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Fragestellung: Die inverser Schulterprothesen (ITEP) gewinnt generell bei steigenden Implantationszahlen und guten klinischen Ergebnissen an Bedeutung. Verschiedene Materialdesigns wurden in letzter Zeit entwickelt. Als Ziel der prospektiven Studie wurden radiologische und klinische Ergebnisse inverser [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Karpaltunnelspaltung stellt die am häufigsten durchgeführte handchirurgische Operation mit verschiedensten chirurgischen Optionen dar. Im Rahmen einer anatomischen Studie anhand 60 oberer Extremitäten konnte die Ausdehnung des Retinaculum musculorum flexorum (RF) zur [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Spanish Jews in Rome after the expulsion: Delicado and La Lozana Andaluza. La Lozana Andaluza (c. 1530), a playful work by the Spanish presbyter Francisco Delicado, written and set in Rome in the years preceding the imperial sack of 1527, portrays, together with the protagonist, a Spanish woman from Córdoba, also the city itself, seen through the eyes of those who immigrated, like almost all the 125 characters who animate this curious dialogued novel. The protagonist, like the author himself, is of Jewish origin and her frequentations, especially at the beginning, were confined to the Roman quarters inhabited mainly by Spanish Jews and conversos. For this reason, the work is a source of information on the daily life of these two communities and their relationships both with Christians and with Jews of other nationalities., RiCOGNIZIONI. Rivista di Lingue e Letterature straniere e Culture moderne, V. 7 N. 13 (2020)

Mitteilungen des Kunsthistorischen Institutes in Florenz, Bd. 35 Nr. 2./3. (1991): Mitteilungen des Kunsthistorischen Institutes in Florenz

Zielsetzung: Seit 2011 wird in der Schweiz eine nationale Schlussprüfung mit einem strukturierten klinisch-praktischen Teil im OSCE Format durchgeführt. Der vorliegende Beitrag beschreibt die Erstellung, Durchführung, Auswertung und Qualitätssicherung der Eidgenössischen Prüfung[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Pacing threshold is not a stable value during the pacemaker's life. It is affected by many physiological, pharmacological and pathophysiological factors. A pacing system able to confirm capture and automatically adjust its output to the actual pacing threshold is highly desirable for a prolonged battery life and maximal patient safety. The Autocapture(TM) of St. Jude Medical and the Capture Management(TM) of Medtronic are currently available on the market. The key feature is the measurement of the evoked response (ER) signal by the pacemaker for capture confirmation. In case of loss of capture, the Autocapture(TM) System delivers a back up safety pulse of 4.5 Volt and 0.49 ms and starts a new threshold search. The pacemaker adapts its output to 0.3V/0.25V above the newly measured threshold. This system needs bipolar leads with low polarization for the first generation in Microny® and Regency® pacemakers; in the second generation with Affinity® and Integrity® pacemakers various bipolar leads are suitable. The Capture Management(TM) System of Medtronic, available in the Kappa® DR 700 series, performs a two point automatic threshold search once every day during rest. The output is determined by the programmed safety margin (nominal 1.5×voltage threshold). A backup pulse is only delivered during the threshold search. No special electrodes are necessary. These functions were shown to work safely and efficaciously in multicenter trials to decrease the current consumption with a prolongation of battery life up to 142%. The patients safety was increased by identifying changes of the capture threshold over time and adjusting the pacing stimulus. The conventional safety margins of 100% might not be safe for all patients. We also learned much about lead maturation and lead instability by the possibility of continuous follow-up of threshold changes in a larger group of leads in order to identify the risk group of about 10% of patients with late threshold increase and lead instability.

