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Low back pain during pregnancy caused by a sacral stress fracture: a case report
Miguel Pishnamaz, Richard Sellei, Roman Pfeifer, Philipp Lichte, Hans C Pape, Philipp Kobbe
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-98
Abstract: We report the case of a 26-year-old Caucasian European primigravid patient (30 weeks and two days of gestation) who presented to our outpatient clinic with severe low back pain that had started after a downhill walk 14 days previously. She had no history of trauma. A magnetic resonance imaging scan revealed a non-displaced stress fracture of the right lateral mass of her sacrum. Following her decision to opt for non-operative treatment, our patient received an epidural catheter for pain control. The remaining course of her pregnancy was uneventful and our patient gave birth to a healthy child by normal vaginal delivery.We conclude that a sacral stress fracture must be considered as a possible cause of low back pain during pregnancy.Although sacral stress fractures are uncommon, they are a well-known cause of low back pain, especially in athletes [1-5]. The underlying pathology of stress fractures is either a weakened bone or an unusually high load that normal bone is unable to withstand [6]. The latter has been cited by several authors as the cause of postpartum sacral fractures occurring during the course of childbirth [7-10]. Usually, the fracture is diagnosed by magnetic resonance imaging (MRI), which shows a vertical fracture line with surrounding osseous edema. This fracture is particularly challenging during pregnancy since adequate analgesic control is complicated by drug interactions with the fetus, as well as the continued load imposing stress on the sacrum over the course of the pregnancy. To the best of our knowledge, this case is the first report of an intrapartum sacral stress fracture and outlines the difficulties and limitations of pain control in these patients.A 26-year-old Caucasian European primigravid patient (30 weeks plus two days of gestation) was transferred from a local area hospital with severe low back pain. She first experienced slight discomfort over her bilateral iliosacral joints while walking downhill 14 days previously. She reported
A civilian perspective on ballistic trauma and gunshot injuries
Philipp Lichte, Reiner Oberbeck, Marcel Binneb?sel, Rene Wildenauer, Hans-Christoph Pape, Philipp Kobbe
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-35
Abstract: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed.Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference.The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.In contrast to a stagnating incidence of civilian gunshot wounds in the United States, gunshot violence shows different trends in European countries. Firearm associated crime was increasing up to 30% in the UK between 1998 and 2002 [1]. In the same period firearm associated crime in Germany was markedly decreasing. In 2007 in Germany only 4558 criminal acts with the use of firearms were registered [2]. Additionally, in high income countries a significant number of gunshot wounds are related to suicide attempts [3]. As seen in the United States, gunshot violence has bes
Inhalative IL-10 Attenuates Pulmonary Inflammation following Hemorrhagic Shock without Major Alterations of the Systemic Inflammatory Response
Philipp Kobbe,Philipp Lichte,Helen Schreiber,Lucy Kathleen Reiss,Stefan Uhlig,Hans-Christoph Pape,Roman Pfeifer
Mediators of Inflammation , 2012, DOI: 10.1155/2012/512974
Abstract: Several studies report immunomodulatory effects of endogenous IL-10 after trauma. The present study investigates the effect of inhalative IL-10 administration on systemic and pulmonary inflammation in hemorrhagic shock. Male C57/BL6 mice (8 animals per group) were subjected to pressure-controlled hemorrhagic shock for 1.5 hrs followed by resuscitation and inhalative administration of either 50 μL PBS (Shock group) or 50 μg/kg recombinant mouse IL-10 dissolved in 50 μL PBS (Shock
IL-6 predicts organ dysfunction and mortality in patients with multiple injuries
Michael Frink, Martijn van Griensven, Philipp Kobbe, Thomas Brin, Christian Zeckey, Bernhard Vaske, Christian Krettek, Frank Hildebrand
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2009, DOI: 10.1186/1757-7241-17-49
Abstract: A total of 143 patients with an injury severity score ≥ 16, between 16 and 65 years, admitted to the Hannover Medical School Level 1 Trauma Center between January 1997 and December 2001 were prospectively included in this study. Marshall Score for MODS was calculated for at least 14 days and plasma levels of TNF-α, IL-1β, IL-6, IL-8 and IL-10 were measured. To determine the association between cytokine levels and development of MODS the Spearman rank correlation coefficient was calculated and logistic regression and analysis were performed.Patients with MODS had increased plasma levels of IL-6, IL-8 and IL-10. IL-6 predicted development of MODS with an overall accuracy of 84.7% (specificity: 98.3%, sensitivity: 16.7%). The threshold value for development of MODS was 761.7 pg/ml and 2176.0 pg/ml for mortality during the in patient time.We conclude that plasma IL-6 levels predict mortality and that they are a useful tool to identify patients who are at risk for development of MODS.During the last decades, improvement of therapeutic concepts has decreased trauma related fatalities [1]. Organ dysfunction is still a frequent and severe complication during clinical course and the most common cause for late fatalities following major trauma. Although the survival rate of patients with multiple injuries improved during the last decades the frequency of development of organ dysfunction has not changed [2,3]. The mortality of patients developing multiple organ dysfunction syndrome (MODS) following severe injuries is still 50% [4-6]. For adequate treatment, it would be desirable to identify patients with a high risk for posttraumatic complications in the early clinical course. The evaluation of clinical state and prognosis still remains one of the greatest challenges during treatment of patients suffering from multiple injuries. Many clinical parameters such as blood pressure, pH or heart rate failed to assess the posttraumatic situation [7].Several clinical studies have demon
