[Pulmonary embolism treatment].
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Anticoagulants↗
Biomedical subjects
G Meyer
Publications and source records attributed to G Meyer.
[Current indications of low-molecular-weight heparins].
Low-molecular-weight heparins (LMWH) have different properties than non-fractionated heparins. Bioavailability is better after subcutaneous administration and a longer halflife allows a single daily injection. Efficacy is equivalent for postoperative thromboembolism prophylaxis for all types of surgery. In most reports, low-molecular-weight heparins are more effective than non fractionated heparin and lead to fewer episodes of hemorrhage and thrombocytopenia. For treatment of deep vein thrombosis, low-molecular-weight heparins are as effective as non-fractionated heparins after two, or even one, daily injection without hemostasis tests. Other on-going studies are evaluating LMWH indications in pulmonary embolism, artery disease, pregnancy or other medical conditions.
Cerebrovascular Disorders↗
Accuracy of single-voxel proton MR spectroscopy in distinguishing neoplastic from nonneoplastic brain lesions.
PURPOSE: To measure the accuracy of single-voxel, image-guided proton MR spectroscopy in distinguishing normal from abnormal brain tissue and neoplastic from nonneoplastic brain disease. METHODS: MR spectroscopy was performed at 0.5 T with the point-resolved spectroscopic pulse sequence and conventional postprocessing techniques. Subjects consisted of a consecutive series of patients with suspected brain neoplasms or recurrent neoplasia and 10 healthy adult volunteers. Fifty-five lesions in 53 patients with subsequently verified final diagnoses were included. Spectra were interpreted qualitatively by visual inspection by nonblinded readers (prospectively) with the benefit of prior clinical data and imaging studies, and by blinded readers (retrospectively). The nonblinded readers interpreted the spectra as diagnostic or not, and, if diagnostic, as neoplastic or nonneoplastic. The blinded readers classified the spectra as diagnostic or not, and, if diagnostic, as normal or abnormal and as neoplastic or nonneoplastic (when abnormal). The sensitivity, specificity, positive and negative predictive values, and accuracy were calculated from blinded and nonblinded MR spectroscopy interpretations. A receiver operator characteristic (ROC) curve analysis was performed on blinded MR spectroscopy interpretations. RESULTS: The diagnostic accuracy averaged across four blinded readers in differentiating patients from control subjects was .96, while the area under the aggregate (pooled interpretations) ROC curve approached unity. Accuracy in the nonblinded and blinded discrimination of neoplastic from nonneoplastic disease was .96 and .83, respectively. The area under the aggregate ROC curve in the blinded discrimination of neoplasm from nonneoplasm was .89. CONCLUSIONS: Image-guided proton spectra obtained at 0.5 T from patients with suspected neoplasia can be distinguished from spectra in healthy control subjects, and neoplastic spectra can be distinguished from nonneoplastic spectra with a high degree of diagnostic accuracy.
Adult↗
[The conversion of innovative technics into surgical practice].
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Diffusion of Innovation↗
[Responsible conversion to new technology in surgical practice].
The continuing rapid increase in medical knowledge with its more complex technology together with the experiences we have made during the introduction of minimal invasive surgery suggest that the traditional methods of surgical teaching and learning do not suffice. The responsible application of new surgical technologies must engage a step by step introduction process, including standardized training courses at institutions with adequate training facilities. Uncontrolled ubiquitous spread of new methods without sufficient evaluation and quality control is dangerous and should not be allowed to repeat itself.
Curriculum↗
[Prognostic factors in gallbladder carcinoma as a decision aid for reoperation].
In a retrospective study of patients with gallbladder carcinoma, predictive factors for survival were evaluated. TNM stage, according to the UICC and complete tumor resection, turned out to be the strongest values in multivariate analysis. So it is important to make an early correct diagnosis and to reach complete tumor resection during surgical procedure. In case of an incidental tumor after simple cholecystectomy, hepatic wedge resection and lymph node dissection should be performed in T2 stage and above.
Adult↗
Scanning Tunneling Microscopy Manipulation of Native Substrate Atoms: A New Way to Obtain Registry Information on Foreign Adsorbates.
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Journal Article↗
[Treatment of severe pulmonary embolism].
