Biomedical subjects
Publications and source records attributed to H Becker.
Investigation of the aerial parts of Rhyncholacis penicillata afforded the new chromenes, 7-hydroxy-6-(3-methylbutyryl)-5-oxymethyl-chromene (rhynchonin A) and 7-hydroxy-6-(2-methylbutyryl)-6-oxymethylchromene (rhynchonin B). Structures were elucidated by spectroscopic methods and independent synthesis. Rhynchonin A showed broad insecticidal, acaricidal and nematicidal potency including strong biological activity against Heliothis zea.
By means of a bioassay-oriented fractionation of the CO2 extract of Calendula flowers, the triterpenoids are shown as the most important anti-inflammatory principles of the drug. Among them, the faradiol monoester appears to be the most relevant principle for the activity of the drug, due to its quantitative prevalence. The unesterified faradiol, not present in the extract, is the most active of the tested compounds and equals indomethacin in activity, whereas the monools psi-taraxasterol, lupeol, taraxasterol, and beta-amyrin are less active than the free diol. The anti-inflammatory activity of different CO2 extracts is proportional to their content of faradiol monoester, which can be taken as a suitable parameter for the quality control of Calendula preparations.
Referring to the recent debate on how to describe and classify "transsexual phenomena" according to psychopathological and diagnostic criteria and the necessary definition of standards of care, this investigation is intended as a clinically oriented contribution to the study of gender identity disorders. Beside a literature review to outline the different theoretical positions, several case reports are presented to illustrate and analyze the variety and complexity of conditions which are underlying or concomitant to the desire for a sex change. This study focuses on the need for more careful diagnostic considerations and scrupulous follow-up of patients presenting with the conviction of wrong sex assignment. Although it seems reasonable to "detotalize" transsexualism, the authors plead for the adherence to a clinically oriented approach to this issue. They disagree with arguments to abandon a "nosomorphic view" or with notions that regard transsexualism as a "minority which has been pathologized". In order to match demands properly and to give adequate advice it appears necessary to improve general knowledge and specific therapeutic competence in the field of gender identity disorders.
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Between 1975 and 1992, in 16 infants (14%) out of 113 neonates with previous necrotizing enterocolitis (NEC) a total of 25 intestinal strictures had to be treated. Four (16%) were found in the ileum and 21 (84%) in the colon, and in 50% multiple strictures were present. In these 16 patients initial treatment for acute NEC included conservative treatment in 5, primary resection and enterostomies in 6 and proximal diverting enterostomies in 5. Therefore, the incidence of late strictures was 11% after conservative therapy, 11% after primary resection and 55% after primary proximal diverting enterostomies. An average of 49 days elapses between the recovery from NEC and the diagnosis of late strictures in conservatively treated patients. After initial surgical treatment, late strictures were detected on contrast studies on an average of 80 days. In pathologic specimens, marked fibrosis in the submucosa was consistently present in all strictures, whereas inflammatory changes in the mucosa, disruption or hypertrophy of the muscle layers or absence of ganglion cells were seen less frequently. All strictures were resected and primary end-to-end anastomosis was performed. But despite the development of late intestinal strictures, bowel preservation was improved after initial restrictive surgical therapy and aggressive medical treatment.
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Injuries of the biliary tract remain an important concomitant lesion following liver trauma. Intra- and extrahepatic bile duct injuries differ substantially in etiology and choice of surgical procedure. Intrahepatic bile duct injuries gain clinical relevance postoperatively following primary surgical liver treatment. Characteristic consequences of intrahepatic bile duct injuries are: infected necrosis, abscess, bilious fistula, bilhemia, hemobilia and biliary duct stricture. In contrast, concomitant organ or vessel injury are of primary importance in extrahepatic biliary duct injury. Lesions of the distal biliary duct, always associated with duodenal or pancreatic injury, remains a particular thrill in general surgery. The approach to surgical treatment in case of biliary duct injury and its consequences are outlined and discussed in detail.
Between 1986 and 1993 fifty-two patients with ductal adenocarcinoma of the pancreatic head underwent pancreatoduodenectomy, 34 in a standard Whipple technique (Whipple), 18 since 1990 preserving the pylorus (PPPD). Operating time was significantly longer for Whipple compared to PPPD (5.5 +/- 1.4 vs. 3.8 +/- 1.0; p < 0.01). Postoperative morbidity (32 vs. 56%) resulted to 50% after PPPD of early postoperative delayed gastric emptying. Hospital mortality was 6% vs. none, respectively. Histopathologic workup of 28 node positive Whipple specimens revealed node involvement in only 11% along the stomach (1) or the pyloric region (2), but in these cases tumors had obviously close relation to the gastric outlet as the reason to chose Whipple. Actuarial survival was very similar in both groups, being 41 vs. 53% at one year, 13 vs. 18% at two years, and only 3.3% at five years for the whole cohort. In conclusion distal gastric resection in Whipple's procedure in ductal carcinoma is oncologically not effective. There is no hazard for survival relating to the preservation of the pylorus. Therefore PPPD as the technically less expensive and for nutritional status more beneficial operation should be the procedure of choice also for this type of tumor.
