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Sample records for dupuytren erste ergebnisse

  1. Optimization of radiotherapy for Dupuytren's disease; Optimierung der Radiotherapie bei Morbus Dupuytren. Erste Ergebnisse einer kontrollierten Studie

    Energy Technology Data Exchange (ETDEWEB)

    Seegenschmiedt, M.H.; Olschewski, T.; Guntrum, F. [Alfried-Krupp-Krankenhaus Essen (Germany). Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin

    2001-02-01

    prophylactic radiotherapy for the contralateral hand due to disease progression. Conclusions: Prophylactic radiotherapy reduces symptoms and prevents disease progression in early-stage Dupuytren's disease. Both treatment concepts are well-tolerated and equally effective. Acute toxicity is slightly increased with treatment concept B (7 times 3 Gy), while chronic sequelae are low in both treatment groups. Long-term evaluation with follow-up of more than 5 years has to be awaited to recommend one or the other dose concept. (orig.) [German] Ziel: Es werden zwei Dosiskonzepte bei Bestrahlung des Morbus Dupuytren verglichen, um die Progression der Erkrankung bzw. eine Handoperation zu verhindern. Patienten und Methode: 129 Patienten (67 Maenner, 62 Frauen) wurden prospektiv in zwei Gruppen behandelt und fuer mindestens ein Jahr nachbeobachtet. 69 Patienten waren an beiden Haenden, 60 an einer Hand erkrankt (gesamt: 198 bestrahlte Haende). Nach Tubiana befanden sich 73 Haende im Stadium N, 61 im Stadium N/I ({<=}10 Beugekontraktur), 59 im Stadium I (11 bis 45 ) und fuenf im Stadium II (46 bis 90 ). Bestrahlt wurde am Orthovoltgeraet (120 kV) mit 40 cm Abstand und individuellen Bleigummi-Blenden. Gruppe A (63 Patienten/95 Haende) erhielt 10-mal 3 Gy (gesamt: 30 Gy); 5-mal 3 Gy taeglich in zwei Serien, acht Wochen Pause zwischen den Serien; Gruppe B (66 Patienten/103 Haende) erhielt 7-mal 3 Gy (gesamt: 21 Gy) in zwei Wochen. Die Patienten- und Krankheitsparameter waren in beiden Gruppen gleich verteilt. Die Auswertung (Toxizitaet, Effektivitaet) erfolgte drei und zwoelf Monate nach Bestrahlung. Subjektive (Patient) und objektive Parameter (Palpation, Messungen, Photovergleich-Arzt) wurden bewertet. Ergebnisse: Die Akuttoxizitaet war gering: 76 (38%) Haende hatten Hautreaktionen CTC-Grad 1 und zwoelf (6%) CTC-Grad 2. Chronische Folgen (Trockenheit, Atrophie, Sensibilitaetsstoerungen, LENT-Grad 1) traten bei neun (5%) Haenden auf. Drei und zwoelf Monate nach Radiotherapie wurde

  2. Vibrant Soundbridge bei Kindern - erste Ergebnisse

    OpenAIRE

    Hey, C; Ernst, B; Leinung, M; Stöver, T

    2012-01-01

    Einleitung: Das Mittelohr-Implantatsystem VIBRANT SOUNDBRIDGE (VSB), Fa. MED-EL GmbH wurde seit 1996 bei erwachsenen Patienten mit konduktiver Hörstörung vielfach erfolgreich implantiert. Seit 2009 ist die VSB auch für Kinder in Europa zugelassen, weltweit jedoch bislang erst bei ca. 100 Kindern eingesetzt, davon nur wenige unter dem 5. Lebensjahr.Material und Methodik: Seit 11/2011 wurden in domo 4 Jungen mit unilateraler Gehörgangsatresie bzw. 1 Mädchen mit bilateraler Gehörgangsatresie (...

  3. Erste in vivo-Ergebnisse mit endourologischen bioerodierbaren Schienensystemen

    Directory of Open Access Journals (Sweden)

    Schlick RW

    2003-01-01

    Full Text Available Die Möglichkeit der uretralen Insertion eines internalen Schienensystems zur temporären Harnableitung zur Sicherung des Harnflusses ist ein häufiger urologischer Eingriff, der zweifellos die operative Endoskopie revolutionierte. Jedoch haben alle Stentsysteme nach wie vor den Nachteil, daß sie endoskopisch entfernt werden müssen, was wiederum zu Problemen führen kann. Die Autoren haben in den letzten 10 Jahren ein Material entwickelt und getestet, das für ein effektives Stentsystem verwendbar ist, ohne am Ende der Behandlung einer endoskopischen Entfernung zu bedürfen. Damit könnten die Indikationen für die Verwendung von ureteralen Stents erweitert werden. Das Prinzip dieses Stents beruht auf der Ausnützung des physiologischen Umfeldes: Harn hat normalerweise einen sauren pH-Wert von 5-6 und kann mittels Medikamenten alkalisch gemacht werden. Dieser neue Stent ist im sauren pH-Bereich stabil und löst sich im alkalischen Bereich auf. In dieser Arbeit wird über die ersten in vivo-Ergebnisse an 10 weiblichen Schweinen berichtet, denen entweder ein normaler Doppel-J-Stent oder ein bioauflösbarer Stent implantiert wurde.

  4. Rotoresect zur blutungsarmen transurethralen Resektion der Prostata: technische Konzeption und erste klinische Ergebnisse

    Directory of Open Access Journals (Sweden)

    Michel MS

    1999-01-01

    Full Text Available Bei der instrumentellen Therapie der benignen Prostatahyperplasie wird eine hohe Gewebeabtragerate bei geringer Blutungsrate angestrebt. Mit den bisher verfügbaren Hochfrequenzstromelektroden mußte jedoch entweder eine hohe Blutungsrate (Standardschlinge oder eine stark reduzierte Gewebeablation (Elektrovaporisation in Kauf genommen werden. Zur Optimierung der TUR-P wurde Rotoresect entwickelt. Rotoresect besteht aus einem speziellen Arbeitselement, bei dem eine Gewebefräskopfelektrode durch einen Mikromotor aktiv angetrieben wird. Im Anschluß an eine Phase 1-Studie mit 20 Patienten wurde in einer Phase 2-Studie an 20 Patienten eine transurethrale Rotoresektion der Prostata durchgeführt. Das durchschnittliche Prostatavolumen (TRUS betrug 44,0 ± 15,4 ml. Die rotierende Gewebefräskopfelektrode ermöglicht eine Gewebekoagulation, -vaporisation und eine zusätzliche mechanische Ablation. Während der Resektion konnten keine signifikanten Blutungen beobachtet werden. Daraus resultierend konnten keine signifikanten Änderungen von prä- und postoperativer Hämoglobin- (1,0 ± 0,8 g/dl sowie Natriumkonzentration (2,6 ± 3,1 mmol/l festgestellt werden. Die postoperative Katheterzeit betrug durchschnittlich 1,5 ± 1 Tage. Der Uroflow konnte von durchschnittlich 9,1 ± 3,4 auf 22,0 ± 6,33 ml/sec. gesteigert, der Restharn von durchschnittlich 170,9 ± 117,7 auf 29,1 ± 17,6 ml gesenkt, der IPSS um durchschnittlich 17 Punkte (22,0 ± 8,5 auf 4,9 ± 2,9 und der Quality of life-Index um durchschnittlich 3 Punkte (4,2 ± 3,1 auf 0,9 ± 0,8 gesenkt werden. Rotoresect kombiniert die Vorteile der aktiv angetriebenen Gewebefräskopfelektrode zur Geweberesektion mit den Vorteilen der Koagulation und Vaporisation zur exzellenten Haemostasis. Beim transurethralen Einsatz zur Therapie der benignen Prostatahyperplasie sind die initialen postoperativen Ergebnisse vielversprechend.

  5. Dupuytren contracture

    Science.gov (United States)

    Palmar fascial fibromatosis - Dupuytren; Flexion contracture - Dupuytren; Needle aponeurotomy - Dupuytren; Needle release - Dupuytren; Percutaneous needle fasciotomy - Dupuytren; Fasciotomy- Dupuytren; Enzyme injection - Dupuytren; Collagenase ...

  6. Einsatz und Wirksamkeit von Systemtherapien bei Erwachsenen mit schwerer Neurodermitis: Erste Ergebnisse des deutschen Neurodermitis-Registers TREATgermany.

    Science.gov (United States)

    Schmitt, Jochen; Abraham, Susanne; Trautmann, Freya; Stephan, Victoria; Fölster-Holst, Regina; Homey, Bernhard; Bieber, Thomas; Novak, Natalija; Sticherling, Michael; Augustin, Matthias; Kleinheinz, Andreas; Elsner, Peter; Weidinger, Stephan; Werfel, Thomas

    2017-01-01

    Versorgungsregister dienen der Erfassung des Einsatzes und der Wirksamkeit von Therapien unter realen Versorgungsbedingungen und sind als Basis einer evidenzbasierten Gesundheitsversorgung unverzichtbar. Das deutsche Neurodermitis-Register TREATgermany wurde als weltweit erstes Register für Patienten mit schwerer Neurodermitis 2011 initiiert. Erwachsene mit schwerer Neurodermitis (aktuelle/frühere antientzündliche Systemtherapie und/oder objektiver SCORAD ≥ 40) werden über einen Zeitraum von 24 Monaten prospektiv beobachtet. Anhand validierter Erhebungsinstrumente werden die klinische Erkrankungsschwere (EASI, SCORAD), Lebensqualität (DLQI), Symptome, globale Erkrankungsschwere sowie die Patientenzufriedenheit erfasst und die durchgeführten Therapien dokumentiert. Die vorliegende Analyse beschreibt die Charakteristika, Therapiewahl und Wirksamkeit der eingesetzten antiinflammatorischen Systemtherapien der bis Oktober 2014 eingeschlossenen Patienten. An fünf Zentren wurden insgesamt 78 Patienten (Durchschnittsalter 39 Jahre, 61 % männlich) eingeschlossen. Bei den Patienten besteht eine hohe Inanspruchnahme ambulanter und stationärer Leistungen. Ciclosporin war das am häufigsten eingesetzte Systemtherapeutikum und zeigte die höchste klinische Effektivität (EASI-50-Ansprechrate 51 %; EASI-75-Ansprechrate 34 % nach zwölfwöchiger Therapie). Azathioprin, Methotrexat (MTX), Prednisolon oral, Mycophenolat, Alitretinoin und Leflunomid wurden ebenfalls bei einzelnen Patienten eingesetzt. Die vorliegende Registerauswertung gibt wichtige Hinweise zur derzeitigen Versorgung von Erwachsenen mit schwerer Neurodermitis in Deutschland, dokumentiert die hohe Erkrankungslast, den Nutzen vorhandener Therapien und den Bedarf an weiteren, effektiven und in der Langzeitanwendung sicheren Therapieoptionen. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  7. Medienkompetent zum Schulübergang: Erste Ergebnisse einer Forschungs- und Interventionsstudie zum Medienumgang in der Frühen Bildung

    Directory of Open Access Journals (Sweden)

    Gudrun Marci-Boehncke

    2012-12-01

    Full Text Available Das Mediennutzungsverhalten von Vierjährigen und ihrer Erzieherinnen in der Kita wurde in dieser Studie betrachtet. Über die Aussagen von Erzieherinnen und Eltern, aber auch qualitative Verfahren wurde erhoben, wie medienkompetent einerseits die Kinder eingeschätzt werden und welchen Medienumgang sie zeigen. Andererseits sollten auch die Erzieherinnen ihre Einstellungen zu Medien darstellen. Vor dem Hintergrund der Kapitalsorten- und Habitustheorie Bourdieus wurde ein Forschungs- und Interventionsprojekt konzipiert, das bei Erzieherinnen und Kindern gleichzeitig den integrierten Medienumgang fördert und über metakognitive Prozesse der Evaluation und Fortbildung die Einstellung zu Medien positiv beeinflussen soll. Ergebnisse der Studie aus dem ersten Projektjahr liegen vor, sie zeigen positive Veränderungen bei den Erzieherinnen in der Einschätzung der eigenen Fähigkeiten und denen der Kinder.

  8. Safety aspects of decentral, grid-connected power supply systems - first results of the SIDENA research project; Sicherheitsaspekte bei dezentralen netzgekoppelten Energieerzeugungsanlagen - Erste Ergebnisse des Forschungsprojektes SIDENA

    Energy Technology Data Exchange (ETDEWEB)

    Bendel, C.; Viotto, M. [Institut fuer Solare Energieversorgungstechnik (ISET), Kassel (Germany)

    2003-07-01

    After finishing of the DeMoTec experimental network, the function of the new method for impedance measuring during parallel operation was tested using commercial methods. Tests with high-impedance loads are projected as well, as are investigations of the reduction of the network effect by the testing current and the shortening of the measuring time. The results will be applied in making network monitoring systems ready for the market and in national and international standardization efforts. (orig.) [German] Nach der Fertigstellung des Experimentalnetzes in der DeMoTec wird die Funktion des neuen Verfahrens zur Impedanzmessung im Parallelbetrieb mit Methoden, die bereits auf dem Markt sind, ueberprueft. Untersuchungen mit stark stoerenden Verbrauchern sind ebenfalls geplant. Weitere Arbeiten befassen sich mit der Reduktion der Netzbeeinflussung durch den Pruefstrom und der Verkuerzung der Messdauer. Die Ergebnisse werden sowohl in die Marktreifmachung einer Netzueberwachungseinheit als auch in die nationale und internationale Normenarbeit einfliessen. (orig.)

  9. Preliminary experience with balloon kyphoplasty for the treatment of painful osteoporotic compression fractures; Ballon-Kyphoplastie zur Behandlung schmerzhafter osteoporotischer Wirbelkoerperfrakturen - Technik und erste Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Wilhelm, K.; Urbach. H. [Bonn Univ. (Germany). Radiologische Klinik; Stoffel, M; Ringel, F.; Rao, G.; Roesseler, L.; Meyer, B. [Bonn Univ. (Germany). Neurochirurgische Klinik

    2003-12-01

    the final judgment of this method. (orig.) [German] Ziel: Beschreibung der Technik sowie der ersten Ergebnisse der Ballon-Kyphoplastie zur Behandlung schmerzhafter osteoporotischer Wirbelkoerper-Kompressionsfrakturen. Methode: In dieser prospektiven Studie wurde die Ballon-Kyphoplastie bei 34 konsekutiven Patienten (25 Frauen, 9 Maenner; mittleres Alter 75 Jahre) zur Behandlung von 56 Wirbelkoerper-Kompressionsfrakturen (Level Th6 - L5) eingesetzt. In 22 Faellen bestand eine Beteiligung der Wirbelkoerperhinterkante. Die mittlere Symptomdauer betrug 9,7 Wochen. Q-CT-Knochendichtemessung und MRT wurden praeinterventionell angefertigt. Prae- und post-interventionell erfolgte die prospektive Dokumentation und Erhebung der klinischen Parameter (Karnofsky- und Schmerzintensitaets-Index) sowie die bildgebende Verlaufskontrolle mittels konventioneller Aufnahmetechnik und CT. Ergebnisse: Postinterventionell kam es zu einer Verbesserung des Karnofsky-Index von 40 auf 70%, sowie zu einer Reduktion der Schmerzintensitaet von 64 auf 21 (p<0.001). In einem Fall trat eine transiente L2-Nervenwurzel-Reizung auf. Klinisch inapparente Zementleckagen wurden in 10 Faellen beobachtet. Die Ballon-Kyphoplastie fuehrte im Median zu einer Aufrichtung der Wirbelkoerper von 11,5 auf 5 (Sagittale Index). Schlussfolgerung: Die Ballon-Kyphoplastie stellt im kurzfristigen Verlauf ein sicheres und effektives Verfahren zur Behandlung schmerzhafter osteoporotisch bedingter Wirbelkoerper-Kompressionsfrakturen dar, das auch beim Vorliegen einer Wirbelkoerperhinterkantenbeteiligung eingesetzt werden kann, da die Wirbelkoerperhoehe teils wiederaufgerichtet wird und es sich um ein Niederdruck-Injektionsverfahren handelt. (orig.)

  10. Laser-induced thermotherapy (LITT). Application of round and sharp laser systems; Laserinduzierte interstitielle Thermotherapie (LITT). Anwendung und spitzer Laserapplikatorsysteme - erste Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Puls, R.; Stroszczynski, C.; Felix, R. [Virchow Klinikum Berlin (Germany). Strahlenklinik; Humboldt-Universitaet, Berlin (Germany). Inst. fuer Roentgendiagnostik; Hosten, N. [Greifswald Univ. (Germany). Inst. fuer Diagnostische Radiologie; Kreissig, R.; Gaffke, G. [Virchow Klinikum Berlin (Germany). Strahlenklinik

    2001-03-01

    MRT-Kontrolle mit durchschnittlich 25 W ueber 20 Minuten. Ergebnisse: Bei entsprechender Lokalisation der Lebermetastasen unter dem Zwerchfell oder am Leberrand fuehrt die Anwendung der runden Laserapplikatorsysteme durch den verringerten Totraum durch Wegfall der Spitze (0,5-1 cm bei spitzen Applikator-Systemen) zu einer besseren Positionierung des Lasers in der Metastase und damit zu einem besseren Therapieergebnis i.S. einer vollstaendigen Tumorablation. Bei allen Patienten, die mit runden Applikatorsystemen behandelt wurden, konnte die Metastase vollstaendig entfernt werden. Bei 3 der 5 Patienten mit spitzem Applikatorsystem zeigte die Nachkontrolle am 2. Tag nach der LITT einen vitalen Tumorrand auf der dem Zwerchfell zugewandten oder dem Gefaess anliegenden Seite. Schlussfolgerung: Bei Lokalisation von Lebermetastasen an Grenzflaechen der Leber und unterm Zwerchfell fuehrt die Anwendung von runden Laserapplikationssystemen zu einer sicheren Metastasenablation als bei spitzen Applikationssets durch die Moeglichkeit einer besseren Positionierung des Lasers in der Mitte der Metastase. (orig.)

  11. Percutaneous thermoablation of lung metastases. Indication, techniques, first results, and imaging findings; Perkutane Laserablation von Lungenmetastasen. Indikation, technische Durchfuehrung, erste Ergebnisse und Bildbefunde

    Energy Technology Data Exchange (ETDEWEB)

    Weigel, C.; Schuchmann, S.; Kirsch, M.; Mensel, B.; Hosten, N. [Abteilung fuer Diagnostische und Interventionelle Radiologie, Klinikum der Ernst-Moritz-Arndt-Universtiaet Greifswald (Germany)

    2004-05-01

    -(RF-)Ablation und die laserinduzierte Thermotherapie (LITT) zum Einsatz. Befuerchtungen, dass die perkutane Behandlung von Lungenmetastasen zu nicht akzeptablen Pneumothoraxraten und nicht tolerierbaren Lungenreaktionen fuehrt, haben sich bisher nicht bestaetigt. Wegen der Gefahr eines Pneumothorax werden Zugangssysteme mit moeglichst geringem Durchmesser bevorzugt. Auch wenn klinische Ergebnisse derzeit nur in unzureichendem Masse vorliegen, existieren jedoch verlaessliche Zahlen zum technischen Erfolg der Methode. Die Pneumothoraxraten liegen insgesamt in dem Bereich, der bei diagnostischen Punktionen beobachtet werden kann. Groessere Metastasen koennen wie bei der Ablation von Lebermetastasen durch gleichzeitigen Einsatz mehrerer Laserapplikatoren oder durch konsekutive Umpositionierung eines Applikators behandelt werden. Zur Beantwortung der Frage, welche Primaertumoren eine erfolgreiche Behandlung von Lungenmetastasen zulassen, kann die chirurgische Literatur herangezogen werden. Gesichertes liegt hier v. a. fuer Lungenmetastasen kolorektaler Karzinome vor. Die Strahlentherapie stellt bei Lungenmetastasen nur dann ein Alternativverfahren dar, wenn diese eine Symptomatik verursachen (z. B. Schmerzsymptomatik bei Thoraxwandinfiltration oder Luftnot bei Bronchusalteration). Eine generelle Strahlentherapie ist bei Lungenmetastasierung aufgrund der Pneumonitisgefahr nicht zu befuerworten. Die Moeglichkeit einer stereotaktischen Bestrahlung wird zwar diskutiert, ist aber aufgrund der Atemverschieblichkeit der Metastasen derzeit noch nicht praktikabel geloest. Somit koennte die perkutane Thermoablation bei einem relativ hohen Prozentsatz nichtoperabler Lungenmetastasen als minimal-invasive, komplikationsarme Therapieoption eingesetzt werden. (orig.)

  12. The technique of MRT aided abdominal drainage using an open low field magnet. Feasibility and first results; Technik der MRT-gesteuerten abdominellen Drainage an einem offenen Niederfeldmagneten. Durchfuehrbarkeit und erste Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Gehl, H.B. [Medizinische Univ. Luebeck (Germany). Inst. fuer Radiologie; Frahm, C. [Medizinische Univ. Luebeck (Germany). Inst. fuer Radiologie; Schimmelpenning, H. [Medizinische Univ. Luebeck (Germany). Klinik fuer Chirurgie; Weiss, H.D. [Medizinische Univ. Luebeck (Germany). Inst. fuer Radiologie

    1996-07-01

    To test the practicality of MRT-aided drainage using an open low field magnet and to report on the early clinical results. So far seven patients have been treated (four subphrenic abscesses, two psoas abscesses and one pancreatic pseudocyst). The planning of the approach and catheter insertion were carried out under MRT control (Magnetom Open, 0.2 T). Subsequent treatment was controlled by CT and fluoroscopy. Initial puncture was carried out with a non-magnetic 18 gauge Chiba needle. The drainage catheter was introduced by Seldinger`s technique in six cases and with a trocar in one patient. In all seven patients drainage could be started successfully. The design of the magnet and coils permitted adequate accessibility of the patient. There were no problems in visualising the puncture needle. Controlling the position of the catheter by MRT was, however, difficult. The first two steps in abscess drainage (planning the approach and inserting the catheter) can be carried out under MRT control. For further catheter control and observing the course of the disease we presently prefer CT or fluoroscopy. (orig.) [Deutsch] Ziel dieser Studie war es, die technische Durchfuehrbarkeit einer Magnetresonanztomographie (MRT)-gesteuerten Drainage mittels passiver Visualisierung an einem offenen Niederfeldmagneten zu pruefen und ueber erste klinische Ergebnisse zu berichten. Es wurden bisher 7 Patienten (4 subphrenische Verhalten, zwei Psoasabszesse und eine pankreatogene Pseudozyste) behandelt. Die ersten Schritte der perkutanen Abszessdrainage wie Planung des Zugangs und Katheterinsertion wurden MRT-gesteuert (Magnetom Open, 0,2 T Flussdichte) durchgefuehrt. Die Katheternachsorge und Verlaufsbeobachtung erfolgten wie der CT und der Durchleuchtung. Zur Punktion dienten MRT-faehige Chiba-Nadeln und 18 G. Die Einbringung des Drainagekatheters erfolgte in 6 Faellen in Seldinger-Technik und in einem Fall in Trokartechnik. In allen 7 Faellen war die Drainage erfolgreich im Sinne der

  13. Digital flat-panel X-ray technology based on cesium iodide and amorphous silicon: experimental studies and preliminary clinical results; Digitale Flachbilddetektortechnik basierend auf Caesiumjodid und amorphem Silizium: Experimentelle Untersuchungen und erste klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Strotzer, M.; Gmeinwieser, J.; Voelk, M.; Fruend, R.; Feuerbach, S. [Regensburg Univ. (Germany). Inst. fuer Roentgendiagnostik

    1999-01-01

    Purpose: Experimental and clinical evaluation of a digital flat-panel X-ray system based on cesium iodide (CsI) and amorphous silicon (a-Si). Methods: Performance of a prototype detector was compared with conventional screen-film radiography (SFR) using several phantom studies. Foreign bodies, fractures, osteolyses, and pulmonary lesions were analyzed. Additionally, 120 patients were studied prospectively, resulting in 400 comparative X-ray studies. The flat-panel detector was exposed with standard dose and with a dose reduction of up to 75%. Detector size was 15x15 cm, pixel matrix was 1x1 k with a pixel size of 143 {mu}m. Modulation-transfer function was determined to be 18% at the maximum spatial resolution of 3.5 Ip/mm. Results: The diagnostic results achieved with the digital detector were similar to those of conventional SFR, even at reduced radiation exposure. A potential for dose reduction was observed: 50% with respect to osteoarthrosis and fractures, and 75% for determining bony alignment. Discussion: This new technology can be used in thoracic and skeletal radiography. A significant dose reduction is possible, depending on the suspected disease. (orig.) [Deutsch] Ziel: Experimentelle und klinische Pruefung eines digitalen Flachbilddetektors aus Caesiumjodid (CsJ) und amorphem Silizium (a-Si). Methoden: Mit Hilfe verschiedener Phantommodelle wurde ein Detektor-Prototyp mit konventionellen Folien-Filmsystemen (FFS) verglichen. Untersucht wurden die Nachweisbarkeit von Fremdkoerpern, Frakturen, Osteolysen und artefiziellen pulmonalen Laesionen. Zusaetzlich erfolgten prospektiv an 120 Patienten insgesamt 400 vergleichende Skelettuntersuchungen. Der Flachbilddetektor wurde mit identischer Dosis bzw. mit um bis zu 75% reduzierter Dosis belichtet. Seine aktive Flaeche betrug ca. 15x15 cm bei einer Pixelmatrix von 1x1 k und eine Pixelgroesse von 143 {mu}m. Bei der Grenzaufloesung von 3,5 Lp/mm betrug der Wert der Modulationsuebertragungsfunktion 18%. Ergebnisse

  14. Low-field MR arthrography of the shoulder: early results using an open 0.2 T MR system; Niederfeld MR-Arthrographie der Schulter: Erste Ergebnisse mit einem offenen 0,2 T MR-System

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    Loew, R.; Kreitner, K.F.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Runkel, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Unfallchirurgie; Zoellner, J. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Orthopaedie

    1998-04-01

    Purpose: To assess the practicability and image quality of doing MR arthrography of the shoulder using a 0.2 T system. Results: Image quality of the T{sub 1}- and T{sub 2}{sup *}-weighted FLASH 2D sequences was regarded as good or adequate and movement artifacts were minor or moderate. STIR sequences were statistically significantly worse in respect of image quality and movement artifacts (p<0.001, p<0.005). The sensitivity and specificity in the diagnosis of rotator cuff rupture as confirmed by surgery was 100% (labrum lesions 100%, 93%). Agreement in the diagnosis of rupture of the supraspinatus and infraspinatus tendons was 0.93 and 0.65. (orig./AJ) [Deutsch] Ziel: Die Durchfuehrbarkeit und die Bildqualitaet einer MR-Arthrographie der Schulter an einem 0,2 Tesla Niederfeldsystem sollten ueberprueft werden. Ergebnisse: Fuer die T{sub 1}-gewichteten und die T{sub 2}{sup *}-gewichteten FLASH-2D-Sequenzen wurde die Bildqualitaet als gut bzw. ausreichend und Bewegungsartefakte als gering oder moderat bewertet. STIR-Sequenzen wurden in bezug auf Bildqualitaet und Bewegungsartefakte statistisch signifikant schlechter beurteilt (p<0,001, p<0,005). Sensitivitaet und Spezifitaet der operierten Patienten in der Beurteilung von Rotatorenmanschettenrupturen betrugen 100% (Labrumlaesionen 100%, 93%). {kappa}-Werte fuer die Uebereinstimmung der Beurteilung von Rupturen der Supraspinatussehne und der Infraspinatussehne betrugen 0,93 und 0,65. (orig./AJ)

  15. Gore BioA Fistula Plug in the treatment of high anal fistulas – initial results from a German multicenter-study [Gore BioA Fistel Plug zur Behandlung hoher Analfisteln – erste Ergebnisse einer deutschen Multicenter-Studie

    Directory of Open Access Journals (Sweden)

    Ommer, A.

    2012-09-01

    anal fistula plugs might be discussed as a treatment option for high anal fistulas, but further studies are needed to gain conclusive evidence.[german] Hintergrund: Die Behandlung hoher Analfisteln ist mit einem hohen Risiko für eine postoperative Kontinenzstörung behaftet. Neben den traditionellen Verfahren wie der Rekonstruktion mittels Verschiebelappen ermöglicht die Okklusion des Fisteltraktes mit einem resorbierbaren Fistel-Plug ein neues Schließmuskel schonendes Operationsverfahren. In dieser Studie werden erstmals in einer multizentrischen Studie Ergebnisse dieses neuen Verfahrens vorgestellt.Patienten und Methode: Bei 40 Patienten (30 männl., 10 weibl., Alter 51±12 Jahre aus drei chirurgischen Abteilungen mit hohen transphinktären (n=28 oder suprasphinktären (n=12 Fisteln wurde ein Fistelverschluss mit dem Gore BioA Fistula Plug durchgeführt. Die Operation wurde von fünf erfahrenen kolorektalen Chirurgen ausgeführt. Bei vier Patienten war ein Morbus Crohn bekannt. Präoperativ waren 33 Patienten vollkommen kontinent, sieben Patienten berichteten über leichte Kontinenzstörungen. Die Evaluation der Ergebnisse erfolgte auf der Grundlage retrospektiv zusammengestellter Daten der einzelnen Zentren.Ergebnisse: Postoperativ entwickelte ein Patient einen Abszess, der operativ behandelt werden musste. Bei zwei Patienten zeigte sich ein spontaner Plug-Verlust innerhalb von zwei Wochen postoperativ. Nach sechs Monaten war die Fistel bei 20 Patienten (50,0% verheilt. Drei weitere Fisteln heilten nach 7, 9 bzw. 12 Monaten. Die gesamte Heilungsrate lag somit bei 57,5% (23/40. Sie zeigte große Unterschiede zwischen den einzelnen Operateuren von 0 bis 75% und zeigte eine Abhängigkeit von der Zahl der vorausgegangenen Interventionen. Bei Patienten, bei denen lediglich eine Abszessdrainage stattgefunden hatte, lag die Heilungsrate bei 63,6% (14/22, während bei Patienten mit vorausgegangener Flap-Rekonstruktion diese auf 50% (9/18 sank. Kein Patient klagte

  16. Dupuytren contracture

    Energy Technology Data Exchange (ETDEWEB)

    Herbst, M.; Regler, G.

    1985-03-01

    Conventional radiotherapy is the treatment of choice for the early stages of the Dupuytren contracture. The conventional semi-deep therapy is more favorable than the soft ray technique and the moulage technique. 62 patients have been treated at Erlangen; 33 out of them (46 irradiated hands) with a minimum observation time of 18 months have been evaluated. The pathologic process was stopped in 98% of the cases. 85% of the patients showed an improvement of troubles by regression of tubercules and cords, pains and sensation of pressure. A recurrence was observed only in one patient at the edge of the irradiated volume.

  17. [Dupuytren disease].

    Science.gov (United States)

    Wagner, Pablo; Román, Javier A; Vergara, Jorge

    2012-09-01

    Dupuytren disease (DD) is a connective tissue disorder that consists in fibromatosis of the palmar and digital fascia (in form of nodules or flanges) that leads to the development of flexion contractures of the palm and fingers. The little and ring finger are particularly affected. The disease can limit hand function, reducing the quality of life. The disease can have a traumatic origin and is also associated with conditions such as diabetes mellitus, alcoholism, dyslipidemia, epilepsy and AIDS, among others. However, none of these conditions can fully explain the genesis of DD. A hereditary component is described in 40% of patients and is attributed to an autosomal dominant gene of variable penetrance, probably related to collagen synthesis. However there are also spontaneous and recessive inheritance cases. The diagnosis is clinical and based on physical examination. Treatment ranges from observation or use of injectable collagenase to the surgical option in cases with significant functional limitations.

  18. Genetics Home Reference: Dupuytren contracture

    Science.gov (United States)

    ... Facebook Twitter Home Health Conditions Dupuytren contracture Dupuytren contracture Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Dupuytren contracture is a deformity of the hand in which ...

  19. Baron Guillaume Dupuytren: Dupuytren's contracture.

    Science.gov (United States)

    Ellis, Harold

    2013-05-01

    Dupuytren's contracture of the hand is an extremely common deformity in middle aged and elderly men but it is rarely encountered in women. It usually involves the fifth and fourth fingers, less commonly the other two fingers, and never the thumb. There is a flexion deformity between the head of the metacarpal and the adjacent proximal phalanx and at the proximal interphalangeal joint. However, the distal interphalangeal joint is not affected. Indeed, in a severe case, the distal phalanx may actually be extended as it becomes progressively pressed into the palm of the hand. It is often bilateral and may affect the sole of the foot--although I have only had one old gentleman where his foot lesion troubled him enough for him to request surgical cure.

  20. Enfermedad de Dupuytren

    Directory of Open Access Journals (Sweden)

    Jorge Badilla-Mora

    2004-10-01

    Full Text Available Desde que fue descrita por primera vez en el Hotel Dieu, en París, por el Dr. Guilliaume Dupuytren, durante una de sus famosas conferencias en 1832, el diagnóstico y tratamiento de la contractura de Dupuytren han permanecido sin cambio alguno a lo largo del tiempo. A pesar de que esta enfermedad afecta usualmente a individuos del noroeste europeo, y por ende es bastante rara en la sociedad latina, es importante reconocer los signos que definen la contractura y correlacionarlos con los factores predisponentes y los de riesgo. Se evitará así confundirla con otras enfermedades que comprometen la mano y al hacer un diagnóstico correcto, el paciente será referido en el momento adecuado, para su corrección quirúrgica

  1. Enfermedad de Dupuytren

    Directory of Open Access Journals (Sweden)

    Jorge Badilla-Mora

    2004-10-01

    Full Text Available Desde que fue descrita por primera vez en el Hotel Dieu, en París, por el Dr. Guilliaume Dupuytren, durante una de sus famosas conferencias en 1832, el diagnóstico y tratamiento de la contractura de Dupuytren han permanecido sin cambio alguno a lo largo del tiempo. A pesar de que esta enfermedad afecta usualmente a individuos del noroeste europeo, y por ende es bastante rara en la sociedad latina, es importante reconocer los signos que definen la contractura y correlacionarlos con los factores predisponentes y los de riesgo. Se evitará así confundirla con otras enfermedades que comprometen la mano y al hacer un diagnóstico correcto, el paciente será referido en el momento adecuado, para su corrección quirúrgicaSince first described at Hotel Dieu in Paris by Doctor Guilliaume Dupuytren during one of his famous lectures in 1832, the diagnosis and treatment of Dupuytren’s contracture has remained pretty much unchanged. Although this disease affects usually northwestern European individuals and therefore is very uncommon in our Latin society, it is always important to be able to recognize not only the signs that define the contracture itself but also to be able to correlate them with the risk and predisposing factors. The recognition and differential diagnosis with other diseases of the hand will facilitate proper and prompt patient referral for surgical treatment

  2. Wnt Signaling and Dupuytren's Disease

    NARCIS (Netherlands)

    Dolmans, Guido H.; Werker, Paul M.; Hennies, Hans C.; Furniss, Dominic; Festen, Eleonora A.; Franke, Lude; Becker, Kerstin; van der Vlies, Pieter; Wolffenbuttel, Bruce H.; Tinschert, Sigrid; Toliat, Mohammad R.; Nothnagel, Michael; Franke, Andre; Klopp, Norman; Wichmann, H-Erich; Nuernberg, Peter; Giele, Henk; Ophoff, Roel A.; Wijmenga, Cisca; Nurnberg, P.; Dutch Dupuytren Study Group, [No Value; German Dupuytren Study Group, LifeLines Cohort Study; BSSH-GODD Consortium, [No Value

    2011-01-01

    BACKGROUND Dupuytren's disease is a benign fibromatosis of the hands and fingers that leads to flexion contractures. We hypothesized that multiple genetic and environmental factors influence susceptibility to this disease and sought to identify susceptibility genes to better understand its

  3. Skin involvement in Dupuytren's disease.

    OpenAIRE

    Wade, R.; Igali, L; Figus, A

    2016-01-01

    Whether the palmar skin has a role in the development, propagation or recurrence of Dupuytren's disease remains unclear. Clinical assessment for skin involvement is difficult and its correlation with histology uncertain. We prospectively biopsied the palmar skin of consecutive patients undergoing single digit fasciectomy (for primary Dupuytren's disease without clinically involved skin) and dermofasciectomy (for clinically involved skin or recurrence) in order to investigate this relationship...

  4. Guillaume Dupuytren: his life and surgical contributions.

    Science.gov (United States)

    Holzer, Lukas A; de Parades, Vincent; Holzer, Gerold

    2013-10-01

    Guillaume Dupuytren (1777-1835) was one of the most influential surgeons of the past. He described and popularized many conditions, including Dupuytren disease, which continues to carry his name. This article reviews Guillaume Dupuytren's life and his contributions in surgery.

  5. Dupuytren's Contracture: Fibroblast Contraction?

    Science.gov (United States)

    Gabbiani, Giulio; Majno, Guido

    1972-01-01

    In 6 cases of Dupuytren's disease and 1 of Ledderhose's disease, the nodules of the palmar and plantar aponeurosis were examined by light and electron microscopy. The cells composing these nodules, presumably fibroblasts, showed three significant ultrastructural features: (1) a fibrillar system similar to that of smooth muscle cells; (2) nuclear deformations such as are found in contracted cells, the severest being recognizable by light microscopy (cross-banded nuclei); (3) cell-to-cell and cell-to-stroma attachments. Based on these data and on recent information about the biology of the fibroblasts, it is suggested that these cells are fibroblasts that have modulated into contractile cells (myofibroblasts), and that their contraction plays a role in the pathogenesis of the contracture observed clinically. ImagesFig 10Fig 5Fig 11Fig 6 and 7Fig 8Fig 1Fig 2Fig 9Fig 3Fig 4 PMID:5009249

  6. Radiotherapy in early stage dupuytren's contracture; Die Radiotherapie des Morbus Dupuytren im Fruehstadium. Langzeitresultate nach einer medianen Nachbeobachtungszeit von 10 Jahren

    Energy Technology Data Exchange (ETDEWEB)

    Adamietz, B.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Keilholz, L. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Praxis fuer Strahlentherapie, Klinikum Fuerth (Germany); Gruenert, J. [Abt. fuer Plastische und Handchirurgie der Chirurgischen Universitaetsklinik Erlangen-Nuernberg, Erlangen (Germany)

    2001-11-01

    Purpose: In early stage Dupuytren's contracture radiotherapy was applied to prevent disease progression. Long-term results and late toxicity of this treatment were evaluated in a retrospective analysis. Patients and Methods: Between 1982 and 1994, 99 patients (176 hands) received orthovoltage radiotherapy, which consisted of two courses with 5 x 3 Gy (total dose: 30 Gy, daily fractionated; 120 kV, 4 mm Al), separated by a 6 to 8-week pause. The Dupuytren's contracture was staged according to the classification of Tubiana et al. The long-term outcome was analyzed at last follow-up between July and November 1999. The median follow-up was 10 years (range 7-18 years). Late toxicity was assessed using the LENT-SOMA criteria. Results: In Stage N 84% and Stage N/I 67% of cases remained stable. 65% of the cases in Stage I and 83% in Stage II showed progressive nodules and cords. In case of progression we saw no complications after a second radiotherapy or salvage operation. Conclusion: Radiotherapy effectively prevents disease progression for early stage Dupuytren's contracture (Stage N, N/I). Moreover, in case of disease progression despite radiotherapy salvage surgery is still feasible. (orig.) [German] Hintergrund: Im Fruehstadium des Morbus Dupuytren wird die externe Radiotherapie mit dem Ziel eingesetzt, den progressiven Verlauf der Erkrankung zu verhindern. Eine aktuelle Langzeitverlaufskontrolle soll die Ergebnisse und Nebenwirkungen der Radiotherapie darstellen. Patienten und Methode: Wir untersuchten 99 Patienten (176 Haende), welche sich von 1982-1994 einer Radiotherapie an unserer Klinik unterzogen. Jeder Patient erhielt zwei Serien einer Radiotherapie mit jeweils 5 x 3 Gy (Gesamtdosis 30 Gy, 120 kV, 4 mm Al, Bestrahlungspause von 6-8 Wochen nach 15 Gy). Die Beugekontraktur wurde nach Tubiana et al. eingeteilt. Von Juli bis November 1999 erfolgte nach einer medianen Nachbeobachtungszeit von 10 Jahren (7-18 Jahre) eine Kontrolluntersuchung. Die

  7. First results and operating experience of GALLEX. Erste Ergebnisse und Betriebserfahrungen bei GALLEX

    Energy Technology Data Exchange (ETDEWEB)

    Henrich, E. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Ammon, R. v. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Ebert, K. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Fritsch, T. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Habicht, W. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Hellriegel, K. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Kluth, M. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Roesch, W. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Stieglitz, L. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Weirich, F. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Will, R. (Kernforschungszentrum Karlsruhe GmbH (Germany). Inst. fuer Heisse Chemie); Balata, M. (INFN/LNGS,

    1992-01-01

    In GALLEX low-energy neutrinos of the main reaction during proton fusion in the sun's interior are measured by a radiochemical GaCl[sub 3] detector. The aim is to verify theories of the structure and development of stars and of the possible existence of a neutrino rest mass. The experiment is performed by international collaboration at the Gran Sasso Underground Laboratory (LNGS) in Italy. Under that collaboration, the KfK/Institute of Hot Chemistry, is responsible, for planning, construction and operation of the detector and technical equipment necessary to isolate some few [sup 71]Ge atoms from 101 t of GaCl[sub 3] solution in 1 l of water. The paper centers on the chemical aspects of the experimental and preliminary operating experiences with relevant process engineering equipment. (orig.)

  8. Erste experimentelle Ergebnisse Radiofrequenz-Zement-augmentierter und kanülierter Pedikelschrauben

    Directory of Open Access Journals (Sweden)

    Goost H

    2010-01-01

    Full Text Available Bei Osteoporose ist die Gefahr des Cut-out einer Pedikelschraube erhöht. Die Zementaugmentation von Pedikelschrauben erhöht die Ausrisskraft im Kadaverversuch deutlich. Aufgrund der Verwendung von herkömmlichen, dünnflüssigen Vertebro- oder Kyphoplastiezementen besteht allerdings die Gefahr der Zementextravasation. Dieses Risiko könnte durch die Verwendung eines zähflüssigen, Radiofrequenz- aktivierten Knochenzements deutlich vermindert werden. Nach einem Dexa-Scan wurden 6 fresh-frozen Kadaverwirbelkörper verschiedener Knochendichte ausgewählt. Nach Instrumentation der Pedikel mit einer WSI Expertise-Injekt-Schraube (Peter Brehm, Weisendorf, Deutschland wurde über einen Zementierungsadapter ca. 3 ml ultrahochvisköser, mit Radiofrequenz aktivierter Zement (ER2 Bone Zement, DFine Europe GmbH, Deutschland über die rechte Pedikelschraube injiziert. Die linke Pedikelschraube verblieb unzementiert im Sinne einer Kontrolle. Die Testung der Ausrisskraft erfolgte durch axialen Ausriss (Zwick/Roell Zmartpro, Ulm, Deutschland. Im Ausrissversuch konnte durch die Zementaugmentation die Ausrisskraft der Pedikelschrauben massiv gesteigert werden, Zementextravasation wurde nicht festgestellt. Die Aussagekraft der Studie ist bei einer Probenzahl von 6 begrenzt. Weitere Kadaverversuche und die klinische Evaluation sind in Zukunft notwendig. Diese Pilotstudie zeigt, dass die Kombination einer kanülierten Pedikelschraube mit maschineller Applikation von Radiofrequenzaktiviertem Zement einen Mehrwert ergibt. Die Revisionsrate aufgrund eines Cut-out der Pedikelschrauben sowie die Komplikationen durch Zementaustritt sinkt hierdurch.

  9. The treatment of Dupuytren disease.

    Science.gov (United States)

    Desai, Shaunak S; Hentz, Vincent R

    2011-05-01

    The treatment of progressive Dupuytren contractures has historically been and continues to be largely surgical. Although a number of surgical interventions do exist, limited palmar fasciectomy continues to be the most common and widely accepted treatment option. Until recently, nonsurgical options were limited and clinically ineffective. However, the commercial availability and recent approval of collagenase clostridium histolyticum now provides practitioners with a nonsurgical approach to this disease. This article presents a comprehensive review of the surgical and nonsurgical treatments of Dupuytren disease, with a focus on collagenase.

  10. First field experiences with OBD II; Erste Felderfahrungen mit OBD II

    Energy Technology Data Exchange (ETDEWEB)

    Zander, W. [AUDI AG, Ingolstadt (Germany)

    1994-12-31

    A report is given on first field experiences of the diagnosis technology (OBD II) with the help of examples. Since the vehicles which were sold to customers have not done enough miles yet the experience report mainly refers to AUDI`s own vehicles. The results are positive. Hence the company AUDI AG can claim that a sensitive, reliable system for assessing important engine components is available due to this new technology. (orig.) [Deutsch] Es wird anhand von Beispielen aus der Diagnosetechnik (OBD II) ueber erste Felderfahrungen berichtet. Da ausgelieferte Fahrzeuge beim Kunden noch zu geringe Laufstrecken hinter sich haben, beziehen sich die Erfahrungen in erster Linie auf eigene Dauerlaeufer. Die Ergebnisse sind positiv, so dass wir behaupten koennen, mit dieser Technik ein sensibles, zuverlaessiges System zur Beurteilung wesentlicher Motorkomponenten zur Verfuegung zu haben. (orig.)

  11. Dupuytren diathesis and genetic risk

    NARCIS (Netherlands)

    Dolmans, Guido H; de Bock, Geertruida H; Werker, Paul M

    2012-01-01

    PURPOSE: Dupuytren disease (DD) is a benign fibrosing disorder of the hand and fingers. Recently, we identified 9 single nucleotide polymorphisms (SNPs) associated with DD in a genome-wide association study. These SNPs can be used to calculate a genetic risk score for DD. The aim of this study was

  12. Dupuytren diathesis and genetic risk

    NARCIS (Netherlands)

    Dolmans, Guido H; de Bock, Geertruida H; Werker, Paul M

    2012-01-01

    PURPOSE: Dupuytren disease (DD) is a benign fibrosing disorder of the hand and fingers. Recently, we identified 9 single nucleotide polymorphisms (SNPs) associated with DD in a genome-wide association study. These SNPs can be used to calculate a genetic risk score for DD. The aim of this study was t

  13. Wnt Signaling and Dupuytren's Disease

    NARCIS (Netherlands)

    Dolmans, Guido H.; Werker, Paul M.; Hennies, Hans C.; Furniss, Dominic; Festen, Eleonora A.; Franke, Lude; Becker, Kerstin; van der Vlies, Pieter; Wolffenbuttel, Bruce H.; Tinschert, Sigrid; Toliat, Mohammad R.; Nothnagel, Michael; Franke, Andre; Klopp, Norman; Wichmann, H-Erich; Nuernberg, Peter; Giele, Henk; Ophoff, Roel A.; Wijmenga, Cisca; Nurnberg, P.; Dutch Dupuytren Study Group, [No Value; German Dupuytren Study Group, LifeLines Cohort Study; BSSH-GODD Consortium, [No Value

    2011-01-01

    BACKGROUND Dupuytren's disease is a benign fibromatosis of the hands and fingers that leads to flexion contractures. We hypothesized that multiple genetic and environmental factors influence susceptibility to this disease and sought to identify susceptibility genes to better understand its pathogene

  14. Prevalence of Dupuytren Disease in The Netherlands

    NARCIS (Netherlands)

    Lanting, Rosanne; van den Heuvel, Edwin R; Westerink, Bram; Werker, Paul M N

    Background: Dupuytren disease is a fibroproliferative disease of palmar fascias of the hand. The prevalence of Dupuytren disease and the association with potential risk factors have been the subject of several studies, although there is a paucity of such data from The Netherlands. Methods: To study

  15. Prevalence of Dupuytren Disease in The Netherlands

    NARCIS (Netherlands)

    Lanting, Rosanne; van den Heuvel, Edwin R; Westerink, Bram; Werker, Paul M N

    2013-01-01

    Background: Dupuytren disease is a fibroproliferative disease of palmar fascias of the hand. The prevalence of Dupuytren disease and the association with potential risk factors have been the subject of several studies, although there is a paucity of such data from The Netherlands. Methods: To study

  16. Radiotherapy in early stage Dupuytren`s contracture; Radiotherapie im fruehen Stadium des Morbus Dupuytren. Indikation, Technik und Langzeitergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Keilholz, L. [Univ. Erlangen-Nuernberg, Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik; Seegenschmiedt, M.H. [Univ. Erlangen-Nuernberg, Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik]|[Alfried-Krupp-Krankenhaus, Essen (Germany). Klinik fuer Radiologie, Strahlentherapie und Nuklearmedizin; Born, A.D. [Univ. Erlangen-Nuernberg, Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik; Sauer, R. [Univ. Erlangen-Nuernberg, Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik

    1997-01-01

    Patients and Method: Between 1982 and 1993, 96 patients (142 hands) received orthovoltage radiotherapy, which consisted of 2 radiotherapy courses with daily fractionation of 5 x 3 Gy (total dose: 30 Gy) separated by a 6 weeks interval. The Dupuytren`s contracture was staged according to the classification of Tubiana et al. [38]. The initial evaluation was performed 3 months after completion of radiotherapy, while long-term outcome was analysed at last follow-up between February and April 1994. The mean follow-up was 6{+-}2 (range 1 to 12) years. Fifty-seven patients with a follow-up of {>=}5 (median 7,5; mean 9,5 to 12) years were separately evaluated for long-term outcome, i.e. prevention of disease progression. Acute and late treatment toxicity was assessed using the RTOG/EORTC criteria. Results: According to stage, 130 (92%) cases remained stable at 3 months follow-up, 10 (7%) improved and 2 (1%) progressed. An objective reduction of symptomatic cords and nodules was achieved in 107 (75%) case at 3 months follow-up. Moreover, 87% of the patients reported a subjective relief of symptoms. In long-term follow-up, only 16 of 142 (11%) cases had progressed according to stage. In the group with a minimum follow-up of 5 years (n=57), 44 (77%) patients experienced no progression, while 13 (23%) progressed inside (8 cases) or outside (5 cases) of the radiotherapy field. Many `failures` could have been avoided with appropriate choice of larger safety margins included in the treated portals, however, most failures were successfully managed by a second radiotherapy or hand surgery. (orig./AJ) [Deutsch] Patienten und Methode: Von 1982 bis 1993 wurden 96 Patienten (142 Haende) mit Orthovolt-Radiotherapie bestrahlt. Dazu wurden zwei Kurse zu je 5 x 3 Gy taeglich fraktioniert im Abstand von sechs Wochen verabreicht (insgesamt 30 Gy). Das klinische Stadium der Dupuytrenschen Kontraktur wurde nach Tubiana et al. [38] bestimmt. Die initiale Beurteilung erfolgte drei Monate nach

  17. Prevalence of Dupuytren disease in The Netherlands.

    Science.gov (United States)

    Lanting, Rosanne; van den Heuvel, Edwin R; Westerink, Bram; Werker, Paul M N

    2013-08-01

    Dupuytren disease is a fibroproliferative disease of palmar fascias of the hand. The prevalence of Dupuytren disease and the association with potential risk factors have been the subject of several studies, although there is a paucity of such data from The Netherlands. To study the prevalence of Dupuytren disease, the authors drew a random sample of 1360 individuals, stratified by age, from the northern part of The Netherlands. Of this sample, 763 individuals aged 50 to 89 years participated in this cross-sectional study. The authors examined both hands for signs of Dupuytren disease, and a questionnaire was conducted to identify potential risk factors. The effects of these risk factors were investigated using logistic regression analysis. Additional analyses were performed to develop a logistic prediction model for the prevalence of Dupuytren disease. The prevalence of Dupuytren disease was 22.1 percent. Nodules and cords were seen in 17.9 percent, and flexion contractures were present in 4.2 percent of the study population. Prevalence increased with age, from 4.9 percent in participants aged 50 to 55 years to 52.6 percent among those aged 76 to 80 years. Men were more often affected than women; 26.4 percent versus 18.6 percent, respectively (p=0.007). Other significant risk factors were previous hand injury, excessive alcohol consumption, familial occurrence of Dupuytren disease, and presence of Ledderhose disease. The results show a high prevalence of Dupuytren disease in The Netherlands, particularly the nodular form. Using the developed logistic prediction model, the prevalence of Dupuytren disease can be estimated, based on the presence of significant risk factors. Risk, III.

  18. Postoperative hand therapy in Dupuytren's disease

    NARCIS (Netherlands)

    Herweijer, H.; Dijkstra, P.U.; Nicolai, J.P.A.; van der Sluis, C.K.

    2007-01-01

    Background. Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common medical practice to improve outcomes. Until now, patients are referred for postoperative hand rehabilitation on an empirical basis. Purpose. To evaluate whether referral criteria after surgery

  19. Postoperative hand therapy in Dupuytren's disease

    NARCIS (Netherlands)

    Herweijer, H.; Dijkstra, P.U.; Nicolai, J.P.A.; van der Sluis, C.K.

    2007-01-01

    Background. Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common medical practice to improve outcomes. Until now, patients are referred for postoperative hand rehabilitation on an empirical basis. Purpose. To evaluate whether referral criteria after surgery beca

  20. Genetic and environmental influences in Dupuytren's disease

    DEFF Research Database (Denmark)

    Larsen, Søren; Krogsgaard, D G; Larsen, Lisbeth Aagaard;

    2015-01-01

    We aimed to assess the relative contribution of genes and environment in the aetiology of Dupuytren's disease by studying Danish twins born between 1870 and 2000. Twins with a diagnosis (n = 365) and the subgroup who also had an operation (n = 259) after 1977 were identified through linkage...... is involved. The number of concordant male twin pairs with Dupuytren's disease was 17 and 7 (monozygotic and dizygotic pairs, respectively), compared with 60 and 174 discordant monozygotic and dizygotic pairs, yielding probandwise concordance rates of 0.37 (95% confidence interval (CI): 0.26 to 0.50) and 0.......07 (95% CI: 0.04 to 0.14), respectively. The heritability of Dupuytren's disease was approximately 80%. We conclude that genetic factors play a major role in the development of Dupuytren's disease....

  1. Dupuytren contracture in the pediatric population: a systematic review.

    Science.gov (United States)

    Izadpanah, Ali; Viezel-Mathieu, Alex; Izadpanah, Arash; Luc, Mario

    2015-04-01

    Dupuytren contracture of the palm is a relatively common benign fibroproliferative disease of the palmar fascia typically affecting the adult population. There have however been several reported cases of Dupuytren contracture in children. We sought to review the literature for Dupuytren contracture and highlight the main clinical features and management of the disease in children.

  2. Behandeling van de ziekte van Dupuytren : Een overzicht van de mogelijkheden

    NARCIS (Netherlands)

    van Rijssen, Annet L; Werker, Paul M N

    2009-01-01

    In this article we systematically review treatment options for Dupuytren's contracture. There is little evidence on the effectiveness of many treatment modalities for Dupuytren's disease other than expert's opinions (level 4). Most hand surgeons perform selective fasciectomy for Dupuytren's disease.

  3. Behandeling van de ziekte van Dupuytren : Een overzicht van de mogelijkheden

    NARCIS (Netherlands)

    van Rijssen, Annet L; Werker, Paul M N

    2009-01-01

    In this article we systematically review treatment options for Dupuytren's contracture. There is little evidence on the effectiveness of many treatment modalities for Dupuytren's disease other than expert's opinions (level 4). Most hand surgeons perform selective fasciectomy for Dupuytren's disease.

  4. Painful nodules and cords in Dupuytren disease.

    Science.gov (United States)

    von Campe, A; Mende, K; Omaren, H; Meuli-Simmen, C

    2012-07-01

    The etiology of Dupuytren disease is unclear. Pain is seldom described in the literature. Patients are more often disturbed by impaired extension of the fingers. We recently treated a series of patients who had had painful nodules for more than 1 year, and we therefore decided to investigate them for a possible anatomical correlate. Biopsies were taken during surgery from patients with Dupuytren disease and stained to enable detection of neuronal tissue. We treated 17 fingers in 10 patients. Intraoperatively, 10 showed tiny nerve branches passing into or crossing the fibrous bands or nodules. Of 13 biopsies, 6 showed nerve fibers embedded in fibrous tissue, 3 showed perineural or intraneural fibrosis or both, and 3 showed true neuromas. Enlarged Pacinian corpuscles were isolated from 1 sample. All patients were pain free after surgery. Although Dupuytren disease is generally considered painless, we treated a series of early stage patients with painful disease. Intraoperative inspection and histological examination of tissue samples showed that nerve tissue was involved in all cases. The pain might have been due to local nerve compression by the fibromatosis or the Dupuytren disease itself. We, therefore, suggest that the indication for surgery in Dupuytren disease be extended to painful nodules for more than 1 year, even in the early stages of the disease in the absence of functional deficits, with assessment of tissue samples for histological changes in nerves. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Evidence-based medicine: Dupuytren contracture.

    Science.gov (United States)

    Eaton, Charles

    2014-05-01

    After studying this article, the participant should be able to: (1) Describe features and clinical importance of Dupuytren diathesis. (2) Explain the difference between the new definition of recurrence used in collagenase studies compared with prior definitions of recurrence. (3) Compare and list the main advantage/main disadvantage of fasciectomy versus minimally invasive treatment (collagenase injection or needle aponeurotomy) of Dupuytren contracture. The large body of existing literature on Dupuytren disease is spread across many journals in many specialties. It is thus a daunting task for practitioners to follow trends and practice recommendations. It is also a testimony to the lack of an acceptable solution to this common problem. Recent publications provide evidence to highlight controversies and challenge some traditional teachings. Literature from 2010 to 2012 was reviewed with the intent of clarifying some of these issues.

  6. Open palm technique in Dupuytren's disease treatment

    Directory of Open Access Journals (Sweden)

    Marcio Carpi Malta

    2013-06-01

    Full Text Available OBJECTIVE: To evaluate the results of the open palm technique for the treatment of Dupuytren's disease. METHOD: The authors used the technique described by McCash. Twelve patients (13 hands were surgically treated, between october 2002 and september 2011. RESULTS: The wounds healed in a medium of 25 days (variation of 17 to 30 days. There were no complications, such as infection, haematoma formation, skin necrosis, residual edema. CONCLUSION: The open palm technique remains a safe alternative for the treatment of Dupuytren's disease, with satisfactory results and low risk of complications.

  7. Minimally invasive partial fasciectomy for Dupuytren contractures.

    Science.gov (United States)

    Gelman, Scott E; Schlenker, Robert; Jacoby, Sidney M; Shin, Eon K; Culp, Randall W

    2012-12-01

    Treatment options for the Dupuytren contractures vary from percutaneous needle aponeurotomy, open fasciotomy or fasciectomy, dermofasciectomy, and more recently, injectable collagenase. Although utilization of injectable collagenase avoids a formal surgical procedure, not all patients are eligible and some patients do not feel comfortable with an enzyme injection or the associated risks, which may include hematoma, wound dehiscence, or tendon rupture. This study describes the technique and early results of partial fasciectomy through a mini-incision approach as an additional treatment option for Dupuytren contractures. We found that this procedure results in contracture correction with a low rate of complications and thus provides the surgeon with an alternative treatment option to offer patients.

  8. Contemporary management of dupuytren contracture.

    Science.gov (United States)

    Rizzo, Marco; Stern, Peter J; Benhaim, Prosper; Hurst, Lawrence C

    2014-01-01

    Dupuytren contracture is a condition that affects the palmar fascia. It most commonly affects men of northern European ancestry and initially presents at middle age. The diseased fascia may form cords that extend into the digits, resulting in limited motion and function. Treatment is aimed at either releasing or removing the diseased cord so that the finger can extend fully. Common interventions include surgery, needle aponeurotomy, and collagenase injection. Surgery remains the gold standard in treatment and most commonly includes a limited fasciectomy. Although often successful, surgery carries inherent risks and may involve a lengthy recovery with extensive therapy. Needle aponeurotomy and collagenase injections are office-based alternatives that aim to weaken the cord and release the contracture. Needle aponeurotomy involves repeated needling along the cord in intervals and collagenase injections to dissolve a portion of the cord. Despite being less invasive, problems such as nerve and/or tendon injury, skin tears, and autoimmune reactions have been reported. Regardless of treatment, recurrence remains a concern.

  9. Europäische Nachbarschaftspolitik: eine erste Bilanz

    OpenAIRE

    Zorob, Anja

    2007-01-01

    Im Dezember 2006 stellte die Europäische Kommission die Ergebnisse der ersten 18 Monate der Implementierung der Europäischen Nachbarschaftspolitik (ENP) vor. Diese ersten "Ergebnisse" fallen trotz länderspezifischer Unterschiede und auch eingedenk der relativ kurzen Zeitspanne moderat aus. Die ENP kann die wichtigsten Hemmfaktoren des Barcelona-Prozesses nicht wirklich beheben. Dazu zählen die schleppende Liberalisierung des Agrar- und Dienstleistungshandels, der ungenügende Abbau nichttarifä...

  10. Gewalterfahrungen von Kindern und Jugendlichen im subjektiven Selbstbericht : Erste Ergebnisse aus dem Kinder- und Jugendgesundheitssurvey (KiGGS)

    OpenAIRE

    2007-01-01

    Gewalterfahrungen in Kindheit und Jugend sind mit potenziell schwerwiegenden Konsequenzen für die physische und psychische Gesundheit verbunden. Gewalterfahrungen können Kinder und Jugendliche dabei als Täter, Opfer oder Täter/Opfer machen. Im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) beantworteten 3382 Jungen und 3237 Mädchen Fragen zur 12-Monats-Prävalenz von Gewalterlebnissen, unterteilt nach Täter- und Opfer-Erfahrung. Außerdem wurden Einstellungen zu instrumenteller und exp...

  11. Percutaneous needle fasciotomy in dupuytren's disease

    NARCIS (Netherlands)

    van Rijssen, A L; Werker, P M N

    2006-01-01

    The aim of this study was to examine our results of 74 percutaneous needle fasciotomies for Dupuytren's contracture. Pre-operative and postoperative total passive extension deficit was measured. Patients were seen at the outpatient clinic at 32 months for final follow-up. Extension deficit and

  12. The association between Peyronie's and Dupuytren's disease

    NARCIS (Netherlands)

    Nugteren, H. M.; Nijman, J. M.; de Jong, I. J.; van Driel, M. F.

    2011-01-01

    Peyronie's disease (PD) is known to be associated with Dupuytren's disease (DD) since 1828. The aim of this study was to investigate the coexistence of DD in a consecutive series of patients with PD and their clinical characteristics. From January 1988 to December 2009 all patients, presenting at ou

  13. Readability of online materials for Dupuytren's contracture.

    Science.gov (United States)

    Santos, Pauline Joy F; Daar, David A; Badeau, Austin; Leis, Amber

    2017-08-23

    Descriptive. Dupuytren's contracture is a common disorder involving fibrosis of the palmar fascia. As patients are increasingly using online materials to gather health care information, it is imperative to assess the readability and appropriateness of this content. The recommended grade level for patient educational materials is seventh to eighth grade according to the National Institutes of Health. This study aims to assess the readability and content of online patient resources for Dupuytren's contracture. Evaluate readability of online patient education materials for Dupuytren's contracture. The largest public search engine, Google, was queried using the term "Dupuytren's contracture surgery" on February 26, 2016. Location filters were disabled, and sponsored results were excluded to avoid any inadvertent search bias. The 10 most popular Web sites were identified, and all relevant patient-directed information within 1 click from the original site was downloaded and saved as plain text. Readability was analyzed using 6 established analyses (Readable.io, Added Bytes, Ltd, UK). Analysis of 10 Web sites demonstrates an average grade level of at least 11th grade (Flesch-Kincaid grade level, 10.2; Gunning-Fog grade level, 13.1; Coleman-Liau grade level, 14.4; Simple Measure of Gobbledygook grade level, 10.0; automated readability grade level, 9.7; and average grade level, 11.5). Overall Flesch-Kincaid reading ease index was 46.4, which is difficult. No single article was at the recommended reading level. Online materials available for treatment of Dupuytren's contracture are above recommended reading levels and do not include a comprehensive explanation of treatment options, which may negatively impact decision making in patients seeking treatment for this condition. Surgeons and hand therapists alike should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials. V. Copyright © 2017 Hanley & Belfus

  14. An Applied Methodology for the Use of "Deutsch, Erstes Buch."

    Science.gov (United States)

    Dimler, G. Richard

    Discussion of teaching methods used with the text, "Deutsch, Erstes Buch" by Hugo Mueller, focuses on practical approaches to the problem of teaching culture through the spoken language and the use of pattern practice. While concentrating on Chapter Eight, "In der Sommerfrische," discussion is presented in subdivisions characteristic of every…

  15. The Risk of Dupuytren Surgery in Obese Individuals.

    Science.gov (United States)

    Hacquebord, Jacques H; Chiu, Vicki Y; Harness, Neil G

    2017-03-01

    Dupuytren disease is a common benign fibroproliferative disorder causing thickening and shortening of the palmar fascia of the hand. The exact etiology of the disease is unclear but known risk factors such as increased age, male sex, and northern European ethnicity have been established. A link between body mass index (BMI) and Dupuytren disease has not been established previously. The purpose of this study was to test the hypothesis that lower BMI is associated with increased risk for Dupuytren disease diagnosis. After we obtained institutional review board approval, we performed a retrospective review using an electronic medical record and an administrative database from Kaiser Permanente Southern California to identify all enrolled patients there between 2007 and 2014 who were diagnosed with Dupuytren disease. Basic demographic data including age, sex, ethnicity, and BMI were collected. Bivariate and multivariable logistical regression analyses were performed to evaluate for associations between Dupuytren disease and BMI. A total of 2,049,803 patients aged 18 years and older were enrolled in Kaiser Permanente Southern California from 2007 to 2014. During that period, 14,844 patients were identified as having Dupuytren disease. The data were consistent with well-defined demographic trends in Dupuytren disease, with increased rates seen in males, Caucasians, and patients aged 50 years and older. In the multivariable analysis, when controlling for age, race, and sex, the risk of Dupuytren disease was inversely proportional to BMI. The current study showed that higher BMI is associated with decreased odds of having Dupuytren disease. Further work will be required to determine the cause for the apparent relationship between Dupuytren disease and BMI and whether physiologic factors related to obesity may be protective against the development of Dupuytren disease. Prognostic II. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All

  16. Wnt pathway in Dupuytren disease : connecting profibrotic signals

    NARCIS (Netherlands)

    Van Beuge, Marike M.; Ten Dam, Evert-Jan P. M.; Werker, Paul M. N.; Bank, Ruud A.

    2015-01-01

    A role of Wnt signaling in Dupuytren disease, a fibroproliferative disease of the hand and fingers, has not been fully elucidated. We examined a large set of Wnt pathway components and signaling targets and found significant dysregulation of 41 Wnt-related genes in tissue from the Dupuytren nodules

  17. Complications Following Collagenase Treatment for Dupuytren Contracture.

    Science.gov (United States)

    Wozniczka, Jennifer; Canepa, Clifford; Mirarchi, Adam; Solomon, Joel S

    2017-09-01

    Collagenase Clostridium histolyticum (CCH) injection and manipulation is a relatively new method for treating Dupuytren contracture that is growing in popularity. Although side effects such as swelling and ecchymosis are common, they are typically mild and self-limited. Major complications are rare but have included flexor tendon rupture and complex regional pain syndrome. This study describes a case report of 2 patients seen at our institution. Here, we report 2 patients seen at our institution each with different, yet serious complications after CCH injection and manipulation. One patient had extensive skin loss and chose amputation over reconstruction. The other patient had loss of perfusion and required finger amputation. Although it is unclear how directly the administration of CCH is connected to the observed complications, physicians should recognize the potential for serious rare complications in any treatment of Dupuytren contracture.

  18. [Collagenase Clostridum histolyticum in the management of Dupuytren's contracture].

    Science.gov (United States)

    Holzer, L A; Holzer, G

    2011-10-01

    Dupuytren's contracture is a fibroproliferate disease of the palmar aponeurosis with a formation of nodules and cords. Surgical treatment is the gold standard for Dupuytren's contracture at the moment. A short while ago Collagenase clostridium histolyticum was licensed as a non-surgical method to treat Dupuytren's contracture. Collagenase clostridium histolyticum is injected directly into the Dupuytren's cord and after 24 h the contracture is distended by manual rupturing. Collagenase clostridium histolyticum causes a depletion of collagen, however neurovascular structures are spared. 2 clinical phase III studies showed that contractures could be effectively reduced when using Collagenase clostridium histolyticum. However, there are no long-term results regarding effectiveness and side effects, or comparative studies using surgical methods. This paper presents a review of Collagenase clostridium histolyticum and its role in the management of Dupuytren's contracture. Indication, technical procedure, treatment results and complications are described.

  19. Sponsoring-Controlling: Empirische Ergebnisse offenbaren Defizite

    OpenAIRE

    Hohenauer, Robert; Fischer, Peter Mathias; Reinecke, Sven

    2013-01-01

    Was kann Sponsoring wirklich zum langfristigen Unternehmenserfolg beitragen? Wie lässt sich die Wirtschaftlichkeit des Kommunikationstools belegen? Die Antwort auf diese Fragen ist nur durch ein professionell durchgeführtes Sponsoring-Controlling möglich. Die folgenden exemplarischen Ergebnisse der Studie Sponsoring-Controlling des Instituts für Marketing an der Universität St.Gallen (HSG) liefern Erkenntnisse über die Stellung der Erfolgsmessung des Kommunikationstools im Unternehmen.

  20. The early history of Dupuytren's disease.

    Science.gov (United States)

    Elliot, D

    1999-02-01

    Dupuytren's disease may have originated among the Vikings of northern Europe. Possible association of the disease with the Scottish bagpipe-playing MacCrimmon clan and the Papal Sign of Benediction also are examined. The evolution of pathologic understanding and the advent of surgical treatment of the disease in the late eighteenth and early nineteenth centuries in Europe and North America are reviewed in detail.

  1. Radiotherapy in Dupuytren's contracture

    Energy Technology Data Exchange (ETDEWEB)

    Koehler, A.H. (Bezirkskrankenhaus Cottbus (German Democratic Republic))

    1984-01-01

    In Dupuytren's contracture grade I by Iselin radiotherapy is indicated. With X-ray half-depth therapy and a total dose of 20.0 Gy the disease could be treated successfully in 82 % of the cases in a sense of inhibition of progression, whereas in 18 % radiotherapy failed. Possibly the results can be improved by increase of the radiation dose and/or modified fractionating.

  2. [Manifestation of Dupuytren nodules following fracture of the distal radius].

    Science.gov (United States)

    Wichelhaus, Alice; Wendt, M; Mielsch, N; Gradl, G; Mittlmeier, T

    2015-02-01

    The aim of this study is to evaluate the incidence of post-traumatic development of Dupuytren nodules in distal radius fractures treated operatively. In 2 prospective randomised studies for operative treatment of distal radius fractures, the formation of Dupuytren nodules was registered. One of the exclusion criteria was a pre-existing Dupuytren's disease at the date of trauma. In addition to the notification of the development of Dupuytren nodules, signs of a complex regional pain syndrome were registered as well as the wrist function, level of pain and grip strength. The Castaing and the Gartland and Werley scores were assessed. The clinical outcomes of patients with and without Dupuytren nodules were compared. 239 of 275 (87%) of the patients could be examined 1 year after the operation, consisting of 32 men and 207 women with a median age of 64.2 years. The patients with Dupuytren nodules were re-evaluated after 16-60 months (median 41.8) for progression of the disease. 21 patients (8.7%) developed changes of the palmar aponeurosis. In 20 patients nodules were stated, one patient showed a cord at the fourth ray of the injured hand. 19 out of 21 patients were female (90.5%). At re-evaluation after 41.8 months (16-60) progression could not be noted nor could similar changes be seen on the contralateral side. Patients with Dupuytren nodules were not handicapped in their hand function. 3 patients (14.3%) revealed a positive family history for Dupuytren's disease. Abuse of alcohol or diabetes was not present in any of the patients with Dupuytren nodules, 7 (33%) were smokers. The occurrence of Dupyutren nodules can be triggered by a trauma or operation. It may be speculated that these nodules are an entity of their own as no progression of the contracture could be seen during the follow-up period. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Treatment considerations in carpal tunnel syndrome with coexistent Dupuytren's disease.

    Science.gov (United States)

    Nissenbaum, M; Kleinert, H E

    1980-11-01

    Twenty-nine patients with involvement of 31 hands presented with coexisting carpal tunnel syndrome and ipsilateral Dupuytren's disease. Analysis of the patient population showed a high proportion of women, dominant hand involvement, and repetitive manual trauma. Various treatment combinations were used and the results evaluated. Simultaneous surgical excision of Dupuytren's contracture and carpal tunnel release gave compromised long-term results, particularly among the women. To minimize complications, it is advised that carpal tunnel release not be performed at the same time as excision of Dupuytren's contracture.

  4. Percutaneous needle fasciotomy for recurrent Dupuytren disease.

    Science.gov (United States)

    van Rijssen, Annet L; Werker, Paul M N

    2012-09-01

    Increasing options to treat Dupuytren disease include percutaneous needle fasciotomy (PNF), a minimally invasive technique that has proven to be effective for the treatment of primary disease. However, its effect on recurrent disease is not clear. We studied 30 patients with recurrent Dupuytren disease in 40 fingers, with a mean follow-up of 4.4 years. Primary outcome measures were total passive extension deficit reduction and interval to a second recurrence, defined as an increase of more than 30° compared with the result at the end of the previous treatment. We noted complications. Total passive extension reduction was 76%. Percutaneous needle fasciotomy was especially effective for the metacarpophalangeal joint, with an average reduction of 93%, whereas the average reduction in the proximal interphalangeal joint was 57%. A total of 50% of patients did not develop a secondary recurrence during follow-up. The other 50% did, and we treated recurrence within an average of 1.4 years after PNF. By means of PNF, we postponed tertiary treatment an average of 2.9 years starting from the initial treatment for Dupuytren disease. We successfully treated all secondary recurrences by limited fasciectomy, according to patients' wishes. We noted no major adverse effects. Percutaneous needle fasciotomy can be applied effectively for recurrent disease; 50% of patients remain free of recurrence for a mean of 4.4 years. If a secondary recurrence occurs, it does so relatively early after treatment. Patients must therefore be willing to accept this uncertainty in the context of the advantages of PNF, such as fast recovery, low complication rate, and minimal invasiveness. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Management of complications of Dupuytren contracture.

    Science.gov (United States)

    Cheung, Kevin; Walley, Kempland C; Rozental, Tamara D

    2015-05-01

    This evidence-based article discusses the current management options of Dupuytren disease and strategies to avoid and manage any potential complications. Treatment options include fasciectomy, needle fasciotomy/aponeurotomy, and collagenase injection. Complications include digital nerve and artery injury, flexor tendon injury, skin fissures and wound healing complications, hematoma, infection, flare reaction/complex regional pain syndrome, and recurrence. Complication rates, prevention, and management differ with each treatment modality. A detailed understanding of each of these options allows hand surgeons to select the most appropriate treatment for each patient.

  6. Dupuytren contracture. Radiotherapy of early stages

    Energy Technology Data Exchange (ETDEWEB)

    Herbst, M.; Regler, G.

    1985-03-01

    Conventional radiotherapy is the treatment of choice for the early stages of theDupuytren contracture. The conventional semi-deep therapy is more favorable than the soft ray technique and the moulage technique. 62 patients have been treated at Erlangen; 33 out of them (46 irradiated hands) with a minimum observation time of 18 months have been evaluated. The pathologic process was stopped in 98% of the cases. 85% of the patients showed an improvement of troubles by regression of tubercules and cords, pains and sensation of pressure. A recurrence was obseved only in one patient at the edge of the irradiated volume.

  7. Fractionated X-ray treatment for Dupuytren`s contracture. Ultrasound-controlled results; Roentgenweichstrahltherapie der Dupuytrenschen Kontraktur. Ultraschall-kontrollierte Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Kowalzick, L. [Hautklinik, Vogtlandklinikum, Plauen (Germany); Karnbach, C.; Stahlberg, B.; Mohr, P.; Weichenthal, M.; Schreer, I.; Wisch, K. [Universitaets-Hautklinik und -Frauenkliniken, Hamburg (Germany)

    1997-09-19

    The retrospective evaluation included 180 patients (137 m, 43 f, 63{+-}9 years), while serial ultrasound data were available for 15 patients (9 m, 6 f, 62{+-}4 years) with D.C. grade 1 to 2 according to Iselin. X-ray treatment (4 Gy per session, 55 kV) was given on two consecutive days every four months until 3 to 5 series had been aministered. Thus, total does per patient range from 24 to 40 Gy. Ultrasound examinations were carried out using 7.5 MHz equipment (B-mode). The 180 patients were interviewed after a median period of 10 years following treatment. Of these patients, 28% reported a complete remission of their symptoms, 53% had regained full functional use of their hands, and 19% did not observe any improvement following X-ray treatment. In 7%, later progression of the disease had necessitated surgery. Local side effects of the X-ray treatment consisted of dry skin (68%), scaling (5%), roughness (10%), and exsudative reactions (2%). In all 15 patients of the prospective study, palmar nodules could be measured by ultrasound. In these patients, the average diameter area of the nodules had decreased from 31.7{+-}17.8 mm{sup 2} before beginning treatment to 24.8{+-}19.4 mm{sup 2} after completing. The differences is stastistically significant (p<0.005). The overall decrease resulted from a reduction of the size of the nodules in 53% of the patients. In 27% the disease was stable, and in 20% progression was noticed. X-ray treatment has a therapeutic efficacy comparable to surgery in D.C. 7.5 MHz ultrasound is a suitable method for the quantitative evaluation of noninvasive treatment modalities in D.C. (orig./MG) [Deutsch] In die retrospektive Untersuchung gingen die Daten von 180 Patienten (137 m, 43 w, 63{+-}9 Jahre), in die prospektive Untersuchung die Daten von 15 Patienten (9 m, 6 w, 62{+-}4 Jahre) mit D.K. im Stadium 1 und 2 nach Iselin ein. Die Therapie erfolgte mit jeweils 4 Gy an zwei aufeinanderfolgenden Tagen (55 kV). Insgesamt wurden je nach Verlauf 3 bis 5 dieser Serien in 4monatlichen Abstaenden appliziert (Gesamtdosis 24 bis 40 Gy). Die Ultraschalldickenmessung der palmaren Knotenbildungen erfolgte mit einem 7,5-MHz-Geraet im B-Mode-Verfahren. Bei einem medianen Nachbeobachtungszeitraum von 10 Jahren gaben 28% der 180 Patienten eine voellige Rueckbildung der Knoten und Straenge an, 53% eine Besserung mit Wiederherstellung der funktionellen Gebrauchsfaehigkeit und 19% keine Veraenderung unter der Therapie. Im weiteren Verlauf der Erkrankung erfuhren 7% eine Progression, die noch zu einer spaeteren operativen Therapie fuehrte. An lokalen Nebenwirkungen infolge der Roentgenweichstrahltherapie fuehrten 68% Hauttrockenheit, 5% Schuppung, 10% Rissigkeit und 2% naessende Hautveraenderungen an. In der prospektiven therapiebegleitenden Ultraschalluntersuchung liessen sich die palmaren Knoten bei allen 15 Patienten darstellen. Die mittere Knotenquerschnittsflaeche betrug praetherapeutisch 31,7{+-}17,8 mm{sup 2} und posttherapeutisch 24,8{+-}19,4 mm{sup 2}. Insgesamt nahm unter der Therapie bei 53% der Patienten die Knotengroesse ab, bei 27% blieb sie stabil und bei 20% liess sich eine Progression nachweisen. Die Roentgenweichstrahltherapie besitzt einen nachweisbaren, der operativen Therapie vergleichbaren Effekt bei der D.K. Die 7,5-MHz-Ultraschalldiagnostik ist geeignet, zur Verlaufskontrolle bei konservativen Therapieverfahren der D.K. zu dienen. (orig./MG)

  8. Dupuytren Disease Infiltrating a Full-Thickness Skin Graft.

    Science.gov (United States)

    Wade, Ryckie George; Igali, Laszlo; Figus, Andrea

    2016-08-01

    Although the role of the skin in the development and propagation of Dupuytren disease remains unclear, dermofasciectomy and full-thickness skin grafting (FTSG) appears to delay recurrence. In 2011, a 71-year-old, left-handed man presented with recurrent Dupuytren disease in the dominant hand. In 1991, he originally underwent a primary dermofasciectomy and FTSG for Dupuytren disease involving the palmar skin. Twenty years later, the left middle finger was drawn into flexion by a recurrent cord, and the old graft and adjacent palmar skin were clinically involved by fibromatosis. We performed a revision dermofasciectomy and FTSG. Microscopic analysis of the excised graft demonstrated dense infiltration of the entire skin graft by Dupuytren disease, with areas of active and burnt-out fibromatosis distinct from hypertrophic scarring. This report of Dupuytren fibromatosis infiltrating a skin graft raises questions about the pathophysiology of Dupuytren disease. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  9. The Surgical Release of Dupuytren's Contracture Using Multiple Transverse Incisions

    Directory of Open Access Journals (Sweden)

    Hyunjic Lee

    2012-07-01

    Full Text Available Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP joints, and the proximal interphalangeal (PIP joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.

  10. Dupuytren's contracture: A retrospective database analysis to determine hospitalizations in the Netherlands

    NARCIS (Netherlands)

    J.A. Overbeek (Jetty); F.J.A. Penning-Van Beest (Fernie); E.M. Heintjes (Edith); R.A. Gerber (Robert); J.C. Cappelleri (Joseph); S.E.R. Hovius (Steven); R.M.C. Herings (Ron)

    2011-01-01

    textabstractBackground: Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's

  11. Dupuytren's contracture: A retrospective database analysis to determine hospitalizations in the Netherlands

    NARCIS (Netherlands)

    J.A. Overbeek (Jetty); F.J.A. Penning-Van Beest (Fernie); E.M. Heintjes (Edith); R.A. Gerber (Robert); J.C. Cappelleri (Joseph); S.E.R. Hovius (Steven); R.M.C. Herings (Ron)

    2011-01-01

    textabstractBackground: Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's contractu

  12. Irradiation programme MANITU: Results of pre-examinations and Charpy tests with unirradiated materials; Bestrahlungsprogramm MANITU. Ergebnisse der Voruntersuchungen und der Kerbschlagbiegeversuche mit den unbestrahlten Werkstoffen

    Energy Technology Data Exchange (ETDEWEB)

    Rieth, M.; Dafferner, B.; Ries, H.; Romer, O.

    1995-04-01

    The irradiation project MANITU was planned in the frame of the European Long-term Fusion Materials Development Programme. The results of MANITU will have a lasting influence on the future actions within the materials development programme. The problem of the irradiation induced embrittlement of possible martensitic alloy candidates is still unsolved. But after the evaluation of sub-size Charpy tests with the unirradiated refrence specimens of MANITU a first tendency is recognizable. The Charpy properties of the newly developed low activation 7-10% Cr-WVTa alloys are clearly better compared with the modified commerical 10-11% Cr-NiMoVNb steels. In the present report the pre-examinations are documented and the Charpy test results with unirradiated reference specimens are analysed and assessed. (orig.) [Deutsch] Das Bestrahlungsprojekt MANITU wurde im Rahmen des europaeischen Langzeitprogramms fuer Materialentwicklung fuer die Kernfusion geplant. Die daraus gewonnenen Ergebnisse werden das weitere Vorgehen bei der Materialentwicklung entscheidend beeinflussen. Das Problem der bestrahlungsinduzierten Versproedung bei den in Frage kommenden martensitischen Werkstoffen ist nach wie vor ungeloest. Eine erste Tendenz zeichnet sich nach der Auswertung der Kerbschlagbiegeversuche an den unbestrahlten miniaturisierten Referenzproben des MANITU-Programms ab. Die neu entwickelten niedrig aktivierbaren 7-10% Cr-WVTa-Legierungen weisen gegenueber den modifizierten kommerziellen 10-11% Cr-NiMoVNb-Staehlen deutlich bessere Kerbschlageigenschaften auf. Im vorliegenden Bericht werden die Voruntersuchungen dokumentiert und die Ergebnisse aus den Kerbschlagbiegeversuchen der unbestrahlten Referenzproben analysiert und bewertet. (orig.)

  13. Low second to fourth digit ratio in Dupuytren disease.

    Science.gov (United States)

    Yokoi, Takuya; Uemura, Takuya; Kazuki, Kenichi; Onode, Ema; Shintani, Kosuke; Okada, Mitsuhiro; Nakamura, Hiroaki

    2017-08-01

    The ratio of the lengths of the second and fourth digits (2D:4D) has been described as reflecting endogenous prenatal androgen exposure. In general, 2D:4D is lower in men than in women and has potential as a biomarker or predictor for various diseases, athletic ability, and academic performance. Dupuytren disease has digital flexion contractures and is known to predominate in men, but the pathogenesis of the disease remains unclear. To clarify the relationships between Dupuytren disease and endogenous androgens, we performed a retrospective analysis of hand radiographs to investigate 2D:4D in Dupuytren disease. The study included male patients with Dupuytren disease (n = 22) and a control group (n = 18) of male patients with carpal tunnel syndrome. Only unaffected hands, without contractures or osteoarthritis, were evaluated for the purpose of radiographic assessment. The lengths of the phalanx and metacarpal bones in the second and fourth digits were measured by 2 independent observers who each performed 2 sets of measurements separated by a minimum 1-week interval. The 2D:4D was calculated separately for the phalanges and metacarpals, and a combined (phalanx + metacarpal) 2D:4D was also calculated. The reliability of the observer measurements was established using the intraclass correlation coefficient, and both the intra- and interobserver reliability showed excellent agreement. We found that compared with control group, the Dupuytren disease group had significantly lower phalanx and combined 2D:4D. These findings suggest that endogenous prenatal androgens could contribute to the development of Dupuytren disease, leading to its characteristic clinical presentation predominantly in men and affecting the ulnar rays.

