Search PubMed⌕ Search

Biomedical subjects

A Blum

Publications and source records attributed to A Blum.

At least 37 records · Page 2Linked to original sources
PubMed2004

Six-month trial of on-demand rabeprazole 10 mg maintains symptom relief in patients with non-erosive reflux disease.

BACKGROUND: Compliance studies have shown that patients with reflux symptoms generally take their medication only when experiencing these symptoms. AIM: To evaluate the efficacy of on-demand rabeprazole maintenance therapy in patients with non-erosive reflux disease. METHODS: This multicentre, randomized, double-blind, placebo-controlled, withdrawal study compared 6 months of on-demand treatment with rabeprazole 10 mg vs. placebo. Adults with a history of reflux symptoms, a negative endoscopy, and > or = 3 days of moderate to very severe heartburn in the 7 days before enrollment (N = 535) entered 4 weeks of open-label, acute treatment with rabeprazole 10 mg once daily. Patients with complete symptom relief then entered the on-demand phase. The primary end-point was discontinuation due to lack of heartburn control during the on-demand phase. RESULTS: Eighty-three percent (432 of 523) of patients reported complete symptom relief at the end of the acute phase. During on-demand treatment, rates of discontinuation because of inadequate heartburn control were 20% (28 of 139) for placebo vs. 6% (16 of 279) for rabeprazole (P < 0.00001). Antacid use was twofold higher in the placebo group vs. the rabeprazole group (P = 0.0009). CONCLUSIONS: Rabeprazole 10 mg once daily is highly effective in acute symptom relief and as on-demand long-term maintenance therapy in non-erosive reflux disease patients.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

[Addiction to tobacco and the consequences for the skin].

Consumption of tobacco is hazardous to the health. It leads to cardiovascular diseases, and increases the incidence of numerous neoplasms. The adverse effects on the skin are less well-known and often ignored. Changes in the rheologic characteristics of the blood, increased vasoconstriction and damage to the epithelial layer of the vessel play an important pathogenic role in impaired wound healing, thromboangiitis obliterans and peripheral arterial obstructive diseases. Interactions with collagen metabolism are of special significance in wound healing and skin aging. The immunological effects, such as the induction of an inflammation reaction play a role in palmoplantar pustulosis, psoriasis, atopic dermatitis, acne vulgaris, acne inversa, thromboangiitis obliterans and lupus erythematodes. In addition, immunosuppression caused by nicotine consumption may contribute to the pathogenesis of human papilloma-virus infections, malignant melanoma and epithelial tumors of the skin and neighboring mucous membranes.

Estrogens↗
PubMed2004

[The moat technique. A two-step surgical technique for extensive basal cell carcinomas of the lip].

Surgery of large basal cell carcinomas (BCC) in problematic locations is sometimes challenging. A two-step surgical treatment of extensive BCC of the upper lip with the moat technique as an alternative to temporary wound closure will be illustrated using the example of two patients: In the first step, only the safety margin around the tumor is removed. After micrographic examination proves the lateral margins to be tumor-free, the tumor itself with all layers of the upper lip is removed in a second step. The defect is then closed with advancement flaps. If tumor resection does not involve all layers, the histopathologic interpretation of the base is first possible after complete surgical closure. The moat technique offers several advantages: The infection risk is minimized and the patient can eat and drink with an intact lip while resection margins are processed overnight. Tumor-free tissue is spared through the step-by-step procedure; the extent of plastic surgery is thus reduced and good functional and cosmetic results can be achieved. In addition, the perioperative period is less complicated.

Adult↗
PubMed2004

[Taking responsibility for one's own health. Possibilities and limits using the example of malignant melanoma].

Because of the persistent shortage of health care resources, scientists and politicians are discussing ways to increase the patients' personal responsibility for their own health. Based on a philosophical analysis of the concept of responsibility, this article tries to assess strengths and limits of a personal responsibility for health, illustrated by the prevention of cutaneous melanoma. On the one hand, individuals bear prospective responsibility for their health status by adopting a healthy lifestyle and participating in prevention programs. On the other hand, individuals can--retrospectively--be held responsible for those conditions that result from the voluntary choice of health risks. Considering the tremendous practical and ethical problems associated with retrospective responsibility, prevention and public health policies should emphasize prospective personal responsibility for health.

Cost Control↗
PubMed2004

T2 mapping: an efficient MR quantitative technique to evaluate spontaneous cartilage repair in rat patella.

