[Hamartomatous diffuse hyperplasia of the right heart ventricle in combined cardiovascular abnormality].
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Adult↗
Biomedical subjects
H Becker
Publications and source records attributed to H Becker.
[Occurrence of antigen-antibody complexes in the clinic].
We have analyzed 3,671 out of 16,000 immune-complex determination for this I.U.I.S.-Symposium in St. Georgen/Längsee, Carinthia, Austria. Patients came from various parts of Austria suffering from various inflammatory, regressive, autoimmune diseases or immunodeficiency. After extended trials of standardization with various complement tests and biological assays we have studied systematically PEG-precipitation and correlated with the clinic and biopsy in representative cases. Our experience showed, that complement assays may be sensitive to storage, shipping and sampling errors and have to be considered with this respect. Physical methods give additional informations to the diagnosis, prognosis and course of some diseases and are very useful for the clinical routine laboratory with the reservation, that the precipitated material consists of inflammatory and other denatured proteins but immunecomplexes. Precipitated materials is easily accessible to further biochemical identification.
Antigen-Antibody Complex↗
[Survey of the attitude of specialists faced with bronchial small cell carcinoma].
The practice of therapeutic trials is indispensable in the management of bronchial carcinoma if one hopes to improve the results. We have questioned 134 doctors in the Alsace region who are involved in the diagnosis and treatment of bronchial cancer. We asked how they would wish to be treated if they had a small cell cancer, and if they would agree to participate in a therapeutic trial should the occasion arise. Four different clinical situations of small cell carcinoma localised to the hemithorax were presented, illustrating current controversy on the best treatment or treatments to apply. The 4 proposed protocols were refused by 50% to 84% of the doctors questioned in different cases. The greater the level of consensus on a therapeutic treatment in a given clinical situation the greater the level of refusal to participate in a randomised protocol was. The fact that at least half of the specialist doctors questioned would refuse to be included in a current therapeutic protocol which is underway for patients in Europe leads to the suggestion that before the application for new protocols experts surrogates should give their opinion in association with ethical committee.
Adult↗
[Primary therapy of polytraumatized patients and reasons for early transfer to a specialty hospital].
200 polytraumatized patients were treated at our institution between 1.1.1987 to 28.2.1989. 58 patients had been submitted from other hospitals. Reasons for submissions were complex cranio-facial-trauma in 27 patients, thoracic trauma in 9 patients and complex abdominal injury in 8. In 13 of 44 patients (29.5%), submitted in between the first 24 h after trauma, severe and partially life threatening injuries had not been diagnosed at the first hospital. Failures in decision making burden especially patients with cranio-facial injuries, in whom intraabdominal and thoracical injuries are often overseen. Patients with abdominal trauma were often submitted after an operative attempt demonstrating complex traumatisation which was underestimated at primary diagnosis. Polytraumatized patients need to have a multidisciplinary management performed by a specified crew with all diagnostic facilities available to avoid overestimation or neglection of additive injuries. Direct submission into a specified medical center is therefore recommended and seems preferable to submission after failed or insufficient primary therapy in inadequately equipped smaller hospitals.
Adult↗
[Prognosis and therapy of liver injury in patients with multiple injuries].
Between 1.7. 1986 and 31.10. 1989 abdominal trauma was seen in 108 (35.8%) of 300 polytraumatized patients, 44 of these showed rupture of the liver. 23 patients belonged to grade I-III (Moore-classification) and 11 patients to grade IV. Extensive bilobar parenchymal destruction (grade V) was found in 10 patients including 6 patients with retrohepatic vena cava injury. 80% of all patients with liver trauma had intraabdominally associated injuries. In Grade I-II (n = 4) patients were treated conservatively and continuously observed by ultrasound. Injuries graded to III (n = 19) and IV (n = 11) were mostly treated by simple suture or segmental resection. In grade V hemihepatectomy was done in 4 cases, in 2 cases combined by packing and in 1 patient packing only. In 3 patients no adequate therapy was possible. The mortality rate being 36% (n = 16), hemorrhagic complications were the most common cause of death (7 of 16 patients). This was due only to the patients graded to V. In comparison the prognostic factor in grade I-IV ruptures were the associated injuries. In all these cases hemorrhage was stopped by a conservative, organ-retaining therapy. No further hemorrhage occurred. Liver packing was mainly used as additional treatment in cases of coagulopathy after resection. Further indications are extensive bilobar parenchymal destruction without the possibility of primary reconstruction and temporary hemostasis to allow transport to a specialized hospital.