  14. [Baron Gijom Dipitren, Guillaume Dupuytren (1777-1835)].

    Science.gov (United States)

    Bumbasirević, Marko Z; Palibrk, Tomislav; Lesić, Aleksandar R; Durasić, Ljubomir M

    2011-01-01

    Baron Dupuytren, Guillaume (1777-1835), French anatomist, pathologyst and surgeon, although was a personal doctor of Napoleon, Lui XVI and Sharles X, remain known for Dupuytrene contracture, due to his name, after he described this disease of palmar fascia in 1833. He started his education at Paris at age of 12, at 18 he was chief demostrator of anatomist prosectors. In 1802. he become surgeon assistant and in 1812 professor of surgery. At age of 38 he become surgeon-in-chief in Hôtel-Dieu the most famous hospital in Europe of that time. Dipitren was a dostor of Lui VIII, who gave him the title of baron in 1823. Also, he was the doctor of Sharles X, and from Napoleon he was decorated by Legue of the Honour. He was the richest doctor of the France, and that time was named Dupuytrens time. He was working the whole day, and was dealing with all parts of surgery, but he become most prominent in orthopaedics, making connections between anatomy, pathology and surgery, what make him popular and famous. Dupuytren dies in age of 58 due to the pleural empyema, but he refused surgery. Before that he had brain stroke, from which he never recover, although he continue with lectures.

  15. Håndtraumer kan muligvis fremprovokere udvikling af Dupuytrens sygdom

    DEFF Research Database (Denmark)

    Klingenberg, Louise; Boeckstyns, Michel

    2011-01-01

    The purpose of this paper is to review the literature concerning a possible relationship between acute injury, infection, or operation of the hand and the development of Dupuytren's disease for two centuries. There has been an ongoing documentation of various cases showing this relationship...

  16. Traume som mulig årsag til Dupuytrens kontraktur

    DEFF Research Database (Denmark)

    Klingenberg, Louise; Boeckstyns, Michel

    2011-01-01

    During two centuries, there has been an ongoing discussion in the literature on whether Dupuytren's disease (DD) can be caused by a single injury to the upper extremity. This paper presents three cases from daily clinical life and draws attention to a possible relationship between specific injury...

  17. Response of dupuytren fibroblasts to different oxygen environments.

    Science.gov (United States)

    Türker, Tolga; Murphy, Erin; Kaufman, Christina L; Kutz, Joseph E; Meister, Edward A; Hoying, James B

    2013-12-01

    It is thought that local ischemia and oxygen radicals are responsible for fibroblast-to-myofibroblast cell transformation and proliferation. We hypothesized that hypoxia could differentially activate the contractility of fibroblasts from normal human palmar fascia and from fibroblasts-myofibroblasts of Dupuytren cords. Normal palmar fascia from 5 patients with carpal tunnel syndrome and Dupuytren cords from 5 patients were harvested. Cells were cultured from all tissue samples, and collagen lattices were prepared containing these cells. Oxygen treatment subgroups were created and incubated under hypoxic (1% O(2), 5% CO(2), and 94% N(2)), normoxic (21% O(2), 5% CO(2), and 74% N(2)), and hyperoxic (100% oxygen using 2.4 atm pressure twice a day for 7 d) conditions. After 7 days, each subgroup was photographed, and lattices were released from dishes. Postrelease photographs were taken immediately, 5 minutes after release, and after 1 hour. Areas of the lattices at each time point were calculated using MetaMorph software. Actin staining and live/dead cell analysis was performed. Linear repeated measures analysis of variance was used for data analysis given that contraction levels were measured over 3 distinct time points. We found a statistically significant difference between normal samples and Dupuytren samples in mean contraction levels over time. There was no statistically significant difference between tissue groups over the 3 time periods based on the oxygen treatment received. Our results showed a greater degree of contractility in Dupuytren disease cells than normal fibroblasts. However, the contraction in either group was not affected by oxygen level. Future in vivo research is needed to better understand the nature of pathophysiology of Dupuytren disease. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. Ultrasonographic evaluation of displaced neurovascular bundle in Dupuytren disease.

    Science.gov (United States)

    Uehara, Kosuke; Miura, Toshiki; Morizaki, Yutaka; Miyamoto, Hideaki; Ohe, Takashi; Tanaka, Sakae

    2013-01-01

    Neurovascular injury is a serious complication after surgery for Dupuytren disease. The purpose of this study was to evaluate the relationship between the cord and the neurovascular bundle ultrasonographically. We included 22 healthy volunteers and 14 Dupuytren disease patients (25 fingers) in this study. We evaluated the cord and the digital artery with high-resolution ultrasound. We first investigated the effect of the angle of metacarpophalangeal joint on the position of the radial and ulnar digital arteries in volunteers without evidence of Dupuytren disease. We compared 3 parameters of the radial and ulnar digital arteries, including differences in depth, differences in lateral shift, and the shape of the cross-section of the artery, between volunteers and patients with Dupuytren disease. None of these parameters changed with flexion of the metacarpophalangeal joint of 0°, 30°, and 60°. Digital arteries and cords could be identified ultrasonographically in all patients, and we confirmed ultrasonographic findings by operative findings in 13 fingers. We classified the fingers into 3 subgroups based on the ultrasonographic findings: type A (n = 13), in which the cord was above the artery; type B (n = 5), in which the cord was below the artery; and type C (n = 7), in which the cord was located between the radial and ulnar digital arteries. Types A, B, and C corresponded to natatory cord/abductor digiti minimi cord, spiral cord, and central cord, respectively. Comparisons among volunteers and patient subgroups showed that the difference in depth in type B patients was significantly larger than that of the other groups. When we set the cutoff point of the difference in depth to 3 mm, sensitivity and specificity to detect the spiral cord were 80% and 76%, respectively. The relationship between the neurovascular bundle and the type of Dupuytren disease cord can be evaluated by high-resolution ultrasound. Diagnostic III. Copyright © 2013 American Society for

  19. Wnt pathway in Dupuytren disease: connecting profibrotic signals.

    Science.gov (United States)

    van Beuge, Marike M; Ten Dam, Evert-Jan P M; Werker, Paul M N; Bank, Ruud A

    2015-12-01

    A role of Wnt signaling in Dupuytren disease, a fibroproliferative disease of the hand and fingers, has not been fully elucidated. We examined a large set of Wnt pathway components and signaling targets and found significant dysregulation of 41 Wnt-related genes in tissue from the Dupuytren nodules compared with patient-matched control tissue. A large proportion of genes coding for Wnt proteins themselves was downregulated. However, both canonical Wnt targets and components of the noncanonical signaling pathway were upregulated. Immunohistochemical analysis revealed that protein expression of Wnt1-inducible secreted protein 1 (WISP1), a known Wnt target, was increased in nodules compared with control tissue, but knockdown of WISP1 using small interfering RNA (siRNA) in the Dupuytren myofibroblasts did not confirm a functional role. The protein expression of noncanonical pathway components Wnt5A and VANGL2 as well as noncanonical coreceptors Ror2 and Ryk was increased in nodules. On the contrary, the strongest downregulated genes in this study were 4 antagonists of Wnt signaling (DKK1, FRZB, SFRP1, and WIF1). Downregulation of these genes in the Dupuytren tissue was mimicked in vitro by treating normal fibroblasts with transforming growth factor β1 (TGF-β1), suggesting cross talk between different profibrotic pathways. Furthermore, siRNA-mediated knockdown of these antagonists in normal fibroblasts led to increased nuclear translocation of Wnt target β-catenin in response to TGF-β1 treatment. In conclusion, we have shown extensive dysregulation of Wnt signaling in affected tissue from Dupuytren disease patients. Components of both the canonical and the noncanonical pathways are upregulated, whereas endogenous antagonists are downregulated, possibly via interaction with other profibrotic pathways.

  20. A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release.

    Science.gov (United States)

    Rubin, G; Rinott, M; Wolovelsky, A; Rosenberg, L; Shoham, Y; Rozen, N

    2016-05-01

    Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren's cords. Specially prepared medical grade IBS was injected into fresh Dupuytren's cords excised from patients undergoing surgical fasciectomy. These cords were tested by tension-loading them to failure with the Zwick 1445 (Zwick GmbH & Co. KG, Ulm, Germany) tension testing system. We completed a pilot concept-validation study that proved the efficacy of IBS to induce enzymatic fasciotomy in ten cords compared with control in ten cords. We then completed a dosing study with an additional 71 cords injected with IBS in descending doses from 150 mg/cc to 0.8 mg/cc. The dosing study demonstrated that the minimal effective dose of 0.5 cc of 6.25 mg/cc to 5 mg/cc could achieve cord rupture in more than 80% of cases. These preliminary results indicate that IBS may be effective in enzymatic fasciotomy in Dupuytren's contracture.Cite this article: Dr G. Rubin. A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release. Bone Joint Res 2016;5:175-177. DOI: 10.1302/2046-3758.55.BJR-2016-0072. © 2016 Rubin et al.

  1. Cellular phone network and health: a pilot study. Design and first results; Mobilfunk und Befinden - eine Pilotstudie. Design und erste Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Spegel, H.; Meyer, N.; Ehrenstein, V.; Heinrich, S.; Schulze, A.; Klein, J.; Praml, G.; Nowak, D.; Radon, K. [Inst. und Poliklinik fuer Arbeits- und Umweltmedizin der Ludwig-Maximilians-Univ., Arbeitsgruppe Arbeits- und Umweltepidemiologie und NetTeaching, Muenchen (Germany); Brix, J. [Bayerisches Staatsministerium fuer Umwelt, Gesundheit und Verbraucherschutz, Muenchen (Germany); Kries, R. von [Inst. fuer Sozialpaediatrie und Jugendmedizin, der Ludwig-Maximilians-Univ., Muenchen (Germany)

    2006-07-01

    Background: we designed a cross-sectional population-based pilot study of possible acute health effects of cellular phone networks. We aimed to examine feasibility of such a study in the field and to assess adequacy of personal dosimetry. Methods: using personal dosimeters, we obtained a 24-hour exposure profile for each study participant. Exposure to frequencies within the mobile communication range (D-net, E-net, universal mobile telecommunications system (UMTS), and wireless local area networks (WLAN)) was measured and recorded every second. Simultaneously we used computer assisted personal interview (CAPI) to collect data on participants' symptoms, socio-demographic characteristics, and potential confounders. The initial results are now available for 42 children (ages 8-12 years), 57 adolescents (ages 13-17 years), and 64 adults (ages 18-65 years), all of them residents of Munich, Germany. Results: personal dosimetry proved to be an adequate and well accepted instrument for the use in the field. The duration of the cumulative exposure to all frequencies in excess of 0.1 V/m ranged from 0.1 to 96.5% of the 24-hour period, and the median daily duration across all age groups was 4.1%. The exposure was dominated by frequencies in the D-net range. Fatigue was the most prevalent symptom, reported by 47% of the children and adolescents and by 44% of the adults. Conclusions: this pilot study shows that both design and the questionnaire instrument are adequate for use in epidemiologic studies of association between exposure to high-frequency electromagnetic fields and health. Personal dosimeters have been optimised and fine-tuned through continuous use. The association between the exposure and health can now be further assessed in a dedicated study. (orig.)

  2. MR imaging and MR spectroscopy for characterization of cardiomyopathies in adolescents - preliminary results; MR-Bildgebung und MR-Spektroskopie zur Charakterisierung von Kardiomyopathien bei Jugendlichen - erste Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Beer, M.; Buchner, S.; Fuchs, J.; Machann, W.; Ritter, C.O.; Beissert, M.; Darge, K.; Hahn, D.; Koestler, H. [Inst. fuer Roentgendiagnostik, Universitaetsklinikum Wuerzburg (Germany); Wirbelauer, J. [Kinderklinik und Poliklinik, Universitaetsklinikum Wuerzburg (Germany)

    2007-09-15

    Purpose: Cardiomyopathy is a rare but life-threatening disease in children and adolescents. Recent studies reported morphological, functional or metabolic alterations of the heart. We discuss a combined MR imaging and {sup 31}P MR spectroscopy (MRS) protocol allowing the analysis of interdependencies between these parameters. Since normal values of cardiac MR parameters in this age group are not available, we included studies of age-matched healthy adolescents. Materials and Methods: 2D-CINE was used to assess left ventricular (LV) parameters. Additional 3D-Chemical Shift Imaging (3D-CSI) and Spectral Localization with Optimal Pointspread Function (SLOOP) reconstruction allowed quantification of the cardiac energy metabolism. Patients (n = 4; all male; age 16.8 {+-} 2.9 years) were included on the basis of an echocardiographic diagnosis of possible cardiomyopathy. The same protocol was applied to healthy young volunteers (n = 4; 1 female, 3 male; age 15.5 {+-} 0.6 years). Results: The patients had a significantly higher LV mass index compared to the control group (147 {+-} 41 g/m2 versus 97 {+-} 16 g/m2; p = 0.04). The other LV parameters (including LV EF with 59 {+-} 22 % versus 67 {+-} 10 %) showed no significant differences. The phosphocreatine to adenosine triphosphate ratio (PCr/ATP-ratio) of the patients was reduced to 1.71 {+-} 0.40 versus 2.44 {+-} 0.30 (p = 0.01), combined with a tendency towards decreased PCr concentrations of 9.1 {+-} 2.5 versus 7.9 {+-} 1.0 mmol/kg. Conclusion: The combination of {sup 31}P MR spectroscopy and MR imaging allows quantitative determination of morphologic, functional and metabolic alterations in adolescents with suspected cardiomyopathy in one examination procedure. The reduction of energy metabolism combined with unaltered global function may indicate a primary role of metabolism in the pathogenesis of cardiomyopathies in adolescents. (orig.)

  3. Textproduktion bei bilingualen Daf-Studierenden - erste Analysen und Ergebnisse einer Forschungsarbeit zum Deutschunterricht am IFPLA in São Leopoldo (RS

    Directory of Open Access Journals (Sweden)

    Angelika Gärtner

    2001-12-01

    Full Text Available O artigo pretende chamar a atenção para a existência de uma forma específica do bilinguismo no Rio Grande do Sul: alemão (dialetal e português. Assim, abordará as consequências linguísticas da imigração alemã e, com isso, a influência do alemão dialetal e do português no processo de aprendizagem da língua alemã padrão respectivamente estrangeira por estudantes teuto-brasileiros numa universidade.

  4. Robot-assisted biopsies in a high-field MRI system. First clinical results; Roboterunterstuetzte Punktion in einem Hochfeld-Kernspintomografen. Erste klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schell, B.; Eichler, K.; Mack, M.G.; Mueller, C.; Kerl, J.M.; Beeres, M.; Thalhammer, A.; Vogl, T.J.; Zangos, S. [Frankfurt Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Czerny, C. [Frankfurt Univ. (Germany). Inst. fuer Unfall-, Hand- und Wiederherstellungschirurgie

    2012-01-15

    Purpose: The purpose of this study was to examine the clinical use of MR-guided biopsies in patients with suspicious lesions using a new MR-compatible assistance system in a high-field MR system. Materials and Methods: Six patients with suspicious focal lesions in various anatomic regions underwent percutanous biopsy in a high-field MR system (1.5 T, Magnetom Espree, Siemens) using a new MR-compatible assistance system (Innomotion). The procedures were planned and guided using T1-weighted FLASH and TrueFISP sequences. A servopneumatic drive then moved the guiding arm automatically to the insertion point. An MRI compatible 15G biopsy system (Somatex) was introduced by a physician guided by the needle holder and multiple biopsies were performed using the coaxial technique. The feasibility, duration of the intervention and biopsy findings were analyzed. Results: The proposed new system allows accurate punctures in a high-field MR system. The assistance device did not interfere with the image quality, and guided the needle virtually exactly as planned. Histological examination could be conducted on every patient. The lesion was malignant in four cases, and an infectious etiology was diagnosed for the two remaining lesions. Regarding the differentiation of anatomical and pathological structures and position monitoring of the insertion needle, TrueFISP images are to be given preference. The average intervention time was 41 minutes. Lesions up to 15.4 cm beneath the skin surface were punctured. Conclusion: The proposed MR-guided assistance system can be successfully utilized in a high-field MR system for accurate punctures of even deep lesions in various anatomic regions. (orig.)

  5. Patterns of dupuytren disease in fingers : studying correlations with a multivariate ordinal logit model

    NARCIS (Netherlands)

    Lanting, Rosanne M.D.; Nooraee, Nazanin; Werker, Paul M.N.; van den Heuvel, Edwin R.

    BACKGROUND: Dupuytren disease affects fingers in a variable fashion. Knowledge about specific disease patterns (phenotype) based on location and severity of the disease is lacking. METHODS: In this cross-sectional study, 344 primary affected hands with Dupuytren disease were physically examined. The

  6. In the palm of your hand : prevalence, disease patterns and natural course of Dupuytren Disease

    NARCIS (Netherlands)

    Lanting, Rosanne

    2014-01-01

    De ziekte van Dupuytren is een aandoening van de bindweefselplaat in de hand en vingers, waarbij knobbels en strengen in de handpalm voorkomen. Dit kan leiden tot een kromstand van de vingers en op dit moment zijn er geen mogelijkheden om de ziekte van Dupuytren te genezen of te voorkomen. Met ons

  7. Dupuytren Contracture in a Patient with Congenital Camptodactyly and Incidental Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    S Mahendran

    2008-11-01

    Full Text Available Dupuytren contracture is commonly seen in northern European populations but not in Asians. Even more rare is a presentation of flexion deformity of fingers involving two different pathologies with incidental carpal tunnel syndrome in the same patient. We report herein a case of Dupuytren contracture with congenital camptodactyly and unilateral carpal tunnel syndrome.

  8. In the palm of your hand : prevalence, disease patterns and natural course of Dupuytren Disease

    NARCIS (Netherlands)

    Lanting, Rosanne

    2014-01-01

    De ziekte van Dupuytren is een aandoening van de bindweefselplaat in de hand en vingers, waarbij knobbels en strengen in de handpalm voorkomen. Dit kan leiden tot een kromstand van de vingers en op dit moment zijn er geen mogelijkheden om de ziekte van Dupuytren te genezen of te voorkomen. Met ons o

  9. Patterns of dupuytren disease in fingers : studying correlations with a multivariate ordinal logit model

    NARCIS (Netherlands)

    Lanting, Rosanne M.D.; Nooraee, Nazanin; Werker, Paul M.N.; van den Heuvel, Edwin R.

    2014-01-01

    BACKGROUND: Dupuytren disease affects fingers in a variable fashion. Knowledge about specific disease patterns (phenotype) based on location and severity of the disease is lacking. METHODS: In this cross-sectional study, 344 primary affected hands with Dupuytren disease were physically examined. The

  10. A prospective study linked both alcohol and tobacco to Dupuytren's disease

    DEFF Research Database (Denmark)

    Godtfredsen, Nina S; Lucht, Hasse; Prescott, Eva;

    2004-01-01

    To address the role of alcohol intake and tobacco smoking and the combination of the two on subsequent risk of Dupuytren's disease.......To address the role of alcohol intake and tobacco smoking and the combination of the two on subsequent risk of Dupuytren's disease....

  11. GLYCOSAMINOGLYCANS AND PROTEOGLYCANS IN PALMAR FASCIA OF PATIENTS WITH DUPUYTREN.

    Science.gov (United States)

    Nascimento, Priscilla Carneiro Hirai; Kobayashi, Elsa Yoko; Lenzi, Luiz Guilherme de Saboya; Dos Santos, João Baptista Gomes; Nader, Helena Bonciani; Faloppa, Flávio

    2016-01-01

    : To evaluate and compare the behavior of glycosaminoglycans (GAGs) in Dupuytren disease (DD). : This is an experimental study with 23 patients diagnosed with DD. Tissue collected through fasciectomy with incision type Brunner or McCash were evaluated by electrophoresis for identification of GAGs. The quantification was carried out by immunofluorescence and dosage of proteins for different types of glycosaminoglycans. The results were expressed in percentage and statistically evaluated. : A significant increase was observed through eletrophoresis in GAGs, as compared to the control (pDupuytren's disease, mainly dermatan sulfate, was evident from our results, as well as a pronounced decrease of hyaluronic acid in the palmar aponeurosis from the same patients. Level of Evidence III, Case-Control Study.

  12. Technical tips for collagenase injection treatment for Dupuytren contracture.

    Science.gov (United States)

    Meals, Roy A; Hentz, Vincent R

    2014-06-01

    We describe technical tips for injecting collagenase into Dupuytren cords based on experience acquired during the prerelease Food and Drug Administration clinical trials and with subsequent clinical practice. These tips include techniques for extracting the reconstituted enzyme efficiently from the vial, injecting the cord(s) with increased safety to the tendons, and anesthetizing the hand before manipulation. The tips are intended to supplement but by no means replace the manufacturer's prescribing information and training video.

  13. Patterns of recontracture after surgical correction of Dupuytren disease.

    Science.gov (United States)

    Dias, Joseph J; Singh, Harvinder Pal; Ullah, Aamer; Bhowal, Bhaskar; Thompson, John R

    2013-10-01

    To study the evolution of deformity of the proximal interphalangeal joint over 5 years after good surgical correction of Dupuytren-induced contracture. We assessed 63 patients (72 fingers; 69 hands) with Dupuytren disease for the degree of contracture, its correction after surgery, and the range of movement at the proximal interphalangeal joints at 3 and 6 months, and 1, 3, and 5 years after fasciectomy with or without the use of a firebreak graft. We investigated associations between the recurrence of contracture and preoperative patient and surgical factors. There were 4 patterns of evolution of contracture after surgical correction. A total of 31 patients (33 hands) showed good improvement that was maintained for 5 years (minimal recontracture group). Twenty patients (23 hands) showed good initial improvement, which mildly worsened ( 20°) but there was no further worsening (severe early recontracture group). Eight patients (8 hands) worsened progressively over 5 years (progressive recontracture group). Worsening of contracture more than 6° between 3 and 6 months after surgery predicted progressive recontracture at 5 years. Recurrence of contracture (not disease recurrence) could be predicted as early as 6 months after surgery for Dupuytren disease. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. [Plantar fibromatosis and Dupuytren's contracture in an adolescent].

    Science.gov (United States)

    Nikolić, Jelena; Janjić, Zlata; Momcilović, Dragan; Ninković, Srdjan; Harhai, Vladimir

    2011-10-01

    Fibromatosis represents a wide group of benign, locally proliferative disorders of fibroblasts. Dupuytren's disease is a benign proliferative disease of palmar aponeurosis which usually affects adults between 40 and 60 years of age. Ledderhose's disease or plantar fibromatosis is plantar equivalent of Dupuyten's disease most often affecting middle-aged and older men, usually bilateral, represented with painless nodule in the medial division of plantar fascia. We presented a 19-year old adolescent that turned to a plastic surgeon complaining to his small finger contracture. He noticed palmar thickening with nodule over the metacarpophalangeal joint of small finger of his right hand when he was 16 years old. A year later a finger started to band. During physical checkup we noticed plantar nodule that also had his father and grandmother. Magnetic resonance and tumor biopsy confirmed a suspicion on plantar fibromatosis - Ledderhose's disease. Clinical exam of the hand clearly led to a conclusion that the patient had Dupuytren's contracture with pretendinous cord over the small finger flexor tendons and lack of extension of proximal interphalangeal (PIP) joint. On the extensor side of the PIP joints there were Garrod's nodes. The patient refused surgical treatment of plantar tumor, but agreed to surgical correction of finger contracture. Despite the fact that Dupuytren's disease and plantar fibromatosis are diseases of adults, the possibility of conjoint appearance of these forms of fibromatosis in adolescent period of life should be kept in mind especially in patients with strong genetic predisposition.

  15. Dupuytren disease: on our way to a cure?

    Science.gov (United States)

    Degreef, Ilse; De Smet, Luc

    2013-06-01

    Despite its high prevalence, the clinical presentation and severity of Dupuytren disease is extremely variable. The disease features a broad spectrum of symptoms, from simple nodules without the slightest clinical impact towards an extremely disabling form requiring multiple surgical procedures, sometimes even partial hand amputations. Recurrence after surgery is considered a failure for both patient and surgeon, but its definition is vague. The term 'recontracture' was coined by a patient and reflects the disappointment of recurrent disease. Wether or not a treatment option will insure a definite result, may depend more on the severity of the disease, which is patient specific, than on the treatment method itself. If a patient presents with Dupuytren disease, one should not merely evaluate his hands. Different clinical and personal history features may uncover a severe fibrosis diathesis and both correct information to the patient and an individualized treatment plan are needed. In the near future, a simple genetic test may help to identify patients at risk. Similar to the evolving knowledge and treatment modalities seen in rheumatoid arthritis, treatment of Dupuytren disease is likely to advance in the direction of disease control with pharmacotherapy and single shot minimal invasive enzymatic fasciotomy with collagenase to correct established contractures.

  16. Bridging the Gap: A Literacy-Oriented Approach to Teaching the Graphic Novel "Der erste Fruhling"

    Science.gov (United States)

    Bridges, Elizabeth

    2009-01-01

    This article examines the phenomenon of graphic novels generally, and in particular, their utility in second-language contexts via the example of the graphic adaptation of Klaus Kordoris "Der erste Fruhling." This text lends itself especially to bridging thematic gaps in 20th-century German literature courses, as well as the "language/literature…

  17. Utilización de implantes de silicona en la enfermedad de Dupuytren Use of silicone implants in Dupuytren's disease

    Directory of Open Access Journals (Sweden)

    J. Ballesta Alcaraz

    2006-06-01

    Full Text Available Presentamos nuestra experiencia en el tratamiento de la enfermedad de Dupuytren mediante la utilización de unos implantes de silicona que se colocan en la palma de la mano una vez efectuada la aponeurectomia. Efectuamos este tratamiento en un grupo de 44 pacientes afectos de dicha enfermedad a los que hemos aplicado unos criterios de selección tales como el grado de afectación y que no fueran manos ya intervenidas con anterioridad. La idea es presentar una técnica quirúrgica que soluciona de una manera eficaz un determinado tipo de casos. La tolerancia y resultados dan validez a la técnica.We present our experience in the treatment of Dupuytren's disease by the use of a silicone implants in the palm of the hand after the aponeurectomy. The above mentioned treatment has been carried out in a group of 44 patients with Dupuytren's disease to whom we have applied selection criteria such as afectation degree and were not operated hands. The idea is to present a surgical technique that solves in an effective way specific cases. The tolerance and the obtained results state that the technique is valid.

  18. Dupuytren in a Child: Rare Presentation of a Rare Clinical Entity.

    Science.gov (United States)

    Spyropoulou, Georgia-Alexandra; Pavlidis, Leonidas; Mylothridis, Panagiotis; Zaraboukas, Thomas; Demiri, Efterpi

    2016-12-01

    Dupuytren disease in children younger than 10 years is rare and only 8 histologically proven cases have been reported. A histologically proven Dupuytren disease in a 10-year-old with an uncommon clinical presentation as a nodule on the radial side of the middle phalanx of the little finger is documented. Dupuytren's disease should be in the differential diagnosis in cases of nodules and contractures in the palm and fingers of children. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Dupuytren's contracture: a retrospective database analysis to determine hospitalizations in the Netherlands

    Directory of Open Access Journals (Sweden)

    Gerber Robert A

    2011-10-01

    Full Text Available Abstract Background Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's contracture. In this study we determined the prevalence of patients with a hospitalization for Dupuytren's contracture in the Netherlands and characterized their (rehospitalizations. Methods From the PHARMO database, which consists of multiple observational databases linked on a patient level, all patients hospitalized for Dupuytren's contracture between 2004 and 2007 were included in the source population (ICD-9-CM code 728.6. Numbers from this source population were used to provide estimates of hospitalizations for Dupuytren's contracture in the Netherlands. Patients with a medical history in the PHARMO database of at least 12 months before their hospitalization were included in the study cohort and followed until end of data collection, death, or end of study period, whichever occurred first. Type of admission, length of stay, recorded procedures, treating specialty, number of rehospitalizations for Dupuytren's contracture, and time to first rehospitalization were assessed. Results Of 3, 126 patients included in the source population, 3, 040 were included in the study population. The overall prevalence of patients with a hospitalization for Dupuytren's contracture was 0.04%, with the highest prevalence (0.25% among 60-79 year old males. The majority (85% of all hospitalizations were day-case admissions. Of the admitted inpatients (15% the majority (81% had one overnight stay in the hospital. The most common recorded procedure was fasciectomy (87% and 78% of patients was treated by a plastic surgeon. During a median (IQR follow-up of 2.9 (1.8-4.0 years, 523 patients were rehospitalized for Dupuytren's contracture. The median (IQR time to first rehospitalization

  20. Multiple collagenase injections are safe for treatment of Dupuytren's contractures.

    Science.gov (United States)

    Gajendran, Varun K; Hentz, Vincent; Kenney, Deborah; Curtin, Catherine M

    2014-07-01

    The authors report the case of a 65-year-old, right-hand-dominant man who had severe Dupuytren's disease with multiple cords and flexion contractures of the metacarpophalangeal and proximal interphalangeal joints of both hands and underwent repeated collagenase injections for treatment. Collagenase has been shown to be safe and effective in the treatment of Dupuytren's contractures when administered as a single dose, but the results of multiple injections over a prolonged period are unknown. Antibodies to collagenase develop in all patients after several treatments, raising concerns about safety and efficacy as a result of sensitization from repeated exposures. The antibodies generated as a result of repeated exposure to collagenase could theoretically render it less effective with time and could also lead to immune reactions as severe as anaphylaxis. The authors present the case of a single patient who experienced continued correction of his contractures with only minor and self-limited adverse reactions after administration of 12 collagenase doses through 15 injections during a 4-year period. Over time, the injections continued to be effective at correcting metacarpophalangeal joint contractures, but less effective at correcting proximal interphalangeal joint contractures. The patient did eventually require a fasciectomy, but the safety and modest success of the repeated collagenase injections shows promise for a less invasive treatment with a better risk profile than open fasciectomy. Although further studies are needed, repeated administration of collagenase appears to be safe and modestly effective for severe Dupuytren's contractures, although a fasciectomy may ultimately be required in the most severe cases.

  1. Modified McCash Technique for Management of Dupuytren Contracture.

    Science.gov (United States)

    Lesiak, Alex C; Jarrett, Nicole J; Imbriglia, Joseph E

    2017-05-01

    Despite recent advancements in the nonsurgical treatment for Dupuytren contracture, a number of patients remain poor nonsurgical candidates or elect for surgical management. The traditional McCash technique releases contractures while leaving open palmar wounds. Although successful in alleviating contractures, these wounds are traditionally large, transverse incisions across the palm. A modification of this technique has been performed that permits the surgeon to utilize smaller wounds while eliminating debilitating contractures. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  2. [Fibromatosis plantaris Ledderhose (Dupuytren's contracture of the foot sole].

    Science.gov (United States)

    Villiger, K J

    1982-05-01

    Fibromatosis plantaris, also called Ledderhose disease, is presented on the basis of the limited literature available. The possible causes are mentioned. Two cases are reported of patients suffering from fibromatosis palmaris (Dupuytren) on both hands and fibromatosis plantaris (Ledderhose) on both feet simultaneously. It is suggested that more attention be paid to examination of the soles of the feet, especially after a period of immobilization and plaster fixation of the shank. On diagnosis of Ledderhose disease, surgery should be performed before the often irreversible deformation of the toes develops.

  3. Advances in the management of Dupuytren disease: collagenase.

    Science.gov (United States)

    Hentz, Vincent R; Watt, Andrew J; Desai, Shaunak S; Curtin, Catherine

    2012-11-01

    Dupuytren disease (DD) is a benign, generally painless connective tissue disorder affecting the palmar fascia that leads to progressive hand contractures. Mediated by myofibroblasts, the disease most commonly begins as a nodule in the palm or finger, and can progress where pathologic cords form leading to progressive flexion deformity of the involved fingers. The palmar skin overlying the cords may become excessively calloused and contracted and involved joints may develop periarticular fibrosis. Although there is no cure, the sequellae of this affliction can be corrected. This article focuses on the role of collagen in DD and the development of a collagen-specific enzymatic treatment for DD contractures.

  4. [Paleopathology of deafness: skulls of the Dupuytren Museum].

    Science.gov (United States)

    Benmoussa, Nadia; Muller, A -L; Kerner, J; Josset, P; Conan, P; Charlier, P

    2015-01-01

    In the 18th and 19th centuries, the Dupuytren Museum was indispensable for the knowledge of pathological anatomy for physicians and surgeons. Nowadays, it is more a museum than a learning unit, but it provides an opportunity to understand through numerous scientific studies the origin of diseases, injuries mechanism and the functional consequences of which could suffer some patients. This study illustrates the interest of the study on pieces in pathological anatomy's museums, this time across selected skulls which belonged to hearing loss people. bizarre.

  5. Adipose-derived stem cells inhibit the contractile myofibroblast in Dupuytren's disease.

    NARCIS (Netherlands)

    Verhoekx, J.S.; Mudera, V.; Walbeehm, E.T.; Hovius, S.E.

    2013-01-01

    BACKGROUND: In an attempt to provide minimally invasive treatment for Dupuytren's disease, percutaneous disruption of the affected tissue followed by lipografting is being tested. Contractile myofibroblasts drive this fibroproliferative disorder, whereas stem cells have recently been implicated in

  6. Bayesian modelling of Dupuytren disease by using Gaussian copula graphical models

    NARCIS (Netherlands)

    Mohammadi, Abdolreza; Abegaz, Fentaw; van den Heuvel, Edwin; Wit, Ernst C.

    Dupuytren disease is a fibroproliferative disorder with unknown aetiology that often progresses and eventually can cause permanent contractures of the fingers affected. We provide a computationally efficient Bayesian framework to discover potential risk factors and investigate which fingers are

  7. Adipose-derived stem cells inhibit the contractile myofibroblast in Dupuytren's disease.

    NARCIS (Netherlands)

    Verhoekx, J.S.; Mudera, V.; Walbeehm, E.T.; Hovius, S.E.

    2013-01-01

    BACKGROUND: In an attempt to provide minimally invasive treatment for Dupuytren's disease, percutaneous disruption of the affected tissue followed by lipografting is being tested. Contractile myofibroblasts drive this fibroproliferative disorder, whereas stem cells have recently been implicated in p

  8. Risk factors in Dupuytren's diathesis: is recurrence after surgery predictable?

    Science.gov (United States)

    Degreef, Ilse; De Smet, Luc

    2011-02-01

    In order to investigate the prognostic value of possible risk factors for Dupuytren's diathesis, clinical parameters on disease presentation in an operated group of patients were compared with self-reported recurrence after a minimum 2 years follow-up. In order of significance, the following factors were found to be significantly correlated with disease recurrence : age of onset under 50 years (p = 0.01), bilateral disease (p = 0.01), Ledderhose disease (p = 0.01), first ray involvement (p = 0.02), multiple ray involvement (more than 2 digits, p = 0.02), ectopic fibromatosis (p = 0.02), family occurrence (p = 0.04) and male gender (p = 0.05). No correlation of self-reported disease recurrence was seen with diabetes, frozen shoulder syndrome or epilepsy. An insight in the significance of the influence of specific risk factors on recurrence rates, helps in creating a clearer representation of Dupuytren's diathesis. This will help the surgeon to more accurately inform the patient and possibly to reconsider and adjust the choice in treatment options.

  9. Dupuytren contracture: comparative study between partial fasciectomy and percutaneous fasciectomy

    Directory of Open Access Journals (Sweden)

    Samuel Ribak

    2013-12-01

    Full Text Available Objectives: To compare the clinical results obtained by using the techniques of open limited fasciectomy (FP and percutaneous needle fasciectomy (FPC in patients with Dupuytren's contracture after one year follow up. Methods: Thirty-three patients and a total of 50 fingers with Dupuytren's contracture were divided non-randomly and evaluated after undergoing procedures with FP or FPC. The results were evaluated based on the Tubiana classification, DASH score (Disabilities of the Arm, Shoulder, and Hand, time until return to professional activities, total passive extension deficit (DTEP, the relationship between the extension deficit and DASH, recurrence and complications. Results: Twenty-six fingers were treated with FPC technique and 24 fingers with FP. The DTEP was significantly lower in FP group (10.23º when compared to FPC group (23.46º at 12 months postoperatively (p = 0.038. The remaining items assessed did not show any statistically significant differences. Conclusion: Total passive extension deficit at 12 months is lower in the group of open limited fasciectomy. There are no significant differences between groups FP and FPC over the classification of Tubiana, the DASH score, time until return to professional activities and the incidence of recurrence.

  10. Elevated transforming growth factor β and mitogen-activated protein kinase pathways mediate fibrotic traits of Dupuytren's disease fibroblasts

    Directory of Open Access Journals (Sweden)

    Krause Carola

    2011-06-01

    Full Text Available Abstract Background Dupuytren's disease is a fibroproliferative disorder of the palmar fascia. The treatment used to date has mostly been surgery, but there is a high recurrence rate. Transforming growth factor β (TGF-β has been implicated as a key stimulator of myofibroblast activity and fascial contraction in Dupuytren's disease. Results We studied Dupuytren's fibroblasts in tissues ex vivo and in cells cultured in vitro and found increased TGF-β expression compared to control fibroblasts. This correlated not only with elevated expression and activation of downstream Smad effectors but also with overactive extracellular signal-regulated kinase 1/2 (ERK1/2/mitogen-activated protein (MAP kinase signalling. Treatment with the TGF-β type I receptor kinase inhibitor SB-431542 and bone morphogenetic protein 6 (BMP6 led to inhibition of elevated Smad and ERK1/2/MAP kinase signalling as well as to inhibition of the increased contractility of Dupuytren's fibroblasts. BMP6 attenuated TGF-β expression in Dupuytren's fibroblasts, but not in control fibroblasts. Platelet-derived growth factor (PDGF expression was strongly promoted by TGF-β in Dupuytren's fibroblasts and was curbed by SB-431542 or BMP6 treatment. High basal expression of phosphorylated ERK1/2 MAP kinase and fibroproliferative markers was attenuated in Dupuytren's fibroblasts by a selective PDGF receptor kinase inhibitor. Cotreatment of Dupuytren's fibroblasts with SB-431542 and the mitogen-activated protein kinase kinase 1 inhibitor PD98059 was sufficient to abrogate proliferation and contraction of Dupuytren's fibroblasts. Conclusions Both TGF-β and ERK1/2 MAP kinase pathways cooperated in mediating the enhanced proliferation and high spontaneous contraction of Dupuytren's fibroblasts. Our data indicate that both signalling pathways are prime targets for the development of nonsurgical intervention strategies to treat Dupuytren's disease.

  11. Dupuytren disease is highly prevalent in male field hockey players aged over 60 years.

    Science.gov (United States)

    Broekstra, Dieuwke C; van den Heuvel, Edwin R; Lanting, Rosanne; Harder, Tom; Smits, Inge; Werker, Paul M N

    2016-09-22

    Dupuytren disease is a fibroproliferative hand condition. The role of exposure to vibration as a risk factor has been studied with contradictory results. Since field hockey is expected to be a strong source of hand-arm vibration, we hypothesised that long-term exposure to field hockey is associated with Dupuytren disease. In this cross-sectional cohort study, the hands of 169 male field hockey players (IQR: 65-71 years) and 156 male controls (IQR: 59-71 years) were examined for signs of Dupuytren disease. Details about their age, lifestyle factors, medical history, employment history and leisure activities were gathered. Prior to the analyses, the groups were balanced in risk factors using propensity score matching. The association between field hockey and Dupuytren disease was determined using a subject-specific generalised linear mixed model with a binomial distribution and logit link function (matched pairs analysis). Dupuytren disease was observed in 51.7% of the field hockey players, and in 13.8% of the controls. After propensity score matching, field hockey playing as dichotomous variable, was associated with Dupuytren disease (OR=9.42, 95% CI 3.01 to 29.53). A linear dose-response effect of field hockey (hours/week x years) within the field hockey players could not be demonstrated (OR=1.03, 95% CI 0.68 to 1.56). We found that field hockey playing has a strong association with the presence of Dupuytren disease. Clinicians in sports medicine should be alert to this less common diagnosis in this sport. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. The Impact of Mergers and Acquisitions on the Market Value of Shares of Erste Bank Group

    Directory of Open Access Journals (Sweden)

    Popovici Andreea Nicoleta

    2014-06-01

    Full Text Available Mergers and acquisitions are ways used by banks to improve their profitability and to obtain other advantages. The purpose of this study is to analyze the impact of mergers and acquisitions on the performance of the bidder bank. For this study, I have chosen to research the impact of acquisitions and mergers of Erste Group during 2000-2011, considering the target bank is in Central and Eastern Europe. Using the event study methodology, the result of the study shows that a merger or an acquisition does not improve the value market of the shares of the bidder bank.

  13. Delayed manipulation after collagenase clostridium histolyticum injection for Dupuytren contracture.

    Science.gov (United States)

    Kaplan, F Thomas D; Badalamente, Marie A; Hurst, Lawrence C; Merrell, Gregory A; Pahk, Raymond

    2015-09-01

    Collagenase clostridium histolyticum (CCH) injection for Dupuytren contracture was approved in the USA in 2010. Current FDA guidelines stipulate that finger manipulation occurs the day following injection. To investigate the safety and efficacy of delaying manipulation to 2 or 4 days following CCH injection, we conducted a prospective, randomized trial at two sites. Patients with Dupuytren contracture involving the metacarpophalangeal (MCP) joint ≥20° caused by a palpable cord participated. All patients received one dose of CCH (0.58 mg/0.25 ml) and were followed for 90 days. The primary end point was the percent of patients maintaining clinical success (reduction of contracture to 0°-5°) at 90 days post-injection. Adverse events and change in Michigan Hand Questionnaire (MHQ) score were recorded as secondary end points. Thirty-seven patients enrolled; 13 were manipulated on day 1, 11 on day 2, and 13 on day 4. At 30 days after injection, the percentage of patients obtaining reduction of contracture to <0°-5° extension was 92, 82, and 85 % in groups 1, 2, and 3, respectively, with no significant difference. At 90 days follow-up, the percentage of patients maintaining 0°-5° extension was 91, 82, and 83 % in groups 1, 2, and 3, respectively, with no significant difference. Adverse events were comparable to rates in prior studies. There were no serious adverse events. There was no statistical difference in MHQ scores between groups at any time point. Delaying manipulation to day 2 or 4 following CCH injection for MCP joint contractures does not increase adverse events or result in loss of efficacy. Therapeutic, Level II.

  14. Patterns of Dupuytren disease in fingers: studying correlations with a multivariate ordinal logit model.

    Science.gov (United States)

    Lanting, Rosanne; Nooraee, Nazanin; Werker, Paul M N; van den Heuvel, Edwin R

    2014-09-01

    Dupuytren disease affects fingers in a variable fashion. Knowledge about specific disease patterns (phenotype) based on location and severity of the disease is lacking. In this cross-sectional study, 344 primary affected hands with Dupuytren disease were physically examined. The Pearson correlation coefficient between the coexistence of Dupuytren disease in pairs of fingers was calculated, and agglomerative hierarchical clustering was applied to identify possible clusters of affected fingers. With a multivariate ordinal logit model, the authors studied the correlation on severity, taking into account age and sex, and tested hypotheses on independence between groups of fingers. The ring finger was most frequently affected by Dupuytren disease, and contractures were seen in 15.1 percent of affected rays. The severity of thumb and index finger, middle and ring fingers, and middle and little fingers was significantly correlated. Occurrences in pairs of fingers were highest in the middle and ring fingers and lowest in the thumb and index finger. Correlation between the ring and little fingers and a correlation between fingers from the ulnar and radial sides could not be demonstrated. Rays on the ulnar side of the hand are predominantly affected. The middle finger is substantially correlated with other fingers on the ulnar side, and the thumb and index finger are correlated; however, there was no evidence that the ulnar side and the radial side were correlated in any way, which suggests that occurrence on one side of the hand does not predict Dupuytren disease on the other side of the hand. Risk, III.

  15. [Characteristics of Dupuytren's disease in women. A study of 67 cases].

    Science.gov (United States)

    Ferry, N; Lasserre, G; Pauchot, J; Lepage, D; Tropet, Y

    2013-12-01

    The aim of this study was to identify the clinical differences of the Dupuytren's disease in gender. Testosterone induces an increase of the Dupuytren's fibroblast proliferation via androgen's receptors. Testosterone rate increases during pregnancy and menopausis. We also reached a link between this factors and the clinical aspects of Dupuytren' disease in the women of our study. This retrospective, comparative study was about all women and a randomized number of men, who underwent surgery for Dupuytren' disease between 1980 and 2010. We analysed all the epidemiologic and clinical data, the surgery procedures and the complications. Pre- and postoperative measurements of the extension lack of all the joints were performed with a manual goniometer. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate the patients function. This specific data of women were reached. Sixty-seven women and 69 men were compared. The complex regional pain syndrome was significantly more common in women and the correction of the proximal interphalangeal joint was significantly lower in women. Recurrence rate and mean follow up were not statistically different. Mean DASH score was higher in women. We have not found any association between menopausis, pregnancy and the average age at presentation of the disease, the recurrence rate or the extension rate. The prognosis of the Dupuytren's disease is worse in women than in men. Other studies are necessary to reach the link between the testosterone and the clinical history of the disease in women. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  16. Collagenase Treatment in Dupuytren Contractures: A Review of the Current State Versus Future Needs.

    Science.gov (United States)

    Degreef, Ilse

    2016-06-01

    Dupuytren disease is highly prevalent and the finger contractures can be very extensile, compromising the patients' hand function. To restore full function, contractures have been addressed by cutting the causative strands for nearly 200 years, ever since Baron Guillaume Dupuytren demonstrated his technique at the beginning of the nineteenth century. Surgery can be minimal (fasciotomy) or quite invasive (fasciectomy and even skin replacement). However, in the last decade translational research has introduced the non-surgical technique of enzymatic fasciotomy with collagenase injections. Now, finger contractures can be released with single injections on monthly intervals, to address one joint contracture at a time. However, in hands affected with Dupuytren contractures to the extent that the patient calls for treatment, most often more than one joint is involved. In surgical treatment options all contracted joints are addressed in a single procedure. Nevertheless, extensile surgery withholds inherent risks of complications and intense rehabilitation. Today, the minimally-invasive method with enzymatic fasciotomy by collagenase injection has demonstrated reliable outcomes with few morbidities and early recovery. However, single-site injection is todays' standard procedure and multiple joints are addressed in several sessions with monthly intervals. This triggers a longer recovery and treatment burden in severely affected hands even though surgery is avoided. Therefore, further treatment modalities of collagenase use are explored. Adjustments in the treatment regimes' flexibility and collagenase injections addressing more than one joint contracture simultaneously will improve the burden of multiple sessions and, therefore, enzymatic fasciotomy may become the preferred method in more extensile Dupuytren contractures. In this independent review, the challenge of Dupuytren disease affecting a single versus multiple joints is presented. The pros and cons of collagenase

  17. Epileptische Anfälle nach zerebrovaskulären Ereignissen - Erste Auswertungen der Wiener Schlaganfalldatenbank

    Directory of Open Access Journals (Sweden)

    Glawar B

    2002-01-01

    Full Text Available Die Inzidenz isolierter epileptischer Anfälle nach Schlaganfällen wird in der Literatur zwischen 4 und 15 % angegeben. Die Wahrscheinlichkeit, eine Epilepsie nach einem zerebrovaskulären Ereignis zu entwickeln, liegt nach bisherigen Erkenntnissen zwischen 4 und 9 %. In einer prospektiven, multizentrischen Datenerhebung im Rahmen der Wiener Schlaganfalldatenbank werden seit Oktober 1998 Patienten mit der Diagnose Schlaganfall (nach der WHO-Definition und TIA, die innerhalb von 72 Stunden nach dem Ereignis zur Aufnahme an eine neurologische Abteilung kommen, erfaßt. Unter anderem werden auch Auftreten und Art von epileptischen Anfällen nach dem Ereignis beziehungsweise die Entwicklung einer vaskulären Epilepsie erfaßt. Für die vorliegende Fragestellung wurden die Daten von 1969 Patienten inklusive einer Dreimonatskontrolle ausgewertet. 82 dieser 1969 Patienten (= 4,2 % erlitten einen oder mehrere epileptische Anfälle nach dem Ereignis. Bei 55 Patienten (= 67 % trat der erste Anfall innerhalb von 24 Stunden, entsprechend einem Immediatanfall, auf. 22 Patienten (= 27 % hatten den ersten Anfall innerhalb der ersten 14 Tage, und bei 5 Personen (= 6 % wurde der erste Anfall erst zu einem späteren Zeitpunkt dokumentiert. Bei 67 % (n = 55 traten fokale Anfälle mit/ohne sekundäre Generalisierung auf, und bei ca. 33 % (n = 27 kam es zu phänomenologisch primär generalisierten Anfällen. In einer multivariaten Analyse zeigt sich, daß vor allem Patienten mit initial schwerer Behinderung nach dem NIH-Stroke Score ein höheres Risiko haben, epileptische Anfälle zu entwickeln. Bei 12 Patienten trat mehr als ein epileptischer Anfall auf, dies entspricht einer Inzidenz von 0,6 % für die Entwicklung einer vaskulären Epilepsie. In einem Beobachtungszeitraum von 3 Monaten sind noch nicht alle Patienten, die epileptische Anfälle entwickeln, erfaßt. Längere Beobachtungszeiträume und Kontrollen nach einem und nach zwei Jahren werden ausf

  18. Numerical integration - connecting link between theory and practice. Pt. 1. Functionalism and action of numerical mathematical algorithms and their influence to the results of the system performance; Numerische Integration - Bindeglied zwischen Theorie und Praxis. T. 1. Funktionalitaet und Wirken numerischer mathematischer Algorithmen, sowie deren Einfluss auf die Ergebnisse des ``Systemverhaltens``

    Energy Technology Data Exchange (ETDEWEB)

    Rauch, K.C.

    1997-04-01

    The consideration of dynamic processes becomes more and more important on investigations of building heating plants, because of their influence on the economics, but also on the determination of an energy-optimal operation of such a system. For practical considerations of counter-clockwise operated heat exchanger model with known system parameters has been extracted for the theoretical investigations. The first part of this contribution deals with the functionalism and the action of the proposed numerical methods (the kind of finite differencing-scheme, grid spacing of time and space). The second part belongs to the results of the system performance of the technical component. The resulting differences which are produced by the used numerical method will be considered by special investigations of the asymptotik behaviour according to the grid spacing (number of nodes). (orig./GL) [Deutsch] Die Betrachtung dynamischer Vorgaenge spielt zunehmend bei der Untersuchung von Gebaeudewaermeversorgungssystemen eine erhebliche Rolle, da deren Auswirkungen massgeblich die Wirtschaftlichkeit eines Anlagensystems beeinflussen, sowie zur Findung und Beurteilung energieoptimaler Fahrweisen benoetigt werden. Anhand eines konkreten Beispiels (Waermeuebertrager im Gegenstrom) wird auf die speziellen Belange und Eigentuemlichkeiten bei der Modellerstellung (verteilt/konzentriert) sowie die gaengigsten Loesungsansaetze eingegangen und deren Einfluss auf die ermittelten Ergebnisse dargestellt. Der Aufsatz wird dabei in zwei Teile untergliedert. Der erste Teil beschaeftigt sich mit der Funktionalitaet und dem Wirken der vorgestellten numerischen mathematischen Algorithmen, sowie mit den den Loesungsmethoden eigenen Diskretisierungsansaetzen fuer die notwendige Umwandlung der partiellen Differentialquotienten in Differenzenquotienten zur Bildung der gewoehnlichen Differentialgleichungen. Der zweite Teil des Aufsatzes untersucht den Einfluss der beschriebenen numerischen Verfahren auf die

  19. Experimental geothermal well at Bad Schinznach. First results; Geothermiebohrung Bad Schinznach. Erste Resultate

    Energy Technology Data Exchange (ETDEWEB)

    Haering, M.O. [Haering Geo-Project, Steinmaur (Switzerland)

    1997-12-01

    The spa of Bad Schinznach (Canton Argovia, Switzerland) endeavours to cover its heating requirements with geothermal energy. A recently drilled well to a depth of 890 meters encountered the regional acquifer of thermal water (Oberer Muschelkalk, Triassic) in three levels. Preliminary results indicate a productive aquifer in the uppermost level with a wellhead temperature of 42 C. An additional exploitation of the bottomhole formation temperature of 63 C is envisaged. (orig.) [Deutsch] Das Bad Schinznach (Kanton Aargau, Schweiz) moechte im Rahmen der wirtschaftlichen Moeglichkeiten seinen Waermebedarf mit der Nutzung des Thermalwassers aus dem Oberen Muschelkalk (Trias) decken. Eine neulich abgeteufte Bohrung bis auf 890 Meter Tiefe hat die Formation auf drei Niveaus angetroffen. Erste Resultate deuten auf ein nutzbares Vorkommen im obersten Horizont mit einer Austrittstemperatur von 42 C. Eine zusaetzliche Nutzung der hohen Formationstemperatur von 63 C auf Endtiefe wird erwogen. (orig.)

  20. Dupuytren-Like Contracture of the Foot: Ledderhose Disease.

    Science.gov (United States)

    Akdag, Osman; Yildiran, Gokce; Karamese, Mehtap; Tosun, Zekeriya

    2016-07-01

    Introduction  Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report  A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion  Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion  The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.

  1. Scientific understanding and clinical management of Dupuytren disease.

    Science.gov (United States)

    Shih, Barbara; Bayat, Ardeshir

    2010-12-01

    Dupuytren disease (DD) is a fibroproliferative disorder of unknown etiology that often results in shortening and thickening of the palmar fascia, leading to permanent and irreversible flexion contracture of the digits. This Review provides a detailed update of the scientific understanding of DD and its clinical management, with perspectives on emerging research and therapy. Established risk factors include genetic predisposition and ethnicity, as well as sex and age. Several environmental risk factors (some considered controversial) include smoking, alcohol intake, trauma, diabetes, epilepsy and use of anticonvulsant drugs, and exposure to vibration. DD has been variously attributed to the presence of oxygen free radicals, trauma to the palmar fascia, or aberrant immune responses with altered antigen presentation, or to interactions between these proposed mechanisms. The presence of immune cells and related phenomena in DD-affected tissue suggests that DD is possibly immune-related. Mechanically, digital contracture is caused by myofibroblasts in the DD palmar fascia; however, the exact origin of this cell type remains unknown. The mainstay of treatment is surgical release or excision of the affected palmodigital tissue, but symptoms often recur. Nonsurgical correction of DD contractures can be achieved by Clostridium histolyticum collagenase injection, although the long-term safety and recurrence rate of this procedure requires further assessment.

  2. Technik und Ergebnisse der operativen Therapie des Total- und Subtotalprolaps

    Directory of Open Access Journals (Sweden)

    Klaritsch P

    2006-01-01

    Full Text Available In einer retrospektiven Studie wurde das Outcome der operativen Therapie des Genitalprolaps an der Klinischen Abteilung für Gynäkologie zwischen 1999 und 2004 untersucht und die Ergebnisse mit der Literatur verglichen. Im beobachteten Zeitraum wurden 104 Frauen wegen eines Total- oder Subtotalprolaps des Uterus bzw. des Scheidenblindsackes an unserer Abteilung operiert. 65 Fälle mit Subtotalprolaps erfüllten die Kriterien des Stadiums III des "pelvic organ prolapse quantification system", 39 Fälle mit Totalprolaps des Uterus und Prolaps des Scheidenblindsackes wurden als Stadium IV klassifiziert. Das durchschnittliche Alter zum Zeitpunkt der Operation betrug 69,5 (46–92 Jahre. In 101 Fällen wurde ein vaginaler Zugang gewählt, während in 3 Fällen Zusatzindikationen ein abdominales Vorgehen erforderten. Intraoperative Komplikationen traten in Form von zwei Blasen- und einer Rektumläsion auf. Postoperativ kam es zu einer Nachblutung und einem Harnwegsinfekt. Im Follow-up konnten wir 69 Frauen (66 % über einen mittleren Zeitraum von 13 (1–55 Monaten nachbeobachten. In diesem Zeitraum fanden wir 13 Fälle eines Rezidivprolaps, wobei 12 der Rezidive nach vaginalem Verfahren vorkamen (11,5 %. Aus dem Vergleich der Daten mit publizierten Arbeiten läßt sich in bezug auf Rezidivraten kein Vorteil eines primär abdominalen Vorgehens ableiten. Die höhere Morbidität der abdominalen Technik, die sich mit längeren Spitalsaufenthalten und höheren Kosten zu Buche schlägt, ist zusätzlich ein wichtiger gesundheitspolitischer und ökonomischer Aspekt.

  3. Unraveling the signaling pathways promoting fibrosis in Dupuytren's disease reveals TNF as a therapeutic target

    NARCIS (Netherlands)

    L.S. Verjee (Liaquat S); J.S.N. Verhoekx (Jennifer); J.K.K. Chan (James K K); T. Krausgruber (Thomas); V. Nicolaidou (Vicky); D. Izadi (David); D. Davidson (Dominique); H. Feldmann (Heinz); K.S. Midwood (Kim S); J. Nanchahal (Jagdeep)

    2013-01-01

    textabstractDupuytren's disease is a very common progressive fibrosis of the palm leading to flexion deformities of the digits that impair hand function. The cell responsible for development of the disease is the myofibroblast. There is currently no treatment for early disease or for preventing recu

  4. The quantitative role of flexor sheath incision in correcting Dupuytren proximal interphalangeal joint contractures.

    Science.gov (United States)

    Blazar, P E; Floyd, E W; Earp, B E

    2016-07-01

    Controversy exists regarding intra-operative treatment of residual proximal interphalangeal joint contractures after Dupuytren's fasciectomy. We test the hypothesis that a simple release of the digital flexor sheath can correct residual fixed flexion contracture after subtotal fasciectomy. We prospectively enrolled 19 patients (22 digits) with Dupuytren's contracture of the proximal interphalangeal joint. The average pre-operative extension deficit of the proximal interphalangeal joints was 58° (range 30-90). The flexion contracture of the joint was corrected to an average of 28° after fasciectomy. In most digits (20 of 21), subsequent incision of the flexor sheath further corrected the contracture by an average of 23°, resulting in correction to an average flexion contracture of 4.7° (range 0-40). Our results support that contracture of the tendon sheath is a contributor to Dupuytren's contracture of the joint and that sheath release is a simple, low morbidity addition to correct Dupuytren's contractures of the proximal interphalangeal joint. Additional release of the proximal interphalangeal joint after fasciectomy, after release of the flexor sheath, is not necessary in many patients. IV (Case Series, Therapeutic). © The Author(s) 2015.

  5. Epidemiology of Dupuytren disease unraveled : Prevalence, risk factors and disease course

    NARCIS (Netherlands)

    Broekstra, Dieuwke

    2017-01-01

    Bij de meeste patiënten met de ziekte van Dupuytren verergert hun aandoening over tijd, hoewel er ook mensen zijn bij wie de ziekte stabiel is of zelfs verbetert. Dit is de belangrijkste bevinding uit dit proefschrift. Daarnaast hebben we geprobeerd factoren aan te wijzen die verergering kunnen

  6. Unraveling the signaling pathways promoting fibrosis in Dupuytren's disease reveals TNF as a therapeutic target

    NARCIS (Netherlands)

    L.S. Verjee (Liaquat S); J.S.N. Verhoekx (Jennifer); J.K.K. Chan (James K K); T. Krausgruber (Thomas); V. Nicolaidou (Vicky); D. Izadi (David); D. Davidson (Dominique); H. Feldmann (Heinz); K.S. Midwood (Kim S); J. Nanchahal (Jagdeep)

    2013-01-01

    textabstractDupuytren's disease is a very common progressive fibrosis of the palm leading to flexion deformities of the digits that impair hand function. The cell responsible for development of the disease is the myofibroblast. There is currently no treatment for early disease or for preventing

  7. Results of partial fasciectomy for Dupuytren disease in 261 consecutive patients

    NARCIS (Netherlands)

    Coert, JH; Nerin, JPB; Meek, MF

    Many different surgical techniques are still being used for Dupuytren disease. The outcome of 558 consecutive operations with 1 technique was reviewed. Distinct subgroups were made to detect risk factors for a poor outcome and complications. The mean follow-up time was 7.3 years. Younger patients

  8. Collagenase Treatment for Dupuytren Disease of the Thumb and First Web

    NARCIS (Netherlands)

    Dreise, Marieke M.; Stenekes, Martin W.; Werker, Paul M. N.

    2016-01-01

    Purpose To evaluate the short-term effectiveness of collagenase Clostridium histolyticum to treat thumb and first web contractures in Dupuytren disease. Methods We prospectively included 14 thumbs in 12 patients with a contracture at the metacarpophalangeal or interphalangeal joint of at least 20 de

  9. Collagenase Treatment for Dupuytren Disease of the Thumb and First Web

    NARCIS (Netherlands)

    Dreise, Marieke M.; Stenekes, Martin W.; Werker, Paul M. N.

    Purpose To evaluate the short-term effectiveness of collagenase Clostridium histolyticum to treat thumb and first web contractures in Dupuytren disease. Methods We prospectively included 14 thumbs in 12 patients with a contracture at the metacarpophalangeal or interphalangeal joint of at least 20

  10. A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren's disease

    NARCIS (Netherlands)

    Kemler, M. A.; Houpt, P.; van der Horst, C. M. A. M.

    2012-01-01

    Before surgery for Dupuytren's contracture, 54 patients with a proximal interphalangeal (PIP) joint flexion contractures of at least 30 degrees were randomized to receive either a 3-month splinting protocol together with hand therapy under the direct supervision of hand therapists, or the same hand

  11. Results of partial fasciectomy for Dupuytren disease in 261 consecutive patients

    NARCIS (Netherlands)

    Coert, JH; Nerin, JPB; Meek, MF

    2006-01-01

    Many different surgical techniques are still being used for Dupuytren disease. The outcome of 558 consecutive operations with 1 technique was reviewed. Distinct subgroups were made to detect risk factors for a poor outcome and complications. The mean follow-up time was 7.3 years. Younger patients (f

  12. Further evidence of the involvement of the Wnt signaling pathway in Dupuytren's disease

    NARCIS (Netherlands)

    ten Dam, Evert-Jan P. M.; van Beuge, Marike M.; Bank, Ruud A.; Werker, Paul M. N.

    2016-01-01

    Genetic background plays an important role in the development of Dupuytren's disease. A genome-wide association study (GWAS) showed that nine loci are associated with the disease, six of which contain genes that are involved in Wnt signaling (WNT2, WNT4, WNT7B, RSPO2, SFRP4, SULF1). To obtain insigh

  13. Dupuytren disease is highly prevalent in male field hockey players aged over 60 years

    NARCIS (Netherlands)

    Broekstra, Dieuwke C; van den Heuvel, Edwin R; Lanting, Rosanne; Harder, Tom; Smits, Inge; Werker, Paul M N

    2016-01-01

    BACKGROUND/AIM: Dupuytren disease is a fibroproliferative hand condition. The role of exposure to vibration as a risk factor has been studied with contradictory results. Since field hockey is expected to be a strong source of hand-arm vibration, we hypothesised that long-term exposure to field hocke

  14. A survey of clinical manifestations and risk factors in women with Dupuytren's disease.

    Science.gov (United States)

    Degreef, Ilse; Steeno, Pieter; De Smet, Luc

    2008-08-01

    Dupuytren's disease is very common, with a prevalence of up to 40% in the Scandinavian population. Although many epidemiological surveys have been conducted, little is known about its aetiology. Multiple risk factors in Dupuytren's disease have been identified. About 80% of the affected patients are male. Even though recent data suggest similar outcome after surgical treatment in the female patient, recurrence after surgery is more frequent. To assess Dupuytren's disease in women, a record analysis and a survey of risk factors was conducted in 130 female patients surgically treated at our institution between 1988 and 2005. With a response rate of 52%, 65 women were included (6 patients were confirmed dead). The mean age of onset of the disease was 50 years and 6 months. After a mean follow-up of 7 years and 7 months (2y1m to 21y9m), recurrent disease after surgery was reported in 42%. Bilateral disease was present in 54%, unilateral in 26% right and 20% left hands. The fifth finger was involved in 77%, the 4th finger in 48% and the 1st ray in 14%. Ectopic lesions were seen in 19%, with a positive family history in 55%. Only one patient had a confirmed alcohol abuse; 22% were smokers. There were 32% manual workers. Shoulder pain was present in 54% of the patients, with confirmed diagnosis of frozen shoulder syndrome in 45%. High cholesterol was diagnosed in 39% and only 6% had diabetes. Epilepsy was seen in 5%. High disease recurrence and factors related to an aggressive course of the disease are present in female patients with Dupuytren's contracture, with a high family history occurrence, bilateral disease and associated Ledderhose disease. Several known risk factors were present: high cholesterol, smoking and manual work. Frozen shoulder showed a very high prevalence in women with Dupuytren's disease.

  15. Surgical treatment of Dupuytren's disease - outcome and health economy in relation to smoking and diabetes.

    Science.gov (United States)

    Eckerdal, David; Nivestam, Axel; Dahlin, Lars B

    2014-04-02

    The conventional treatment for Dupuytren's disease is surgery. The introduction of alternative treatment strategies creates a need to track outcomes and costs relating to surgical treatment and risk factors, such as smoking and diabetes. This was the aim of the present study. In a prospective study, the outcome of open surgical treatment for finger flexion contracture in Dupuytren's disease (175 patients; 182 surgical procedures) was studied by evaluating valid QuickDASH forms answered by subjects before surgery and one year postoperatively. Data were also obtained from medical records, and preoperative declarations concerning health. In all subjects (median [25% - 75% percentiles] age 68 [62-73]), the QuickDASH score improved from 22 [9-36] to 5 [0-18]. Smokers (27/179 procedures) were younger and had a more severe degree of disease and dysfunction preoperatively than non-smokers, but the outcome of surgery did not differ between the groups. Subjects with diabetes (20/181 procedures) were younger than those without diabetes, but their disease severity or outcome did not differ. Hand specialists operated faster than residents, but the surgical outcome did not differ. Healthcare costs for surgery for Dupuytren's contracture were $ 2392 (€ 1859), which were not higher among smokers or subjects with diabetes. Only 22 patients remained in hospital (2 [1-2.3] days) and 28 patients needed sick leave (28 [21-31] days). The occurrence of necrosis of skin flaps (12%) or infections (6%) was no more frequent among smokers or those with diabetes. There is no difference in surgical outcome for finger flexion contracture in Dupuytren's disease between smokers and non-smokers or between subjects with or without diabetes, although smokers had more severe preoperative contracture. The costs for surgical treatment for finger flexion contracture in Dupuytren's disease should be viewed in relation to that for other treatment strategies.

  16. DOING SOCIAL BUSINESS IN EUROPE. FROM BANKS TO SOCIAL ENTREPRENEURSHIP. INTERVIEW WITH MR. FRANZ KARL PRÜLLER, ERSTE FOUNDATION FROM AUSTRIA

    Directory of Open Access Journals (Sweden)

    Dorian Ilie

    2013-05-01

    Full Text Available This interview was conducted with Mr. Franz Karl Prüller, member of the board of the Austrian Erste Foundation, one of the most active organizations in Central and Eastern Europe in terms of social involvement. We talked with him about social business in Europe, social entrepreneurship, cases of good practice, the situation inRomania and the Erste Foundation projects in our country

  17. Radiation therapy for Morbus Ledderhose - indication and clinical results; Strahlentherapie beim Morbus Ledderhose - Indikation und klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Seegenschmiedt, M.H.; Attassi, M. [Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus, Essen (Germany)

    2003-12-01

    were minimal: during and within 3 months of the RT course only a slight erythema (CTC 1 ) was seen in five treated lesions, while dry skin changes within the RT portal were observed in three cases (11%) in long term FU (> 12 months). Conclusions: radiotherapy is effective in treating ML and may prevent otherwise necessary surgical interventions. Nodules, cords and symptoms regress, but long-term outcome of at least 5 years has to be awaited. Prospective phase III studies should confirm these results. (orig.) [German] Hintergrund: Der morbus ledderhose (ML) ist eine hyperproliferative Erkrankung der Plantaraponeurose, die dem morbus dupuytren (MD) sehr aehnlich ist. Wir prueften, ob eine Bestrahlung die Symptome lindern und die Progression der Erkrankung aufhalten kann. Patienten und Methoden: Von Juni 1996 bis Dezember 2002 wurden zwoelf Frauen und 13 Maenner im Alter von 9-76 (median 56) Jahren mit symptomatischem ML bestrahlt und mindestens 1 Jahr kontrolliert. Insgesamt wurden 36 Fuesse (16 rechts, 20 links) bestrahlt, da elf Patienten beidseits einen Befall hatten. Zwoelf (48%) Patienten hatten auch einen MD. An 36 Fuessen lagen 63 Knoten (mit 0,5-6,5 cm Groesse) und an 13 (52%) Fuessen 20 Straenge (mit 1-4 cm Laenge) vor. Zusaetzlich bestanden 14-mai (56%) starke Fussschmerzen, achtmal (32%) Probleme beim Laufen, zwoelfmal (48%) andere Symptome (Druck, Schwellung, Spannung). Die Orthovolt-Radiotherapie erfasste alle tastbaren Knoten und Straenge. Es wurden zwei Serien zu je 5 x 3 Gy pro Woche (gesamt: 30 Gy) im Abstand von 8-12 Wochen gegeben. Die Auswertung erfolgte am Ende der RT, nach 3 und 12 Monaten und zuletzt im Dezember 2002. Primaerer Endpunkt war die Vermeidung einer Progression bzw. Operation; sekundaere Endpunkte waren mehrere objektive morphologisch-funktionelle sowie subjektive Parameter (visuelle analogskala (VAS)). Ergebnisse: Nach 38 (12-67) Monaten medianem FU war kein Fuss progredient oder musste operiert werden. Bei 11 von 36 (44%) Fuessen nahm

  18. Cataracts and Dupuytren disease: a case report and review of the literature.

    Science.gov (United States)

    Cutolo, Carlo A; Lombardo, Sara; Verticchio Vercellin, Alice C; Bertone, Chiara; De Amici, Mara; Antoniazzi, Elena; Milano, Giovanni

    2012-11-08

    Purpose. Dupuytren disease is an inherited proliferative and progressive connective disease. Ectopic disease may, however, be located distant from the palmar fascia. 
Methods. Case report and review of the literature. 
Results. We describe a case of symmetric bilateral posterior subcapsular cataracts associated with symmetric bilateral Dupuytren disease and symmetric bilateral Ledderhose disease in a 56-year-old Caucasian man. His medical history was negative for glucocorticoids intake, diabetes, and exposure to radiation. Serum transforming growth factor β (TGF-β)1 concentration has been evaluated and was found to be almost double compared to the controls. 
Conclusions. We speculate that the TGF-β plays an important role for ocular and connective tissue disorders.

  19. Re-visiting Luck's classification: a histological analysis of Dupuytren's disease.

    Science.gov (United States)

    Lam, W L; Rawlins, J M; Karoo, R O S; Naylor, I; Sharpe, D T

    2010-05-01

    Luck (1959) described a histological staging system for Dupuytren's disease, classifying the disease into three stages. Previous biochemical and immunochemical studies have detailed the decrease in type III/I collagen ratio with disease progression. Herovici (1963) described a histological stain that produced a differential red/purple and blue colour for type I and III collagen respectively. We stained 15 specimens of Dupuytren's disease and quantified the different collagen types in each using computer analysis. We found a corresponding decrease in the amount of type III collagen as a percentage of the total collagen with disease progression: stage I range 35-49% (mean 38%); stage 2 range 21-33% (mean 27%) and stage 3 range 11-19% (mean 14%). We propose a new staging system based on the relative amount of type III collagen, where stage 1: >35%, stage 2: >20% and <35%, and stage 3: <20%.

  20. Dupuytren's disease: comparative growth dynamics and morphology between cultured myofibroblasts (nodule) and fibroblasts (cord).

    Science.gov (United States)

    Vande Berg, J S; Gelberman, R H; Rudolph, R; Johnson, D; Sicurello, P

    1984-01-01

    The excised palmar fascia of 11 patients with Dupuytren's disease was separated clinically into nodules and cords. Myofibroblasts were seen by light and electron microscopy in each of the nodules, but the cords generally lacked myofibroblasts. Only one cord specimen had microscopic features that were intermediate between nodule and cord. Electron microscopy demonstrated that in vivo differences between myofibroblasts from nodules and fibroblasts from cords and control skin samples could be preserved in vitro. Growth studies showed slower growth of cultured myofibroblasts (mean +/- SD generation time 68.7 +/- 15 h) than cord-derived fibroblasts (mean +/- SD generation time 51.5 +/- 0.9 h). These data suggest that the life cycle of the myofibroblasts from Dupuytren's disease nodules differs from that of fibroblasts found in cordlike tissues. These myofibroblasts have biological characteristics nearly identical to those of myofibroblasts found in other contracting tissues, such as granulating wounds and breast cancer.

  1. Improved postoperative outcome of segmental fasciectomy in Dupuytren disease by insertion of an absorbable cellulose implant.

    Science.gov (United States)

    Degreef, Ilse; Tejpar, Sabine; De Smet, Luc

    2011-06-01

    In this case-control prospective study, we investigated if we could improve the surgical outcome of interrupting strands in Dupuytren disease by creating a blocking effect with an absorbable cellulose implant, a known absorbable adhesion barrier. We studied 33 operations in 29 patients who had the potential for recurrent disease. The cellulose was implanted in the first 15 patients. An intraindividual control was added in 4 patients, who were given the implant in 1 of 2 operated hands. Goniometric evolution was monitored on digital photography, and satisfaction was measured on a visual analogue scale (VAS) with a preliminary one year follow-up. With the implant the postoperative range of movement improved significantly (by 33%) and remained unchanged after three months to a one year follow-up. The VAS for satisfaction also improved. We conclude that cellulose implants may improve the outcome of segmental fasciectomy in Dupuytren disease by achieving a better extension of fingers and a higher patients' satisfaction.

  2. Tratamiento no quirúrgico de la contractura de Dupuytren con colagenasa de Clostridium hystoliticum

    Directory of Open Access Journals (Sweden)

    S. Mármol-Soler

    2013-09-01

    Full Text Available La contractura de Dupuytren origina una pérdida progresiva de la función de la mano. Su tratamiento de elección es quirúrgico. La inyección de una solución compuesta por dos colagenasas distintas aisladas y purificadas a partir de la bacteria Clostridium histolyticum realiza lisis selectiva del colágeno en la cuerda pretendinosa. Presentamos nuestra experiencia en el tratamiento de la enfermedad mediante la inyección de dicha colagenasa en 15 pacientes como opción no quirúrgica. Se trata de un tratamiento mínimamente invasivo, eficaz y seguro en la reducción de las contracturas de Dupuytren, tanto en las articulación metacarpofalángica como en la interfalángica proximal, al tiempo que elimina los gastos de ingreso hospitalario y las complicaciones del postoperatorio.

  3. Collagenase enzymatic fasciotomy for Dupuytren contracture in patients on chronic immunosuppression.

    Science.gov (United States)

    Waters, Michael J; Belsky, Mark R; Blazar, Philip E; Leibman, Matthew I; Ruchelsman, David E

    2015-11-01

    Collagenase enzymatic fasciotomy is an accepted nonsurgical treatment for disabling hand contractures caused by Dupuytren disease. We conducted a study to investigate use of collagenase in an immunosuppressed population. We retrospectively reviewed data from 2 academic hand surgical practices. Eight patients on chronic immunosuppressive therapies were treated with collagenase for digital contractures between 2010 and 2011. Thirteen collagenase enzymatic fasciotomies were performed in these 8 patients. Mean preinjection contracture was 53.0°. At mean follow-up of 6.7 months, mean magnitude of contracture improved to 12.9°. Mean metacarpophalangeal joint contracture improved from 42.0° to 4.2°. Mean proximal interphalangeal joint contracture improved from 65.8° to 21.7°. Three of the enzymatic fasciotomies were complicated by skin tears. There were no infections. As more patients seek nonsurgical treatment for Dupuytren disease, its safety and efficacy in select cohorts of patients should continue to be evaluated prospectively.

  4. Dupuytren disease: an evolving understanding of an age-old disease.

    Science.gov (United States)

    Black, Eric M; Blazar, Philip E

    2011-12-01

    Dupuytren disease, a clinical entity originally described more than 400 years ago, is a progressive disease of genetic origin. Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia; the resultant digital flexion contractures may severely limit function. The pathophysiology is multifactorial and remains a topic of research and debate. Genetic predisposition, trauma, inflammatory response, ischemia, and environment, as well as variable expression of proteins and growth factors within the local tissue, all play a role in the disease process. Common treatments of severe disease include open fasciectomy or fasciotomy. These procedures may be complicated by the complex anatomic relationships between cords (pathologic contracted fascia) and adjacent neurovascular structures. Recent advances in the management of Dupuytren disease involve less invasive treatments, such as percutaneous needle fasciotomy and injectable collagenase Clostridium histolyticum. Postoperative management focuses on minimizing the cellular response of cord disruption and maximizing range of motion through static or dynamic extension splinting.

  5. Dupuytren Contracture Recurrence Following Treatment With Collagenase Clostridium histolyticum (CORDLESS [Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-Year Data.

    Science.gov (United States)

    Peimer, Clayton A; Blazar, Philip; Coleman, Stephen; Kaplan, F Thomas D; Smith, Ted; Lindau, Tommy

    2015-08-01

    Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study was a 5-year noninterventional follow-up study to determine long-term efficacy and safety of collagenase clostridium histolyticum (CCH) treatment for Dupuytren contracture. Patients from previous CCH clinical studies were eligible. Enrolled patients were evaluated annually for contracture and safety at 2, 3, 4, and 5 years after their first injection (0.58 mg) of CCH. In successfully treated joints (≤ 5° contracture following CCH treatment), recurrence was defined as 20° or greater worsening (relative to day 30 after the last injection) with a palpable cord or any medical/surgical intervention to correct new/worsening contracture. A post hoc analysis was also conducted using a less stringent threshold (≥ 30° worsening) for comparison with criteria historically used to assess surgical treatment. Of 950 eligible patients, 644 enrolled (1,081 treated joints). At year 5, 47% (291 of 623) of successfully treated joints had recurrence (≥ 20° worsening)-39% (178 of 451) of metacarpophalangeal and 66% (113 of 172) of proximal interphalangeal joints. At year 5, 32% (198 of 623) of successfully treated joints had 30° or greater worsening (metacarpophalangeal 26% [119 of 451] and proximal interphalangeal 46% [79 of 172] joints). Of 105 secondary interventions performed in the successfully treated joints, 47% (49 of 105) received fasciectomy, 30% (32 of 105) received additional CCH, and 23% (24 of 105) received other interventions. One mild adverse event was attributed to CCH treatment (skin atrophy [decreased ring finger circumference from thinning of Dupuytren tissue]). Antibodies to clostridial type I and/or II collagenase were found in 93% of patients, but over the 5 years of follow-up, this did not correspond to any reported clinical adverse events. Five years after successful CCH treatment, the overall recurrence rate of 47% was comparable with published recurrence rates after

  6. Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014.

    Science.gov (United States)

    Lipman, Marc D; Carstensen, Samuel Evan; Deal, Dylan Nicole

    2017-01-01

    Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.

  7. A clinical trial of tension and compression orthoses for Dupuytren contractures.

    Science.gov (United States)

    Brauns, Annelien; Van Nuffel, Maarten; De Smet, Luc; Degreef, Ilse

    Randomized clinical trial on 2 patient groups with Dupuytren's disease. Despite an unpredictable outcome, surgery remains an important treatment for Dupuytren's disease. Orthotic devices are a controversial noninvasive treatment method to influence the myofibroblasts in the nodules. To detect how much improvement 2 types of orthotic device (tension and compression) as only treatment intervention can provide on a Dupuytren's contracture. Is a compression orthosis better than a tension orthosis? Thirty patients with measurable flexion contractures of the fingers were identified. Both primary and recurrence cases were included. Patients were randomized in 2 groups of 15 patients. One group had a standard tension orthosis (Levame), the other group a newly designed silicon compression orthotic device. Patients were instructed to wear the orthotic devices 20 hours a day during 3 months. Data were collected at first visit and after 3 months of orthotic treatment. Primary outcomes were active extension deficit of each joint and total active extension (TAE) of the digit. Secondary outcome was patient satisfaction. Visual Analog Scale (VAS) score of function and esthetics (0-10 points) were recorded at the start and after 3 months. Flexion contracture was reduced at least 5 degrees in all patients. After 3 months, TAE was significantly reduced in both groups (both P Dupuytren's disease in both early proliferative untreated hands and aggressive postsurgery recurrence. Although there is no statistically significant difference, compression orthoses appear to be more effective and are better tolerated. Nevertheless, adjustment of orthotic design and research on long-term results are needed. I (Randomized controlled trial, Therapeutic study). Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  8. Measurement Properties of the Brief Michigan Hand Outcomes Questionnaire in Patients With Dupuytren Contracture.

    Science.gov (United States)

    Wehrli, Martina; Hensler, Stefanie; Schindele, Stephan; Herren, Daniel B; Marks, Miriam

    2016-09-01

    The brief Michigan Hand Outcomes Questionnaire (briefMHQ) was developed as a shorter version of the Michigan Hand Outcomes Questionnaire (MHQ), but its measurement properties have not been investigated in patients with Dupuytren contracture. The objective of the study was to investigate the reliability, validity, responsiveness, and interpretability of the briefMHQ. Fifty-seven patients diagnosed with Dupuytren contracture completed the briefMHQ as well as the full-length MHQ and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at baseline. Two to 14 days after baseline and 1 year after collagenase injection or surgery, patients again filled out the briefMHQ. Reliability was determined using the intraclass correlation coefficient and by calculating internal consistency (Cronbach alpha). Validity was tested by quantifying correlations with the full-length MHQ and QuickDASH. Responsiveness, based on the standardized response mean and the minimally clinically important change, was also determined. The briefMHQ had an intraclass correlation coefficient of 0.87, Cronbach alpha of 0.88, and correlations of r = 0.88 and -0.82 with the original MHQ and QuickDASH, respectively. The standardized response mean was 0.9 and the minimally clinically important change was 7 points. Overall, the briefMHQ demonstrates excellent reliability, good validity, and high responsiveness in patients with Dupuytren contracture. The briefMHQ is an accurate and time-saving tool to evaluate patients with Dupuytren contracture and the effect of a corresponding treatment. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  9. Enhanced alpha 1(I) mRNA expression in frozen shoulder and dupuytren tissue.

    Science.gov (United States)

    Kilian, Olaf; Pfeil, U; Wenisch, S; Heiss, C; Kraus, R; Schnettler, R

    2007-12-14

    The purpose of this study has been to investigate collagen I and III synthesis during the fibrosing stage of frozen shoulder and Dupuytren samples in comparison to normal capsule tissue. - By using the quantitative PCR significantly increased levels of alpha 1(I) mRNA transcription in samples of frozen shoulder (p = 0.016) and Duypuytren (p = 0.041) could be demonstrated, whereas alpha 2(I) and alpha 1(III) chains have shown the same mRNA levels as in normal capsule tissue. - Despite an enhancement of alpha 1(I) mRNA transcription in frozen shoulder and Dupuytren samples the intracellular precursor procollagen I and extracellular mature collagen I was detected immunohistochemically in reduced levels. - The structural alteration of collagen I assembly might be caused by disturbed post-translation from the polypeptide chains into the triple helices procollagen I though alpha 1(I) mRNA transcription was significantly increased and alpha 2(I) mRNA transcription was in normal range. Fibroblasts might release high quantities of free alpha 1(I) polypeptide chains or (alpha 1(I)) 3 homotrimer into the extracellular space during the fibrosing stage of frozen shoulder and Dupuytren disease. - In all samples neither differences of alpha 1(III) mRNA transcription nor differences of immunohistochemical staining intensity of collagen III could be seen. This might result from apoptosis of myofibroblasts in the final phase of the fibrosing processes. - The stimulating effect of insulin-like growth factor type I (IGF-I) to induce fibrosis in connective tissue such as scarlet is known. In all patients suffering from frozen shoulder and Dupuytren disease the serum IGF-I level was in a normal range and the IGF-I receptor - (IGFR-I) mRNA transcription in the samples was also in the same level compared with normal capsule tissue.

  10. Identification of histological patterns in clinically affected and unaffected palm regions in dupuytren's disease.

    Directory of Open Access Journals (Sweden)

    Camilo-Andrés Alfonso-Rodríguez

    Full Text Available Dupuytren's disease is a fibro-proliferative disease characterized by a disorder of the extracellular matrix (ECM and high myofibroblast proliferation. However, studies failed to determine if the whole palm fascia is affected by the disease. The objective of this study was to analyze several components of the extracellular matrix of three types of tissues-Dupuytren's diseased contracture cords (DDC, palmar fascia clinically unaffected by Dupuytren's disease contracture (NPF, and normal forehand fascia (NFF. Histological analysis, quantification of cells recultured from each type of tissue, mRNA microarrays and immunohistochemistry for smooth muscle actin (SMA, fibrillar ECM components and non-fibrillar ECM components were carried out. The results showed that DDC samples had abundant fibrosis with reticular fibers and few elastic fibers, high cell proliferation and myofibroblasts, laminin and glycoproteins, whereas NFF did not show any of these findings. Interestingly, NPF tissues had more cells showing myofibroblasts differentiation and more collagen and reticular fibers, laminin and glycoproteins than NFF, although at lower level than DDC, with similar elastic fibers than DDC. Immunohistochemical expression of decorin was high in DDC, whereas versican was highly expressed NFF, with no differences for aggrecan. Cluster analysis revealed that the global expression profile of NPF was very similar to DDC, and reculturing methods showed that cells corresponding to DDC tissues proliferated more actively than NPF, and NPF more actively than NFF. All these results suggest that NPF tissues may be affected, and that a modification of the therapeutic approach used for the treatment of Dupuytren's disease should be considered.

