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Biomedical subjects

S Rupp

Publications and source records attributed to S Rupp.

At least 19 recordsLinked to original sources
PubMed2006

[Involuntary patient admission and treatment against patient's will by emergency physicians].

INTRODUCTION: The treatment of acutely ill patients who presumably lack the insight or judgement to determine their need for medical treatment, is a difficult challenge for emergency physicians. We have carried out a study to assess the frequency and relevance of involuntary treatment and procedures in medical emergency services. METHODS: Retrospective chart analysis for a 1-year period was performed for all treatment protocols of a medical emergency service unit and for all court-ordered treatments of a guardianship court. Cases of involuntary treatment by emergency physicians were identified and analysed. RESULTS: In 10.4% of all emergency calls analysed a relevant and acute psychiatric condition was found. In 0.3% of the cases or 4.8% of the psychiatric cases, involuntary inpatient commitment was chosen by the emergency physician. DISCUSSION: Involuntary inpatient commitment by emergency physicians was only necessary in relatively few cases. Nevertheless, in order to be able to correctly consider treatment and management options, emergency physicians should be aware of the basic conditions for treatment without a patient's consent.

Adolescent↗
PubMed2005

Posttraumatic anterior-inferior instability of the shoulder: arthroscopic findings and clinical correlations.

INTRODUCTION: The main purpose of our study was to evaluate intra-articular lesions in glenohumeral-instability with arthroscopy and correlate them with clinical findings as well as history of instability. MATERIAL AND METHODS: In this prospective multi-centre study, we evaluated arthroscopic findings in 303 patients with posttraumatic anterior-inferior instability of the shoulder. The study cohort was divided into 2 groups: patients with a history of one dislocation (Group 1, n=61, 20.1%) and patients with a history of more than one dislocation (Group 2, n=242, 79.9%). RESULTS: In Group 1, 37 patients had an IGHL-lesion, 31 a MGHL-lesion and 41 a Hill-Sachs lesion. In Group 2, 182 patients had an IGHL-lesion, 172 a MGHL-lesion and 203 a Hill-Sachs lesion. The percentage of lesions in Group 2 (IGHL-75.2%, MGHL-71.1%, Hill-Sachs-83.9%) was significantly higher than in Group 1 (IGHL-60.7%, MGHL-50.8%, Hill-Sachs-67.2%, P=0.0233, P=0.0026, and P=0.0033, respectively). Within Group 2 we found significantly more Hill-Sachs-lesions with a history of an increasing number of recurrences (P=0.0436). We also found an increase of IGHL- and MGHL-lesions with an increasing number of recurrences, but this difference was not significant. The distribution of lesion types of the anterior labrum-ligament complex showed no significant difference between the two groups, apart from a higher incidence of ALPSA-lesions within Group 2 (34.7% versus 18.0% in Group 1). The results of this study show that recurrences after primary posttraumatic anterior-inferior shoulder dislocation cause increasing ligamental damage as well as increasing Hill-Sachs lesions within the gleno-humeral joint. CONCLUSION: Thus we conclude that early surgical stabilization after posttraumatic anterior-inferior shoulder dislocation is necessary to prevent increasing damage within the shoulder joint.

Adolescent↗
PubMed2005

Identification and characterization of Cor33p, a novel protein implicated in tolerance towards oxidative stress in Candida albicans.

