bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Management of Diverticular Disease in the Elective Setting
Authors: Neale Jeffrey
Published: June 2018

Diverticulosis is a common condition that has increased in prevalence in industrialized countries over the past century. Estimates of developing diverticular disease in the United states range from 5% by 40 years of age up, to over 80% by age 80. It is estimated that approximately 20% of patients with diverticulosis develop diverticulitis over the course of their lifetime. Diverticular disease can be divided into simple and chronic diverticulitis with various sub categories. There are various instances and circumstances where elective resection is indicated for both complex and simple forms of this disease process. When planning surgery there are general preoperative considerations that are important to be reviewed prior to surgery. There are also more specific considerations depending on secondary problem attributed to diverticulitis, that is, fistula vs stricture. Today, treatment for elective resection includes open, laparoscopic and robotic surgery. Over the last several years we have moved away from open surgery to laparoscopic surgery for elective resection. With the advent of robotic surgery and introduction of 3D laparoscopic surgery the discussion of superiority, equivalence between these modalities, is and should remain an important discussion topic.
Evaluation of Quality of Life and Surgical Outcomes for Treatment of Diverticular Disease
Authors: Lin Mayin , Raman Shankar
Published: June 2018

The prevalence of diverticular disease in the Western and industrialized nations has increased over the last century, and our understanding of this disease and its management continues to evolve. In this article, we review the literature regarding the postoperative quality of life (QOL) and functional outcomes following surgical management of diverticulitis, including information regarding bowel function, recurrence of symptoms, and other postoperative sequelae. While objective parameters, such as attacks of diverticulitis, complications, and clinical episodes have been studied, there is a paucity of data on less objective factors, such as overall patient satisfaction after operative management of diverticular disease. The literature shows improvement in QOL following surgical intervention for diverticulitis if preoperative QOL was significantly low, secondary to severe/complicated diverticulitis. However, a subset of patients does continue to have symptoms following surgical intervention for diverticulitis. Often neglected in the literature, there remains a need for prospective data evaluating preoperative function to ascertain the impact of surgery on patients' QOL and postoperative function.
Über den Einfluß verschiedener Stoffwechselhemmer auf die Thrombozytenfunktion
Authors: Breddin K , Langbein H
Published: June 2018

Es wurde der Einfluß verschiedener Stoffwechselhemmer auf die Ausbreitungsfähigkeit der Thrombozyten an silikonisierten Glasflächen, auf die Retraktion und auf die Thrombusfestigkeit im Thrombelastogramm untersucht.

Unter dem Einfluß von Monojodacetat, Malonsäure, Natriumcyanid, HgCl2, Promazinhydrochlorid, Primaquin und EDTA wurde die Ausbreitungsfunktion der Thrombozyten jeweils mit geringeren Konzentrationen gehemmt als die Retraktion, während sich die Thrombusfestigkeit im Thrombelastogramm als die relativ unempfindlichste Methode gegenüber den verwendeten Substanzen erwies. Es wird angenommen, daß die Ausbreitungsfunktion der Thrombozyten einen besonders hohen Energiebedarf hat. Auf die Möglichkeit zur besseren Beurteilung von Thrombozytenkonserven durch Bestimmung der Ausbreitungsfähigkeit wird hingewiesen. Unter dem Einfluß von NaF im Konzentrationsbereich zwischen 5 und 15 mMol fand sich eine Steigerung der Ausbreitungsfähigkeit der Thrombozyten.
The Levels of the Plasma Coagulation Factors in the Post-Operative Period
Authors: Davidson E , Tomlin S
Published: June 2018

In the post-operative period the levels of factor I, VII—X, VIII, IX and X as well as the platelets are increased. In the immediate post-operative period there is a decrease in the levels of factors II and XI. The significance of these changes in relation to venous thrombosis is discussed.
Rôle du complément dans la pathogénie du purpura thrombopénique immunologique
Authors: Salmonet J , Lambert P. H
Published: June 2018

Résumé et Conclusions

1. La lésion vasculaire responsable du purpura thrombopénique immunologique, chez le rat, est inhibée par la décomplémentation préalable de l'animal

2. Dans ce purpura, le complément jouerait le role de médiateur entre la réaction plaquettes-sérum anti-plaquettes et !'activation protéolytique, effecteur de l'alteration pariétale.
The Streptokinase Activation of Human Plasminogen. Direct Analysis of the Activation Mixture
Authors: Rifé Ubaldo , Shulman Sidney
Published: June 2018

1. Incubated mixtures of plasminogen and streptokinase revealed three components in optical electrophoresis at pH 2.00. The fastest component was identified as plasmin, and the other two components were taken to represent plasminopeptides A and B, in accordance with their mobilities.

2. By means of gel filtration, it was possible to show the presence of three constituents. The major one had caseinolytic activity, while the other two had no such activity.

3. From the known properties of molecular exclusion by various Sephadex preparations, it was estimated that the two peptides had molecular weights of approximately 10,000.

4. The possibility of improving the purity of plasmin preparations was demonstrated.
Oxalate Induced Correction of the Plasma Antithromboplastin Deficiency in the Aging Arteriosclerotic Subject
Authors: Commers L. R , Pilgeram L. O
Published: June 2018

Intravenous heparin will correct the enhanced thromboplastin generation of oxalated plasma obtained from the human arteriosclerotic patient. It will not,

however, correct the deficiency of antithromboplastin activity in non-oxalated plasma obtained from the pathological subject. This deficiency of antithromboplastin disappears if oxalate ion is introduced into the heparinized plasma.
Les inhibiteurs de la fibrinolyse et le dosage de l’activité antiplasminique physiologique et pathologique
Authors: Moriau M , de Vries S. I , Dik H. J
Published: June 2018

Dans cet exposé une technique de dosage quantitatif de l’activité antiplas-minique sérique a été décrite. Ses variations sur 100 sujets normaux et dans certaines affections on été envisagées. Un dosage de l’activité antiplasminique pla-quettaire a été réalisé chez un certain nombre de patients présentant une thrombopathie liée à une myélofibrose ou polycythémie. Le fractionnement électro-phorétique ou au Rivanol des protéines du sérum ou d’un extrait plaquettaire normal a permis de localiser l’activité antiplasminique au sein des fractions alpha1-, alpha2-et gammaglobulines, et l’activité antitrypsique au sein de la fraction alpha1-globuline. Diverses propriétés de certaines antiplasmines non sanguines ont également été mentionnées.
Influence of Fibrinogen Degradation Products (FDP) on Platelet Aggregation, Adhesiveness and Viscous Metamorphosis
Authors: Kowalski E , Kopeć M , Wegrzynowicz Z
Published: June 2018

Influence of SKPL on platelet function tests has been studied.

