[Focused sonography in orthopedic emergencies]. / Fokussierte Sonographie von Bewegungsorganen in der Notaufnahme.

Focused sonography of the musculoskeletal system in the emergency room should be done for time-effective and symptom-oriented detection of suspected findings. Analogous to other point-of-care ultrasound in emergency medicine, it is by definition not a complete ultrasound examination of the respective organ (e.g., shoulder, elbow). It allows detection of important findings (luxation, effusion, fracture or rupture) with good to excellent diagnostic accuracy. Afterwards computed tomography, magnetic resonance imaging or complete sonographic examination (according to the guidelines of the working group Bewegungsorgane der Deutschen Gesellschaft für Ultraschall in der Medizin, which are identical to those of the working group Orthopädie und Unfallchirurgie) should be added as clinically required. Sonography of the musculoskeletal system in the emergency room can be performed on the lying or sitting patient, except when examining the shoulder, in which there is a difference. The interventional procedures are safe, useful and time saving.

[Impact of breast ultrasound screening in gynecological practice]. / Bedeutung der Mammasonografie für die Brustkrebsfrüherkennung in der gynäkologischen Praxis.

PURPOSE: To define the value of whole breast ultrasound for breast cancer detection in primary women's health care in gynecological routing practice. MATERIALS AND METHODS: Among women who were operated at the breast center of the German Diagnostic Clinic (DKD) in the year 2007, we selected different indications for the examinations which were relevant for the detection of breast lesions. RESULTS: Twenty-one of 86 breast cancers (24 %) which were treated at the DKD in the year 2007 were detected only because of an individual ultrasound screening examination. None of these women had abnormal clinical findings and only 8 of these women had abnormal mammograms. The majority of these cancers were early stages, pT1a/b. In this group of patients, only 8 benign lesions detected by ultrasound were operated. This corresponds to a ratio of benign vs. malignant operations of 0.4 to 1, which is far superior to the recommendations of international guidelines for quality assurance. CONCLUSION: Our results show that ultrasound screening considerably increases the detection of early breast cancers without increasing the rate of unnecessary biopsies. This should encourage gynecologists to learn and perform systematic breast ultrasound examinations and to increase their own performance by continuous training. We can expect that additional studies will prove breast ultrasound to be a powerful method for improving breast cancer detection. Currently available state-of-the-art ultrasound technology allows for early detection, but further education and quality control are important for implementation in nation-wide health care.

[The value of sonography in traumatology and orthopedics : Part 2: emergency diagnostics in blunt abdominal and thoracic trauma]. / Stellenwert der Sonographie in Traumatologie und Orthopädie : Teil 2: Notfalldiagnostik beim stumpfen Bauch- und Thoraxtrauma.

Ultrasound examinations in trauma patients should be done in the emergency department using curved-array (3.5-7.5 MHz) probes. Blunt trauma of the abdomen and thorax must be regarded as a single organ injury. Sonography is the imaging technique of first choice and has completely replaced peritoneal lavage. Paramount advantages are its ability to provide rapid information and reproducible results at short intervals and in a noninvasive manner. The sensitivity and specificity of sonography in detecting intraabdominal fluid are 97-100% and 80-90%, respectively. To achieve such good results, though, adequate education in ultrasound and state-of-the-art devices is crucial. Clinical experiences prove that standardized sonography must be part of polytrauma management and should be integrated in advanced trauma life support courses. Technical improvements with better image quality and miniaturization of hardware will contribute to increase the use of this technique. However, ultrasound does not replace computed tomography for follow-up in answering more sophisticated questions in multiple injured patients.

[Significance of sonography in traumatology and orthopedics: part 1: ultrasonography of the musculoskeletal system]. / Stellenwert der Sonographie in Traumatologie und Orthopädie :Teil 1: Sonographie des Bewegungsapparats.