  11. Whole-body MR imaging in children with suspected osteonecrosis after intensive chemotherapy: preliminary results; Ganzkoerper-MRT bei Kindern mit Verdacht auf Osteonekrose nach intensiver Chemotherapie: Erste Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Beer, M.; Stenzel, M.; Darge, K. [Universitaetsklinikum Wuerzburg (Germany). Inst. fuer Roentgendiagnostik; Girschick, H.; Schlegel, P.G. [Universitaetsklinikum Wuerzburg (Germany). Kinderklinik

    2008-03-15

    Purpose: use of multidrug chemotherapy poses the risk of avascular osseous necroses in children. Depiction of the whole body, including clinically non-apparent sites is mandatory for starting early and proper treatment, including surgical approaches in lesions near the joints. We analyzed the value of whole-body MRI in the detection of osteonecrosis, (1) in relation to conventional X-ray imaging and clinical symptoms, (2) using different MRI sequences, (3) with follow-up examinations. Materials and methods: 5 patients suffering from an oncological disease, 13 to 16 years old (3 x ALL, 1 x medulloblastoma, 1 x CML), and recently developing bone pain were examined with X-ray imaging of the particular region and a whole-body MRI (T2w TIRM, T1w TSE sequences, pre- and post-contrast GD-DTPA, including fat suppression techniques). Neck/thorax/abdomen/pelvis, and upper and lower extremities were acquired in the coronal plane, and the feet in sagittal orientation. 4 of 5 patients had at least one follow-up examination (in the mean after 10 {+-} 4 months). Results: none of the initial X-ray images revealed an abnormal finding. The whole-body MRI showed in 4 of 5 children bone marrow lesions compatible with osteonecrosis. The locations were around the knee joints (n = 3) and the tibiae/ankle joints (n = 4). In addition to the symptomatic sites, MRI revealed additional lesions at the following sites: humerus (n = 5), hip joints (n = 4), knee joints (n = 6), ankle joints (n = 4). The size varied from small focal lesions to lesions measuring 90% of the whole transverse diameter of the bone. The lesions were able to be detected most easily with heavily T2-weighted (TIRM) sequences, and the diagnosis was most easily established using the non-enhanced TSE T1-weighted sequences. As a consequence of the results of the whole-body MRI, all patients with lesions compatible with osteonecrosis received symptomatic (n = 2) or specific (n = 2) therapy. In the follow-up examinations, a higher number of patients showed no changes in the lesions as to size and distribution. 2 patients showed partial resolution of the osteonecroses. (orig.)

  12. Fluoroscopic-guided primary single-step percutaneous gastrostomy. Initial results using the Freka {sup registered} GastroTube; Primaere einzeitige durchleuchtungsgesteuerte perkutane Gastrostomie (PG). Erste Ergebnisse mit dem Freka {sup registered} GastroTube

    Energy Technology Data Exchange (ETDEWEB)

    Hahne, J.D.; Schoennagel, B.P.; Arndt, C.; Bannas, P.; Koops, A.; Adam, G.; Habermann, C.R. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Zentrum fuer Radiologie; Herrmann, J. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Zentrum fuer Radiologie; Universitaetsklinikum Hamburg-Eppendorf (Germany). Abt. Paediatrische Radiologie

    2011-07-15

    Purpose: To determine the practicability and outcome of fluoroscopic-guided primary one-step treatment of percutaneous gastrostomy (PG) with the system Freka {sup registered} Gastro Tube (Fresenius Kabi, Germany). Materials and Methods: In 39 patients (mean age 62.7 {+-} 12.0 years), primary PG was performed based on clinical indication from August 2009 to April 2010. The intervention was performed by an experienced radiologist under aseptic conditions by direct puncture with Freka {sup registered} Gastro Tube under fluoroscopic guidance. The clinical data and outcome as well as any complications originated from the electronic archive of the University Medical Center Hamburg-Eppendorf. Results: The intervention was technically successful in all 39 patients. Within the mean follow-up time of 155.3 {+-} 73.6 days, 29 patients (74.4 %) did not experience complications. 10 patients (25.6 %) had to be revised. Complications manifested after a mean of 135.6 {+-} 61.2 days and mainly corresponded to accidental dislocation (50 %). One patient had to be surgically revised under suspicion of a malpositioned tube and suspected intestinal perforation. Clinically relevant wound infections were not detected. The total costs per patient were 553.17 Euro for our single-step treatment (OPS 5 - 431.x) vs. 963.69 Euro (OPS 5 - 431.x and OPS 8 - 123.0) for the recommended two-step treatment. Conclusion: Fluoroscopic-guided primary single-step treatment with Freka {sup registered} Gastro Tube system is feasible and not associated with an increased complication rate when compared to published literature applying a two-step treatment approach. Material costs as well as human and time resources could be significantly reduced using the single-step treatment. (orig.)

  13. Incidence of cerebral ischemia in patients with suspected cervical artery dissection: first results of a prospective study; Inzidenz zerebraler Ischaemien bei Patienten mit dem Verdacht einer spontanen Dissektion der extrakraniellen Arterien: Erste Ergebnisse einer prospektiven Studie

    Energy Technology Data Exchange (ETDEWEB)

    Nassenstein, I. [Westfaelische Wilhelms-Univ. Muenster (Germany). Leibniz-Inst. fuer Arteriosklerose-Forschung; Kraemer, S.C.; Niederstadt, T.; Stehling, C.; Bachmann, R. [Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie; Dittrich, R.; Ringelstein, E.B. [Westfaelische Wilhelms-Univ. Muenster (Germany). Klinik fuer Neurologie; Kuhlenbaeumer, G. [Westfaelische Wilhelms-Univ. Muenster (Germany). Leibniz-Inst. fuer Arteriosklerose-Forschung; Westfaelische Wilhelms-Univ. Muenster (Germany). Klinik fuer Neurologie; Heindel, W. [Westfaelische Wilhelms-Univ. Muenster (Germany). Leibniz-Inst. fuer Arteriosklerose-Forschung; Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie

    2005-11-15

    Purpose: Aim of this prospective study was to investigate the incidence of spontaneous cervical artery dissection (sCAD) and cerebral ischemia in patients with suspected sCAD by using a combined head-neck MR-imaging protocol. Materials and Methods: 51 consecutive patients (24 m, 27 f, mean age 39.5 years, range 18 - 55 yrs) admitted to our stroke unit with suspected sCAD according to clinical criteria and age <55 years underwent a combined head and neck MR examination within 24 hours of admission (Gyroscan Intera 1.5 T, Philips). Head MRI included ax FLAIR, ax T{sub 1}, ax DWI and TOF angiography (imaging time 12 min). Neck MRI consisted of ax T1w-TSE, T2w-TSE, contrast enhanced T1w-TSE and CE-MRA (imaging time 17 min). Three radiologists assessed both studies in consensus with regard to the presence of sCAD and acute ischemia. Results: One patient had to be excluded because of motion artefacts. In 17 of 50 patients sCAD was diagnosed, and in 20 of 50 patients cerebral ischemia. In 5 patients cerebral ischemia was caused by sCAD. Conclusion: The proposed combined MR protocol allows imaging work-up of patients with suspected sCAD within approximately 30 min, resulting in conclusive information about the status of the extracranial vasculature and the presence of ischemia. The high incidence of patients with definite sCAD and the low incidence of cerebral ischemia indicates the necessity of an early definite diagnosis in order to start timely anticoagulation to prevent development of stroke. (orig.)

  14. Modality-dependent dose requirements in the Austrian breast cancer early detection program. First results from technical quality assurance; Geraeteabhaengiger Dosisbedarf im Oesterreichischen Brustkrebsfrueherkennungsprogramm. Erste Ergebnisse aus der technischen Qualitaetssicherung

    Energy Technology Data Exchange (ETDEWEB)

    Osanna-Elliott, A.; Semturs, F.; Menhart, S.; Schloegl, C.; Wildner, S.; Zwettler, G. [AGES, Wien (Austria). Referenzzentrum fuer technische Qualitaetssicherung im Brustkrebsfrueherkennungsprogramm

    2015-07-01

    The Austrian Breast Cancer Early Detection Program (BKFP) has officially started in January 2014. In order to ensure that all participating women can rely on a sufficient cancer detection rate while at the same time the required dose is as low as reasonably achievable, all participating radiology institutes (approx. 200) have to fulfill strict quality assurance requirements. The control and certification is performed by the Reference Center for Technical Quality Assurance (RefZQS), which has been developing the methods and tolerances in a pilot project since 2007. The limits are defined in the EUREF-Oeprotocol which is based on the European EPQC guidelines. From the requirement for optimized image quality while simultaneously following the ALARA principle, we found modality-dependent dose requirements, which we had expected but which have now been compiled for the first time for Austria.

  15. Initial results using MRI-guided laser-induced interstitial thermotherapy for head and neck tumors; Erste Ergebnisse der MRT-gesteuerten laserinduzierten interstitiellen Thermotherapie von Kopf- und Halstumoren

    Energy Technology Data Exchange (ETDEWEB)

    Jaeger, L. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern der Ludwig-Maximilians-Universitaet, Muenchen (Germany); Mueller-Lisse, G.U. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern der Ludwig-Maximilians-Universitaet, Muenchen (Germany); Gutmann, R. [Klinikum und Poliklinik fuer Hals-, Nasen- und Ohrenkranke, Klinikum Grasshadern der Ludwig-Maximilians-Universitaet, Muenchen (Germany); Feyh, J. [Klinikum und Poliklinik fuer Hals-, Nasen- und Ohrenkranke, Klinikum Grasshadern der Ludwig-Maximilians-Universitaet, Muenchen (Germany); Thoma, M. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern der Ludwig-Maximilians-Universitaet, Muenchen (Germany); Reiser, M. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern der Ludwig-Maximilians-Universitaet, Muenchen (Germany)

    1996-03-01

    Laser-induced interstitial thermotherapy (LITT) was introduced as a minimally invasive form of therapy for tumors in different anatomic regions. However, in the orofacial region, it has not been used so far for inoperable T4 carcinomas. Since vascular and neural structures are often close to the tumor or are even involved, online monitoring of LITT is necessary. The aim of our study was to establish a method of monitoring LITT with MRI (magnetic resonance imaging) in the orofacial region. Five patients with T4 carcinomas of the orofacial region underwent LITT under anesthesia. A 1.5 T wholebody imager with a circulary polarized head coild was used. Before and after the intervention, the region of interest was studied using T1- and T2-weighted sequences in axial and coronal planes, with and without contrast enhancement (intravenous Gd-DTPA). Temperature distribution was monitored with a T1-weighted 2D-FLASH (fast low angle shot) sequence. The positioning of the optical fibers was monitored with MRI. Nd:YAG laser equipment was used for laser application. The necrosis was best seen on contrast-enhanced MRI. Immediately after LITT, the outcome could be determined by MRI. We proposed that MRI-guided LITT be used for neoplasma in the orofacial region at advanced stages. (orig.) [Deutsch] Als neues minimalinvasives Verfahren wird die laserinduzierte interstitielle Thermotherapie (LITT) zunehmend bei tumoroesen Raumforderungen eingesetzt. In der Therapie von ausgedehnten Tumoren der Orofazialregion liegen bisher keine Erfahrungen vor. Die anatomische Komplexitaet dieser Region mit eng benachbarten vaskulaeren und nervalen Strukturen, an die meist der Tumor reicht, erlaubt keine Eingriffe ohne eine kontinuierliche Ueberwachung. Ziel unserer Untersuchungen war die Etablierung einer LITT von ausgedehnten inoperablen Kopf- und Halstumoren unter MRT-(Magnetresonanztomographie-)Kontrolle. Die Untersuchungen wurden an einem 1,5-T-Ganzkoerpertomographen, unter Verwendung einer zirkularpolarisierten Kopfspule, durchgefuehrt. Mit T1- und T2-gewichteten Sequenzen nach T1-gewichteten Sequenzen nach intravenoeser Applikation von Gd-DTPA wurde die zu therapierende Region in axialer und koronarer Schichtfuehrung kontrolliert. Die Ueberwachung der Temperaturverteilung im Gewebe erfolgte mit einer T1-gewichteten 2D-FLASH-(fast low angle shot) Sequenz. Es wurden 5 Patienten mi inoperablen Tumoren der orofazialen Region mit LITT unter kontinuierlicher MRT-Kontrolle therapiert. Die Eingriffe erfolgten in Vollnarkose. Die Laserlichtleiter wurden unter MRT-Kontrolle eingebracht. Die Laserung wurde mit einem Nd:YAG-Laser durchgefuehrt. Mit Hilfe der T1-gewichteten 2D-FLASH-Sequenz gelang das Monitoring der Temperaturverteilung unter LITT. Die Nekrose konnte bereits auf den kontrastverstaerkten T1-gewichteten Bildern unmittelbar im Anschluss an die Intervention bestimmt werden. Sie entsprach in ihrer Groesse dem entstehenden Defekt. Nach unseren ersten Erfahrungen scheint die von uns vorgestellte interventionelle MRT zum Monitoren der LITT von Kopf- und Halstumoren geeignet zu sein. (orig.)

  16. First results from the field test of households with dynamic tarif and automatic control in the regenerative model region Harz; Erste Ergebnisse des Haushaltsfeldtests mit dynamischen Tarif und automatischer Steuerung in der Regenerativen Modellregion Harz

    Energy Technology Data Exchange (ETDEWEB)

    Funke, Stephan; Landau, Markus [Fraunhofer Institut fuer Windenergie und Energiesystemtechnik (IWES), Kassel (Germany); Filzek, Dirk; Volkert, Christina [CUBE Engineering GmbH, Kassel (Germany); Fechner, Amelie [Saarland Univ., Saarbruecken (Germany). Forschungsgruppe Umweltpsychologie

    2012-07-01

    As part of the E-Energy research project RegModHarz (Regenerative Model Region Harz) a field test with test households is carried out. A system developed in the project and consisting of a dynamic tariff, appliance control and monitoring system is tested. Concomitant to this, the acceptance of this system by the participants of the field test is evaluated. First results from the commissioning of the system are already available. Currently, the second phase of the field test is performed. At this, the participants of the field test can adjust their power consumption actively and automatically to the availability of electricity from renewable energy sources in the model region.

  17. Needle aponeurotomy for Dupuytren contracture: Effectiveness of postoperative night extension splinting.

    Science.gov (United States)

    Tam, Louisa; Chung, Yin-Yin

    2016-01-01

    Night extension splinting has been used to treat patients with Dupuytren contracture to improve active range of motion (AROM) of the hand. A published case study demonstrated the benefit of splinting following needle aponeurotomy; however, no larger studies have evaluated the impact of postoperative splinting. To compare the impact of night extension splinting on AROM, specifically extension, following needle aponeurotomy for Dupuytren contracture. A retrospective chart review was conducted in which the charts of 53 patients who underwent needle aponeurotomy for Dupuytren contracture between 2009 and 2013 were reviewed. The control group consisted of patients who underwent needle aponeurotomy only, whereas the treatment group was also referred for fabrication of custom night extension splints after surgery. Comparisons in pre- and postoperative AROM measurements for the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were made between both groups of patients. The degrees of change in AROM for each joint were categorized in terms of levels of change: mild (0° to 29°); moderate (30° to 60°); and significant (≥61°). All patients exhibited increased AROM after surgery for both MCP and PIP joints. Both groups had a greater increase in AROM in the MCP joint. Twelve joints from the control group had moderate changes and two from the treatment group had significant changes. When both groups were compared, the levels of change of AROM between both groups did not vary significantly. Night extension splinting following needle aponeurotomy may not improve AROM of the MCP or PIP joints.

  18. Night Orthosis After Surgical Correction of Dupuytren Contractures: A Systematic Review.

    Science.gov (United States)

    Samargandi, Osama A; Alyouha, Sarah; Larouche, Patricia; Corkum, Joseph P; Kemler, Marius A; Tang, David T

    2017-08-31

    To determine the role of night orthosis use after surgical correction of Dupuytren contracture. We searched MEDLINE, EMBASE, CINAHL, AMED, OTSeeker, and CENTRAL for articles published from inception of the databases to August 2015. Assessment was undertaken by 2 independent reviewers (O.A.S. and S.A.). Methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa instrument. Seven studies met the standard for inclusion in this review. A total of 659 patients across these 7 studies were included in the analysis, with follow-up ranging from 3 to 72 months. None of the included studies assessed recurrence. The analysis revealed no significant improvement in range of motion of hand joints for patients who received a static night orthosis after Dupuytren surgery compared with patients without an orthosis. Similarly, no differences were found in patient-reported functional status across the 2 groups. The current literature does not appear to support the use of static night orthosis in addition to hand therapy after surgical correction of Dupuytren contracture. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Cost comparison of open fasciectomy versus percutaneous needle aponeurotomy for treatment of Dupuytren contracture.

    Science.gov (United States)

    Herrera, Fernando Antonio; Benhaim, Prosper; Suliman, Ahmed; Roostaeian, Jason; Azari, Kodi; Mitchell, Scott

    2013-04-01

    Many surgical options exist for the treatment of Dupuytren contracture. Little has been written regarding their financial implications. The purpose of this study was to compare the immediate direct costs of open fasciectomy to percutaneous needle aponeurotomy (NA) for the surgical treatment of Dupuytren contracture. A retrospective review was performed comparing patients treated with open fasciectomy (group 1) to patients treated with percutaneous NA (group 2) for the treatment of Dupuytren disease from 2008 to 2010. Financial and medical records were reviewed. Direct cost of treatment was calculated from hospital billing records, including surgical, anesthesia, and facility fees. Statistical analysis was performed using unpaired t test. Twenty-four patients received open segmental palmar and/or digital fasciectomy (group 1). Average preoperative metacarpophalangeal joint flexion contracture was 30 degrees, and proximal interphalangeal joint flexion contracture was 42 degrees. Group 2 consisted of 24 patients. Average preoperative metacarpophalangeal flexion contracture was 31 degrees, and proximal interphalangeal flexion contracture was 27 degrees. Mean cost for group 1 was $11,240 and mean cost for group 2 was $4657 (P < 0.0001). Immediate postoperative contracture correction was similar between both. Two complications occurred in group 1 (wound dehiscence and nerve injury); no complications in group 2. Percutaneous NA is associated with decreased direct costs in the short-term compared to traditional open fasciectomy with comparable deformity correction.

  20. Long-term follow-up of Dupuytren disease after injection of triamcinolone acetonide in Chinese patients in Taiwan.

    Science.gov (United States)

    Yin, C-Y; Yu, H-H M; Wang, J-P; Huang, Y-C; Huang, T-F; Chang, M-C

    2017-09-01

    Injection of triamcinolone acetonide is a non-operative treatment for early-stage Dupuytren disease in Caucasians, but its effectiveness in non-Caucasians is unclear. We report averaged 5-year follow-up results of 37 patients (49 affected hands) with early-stage Dupuytren disease for patients in Taiwan (non-Caucasian) who received a single dose of 5 mg triamcinolone acetonide injection into nodules monthly for 3 months. Using ultrasound, we recorded no progression of sizes of the modules following injection after 6 months. After an average 5-year follow-up, two patients with three hands (6%) experienced reactivation of the treated nodules. None required surgical intervention. Ultrasound examination showed that sizes of the treated Dupuytren nodules decreased significantly by 40% 6 months after injection and 56% at the final follow-up. We conclude that in these Chinese patients in Taiwan with early Dupuytren nodules, triamcinolone acetonide injection was effective in reducing the size of the Dupuytren nodules and maintaining long-term durable control of the nodular growth. III.

  1. Rezension von: Frauke Mahrt-Thomsen: Bona Peiser. Die erste deutsche Bibliothekarin. Berlin: Verlag BibSpider 2013.

    Directory of Open Access Journals (Sweden)

    Ulrike Koch

    2014-03-01

    Full Text Available Bona Peiser (1864–1929, die erste Bibliothekarin Deutschlands, hat nicht nur ein neues Ausleihsystem für Bibliotheken entwickelt, sie hat sich auch intensiv mit Fragen zur Ausbildung von Bibliothekarinnen und allgemeiner mit Frauen im Beruf beschäftigt. Welche große Rolle ihr dabei bei der Entstehung der Lesehallen in Deutschland zuzuschreiben ist, dem geht Frauke Mahrt-Thomsen in der vorliegenden Biographie nach und liefert damit, neben einem Einblick in Bona Peisers Arbeiten und Wirken, eine fundierte Übersicht in die Entstehung des Bibliothekswesen in Deutschland.

  2. Skin graft loss resulting from collagenase clostridium histolyticum treatment of Dupuytren contracture: case report and review of the literature.

    Science.gov (United States)

    Swanson, Jordan W; Watt, Andrew J; Vedder, Nicholas B

    2013-03-01

    Treatment of Dupuytren disease with collagenase clostridium histolyticum is increasingly used among hand surgeons. Although it is generally safe and efficacious, complications related to enzymatic fasciotomy occur. Postapproval surveillance and communication among hand surgeons continues to refine the indications, contraindications, and complications recognized in the treatment of Dupuytren disease with enzymatic therapy. Major treatment-related adverse events previously reported include flexor tendon rupture and complex regional pain syndrome. We report a patient who experienced total loss of a well-established volar ring finger skin graft following collagenase injection and propose a potential mechanism of vulnerability. This case may illustrate the susceptibility of type I collagen, which is uniformly present in a healed skin graft bed, to degradation with collagenase. We propose a cautious approach when considering treatment of a Dupuytren cord with collagenase in the presence of an overlying skin graft, regardless of the age of the graft.

  3. Doenças de Dupuytren e de Ledderhose associadas ao uso crônico de anticonvulsivantes: relato de caso Dupuytren's and Ledderhose's diseases associated with chronic use of anticonvulsants: case report

    OpenAIRE

    PATRÍCIA CORAL; ALESSANDRA ZANATTA; Teive, Hélio A. G.; YLMAR CORREA NETO; EDISON MATOS NÓVAK; LINEU CÉSAR WERNECK

    1999-01-01

    Relatamos o caso de um paciente que após uso crônico de anticonvulsivantes, sem epilepsia definida, desenvolveu contraturas das aponeuroses palmar (doença de Dupuytren) e plantar (doença de Ledderhose). Discutimos as principais dessas complicações, os fatores predisponentes e sua estreita relação com o uso de anticonvulsivantes, particularmente de fenobarbital.We present the case of a patient that after chronic use of anticonvulsant drugs without proven epilepsy , developed Dupuytren's and Le...

  4. Die E-Book-Umfrage an der UB Mannheim – Zusammenfassung der Ergebnisse

    OpenAIRE

    Kaiser, Jessica; Klein, Annette

    2011-01-01

    Im Dezember 2010 führte die UB eine Online-Umfrage zum Thema E-Books durch, um Anregungen für die Weiterentwicklung dieses Angebots insgesamt sowie Rückmeldungen zu der seit einigen Monaten im Test befindlichen Plattform "Dawsonera" zu bekommen, bei der E-Books zunächst "angelesen" und dann für eine elektronische Ausleihe angefragt werden können. Der Bericht fasst die wichtigsten Ergebnisse zusammen.

  5. Irradiation programme MANITU. Results of impact tests with the irradiated materials of the first irradiation phase (0.8 dpa); Bestrahlungsprogramm MANITU. Ergebnisse der Kerbschlagbiegeversuche mit den bis 0,8 dpa bestrahlten Werkstoffen der ersten Bestrahlungsphase

    Energy Technology Data Exchange (ETDEWEB)

    Rieth, M.; Dafferner, B.; Ries, H.; Romer, O.

    1995-09-01

    The irradiation project MANITU was planned and carried out in the frame of the European Longterm Fusion Materials Development Programme. The problem of the irradiation induced embrittlement of possible martensitic alloy candidates is still unsolved. But after the evaluation of subsize Charpy tests with the unirradiated reference specimens of MANITU a first tendency was recognizable. The mechanical properties of the newly developed low activation 7-10% Cr-W(Ge)VTa alloys are partly better compared to the modified commercial 10-11% Cr-NiMoVNb steels. In the present report the results of instrumented impact tests within the first phase of the MANITU programme (irradiation dose 0.8 dpa, irradiation temperatures 250, 300, 350, 400, and 450 C) are analysed and assessed. Among all examined alloys (MANET-I, MANET-II, K-heat, OPTIFER-Ia, OPTIFER-II, F82H, 9Cr-2WVTa ORNL 3791) the ORNL steel shows the very best embrittlement behaviour after neutron irradiation. (orig.) [Deutsch] Das Bestrahlungsprojekt MANITU wurde im Rahmen des europaeischen Langzeitprogramms fuer Materialentwicklung fuer die Kernfusion geplant und durchgefuehrt. Das Problem der bestrahlungsinduzierten Versproedung bei den in Frage kommenden martensitischen Werkstoffen ist nach wie vor ungeloest. Eine erste Tendenz zeichnete sich jedoch nach der Auswertung der Kerbschlagbiegeversuche an den unbestrahlten miniaturisierten Referenzproben des MANITU-Programms ab. Die neu entwickelten niedrig aktivierbaren 7-10% Cr-W(Ge)VTa-Legierungen weisen gegenueber den modifizierten kommerziellen 10-11% Cr-NiMoVNb-Staehlen teilweise bessere mechanische Eigenschaften auf. Im vorliegenden Bericht werden die Ergebnisse aus den instrumentierten Kerbschlagbiegeversuchen der ersten Phase des MANITU-Programms (Bestrahlungsdosis 0,8 dpa, Bestrahlungstemperaturen 250, 300, 350, 400 und 450 C) analysiert und bewertet. Von den untersuchten Legierungen (MANET-I, MANET-II, Kastencharge, OPTIFER-Ia, OPTIFER-II, F82H, 9Cr-2WVTa ORNL 3791

  6. Irradiation programme MANITU. Results of impact tests with the irradiated materials (0.2 dpa); Bestrahlungsprogramm MANITU. Ergebnisse der Kerbschlagbiegeversuche mit den bis 0,2 dpa bestrahlten Werkstoffen

    Energy Technology Data Exchange (ETDEWEB)

    Rieth, M.; Dafferner, B.; Kunisch, W.; Ries, H.; Romer, O.

    1997-04-01

    The irradiation project MANITU was planned and carried out in the frame of the European Longterm Fusion Materials Development Programme. The problem of the irradiation induced embrittlement of possible martensitic alloy candidates is still unsolved. But after the evaluation of subsize Charpy tests with specimens of MANITU (0.8 dpa) a first tendency was recognizable. The mechanical properties of the newly developed low activation 7-10% Cr-W(Ge)VTa alloys are better compared to the modified commercial 10-11% Cr-NiMoVNb steels. In the present report the results of instrumented impact tests of the MANITU programme (irradiation dose 0.2 dpa, irradiation temperatures 250, 300, 350, 400, and 450 C) are analysed and assessed. Among all examined alloys (MANET-I, MANET-II, K-heat, OPTIFER-Ia, OPTIFER-II, F82H, 9Cr-2WVTa ORNL 3791) the ORNL steel shows the best embrittlement behaviour after neutron irradation. (orig.) [Deutsch] Das Bestrahlungsprojekt MANITU wurde im Rahmen des europaeischen Langzeitprogramms fuer Materialentwicklung fuer die Kernfusion geplant und durchgefuehrt. Das Problem der bestrahlungsinduzierten Versproedung bei den in Frage kommenden martensitischen Werkstoffen ist nach wie vor ungeloest. Eine erste Tendenz zeichnete sich jedoch nach der Auswertung der Kerbschlagbiegeversuche an den bis 0,8 dpa bestrahlten miniaturisierten Proben des MANITU-Programms ab. Die neu entwickelten niedrig aktivierbaren 7-10% Cr-W(Ge)VTa-Legierungen weisen gegenueber den modifizierten kommerziellen 10-11% Cr-NiMoVNb-Staehlen bessere mechanische Eigenschaften auf. Im vorliegenden Bericht werden die Ergebnisse aus den instrumentierten Kerbschlagbiegeversuchen des MANITU-Programms (Bestrahlungsdosis 0,2 dpa, Bestrahlungstemperaturen 250, 300, 350, 400 und 450 C) analysiert und bewertet. Von den untersuchten Legierungen (MANET-I, MANET-II, Kastencharge, OPTIFER-Ia, OPTIFER-II, F82H, 9Cr-2WVTa ORNL 3791) zeigt der ORNL-Stahl das beste Versproedungsverhalten nach

  7. The use of multiple needle fasciotomy in Dupuytren disease: retrospective observational study of outcome and patient satisfaction.

    Science.gov (United States)

    Medjoub, Karima; Jawad, Ahmad

    2014-04-01

    The aim of our study was to assess the efficacy, safety, and patient satisfaction of multiple needle fasciotomy for Dupuytren disease. During this observational study, patients who underwent the procedure between 2008 and 2010 were followed up, and outcomes, complications, and patient satisfaction were assessed. Satisfaction rate was 75%, with no postoperative complications noted. As predicted, early recurrence rate was the main issue with a rate of 28% at the time of the questionnaire. Percutaneous needle fasciotomy is a safe and efficient procedure in treating patients with early Dupuytren or those who would not potentially achieve good results with more aggressive surgical intervention.

  8. Feasibility of flat-panel volumetric computed tomography (fpVCT) in experimental small animal imaging of osteoporosis - initial experience; Erste Erfahrungen mit einem Flaechendetektor-Volumen-CT (fpVCT) in der experimentellen Osteoporosediagnostik am Kleintiermodell

    Energy Technology Data Exchange (ETDEWEB)

    Valencia, R.; Dullin, C.; Herrmann, K.P.; Kluever, I.; Zaroban, A.; Knollmann, F. [Universitaetsklinikum Goettingen (Germany). Abteilung Diagnostische Radiologie, Goettingen; Stuermer, E.K.; Sehmisch, S. [Universitaetsklinikum Goettingen (Germany). Klinik fuer Unfallchirurgie, Plastische und Wiederherstellungschirurgie; Funke, M. [Klinikum Mittelbaden, Baden-Baden (Germany). Radiologische Klinik an der Stadtklinik

    2006-10-15

    Flat-panel volumetric computed tomography (fpVCT) is a new, noninvasive CT imaging modality with increased isotropic resolution. Technical details, potential applications, and our initial experience with a fpVCT prototype scanner in the imaging of osteoporosis in a rat model are presented. To date, 21 rats have been investigated in vivo with fpVCT. Pharmacologic effects on bone mineral density (BMD) and structure were of special interest. Image evaluation focussed on the second lumbar vertebra and the left femoral bone. To validate measurement results, BMD values calculated with fpVCT were correlated with results of BMD measurements from ashing of the second lumbar vertebra and femoral bones. Our initial results show that fpVCT is capable of detecting differences in BMD between ovariectomized rats treated with estradiol and a control group with high statistical significance (p<0.05), corresponding to ashing as the gold standard. In a rat model, fpVCT imaging is especially useful in longitudinal in vivo investigations of BMD measures. Spatial resolution of up to 150 {mu}m allows imaging of the trabecular structure only in human cadaveric bones. (orig.) [German] Die Flaechendetektor-Volumen-Computertomographie (fpVCT) ist eine neuartige CT-Bildgebungstechnik, die eine gesteigerte isotrope Ortsaufloesung ermoeglicht. In dieser Arbeit wird ueber Technik, Anwendungsmoeglichkeiten und erste Erfahrungen beim Einsatz eines fpVCT-Prototyps in der experimentellen Diagnostik der Osteoporose am Rattenmodell berichtet. Bisher konnten 21 Ratten in vivo am fpVCT untersucht werden. Von besonderem Interesse waren Medikamentenwirkungen auf Knochendichte (''bone mineral density'', BMD) und -struktur. Die Auswertung der gewonnenen Bilddaten fokussierte sich auf den 2. Lendenwirbelkoerper und das linke Femur. Um die Messergebnisse zu ueberpruefen, wurden die mittels fpVCT errechneten BMD-Werte mit den Ergebnissen der Dichtemessung der veraschten 2. LWK und Femora

  9. Extensive percutaneous aponeurotomy and lipografting: a new treatment for Dupuytren disease.

    Science.gov (United States)

    Hovius, Steven E R; Kan, Hester J; Smit, Xander; Selles, Ruud W; Cardoso, Eufimiano; Khouri, Roger K

    2011-07-01

    Surgical resection of Dupuytren contracture is fraught with morbidity and prolonged recovery. This article introduces a novel minimally invasive alternative for Dupuytren disease and its outcome. The procedure consists of an extensive percutaneous aponeurotomy that completely disintegrates the cord and separates it from the dermis. Subsequently, the resultant loosened structure is grafted with autologous lipoaspirate. After 1 week of postoperative extension splinting, patients are allowed normal hand use and are advised to use night splints for 3 to 6 months. The authors treated and report on their experience with 91 patients (99 hands) operated on in Miami and Rotterdam; from 50 patients, the authors report on goniometry (average follow-up, 44 weeks). The contracture from the proximal interphalangeal joint improved significantly from 61 degrees to 27 degrees, and contracture from the metacarpophalangeal joint improved from 37 degrees to -5 degrees. Ninety-four percent of patients returned to normal use of the hand within 2 to 4 weeks and 95 percent were very satisfied with the result. No new scars were added, and a supple palmar fat pad was mostly restored. Complications were digital nerve injury in one patient, postoperative wound infection in one patient, and complex regional pain syndrome in four patients. This new minimally invasive technique shortens recovery time, adds to the deficient subcutaneous fat, and leads to scarless supple skin. By its ability to treat multiple rays, it addresses the abnormality in the entire hand. The procedure is safe and effective, especially for primary cases. Currently, comparative prospective randomized studies are in process to fully determine its role in the treatment of Dupuytren contracture. Therapeutic, IV.(Figure is included in full-text article.).

  10. Identification of differentially expressed genes in fibroblasts derived from patients with Dupuytren's Contracture

    Directory of Open Access Journals (Sweden)

    Hu Fen Z

    2008-04-01

    Full Text Available Abstract Dupuytren's contracture (DC is the most common inherited connective tissue disease of humans and is hypothesized to be associated with aberrant wound healing of the palmar fascia. Fibroblasts and myofibroblasts are believed to play an important role in the genesis of DC and the fibroproliferation and contraction that are hallmarks of this disease. This study compares the gene expression profiles of fibroblasts isolated from DC patients and controls in an attempt to identify key genes whose regulation might be significantly altered in fibroblasts found within the palmar fascia of Dupuytren's patients. Total RNA isolated from diseased palmar fascia (DC and normal palmar fascia (obtained during carpal tunnel release; 6 samples per group was subjected to quantitative analyses using two different microarray platforms (GE Code Link™ and Illumina™ to identify and validate differentially expressed genes. The data obtained was analyzed using The Significance Analysis of Microarrays (SAM software through which we identified 69 and 40 differentially regulated gene transcripts using the CodeLink™ and Illumina™ platforms, respectively. The CodeLink™ platform identified 18 upregulated and 51 downregulated genes. Using the Illumina™ platform, 40 genes were identified as downregulated, eleven of which were identified by both platforms. Quantitative RT-PCR confirmed the downregulation of three high-interest candidate genes which are all components of the extracellular matrix: proteoglycan 4 (PRG4, fibulin-1 (FBLN-1 transcript variant D, and type XV collagen alpha 1 chain. Overall, our study has identified a variety of candidate genes that may be involved in the pathophysiology of Dupuytren's contracture and may ultimately serve as attractive molecular targets for alternative therapies.

  11. Efficacy and safety of collagenase clostridium histolyticum for Dupuytren disease nodules: a randomized controlled trial.

    Science.gov (United States)

    Costas, Bronier; Coleman, Stephen; Kaufman, Greg; James, Robert; Cohen, Brian; Gaston, R Glenn

    2017-08-30

    To determine the safety and efficacy of collagenase clostridium histolyticum (CCH) injection for the treatment of palmar Dupuytren disease nodules. In this 8-week, double-blind trial, palpable palmar nodules on one hand of adults with Dupuytren disease were selected for treatment. Patients were randomly assigned using an interactive web response system to receive a dose of 0.25 mg, 0.40 mg, or 0.60 mg (1:1:1 ratio) and then allocated to active treatment (CCH) or placebo (4:1 ratio). All patients and investigators were blinded to treatment. One injection was made in the selected nodule on Day 1. Caliper measurements of nodule length and width were performed at screening and at Weeks 4 and 8. Investigator-reported nodular consistency and hardness were evaluated at baseline and Weeks 1, 4, and 8. Investigator-rated patient improvement (1 [very much improved] to 7 [very much worse]) and patient satisfaction were assessed at study end. In the efficacy population (n = 74), percentage changes in area were significantly greater with CCH 0.40 mg (-80.1%, P = 0.0002) and CCH 0.60 mg (-78.2%, P = 0.0003), but not CCH 0.25 mg (-58.3%, P = 0.079), versus placebo (-42.2%) at post-treatment Week 8. Mean change in nodular consistency and hardness were significantly improved with CCH versus placebo at Weeks 4 and 8 (P ≤ 0.0139 for all). At Week 8, investigator global assessment of improvement was significantly greater with CCH 0.40 mg and 0.60 mg (P ≤ 0.0014) but not statistically significant with CCH 0.25 mg versus placebo (P = 0.13). Most patients were "very satisfied" or "quite satisfied" with CCH 0.40 mg and 0.60 mg. Contusion/bruising (50.0% to 59.1%) was the most common adverse event with CCH treatment. In patients with Dupuytren disease, a single CCH injection significantly improved palmar nodule size and hardness. The safety of CCH was similar to that observed previously in patients with Dupuytren contracture. ClinicalTrials.gov identifier: NCT

  12. Tratamiento no quirúrgico de la contractura de Dupuytren con colagenasa de Clostridium hystoliticum

    OpenAIRE

    S. Mármol-Soler; L. Espejo-Ortega; C. Gutiérrez-Ortega; M. García-Rosado; A. Valera-Núñez; C. Ramos-Lozada; A. Martínez-Murillo; F. De Juan-Pérez

    2013-01-01

    La contractura de Dupuytren origina una pérdida progresiva de la función de la mano. Su tratamiento de elección es quirúrgico. La inyección de una solución compuesta por dos colagenasas distintas aisladas y purificadas a partir de la bacteria Clostridium histolyticum realiza lisis selectiva del colágeno en la cuerda pretendinosa. Presentamos nuestra experiencia en el tratamiento de la enfermedad mediante la inyección de dicha colagenasa en 15 pacientes como opción no quirúrgica. Se trata de u...

  13. Percutaneous Aponeurotomy and Lipofilling (PALF): A Regenerative Approach to Dupuytren Contracture.

    Science.gov (United States)

    Hovius, Steven E R; Kan, Hester J; Verhoekx, Jennifer S N; Khouri, Roger K

    2015-07-01

    Dupuytren disease is a progressive fibroproliferative disorder, which leads to flexion contractures of the digits. A minimally invasive technique consisting of an extensive percutaneous aponeurotomy of the cord with a needle combined with lipofilling is presented. The selective cutting of the cords under continuous tension disintegrates the cords while sparing the looser neurovascular bundles. Subsequently, lipoaspirate is injected subcutaneously. The authors' prospective results show a significantly shorter recovery time and less overall complications in this technique when compared with open surgery, while no significant difference was observed in the extent of immediate contracture correction and in the recurrence rate at 1 year follow-up.

  14. A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries

    NARCIS (Netherlands)

    Lanting, Rosanne; Broekstra, Dieuwke C; Werker, Paul M N; van den Heuvel, Edwin R

    BACKGROUND: Dupuytren disease is a fibroproliferative disease of palmar fascia of the hand. Its prevalence has been the subject of several reviews; however, an accurate description of the prevalence range in the general population--and of the relation between age and disease--is lacking. METHODS:

  15. Injectable Collagenase Versus Percutaneous Needle Fasciotomy for Dupuytren Contracture in Proximal Interphalangeal Joints: A Randomized Controlled Trial.

    Science.gov (United States)

    Skov, Simon Toftgaard; Bisgaard, Therkel; Søndergaard, Per; Lange, Jeppe

    2017-05-01

    Collagenase Clostridium histolyticum (CCH) injection was introduced commercially as a treatment for Dupuytren contracture following initial phase-3 investigations in 2009 with promising results. However, the efficacy of CCH has not been prospectively investigated in a direct comparison to other active treatments of Dupuytren contracture with more than 1-year follow-up, despite a wide and increasing clinical use. In this prospective, independent, open-label, randomized controlled trial, (Clinicaltrials.gov; NCT 01538017), percutaneous needle fasciotomy (PNF) was directly compared with CCH. Fifty patients with primary isolated proximal interphalangeal joint Dupuytren contractures were enrolled and followed for 2 years. The primary outcome was clinical improvement defined as a reduction in contracture by 50% or more relative to baseline. Secondary outcomes included change in contracture, recurrence, adverse events, complications, and Disabilities of the Arm, Shoulder, and Hand questionnaire score. Clinical improvement at 2 years was maintained in 7% of CCH patients (2 of 29) and 29% of PNF patients (6 of 21). Collagenase Clostridium histolyticum led to more, mainly transient, complications, in 93% of patients versus 24% of the patients treated with PNF. No other differences were observed. This study provides evidence that CCH is not superior to PNF in the treatment of isolated proximal interphalangeal joint Dupuytren contracture regarding clinical outcome, and it led to more complications than PNF. Therapeutic I. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  16. Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent

    NARCIS (Netherlands)

    Broekstra, Dieuwke C.; Lanting, Rosanne; Werker, Paul M. N.; van den Heuvel, Edwin R.

    Introduction: Dupuytren disease (DD) is a fibrosing disease affecting the palmar aponeurosis, and is mostly treated by surgery based on measurement of severity of flexion contracture of the fingers. Literature concerning the measurement reliability is scarce. This study aimed to determine the intra-

  17. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment : the importance of clear definitions

    NARCIS (Netherlands)

    Werker, Paul M N; Pess, Gary M; van Rijssen, Annet L; Denkler, Keith

    2012-01-01

    PURPOSE: To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. METHODS: This study

  18. Recognition, diagnosis and referral of patients with Dupuytren's disease : a review of current concepts for general practitioners in Europe

    NARCIS (Netherlands)

    van Dijk, Dilaine; Finigan, Peter; Gerber, Robert A.; Szczypa, Piotr P.; Werker, Paul M. N.

    2013-01-01

    Background: Dupuytren's disease (DD) is a fairly prevalent yet under-recognised disorder of the palmar fascia, resulting in fixed-flexion contractures of joints in the hand. Numerous population-based studies have been conducted in countries around the world, and published prevalence estimates vary w

  19. A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries

    NARCIS (Netherlands)

    Lanting, Rosanne; Broekstra, Dieuwke C; Werker, Paul M N; van den Heuvel, Edwin R

    2014-01-01

    BACKGROUND: Dupuytren disease is a fibroproliferative disease of palmar fascia of the hand. Its prevalence has been the subject of several reviews; however, an accurate description of the prevalence range in the general population--and of the relation between age and disease--is lacking. METHODS: Em

  20. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions.

    Science.gov (United States)

    Werker, Paul M N; Pess, Gary M; van Rijssen, Annet L; Denkler, Keith

    2012-10-01

    To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English. The search returned 218 studies, of which 21 had definitions, quantitative results for contracture correction and recurrence, and a sample size of at least 20 patients. Definitions for correction of contracture and recurrence varied greatly among articles and were almost always qualitative. Percentages of patients who achieved correction of contracture (ie, responder rate) when evaluated at various times after completion of surgery ranged from 15% to 96% for fasciectomy/aponeurectomy. Responder rates were not reported for fasciotomy/aponeurotomy. Recurrence rates ranged from 12% to 73% for patients treated with fasciectomy/aponeurectomy and from 33% to 100% for fasciotomy/aponeurotomy. Review of these reports underscored the difficulty involved in comparing correction of contracture and recurrence rates for different surgical interventions because of differences in definition and duration of follow-up. Clearly defined objective definitions for correction of contracture and for recurrence are needed for more meaningful comparisons of results achieved with different surgical interventions. Recurrence after surgical intervention for Dupuytren contracture is common. This study, which evaluated reported rates of recurrence following surgical treatment of Dupuytren contracture, provides clinicians with practical information regarding expected long

  1. The use of skeletal extension torque in reversing Dupuytren contractures of the proximal interphalangeal joint.

    Science.gov (United States)

    Agee, John M; Goss, Ben C

    2012-07-01

    Dupuytren contracture of the proximal interphalangeal (PIP) joint can be reversed by an extension torque transmitted from an external device, the Digit Widget, by skeletal pins to the middle phalanx. This extension torque, generated by the same elastic bands dentists use to align teeth, gradually restores length to soft tissues palmar to the PIP joint's axis of rotation. Simultaneously, tissues dorsal to the joint's axis will shorten toward normal length as the PIP progressively straightens. Although the contractile nodules and bands of Dupuytren disease may be excised either before or after reversal of the joint's contracture, a 2-staged approach is preferred: (1) reverse the PIP flexion contracture, and (2) excise the diseased tissue from the straightened finger. We believe this 2-staged approach yields better results. In addition, it is technically easier to avoid injury to nerves and arteries while excising the nodules and bands, when one operates through palmar skin of more nearly normal length. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  2. Early post-operative results of percutaneous needle fasciotomy in 451 patients with Dupuytren disease.

    Science.gov (United States)

    Molenkamp, Sanne; Schouten, Tanneke A M; Broekstra, Dieuwke C; Werker, Paul M N; Moolenburgh, J Daniel

    2017-02-13

    Percutaneous needle fasciotomy (PNF) is a minimally invasive treatment modality for Dupuytren disease (DD). In this study we analyzed the efficacy and complication-rate of PNF using a statistical method that takes the multi-level structure of data, regarding multiple measurements from the same patients, into account. The data of 470 treated rays from 451 patients with Dupuytren disease that underwent percutaneous needle fasciotomy (PNF) were analyzed retrospectively. We described the early postoperative results of PNF and we applied linear mixed models to compare mean correction of PED between joints and efficacy of primary versus secondary PNF. Mean preoperative PED's at the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints were 37˚, 40˚ and 31˚ respectively. Mean preoperative TPED was 54˚. Results were excellent, with a mean TPED correction of 85%. PNF was most effective for MCP-joints and less effective for PIP and DIP-joints. Secondary PNF was as effective as primary PNF. Complications were rare and mostly minor. The results of this study confirm that PNF is an effective and safe treatment modality for patients with mild to moderate disease who prefer a minimally invasive procedure.

  3. Dupuytren Disease: Is There Enough Comprehensive Patient Information on the Internet?

    Science.gov (United States)

    Zuk, Grzegorz; Reinisch, Katharina B; Raptis, Dimitri A; Fertsch, Sonia; Guggenheim, Merlin; Palma, Adrian F

    2017-06-22

    Dupuytren disease is a chronic nonmalign fibroproliferative disorder that causes finger contractures via proliferation of new tissue under the glabrous skin of the hand, resulting in multiple functional limitations for the patient. As many surgical therapy options exist, patients suffering from this condition actively search for information in their environment before consulting a health professional. As little is known about the quality of Web-based patient information, the aim of this study was to conduct its systematic evaluation using a validated tool. A total of 118 websites were included, and qualitative and quantitative assessment was performed using the modified Ensuring Quality Information for Patients (EQIP) tool. This standardized and reproducible tool consists of 36 items to assess available information in three categories: contents, identification, and structure data. Scientific data with restricted access, duplicates, and irrelevant websites were not included. Only 32 websites addressed more than 19 items, and the scores did not significantly differ among the website developers. The median number of items from the EQIP tool was 16, with the top websites addressing 28 out of 36 items. The quality of the newly developed websites did not increase with passing time. This study revealed several shortcomings in the quality of Web-based information available for patients suffering from Dupuytren disease. In the world of continuously growing and instantly available Web-based information, it is the health providers' negligence of the last two decades that there are very few good quality, informative, and educative websites that could be recommended to patients.

  4. Early Postoperative Results of Percutaneous Needle Fasciotomy in 451 Patients with Dupuytren Disease.

    Science.gov (United States)

    Molenkamp, Sanne; Schouten, Tanneke A M; Broekstra, Dieuwke C; Werker, Paul M N; Moolenburgh, J Daniel

    2017-06-01

    Percutaneous needle fasciotomy is a minimally invasive treatment modality for Dupuytren disease. In this study, the authors analyzed the efficacy and complication rate of percutaneous needle fasciotomy using a statistical method that takes the multilevel structure of data, regarding multiple measurements from the same patient, into account. The data of 470 treated rays from 451 patients with Dupuytren disease that underwent percutaneous needle fasciotomy were analyzed retrospectively. The authors described the early postoperative results of percutaneous needle fasciotomy and applied linear mixed models to compare mean correction of passive extension deficit between joints and efficacy of primary versus secondary percutaneous needle fasciotomy. Mean preoperative passive extension deficits at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 37, 40, and 31 degrees, respectively. Mean preoperative total passive extension deficit was 54 degrees. Results were excellent, with a mean total passive extension deficit correction of 85 percent. Percutaneous needle fasciotomy was most effective for metacarpophalangeal joints and less effective for proximal interphalangeal and distal interphalangeal joints. Secondary percutaneous needle fasciotomy was as effective as primary percutaneous needle fasciotomy. Complications were rare and mostly minor. The results of this study confirm that percutaneous needle fasciotomy is an effective and safe treatment modality for patients with mild to moderate disease who prefer a minimally invasive procedure. Therapeutic, IV.

  5. A comparison of percutaneous needle fasciotomy and collagenase injection for dupuytren disease.

    Science.gov (United States)

    Nydick, Jason A; Olliff, Bailee W; Garcia, Michael J; Hess, Alfred V; Stone, Jeffrey D

    2013-12-01

    To compare percutaneous needle fasciotomy (PNF) with collagenase injection in the treatment of Dupuytren contracture. A retrospective review was performed for patients with Dupuytren disease treated with PNF or collagenase. Range of motion, patient satisfaction, and complications were recorded. There were 29 patients in the collagenase group with mean baseline contractures of 40° for 22 affected metacarpophalangeal joints and 50° for 12 affected proximal interphalangeal joints. The PNF group was composed of 30 patients with mean baseline contractures of 37° for 32 affected metacarpophalangeal joints and 41° for 18 affected proximal interphalangeal joints. All patients were observed for a minimum of 3 months. Clinical success (reduction of contracture within 0° to 5° of normal) was accomplished in 35 of 50 joints (67%) in the PNF group and in 19 of 34 joints (56%) in the collagenase group. Patient satisfaction was similar between groups. Only minor complications were observed, including skin tears, ecchymosis, edema, pruritus, and lymphadenopathy. In the short term, both PNF and collagenase have similar clinical outcomes and patient satisfaction. Therapeutic III. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Expression of gap junction proteins connexins 26, 30, and 43 in Dupuytren's disease.

    Science.gov (United States)

    Holzer, Lukas A; Cör, Andrej; Holzer, Gerold

    2014-02-01

    Dupuytren's disease (DD) is a benign fibroproliferative process of the palmar aponeurosis showing similarities to wound healing. Communication of cells involved in wound healing is mediated by the composition of gap junction (GJ) proteins. We investigated the expression of 3 GJ proteins, connexins 26, 30, and 43 (Cx26, Cx30, and Cx43) in DD. Fragments of Dupuytren's tissue from 31 patients (mean age 56 (30-76) years, 24 male) were analyzed immunohistochemically and compared to control tissue for expression of the GJ proteins Cx26, Cx30, and Cx43 and also alfa-smooth muscle actin (α-SMA). 14 of 31 samples could be attributed to the involutional phase (α-SMA positive) whereas 17 samples had to be considered cords in the residual phase (α-SMA negative). Expression of Cx26 and Cx43 was seen in 12 of the 14 samples from the involutional phase, and Cx30 was seen in 7 of these. Only 4 of the 17 samples from the residual phase showed any Cx, and there was none in the controls. The high expression of GJ proteins Cx26, Cx30, and Cx43 in α-SMA positive myofibroblast-rich nodules, which are characteristic of the active involutional phase of DD, suggests that connexins could be a novel treatment target for the treatment of DD.

  7. [Razemon's lateral digital rotation flap in severe Dupuytren contracture of the fifth finger].

    Science.gov (United States)

    Ould-Slimane, M; Guinet, V; Foulongne, E; Melconian, A; Beccari, R; Milliez, P-Y; Auquit-Auckbur, I

    2013-10-01

    In Dupuytren's disease, correction of severe contracture deformities and excision of dermal lesions are often responsible for palmar skin defects. This study aimed to assess the results of the lateral digital flap described by Razemon. Thirty-seven patients were analysed retrospectively for functional and trophic results. Twelve months of follow-up were at least required. The lack of extension was appreciated through Thomine's coefficient. Subjective patient's opinion was noted about function of fifth finger and hand. The flap trophicity was evaluated through softness, coverage quality and esthetic aspect. In the preoperative period, the average lack of extension was 105°; 89% of the patients were ranked as stages 3 or 4 of Tubiana's classification. At the 12th month, the average Thomine's coefficient was 0.74; 70% of the patients were very satisfied. Two patients exhibited some lack of suppleness and seven a dyschromic scars. The lateral digital rotation flap is a quite simple surgical procedure. It allows satisfactory results corresponding to functional and trophic coverage in severe Dupuytren's contracture involving the fifth finger.

  8. Virtual colonoscopy with multi-slice computed tomography; Virtuelle Koloskopie mit der Mehrschichtcomputertomographie. Vorlaeufige Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Rust, G.-F.; Eisele, O.; Reiser, M. [Institut fuer Klinische Radiologie, Klinikum Grosshadern, Muenchen Univ. (Germany); Hoffmann, J.N.; Kopp, R.; Fuerst, H. [Chirurgische Klinik und Poliklinik, Klinikum der Univ. Muenchen (Germany)

    2000-03-01

    Subject: Using multi-slice computed tomography (MSCT) large body areas can scanned with high spatial resolution. In this study, MSCT was employed for virtual colonoscopy in various pathologies of the colon. Results: Nine polyps and four of five colon carcinomas were detected using MSCT virtual colonoscopy. In three patients with ulcerative colitis virtual coloscopy revealed morphological alterations compatible with this disease. In two of four patients with multiple diverticula of the colon the true extent of the disorder could be assessed in virtual colonoscopy. (orig.) [German] Fragestellung: Die Mehrschichtcomputertomographie (MSCT) vermag, grosse Organbereiche mit hoher raeumlicher Aufloesung zu untersuchen. Daher koennen auch fuer die virtuelle Koloskopie eine bisher nicht erreichbare Ortsaufloesung und Detailtreue erwartet werden. Die ersten Ergebnisse mit der MSCT-Koloskopie bei unterschiedlichen pathologischen Veraenderungen des Kolons werden vorgestellt. Ergebnisse: 4 von 5 Kolonkarzinomen konnten mit der virtuellen Koloskopie dargestellt werden. Bei 3 Patienten wurden mit der virtuellen Koloskopie typische Veraenderungen der Colitis ulcerosa dargestellt, wovon ein Patient die konventionelle Koloskopie nicht tolerierte. Bei 9 Patienten mit Kolonpolypen stimmten die virtuelle und konventionelle Koloksopie vollstaendig ueberein. Bei 4 Patienten mit Divertikulose war mit der virtuellen Koloskopie nur in 2 Faellen der Befund vollstaendig zu sichern. (orig.)

  9. Martin Kreuels & Sascha Buchholz (2006: Ökologie, Verbreitung und Gefährdungsstatus der Webspinnen Nordrhein-Westfalens – Erste überarbeitete Fassung der Roten Liste der Webspinnen (Arachnida: Araneae

    Directory of Open Access Journals (Sweden)

    Finch, Oliver-David

    2006-12-01

    Full Text Available book review: Martin Kreuels & Sascha Buchholz (2006: Ökologie, Verbreitung und Gefährdungsstatus der Webspinnen Nordrhein-Westfalens – Erste überarbeitete Fassung der Roten Liste der Webspinnen (Arachnida: Araneae.

  10. Enterprise Content Management und E-Kollaboration als Cloud-Dienste : Potenziale, Herausforderungen und Erfolgsfaktoren : Ergebnisse einer qualitativen Studie

    OpenAIRE

    2014-01-01

    Studie Zahlreiche Cloud-basierte Angebote für Enterprise Content Management und E-Kollaboration drängen auf den Unternehmensmarkt. Organisation aller Grössen und Branchen setzen sich mit den Chancen und Risiken dieser Angebote auseinander und sammeln erste Erfahrungen bei der Evaluation, Konzeption, Einführung sowie beim Betrieb. Die vorliegende Studie präsentiert auf der Grundlage von Experteninterviews ein breites Spektrum von qualitativen Einschätzungen aus der Perspektive von Anwender-...

  11. Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS study): 3-year data.

    Science.gov (United States)

    Peimer, Clayton A; Blazar, Philip; Coleman, Stephen; Kaplan, F Thomas D; Smith, Ted; Tursi, James P; Cohen, Brian; Kaufman, Gregory J; Lindau, Tommy

    2013-01-01

    To evaluate long-term efficacy and safety of collagenase clostridium histolyticum (CCH) after the third year of a 5-year nontreatment follow-up study, Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study. This study enrolled Dupuytren contracture patients from 5 previous clinical studies. Beginning 2 years after their first CCH injection, we re-evaluated patients annually for joint contracture and safety. Recurrence in a previously successfully treated joint (success = 0° to 5° contracture after CCH administration) was defined as 20° or greater worsening in contracture in the presence of a palpable cord or medical/surgical intervention to correct new or worsening contracture. We assessed partially corrected joints (joints reduced 20° or more from baseline contracture but not to 0° to 5°) for nondurable response, also defined as 20° or greater worsening of contracture or medical/surgical intervention. Of 1,080 CCH-treated joints (648 metacarpophalangeal [MCP]; 432 proximal interphalangeal [PIP]; n = 643 patients), 623 (451 MCP, 172 PIP) had achieved 0° to 5° contracture in the original study. Of these joints, 35% (217 of 623) recurred (MCP 27%; PIP 56%). Of these recurrences, an intervention was performed in 7%. Of the 1,080 CCH-treated joints, 301 were partially corrected in the original study. Of these, 50% (150 of 301; MCP: 38% [57 of 152]; PIP: 62% [93 of 149]) had nondurable response. We identified no new long-term or serious adverse events attributed to CCH during follow-up. Anti-clostridial type I collagenase and/or anti-clostridial type II collagenase antibodies were reported for 96% or more of patients who received 2 or more CCH injections and 82% who received 1 injection. The recurrence rate, which is comparable to other standard treatments, and the absence of long-term adverse events 3 years after initial treatment indicate that CCH is an effective and safe treatment for Dupuytren contracture. Most successfully

  12. The Impact of Collagenase Clostridium histolyticum Introduction on Dupuytren Treatment Patterns in the United States.

    Science.gov (United States)

    Zhao, John Z; Hadley, Scott; Floyd, Emerson; Earp, Brandon E; Blazar, Philip E

    2016-10-01

    The U.S. Food and Drug Administration approved the use of collagenase Clostridium histolyticum (CCH) in the United States in February 2010. This study addresses the impact of that approval on the number of Dupuytren contracture (DC) encounters and treatment patterns in the United States. Using the Intercontinental Marketing Services Health Office-Based Medical Claims database, we identified the monthly number of DC encounters and DC procedures between January 2007 and December 2013. Collagenase Clostridium histolyticum usage data from March 2010 to December 2013 was derived from the U.S. CCH manufacturer's data warehouse. Using the combined data, the yearly increasing trends in DC encounters and treatment volume were compared before and after the introduction of CCH. Time trends in the relative procedure frequencies were then examined. Finally, the presence of seasonal variation was tested for in each treatment type. Dupuytren contracture encounters increased on average by 19,015 per year between 2007 and 2009, whereas between 2011 and 2013, DC encounters increased on average by 34,940 per year. In terms of absolute procedure counts, the surgery trend line began decreasing in 2010 with the release of CCH. Meanwhile, CCH continuously increased between 2010 and 2013, and needle aponeurotomy (NA) remained relatively stable. By the year 2013, minimally invasive techniques (NA and CCH) comprised 39% of all treatment, compared with only 14% in 2007. Lastly, there was a statistically significant seasonal increase in the number of surgical procedures during the wintertime but no seasonal variation in NA or CCH. After the introduction of CCH, the number of Dupuytren encounters increased at a greater annual rate. The introduction and growth of CCH coincided with a decrease in surgery. The number of NA procedures remained steady throughout the study period. The number of open surgery cases followed a predictable seasonal variation with more procedures during the winter months

  13. Steroid injection and needle aponeurotomy for Dupuytren contracture: a randomized, controlled study.

    Science.gov (United States)

    McMillan, Catherine; Binhammer, Paul

    2012-07-01

    To compare flexion deformity at 6 months in patients with Dupuytren contracture who had percutaneous needle aponeurotomy (PNA) combined with a series of triamcinolone acetonide (TA) injections to that of patients who had PNA alone. Forty-seven patients with Dupuytren disease who were candidates for PNA (at least 1 contracture of at least 20°) participated in the study. Patients were randomized either to receive TA injections immediately following and 6 weeks and 3 months after the procedure or to receive no injections. Injections were administered into cords. The number of injections and the amount of TA per injection was determined based on the number of digits involved and the cord size. All subjects returned for 3 follow-up visits after the procedure, and contractures were measured using a goniometer. Change in total active extension deficit (TAED) was analyzed using a repeated measures analysis of variance to assess for differences between groups, time points, and interaction between group and time point. Descriptive statistics were calculated for all variables of interest. Continuous measures were summarized using means and standard deviations. There was no significant difference in TAED between groups before cord aponeurotomy. Correction at 6 months was 87% of preoperative TAED for the TA group versus 64% for the control group. This difference was statistically significant. The amount of TA administered did not correlate with TAED improvement. The study group who received TA in combination with PNA experienced a significantly greater degree of correction of flexion deformity at 6 months than those who had PNA alone. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Collagenase Treatment for Dupuytren Disease of the Thumb and First Web.

    Science.gov (United States)

    Dreise, Marieke M; Stenekes, Martin W; Werker, Paul M N

    2016-03-01

    To evaluate the short-term effectiveness of collagenase Clostridium histolyticum to treat thumb and first web contractures in Dupuytren disease. We prospectively included 14 thumbs in 12 patients with a contracture at the metacarpophalangeal or interphalangeal joint of at least 20° with a palpable cord in the thumb (n = 8) or an adduction contracture of the thumb with palpable cords in the first web (n = 6). They received an injection containing 0.58 mg of collagenase Clostridium histolyticum in the fibrous cord divided over 3 spots. The contracture was released by carefully manipulating the thumb under local anesthesia 1 day later. The extension and abduction deficits were measured before and after the intervention (follow-up at 7 and 30 days and 6 months). Wilcoxon signed rank test was used to analyze the data. In the total sample, postintervention extension deficits were statistically significantly lower than preintervention deficits except in one patient who had a recurrence at 6 months compared with the 30-day posttreatment result. Intermetacarpophalangeal head distance (IMD) also improved significantly. In an analysis of subgroups, we compared the separate contributions of treatment of a pretendinous cord and a first web cord on both extension deficit and IMD. Treatment of pretendinous cords significantly affected both extension deficit and IMD. However, treatment of first web contractures did not significantly improve extension or IMD. Collagenase Clostridium histolyticum is a good treatment option for pretendinous cords in thumbs affected with Dupuytren disease because it provides good results, is minimally invasive, and has minor adverse events. Therapeutic IV. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Collagenase Dupuytren Contracture: Achieving Single Treatment Success with a Hand Therapist-Based Protocol.

    Science.gov (United States)

    Malafa, Menyoli M; Lehrman, Craig; Criley, Jerry W; Amirlak, Bardia

    2016-02-01

    Surgery remains the gold standard in the treatment of Dupuytren contracture but is technically demanding, carries significant risk of complications, and requires prolonged recovery time. Collagenase injection is an efficacious alternative to surgery; however, contracture release often requires multiple treatments spaced a month apart. We report our experience with a new collagenase treatment protocol aimed to minimize the total treatment time per joint contracture. We performed a single institution retrospective review of patients with Dupuytren contracture treated with collagenase using our protocol from 2011 to 2013. Patients returned 24 hours after collagenase injection for cord manipulation by a certified hand therapist while under digital block. Treatment success was defined as reduction in contracture to 5 degrees or less. Successfully treated joints were evaluated for recurrence (>10 degrees contracture) at 30-day and 6-month follow-up appointments. Serious adverse events, including skin tears, were recorded. Success was achieved in 36 of 47 treated joints (76.6%) after a single injection. There were 2 recurrences in 32 joints at 30-day follow-up (6.2%) and no recurrences in 17 joints available at 6-month follow-up. Skin tears were the only serious adverse event occurring in 18 of 47 cord ruptures (38.3%). All healed secondarily without complication. Our protocol preserves treatment efficacy while maximizing efficiency. Achieving successful cord rupture with a single injection allows earlier return of function, reduced cost of treatment, and increased convenience for the patient. Patients, particularly those with greater contractures, should be counseled regarding the risk of skin tear during cord manipulation.

  16. The impact of Dupuytren disease on patient activity and quality of life.

    Science.gov (United States)

    Wilburn, J; McKenna, S P; Perry-Hinsley, D; Bayat, A

    2013-06-01

    To explore the impact of Dupuytren disease (DD) from the patients' perspective. Audio-recorded interviews were conducted for patients with Dupuytren disease (DD) attending outpatient clinics. The interviews were transcribed and subjected to content analysis. This analysis highlighted key impact areas and common themes in individuals' personal experiences. These were then allocated to categories specified by the World Health Organization International Classification of Functioning, Disability, and Health (impairments and activity limitations) and the needs-based model of quality of life (QoL). Qualitative unstructured interviews were conducted with 34 patients (74% men; age, 41-80 y; mean [SD], 64 [13] y). The sample had a wide range of severity and duration of DD (range, 0.5-40; mean [SD], 13 [10] y). Nine hundred fifty-three statements relating to the impact of DD were identified from the interview transcripts. These statements fell into 2 major categories of impact: activity limitations (10 themes including problems with dressing, gripping, and personal care) and QoL (6 need categories: physiological, safety and security, social, affection, esteem, and cognitive needs). Findings from the interviews suggest that DD affects both performance of activities and QoL. To determine accurately the effectiveness of DD interventions from the patients' perspective, it is important to determine their impacts on both activity limitations and QoL. We intend to develop valid, reproducible, and responsive DD-specific scales for this purpose. The study identifies key issues specific to DD that influence patients' functioning and QoL. The information reported will form the basis of DD-specific patient-reported outcomes measures for use in clinical practice and evaluations of interventions. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Hand function and quality of life before and after fasciectomy for Dupuytren contracture.

    Science.gov (United States)

    Engstrand, Christina; Krevers, Barbro; Nylander, Göran; Kvist, Joanna

    2014-07-01

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol. The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time. After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. Prospective randomized controlled trial comparing 1- versus 7-day manipulation following collagenase injection for dupuytren contracture.

    Science.gov (United States)

    Mickelson, Dayne T; Noland, Shelley S; Watt, Andrew J; Kollitz, Kathleen M; Vedder, Nicholas B; Huang, Jerry I

    2014-10-01

    To compare the efficacy, tolerance, and safety of manual manipulation at day 7 to day 1 following collagenase Clostridium histolyticum (CCH) injection for Dupuytren contracture. Eligible patients were randomized to manipulation at day 1 versus day 7 following CCH injection. Preinjection, premanipulation, postmanipulation, and 30-day follow-up metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint contractures were measured. Pain scores were recorded at each time point. Data were stratified per cohort based on primary joint treated (MCP vs PIP). Means were compared using paired and unpaired t-tests. Forty-three patients with 46 digits were eligible and were randomized to 1-day (22 digits) and 7-day (24 digits) manipulation. For MCP joints, there were no significant differences in flexion contractures between 1- and 7-day cohorts for initial (47° vs 46°), postmanipulation (0° vs 2°), or 30-day follow-up (1° vs 2°) measurements. Premanipulation, the residual contracture was significantly lower in the 7-day group (23° vs 40°). For PIP joints, there were no significant differences between 1- and 7-day cohorts for initial (63° vs 62°), premanipulation (56° vs 52°), postmanipulation (13° vs 15°), or 30-day (14° vs 16°) measurements. There were no significant differences in pain or skin tears between the 2 groups. No flexor tendon ruptures were observed. The effectiveness of CCH in achieving correction of Dupuytren contractures was preserved when manipulation was performed on day 7, with no differences in correction, pain, or skin tears. These data suggest that manipulation can be scheduled at the convenience of the patient and surgeon within the first 7 days after injection. Therapeutic I. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. The Use of Residual Collagenase for Single Digits With Multiple-Joint Dupuytren Contractures.

    Science.gov (United States)

    Grandizio, Louis C; Akoon, Anil; Heimbach, Janice; Graham, Jove; Klena, Joel C

    2017-06-01

    Standard 0.58 mg (0.25 mL) collagenase Clostridium histolyticum (CCH) preparations result in unused CCH that is often discarded. Our purpose was to assess the results on Dupuytren contractures affecting both the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in the same digit utilizing an injection containing the maximum CCH volume that can be withdrawn from a single vial. A consecutive series of patients with MCP and PIP cords in the same digit received a single treatment with 2 injections totaling 0.30 mL distributed between the MCP and the PIP cords and underwent manipulation approximately 24 hours later. Reduction in contracture, clinical success, and complications were assessed 30 days after manipulation. Thirty-one patients (34 digits) had a mean preinjection flexion contracture of 50° at the MCP joint and 53° at the PIP joint. Clinical success (reduction in joint contracture to 0°-5° of full extension 30-days postmanipulation) was noted in 65% of MCP cords and 38% of PIP joint cords. We had a 24% incidence of skin tears, which correlated with the degree of preinjection contracture. For Dupuytren contractures involving the MCP and PIP joints in the same digit, distributing the maximum amount of CCH that can be withdrawn from a single vial provides efficacy at both joints that is similar to that reported in previously published series, with a comparable complication rate. Utilizing excess CCH typically discarded may provide cost savings. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. Hyaluronan (Erectus(R in der Behandlung der Osteoarthritis (OA des Kniegelenks - Ergebnisse einer offenen Anwendungsbeobachtung

    Directory of Open Access Journals (Sweden)

    Leeb BF

    2007-01-01

    Full Text Available Ziel der Untersuchung war es, praxisrelevante Daten hinsichtlich der Wirksamkeit, Verträglichkeit und Auswirkung auf die Lebensqualität einer in Österreich neu zugelassenen Hyaluronan-Präparation (Erectus(R; MW 1.100 KD zu erhalten. Patienten und Methodik: Zu diesem Zweck wurden 204 Patienten mit OA des Kniegelenkes, Kellgren-Lawrence (KL I–III (mean 61,1 a [31 a–100 a]; mean BMI 26,9; 57,2% weiblich, 42,8 % männlich von Oktober 2005 bis April 2006 in diese offene multizentrische Anwendungsbeobachtung eingeschlossen. Die Patienten erhielten fünf Injektionen Erectus(Rintraartikulär im Abstand von einer Woche. Primärer Endpunkt war die Verbesserung des Ruheschmerzes zu Visite 5 (Woche 5. Sekundäre Endpunkte waren Verbesserung des Ruheschmerzes bei Visite 6 (Woche 13 sowie des Bewegungsschmerzes, der Beweglichkeit und der Zufriedenheit mit der Lebenssituation. Alle Parameter wurden von den Patienten anhand einer Likert-Skala (0–10 beurteilt. Darüber hinaus erfolgte die Beurteilung von Gesamtwirksamkeit, Verträglichkeit und Gesamtzufriedenheit durch Prüfarzt und PatientIn. Die statistische Auswertung erfolgte mittels T-Test und Chi-Quadrat-Test. Fehlende Werte wurden gemäß LOCF ersetzt. Ergebnisse: Der Ruheschmerz wurde von den Patienten zu Beginn mit im Mittel 4,68 angegeben und verbesserte sich auf 2,04 bei Visite 5 bzw. auf 1,8 bei Visite 6 (p 0,01. Die Verbesserung war bei Patienten mit KL Grad I am stärksten und bei KL III am geringsten ausgeprägt. Die subjektive Beurteilung der Beweglichkeit sowie die Zufriedenheit, mit dem aktuellen Krankheitszustand längerfristig leben zu müssen, verbesserte sich ebenfalls signifikant (p 0,01, wobei dabei interessanterweise die stärksten Veränderungen bei Patienten mit KL III festzustellen waren. Patienten und Behandler beurteilten die globale Wirksamkeit parallel positiv, wie auch die Verträglichkeit. Die Beurteilung der Gesamtzufriedenheit nach einem Schulnotensystem (1–5 ergab

  1. DREIAXIALE ANLAGEN ENTWICKELT AN DER BERGAKADEMIE FREIBERG, IHR GEBRAUCH UND DIE ERREICHTEN ERGEBNISSE

    Directory of Open Access Journals (Sweden)

    Heinz Gloth

    1990-12-01

    Full Text Available Dreiaxiale Anlagen sind fur die geomechanischen Berechnun-gen bei Untergrundarbeiten notwendig. Nach dem Experiment von V. Karman 1911 wurden die Anlagen weiterentwickelt. Die Anlage vom Beginn der 70—er Jahren ermoglichte die Gewinnung von den folgenden Indexen: die Axiallast vom Muster bis zu 20(X kN, der Seitendruck in der Kammcr bis zu 400 MPa und der Porendruck im Muster bis 330 MPa. Der Einbau einer Thermoumhullung fiir die Musterheizung bis zu 3000°C is vorgesehen. Am Beginn der 80—er Jahren wurde in Freiberg erne Anlage mit elektronischer Steuerung hergestellt, die das Entstehen von 40 MPa vom Seilen— und Porendruck ermoglichte. Die Ergebnisse von den Experimenten mil diesen Anlagen sind auch dargeslellt.

  2. The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial.

    Science.gov (United States)

    Collis, Julie; Collocott, Shirley; Hing, Wayne; Kelly, Edel

    2013-07-01

    To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture. We conducted a single-center, randomized, controlled trial to investigate the effect of night extension orthoses on finger range of motion and hand function for 3 months following surgical release of Dupuytren contracture. We also wanted to determine how well finger extension was maintained in the total sample. We randomized 56 patients to receive a night extension orthosis plus hand therapy (n = 26) or hand therapy alone (n = 30). The primary outcome was total active extension of the operated fingers (°). Secondary outcomes were total active flexion of the operated fingers (°), active distal palmar crease (cm), grip strength (kg), and self-reported hand function using the Disabilities of the Arm, Shoulder, and Hand questionnaire (0-100 scale). There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes. Between the first postoperative measure and 3 months after surgery, 62% of little fingers had maintained or improved total active extension. The use of a night extension orthosis in combination with standard hand therapy has no greater effect on maintaining finger extension than hand therapy alone in the 3 months following surgical release of Dupuytren contracture. Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery. Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries.

    Science.gov (United States)

    Lanting, Rosanne; Broekstra, Dieuwke C; Werker, Paul M N; van den Heuvel, Edwin R

    2014-03-01

    Dupuytren disease is a fibroproliferative disease of palmar fascia of the hand. Its prevalence has been the subject of several reviews; however, an accurate description of the prevalence range in the general population--and of the relation between age and disease--is lacking. Embase and PubMed were searched using database-specific Medical Subject Headings; titles and abstracts were searched for the words "Dupuytren," "incidence," and "prevalence." Two reviewers independently assessed the articles using inclusion and exclusion criteria, and rated the included studies with a quality assessment instrument. In a meta-analysis, the median prevalence, as a function of age by sex, was estimated, accompanied by 95 percent prediction intervals. The observed heterogeneity in prevalence was investigated with respect to study quality and geographic location. Twenty-three of 199 unique identified articles were included. The number of participants ranged from 37 to 97,537, and age ranged from 18 to 100 years. Prevalence varied from 0.6 to 31.6 percent. The quality of studies differed but could not explain the heterogeneity among studies. Mean prevalence was estimated as 12, 21, and 29 percent at ages 55, 65, and 75 years, respectively, based on the relation between age and prevalence determined from 10 studies. The authors describe a prevalence range of Dupuytren disease in the general population of Western countries. The relation between age and prevalence of Dupuytren disease is given according to sex, including 95 percent prediction intervals. It is possible to determine disease prevalence at a certain age for the total population, and for men and women separately.

  4. Should we consider Dupuytren's contracture as work-related? A review and meta-analysis of an old debate

    Directory of Open Access Journals (Sweden)

    Jauffret Pénélope

    2011-05-01

    Full Text Available Abstract Background In view of the conflicting opinions published, a meta-analysis was undertaken on epidemiological studies in order to assess any association between Dupuytren's contracture and work exposure. Methods Using the key words: "occupational disease", "work" and "Dupuytren contracture" without limitation on language or year of publication, epidemiological studies were selected from four databases (Pub-Med, Embase, Web of science, BDSP after two rounds (valid control group, valid work exposure. A quality assessment list was constructed and used to isolate papers with high quality methodological criteria (scores of 13 or above, HQMC. Relevant associations between manual work, vibration exposure (at work and Dupuytren's contracture were extracted from the articles and a metarisk calculated using the generic variance approach (meta-odds ratios, meta-OR. Results From 1951 to 2007, 14 epidemiological studies (including 2 cohort studies, 3 case-control studies, and 9 cross-sectional studies/population surveys were included. Two different results could be extracted from five studies (based on different types of exposure, leading to 19 results, 12 for manual work (9 studies, and 7 for vibration exposure (5 studies. Six studies met the HQMC, yielding 9 results, 5 for manual work and 4 for vibration exposure. Five studies found a dose-response relationship. The meta-OR for manual work was 2.02[1.57;2.60] (HQMC studies only: 2.01[1.51;2.66], and the meta-OR for vibration exposure was 2.88 [1.36;6.07] (HQMC studies only: 2.14[1.59;2.88]. Conclusion These results support the hypothesis of an association between high levels of work exposure (manual work and vibration exposure and Dupuytren's contracture in certain cases.

  5. Stenting of the SFA - indications, techniques,; Stents in der A. femoralis superficialis - Indikationen, Technik, Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Rieger, J.; Treitl, M.; Reiser, M. [Klinikum Innenstadt der Ludwigs-Maximilians-Universitaet,, Muenchen (Germany). Institut fuer Klinische Radiologie; Ruppert, V. [Chirurgische Klinik und Poliklinik Innenstadt - Klinikum der Ludwigs-Maximilians-Universitaet Muenchen (Germany). Funktionsbereich Gefaesschirurgie

    2006-11-15

    Aggressive risk factor modification, change of eating habits, exercise programs, and forceful antiplatelet therapy are the most important tools for the treatment of PAOD in symptomatic patients suffering from intermittent claudication. There are however no guidelines for revascularization at this stage. Endovascular treatment has been increasingly utilized over the last decade and increasingly displaced vascular surgery. Amongst numerous endovascular techniques beside PTA, stents meanwhile play the most important role due to constant technical progress. Results regarding the rate of restenosis or patency rates still remain worse compared to other vascular beds. This paper gives a review over recent results, currently available stent techniques, and possible indications for the endovascular therapy of an artery, which has turned out to be the biggest ordeal for material and construction of stents. (orig.) [German] Aggressives Risikofaktorenmanagement, Aenderungen der Lebens- und Essgewohnheiten sowie eine konsequente antithrombotische Therapie sind die wichtigsten Saeulen bei der Sekundaerprophylaxe einer symptomatischen peripheren arteriellen Verschlusskrankheit (PAVK) im Stadium der Claudicatio. Bei den revaskularisierenden Verfahren existieren in diesem Stadium keine verbindlichen Richtlinien zur Indikationsstellung. Endovaskulaere Techniken draengen jedoch den klassischen Bypass mehr und mehr zurueck. Unter den zahlreichen endovaskulaeren Therapiemoeglichkeiten haben sich in der A. femoralis superficialis (AFS) neben der perkutanen transfemoralen Angioplastie (PTA) v. a. technisch immer weiter verbesserte Stents etabliert. Die Ergebnisse bzgl. der Inzidenz von Restenosen bzw. der Offenheitsraten fallen aber weiterhin im Vergleich zu anderen arteriellen Stromgebieten schlechter aus. Dieser Artikel gibt einen Ueberblick ueber die z. Z. einsetzbaren Stentmodelle, moegliche Indikationen und die juengsten Ergebnisse der endovaskulaeren Behandlung eines Gefaesses, das

  6. Targets and results of the German Reactor Safety Program; Ziele und Ergebnisse der deutschen Reaktorsicherheitsforschung

    Energy Technology Data Exchange (ETDEWEB)

    Walte, F.; Schmitz, V.; Kroening, M. [FhG - IZFP, Saarbruecken (Germany)

    1999-08-01

    The results obtained so far by the first two austenitic weld research projects show that the approach taken was the right one, as the modelling work in connection with the pulse-echo testing techniques did in fact achieve enhancements in the ultrasonic inspection of austenitic welds. The tools developed are: Ray tracing, point source synthesis, and EFIT, and can be successfully applied for NDE of transverse-isotropic weld microstructures, as was shown by all verification experiments. The project tasks for EFIT simulation and verification of the ultrasonic test method applied to anisotropic, dissimilar welds are expected to be concluded towards the end of the project period. If these activities prove to be successful, too, there will be several examples available giving evidence of the feasibility and suitability of the tools for an optimisation of the test parameters. The results available to date have been obtained with tests at several welds, assuming flaw types such as root defects perpendicular to the surface, which were introduced into the specimens by notches. (orig./CB) [Deutsch] Die bisher in den beiden Austenit-Forschungsprojekten erzielten Ergebnisse zeigen, dass der Ansatz, durch Modellierung der Impulsechopruefung einen Beitrag zur Verbesserung der Ultraschallpruefung von austenitischen Schweissnaehten zu leisten, richtig war. Die Werkzeuge: - Ray Tracing, - Punktquellensynthese, und - EFIT sind fuer transversal-isotrope Schweissnahtgefuege entwickelt und verfuegbar. Alle bisher durchgefuehrten Verifikationsexperimente waren erfolgreich. Die EFIT-Simulation und Verifikation der Ultraschallpruefung der anisotropen, inhomogenen Schweissnaht steht jedoch noch aus, wird aber bis zum Ende des Projektes erfolgen. Wenn auch dies gelingt, ist exemplarisch an einigen Beispielen gezeigt, dass die o.g. Werkzeuge tauglich sind, durch Vorausrechnung reale Ultraschallpruefungen hinsichtlich der Pruefparameter zu optimieren. Die bisherigen Ergebnisse wurden

  7. Preliminary soft-tissue distraction versus checkrein ligament release after fasciectomy in the treatment of dupuytren proximal interphalangeal joint contractures.

    Science.gov (United States)

    Craft, Randall O; Smith, Anthony A; Coakley, Brandon; Casey, William J; Rebecca, Alanna M; Duncan, Scott F M

    2011-11-01

    Checkrein ligament release for treatment of proximal interphalangeal joint Dupuytren contractures does not address the shortened arteries or deficient skin. The Digit Widget uses soft-tissue distraction to overcome these issues. This study compares checkrein ligament release after fasciectomy versus preliminary soft-tissue distraction, followed by operative release, for treatment of proximal interphalangeal joint Dupuytren contractures. The authors compared operative and postoperative characteristics of patients treated with either fasciectomy plus checkrein ligament release or Digit Widget distraction between 2001 and 2008. Seventeen patients (20 digits) underwent ligament release (mean contracture, 55.9 degrees); six of these 20 were reoperations. Thirteen patients (17 digits) underwent distraction (mean contracture, 67.6 degrees); 10 of 17 were reoperations. The 20 digits treated with fasciectomy plus ligament release had an average extension improvement of 31.4 degrees (range, -4 to 70 degrees). Digits treated with distraction had an average extension improvement of 53.4 degrees (range, 30 to 75 degrees) (pDupuytren fasciectomy plus checkrein ligament release. Therapeutic, III.

  8. Periostin differentially induces proliferation, contraction and apoptosis of primary Dupuytren's disease and adjacent palmar fascia cells

    Energy Technology Data Exchange (ETDEWEB)

    Vi, Linda; Feng, Lucy; Zhu, Rebecca D.; Wu, Yan [Cell and Molecular Biology Laboratory, Hand and Upper Limb Centre, London, Ontario (Canada); Lawson Health Research Institute, London, Ontario (Canada); Satish, Latha [Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA (United States); Gan, Bing Siang [Cell and Molecular Biology Laboratory, Hand and Upper Limb Centre, London, Ontario (Canada); Lawson Health Research Institute, London, Ontario (Canada); Department of Surgery, University of Western Ontario, London, Ontario (Canada); Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); O' Gorman, David B., E-mail: dogorman@uwo.ca [Cell and Molecular Biology Laboratory, Hand and Upper Limb Centre, London, Ontario (Canada); Lawson Health Research Institute, London, Ontario (Canada); Department of Surgery, University of Western Ontario, London, Ontario (Canada); Department of Biochemistry, University of Western Ontario, London, Ontario (Canada)

    2009-12-10

    Dupuytren's disease, (DD), is a fibroproliferative condition of the palmar fascia in the hand, typically resulting in permanent contracture of one or more fingers. This fibromatosis is similar to scarring and other fibroses in displaying excess collagen secretion and contractile myofibroblast differentiation. In this report we expand on previous data demonstrating that POSTN mRNA, which encodes the extra-cellular matrix protein periostin, is up-regulated in Dupuytren's disease cord tissue relative to phenotypically normal palmar fascia. We demonstrate that the protein product of POSTN, periostin, is abundant in Dupuytren's disease cord tissue while little or no periostin immunoreactivity is evident in patient-matched control tissues. The relevance of periostin up-regulation in DD was assessed in primary cultures of cells derived from diseased and phenotypically unaffected palmar fascia from the same patients. These cells were grown in type-1 collagen-enriched culture conditions with or without periostin addition to more closely replicate the in vivo environment. Periostin was found to differentially regulate the apoptosis, proliferation, {alpha} smooth muscle actin expression and stressed Fibroblast Populated Collagen Lattice contraction of these cell types. We hypothesize that periostin, secreted by disease cord myofibroblasts into the extra-cellular matrix, promotes the transition of resident fibroblasts in the palmar fascia toward a myofibroblast phenotype, thereby promoting disease progression.

