Periodontal ligament cells as alternative source for cell-based therapy of tendon injuries: in vivo study of full-size Achilles tendon defect in a rat model.

Tendon's natural healing potential is extremely low and inefficient, with significant dysfunction and disability due to hypocellularity and hypovascularity of tendon tissues. The application of stem cells can aid in significantly enhanced repair of tendon rupture; therefore, the main aim of this study is to assess the potential of using periodontal ligament cells (PDL), usually obtained from patients undergoing orthodontic treatment, as a novel cell source for cell-based therapy for tendon injuries in a clinically relevant rat full-size Achilles tendon defect. In addition, the study compares the differences between the healing effects of Achilles tendon-derived cells (AT) versus PDL and, hence, comprises of four experimental groups, native tendon (NT), empty defect (ED), PDL and human AT (hAT). The tendon healing in each group was assessed in the late remodelling phase at 16 weeks after surgery using a combination of methods, including evaluation of gross morphological appearance; various histological and immunohistological stainings; and detailed analyses of cell morphometry. Based on these outcome measures, PDL cell-implanted tendons exhibited not only advanced tissue maturation, less ectopic fibrocartilage formation, more organised collagen fibres, tendon matrix expression corresponding to the final healing stage, and better cell-morphometry parameters when compared with the ED group, but were also very similar to the tendons treated with hAT-derived cells. Taken together, our study clearly demonstrates the feasibility of using PDL cells as a novel cell source for tendon repair and strongly recommends this cell type for the future development of innovative regenerative applications for treatment of different tendon or ligament pathologies.

[Isolation and Characterization of Multipotent Precursor Cells from Murine Adipose Tissue using a Clinically Approved Cell Separation System]. / Isolation und Charakterisierung von multipotenten Vorläuferzellen aus murinem Fettgewebe mithilfe eines klinisch zugelassenen Aufbereitungssystems.

INTRODUCTION: Recent studies underscored the clinical potential of adipose-derived multipotent stem-/precursor cells (ASPCs). One of the main hurdles en route to clinical application was to isolate cells without having to perform expansion cultures outside the OR. A new generation of clinically approved, commercially available cell separation systems claims to provide ASPCs ready for application without further expansion cultures. However, it is unclear if the new systems yield sufficient cells of adequate quality for the use in autologous murine models. The aim of this study was to isolate and characterize adipose-derived precursor cells taken from the inguinal fat pat of wistar rats using InGeneron's clinically approved ARC™-cell separation system. MATERIALS AND METHODS: We isolated cells from the inguinal fat pad of 3 male Wistar rats according to the manufacturer's protocol. In order to reduce the influence of the atmospheric oxygen on the multipotent precursor cells, one half of the cell suspension was cultivated under hypoxia (2% O2) simulating physiological conditions for ASPCs. As a control, the other half of the cells were cultivated under normoxia (21% O2). Cell surface markers CD90, CD29, CD45 and CD11b/c were analyzed by FACS, and osteogenic and adipogenic differentiation of the ASPCs was performed. Finally, cellular growth characteristics were assessed by evaluation of the cumulative population doublings and CFU assay, and metabolic activity was evaluated by WST-1 assay. RESULTS: Processing time was 90 (± 12) min. 1 g of adipose tissue yielded approximately 60 000 plastic adhering cells. Both groups showed a high expression of the mesenchymal stem cell markers CD90 and CD29 while they were negative for the leucocyte markers CD45 and CD11b/c. A strong osteogenic differentiation and a sufficient adipogenic differentiation potential was proven for all ASPCs. Under hypoxia, ASPCs showed increased proliferation characteristics and CFU efficiency as well as a significantly increased metabolic activity. CONCLUSION: This study showed that sufficient multipotent ASPCs of appropriate quality can be isolated from the inguinal fat pad of Wistar rats using the ARC™-cell separation system. As shown in previous studies, cultivation of cells under hypoxic conditions increased their stemness. Our findings will enable future studies that focus on autologous transplantation of ASPCs in a rat model, which most closely resembles a possible clinical application.

[En Route for Objective Evaluation of Form, Volume, and Symmetry in Plastic Surgery using 3-D Intraoperative Scans]. / Auf dem Weg zur objektiven Evaluation von Form, Volumen und Symmetrie in der Plastischen Chirurgie mittels intraoperativer 3D Scans.