1. Human platelets suspended in borate buffer lose after SKPL treatment the ability to aggregate under the influence of thrombin, ADP and connective tissue extract.

2. Washed platelets incubated with SKPL did not influence the thrombin time of prothrombin free plasma.

3. The digestion of platelet rich plasma with SKPL diminished the ability of platelets to aggregate under the influence of thrombin, ADP and connective tissue extract and the adhesiveness to glass.

4. Viscous metamorphosis after addition of thrombin or ADP was delayed and less advanced in SKPL treated platelet rich plasma as compared with control undigested plasma.

5. The addition of FDP preparation to platelet suspension or to platelet rich plasma impaired their ability to aggregate under the influence of thrombin, ADP and connective tissue extract.

6. Adhesiveness of platelets to glass in the whole blood containing FDP was decreased in comparison with controls.

7. FDP inhibits also the adhesion of platelets from platelet rich plasma to connective tissue fibers (collagen).

8. Viscous metamorphosis induced by thrombin, ADP or connective tissue extract in platelet rich plasma could be delayed or inhibited by addition of FDP.

9. Inhibiting effect of FDP on platelet functions were dependent on concentration of FDP and aggregating agent. FDP influence platelet functions in such concentration which inhibit significantly the thrombin time. Increase of the concentration of the inducing agent can overcome the inhibitory effects of FDP.

10. The significance of the described findings for the hemostatic function of platelets is discussed.
ADP-Induced Platelet Adhesiveness as a Diagnostic Test in von Willebrand’s Disease)
Authors: Ödegaard A. E , Skâlhegg B. A , Hellem A. J
Published: June 2018

In von Willebrand’s disease the ADP-induced platelet adhesiveness in plasma is zero at a final concentration of 0.05 µg/ml. Several coagulopathies react as normals giving a detectable platelet adhesiveness ranging from 18% to 44%. This may be used as a diagnostic test in von Willebrand’s disease.
Increased Activity of “Anti-Willebrand Factor” in Diabetic Plasma
Authors: Ödegaard A. E , Skalhegg B. A , Hellem A. J
Published: June 2018

In a group of 25 patients with insulin-treated diabetes mellitus a marked increase in the ADP-induced platelet adhesiveness was demonstrated. This phenomenon was due to a plasmatic factor. In vitro-plasma from these patients restored the decreased ADP-induced platelet adhesiveness in von Willebrand’s disease.

The factor was also effective in vivo, since transfusion of 450 ml diabetic plasma to a patient with von Willebrand’s disease normalized the decreased platelet adhesiveness and shortened the prolonged bleeding time. The role of this factor in the ADP platelet reaction as a cofactor together with calcium is stressed.
Coagulation Studies in Liver Disease
Authors: Hallén Acke , Nilsson Inga Marie
Published: June 2018

Various caogulation factors were studied in 20 cases of liver cirrhosis for their possible diagnostic value. Special attention was given to determination of antithrombin (AT), and AT values were also studied in a series of hepatitis and obstructive jaundice.

The P & P test was decreased in 75%, the factor V content in 83%, the factor IX content in 40% and the platelet count in 55% of the cases of liver cirrhosis.

Increased fibrinolytic activity was noted in 5 cases. Only 2 cases had significantly decreased fibrinogen levels and most probably due to fibrinolysis. The AHF (f. VIII) level was slightly decreased in 2 cases, one of which had fibrinolysis, while the other had normal AHF levels.

In 12 of 18 cases of liver cirrhosis the AT II and III was decreased and only in one case was it increased but the decreased values deviated only slightly from the normal range. AT II and III in 23 cases of obstructive icterus and in 19 cases of hepatitis gave practically normal values.

Judging from our results determination of P & P and factor V is valuable in the diagnosis of liver cirrhosis. Determination of AT II and III by use of an improved method proved not to give any further help in the diagnosis of liver cirrhosis or the differential diagnosis between cirrhosis, hepatitis and obstructive jaundice.
Haemorrhagic Diathesis as the Result of Severe Deficiency of Plasma Thromboplastin Antecedent (PTA, Factor XI)
Authors: de Vries S. I , Straaten M. A. J. Braat-van
Published: June 2018

The coagulation mechanism in a patient with multiple cerebral formation of haematomas after a relatively slight trauma gave rise to diagnostic difficulties. In the beginning a diagnosis of Hageman factor (factor-XII-) deficiency was made, but the results had to be reconsidered and the diagnosis changed into PTA(factor-XI-) deficiency. The authors communicate their difficulties in detail and explain their wrong interpretations which are attributable to the fact that both factors XI and XII are involved in the process of glass activation. Further it was pointed out that the activation of the factors VIII and IX is dependent on both PTA and HF. The narrow relationship of both factors is stressed.
Factor XI (P. T. A.) Deficiency with No Hemorrhagic Symptoms
Authors: Todd Margaret , Wright Irving S.
Published: June 2018

A case has been presented, which has been diagnosed as a familial deficiency of Factor XI (PTA).

