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Epigastric hernias in children and the use of ultrasound in its diagnosis

World Journal of Pediatric Surgery 2023年第2期6卷 92-96页

作者： tatjana t König Laura S Oerters Ljuba Spiller Martin Schwind Mark Born Christina Oetzmann von Sochaczewski Andreas C Heydweiller klinik und poliklinik für Kinderchirurgie Universitätsmedizin der Johannes Gutenberg-Universität MainzMainzGermany Sektion Kinderchirurgie der klinik und poliklinik für Allgemein- Viszeral-Thorax-und GefächirurgieUniversität sklinikum BonnBonnGermany Sektion Kinderradiologie der klinik für Diagnostische und Interventionelle radiologie Universitätsklinikum BonnBonnGermany

Introduction there is a paucity of clinical data on pediatric epigastric hernias despite them accounting for up to 6%of all hernia repairs in *** aimed to provide additional data to supplement those 117 cases of a recent systematic review and to further clarify the role of ultrasound in diagnosing pediatric epigastric *** We retrospectively included all 60 patients treated for epigastric hernias in children in two tertiary pediatric surgical departments within 12 *** were tested via point-biserial correlation *** Epigastric hernias primarily affected preschool children with a median age of 39 *** vast majority of patients(88%)presented with swelling that was occasionally(30%)accompanied by *** defects could be found during clinical examination in 45%of patients with a median size of 5 mm(95%CI 3 to 10).Smaller defects were less likely to be palpable(r=-0.44,95%CI-0.08 to-0.7,p=0.021).Likewise,ultrasound was used more frequently with smaller fascial defect sizes(r=-0.51,95%Cl-0.16 to-0.74,p=0.007).Laparoscopic repair was used in 11 patients(19%)and more often(4/11)in combination with another simultaneous procedure than open repair(11/48).Conclusions Epigastric hernias are primarily a condition of the preschool *** can be beneficial if the diagnosis cannot be made clinically;otherwise,it is abdicable if it does not change the management of the patient's epigastric *** repairs might be beneficial for children with multiple defects or simultaneous procedures.

关键词： diagnosis primarily otherwise

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Biomechanische Untersuchungsergebnisse ber die verbesserte Verankerung von Pedikelschraubenmit resorbierbarem Zement in menschenlichen Wirbelk rpern

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Journal of Huazhong university of Science and technology(Medical Sciences) 2001年第1期21卷 48-51页

作者：邵景范罗永湘 Luo Yongxiang Lutz Claes Lothar Kinzl Abteilung für chirurgie Tongji KlinikTongji medizinisches institutHuazhong Universitat für Wissenschaft und Technik Abteilung für Unfallchirurgie Hand-und Wiederherstellungschirurgie der Universitat UlmDeutschland Abteilung für Unfallchirurgische forschung und Biomechanik der universitat Ulm Deutschland

Die Prim rstabilit t von Pedikelschrauben im Knochen h ngt in hohem Masse von der Knochendichte ab. Die Augmentation mit Zement ist ein klinisch einsetzbares Verfahren, um die Schrauben Verankerung im osteoporotischen Knochen zu *** dieser Studie wurde eine neuartiges resorbierbares Knochenersatzmaterial (α BSM tM ) für diese Augmentation benutzt. Biomechanische testungen wurden in vitro bei 16 Lendwirbelk rpern (L3-L5) aus 6 Individuen(75,2±13,7 Jahre) durchgeführt. Vor der biomechanischen testung wurde bei allen Pr paraten die trabekul re Knochendichte mittels pQCt gemessen und beide Pedikel mit USS Pedikelschrauben (5,0 mm × 45 mm) besetzt, von welchen eine mit α BSM tM augmentiert war. Beim axialen Auszugstest wurden die maximale axiale Auszugskraft (f max) sowie die Energieaufnahme bestimmt. der Medianwert der f max stieg beim Auszugstest durch die Zementierung mit α BSM tM um 80 % von 370 N (ohne Zement) auf 665 N (mit Zement). Die Energieaufnahme bis zum Erreichen der f max (E f max) und bei Dislokation bis 2,0 mm (E 2 mm) steigerte sich ebenfalls um 83 % und 68 %. Die Unterschiede waren signifikant. (Wilcoxon′s test, P reisskrafte f max (ohne oder mit Zement) korrelierten eng mit der Knochendichte ( r =0,9056 und r =0,9585). Unsere resultate zeigen, da eine Augmentation mit dem α BSM tM die primare Stabilitat von Pedikelschrauben verbessern kann. der Effekt scheint auf einer Optimierung der Kontaktfl che und einer Aussteifung der schraubennahen Spongiosa zu beruhen. Das Material k nnte geeignet sein, die Verankerung von Pedikelschrauben bei osteoporotischen Patieten zu verbessern.

