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Biomedical subjects

B Nachbur

Publications and source records attributed to B Nachbur.

At least 19 recordsLinked to original sources
PubMed1992

Prevalence of the Rhesus-negative phenotype in Caucasian patients with small-cell lung cancer (SCLC).

We report that the Rhesus (Rh)-negative phenotype is more prevalent in patients with small-cell lung cancer (SCLC) than in the normal Caucasian population (SCLC: 25% Rh-negative vs. 15% expected, p less than 0.0001). This finding has been validated for a Central and a Northern European population (Switzerland and UK). In contrast, the Rh-negative phenotype is no more frequent in non-small-cell lung cancer patients or in heavy smokers with coronary heart disease than in the general population. There was a normal distribution of the ABO blood group phenotype in all patients studied. Whilst the significance of this observation is unclear, we hypothesize that a genetic predisposition to the development of SCLC may be linked to a hitherto unidentified gene on chromosome 1p near the Rh locus. Our observation may perhaps allow further progress to be made in understanding genetic mechanisms of SCLC carcinogenesis.

ABO Blood-Group System↗
PubMed1992

The fate of bilateral lower limb amputees in end-stage vascular disease.

Sixty-six patients with end-stage peripheral vascular disease who had undergone bilateral major amputation of the lower extremities in our institution during the 10-year period January 1980-December 1989 were reviewed. There were 46 males and 20 females with an age range from 34 to 91 years (mean 67.7 years). A 98.5% follow-up was achieved. Of these patients 25% underwent their second amputation in the first, 50% within the second and 75% within the third postoperative year, notwithstanding the fact that prior attempts at revascularisation had been performed in 62% of all patients. The 30-day hospital mortality was 4.5%. The initial level of amputation was metatarsal in 14.4%, below knee in 66.6%, through knee in 9.9% and above knee in 9.1%. Out of a total of 132 stumps 89 healed by primary intention. Following secondary revisions and amputations the final level of amputation was metatarsal in 7%, below knee in 49%, through knee in 14% and above knee in 30%. Survival rates were 62% after 2 years, 31% after 5 years, and 14% after 8 years. By this time all diabetics had died, while 33% of non-diabetics were still alive (p greater than 0.02). Age, sex and amputation level had no bearing upon survival rate. Forty-three patients (65.1%) were ambulatory after their first amputation, but following contralateral amputation barely more than half (23 patients) were able to walk. In the presence of bilateral stage IV disease it is highly important to rehabilitate the patient immediately following unilateral amputation before considering amputation of the contralateral limb, otherwise the patient will not become ambulatory.

Adult↗
PubMed1991

Comparative evaluation of three ambulatory plethysmographic devices as regards accuracy and handling in daily practice.

We compared a computed strain gauge plethysmograph (SGP1) with a Gutmann strain gauge plethysmograph (SGP2) and a photoplethysmograph (PPG) in 24 normal and 12 radiologically proven postphlebitic limbs with respect to assessment of the calf pump function, discrimination between normal and pathologic values, and handling. Recovery time (RT50), refilling volume (RV) and the Index (RT50xRV) were measured at the ankle and the calf in each limb after 20 dorsiflexions of the feet in the sitting position. The PPG device could only measure RT50. There was a strong positive correlation in RT50, RV and Index values between SGP1 and SGP2 at the ankle and at the calf (p less than 0.001), but none in RT50 ankle and calf values between PPG and SGP1 (p = 0.1) and PPG and SGP2 (p = 0.1). The comparison between normal and postphlebitic limbs revealed significant differences for all three values RT50, RV and Index only for SGP1 ankle measurements (p less than 0.02, p less than 0.01, respectively). Ankle RT50 values were significantly longer than calf RT50 values for both strain gauge devices (p less than 0.01), where PPG results were not influenced by the site of measurement. The average number of tests required to obtain a valid curve in each limb at the ankle and calf was lowest for SGP1 measurements. Vein calf pump function is easily and accurately assessed by SGP1 ankle measurements. However a threshold limit between normal and pathologic values can not be defined either for RT50 or for RV values in the individual case, and the creation of an Index adds little to solve this problem.

Adult↗
PubMed1991

Photodynamic therapy with chlorins for diffuse malignant mesothelioma: initial clinical results.