BACKGROUND: There has been ongoing development in the field of 3-dimensional (3-D) Surface Imaging by laser scanner and digital 3-D photography (Photogrammetry) in recent years. Manufacturers tend to make new 3-D cameras compact, light-weighted, mobile, and user-friendly, similar to the development on the smartphone market. Although 3D scans have been used for patient consultations and digital documentation in Plastic Surgery since the 1980, there has been no significant development lately regarding its use for objective assistance during surgery. PATIENTS, MATERIAL AND METHODS: Our research team presents a new intraoperative 3-D scanning method for plastic-surgical procedures with selected mobile 3-D scanner systems. In the future, these might assist surgeons with the pre-, post-, and intraoperative 3-D analysis, choice of therapy, consultation, and documentation. RESULTS: The 3-D scanners were successfully validated for their intraoperative application to several patients. With their introduction, an intraoperative, objective measurement of volume to evaluate form and symmetry was possible. CONCLUSION: In this work, we share our first experience with the intraoperative use of new mobile 3D camera systems, discuss pros and cons, and show selected patient examples.

[Results after Arthroscopically Assisted Management of Intra-Articular Distal Radius Fractures]. / Ergebnisse nach arthroskopisch assistiert versorgter distaler Radiusfraktur mit Gelenkbeteiligung.

UNLABELLED: Background/Goal: An arthroscopically assisted management of intra-articular distal radius fractures may improve the quality of reduction. Furthermore, concomitant ligament and triangular fibrocartilage complex injuries can be identified and treated. However, this approach increases the duration of surgery. If severe soft tissue lesions, such as SL-ligament disruptions are treated simultaneously, a longer post-operative immobilisation will be required. The aim of this study was to measure the clinical outcome one year after arthroscopically assisted treatment of intra-articular distal radius fractures. PATIENTS AND METHODS: In a retrospective study from 2011 to 2013 we identified 27 patients with intra-articular distal radius fractures who were treated with volar fixed angle plates in an arthroscopically assisted fashion. The amount of associated injuries, the duration of surgery and the time of immobilisation were documented. One year postoperatively we evaluated 23 of these patients using several scores. Patient satisfaction, range of motion, visual analogue scale and grip strength were assessed using a standardised questionnaire. RESULTS: The mean surgery time was 111 min (60-190 min). On average, we found 1.4 (0-3) associated injuries per patient. Seventy percent (19) of all patients had a triangular fibrocartilage complex lesion, 67% (16) had some degree of scapholunate ligament lesion. The mean number of interventions in addition to the plate fixation was 1.1 per patient (0-3). Among these were debridements of the triangular fibrocartilage complex in 11 cases (41%) and scapholunate ligament repairs in 4 cases (15%). The mean immobilisation time was 22 (0-42) days. At one year after surgery, the mean Mayo wrist score was 79 (65-95) and the DASH score was 12 (0-49). CONCLUSION: The arthroscopically assisted management of intra-articular distal radius fractures helps to identify and treat associated injuries. However, it results in extended surgery and immobilisation time, especially if concomitant intra-articular lesions are treated. In our group of patients, the clinical outcome after one year was nonetheless very good.

[Interrater Reliability of Scapholunate Advanced Collapse (SLAC) Wrist Stage Classification and Influence of Diagnostic Wrist Arthroscopy]. / Interrater-Reliabilität der Schweregradeinteilung des karpalen Kollapses bei skapholunärer Dissoziation und Einfluss der Handgelenksarthroskopie.

AIM: Therapy of scapholunate advanced collapse (SLAC) wrist should be guided by the degree of arthritic changes within the radioscaphoid and midcarpal joints (stage 1-3 after Watson). Diagnostic investigations usually include X-ray imaging and wrist arthoscopy. In the present study, the interrater reliability of SLAC wrist stage classification by means of X-ray image analysis was evaluated between radiologists and hand surgeons. Ultimately, the influence of diagnostic wrist arthroscopy on the final stage classification was determined. PATIENTS AND METHODS: Retrospectively, 38 SLAC wrists of 37 patients were included in this study. Conventional X-ray images in a dorso-palmar and lateral view were performed before diagnostic wrist arthroscopy. The degree of carpal collapse on X-rays was determined by 2 radiologists and 2 surgeons (1 board certified hand surgeon, 1 plastic surgeon, both experienced in hand surgery since years). After 14 days the stages were re-evaluated by the surgeons with the digital images from the wrist arthroscopies at hand. RESULTS: While the interrater reliability turned out to be 'weak' amidst the radiologists, it was classified as 'light' among the surgeons. We found a 'weak' and a 'light' interrater reliability between the surgeons and the radiologists. Radiologists tended to assess the degree of severity higher than surgeons. The additional knowledge of the digital arthroscopy images led to a different classification in 55%. When X-rays were assessed in combination with the arthroscopy findings, both stage 1 and stage 3 were diagnosed less frequently. CONCLUSIONS: Our study suggests that interpreting X-ray films alone is an unreliable method to assess the stage of SLAC wrist. We believe that additional diagnostic measures such as wrist arthroscopy are needed to accurately diagnose the SLAC wrist stage.