Multiplicity of Plasmodium falciparum infection following intermittent preventive treatment in infants
Ulrike Buchholz, Robin Kobbe, Ina Danquah, Philipp Zanger, Klaus Reither, Harry H Abruquah, Martin P Grobusch, Peter Ziniel, Jürgen May, Frank P Mockenhaupt
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-244
Abstract: Plasmodium falciparum isolates were obtained from children participating in two Ghanaian IPTi-SP trials (Tamale, Afigya Sekyere) at 15 months of age, i.e., six months after they had received the second dose of IPTi-SP or placebo. By typing the polymorphic merozoite surface protein 1 (msp1) and msp2 genes, multiplicity of infection (MOI) was assessed in 389 isolates. A total of additional 133 samples were collected in Tamale at 3, 6, 9, and 12 months of age. Comparisons of MOI between groups were done by non-parametric statistical tests.The number of distinguishable P. falciparum clones (MOI) ranged between one and six. Mean MOI in Tamale was stable at 2.13 - 2.17 during the first year of life, and increased to 2.57 at age 15 months (P = 0.01). At no age did MOI differ between the IPTi-SP and placebo groups (each, P ≥ 0.5). At 15 months of age, i.e., six months after the second dose, MOI was very similar for children who had received IPTi or placebo (means, 2.25 vs. 2.33; P = 0.55) as was the proportion of polyclonal infections (69.6% vs. 69.7%; P = 0.99). Adjusting for study site, current and prior malaria, parasite density, and season did not change this finding.IPTi-SP appears to have no impact on the multiplicity of infection during infancy and thereafter. This suggests that tolerance of multiple infections, a component of protective immunity in highly endemic areas, is not affected by this intervention.Efficient and safe means of controlling falciparum malaria in endemic areas are urgently needed to reduce its intolerable high burden, particularly in young children. Reducing parasite exposure, however, may compromise the acquisition of protective immunity, as has been debated with respect to vector control and was observed following chemoprophylaxis [1-3].Multiplicity of infection (MOI) denotes the number of distinguishable Plasmodium falciparum clones per isolate. Commonly, MOI is assessed by using the polymorphic regions of P. falciparum merozoite surface prot
A randomized trial on effectiveness of artemether-lumefantrine versus artesunate plus amodiaquine for unsupervised treatment of uncomplicated Plasmodium falciparum malaria in Ghanaian children
Robin Kobbe, Philipp Klein, Samuel Adjei, Solomon Amemasor, William Thompson, Hanna Heidemann, Maja V Nielsen, Julia Vohwinkel, Benedikt Hogan, Benno Kreuels, Martina Bührlen, Wibke Loag, Daniel Ansong, Jürgen May
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-261
Abstract: A randomized open-label trial was conducted at two district hospitals in the Ashanti region, Ghana, an area of intense malaria transmission. A total of 246 children under five years of age were randomly assigned to either ASAQ (Arsucam?) or AL (Coartem?). Study participants received their first weight-adjusted dose under supervision. After the parent/guardian was advised of times and mode of administration the respective three-day treatment course was completed unobserved at home. Follow-up visits were performed on days 3, 7, 14 and 28 to evaluate clinical and parasitological outcomes, adverse events, and haematological recovery. Length polymorphisms of variable regions of msp1 and msp2 were determined to differentiate recrudescences from reinfections. Acceptance levels of both treatment regimens were assessed by means of standardized interviews.Adequate clinical and parasitological responses after AL and ASAQ treatment were similar (88.3% and 91.7%, respectively). Interestingly, more late clinical failures until day 28 occurred in AL-treated children than in those who received ASAQ (17.5% and 7.3%, respectively; Hazard Ratio 2.41, 95% CI 1.00–5.79, p < 0.05).Haematological recovery and drug tolerability were not found to be significantly different in both study arms. The acceptance of treatment with ASAQ was higher than that with AL (rank-scores 10.6 and 10.3, respectively; p < 0.05).Unobserved AL and ASAQ treatment showed high adequate clinical and parasitological responses, though AL was inferior in preventing late clinical failures.Artemisinin-based combination therapy (ACT) is advocated as the way forward in antimalarial treatment to overcome the global spread of Plasmodium falciparum drug resistance [1]. ACT rapidly diminishes parasite biomass leading to clinical and parasitological cure while at the same time gametocytocidal activity might be able to reduce overall malaria transmission [2]. Initially, efficacy and safety of ACT had been evaluated in Southeast
Information Theory Model for Radiation  [PDF]
Philipp Kornreich
Journal of Applied Mathematics and Physics (JAMP) , 2016, DOI: 10.4236/jamp.2016.48171
Abstract: Information based models for radiation emitted by a Black Body which passes through a scattering medium are analyzed. In the limit, when there is no scattering this model reverts to the Black Body Radiation Law. The advantage of this mathematical model is that it includes the effect of the scattering of the radiation between source and detector. In the case when the exact form of the scattering mechanism is not known a model using a single scattering parameter is derived. A simple version of this model is derived which is useful for analyzing large data.
