[Treatment of recurrent Dupuytren's disease]. / Rezidiveingriffe beim Morbus Dupuytren.

BACKGROUND: The tendency of recurrence or progression is a frequent problem in Dupuytren's disease. The management of recurrence is adapted to the individual situation and the patient's needs. In mild cases a non-operative approach is recommended. Revision surgery is reserved for disabling situations with acceptable circulation and sensation in absence of dystrophy. It is complicated by a combined formation of scar tissue and new cords. This increases the risk of soft tissue loss and injuries to the neurovascular bundles, which impair sensation and circulation and may result in loss of the finger. TECHNIQUE: The strategy consists of preoperative planning of the soft tissue reconstruction, meticulous preparation of the neurovascular bundles, arthrolyses and skin closure by Z­plasty or transposition flaps. The corrective arthrodesis of the proximal interphalangeal joint may be an alternative to improve function without the risks of revision surgery. In cases of severe impaired circulation, sensation or dystrophy of the finger, amputation or ray resection may be indicated.

Effects of metabolite uptake on proton-equivalent elimination by two species of deep-sea vestimentiferan tubeworm, Riftia pachyptila and Lamellibrachia cf luymesi: proton elimination is a necessary adaptation to sulfide-oxidizing chemoautotrophic symbionts.

Intracellular symbiosis requires that the host satisfy the symbiont's metabolic requirements, including the elimination of waste products. The hydrothermal vent tubeworm Riftia pachyptila and the hydrocarbon seep worm Lamellibrachia cf luymesi are symbiotic with chemolithoautotrophic bacteria that produce sulfate and protons as end-products. In this report, we examine the relationship between symbiont metabolism and host proton equivalent elimination in R. pachyptila and L. cf luymesi, and the effects of sulfide exposure on proton-equivalent elimination by Urechis caupo, an echiuran worm that lacks intracellular symbionts (for brevity, we will hereafter refer to proton-equivalent elimination as 'proton elimination'). Proton elimination by R. pachyptila and L. cf luymesi constitutes the worms' largest mass-specific metabolite flux, and R. pachyptila proton elimination is, to our knowledge, the most rapid reported for any metazoan. Proton elimination rates by R. pachyptila and L. cf luymesi correlated primarily with the rate of sulfide oxidation. Prolonged exposure to low environmental oxygen concentrations completely inhibited the majority of proton elimination by R. pachyptila, demonstrating that proton elimination does not result primarily from anaerobic metabolism. Large and rapid increases in environmental inorganic carbon concentrations led to short-lived proton elimination by R. pachyptila, as a result of the equilibration between internal and external inorganic carbon pools. U. caupo consistently exhibited proton elimination rates 5-20 times lower than those of L. cf luymesi and R. pachyptila upon exposure to sulfide. Treatment with specific ATPase inhibitors completely inhibited a fraction of proton elimination and sulfide and inorganic carbon uptake by R. pachyptila, suggesting that proton elimination occurs in large part via K(+)/H(+)-ATPases and Na(+)/H(+)-ATPases. In the light of these results, we suggest that protons are the primary waste product of the symbioses of R. pachyptila and L. cf luymesi, and that proton elimination is driven by symbiont metabolism, and may be the largest energetic cost incurred by the worms.

Contrast sensitivity loss is coupled with capillary dropout in patients with diabetes.

PURPOSE: To assess the relationship of foveal microcirculation to contrast sensitivity function in early diabetes mellitus. METHODS: Twenty patients with diabetes with visual acuity of 20/25 or better without clinically significant macular edema were evaluated. Measurements of contrast sensitivity at four spatial frequencies (3, 6, 12, and 18 cycles/degree [c/deg]), macular capillary blood velocity (CBV), capillary density (PIA: perifoveal intercapillary area), foveal avascular zone (FAZ), and microaneurysm count were performed. Contrast sensitivity data collected from age-matched normal subjects and previously published normal angiographic data were used for comparison with our cohort with diabetes. RESULTS: The CBV was significantly reduced (P < 0.0001) and PIA and FAZ were significantly enlarged (P < 0.0001) when compared with healthy subjects. Contrast sensitivity was significantly lower in the group with diabetes at 6 (P = 0.01) and 12 (P = 0.002) c/deg as compared with healthy control values. FAZ and PIA correlated significantly (FAZ; r = -0.60, P = 0.005; PIA; r = -0.54, P = 0.02) with contrast sensitivity at 12 c/deg. CONCLUSIONS: The alterations of the perifoveal network are related to selective disturbances of central visual function as measured by contrast sensitivity. In patients with diabetes measurement of contrast sensitivity may provide a clinical adjunct in further identifying early ischemic diabetic maculopathy.

[Cost analysis of clinical treatment of polytrauma patients]. / Kostenanalyse der klinischen Behandlung polytraumatisierter Patienten.

In order to assess the costs arising from the treatment of polytraumatized patients we analysed the data of 100 prospectively studied multiple trauma patients (ISS 38) calculating all medical expenses during their clinical stay. The average cost per patient in the studied group (n = 100) amounted to 63989.- DM. About 65% of this sum derived from the costs of intensive care, while the expenses for operations covered 19%. The group of primarily deceased patients (n = 25) generated the lowest costs of 8468.- DM (per pat.). The highest costs of 95626.- DM were caused by the treatment of patients (n = 32) that developed one or more complications (organ failure) during their stay in the intensive care unit or died (n = 10) during this therapy (101940.- DM). Since the data concerning medical equipment (i.e. surgical devices, radiological equipment) were not centrally registered in the administration department of our clinic, it was not possible to include these costs into this calculation. Thus the total costs must be presumed higher. A relationship between costs of treatment and injury severity (ISS) appeared in polytrauma only by a cost reduction in early deceased very severely injured patients (ISS > 70). The primary diagnosis (injury pattern and severity) cannot predict the incidence of complications increasing the costs of treatment. In the presented study we did not find a correlation between age and treatment costs.(ABSTRACT TRUNCATED AT 250 WORDS)

Temporary pacemaking by general internists.

The medical records of 126 patients requiring 129 temporary pacemakers were viewed retrospectively. The pacemakers were inserted by general internists using venous access from subclavian and internal jugular veins under ECG guidances. Fluoroscopy was not used. There was 14% incidence of pacemaker electrode malfunction and a 4% risk of complication with no pacemaker-related mortality. These results compare favorably with reports from university cardiology services. Temporary pacemakers can be safely inserted by general internists without fluoroscopy.