bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patientensicherheit
Authors: Beyer Katharina , Heidecke Claus-Dieter 
Published: July 2018

ZusammenfassungSeit vor knapp 20 Jahren vermeidbare Fehler in Bezug auf die Krankenhausmortalität einen höheren Stellenwert in der öffentlichen Aufmerksamkeit erfuhren, wurden sowohl international als auch national Maßnahmen zur Verbesserung der Patientensicherheit ergriffen. Dabei definierte die WHO sogenannte „Global Patient Safety Challenges“ mit dem Ziel, Risikobereiche für vermeidbare Fehler zu identifizieren und durch Maßnahmenpakete diesen vorzubeugen. In Deutschland wurde die Kampagne „Save lives: clean your hands“ durch die Aktion Saubere Hände umgesetzt. Diese führte zu einer verbesserten Compliance hinsichtlich der hygienischen Händedesinfektion. Die flächendeckenden Folgen hinsichtlich nosokomialer Infektionen und der Übertragung multiresistenter Erreger sind noch nicht ausreichend evaluiert.Die Kampagne „Save Surgery saves lives“ führte mit der Etablierung der WHO Operationscheckliste zu einem Meilenstein in der Patientensicherheit bei chirurgischen Eingriffen. Eine Umfrage der DGCH und des BDCs ergab, dass die Checkliste mittlerweile flächendeckend etabliert ist, jedoch nur in knapp zwei Drittel der Fälle vollständig abgefragt wird. Dass die Implementierung der Checkliste zu einer erniedrigten postoperativen Mortalität führt, ist durch Kohortenstudien und Metaanalysen belegt.
Register der schwierigen chirurgischen Situationen
Authors: Korenkov Michael , Dralle Henning , Klar Ernst , Saad Stefan , Senninger Norbert , Standop Jens , Stier Albrecht , Strik Martin , Ulrich Alexis , Weiner Rudolf 
Published: July 2018

ZusammenfassungAls schwierige chirurgische Situation wird jedes Problem, das zu einem erhöhten Risiko für intra- oder postoperative Komplikationen führen kann, bezeichnet. Bezogen auf diese Definition wurde von Korenkov et al. eine präoperative Klassifikation erweiterter intraoperativer Schwierigkeiten entwickelt. Diese Klassifikation bezieht sich auf das Ausmaß der chirurgisch-technischen Schwierigkeiten von Schweregrad 1 – technisch einfach zu operieren, bis Schweregrad 4 – jede operationstechnische Handlung ist sehr schwierig. Für die Evaluierung des Schweregrads der intraoperativen Komplikationen schlug die Arbeitsgruppe um Kaafarani die Klassifikation der intraoperativen negativen Ereignisse vor. In Abhängigkeit vom Schweregrad wurden die intraoperativen Komplikationen auf 6 Klassen von der 1. (unproblematisch beseitigte Komplikationen) bis zur 6. Klasse (intraoperativer Exitus letalis) aufgeteilt. Für eine Systematisierung des Schweregrads der postoperativen Komplikationen hat sich weltweit die Klassifikation von Clavien-Dindo etabliert. In dieser Klassifikation sind die postoperativen Komplikationen von Schweregrad 1 (jede Abweichung vom normalen postoperativen Verlauf mit „minimaler“ Behandlung) bis zum Schweregrad 5 (Tod des Patienten) aufgeteilt. Gestützt auf die vorgeschlagenen Klassifikationen und auf die Problematik der individuellen Entscheidungen in der Chirurgie entstand die Grundidee, ein Register (SCS-Register) zu etablieren. Das Hauptprinzip solcher Studien ist die Ansammlung der individuellen Erfahrungen von operierenden Chirurgen. Die wissenschaftliche Analyse fokussiert sich auf die Sondersituationen, bei denen das Behandlungskonzept an die individuelle Patientensituation adaptiert war und manchmal von den gängigen Standards abwich. Die Registrierung und Bearbeitung der angemeldeten Fälle wird auf der Basis der entsprechenden IT-Plattform anonym geführt. Das Ziel dieses Registers ist, die schwierigen chirurgischen Fälle bundesweit zu sammeln, zu registrieren und zu analysieren, um für die operierenden Chirurgen eine zugängliche Datenbank zu gestalten. Dabei wird für jeden Chirurgen die Möglichkeit bestehen, nachzulesen, wie der eine oder andere Kollege in ähnlich schwierigen Situationen gehandelt hat.
Risk of Postoperative Performance Status Worsening after Resection of Lesions Involving the Motor Pathway: A Multinomial Logistic Regression Model
Authors: Pesce Alessandro , Fraschetti Flavia , D'Andrea Giancarlo , Polli Filippo , Acqui Michele , Frati Alessandro , Raco Antonino 
Published: July 2018