Acute circulatory failure is the major complication of acute pulmonary embolism. It may be clinically silent, but sometimes leads to systemic hypotension, shock, or clinical manifestations of right ventricular failure. In these patients, oxygen, inotropic drugs, and fluid loading are indicated. Unless contra-indicated, thrombolytic therapy should be undertaken when clinical signs of circulatory failure occur. Surgical embolectomy is now undertaken in the very few patients not responding to maximal medical treatment. Vena cava interruption is not more often useful in massive pulmonary embolism than in non massive pulmonary embolism.
Anticoagulants↗
Synaptic targeting of ionotropic neurotransmitter receptors.
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Animals↗
The dorsomedial and dorsolateral forebrain of the zebra finch, Taeniopygia guttata: a Golgi study.
Neurones in the zebra finch dorsal forebrain (hippocampal and lateral corticoid complexes) were described and located using Golgi methods. We distinguish two main classes of neurones, spinous with distant projecting axons, and aspinous with local axons. Spinous neurones are subclassified into bitufted pyramids, localised in the medial hippocampus, modified bitufted pyramids in the intermediate corticoid area, multipolar neurones in the parahippocampal area, lateral hippocampus and corticoid complex, and stellate neurones in the corticoid complex. Among the aspinous neurones, we distinguish neurones with basket axons, dense pericellular axons, radial axons, and net-like axons, and horizontal cells seen in the dorsolateral corticoid area. This group includes sparsely spinous neurones found in the intermediate corticoid area. On the basis of the neuronal characteristics, we divide the hippocampal complex into 5 fields: medial and lateral hippocampus, parahippocampal area, central field of the parahippocampal area, and crescent field. The lateral corticoid complex is subdivided into an intermediate corticoid area and a dorsolateral corticoid area. We conclude that the avian dorsal forebrain is an assembly of fields interconnected by axonal collaterals. The medial hippocampus and possibly the intermediate corticoid area display a primitive cortex-like organisation, whereas the other fields lack any sign of cortical structure.
Animals↗
[Classical anticoagulant treatment of venous thromboembolic disease in cancer patients. Apropos of a retrospective study of 71 patients].
In order to evaluate the efficiency of classical anticoagulant therapy for venous thromboembolic disease in cancer patients, we retrospectively analysed 71 patients treated with intravenous heparin first and then with antivitamin K. After a mean follow-up of 185 +/- 25 days, 23 patients (33%) were dead; nine patients (12%) had suffered from major haemorrhagic complications, which were not fatal, four of which were due to heparin overdosage; 17 patients (24%) showed recurrent venous thromboembolic disease. According to univariate statistical analysis, risk of major bleeding was not associated with the presence of either thrombocytopenia, abnormal blood coagulation, metastases and/or any other hemorrhagic risk factors; recurrence of venous thromboembolic disease was not associated with the presence of other risk factors for venous thromboembolic disease, nor with the presence or absence of metastases and/or of ongoing chemotherapy. Such results suggest that classical anticoagulant therapy for venous thromboembolic disease in cancer patients is neither effective nor safe. The present retrospective study underlines needs for further prospective analyses in order to evaluate potential benefit from other therapeutic strategies, such as use of low molecular weight heparins and/or vena cava filter placement.
4-Hydroxycoumarins↗
Establishment of a rabbit model for bovine herpesvirus type 5 neurological acute infection.
This study was conducted to evaluate the suitability of the rabbit as a model for bovine, herpesvirus 5 (BHV-5) acute infection. In a preliminary experiment, a total of 24 one-month old New Zealand white rabbits were inoculated with BHV-5 or bovine herpesvirus 1 (BHV-1) by the intraconjunctival, intracerebral or intranasal routes. BHV-5 or BHV-1 inoculated in the conjunctiva induced virus proliferation in the eye mucosae and the nasal cavity of rabbits without meningo-encephalitis. On the other hand, only BHV-5 infection by intranasal or intracerebral routes produced a fatal meningo-encephalitis. The intranasal route was used in a further experiment for the establishment of a rabbit model for BHV-5 infection. A total of 45 rabbits were inoculated intranasally with BHV-5 or BHV-1. The results showed that intranasal inoculation of BHV-5 strain N569 in rabbits was followed by the development of a lethal meningo-encephalitis for 66% of rabbits while all BHV-1 infected rabbits remained healthy throughout this experiment (28 days). Analysis between the mortalities of rabbits infected with BHV-5 and BHV-1 were highly significant (p < 0.001). The presence of BHV-5 in the central nervous system (CNS) was confirmed by virus isolation (essentially the cerebrum, midbrain and pons) and by immunohistochemical staining of BHV-5 antigen (essentially in the neurons of the cerebrum) only in BHV-5 infected rabbits showing clinical signs of meningo-encephalitis. The findings obtained confirmed the suitability of a rabbit model for the establishment of BHV-5 neurological acute infection and also as a valuable tool for the comparative study of BHV-5 and BHV-1 neuropathogenicity.