关键词： Biomechanik Zement Pedikelschraube Stabilit t Wirbelk rper

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Controlled and reversible induction of differentiation and activation of adult human hepatocytes by a biphasic culture technique

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World Journal of Gastroenterology 2005年第14期11卷 2080-2087页

作者： Marcus K.H. Auth Kim A. Boost Kerstin Leckel Wolf-Dietrich Beecken tobias Engl Dietger Jonas Elsie Oppermann Philip Hilgard Bernd H. Markus Wolf-Otto Bechstein roman A. Blaheta universit(a|¨)ts-Kinderklinik Essen Abteilung für allgemeine P(a|¨)diatrie Germany Zentrum der An(a|¨)sthesiologie und Wiederbelebung Johann Wolfgang Goethe-universit(a|¨)t Frankfurt am MainGermany klinik für Allgemein-und Gef(a|¨)βchirurgie Germany klinik für Urologie und Kinderurologie Zentrum der chirurgie Johann Wolfgang Goethe-Universit(a|¨)tFrankfurt am MainGermany klinik für Allgemein- und Gef(a|¨)βchirurgie Germany universit(a|¨)tsklinikum Essen Abteilung für Gastroenterologie und Hepatologie Germany klinik für Allgemein- und Viszeralchirurgie St(a|¨)dt. klinikum Kemperhof KoblenzGermany

AIM:Clinical application of human hepatocytes (HC) is hampered by the progressive loss of growth and differentiation in vitro. the object of the study was to evaluate the effect of a biphasic culture technique on expression and activation of growth factor receptors and differentiation of human adult HC. MEtHODS: Isolated HC were sequentially cultured in a hormone enriched differentiation medium (DM) containing nicotinamide, insulin, transferrin, selenium, and dexame-thasone or activation medium (AM) containing hepatocyte growth factor (HGf), epidermal growth factor (EGf), and granulocyte-macrophage colony-stimulating factor (GMCSf). Expression, distribution and activation of the HC receptors (MEt and EGfr) and the pattern of characteristic cytokeratin (CK) filaments were measured by fluorometry, confocal microscopy and Western blotting. rESULtS: In the biphasic culture system, HC underwent repeated cycles of activation (characterized by expression and activation of growth factor receptors) and re-differentiation (illustrated by distribution of typical filaments CK-18 but low or absent expression of CK-19). In AM increased expression of MEt and EGfr was associated with receptor translocation into the cytoplasm and induction of atypical CK-19. In DM low expression of MEt and EGfr was localized on the cell membrane and CK-19 was reduced. receptor phosphorylation required embedding of HC in collagen type I gel. CONCLUSION: Control and reversible modulation of growth factor receptor activation of mature human HC can be accomplished in vitro, when defined signals from the extracellular matrix and sequential growth stimuli are provided. the biphasic technique helps overcome dedifferentiation, which occurs during continuous stimulation by means of growth factors.

关键词： Human hepatocytes Differentiation Hepatocyte growth factor Epidermal growth factor HGf receptor EGf receptor Cytokeratin Collagen gel

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Development of an internally braced prosthesis for total talus replacement

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World Journal of Orthopedics 2017年第3期8卷 221-228页