A wide variety of modern ultrasound systems - including linear probes (7.5-15 MHz) and curved array probes (3.5-7.5 MHz), with color Doppler and duplex as well as harmonic imaging are used in trauma surgery and orthopedics to image and investigate almost all regions of the body. It is generally possible to assess all joints by ultrasonography. Valid procedures for ultrasonographic examination of the elbow, hip, knee, and ankle joints have been described in the literature. In the clinical setting, the use of ultrasound to examine the Achilles tendon and joints such as the shoulder and knee is particularly well documented. An important feature of ultrasound is that it allows dynamic examinations and side-to-side comparisons. Because ultrasonography is a very widely used imaging modality, it is a useful tool for screening and monitoring and especially for investigating venous thrombosis and diseases and injuries of the tendons and muscles.

Rotational state-dependent mixings between resonance states of vibrationally highly excited DCO (X2A').

Rotational state-dependent mixings between highly excited resonance states of DCO (X (2)A(')) were investigated by stimulated emission pumping spectroscopy via a series of intermediate rotational levels in the B (2)A(') electronic state of the radical. Two examples for such interactions, between pairs of accidentally nearly degenerate vibrational states at energies of E(v) approximately 6450 and E(v) approximately 10 060 cm(-1), respectively, were analyzed in detail. Deperturbations of the measured spectra provided the zeroth-order vibration-rotation term energies, widths, and rotational constants of the states and the absolute values of the vibrational coupling matrix elements. The coupled states turned out to have very different A rotational constants so that their mixings switch on or off as they are tuned relative to each other as function of the K(a) rotational quantum number. The respective zeroth-order states could be assigned to different interlaced vibrational polyads. Thus, when two states belonging to different polyads are accidentally nearly isoenergetic, even very weak interpolyad interactions may start to play important roles. The derived interpolyad coupling elements are small compared to the typical intrapolyad coupling terms so that their influences on the vibrational term energies are small. However, large effects on the widths (i.e., decay rates) of the states can be observed even from weak coupling terms when a narrow, long-lived state is perturbed by a broad, highly dissociative state. This influence contributes to the previously observed strong state-to-state fluctuations of the unimolecular decay rates of the DCO radical as function of vibrational excitation. Similar mechanisms are likely to promote the transition to "statistical" rates in many larger molecules.

Physiological disturbances at critically high temperatures: a comparison between stenothermal antarctic and eurythermal temperate eelpouts (Zoarcidae)

The effect of gradually increased water temperature on the metabolism of temperate eelpout from the North Sea (Zoarces viviparus) and Antarctic eelpout (Pachycara brachycephalum) was investigated. Standard metabolic rate (SMR) was similar in cold-adapted P. brachycephalum and cold-acclimated Z. viviparus in the low temperature range. This indicates that Antarctic eelpout show no metabolic cold adaptation (as originally defined by Wohlschlag); however, they do show a compensatory increase of oxygen consumption compared to warm-acclimated eelpout. SMR increased more strongly with rising temperature in P. brachycephalum than in Z. viviparus, which is reflected in a higher Arrhenius activation energy for oxygen consumption (99+/-5 kJ mol(-)(1), versus 55+/-3 kJ mol(-)(1) for cold-acclimated Z. viviparus; means +/- s.d.). The intracellular pH in the white musculature of Z. viviparus follows alphastat regulation over the whole investigated temperature range and dropped at a rate of -0.016 pH units per degrees C between 3 degrees C and 24 degrees C. In Antarctic eelpout white muscle pH declined at a rate of -0.015 pH units per degrees C between 0 degrees C and 3 degrees C, but deviated from alphastat at higher temperatures, indicating that thermal stress leads to acid-base disturbances in this species. The upper critical temperature limit (Tc(II); characterised by a transition to anaerobic metabolism) was found to be between 21 degrees C and 24 degrees C for Z. viviparus and around 9 degrees C for P. brachycephalum. In both species a rise of succinate concentration in the liver tissue turned out to be the most useful indicator of Tc(II). Obviously, liver is more sensitive to heat stress than is white muscle. Accordingly, the energy status of white muscle is not diminished at Tc(II). Heat-induced hyperglycaemia was observed in Antarctic eelpout (at 9 degrees C and 10 degrees C), but not in common eelpout. Based on our results and on literature data, impaired respiration in combination with circulatory failure is suggested as the final cause of heat death. Our data suggest that the southern distribution limit of Zoarces viviparus is correlated with the limit of thermal tolerance. Therefore, it can be anticipated that global warming would cause a shift in the distribution of this species.