Abdominal Injuries↗
[Misinterpretation of the adhesio interthalamica and the commissura epithalamica (posterior) in occlusive hydrocephalus in the computed tomogram].
As a cause of an occlusive hydrocephalus, sometimes by CT a cystic malformation of the third ventricle is falsely assumed. This misinterpretation is based on the enlargement of the ventricular system, which leads to an unusual visualization of the interthalamic adhesion and the epithalamic (posterior) commissure. We show these structures to be the reason for the misleading diagnosis by comparing anatomical sections, ventriculography and magnetic resonance imaging (MR) with each other. Finally we discuss the clinical significance by presenting cases, in which an operative treatment of the so called "cyst" already had been planned. For the definite diagnosis we favor MR.
Cerebral Ventriculography↗
[Onset of Wegener's granulomatosis with skin and joint symptoms].
A 54-year-old female presenting with arthralgias, weight loss, and anemia developed Raynaud's phenomenon and subcutaneous nodules at her hands. Granulomatous inflammation was observed in biopsies taken from her hands and sinuses, and later on the patient suffered from glomerulonephritis. The diagnosis Wegener's granulomatosis was further supported by detection of anticytoplasmic antibodies.
Female↗
Aberrant fatty acyl alpha-hydroxylation in human neuroblastoma tumor gangliosides.
Abnormalities of ganglioside structure characterize the neoplastic state, and aberrant glycosylation has been implicated as underlying many new tumor ganglioside structures. However, variations in ceramide structure can also result in novel tumor gangliosides. To address systematically this aspect of ganglioside metabolism, we have initiated a study of the structures of the ceramide species of an oligosaccharide-homogeneous human tumor-derived ganglioside, GM2. The ganglioside was isolated from neuroblastoma tissue and purified by normal-phase high pressure liquid chromatography. Marked ceramide heterogeneity was observed; 18 individual ceramide species of neuroblastoma GM2 were separated by reversed-phase high pressure liquid chromatography and collected. Their structures were determined by a combination of negative- and positive-ion fast atom bombardment mass spectrometry and collisionally activated dissociation tandem mass spectrometry of the underivatized gangliosides. The striking finding was the detection of alpha-hydroxylation of a significant fraction of each of the major fatty acid species (16:0, 18:0, 20:0, 22:0, and 24:1); alpha-hydroxylated species quantitatively represented almost one-fifth of the total tumor GM2 species. Fatty acyl hydroxylation was also detected in the ceramide of several other human tumor gangliosides. In contrast, as previously known, fatty acyl hydroxylation was not detected in the normal human brain gangliosides GM3, GM2, and GM1. We propose that aberrant fatty acid alpha-hydroxylation is a novel and sometimes quantitatively significant characteristic of human tumor ganglioside metabolism.
Ceramides↗
Immunomodulating therapy of rheumatoid arthritis by high-dose intravenous immunoglobulin.
11 patients with rheumatoid arthritis were treated with intravenous immunoglobulin (IVGG). In 6 patients clinical results were impressive, although lasting responses could be achieved in 3 patients only. This treatment was immunomodulating, since the immunoregulatory T-cell ratio (CD4/CD8) decreased following therapy by reducing CD4-positive cells in-vivo. By use of anti-mu-antibodies as a B-cell specific mitogen, IVGG-treatment was seen to suppress early processes of B cell activation. In parallel to these cellular effects, IVGG led to a reduction in the levels of polyethyleneglycol-precipitated circulating immune complexes as measured by lasernephelometry.
Adult↗
Potent leukocidal action of Escherichia coli hemolysin mediated by permeabilization of target cell membranes.
