[Imaging methods in the injuries of the elbow].
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Elbow Joint↗
Biomedical subjects
J Preis
Publications and source records attributed to J Preis.
Elevated serum levels of TNF-alpha, sTNF-RI and sTNF-RII in murine schistosomiasis correlate with schistosome oviposition and circumoval granuloma formation.
Levels of circulating tumour necrosis factor (TNF-alpha) and its soluble receptors are elevated in chronic human schistosomiasis. However, the kinetics of TNF-alpha production and release of its soluble receptors have not been studied in humans or animals. Here we report on increased levels of TNF-alpha and its soluble receptors in murine schistosomiasis, beginning with schistosome oviposition and circumoval granuloma formation. TNF-alpha, sTNF-RI and sTNF-RII were measured in sera of mice infected with Schistosoma mansoni each week for 10 weeks postinfection. TNF-alpha levels increased gradually in all mice during the first 3 weeks. From 6th week postinfection, TNF-alpha levels in infected mice increased steadily, whereas those of uninfected mice remained essentially unchanged. sTNF-RI levels fluctuated in all mice during the first 3 weeks, and increased in infected mice during the following 5 weeks. sTNF-RII levels were similar in all mice for the first 4 weeks but increased in infected mice throughout the remainder of the experimental period. These data may be helpful in understanding pathogenesis in schistosomiasis as TNF-alpha plays a crucial role in circumoval granuloma formation and adversely affects schistosome fecundity.
Animals↗
The marks, mechanisms and memory of epigenetic states in mammals.
It is well recognized that there is a surprising degree of phenotypic variation among genetically identical individuals, even when the environmental influences, in the strict sense of the word, are identical. Genetic textbooks acknowledge this fact and use different terms, such as 'intangible variation' or 'developmental noise', to describe it. We believe that this intangible variation results from the stochastic establishment of epigenetic modifications to the DNA nucleotide sequence. These modifications, which may involve cytosine methylation and chromatin remodelling, result in alterations in gene expression which, in turn, affects the phenotype of the organism. Recent evidence, from our work and that of others in mice, suggests that these epigenetic modifications, which in the past were thought to be cleared and reset on passage through the germline, may sometimes be inherited to the next generation. This is termed epigenetic inheritance, and while this process has been well recognized in plants, the recent findings in mice force us to consider the implications of this type of inheritance in mammals. At this stage we do not know how extensive this phenomenon is in humans, but it may well turn out to be the explanation for some diseases which appear to be sporadic or show only weak genetic linkage.
Agouti Signaling Protein↗
Complex patterns of inheritance of an imprinted murine transgene suggest incomplete germline erasure.
Here we report a transgenic mouse line that exhibits significant deviations from a classic pattern of parental imprinting. When the transgene is passed through the female germline, it is completely silenced in some offspring while in others expression is reduced. This variable expressivity does not appear to be the result of differences in the presence of unlinked modifiers. Female transmission of the transgene is associated with hypermethylation. The transgene is generally reactivated on passage through the male germline. Extended pedigrees reveal complex patterns of inheritance of the phenotype. The most likely explanation for this result is that the imprint is not completely erased and reset when passed through the germline of either sex. FISH analysis reveals that the transgene has integrated into chromosome 3 band E3, a region not known to carry imprinted genes, and the integration site shows no sign of allele-specific differential methylation. These findings, in conjunction with other recent work, raise the possibility that the introduction of foreign DNA into the mammalian genome, either through retrotransposition or transgenesis, may be associated with parental imprinting that is not always erased and reset during meiosis.
Animals↗
[Significance of the radial artery pulse in dislocated supracondylar fractures of the humerus in children].
The importance of palpable or non-palpable pulsation of the radial artery in children with supracondylar fractures of the humerus is still not correctly appreciated either in the practice or in the literature. Despite the relatively frequent occurrence both the diagnostic and therapeutic procedures are not yet uniform. The objective of this study was to evaluate retrospectively the importance of the pulsation of the radial artery in children with this injury treated in author's departments. Impaired pulsation was recorded in 24 of 244 children (9.8%). In all of 7 patients with impaired pulsation in the years 1984-1992 a vascular operation was made. On the other hand, during the period from 1993 till June 30, 1999, only 4 patients were thus operated on for this reason. In other 7 children pulsation was restored immediately after reposition and percutaneous pinning, while in the remaining 6 children with obstruction of the brachial artery confirmed by triplex Doppler examination pulsation was restored within 1-18 days, always without complications and sequelae. Based on their own results and data in the literature, the authors draw attention to the relative independence of the feared Volkmann's contracture on palpable or non-palpable pulsation of the radial artery and to the minor importance of urgent vascular reconstruction if the collateral circulation is satisfactory. In the case of patent circulation in the hand and forearm muscles a minimal invasive (closed) approach to treatment is possible in spite of concurrent obliteration of the brachial artery, just with reduction and percutaneous pinning of the displaced fracture with K-wires.