Background and Study Objective In surgery for gliomas and brain metastases, preservation of neurologic functions is essential to ensure a good quality of life and the eligibility for adjuvant therapies. This article assesses which factors could influence the functional outcome in patients with lesions located in the motor pathways.
Materials and Methods A total of 92 patients with gliomas and metastases involving the motor pathways were studied for concerns regarding quality of life (Karnofsky performance status [KPS] and modified Rankin scale [mRS]) before and after surgical treatment supported by intraoperative neuromonitoring. Patient-related, surgery-related, and lesion-related data were recorded to identify the relationships with postoperative performance status. The relationship between lesions and the corticospinal tract were investigated with preoperative magnetic resonance imaging sequences and tractographic reconstructions.
Results Means of preoperative mRS and KPS were 1.91 ± 1.34 and 80.8 ± 20, and at 30 days postoperatively they were 1.93 ± 1.63 and 79.8 ± 24.4, respectively. The better preoperative performance status was a predictor of better outcome in terms of quality of life. Gender showed a statistical association with ∆KPS (p = 0.033) and ∆mRS (p = 0.031). A recurrent lesion was a predictor of poor functional outcome (p= 0.045 for KPS at 30 days).A left-sided lesion showed a statistical association with a lesser improvement with respect to right sided. Complications were associated with a lesser functional improvement (∆mRS, ∆KPS, and clinical improvement: p = 0.001, p = 0.006, and p = 0.003, respectively). Hemorrhagic complications were associated with the worst functional prognosis.
Conclusions In our experience, factors associated with worse functional prognosis and quality of life were a poor preoperative performance status, female gender, operating on a recurrent lesion, involvement of the left corticospinal tract, and surgical or medical postoperative complications.
Plasma Kallikrein-Kinin System in Patients with Uncomplicated Sepsis and Septic Shock-Comparison with Cardiogenic Shock
Authors: Martínez-Brotóns F , Oncins J R , Mestres J , Amargós V , Reynaldo C 
Published: July 2018

SummaryAlterations of the kallikrein-kinin system consistent with activation and increased consumption have been re2ported in septic patients and it has been suggested that this activation could contribute to the development of septic shock.The aim of this work was to confirm these alterations in septic patients and to investigate the possible existence of similar changes in subjects developing cardiogenic shock secondary to myocardial infarction as a model of non septic shock.Patients with septic shock, especially in fatal cases, showed a highly significant decrease in levels of factor XII, prekallikrein, high molecular weight kininogen (HMW-kininogen), α2-macro-globulin (α2-M) and antithrombin III (AT-III). C1-esterase inhibitor (C1-INH) activity was increased in uncomplicated sepsis but came back to normal or was slightly decreased in septic shock.Components and inhibitors of the kallikrein-kinin system were within normal limits in patients with cardiogenic shock.Our findings support the idea of a contribution of the kallikrein-kinin system to the development of septic shock though this system does not seem to play a significant role in the pathogenesis of cardiogenic shock or seem to be altered as a consequence of it.
Genotype Assignment of Haemophilia A by Use of Intragenic and Extragenic Restriction Fragment Length Polymorphisms
Authors: Bröcker-Vriends A H J T , Briët E , Quadt R , Dreesen J C F M , Bakker E , Claassen-Tegelaar R , Kanhai H H H , van de Kamp J J P , Pearson P L 
Published: July 2018

SummaryWe performed DNA analysis in 20 families with haemophilia A in order to evaluate its usefulness for carrier detection and prenatal diagnosis.The polymorphic Bell site within intron 18 of the factor VIII gene and the extragenic TaqI and Bglll polymorphic sites which are detected by the random DNA probes designated St 14 and DX13, respectively, were investigated for.Two events of recombination were found between the St 14 and the haemophilia A locus in 51 informative meioses. In one of these recombinant meioses crossing over had also occurred between the DX13 and the haemophilia A locus. No further crossovers between the DX13 and the haemophilia A locus were found in 20 informative meioses.Segregation analysis of the polymorphic markers and the deleterious mutation within the families allowed a diagnosis at the gene level for 52 out of 57 potential carriers. The new method considerably decreased the uncertainty about carriership for seventeen of the nineteen women with a probability of carriership between 5% and 95% based on pedigree analysis and factor VIII assays.In seven cases chromosome and DNA analysis of a chorionic villus biopsy was carried out. Three of the fetuses were female, four were male. Three of the male fetuses had inherited the normal maternal X-chromosome and were, therefore, not affected. For another male fetus no diagnosis at the gene level was possible since the mother was homozygous for all the known restriction fragment length polymorphisms within or closely linked with the haemophilia A locus.
Molecular Basis and Clinical Aspects of Hereditary Megakaryocyte and Platelet Membrane Glycoprotein Disorders
Authors: Scharf R. E. 
Published: July 2018

