Thesis (M.S.)--University of Hong Kong, 1981.

Zugl.: Bonn, University, Habil.-Schr., 2005.

Thesis (M.S.)--University of Hong Kong, 1981. / Also available in print.

published_or_final_version / Surgery / Master / Master of Surgery

München, Techn. Univ., Diss., 2004. / Erscheinungsjahr an der Haupttitelstelle: 2003

Ziel unserer Studie war es, die Häufigkeit und das Outcome von Patienten zu ermitteln, welche nach einer transvenösen Sondenextraktion aufgrund einer Infektion ihres kardial implantierten Gerätes keine Reimplantation benötigten. Darüber hinaus sollten die Gruppen der Reimplantierten und Nicht-Reimplantierten anhand persönlicher und implantatbezogener Merkmale verglichen und Daten hinsichtlich Komplikationen und Mortalität analysiert werden. Dafür wurden alle Patienten mit einer Infektion ihres kardial implantierten Gerätes im Herzzentrum Leipzig von Januar 2012 bis Juni 2017 untersucht.:Inhaltsverzeichnis Seite Inhaltsverzeichnis 3 Abkürzungsverzeichnis 4 1 Einleitung 5 1.1 kardiale elektronische Implantate 5 1.1.1 kurze historische Entwicklung 5 1.1.2 Physiologische und pathophysiologsiche Grundlagen 7 1.1.3 Aufbau und Funktionsweise 7 1.1.4 Indikation 9 1.2 Infektion kardialer elektronischer Implantate 11 1.2.1 Definition 11 1.2.2 Risikofaktoren 11 1.2.3 Diagnose und klinisches Management 13 1.2.4 Reimplantation 15 2 Ziel der Arbeit 16 3 Publikation 17 4 Zusammenfassung 26 5 Literaturverzeichnis 32 6 Anhang 40 6.1 Beitrag der Promovendin zur Publikation 40 6.2 Erklärung über die eigenständige Abfassung der Arbeit 41 6.3 Danksagung 42 / Background: Little is known about rates of re-implantation and outcomes of patients not implanted with a device after transvenous lead extraction (TLE) in cardiac device related infections (CDRI). Methods: All patients with CDRI were included in a prospective registry. After TLE, the indication for re-implantation was evaluated according to the patients' history and most recent cardiac examinations. All patients were followed for complications and mortality. In addition, in patients discharged without device the frequency of device implantations was analyzed. Results: Among 302 patients, only 123 (40.7%) met the indication for implantation of the same cardiac implantable electronic device (CIED), 68 (22.5%) received a different device and 111 (36.8%) patients were discharged without CIED. Reimplanted patients were younger (70 ± 11 vs. 73 ± 13 years; p = 0.004), more often male (83 vs. 69%, p = 0.006), had less systemic infection (38 vs. 60%; p < 0.001) and a higher prevalence of complete heart block (28 vs. 7%, p < 0.001). Reasons against re-implantation were: loss of indication (45%), never met indication (27%), patients' preference (17%), persistent infection (8%) and advanced age (3%). During 26 ± 18 months of follow-up, mortality in both groups was similar after adjusting for cofactors (HR 0.79; 95% CI 0.49–1.29; p = 0.352). Conclusion: More than one third of patients undergoing TLE for CDRI in our study are not implanted with a new device. Careful evaluation of the initial CIED indication allows for detection of over treated patients and may avoid unnecessary device–related complications.:Inhaltsverzeichnis Seite Inhaltsverzeichnis 3 Abkürzungsverzeichnis 4 1 Einleitung 5 1.1 kardiale elektronische Implantate 5 1.1.1 kurze historische Entwicklung 5 1.1.2 Physiologische und pathophysiologsiche Grundlagen 7 1.1.3 Aufbau und Funktionsweise 7 1.1.4 Indikation 9 1.2 Infektion kardialer elektronischer Implantate 11 1.2.1 Definition 11 1.2.2 Risikofaktoren 11 1.2.3 Diagnose und klinisches Management 13 1.2.4 Reimplantation 15 2 Ziel der Arbeit 16 3 Publikation 17 4 Zusammenfassung 26 5 Literaturverzeichnis 32 6 Anhang 40 6.1 Beitrag der Promovendin zur Publikation 40 6.2 Erklärung über die eigenständige Abfassung der Arbeit 41 6.3 Danksagung 42