The contribution of Escherichia coli hemolysin (ECH) to bacterial virulence has been considered mainly in context with its hemolytic properties. We here report that this prevalent bacterial cytolysin is the most potent leukocidin known to date. Very low concentrations (approximately 1 ng/ml) of ECH evoke membrane permeability defects in PMN (2-10 x 10(6) cells/ml) leading to an efflux of cellular ATP and influx of propidium iodide. The attacked cells do not appear to repair the membrane lesions. Human serum albumin, high density and low density lipoprotein, and IgG together protect erythrocytes and platelets against attack by even high doses (5-25 micrograms/ml) of ECH. In contrast, PMN are still permeabilized by ECH at low doses (50-250 ng/ml) in the presence of these plasma inactivators. Thus, PMN become preferred targets for attack by ECH in human blood and protein-rich body fluids. Kinetic studies demonstrate that membrane permeabilization is a rapid process, ATP-release commencing within seconds after application of toxin to leukocytes. It is estimated that membrane permeabilization ensues upon binding of approximately 300 molecules ECH/PMN. This process is paralleled by granule exocytosis, and by loss of phagocytic killing capacity of the cells. The recognition that ECH directly counteracts a major immune defence mechanism of the human organism through its attack on granulocytes under physiological conditions sheds new light on its possible role and potential importance as a virulence factor of E. coli.
Adenosine Triphosphate↗
Monoclonal antibody that defines the prostate specific antigen.
A monoclonal antibody to a protein with a single band in the 30-kD region was obtained from fusion of Balb/C mouse spleen cells immunized with epithelial fractions of BPH, with the myeloma cell line P3 x 63 Ag8 6.5.3 by standard procedures. This antigen was characterized in immunobinding studies with various cellular and target antigens and in immunoperoxidase staining.
Animals↗
Sneddon's syndrome: clinical course and outcome.
Fifteen patients with Sneddon's syndrome presenting since 1979 were re-examined. After a neurological examination, an orienting test of mental ability as well as an electroencephalogram were performed in all patients. In 10 of the 15 patients computed tomography of the brain was performed, too. Preceding reports and the results of the present study have been used to discuss the characteristics and prognosis of Sneddon's syndrome.
Adult↗
[The effect of preoperative parenteral nutrition on the perioperative course in patients with esophageal cancer].
In 35 consecutive patients who underwent esophagectomy for malignancy the nutritional status was evaluated. 15 patients were estimated to be malnourished and were therefore treated by total parental nutrition (TPN) for 7 days. In the control group (n = 20, no TPN) the nutritional status was normal. TPN corrected abnormal serum parameters with short half-life time. Therefore the nutritional status of both groups was equal at time of operation. The postoperative clinical outcome of both groups was as follows: In TPN-treated patients postoperative hospital stay for 26 days was shorter compared to 32 days in controls, no patients died (vs n = 4), no patient developed sepsis (vs n = 4), no patient developed acute renal failure (vs n = 3). These differences did not reach levels of significance due to the small patient groups. In conclusion our study shows that patients with esophageal cancer and regarded as well nourished seemed to suffer from nutritional deficits. Assessment of the nutritional status by commonly used nutritional parameters does not reveal these deficits.
Adult↗
Chronic cerebrovascular insufficiency on the xenon CT scan.
Several investigators have described CT-negative low flow areas in TIA and stroke patients in the chronic phase. The emission tomographic SPECT image they employed has, in contrast to the xenon CT method, no direct relation to the x-ray transmission CT scan. The aim of our study was to study the phenomenon of CT-negative low flow areas using the xenon CT method, a method especially well suited for such cases. 57 xenon CT examinations were performed in 40 TIA patients. Flow data from brain tissue which appeared to be anatomically intact in a slice 5 cm above the canthomeatal plane were analyzed. In the TIA group, the flow in the gray matter was found to be significantly lower on the clinically affected side: symptomatic side, 61.8 +/- 14.7 ml/100 g/min; asymptomatic side, 66.4 +/- 15.8 ml/100 g/min (p less than 0.001). In the stroke group, the flow in the white matter was also affected; symptomatic side, 31.2 +/- 9.8 ml/100, g/min; asymptomatic side, 35.3 +/- 11.1 ml/100 g/min (p less than 0.01). Gray matter: symptomatic side, 56.1 +/- 11.4 ml/100 g/min; asymptomatic side, 66.0 +/- 11.0 ml/100 g/min (p less than 0.001). The findings indicate that the appearance of CT-negative low flow areas in TIA and stroke patients during the chronic phase is the rule rather than the exception. Flow adaptation to anatomic changes not discernible by CT can be differentiated from clinically relevant flow impairment only by testing the cerebrovascular reserve.
