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Biomedical subjects

E Schindler

Publications and source records attributed to E Schindler.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Injuries of the spinal cord].

Every spinal cord injury includes the possibility that neurological symptoms will remain that threaten to reduce the quality of life considerably. Prompt and well-planned therapy-often surgical-is required in order to prevent these symptoms. Prompt and relevant diagnostic measures are indicated. MR imaging is the diagnostic modality of choice, since traumatic intramedullary lesions can only be visualized with MRI. Moreover, in the acute stage, MRI findings provide important prognostic information. If MRI is available, it should be carried out in all cases when spinal cord injury is suspected despite the problems involved when examining acutely traumatized patients.

Humans↗
PubMed1994

[Effectiveness of oral versus parenteral iron substitution in autologous blood donors].

OBJECTIVE: Is intravenous iron therapy as efficient as oral iron supplementation in patients undergoing autologous blood donation? DESIGN: Prospective, randomized study. PATIENTS AND SETTING: 30 male and 30 female patients, separated into two groups were examined prior to total hip replacement. INTERVENTIONS: Patients of group O were given 6 x 50 mg Fe2+ aspartate/day orally, and patients of group P were given 0.75 mg/kg BW complex-bound Fe3+ once a week by infusion. In both groups therapy was started two weeks prior to the first donation. The substitution was continued the following six weeks until surgery. Hemoglobin, ferritin plasma concentrations and reticulocytes were monitored. The appearance of unwanted side effects was studied by questionnaire. RESULTS: Hb decreased significantly in both groups. A difference was seen in the reticulocyte count and in the ferritin levels. Here we found a significant increase in group P compared with group O. 40% of the patients who took the iron orally complained about unwanted side effects such as obstipation and diarrhoea, whereas none of the patients of the parenteral group had any complaints. CONCLUSIONS: Stimulation of the erythropoiesis appeared to be more efficient with intravenous iron therapy than with oral iron supplementation. The oral dose has in about 40% unwanted side effects. For this reason a parenteral iron therapy can be considered, but one must be aware that in some cases dangerous anaphylactic reactions could appear.

Administration, Oral↗
PubMed1993

Does platelet size correlate with function in patients undergoing cardiac surgery?

OBJECTIVE: Platelet dysfunction secondary to cardiopulmonary bypass (CPB) is one of the major reasons for nonsurgical post-operative bleeding in cardiac surgery. Whether platelet size is an indicator for platelet function was investigated in patients undergoing coronary artery bypass grafting. DESIGN: Prospective study. SETTING: Intra-operative, cardiac surgery operations. PATIENTS: 80 consecutive patients undergoing coronary artery bypass grafting. Excluding criteria were pre-operative coagulation disorders and medication with anticoagulants within the last 10 days before the operation day. MEASUREMENTS AND RESULTS: Platelet function was assessed by aggregometry using a turbidimetric method (inductors: ADP 2.0 mumol/l, collagen 4 micrograms/l, epinephrine 25 mumol/l). Mean platelet volume (MPV) was measured by an electrical conductivity method. Measurements were carried out before, during, and after CPB until the 1st post-operative day on intensive care unit (ICU). Platelet size decreased significantly during CPB (max. -25% after weaning from bypass) and returned to baseline values on the 1st post-operative day. Platelet count (ranging from 93 - 304 x 10(9)/l) did not correlate significantly with MPV or aggregation variables. Maximum aggregation and maximum gradient of aggregation induced by ADP and collagen were significantly decreased by CPB with the most pronounced reduction at the end of CPB (ranging from -25% to -45%). Analyses of co-variance revealed a significant correlation between changes in MPV and changes in aggregation variables (ADP, collagen). CONCLUSIONS: Platelet volume is easy to measure even in the operation room or in ICU and may indicate abnormalities in platelet function in the post-bypass period of cardiac surgery patients.

Adult↗
PubMed1993

Volume replacement with hydroxyethyl starch solution in children.

In 30 consecutive children undergoing cardiac surgery, two different types of fluid were given randomly for volume replacement in the pre-bypass period. In group 1 (n = 15), low molecular weight hydroxyethyl starch solution (LMW-HES) (6% HES; mean molecular weight 200,000 Da, molar substitution 0.5) and in group 2 (n = 15) 20% albumin (HA) was infused from the induction of anaesthesia until the start of cardiopulmonary bypass (CPB). In addition to haemodynamic values, various laboratory variables were measured before and after CPB until the morning of the 1st day after operation. The patients did not differ in diagnosis and conduct of CPB (lowest rectal temperatures: group 1 29.0 (SD 1.1) degrees C; group 2 29.4 (1.0) degrees C). Haemodynamic data (MAP, HR, CVP), anti-thrombin-III, fibrinogen, platelet count and coagulation variables were comparable between the groups until the 1st day after operation. Postoperative blood loss and the use of homologous blood or blood products were similar in all children. Albumin concentration increased after infusion of albumin (35-47 g litre-1) and was significantly greater until the end of the operation compared with the LMW-HES-treated children. Colloid osmotic pressure, however, was similar in the two groups and returned to baseline values on the 1st day after operation (LMW-HES group 19.31 (1.2) mm Hg; HA group 18.0 (1.3) mm Hg). Post-bypass urine output and creatinine values also did not differ between the groups. Anaphylactic reactions were not observed in any of the patients. It can be concluded that LMW-HES solution can be used effectively and safely for volume replacement in the pre-bypass period in small children undergoing cardiac surgery.