  9. Management of Dupuytren contracture with ultrasound-guided lidocaine injection and needle aponeurotomy coupled with osteopathic manipulative treatment.

    Science.gov (United States)

    Sampson, Steven; Meng, Michael; Schulte, Adam; Trainor, Drew; Montenegro, Roberto; Aufiero, Danielle

    2011-02-01

    Dupuytren contracture is a debilitating disease that characteristically presents as a firm nodularity on the palmar surface of the hand with coalescing cords of soft tissue on the webs and digits. With few nonsurgical modalities providing clinical benefits, open surgical procedures are the standard of care for patients with this condition. However, recent studies have associated surgical intervention with many complications, necessitating further exploration of nonsurgical treatment options. We describe the case of a 64-year-old woman who presented with decreased extension of the fourth and fifth digits on the upper extremities bilaterally; previous conservative treatment regimens had been unsuccessful. After a diagnostic ultrasound, the patient was diagnosed as having Dupuytren contracture and underwent 5 treatments consisting of ultrasound-guided dry-needle aponeurotomy, lidocaine injections, and osteopathic manipulative treatment. During the fifth treatment session, the patient experienced dramatic relief of her symptoms after a palpable release during the manual manipulation portion of her therapeutic regimen. At 2-week follow-up, the patient was symptom-free. Based on this desirable outcome, the authors suggest future research be directed at minimally invasive therapeutic options in the management of Dupuytren contracture.

  10. Dupuytren disease: European hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline: results from the HANDGUIDE study.

    Science.gov (United States)

    Huisstede, Bionka M A; Hoogvliet, Peter; Coert, J Henk; Fridén, Jan

    2013-12-01

    Multidisciplinary treatment guidelines for Dupuytren disease can aid in optimizing the quality of care for patients with this disorder. Therefore, this study aimed to achieve consensus on a multidisciplinary treatment guideline for Dupuytren disease. A European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of interventions was conducted and used as an evidence-based starting point for this study. In total, 39 experts (hand surgeons, hand therapists, and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report. After four Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of Dupuytren disease. No nonsurgical interventions were included in the guideline. Needle and open fasciotomy, and a limited fasciectomy and dermofasciectomy, were seen as suitable surgical techniques for Dupuytren disease. Factors relevant for choosing one of these surgical techniques were identified and divided into patient-related (age, comorbidity), disease-related (palpable cord, previous surgery in the same area, skin involvement, time of recovery, recurrences), and surgeon-related (years of experience) factors. Associations of these factors with the choice of a specific surgical technique were reported in the guideline. Postsurgical rehabilitation should always include instructions and exercise therapy; postsurgical splinting should be performed on indication. Relevant details for the use of surgical and postsurgical interventions were described. This treatment guideline is likely to promote further discussion on related clinical and scientific issues and may therefore contribute to better treatment of patients with Dupuytren disease.

  11. Involvement of the Interosseous and Lumbrical Muscle-Tendon Units in the Lateral and Spiral Cords in Dupuytren's Disease of the Middle Fingers.

    Science.gov (United States)

    Thoma, Achilleas; Karpinski, Marta

    2017-07-01

    The nature of intrinsic muscle involvement in Dupuytren's disease of the middle fingers (long and ring) remains poorly characterized. Over the years, the authors have observed that both the spiral and lateral digital cords in the middle fingers receive contribution from intrinsic muscle-tendon units. This report describes the anatomical characteristics and frequency of intrinsic muscle-tendon unit involvement in Dupuytren's disease of the middle fingers. Intrinsic muscle involvement in the middle digits was recorded in the operative reports of patients undergoing Dupuytren's surgery between October of 2013 and February of 2016. The anatomical variations of diseased fascia were delineated and classified. Of the 113 digits with Dupuytren's contracture operated on during this period, 52 involved the middle fingers (12 long and 40 ring fingers). Intrinsic muscles were found to be involved in the contracture of 14 of these digits. Two unique contracture patterns were identified: type I contracture, which involves a lateral digital cord originating from intrinsic muscle-tendon units and contracting only the proximal interphalangeal joint; and type II contracture, which involves a spiral cord receiving contribution from intrinsic muscle-tendon units and contracting both the metacarpophalangeal and proximal interphalangeal joints. The frequency of type I and type II contractures was 6 percent and 12 percent, respectively. Intrinsic hand muscles may contribute to Dupuytren's disease in the middle digits, and the authors suggest resecting cords as close as possible to their musculotendinous origin to improve postoperative outcomes.

  12. Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

    Science.gov (United States)

    Baltzer, H; Binhammer, P A

    2013-08-01

    In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

  13. erst oder schon? erst oder nur?

    Institute of Scientific and Technical Information of China (English)

    宋玉华; 徐嘉

    2008-01-01

    erst、schon、和nut是使用频率较高的副词,只有弄清楚它们的语义才能够正确地使用它们。这里之所以把erst—schon和erst与nut这两组词放在一起探讨,是因为它们之间存在着一定的关联。

  14. Irradiation programme MANITU. Results of impact tests with the irradiated materials of the second irradiation phase (0.8 dpa); Bestrahlungsprogramm MANITU. Ergebnisse der Kerbschlagbiegeversuche mit den bis 0,8 dpa bestrahlten Werkstoffen der zweiten Bestrahlungsphase

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, H.C.; Rieth, M.; Dafferner, B.; Ries, H.; Romer, O.

    2000-09-01

    The irradiation project MANITU was planned and carried out in the frame of the European Longterm Fusion Materials Development Programme. The problem of the irradiation induced embrittlement of possible martensitic alloy candidates is still unsolved. But after the evaluation of sub-size Charpy tests with the unirradiated reference specimens of MANITU a first tendency was recognizable. The mechanical properties of the newly developed low activation 7-10% Cr-W(Ge)VTa alloys are partly better compared to the modified commercial 10-11% Cr-NiMoVNb steels. After the evaluation of subsize Charpy tests with specimens irradiated up to 0.2 and 0.8 dpa in the first phase of the MANITU programme, better mechanical properties of the 7-10% Cr-W(Ge)VTa alloys were obvious. In the present report the results of instrumented impact tests within the second phase of the MANITU programme (irradiation dose 0.8 dpa, irradiation temperatures 250, 300, 350, 400, and 450 C) are analysed and assessed in comparison to the results of the irradiation up to 0.8 dpa in the first phase of the project. Among the examined alloys (OPTIMAR, OPTIFER-IV, GA3X) the GA3X steel shows the very best embrittlement behaviour after neutron irradiation. (orig.) [German] Das Bestrahlungsprojekt MANITU wurde im Rahmen des europaeischen Langzeitprogramms fuer Materialentwicklung fuer die Kernfusion geplant und durchgefuehrt. Das Problem der bestrahlungsinduzierten Versproedung bei den in Frage kommenden martensitischen Werkstoffen ist nach wie vor ungeloest. Eine erste Tendenz zeichnete sich jedoch nach der Auswertung der Kerbschlagbiegeversuche an den unbestrahlten miniaturisierten Referenzproben des MANITU-Programms ab. Die neu entwickelten niedrig aktivierbaren 7-10% Cr-W(Ge)VTa-Legierungen weisen gegenueber den modifizierten kommerziellen 10-11% Cr-NiMoVNb-Staehlen teilweise bessere mechanische Eigenschaften auf. Nach Auswertung der Kerbschlagbiegeversuche an den in der ersten Phase des MANITU-Programms mit 0

  15. Ergebnisse einer neuen Technik der Meatusplastik im Rahmen der geschlechtsangleichenden Operation von Mann zu Frau

    Directory of Open Access Journals (Sweden)

    Rossi Neto R

    2011-01-01

    Full Text Available In unserer Klinik stellt sich die Meatusstenose als die häufigste Komplikation nach einer geschlechtsangleichenden Operation mit ca. 40 % betroffenen Patientinnen dar, gefolgt von lokalen Wundheilungsstörungen (26 % und Verengung des Introitus vaginalis mit 12 %. Die Hauptkomplikationen werden bei der zweiten Sitzung mit kleinen ästhetischen Korrekturen beseitigt. Trotz einer zweiten Korrektur besteht jedoch immer noch das Risiko (15–20 % der Entstehung einer Striktur der Anastomose. Im Rahmen der Neo-Urethrokutaneostomie besteht grundsätzlich das Problem, dass eine zirkuläre kutane Anastomose im Verlauf zur narbigen Verengung neigt. Um das Stenoserisiko zu reduzieren, ist eine neue Technik der Neo- Urethrokutaneostomie entwickelt und der Verlauf der Patientinnen im Vergleich zur konventionellen Methode verglichen worden. Insgesamt wurden 45 Patientinnen mit dieser Methode operiert und prospektiv analysiert: Gruppe A mit 23 Patientinnen, die eine konventionelle Neo-Urethrokutaneostomie mit Absetzung der Harnröhren auf Hautniveau erhielten, und Gruppe B mit 22 Patientinnen, wobei hier die Harnröhre ca. 1,0–1,5 cm oberhalb des Hautniveaus abgesetzt und eine lange Eversion der Schleimhaut durchgeführt wurde. Insgesamt wurde eine Nachbeobachtung der postoperativen Ergebnisse über 7 Monate durchgeführt, wobei das besondere Augenmerk auf das Maß der subvesikalen Obstruktion gelegt wurde. In Gruppe A wurden bei 19 Patientinnen (82,6 % obstruktive Miktionsbeschwerden aufgrund progressiver Meatusstenosen festgestellt. Insgesamt 14 (61 % von 23 Patientinnen konnten nach 7 Monaten ohne eine zweite Korrektur normal miktionieren. In Gruppe B hingegen berichteten nur 3 (13,6 % Patientinnen über obstruktive Miktionsbeschwerden. Bei 4 Patientinnen (18 % wurde der Dauerkatheter aufgrund einer Durchblutungsstörung des Meatus 3 Tage länger belassen, bei 3 Patientinnen war zur Verbesserung der Wundheilung eine Abtragung von Nekrosen am Harnr

  16. Über den Nachrichtenwert von Friedensjournalismus - Ergebnisse einer experimentellen Studie

    Directory of Open Access Journals (Sweden)

    Monika Spohrs

    2006-04-01

    Full Text Available Laut Nachrichtenwertforschung hängt die Publikations- und Lesenswürdigkeit von Nachrichtentexten von den Nachrichtenfaktoren der zu publizierenden Ereignisse ab. Als anerkannte Nachrichtenfaktoren gelten beispielsweise Negativität, Vereinfachung und Personifizierung. Friedensjournalistische Arbeiten weichen von diesen Kriterien oft ab, indem sie versuchen, die berichteten Ereignisse in ihrer Komplexität darzustellen, den Fokus nicht auf negative Ereignisse zu legen und auch strukturellen Themen Raum zu geben. Aber sind sie deshalb weniger publikationswürdig? Der folgende Artikel zeigt anhand einer experimentellen Studie, welche Akzeptanz Friedensjournalismus beim Leser finden kann, auch wenn dies teilweise den Theorien der Nachrichtenwertforschung widerspricht. Des weiteren wird gezeigt, wie sich konstruktive Berichterstattung auf die mentalen Modelle der Rezipienten auswirkt und in welchem Zusammenhang diese beiden Ergebnisse miteinander stehen. In der vorliegenden Studie wurden einer für die Leserschaft der deutschen Qualitätspresse hinsichtlich Alter und Bildungsgrad repräsentativen Stichprobe von n = 128 Versuchspersonen Zeitungsartikel zu drei verschiedenen Ereignissen im Konfliktfeld des ehemaligen Jugoslawien dargeboten. Zu jedem Ereignis wurden vier verschiedene Textvarianten verwendet: eine gemäßigt eskalationsorientierte Originalfassung aus einer deutschen Qualitätszeitung (Die Welt, Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung und drei modifizierte Versionen dieser Artikel, (a mit gemäßigt deeskalations-orientiertem Framing, (b mit stark deeskalationsorientiertem Framing und (c mit einer Verschärfung der Eskalationsorientierung der dargestellten Konflikte. Die Aufgabe der Vpn bestand darin, zu jedem der drei Ereignisse eine Textvariante zu lesen und danach in eigenen Worten schriftlich wiederzugeben und anschließend einen Fragebogen zu Akzeptanz, Glaubwürdigkeit, Ausgewogenheit, Neuigkeitsgehalt, Bewertung und

  17. Quality assessment with the AGIR software results and experience; Qualitaetsmanagement mittels AGIR: Ergebnisse und Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Rauch, D.; Kotter, E.; Kurtz, C.; Schaefer, O.; Ehritt-Braun, C.; Burger, D.; Schaper, J.; Uhrmeister, P. [Freiburg Univ. (Germany). Radiologische Universitaetsklinik, Abt. fuer Roentgendiagnostik

    2001-02-01

    Purpose: To evaluate whether a new software from the working group for interventional radiology (AGIR) is an appropriate tool for quality assurance in interventional radiology, and presentation of results acquired within the quality improvement process in 1999. Patients and methods: AGIR-defined parameters such as patient data, risk profile, given interventions as well as complications were registered by a recently developed software. Based on monthly data analyses, possible complications were identified and discussed in morbidity and mortality conferences. Results: 1014 interventions were performed in our institution in 1999. According to criteria established by AGIR, the complication rate was 2.7%. In addition and according to SCVIR criteria, complications were distinguished quantitatively in five classes and semiquantitatively in minor and major groups. The result was a minor complication rate of 1.8%, and a major rate of 0.9%. There were no cases of death associated with the intervention. Further strategies were developed in order to reduce the complication rate. Conclusion: Extensive quality assurance methods can be integrated in daily routine work. These methods lead to an intensive transparency of treatment results, and allow the implementation of continuous quality improvements. The development of the software is a first step in establishing a nation-wide quality assurance system. Nevertheless, modification and additional definition of the AGIR predefined parameters are required, for example, to avoid unnecessary procedures. (orig.) [German] Ziel: Evaluierung einer neuen Software der arbeitsgemeinschaft interventionelle radiologie (AGIR) hinsichtlich der Eignung als Instrument zur Qualitaetssicherung in der interventionellen Radiologie sowie Praesentation der Ergebnisse innerhalb des Qualitaetsprozesses aus dem Jahre 1999. Patienten und Methoden: Mit Hilfe einer neuen Software wurden AGIR definierte Parameter wie Patientendaten, Risikoprofil, die jeweilige

  18. The emerging role of Clostridium histolyticum collagenase in the treatment of Dupuytren disease

    Directory of Open Access Journals (Sweden)

    Alexis Thomas

    2010-11-01

    Full Text Available Alexis Thomas1, Ardeshir Bayat1,21Plastic and Reconstructive Surgery Research, School of Translational Medicine, University of Manchester, Manchester Interdisciplinary Biocentre, Manchester, UK; 2Department of Plastic and Reconstructive Surgery, Manchester Academic Health Science Centre, University Hospital of South Manchester National Health Service Foundation Trust, Wythenshawe Hospital, Manchester, UKAbstract: Dupuytren disease (DD is a common fibroproliferative disease of unknown etiopathogenesis affecting the palmar aponeurosis, causing reduced hand function and resulting in fixed flexion contractures of the digits. Current gold standard treatment for the management of DD is surgical excision involving removal of the affected palmar fascial tissue. However, there are potential complications associated with surgery as it is costly and a positive surgical outcome is often short-lived because the disease tends to recur. Therefore, there is growing interest in nonsurgical, outpatient-based treatments that could be quicker, cheaper, reduce morbidity, show a decreased rate of recurrence, and give DD patients an improved quality of life when compared with traditional surgical management. Of the available nonsurgical options, injectable Clostridium histolyticum collagenase (CHC has received recent clinical interest. In this article, a brief overview of DD surgical and nonsurgical treatments utilized is given, followed by a detailed examination of the nine papers published to date on the use of CHC in DD (and similar fibrotic disorders. These papers have investigated safe and efficacious doses for the injection of CHC to treat palpable DD cords in adult patients and have shown significant short- to mid-term results for correction to near-full digital extension (≤5° extension following CHC injection of DD cords. CHC has been shown to target the collagen-based DD cords while sparing surrounding neurovasculature, with a complication profile that

  19. In vitro study of novel collagenase (XIAFLEX® on Dupuytren's disease fibroblasts displays unique drug related properties.

    Directory of Open Access Journals (Sweden)

    Farhatullah Syed

    Full Text Available Dupuytren's disease (DD is a benign, fibroproliferative disease of the palmar fascia, with excessive extracellular matrix (ECM deposition and over-production of cytokines and growth factors, resulting in digital fixed flexion contractures limiting hand function and patient quality of life. Surgical fasciectomy is the gold standard treatment but is invasive and has associated morbidity without limiting disease recurrence. Injectable Collagenase Clostridium histolyticum (CCH--Xiaflex®--is a novel, nonsurgical option with clinically proven in vivo reduction of DD contractures but with limited in vitro data demonstrating its cellular and molecular effects. The aim of this study was to delineate the effects of CCH on primary fibroblasts isolated from DD and non-DD anatomical sites (using RTCA, LDH, WST-1, FACS, qRT-PCR, ELISA and In-Cell Quantitative Western Blotting to compare the efficacy of varying concentrations of Xiaflex® against a reagent grade Collagenase, Collagenase A. Results demonstrated that DD nodule and cord fibroblasts had greater proliferation than those from fat and skin. Xiaflex® exposure resulted in dose- and time-dependent inhibition of cellular spreading, attachment and proliferation, with cellular recovery after enzyme removal. Unlike Collagenase A, Xiaflex® did not cause apoptosis. Collagen expression patterns were significantly (p<0.05 different in DD fibroblasts across anatomical sites - the highest levels of collagen I and III were detected in DD nodule, with DD cord and fat fibroblasts demonstrating a smaller increase in both collagen expression relative to DD skin. Xiaflex® significantly (p<0.05 down-regulated ECM components, cytokines and growth factors in a dose-dependent manner. An in vitro scratch wound assay model demonstrated that, at low concentrations, Xiaflex® enabled a faster fibroblast reparatory migration into the wound, whereas, at high concentrations, this process was significantly (p<0.05 inhibited

  20. Prevalence of Peyronie's Disease-Like Symptoms in Men Presenting With Dupuytren Contractures.

    Science.gov (United States)

    Shindel, Alan W; Sweet, Genevieve; Thieu, William; Durbin-Johnson, Blythe; Rothschild, Jennifer; Szabo, Robert

    2017-09-01

    Peyronie's disease (PD) and Dupuytren contractures (DC) are often comorbid and are believed to have a similar underlying pathophysiologic mechanism. To investigate the prevalence of PD-like symptoms (PDLS) in men with DC. From October 2013 to December 2016, men who were seen and evaluated for DC were offered the opportunity to participate in an anonymous survey. The survey assessed several basic demographic and sexual health factors and included items from the International Index of Erectile Function and the Erection Hardness Scale. Men who reported PDLS were asked a series of questions derived from the Peyronie's Disease Questionnaire and for their opinions on theoretical treatment modalities for sexual problems and penile deformity. Prevalence of PDLS in men with DC. One hundred forty men with DC were invited to participate; 85 surveys were returned (response rate = 61%). Twenty-two respondents (26%, 95% confidence interval = 17-35) reported PDLS. Approximately one fourth of all respondents had an Erection Hardness Scale score lower than 3. The most common specific PDLS concerns were penile curvature (91%), length loss (55%), narrowing (36%), and hinging (32%). In men with PDLS, 73% felt at least a little bothered by the symptoms when attempting sexual activity and 40% reported having sex less frequently because of the symptoms. Just 27% of men with PDLS had ever used a treatment for a sexual concern. In terms of treatments for penile deformities, 64% of men with PDLS expressed an interest in treatment administered in the form of an in-office procedure; 41% were potentially amenable to a surgical procedure. The prevalence of PDLS in men with DC is similar to the prevalence of DC in men diagnosed with PD. A substantial number of these men have distress and would consider standard-of-care treatments for PD. Shindel AW, Sweet G, Thieu W, et al. Prevalence of Peyronie's Disease-Like Symptoms in Men Presenting With Dupuytren Contractures. Sex Med 2017;5:e135-e141

  1. A Genome-wide Association Study of Dupuytren Disease Reveals 17 Additional Variants Implicated in Fibrosis.

    Science.gov (United States)

    Ng, Michael; Thakkar, Dipti; Southam, Lorraine; Werker, Paul; Ophoff, Roel; Becker, Kerstin; Nothnagel, Michael; Franke, Andre; Nürnberg, Peter; Espirito-Santo, Ana Isabel; Izadi, David; Hennies, Hans Christian; Nanchahal, Jagdeep; Zeggini, Eleftheria; Furniss, Dominic

    2017-09-07

    Individuals with Dupuytren disease (DD) are commonly seen by physicians and surgeons across multiple specialties. It is an increasingly common and disabling fibroproliferative disorder of the palmar fascia, which leads to flexion contractures of the digits, and is associated with other tissue-specific fibroses. DD affects between 5% and 25% of people of European descent and is the most common inherited disease of connective tissue. We undertook the largest GWAS to date in individuals with a surgically validated diagnosis of DD from the UK, with replication in British, Dutch, and German individuals. We validated association at all nine previously described signals and discovered 17 additional variants with p ≤ 5 × 10(-8). As a proof of principle, we demonstrated correlation of the high-risk genotype at the statistically most strongly associated variant with decreased secretion of the soluble WNT-antagonist SFRP4, in surgical specimen-derived DD myofibroblasts. These results highlight important pathways involved in the pathogenesis of fibrosis, including WNT signaling, extracellular matrix modulation, and inflammation. In addition, many associated loci contain genes that were hitherto unrecognized as playing a role in fibrosis, opening up new avenues of research that may lead to novel treatments for DD and fibrosis more generally. DD represents an ideal human model disease for fibrosis research. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  2. Clusters in Short-term Disease Course in Participants With Primary Dupuytren Disease.

    Science.gov (United States)

    Lanting, Rosanne; van den Heuvel, Edwin R; Werker, Paul M N

    2016-03-01

    The course of Dupuytren disease (DD) is thought to be progressive; however, the course differs for each patient. The purpose of this study was to study the rate and pattern of progression of DD. We prospectively analyzed the course of DD at intervals of 3 to 6 months in 247 Dutch participants with primary DD by measuring the surface area of nodules and cords and the total passive extension deficit. The association between surface area and Tubiana stage was tested with generalized estimating equations. Latent class models were used to study different clusters in changes regarding the course of the disease. The variance in disease course between participants was large. Regarding the change in surface area (in all fingers) and total passive extension deficit (in the ring and little finger), different clusters were observed. Progression of disease was seen but there were also signs of stability and even regression. Patients with a smaller surface area at baseline were more likely to exhibit regression. This study showed that DD is not always progressive and that up to 75% of patients have a different short-term disease course, such as stability or even regression of disease. This should be taken into account when evaluating the effects of treatment for early-phase DD and in the design of future studies. Furthermore, this information may be useful when counseling patients. Prognostic II. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Adverse Effects of Collagenase in the Treatment of Dupuytren Disease: A Systematic Review.

    Science.gov (United States)

    Sanjuan-Cerveró, Rafael; Carrera-Hueso, Francisco J; Vazquez-Ferreiro, Pedro; Gomez-Herrero, Diego

    2017-04-01

    Collagenase clostridium histolyticum (CCH) has proven to be both safe and effective in the treatment of Dupuytren disease (DD). The medium-term outcomes are similar to those achieved with surgery, and most adverse effects are self-limiting and considered to be mild or moderate. Our objective was to conduct a systematic review of the adverse effects of CCH in DD since the release of the drug to evaluate the incidence, severity, classification, and definitions of these effects. We analyzed the literature in terms of modifications to the original treatment protocol and grouped adverse effects according to their pathophysiological origin. We included 28 clinical studies and five case reports or case series analyzing 4456 patients with a mean age of 63.6 years. Mean follow-up was 7.07 months (range 3-24); the mean number of patients per study was 148 (range 5-1082). The studies did not classify the adverse effects they reported into groups. The most common effects were peripheral edema (54.4%), bruising (42.9%), and upper limb pain (28.3%). Significant biases were observed for use of terminology, demarcation of sites of involvement, severity criteria, and assessment methods. A simpler and clearer consensus-based classification system would enable better evaluation and comparison of the adverse effects of CCH in the treatment of DD. Consideration of inflammatory phenomena as part of the drug's mechanism of action would significantly reduce overall rates of adverse effects.

  4. Pain Associated With Treatment of Dupuytren Contracture With Collagenase Clostridium histolyticum.

    Science.gov (United States)

    Sanjuan-Cerveró, Rafael; Carrera-Hueso, Francisco J; Vazquez-Ferreiro, Pedro; Fikri-Benbrahim, Narjis; Franco-Ferrando, Nuria; Peimer, Clayton A

    2017-02-01

    The primary objective of this study was to quantify the degree of pain associated with collagenase Clostridium histolyticum (CCH) injection and to determine whether it is related to other factors in the intervention. A prospective study of 135 patients was performed to evaluate pain at 3 points during treatment: (1) after CCH injection, using a numerical rating scale (NRS), (2) a binary (positive/negative) assessment before manipulation 24 hours after CCH and after removing the bandage, and (3) after joint manipulation performed with wrist block anesthesia. The average NRS for pain during infiltration was 4.7. Pain was present before manipulation in 52.6% of patients. Pain from manipulation showed an average NRS score of 3.6. The amounts of pain at CCH infiltration, pain after 24 hours, and pain from the manipulation were correlated because patients who experienced pain during CCH infiltration were more likely to report experiencing pain during manipulation. Collagenase Clostridium histolyticum injection for treating Dupuytren contracture can be a painful process. There is a clear relationship between a patient's level of pain during injection of CCH and the likelihood that the patient will experience pain during manipulation, even with the use of local anesthesia. Prognostic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Late complications of clinical clostridium histolyticum collagenase use in Dupuytren's disease.

    Directory of Open Access Journals (Sweden)

    Warren M Rozen

    Full Text Available INTRODUCTION: While Dupuytren's disease can cause disabling contractures requiring open surgery, a less-invasive option using Clostridium Histolyticum collagenase (CHC via percutaneous injection was recently reported. A recent prospective, randomized trial demonstrated few complications during 90 days follow-up, however did not assess any longer term follow-up for these patients. Long-term outcomes in this setting have not been adequately reported, and the current manuscript aims to identify late complications from the clinical use of percutaneous CHC. METHODS: The current manuscript reports an extended 12-month follow-up for a cohort of twelve of patients enrolled in the original prospective, randomized trial, treated at a single institution. An analysis of complications requiring surgical intervention was undertaken. RESULTS: Two of twelve patients reported debilitating pain and triggering requiring surgical intervention. Extensive deep-tissue scarring and adhesions were identified, providing the first visual and qualitative analysis of the pathologic effects of CHC. CONCLUSION: Late complications from CHC use can and have occurred, outside the follow-up period of the initial phase III trials. Longer term follow-up of such patients is thus essential, and further investigation and characterization of the late effects of CHC use is warranted.

  6. WT1 expression is increased in primary fibroblasts derived from Dupuytren's disease tissues.

    Science.gov (United States)

    Crawford, Justin; Raykha, Christina; Charles, Daevina; Gan, Bing Siang; O'Gorman, David B

    2015-12-01

    Dupuytren's disease (DD) is a fibroproliferative and contractile fibrosis of the palmar fascia that, like all other heritable fibroses, is currently incurable. While DD is invariably benign, it exhibits some molecular similarities to malignant tumours, including increased levels of ß-catenin, onco-fetal fibronectin, periostin and insulin-like growth factor (IGF)-II. To gain additional insights into the pathogenesis of DD, we have assessed the expression of WT1, encoding Wilm's tumour 1, an established tumour biomarker that is syntenic with IGF2, the gene encoding IGF-II in humans. We found that WT1 expression is robustly and consistently up regulated in primary fibroblasts derived from the fibrotic palmar fascia of patients with DD (DD cells), whereas syngeneic fibroblasts derived from the macroscopically unaffected palmar fascia in these patients and allogeneic fibroblasts derived from normal palmar fascia exhibited very low or undetectable WT1 transcript levels. WT1 immunoreactivity was evident in a subset of cells in the fibrotic palmar fascia of patients with DD, but not in macroscopically unaffected palmar fascia. These findings identify WT1 expression as a novel biomarker of fibrotic palmar fascia and are consistent with the hypothesis that the pathogeneses of DD and malignant tumours have molecular similarities.

  7. Long-term follow-up of flaps for extensive Dupuytren's and Ledderhose disease in one family.

    Science.gov (United States)

    Kan, Hester J; Hovius, Steven E R

    2012-12-01

    Dupuytren's and Ledderhose disease can be a cumbersome condition in patients with a severe diathesis with a very early onset. Two brothers are described with a reversed radial forearm flap on both hands and two upper lateral arm flaps on both feet with a long-term follow-up ranging from 14 to 25 years. They had multiple procedures of both hands before the flaps were considered. No recurrence occurred under the flap. In very severe diathesis flaps should be considered in an earlier phase to prevent multiple procedures and early recurrence.

  8. Antifibrotic medication using a combination of N-acetyl-L-cystein (NAC) and ACE inhibitors can prevent the recurrence of Dupuytren's disease.

    Science.gov (United States)

    Knobloch, Karsten; Redeker, Joern; Vogt, Peter M

    2009-11-01

    Dupuytren's disease is a progress fibromatosis of unknown origin first described in 1831. Nonoperative treatment options have been suggested involving radiation therapy, vitamin E, local injection therapy suing calcium channel blockers, interferon, corticosteroids or collagenase. Transforming growth factor-beta1 (TGF-beta1) and its downstream Smad signalling system is well established as a key player during fibrogenesis. A number of in vitro experiments have been assessed the blockade of TGF-beta1 and TGF-beta 2. Clinically, a number of antifibrotic agents are available such as N-acetyl-L-cysteins (NAC) as well as angiotensin-converting enzyme (ACE) inhibitors or AT II antagonists. However, to date none of the well known substances has been tested clinically in fibromatosis such as Dupuytren's disease especially to prevent recurrences after surgical release. Antifibrotic medication using a combination of N-acetyl-L-cystein (NAC) and ACE inhibitor can prevent the recurrence of Dupyutren's disease. Given the fact that recurrence rate in Dupuytren's disease is high and unpredictable after surgical release, an antifibrotic intervention might be worthwhile to consider in the clinical setting. Antifibrotic agents inhibit TGF-beta1, which play a key role in fibromatosis. Thus, antifibrotic medication might reduce the recurrence rate in fibromatosis such as Dupuytren's disease in a clinical significant way.

  9. Die MAZE-Operation zur Behandlung des chronischen Vorhofflimmerns im Langzeitverlauf: 3-Jahres-Ergebnisse

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    Aigner C

    2005-01-01

    Full Text Available Grundlagen: Die MAZE-Operation mittels Ablation mit Mikrowelle oder Radiofrequenz ist ein etabliertes Verfahren zur Behandlung des chronischen Vorhofflimmerns. Diese Studie untersucht die Langzeitergebnisse nach 36 Monaten. Methodik: Zwischen 2/2001 und 12/2002 wurden 42 Patienten (64,5 ± 2,2 Jahre; 21 Männer mit chronischem Vorhofflimmern 6 Monate und zusätzlicher teils kombinierter Klappenerkrankung mittels Mitralklappenersatz/-rekonstruktion ± Trikuspidalklappenrekonstruktion (n = 30, Aortenklappenersatz ± Trikuspidalklappenrekonstruktion (n = 6 und Mitralklappen- und Aortenklappenersatz/- rekonstruktion ± Trikuspidalklappenrekonstruktion (n = 6 und MAZE operiert. Die mittlere Dauer des Vorhofflimmerns lag bei 63 ± 29 Monaten (7–384 Monate. Bei der MAZE-Operation wurden, dem Cox-III-Konzept folgend, in beiden Vorhöfen lineare Läsionen mit Mikrowellen- bzw. Radiofrequenzablation gesetzt. Ergebnisse: Die MAZE-Operation führte zu 23 ± 2 Minuten zusätzlicher Aortenklemmzeit (total: 89 ± 3 Min.. Aufgrund eines SIRS war bei einem Patienten der Intensivaufenthalt verlängert. Bei den restlichen Patienten war die Intubationsdauer 18,3 ± 6,7 Stunden, der Intensivaufenthalt 1,7 ± 0,6 Tage. 52,3 % wurden mit Amiodaron behandelt, 64,3 % kardiovertiert. 23,8 % Patienten benötigten einen Schrittmacher wegen eines AV-Blocks bzw. eines Sick-Sinus-Syndroms. Nach 12 Monaten waren 80,8 % frei von Vorhofflimmern. Beim letzten Nachuntersuchungszeitpunkt (36 ± 8 Monate waren 78,6 % frei von Vorhofflimmern. Schlußfolgerungen: Die MAZE-Operation mittels Mikrowellen- bzw. Radiofrequenzablation, folgend dem Cox-III-MAZE-Konzept, erhöht das chirurgische Risiko nur gering. Die Freiheit von Vorhofflimmern ist nach 1 und 3 Jahren praktisch gleich. Es ist also auch langfristig möglich, Patienten mit chronischem Vorhofflimmern einen stabilen Sinusrhythmus zu gewährleisten.

  10. Analysis of efficacy and safety of treatment with collagenase Clostridium histolyticum among subgroups of patients with Dupuytren contracture.

    Science.gov (United States)

    Raven, Raymond B; Kushner, Harvey; Nguyen, Dat; Naam, Nash; Curtin, Catherine

    2014-09-01

    Collagenase Clostridium histolyticum (CCH) injection is a nonoperative treatment of hand contractures from Dupuytren disease. This study assessed the efficacy and safety of CCH in several subgroups of patients with increased surgical risk.Data were pooled from 3 randomized, placebo-controlled, double-blind trials. This analysis included 271 patients with metacarpophalangeal (n = 167) or proximal interphalangeal (n = 104) joint contractures greater than or equal to 20 degrees treated with CCH (0.58 mg collagenase per injection). Subgroups included age, sex, and diabetes status. End points included rate of clinical success (reduction in contracture to 0-5 degrees of normal) and percentage of adverse events.There was no significant difference in clinical success by age, diabetes status, or sex with 63% reaching the end point. There was no difference in adverse events among the subgroups, with peripheral edema, contusion, and injection-site hemorrhage being most common.High-risk subgroups do not demonstrate differences in efficacy or safety with CCH treatment of Dupuytren-related contractures.

  11. Inflammatory Gene Expression Upon TGF-β1-Induced p38 Activation in Primary Dupuytren's Disease Fibroblasts

    Science.gov (United States)

    Bujak, Maro; Ratkaj, Ivana; Markova-Car, Elitza; Jurišić, Davor; Horvatić, Anita; Vučinić, Srđan; Lerga, Jonatan; Baus-Lončar, Mirela; Pavelić, Krešimir; Kraljević Pavelić, Sandra

    2015-01-01

    Objectives: Inflammation is an underlying mechanism behind fibrotic processes and differentiation of cells into myofibroblasts. Presented study therefore provides new data on activation of autoimmune and inflammatory immune response genes that accompany activation of p38 and cell differentiation in primary cells derived from Dupuytren's disease (DD) patients. Methods: Primary non-Dupuytren's disease cells (ND) were isolated from macroscopically unaffected palmar fascia adjacent to diseased tissue obtained from patients diagnosed with the last stage of DD and cultured in vitro. Gene expression, collagen gel contraction assay and analysis of secreted proteins were performed in ND cells treated with TGF-β1 and/or inhibitor of p38 phosphorylation. Results: During differentiation of ND fibroblasts, increased expression of immune response genes PAI-1, TIMP-1, CCL11, and IL-6 was found. These changes were accompanied by increased cell contractility and activation of p38 and its target kinase MK2. Inhibition of p38 phosphorylation reversed these processes in vitro. Conclusions: TGF-β1 induced p38 phosphorylation in ND cells grown from macroscopically unaffected palmar fascia adjacent to diseased tissue from DD patients. This was accompanied by activation of the cytokine genes CCL-11 and IL-6 and secretion of extracellular matrix regulatory proteins PAI-1 and TIMP-1. A combined approach directed toward inflammation and p38 MAPK-mediated processes in DD might be considered for improving management of DD patients and prevention of recurrence. PMID:26697433

  12. Intraoperative Komplikationen und mittelfristige Ergebnisse bei mikrochriurgischer Bandscheibenoperation und deren Abhängigkeit von der Erfahrung des Operateurs

    OpenAIRE

    Zahedi, André-Ramin

    2001-01-01

    Aus verschiedenen Gebieten der Medizin wird eine Abhängigkeit des Erfolgs von der Erfahrung des Operateurs beschrieben (McARDLE91, HUGES91, LAFFEL92). Für diese Untersuchung wurden 463 Patienten, die von 1991-1996 in der orthopäd. Uniklinik im St. Josef-Hospital Bochum operiert wurden nachuntersucht. Dabei wurden die periop. Komplikationen und die mittelfristigen Ergebnisse (2,5 Jahre postop.) des erfahrensten Operateurs (A n=248) mit denen der erfahrenen Operateure (B n=204) verg...

  13. Construct validity of the canadian occupational performance measure in participants with tendon injury and Dupuytren disease.

    Science.gov (United States)

    van de Ven-Stevens, Lucelle A W; Graff, Maud J L; Peters, Marlijn A M; van der Linde, Harmen; Geurts, Alexander C H

    2015-05-01

    In patient-centered practice, instruments need to assess outcomes that are meaningful to patients with hand conditions. It is unclear which assessment tools address these subjective perspectives best. The aim of this study was to establish the construct validity of the Canadian Occupational Performance Measure (COPM) in relation to the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) in people with hand conditions. It was hypothesized that COPM scores would correlate with DASH and MHQ total scores only to a moderate degree and that the COPM, DASH questionnaire, and MHQ would all correlate weakly with measures of hand impairments. This was a validation study. The COPM, DASH questionnaire, and MHQ were scored, and then hand impairments were measured (pain [numerical rating scale], active range of motion [goniometer], grip strength [dynamometer], and pinch grip strength [pinch meter]). People who had received postsurgery rehabilitation for flexor tendon injuries, extensor tendon injuries, or Dupuytren disease were eligible. Seventy-two participants were included. For all diagnosis groups, the Pearson coefficient of correlation between the DASH questionnaire and the MHQ was higher than .60, whereas the correlation between the performance scale of the COPM and either the DASH questionnaire or the MHQ was lower than .51. Correlations of these assessment tools with measures of hand impairments were lower than .46. The small sample sizes may limit the generalization of the results. The results supported the hypotheses and, thus, the construct validity of the COPM after surgery in people with hand conditions. © 2015 American Physical Therapy Association.

  14. Cost-effectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture.

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    Chen, Neal C; Shauver, Melissa J; Chung, Kevin C

    2011-11-01

    We undertook a cost-utility analysis to compare traditional fasciectomy for Dupuytren with 2 new treatments, needle aponeurotomy and collagenase injection. We constructed an expected-value decision analysis model with an arm representing each treatment. A survey was administered to a cohort of 50 consecutive subjects to determine utilities of different interventions. We conducted multiple sensitivity analyses to assess the impact of varying the rate of disease recurrence in each arm of the analysis as well as the cost of the collagenase injection. The threshold for a cost-effective treatment is based on the traditional willingness-to-pay of $50,000 per quality-adjusted life years (QALY) gained. The cost of open partial fasciectomy was $820,114 per QALY gained over no treatment. The cost of needle aponeurotomy was $96,474 per QALY gained versus no treatment. When we performed a sensitivity analysis and set the success rate at 100%, the cost of needle aponeurotomy was $49,631. When needle aponeurotomy was performed without surgical center or anesthesia costs and with reduced hand therapy, the cost was $36,570. When a complete collagenase injection series was priced at $250, the cost was $31,856 per QALY gained. When the injection series was priced at $945, the cost was $49,995 per QALY gained. At the market price of $5,400 per injection, the cost was $166,268 per QALY gained. In the current model, open partial fasciectomy is not cost-effective. Needle aponeurotomy is cost-effective if the success rate is high. Collagenase injection is cost-effective when priced under $945. Economic and Decision Analysis II. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. The influence of Dupuytren's disease fingers contracture degree on surgical treatment outcome

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    Stepić Nenad

    2017-01-01

    Full Text Available Background/Aim. Dupuytren’s disease is a progressive disease of the palmar and digital fascial structures, with functional limitations. There are no clear recommendations about the optimal time of surgical repair, concerning the hand impairment. The aim of our study was to investigate the relation between finger’s contracture degree and success of surgical treatment of the Dupuytren's disease. Methods. This prospective analysis included 60 patients operated on due to Dupuytren’s contracture. According to preoperative contracture degree of proximal interphalangeal (PIP and metacarpophalangeal (MCP joint, patients were divided into three groups: the group 1: 30°. All the patients underwent operation of partial palmar fasciectomy. Postoperative improvement was expressed with contracture reduction INDEX. Results. There were 60 patients with 85 fingers affected. The groups 1, 2 and 3 had 22 (37%, 37 (62% and 26 (43% fingers with MCP contracture and 32 (37.4%, 24 (28.2% and 29 (34.1% fingers with PIP contracture, respectively. Postoperative contractures of MCP joint in these groups were 0, 0.135° and 5°, and of PIP joint 0, 2.08 ° and 16.89°, respectively. After six months all MCP contractures resolved, while PIP joint contracture in the group 3 remained 13.62°. The reduction INDEX was 98.85%, 97.62% and 75.52% in the groups 1, 2 and 3, respectively. There was a statistically significant difference in the INDEX value between the groups (p = 0.0001. Conclusion. The degree of PIP joint contracture is related to the outcome of surgical treatment of Dupuytren’s disease. Optimal results are achieved when contracture degree is between 15° and 30°. Surgical treatment of MCP joint contracture is successful regardless of the preoperative joint contracture degree.

  16. Treatment of Recurrent Dupuytren Contracture in Joints Previously Effectively Treated With Collagenase Clostridium histolyticum.

    Science.gov (United States)

    Bear, Brian J; Peimer, Clayton A; Kaplan, F Thomas D; Kaufman, Gregory J; Tursi, James P; Smith, Ted

    2017-05-01

    Collagenase Clostridium histolyticum (CCH) is approved for the treatment of adults with Dupuytren contracture with a palpable cord. This open-label, phase 4 study evaluated the safety and efficacy of CCH for the retreatment of recurrent contractures in joints that were previously effectively treated with CCH. Patients participating in a long-term follow-up study who had contracture recurrence (increased ≥ 20° with a palpable cord) after successful treatment in the previous study were eligible. Recurrent joint contractures were treated with up to 3 CCH injections (∼ 1 month apart). Patients were followed for 1 year to evaluate safety. Assessments included change in joint contracture, range of motion, and the percentage of joints that achieved contracture of 5° or less at day 30 after the last injection. The efficacy analysis included 51 patients with 1 treated joint per patient (31 metacarpophalangeal, 20 proximal interphalangeal). A total of 35 joints (69%) received 1 injection, 12 (24%) received 2 injections, and 4 (8%) received 3 injections. Fifty-seven percent of joints achieved contracture of 5° or less (29 of 51). Overall, 86% (43 of 50) patients had a 20° or greater increase in range of motion. The adverse event profile was consistent with previous studies. One ligament injury was reported. At a short-term follow-up of 1 year, recurrent contracture in joints previously successfully treated with CCH may be effectively retreated with up to 3 injections of CCH. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Wnt expression is not correlated with β-catenin dysregulation in Dupuytren's Disease

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    Zhu Rebecca D

    2006-08-01

    Full Text Available Abstract Background Dupuytren's contracture or disease (DD is a fibro-proliferative disease of the hand that results in finger flexion contractures. Increased cellular β-catenin levels have been identified as characteristic of this disease. As Wnts are the most widely recognized upstream regulators of cellular β-catenin accumulation, we have examined Wnt gene expression in surgical specimens and in DD-derived primary cell cultures grown in two-dimensional monolayer culture or in three-dimensional FPCL collagen lattice cultures. Results The Wnt expression profile of patient-matched DD and unaffected control palmar fascia tissue was determined by a variety of complimentary methods; Affymetrix Microarray analysis, specific Wnt and degenerative primer-based Reverse Transcriptase (RT-PCR, and Real Time PCR. Microarray analysis identified 13 Wnts associated with DD and control tissues. Degenerate Wnt RT-PCR analysis identified Wnts 10b and 11, and to a lesser extent 5a and 9a, as the major Wnt family members expressed in our patient samples. Competitive RT-PCR analysis identified significant differences between the levels of expression of Wnts 9a, 10b and 11 in tissue samples and in primary cell cultures grown as monolayer or in FPCL, where the mRNA levels in tissue > FPCL cultures > monolayer cultures. Real Time PCR data confirmed the down-regulation of Wnt 11 mRNA in DD while Wnt 10b, the most frequently isolated Wnt in DD and control palmar fascia, displayed widely variable expression between the methods of analysis. Conclusion These data indicate that changes in Wnt expression per se are unlikely to be the cause of the observed dysregulation of β-catenin expression in DD.

  18. IGF-II and IGFBP-6 regulate cellular contractility and proliferation in Dupuytren's disease.

    Science.gov (United States)

    Raykha, Christina; Crawford, Justin; Gan, Bing Siang; Fu, Ping; Bach, Leon A; O'Gorman, David B

    2013-10-01

    Dupuytren's disease (DD) is a common and heritable fibrosis of the palmar fascia that typically manifests as permanent finger contractures. The molecular interactions that induce the development of hyper-contractile fibroblasts, or myofibroblasts, in DD are poorly understood. We have identified IGF2 and IGFBP6, encoding insulin-like growth factor (IGF)-II and IGF binding protein (IGFBP)-6 respectively, as reciprocally dysregulated genes and proteins in primary cells derived from contracture tissues (DD cells). Recombinant IGFBP-6 inhibited the proliferation of DD cells, patient-matched control (PF) cells and normal palmar fascia (CT) cells. Co-treatments with IGF-II, a high affinity IGFBP-6 ligand, were unable to rescue these effects. A non-IGF-II binding analog of IGFBP-6 also inhibited cellular proliferation, implicating IGF-II-independent roles for IGFBP-6 in this process. IGF-II enhanced the proliferation of CT cells, but not DD or PF cells, and significantly enhanced DD and PF cell contractility in stressed collagen lattices. While IGFBP-6 treatment did not affect cellular contractility, it abrogated the IGF-II-induced contractility of DD and PF cells in stressed collagen lattices. IGF-II also significantly increased the contraction of DD cells in relaxed lattices, however this effect was not evident in relaxed collagen lattices containing PF cells. The disparate effects of IGF-II on DD and PF cells in relaxed and stressed contraction models suggest that IGF-II can enhance lattice contractility through more than one mechanism. This is the first report to implicate IGFBP-6 as a suppressor of cellular proliferation and IGF-II as an inducer of cellular contractility in this connective tissue disease.

  19. Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence.

    Science.gov (United States)

    Felici, N; Marcoccio, I; Giunta, R; Haerle, M; Leclercq, C; Pajardi, G; Wilbrand, S; Georgescu, A V; Pess, G

    2014-12-01

    The aim of this study was to determine a definition of recurrence of Dupuytren disease that could be utilized for the comparison of the results independently from the treatment used. 24 hand surgeons from 17 countries met in an international consensus conference. The participants used the Delphi method to evaluate a series of statements: (1) the need for defining recurrence, (2) the concept of recurrence applied to the Tubiana staging system, (3) the concept of recurrence applied to each single treated joint, and (4) the concept of recurrence applied to the finger ray. For each item, the possible answer was given on a scale of 1-5: 1=maximum disagreement; 2=disagreement; 3=agreement; 4=strong agreement; 5=absolute agreement. There was consensus on disagreement if 1 and 2 comprised at least 66% of the recorded answers and consensus on agreement if 3, 4 and 5 comprised at least 66% of the recorded answers. If a threshold of 66% was not reached, the related statement was considered "not defined". A need for a definition of recurrence was established. The presence of nodules or cords without finger contracture was not considered an indication of recurrence. The Tubiana staging system was considered inappropriate for reporting recurrence. Recurrence was best determined by the measurement of a specific joint, rather than a total ray. Time 0 occurred between 6 weeks and 3 months. Recurrence was defined as a PED of more than 20° for at least one of treated joint, in the presence of a palpable cord, compared to the result obtained at time 0. This study determined the need for a standard definition of recurrence and reached consensus on that definition, which we should become the standard for the reporting of recurrence. If utilized in subsequent publications, this will allow surgeons to compare different techniques and make is easier to help patients make an informed choice.

  20. [Cardiodoron® bei Patienten mit Schlafstörungen - Ergebnisse einer prospektiven Beobachtungsstudie].

    Science.gov (United States)

    Rother, Claudia; Schnelle, Martin

    2017-01-01

    Hintergrund: Schlafstörungen gehören zu den häufigsten gesundheitlichen Problemen der heutigen Zeit. Stress und die dadurch bedingte innere Anspannung sowie eine unrhythmische Lebensführung z.B. durch Schichtarbeit sind bekannte auslösende Faktoren. Weniger bekannt ist, dass auch funktionelle Herz-Kreislauf-Beschwerden zu Störungen des Schlafs führen können und dass deren Behandlung zu einer Verbesserung der Schlafqualität beiträgt. Ganzheitlich betrachtet geht es daher um die Wiederherstellung einer gesunden Rhythmik, insbesondere des Herz-/Atem- sowie des Schlaf-Wach-Rhythmus, die Cardiodoron®, eine Heilpflanzenkomposition aus Primula veris, Hyoscyamus niger und Onopordum acanthium, unterstützt. Patienten und Methoden: Mittels einer prospektiven, multizentrischen Beobachtungsstudie sollte ermittelt werden, wie sich funktionelle Herz-Kreislauf-Beschwerden und/oder Schlafstörungen unter der Behandlung mit Cardiodoron® (Dilution) über 3-6 Monate entwickeln. Im Zeitraum von September 2009 bis März 2012 dokumentierten 92 Ärzte 501 Patienten, von denen 380 über Schlafstörungen klagten und deren Daten in dieser Publikation näher betrachtet werden. Nach einer Aufnahmeuntersuchung erfolgte nach 90 Tagen eine Abschlussuntersuchung und bei Fortführung der Therapie nach nochmals 90 Tagen eine Follow-up-Untersuchung. Neben 30 ärztlicherseits bewerteten Symptomen beurteilten die Patienten ihr Befinden mittels Pittsburgh Sleep Quality Index (PSQI) nach Buysse und der Beschwerden-Liste nach von Zerssen (B-L und B-L'). Ergebnisse: Unter der Cardiodoron®-Therapie gingen bei guter Verträglichkeit sowohl die Ausprägung der Schlafstörungen (um 65% von 2,0 auf 0,7 Punkte) als auch die erfassten 30 Symptome (um 59% von 24,3 auf 9,9 Punkte) deutlich zurück (p mit Schlafstörungen (mit oder ohne funktionelle Herz-Kreislauf-Beschwerden) kann die Ausprägung der Beschwerden mit Cardiodoron® deutlich gesenkt werden. Cardiodoron® ist gut verträglich. © 2016 S

  1. Transjugular intrahepatic portosystemic shunt in children; Der transjugulaere intrahepatische portosystemische Shunt bei Kindern. Erste klinische Erfahrungen und Literaturuebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Huppert, P.E.; Brambs, H.J.; Schott, U.; Pereira, P.; Duda, S.H.; Claussen, C.D. [Tuebingen Univ. (Germany). Abt. fuer Radiologische Diagnostik; Astfalk, W.; Schweizer, P. [Tuebingen Univ. (Germany). Abt. Kinderchirurgie; Dopfer, R.E. [Tuebingen Univ. (Germany). Abt. Kinderheilkunde I

    1998-06-01

    . Patienten und Methoden: Von 1993-1996 wurden 6 Kinder im Alter von 2-13 Jahren durch Anlage eines TIPSS behandelt. In 4 Faellen lag aetiologisch eine extrahepatische Gallengangsatresie (EHGA) vor und in zwei Faellen eine sekundaere Leberfibrose nach fruehkindlicher Tumortherapie. Indikationen zur TIPSS-Anlage waren bei drei Kindern therapieresistente Varizenblutungen, bei einem Kind ein Hypersplenismus und bei zwei Kindern Varizenblutungen und Hypersplenismus. Zur Pfortaderpunktion wurden 16-G-Hohnadeln verwendet, da 19-G-Feinnadeln nicht ausreichend punktionsstabil waren. In allen Faellen wurden Wallstents implantiert, in einem Fall zusaetzlich ein Palmaz-Stent. Die mittlere Nachbeobachtungszeit betrug 24,5 Monate. Ergebnisse: Die Shuntanlage gelang in allen Faellen mit einer mittleren Interventionsdauer von 5,2 Stunden. Methodisch erschwerend waren die Periportalfibrose bei EHGA, atypisch gelegene Lebervenen sowie geringe Kaliber und Distanzen der Gefaesse. Die Blutungen sistierten in allen Faellen, die periphere Thrombozytenzahl stieg im Mittel um 58%. Als Komplikationen traten je eine geringgradige extrahepatische Blutung und temporaere Haemolyse auf sowie in drei Faellen Restenosen, die erfolgreich transjugulaer behandelt wurden. 5 Kinder blieben symptomfrei; ein Kind wurde 8 Monate spaeter erfolgreich lebertransplantiert. Schlussfolgerungen: Die TIPSS-Anlage weist im Kindesalter einen erhoehten technischen Schwierigkeitsgrad auf und muss das Wachstum sowie eine eventuelle spaetere Transplantation methodisch beruecksichtigen. Potentielle Indikationen sind therapieresistente Varizenblutungen, auch intestinalen Ursprungs, und ein klinisch relevanter Hypersplenismus. (orig.)

  2. Multislice spiral CT of the paranasal sinuses; Mehrschicht-Spiral-CT der Nasennebenhoehlen: Erste Erfahrungen unter besonderer Beruecksichtigung der Strahlenexposition

    Energy Technology Data Exchange (ETDEWEB)

    Dammann, F.; Bode, A.; Heuschmid, M.; Kopp, A.; Georg, C.; Pereira, P.L.; Claussen, C.D. [Tuebingen Univ. (Germany). Radiologische Universitaetsklinik

    2000-08-01

    Aufnahmen des SS-CT hinsichtlich der Beurteilbarkeit anatomisch relevanter Strukturen verglichen. Ergebnisse: Die Oberflaechendosis des MS-CT lag bei transversaler Schichtrichtung sowohl im Bereich der Augenlinsen mit 3,62 mGy als auch in Hoehe der Schilddruese (0,12 mGy) hoeher als beim SS-CT (2,96 mGy/0,07 mGy). Die Bildqualitaet der koronaren Rekonstruktionen der MS-CT war den SS-CT-Aufnahmen mit Ausnahme eines Falles gleichwertig oder ueberlegen. Die Einschraenkungen der SS-CT durch Zahnmetallartefakte in den primaer koronaren Schichten oder Stufenbildungen und Partialvolumeneffekte der sekundaeren Rekonstruktionen waren in den MS-CT ohne Bedeutung. Schlussfolgerung: Mit dem MS-CT scheinen erstmals koronare Rekonstruktionen der NNH die primaer koronare Aufnahme vollstaendig ersetzen zu koennen und sogar die diagnostische Aussagekraft zu verbessern. Die Dosis sollte allerdings noch reduziert werden koennen. (orig.)

  3. Efficacy and safety of concurrent collagenase clostridium histolyticum injections for multiple Dupuytren contractures.

    Science.gov (United States)

    Coleman, Stephen; Gilpin, David; Kaplan, F Thomas D; Houston, Anthony; Kaufman, Gregory J; Cohen, Brian M; Jones, Nigel; Tursi, James P

    2014-01-01

    To assess the safety and efficacy of 2 concurrent injections of collagenase clostridium histolyticum (CCH) in the same hand to treat multiple Dupuytren flexion contractures. In a multicenter, open-label phase IIIb study, 60 patients received two 0.58-mg CCH doses injected into cords affecting 2 joints in the same hand during 1 visit, followed by finger extension approximately 24 hours later. Efficacy at postinjection day 30 (change in flexion contracture and active range of motion, patient satisfaction, physician-rated improvement, and rates of clinical success [flexion contracture 5° or less]) and adverse events were summarized. The concurrent injections were most commonly administered in cords affecting metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints on the same finger (47%) or 2 MCP joints on different fingers of the same hand (37%). Mean total (sum of the 2 treated joints) flexion contracture decreased 76%, from 87° to 24° (MCP joints: 86%; PIP joints: 66%). Mean total range of motion increased from 100° to 161°. Clinical success was 76% for MCP joints and 33% for PIP joints. Most patients were very satisfied (60%) or quite satisfied (28%) with treatment. Most investigators rated treated joints as very much improved (55%) or much improved (37%). The most common treatment-related adverse events (> 75% of patients) were contusion, pain in extremity, and edema peripheral (local edema). Most adverse events were mild to moderate in severity. Serious complications included 1 pulley rupture related to study medication and 1 flexor tendon rupture (following conclusion of the study). There were no systemic complications. Results suggest that 2 affected joints can be effectively and safely treated with concurrent CCH injections. There was an increased incidence of some adverse events with concurrent treatment (pruritus, lymphadenopathy, blood blister, and skin laceration) compared with treatment of a single joint. High degrees of patient

  4. Enfermedad de Dupuytren en una población del noroeste de España: hallazgos clínicos en 184 pacientes Dupuytren's disease in a north-west Spanish population: clinical findings on 184 patients

    Directory of Open Access Journals (Sweden)

    I. Couto González

    2010-06-01

    Full Text Available El propósito de este estudio es analizar los factores clásicos relacionados con la Enfermedad de Dupuytren en nuestra región así como la evolución clínica del proceso, con el objeto de comparar nuestros resultados con otros publicados, especialmente de estudios procedentes del norte de Europa y de Norteamérica. Realizamos un análisis retrospectivo sobre 184 pacientes diagnosticados de Enfermedad de Dupuytren en nuestro Servicio y estudiamos sus historias clínicas buscando factores relacionados con el proceso descritos en la literatura médica El 86% de los pacientes estudiados fueron varones, entre la quinta o sexta décadas de la vida en el momento de realizar el diagnóstico. El 64,5% trabajaba o había tenido un trabajo relacionado con traumatismo manual crónico; el 16% reconoció antecedentes familiares; el 43,5% consumía de forma habitual bebidas alcohólicas; el 51% era fumador; el 0% presentaba diabetes mellitus tipo 1 y el 28,8% diabetes mellitus tipo 2; el 1,6% tenían epilepsia; el 19% presentaba algún tipo de vasculopatía periférica; el 6,4% algún tipo de trastorno autoinmune; el 0% una neuropatía degenerativa; el 10,3% Síndrome del Túnel Carpiano; el 32,1% hiperlipemia; el 28,8% hiperuricemia; el 3,8% presentaba algún trastorno hepático; el 77,7% tenía afectación de la mano derecha, el 70,1% de la mano izquierda y el 47,3% bilateral. Los radios palmares afectados con más frecuencia fueron el 4º y el 5º. Las fibromatosis ectópicas fueron un hallazgo infrecuente. Concluimos que el género, la edad y los hallazgos clínicos en nuestros pacientes parecen ser similares a los expuestos en los resultados de las series realizadas en el norte de Europa y Norteamérica. Los factores involucrados en el incremento de los radicales libres del oxígeno como el tabaquismo, las bebidas alcohólicas, la diabetes mellitus, la hiperuricemia o las alteraciones vasculares periféricas aparecen frecuentemente en nuestros

  5. Transjugular liver core biopsy: indications, results, and complications; Transjugulaere Leberstanzbiopsie: Indikationen, Ergebnisse, Komplikationen

    Energy Technology Data Exchange (ETDEWEB)

    Dinkel, H.P.; Wittchen, K.; Hoppe, H.; Triller, J. [Inst. fuer Diagnostische Radiologie, Inselspital, Univ. Bern (Switzerland); Dufour, J.F. [Inst. fuer Klinische Pharmakologie, Inselspital, Univ. Bern (Switzerland); Zimmermann, A. [Inst. fuer Pathologie, Inselspital, Univ. Bern (Switzerland)

    2003-08-01

    ] Ziel: Nutzen, Durchfuehrbarkeit und Komplikationsrate der transjugulaeren Leberbiopsie mit einem halbautomatischen Stanzbiopsiesystem wurden retrospektiv evaluiert. Methode: 85 konsekutive Patienten (57 Maenner, 28 Frauen) mit unterschiedlichen Lebererkrankungen (30 Leberzirrhose, 12 Hepatitis, 34 akute Hepatopathie, 8 nach Lebertransplantation, 1 hepatozellulaeres Karzinom) und Gerinnungsstoerungen (n = 71) oder/und Aszites (n = 46) wurden zur transjugulaeren Leberbiopsie vorgestellt. Das Durchschnittsalter betrug 48 {+-} 16 Jahre (Spanne 17-75 Jahre). Als erfolgreiche Biopsie wurde die Gewinnung eines Gewebszylinders definiert, der eine eindeutige histologische Diagnose gestattete. Komplikationen wurden anhand der Akten erfasst. In die Mortalitaetsrate flossen alle Todesfaelle innerhalb von 30 Tagen ein. Die prozedurbedingte Mortalitaet umfasst alle Todesfaelle, die mit der Leberbiopsie in Verbindung standen. Ergebnisse: In 80 von 85 Faellen war die Sondierung der Lebervenen erfolgreich (94%). In 5 Faellen scheiterte sie an einem unguenstigen Lebervenenabgangswinkel (1 bei einem Patienten mit Budd-Chiari Syndrom und vollstaendigem Lebervenenverschluss, 4 bei schwierigen anatomischen Verhaeltnissen). Bei 22 Patienten wurde einmal, bei 45 zweimal und bei 14 Patienten dreimal oder oefter - jeweils in gleicher Sitzung - gestanzt. Nach Angaben des Pathologen war die Qualitaet der Zylinder in 71/80 Faellen (89%) gut und in 8 Faellen (10%) maessig; in einem Fall war keine Diagnose moeglich. In 8 Faellen traten Komplikationen (nach den Kriterien der society of interventional radiology [SIR/SCVIR]) auf, wobei es sich um 5 Minorkomplikationen (3 x Typ A, 2 x Typ B) und 3 Major-Komplikationen (1 Pneumothorax, Typ C, 1 nicht-fatale Blutung, Typ D, und eine Blutung mit Todesfolge, Typ F) handelte. Die prozedurbedingte Mortalitaet betrug 1% (1/85), die Gesamtmortalitaet, vor allem bedingt durch fulminantes Leberversagen. (orig.)

  6. Brexit bleibt vor allem europäisches Problem: Ergebnisse einer Sonderfrage im jüngsten Ifo World Economic Survey

    OpenAIRE

    Boumans, Dorine

    2016-01-01

    Um die Auswirkungen des Brexit-Votums auf die Weltwirtschaft zu beleuchten, wurden im Juli die Teilnehmer des Ifo World Economic Survey zu den kurz- und mittelfristigen ökonomischen Auswirkungen eines Brexit in ihrem Land befragt. Die Ergebnisse der Sonderfrage geben ein differenziertes Bild. Vor allem für die EU 15 werden kurzfristige signifikante ökonomische Konsequenzen erwartet.

  7. Steroid injection and needle aponeurotomy for Dupuytren disease: long-term follow-up of a randomized controlled trial.

    Science.gov (United States)

    McMillan, Catherine; Binhammer, Paul

    2014-10-01

    To compare long-term outcomes and retreatment rates for patients with Dupuytren disease who underwent needle aponeurotomy (NA) combined with a series of triamcinolone acetonide injections or underwent NA alone as part of a prior randomized controlled trial. During this follow-up study, 44 of 47 participants in the original study were examined as needed between 6 and 53 months from their initial procedure. Those who had not been reassessed within 18 months of the original NA were asked to return for follow-up. The average total active extension deficit (TAED) of previously treated joints was compared between groups 7 to 12, 13 to 24, 25 to 36, and 37 to 48 months following treatment. Timing of retreatment (if performed) was recorded. Forty-four participants returned for assessment an average of 4.8 times over 53 months. Mean TAED was significantly less in needle aponeurotomy triamcinolone injection patients at 6 months and between 13 and 24 months. Sixty-two percent of NA group patients and 30% of needle aponeurotomy triamcinolone injection patients returned for a second treatment on the same digit(s) (retreatment). This difference was not significant. Mean time to retreatment and mean TAED immediately prior to retreatment did not differ significantly between groups. Kaplan-Meier survival estimates demonstrated a significantly higher percentage of NA group patients expected to return for retreatment by 24 but not by 36 months. Younger age, more than one joint treated at the initial NA, and TAED severity throughout the follow-up period were associated with earlier retreatment. Serial triamcinolone injections combined with NA was associated with lower TAED for up to 24 months. A larger study would more accurately quantify the potential benefits of combining triamcinolone injections with NA for treatment of Dupuytren disease. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. Splinting after contracture release for Dupuytren's contracture (SCoRD: protocol of a pragmatic, multi-centre, randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Chojnowski Adrian J

    2008-04-01

    Full Text Available Abstract Background Splinting as part of the overall post-surgical management of patients after release of Dupuytren's contracture has been widely reported, though there is variation in practice and criteria for using it. The evidence on its effectiveness is sparse, of poor quality and contradictory with studies reporting negative and positive effects. Methods/Design A multi-centre, pragmatic, randomized, controlled trial is being conducted to evaluate the effect of static night splinting for six months on hand function, range of movement, patient satisfaction and recurrence at 1 year after fasciectomy or dermofasciectomy. Using a centrally administered computer randomization system consented patients will be allocated to one of two groups: i splint group who will be given a static splint at approximately 10 to 14 days after surgery to be worn for 6 months at night time only as well as hand therapy; ii non-splint group, who will receive hand therapy only. The primary outcome measure is the patient-reported Disabilities of the Arm, Hand and Shoulder Questionnaire (DASH. Secondary outcomes are total active flexion and extension of fingers, patient satisfaction and recurrence of contracture. Outcome measures will be collected prior to surgery, 3 months, 6 months and 1 year after surgery. Using the DASH as the primary outcome measure, where a difference of 15 points is considered to be a clinically important difference a total of 51 patients will be needed in each group for a power of 90%. An intention-to-treat analysis will be used. Discussion This pragmatic randomized controlled trial will provide much needed evidence on the clinical effectiveness of post-operative night splinting in patients who have undergone fasciectomy or dermofasciectomy for Dupuytren's contracture of the hand. Trial Registration Current Controlled Trials ISRCTN 57079614

  9. Doenças de Dupuytren e de Ledderhose associadas ao uso crônico de anticonvulsivantes: relato de caso

    Directory of Open Access Journals (Sweden)

    CORAL PATRÍCIA

    1999-01-01

    Full Text Available Relatamos o caso de um paciente que após uso crônico de anticonvulsivantes, sem epilepsia definida, desenvolveu contraturas das aponeuroses palmar (doença de Dupuytren e plantar (doença de Ledderhose. Discutimos as principais dessas complicações, os fatores predisponentes e sua estreita relação com o uso de anticonvulsivantes, particularmente de fenobarbital.

  10. Treatment of dupuytren disease with injectable collagenase in a veteran population: a case series at the department of veterans affairs new jersey health care system.

    Science.gov (United States)

    Sood, Aditya; Therattil, Paul J; Paik, Angie M; Simpson, Mary F; Lee, Edward S

    2014-01-01

    Clinical trials seeking to establish long-term efficacy of injectable collagenase clostridium histolyticum for treatment of Dupuytren disease are ongoing. In this quality improvement study, the efficacy, recurrence rate, and complications of collagenase injection for Dupuytren disease are reviewed in a population of Veteran patients. A retrospective chart review was performed for patients who underwent treatment with injectable collagenase for Dupuytren disease from 2010 to 2013 at our regional Department of Veterans Affairs medical center. Data points of interest included the degree of joint contracture preoperatively, immediately after treatment, and at follow-up, complications, and patient satisfaction. Sixteen patients received 27 injections (18 metacarpophalangeal and 9 proximal interphalangeal injections). The mean time of follow-up was 12.3 months. There was a 50% or greater reduction of the original extension deficit in 74.1% (n = 27) of the joints treated. Metacarpophalangeal joint recurrence was "high" (≥50°) in 0% (n = 18) of joints, and "low" (5°-50°) in 33.3% (n = 18) of joints with a mean follow-up of 12 months. Proximal interphalangeal joint recurrence was "high" (≥40°) in 18.5% (n = 9) of joints and "low" (5°-40°) in 7.4% (n = 9) of joints with a mean follow-up of 12.9 months. Minor complications were experienced in 93.8% (n = 16) of patients who underwent collagenase injection and included ecchymosis, skin laceration, injection-site swelling, injection-site hemorrhage, tenderness, and pruritus. Seventy-five percent (n = 12) of patients in our study reported they would undergo treatment with collagenase again. The case series presented demonstrates that injectable collagenase clostridium histolyticum produced a clinical success rate of 74.1% and is a safe method to treat Dupuytren disease.

  11. Doenças de Dupuytren e de Ledderhose associadas ao uso crônico de anticonvulsivantes: relato de caso

    OpenAIRE

    CORAL PATRÍCIA; ZANATTA ALESSANDRA; TEIVE HÉLIO A. G.; CORREA NETO YLMAR; NÓVAK EDISON MATOS; WERNECK LINEU CÉSAR

    1999-01-01

    Relatamos o caso de um paciente que após uso crônico de anticonvulsivantes, sem epilepsia definida, desenvolveu contraturas das aponeuroses palmar (doença de Dupuytren) e plantar (doença de Ledderhose). Discutimos as principais dessas complicações, os fatores predisponentes e sua estreita relação com o uso de anticonvulsivantes, particularmente de fenobarbital.

  12. Collagenase clostridium histolyticum for the treatment of Dupuytren's contracture: systematic review and economic evaluation.

    Science.gov (United States)

    Brazzelli, Miriam; Cruickshank, Moira; Tassie, Emma; McNamee, Paul; Robertson, Clare; Elders, Andrew; Fraser, Cynthia; Hernandez, Rodolfo; Lawrie, David; Ramsay, Craig

    2015-01-01

    BACKGROUND Dupuytren's disease is a slowly progressive condition of the hand, characterised by the formation of nodules in the palm that gradually develop into fibrotic cords. Contracture of the cords produces deformities of the fingers. Surgery is recommended for moderate and severe contractures, but complications and/or recurrences are frequent. Collagenase clostridium histolyticum (CCH) has been developed as a minimally invasive alternative to surgery for some patients. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of collagenase as an alternative to surgery for adults with Dupuytren's contracture with a palpable cord. DATA SOURCES We searched all major electronic databases from 1990 to February 2014. REVIEW METHODS Randomised controlled trials (RCTs), non-randomised comparative studies and observational studies involving collagenase and/or surgical interventions were considered. Two reviewers independently extracted data and assessed risk of bias of included studies. A de novo Markov model was developed to assess cost-effectiveness of collagenase, percutaneous needle fasciotomy (PNF) and limited fasciectomy (LF). Results were reported as incremental cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were undertaken to investigate model and parameter uncertainty. RESULTS Five RCTs comparing collagenase with placebo (493 participants), three RCTs comparing surgical techniques (334 participants), two non-randomised studies comparing collagenase and surgery (105 participants), five non-randomised comparative studies assessing various surgical procedures (3571 participants) and 15 collagenase case series (3154 participants) were included. Meta-analyses of RCTs assessing CCH versus placebo were performed. Joints randomised to collagenase were more likely to achieve clinical success. Collagenase-treated participants experienced significant reduction in contracture and an increased range of

  13. Bioavailability of very finely distributed metallic platinum in the lungs and first orienting studies on effects. Part 2; Bioverfuegbarkeit von feinstverteiltem metallischem Platin in der Lunge und erste orientierende Wirkungsuntersuchungen (VPT 09; 2. Teil)

    Energy Technology Data Exchange (ETDEWEB)

    Emmendoerffer, A. [Fraunhofer-Institut fuer Toxikologie und Aerosolforschung, Hannover (Germany)

    1997-12-31

    Platinum is emitted from automotive catalytic converters in particulate form. The first organ to be exposed to it after its uptake by the organism is the lung. Lung macrophages therefore constitute the first barrier of the immune system which can to react to platinum. In this study the production of nitrogen oxides and cytokines was studied. These parameters play an important role in the initiation of inflammation and in the maintenance of chronic inflammatory processes that can lead to fibrosis of the lung. [Deutsch] Platin wird partikulaer aus Automobilabgaskatalysatoren emittiert. Das erste Zielorgan fuer eine Aufnahme im Organismus ist deshalb die Lunge. Die Lungenmakrophagen stellen also die erste Barriere des Immunsystems dar, das auf Platin reagieren kann. In vitro wurde die Produktion von Stickoxiden und Zytokinen untersucht. Diese Parameter spielen eine Rolle bei der Initiation von Entzuendungen und auch bei der Aufrechterhaltung chronisch entzuendlicher Prozesse, die in der Lunge zu einer Fibrose fuehren koennen. (orig.)

  14. Site-adapted optimization of the cultivation of energy crops for biogas plants. Initial results and prospects of the FNR-subsidized multi-partner project; Standortangepasste Optimierung des Anbaus von Energieplanzen fuer Biogasanlagen. Erste Ergebnisse und Perspektiven des von der FNR gefoerderten Verbundprojektes

    Energy Technology Data Exchange (ETDEWEB)

    Vetter, A.; Goedeke, K.; Nehring, A. [Thueringer Landesanstalt fuer Landwirtschaft (Germany)

    2007-07-01

    The use of biomass as renewable energy source is on the increase, driven by the rising price of oil, measures to reduce the emission of carbon dioxide and favorable general political conditions. In addition to wood as heat source, rapeseed and cereal crops as feedstock for power plants of the first generation, mainly so called wet line crops, i.e., silage for biogas generation and fuels of the second generation can gain in importance dramatically. The generation of biogas from liquid manure and renewable primary products has seen a virtual boom after the amendment of the Renewable Energies Act (EEG) in 2004. The technology allowance also introduced at that time is responsible for the present expansion of dry fermentation exclusively based on renewable primary products. The current favorite among feedstock substrates is corn. Cultivation, maintenance, harvest and silage are common practice for this crop, which is rich in biomass. Experience is extensive and the method proven. There is no need for changes of crop rotation, corn cultivation is established. In addition to corn, any type of biomass, except lignified types, can be used for biogas production. This makes the spectrum of potential candidates wide. The choice of crops should be guided by financial and ecological considerations. The latter is of interest in as far as weeds and grasses can be tolerated in the crop stand as long as they have no negative effect on the yields or the technological sequence of substrate preparation and fermentation. In the final instance, the farmer will pick the crop according to the net revenue he can earn from the yield per unit of area, the cost per unit of energy and the way he can fit it into the normal practice of his farm. After the reform of the EU's agrarian policy in 2005, the bonus system improved the financial rating, e.g., of perennial field forage crops, winter catch crops, etc. in comparison with corn. In addition to this, new crops, e.g., Sudan grass, sweet sorghum, silphie, have been tested for their suitability as renewable primary products in projects of the specialized agency. Under the multi-partner project 'Development and comparison of optimal cultivation systems for energy crops under different site conditions in Germany', in which 12 institutions from all of Germany participate, different field crops are tested for their yield potential (limit crop yield) and suitability as energy crop under typical site conditions. The crops are studied in the cultivation system, i.e., main crop with and without summer catch crop, winter catch crop - catch crop, as mixed crop and with reduced factor application in the crop rotation. In addition to the net energy yield per unit area, the selected task can provide information on the effects of crop rotation such as higher or lower yield, effects on the nutrient, water and humus contents of the soil, effects on crop health, e.g., mycotoxin load in cereal crops, the observation of farming deadlines, e.g., for rapeseed drilling. These parameters will then be analyzed for their financial and environmental relevance. The task therefore is to asses the system over several years instead of the yield of one type of crop in a certain year of cultivation. (orig.)

  15. "Erlösung ist, wenn man schulfrei hat!". Erste Ergebnisse einer qualitativ-empirischen Studie zur Erfassung und didaktischen Bearbeitung von Erlösungsvorstellungen 10- bis 14-jähriger SchülerInnen der Sekundarstufe I in Österreich.

    Directory of Open Access Journals (Sweden)

    Thomas Weiß

    2014-07-01

    Full Text Available ENGLISH: The teaching of redemption of mankind through God in Jesus Christ is fundamental to the Christian religion. This article expands on this central topic and presents the first results of a research carried out in schools as part of a current qualitative study about what ideas of redemption ten- to fourteen-year-old students have. The aim of this basic empirical research is to generate views and perspectives on ‚redemption‘ in children and adolescents. A further objective is to develop and integrate didactic tasks for Religious Education as a subject, in order to work on the topic of ‚redemption‘. By doing so, theological reflection should be applied and an alignment within the spheres of life of young people should be provided in lessons at School. DEUTSCH: Die Rede von der Erlösung des Menschen durch Gott in Jesus Christus ist für die christliche Religion fundamental. Der Beitrag widmet sich diesem zentralen Thema und präsentiert die ersten Forschungsergebnisse, die im Rahmen einer aktuellen qualitativen Studie zu Erlösungsvorstellungen von 10- bis 14-jährigen SchülerInnen in Schulen erhoben wurde. Diese grundlagenorientierte empirische Forschungsarbeit hat zum Ziel, kindliche / jugendliche Denk- und Sichtweisen zu ‚Erlösung’ zu generieren und didaktische Aufgaben im Religionsunterricht zu entwickeln und zu implementieren, um das Thema ‚Erlösung’ lebensweltlich orientiert und theologisch reflektiert im schulischen Unterricht bearbeiten zu können.

  16. Target-setting and first results upon the refurbishment of the 500 MW-LMZ turbines of VEAG, the power plant Boxberg serving as an example; Zielstellung und erste Ergebnisse bei der Ertuechtigung der 500-MW-LMZ-Turbinen der VEAG am Beispiel Kraftwerk Boxberg

    Energy Technology Data Exchange (ETDEWEB)

    Lipinski, B. [VEAG Vereinigte Energiewerke AG, Kraftwerk Boxberg (Germany); Altmann, D. [VEAG Vereinigte Energiewerke AG, Kraftwerk Boxberg (Germany); Tanner, W. [VEAG Vereinigte Energiewerke AG, Kraftwerk Boxberg (Germany); Klauke, U. [VEAG Vereinigte Energiewerke AG, Hauptverwaltung, Berlin (Germany); Bopp, P. [ABB Kraftwerke AG, Mannheim (Germany)

    1995-11-01

    With an installed capacity of 3520 MW, the power plant Boxberg is Germany`s largest brown coal-fired power plant. It is situated in the centre of the Lusation brown coal mining area. The power plant is supplied mainly by coal from the openpit mines Nochten and Reichwalde; water supply is ensured. Owing to these ideal site conditions, VEAG`s concept envisages the continuation of the power plant site. The existing two 500 MW units are modified and 800 MW units are erected. The aim of the refurbishment and the results obtained are described. (orig.) [Deutsch] Das Kraftwerk Boxberg ist mit einer installierten Leistung von 3520 MW das groesste Braunkohlenkraftwerk Deutschlands. Es liegt mitten im Lausitzer Braunkohlenrevier. Die Kohleversorgung des Kraftwerkes Boxberg erfolgt vorrangig aus den beiden benachbarten Tagebauen Nochten und Reichwalde, die Wasserversorgung ist gesichert. Aufgrund dieser idealen Standortbedingungen sieht das Unternehmenskonzept der VEAG die Erhaltung dieses Kraftwerksstandortes vor. Die vorhandenen zwei 500-MW-Bloecke werden ertuechtigt und 800-MW-Bloecke errichtet. Die Zielrichtung der Ertuechtigung und der erreichte Stand werden beschrieben. (orig.)

  17. Pumpspeicherbecken im Karstgrundwasserleiter des Weißen Jura der Schwäbischen Alb. Erste Ergebnisse aus der geologischen und hydrogeologischen Erkundung für die Planfeststellung Pumped-storage hydroelectric power plant in the Jurassic karst aquifer of the swabian alb, Germany

    Science.gov (United States)

    Neukum, Christoph; Köhler, Hans Joachim; Fernandez-Steeger, Tomas; Hennings, Sibylle; Azzam, Rafig

    2014-06-01

    Extensive geological and hydrogeological investigations have been undertaken for the planned pumped-storage hydroelectric power plant in "Blautal" (Swabian Alb, Germany) in order to characterise the Jurassic karst aquifer in which the lower reservoir will be constructed. The preferred option for the plant setup is to integrate the lower reservoir into the groundwater without sealing. Therefore, in order to reliably predict the impact of the pumped storage plant operations on the surrounding drinking water wells and groundwater dependent ecosystems, a comprehensive database has been developed to assess the hydraulic conditions of the karst aquifer. A large scale geological site investigation was carried out to characterise the rock mass and extensive hydraulic tests were performed in many boreholes. The results of the hydraulic characterisation were then implemented in a three dimensional flow model. In this paper, the first results of the geological and hydrogeological investigations are presented and discussed.

  18. Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years

    Energy Technology Data Exchange (ETDEWEB)

    Betz, Nicolas; Ott, Oliver J.; Sauer, Rolf; Fietkau, Rainer [Dept. of Radiation Oncology, Univ. Hospital Erlangen (Germany); Adamietz, Boris [Radiologic Inst., Univ. Hospital Erlangen (Germany); Keilholz, Ludwig [Dept. of Radiation Oncology, Univ. Hospital Erlangen (Germany); Dept. of Radiotherapy, Klinikum Bayreuth GmbH (Germany)

    2010-02-15

    Background and Purpose: In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. Patients and Methods: Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response. Results: According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy. Conclusion: After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a ''salvage'' operation is still feasible. (orig.)

  19. 掌腱膜挛缩症的手术治疗%The surgical treatment of Dupuytren's contracture

    Institute of Scientific and Technical Information of China (English)

    王晓南; 陈克俊; 韩宝平; 阚世廉

    2011-01-01

    Objective To investigate a modified technique in the surgical treatment of Dupuytren' s contracture and its clinical outcomes. Methods Eleven cases in 9 patients of Dupuytren's contracture were treated by partial resection of the palmar aponeurosis from September 2008 to August 2009. The conventional method was modified by treating the skin flap as a skin graft. Results Primary wound healing was achieved in all cases. There was no infection, hematoma or skin necrosis. The follow-up period ranged from 1 to 6 months,with an average of 3.3 months. There was no recurrence. The results were graded as good in 9 cases and fair in 2 cases according to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association. The overall satisfactory rate was 100%. Conclusion Early postoperative complication rate can be greatly reduced by treating palmar skin flap as free skin graft after partial resection of the palmar aponeurosis.%目的 探讨掌腱膜挛缩症手术方法的改进,分析其疗效.方法 2008年9月至2009年8月,采用掌腱膜部分切除术治疗掌腱膜挛缩症患者9例11侧,对传统的治疗方法加以改进,以游离植皮的理念处理掌侧皮瓣.结果 本组患者术后切口均Ⅰ期愈合,无皮下血肿、皮缘坏死、切口感染等术后早期并发症发生.随访1~6个月,平均3.3个月,无一例复发.按中华医学会手外科学会上肢部分功能评定试用标准评定:患手运动功能优9例,良2例;优良率为100%.结论 在掌腱膜部分切除术中以游离植皮的理念处理掌侧皮肤可明显降低术后早期并发症.

  20. Surgical management of peripheral arterial disease. Operative methods and results; Die chirurgische Behandlung der arteriellen Verschlusskrankheit. Operationsmethoden und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Wulff, B.; Jungbluth, T.; Esnaashari, H.; Franke, C.; Bruch, H.P. [Universitaetsklinikum Schleswig-Holstein, Luebeck (Germany). Klinik fuer Chirurgie

    2006-11-15

    Various operative and interventional methods are available to treat patients with peripheral arterial disease (PAD). The selection of the appropriate therapy should be made after a careful review of the patient's general condition, the morphology of the arterial occlusion, the risk of possible complications, and the likelihood of long-term success for each type of treatment. The different procedures complement one another in their technical possibilities and their risk profile The combination of surgical and interventional methods offers new therapeutic possibilities. The different surgical procedures and their long-term outcome are presented in this publication. (orig.) [German] Zur invasiven Therapie der arteriellen Verschlusskrankheit (AVK) stehen verschiedene operative und interventionelle Behandlungsformen zur Verfuegung. Die Auswahl der geeigneten Methode richtet sich nach dem Allgemeinzustand des Patienten, der Morphologie des arteriellen Verschlusses, dem Komplikationsrisiko und der Erfolgswahrscheinlichkeit der jeweiligen Behandlung im Langzeitverlauf. Hierbei konkurrieren die verschiedenen Verfahren nur oberflaechlich betrachtet miteinander, sie ergaenzen sich in ihren jeweiligen technischen Moeglichkeiten und dem Risikoprofil. Die Kombination chirurgischer und interventioneller Methoden bietet neue Behandlungsoptionen. Im Rahmen dieses Artikels werden die verschiedenen Operationsverfahren und deren Ergebnisse dargestellt. (orig.)