The patient with Factor XI deficiency has a gross coagulation defect as demonstrated by numerous in vitro tests. However, to date neither the proband, his mother, nor his sister, who share the same deficiency, has shown any evidence of an abnormal bleeding tendency, even when subjected to repeated surgical procedures. These patients have a minor PTA deficiency and are heterozygous for the deficiency, which is transmitted as an autosomal recessive.
Erfahrungen mit Kapillarblutmethoden zur Überwachung der Antikoagulantientherapie: Thrombotest-Owren und Prothrombinzeit nach Hartert
Authors: Fischer M
Published: June 2018

Die Kapillarblutmethoden mit Thrombotest-Owren und die PTZ nach Hartert wurden mit einer mit menschlichem Hirnthromboplastin durchgeführten PTZ nach Quick verglichen. Die Untersuchungen wurden an insgesamt 183 Patienten im Rahmen des Thrombosedienstes der I. Med. Univ. Klinik durchgeführt. Die Ergebnisse wurden besprochen und statistisch geprüft. Eine Modifikation zur einfachen Erstellung einer Eichkurve für die PTZ aus Kapillarblut nach Hartert wurde vorgeschlagen. Beide Kapillarblutmethoden sind einfach zu handhaben und für eine Kontrolle der AC-Therapie gut geeignet.
Vereinfachte Methode zur Auswertung von Standardfibrinplatten
Authors: Schulte Willi
Published: June 2018

Es wird eine einfache und zeitsparende Auswertschablone zur Größenbe- stimmung fibrinolytischer Höfe auf Standardfibrinplatten bzw. deren Photo - abzug beschrieben. Die Schablone enthält Kreise mit um jeweils 0,5 mm wachsendem Durchmesser. Zu jedem Kreis ist das Quadrat seines Durchmessers (oder seine Fläche bzw. Volumen), zu jeweils zwei benachbarten Kreisen der errechnete Mittelwert auf der Schablone eingezeichnet. Die Kreise werden mit den fibrinolytischen Höfen zur Deckung gebracht und der zugehörige Wert direkt auf der Schablone abgelesen. Herstellungs- und Gebrauchstechnik der Schablone werden beschrieben.
Über den immunologischen Nachweis von Faktor VIII-Protein im Bluterplasma und seine Bedeutung für das Verständnis der Hämophilie A
Authors: Piper W , Schreier M. H
Published: June 2018

Durch Immunisierung von Kaninchen wurden Antiseren gegen humanen Faktor VIII gewonnen, deren spezifische Anti-Faktor VIII-Wirkung mit einem modifizierten Thrombokinasebildungstest (Faktor VIII-Neutralisationstest) nachgewiesen werden konnte.

Die gegen den Faktor VIII gerichteten Antikörper der Immunseren ließen sich in gleichem Maße mit Normalplasma und Bluterplasma absorbieren, woraus sich ergibt, daß im Bluterplasma etwa ebensoviel Faktor Vlll-Protein enthalten ist wie im normalen Plasma. Im Normalserum und Bluterserum wurden mit dieser Methode deutlich geringere und ebenfalls annähernd gleiche Faktor VIII-Konzentrationen gefunden.

Es wird die Auffassung vertreten, daß es sich bei dem im Bluterplasma vorhandenen Faktor VIII-Protein - in Analogie zu den kreuzreagierenden Substanzen (CRM) bei Bakterien-Mangelmutanten um das Produkt einer genetisch bedingten Faktor VIII-Fehlsynthese handelt, welches funktionell minderwertig ist, in seinen Antigendeterminanten jedoch weitgehend mit normalem Faktor VIII übereinstimmt.

Um gewisse Inhibitoreigenschaften des Bluterplasmas zu erklären, wird auf die Möglichkeit hingewiesen, daß dem fehlgebildeten Faktor VIII aufgrund seiner strukturellen Ähnlichkeit eine kompetitive Hemmwirkung auf normalen Faktor VIII zukommen könnte. Für diese Annahme spricht, daß der von Mammen im Bluterplasma gefundene Inhibitor ähnliche Eigenschaften zeigte, wie sie vom Faktor VIII bekannt sind.

Die These verschiedener Autoren, daß Bluterplasma den Faktor VIII in normaler Quantität und Qualität enthalte und daß ein gegen ihn gerichteter Inhibitor das pathogenetische Agens der Hämophilie A darstelle, wird abgelehnt. Der Widerspruch wird mit genetischen Überlegungen und der Beobachtung begründet, daß der im Bluterplasma nach Ätherbehandlung auftretende Accelerator nicht mit Faktor VIII identisch ist.

Unser Dank gilt Herrn Prof. E. Lüscher, Bern, für die Überlassung reinen Human-Fibrinogens, Herrn Dr. W. Osten, Rudolf-Virchow-Krankenhaus, Berlin, für die Zuweisung dreier Bluterpatienten und Herrn Dr. Wiek, Rudolf - Virchow-Krankenhaus, Berlin, für die Durchführung der präparativen Elektrophorese mit seiner Apparatur.
A Study of Three Cases of Familial Congenital Hypoprothrombinaemia (Factor II Deficiency)
Authors: de Bastos O , Reno R. S , Correa O. T
Published: June 2018

Three cases of true congenital hypoprothrombinaemia are presented.

Studies were made to prove the deficiency of prothrombin in the patient’s plasma and to rule out deficiency of other clotting factors or the presence of abnormal anti-thrombin substances.

All the patients were of group B.

The results obtained confirm that the patients have a real prothrombin deficiency as the cause of a severe haemorrhagic disease.
Erworbene Thrombozytenfunktionsstörungen
Authors: Schneider W. , Scharf R. E.
Published: June 2018

Erworbene Thrombozytenfunktionsstörungen sind außerordentlich häufig und können bei zahlreichen, ganz unterschiedlichen Erkrankungen sowie unter Therapie mit den verschiedenartigsten Medikamenten auftreten. In der Mehrzahl der Fälle handelt es sich um extrinsische Störungen, deren Pathogenese noch weitgehend unklar ist. Vor allem bei malignen Erkrankungen wie akuten und chronischen Leukämien sowie anderen myeloproliferativen und myelodysplastischen Syndromen können sich extrinsische und intrinsische Komponenten zu einem komplizierten Bild überlagern und zu bedrohlicher Blutungsneigung führen. Häufig spielen hierbei Gerinnungsstörungen eine wichtige zusätzliche Rolle.

