bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel radiographic method to facilitate measurement of the tibial plateau angle in dogs
Authors: Cook J. , Helphrey M. , Crouch D. , Fox D. , Schultz L. , Cook C. , Kunkel J. , Headrick J. 
Published: March 2018

SummaryThe tibial plateau levelling osteotomy (TPLO) is commonly performed for treatment of cranial cruciate ligament deficiency in dogs. In order to be performed as described, this procedure relies on consistent measurement of the tibial plateau angle (TPA) on radiographs. This prospective study compared two radiographic methods for subsequent TPA measurement with respect to measured angle and ease of determining landmarks for measurement as determined by four observers. One method was the accepted standard radiographic protocol outlined in the TPLO training seminars. The other method involved a novel split image radiographic protocol not yet described in the literature. Participants' subjective scores as to ease of identifying landmarks and determining TPA on radiographs for each method were evaluated. Inter-observer TPA measurement variability was also assessed for each method. The novel radiographic method was judged to be significantly better in terms of ease of measuring TPA. Inter-observer measurement variability was considered appropriate for recommending use of this novel method for radiographing patients for TPA measurements.
Contact mechanics of the ovine stifle during simulated early stance in gait
Authors: Lee-Shee N. K. , Hurtig M. B. , Dickey J. P. 
Published: March 2018

SummaryOvine stifle joint contact pressures and contact areas were measured in vitro using a six degree-of-freedom (DOF) robotic system. The robot generated static joint loads of 1.875 times body weight (BW) compression, 0.15 BW medial shear and 0.625 BW cranial shear at 6.5o of flexion for four specimens, simulating the early stance phase of gait (walking). This condition represents a period of intense loading and was implemented as a worst-case loading scenario for the joint at this gait. We determined that the medial and lateral compartments bore 5.5 ± 0.9 MPa and 4.4 ± 1.1 MPa of mean pressure, respectively, on 107.7 ± 28.7 mm2 and 60.8 ± 56.3 mm2 of area, respectively. The unique contribution of this study is that stifle contact pressures and areas were determined during loading which simulated physiological levels (early stance phase of gait). This information is important to our understanding of the stresses that must be borne by repair tissues/constructs that are implanted into human and animal tibio-femoral joints.
Diagnostic findings in a lame-free dog with complete rupture of the biceps brachii tendon
Authors: van Ryssen B. , Gielen I. , Taeymans O. , van Bree H. , Wiemer P. 
Published: March 2018

SummaryA case of a complete rupture of the biceps brachii tendon in a lame-free three-year-old Labrador Retriever is described. The dog had a history of chronic lameness following a trauma, but had become lame-free shortly before presentation. Clinical examination, biceps tendon test and shoulder instability tests under general anaesthesia were inconspicuous for shoulder instability. Routine radiographs, arthrography and ultrasound were suspicious for bicipital tendopathy. The definite diagnosis of a complete rupture of the biceps brachii tendon was made upon arthroscopic inspection of the glenohumeral joint.
Schwere systemische juvenile idiopathische Arthritis und familiäres Mittelmeerfieber mit homozygoter Mutation im MEFV-Gen
Authors: Geikowski T. , Peters D. , Peitz J. , Horneff G. , Wintrich S. 
Published: March 2018

