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1.
Int J Mol Sci ; 21(19)2020 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-32993057

RESUMEN

BACKGROUND: Cold atmospheric plasma (CAP) is increasingly used in the field of oncology. Many of the mechanisms of action of CAP, such as inhibiting proliferation, DNA breakage, or the destruction of cell membrane integrity, have been investigated in many different types of tumors. In this regard, data are available from both in vivo and in vitro studies. Not only the direct treatment of a tumor but also the influence on its blood supply play a decisive role in the success of the therapy and the patient's further prognosis. Whether the CAP influences this process is unknown, and the first indications in this regard are addressed in this study. METHODS: Two different devices, kINPen and MiniJet, were used as CAP sources. Human endothelial cell line HDMEC were treated directly and indirectly with CAP, and growth kinetics were performed. To indicate apoptotic processes, caspase-3/7 assay and TUNEL assay were used. The influence of CAP on cellular metabolism was examined using the MTT and glucose assay. After CAP exposure, tube formation assay was performed to examine the capillary tube formation abilities of HDMEC and their migration was messured in separate assays. To investigate in a possible mutagenic effect of CAP treatment, a hypoxanthine-guanine-phosphoribosyl-transferase assay with non malignant cell (CCL-93) line was performed. RESULTS: The direct CAP treatment of the HDMEC showed a robust growth-inhibiting effect, but the indirect one did not. The MMT assay showed an apparent reduction in cell metabolism in the first 24 h after CAP treatment, which appeared to normalize 48 h and 72 h after CAP application. These results were also confirmed by the glucose assay. The caspase 3/7 assay and TUNEL assay showed a significant increase in apoptotic processes in the HDMEC after CAP treatment. These results were independent of the CAP device. Both the migration and tube formation of HDMEC were significant inhibited after CAP-treatment. No malignant effects could be demonstrated by the CAP treatment on a non-malignant cell line.


Asunto(s)
Inhibidores de la Angiogénesis/farmacología , Movimiento Celular/efectos de los fármacos , Células Endoteliales/efectos de los fármacos , Neovascularización Fisiológica/efectos de los fármacos , Gases em Plasma/farmacología , Apoptosis/efectos de los fármacos , Línea Celular , Proliferación Celular/efectos de los fármacos , Células Endoteliales/citología , Células Endoteliales/metabolismo , Humanos , Neovascularización Patológica/tratamiento farmacológico , Neovascularización Patológica/metabolismo
2.
Int J Mol Sci ; 21(12)2020 Jun 23.
Artículo en Inglés | MEDLINE | ID: mdl-32585948

RESUMEN

Osteosarcoma and Ewing's sarcoma are the most common malignant bone tumors. Conventional therapies such as polychemotherapy, local surgery, and radiotherapy improve the clinical outcome for patients. However, they are accompanied by acute and chronic side effects that affect the quality of life of patients, motivating novel research lines on therapeutic options for the treatment of sarcomas. Previous experimental work with physical plasma operated at body temperature (cold atmospheric plasma, CAP) demonstrated anti-oncogenic effects on different cancer cell types. This study investigated the anti-cancer effect of CAP on two bone sarcoma entities, osteosarcoma and Ewing's sarcoma, which were represented by four cell lines (U2-OS, MNNG/HOS, A673, and RD-ES). A time-dependent anti-proliferative effect of CAP on all cell lines was observed. CAP-induced alterations in cell membrane functionality were detected by performing a fluorescein diacetate (FDA) release assay and an ATP release assay. Additionally, modifications of the cell membrane and modifications in the actin cytoskeleton composition were examined using fluorescence microscopy monitoring dextran-uptake assay and G-/F-actin distribution. Furthermore, the CAP-induced induction of apoptosis was determined by TUNEL and active caspases assays. The observations suggest that a single CAP treatment of bone sarcoma cells may have significant anti-oncogenic effects and thus may be a promising extension to existing applications.


