Standard vs. carbone dioxide adapted kidney replacement therapy in hypercapnic ARDS patients: a randomized controlled pilot trial (BigBIC).

Background: Current continuous kidney replacement therapy (CKRT) protocols ignore physiological renal compensation for hypercapnia. This study aimed to explore feasibility, safety, and clinical benefits of pCO2-adapted CKRT for hypercapnic acute respiratory distress syndrome (ARDS) patients with indication for CKRT.

Methods: We enrolled mechanically ventilated hypercapnic ARDS patients (pCO2 > 7.

Prevention of Encrustation on Ureteral Stents: Which Surface Parameters Provide Guidance for the Development of Novel Stent Materials?

Encrustations of ureteral stents are one of the biggest problems with urological implants. Crystalline biofilms can occur alone or in combination with bacterial biofilms. To identify which surface parameters provide guidance for the development of novel stent materials, we used an in vitro encrustation system.

Influence of Synthetic Bone Substitutes on the Anchorage Behavior of Open-Porous Acetabular Cup.

Background: The development in implants such as acetabular cups using additive manufacturing techniques is playing an increasingly important role in the healthcare industry.

Method: This study compared the primary stability of four selectively laser-melted press-fit cups (Ti6Al4V) with open-porous, load-bearing structural elements on the surface. The aim was to assess whether the material of the artificial bone stock affects the primary stability of the acetabular cup.

Effects of Build Orientation on Surface Morphology and Bone Cell Activity of Additively Manufactured Ti6Al4V Specimens.

Additive manufacturing of lightweight or functional structures by selective laser beam (SLM) or electron beam melting (EBM) is widespread, especially in the field of medical applications. SLM and EBM processes were applied to prepare Ti6Al4V test specimens with different surface orientations (0°, 45° and 90°). Roughness measurements of the surfaces were conducted and cell behavior on these surfaces was analyzed.

A novel approach to determine primary stability of acetabular press-fit cups.

Today hip cups are used in a large variety of design variants and in increasing numbers of units. Their development is steadily progressing. In addition to conventional manufacturing methods for hip cups, additive methods, in particular, play an increasingly important role as development progresses.

Cellular Nutrition in Complex Three-Dimensional Scaffolds: A Comparison between Experiments and Computer Simulations.

Studies on bone cell ingrowth into synthetic, porous three-dimensional (3D) implants showed difficulties arising from impaired cellular proliferation and differentiation in the core region of these scaffolds with increasing scaffold volume in vitro. Therefore, we developed an in vitro perfusion cell culture module, which allows the analysis of cells in the interior of scaffolds under different medium flow rates. For each flow rate the cell viability was measured and compared with results from computer simulations that predict the local oxygen supply and shear stress inside the scaffold based on the finite element method.

Prenatal ultrasound diagnosis in 51 cases of holoprosencephaly: craniofacial anatomy, associated malformations, and genetics.

Objective: To analyze the prenatal ultrasound findings of the craniofacial and extracephalic anatomy, the postnatal pathological findings, and the genetic anomalies in 51 cases of holoprosencephaly (HPE).

Materials And Methods: Between 1990 and 2005, a collective of 51 fetuses with tentative ultrasound diagnosis of HPE was recruited at two tertiary referral centers for prenatal ultrasound diagnostics via the Pia Fetal Database (GEMedical Systems, Webling, Germany). Cephalic as well as extracephalic anomalies were investigated, and all cases were subdivided into the subgroups lobar, a lobar, and semilobar HPE.

Analysis of leukocyte binding to depletion filters: role of passive binding, interaction with platelets, and plasma components.

Since limited knowledge exists on the mechanisms which regulate cell binding to leukocyte removal filter surfaces, we investigated the binding patterns of leukocytes to individual layers of leukocyte depletion filters. After passage of 1 unit of whole blood, blotting of isolated filter layers on glass slides or elution of cells from filter layers revealed that most leukocytes were located within the first 10 of a total of 28 filter layers, peaking at layers 6 to 8, with granulocytes binding on average to earlier filter layers than lymphocytes. Leukocytes preincubated with inhibitors of actin activation showed unchanged distribution between filter layers, suggesting that cytoskeletal activation does not significantly contribute to their binding.

[Radiologic after-care of transjugular intrahepatic stent shunt (TIPSS)]].

The transjugular intrahepatic stent-shunt (TIPSS) is a well accepted minimal invasive therapy for complications of portal hypertension: recurrent variceal bleeding, refractory ascites and liver failure due to the Budd-Chiari syndrome. The high frequency of shunt stenoses and occlusions makes regular follow up examinations essential. Despite modern non invasive imaging methods direct portography still is the gold standard for shunt surveillance in TIPSS.