Aged↗
Mapping of rCBF and cerebrovascular reserve capacity by stable xenon CT in cerebrovascular disease: pathophysiological aspects and effects of operative therapy.
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Blood Flow Velocity↗
Cranial computed tomography and magnetic resonance tomography in cerebrovascular occlusive disease.
CT is the method of choice for acute diagnosis of cerebral infarction. Attention is to be paid to the alterations of the absorption values with time during the infarction course. In particular, the "fogging effect" should be considered in the second and third week when the infarct may not be demonstrable in the simple CT owing to isodensity and lack of signs of space occupation. The xenon CT enables cerebral blood flow to be measured with calculation of regional cerebral blood flow in ml/100 g brain tissue/min. The simple clinical implementation and the good anatomical correlation are advantageous. MR offers a further non-invasive possibility of diagnosing cerebrovascular diseases. MR is especially efficient in detecting small lacunar infarcts in the medullary bed and in the brain stem. The application of gadolinium-DTPA has in particular differential diagnostic significance. In MR angiography, it is to be expected that the large vessels of the neck and brain can be imaged in the future without administration of contrast media.
Arterial Occlusive Diseases↗
[Nasal high pressure ventilation in obstructive sleep apnea syndrome. Theoretical and practical otorhinolaryngologic aspects].
Nasal CPAP therapy has been found to be the most effective treatment of OSAS apart from tracheotomy. Its long-term application, however, can cause several ENT complications like dryness of the nasal and pharyngeal mucosa, rhinitis and an increased frequency of sinusitis and infections of the lower airways. CPAP therapy is not applicable if nasal resistance is elevated, so that septal correction may become necessary. Unsuccessful UPPP can cause pressure loss through the mouth during CPAP therapy and in this case tracheotomy remains the only alternative. In order to evaluate the clinical significance of flexible nasopharyngoscopy with Mueller's manoeuvre (FNMM), we compared the endoscopic findings of 71 patients with their individual CPAP pressure required to keep their pharynx patent during sleep, 22 patients showed poor pharyngeal wall movement, 23 patients had moderate obstruction (about 50 percent closure) and 26 patients had nearly complete or complete pharyngeal obstruction. We found that patients with poor pharyngeal mobility needed a significantly lower CPAP pressure (mean 9 mbar) than those with nearly complete pharyngeal obstruction during FNMM (mean 11 mbar). Mean CPAP pressure of patients with moderate obstruction was 10 mbar, but this group could not be separated statistically from the other groups, indicating a not exactly defined category. Rhinomanometry showed no differences in nasal resistance between all groups. There was neither a correlation between CPAP pressure and rhinomanometry, nor between CPAP pressure and BROCA Index or distance of palatal arcs.
Airway Obstruction↗
[Lung perfusion-ventilation scintigraphy in squamous cell carcinoma of the lung].
The effect of tumour size, as determined surgically, and tumour position, as determined by bronchoscopy, on ventilation and perfusion scintigraphy was examined in 53 patients with squamous cell carcinomas of the lung. The findings were compared with reduction in one-second-capacity. Central tumours were frequently associated with marked reduction in perfusion. In these patients there was a linear positive correlation between ventilation and one-second-capacity. The reduction in perfusion, and the need to measure this, became with more peripheral tumours. There was a correlation between ventilation and tumour size in patients with V/Q quotient of greater than 1.2. The results show that tumour size and position do not necessarily indicate operability. For planning surgery of central tumours, perfusion scintigraphy therefore occupies an important position.
Aged↗