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Biomedical subjects

A Berger

Publications and source records attributed to A Berger.

At least 127 records · Page 7Linked to original sources
PubMed2000

Preterm infants with low immunoglobulin G levels have increased risk of neonatal sepsis but do not benefit from prophylactic immunoglobulin G.

OBJECTIVE: In a prospective, randomized, placebo-controlled, multicenter study, we evaluated the prevention of neonatal infections with intravenous immunoglobulin G (IVIgG) prophylaxis for preterm infants (gestational age <33 weeks) with umbilical cord blood IgG levels < or =4 g/L. STUDY DESIGN: Intravenous IgG or placebo (albumin), 1 g/kg body weight, was given on days 0, 3, 7, 14, and 21 to 81 infants with umbilical cord blood IgG levels < or =4 g/L: (1) IVIgG group, n = 40, mean (SD) gestational age 27.5 (2.2) weeks and birth weight 1.06 (0.39) kg; (2) placebo group, n = 41, mean (SD) gestational age 27.7 (2.5) weeks and birth weight 1.13 (0.38) kg. Infants with umbilical cord blood IgG levels >4 g/L (n = 238) served as a separate comparison group. Neonatal infections according to European Society of Pediatric Infectious Disease criteria were monitored until 28 days of life. RESULTS: Infants with IgG levels < or =4 g/L at birth who received IVIgG had no significant reduction in infectious episodes or mortality rate when compared with those given placebo. However, infants with a serum concentration of IgG >4 g/L at birth had significantly fewer infectious episodes (culture-proven sepsis) than infants with low serum concentrations of IgG (< or =4 g/L) when compared at the same gestational ages (26 to 29 weeks, P <.003). CONCLUSIONS: Prophylactic immunotherapy with IVIgG did not improve the immune competence in preterm infants with low serum IgG concentrations at birth. We speculate that a spontaneously high serum IgG concentration at birth reflects placenta function and is an indicator of a more mature immune system capable of protecting the preterm infant against severe neonatal infections.

Cross Infection↗
PubMed2000

Free flap to the arteria peronea magna for lower limb salvage.

A 36-year-old woman sustained an amputation of her right leg at the thigh level and a degloving injury of her left foot and ankle region in an accident during a suicide attempt. Primarily, her left foot was covered with a split skin graft, resulting in a soft-tissue defect at the medial malleolus and at the calcaneus bone. Reconstruction was planned with a free latissimus dorsi muscle flap. Preoperative examinations revealed an arteria peronea magna with a hyperplastic peroneal artery solely providing arterial blood supply to the foot. The arteria peronea magna divided into two branches proximal to the upper ankle joint, replacing the dorsal pedis artery and the medial plantar artery. Tibial posterior and tibial anterior arteries were hypoplastic-aplastic. Microvascular end-to-end anastomoses of the flap vessels to the medial branch ("medial plantar artery") of the arteria peronea magna and its concomitant vein at the medial malleolar bone level were successfully performed. The postoperative course was uneventful. Four weeks postoperatively, the patient started walking assisted by a prosthesis on her right thigh stump. This experience demonstrates that even in a case of arteria peronea magna, free flap surgery for lower limb salvage is a reliable and worthwhile method.

Adult↗
PubMed2000

Forefoot reconstruction by reversed island flaps in diabetic patients.

Soft-tissue coverage of the foot is often difficult, especially when the distal third of the foot (dorsal or plantar aspects) is involved. The clinical situation can be further complicated when diabetic patients are affected by painful and unstable wounds of this kind because of the familiar phenomenon of vasculopathy. The purpose of this study was to evaluate the possibility of using distally based foot flaps to cover forefoot defects in diabetic patients. Preoperative selection of patients was the key to this study; those who had other major disease, chronic infection, bone involvement, and/or insufficient foot vascularization were excluded from the study. The authors report a series of 12 diabetic patients in whom the reconstruction of medium-sized defects (ranging from 1.5 x 2.0 cm to 3.0 x 7.0 cm) of the forefoot was performed using distally based dorsalis pedis flaps or medial plantar flaps. The transferred flaps survived and adapted well to the defects, except for one flap in a patient who had a slight venous insufficiency at outset. Wearing their own footwear, patients could walk after 20 to 30 days. After the follow-up period (3 months to 3 years), no skin breakdown in the treated areas was observed. Temporary donor-site pain was reported by medial plantar flap patients, and partial skin graft loss at the donor site occurred in some of the dorsalis pedis patients. The authors suggest that in selected cases, medium-sized soft-tissue defects involving the dorsal aspects or the weight-bearing areas of the diabetic foot can be successfully covered with distally based island flaps.