Während in der Diagnostik klinisches Bild, Familienund Eigenanamnese, Blutungszeit und Plättchenzahl sowie der Ausschluß von Gerinnungsstörungen wichtig sind, besteht die Therapie vorwiegend in einer Behandlung der Grunderkrankung oder Absetzen des auslösenden Medikamentes. Nur in seltenen Fällen ist eine Thrombozytensubstitution erforderlich.
Über die Bedeutung der fibrinolytischen Aktivität der Lunge unter dem Aspekt des akuten Atemnotsyndroms
Authors: Blasini R. , Krieglsteiner P. , Blümel G. , Haas S.
Published: June 2018

In tierexperimentellen Studien wurde histochemisch untersucht, inwieweit Pharmaka, die in der Gynäkologie bei Frühgeburtsgefahr prophylaktisch gegen die Entstehung eines akuten Atemnotsyndroms verwendet werden, einen Einfluß auf die fibrinolytische Aktivität der Lunge haben. Hierbei wurde nach Gabe von Betamethason eine Abnahme der gewebeständigen Fibrinolyse und eine Zunahme von Plasmininhibitoren in maternalem und fetalem Lungengewebe der Ratte gefunden, was nach Gabe von Ambroxol nicht der Fall war. Daraus ergibt sich im Hinblick auf eine nicht iatrogen verminderte fibrinolytische Aktivität der Frühgeborenenlunge ein Vorteil von Ambroxol.

In einer weiteren Untersuchungsreihe wurde geprüft, welchen Einfluß Aprotinin auf die gewebeständige Fi im Rahmen des traumatischen Schockgeschehens hat. Bei narkotisierten Ratten mit bilateraler Oberschenkelfraktur blieb nach 20000 KIE Aprotinin pro kg KG die fibrinolytische Aktivität des Lungengewebes erhalten, was für den Kliniker zeigt, daß im Falle einer sekundären Hyperfibrinolyse beim Schockpatienten keine Kontraindikation für Aprotinin besteht. Synthetische Fibrinolysehemmkörper dagegen, wie z. B. Tranexamsäure-Derivate, interferieren mit der Wirkung gewebeständiger Plasminogenaktivatoren und bewirken u. U. die Bildung von lyseresistenten Gerinnseln. Diese Substanzen dürfen deshalb bei keinem Zustand mit vermehrter Fibrinbildung gegeben werden.
Die Atemnotsyndrom-Lunge-Sequestrationsorgan für lösliches Fibrin
Authors: Bleyl U.
Published: June 2018

Multifactorial permeability disorders of the alveolo-capillary exchange membranes are one of the main pathophysiologic principles of pulmonary failure in the ARDS. Under the conditions of a generalized activation of coagulation these permeability disorders result in a leakage of circulating fibrin monomers and oligomers into the pulmonary interstitia and alveoli, even before the monomers and oligomers may precipitate intravascularly to disseminated microthrombi. Under the patho-physiologic conditions of an ARDS the lungs thus become an organ of excretion for soluble, intravascularly circulating fibrin monomers and oligomers, an organ of sequestration for soluble fibrin.
Heparin
Authors: Jaques L. B.
Published: June 2018

In vivo bewirkt Heparin das Auftreten einer Lipoprotein-Lipase, einer Diaminoxydase (Histaminase) und anderer Enzyme. In Tierversuchen konnten viele günstige Wirkungen von Heparin und Heparinoiden aufgezeigt werden, wie z.B. Schutzeffekte gegen toxische Medikamente und Prozeduren, gegen Überempfindlichkeitsreaktionen, Änderungen von Hormoneffekten und die Erhöhung der negativen elektrischen Ladung von Körperzellen. Die Einzelwirkungen sind für bestimmte Kettenstrukturen spezifisch. Während Heparin in vitro gerinnungshemmend wirksam ist, zeigt der Vergleich der gerinnungshemmenden Wirkung in der Blutzirkulation mit der chemischen Konzentration im Blut, daß in vivo eine Aktivierung von nicht gerinnungshemmend aktiven Fraktionen bzw. Heparinketten erfolgt. Heparin wird rasch von den Zellen des RES-Systems gegen einen Konzentrationsgradienten aufgenommen, so daß in vivo die Heparinkonzentration im Gefäßendothel lOOOfach höher ist als im Blut.

Die Fixierung des Heparins im Endothel vermehrt das elektronegative Potential des Endothels. Diese Wirkung und andere Wirkungen (die Aktivierung von Antithrombin III etc.) sind lokal die Basis der thromboseverhütenden Heparinwirkung. Demnach ist das Endothel das Zielorgan für Heparin.
Veränderungen im Prostaglandinsystem als Risikofaktor für die arterielle Thrombose
Authors: Sinzinger H
Published: June 2018

Die Defekte (a-d), die angeboren, erworben oder aber assoziiert Vorkommen, zeigen, daß stets bei Erkrankungen der arteriellen Strombahn eine Kombination im Sinne einer gesteigerten Thrombozytenfunktion vorliegt. Sind diese Defekte vererbt, liegt stets nur einer isoliert vor, aber auch er betrifft im Regelfall das arterielle System. Nimmt man die Häufigkeit des Auftretens dieser Störungen zusammen, so findet man diese bei mehr als 20% der Gesamtbevölkerung; nimmt man die Defekte allein, so liegen diese etwa um 1%. Wir sind derzeit daran, die Häufigkeiten in Screening-Untersuchungen der Erwachsenen exakt festzustellen.

