Biomedical subjects

R Ruckert

Publications and source records attributed to R Ruckert.

13 recordsLinked to original sources

PubMed2006

[Acute mesenteric ischemia in a patient with relapsing polychondritis].

We report about a 43-year old woman with relapsing polychondritis, admitted with progressive malaise, fatigue, anorexia and profound weight loss. Two years ago a nasal chondritis with characteristic changes of the nasal profil, scleritis, laryngitis and unspecific general symptoms (fever, fatigue, signs of a systemic inflammation) developed and relapsing polychondritis was diagnosed. The patient was treated initially with azathioprine followed by methotrexate in combination with ciclosporine and glucocorticoids. During the hospitalization her condition slowly worsened, and crampy abdominal pain developed subsequently with massive tenderness, rebound and guarding. The clinically presumed diagnosis of ileus and peritonitis was radiomorphologically confirmed with signs of enteric perforation and a laparatomy was performed. A complete occlusion of the A. mesenterica superior and stenosis of the truncus coeliacus were diagnosed followed by a revascularization with an aorto-mesenteric bypass and subsequent resection of the necrotic ischemic ileum. An association with various autoimmune disorders including vasculitic syndromes is well known for relapsing polychondritis. The case demonstrated a progressive mesenteric ischemia with the acute exacerbation caused by a vasculitic mesenterial occlusion. The unusual presentation should be considered in the differential diagnosis of uncommon abdominal symptoms during the course of relapsing polychondritis.

Acute Disease↗

PubMed1999

Death deflected: IL-15 inhibits TNF-alpha-mediated apoptosis in fibroblasts by TRAF2 recruitment to the IL-15Ralpha chain.

Interleukin-15 (IL-15) is a potent inhibitor of several apoptosis pathways. One prominent path toward apoptosis is the ligand-induced association of TNF receptor 1 (TNFR1) with death domain adaptor proteins. Studying if and how IL-15 blocks TNFR1-mediated apoptosis in a murine fibroblast cell line (L929), we show here that IL-15 blocks TNFR1-induced apoptosis via IL-15Ralpha chain signaling. The intracellular tail of IL-15Ralpha shows sequence homologies to the TRAF2 binding motifs of CD30 and CD40. Most important, binding of IL-15 to IL-15Ralpha successfully competes with the TNFR1 complex for TRAF2 binding, which may impede assembly of key adaptor proteins to the TNFR1 complex, and induces IkappaBalpha phosphorylation. Thus, IL-15Ralpha chain stimulation is a powerful deflector of cell death very early in the apoptosis signaling cascade, while TNF-alpha and IL-15 surface as major opponents in apoptosis control.

Amino Acid Sequence↗

PubMed1997

Comorbid conditions in old patients with femur fractures.

BACKGROUND AND METHODS: The incidence of preexisting medical diseases (comorbid conditions) and their influence on the high rate of falls, associated severe injuries, operative treatment, and outcome including mortality rate, duration of hospitalization, and rehabilitation success was retrospectively evaluated in a group of 102 patients (mean age, 81 years; 81% women) with femoral fractures. A comparison of polymorbidity rates in a control group of 102 patients (mean age, 79 years; 86% women) with proximal humeral fractures was added. RESULTS: The associated polymorbidity rate among patients with femoral fractures (FF) usually was statistically significantly higher than among patients with proximal humeral fractures (PHF) despite a comparable age and sex distribution: 80% of the patients with FF presented with cardiovascular (p < or = 0.001), 41% with pulmonary (p < 0.001), 67% with gastrointestinal (p < or = 0.001), 71% with neurologic (p < or = 0.001), 55% with urologic (p < or = 0.001), 75% with musculoskeletal (p < or = 0.1), and 61% with psychiatric (p < or = 0.001) disorders and complaints. Ninety percent of the patients used different medications (diuretics, cardiac agents, anticoagulants, antidiabetic agents, steroids, hypnotics, analgesics, psychotropic agents). The postoperative mortality rate was 11%, and the mean hospitalization period was 30 days. Forty-nine percent of the patients were discharged to their homes. Only 56% of the patients with PHF, however, presented with cardiovascular, 8% with pulmonary, 11% with gastrointestinal, 8% with neurologic, 9% with urologic, 64% with musculoskeletal, and 10% with psychiatric disorders. CONCLUSION: The polymorbidity in the old patient probably is a major intrinsic cause of the high incidence of falls and associated severe femoral fractures. It influences the perioperative and postoperative medical and anesthesiologic treatment, the postoperative mortality rate, and the duration and success of the postoperative rehabilitation phase.

