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Biomedical subjects

D Beck

Publications and source records attributed to D Beck.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Treatment of constipation and different laxative requirements in palliative medicine].

The significance of constipation with its variety of possible complications is often underestimated in the context of the tumour patient's complaints although difficulties in stool management are more common in patients with advanced cancer than in those with other terminal diseases. Without treatment constipated patients will suffer from nausea and emesesis and will possibly develop small bowel paralysis. About half of all patients admitted to specialist palliative care units report constipation, but about 75% of the patients will require laxatives. Unlike for pain, no generally accepted and widely disseminated management guidelines are available. Effective prophylaxis and cause-based therapy do improve the alimentary condition and can help to prevent the transition to ileus situations. Effective symptom management presupposes exact knowledge of the pharmacokinetics.

Cathartics↗
PubMed1999

Ovarian dysplasia in prophylactic oophorectomy specimens: cytogenetic and morphometric correlations.

BACKGROUND: Ovarian dysplasia, a potential precursor to ovarian carcinoma, has been described in ovarian tissue obtained by prophylactic oophorectomy and also adjacent to ovarian carcinoma. Women with a family history of ovarian carcinoma, especially those of Jewish Ashkenazi descent, often test positive for BRCA mutant genes. Prophylactically removed ovaries, generally described as normal on macroscopic examination, can exhibit a "preneoplastic phenotype" and unsuspected neoplasm. METHODS: Histologic slides of ovarian tissue from 54 Ashkenazi Jewish women were reviewed. All had a family history of ovarian carcinoma and all were tested for BRCA mutations. Forty-four women tested positive. Thirty-one women underwent prophylactic oophorectomy and 23 underwent oophorectomy for ovarian carcinoma. Normal, dysplastic, and ovarian carcinoma epithelial cells were analyzed morphometrically combining nuclear area measurements with chromatin texture assessment using a novel method based on the computation of autocorrelation coefficients and a derived parameter (Beta). Discriminant analysis between classificatory algorithms was used to obtain results. RESULTS: Ovarian dysplasia was identified in 77.6% of the prophylactic oophorectomy specimens. An unsuspected ovarian carcinoma was diagnosed in one prophylactic oophorectomy specimen. Of 10 women who underwent prophylactic oophorectomy and were negative for BRCA mutations, three had ovarian dysplasia. The average nuclear measurements of the dysplastic cells were similar to those published previously. The new autocorrelation-based method evaluating nuclear texture, as revealed by tridimensional surface plots, demonstrated high discriminatory potential. Discriminant analysis based on nuclear area and nuclear texture information resulted in the correct classification of nearly all the cases in the three diagnostic categories. CONCLUSIONS: Ovaries removed by prophylactic oophorectomy examined in their entirety often reveal ovarian dysplasia and occasionally ovarian carcinoma. The new morphometric method used was highly discriminatory in the evaluation of nuclear texture. Ovarian dysplasia in women with risk factors for ovarian carcinoma is significant in early ovarian carcinogenesis.

Adult↗
PubMed1999

Involvement of an anaesthetic department in terminal therapy.

The goal of hospital treatment in terminal therapy must be a functional integration of all modes of care including psychosocial support. Anaesthesiologists who practise pain management and critical care medicine are predestined to care for terminally ill patients and their families. An anaesthetic department can assume superordinate responsibilities within the organization of a palliative network coordinating inpatient and outpatient arrangements.

Journal Article↗
PubMed1999

The effect of the anastomotic size on gastric emptying after hemigastrectomy with Billroth II reconstruction.

OBJECTIVE: To determine if the size of the gastrojejunal anastomosis after Billroth II reconstruction was the rate-limiting factor in gastric emptying in the postoperative period. METHODS: Twelve mongrel dogs were randomized to have either 1.5 cm or 5 cm gastrojejunal anastomoses prior to Billroth II hemigastrectomy. Each dog had three solid and three liquid radiolabelled emptying studies pre- and postoperatively. Data were collected using a gamma camera. For liquid studies, images were obtained at 0 min, 2 min, 4 min, 6 min, 8 min, 10 min, 20 min, 30 min, 40 min, 50 min and 60 min. For solid studies, images were obtained at 0 min, 5 min, 10 min, 20 min, 30 min, 40 min, 50 min, 60 min, 70 min, 80 min, 90 min, 100 min, 110 min and 120 min. Means were compared by analysis of variance using the repeated measures option. RESULTS: Postoperative liquid emptying was significantly faster in the first 10 min with both 1.5 cm and 5 cm anastomoses compared with preoperative scans in the same animals (45% versus 20% and 48% versus 29%, respectively). On the other hand, solid gastric emptying was much slower postoperatively with the 1.5 cm anastomosis compared with preoperative scans (29% versus 65%) as well as compared with postoperative 5 cm anastomosis (29% versus 62%) at the end of 120 min. CONCLUSIONS: Our model suggests that the gastric emptying of solids is affected by the size of the gastrojejunal anastomosis and not by the diameter of the efferent limb of the small intestine following Billroth II reconstruction.

