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Biomedical subjects

A Foerster

Publications and source records attributed to A Foerster.

At least 37 records · Page 2Linked to original sources
PubMed1995

[An answer to an inquiry on diffuse panbronchiolitis. Now it has found its way here!].

Diffuse panbronchiolitis (DPB) is a disease characterised by chronic inflammation in the region of respiratory bronchioles. The condition has mainly been observed in Japanese patients, though isolated cases have been reported from other countries. In a review published in Läkartidningen (37/94), the question was raised of why this disease had not been seen in Scandinavia, and whether this might be the result of missed diagnosis. The diagnostic criteria were listed, and the question was posed of whether (Scandinavian) physicians existed who had encountered patients with chronic sinusitis, persistent cough and inexplicable nodular changes in lung x-rays. As a direct result of this enquiry, the present article reports what may well be the first Scandinavian patient to fulfil all the diagnostic criteria of DPB. The patient responded with improved lung function and normalised blood gases to a combined treatment regimen comprising immunosuppression (cyclophosphamide and prednisolone) and nebulised antibiotics (gentamicin).

Adult↗
PubMed1995

Risk factors for early and late mortality in surgical treatment of coronary artery disease.

A total of 1025 patients who had coronary bypass surgery at the Surgical Department A, Rikshospitalet, Oslo, between 1982 and 1986, were analysed for factors associated with early mortality and long-term survival. The cumulative follow-up time accounted for 6553 patient-years; the median follow-up was 6.45 years and ranged from the day of admission to 10 years. In total, 31 patients (3%) died within 30 days of surgery. Some 30 possible risk factors were analysed. Univariate analysis followed by a multivariate analysis defined six independent risk factors for early mortality. These were lack of sinus rhythm, previous heart surgery, mitral regurgitation, left main stem stenosis, unstable angina, and an elevated left ventricular end-diastolic pressure. Estimation of attributable risk showed that these factors could identify all patients who died early. Independent risk factors for late death were: lack of sinus rhythm, resection of a left ventricular aneurysm, left main stem stenosis, New York Heart Association (NYHA) class IV on admission, an elevated end-diastolic pressure, and prolonged cross-clamping time. The attributable risk analysis showed that independent risk factors for total mortality explained only about half of the patients who died. This appeared to be because of the competing effect of non-cardiac mortality. Results of the study show that risk factors for early mortality are good indicators for the outcome of coronary artery bypass surgery, identifying all deaths, whereas long-term mortality cannot be predicted. Stratification of independent risk factors allows a better comparison of mortality in different centres, and also better quality control of bypass surgery.

Aged↗
PubMed1995

Effects of combined radiofrequency and direct current energy catheter ablation on ventricular myocardium in pigs.

When radiofrequency catheter ablation of ventricular arrhythmias is unsuccessful, an option may be to combine it with direct current energy. We therefore investigated the effects of such a combination. Radiofrequency energy was delivered in a bipolar or unipolar fashion to the left and right ventricles through an ablation catheter with a tip electrode 2 mm long, using a temperature-guided radiofrequency generator. Radiofrequency ablation was followed by a single cathodal direct current shock (66 J) with the ablation catheter positioned similarly in six closed-chest pigs. In a control group (six animals) only direct current ablation was performed, with one or two energy applications (66 J) in each ventricle. Two of six animals in the radiofrequency/direct current group died due to perforation in the follow-up period, 1 and 3.5 h after the direct current ablation, respectively. Gross pathological examination of the hearts revealed transmural lesions in all animals. In the radiofrequency/direct current group four lesions were perforated, three of which were located in the left ventricle. There was a significant increase in the number of perforations in the radiofrequency/direct current group compared to the control group, where perforation was never observed. Haemorrhagic pericardial fluid was found in five of the six animals in the radiofrequency/direct current group compared to none in the control group. These findings show that myocardial ablation with radiofrequency energy followed by direct current energy in the same session may have a high complication rate.

Animals↗
PubMed1995

Insight and psychotic illness. Cross-sectional and longitudinal associations.

BACKGROUND: Insight has recently re-emerged as an important aspect of psychopathology amenable to empirical study. We sought to examine the relationship between various aspects of insight into illness and clinical, sociodemographic and neuropsychological variables. METHOD: From an inner-London catchment area population, 150 in-patients with recent onset of psychosis were assessed on a variety of measures, including the Present State Examination (PSE). Subjects were followed up for a mean of four years and reassessed. RESULTS: High IQ was associated with better insight as rated on the PSE, while gender, ethnicity and a diagnosis of schizophrenia appeared to be unrelated. At follow-up, similar associations were found, as well as correlations with attitudes to treatment and a more elaborate measure of insight. Cerebral ventricular enlargement and tests of frontal lobe function did not correlate with insight, but there was a curious, strong association with left-handedness at both assessment points. Initial insight correlated significantly but weakly with insight at follow-up. CONCLUSIONS: The assessment of insight in psychosis has concurrent validity and is a distinct aspect of psychotic phenomenology. It may, in part, have a neuropsychological basis.

