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Loerbroks A, Dreher A, Scharf J, Mambrey V, Vu-Eickmann P, Angerer P. The Relationship of Workplace Bullying with Health Outcomes, the Intention to Leave the Profession and Medical Errors: A Cross-sectional Study among Medical Assistants in Germany. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf
| | - A Dreher
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf
| | - J Scharf
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf
| | - V Mambrey
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf
| | - P Vu-Eickmann
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf
| | - P Angerer
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf
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2
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Scharf JL, Gitas G, Hartge D, Rody A, Kotanidis C. Fallbericht einer 38-jährigen Patientin II G I P in 18+5 SSW. mit Uterusruptur bei Uterussacculation. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- JL Scharf
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe (Gynäkologie), Lübeck, Deutschland
| | - G Gitas
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe (Gynäkologie), Lübeck, Deutschland
| | - D Hartge
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe (Gynäkologie), Lübeck, Deutschland
| | - A Rody
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe (Gynäkologie), Lübeck, Deutschland
| | - C Kotanidis
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe (Gynäkologie), Lübeck, Deutschland
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Scharf J, Vu-Eickmann P, Angerer P, Müller A, Loerbroks A. Welche berufsbezogenen Veränderungswünsche haben Medizinische Fachangestellte? Ergebnisse einer Fragebogenstudie. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Scharf
- Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - P Vu-Eickmann
- Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - P Angerer
- Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - A Müller
- Institut für Psychologie, Arbeits- und Organisationspsychologie, Universität Duisburg-Essen, Essen, Deutschland
| | - A Loerbroks
- Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Abstract
We report a case of a young man suffering from both ankylosing spondylitis and Behçet's disease in whom the character of the ocular involvement changed according to the predominant disease at a given time. When the clinical picture was one of ankylosing spondylitis, only anterior uveitis was observed, while the clinical picture of Behçet's disease occurred with panuveitis and retinal vasculitis. To the best of our knowledge, this is the first report in the English literature of two different patterns of ocular involvement in the same patient with two seronegative arthritides.
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Affiliation(s)
- I Beiran
- Department of Ophthalmology, Rambam Medical Center, Haifa, Israel
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Beiran I, Reissman P, Scharf J, Nahum Z, Miller B. Hyperbaric Oxygenation Combined with Nifedipine Treatment for Recent-Onset Retinal Artery Occlusion. Eur J Ophthalmol 2018; 3:89-94. [PMID: 8353436 DOI: 10.1177/112067219300300207] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the results of early hyperbaric oxygenation combined with nifedipine treatment for central retinal artery occlusion, and explain the results pathophysiologically. We report four cases in which hyperbaric oxygenation therapy was applied in combination with nifedipine, eyeball massage, and glycerol for the treatment of central retinal artery occlusion. In two of the cases in which therapy was started less than 100 minutes after the acute onset of visual loss and one case in which therapy was started during the course of central arterial occlusion, considerable improvement in visual acuity was observed, while in the fourth case in which therapy was started six hours after the acute onset of visual loss, no improvement appeared. We conclude from these results that hyperbaric oxygenation therapy has a beneficial effect on the final visual outcome of central retinal artery occlusion, provided it is applied early enough. Further investigation is needed to fully define the nature and terms of this beneficial effect.
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Affiliation(s)
- I Beiran
- Department of Ophthalmology, Rambam Medical Center, Haifa, Israel
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Wedler K, Mersmann J, Schuster S, Stadelmeyer U, Stork G, Schwarz C, Machner M, Krebs A, Petri B, Fuchs A, Scharf J, Friesdorf M, Swistun H, Glien P, Weiß C, Dietz-Wittstock M, Dormann P, Schilling T, Walcher F. Positionspapier zur Stärkung und Weiterentwicklung der Notfallpflege in deutschen Notaufnahmen. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0333-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wenz H, Al Mahdi MM, Ehrlich G, Scharf J, Schmiedek P, Seiz M. De novo aneurysm of the anterior communicating artery presenting with subarachnoid hemorrhage 7 years after initial cryptogenic subarachnoid hemorrhage: a case report and review of the literature. Clin Neuroradiol 2014; 25:93-7. [PMID: 24384679 DOI: 10.1007/s00062-013-0278-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
Abstract
Spontaneous subarachnoid hemorrhage (SAH) is usually caused by a ruptured cerebral aneurysm. Despite the use of initial four-vessel cerebral digital subtraction angiography (DSA), 15 % of all cases remain idiopathic. According to the initial computed tomographic scan, the spontaneous SAH can be divided into a perimesencephalic group associated with a benign nature and a nonperimesencephalic group with a similar clinical course as aneurysmal SAH. We present a case of a 49-year-old man with a de novo aneurysm formation of the anterior communicating artery with SAH 7 years after initial cryptogenic nonperimesencephalic SAH. This observation suggests that in some cases, long-term angiographic studies might be justified.