Systemic effects and side effects of interstitial techniques used in liver tissue.

BACKGROUND: Percutaneous ethanol injection (PEI) and cryosurgery are increasingly used for the treatment of liver malignancies. To create a safety margin and to destroy completely diffusely growing tumors, the precise destruction of healthy liver tissue is necessary. Little is known about the effects of operating on this type of tissue. This study evaluated the effects and side effects of PEI and cryosurgery when applied to normal parenchyma of the liver. STUDY DESIGN: Two groups of six minipigs each were treated with either PEI or cryosurgery to create necrosis in the liver. During and after the procedures, vital signs were monitored and necrotic areas were observed by ultrasonography. Standard and immunohistochemistry stains were made from samples of the necrosis, the liver, and the lung. RESULTS: In the PEI group, thromboembolic complications occurred in all animals (fatality rate 50%). Hematogenous spread of hepatocytes was demonstrated by immunohistochemistry and was a cause of pulmonary embolism. In the cryosurgery group, neither specific complications nor signs of cell spillage occurred. Because of an isolating effect of blood perfusion, hepatocytes close to the portal triads were less damaged, vital cells were present in the periphery, and the necroses were smaller than the induced lesions. CONCLUSIONS: The effect of PEI in healthy liver tissue is unpredictable. This makes the creation of a safety margin or the treatment of a diffusely infiltrating tumor impossible. PEI always introduces the risk of hematogenous cell spread. Effects of cryosurgery are less dependent on tissue qualities. In both techniques, the real extent of complete tissue destruction cannot be visualized by ultrasonography.

[Pleural drainage in acute thoracic trauma. Comparison of the radiologic image and computer tomography]. / Pleuradrainagen bei akuten Thoraxtraumen. Vergleich der Röntgenaufnahme im Liegen mit der Computertomographie.

PURPOSE: Estimation of chest tube placement in patients with thoracic trauma with regard to chest tube malposition in chest radiography in the supine position compared to additional computed tomography of the thorax. MATERIAL AND METHODS: Apart from compulsory chest radiography after one or multiple chest tube insertions, 31 severely injured patients with thoracic trauma underwent a CT scan of the thorax. These 31 patients with 40 chest tubes constituted the basis for the present analysis. RESULTS: In chest radiography in the supine position there were no chest tube malpositions (n = 40); In the CT scans 25 correct positions, 7 pseudo-malpositions, 6 intrafissural and 2 intrapulmonary malpositions were identified. Moreover 16 sufficient, 18 insufficient and 6 indifferent functions of the chest tubes were seen. CONCLUSION: In case of lasting clinical problems and questionable function of the chest tube, chest radiography should be supplemented by a CT scan of the thorax in order to estimate the position of the chest tube.

Prospective randomized study of drainage and resection on non-occlusive segmental portal hypertension in chronic pancreatitis.