Asunto(s)
Neoplasias Óseas/tratamiento farmacológico , Osteosarcoma/tratamiento farmacológico , Gases em Plasma/farmacología , Sarcoma de Ewing/tratamiento farmacológico , Apoptosis , Neoplasias Óseas/patología , Proliferación Celular , Humanos , Osteosarcoma/patología , Sarcoma de Ewing/patología , Células Tumorales Cultivadas
3.
Acta Orthop ; 91(1): 53-57, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31735107

RESUMEN

Background and purpose - The neck-shaft angle (NSA) is valuable for diagnostics and therapy of the hip, but current reference values derive mostly from studies on anatomic specimens, small cohorts, or are hospital-based. Moreover, associated factors such as age, sex, or anthropometric data have rarely been considered. Therefore, we determined associated factors for NSA and reassessed the historical reference values in a general adult population.Methods - NSAs on both sides of 3,226 volunteers from the population-based Study of Health in Pomerania (SHIP) were measured with MRI. SHIP drew a representative sample of the population of Pomerania (northeastern Germany). NSAs were compared with sex, age, and anthropometric data by bivariable linear regression models. Reference values were assessed by quantile regressions for 2.5th and 97.5th percentiles.Results - The mean NSA was 127° (SD 7), while men had a lower NSA than women (95% confidence interval [CI] 0.4°-1.4°). The reference range was 114°-140°. Age was inversely associated with NSA (CI -0.2 to -0.1). Body height was positively associated with the NSA, while BMI and waist circumference showed a negative association. There was no association between body weight and NSA.Interpretation - The historical lower limit of 120° might be too high, so the radiological prevalence of hip pathology might have been overestimated. The previously reported influence of age, sex, and body height on the NSA has been confirmed.


Asunto(s)
Cabeza Femoral/diagnóstico por imagen , Cuello Femoral/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Cabeza Femoral/anatomía & histología , Cuello Femoral/anatomía & histología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valores de Referencia , Adulto Joven
4.
Hautarzt ; 70(6): 422-431, 2019 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-31134288

RESUMEN

BACKGROUND: The microbiome, collective microbial life in defined areas of the body, is of great importance. OBJECTIVE: What is the significance of the wound microbiome in the treatment of chronic wounds? Which interactions exist with other microbiomes and which conclusions can be drawn for wound management? MATERIALS AND METHODS: Swabs or debridement samples from wounds were analysed for microbial growth by culture or gene-based techniques. The genetic results are used to determine the wound microbiome. The pathogens were evaluated according to proportion of different species and related to different factors like type and location of wound, disease and underlying illnesses and to define the wound microbiome. RESULTS: In comparison with conventional microbiological detection methods the wound microbiome comprises many more types and quantities of species. The wound microbiome is related to skin microbiome showing complex and time-dependent composition, as well as inter- and intraindividual differences. Diabetic wounds exhibit disease-related changes, e.g. staphylococcal species dominate whereas streptococcal species dominate in nondiabetic wounds. CONCLUSIONS: The analysis of wound microbiome is still at an early stage; however it has already been shown that in hemodynamic disorders there are disease-specific relationships with the wound microbiome, which can also provide clues about the course of the disease. Phenomena from the skin microbiome should also be effective in wounds. In this context modern antimicrobial treatment options beyond conventional chemotherapy like colonization modulation become possible.


Asunto(s)
Antiinfecciosos/uso terapéutico , Microbiota/efectos de los fármacos , Piel/microbiología , Cicatrización de Heridas/efectos de los fármacos , Antibacterianos/uso terapéutico , Desbridamiento , Humanos , Microbiota/genética , Cicatrización de Heridas/genética
5.
Clin Orthop Relat Res ; 476(11): 2249-2259, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30024461