Anastomosis, Surgical↗
PubMed1999

Rifampin and rifabutin resistance mechanism in Helicobacter pylori.

Eighty-one clinical isolates of Helicobacter pylori showed no resistance to rifampin (MIC range, 0.032 to 2 microg/ml; MIC at which 50% of isolates are inhibited [MIC50], 0.25 microg/ml). The MIC50 of rifabutin was 0.008 microg/ml (n = 16). All resistant laboratory mutants of H. pylori ATCC 43504 showed amino acid exchanges in codons 524 to 545 or codon 585 of the rpoB gene, corresponding to the gene sequences from Mycobacterium tuberculosis and Escherichia coli.

Amino Acid Sequence↗
PubMed1998

A lack of neuroblastoma in Down syndrome: a study from 11 European countries.

An epidemiological investigation in 11 European countries comprising a total childhood population of 54.1 million children and using 8 separate data sources was conducted to evaluate the occurrence of neuroblastoma in Down syndrome (DS). No cases of DS were detected among 6724 infants and children with neuroblastoma, although more than five were expected. This highly significant result (P = 0.0045 according to the Poisson test) is consistent with data in the literature, which contains only two poorly detailed cases in epidemiological studies and one ganglioneuroma in a DS mosaic patient. Like other tumors, such as leukemias, testicular germ cell tumors and lymphomas are in excess in DS patients; the lack of neuroblastomas does not reflect a general decreased incidence of cancer but rather a specific underrepresentation of this precise tumor. S-100 b protein, the gene for which maps to the long arm of chromosome 21, (a) is overproduced in DS patients, (b) produces growth inhibition and differentiation of neural cells in vitro, (c) is abundant in good-prognosis neuroblastomas, and (d) has been shown to induce growth inhibition and differentiation and cell death in several human and murine neuroblastoma cell lines and could be responsible for this variation. Additional epidemiological and experimental studies are warranted to confirm our interpretation of these data.

Adolescent↗
PubMed1998

Spatial attention deficits in humans: a comparison of superior parietal and temporal-parietal junction lesions.

Although clinical evidence of spatial attention deficits, such as neglect and extinction, is typically associated with lesions of the right temporal-parietal junction, recent evidence has suggested an important role for the superior parietal lobe. Two groups of patients, selected for lesions at the temporal-parietal junction including the superior temporal gyrus (TPJ group), or for lesions involving the parietal but not the superior temporal region (PAR group), performed cued-target detection tasks in 2 experiments. An extinction-like response time pattern was found for the TPJ but not the PAR group. In addition, both groups were able to use expectancy information, in the form of cue predictiveness, suggesting that separate mechanisms mediate exogenous and endogenous processes during attention shifts.

Adult↗
PubMed1998

[What is the future of palliative medicine in Germany?].

Traditional medical treatment approaches for incurably and terminally ill persons are often felt by the patients and their families to be lacking, since distressing physical and spiritual symptoms of the disease cannot be adequately addressed. In many cases, care in the final stage of life represents a complex medical challenge whose objective is to maintain an individually sufficient quality of life for the patient. New strategies for therapy and care evolving out of the international hospice movement have entered medical training programs under the heading of palliative medicine. Although palliative medicine has only recently enjoyed increasing acceptance in professional as well as lay circles in Germany, it is widespread in many Anglo-Saxon countries, where it also is offered as an academic discipline in research and teaching. According to the most recent American legal interpretations, palliative treatment has been approved as a constitutional right for patients with severely debilitating symptoms. Against the background of sweeping social restructuring, demographic and tumor-epidemiological developments are exerting increasing pressure on our modern societies to improve treatment approaches for incurable patients. In the public itself a changed and more open treatment of the topics of death and dying is becoming apparent, resulting in a demand as well for medical treatment options. From all this, as well as the fact that Germany has been strongly hesitant to establish palliative medicine facilities, it is apparent that there is a clear need to catch up in the area of palliative medicine treatment, research and teaching. The current mood of fiscal restraint in health care may delay medical progress, but it will not be able to prevent it.

Euthanasia↗
PubMed1998

[Pain therapy in tumor patients and in palliative medicine. 2: Invasive measures].

