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BACKGROUND AND PURPOSE: After endovascular treatment of intracranial aneurysms with the Woven EndoBridge (WEB) device, worsening of aneurysm occlusion or re-opening was reported to be possibly associated with WEB shape modification. This study analyzed quantitatively the WEB shape modification with time in association with anatomic results. MATERIALS AND METHODS: Thirty patients with 32 WEB-treated intracranial aneurysms fulfilled the inclusion criteria of cranial CT at baseline (day of intervention) and a follow-up CT at least >1 months' later (median follow-up time, 11.4 months; interquartile range, 6.5-21.5 months). Adequate occlusion was observed in 84.4%, and aneurysm remnant, in 15.6%. WEB shape modification was quantified by a semiautomated approach on CT scans. Time courses were evaluated graphically and analytically; association analyses were performed by linear mixed-effects regression models. RESULTS: In 29/32 WEB devices (90.6%), the reduction in height was found to be at least 5%. The decrease in height with time was significantly associated with the time interval in days since the intervention (P < .0001): A stronger decrease in WEB height was associated with a longer time since the intervention (median reduction in 1 year, 19.2%; range, 8.6%-52.3%). No significant association was found with the quality of aneurysm occlusion, device size, rupture status of the aneurysm, aneurysm location, and reintervention rate. CONCLUSIONS: Shape modification was common in WEB-treated intracranial aneurysms with a median height reduction of 19.2% in 1 year. The quality of aneurysm occlusion was not associated with WEB modification.
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Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/instrumentación , Aneurisma Intracraneal/terapia , Resultado del Tratamiento , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: To date, insertable cardiac monitors (ICMs) are the most effective method for the detection of occult atrial fibrillation (AF) in cryptogenic stroke. The overall detection rate after 12 months, however, is low and ranges between 12.4 and 33.3%, even if clinical predictors are considered. Ischemic stroke patients due to cardiogenic embolism present with particular lesion patterns. In patients with cryptogenic stroke, MR-imaging pattern may be a valuable predictor for AF. METHODS: This is an MRI-based, retrospective, observational, comparative, single-center study of 104 patients who underwent ICM implantation after cryptogenic stroke. The findings were compared to a reference group with related stroke etiology, i.e., 166 patients with embolic stroke due to AF detected for the first time by long-term ECG. Lesion patterns were evaluated with regard to affected territories, distribution (cortical, lacunar, scattered), lesion volume, and lesion size (diameter of the lesion size > 20 mm). RESULTS: The MR-imaging analysis of acute ischemic lesions yielded no association between AF and lesion size or volume, arterial vessel distribution, or the number of affected territories. There was no significant difference between the cohorts regarding ischemic patterns (cortical lesions, scattered lesions, and lacunar infarcts). An important clinical inference of our findings is that 10% (2 of 20) of cases in the ICM group in whom AF was detected had a lacunar infarct pattern. Similar results were shown in cases of ischemic stroke patients with AF detected for the first time by long-term ECG, with 10.9% (16 of 147) of them showing lacunar infarcts. The analysis of chronic MRI lesions revealed no differences between the groups in the rate of chronic lesions, arterial vessel distribution, or the number of affected territories. Left atrial size (LA size) and the presence of atrial runs in long-term ECG were independently associated with AF. CONCLUSIONS: In this MRI-based analysis of patients with cryptogenic stroke who had received ICM implantation, the detection rate of AF in patients with ICM was not related to the imaging pattern. In addition, the lacunar infarct pattern should not be an exclusion criterion for ICM insertion in patients with cryptogenic stroke. ICM insertion in patients with cryptogenic stroke should not be evaluated solely on the basis of reference to infarct patterns.