[3D-imaging and analysis for plastic surgery by smartphone and tablet: an alternative to professional systems?]. / 3D Bilderfassung und Analyse in der Plastischen Chirurgie mit Smartphone und Tablet: eine Alternative zu professionellen Systemen?

BACKGROUND: A new approach of using photographs from smartphones for three-dimensional (3D) imaging was introduced besides the standard high quality 3D camera systems. In this work, we investigated different capture preferences and compared the accuracy of this 3D reconstruction method with manual tape measurement and an established commercial 3D camera system. METHODS: The facial region of one plastic mannequin head was labelled with 21 landmarks. A 3D reference model was captured with the Vectra 3D Imaging System®. In addition, 3D imaging was executed with the Autodesk 123d Catch® application using 16, 12, 9, 6 and 3 pictures from Apple® iPhone 4 s® and iPad® 3rd generation. The accuracy of 3D reconstruction was measured in 2 steps. First, 42 distance measurements from manual tape measurement and the 2 digital systems were compared. Second, the surface-to-surface deviation of different aesthetic units from the Vectra® reference model to Catch® generated models was analysed. For each 3D system the capturing and processing time was measured. RESULTS: The measurement showed no significant (p>0.05) difference between manual tape measurement and both digital distances from the Catch® application and Vectra®. Surface-to-surface deviation to the Vectra® reference model showed sufficient results for the 3D reconstruction of Catch® with 16, 12 and 9 picture sets. Use of 6 and 3 pictures resulted in large deviations. Lateral aesthetic units showed higher deviations than central units. Catch® needed 5 times longer to capture and compute 3D models (average 10 min vs. 2 min). CONCLUSION: The Autodesk 123d Catch® computed models suggests good accuracy of the 3D reconstruction for a standard mannequin model, in comparison to manual tape measurement and the surface-to-surface analysis with a 3D reference model. However, the prolonged capture time with multiple pictures is prone to errors. Further studies are needed to investigate its application and quality in capturing volunteer models. Soon mobile applications may offer an alternative for plastic surgeons to today's cost intensive, stationary 3D camera systems.

Protective effects of antithrombin on free groin flaps after secondary venous stasis in the rat model.

BACKGROUND: The anticoagulant activity of heparin is well established and led to its widespread clinical use for the prophylaxis and treatment of venous thrombosis in microsurgery. Heparin accelerates antithrombin (AT)-mediated inhibition of clotting and fibrinolytic proteinases. AIM: The aim of the study is to determine whether the focussed delivery of AT by rinsing of free adipocutaneous groin flaps shows protective effects on flap survival, following a fatal secondary venous stasis in the rat model. Further, intravital video microscopy (IVM) is used to detect substance-specific alterations in microvascular perfusion with special focus on regional differences between central and peripheral flap regions. METHODS: Free microvascular groin flaps (n = 22) were transplanted to the neck in adult Sprague-Dawley rats. The flap pedicle was re-explored and the distal stump of the flap artery was catheterised 20 h later. Animals in group I (n = 11) were treated with 1 ml of Ringer's solution administered over 10 min via intraarterial infusion. Those in group II (n = 11) received 1 ml of AT (50 IU/kg). Afterwards, the flap vein was clamped for 35 min. The skin of the flaps and the native contralateral groin was examined by IVM using the plasma-marker fluorescein isothiocyanate (FITC)-dextran and carboxyfluorescein diacetate succinimidyl ester (CFDA-SE)-labelled thrombocytes. After 14 days, the viability of the flaps was evaluated. RESULTS: The treatment with AT significantly increased the functional capillary density (FCD) of the flaps. After 14 days, flap necrosis occurred in nine animals of group I and three animals of group II, respectively. No partial flap loss was detected. CONCLUSIONS: The focussed delivery of AT resulted in significantly improved flap salvage. The results may reinforce the clinical custom of AT substitution in the setting of major surgical procedures such as elaborate microsurgical reconstructions, at least in cases with diminished AT levels.

