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D Steiner

Publications and source records attributed to D Steiner.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Radioiodine therapy of small, solitary autonomous adenomas].

AIM: In most cases of unifocal autonomous adenomas the indication of radioiodine therapy has so far been given only if the volume of the adenomas is > 8 ml, or if the Tc-Uptake is > 2% in combination with suppressed TSH incretion. We have investigated the question how far the indication of radioiodine therapy should be extended to other cases. METHODS: Between March 1993 and April 1994 we treated 11 patients who did not fulfil these criteria but suffered from thyreogenic complaints. RESULTS: After the radioiodine therapy, all the 11 patients improved evidently. CONCLUSION: We suggest extending the indication of radioiodine therapy in order also to treat small unifocal adenomas.

Adenoma↗
PubMed1996

Acute pulmonary embolism: value of transthoracic and transesophageal echocardiography in comparison with helical CT.

OBJECTIVE: The goal of this study was to prospectively compare the accuracy of transthoracic and transesophageal B-mode and Doppler echocardiography with helical CT for detecting acute pulmonary embolism. SUBJECTS AND METHODS: Thirty-five consecutive patients underwent transthoracic and transesophageal echocardiography and contrast-enhanced helical CT. Echocardiographic examinations were analyzed for indirect criteria, including increased main pulmonary artery diameter, tricuspid regurgitation, and dilatation of the right ventricular cavity, as well as for direct thrombus visualization. Sensitivity, specificity, and negative and positive predictive values were calculated. RESULTS: Pulmonary embolism was revealed by helical CT in 22 of 35 patients; in 11 of these 22 cases, central pulmonary embolism was seen. Transthoracic and transesophageal B-mode echocardiography failed to reveal pulmonary embolism in nine patients, two of whom had central pulmonary embolism. The sensitivity and specificity of the combination of both echocardiographic investigations were 59% and 77% respectively (82% and 92% for central pulmonary embolism). In three patients, pulmonary embolism was diagnosed by direct clot detection with transesophageal echocardiography. In two patients, only the indirect parameters indicated pulmonary embolism. Overall indirect echocardiographic parameters were characterized by a low sensitivity that ranged from 50% for tricuspid regurgitation to 21% for main pulmonary artery diameter. CONCLUSION: In comparison with helical CT, transthoracic and transesophageal echocardiography had limited accuracy for detecting pulmonary embolism.

Acute Disease↗
PubMed1994

Anaerobic pericarditis: case report and review.

Purulent pericarditis is uncommon and is rarely caused by anaerobic bacteria. We describe a 58-year-old man with purulent pericarditis secondary to infection with Bacteroides fragilis; the most likely source for the B. fragilis infection was subsequently found to be a ruptured appendix. His pericarditis eventually resolved after drainage of purulent fluid and treatment with antibiotics directed against B. fragilis. We also review 29 cases of anaerobic pericarditis previously reported in the English-language literature (we excluded those cases due to actinomyces). In 17 cases only anaerobic bacteria were isolated, while in 13 anaerobes were isolated with a mixture of facultative and/or aerobic bacteria. The cases were secondary to a contiguous focus of infection or occurred via hematogenous seeding. Treatment of both anaerobic pericarditis and purulent pericarditis due to aerobic bacteria entails adequate drainage and appropriate antibiotic therapy, and in all cases there should be a search for the source of the organism infecting the pericardium.

Appendicitis↗
PubMed1993

[My work place].

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Humans↗
PubMed1992

Microvascular ischemia-reperfusion injury in striated muscle: significance of "no reflow".