RESUMEN

BACKGROUND: The available evidence regarding normal ranges for the center-edge angle and the alpha angle derives from a few small studies, and associated factors such as sex and anthropometric factors have not been well evaluated. Knowing more about normal values for these parameters is critical, because this can inform decisions about when to perform elective hip preservation surgery. Population-level studies would provide considerable clarity on these issues, but to our knowledge, no such studies are available. QUESTIONS/PURPOSES: The purposes of this study were (1) to use MRI in patients of a population-based study to establish normal values for the alpha and center-edge angles in the normal adult hip; and (2) to determine whether age, sex, or anthropometric variables were associated with differences in these values. METHODS: We used MRI images (1.5 T) of 3226 participants of the Study of Health in Pomerania (SHIP). SHIP is a population-based study that started with 4308 participants in 1997. Participants were recruited randomly from official inhabitant data files as a stratified cluster sample of the population from a defined region in northeastern Germany. To ensure a representative epidemiologic cohort, stratification variables were sex, age, and city of residence. Between 2008 and 2012, 1094 of these participants underwent whole-body MRI with pelvic sequences in the second followup. In parallel, the next cohort, SHIP-Trend, started with the same protocol in which 2132 participants underwent MRI examination. Reference values were calculated by quantile regressions for the 2.5 and 97.5 percentiles. Associations with the demographic features sex, age, weight, height, body mass index (BMI), and waist circumference were analyzed by bivariate linear regression models. RESULTS: The mean center-edge angle was 31° (± 7°) with a corresponding calculated normal range of 17° to 45°. The mean alpha angle was 55° (± 8°) with a corresponding calculated normal range between 39° and 71°. Men (30° ± 7°) had a lower center-edge angle than women (32° ± 8°) (p < 0.001, ß = 1.4°; 95% confidence interval [CI], 0.9°-1.9°) and a higher alpha angle (57° ± 8° versus 52° ± 7°, p < 0.001, ß = 5.7°; 95% CI, 5.2°-6.3°). Moreover, a higher center-edge angle for the left side was found (33° ± 8° versus 30° ± 8°, p < 0.001, ß =3.2°; 95% CI, 3.0°-3.4°). In addition to sex, we found that age, height, waist circumference, and BMI affected both center-edge angle and alpha angle. Weight was associated with the alpha angle as well. Because of these associations, age- and sex-adjusted reference values with belonging formulas were calculated. CONCLUSIONS: The range of normal center-edge and alpha angles is quite wide. Therefore, only markedly abnormal angles may be associated with pathology. Moreover, center-edge angle and alpha angle are associated with age, sex, and anthropometric factors, which have to be taken into account for better interpretation. CLINICAL RELEVANCE: The association of abnormal radiographic values with true clinical hip pathology is tenuous at best. Assuming that a patient with an abnormal radiograph requires treatment is unwise. The clinical picture has to be substantial for therapeutic decisions.


Asunto(s)
Puntos Anatómicos de Referencia , Articulación de la Cadera/diagnóstico por imagen , Imagen por Resonancia Magnética/normas , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Valores de Referencia , Factores Sexuales , Adulto Joven
6.
Int Wound J ; 14(3): 512-515, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27396987

RESUMEN

After debridement and before dressing a wound with maggots of calliphorid flies, one frequently performed step is the application of antiseptics to the prepared wound bed. However, the concomitant application of antiseptic agents during maggot therapy is regarded controversial as antiseptics may interfere with maggots' viability. In this experimental in vitro study, the viability of fly maggots was investigated after exposure to various antiseptics frequently used in wound care. Here, we show that Lucilia sericata fly maggots can survive up to an hour's exposure to wound antiseptics such as octenidine, povidone-iodine or polihexanide. Concomitant short-term application of wound antiseptics together with maggots on wound beds is tolerated by larvae and does not impair their viability.


Asunto(s)
Antiinfecciosos Locales/efectos adversos , Supervivencia Celular/efectos de los fármacos , Desbridamiento/métodos , Larva/efectos de los fármacos , Larva/crecimiento & desarrollo , Heridas y Lesiones/terapia , Animales , Humanos
7.
Infection ; 44(4): 531-7, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26951157

RESUMEN

BACKGROUND: Staphylococcus aureus may be the most important wound pathogen and causative for most of surgical site infections. As many anti-staphylococcal drugs are useless because of resistance, novel antimicrobial strategies are strongly needed and may be provided by cold atmospheric plasma (CP), which is being currently investigated for antiseptic efficacy. METHODS: To test the antimicrobial properties of CP against Staphylococcus aureus, 168 methicillin-susceptible isolates (MSSA) and 50 methicillin-resistant isolates (MRSA) were treated with two technically different plasma sources [an atmospheric pressure plasma jet (APPJ) and a dielectric barrier discharge plasma (DBD)] in vitro. RESULTS: CP treatment allowed a reproducible and significant growth reduction of MRSA and MSSA. However, MRSA was significantly less susceptible to treatment with DBD than was MSSA, while no difference between MRSA and MSSA was found using APPJ. CONCLUSIONS: As the initial physical antiseptic on skin, CP may be suitable for rapid decolonization of microbial pathogens in vivo. Each device must undergo validated efficacy testing prior to clinical application, as device related differences may occur.