OBJECTIVE: To evaluate the ability of T2 mapping on an 8.5 T imager to characterize morphologically and quantitatively spontaneous repair of rat patellar cartilage following full thickness defect. METHODS: Patellar cartilage defects were created in 24 rats knees on D0. Eight rats per time-point were killed on D20, D40 and D60 after surgery. T2 maps of repair tissue in patellar defects were obtained from eight different axial spin echo images on an 8.5 T imager. Global, superficial and deep T2 values were evaluated in spontaneous repair tissues (3x8 right patellae) vs the opposite patellae (3x8 left patellae) of the same animals. MR data were compared with macroscopic and histological studies. RESULTS: T2 map was able to identify morphologically three types of repair tissue observed macroscopically and histologically: 'total', 'partial' and 'hypertrophic' repair tissue. 'Total' and 'partial' repair tissues were characterized by global T2 values almost similar to controls, whereas 'hypertrophic' repair tissues were characterized by T2 global values higher than controls. Zonal variation between superficial and deep T2 values observed in controls was not depicted in repair tissue before D60. CONCLUSION: T2 map is able to characterize quantitatively and qualitatively rat patellar cartilage repair, and thus can be promoted, as a non invasive technique, in clinical longitudinal studies of articular cartilage repair.

Animals↗
PubMed2004

[Distal fibula reconstruction using a frozen allograft: a case report].

We report the case of a 25-year-old woman who developed recurrent chondromyxoid fibroma involving the distal portion of the right fibula. This patient had been treated two years earlier with curettage without grafting. The treatment associated en bloc resection of the distal 12 cm of the fibula and reconstruction with a cryopreserved allograft fixed with a lateral plate and pin associated with a syndesmodesis screw for six weeks. The lateral collateral ligament and the tibiofibular ligaments were also repaired. At two years, the patient has no sign of recurrence and the ankle motion is satisfactory. The ankle is stable and pain free with an esthetic aspect similar to the healthy side. Allograft reconstruction is a novel alternative for reconstruction of the distal fibula. We have found only one other case reported in the literature.

Adult↗
PubMed2004

[MR imaging accuracy in the prediction of bone graft healing potential in scaphoid non-union].

PURPOSE: To determine the accuracy of MR imaging in predicting bone graft healing in patients with scaphoid non-union. MATERIAL AND METHODS: 21 patients with scaphoid non-union were examined with MR imaging prior to bone grafting (conventional bone graft in 14 cases and vascularized bone graft in 7 cases). The protocol included unenhanced and Gadolinium-enhanced sequences. Signal intensity and homogeneity of the proximal fragment was analysed by two independent radiologists. MRI findings were then correlated to the postoperative rate of union. RESULTS: Healing occurred in 17 cases and failed in 4 cases with a mean follow up of 14 months. Intraobserver agreement in MR reading was respectively 0.92 et 0.86. Interobserver agreement was 0.88. On Tl-wi, the proximal fragment was hyperintense in 1 case (with positive surgical result), heterogeneous low signal intensity in 7 cases (healing in n = 7) and homogeneous low signal intensity in 13 cases (healing in n = 9). On T2-wi, the proximal fragment was hypointense in 4 cases (healing in n = 3), homogeneous high signal in 5 cases (healing in n = 4) and heterogeneous high signal intensity in 12 cases (healing in n = 10). After Gadolinium injection, enhancement was homogeneous in 4 cases (healing in n = 4), heterogeneous in 8 cases (healing in n = 7) and absent in 9 cases (healing in n = 6). In the group with no enhancement, 5 patients were treated with vascularized bone graft (healing in n = 4) and 4 with conventional bone graft (healing in n = 2). CONCLUSION: The absence of enhancement of the proximal scaphoid fragment leads to poor surgical results except for vascularized bone graft.

Adolescent↗
PubMed2004

[Imaging of the coronary arteries with multi-channel CT: a pictorial assay].

Advances in cardiac imaging with multidetector row CT allow new applications in the diagnosis of cardiac pathology. The purpose of this article is to illustrate the normal anatomy and main anatomical variants of the coronary arteries that can be detected with multi-channel CT. The images presented here were obtained using 4-channel and 16-channel multi-detector row CT units. Post-processing of CT imaging data was performed using: VRT, MPVR, and 2D curved MPR. Because of continuing technical advances, the use of CT imaging in the evaluation of cardiac disorders is likely to increase.

Coronary Angiography↗
PubMed2004

Digital image analysis for diagnosis of cutaneous melanoma. Development of a highly effective computer algorithm based on analysis of 837 melanocytic lesions.