"No reflow" has been implicated as prominent phenomenon in microvascular injury associated with ischemia-reperfusion (I/R). The objectives of this study were 1) to elucidate the significance of no reflow in microvascular I/R injury of striated muscle and 2) to determine whether reactive oxygen metabolites play a role in the development of postischemic no reflow. By use of the hamster dorsal skinfold preparation and intravital microscopy, microvascular perfusion of capillaries and postcapillary venules of striated muscle was quantitatively assessed before and 30 min, 2 h, and 24 h after 4 h of tourniquet-induced ischemia. I/R was characterized by a significant reduction (P < 0.01) in functional capillary density to 35% of baseline values during initial reperfusion, with incomplete recovery after 24 h (n = 9). In addition, capillary perfusion was found to be extremely heterogeneous, and wall shear rate in postcapillary venules was significantly decreased (P < 0.01). Treatment with either superoxide dismutase (SOD; n = 9) or allopurinol (n = 9) resulted in maintenance of capillary density of 60% of baseline (P < 0.05). Furthermore, I/R-induced capillary perfusion inhomogeneities and decrease of wall shear rate in venules were attenuated significantly (P < 0.01) by SOD and allopurinol. Thus part of capillary perfusion disturbances during I/R in striated muscle may be caused by increased postcapillary vascular resistance, probably mediated by reactive oxygen metabolites. However, the fact that in SOD- and allopurinol-treated animals 40% of the capillaries were still found to be nonperfused indicates that mechanisms other than oxygen radicals play an important role in the development of postischemic no reflow.

Allopurinol↗
PubMed1992

Microvascular ischemia-reperfusion injury in striated muscle: significance of "reflow paradox".

Ischemia-reperfusion (I/R)-induced microvascular injury is characterized by capillary "no-reflow" and reflow-associated events, termed "reflow paradox," including leukocyte-endothelium interaction and increase in microvascular permeability. The major objectives of this study were 1) to elucidate the significance of reflow paradox after 4 h of tourniquet-induced ischemia in striated muscle and 2) to determine the role of reactive oxygen metabolites in the pathogenesis of reflow paradox-dependent microcirculatory alterations. By use of in vivo fluorescence microscopy in a striated muscle preparation of hamsters, leukocyte-endothelium interaction in postcapillary venules and macromolecular extravasation from capillaries and venules were quantified before ischemia and after 30 min, 2 h, and 24 h of reperfusion. I/R elicited marked enhancement (P < 0.01) of leukocyte rolling during initial reperfusion and a 20-fold increase of leukocyte adherence (P < 0.01) lasting for the entire postischemic reperfusion period (n = 7). These phenomena were accompanied by significant leakage (P < 0.01) of macromolecules from capillaries and in particular from postcapillary venules (n = 9). Both superoxide dismutase (SOD, 20 mg/kg body wt, n = 7) and allopurinol (50 mg/kg body wt, n = 7) were effective in attenuating I/R-induced leukocyte rolling and adherence. In addition, microvascular leakage was significantly reduced by allopurinol (n = 9) and completely abolished by SOD (n = 9) (P < 0.01). These results support the concept that reactive oxygen metabolites contribute to I/R-induced reflow paradox, resulting in leukocyte accumulation, adherence, and increase in microvascular permeability.

Allopurinol↗
PubMed1992

Anatomical study of the blood supply in the human shoulder region.

The blood supply of the shoulder muscles, ligaments and joint capsule was investigated by injection of silicone rubber into the arteria subclavia of postmortem cases. We show that the a. suprascapularis forms important anatomoses with other arteries in the region and is of greater importance for the blood supply of the rotator cuff as hitherto believed. We also describe the a. subcoracoidea as a so far unknown branch of the a. axillaris.

Axillary Artery↗
PubMed1992

Evaluation of humoral responsiveness in children.

The evaluation of postvaccine antibody responses can provide a reasonably convenient and useful adjunct to the evaluation of possible humoral immune dysfunction syndromes. In patients whose clinical history is suspicious for an antibody deficiency syndrome, such studies can document normal antibody responsiveness. On the other hand the wide age-dependent variation in antibody responses makes careful interpretation necessary in concluding that a patient falls outside the "normal" pattern of antibody responsiveness. Finding a patient well below the mean values for age for multiple vaccines in concert with an appropriate clinical history would strongly suggest an abnormality of immune regulation. At this time the finding of abnormal antibody responses does not always imply that intervention with immunoglobulin therapy is indicated or that it would lead to improvement in clinical symptoms. It might help justify prophylactic antibiotic programs, however, similar to those used for recurrent otitis media. Interpretation of antibody responses in children younger than 2 years of age is probably hazardous since many patients may have relative retardation in their normal development of polysaccharide antibody responsiveness. Such patients usually develop a normal response as they grow older and do not need long term therapy. Until new technologies for measuring immune competence are developed, the above-mentioned measures of humoral immunity, when combined with clinical judgment, should be adequate to guide clinical decision-making in most cases.

