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Biomedical subjects

B Langer

Publications and source records attributed to B Langer.

At least 91 records · Page 5Linked to original sources
PubMed1996

Nutritional status and function in patients following Whipple procedure compared with controls.

OBJECTIVE: Despite the potential for nutritional deficits in patients undergoing pancreaticoduodenectomy or Whipple procedure, long-term assessment of nutritional status has largely been ignored. This study assessed nutritional status of 24 Whipple patients compared with matched post-cholecystectomy controls. METHODS: Clinical assessment was by subjective global assessment, body composition was assessed by bioelectric impedance analysis and functional assessment was by respiratory muscle strength and skeletal muscle function performed by electrical stimulation of the ulnar nerve of the wrist and hand-grip dynamometry. RESULTS: Whipple patients studied 4.6+/-0.7 years since surgery and controls (4.8+/-0.7 years since surgery) were all judged clinically to be in a good nutritional state. Compared with controls, Whipple patients had significantly lower body weight (Whipple: 72.5+/-2.8 kg, control: 83.9+/-3.3 kg, p<0.05) however, the mean body weight of both Whipple and controls was above ideal weight (Whipple: 113.3+/-4.3%, control: 122.3+/-3.7% p = NS). No significant differences in functional performance were observed between groups. Energy intake of Whipple and controls was also comparable. In the Whipple group, neither the extent of gastric resection or the pathological diagnosis had an effect on the nutritional parameters studied. CONCLUSIONS: Long-term follow-up of patients having undergone Whipple procedure failed to reveal the presence of any nutritional or functional deficits suggesting that a full nutritional recovery is possible after this surgery.

Aged↗
PubMed1996

Lipiodol accumulation in hepatic hemangioma. Detection with osmium postfixation.

Lipiodol has been used to increase the detectability of small primary neoplasms in the liver. We report a patient who was found to have lipiodol deposits in the liver one month after intra-arterial injection. The region was resected, under ultrasound control, because of the impression that the lesion was malignant. The specimen contained two small hemangiomas as well as many small dysplastic nodules (adenomatous hyperplasia) in a noncirrhotic parenchyma. To locate the lipiodol deposit in this case, the tissue was radiographed, postfixed in osmium tetroxide, and embedded in paraffin. Black osmium-stained deposits were found within the cavities of the hemangiomas but not in the dysplastic nodules. Most of the deposits were extracellular multivesiculated bodies with a small focus of lipid droplets engulfed by multinucleated foreign-body type giant cells. This report reinforces that hepatic lipiodol retention is not specific for hepatocellular carcinoma. We present, for the first time, the histologic appearance of lipiodol accumulation in an hemangioma. The value of osmium tetroxide postfixation for the detection of lipiodol is also demonstrated.

Adult↗
PubMed1996

[Risk of development of false aneurysm and graft infection after aorta-femoral bypass graft. Retrospective study. Report of 211 cases].

Anastomotic aneurysm and infection of arterial graft are complications that occur late after aorto-femoral bypass graft surgery. The objective of this paper is to calculate the percentage of patients free of these complications after 10 years. From 1966 to 1983, 211 patients were operated on consecutively to treat aortoiliac atherosclerotic obstructive disease. There were 173 (82%) men and 38 (18%) women of mean age 54.7 +/- 9.1 years. Forty-one percent of patients were operated on for limb salvage. Aorto-bi-femoral bypass was performed in 196 (92.9%) patients; the unilateral aorto-femoral bypass in 8 (3.8%) and the aorto-femoral to one side and aorto-iliac to the order in 7 (3.3%). In 28 patients, the bypass was associated with femoro-popliteal bypass (21 patients) or reconstruction of visceral arteries (7 patients). The anastomosis was end-to-side both in the aorta and in the femoral arteries, made of synthetic sutures. Diagnosis of the complications was made by physical examination, ultrasonography, CT scan or arteriography. The Kaplan-Meier method was used to determine the percentage of patients without complications. After 24, 60 and 120 months, 98.5%, 92.6% and 85.4% of the patients were free of anastomotic aneurysm, respectively and after the same periods, 97.3%, 90.4% and 75.2% of the patients respectively were free of graft infection (table 2). We conclude that the risk of developing complications is a permanent risk and increases with time, but the use of grafts cannot be invalidated.

Adult↗
PubMed1996

[Natural estrogens and the cardiovascular system].

The significant relationship between hormone substitution therapy during menopause and reduced cardiovascular risk has been demonstrated in many studies. The beneficial effect of natural estrogens on plasma lipids has been questioned, accounting for no more than 25% of the vascular effect. Natural estrogens act on the vascular wall by favoring the penetration of potassium into the cell and stimulating synthesis of prostacycline synthetase and prostaglandin cyclooxygenase. Capacity for dilatation is partially restored and sensitivity to vasoconstrictor substances is reduced by increased synthesis of endothelium derived relaxing factor (EDRF). In addition to the endothelium-dependent mechanism, there is also an endothelium-independent mechanism due to the anti-calcium effect and endothelin antagonism. Thus natural estrogens increase vascular flow and reduce resistance. Besides the direct or indirect vascular effect, estrogens also have an anti-atherogenic effect resulting from a modulation of gene expression due to specific receptors situated on smooth muscle and endothelial cells. Indications for hormone substitution have been modified due to this better understanding of the different actions of natural estrogens. Patients with atheromatosis or hypertension are legitimate candidates.

