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Biomedical subjects

E Deutsch

Publications and source records attributed to E Deutsch.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Expert testimony in malpractice suits].

As part of his professional activities, every physician has the right, and--if he is appointed by a court of law as an expert witness according to sec. 407 ZPO, 75 StPO--even the duty to write expert opinions. An expert witness has the same privileges not to testify as any other witness. The expert opinion has to contain only information about the basics and the standards of the expert's field as well as informing about the necessity of each step of the medical treatment. He is not up to the expert to answer legal questions or decide the question of negligence. In case of a culpable violation of the duty to provide a correct expert opinion, there may result a liability for a wrong expert opinion.

Clinical Competence↗
PubMed1995

[Legal liability in risk of suicide from the legal viewpoint].

The liability during the danger of a patient committing suicide has to be orientated on the discretion which is granted to the physician. The suicide must be specifically prevented during a clear danger of suicide or a tendency of a patient to harm himself. However, is there a lack of clear signs, the physician is granted more discretion. Physicians have to assess the risk in every individual case. Criteria for this assessment are the predictability and the possibility to prevent a suicide attempt. The patient has to be referred to psychiatric treatment when there are clear symptoms of a psychiatric illness.

Germany↗
PubMed1994

Myocardial uptake and kinetic properties of technetium-99m-Q3 in dogs.

UNLABELLED: We postulated that 99mTc-Q3, a cationic imaging agent, produces myocardial activity related to myocardial blood flow during myocardial ischemia and pharmacologic coronary artery vasodilation, and shows little or no myocardial redistribution over 4 hr after intravenous injection. METHODS: In six Group 1 dogs, the chest was opened, the left circumflex coronary artery was acutely ligated, and dipyridamole (0.32, 0.56 or 0.84 mg/kg) was infused into the right atrium, followed by 10 mCi of 99mTc-Q3. Myocardial blood flow was measured by radiolabeled microspheres. The animals were euthanized and 357 myocardial samples were assayed in a well counter for 99mTc activity. One week later, radiolabeled microsphere activity was counted and myocardial blood flow calculated. In nine Group 2 dogs, a variable occluder was placed around the left circumflex coronary artery and an ischemic level of circumflex blood flow was maintained constant over 4 hr as measured by an ultrasonic flow meter. Dipyridamole (0.56 mg/kg) was then infused into the right atrium followed by 10 mCi of 99mTc-Q3. Gamma camera images were acquired at 5, 15, 30, 60, 120 and 240 min following 99mTc-Q3 injection. Microsphere blood flow and endocardial biopsies (n = 6 dogs) were performed at 30, 60, 120 and 240 min following 99mTc-Q3 injection. RESULTS: In the Group 1 animals, 99mTc activity (y) was related to myocardial blood flow (x) from 0 to 6.1 ml/min/g by the relationship y = 0.83X + 0.18, r = 0.95, p = 0.0001. The scintigraphic ratio of myocardial perfusion defect zone counts-to-normal myocardial zone counts (0.54 +/- 0.05 at 30 min) remained constant over 4 hr, as did technetium counts from direct endocardial sampling. Scintigraphic count ratios allowed discrimination between perfusion defect and normal myocardial regions beginning at 5 min following 99mTc-Q3 injection. CONCLUSIONS: Over a range of myocardial blood flows from 0 to 6.1 ml/min/g, 99mTc-Q3 myocardial activity is related to myocardial flow at the time of tracer injection. Technetium-99m-Q3 shows no evidence of myocardial redistribution over a 4-hr period.

Animals↗
PubMed1994

Comparison of technetium-99m-Q3 and thallium-201 for detection of coronary artery disease in humans.

UNLABELLED: Technetium-99m-Q3 is a myocardial imaging agent that produces prompt myocardial visualization in humans. METHODS: In 19 patients with angiographic coronary artery disease, 2 patients with no angiographic coronary artery stenosis greater than 50% of the luminal diameter and 6 healthy volunteers, exercise and resting myocardial imaging were performed with 99mTc-Q3 and also with 201Tl. Technetium-99m-Q3 imaging began 15 min after injection at rest and with exercise, in a complete imaging sequence that required less than 100 min. RESULTS: Overall accuracy for coronary disease detection was 78% (21 true-positive or true-negative studies among 27 study participants) by tomographic thallium imaging versus 89% for 99mTc-Q3 tomographic imaging (p = ns). Accuracy for detection of individual coronary stenoses was 75% (61 true-positive or true-negative coronary segment classifications among 81 total coronary segments) for 201Tl imaging and 83% for 99mTc-Q3 imaging (p = ns). CONCLUSIONS: Technetium-99m-Q3 when used in a rest-exercise sequence that can be completed in 100 min appears to provide comparable diagnostic accuracy to 201Tl for overall coronary disease detection and detection of individual coronary artery stenoses.