ZusammenfassungDie systemische juvenile idiopathische Arthritis (sJIA) und das familiäre Mittelmeerfieber (FMF) zeigen mit Fieber, Arthritis, Exanthem, generalisierter Lymphadenopathie und Sero sitis viele Gemeinsamkeiten. Therapieoptio-nen bei der sJIA sind neben Glukokortikoi-den, nichtsteroidalen Antirheumatika und Methotrexat, Biologika wie Interleukin-1-und Interleukin-6-Antagonisten. Firstline Therapie des FMF ist Colchicin. Bei Therapie resistenz oder -unverträglichkeit können aber auch bei dieser Erkrankung Interleukin-1-und Interleukin-6-Antagonisten erfolgreich eingesetzt werden.Berichtet wird über einen elf Jahre alten Jungen, geboren in Armenien. Im Alter von zwei Jahren kam es zu anhaltendem Fieber mit ausgeprägter Arthritis. Die Diagnose sJIA wurde gestellt und das Vorliegen eines FMF genetisch nachgewiesen. Unter Therapie mit Kortikosteroiden, Sulfasalazin und Colchicin entwickelte der Patient eine deutliche Dystro phie und ausgeprägte Destruktionen der Hüft-, Knie- und Sprunggelenke mit resultie-render Laufunfähigkeit. Die Halswirbelsäule war durch Ankylosen kyphotisch fixiert. La borchemisch waren die Entzündungszeichen deutlich erhöht. Röntgen- und CT-Aufnah-men zeigten das Ausmaß der Gelenkzer -störung. Nach einem Jahr unter intravenöser Tocilizumab-Therapie liegen CRP, SAA und BSG im Normbereich. Bestehende Kontraktu ren sind unter intensiver Physiotherapie rück-läufig. Der Patient ist mit eigenem Rollstuhl mobil.Bei diesem Patient liegt sowohl eine systemische JIA als auch ein familiäres Mittelmeerfieber vor. Tocilizumab ist bereits seit mehreren Jahren für die Behandlung der systemischen JIA zugelassen. Unser Patient zeigt unter Tocilizumab eine Remission beider Erkrankungen.
Perikoxale Schmerzsyndrome – nicht immer einfach zu diagnostizieren
Authors: Guttke T. , Arnold I. 
Published: March 2018

ZusammenfassungPertrochantäre Schmerzen stellen ein häufiges klinisches Problem dar. Auch wenn perikoxale Schmerzsyndrome bereits früh beschrieben worden sind, hat die Weiterent-wicklung der arthroskopischen Techniken unter Einbezug der extrakapsulären Kompartimente die Sensibilität für diese häufig fehl -interpretierten Erkrankungsformen erhöht. Voos und Mitarbeiter veröffentlichten 2007 sehr früh ihre ersten Ergebnisse im Hinblick auf endoskopische Interventionen in diesem Zusammenhang (1). Andere Erkrankungsformen wie das “low anterior inferior iliac spine impingement” wurden sogar erst durch die Hüftarthroskopie der Beschreibung zugänglich. Zu den pertrochantären Pathologien, die das laterale Kompartiment betreffen, zählen Bursitiden und Insertionstendinosen der Glutealmuskulatur bis hin zur Ruptur und das Tractus-iliotibialis-Syndrom einschließlich der externen Schnapphüfte. Projektionsschmerzen von der proximalen Lendenwirbelsäule sind in dieser Übersicht nicht berücksichtigt, verursachen aber in bis zu 30 % pertrochantäre Beschwerden. Auf nervaler Ebene können Irritationen des inferioren Glutealnervs mit radikulärem Ursprung L5–S2 (Innervation des M. gluteus maximus) oder des N. gluteus superior (Wurzeln L4–S1; Innervation des M. gluteus medius und minimus, M. tensor fasciae latae und vordere Partien des Hüft gelenks) Trochanter-bezogene Schmerzen imitieren. Im ventralen extraartikulären Kompartiment kann eine Friktion der Sehne des M. iliopsoas ein internes Impingement und Schnappen verant-worten. Natürlich sind differenzialdiagnostisch auch Arthrose-assoziierte muskulotendinöse Kontrakturen oder auch Gangasymmetrien bzw. Störungen im lumbosakralen Übergang mit konsekutiven muskulären Dysbalancen auszuschließen. Aber auch nach Hüftgelenkersatz stellen unzureichend azetabulär-knöchern gedeckte Pfannenkomponenten eine Disposition für eine Irritation der Hüftbeuger dar. Anatomisch dem posterioren Bereich zugeordnet sind die Strukturen um den Nervus ischiadicus (z. B. Entrapmentphänomene durch fibrinöse Stränge), die Hüftaußenrotatoren und explizit der M. piriformis. Aber auch Insertionstendinopathien der Hamstrings sind differenzialdiagnostisch perikoxalen Schmerzsyndromen zuzuordnen.
Thrombophilia in the young
Authors: Kurnik K. , Krümpel A. , Stoll M. , Nowak-Göttl U. 
Published: March 2018