  1. Radiotherapy of heterotopic bone formation in patients with paraplegia. Preliminary results; Strahlentherapie heterotoper Ossifikationen bei Querschnittsgelaehmten. Praeliminaere Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L. [Klinik fuer Strahlentherapie, Staedtisches Klinikum Karlsruhe (Germany); Liebermeister, E. [Klinik fuer Strahlentherapie, Staedtisches Klinikum Karlsruhe (Germany); Heinze, H.G. [Klinik fuer Strahlentherapie, Staedtisches Klinikum Karlsruhe (Germany); Nanassy, A. [Klinik fuer Orthopaedie, Rehabilitationskrankenhaus Langensteinbach (Germany); Stoltze, D. [Klinik fuer Orthopaedie, Rehabilitationskrankenhaus Langensteinbach (Germany)

    1995-08-01

    In 20 patients with paralysis, 25 regions were irradiated with (mostly) 10 Gy in single fractions of 2 to 2.5 Gy using 8 MW photons. In 15 patients radiotherapy was performed as a primary treatment in the status of myositis; 7 patients were treated after (subtotal) resection of already manifest ossifications (2 patients were treated twice, primarily and postoperatively). In a minimum follow-up 12 weeks, none of the 20 irradiated patients showed any progression of the developing or already manifest ossification; thus mobilisation and rehabilitation could be carried out as desired. No side effects occurred. The preliminary results of the present study suggest that radiotherapy is an effective local treatment with minimal side effects for the prevention of heterotopic bone formation in patients with paraplegia. (orig.) [Deutsch] Bei 20 Patienten (18 Maenner, zwei Frauen, Alter 19 bis 62 Jahre) mit Querschnittssyndrom wurden 25 Regionen mit ueberwiegend 10 Gy a 2 bis 2,5 Gy Einzeldosis mit 8-MW-Photonen bestrahlt. Die Radiatio erfolgte bei 15 Patienten als Primaerprophylaxe im entzuendlichen Stadium, bei sieben Patienten sekundaer nach (subtotaler) Resektion von Ossifikationen (zwei Patienten wurden sowohl primaer als auch sekundaer bestrahlt). Bei einer Mindestnachbeobachtungszeit von zwoelf Wochen trat in keinem Fall eine Progression der sich entwickelnden bzw. bereits bestehenden heterotopen Ossifikationen auf: saemtliche Patienten konnten wunschgemaess mobilisiert und im Rahmen ihrer neurologischen Ausfaelle rehabilitiert werden. Nebenwirkungen traten nicht auf. Die vorliegende praeliminaeren Ergebnisse deuten hin, dass die Strahlentherapie eine effektive und nebenwirkungsarme lokale Therapie zur Verhinderung heterotoper Ossifikationen beim Querschnittssyndrom darstellt. (orig.)

  2. The Incidence of Complex Regional Pain Syndrome in Simultaneous Surgical Treatment of Carpal Tunnel Syndrome and Dupuytren Contracture.

    Science.gov (United States)

    Buller, Mitchell; Schulz, Steven; Kasdan, Morton; Wilhelmi, Bradon J

    2017-07-01

    To determine the incidence of complex regional pain syndrome (CRPS) in the concurrent surgical treatment of Dupuytren contracture (DC) and carpal tunnel syndrome (CTS) through a thorough review of evidence available in the literature. The indices of 260 hand surgery books and PubMed were searched for concomitant references to DC and CTS. Studies were eligible for inclusion if they evaluated the outcome of patients treated with simultaneous fasciectomy or fasciotomy for DC and carpal tunnel release using CRPS as a complication of treatment. Of the literature reviewed, only 4 studies met the defined criteria for use in the study. Data from the 4 studies were pooled, and the incidence of recurrence and complications, specifically CRPS, was noted. The rate of CRPS was found to be 10.4% in the simultaneous treatment group versus 4.1% in the fasciectomy-only group. This rate is nearly half the 8.3% rate of CRPS found in a randomized trial of patients undergoing carpal tunnel release. Our analysis demonstrates a marginal increase in the occurrence of CRPS by adding the carpal tunnel release to patients in need of fasciectomy, contradicting the original reports demonstrating a much higher rate of CRPS. This indicates that no clear clinical risk is associated with simultaneous surgical treatment of DC and CTS. In some patients, simultaneous surgical management of DC and CTS can be accomplished safely with minimal increased risk of CRPS type 1.

  3. [Demonstration of the impossibility of simultaneous Dupuytren and Destot fractures in the result of the car-pedestrian collision].

    Science.gov (United States)

    Gusarov, A A; Fetisov, V A; Kucheryavets, Yu O

    2016-01-01

    This article reports the results of the commission forensic medical expertise undertaken to evaluate the possibility of severe injury to the ankle joint resulting from the road traffic accident as exemplified by the collision of a VAS 21043 car moving backward with a pedestrian. It was shown that the injury to the victim's right lower leg included the tear of the right crural deltoid ligament, the open communicated fracture of the lower third of fibular diaphysis with the displacement of the distal fragment, the lacerated wound in the lower third of the right leg, the rupture of distal tibiofibular synedesmosis, the closed communicated fracture of the posterior edge of the tibia without displacement, and outward subluxation of the right foot. According to the classification accepted in orthopedics , this variant of the injury to the ankle joint is a combination of the classical «complete» Dupuytren fracture and the Destot-type fracture. The analysis of the mechanism underlying formation of such injury has shown that it was a consequence of the indirect injurious action in the absence of the primary impact without the car running over the victim's leg.

  4. High-dosage tamoxifen as neoadjuvant treatment in minimally invasive surgery for Dupuytren disease in patients with a strong predisposition toward fibrosis: a randomized controlled trial.

    Science.gov (United States)

    Degreef, Ilse; Tejpar, Sabine; Sciot, Raf; De Smet, Luc

    2014-04-16

    Tamoxifen, a synthetic nonsteroidal anti-estrogen known to modulate the production of transforming growth factor-beta (TGF-β), has demonstrated effectiveness on fibroblast activity in vitro and in vivo. The main purpose of this study was to investigate the effect of tamoxifen on the outcome of surgery for Dupuytren contractures in patients with a strong predisposition toward fibrosis. We used a prospective, randomized, double-blind study protocol (conforming to the CONSORT standards) to investigate the influence of tamoxifen compared with placebo on the total passive extension deficit in the finger and patient satisfaction after subtotal fasciectomy in thirty patients with a strong predisposition toward fibrosis (grade, >4 according to the Abe scale). High-dosage tamoxifen (80 mg/day) was administered from six weeks prior until twelve weeks after surgery, and patients were monitored for two years. Three months after surgery, patients in the tamoxifen group had a smaller total passive extension deficit and higher satisfaction compared with the placebo group. This positive effect was lost over the two years following cessation of the medication. This study demonstrated that the short-term outcome of Dupuytren disease treatment could be influenced by use of tamoxifen as a neoadjuvant from six weeks prior to three months after subtotal fasciectomy in patients with a strong predisposition toward fibrosis. However, the beneficial effect disappeared within two years after surgery, with worsening of the contractures after the medication was discontinued. Thus, tamoxifen may have a short-term effect on the outcome of surgery for Dupuytren disease.

  5. Down-regulation of collagen synthesis and matrix metalloproteinase expression in myofibroblasts from Dupuytren nodule using adenovirus-mediated relaxin gene therapy.

    Science.gov (United States)

    Kang, Young-Mi; Choi, Yun-Rak; Yun, Chae-Ok; Park, Jin-Oh; Suk, Kyung-Soo; Kim, Hak-Sun; Park, Moon-Soo; Lee, Byung-Ho; Lee, Hwan-Mo; Moon, Seong-Hwan

    2014-04-01

    Dupuytren's disease is a fibroproliferative connective tissue disorder characterized by contracture of the palmer fascia of the hand. Relaxin (RLN) is a multifunctional factor which contributes to the remodeling of the pelvic ligament by inhibiting fibrosis and inflammatory activities. The aim of this study was to investigate the effect of the RLN gene on the inhibition of fibrosis in myofibroblastic cells. Myofibroblast cells with adenovirus LacZ (Ad-LacZ) as a marker gene or adenovirus relaxin (Ad-RLN) as therapeutic gene showed transgene expressions in beta-galactosidase assay and Western blot analysis. Myofibroblastic cells with Ad-RLN demonstrated a 22% and 48% reduction in collagen I and III mRNA expressions respectively, a 50% decrease in MMP-1, 70% decrease in MMP-2, 80% decrease in MMP-9, and a 15% reduction in MMP-13 protein expression compared with cultures with viral control and saline control. In addition, myofibroblastic cells with Ad-RLN showed a 40% decrease in TIMP 1 and a 15% increase in TIMP 3 protein expression at 48 h compared to cultures with viral control and saline control. Also, myofibroblastic cell with Ad-RLN demonstrated a 74% inhibition of fibronectin and a 52% decrease in total collagen synthesis at 48 h compared with cultures with viral control and saline control. In conclusion, the RLN gene render antifibrogenic effect on myofibroblastic cells from Dupuytren's nodule via direct inhibition of collagen synthesis not through collagenolytic pathway such as MMP-1, -13, TIMP 1, and 3. Therefore relaxin can be an alternative therapeutic strategy in initial stage of Dupuytren's disease by its antifibrogenic effect.

  6. Avaliação do tratamento cirúrgico da doença de Dupuytren pela técnica da palma aberta modificada

    OpenAIRE

    2014-01-01

    Objetivo: avaliar o tratamento cirúrgico com o uso da técnica da palma aberta modificada para o tratamento das contraturas graves da doença de Dupuytren. Métodos: em quatro anos, foram submetidos ao tratamento cirúrgico 16 pacientes, que pertenciam aos estágios III e IV da classificação proposta por Tubiana et al. Foram feitas aferições do déficit de extensão das articulações metacarpofalangeanas e inferfalangeana proxima...

  7. Efficacy and safety of collagenase clostridium histolyticum in the treatment of proximal interphalangeal joints in dupuytren contracture: combined analysis of 4 phase 3 clinical trials.

    Science.gov (United States)

    Badalamente, Marie A; Hurst, Lawrence C; Benhaim, Prosper; Cohen, Brian M

    2015-05-01

    To examine the results of proximal interphalangeal (PIP) joint contractures from 4 phase 3 clinical trials of collagenase clostridium histolyticum (CCH) injection for Dupuytren contracture. Patients enrolled in Collagenase Option for Reduction of Dupuytren I/II and JOINT I/II with one or more PIP joint contractures (20° to 80°) received CCH 0.58 mg/0.20 mL or placebo (Collagenase Option for Reduction of Dupuytren I/II only) injected directly into a palpable cord. The percentage of PIP joints achieving clinical success (0° to 5° of full extension), clinical improvement (50% or more reduction in baseline contracture), and range of motion improvement at 30 days after the first and last CCH injections was assessed. The PIP joint contractures were classified into low (40° or less) and high (more than 40°) baseline severity. Adverse events were recorded. A total of 506 adults (mean age, 63 ± 10 y; 80% male) received 1,165 CCH injections in 644 PIP joint cords (mean, 1.6 injections/cord). Most patients (60%) received 1 injection, with 24%, 16%, and 1% receiving 2, 3, and 4 injections, respectively. Clinical success and clinical improvement occurred in 27% and 49% of PIP joints after one injection and in 34% and 58% after the last injection. Patients with lower baseline severity showed greater improvement and response was comparable between fingers, as were improvements in range of motion. Adverse events occurring in more than 10% of patients were peripheral edema (58%), contusion (38%), injection site hemorrhage (23%), injection site pain (21%), injection site swelling (16%), and tenderness (13%). This incidence was consistent with data reported in phase 3 trials. Two tendon ruptures occurred. No further ruptures occurred after a modified injection technique was adopted. Collagenase clostridium histolyticum was effective and well tolerated in the short term in patients with Dupuytren PIP joint contractures. Therapeutic II. Copyright © 2015 American Society for

  8. 掌腱膜挛缩症的临床回顾性研究%Dupuytren's disease: a clinical retrospective study

    Institute of Scientific and Technical Information of China (English)

    李秀存; 路来金; 崔建礼; 孙希光; 刘红霞; 张颖; 王维

    2015-01-01

    Objective To introduce the clinical experiences of treating Dupuytren's disease.Methods A retrospective study was conducted of 78 cases of Dupuytren' s disease treated from October 2004 to December 2013 to analyze the clinical characteristics,surgical methods,postoperative complications,and long-term results.Results Of the 111 hands in this group,99 hands had primary healing of the wound,while 12 had various degrees of early postoperative complicatiom.The incidence of complications was 10.81%.Among them,98 hands of 68 patients were follow-up for a mean of 3.9 years after the surgery.Recurrence of Dupuytren' s was seen in 6 hands,the rate of postoperative recurrence being 6.12%.According to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,the results were excellent in 81 hands,good in 11 hands and poor in 6 hands.The overall satisfactory rate was 93.88%.Conclusion Early surgery and careful operation will significantly reduce the incidence of early postoperative and long-term comphcations in the treatment of Dupuytren's contracture.%目的 探讨掌腱膜挛缩症的治疗体会.方法 对我院2004年10月至2013年12月收治的78例掌腱膜挛缩症患者的发病特点、手术方法、术后并发症及远期疗效进行回顾性分析.结果 本组患者111只手,99只手Ⅰ期愈合,12只手术后出现不同程度的早期并发症,发生率10.81%.其中68例患者98只手术后平均随访3.9年,6只手复发,术后复发率为6.12%.依据中华医学会手外科学会上肢部分功能评定试用标准评定:优81只手,良11只手,差6只手;优良率为93.88%.结论 早期手术、精细操作将极大降低掌腱膜挛缩症术后出现早期及远期并发症的机会.

  9. Dupuytren's contracture in a patient with diabetes mellitus and literatures review%糖尿病合并掌腱膜挛缩症1例及文献复习

    Institute of Scientific and Technical Information of China (English)

    王译晨; 刘艳; 高鹏

    2011-01-01

    掌腱膜挛缩症是由于手掌皮下组织增生变性,形成许多结节和条索结构,进而导致手指关节继发性挛缩.糖尿病合并掌腱膜挛缩症在国外早有报道,发病率在3%~32%,相关文献表明,糖尿病患者掌腱膜挛缩症的发病率是正常人的10倍.然而,国内糖尿病合并掌腱膜挛缩症的病例报道较少.现报道糖尿病合并掌腱膜挛缩症1例,并探讨糖尿病与掌腱膜挛缩症的关系、可能的发病机制、临床表现、诊断及治疗方法.%Dupuytren's contracture is due to proliferation of palm subcutaneous tissue and the formation of many nodules and cord structures,thus leading to contracture of finger joints. Dupuytren's contracture combined with diabetes mellitus has been reported in foreign countries, the incidence was 3%-32%. Literatures suggest that the incidence of Dupuytren's contracture in diabetic patients is ten times greater than that in the general population. In China,Dupuytren's contracture combined with diabetes mellitus has been reported less. This article reports Dupuytren's contracture in a patient with diabetes mellitus and discusses their relationship ,possible pathogenesis,clinical manifestations,diagnosis and therapies.

  10. Results of immunoscintigraphy of osteomyelitis (LeukoScan) {sup trademark}; Ergebnisse zur Immunszintigraphie der Osteomyelitis (LeukoScan) {sup trademark}

    Energy Technology Data Exchange (ETDEWEB)

    Gratz, S.; Becker, W. [Goettingen Univ. (Germany). Abt. fuer Nuklearmedizin

    2000-05-01

    99mTc-labeled antigranulocyte monoclonal antibody Fab' fragments have shown a high sensitivity and specificity for detecting osteomyelitis in prospective studies. We retrospectively evaluated the use of LeukoScan {sup trademark} (Immunomedics, Morris Plains, N.J.) in clinical routine for the detection of bone and soft tissue infections and we want to present the results of our findings as well as some of the more interesting cases in this occasion. Imaging infection can be performed fast and easy with {sup 99m}Tc-Fab' fragments due to a fast targeting of infection and good background clearance, which increases in imaging quality. The application of {sup 99m}Tc-Fab' fragments gives good results in patients with bone and soft tissue infections of peripheral bones, as well as in patients with infected prostheses and infected arthritis. The use of {sup 99m}Tc-Fab' fragments should not be limited to these patients only, since good results can also be achieved in patients with infections of vascular grafts, of appendicitis and of endocarditis as well. A higher number of false-negative results has to be expected in case of subacute/chronic infections instead. Independent of the grade of infection acute/subacute infections of the spine always show 'cold lesions'. If cold lesions are used as guide for diagnosing a pathologic finding, an increase in sensitivity together with a decrease in specificity can be achieved. (orig.) [German] {sup 99m}Tc-markierte Antigranulozytenantikoerper-Fab'-Fragmente konnten in prospektiven Studien eine hohe Sensitivitaet und Spezifitaet bei der Detektion von Osteomyelitiden unter Beweis stellen. Retrospektiv haben wir die Anwendung von {sup 99m}Tc-markierten Fab'-Fragmenten ({sup 99m}Tc-Fab') (LeukoScan {sup trademark}, Immunomedics, Morris Plains, N.J.) in der klinischen Routine zum Nachweis von Knochen- und Weichteilentzuendungen ausgewertet und moechten einen Teil unserer Ergebnisse sowie einige

  11. General Motors Well-to-Wheel Study - results and conclusions; General Motors Well-to-Wheel Studie - Ergebnisse und Schluesse

    Energy Technology Data Exchange (ETDEWEB)

    Wurster, R. [L-B-Systemtechnik GmbH (Germany)

    2003-07-01

    L-B Systemtechnik GmbH carried out this study on behalf of General Motors and in co-operation with BP, Exxon, Shell and Total. The study is available on the web as http://www.lbst.de/gm-wtw for downloading. This contribution presents current results, which are compared with other recent findings (e.g. the MIT study by Weiss et al. and the publication of Bossel/Elliasson). The marketing potentials of motor fuels from renewable energy sources (natural gas, Fischer-Tropsch diesel fuel, ethanol, methanol, RME, pressurised and liquid hydrogen) is compared. The contribution also presents fuel cost (Euro/a and Euro/km)for these fuels and drives. The data are derived from the LBST E2 database. [German] Die L-B-Systemtechnik GmbH (LBST) hat in 2001/2002 im Auftrag von General Motors und in Kooperation mit BP, Exxon, Shell und Total eine umfangreiche Well-to-Whell Studie fuer den technologischen Stand von 2010 durchgefuehrt. Die gesamte LBST/GM-Studie ist unter http://www.lbst.de/gm-wtw im Internet als PDF-Dokumente zum Herunterladen verfuegbar. Auf Basis dieser Untersuchung und im Vergleich zu anderen in Diskussion befindlichen neueren Arbeiten (z.B. MIT-Studie von Weiss et al., Bossel/Elliasson Papier) werden aktuelle Ergebnisse praesentiert und ableitbare Folgen fuer die Einfuehrung von Wasserstoff als Kraftstoff fuer Strassenfahrzeuge praesentiert und diskutiert. Es sollen auch die prinzipiell realisierbaren Marktpotentiale der verschiedenen verglichenenen Fahrzeugkraftstoffe (Erdgas, Fischer-Tropsch-Diesel, Ethanol, Methanol, RME, Druck- und Fluessigwasserstoff) auf Basis erneuerbarer Energiepotenziale in Europa vergleichend dargestellt werden. Nicht in der Studie untersuchte Kraftstoffkosten (Euro/MJ und Euro/km) fuer die praesentierten Kraftstoffpfade und Fahrzeugantriebe auf der Basis der LBST E2 database werden ebenfalls praesentiert. (orig.)

  12. Die Relation von Medienkultur und sozialer Schicht. - Ergebnisse einer empirisch-quantitativen Fragebogenstudie bei Volksschulkindern und deren Lehrerinnen und Lehrern.

    Directory of Open Access Journals (Sweden)

    Ursula Mutsch

    2009-12-01

    Full Text Available In der vorliegenden Studie wird die Medienkultur von Volksschülerinnen und -schülern, deren Eltern und deren Lehrerinnen und Lehrern mittels einer quantitativen Fragebogenerhebung in Wien verglichen. Die Erhebung wurde im Rahmen eines Forschungsprojekts der Wiener Medienpädagogik (Universität Wien durchgeführt. Ausgangspunkt der Studie sind die Annahmen, dass Medienkultur (1 von geografischen und historischen Determinanten bestimmt und im soziokulturellen Kontext zu betrachten ist und (2 Auswirkungen auf die erfolgreiche Integration von Medienbildung und Media Literacy in Volksschulen hat. Zunächst werden der Kontext der Studie und allgemeine Überlegungen vorgestellt. Dem folgt eine Beschreibung der methodischen Umsetzung der Studie mit anschließender Präsentation und Diskussion ausgewählter Resultate. Die Ergebnisse weisen auf schichtspezifische Unterschiede der Medienkultur zwischen Schülerinnen bzw. Schülern und Lehrkräften hin. This study aims to achieve an understanding how media culture of pupils and teachers meet in Austrian (Viennese primary schools. This investigation is part of a project at the University of Vienna which examines media ecudation and media literacy in primary schools, trying to support their development in classrooms. The thesis is that media culture is (1 determined by sociocultural, geographical and historical factors and (2 has an impact on a successful integration of media education in primary schools. So a first aim is to describe and compare the use and access of media in the home of children, their parents and teachers, applying a quantitative questionnaire. At first the context of the study as well as general and theoretical considerations will be presented, following a description of the methodical approach. Finally selected, important results of the study will be discussed. The results show differences concering media culture and literacy practices because of the social class gap.

  13. Avaliação do tratamento cirúrgico da doença de Dupuytren pela técnica da palma aberta modificada

    Directory of Open Access Journals (Sweden)

    Thiago Almeida Guilhen

    2014-01-01

    Full Text Available Objetivo: avaliar o tratamento cirúrgico com o uso da técnica da palma aberta modificada para o tratamento das contraturas graves da doença de Dupuytren. Métodos: em quatro anos, foram submetidos ao tratamento cirúrgico 16 pacientes, que pertenciam aos estágios III e IV da classificação proposta por Tubiana et al. Foram feitas aferições do déficit de extensão das articulações metacarpofalangeanas e inferfalangeana proximal e distal nos períodos pré-operatório, pós-operatório (três meses e pós-operatório tardio (cinco a oito anos. Angulações maiores do que 30° nas articulações metacarpofalangeanas e 15° nas interfalangeanas proximais foram consideradas como recidiva cirúrgica. Resultados: obtivemos uma média de déficit de extensão de 6,3° ao nível da articulação metacarpofalangeana, 13,8° na interfalangeana proximal e 1,9° na interfalangeana distal. Conclusão: a técnica da palma aberta modificada é um método eficaz no tratamento cirúrgico das contraturas graves na doença de Dupuytren.

  14. [Comparative Cost Effectiveness of Clostridium Histolyticum Collagenase (Xiapex®) and Partial Fasciectomy for the Treatment of Dupuytren's Contracture in Austria].

    Science.gov (United States)

    Neuwirth, M; Binter, A; Pipam, W; Rab, M

    2016-08-01

    Since Dupuytren's contracture is a common disorder, the costs for its surgical treatment impose a considerable burden on the healthcare system. For the first time in the German-speaking area, this study aimed to provide a comparative cost-effectiveness analysis for partial fasciectomy vs. treatment with Clostridium histolyticum collagenase (CCH). A retrospective monocentric study of the period from 2012 to 2014 comprised 40 patients with previously untreated Dupuytren's contracture of one finger. 20 outpatients received one CCH treatment (Group 1), while 20 inpatients underwent partial fasciectomy (Group 2). The direct pre-interventional treatment and post-interventional costs were compared. The direct post-interventional and postoperative results were comparable. Group 1 (CCH) showed a mean reduction in contracture of 96.4%; in Group 2 (partial fasciectomy), this was 97.7%. There were fewer complications in Group 1 than in Group 2. Mean treatment costs in Group 1 were € 1 458.60 and in Group 2, € 5 315.20. Treatment with CCH is more cost effective than with partial fasciectomy. This is due to greater costs for personnel, time and surgical material, as well as the treatment of the more frequent complications in Group 2. Despite the limited comparability, our findings are consistent with the present international literature. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent.

    Science.gov (United States)

    Broekstra, Dieuwke C; Lanting, Rosanne; Werker, Paul M N; van den Heuvel, Edwin R

    2015-08-01

    Dupuytren disease (DD) is a fibrosing disease affecting the palmar aponeurosis, and is mostly treated by surgery based on measurement of severity of flexion contracture of the fingers. Literature concerning the measurement reliability is scarce. This study aimed to determine the intra- and inter-observer agreement of four variables for diagnosing DD, determining severity of contracture, and disease extent. One of them is a new measurement on the area of nodules and cords for measuring the disease extent in early disease stages. An agreement study (n = 54) was performed by two trained investigators. Agreement was calculated per finger, based on an intraclass correlation coefficient (ICC) using a latent variable model on subjects for diagnosis and Tubiana stage. For total passive extension deficit (TPED) and the area of nodules and cords, agreement was calculated with an ICC using a one-way random effects model with subject as random effect. Inter-observer agreement was very good for diagnosing DD (ICC: 95.5%-99.9%) and good to very good for classifying Tubiana stage (ICC: 73.5%-94.9%). Agreements for area and TPED were moderate (middle finger) to very good (ICC: 48.4%-98.6% and 45.0%-99.5%, respectively). Intra-observer agreement was slightly higher on average than inter-observer agreement. Overall, the intra- and inter-observer agreement in diagnosing DD, and determining the severity of flexion contracture is high. Also, the newly introduced variable area of nodules and cords has high intra- and inter-observer agreement, indicating that it is suitable to measure disease extent. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Costs for collagenase injections compared with fasciectomy in the treatment of Dupuytren's contracture: a retrospective cohort study

    Science.gov (United States)

    Atroshi, Isam; Strandberg, Emelie; Lauritzson, Anna; Ahlgren, Eva; Waldén, Markus

    2014-01-01

    Objectives To compare collagenase injections and surgery (fasciectomy) for Dupuytren's contracture (DC) regarding actual total direct treatment costs and short-term outcomes. Design Retrospective cohort study. Setting Orthopaedic department of a regional hospital in Sweden. Participants Patients aged 65 years or older with previously untreated DC of 30° or greater in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints of the small, ring or middle finger. The collagenase group comprised 16 consecutive patients treated during the first 6 months following the introduction of collagenase as treatment for DC at the study centre. The controls were 16 patients randomly selected among those operated on with fasciectomy at the same centre during the preceding 3 years. Interventions Treatment with collagenase was given during two standard outpatient clinic visits (injection of 0.9 mg, distributed at multiple sites in a palpable cord, and next-day finger extension under local anaesthesia) followed by night-time splinting. Fasciectomy was carried out in the operating room (day surgery) under general or regional anaesthesia using standard technique, followed by therapy and splinting. Primary and secondary outcome measures Actual total direct costs (salaries of all medical personnel involved in care, medications, materials and other relevant costs), and total MCP and PIP extension deficit (degrees) measured by hand therapists at 6–12 weeks after the treatment. Results Collagenase injection required fewer hospital outpatient visits to a therapist and nurse than fasciectomy. Total treatment cost for collagenase injection was US$1418.04 and for fasciectomy US$2102.56. The post-treatment median (IQR) total extension deficit was 10 (0–30) for the collagenase group and 10 (0–34) for the fasciectomy group. Conclusions Treatment of DC with one collagenase injection costs 33% less than fasciectomy with equivalent efficacy at 6 weeks regarding

  17. First identification of resident and circulating fibrocytes in Dupuytren's disease shown to be inhibited by serum amyloid P and Xiapex.

    Directory of Open Access Journals (Sweden)

    Syed Amir Iqbal

    Full Text Available Dupuytren's disease (DD is a common progressive fibroproliferative disorder causing permanent digital contracture. Proliferative myofibroblasts are thought to be the cells responsible for DD initiation and recurrence, although their source remains unknown. DD tissue has also been shown to harbor mesenchymal and hematopoietic stem cells. Fibrocytes are circulating cells that show characteristics of fibroblasts and they express surface markers for both hematopoietic and mesenchymal stromal cells. Fibrocytes differentiate from peripheral CD14+ mononuclear cells, which can be inhibited by serum amyloid P (SAP. In this study we have demonstrated the presence of fibrocytes in DD blood and tissue, moreover we have evaluated the effects of SAP and Xiapex (Collagenase Clostridium histolyticum on fibrocytes derived from DD. H&E staining showed typical Spindle shaped morphology of fibrocytes. FACS analysis based on a unique combination of 3 markers, revealed the increased presence of fibrocytes in blood and tissue of DD patients. Additionally, immunohistology of DD nodule and cord tissue showed the presence of collagen 1+/CD34+ cells. No difference in plasma SAP levels was observed between DD and control. Higher concentrations of SAP significantly inhibited fibrocytes differentiated from DD derived monocytes compared to control. DD fascia derived fibrocytes showed resistance to growth inhibition by SAP, particularly nodule derived fibrocytes showed robust growth even at higher SAP concentrations compared to control. DD derived fibrocytes were positive for typical fibrocyte dual markers, i.e. Collagen 1/LSP-1 and collagen 1/CD34. Xiapex was more effective in inhibiting the growth of nodule derived cells compared to commercially available collagenase A. Our results show for the first time the increased presence of fibrocytes in DD patient's blood and disease tissue compared to control tissue. Additionally, we evaluate the response of these fibrocytes to SAP

  18. Type-1 Collagen differentially alters β-catenin accumulation in primary Dupuytren's Disease cord and adjacent palmar fascia cells

    Directory of Open Access Journals (Sweden)

    Gan Bing

    2009-06-01

    Full Text Available Abstract Background Dupuytren's Disease (DD is a debilitating contractile fibrosis of the palmar fascia characterised by excess collagen deposition, contractile myofibroblast development, increased Transforming Growth Factor-β levels and β-catenin accumulation. The aim of this study was to determine if a collagen-enriched environment, similar to in vivo conditions, altered β-catenin accumulation by primary DD cells in the presence or absence of Transforming Growth Factor-β. Methods Primary DD and patient matched, phenotypically normal palmar fascia (PF cells were cultured in the presence or absence of type-1 collagen and Transforming Growth Factor-β1. β-catenin and α-smooth muscle actin levels were assessed by western immunoblotting and immunofluorescence microscopy. Results DD cells display a rapid depletion of cellular β-catenin not evident in patient-matched PF cells. This effect was not evident in either cell type when cultured in the absence of type-1 collagen. Exogenous addition of Transforming Growth Factor-β1 to DD cells in collagen culture negates the loss of β-catenin accumulation. Transforming Growth Factor-β1-induced α-smooth muscle actin, a marker of myofibroblast differentiation, is attenuated by the inclusion of type-1 collagen in cultures of DD and PF cells. Conclusion Our findings implicate type-1 collagen as a previously unrecognized regulator of β-catenin accumulation and a modifier of TGF-β1 signaling specifically in primary DD cells. These data have implications for current treatment modalities as well as the design of in vitro models for research into the molecular mechanisms of DD.

  19. Wirksamkeit und Verträglichkeit von Mepartricin (Iperplasin® bei benigner Prostatahyperplasie: Ergebnisse eine Anwendungsbeobachtung

    Directory of Open Access Journals (Sweden)

    Madersbacher H

    2000-01-01

    Full Text Available Ziel der Studie: Das Ziel dieser Anwendungsbeobachtung war es, Wirksamkeit und Verträglichkeit von Mepartricin-Filmtabletten (Iperplasin® bei der Behandlung von Patienten mit benigner Prostatahyperplasie (BPH bzw. Prostatavergrößerung (BPE zu untersuchen. Patienten und Methoden: Im Rahmen einer österreichweiten Anwendungsbeobachtung wurden Patienten mit unterer Harntraktsymptomatik (LUTS, verursacht durch eine BPH/BPE, untersucht. Die wichtigsten Einschlußkriterien waren eine reduzierte maximale Harnflußrate (Qmax von 6-15 ml/sec und ein Restharn 100 ml. Als Studienmedikation erhielten die Patienten 3 x 1 Tbl. Iperplasin®. Ein, drei und sechs Monate nach Studienbeginn wurden die Patienten nachkontrolliert. Die wichtigsten Zielparameter waren eine Verbesserung des Internationalen Prostata Symptomen Scores (IPSS, der Lebensqualitätsfrage des IPSS (IPSS-Ql sowie des Qmax. Ein Einfluß auf die Sexualität wurde anhand des GRISS-Scores erhoben. Ergebnisse: Insgesamt wurden 130 Patienten (67,4 ± 8,4 Jahre; Durchschnitt ± Standardabweichung in diese Studie aufgenommen. Der IPSS sank von 16,4 ± 5,0 zu Studienbeginn auf 9,4 ± 6,0 (-41 %; p 0,0001 nach 6 Monaten Therapie, der IPSS-Ql von 3,3 ± 0,8 auf 2,0 ± 1,1 (-39 %; p 0,0001. Im gleichen Zeitraum stieg der Qmax von 11,3 ± 6,0 auf 12,5 ± 6,4 ml/sec (+11 %; p 0,0001, der Restharn sank von 49 ± 36 ml auf 33 ± 35 ml (-33 %; p 0,0001. Insgesamt war die Therapie mit Iperplasin® gut verträglich, bei 10 % traten im Rahmen der Studie unerwünschte Ereignisse oder interkurrente Erkrankungen auf, bei zwei Patienten mußte eine TURP durchgeführt werden. Der GRISS-Score blieb über den gesamten Studienzeitraum konstant. Schlußfolgerung: Diese Anwendungsbeobachtung belegt die Sicherheit von Iperplasin® bei Patienten mit LUTS und BPH/BPE, vor allem kommt zu keiner Beeinträchtigung der Vita sexualis. Obwohl eine signifikante Verbesserung von subjektiven und objektiven Parametern in dieser

  20. Forest report 2002. Results of the ecosystem study for Hessen; Waldzustandsbericht 2002. Ergebnisse der Waldoekosystemforschung in Hessen

    Energy Technology Data Exchange (ETDEWEB)

    Paar, U.; Gawehn, P.; Rockel, A.; Schoenfelder, E.; Schulze, I.; Eichhorn, J. (comps.)

    2002-10-01

    und Boden zur Folge. Andere Ergebnisse mahnen zur Vorsicht: Neben einer fuer Waldgebiete in Hessen seit Ende der 80er Jahre vielfach zu warmen und zu trockenen Witterung zaehlen hierzu hohe Ozonkonzentrationen sowie anhaltend hohe Stickstoffeintraege. (orig.)

  1. Efficacy and safety of collagenase clostridium histolyticum injection for Dupuytren contracture: short-term results from 2 open-label studies.

    Science.gov (United States)

    Witthaut, Jörg; Jones, Graeme; Skrepnik, Nebojsa; Kushner, Harvey; Houston, Anthony; Lindau, Tommy R

    2013-01-01

    The JOINT I (United States) and JOINT II (Australia and Europe) studies evaluated the efficacy and safety of collagenase clostridium histolyticum (CCH) injection for the treatment of Dupuytren contracture. Both studies used identical open-label protocols. Patients with fixed-flexion contractures of metacarpophalangeal (MCP) (20° to 100°) or proximal interphalangeal (PIP) joints (20° to 80°) could receive up to three 0.58-mg CCH injections per cord (up to 5 total injections per patient). We performed standardized finger extension procedures to disrupt injected cords the next day, with follow-up 1, 2, 6, and 9 months thereafter. The primary end point (clinical success) was reduction in contracture to within 0° to 5° of full extension 30 days after the last injection. Clinical improvement was defined as 50% or more reduction from baseline contracture. Dupuytren cords affecting 879 joints (531 MCP and 348 PIP) in 587 patients were administered CCH injections at 14 U.S. and 20 Australian/European sites, with similar outcomes in both studies. Clinical success was achieved in 497 (57%) of treated joints using 1.2 ± 0.5 (mean ± SD) CCH injections per cord. More MCP than PIP joints achieved clinical success (70% and 37%, respectively) or clinical improvement (89% and 58%, respectively). Less severely contracted joints responded better than those more severely contracted. Mean change in contracture was 55° for MCP joints and 25° for PIP joints. With average contracture reductions of 73% and improvements in range of motion by 30°, most patients (92%) were "very satisfied" (71%) or "quite satisfied" (21%) with treatment. Physicians rated change from baseline as "very much improved" (47%) or "much improved" (35%). The CCH injections were well tolerated, causing no tendon ruptures or systemic reactions. Collagenase clostridium histolyticum was an effective, minimally invasive option for the treatment of Dupuytren contracture of a broad range of severities. Most

  2. Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

    Directory of Open Access Journals (Sweden)

    Satish Latha

    2012-05-01

    Full Text Available Abstract Background Dupuytren's contracture (DC is a fibroproliferative disorder characterized by the progressive development of a scar-like collagen-rich cord that affects the palmar fascia of the hand and leads to digital flexion contractures. DC is most commonly treated by surgical resection of the diseased tissue, but has a high reported recurrence rate ranging from 27% to 80%. We sought to determine if the transcriptomic profiles of fibroblasts derived from DC-affected palmar fascia, adjacent phenotypically normal palmar fascia, and non-DC palmar fascial tissues might provide mechanistic clues to understanding the puzzle of disease predisposition and recurrence in DC. Methods To achieve this, total RNA was obtained from fibroblasts derived from primary DC-affected palmar fascia, patient-matched unaffected palmar fascia, and palmar fascia from non-DC patients undergoing carpal tunnel release (6 patients in each group. These cells were grown on a type-1 collagen substrate (to better mimic their in vivo environments. Microarray analyses were subsequently performed using Illumina BeadChip arrays to compare the transcriptomic profiles of these three cell populations. Data were analyzed using Significance Analysis of Microarrays (SAM v3.02, hierarchical clustering, concordance mapping and Venn diagram. Results We found that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected fascia of DC patients exhibited a much greater overlap than fibroblasts derived from the palmar fascia of patients undergoing carpal tunnel release. Quantitative real time RT-PCR confirmed the differential expression of select genes validating the microarray data analyses. These data are consistent with the hypothesis that predisposition and recurrence in DC may stem, at least in part, from intrinsic similarities in the basal gene expression of diseased and phenotypically unaffected palmar fascia fibroblasts. These data also demonstrate that

  3. Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

    Science.gov (United States)

    2012-01-01

    Background Dupuytren's contracture (DC) is a fibroproliferative disorder characterized by the progressive development of a scar-like collagen-rich cord that affects the palmar fascia of the hand and leads to digital flexion contractures. DC is most commonly treated by surgical resection of the diseased tissue, but has a high reported recurrence rate ranging from 27% to 80%. We sought to determine if the transcriptomic profiles of fibroblasts derived from DC-affected palmar fascia, adjacent phenotypically normal palmar fascia, and non-DC palmar fascial tissues might provide mechanistic clues to understanding the puzzle of disease predisposition and recurrence in DC. Methods To achieve this, total RNA was obtained from fibroblasts derived from primary DC-affected palmar fascia, patient-matched unaffected palmar fascia, and palmar fascia from non-DC patients undergoing carpal tunnel release (6 patients in each group). These cells were grown on a type-1 collagen substrate (to better mimic their in vivo environments). Microarray analyses were subsequently performed using Illumina BeadChip arrays to compare the transcriptomic profiles of these three cell populations. Data were analyzed using Significance Analysis of Microarrays (SAM v3.02), hierarchical clustering, concordance mapping and Venn diagram. Results We found that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected fascia of DC patients exhibited a much greater overlap than fibroblasts derived from the palmar fascia of patients undergoing carpal tunnel release. Quantitative real time RT-PCR confirmed the differential expression of select genes validating the microarray data analyses. These data are consistent with the hypothesis that predisposition and recurrence in DC may stem, at least in part, from intrinsic similarities in the basal gene expression of diseased and phenotypically unaffected palmar fascia fibroblasts. These data also demonstrate that a collagen

  4. Catheter visualisation in MR tomography: first animal experimental experiences with field inhomogeneity catheters; Kathetervisualisierung in der MR-Tomographie: erste tierexperimentelle Erfahrungen mit Feldinhomogenitaetskathetern

    Energy Technology Data Exchange (ETDEWEB)

    Adam, G. [Technische Hochschule Aachen (Germany). Klinik fue Radiologische Diagnostik; Glowinski, A. [Technische Hochschule Aachen (Germany). Klinik fue Radiologische Diagnostik; Neuerburg, J.; Buecker, A.; Vaals, J.J. van; Hurtak, W.; Guenther, R.W.

    1997-04-01

    Purpose: To assess the feasibility of a new developed field inhomogeneity catheter for interventional MR imaging in vivo. Materials and methods: Three different prototypes of a field inhomogeneity catheter were investigated in 6 pigs. The catheters were introduced in Seldinger technique via the femoral vessels over a guide wire on an interventional MR system (Philips Gyroscan NT combined with a C-arm fluoroscopy unit [Philips BV 212]). Catheters were placed in veins and arteries. The catheter position was controlled by a fast gradient echo sequence (Turbo Field Echo [TEF]). Results: Catheters were introduced over a guide wire without complications in all cases. Using the field inhomogeneity concept, catheters were easily visualised in the inferior vena cava and the aorta by the fast gradient echo technique on MR in all cases. Although aortic branches were successfully cannulated, the catheters were not displayed by the TFE technique due to the complex and tortuous anatomy. All animals survived the experiments without complications. Conclusion: MR guided visualisation of a field inhomogeneity catheter is a simple concept which can be realised on each MR scanner and may allow intravascular MR guided interventions in future. (orig.) [Deutsch] Zielsetzung: Ziel der Untersuchungen war die Ueberpruefung der Tauglichkeit eines neu entwickelten Feldinhomogenitaetskatheters fuer die interventionelle MR-Tomographie in vivo. Material und Methoden: An 6 Schweinen wurden an einem interventionellen MR-Tomographen (Philips Gyroscan NT in Verbindung mit einer C-Bogen-Durchleuchtungseinheit [Philips BV 212]) in Seldinger-Technik ueber die Femoralgefaesse drei verschiedene Prototypen eines neu entwickelten Feldinhomogenitaetskatheters venoes und arteriell plaziert und mittels schneller Gradienten-Echo-Sequenzen (Turbo Field Echo) MR-tomographisch dargestellt. Ergebnisse: Alle Katheter konnten problemlos ueber Fuehrungsdraehte in das Gefaesssystem eingefuehrt werden. Die Darstellung

  5. Avaliação do tratamento cirúrgico da doença de Dupuytren pela técnica da palma aberta modificada

    OpenAIRE

    2014-01-01

    Objetivo: avaliar o tratamento cirúrgico com o uso da técnica da palma aberta modificada para o tratamento das contraturas graves da doença de Dupuytren. Métodos: em quatro anos, foram submetidos ao tratamento cirúrgico 16 pacientes, que pertenciam aos estágios III e IV da classificação proposta por Tubiana et al. Foram feitas aferições do déficit de extensão das articulações metacarpofalangeanas e inferfalangeana proximal e distal nos períodos pré-operatório, pós-operatório (três meses) e ...

  6. A Simple Dressing Technique Following Dermofasciectomy and Full Thickness Skin Grafting of the Fingers in the Treatment of Severe Dupuytren's Contracture.

    Science.gov (United States)

    Tanagho, Andy; Beaumont, Jan; Thomas, Roshin

    2015-12-01

    Dupuytren's disease with severe finger contractures and recurrent contractures following previous surgery often have extensive skin involvement. In these severe cases, excision of the diseased chord along with the involved skin is a good option to reduce the risk of recurrance. The resulting skin defect can be covered with a full thickness skin graft (FTSG) or a cross finger flap. Cross finger flaps have donor finger morbidity and hence a full thickness graft is usually preferred. The FTSG extending to the midlateral margins on both sides of the finger reduces the risk of joint contracture due to graft shrinkage. Once the FTSG is sutured in place, the standard practice is to compress and secure the graft to its recipient bed with a tie-over dressing and this can be time consuming. We present a simple dressing technique to secure the FTSG without the need for a tie-over dressing.

  7. The effect of a therapy protocol for increasing correction of severely contracted proximal interphalangeal joints caused by dupuytren disease and treated with collagenase injection.

    Science.gov (United States)

    Skirven, Terri M; Bachoura, Abdo; Jacoby, Sidney M; Culp, Randall W; Osterman, A Lee

    2013-04-01

    To determine the effect of a specific orthotic intervention and therapy protocol on proximal interphalangeal (PIP) joint contractures of greater than 40° caused by Dupuytren disease and treated with collagenase injections. All patients with PIP joints contracted at least 40° by Dupuytren disease were prospectively invited to participate in the study. Following standard collagenase injection and cord rupture by a hand surgeon, a certified hand therapist evaluated and treated each patient based on a defined treatment protocol that consisted of orthotic intervention to address residual PIP joint contracture. In addition, exercises were initiated emphasizing reverse blocking for PIP joint extension and distal interphalangeal joint flexion exercises with the PIP joint held in extension to lengthen a frequently shortened oblique retinacular ligament. Patients were assessed before injection, immediately after injection, and 1 and 4 weeks later. There were 22 fingers in 21 patients. The mean age at treatment was 63 years (range, 37-80 y). The mean baseline passive PIP joint contracture was 56° (range, 40° to 80°). At cord rupture, the mean PIP joint contracture became 22° (range, 0° to 55°). One week after cord rupture and therapy, the contracture decreased further to a mean of 12° (range, 0° to 36°). By 4 weeks, the mean contracture was 7° (range, 0° to 35°). The differences in PIP joint contracture were statistically significant at all time points except when comparing the means at 1 week and 4 weeks. The results represent an 88% improvement of the PIP joint contracture. In the short term, it appears that severe PIP joint contractures benefit from specific, postinjection orthotic intervention and targeted exercises. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. Reversal of TGF-β1 stimulation of α-smooth muscle actin and extracellular matrix components by cyclic AMP in Dupuytren's - derived fibroblasts

    Directory of Open Access Journals (Sweden)

    Johnson Sandra

    2011-05-01

    Full Text Available Abstract Background Myofibroblasts, a derived subset of fibroblasts especially important in scar formation and wound contraction, have been found at elevated levels in affected Dupuytren's tissues. Transformation of fibroblasts to myofibroblasts is characterized by expression of alpha- smooth muscle actin (α-SMA and increased production of extracellular matrix (ECM components, both events of relevance to connective tissue remodeling. We propose that increasing the activation of the cyclic AMP (cAMP/protein kinase A signaling pathway will inhibit transforming growth factor-beta1 (TGF-β1-induced ECM synthesis and myofibroblast formation and may provide a means to blunt fibrosis. Methods Fibroblasts derived from areas of Dupuytren's contracture cord (DC, from adjacent and phenotypically normal palmar fascia (PF, and from palmar fascia from patients undergoing carpal tunnel release (CTR; CT were treated with TGF-β1 (2 ng/ml and/or forskolin (10 μM (a known stimulator of cAMP. Total RNA and protein extracted was subjected to real time RT-PCR and Western blot analysis. Results The basal mRNA expression levels of fibronectin- extra domain A (FN1-EDA, type I (COL1A2 and type III collagen (COL3A1, and connective tissue growth factor (CTGF were all significantly increased in DC- and in PF-derived cells compared to CT-derived fibroblasts. The TGF-β1 stimulation of α-SMA, CTGF, COL1A2 and COL3A1 was greatly inhibited by concomitant treatment with forskolin, especially in DC-derived cells. In contrast, TGF-β1 stimulation of FN1-EDA showed similar levels of reduction with the addition of forskolin in all three cell types. Conclusion In sum, increasing cAMP levels show potential to inhibit the formation of myofibroblasts and accumulation of ECM components. Molecular agents that increase cAMP may therefore prove useful in mitigating DC progression or recurrence.

  9. Night traffic and health: Results of laboratory and field studies; Naechtlicher Verkehrslaerm und Gesundheit: Ergebnisse von Labor- und Feldstudien

    Energy Technology Data Exchange (ETDEWEB)

    Maschke, C. [Technische Univ. Berlin (Germany). Inst. fuer Technische Akustik; Ising, H. [Umweltbundesamt, Berlin (Germany). Inst. fuer Wasser-, Boden-, und Lufthygiene; Arndt, D. [Robert Koch-Institut, Medizinische Diagnostik - Umweltmedizin, Berlin (Germany)

    1995-04-01

    Cortisolausscheidung zu beobachten. Der naechtliche Laerm ist als Stressor zu bezeichnen, da er imstande ist, sowohl den `Hypothalamus-Hypophysen-Nebennierenrinden-Regelkreis` als auch den `Hypothalamus-Nebennierenmark-Regelkreis` zu aktivieren. Die relative Erhoehung der Adrenalinausscheidung ist in der Fluglaerm-Feldstudie deutlich geringer als in der Laborstudie. Die relative Erhoehung der Cortisolausscheidung lag im Feldversuch in der gleichen Groessenordnung wie die Adrenalinausscheidung. Eine naechtliche, laermbedingt erhoehte Adrenalinausscheidung scheint an eine ungewohnte Geraeuschbelastung gebunden zu sein, die einem adaptiven Prozess unterliegt und laengerfristig in eine erhoehte Cortisolausscheidung uebergeht. Eine Erhoehung sowohl der Cortisolausscheidung als auch der Adrenalinausscheidung ist ein Hinweis auf eine belastende Verkehrslaermsituation. In der Fluglaerm-Laborstudie und der Fluglaerm-Feldstudie konnte eine Verschlechterung des Schlaferlebens und eine Erhoehung der Adranalinausscheidung verzeichnet werden. Ein Zusammenhang zwischen dem Ueberflugpegel und der Adrenalin- bzw. Cortisolausscheidung kann in der Feldstudie nicht abgesichert werden, ebensowenig konnte ein Zusammenhang zwischen der Anzahl naechtlicher Fluege und der Katecholaminausscheidung weder in der Labor- noch in der Feldstudie nachgewiesen werden. Auch fuer die Cortisolausscheidung war eine Abhaengigkeit von der Anzahl der Fluege nicht zu erkennen. Die vorliegenden Ergebnisse erhaerten die These, dass naechtlicher Flug- und Strassenlaerm als Distress zu bewerten ist. Damit ist das gesundheitliche Risiko von chronisch Nachtlaermexponierten als erhoeht zu betrachten. (orig./MG)

  10. The 1000-roofs programme. World`s biggest practical performance test of grid-connected photovoltaic systems. Evaluation of the Berlin results; Das 1000-Daecher-Programm. Weltweit groesster Breitentest fuer netzgekoppelte Photovoltaik-Anlagen - Auswertung der Berliner Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, U. [Deutsche Gesellschaft fuer Sonnenenergie, Landesverband, Berlin-Brandenburg e.V. (Germany); Wuest, R.; Hielscher, T.

    1994-12-31

    The world`s biggest practical performance test of grid-connected photovoltaic systems is discussed on the basis of the Berlin results. (orig.) [Deutsch] Der weltweit groesste Breitentest fuer netzgekoppelte Photovoltaik-Anlagen wird anhand der Berliner Ergebnisse vorgestellt. (orig.)

  11. Cooperative project for energy-oriented modernisation of industrial buildings - coordination results; Projektverbund zur energiegerechten Sanierung industriell errichteter Gebaeude - Ergebnisse der Koordination

    Energy Technology Data Exchange (ETDEWEB)

    Kerschberger, A. [Assmann Beraten und Planen GmbH, Stuttgart (Germany)

    1997-12-31

    The cooperative project concept of the federal ministry of science and technology is discussed. Coordination activities as well as pilot projects and comparative projects are described. Results obtained so far are reported in detail; heat energy conservation potentials as substantiated by means of measurements are shown in tabulated form. Further indicated in tabulated form are the redevelopment costs per residential unit, the payback period of the entire project, and a comparison of reduced heating costs with increased basic rent for apportioning the costs of modernization. (MSK) [Deutsch] Die Konzeption des Projektverbundes des BMBF wird naeher erlaeutert. Die Aktivitaeten der Koordination und die Versuchs-und Vergleichsbauvorhaben werden beschrieben. Die bisherigen Ergebnisse werden detailliert geschildert und die mess

  12. Contrast-enhanced 3D MR venography of thoracic central veins: preliminary experience; Kontrastmittelverstaerkte 3D-MR-Venographie der oberen Thoraxapertur: erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Goyen, M.; Barkhausen, J.; Kuehl, H.; Goehde, S.C.; Bosk, S.; Debatin, J.F.; Ruehm, S.G. [Universitaetsklinikum Essen (Germany). Zentralinst. fuer Roentgendiagnostik; Kroeger, K. [Universitaetsklinikum Essen (Germany). Klinik und Poliklinik fuer Angiologie

    2001-04-01

    koronarer Schnittfuehrung mit einer Akquisitionszeit von 3,74 s (TR 1,6 ms, TE 0,6 ms, Flipwinkel 15 , Slabdicke 110 mm, effektive Schichtdicke 2,75 mm, 40 Partitionen, FOV 360 mm, Matrix 140x256) eingesetzt. Ohne Testbolus wurden 20 ml Gd-BOPTA (MultiHance {sup trademark}, Bracco, Italien) gefolgt von 20 ml NaCl mit einer Flussrate von 4 ml/s injiziert (MEDRAD {sup trademark}, Pittsburgh, USA). 10 Sekunden nach Beginn der KM-Injektion wurden 6 3D-Datensaetze in unmittelbarer Folge waehrend einer einzigen Atemanhalteperiode (24 s) akquiriert. Ergebnisse: Die kontrastmittelverstaerkte MR-Venographie lieferte bei allen Patienten diagnostisch verwertbare Bildsequenzen. Im Vergleich zur Duplexsonographie wurden Thrombosen, postthrombotische Veraenderungen sowie funktionelle Abflussstoerungen zuverlaessig erkannt. Schlussfolgerung: Das vorgestellte Verfahren erlaubt die diagnostische Darstellung der Venen der oberen Thoraxapertur. Die dynamische Akquisition von 3D-Datensaetzen ermoeglicht die Darstellung der arteriellen und venoesen Gefaesssysteme in den unterschiedlichen Kontrastmitteldurchflutungsphasen von frueh-arteriell bis spaet-venoes. Der repetitive Einsatz der Technik mit unterschiedlichen Armpositionen ermoeglicht ferner eine Darstellung funktioneller Gefaessstenosen. (orig.)

  13. Comparison of high resolution whole-body MRI using parallel imaging and PET-CT. First experiences with a 32-channel MRI system; Hochaufloesendes Ganzkoerpertumorstaging unter Verwendung paralleler Bildgebung im Vergleich zur PET-CT. Erste Erfahrungen auf einem 32-Kanal-MRT-System

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, G.P.; Baur-Melnyk, A.; Reiser, M.F.; Schoenberg, S.O. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie (Germany); Tiling, R.; Hahn, K. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Klinik und Poliklinik fuer Nuklearmedizin (Germany)

    2004-09-01

    technique in the detection of primary tumor and metastatic disease. Sensitivity in the assessment of lymph node metastases seems to be limited. With the use of parallel imaging (iPAT), dedicated high-resolution whole-body MRI is possible within acceptable scanning times. (orig.) [German] Vergleich der Genauigkeit eines hochaufloesenden Ganzkoerper-MRT-Tumorstagings unter Verwendung paralleler Bildgebung mit den Ergebnissen der PET-CT. Es werden erste Ergebnisse einer Interimsanalyse aus einer prospektiven, geblindeten Studie vorgestellt, in der an 20 Patienten (Durchschnittsalter 59 Jahre, Range 27-77 Jahre) mit unterschiedlichen onkologischen Erkrankungen im Rahmen der klinischen Diagnostik eine Tumor- oder Metastasensuche mit der Ganzkoerper-FDG-PET-CT durchgefuehrt wurde. Bei allen Patienten erfolgte zusaetzlich eine Ganzkoerper-MRT-Bildgebung mit Einsatz der parallelen Bildgebungstechnik (iPAT). Angewendet wurden hochaufloesende koronare T1-gewichtete- und STIR-Sequenzen von 5 Koerperregionen mit einer Matrix von 512 x 512 mm, axiale T2-gewichtete Turbospinechosequenzen (HASTE) der Lunge und des Abdomens sowie kontrastverstaerkte dynamische und statische T1-gewichtete Sequenzen von Leber, Gehirn, Abdomen und Becken. Bei Verwendung eines 32-Kanal-Systems (Magnetom Avanto, Siemens Medical Solutions) mit einem gesamten field of view von 205 cm und freier Tischbewegung konnten alle Patienten in einem Untersuchungsgang vollstaendig von Kopf bis zu den Fuessen gescannt werden. Dabei wurde eine hohe raeumliche Aufloesung erzielt. Die Messzeit betrug ca. 55 min. Zwei erfahrene Radiologen werteten die MRT-Untersuchung, ein Radiologe und ein Nuklearmediziner die PET-CT-Untersuchung, jeweils im Konsensus, aus. Es wurden der Nachweis und das Stadium des Primaertumors oder des Tumorrezidivs sowie von Lymphknoten- und Fernmetastasen bewertet. Als Referenzmethode wurde das durch die PET-CT identifizierte TNM-Stadium herangezogen. Es wurden Metastasen von gastrointestinalen Tumoren (25

  14. Use of resources and costs associated with the treatment of Dupuytren's contracture at an orthopedics and traumatology surgery department in Denia (Spain): collagenase clostridium hystolyticum versus subtotal fasciectomy.

    Science.gov (United States)

    Sanjuan Cerveró, Rafael; Franco Ferrando, Nuria; Poquet Jornet, Jaime

    2013-10-14

    Our purpose was to analyze and compare the use of direct health resources and costs generated in the treatment of Dupuytren's contracture using two different techniques: subtotal fasciectomy and infiltration with Collagenase Clostridium Histolyticum (CCH) in regular clinical practice at the Orthopedic and Traumatology Surgery (OTS) Department at the Hospital de Denia (Spain). Observational, retrospective study based on data from the computerized clinical histories of two groups of patients- those treated surgically using a one or two digit subtotal fasciectomy technique (FSC) and those treated with CCH infiltration, monitored in regular clinical practice from February, 2009 to May, 2012. Demographic (age, sex), clinical (number of digits affected and which ones) and use of resources (hospitalizations, medical visits, tests and drugs) data were collected. Resource use and associated costs, according to the hospital's accounting department, were compared based on the type of treatment from Spain's National Health Service. 91 patients (48 (52.8%) in the FSC group) were identified. The average age and number of digits affected was 65.9 (9.2) years and 1.33 (0.48) digits affected in the FSC group, and 65.1 (9.7) years and 1.16 (0.4) digits in the CCH group.Overall, the costs of treating Dupuytren's disease with subtotal FSC amount to €1,814 for major ambulatory surgery and €1,961 with hospital stay including admission, surgical intervention (€904), examinations, dressings and physiotherapy. As to collagenase infiltration, costs amount to €952 (including minor surgery admission, vial with product, office examination and dressings). Finally, comparing total costs for treatments, a savings of €388 is estimated in favor of CCH treatment in the best-case scenario (patient under MAS system with no need for physiotherapy) and €1,008 in the worst-case scenario (patient admitted to hospital needing subsequent physiotherapy), implying a savings of 29% and 51

  15. 50 years experience with Dupuytren's contracture in the Erlangen University Hospital – A retrospective analysis of 2919 operated hands from 1956 to 2006

    Directory of Open Access Journals (Sweden)

    Puschkin Valerij

    2007-07-01

    Full Text Available Abstract Background Dupuytren's disease (DD is a hand disorder mainly among the northern population. In contrast it is rare in the mediterranean population. Therefore typical habits and dietetic influences have been discussed as well as genetic predisposition. Still, since the first description by Dupuytren in 1834 only little is known about the etiology and pathogenesis of this disease. Some hints were found for a higher prevalence among people with diabetes, alcohol abuse or smoking. Also, intensive manual work or hand injuries have been discussed to have an influence on DD. To our knowledge this is the largest retrospectively evaluated series of symptomatic patients published to date. The study includes patients from the last 50 years. It was performed to show possible correlations between DD and typical risk factors such as diabetes, alcohol consumption, and smoking. Methods We retrospectively analysed all patient records with DD documented between 1956 and 2006 in the Surgical University Hospital in Erlangen. Data acquisition was conducted by reviewing the medical records from 1956 to 2006 including data from all patients who were surgically treated because of DD. Results We reviewed 2579 male and 340 female surgically treated patients with DD. More than 80% of the patients were between 40 and 70 years old. In 28.9% only the right hand was effected by DD, in 25.3% only the left hand and in 45.8% both hands. In 10.3% of all Patients suffered from Diabetes mellitus. Statistical analysis revealed no significant correlation between diabetes, alcoholism or smoking on the degree of DD in our patients. Conclusion Most data are consistent with previously published results from smaller, comparable retrospective studies with regard to right- or left handedness. We could not confirm a statistically significant correlation of DD with diabetes mellitus, severe alcohol consumption, heavy smoking or epilepsy and the stage of the disease as described in

  16. Behandling af Dupuytrens kontraktur

    DEFF Research Database (Denmark)

    Raundrup Kornø, Maj; Søe, Niels Henrik; Dahlin, Lars B

    2015-01-01

    Dupuytren’s disease treatment Dupuytren’s disease is a hereditary fibroproliferative disease commonly affecting the palmar fascia of the hand, which results in progressive and irreversibly fixed flexion contractures of the hand. It may occur in the sole of the foot or in the penis. Gen­erally, tr......Dupuytren’s disease treatment Dupuytren’s disease is a hereditary fibroproliferative disease commonly affecting the palmar fascia of the hand, which results in progressive and irreversibly fixed flexion contractures of the hand. It may occur in the sole of the foot or in the penis. Gen...

  17. Lernen und Prüfen mit virtuellen Patienten am Zentrum für Kinder- und Jugendmedizin des Universitätsklinikums Heidelberg: Ergebnisse der Evaluation im Rahmen des E-Learning-Preises Baden-Württemberg 2007

    Directory of Open Access Journals (Sweden)

    Tönshoff, Burkhard

    2009-02-01

    Full Text Available Einleitung: Elektronische virtuelle Patienten kommen in der medizinischen Ausbildung zunehmend zum Einsatz. Evaluationen zur umfassenden curricularen Einbindung dieser innovativen E-Learning-Programme liegen bisher nicht vor. Methoden: Virtuelle Patienten wurden entsprechend wichtiger didaktischer Prinzipien gestaltet und seit Jahren sowohl zum Lernen als auch Prüfen im Rahmen des regulären Unterrichts von Medizinstudierenden in der Kinderheilkunde eingesetzt. Dieses Projekt wurde anhand eines Fragebogens des Kompetenzzentrums E-Learning Baden-Württemberg (Ulm evaluiert. Die Stichprobe bestand aus Studierenden des Pädiatrie-Moduls 4 (n=28, die dieses Modul an der Universität Heidelberg vom 25.6.–19.7.07 absolvierten. Ergebnisse: Der Rücklauf betrug 93%. Die Ergebnisse zeigten eine sehr hohe Akzeptanz, Relevanz und Anwenderfreundlichkeit, einen sehr hohen Grad der Integration in das Gesamtcurriculum und einen sehr guten Lernerfolg. Das Projekt erhielt aufgrund der Bewerbungsunterlagen und der Evaluationsergebnisse den 1. Platz des E-Learning-Preises Baden-Württemberg 2007. Diskussion: Die Stichprobe ist klein. Sie bestätigt jedoch die Ergebnisse vorangegangener systematischer Evaluationen mit großen Studierendenzahlen. Fazit: Die umfassende curriculare Einbindung virtueller Patienten wird von Studierenden als sinnvoll und das praxisnahe Lernen unterstützend angesehen.

  18. A ten years follow-up of the results of surgery for Dupuytren's disease. A study of fifty-eight cases.

    Science.gov (United States)

    Norotte, G; Apoil, A; Travers, V

    1988-01-01

    Fifty-eight patients (52 males and 6 females) operated on for Dupuytren contracture were examined by the same author with a more than ten year follow-up. At time of surgery the average was 55 years old. 69 hands (169 fingers) rated 4.33 according to the simplified Tubiana's score were treated by the same operative procedure: Mac Indoe's incision, digital Z plasty (if needed), subtotal fasciectomy and physiotherapy beginning 8 days postoperatively. At long term, recurrence appears for 49 hands (71%) one every two in the two first postoperative years, one out of five after five years. 24 of them were graded stage I. The recurrence appeared 14 times associated with an extension of the disease and the earlier, the higher was the initial stage. Some factors seem to be of a bad prognosis regarding recurrence: age (93% of recurrence under 50 years old) Ledderhose or Lapeyronie (100%) other associated diseases (Alcoholism, diabetes mellitus, epilepsy) and severe preoperative stage. Subjective results are good: 45 patients are satisfied and only 3 underwent a second operation.

  19. Activities for gaining insight into IASCC and continuous evaluation of in-service inspection data; Arbeiten zu IASCC und Kontinuierliche Auswertung und Bewertung der Ergebnisse der wiederkehrenden Pruefungen

    Energy Technology Data Exchange (ETDEWEB)

    Huettner, F.; Weber, G.; Wuensch, G.

    1999-06-01

    The report is a documentation of the important results of various international studies conducted to gain insight into the occurrence, mechanisms, and characteristic features of irradiation-assisted stress corrosion cracking, IASCC, as well as measures preventing IASCC in light water reactors. The major information can be summarised as follows: the number of cases of damage clearly induced by IASCC is low, as compared to the damage induced by intergranular stress corrosion cracking, IGSCC. In fact, recent information from a review of documented stress corrosion cracking damage of BWR type reactor internals reveals that an increasing number of cracks formerly thought to have been caused by IASCC now can be attributed to ICSCC as the most probable cause. Generally speaking, current knowledge of the impact of ionizing radiation on the corrosion resistance of LWR materials is rather insufficient. (orig./CB) [German] Ziel des Berichts ist es, die aus internationalen Untersuchungen bekannt gewordenen wichtigsten Erkenntnisse zu Umfang, Mechanismen, Charakterisierung und Vermeidung von IASCC in Leichtwasserreaktoren zusammenzufassen. Die Ergebnisse lassen sich wie folgt zusammenfassen: Die Zahl der eindeutig auf IASCC zurueckzufuehrenden Schadensfaelle ist gering im Vergleich zur Anzahl der Schaeden infolge interkristalliner Spannungsrisskorrosion (IGSCC). Insgesamt ist bei der Beurteilung von Risslorrosionsschaeden an RDB-Einbauten in SWR in juengerer Zeit die Tendenz zu verzeichnen, dass bei Rissbildungen, welche zunaechst ursaechlich der IASCC zugeordnet wurden, zunehmend interkristalline Spannungsrisskorrosion (IGSCC) als wahrscheinliche Schadensursache in Betracht gezogen wird. Insgesamt ist der Wissensstand ueber den Einfluss ionisierender Strahlung auf das Korrosionsverhalten von LWR-Werkstoffen noch lueckenhaft. (orig./MM)

  20. Indications for and results of CT colonography: from screening to the symptomatic patient; Indikationen und Ergebnisse der CT-Kolonographie: von der Vorsorge bis zum symptomatischen Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Graser, A.; Becker, C.R.; Reiser, M.F. [Klinikum Grosshadern der LMU Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany); Mang, T. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiodiagnostik, AKH Wien, Wien (Austria)

    2008-02-15

    CT colonography (CTC) is also referred to as virtual colonoscopy and is being used with increasing frequency in radiological practice. While there are still no generally accepted, clear-cut indications for its use in mass colorectal cancer screening, there is evidence that this investigation is useful in patients in whom colonoscopy has not been successful or who have known stenotic lesions in the colon. Recent results of significant comparative studies of CTC and conventional colonoscopy will have some influence on the future place of CTC in screening for cancer of the bowel; they show the great potential of CT-aided bowel examination. (orig.) [German] Die CT-Kolonographie (CTK), auch als virtuelle Koloskopie bezeichnet, wird zunehmend in der radiologischen Praxis eingesetzt. Waehrend fuer die reine Vorsorgeuntersuchung z. Z. noch keine rechtfertigende Indikation besteht, koennen symptomatische Patienten nach fehlgeschlagener Koloskopie oder zur Beurteilung des Darms proximal einer Stenose mittels CTK untersucht werden. Ergebnisse wichtiger Studien, die die CT-Kolonographie mit der herkoemmlichen Koloskopie vergleichen, beeinflussen die zukuenftige Position der Untersuchungsmethode beim Darmkrebsscreening. Vergleichsstudien mit der Koloskopie zeigen das grosse Potenzial der CT-gestuetzten Darmuntersuchung. (orig.)

  1. The Barrien natural gas deposit. Status, results and outlook of an interdisciplinary reservoir study; Die Erdgaslagerstaette Barrien. Status, Ergebnisse und Ausblick einer interdisziplinaeren Reservoirstudie

    Energy Technology Data Exchange (ETDEWEB)

    Baerle, C.; Beuthan, H. [Wintershall AG Erdoelwerke, Barnstorf (Germany); Weihe, T. [Wintershall AG, Kassel (Germany)

    1999-07-01

    Geological and geophysical investigation and modelling of the Detfurth series of the Barrien natural gas deposit provided new and detailed information on the reservoir horizon. Seismic reinterpretation yielded new findings especially on the crest region of the structure and verified the complex fault model. Core profiles, facial analysis and log correlation demonstrate the lateral distribution and horizontal variability of the sedimentary units and thus of the petrophysical characteristics (porosity, permeability). Petrographic investigations provided detailed, production-relevant information on sandstone cementation and pore space characteristics. The results were integrated in the geological models together with the known deposit parameters. [German] Die geologische-geophysikalische Bearbeitung und Modellierung der Detfurth-Folge in der Gaslagerstaette Barrien erbrachte neue und z.T. detailliertere Informationen ueber die Ausbildung der Traegerhorizontale. Die Reinterpretation der Seismik liefert hauptsaechlich im Scheitelbereich der Struktur neue Erkenntnisse und verifiziert das komplexe Stoerungsmodell. Die Kernaufnahme, fazielle Einstufung und Logkorrelation demonstriert die laterale Verbreitung sowie horizontale Variabilitaet der sedimentaeren Einheiten und damit der petrophysikalischen Werte (Porositaet, Permeabilitaet). Die petrographischen Untersuchungen erbrachten detaillierte und produktionsrelevante Informationen zur Sandsteinzementation und der Porenraumbeschaffenheit. Zusammen mit den bekannten Lagerstaettenparametern wurden diese Ergebnisse in die geologische Modellierung integriert. (orig.)

  2. Concepts to optimize stent-grafting of abdominal aortic aneurysms based on results of experimental studies; Konzepte zur Optimierung der Stentgraftversorgung von Bauchaortenaneurysmen auf der Basis tierexperimenteller Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Chavan, A.; Kirchhoff, T.; Baus, S.; Galanski, M. [Medizinische Hochschule Hannover (Germany). Abt. Diagnostische Radiologie 1; Pichlmaier, M. [Medizinische Hochschule Hannover (Germany). Leibniz Forschungslab. fuer Biotechnologie und Kuenstliche Organe an der Klinik fuer Thorax-, Herz- und Gefaesschirurgie

    2001-08-01

    ] Zielsetzung. Bei der endoluminalen Versorgung des Bauchaortenaneurysmas (BAA) stellen der kurze infrarenale Aneurysmahals, die Endoleckage und die grossen steifen Einfuehrsysteme wesentliche Problemstellen dar, die zu Komplikationen bzw. suboptimalen Ergebnissen fuehren. Ziel der vorliegenden Uebersichtsarbeit ist es, mit Hilfe der tierexperimentellen Literaturergebnisse Vorgehensweisen bzw. Empfehlungen zur Vermeidung dieser Komplikationen vorzustellen. Material und Methode. Nach Ueberdeckung der Nierenarterien mit verschiedenen Stentarten wurden die Auswirkungen auf die Nierenfunktion sowie auf die Nierenmorphologie von verschiedenen Arbeitsgruppen untersucht. Um eine progressive Erweiterung des proximalen Aneurysmahalses und somit eine Endograftdislokation zu vermeiden, wurde von Sonesson ein laparoskopisches 'Banding' der Aorta im Bereich des proximalen Halses bei Schweinen durchgefuehrt. Zur Ueberpruefung der Auswirkung von Endoleckagen fuehren Marty, Schurink und Pitton Druckmessungen in experimentellen Aneurysmen mit und ohne Endoleckagen durch. Zur Verkleinerung der Einfuehrbesteckgroessen wurden von Sakaguchi und Pavcnik die 'Twin-tube endografts' (TTEG) und die 'Bifurcated drum occluder endografts' (BDOEG) entwickelt und deren Effektivitaet bei Hunden ueberprueft. Ergebnisse. Chavan et al. beobachteten keinen signifikanten Abfall der mittleren Inulinclearance in Verlauf von 3 Monaten nach Ueberdeckung der Nierenarterienabgaenge (140{+-}46 ml/min vorher, 137{+-}58 ml/min nachher). Nasim et al. und Malina et al. beobachteten aehnliche Ergebnisse bzgl. der Nierenfunktion. Die suprarenale Verankerung fuehrte zu vereinzelten thrombotischen Verschluessen und Mikroinfarkten. Nach 'Banding' der Aorta waren die Aortendurchmesser der Versuchsgruppe in Hoehe des Bandes signifikant kleiner als die der Kontrollgruppe (8 mm Versuchsgruppe, 11 mm Kontrollgruppe, p=0,004). Das Banding sorgte fuer eine sichere Verankerung des Stentgrafts

  3. Autologous chondrocyte transplantation for the treatment of articular cartilage defects in the knee joint. Techniques and results; Autologe Chondrozytentransplantation zur Behandlung von Knorpeldefekten des Kniegelenks. Techniken und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Marlovits, S.; Kutscha-Lissberg, F.; Aldrian, S.; Resinger, C.; Singer, P.; Zeller, P.; Vecsei, V. [Universitaetsklinik fuer Unfallchirurgie, Medizinische Universitaet Wien (Austria)

    2004-08-01

    Currently the use of autologous chondrocytes as a cartilage-repair procedure for the repair of injured articular cartilage of the knee joint, is recommended. This review presents the technique of autologous chondrocyte transplantation (ACT) and their modifications as matrix-associated autologous chondrocyte transplantation (MACT). Beside the surgical procedure the experimental and clinical results are discussed. Furthermore the major complications and the indication guidelines are presented. Articular cartilage in adults has a poor ability to self-repair after a substantial injury. Surgical therapeutic efforts in treating cartilage defects have focused on bringing new cells capable of chondrogenesis into the lesions. With ACT good to excellent clinical results are seen in isolated posttraumatic lesions of the knee joint in the younger patient with the formation of hyalinelike repair tissue. The major complications are periosteal hypertrophy, delamination of the transplant, arthrofibrosis and transplant failure. The current limitations include osteoarthritic defects and higher patient age. With the right indication and operative technique ACT is an effective and save option for the treatment of large full thickness cartilage defect of the knee joint. (orig.) [German] Zur Behandlung umschriebener Defekte des artikulaeren Kniegelenkgelenkknorpels wird der Einsatz autologer Knorpelzellen zunehmend als neue biologische Methode empfohlen. Die Technik der autologen Chondrozytentransplantation (ACT) und deren Modifikationen als matrixassoziierte autologe Chondrozytentransplantation (MACT) werden dargestellt. Es erfolgt ein Ueberblick ueber die experimentellen und klinischen Ergebnisse mit der Darstellung der haeufigsten Komplikationen und den derzeit gueltigen Indikationsrichtlinien. Unter Verwendung qualitativ hochwertiger Zellen zeigen besonders posttraumatische Knorpeldefekte bei juengeren Patienten eine hohe Erfolgsquote mit der Ausbildung eines hyalinartigen

  4. Comparison of Treatment Outcome After Collagenase and Needle Fasciotomy for Dupuytren Contracture: A Randomized, Single-Blinded, Clinical Trial With a 1-Year Follow-Up.

    Science.gov (United States)

    Strömberg, Joakim; Ibsen-Sörensen, Allan; Fridén, Jan

    2016-09-01

    This study compared the efficacy of collagenase treatment and needle fasciotomy for contracture of the metacarpophalangeal (MCP) joint in Dupuytren disease. This is a prospective, single-blinded, randomized study with follow-up 1 week and 1 year after treatment. One hundred and forty patients with an MCP contracture of 20° or more in a single finger were enrolled, of whom 69 patients were randomized to collagenase treatment and 71 patients to needle fasciotomy. The patients were followed at 1 week and were examined by a physiotherapist after 1 year. Measurements of joint movement and grip strength were recorded as well as patient-perceived outcomes measured by the Unité Rhumatologique des Affections de la Main (URAM) questionnaire and a visual analog scale (VAS) for the estimation of procedural pain and subjective treatment efficacy. Eighty-eight percent of the patients in the collagenase group and 90% of the patients in the needle fasciotomy group had a reduction in their MCP contracture to less than 5° 1 week after treatment, and the median gains in passive MCP movement were 48° and 46°, respectively. The median VAS score for procedural pain was 4.9 of 10 in the collagenase group and 2.7 of 10 in the needle fasciotomy group. After 1 year, 90% of the patients in both groups had full extension of the treated MCP joint. One patient in each group had a recurrence of the contracture. The median improvement in URAM score was 8 units in both groups and the VAS estimation of treatment efficacy by the patients was 8.7 of 10 in both groups. There was no significant difference between the treatment outcomes after collagenase and needle fasciotomy treatment after 1 year. Therapeutic I. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. SOFC high-temperature fuel cell for decentralised energy supply - state of the art and first operating experiences; Die Hochtemperatur Brennstoffzelle SOFC in der dezentralen Energieversorgung - Technischer Stand und erste Betriebserfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Blum, L. [Siemens AG Energieerzeugung KWU, Erlangen (Germany); Sukkel, J. [NUON Milieubedrijf, Arnheim (Netherlands)

    1999-07-01

    Due to its high efficiency and environmental friendliness, which is accounted for by its perfect adaptability to natural gas, the SOFC high-temperature fuel cell is especially well suited for decentralised power and heat supply systems. While the planar SOFC version is still largely in the development stage, with units of up to 10kW under study at various research institutions, the pipe version of Siemens Westinghouse has already reached a more advanced technical stage. A first 100 kW demonstration plant is being operated in the Netherlands by the Dutch/Danish EDB/ELSAM consortium. Despite certain starting difficulties the first 6,000 operating hours showed a very satisfactory behaviour. Net electrical efficiency reached 46%, a globally unrivalled achievement for a plant of this size. Using this concept as a starting point Siemens plans to put demonstration plants of up to 3 MW into operation in the course of the next three years. [German] Die Hochtemperatur-Brennstoffzelle SOFC ist aufgrund ihres hohen Wirkungsgrades und ihrer Umweltfreundlichkeit und durch den problemlosen Einsatzes von Erdgas besonders gut fuer die dezentrale Versorgung mit Strom und Waerme geeignet. Waehrend sich die planare SOFC noch weitgehend im Entwicklungsstadium von Einheiten bis 10 kW befindet und in Deutschland vorwiegend an Forschungseinrichtungen untersucht wird hat das Roehrenkonzept von Siemens Westinghouse bereits einen fortgeschrittenen technischen Stand erreicht. Eine erste 100 kW Demo-Anlage wird in den Niederlanden von dem hollaendisch/daenischen Konsortium EDB/ELSAM betrieben. Trotz einiger Startschwierigkeiten zeigten die ersten 6000 Betriebsstunden ein sehr zufriedenstellendes Verhalten. Mit 46% elektrischem Nettowirkungsgrad wurde ein fuer Anlagen dieser Groessenordnung bislang weltweit einmaliger Wert erreicht. Die Siemens AG plant, basierend auf diesem Konzept, in den naechsten drei Jahren Demonstrationsanlagen bis 1 MW in Betrieb zu nehmen. (orig.)

  6. Iron-oxide-enhanced MR imaging of inflammatory atherosclerotic lesions: overview of experimental and initial clinical results; Eisenoxidverstaerkte MRT inflammatorischer atherosklerotischer Laesionen: Uebersicht experimenteller und erster klinischer Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schmitz, S.A. [Klinik und Poliklinik fuer Radiologie und Nuklearmedizin, Universitaetsklinikum Benjamin Franklin, Berlin (Germany)

    2003-04-01

    folgenden Uebersicht werden experimentelle und erste klinische Daten von der eisenoxidverstaerkten MRT atherosklerotischer Laesionen vorgestellt. (orig.)

  7. The Efficacy and Safety of Concurrent Collagenase Clostridium Histolyticum Injections for 2 Dupuytren Contractures in the Same Hand: A Prospective, Multicenter Study.

    Science.gov (United States)

    Gaston, R Glenn; Larsen, Søren Erik; Pess, Gary M; Coleman, Stephen; Dean, Brian; Cohen, Brian M; Kaufman, Gregory J; Tursi, James P; Hurst, Lawrence C

    2015-10-01

    To evaluate efficacy and safety of concurrent administration of 2 collagenase clostridium histolyticum (CCH) injections to treat 2 joints in the same hand with Dupuytren fixed flexion contractures (FFCs). Patients with 2 or more contractures in the same hand caused by palpable cords participated in a 60-day, multicenter, open-label, phase 3b study. Two 0.58 mg CCH doses were injected into 1 or 2 cords in the same hand (1 injection per affected joint) during the same visit. Finger extension was performed approximately 24, 48, or 72 or more hours later. Changes in FFC and range of motion, incidence of clinical success (FFC ≤ 5°), and adverse events (AEs) were summarized. The study enrolled 715 patients (725 treated joint pairs), and 714 patients (724 joint pairs) were analyzed for efficacy. At day 31, mean total FFC (sum of 2 treated joints) decreased 74%, from 98° to 27°. Mean total range of motion increased from 90° to 156°. The incidence of clinical success was 65% in metacarpophalangeal joints and 29% in proximal interphalangeal joints. Most treatment-related AEs were mild to moderate, resolving without intervention; the most common were swelling of treated extremity, contusion, and pain in extremity. The incidence of skin lacerations was 22% (160 of 715). Efficacy and safety were similar regardless of time to finger extension. Collagenase clostridium histolyticum can be used to effectively treat 2 affected joints concurrently without a greater risk of AEs than treatment of a single joint, with the exception of skin laceration. The incidence of clinical success in this study after 1 injection per joint was comparable to phase 3 study results after 3 or more injections per joint. Two concurrent CCH injections may allow more rapid overall treatment of multiple affected joints, and the ability to vary the time between CCH injection and finger extension may allow physicians and patients greater flexibility with scheduling treatment. Copyright © 2015 American

  8. Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Larson Debbie

    2011-06-01

    Full Text Available Abstract Background Dupuytren's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired hand function. Standard treatment involves surgical release or excision followed by post-operative hand therapy and splinting, however the evidence supporting night splinting is of low quality and equivocal. Methods A multi-centre, pragmatic, open, randomised controlled trial was conducted to evaluate the effect of night splinting on self-reported function, finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy. 154 patients from 5 regional hospitals were randomised after surgery to receive hand therapy only (n = 77 or hand therapy with night-splinting (n = 77. Primary outcome was self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. Primary analysis was by intention to treat. Results 148 (96% patients completed follow-up at 12 months. No statistically significant differences were observed on the DASH questionnaire (0-100 scale: adjusted mean diff. 0.66, 95%CI - 2.79 to 4.11, p = 0.703, total extension deficit of operated digits (degrees: adjusted mean diff 5.11, 95%CI -2.33 to 12.55, p = 0.172 or patient satisfaction (0-10 numerical rating scale: adjusted mean diff -0.35, 95%CI -1.04 to 0.34, p = 0.315 at 1 year post surgery. Similarly, in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes. Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving hand therapy and only splinted if and when contractures occurred. Given the added expense of therapists' time, thermoplastic materials and the potential inconvenience to

  9. Endovascular therapy of abdominal aortic aneurysm: results of a mid-term follow-up; Endovaskulaere Therapie von abdominellen Aortenaneurysmen: Klinisch-radiologishe Ergebnisse im mittelfristigen Verlauf

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Schweitzer, H.; Herber, S.; Thelen, M. [Universitaetsklinik Mainz (Germany). Klinik fuer Radiologie; Schmiedt, W.; Neufang, A. [Universitaetsklinik Mainz (Germany). Klinik fuer Herz-, Thorax-, und Gefaesschirurgie; Dueber, C. [Universitaetsklinikum Mannheim (Germany). Inst. fuer Diagnostische Radiologie

    2003-10-01

    following ineffective secondary coil embolization (n=1), and femorofemoral crossover bypasses (n=4). A total of 10 secondary conversion operations were performed because of damage to the membrane (n=4; 3 Vanguard endografts, 1 Talent endograft), significant caudal migrations (n=5; 4 Vanguard endografts, 1 Talent endograft) associated with type-I endoleaks (n=2), limb occlusion (n=1), disconnection of graft components (n=1), and significant endoluminal thrombus deposits (n=1). One patient, who was followed for 82 months, suffered from a significant endoleak for 10 months with increasing aneurysm diameter but he refused surgery. He was admitted with aneurysm perforation and was successfully operated with aortic graft replacement. Compared to group II, the incidence and size of endoleaks was reduced in group I (incidence 19.2% versus 29.9%, p<0.05). Group I demonstrated significantly better aneurysm shrinkage at 36 months follow-up ({delta} sagittal diameter -11.1{+-}8.4 mm versus -4.9{+-}6.2 mm, p<0.05). (orig.) [German] Zielsetzung: Prospektive Studie zur Erfassung der klinisch-radiologischen Ergebnisse und Komplikationen im mittelfristigen Verlauf nach endovaskulaerer Aneurysmatherapie. Material und Methoden: 122 Patienten (9 Frauen, 113 Maenner, Alter 70,9{+-}7,9 Jahre) mit abdominellen Aortenaneurysmen wurden mittels Stentprothesen endovaskulaer behandelt (Vanguard/Stentor n=53, Talent n=69). Patienten mit verschlossenen aortalen Seitenaesten im Aneurysmabereich (spontan oder, nach Embolisationsbehandlung) wurden in Gruppe I (n=40) zusammengefasst, Patienten mit mindestens einem perfundierten Seitenast in Gruppe II (n=82). Die Implantationen erfolgten zunaechst in Allgemeinnarkose (n=21), spaeter in Periduralanaesthesie (n=15) und schliesslich in Lokalanaestesie (n=86). Die Ergebniskontrollen erfolgten mittels Spiral-CT, MRT und Stent-Radiographie postinterventionell, nach 3, 6 und 12 Monaten, dann jaehrlich. Ergebnisse: Die Implantationen wurden in allen Faellen

  10. Visualization of coronary arteries in CT as assessed by a new 16 slice technology and reduced gantry rotation time: first experiences; Darstellung der Herzkranzgefaesse im CT mittels neuer 16-Zeilen-Technologie und reduzierter Rotationszeit: erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Heuschmid, M.; Kuettner, A.; Kopp, A.F.; Claussen, C.D. [Abt. Radiologische Diagnostik, Universitaetsklinikum Tuebingen (Germany); Flohr, T.; Schaller, S.; Hartung, A.; Ohnesorge, B. [Siemens Medical Solutions, Forchheim (Germany); Wildberger, J.E. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum (RWTH) Aachen (Germany); Lell, M.; Baum, U. [Abt. Innere Medizin IV (Kardiologie), Universitaetsklinikum Tuebingen (Germany); Schroeder, S. [Inst. fuer Diagnostische Radiologie, Universitaetsklinikum Erlangen (Germany)

    2002-06-01

    Purpose: First evaluation of image quality of a new 16-slice multidetector-row computed tomography (MDCT) for the assessment of coronary artery disease and lesion detection of the coronary arteries. Materials and Methods: On a newly developed 16-slice CT scanner (SOMATOM Sensation 16, Siemens, Forchheim, Germany) a calcium score as well as a contrast-enhanced CT angiography (CTA) were performed on 4 patients with retrospective ECG-gating and a gantry rotation time of 420 ms to exclude or follow-up coronary heart disease. CTA was performed after injecting 120 ml contrast media intravenously. After medication with a {beta}-Blocker, the heart rate was between 55 and 67 bpm. Results: The scan time for calcium score was 12s, for CTA 18s (scan range 15 and 12 cm, respectively). Volume score was between 0 and 256.4. In the CT angiography the entire coronary tree could be visualized in all patients up to the very distal subsegmental branches. In two patients a complete occlusion of the RCA and the LAD were depicted, respectively. In one of these patients, a large aneurysm of the left anterior ventricular wall was also delineated. Conclusion: Considering our first experiences with the new 16-slice technology, an excellent visualization of the entire coronary tree including the very distal and side branches due to substantially increased spatial resolution seems to be achievable. In these patients the acquired image quality raises the hope for improved, non-invasive cardiac diagnostics. In larger studies, the clinical impact of this new technology needs to be further investigated. (orig.) [German] Ziel: Darstellung erster Ergebnisse zur Bildqualitaet eines neuen 16-Zeilen Multidetektor-Computertomographen (MDCT) bei der Diagnostik der koronaren Herzerkrankung (KHK) und hochgradiger Stenosen der Herzkranzgefaesse. Material und Methode: Mit einem neuen 16-Zeilen-Computertomographen (SOMATOM Sensation 16, Siemens, Forchheim) wurde bei 4 Patienten zum Ausschluss oder

  11. First status seminar `Druckflamm`. Development of a coal-fuelled combined cycle process with liquid ash separation. Conference report; Erstes Statusseminar `Druckflamm`. Entwicklung eines kohlegefeuerten Gas- und Dampfturbinenprozesses mit Fluessigascheabscheidung. Tagungsband

    Energy Technology Data Exchange (ETDEWEB)

    Hannes, K. [ed.