Adolescent↗
PubMed1994

Power and temperature guided radiofrequency catheter ablation of the right atrium in pigs.

The aim of the present study was twofold: to assess the safety of ablating the atrial free wall using RF current; and to assess the effect of a single dose of intravenous heparin followed by aspirin once daily to prevent thrombus formation after RF ablation. Temperature and power guided catheter ablation were evaluated. Twenty pigs were randomized to power or temperature guided unipolar RF catheter ablation. Ten animals received a bolus of heparin (150 U/kg) followed by 150-mg aspirin daily, and ten served as controls. A mid-sternal thoracotomy was performed 5-7 days later. The ability of a lesion to resist an increased transmural atrial pressure was examined by inflating a cuff around the pulmonal artery. Transmural lesions were found in all animals. Right atrial pressure was increased from 5 to 30 mmHg with no sign of perforation. In 11 of 20 (55%) animals, 1-3 lesions were found in the lungs (diameter 4-18 mm). The localization of these lesions corresponded to the lesions in the atria. There were no differences in the energy delivery modes with regard to the number of animals with lung lesions. Lesions with thrombus formation were found in four animals in the heparin/aspirin group and in nine animals in the control group. The incidence of thrombi was significantly smaller in the treatment group. There were no differences between temperature and power guided catheter ablation with regard to the size of the atrial lesions or to the incidence of thrombus formation. Transmural lesions induced in the right atrium by RF energy are resistant to increases in transmural pressure. However, lung tissue overlying the ablated target may be injured by the RF energy delivered. The combination of a single dose intravenous heparin followed by aspirin daily may reduce the incidence of thrombus formation.

Animals↗
PubMed1994

Development of granulomas and vascular fibrocellular proliferation in the lungs of pigs receiving long-term lipid-based parenteral nutrition.

The lungs of pigs receiving long-term total parenteral nutrition (TPN) have been studied. A total of 20 pigs were tentatively infused with TPN through central venous catheters for 7 weeks. To secure adequate nutrition and gastrointestinal absorbance of nutrients, an additional full oral diet was given to eight of these animals. Fifteen control animals received Ringer solution through central venous catheters in addition to the oral diet. All animals infused with TPN for 7 weeks developed lung granulomas, a finding not observed in control animals. No lung granulomas were seen in three TPN animals sacrificed after 3 to 5 weeks owing to illness. All TPN animals also developed tissue reactions suggesting long-standing lung vascular inflammation. Similar vascular changes were seen in seven control animals that had bacterial infection or endotoxemia. The total amount of neutral fat in lung homogenate tended to increase in animals given TPN, and the linoleic acid content was significantly increased. In conclusion, long-term TPN caused lung granulomas in pigs. Vascular damage seemed to be accelerated by bacterial infection as well as by the TPN. The tissue reactions presumably involved long-term activation of monocytes/macrophages.

Animals↗
PubMed1993

Quantitative assessment of sudomotor activity by capacitance hygrometry.

A commercial capacitive hygrometer device manufactured for use in technical or chemical laboratory environments has been used for quantitative and dynamic assessment of sweat gland activity in selected skin areas. For this purpose the hygrometer device was supplemented by a chamber attached to the skin for collecting evaporated water and a supply of dry nitrogen gas providing a gas flow through the chamber and through the hygrometer capsule. The accuracy of the technique was proven in pilot experiments in which fixed amounts of water were evaporated. A positive correlation was found between the weight of the water and the water evaporation computed from the hygrometer readings (r = 0.997). The time constant of the device was in the range of 10 s. This time constant appears to be fast enough for recording physiological changes in the sweating rate of human subjects. In experiments on healthy subjects sudomotor reflexes were assessed and compared to vasoconstrictor responses and to thermographically measured temperature changes of the skin during the Valsalva manoeuvre and a painful mechanical stimulus. Direct measurement of water evaporation such as by this technique may provide information on sympathetic reactions which could be utilized in both physiological and pathophysiological states.

Absorption↗
PubMed1993

The effect of temperature-guided radiofrequency ablation of ventricular myocardium.