SummaryVenous thromboembolism (VTE) is a rare disease that is being increasingly diagnosed and recognized in paediatrics in the past decade, usually as a secondary complication of primary severe underlying diseases. Apart from acquired thrombophilic risk factors, such as lupus anticoagulants, inherited thrombophilias (IT) have been established as risk factors for venous thromboembolic events in adults. In children with idiopathic VTE and in paediatric populations in which thromboses were associated with underlying medical diseases, IT have been described as additional prothrombotic risk factors. Follow-up data for VTE recurrence in children are available and suggest a recurrence rate of approximately 3% in neonates and 8% in other children. Here we present a review of the impact of IT on early onset of VTE and recurrence in children. Statistically significant associations between the IT traits investigated, e.g. factor V G1691A, factor II G20210A, protein C-, protein S-, antithrombin deficiency, elevated lipoprotein (a), combined IT and VTE onset were reported. In addition, statistically significant associations with recurrent VTE were calculated for protein S-, antithrombin-deficiency, and the factor II variant and combined IT. The absolute risk increase for VTE recurrence associated with IT ranged from 9.8 % for children carrying the factorII variant to 26% and 29% in children with combined IT and protein S-deficiency, respectively. Data obtained gave evidence that the detection of IT is clinically meaningful in children with VTE and underlines the importance of a paediatric thrombophilia screening program. Based on these data treatment algorithms have to be discussed.
Role of coagulation and fibrinolysis in lung and renal fibrosis
Authors: Ruppert C. , Markart P. , Wygrecka M. , Preissner K. T. , Günther A. 
Published: March 2018

SummaryElevated procoagulant and suppressed fibrinolytic activities are regularly encountered in different forms of clinical and experimental fibrosis of the lungs and the kidneys. Although primarily serving to provide a provisional matrix of repair largely consisting of fibrin and fibronectin, the involved procoagulant serine proteases and protease inhibitors may also exert distinct cellular downstream signaling events modifying the fibrotic reponse.In this review, evidence for an impaired regulation of coagulation and fibrinolysis factors in clinical and experimental lung and renal fibrosis is provided and the role of PAR (protease activated receptor) induced profibrotic and HGF (hepatocyte growth factor) elicited antifibrotic cellular events is worked out. In view of experiments obtained in animal models of lung and renal fibrosis, the potential therapeutic usefulness of anticoagulant or profibrinolytic strategies is discussed.
Pulmonary embolism
Authors: Humenberger M. , Lang I. M. 
Published: March 2018

ZusammenfassungDie akute Pulmonalembolie ist Teil des Spektrums venöser Thromboembolien. Die tiefe Beinvenenthrombose, der akute Thrombus in Transit durch das rechte Herz, die akute Pulmonalembolie selbst und die chronisch thromboembolische pulmonale Hypertension (CTEPH) gehören dazu. Pulmonalembolie kann rezidivieren und schwere Spätfolgen (z. B. postthrombotisches Syndrom, CTEPH) nach sich ziehen.Diese Übersicht fasst aktuelle Konzepte zur Pathophysiologie, Epidemiologie, Diagnose und Therapie dieser häufigen Erkrankung zusammen.
Thrombophilia in the young
Authors: Kurnik K. , Krümpel A. , Stoll M. , Nowak-Göttl U. 
Published: March 2018