    1999-09-01

    Six industrial enterprises in the Ruhr, plus several universities and national rsearch centers are working on the `Druckflamm` process of pressurized coal dust combustion, which is described in this status report and is scheduled to be implementable within the next 20 years. To this end, an experimental facility (DKSF) was constructed at Dorsten. The plant works by a coal-fuelled combined cycle process in which the flue gas can be led directly onto a gas turbine after purification. This means that the flue gas must be free of particulate materials and noxious vapours, i.e. a particle size of less than 3 mg/m{sup 3}, a particle diameter of less than 3 {mu}m and an alkali concentration of less than 1 ppm. The Dorsten plant is fuelled with coal; it has a thermal capacity of 1 MW and can be operated at pressures up to 20 bar. The contribution presents an outline drawing of the plant and a survey of the results and information obtained so far. Material problems and methods of measurement are reported separately. The fuel coals were of different composition, with slag flow points between 1200 and 1400 degrees centigrade. [Deutsch] Im Ruhrgebiet wird an einem neuen Verfahren zur Verstromung von Steinkohle gearbeitet. Es soll in etwa 20 Jahren mit einem neuen Kraftwerkstyp einsetzbar sein. Kennzeichen dieses Verfahrens sind ein hoher Wirkungsgrad von mehr als 50% und eine geringe CO{sub 2}-Emission. Entwickelt wird das ``Druckkohlenstaubfeuerung`` genannte Projekt von sechs Industrieunternehmen. Zusaetzlich arbeiten an diesem Thema weitere Unternehmen sowie Universitaeten und Grossforschungseinrichtungen unter dem Arbeitstitel ``Druckflamm``. Bisherige Ergebnisse der grundlegenden Entwicklungsarbeiten sind in diesem Statusbericht zusammengefasst. Ziel des Verbundprojektes Druckkohlenstaubfeuerung (DKSF) in Dorsten ist, einen GUD-Prozess auf Kohlebasis zu entwickeln, der dadurch charakterisiert ist, dass das Rauchgas nach Reinigung unmittelbar auf eine Gasturbine geleitet

  12. Operationsindikationen und Ergebnisse der Analplastik

    OpenAIRE

    2003-01-01

    Der Analkanal stellt eine wesentliche anatomisch physiologische Einheit zur Aufrechterhaltung der Analkontinenz dar. Dabei kommt der Sensorik des Anoderm eine besondere Rolle zu. Nicht mehr reponible, fixierte Hämorrhoiden 4. Grades können mit den Standardmethoden (Operation nach Milligan-Morgan oder Staplerresektion) nicht operiert werden, weil dadurch keine Reposition des vorgefallenen Anoderm in den Analkanal erfolgt sondern lediglich eine Resektion. Sie müssen mit der Analplas...

  13. 连续“Z”字成形术治疗掌腱膜挛缩症28例%Continuous Z shape plasty in treatment of 28 cases of Dupuytren's contracture

    Institute of Scientific and Technical Information of China (English)

    虞泽珑; 陈荣国; 蒋纯志; 曾怿; 欧先锋; 钱建吉

    2016-01-01

    目的:探讨连续“Z”字成形术治疗掌腱膜挛缩症的临床疗效。方法筛选2007年6月-2014年6月收治的掌腱膜挛缩症患者48例,作为研究对象。分为对照组与观察组,对照组20例,观察组28例。对照组应用“齿”状切口、“Z”字切口、“S”形切口、“L”形切口、直切口+“Z”字改形切口治疗掌腱膜挛缩症;观察组采用连续“Z”字成形术治疗掌腱膜挛缩症,比较两组患者并发症并通过随访复查统计其临床疗效。结果随访3个月~4年。对照组皮肤坏死率为35.0%(7/20),观察组皮肤坏死率为7.1%(2/28)。采用卡方检验比较统计两组之间的皮肤坏死率,χ2=4.255,P<0.05,两组术后皮肤坏死率差异有显著统计学意义。结论连续“Z”字成形术治疗掌腱膜挛缩症可显著提升其临床疗效,降低术后皮肤坏死率,具有临床应用及推广价值。%Objective To explore clinical effect of continuous Z-shape plasty in treatment of Dupuytren's contracture. Methods Selected 48 Dupuytren's contracture patients, who were treated from June 2007 to June 2014 in our hospital as the research object. They were divided into the experimental group and control group. There were 20 cases in the control group, and 28 cases in the experiment group. The control group was treated with dentate incision, Z shape incision, S shape incision, L shape incision or straight incision plus Z shape plasty incision. The experiment group adopted continuous Z shape plasty to treat Dupuytren's contracture, counted curative effect through comparing complications and follow-up review after operation. Results All the patients were followed up from 3 months to 4 years. In the control group postoperative skin necrosis rate was 35.0%(7/20), and 7.1%(2/28) in the experimental group. The Chi-square test was used to compare statistically the skin necrosis rate between the two groups, and the result showed the χ2 was 4

  14. Paradigmenwechsel in der Anti-Aging-Medizin: Hormesis, Target-of-Rapamycin-Komplex und erste Anti-Aging-Pillen // Paradigm Shift in Anti-Aging Medicine: Hormesis, Target of Rapamycin Complex and First Human Anti-Aging-Pills

    Directory of Open Access Journals (Sweden)

    Römmler A

    2016-01-01

    dieser Gesellschaften. Manche Maßnahmen der Lebensführung (z. B. kalorienreduzierte Ernährung, regelmäßiges Training verbessern die Altersgesundheit, dennoch benötigen viele zusätzlich Therapien gegen Krankheiten im Alter. Deren größter Risikofaktor ist „das Altern“ selbst.brIn Tiermodellen können durch bestimmte Substanzen und Lebensführung die gesunde Lebensspanne verlängert und das Altern verzögert werden. Dies wird durch physiologische Signalketten vermittelt, die evolutionär konserviert erscheinen. Im Mittelpunkt solcher Regulatoren steht der mTOR-Komplex („mechanistic Target of Rapamycin“. Er verknüpft Signale wie Energie-, Nahrungs- und Stressstatus mit grundlegenden Aktivitäten der Zelle, zu denen Proliferation versus Zellarrest sowie Reparatur versus Apoptose gehören.brDie Zellregulation auf solche Signale bzw. Stressoren erfolgt nicht linear, sondern biphasisch (U-förmig, glockenförmig als hormetisches Prinzip. Demnach führen milde Stress-Dosen zunächst zur Aktivierung von Reparatursystemen, womit sich die Zelle an solche „giftigen“ Reize adaptiert und widerstandsfähiger wird. Erst bei höheren Reizen kommt es zum Umkehreffekt und zu toxischer Schädigung. „Hormesis“ beschreibt plausibel die in Modellorganismen beobachteten Anti-Aging-Effekte solcher milden Reize, die sich durch verlängerte Lebensspanne bei verminderter Krankheitsinzidenz (Diabetes mellitus, Karzinome, Demenz auszeichnen.brEinige natürliche mTOR-Inhibitoren sind für humane Anwendungen bereits verfügbar. Hierzu zählen Resveratrol, Rapamycin (Sirolimus und Metformin, die von Bakterien, Pilzen oder Pflanzen jeweils als „Giftstoffe“ zur Abwehr von Fressfeinden gebildet werden. Erste Humandaten bei Diabetikern unter Metformin und bei Älteren mit Immunseneszenz unter Rapamycin zeigen bereits Anti-Aging-Effekte, was neue Perspektiven für die Altersmedizin eröffnet.

  15. Interkulturelle Kompetenz in der Facharztausbildung von Psychiatern in Deutschland: Ergebnisse einer Umfrage [Intercultural competence in the psychiatric training curriculum in Germany: Results of a survey

    Directory of Open Access Journals (Sweden)

    Machleidt, Wielant

    2008-08-01

    Psychiatrie und Psychotherapie in Deutschland. Methodik: Es wurde ein semistrukturierter Fragebogen mit 30 Fragen (davon 28 strukturiert, 2 mit Freitextangaben entwickelt, der sich an den „Local Survey of Realities in Transcultural Psychiatry“ der (APA anlehnt und für Deutschland modifiziert wurde. Dieser wurde an die Leiter aller psychiatrischen Weiterbildungsinstitutionen in Deutschland verschickt (n=450. Als psychiatrische Weiterbildungsinstitutionen wurden diejenigen klinischen Einrichtungen definiert, deren Leiter über eine Ermächtigung zur Facharztweiterbildung durch die Landesärztekammern verfügen. Der Rücklauf erfolgte nicht anonymisiert. Ergebnisse: Die Rücklaufquote betrug 25,5% (Gesamt-N=114. In 71,7% der Weiterbildungsinstitutionen (n=81/113 gültige Fälle wurden in der klinikinternen Weiterbildung Themen aus dem Gebiet der transkulturellen Psychiatrie selten oder gar nicht angesprochen. 83,3% der Weiterbildungsleiter (n=70/84 gültige Fälle formulierten Bedarf an Weiterbildung in transkultureller Psychiatrie für die jeweils eigene Institution, 94,5% (n=69/73 gültige Fälle sahen den Bedarf grundsätzlich auch für das Curriculum der Facharztausbildung in Psychiatrie und Psychotherapie. Die am häufigsten genannten Themen betrafen eine allgemeine Schulung kultureller Kompetenz sowie kulturspezifische Aspekte seelischer Erkrankungen. Schlussfolgerungen: Im Rahmen der Weiterbildungsordnung zum Facharzt für Psychiatrie und Psychotherapie sind aktuell in keinem Bundesland entsprechende Inhalte aus dem Bereich der transkulturellen Psychiatrie verankert. Angesichts des formulierten Bedarfs muss die Implementierung eines entsprechenden Curriculums in die Weiterbildungsordnung zum Facharzt für Psychiatrie und Psychotherapie diskutiert werden.

  16. Thorotrast-induced liver cancer: results of the German thorotrast study; Thorotrast-induzierte Tumoren der Leber. Ergebnisse der Deutschen Thorotraststudie

    Energy Technology Data Exchange (ETDEWEB)

    Kaick, G. van; Bahner, M.L.; Liebermann, D.; Luehrs, H.; Wesch, H. [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie

    1999-08-01

    fuehrt zu einer chronischen Exposition durch {alpha}-Strahlung. Ziel der Deutschen Thorotraststudie sind die Erfassung der Strahlenspaetfolgen und die Berechnung des Strahlenrisikos. Patienten und Methoden: Die Deutsche Thorotraststudie laeuft seit 1968 im Sinn einer Kohortenstudie und umfasst 2326 Thorotrastpatienten und 1890 Patienten einer Kontrollgruppe. Bei den noch lebenden Thorotrastpatienten wurden Roentgenaufnahmen der Oberbauchorgane und der frueheren Injektionsstelle sowie Messungen mit dem Ganzkoerperzaehler durchgefuehrt. Zur fruehen Erkennung von Lebertumoren wurden den Patienten in regelmaessigen Abstaenden sonographische und spaeter computertomographische und magnetresonanztomographische Untersuchungen angeboten. Ergebnisse: In der Gruppe der Thorotrastpatienten traten bisher 454 primaere Lebertumoren auf, im Vergleich zu 3 Lebertumoren in der Kontrollgruppe. Bei einem Teil der Patienten konnten mit Hilfe moderner bildgebender Verfahren relativ kleine Lebertumoren nachgewiesen werden, die z.T. einer chirurgischen Therapie zugaenglich waren. Diskussion: Es besteht eine Korrelation zwischen der akkumulierten mittleren Dosis in der Leber und der Inzidenz von malignen Lebertumoren. Das kumulative Risiko fuer Lebermalignome liegt bei etwa 600 Erkrankungen pro 10{sup 4} Personen, deren Leber mit 1 Gy exponiert wurde. Auch fuer Leberzirrhosen besteht eine Korrelation zwischen akkumulierter Dosis und Inzidenz der Erkrankung. (orig.)

  17. Retrospective results of radiation therapy of the Eustachian tube in chronic otitis media; Retrospektive Ergebnisse der perkutanen Strahlentherapie der Tuba Eustachii bei chronischer Otitis media

    Energy Technology Data Exchange (ETDEWEB)

    Schultze, J.; Reinke, C.; Kimmig, B. [Klinik fuer Strahlentherapie (Radioonkologie), Universitaetsklinikum Kiel (Germany); Frese, K.A. [Klinik fuer Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitaetsklinikum Kiel (Germany)

    2003-01-01

    Methoden: Zwischen 1980 und 1997 wurden 66 Patienten vorgestellt. Der Altersmedian war bei 58 Jahren. Klinisch lag bei allen Patienten eine Hoerminderung vor, 35 Patienten gaben Schmerzen, 21 weitere Ohrfluss an. 20 Patienten klagten ueber rezidivierende Infekte. Die Beschwerden bestanden im Median 4,7 Jahre, die primaer konservative (Adstringentien, Antibiotika) und operative Therapie (Parazentese, Paukenroehrchen, Tympanoplastik) hatte keine dauerhafte Besserung erbracht. Bei 40 der 66 Patienten erfolgte schliesslich eine perkutane Radiotherapie beider Tuben ueber opponierende Stehfelder und eine Gesamtdosis von 6 Gy bei Einzeldosen von 1 Gy dreimal woechentlich. Unter den Ausschlussgruenden fuer eine Strahlentherapie waren Ablehnung des Patienten (neunmal), radiogene Vorbelastungen (sechsmal) und spontane Besserung nach initialer Vorstellung. Die Ergebnisevaluation erfolgte ueber die subjektiven Angaben der Patienten und den HNO-aerztlichen Untersuchungsbefund. Ergebnisse: Es traten keine Nebenwirkungen auf. 28 der 40 bestrahlten Patienten (70%) gaben eine auch HNO-aerztlich objektivierbare symptomatische Besserung an. In der Gruppe der nicht bestrahlten 26 Patienten, von denen 22 evaluiert werden konnten, gaben 16 (72%) unveraendert Beschwerden und ein Persistieren der Otitis media an. In einer Subgruppenanalyse hinsichtlich der Beschwerdedauer zeigte sich die Strahlentherapie bei den akuten und subakuten Faellen als sehr effektiv, waehrend die Patienten in einem chronischen Stadium, mehr als 5 Jahre nach Diagnosestellung, kaum noch auf die Radiotherapie reagierten. Schlussfolgerung: Die Radiotherapie ist eine geeignete Methode zur symptomatischen Besserung der therapierefraktaeren chronischen Otitis media. Eine Dosis von 6 Gy scheint ausreichend zum Erreichen einer antiinflammatorischen Wirkung. Die Strahlentherapie sollte bereits nach Versagen der initial erfolglosen konservativen und operativen Therapie durchgefuehrt werden. (orig.)

  18. Computed tomography in the diagnosis of inflammatory bowel disease - methodics of MSCT and clinical results; Die Computertomographie in der Diagnostik entzuendlicher Darmerkrankungen: Methodik der MSCT und klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Bitterling, H.; Rock, C.; Reiser, M. [Institut fuer Klinische Radiologie, Klinikum der Universitaet Muenchen (Germany)

    2003-01-01

    eine medikamentoese Relaxation. Die Darmkontrastierung kann mit positivem hyperdensem oder negativem hypodensem Kontrastmittel (KM) erfolgen.Ergebnisse Die MSCT gestattet die Duennschichtuntersuchung des gesamten Abdomens, MPR- und MIP-Duennschichtrekonstruktionen hoher Qualitaet werden ermoeglicht. Das Sellink-CT ermoeglicht aufgrund ueberlegener Darmdistension die bessere Beurteilbarkeit von Stenosierungen oder Darmwandveraenderungen.Aufgrund sicherer Differenzierung zwischen Intra- und Extraluminalraum eignet sich positives KM zum Nachweis von Abszessen, Fisteln,Konglomerattumoren und zur OP-Vorbereitung. Negatives KM erleichtert die quantitative Auswertung von Darmwandverdickung und -enhancement sowie den Nachweis einer gastrointestinalen Blutung.Diskussion In der Duenndarmdiagnostik zeigt die CT deutliche Vorteile gegenueber dem konventionellen Enteroklysma bei der Diagnostik mesenterialer und extraintestinaler Komplikationen, zusaetzlich wird der Kolonrahmen mit erfasst.Die Strahlendosis liegt bei der CT niedriger (7,8-13,3 mSv) als beim Enteroklysma (13,99{+-}7,57 mSv). Die CT bietet sich als Alternative bei undurchfuehrbarer Koloskopie an, in der Notfalldiagnostik (Divertikulitis) hat sie sich bereits etabliert. (orig.)

  19. Application of the results of pipe stress analyses into fracture mechanics defect analyses for welds of nuclear piping components; Uebernahme der Ergebnisse von Rohrsystemanalysen (Spannungsanalysen) fuer bruchmechanische Fehlerbewertungen fuer Schweissnaehte an Rohrleitungsbauteilen in kerntechnischen Anlagen

    Energy Technology Data Exchange (ETDEWEB)

    Dittmar, S.; Neubrech, G.E.; Wernicke, R. [TUeV Nord SysTec GmbH und Co.KG (Germany); Rieck, D. [IGN Ingenieurgesellschaft Nord mbH und Co.KG (Germany)

    2008-07-01

    For the fracture mechanical assessment of postulated or detected crack-like defects in welds of piping systems it is necessary to know the stresses in the un-cracked component normal to the crack plane. Results of piping stress analyses may be used if these are evaluated for the locations of the welds in the piping system. Using stress enhancing factors (stress indices, stress factors) the needed stress components are calculated from the component specific sectional loads (forces and moments). For this procedure the tabulated stress enhancing factors, given in the standards (ASME Code, German KTA regulations) for determination and limitation of the effective stresses, are not always and immediately adequate for the calculation of the stress component normal to the crack plane. The contribution shows fundamental possibilities and validity limits for adoption of the results of piping system analyses for the fracture mechanical evaluation of axial and circumferential defects in welded joints, with special emphasis on typical piping system components (straight pipe, elbow, pipe fitting, T-joint). The lecture is supposed to contribute to the standardization of a code compliant and task-related use of the piping system analysis results for fracture mechanical failure assessment. [German] Fuer die bruchmechanische Bewertung von postulierten oder bei der wiederkehrenden zerstoerungsfreien Pruefung detektierten rissartigen Fehlern in Schweissnaehten von Rohrsystemen werden die Spannungen in der ungerissenen Bauteilwand senkrecht zur Rissebene benoetigt. Hierfuer koennen die Ergebnisse von Rohrsystemanalysen (Spannungsanalysen) genutzt werden, wenn sie fuer die Orte der Schweissnaehte im Rohrsystem ausgewertet werden. Mit Hilfe von Spannungserhoehungsfaktoren (Spannungsindizes, Spannungsbeiwerten) werden aus den komponentenweise berechneten Schnittlasten (Kraefte und Momente) die benoetigten Spannungskomponenten berechnet. Dabei sind jedoch die in den Regelwerken (ASME

  20. Entwicklung eines Fragebogens zur Erfassung von Kompetenzen in der Medizin: Ergebnisse zur Reliabilität und Validität [Development of a questionnaire to assess medical competencies: Reliability and validity of the Questionnaire

    Directory of Open Access Journals (Sweden)

    Giesler, Marianne

    2011-05-01

    Kompetenzbereiche stimmen im Wesentlichen mit den CanMEDS-Rollen überein. Methode: Um die Reliabilität und Validität des Fragebogens zu überprüfen, wurden seit Mai 2008 mehrfach Studierende und Assistenzärzte befragt. In dem vorliegenden Beitrag werden die Ergebnisse einer Querschnittsstudie berichtet, in der 698 Studierende des ersten und zweiten Studienabschnitts den FKM beantwortet haben. Des Weiteren werden die Ergebnisse von 514 Assistenzärzten mit bis zu zwei Jahren Berufserfahrung beschrieben, die den FKM im Rahmen einer Absolventenbefragung ausgefüllt haben.Ergebnisse und Schlussfolgerungen: Die bisherigen Ergebnisse zeigen, dass die einzelnen Kompetenzskalen des FKM hinreichend reliabel sind (Cronbach's α=.68 bis .97. Mittelwertunterschiede zwischen ausgewählten Gruppen von Studierenden stützen die Annahme der Konstruktvalidität des Verfahrens. Zudem gibt es Hinweise darauf, dass der FKM zumindest ab dem 2. Abschnitt des Studiums der Humanmedizin und im Rahmen von Absolventenstudien als Screening-Instrument eingesetzt werden kann, um Schwächen in der Ausbildung festzustellen.

  1. Prediction of the flooding process at the Ronneburg site - results of an integrated approach; Flutungsprognose am Standort Ronneburg - Ergebnisse eines integrierten Modellansatzes

    Energy Technology Data Exchange (ETDEWEB)

    Paul, M.; Saenger, H.-J.; Snagowski, S. [Wismut GmbH, Chemnitz (Germany); Maerten, H. [UIT Dresden (Germany); Eckart, M. [Geocontrol Gera (Germany)

    1998-12-31

    Charakterisierung der Standortverhaeltnisse im Endstand der Flutung dient ein dreidimensionales Grossraummodell, welches bestehende Teilmodelle integriert und eine Verknuepfung mit dem Boxmodell gestattet. Die Ergebnisse durchgefuehrter Variantenrechnungen zeigen, dass trotz noch bestehender Unsicherheiten von wichtigen Eingangsparametern fundierte Aussagen ueber den Nachflutungszustand ableitbar sind. Der Wasserspiegel wird sich im Endflutungszustand im Zentralteil des Ronneburger Reviers bei >270 mNN einstellen. Derzeitige Arbeiten konzentrieren sich auf die Ermittlung detaillierterer Modellparameter fuer eines der drei wesentlichen potentiellen Austrittsgebiete der Flutungswaesser sowie die Modellkalibrierung durch Abgleich mit dem Flutungsmonitoring. (orig.)

  2. The diagnosis and treatment of Dupuytren' s contracture combined with carpal tunnel syndrome%掌腱膜挛缩症合并腕管综合征的诊断和治疗

    Institute of Scientific and Technical Information of China (English)

    李建峰; 赵亮; 刘井达; 王小磊; 赵民; 李大村

    2012-01-01

    Objective To investigate the correlation of Dupuytren's contracture and carpal tunnel syndrome and evaluate the clinical outcomes of treating both diseases in one surgery. Methods From March 2003 to August 2011,8 cases of Dupuytren's contracture combined with carpal tunnel syndrome were surgically treated.Through an M-shaped palm incision and a Y-shaped incision extended to the finger,the palmar aponeurosis was partially removed and the flexor retinaculum was cut open to release the median nerve at the same time. Results Primary wound healing was achieved in all of the eight cases.There were no flap edge necrosis and hematoma formation.Numbness of the thumb,index finger and middle finger gradually reduced postoperatively.The numbness disappeared after 3 months.All patients were follow-up for 6 months to 2 years with no recurrence. Conclusion When more predisposing factors of both diseases occur in one patient,the probability of the occurrence of both Dupuytren' s contractue and carpal tunnel syndrome in one patient also increases significantly.The two diseases can be treated in one surgery.%目的 探讨掌腱膜挛缩症与腕管综合征的相关性及一次完成两种手术的治疗效果.方法 2003年3月至2011年8月,对8例掌腱膜挛缩症合并腕管综合征的患者,其中右手5例、左手3例,设计手掌部“M”形切口,或同时加手指的“Y”形切口,同时切除部分掌腱膜,行屈肌支持带切开、正中神经松解术.结果 术后全部伤口均Ⅰ期愈合,无皮瓣边缘坏死及血肿形成,术后拇、示、中指麻木逐渐减轻,术后3个月手指麻木全部消失.术后随访时间为6个月至2年,掌腱膜挛缩无复发.结论 掌腱膜挛缩症与腕管综合征两种疾病的诱发因素较多地发生在同一个体时,两种疾病同时并发的几率明显增加,可通过一次手术完成.

  3. Early results with a monorail-stent-balloon device for endovascular treatment of renal artery stenosis; Erste Erfahrungen mit einem Monorail-Stent-Ballon-System zur endovaskulaeren Behandlung von Nierenarterienstenosen

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Huelsbeck, S.; Jahnke, T.; Grimm, J.; Behm, C.; Hilbert, C.; Frahm, C.; Biederer, J.; Brossmann, J.; Heller, M. [Kiel Univ. (Germany). Klinik fuer Diagnostische Radiologie

    2002-03-01

    transfemoralen (n = 35) oder transbrachialen Zugang (n = 6) implantiert. Stenosegrad und -laenge betrugen 88{+-}10% bzw. 8{+-}5 mm. Ergebnisse: Die renale Stentimplantation war in allen Faellen (100%) technisch erfolgreich. In 7 Faellen musste ein zweiter Stent zur vollstaendigen Erfassung der Laesion implantiert werden. Der transstenotische Druckgradient reduzierte sich von 88{+-}10 mmHg vor auf 1{+-}1,8 mmHg nach Stentimplantation. Der Reststenosegrad betrug 0,7{+-}4,2%. Das Serumkreatinin sank nach der Intervention von 1,9 mg/dl auf 1,5 mg/dl (n.s.), der Blutdruck sank von 178/94 mmHg auf 148/79 mmHg (p<0,0001). Die primaere und sekundaere Offenheitsrate (Kaplan-Meier) betraegt nach 6 Monaten 72% (Standard Error 9,8%) bzw. 77% (Standard Error 9,2%). Schlussfolgerungen: Das verwendete Monorail-Stent-Ballon-System gewaehrleistet in der vorgestellten Technik technisch einfache, sicher durchfuehrbare renale Stentplatzierungen, die Offenheitsraten entsprechen den bisher in der Literatur bekannten. (orig.)

  4. Initial clinical experience with a new percutaneous peripheral atherectomy device for the treatment of femoro-popliteal stenoses; Erste klinische Erfahrungen mit einem neuen Atherektomiekatheter zur Behandlung femoro-poplitealer Stenosen

    Energy Technology Data Exchange (ETDEWEB)

    Zeller, T.; Frank, U.; Buergelin, K.; Schwarzwaelder, U.; Neumann, F.J. [Herz-Zentrum Bad Krozingen (Germany). Abt. Angiologie; Krankenberg, H. [Kardiologische Gemeinschaftspraxis Mathey, Schofer u. Partner, Hamburg (Germany); Reimers, B. [Centro Civile Mirano (Italy)

    2004-01-01

    einem Gefaessdurchmesser von 2,5-7 mm (Phase-2-Studie). Material und Methoden: Wir behandelten 58 femoro-popliteale Stenosen bei 46 Patienten (67% maennlich, mittleres Alter 66 {+-} 9 Jahre) mit chronischer AVK der unteren Extremitaeten [Rutherford Stadium 2: n = 13 (28%); Stadium 3: n = 29 (63%); Stadium 4: 2 (4%); Stadium 5: n = 2 (4%)] mit direktionaler Atherektomie. Zielgefaesscharakteristika: A. femoralis communis: n = 1 (2%); A. Femoralis superficialis: n = 47 (81%); A. poplitea: n = 10 (17%); intrastent: n = 3 (5%). Dreissig (65%) der Interventionen wurden antegrad, 16 (35%) cross-over durchgefuehrt. Der mittlere Stenosegrad betrug 83 {+-} 11%, die mittlere Stenoselaenge war 37 {+-} 37 mm. Ergebnisse: Es folgen 6.5 {+-} 2 (4-10) Katheterpassagen, 3 Laesionen wurden nach Vordilatation atherektomiert, 55 (95%) primaer. Bei 31/58 Stenosen (53%) erfolgte eine zusaetzliche Ballondilatation, bei einer Intervention (2%) eine zusaetzliche Stentimplantation. Der mittlere Stenosegrad nach Atherektomie betrug 29 {+-} 20% (0-60%), nach zusaetzlicher Ballondilatation 11 {+-} 10% (0-30%); eine Reststenose < 50% verblieb nach alleiniger Atherektomie bei 55 (95%) Stenosen, < 30% bei 49 (84%) Faellen. Komplikationen: 3 (6,5%) periphere Embolien von atherektomierten Wandbestandteilen, jeweils durch Aspiration komplett entfernt. Der mittlere Knoechel-Arm-Index stieg von 0,65 {+-} 0,17 auf 0,92 {+-} 0,36 bei Entlassung und 0,85 {+-} 0,17 nach 30 Tagen. Rutherford Stadien nach 30 Tagen: Stadium 0: n = 38 (83%); Stadium 1: n = 4 (8%); Stadium 2: n = 3 (6%); Stadium 5: n = 1 (2%). (orig.)

  5. Results of positron emission tomography with fluorine-18-labelled fluorodeoxyglucose in staging and differential diagnosis of pancreatic cancer; Ergebnisse der Positronenemissionstomographie mit Fluor-18-markierter Fluordesoxyglukose bei Differentialdiagnose und Staging des Pankreaskarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Bares, R. [Abt. fuer Nuklearmedizin, Radiologische Universitaetsklinik Tuebingen (Germany); Dohmen, B.M. [Abt. fuer Nuklearmedizin, Radiologische Universitaetsklinik Tuebingen (Germany); Cremerius, U. [Technische Hochschule Aachen (Germany). Klinik fuer Nuklearmedizin; Fass, J. [Technische Hochschule Aachen (Germany). Chirurgische Klinik; Teusch, M. [Abt. fuer Nuklearmedizin, Radiologische Universitaetsklinik Tuebingen (Germany); Buell, U. [Technische Hochschule Aachen (Germany). Klinik fuer Nuklearmedizin

    1996-05-01

    Nachweis morphologischer sondern metabolischer Tumorcharakteristika beruht. Bei 85 Patienten mit vermutetem Pankreaskarzinom wurde praeoperativ eine FDG-PET durchgefuehrt und der Befund mit der histopathologischen Aufarbeitung des Operationspraeparats verglichen. Von 55 malignen Tumoren konnten 47 anhand ihres Hypermetabolismus korrekt klassifiziert werden (85%), 23 von 30 benignen Tumoren (77%) wiesen keine Stoffwechselsteigerung auf (richtig-negativ). In der Ausbreitungsdiagnostik zeigte PET in 19 von 31 Faellen (61%) korrekt das Vorliegen regionaler Lymphknotenmetastasen, in 7 von 13 Faellen (54%) eine Lebermetastasierung an. Falsch negative Befunde fanden sich bei Diabetikern (5 von 8 unentdeckten Primaertumoren) waehrend falsch positive Ergebnisse mehrheitlich (4 von 7) auf akut entzuendliche Veraenderungen bei chronischer Pankreatitis zurueckzufuehren waren. Diese Ergebnisse belegen, dass durch die FDG-PET eine Verbesserung der Diagnostik unklarer pankreatischer Raumforderungen erreicht werden kann, die zu einer Reduktion unnoetiger Laparatomien beitragen koennte. (orig.)

  6. Statistical results 1988-1990 of the Official Personal Dosimetry Service and data compilation 1980-1990; Statistische Ergebnisse aus der amtlichen Personendosisueberwachung 1988-1990 und Zusammenfassung 1980-1990

    Energy Technology Data Exchange (ETDEWEB)

    Boerner, E.; Drexler, G.; Scheibe, D.; Schraube, H.

    1994-08-01

    The report consists of a summary of relevant statistical data in the official personal dosimetry in 1988-1990 for the Federal States of Bavaria, Hesse, Schleswig-Holstein, and since 1989, Baden-Wuerttemberg. The data are based on the survey of more than 8000 institutions with over 100000 occupational exposed persons and are derived from more than one million single measurements. The report covers informations on the institutions, on the persons as well as dosimetric values. The measuring method is described briefly with respect to dosimeters used, their range and the interpretation of values. Information on notional doses and the interpolation of values nearby the detection limits are given. (HP) [Deutsch] Der Bericht enthaelt eine Zusammenfassung der wichtigsten statistischen Ergebnisse der Personendosisbewachung fuer die Bundeslaender Bayern, Hessen, Schleswig-Holstein und seit 1989, Baden-Wuerttemberg. Die Daten basieren auf ueber 8000 ueberwachten Betrieben mit mehr als 100000 Personen, d.h. mehr als 1 Million Einzelmessungen. Es werden betriebs- und personenspezifische Daten und dosimetrische Daten erfasst. Bei letzteren werden neben Dosimetereigenschaften wie Anwendungsbereich, Messbereich usw. auch allgemeine Verfahren wie Festlegung von Ersatzdosen und die Rundung der Messwerte, besonders im Bereich der unteren Messgrenze, dargestellt. (HP)

  7. Contribuição das moléculas de antígeno de histocompatibilidade leucocitária (HLA para a contratura de Dupuytren em uma população do Sudeste do Brasil

    Directory of Open Access Journals (Sweden)

    Sônia Maria Ruiz Silva Usó

    2014-01-01

    Full Text Available Objetivo: O objetivo deste estudo foi investigar o fenótipo do HLA em pacientes com contratura de Dupuytren (CD para verificar a correlação desses alelos com os fatores de risco para o desenvolvimento da CD na população brasileira. Métodos: Este foi um estudo de caso-controle de 25 pacientes com CD e 443 indivíduos saudáveis sem histórico de doenças associadas ao HLA. As tipagens classe I e classe II do HLA foram feitas utilizando o método iniciador de sequências específicas da reação em cadeia da polimerase. Resultados: O fenótipo HLA-B*18 foi observado em 32% dos pacientes e 10,5% do grupo controle. Contudo, os valores de p não permaneceram significativos após correção. Discussão: Apesar de termos observado um aumento na tendência de os pacientes com CD terem o alelo HLA-B*18, os resultados não foram estatisticamente significativos após correção. Esse alelo foi maior em pacientes de etnia italiana e/ou espanhola, locais com frequências superiores a 18% e 14%, respectivamente. São necessárias investigações adicionais com uma coorte maior de pacientes com CD para confirmar o possível papel do HLA nessa doença.

  8. Concurrent chemotherapy and radiation therapy for unresectable locally advanced carcinoma of the esophagus. Phase II study and clinical review on literature; Primaere Radiochemotherapie inoperabler fortgeschrittener Oesophaguskarzinome. Ergebnisse einer Phase-II-Studie und Literaturuebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Fritz, P. [Abt. Klinische Radiologie (Schwerpunkt Strahlentherapie und Poliklinik) der Univ. Heidelberg (Germany); Klinik fuer Radioonkologie, St.-Marien-Krankenhaus, Siegen (Germany); Stoll, P. [Inst. fuer Diagnostische und Interventionelle Radiologie, Krankenhaus Muenchen-Schwabing, Muenchen (Germany); Wannenmacher, M.; Zierhut, D. [Abt. Klinische Radiologie (Schwerpunkt Strahlentherapie und Poliklinik) der Univ. Heidelberg (Germany)

    2003-05-01

    . Due to the heterogeneous data available, the value of the primary, sequential treatment combining chemotherapy and radiation therapy is uncertain. (orig.) [German] Hintergrund: Weder die chirurgischen noch die strahlentherapeutischen Fortschritte konnten die Mortalitaet des Oesophaguskarzinoms signifikant senken. Die seit Jahrzehnten unbefriedigenden Ergebnisse von ''Stahl und Strahl'' motivieren zu multimodalen Therapiekonzepten. Patienten und Methodik: Bei 50 Patienten mit inoperablen lokal fortgeschrittenen Oesophaguskarzinomen wurde eine palliative simultane Radiochemotherapie nach dem ''Intent to treat''-Prinzip durchgefuehrt. Es sollte eine Mindestdosis von 40 Gy angestrebt werden. Die simultane Chemotherapie wurde mit Cisplatin/5-FU in der 1. und 4. Bestrahlungswoche durchgefuehrt. Bei partieller oder kompletter Remission sollte die Chemotherapie als Erhaltungstherapie mit maximal vier Zyklen fortgesetzt werden. Bei ''No Change'' oder ''Minor Response'' sollte statt einer Erhaltungschemotherapie eine Erhoehung der lokalen Strahlendosis mittels Brachytherapie durchgefuehrt werden. Ergebnisse: Die mediane Ueberlebenszeit des Gesamtkollektivs betrug 8,7 Monate. Die 1-, 2-, 3-, 4- und 5-Jahres-Ueberlebensraten waren: 38%, 20,5%, 13,7%, 6,8% und 6,8%. Die Remissionsraten waren NC: 14 Patienten (28%), PR: 32 Patienten (64%) und CR: vier Patienten (8%). Die volle simultane Chemotherapie vertrugen 17 (34%), eine simultane und adjuvante Chemotherapie nur zwoelf Patienten (24%). Mit dem Ueberleben korrelierten signifikant: die Intensitaet der Chemotherapie, der Karnofsky-Index, das Lebensalter sowie die Verbesserung der oralen Ernaehrungsmoeglichkeit. Schlussfolgerungen: Die simultane Chemotherapie war toxisch und der Benefit fuer den Patienten fraglich. Metaanalysen randomisierter Studien auf der Basis der ''Evidence-based Medicine'' koennen fuer die simultane

  9. Konjunktur aktuell: Zyklische Wende in Deutschland steht unmittelbar bevor

    OpenAIRE

    2002-01-01

    Das IWH nimmt die Veröffentlichung der gesamtwirtschaftlichen Ergebnisse für 2001 durch das Statistische Bundesamt zum Anlass, seine Konjunkturprognose für Deutschland und für Ostdeutschland vom Dezember 2001 für das laufende Jahr zu aktualisieren. Zugleich gibt es eine erste Vorausschätzung für das Jahr 2003 ab.

  10. Sexuelles Verlangen und sexuelle Aktivität von Männern und Frauen über die Lebensspanne - Ergebnisse einer repräsentativen deutschen Bevölkerungsumfrage

    Directory of Open Access Journals (Sweden)

    Beutel M

    2008-01-01

    Full Text Available Zielsetzung: Bisherige Studien zum sexuellen Verlangen und zur sexuellen Aktivität wurden überwiegend an nach dem Geschlecht und dem Alter selektierten Stichproben durchgeführt. Nachfolgend werden Daten aus einer repräsentativen Umfrage an Männern und Frauen vorgestellt, welche die gesamte Altersspanne der erwachsenen deutschen Bevölkerung umfasst. Stichprobe und Methode: Eine repräsentative Stichprobe von n = 2314 Männern und Frauen im Alter von 18–93 Jahren wurde unter der Zielsetzung befragt, die Häufigkeit und Intensität sexuellen Verlangens und sexueller Aktivität sowie die sozialen, individuellen und interpersonalen Determinanten zu bestimmen. Ergebnisse: Sexuelles Verlangen verringert sich mit zunehmendem Alter. Insgesamt geben Männer ein häufigeres und stärkeres sexuelles Verlangen an als Frauen. Signifikante Interaktionen zwischen Geschlecht und Alter wiesen auf eine frühere Abnahme des sexuellen Verlangens bei Frauen hin. Sowohl bei Frauen als auch bei Männern war die sexuelle Aktivität im Alter hauptsächlich eine Frage des Vorhandenseins eines Partners. Für den Mangel an sexuellem Verlangen und sexueller Aktivität wurden soziale und Persönlichkeits-Determinanten gefunden. Bei Männern war das sexuelle Verlangen vor allem von sozialen Faktoren (Arbeitslosigkeit, geringes Einkommen bestimmt, bei Frauen waren dies überwiegend frühere sexuelle Traumata (Misshandlungen in der Kindheit, Vergewaltigung. Schlussfolgerung: Bevölkerungsumfragen geben Aufschluss über den Verlauf des sexuellen Verlangens und der sexuellen Aktivität über die Lebensspanne. Zukünftige Forschung zu den Determinanten und Risikofaktoren für einen Mangel an sexuellem Verlangen und sexuelle Inaktivität sollte die Zusammensetzung des Geschlechts und des Alters der Stichproben berücksichtigen.

  11. Comparison of electricity and heat production in combined and single-purpose systems against the background of energy saving by means of thermal insulation. Pt. 1. System comparison and general results; Vergleich der Strom- und Heizenergieerzeugung in gekoppelten und ungekoppelten Anlagen vor dem Hintergrund der Einsparmoeglichkeiten durch Waermedaemmung. T. 1. Systemvergleich und allgemeine Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Damberger, S.; Guenther, M.; Kluender, M.; Moeller, K.P.; Wenk, N.

    1994-06-01

    The study comprises investigations for the purpose of increasing the generation of electricity and heat in dual-purpose power plants and for promoting thermal insulation of buildings: Methods for comparatiave calculations; economic aspects; separate generation of electric power and heat; cogeneration of electric power and heat; economic efficiency of thermal insulation measures in domestic buildings; comparison of results. (HW) [Deutsch] Die Studie umfasst Untersuchungen zur Erhoehung des Anteils der gekoppelten Erzeugung von Strom und Waerme und zur vermehrten Waermedaemmung von Gebaeuden: - Methoden fuer Vergleichsrechnungen - Ekonomie - getrennte Erzeugung von Strom und Waerme - gekoppelte Erzeugung von Strom und Waerme - Wirtschaftlichkeit von Massnahmen einer Waermedaemmung von Wohngebaeuden - Vergleich der Ergebnisse. (HW)

  12. Colgajo comisural palmar: su utilidad en el abordaje de la enfermedad de Dupuytren con compromiso de dedos contiguos. [Commissural­ palmar­ flap:­ use­ in­ Dupuytren’s­ disease­ involving­ adjacent­ fingers

    Directory of Open Access Journals (Sweden)

    Sebastián E. Valbuena

    2015-01-01

    Full Text Available In­tro­duc­ción: El diseño de las incisiones en la enfermedad de Dupuytren es probablemente el detalle técnico más importante en el tratamiento quirúrgico. El objetivo de este trabajo es realizar una valoración retrospectiva de la utilidad del colgajo comisural palmar en el abordaje de la enfermedad de Dupuytren con compromiso de dedos contiguos. Materiales­ y­ Métodos:­ Entre abril de 2009 y diciembre de 2012, los autores operaron a 32 pacientes con enfermedad de Dupuytren. Se incluyeron 12 pacientes con compromiso de, al menos, 2 dedos contiguos y el diseño de un colgajo comisural palmar. Se evaluaron entre los días 3-5, 15-21, 45-60 y a los 6 meses posoperatorios. Al final del seguimiento, se constataron las recidivas, la satisfacción y el puntaje QuickDASH. Resultados: Se realizaron 13 colgajos comisurales palmares en 12 pacientes, 6 manos derechas y 6 izquierdas. Los rayos contiguos afectados fueron el 4° y 5° dedos (8 casos, el 3°, 4° y 5° dedos (3 casos, y el 3° y 4° dedos (un caso. La distancia promedio del colgajo comisural palmar comisura-vértice fue de 2,23 cm (rango 1,2-4,3 y la transversal, de 2,42 cm (rango 1,6-3,8. Siempre se pudo realizar la resección de las cuerdas patológicas y la fasciectomía parcial sin complicaciones intraoperatorias. Hubo una necrosis distal parcial, tratada con técnica de palma abierta. Conclusiones: El colgajo comisural palmar es de fácil disección y seguro a causa de su múltiple vascularización, permite una correcta visualización de las estructuras vasculonerviosas digitales y las bandas patológicas, útil en afección de dedos contiguos.

  13. Investigation concerning the use of organic compost as a fertilizer in farming. Results of field tests using winter wheat, winter barley, winter rye, winter rape and sugar beet; Untersuchung ueber die Verwendung von Bio-Kompost als Kreislaufduenger im Landbau. Ergebnisse von Feldversuchen mit Winterweizen, Wintergerste, Winterroggen, Winterraps und Zuckerrueben

    Energy Technology Data Exchange (ETDEWEB)

    Oehmichen, J. [Paderborn Univ. (Gesamthochschule), Soest (Germany). Fachbereich 9 Landbau; Groeblinghoff, F.F. [Paderborn Univ. (Gesamthochschule), Soest (Germany). Fachbereich 9 Landbau; Reinders, A. [Paderborn Univ. (Gesamthochschule), Soest (Germany). Fachbereich 9 Landbau; Doerendahl, A. [Paderborn Univ. (Gesamthochschule), Soest (Germany). Fachbereich 9 Landbau

    1995-02-01

    At two farms, a test programme of several years` duration concerning the advantages of the application of organic compost was conducted. The problem of heavy metal contents was also dealt with. The article reports in detail on the test arrangements, nutritive effects observed, additional crop yield, and the value of the compost to be derived from this. At an annual application of 10 tonnes of compost per hectare, the limiting value for zinc would only be attained in more than 200 years` time. (orig.) [Deutsch] In zwei landwirtschaftlichen Betrieben wurde ein mehrjaehriges Versuchsprogramm ueber die Vorteile der Anwendung von Biokompost durchgefuehrt. Dabei wurde auch das Problem der Schwermetallgehalte behandelt. Ueber die Anlage der Versuche, die beobachtete Naehrstoffwirkung, die Mehrertraege und den daraus abzuleitenden Wert des Komposts wird ausfuehrlich berichtet. Eine alljaehrliche Kompostaufbringung von 10 t/ha wuerde erst in ueber 200 Jahren zum Erreichen der Grenzwerte fuer Zink fuehren. (orig.)

  14. Das Ende eines Mythos: Die männliche Zirkumzision ist nicht mit einer höheren Prävalenz der erektilen Dysfunktion assoziiert – Ergebnisse der „Cottbuser 10.000-Männer-Fragebogenstudie“

    Directory of Open Access Journals (Sweden)

    Brookman-May S

    2014-01-01

    Full Text Available Hintergrund: Es existieren widersprüchliche Daten hinsichtlich des Stellenwertes des männlichen Präputiums bzw. der Zirkumzision im Hinblick auf Erektionsfähigkeit und sexuelle Zufriedenheit des Mannes. Patienten und Methoden: 10.000 entsprechend der stadtbezogenen Altersstruktur ausgewählte Männer in Cottbus (Bundesland Brandenburg erhielten einen 35 Items umfassenden Fragebogen, der den International Index of Erectile Function (IIEF-6 und weitere Fragen zur sexuellen Lebensqualität, zu speziellen Erkrankungen und zu verschiedenen Operationen integrierte. 2499 der Männer, die den Fragebogen komplett ausfüllten, lebten in einer Partnerschaft und bildeten die Studiengruppe dieser Untersuchung. Anhand des IIEF-6 wurden 2 Studienendpunkte definiert (Punktwerte ≤ 25/SEP1 bzw. ≤ 21/SEP2 Punkte. Mittels multivariater logistischer Regressionsmodelle wurde der unabhängige Einfluss der Zirkumzision auf die beiden SEPs geprüft. Zudem wurde die Korrelation zwischen der sexuellen Zufriedenheit des Mannes und der Zirkumzision analysiert. Ergebnisse: 167 Männer der Studiengruppe waren zirkumzidiert (6,7 %. Die erektile Dysfunktion (ED betrug im SEP1 40,1 % (leichte-schwere ED und im SEP2 27,8 % (moderate-schwere ED. Einen unabhängigen Einfluss auf die ED wiesen sowohl für den SEP1 als auch den SEP2 die Kriterien Alter, Raucheranamnese, arterielle Hypertonie, Diabetes mellitus, chronisch-ischämische Herzerkrankung, periphere-arterielle Verschlusskrankheit, Leberzirrhose und Zustand nach beckenchirurgischem Eingriff auf. Die Zirkumzision zeigte keinen unabhängigen Einfluss auf die Studienendpunkte 1 (OR 1,36; p = 0,174 und 2 (OR 1,42; p = 0,175. Darüber hinaus bestand kein signifikanter Zusammenhang zwischen der sexuellen Zufriedenheit des Mannes und einer erfolgten Zirkumzision. Schlussfolgerungen: In dieser weltweit größten Fragebogenstudie zur männlichen ED, die sich des IIEF als hierfür validiertes Instrument bediente, konnte keine

  15. Adjuvant simultaneous radiochemotherapy following radical hysterectomy for patients with cervical cancers in high-risk situation. Results of a pilot study; Adjuvante simultane Radiochemotherapie nach operiertem Uteruszervixkarzinom in der High-Risk-Situation. Ergebnisse einer Pilotuntersuchung

    Energy Technology Data Exchange (ETDEWEB)

    Haensgen, G.; Kuhnt, T.; Pigorsch, S.; Dunst, J. [Halle-Wittenberg Univ., Halle (Germany). Klinik und Poliklinik fuer Strahlentherapie; Strauss, H. [Klinik fuer Gynaekologie der Martin-Luther-Univ. Halle/Wittenberg (Germany)

    2002-02-01

    histopathomorphologische Risikofaktoren wie Tumorgroesse, Lymphknotenbefall, Lymphangiosis/Haemangiosis und hohes Grading. Es werden die Resultate einer simultanen Radiochemotherapie bei operierten Zervixkarzinomen in der High-Risk-Situation vorgestellt. Patienten und Methode: Zwischen November 1995 und Juni 1999 wurden 34 Patientinnen mit einem mittleren Alter von 40 (26-63) Jahren nach erfolgter Wertheim'scher Operation bei Zervixkarzinom im FIGO-Stadium IB (n = 19) und IIB (n = 15) mit einer simultanen Radiochemotherapie adjuvant behandelt. Voraussetzung waren der histologische Nachweis einer Lymphknotenmetastasierung oder einer Lymphangiosis/Haemangiosis und eines G3-Tumors. Die Chemotherapie erfolgte in der 1. und 5. Woche (Tag 1-5 und Tag 29-33) simultan zur Bestrahlung. Es wurden Cisplatin in einer Dosierung von 20 mg/m{sup 2} KOF/Tag als Bolus und 5-Fluorouracil mit 600 mg/m{sup 2} KOF/Tag als 120-Stunden-Dauerinfusion verabreicht. 32 Patientinnen erhielten eine Beckenbestrahlung in 1,8 Gy bis 50,4-54 Gy, in zwei Faellen wurde die paraaortale Region wegen einer Lymphknotenmetastasierung einbezogen. Ergebnisse: Bei einer medianen Nachbeobachtungszeit von 48 Monaten leben 30 Patientinnen (88%) in Komplettremission, vier sind verstorben. Die mittlere Ueberlebenszeit betrug 61 {+-} 3 Monate. Die Akuttoxizitaeten beschraenkten sich im Wesentlichen auf Grad-1/2-Reaktionen, in je drei Faellen wurde eine Grad-3-Enteritis und Grad-3-Leukopenie beobachtet. Als Spaetkomplikation entwickelten sieben Patientinnen ein sekundaeres Lymphoedem. Schlussfolgerungen: In der High-Risk-Situation erscheint beim operierten Zervixkarzinom eine Verbesserung des Gesamtueberlebens mit einer simultanen cisplatinhaltigen Radiochemotherapie moeglich. (orig.)

  16. Multicenter study of radiosynoviorthesis. Clinical outcome in osteoarthritis and other disorders with concomitant synovitis in comparison with rheumatoid arthritis; Multizenterstudie zur Radiosynoviorthese: Klinische Ergebnisse bei aktivierten Arthrosen und anderen Gelenkerkrankungen mit chronischer Synovialitis im Vergleich zur rheumatoiden Arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Rau, H.; Lohmann, K.; Spitz, J. [Praxis fuer Nuklearmedizin, am Staedtischen Klinikum Wiesbaden (Germany); Franke, C. [Praxis fuer Nuklearmedizin, Hamburg (Germany); Goretzki, G. [Praxis fuer Nuklearmedizin, Bielefeld (Germany); Lemb, M.A. [Praxis fuer Nuklearmedizin, Bremen (Germany); Mueller, J. [Klinik fuer Nuklearmedizin, Kantonspital St. Gallen (Switzerland); Panholzer, P.J. [Abt. fuer Nuklearmedizin und Endokrinologie, PET-Zentrum, Krankenhaus der Barmherzigen Schwestern, Linz (Austria); Stelling, E. [Praxis fuer diagnostische und therapeutische Nuklearmedizin, Berlin (Germany)

    2004-04-01

    sie eingeteilt in Gruppe A (primaer chronische Polyarthritis) und Gruppe B (aktivierte Arthrose, Psoriasisarthritis, reaktive Arthritis, postoperative Arthritis, villonodulaere Synovialitis, Synovialitis nach TEP-Implantation). Ergebnisse: Die Ansprechraten betrugen 80% bei Gruppe A und 56% bei Gruppe B (p <0,01), Besserungen der Lebensqualitaet gaben 78% (Gruppe A) bzw. 59% (Gruppe B) an (p <0,01). Im Gegensatz zu Gruppe A zeigte sich in Gruppe B bei kleinen Gelenken eine schlechtere Ansprechrate als bei grossen (p <0,01). Ausserdem hielten die Besserungen von Schmerz, Schwellung/Erguss und Beweglichkeit in Gruppe A laenger an (p <0,01). Wiederholte RSOs waren aehnlich effektiv wie erstmalige. Hinsichtlich des Therapieerfolgs konnte kein Einfluss von Patientenalter, Geschlecht oder postinterventioneller Immobilisation ueber 48 Stunden nachgewiesen werden. Schlussfolgerung: Wenngleich mit etwas geringerer Wirksamkeit als bei der rheumatoiden Arthritis, so ist die RSO auch bei aktivierter Arthrose und anderen Gelenkerkrankungen mit chronischer Synovialitis eine effektive Therapie. (orig.)

  17. Familienfreundlichkeit im Medizinstudium in Baden-Württemberg. Ergebnisse einer landesweiten Studie [Family-friendliness in Medical Studies in Baden-Württemberg. Results of a State-wide Study

    Directory of Open Access Journals (Sweden)

    Niehues, Johanna

    2012-04-01

    Full Text Available [english] This paper describes the results of the study on “Family-friendliness of the Medical Studies in Baden-Württemberg” carried out in 2009-2011 by the working group “Family, Time policy and E-Learning” of the University Hospital of Ulm, supported by the Ministry of Science, Research and the Arts of Baden-Württemberg. This state-wide survey of the studying conditions and personal circumstances of medical students with children at the five medical schools in Baden-Württemberg aims to describe existing and necessary factors of family-friendliness. A total of 238 students with children participated in the quantitative online survey conducted during the summer semester 2010 which was based on topics from previous qualitative interviews with student parents.The data shows that even though founding a family while at university is usually planned, student parents are faced with significant compatibility issues, demonstrating the need for additional measures to individualise course organisation and to make the curriculum more flexible. At the same time, the need to significantly increase information and advisory services alongside the establishment of additional support services for student parents is discernable.The study contributes to the debate on the family-friendliness of universities and university hospitals and adds practice-oriented approaches to solutions.[german] Die vorliegende Arbeit beschreibt die Ergebnisse der im Zeitraum 2009-2011 durch die Arbeitsgruppe ‚Familie, Zeitpolitik und E-Learning’ des Universitätsklinikums Ulm durchgeführten, durch das Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg geförderten Studie zum ‚Familienfreundlichen Studium in der Medizin in Baden-Württemberg’. Die landesweite Erhebung der Studien- und Lebensbedingungen Studierender mit Kind in der Humanmedizin an den fünf Medizinischen Fakultäten in Baden-Württemberg hat zum Ziel, bestehende und notwendige

  18. Low-dose fractionated percutaneous teletherapy in age-related macular degeneration with subfoveolar neovascularization - 3 year results; 3 Jahre Erfahrung mit der niedrig dosierten fraktionierten perkutanen Teletherapie bei subfoveolaeren Neovaskularisationen. Klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schittkowski, M.; Schneider, H.; Guthoff, R. [Universitaetsaugenklinik Rostock (Germany); Grueschow, K.; Ziegler, P.G.; Fietkau, R. [Zentrum fuer Radiologie, Univ. Rostock (Germany)

    2001-07-01

    ophthalmologischer Status wurde bei der Voruntersuchung sowie bei den Kontrollen 3, 6, 12, 18, 24, 30, 36 Monate nach der Therapie erhoben. Zur Auswertung, in die wegen okulaerer Nebenerkrankungen nur 78 Augen von 70 Patienten einbezogen werden konnten, wurden die Patientendaten nach dem Ausgangsvisus und der Art der chorioidalen Neovaskularisationen (klassischokkult) in Gruppen unterteilt. Die maximale Nachbeobachtungsdauer betraegt 36 Monate. - Die 9-MeV-Photonen-Teletherapie erfolgte ueber ein seitliches Stehfeld mit einer Einzeldosis von 2 Gy bis zu einer Gesamtdosis von 20 Gy (90%-Isodose). Die zehn Einzeldosen wurden an jeweils 5 aufeinander folgenden Wochentagen mit Wochenendpause appliziert. Ergebnisse: Schwerwiegende Nebenwirkungen konnten wir nicht beobachten. Die Therapie wurde bis auf subjektiv beobachtete Epiphora (acht Patienten) und passagere Siccasymptomatik (vier Patienten) gut vertragen und angenommen. Die Gruppe Ausgangsvisus 0,05-0,2 zeigte einen durchschnittlichen Visusabfall von mehr als einer Zeile. Bei einem Ausgangsvisus 0,3-0,5 fanden wir Visusstabilitaet bis zu 12 Monaten, danach langsame Visusreduktion. Die Gruppe Ausgangsvisus {>=} 0,6 wies einen tendenziellen Visusanstieg fuer ca. 12 Monate auf, beginnend nach 18 Monaten zeigte sich ein allmaehlicher Visusabfall. Die Patienten der beiden letztgenannten Gruppen zeigten eine Abnahme der Metamorphopsien sowie gesteigerte Farb- und Kontrastwahrnehmung. Schlussfolgerung: Die vorliegende Untersuchung zeigt, dass die niedrig dosierte fraktionierte perkutane Teletherapie die subfoveolaere Membran, die Sehschaerfe und das Auftreten von Metamorphopsien beeinflusst. Dabei spielen Ausgangsvisus und Anamnesedauer eine entscheidende Rolle. Ein anhaltender Effekt scheint nicht zu bestehen; moeglicherweise kann ein Applikationsmodus mit erhoehter Dosis hilfreich sein. (orig.)

  19. Solar-assisted district heating system - Scientific study. Solar-assisted district heating system with long-term thermal storage in Friedrichshafen-Wiggenhausen and Hamburg-Bramfeld.. Results of the first year of operation; Solar unterstuetzte Nahwaermeversorgung - Wissenschaftliches Begleitprogramm. Solare Nahwaermeversorgung mit Langzeitwaermespeicher in Friedrichshafen-Wiggenhausen und Hamburg-Bramfeld. Ergebnisse des ersten Betriebsjahres

    Energy Technology Data Exchange (ETDEWEB)

    Schulz, M.E.; Mahler, B.; Hahne, E. [Stuttgart Univ. (Germany). Inst. fuer Thermodynamik und Waermetechnik

    1998-12-31

    The first two pilot plants for solar district heating with seasonal thermal energy storage were put in operation in October 1996. Both projects were initiated by the Institute for Thermodynamics and Thermal Energy Technology (ITW) of the University of Stuttgart that also provided scientific support up to the present. This report presents the results of the first two years of operation of both plants. Both solar plants have been operated without any major problems. The solar energy yield in the first year of operation has only been reduced by the unsatisfactory operation of the heating grid. The most important step towards optimising the plants is the adjustment of the internal heating systems and thus the reduction of the heating temperatures which are currently too high. Based on subject pre-conditions the results projected for the first pilot plants for solar district heating and long-term thermal energy storage will be reached in the following years of operation. (orig.) [Deutsch] Im Oktober 1996 gingen die ersten beiden Pilotanlagen zur solaren Nahwaermeversorgung mit saisonaler Waermespeicherung in Betrieb. Beide Projekte wurden vom Institut fuer Thermodynamik und Waermetechnik (ITW), Universitaet Stuttgart initiiert und ueber die gesamte bisherige Laufzeit wissenschaftlich begleitet. Die Ergebnisse des ersten Betriebsjahres der beiden Anlagen sind in diesem Bericht zusammengestellt. In beiden Faellen funktionieren die Solaranlagen ohne grosse Probleme. Die solaren Ertraege wurden im ersten Betriebsjahr noch durch die unzureichende Betriebsweise der Heiznetze gemindert. Wichtigster Ansatzpunkt fuer eine Optimierung der Anlagen ist die Einregulierung der hausinternen Heizungssysteme und damit die Absenkung der derzeit noch zu hohen Heiznetztemperaturen. Unter dieser Voraussetzung werden die vorausgesagten Ergebnisse fuer die ersten Pilotanlagen zur solaren Nahwaerme mit Langzeit-Waermespeicher in den naechsten Betriebsjahren erreicht werden. (orig.)

  20. Die Maschine konnte erstes Licht ins dunkle Universum bringen

    CERN Multimedia

    Hartmeier, Peter

    2009-01-01

    Rolf-Dieter Heuer, Director General of CERN, is the main speaker at the "Tages-Anzeiger" meeting today. With the most complicated accelerator, which was ever designed, CERN physicists want to find how the universe is built. (3 pages)

  1. Die erste Dissertation über Jaan Kross / Cornelius Hasselblatt

    Index Scriptorium Estoniae

    Hasselblatt, Cornelius

    2001-01-01

    Arvustus: Wagner, Kerttu. Die historischen Romane von Jaan Kross : am Beispiel einer Untersuchung der deutschen und englischen Übersetzungen von "Professor Martensi ärasõit" (1984). Frankfurt/M : P. Lang, 2001.

  2. Die erste Dissertation über Jaan Kross / Cornelius Hasselblatt

    Index Scriptorium Estoniae

    Hasselblatt, Cornelius

    2001-01-01

    Arvustus: Wagner, Kerttu. Die historischen Romane von Jaan Kross : am Beispiel einer Untersuchung der deutschen und englischen Übersetzungen von "Professor Martensi ärasõit" (1984). Frankfurt/M : P. Lang, 2001.

  3. "Wastne Testament" : das erste estnischsprachige Neue Testament / Peeter Roosimaa

    Index Scriptorium Estoniae

    Roosimaa, Peeter

    2003-01-01

    Ettekanne sümpoosionilt: Gemeinsames Symposium der Evangelisch-Theologischen Fakultät der Universität Tartu, der Estnischen Studiengesellschaft für Morgenlandkunde und der Deutschen Religionsgeschichtlichen Studiengesellschaft. Tartu, 2001

  4. Hans Woller, Mussolini. Der erste Faschist. Eine Biographie

    OpenAIRE

    Salvador, Alessandro

    2017-01-01

    La vita di Benito Mussolini, il fascismo e la Seconda guerra mondiale occupano una posizione ancora scomoda nella memoria storica italiana. È un po’ questo il pensiero dominante della biografia realizzata da Hans Woller. La stessa definizione di biografia, per questo volume, è decisamente riduttiva. Attraverso undici date e luoghi chiave della storia di Mussolini e del fascismo, Woller riesce in un’impresa non semplice: sintetizzare il più recente e completo stato della ricerca su quel period...

  5. Wahlfach Teamarbeit: Ergebnisse eines Pilotprojektes zur interprofessionellen und interdisziplinären Ausbildung mit formativem Team-OSCE (TOSCE [Teamwork elective: Results of a German pilot project on interprofessional and interdisciplinary education with formative team OSCE

    Directory of Open Access Journals (Sweden)

    Schmidt, Anita

    2010-08-01

    der Medizinischen Fakultät und der Berufsfachschule für Gesundheits- und Krankenpflege in Erlangen, in dem Pflegeschüler und Medizinstudenten interdisziplinär vor Aufgaben gestellt werden, die sie im interprofessionellen Team lösen sollen. Sie werden unter Einsatz von Simulationspatienten (SP oder Phantomen mit Szenen aus dem Stationsalltag, interdisziplinären Notfällen und schwierigen Situationen konfrontiert, die interprofessionelles Handeln erfordern. Die Planung des Konzeptes wurde angelehnt an die von Kern beschriebenen Schritte zur Curriculumsentwicklung. Der Kurs wurde mit einem formativen Team-OSCE evaluiert.Methodik: An dem Projekt nahmen im Wintersemester 2008/09 und im Sommersemester 2009 insgesamt 20 Schüler der Berufsfachschule und 10 Medizinstudenten (Curriculäres Wahlpflichtfach nach Approbationsordnung im 5.-9. Semester teil.Ergebnisse: Der Kurs wurde als Wahlpflichtfach für Studierende der Medizin und freiwillig für Pflegeschüler durchgeführt. Initial waren ein Dozent aus der medizinischen Fakultät und ein Dozent aus der Berufsfachschule anwesend, sowie meistens 1-2 SPs. Im zweiten Durchgang wurde der Kurs von einem Dozenten durchgeführt und einem Experten, der bei Bedarf hinzugezogen werden konnte. Anhand der Evaluationsergebnisse des ersten Kurses konnten konkrete Verbesserungsvorschläge (generell zur Organisation und speziell zum vorausgesetzten Fachwissen in den Kurs des Folgesemesters implementiert werden. Die Durchführung eines 4-Stationen-Team-OSCE gelang organisatorisch. Im ersten Durchlauf zeigte sich, dass eine gleichzeitige Prüfung der Einzelleistung und der Teamleistung nicht möglich ist. Im Verlauf erfolgte nur eine Beurteilung der Teamleistung mit einem Inter-Observer Kappa-Quotienten von 0,35.Schlussfolgerung: Ein interdisziplinäres und interprofessionelles Ausbildungskonzept für Pflegeschüler und Medizinstudenten ist planbar und umsetzbar, braucht aber große personelle Ressourcen. Die Entwicklung und Umsetzung

  6. Percutaneous transfemoral placement of a new flexible stent-graft into the thoracic aorta followed by a percutaneous suture-mediated closure of the access site - initial experience; Perkutane transfemorale implantation einer neuen, flexiblen thorakalen Aortenendoprothese unter Verwendung eines perkutanen Nahtsystems zum Gefaessverschluss - erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Manke, C.; Lenhart, M.; Strotzer, M.; Feuerbach, S.; Link, J. [Klinikum der Univ. Regensburg (Germany). Inst. fuer Roentgendiagnostik; Kobuch, R.; Merk, J.; Birnbaum, F. [Klinikum der Univ. Regensburg (Germany). Klinik und Poliklinik fuer Herz-, Thorax- und herznahe Gefaesschirurgie

    2001-05-01

    To evaluate the transfemoral placement of a new, flexible stent-graft into the thoracic aorta and the suture-mediated closure of the femoral access. Patients and Methods: five patients were treated endovascularly with a stent-graft for an aneurysm (n = 3) or acute dissection (n = 2) of the thoracic aorta via a femoral 24 F sheath. The femoral access site was closed with two suture-mediated closure devices after placement of the stent-graft. Results: the aneurysm or the false lumen was excluded from perfusion by the placement of the stent-graft in all patients. Hemostasis at the femoral access site was successful in all patients with the percutaneous suture device. A minor stenosis of the femoral artery was found angiographically in four patients after suture-mediated closure. Besides a reversible renal failure due to the medically induced hypotension for the treatment of an acutely ruptured aneurysm, no complications resulted from the stent-graft placement or the percutaneous suture. Conclusion: the percutaneous transfemoral placement of stent-grafts in the thoracic aorta using a suture-mediated closure of the access site is technically feasible. Long-term results of the technique have to be awaited. (orig.) [German] Evaluation der transfemoralen Implantation einer neuen, flexiblen thorakalen Aortenprothese unter Verwendung eines perkutanen Nahtsystems zum Verschluss des femoralen Zugangs. Patienten und Methoden: fuenf Patienten wurden wegen Aneurysma (n = 3) oder akuter Dissektion (n = 2) der thorakalen Aorta endovaskulaer ueber eine perkutan eingebrachte 24F-Schleuse mit einem Stentgraft versogt. Der femorale Zugang wurde nach Plazierung der Endoprothese mit zwei perkutanen Nahtgeraeten verschlossen. Ergebnisse: bei allen Patienten fuehrte die Platzierung der Prothese zur Ausschaltung des Aneurysmas oder des falschen Lumens von der Perfusion. Mit der perkutanen Gefae paragraph naht konnte in allen Faellen ein Verschluss des femoralen Zugangs erreicht werden. In

  7. Collagenase injections for treatment of Dupuytren disease.

    Science.gov (United States)

    Hentz, Vincent R

    2014-02-01

    Palmodigital fasciectomy remains the gold standard. The initial outcome is, in my experience, far more predictable than either NA or enzyme fasciotomy (EF). It is also a more durable treatment. NA and EF can be conceptualized as similar procedures--one uses a needle and the other an enzyme to weaken a cord sufficient to be able to rupture it and thus straighten a contracted joint. Both are less invasive and the hand is quick to recover. Both procedures are equally initially effective. CHH seems to offer greater durability. Today’s patients are often better educated and seek a specific type of treatment, in particular, effective nonoperative treatment. Pharmaceutical companies now market directly and effectively to patients, and this strategy and Internet use have already resulted in an increase in the number of patients searching for practitioners willing to administer and capable of administering collagenase treatment.

  8. 对比掌腱膜部分切除术与掌腱膜切除加受累皮肤切除、皮肤移植术治疗掌腱膜挛缩症的临床效果%Clinical Effect Comparison of Palmar Aponeurosis Partial Resection, Palmar Aponeurosis Resection with Involved Skin Resection and Skin Transplantation in Treatment of Dupuytren's Contracture

    Institute of Scientific and Technical Information of China (English)

    梁运海; 董明; 刘东; 闻梓钧

    2015-01-01

    目的:对比掌腱膜部分切除术与掌腱膜切除加受累皮肤、皮肤移植术治疗掌腱膜挛缩症患者的临床疗效。方法筛选2008年1月至2013年1月我院收治的掌腱膜挛缩症患者56例,作为研究对象。采用随机数表法将其分为试验组与对照组,每组28例,对照组单纯应用掌腱膜部分切除术治疗,试验组采用掌腱膜切除联合受累皮肤切除、皮肤移植术用于治疗掌腱膜挛缩症,比较两组患者术后并发症并通过随访复查统计其临床疗效。结果随访复查显示对照组复发11例,试验组复发3例,两组术后复发率比较存在显著差异;试验组术后并发症皮下血肿1例,手指麻木1例,治疗总有效率92.86%,明显高于对照组(P<0.05)。结论采用掌腱膜切除联合受累皮肤切除、皮肤移植用于治疗掌腱膜挛缩症可显著提升其临床疗效,降低术后复发率及手术并发症,具有临床应用及推广价值。%Objective To compare the curative efifciency of palmar aponeurosis partial resection, palmar aponeurosis resection with involved skin resection and skin transplantation in treatment of Dupuytren's contracture. Methods Selected 56 Dupuytren's contracture patients who were treated from 2005 January to 2013 January in our hospital as the research object. They were randomly divided into the experimental group and control group, with 28 cases in each group, the control group was treated with palmar aponeurosis partial resection, the experiment group adopted the palmar aponeurosis resection with involved skin resection and skin transplantation to treat Dupuytren's contracture, counted curative effect through comparing complications and follow-up review after operation. Results The follow-up examination showed that there were 11 recurrence in the control group and 3 cases in experimental group, two groups’ postoperative recurrence rate were signiifcant difference;there was 1 case

  9. Mid-term results after midcarpal arthrodesis using an iliac crest cortical chip for grade II/III SLAC/SNAC-wrists [Mittelfristige Ergebnisse nach mediokarpaler Teilarthrodese mit kortikospongiösem Beckenkammspan bei SLAC/SNAC-wrist Grad II/III

    Directory of Open Access Journals (Sweden)

    Zeplin, Philip H.

    2013-06-01

    Full Text Available [english] Purpose: The four-corner-fusion is an option for grade II/III SNAC-/SLAC-wrists. The case-control study evaluates the results of a four-corner-f with a screw-fixed iliac crest cortical chip. Methods: Ten patients with SNAC/SLAC-wrist ≥ grade II were treated. The evaluation occurred after 24 months using a standard study protocol. Results: The mean postoperative active range of motion were 46% (extension/flexion and 52% (radial/ulnar deviation of the contralateral wrist respectively. The postoperative mean grip strength was 43% of the contralateral side, and 84% compared to the preoperative values. The mean Cooney-Bussey Score was 63 and the mean DASH score was 25 (p≤0.05. Four of the patients (40% had to undergo a partial removal of the osteosynthetic material because of radiodorsal impingement. Conclusions: The four-corner fusion using an iliac crest cortical chip represents an alternative operating procedure for treatment, even though the period of immobilisation cannot be reduced. [german] Hintergrund: Die mediokarpale Teilarthrodese stellt eine anerkannte Behandlungsmethode bei karpalen Kollaps nach Skaphoidpseudarthrose (SNAC-wrist oder nach Ruptur des skapholunären Bandes (SLAC-wrist dar. Anhand der vorliegenden Fall-Kontrollstudie wurden die Ergebnisse nach mediokarpaler Teilarthrodese unter Verwendung eines kortikospongiösen Beckenkammspanes evaluiert. Material und Methoden: Zehn Patienten wurden 24 Monate nach mediokarpaler Teilarthrodese bei mit SLAC/SNAC-wrist Grad II/III mit einem kortikospongiösen Beckenkammspan nachuntersucht. Ergebnisse: Das mittlere postoperative Bewegungsausmaß des Handgelenkes betrug für Extension/Flexion 46% und für Radial-/Ulnaradduktion 52% im Vergleich zur unbehandelten Gegenseite. Die postoperative Griffstärke betrug im Mittel 43% der Gegenseite und 84% der präoperativen Werte. Der mittlere Cooney-Bussey-Score lag bei 63, der mittlere DASH-Score bei 25 (p≤0.05. Bei vier Patienten

  10. Interkulturelle Kompetenz im Unternehmen : die historische Dimension

    OpenAIRE

    Fabbro, Rene del

    2000-01-01

    Der Autor stellt erste Ergebnisse und weitere Vorhaben des Projekts 'Interkulturelle Kompetenz im Unternehmen. Entwicklung, Nutzung, Theoriebildung, Praxis 1895-1995 (IKU)' vor, welches von der Volkswagen-Stiftung im Forschungsschwerpunkt 'Das Fremde und das Eigene' gefördert wurde. Das Projekt IKU ist interdisziplinär ausgerichtet und orientiert sich an Theorien aus den Sozialwissenschaften, der Psychologie, Anthropologie und Linguistik, um deren Hypothesen und Modelle zur interkulturellen K...

  11. Transparency in information about health

    OpenAIRE

    Bodemer, Nicolai

    2012-01-01

    Diese Dissertation umfasst vier Manuskripte zum Thema Risikokommunikation und medizinischen Entscheidungen. Das erste Manuskript diskutiert Unterschiede, Gemeinsamkeiten und die Anwendbarkeit von drei zentralen Ansätzen, die helfen sollen, bessere Entscheidungen zu treffen (Nudging, Social Marketing, Empowerment). Das zweite Manuskript präsentiert Ergebnisse einer Medienanalyse zur Evaluation von Zeitungs- und Internetberichten in Deutschland und Spanien über die HPV-Impfung. Basierend auf vo...

  12. The impact of Erasmus mobility on the professional career: Empirical results of international studies on temporary student and teaching staff mobility Die Auswirkungen der Erasmus-Mobilität auf die berufliche Entwicklung : empirische Ergebnisse internationaler Studien über temporäre Mobilität von Studierenden und Lehrenden

    Directory of Open Access Journals (Sweden)

    Constanze Engel

    2012-12-01

    Full Text Available The impact of an Erasmus study period abroad for mobile students and teaching assignments of Erasmus teachers on professional development is the focus of the article. Temporary study abroad is expected to have a positive impact on personal and academic development, but also to be conducive to transition to employment and career development. Though the impact has been declining, study abroad remains an important experience for the professional career. Erasmus teaching assignments often do not last longer than a few days. Nevertheless, mobile teachers report a positive impact on their career. The article is based on the VALERA Study1 “The professional value of Erasmus mobility”, a European-wide evaluation study by the International Centre for Higher Education Research Kassel.Im Zentrum des Artikels steht der Einfluss temporärer internationaler Studien- und Lehraufenthalte auf den Berufsweg ehemaliger Erasmus Studierender und Lehrender. Es wird erwartet, dass ein Auslandsaufenthalt während des Studiums nicht nur auf die persönliche und akademische Entwicklung der mobilen Studierenden einen positiven Einfluss hat, sondern auch auf den Übergang in den Beruf und die erste Karriere. Ein Auslandsaufenthalt im Studium hat einen sehr wichtigen Einfluss auf die berufliche Entwicklung ehemals mobiler Studierender, auch wenn der individuelle Ertrag im Laufe der Zeit gesunken ist. Lehraufenthalte im Rahmen des Erasmus Programmes dauern häufig nicht länger als wenige Tage. Dennoch berichten auch die Erasmus Lehrenden von einem positiven Einfluss des Lehraufenthaltes im Ausland auf ihre berufliche Entwicklung. Dieser Artikel basiert auf Ergebnissen der VALERA-Studie “Der berufliche Ertrag der Erasmus-Mobilität“, einer europaweiten Evaluierungstudie des Erasmus Programms durchgeführt vom Internationalen Zentrum für Hochschulforschung Kassel.

  13. Familiengründung bei Medizinerinnen und Medizinern bereits im Studium? Ergebnisse einer Pilotstudie zur Familienfreundlichkeit im Studium der Humanmedizin an der Universität Ulm [Starting a family during medical studies? Results of a pilot study on family friendliness in the study of medicine at the University of Ulm

    Directory of Open Access Journals (Sweden)

    Liebhardt, Hubert

    2011-02-01

    Ergebnisse der Studie dienen als Grundlage einer evidenzbasierten Curriculumreform nach familienfreundlichen Kriterien.Methodik: Im Jahr 2009 wurde eine qualitative Interviewstudie mit 37 der 79 Medizinstudierende mit Kindern der Universität Ulm durchgeführt und inhaltsanalytisch ausgewertet. Auf Grundlage der festgestellten Problem- und Lösungsfaktoren wurde eine quantitative Fragebogenerhebung durchgeführt, an der 45 studierende Eltern und 53 Lehrende in der Medizin teilnahmen. Ergebnisse: Studierende Eltern der Ulmer Humanmedizin sind durchschnittlich älter, häufiger verheiratet und haben bereits häufiger als andere Studierende eine Erstausbildung absolviert. Knapp ein Drittel der befragten Studierenden und Lehrenden sehen keinen idealen Zeitpunkt für die Familiengründung im Arztberuf. Allerdings wird die Vereinbarkeit von Familie und Studium mehrheitlich leichter eingeschätzt (61% der befragten Studierenden als die Vereinbarkeit im Arztberuf, insbesondere während der Facharztausbildung. Die Ulmer Interviewdaten zeigen, dass sich vor allem das Ende des Studiums – idealerweise mit Geburtstermin in den Semesterferien – zur Familiengründung ohne größeren Zeitverlust eignet. Schlussfolgerung: Sowohl die Lebensbiographien als auch die Ausbildungs- und Berufsprofile von studierenden Eltern weisen Besonderheiten auf. Die Universitäten und Kliniken sind gefordert, Vereinbarkeitsfragen nicht mehr nur der Verantwortung der jungen Nachwuchskräfte in der Medizin zu überlassen, sondern verlässliche Strukturen zu schaffen, die es ermöglichen die Familienphase parallel zur Ausbildungsphase zu beginnen. Hierzu gehören neben dem Ausbau von Kinderbetreuungsmöglichkeiten auch die stärkere Unterstützung der Universitäten im Bereich Studienberatung und Karriereförderung.

  14. CT-guided percutaneous intratumoral chemotherapy with a novel cisplatin/epinephrine injectable gel for the treatment of unresectable malignant liver tumors; CT-gesteuerte perkutane intratumorale Chemotherapie mit Cisplatin-/Adrenalin-Gel zur Behandlung inoperabler maligner Lebertumoren. Ergebnisse einer klinischen Phase-II-Pruefung

    Energy Technology Data Exchange (ETDEWEB)

    Engelmann, K.; Mack, M.G.; Straub, R.; Eichler, K.; Zangos, S.; Vogl, T.J. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Orenberg, E. [Matrix Pharmaceutical Inc., Fremont, CA (United States)

    2000-12-01

    durchschnittlich 5,1 CT-gesteuerten Injektionen sowie 8 Patienten mit 11 Herden bei hepatozellulaeren Karzinom (mittleres Volumen 22,1 ml) mit durchschnittlich 3,25 Injektionen des Cisplatin-/Adrenalin-Gels behandelt. Diese Applikation bewirkt eine Erhoehung der lokalen gegenueber der systemischen Zytostatika-Konzentration. Tumor- und Nekrosegroesse wurden vor sowie nach 1 bis 2 Therapiezyklen durch kontrastverstaerkte CT-Volumetrie bestimmt. Ergebnisse: Vor der Behandlung ergab die kontrastverstaerkte CT-Volumetrie eine mittlere Tumornekrose von 12,6% bei den Metastasen und 6% beim HCC. Nach intratumoraler Zytostatikaapplikation stieg das mittlere Nekrosevolumen auf 110% (Metastasen) und 128% (HCC) im Verhaeltnis zum initialen Tumorvolumen, nach mindestens 4 woechentlichen Injektionen auf 122% (Metastasen) bzw. 130% (HCC). Nach 6 Monaten ergab sich eine lokale Tumorkontrollrate von 38% fuer die Metastasen und 83,3% fuer das HCC. Schlussfolgerungen: Intratumorale CT-gesteuerte Injektion von Cisplatin-/Adrenalin-Gel fuehrt zur Induktion relevanter Nekrosen bei malignen Lebertumoren. Unsere Ergebnisse lassen auf ein besseres Ansprechen von HCC-Herden im Vergleich zu Lebermetastasen kolorektaler Karzinome schliessen. (orig.)