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Affiliation(s)
- H Wenz
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany,
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8
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Scharf J, Yu D, Mathews C, Neale B, Stewart E, Fagerness J, Evans P, Gamazon E, Service S, Osiecki L, Illmann C, Cath D, King R, Dion Y, Sandor P, Barr C, Budman C, Lyon G, Grados M, Singer H, Jankovic J, Gilbert D, Hoekstra P, Heiman G, Tischfield J, State M, Robertson M, Kurlan R, Ophoff R, Gibbs JR, Cookson M, Hardy J, Singleton A, Ruiz-Linares A, Rouleau G, Heutink P, Oostra B, McMahon W, Freimer N, COX N, Pauls D. Genome-Wide Association Study of Gilles de la Tourette Syndrome (IN10-1.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in10-1.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Scharf J, Yu D, Mathews C, Neale B, Stewart E, Fagerness J, Evans P, Gamazon E, Service S, Osiecki L, Illmann C, Cath D, King R, Dion Y, Sandor P, Barr C, Budman C, Lyon G, Grados M, Singer H, Jankovic J, Gilbert D, Hoekstra P, Heiman G, Tischfield J, State M, Robertson M, Kurlan R, Ophoff R, Gibbs JR, Cookson M, Hardy J, Singleton A, Ruiz-Linares A, Rouleau G, Heutink P, Oostra B, McMahon W, Freimer N, COX N, Pauls D. Genome-Wide Association Study of Gilles de la Tourette Syndrome (S32.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s32.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Castellanos I, Rellensmann G, Scharf J, Bürkle T. Computerized Physician Order Entry (CPOE) in pediatric and neonatal intensive care: Recommendations how to meet clinical requirements. Appl Clin Inform 2012; 3:64-79. [PMID: 23616901 DOI: 10.4338/aci-2011-08-ra-0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 02/07/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify and summarize the requirements of an optimized CPOE application for pediatric intensive care. METHODS We analyzed the medication process and its documentation in the pediatric and neonatal intensive care units (PICU/NICU) of two university hospitals using workflow analysis techniques, with the aim of implementing computer-supported physician order entry (CPOE). RESULTS In both PICU/NICU, we identified similar processes that differed considerably from adult medication routine. For example, both PICU/NICU prepare IV pump syringes on the ward, but receive individualized ready-to-use mixed IV bags for each patient from the hospital pharmacy on the basis of a daily order. For drug dose calculation, both PICU/NICU employ electronic calculation tools that are either incorporated within the CPOE system, or are external modules invoked via interface. CONCLUSION On the basis of this analysis, we provide suggestions to optimize CPOE applications for use in the pediatric and neonatal intensive care unit in the form of three catalogues of desiderata for drug order entry support.
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Affiliation(s)
- I Castellanos
- Anästhesiologische Klinik, Universitätsklinikum Erlangen , Germany
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Gerigk L, Bostel T, Hegewald A, Thomé C, Scharf J, Groden C, Neumaier-Probst E. Dynamic Magnetic Resonance Imaging of the Cervical Spine with High-Resolution 3-Dimensional T2-Imaging. Clin Neuroradiol 2011; 22:93-9. [DOI: 10.1007/s00062-011-0121-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/01/2011] [Indexed: 11/28/2022]
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Brockmann C, Seker F, Weiss C, Groden C, Scharf J. Acetylsalicylic Acid Does Not Prevent Digital Subtraction Angiography-Related High Signal Intensity Lesions in Diffusion-Weighted Imaging in Cerebrovascular Patients. Clin Neuroradiol 2011; 22:15-20. [DOI: 10.1007/s00062-011-0076-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
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Jochum S, Brockmann C, Lederle K, Schönberg SO, Diehl SJ, Scharf J. Detektion von intrakraniellen Aneurysmen: Dual Energy CT versus DSA. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zimmermann T, Cesnjevar R, Carbon R, Zenk J, Dittrich S, Glöckler M, Scharf J, Schönecker V. Trachealstenose im Kindesalter- Fallbeschreibung 3 Kinder. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Danner B, Emmert A, Hagenah G, Tirilomis T, Stojanovic T, Scharf J, Seipelt R, Schöndube FA. Acute gastrointestinal bleeding due to oesophageal varices: An unusual case of a thoracic spleen. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Czabanka M, Peña-Tapia P, Scharf J, Schubert G, Münch E, Horn P, Schmiedek P, Vajkoczy P. Characterization of Direct and Indirect Cerebral Revascularization for the Treatment of European Patients with Moyamoya Disease. Cerebrovasc Dis 2011; 32:361-9. [DOI: 10.1159/000330351] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/08/2011] [Indexed: 11/19/2022] Open
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Brockmann C, Scharf J, Nölte IS, Seiz M, Groden C, Brockmann MA. Dual-energy CT after peri-interventional subarachnoid haemorrhage: a feasibility study. Clin Neuroradiol 2010; 20:231-5. [PMID: 21052614 DOI: 10.1007/s00062-010-0036-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 09/13/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to assess the feasibility of dual-energy computed tomography (DE-CT) for detection of peri-interventional re-bleeding in patients with aneurysmal subarachnoid hemorrhage (re-SAH). METHODS For in vitro-analyses DE-CT of partially clotted blood intermixed with fresh blood containing contrast agent was performed. In a clinical setting, 4 patients routinely underwent DE-CT after suspected peri-interventional re-SAH. DE-CT source data images, iodine maps and virtual non-contrast images (VNC) were analyzed and regions-of-interest (ROI) measurements of density values were performed. RESULTS In vitro experiments demonstrated the feasibility of DE-CT to discriminate between blood with and without contrast agent. In all patients peri-interventional re-SAH was confirmed by detection of extravasated iodine within the subarachnoid spaces in post-interventional DE-CT. Dual-energy CT allowed the discrimination of old blood clots of the initial SAH and blood originating from peri-interventional re-SAH. After subtraction of the iodine-related high density signal, VNC images optimized the estimation of the true amount of subarachnoid blood. CONCLUSION Dual-energy CT allows the discrimination and subtraction of blood and iodine mixed within the subarachnoid spaces in patients with peri-interventional re-SAH. It helps to avoid overestimation of SAH after peri-interventional re-bleeding and therefore is a potentially valuable tool in the assessment of peri-interventional re-SAH.
