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Biomedical subjects

G Becker

Publications and source records attributed to G Becker.

At least 199 records · Page 11Linked to original sources
PubMed1994

Surgical intervention and heparin-anticoagulation improve prognosis of rhinogenic/otogenic and posttraumatic meningitis.

It is still controversial, whether early surgical removal of infectious material and heparin-anticoagulation to reduce vascular complications will improve outcome in acute meningitis. In the present pilot-study 40 patients with acute or delayed post-traumatic or oto-/rhinogenic purulent bacterial meningitis were analysed for neurological outcome by using the Glasgow outcome score (GOS) and the Tuthill functional score; patients were treated either by early surgical revision of the septic focus (Group 1, within 6 days, n = 15), late surgery (Group 2, later than 6 days, n = 19), or no surgery at all (Group 3, n = 6). All patients, independent of surgical approach, received therapeutic heparin-anticoagulation. Patient groups were otherwise comparable for antibiotic treatment, osmotherapy, microbiology, CSF-findings, CT-scans and prognostic factors. Outcome according to GOS was superior in Group 1 compared with Groups 2/3 (non-significant). Although there was no significant difference on admission in the Tuthill functional score, Group 1 achieved a superior final outcome of 96 points compared with Groups 2 and 3, who gained 72 points (p < 0.01). In addition, Group 1 patients had significantly less intracranial complications (8/15 patients versus 21/25 patients in Groups 2/3, p < 0.01) and were dependent upon respirator treatment for fewer days (10.2 days) than Groups 2/3 (12.5 days, non-significant). In 31 patients CSF-leakage was identified: among these, 17 patients had CSF-leakage, which had not been anticipated by clinical/neuroradiological examinations and revealed only by surgery. The overall mortality in this study population was very low (2.5%), therefore, therapeutic heparin seems to represent an additional favorable treatment measure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Identification of ventricular enlargement and estimation of intracranial pressure by transcranial color-coded real-time sonography.

Transcranial color-coded real-time sonography (TCCS) was applied to 26 patients with ventricular enlargement to quantify the ventricular size and to estimate intracranial pressure. Intracranial pressures, as determined by lumbar, epidural, or ventricular tonometry, ranged from 6.5 to 55 cm H2O (8 patients had pressures > 18 cm H2O). The widths of the third ventricle and the frontal horns of both lateral ventricles depicted by TCCS were compared to corresponding computed tomography data: TCCS and computed tomography findings correlated well for the third ventricle (r = 0.96) and for the right (r = 0.86) and left (r = 0.92) frontal horns. The capability of the septum pellucidum to undulate relative to the ventricular wall during short (20-degree) rotatory movements of the head was related to intracranial pressure. In all patients with intracranial pressure below 17 cm H2O, rotatory head movements induced septum pellucidum undulation; no lateral deflection of the septum pellucidum was found in patients with an intracranial pressure above 21 cm H2O. Therefore, TCCS may be employed to quantify and follow-up ventricular enlargement. Dynamic neurosonographic tests may allow a gross estimation of intracranial pressure.

Adult↗
PubMed1994

Vascularization of primary central nervous system tumors: detection with contrast-enhanced transcranial color-coded real-time sonography.

PURPOSE: To study the potential of contrast material-enhanced transcranial color-coded real-time sonography (TCCS) in detection of primary intracranial tumor vascularization. MATERIALS AND METHODS: Primary central nervous system (CNS) tumors in 28 patients were examined with TCCS before and during administration of a transpulmonary, stable, galactose, microparticle-based ultrasound (US) contrast agent. All patients underwent cranial computed tomography and magnetic resonance imaging; nine patients also underwent intraarterial digital subtraction angiography. RESULTS: All lesions were hyperechoic on B-mode US scans except one grade 2 astrocytoma. The location and extent of hyperechoic lesions correlated well with findings on CT scans and MR images. After injection of contrast material, color Doppler flow signals were seen in nine of 14 low-grade lesions and 14 of 14 high-grade lesions. High-grade malignant tumors always had atypical arterial and venous Doppler spectra with irregular distribution of Doppler shift and signal intensities; these atypical flow patterns were also detected in some low-grade tumors. CONCLUSION: In addition to depiction of primary CNS tumors in B-mode, contrast-enhanced TCCS enables evaluation of vascularization associated with tumor parenchyma.

Adult↗
PubMed1994

Chemical preservation of urine sediment for phase-contrast microscopic examination.

