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  • 1
    Language: English
    In: Legal Medicine, 2011, Vol.13(5), pp.254-258
    Description: Diethyl ether was widely used as an anesthetic agent in many countries in the second half of the 19th century and the first half of the 20th century. For this reason the majority of lethal cases involving diethyl ether reported during this period were associated with anesthesia. We present a case of asphyxial death by plastic-bag suffocation with additional detection of diethyl ether in autopsy specimens. Autopsy initially failed to reveal the cause of death. Macroscopic and microscopic findings as well as subsequent toxicological examination procedures and results are pointed out in the present case report. Headspace gas chromatography with flame ionization detection (HS-GC–FID) coupled with gas chromatography/mass spectrometry (GC–MS) proved to be the method of choice for fast and reliable analysis of unknown highly volatile substances (other than blood alcohol). In this case the detection of diethyl ether in autopsy specimens led to further investigations by the police at the death scene. During these investigations a bottle bearing a diethyl ether label was found and confiscated, which proved the insufficiency of prior death scene investigation. In order to evaluate the case from every possible angle, in such cases, especially when plastic-bag suffocation is suspected, we strongly recommend the collection of postmortem specimens in gas-tight vessels as well as the presence of a forensic expert at the death scene.
    Keywords: Forensic Science ; Diethyl Ether ; Asphyxia ; Plastic-Bag Suffocation ; Gc–MS ; Hs-Gc–Fid ; Public Health
    ISSN: 1344-6223
    E-ISSN: 1873-4162
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  • 2
    Language: English
    In: International Orthopaedics, 2012, Vol.36(6), pp.1181-1183
    Description: Byline: Kiriakos Daniilidis (1), Bjoern Vogt (1), Georg Gosheger (1), Marcel Henrichs (1), Ralf Dieckmann (1), Dino Schulz (1), Steffen Hoell (1) Abstract: Purpose Knee pain after total knee arthroplasty may be caused by an unresurfaced patella. Secondary isolated resurfacing of the previously unresurfaced patella in total knee arthroplasty remains controversial. The aim of this retrospective study was to evaluate the outcome after patellar resurfacing as a second stage procedure. Methods The study included 22 patients (13 female/nine male) who underwent resurfacing of the patella with a mean follow-up of 61.8+-39.2 months. The mean age of the patients was 60+-9.7 years at the time of operation. The average period between total knee arthroplasty and patellar resurfacing was 26.3+-15.2 months. The patient's subjective satisfaction was assessed by a custom-made questionnaire. Results The mean Knee Society Score improved significantly from 60.1+-8.3 to 77.0+-6.3 (p=0.0063). The mean functional score also improved significantly from 42.7+-2.3 to 60.2+-3.9 (p=0.001). Three patients (13.6%) needed further operative revision. Conclusions Although clinical scores showed significant improvement some patients continued to have pain and remained dissatisfied without detecting a specific reason. Further studies are needed to better elucidate the benefit of patellar resurfacing as second stage procedure. Author Affiliation: (1) Orthopaedic and Tumour Orthopaedic, University Hospital Munster, Munster, Germany Article History: Registration Date: 06/12/2011 Received Date: 31/10/2011 Accepted Date: 05/12/2011 Online Date: 14/01/2012
    Keywords: Arthroplasty ; Orthopedic Surgery ; Knee Replacement Arthroplasty;
    ISSN: 0341-2695
    E-ISSN: 1432-5195
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  • 3
    Language: English
    In: The Journal of Infectious Diseases, 1 July 1999, Vol.180(1), pp.141-149
    Description: Surface molecules with the potential relevance for resistance against Mycobacterium tuberculosis were investigated. The expression of lymphocyte function antigen-1, very late antigen (VLA)-4, L-selectin, intercellular adhesion molecule (ICAM)-1, major histocompatibility complex class II, Fas, and CD40 on αβ T cells, γδ T cells, NK cells, and monocytes of healthy donors and patients with tuberculosis were analyzed. A high activation status of γδ T cells and increased levels of soluble ICAM-1 in plasma of patients with tuberculosis versus healthy individuals was detected. Tuberculosis patients with and without an underlying systemic disease could be segregated by differential expression of VLA-4 and ICAM-1 on γδ T cells and on monocytes. The composition of peripheral blood mononuclear cells varied slightly, whereas the proportion of monocytes decreased significantly in patients with tuberculosis, compared with healthy controls. The activation phenotype of peripheral γδ T cells in patients with tuberculosis emphasizes the role of these T cells in controlling the inflammatory process during tuberculosis and perhaps other microbial infections.