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Affiliation(s)
- C Brockmann
- Department of Neuroradiology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Böhles H, Dick W, Scharf J. Die Behandlung der Glykogenose Typ III mit totaler parenteraler Ernährung, intragastraler Dauertropfinfusion und D-Thyroxin. Transfus Med Hemother 2009. [DOI: 10.1159/000221344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Meissner U, Scharf J, Dötsch J, Schroth M. Very early extubation after open-heart surgery in children does not influence cardiac function. Pediatr Cardiol 2008; 29:317-20. [PMID: 17676368 DOI: 10.1007/s00246-007-9023-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Accepted: 06/13/2007] [Indexed: 10/23/2022]
Abstract
The objective of our study was to evaluate hemodynamic effects and the cardiac function after very early extubation within the first 6 hours after open-heart surgery in children. During a 12-month period, we performed a retrospective study of 50 children (ages 3 months to 7 years) admitted to the pediatric intensive care unit immediately after minor cardiac surgery. All children were extubated within the first 6 hours after their arrival. Arterial blood and central venous pressure were monitored, and arterial blood gas analysis was performed. Cardiac index, stroke volume index, systemic vascular resistance index, and extravascular lung water index were measured by thermodilution. Early extubation of children after minor open-heart surgery with cardiopulmonary bypass is safe and does not affect cardiac functions. A slight decrease of arterial oxygen tension not resulting in respiratory or metabolic acidosis or reintubation was noted. Very early extubation in children after open-heart surgery does not promote cardiodepressive effects. It is a safe procedure that helps to reduce the unnecessary and prolonged mechanical ventilation of children after cardiopulmonary bypass surgery.
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Affiliation(s)
- U Meissner
- Department of Pediatrics, Leopoldina Hospital, D-97422, Schweinfurth, Germany
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Scharf J, Groden C. Was definiert den engen Spinalkanal? ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Seiz M, Brockmann M, Schneider U, Woitzik J, Scharf J. Combination of a Supratentorial Venous Anomaly and Infratentorial Developmental Venous Anomalies Mimicking AV-Malformation: A Case Report. ACTA ACUST UNITED AC 2007; 68:217-9. [DOI: 10.1055/s-2007-985854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- H Köhler
- Division of Gastroenterology, Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Erlangen, Germany.
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Schroth M, Scharf J, Dötsch J, Rascher W. Very Early Extubation After Open Heart Surgery In Children Does Not Influence Cardiac Function. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-946242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schroth M, Scharf J, Dötsch J, Rascher W. Very Early Extubation After Open Heart Surgery In Children Does Not Influence Cardiac Function. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-943327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Various techniques for injection into the larynx have been well described, including transoral injection with indirect laryngoscopy or direct laryngoscopy and transcutaneous injection through the thyroid cartilage or cricothyroid membrane. We describe a case not amenable to these techniques, in which entry through the thyrohyoid membrane for injection of cidofovir was successfully performed with a thyrohyoid approach. This technique is described, and comparisons are made with currently available techniques.
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Affiliation(s)
- A E Getz
- Department of Otolaryngology, Temple University School of Medicine, Philadelphia, PA 19107, USA
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Rupprecht T, Scharf J, Zink S, Wagner M. Ascending arterial blood flow velocities during cardiac diastole in critical care patients--a characteristic flow pattern with a bad prognosis. Ultraschall Med 2005; 26:307-11. [PMID: 16123925 DOI: 10.1055/s-2005-858065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM Pulsed Doppler ultrasound is a standard noninvasive investigation to measure the velocity and pulsatility of blood flow within the major intracranial and organ-supplying arteries in critical care patients. The normal arterial flow pattern in organ-supplying vessels is characterised by a systolic-diastolic forward flow which is caused by the aortic "Windkessel" function and the low peripheral resistance of the parenchymatous organs. A variety of well known pathological conditions may cause a change of the vascular characteristics within the perfused organs which are diagnosed by the typical changes of the flow pattern in the supplying arteries. In the cardiac diastole, however, there is always a slow decrease of the flow velocity which is terminated by the onset of the following systole. METHOD AND RESULTS We report on 11 patients investigated by Doppler ultrasound during their stay in our intensive care unit. All these patients presented a markedly different flow pattern measured in their intra- and/or extracerebral vessels. This very distinctive flow pattern is characterised by a diastolic ascent of the arterial flow velocity and is caused by an excessively increased venous pressure within the draining veins of the affected organs. All patients died due to (multiple) organ failure. CONCLUSION It is of major importance to be aware of the rare but very characteristic flow pattern described here because of the poor prognosis associated with it.