Ausgangspunkt der Diplomarbeit ist der Diskurs des Architekten und Senators auf Lebenszeit Renzo Piano, der ��ber die Notwendigkeit der Flickarbeit in den Peripherien - "il rammendo delle periferie" - spricht. "Es bedarf an finanziellen Investitionen und st��dteplanerischen Ideen, um diese Orte zu revitalisieren, denn dort findet das Leben, der Motor, der Antrieb der St��dte statt!" Die Arbeit besch��ftigt sich n��her mit dem Thema der Revitalisierung norditalienischer Vorst��dte, speziell jene, die in den 60er und 70er Jahren einen enormen Wohnquartierboom erfahren haben. Genau diese haben heute viel an Lebensqualit��t verloren. Ein st��dtebaulicher Entwurf am Beispiel San Giuliano Milanese, einem Vorort etwa 11 km s��d��stlich von Mailand, der durch mangelnde st��dtebauliche Strukturen und Sozialr��ume noch nicht zu seiner Identit��t gefunden hat, wird ausgearbeitet. Eine umfangreiche Analyse der Funktionen und Gestaltungsqualit��ten wird vorgenommen und nach Potentialen und M��ngeln qualifizierend geordnet. M��glicherweise entsteht ein Tool, das durchaus in anderen europ��ischen Vorst��dten angewendet werden kann., Starting point of this thesis is the discourse of architect and senator for life Renzo Piano, who speaks about the necessity of patchwork in peripheries - "il rammendo delle periferie". "It requires financial investments and urban planning ideas to revitalize these places, because they are where life takes place, where the engines of the cities work!" The thesis takes a closer look at the revitalization of northern Italian suburbs, especially those which have experienced an enormous boom of housing estates during the 60ies and 70ies. Today, exactly those places have lost quality of life. An urban planning project will be developed for San Giuliano Milanese - a suburb about 11 km south-east from Milan, which has not yet found its identity due to lack of urban and social structures. A wide analysis of functions and design qualities will be carried out and sorted according to their potentials and shortcomings. The development of a tool which can be used on other European peripheries, is possible.

BACKGROUND: Long-QT syndrome is an inherited cardiac channelopathy characterized by delayed repolarization, risk of life-threatening arrhythmia, and significant clinical variability even within families. Three single-nucleotide polymorphisms (SNPs) in the 3' untranslated region of KCNQ1 were recently suggested to be associated with suppressed gene expression and hence decreased disease severity when located on the same haplotype with a disease-causing KCNQ1 mutation. We sought to replicate this finding in a larger and a genetically more homogeneous population of KCNQ1 mutation carriers. METHODS AND RESULTS: The 3 SNPs (rs2519184, rs8234, and rs10798) were genotyped in a total of 747 KCNQ1 mutation carriers with A341V, G589D, or IVS7-2A>G mutation. The SNP haplotypes were assigned based on family trees. The SNP allele frequencies and clinical severity differed between the 3 mutation groups. The different SNP haplotypes were neither associated with heart rate-corrected QT interval duration (QTc) nor cardiac events in any of the 3 mutation groups. When the mutation groups were combined, the derived SNP haplotype of rs8234 and rs10798 located on the same haplotype with the mutation was associated with a shorter QTc interval (P

RWTH-Themen 2015(1), 22-26(2015). special issue: "Energy, chemical & process engineering / Redaktion: Angelika Hamacher, Melanie Kaesler", Published by RWTH, Aachen