Adult↗
PubMed1993

Radiation synovectomy revisited.

Radiation synovectomy is a potential weapon in the therapeutic armamentarium of nuclear medicine. It is an attractive alternative to surgical or chemical synovectomy for the treatment of rheumatoid arthritis. In this article the clinical results obtained with radiation synovectomy from the 1950s through 1992 are summarized and reviewed. Even after taking into account the paucity of well-controlled trials and rigorous clinical follow-up, it is clear that radiation synovectomy is efficacious in controlling the symptoms of rheumatoid arthritis. However, the procedure is not widely used because of concerns about leakage of radioactivity from the treated joint, and the resulting high doses that can be delivered to nontarget organs. New approaches to the preparation of radiolabeled particles for use in radiation synovectomy promise to minimize this leakage and thus allow the full potential of this important radiotherapy to be realized.

Arthritis, Rheumatoid↗
PubMed1993

Foetus protection in Germany: the Foetus Protection Act of 13 December 1990.

With the introduction of the Foetus Protection Act of 1990 Germany has taken the lead of those countries which put criminal sanctions on the use of types of reproductive medicine which appear to be immoral. This is not merely a symbolic law. A whole range of possible practices is singled out and declared to be punishable: Research on foetuses, doctors' participation in surrogate motherhood, cloning and also the blending of animals and human beings. The Foetus Protection Act's jurisdiction, however, is restricted to the Federal Republic of Germany.

Child Advocacy↗
PubMed1992

A new, general synthetic route to multidentate N,S ligands for use in technetium-99m radiopharmaceuticals. Preparation of diamido disulfur, diamino dithiol, and tripodal N3S3 prototypes. Comparative biodistributions of [99mTcvO-DADS]- analogues which contain 5,5,5- and 5,7,5-membered chelate ring systems.

A new, versatile synthetic route to a variety of tetradentate N2S2 and hexadentate N3S3 ligands for use in technetium-99m radiopharmaceuticals has been developed. The key reaction employs 1-(ethoxycarbonyl)-2-ethoxy-1,2-dihydroquinoline (EEDQ) for coupling an appropriate di- or triamine with S-protected thioglycolic acid. Selected DADS (diamido disulfur) and DADT (diamino dithiol) and analogues derived from ethanediamine-1,2 and butanediamine-1,4, as well as a tripodal N3S3 analogue, were synthesized in high yield. The labeling of DADS analogue ligands derived from butanediamine-1,4 (DADS-bn) with 99mTc results in a single radiochemical product, or the expected number of stereoisomeric products. FAB MS analysis, using 99Tc, indicates that DADS-bn ligands form a tetradentate 5,7,5-membered ring chelate system with the monooxo Tc(V) core: [TcO-DAD-bn]-. In rat biodistribution studies the DADS-en and DADS-bn complexes show very similar biological activity. Phenyl substituents on the 7-membered ring give rise to a 99mTc complex of increased lipophilicity, increased liver uptake, and minimal hepatobillary clearance. Thus, new classes of DADS ligand analogues which contain a 5,7,5-membered chelate ring system are readily synthesized and labeled with 99mTc to form stable complexes. The presence of the 7-membered chelate ring allows for facile introduction of pendant groups into the ligand system, and thus for a ready route to control the biodistribution of the resulting 99mTc radiopharmaceutical. The 99mTc labeling of the DADT analogues derived from butanediamine-1,4 provided to be erratic, despite the use of a variety of labeling techniques; the larger ring system of DADT-bn apparently does not favor the monooxo Tc(V) core and appears to generate a mixture of mono- and dioxo Tc(V) cores.

Amides↗
PubMed1992

Comparison of angiographic center and local site analysis of PTCA results in a multicenter angioplasty-restenosis trial. The M Heart Group.