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Affiliation(s)
- T Rupprecht
- Hospital for Sick Children, Bayreuth, Germany.
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Schroth M, Singer H, Scharf J, Klinge J. Applikation von humanem Faktor XIII (FXIII) bei Kindern mit massiven Pleuraergüssen nach herzchirurgischen Eingriffen. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2004-829396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gerigk L, Nölte S, Scharf J, Boschert J, Groden C. Messung des aquäduktalen Liquorflusses mittels Phasenkontrast-MRT mit Pulstriggerung und retrospektivem Gating. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gerigk L, Scharf J, Podlesek D, Nölte I, Groden C. Funktionsuntersuchungen in der MRT zur Darstellung belastungsabhängiger Veränderungen bei lumbaler Spinalkanalstenose. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
AIMS The present report was aimed at finding out whether gammaglobulin could have a role in treating ocular Behçet's disease (BD) refractory to accepted medical therapy. METHODS Six eyes of four patients with ocular BD refractory to steroids and cyclosporin A were treated with a course of intravenous gammaglobulin and followed up for their response to treatment. RESULTS All six eyes of all four patients showed good response to gammaglobulin therapy. CONCLUSION Gamma globulin may have a role in treating refractory ocular BD. A wide range of controlled studies with longer follow up is needed to substantiate this impression.
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Affiliation(s)
- N Seider
- Department of Ophthalmology, Rambam Medical Center, POB 9602, 31096 Haifa, Israel
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Böswald M, Döbig C, Kändler C, Krüger C, Scharf J, Soergel F, Zink S, Guggenbichler JP. Pharmacokinetic and clinical evaluation of serious infections in premature and newborn infants under therapy with imipenem/cilastatin. Infection 2000; 27:299-304. [PMID: 10885853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Efficacy and pharmacokinetic parameters of imipenem/cilastatin (I/C) were investigated in a retrospective evaluation in 104 premature and newborn infants. Patients enrolled in this investigation constituted a particularly high risk group with extreme prematurity, perinatal asphyxia and amnion infection as well as various malformations. In 15 of the 104 infants serum concentrations were measured for drug monitoring and determination of optimal total daily dosage. A total daily dose of 50 mg/kg birth weight for premature and newborn infants divided into two doses led to imipenem peak concentrations of 17.7 mg/l +/- 9.2 mg/l (range: 1.95-38.05) and trough levels were 2.35 mg/l +/-1.02 (range 2.34-10.88) in premature infants. Imipenem peak concentrations of 20.6 +/- 10.8 (range 3.94-32.3) and trough levels of 0.43 +/- 0.17 (range 0.16-0.94) were measured in newborns. The half-life of elimination was 3.3 h and 1.86 h, respectively. Six of the 104 treated patients died, five of them of causes unrelated to infection. Seizures occurred in 8.9% of patients during therapy with I/C compared with 5.8% of a large survey of premature and newborn infants in our intensive care unit (ICU). However, the severity of illness of these two groups cannot be compared. I/C can be expected to constitute effective therapy in premature and newborn infants with serious nosocomial infections even after failure of other broad spectrum antibiotics.
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Affiliation(s)
- M Böswald
- Children's Hospital, University of Erlangen-Nürnberg, Erlangen, Germany
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Dori D, Beiran I, Gelfand Y, Lanir N, Scharf J, Miller B, Brenner B. Multiple retinal arteriolar occlusions associated with coexisting primary antiphospholipid syndrome and factor V Leiden mutation. Am J Ophthalmol 2000; 129:106-8. [PMID: 10653428 DOI: 10.1016/s0002-9394(99)00278-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate a case of a young woman with both primary antiphospholipid syndrome and factor V Leiden mutation who developed multiple retinal arteriolar occlusions. METHOD Case report of a 25-year-old woman with history and laboratory tests confirming the diagnosis of both primary antiphospholipid syndrome and factor V Leiden mutation who presented with blurred vision in both eyes. RESULTS Multiple retinal arteriolar occlusions were observed in both of her eyes. The patient was treated first with heparin and then with warfarin. CONCLUSIONS Primary antiphospholipid syndrome and factor V Leiden mutation, as well as other forms of thrombophilia, should be considered in the differential diagnosis of unexplained retinal vascular occlusions. The coexistence of several thrombophilic disorders may carry a particularly high risk for thrombotic manifestations.
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Affiliation(s)
- D Dori
- Department of Ophthalmology, Rambam Medical Center, Haifa, Israel.
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Leutloff UC, Richter GM, Libicher M, Schenk JP, Stegen P, Scharf J, Kauffmann GW. [Follow-up of TIPSS by color-coded duplex sonography using an ultrasonic signal enhancer. First results]. Radiologe 1999; 39:1072-7. [PMID: 10643032 DOI: 10.1007/s001170050604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.