The safety and feasibility of temperature-guided radiofrequency (RF) ablation of ventricular myocardium were assessed in an open-chest animal model. RF ablation was performed in the ventricles of 19 pigs using ablation catheters with a tip electrode of 2 or 4 mm length. The energy was delivered in a bipolar (2 mm tip electrode only) or unipolar configuration. Set temperature ranged from 60 to 90 degrees C. Pulse duration was 30 s. Histological examination showed coagulation necrosis with a haemorrhagic zone. However, lesions with a deep cleavage were found after five unipolar (2 mm tip electrode) energy applications. No such lesions were found after unipolar energy applications with a 4 mm tip electrode. During or shortly after ablation, premature ventricular beats and non-sustained VT were frequently observed and in some instances ventricular fibrillation. In the bipolar mode we found a positive correlation between lesion area/volume and peak temperature with a correlation coefficient of 0.48 and 0.56, respectively (P < 0.05). However no correlation was found between lesion size and applied energy. In the unipolar configuration there was no correlation between lesion size and these parameters. Median depth and area were: bipolar: 4.0 mm/23.5 mm2, unipolar (2 mm tip electrode): 3.5 mm/12.2 mm2, unipolar (4 mm tip electrode): 4.0 mm/15.7 mm2. We conclude that in a beating heart it is difficult to predict lesion size from temperature or energy.

Animals↗
PubMed1993

Single lung transplantation. Morphological surveillance by transbronchial biopsy.

Seven cases of single lung transplantation are reported. The recipients were all below 60 years of age and severely disabled with end-stage lung disease. Transplantation was performed according to ABO blood group compatibility and negative lymphocytotoxic cross-match between donor and recipient irrespective of HLA mismatch. Recipients' diagnoses were sarcoidosis (3), alfa-1 antitrypsin deficiency (3), and idiopathic emphysema (1). Mean recipient age was 48 +/- 2.4 years (range 45-52). Donor age was 29.7 +/- 5.6 years (range 16-49). The immunosuppressive regimen included cyclosporin A, azathioprine, steroids and rabbit antithymocyte globulin. Excellent graft function was achieved. Six patients survived the postoperative period and are alive 4-18 months posttransplant. One patient died after the operation due to pneumonia with respiratory distress syndrome. Graft function was also monitored by transbronchial biopsy, and 57 biopsy procedures were performed without fatal complications. Acute cellular rejection was seen in 16 biopsy specimens from 5 recipients (grade 1 and 2 rejection in 14, grade 3 rejection in 2). Neither severe rejection with septal necrosis (grade 4) nor obliterative bronchiolitis was seen. The rejection rate was 0.03 episodes per patient/month. In contrast to other reports, episodes of cellular rejection occurred throughout the observation period, and were not mainly limited to the first 4 months posttransplant. Graft vascular occlusive disease or chronic vascular rejection was found in 6 biopsy specimens from one recipient. Five patients experienced 7 episodes of cytomegalovirus infection. The cytomegalovirus infection rate was 0.01 episodes per patient/month. The incidence of infection was significantly lower compared to previous studies of rejection in other lung graft combinations. Both infections and rejection episodes may contribute to the development of obliterative bronchiolitis. Almost one third of the specimens (30%) showed lymphocytic bronchitis without perivascular inflammation. The absence of perivascular infiltrates and exclusion of infectious agents leaves in question the aetiology of this inflammation. The lymphocytic bronchitis could be ischaemic, related to aspiration, or represent recurrent sarcoidosis, or, in fact, express bronchial rejection. All biopsy specimens regarded as rejection with cellular infiltrates in the lung parenchyma also showed a lymphocytic bronchitis. The impact of HLA mismatch on cellular and vascular rejection is unclear. Transbronchial biopsy is a reasonably safe and reliable method in the diagnosis of rejection and infection in single lung transplantation.

Adult↗
PubMed1993

Simultaneous occurrence of primary choroidal and cutaneous malignant melanoma and skin metastasis.

This case report describes the clinical and histopathological findings in a 65-year-old woman enucleated for a malignant choroidal melanoma. Simultaneously, an excision was performed of a cutaneous melanoma together with a satellite nodule presumed to be a metastasis from the cutaneous, superficial spreading melanoma. Six months later, chemotherapy for liver metastasis was given without effect. There were no signs of dysplastic nevus syndrome. A 39-year-old cousin, however, had been enucleated for a malignant choroidal melanoma. This sporadic case might suggest a common etiologic factor in the pathogenesis of multicentric melanomas.

Adult↗
PubMed1993

Premorbid social underachievement in schizophrenia. Results from the Camberwell Collaborative Psychosis Study.

In an investigation of the timing and precursors of social decline in schizophrenia and affective psychosis, 195 subjects from the Camberwell Collaborative Psychosis Study were currently of lower social class than were their fathers. A comparison between father's occupation and proband's best premorbid occupational level indicated underachievement confined to DSM-III schizophrenia, there being no such effect in affective psychosis. Decline in social status following onset of psychosis, analysed by comparing best premorbid occupation with current occupation, was marked in both schizophrenia and affective psychosis, indicating a non-specific effect. Schizophrenic patients who failed to achieve their fathers' social status had poorer educational qualifications than those who equalled or bettered their paternal social class, despite similar premorbid IQ (NART) scores and age at onset of psychosis. These results indicate that schizophrenia may be manifest before the onset of psychosis, and lend weight to the notion of a developmental origin to this disorder.

