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Biomedical subjects

H Becker

Publications and source records attributed to H Becker.

At least 181 records · Page 10Linked to original sources
PubMed1997

Influence of sleep apnea on 24-hour blood pressure.

OBJECTIVE: To study the influence of obstructive sleep apnea (OSA) on 24-h BP. SETTING: Sleep laboratory of the Medical Department, Neukölln Hospital, Berlin, Germany. METHODS: In 93 subjects, noninvasive 24-h BP monitoring was performed with BP recordings made at 15-min intervals. Apnea severity was evaluated by means of a portable device that allows calculation of an oxygen desaturation index (ODI). A normal 24-h BP profile (dipping) was defined by a night/day BP ratio of 0.9. RESULTS: ODI was related to systolic and diastolic daytime (p<0.001) and nighttime BP (p<0.001) as well as systolic and diastolic BP night/day ratios (p<0.001). Multiple regression analysis showed that age and ODI were independently related to daytime BP. When subjects were grouped according to apnea severity, daytime BP increased as ODI increased: 127/80+/-10/11 mm Hg in habitual snorers (ODI 0 to 5), 135/87+/-15/9 mm Hg in mild OSA (ODI 6 to 30), and 140/90+/-13/10 mm Hg in severe OSA (ODI >30) (p values <0.05 for comparisons of OSA groups with habitual snorers). Compared to subjects with mild OSA or habitual snorers, BP night/day ratios were greater in patients with severe OSA (p values <0.05). Accordingly, hypertension and nondipping increased as ODI increased. CONCLUSION: OSA is associated with hypertension independent of the confounding factors of age and obesity. Nondipping is related to apnea severity. These alterations might contribute to the increased mortality in patients with severe OSA.

Blood Pressure↗
PubMed1997

[Work of breathing in noninvasive proportional assist ventilation in patients with respiratory insufficiency].

BACKGROUND: The aim of the present study was to evaluate if Proportional Assist Ventilation (PAV), when applied noninvasively via face mask, can reduce ventilatory effort in patients with respiratory failure. We present preliminary results of an ongoing study. PATIENTS AND METHODS: In 5 patients with respiratory failure due to different underlying disorders (pulmonary fibrosis, bilateral diaphragm paralysis, COPD) we compared the transdiaphragmal pressure-time integral. PTdi (integral off Pdi dt) after 15 minutes of noninvasive PAV to the baseline values without ventilatory support. RESULTS AND CONCLUSION: Four patients showed reduction of PTdi to various extend. One patient who presented low diaphragmal activity at baseline due to diaphragmal paralysis showed a slight increase in PTdi during ventilation. Mean PTdi decreased by 26.7%. PaCO2 in the 5 patients showed no significant change after 15 minutes of ventilation, thus indicating that with noninvasive PAV patients can maintain constant ventilation with reduced effort.

Aged↗
PubMed1997

Molecular genetic analysis of a patient with hereditary nonpolyposis colorectal cancer syndrome.

Hereditary nonpolyposis colorectal cancer types I and II constitute approximately 5% to 10% of the cases of colorectal cancer annually. Recognition of its clinical features and identification of affected families are imperative for appropriate medical and surgical management. Furthermore, molecular analysis can be performed in such families because the DNA mismatch repair genes have been identified as being mutated, thereby leading to microsatellite instability. We describe a 33-year-old woman with ovarian, uterine, and colorectal cancer, whose family, on close examination, had features consistent with hereditary nonpolyposis colorectal cancer. The patient had evidence of microsatellite instability in her colon cancer.

Adult↗
PubMed1997

Enhanced bilateral somatostatin receptor expression in mediastinal lymph nodes ("chimney sign") in occult metastatic medullary thyroid cancer: a typical site of tumour manifestation?

In medullary thyroid cancer (MTC), post-surgically elevated plasma calcitonin and/or carcinoembryonic antigen levels frequently indicate persisting metastatic disease, although conventional diagnostic procedures fail to localize the responsible lesions (occult disease). Somatostatin analogues have been used successfully in disease localization, but recently concerns have been raised that increased thoracic uptake of indium-111 pentetreotide in patients with previous external beam irradiation may represent a false-positive finding, caused by post-irradiation pulmonary fibrosis. We recently examined seven patients with metastatic MTC by somatostatin receptor scintigraphy (six with occult and one with established disease). In four patients, all of whom had stable or slowly rising tumour marker levels over several years, a chimney-like bilateral mediastinal uptake of indium-111 pentetreotide was found. In two patients with persisting hypercalcitonaemia immediately after primary surgery, supraclavicular lymph node metastases were identified as the responsible lesions. None of these seven patients had prior external beam radiation therapy. In two cases, histological confirmation was obtained. In one patient, disease progression could be shown during follow-up. These data suggest that bilateral mediastinal lymph node involvement is a typical site of disease in slowly progressing occult metastatic MTC; the "chimney sign" may represent a typical finding with somatostatin analogues in such cases. Therefore, we believe that even in the case of prior external beam irradiation, mediastinal uptake of octreotide might represent metastatic MTC rather than radiation fibrosis.