  15. Treatment of malignant biliary occlusion by means of transhepatic percutaneous biliary drainage with insertion of metal stents - results of an 8-year follow-up and analysis of the prognostic parameters; Behandlung der malignen Gallenwegsstenose mittels perkutaner transhepatischer Metallendoprothesenimplantation: 8 Jahres-Ergebnisse und Analyse prognostischer Faktoren

    Energy Technology Data Exchange (ETDEWEB)

    Alfke, H.; Alfke, B.; Froelich, J.J.; Klose, K.J.; Wagner, H.J. [Klinik fuer Strahlendiagnostik Philipps Univ. Marburg (Germany)

    2003-08-01

    Purpose: To analyze outcome and predictive factors for patient survival and patency rates of unresectable malignant biliary obstruction treated with percutaneous transhepatic insertion of metal stents. Materials and Methods: This is a retroselective analysis of 130 patients treated in one interventional radiological center with data collected from patient records and by telephone interviews. The procedure-related data had been prospectively documented in a computer data base. The Kaplan-Meier analysis was performed for univariate and multivariate comparison of survival and patency rates with the log-rank test used for different tumor types. Predictive factors for survival and 30-day mortality were analyzed by a stepwise logistic regression. Results: Underlying causes of malignant biliary obstructions were cholangiocarcinoma in 50, pancreatic carcinoma in 29, liver metastases in 27, gallbladder carcinoma in 20, and other tumors in 4 patients. The technical success rate was 99%, the complication rate 27% and the 30-day mortality 11%. Primary patency rates (406 days with a median of 207 days) did not differ significantly for different tumor types. The survival rates were significantly (p = 0.03 by log-rank test) better for patients with cholangiocarcinoma than for patients with pancreatic carcinoma and liver metastases. Multiple regression analysis revealed no predictive factor for patient survival and 30-day mortality. Conclusion: Percutaneous transhepatic insertion of metal biliary endoprostheses offers a good initial and long-term relief of jaundice caused by malignant biliary obstruction. Although survival rates for patients with cholangiocarcinoma are better than for other causes of malignant biliary obstruction, a clear predictive factor is lacking for patients undergoing palliative biliary stent insertion. (orig.) [German] Ziel: Ergebnisse der perkutanen transhepatischen Metallendoprothesenimplantation bei malignen Gallenwegsverschluessen zu evaluieren und

  16. Longitudinales, bologna-kompatibles Modell-Curriculum "Kommunikative und Soziale Kompetenzen": Ergebnisse eines interdisziplinären Workshops deutschsprachiger medizinischer Fakultäten [A longitudinal, Bologna-compatible model curriculum "communication and social competencies": Results of an interdisciplinary workshop of German-speaking medical schools

    Directory of Open Access Journals (Sweden)

    Hölzer, Henrike

    2009-11-01

    Full Text Available [english] Aim: The aim of the project is to present and discuss a longitudinal model curriculum “Communication and social competencies” for undergraduate medical education. Procedure and results: In a two-day workshop, a multidisciplinary, cross-faculty group of medical educators developed a curriculum model based on the “Basel Consensus Statement”. It can now be used by German-speaking medical schools as a blueprint for curriculum planning and implementation processes. The modular structure enables it to be implemented either in whole or in part. The model can also be used to facilitate the conversion of medical education into Bachelor and Master degree programmes. The longitudinal model curriculum features 131 educational objectives and makes suggestions for didactic concepts and assessment tools. For various disciplines, it also recommends at what point in time specific topics should be taught. Conclusion: The longitudinal model curriculum “Communication and social competencies”, based on the educational objectives of the “Basel Consensus Statement”, is a new curricular instrument that can be used by German, Austrian and Swiss medical schools. It can help to simplify the realisation of the Bologna process, also across different faculties. [german] Zielsetzung: Ziel des Projekts ist es, ein longitudinales Modell-Curriculum „Kommunikative und soziale Kompetenzen“ für die medizinische Ausbildung zur Diskussion zu stellen. Vorgehen und Ergebnisse: Auf einem 2-tägigen Workshop wurde interfakultär und interdisziplinär auf der Grundlage des „Basler Consensus Statements: Kommunikative und soziale Kompetenzen im Medizinstudium“ ein Curriculum entwickelt, das deutschsprachigen Fakultäten bei der Planung und Implementierung als Vorlage dienen kann. Das Modell lässt sich als Gesamt-Curriculum oder in Teilmodulen implementieren. Es kann auch bei der Umstellung auf Bachelor- und Masterstudiengänge genutzt werden. Das

  17. Investigations into the yellowing of spruce at a Mg-deficient and ozone polluted mountain site. Results of the 2nd field study at Freudenstadt/Schoellkopf (1993-1996); Untersuchungen zur Vergilbung einer Fichte auf montanem, durch Mg-Mangel und Ozonbelastung gekennzeichnetem Standort. Ergebnisse der 2. Freilandstudie am Standort Freudenstadt/Schoellkopf (1993-1996)

    Energy Technology Data Exchange (ETDEWEB)

    Siefermann-Harms, D. [Karlsruhe Univ. (T.H.) (Germany). Botanisches Inst. und Botanischer Garten]|[Forschungszentrum Karlsruhe GmbH Technik und Umwelt (Germany). Inst. fuer Toxikologie; Boxler-Baldoma, C.; Heumann, H.G. [Karlsruhe Univ. (T.H.) (Germany). Botanisches Inst. und Botanischer Garten; Einig, W. [Tuebingen Univ. (Germany). Botanisches Inst.; Godde, D. [Bochum Univ. (Germany). Lehrstuhl fuer Biochemie der Pflanzen; Schneckenburger, H. [Fachhochschule Aalen (Germany). Fachbereich Optoelektronik; Wilpert, K. von [Forstliche Versuchs- und Forschungsanstalt Baden-Wuerttemberg, Freiburg im Breisgau (Germany)

    1997-12-01

    definierter Beschattung auf diese Vorgaenge und die Reaktion der Fichte auf Episoden erhoehter Ozonbelastung untersucht wurde. In zwei- bis dreiwoechigem Abstand wurden die Nadeln einer vergilbenden und einer symptomfreien Fichte (Picea abies (L.) Karst.) anhand diverser Parameter charakterisiert, wie z.B.: Naehrelement-, Chlorophyll- und Carotinoidgehalt, Parameter der Chlorophyll-Fluoreszenz, Eigenschaften von Proteinen des Photosystems II, Stabilitaet des Antennenkomplexes LHC II, Metabolite und Enzymaktivitaeten des Kohlenhydrat- und Stickstoff-Stoffwechsels, Struktur der Chloroplasten und des Zentralzylinders. Ausserdem wurde der Grundwasserstand unter den Baeumen kontinuierlich gemessen und die chemischen Eigenschaften des Bodens vor und nach Duengung mit Mg-Sulfat analysiert. Erste visuell erkennbare Vergilbungssymptome traten zumeist als Vergilbungsschuebe, verbunden mit einer starken Abnahme des Chlorophyllgehalts, auf. Daneben lief eine Vielzahl von Aenderungen in den Nadeln ab, die langsam einsetzten und sich in den vergilbten Nadeln mehr und mehr auspraegten. Die Befunde legen nahe, dass der Vergilbungsvorgang am Schoellkopf auf die kombinierte Wirkung von Mg-Mangel und Ozon-Belastung zurueckzufuehren ist, wobei Episoden hoher Ozon-Belastung die unter Mg-Mangel auftretende Vergilbung beschleunigen. (orig.)

  18. Schulische und nicht-schulische Prädiktoren für die Studienplatzzusage an der Universität Witten / Herdecke - Ergebnisse einer QUEST-Analyse [Academic and non-academic predictors for acceptance to medical studies at Witten/Herdecke University - findings of a QUEST-analysis

    Directory of Open Access Journals (Sweden)

    Hofmann, Marzellus

    2007-11-01

    ädiktorkombination betrug 0,53, die Spezifität 0,92. Der positiv-prädiktiver Wert lag bei 0,77, der negativ-prädiktive Wert ergab 0,83. Schlussfolgerung: Für das Auswahlverfahren der UWH scheint auch die Abiturnote retrospektiv einen übergeordneten Stellenwert zu besitzen. Darüber hinaus spielen Faktoren wie Schulform, Berufsziel und Leistungskurskombination eine Rolle. Der hohe negativ-prädiktive Wert weist darauf hin, dass die Ergebnisse des QUEST-Modells nicht dazu geeignet sind, das bestehende Auswahlverfahren zu ersetzen, evtl. könnten sie aber zu einer Art „Vorselektion“ herangezogen werden. Weiterführende Untersuchungen müssen zeigen, ob es sich hier um kohortenspezifische Effekte oder repräsentative Ergebnisse für die Studierendenauswahl an der UWH handelt.

  19. Wirtschaftliche Stellung deutscher Unternehmen in Chile: Ergebnisse einer empirischen Analyse

    OpenAIRE

    Kassai, László B.

    2014-01-01

    Die Abschätzung der wirtschaftlichen Bedeutung deutscher Unternehmen in Chile anhand der Auswertung von 14 schriftlichen Interviews mit deutschen Tochtergesellschaften im Jahre 1987 ist der Inhalt dieses Beitrages. Die Einordnung erfolgt vor dem Hintergrund sowohl der wirtschaftlichen Situation der ganzen Region (Lateinamerika) als auch der industriellen Entwicklung in Chile bis 1987. Die Analyse kommt zum Schluß, daß die im Durchschnitt lang ansässigen Unternehmen a) eine rege Innovations...

  20. Ergebnisse einer Expertenbefragung zu den Arbeitsmarktpotenzialen im betrieblichen Gesundheitsmanagement

    OpenAIRE

    2011-01-01

    Das Institut für Gesundheitsmanagement (IGM) der Fakultät IV (Wirtschaft und Informatik) der Fachhochschule Hannover hat im Auftrag der Wirtschaftsförderungsgesellschaft „hannoverimpuls“ ein Projekt zum Thema „betriebliches Gesundheitsmanagement – Ansatzpunkte für Arbeitsmarktpotenziale in der Region Hannover“ durchgeführt und im Oktober 2008 mit Übergabe des Projektberichts abgeschlossen. Im Rahmen dieses Projektes wurden u. a. gezielt Experten zum betrieblichen Gesundheitsmanagement (BGM) a...

  1. Interne Kommunikation in der Wahrnehmung von Mitarbeitern : Ergebnisse einer Befragung

    OpenAIRE

    2009-01-01

    Die interne Kommunikation ist eines der zentralen Felder der Organisations- oder Unternehmenskommunikation. In der Praxis professionalisiert sie sich zusehends: Was früher von PR-Fachleuten als Allroundern der Organisationskommunikation mit abgedeckt wurde, ist heute in immer mehr Organisationen eine eigenständige Teilfunktion der Kommunikation. Abteilungen für interne Kommunikation existieren nicht mehr länger nur in Großunternehmen, sondern zunehmend auch in mittelständischen Unternehmen, ...

  2. Lifestyle und Endometriose - Ergebnisse aus einer Fall-Kontroll-Studie

    OpenAIRE

    2011-01-01

    Zusammenfassung Hintergrund und Ziele Die heutige Medizin ermöglicht es die Symptome Endometriose erkrankter Frauen medikamentös oder chirurgisch zu lindern. Doch viele Patienten wollen sich in die Behandlung selbst einbringen und einen eigenen Beitrag zu ihrer Genesung leisten. Eine Möglichkeit für Patientinnen dies zu tun ist eine Änderung des Lifestyles. Ziel dieser Arbeit ist es, Unterschiede im Lifestyle erkrankter und gesunder Frauen in einer großen Fall Kontroll-Studie zu untersuchen. ...

  3. Drug-eluting Stents - Grundlagen, Indikationen und klinische Ergebnisse

    Directory of Open Access Journals (Sweden)

    Vogt AM

    2003-01-01

    Full Text Available Die Wiederverengung eines Koronargefäßes nach zunächst erfolgreicher Ballondilatation (Restenose ist ein häufiges, bislang unzureichend gelöstes Problem der interventionellen Kardiologie mit bedeutenden gesundheitsökonomischen Auswirkungen. Die sogenannten drug-eluting Stents (DES stellen diesbezüglich ein erfolgversprechendes Therapiekonzept dar: Solche meist mit einer Polymermatrix überzogenen endovaskulären Prothesen setzen nach ihrer Implantation Substanzen frei, die bekannte Mechanismen der Restenoseentstehung - zelluläre Proliferation, Migration, Inflammation und Zellteilung - hemmen und somit einer Wiederverengung des Interventionsbereiches entgegenwirken. Mit Taxol und seinen Derivaten sowie mit dem Immunsuppressivum Rapamycin (Sirolimus und Analoga stehen heute bereits zwei Substanzgruppen zur Auswahl, deren Nutzen hinsichtlich angiographischer Restenoserate und klinischem Verlauf für ausgewählte Indikationen im Rahmen kontrollierter klinischer Studien nachgewiesen werden konnte. Weitere, z. T. bereits laufende Studien werden zeigen, welcher Stellenwert dieser erfolgversprechenden neuen Technologie tatsächlich zukommt und ob die therapeutischen Vorteile der DES - angesichts limitierter finanzieller Ressourcen - ihren höheren Preis rechtfertigen.

  4. Wie vergleichbar sind Ergebnisse von Rechtschreib-und Lesetests?

    OpenAIRE

    Steinhauser, Susanne

    2006-01-01

    Eine umschriebene Lese-Rechtschreibstörung (ICD-10: F81) ist durch eine Diskrepanz zwischen den allgemeinen kognitiven Fähigkeiten eines Kindes und dessen Lese-Rechtschreibleistungen gekennzeichnet. Für die Diagnostik steht eine Vielzahl von Lese- und Rechtschreibtests zur Verfügung. In der Studie wurde untersucht, ob die Diagnosestellung von der Wahl des Testverfahrens abhängt. Es wurden Kinder mit mehreren Rechtschreib- und Lesetests untersucht. Die allgemeinen kognitiven Fähigkeiten wur...

  5. Ergebnisse der mikrobiologischen und histopathologischen Revisionsdiagnostik bei unklarem Endoprothesenversagen

    OpenAIRE

    Riemann, Johannes; Kienapfel, Heino

    2016-01-01

    Die Endoprothetik ist eine der erfolgreichsten operativen Behandlungs-methoden der modernen Medizin und bietet Patienten mit fortgeschrittener Arthrose eine etablierte Therapiemöglichkeit. In Deutschland gehört der künst-liche Gelenkersatz im Bereich des Hüft- und Kniegelenkes zu den häufigsten durchgeführten Operationen. Bei hohen Implantationszahlen und steigender Lebenserwartung kam es in den letzten Jahren auch zu einem Anstie...

  6. Wie häufig und belastend sind negative Erfahrungen im Medizinstudium? – Ergebnisse einer Online-Befragung von Medizinstudierenden [Frequency and perceived severity of negative experiences during medical education in Germany – Results of an online-survery of medical students

    Directory of Open Access Journals (Sweden)

    Gágyor, Ildikó

    2012-08-01

    Belästigung, Benachteiligung aufgrund von Herkunft, Nationalität oder Hautfarbe, und anderen Formen negativer Erfahrungen befragt. Ergebnisse: Von 391 Studierenden berichteten 56% von mangelnder Wertschätzung, 51% davon, Konkurrenz erlebt zu haben, und 34% von verbal unangemessener Behandlung. Während 59% sich durch verbal unangemessene Behandlung belastet fühlten, lag der Anteil der Belasteten bei mangelnder Wertschätzung bzw. Konkurrenz bei 46% bzw. 32%. Diese Rate war in anderen Fällen, wie bei der Erfahrung „Übergangen oder nicht beachtet zu werden“ deutlich niedriger (21%. Weibliche Studierende fühlten sich insgesamt häufiger belastet als männliche. Schlussfolgerung: Weniger spektakuläre Formen wie mangelnde Wertschätzung oder verbal unangemessene Behandlung sind nicht nur häufig, sondern werden auch als belastend empfunden. Lehrende in der medizinischen Ausbildung sollten die Gefahr, Studierende gerade auch auf diese Weise zu verletzen, kritisch reflektieren.

  7. Local lysis with Alteplase for the treatment of acute embolic leg ischemia following the use of the Duett {sup trademark} closure device: preliminary results; Lokale Alteplase-Lyse zur Therapie der akuten embolischen Beinischaemie nach Einsatz des Duett {sup trademark} -Verschluss-Systems: vorlaeufige Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schuermann, K.; Buecker, A.; Wingen, M.; Tacke, J.; Wein, B.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik des Universitaetsklinikums der RWTH Aachen (Germany); Janssens, U. [Medizinische Klinik I (Kardiologie) des Universitaetsklinikums der RWTH Aachen (Germany)

    2004-04-01

    unter intravaskulaeren Ballonschutz der arteriellen Punktionsstelle in den Punktionskanal gespritzt wird. Bei 9 Patienten (0,64%) wurde das Prokoagulans unbemerkt in die Femoralarterie injiziert, und es trat eine akute Beinischaemie auf. Acht Patienten erhielten ueber einen kontralateralen femoralen Zugang eine lokale Alteplase-Lyse. Ein Patient wurde operiert. Im Mittel wurden 21 mg Alteplase (4-35 mg) in 14 h (4-21 h) appliziert. Der Verlauf der Lyse wurde angiographisch und klinisch kontrolliert. Die Patienten wurden nach 23 Monaten (4-35 Monaten) telefonisch befragt. Ergebnisse: Bei 3 Patienten war die Lyse vollstaendig, bei 5 Patienten verblieb wenig Restmaterial. In allen Faellen bildete sich die Ischaemiesymptomatik vollstaendig innerhalb der ersten Stunden nach Lysebeginn zurueck. In 5 Faellen trat waehrend der Lyse eine Blutung aus der mit dem Duett-System verschlossenen Punktionsstelle auf, in 2 Faellen mit Ausbildung eines falschen Aneurysmas. Dies fuehrte zum vorzeitigen Ende (n=2) oder zur Unterbrechung der Lyse (n=3). Alle Komplikationen wurden konservativ behandelt. Klinisch verblieben als Spaetfolgen bei 2 lysierten und dem operierten Patienten Par- und Hypaesthesien am Unterschenkel bzw. Fuss. (orig.)

  8. Comparison of contrast-enhanced MR angiography of the aortoiliac vessels using a 1.0 molar contrast agent at 1.0T with intra-arterial digital subtraction angiography; Ergebnisse der kontrastverstaerkten MR-Angiographie der aortoiliakalen Gefaesse mit einem 1-molaren Kontrastmittel bei 1,0 T; Vergleich zur i.a. DSA

    Energy Technology Data Exchange (ETDEWEB)

    Mohrs, O.K. [Klinik und Poliklinik fuer Radiologie, Johannes Gutenberg-Univ. Mainz (Germany); Cardioangiologisches Centrum Bethanien, Frankfurt/Main (Germany); Oberholzer, K.; Bernhard, S.; Kalden, P.; Thelen, M.; Kreitner, K.F. [Klinik und Poliklinik fuer Radiologie, Johannes Gutenberg-Univ. Mainz (Germany); Krummenauer, F. [Inst. fuer Med. Biometrie, Epidemiologie und Informatik, Johannes Gutenberg-Univ. Mainz (Germany); Neufang, A. [Klinik fuer Herz- und Thoraxchirurgie, Johannes Gutenberg-Univ. Mainz (Germany)

    2004-07-01

    entsprechend einer Dosis von 0,1-0,15 mmol/kg KG und einer 3-D-Gradientenecho-Sequenz. Das Bildmaterial wurde von zwei Auswertern unabhaengig voneinander und in Unkenntnis der Patientenanamnese und i. a. DSA hinsichtlich Bildqualitaet, der Detektion von Stenosen < 50% und > 50% bzw. Verschluessen sowie von Aneurysmen ausgewertet und es wurde die Interobservariabilitaet bestimmt. Die Bildqualitaet wurde mittels einer 4-Punkte-Skala evaluiert. Ergebnisse: Von den 19 Patienten konnten insgesamt 144 Gefaesssegmente bewertet werden. Die Bildqualitaet der ce-MRA betrug durchschnittlich 3,4 Punkte auf einer 4-Punkte-Skala. Der segmentweise Vergleich zur invasiven Angiographie zeigte eine Sensitivitaet von 96%, eine Spezifitaet von 99%, einen positiven Vorhersagewert von 96% und einen negativen Vorhersagewert von 99%. Mit einem Kappa-Wert von 0,82 fand sich eine niedrige Interobservervariablitaet. Schlussfolgerung: Die ce-MRA unter Verwendung eines 1-molaren, paramagnetischen Kontrastmittels bei 1,0 T erlaubt im Vergleich zu i. a. DSA eine genaue Beurteilung des Vorhandenseins von relevanten Stenosen bzw. Verschluessen sowie Aneurysmen der aortoiliakalen Gefaesse. (orig.)

  9. CT assisted follow-up of arthroscopically placed hydroxylapatite grafts in repair of fracture of the tibial head. Initial results of a CT assisted, quantitative assessment of the incorporation of the calcium hydroxylapatite graft and the reactions of the surrounding tissue; Computertomographie-gestuetzte Verlaufskontrolle arthroskopisch eingebrachter Hydroxylapatit-Implantate bei Tibiakopffrakturen. Vorlaeufige Ergebnisse zur CT-gestuetzten quantitativen Bewertung der Einheilung und der Umgebungsreaktion bei Kalziumhydroxylapatit-Implantaten

    Energy Technology Data Exchange (ETDEWEB)

    Liebig, T. [Strahlenklinik und Poliklinik, Virchow-Klinikum der Humboldt-Univ. zu Berlin (Germany); Schedel, H. [Strahlenklinik und Poliklinik, Virchow-Klinikum der Humboldt-Univ. zu Berlin (Germany); Kodadadyan, Z. [Unfallchirurgische Klinik, Virchow-Klinikum der Humboldt-Univ. zu Berlin (Germany); Ricke, J. [Strahlenklinik und Poliklinik, Virchow-Klinikum der Humboldt-Univ. zu Berlin (Germany); Hoffmann, R. [Unfallchirurgische Klinik, Virchow-Klinikum der Humboldt-Univ. zu Berlin (Germany); Haas, N. [Unfallchirurgische Klinik, Virchow-Klinikum der Humboldt-Univ. zu Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik, Virchow-Klinikum der Humboldt-Univ. zu Berlin (Germany)

    1996-06-01

    Four patients bearing a hydroxylapatite graft in repair of tibial head fracture have been examined by CT immediately after surgery and several times in the post operative period of up to 24 months. Density measurements of the graft, the spongiosa immediately next to it, and the spongiosa in fibula and tibia reveal the integration and ossous connection of the graft, quantifiable by the X-ray density. The spongiosa in immediate contact with the graft shows an initial density increase related to the first post-operative data, followed by a density decrease observed by subsequent measurements. These results are in agreement with animal experimental data and histomorphologic studies of other authors, which show that porous hydroxylapatite is used by the bone as a matrix serving as a pathway for osteoblast migration and subsequent ossification of the graft. Thus CT is capable of showing the post-operative integration process by quantifying and reproducible data. (orig.) [Deutsch] Es wurden 4 Patienten nach arthroskopischer Versorgung von Tibiakopffrakturen mit einem Hydroxylapatit-Implantat unmittelbar postoperativ sowie im weiteren Verlauf bis 24 Monaten post OP mehrfach computertomographisch untersucht. Dichtemessungen des Implantates, der unmittelbar an das Implantat grenzenden Spongiosa und der Spongiosa in Fibula und Tibia ergeben eine anhand der Roentgendichte quantifizierbare Integration und knoecherne Durchbauung des Implantates. Die unmittelbar angrenzende Spongiosa wies abhaengig vom Zeitpunkt der ersten postoperativen Kontrolle einen initialen Dichteanstieg mit einer Dichteabnahme im weiteren Verlauf auf. Diese Ergebnisse stehen im Einklang mit den Ergebnissen tierexperimenteller und histomorphologischer Untersuchungen anderer Autoren, die zeigen, dass poroese Hydroxylapatit vom Knochen als Matrix genutzt wird, entlang derer es zum Einwandern von Osteoblasten mit nachfolgender Ossifikation des Implantates kommt. Die Computertomographie ist somit in der Lage

  10. Combined weekly paclitaxel and radiotherapy of stage III inoperable non-small-cell lung cancer (NSCLC). Results of a dose escalation study; Sequentielle Chemo- und Radiochemotherapie mit Paclitaxel/Carboplat und 3D-konformer Bestrahlung beim inoperablen nichtkleinzelligen Bronchialkarzinom. Ergebnisse einer Dosiseskalationsstudie

    Energy Technology Data Exchange (ETDEWEB)

    Willner, J.; Flentje, M. [Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Strahlentherapie; Schmidt, M.; Wirtz, H. [Wuerzburg Univ. (Germany). Abt. Pneumologie; Huber, R.M.; Fischer, R.; Lang, S. [Muenchen Univ. (Germany). Medizinische Klinik

    1997-11-01

    % with a median follow-up of 12 months. Conclusion: The maximum tolerable dose of weekly paclitaxel infusions with 60 Gy radiotherapy is 60 mg/m{sup 2}. Combined treatment of sequential chemotherapy with paclitaxel/Carboplat and radiochemotherapy with weekly doses of up to 60 mg/m{sup 2} paclitaxel and 60 Gy radiotherapy is a highly effective treatment with tolerable side effects, mainly esophagitis. A potential increase in pulmonary toxicity of irradiation is suspected. (orig.) [Deutsch] Ziel: Prospektive Bestimmung der maximal tolerablen woechentlichen Taxol {sup trademark} -Dosis in Kombination mit 3D-konformer Strahlentherapie beim nichtkleinzelligen Bronchialkarzinom (NSCLC) nach initialer Chemotherapie mit Carboplat/Paclitaxel. Patienten und Methode: Patienten mit inoperablem NSCLC (IIIA/B) erhielten zwei Zyklen Kombinationschemotherapie mit Paclitaxel (175 mg/m{sup 2})/Carboplatin (AUC 5). Anschliessend wurde eine Radiochemotherapie mit sechs woechentlichen Taxol {sup trademark} -Infusionen mit Dosissteigerung von 40 mg/m{sup 2} in 10-mg/m{sup 2}-Schritten durchgefuehrt. Die Radiatio wurde 3D-konform geplant. Primaertumor und Lymphknotenmetastasen erhielten 60 bis 66 Gy (2 Gy, 5mal pro Woche). Die Toxizitaet der Therapie wurde nach WHO-Kriterien klassifiziert. Ergebnisse: Befunde von 30 bis 35 eingeschlossenen Patienten sind derzeit auswertbar. Die Studie wurde im Dosislevel 70 mg/m{sup 2} bei Ueberschreitung der maximal tolerablen Dosis beendet. Bei zwei Patienten (Level 50 mg/m{sup 2}) wurde die Taxol {sup trademark} -Infusion wegen Hypersentitivitaetsreaktionen abgebrochen, eine Patient (Level 60 mg/m{sup 2}) entwickelte eine Grad-III-Leukopenie. Die Strahlentherapie dieser drei Patienten konnte ohne Probleme beendet werden. Bei einem Patienten im Level 60 mg/m{sup 2} wurde die Bestrahlung bei 50 Gy wegen Pneumonie, Oesophagitis Grad II und Verschlechterung des Allgemeinzustands abgebrochen. Drei Patienten entwickelten eine Oesophagitis Grad II, eine

  11. Acute Gout Following Dermofasciectomy in a Patient With Dupuytren Disease.

    Science.gov (United States)

    Cochrane, Elliott; Harper, Rosalyn

    2017-01-01

    A 62-year-old man underwent uncomplicated dermofasciectomy of the right little finger. In the week after surgery, he presented with erythema, tenderness, reduced range of movement, and a chalklike discharge from the suture line. Investigations revealed a raised serum urate level accompanied with a borderline rise in inflammatory markers. A diagnosis of acute gout was made. The patient was managed with nonsteroidal anti-inflammatory drugs. Clinicians should consider the diagnosis of gout when patients present after surgery with redness, pain, and swelling and also consider measuring urate levels before surgery and initiating colchicine prophylaxis when there is a known diagnosis of gout before surgery. Accurate diagnosis may prevent unnecessary antibiotic use. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. The Surgical Release of Dupuytren's Contracture Using Multiple Transverse Incisions

    Directory of Open Access Journals (Sweden)

    Hyunjic Lee

    2012-07-01

    Full Text Available Dupuytren’s contracture is a condition commonly encountered by hand surgeons, although itis rare in the Asian population. Various surgical procedures for Dupuytren’s contracture havebeen reported, and the outcomes vary according to the treatment modalities. We report thetreatment results of segmental fasciectomies with multiple transverse incisions for patientswith Dupuytren’s contracture. The cases of seven patients who underwent multiple segmentalfasciectomies with multiple transverse incisions for Dupuytren’s contracture from 2006 to 2011were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites wereperformed initially, and additional incisions to the metacarpophalangeal (MCP joints, and theproximal interphalangeal (PIP joints were performed if necessary. Segmental fasciectomiesby removing the fibromatous nodules or cords between the incision lines were performed andthe wound margins were approximated. The mean range of motion of the involved MCP jointsand PIP joints was fully recovered. During the follow-up periods, there was no evidence ofrecurrence or progression of disease. Multiple transverse incisions for Dupuytren’s contractureare technically challenging, and require a high skill level of hand surgeons. However, weachieved excellent correction of contractures with no associated complications. Therefore,segmental fasciectomies with multiple transverse incisions can be a good treatment option forDupuytren’s contracture.

  13. Recurrence of Dupuytren's contracture: A consensus-based definition

    NARCIS (Netherlands)

    H.J. Kan (Hester); F.W. Verrijp (Frank); S.E.R. Hovius (Steven); C.A. van Nieuwenhoven (Christianne); R.W. Selles (Ruud); P.C. Amadio (Peter ); Degreef, I. (Ilse); Denkler, K. (Keith); J.J. Dias (Joseph); Eaton, C. (Charles); Goldfarb, C.A. (Charles A.); Hentz, V. (Vincent); E Horch, R. (Raymund); Hurst, L. (Lawrence); Jerosch-Herold, C. (Christina); R.K. Khouri (Roger); Lalonde, D. (Donald); Leclercq, C. (Caroline); McGrouther, D.A. (Ducan Angus); J. Nanchahal (Jagdeep); Pelissier, P. (Phillipe); Tonkin, M. (Michael); P.M.N. Werker (Paul); Wilbrand, S. (Stephan); Zyluk, A. (Andrzej)

    2017-01-01

    textabstractPurpose: One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available

  14. Industrie 4.0 im Aufbruch? Ein beispielhafter Ausschnitt aus dem betrieblichen Stand

    OpenAIRE

    Kleinhempel, Karla; Satzer, Angelika; Steinberger, Viktor

    2015-01-01

    - Die Ergebnisse geben einen ersten Einblick in die betriebliche Praxis der Umsetzung von Industrie 4.0. - Es gibt nicht die Einfuhrung von Industrie 4.0. - Die betrieblichen Fallbeispiele lassen sich in drei Kategorien einteilen. Am Standort: o wird Industrie 4.0 unter diesem Begriff umgesetzt. o gibt es erste Ansatze von Industrie 4.0 o ist Industrie 4.0 kein Thema - Betriebsräte besitzen nicht immer Informationen daruber, ob Industrie 4.0 eingefuhrt wird oder nicht. - Es fehlen allgemein K...

  15. Investigations of microbial regeneration of abandoned mining land. Project 1: Leachate reduction in ore mining regions with high levels of heavy metal sulfides. Final report 2000; Untersuchungen zur mikrobiellen Sicherung von Bergbaualtlasten. Teilvorhaben 1: Laugungsreduzierung in Schwermetallsulfid-belasteten Erzbergbauregionen. Abschlussbericht 2000

    Energy Technology Data Exchange (ETDEWEB)

    Sand, W.; Jozsa, P.G.; Schippers, A.

    2001-02-01

    The project was aimed at the development of an optimized catalogue of measures for regeneration and reclamation of polluted mining land. Reports were published in 1995, 1996, 1997 and 1998. This report summarizes the work of 1999 and 2000. A catalogue of measures is proposed on the basis of the results. [German] Ziel des Projektes ist die Erarbeitung eines optimierten Massnahmenpaketes zur Sicherung und Sanierung von Bergbaualtlasten, die durch mikrobiologische Sauerwasserbildung und Schwermetallmobilisierung Boeden und Gewaesser kontaminieren. Die Problematik und der Stand der Kenntnisse sowie erste Ergebnisse der Bestandsaufnahmen wurden in den Jahresberichten 1995 und 1996 sowie im Fortsetzungsantrag ausfuehrlich dargestellt. Ueber die Versuchsergebnisse der Jahre 1997 und 1998 wurde bereits berichtet. Im Folgenden werden die in den Jahren 1999 und 2000 erzielten Ergebnisse zusammengefasst und eine Bewertung der Projektarbeit vorgenommen. Abschliessend wird ein Massnahmenkatalog vorgeschlagen, der bei der Planung und Durchfuehrung von Sanierungsaufgaben an Bergbaualtlasten den Anwendern die aus mikrobiologischer Sicht zu beruecksichtigenden Aspekte mit Loesungsmoeglichkeiten gebuendelt zur Verfuegung stellt. (orig.)

  16. Operational experience of HR AVI Amsterdam; Erste Betriebserfahrungen der HR AVI, Amsterdam

    Energy Technology Data Exchange (ETDEWEB)

    Wandschneider, Joern [wandschneider + gutjahr ingenieurgesellschaft mbH, Hamburg (Germany)

    2010-05-15

    The HR-AVI (which derives from ''high efficiency waste treatment plant'' in Dutch) in Amsterdam is the first waste fired power plant worldwide to demonstrate more than 30 % net electrical efficiency. This was in fact the target when designing the plant; it thus features a number of innovations. The HR-AVI is in operation since September 2007, and two years of operational experience are available for evaluation. The first year was marked by a number of extraordinary difficulties that could not have been anticipated in this form, and which bear no significance on the plant efficiency. In particular, the break-age of the generator shaft led to a turbine outage for a lengthy period, resulting in operating modes that had not been intended continuously. It proved that the plant is able to meet the efficiency require ment with ease. But some problems evolved when operating the complex systems in automatic or manual control. Moreover, the maximum electrical efficiency is a diver ging requirement with regard to the maximum refuse through put, if the turbine including peripherals is not always fully available. A display is installed in the control room to indicate the current efficiency. Unfortunately, there are no operational means to compensate for losses in that efficiency figure. The remaining task is to optimize both the operation and the reliability of the water and steam cycle, meaning to produce more of the built-in efficiency in the actually practiced day to day operation. (orig.)

  17. Von Roll RCP method - first experiences; Von Roll RCP - Verfahren. Erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Capitaine, P.; Engweiler, J. [Roll Umwelttechnik AG, Zuerich (Switzerland)

    1998-09-01

    The RCP method was designed as a residue-optimised alternative to the thermally optimised grate firing of residual wastes. Its technical realisation and development to market maturity took no more than 5 years. In the first process stage the waste is converted to high-carbon pyrolysis charcoal and high-rank gas in the absence of oxygen. In the second stage these substances are oxidised by addition of oxygen. The resulting temperature causes the non-combustible constituents of the slag to melt. In a third, optional, stage this molten slag can be liberated of (heavy) metals to such an extent that it can subsequently be used directly as additive for grinding. Further exhaust gas treatment is facilitated by the use of a circulatory fluidised-bed secondary combustion chamber. Despite the reduced flue gas volume and resultant higher pollutant concentrations in the crude gas, overall emissions are lower than in conventional plants. [Deutsch] Das reststoffoptimierte RCP Verfahren ist als Alternative zur thermisch optimierten Rostverbrennung von Restabfaellen konzipiert. In nur fuenf Jahren wurde das Verfahren technisch umgesetzt und zur Marktreife entwickelt. In einer ersten Stufe des Verfahrens wird der Abfall unter Luftabschluss in einen kohlenstoffreichen Pyrolysekoks und eine heizwertreiches Gas umgesetzt. Im zweiten Schritt werden diese Stoffe unter Zugabe von Sauerstoff oxidiert. Dabei treten Temperaturen auf, bei denen die nichtbrennbaren Bestandteile der Schlacke schmelzen. Optional wird diese Schmelzschlacke in einem dritten Schritt derart von (Schwer-) Metallen befreit, dass sie anschliessend direkt als Zement-Zumahlstoff eingesetzt werden kann. Die Nutzung der zirkulierenden Wirbelschicht - Nachbrennkammer zur Abgasbehandlung vereinfacht die weitergehende Abgasbehandlung. Trotz verringertem Rauchgasvolumen und damit hoeheren Schadstoffkonzentrationen im Rohgas werden die Gesamtemissionen gegenueber konventionellen Anlagen verringert. (orig./SR)

  18. Erste Nachweise sowie Kenntnisse zur Biologie von Cyclosa oculata (Araneae: Araneidae in der Schweiz

    Directory of Open Access Journals (Sweden)

    Zschokke, Samuel

    2007-06-01

    Full Text Available The orb-web spider Cyclosa oculata (Walckenaer, 1802 was found at eleven localities in north-western Switzerland. All records were from wildflower strips ("Buntbrachen" with a relatively high proportion of dried vegetation from the previous year, a relatively low vegetation height and a low proportion of grasses in the vegetation. C. oculata built its vertical orb-web near the ground, deep in the vegetation. Among ecribellate orb-web spiders in Central Europe, C. oculata is unique because it sometimes builds rudimentary webs on which it stays, because it builds its cocoons into the web, and because its stabilimentum is long-lasting and consists largely of debris. Based on our observations, we deduce that the stabilimentum of C. oculata serves as camouflage.

  19. Spinal trauma: first aid from cross-sectional imaging; Trauma der Wirbelsaeule: erste Hilfe durch Schnittbildverfahren

    Energy Technology Data Exchange (ETDEWEB)

    Schueller, G.; Schueller-Weidekamm, C. [Emergency Radiology Schueller, Neerach (Switzerland)

    2014-09-15

    The diagnosis of the traumatized spine is one of the key issues for trauma radiologists. The cross-sectional imaging procedures, computed tomography (CT) and magnetic resonance imaging (MRI) are the essential methods in spinal trauma radiology. These modalities are of great help in accurately assessing injury patterns and extent and in providing indications of patient outcome. In contrast to cross-sectional imaging, radiography has a role in the evaluation of minor spinal trauma only. It is generally accepted that trauma radiologists do not use typical classifications to evaluate the spine partly because such an ideal classification system does not yet exist. Not least because of this classification difficulty, eponyms and synonyms are widely used to describe traumatology of the spine as a high level of specific information is included in these various terms. The members of the trauma team should be aware of the strengths and limitations of the methods used in the assessment of the spine. This article provides a brief outline of fundamental knowledge about the diagnosis of spinal trauma. (orig.) [German] Die Beurteilung der verletzten Wirbelsaeule nimmt fuer Traumaradiologen eine zentrale Stellung ein. Die Schnittbildverfahren CT und MRT sind ihre wesentlichen Arbeitsmethoden. Sie helfen dabei, schnell und mit hoher Zuverlaessigkeit Aussagen ueber Art und Ausmass von Verletzungen zu treffen sowie Hinweise auf die Prognose der Patienten zu geben. Die Projektionsradiographie hat ihre Bedeutung lediglich in der Diagnostik des Bagatelltraumas und ist in ihrer Aussagekraft auch dort nicht unumstritten. Traumaradiologen bedienen sich nicht ausschliesslich typischer Klassifikationen des Wirbelsaeulentraumas, z. T. auch deshalb, da es die ideale Klassifikation aus heutiger Sicht nicht gibt. Vielmehr ist es wichtig, auch ueber Eponyme und Synonyme Bescheid zu wissen, da sie ein hohes Mass an spezifischen Informationen der spinalen Verletzungen verinnerlichen. Alle Mitglieder eines Traumateams sollen sich der Staerken und Schwaechen der verwendeten radiologischen Techniken bei der Beurteilung des Wirbelsaeulentraumas bewusst sein. Dieser Artikel gibt einen kurzen Abriss ueber die wesentlichen diagnostischen Kenntnisse der traumatisierten Wirbelsaeule. (orig.)

  20. Comparative Study on the Banking Performances at BCR ERSTE BANK, BRD – GSG and Raiffeisen Bank

    Directory of Open Access Journals (Sweden)

    Claudia MITITELU

    2014-11-01

    Full Text Available This paper aims to make a comparison between the performances of three banks in the banking system in Romania, considered the most representative but also to achieve their classifications and identify correlations between a number of used indicators and indicators expressing banking performance.

  1. Diagnosis of thyroid disease. Anamnesis and physical examination; Erste Schritte in der Schilddruesendiagnostik. Anamnese und Untersuchung

    Energy Technology Data Exchange (ETDEWEB)

    Freudenberg, L.S. [Kreiskrankenhaus Grevenbroich (Germany). Zentrum fuer Radiologie und Nuklearmedizin

    2008-09-15

    Anamnesis and physical examination rank first in the diagnostic process of thyroid disease. They provide a basis for subsequent diagnostic procedures and treatment. This article focusses on personal, medical and familial history as well as physical examination of the neck and general clinical examination with respect to signs and symptoms of hypo- or hyperthyreoidism. In addition indications for fine-needle biopsy and biopsy technique are described. (orig.)

  2. Peter Andreas Hansen und die astronomische Gemeinschaft - eine erste Auswertung des Hansen-Nachlasses.

    Science.gov (United States)

    Schwarz, O.; Strumpf, M.

    The literary assets of Peter Andreas Hansen are deposited in the Staatsarchiv Hamburg, the Forschungs- und Landesbibliothek Gotha and the Thüringer Staatsarchiv Gotha. They were never systematically investigated. The authors present here some results of a first evaluation. It was possible to reconstruct the historical events with regard to the maintenance of the Astronomische Nachrichten and the Altona observatory in 1854. Hansen was a successful teacher for many young astronomers. His way of stimulating the evolution of astronomy followed Zach's tradition.

  3. Finnland und das erste allgemeine Sängerfest der Esten 1869 / Seppo Zetterberg

    Index Scriptorium Estoniae

    Zetterberg, Seppo, 1945-

    2005-01-01

    Esimesele Eesti laulupeole oli kutsutud ka Soome fennomaanide liider ajaloo professor Yrjö Koskinen, kes siiski laulupidu ei külastanud. Soomlastest käisid laulupeol J. R. Aspelin ja C. G. Swan, kes olid Jannsenite külalisteks. Esimesest Eesti-buumist Soomes

  4. Real-time Elastografie: Erste Messungen von gewebeelastischen Eigenschaften der Zervix uteri

    OpenAIRE

    Burger, Katharina Adriana

    2014-01-01

    Introduction: in this study were investigated aged and duration of pregnancy dependend tissue elastic properties and changes of the normal cervix and in pregnant women. The normal findings were compared with the results in a group of patients with focal pathology of the cervix and with cervical insufficiency. Materials and Methods: a total of 165 patients, among them 52 pregnant women, underwent transvaginal ultrasound using a 9 MHz high-end US device with a vaginal probe. The examiner pla...

  5. Low emission zone Munich. First results; Umweltzone Muenchen. Eine erste Bilanz

    Energy Technology Data Exchange (ETDEWEB)

    Cyrys, Josef [Helmholtz Zentrum Muenchen - Deutsches Forschungszentrum fuer Gesundheit und Umwelt, Inst. fuer Epidemiologie, Neuherberg (Germany); Wissenschaftszentrum Umwelt (WZU) der Univ. Augsburg (Germany); Peters, Annette [Helmholtz Zentrum Muenchen - Deutsches Forschungszentrum fuer Gesundheit und Umwelt, Inst. fuer Epidemiologie, Neuherberg (Germany); Wichmann, H. Erich [Helmholtz Zentrum Muenchen - Deutsches Forschungszentrum fuer Gesundheit und Umwelt, Inst. fuer Epidemiologie, Neuherberg (Germany); Inst. fuer Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig-Maximilians-Univ. Muenchen, Lehrstuhl fuer Epidemiologie, Neuherberg (Germany)

    2009-07-01

    In order to reduce the PM{sub 10} concentrations in the ambient air in Munich, Germany two measures have been introduced in 2008. In February 2008 the law forbidding transit of vehicles heavier than 3.5 tons through the city area took effect. Additionally, a low emission zone was established in the inner city of Munich in October 2008. In our analysis we study the impact of those measures on the ambient PM{sub 10} concentrations by comparing two 4 months periods, the first one before the measures became operative and the second one after it. By means of a reference station located in a background area we adjusted our analysis on the influence of the meteorological conditions. A reduction of the relative PM{sub 10} burden was observed and the magnitude of the decrease was in line with the results calculated by modelling. The decrease was small and especially pronounced at traffic sites. Due to the kind of measures it is obvious that the reduced fraction of PM{sub 10} was mostly generated by traffic (and especially diesel engines), which is known to be especially relevant for human health. (orig.)

  6. Preliminary experience in the monitoring of geothermal probes by borehole logging; Erste Erfahrungen bei der bohrlochgeophysikalischen Ueberpruefung von Erdwaermesonden

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, Karsten [Bohrlochmessung-Storkow GmbH, Storkow (Germany)

    2010-05-15

    Authorities as well as waterworks experts have long been calling for a control strategy to ensure that groundwater protection is considered in geothermal projects. So far, control options for geothermal probes were lacking, which raised doubts about the efficiency of sealing. Waterworks experts also were unable to understand why new groundwater wells or groundwater measuring fonts are subject to careful control via geophysical borehole logs while geothermal probes with a depth of 100 m and more can be installed nearby without adequate monitoring. The contribution presents a preliminary approach for monitoring and testing of shallow geothermal probes. (orig.)

  7. Bank interest policy in the function of lending loans: With Erste Bank Novi Sad as an example

    Directory of Open Access Journals (Sweden)

    Obradović Jelena

    2012-01-01

    Full Text Available In this paper, attention is focused on the interest and credit policies of banks, and on the way employees in the banks contribute to the proper implementation of these policies, the way in which National Bank of Serbia, using different interest rates, affects the performance of open market operations, as well as preserving and enhancing stability of functioning of the entire banking system. Recognizable and effective credit policy is an objective of each successful bank. Formulating and achieving that policy is not an easy task. Many sections of the bank contribute to this task, which include Credit Committee and ALCO Committee. Performing their functions, they improve the quality of bank lending, reduce risk, and improve the entire business of the bank.

  8. Der Erste Weltkrieg als Medium der Gegenmoderne: zu den Werken von Walter Flex und Ernst Jünger

    OpenAIRE

    Koch, Lars

    2004-01-01

    1. Inleiding Tussen de ‘visies op de oorlog’ die in de teksten van Walter Flex enerzijds, in die van Ernst Jünger anderzijds tot uitdrukking komen, ligt het trauma van de materiaalslag. Walter Flex, voornamelijk aan het oostfront ingezet, vocht in een van de laatste veldslagen van de door Eric Hobsbawn zo genoemde ‘lange’ 19de eeuw. Ernst Jünger daarentegen, in België en Frankrijk ingezet, nam deel aan de eerste ‘moderne’ oorlog van de 20ste eeuw. Walter Flex vervulde in zijn rol van schrijve...

  9. Der Erste Weltkrieg als Medium der Gegenmoderne : zu den Werken von Walter Flex und Ernst Jünger

    NARCIS (Netherlands)

    Koch, Lars

    2004-01-01

    1. Inleiding Tussen de ‘visies op de oorlog’ die in de teksten van Walter Flex enerzijds, in die van Ernst Jünger anderzijds tot uitdrukking komen, ligt het trauma van de materiaalslag. Walter Flex, voornamelijk aan het oostfront ingezet, vocht in een van de laatste veldslagen van de door Eric Hobsb

  10. A look back on 2012. The first year of implementation; Rueckblick 2012. Das erste Jahr der Umsetzung

    Energy Technology Data Exchange (ETDEWEB)

    Wetzel, Daniel [Die Welt, Welt am Sonntag, Welt Digital, Wirtschaftsredaktion, Berlin (Germany)

    2012-12-15

    At various meetings and conferences of the energy economy in late 2011 participants voiced their expectations that as far as the energy turnaround was concerned the year 2012 would become even more exciting than the year before. After all, it was only now that all the decisions taken by the German federal government in the wake of the nuclear disaster of Fukushima such as the nuclear phase-out or the accelerated deployment of renewable energies and network infrastructure would have to be implemented and made reality. While in the year before, the energy turnaround was variously described as a project whose complexity equalled that of a moon landing, the question for 2012 is whether the rocket will actually lift off the launch pad.

  11. The market bonus in EEG 2012. A first interim result; Die Marktpraemie im EEG 2012. Eine erste Zwischenbilanz

    Energy Technology Data Exchange (ETDEWEB)

    Schomerus, Thomas; Henkel, Andrea [Leuphana Univ. Lueneburg (Germany). Lehrstuhl fuer Oeffentliches Recht, insbesondere Energie- und Umweltrecht

    2012-07-15

    Six months after the implementation of the market bous as a core component of the direct marketing by paragraph paragraph 33a ff EEG 2012 initial experiences show that the market bonus particularly was accepted by the onshore wind energy industry very well. However, with respect to the current developments the control effect of the market bonus model towards market integration and system integration is questionable. This is due to the registration of mainly fluctuating energy sources to the market bonus where deadweight effects by the management bonus are obvious.

  12. Erste Hilfe für die Bibliotheksnutzung am PC: Webinare animieren zur Nutzung, erreichen jeden und sparen Kosten

    Directory of Open Access Journals (Sweden)

    Pfob, Sandra

    2014-12-01

    Full Text Available [english] Helios Central Library offers introduction in the library portal and PubMed training as webinars since 2013. The poster shows why a webinar as professional training can be wise and what considerations are necessary to prepare the online lesson.

  13. Open-door-Laminoplastie bei zervikaler Myelopathie mithilfe eines Titan-Miniplättchensystems (Arch-Laminoplastie: Erste klinische Erfahrungen

    Directory of Open Access Journals (Sweden)

    Burtscher J

    2009-01-01

    Full Text Available Der Autor berichtet von ersten klinischen Erfahrungen mit einer speziellen Laminoplastietechnik bei Patienten, die an spondylogener zervikaler Myelopathie leiden. Zwischen Juni 2007 und Februar 2009 wurden 20 Patienten mit zervikaler Myelopathie aufgrund einer mehrsegmentalen zervikalen Spondylose und Spinalkanalstenose mithilfe einer speziellen Open-door-Laminoplastietechnik operiert. Diese Technik nützt ein Titan-Miniplättchensystem, um die aufgeklappten Wirbelbögen zu fixieren. Der durchschnittliche postoperative Beobachtungszeitraum beträgt 9 Monate, das durchschnittliche Patientenalter 63 Jahre. Insgesamt wurden 68 Etagen laminoplastiert. Die Klinik der Patienten wurde mithilfe der modifizierten JOA-Skala beurteilt. Die klinische Evaluierung der zervikalen Myelopathie erfolgte vor sowie drei und sechs Monate nach der Operation. Insgesamt sind zwei Patientengruppen mit oben beschriebener Technik chirurgisch versorgt worden. Gruppe 1 umfasst 14 Patienten mit zervikaler Myelopathie ohne klinische und/oder radiologische Zeichen der Instabilität, normaler zervikaler Lordose oder nur relativer Streckstellung der Halswirbelsäule (HWS, aber ohne Kyphose. Gruppe 2 umfasst 6 Patienten, die im Rahmen einer geplanten ventro-dorsalen Operation zuerst laminoplastiert wurden. Im Beobachtungszeitraum ist von den 68 operierten Etagen bei 20 Patienten keines der verwendeten Titan-Miniplättchensysteme disloziert. Klinische Verbesserungen konnten bei allen Patienten nachgewiesen werden. Die Verbesserung der Klinik schwankt zwischen 2 (Minimum und 7 Score-Punkten (Maximum. Die durchschnittliche klinische Verbesserung liegt bei 4,3 Score-Punkten pro Patient. Vier Patienten erholten sich vollständig. Ein Patient aus Gruppe 1 beklagte nach Laminoplastie verstärkte Nackenschmerzen. In Gruppe 1 sind im postoperativen Beobachtungszeitraum keine klinischen und/oder radiologischen Hinweise für Instabilität und Fehlstellungen (Kyphosierung aufgetreten. Die Verwendung des Titan-Miniplättchensystems zur Fixierung der aufgeklappten Wirbelbögen erwies sich an unserer Abteilung bisher als eine sichere und effektive Methode in der Behandlung von bestimmten Patienten mit zervikaler Myelopathie.

  14. Mischung und Produktivität von Waldbeständen. Ergebnisse langfristiger ertragskundlicher Versuche

    DEFF Research Database (Denmark)

    Pretzsch, H.; Bielak, K.; Bruchwald, A.

    2013-01-01

    The paper reviews theoretical considerations and empirical facts on the productivity of mixed species forest stands versus pure stands. The theoretical part first draws attention on the combined effect of facilitation and competition and the net result for both individual and mean tree growth...... in pure and mixed forest stands (Figs. 1-3). By species mixing, competition as well as facilitation may be changed. Mixing effects can modify the productivity of individual trees and the productivity of the mean tree in a stand, and they can also modify the carrying capacity, i.e., the stand density...... of mixed versus pure stands (Figs. 4). The combination of mean tree productivity and density results in the overall stand productivity. Stand productivity of mixed versus pure stands can be quantified by ratios of relative productivity (LER, RYT, RPR) and illustrated by cross-diagrams (Fig. 5). How mixed...

  15. Therapie des Femoralisverschlusses: Indikation, Technik und Ergebnisse aus Sicht des Gefäßchirurgen

    Directory of Open Access Journals (Sweden)

    Neumayer Ch

    2005-01-01

    Full Text Available Die periphere arterielle Verschlußkrankheit (PAVK betrifft 20 % der Patienten über 65 Jahre. Mittel- bis langfristig benötigen 25 % dieser Patienten eine therapeutische Intervention, überwiegend im femoropoplitealen Bereich. In dieser Übersichtsarbeit werden diagnostische Verfahren und therapeutische Maßnahmen mit Schwerpunkt auf gefäßchirurgische Revaskularisationsverfahren dargestellt. Kurzstreckige Stenosen werden bevorzugt interventionell mittels perkutaner transluminaler Angioplastie (PTA und/oder Stentimplantation behandelt. Als chirurgische Alternative steht in derartigen Fällen eine Thrombendarterektomie-Ausschälplastik (TEA zur Verfügung. Bei langstreckigen Stenosen und/oder Verschlüssen im femoropoplitealen Bereich ist der autologe Venenbypass Methode der Wahl. Dabei kann die Vene reversiert oder in situ nach Klappendestruktion verwendet werden. Kunststoffbypasses stellen nur bei supragenualen Anschlüssen eine brauchbare Alternative dar.

  16. Results of incorporation measurements in children of Belarus; Ergebnisse von Inkorporationsmessungen an weissrussischen Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, F.; Ogris, E.; Weidlich, G. [Donauspital, Wien (Austria). Abt. fuer Nuklearmedizinische Diagnostik und Therapie; Aiginger, H. [Atominstitut der Oesterreichischen Universitaeten, Vienna (Austria)

    1998-12-31

    By sponsoring of the Austrian government 24 children from Belarus were invited for treatment of thyroid cancer by Iodine-131 in the Donauspital, Vienna. As part of the diagnostic procedure whole-body-acquisitions were performed with the whole-body-counter of the department. The obtained spectra were evaluated for {sup 131}I and {sup 137}Cs. All children showed activities of Iodine-131. The mean `minimum detectable activity` (MDA) was 80 Bq. In 88 percent of the children activities in the range between 194 Bq and 2160 Bq were detected. Partly these incorporations can be explained by a previous iodine therapy, the rest is assumed to be the result from diagnostic interventions. 23 out of 24 children showed more ore less activities of {sup 137}Cs. {sup 137}Cs was measured from 2 Bq/kg up to 59 Bq/kg. The results have been compared with the official topographic map with the data on radiation contamination of the republic Belarus. (orig.) [Deutsch] Im Rahmen eines Hilfsprogrammes der Oesterreichischen Bundesregierung wurden 24 Kinder aus Weissrussland im Wiener Donauspital mittels einer Radiojodtherapie wegen des Vorliegens eines Schilddruesenkarzinoms behandelt. Als Bestandteil der diagnostischen Abklaerung wurden die Kinder einer Messung am Ganzkoerperzaehler unterzogen. Die dabei erhaltenen Spektren wurden hinsichtlich ihrer {sup 131}I und {sup 137}Cs Aktivitaeten ausgewertet. Bei allen Kindern konnte {sup 131}I erkannt werden. Bei einer mittleren `Minimum Detectable Activity` (MDA) von ca. 80 Bq wurden bei 88 Prozent der Kinder Aktivitaeten zwischen 194 Bq und 2160 Bq nachgewiesen. Ein Teil dieser Aktivitaeten laesst sich durch eine vorangegangene Radiojodtherapie recht gut erklaeren. Fuer die restlichen {sup 131}I Inkorporationen wurden vorangegangene diagnostische Fragestellungen angenommen. 23 von 24 Kindern zeigten Hinweise auf mehr oder weniger grosse Aktivitaeten von {sup 137}Cs. Der Bereich der gemessenen Aktivitaeten liegt von 2 Bq/kg bis 59 Bq/kg. Die Messergebnisse der Inkorporationsmessungen wurden anschliessend mit der Topographischen Uebersichtskarte mit den Angaben zur Strahlenbelastung der Republik Weissrussland verglichen. (orig.)

  17. Zweiwegintegration durch zweisprachige Bildung? Ergebnisse aus der Staatlichen Europa-Schule Berlin

    Science.gov (United States)

    Meier, Gabriela

    2012-06-01

    While there is no simple recipe of how to respond to the multitude of languages present in many European schools, this article presents a promising alternative to monolingual education. The focus is on Staatliche Europa-Schule Berlin (SESB), a two-way immersion (TWI) model that unites children whose mother tongue is German with children whose mother tongue is another locally spoken language in one class and teaches them together in two languages. Thus in this model, offered by 17 primary schools and 13 secondary schools in Berlin, pupils learn in two languages from and with each other. Based on a largely quantitative, quasi-experimental study with 603 students, evidence is provided that there are a number of peace-linguistic benefits that can promote two-way social integration, besides fostering personal and societal multilingualism. This suggests that TWI education as practised in Berlin could serve as an educational model for other multilingual parts of Europe.

  18. Ergebnisse der SICA-HF-Studie (Studies Investigating Co-morbidities Aggravating Heart Failure)

    OpenAIRE

    Steinbeck, Lisa

    2016-01-01

    Skeletal muscle wasting affects about 20% of ambulatory patients with chronic heart failure and has serious implications for their activities of daily living. The assessment of muscle wasting is technically challenging. C-terminal agrin-fragment (CAF), a breakdown product of the synaptically located protein agrin, has shown early promise as biomarker for the detection of muscle wasting. We sought to investigate the diagnostic properties of CAF in the detection of muscle wasting among patients...

  19. Ergebnisse einer Querschnittsstudie zum Zusammenhang von elektromagnetischen Feldern von Mobilfunksendeanlagen und unspezifischen gesundheitlichen Beschwerden

    DEFF Research Database (Denmark)

    Breckenkamp, Jürgen; Blettner, Maria; Kowall, Bernd;

    2010-01-01

    Background: Despite the fact that adverse health effects are not confirmed for exposure to radiofrequency electromagnetic field (RFEMF) levels below the limit values, as defined in the guidelines of the International Commission on Non-Ionizing Radiation Protection, many persons are worried about...... possible adverse health effects caused by the RF-EMF emitted from mobile phone base stations, or they attribute their unspecific health complaints like headache or sleep disturbances to these fields. Method: In the framework of a cross-sectional study a questionnaire was sent to 4150 persons living......,808 (51%) agreed to dosimetric measurements in their flats. Exposure was measured in 1,500 flats. Results: The measurements accomplished in the bedrooms in most cases showed very low exposure values, most often below sensitivity limit of the dosimeter. An association of exposure with the occurrence...

  20. Evaluation and development of new petroleum demulsifiers. Ergebnisse der Entwicklung neuer Erdoeldemulgatoren

    Energy Technology Data Exchange (ETDEWEB)

    Abendroth, P.; Koch, B.; Meerbote, M.; Sczekalla, B.

    This paper presents oligomeric esters which are very effective as mineral-oil demulsifiers. They are synthesized by reaction of dibutylmaleate and -phtalate with polyalkyleneglycols and block-copolymeric polyetheralcohols with alcali catalysis at 10 and 125 C. The reaction was followed by GPS-analysis and viscosity measurements. The demulsifying capacity of the oligomeric esters was determined for both, in our laboratory for reinkenhagener mineral-oil emulsions and in Petrol-Institutes of the GUS. Mixing with short-chained alcohols showed synergistic effects, which were used in the formulation of commercial products. Moreover, mixing of the oligoesters with other demulsifiers gave formulations with a synergistic effect, whose demulsifying capacity surpassed that of the single components. (orig.)

  1. Results of radiation therapy in periarthritis humeroscapularis; Ergebnisse der Strahlentherapie bei Periarthropathia humeroscapularis

    Energy Technology Data Exchange (ETDEWEB)

    Schultze, J.; Schlichting, G.; Galalae, R.; Kimmig, B. [Klinik fuer Strahlentherapie (Radioonkologie), Universitaetsklinikum Schleswig-Holstein, Kiel (Germany); Koltze, H. [Radiologische Gemeinschaftspraxis, Celle (Germany)

    2004-07-01

    Background: radiation therapy is applied in painful degenerative shoulder diseases. Aim of this work was to evaluate the contribution of radiation therapy to symptomatic improvement in periarthritis humeroscapularis. Methods: ninety-four patients with periarthritis humeroscapularis were treated in two institutions. Mean age was 68 years, sex distribution were 32 men and 62 women. In 58 cases the right side was affected, left in 36 cases. At single doses of 0,75 Gy once a week a total dose of 6 Gy was applied The treatment effect was evaluated by the standardized von Pannewitz-score at the end of the treatment up to 6 months thereafter. Results: the treatment results of all the 94 patients were documentated at the end of therapy. Seventy-one patients were followed at least for further 4 months. Radiogenic side-effects were not noticed. The symptoms of 54 patients (57.4%) were improved or vanished, in 40 cases the symptoms were not significantly affected (42.6%). Four months after therapy 42 of 71 patients were improved (59.2%), 29 unchanged (40.8%). The treatment effect occured typically up to 2 months after therapy, there were no age-related differences. Also in recurrent radiation therapies the symptoms improved, in 80 percent after one preceding therapy, however only in 31.2 percent after multiple prior radiotherapies. (orig.)

  2. Das Pommerische in Espírito Santo: ergebnisse und perspektiven einer soziolinguistischen studie

    Directory of Open Access Journals (Sweden)

    Beate Höhmann

    2011-12-01

    Full Text Available The present article deals with aspects of language maintenance and measurement for language revitalization of Pomeranian in the Brazilian state of Espírito Santo, based on the sociolinguistic study by Höhmann (2011. Following the introduction, in which an overview of the research situation and the socio-demographic data is provided, the text presents quantitative data on language preference and intergenerational language transmission of the studied language community. In addition, the use of the minority language ​​in education and the resulting research desiderata are stated. The Pomeranian language revitalization project PROEPO and aspects of the latest standardization activities of the minority language are presented. Finally, perspectives for language preservation are discussed.

  3. Mischung und Produktivität von Waldbeständen. Ergebnisse langfristiger ertragskundlicher Versuche

    DEFF Research Database (Denmark)

    Pretzsch, H.; Bielak, K.; Bruchwald, A.;

    2013-01-01

    of mixed versus pure stands (Figs. 4). The combination of mean tree productivity and density results in the overall stand productivity. Stand productivity of mixed versus pure stands can be quantified by ratios of relative productivity (LER, RYT, RPR) and illustrated by cross-diagrams (Fig. 5). How mixed...

  4. Ergebnisse einer neuen Technik der Meatusplastik im Rahmen der geschlechtsangleichenden Operation von Mann zu Frau

    OpenAIRE

    Rossi Neto R; Hueppe P; Pelzer N; Rübben H; vom Dorp F

    2011-01-01

    In unserer Klinik stellt sich die Meatusstenose als die häufigste Komplikation nach einer geschlechtsangleichenden Operation mit ca. 40 % betroffenen Patientinnen dar, gefolgt von lokalen Wundheilungsstörungen (26 %) und Verengung des Introitus vaginalis mit 12 %. Die Hauptkomplikationen werden bei der zweiten Sitzung mit kleinen ästhetischen Korrekturen beseitigt. Trotz einer zweiten Korrektur besteht jedoch immer noch das Risiko (1520 %) der Entstehung einer Striktur der Anastomos...

  5. Windfelduntersuchung in Zürich : Ergebnisse von Messungen und numerischen Modellierungen

    Directory of Open Access Journals (Sweden)

    P. Schuhmacher

    Full Text Available From 1985 to 1989 the Department of Geography of the ETH in Zürich carried out a project called "Stadtklima Zürich". Following a brief description of the project the paper is centered on theoretical and experimental studies concerning the air-flow above Zürich. The wind measurements were undertaken with a network of about 20 stations. The interpretation of these measurements was concentrated on important weather types. Apart from a cartographie representation of the measured data, a diagnostic model (DIAMO was used for the data interpolation. A non-hydrostatic numerical model (MONARC helped to interprete dynamicalm processes over complex topography. With an example of a Situation with easterly synoptic wind the measured windfield is compared with the simulations which show a fairly good correspondence. Measurements over the railroad tracks near the Central Station show the transition from mesoscale topographic to microscale or urban building effects. By using a particle trajectory model (LADI and TRAMO, the problem of air pollution dispersion over the complex urban topography is discussed.

  6. Compressed-air: results of an analysis made for the Clariant company; Ergebnisse der Druckluftanalyse Clariant

    Energy Technology Data Exchange (ETDEWEB)

    Radgen, R. [Fraunhofer-Institut fuer Systemund Innovationsforschung (ISI), Karlsruhe (Germany); Stadelmann, B. [Hochschule fuer Technik und Architektur Luzern (HTA), Horw (Switzerland)

    2005-05-15

    This comprehensive, illustrated report for the Swiss Federal Office of Energy (SFOE) presents the results of a project that examined the compressed-air supply at the facilities of the Clariant company in Muttenz, Switzerland. The various compressors and compressed-air installations in the company's facilities are described and detailed technical data is presented. The control of these systems and the distribution of the compressed air is discussed. Needs, usage and consumption of compressed air is analysed at macro and detail levels. Leakage is looked at as is the dimensioning of the distribution systems. Finally, possibilities for making savings are presented.

  7. DIE DIFFUSION VON TELEARBEIT: Wo steht die Schweiz heute im internationalen Vergleich? Ergebnisse einer empirischen Untersuchung

    OpenAIRE

    Harabi, Najib; Schoch, Rolf; Hespeler, Frank

    2001-01-01

    Unter „Telearbeit“ versteht man heute allgemein berufliche Erwerbstätigkeit an einem Arbeitsplatz, der mit Informatikmitteln ausgerüstet, organisatorisch dezentral zu Hause, in der Nähe des Wohnortes, unterwegs oder bei Kunden eingerichtet ist und Telekommunikationsverbindung zu einem räumlich entfernten Standort des Arbeit- oder Auftraggebers ermöglicht.Im angelsächsischen Sprachgebrauch finden wir die Bezeichnungen „Telework“; wir verwenden die beiden Ausdrücke synonym oder auch „Telecommut...

  8. Einige Ergebnisse der Sichtung der Gattungen Melitaea und Argynnis im Rijksmuseum van Natuurlijke Historie, Leiden

    NARCIS (Netherlands)

    Eisner, C.

    1942-01-01

    Melitaea cinxia L. subsp. balcanensis nov. subsp. ♂ ähnelt dem von subsp. australis Vrty., glänzend braun mit prägnanter Schwarzzeichnung. ♀ fahlgelb, oft grün überstäubt, meist mit zurücktretender Schwarzzeichnung; zwei Exemplare indessen dunkel, f. obscurior Stgr. Die Unterseite wie die von subsp.

  9. Bibliothekarische Berufsethik in der Praxis – Ergebnisse eines Studienprojekts aus Deutschland und Großbritannien

    Directory of Open Access Journals (Sweden)

    Jens Boye

    2011-10-01

    Full Text Available Sowohl in Deutschland als auch in Großbritannien existieren seit einigen Jahren Grundsatzpapiere zur Berufsethik im Informations- und Bibliotheksbereich. Neben der bloßen Existenz derartiger Kodizes stellt sich die Frage, welche Relevanz diese Dokumente in der beruflichen Praxis haben. Dieser Frage wurde im Rahmen einer Team-Projektarbeit an der FH Köln nachgegangen. Mithilfe eines standardisierten Fragebogens wurden deutsche Bibliotheksleitungen zu der Thematik befragt. In Großbritannien wurde ein Interview mit Paul Sturges geführt, darüber hinaus erfolgte eine Analyse der Online-Angebote von CILIP, insbesondere des Information Ethics Blog.

  10. Multidetector computed tomography of urolithiasis. Technique and results; Multidetektor-Computertomografie der Urolithiasis. Technik und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Karul, M.; Regier, M. [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Zentrum fuer Radiologie und Endoskopie; Heuer, R. [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Zentrum fuer Operative Medizin

    2013-02-15

    The diagnosis of acute urolithiasis results from unenhanced multidetector computed tomography (MDCT). This test analyses the functional and anatomical possibility for passing an ureteral calculi, the localization and dimension of which are important parameters for further therapy. Alternatively chronic urolithiasis could be ruled out by magnetic resonance urography (MRU). MRU is the first choice especially in pregnant women and children because of radiation hygiene. Enhanced MDCT must be emphasized as an alternative to intravenous urography (IVU) for diagnosis of complex drainage of urine and suspected disorder of the involved kidney. This review illustrates the principles of different tests and the clinical relevance thereof. (orig.)

  11. Ergebnisse der Nachuntersuchung einiger Rhizostomeen-Typen Haeckel's und Chun's aus dem Zoologischen Museum in Hamburg

    NARCIS (Netherlands)

    Stiasny, G.

    1922-01-01

    Durch das Entgegenkommen der Herren Prof. Dr. Hans Lohmann und Prof. Dr. Ernst Hentschel, denen ich hiefür bestens danke, wurde ich in die Lage versetzt, einige Typen-Exemplare von Haeckel und Chun, die sich im Zoologischen Museum der Universität in Hamburg befinden, nachzuuntersuchen. Dies erwies

  12. Percutaneous radiofrequency ablation - clinical indications and results; Perkutane Radiofrequenzablation - klinische Indikationen und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Tacke, J. [Universitaetsklinikum Aachen (Germany). Klinik fuer Radiologische Diagnostik

    2003-02-01

    Percutaneous interstitial tumor ablation therapy is a relatively new and steadily growing field within interventional radiology. Radiofrequency ablation (RFA) became one of the most accepted techniques among hyperthermal ablation procedures, presumably due to its superior relation between probe diameter and efficacy. The first part of this review provided an overview of the underlying principles, technical background and application techniques. This second part describes the indications, techniques and results of clinical RFA applied to primary and secondary liver tumors as well as experiences with extrahepatic RFA applied to kidney, bone and lung, together with a discussion of the current literature. (orig.) [German] Die perkutane interstitielle Tumortherapie stellt innerhalb der interventionellen Radiologie ein noch junges, sich aber stetig weiterentwickelndes Verfahren dar. Unter den Thermoablationsverfahren hat die Radiofrequenzablation (RFA) die weiteste Verbreitung gefunden, nicht zuletz aufgrund des guenstigen Verhaeltnisses von Sonderdurchmesser und Wirkungsrad. Die Grundlagen, technischen Hintergruende und Applikationstechniken wurden im ersten Teil der Uebersichtsarbeit zur perkutanen Radiofrequenzablation beschrieben. In diesem zweiten Teil werden die Indikationen, Techniken und Ergebnise der klinischen RFA primaerer und sekundaerer Lebertumoren sowie Erfahrungen der extrahepatischen RFA im Bereich der Niere, des Knochens und der Lunge vorgestellt und anhand der Literatur diskutiert. (orig.)

  13. Irradiation programme SAMARCANDE. Impact test results; Bestrahlungsprogramm SAMARCANDE. Ergebnisse der Kerbschlagbiegeversuche

    Energy Technology Data Exchange (ETDEWEB)

    Rieth, M.; Dafferner, B.; Ries, H.; Romer, O.

    1994-08-01

    To produce proof of the usability of the martensitic 10.5% Cr-steel 1.4914 as alternative wrapper tube material the irradiation induced embrittlement was characterised with impact tests. The examinations were based on specimens, which were fabricated out of an irradiated wrapper tube. The irradiation was carried out within the EFR project (European Fast Reactor) in the PHENIX reactor in Cadarache (irradiation programme SAMARCANDE). The evaluation of ductile-to-brittle-transition temperatures and upper shelf energies of safety relevant segments of the tube led to a positive assessment: the 10.5% Cr-steel 1.4914 is excellently suited to the usage as wrapper tube material. (orig.) [Deutsch] Zum Nachweis der Tauglichkeit des martensitischen 10,5% Cr-Stahls 1.4914 als alternaties Kastenmaterial wurde anhand von Kerbschlagbiegeversuchen die bestrahlungsinduzierte Versproedung charakterisiert. Die Untersuchungen stuetzten sich hauptsaechlich auf Proben, die aus einem im Rahmen des EFR-Projekts in Cadarache (PHENIX-Reaktor, Bestrahlungsprogramm SAMAR-CANDE) bestrahlten Brennelementhuellkasten gefertig wurden. Die Auswertung der Sproedbruchuebergangstemperatur und der Schlagarbeit in der Hochlage der sicherheitsrelevanten Segmente des Huellkastens fuehrte zu einer positiven Bewertung: der 10,5% Cr-Stahl 1.4914 ist fuer den Einsatz als Brennelementhuellkastenwerkstoff bestens geeignet. (orig.)

  14. Die aktuelle Position Estlands im internationalen Steuerwettbewerb : empirische Ergebnisse / Jüri Sepp, Ralph M Wrobel

    Index Scriptorium Estoniae

    Sepp, Jüri

    2003-01-01

    Olulisematest trendidest ja Eesti positsioonist rahvusvahelises maksukonkurentsis nii maksukoormuse, maksude struktuuri kui ka vastavuse mõttes ausa (mittediskrimineeriva) konkurentsi reeglitele. Tabelid

  15. Cofermentation of energy crops and organic residues; Ergebnisse der Kovergaerung von Energiepflanzen und organischen Reststoffen

    Energy Technology Data Exchange (ETDEWEB)

    Linke, B. [Institut fuer Agrartechnik Bornim e.V. (ATB), Potsdam-Bornim (Germany); Vollmer, G.R. [Biotechnologie Nordhausen (BTN) (Germany)

    2002-07-01

    There are currently more than 1500 agricultural biogas plans in Germany, most of which work by the liquid fermentation principle which is commercially available. At a mean hydraulic time of residue of 20 - 30 days and a charge of about 1.5 to 4 kg of organic matter m{sup -1}d{sup -1}, about 350 - 550 l of biogas can be produced per kg of organic matter (liquid or solid manure). Biogas yields are higher for cofermentation of liquid manure with energy crops and/or high-energy organic residues. Some figures are given: About 1000 l per kg{sup -1} for beetroot, pressed pellets of rape, sugarbeet, or rye, 600 - 700 l per kg{sup -1} for grass, malt residuum, sugar pulp, grape cake or potato pulp. In the case of silo-fermented corn, yields were higher than reported in earlier publications, i.e. about 800 instead of 200 l per kg{sup -1}. [German] Die Gewinnung von Biogas aus Guelle, Stallmist, pflanzlichen Biomassen oder organischen Reststoffen aus der Agro- oder Lebensmittelindustrie leistet heute durch das EEG in ueber 1500 Landwirtschaftsbetrieben Deutschlands einen Beitrag zur Sicherung des Einkommens. Die Landwirte nutzen hierfuer vorwiegend die Technik der Fluessigvergaerung, die von zahlreichen Firmen auf dem Markt angeboten werden. Bei mittleren hydraulischen Verweilzeiten von 20 bis 30 Tagen oder Faulraumbelastungen von etwa 1,5 bis 4 kg oS m{sup -3} d{sup -1} koennen aus Guelle oder Stallmist je kg zugefuehrte organische Substanz 350 bis 550 l Biogas gewonnen werden. Deutlich hoehere spezifische Biogasausbeuten erhaelt man durch die gemeinsame Vergaerung von Guelle mit Energiepflanzen und/oder energiereichen organischen Reststoffen (Kofermentation). Fuer Ruebensilage, Rapskuchen, Zuckerrueben-Pressschnitzel oder Roggen kann man oS-Biogasausbeuten von etwa 1000 l kg{sup -1} rechnen, waehrend sich der entsprechende Wert fuer Graeser, Schlempe, Melasse, Trester oder Kartoffelpuelpe im Bereich von 600 bis 700 l kg{sup -1} bewegt. Der in der Fachliteratur oft zu findende Wert fuer Silomais von etwa 200 m{sup 3} je Tonne Frischmasse mit 35% TS (=0,6 m{sup 3} kg{sup -1}) wurde bei den Versuchen trotz relativ hoher Abweichungen immer ueberschritten. Fuer die Auslegung von Biogasanlagen sollte fuer Silomais als vorrangig verwendete Energieplfanze mit einer oS-Biogasausbeute von etwa 800 l kg{sup -1} gerechnet werden. (orig.)

  16. Ergebnisse der dorsalen Spondylodese bei Frakturen des dorsolumbalen Übergangs

    OpenAIRE

    Ramzy, Magdy

    2002-01-01

    Ziel der vorliegenden Arbeit ist es, die Technik der dorsalen Spondylodese bei Frakturen des dorsolumbalen Überganges anhand von Komplikationen und Behandlungsergebnissen zu beurteilen. Es wurden in dieser retrospektiven Untersuchung 161 Patienten (60% männlich, 40% weiblich) eingeschlossen, die in den Jahren 1985 bis 1994 an der Unfallchirurgie Bergmannsheil Bochum behandelt wurden. 142 dieser Patienten wurden in standardisierter Technik durch dorsale Spondylodes mit internem Fix...

  17. Die aktuelle Position Estlands im internationalen Steuerwettbewerb : empirische Ergebnisse / Jüri Sepp, Ralph M Wrobel

    Index Scriptorium Estoniae

    Sepp, Jüri

    2003-01-01

    Olulisematest trendidest ja Eesti positsioonist rahvusvahelises maksukonkurentsis nii maksukoormuse, maksude struktuuri kui ka vastavuse mõttes ausa (mittediskrimineeriva) konkurentsi reeglitele. Tabelid

  18. Marketing for green building; Marketing fuer oekologisches Bauen. Ergebnisse einer Studie zum SynergieHaus-Projekt

    Energy Technology Data Exchange (ETDEWEB)

    Winkler, S.; Niedergesaess, U. [imug Beratungsgesellschaft mbH, Hannover (Germany)

    2001-03-12

    Ecological or green building becomes increasingly relevant in Germany. Of specific concern are the following questions that are considered more closely in the following article: Who are the customers or builder-owners of low energy houses? How to involve and motivate potential customers for this environmental form of building? What are the central motives in buying or building low energy houses and how to address private households with the issue of ecological building and living? These questions are discussed with reference to the results of a study carried out in the context of a specific green building sponsoring project named ''SynergieHaus''. (orig./CB) [German] Oekologisches Bauen gewinnt in Deutschland zunehmend an Bedeutung. Wer aber sind die Kaeufer bzw. Bauherren von Niedrigenergiehaeusern? Wie koennen Bauinteressenten fuer diese umweltorientierte Form des Bauens begeistert und gewonnen werden? Welches sind die zentralen Motive fuer den Kauf eines Niedrigenergiehauses bzw. wie koennen private Haushalte fuer oekologisches Bauen und Wohnen angesprochen werden? Diese marketingrelevanten Fragen werden in dem Beitrag naeher betrachtet anhand von Ergebnissen einer Studie zum SynergieHaus-Projekt. (orig./CB)

  19. Hydrothermal carbonisation of biomass. Results and perspectives; Hydrothermale Carbonisierung von Biomasse. Ergebnisse und Perspektiven

    Energy Technology Data Exchange (ETDEWEB)

    Grimm, Christiane (ed.)

    2013-06-01

    Due to the ambitious political targets for the utilization of renewable energy in the energy supply, climate protection and resource conservation, biomass gained increasing attention. With the aim of developing new and more efficient ways of recycling organic waste, the Federal Foundation for the Environment (Osnabrueck, Federal Republic of Germany) supports funding projects for the technological development of the hydrothermal carbonization with respect to the optimization of reaction processes and targeted production of certain qualities of biochar. The results of the funded projects of Federal Foundation for the Environment are presented in this conference proceedings.

  20. Vernetztes Lernen an der Hochschule? Ergebnisse und Erfahrungen eines cMOOS

    OpenAIRE

    Kahnwald, Nina; Pscheida, Daniela

    2015-01-01

    Der Ansatz des Konnektivismus und die rasante Verbreitung von Massive Open Online Courses (MOOCs) haben eine anhaltende Debatte um die Chancen, Schwierigkeiten und Perspektiven offener Lernnetzwerke in der Hochschulbildung ausgelöst. Die Diskussion reicht dabei vom befürchteten Verlust des Einflusses der Dozierenden als Gewährleister einer kritischen und vielseitigen Auseinandersetzung mit Themen und Lerninhalten, über die lernerseitigen Voraussetzungen für eine erfolgreiche und gewinnbringen...

  1. Die vier Social-Media-Typen in der Wissenschaft. Ergebnisse einer bundesweiten Studie

    Directory of Open Access Journals (Sweden)

    Ostrzinski, Ulrike

    2014-12-01

    Full Text Available [english] ZB MED and its partners within the Leibniz Research Alliance Scienc participated in a nationwide study involving academics and researchers from universities and Leibniz Association research institutions. The purpose was to examine the use of social media tools. One of the key goals was to learn more about the usage patterns and behaviours of target groups, and the study has provided some important pointers to assist in this task. The preliminary part of the study identified four types of social media user who display significantly different patterns of behaviour in their use of and attitudes toward social web applications. The poster shows the figures for researchers working in the fields of medicine and life sciences – the main user group of ZB MED.

  2. Permanente sakrale Neuromodulation mittels InterStim®: Ergebnisse einer Anwendungsbefragung zu aktuellen technischen Entwicklungen

    Directory of Open Access Journals (Sweden)

    Sievert KD

    2007-01-01

    Full Text Available In den vergangenen über 20 Jahren wurde die sakrale Neuromodulation als klinische Therapie etabliert. Die anfängliche Indikation wurde ständig erweitert und umfaßt heute verschiedene Formen der Blasen- und Stuhlentleerungsstörung sowie eingeschränkt die Schmerztherapie im kleinen Becken. Fortwährend wurde die Technik der Implantation verbessert und die zur Verfügung stehende Hardware verkleinert. Als Resultat der konsequenten Weiterentwicklung wurde im letzten Jahr der miniaturisierte InterStim® II vorgestellt und dessen klinischer Einsatz durch versierte Operateure der unterschiedlichsten Disziplinen mittels einer internetbasierten Befragung beurteilt. Durch die Verwendung des InterStim® II werden im Vergleich zum InterStim® die operative Invasivität mit der Operationszeit und daraus resultierend der postoperative Schmerz gesenkt. Die neue Fernbedienung läßt einen weiteren Anstieg der Akzeptanz erwarten, da durch das Display der Fernbedienung der Patient die Einstellungen kontrollieren kann. Die weitere Miniaturisierung mit gleichzeitig erweiterter Programmierbarkeit des Implantates, der direkten Verbindung von Elektrode und Impulsgeber mit einer einzelnen Schraube verbessert die Option der Neuromodulation weiter. Die Entwicklungen unterstützen den minimal-invasiven Aspekt der InterStim®-Therapie, wodurch die Möglichkeit der ambulanten Therapieoption gegeben sein könnte. Es bleibt abzuwarten, ob die Therapie der Neuromodulation durch die erweiterten Programmiermöglichkeiten für den einzelnen Patienten in Zukunft noch individueller im chronischen Einsatz optimiert werden kann.

  3. Results of ultrasonic disintegration of sewage sludge in practice; Ergebnisse des Praxiseinsatzes der Schlammdesintegration mittels Ultraschall

    Energy Technology Data Exchange (ETDEWEB)

    Friedrich, E. [IWE-Ingenieurgesellschaft fuer Wasser und Entsorgung mbH, Radebeul (Germany); Friedrich, H. [Fraunhofer-Institut fuer Keramische Technologien und Sinterwerkstoffe (IKTS), Dresden (Germany); Hielscher, H. [Hielscher GmbH, Teltow (Germany)

    1999-07-01

    Using high-performance ultrasonic sludge disintegration in different stages of sewage and sludge treatment is found to be an innovative approach for reducing the accruing amounts of sewage sludge in terms of both mass and volume. By means of practical tests with sludge disintegration at sewage treatment plants, its effects are demonstrated. (orig.) [German] Der Einsatz einer Hochleistungs-Ultraschalltechnik zur Schlammdesintegration in verschiedenen Stufen der Abwasser- und Schlammbehandlung zeigt sich als innovativer Loesungsweg zur weitestgehenden massenmaessigen sowie volumenmaessigen Minimierung des Klaerschlammanfalles. An Hand von Einsatzerprobungen der Desintegration in der Klaeranlagenpraxis werden die Effekte der Desintegration vorgestellt. (orig.)

  4. Percutaneous radiofrequency ablation of osteoid osteomas. Technique and results; Perkutane Radiofrequenzablation von Osteoidosteomen. Technik und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Bruners, P.; Penzkofer, T. [Lehrstuhl fuer Angewandte Medizintechnik, Helmholtz Inst. fuer Biomedizinische Technik, RWTH Aachen (Germany); Guenther, R. W.; Mahnken, A. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum RWTH Aachen (Germany)

    2009-08-15

    Purpose: Osteoid osteoma is a benign primary bone tumor that typically occurs in children and young adults. Besides local pain, which is often worse at night, prompt relief due to medication with acetylsalicylic acid (ASS) is characteristic for this bone lesion. Because long-term medication with ASS does not represent an alternative treatment strategy due to its potentially severe side effects, different minimally invasive image-guided techniques for the therapy of osteoid osteoma have been developed. In this context radiofrequency (RF) ablation in particular has become part of the clinical routine. The technique and results of image-guided RF ablation are compared to alternative treatment strategies. Materials and Methods: Using this technique, an often needle-shaped RF applicator is percutaneously placed into the tumor under image guidance. Then a high-frequency alternating current is applied by the tip of the applicator which leads to ionic motion within the tissue resulting in local heat development and thus in thermal destruction of the surrounding tissue including the tumor. Results: The published primary and secondary success rates of this technique are 87 and 83%, respectively. Surgical resection and open curettage show comparable success rates but are associated with higher complication rates. In addition image-guided RF ablation of osteoid osteomas is associated with low costs. (orig.)