A major difficulty in diagnostic urinary microscopy is the need to observe a freshly passed urine specimen. This study illustrates the use of glutaraldehyde (GA) and formaldehyde (FA) to preserve urinary sediment for diagnostic microscopy. GA and FA in whole urine cause a precipitate to form if there is a trace or more of proteinuria. This can be eliminated by centrifugation and fixation of urine sediment. Red blood cells (RBC) and casts are adequately preserved for diagnostic microscopy for at least 3 months. However, subtle changes in RBC morphology consisting of hexagonal distortion and wrinkling of cell margins are seen in some cells. White blood cells (WBC) are less reliably preserved. Diagnostic phase-contrast microscopy can be performed on urine sediment stored at room temperature for up to 3 months after fixation with GA or FA.

Cell Count↗
PubMed1994

[Nuclear magnetic resonance tomography as a functional diagnostic method. New approaches to non-invasive quantification of cerebral blood volume and blood flow].

This paper presents a brief introduction to the current status of cerebral blood volume and blood flow imaging with magnetic resonance imaging (MRI) techniques. A new method for the quantitative assessment of regional cerebral blood volume (rCBV) and regional cerebral blood flow (rCBF) on the basis of the indicator dilution theory is described and preliminary quantitative results from healthy volunteers are presented. The mean values for the rCBV are 8.27 +/- 1.85 ml/100 g for grey matter and 3.78 +/- 1.34 ml/100 g for white matter. The mean values for the rCBF are 44.8 +/- 11.29 ml/min/100 g for the grey matter and 20.88 +/- 8.42 ml/min/100 g for the white matter. These results are in good agreement with PET results from the literature.

Adolescent↗
PubMed1994

Uterine artery waveform as a predictor of pregnancy outcome in women with underlying renal disease.

To investigate the use of uterine artery flow velocity waveforms in predicting gestational hypertension (GH), preeclampsia (PE) and intrauterine growth retardation (IUGR), Colour Doppler ultrasound of the uterine arteries was performed at 19-24 weeks gestation in 51 women with known renal disease. On four consecutive waveforms, peak systolic (A), end-diastolic (B) and early diastolic (C) velocities were measured. Resistance index (RI) was calculated as (A-B)/A, and the severity of the waveform notch expressed as the AC ratio (A/C). Gestational hypertension was defined as a blood pressure (BP) > or = 140/90 mmHg with an increase of at least 15 mmHg in diastolic BP. PE included women with gestational hypertension and proteinuria > 300 mg/24 h or a doubling of early gestation protein excretion. IUGR was defined as a birthweight less than the 10th percentile for gestation. RI and/or AC ratio in 14 women (27%) exceeded the 90th percentile for gestational age of our low risk control population. Of the women with an abnormal test, 11 (79%) developed complications, 8 (57%) developed GH or PE, 3 (21%) IUGR alone, 2 (14%) GH and IUGR, and in one women intrauterine fetal death of an IUGR infant occurred, and 3 (21%) had an uncomplicated pregnancy. Of the women with a normal test, 34 (92%) had an uncomplicated pregnancy, and only 3 (8%) developed GH or IUGR. In summary, uterine artery waveform indices at 19-24 weeks gestation may be useful for the prediction of pregnancy complications in woman with underlying renal disease.

Adult↗
PubMed1994

[Diagnosis and therapy of olfactory neuroblastoma].

Esthesioneuroblastomas (EN) exhibit problems in early diagnosis and therapy due to their localization at the frontal skull base. Analysis of six cases with EN (four male, two female; average age, 34.8 years) showed atypical initial symptoms, beginning as nasal bleeding, hyposmia and frontal headache. CT scans demonstrated hypo- to isodense tumors at the anterior skull base with extension to the sinuses and orbits. Five patients were operated on by an extranasal approach; one patient required orbital exenteration with later reconstructive surgery of the orbit by a microvascularly adapted forearm flap. One patient underwent a neurosurgical procedure first that was followed by chemotherapy and stereotactically guided radiation. One patient died 1 year after onset of therapy due to intracranial tumor. One patient developed lung metastasis 5 years after treatment. Four patients remain in clinical remission and receive regular follow-ups. Our analysis shows the guarded prognosis of EN despite multimodality therapy. This includes the problems of advanced disease with complications of surgery and radiation. All therapeutic procedures should be planned in collaboration with otolaryngologists, neurosurgeons and radiotherapists. New computer-aided and stereotactically guided radiation procedures can be helpful, especially in patients with extensive disease.