O objetivo deste trabalho, foi analisar os prontuários de pacientes acidentados, que tiveram dentes avulsionados e reimplantados no período de 1983 a 2000, atendidos no Serviço de Urgência Odontológica da Faculdade de Odontologia de Bauru da Universidade de São Paulo. Foram coletados dados sobre: o tempo de permanência extra-alveolar, o meio usado na conservação do dente avulsionado e o tipo de contenção empregado, assim como a proservação instituída, correlacionando-os com a situação atual do dente reimplantado. Esta análise foi complementada pelos seguintes dados epidemiológicos: elementos dentais mais atingidos, idade do paciente na época da reimplantação, sexo, raça, tipo de acidente, ambiente de ocorrência, época do ano de maior incidência e o número de dentes avulsionados por paciente. Desse modo os dados obtidos foram os seguintes: - Foram atendidos 87 pacientes, totalizando 116 dentes avulsionados. - O tempo de permanência extra-alveolar variou de 30 minutos (13,8 %) até 96 horas (1,1 %). - O meio mais utilizado para conservação do elemento dental avulsionado foi o leite (43,5 %). - O tipo de contenção mais empregado foi a esplintagem com resina composta (50,0 %). - Os dentes mais atingidos foram os incisivos centrais superiores (72,4%). - A avulsão ocorreu com mais freqüência na faixa etária compreendida entre 8 e 12 anos. - Predominância do sexo masculino (60,9 %) em relação ao sexo feminino (39,1 %). - 81,6% dos pacientes são da raça branca, 17,2 % negros e 1,2 % amarelos. - Os acidentes ocorreram com maior freqüência no outono. - 21,9 % dos acidentados tiveram mais que 1 dente avulsionado. Confrontando essas informações com a literatura pertinente pode-se observar que os nossos dados são semelhantes àqueles contidos nos estudos sobre avulsão e reimplantação e concluir que nos últimos 5 anos o grau de conhecimento do público leigo em relação à conservação de dentes avulsionados evoluiu muito, porém, ainda predomina entre os profissionais da Odontologia o conceito do reimplante imediato, independente do tempo de permanência extra-alveolar e do meio de conservação utilizado. A terapêutica endodôntica realizada com curativo intracanal de hidróxido de cálcio, pelo período de 1 a 2 anos, mostrou-se eficiente na prevenção da reabsorção externa inflamatória. / The objective os this project was to analyze the records of patients who suffered accidents and had avulsed and replanted teeth in the period between 1983 and 2000, attended to by the Dental Urgency Service of the School of Dentistry at Bauru of the University of São paulo. Data regarding: the time of extra-alveolar permanence, the means used in the conservation of the avulsed tooth and the type of splint employed, as well as instituted preservation, correlating them to the current situation of the replanted dental element, was collected. This analysis was complemented by the following epidemiological data: the most affected dental, the age of the patients at the time of the replantation, gender, race, kind of accident, environment of the incident, the time of year with the highest incidence, and the number of avulsed teeth per patient. In such a way, the data obtained was de following: - 87 patients were attended to, making a total of 116 avulsed teeth; - The time of extra-alveolar permanence ranged from 30 minutes (13,8 %) to 96 hours (1,1 %); - The most utilized means for the conservation of the avulsed dental elements was milk (43,5 %); - The kind of splint most used was a variety with compound resin (50,0 %); - The teeth most affected were the upper central incisors (72,4 %); - Avulsion occurred most frequently in the age range between 8 and 10; - Predominance of the male sex (60,9 %) in relation to that of the female (39,1 %); Abstract 1 0 7 - 81,6 % of the patients were white, and 17,2 % were black, while 1,2 % were Asiatic; - The accidents occurred most frequently in the fall; - 21,9 % of the accidents had more than 1 avulsed tooth. Confronting this information with the pertinent literature, one can observe that our data is similar to that which is contained in the studies on avulsion and replantation, and conclude that in he last 5 years, the extent of the layman publics knowledge in relation to the conservation of avulsed teeth has evolved quite a bit, although among professionals in dentistry, the concept of immediate replantation predominates, regardless of the time of extra-alveolar permanence or the means of conservation utilized. Endodontic therapy performed with intra-canal calcium hydroxide dressing, over the period of 1 at 2 years, proved to be efficient in the prevention of external inflammatory reabsorption.

