 and M 12.4 +/- 2.6 micrograms.ml-1. At the end of surgery the P concentrations were in the projected range while those of M were somewhat lower than expected (P 3.7 +/- 0.4 microgram.ml-1; M 3.5 +/- 0.6 microgram.ml-1). Three patients each in the P-A and M-A groups required supplementary A injections. Five patients in the P-A group required additional bolus injections of the hypnotic as compared to 2 in the M-A group. The median recovery times were Iso 15 min, M-A 50 min, and P-A 25 min (P < 0.05). The incidence of shivering was Iso 3/9, M-A 5/9, and P-A 0/9 (P < 0.05); vomiting occurred with equal frequency in all groups (Iso 33%, M-A 33%, P-A 22%). The patients were somewhat more restless in group M-A. Systolic blood pressure dropped in a similar manner in all groups after induction of anaesthesia (Iso -31%, M-A -37%, P-A -36%) but recovered during surgery. The intraoperative response of cortisol (Iso + 216%, M-A +92%, P-A +43%) and catecholamines (noradrenaline Iso +56%, M-A +30%, P-A -21%) was lower in the TIVA groups, whereas prolactin increased after induction in all groups. Plasma concentrations of glucose, lactate, and fatty acids were lower in the TIVA groups than in the Iso group intraoperatively, but increased to comparable postoperative levels. CONCLUSIONS. Both TIVA regimens are acceptable alternatives to balanced anaesthesia with Iso N2O. (ABSTRACT TRUNCATED)
Adult↗
Effect of anaesthesia on the cytokine responses to abdominal surgery.
Plasma concentrations of interleukins, particularly IL-6, increase after trauma and surgery. We have undertaken this study to see if the choice of anaesthetic directly or indirectly influences cytokine release. Twenty women (ASA I-II, aged 26-60 yr) undergoing elective hysterectomy for non-malignant disease were allocated randomly to receive either inhalation anaesthesia with isoflurane and nitrous oxide (group 1), or total i.v. anaesthesia with alfentanil and propofol (group 2). Blood samples for measurement of interleukins IL-1 beta and IL-6, and cortisol and prolactin concentrations were obtained at intervals from before induction to 6 h after surgery. IL-1 beta concentrations did not change during the study. IL-6 increased significantly in both groups (P < 0.05). The IL-6 increase in group 1 began earlier than in group 2. Median IL-6 concentrations were greater in group 1 (median 62 (range 0-214) pg ml-1 vs 46 (0-220) pg ml-1) (P < 0.01). Cortisol concentrations increased more rapidly and reached greater maximum concentrations in group 1. Prolactin concentrations increased immediately and to the same degree after induction in both groups, but were greater in group 2 after operation. We conclude that anaesthesia with alfentanil and propofol diminished release of IL-6 in response to abdominal surgery compared with isoflurane and that this reduction was an effect of alfentanil.
Adult↗
[Indications, technique and results of muscle flaps in decubitus ulcers of the pelvic region in paraplegic patients].
Over a period of 10 years 57 pelvic pressure sores of 47 para- and tetraplegic patients were covered operatively with a muscle flap at the Co-Operative Trade Association Hospital for Accidents, at Tübingen, Germany. 39 patients with 49 muscle flap-covered decubiti were seen in a follow-up examination. Despite many postoperative complications--not uncommon for septic patients--there was a high rate of complete healing (94%) of the pressure sores within a short period of rehabilitation. Indeed one cannot prove the superiority of the muscle flaps over cutaneous and fasciocutaneous flaps because of the missing statistical comparability and correlation capability of the results with other studies. In our opinion muscle flaps in the pelvic area seem to be advantageous to cutaneous and fasciocutaneous flaps.
Adult↗
[C-reactive protein as infection parameter in clinically suspected postoperative infection after trauma surgery and orthopedic interventions. 2].
Prospectively the levels of C-reactive protein (CRP) of 40 patients were studied twice within 6-12 hours in case of a suspected infection after different osteosynthetic and orthopedic procedures and compared with the levels of the erythrocyte sedimentation rate (ESR). 16 patients showed an increase of CRP in relation to a wound infection, hematoma or effusion in all but one case. 6 patients showed an increase of ESR, which also could be cleared in all but one case. Those patients with a proved wound infection demonstrated a CRP-rise in 8 cases, a CRP-plateau in 4 cases and no CRP-decrease. The same patients showed an ESR-rise in 3, an ESR-plateau in 7 and an ESR-decrease in even 2 cases. This study indicates that the determination of two CRP-levels with a short interval in case of a clinically suspected infection is another, meaningful criterion in making a decision for an operative revision.
Blood Sedimentation↗
[Variability of the length and joint angle proportions of the distal radius].
