Search PubMed⌕ Search

Biomedical subjects

A Steiner

Publications and source records attributed to A Steiner.

At least 109 records · Page 6Linked to original sources
PubMed1996

The Bath Ankylosing Spondylitis Patient Global Score (BAS-G).

In the absence of an ideal objective measure for assessing ankylosing spondylitis (AS), self-administered measures of disease activity (the Bath Ankylosing Spondylitis Disease Activity Index, BASDAI) and function (the Bath Ankylosing Spondylitis Functional Index, BASFI) have been developed, in addition to an objective measure of spinal mobility (the Bath Ankylosing Spondylitis Metrology Index, BASMI). However, a more global assessment is also desirable. We report on the design and validation of a global measure (the Bath Ankylosing Spondylitis Patient Global Score, BAS-G) which reflects the effect of AS on the patient's well-being. A pilot study was performed to select the most appropriate wording for BAS-G. Using 392 patients with AS, BAS-G's construct and predictive validity and test-retest reliability were assessed. Correlations between BAS-G and BASDAI/BASFI were calculated, and multiple regression was used to examine the significant correlates. The distribution of the responses covered the whole scale. As predicted, BAS-G correlated best with BASDAI (r=0.73), followed by BASFI (r=0.54). The best fitting regression equation included these scales as well as patients' gender and current age. One week and 6 month scores were significantly different (P<0.001). Construct validity was good: BAS-G correlated more strongly with each component of BASDAI and BASFI than with BASMI or with gender. Predictive validity was satisfactory: there was an improvement (mean=29%) in in-patient BAS-G scores over a 2 week treatment period (P<0.001). Test-retest reliability was excellent (1 week r=0.84, 6 months r=0.93). BAS-G correlates well with both BASDAI and BASFI, suggesting that disease activity and functional ability play a major role in patients' well-being, whereas metrology does not. The score is sensitive to change, reliable, and meets face, predictive and construct validity criteria.

Adult↗
PubMed1996

Increased nuclear volume in metastasizing "thick" melanomas.

Tumor invasion is the most reliable prognostic factor for primary stage I melanoma. "Thick" melanomas, with a Breslow thickness of more than 4 mm, tend to have a poor prognosis. Exceptions occur: some patients have no further recurrence of tumor. In an attempt to determine prognostic markers for "thick" clinical stage I melanomas, we investigated the volume-weighted mean nuclear volume of primary melanomas with tumor invasions > or = 4.0 mm in 32 patients. Seventeen of these patients developed melanoma metastases within a follow-up period of 60 mo; 15 patients who did not developed metastases and were comparable with regard to clinical and histological criteria were selected as a comparison group. Volume-weighted mean nuclear volume (Vv) is determined by a technique that permits an unbiased, efficient, shape- and orientation-independent, 3-dimensional estimation of nuclear size in tissues. This technique has been employed successfully in the prognostic assessment of stage I and II melanomas and was recently proven to be a sensitive marker for thin, high-risk melanomas. In our patients, Vv was determined by computer-assisted image analysis on Feulgen-stained sections by stereologic estimation of the Vv. The mean Vv (+/-SD) of primary melanomas with subsequent metastatic course was 794.99 +/- 209.18 micron3 (range: 409.48-1161.9 micron3), whereas primary melanoma lesions without subsequent metastases exhibited a mean Vv 640.54 +/- 205.07 micron3 (range: 206.7-927.48 micron3). This difference was found to be statistically significant (p = 0.0439). "Thick" melanomas with subsequent metastases thus exhibited a significantly higher Vv than did melanomas that did not metastasize.

Adult↗
PubMed1996

Management of malunion of metacarpus III/IV in two calves.

This report describes the case histories of two calves with non-functional malunion of the metacarpus (MC) III/IV. In both cases, severe valgus deviation occurred after closed reduction and external coaptation of a shaft fracture of MC III/IV. The malunion was corrected by closing wedge osteotomy and internal fixation. Long-term follow up of both cases revealed complete healing in good alignment without any signs of impairment of gain.

Animals↗
PubMed1996

Benign and malignant stenoses of the stomach and duodenum: treatment with self-expanding metallic endoprostheses.