    Keywords: Biological sciences -- Biology -- Physiology -- Lymphocytes ; Biological sciences -- Biology -- Microbiology -- Mycobacterium tuberculosis ; Health sciences -- Medical conditions -- Infections -- Monocytes ; Biological sciences -- Biology -- Physiology -- Lymphocytes ; Physical sciences -- Physics -- Microphysics -- Lymphocytes ; Biological sciences -- Biology -- Physiology -- Lymphocytes ; Health sciences -- Medical conditions -- Infections -- Lymphocytes ; Health sciences -- Medical conditions -- Diseases -- Lymphocytes ; Biological sciences -- Biology -- Physiology -- Lymphocytes ; Biological sciences -- Biology -- Physiology -- Lymphocytes
    ISSN: 00221899
    E-ISSN: 15376613
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  • 4
    Language: English
    In: Knee Surgery, Sports Traumatology, Arthroscopy, 2012, Vol.20(12), pp.2513-2518
    Description: Byline: Steffen Holl (1), Annabel Schlomberg (1), Georg Gosheger (1), Ralf Dieckmann (1), Arne Streitbuerger (1), Dino Schulz (1), Jendrik Hardes (1) Keywords: Megaprosthesis; Knee arthroplasty; Limb salvage; Revision arthroplasty; Distal femur replacement Abstract: Purpose The aim of the present study was to assess whether using megaprostheses in revision knee arthroplasty procedures allows limb salvage with an acceptable outcome and complication rate, in comparison with other limb-saving procedures. Methods Between 2000 and 2010, megaprosthesis implantation was required for non-oncologic indications in 20 patients (21 knees) (average age 73 years). Reconstructions involved the distal femur (n = 15), proximal tibia (n = 4), and both femur and tibia (n = 2). The indications, type, and numbers of previous operations and implants, as well as complications associated with megaprosthesis implantation, were reviewed, and the clinical and radiographic outcomes after an average follow-up period of 34 months (range 10--84 months) were evaluated. Results The indications for megaprosthesis implantation were periprosthetic infection (n = 5), fracture (n = 9), nonunion (n = 5), and aseptic loosening (n = 2). The types of implant placed before the megaprosthetic reconstruction were a cemented rotating-hinge arthroplasty (n = 16) and a primary total knee arthroplasty (n = 5). Six patients had an additional osteosynthesis of the distal femur. An average of 3.8 operations (range 1--7) had been carried out before megaprosthesis implantation. Complications developed in 11 patients. The Knee Society Score improved significantly, from 43 (+-15) to 68 (+-16.8) P 〈 0.05. Conclusions Megaprosthesis implantation in revision knee arthroplasty is an exceptional indication. Despite the high complication rate, the patients can be spared amputation in most cases, and rapid mobilization with full weight-bearing is possible. Author Affiliation: (1) Department of General Orthopedics and Tumor Orthopedics, Munster University Hospital, Albert Schweitzer-Campus 1, 48149, Munster, Germany Article History: Registration Date: 27/02/2012 Received Date: 05/08/2011 Accepted Date: 09/02/2012 Online Date: 06/03/2012
    Keywords: Megaprosthesis ; Knee arthroplasty ; Limb salvage ; Revision arthroplasty ; Distal femur replacement
    ISSN: 0942-2056
    E-ISSN: 1433-7347
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  • 5
    In: American Journal of Transplantation, August 2003, Vol.3(8), pp.1033-1035
    Description: A 50‐year‐old recipient of an intestinal and coecal graft with sudden onset of abdominal distention and pain, lack of bowel movements, and vomiting after closure of the diagnostic ostomy 7 months after transplantation is reported. A plain abdominal radiograph revealed pneumatosis intestinalis. An angiography excluded obstruction of large vessels, however, with absent microcirculation of the intestine. Upper gastrointestinal endoscopy showed extensive ulcerative enteritis with several spontaneous perforations. The patient underwent exploration demonstrating a nonviable intestine. The entire necrotic intestine was removed. Vascular thrombosis was excluded. Clinical data, and macroscopic and histologic features of the intestinal graft were diagnostic for necrotizing enterocolitis (NEC). Though there has been evidence for the occurrence of NEC not only in premature infants but even in older infants, children and adolescents, the presented case is, to our knowledge, the first report of NEC as etiology of late graft loss after intestinal transplantation in an adult recipient.