The Contribution of the Gravitational Propagation Delay to Orbital and Center of Mass Motions  [PDF]
Philipp Kornreich
Journal of Modern Physics (JMP) , 2016, DOI: 10.4236/jmp.2016.714169
Abstract: Recent measurements have shown that gravitational waves and thus the gravitational interaction propagate with the speed of light. The propagation delay of the gravitational interaction in orbiting systems couples the orbital and center of mass motions. This causes the orbits to spiral out and the center of mass to accelerate. It is one of a number of small effects modifying the Kepler orbits. The calculations show that the analytical describable expansion of the semimajor axis started at a time that is less than the age of the systems. This could be caused by a collision of a system component in the past. The effect of this propagation delay on the motion of the Earth Moon and the Brown Dwarf 569Bab binary star system is analyzed. These systems were chosen because a considerable amount of measured astronomical data is available. The calculated results are in excellent agreement with the measured data. In galaxies, too, the energy transfer from the orbit of the star cloud to the center of mass motion causes the galaxies to ac-celerate. If galaxies are considered to be molecules of the universe, then the acceleration of the galaxies will cause the molecular gas to heat and expand. Alternatively, the loss in orbital internal energy of the galaxies should be included in the mass and energy in the calculation of the expanding Universe.
Reaction Mechanics for Point Objects  [PDF]
Philipp Kornreich
Journal of Applied Mathematics and Physics (JAMP) , 2017, DOI: 10.4236/jamp.2017.51015
Abstract: The least action principle is used to derive a general mathematical model of the motion of point objects subject to non-instantaneous interactions. A Lagrangian Equation of Motion, a Hamiltonian Formalism, a Poisson Bracket and the Relation of Reaction Mechanics and the General Theory of Relativity are derived here. In the limit of no delay, the equation of motion reverts to Newtonian Mechanics. In the limit of infinitesimal delay, the equation of motion takes the form of the Geodesic Equation of Motion of the General Theory of Relativity. For two objects, the single instantaneous interaction splits into two interactions when the propagation delay is considered. Object ONE experiences the following interactions at the present: it senses an interaction radiated by object TWO in the past. It also radiates an interaction that other objects might or might not sense in the future. It experiences a Recoil interaction equal in magnitude and opposed to the direction of the interaction it radiated. The Recoil interaction is independent of the radiated interaction reaching its target or not reaching its target. The Recoil interaction is causal.
Energy Conservation and Gravitational Wavelength Effect of the Gravitational Propagation Delay Analysis  [PDF]
Philipp Kornreich
Journal of Applied Mathematics and Physics (JAMP) , 2017, DOI: 10.4236/jamp.2017.54080
Abstract: The motion of objects where the interaction propagated with a finite velocity was analyzed in my previous paper “The Contribution of the Gravitational Propagation Delay to Orbital and Center of Mass Motions”. It is shown here that this analysis is valid for the case when the wavelength of the gravitational wave excited by the motion of the masses is much larger than the system of masses. It is also proven here that the conclusion reached in my previous paper conserves energy. Since this interaction is conservative, the energy is equal to the Hamiltonian. Therefore, the Hamiltonian is calculated and it is shown that the time derivative of the Hamiltonian is equal to zero. Thus, the Hamiltonian and therefore, the energy, are constants.
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