Accidental Falls↗

PubMed1994

[Localized pleural mesothelioma].

About 500 cases of localized pleural mesothelioma are known from the literature. These benign or malignant tumors arise most frequently from the visceral pleura, rarely from the pericardium. They are not associated with asbestos. Correct diagnosis is rarely made preoperatively. Resection is the treatment of choice and can be curatively even in the malignant type. Clinical, radiological and pathological findings, therapy and prognosis are described.

Aged↗

PubMed1992

[Hemorrhage-induced rupture of the pancreatic pseudocyst].

Hemorrhage from pseudocyst may be the most serious complication of chronic pancreatitis: the mortality from such hemorrhage approaches 80%. The bleeding arises from a major artery--the artery is eroded by the basic process of autodigestion, and the pseudocyst is converted into a pseudoaneurysm. The wall of the pseudoaneurysm is subjected to arterial pressure and may perforate into the peritoneal cavity, an adjacent segment of the gastrointestinal tract, or the pancreatic ductal system. Clinical signs and indications of complicated pseudocyst are sudden abdominal pain, hypotension, sudden increase in abdominal tenderness, decrease of hematocrit and sudden disappearance of the mass. Sonography, CT and angiography accurately define the bleeding lesion and greatly aid in planning operative strategy. Surgery, angiographic embolisation, or a combination of both may be employed. Transcystic arterial ligation and internal drainage of the pseudocyst or distal pancreatectomy are the operative procedures of choice and give the best results.

Diagnosis, Differential↗

PubMed1991

[Choledochal cyst as an unexpected intraoperative finding].

In adulthood, choledochal cysts often surprisingly are discovered during cholecystectomy. Abdominal ultrasonography incorrectly identified the cyst as a dilated or septated gallbladder. Once suspected preoperatively, confirmation of the diagnosis is obtained by ultrasonography or computerized axial tomography, which define its relationship to the vascular structures in the porta. The rapidity and accuracy of ultrasonography favour its use as the initial investigative procedure. Direct cholangiography is the preferred modality for accurate definition of the type of choledochal cyst, ductal strictures, intrahepatic ductal configuration, and polypoid filling defects suggesting cholangiocarcinoma. The well known risk of development of ascending cholangitis as well as cystic cancer, mainly in the adult, indicates the excisional operation for preventing these complications. Cyst excision and Roux-en-Y hepaticojejunostomy is the definitive treatment of choice.

Adult↗

PubMed1990

[Colonic perforation following blunt abdominal trauma].

We describe the case of a fisherman who developed a delayed colonic perforation after falling into the bed of a stream. Colonic perforations after blunt abdominal trauma are not common; they mainly occur after a trauma of sudden deceleration, i.e. usually a traffic accident. Delayed perforations occur relatively frequently and are difficult to diagnose. In the initial stages the common diagnostic procedures are of little help and - except for early peritonitis - the clinical signs may be masked behind more impressive injuries. The history of sudden deceleration and the finding of persistent abdominal tenderness may point to the imminent or manifest perforation. Usually the correct diagnosis is made at laparotomy performed for suspected abdominal injury.

Abdominal Injuries↗

PubMed1989

[Inflammatory aneurysm of the abdominal aorta and ureteral obstruction].