Asunto(s)
Antibacterianos/farmacología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Gases em Plasma/farmacología , Infecciones Cutáneas Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Humanos , Modelos Biológicos
8.
Arch Orthop Trauma Surg ; 136(12): 1663-1672, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27628620

RESUMEN

BACKGROUND: Open fractures are orthopaedic emergencies that carry a high risk for infection, non-union and soft tissue complications. Evidence-based treatment is impeded by the lack of high-quality evidence-based studies. The aim of this investigation was to elucidate the current practice of open fracture management in Germany and to determine major differences in treatment. METHODS: Surgeons were asked to complete an online questionnaire consisting of 45 items developed by an expert consensus. The first part covered questions on general principles of open fracture management. The second part included questions on soft tissue management, the preferred method of initial surgical stabilisation, microbiological testing, employment of pulsatile lavage and local antibiotics, antibiotic regimen, second-look operations, and blood testing. RESULTS: Of 653 respondents, 364 (65 %) completed the first part and 314 (48 %) completed the second part of the online survey. 55 % answered that a standard operating procedure for the diagnosis and treatment of patients with open fractures exists in their hospital. Only 25 % leave pre-hospitalisation applied dressings intact until arrival of the patient in the operating room, and 40 % make this decision depending on information provided by pre-hospitalisation emergency personnel. 84 % participants exclude the use of antibiotic-coated implants in the treatment of open fractures. The favoured stabilisation method in Gustilo type I fractures is definitive internal osteosynthesis and primary wound closure for 61 % of respondents. In Gustilo type II (74 %) and type III fractures (93 %), temporary external fixation is preferred. High-pressure pulsatile lavage is used by 22 % responding surgeons in Gustilo type I fractures, 53 % for type II fractures and 67 % for type III fractures. CONCLUSIONS: Open fracture management differs considerably among surgeons in Germany. Further studies are needed to deliver high-quality evidence concerning primary fracture stabilisation, soft tissue management and second-look operations. Existing evidence-based recommendations for general treatment, antibiotic prophylaxis and soft tissue management should be followed more strictly in clinical practice.


Asunto(s)
Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Protocolos Clínicos , Fijación Interna de Fracturas/métodos , Fracturas Abiertas/cirugía , Encuestas y Cuestionarios , Infección de Heridas/prevención & control , Vendajes , Alemania/epidemiología , Hospitales , Humanos , Incidencia , Infección de Heridas/epidemiología
9.
Blood ; 115(9): 1797-803, 2010 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-19965682

RESUMEN

Heparin can induce heparin-induced thrombocytopenia (HIT). The combined effect of type of surgery (major vs minor) and heparin on this prothrombotic immune reaction to platelet factor 4 (PF4)/heparin was analyzed. In a randomized, double-blind study, trauma patients receiving low-molecular-weight (LMWH) or unfractionated heparin (UFH) for thrombosis prophylaxis were assessed for PF4/heparin-antibody seroconversion, HIT, and thrombosis according to type of surgery. The risk for seroconversion was higher than major versus minor surgery odds ratio, 7.98 [95% confidence interval, 2.06-31.00], P = .003, controlled for potential confounders, as was the risk for HIT (2.2% [95% confidence interval, 0.3%-4.1%] vs 0.0%, P = .010). During LMWH compared with UFH thromboprophylaxis, HIT (1 of 298 vs 4 of 316; P = .370) and PF4/heparin seroconversion (1.7% vs 6.6%; P = .002) were less frequent, driven by differences in patients undergoing major surgery (incidence of HIT: LMWH 0.8% vs UFH 4.0%; P = .180; seroconversion rates: 4.0% vs 17.0%; P = .001). After minor surgery, no case of HIT occurred. The severity of trauma and the need for major surgery strongly influence the risk of an anti-PF4/heparin immune response, which is then increased by UFH. In major trauma certoparin may be safer than UFH because it induces HIT-antibody seroconversion, and the corresponding risk of HIT, less frequently.


Asunto(s)
Heparina/efectos adversos , Heparina/inmunología , Factor Plaquetario 4/inmunología , Trombocitopenia/inducido químicamente , Heridas y Lesiones/tratamiento farmacológico , Heridas y Lesiones/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Anticoagulantes/inmunología , Método Doble Ciego , Femenino , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina de Bajo-Peso-Molecular/inmunología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Trombocitopenia/inmunología , Trombosis/prevención & control , Heridas y Lesiones/complicaciones , Adulto Joven
10.
Int J Legal Med ; 126(1): 13-8, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21279374

RESUMEN

Although potato cannons are an area of great interest among internet users, they are almost completely unknown in the medical community. These simple ballistic devices are made from plastic plumbing pipes and are powered with propellant gas from aerosol cans. By combustion of the gas-oxygen mixture, a high pressure is produced which propels the potato chunks through the barrel. It is the aim of this study to investigate the hazardous potential of these shooting devices. Test shots were performed using three illegally manufactured potato cannons that were confiscated by police authorities. Velocity, impulse, kinetic energy, and energy density were calculated. The risk of head and chest injuries was investigated by using Sturdivan's Blunt Criterion (BC), an energy based five parametric trauma model assessing the vulnerability to blunt weapons, projectile impacts, and behind-body-armor exposures. The probability of lethality due to blunt impact trauma to the chest was assessed using Sturdivan's lethality model. For potential head impacts, all test shots far exceeded the critical BC (head) value which corresponds to a 50% risk of skull fracture. The risk of injury with regard to chest impacts was similar. All but two test shots far exceeded the critical BC (chest) value corresponding to a 50% risk of sustaining a thoracic skeletal injury of Abbreviated Injury Scale 2 or 3. The probability of a lethal injury due to blunt chest impact was as high as 20%. To conclude, this work demonstrates that potato cannons should be considered dangerous weapons rather than as toys used by adventurous adolescents.