Alle diese Defekte im Prostaglan- dinsystem stellen unseres Erachtens einen Risikofaktor für die Entstehung arterieller Gefäßveränderungen und Thrombosen dar. Die sehr spekulative und hypothetische Auflistung soll aber deutlich machen, daß auch in den nächsten Jahren noch nicht bekannt sein wird, ob diese Veränderungen als bedeutende pathogenetische Faktoren einer arteriellen Thrombose oder aber nur als seltene Defekte in die praktisch-klinische Diagnostik bzw. Therapie Eingang finden werden. Ohne diese Informationen sind auch therapeutische Interventionen, die auf dem Prostaglandinsystem basieren, noch zu unreif, um in einem größeren Rahmen Anwendung zu finden.
Heparin
Authors: Jaques L. B.
Published: June 2018

Die Verteilung des Heparins ist von der Zahl der betroffenen RES-Zellen abhängig, die nach der Art der Heparinanwendung variiert. Intravenöses Heparin (besonders dauerinfundiertes und »Ultra-low dose«-Heparin) ist hauptsächlich auf das kardiovaskuläre Endothel beschränkt. Bei intramuskulärer, subkutaner und intrapulmonaler Applikation wird es auf dem Lymphweg ab transportiert, ist im lokalen Kreislauf mit einer zunehmenden Zahl von RES-Zellen konfrontiert und tritt daher im Venensystem verzögert auf.

Inhalation oder Instillation in die Lunge ist eine neue Form der Heparinanwendung, die das Heparin einem sehr großen Zellpool zuleitet, mit dem Ergebnis einer langsamen Freisetzung des Heparins in den Kreislauf und das Gefäßendothel, was aber den Streß der wiederholten Venenpunktionen bzw. Injektionen vermeidbar macht. Das offensichtliche Fehlen einer Nachweisbarkeit des Heparins in der allgemeinen Zirkulation bei oraler Anwendung ist wahrscheinlich nicht die Folge einer fehlenden Resorption, sondern dadurch bewirkt, daß das Heparin dabei zuerst einen Großteil des RES und des Endothels passieren muß.

Die Schwierigkeiten, Heparin zu standardisieren, erklären sich aus seiner einzigartigen chemischen Natur sowie aus der daraus resultierenden Pharmakokinetik und aus der klinischen Wirkung.

Es ist zu vermuten, daß diese Schwierigkeiten durch eine Reihe von physikochemischen Spezifikationen überwindbar wären ausgehend von einer Anzahl von klinisch effektiven Handelsheparinpräparaten.

Die mangelnde Korrelation von Thromboseverhütungspotenz und Antikoagulansaktivität in vitro läßt vermuten, daß ein Heparin mit geringer Gerinnungsaktivität klinisch wirksam sein könnte. Blutungen bei der Anwendung von Antikoagulantien kommen durch eine Kombination von Ursachen, meist von Streß und Antikoagulation, zustande. Die Schutzwirkungen des Heparins und der Heparinoide bedürfen weiterer klinischer Erforschung, da sie vielleicht einen bedeutenden Faktor der Heparinwirkung darstellen.
Blutplättchen, Endothel und Tumorzellen
Authors: Steiner M.
Published: June 2018

Wir haben uns um eine ausgeglichene Interpretation des Für und Wider einer Beteiligung der Ausscheidungsprodukte von Thrombozyten und Endothelzellen an der hämatogenen Metastasierung maligner Tumoren bemüht. Die Bilanz reicht jedoch nicht aus, um den Thrombozyten die dominierende Rolle bei der Aussaat von Tumorzellen zuzuschreiben. Zweifellos gibt es maligne Tumoren, deren hämatogene Ausbreitung in hohem Maße von den Sekretionsprodukten der Blutplättchen und Endothelzellen abhängt. Eine tabellarische Zusammenstellung derartiger Tumoren müßte allerdings erst noch erstellt werden und würde bruchstückhaft bleiben. Jedoch selbst innerhalb der speziellen Gruppe beeinflußbarer Tumoren bleibt fraglich, ob die Verabreichung antithrombozytärer Substanzen und/ oder PGI2-Agonisten mehr als eine nur nachgeordnete Rolle in der Hemmung einer Metastasenbildung zu spielen vermag. Die hämatogene Aussaat bösartiger Zellen stellt einen so multifaktoriell ausgelösten Prozeß dar, daß eine scharf fokussierte Therapie wohl kaum in der Lage sein wird, dieses Geschehen zu unterdrücken. Da jedoch keine großangelegten Studien entsprechender therapeutischer Maßnahmen an einem repräsentativen Querschnitt verschiedener Tumoren existieren, muß jeder seine eigenen Schlußfolgerungen aus den vorliegenden Daten ziehen.
Dementia and Hearing Loss: Interrelationships and Treatment Considerations
Authors: Mamo Sara , Hopper Tammy , Hubbard H.
Published: June 2018

Hearing loss is common among typically aging older adults and those with dementia. In recent years, there has been a renewed interest in the relationship between hearing and cognition among older adults, and in hearing loss as a modifiable risk factor for dementia. However, relatively less attention has been focused on the management of hearing loss among individuals with dementia and the key roles of speech–language pathologists and audiologists in providing such care. In this article, the authors review the literature on hearing loss and dementia, and analyze the research evidence for treatment of hearing loss in the context of major neurocognitive disorders, such as Alzheimer's disease. This article provides an up-to-date review of research evidence for hearing interventions, as well as recommendations for speech–language pathologists and audiologists to work together to ensure access to hearing health care and increased opportunities for meaningful life engagement for people with dementia and hearing loss.
Person-Centered, Skilled Services Using a Montessori Approach for Persons with Dementia
Authors: Brush Jennifer , Bourgeois Michelle , Douglas Natalie
Published: June 2018

The current mandate for person-centered care throughout the health care system, and especially in the nursing home industry, requires that speech–language pathologists ensure that the services they provide to elders with dementia are skilled, person centered, and relevant to positive overall health outcomes. Guidelines developed by the Association Montessori International Advisory Board for Montessori for Aging and Dementia are one avenue toward such skilled and person-centered services. The purpose of this article is to provide clinicians with practical strategies for guiding their assessment, goal writing, and intervention plans to meet the expectations of a person-centered approach to services for elders with dementia, using the Montessori approach as a philosophical guide.
Arrested Hydrocephalus in Childhood: Case Series and Review of the Literature
Authors: Hurni Yannick , Poretti Andrea , Schneider Jacques , Guzman Raphael , Ramelli Gian Paolo
Published: June 2018

Introduction Hydrocephalus can be progressive or spontaneously arrested. In arrested hydrocephalus, the balance between production and absorption of the cerebrospinal fluid is restored. Patients are mostly asymptomatic, and no surgical treatment is necessary for them.