SummarySpecific membrane glycoproteins (GP) expressed by the megakaryocyte-platelet system, including GPIa-lla, GPIb-V-IX, GPIIb-llla, and GPIV are involved in mediat-ing platelet adhesion to the subendothelial matrix. Among these glycoproteins, GPIIb-llla plays a pivotal role since platelet aggregation is exclusively mediated by this receptor and its interaction with soluble macromolecular proteins. Inherited defects of the GPIIb-llla or GPIb-V-IX receptor complexes are associated with bleeding disorders, known as Glanzmann's thrombasthenia, Bernard-Soulier syndrome, or platelet-type von Willebrand's disease, respectively. Using immuno-chemical and molecular biology techniques, rapid advances in our understanding of the molecular genetic basis of these disorders have been made during the last few years. Moreover, analyses of patients with congenital platelet membrane glycoprotein abnormalities have provided valuable insights into molecular mechanisms that are required for structural and functional integrity, normal biosynthesis of the glycoprotein complexes and coordinated membrane expression of their constituents. The present article reviews the current state of knowledge of the major membrane glycoproteins in health and disease. The spectrum of clinical bleeding manifestations and established diagnostic criteria for each of these dis-orders are summarized. In particular, the variety of molecular defects that have been identified so far and their genetic basis will be discussed.
Hemodynamic and Platelet Response to the Bolus Intravenous Administration of Porcine Heparin
Authors: Bjoraker David G , Ketcham Thomas R 
Published: July 2018

SummaryThere is considerable evidence that under some conditions intravenous heparin infusion may cause or at least enhance platelet aggregation in vivo. Reports of heparin-induced vasodilatation and decreases in arterial blood pressure have not been accompanied by simultaneous observations of the platelet response. In this study both the hemodynamic and platelet response to the bolus administration of porcine intestinal mucosa sodium heparin were monitored in 24 cardiac and 12 vascular surgery patients. Mean arterial blood pressure decreased 7.1 ± 0.8 mmHg as a result of a 247 ± 34 dyne · sec/cm5 decrease in systemic vascular resistance. Platelet count, platelet volume distribution, and beta-thromboglobulin levels did not change with heparin infusion. These responses did not differ when comparing the 155 unit/kg group and the 400 unit/kg group or the 400 unit/ kg groups treated with different commercial preparations. The single patient who did have a decrease in platelet count and a severe rise in beta-thromboglobulin with heparin died intraoperat- ively of a massive myocardial infarction. Large increases in platelet factor 4 with heparin administration were not associated with platelet release but were dependent on whether or not the patient was treated with preoperative subcutaneous or intravenous heparin. There was no evidence that heparin-induced vasodilatation was mediated by platelet aggregation and release.
Intracoronary Platelet Release in Patients with and without Coronary Artery Disease
Authors: Verheugt F W , Serruys P W , Vliet H van , Spijkers A , Hugenholtz P G 
Published: July 2018

SummaryIntracoronary platelet release of beta-thromboglobulin (BTG) was measured in 18 patients with a history of chest pain by analysis of aortic and coronary sinus blood samples in rest and during atrial pacing. Eleven proved to have coronary artery disease, while seven had normal coronary arteriograms and served as controls. In both groups no statistically significant transmyocardial gradient of platelet and plasma BTG content was observed under basal conditions, although the aortic plasma BTG levels in the patients (60.4 ± 4.1 ng/ml) were significantly (p <0.05) higher than in the controls (47.5 ± 2.6 ng/ml). However, also during atrial pacing no significant gradient could be demonstrated in the patients nor in the controls. It is concluded, that in stable coronary artery disease measurable intracoronary platelet release does not occur in rest nor atrial pacing and, therefore, does not seem to contribute to the development of exercise-induced myocardial ischaemia.
Heterogeneity of Sugar Composition of Factor VIII/ von Willebrand Factor in von Willebrand's Disease: Analysis by Crossed Affinoimmunoelectrophoresis Using Lectin (Ricinus communis Agglutinin-120)
Authors: Mikami S , Ueda M , Yasui M , Takahashi Y , Nishino M , Fukui H 
Published: July 2018