eingereicht von Valentina Anelli-Monti Graz, Univ., Dipl.-Arb., 2010

Die arterielle Hypertonie sowie deren Folgeerkrankungen stellen unverändert eine der wichtigsten Morbiditäts- und Mortalitätsursachen in den entwickelten Industrieländern dar. Eine Reihe von Studien konnte einen erheblichen Einfluss genetischer Faktoren auf Entstehung und Verlauf dieser Erkankungen belegen – dennoch sind die genauen genetischen und molekularen Determinanten von Hypertonie und Herzinsuffizienz nach wie vor weitgehend unbekannt. Eine Analyse dieser Determinanten im Menschen ist jedoch aufgrund der Komplexität der Erkankungen und der vielfältigen genetischen- und Umwelt-Interaktionen schwierig. Daher wurden in den vorliegenden Arbeiten zu einem grossen Teil ingezüchtete Tiermodelle genutzt, die eine reduktionistische Betrachtungsweise solch komplexer Phänotypen ermöglichen. Einerseits fehlt diesen Tierstämmen die genetische Heterogenität, andererseits lassen sich durch die Kontrolle der Umweltbedingungen exogene Determinanten und deren vielschichtige Interaktionen untereinander minimieren. In den hier vorgestellten Studien wurden experimentelle genetische Strategien in Ratte und Maus mit genomweiten Expressionsuntersuchungen kombiniert, um zunächst genomische Regionen und in weiteren Experimenten einelne Kandidatengene zu identifizieren, die kausal an der Entstehung der o.g. Erkrankungen mitwirken. Paradigmatisch gelang dies bei der Identifizierung der löslichen Epoxidhydrolase als wichtiges Krankheitsgen bei der Entstehung der Hypertonie-assoziierten Herzinsuffizienz. Dabei wurde unter Nutzung von Sequenz- und Kartierungsressourcen zunächst im Rattenmodell eine krankheitsrelevante genomische Region identifiziert, aus der im zweiten Schritt ein Kandidatengen extrahiert und im entsprechenden Mausmodell validiert wurde. Die hier vorgestellten humanen Daten legen zudem eine Bedeutung dieses Gens auch für die Entstehung der Herzinsuffizienz im Menschen nahe. Die Validierung der im Ratten- und Mausmodell identifizierten Krankheitsgene für die Krankheitsentstehung im Menschen bleibt jedoch auch weiterhin wichtige Zielstellung für zukünftig geplante Studien. Dabei sind sowohl Fortschritte für die individuelle genetische Risikostratifizierung als auch neue Ansatzpunkte für therapeutische Interventionen zu erwarten., Arterial hypertension and associated end organ damage are major causes of morbidity and mortality in industrialized countries. Many studies have demonstrated a major impact of genetic factors on the pathogenesis of these diseases, however, the genetic and finally molecular susceptibilty factors for arterial hypertension and heart failure are largely unknown. Analysis of genetic determinants of these diseases in human is difficult due to the complex interaction of genetic and environmental factors that are involved in disease initiation. Therefor, in this present work we have analyzed inbred animal models. This strategy has enabled us to reduce complexity of cardiovascular disesases by excluding genetic background effects and by controlling confounding environmental factors. In the present studie we have combined experimental genetic strategies in rat and mouse with genome wide expression analyses leading to the identification of quantitative trait loci and finally single genes underlying complex cardiovascular diseases. Using this strategy we have identified soluble epoxide hydrolase as an important susceptibilty gene for hypertension-associated heart failure. Using sequence and mapping information we have identified a quantitative trait locus in the hypertensive rat model, followed by analysis of candidate genes and functional validation of a suspected disease gene in a mouse model. In addidation, we have analyzed human biopsies suggesting a role for soluble epoxide hydrolase also in the causation of human disease. The further validation of disease susceptibility genes generated by using mouse and rat models remaines a major focus for future investigations. Thus, we expect to open new avenues for risc stratification and therapeutic interventions in human cardiovascular disease.

The perioperative risk for patients with pacemakers or implanted cardioverter/defibrillators (ICD) is mainly dependent on the underlying disease. However, severe to life-threatening complications of the implanted system can occur due to electromagnetic interference in the environment of the operation. These complications can be prevented or adequately treated by taking special precautions and measures. Even though the currently available data on the optimal perioperative management to pacemakers and ICDs is still unsatisfactory, the increasing clinical relevance of this topic was the reason for the formulation of recommendations by an interdisciplinary working group in Austria.

The grounds for liability with robotic surgery include damage to patients, causality, illegality and guilt. The patient must receive very comprehensive information on the treatment under consideration, his/her risk and what will be done in the case of technical failure. The surgeon operating the robotic device is obliged to provide normal conscientious care and state-of-the-art treatment. In addition, there is possible neglect of supervisory duties vis-à-vis other hospital personnel to be considered. A special problem is posed by a forensic physician who lacks experience in robotic surgery. There should be a surgeon at the operating table who is at least equally skilled as the surgeon operating the monitor. Robotic surgery must ultimately be at least as effective as conventional surgery, if not better. It must, however, be borne in mind that in cases involving this new technology, it is that patient who is the pioneer.

