[The patient as partner -- observations regarding a respectful relationship with sick people].
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Empathy↗
Biomedical subjects
K Rösler
Publications and source records attributed to K Rösler.
[Hereditary liver diseases].
In recent years the identification and characterization of gene defects underlying hereditary liver diseases lead to a better understanding of their pathogenesis. Heditary hemochromatosis, Wilson's disease and alpha1-antitrypsin deficiency are the most common hereditary liver diseases. While gene defects and disease manifestation may correlate, genetic testing is generally not contributing to diagnosis. This review summarizes the clinical manifestations, diagnosis and therapy of the most frequent hereditary liver diseases: hereditary hemochromatosis, Wilson's disease and alpha1-antitrypsin deficiency.
Algorithms↗
[The role of the virus specific T-cell response in acute and chronic HBV and HCV infection].
Infections with hepatitis B (HBV) and hepatitis C virus (HCV) are worldwide one of the most frequent causes for chronic liver disease, liver cirrhosis and hepatocellular carcinoma. The mechanisms responsible for the elimination or the persistence of the virus are not well understood. The immunopathogenesis of HBV and HCV infection is primarily mediated by virus specific CD4+- and CD8+-T-cells. During acute infection a strong and multispecific T-cell response against different viral epitopes can be detected and is associated with the clearance of the virus. In case of viral persistence virus specific T-cells contribute to liver inflammation. In this article we summarize the current concepts about the role of the virus specific T-cell response in acute and chronic HBV and HCV infection.
Animals↗
Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. Do short-term results predict long-term outcome?
OBJECTIVE: Long-term evaluation of efficacy and quality of life after radical surgical approach for myasthenia gravis (MG). Comparison between short-term follow-up and long-term outcome. METHODS: All patients (n=26, 16 men and 10 women, mean age: 40.7 years) underwent total transsternal thymectomy for MG between 1986 and 1989. Prospective analysis of the patients for short-term follow-up (mean 22.4 months) was published in 1991. The same group of patients was reevaluated in 2001 (range of follow-up 11.4-15.2 years) and assessed according to the classification of Osserman and Oosterhuis. RESULTS: Mean follow-up was 13.0 years (range 11.4-15.2 years). Two patients were lost from follow-up and one died 4 years after thymectomy for reasons unrelated to MG (n=23). No early or late postoperative mortality was observed. One sternal osteomyelitis occurred. Late postoperative morbidity included sternal instabilities (n=2), mild residual thoracic pain (n=6), and hypertrophic scars (n=7). Five patients were rehospitalized for aggravating MG and needed plasmapheresis (n=3) and intubation (n=1). Thirteen patients (56.5%) showed objective clinical improvement, including six patients (26.1%) with complete remission. Eleven patients (47.8%) do not take any medication at all. Because some late relapse may occur several years after operation, the rate of improvement decreased slightly, whereas the difference between short and long-term follow-up was not statistically significant (P=0.405). Twenty patients (87%) returned to work, including part-time occupation (n=4). Fourteen patients (61%) are performing sports regularly. CONCLUSIONS: Our data confirm that radical, transsternal thymectomy is an effective and safe therapeutic modality for MG. Short-term results seem to deteriorate over time, therefore long-term studies for minimally invasive approaches have to prove equal results before replacing the standard procedure.
Adolescent↗
First clinical application of a newly developed device for intragastric surgery for the treatment of pancreatic pseudocysts.
BACKGROUND: Instruments that have been used during GI endoscopy have always been confined to the accessory channel of the endoscope. We have therefore developed a device that allows transabdominal manipulation in the stomach under gastroscopic control. Here we report the first clinical application of this device, which was used for the drainage of pancreatic pseudocysts. METHODS: The device is similar to a PEG tube and consists of a 7 mm polyethylene tube that is inserted by the "thread pull through" method. A trocar valve is mounted at the external tip of the tube. Four pseudocysts were treated in three patients. The retrogastric pseudocysts were punctured through the device under endoscopic (n = 2) and CT (n = 2) guidance. External drainage was used for 3 to 5 days; thereafter the drain was cut and internalized. The device was also cut and sealed. After 10 days it was removed as with a standard PEG tube. RESULTS: No complications related to the device occurred. In two patients the pseudocysts resolved completely. One patient had to undergo pseudocystojejunostomy for an infected pseudocyst containing large amounts of necrotic material. CONCLUSIONS: We believe that our new device is valuable to the further development of intragastric surgery and can be used to safely perform pseudocystogastrostomy.
Adult↗
ISDN based teleradiology and image analysis with the software system KAMEDIN.
This contribution describes the software system KAMEDIN (Kooperatives Arbeiten und MEdizinische Diagnostik auf Innovativen Netzen) that is designed as an ISDN based computer supported cooperative work (CSCW) tool for usage in medical diagnostics. Medical image data from various sources (for example CT and MR) can be interchanged and analyzed in bilateral teleconferences via ISDN. During a cooperative session, user interactions for image processing etc., are synchronized and performed on both workstations, Features like telepointing, remote control, and audio connection enhance communication quality. With ISDN as a transmission line, widespread availability and low communication costs are achieved. Further, automatic tissue labeling in intracranial MR data can be invoked. For this purpose, artificial neural network classifiers such as multilayer perceptron and Kohenen feature map are integrated. Classification results can be viewed as 3D-reconstructions.