We applied two-dimensional gel electrophoresis to identify downstream effectors of CPH1 and EFG1 under hypha-inducing conditions in Candida albicans. Among the proteins that were expressed in wild-type cells but were strongly downregulated in a cph1Delta/efg1Delta double mutant in alpha-minimal essential medium at 37 degrees C, we could identify not-yet-characterized proteins, including Cor33-1p and Cor33-2p. The two proteins are almost identical (97% identity) and represent products of allelic isoforms of the same gene. Cor33p is highly similar to Cip1p from Candida sp. but lacks any significant homology to proteins from Saccharomyces cerevisiae. Strikingly, both proteins share homology with phenylcoumaran benzylic ether reductases and isoflavone reductases from plants. For other hypha-inducing media, like yeast-peptone-dextrose (YPD) plus serum at 37 degrees C, we could not detect any transcription for COR33 in wild-type cells, indicating that Cor33p is not hypha specific. In contrast, we found a strong induction for COR33 when cells were treated with 5 mM hydrogen peroxide. However, under oxidative conditions, transcription of COR33 was not dependent on EFG1, indicating that other regulatory factors are involved. In fact, upregulation depends on CAP1 at least, as transcript levels were clearly reduced in a Deltacap1 mutant strain under oxidative conditions. Unlike in wild-type cells, transcription of COR33 in a tsa1Delta mutant can be induced by treatment with 0.1 mM hydrogen peroxide. This suggests a functional link between COR33 and thiol-specific antioxidant-like proteins that are important in the oxidative-stress response in yeasts. Concordantly, cor33Delta deletion mutants show retarded growth on YPD plates supplemented with hydrogen peroxide, indicating that COR33 in general is implicated in conferring tolerance toward oxidative stress on Candida albicans.

Alleles↗
PubMed2005

Primary stability of various forms of osteosynthesis in the treatment of fractures of the proximal tibia.

The treatment of fractures of the proximal tibia is complex and makes great demands on the implants used. Our study aimed to identify what levels of primary stability could be achieved with various forms of osteosynthesis in the treatment of diaphyseal fractures of the proximal tibia. Pairs of human tibiae were investigated. An unstable fracture was simulated by creating a defect at the metaphyseal-diaphyseal junction. Six implants were tested in a uniaxial testing device (Instron) using the quasi-static and displacement-controlled modes and the force-displacement curve was recorded. The movements of each fragment and of the implant were recorded video-optically (MacReflex, Qualysis). Axial deviations were evaluated at 300 N. The results show that the nailing systems tolerated the highest forces. The lowest axial deviations in varus and valgus were also found for the nailing systems; the highest axial deviations were recorded for the buttress plate and the less invasive stabilising system (LISS). In terms of rotational displacement the LISS was better than the buttress plate. In summary, it was found that higher loads were better tolerated by centrally placed load carriers than by eccentrically placed ones. In the case of the latter, it appears advantageous to use additive procedures for medial buttressing in the early phase.

Biomechanical Phenomena↗
PubMed2004

[Imaging and preoperative planning of osteotomy of tibial head osteotomy].

Valgus-producing osteotomy of the proximal tibia is a well-established treatment for medial femorotibial osteoarthritis in the varus knee. The ideal patient is active, under 55 years of age, has a stable varus deformity of less than 10 degrees, a good bone stock, and an osteoarthritis stage that is restricted to the medial compartment of the knee. Coventry reported a failure rate in proximal tibial osteotomy to be significantly higher when the postoperative alignment was less than 8 degrees of anatomical valgus. Hernigou noted better clinical long-term results in cases with a precise correction of malalignment. There are different preoperative planning methods varying between simple estimates of correction angles and specific radiographic planning tools. The reproducibility of operative outcome with regard to a predictable anatomic alignment and functional recovery must have high priority. This chapter deals with different preoperative planning methods to improve the reliability of surgical results after tibial osteotomy.

Adult↗
PubMed2004

[Stability, bone healing and loss of correction after valgus realignment of the tibial head. A roentgen stereometry analysis].

