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Biomedical subjects
Publications and source records attributed to E Thomas.
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In a survey experimental and clinical investigations on Trapidil (Rocornal) are briefly demonstrated. The great number of recent investigations, particularly by Japanese authors, render it necessary anew to think over the application of Trapidil in the GDR. Apart from possibilities of the treatment of the ischaemic heart disease, the survey shows further possible indications, such as inhibitions or the aggregation of thrombocytes, improvement of the microcirculation and treatment of hyperlipidaemias. It was made evident that Trapidil induces no steal phenomenon and thus a restriction as an antianginal pharmacon it not justified. A renaissance for Trapidil indicates itself.
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Although bacterial culture is considered to provide the most definitive diagnosis of gonorrhea, it has limitations when specimens must be transported long distances. A study was carried out to evaluate the validity and cost-effectiveness of an alternative method of diagnosing gonorrhea, the Gonozyme test, a commercially available enzyme immunoassay. Urogenital specimens from 100 men and 100 women with symptoms suggestive of or a history of exposure to gonorrhea were tested for the presence of Neisseria gonorrhoeae by means of bacterial culture and for gonococcal antigen with the Gonozyme test. The specimens from the men were also examined by means of microscopy of Gram-stained smears. The sensitivity and specificity of the Gonozyme test with reference to culture results were 95.6% and 97.4% respectively in the men and 84.2% and 98.7% in the women. The predictive value of a positive result was 91.6% in the men and 94.1% in the women, and the predictive value of a negative result 98.6% in the men and 96.3% in the women. The cost-effectiveness of the Gonozyme test was higher than that of bacterial culture in this population, which had a high prevalence rate of gonorrhea (23% in the men and 19% in the women). The Gonozyme test would be an adequate alternative to culture for the diagnosis of gonorrhea and contact tracing in areas far from diagnostic laboratories.
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A fistula between the pancreatic duct and the colon is quite rare and usually associated with such manifestations as bleeding and sepsis. We have seen a patient with such a fistula detected almost incidentally at ERCP. We report the course of this fistula and review the literature to suggest a place for conservative surgical management.
A 22-year-old patient with hemoglobin SC disease developed benign intracranial hypertension during two successive pregnancies; both resulted in uncomplicated vaginal deliveries of healthy male infants. Benign intracranial hypertension in pregnancy and its management are discussed.
A retrospective analysis of 26 patients with squamous cell carcinoma of the esophagus treated at our center over a five-year period showed that the prognosis of this condition was still poor, with a mean length of survival of only 29 weeks after diagnosis; 88% of this period was spent in the hospital. The one-year survival rate was 23%. There were no two-year survivors. No major difference in survival based on method of treatment was evident though the groups were not truly comparable. We believe that a more thorough initial work-up including computerized tomography (CT) of the chest and upper abdomen in all cases would be invaluable in more accurately assessing the degree of spread. More frequent use of dilation and stents for palliation, rather than gastrostomy or jejunostomy will improve both survival and the quality of remaining life.
Although nifedipine therapy resulted in substantial relief of dysphagia in six patients with diffuse esophageal spasm, significant side effects, particularly in young working subjects, precluded prolonged use.
We have described a patient who was admitted to the hospital for evaluation of RUQ abdominal pain 40 years after a Billroth II gastrectomy, as well as a cholecystectomy of which the patient was unaware. Gray-scale abdominal ultrasonography and Tc 99m-IDA hepatobiliary imaging were interpreted as revealing an enlarged gallbladder and cholelithiasis. An obstructed afferent loop of the Billroth II anastomosis had mimicked a gallbladder on ultrasonography and hepatobiliary imaging.
Three short-course regimens, all comprising isoniazide (H), rifampicine (R), streptomycine (S) and pyrazinamide (Z), are compared in a randomized prospective cooperative clinical trial. The drugs are given daily in a 3-month regimen (3-HRSZ), twice a week in a 6-month regimen (6-HRSZ2), and in a further two-phase 6-month regimen the 4 drugs are administered 3 times a week for the first 3 months followed by the administration of HSZ twice a week (without R) for further 3 months (3-HRSZ3/3-HSZ2). The number of patients admitted to study is 80, 144 and 139 respectively. The 3-month regimen has been stopped because of a high rate of relapses. 17 p.c. of the patients admitted have to be excluded from analysis for various reasons, out of these 5.8 p.c. because of adverse reactions. Two thirds of the patients had heavily positive sputum cultures at the start. 300 patients completed therapy. At the end of therapy cultures were negative in 94 p.c., 100 p.c. and 99 p.c. respectively. The rate of bacteriological relapses is 19 p.c. in 3-HRSZ, 9 p.c. in 3-HRSZ3/3-HSZ2 and 3 p.c. in 6-HRSZ2, during a follow-up period of 3-4 years after completing therapy. The acceptability was good in all treatment groups. Adverse reactions like "flu" were rarely observed. Increased blood urea was common but in general without clinical symptoms. Elevation of ALAT and ASAT was relatively frequent but mostly transient and without clinical importance. The results served as basis for the new "Recommendation for Treatment of Tuberculosis" and are interpreted with regard to practical consequences and possibilities for further rationalisation of treatment.
Lipid corpuscles have been found in the urine in about 40 per cent of women (4/10) after extracorporeal shock wave lithotripsy, however this lipuria is very rare in men (1 or 2 per cent of cases) and less pronounced. During three days after treatment, this post-therapeutic lipuria was found to be independent of the age of patients, of the site of the calculi, of their chemical composition or of the number of shock waves administered. This lipuria probably results from the liquefaction of peri-pelvic fat tissue by exothermic reaction. These lipid corpuscles consist mostly of triglycerides and to a lesser extent phospholipids with a very small proportion of cholesterol and fatty acids.
Thirty five subjects with both parents in the top third of their age specific blood pressure distributions and 31 subjects with both parents in the bottom third of their blood pressure distributions restricted their intake of sodium for eight weeks while taking part in a double blind, randomised crossover trial of supplements of sodium and placebo. A comparison of two periods of four weeks at different intakes of sodium showed no differences in blood pressure in either the groups as a whole or the subgroups who complied best with the diet and tablets. In the compliant subgroups mean urinary sodium excretions were above 120 mmol(mEq) and below 50 mmol/day. The study provides evidence against the hypothesis that people with a family history of high blood pressure are more susceptible in their blood pressure response to dietary sodium.
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