Four patients underwent intraoperative photodynamic therapy after surgery with meso-tetra-(hydroxyphenyl)-chlorin (mTHPC-PDT) for diffuse malignant mesothelioma. Preliminary procedures were performed in two patients in order to establish the efficacy of mTHPC-PDT and to optimise its tumoricidal effect. The tumoricidal effect was related to the mTHPC dose, light dose and the time interval between sensitation and activation. 0.3 mg kg-1 mTHPC activated after 48 h with 10 Joules cm-2 of non-thermal laser light at 650 nm resulted in a 10 mm deep tumour infarction, due to tumour vessel necrosis and thrombosis. The mTHPC tissue concentration was up to 14 times higher in the tumour than in normal tissues. Skin photosensitivity was mild, dose dependent and occurred 3 to 10 days after administration of mTHPC. According to the results obtained, intraoperative mTHPC-PDT was performed following pleuropneumonectomy in two, pleurectomy and lobectomy in one and pleurectomy in one patient. Ten Joules cm-2 were delivered to the diaphragm and the costophrenic sulcus and 5 Joules cm-2 to the remaining thoracic cavity. The postoperative course was marked by loss of appetite, fluid retention, hypoproteinemia and severe chest pain. One patient succumbed from aspiration pneumonia. The remaining patients developed no neural or vascular alterations and no bronchial stump insufficiency during follow-up. mTHPC-PDT following surgical tumour resection deserves further evaluation in good risk patients with diffuse malignant mesothelioma.

Combined Modality Therapy↗
PubMed1991

Surgery and chemotherapy for pulmonary metastases: long-term results from a combined modality approach.

Eighty-three patients underwent pulmonary metastatectomy as part of a combined modality approach between 1. 1. 1972 and 31. 12. 1988 and 80 were followed up until 1. 1. 1990 or until death, with an average follow-up of 110 months. The estimated 5-, 10-, and 15-year survival rate was 38%, 32%, and 22% respectively. Recurrent pulmonary metastases were observed in 60% of the patients during follow-up with an estimated 24 months relapse-free survival rate of 50%. An additional 20% of the patients developed extrapulmonary recurrent tumor manifestation without evidence of pulmonary disease. One of five patients remained tumor free up to 207 months (an average of 87 months) after the initial pulmonary metastatectomy. A multivariate analysis identified completeness of tumor removal, the type of primary tumor, and a difference in histology between primary and metastatic neoplasm as three independent prognostic factors with significant impact on overall survival, the completeness of tumor removal being the most important one. Disease-free long-term survival for patients with pulmonary metastases treated by surgery and chemotherapy is related to completeness of tumor removal and the type of primary tumor.

Combined Modality Therapy↗
PubMed1991

[Trans-sternal thymectomy in myasthenia gravis].

Between 1986 and 1989 27 patients with myasthenia gravis underwent radical thymectomy: 24 patients without and two patients with thymoma through a trans-sternal incision, another with thymomatous myasthenia through a left-sided thoracotomy. The patients were staged according to the modified Ossermann classification. The results were evaluated prospectively according to the Disability Status Scale of Oosterhuis. During a mean follow up of 22.4 months, 21 patients (77%) benefited from the operation with complete remission achieved in 9 (33%) and significant improvement noted in 12 (44%). There were no operative deaths and no hospital morbidity. The mean operation time was 88 minutes, the mean postoperative hospital stay 10.5 days. These results support the recommendation for radical trans-sternal thymectomy in the treatment of patients with myasthenia gravis as a safe procedure.

Adolescent↗
PubMed1990

En bloc resection for bronchogenic carcinoma with chest wall invasion. Value of pre-operative radiotherapy.

A small number of patients with lung cancer will have a tumour invading the chest wall. Pre-operative radiotherapy and surgical resection provide the best results in patients with Pancoast's tumours, although chest wall invasion is often considered to indicate incurability. We reviewed the outcome in 46 patients with bronchogenic carcinoma and non-apical chest wall invasion and have tried to clarify the role of adjuvant pre-operative radiotherapy. All patients underwent combined chest wall and lung resection for treatment of lung cancer which had extended grossly and microscopically into the chest wall. In this retrospective study, we identified two groups of patients, those (n = 21) who received and those (n = 25) who did not receive pre-operative radiotherapy. Curative resection had been possible in 80% of the patients. There was one early post-operative death, due to pneumonia. The survival in all 46 patients is 32% at 5 years. In the most favourable cases, those without nodal involvement and who received pre-operative radiotherapy, the 5-year survival is 56%. In our series, there was a notable difference in 5-year survival between irradiated and non-irradiated patients at every stage of disease.

Adult↗
PubMed1990

[Surgical thrombectomy versus conservative treatment of ileo-femoral phlebothrombosis. Functional comparison of long-term results].