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Fibrilación Atrial/diagnóstico , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/patología , Imagen por Resonancia Magnética , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/patología , Anciano , Anciano de 80 o más Años , Electrocardiografía Ambulatoria , Femenino , Humanos , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/etiología , Accidente Vascular Cerebral Lacunar/diagnóstico , Accidente Vascular Cerebral Lacunar/etiología , Accidente Vascular Cerebral Lacunar/patologíaRESUMEN
OBJECTIVES: Many children are insufficiently active, and children with a migration background appear to be even less active and at a higher risk of developing obesity. This study evaluated the weight status, and the frequencies and intensities of objectively assessed physical activity (PA) of children with and without a migration background. STUDY DESIGN: Cross-sectional study. METHODS: PA was assessed objectively for 6 days in 273 children (aged 7.1 ± 0.6 years). In total, 74 children (27%) were classified as having a migration background. PA was grouped in light and moderate-to-vigorous (MVPA) intensities. Body mass index (BMI) percentiles (BMIPCT) were determined. RESULTS: Children without a migration background spent more time in MVPA compared with children with a migration background (138.2 ± 62.6 vs 121.7 ± 54.9 min, respectively; P < 0.01). On weekends, time in MVPA decreased significantly for all children (112.3 ± 66.0 min, P < 0.01), especially for children with a migration background (97.7 ± 56.7 min, P < 0.01). Children with a migration background displayed significantly higher BMIPCT than children without a migration background (55.7 ± 29.6 vs 44.3 ± 26.8, respectively; P < 0.01) and were significantly more often overweight and/or obese (13.5% vs 8.5%, respectively; P < 0.02). CONCLUSIONS: Children with a migration background are less physically active and more often overweight, resulting in higher risks of developing secondary diseases. The results of this study should be considered when designing interventions to increase PA in children with a migration background. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494.
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Peso Corporal , Emigración e Inmigración/estadística & datos numéricos , Ejercicio Físico , Acelerometría , Niño , Estudios Transversales , Femenino , Alemania/epidemiología , Humanos , Masculino , Obesidad Infantil/epidemiología , Instituciones AcadémicasRESUMEN
OBJECTIVE: To identify obstetric and neonatal risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) in high-risk preterm neonates. METHODS AND PATIENTS: Data from 279 preterm infants (246 mothers) with a gestational age≤28+0 weeks admitted to our NICU between January 2004 and December 2009 were analyzed retrospectively. Occurrence of (GM-IVH) was diagnosed by using ultrasound and important clinical variables were extracted from the patient charts. Infants were divided into 2 groups: GM-IVH and non-GM-IVH. To account for multiple gestation, generalized estimation equations (GEE) were used for univariate analysis and for the evaluation of independent risk factors. RESULTS: A low 5-min APGAR-Score, multiple birth, low arterial blood pressure at NICU admission, hypercapnia during the first 72 h of life in life and absence of any antenatal corticosteroids were found to be significant independent risk factors in the development of GM-IVH. CONCLUSION: Preterm infants with low arterial blood pressure, absence of antenatal corticosteroids, low 5-min APGAR-Score, higher paCO2 within the first 3 days of life and multiple gestation were at higher risk to develop GM-IVH. Avoiding these risk factors may help to decrease the rate of GM-IVH.
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Hemorragia Cerebral/diagnóstico , Ventrículos Cerebrales , Recien Nacido Extremadamente Prematuro , Enfermedades del Prematuro/etiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Unidades de Cuidado Intensivo Neonatal , Masculino , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
In order to reduce heterogeneity in schizophrenia, a system-specific approach consisting of the domains "language", "affect" and "motor behavior" has been proposed. We examined this system-specific approach for its applicability to clinical practice in the motor behavior domain, using the methodological approach of case studies, and discuss here the differences to the positive/negative concept. We analyzed eight cases with stable motor-dominant symptoms, and also quantitatively assessed motor behavior by using the Bern Psychopathology Scale (BPS), a standardized psychopathological assessment instrument, as well as actigraphic data. Characterization of cases using the positive/negative approach was not helpful. We found an overlap of the motor behavior domain with the other two domains. This complicates the application of the system-specific approach in the sense of a typology. Furthermore, we found both relapsing courses with full remission and chronic courses with deterioration within the motor-dominant subtype. Nevertheless, the system-specific approach has heuristic utility for the future.
