Biomedical subjects

E Lang

Publications and source records attributed to E Lang.

At least 37 records · Page 2Linked to original sources

PubMed2001

Spontaneous extraperitoneal hemorrhage with hemodynamic collapse in patients undergoing anticoagulation: management with selective arterial embolization.

The authors report their experience with management of unstable spontaneous extraperitoneal hemorrhage (SEH) with selective transcatheter embolization. Five consecutive patients underwent angiographic evaluation for SEH complicated by hemodynamic collapse while undergoing anticoagulation therapy. Bleeding occurred via one or two lumbar arteries in psoas hematomas. Two abdominal wall hematomas were supplied by the inferior epigastric artery, with additional supply via the deep circumflex iliac artery in one. Microcoil embolization successfully controlled extravasation in all patients, with stabilization of hemodynamic parameters. Four of the five patients survived the immediate postprocedural interval. Selective transcatheter embolization may be a viable life-saving option in SEH-associated hemodynamic collapse.

Adult↗

PubMed2001

[Cross-over comparison of the pharmacokinetics of estradiol during hormone replacement therapy with estradiol valerate or micronized estradiol].

OBJECTIVE: The aim of this randomized cross-over study was the comparison between a sequential 28-day hormone replacement therapy (HRT) using micronized estradiol and a cyclic 21-day HRT using estradiol valerate with regard to the pharmacokinetics of estradiol. - MATERIAL AND METHODS: Fifty postmenopausal women were randomly assigned to be treated either with Trisequens(R) for 28 days or with Sisare(R) for 21 days. After a wash-out cycle, the women were treated for one cycle with the other preparation in a cross-over fashion. The pharmacokinetic profile of the serum concentrations of estradiol was measured on day 1, 21 and 28 each immediately before and 1, 2, 4, 6, 8, and 10 hours after intake of a tablet, and the AUC (area under the curve) was calculated. - RESULTS: The serum concentrations of estradiol increased from a mean of 10 pg/ml up to 40 pg/ml (Trisequens(R)) and 30 pg/ml (Sisare(R)) on day 1, and to 80 pg/ml (Trisequens(R)) and 60 pg/ml (Sisare(R)) on day 21, and declined to 40 pg/ml (Trisequens(R)) and 10 pg/ml (Sisare(R)) on day 28. The AUC as calculated from both treatment cycles, was significantly higher on day 1, 21, and 28 during treatment with Trisequens(R) than with Sisare(R). This difference was, however, not signifcant on day 1 and 21 of the first treatment cycle. - CONCLUSION: During treatment with 2 mg micronized estradiol the serum concentrations are significantly higher than with 2 mg estradiol valerate. On day 28 of treatment with Sisare(R), the estradiol levels decline to baseline values, while using Trisequens(R) they remain in the range of those measured on day 1.

Aged↗

PubMed2000

Influence of incubation temperature on activity of ligninolytic enzymes in sterile soil by Pleurotus sp. and Dichomitus squalens.

Solid state straw cultures of the white rot fungi Pleurotus sp. and Dichomitus squalens covered with a layer of sterile soil were incubated at 20 degrees C, 25 degrees C, 30 degrees C, and 34 degrees C. The activities of the extracellular enzymes laccase and manganese peroxidase (MnP) in the soil layers were measured over eight weeks. Pleurotus sp. produced high enzyme activity at low temperatures. Laccase was maximum at 25-30 degrees C and manganese peroxidase at 20 degrees C. D. squalens showed uniformly high levels of manganese peroxidase at 20-30 degrees C whereas at 34 degrees C, MnP was low and laccase showed an atypical time pattern. The discrepancy between low activity of the main enzyme, MnP, and high straw decomposition at 34 degrees C by D. squalens warrants further investigation of the enzyme inventory produced at that temperature.

Biodegradation, Environmental↗

PubMed2000

[Outcome quality of treatment for chronic low back pain under primary care conditions].