Blood Flow Velocity↗
PubMed1996

Successful cord blood stem cell transplantation for congenital erythropoietic porphyria (Gunther's disease).

Congenital erythropoietic porphyria (Gunther's disease, GD) is a rare autosomal recessive disease. It results from the deficiency of uroporphyrinogen III synthase, the fourth enzyme on the metabolic pathway of heme synthesis. GD leads to severe scarring of the face and hands as a result of photosensitivity and fragility of the skin due to uroporphyrin I and coproporphyrin I accumulation. It also causes erythrocyte fragility leading to haemolytic anaemia. The other clinical features include hirsutism, red discolouration of teeth, finger-nails and urine and stunted growth. The outcome is poor, and the disfiguring nature of GD may partly explain the legend of the werewolf. No curative treatment was known until 1991, when the first case of BMT in GD was reported. The clinical and biological outcome after transplantation was encouraging, with an important regression of the symptoms of the disease, but the child died of CMV-infection 11 months after BMT. We report the second case of GD treated successfully by stem cell transplantation using umbilical cord blood from an HLA-identical brother in a 4-year-old girl suffering from severe GD. Our patient is very well 10 months after transplantation. We confirm that stem cell transplantation is curative for GD.

Amniocentesis↗
PubMed1996

The regeneration of soft tissue and bone around implants with and without membranes.

The popularity of osseointegration for the replacement of anterior teeth has placed an increased demand on the preservation of normal gingival anatomy. This has led to the development of a variety of soft-tissue and bone-augmentation techniques that either prevent tissue collapse or restore previously damaged areas of the alveolus. With bone grafts, barrier membranes, and autogenous connective-tissue grafts used in combination with each other or separately, lost structures can be reconstructed into a normal configuration for optimum esthetic restorations.

Alveolar Bone Loss↗
PubMed1995

Quality of life, nutritional status, and gastrointestinal hormone profile following the Whipple procedure.

BACKGROUND: To compare the quality of life, nutritional status, and gastrointestinal profiles of post-Whipple patients and postcholecystectomy patients. METHODS: A cross-sectional survey of post-Whipple procedure patients and age- and sex-matched postcholecystectomy patients was performed. Quality of life was assessed using six instruments: Time Trade-off Technique, Direct Questioning of Objectives, Gastrointestinal Quality of Life Index, Sickness Impact Profile, Physician Global Assessment, and Visick Scale. A gastrointestinal symptomatology questionnaire was completed. Nutritional status was assessed by weight, the Subjective Global Assessment instrument, and skin anthropometry. Fasting and postprandial serum gastrin, somatostatin, insulin, pancreatic glucagon, enteroglucagon, and pancreatic polypeptide were measured. RESULTS: The quality of life and gastrointestinal function of the Whipple patients was excellent and was not significantly different from that of the control subjects. There were no significant differences in gastrointestinal symptomatology although 5 Whipple patients complained of greasy bowel movements, and 1 patient reported difficulty maintaining weight. Despite this, nutritional status was within normal limits in all subjects. Six patients in the Whipple group followed a diabetic diet, 1 required insulin, and 3 required an oral hypoglycemic agent, whereas none of the control subjects were diabetic. There were no significant differences in the mean basal, peak, or integrated postprandial responses of the gut hormones with the exception of pancreatic polypeptide and gastrin (in patients having a standard Whipple procedure only). CONCLUSION: Quality of life and nutritional status are excellent in patients following a Whipple procedure.

Adult↗
PubMed1995

Spontaneous regression of fetal pulmonary sequestration.

The prenatal diagnosis of pulmonary sequestration can usually be made by the third trimester of pregnancy, from the combination of an intrathoracic mass and indirect signs such as cardiac deviation, fetal hydrops, pleural effusion and polyhydramnios. We describe four cases in which pulmonary hyperechogenicity was detected before 26 weeks' gestation. In three cases the hyperechogenic mass was isolated. In all cases it had mostly regressed during the pregnancy. A review of the cases of isolated pulmonary sequestration that have been diagnosed during the antenatal period is presented. Antenatal evolution was found to be unpredictable regardless of the type or severity of the case at the first diagnosis. We propose a classification to define more clearly the optimal management of pulmonary sequestration.

Adult↗
PubMed1995

The successful use of osseointegrated implants for the treatment of the recalcitrant periodontal patient.

This study reports the successful use of osseointegrated implants to replace teeth in patients whose periodontal disease has been categorized as recalcitrant. It includes partially and totally endentulous jaws. A total of 309 implants placed by two periodontists practicing in traditional office settings were included in the survey. Of the 132 mandibular implants, 4 failed, for a success rate of 97%; and 3 of the 177 maxillary implants failed, for a success rate of 98%. There were 21 implants placed in 1985; 38 in 1986 and 1987; 185 from 1988 to 1990; 42 in 1991; and 23 in 1992. The report includes 42 mandibular and 50 maxillary prostheses, none of which has failed. One female mandibular case was converted from 2 posterior free-standing to a full arch prosthesis when the anterior teeth failed periodontally. These results demonstrate that individuals with a strong susceptibility to periodontal disease can be treated successfully with osseointegrated implants.

Adult↗