Methods We performed a two-center consecutive case series study, aimed at investigating the safety of nonsurgical management of hydrocephalus in selected pediatric patients. We retrospectively selected all consecutive patients, suspected to suffer from arrested hydrocephalus and referred to our two institutions between January 2011 and December 2013. Data on clinical and radiological follow-up were collected until June 2017.

Results Five children diagnosed with arrested hydrocephalus were included in the study. All patients presented macrocephaly as the main presenting sign. Associated mild-to-moderate stable motor disorders were assessed in four out of five cases. Typical symptoms and signs associated with acute raised intracranial pressure were absent in all patients. Magnetic resonance imaging studies showed ventriculomegaly in all patients. A diagnosis of arrested hydrocephalus was made in all five cases based on stable clinical and radiological findings during the initial observation. Conservative management based on active surveillance was, therefore, proposed. During the follow-up period, we observed stable or improved conditions in four out of five patients, while the remaining patient presented progressive hydrocephalus.

Discussion Making a distinction between arrested and progressive hydrocephalus is fundamental, because of the opposed appropriate management. Any newly discovered case of hydrocephalus, not characterized by clear signs of progressive hydrocephalus, should benefit from active surveillance before any definitive decision is taken.
Kongressnachlese DDG
Authors: Heinzl Susanne
Published: June 2018

Rund 1 000 Teilnehmer kamen zur DDG KOMPAKT & PRAXISNAH Anfang März 2018 in Stuttgart, die von der Deutschen Dermatologischen Gesellschaft (DDG) zusammen mit dem Berufsverband der Deutschen Dermatologen veranstaltet wurde. Ziel war es, praxisrelevante Inhalte in didaktisch ansprechender Weise zu präsentieren.
Use of an Elastomeric Knee Brace in Patellofemoral Pain Syndrome: Short-Term Results
Authors: Uboldi Francesco , Ferrua Paolo , Tradati Daniele , Zedde Pietro , Richards Jim , Manunta Andrea , Berruto Massimo
Published: June 2018

Purpose This article verifies the effectiveness of a new brace on patellofemoral pain syndrome (PFPS) in adjunct to a specifically developed rehabilitation program.

Methods Two groups of 30 patients with PFPS were prospectively and randomly allocated to a rehabilitation protocol, with (group A) or without (group B) the use of a specific brace. All the patients were assessed at 3, 6, and 12 months using the disease-specific Kujala scale and a visual analog scale (VAS) for pain; time to return to sport and patient satisfaction with the brace were also recorded.

Results Kujala scale's values showed constant and progressive improvement. The mean score at 6 months was 79.8 ± 6.8 points in group A and 76.8 ± 8.6 in group B, rising at 12 months to 80.9 ± 7.5 in group A and 78.4 ± 8.3 in group B. VAS scores significantly differed (p < 0.05) between the two groups at both 6 and 12 months; the score recorded at 12 months was 0.9 ± 1.3 in the brace-treated group and 1.8 ± 1.6 in the controls. The patients who used a brace showed a quicker return to sports and 75% of the patients in this group were satisfied.

Conclusion All the scores improved progressively in both groups. The most significant improvement concerned pain, showing that the brace used in this study may allow a better subjective outcome and a quicker return to sport.

Level of Evidence Level II, prospective randomized controlled trial.
Distalization and Medialization of Tibial Tuberosity for the Treatment of Potential Patellar Instability with Patella Alta
Authors: Enea Davide , Canè Pier Paolo , Fravisini Marco , Gigante Antonio , Dei Giudici Luca
Published: June 2018

Purpose The aim of the study was to test the distalization and medialization of the tibial tuberosity (DMTT) for the treatment of patellar instability associated with patella alta, focusing on residual instability and pain.

Methods Twenty-four consecutive patients (26 knees) suffering from patellofemoral instability and patella alta were treated by DMTT. Two groups were identified, which differed for documented history of frank patella dislocation. The groups were named objective patellar instability (OPI) (history of dislocation) and potential patella instability (PPI) (no dislocation). Outcome was measured with visual analogue scale (VAS), Kujala score, and Tegner score. Comparison between groups was performed using Student's t-test, Wilcoxon rank score, and Fisher's exact test (significance at p < 0.05).

Results At 50 ± 18 and 41 ± 18 months of follow-up, respectively, both PPI and OPI groups obtained a significant pain reduction and functional improvement. The PPI group showed a significant decrease of the subjective instability. No procedure-related complications were reported.

Conclusion This study suggests that DMTT is a viable option for PPI patients with patella alta. The outcome was comparable between PPI and OPI cases; however, decrease in subjective instability was significantly greater in PPI patients.