BACKGROUND: Little is known about the outcome quality of treatment for chronic low back pain under primary care conditions in Germany. METHODS: All physicians (2100) of middle Franconia, a region of Bavaria with 1.6 million inhabitants, involved in outpatient management were asked to include consecutively patients who suffered from low back pain of at least 4 weeks duration without decreasing intensity. Before and after a 6-month interval patients documented the following outcome data in a questionnaire: pain intensity during the last 24 hours (numerical rating scale), pain-dependent disability (Brief Pain Inventory, German version), health-related quality of life (SF-36, German version), depression (Allgemeine Depressionsskala), pain chronification state (Mainz Pain Staging System) and the days of inability to work within 3 months before start and end of the interval. Treatment of patients was not standardized and included the natural spectrum of non-surgical therapies for low back pain except multimodal pain therapy programs. RESULTS: Thirty-five physicians participated in the study. "Before and after" data of 157 patients (43+/-12 years) could be analysed. Initially 20% were classified in pain chronification state I, 57% in state II and 23% in state III. The pain intensity, pain-dependent disability, depression and quality of life improved significantly but mean differences and effect sizes were small (p<0.41). Less than one third of patients improved by 30% or more from baseline or by one step in the chronification state of pain. Days off work did not change significantly. Predictors for positive therapy response could not be identified. CONCLUSIONS: Monodisciplinary treatment procedures are not sufficient to ameliorate problems of patients in advanced chronification states of back pain.

English Abstract↗

PubMed2000

[Outcome-quality of treatment for headache on primary care conditions].

BACKGROUND: Little is known about the outcome-quality of treatment for headache on primary care conditions in Germany. METHODS: All physicians (2100) of middle franconia, a bavarian greater district with 1,6 Mio. inhabitants, involved in outpatient management were asked to include consecutively patients in the study which suffer from migraine (at least 2 attacks/month) and/or tension type headache (at least 8 days/month) of at least 4 weeks duration. Before and after a 6 months interval patients documented the following outcome data in a questionnaire: pain intensity during the last attack (numeric rating scale), pain dependent disability (Brief Pain Inventory, German version), health related quality of life (SF-36, German version) and depressivity (Allgemeine Depressionsskala). The pain chronification state (Mainz Pain Staging System) has been assessed by the physician. Therapy was not standardized and included the natural spectrum of medicamental and non-medicamental therapy of headache. Agreement of therapy with recommendations of the "Arzneimittelkommission der Deutschen Aerzteschaft" has been assessed. RESULTS: 24 physicians participated in the study. Pre-post-data of 80 patients (46+/-14 y) could be analysed. Initially 67% were classified in pain chronification state I, 27% in state II and 6% in state III. Medicamental therapy agreed with recommendations in approximately 50% of patients, non-medicamental therapy has been used rarely. The pain intensity, pain dependent disability, depression and quality of life improved significantly. 45% and 55% of patients improved in at least 2 of 6 outcome-parameters by 30% of baseline value or by half standard deviation of the corresponding pre-post-differences, respectively. The latter outcome-measure reflects a medium effect size. CONCLUSIONS: On primary care conditions about 50% of patients suffering from migraine and/or tension type headache (predominantly low chronification stae) perceive a therapy effect that corresponds to a medium effect size.

English Abstract↗

PubMed2000

[Structure quality of independent physicians for pain management--is there a standard?].

BACKGROUND: Evidence based standards for structure quality in out-patient management of chronic pain states do not exist. Therefore we tried to evaluate if german standards for outpatient management of chronic pain states which are based on opinions of experts for pain management influence the outcome quality of independent physicians for treatment of chronic low back pain. METHODS: 35 independent physicians, selected on a voluntary basis from 2100 physicians of a bavarian greater district with 1,6 Mio. inhabitants, and one outpatient treatment facility for pain patients of the university of Erlangen-Nuremberg have been evaluated by questionnaires. Questions examined certain structural conditions of the treatment facility as compared to german guidelines for outpatient treatment of pain patients ("Schmerztherapievereinbarung"). 157 patients suffering from chronic low back pain documented before and after a treatment interval of 6 months their pain intensity during the last 24 hours (numeric rating scale), the interference of pain with daily living (german version of the Brief Pain Inventory) and their quality of life (SF-36). Pre-post changes have been used as parameters for outcome quality. RESULTS: Neither baseline data nor pre-post differences of outcome parameter did correlate significantly with the scores of structure quality (17-71% of maximum) of the treatment facilities. However, multimodal therapy programs have not been used for pain management. CONCLUSIONS: Structural indicators of german guidelines for outpatient treatment of pain patients ("Schmerztherapievereinbarung") are not sufficient to improve outcome quality of patients with chronic back pain. Multimodal therapy programs have been shown to be effective in chronic back pain and should be implemented in the guidelines.