Acute Disease↗
Subclavian carotid transposition: an analysis of a clinical series and a review of the literature.
OBJECTIVE: To analyse the clinical results and long-term patency rates of 108 patients with subclavian carotid transposition (SCT) and compare the outcomes to other clinical series using the same technique, as well as to those reported for other surgical procedures and PTA in the treatment of proximal subclavian artery disease. METHODS: The hospital records of 108 patients with carotid subclavian transposition were retrospectively reviewed for preoperative symptoms, Doppler examination, arteriography, blood pressure differentials and postoperative complications. Long-term patency and symptoms were determined during a follow-up examination including a history, physical examination, blood pressure differentials, Doppler examinations and arteriography in selected cases. RESULTS: The indication for SCT were subclavian steal (78%), upper extremity ischaemia (59%), rest pain or acral necrosis (5%), vertigo (6%). There was no mortality, blood pressure differentials were equalised in all patients without any early reocclusions. The complication rate was 15% with a permanent morbidity of 3%. Eighty-four patients (77%) could be re-examined during follow-up. For them the overall patency after a mean observation period of 70 months (1-144 months) was 100%. CONCLUSIONS: Subclavian carotid transposition is an excellent method for the treatment of proximal subclavian occlusive disease because of its exceptional long-term patency and low morbidity.
Anastomosis, Surgical↗
Heparin-induced thrombocytopenia with thrombotic complications during prophylactic treatment with low-molecular-weight heparin.
Heparin-induced thrombocytopenia is very uncommon with low-molecular-weight heparin, especially when given for prophylaxis of venous thromboembolism. In two of the four published cases, with thrombotic complications, thrombocytopenia may have been related to cross-reactivity between unfractionated heparin and low-molecular-weight heparin. We report one patient who received low-molecular-weight heparin for prophylaxis against venous thromboembolism without any previous injection of unfractionated heparin, and experienced thrombocytopenia with thrombotic complications. Heparin-induced thrombocytopenia was confirmed by several laboratory assays. This observation emphasizes the need for platelet count monitoring during low-molecular-weight heparin therapy.
Aged↗
Clinical presentation and results of thrombolytic therapy in older patients with massive pulmonary embolism: a comparison with non-elderly patients.
OBJECTIVE: To assess the clinical presentation and effectiveness of thrombolytic therapy in older patients suffering from massive pulmonary embolism. DESIGN: Analysis of a previously reported study of patients with massive pulmonary embolism using a dichotomous classification of age. SETTING: A medical intensive care unit in one hospital center. PARTICIPANTS: All subjects had massive pulmonary embolism as evidenced by scintigraphic and/or angiographic assessment. The 54 patients included in this study were divided into two groups according to age: 28 patients were less than 75 years old and 26 patients were 75 years old or older. INTERVENTION: All patients received a bolus regimen of single-chain recombinant tissue-type plasminogen and were subsequently treated by heparin and warfarin. MEASUREMENTS: Clinical symptoms at admission, resolution of scintigraphic vascular obstruction, death rate, hemorrhagic complications, recurrent pulmonary embolism, and long-term follow-up were compared between both groups. RESULTS: Clinical symptoms at admission were similar in both groups. The mean absolute improvement in the lung scan perfusion defect, the rate of major bleeding, and the long-term evolution were not statistically different between older and younger patients. CONCLUSION: Clinical symptoms, including hemodynamic condition, did not differ between elderly and nonelderly patients suffering from massive pulmonary embolism. Old age should not preclude thrombolytic therapy in massive pulmonary embolism, provided there is no other contraindication for thrombolytic treatment.
Age Factors↗
Factors for changes of caries prevalence among adolescents in Germany.