[Optimising care structures for severe hand trauma and replantation and chances of launching a national network]. / Über Versorgungsstrukturen und Möglichkeiten der Optimierung durch Vernetzung bei schweren Handverletzungen und Replantationen.

Severe hand traumata have a significant impact on our health system and on insurance companies, respectively. It is estimated that 33% of all occupational injuries and 9% of all invalidity pensions are due to severe hand trauma. Unfortunately, these high numbers are not only due to the severity of the trauma but to organisational deficiencies. Usually, the patient is treated at the general surgical emergency in the first place and only then forwarded to a microsurgeon. This redirection increases the time that is required for the patient to finally arrive at an expert for hand surgery. On the one hand, this problem can be explained by the population's lack of awareness for distinguished experts for hand and microsurgery, on the other hand, the emergency network, or emergency doctors in particular are not well informed about where to take a patient with a severe hand trauma - clearly a problem of communication between the hospitals and the ambulance. It is possible to tackle this problem, but put participating hand trauma centres have to work hand in hand as a network and thus exploit synergy effects. The French system "FESUM" is a good example for such a network and even comprises centres in Belgium and Switzerland. To improve the treatment of severe hand trauma, a similar alliance was initiated in Germany just recently. The pilot project "Hand Trauma Alliance" (www.handverletzung.com) was started in April 2013 and currently comprises two hospitals within the region of upper Bavaria. The network provides hand trauma replantation service on a 24/7 basis and aims at shortening the way from the accident site to the fully qualified hand surgeon, to improve the therapy of severe hand injuries and to optimise acute patient care in general. In order to further increase the alliance's impact it is intended to extend the project's scope from regional to national coverage - nevertheless, such an endeavour can only be done in collaboration with the German Society for Hand Surgery (DGH). This article comprises 2 parts. First, the state-of-the-art of acute severe hand trauma care is summarised and explained. Subsequently, the above-mentioned pilot project is described in every detail, including positive effects but also barriers that still have to be overcome.

Porosity and mechanically optimized PLGA based in situ hardening systems.

Goal of the present study was to develop and to characterize in situ-hardening, porous PLGA-based systems for their future application as bone grafting materials. Therefore, we investigated the precipitation behavior of formulations containing PLGA and a water-miscible solvent, DMSO, PEG 400, and NMP. To increase porosity, a pore forming agent (NaCMC) was added and to enhance mechanical properties of the system, an inorganic filler (α-TCP) was incorporated. The behavior upon contact with water and the influence of the prior addition of aqueous media on the morphology of the corresponding hardened implants were investigated. We proved cell-compatibility by live/dead assays for the hardened porous polymer/ceramic-composite scaffolds. The IsHS formulations can therefore be used to manufacture hardened scaffolds ex vivo by using molds with the desired shape and size. Cells were further successfully incorporated into the IsHS by precultivating the cells on the α-TCP-powder prior to their admixing to the formulation. However, cell viability could not be maintained due to toxicity of the tested solvents. But, the results demonstrate that in vivo cells should well penetrate, adhere, and proliferate in the hardened scaffolds. Consequently, we consider the in situ hardening system being an excellent candidate as a filling material for non-weight-bearing orthopedic indications, as the resulting properties of the hardened implant fulfill indication-specific needs like mechanical stability, elasticity, and porosity.

[3-dimensional imaging systems: first experience in planning and documentation of plastic surgery procedures]. / 3-dimensionale Bilderfassung: Erste Erfahrungen in der Planung und Dokumentation plastisch-chirurgischer Operationen.

A reproducible 3-dimensional photographic system enables plastic surgeons to perform preoperative planning and helps them to understand the patient's expectations. There are a few systems available that allow a reproducible 3-dimensional scans of the patient with direct simulation of the planned procedure. The Vectra Volumetric 3D Surface Imaging® by Canfield® provides such an option and helps the surgeons to document and compare postoperative changes at different time points. Since January 2011 we are digitally documenting all patients receiving form-modulating procedures in our plastic surgery unit. We present the spectrum of clinical implications and discuss advantages and disadvantages of the system. Furthermore, we have studied the accuracy of the system in comparison to direct measurement in 15 volunteers. The system is especially suited for planning and evaluation of breast augmentation, facial aesthetic and reconstructive surgery as well as volumetric measurements before and after liposuction and lipofilling. Computer-assisted measurements correlate with a median deviation of 2.3% with manually measured distances in the face. We found the user-friendly Vectra® system to be a reliable and reproducible device for planning plastic surgery therapies and for documenting postoperative results.

