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Biomedical subjects

C Fink

Publications and source records attributed to C Fink.

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

[Long-term outcome of conservative or surgical therapy of anterior cruciate ligament rupture].

The treatment of anterior cruciate ligament (ACL) rupture continues to be a controversial subject. This study was undertaken to compare long-term results of different therapy regimens A total of 52 patients (mean age: 34.7 +/- 3.2 years) who underwent ACL reconstruction using the central one third of the patellar tendon and 32 patients (mean age: 38.3 +/- 5.2 years) treated conservatively were evaluated 5-7 years clinically, radiologically and with respect to their sports activities. In all, 25% of the patients operated on subjectively rated their knees as "excellent", 40.4% as "very good", 22.2% "good", 12.5% "fair" and 0% as "poor". The ratings for the conservatively treated group were: 12.9%, 19.4%, 29%, 25.8% and 12.5%, respectively. The results of the OAK score were significantly better for the surgically treated group (87.5 +/- 7.1 points compared with 77.1 +/- 13.4). An increasing number of degenerative changes were found on radiographs in both groups at follow-up as compared with their pre-injury status.

Adult↗
PubMed1995

Cardiac troponin T and creatine kinase MB mass concentrations in children receiving anthracycline chemotherapy.

Anthracyclines (doxorubicin, daunorubicin, and derivatives) are among the most effective antineoplastic drugs for pediatric cancer with dose-limiting acute and long-term cardiotoxicity. The exact mechanism of the development of cardiomyopathy is still not clear. Anthracyclines may induce subclinical acute myocardial injury leading to lysis of a limited number of myocytes. Alternatively, myocytes may experience a transient loss of cytoplasmic membrane integrity. Both conditions may lead to a transient efflux of small amounts of cytoplasmic enzymes and other proteins specific to the heart muscle fibers. To test these hypotheses we assayed plasma creatine kinase (CK) MB mass and cardiac specific troponin T (TnT). CKMB may be released even in case of reversible cell membrane injury, while prolonged elevation of TnT is the most sensitive and specific marker of limited myocardial necrosis. Thirty-five anthracycline-containing chemotherapy courses in 22 children with cancer were analyzed. CKMB mass and TnT concentrations were within the normal range in all children before anthracycline therapy. Within 72 hours from anthracycline therapy no increment of one of these two marker proteins was detected (ANOVA for repeated measures, P = 0.94 [TnT] and 0.25 [CKMB]). We conclude that only minimal if any acute necroses of cardiac myocytes occur after anthracycline therapy. Even membrane integrity appears to be maintained within the first 3 days after anthracycline therapy, in the absence of electrocardiographic or echocardiographic signs of acute cardiotoxicity.

Adolescent↗
PubMed1995

Withholding and withdrawing of life support from patients with severe head injury.

OBJECTIVE: To characterize the withholding or withdrawing of life support from patients with severe head injury. SETTING: San Francisco General Hospital, a city and county hospital with a Level I trauma center. DESIGN: A standardized questionnaire was used to collect data on demographics and functional outcome of severely head-injured (Glasgow Coma Score of < or = 7) patients admitted to the medical-surgical intensive care unit, and to interview the patients' physician and family members. PATIENTS: Forty-seven patients who were admitted to a medical-surgical intensive care unit over a 1-yr period. INTERVENTIONS: Twenty-four patients had life support withheld or withdrawn, and 23 patients did not. MEASUREMENTS AND MAIN RESULTS: Physician and family separately assessed patient's probable functional outcome, degree of communication between them, reasons important in recommending or deciding on discontinuation of life support, and the result of action taken. Six months later, the families reviewed the process of their decision, how well physician(s) had communicated, and what might have improved communication. Of 24 patients with life support discontinued, 22 died; two were discharged from the hospital. Twenty-three of the 24 patients had a poor prognosis on admission. Of the 23 patients who were continued on life support for the duration of their hospitalization, ten had a poor (p < .001) prognosis on admission. Prognosis improved for two patients from the first group and five from the latter. Family's assessment of prognosis agreed with physician's assessment in 22 of the 24 patients from whom life support was discontinued (p < .001). Physicians' ability to convey the prognosis appeared to influence families' assessments. Physicians' considerations in recommending limitation of care and families' considerations in making decisions were the same, primarily an inevitably poor prognosis. Neither physician nor families cited cost or availability of care as a deciding factor. Two families disagreed with the recommendation to limit care after initial agreement because the patients' prognosis improved from "likely death" to "vegetative." Care was therefore continued, and both patients remained vegetative 6 months after admission to the hospital and discharge to chronic care facilities. CONCLUSIONS: Life support is commonly withheld or withdrawn from patients with severe head injury at San Francisco General Hospital, and usually it is accompanied by death. A reciprocal consideration exists in most cases between the physician and family making the difficult decision to limit care. Care is provided for patients whose families request it despite physician recommendations.