PURPOSE: To assess palliation of inoperable stenoses of the stomach and the duodenum with self-expanding metallic endoprostheses. MATERIALS AND METHODS: Under combined endoscopic and fluoroscopic guidance, 13 Wallstents were placed in nine consecutive patients, two with benign and seven with malignant obstruction. RESULTS: Technical success was achieved in eight patients (89%). One failure was due to stent dislocation during implantation. No major complications occurred; in two patients (22%), additional stents were implanted to improve patency. During the follow-up, which was 1-52 weeks (mean, 17 weeks) or until death there were no signs of stent obstruction. In seven patients (78%), quality of life improved substantially with restoration of oral food intake and relief of vomiting. CONCLUSION: The placement of Wallstents offers good palliation of inoperable outlet stenoses of the stomach and the duodenum. With a combined radiologic and endoscopic approach, it is an easy and rapid procedure that can be performed without general anesthesia.

Deglutition Disorders↗
PubMed1996

[Nephrectomy for chronic, unilateral suppurative pyleonephritis in cattle].

This report presents the case history of a five-year-old Eringer cow suffering from chronic hematuria. Results of clinical examination, ultrasonography of the kidneys, endoscopy of the bladder, and cytologic and bacteriologic analysis of the urine revealed unilateral pyelonephritis of the right kidney caused by Corynebacterium renale. Antimicrobial treatment with procaine penicillin was not successful. Therefore, nephrectomy of the affected kidney was performed through a right flanc approach in the standing animal. Follow-up examination ten months after surgery revealed normal general condition. Etiopathogenesis and diagnostic and therapeutic procedures of pyelonephritis in cattle are discussed.

Animals↗
PubMed1996

[The surgical treatment of left-sided abomasal displacement in the cow: a literature review].

In this paper, a literature review of the 4 most common surgical techniques for treatment of left displacement of the abomasum in cattle is provided, and advantages and disadvantages of the different techniques are described. Many aspects as economy, cosmetics, stage of reproduction, degree of periparturient abdominal edema, availability of assistants, and the surgeons preference determine the decision making process of the technique to be chosen. It is the author's recommendation to perform the left flank abomasopexy in cattle during the last months of pregnancy, the percutaneous toggle-pin fixation as economic procedure in less valuable animals to afford savings to the owner, and the right flank omentopexy in all other cases. Becoming acquainted with the right flank omentopexy has the advantage that this is the technique of choice for correction of right displacement of the abomasum. Ventral paramedian abomasopexy has the distinct disadvantage that 2 or 3 assistants are required to cast and position the animal. Ventral paramedian abomasopexy is, therefore, only recommended in cases, where the cosmetic result plays an important role in the decision making process.

Abomasum↗
PubMed1996

Fatigue in ankylosing spondylitis: its prevalence and relationship to disease activity, sleep, and other factors.

OBJECTIVE: To assess the symptom of fatigue in patients with ankylosing spondylitis (AS) with regard to its prevalence and its relationship to disease activity and other factors. METHODS: A self-administered questionnaire, including visual analog scales to assess fatigue, other components of disease activity, and functional ability (the Bath AS Functional Index, BASFI) was sent to 350 patients with AS. Questionnaires were completed and returned by 295 patients (84% response rate). Statistical analyses were descriptive and predictive and included t tests, chi-squared tests, and multiple regression. RESULTS: Sixty-five percent of the patients (n = 192) described fatigue as a major symptom (F+ group) while 31% (n = 91; F- group) did not consider it to be important (4% noncommittal). Excluding fatigue, the mean of a disease activity composite score was significantly higher in the F+ group (5.26, standard deviation (SD) + or - 2.33) than in the F- cohort (3.67, SD + or - 2.09, p <0.001). The former group also had significantly worse scores on the functional index (BASFI mean 5.87, SD + or - 2.42 vs 4.29. SD + or - 2.46, p <0.001). Of the total, 55% had, on occasion, suffered fatigue without accompanying pain or stiffness. After controlling for other factors, pain (p <0.001), functional disability (BASFI, p <0.001) and stiffness (p <0.05) were significantly associated with level of fatigue. The F+ group reported more sleep disturbance, with 41 % (compared to 26% of the F- group) waking more than 3 times a night (p = 0.04). In addition, usual fatigue on waking was more common in the F+ group (71 vs 36%, p <0.001). CONCLUSION: (1) Fatigue is a major symptom in the majority of patients with AS, in particular those with more severe disease; (2) fatigue is more likely to occur with active disease but may also occur as a lone symptom. (3) those with severe fatigue function less well; and (4) the management of fatigue remains an enigma - exercise, for example, having only an equivocal effect.

Adult↗
PubMed1995

A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community.