[Implant position of total hip arthroplasty shafts. Establishment of a new method for comparison between planned and achieved shaft positions]. / Implantatposition von Hüftendoprothesenschäften. Etablierung einer neuen Methode zum Vergleich zwischen geplanter und erreichter Schaftposition.

BACKGROUND: One of the main goals of the preoperative planning of hip prostheses is adequate shaft positioning with reconstruction of leg length and offset. The purpose of this study was to compare the planned and achieved shaft positions using a modified program for migration measurement. METHODS: In 60 cases of total hip replacement the preoperative planning was compared with the postoperative radiograph using a modified version of the well-established EBRA-FCA program. The results of this new measurement were compared to conventional measurements. In 25 cases the intraobserver and interobserver reliability was determined. RESULTS: The novel measurements correlated best with the measured distance between the greater trochanter and the center of rotation and yielded the best intraobserver and interobserver reliability. In general, cementless stems had a slightly more proximal position (0.65 mm) compared to cemented stems. CONCLUSIONS: The modified program for migration measurement facilitates a reproducible and fast comparison of the planned and achieved shaft positions thus implementing an early and objective control of postoperative shaft position.

[Alterations of cell phenotype in Dupuytren's disease--an in vitro analysis]. / Veränderung des Zell-Phänotyps durch Morbus Dupuytren--eine in-vitro-Analyse.

INTRODUCTION: Despite its potential complications, partial aponeurectomy still is the mainstay of treatment whenever it comes to significant contracture in Dupuytren's disease. With the goal in mind to identify new therapeutic strategies we isolated and characterised cells from healthy palmar aponeurosis (Kon) and compared them to cells isolated from palmar aponeurosis of patients with a primary manifestation of Dupuytren's disease (PrimDup) as well as from patients with recurrent Dupuytren's disease (RezDup). As cells from palmar aponeurosis from patients with Dupuytren's disease share characteristics with stem cells, such as the ability to differentiate into other cell types, we analysed the stemness, morphology and integrin receptor profiles of the cells. MATERIALS AND METHODS: A total of 15 Dupuytren samples were collected from regular partial aponeurectomy procedures. From these, 3 donors without extrinsic risk factors were selected per group (RezDup, PrimDup). Cells were isolated and expanded under standard cell culture conditions. Cells from healthy patients served as control (Kon). Growth curves were produced. Cells were subjected to osteogenic and adipogenic differentiation using standard protocols. Semiquantitative PCR analysis of the integrins α2, ß3, ß5 and fibronectin was performed. RESULTS: PrimDup cells proliferated significantly faster than control cells, which in turn proliferated faster than RezDup cells. Both PrimDup and control cells went into senescence after approximately 40 days whereas RezDup cells proliferated over the entire period of 100 days. Osteogenic and adipogenic differentiation was best in cells derived from Dupuytren patients while Kon cells differentiated poorly. PCR analysis revealed that fibronectin-binding integrins ß3 and ß5 are upregulated in Dupuytren's disease. CONCLUSIONS: PrimDup cells grow faster than the other cell types suggesting that their growth regulation may be altered. The fact that RezDup cells do not reach senescence over 100 days in culture indicates that senescence regulating factors may be altered. As cells from Dupuytren patients differentiate better along the osteogenic and adipogenic lineages, they probably possess a higher level of stemness. Their modified integrin profile may be a key to future therapies.

[Microscope-integrated intraoperative indocyanine green angiography in plastic surgery]. / Intraoperative Indocyaningrün-Fluoreszenzdiagnostik mittels Operationsmikroskop in der plastischen Chirurgie.