SummaryVenous thromboembolism (VTE) is a rare disease that is being increasingly diagnosed and recognized in paediatrics in the past decade, usually as a secondary complication of primary severe underlying diseases. Apart from acquired thrombophilic risk factors, such as lupus anticoagulants, inherited thrombophilias (IT) have been established as risk factors for venous thromboembolic events in adults. In children with idiopathic VTE and in paediatric populations in which thromboses were associated with underlying medical diseases, IT have been described as additional prothrombotic risk factors. Follow-up data for VTE recurrence in children are available and suggest a recurrence rate of approximately 3% in neonates and 8% in other children. Here we present a review of the impact of IT on early onset of VTE and recurrence in children. Statistically significant associations between the IT traits investigated, e.g. factor V G1691A, factor II G20210A, protein C-, protein S-, antithrombin deficiency, elevated lipoprotein (a), combined IT and VTE onset were reported. In addition, statistically significant associations with recurrent VTE were calculated for protein S-, antithrombin-deficiency, and the factor II variant and combined IT. The absolute risk increase for VTE recurrence associated with IT ranged from 9.8 % for children carrying the factor II variant to 26% and 29% in children with combined IT and protein S-deficiency, respectively. Data obtained gave evidence that the detection of IT is clinically meaningful in children with VTE and underlines the importance of a paediatric thrombophilia screening program. Based on these data treatment algorithms have to be discussed.
Niedrigdosierte direkte Katheterlyse venöser Thrombosen des Schultergürtels
Authors: van Werde M. , Timmermann J. , Lachhein M. 
Published: March 2018

ZusammenfassungBei venösen Thrombosen des Schultergürtels bietet sich eine direkte Applikation thrombolytischer Substanzen in das verschlossene Venensegment an, da man von einer geringen Spontanrekanalisationsrate und der Wahrscheinlichkeit chronischer Beschwerden ausgehen muß.Bei 14 Patienten mit nachgewiesenen ausgeprägten Schultervenenthrombosen (Anamnesedauer 2-35 d, Mittelwert 11 d) wurde eine direkte venöse Katheterlyse durchgeführt. Über einen Lysekatheter wurde das Fibrinolytikum (20 mg rt-PA in 6 h/d) mit suffizienter Heparingabe (PTT 1,5fach) in das thrombosierte Venensegment appliziert. Die Therapiedauer betrug 2 bis maximal 5 Tage. Zusätzlich führten wir nach der Lysetherapie bei 5 Patienten eine Ballondilatation und ergänzend zweimal eine Stentimplantation bestehender venöser Stenosen im ehemals thrombosierten Gefäßsegment durch.Eine vollständige Rekanalisation wurde bei 8 Patienten erreicht, bei 3 Patienten eine Teilrekanalisation; 3 Fälle waren nicht zu eröffnen. Lebensbedrohliche Komplikationen traten nicht auf. In der Langzeitbeobachtung bis 30 Monate nach der Therapie wiesen 12 Patienten keine Beschwerden mehr auf, 2 Patienten klagten über Funktionseinschränkungen und Schwellneigung.
Response to DDAVP in children with von Willebrand disease type 2
Authors: Budde U. , Beutel K. , Hassenpflug W.-A. , Hauch H. , Obser T. , Oyen F. , Schneppenheim S. , Schrum J. , Schneppenheim R. 
Published: March 2018

SummaryWe have prospectively evaluated the biologic response to desmopressin (DDAVP) in 28 children with type 2 von Willebrand disease (VWD) in correlation with the phenotype and the molecular defect of VWF. The diagnosis of VWD type 2 was mainly based on VWF functional parameters and/or an aberrant VWF multimer pattern. Seventeen different mutations were identified (6 of them novel). No response with respect to the functional parameters VWF:RCo and/or VWF:CB was seen in patients with severe abnormality of the VWF multimer pattern. One patient with VWD type 2A phenotype IIC Miami did not respond with respect to VWF:CB, but showed a good response of VWF:Ag and FVIII:C as expected. Interestingly he showed a persistently high level of VWF:Ag and FVIII:C up to 4 hours after DDAVP infusion. Patients with minor alterations of multimer structure and particular mutations responded well to DDAVP, whereas patients with normal multimer structure but a defect in platelet dependent functional parameters did not respond with VWF:RCo. Conclusion: Children with VWD type 2 show a variable response to desmopressin depending on the mutation that correlates with the functional defect and the presence or absence as well as the half-life of large VWF multimers. Our data emphasize the usefulness of DDAVP testing even in patients with VWD type 2, possibly with the exception of VWD type 2B.
ITI with high-dose FIX and combined immunosuppressive therapy in a patient with severe haemophilia B and inhibitor
Authors: Hauch H. , Rischewski J. , Kordes U. , Schneppenheim J. , Schneppenheim R. , Beutel K. 
Published: March 2018