Adolescent↗
PubMed1995

Diagnosis of congenital pericardial defects, including a pathognomic sign for dangerous apical ventricular herniation, on magnetic resonance imaging.

OBJECTIVE: To establish criteria for the accurate diagnosis of different forms of left sided pericardial defects on magnetic resonance imaging. Early detection of a partial apical defect is essential as it is potentially fatal. DESIGN: Examination of four children with congenital pericardial defects by magnetic resonance imaging, the results being compared with the features on conventional chest radiography and echocardiography and with published data. RESULTS: Magnetic resonance imaging improved the ability to diagnose and distinguish between complete and partial left sided pericardial defects. A deep myocardial crease was visualised in a patient with apical pericardial defect, indicating the risk of a life threatening ventricular strangulation. A prominent left atrial appendage was, in contrast to many reports, not a reliable sign for partial left sided pericardial defect. CONCLUSIONS: The various forms of congenital left sided pericardial defects cannot reliably be diagnosed in plain chest radiographs or on echocardiography. Their diagnosis and the distinction between partial and complete defects, however, is of clinical importance and can be accomplished more confidently by magnetic resonance imaging.

Adolescent↗
PubMed1995

Sequence analysis of the tumor necrosis factor gene in pediatric patients with autoimmunity.

Tumor necrosis factor-alpha (TNF) is a multifunctional protein hormone that contributes to host defense and perinatal immunologic development. Dysregulated TNF production, however, occurs during the pathogenesis of autoimmune diseases and may be inherent to their development. In animal models of autoimmunity, dysregulated TNF synthesis has resulted from mutations in TNF gene regulatory sequences, specifically those sequences involved in translational control of TNF gene expression. In this study, we have determined whether mutations in the TNF translational control sequences are present in pediatric patients with type I diabetes mellitus and connective tissue diseases. Blood samples were collected from 48 patients with connective tissue diseases, 32 patients with diabetes, and 29 controls. A 250-bp fragment of the translational control sequences present in the TNF 3'-untranslated region was amplified by the polymerase chain reaction, sequenced, and analyzed relative to the published TNF sequence. In this study, all patients and controls exhibited the normal sequence, with no insertions or deletions in the translational control motifs. We conclude that polymorphisms in the TNF 3'-untranslated region occur infrequently, if at all, in patients with diseases examined here.

Autoimmune Diseases↗
PubMed1995

[Standards in pediatric pacemaker therapy].

Despite differences between pediatric and adult pacing have narrowed, implantation procedures in children require special considerations. Patients are physically smaller, they often suffer from complex cardiac defects necessitating further open heart surgery procedures. As there are no pacemakers and only some electrodes designed specially for pediatric pacing, selection of appropriate systems is important. At this time we care for 18 patients with a mean age of 11.5 +/- 6.5 years (= 138.6 +/- 78.4 months, range 10 to 280 months). 50% of them received a permanent pacemaker because of surgically induced heart block, 33.3% because of congenital complete heart block and 16.7% because of sick sinus syndrome. Mean age at first pacemaker implantation was 57 +/- 42 months (Range 0 to 120 months). 72.2% of these children had their first pacing system implanted in the abdominal wall with an epicardial electrode, 27.8% had endovenous endocardial electrodes with subpectoral generator placement. 72.2% of our patients had already revisions of their pacing systems, mean longevity time of pulse generators were 36.8 +/- 21.8 months. Upgrading from single chamber pacing to physiological AV-sequential dual chamber pacing was performed at a mean age of 9.0 +/- 2.8 years (= 108.3 +/- 33.9 months, range 66 to 154 months). By reviewing our patient data we want to discuss present standards and guidelines of surgical pacemaker therapy in children and how to prevent potential complications.

Adolescent↗
PubMed1994

[(Neuro)muscular changes in the knee stabilizing muscles after rupture of the anterior cruciate ligament].