Anesthesiological and neurosurgical methods in the treatment of cancer pain have to be considered as parts of a holistic approach. To treat cancer pain patients appropriately, an interdisciplinary setting is essential. In the eyes of experienced pain specialists as well as physicians in palliative medicine invasive procedures are only of minor importance. Their use has been steadily decreasing while neuromodulatory (e.g. intraspinal opioids) or stimulatory (e.g. TENS, DBS, SCS) methods gained wider acceptance. The only neurolytic procedure which still has some importance is the neurolysis of the celiac ganglion for alleviation of pain in the upper abdomen mostly due to pancreatic cancer. This approach seems to be highly effective and tends to be afflicted with only minor complications. Other neurolytic blocks have shown solely local and temporal efficacy. In their majority they are unprecise and often accompanied by severe complications. Therefore these procedures should be scheduled only after carefully weighing risk versus benefit. Where suitable, the use of neurolytics is replaced by radiofrequency thermocoagulation, to a lesser degree by cryoanalgesia. Both procedures normally do not yield better analgesia but do result in fewer complications. Physicians tend to treat pain as a completely somatic disorder, but chronic pain states are always bio-psycho-social in nature. In order to achieve an effective pain treatment all influencing variables have to be taken into account. Anesthesiological and neurosurgical procedures are only a part of the possible and necessary treatment options. Especially before using one of the invasive methods described here, it seems imperative to involve the patient in the process of decision making more closely than currently practiced.

Analgesia, Epidural↗
PubMed1997

Clinical relevance of CD44 cell surface expression and MYCN gene amplification in neuroblastoma.

This multicentric analysis of tumours obtained from 140 patients with neuroblastoma confirms that the lack of CD44 expression is a highly significant factor of poor prognosis and, as previously published in multivariate analysis of the four factors, i.e. MYCN amplification, CD44 expression, age and tumour stage, CD44 expression and tumour stage were the only independent prognostic factors of event-free survival (Combaret et al., J Clin Oncol 1996, 14, 25-34). Furthermore, CD44 analysis affords significant prognostic discrimination in subgroups of patients with or without MYCN amplified tumours, both in low-stage neuroblastomas and high-grade neuroblastomas. In the subgroup of patients with low-stage neuroblastoma and the stage 4 subgroup, CD44 was the only independent prognostic factor for the prediction of event-free survival in a multivariate analysis. In conclusion, CD44 is one of the most powerful factors for predicting clinical outcome in neuroblastoma at the time of initial staging.

Age Factors↗
PubMed1997

Particle size does not affect the rate of intracellular routing for ligands internalized by non-adsorptive pinocytosis.

The rate at which three different species of a fluid phase marker (horseradish peroxidase) reached the lysosomal compartment of mouse LM fibroblasts was compared. Initial observations suggested that the rate was a function of particle size. Adjustment of the concentrations of the various species of HRP to equal numbers of physical particles negated the apparent affect. Thus, particle size does not affect the intracellular routing of a ligand entering fibroblasts by non-adsorptive pinocytosis.

Animals↗
PubMed1997

NB87 induction protocol for stage 4 neuroblastoma in children over 1 year of age: a report from the French Society of Pediatric Oncology.

PURPOSE: NB87 was designed to test the efficacy of a short, non cross-resistant, induction protocol for unselected patients over 1 year of age with stage 4 neuroblastoma. A secondary objective was to compare in a randomized study the toxicity of two modalities of cisplatin administration. PATIENTS AND METHODS: A total of 183 patients received two cycles of alternating sequences: cyclophosphamide 300 mg/m2/d on days 1 to 5, vincristine 1.5 mg/m2/d on days 1 and 5, and doxorubicin 60 mg/m2/d on day 5 (CADO); and cisplatin 40 mg/m2/d and etoposide 100 mg/m2/d on days 1 to 5 (CVP), followed by surgery of the primary tumor (126 patients). Ninety-one were randomized to receive cisplatin either as bolus (BO; n = 48) or continuous infusion (CI; n = 43). International Neuroblastoma Staging System (INSS) and Response Criteria (INRC) were used with emphasis on skeletal evaluation by meta-iodobenzylguanidine (MIBG). RESULTS: Hematotoxicity was predominant, with a higher incidence of neutropenia (P = .01) for CADO and of thrombocytopenia for CVP (P < .001). Severe infections, as well as nonhematologic toxicities, occurred more often after the first sequence. Gastrointestinal complications were predominant during both courses of CVP. The toxic death rate, including surgery, was 3%. Complete remissions (CRs) were less frequent on MIBG (45%) compared with marrow (66%) or other metastases (61%). Combining all metastatic sites resulted in a 39% CR rate. After surgery, the final CR rate was 42%. Nephrotoxicity was minimal in both arms (92% normal clearance for CI v 82% for BO). Hearing loss greater than 40 dB at 6,000 to 8,000 Hz was reported equally in both arms (n = 6 for CI v n = 5 for BO). CONCLUSION: Intensified chemotherapy using CADO/CVP increases CR rates despite a shorter induction duration. However, the rate of MIBG normalization remains unsatisfactory and could be raised through the dose-intensive use of agents such as cyclophosphamide.