SummaryInhibitor development is a rare but serious event in hemophilia B patients. Management is hampered by the frequent occurrence of allergic reactions to factor IX, low success rates of current inhibitor elimination protocols and the risk of development of nephrotic syndrome. Single cases of immune tolerance induction (ITI) including immunosuppressive agents like mycophenolat mofetil (MMF) or rituximab have been reported. We present a case of successful inhibitor elimination with a combined immune-modulating therapy and high-dose factor IX (FIX). This boy had developed a FIX inhibitor at the age of 5 years and had a history of allergic reactions to FIX and to FEIBA→. Under on-demand treatment with recombinant activated FVII the inhibitor became undetectable but the boy suffered from multiple joint and muscle bleeds. At the age of 11.5 years ITI was attempted with a combination of rituximab, MMF, dexamethasone, intravenous immunoglobulins and high-dose FIX. The inhibitor did not reappear and FIX half-life normalized. No allergic reaction, no signs of nephrotic syndrome and no serious infections were observed.
Severe prekallikrein deficiency due to a compound heterozygosis in the KLKB1-gene
Authors: Kochhan L. , Heuchel P. , Jenderny J. , Maak B. 
Published: March 2018

SummaryA 14 year old boy was referred to us for a detailed coagulation study because a previously performed aPTT has been found prolonged. The boy had no history of bleeding symptoms and also the family history was negative for bleeding or thrombotic events. The aPTT in the patient was 96 s (reference range: 24–36 s), prothrombin time and thrombin time were both normal.As the cause for the prolonged aPTT we identified a severe prekallikrein deficiency (prekallikrein activity < 1%). The prekallikrein deficiency results from two mutations in the KLKB 1-gene: first, an insertion of 1 bp in codon 149 in exon 5 and, second, a base exchange Cys 548 (TGC) > Tyr (TAC) in exon 14. The boy inherited the first mutation from his father and the second from his mother. The mutation in the paternal allele was not described before the completion of our study. There are two brothers of the propositus, one with normal prekallikrein activity and no mutations in the KLKB1-gene, the other showed the same constellation as the propositus.
New anticoagulants for secondary haemostasis
Authors: Nowak G. 
Published: March 2018

SummaryIn contrast to heparins and oral anticoagulants, anti IIa inhibitors (thrombin inhibitors) are able to directly inhibit the protease activity of thrombin and can thereby precisely control the blood coagulation process.Direct thrombin inhibitors are either biosimilars (r-hirudin) or synthetically produced substances (bivalirudin, argatroban, dabigatran). In 1997 r-hirudin was introduced into clinical practice, however due to its narrow therapeutic range and the necessity of drug monitoring it has not gained widespread clinical use by now. Since 2004 and 2005 the synthetic thrombin inhibitors bivalirudin and argatroban, respectively, are available. With dabigatran the first oral synthetic thrombin inhibitor followed in 2008. These four drugs can inhibit even clot bound thrombin and show low plasma protein binding. They differ in respect to route and duration of application as well as elimination from the body, thereby offering a precise inhibition of blood coagulation adjusted to the individual case and without danger of HIT II. These advantages shall be used and advanced by the development of further direct thrombin inhibitors.
Psychosoziale Krankheitsbelastungen und Lebensqualität beim Lymphödem
Authors: Földi E. , Vanscheidt W. , Augustin M. , Bross F. 
Published: March 2018