Aged↗
PubMed2000

Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialysis.

OBJECTIVE: The aim of this study was to identify factors associated with severe outcome in patients with ischemic colitis. METHODS: The files of 60 consecutive inpatients (34 women, 26 men, mean age 67 yr) with ischemic colitis were reviewed. The following data were analyzed: age, sex, smoking, medications, history of cardiovascular disease, metabolic disease, chronic renal failure and hemodialysis, the time elapsed between the first symptoms and the diagnosis, and the site and extension of their colonic involvement. Patients were divided into two groups according to outcome: those with severe disease, including those who died from ischemic colitis (n = 3) or who required surgical resection (n = 21); and those with mild forms of colitis who were treated successfully without surgery (n = 36). The two groups were compared by means of univariate and multivariate analysis to identify factors associated with unfavorable outcomes. Only patients who had a complete examination of the colon (n = 51) were entered into the statistical analysis. RESULTS: By univariate analysis, chronic renal failure (p = 0.03), hemodialysis (p = 0.01), short delay between symptoms and diagnosis (p = 0.01), and right colonic involvement (p = 0.002) were significantly more common in the patients with severe colitis. By logistic regression, right colonic involvement was the only factor independently associated with severity (p = 0.01). Right-sided lesions were present in 82% of patients on dialysis but in only 26% of patients not on dialysis (p = 0.0005). CONCLUSIONS: Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialysis.

Adult↗
PubMed2000

Metastatic jejunal VIPoma: beneficial effect of combination therapy with interferon-alpha and 5-fluorouracil.

The VIPoma syndrome is rare. It is usually caused by a neuroendocrine tumor located in the pancreas. Somatostatin analogs and interferon-a can be helpful in the symptomatic control of the disease, but the efficacy of chemotherapy in metastatic disease is limited. We report the case of a 32-yr-old patient who had a primary intestinal VIPoma with peritoneal carcinomatosis and hepatic metastases. Somatostatin analogs and conventional chemotherapy regimens were not effective on VIPoma syndrome and tumor progression. The combination of 5- fluorouracil and interferon-alpha was associated with a major clinical improvement and tumor regression. Further investigations should evaluate the place of such a combination as a first line treatment for patients with metastatic neuroendocrine tumors.

Adult↗
PubMed2000

Detection of Herpes simplex virus DNA by real-time PCR.

Molecular detection of herpes simplex virus (HSV) DNA is recognized as the reference standard assay method for the sensitive and specific diagnosis of central nervous system infections caused by HSV. In this study, a molecular assay based on real-time PCR on the LightCycler (LC) instrument was evaluated and compared with a home-brew molecular assay. The detection limit of the LC assay was determined with 10-fold dilutions of plasmid pS4 with the SalI restriction fragment of the DNA polymerase gene and with the First European Union Concerted Action HSV Proficiency Panel. A total of 59 cerebrospinal fluid (CSF) specimens were investigated for the comparative study. With plasmid pS4, the detection limit of the LC assay was found to be 10(4) copies per ml, i.e., 12.5 copies per run. When samples of the First European Union Concerted Action HSV Proficiency Panel were tested, 2x10(3) to 5x10(3) HSV type 1 genome equivalents (GE) per ml, i.e., 2.5 to 6.3 GE per run, could consistently be detected. There was a correlation between the LC assay and the home-brew assay in 55 of 59 specimens. In conclusion, the LC assay allows very rapid detection of HSV DNA in CSF. It was found to be laborsaving and showed sufficient sensitivity.

Adult↗
PubMed2000

Severity of HCV-induced liver damage alters glucose homeostasis in noncirrhotic patients with chronic HCV infection.