  5. Zur nacheiszeitlichen Gletschergeschichte des Liefdefjords (Spitzbergen (Ergebnisse der Geowissenschaftlichen Spitzbergenexpedition 1990

    Directory of Open Access Journals (Sweden)

    G. Furrer

    interdisziplinären Spitzbergenexpedition SPE '90. Schwerpunkte der Forschungsarbeiten sind nacheiszeitliche und aktuelle geomorphologische und geoökologische Prozesse in diesem vom Menschen noch fast völlig unberührten Raum. Das Expeditionsgebiet besitzt zahlreiche Kar- und einzelne Talgletscher sowie ein stark differenziertes, «alpin» anmutendes Relief. Mit unserem Teilprojekt «Gletscherentwicklung und Moränendatierung» wird versucht, einen Beitrag zur noch wenig bekannten Gletschergeschichte Spitzbergenszuleisten: – Viele Gletscher – so der Monacobreen – münden heute direkt ins Meer oder enden nahe der Küste. Die Gletschervorfelder sind in der Regel durch einen markanten Wallmoränenkomplex (Moränenwall umschlossen. Das Moränenmaterial im gletschernahen Bereich wurde von Vorstößen der Neuzeit (ab 16. Jahrhundert abgelagert. – Im Liefdefjorden und Bockfjorden konnten aber durch Grabungen an der Außenseite der Moränenwälle mehrere, von Gletschern überfahrene, fossileorganische Bodenhorizonte (fAh gefunden werden. Deren Radiokarbondatierungen lassen auf Gletschervorstöße im frühen und späten Älteren Subatlantikum (2800 – 1000 yBP und im frühen und mittleren Jüngeren Subatlantikum (ab 1000 yBP schließen. – Mächtigkeit und Polleninhalt der datierten fossilen Boden- und Torfbildungen deuten daraufhin, daß die Vegetation zur Zeit der organischen Sedimentation ähnlich wie heute in Küstennähe entwickelt war. Die klimatischen Bedingungen dürften während der früheren Torf-/Bodenbildungsphasen zumindest nicht ungünstiger gewesen sein als heute. Diese Resultate führen zur Schlußfolgerung, daß die heutigen Gletschervorfelder von Moränenwällen umschlossen sind, die aus Material von verschiedenen Gletschervorstößen zusammengesetzt sind, und daß die maximale Ausdehnung der Gletscherhochstände in den letzten 2800 Jahren (vermutlich im ganzen Holozän stets etwa dieselbe war. Diese Charakteristika treffen auch für die nacheiszeitliche Gletschergeschichte der Alpen zu. – Im Untersuchungsgebiet konnten keine Hinweise auf ältere postglaziale und spätglaziale Gletschervorstöße gefunden werden. Vorallem die Frage nach dem Gletscherverhalten während der Jüngeren Dryas (11000–10200 yBP bleibt offen. Aufgrund unserer Beobachtungen muß man vermuten, daß allfällige Gletschervorstöße während dieser Zeit die Maximalstände des Subatlantikums nicht übertroffen haben. –Spätestens zu Beginn des Alleröds (11800–11000 yBP war der Liefdefjord mindestens soweit eisfrei wie heute.

  6. Leben in Galgenhof/Steinbühl : Ergebnisse der BewohnerInnenbefragung

    OpenAIRE

    2001-01-01

    "Der BewohnerInnenbefragung lagen unterschiedliche Zielsetzungen zugrunde. Zum einen sollten die Meinungen, Ansichten und Urteile der BewohnerInnen zu ihrer Wohnung, zur Wohnumgebung, zu ausgewählten öffentlichen Räumen, zu sozialen Problemen und zur sozialen Infrastruktur in den beiden Stadtteilen Galgenhof/Steinbühl sowie deren Image erfasst werden, zum anderen sollte der soziale Status und die Lebenssituation der Befragten, ihre sozialen Beziehungen, insbesondere zwischen den ethnischen Gr...

  7. Das religiöse Leben der „Gastarbeiter“ aus Bosnien-Herzegowina in Deutschland in den 1970er und 1980er Jahren

    Directory of Open Access Journals (Sweden)

    Duranović, Amir

    2014-08-01

    Full Text Available Jugoslawische und insbesondere bosnisch-herzegowinische Arbeitsmigranten in der Bundesrepublik Deutschland waren und sind Thema verschiedener wissenschaftlicher Studien sowohl der deutschsprachigen Südosteuropaforschung als auch zunehmend der Geschichtswissenschaft im postjugoslawischen Raum. Und doch weist dieser Themenbereich diverse Forschungslücken auf. Zu den Forschungsdesideraten gehört auch die Frage nach dem religiösen Leben der „Gastarbeiter“ aus Bosnien-Herzegowina in der Bundesrepublik in den etwas mehr als zwei Jahrzehnten seit Ende der 1960er Jahre bis zum Zerfall des sozialistischen Jugoslawiens. Der vorliegende Beitrag stellt erste Ergebnisse eines umfangreicheren Forschungsprojektes dar, im Rahmen dessen die bosnisch-herzegowinische Migration in der zweiten Hälfte des 20. Jahrhunderts untersucht wird.

  8. Kulturspezifische Elemente und ihre Problematik bei der Filmsynchronisierung

    Directory of Open Access Journals (Sweden)

    Prof. Dr. Carmen Cuéllar Lázaro

    2013-07-01

    Full Text Available Bei der Untersuchung der Übersetzungsproblematik von kulturspezifischen Elementen geht es darum, diese Konzepte begrifflich abzugrenzen, inhaltlich und sprachlich zu klassifizieren sowie die Problematik ihrer Übersetzung zu beschreiben. Bei der Filmsynchronisierung sind außerdem die Merkmale und besonderen Bedingungen des Mediums und des audiovisuellen Textes zu berücksichtigen. Die Zielsetzung dieser Studie ist, die Übersetzung von kulturspezifischen Elementen der Filmsynchronisierung (Deutsch-Spanisch zu analysieren. Wir schlagen ein Zwei-Ebenen-Modell vor: Die erste Ebene berücksichtigt die Art der erfahrenen sprachlichen Bearbeitung. Auf der zweiten Ebene wird die kulturelle Orientierung der Ergebnisse untersucht. Danach werden einige Schlussfolgerungen aus der spanischen Synchronfassung gezogen.

  9. Kulturspezifische Elemente und ihre Problematik bei der Filmsynchronisierung

    Directory of Open Access Journals (Sweden)

    Prof. Dr. Carmen Cuéllar Lázaro

    2013-07-01

    Full Text Available Bei der Untersuchung der Übersetzungsproblematik von kulturspezifischen Elementen geht es darum, diese Konzepte begrifflich abzugrenzen, inhaltlich und sprachlich zu klassifizieren sowie die Problematik ihrer Übersetzung zu beschreiben. Bei der Filmsynchronisierung sind außerdem die Merkmale und besonderen Bedingungen des Mediums und des audiovisuellen Textes zu berücksichtigen.   Die Zielsetzung dieser Studie ist, die Übersetzung von kulturspezifischen Elementen der Filmsynchronisierung (Deutsch-Spanisch zu analysieren. Wir schlagen ein Zwei-Ebenen-Modell vor: Die erste Ebene berücksichtigt die Art der erfahrenen sprachlichen Bearbeitung. Auf der zweiten Ebene wird die kulturelle Orientierung der Ergebnisse untersucht. Danach werden einige Schlussfolgerungen aus der spanischen Synchronfassung gezogen.

  10. Die Transurethrale Nadel-Ablation der Prostata (TUNA

    Directory of Open Access Journals (Sweden)

    Stark L

    1998-01-01

    Full Text Available 25 Patienten im Alter von 56?92 Jahren (Durchschnitt: 74,9 mit symptomatischer BPH wurden mittels TUNA therapiert. Das Prostatavolumen betrug 19-160 ml (durchschnittlich 56,6. 14 Patienten (56 % wurden aufgrund eines akuten Harnverhaltes therapiert, 9 Patienten (36 % hatten Restharn zwischen 30 und 700 ml, 2 Patienten (8 % wurden wegen irritativer Symptome behandelt. Bei 4 Patienten wurde die TUNA 2-3 mal wiederholt, bei 5 Patienten kombinierten wir die TUNA mit einer transurethralen Resektion einer Mittellappenhyperplasie. Von den 25 Patienten waren 17 Hochrisikopatienten (ASA III-IV. Die Erfolgsquote betrug 68 %. 6 Patienten (24 % benötigten weiterhin eine transurethrale oder suprapubische Harnableitung, 2 Patienten benötigten eine weitere invasive Therapie. Unsere Ergebnisse bestätigen die TUNA als wirkungsvolle und äußerst nebenwirkungsarme Therapiemöglichkeit bei Patienten mit symptomatischer BPH.

  11. Rezension zu: Birol Mertol: Männlichkeitsbilder von Jungen mit türkischem Migrationshintergrund. Berlin u.a.: LIT Verlag 2008

    Directory of Open Access Journals (Sweden)

    Martin Spetsmann-Kunkel

    2009-03-01

    Full Text Available Mertol analysiert in seiner qualitativen Studie das Männlichkeitskonzept von fünf jungen Männern mit türkischem Migrationshintergrund. Die Ergebnisse zeigen ein heterogenes Bild, werden in der Auslegung durch den Autor aber weitgehend als Bestätigung vorhandener Studien gewertet, welche veranschaulichen, dass ‚die jungen türkischen Männer‘ – hin und her gerissen zwischen Tradition und Moderne – letztlich traditionelle Männlichkeitsbilder präferieren. Äußerst problematisch an Mertols Studie ist der unkritische Gebrauch der Kategorie ‚Kultur‘ als zentrale Variable zur Erklärung von Männlichkeitsvorstellungen. Damit wird die Studie Teil des populären kulturalistischen Diskurses in Wissenschaft, Medien, Politik und Alltag, der Einstellungen, Praktiken, Kommunikationen und Konflikte überwiegend durch die ‚kulturelle Brille‘ deutet.

  12. Ein erweiterter Blickwinkel auf Gender Mainstreaming A Broader Perspective on Gender Mainstreaming

    Directory of Open Access Journals (Sweden)

    Gesine Fuchs

    2005-11-01

    Full Text Available Der vorliegende Band füllt eine Lücke zwischen der wissenschaftlichen Fundamentalkritik an Gender Mainstreaming und optimistischen Anleitungen zur Umsetzung von Gender-Mainstreaming-Strategien, indem er Kontroversen, Ansätze theoriegeleiteter Begleitforschung und erste Ergebnisse versammelt. Die Autorinnen konzentrieren sich insbesondere auf die politischen, auch mikropolitischen, Bedingungen zur Umsetzung. Das Buch ist empfehlenswert für alle, die Gender Mainstreaming umsetzen wollen und dazu Politik treiben müssen.This volume fills an important gap in the current literature on Gender Mainstreaming, where fundamental critics and optimistic “How-to-manuals” prevail. It gathers conceptual controversies, theory-grounded approaches to research and first research results. The authors focus in particular on political conditions, including micro-politics, for successful implementation. The book is recommended for all who want to implement Gender Mainstreaming and therefore have to act politically.

  13. Aktuelle Therapieansätze bei der alkoholischen Lebererkrankung

    Directory of Open Access Journals (Sweden)

    Renner F

    2006-01-01

    Full Text Available Alkohol ist einer der wichtigsten Auslöser oder aggravierenden Faktoren für chronische und akute Lebererkrankungen. Pathophysiologisch sind neben nutritiven Defiziten vor allem eine direkte Alkoholtoxizität mit vermehrter Bildung freier Radikale, konsekutiver Störungen des Intermediärstoffwechsels und schließlich eine inadäquate Zytokinaktivierung von Bedeutung. Dementsprechend sind Abstinenz, Ausgleich kalorischer Defizite, sowie bei der schweren Alkoholhepatitis die Gabe von Steroiden und der Einsatz von Pentoxifyllin zur Vermeidung des hepatorenalen Syndroms von gesicherter therapeutischer Effizienz. Die Lebertransplantation hat sich insbesonders in Kombination mit Abstinenz als effizienteste Therapie der alkoholischen Leberzirrhose erwiesen. Leberschutzpräparate und gezielte Nahrungsmittelergänzungen sind von nicht gesichertem Nutzen, über Tumornekrosefaktor- (TNF- alpha Antikörper und Insulinsensitizer liegen erste Ergebnisse vor.

  14. Automatic analytical monitoring of water-steam cycles; Automatische analytische Ueberwachung von Wasser-Dampf-Kreislaeufen

    Energy Technology Data Exchange (ETDEWEB)

    Pflug, H.D. [PreussenElektra AG, Hannover (Germany); Lutat, A.; Schoenfelder, T. [Kraftwerks- und Netzgesellschaft mbH (KNG), Kraftwerk Rostock (Germany)

    1998-05-01

    Continuously operating analytical measuring instruments have, in the meantime, been introduced into power station chemistry, at least for the more recently installed units. Naturally, a breakthrough to systematic consistent processing of the volumes of data is to date still to be achieved. This instrumentation leads a more or less isolated existence compared with conventional analysis techniques. This paper explains the principles of a data processing system for water-steam cycles and the initial results of practical trials on a conventional unit with a once-through boiler. (orig.) [Deutsch] Kontinuierlich arbeitende analytische Messgeraete sind in der Kraftwerkschemie, zumindest bei den neueren Bloecken, inzwischen eingefuehrt. Allerdings ist der Durchbruch zu einer systematischen konsequenten Verarbeitung der Datenmengen bisher ausgeblieben. Die Geraete fuehren ein mehr oder weniger isoliertes Dasein neben der konventionellen Analysentechnik. In dem Beitrag sollen die Grundlagen eines Datenverarbeitungssystems fuer Wasser-Dampf-Kreislaeufe sowie erste Ergebnisse der praktischen Erprobung in einem konventionellen Block mit Durchlaufkessel erlaeutert werden. (orig.)

  15. The Ludwigslust geothermal project; Das Geothermieprojekt Ludwigslust

    Energy Technology Data Exchange (ETDEWEB)

    Bosecke, W.P. [Stadtwerke Ludwigslust-Grabow GmbH, Ludwigslust (Germany)

    1994-12-31

    The Ludwigslust-Grabow GmbH town works have been planning the erection of a goethermal heating station since 1991. An energy consumption analysis shows not only that geothermal energy can be used economically, but also that the use of combined heat and power would prove economical. From January 1993 onwards, the first conversion work was carried out in selected parts of the town. This is a report on results of the project so far. (HW) [Deutsch] Die Stadtwerke Ludwigslust-Grabow GmbH planen seit 1991 die Errichtung eines Geothermieheizwerkes. Eine Energieverbrauchserhebung zeigt, dass nicht nur Geothermie wirtschaftlich nutzbar ist, sondern auch die Ausnutzung der Kraft-Waerme-Kopplung sich als wirtschaftlich tragfaehig erwies. Ab Januar 1993 wurden dann erste Umbauarbeiten in den ausgewaehlten Stadtvierten durchgefuehrt. Ueber bisherige Ergebnisse des Projektes wird berichtet. (HW)

  16. Qualitative Inhaltsanalyse – Versuch einer Begriffsbestimmung und Systematisierung

    Directory of Open Access Journals (Sweden)

    Christoph Stamann

    2016-09-01

    Full Text Available Unter der Bezeichnung qualitative Inhaltsanalyse findet sich in wissenschaftlichen Publikationen eine Vielfalt an Vorgehensweisen. Mit dieser Vielfalt, die wir in der Anzahl inhaltsanalytischer Verfahren und ihrer je forschungsspezifischen Modifikation begründet sehen, geht die Notwendigkeit einer Systematisierung einher. In unserem Beitrag nähern wir uns zunächst einer Definition von Inhaltsanalyse an, deren Kern wir in der Systematisierung und Interpretation von Inhalten sehen. Davon ausgehend stellen wir vier Bezugspunkte für eine erste Systematisierung dieser forschungspraktischen Vielfalt dar. In diesem Zusammenhang diskutieren wir offene Fragen zum Thema Kategorien, also jenem Instrument, welches im Zentrum aller Inhaltsanalysen steht. Im letzten Abschnitt werden die Ergebnisse der Auseinandersetzung zusammengefasst und forschungspraktische Ableitungen formuliert, die eine Orientierung im Forschungsprozess bieten. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1603166

  17. Verbesserung der Lebensqualität bei Kinderwunsch-Behandlung durch den Gebrauch patientenfreundlicher Follitropin-Fertigpens

    Directory of Open Access Journals (Sweden)

    Bitzer J

    2011-01-01

    Full Text Available Zur Behandlung des unerfüllten Kinderwunsches unterziehen sich viele Frauen einer assistierten Reproduktionstherapie mit ovarieller Stimulation. Dazu erfolgen tägliche subkutane Injektionen mit Gonadotropinen, welche die Patientinnen eigenständig durchführen können. Häufig haben Patientinnen dabei Angst vor Spritzen und injektionsbedingten Schmerzen. Die vorliegende Beobachtungsstudie zum Einfluss der Anwendung des Follitropin alfa-Fertigpens (Gonal-f®-Pen auf die Lebensqualität der Patientinnen zeigt die Ergebnisse einer Befragung von 170 Frauen zu Angst und Zufriedenheit mit diesem Applikationssystem. Die Erfahrungen wurden vor und nach den Behandlungszyklen auf numerischen Analogskalen quantifiziert und nachfolgend verglichen. Die Studie ergab, dass durch die Verwendung des Gonal-f®-Pens die Angst vor der Injektion und vor Schmerzen signifikant abnahm. Zudem waren die Patientinnen mit dem Applikationssystem äußerst zufrieden.

  18. Ideen zu einer Literatursoziologie des Internets. Mit einer Blogotop-Analyse

    Directory of Open Access Journals (Sweden)

    Peer Trilcke

    2013-11-01

    Full Text Available Der Essay skizziert und exemplifiziert die Möglichkeiten einer Literatursoziologie des Internets und plädiert in diesem Zusammenhang für eine Empirisierung der Forschung zu diesem rasant wachsenden, jedoch bisher in seiner Differenziertheit allenfalls oberflächlich beschriebenen Feld der Kommunikation über Literatur. Hierzu werden die literaturwissenschaftlichen Internet Studies und ihr literatursoziologischer Teilbereich innerhalb der allgemeinen Digital Humanities verortet. Als Beispiel für eine in diesem Sinne relational-empirische Literatursoziologie des Internets werden erste Ergebnisse der Analyse eines sog. Bücherblogotops präsentiert, anhand derer sich einige Mechanismen der sekundären literarischen Kommunikation zwar nicht repräsentativ, aber doch exemplarisch diskutieren lassen.

  19. Pretreatment of excess sludge by electroporation; Vorbehandlung von Ueberschussschlamm durch Elektroporation

    Energy Technology Data Exchange (ETDEWEB)

    Kopplow, O.; Barjenbruch, M. [Univ. Rostock, Rostock (Germany); Heinz, V. [TU Berlin, Berlin (Germany)

    2003-07-01

    Disintegration of sewage sludge destroys microorganisms and releases cell constituents, thus making carbon available more quickly for reactions. Electroporation is a high-power pulsed technology which has hardly ever been tested in Germany. The paper presents laboratory results, which are compared with other processes (high-pressure homogeniser, thermal treatment). (orig.) [German] Der anaerobe Stabilisationsprozess haengt unter anderem von der Bioverfuegbarkeit des Kohlenstoffs ab. Durch eine Vorbehandlung (Desintegration) des Schlammes kann infolge der Zerstoerung von Mikroorganismen und der Freisetzung von Zellinhaltsstoffen der Kohlenstoff mikrobiell besser und schneller umgesetzt werden. Die Elektroporation, eine Technologie der Hochleistungspulstechnik, wird als Desintegrationsverfahren in der Literatur genannt, es liegen aber kaum Ausfuehrungen dazu in Deutschland vor. Erste Ergebnisse, die in Laborversuchen mit der Elektroporation von Ueberschussschlamm gewonnen wurden, werden hier vorgestellt und mit anderer Verfahren (Hochdruckhomogenisator, thermische Behandlung) verglichen. (orig.)

  20. Collagenase clostridium histolyticum for dupuytren contracture: patterns of use and effectiveness in clinical practice.

    Science.gov (United States)

    Peimer, Clayton A; Skodny, Paul; Mackowiak, John I

    2013-12-01

    To collect data on the real-world effectiveness of collagenase clostridium histolyticum (CCH) during its first year of use following U.S. Food and Drug Administration approval and compare those results with clinical trial efficacy data. This retrospective chart review was conducted at 10 U.S. community and academic practice sites with major experience using CCH. Charts of patients treated with CCH between February and December 2010 were abstracted, and anonymized data were analyzed. Clinical use, including number of injections per cord and effectiveness outcomes (joint contracture and range of motion) were compared with results from 2 registration trials. Data were collected from 501 patients (74% male; 48% employed; mean [SD] age, 65 [10] y); 463 patients had sufficient data for analysis. We found that 1.08 CCH injections were used per treated joint, compared with a mean of 1.7 injections in registration trials. Ninety-three percent of joints received only 1 injection. The mean (SD) number of visits per injection was 2.92 (1.0). Mean (SD) contracture was reduced by 75% from 49° (21) at baseline to 12° (17), similar to the 71% to 79% reduction in clinical trials. Mean (SD) range of motion was improved by 37° from 44° (20) at baseline to 81° (14), similar to the increase of 35° and 37° in the 2 clinical trials; and 67% of first injections resulted in full correction to 0° to 5°, compared with the clinical trial rate of 39%. Despite a lower injection rate, correction of joint contracture and range of motion was similar to findings from clinical trials. Effectiveness reports using this kind of surveillance design could provide patients, physicians, and payers with the information needed to make better treatment and reimbursement decisions. Therapeutic III. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Human Dupuytren's Ex Vivo Culture for the Study of Myofibroblasts and Extracellular Matrix Interactions.

    Science.gov (United States)

    Karkampouna, Sofia; Kloen, Peter; Obdeijn, Miryam C; Riester, Scott M; van Wijnen, Andre J; Kruithof-de Julio, Marianna

    2015-01-01

    Organ fibrosis or "scarring" is known to account for a high death toll due to the extensive amount of disorders and organs affected (from cirrhosis to cardiovascular diseases). There is no effective treatment and the in vitro tools available do not mimic the in vivo situation rendering the progress of the out of control wound healing process still enigmatic. To date, 2D and 3D cultures of fibroblasts derived from DD patients are the main experimental models available. Primary cell cultures have many limitations; the fibroblasts derived from DD are altered by the culture conditions, lack cellular context and interactions, which are crucial for the development of fibrosis and weakly represent the derived tissue. Real-time PCR analysis of fibroblasts derived from control and DD samples show that little difference is detectable. 3D cultures of fibroblasts include addition of extracellular matrix that alters the native conditions of these cells. As a way to characterize the fibrotic, proliferative properties of these resection specimens we have developed a 3D culture system, using intact human resections of the nodule part of the cord. The system is based on transwell plates with an attached nitrocellulose membrane that allows contact of the tissue with the medium but not with the plastic, thus, preventing the alteration of the tissue. No collagen gel or other extracellular matrix protein substrate is required. The tissue resection specimens maintain their viability and proliferative properties for 7 days. This is the first "organ" culture system that allows human resection specimens from DD patients to be grown ex vivo and functionally tested, recapitulating the in vivo situation.

  2. Vemurafenib-associated Dupuytren- and Ledderhose palmoplantar fibromatosis in metastatic melanoma patients.

    Science.gov (United States)

    Vandersleyen, V; Grosber, M; Wilgenhof, S; De Kock, J; Neyns, B; Gutermuth, J

    2016-07-01

    The BRAF-inhibitor vemurafenib, used in patients with metastatic melanoma, induces multiple cutaneous side-effects. The aim of this work was to evaluate the development of palmoplantar fibromatosis in a population of patients treated with the BRAF inhibitor vemurafenib. Between April 2011 and February 2013, we initiated a treatment with vemurafenib in 53 patients with an unresectable stage IIIC or stage IV melanoma. The patients were followed-up on a regular base to monitor possible side-effects. A plantar or palmar fibromatosis was observed in five of 53 patients treated with vemurafenib. In four of these patients other risk factors for the development of palmoplantar fibromatosis were absent. The BRAF-inhibitor vemurafenib might induce palmoplantar fibromatosis. © 2015 European Academy of Dermatology and Venereology.

  3. Molecular mechanisms and treatment strategies for Dupuytren’s disease

    OpenAIRE

    2010-01-01

    David B O’Gorman1,2,3,4, Linda Vi1,2,5, Bing Siang Gan1,2,3,5,61Cell and Molecular Biology Laboratory, 2The Hand and Upper Limb Centre, St. Joseph’s Health Care London, Schulich School of Medicine and Dentistry, 3Departments of Surgery, 4Biochemistry, 5Physiology and Pharmacology, 6Medical Biophysics, The University of Western Ontario, London, OT, CanadaAbstract: Dupuytren’s disease (DD) is a common disease of the hand and is characterized by thickening of the pa...

  4. Dupuytren's Fracture and It's typing%Dupuytren骨折及其分型

    Institute of Scientific and Technical Information of China (English)

    鲍丰; 黄洪斌; 季向荣; 杨晓东; 陈旭宏

    2003-01-01

    目的:探讨Dupuytren骨折的定义及其分型.方法:通过60例归入观察对象的旋前型踝关节损伤病人的治疗,结合回顾病人的病史、体检及影像学资料,描述Dupuytren骨折并对其分型.结果:对Dupuytren骨折作了较合理的定义,将其分为Ⅰ、Ⅱ、Ⅲ3型.结论:该定义及其分型有助于提高对这类损伤的全面认识,更好地指导临床诊断和治疗.

  5. Dupuytren骨折的诊断和治疗%Diagnosis and treatment of Dupuytren fracture

    Institute of Scientific and Technical Information of China (English)

    李高舜; 杨迪生; 叶招明

    2006-01-01

    目的:探讨Dupuytren骨折的诊断和治疗.方法:20例患者中男14例,女6例;平均年龄32.8岁(19~65岁).左踝12例,右踝8例.扭伤14例,坠落伤3例,车祸伤3例.开放伤5例,闭合伤15例.明确诊断时间:2 h内13例,3 d内5例,7 d内2例.13例通过踝关节正侧位X线片确诊,5例在加摄小腿全长正侧位X线片后确诊,2例在行双踝外翻应力X线片对照检查后确诊.20例确诊患者均行腓骨解剖复位半管形钢板内固定,10例伴内踝骨折者在内踝复位后用松质骨螺钉或张力带固定,14例固定下胫腓联合.结果:通过对17例患者进行了1.3~6年(平均3.1年)的随访,根据Meyer和Kumler的踝关节功能评价标准,17例中优10例,良4例,一般2例,差1例(此例患者在2个月后踝关节正侧位X线片显示内踝踝穴增宽).结论:对于Dupuytren骨折,早期准确的诊断和正确的外科治疗是恢复踝关节良好功能的关键.

  6. Anreizkomponenten von Bonus-programmen der gesetzlichen Krankenversicherungen - Kommunikation als unterschätzte Erfolgskomponente

    Directory of Open Access Journals (Sweden)

    Gerd Glaeske

    2009-10-01

    Full Text Available Ziel: Die Bonusprogramme der gesetzlichen Krankenversicherungen (GKV sollen insbesondere Risikogruppen durch monetäre Anreize zu gesundheitsbewussten Verhaltensweisen stimulieren, um schlummernde präventive Rationalisierungspotenziale auszuschöpfen. Erste Studien deuten darauf hin, dass Mitnahmeeffekte (guter Risiken vor Präventionseffekte dominieren. Ziel des Beitrags ist es, die Erfolgsfaktoren von Anreizsystemen darzustellen.Methodik: Um den Stand der aktuellen Forschung zu identifizieren, wurde eine Literaturanalyse vorgenommen. Da die gesetzlich geforderten Effizienznachweise, nur die Kosten-Nutzen-Verhältnisse abbilden und keine übergreifenden Lerneffekte hinsichtlich einer optimierten Ausgestaltung zulassen, wurden ebenfalls Studien aus dem kommerziellen Bereich einbezogen, um mögliche Erfolgsfaktoren und Forschungsbedarf identifizieren zu können.Ergebnisse: Die Ergebnisse der Literaturanalyse macht deutlich, dass nicht allein die Kernelemente der Bonusprogramme, sondern Zusatzelemente (Erinnerungssysteme, Abbau von Barrieren einen bedeutende Rolle spielen, um die Teilnahmeraten von Präventionsinterventionen zu erhöhen.Schlussfolgerung: Zur Stimulierung gesundheitsbewussten Verhaltens sollte zukünftig verstärkt Augenmerk auf den Abbau von Informations-, Wissens- und Fähigkeitsbarrieren gelegt werden.

  7. Faster, deeper and safer drilling with tailor-made ``designer tools`` - a new approach in borehole technology; Schneller, weiter und sicherer Bohren mit massgeschneiderten ``Designer Garnituren`` - Ein neuer Ansatz in der Bohrtechnologie

    Energy Technology Data Exchange (ETDEWEB)

    Reich, M. [Technical Services Baker Hughes INTEQ, Celle (Germany)

    1998-12-31

    In the past few years, progress has been made in all deep drilling components, but a systemic approach tends to be neglected. Combinations of optimized components alone will not ensure maximum heading rates, long life and economic efficiency. Since about two years ago, research is being made into ``designer tool combinations``. The contribution describes a typical example along with the software used to select the components. (orig.) [Deutsch] In den vergangenen Jahren sind deutliche Fortschritte bei der Entwicklung aller fuer Tiefbohrungen erforderlicher Komponenten erzielt worden. Vermisst wird aber ein Ansatz zum Systemdenken, da leider haeufig das Zusammenspiel dieser Komponenten im praktischen Einsatz nicht beruecksichtigt wird. Die Kombination optimierter Einzelkomponenten allein fuehrt weder zu maximalem Bohrfortschritt noch zu hoechster Lebensdauer oder einem wirtschaftlichen Optimum. Beste Ergebnisse sind vielmehr von Bohrgarnituren zu erwarten, die nach mechanischen und hydraulischen Gesetzmaessigkeiten fuer eine maximale Leistung des Gesamtsystems zusammengestellt werden. Diese relativ einfache Erkenntnis wird erst seit kurzem systematisch in die Praxis umgesetzt. In den letzten zwei Jahren wurden mehrere umfassende Programme zur Optimierung von Bohrgarnituren durchgefuehrt. Die Ergebnisse, die mit diesen `Designer-Bohrgarnituren` erzielt wurden, demonstrieren in eindrucksvoller Weise das Verbesserungspotential. Nachfolgend werden die typischen Komponenten einer `Designer-Garnitur` beschrieben und ein Einblick in die Software gegeben, die zur Optimierung eingesetzt wird. Die erreichten Verbesserungen gegenueber den zuvor benutzten konventionellen Garnituren werden mit Fallbeispielen belegt. (orig.)

  8. Radiale extrakorporale Stoßwellentherapie in der Orthopädie

    Directory of Open Access Journals (Sweden)

    Gerdesmeyer L

    2004-01-01

    Full Text Available Die radiale extrakorporale Stoßwellentherapie (rESWT stellt eine alternative Behandlungsform zur Therapie der chronischen Enthesiopathien dar. Zahlreiche klinische Studien konnten die hohe Effektivität der rESWT bei fehlenden Nebenwirkungen zeigen. Neben den etablierten Indikationen Tennisellenbogen und Fersensporn konnten auch bei der Behandlung der chronischen Tendinitis calcarea der Schulter und beim Patellaspitzensyndrom gute klinische Ergebnisse erreicht werden. Als eine neue Indikation der rESWT stellt sich die Triggerpunktbehandlung bei muskulären Erkrankungen in der Orthopädie dar. Hier liegen erste Ergebnisse über erfolgreiche Anwendungen bei chronischen Kopf-, Nacken- und LWS-Schmerzen vor. Auch wenn zahlreiche klinische Studien einen erfolgreichen Einsatz der rESWT zeigen konnten, bleibt die Methode bis heute ohne Wirksamkeitsnachweis. Fehlende klinisch relevante Nebenwirkungen bei guten Ergebnissen lassen den Einsatz der rESWT sinnvoll erscheinen. Es bleibt aber die Notwendigkeit, hochwertige Studien durchzuführen, um den Stellenwert der rESWT im klinischen Einsatz beurteilen zu können. Unter Verwendung der radialen Applikationstechnik können Stoßwellen bis zu einer Energieflußdichte von 0,16 mJ/mm2 erreicht werden.

  9. Aggregate emissions and evaluation of process combinations; Aggregierte Emissionen und Bewertung der Verfahrenskombinationen

    Energy Technology Data Exchange (ETDEWEB)

    Schwing, E.; Jager, J. [Institut WAR, Darmstadt (Germany). Fachgruppe Abfalltechnik

    1998-12-31

    Within the framework of the R and D project ``Mechanical-biological waste conditoning in combination with thermal processing of partial waste fractions``, numerous measurements to determine gaseous and liquid emissions were carried out. These measurements reveal the environmental impact of different treatments and different inputs. They further permit to verify the quality of a treatment. Particularly interesting for the purpose of the project were the total emissions of the considered process combinations. The paper reports the outcome of emission measurements and indicates the variants of process combinations for which the emissions were aggregated. First results of the evaluation of gaseous and liquid emissions are given for these variants. (orig.) [Deutsch] Im Zuge des Forschungs- und Entwicklungsvorhabens `Mechanisch-biologische Restmuellbehandlung unter Einbindung thermischer Verfahren fuer Teilfraktionen` sind zahlreiche Emissionsmessungen bezueglich der luft- und wasserseitigen Emissionen durchgefuehrt worden. Die Ergebnisse dieser Messungen geben Aufschluss ueber die Umweltauswirkungen der verschiedenen Behandlungsverfahren bei unterschiedlichem Input. Des weiteren kann durch sie die Guete des Prozesses ueberprueft werden. Im Projekt interessant sind aber insbesondere die Gesamtemissionen der betrachteten Verfahrenskombinationen. Im folgenden werden die durchgefuehrten Emissionsmessungen und die Varianten der Verfahrenskombinationen, fuer die die Emissionen aggregiert wurden, dargestellt. Dnach werden erste Ergebnisse der Bewertung der luft- und wasserseitigen Emissionen fuer diese Varianten praesentiert. (orig.)

  10. Ozeane: Ergebnisse der 7. Sitzung der Kommission für nachhaltige Entwicklung (CSD) der Vereinten Nationen

    Science.gov (United States)

    Schlimm, Jutta; Stietzel, Hans-Joachim

    1999-12-01

    The 7th session of the United Nations Commission on Sustainable Development (CSD) was organised from 19 30 April in the UN Headquarters in New York. The Commission on Sustainable Development was established in 1992 with the aim to implement the comprehensive action programme of Agenda 21. The topics on the agenda of this year’s CSD session included: oceans, tourism as well as consumption and production patterms with a special focus on the oceans item. The 7th Session covered two weeks. It began with the so-called “High Level Segment” during the first week when 89 ministers and high-ranking government representatives stated their points of view on various themes-sometimes also in interaction with the chairman. Concerning the topic of oceans CSD 7 focussed on a few main items of special priority for the implementation of the Agenda 21, both during the preparatory “Intersessional Working Group” and in the final document. These main items are: the conservation and integrated as well as sustainable management of fisheries and marine resources, including the ecosystem of the oceans, the prevention of pollution and degradation of the marine environment through land-based and other acticities, the improvement of the scientific knowledge on oceans and the interaction between the oceans and the global climate system. The decisions of CSD 7 adressed detailed and for the major part concrete proposals for action, appeals or requests to the international organisations and the interntional community with regard to these main items. Summarizing the 7th session, it can be said that in the oceans sector CSD 7 was quite successful in fullilling the task to study the implementation of Agenda 21, to set priorities and to address actors and the necessary actions.

  11. Environmental awareness in Germany 2010. Results of a representative population survey; Umweltbewusstsein in Deutschland 2010. Ergebnisse einer repraesentativen Bevoelkerungsumfrage

    Energy Technology Data Exchange (ETDEWEB)

    Borgstedt, Silke; Christ, Tamina [Sinus-Institut, Heidelberg (Germany); Reusswig, Fritz [Potsdam-Institut fuer Klimafolgenforschung e.V., Potsdam (Germany)

    2010-11-15

    In the background paper under consideration, the Federal Ministry of Environment, Nature Conservation and Nuclear Safety (Berlin, Federal Republic of Germany) reports on the results of a representative population survey on the environmental awareness in Germany. The topics of this paper are: (a) Environmental policy as a organisational task; (b) Environmental quality, health and risk perception; (c) Climatic change as a cultural change?; (d) Technological and cultural innovations; (e) Environment engagement between personal responsibility and delegation; (f) Milieu-specific potentials for environmentally sensitive consumer behaviour.

  12. Results of silage maize experiments in Baden-Wuerttemberg in 1992; Ergebnisse der Landessortenversuche mit Silomais 1992

    Energy Technology Data Exchange (ETDEWEB)

    Kusterer, B. [Lehr- und Versuchsanstalt fuer Viehhaltung und Gruenlandwirtschaft, Aulendorf (Germany); Wurth, W. [Lehr- und Versuchsanstalt fuer Viehhaltung und Gruenlandwirtschaft, Aulendorf (Germany)

    1992-12-31

    Besides dry mass yield per hectare as a judging criterion, the energetic rating of species is increasingly gaining importance. Apart from the dry mass yield, the energy rating (by kilogramme units of starch per hectare) comprises futher species-typical characteristics. These are the dry cob percentage and dry substance percentage of plant parts at the time of harvesting. (EF) [Deutsch] Neben dem Beurteilungskriterium Trockenmasseertrag (TM-Ertrag) je Hektar gewinnt die Energiebewertung der Sorten immer mehr an Bedeutung. Die Energiebewertung (KStE/ha) beinhaltet neben dem TM-Ertrag weitere sortentypische Merkmale. Dies sind der Trockenkolbenanteil (TKA) und der Trockensubstanzgehalt (TS%) der Pflanzenteile zur Ernte. (EF)

  13. Results of a demonstration experiment: Hydrogenation of pyrolysis oils from biomass; Ergebnisse eines Demonstrationsversuchs zur Hydrierung von Pyrolyseoelen aus Biomassen

    Energy Technology Data Exchange (ETDEWEB)

    Kaiser, M. [DMT-Gesellschaft fuer Forschung und Pruefung mbH, Essen (Germany)

    1998-09-01

    Sump phase hydrogenation is a technique specially developed for coal liquefaction; it provides a possibility of processing the liquid products of biomass pyrolyis into high-grade carburettor fuels. A demonstration experiment was carried out at the hydrogenation plant of DMT. The plant has a capacity of 10 kg/h. The technical feasibility of hydrogenation of biomass oils was demonstrated in a continuous experiment. The contribution describes the experimental conditions, yields, and product qualities. (orig.) [Deutsch] Die fuer die Kohleverfluessigung entwickelte Sumpfphasenhydrierung bietet die Moeglichkeit, die Fluessigprodukte der Pyrolyse von Biomassen zu hochwertigen Vergaserkraftstoffen zu veredeln. Im Hydriertechnikum der DMT wurde hierzu ein Demonstrationsversuch durchgefuehrt. Die Anlage ist fuer einen Kohledurchsatz von 10 kg/h ausgelegt. In einem kontinuierlichen Versuchslauf wurde mit dieser Anlage die technische Machbarkeit der Hydrierung von Bio-Oelen demonstriert. In dem vorliegenden Beitrag werden die Versuchsbedingungen, Ausbeuten und Produktqualitaeten vorgestellt. (orig.)

  14. Bioindication with Peregrine falcons. New results from Baden-Wuerttemberg; Bioindikation mit Wanderfalken. Neue Ergebnisse aus Baden-Wuerttemberg

    Energy Technology Data Exchange (ETDEWEB)

    Trenck, K.T. von der [Landesanstalt fuer Umwelt, Messungen und Naturschutz Baden-Wuerttemberg, Karlsruhe (Germany); Schilling, F. [Arbeitsgemeinschaft Wanderfalkenschutz (AGW), Nuertingen (Germany); Schmidt, D. [NABU-Vogelschutzzentrum Moessingen (Germany)

    2007-04-15

    Goal and Scope. The Stockholm convention bans 12 prominent persistent organic pollutants (POPs), and the pertinent global monitoring programme recommends birds' eggs as bio-indicators for the terrestrial food web. As top predators, Peregrine falcons are uniquely suited indicators because of their accumulating power for persistent and lipophilic compounds. On the other hand, the Peregrine falcon as a sentinel species was closer to extinction than other birds of prey. Only unremitting efforts of private ornithologists throughout the past four decades in conjunction with the timely banning of organochlorine pesticides like DDT succeeded in saving the Peregrine population of Baden-Wuerttemberg from extinction, in contrast to the Peregrine falcons of other German states or other European countries. Methods. See vd Trenck et al. (2006). Results and Conclusions. New results confirm the findings of the past long-term bio-monitoring. The main pollutants are PCBs (ca. 20 {mu}g/g) and pp'-DDE (ca. 11 {mu}g/g), the latter contributing >96% of all organochlorine pesticide residues (all concentrations on a dry matter basis). Both substances have followed a slightly increasing trend since 2004. The sum of the polychlorinated diphenyl ethers (PBDE) has fluctuated strongly in the past four years, and in 2006 amounted to 0.6 {mu}g/g (mean without outliers), just as the mercury contamination of the eggs. PCB-156 as the main dioxin-like PCB followed with an average concentration of 0.35 {mu}g/g. Only 10 out of 23 eggs analysed contained hexabromocyclododecane (HBCD) in measurable concentrations; the mean concentration of these eggs was 0.024 {mu}g/g. Tetrabromobisphenol A (TBBA) was detected in all egg samples with a mean of 0.004 {mu}g/g. Due to the many and diverse effects exerted by PCBs, the assessment of this group of compounds, with the aid of European and German regulations for food, proves to be a complex matter, which is currently in a state of flux. There is no doubt, however, that the mean pollution of the Peregrine eggs with toxic dioxin equivalents (WHO TEQ) has reached the no observed adverse effect level (NOAEL) known for chickens and osprey chicks, and the most polluted eggs exceed this threshold considerably. The toxic profile of PBDEs is similar to that of PCBs. They are known to promote tumour growth, to interfere with the thyroid hormone system resulting in toxicity for the neuronal development, to suppress the immune system, and to trigger stress reactions. Tests with highly purified BDE-47 have ruled out dioxin-like effects via Ah-receptor binding for this congener and such effects are therefore very unlikely for the whole class of compounds. At the present time, quantitative criteria for the assessment of the risk posed by PBDEs are not sufficiently reliable, and less so for HBCD and TBBA. (orig.)

  15. Methods and results of diuresis renography in infants and children. Methodik und Ergebnisse der Diurese-Nephrographie im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Kleinhans, E. (Klinik fuer Nuklearmedizin, RWTH Aachen (Germany)); Rohrmann, D. (Urologische Klinik, RWTH Aachen (Germany)); Stollbrink, C. (Paediatrische Klinik, RWTH Aachen (Germany)); Mertens, R. (Paediatrische Klinik, RWTH Aachen (Germany)); Jakse, G. (Urologische Klinik, RWTH Aachen (Germany)); Buell, U. (Klinik fuer Nuklearmedizin, RWTH Aachen (Germany))

    1994-02-01

    In infants and children with hydronephrosis, the decision-making process for those instances of urinary tract dilatation that require surgical correction and those that do not is based in part on the findings of diuresis renography. Quantitative analysis of renogram curve pattern is a well established tool which, in addition, provides comparable results in follow-up studies. However, standardization of the method including data analysis does not yet exist. In this study, three parameters obtained by mathematical curve analysis were examined: clearance half-time for diuretic response, clearance within 5 minutes and clearance within 16 minutes. As a result, 16 minutes clearance revealed superior results in discriminating obstructive impairments of urine drainage from not obstructive ones. Compared to the clearance halftime, the markedly shorter duration of the examination (16 minutes) is an additional benefit. (orig.)

  16. Structural and strong structural controllability. Survey and new results; Strukturelle und streng strukturelle Steuerbarkeit. Uebersicht und neue Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Svaricek, Ferdinand; Jarczyk, Jan Christian; Alt, Benedikt [Univ. der Bundeswehr Muenchen, Neubiberg (Germany). Inst. fuer Steuer- und Regelungstechnik

    2011-06-15

    This paper gives both an overview of the concepts of structural and strong structural controllability of structured linear systems and some new results to strong structural controllability. A system is called strongly structurally controllable if the controllability conditions are fulfilled for any nonzero system parameters. (orig.)

  17. Wie sich die Bilder gleichen – und die Geister scheiden: Mainstream-Ergebnisse in einem keynesianischen (? Lehrbuchmodell

    Directory of Open Access Journals (Sweden)

    Rainer Bartel

    2014-03-01

    Full Text Available Der ökonomische Mainstream (Orthodoxie und seine Alternativen (Heterodoxie werden hier grob in Neoklassik und Keynesianismus eingeteilt und kontrastiert. Ausgangspunkt ist die kognitive Dissonanz zwischen Mainstream-Theorie und Wirtschaftssystem-Realität. Es gibt aber auch breit verwendete Lehrbücher der Makroökonomik, die sich als fortschrittlich, weil keynesianisch fundiert, verstehen. Ich untersuche ein solches Modell: jenes von Blanchard et al. (2010, das ich das Blanchard-Modell nenne. Nach einer Charakterisierung und einem Vergleich des neoklassischen Arbeitsmarktmodells und seiner realwirtschaftlichen Implikationen mit dem Keynes’schen Modell des Gütermarktes und seinen Konsequenzen für den Arbeitsmarkt wird das Blanchard-Modell betrachtet und sein Fortschrittlichkeitsanspruch beurteilt. Es stellt sich heraus, dass das Blanchard-Modell dem neoklassischen Gleichgewichtsmodell sehr stark verhaftet ist und als kompatibel mit der Neoklassischen Synthese angesehen werden kann. Nach einem Fazit wird ein Ausblick auf mögliche Weiterent- wicklungen der Makroökonomik versucht.

  18. Results of the energetic retrofitting of an university library; SuUB Bremen: Ergebnisse der energetischen Sanierung

    Energy Technology Data Exchange (ETDEWEB)

    Ritzenhoff, P. [Hochschule Bremerhaven (Germany); Aslan, F. [ttz Bremerhaven - Umweltinstitut, Bremerhaven (Germany); Schiller, H. [Schiller engineering, Hamburg (Germany)

    2007-03-15

    The university library was built in the 60s and 70s and consumed enormous amounts of energy. Therefore, it was decided to retrofit the building with a focus on energy efficiency aiming at saving more than 50% of the original primary energy consumption. The retrofitting was co-funded by the Federal Ministry of Economics and Technology within the programme 'Improvement of structural energy efficiency'. The whole process was accompanied by a detailed measurement and analysis programme to develop the retrofitting concept and to adapt it during the work whenever necessary. This article provides an overview about the energy saving potentials in this fully air-conditioned building. (orig.)

  19. Plentern mit Kiefern--Ergebnisse aus den USA [Plentering with pines--results from the United States

    Science.gov (United States)

    James M. Guldin; Don C. Bragg; Andreas Zingg

    2017-01-01

    Until now, scientifically reliable data on plentering of light-demanding tree species in Europe have been lacking. This gap is filled with long-term trials from the USA, among others with southern yellow pines. In the southern state of Arkansas, two plots of 16 hectares were installed in 1936, in the context of a large-scale trial of mixed loblolly pine (...

  20. Transarterial Chemoembolization (TACE) in hepatocellular carcinoma: Technique, indication and results; Transarterielle Chemoembolisation (TACE) des hepatozellulaeren Karzinoms: Technik, Indikationsstellung und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Zangos, S.; Balzer, J.O.; Nabil, M.; Rao, P.; Eichler, K.; Abdelkader, A. [Inst. fuer Diagnostische und Interventionelle Radiologie, J.W. Goethe-Univ., Frankfurt (Germany); Bechstein, W.O. [Klinik fuer Allgemeinchirurgie, J.W. Goethe-Univ., Frankfurt (Germany); Zeuzem, S. [Klinik fuer Innere Medizin, Hepatologie, J.W. Goethe-Univ., Frankfurt (Germany)

    2007-11-15

    To present current data on technique, indications and results of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The principle of TACE is the intra-arterial injection of chemotherapeutic drug combinations like doxorubicin, cisplatin and mitomycin into the hepatic artery, followed by lipiodol injection, Gelfoam for vessel occlusion and degradable microspheres. The side effects and complications after TACE range from fever, upper abdominal pain and vomiting to acute or chronic liver cell failure. The palliative effect in unresectable HCC using TACE allows local tumor control in 15 to 60% of cases and 5-year survival rates ranging from 8 - 43%. The potentially curative treatment option allows local tumor control from 18 - 63%. The neoadjuvant treatment option of TACE in combination with other treatment options like percutaneous ethanol injection (PEI) or radiofrequency ablation (RFA) reach local tumor control rates between 80 - 96%. The bridging effect of TACE before liver transplantation reaches 5-year survival rates from 59 - 93%. The symptomatic therapy option of TACE is used to counteract pain directly caused by HCC and acute/subacute bleeding in the HCC. The local tumor response reaches up to 88% and the bleeding control is from 83 to 100%. (orig.)

  1. Klinische Ergebnisse mit Dronedaron (Multaq® bei nicht-permanentem Vorhofflimmern - Resultate des DEMETER-Registers

    Directory of Open Access Journals (Sweden)

    Pürerfellner H

    2015-01-01

    Full Text Available iEinleitung:/i Dronedaron (Multaq®, Sanofi wird als Mehrkanalblocker bei nicht-permanentem Vorhofflimmern (VHF eingesetzt und ist in Österreich seit 02/2010 verfügbar. Wir berichten über die klinischen Resultate aus dem prospektiven DEMETER Register (02/2010– 12/2011.iMethoden:/i Sechs österreichische Kliniken schlossen 94 ambulante oder stationäre Patienten in die Studie ein. Einschlusskriterien waren Erstmanifestation von VHF (2,2 %, paroxysmales VHF (72,3 %, persistierendes VHF (24,4 % und lang anhaltend persistierendes VHF (1,1 %. Zur Baseline (BL wurden EKG-Parameter (Rhythmus, Herzfrequenz, PQ, QTC, Nieren- und Leberwerte, NYHA-Stadien, CHADS2- Scores und echokardiographische Parameter (LVEF, linksatrialer Diameter erfasst und nach 3 sowie 6 Monaten zusammen mit einer Einschätzung der Lebensqualität (QoL hinsichtlich VHF re-evaluiert. iResultate:/i 55 % der Patienten konnten die Studie protokollkonform abschließen, 20 % waren nicht auswertbar („Lost-to- Follow-up“ und bei 15 % wurde ein Abbruch dokumentiert. Der Hauptgrund für einen Studienabbruch war rezidivierendes VHF (75 %; proarrhythmogene Effekte oder Todesfälle traten nicht auf. Die Rate an Rehospitalisierungen war gering (8,3 % und auf VHF-Rezidive beschränkt; über einen Zeitraum von 6 Monaten konnte keine relevante Progression von Sinusrhythmus (SR in persistierendes VHF beobachtet werden. Die Leberwerte und Nierenwerte blieben im Verlauf stabil, Serumkreatinin stieg pharmakodynamisch erwartungsgemäß signifikant an. Relevante EKG-Veränderungen kamen nicht vor, die NYHA-Stadien nahmen von Visite zu Visite signifikant ab, und bereits ab dem ersten Follow-up (FU1 wurde eine signifikant gebesserte QoL angegeben. iSchlussfolgerungen:/i Unter Beobachtung von Klinik, EKG, Serumkreatinin und Leberwerten zeigte sich Dronedaron bei Patienten mit nicht-permanentem VHF ohne rezente kardiale Dekompensation sicher und nebenwirkungsarm in der Anwendung. Zudem kam es zu einer signifikanten Abnahme an klinischer Herzinsuffizienz (p = 0,001 und einer signifikant gebesserten QoL der Patienten (p = 0,013. Ein hoher Lost-to-Follow-up-Anteil von 45 % der Patienten limitiert allerdings die Aussagekraft des Registers.

  2. Klinische Ergebnisse nach stereotaktischer Präzisionsbestrahlung großer uvealer Melanome mit dem Gamma-Knife

    OpenAIRE

    Schonenbach, Sabine

    2006-01-01

    Von Juni 1997 bis April 2001 wurden 97 Patienten, die an einem unilateralen uvealen Melanom litten, mit dem Gamma-Knife radiochirurgisch behandelt. Die Melanome aller 97 Patienten waren aufgrund der Lokalisation oder der Größe für eine Therapie mit Ruthenium-Applikatoren nicht geeignet. Alle 97 Patienten, die sich der Therapie mit dem Gamma-Knife unterzogen, wurden in eine engmaschige Nachsorge aufgenommen. Bei der Nachsorge wurden in regelmäßigen Abständen klinische, echographische und n...

  3. Minergie-Eco system audit - Results of the concept phase; Systemnachweis MINERGIE-ECO. Bericht ueber die Ergebnisse der Konzeptphase

    Energy Technology Data Exchange (ETDEWEB)

    Lenel, S.; Schinabeck, J.; Sigg, R. [Intep, Integrale Planung GmbH, Zuerich (Switzerland); Foradini, F. [E4tech Sarl, Lausanne (Switzerland); Citherlet, S. [Ecole d' Ingenieurs du Canton de Vaud (EIVD), Yverdon (Switzerland); Roulet, C.-A. [Swiss Federal Institute of Technology (EPFL), Laboratoire d' Energie Solaire et de Physique du Batiment (LESO-PB), Lausanne (Switzerland)

    2006-05-15

    This comprehensive report for the Swiss Federal Office of Energy (SFOE) presents the results of the concept phase of a project that developed a system-verification method for the Swiss Minergie-Eco label. This label considers not only energy aspects of building but also the materials used along with health aspects. Swiss and international standards that form the basis for the audit are described. The methods used and the work packages involved in the whole project are described and their implementation is discussed in detail. The framework for the software building-blocks to be developed is presented. The further project phases involved in the project are briefly discussed and the planned implementation time-scales are presented.

  4. Clinical 3-year follow-up of uterine fibroid embolization; Klinische 3-Jahres-Ergebnisse nach Uterusmyomembolisation

    Energy Technology Data Exchange (ETDEWEB)

    Radeleff, B.A.; Satzl, S.; Eiers, M.; Fechtner, K.; Hakim, A.; Kauffmann, G.W.; Richter, G.M. [Universitaetsklinikum Heidelberg (Germany). Abt. Radiodiagnostik; Rimbach, S. [Klinikum Konstanz (Germany). Frauenklinik

    2007-06-15

    Purpose: The purpose of this study was to evaluate the clinical long-term success of uterine artery embolization (UAE) in patients with symptomatic fibroids using spherical particles (Embosphere). Materials and Methods: 34 consecutive patients treated with UAE were initially enrolled in the study which had the following study goals (1) 1-year follow-up MRI evaluation of the fibroid behavior and (2) clinical long-term success due to standardized assessment of the main fibroid-related symptoms (hypermenorrhoea, dysmenorrhoea and dysuria) of the patients' individual overall health status and their therapy satisfaction at 1-year, 2- year and 3-year intervals after UAE. Results: Technical success was achieved in all procedures. Four patients had to be excluded from the long-term evaluation schedule: one because of a hysterectomy due to bleeding after 6 weeks, 3 patients were not available for the designated minimum follow-up interval. The preinterventional severe hypermenorrhoea (n = 27) with a score of 4.4 {+-} 0.7 (5 = extreme menstrual bleeding) decreased after one year to 2.1 {+-} 0.5 (p = 0.0001), after two years to 1.7 {+-} 0.5 (p = 0.0042) and after three years to 1.3 {+-} 0.6 (p = 0.0001). The preinterventional dysmenorrhoea (n = 15) with a score of 3.1 {+-} 1.5 (3 = distinctly increased dysmenorrhoea) decreased after one year to 1.1 {+-} 0.3 (p = 0.0001), after two years to 1.2 {+-} 0.2 and after three years to 1.2 {+-} 0.4 (p = 0.148). The pretreatment dysuria (n = 12) with a preinterventional score of 3.1 {+-} 1.5 (3 = distinctly increased dysuria) decreased after one year to 1.1 {+-} 0.3 (p = 0.0069) and remained after two years at 1.1 {+-} 0.2 and after three years at 1.2 {+-} 0.4 (p = 0.905). The initial overall health status was 54.7 {+-} 20.1 (maximal value 100). After one year it rose to 90.5 {+-} 15.4 (p = 0.0001), was 91.8 {+-} 5.6 after two years and was 91.3 {+-} 8.5 (p = 0.8578) after three years. The satisfaction with the therapy was 2.9 {+-} 0.2 after one year, 2.6 {+-} 0.3 after two years and 2.7 {+-} 0.5 (3 = extremely satisfied) after three years. We observed 12 minor and 3 major complications (one hysterectomy, one fibroid expulsion associated with a short bleeding episode and one transient amenorrhoea for three months). All patients benefited clinically from the procedure and a clinical benefit was achieved in all cases. (orig.)

  5. Compression of digital images in radiology. Results of a consensus conference; Kompression digitaler Bilddaten in der Radiologie. Ergebnisse einer Konsensuskonferenz

    Energy Technology Data Exchange (ETDEWEB)

    Loose, R. [Klinikum Nuernberg-Nord (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Braunschweig, R. [BG Kliniken Bergmannstrost, Halle/Saale (Germany). Klinik fuer Bildgebende Diagnostik und Interventionsradiologie; Kotter, E. [Universitaetsklinikum Freiburg (Germany). Abt. Roentgendiagnostik; Mildenberger, P. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie; Simmler, R.; Wucherer, M. [Klinikum Nuernberg (Germany). Inst. fuer Medizinische Physik

    2009-01-15

    Purpose: Recommendations for lossy compression of digital radiological DICOM images in Germany by means of a consensus conference. The compression of digital radiological images was evaluated in many studies. Even though the results demonstrate full diagnostic image quality of modality-dependent compression between 1:5 and 1:200, there are only a few clinical applications. Materials and Methods: A consensus conference with approx. 80 interested participants (radiology, industry, physics, and agencies) without individual invitation was organized by the working groups AGIT and APT of the German Roentgen Society DRG to determine compression factors without loss of diagnostic image quality for different anatomical regions for CT, CR/DR, MR, RF/XA examinations. The consent level was specified as at least 66 %. Results: For individual modalities the following compression factors were recommended: CT (brain) 1:5, CT (all other applications) 1:8, CR/DR (all applications except mammography) 1:10, CR/DR (mammography) 1:15, MR (all applications) 1:7, RF/XA (fluoroscopy, DSA, cardiac angio) 1:6. The recommended compression ratios are valid for JPEG and JPEG 2000 /Wavelet compressions. Conclusion: The results may be understood as recommendations and indicate limits of compression factors with no expected reduction of diagnostic image quality. They are similar to the current national recommendations for Canada and England. (orig.)

  6. Machbarkeit und Akzeptanz eines Notfall-Management-Systems unter Etablierung der "First Responder Defibrillation" : Ergebnisse eines 2 Jahres Zeitraums

    OpenAIRE

    Robert, Nils

    2010-01-01

    Problem: Die Letalität nach innerklinischen Reanimationen ist hoch. Daher wurde nach Einführung eines Notfall- Managementsystems unter Etablierung der "First Responder" Defibrillation das Überleben retrospektiv untersucht und die Meinung der Mitarbeiter erfragt. Methode: Aus 2 Jahren wurden 41 Reanimationen untersucht. Eine Mitarbeiterumfrage zum Wissen und der Meinung zum Notfall-Management wurde durchgeführt. Ergebnis: Das Outcome nach Reanimation betrug 30%. 89-100% der Mita...

  7. Renal denervation: Results of a single-center cohort study; Renale Denervation. Ergebnisse einer Single-Center Kohortenstudie

    Energy Technology Data Exchange (ETDEWEB)

    Luetkens, J.A.; Thomas, D.; Doerner, J.; Schild, H.H.; Naehle, C.P. [Bonn Univ. (Germany). Dept. of Radiology; Wilhelm, K. [Johanniter Hospital, Bonn (Germany). Dept. of Radiology; Duesing, R. [Hypertension Center, Bonn (Germany); Woitas, R.P.; Hundt, F. [Bonn Univ. (Germany). Dept. of Internal Medicine I

    2015-01-15

    To investigate the effect of renal denervation on office-based and 24-h ambulatory blood pressure measurements (ABPM) in a highly selective patient population with drug-resistant hypertension. Patients with drug resistant hypertension eligible for renal denervation were included in the study population. Office blood pressure and ABPM were assessed prior to and after renal denervation. To detect procedure related renal or renal artery damage, magnetic resonance imaging (MRI) and angiography (MRA) were performed pre-interventional, one day post-interventional, and one month after renal denervation. Mean follow-up time between renal denervation and blood pressure re-assessment was 9.5 ± 3.9 months. Between August 2011 and March 2013, 17 patients prospectively underwent renal denervation. Pre-interventional mean office blood pressure and ABPM were 177.3 ± 20.3/103.8 ± 20.4 mmHg and 155.2 ± 20.5/93.7 ± 14.5 mmHg, respectively. Post-interventional, office blood pressure was significantly reduced to 144.7 ± 14.9/89.5 ± 12.1 (p < 0.05). ABPM values remained unchanged (147.9 ± 20.3/90.3 ± 15.6, p > 0.05). The number of prescribed antihypertensive drugs was unchanged after renal denervation (4.7 ± 2.0 vs. 4.2 ± 1.2, p = 0.18). No renovascular complications were detected in follow-up MRI. After renal denervation, no significant decrease in ABPM was observed. These results may indicate a limited impact of renal denervation for drug resistant hypertension.

  8. Combustion chambers for wood furnaces with low particle emissions; Brennkammern fuer Holzfeuerstaetten mit geringen Partikelemissionen. Erste Messergebnisse zum Stand der Technik

    Energy Technology Data Exchange (ETDEWEB)

    Gaegauf, Ch.; Sattler, M.

    2007-12-15

    This interim report for the Swiss Federal Office of Energy (SFOE) takes a look at the results of a study made on the particle emissions of wood-burning ovens and furnaces by the Eco-Centre Langenbruck, Switzerland, in co-operation with the North-West Switzerland University of Applied Sciences. The work concentrated on finding innovative ways of reducing the emission of fine dust and aerosols by domestic heating units. Initial analysis has shown that present-day installations exhibit a potential for improvement both when firing-up as well as when in full operation. The measurement and analysis methods used in the tests are described. The results obtained are presented in graphical form and discussed. Measurements made on a storage-oven are presented and the results of extended particle analysis are discussed. Further development of the combustion technologies used in this area is suggested in the report's conclusions.

  9. Sprachlicher Ausbau in gesprochenen und geschriebenen Texten : zum Gebrauch komplexer Nominalphrasen als Merkmale literater Strukturen bei Jugendlichen mit Deutsch als Erst- und Zweitsprache in verschiedenen Schulformen

    OpenAIRE

    Siekmeyer, Anne

    2013-01-01

    Viele Schüler haben Schwierigkeiten, sich im formellen Register, das durch das Schriftliche repräsentiert wird, angemessen auszudrücken. Dies gilt nicht nur für Schüler mit Deutsch als Zweitsprache, denn oft erwerben Seiteneinsteiger, die in einer anderen Sprache literarisiert wurden, die literaten Strukturen des Deutschen recht schnell. Die Grundannahmen, auf denen die vorliegende Arbeit aufbaut, lauten: Die Fähigkeit zur Registerdifferenzierung, die von Erfahrungs- und Bildungsmöglichkeiten...

  10. First experiences of operation in solar process heat generation of the Hofmuehl brewery in Eichstaett; Erste Betriebserfahrungen zur solaren Prozesswaermeerzeugung der Hofmuehlbrauerei in Eichstaett

    Energy Technology Data Exchange (ETDEWEB)

    Wutzler, Mike; Schirmer, Ulrich; Platzer, Bernd [Technische Univ. Chemnitz (Germany). Professur Technische Thermodynamik

    2010-07-01

    The Hofmuehl brewery (Eichstaett, Federal Republic of Germany) is a brewery with a production volume of 80,000 hectoliters per year. The annual primary energy demand for heat generation in the brewing process amounts nearly 2,200 MWh and has been covered by oil. The process control of the beer production shall be adjusted on the supply of solar energy. Under this aspect, the authors of the contribution under consideration report on the early experiences of operation for solar process heat generation of the Hofmuehl brewery. Thus, the solar project shall demonstrate the future use of solar thermal systems in breweries as a pilot project. Furthermore, results that are transferable to other companies and breweries shall be supplied.

  11. Sorption-assisted solar air conditioning system in a factory building in Singapore. First operating experience; Solare sorptionsgestuetzte Klimatisierung eines Fabrikgebaeudes in Singapur. Erste Betriebserfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Hublitz, A.; Laevemann, E. [Bayerisches Zentrum fuer Angewandte Energieforschung e.V. (ZAE Bayern), Garching (Germany). Abt. Technik fuer Energiesysteme und erneuerbare Energien; Pelzer, M. [L-DCS Technology GmbH, Ismaning (Germany)

    2006-07-01

    In the last ten years, ZAE Bayern has been developing an ultra low-flow absorber, which enables efficient energy storage within the liquid desiccant. This technology is commercially available through L-DCS Technology GmbH, founded in 2003. In the current demonstration project L-DCS Technology supplied a liquid desiccant air dehumidification system (11,000 m{sup 3}/h) for a factory unit in Singapore, owned by JTC Corporation. A 550 m{sup 2} flat plate solar collector array drives the desiccant regeneration and 12 m{sup 3} desiccant energy storage covers the difference between the energy need for absorption and the energy supply for regeneration. First operational tests in February 06 showed acceptable absorber performance and energy storage capacity. (orig.)

  12. Energy from biomass: Wood-fuelled sewage sludge drying plant; Energetische Nutzung von Biomasse am Beispiel einer holzbefeuerten Klaerschlammtrocknungsanlage. Planung, Bau und erste Betriebserfahrung

    Energy Technology Data Exchange (ETDEWEB)

    Burgtorf, J. [Saarberg-Oekotechnik GmbH, Saarbruecken (Germany)

    1998-09-01

    A unique concept was developed for the drying plant of Biowaerme-Braeunlingen GmbH (BWB): The heat for drying sewage sludge is generated by a wood chip furnace with staggered grate, and the waste heat from plume condensation is fed into a district heating system supplying a neighbouring commercial and trade center. (orig./SR) [Deutsch] Fuer die Trocknungsanlage der Biowaerme-Braeunlingen GmbH (BWB) wurde ein bisher einmaliges Konzept entwickelt: Die zur Trocknung der kommunalen Klaerschlaemme des Kreises erforderliche Waerme wird durch ein Holzhackschnitzelheizwerk mit Treppenrostfeuerung erzeugt und die bei der Kondensation der Brueden anfallende Abwaerme wird in einem Fernwaermenetz zur Versorgung des umliegenden Gewerbegebietes genutzt. (orig./SR)

  13. The first test results of the new MAN 6 MW gas turbine; Erste Erprobungsergebnisse zur neuen 6-MW-MAN-Gasturbine

    Energy Technology Data Exchange (ETDEWEB)

    Beukenberg, Markus; Wiedermann, Alexander; Orth, Ulrich; Aschenbruck, Emil; Reiss, Frank [MAN Diesel und Turbo SE, Oberhausen (Germany)

    2011-07-01

    The development of a completely new series of gas turbines requires significant capital, resources and know-how. MAN Diesel and Turbo strategically decided to create a gas turbine in the 6 MW class. The construction of the gas turbine has been on the basis of opportunities in current and future markets and the positioning of competition, this has determined the characteristics and technical parameters which have been optimised in the 6 MW design. (orig.)

  14. Combustion of high-rank light fraction. First experiences with GAVI/VAM; Verbrennung von heizwertreicher Leichtfraktion. Erste Erfahrungen aus der GAVI-VAM (Wijster)

    Energy Technology Data Exchange (ETDEWEB)

    Wandschneider, J. [Goepfert, Reimer und Partner Ingenieurgesellschaft mbH, Hamburg (Germany)

    1998-09-01

    GAVI/VAM consists of a sorting plant which is topped by an RDF combustion plant. These two plant components are directly linked with each other via an RDF bunker (24 h). The present contribution addresses the main components of the combustion plant individually and points out its special features as compared with crude waste combustion. [Deutsch] Die GAVI/VAM besteht aus einer Sortieranlage mit nachgeschalteter RDF-Verbrennungsanlage, beide Anlagenteile sind durch einen RDF-Bunker (24 h) unmittelbar miteinander verbunden. Nachfolgend werden die wesentlichen Komponenten der Verbrennungsanlage einzeln angesprochen und die Besonderheiten im Vergleich zur Rohmuellverbrennung dargestellt. (orig./SR)

  15. First examination of CASCADE-X-ray-detector and measurement of neutron-mirrorneutron-oscillation; Erste Untersuchungen zum CASCADE-Roentgendetektor und Messung zur Neutron-Spiegelneutron-Oszillation

    Energy Technology Data Exchange (ETDEWEB)

    Boehm, B.

    2007-02-07

    The detection of X-radiation is of utmost importance for both fundamental physics and medical diagnostics. This work investigates whether or not the CASCADE detector working principle, first developed for the detection of neutrons, can be adapted for the detection of X-rays. This modular detector concept combines the use of a solid neutron or X-ray converter with the advantages of a counting gas detector. Thus, it gives the possibility to optimize efficiency, dynamics and spatial resolution independently. Firstly, it is necessary to find a suitable converter material that allows for the best possible detector efficiency. In order to do so, a mathematical model of the complete detector system was developed that yields the total efficiency for any given material. Respecting technical constraints, gold and gadolinium showed to be favorable choices. Based on these theoretical considerations a prototype of a CASCADE X-ray detector was built, and measurements for the determination of this detector's efficiency were conducted. In the second part of this work a CASCADE neutron detector was used to conduct the first measurement the neutron-mirrorneutron oscillation time. Mirrormatter was proposed in 1956 by Lee and Yang to allow for symmetry in the description of the universe despite the existence of parity violation. By using neutrons it was possible to determine a lower limit for the oscillation time in this work. (orig.)

  16. MRI in patients with pacemakers? First global consensus recommendations from radiologists and cardiologists; Mit Schrittmacher ins MRT? Weltweit erste konsentierte Handlungsempfehlung von Radiologen und Kardiologen

    Energy Technology Data Exchange (ETDEWEB)

    Heindel, Walter; Kugel, Harald [University Hospital Muenster (Germany). Dept. of Clinical Radiology

    2017-03-15

    Under the title ''MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators'', this issue of Roefo - simultaneously with the journal of the German Cardiac Society ''Der Kardiologe'' - presents a consensus paper of the German Roentgen Society and the German Cardiac Society [1] [2] that was jointly written by the authors in radiology and cardiology but does not exclusively address cardiac MRI. This publication relates to MR imaging of all regions of the body. In Germany and internationally the number of MRI examinations is increasing: 1,008,944 examinations were performed on patients receiving inpatient treatment in 2005 while 1,767,005 examinations were performed in 2013 (DRG hospitals). This development can be attributed to our aging population as well as to new indications for MRI including: Analyses of tissue composition and function, for example in the liver [3] [4] and the heart [5] [6]; multiparametric analyses of MR perfusion, e.g. in treated brain tumors [7]; new organs such as the lung [8]; dedicated examinations for intervention planning and operation monitoring [9] [10] [11]; as well as MRI-guided interventions [12] [13] [14] [15] [16]. Implants must always be considered in all of these MRI examinations even if the reason for the examination request is not related to an implant. The involvement of cardiology in this case is not based on the medical issue but rather on the type of implant. Expertise in cardiology is required when dealing with cardiac pacemakers (PM) and implantable cardioverter defibrillators (ICD).

  17. Umbrella-type borehole heat exchangers with a high heat transfer - first practical experience; Regenschirmerdwaermesonde mit hohem Waermeuebergang - Erste Erfahrungen aus der Praxis

    Energy Technology Data Exchange (ETDEWEB)

    Kapp, C. [NEK Umwelttechnik AG, Zuerich (Switzerland)

    1997-12-01

    A building at Zumikon (near Zurich) was redeveloped using novel borehole heat exchangers. The so-called `umbrella` borehole heat exchangers are connected to a brine-to-water heat pump operated with ammonia as a refrigerant. The new type of unit performs distinctly better than the usual double-U borehole heat exchangers, as has been verified by measurements. (orig.) [Deutsch] Fuer eine Gebaeudesanierung in Zumikon (Umgebung von Zuerich) wurden neuartige Erdwaermesonden verwendet. Die sogenannten `Regenschirmerdwaermesonden` sind mit einer Sole-Wasser-Waermepumpe verbunden, welche mit dem Kaeltemittel Ammoniak betrieben wird. Die bislang durchgefuehrten Messungen an der Anlage zeigen, dass dank der neuen Sondentechnik im Vergleich zu herkoemmlichen Doppel-U-Sonden deutlich hoehere Leistungen erzielt werden. (orig.)

  18. Operating experience with factory-made air-insulated 1AC/2AC switchgear systems; Erste Betriebserfahrungen mit fabrikgefertigten, luftisolierten 1AC-/2AC-Schaltanlagen

    Energy Technology Data Exchange (ETDEWEB)

    Northe, J. [Balfour Beatty Rail GmbH, Offenbach (Germany); Loenard, D. [Bombardier Transportation GmbH, Mannheim (Germany)

    2007-07-01

    Today, factory-made air-insulated switchgear systems of the type TracFeed {sup registered} are available for all supply versions of 16.7 Hz and 50 Hz a.c. railways. These are supported by auxiliary equipment to ensure reliable railway operation through specific protective functions and a simplified line test. (orig.)

  19. First experiences with apartment buildings built in monolithic construction to Passivhaus standard; Erste Erfahrungen mit Mehrfamilien-Passivhaeusern in monolithischer Bauweise

    Energy Technology Data Exchange (ETDEWEB)

    Messari-Becker, Lamia; Bollinger, Klaus; Grohmann, Manfred [Bollinger + Grohmann Ingenieure GmbH, Frankfurt am Main (Germany)

    2011-02-15

    For the first time, apartment buildings are being built in monolithic construction that meet the most exacting requirements regarding energy efficiency and sustainability. These buildings are under construction in the northern district of Kalbach Sued in Frankfurt (Main) by ABG Frankfurt Holding. The architectural design was produced by Scheffler and Partners, the Frankfurt structural engineers Bollinger + Grohmann undertook the structural design including building physics and energy related aspects, and Baumgartner Engineers took charge of M and E design. These apartment buildings are the first monolithically constructed apartment buildings built to Passivhaus standard. They therefore represent a milestone in single-skin monolithic construction in connection with an exacting energy standard. The challenge for architects and engineers was to consider a range of different aspects and accommodate them in the design. In addition to given parameters such as the urban development plan, client requirements such as the number of apartments, aspects of family living and barrier-free standards, the briefing called for the highest construction standard in terms of efficient use of resources in the widest sense. This meant that the emphasis was not only on energy efficiency. Cost efficiency throughout the entire lifecycle of the building was equally as important in order to ensure long term economic sustainability for users and owners. The experience gained on this project will also provide answers to important questions regarding research and development in sustainable building, which is not in any conflict with the creativity and diversity of our architectural culture. (Copyright copyright 2011 Ernst and Sohn Verlag fuer Architektur und technische Wissenschaften GmbH and Co. KG, Berlin)

  20. Imaging of cerebral flow dynamics via MR angiography and selective presaturation: Initial experiences. Darstellung zerebraler Flussdynamik mit MR-Angiographie und selektiver Vorsaettigung: Erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Wallner, B.; Weidenmaier, W.; Vogel, J.; Bargon, G. (Ulm Univ. (Germany). Abt. fuer Roentgendiagnostik)

    1991-11-01

    MR angiography with selective presaturation was applied in 5 normal volunteers, 22 patients with cerebrovascular disease, 3 patients with arteriovenous malformations (AVM) and one patient with thrombosis of the superior sagittal sinus. The results were compared with Doppler ultrasound and conventional angiography. MR angiography reliably demonstrated the direction of blood flow and the presence or absence of collateral flow on the circle of Willis. Collateral flow via leptomeningeal vessels and the ophthalmic artery could not be demonstrated. In the patient with superior sagittal sinus thrombosis, the absence of flow was well seen. MR angiography was able to demonstrate the major supplying arteries in the patients with AVMs. MR angiography is a valid noninvasive means to demonstrate direction of flow and blood supply of the major intracranial arteries. (orig.).

  1. MR myelography of the lumbar spine with a PSIF sequence: First experiences. MR-Myelographie der Lendenwirbelsaeule mit einer PSIF-Sequenz: Erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Schnarkowski, P.; Wallner, B.; Goldmann, A.; Friedrich, J.M. (Abt. fuer Roentgendiagnostik, Klinikum der Univ. Ulm (Germany))

    1993-01-01

    A rapid gradient-echo acquisition (PSIF) was used to delineate the lumber spine. Because this sequence is heavily T[sub 2] weighted the cerebrospinal fluid shows a bright signal, the myelon has a poor signal. 5 healthy voluteers and 5 patients with suspected lumbar disc herniation were examined by this technique. All MR myelograms were compared with spin-echo sequences (sagittal and transversal slices). All lumbar disc herniations which were recognized by MRI were also delineated by MR myelography. (orig.).

  2. Evaluation of a novel Seldinger-needle for computed tomography guided interventions: initial experiences; Evaluierung einer neuen Seldinger-Nadel fuer computertomografisch gesteuerte Interventionen: Erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Plumhans, C.; Mahnken, A.; Iwa, R.; Behrendt, F.F.; Sebastian, K.; Guenther, R.W.; Honnef, D. [Universitaetsklinikum RWTH Aachen (Germany). Klinik fuer Radiologische Diagnostik

    2009-02-15

    To evaluate a new Seldinger puncture device for computed tomography-guided interventions under difficult conditions, to analyze applicability, and to investigate assets and drawbacks. From November 2007 to March 2008, we performed CT-guided interventions in 16 patients (7 women, 9 men; mean age 62 years old) using a new 20G-Seldinger needle (Sika-Med, Wiehl, Germany). This novel needle serves as a guide for many different interventional devices due to a guide wire welded on the proximal needle end. It allows continuous application of anesthesia via four tiny holes at the distal needle end until the region of interest is reached. Each intervention was subject to difficult interventional conditions. The indications for intervention were drainage (n = 7), Trucut biopsy of tumor (n = 8) and radiofrequency ablation (n = 1). Handling, success, advantages, drawbacks, complications and patient tolerance were noted after each procedure. A pain scale from 1 - 10 was used to grade the pain level during the intervention. All interventions were performed successfully and no severe complications were observed. Patient tolerance was very good resulting in a mean pain score of 2 {+-} 1. Regions with dangerous and difficult access were successfully reached with the new Seldinger needle in 15 of 16 cases by dilatation of the puncture tract and continuous administration of local anesthesia via the system. Furthermore, different devices such as Trucut systems and a drainage catheter were able to be inserted without complication via the needle. With a proximal removable luer-lock connection, liquid material was able to be aspirated in six cases. Under difficult interventional conditions, the use of a Seldinger needle as a reliable technique for CT-guided interventions can provide a safe and successful procedure. (orig.)

  3. Problem-orientiertes Lernen im virtuellen Raum: Erste Erfahrungen in der Nuklearmedizin [An approach towards problem-based learning in virtual space

    Directory of Open Access Journals (Sweden)

    Freudenberg, Lutz S.

    2010-11-01

    Full Text Available [english] Problem-based learning (PBL is an established and efficient approach to sustainable teaching. Here, we describe translation of PBL into the virtual classroom thereby offering novel teaching aspects in the field of Nuclear Medicine. Our teaching approach is implemented on a "moodle" platform and consists of 2 modules: complementary seminar teaching materials and a virtual PBL-classroom, which can be attended via Skype.Over the course of 4 semesters 539 students have accessed our teaching platform. 21 students have participated in the PBL seminar (module 2. After resolving some minor technical difficulties our virtual seminars have evolved into a forum of intense studies, whereby the participating students have learned to become more independent along the workup of the teaching cases. This was reflected in the results of the intra-group presentations and discussions.Quantitative and qualitative evaluation of our moodle-based PBL platform indicates an increasing level of acceptance and enthusiasm by the students. This has initiated discussions about opening our PBL concept to a wider audience within the university and beyond the Nuclear Medicine specialty.[german] Problem-orientiertes Lernen (POL ist eine etablierte und effiziente Methode zur nachhaltigen Lehre. In dem beschriebenen Projekt wurde der Versuch unternommen, das POL-Konzept in den virtuellen Raum zu übertragen, um die Lehre in der Nuklearmedizin zu ergänzen und motivierte Studierende für das Fach zu interessieren. Das Lehrprojekt auf Basis der Lehrplattform „moodle“ besteht aus zwei Teilen: Seminar-begleitende Seiten zur Nachbereitung der Vorlesung und ein virtueller POL-Bereich, in dem über eine Internet-basierte Telefonkonferenz POL-Fälle bearbeitet werden können. Insgesamt haben in vier Semestern 539 Studierende auf die Lehrplattform zugegriffen, von denen 21 an einem POL-Seminar teilgenommen haben. Nach anfänglichen – teils technischen – Schwierigkeiten, entwickelten sich die Seminare zu einem sehr intensiven Forum, in dem die Studierenden zunehmend mehr Selbstständigkeit entwickelten. Dies widerspiegelte sich auch im Ergebnis der Ausarbeitungen und der anschließenden Diskussion, die jeweils auf einem sehr hohen Niveau angesiedelt waren. Die quantitative und qualitative Evaluation spricht für eine hohe Akzeptanz der Lehrveranstaltung von Seiten der Studierenden, und ermutigt uns dazu, das Konzept weiter auszubauen und in einem größeren intra-universitären Rahmen anzubieten.

  4. S 400 BlueHYBRID. First hybrid vehicle with Li-ion technology; S 400 BlueHYBRID. Erstes Hybridfahrzeug mit Li-Ionen-Technologie

    Energy Technology Data Exchange (ETDEWEB)

    Vollrath, Oliver; Armstrong, Neil; Schenk, Juergen; Bitsche, Otmar; Lamm, Arnold [Daimler AG, Stuttgart (Germany)

    2009-07-01

    Mercedes Benz advances the electrification of the drive strand in all performance classes and in all models from the start-stop system till to the full hybrid. Thereby, the S 400 BlueHYBRID presents the first Mercedes-Benz hybrid. Equipped with the characteristics of a start-stop system, with a recovery of the brake energy and with an electrical support of the drive, this hybrid obtains a saving of the consumption of approximately 20 %. By means of the design of the components and by means of the selection of a standard installation size, all hybrid-specific construction units in the vehicle porch could be arranged. Here, a special role comes to the used battery technology, since it became possible to arrange the hybrid battery in the size and the building area of a conventional starter battery accordingly.

  5. The underground heat storage for solar-assisted district heating in Neckarsulm. First measuring results; Der Erdsonden-Waermespeicher fuer die solarunterstuetzte Nahwaermeversorgung in Neckarsulm. Erste Messergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Seiwald, H.; Hahne, E. [Stuttgart Univ. (Germany). Inst. fuer Thermodynamik und Waermetechnik

    1998-12-31

    A solar-assisted district heating system with seasonal underground heat storage is currently under construction in Neckarsulm (Baden-Wurttemberg). In the new residential area approximately 1,300 flats are going to be built during the next years. The overall energy demand (hot water and space heating) is supposed to be covered by 50% with solar energy. During the first phase the project will be subsidised in the frame of the BMBF programme `Solarthermie 2000, Teilprogramm III`. A solar plant consisting of 2,700 square metres of collectors, a buffer tank (100 cubic metre) and an underground heat storage with a volume of approx. 20,000 cubic metres will be constructed by the end of 1998. It will be the first plant in Germany where thermal energy generated of solar energy is stored at high temperatures (up to 80 C) directly in the earth and utilised without a heat pump. (orig.) [Deutsch] In Neckarsulm (Baden-Wuerttemberg) befindet sich derzeit eine solar unterstuetzte Nahwaermeversorgung mit saisonalem Endsonden-Waermespeicher im Aufbau. Im Neubaugebiet Amorbach werden in den naechsten Jahren rund 1300 Wohneinheiten entstehen, deren Gesamtwaermebedarf (Warmwasser und Raumheizung) zu rund 50% mit Sonnenenergie gedeckt werden soll. In der ersten Phase wird das Projekt im Rahmen des BMBF-Programms `Solarthermie 2000, Teilprogramm III` gefoerdert. Bis Ende 1998 wird eine Solaranlage bestehend aus 2.700 m{sup 2} Kollektoren, einem Pufferspeicher (100 m{sup 3}) und einem Endsonden-Waermespeicher mit einem Volumen von ca. 20.000 m{sup 3} erstellt. Damit wird in Deutschland erstmalig eine Anlage realisiert, bei der solar erzeugte Waerme auf hohem Temperaturniveau (bis zu 80 C) direkt im Erdreich gespeichert und ohne Waermepumpe genutzt werden soll. (orig.)

  6. Creative ideas. A competition gave two students of architecture new ideas about ecology; Initialzuendung. Erst durch einen Wettbewerb kamen zwei Nachwuchsarchitekten mit der Oekologie in Beruehrung

    Energy Technology Data Exchange (ETDEWEB)

    Krause, Matthias B.

    2011-10-15

    In the German/Dutch industrial area of Avantis, a model project showing energy-efficient building construction and sustainable housing is currently under construction (''Stadtviertel der Zukunft''). The first building commissioned in September 2011 was a zero-energy house with solar cell arrays. The incorporation of PV and solar thermal energy was new to the students that designed the house.

  7. Anbindung der Detektorkontrolle des ATLAS-Pixeldetektors an das Datennahmesystem und die Conditions-Datenbank sowie erste Studien zur Rekonstruktion von K0s Zerfällen

    CERN Document Server

    Imhäuser, Martin

    Im Jahr 2007 wird am europäischen Kernforschungszentrum CERN mit dem LHC der bislang leistungsfähigste Speicherring der Welt mitsamt vier Großexperimenten seinen Betrieb aufnehmen. Das ATLAS-Experiment wird mit einem Universaldetektor eines dieser Experimente sein.