O objetivo deste trabalho, foi analisar os prontuários de pacientes acidentados, que tiveram dentes avulsionados e reimplantados no período de 1983 a 2000, atendidos no Serviço de Urgência Odontológica da Faculdade de Odontologia de Bauru da Universidade de São Paulo. Foram coletados dados sobre: o tempo de permanência extra-alveolar, o meio usado na conservação do dente avulsionado e o tipo de contenção empregado, assim como a proservação instituída, correlacionando-os com a situação atual do dente reimplantado. Esta análise foi complementada pelos seguintes dados epidemiológicos: elementos dentais mais atingidos, idade do paciente na época da reimplantação, sexo, raça, tipo de acidente, ambiente de ocorrência, época do ano de maior incidência e o número de dentes avulsionados por paciente. Desse modo os dados obtidos foram os seguintes: - Foram atendidos 87 pacientes, totalizando 116 dentes avulsionados. - O tempo de permanência extra-alveolar variou de 30 minutos (13,8 %) até 96 horas (1,1 %). - O meio mais utilizado para conservação do elemento dental avulsionado foi o leite (43,5 %). - O tipo de contenção mais empregado foi a esplintagem com resina composta (50,0 %). - Os dentes mais atingidos foram os incisivos centrais superiores (72,4%). - A avulsão ocorreu com mais freqüência na faixa etária compreendida entre 8 e 12 anos. - Predominância do sexo masculino (60,9 %) em relação ao sexo feminino (39,1 %). - 81,6% dos pacientes são da raça branca, 17,2 % negros e 1,2 % amarelos. - Os acidentes ocorreram com maior freqüência no outono. - 21,9 % dos acidentados tiveram mais que 1 dente avulsionado. Confrontando essas informações com a literatura pertinente pode-se observar que os nossos dados são semelhantes àqueles contidos nos estudos sobre avulsão e reimplantação e concluir que nos últimos 5 anos o grau de conhecimento do público leigo em relação à conservação de dentes avulsionados evoluiu muito, porém, ainda predomina entre os profissionais da Odontologia o conceito do reimplante imediato, independente do tempo de permanência extra-alveolar e do meio de conservação utilizado. A terapêutica endodôntica realizada com curativo intracanal de hidróxido de cálcio, pelo período de 1 a 2 anos, mostrou-se eficiente na prevenção da reabsorção externa inflamatória. / The objective os this project was to analyze the records of patients who suffered accidents and had avulsed and replanted teeth in the period between 1983 and 2000, attended to by the Dental Urgency Service of the School of Dentistry at Bauru of the University of São paulo. Data regarding: the time of extra-alveolar permanence, the means used in the conservation of the avulsed tooth and the type of splint employed, as well as instituted preservation, correlating them to the current situation of the replanted dental element, was collected. This analysis was complemented by the following epidemiological data: the most affected dental, the age of the patients at the time of the replantation, gender, race, kind of accident, environment of the incident, the time of year with the highest incidence, and the number of avulsed teeth per patient. In such a way, the data obtained was de following: - 87 patients were attended to, making a total of 116 avulsed teeth; - The time of extra-alveolar permanence ranged from 30 minutes (13,8 %) to 96 hours (1,1 %); - The most utilized means for the conservation of the avulsed dental elements was milk (43,5 %); - The kind of splint most used was a variety with compound resin (50,0 %); - The teeth most affected were the upper central incisors (72,4 %); - Avulsion occurred most frequently in the age range between 8 and 10; - Predominance of the male sex (60,9 %) in relation to that of the female (39,1 %); Abstract 1 0 7 - 81,6 % of the patients were white, and 17,2 % were black, while 1,2 % were Asiatic; - The accidents occurred most frequently in the fall; - 21,9 % of the accidents had more than 1 avulsed tooth. Confronting this information with the pertinent literature, one can observe that our data is similar to that which is contained in the studies on avulsion and replantation, and conclude that in he last 5 years, the extent of the layman publics knowledge in relation to the conservation of avulsed teeth has evolved quite a bit, although among professionals in dentistry, the concept of immediate replantation predominates, regardless of the time of extra-alveolar permanence or the means of conservation utilized. Endodontic therapy performed with intra-canal calcium hydroxide dressing, over the period of 1 at 2 years, proved to be efficient in the prevention of external inflammatory reabsorption.