Data on caries prevalence among adolescents in East and West Germany before and after unification (1990) were compared with changes in etiologic and preventive parameters. The postwar increase of total sugar consumption resulted in an increase of caries prevalence among adolescents in both East and West Germany until 1970. Parallel to the introduction of preventive measures, especially systemic fluoridation, the national caries level in East Germany stabilized at 4-5 DMFT (in 13-14-year-olds) with significant regional differences. The introduction of fluoridated toothpaste after 1973 in West Germany was followed by a caries decline in children (1970s) and in adolescents (1980s) from very high caries levels (8.8 DMFT in 13-14-year-olds in 1983) to moderate levels (5.1 DMFT in 1989). The sudden increase from 10% to 90% fluoridated toothpaste in East Germany in 1990 was also accompanied by a caries decline in adolescents. Group prevention, which included fluoride varnish programs and the introduction of free prevention (brushing instructions, fluoridations, sealants) at private dentists for 6-19-year-olds since 1983, seems to be responsible for the latest caries reductions all over Germany.
Adolescent↗
Characterization of CCKA receptor mediated pepsinogen secretion in porcine chief cells.
Cholecystokinin octapeptide (CCK-8s) is an endogenous stimulus of gastric pepsinogen secretion. Previous studies with isolated guinea pig chief cells indicated that this process is mediated through the CCKA receptor subtype, with an additional contribution from CCKB receptors. For comparison, we examined the mechanism of CCK-8s stimulated pepsinogen secretion in a larger nonrodent species, using highly enriched porcine chief cells as a functional in vitro model. Porcine chief cells responded weakly to stimulation by CCK-8s alone, but the efficacy was markedly enhanced in the presence of 10 mumol l-1 forskolin. Under these conditions, pepsinogen secretion was potently stimulated by CCK-8s and the CCKA receptor selective heptapeptide, A-71,378 (EC50 = 4.7 and 33 nmol l-1), but not by CCKB receptor selective agonists. The prototype CCKA receptor selective antagonist L-364,718 blocked pepsinogen secretion with approximately 2,000-fold higher affinity than the CCKB receptor selective analogue, L-365,260. This functional profile was consistent with the affinity rank order of all tested compounds at CCKA-receptor-like [125I]-BH-CCK-8s binding sites in the porcine gastric mucosa. Comparison with cloned CCKA receptors from other species revealed that the receptors mediating pepsinogen secretion in the pig have similar pharmacology, possibly with slight differences in agonist potencies. In contrast to the guinea pig, porcine CCKB receptors appear to have no direct role in pepsinogen secretion.
Animals↗
Effects of pressure-induced stretch and convection on low-density lipoprotein and albumin uptake in the rabbit aortic wall.
The effects of pressure-driven convection and vessel wall stretching in the pressure-related changes in low-density lipoprotein (LDL) and albumin transport across the arterial wall were studied in vitro in freshly excised rabbit thoracic aorta held at in vivo length and pressurized at 70, 120, or 160 mm Hg for 30 minutes. External rigid polyester sleeves of various diameters (4, 5, or 6 mm) were passed around half of the arterial segments in order to prevent vessel distension during pressurization. The intraluminal solution contained 131I-LDL and 125I-albumin. The transmural distribution of relative concentrations of LDL (CLDL) and albumin (Calb) across the wall was determined in wrapped and unwrapped segments using a serial frozen-sectioning technique. In the unwrapped segments, Calb increased uniformly between 70 and 120 mm Hg (P < .0001) but did not change significantly between 120 and 160 mm Hg (0.0063 +/- 0.0009 [n = 4], 0.0520 +/- 0.0055 [n = 9], and 0.0620 +/- 0.0071 [n = 12], respectively). In contrast, CLDL increased markedly both between 70 and 120 mm Hg (P < .001) and between 120 and 160 mm Hg (P < .05) (0.0025 +/- 0.0005 [n = 4], 0.0234 +/- 0.0029 [n = 9], and 0.0393 +/- 0.0056 [n = 12], respectively), with the increase being much more pronounced in the inner than in the outer media. In the segments wrapped with the 4-mm sleeves, both CLDL and Calb did not vary significantly between 70, 120, and 160 mm Hg. In the segments wrapped with the 5-mm sleeves, CLDL increased significantly between 120 and 160 mm Hg, whereas Calb did not vary significantly with increasing pressure. Our results demonstrate that (1) pressure-induced stretching of the arterial wall is a major determinant of arterial mass transport, and (2) pressure-driven convection accentuates LDL accumulation in the inner media, which may explain enhanced atherosclerosis in hypertension.
Animals↗