Brain Diseases↗
[Trans-sternal thymectomy in myasthenia gravis].
Between 1986 and 1989 27 patients with myasthenia gravis underwent radical thymectomy: 24 patients without and two patients with thymoma through a trans-sternal incision, another with thymomatous myasthenia through a left-sided thoracotomy. The patients were staged according to the modified Ossermann classification. The results were evaluated prospectively according to the Disability Status Scale of Oosterhuis. During a mean follow up of 22.4 months, 21 patients (77%) benefited from the operation with complete remission achieved in 9 (33%) and significant improvement noted in 12 (44%). There were no operative deaths and no hospital morbidity. The mean operation time was 88 minutes, the mean postoperative hospital stay 10.5 days. These results support the recommendation for radical trans-sternal thymectomy in the treatment of patients with myasthenia gravis as a safe procedure.
Adolescent↗
Structural changes in skeletal muscle tissue with heavy-resistance exercise.
Muscle strength, muscle cross-sectional area, fiber size, fiber type distribution, capillarity, and mitochondrial volume were estimated before and after 6 weeks of heavy-resistance exercise. Isokinetic torque production of the knee extensor muscles increased by a total of 17.6%, mainly during the first half of the training period. The cross-sectional area of the vastus lateralis muscle increased by 8.4%, mainly during the second half of the training period. Morphometrically determined fiber size, fiber type distribution, and capillarity from biopsies of vastus lateralis did not change significantly with training. Likewise, the surface densities of inner and outer mitochondrial membranes as well as the volume density of myofibrils remained unchanged. In contrast, the volume density of mitochondria decreased by 9.6%. However, due to the increase in total muscle volume, the calculated absolute volume of mitochondria remained constant, whereas the absolute volume of myofibrils increased by 10%. It is concluded that strength training of short duration in previously untrained young male subjects does not change the ultrastructural composition of mitochondria and that the apparent dilution of mitochondria can quantitatively be accounted for by the increase in myofibrillar volume.
Adenosine Triphosphatases↗
Specificity of leg power changes to velocities used in bicycle endurance training.
Increases in leg power production resulting from 8 wk of bicycle endurance training (30 min/day, 5 times/wk) were studied using an isokinetic dynamometer. In addition, biopsies of vastus lateralis were analyzed to characterize muscle ultrastructural changes. Performance increased on the dynamometer specifically near the estimated average knee angular velocity used during the bicycle training (200 degrees/s). Power measurements were made during the first 5 contractions (maximal power: Pmax) and last 5 contractions (final power: Pend) of 25 and 50 consecutive contractions (at 60 and 240 degrees/s, respectively). Pmax and Pend increased only at 240 degrees/s but not at 60 degrees/s. These increases in Pmax (86 W) and Pend (78 W) resulted primarily from longer torque maintenance but also from increased peak torque during each contraction and were close to the increase in mechanical power output maintained on the bicycle (Pb; 78 W) during the training sessions. The specificity of these changes to the angular velocities used in the bicycle training indicates a neural basis to these adaptations. We suggest that these neural adaptations, coupled with the observed enhancement of muscle mitochondrial and capillary density (+41 and +15%, respectively) underlie the increased ability to maintain power production on a bicycle after endurance training.
Adult↗
Transfer effects in endurance exercise. Adaptations in trained and untrained muscles.
The effects of 8 weeks of bicycle endurance training (5 X /week for 30 min) on maximal oxygen uptake capacity (VO2max) during arm and leg ergometry, and on the ultrastructure of an untrained arm muscle (m. deltoideus), and a trained leg muscle (m. vastus lateralis) were studied. With the training, leg-VO2max for bicycling increased by +13%, while the capillary per fiber ratio and the volume density of mitochondria in m. vastus lateralis increased by +15% and +40%, respectively. In contrast, the untrained m. deltoideus showed an unchanged capillary per fiber ratio and a decreased mitochondrial volume density (-17%). Despite this decrease of mitochondrial volume arm-VO2max increased by +9%. It seems unlikely that the observed discrepancy can be explained by cardiovascular adaptations, since arm cranking did not fully tax the cardiovascular system (arm-VO2max/leg-VO2max: 0.74 and 0.71 before and after training, respectively). Thus neither cardiovascular adaptations nor local structural changes in the untrained muscles could explain the increased arm-VO2max. However, the enhanced capacity for lactate clearance after endurance training could be sufficient to account for the larger VO2max during arm cranking. We propose that an increased net oxidation of lactate might be responsible for the increased arm-VO2max found after bicycle endurance training.
Adult↗
[Sport-Tester PE 3000 training system].
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Equipment and Supplies↗