Aged↗
PubMed1997

[Appendectomy 1997--open or closed?].

Unlike laparoscopic cholecystectomy, laparoscopic appendectomy (LAE) has not yet become popular. Are there no significant advantages? Or is the poor acceptance of LAE related to its longer learning curve, longer operative times and the need for additional equipment, which lead to some inconvenience when the procedure is done on an emergency basis? LAE may be performed as safely as open appendectomy (OAE) with fewer wound complications. Superior laparoscopic exploration allows an accurate diagnosis and reduces the rate of negative appendectomies. In contrast, postoperative pain, recovery and the cosmetic result are equal to or at best slightly better than in open surgery. Therefore, in the routine patients, there is no need to replace OAE by LAE. In the case of an uncertain diagnosis, the laparoscopic approach is generally superior, allowing thorough abdominal exploration. This has to be considered in each individual case; however, women with lower abdominal pain and suspected appendicitis will certainly benefit from laparoscopy, as well as older patients with an unclear diagnosis. The lower rate of wound infections is beneficial to obese patients and to patients with gangrenous or perforated appendicitis. Furthermore, the decision for one procedure or the other is influenced by the patient's individual preference and cosmetic aspects. The verifiable benefit of the laparoscopic procedure for certain categories of patients and the potential advantages in the individual case suggest that competent handling of laparoscopic technology will be required in future. Therefore, experienced surgeons should take more active interest in instruction and training--even when surgery has to be performed after hours.

Appendectomy↗
PubMed1997

[Initial cranial CT for evaluating the prognosis of craniocerebral trauma].

A total of 208 multiple trauma patients with head injury (HI) were investigated who had been treated in the period from 1990 to 1995. The average age was 35.2 +/- 17.7 years; the injury severity according to ISS was 30.2 +/- 8.6 points; 20.5% died as a result of the HI; the mortality of all patients was 26.5%. The Glasgow Coma Scale (GCS) was determined at an average of 22 min after trauma (8.0 +/- 4.3 points) at the scene of accident. The patients were classified according to GCS into minor HI (group 1: 14-15 points), moderate HI (group 2: 9-13 points) and severe HI (group 3: 3-8 points). Patient outcome was assessed by the Glasgow Outcome Scale (GOS) and was classified as good (GOS 4 and 5) and poor (GOS 1, 2 and 3) outcome. At the latest, 2 h after trauma, a CT scan of the head (CCT) was done. The HI groups are compared regarding frequency of types of injury. In all HI groups the fractures of the bony face occurred at the same frequency (36.0-38.9%). The frequency of calotte fractures (Kal-Fx) increased from group 1 (8.0%) to 2 (19.2%) and 3 (25.6%); fractures of the skull base significantly differed between group 1 (16.0%), 2 (7.8%) and 3 (33.4%). Epidural hemorrhage (EDB) appeared only in group 2 (7.8%) and 3 (6.7); subdural hemorrhage was found in group 1 (2.7%), 2 (7.8%) and 3 (10.0%). Subarachnoid hemorrhage (SAB) was significantly more frequently seen, dependent on HI severity, in group 3 (26.7%) compared to group 2 (11.7%) and 1 (8.0%). Intracerebral contusion (ICK) significantly increased from group 1 (12.0%) to 2 (27.3) and 3 (45.6%). Brain swelling (BS) also significantly increased from group 1 (8.0%) to 2 (19.5%) and 3 (49.0%) and lesions of ventricles (VL) from group 1 (2.7%) to 2 (11.7%) and 3 (20.0%). Midline shift (13.4%) and signs of herniation (4.5%) only occurred in group 3. The analysis of correlation/regression and receiver operating characteristics was able to predict 79% of patients' outcome accurately using GCS (r 0.54; P < 0.0001) alone, using CCT (r 0.65; P < 0.0001) 87% were correctly predicted with significant variables Cal-Fx, EDB, SAB and BS. CCT with GCS (r 0.74; P < 0.0001) were able to predict 88% accurately with significant variables Cal-Fx, EDB, BS and GCS. The combination of CCT with GCS, age and ISS (r 0.78; P < 0.0001) was able to predict only 87% correctly, although the r value was the highest; significant variable were Kal-Fx, EDB, BS, VL, GCS, age and ISS.