作者： Markus regauer Mirjam Lange Kevin Soldan Steffen Peyerl Sebastian Baumbach Wolfgang Bocker Hans Polzer klinik für allgemeine Unfall und Wiederherstellungschirurgie Klinikum der Ludwig-Maximilians-Universitat München Stryker GmbH

total loss of talus due to trauma or avascular necrosis,for example,still remains to be a major challenge in foot and ankle surgery with severely limited treatment *** of a custom made total talar prosthesis has shown promising results so *** important factors for long time success are degree of congruence of articular surfaces and ligamentous stability of the ***,our aim was to develop an optimized custom made prosthesis for total talus replacement providing a high level of primary stability.A custom made hemiprosthesis was developed using computed tomography and magnetic resonance imaging data of the affected and contralateral talus considering the principles and technology for the development of the ***(Stryker).Additionally,four eyelets for fixation of artificial ligaments were added at the correspondent footprints of the most important *** modifications can be provided according to the clinical requirements:A tri-articular hemiprosthesis or a bi-articular hemiprosthesis combined with the tibial component of the *** ankle replacement system.A feasibility study was performed using a fresh frozen human *** range of motion of the ankle was measured and ligamentous stability was evaluated by use of standard X-rays after application of varus,valgus or sagittal stress with 150 *** implantation of the prosthesis was technically possible via an anterior approach to the ankle and using standard *** osteotomies were not *** ankle dorsiflexion and plantarflexion were measured as 22-0-28 *** anterior displacement of the talus was 6 mm,maximum varus tilt 3 degrees and maximum valgus tilt 2 *** of an internally braced prosthesis for total talus replacement in humans is technically feasible and might be a reasonable procedure in carefully selected cases with no better alternatives left.

关键词： Ankle Avascular necrosis total loss of talus Prosthesis Hemiprosthesis InternalBrace talus replacement

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Die　selektive　Sklerosierung　der　Vena　coronaria　ventriculi　─eine　neuartige　therapie　der　Osophagusvarizenblutung

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Journal of Huazhong university of Science and technology(Medical Sciences) 1996年第1期16卷 36-40页

作者：叶启发戴植本裘法祖刘效恭 Abteilung für chirurgie Tongji Klinik Tongji Medizinische Universität Wuhan Chirurgische klinik Medizinische Universität Xian China

Patienten beiderlei Geschlechts mit portaler Hypertension bei Leberzirrhose wurden nach erfolgloser endoskopischer Behandlung einer akuten sophagusvarizenblutung operiert. 134 flle waren als posthepatitische, 62 als schistosomatische und 25 als bilire Leberzirrhosen diagnostiziert. Das wichtigste bei unserem Operationsverfahren ist: Darstellung der V. coronaria ventriculi in der Mitte der kleinen Kurvatur und Kanlierung der beiden Venensegmente. Nach Setzen von Klemmen 5 cm pr- und 5 cm postkardial und in der Korpusmitte Sklerosierung des kranialen V. coronaria-Segmentes mit α-Octyl-Cyanoacrylat und Venenligatur; Messung des portalvensen Druckes im kaudalen Segment. Die selektive Sklerosierung der V. coronaria ventriculi (SSVCV) wurde bei 18 fllen als prophylaktischer, bei 106 fllen als notfallmβiger und bei 98 fllen als elektiver Eingriff durchgefhrt, und bei allen Patienten konnte die Varizenblutung gestillt werden. 219 Patienten berlebten , 3 Patienten verstarben an Leberversagen 24 Stunden postoperativ. Bei 189 operierten Patienten der Gruppe zeigte sich bei der Durchleuchtung, rntgenkontrastfllung und Endoskopie, daβ die sophagusvarizen 3-6 Monate nach der SSVCV eine offensichtliche Verbesserung aufwiesen. Die postoperative Untersuchung nach 1 bis 2 Jahren zeigte, daβ die sophagusvarizen nicht mehr ezistierten. Bei 182 operierten Patienten hat sich beim follow-up im Zeitraum von 6 1/2 Jahren bis 7 1/2 Jahren ergeben, daβ nach der Operation keine Blutung mehr aufgetreten ist.

关键词： sophagusvarizenblutung selektive Sklerosierung Vena coronaria ventriculi α-Octyl-Cyano-acrylat

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Adult-to-adult right lobe living donor liver transplantation:Comparison of endoscopic retrograde cholangiography with standard t2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy

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World Journal of Gastroenterology 2006年第36期12卷 5820-5825页

作者： Perdita Wietzke-Braun felix Braun Dieter Müller thomas Lorf Burckhardt ringe Giuliano ramadori Abteilung für Gastroenterologie und Endokrinologie Georg-August-Universitt Gttingen Germany klinik für allgemeine chirurgie und thorax-chirurgie Universitt Schleswig-Holstein Campus Kiel Germany Abteilung für Diagnostische radiologie Georg-August-Universitt Gttingen Germany klinik für allgemeine chirurgie Georg-August-Universitt Gttingen Germany Center for Liver Pancreas and Biliary Disease Drexel University College of Medicine Philadelphia United States