Adolescent↗
PubMed1994

Prevalence of HPV DNA in cervical specimens in women with renal transplants: a comparison with dialysis-dependent patients and patients with renal impairment.

The aim of this study was to assess the prevalence of human papillomavirus (HPV) DNA in women who had received a renal transplant and to compare this with two control groups. Women who had a functioning renal transplant for greater than 6 months (n = 69) were compared with women on maintenance dialysis (n = 89) and women with impaired renal function (creatinine 0.15-0.39 mmol/l) (n = 22). Women were excluded if they had had a hysterectomy, were older than 65 years, or were not yet sexually active. A questionnaire and cervical scrape were obtained from each participant. The cervical scrape was analysed for HPV DNA using PCR and the L1 consensus primers. The participation rate of transplant patients, dialysis patients and those with impaired renal function ('normal' group) was 69, 68, and 78% respectively. The characteristics of the three groups of women at enrollment were similar. No cytological abnormalities were present in the 'normal' population but 11 of 89 patients on maintenance dialysis and nine of 69 transplant patients had cytological abnormalities of atypia or greater (P = 0.08 and P = 0.07, for 'normal' compared to dialysis and transplant groups respectively). One (4.5%) of the 'normal' women had evidence of HPV DNA, while 18 (20%) of patients on maintenance dialysis and 15 (22%) of transplant patients were positive (P = 0.07 and P = 0.05, for 'normal' compared to dialysis and transplant groups respectively). This study suggests that not only transplant recipients but also dialysis patients may have a higher prevalence of risk factors (cytological abnormalities and HPV DNA) for the development of cervical cancer.

Adult↗
PubMed1993

Human papillomavirus detection in cervical adenocarcinoma by polymerase chain reaction.

Twenty-five primary cervical adenocarcinomas and five cervical infiltrates from endometrial or rectal adenocarcinomas were analyzed for human papillomavirus (HPV) DNA by polymerase chain reaction with consensus and type-specific primers. Sixty-four percent (16 of 25) of the primary carcinomas and 20% (one of five) of the secondary infiltrates were positive for HPV types 16 and/or 18 DNA. Among the primary tumors HPV DNA was found in 80% of the endocervical cell-type tumors and in 60% of the endometrioid tumors, whereas two undifferentiated scirrhous carcinomas, one clear cell carcinoma, and one serous-papillary tumor were HPV negative. Human papillomavirus-positive patients were younger than HPV-negative patients (mean ages, 49.2 v 64.2 years). Our results indicate that papillomavirus play a major role in the etiology of cervical adenocarcinomas, at least in premenopausal women. However, in contrast to other studies, HPV type 18 was not the predominant type of HPV, HPV types 16 and 18 occurring with similar frequency in our patients.

Adenocarcinoma↗
PubMed1993

The dilemma of seeking urgent care: asthma episodes and emergency service use.

Asthma is an invisible and unpredictable chronic illness characterized by recurrent episodes of airflow obstruction and airway inflammation. Until recently, psychological factors were thought to play a major role in this condition. The notion of an emotionally-based illness serves to discredit asthma as a 'real' illness among health professionals and patients alike, contributes to the sense of stigma that persons who have asthma experience, and impedes effective management. Findings from research with a sample of 95 adults with physician diagnosed and documented asthma indicate that persons who have asthma walk a tightrope between delaying formal medical intervention and seeking treatment too soon. Uncertainty about the quality and speed of care available in an emergency department shapes, in part, the nature of the lived experience of asthma and affects feelings of control over the illness. These concerns create a push-pull dynamic, as individuals struggle to make decisions about emergency department use that will provide relief, ensure autonomy, deter the experience of stigma, and diminish the threat of death.

Adult↗
PubMed1993

Continuity after a stroke: implications of life-course disruption in old age.

Life-course disruption caused by a stroke and subsequent attempts on the part of stoke victims to restore continuity was explored through qualitative research with a sample of 216 persons. This research suggests: 1) that theory in gerontology could be deepened by framing continuity to include discontinuous experience in late life; and 2) that research on what elderly persons themselves make of continuity--how they perpetuate it or recreate it and the obstacles they perceive in doing so--may inform our understanding of the experience of old age and lead to applications in the practice of gerontology that address the disruption illness poses for people's lives.