English Abstract↗

PubMed2000

Report of an integrated brief intervention with self-defined problem cannabis users.

A range of strategies have been employed elsewhere to treat cannabis dependency, but until recently few treatment options were available in Australia. This article discusses the development and evaluation of the trial on a Integrated Brief Intervention (IBI) with self-defined problem cannabis users in Melbourne. Sixty-one people were recruited to the intervention between December 1997 and June 1998. Participants received a brief one-to-one clinical assessment interview and received self-help materials. Due to time limitations only 33 persons were eligible for inclusion in the evaluation involving follow-up interviews at 1 and 3 months to assess the impact of the intervention. Most participants reported a marked reduction in the frequency and/or quantity of cannabis used. These positive changes in patterns of use are reported to have resulted in improved health and social functioning. It is suggested that while these results support the use of brief interventions, further research is needed to determine whether this type of brief intervention is a cost-effective way for treating cannabis dependency.

Adolescent↗

PubMed2000

Evaluation of dermal-epidermal skin equivalents ('composite-skin') of human keratinocytes in a collagen-glycosaminoglycan matrix(Integra artificial skin).

Integra artificial skin (Integra LifeSciences Corp., Plainsboro, NJ, USA) is a dermal template consisting of bovine collagen, chondroitin-6-sulphate and a silastic membrane manufactured as Integra. This product has gained widespread use in the clinical treatment of third degree burn wounds and full thickness skin defects of different aetiologies. The product was designed to significantly reduce the time needed to achieve final wound closure in the treatment of major burn wounds, to optimise the sparse autologous donor skin resources and to improve the durable mechanical quality of the skin substitute. The clinical procedure requires two stages. The first step creates a self neodermis, the second creates a self epidermis on the neodermis. However, it is desirable to cover major burn wounds early in a single step by a skin substitute consisting of a dermal equivalent seeded in vitro with autologous keratinocytes ('composite-skin') out of which a full thickness skin develops in vivo.The goal of this experimental study was to develop a method to integrate human keratinocytes in homogeneous distribution and depth into Integra Artificial Skin. The seeded cell-matrix composites were grafted onto athymic mice in order to evaluate their potential to reconstitute a human epidermis in vivo. We were able to demonstrate that the inoculated human keratinocytes reproducibly displayed a homogeneous pattern of distribution, adherence, proliferation and confluence. The cell-matrix composites grafted in this model exhibited good wound adherence, complete healing, minor wound contraction and had the potential to reconstitute an elastic, functional and durable human skin. Histologically we were able to show that the inoculated human keratinocytes in vivo colonised the matrix in a histomorphologically characteristic epidermal pattern (keratomorula, keratinocyte bubbling) and developed a persisting, stratified, keratinising epidermis which immunohistologically proved to be of human origin. These experimental results demonstrate the establishment of an effective cell cultivation process which may be suitable for scale-up production of the epidermal component as large-scale composite-skin grafts. When seeded into Integratrade mark and grafted onto the nude mouse a replacement skin with normal functioning dermal-epidermal components was developed. These results encourage the design of a clinical trial to assess the function of this composite graft in man.

Animals↗

PubMed2000

[Experiences with the alloplastic joint prosthesis of the interphalangeal joint].