The anatomical proportions of length and degree of joint-angles on the distal end of the radius and ulna show an wide variety in our population. 926 x-rays of "normal" and injured wrist-joints performed during 1984-89 were exactly measured and compared in respect to length and joint-angles of radius and ulna. Comparing the results with earlier reports in the literature it can be demonstrated that apparently there has been a remarkable change of the anatomical proportions in this region in the course of time and generations. The knowledge of the anatomical conditions is essential in acute traumatology as well as in corrections of posttraumatic wrist-deformities by osteotomy, bone grafting and internal fixation in regard to a posttraumatic restricted joint-function.
Adult↗
[C-reactive protein as a postoperative parameter of infection in hip joint replacement and knee joint operations].
Prospectively 70 male patients with elective arthroplasty of the hip (n = 34) and with operation of the anterior cruciate ligament (n = 36) were studied in respect of the postoperative screening of C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), the white blood cell count and the clinical signs of infection. There were 9 infectious postoperative complications, all with an increase of CRP. But also 6 other patients with no clear infection showed a rise or a plateau of CRP, which could only be explained by the presence of a hematoma, an effusion or a subclinical infection. The close postoperative screening of CRP appeared to be quite costly and laborious, especially in a population with a low infection rate. We therefore suggest a CRP-screening only on patients or operative procedures with wellknown high risk. In addition we studied the determination of two CRP-levels with a short interval following the clinical suspect of a postoperative infection (described in part II of this paper).
Adolescent↗
[Eponyms of distal radius fractures. Colles-Pouteau, Smith-Goyrand and Barton fractures and their importance in the trauma surgery patient sample].
Fractures at the distal end of the radius are quite common. So, these fractures are well known to represent consequences of industrial accidents leading to temporary unfitness for work, too. Eponym descriptions of fractures may mislead authors and readers as well if used in a non-uniform way in medical literature. Using the original articles of the first describing authors a clear distinction of eponyms concerning fractures near to the wrist joint is given. The authors of this feature report of the clinical experience in treatment and results of distal radius fractures in combination with aspects of expert opinions on these fractures.
Accidents, Occupational↗
[Injuries with severe soft tissue damage. Osseous defects--septic complications; plastic surgery management to osseous reconstruction].
Most of the severe soft tissue problems following open or closed fractures can be treated successfully by means of local or microvascular muscle flaps. Thus open fractures can be changed to closed fractures, or cases of high grade osteomyelitis can be transformed into non-infected or low-grade infected ones as a prerequisite for successful internal fracture fixation or bony reconstruction. Follow-up of 319 muscle flaps shows a low flap loosening rate (4%) and low overall complication rate (8%). The results demonstrate the high value and benefit of soft tissue reconstruction in trauma and reconstructive surgery.
Adolescent↗
[Interleukin-1 beta and interleukin-6-plasma concentrations in laparotomies. Interaction with neuroendocrine secretion and postoperative temperature regulation?].
Elevated body temperature, increased plasma cortisol concentrations, and loss of the circadian secretory pattern are typical changes observed after trauma and surgery. We investigated the hypothesis that the interleukins IL-1 beta and IL-6 are involved in these phenomena, since both are endogenous pyrogens and can induce ACTH and cortisol secretion. METHODS. Eight healthy women undergoing hysterectomy for non-malignant diseases participated in the study after having given written consent. The study had the approval of our institution's ethics committee. Anaesthesia was induced with fentanyl 0.1 mg and methohexitone 1.5 mg/kg and maintained with isoflurane in 60% N2O and 40% O2. Blood samples were drawn before induction, before incision, during surgery, at the end of surgery, and 30, 60, 120, 240 and 360 min after surgery. Cortisol, prolactin, IL-1 beta, and IL-6 concentrations were determined with commercially available ELISAs. Statistical analysis was performed with non-parametric methods. RESULTS. IL-6 increased significantly from 15 (4.3-23) to 68 (18-107) pg/ml (medians and range) at the end of surgery and peaked at 128 (52-214) pg/ml 60 min postoperatively (p < 0.01, Table 2). Baseline IL-1 beta concentrations were 20 (1-35) pg/ml with a significant increase in median postoperative concentrations in the postoperative period (p < 0.001). Prolactin increased from 22 (13-43) to 210 (115-291) ng/ml immediately after induction of anaesthesia (p < 0.001) and remained elevated until 240 min after surgery. Cortisol increased from 99 (26-167) to 384 (241-553) ng/ml during surgery and reached a maximum of 475 (246-597) ng/ml 30 min postoperatively (Table 3). Rectal and mean body temperatures increased significantly in the postoperative period (Table 1). There was a significant correlation between IL-6 and cortisol concentrations (r = 0.468; p < 0.001), but none was found between IL-6 and temperature or between IL-1 beta and cortisol or temperature. CONCLUSIONS. Surgical trauma markedly stimulates the secretion of IL-6, and to a lesser extent that of IL-1 beta. The data do not yield any evidence indicating an effect of IL-1 beta or IL-6 on body temperature. Postoperative prolactin concentrations might be influenced by IL-6. The positive correlation between plasma concentrations of IL-6 and cortisol may be coincidental, but could reflect a causal relationship, particularly in the postoperative period during which time the circadian pattern of cortisol secretion is disturbed.