In high tibial closing-wedge osteotomies (HTO), closure of an osteotomy gap after resection of a bony wedge can be associated with a fissure of the medial cortex of the tibial head (MCT). The effect of a broken MCT on the recurrence of varus deformity is disputed. In this study, serial roentgen stereometric analysis (RSA) was used to determine the fixation stability of a rigid internal "L" plate after HTO. Full weight lower limb radiographs were used to determine the sagittal alignment in patients with varying degrees of varus malalignment and correction over time. Forty-two patients with varus gonarthrosis stage I-III (Ahlback) were treated with HTO and internal fixation with an L-shaped rigid plate. Patients were followed by serial RSA, conventional radiographs, and clinical evaluation (Hospital of Special Surgery score) over a 12-month period. In 19 of 42 successive patients, an average wedge size of 6.9 degrees was resected leaving the MCT intact (group 1). In 23 of 42 of patients, the MCT was unintentionally fissured during surgery when an average 10.3 degrees -wedge was resected (group 2). In group 2, RSA revealed a fivefold increase in lateral displacement of the distal tibial segment within 3 weeks after HTO. Twelve weeks after HTO, translations between tibial segments were below the accuracy of the RSA setup in the majority of patients. Group 1 patients demonstrated a higher initial fixation stability, less occurrence of varus deformity, and a higher HSS score compared to patients with larger wedge sizes and frequent fracture of the MCT (group 2). Before bone healing is achieved, the integrity of the MCT plays a crucial role for the clinical and radiological outcome after HTO.

Adult↗
PubMed2003

Identification of cell surface determinants in Candida albicans reveals Tsa1p, a protein differentially localized in the cell.

To identify cell surface proteins of Candida albicans, the predominant fungal pathogen in humans, we have established an approach using a membrane impermeable biotin derivative in combination with affinity purification. We were able to identify 29 different proteins under two distinct conditions. Among mannoproteins, heat shock proteins and glycolytic enzymes we found thiol-specific antioxidant-like protein 1 (Tsa1p) to be differentially localized depending on the conditions applied. Only in hyphally grown cells Tsa1p was localized to the cell surface whereas in blastospores no surface but mainly nuclear localization was found. This indicates that cell surface expression of at least some proteins is mediated by differential translocation.

Biotinylation↗
PubMed2003

[Arthroscopic elbow surgery in rheumatoid arthritis].

The technique of arthroscopic elbow surgery and its possibilities in the rheumatoid arthritic elbow is discussed. Emphasis is placed on the description of arthroscopic anterior (anterolateral, anteromedial, superomedial) and posterior approaches (straight lateral, posterolateral, straight posterior) to the elbow and the surrounding neurovascular anatomy. Technical hints for elbow arthroscopy especially with relevance to the rheumatoid population are given.

Arthritis, Rheumatoid↗
PubMed2003

EFG1 is a major regulator of cell wall dynamics in Candida albicans as revealed by DNA microarrays.

Cell wall dynamics in Candida albicans, the most common fungal pathogen in man, underlie regulatory processes during the yeast-to-hyphae transition. To analyse this regulation at the transcriptional level, we have established a DNA microarray representing genes implicated in cell wall biogenesis. Using these microarrays, we were able to identify YWP1 and HWP2 that are specifically transcribed in the yeast or hyphal growth form respectively. Cluster analysis revealed at least two major clusters of genes: cluster I comprised genes that were upregulated under at least one hyphae-inducing condition. Three as yet not further characterized genes were attributed to cluster II. These genes were transcribed in the yeast form of C. albicans and were downregulated in an EFG1-dependent manner under specific hyphae-inducing conditions. We show further that, in contrast to CPH1, EFG1 plays a major role in the transcriptional regulation of cell wall proteins under the conditions investigated. EFG1 was essential for the transcription of both hyphae-specific genes such as HWP1 and HWP2 as well as the yeast form-specific gene YWP1. Moreover, we found that, under various conditions, EFG1 also can act as a strong repressor for the transcription of RBE1, another not yet characterized cell wall protein. Overall, our data show that EFG1 plays a major role in the induction and repression of cell wall genes, not only in the hyphal form but also in the yeast form of C. albicans.

Candida albicans↗
PubMed2003

A screen in Saccharomyces cerevisiae identified CaMCM1, an essential gene in Candida albicans crucial for morphogenesis.