We compared three methods of coronary stenosis (S) sizing in a multihospital PTCA restenosis trial: visual analysis by independent observers, single point caliper measurements, and quantitative coronary angiography (QCA). Cine films from 50 patients were submitted from the clinical site to the quantitative angiographic center, where visual analysis and computer quantitation were performed. Regression analysis revealed a correlation coefficient of .857 for caliper vs. QCA (p less than .0001) and .876 for visual observation vs. QCA (p less than .0001). No significant differences were found between any of the 3 methods for pre- or post-PTCA stenosis values. However, QCA yielded smaller PTCA changes in stenosis severity than either caliper or visual observation (p less than .05). Both caliper and visual methods correlated well with QCA in assessing stenosis size pre- and post-PTCA. Trained observers can visually assess lesion severity with accuracy approaching QCA. QCA is likely to be less expensive when compared to visual analysis by three experienced observers and should be the method used for estimating the results of PTCA in clinical trials.

Adrenal Cortex Hormones↗
PubMed1992

Synthesis and renal excretion of technetium-99m-labeled organic cations.

Organic cations are excreted more efficiently than organic anions in uremia suggesting superiority as renal imaging agents. In this study, three 99mTc-labeled cationic cyclam complexes were synthesized and their renal clearance quantified in rats. The complexes are cleared at a rate of about 2.5-3 times that of inulin and about 60% that of p-amino-hipurate. Inhibition of 99Tc-cyclam excretion by quinine indicates transport by the organic cation process. Comparative in vivo imaging experiments demonstrated that in normal rats 99mTc-cyclam reached peak renal activity 1.8 +/- 0.6 min after injection, a value intermediate between that for [131I]OIH (1.0 +/- 0) and 99mTc-MAG3 (2.8 +/- 0.6). In rats injected with the acute nephrotoxin cisplatin, the times to peak were lengthened with the relative order being 99mTc-cyclam > 99mTc-MAG3 > [131I]OIH. The results demonstrate that cationic complexes may be useful for renal imaging diagnostic applications.

Animals↗
PubMed1991

External fixation using microplates after laryngotracheal expansion surgery. An animal study.

Management of severe laryngotracheal stenosis requires treatment with open laryngeal surgical approaches. Performing the necessary anterior, and possibly posterior, incisions to expand the cricoid and tracheal rings causes instability of the segments. Placing an intraluminal stent has several disadvantages, ranging from injury of healthy tissue to airway obstruction. The availability of an external stent would avoid many of these complications. We performed expansion laryngeal surgery in dogs and explored the use of microplates for external fixation and determined the surgical outcome if no fixation is used. The results show that microplates are very effective in maintaining external fixation and that a need for placing an intraluminal stent when a posterior cricoid split is performed exists.

Animals↗
PubMed1991

Regulation of human interleukin-2 and interferon-gamma gene expression by suppressor T lymphocytes.

Concomitant with induction of interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) gene expression in human tonsil cells, mitogenic stimulation induces a transient activation of cells able to effectively suppress expression of these genes. Induction of IL-2 and IFN-gamma genes largely precedes appearance of suppressor cell activity, allowing expression of both genes to occur before strong down-regulation is exerted by activated suppressor cells. Suppressive activity induced in one cell population can inhibit IL-2 and IFN-gamma gene expression in another population from the same donor. The distinct nature of suppressor cells is supported by the absence of down-regulation of IL-2 gene expression in a helper cell line, MLA-144; yet, in these cells, negative control can be expressed when active suppressor cells are introduced. Our findings support the concept that actual levels of IL-2 and IFN-gamma gene activity are regulated to a large extent by the differential kinetics of activation of suppressor cells on one hand and of cells expressing the IL-2 and IFN-gamma genes on the other.

Antigens, Differentiation, T-Lymphocyte↗
PubMed1990

Influence of heparin therapy on percutaneous transluminal coronary angioplasty outcome in unstable angina pectoris.

The acute procedural outcome of percutaneous transluminal coronary angioplasty in 304 patients with unstable angina was retrospectively examined with respect to the influence of prolonged preprocedural intravenous heparin therapy. Clinical and angiographic success in 135 patients receiving heparin therapy for greater than or equal to 24 hours was 91% while such success was noted in 81% of patients not treated with heparin (p = 0.02). The incidence of immediate postprocedural thrombotic vessel occlusion was higher in the nonheparin group than in the heparin-treated group (8.3 vs 1.5%, respectively, p less than 0.01). In addition, the overall rate of thromboembolic target and branch or distal vessel occlusion was 12.4% in the nonheparin group and 1.5% in the heparin-treated group (p less than 0.001). Thus, prolonged preprocedural intravenous heparin administration in this well-defined group of patients with unstable angina resulted in an improved procedural success rate and a significant decrease in the risk of abrupt vessel closure. These observations are concordant with current understanding of the pathophysiology of unstable angina.

Aged↗