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Burkhardt W.,TU Dresden | Kraft S.,Klinikum Mutterhaus der Borromaerinnen | Ochs M.,Hannover Medical School | Proquitte H.,Charite - Medical University of Berlin | And 2 more authors.
PLoS ONE | Year: 2012

Purpose: Exogenous surfactant is not very effective in adults with ARDS, since surfactant does not reach atelectatic alveoli. Perfluorocarbons (PFC) can recruit atelectatic areas but do not replace impaired endogenous surfactant. A surfactant-PFC-mixture could combine benefits of both therapies. The aim of the proof-of-principal-study was to produce a PFC-in-surfactant emulsion (Persurf) and to test in surfactant depleted Wistar rats whether Persurf achieves I.) a more homogenous pulmonary distribution and II.) a more homogenous recruitment of alveoli when compared with surfactant or PFC alone. Methods: Three different PFC were mixed with surfactant and phospholipid concentration in the emulsion was measured. After surfactant depletion, animals either received 30 ml/kg of PF5080, 100 mg/kg of stained (green dye) Curosurf™ or 30 ml/kg of Persurf. Lungs were fixated after 1 hour of ventilation and alveolar aeration and surfactant distribution was estimated by a stereological approach. Results: Persurf contained 3 mg/ml phospholipids and was stable for more than 48 hours. Persurf-administration improved oxygenation. Histological evaluation revealed a more homogenous surfactant distribution and alveolar inflation when compared with surfactant treated animals. Conclusions: In surfactant depleted rats administration of PFC-in-surfactant emulsion leads to a more homogenous distribution and aeration of the lung than surfactant alone. © 2012 Burkhardt et al.

Murawski N.,Medical School Hamburg | Held G.,Medical School Hamburg | Ziepert M.,University of Leipzig | Kempf B.,Klinikum Landshut | And 9 more authors.
Blood | Year: 2014

To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma, we analyzed 11 consecutive German High-Grade Non-Hodgkin Lymphoma Study Group trials. ECFI occurred in 290/4155 (7.0%) patients (orbita, 31; paranasal sinuses, 93; main nasal cavity, 38; tongue, 27; remaining oral cavity, 99; salivary glands, 54). In a multivariable analysis adjusted for International Prognostic Index rituximab improved event-free and overall survival both in patients with and without ECFI. Three-year event-free (79% vs 79%; P = .842) and overall survival (86% vs 88%; P = .351) rates were similar in 145 patients receiving and 57 not receiving radiotherapy. Without rituximab, the 2-year cumulative rate of central nervous system (CNS) disease was increased in 205 ECFI patients compared with 2586 non-ECFI patients (4.2% vs 2.8%; P = .038), whereas this was not observed with rituximab (1.6% in 83 ECFI vs 3.4% in 1252 non-E CFI patients; P = .682). In 88 ECFI patients who received intrathecal prophylaxis with methotrexate, the 2-year rate of CNS disease was 4.2% compared with 2.3% in 191 patientswho did not ( P = .981). In conclusion, rituximab eliminates the increased risk for CNS disease in patients with E CFI. This retrospective analysis does not support intrathecal prophylaxis or radiotherapy to ECFI patients in complete remission/unconfirmed complete remission. These findings should be confirmed in a prospective study. © 2014 by The American Society of Hematology.

Bartsch O.,Johannes Gutenberg University Mainz | Schindler D.,University of Wurzburg | Beyer V.,Johannes Gutenberg University Mainz | Gesk S.,University of Kiel | And 7 more authors.
European Journal of Medical Genetics | Year: 2012

A 9-year-old girl born to healthy parents showed manifestations suggestive of ataxia telangiectasia (AT), such as short stature, sudden short bouts of horizontal and rotary nystagmus, a weak and dysarthric voice, rolling gait, unstable posture, and atactic movements. She did not show several cardinal features typical of AT such as frequent, severe infections of the respiratory tract. In contrast, she showed symptoms not generally related to AT, including microcephaly, profound motor and mental retardation, small hands and feet, severely and progressively reduced muscle tone with slackly protruding abdomen and undue drooling, excess fat on her upper arms, and severe oligoarthritis. A cranial MRI showed no cerebellar hypoplasia and other abnormalities. In peripheral blood samples she carried a de novo duplication of 3.14. Mb in chromosomal region 19q12 containing six annotated genes, UQCRFS1, VSTM2B, POP4, PLEKHF1, CCNE1, and ZNF536, and a de novo mosaic inversion 14q11q32 (96% of metaphases). In a saliva-derived DNA sample only the duplication in 19q12 was detected, suggesting that the rearrangements in blood lymphocytes were acquired. These findings reinforced the suspicion that she had AT. AT was confirmed by strongly elevated serum AFP levels, cellular radiosensitivity and two inherited mutations in the ATM gene (c.510_511delGT; paternal origin and c.2922-50_2940del69; maternal origin). This case suggest that a defective ATM-dependent DNA damage response may entail additional stochastic genomic rearrangements. Screening for genomic rearrangements appears indicated in patients suspected of defective DNA damage responses. © 2011 Elsevier Masson SAS.