Asunto(s)
Balística Forense , Juego e Implementos de Juego , Solanum tuberosum , Heridas no Penetrantes/inmunología , Heridas no Penetrantes/patología , Adolescente , Traumatismos Cerrados de la Cabeza/patología , Humanos , Masculino , Medición de Riesgo , Traumatismos Torácicos/patología
11.
Int J Public Health ; 67: 1605215, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36238857

RESUMEN

Objectives: To investigate the co-occurrence of 4 behavioral health risk factors (BHRFs), namely tobacco smoking, alcohol at-risk drinking, physical inactivity and unhealthy diet and their association with sick days prior to hospitalization in general hospital patients. Methods: Over 10 weeks (11/2020-04/2021), all 18-64-year-old patients admitted to internal medicine, general and trauma surgery, and otorhinolaryngology wards of a tertiary care hospital were systematically approached. Among 355 eligible patients, 278 (78.3%) participated, and 256 (72.1%) were analyzed. Three BHRF sum scores were determined, including current tobacco smoking, alcohol use, physical inactivity and 1 of 3 indicators of unhealthy diet. Associations between BHRF sum scores and sick days in the past 6 months were analyzed using multivariate zero-inflated negative binomial regressions. Results: Sixty-two percent reported multiple BHRFs (≥2). The BHRF sum score was related to the number of sick days if any (p = 0.009) with insufficient vegetable and fruit intake as diet indicator. Conclusion: The majority of patients disclosed multiple BHRFs. These were associated with sick days prior to admission. The findings support the need to implement interventions targeting multiple BHRFs in general hospitals.


Asunto(s)
Hospitales Generales , Ausencia por Enfermedad , Adolescente , Adulto , Consumo de Bebidas Alcohólicas , Humanos , Persona de Mediana Edad , Factores de Riesgo , Conducta Sedentaria , Fumar/efectos adversos , Adulto Joven
12.
Exp Dermatol ; 20(6): 488-90, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21371126

RESUMEN

Most treatments in dermatology and cosmetology are based on the penetration of topically applied drugs into the skin or through the skin barrier to the target structure in the living tissue. In the case of healthy skin, scarcely 1% of the applied drugs pass the skin barrier, depending on their chemical properties. Therefore, different physical and chemical methods have been developed to stimulate the penetration process. All these methods are based on the partial destruction of the barrier. In this study, an electrical tissue-tolerable plasma (TTP) was used to increase the penetration of a topically applied model drug (fluorescent dye) through the skin barrier. Using laser scanning microscopy, the distribution of the model drug in different depths of the skin was investigated. It was found that the plasma treatment of the skin is a very efficient process to deliver topically applied substances into the living tissue. In the case of the non-plasma-treated skin, it was found that the fluorescent dye could be detected exclusively on the skin surface. If the dye was applied to the TTP-treated skin, it could be observed in high concentration also in deeper parts of the skin extending down to the stratum basale and the papillary structure.


Asunto(s)
Sistemas de Liberación de Medicamentos/métodos , Piel/efectos de los fármacos , Piel/metabolismo , Administración Cutánea , Animales , Sistemas de Liberación de Medicamentos/instrumentación , Fluoresceína/administración & dosificación , Fluoresceína/farmacocinética , Colorantes Fluorescentes/administración & dosificación , Colorantes Fluorescentes/farmacocinética , Técnicas In Vitro , Absorción Cutánea/fisiología , Sus scrofa
13.
Skeletal Radiol ; 40(4): 423-30, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20706714