ZusammenfassungObwohl die Erforschung der Lebensqualität in den letzten Jahren zunehmend an Bedeutung gewonnen hat, gibt es bisher kaum Untersuchungen zur Krankheitsbelastung beim chronischen Lymphödem. Die wenigen publizierten Arbeiten betreffen vorwiegend Frauen mit sekundärem Lymphödem nach Brustkrebsbehandlung. Sie zeigen, daß diese Patienten unter zahlreichen funktionellen und psychosozialen Belastungen leiden. Neben der Bewegungsbeeinträchtigung der betroffenen Extremität fällt vielen Frauen vor allem das Annehmen des neuen, disproportionierten Körpers schwer. Verbunden mit Einschränkungen der Arbeits- und Leistungsfähigkeit bedeutet dies für viele Patienten eine Einschränkung ihres Selbstwertgefühls und ihrer Lebensqualität. Weitere Studien mit verbesserten Methoden der Lebensqualitätserfassung sind notwendig, um Patienten mit besonders hohen zu erwartenden Belastungen im Vorfeld zu erkennen und rechtzeitig zu behandeln.
Duplexsonographische Untersuchungen zum venösen Stromzeitvolumen in der Vena femoralis bei CVI
Authors: Köhler P. , Utermann Sabine , Kahle Birgit 
Published: March 2018

Zusammenfassung
Ziel: Die Duplexsonographie eignet sich zur Erfassung funktioneller Parameter in der phlebologischen Diagnostik. Die Hämodynamik in der Vena femoralis communis kann durch das Stromzeitvolumen (SV) charakterisiert werden. Ob dieser Wert als Referenzwert für die Schwere einer venösen Abstromstörung bei Venenerkrankungen gelten kann, ist Thema der vorgestellten Arbeit. Methode: Drei Kollektive wurden untersucht: 77 Venengesunde, Patienten mit kompletter (n = 82) und inkompletter (n = 30) Stammvarikose der V. saphena magna. SV wurde unter standardisierten Bedingungen in horizontaler Lage bei außenrotiertem Bein und 45° erhöhten Oberkörper bestimmt. Die Berechnung erfolgte durch Integration der venösen Flußgeschwindigkeit in bezug auf den Diameter (SV-D) und den Umfang (SV-U) der V. femoralis. Ergebnis: Die drei Kollektive unterschieden sich signifikant hinsichtlich der erhobenen SV-Daten (p <0,005). Die Mittelwerte m-SV bei kompletter Stammvarikose lagen mit mSV-D = 0,34 l/min und mSV-U = 0,37 l/min signifikant höher als die Werte bei Gesunden. mSV-D und mSV-U betrugen hier jeweils 0,15 l/min. Bei inkompletter Stammvarikose lagen die Mittelwerte mit mSV-D = 0,27 l/min und mSV-U = 0,30 l/min numerisch zwischen den Werten der beiden anderen Gruppen. Schlußfolgerung: Die Ergebnisse lassen darauf schließen, daß das Stromzeitvolumen der V. femoralis als valider Parameter zur Quantifizierung einer venösen Abstromstörung gelten kann.
Out-patients haemophilia treatment in hospital
Authors: Glaeske G. , Schramm W. , Herzig D. 
Published: March 2018

SummaryAlthough hospitals primarily provide treatment for in-patients, treatment is also given to a large number of out-patients. The law covering haemophilia patients, who receive their treatment as out-patients, actually has several different bases. This has advantages and disadvantages. The question concerning us: Which, at the moment, is the best legal basis for any care-agreement? Another important factor for any agreement between the two parties, is that there should be a broad consensus, based on shared interests.The common aim should be the future guarantee for the treatment of patients suffering from haemophilia in suitable medical facilities. At the same time care must be taken to provide an efficient and economically viable care-service for these patients, as well as ensuring that the quality and efficiency of the service remain transparent.