[Prospective study to compare high-resolution computed tomography and magnetic resonance imaging in the detection of pancreatic neoplasms: use of intravenous and oral MR contrast media].

Purpose: To compare thin-section hydro-CT and MRI in the detection of pancreatic neoplasms. Evaluation of an oral, superparamagnetic contrast agent (OMP) for pancreatic MRI.

Material And Methods: 45 patients with suspected pancreatic neoplasms were examined with consecutive thin-section helical CT (Hydro-CT, 3/6/3, 130 ml Ultravist, Schering) and MRI (1.

[Rational radiologic after-care of endoluminal aortic bypass].

Goal: To identify essential and relevant diagnostic algorithms in the follow-up of stent-grafts placed for aortic dissections and aneurysms based on our 7 years experience including the use of more than 10 different devices.

Material And Methods: Evaluation of conventional biplane imaging, angiography, sonography, CT and MR in the efficacy of demonstrating endoleaks, sac shrinkage, changes of stent-graft integrity and, with special reference to MR-compatibility of various stent-graft devices.

Results: Endoleaks are found in 20-30% of patients after endovascular exclusion of abdominal aortic aneurysms.

Long term changes of the throwing arm of former elite javelin throwers.

The aim of this study was to determine long term changes in shoulder and elbow joints of former elite javelin throwers. Twenty-one elite javelin throwers were examined at an average of 19 years after the end of their high performance phase. Mean age at examination was 50 years.

[MRI in chronic inflammatory bowel disease].

Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease.

[Various spiral CT protocols and their significance in the diagnosis of aortic dissections: results of a prospective study].

Purpose: Development of an optimized Spiral CT protocol type for the diagnosis of aortic dissections.

Material And Methods: 121 consecutive CT examinations applying 5 different protocol types were blindly read by two experienced radiologists and then compared with: (a) 45 biplane transesophageal echocardiographies (TEE), (b) 52 transthoracic echocardiographies (TTE), (c) 52 operative findings and, furthermore, related to the clinical course over at least six months in 79 patients.

Results: The sensitivity of the spiral computed tomography for detection of dissection was 97% (biplane TEE: 88%), the specificity 100% (biplane TEE: 91%).

[Renal tumor embolization].

Today the relevance of renal tumor embolization is not determined only by the technical and clinical success of the method. Progress in diagnosis of early stages of renal carcinomas as well as the improvement of both surgical techniques and anesthetic procedures have lead to a change in the selection of patients for embolization. Preoperative embolization of advanced renal cell carcinomas with tumor thrombus into the vena cava or of T4 tumors is now an established clinical procedure.

[Diagnostic imaging for therapy control of primary bone tumors].

Adjuvant chemotherapy has significantly improved the prognosis of patients with bone sarcomas. Preoperative diagnostic imaging of tumor response to such therapy has become a mainstay for the assessment of prognosis, planning of surgery and further treatment. During therapy, responding tumors show characteristic changes on conventional radiography, angiography, sonography, radionuclide studies, CT and MR.

[Interventional therapy of primary and secondary tumors of the spine].

Therapeutic interventions in the skeletal system are an essential part of interventional radiology. Although in terms of figures these procedures are applied less frequently, they are very effective. Percutaneous transarterial embolization of a spinal tumor is well-established interventional treatment.

[Radiologic diagnosis of bone metastases].

Metastases are the most common malignant tumors of the skeleton. Several imaging modalities can be engaged for the diagnosis of skeletal metastases. They may be combined, depending on the individual clinical setting.

[The hydro-MRT of chronic inflammatory bowel diseases].

Purpose: Evaluation of hydro-MRI in the diagnosis of chronic inflammatory bowel disease (IBD).

Material And Methods: 33 patients with suspected Crohn's disease or ulcerative colitis were studied prospectively. After distension of the colon by a rectal enema, breathhold MR imaging was performed during bowel relaxation.

The economics and ethics of markets for human organs.

In 1984, federal legislation outlawing payment for human organs for transplantation was adopted after only cursory discussion of the underlying policy issues. More considered analysis suggests that this prohibition may be overly broad. It appears possible to design suitably regulated market-type approaches to the acquisition and allocation of cadaveric organs (and perhaps of organs from living donors as well) that will be neither unduly offensive to ethical sensibilities nor easily abused and that may yield significant improvements over the existing system of organ procurement, which presents important ethical and practical problems of its own.