SummaryThe nature of sugar chain of factor VTII/von Willebrand factor in plasma of normal subjects and patients with von Willebrand’s disease (vWd) was examined by crossed affinoimmunoelectrophoresis using anti-human factor VIII rabbit serum, with inserted Ricinus communis agglutinin-120 (RCA-120) agarose layer (RCA – CIE). Molecular weights of factor VlU-related antigen (VIIIR: Ag) were estimated by SDS polyacrylamide gel electrophoresis — crossed affinoimmunoelectrophoresis (SDS PAGE – RCA – CIE).VIIIR :Ag, in normal plasma and in classical form of vWd, showed two precipitin peaks on RCA – CIE. The slower moving component of VIIIR :Ag with molecular weights over 3×106 daltons from normal subjects and patients with classical form of vWd showed a high affinity for RCA-120. The faster moving component of VIIIR: Ag below 3×106 daltons from the abovementioned subjects and patients with a variant form (Type IIA) showed a very weak affinity for RCA-120.These results suggested that all of VIIIR: Ag in these variant cases may have a deficiency of galactose residues reactive with RCA, in addition to an incomplete polymerization of VIIIR: Ag, similar to that of the faster moving component of normal subjects.
Platelets, Coagulation and Fibrinolysis in Patients with Diabetic Retinopathy
Authors: Brooks A M V , Hussein S , Chesterman C N , Martin J F , Alford F P , Penington D G 
Published: July 2018

SummaryTwenty control subjects, 12 insulin treated and 10 non-insulin treated diabetics were studied. All diabetics had retinopathy documented by fluorescein angiography and fluorophotometry. Factor VUIRiAg and plasma fibrinogen concentrations were elevated in both diabetic groups, but more so in the insulin treated patients. Within this latter group the plasma fibrinogen was also correlated with the degree of retinopathy.Platelets separated on linear isosmolar Percoll gradients showed an increase in intraplatelet βTG content and concentration and a slight increase in volume of the lightest platelets in the insulin treated diabetics. Plasma platelet factor 4 and antithrombin III concentrations were normal and plasma βTG levels were elevated only in those patients with renal insufficiency. Platelet aggregometry was performed in 18 diabetic subjects and found to be normal.It is concluded that abnormalities of coagulation and platelets in diabetes are determined by metabolic factors rather than the severity of microvascular disease per se.
Antithrombin III Infusion in Patients Undergoing Peritoneovenous Shunt Operation: Failure in the Prevention of Disseminated Intravascular Coagulation
Authors: Büller Harry Roger , ten Cate Jan W 
Published: July 2018

SummaryFive patients with chronic liver disease and acquired antithrombin III (AT III) deficiency undergoing peritoneovenous (LeVeen) shunting for ascites, resistant to medical therapy, were studied prospectively for the development of disseminated intravascular coagulation (D.I.C.) after selective correction of the plasma AT III activity. This was accomplished by continuous infusion of purified human AT III concentrate beginning one day prior to surgery and continuing five to seven days post-operatively. This rigorous transfusion scheme of AT III concentrate could not prevent D.I.C. and bleeding.
Platelet Abnormalities in Muscular Dystrophy
Authors: Yarom R , Meyer S , More R , Liebergall M , Eldor A 
Published: July 2018

SummaryPlatelets which have complex membranes and calcium shifts similar to those in muscles were investigated in 14 patients with muscular dystrophy and 20 suitable controls. In 4 Duchenne and one limb-girdle dystrophy aggregations were done and found to be depressed with adrenaline and ADP. Electron microscopic and chemical examinations revealed an increased number of dense bodies, changed permeability and/or binding of cations and elevated intracellular calcium in all the 9 cases of Duchenne dystrophy while the 2 limb-girdle and 3 myotonic dystrophies varied.A two phase polymer separation system applied to fixed platelets of all patients and controls showed no abnormality of surface negative charge.
Detection of Carriers in Glanzmann's Thrombasthenia
Authors: Zonneveld G T E , van Leeuwen E F , Sturk A , ten Cate J W 
Published: July 2018

SummaryQuantitative glycoprotein (GP) analysis of whole platelets or platelet membranes was performed by SDS-polyacrylamide gelelectrophoresis (SDS-PAGE) and periodic acid Schiff staining in the families of two unrelated Glanzmann’s thrombasthenia (GT) patients. Each family consisted of two symptom free parents, a symptom free daughter and a GT daughter. All symptom free members had a normal bleeding time, clot retraction and platelet aggregation response to adenosine 5’-diphosphate (ADP), collagen and adrenalin. Platelet Zw* antigen was normally expressed in these subjects. GT patiens, classified as a type I and II subject, showed reduced amounts of GP lib and of GP nia. Analysis of isolated membranes in the non-reduced state, however, showed that the amount of GP Ilia was also reduced in three of the four parents, whereas one parent (of the GT type I patient) and the two unaffected daughters had normal amounts of GP Ilia. Quantitative SDS-PAGE may therefore provide a method for the detection of asymptomatic carriers in GT type I and II.
Comparative Studies on Thrombin Inhibitors in Experimental Microthrombosis
Authors: Markwardt F , Nowak G , Hoffmann J 
Published: July 2018