RESUMEN

BACKGROUND: Acute inversion injuries of the ankle are the most common sports accidents, accounting for approximately 10% of emergency room admissions. In up to 85%, an injury of the lateral collateral ligaments is observed. Classically, the assessment of these injuries has relied on clinical examination and radiographs, including stress views. The aim of our study was to correlate prospectively the findings of high-field 3 T MRI in acute ankle distortion with clinical outcome. METHODS: During a 6-month period, 38 patients were prospectively included. MRI was performed within 48 h of trauma and clinical examination using a protocol consisting of axial T2-weighted and coronal and sagittal T1-weighted images and a sagittal proton density (PDw) sequence. Each ligament injury was graded on a three-point scale. Functional outcome was evaluated using the AOFAS ankle-hindfoot scale. RESULTS: In 24/38 patients (63.12%), ligament injury was observed. In 22/24 cases, this was an injury of the lateral ligaments and in 2/24 cases of the medial ligaments. Injury of the syndesmosis occurred in three patients, a bone bruise in four, and an osteochondral lesion in three cases. Patients with an injury of two or more ligaments or a bone bruise had a lower AOFAS score and returned to sports activities and full weight-bearing later (P < 0.01). CONCLUSION: MR imaging at 3 Tesla is an independent predictor for clinical outcome. Therefore MRI may be beneficial in those cases where the findings influence further treatment.


Asunto(s)
Traumatismos del Tobillo/diagnóstico , Imagen por Resonancia Magnética , Adulto , Anciano , Traumatismos del Tobillo/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Físico , Resultado del Tratamiento
14.
Urologe A ; 60(4): 523-532, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33738559

RESUMEN

Vasectomy is considered to be the simplest, most effective and cheapest method of fertility control in men, with a significantly lower risk of morbidity and mortality compared to tubal ligation in women. Patient informed consent is particularly important and should include potential irreversibility, surgical options, anesthesia, possible complications as well as postoperative behavior and the need for re-evaluation. There are different access routes available with conventional and no-scalpel vasectomy as well as different techniques for closing the ends of the vas deferens. To confirm sterility the European Association of Urology (EAU) recommends that an ejaculate analysis should be performed 3 months after the procedure and after approximately 20 ejaculations. Complications are relatively rare, although particularly vasectomy failure due to recanalization has to be considered. Approximately 3-6% of vasectomized men strive for a refertilization, which with experienced surgeons is successful in about 90% of cases.


Asunto(s)
Vasectomía , Anticoncepción , Femenino , Humanos , Masculino , Vasectomía/efectos adversos
15.
PLoS One ; 15(6): e0234156, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32502206

RESUMEN

OBJECTIVE: Mis-triage may have serious consequences for patients in mass casualty incidents (MCI) at sea. The purpose of this study was to assess outcome, reliability and validity of an analogue and a digital recording system for triage of a MCI at sea. METHODS: The study based on a triage exercise conducted with a cross-over-design. Forty-eight volunteers were presented a fictional MCI with 50 cases. The volunteers were randomly assigned to start with the analogue (Group A, starting with the analogue followed by the digital system) or digital system (Group B, starting with the digital followed by the analogue system). Triage score distribution and agreement between the triage methods and a predefined standard were reported. Reliability was analysed using Cronbach's Alpha and Cohen's Kappa. Validity was measured through sensitivity, specificity and predictive value. Treatment, period and carry-over-effects were analysed using a linear mixed-effects model. RESULTS: The number of patients triaged (total: n = 3545) with the analogue system (n = 1914; 79.75%) was significantly higher (p = 0.001) than with the digital system (n = 1631; 67.96%). A trend towards a higher percentage of correct triages with the digital system was observed (p = 0.282). Ratio of under-triage was significantly smaller with the digital system (p = 0.001). Validity measured with Cronbach's Alpha and Cohen's Kappa was higher with the digital system. So was sensitivity (category; green: 80.67%, yellow: 73.24%, red: 83.54%; analogue: green: 93.28%, yellow: 82.36%, red: 94.04%) and specificity of the digital system (green: 78.07%, yellow: 63.75%, red: 66.25%; analogue: green: 85.50%, yellow: 79.88%, red: 91.50%). Comparing the predictive values and accuracy, the digital system showed higher scores than the analogue system. No significant patterns of carry-over-effects were observed. CONCLUSIONS: Significant differences were found for the number of triages comparing the analogue and digital recording system. The digital system has a slightly higher reliability and validity than the analogue triage system.


