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Biomedical subjects

C Moll

Publications and source records attributed to C Moll.

At least 19 recordsLinked to original sources
PubMed2006

[More haste less speed].

A 36 year old Portuguese man was admitted to our hospital with diffuse malaise, 25 kg weight loss in the past 6 months and night sweats. The diagnostic workup revealed hyperthyroidism due to graves disease and a mass lesion in the upper anterior mediastinum. Because of the uncertain dignity of the tumor a thoracoscopic thymectomy was performed. Histologically we found a thymic hyperplasia without any signs of malignancy. If systematically searched, thymic hyperplasia is often found with graves disease, however, this association is not widely appreciated and is not mentioned in general text books. The pathophysiology of thymic hyperplasia in graves disease is not fully understood. Immunological mechanisms seem to play an important role, since TSH receptors have been found on human thymic epithelial cells. Thyreostatic therapy leeds to spontaneous shrinkage of the thymic gland. Awareness of thymic hyperplasia in the differential diagnosis of an anterior mediastinal mass lesion is essential, since it prevents further invasive diagnostic procedures that might cause unnecessary morbidity.

Adult↗
PubMed2005

Anti-infectious prophylaxis after splenectomy: current practice in an eastern region of Switzerland.

Overwhelming post-splenectomy infection (OPSI) is a long-term risk in asplenic patients, which may be minimised by appropriate preventive measures. In this survey anti-infectious strategies after splenectomy were evaluated in an eastern part of Switzerland. We found 91 individuals in the canton of Thurgau, who underwent splenectomy between 1998 and 2003. We assessed adherence to vaccination guidelines, the use of antibiotics and the awareness of the infectious risks by review of hospital charts and by structured interviews with patients and their general practitioners. The total vaccination rate was 64/91 (70%). 6 patients were vaccinated pre-operatively, 50 during the hospital stay and 8 after discharge by the general practitioner. 64 received vaccination against pneumococci, 6 against haemophilus influenzae and 3 against meningococci. Although 39 died during the study period, none died of overwhelming sepsis. None of the patients received a booster vaccination. Prophylactic long-term antibiotics were given to 2 children but to none of the 89 adults. Three adults had a supply of stand-by antibiotics at home. Less than half of the patients who were interviewed knew that asplenia puts them at greater risk for life-threatening infections and few practitioners were aware that travel and animal bites pose a special threat. We conclude that after splenectomy vaccination discipline and patient education should be substantially improved and suggest the publication of comprehensive guidelines.

Adolescent↗
PubMed2004

[Cutaneous oxygen supply. With special consideration of skin uptake of oxygen from the atmosphere].

Oxygen reaches the skin from the blood as well as from the atmosphere. The diffusion gradient is a key factor in oxygen delivery. Measurements with puncture electrodes show a maximum oxygen partial pressure on the skin surface and a minimum in the deeper dermis. Non-invasive measures show that oxygen uptake depends on location. Assuming the oxygen consumption is 0.276+/-0.029 ml O(2).100 g(-1).min(-1) (37 degrees) and no oxygen is removed by capillaries, then the skin can be supplied by atmospheric oxygen to a depth of 0.25 to 0.40 mm, well into the dermis. Only the deeper dermis receives oxygen from the blood. The stratum corneum is a significant barrier to diffusion from the atmosphere. When this barrier is damaged, the oxygen diffusion increases Keratinocytes in culture proliferate in response to increased oxygen pressure; the same mechanism may explain epidermal hyperplasia following stratum corneum damage in vivo.

Blood Gas Monitoring, Transcutaneous↗
PubMed2004

Chronic necrotizing pulmonary aspergillosis complicated by pneumothorax.

A 61-year-old man presented with left-sided pneumothorax. On the chest computed tomograghy (CT), severe bilateral emphysema and left-sided pleural thickening were seen. His pneumothorax was drained with a chest tube. Because of a persistent air leakage, video-thoracoscopic wedge-resection of the suspected fistula and muscle-sparing minithoracotomy with extensive wedge resections of the left upper lobe were performed. Biopsy specimens showed micronodular mycetomas with septate hyphae highly suggestive of Aspergillus. The fungus destructed the lung tissue without vessel invasion. The patient had not been taking immunosuppressant drugs and had no prior opportunistic infections. Itraconazole was begun, the lung was expanded and the patient recovered. We propose that extensive resection of affected lung tissue in combination with long-term antifungal therapy with itraconazole is a valuable therapeutic option in patients with a complicated course of chronic necrotizing pulmonary aspergillosis (CNPA).