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Affiliation(s)
- U C Leutloff
- Radiologische Universitätsklinik, Abteilung Radiodiagnostik, Ruprecht-Karls-Universität Heidelberg
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35
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Böswald M, Lugauer S, Regenfus A, Braun GG, Martus P, Geis C, Scharf J, Bechert T, Greil J, Guggenbichler JP. Reduced rates of catheter-associated infection by use of a new silver-impregnated central venous catheter. Infection 1999; 27 Suppl 1:S56-60. [PMID: 10379447 DOI: 10.1007/bf02561621] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A central venous catheter with a new form of silver impregnation of the internal and external surfaces was investigated for antimicrobial activity and tolerance in patients in a controlled comparative, prospective and randomized clinical study. Commercially available catheters with no antimicrobial activity were used as controls. One hundred sixty-five catheters were included in the final evaluation. All catheters were percutaneously inserted for the first time with a duration of > or = 5 days and a microbiological examination of the catheter tip. Catheter location (> 90% internal jugular vein), mean duration of catheterization (8-9 days), patients' age and diagnosis were comparable in both groups. Silver-impregnated catheter tips showed an incidence of colonization in 14.2/1000 catheter days and control catheters in 22.8/1000 catheter days. This represents a reduction of 37.7%. Catheter-associated infections were diagnosed in the silver group in 5.26/1000 catheter days and 18.34/1000 catheter days in the control group, indicating a reduction rate of 71.3% (P < 0.05, chi 2-test). No complications or side effects were documented in either group.
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Affiliation(s)
- M Böswald
- Klinik mit Poliklinik für Kinder und Jugendliche, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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36
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Scharf J, Zapletal C, Hess T, Hoffmann U, Mehrabi A, Mihm D, Hoffmann V, Brix G, Kraus T, Richter GM, Klar E. Assessment of hepatic perfusion in pigs by pharmacokinetic analysis of dynamic MR images. J Magn Reson Imaging 1999; 9:568-72. [PMID: 10232516 DOI: 10.1002/(sici)1522-2586(199904)9:4<568::aid-jmri10>3.0.co;2-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to evaluate a new method based on magnetic resonance imaging for the characterization of hepatic perfusion. In nine pigs dynamic MRI was performed before and after partial occlusion of the portal vein. The pharmacokinetic analysis of the contrast enhancement resulted in a set of parameters (amplitude, A; perfusion rate, kp; elimination rate, kappa(e1); lag time, t(lag)) of which kp was expected to correlate with hepatic perfusion. Reference measurements were done with ultrasound flow-meters and with a thermal diffusion probe (TDP). MR perfusion rate kp significantly dropped under partial portal vein occlusion from an average of 11.3 to 4.9 min(-1) (P < 0.001), while the difference in amplitude A was not significant. The correlation between kp and the TDP measurement was r = 0.89 (P < 0.001). Pharmacokinetic analysis of MRI contrast enhancement provides a non-invasive assessment of hepatic perfusion.
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Affiliation(s)
- J Scharf
- Department of Radiology, University of Heidelberg Medical School, Germany.
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37
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Zapletal C, Mehrabi A, Scharf J, Hess T, Mihm D, Jahnke C, Schäffer F, Golling M, Kraus T, Gebhard MM, Herfarth C, Klar E. Experimental evaluation of dynamic MRI for quantification of liver perfusion. Transplant Proc 1999; 31:421-2. [PMID: 10083170 DOI: 10.1016/s0041-1345(98)01688-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Zapletal
- Department of Surgery, University of Heidelberg, Germany
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38
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Klinge J, Scharf J, Rupprecht T, Böswald M, Hofbeck M. Selective thrombolysis in a newborn with bilateral renal venous and cerebral thrombosis and heterozygous APC resistance. Nephrol Dial Transplant 1998; 13:3205-7. [PMID: 9870492 DOI: 10.1093/oxfordjournals.ndt.a027807] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Klinge
- University Hospital for Children and Adolescents, Erlangen, Germany
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39
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Zenker M, Klinge J, Krüger C, Singer H, Scharf J. Severe pulmonary hypertension in a neonate caused by premature closure of the ductus arteriosus following maternal treatment with diclofenac: a case report. J Perinat Med 1998; 26:231-4. [PMID: 9773385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The administration of non-steroidal antiinflammatory drugs (NSAID) has occasionally been related to fetal and neonatal cardiopulmonary, gastrointestinal, cerebral and renal complications. This report describes a term newborn with severe persistent pulmonary hypertension due to premature closure of the ductus arteriosus following a 5 day maternal treatment with diclofenac two weeks before delivery. Pulmonary hypertension only responded to unusually high doses of inhaled NO. The treatment was necessary for 22 days suggesting structural alteration of pulmonary vasculature. The child recovered, but tricuspid regurgitation persisted, presumably because of irreversible ischemic damage of one papillary muscle. This is the first reported case of persistent pulmonary hypertension of the newborn (PPHN) in association with maternal diclofenac treatment and represents a most severe form of PPHN induced by NSAID.