From 1990 to 1999, 2,853 ventricular and 1,084 atrial bipolar leads of various manufacturers (Medtronic, Biotronik, Vitatron, Ela, Pacesetter and Stöckert) were implanted during first implantations of pacemakers at the University of Graz, Dept. of Cardiac Surgery. Surgical complications with the need of reintervention were analyzed during a follow up period of up to 10 years. The overall lead-related complication rate for ventricular bipolar leads was 6.5% (187 of 2,853) and 5.3% (58 of 1,084) for atrial bipolar leads. Early complications within the first month were higher in the atrium (5.3% versus 2.2% in the ventricle), primarily due to dislocation, late complications were higher in the ventricle (4.3% versus 2% in the atrium) due to insulation problems and lead fracture. Insulation material had a marked influence with a higher failure rate in some leads with polyurethane insulation compared with silicone. Therefore we recommend a close follow-up of bipolar polyurethane leads by measurement of chronic impedance in order to assess insulation problems as early as possible.

This review article summarizes the long-term standard therapy for patients with myocardial infarction. The chronic therapy is able to significantly improve quality of life and survival of affected patients. Previous studies showed that in most western countries, the established standard therapy is not given to all patients who would benefit from chronic treatment. The essential parts of today's myocardial infarction treatment consists of effective beta-blockade, inhibition of the angiotensin-conversion enzyme, inhibition of platelet aggregation and lipid lowering agents. This article reviews the clinical benefits which may be expected from each of these therapeutic approaches. Newer, but not yet proven strategies, like blockade of the angiotensin receptor subtype 1 and treatment with antioxidative agents will be discussed.

Transmitral flow velocity profiles by Doppler echocardiography are strongly related to left ventricular diastolic properties. The aim of this study was to address the assessment of left ventricular filling pressures by transmitral flow velocity curves in patients with impaired systolic function. 90 patients (23 female, 67 men, age 60.0 +/- 9,9 a) with an ejection fractionor = 45% either due to coronary artery disease (n = 67) or dilated cardiomyopathy (n = 23) were investigated by Doppler echocardiography prior to left heart catheterization. Early diastolic deceleration time (DT) and ratio of early to late diastolic peak velocities (VE/VA) were measured. Both, DT and VE/VA showed a significant correlation to left ventricular enddiastolic pressures (r = -0.79 respectively r = 0.73, p0.001 for all). According to DT three different transmitral flow patterns were identified. All patients with restrictive filling patterns (DT160) had elevated left ventricular filling pressures, whereas impaired relaxation (DT210) was a strong predictor of normal filling pressures. In patients with pseudonormal transmitral flow patterns (DT 160 to 210) filling pressures could not be predicted. Furthermore DT was strongly related to clinical signs of left heart failure. Doppler echocardiography gives useful additional information on left ventricular filling pressures in patients with systolic dysfunction.