Furderer S.,Klinikum Mutterhaus der Borromaerinnen | Scholten N.,University of Cologne | Coenen O.,University of Cologne | Koebke J.,University of Cologne | Eysel P.,University of Cologne
Journal of Spinal Disorders and Techniques | Year: 2011

Summary Of Background Data: Dvorak et al in 1993 and Husted et al in 2003 reported 2 different screw fixation techniques at the thoracic spine as alternatives to transpedicular screws. So far, there is no investigation comparing the pullout stability of all 3 possible screw fixation techniques. Objective: To evaluate the stability of possible alternatives for transpedicular screw fixation. Study Design: A biomechanical human cadaver investigation of the transpedicular and 2 different extrapedicular techniques was performed in the form of a comparative pullout test. Materials And Methods: Eighteen human vertebral bodies from Th7 to Th9 were harvested from 6 donors, dissected from surrounding tissue, and matched to 3 different fixation groups. As alternatives for transpedicular screw fixation, an extrapedicular supratransverse screw insertion from posterolateral and a tricortical screw fixation technique, penetrating the transverse process and reentering the vertebral body at the pedicle base were evaluated biomechanically. A unilateral screw fixation was performed in one of the described techniques. Axial pullout strength was measured using a Zwick Z50 servoelectric testing machine. Results: The average pullout strength of the pedicle screws was 400 N, whereas the supratransverse and the pertransverse screw fixation resisted 370 N pullout force on average. There was neither a statistic significant difference between the pullout forces of the 3 groups nor a significant correlation of pullout strength and bone mineral density measured by quantitative computed tomography. Conclusions: In-vitro pullout resistance of thoracic screw fixation does not differ significantly in intrapedicular and extrapedicular insertion techniques. Copyright © 2011 by Lippincott Williams & Wilkins.

Turial S.,University Hospital Freiburg | Enders J.,University Hospital Freiburg | Schier F.,University Hospital Freiburg | Santos M.,Klinikum Mutterhaus der Borromaerinnen
Journal of Gastrointestinal Surgery | Year: 2011

Introduction: The aim of this retrospective comparative study was to compare the surgical results and outcomes of the newly inaugurated approach of microlaparoscopic pyloromyotomy with open techniques. Methods: The surgical charts of 110 infants (85 boys and 25 girls, ages ranging from 10 to 98 (average 28) days) undergoing pyloromyotomy microlaparoscopically (28), through the circumbilical approach (56), or via the right upper quadrant access (26) were reviewed. The variables were compared between the three surgical approach groups, and the statistical analysis was performed. Results: There was a significant difference between Bianchi and microlaparoscopy in terms of operation time (average 38.5 vs. 20.5 min, p < 0.0001) and time to full enteral feed (average 48 vs. 32 h, p = 0.001). There was no significant difference in postoperative length of stay (75 vs. 82 h, p = 0.12). The operative time for the surgeons experienced in microlaparoscopy was in average of 14 min (range, from 9 to 18 min). When comparing the Weber-Ramstedt procedure and microlaparoscopy, microlaparoscopy required significantly less operative time (50 vs. 20 min, p < 0.0001), a shorter time to full enteral feed (70 vs. 32 h, p < 0.001), and a shorter postoperative length of stay (90 vs. 82 h, p = 0.04). There were no cases of mucosal perforation or incomplete pyloromyotomy. Conclusion: Despite the small sample size included in the present study, it seems that microlaparoscopic pyloromyotomy is safe and feasible with the lowest rate of complications and the shortest operative time. The Bianchi approach is a good alternative to achieve a small scar without laparoscopy. © 2011 The Society for Surgery of the Alimentary Tract.

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