Brachial Artery↗
[Volkmann's contracture and suprcondylar fractures of the humerus in children].
The most frequent cause of the compartment syndrome with subsequent Volkmann's contracture of the upper extremity in children is a supracondylar fracture of the humerus. Often it is being associated by some with the concurrent injury and obliteration of the brachial artery. In the majority of cases of Volkmann's contracture in children with dislocated supracondylar fractures of the humerus, described in the available literature, the development of Volkmann's contracture was preceded by reduction of the fracture and fixation with bandage or in cast with the elbow in flexion. The aim of this study work was to evaluate the impact of specific methods of treatment on the development of Volkmann's contracture. No Volkmann's contracture was observed in a group of 257 patients with displaced supracondylar fracture of the humerus at the authors department from 1984 till 1999 while 7 children with obliteration of the brachial artery were successfully treated without an operation. The development of Volkmann's contracture can be successfully prevented for patients with the displaced supracondylar fracture of the humerus. Minimal elbow flexion, careful manipulation during closed reduction, stabilisation of fragments by percutaneous pinning and careful clinical follow-up are the crucial factors in the prevention of compartment syndrome in this context.
Child↗
Confidentiality and right to privacy issues in mental health managed care.
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Confidentiality↗
[Disorders of intestinal rotation and fixation in older children].
The authors discuss five older children where malrotation of the gut was diagnosed. The youngest child was three years old, the oldest 16 years. In three children the malrotation was diagnosed from clinical symptoms and examination by imaging methods, in two it was detected by chance during operation. In the two children where the impaired rotation of the gut was detected on operation, non-rotation was involved. In the remaining three children twice a left side paraduodenal hernia was diagnosed and once an external stenosis of the duodenum by Ladd's bands.
Adolescent↗
[Diagnosis and therapy of post-traumatic hemobilia].
The submitted case-history deals with a successfully diagnosed and treated case of post-traumatic hemobilia in a 13-year-old girl. Hemobilia was manifested clinically by the typical Sandblom triad of symptoms. It was due to a pseudoaneurysm of the peripheral arteriole of the hepatic artery diagnosed by selective liver angiography. In treatment selective intraarterial embolization of the supplying artery proved useful.
Abdominal Injuries↗
[Adnexal torsion in childhood].
During the 7-year period (1987-1993) the authors treated nine girls on account of torsion of the adnexa. In six girls torsion of primarily unaltered adnexa occurred, in one girl torsion of an ovary enlarged by a cyst and in two torsion of the ovary affected with a benign tumour, a coetaneous teratoma. In seven instances the organ affected with ischaemic necrosis had to be resected. In two girls detorsion of the ovary was performed, according to a sonographic control examination, however, in one the affected ovary atrophied. In the discussion the authors deal with the diagnosis of torsion of the adnexa and the method of treatment. The authors consider ultrasonic examination of organs of the abdominal cavity and retroperitoneum a very suitable method in all cases of abdominal pain in childhood, as this method can greatly contribute to the diagnosis of acute abdominal and gynaecological attacks. During surgery they recommend to preserve adnexa with a doubtful vitality because there is certain hope that they will be saved. During the postoperative period they recommend the long-term follow up of girls clinically and by ultrasonographic checks. If pathological changes are detected on the preserved adnexa, they recommend early re-operation and elimination of the risk factor (cysts etc.). The operation should be supplemented by prophylactic fixation of the preserved adnexa if this fixation was not done already during the primary operation.
Adnexal Diseases↗
[Comparison of the results of conservative and surgical therapy of dislocated supracondylar fractures of the humerus in children].
The authors evaluate retrospectively in a group of 121 children with a dislocated supracondylar fracture in 1984-1993 the results of different therapeutic methods. The highest percentage of excellent and satisfactory results was recorded in children treated by closed reposition with percutaneous pinning with Kirschner wires (88%). In open reposition with Kirschner wires 60% of the results were excellent of satisfactory. The lowest percentage of excellent and satisfactory results was recorded when fixation with a plaster bandage was used (48%). The highest percentage of poor results was observed in surgical reposition with internal fixation (37%). The cause of failure in the majority of patients is according to the authors inadequate reposition of fragments. The authors discuss different types of treatment. They recommend non-surgical reposition with percutaneous pinning, even for less dislocated extension supracondylar fractures of the humerus as well as for fractures complicated by vascular injuries.
Adolescent↗
[A solitary congenital hepatic cyst].
The author discusses a congenital, solitary, multilocular liver cyst in a two-year-old boy. The cyst originated in the margo ventralis of the right liver lobe. Clinically it was manifested by marked enlargement of the abdomen. The diagnosis was established by ultrasonography. The whole cyst was removed surgically.
Child, Preschool↗
[Conservative therapy of liver injuries in children].