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Trastornos del Movimiento/etiología , Trastornos del Movimiento/psicología , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Acelerometría , Adulto , Edad de Inicio , Conducta , Enfermedad Crónica , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Recurrencia , Adulto JovenRESUMEN
PURPOSE: The purpose of this study was to analyse true lateral radiographs of children and adolescents to determine the relation of the origin of the MPFL and the distal femoral physis considering the complex anatomy of the physis. The hypothesis was that the femoral insertion of the MPFL is distal to the growth plate. METHODS: Antero-posterior and true lateral radiographs from PACS computer records of 27 patients with a history of patellofemoral instability were assessed. To determine the femoral origin of the MPFL, the method by Schöttle et al. and the method by Redfern et al. were applied independently. On the anteroposterior radiograph, the distance between the medial most part of the physis and the central part of the physis was measured to quantify the concave curvature of the physis. To cross-reference the femoral insertion of the MPFL onto an ap view, the projected MPFL origin-physis distance was subtracted from the distance between the most medial part of the physis and the central part of the physis. RESULTS: The projected median origin of the MPFL as measured on a lateral radiograph was located 3.2 mm (1.2-5.8 mm) proximal to the physis. The median distance between the most medial part of the physis and the physeal line on the anteroposterior radiograph was 9.9 mm (4.1-12.0 mm). Subtracting the two measured values, the median origin of the MPFL as seen on the ap view was 6.4 mm (2.9-8.5 mm) distal to the femoral physis. CONCLUSION: Considering the concave curvature of the distal femoral physis, it can be assumed that the femoral insertion of the MPFL is distal to the femoral physis. As a too proximal insertion of the graft can cause unintentional tightening of the MPFL in knee flexion, these results have to be considered when performing reconstruction of the MPFL in children and adolescents with open growth plates.
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Fémur/diagnóstico por imagen , Placa de Crecimiento/diagnóstico por imagen , Inestabilidad de la Articulación/diagnóstico por imagen , Luxación de la Rótula/diagnóstico por imagen , Ligamento Rotuliano/diagnóstico por imagen , Articulación Patelofemoral/diagnóstico por imagen , Adolescente , Niño , Femenino , Fémur/anatomía & histología , Placa de Crecimiento/anatomía & histología , Humanos , Masculino , Ligamento Rotuliano/anatomía & histología , Articulación Patelofemoral/anatomía & histología , RadiografíaRESUMEN
RATIONALE: The MARAN (Macular Relocation in Age-related Neovascular disease) trial was planned to assess the effectiveness of full macular relocation (MR) in patients with neovascular age-related macular degeneration (AMD). DESIGN: Randomised, prospective, controlled clinical trial. METHODS: Patients suffering from visual loss because of AMD were randomised to either surgery or a control group receiving standard treatment (observation or photodynamic therapy (PDT)). The primary end point was the change of visual acuity (VA) (ETDRS) 52 weeks after randomisation compared with initial VA, and secondary end points included reading performance, contrast sensitivity, stability of fixation, eye-specific quality of life, and the absolute number of letters read correctly at 52 weeks compared with initial examination. RESULTS: Owing to early determination, only 28 patients were included in the study. The study did not show a difference between the two groups with respect to the final visual result or any of the secondary outcomes measured. The study was limited by the low recruitment that was, at least in part, attributed to the inherent risks for those patients randomised to the surgical arm of the study as well as to the emerging new treatments for AMD. CONCLUSION: The results of the MARAN trial failed to recruit a sufficient number of patients and a superiority of surgery over observation or PDT in patients with exudative AMD was not shown. There was a trend that the reading function was superior after surgery. In the light of the new pharmacological treatments, surgical options such as MR will be an option for only selected cases.
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Neovascularización Coroidal/cirugía , Degeneración Macular/cirugía , Anciano , Anciano de 80 o más Años , Neovascularización Coroidal/etiología , Neovascularización Coroidal/fisiopatología , Sensibilidad de Contraste/fisiología , Femenino , Fijación Ocular/fisiología , Humanos , Degeneración Macular/complicaciones , Degeneración Macular/fisiopatología , Masculino , Estudios Prospectivos , Calidad de Vida , Lectura , Análisis y Desempeño de Tareas , Agudeza VisualRESUMEN
The objective of this study was to evaluate the clinical wear behaviour of posterior, metal-free polymer crowns and to compare it with that of metal-ceramic crowns. After randomization, a total of 120 single crowns were set in posterior teeth. These 120 crowns were divided into three groups: 40 polymer crowns with a glass-fibre framework (group 1), 40 polymer crowns without framework stabilization (group 2) and 40 metal-ceramic crowns (control group). Wear was measured by use of gypsum replicas and a 3D laser scanner at baseline and after 2 years. Statistical analysis was performed by use of a mixed-effects regression model. The mean total wear of posterior single crowns was -19.0 mum (+/- 18.5 microm) in group 1, -24.3 microm (+/- 31.5 microm) in group 2 and -7.0 microm (+/- 8.8 microm) in the control group. Statistical analysis revealed the mean total wear of the polymer crowns in groups 1 (P < or = 0.01) and 2 (P < or = 0.01) was significantly greater than in the control group. No significant difference was detected between groups 1 and 2 (P = 0.58). Age, gender and opposing teeth had no significant effect on wear behaviour.