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Affiliation(s)
- M Zenker
- University Hospital for Children and Adolescents, Erlangen, Germany
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40
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Libicher M, Scharf J, Wunsch A, Stern J, Düx M, Kauffmann GW. MRI of pouch-related fistulas in ulcerative colitis after restorative proctocolectomy. J Comput Assist Tomogr 1998; 22:664-8. [PMID: 9676464 DOI: 10.1097/00004728-199807000-00029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Our purpose was to determine the value of MRI in diagnosing pouch-related fistulas in patients with ulcerative colitis and to compare pulse sequences with and without contrast enhancement in their performance of visualization. METHOD Forty-four patients with pelvic symptoms after restorative proctocolectomy underwent MRI. All 26 patients with pouch-related fistulas were treated surgically; 18 patients with pouchitis were treated conservatively. MRI was performed at 1.0 T with T1-weighted FLASH sequences before and after administration of Gd-DTPA, T2-weighted and proton density-weighted turbo SE sequences, and a T2-weighted fat saturation sequence. Images were analyzed for the presence of fistula; pulse sequences were additionally compared for best visualization on a four point scale of diagnostic confidence. RESULTS MRI detected 23 of 26 cases of fistulas; there were no false-positive diagnoses. Surgery revealed fistulas in three cases in which no pathology was found on MRI. Two patients had a short sinus tract at the pouch-anal anastomosis, and a third patient had a pouch-vaginal fistula. The Gd-enhanced FLASH sequence obtained the highest score, and second best was the T2-weighted fat saturation technique. CONCLUSION MRI is a valuable technique for diagnosing pouch-related fistulas, However, there are limitations in detection of short sinus tracts and pouch-vaginal fistulas. Highest diagnostic confidence is obtained with a Gd-enhanced FLASH sequence, which might be helpful after pelvic surgery or if the fact saturation technique is equivocal.
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Affiliation(s)
- M Libicher
- Department of Diagnostic Radiology, University of Heidelberg, Germany
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41
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Leutloff UC, Scharf J, Richter GM, Libicher M, Wunsch A, Schenk JP, Kauffmann GW. [Use of the ultrasound contrast medium levovist in after-care of liver transplant patients. Improved vascular imaging in color Doppler ultrasound]. Radiologe 1998; 38:399-404. [PMID: 9646347 DOI: 10.1007/s001170050371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A study was carried out to determine whether an improvement in the detection of vascular signals in patients after orthotopic liver transplantation can be achieved by the use of ultrasound contrast medium in colour Doppler sonography. MATERIAL AND METHODS In the early postoperative follow-up of liver transplant recipients, 31 colour Doppler sonograms were obtained in 21 patients before and after intravenous injection of the ultrasound contrast agent Levovist (Schering, Berlin). A grading score with four categories was used to evaluate the sonograms with special regard to the visibility of colour and flow signals in the hepatic artery and also in the portal vein and the hepatic veins. The arterial and portal venous signals were evaluated in the hepatic portal and in the left and right lobe. RESULTS With contrast enhancement significantly better arterial signals were seen in 20 of 31 sonograms for the hepatic portal, in 22 for the right lobe and in 26 for the left lobe. Better portal vein signals were obtained in 17 of 31 examinations for the right lobe and in 16 for the left lobe; only little improvement was obtained for the main stem of the portal vein. For the hepatic veins there was no significant improvement. CONCLUSIONS Early vascular complications after liver transplantation usually occur in the hepatic arteries. With the use of contrast-enhanced colour Doppler sonography, better detection of arterial and peripheral portal signals can be achieved; peripheral portal vein branches can be helpful in finding small arteries.
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Affiliation(s)
- U C Leutloff
- Abteilung Radiodiagnostik, Radiologische Universitätsklinik, Heidelberg
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42
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Scharf J, Hoffmann V, Lehnert T, Anselm H, Richter GM, Kauffmann GW. Pseudolesions at T1-weighted gradient-echo imaging after administration of superparamagnetic iron oxide: comparison with portal perfusion abnormalities at CT during arterial portography. Radiology 1998; 207:67-72. [PMID: 9530300 DOI: 10.1148/radiology.207.1.9530300] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare specific findings at T1-weighted gradient-echo (GRE) magnetic resonance (MR) imaging performed after administration of superparamagnetic iron oxide (SPIO) with nontumorous regional portal perfusion abnormalities seen at computed tomography (CT) during arterial portography (CTAP). MATERIALS AND METHODS The results of CTAP, MR imaging, and surgery were compared in 19 patients with liver metastases and five with benign liver tumors. MR imaging was performed by using turbo spin-echo (SE) sequences and a GRE sequence before and after infusion of SPIO. RESULTS At CTAP, 34 nontumorous portal perfusion defects ("straight line sign," pseudolesions) were seen. After intravenous administration of SPIO, 18 nontumorous signal intensity differences were seen on T1-weighted GRE images in corresponding locations. No corresponding nontumorous signal intensity differences were seen on unenhanced MR images. The mean signal-to-noise ratio on the SPIO-enhanced GRE images was reduced from 26.3 to 16.6 in the areas of nontumorous signal intensity differences, whereas that in areas of normal portal perfusion (normal CTAP findings) was reduced to 10.2. CONCLUSION Impaired portal perfusion decreased the uptake of SPIO in histopathologically normal regions of liver parenchyma. Resultant differences in signal intensity were better visualized on GRE than on turbo SE images.