Level of Evidence Level III, retrospective comparative study.
Total Hip Arthroplasty in Patients 21 Years and Younger Using Highly Cross-Linked Polyethylene: Excellent Survivorship at Five Years
Authors: Adelani Muyibat , Bohnenkamp Frank , Pashos Gail , Clohisy John , Sassoon Adam
Published: June 2018

The survivorship of contemporary total hip arthroplasty has improved substantially as a result of the success of highly cross-linked polyethylene. Nevertheless, there is limited information on its performance in extremely young patients. The purpose of this study is to evaluate the (1) clinical and radiographic outcomes, (2) polyethylene wear rates, and (3) mid-term survivorship of total hip arthroplasty in patients 21 years or younger using highly cross-linked polyethylene. After Institutional Review Board approval, the authors identified 45 patients aged 21 years or younger (56 hips) who underwent primary total hip arthroplasty with highly cross-linked polyethylene at their institution by the senior author between 2000 and 2009. Patients were followed for a minimum of 2 years, or until revision. At a mean follow-up of 57 months, modified Harris Hip Scores, Western Ontario McMaster Universities Arthritis Index scores, Short Form-12 physical function scores, and University of California, Los Angeles activity scores improved significantly in all patients. There was no radiographic evidence of osteolysis in any patient. The mean linear polyethylene wear rate was 0.02 mm per year. Survivorship was 98% with one revision for acetabular loosening at 71 months. Total hip arthroplasty in patients 21 years or younger with highly cross-linked polyethylene had excellent clinical and radiographic outcomes at mid-term follow-up. Longer-term data are needed in this patient population to confirm continued survivorship in the extremely young. The level of evidence used for this study was level III.
Outpatient Surgical Management of Orbital Blowout Fractures
Authors: Bregman Jana A. , Vakharia Kalpesh T. , Idowu Oluwatobi O. , Vagefi M.Reza , Grumbine F. Lawson
Published: June 2018

There is ample investigation into the optimal timing and approach to orbital blowout fracture (OBF) repair; however, less attention has been directed toward postoperative care. This is a multicenter IRB-approved retrospective review of patients with OBF presenting to our study sites between November 2008 and August 2016. Those with isolated OBF, over 18 years of age, and who had not suffered additional facial injuries or globe trauma were included. A total of 126 surgical cases of isolated OBF repair were identified that met our inclusion and exclusion criteria; 42.1% were outpatient repairs while the remaining 57.9% were admitted for overnight monitoring. Time elapsed prior to repair differed between the two groups at a mean of 8.4 days versus 5.2 days for the outpatient and inpatient cohorts, respectively ( p = 0.001). A majority of inpatient cases underwent immediate repair, while a majority of outpatient cases were delayed. There were two cases of RBH in the outpatient cohort resulting in an overall incidence of 1.6%. In both instances, a significant change in clinical exam including decreased visual acuity, diplopia, and eye pain prompted repeat evaluation and immediate intervention for hematoma evacuation. Estimated hospital charges to the patient's insurance for key components of an inpatient versus outpatient isolated OBF repair amounted to a total cost of $9,598.22 for inpatient management and $7,265.02 for outpatient management without reflexive postoperative imaging. Reflexive postoperative CT scans were obtained in 76.7% of inpatient cases and only two led to a reoperation. No outpatient repairs included reflexive postoperative imaging. Outpatient OBF repair is an attractive alternative to inpatient management.

The potential cost savings of outpatient management of OBF, which do not detract from quality or safety of patient care, should not be ignored. Our results will hopefully contribute to updated shared practice patterns for all subspecialties that participate in the surgical management of OBF.
Neue Substanzen für die CLL: Einordnung der minimalen Resterkrankung
Authors: Krome Susanne
Published: June 2018

Chemoimmuntherapien (CIT) haben sich als Standard für Patienten mit einer neu diagnostizierten oder rezidivierten CLL etabliert. Die minimale Resterkrankung (MRD) als prognostisches und prädiktives Kriterium ergänzt den klassischen Remissionsstatus. Die beste Nachweismethode, der günstigste Zeitpunkt für die Erhebung des MRD-Status und die klinische Relevanz sind für die neuen Substanzen nicht eindeutig geklärt. Ein aktueller Review fasst die vorliegenden Daten zusammen und belegt, dass es vor allem an einer Standardisierung fehlt.
Immuntherapie des NSCLC: Next Generation Sequencing sagt Ansprechen voraus
Authors: Kretzschmar Alexander
Published: June 2018

Mithilfe eines Next Generation Sequencing (NGS) kann man bei Patienten mit fortgeschrittenem nicht-kleinzelligem Bronchialkarzinom (NSCLC) die Tumorlast bestimmen und daraus die Wahrscheinlichkeit errechnen, ob der Patient von einer Therapie mit Immun-Checkpoint-Inhibitoren profitiert.
Immuntherapien beim NSCLC: Mutationsstatus als Prädiktor für den Therapieerfolg
Authors: Krome Susanne
Published: June 2018

PD1- und PD-L1-Inhibitoren sind für die Zweitlinienbehandlung des fortgeschrittenen nicht kleinzelligen Bronchialkarzinoms (NSCLC) in Konkurrenz zur Standardtherapie mit Docetaxel getreten. Unklar ist, welche Patienten eher von den Immun-Checkpoint-Inhibitoren und welche stärker von einer Standard-Chemotherapie profitieren. In einer Metaanalyse erwies sich der EGFR-Mutationsstatus als prädiktiv für das Therapieergebnis.
Micro-spot gamma-ray generation based on laser wakefield acceleration
Authors: Dong Kegong , Zhang Tiankui , Yu Minghai , Wu Yuchi , Zhu Bin , Tan Fang , Wang Shaoyi , Yan Yonghong , Yang Jing , Yang Yue , Lu Feng , Li Gang , Fan Wei , Hong Wei , Zhao Zongqing , Zhou Weimin , Cao Leifeng , Gu Yuqiu
Published: June 2018