Adolescent↗
PubMed1993

Life events and psychosis. Initial results from the Camberwell Collaborative Psychosis Study.

Data from the Camberwell Collaborative Psychosis Study were used to examine the proposition that there is an excess of life events preceding the onset of psychoses of all types. Of 97 patients from the study who had episodes within the past year that were datable, 51 had developed psychotic symptoms from an essentially symptom-free state, 29 had been suffering only from neurotic symptoms, and 17 had experienced a marked exacerbation of psychotic symptoms. DSM-III diagnoses were collapsed into three major groups: 51 cases of schizophrenia; 31 cases of mania; and 14 cases of depressive psychosis. Life-event histories were taken for the six months before onset, and when these were compared with equivalent histories from a psychiatrically healthy sample from the local general population, there was a significant excess of life events, particularly in the three months before onset of psychosis. This was apparent in all groups, and remained even when events were restricted to the independent category. The excess of events began rather earlier than has been found in previous studies. In our view, this study provides some of the strongest evidence for a link between life events and the emergence of psychotic symptoms.

Adolescent↗
PubMed1993

Daily home spirometry facilitates early detection of rejection in single lung transplant recipients with emphysema.

Eight single lung transplant recipients with emphysema, aged 40-58 yrs, have been followed up for 90 patient months. Starting 2-4 weeks postoperatively, they recorded their forced vital capacity (FVC), and forced expiratory volume in one second (FEV1), at a fixed time every morning using a Micro Spirometer. They were instructed to contact the hospital if the FVC or FEV1 displayed a persistent (two days or more) decrease of 10%, compared with the average values during the last seven days. Transbronchial biopsies (TBB) were performed regularly in the follow-up, and whenever the patients had respiratory symptoms, or the FVC or FEV1 displayed a persistent decline of more than 10%. We performed 59 TBBs, and 23 biopsy specimens showed rejection. The FVC and FEV1 values on the TBB day were compared with the mean values of the 7 previous days. FVC and FEV1, associated with negative TBBs (16 events), showed no significant changes. However, FVC and FEV1 decreased significantly (p < 0.001, paired t-test) during rejections (mean percentage change 14 and 21% respectively, range +8% to -53%). In 16 of the 23 rejections, the FEV1 decreased by > 10%. We recommend the use of daily home spirometry when monitoring single lung recipients with emphysema, and suggest that a persistent 10% decrease in FEV1 or FVC for at least two days is an indication for hospital admission and possible TBB.

Adult↗
PubMed1992

VACTERL or MURCS association in a girl with neurenteric cyst and identical thoracic malformations in the father: a case of gonosomal mosaicism?

We report on a female infant with lethal congenital malformations including extreme hydrocephalus due to aqueductal stenosis, vertebral segmentation anomalies, fused costae, anal atresia, renal dysplasia, and bicornuate uterus with a double blind vagina. The VACTERL and the MURCS associations are possible diagnoses. Her father had a neurenteric cyst in infancy. He has identical vertebral and costal malformations as his daughter but is otherwise healthy. The possibility of dominant inheritance with gonosomal mosaicism in the father is discussed.

Abnormalities, Multiple↗
PubMed1992

The conduction system in human cardiac allografts. A histological and immunopathological study.

Twenty-five hearts were lost in the first 103 orthotopic human cardiac allografts in 100 recipients. Twenty-two patients died. The first nine recipients were treated with Cyclosporin A and high dose Prednisolone and the subsequent recipients were immunosuppressed with a triple regimen consisting of Azathioprine in addition to Cyclosporin A and low dose Prednisolone. Twenty grafts were examined at autopsy and three after retransplantation. Fourteen hearts with acute rejection and vascular pathology were investigated regarding the histological and immunopathological alterations due to cellular and vascular rejection. The recipient sinoatrial node was available for examination in 10, the donor node in 13 and the atrioventricular conductive tissue in all 14 grafts. The conduction system was involved in 8 out of 11 allografts attacked by acute cellular rejection. In one allograft in which the patient developed AV block, the cellular infiltrates were almost exclusively observed in the atrioventricular tissue. Most of the cells were T lymphocytes, while macrophages and B cells were present to a lesser extent. There was little evidence of permanent structural damage to the atrioventricular tissue after recurrent mild or moderate episodes of acute cellular rejection. In the sinus nodes, however, risk of traumatic damage to the recipient and donor sinus node was about half and a quarter respectively. Acute and chronic vascular rejection seemed to be equally distributed in the sinus node, atrioventricular arteries and in the intramural branches of the coronaries. No morphological differences were established between the two types of immunosuppressive regimes.

Adolescent↗