Morphogenesis in Saccharomyces cerevisiae and the pathogenic yeast Candida albicans is governed in part by the same molecular circuits. In S. cerevisiae, FLO11/MUC1 expression has been shown to be modulated by multiple signalling pathways required for pseudohyphal development. We have established a screen in S. cerevisiae to identify regulators of fungal development in C. albicans based on FLO11::lacZ expression as a reporter. This screen identified both known components of the mitogen-activated protein kinase (MAPK) cascade and the cAMP cascade that are important for hyphal development in C. albicans, as well as genes not yet known to be involved in morphogenesis. The Candida homologue of MCM1 is one of the novel factors identified in this screen as being important for morphogenesis. CaMcm1p levels do not vary significantly in different cell types and respond to an autoregulatory feedback mechanism, arguing that CaMcm1p activity is regulated by post-translational modifications. Both overexpression and repression of this essential gene led to the induction of hyphae. Moreover, we found that the expression of HWP1, a hyphae-specific gene, was induced by repression of CaMCM1. The changes in morphology and HWP1 expression were not the result of a change in expression levels of NRG1 or TUP1, known repressors of hyphal development. Thus, CaMcm1p is a component of a hitherto unknown regulatory mechanism of hyphal growth.

Base Sequence↗
PubMed2003

[Biodegradable meniscus fixations: a comparative biomechanical study].

PURPOSE: Numerous new all inside meniscus repair techniques using biodegradable fixation devices have become available in the last years. Few studies have dealt with the biomechanical properties of these implants so far. The aim of this study was to analyze meniscus repairs under cyclic loading conditions for different fixation devices (Meniscus Arrow, Clearfix Meniscal Screw, Meniscal Dart, BioStinger) and to compare them to standard suture techniques. MATERIAL AND METHODS: Eighty meniscus repairs on 27 medial porcine menisci were performed. For biomechanical testing loosening, number of failures, failure modes and failure loads were evaluated under cyclic and maximum loading conditions. Testing was performed on a materials testing machine. RESULTS: During cyclic loading 10 out of 40 (25%) fixation devices failed. A gap appeared between the 2 parts of the meniscus within the first loading cycles. The failure strengths obtained with the 4 meniscus fixation devices did not differ significantly (Meniscus Arrow: 44 N; Clearfix Meniscal Screw: 35 N; Meniscal Dart: 33 N; BioStinger: 54 N). Besides for the BioStinger, the values of the sutures were significantly higher. The use of a stronger suture material (PDS 0) increased the failure load significantly. During maximum loading the fixation devices failed by both pull-out of the head or the tip of the device, except for the BioStinger showing only pull-out of the head. All sutures failed by breakage, except for the PDS 0 horizontal sutures in which 50% of complete tissue failures could be noted. CONCLUSION: This study shows that meniscal fixation devices may fail under repetitive loading conditions. A gap appeared between the meniscal margins within the first loading cycles irrespective of the suture type and fixation device used. Both gapping and failure modes of the fixation devices may be design-specific. The maximum failure loads differed significantly between the bioabsorbable devices and the sutures. Stronger suture materials increased the failure loads significantly. To allow a complete evaluation of new meniscus fixation devices not only biomechanical, but also biological and clinical parameters need to be analyzed in forthcoming studies.

Absorbable Implants↗
PubMed2002

[Replacement of the anterior cruciate ligament with a patellar tendon transplant].

The bone-patellar tendon-bone graft (BTPB) was the most commonly used graft for many years. The scientific database is more complete than for every other graft option. This review article presents the surgical techniques of ACL reconstruction with the BPTB graft, aspects of rehabilitation, clinical results, and postoperative problems with special emphasis on donor site morbidity.

Anterior Cruciate Ligament↗
PubMed2002

[Diagnosis of rupture of the anterior cruciate ligament].

Clinical examination has remained the key for diagnosis of meniscal and ligament lesions of the knee. Economical use of imaging techniques is based on adequate clinical examination. Standard radiographic examination is still a simple and valuable method. Magnetic resonance tomography has made great progress during the past few decades. For this reason, this article centers on this imaging modality.

Anterior Cruciate Ligament↗
PubMed2002

In vitro reconstructed human epithelia reveal contributions of Candida albicans EFG1 and CPH1 to adhesion and invasion.