The radiography of gamma-ray is one of the most important non-destructive testing in many fields. However, the spot size is always in millimeter scale for the generation of gamma-ray by conventional way. As the development of laser wakefield acceleration, the electron beam with small divergence and spot size can be generated easily in the experiment by tens of terawatt ultra-short laser pulse. Based on this electron beam, gamma-ray with micro spot size is generated and the properties are measured and tested in detail experimentally. The experiment demonstrates that the spot size of this gamma-ray is always smaller than 200 μm, no matter the conversion target thickness, and can be as small as about 40 μm when the conversion target thickness of 0.2 mm is used. The spatial resolution of this gamma-ray is much better than 2.5 LP/mm, the fitting temperature (which is relative to the average energy of gamma-ray) is between 5 MeV and 8 MeV, and the maximum yield per shot of the gamma-ray can be up to 9.1 × 109 photons (energy higher than 1 MeV). High-resolution radiography shows that the areal density of the gamma-ray radiography can be up to 51.3 g/cm2 (stainless steel thickness equivalent is about 6.5 cm). Such micro-spot gamma-ray can play an important role in the high-resolution radiography of high areal density objects.
Introducing hinge mechanisms to one compressive-mode piezoelectric energy harvester
Authors: Li Zhongjie , Zu Jean , Yang Zhengbao
Published: June 2018

In this paper, a hinge mechanism is introduced into one compressive-mode piezoelectric energy harvester to improve its performance. First, the concept of implementing hinge mechanisms is introduced on a high-efficiency compressive-mode piezoelectric energy harvester (HC-PEH). Second, a numerical model based on the piezoelectric constitutive equation and the Duffing oscillator equations is formulated to obtain voltage responses, velocity responses, and the fundamental frequency and bandwidth. Then, a prototype is fabricated to validate the results of the model. Depending on the number of hinges applied to the HC-PEH, three cases are investigated: fully hinged, partially hinged, and clamped. In both numerical modeling and experimental studies, the HC-PEH prototypes in the three cases are exposed to frequency-sweep excitations to illustrate the dynamic and transduction behaviors. The results demonstrate that the overall performance in the hinged cases is improved significantly compared to that in the clamped case. The output voltage and output power are increased by 2–3 times and up to 5 times, respectively, and fundamental resonant frequency is lowered to below 20 Hz. Furthermore, it is shown that the operational bandwidth is widened by up to 37%.
Coherent states for Kratzer-type potentials
Authors: Kandirmaz Nalan
Published: June 2018

The coherent states for a particle in Kratzer type potentials are constructed by solving Feynman’s path integral. The action of the generalized Kratzer potential is transformed into two harmonic oscillators by Levi-Civita transformation to derive the parametric time coherent states. Green’s function, energy eigenvalues, and the corresponding wave functions for this potential are calculated. The evaluated results are reduced to the modified Kratzer potentials and Kratzer-Fues oscillators which are special cases of the generalized Kratzer potential.
Large field of view imaging system for remote target capture and trajectory measurement based on cone rotation
Authors: Zhang Xiang , Gao Yunguo
Published: June 2018

In the remote target trajectory measurement system, because of the size limitation of the image sensor, the angle of view of the current telephoto camera is very small, which cannot meet the requirements of target acquisition. After comparing the current large-field imaging methods, a scheme of a large field of view (FoV) and high frame rate scanning by controlling the camera to perform conical rotation is proposed, and a 3 × 3 external FoV stitching system that includes the scheme is designed. An experimental prototype was constructed to verify the system. In this paper, the mechanical structure of the prototype, the camera exposure control flow, and the image data processing flow are introduced, and the imaging motion feature of the prototype caused by the camera exposure during conical motion is analyzed. In the experiment, the prototype controlled the camera accurately exposed to the sub-fields. Using a camera with an angle of view of 0.78°, a large angle of view system of 2.23° was obtained by FoV stitching. The system we present is less difficult to implement and has obvious advantages in volume and weight compared to multi-camera arrays. It is suitable for engineering applications in remote target measurement system.
Criegee intermediate inside fullerene cage: Evidence for size-dependent reactivity
Authors: Kumar Manoj , Zhong Jie , Zeng Xiao Cheng , Francisco Joseph S.
Published: June 2018

In the theoretical calculations reported here, we show that the hydration of the Criegee intermediate within the sub-nanospace of fullerene cages occurs differently in different fullerenes, thereby providing evidence for the size-dependent reactivity inside these exotic carbon cages. Upon C70 or C84 encapsulation, the Criegee hydration occurs instantaneously without any activation barrier, whereas inside the C120 cage, the hydration involves a small barrier of 4.4 kcal/mol. Our Born-Oppenheimer molecular dynamics simulations suggest that the Criegee intermediate and the product of its hydration, α-hydroxy methyl hydroperoxide, remain dynamically stable over 20 ps time scale at the 300 K, implying that fullerene cages provide a robust framework for reactivity.
Atomic diffusion in liquid nickel: First-principles modeling
Authors: Walbrühl Martin , Blomqvist Andreas , Korzhavyi Pavel A.
Published: June 2018

Self- and impurity diffusion coefficients are assessed in the liquid nickel system by the fundamental ab initio molecular dynamics approach. The impurity diffusion coefficients in the Ni-X systems (X=C, Co, N, Nb, Ta, Ti, W) are mostly not available in the current literature. The simulations are performed at four temperatures, in the range from 1903 to 2303 K, which allows to extract activation energies and frequency factors for the temperature dependent diffusion coefficient assuming an Arrhenius-type behavior in the liquid. In addition to the temperature dependence, the concentration-dependent impurity diffusion was investigated for the Ni-Co system. The data are of relevance for the development of the state-of-the art Ni-based superalloys and alternative binder systems in cemented carbides. The obtained theoretical results are in very good agreement with the limited experimental data for the diffusion in liquid Ni systems.
Waveguide instability in streaming e-p-i dense plasmas
Authors: Jamil M. , Ayesha R. , Rasheed A. , Iqbal Z. , Asif M.
Published: June 2018

An electrostatic wave in a bounded geometry is studied for e-p-i quantum plasmas. The quantum hydrodynamic model is employed to find the dispersion relation of waveguide mode. The complex frequency leads to the growth rate and the phase speed in the cylindrical geometry. The numerical analysis of the growth rate and the phase speed of cylindrical waveguide is given graphically on varying the parameters. The growth rate and the phase are affected by the geometric dimensions, quantum parameter, streaming effects, and the number density.