Antifungal Agents↗
PubMed2004

[Bavarian mammography screening: results of consistency tests in X-ray units over three months].

PURPOSE: To find out whether the quality requirements in daily, weekly or monthly tests of the "European protocol for the quality control of the physical and technical aspects of mammographic screening (EPQC)" can be maintained when screening the population of a large area. Furthermore, to check the specific tolerances of different test positions given by the EPQC for redundancy and statistical correlation. MATERIALS AND METHODS: Daily test images were obtained with an additional exposition of a sensitometric step wedge according DIN 6868 - 2. Weekly densitometry and visual inspection were performed at the University of Applied Sciences, Cologne. RESULTS: All units were able to maintain basic requirements on image quality as long as films of the same batch number were used. Some tolerance requirements of the EPQC are inconsistent and redundant. CONCLUSION: The occasionally considerable fluctuations of film processing require a daily check on the processing conditions. Daily test images of the units are only obligatory in the first 4 to 5 weeks of a new operation. All test results should be analyzed retrospectively in an independent test laboratory with emphasis on the statistical behavior of the unit. The tolerances prescribed by the EPQC are not always consistent and should be adapted to today's scientific standard when applied in mammography screening centers.

Female↗
PubMed2004

Effects of localized cutaneous vascular alteration on reactive hyperemia.

BACKGROUND: Cutaneous microcirculation shows a distinctive spatiotemporal inhomogeneity. Therefore provocation tests are necessary to receive significant and reproducible data. The present study investigated the effect of localized cutaneous vascular alteration, like in psoriasis vulgaris, on different parameters of reactive hyperemia (peak capillary blood cell velocity [pCBV], postocclusive reactive hyperemia [PRH%], and time to peak capillary blood cell velocity [tpCBV]). MATERIAL AND METHODS: Psoriatic plaques and normal skin on the contralateral side of 20 patients with psoriasis vulgaris were examined by Laser Doppler Anemometry. Capillary blood cell velocity was measured before suprasystolic occlusion and during postocclusive hyperemia. RESULTS: Compared to normal skin psoriatic plaques showed a significant increase of peak capillary blood cell velocity (pCBV, normal skin: 0.89+/-0.23 mm/s, psoriatic plaque: 2.03+/-0.94 mm/s), resting capillary blood cell velocity (rCBV, normal skin: 0.43+/-0.12 mm/s psoriatic plaque: 0.72+/-0.20 mm/s) and postocclusive reactive hyperemia (PRH%, normal skin: 107%, psoriatic plaque: 180%). The time to peak capillary blood cell velocity (tpCBV) during reactive hyperemia did not change significantly. CONCLUSION: In reactive hyperemia, changing of pCBV and PRH% combined with unaltered tCBV indicate a dysfunction of cutaneous microcirculation. In contrast acute closure of upper and lower arterial extremity show a changed tCBV with stable pCBV and PRH%.

Blood Flow Velocity↗
PubMed2003

Fibrinogen adsorption--a new treatment option for venous leg ulcers?

The initial element in the causation of venous ulceration is a disturbance of venous blood flow that leads to an increase in venous pressure. Eventually, however, it is the microcirculatory consequences of venous hypertension that lead to trophic skin changes and finally to ulceration. A reduction in blood viscosity results in an improvement at the microcirculatory level. The elimination of fibrinogen from plasma improves blood viscosity. This case report concerns a 75-year-old woman with venous ulcers of both legs (left lower leg: deep ulceration with a surface area of 3 x 5 cm; right lower leg: superficial, confluent ulceration with a total surface area of 5 x 10 cm). The patient underwent 20 sessions of fibrinogen adsorption, while simultaneously continuing with a regimen of conservative measures (activated charcoal cloth dressing with silver, calcium alginate dressings and short-stretch compression bandages). Following binding to a peptide (Gly-Pro-Arg-Pro-Lys), fibrinogen and fibrin were specifically removed from the patient's plasma: her fibrinogen concentration was lowered from an original mean level of 310 mg/dl (SD +/- 104 mg/dl) to 136 mg/dl (SD +/- 54 mg/dl), and there was no return to the baseline concentration by the time of the next fibrinogen adsorption session. In response to this treatment the patient's ulcers healed rapidly within 9 weeks. Dizziness and hematomas at the vascular access sites in both antecubital fossae were reported as adverse effects. A fall in hematocrit was also noted (before treatment 37% +/- 1%; after treatment 35% +/- 2%). This may have been caused by hemodilution due to the procedure and to cell losses during blood-plasma separation, a phenomenon that is known to occur during apheresis. This case report suggests that fibrinogen adsorption is low in adverse effects and is a useful addition to the range of treatments available for ulcers of venous etiology.