BACKGROUND: In chronic pancreatitis, compression of the splenic vein and superior mesenteric vein (SMV) by an inflammatory mass may cause segmental portal hypertension. Drainage and resection are the principles of surgery for chronic pancreatitis. This study was devised to evaluate the effect of drainage and resection on venous splanchnic blood flow in patients with non-occlusive segmental portal hypertension. METHODS: In 14 of 30 patients with chronic pancreatitis predominantly involving the pancreatic head, segmental portal hypertension due to compression of the splenic vein and SMV was detected by means of indirect splenomesentericoportography and Doppler ultrasonography. None of these 14 patients had symptomatic gastric fundic varices. They were allocated randomly to surgical drainage or resection. Median follow-up was 30 (range 12-48) months. RESULTS: In the resection group, mean(s.d.) splenic vein blood flow increased from 316(46) ml/min before operation to 396(57) ml/min at follow-up (P < 0.01). In the drainage group, preoperative splenic vein blood flow (318(37) ml/min) was not increased after operation (322(37) ml/min). Mean(s.d.) SMV flow increased from 292(42) ml/min before operation to 436(64) ml/min at follow-up (P < 0.01) in the resection group. In the drainage group mean(s.d.) SMV blood flow was 296(32) ml/min before operation and 314(34) ml/min at follow-up. No patient developed fundic gastric varices during follow-up. CONCLUSION: In non-occlusive segmental portal hypertension due to chronic pancreatitis, resection, but not drainage, restores normal venous splanchnic blood flow.

Biochemical and molecular characterization of the extracellular esterase from Streptomyces diastatochromogenes.

An esterase of Streptomyces diastatochromogenes was purified to homogeneity from culture filtrate. The purified enzyme had a molecular mass of 30,862 +/- 5.8 Da, as determined by electrospray mass spectrometry. The esterase-encoding gene was cloned on a 5.1-kb MboI fragment from S. diastatochromogenes genomic DNA into Streptomyces lividans TK23 by using plasmid vector pIJ702. Nucleotide sequence analysis predicted a 978-bp open reading frame, estA, encoding a protein of 326 amino acids, a potential ribosome binding site, and a putative 35- or 36-residue signal peptide for secretion in S. lividans or S. diastatochromogenes, respectively. The transcriptional initiation site was mapped 29 nucleotides upstream from the predicted translational start codon of estA in S. diastatochromogenes. The protein sequence deduced from the estA gene was similar to that of the esterase from the plant pathogen Streptomyces scabies. Both enzymes lacked the conserved motif GXSXG carrying the active-site serine of hydrolytic enzymes. A serine modified by [1,3-3H]diisopropyl fluorophosphate was located at position 11 of the mature enzyme in the sequence GDSYT. This finding and results obtained by site-directed mutagenesis studies indicate that serine 11 may be the active-site nucleophile.

[Open lymph vessels of the ligamentum falciforme hepatis in the human]. / Offene Lymphgefässe im Ligamentum falciforme hepatis des Menschen.

The falciform ligament and the ligamentum teres of the liver are the so-called ventral mesohepaticum. These ligaments are covered on both sides by one layer of mesothelial cells and consist of a dense network of lymphatic capillaries. Preparations of semithin sections were examined light microscopically, ultrathin sections by means of transmission electron microscopy and gold sputtered surface preparations by scanning electron microscopy. It could be shown for the first time that in the mesothelial cell surface there are so-called "stomata", holes which are considered to be connections between the peritoneal cavity and lymphatic capillaries. This network of lymphatics is able to rapidly absorb fluids and particles like blood cells. The knowledge of localisation, structure and function of the submesothelial lymphatic system is of high importance for surgical processing, because in most infections and tumor diseases it is also affected.

[Prevention of adhesions by intraperitoneal administration of substances in abdominal interventions]. / Adhäsionsprophylaxe durch intraperitoneal applizierte Substanzen bei abdominellen Eingriffen.

Various substances (saline solution, dextran, heparin, proteinase inhibitors, etc.) have been investigated to determine their influence on adhesion prevention, but until recently the results were controversial and lacked any implication for clinical use. The analysis of intraperitoneal plasminogen activating factor (PAA) and the fibronectin production rate of peritoneal macrophages promises new aspects of adhesion formation and prevention. The results of studies show a close correlation between ischemia/infection and the decrease of PAA as well as increased adhesion formation in patients (endometriosis) with increased fibronectin production by peritoneal macrophages.