Antithrombin III↗
PubMed1993

Circulatory effects of the PDE-inhibitors piroximone and enoximone.

1. The isolated circulatory response to intravenous application of the phosphodiesterase (PDE) inhibitors piroximone and enoximone was studied. 2. In a randomized sequence of 30 male patients undergoing elective aortocoronary bypass grafting either piroximone (0.5 mg kg(-1); n = 10) or enoximone (0.5 mg kg(-1); n = 10) were given during steady state of cardiopulmonary bypass (CPB). A group in which NaCl was given as a placebo served as a control (n = 10). 3. MAP was reduced by piroximone (maximum -23 mm Hg) and enoximone (maximum -18 mm Hg), whereas it increased in the control (+20 mm Hg). Volume of the extracorporeal circuit indicating venous pooling decreased more pronouncedly in the enoximone patients (-440 ml) than in the piroximone group (-300 ml). 4. Laser Doppler flows (LDFs) increased in both PDE-III inhibitor groups with the higher and longer increase in the enoximone-treated patients (LDF-forehead maximum +44%, LDF-forearm maximum +33%). Piroximone-induced increase in both LDFs was less pronounced with respect to both time and degree (LDF-forehead maximum +30%, LDF-forearm +12%). 5. Oxygen consumption (VO2) was significantly higher in the PDE-III inhibitor-treated than in the control patients. 6. Piroximone and enoximone showed significant vasodilatory properties at the arterial and venous side (= 'venous pooling'), from which patients with heart failure would profit. 7. Vasodilation could be observed for a longer period and was more pronounced in the enoximone-treated than in the piroximone patients. Alterations in capillary skin blood flow measured by laser Doppler technique gave evidence for an improvement in nutritive microcirculation, which was slightly more pronounced in the enoximone patients.

Aged↗
PubMed1993

Cranial MR imaging and cerebral 99mTc HM-PAO-SPECT in patients with subacute or chronic severe closed head injury and normal CT examinations.

Eighteen patients in the subacute or chronic state following severe closed head injury with normal cranial CT scans were examined by MR and 99mTc HM-PAO SPECT. Correlations were sought between these 2 imaging modalities and the clinical outcome, as defined by the Glasgow Outcome Scale (GOS) score. Both MR and SPECT revealed cerebral damage in all patients examined but structural and functional alterations did not coincide topographically in 64.9% of lesions. Nevertheless, complementary injury patterns suggesting poor recovery were found; cortical contusions and diffuse axonal injury (MR) in conjunction with cortical and thalamic hypoperfusion (SPECT) were noticed in 8 out of 12 patients with unfavorable outcome (GOS = III and IV). The synthesis of MR and SPECT information clearly enhanced the ability both to accurately assess posttraumatic brain damage and to improve patients' outcome prediction.

Adolescent↗
PubMed1990

[Magnetic resonance tomography of the failed back surgery syndrome: a comparison with computed tomography].

The term "failed back surgery syndrome" includes a variety of clinical-neurological symptoms following disc surgery. In a prospective study 18 patients suffering from monoradicular symptoms after disc surgery were examined by MRI and CT (both prior to and following intravenous application of contrast material). Findings were then compared to microsurgery. MRI produced correct diagnoses in 17 cases, CT in 13 cases. Recurrent disc herniation caused symptoms four times, and epidural scar formation twice. In twelve cases there was herniated disc material as well as an epidural scar present; disc material preponderated nine times, scar formation in three instances.

Adult↗
PubMed1988

Craniopagus twins: neuroradiological findings (CT, angiography, MRI).

A pair of craniopagus twins was examined with CT, angiography and MRI, to preoperatively assess their cerebral anatomy and blood flow. Angiography revealed a common venous sinus and a venous cross-flow from one brain to the other. This common sinus was also identified in magnetic resonance images. The significance of accurately evaluating the veins and sinuses in craniopagus twins is stressed.

Brain↗
PubMed1988

Computed tomographic and angiographic findings in renal oncocytoma.