Adolescent↗
PubMed1997

Breakdown of the meningeal barrier surrounding the intraorbital optic nerve after experimental subarachnoid hemorrhage.

PURPOSE: The intraorbital optic nerve sheath meninges contain a perineural subarachnoid space lined by meningeal cell layers and intercellular fibrous tissue. We sought to determine whether functional or structural characteristics, or both, of the optic nerve sheath are influenced by the increased intracranial pressure after the rupture of cerebral aneurysms. METHODS: We infused the great cisterns of cats with either x-ray contrast medium or autologous blood. The cisternal infusions were done under the experimental condition of a sudden 2.5-minute increase in intracranial pressure similar to that recorded after the rupture of cerebral aneurysms in humans. RESULTS: Digital subtraction radiographs of the optic nerves taken during the cisternal infusion of contrast medium at the start showed the opacification of the optic nerve subarachnoid space. After 2 minutes, the contrast medium leaked into the orbit, indicating the breakdown of the meningeal fluid barrier. Ultrastructural investigation of the optic nerve sheath after high-pressure cisternal infusions showed the arachnoid cell layers scattered. The flattened arachnoid cells displayed mainly intracellular and some intercellular, porelike openings. After infusion of blood into the great cistern, erythrocytes were found within porelike openings of the arachnoid cells. CONCLUSIONS: The meningeal fluid barrier of the optic nerve sheath can be destroyed by pressure changes associated with subarachnoid hemorrhage. This disruption might be regarded as a natural optic nerve sheath fenestration that allows outflow of cerebrospinal fluid into the orbit to protect the optic nerve from increased intracranial pressure after aneurysmal rupture.

Angiography, Digital Subtraction↗
PubMed1997

Reproductive health care experiences of women with physical disabilities: a qualitative study.

OBJECTIVE: To explore the reproductive health care experiences of women with physical disabilities and how reproductive health care experiences could be improved. DESIGN: A qualitative interview study was conducted. PARTICIPANTS: Ten women, ages 28 to 47 years, with physical disabilities, including multiple sclerosis, cerebral palsy, and paralysis, were recruited through the investigators' contacts with local disability groups. RESULTS: Interviewees encountered numerous barriers to quality reproductive health care services, including inaccessible equipment and facilities, limited contraceptive options, health care providers' insensitivity and lack of knowledge about disabilities, and limited information tailored to their needs. Providers sometimes appeared surprised that they would be sexually active, and did not ask about contraceptive use or assess for sexually transmitted diseases. Although most interviewees had private health insurance, some had problems seeing preferred providers. Accessing reproductive health care services is so difficult that some women avoid regular gynecologic visits. Suggestions for improving services included involving women with disabilities in teaching health care providers about their special needs and self-advocacy training to help disabled women become more knowledgeable partners in their own health care. CONCLUSIONS: Additional research should address the gaps in knowledge about the reproductive health care needs of women with disabilities.

Adult↗
PubMed1997

[Genital self-injury behavior--phenomenologic and differential diagnosis considerations from the psychiatric viewpoint].

There is only a small number of publications concerning psychiatric aspects of genital-self-mutilation, all of these are case reports. This presentation adds results of self-inflicted genital injuries in another seven males which are discussed in relation to relevant scientific literature focussing on psychopathology and dynamic considerations. It is argued that genital self-mutilations should primarily be considered as symptomatic behavioural patterns and that-beside quasi-normal psychological procedures as part of certain religious or cultural rituals-such acts can be interpreted as a common final pathway of a variety of psychopathological problems. The inclusion of sexually (co-)motivated genital-automutilations in a complete work up and analysis of this topic seems to be reasonable and is advocated by the authors. The assumption that genital self-injuries are more often seen in non-psychotic conditions than in productive psychotic states is substantiated. Finally, the relation between genital automutilations and self-harm in general is discussed and some recommendations on the management are listed.

Adult↗
PubMed1997

Clostridial gas gangrene of the abdominal wall after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is associated with a considerable rate of infectious complications of up to 2.8%. Such infections are usually of minor clinical importance. However, we observed a case of life-threatening Clostridial gas gangrene centering around the right lateral port site and developing across all of the right-sided abdominal wall, causing septic shock and severe multi-organ failure. Considering the overall infection rate and the possibility of even severe morbidity, we advocate perioperative antibiotics in laparoscopic cholecystectomy.