Adsorption↗
PubMed2000

Comparative genomic hybridization of fine needle aspirates from breast carcinomas.

Detailed knowledge of chromosomal aberrations in a specific tumor may facilitate the development of individually tailored chemotherapy, hormone or gene therapy. Unfortunately, karyotype analysis requires living cells and is complicated by the low number of good metaphase spreads obtained. Comparative genomic hybridization (CGH), however, is capable of detecting and mapping genome-wide amplifications and deletions using an equimolar mixture of normal and tumor cell DNA. We show here that even the few cells from a fine needle aspirate of a tumor are sufficient for a direct CGH assay, independent of DNA amplification. Ten primary breast cancers were analyzed by CGH. A fresh frozen fine needle aspirate and a formalin-fixed and paraffin-embedded section were used for each tumor. Metaphases from each CGH reaction were imaged, and a sum ratio profile was determined for every chromosome. The ratio profiles of DNA isolated from the 2 material sources were then compared. Fine needle aspirates and the paraffin-embedded material of a single tumor yielded the same fluorescence ratio profiles, albeit with slightly different confidence intervals. Different tumors showed a variety of aberrations. The most frequently observed changes were 1q+, 8q+, 14q-, 16p+, 16q-, 17p-, 17q+, 19q+, 20q+, 21q- and 22q-. The ability of CGH to assess chromosomal changes in breast cancer from fine needle aspirates could facilitate genetic evaluation of tumors prior to surgery.

Adult↗
PubMed1999

Interactive MR-guided biopsies of maxillary and skull-base lesions in an open-MR system: first clinical results.

The purpose of this study was to explore the potential of interactive MR-guided biopsies in the maxillary and skull base region using a 0.5-T open-configuration scanner in patients with tumours affecting the maxilla or skull base. Ten patients with cystic or solid tumours affecting the maxillary and skull base regions underwent MR-guided biopsy in a superconducting, open 0.5-T MR system equipped with an optical frameless stereotaxic system. T2-weighted spin-echo images were acquired prior to and following biopsy, which was performed with 18- or 22-G needles using an enoral or percutaneous approach following infiltration of the skin, mucosa and periosteum with local anaesthetics. The position of the needle tip was continuously updated on fast T1-weighted gradient-recalled-echo images (TR 19 ms, TE 7.1 ms, flip angle 30 degrees, slice thickness 1 cm, field of view 24 x 24 cm) using the frameless stereotaxic system. In addition, the needle was identified based on the associated susceptibility artefact in all three planes. Once the target lesion had been reached, cytology material was aspirated. All ten patients tolerated the interactive MR-guided biopsies well without complications. Vital structures, including the brain, neurovascular bundles, vessels and eyes, were visualized on MR imaging and could be spared. There was no difference in the use of 18- or 22-G non-ferromagnetic needles concerning the susceptibility artefact. Sufficient material for cytological analysis was obtained in nine of ten cases. The mean biopsy time was 15 min. Interactive MR-guided biopsies of the head and neck in an open system are technically feasible and safe. Monitoring of the needle path in multiple planes permits the interactive adjustment of the needle course in near real time. Interactive MR-guided biopsies may well replace open surgical procedures in the maxillary region in selected patients.

Adult↗
PubMed1997

Pneumocystis carinii infection of the conjunctiva in a patient with acquired immune deficiency syndrome.

