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Biomedical subjects

H Reich

Publications and source records attributed to H Reich.

At least 19 recordsLinked to original sources
PubMed2006

Isotropic-nematic interface and wetting in suspensions of colloidal platelets.

We study interfacial phenomena in a colloidal dispersion of sterically stabilized gibbsite platelets, exhibiting coexisting isotropic and nematic phases separated by a sharp horizontal interface. The nematic phase wets a vertical glass wall and polarized light micrographs reveal homeotropic surface anchoring both at the free isotropic-nematic interface and at the wall. On the basis of complete wetting of the wall by the nematic phase, as found in our density functional calculations and computer simulations, we analyze the balance between Frank elasticity and surface anchoring near the contact line. Because of weak surface anchoring, the director field in the capillary rise region is uniform. From the measured rise (6 microm) of the meniscus at the wall we determine the isotropic-nematic surface tension to be 3 nN/m, in quantitative agreement with our theoretical and simulation results.

Journal Article↗
PubMed2003

Fertility after laparoscopic myomectomy of large uterine myomas: operative technique and preliminary results.

OBJECTIVE: The purpose of this study was to evaluate indications and complications of laparoscopic myomectomy with regard to the reproductive outcome of infertile women with a large leiomyomatous uterus. METHODS: From January 1997 to July 1999, 144 patients underwent laparoscopic myomectomy for a myoma measuring > or = 5 cm in diameter. Indications for surgery were increase in size of myoma in infertile patients (70.8%), pain (44.4%) or abnormal bleeding (68%). Average size of myomas were 7.8 cm with a range of 5 cm to 18 cm. The myomas were intramural/submucosal (n = 108), subserosal (n = 15), intraligamentous (n = 14) and peduncolated (n = 7). The laparotomy conversion rate was 1.39% (n = 2); one case required a blood transfusion. Operating time ranged from 58 to 180 minutes with an average of 95 minutes. Average hospital stay was 2.6 days and the overall complication rate was 2.08%. Eighteen patients (12.5%) underwent second-look laparoscopy. The rate of postoperative adhesion was 33.3%; there were no adnexal adhesions. In all cases ultrasonography was done one day after the operation and five weeks postoperatively to compare wound healing, the last control showed an irregular hypodense area in only 14 patients (9.7%). RESULTS: Twenty-six patients operated on in 1997 went on to conceive: nine vaginal deliveries, 12 Caesarean sections, four miscarriages and one ectopic pregnancy. No uterine rupture was observed. The pregnancy rate for patients submitted to laparoscopic myomectomy in 1997 (n = 38) was 34.21% at six months (n = 13) and 55.26% (n = 21) at 12 months after the procedures. CONCLUSIONS: Our preliminary results confirm that conception occurs in the majority of infertile women with a large leiomyomatous uterus who undergo myomectomy and second-look laparoscopy leads to a low complication rate.

Adult↗
PubMed2001

Issues surrounding surgical menopause. Indications and procedures.

More than 25% of women in the United States undergo hysterectomy by age 60. In assessing the appropriateness of this procedure, physicians should consider the surgical techniques available, the impact of ovary removal and the subsequent induction of menopause, and the requirement of long-term estrogen replacement. The option of ovarian preservation should also be explored. When ovaries are healthy and viable, without malignancy, preservation may be possible to ensure that the maximum natural hormonal benefits can be gained by the patient, thus avoiding the immediate and sharp decline in hormone production created by surgical menopause. The long-term effects of loss of ovarian function--including impact on cardiovascular and bone health and the immediate vasomotor symptoms and urogenital impact--are also problematic. The loss of androgens and estrogen, the physical and psychologic implications, and the requirement of compliance with a hormone replacement regimen over a longer period of time should be balanced carefully. In the gynecologic profession, no consensus exists concerning the optimum method by which to perform a hysterectomy in different situations. The method selected depends more on the experience and biases of the surgeon than on a critical evaluation of operative and outcome data. This paper reviews indications for hysterectomy, the advantages and disadvantages of various procedures, and the circumstances in which ovarian preservation is warranted. Options and various procedures are discussed for treating such conditions as pelvic inflammatory disease and tuboovarian abscess, chronic pelvic pain, cancer and residual ovary syndrome. Also discussed is the impact of various procedures on patient well-being, cost, complications and the need for additional surgery.

Adult↗
PubMed2000

1s lamb shift in hydrogenlike uranium measured on cooled, decelerated ion beams.