During the 14-year period between 1979 and 1992 the authors treated by conservative methods nine children with liver injuries. They operated on four children. The liver injury did not bleed during operation or haemorrhage was only minimal and probably the patients would have also recovered after conservative treatment. In the discussion the authors mention diagnostic approaches in liver injuries and criteria and methods of conservative treatment. The authors consider conservative treatment of liver injuries in children to be a very suitable method which is associated only with a very small number of complications, and which proves successful in the majority of patients. The prerequisite for its application are high standard of diagnostic visualization methods, monitoring of the child's condition and the possibility of immediate surgery, if conservative treatment fails.
Adolescent↗
Giant Meckel's diverticulum.
A case of incomplete intestinal obstruction caused by a giant Meckel's diverticulum in a 13-year-old girl is reported. Short resection of the ileum with the diverticulum and end-to-end anastomosis was carried out. The possibilities of diagnosis and treatment as well as the controversial classification of this rare congenital anomaly are discussed.
Adolescent↗
[Epilepsy and intelligence. I. Intellectual status in a group of 215 ambulatory patients].
A group of 119 men and 96 women, mean age 32.8 years, with a mean onset of the disease at the age 13 years was examined by Wechsler's intelligence test for adults (Wechsler-Bellevue). They assessed the mean intellectual level, total IQ mean = 104.4, s = 15.3. The intellectual performance of female patients had roughly a normal distribution, in men it was shifted slightly to higher zones. The mean absolute difference of the verbal IQ and performance IQ was mean = 8.4, s = 7.0, median = 7. The results are consistent with some more recent data in the literature on good intellectual abilities of the majority of epileptic subjects. The authors discuss the causes of frequent erroneous ideas of laymen and health professionals on an association of epilepsy and intellectual inadequacy. Among others there persists prejudice, problems of patients as regards memory, problems in the psychosocial sphere, psychopathological manifestations, adverse side-effects of drugs, sequelae of transient impairment of consciousness manifested clinically by short-term reduced performance. Real impairment of epileptic patients are assessed best by special neuropsychological methods, however, evaluation of intellectual abilities is necessary.
Adult↗
[The significance of endoscopic retrograde cholangiopancreatography in the diagnosis of pancreatic injuries in children].
The condition of the main pancreatic duct determines very probably in a decisive way the fate of posttraumatic pancreatic pseudocysts and acute pancreatic injuries. Endoscopic retrograde cholangiopancreatography is the only diagnostic method which makes possible to evaluate the condition of this duct. The authors performed ERCP in three children, in two of them an internal drainage of the pseudocyst was carried out on account of verified ductal rupture. In the third girl, after evidence of an intact main pancreatic duct, conservative therapy was successfully applied. In the discussion the authors summarize data from the literature regarding the use of ERCP in the preoperative diagnosis of posttraumatic pancreatic pseudocysts and acute pancreatic injuries. The authors consider ERCP a method which renders the diagnosis of posttraumatic pancreatic pseudocysts and acute pancreatic injuries more accurate.
Adolescent↗
[Diagnostic value of the rectal examination and the difference in axillo-rectal temperatures in acute appendicitis in childhood].
The authors deal with the importance of pain in the Douglas space during rectal examination and the contribution of the axillo- rectal difference in temperature in the diagnosis of acute appendicitis in a group of 402 children operated on who had the above preoperative diagnosis. Marked pain in the Douglas space was recorded in 53.6% children and complete absence of pain in 31.2% of the children with acute appendicitis proved at operation. In children where so-called negative laparotomy was performed this ratio was reversed. When evaluating the axillo-rectal difference in temperature the authors reached the paradoxical conclusion that an obviously physiological difference in the axillo-rectal temperature (up to 0.5 degrees C) was slightly more frequent in acute appendicitis than in negative laparotomy. An obviously pathological difference (1 degrees C or more) was three times more frequent in patients with negative laparotomies than in acute appendicitis. Next the authors discuss views reported in the literature where data on the asset of rectal examination in acute appendicitis vary between 2.9-73%. In the conclusion the authors recommend rectal examinations in all children with suspicion of any type of acute abdomen, however, taking into account that pain in the Douglas space will contribute only little to the reduction of the number of negative laparotomies. They consider assessment of the axillo-rectal difference in temperature practically useless.
Acute Disease↗
[Air gun injuries in children].
The authors describe four cases of air rifle child injuries. One was a potentially lethal injury, a penetrating wound of the transverse colon and injury to the stomach. During urgent laparotomy the perforations of the gastrointestinal tract were sutured. In the remaining three children the injuries were less serious and affected soft tissues. In the discussion the authors summarize data from the literature concerning injuries to the head, neck, chest, abdomen and extremities, incl. lethal injuries. In instances when a penetrating abdominal injury cannot be ruled out, the authors emphasize the necessity of urgent laparotomy and surgical treatment of possible intraabdominal lesions. In injuries to other parts of the body a strictly individual procedure focused on repair of the injury is indicated. The authors also emphasize prevention of these injuries by adherence to safety during shooting and other manipulations with arms an air rifle must not be a toy for children and adolescents unless they are supervised by a responsible adult.
Adolescent↗