The replacement of finger joints, especially of the proximal interphalangeal joint (PIP), remains an unsolved problem. Long-term results of conventional reconstructive procedures as well as previously available artificial joint implants have been disappointing. In a controlled study, 12 PIP-joints were replaced by a new type of total endoprosthesis as an alternative to joint fusion. The cementless prosthesis is unhinged and consists of metal joint surfaces. After a follow-up of 18 months, implantation of this metal prosthesis resulted in almost complete pain relief and an active range of movement of 58 degrees. The absolute gain in mobility, however, was only 6 degrees. A swan-neck deformity was found in nine out of 12 cases but corrective surgery was not required. The proximal half of the implant had to be exchanged in two cases due to loosening. All patients were satisfied with the result. The disparity between subjective acceptance by the patients, who clearly prefer joint replacement to fusion, and objective results demonstrates the necessity for further development in this field. The type of prosthesis used in this study seems to be a useful baseline tool which could be turned into a ingenious PIP-joint replacement by further development aiming at reduced abrasion, increased initial stability, a more individual configuration, to name just a few goals.

Equipment Failure Analysis↗

PubMed2000

Pain-related somatosensory evoked magnetic fields induced by controlled ballistic mechanical impacts.

The purpose of this study was to investigate cortical processing of painful compared with tactile mechanical stimulation by means of magnetoencephalography (MEG) using the novel technique of mechanical impact loading. A light, hard projectile is accelerated pneumatically in a guiding barrel and elicits a brief sensation of pain when hitting the skin in free flight. Controllable noxious and innocuous impact velocities facilitate the generation of different, predetermined stimulus intensities. The authors applied painful as well as tactile mechanical impacts to the dorsum of the second, third, and fourth digit of the nondominant hand. Pain-related somatosensory evoked magnetic fields (SSEFs) were compared with those following tactile stimulation in seven healthy volunteers. Contralateral primary sensory cortical area activation was observed within the first 70 msec after tactile as well as painful stimulus intensities. Only painful impacts elicited SSEF responses assigned to the bilateral secondary sensory cortical regions and to the middle part of the contralateral cingulate gyrus, which were active at latency ranges of 55 to 155 msec and 90 to 220 msec respectively. Additional long-latency responses occurred in these cortical areas as long as 280 msec after painful stimulation in three subjects. In contrast to tactile stimulation, painful mechanical impacts elicited SSEF responses in cortical areas demonstrated to be involved in central pain processing by previous MEG and neuroimaging studies. Because of its similarity to natural noxious stimuli and the possibility of adjustable painful and tactile impact velocities, the technique of mechanical impact loading provides a useful method for the neurophysiologic evaluation of cortical pain perception.

Adult↗

PubMed1999

[Structure quality in outpatient care of chronic pain patients].

BACKGROUND: Outcome quality of medical treatment depends on structure quality of the treatment facility. In the present study we tried evaluate structural parameters of outpatient treatment facilities relating to management of headache, low back pain and cancer pain. METHODS: 109 outpatient treatment facilities (104 offices, 3 outpatient departments of hospitals, 2 pain ambulances of hospitals) in middle franconia, one of the larger Bavarian administrative division (population: 1,6 Mio.), have been evaluated by questionnaires. Questions examined certain structural conditions of the treatment facility as compared to german guidelines for outpatient treatment of pain patients ("Schmerztherapievereinbarung"). RESULTS: Only one treatment facility worked within an interdisciplinary setting. Less than 25% (median) of total patients of an outpatient treatment facility suffered from acute or chronic headache, low back pain or cancer pain. 38% of physicians participated regularly on pain conferences. Established methods for diagnosis and documentation of patients suffering from chronic headache, chronic back pain and cancer pain were regularly used by 16%, 12% and 10% of physicians, respectively. Regular interdisciplinary cooperation in the management of patients with chronic headache, chronic back pain and cancer pain was indicated by 28%, 24% and 41% of physicians, respectively. However, personal discussion of patient related problems took place in less than 5% of physicians. Although a considerable number of different therapies (included as standard therapy for outpatient management of chronic pain in the "Schmerztherapievereinbarung") can be applied in each outpatient treatment facility (median:5), psychological therapy for management of chronic headache, chronic back pain and cancer pain was used regularly by 5%, 2% and 7% of physicians, respectively. Scoring of all examined structural parameters provides a measure for the quality of the parameters of a certain outpatient treatment facility as compared to that of an optimal outpatient facility for pain treatment (quality score=100%). However, 75% of examined outpatient treatment facilities reached quality scores only up to 43%. CONCLUSIONS: There are considerable structural deficits in outpatient treatment facilities involved in management of patients suffering from chronic headache, chronic back pain and cancer pain. Realisation of standards according to the "Schmerztherapievereinbarung" needs organisation of an interdisciplinary network between the different specialties necessary for pain management. Interdisciplinary cooperation should be supported by the official organization of the medical self-government in Germany--the Kassenärztliche Vereinigung--which has to assure optimal conditions for outpatient treatments.