Activities of Daily Living↗
PubMed1993

Differentiation between ischemic and hemorrhagic stroke by transcranial color-coded real-time sonography.

Transcranial color-coded real-time sonography was applied to 20 patients with ischemic stroke and 28 patients with spontaneous intracerebral hemorrhage. In all patients the sonographic diagnosis corresponded closely to cranial computed tomography findings. Recent hemorrhages were visualized as a hyperechodense mass. The high contrast to minor echodense adjacent parenchyma led to a clear sonographic distinction. Older clots were characterized by a continuous decrease of echodensity and subsequently were interspersed by hypoechodense zones. In the acute stage of ischemic infarction, the vessel occlusion (17/20) and collateral vascular supply (10/20) could be depicted in the color-B-mode in two perpendicular planes and further verified by the Doppler mode. Brain edema was not visualized. Although in the acute stage no change of echo texture was observed within the infarction, hyperechodense regions (7/11) could be observed in some patients during the time course. Complications of intracerebral hemorrhage and ischemic stroke, such as disturbance of cerebrospinal fluid circulation, midline shift, and compression of adjacent territories, were depicted by transcranial color-coded sonography. These preliminary results illustrate that transcranial color-coded real-time sonography may be helpful in the early noninvasive differential diagnosis as well as long-term follow-up in patients with cerebrovascular disorders.

Brain Ischemia↗
PubMed1993

Effects of amiloride and ouabain on short-chain fatty acid transport in guinea-pig large intestine.

1. Effects of H+ secreting mechanisms on unidirectional passage of the short-chain fatty acids (SCFA) acetate, propionate and n-butyrate across isolated guinea-pig caecum, proximal and distal colon were studied under short-circuit current conditions in Ussing chamber isotope flux experiments. 2. In the caecum and the proximal colon the serosal-to-mucosal fluxes (Jsm) were higher than the mucosal-to-serosal fluxes (Jms). Thus a net secretion of SCFA was present in the caecum and proximal colon. The higher Jsm appears to be coupled to the Na+ gradient established by the basolateral membrane Na(+)-K(+)-ATPase, whereas Jms is related to the operation of an apical membrane Na(+)-H+ exchanger. Inhibition of Na(+)-H+ exchange by amiloride (1 mM) added to the mucosal solution decreased Jms of SCFA in caecum and in proximal colon, but had no major effect in distal colon. 3. In distal colon Jms exceeds Jsm and thus a net absorption of SCFA was observed. Jms is Na+ independent and coupled to the activity of the apical membrane K(+)-H(+)-ATPase. Inhibition of the K(+)-H(+)-ATPase by addition of ouabain (0.1 mM) to the mucosal solution diminished Jms in the distal colon; in the caecum and proximal colon ouabain had no effect on Jms. 4. Neither amiloride nor ouabain caused major changes in Jsm in any of the large intestinal segments. 5. In conclusion, absorption of SCFA, e.g. Jms, in all large intestinal segments is related to the presence and activity of H+ secreting systems located in the apical membrane of colonocytes. In the caecum and proximal colon the predominant system appears to be Na(+)-H+ exchange, and in the distal colon K(+)-H(+)-ATPase. Supply of H+ ions allows protonation of SCFA anions and subsequent permeation by non-ionic diffusion across the apical membrane. These mechanisms account for 35, 40-50 and 60-80% of SCFA transport in the caecum, the proximal and the distal colon of guinea-pig, respectively. The nature of the Na(+)-dependent secretory pathway in the caecum and proximal colon remains to be determined.

Acetates↗
PubMed1993

Contrast-enhanced transcranial color-coded real-time sonography. Results of a phase-two study.