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Children and adolescents, who received an autologous reimplant of the spleen because of traumatic injury between 1979 and 1986 were matched to a cohort of patients, splenectomized because of traumatic injury of the spleen as well and to a control group of healthy age matched individuals. In addition to a physical check-up, markers of humoral and cellular immunity (e.g. lymphocyte subpopulations and phagocytosis of pneumococcy) as well as the coagulatory and fibrinolytic system were examined. All parameters tested, were found to between results from splenectomized and healthy individuals. Our studies stress the fundamental ability of autologous spleen transplants to take over part of the splenic function on the basis of a largerly histomorphologic restitution. Thus autologous reimplantation of the spleen in children and adolescents is an excellent choice as compared to otherwise necessary splenectomy, if preservation of the organ is impossible.
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A variety of different scoring systems are in current use, with an increasing impact on intensive care treatment. Originally these scoring systems were applied to evaluate objective grading and to estimate survival and mortality. More recently, other potential applications have been investigated. While clinical monitoring and assessment of therapeutic success are the primary goals, scoring systems can be used to define comparable patient collectives and to delineate predefined patient groups for clinical trials. Scoring systems are gaining increasing importance in evaluation of the level of therapeutic intervention and care provided as well as in quality assessment. On the whole, however, accuracy, the probability that outcome will be correctly predicted for an individual patient, is still inadequate. Although desirable, individual patient prediction is therefore not allowed, and therapeutic strategies and therapy evaluation based on scoring systems cannot be implemented, or only in a limited way. For daily use in individual patient evaluation--monitoring, therapy response, prognosis--biochemical monitoring is still of primary importance. Scoring systems have now found a useful application as a supplement, rather than a rival, to clinical patient evaluation.
In a German multicenter trial, previously untreated patients with unresectable stages IIIA and IIIB non-small cell lung cancer were randomly assigned to receive either radiotherapy alone (arm A) or chemotherapy followed by radiotherapy (arm B). Chemotherapy in arm B consisted of ifosfamide 1,500 mg/m2 intravenously on days 1 to 5 and 29 to 33, and vindesine 3 mg/m2 intravenously on days 1 and 5 and 29 and 33. Radiotherapy started on day 1 in arm A and on day 56 in arm B. Single doses of 2 Gy were given 5 days a week for 3 weeks and after a 2-week interval for an additional 2 weeks. The total radiation dose was 50 Gy. Concurrent to radiotherapy, cisplatin was given as a radiosensitizer at a dose of 20 mg/m2 once a week. From July 1986 to March 1989, 85 patients were randomized, of whom 78 were evaluable. Main prognostic factors were well balanced. Of the patients receiving chemotherapy, 25% had a partial remission after two cycles, 46% showed no change, and 29% had progressive disease. After radiotherapy, response rates were 49% in arm A and 58% in arm B, including a 10% complete remission rate in both groups. After two thirds of the projected sample size had been included, an analysis of survival was performed and showed a statistically significant advantage for the treatment group including chemotherapy (P = .016). Median survival was 9.0 months versus 13.7 months and 2-year survival was 12% versus 24%, both in favor of the group receiving chemotherapy. These results caused premature discontinuation of patient accrual according to the study protocol and the recommendations of the Ethics Review Board of the Philipps-University Hospital. The results of this trial indicate that chemotherapy is able to prolong survival of patients with locally advanced unresectable non-small cell lung cancer and should be considered for treatment of these patients.
Bryophytes have been screened for lectins. From the liverwort Marchantia polymorpha (Marchiantiales) a lectin could be purified to homogeneity using a combination of ultrafiltration, size exclusion chromatography and ion exchange chromatography. SDS polyacrylamide gel electrophoresis, size exclusion chromatography and electrospray mass spectroscopy showed that the lectin is a monomeric protein with a M(r) of 16,134.64 +/- 2.93. Marchantia polymorpha lectin agglutinates erythrocytes of different mammalia and exhibits carbohydrate specificity against complex carbohydrate structures. This is the first report of a lectin isolated from liverworts.
Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) was given to an intensive-care patient with polytrauma in a life-threatening situation with acquired agranulocytosis and sepsis. Mature granulocytes reappeared in the blood 2 days after initiation of rhGM-CSF therapy; granulocyte precursors peaked at 43% after 5 days. Bone marrow examination performed 7 days after the beginning of rhGM-CSF therapy revealed complete regeneration of granulopoiesis. The functional analysis of these blood leukocytes in vitro showed regular production of reactive oxygen radicals. Clinically, the patient recovered without any serious side effects due to the rhGM-CSF therapy. These results suggest that rhGM-CSF accelerates granulocyte recovery from acquired agranulocytosis with the presence of their functional activity.
Three-dimensional imaging in computer tomography (3-D CT) has been rendered feasible by the development of special software programs. On the basis of the data from 50 spinal CTs, 3-D reformations are made. The method has proved effective especially in complicated vertebral fractures. There are regular correlations between the plane of the fracture and the choice of the axis of rotation as well as the nature of the reformations. A 3-D reformation is frequently more appropriate than a coronary or a sagittal 2-D reformation. In destructions of vertebrae due to tumors, the extent of bone destruction and the altered position of the vertebrae in relation to each other can be imaged. 3-D computer tomograms do not provide fundamentally new diagnostic information, but the understanding of pathological topography is improved.
Three-dimensional (3D) computed tomography of the middle ear and adjacent structures has been carried out in two cadaveric heads from axial and coronal high-resolution images. The structures shown on the images of the walls of the tympanic cavity are illustrated. The usefulness and limitations of the technique, in this region, are discussed: use of grey level volumes at the surface of the slices and the inclusion of structural landmarks is emphasized. The 3D representations show the anatomical spacial relationships of the small structures in and around the middle ear to advantage. The information may be of use in surgical orientation.