The Lyman- alpha transitions of hydrogenlike uranium associated with electron capture were measured in collisions of stored bare U (92+) ions with gaseous targets at the storage ring ESR. By applying the deceleration technique, the experiment was performed at slow collision energies in order to reduce the uncertainties associated with Doppler corrections. From the measured centroid energies, a ground state Lamb shift of 468 eV+/-13 eV is deduced which gives the most precise test of quantum electrodynamics for a single electron system in the strong field regime. In particular, the technique applied paves the way towards the 1 eV precision regime.

Journal Article↗
PubMed2000

Use of laparoscopically mobilized peritoneum in the creation of a neovagina.

OBJECTIVE: To present an alternative technique for the creation of a neovagina. DESIGN: Case study. SETTING: Academic university gynecology clinic. PATIENT(S): A patient diagnosed with müllerian agenesis. INTERVENTION(S): Laparoscopically assisted creation of a neovagina by using peritoneum. MAIN OUTCOME MEASURE(S): Patient morbidity and satisfactory intercourse. RESULT(S): The patient underwent the procedure satisfactorily and was discharged within 24 hours. She had no perioperative or postoperative complications, and she became satisfactorily sexually active. CONCLUSION(S): The use of laparoscopically mobilized peritoneum in the creation of a neovagina provided the patient with a functional vagina, allowing satisfactory intercourse.

Adult↗
PubMed2000

A new technique for the creation of a neovagina

Background: There are many described reconstructive techniques for vaginal agenesis including vaginal dilators, skin covered molds, sigmoid grafts, vulval and large muscle flaps all of which aim to produce a vagina of normal axis, secretory capacity and length. We report the laparoscopic approach to Davydov's operation which utilizes peritoneum to line the newly dissected vesicorectal space. Methods: A case report detailing preoperative evaluation, surgical technique and outcome.Results: There were no intraoperative or immediate postoperative complications. The patient was discharged from hospital within 23 hours of surgery. Six month follow up revealed a vagina 7-8 cm in length, lined with squamous epithelium. The patient reports satisfactory sexual intercourse.Conclusion: This technique provides a satisfactory option for the surgical management of vaginal agenesis.

Journal Article↗
PubMed1999

Laparoscopic myomectomy and pregnancy outcome in infertile patients.

OBJECTIVE: To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients. DESIGN: Retrospective analysis. SETTING: Tertiary care advanced laparoscopic center. PATIENT(S): Twenty-eight infertile patients with at least one uterine leiomyoma of >5 cm in diameter. INTERVENTION(S): Laparoscopic myomectomy. MAIN OUTCOME MEASURE(S): Occurrence of pregnancy, delivery rate, and pregnancy-related complications. RESULT(S): The average size of the myomas removed was 6 cm (range, 4-13.3 cm). None of the procedures were converted to laparotomy. The postoperative rate of intrauterine pregnancy was 64.3% (n = 18), including 1 of 2 patients who underwent concomitant hysteroscopic myomectomy. Four patients had spontaneous abortions and 14 delivered viable term neonates. Six women had a vaginal delivery without complications and 8 had a cesarean section. No antepartum or intrapartum complications were reported. CONCLUSION(S): Laparoscopic myomectomy can be offered to patients who want to have children and who refuse to undergo an abdominal myomectomy. Patient selection as well as meticulous surgical technique are the key factors in achieving a successful outcome.

Adult↗
PubMed1999

Carcinoid tumors of the appendix detected at laparoscopy for gynecologic indications.

STUDY OBJECTIVE: To evaluate the significance of the abnormal-appearing appendix during gynecologic laparoscopy. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred sixty-six women. INTERVENTIONS: Laparoscopic appendectomy. MEASUREMENTS AND MAIN RESULTS: Five of 166 appendixes removed for abnormal appearance contained a carcinoid tumor. At least one patient was a candidate for additional resection. CONCLUSION: It is important for gynecologists to be aware of the possibility of a carcinoid tumor of the appendix, particularly if an abnormality is seen at the time of surgery. (J Am Assoc Gynecol Laparosc 6(3):303-306, 1999)

Adolescent↗
PubMed1999

Hysterectomy as treatment for dysfunctional uterine bleeding.

The surgical treatment of patients with dysfunctional uterine bleeding (DUB) is discussed in this chapter, including indications, techniques and complications. Hysterectomy is the definitive treatment for DUB; in most studies it has a higher rate of patient satisfaction than does hysteroscopic endometrial ablation. The vaginal or laparoscopic approach should be selected in this group of patients with small uteri, while laparotomy is seldom indicated. In general, the indications for vaginal hysterectomy and endometrial ablation differ from those of laparoscopic hysterectomy. Ablation and vaginal hysterectomy are done for hypermenorrhoea, while laparoscopic hysterectomy is best when pathology is present, usually adhesions, endometriosis or fibroids.