Recent data indicate that the function of the knee joint may be the result of a complex synergy between bones, ligaments, muscles and proprioceptive receptors in these structures. Therefore, it was the aim of this study to investigate if muscular changes could be found more than 5 years following ACL-injury and if there are therapy-dependent differences. 35 patients with ACL-reconstruction and 25 conservatively treated patients were studied. The thigh circumference was measured and in 5 randomly selected patients of each group additionally MRI cross-sections of both limbs were made. Using an isokinetic dynamometer and an EMG device the relation of strength, electrical activity and muscle size were analyzed. Only minimal differences in thigh circumference as well as in muscular cross sections were found between the uninjured and injured limb of both groups; however, the isokinetic torque and iEMG values showed significant differences. It may be assumed that the major reason for these results is a modified muscle fiber utilization in the ACL-injured limb, caused by a changed joint receptor afferent inflow or a compensation of the central nervous system to primary alterations of the muscle fibers.

Adult↗
PubMed1994

[Balloon dilatation of postoperative and congenital aortic isthmus stenoses].

From July 1987 to December 1992, 52 patients underwent balloon-angioplasty of aortic coarctation at three units of pediatric cardiology in Austria (Graz = 35 patients, Innsbruck = 15 patients, and Vienna = 2 patients). 35 patients had postoperative and 17 had native coarctation. Mean age at intervention was 7 10/12 years with 2 patients under 1 year and 5 patients over 18 years old. The mean relation balloon diameter-coarctation diameter was 2.6 +/- 0.9. The blood pressure gradient between upper and lower extremities decreased from a mean of 44 +/- 16 mm Hg to 15 +/- 13 mm Hg (p < 0.0001). The diameter of the stenosed segment was increased from 5 +/- 3 mm to 8.5 +/- 3.5 mm (p < 0.0001). Native coarctation showed a significantly better result in respect to decrease of the gradient (36 +/- 12 mm Hg) than did postoperative coarctations (25 +/- 19 mm Hg) (p < 0.03). 13 patients did not respond adequately to angioplasty. 10 patients out of this group had tubular narrowings and belonged to the group of postoperative coarctations, whereas localized stenoses in native coarctations gave the best results. Localized wall irregularities were found in 4 patients with native coarctation. Balloon angioplasty of postoperative and native coarctations in childhood and adolescence is a secure and effective means of treatment and should be considered as therapy of first choice. The best results can be found in the group of the circumscript type of stenoses in native coarctation, whereas long and tubular stenoses in the group of postoperative coarctations give less satisfying results.

Adolescent↗
PubMed1994

[Development of arthrosis after rupture of the anterior cruciate ligament. A comparison of surgical and conservative therapy].

Degenerative changes of the knee joint are a well-known problem after ACL injury. In this study two groups of patients, one treated with ACL reconstruction (OP group) and one with conservative treatment (non OP group), were compared with reference to the development of arthritic signs after a mean follow-up of 77.9 (+/- 7.5). X-rays, taken at the time of the diagnosis of the ACL rupture and at follow up, were rated according to the classification described by Fairbank: 20% of the patients in the OP group and 50% in the non OP group showed no degenerative changes. The number of severe changes (grade III) was higher in the non OP group (18%) than in the OP group (4.5%). For patients in the non OP group a significant correlation was found between sports activity and the development of osteoarthritis. Meniscus pathology was seen to be a factor promoting the development of degenerative changes, but a significant correlation could not be found for either group.

Anterior Cruciate Ligament↗
PubMed1994

[The treatment of fresh anterior cruciate ligament ruptures in relation to age and level of sports activity].

Due to its exposure as well as a lack of securing muscles the knee is the human joint with the higher incidence of traumatic injury. The aim of this retrospective study was to illustrate our five-year results following conventional and surgical therapy and to relate these results to the extent of sports activity enjoyed by the accident victim. Assessment was made according to subjective, objective and functional criteria. The surgical group consisted of 52 patients and the conventionally treated group 31 patients. Subjective assessment of the surgical group showed 65.5% of the patients to have very good or good results, as opposed to 32% for the conventionally treated group. When related to average overall sports activities and when using the Innsbruck Scors a significant change was seen in both groups. Surgical patients who participated in competitive or leisure sports showed better results.

Adolescent↗
PubMed1993

[Sports capacity after rupture of the anterior cruciate ligament--surgical versus non-surgical therapy].

Using a new rating system (Innsbruck Knee-Sports Rating Scale) 75 patients 5 to 6 years after ACL-injury have been compared to their sports activity (47 patients with ACL reconstruction and 28 conservative treated patients). Under the viewpoint of knee load and especially the demand on stability sports activities have been divided into 3 categories: High Risk, Low Risk and Non Risk Pivoting Sports. Operative therapy shows an advantage in High Risk Pivoting sports (e.g. soccer, basketball) and in Low Risk Pivoting (e.g. running, hiking) sports, expressed by fewer knee related symptoms and higher participation levels. In the Non Risk Pivoting category (e.g. swimming, cycling) good results could also be achieved by conservative therapy. The careful evaluation of each patient's sports activities is therefore an important factor in the decision for the right therapy on one hand, and for comparing the results of different therapy programs or patient collectives on the other.