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Coronas , Alisadura de la Restauración Dental , Adulto , Anciano , Oclusión Dental , Diseño de Prótesis Dental , Femenino , Vidrio , Humanos , Masculino , Ensayo de Materiales/métodos , Aleaciones de Cerámica y Metal , Persona de Mediana Edad , Polímeros , Estudios Prospectivos , Adulto JovenRESUMEN
BACKGROUND: Due to the increasing number of scuba divers in Germany, the otorhinolaryngologist has to face rising numbers of diving-associated ENT disorders. However, data about the lifetime prevalence of these disorders are insufficient. The aim of this study was to determine the frequency of ENT disorders in scuba divers correlated with their diving history. METHODS: The study design was a non-randomized, retrospective, cross-sectional study based on questionnaires. The study population included 429 active divers attending three medical diving symposia. RESULTS: The study population consisted of highly experienced divers (mean of logged dives m= 670.0) with a high diving certification level. Otitis externa was the most frequent disorder (43.6%). Barotrauma of the sinuses (10.9%), alternobaric vertigo (9.0%) and barotrauma of the middle ear (8.7%) played an important role as well. In contrast, inner ear barotrauma and decompression illness of the inner ear were less frequent but not rare (1.7 % each). CONCLUSION: A substantial number of scuba divers suffered diving-related ENT disorders.
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Certificación/estadística & datos numéricos , Enfermedad de Descompresión/epidemiología , Buceo/estadística & datos numéricos , Enfermedades Otorrinolaringológicas/epidemiología , Medición de Riesgo/métodos , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Alemania/epidemiología , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Insulin clearance and the degree of insulin resistance change in type 1 diabetes in patients with reduced kidney function and make it more difficult to achieve good metabolic control. For some years different analogue insulins have become available. Their pharmacological characteristics in renal failure have not as yet been investigated in detail. The aim of the present retrospective study was to determine the insulin dosage in relation to kidney function in patients with type 1 diabetes treated with human or analogue insulin. METHODS: Insulin dosage of 68 patients treated with human insulin and 74 patients treated with analogue insulin was related to the creatinine clearance (calculated with the Cockcroft-Gault formula). In addition, diabetes-related laboratory parameters, the prevalence of hypertension and the kind of antihypertensive therapy were analysed in both groups. RESULTS: Patients with type 1 diabetes treated with human or analogue insulin have different insulin demands if their renal function is decreased. In analogue-treated patients, insulin dosage significantly decreased with reduced creatinine clearance (r = 0,257; p = 0,026) in contrast to human insulin treated patients who did not show such a decrease (r = 0,159; p = 0,165). There were no significant differences between treatment groups with respect to demographic data, metabolic control or antihypertensive therapy. Linear regression analysis revealed kidney function as a significant factor influencing insulin dosage in the analogue group, while the corresponding factors in the human insulin group were metabolic control and age. CONCLUSION: The results indicate that insulin clearance and/or the metabolic activity of human and analogue insulin differ if renal function is reduced. This may be due to different pharmacokinetic or pharmacodynamic characteristics of these insulins in renal failure, a finding which needs further investigation.