AIM: to compare the value of endoscopic retrograde cholangiography (ErC) and standard t2-weighted magnetic resonance cholangiography (MrC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLtx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications, ***: After starting the LDLtx program, 18 liver transplant candidates were selected for LDLtx by a stepwise evaluation process. ErC and standard t2-weighted MrC were performed to evaluate the biliary system of the donor liver. the anatomical findings of ErC and MrC mapping were compared using the Ohkubo classification. rESULtS: ErC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%) with biliary variants while routine MrC was only accurate in 2/13 (15.4%) cases. MrC was limited in depicting the biliary system proximal of the hepatic bifurcation. Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3 recipients with biliary leak received a graft with multiple (≥2) bile ducts. CONCLUSION: Pretransplant ErC is safe and superior over standard MrC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.

关键词： Living donor liver transplantation Donors biliary tree Endoscopic retrograde cholangiography Magnetic resonance cholangiography

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Syndesmotic Internal Brace^(tM) for anatomic distal tibiofibular ligament augmentation

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World Journal of Orthopedics 2017年第4期8卷 301-309页

作者： Markus regauer Gordon Mackay Mirjam Lange Christian Kammerlander Wolfgang Bocker SportOrtho rosenheim Praxis für Orthopadie und Unfallchirurgie klinik für allgemeine Unfall-und WiederherstellungschirurgieKlinikum der Ludwig-Maximilians-Universitat München faculty of Health Sciences and Sport University of Stirling

reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. thus, there still remain considerable controversies regarding diagnosis, classification and treatment of syndesmotic injuries. Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery, and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%. Outcome of ankle fractures with syndesmosis injury is worse than without, even after surgical syndesmotic stabilization. this may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls. therefore, even open visualization of the syndesmosis during the reduction maneuver has been recommended. thus, the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis. In this context the tight rope~?system is reported to have advantages compared to classical syndesmotic screws. However, rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 tight ropes~?. therefore, we developed a new syndesmotic Internal Brace^(tM) technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments. the Internal Brace^(tM) technique was developed by Gordon Mackay from Scotland in 2012 using Swive Locks~? for knotless aperture fixation of a fiber tape~? at the anatomic footprints of the augmented ligaments, and augmentation of the anterior talofibular ligament, the deltoid ligament, the spring ligament and the medial collateral ligaments of the knee have been published so far. According to the individual injury pattern,patients can either be treated by the new syndesmotic Internal Brace^(tM) technique alone as a single anterior stabilization, or in combination with one posteriorly directed tight rope~? as a doub

关键词： Syndesmosis injury rotational instability Stabilization Anatomic repair Internal Brace^(tM) Surgical technique

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克隆病的外科治疗

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德国医学 1998年第4期15卷 228-229页

作者： G.Schürmann C.Krieglstein C.Herfarth 张林 klinik und poliklinik für allgemeine chirurgie der universitt Waldeyerstr. 1 D-48149 Mǜnster Germany 同济医科大学附属同济医院

克隆病是一种自发性慢性炎症性肠病,由 Crohn等于1932年据52例病例首次报道。克隆病的流行病学特点:好发于西方工业化国家,妇女发病高于男性1.5倍,好发于30多岁。在欧洲克隆病的发生据4～6位,每100 000人中有50～100人发病。克隆病可侵... 详细信息

克隆病是一种自发性慢性炎症性肠病,由 Crohn等于1932年据52例病例首次报道。克隆病的流行病学特点:好发于西方工业化国家,妇女发病高于男性1.5倍,好发于30多岁。在欧洲克隆病的发生据4～6位,每100 000人中有50～100人发病。克隆病可侵袭整个消化道,好发部位为末端回肠。肉眼观见肠粘膜疱疹样溃疡。

关键词：克隆病外科手术适应证疗效

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肝破裂的不同手术方法评价

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德国医学 1994年第3期11卷 163-164页

作者： B.Kremer D.Henne-Bruns 张应天 klinik für allgemeine chirurgie und thoraxchirurgie der Christian-Albrechts-UniversittArnold-Heller-Str.7D-24105 KielGermany 武汉市职工医学院附属医院