Adult↗
PubMed1992

Ordering and administration of sedatives and analgesics during the withholding and withdrawal of life support from critically ill patients.

OBJECTIVE: To determine why and how sedatives and analgesics are ordered and administered during the withholding and withdrawal of life support from critically ill patients. DESIGN: Prospective case series. SETTING: Medical-surgical intensive care units at a county hospital and a university hospital. PATIENTS: Consecutive 1-year sample of 22 patients from whom life support was withheld or withdrawn in one intensive care unit at a county hospital and a random sample of 22 similar patients in the intensive care unit in the university hospital over the same period. MAIN OUTCOME MEASURES: Physicians and nurses were interviewed to determine their reasons for ordering and administering drugs, and medical records were reviewed to document amounts of drugs ordered and administered. RESULTS: Drugs were given to 75% of patients during withholding and withdrawal of life support. Patients who did not receive medication were comatose and considered incapable of benefiting from sedation and analgesia. The median time until death following the initiation of the withholding or withdrawal of life support was 3.5 hours in the patients who received drugs and 1.3 hours in those patients who did not (P, not significant). Physicians ordered drugs to decrease pain in 88% of patients, to decrease anxiety in 85%, to decrease air hunger in 76%, to comfort families in 82%, and to hasten death in 39%; in no instance was hastening death the only reason cited. The amounts of benzodiazepines and opiates averaged 2.2 mg/h of diazepam and 3.3 mg/h of morphine sulfate in the 24 hours before withholding and withdrawal of life support and 9.8 mg/h and 11.2 mg/h in the 24 hours thereafter (P less than .025 and P less than .001, respectively). CONCLUSIONS: Large doses of sedatives and analgesics were ordered primarily to relieve pain and suffering during the withholding and withdrawal of life support, and death was not hastened by drug administration.

Analgesics↗
PubMed1992

Report of twelve years experience in open study of Skinner herpes simplex vaccine towards prevention of herpes genitalis.

Three hundred and forty-seven subjects at risk for herpes genitalis were vaccinated with Skinner vaccine, NFUAc.HSV1.(S-MRC5), and were followed for an average duration of 2 years representing a total consortship of 664.4 years. Based on survey information obtained during this consortship, there were estimated to be 3076 recurrences which summated to 3.5 years total duration of disease and comprised at least 6794 lesions; there were an estimated 51997 episodes of intercourse including at least 241 episodes of unprotected intercourse in the presence of herpetic lesions. The rate of contraction of herpes genitalis was 6 of 54 consorts (11.1%) who received one vaccination and 7 of 293 (2.4%) who received two, three of four vaccinations. There was no evidence of physical or psychological side effects from vaccination.

Adolescent↗
PubMed1992

Metabolic and neuroendocrine indices one month after lateral hypothalamic area lesions.

Mature male rats received bilateral electrolytic lateral hypothalamic area lesions (LHAL) or were sham-operated fed ad lib (CON-ADLIB) or sham-operated pair-fed/gained (CON-PF) to LHAL rats. One month later all rats were sacrificed. Rats with LHAL were hypophagic and had reduced body carcass fat, testes, livers, epididymal fat pads (PADS), diaphragms (DIA), and body weight compared to CON-ADLIB. In the liver, LHAL rats incorporated more C14-U-glucose carbon (GLUCINC) into lipid and glycogen than both CON groups, but GLUCINC was similar among CON groups. In PADS, LHAL rats oxidized more glucose carbon (GLUCOX) than CON-ADLIB but less than CON-PF/PG. The latter showed greater GLUCOX than CON-ADLIB. In DIA, LHAL and CON-PF/PG showed reduced GLUCINC into glycogen vs. CON-ADLIB. Plasma glucose was similar among groups, but insulin was lower in LHAL and CON-ADLIB than in CON-PF/PG. Rats with LHAL had lower plasma T3 concentrations than CON-ADLIB, but similar T3 levels compared to CON-PF/PG. Several of the metabolic changes in LHAL rats could be due to hypophagia; however, four out of nine metabolic indices, glucose carbon incorporation into liver lipid and glycogen and epididymal fat pad lipid and oxidation, were significantly different from CON-PF/PG, i.e., they were independent of food intake. Possibly then, they are due to a lesion effect other than on feeding mechanisms. Some aspects of metabolism that were previously found to be altered 48 h after LHAL were recovered, whereas others apparently were not.

Adipose Tissue↗