BACKGROUND AND METHODS: The prevention of disability in elderly people poses a challenge for health care and social services. We conducted a three-year, randomized, controlled trial of the effect of annual in-home comprehensive geriatric assessment and follow-up for people living in the community who were 75 years of age or older. The 215 people in the intervention group were seen at home by gerontologic nurse practitioners who, in collaboration with geriatricians, evaluated problems and risk factors for disability, gave specific recommendations, and provided health education. The 199 people in the control group received their regular medical care. The main outcome measures were the prevention of disability, defined as the need for assistance in performing the basic activities of daily living (bathing, dressing, feeding, grooming, transferring from bed to chair, and moving around inside the house) or the instrumental activities of daily living (e.g., cooking, handling finances and medication, housekeeping, and shopping), and the prevention of nursing home admissions. RESULTS: At three years, 20 people in the intervention group (12 percent of 170 surviving participants) and 32 in the control group (22 percent of 147 surviving participants) required assistance in performing the basic activities of daily living (adjusted odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.8; P = 0.02). The number of persons who were dependent on assistance in performing the instrumental activities of daily living but not the basic activities did not differ significantly between the two groups. Nine people in the intervention group (4 percent) and 20 in the control group (10 percent) were permanently admitted to nursing homes (P = 0.02). Acute care hospital admissions and short-term nursing home admissions did not differ significantly between the two groups. In the second and third years of the study, there were significantly more visits to physicians among the participants in the intervention group than among those in the control group (mean number of visits per month, 1.41 in year 2 and 1.27 in year 3 in the intervention group, as compared with 1.11 and 0.92 visits, respectively, in the control group; P = 0.007 and P = 0.001, respectively). The cost of the intervention for each year of disability-free life gained was about $46,000. CONCLUSIONS: A program of in-home comprehensive geriatric assessments can delay the development of disability and reduce permanent nursing home stays among elderly people living at home.

Activities of Daily Living↗
PubMed1995

[Patient compliance--possibilities for improvement].

In this last of three parts on patient compliance possibilities to improve compliance are reviewed. Compliance-promoting measures include among others uncomplicated prescriptions (such as one daily dose, drug-combinations and written instructions), frequent, well organized controls and the self-involvement of the patient in his treatment. Employment of well educated assistants attending long term patients shows positive results. Furthermore installment of a good patient-physician relation is one of the most important prerequisites for a good compliance.

Cognition Disorders↗
PubMed1995

Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists.

BACKGROUND AND DESIGN: Epiluminescence microscopy (ELM) is a noninvasive technique that, by employing the optical phenomenon of oil immersion, makes subsurface structures of the skin accessible for in vivo examination and thus provides additional criteria for the clinical diagnosis of pigmented skin lesions. At present, almost all studies about the value and clinical importance of ELM are based on data derived from ELM experts (ie, dermatologists specifically trained in this technique). In the present study, we attempt to determine whether the clinical diagnosis of pigmented skin lesions is significantly improved using ELM and whether ELM-trained individuals and dermatologists not trained in this technique profit equally from this technique. Randomly selected histologically proven pigmented skin lesion specimens, photographed with (ELM) and without oil immersion (surface microscopy) were presented by slide projection to six ELM experts and 13 ELM nonexperts (ie, dermatologists not formally trained in ELM) for diagnosis. To evaluate the diagnostic performance of ELM experts and nonexperts with and without the oil immersion technique (ie, ELM vs surface microscopy), the following parameters were obtained: intraobserver and interobserver agreement by kappa statistics and sensitivity and specificity of diagnostic performance. RESULTS: Our results show that by using the ELM technique the ELM experts reach a substantially better intraobserver agreement than nonexperts (median kappa, 0.56 vs 0.36). The interobserver agreement was markedly increased in the ELM experts group (average gain, 7%) but decreased in the ELM nonexperts group (average loss, 6%). The sensitivity of diagnosis was significantly increased in the ELM experts group (average gain, 10%), but decreased in the nonexperts group (average loss, 10%). Finally, the specificity of diagnosis was excellent in the ELM experts group, both with and without oil immersion (0.91) and was somewhat improved by ELM in the nonexperts group (0.77 vs 0.85). CONCLUSIONS: We conclude that the ELM technique increases sensitivity in formally trained dermatologists, but may decrease the diagnostic ability in dermatologists not formally trained in the ELM technique. Consequently, formal broad-based training in ELM should be offered to the dermatologic community.

Clinical Competence↗
PubMed1995

Accreditation: what can we learn from the Anglophone model?