    Keywords: Intestinal Transplantation ; Necrotizing Enterocolitis
    ISSN: 1600-6135
    E-ISSN: 1600-6143
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  • 6
    In: Experimental Dermatology, November 2013, Vol.22(11), pp.725-729
    Description: Patients treated with inhibitors (e.g. vemurafenib), a novel targeted therapy for advanced melanoma harbouring certain mutations, develop numerous adverse cutaneous side effects, including skin tumors such as squamous cell carcinoma or non‐malignant verruciform keratinocyte proliferations, termed ‘‐inhibitor‐associated verrucous keratosis () lesions’. These keratinocyte proliferations are believed to be caused by paradoxical hyperactivation of the pathway in cells with wild‐type , but mutated . However, due to the clinical and histological verruca‐like appearance of these lesions, additional aetiologic cofactors, such as infectious agents (i.e. oncogenic viruses), might be suspected. Therefore, we performed 454 high‐throughput sequencing of lesions from vemurafenib‐treated patients on the transcript level to identify actively transcribed viral sequences of known [e.g. human papilloma viruses ()] or even yet‐unknown viruses. Next‐generation sequencing did not identify transcripts of any human viruses out of 1 595 161 reads obtained from lesions of four patients. Nevertheless, all controls were recognized correctly, and the detection of sequences derived from the cutaneous microbiome (e.g. skin commensals and bacterial phages) confirmed the validity and sensitivity of the sequencing data. Our results are consistent with preliminary histological and immunohistochemical findings recently reported by others, who also failed to detect the expression of proteins in . Although the patient number is limited and we cannot exclude the possibility of having missed a viral transcript of very low abundance, our study argues against a viral aetiology of ‐inhibitor‐associated verruciform keratoses occurring under vemurafenib.
    Keywords: Inhibitors ; Cutaneous Side Effects ; Next‐Generation Sequencing ; Verrucous Keratosis ; Virus
    ISSN: 0906-6705
    E-ISSN: 1600-0625
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  • 7
    Language: English
    In: BMC musculoskeletal disorders, 26 November 2014, Vol.15, pp.398
    Description: Two-stage revision arthroplasty is today regarded as the gold standard treatment method for deep prosthetic joint infection. The aim of the present study was to evaluate clinical and functional outcomes with the Modular Universal Tumor And Revision System (MUTARS) RS stem in patients undergoing two-stage revisions. The functional and clinical outcomes for 43 patients who had undergone two-stage revision procedures for PJI were analyzed in a retrospective study. The minimum follow-up period was 24 months. Shorter follow-up periods were only observed when there were complications such as loosening or recurrent infection. The mean follow-up period was 3.86 years (range 7 months to 11.6 years). The success rate with infection control for PJI was 93%. Reinfection occurred in four cases (7%). The risk of reinfection after MRSA infection was 20.5 times greater (P 〉0.01) than with sensitive or unknown bacteria. Two aseptic loosening occurred after 7 and 20 months. The average Harris Hip Score was 80 (range 62-93). This retrospective study showed a 93% rate of eradication using specific antibiotic therapy. With the modular MUTARS RS stem, there was a low rate of aseptic loosening of 4.6%. MRSA infection was identified as a risk factor for reinfection. The two-stage procedure with modular cementless implants used is therefore appropriate for treating periprosthetic infections associated with hip endoprostheses.
    Keywords: Prosthesis Design ; Anti-Bacterial Agents -- Administration & Dosage ; Arthroplasty, Replacement, Hip -- Adverse Effects ; Hip Prosthesis -- Adverse Effects ; Prosthesis-Related Infections -- Diagnosis
    E-ISSN: 1471-2474
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  • 8
    Language: English
    In: The Journal of Minimally Invasive Gynecology, 2006, Vol.13(5), pp.418-423
    Description: To describe performance of breast duct endoscopy and compare the method with conventional diagnostic techniques. Canadian Task Force classification III. Interdisciplinary Breast Unit of a university hospital. Consecutive and unselected series of 15 female patients including 20 breasts with nipple discharge. Prospective data assessment on all patients with ductoscopy for nipple discharge between April 2003 to April 2004. All preoperative (mammography, ultrasonography, nipple smear) and minimally invasive (galactography, fine needle aspiration cytologic study) diagnostics were evaluated and compared with ductoscopy. Mammography on 20 breasts showed BI-RADS-I (5%), BI-RADS-II (50%), and BI-RADS-III (45%). Breast ultrasound scanning showed abnormalities, classified as BI-RADS-III equivalent lesions in all cases. Nipple smear showed in 69.2% a normal cytology and in most cases revealed a papilloma later (n = 8/9). Unilateral galactography was performed in 46.7% who had spontaneous nipple discharge. Two galactography results were unremarkable, and open biopsy demonstrated 1 atypical ductal hyperplasia and papilloma. On 20 breasts of 15 women, 19 ductoscopies were successfully performed (95%). In 17 cases open biopsy followed ductoscopy, and 1 ductal carcinoma in situ (DCIS), 3 atypical ductal hyperplasia (ADH), 1 ductal hyperplasia without atypias, and 12 ductal papillomas were found. Compared to nipple smear, the diagnostic value of ductoscopy in this study is superior but marginally inferior to galactography and highly specialized breast ultrasound scanning. Therefore ductoscopy needs to be evaluated on a larger scale, preferably in multicenter trials to further determine its potential and indications.