The results of a retrospective study comparing two equally large groups of patients treated either surgically for restoration of venous patency and valvular function (24 patients) or medically with heparine, oral anticoagulants and compression stockings (25 patients) are presented. Follow-up time was 7.6 and 7.9 years respectively, operative mortality nil. Assessment of venous function was based on clinical observations as well as on measurements of haemodynamic parameters. Non-fatal pulmonary embolism after onset of treatment occurred in both cohorts with an equal frequency of 13%. Patients operated on for ilio-femoral deep venous thrombosis (DVT) were with few exceptions totally independent of any form of adjunctive hosiery which was in sharp contrast to the conservatively managed group. If onset of DVT had occurred more than three days earlier and extended from the ilio-femoral axis to the popliteo-crural level, surgery usually failed and patients were no better off than in the comparable medical subgroup. The same pattern of late outcome was found for all other clinical and haemodynamic parameters; i.e. clinical signs of venous hypertension, valvular competence as judged by sonography, patient's self-assessment and the expelled volume and refilling time measured by dynamic plethysmography after standardized leg-work. The mean expelled volume was 1.1 +/- 0.5 ml/100 g/min for the surgical subgroup treated early for ilio-femoral DVT and 0.7 +/- 0.5/100 g/min for the corresponding medical group (p = 0.05). Recovery or refilling time was 50 +/- 21 sec for the surgical group and 28 +/- 26 sec for the medical group (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Bandages↗
PubMed1990

[Use of photoplethysmography with calibration in vivo for assessing venous hemodynamics of the lower extremity and particularly ambulatory venous pressure and refilling time after exercise].

Several invasive and non-invasive methods are used actually for the appreciation of the morphology and the function of the venous system of the lower extremity. Hemodynamic parameters like the ambulatory venous pressure and the venous refilling time can not be determined without invasive measurements. This report describes the results of a prospective comparison of the ambulatory venous pressure and the venous refilling time with the in vivo calibrated photoplethysmography and with invasive measurements. Postural changes of hydrostatic pressure permitted in vivo calibration of the photoplethysmograph. We recorded quantitative photoplethysmography (PPG) ambulatory venous pressure and venous refilling time in 20 normal subjects, 20 patients with superficial varicosis and in 20 patients with chronic venous insufficiency. Quantitative photoplethysmography correlated closely with invasive measurements of ambulatory venous pressure with respect to estimated drop in superficial venous pressure and recovery time. PPG estimates of intravenous pressure in normal patients (24 +/- 9 mm Hg), in patients with varicosis (42 +/- 7 mm Hg) and post-thrombosis patients (63 +/- 9 mm Hg) agreed with ambulatory venous pressure measurements 22 +/- 9 mm Hg, 40 +/- 6 mm Hg and 61 +/- 6 mm Hg, respectively. Non invasive, quantitative photoplethysmography may prove to be an accurate estimate of ambulatory venous pressure in patients with superficial varicosis and in patients with chronic venous insufficiency.

Exercise Test↗
PubMed1990

[Drug-induced acute arterial occlusion].

An acute ischemia has almost its origin in a mechanical obstruction of the vessel caused by embolus, thrombose or dissection. An ischemia caused by medicament, excepted the erronated intraarterial injection of vasoconstrictive medicament, is very seldom encountered in the clinic. We describe the case of a young woman who was referred to our clinic for investigation and treatment of an acute ischemia of both limbs. In her past medical history she was treated because of a liver insufficiency occurring after a spontaneous abortion and received methylergometrine (Methergin) for uterine stimulation. Because of this unusual manifestation in a young patient with a complicated past medical history we considered the possibility of a drug induced ischemia caused by ergotamine-derivate. The rapid recovering after treatment with chlorpromazine and nifedipine confirmed the suspected diagnosis. A well defined therapy of this rare complication has not been described; vasodilatators, nitroglycerin, calcium-antagonists and even streptokinase and balloon dilatation are proposed.

Adult↗
PubMed1989

[Radioimmunoscintigraphy with a 99mTc-labeled F(ab')2 fragment of a monoclonal antibody (HMW-MAA 225.28S) in 71 patients with malignant melanoma].

In 71 patients with malignant melanoma 85 radioimmunoscintigraphies (RIS) with 99mTc-radiolabeled F(ab')2 fragments of a murine monoclonal antibody have been performed. The antibody is specific for an epitope of the HMW-MAA glycoprotein complex which is present in 90% of melanoma tissue samples. Sensitivity for RIS was 79% (73 metastatic sites out of a total of 92). 20 previously unknown lesions were found and there were also 2 false positives. Conventional staging procedures alone revealed 78% of the metastatic sites (72 of 92). No side effects were observed. RIS was especially useful for detection of lymph node metastases not found by conventional methods and is therefore considered complementary to conventional preoperative staging procedures.