There is growing interest in the development and application of standards for the health care to both promote quality assurance but also to improve the processes by which health services are held accountable to the public. This paper maps the development of organisational accreditation systems in the USA, Canada, Australia and the United Kingdom. In the USA, accreditation, which began as a means of ensuring the correct environment for clinical practice has developed into a form of public regulation. In the United Kingdom, many different approaches to the setting of standards and their assessment has created a variety of accreditation systems. The case studies demonstrate that as the concept of accreditation diffuses into the health care systems of different countries, it is being adapted to meet the wider policy needs of different national circumstances.

Accreditation↗
PubMed1995

Drugs coordinating and restoring gastrointestinal motility and their effect on selected hypodynamic gastrointestinal disorders in horses and cattle.

Hypodynamic gastrointestinal disorders in horses and cattle that are thought to benefit from treatment with drugs restoring and coordinating gastrointestinal motility include postoperative ileus and large colon impaction in the horse and displacement of the abomasum and dilatation of the cecum in cattle. Important physiologic, pathophysiologic and pharmacologic mechanisms involved in the intrinsic control of gastrointestinal motility include cholinergic, adrenergic, dopaminergic, serotoninergic, and opioid-mediated pathways. Preliminary results suggest that cisapride, acting on 5-Hydroxytryptamine receptors, might be useful for treatment of idiopathic postoperative ileus and the alpha 2-adrenoceptor blocking agent yohimbine for endotoxic postoperative ileus. Naloxone, an opioid antagonist, and neostigmine, an acetylcholinesterase inhibitor, are thought to restore motility of the large colon in cases of large colon impaction in the horse. Bethanechol and neostigmine significantly increase myoelectric activity of the cecum and proximal loop of the ascending colon in healthy cows. Investigations of the effects of prokinetic drugs on displacement of the abomasum of cattle do not allow any conclusions because no results derived from controlled experimental disease models are available.

Adrenergic Antagonists↗
PubMed1995

Effect of xylazine, cisapride, and naloxone on myoelectric activity of the ileocecocolic area in cows.

The effect of xylazine, cisapride, and naloxone on myoelectric activity of the ileum, cecum, and proximal loop of the ascending colon (PLAC) was determined in 4 healthy Jersey cows implanted with 8 pairs of bipolar electrodes. A 4 x 4 Latin square design was used. The treatments included xylazine (0.04 mg/kg of body weight), cisapride (0.08 mg/kg), naloxone (0.05 mg/kg), and 0.9% sodium chloride solution (20 ml). All treatments were administered i.v. during early phase I of the migrating myoelectric complex in the ileum. Myoelectric activity was recorded for 4 hours after treatment, and data were analyzed for each hour separately. Xylazine significantly (P < 0.05) increased the duration of phase I of the first migrating myoelectric complex in the ileum to 220.72 +/- 26.89 minutes, compared with 30.91 +/- 10.11 minutes after administration of 0.9% sodium chloride solution. The number of cecocolic spikes per minute per electrode and the duration of cecocolic spike activity (percentage of recording time) were significantly (P < 0.05) decreased for the first 3 hours, and the number of propagated spike sequences in the cecum and PLAC was significantly (P < 0.05) decreased for the first 2 hours after administration of xylazine. Significant difference was not found between control and either cisapride or naloxone treatment of healthy cows. However, during hour 1 after treatment with cisapride, number of spikes per minute, duration of spike activity, and number of propagated spike sequences were highest, compared with the other treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1995

[Diaphyseal sequestration of the hollow bones in cattle].

Between 1990 and 1993 ten cows with diaphyseal sequestration of the metacarpal or metatarsal bone were brought to the Clinic for Food Animals and Horses, University of Bern. History, clinical and radiographic findings at admission, therapy, and clinical and radiographic short- and longterm results were evaluated retrospectively. Six animals had a history of trauma. The metatarsal bone (n = 9) was much more frequently affected than the metacarpal bone (n = 1). Lameness was slight in seven cases and intermediate in three cases. Soft tissue swelling was present in all cases, and fistula formation in eight cases. Sequestrectomy was performed in nine cases, the exuberant new bone circumferentially removed in three of these cases, and the skin primarily closed in all nine cases treated surgically. One animal with a small sequestrum, showing no fistula formation, was treated conservatively. Four to 44 months after surgery, interviews with the owners by telephone revealed that the recovery had been satisfactory in all ten cases. At the same time period, clinical and radiographic examinations of the six animals that were still alive were performed by a veterinarian additionally. Normal limb function had been restored in all six animals, although the affected limb was clearly distinctable from the unaffected contralateral limb, because of its increased diameter. From the results of this study we concluded that longterm prognosis after sequestrectomy is favourable; primary wound closure can be attempted with good success. Cosmetically promising results, however, can only be achieved, if sequestrectomy is performed early enough in the course of the disease or if the exuberant new bone is surgically removed.