    Keywords: Nipple Discharge ; Milk-Duct Endoscopy ; Ductoscopy ; Galactoscopy ; Breast Cancer ; Medicine
    ISSN: 1553-4650
    E-ISSN: 1553-4669
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  • 9
    Language: English
    In: European Radiology, 2011, Vol.21(8), pp.1643-1650
    Description: Byline: Ralf Wassmuth (1), Hassan Abdel-Aty (1,2), Steffen Bohl (1,3), Jeanette Schulz-Menger (1) Keywords: Magnetic resonance imaging; Cardiac; Amyloidosis; Contrast; T2 Abstract: Objectives Using cardiac magnetic resonance imaging (MRI) we tested the diagnostic value of various markers for amyloid infiltration. Methods We performed MRI at 1.5 T in 36 consecutive patients with cardiac amyloidosis and 48 healthy volunteers. The protocol included cine imaging, T2-weighted spin echo, T1-weighted spin echo before and early after contrast and late gadolinium enhancement. We compared the frequency of abnormalities and their relation to mortality. Results Median follow-up was 31 months. Twenty-three patients died. Mean left ventricular (LV) mass was 205+-70 g. LV ejection fraction (EF) was 55+-12%. T2 ratio was 1.5+-0.4. 33/36 patients had pericardial and 22/36 had pleural effusions. All but two had heterogeneous late enhancement. Surviving patients did not differ from those who had died with regard to gender, LV mass or volume. Surviving patients had a significantly higher LVEF (60.4+-9.9% vs. 51.6+-11.5% p=0.03). The deceased patients had a lower T2 ratio than those who survived (1.38+-0.42 vs. 1.76+-0.17 p=0.005). Low T2 was associated with shorter survival (Chi-squared 11.3 p〈0.001). Cox regression analysis confirmed T2 ratio〈1.5 as the only independent predictors for survival. Conclusion Cardiac amyloidosis is associated with hypointense signal on T2-weighted images. A lower T2 ratio was independently associated with shortened survival. Author Affiliation: (1) HELIOS Klinikum Berlin Buch & Charite Campus Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany (2) Cardio Imaging Center Berlin, Berlin, Germany (3) Unfallkrankenhaus Berlin, Berlin, Germany Article History: Registration Date: 10/03/2011 Received Date: 02/11/2010 Accepted Date: 02/02/2011 Online Date: 29/03/2011
    Keywords: Magnetic resonance imaging ; Cardiac ; Amyloidosis ; Contrast ; T2
    ISSN: 0938-7994
    E-ISSN: 1432-1084
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  • 10
    Language: English
    In: Health Psychology, 2015, Vol.34(3), pp.270-273
    Description: Background: Recruitment of participants for studies focusing on couples facing illness is a challenging task and participation decline may be associated with nonrandom factors creating bias. This study examines whether patient and relationship characteristics are associated with partner participation in research. Method: Patients invited to participate in a cross-sectional study on adaptation and quality of life after renal transplantation were asked to forward information about an add-on study to their partners. Results: A total of 456 participating patients had a partner; 293 of the partners showed interest in the study and 206 actually completed the questionnaire. Backward logistic regression analyses revealed that demographic, illness, and personal characteristics of the patient were not associated with partner interest in the study nor actual partner participation. However, partners who indicated interest in the study showed more active engagement toward the patients (as reported by the patients). Furthermore, patients of partners who actually completed the questionnaire reported less negative affect and higher relationship satisfaction than patients whose partner did not participate in the study. Discussion: It is encouraging that of the large number of variables tested, only 2 were associated with the participation of partners. Nevertheless, well-functioning couples appear to be overrepresented in our study, calling for specific effort to include marital distressed couples in research focusing on dyadic adaptation to illness.
    Keywords: Couples ; Chronic Illness ; Generalizability ; Recruitment
    ISSN: 0278-6133
    E-ISSN: 1930-7810
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