Asunto(s)
Incidentes con Víctimas en Masa/estadística & datos numéricos , Océanos y Mares , Registros , Adulto , Femenino , Humanos , Modelos Lineales , Masculino , Adulto Joven
16.
J Trauma ; 67(3): 617-23, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19741410

RESUMEN

BACKGROUND: High-pressure blast injuries to the hand due to vole captive bolt devices are serious injuries that are to a great extent unknown to emergency care operators and trauma surgeons. There is no study on the functional outcome of these patients. METHODS: We assessed the functional outcome of patients with injuries inflicted by vole captive bolt devices. Therefore, a protocol consisting of a physical examination and an assessment of static muscle power (grip and pinch strength) was performed. To capture the subjective experience of patients regarding their injury related disability and impairment, the DASH follow-up questionnaire was used. Based on clinical/radiologic findings and outcome, a classification of this unique subgroup of blast injuries was developed. RESULTS: The functional outcome of 34 patients suffering hand injuries due to captive bolt devices between 2004 and 2007 was assessed. A significant reduction of static muscle testing parameters compared with the uninjured hand was revealed. Fourteen patients lost a digit. Average time lost from work was 5.4 weeks. CONCLUSION: Vole captive bolt device-related hand injuries are followed by deterioration of hand function. The present observations alarmed national authorities. The manufacturers were required to take engineering and teaching measures to rule out handling errors that were identified as leading cause of injury.


Asunto(s)
Traumatismos por Explosión/etiología , Traumatismos por Electricidad/etiología , Traumatismos de la Mano/etiología , Traumatismos de la Mano/fisiopatología , Control de Plagas/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Animales , Arvicolinae , Traumatismos por Explosión/fisiopatología , Traumatismos por Explosión/cirugía , Estudios de Cohortes , Traumatismos por Electricidad/fisiopatología , Traumatismos por Electricidad/cirugía , Femenino , Traumatismos de la Mano/cirugía , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos
17.
Gait Posture ; 27(3): 535-8, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17692523

RESUMEN

AIM: The aim of the present study was the assessment of metatarsal head loading in combat boots of the German armed forces. With respect to the prevention of metatarsal stress fractures, we evaluated how cushioning insoles (made of EVA foam or neoprene) achieved a load reduction in comparison with conventional insoles. MATERIAL AND METHODS: Local pressure, force and impulse values were determined with the pedar-m expert in-shoe pressure measurement system applied in 26 volunteers during walking with four different insoles made of synthetic mesh, EVA foam and neoprene. Data analysis was performed with SAS and tested for statistical differences with non-parametric tests (with p<0.05 as a significance level). RESULTS: For the peak pressures under the metatarsal heads (MT) the following order was found: MT-II>MT-III>MT-I>MT-IV>MT-V. A comparison of the insoles indicated that the neoprene insole resulted in the lowest peak pressures with significant load reductions under MT-III to MT-V (p<0.00001). Furthermore, the impulse values under MT-II to MT-V were significantly lower with neoprene insoles (p<0.0002). However, the subjects rated the conventional insoles as more comfortable and better fitting than the newly developed insoles. DISCUSSION/CONCLUSION: The cushioning insoles were superior to the conventional insoles with respect to the plantar pressure distribution. With respect to the load reduction we can conclude that the modified insoles might be able to reduce the incidence of march fractures. The biomechanical advantage does not appear to be related to personal preferences.


Asunto(s)
Fracturas por Estrés/prevención & control , Huesos Metatarsianos/lesiones , Personal Militar , Zapatos , Caminata , Adulto , Fracturas por Estrés/etiología , Alemania , Humanos , Masculino , Presión , Estadísticas no Paramétricas
18.
Am J Emerg Med ; 26(8): 974.e3-5, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18926385

RESUMEN

White phosphorus is an incendiary agent used in particular types of ammunition. Exposure to phosphorus-containing compounds may cause severe burn injuries. Systemic effects may be fatal for the casualty even though only a small surface of the body is burned. We report 4 cases of white phosphorus burn injuries due to an exceptional accident mechanism. All casualties were holidaymakers in a coastal area at the Baltic Sea and confused white phosphorus ammunition residues with amber on a beachwalk. The supposed treasure was taken into the pants pocket. The phosphorus substances ignited spontaneously when they dried because of the body heat. Injury patterns combined simultaneous full thickness burn injuries of both hands with a burn injury of one thigh or the abdominal region. The acute treatment and the controversy surrounding decontamination of such patients are discussed. In addition, pathology of tissue damage and systemic injury are elucidated.