Abstract Prosthetic joint infection (PJI) is one of the most devastating complications of hip or knee arthroplasty. Treatment options for PJI include prosthesis retention, prosthesis exchange and salvage procedures (e.g., arthrodesis or amputation). The purpose of this retrospective study is to assess the impact of shortening antibiotic treatment durations in PJIs treated with debridement, antibiotics and implant retention (DAIR) and to evaluate the predictors of DAIR treatment failure for PJIs. A second aim is to evaluate the outcomes and reimplantation microbiologies of PJIs treated with two-stage revision. The main data consist of 197 patients with PJI treated in Oulu University Hospital, Finland, between February 2001 and August 2009. Patients were identified retrospectively using the hospital’s patient databases. The study shows that, if antibiotic treatments for PJI are completed as planned, then DAIR treatment success rates (88%) are excellent. Prolonging antibiotic treatment over three months in total knee arthroplasty PJIs or over two months in total hip arthroplasty PJIs does not seem to offer any additional benefits. The failure of DAIR in the treatment of PJI is independently associated with high leucocyte counts at admission and with ineffective empirical antibiotics. Rifampin combination therapy, especially the combination of rifampin and ciprofloxacin, is significantly associated with successful DAIR treatments of staphylococcal PJIs. Our study also shows that a six-week course of antibiotics between stages is sufficient for treating PJIs with two-stage revision. Positive reimplantation cultures do not seem to be associated with significantly worse outcomes. / Tiivistelmä Tekonivelinfektio on yksi vakavimmista lonkan ja polven tekonivelleikkauksen komplikaatioista. Tekonivelinfektion hoitovaihtoehtoja ovat tekonivelen säästävä hoito, tekonivelen vaihto ja ns. salvage-toimenpiteet (esimerkiksi jäykistys tai amputaatio). Tämän retrospektiivisen tutkimuksen tavoitteena oli selvittää lyhennetyn mikrobilääkehoidon toimivuutta tekonivelinfektion säästävässä hoidossa. Lisäksi pyrittiin löytämään tekonivelinfektion hoidon epäonnistumiselle altistavia tekijöitä. Tavoitteena oli myös selvittää hoidon tuloksia silloin, kun hoidetaan tekonivelinfektiota kaksivaiheisella revisiolla, sekä tutkia revision toisessa vaiheessa otettavien mikrobinäytteiden merkitystä hoidon onnistumiselle. Tutkimusaineisto koostui 197 potilaasta, joilta hoidettiin tekonivelinfektiota Oulun yliopistollisessa sairaalassa helmikuun 2001 ja huhtikuun 2009 välisenä aikana. Potilastiedot saatiin sairaalan hoitotietojärjestelmästä. Tutkimuksessa todettiin, että lyhyemmällä hoitoajalla voidaan saavuttaa erinomaiset hoitotulokset (88 %) tekonivelinfektion säästävässä hoidossa, jos suunniteltu antibioottihoitoaika voidaan toteuttaa. Yli kahden kuukauden (lonkan tekonivelinfektio) ja kolmen kuukauden (polven tekonivelinfektio) hoitoajasta ei näytä olevan hyötyä säästävässä hoidossa. Lisäksi todettiin, että sairaalaantulovaiheessa mitattu veren leukosyyttiarvo > 10×109/l ja tehoton empiirinen antibiootti ovat itsenäisesti hoidon epäonnistumiselle altistavia tekijöitä. Rifampisiini-yhdistelmähoidon, erityisesti rifampisiini yhdistettynä siprofloksasiiniin, todettiin olevan merkittävästi yhteydessä hoidon onnistumiseen silloin, kun hoidetaan stafylokokki-infektiota tekonivelen säästävällä hoidolla. Tutkimuksemme osoitti myös, että kuuden viikon antibioottihoito on riittävä hoidettaessa tekonivelinfektiota kaksivaiheisella revisiolla. Positiivinen mikrobiviljelynäyte toisen vaiheen leikkauksessa ei näytä olevan yhteydessä huonompaan hoitotulokseen.