Body Temperature↗
[Smith's fracture. A radiological and functional follow-up study of 62 primary and post-primary surgically treated fractures].
The reversed Barton fracture of the distal radius is rare. In the literature there is a rate of 3 to 20.5% of all distal radius fractures. Whereas the reposition is simple, the reduction is difficult. This retrospective report about the treatment by osteosynthesis in the years between 1977 to 1987 in the "Berufsgenossenschaftliche Unfallklinik" Tübingen demonstrates a direct correlation between radiological and functional results. That means in consequence that internal fixation by using a small palmar T-plate is the favorable therapy.
Adult↗
[Significance of microsurgery revascularized soft tissue and bone transplants in plastic reconstructive interventions of the extremities].
By using the fixateur externe in the fixation of bone fractures in the presence of heavily damaged soft tissue, we now have to tackle the challenge of adequate soft tissue coverage besides osteosynthesis of bone fracture. Free microvascular tissue transfer now increasingly replaces the previous method of management in which the soft tissue was reconstructed step by step. This technique is undoubtedly the solution for a lot of earlier problems, but now other questions have come up, particularly regarding time for tissue transfer. The article reports on the experience collected by us.
Adult↗
[The interposition technic. A possibility for avoiding the end-to- side technic in free microvascular myocutaneous flap transfer of the latissimus dorsi muscle].
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Fractures, Open↗
[Changes in the diagnosis and therapy of extrauterine pregnancy with special emphasis on ultrasound. Study at the Gynecologic Clinic of the Düsseldorf University, 1962-1983].
The diagnosis and therapy of ectopic pregnancy underwent a change with the introduction of ultrasound and the sensitive beta-hCG test. The modified management of ectopic pregnancy at the Department of Gynaecology of the University of Düsseldorf was analysed by examining the case history of 938 patients with suspected ectopic pregnancy from 1962-1983. The diagnosis ectopic pregnancy was confirmed for 348 patients (37%), whereas it was excluded in 590 cases (63%). The Pregnosticon test and the Gonavislide test yielded positive results in only little more than half of the cases with ectopic pregnancy. The Neo-Pregnosticon test was positive for 13 out of 15 patients. There was no ectopic pregnancy with a negative beta-hCG test (n = 31). Out of 261 patients examined by ultrasound, an ectopic pregnancy was proved directly four times. Sonographic pointers to an ectopic pregnancy were found with equal frequency in patients with confirmed ectopic pregnancy and in patients with excluded ectopic pregnancy (79%). In 17% of the patients with confirmed ectopic pregnancy this could not be detected by ultrasound. Out of 92 patients who had an ultrasound examination and a beta-hCG test, an intrauterine pregnancy could be excluded in spite of a positive pregnancy test in 94% of the ectopic pregnancies (n = 31) and in 31% of the cases with excluded ectopic pregnancy (n = 61). The incidence rate of ruptured tubule pregnancy was 44% before the introduction of ultrasound in 1973; it dropped subsequently to 37%. Since the introduction of the beta-hCG test in 1981 the incidence dropped further to 21%.(ABSTRACT TRUNCATED AT 250 WORDS)
Diagnosis, Differential↗
Sonographic measurements of the normal liver, spleen, pancreas, and portal vein.
Normal values and upper limits (95th percentile) of liver, spleen, pancreas, and portal vein size were determined prospectively with ultrasound in 915 healthy subjects. Sex, age, weight, height, and body surface area were determined in each case. Since correlation of longitudinal and transverse organ diameters with physical data was poor (r less than or equal to 0.3), the authors do not consider it necessary to correct the measurements accordingly. However, the liver is oriented longitudinally in slender subjects and transversely in heavy subjects; thus both longitudinal and anteroposterior diameters need to be measured, since the longitudinal diameter alone will give too high or too low a value, respectively.
Adolescent↗
[Real-time sonography of the arteries and veins of the epigastric region].
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Abdomen↗
[Real-time sonography of upper abdominal arteries and veins (author's transl)].
Improved resolution of new real time sonographic equipment permits demonstration and demarcation of vascular structures which could not be differentiated formerly. Successful differentiation frequency of upper abdominal vessels and establishment of optimal transducer position were investigated prospectively in 100 patients undergoing sonographic upper abdominal assessment. Aorta, inferior vena cava and their branches were identified in a high percentage. Portal vein contributaries could be demarcated in over 70%. Real-time sonography enables rapid assessment of vascular structures. Pulse and respiration dependent variations of calibre are a valuable means for differentiation.
Abdomen↗