English Abstract↗

PubMed1999

Pseudo-Gaucher cells in peritoneal fluid: an uncommon manifestation of extramedullary hematopoiesis.

Pseudo-Gaucher cells have been observed in the bone marrow of patients suffering from a variety of hematologic disorders, including chronic myeloid leukemia, multiple myeloma, and immune thrombocytopenic purpura, as well as other conditions, such as rheumatoid arthritis. While the presence and potential clinical significance of pseudo-Gaucher cells have been documented in the hematology literature, references in standard cytology texts and journals are lacking. We report a case of ascites developing in the context of myelofibrosis, in which abdominal paracentesis yielded numerous pseudo-Gaucher cells as part of a mixed cellular population containing immature hematopoietic elements, consistent with extramedullary hematopoiesis.

Ascitic Fluid↗

PubMed1999

Cytologic features of lymphoepithelial cyst of the pancreas: two preoperatively diagnosed cases based on fine-needle aspiration.

We describe the cytologic features seen in fine-needle aspiration (FNA) specimens from two cases of preoperatively diagnosed lymphoepithelial cyst (LEC) of the pancreas. Pancreatic LEC is a rare, true cyst of uncertain histogenesis that may clinically and radiologically mimic a pseudocyst or cystic neoplasm. Both our patients were middle-aged men who presented with vague abdominal pain. Computed tomography (CT) of the abdomen revealed a mass in or around the pancreas, and CT-guided percutaneous FNA (patient 1) and endoscopic ultrasound-guided FNA (patient 2) yielded paste-like yellow-gray material. Cytologic smears showed numerous anucleated squamous cells in a background of keratinous and amorphous debris. A few benign nucleated squamous cells and plate-like cholesterol crystals were also seen. Unlike LEC of the head and neck region, only rare lymphocytes and histiocytes were present. Pancreatic LEC was diagnosed based on these cytologic findings and was histologically confirmed following cyst enucleation (patient 1) and partial pancreatectomy (patient 2). We conclude that preoperative FNA and recognition of the characteristic cytologic pattern will enable conservative surgical management of pancreatic LEC. Diagn. Cytopathol. 1999;21:346-350.

Biopsy, Needle↗

PubMed1999

Extracellular oxidative enzyme production and PAH removal in soil by exploratory mycelium of white rot fungi.

Selected strains of three species of white rot fungi, Pleurotus ostreatus, Phanerochaete chrysosporium and Trametes versicolor, were grown in sterilized soil from straw inocula. The respective colonization rates and mycelium density values decreased in the above mentioned order. Three- and four-ringed PAHs at 50 ppm inhibited growth of fungi in soil to some extent. The activities of fungal MnP and laccase (units per g dry weight of straw or soil), extracted with 50 mM succinate-lactate buffer (pH 4.5), were 5 to 20-fold higher in straw compared to soil. The enzyme activities per g dry soil in P. ostreatus and T. versicolor were similar, in contrast to P. chrysosporium, where they were extremely low. Compared to the aerated controls, P. ostreatus strains reduced the levels of anthracene, pyrene and phenanthrene by 81-87%, 84-93% and 41-64% within 2 months, respectively. During degradation of anthracene, all P. ostreatus strains accumulated anthraquinone. PAH removal rates in P. chrysosporium and T. versicolor soil cultures were much lower.

Anthracenes↗

PubMed1999

SWEET - WWW-based rapid 3D construction of oligo- and polysaccharides.