BACKGROUND: Ocular disease, especially the development of choroidal lesions, is a known extrapulmonary manifestation of Pneumocystis carinii infection in the acquired immune deficiency syndrome (AIDS). To our knowledge, conjunctival involvement due to P. carinii has not been described previously. METHODS: The authors describe a 33-year-old homosexual male with AIDS in whom a large placoid, white lesion developed involving the tarsal conjunctiva of the right upper lid. Conjunctival malignancy was suspected and biopsies and swabs were taken. At this time, the patient had been receiving monthly aerosolized pentamidine prophylaxis for 18 months, and there was neither a history of pneumonia nor any clinical signs of disseminated infection due to P. carinii. RESULTS: Histopathologic examination results of the conjunctival biopsy specimen showed a necrotic, frothy tissue surrounded by activated fibroblasts. Within this material, Gomori methenamine silver stains showed numerous round and cup-like cysts of P. carinii, confirming the diagnosis that had already been obtained by an indirect fluorescent-antibody stain of a conjunctival smear specimen. CONCLUSIONS: The presence of white placoid conjunctival lesions in a patient with AIDS may indicate an infection due to P. carinii. Conjunctival disease due to P. carinii widens the spectrum of AIDS-associated ophthalmic pneumocystosis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Detection and typing of human papillomavirus in biopsy and cytological specimens by polymerase chain reaction and restriction enzyme analysis: a method suitable for semiautomation.

Screening for high-risk human papillomavirus (HPV) types allows the detection of women at a high risk of cervical squamous carcinomas, thereby defining a subset of patients targeted for more intensive screening and follow-up. Thirty-four cervical biopsy specimens and isolated cells from cervical smears of normal women or women diagnosed with high-grade intraepithelial lesion (HGSIL) were screened for the presence of HPV by in situ hybridization (ISH) and/or by polymerase chain reaction (PCR). The exact HPV type was determined using a novel restriction typing method. The detection of HPV was facilitated greatly by the use of a PCR-enzyme-linked immunosorbent assay (ELISA)-based method. HPV was detected by PCR in 32% of the biopsy specimens, whereas only 23% had a positive staining by ISH. In one case, a double infection was detected by ISH as well as by PCR. In two cases, the presence of HPV was detected by both methods but the exact type was different. Analyzing cells isolated from cervical smears by the PCR-ELISA technique or by PCR followed by agarose gel electrophoresis, HPV was detected only in patients with HGSIL and not in the control group. The PCR system is more sensitive than conventional ISH, and the PCR-ELISA system presented in this study is efficient in screening large series of cytological samples. Furthermore, this system allows exact HPV typing on the microtiter plate. These innovations may allow the application of HPV detection and typing as a routine screening method to identify patients with a high risk of developing cervical neoplasia.

Automation↗
PubMed1996

Glucocorticoid-sensitive hereditary inclusion body myositis.

We report a hereditary muscle disorder with features of inclusion body myositis (IBM) in two adult sisters with slowly progressive asymmetrical muscle weakness. The findings of light microscopic and ultrastructural investigations of muscle biopsy specimens were consistent with a diagnosis of IBM. Both patients improved and stabilized on immunosuppressive treatment with corticosteroids and azathioprine. This differentiates our patients from other sporadic and familial cases of IBM. Clinical and histological features are described and compared with those of other previously reported families with IBM.

Female↗
PubMed1996

Intratemporal facial nerve perineurioma.

Forty-two cases of perineurioma have been reported in the literature. This report adds the first intratemporal facial nerve perineurioma to the literature and reviews the others. Unlike schwannoma and neurofibroma, the histological features of perineurioma demonstrate onion bulb-like structures with a strong positive immunoreactivity for epithelial membrane antigen. The clinical history of gradual facial nerve paresis was 15 years in the case presentation and the clinical diagnosis of tumor was overlooked.

Adult↗
PubMed1996

[Tumor cells in peritoneal irrigation fluid in conventional and laparoscopic surgery for colorectal carcinoma].