BACKGROUND AND PURPOSE: Transcranial color-coded real-time sonography has been developed as a promising new bedside procedure to monitor central nervous system parenchymal and vascular pathology; the present study was designed to investigate the potential role of galactose microparticles (SH U 508 A) as a new ultrasound contrast-enhancing agent for transcranial sonography. METHODS: Ten patients (four women and six men, 24-63 years of age) with a broad spectrum of central nervous system pathology were investigated by transcranial color-coded real-time sonography in a phase-two clinical study. After conventional ultrasound examination, all patients received a maximum of six injections of 10 ml with 200, 300, or 400 mg/mL SH U 508 A. The intracranial vessels were scanned by color flow imaging in the axial and coronal planes through a transtemporal acoustic bone window; in addition, the vertebrobasilar system was followed through the foramen magnum. RESULTS: SH U 508 A was well tolerated without side effects. In axial and coronal scans, the application of SH U 508 A resulted in detection of peripheral branches of the anterior, middle, and posterior cerebral arteries, as well as the posterior communicating and superior cerebellar arteries. In addition, the deep cerebral veins (i.e., inferior sagittal sinus, internal cerebral veins, great cerebral vein of Galen, straight sinus, and the confluence sinuum) were revealed. The transforaminal approach led to detection of the main infratentorial branches (anterior inferior, posterior inferior, and superior cerebellar arteries). One patient could not be insonated without contrast, but after SH U 508 A the trunks of the large intracranial arteries were detected. No obvious changes in the ultrasound pattern of the central nervous system parenchyma were observed. CONCLUSIONS: These preliminary data indicate that the use of a transpulmonary ultrasound contrast agent (SH U 508 A) may substantially broaden the spectrum and potential diagnostic utility of transcranial ultrasound by allowing detection of supratentorial peripheral central nervous system arteries, deep cerebral veins, and (through the foramen magnum) the entire vertebrobasilar system, including the cerebellar arteries.

Adult↗
PubMed1993

Imaging of the vertebrobasilar system by transcranial color-coded real-time sonography.

The vertebrobasilar system was investigated in 75 persons by TCCS to evaluate the applicability and diagnostic capacity of this transcranial Duplex technique. Transforaminal and transtemporal acoustic windows were employed to identify the vertebral arteries, basilar artery (PCA) and major branches of the vertebrobasilar system. The frequency of identifying the basilar artery and the PCA ranged from 84 to 94% but was poor for the distal segment of the basilar artery (45.3%). The origin of the basilar artery was disclosed by transcranial Duplex sonography at an average depth of 7.0 cm (range 6.0 to 8.0 cm). The assignment of the obtained flow signals to specific vascular segments was improved by this new technique. In addition, four persons received a maximum of six intravenous injections of a transpulmonary stable sonographic contrast agent (SHU 508 A) to enhance Doppler signal intensity derived from the vertebrobasilar system. The vascular trunk and all major branches of the vertebrobasilar system were identified in these four persons. We conclude that TCCS of the vertebrobasilar system will improve reliability of transcranial sonographic examination.

Basilar Artery↗
PubMed1992

Multiple false-positive serologic tests for HIV, HTLV-1, and hepatitis C following influenza vaccination, 1991.

OBJECTIVE: (1) To assess factors associated with the occurrence of multiple false-positive viral enzyme-linked immunosorbent assays (ELISAs) for human immunodeficiency virus (HIV), human T-cell lymphotrophic virus type 1 (HTLV-1), and hepatitis C virus (HCV) among individual blood donors and (2) to determine the frequency and time course of this phenomenon. DESIGN: Case-control study. SETTING: A regional blood center. PARTICIPANTS: Blood donors found to have multiple false-positive viral ELISAs (case donors) and randomly selected seronegative controls (control donors) who donated between October 31, 1991, and December 15, 1991. An additional random sample of 262 donation records was reviewed to calculate the proportion of donors who received influenza vaccine. MAIN OUTCOME MEASURES: Multiple false-positive viral ELISAs, receipt of influenza vaccination formulated for the 1991-1992 influenza season, and follow-up ELISA results on serum samples obtained from case donors. RESULTS: Among 17,941 donors, 10 case donors were identified. Nine of the 10 case donors received influenza vaccine, compared with three of 30 control donors (odds ratio [OR] = 81; 95% confidence interval [CI], 6 to 3670; P less than .001). Among nine case donors, the mean time between vaccination and blood donation was 26 days (range, 9 to 68 days). Follow-up ELISAs of serum samples from seven case donors obtained 52 to 130 days (mean, 75 days) after vaccination demonstrated reversion to HIV and HTLV-1 seronegativity in all but one specimen, with persistence of positive HCV ELISAs in four specimens. We estimate between 0.6% and 1.7% of blood donors who received influenza vaccine this season had multiple false-positive viral ELISAs. CONCLUSIONS: The occurrence of multiple false-positive viral ELISAs among blood donors was associated with influenza vaccination, but was infrequent among vaccinees. This phenomenon is of short duration for HIV and HTLV-1, but may persist longer for HCV. We recommend influenza vaccinees not be deferred from blood donation. Blood donors with multiple false-positive viral ELISAs should be considered for future reentry as blood donors.

Adult↗