BACKGROUND/AIMS: To investigate the link between hepatitis C infection and glucose intolerance, we measured insulin sensitivity, glucose effectiveness and beta-cell secretion in noncirrhotic HCV-infected patients with normal glucose tolerance according to WHO criteria as assessed by oral glucose tolerance tests. METHODS: Glucose, insulin and C-peptide data from frequently sampled intravenous glucose tolerance tests were analyzed using the minimal modeling technique for glucose and C-peptide to determine insulin sensitivity, glucose effectiveness, first and second phase insulin secretion in noncirrhotic HCV-infected patients (n = 10) and in healthy control subjects (n = 10). Histological activity index (HAI) as well as the extent of fibrosis were evaluated by scoring liver biopsies. RESULTS: Insulin sensitivity (2.72 +/- 1.63 vs. 6.84 +/- 1. 20 10(-4) min(-1) per microU/ml, p < 0.01) and glucose effectiveness (2.29 +/- 0.45 vs. 2.89 +/- 0.39 10(-2) min(-1), p < 0.05) ere significantly lower in patients with HCV-induced liver disease. Insulin sensitivity was negatively related to serum alanine aminotransferase (r = -0.47, p < 0.05) and aspartate aminotransferase concentrations (r = -0.65, p < 0.05). Multiple linear regression analysis revealed a strong relation of insulin sensitivity with fibrosis score and HAI (r = -0.82, p < 0.02 for both). Second phase insulin secretion was significantly enhanced in HCV-infected patients (14.30 +/- 2.04 vs. 8.29 +/- 1.65 min(-1), p < 0.05). CONCLUSIONS: HCV-infected patients with normal glucose tolerance are insulin and glucose resistant. The impairment of glucose tolerance appears to be closely related with the severity of HCV-induced liver damage.

Adult↗
PubMed2000

High frequency of HCV infection in individuals with isolated antibody to hepatitis B core antigen.

Although isolated antibody to hepatitis B core antigen (anti-HBc) is frequently nonspecific or may be the only serological marker of past self-limiting hepatitis B, where antibodies against the surface antigen have disappeared, isolated anti-HBc seropositivity is frequently associated with chronic hepatitis B in HIV- and HCV-infected individuals. Of 5,520 samples that tested positive for anti-HBc (IMx and AxSYM CORE, Abbott, Delkenheim, Germany) at the Institute of Virology, University Clinic Frankfurt during the time interval from January 1994 to February 1996, 643 (11.6%) were isolated anti-HBc-reactive in the IMx and AxSYM CORE assays (inhibition values >90%). There was a statistically significant association between isolated anti-HBc seropositivity and HCV and HIV/HCV coinfection (p < 0.05). A total of 190 samples were available for further testing. Six (3.2%) of 190 isolated anti-HBc-positive samples were considered false-positive since they were only positive in the AxSYM or IMx CORE assay and a linear decrease of the measured signal could not be observed in dilution series. Of 184 serum samples tested with nested PCR using primers of the S genome region, only 6 (3.3%) were HBV DNA-positive. Anti-HBc-IgM antibody could be detected in 3 (1.6 %) of the tested samples using the IMx CORE-M. With the more sensitive VIDAS HBc IgM specific IgM antibody was detected in 15 (8.5%) of 177 samples at concentrations ranging from 10 to >200 Paul Ehrlich Institute U/ml. HIV or HCV coinfection was present in 28.1% and 37.5% of isolated anti-HBc-positive individuals, respectively. We conclude from our observations that only a limited proportion of anti-HBc-isolated individuals are potentially infectious, however anti-HBc-IgM which is detectable in any form of liver disease associated with HBV infection was present in more than 8% of the individuals. Of isolated anti-HBc-positive sera 37% were positive for anti-HCV, suggesting that anti-HCV antibody testing should be performed in isolated anti-HBc-positive individuals.

DNA, Viral↗
PubMed2000

The endogenous modulation of IOR is nasal-temporal asymmetric.

Inhibition of return (IOR) refers to a reflexive mechanism mediated by phylogenetically primitive extrageniculate visuomotor pathways, which apparently serves to favor novel spatial locations by inhibiting those recently sampled. We demonstrate an asymmetry between temporal and nasal hemifields in the strategic modulation of IOR by endogenously controlled attention. Exogenous and endogenous precues were manipulated independently on each trial such that precues to initiate endogenous spatial orienting were presented after IOR had been activated by exogenous visual signals. Both types of precues manifested their characteristic effects on reaction time (RT) to detect subsequent targets: facilitation by endogenous precues, and IOR by exogenous precues. Under monocular viewing, an asymmetric interaction between these two mechanisms was observed. While endogenous allocation of attention to the nasal hemifield reduced IOR, no endogenous modulation of IOR was present in the temporal hemifield where the effects of the two types of precues were independent. These observations suggest a framework for understanding the neurobiology of automaticity and control - from an evolutionary perspective.