Nine cases with histologically proven renal oncocytoma are presented. In all cases, ultrasonography gave the first indication of a tumour and intravenous urography was tumour-specific in only six, whilst angiography was so in only four of the cases with peripheral extension beyond the normal organ limits. Examination by computed tomography showed retrospectively, in the three cases with smaller oncocytomas up to 3 cm in diameter, findings that seemed promisingly characteristic: without contrast medium, the tumour appeared homogeneously hyperdense in comparison with normal renal parenchyma, but homogeneously hypodense after injection of contrast medium. One of the smaller oncocytomas, however, showed regions of heterogeneity both with and without contrast medium. Only one oncocytoma of 4 cm diameter presented the central stellate, low-attenuation "scar" described by Quinn et al. The angiographic criteria cited by Ambos were fulfilled in only three of the larger oncocytomas. In four of the cases, the tumour was enucleated and the organ left in situ on the basis of frozen section diagnosis. Those patients with tumours extending outside the organ or those of questionable diagnosis on frozen section were treated by nephrectomy. In one patient, the pathologist suspected metastasis from the thyroid; hemithyroidectomy confirmed on oncocytic adenoma of the left thyroid lobe.

Adenoma↗
PubMed1988

[Spontaneous carotid dissection as the cause of cerebral infarct in a youth].

The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred.

Adolescent↗
PubMed1987

Indication of radical cystectomy in patients with carcinoma of the bladder.

We report on 64 patients subjected to radical cystectomy; 56 had carcinoma and 8 had non-tumorous indications (contracted bladder, exstrophy of the bladder). Indications, early and late results are discussed. In case of malignancy the rate of recurrences in early stages was about the same as in advanced stages. So it is not possible to say anything definitely about the individual prognosis of recurrence in patients undergoing radical cystectomy. It is easier to justify palliative cystectomy because of the relatively low risk of operation.

Carcinoma, Transitional Cell↗
PubMed1987

Demonstration of residual contrast medium in renal parenchyma using computerized tomography.

Residual contrast medium in the renal parenchyma was demonstrated by computerized tomography in 11 patients with renal trauma, inflammatory renal disease, infarction and a large renal cyst. The contrast medium (10 to 100 ml.) was administered intravascularly 30 minutes to 48 hours before the computerized tomography scan. In each patient the scan demonstrated residual contrast medium (either initially or after a second scan with additional contrast enhancement) in a variety of parenchymal zones that frequently appear to be normal with other imaging techniques. After a suitable interval for accumulation of residual contrast medium, computerized tomography appears to provide better visualization of the renal parenchyma than conventional modes of examination. Persistent retention of contrast medium in the renal parenchyma is believed to represent cortical damage.

Adult↗
PubMed1987

[Results of percutaneous cervical chordotomy in 35 patients with urologic neoplasms].

Between 1975 und 1985 we performed 281 percutaneous cervical cordotomies in 212 patients among whom there were 35 patients with urological malignancies. We report about the method, localisation of tumour and pain, results and complications. Altogether we can say, that percutaneous cervical cordotomy is an efficacious procedure with an acceptable complication rate in patients with chronic pain from malignant diseases especially in the urological field.

Adult↗
PubMed1986

Multiple extra-adrenal and thoracic pheochromocytomas.

On the basis of a case of multiple, extra-adrenal intrathoracic pheochromocytomas (total of 6 tumors), the value of dynamic computerized tomography investigations, venous sampling, scintigrams with 131I-meta iodobenzylguanide, and selective arteriography is discussed.

Adolescent↗
PubMed1986

[Visual field fluctuations in necrotic hypophyseal adenoma].

The authors report on an acute bitemporal visual field depression with spontaneous reversibility of the defects, associated with necrotic pituitary adenoma. As the same time as the visual field defects regressed it was established by computer tomography that the suprasellar portion of the pituitary tumor had diminished in size.

Adenoma↗
PubMed1986

[In vitro sensitivity testing of human kidney tumors to cytostatic drugs with a rapid in vitro test].

We present a new modified in vitro culture assay for primary human renal cell carcinoma similar to the 'soft agar clonogenic assay'. However, the carrying out and expense of metrology are more simplified, allowing tumor-specific chemotherapeutic drug sensitivity testing under easier conditions. Twelve different samples of human renal carcinoma and one sample of a transitional cell carcinoma of the renal pelvis were tested for in vitro chemotherapy sensitivity using this modified colony-forming assay. The rate of tumor cells establishing in culture was 100%. Corresponding to clinical experience we observed a nearly complete resistance to the cytotoxic effects of standard chemotherapeutic agents at usual plasma concentrations in man. Only higher concentrated chemotherapeutic drugs showed in vitro therapeutic effects. The assay described here lasts about 7 days, which is beneficial from the clinical point of view. The modification of this in vitro chemotherapeutic drug treatment is unlimited for plasma concentration and duration of standard and experimental chemotherapeutic agents, drug combination and so on. So we have interesting scientific steps which could not have been undertaken under usual clinical-empirical conditions.

Adenocarcinoma↗
PubMed1985

Diagnosis of lesions in the third ventricle.

The precise diagnosis of lesions occupying the third ventricle requires both clinical and radiological examinations. Laboratory tests may provide important additional information in some cases. The specific diagnosis of a third ventricle tumor, however, cannot be established without biopsy except in very rare cases. The diagnostic and differential diagnostic problems are illustrated by some examples and discussed.

Cerebral Angiography↗