BACKGROUND: Digital image analysis has been introduced into the diagnosis of skin lesions based on dermoscopic pictures. OBJECTIVES: To develop a computer algorithm for the diagnosis of melanocytic lesions and to compare its diagnostic accuracy with the results of established dermoscopic classification rules. METHODS: In the Department of Dermatology, University of Tuebingen, Germany, 837 melanocytic skin lesions were prospectively imaged by a dermoscopy video system in consecutive patients. Of these lesions, 269 were excised and examined by histopathology: 84 were classified as cutaneous melanomas and 185 as benign melanocytic naevi. The remaining 568 lesions were diagnosed by dermoscopy as benign. Digital image analysis was performed in all 837 benign and malignant melanocytic lesions using 64 different analytical parameters. RESULTS: For lesions imaged completely (diameter < or = 12 mm), three analytical parameters were found to distinguish clearly between benign and malignant lesions, while in incompletely imaged lesions six parameters enabled differentiation. Based on the respective parameters and logistic regression analysis, a diagnostic computer algorithm for melanocytic lesions was developed. Its diagnostic accuracy was 82% for completely imaged and 84% for partially imaged lesions. All 837 melanocytic lesions were classified by established dermoscopic algorithms and the diagnostic accuracy was found to be in the same range (ABCD rule 78%, Menzies' score 83%, seven-point checklist 88%, and seven features for melanoma 81%). CONCLUSIONS: A diagnostic algorithm for digital image analysis of melanocytic lesions can achieve the same range of diagnostic accuracy as the application of dermoscopic classification rules by experts. The present diagnostic algorithm, however, still requires a medical expert who is qualified to recognize cutaneous lesions as being of melanocytic origin.

Algorithms↗
PubMed2004

Lung cancer in patients with HIV infection: is it AIDS-related?

HIV-infected individuals have an increased risk of malignancy, especially non-Hodgkin's lymphoma and Kaposi's sarcoma. Recently, several workers have noted a raised prevalence of lung cancer in HIV-positive subjects. We describe the diagnosis and clinical course for four HIV-seropositive patients who presented with lung cancer. All of the patients were young and were heavy smokers. They were all on highly active antiretroviral therapy (HAART), although the adherence varied from poor to excellent. The CD4 cell counts of these patients ranged from 200 to 686 cells/microL and their viral loads ranged from undetectable to 29,000 HIV-1 RNA copies/mL. After initial diagnosis of HIV infection between 5 and 13 years previously, they all presented with advanced lung cancer, with a very short clinical course, and all four died within 2-9 months of diagnosis. A comparison of the incidence of lung cancer in patients with HIV infection at our centre with that in the general population suggests that there is an increased prevalence in the HIV-infected patients. We review the literature and discuss whether lung cancer in HIV infection is coincidental or related to the primary disease.

Adult↗
PubMed2004

Value of the clinical history for different users of dermoscopy compared with results of digital image analysis.

BACKGROUND: The clinical history of a given pigmented lesion could influence the therapeutic decision. Teledermatology and automated image analysis also hold great potential for revolutionizing dermatology services. AIM: The aim of this retrospective study was to evaluate the diagnostic accuracy of users with different experiences in dermoscopy with and without information about patients and their history compared with classification by an automated analysing system. SETTING: One hundred and fifty-seven dermoscopic images of pigmented lesions, taken and proved by histopathology at the Pigmented Lesions Clinic of the Department of Dermatology of the University Tuebingen, Germany, were included. METHODS: All images were viewed by three investigators with different experience: excellent (A), average (B) and beginner (C). In the first dermoscopic classification, no information was available. After 3 months the same images were once more classified by the three investigators, now with the information about the patients and their history. The melanocytic lesions were tested by the Tuebinger Mole Analyser. RESULTS: For user A the sensitivity, specificity and diagnostic accuracy revealed no improvement on including the history (81.3% to 84.4%, 94.6% to 92.3% and 92.0% to 90.7%), whereas user B clearly improved his results (75.0% to 87.5%, 76.9% to 88.5% and 76.5% to 88.3%). No change in the sensitivity was seen by user C (84.4%), but there was a clear improvement in the specificity (69.2% to 87.7%) and diagnostic accuracy (72.2% to 87.0%). Using the computer algorithm, a sensitivity of 100%, a specificity of 76.9% and a diagnostic accuracy of 81.9% were achieved. CONCLUSIONS: The study revealed results relevant to the use of dermoscopy: (1) continuing dermoscopic education influences the diagnostic accuracy; (2) the history is helpful for averaged users and beginners in dermoscopy; (3) digital image analysis has the highest sensitivity, but a lower specificity compared to the clinicians; and (4) digital dermoscopy could be used for store-and-forward systems in teledermoscopy.

Adolescent↗