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Diabetes Mellitus Tipo 1/tratamiento farmacológico , Nefropatías Diabéticas/complicaciones , Hipoglucemiantes/uso terapéutico , Insulina/análogos & derivados , Insulina/uso terapéutico , Insuficiencia Renal/complicaciones , Creatinina/metabolismo , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/metabolismo , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/metabolismo , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipoglucemiantes/farmacocinética , Insulina/farmacocinética , Riñón/fisiopatología , Pruebas de Función Renal , Modelos Lineales , Masculino , Tasa de Depuración Metabólica , Persona de Mediana Edad , Insuficiencia Renal/metabolismo , Insuficiencia Renal/fisiopatología , Estudios RetrospectivosRESUMEN
OBJECTIVES: Identifying factors influencing the growth of geographic atrophy (GA) in patients with age-related macular degeneration (AMD). METHODS: Data on the natural course and suspected modifying factors were collected as part of the multicenter, longitudinal, observational FAM-study in 178 eyes of 114 patients with atrophic AMD. The endpoint of interest - the size of GA - was measured in fundus autofluorescence images. The influence of different putative risk factors on progression of GA is investigated with a forward selection procedure based on the likelihood ratio test. In order to interpret non-significant results of the forward selection procedure, the power of the tests used was quantified by a parametric post-hoc bootstrap approach. RESULTS: A mean increase in GA of 1.75 mm(2) per year was estimated for the given population (95% CI: [1.46; 2.02]). Patient and eye-specific random effects could be assessed. Neither patient-specific risk factors nor ocular-specific risk factors show any significant influence on GA growth. The post-hoc bootstrap procedure shows that only very strong effects can be detected on the basis of the given data. For example, the hypercholesteremia which would result in an additional increase of GA by near 4 mm(2) per year can be detected with a power of 80%. CONCLUSIONS: The use of linear mixed effects regression models offers a convenient way to explore sources of variation in the natural course of GA. Data from further follow-up examinations and data about other putative risk factors than those investigated will be needed to further investigate of the GA growth process. The procedure described in this article is easily applicable to other putative risk factors as well as to other fields of application.
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Atrofia , Degeneración Macular/fisiopatología , Retina/patología , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Funciones de Verosimilitud , Estudios Longitudinales , Degeneración Macular/diagnóstico , Degeneración Macular/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Factores de RiesgoRESUMEN
PURPOSE: To model the natural course of geographic atrophy (GA) in patients with age-related macular degeneration (AMD). METHODS: Data on the natural course of GA were collected in the multi-center, longitudinal, prospective observational FAM study. The size of GA was measured by autofluorescence scanning laser ophthalmoscopy. The natural course of GA is modelled by two different mixed effect models (MEM). Both models are compared with respect to the correctness of the model assumptions, goodness of fit, and predictive behavior. RESULTS: The linear model results in better prediction, the non-linear model is more in agreement with the model assumptions. The non-linear model fits the data for small and large areas of GA better, while the linear model seems to be more adequate for the medial areas. More data will be needed to study the interplay of both models in more detail. CONCLUSIONS: The natural course of GA varies extremely between individuals. However, reliable factors for the explanation of this variability have so far not been established. MEM are useful for describing "inter-individual" as well as "intra-individual" influences without the need for precise knowledge of the influencing factors. Using MEM to evaluate data on the natural history of GA allows one to derive parameter estimates, which could be used to design interventional trials for modes of therapy with a potential to reduce or stop the progression of GA in patients with AMD.
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Degeneración Macular/complicaciones , Modelos Biológicos , Modelos Estadísticos , Epitelio Pigmentado Ocular/patología , Retina/patología , Anciano , Anciano de 80 o más Años , Atrofia , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Degeneración Macular/epidemiología , Degeneración Macular/patología , Masculino , Persona de Mediana Edad , Oftalmoscopía , Prevalencia , Pronóstico , Estudios ProspectivosRESUMEN
BACKGROUND: In the treatment of the acute ligamentous mallet finger, conservative therapy with a Stack or Winterstein splint is an established approach, though there are many different conservative therapy regimes. There are even more therapy options for the chronic mallet finger (more than 4 weeks old) including different operation techniques. MATERIAL AND METHODS: In a retrospective study, 44 patients with an acute and 33 patients with a chronic ligamentous mallet finger treated with a Stack or Winterstein splint were investigated. RESULTS: The results in both groups are satisfactory (SD <10 degrees : 70.5% in the acute, 87.9% in the chronic lesions). The subjective satisfaction (scale 1-6) was high in both groups. It was even significantly higher in the group with the chronic lesions (acute: 2.55+/-1.63, chronic: 1.82+/-1.38). In both groups there was no correlation between an initially high extension deficit and a bad therapy outcome. CONCLUSIONS: Also in chronic ligamentous mallet finger, conservative therapy should be attempted before an operation, irrespective of the initial extension deficit, especially because the stress and the therapy risk for the patient with this therapy is small.