Abdominal Muscles↗
PubMed1997

Collaborative assessment: exploring parental injury prevention strategies through bicycle helmet use.

While multiple studies have investigated bicycle helmet use, qualitative studies investigating parental strategies to promote their children's safety are rare. Thirty-four parents were interviewed to explore their injury prevention strategies. Findings suggest that the developmental stage of the child, the child's gender, and rural versus urban residence are all related to strategies parents use and their success in promoting bicycle safety. Peer pressure was the major deterrent, and negative "parent pressure" was also identified as problematic. Themes emerged that may support future injury prevention efforts with children, parents, and their communities and provide agencies information not previously captured quantitatively.

Adolescent↗
PubMed1997

[Psychotic symptoms as the initial manifestation of multiple sclerosis?].

Five case reports with psychiatric disorders prior to the diagnosis of multiple sclerosis are presented and discussed in relation to relevant scientific literature. Particularly the possibility of a causal correlation between psychopathological abnormalities and the CNS-inflammation is investigated. According to several reports and the own observations one has to consider the possibility of a (pure) psychotic onset of multiple sclerosis. The differential diagnosis in patients with psychotic illness should therefore include the encephalitic form of MS. Further studies with a standardized setting and a definite population basis are necessary to expand the knowledge in the epidemiology of psychiatric disturbances in MS.

Adult↗
PubMed1997

[Brief interdisciplinary oncology: a model for ambulatory, multimodal treatment of tumor patients].

Since 10/1994 the Interdisziplinäre Kurzzeit-Onkologie (IKO) is an outpatient department for the treatment of patients with cancer used by the departments of hematology/oncology and surgery. Between 09/1995 and 02/1997, 818 patients received 2024 cytotoxic therapies with neoadjuvant (15%), adjuvant (65%) or palliative (20%) intention-mostly within multicenter clinical studies. Ambulatory operations like removal of lymph nodes for diagnosis or the implantation of venous catheter systems prepared the way for specialized modalities of cancer therapy. The high compliance and consent of patients, combined with better understanding of cancer therapy, resulted in an enhanced quality of life and optimized therapy. Standardization in diagnostics and fast realisation of interdisciplinary treatment schedules lead to reduction of costs and to enhancement of quality and security in cancer therapy.

Ambulatory Care↗
PubMed1996

Expression of CD44 splice variants in normal respiratory epithelium and bronchial carcinomas: no evidence for altered CD44 splicing in metastasis.

Expression of alternatively spliced CD44 adhesion molecules has been implicated in metastatic spread of various rodent and human tumors. To determine whether specific CD44 splice variants contribute to metastatic spread of bronchial cancers, we compared the expression of CD44 splice variants in normal bronchial epithelium and bronchial cancers, including tumors which already spread to regional lymph nodes or distant organs. Variant CD44 expression was analysed by immunohistochemistry using variant exon-specific monoclonal antibodies. The precise composition of CD44 transcripts was delineated by exon-specific RT-PCR. The concurring data obtained by both methods revealed that high levels of standard CD44 and variants v5 and v6 as well as low levels of variants v7 and v10 are expressed both in normal bronchial epithelium and squamous cell lung cancers. No CD44 expression was observed in the highly metastatic small cell lung cancers and adenocarcinomas with the exception of bronchioalveolar cancers showing weak expression of standard CD44. These data suggest that expression of alternatively spliced CD44 molecules in the bronchial tract is related to the distinct differentiation of the respiratory epithelium. No correlation between expression of specific CD44 splice variants and metastasis of bronchial cancers was observed.

Alternative Splicing↗
PubMed1996

Superselective intra-arterial amytal (Wada test) in temporal lobe epilepsy: basics for neuroradiological investigations.

We describe the angioarchitecture of the medial temporal region as a basis for modified superselective Wada tests in patients with temporal lobe epilepsy. Possible functional deficits following the injection of amytal, depending on the superselective placement of the microcatheter in the medial temporal arteries, are discussed. The individual blood supply in each patient determines the ideal super-selective positioning of the micro-catheter.

Amobarbital↗
PubMed1996

A proposed modification of the Wada test for presurgical assessment in temporal lobe epilepsy.

We report experience with a modification of the Wada test used before temporal lobe resection in patients with drug-resistant epilepsy. Our procedure consists of injection of amytal via a microcatheter into the anterior choroidal artery or the P2 segment of the posterior cerebral artery and simultaneous presentation of verbal and figural memory test material before, during and after the injection. Pros and cons of the modification and inherent shortcomings of the amytal test are discussed on the basis of the results in ten patients.

Adolescent↗