SummaryThe influence of thrombin inhibitors, which differ both in their chemical structure and type of inhibition on thrombin-induced microthrombosis was studied in rat lungs. The antithrombotically effective doses and blood levels of the compounds correlated with their kinetic constants for inhibition of thrombin. In preventing microthrombosis, some of the synthetic inhibitors tested surpassed the effectiveness of heparin and approached that of the naturally occurring inhibitor hirudin.
Calibration of Reference Thromboplastins and Standardisation of the Prothrombin Time Ratio
Authors: Kirkwood T B L 
Published: July 2018

SummaryThromboplastins vary in their sensitivity to the haemostatic defect induced by oral anticoagulants. To provide a means of standardising prothrombin time tests, the World Health Organization adopted in 1977 a scheme for calibrating thromboplastins in terms of an International Reference Preparation. Unfortunately, the model on which this scheme was based does not always hold. A revised calibration model has therefore been developed and this has been tested in a recent collaborative study. The revised model, which retains fundamentally the same principle for standardising prothrombin time tests, has proved suitable for calibrating thromboplastins of different species and types and, moreover, has certain statistical advantages over its predecessor. In September 1982, the WHO Expert Committee on Biological Standardization adopted the revised model. This paper explains the nature and rationale of this change and considers its practical implications.
Comparison Between Subcutaneous and Intravenous DDAVP in Mild and Moderate Hemophilia A
Authors: De Sio L , Mariani G , Muzzucconi M G , Chistolini A , Tirindelli M C , Mandelli F 
Published: July 2018

SummarySixteen patients with mild and moderate hemophilia were given Desmopressin (DDAVP) subcutaneously in the absence of any actual bleeding. The response to the drug – in terms of factor VIII coagulant activity rise – became apparent 15 min after the injection, reaching the maximal response after one hour (x̄ 3.2 times the baseline levels; SD 1.21). This response was not different from that elicited using the intravenous route in 18 hemophiliacs of comparable severity after the same time interval. No local or general side-effects were recorded after the subcutaneous administration of DDAVP. We therefore conclude that the subcutaneous route adds further evidence to the reliability of this alternative treatment in mild factor VIII deficiencies, thus making home treatment with this vasopressin analogue possible.
Studies of Alpha2-Adrenergic Receptors of Intact and Functional Washed Human Platelets by Binding of 3H-Dihydroergocryptine and 3H-Yohimbine-Correlation of 3H-Yohimbine Binding with the Potentiation by Adrenaline of ADP-Induced Aggregation
Authors: Lanza François , Cazenave Jean-Pierre 
Published: July 2018

SummaryThe binding of 3H-dihydroergocryptine and 3H-yohimbine to intact, discoid, functional, washed human platelets resuspended in Tyrode’s buffer containing Ca2+, Mg2+, human albumin and apyrase, was studied at 37° C. The binding of 3H-dihydroergocryptine was rapid, reversible and saturable (KD = 19.3 ± 4.2 nM, Bmax = 2590 ± 670 sites per platelet). The results were difficult to interpret because the bound ligand was not easily dissociated. In contrast, 3H-yohimbine bound in a rapid, reversible and saturable fashion to one class of sites (KD = 8.1 ± 1 nM, Bmax = 395 ± 35 sites/platelet) with the characteristics of alpha2-adrenergic receptors. Adrenaline alone did not aggregate intact platelets but potentiated ADP-induced aggregation. This effect of adrenaline was specifically inhibited by alpha2-antagonists such as yohimbine. The inhibition of 3H-yohimbine binding and the inhibition of the synergistic effect of adrenaline on ADP-induced aggregation by 16 different alpha- and beta-adrenergic compounds was significantly correlated (p <0.001). Thus, intact and functional washed human platelets can be used as a simple pharmacological model to screen alpha-adrenergic antagonists by measuring the inhibition of the potentiation of ADP-induced aggregation by adrenaline which is a direct reflection of the physiological effect of adrenaline on human platelet alpha2-adrenergic receptors. The inhibition constant derived from aggregation studies expresses the affinity of the ligand for its receptor as measured by more cumbersome binding studies with radioactive adrenergic antagonists such as 3H-yohimbine.