Adult↗
PubMed1989

The impact of computed tomography in the diagnosis and postoperative follow-up of ureteric obstruction in aorto-iliac aneurysmal disease.

Between 1979, the advent of computed tomography in our institution, and 1987 we have treated 520 aorto iliac aneurysms surgically, almost 2/3 on an elective basis, the others (183 = 35.2%) being ruptured. Among non-ruptured aneurysms 220 were symptomatic and 19 of 20 cases with ureteric entrapment occurred in these patients corresponding to 8.6% of this subgroup and verified at surgery. In all of these cases the association between ureteric obstruction and the underlying aneurysmal disease was clearly documented by computed tomography. In 8 patients ureteric entrapment was caused by an inflammatory aneurysm, in 12 cases by an arteriosclerotic aneurysm which in one case was a largely expanded internal iliac aneurysm left behind during previous surgery for a ruptured aorta aneurysm. Postoperative follow-up studies of the 8 patients with an inflammatory aneurysm revealed a time-dependent regression heading towards complete disappearance of perivascular fibrosis. Because of potential difficulties associated with the surgical treatment of inflammatory aneurysms it is important to identify perivascular fibrosis and its extent and localization pre-operatively, which can only be achieved by a CT scan. Simultaneously, CT offers information concerning the presence and degree of pyelectasis and calyceal dilatation, identifies the localisation of ureteric entrapment, defines the extent of aneurysmal disease of the iliac arteries, is best-suited for postoperative follow-up in all of the cases and has the most to offer if contrast medium investigations are contra-indicated in the presence of renal insufficiency. Probably the main reason, if not the only one for preoperative angiography, is to demonstrate associated anomalies of the visceral arteries the state of which however, can be just as well assessed by duplex sonography. Thus, computed tomography is the single most important diagnostic tool in the assessment of aorto-iliac aneurysmal disease especially when associated with ureteric entrapment.

Aged↗
PubMed1989

[Vascular complications in surgery of the hip joint].

The mechanisms of severe vascular injury during surgery of the hip joint are depicted with reference to the authors' own patient series and a review of the literature. Massive arterial hemorrhage is most commonly caused by the tip of a Hohmann retractor. Special care must be given to placement of the proximal retractor directly against the pelvis behind the anterior lip of the acetabulum, and this must be checked with the finger tip. Other mechanisms of injury are: massive venous bleeding can result if a coil of pelvic vein is rolled up with a Kirschner wire; arterial thrombosis can be caused by the polymerization heat of bone cement; or intimal dissection can be caused by pressure of a retractor or loosening of an intimal plaque, resulting in ischemia of the corresponding limb; arterio-arterial embolism can originate from appositional thrombus formation on a chronically weakened arterial wall; false aneurysms may be due to instrumental arterial injury; and arteriovenous fistulae can be caused by a piercing instrument. Laceration of the external iliac or common femoral artery is best treated by interposition of a saphenous vein graft. Angiological examination before and immediately after hip surgery is advocated.

Amputation, Surgical↗
PubMed1989

[Surgical treatment of the unstable thorax in respiratory insufficiency].

Sixteen patients with traumatic flail chest underwent surgical stabilization using procedures introduced by Rehbein, Judet and Vecsei. Compared with sixteen patients treated by internal stabilization with intermittent positive pressure respiration, there are some advantages: time of artificial respiration is shortened, early mobilization is possible, nursing is easier, the costs are lower. The procedure is indicated in those patients, in whom long-term artificial respiration is not necessary for other reasons.

Flail Chest↗
PubMed1989

[Immunoscintigraphy with 99mTc marked melanoma antibody in patients with malignant melanoma].

In 38 patients with malignant melanoma 44 radioimmunoscintigraphies (RIS) with 99mTc labeled F(ab')2 fragments of an anti-melanoma monoclonal antibody (225.28S, Tecnemab-K, Sorin Biomedica) have been performed. No side effects have been observed even in the patients with repeated RIS. Overall 81% (35/43) of all lesions were detected by imaging and 9 lesions have been previously unknown. Sensitivity and specificity was highest for lymphnode metastases with 100% each. Poor imaging was observed in lung and mediastinal metastases (2/7) as well as small skin metastases. RIS has to be studied for its clinical value in staging of lymphnode metastases preoperatively in patients undergoing regional lymphnode dissection.

Antibodies, Monoclonal↗