Changes in left ventricular (LV) diastolic function lead to characteristic changes in the transmitral flow profile as determined by Doppler echocardiography (DEC). Although DEC cannot provide direct quantitative measurement of LV filling pressures and is influenced by several factors, transmitral flow correlates well with LV haemodynamics. In this prospective study the results of transthoracic DEC were compared with haemodynamic parameters in patients with coronary heart disease (CHD) and their clinical value assessed.254 consecutive patients with CHD (67 women, 187 men, aged 62.5 +/- 8.5 years) underwent transthoracic DEC. The ratio of early to late diastolic velocity (VE/VA) and early diastolic deceleration time (DT) of the transmitral flow were measured as an indication of diastolic LV function.Patients with reduced LV compliance and increased filling pressure (LV end-diastolic pressure [LVEDP]15 mm hg) had a restrictive transmitral flow profile with a significantly higher than normal VE/VA and a shorter DT (1.35 +/- 0.84 vs. 0.86 +/- 0.26, P0.001; and 158 +/- 45 vs. 213 +/- 35, P0.001, respectively). VE/VA and DT also significantly correlated with LVEDP (r = 0.65, P0.001 and r = -0.60, P0.001 respectively). Sensitivity and specificity of an LVEDP of15 mm Hg were 67% and 84%, respectively, for a VE/VA of more than 1, and 65% and 91% for a DT of less than 170. The combination of the two parameters increased specificity to 97%.Determining the transmitral flow profile makes it possible noninvasively to obtain an indication of LV end-diastolic function. Patients with severe diastolic dysfunction and increased filling pressures are recognized with a high degree of specificity.

The original Fontan operation was employed for patients with tricuspid atresia, but its application has been extended to a broad spectrum of congenital cardiac defects with a functional or anatomical single ventricle. From 1989 to 1995, 35 patients (23 males, 12 females) underwent a modified Fontan procedure; their age ranged from 14 months to 15 years (mean 5.1 a). Indications for operation were the following: D(S)ILV = 16, TA = 9, MA = 3, TGA with straddling AV-valve = 2, DORV = 4 and criss-cross heart = 1. The same surgical technique was utilized in all patients with redirection of the systemic venous return by means of a bidirectional cavopulmonary anastomosis and an intraatrial baffle, adaptable to all the various forms of underlying anatomy. Associated anomalies such as dextrocardia, coarctation, anomalous systemic or pulmonary venous return, subaortic stenosis and situs anomalies were present in 26%, 9%, 26%, 9%, and 20%, respectively. 12 patients were presumed to be at high risk and underwent a two-stage procedure (n = 7 bidirectional Glenn preceding the definitive repair and n = 5 a fenestration of the intraatrial baffle). Risk factors in our group of patients were: age under 2 years, abnormal systemic venous drainage, stenotic pulmonary arteries, PVR over 2 Wood units, mPAP over 15 mmHg, AV-valve incompetence, subaortic obstruction and ventricular dysfunction. Two patients had failure of the total cavo-pulmonary connection necessitating the take-down to a bidirectional Glenn anastomosis in the early postoperative period, with one death. Hospital mortality was 24% (n = 8). One child did not survive complications following the fenestration closure 4 months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

The extent of right heart strain determines the prognosis of chronic lung disease. The value of a simple semiquantitative echocardiographic grading system for cor pulmonale was assessed in 69 patients (24 females, 45 males, age 61 +/- 12 years, ranging from 28-82 years) suffering from chronic lung disease. The patients were classified by echocardiography into four groups, Grade 0 consisting of those without evidence of right heart strain and three groups showing increasing severity of change (Grade I: right ventricular hypertrophy; Grade II: I + right ventricular dilation; Grade III: II + Dilation of the inferior vena cava). Echocardiographic investigation, at least from the subcostal view, and grading was possible in all patients. A correlation was found between the echocardiographic grading and the mean pulmonary artery pressure (PAP)-normal echo study 15.7 +/- 4.8; grade I 21.1 +/- 5.6; grade II 28.8 +/- 10.2; grade III 39.4 +/- 9.4 mmHg. In addition, patients with stress-induced pulmonary hypertension (PHT) were detected by Doppler echocardiography. 6 of 11 patients with latent PHT already showed evidence of cor pulmonale (4 Grade I and 2 Grade II). In 42 patients (61%) the systolic PAP was estimated by measuring the velocity of the tricuspid insufficiency jet with Doppler, and these data correlated closely with the invasive data (p0.001; r = 0.81). Doppler echocardiography for evaluation of cor pulmonale is feasible even in patients with chronic lung disease and limited acoustic windows. Semiquantitative grading correlates well with invasive data. Here, this technique is useful as a baseline study as well as for the follow-up of patients with chronic lung disease.