The incidence of inflammatory abdominal aortic aneurysm (IAAA) is reported in between 5 and 15% of all cases of abdominal aortic aneurysms (AAA). As a diagnostic hint the CT- or MRI-scan shows the ureters typically displaced medially, caused by a simultaneously visible retroperitoneal perianeurysmal fibrosis. In IAAA, one has to expect about 25% ureteral congestion, uni- or bilateral. Since the probability of rupture of IAAA--in the natural course between 15 and 25% of the cases--does not apparently differ much from the arteriosclerotic AAA, the operative aorto-iliac reconstruction with bypass grafting is the only solution and procedure of choice. Postoperatively, renal insufficiency caused by congestion normalizes: long-term follow-up by CT-scanning demonstrates the regression of both retroperitoneal fibrotic process and ureteral entrapment. Therefore, the dangerous ureterolysis results to be unnecessary. Hydronephrosis due to ureteral obstruction following aorto-iliac bypass grafting, if progressive or symptomatic, should be treated first non-operatively by ureteral splint.

Aorta, Abdominal↗

PubMed1988

[Cost and benefit of intensive care of seriously injured patients].

59 (82%) of 72 patients with multiple injuries but excluding severe brain trauma or paraplegia, studied 5 or 6 years after intensive care, were fully reintegrated, working normally, and not in receipt of insurance compensation. In patients with severe head injury studied 8 years after intensive care, 38 (55%) of 66 patients had the same final outcome. Disability due to head injury or paraplegia was the predominant factor in costs caused by trauma. Treatment during intensive care was found to be the most costly part of therapy. Considerations on costs and benefits demonstrate that the treatment of severely injured patients, who otherwise would die, results in a considerable social and economic saving (approximately 90 million Swiss francs for the 316 trauma patients analyzed).

Cost-Benefit Analysis↗

PubMed1982

[The fate of critically injured patients].

The prognosis of patients with multiple injuries is very favourable once the critically injured have survived the acute life threatening period. Five to six years after the accident 82% of the surviving patients with injuries of three or more body areas who needed intensive care are fully capable of work and are not receiving any financial compensation. In severe head injuries or in paraplegia, lethality during hospitalization is higher and late prognosis worse: nevertheless, five to six years after the accident 55% of these patients are working full time and do not receive any compensation.

Accidents↗

PubMed1978

[Side effects of proximal selective vagotomy on the esophagus. II. Experimental study of effects of the esophageal motility and the lower esophageal sphincter (author's transl)].

The influence of the proximal selective vagotomy (PSV) with mobilisation of the esophagus of 6 cm or up to the upper thorax apertura on esophageal motility in a first group and mobilisation of 2 or 7 cm on the lower esophageal sphincter tone in a second group was investigated in canine experiments. The loss of coordinated peristalsis in the denuded segment causes a deterioration of esophageal passage. The degree of disturbance of swallowing depends on the length of the mobilisation. Reduction of lower esophageal pressure was observed. These reduction was not influenced by the extent of this motilisation. Acid reflux was not seen. Due to anatomical differences between these two species, these results cannot be readely transferred to human. Enlarged mobilisation of the esophagus for completion of PSV cannot be recommanded without reservation. Clinical studies are needed.

Animals↗

PubMed1977

Intraportal and intrasplenic autotransplantation of pancreatic islets in the dog.

Autotransplantation of pancreatic microfragments into the liver or the spleen of totally pancreatectomized dogs is described. Both modes of transplantation resulted in restoration of normal fasting blood glucose levels. A delayed response to high glucose loads was however observed in both groups. Serum amylase levels indicated a rapid decline of exocrine activity. On the basis of postoperative levels of GOT and GPT in the serum of the dogs with intraportal transplants, permanent proteolytic or ischemic damage to the liver appeared unlikely.

Alanine Transaminase↗

PubMed1976

New experiences with antilymphocyte globulin in human organ transplantation.

This is a retrospective analysis of 100 consecutive primary renal allotransplantations using cadaver kidneys exclusively. Seven patients were sensitive to horse globulin and were therefore not treated with ALG. In all the other 93 patients ALG was given for the first postoperative weeks in addition to standard immunosuppressive therapy. In this group, the one year survival with functioning primary transplan is 73%. The control group is also doing fairly well (5 out of 7 surviving), but it is too small for statistical analysis. Several possible explanations are given for the divergent results in this field.

Antilymphocyte Serum↗