约70%～80%肝外伤为Ⅰ、Ⅱ度,故80%病例手术时用简单术式如暂时局部压迫、缝合包膜和引流等处理即可。轻度肝外伤手术腹部钝挫伤疑肝外伤时有2种切口,即正中切口剖腹和上腹部横切口正中尽量向上延长至剑突。正中切口优点是快速而出血少... 详细信息

约70%～80%肝外伤为Ⅰ、Ⅱ度,故80%病例手术时用简单术式如暂时局部压迫、缝合包膜和引流等处理即可。轻度肝外伤手术腹部钝挫伤疑肝外伤时有2种切口,即正中切口剖腹和上腹部横切口正中尽量向上延长至剑突。正中切口优点是快速而出血少,可迅速扩大作胸骨正中切口,如下腔静脉肝上部损伤;

关键词：肝破裂外科手术方法

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Mutation Status of KrAS, BrAf, PIK3CA and Expression Level of ArEG and ErEG Identify responders to Cetuximab in a Large Panel of Patient derived Colorectal Carcinoma Xenografts of All four UICC Stages

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Journal of Cancer therapy 2013年第2期4卷 678-693页

作者： Paulina Pechanska M.Becker t.Mayr B.Hinzmann H.-P.Adams I.Klaman K.-H.Kretschmar K.Kretschmar K.Stecker r.Mantke r.Pauli J.Pertschy K.Hertel K.ridwelski K.Hellwig M.Pross C.radke I.fichtner J.Hoffmann A.rosenthal Signature Diagnostics AG PotsdamGermany Experimental Pharmacology&Oncology Berlin-Buch GmbH BerlinGermany Stadtisches klinikum Brandenburg GmbH Klinik fur Allgemein-und ViszeralchirurgieInstitut fur PathologieBrandenburg an der HavelGermany Katholisches Krankenhaus St.Johann Nepomuk Klinik fur Allgemeine ChirurgieErfurtGermany HELIOS klinikum Erfurt Institut fur PathologieErfurtGermany klinikum Magdeburg Klinik für Allgemein-und ViszeralchirurgieInstitut fur PathologieMagdeburgGermany DrK kliniken Berlin-Kopenik Klinik fur ChirurgieInstitut fur PathologieBerlinGermany Max Delbruck Center fur Molekulare Medizin(MDC) Experimentale PharmakologieBerlinGermany.

to advance preclinical testing of novel targeted drugs in colorectal cancer (CrC) we established a panel of 133 mouse xenograft models from fresh tumor specimens of 239 patients with CrC of all four UICC stages. A subgroup of 67 xenograft models was treated with cetuximab, bevacizumab and oxaliplatin as single agents. Mutation status of KrAS (G12, G13, A146t), BrAf (V600E) and PIK3CA (E542K, E545K, H1047r) was assessed in all xenografts by allelespecific real-time PCr. KrAS codon 61 was assessed by conventional sequencing. ArEG and ErEG expression levels were analyzed by real-time PCr expression assays. In the treatment experiment we observed response rates of 27% (18/67) for cetuximab, 3% (2/67) for bevacizumab, and 6% (4/67) for oxaliplatin. Classification based on KrAS, BrAf and PIK3CA mutation status identified 15 of the responders (sensitivity 83%, confidence interval at p = 0.05 (CI): 59% - 96%), and 38 nonresponders (specificity 78%, CI: 63% - 88%). If any mutation except in KrAS codon 13 were considered, the classifier reached sensitivity of 94% and specificity of 69%. We improved specificity of the classifiers to 90% and 86% respectively by adding ArEG and ErEG rNA expression thresholds retrospectively. In patient-derived xenograft models, we found a predictive classifier for response to cetuximab that is more accurate than established biomarkers. We confirmed its potential performance in primary human tumors. for patients, the classifier’s sensitivity promises increased response rates and its specificity limits unnecessary toxicity. Given the scope of our xenograft models across all UICC stages, this applies not only to mCrC but also to the adjuvant setting of earlier stages. the xenograft collection allows to mimic randomized phase II trials and to test novel drugs effectively as single agents or in combinations. It also enables the development of highly accurate companion diagnostics as demonstrated by us for cetuximab.

关键词： Colorectal Cancer Xenograft Mutation Biomarker Cetuximab

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