The individual and synergistic contributions of two transcription factors, EFG1 and CPH1, have been characterized with regard to adhesion to, and invasion of, human epithelia by Candida albicans. For this purpose two in vitro reconstructed tissue models were developed. A multi-layered model of human epidermis was used to simulate superficial infections of the skin, whereas a reconstructed human intestinal model was used to mimic the first steps of systemic infections. It was shown that C. albicans deleted for both transcription factors CPH1 and EFG1, in contrast to the congenic clinical isolate Sc5314, was neither able to adhere to, nor to penetrate, either of the model systems. A strain deleted for EFG1 alone showed significant reduction in adhesion and was not able to penetrate through the stratum corneum. However, strains deleted for CPH1 showed phenotypes paralleling the phenotypes of the clinical isolate Sc5314. Using different types of multi-layered human tissues reconstructed in vitro the individual contributions of Efg1p and Cph1p to two important virulence factors of C. albicans, namely adhesion and invasion, could be defined.

Candida albicans↗
PubMed2001

[Effect of various suture strength factors on behavior of meniscus sutures in cyclic loading conditions].

The aim of this study was to analyze meniscal sutures under cyclic loading conditions for different suture types (vertical and horizontal mattress sutures) and suture materials (absorbable monofilament sutures: PDS 2-0; PDS-0, and PDS-1 USP). Testing was performed on medial porcine menisci, using a well-established biomechanical testing model with a complete longitudinal tear 3 mm from the periphery of the meniscus. Sixty specimens were used. One suture was tested at a time. During cyclic testing 100 load cycles were applied with a crosshead speed of 50 mm/min. Three different maximum loads (10 N, 20 N, and 40 N) were used. The preload was set at 5 N. After cyclic loading, the specimens were loaded until failure. During cyclic loading, a gap appeared between the two parts of the meniscus, and partial tissue failures were observed at the surface of the meniscus. Gapping was more marked with higher loads and with the weaker suture material (p < 0.001). Using PDS 0 and PDS 1 sutures, less partial tissue failures were observed compared to PDS 2-0 (p < 0.001). The ultimate failure loads after cyclic loading were higher with PDS-0 and PDS-1 sutures. With these suture materials vertical sutures were stronger than horizontal sutures (p < 0.05). Using PDS 2-0 this difference could not be found. These results show that the primary strength of meniscal sutures depends on the suture material. The frequency and the amount of gapping and partial tissue failures, which can be observed under cyclic loading, are less distinct with PDS-0 and PDS-1 compared to PDS 2-0. From a biomechanical point of view, PDS 0 and PDS 1 sutures are recommended for meniscal sutures to guarantee a high primary stability, a small amount of gapping, and few partial tissue failures.

Animals↗
PubMed2001

[Intermediate-term results after arthroscopic subacromial decompression with special reference to ongoing disability claims].

The objective was to evaluate mid-term results after arthroscopic subacromial decompression (ASD) with special focus on the bias due to an application to social insurance for pension based on sickness disability. The study group consisted of 42 patients (28 male, 14 female). ASD was performed in 1993 or 1994 for impingement stage II. The mean age was 49.5 years. Thirty-nine patients (93%) were evaluated by an independent observer for an average follow-up of 3.5 years (range 1.5-5). Patients satisfaction with the outcome was assessed by a visual analog scale graded from 0 (extremely dissatisfied) to 10 (extremely satisfied). The functional result was assessed using the Constant score. At follow-up the mean VAS value was 6.4 +/- 3.4. The Constant score improved from 49.6 +/- 18.5 to 84.8 +/- 14.3. The subgroup of patients having applied to social insurance for pension had significantly worse results compared with the remaining patients: VAS: 4.9 +/- 3.1 vs. 7.5 +/- 3.1; Constant-Score: 76.1 +/- 12.7 vs. 88.3 +/- 13.5. The fact that patients try to get benefit from social insurance based on sickness disability significantly biased the outcome after ASD.

Acromioclavicular Joint↗