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Affiliation(s)
- J Scharf
- Department of Radiology, University of Heidelberg Medical School, Germany
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Abstract
UNLABELLED To demonstrate and document 10 years of clinical experience gathered by us with TIPSS and to discuss achievements, problems and outlook. MATERIAL AND METHODS The analysis is based on the following parameters: portosystemic gradient; morphological delineation of the portal circulation; determination of the portal perfusion fraction (PPF) and the total liver perfusion (GLP); arterial flow changes; hepatic encephalopathy; incidence of restenotic shunt occlusion and recurrent variceal bleeding. RESULTS Variceal filling was widely reduced by TIPSS, and significantly reduced portal liver perfusion as assessed morphologically and rheologically. However, there was an immediate onset of compensated liver perfusion by increased arterial inflow. Total liver perfusion did not change significantly. In TIPSS portal decompression was readily achieved, the portosystemic gradient dropping from an average of 24 mm Hg to 10.5 mm Hg. In our series we could not demonstrate an increased incidence of hepatic encephalopathy during the 30-day post-TIPSS period. Early mortality was 4% and early rebleeding rate 3%. The 12-month re-intervention rate based on an invasive portography follow-up protocol was 76%, and the 24-month re-intervention rate was 90%. The definite occlusion rate was below 5%. Beyond a follow-up time span of 24-months the necessity for re-intervention dropped significantly: less than one-third of our patients required some sort of re-intervention. CONCLUSION The concept of TIPSS represents an individually calibrated H-shunt. The significant reduction of post-TIPSS portal perfusion appears to be compensated by increased arterial inflow. This is reflected by an invasive flow measurement results and by the clinical results. Lethality of TIPSS is low mostly as a result of a refined technique, careful patient selection, follow-up care and meticulous shunt surveillance.
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Affiliation(s)
- G M Richter
- Abteilung für Radiologische Diagnostik, Universitätsklinik Heidelberg
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44
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Libicher M, Betsch B, Scharf J, Kauffmann GW. [Ileocecal tuberculosis as a cause of lower gastrointestinal hemorrhage in lupus erythematosus]. ROFO-FORTSCHR RONTG 1998; 168:407-9. [PMID: 9589109 DOI: 10.1055/s-2007-1015153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M Libicher
- Radiologische Klinik, Abteilung Radiodiagnostik, Universität Heidelberg.
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45
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Scharf J. Presurgical prosthetic management of the periodontal patient--a modern adhesive approach. Alpha Omegan 1998; 87:17-25. [PMID: 9470524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The comprehensive management of the periodontal prosthetic patient requires that treatment be provided in a logical sequence; initial therapy, presurgical prosthetic management, surgical management of hard and soft tissue lesions, post-surgical prosthetics, followed by maintenance therapy. This article focuses on some of the most perplexing challenges encountered during the presurgical prosthetic management phase of periodontal diagnosis and therapy, including the stabilization of mobile teeth, the immediate replacement of teeth that require removal due to advanced attachment loss, and the correction of visual defects created by soft tissue loss. A number of creative treatment modalities are described that utilize silane-treated etched-glass fiber ropes and tapes (GlasSpan, GlasSpan, Inc.) for the internal reinforcement of periodontal splints and for the attachment of composite and natural tooth pontics as transitional tooth replacements. Gingival-colored composite (Gingiblend, Jeneric Pentron) and its importance as a diagnostic aid during the early stages of periodontal therapy and as an esthetic permanent restorative material are also examined.
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Affiliation(s)
- J Scharf
- University of Pennsylvania School of Dental Medicine, USA
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46
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Zapletal C, Mehrabi A, Scharf J, Hess T, Kraus T, Herfarth C, Klar E. [Experimental evaluation of dynamic MRI for quantifying liver perfusion]. Langenbecks Arch Chir Suppl Kongressbd 1998; 115:581-4. [PMID: 14518321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Gadolinium-DTPA enhanced dynamic MR imaging is a new method for the quantification of portal bloodflow and liver perfusion. In this study we evaluated the validity of this method comparing it with thermodiffusion and dopplerflowmetry in pigs. We found a significant correlation of tissue perfusion between dMRI and thermodiffusion and of portal bloodflow between dMRI and dopplerflowmetry. Partial occlusion of the portal vene was accurately detected by dMRI. Dynamic MRI could become a valuable diagnostic method for the quantification of liver perfusion.