The knowledge of tissue perfusion has not only a prognostic value in microvascular surgery but also the intraoperative detection of malperfusion can lead to a quick surgical intervention. Indocyanine green (ICG) angiography allows a topographic analysis of perfusion and is used to assess lymphatic drainage pathways and to analyse the depth of burn injuries. Integrating the technique into an operating microscope enables visualisation of the flow over microanastomoses and allows the assessment of the transit time of blood flow between arterial and venous anastomosis. Using this method we analysed 11 microsurgical free flaps (3 latissimus dorsi, 3 rectus abdominis, 1 gracilis muscle, 2 radial forearm, 1 ALT, and 1 DIEP flap). The topographic analysis was performed after the assessment of the microanastomoses. We observed no flap loss or partial flap necrosis. The transit time between arterial inflow and venous outflow was 32.8 s on average. Here we observed distinct differences between muscle flaps (27.7 s) on the one hand and fasciocutaneous and perforator flaps (47.5 s) on the other hand. We detected one venous thrombosis by ICG angiography in a case where the clinical patency test was not distinct. Revision was performed immediately. Particularly for intraoperative assessment, ICG angiography is a useful, reliable and safe technique. The integration into the operating microscope allows an "angiographic patency test" and the analysis of the transit time allows the evaluation of blood flow within the flap. Especially when planning perforator flaps the method of ICG angiography provides a new level of safety in flap design by quickly demonstrating the borders of perfusion.

Residual transglutaminase in collagen - effects, detection, quantification, and removal.

In the present study, we developed an enzyme-linked immunosorbent assay (ELISA) for microbial transglutaminase (mTG) from Streptomyces mobaraensis to overcome the lack of a quantification method for mTG. We further performed a detailed follow-on-analysis of insoluble porcine collagen type I enzymatically modified with mTG primarily focusing on residuals of mTG. Repeated washing (4 ×) reduced mTG-levels in the washing fluids but did not quantitatively remove mTG from the material (p < 0.000001). Substantial amounts of up to 40% of the enzyme utilized in the crosslinking mixture remained associated with the modified collagen. Binding was non-covalent as could be demonstrated by Western blot analysis. Acidic and alkaline dialysis of mTG treated collagen material enabled complete removal the enzyme. Treatment with guanidinium chloride, urea, or sodium chloride was less effective in reducing the mTG content.

A rare case of primary actinomycosis of the anterior abdominal wall: diagnosis and treatment.

We present the case of a 60-year-old man who presented with a left hypochondrial swelling first noticed 4 weeks prior to admission to our clinic. Based on the findings of the ultrasound and magnetic resonance imaging investigation, a tumour of uncertain origin of the abdominal wall was suspected, also involving the small bowel. The swelling, including the affected lateral and transverse oblique muscles as well as the subcutaneous tissue and the adjacent omentum majus, was completely excised. The resulting myoaponeurotic defect of the left lateral abdominal wall was closed with interrupted Vicryl sutures and stabilised with a PTFE prosthesis (20 x 10 cm) that was placed intraabdominally and secured by spiral tackers and interrupted transfascial monofilament Prolene sutures. Microscopic examination of the excised specimen revealed an actinomycosis of the anterior abdominal wall, which is extremely rare. The surgical treatment was followed by antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications.

Human homologs of Schizosaccharomyces pombe rad1, hus1, and rad9 form a DNA damage-responsive protein complex.

DNA damage activates cell cycle checkpoints in yeast and human cells. In the yeasts Saccharomyces cerevisiae and Schizosaccharomyces pombe checkpoint-deficient mutants have been characterized, and the corresponding genes have been cloned. Searches for human homologs of S. pombe rad1, rad9, and hus1 genes identified the potential human homologs hRad1, hRad9, and hHus1; however, little is known about the roles of these proteins in human cells. The present studies demonstrate that hRad1 and hHus1 associate in a complex that interacts with a highly modified form of hRad9, but hHus1 and hRad1 do not associate with hRad17. In addition to being a key participant in complex formation, hRad9 is phosphorylated in response to DNA damage. Together, these results suggest that hRad9, hRad1, and hHus1 are central components of a DNA damage-responsive protein complex in human cells.

[A contribution to the psychopathology of patients with open heart surgery (author's transl)]. / Zur Psychopathologie der Herzoperierten.

The results of a larger study of psychopathological disorders in relation to pre-operative and post-operative examined heart surgery patients, where the heart-lung machine was used, will be shown, to begin with, on 20 patients. Pre-operative examination showed quite clearly, among other things, that patients suppress obvious operation risks. General mental disorders were seen post-operative in 4 patients, and these were diagnosed as organic psychosis. A comparison between psychotic and other patients shows, among other things, that somatic predictors such as cerebral sclerosis and atrophy, or a cerebral trauma tend to promote post-operative psychosis. A releasing cause could be a cerebral hypoxia brought about by the extracorporeal blood circulation. In our opinion psychological factors can only be found in the contents of psychosis.