Adolescent↗
PubMed1991

[Indoor hockey: injuries and prevention].

Frequency and mechanisms of injuries in women's indoor-hockey are evaluated in a retrospective study of 89 players. Each athlete sustains 1.1 injury per season on the average. The goalkeeper's risk is about three times as high as that of the outfield players. The risk during match exceeds the risk during practice by a factor of 20. The most common site of injury is the lower limb (55%), 39% are related to the upper limb, 5% to head and trunk. Half of the lesions are caused by ball and stick, they involve especially hands and fingers. The facts allow to draw conclusions concerning preventive measures. The players must be protected by better equipment, special exercises and further development of the rules.

Adolescent↗
PubMed1991

Depression in the elderly. Characteristics and clinical management.

Major depression and clinically significant depressive symptoms occur commonly in the community-dwelling, medically ill, and institutionalized elderly. Both major depression and depressive symptoms need thorough evaluation and treatment because of the significant morbidity and mortality associated with these syndromes. Depression may be difficult to diagnose, especially in the medically ill elderly, because of the masking of depressive symptoms by somatic complaints or the presumption that symptoms are attributable to concurrent medical illness. Therefore, the clinician must be alert to the possibility of depression in the elderly patient. Although no specific diagnostic test is available, rating scales can be useful in screening for depression in the elderly patient. It is necessary to rule out medical illness or medications as contributing factors to depression. Psychotherapy and psychopharmacology, alone or in combination, are effective treatments for most elderly patients with depression. ECT is a safe and effective treatment for major depression in this population. Depression in the elderly is potentially a chronic and relapsing illness with significant associated medical and social morbidity. Because of their frequent contact with the elderly, nurses play a particularly important role in the diagnosis and treatment of depression. They need to recognize typical and atypical symptoms of depression and must be familiar with the potential side effects of antidepressant treatment. Close monitoring for these potential side effects can minimize disability. By working as a team with physicians, psychologists, and others, nurses have a necessary role in the care of the elderly depressed patient.

Aged↗
PubMed1991

Anaphylaxis and desensitization to the murine monoclonal antibody used for renal graft rejection.

The murine monoclonal antibody muromonab CD3 is currently used to reverse acute renal graft rejection. We report a case of systemic anaphylaxis during a muromonab CD3 infusion despite pretreatment with systemic antihistamines and corticosteroids. Rapid intravenous desensitization was performed the following day without untoward reactions and daily muromonab CD3 infusions were successful in reversing renal graft rejection. A second rapid desensitization to CD3 was performed 1 month later without any complications. Serum muromonab CD3-specific IgG and IgE antibodies were detected in serum samples obtained after the anaphylactic reaction. The anaphylactic reaction to muromonoab CD3 monoclonal antibody could have been due to allergen-specific antibodies noted in postreaction serum or a cross-reactive antibody to mouse antigens or both. More importantly, this case illustrates that rapid desensitization can be performed successfully without serious complications; therefore, systemic anaphylaxis can develop in susceptible atopic individuals receiving muromonab CD3 monoclonal antibody for renal graft rejection.

Adolescent↗
PubMed1990

Copper in silicon.

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Journal Article↗
PubMed1990

[Chronic impingement syndrome of the shoulder].

The most common manifestation of periarthritis of the shoulder is the chronic impingement syndrome, which represents an "entrapment situation". When the arm is raised, the supraspinatus tendon that forms part of the rotator cuff, comes into contact with the coracoacromial arch. The complains can often be improved by conservative treatment. If, however, the problem persists--in about 10 to 20% of the cases--surgical decompression of the coracoacromial arch by resecting the coracoacromial ligament and the subacromial bursa is indicated. This limited intervention carries only a low risk and, as studies have shown, has such a high rate of success that, in the individual case, the indication for surgery can be established earlier than has so far been assumed.

Bursa, Synovial↗