Attention↗
PubMed2000

Computerized games to study the development of attention in childhood.

Children enjoy playing games. We can take advantage of this in the designs of computerized tasks that will engage their interest. These designs also serve to advance the study of chronometric measures, such as manual and saccadic reaction times and event related potentials, with young children. The goals of our method development are (1) to allow for comparable tasks across a wide variety of ages, (2) to make possible comparisons of child performance with data gathered in adult cognitive studies, and (3) to help to support inferences about the development of underlying mechanisms. We have designed a battery of computerized tasks in order to study the development of attention functions of alertness, orienting, and executive control during childhood. Our purpose is to describe each of these tasks in detail and present the results that have been obtained so far. The battery was tested using a sample of 5-year-old children as subjects.

Analysis of Variance↗
PubMed2000

Interleukin-18: biological properties and clinical implications.

IL-18, originally identified as interferon-gamma inducing factor (IGIF), is related to the IL-1 family in terms of its structure, processing, receptor, signal transduction pathway and pro-inflammatory properties. IL-18 is also functionally related to IL-12, as it induces the production of Th1 cytokines and participates in cell-mediated immune cytotoxicity. This review summarizes the recent advances in the understanding of IL-18 structure, processing, receptor expression and immunoregulatory functions, and focuses on the role of IL-18 modulation in tumours, infections, and autoimmune and inflammatory diseases.

Animals↗
PubMed2000

[Change of surgical treatment in benign thyroid gland diseases-- influence of surgical management on perioperative complications].

Since the beginning of 1994 standardized primary radical resection was performed in benign thyroid diseases at the surgical department, Barmherzige Brueder Hospital, Graz. In multinodular euthyroid goiter bilateral lobectomy or near total lobectomy respectively was done. In case of Graves' disease unilateral lobectomy and contralateral near total resection or "en bloc" thyroidectomy was performed. In accordance with literature a significant reduction of recurrent laryngeal nerve paralysis from approximately 9% to 1.2% occurred in our patients if this surgical procedure was performed consequently. Hypocalcemia rate after surgery needing treatment was approximately 1% at the time of demission.

Goiter, Nodular↗
PubMed2000

[Pituitary necrosis after spinal anesthesia : a case report].

Spinal anesthesia was administered to a patient for the surgical reduction of an inguinal hernia. However, the procedure was complicated by corticotropic insufficiency secondary to the necrosis of a non-secretory hypophyseal adenoma. The clinical presentation is discussed here together with both medical and neurosurgical managements. Etiology and pathophysiological mechanisms of this complication are analyzed in accordance with the most recent of the literature.

Adenoma↗
PubMed2000

Efficacy of the porcine model for demonstrating pericardial effusion with real-time ultrasound

Ultrasound in emergency medicine (EM) is an invaluable tool for emergent evaluation of pericardial effusion and tamponade. The training in the recognition of such has relied on ultrasonic images or videotapes. OBJECTIVE: To evaluate the efficacy of demonstrating pericardial effusion and tamponade using real-time ultrasound. METHODS: A convenience sample of 10 Yorkshire swine were anesthetized, sedated, intubated, and monitored as per an approved EM training protocol. Using EKG guidance and a subxiphoid approach, an 18-gauge spinal needle was advanced into the pericardium until a current of injury was detected. After a slight withdrawal of the needle, an aliquot of 50-100 mL of normal saline was instilled to produce a pericardial effusion. Ultrasound was used before and after the instillation of fluid into the pericardium. The effusion was confirmed by subsequent pericardiocentesis or by visual inspection on thoracotomy. RESULTS: The instillation saline, detection of effusion, and subsequent confirmation by ultrasound, pericardiocentesis, or visual inspection were successfully performed in 10/10 pigs. Under ultrasound, one pig had a preexisting effusion. Another had much less fluid visualized. On thoracotomy, the saline was found to have leaked into the adjacent lung parenchyma. CONCLUSIONS: We conclude that the porcine model is an adequate model to demonstrate pericardial effusion using real-time ultrasound.

Journal Article↗