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Affiliation(s)
- C Zapletal
- Chirurgische Klinik, Universität Heidelberg
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47
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Klinge J, Hammersen G, Scharf J, Lütticken R, Reinert RR. Overwhelming postsplenectomy infection with vaccine-type Streptococcus pneumoniae in a 12-year-old girl despite vaccination and antibiotic prophylaxis. Infection 1997; 25:368-71. [PMID: 9427057 DOI: 10.1007/bf01740820] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This report describes a 12-year-old girl who developed vaccine-type pneumococcal septicemia (type 4, Danish nomenclature) 2 years after splenectomy for recurrent idiopathic thrombocytopenia despite vaccination with the 23-valent vaccine 4 weeks before surgery and antibiotic prophylaxis with penicillin V. The disease presented as high fever with shivering and vomiting followed by disseminated petechiae and a deteriorated general condition. Initial laboratory studies showed severe sepsis with leucocytopenia and thrombocytopenia, a markedly elevated CRP, and disseminated intravascular coagulation. Despite antibiotic treatment, which was initiated with clindamycin, cefotaxime and trimethoprim/sulfamethoxazole and was switched to cefotaxime and penicillin after the result of the blood culture had been obtained, the patient had to be ventilated, and hemofiltration became necessary because of acute renal insufficiency. Furthermore, she required amputation of all her toes because of severe necrosis. No type-specific pneumococcal antibody titers were detected during and after infection. It remains unclear whether the susceptibility to Streptococcus pneumoniae was due to primary failure of antibody production or a decline in antibody levels after vaccination. Patients and/or their relatives should be informed that neither vaccination nor continuous antibiotic prophylaxis can guarantee full protection against infection with S. pneumoniae in patients after splenectomy.
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Affiliation(s)
- J Klinge
- Klinik mit Poliklinik für Kinder und Jugendliche, Universität Erlangen-Nürnberg, Germany
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48
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Talmon T, Scharf J, Mayer E, Lanir N, Miller B, Brenner B. Retinal arterial occlusion in a child with factor V Leiden and thermolabile methylene tetrahydrofolate reductase mutations. Am J Ophthalmol 1997; 124:689-91. [PMID: 9372726 DOI: 10.1016/s0002-9394(14)70910-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To analyze the potential cause of retinal arterial occlusion in a 9-year-old child. METHODS Case report. Antithrombin III, protein C, free protein S, activated protein C resistance, and antiphospholipid antibodies in plasma were determined. Determination of factor V R506Q (Leiden mutation), thermolabile methylene tetrahydrofolate reductase by polymerase chain reaction, and restriction enzyme analysis were performed. RESULTS The patient was found to be heterozygous for factor V R506Q (Leiden mutation) and homozygous for thermolabile methylene tetrahydrofolate reductase. CONCLUSION Coexistence of two mild hereditary thrombophilic states may result in severe thrombotic manifestations in young people.
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Affiliation(s)
- T Talmon
- Department of Ophthalmology, Rambam Medical Center, Haifa, Israel
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Abstract
UNLABELLED Acute renal failure is a rare but very severe side-effect of methotrexate (MTX) treatment requiring extracorporeal detoxification. A new detoxification regime, consisting of a haemodiafiltration (HDF) and continuous plasma resin perfusion (PRP) over anion exchange resin column with high affinity for MTX, was used for treatment of MTX-induced acute renal failure in a 2-year-old boy with medulloblastoma. More than 99% of MTX was removed from plasma by perfusion over the resin column resulting in a marked decrease of MTX plasma half-life. No haematological complications occurred. CONCLUSION The use of PRP alone or in combination with HDF is a new and effective treatment strategy for extracorporeal detoxification of MTX.
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Affiliation(s)
- J Greil
- Klinik mit Poliklinik für Kinder und Jugendliche, University of Erlangen-Nürnberg, Germany
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50
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Klinge JM, Scharf J, Hofbeck M, Gerling S, Bonakdar S, Singer H. Intermittent administration of furosemide versus continuous infusion in the postoperative management of children following open heart surgery. Intensive Care Med 1997; 23:693-7. [PMID: 9255651 DOI: 10.1007/s001340050395] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the amount of furosemide needed to fulfil defined criteria for renal output if given intermittently or as a continuous infusion and to compare the effect of these two regimens on hemodynamic variables and urine electrolyte concentrations. DESIGN Prospective randomized study of postoperative hemodynamically stable pediatric cardiac patients. The patients were given furosemide according to the urine output, either as an intermittent bolus injection or as a continuous infusion. SETTING Pediatric intensive care unit in a university hospital. PATIENTS The patients were randomly assigned before admission to either the intermittent i.v. or the continuous furosemide i.v. infusion group. MEASUREMENTS AND RESULTS Demographic and hemodynamic data were recorded for a maximum of 72 h, as were furosemide dose, urine output, and fluid and inotropic drug requirements. Forty-six patients completed the study. Maximal hourly urine output was significantly higher in the intermittent group. A significantly lower dose of furosemide in the intermittent group produced the same 24-h urine volume as in the continuous infusion group. CONCLUSIONS Intermittent furosemide administration may be recommended in hemodynamically stable postoperative pediatric cardiac patients because of less drug requirement. However, the high maximal urine output may cause hemodynamic problems in patients who depend on high inotropic support.
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Affiliation(s)
- J M Klinge
- University of Erlangen-Nuremberg, Hospital for Children and Adolescents, Erlangen, Germany
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