Adolescent↗
PubMed1997

Evaluating bone marrow metastasis of neuroblastoma with iodine-123-MIBG scintigraphy and MRI.

Of 10 patients with neuroblastoma who had both 123I-MIBG scintigraphy and MRI at diagnosis, four presented with bone marrow metastasis that was diagnosed by both imaging modalities and confirmed by bone marrow biopsy and smears. This report focuses on the follow up of the four patients with bone marrow metastasis. MIBG scintigraphy and MRI were concordant in two patients, a case of normalization and a case of relapse in the seventh dorsal vertebra confirmed by surgical biopsy. The last two patients presented a normalized MIBG scan for marrow infiltration after chemotherapy but persistent abnormal MRI signal of several vertebrae, suggesting marrow infiltration, up to 27 mo after the end of chemotherapy in one case. In the second patient, MRI bone marrow aspect returned to normal 4 mo after the end of chemotherapy. Bone marrow biopsy remained negative in these two MIBG-negative patients. These cases suggest that in presence of complete normalization of the MIBG scan after chemotherapy, the persistence of a hypointense signal on bone marrow on T1WI does not necessarily indicate persistence of disease but may be due to delayed normalization. Therefore, attention must be paid to the delay of signal normalization on MRI (which can be as long as more than 2 yr after the end of chemotherapy) in order to avoid false-positive interpretation.

3-Iodobenzylguanidine↗
PubMed1996

Truly late onset of eating disorders: a study of 11 cases averaging 60 years of age at presentation.

OBJECTIVE: To study late-onset cases of eating disorders in order to (1) document the occurrence of these cases as truly new onset, even if postmenopausal; (2) to alert clinicians to the category of late-onset eating disorders, especially clinical features and treatment response; (3) to challenge some prevailing assumptions of etiology. METHODS: Selection of cases of eating disorders with first onset after age 40 that met DSM-IV criteria, by review of eating disorders admissions to three university hospital programs. RESULTS: Eleven patients, approximately 1% of all cases of eating disorders, had first onset of an eating disorder after age 40 and as late as 77, with an average onset of 56 and clinical presentation at 60 years. They met DSM-IV criteria for all subtypes of eating disorders. In general, concurrent medical and comorbid psychiatric symptoms made recognition and treatment more complex. DISCUSSION: Truly late-onset cases do occur, challenging etiological theories requiring adolescent age of onset, premenopausal endocrine functioning, or adolescent psychodynamic conflicts. Late-occurring cases, after accurate diagnosis, require an appreciation of psychological themes pertinent to this age group, such as bereavement or unresolved body image issues. Age by itself is no barrier to onset of eating disorders, which may occur whenever self-starvation and/or binge-purge behaviors become entrenched as sustaining behaviors for amelioration of psychodynamic conflicts, mood disorders, or interpersonal distress.

Age of Onset↗
PubMed1996

Ocular hemodynamic effects of acute ethanol ingestion.

PURPOSE: Because the protean biological effects of ethanol include acute alterations in both cortical function and circulatory control, we investigated the effect of acute alcohol consumption on retrobulbar hemodynamics and contrast sensitivity in healthy human volunteers. SUBJECTS AND METHODS: Twelve young adults received orange juice with and without ethanol in a double-masked fashion. The ethanol dose was sufficient to raise blood alcohol to 0.07 +/- 0.003 g/dl. Retrobulbar hemodynamics were assessed at baseline and twice at elevated blood alcohol by color Doppler imaging. RESULTS: Acute elevation of blood alcohol lowered intraocular pressure from 13.0 +/- 0.7 to 10.7 +/- 0.7 mm Hg (p < 0.05). In contrast, elevated blood alcohol left peak systolic velocity, end-diastolic velocity and the resistance index constant in three retrobulbar arteries (ophthalmic, central retinal and posterior ciliary). For example, in the central retinal artery, peak systolic velocity, end-diastolic velocity and the resistance index averaged 11.0 +/- 1.3 cm/s, 2.8 +/- 0.4 cm/s and 0.75 +/- 0.03 before ethanol, as compared with 10.5 +/- 1.0 cm/s, 2.9 +/- 0.3 cm/s and 0.72 +/- 0.03 after ethanol (all p = NS). Alcohol ingestion also failed to alter either visual acuity or contrast sensitivity, as assessed under both photopic and mesopic conditions. CONCLUSIONS: Although ethanol has widespread cognitive and cardiovascular effects, at blood levels near legal definitions of intoxication we found it ineffective in altering either retrobulbar hemodynamics or contrast sensitivity.

Adult↗