BACKGROUND: In minimal invasive cancer surgery port-side metastases are observed. The most plausible theory of there development is by tumor cell contamination during the operation. This prospective controlled study was designed to evaluate the moment of liberation of cancer cells, frequency of implantation and follow up after laparoscopically assisted and open resections. METHODS AND PATIENTS: The peritoneal cavity is washed out 4 times with 200 mls of Ringer' solution (at the beginning of the operation, after central ligation of the vessels, after mobilisation of the cancer and at the end). The aspirate is centrifuged and stained by Papanicolaou. Follow up is by the protocol of the swiss cancer study group. Up to now 71 patients (35 laparoscopical, 4 conversions, 27 open, 5 peritoneal carcinomatosis) have entered the study. RESULTS: Positive cytology was found in 4/35 laparoscopic and 5/27 open resections. Excluding the first wash out 1/35 (3%) and 3/27 (11%) respectively were positive, however, none at the end of operation. Only in 4/5 peritoneal carcinomatosis tumor cells were present in the final wash out. Median follow up of patients with positive cytology was 9,5 months [6-15] for laparoscopy and 8 months [2-11] for open surgery. Three from each group were followed more than 7 months. No recurrence or port-side metastasis was observed. In patients with negative cytology two cancer progressions were detected. DISCUSSION: The significance of free tumor cells for the development of implantation metastases is unclear. In 8/13 patients cytology was positive at the beginning of the operation, and only patients with a peritoneal carcinomatosis demonstrated cancer cells in the final wash out. In laparoscopy no cells were found in the second and one in the third wash out, resulting in a 1/35 risk of cancer cell liberation. Whether this patient will develop a port-side metastasis is unknown. He is followed for 8 months without tumor progression. We believe that a positive cytology alone cannot be the reason for implantation metastases. CONCLUSION: Using the minimal invasive technique for colorectal carcinoma resection liberation of cancer cells tends to be less compared with open surgery. For further conclusions the time of follow up is not yet long enough.

Adult↗
PubMed1996

[Intraperitoneal tumor seeding in colorectal carcinoma surgery--a comparison of laparoscopic versus open procedures in a longitudinal study]].

Tumor cell spread during laparoscopically assisted (n = 35) and open (n = 27) resections of colorectal cancer or patients with peritoneal carcinomatosis (PC) (n = 5) was studied by repeated lavage. Positive cytology was found in 3% during laparoscopy, 11% during open surgery and 80% in PC. We conclude that the risk of cancer cell mobilisation is minimal in laparoscopic surgery.

Adult↗
PubMed1995

Magnetic resonance imaging and intraoperative frozen sections in intratemporal facial schwannomas.

Seven cases of intratemporal facial schwannoma were assessed by preoperative magnetic resonance imaging (MRI) and intraoperative frozen sections to determine tumor boundaries. These results were then analyzed with respect to gross tumor appearance, under the operating microscope, and final histopathologic diagnosis, with immunostains. Gadolinium-enhanced MRI was helpful in planning the surgical and approach and in defining the extent of tumor involvement relative to the facial nerve. Frozen sections on the other hand were often unreliable in confirming the completeness of resection, frequently overestimating tumor infiltration. Ultimately, tumor-nerve interface, especially in the proximal facial segments, is best judged by its gross intraoperative appearance under high magnification, with the aid of MRI. The difficulty in establishing tumor infiltration in the presence of organized neutral fibers and artifacts is emphasized. Immunohistochemical assays are essential in this regard. Complete tumor removal was achieved in all seven cases, with acceptable functional outcome in those with sufficiently long follow-up.

Adolescent↗
PubMed1995

Carotid occlusion without reconstruction: a safe surgical option in selected patients.

Complete resection of extensive skull base tumors can be difficult when the disease involves or is closely related to the carotid artery. Detachable balloons have been used effectively to permanently occlude the carotid artery prior to anticipated surgical resection, but their use involves risk of significant cerebral complications. To better define the risks and benefits of this procedure, 52 patients who underwent balloon occlusion of the carotid artery followed by surgery with resection of a portion of the carotid artery were retrospectively reviewed. Pathologic findings are presented demonstrating the infiltrative nature of many of these tumors and the difficulty in separating histologically benign tumors from the carotid artery when they are closely related to it. Although vascular reconstruction can be considered whenever carotid occlusion or resection is planned, balloon occlusion without reconstruction can be safely performed in selected patients, avoiding unnecessary and hazardous additional surgery.

Brain Neoplasms↗