Asunto(s)
Quemaduras Químicas/etiología , Traumatismos de la Mano/inducido químicamente , Traumatismos de la Pierna/inducido químicamente , Fósforo/toxicidad , Adolescente , Anciano , Quemaduras Químicas/cirugía , Desbridamiento , Descontaminación , Femenino , Traumatismos de la Mano/cirugía , Humanos , Traumatismos de la Pierna/cirugía , Masculino , Persona de Mediana Edad
19.
Alcohol ; 65: 45-50, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29084629

RESUMEN

PURPOSE: The aim of this study was to investigate whether urinary bladder volume (UBV) and blood alcohol concentration (BAC) correlate in a cohort of emergency trauma patients. Furthermore, the feasibility of semi-automated 3D-CT volumetry for urinary bladder volumetry calculations in whole-body CT examinations was elucidated. MATERIAL AND METHODS: Whole-body CT scans of 831 individuals treated in the emergency department with suspected multiple injuries were included. Manual 3D-CT volumetry of the urinary bladder was performed and the mechanism of injury, patient demographics, BAC, serum creatinine, and hematocrit were retrospectively analyzed. Semi-automated calculation of UBV was performed in 30 patients. Statistical analysis included ROC analysis to calculate cut-off values, sensitivity, and specificity. The Mann-Whitney test and Spearman's correlation coefficient were used to detect significant correlations between UBV and BAC. RESULTS: Manual 3D-CT volumetry showed maximum sensitivity and specificity with a cut-off value for urinary bladder volume of 416.3 mL (sensitivity 50.9%; specificity 76.3%; AUC 0.678). With a cut-off value of 4.2 mL/µmol for the creatinine quotient (quotient of serum creatinine and UBV), the sensitivity was 64.2% (specificity 67.0%; AUC 0.681). Semi-automated 3D-CT volumetry resulted in lower UBV values compared to those obtained with manual 3D-CT volumetry. CONCLUSION: Semi-automated 3D-CT volumetry is a reliable method to quantify UBV. UBV correlates with positive BAC results. A UBV above 416 mL seen on an initial whole-body CT must raise suspicion of alcohol intoxication. The creatinine quotient is an even more sensitive and specific parameter for the detection of alcohol intoxication.


Asunto(s)
Intoxicación Alcohólica/sangre , Intoxicación Alcohólica/diagnóstico por imagen , Nivel de Alcohol en Sangre , Imagenología Tridimensional/métodos , Tomografía Computarizada por Rayos X/métodos , Vejiga Urinaria/diagnóstico por imagen , Adolescente , Adulto , Intoxicación Alcohólica/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/sangre , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/epidemiología , Tamaño de los Órganos , Estudios Retrospectivos , Adulto Joven
20.
J Trauma Acute Care Surg ; 80(1): 119-24, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26683398

RESUMEN

BACKGROUND: Tension pneumothorax is one of the leading causes of preventable death in both military and civilian trauma patients. Needle decompression is recommended in trauma guidelines as an emergency procedure to relieve increased intrapleural pressure. The main reason for decompression failure is reported to be insufficient needle length in proportion to the chest wall thickness (CWT). So far, population-based epidemiologic data on CWT are missing. Therefore, it was the aim of this work to investigate the CWT in the second intercostal space, midclavicular line, based on magnetic resonance imaging data of a large population-based sample. The second aim of this study was to explore the potential risk of iatrogenic lesions caused by the proximity of the intended puncture track to the internal mammary artery. METHODS: A total of 2,574 healthy volunteers (mean [SD] age, 53.3 [13.9] years; range, 21-89 years) from the population-based cohort Study of Health in Pomerania (SHIP) were enrolled. CWT and the distance from the intended puncture track to the internal mammary artery were investigated with the chest sequences of a standardized 1.5-T whole-body magnetic resonance imaging. RESULTS: For all 5,148 measured sites in 2,574 volunteers, the mean (SD) CWT was 5.1 (1.4) cm. The mean body mass index was determined to be 27.7 kg/m. The CWT correlated significantly with body weight and body mass index. The internal mammary artery was located medial to the intended puncture site in all participants; the mean (SD) distance was 5.7 (0.7) cm on the right and 5.5 (0.7) cm on the left side. CONCLUSION: Based on the population-based epidemiologic data presented in this study, the use of a needle of 7 cm in length is recommended to decompress a tension pneumothorax in the second intercostal space in the midclavicular line, which might successfully decompress more than 90% of the participants in this study. When using this anterior approach at the anatomically correct puncture site, safety margin to the internal mammary artery is sufficient so that the risk of iatrogenic lesion of the internal mammary artery should be minimal. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.


Asunto(s)
Descompresión Quirúrgica/instrumentación , Agujas , Neumotórax/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Puntos Anatómicos de Referencia , Índice de Masa Corporal , Femenino , Alemania , Voluntarios Sanos , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Punciones
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