A trombose venosa é a principal complicação da microcirurgia vascular e a intervenção precoce é necessária para o salvamento dos retalhos, com índices de sucesso de apenas 50% das revisões cirúrgicas; trombose da microcirculação, produção de radicais livres de oxigênio (RLO) e edema são os elementos principais da lesão de isquemia/reperfusão (I/R), e o planejamento das terapias protetoras tem como objetivo amenizar estas alterações. Os fármacos antioxidantes, antiagregantes plaquetários e anticoagulantes são utilizados no controle da lesão de I/R em diferentes órgãos. Neste estudo, em modelo de amputação subtotal de membro posterior de rato submetido a isquemia global primária, foi testado o efeito protetor dos fármacos alopurinol, heparina, tirofiban ou vitamina C durante a isquemia secundaria pós congestão venosa. Foram operados 100 ratos, que apos isquemia global de 90 minutos, foram divididos em cinco grupos de 20 animais recebendo uma das respectivas drogas na veia femoral contra-lateral: 1ml de solução fisiológica 0,9% no grupo controle (GC), 1ml de alopurinol 45mg/kg no grupo experimental 1 (G1), 1ml de heparina 200UI/kg no grupo experimental 2 (G2), 1ml de tirofiban 50 ug /ml no grupo experimental 3 (G3) e 1 ml de vitamina C 100mg/kg no grupo experimental 4 (G4); o clampe foi então retirado do feixe vascular e se iniciou a reperfusão de 60 minutos; a colocação do clampe vascular apenas na veia femoral direita iniciou a congestão venosa (isquemia secundária) do membro por 90 minutos seguido de outra reperfusão de 60 minutos; O músculo gastrocnêmio foi dissecado e retirado para analise histológica e os animais sacrificados por injeção letal. Foram estudados a porcentagem de viabilidade celular muscular, o edema e o extravasamento de hemácias. A porcentagem de lesão celular do músculo do grupo controle foi 54,6% (±10,6), do G1 31,5% (±13,6), do G2 24,7% (±11,7), do G3 24,6% (±8,6) e do G4 21,3% (±8,6). Os grupos foram comparados por modelo de comparação múltiplas one way-ANOVA e post-hoc Tukey com significância de p < 0,05. A porcentagem de lesão celular foi menor para os grupos G1, G2, G3 e G4 quando comparados ao GC (p < 0,001), e quando comparados os grupos experimentais entre si, apenas o G4 (vitamina C) foi menor estatisticamente que G1(alopurinol) (p < 0,029). A utilização individual dos fármacos alopurinol, heparina ,tirofiban e vitamina C mostraram efeito protetor na congestão venosa secundaria a isquemia global primária, e a vitamina C foi mais efetiva nesta ação que o alopurinol quando comparados os antioxidantes entre si. Quando avaliado o edema, apenas os antioxidantes tiveram índices menores estatisticamente que o GC, enquanto que todos os fármacos diminuíram o extravasamento de hemácias comparados com o grupo controle (p < 0,001) / Venous thrombosis is the main complication of vascular microsurgery an early intervention is mandatory to rescue the flap, with a success rate of only 50% of surgical revisions; microcirculation thrombosis, oxygen free radicals production and edema are the main elements of ischemia/reperfusion (I/R) injury, and protective therapies aim to mitigate these changes. Antioxidants, antiplatelets and anticoagulants are used in different organs to control this injury. In this study, in a partial hind limb amputation model submitted to global ischemia, it was tested the protective effect of Allopurinol, Heparin, Tirofiban or Vitamin C during secondary ischemia after venous congestion. A hundred rats divided in five groups of 20 animals each were operated; after global ischemia of 90 minutes each group was injected into the contra lateral femoral vein one of the following solutions: 1 ml of saline solution NaCl 0,9% - control group (CG); 1ml of Allopurinol 45mg/kg - experimental group 1 (G1); 1ml of Heparin 200 UI/kg - experimental group 2 (G2); 1ml of Tirofiban 50 ug /ml - experimental group 3 (G3); 1ml of Vitamin C 100mg/kg - experimental group 4 (G4). Sixty minutes of limb reperfusion was performed, and a secondary period of limb ischemia started with the clamping of the femoral vein only (limb congestion) which lasted for 90 minutes (secondary ischemia). After that, the vein clamp was removed and a 60 minute reperfusion period was observed; at the end of the second reperfusion period, the right gastrocnemius muscle was removed and fixed in 10% formaldehyde, animals were euthanized with a lethal dose of Pentobarbital. Muscle fibers were scored as uninjured or injured based on the morphology of individual fibers; interstitial edema and bleeding were graded on a four-point scale. The control group had more damaged muscle cells 54.6±10.6% when compared to allopurinol 31.5±13,6%, heparin 24.7±11.7%, tirofiban 24.6±8.6% and Vitamin C 21.3±8.6% all reached statistical significance (p < 0.00 0.029). These comparisons were analysed using ANOVA and post-hoc Tukey. The single use of Allopurinol, Heparin, Tirofiban or Vitamin C showed a protective effect on venous congestion after global ischemia, and Vitamin C was more effective than Allopurinol when compared both antioxidants. When evaluating the edema, only the antioxidants had statistically lower rates than the CG, whilst all drugs reduced the extravasation of red blood cells compared with the control group (p < 0.001)