Animals↗
PubMed1995

[C-reactive protein or blood sedimentation reaction os preventive studies in the physician's laboratory?].

The laboratory examinations are more and more significant in the practical internal medicine. The results are basic for decision-making in medicine. The patients are asking for check-up examinations, including screening examinations in the laboratory. We try to compare the significance of two important laboratory tests. The C-reactive protein (CRP) is very sensitive and allows a graduation of the inflammatory reaction. It is useful to take the CRP in a valuable screening examination. Compared with the erythrocyte sedimentation rate (ESR), an elevated CRP always signifies an organic illness. A normal ESR has a poor predictive value. An elevated ESR supports only the history and the clinical findings of a suspected diagnoses. There is no possibility to screen patients without symptoms by ESR. We use ESR to follow-up diseases like arteritis temporalis and polymyalgia rheumatica and to measure the therapeutic effect.

Adult↗
PubMed1995

Effect of bethanechol, neostigmine, metoclopramide, and propranolol on myoelectric activity of the ileocecocolic area in cows.

The effect of bethanechol, neostigmine, metoclopramide, and propranolol on myoelectric activity of the ileum, cecum, and proximal loop of the ascending colon was determined in 6 healthy Jersey cows implanted with 8 pairs of bipolar electrodes. Assigned at random, each cow received each of 5 treatments in 3-day intervals. The treatments included bethanechol (0.07 mg/kg of body weight, SC), neostigmine (0.02 mg/kg, SC), metoclopramide (0.15 mg/kg, IM), DL-propranolol (0.2 mg/kg, IM), and 0.9% sodium chloride (NaCl) solution (20 ml, SC). All drugs were administered during early phase I of the migrating myoelectric complex in the ileum. Myoelectric activity was recorded for 4 hours after treatment, and data were analyzed for each hour separately. Bethanechol and neostigmine significantly (P < 0.05) increased the number of cecocolic spikes per minute per electrode, duration of cecocolic spike activity (%), and number of cecocolic propagated spike sequences per 10 minutes, relative to NaCl, during 1 or more hours of the recording period. The effect of bethanechol was more pronounced on duration of spike activity and number of propagated spike sequences, whereas neostigmine mainly increased the number of (uncoordinated) spikes. Metoclopramide and propranolol had no significant effect on cecocolic myoelectric activity, relative to NaCl. It was concluded that bethanechol and, less likely, neostigmine at the dosage used in this study may be suitable for medical treatment of cecal dilatation in cattle in which hypomotility of the cecum and proximal loop of the ascending colon has to be reversed. The potential advantage of bethanechol vs neostigmine for medical treatment of cecal dilatation is worth further evaluation.

Adrenergic beta-Antagonists↗
PubMed1994

Inappropriate medication use in community-residing older persons.

BACKGROUND: Elderly patients taking inappropriate drugs are at increased risk for adverse outcomes. We investigated the prevalence of inappropriate drug use and its predisposing factors in community-residing older persons. METHODS: We conducted in-home interviews with 414 subjects aged 75 years and older living in the community of Santa Monica, Calif. Inappropriate medication use was evaluated using explicit criteria developed through a modified Delphi consensus process. These criteria identified drugs that should generally be avoided in elderly community-residing subjects regardless of dosage, duration of therapy, or clinical circumstances. RESULTS: Based on these conservative criteria, 14.0% of the subjects were using at least one inappropriate drug. The most common examples were long-acting benzodiazepines, persantine, amitriptyline, and chlorpropamide. Subjects using three or more prescription drugs, compared with one or two, were more likely to be taking an inappropriate medication (odds ratio, 3.9; 95% confidence interval, 1.9 to 7.9). Furthermore, subjects with depressive symptoms had a higher risk of receiving inappropriate medications than nondepressive subjects (odds ratio, 2.2; 95% confidence interval, 1.1 to 4.1). CONCLUSIONS: Inappropriate drug use is a common problem in community-residing older persons. The risk of inappropriate drug use is increased in patients taking multiple medications and in patients with depressive symptoms.

Age Factors↗