UNLABELLED: SWEET is a WWW-based tool which rapidly converts the commonly used carbohydrate sequence information directly into a preliminary but reliable 3D model which can be visualised and written to files in several ways. AVAILABILITY: SWEET is accessible via the Internet at http://www.dkfz-heidelberg.de/spec/. CONTACT: a. bohne@dkfz-heidelberg.de or w.vonderlieth@ dkfz-heidelberg.de SUPPLEMENTARY INFORMATION: The current version of SWEET generates only one conformation out of a manifold. Several authors have analysed possible conformations of high-mannose N-linked glycans using a combination of NMR methods and computational approaches showing that such molecules are rather flexible populating normally several conformations for each glycosidic linkage. The displayed model exhibits for all glycosidic linkages a conformation which is in accordance with the reported variations of Phi, psi and omega values for specific linkage (see http://www.dkfz-heidelberg. de/spec/sweet2/doc/input/sba_example.html).

Carbohydrate Conformation↗

PubMed1999

Visual evoked potentials in migraine patients: alterations depend on pattern spatial frequency.

Visual information is conducted by two parallel pathways (luminance- and contour-processing pathways) which are thought to be differentially affected in migraine and can be investigated by means of pattern-reversal visual evoked potentials (VEPs). Components and habituation of VEPs at four spatial frequencies were compared between 26 migraineurs (13 without aura, MO; 13 with aura, MA) and 28 healthy volunteers. Migraineurs were recorded in the headache-free interval (at least 72 h before and after an attack). Five blocks of 50 responses to chequerboards of 0.5, 1, 2 and 4 cycles per degree (c.p.d.) were sequentially averaged and analysed for latency and amplitude. Differences in VEPs were dependent on spatial frequency. Only when small checks were presented, i.e. at high spatial frequency (2 and 4 c.p.d.), was the latency of N2 significantly prolonged in MA and did it tend to be delayed in MO subjects. Habituation behaviour was not significantly different between groups under the stimulating conditions employed. Prolonged N2 latency might be explained by the lack or attenuation of a contour-specific component N130 in migraineurs, indicating an imbalance of the two visual pathways with relative predominance of the luminance-processing Y system. These results reflect an interictally persisting dysfunction of precortical visual processing which might be relevant in the pathophysiology of migraine.

Adult↗

PubMed1999

Extra dose due to extravehicular activity during the NASA4 mission measured by an on-board TLD system.

A microprocessor-controlled on-board TLD system, 'Pille'96', was used during the NASA4 (1997) mission to monitor the cosmic radiation dose inside the Mir Space Station and to measure the extra dose to two astronauts in the course of their extravehicular activity (EVA). For the EVA dose measurements, CaSO4:Dy bulb dosemeters were located in specially designed pockets of the ORLAN spacesuits. During an EVA lasting 6 h, the dose ratio inside and outside Mir was measured. During the EVA, Mir crossed the South Atlantic Anomaly (SAA) three times. Taking into account the influence of these three crossings the mean EVA/internal dose rate ratio was 3.2. Internal dose mapping using CaSO4:Dy dosemeters gave mean dose rates ranging from 9.3 to 18.3 microGy h-1 at locations where the shielding effect was not the same. Evaluation results of the high temperature region of LiF dosemeters are given to estimate the mean LET.

Calcium Sulfate↗

PubMed1999

Doses due to the South Atlantic Anomaly during the Euromir'95 mission measured by an on-board TLD system.

During the Euromir'95 mission, a specially designed microprocessor-controlled thermoluminescent detector (TLD) system, called the 'Pille'95', was used by ESA astronaut Thomas Reiter to measure the cosmic radiation dose inside the Mir space station. One of the experiment's objectives was to determine the dose fraction on Mir due to the South Atlantic Anomaly (SAA) on an orbit inclined at 51.6 degrees and at an altitude of about 400 km. Using an hourly measuring period for 170 h in automatic mode, dose components both of galactic (independent of SAA) and SAA origin were determined. It was found that the maximum dose due to crossing the SAA was equal to 55 microGy. Averaging all the measurements it was calculated that the mean dose rate inside the Mir was 12-14 microGy h-1 and that half of this value was caused by the SAA.

Astronauts↗