Female↗
PubMed1999

The value of intra-operative cystoscopy at the time of laparoscopic hysterectomy.

The aim of this study was to determine the usefulness of routine intra-operative cystoscopy in documenting ureteral injury during total laparoscopic hysterectomy with vault suspension and to document the incidence of this complication in a large series. The charts of 118 patients who underwent laparoscopic hysterectomy with vault suspension from January 1992 to January 1998 were retrospectively reviewed. The patients underwent intra-operative cystoscopic evaluation to verify ureteral permeability and bladder integrity. Intra-operative ureteral obstruction occurred in four patients (3.4%). All complications were immediately fixed and there were no postoperative ureteral problems. No late ureteral complications were observed. Intra-operative cystoscopy allows for early recognition and treatment of obstructive ureteral injuries and may reduce the rate of late postoperative complications during advanced laparoscopic procedures.

Cystoscopy↗
PubMed1999

Evaluation of chronic tears of the rotator cuff by ultrasound. A new index.

The diagnosis of chronic lesions of the rotator cuff is challenging. We have developed a new index to improve the sonographic diagnosis of chronic tears of the cuff. In a pilot study, we examined 50 asymptomatic healthy volunteers by ultrasound to establish the diameter of the rotator cuff in relation to the tendon of the long head of biceps. Subsequently, the index was calculated in 64 patients who had had shoulder pain for more than three months caused by clinically diagnosed lesions of the rotator cuff. The compensatory hypertrophy of the biceps tendon was quantified sonographically in relation to the diameter of the cuff. Comparison with the contralateral shoulder revealed a significantly higher biceps rotator-cuff ratio (p < 0.05) for patients with torn rotator cuffs. A ratio greater than 0.8 was considered pathological (index positive); the mean ratio in the control group was 0.43. The sensitivity of a positive index was 97.8%, the specificity 63.2%, the positive predictive value 86.3%, and the negative predictive value 92.4% in comparison with surgical findings. Use of the index improves sensitivity in the diagnosis of chronic tears of the cuff by ultrasound.

Adult↗
PubMed1998

The platelet thrombin receptor and postoperative bleeding.

BACKGROUND: We hypothesized that small amounts of thrombin desensitize the platelet thrombin receptor during cardiopulmonary bypass (CPB), resulting in postoperative platelet dysfunction and bleeding. METHODS: Seventy-nine patients were entered into a study designed to measure changes in platelet thrombin receptor function during CPB and to correlate them to postoperative bleeding. In addition to measurements of clinical blood loss, platelet function tests of aggregation, activation, and cell-cell adhesion were used. The thrombin receptor agonist peptide (TRAP) was used to activate the platelets. Flow cytometry was used to measure various platelet surface markers and platelet-white cell interactions during CPB. RESULTS: Compared with preoperative values, both aggregometry and flow cytometry measured a significant reduction of TRAP-induced activation immediately and up to 24 hours after CPB. The response of other activating agents returned to normal by 24 hours. Postoperatively, 8 of 79 patients required excessive blood transfusion (> or = 10 units of blood products) and had significantly decreased TRAP-induced aggregation response. CONCLUSIONS: Our results show that (1) platelet activation, aggregation, and adhesion to leukocytes induced by TRAP are reduced after CPB, (2) decreased thrombin receptor responsiveness is associated with excessive postoperative blood loss, and (3) because the aggregation and activation responses are different for TRAP and thrombin, there may be a second thrombin receptor on platelets that is protected from damage during CPB. These results imply that prevention of the CPB-induced effects on the thrombin receptor will lessen postoperative morbidity associated with blood transfusion.

Blood Loss, Surgical↗
PubMed1998

Burns.

Inhalation injuries still significantly increase the morbidity and mortality of burn patients. Advances in ventilatory support appear to decrease the frequency of pneumonia and improve the survival of patients. It is now well accepted that early enteral feeding of patients with burn injuries is very important. The addition of anabolic agents in burn care and nutrition may be of importance. Patients receiving pre-storage filtered blood components have fewer blood transfusion-induced side effects and the requirement for transfusion is reduced. Current research on the cellular response to burn injury holds promise for further improvement in burn care.

Journal Article↗
PubMed1998

[Radiologic changes following cement-free implantation of hip prostheses. 5-year follow-up and clinical experience with the cement-free hip prosthesis Autophor-900-S].

PURPOSE: To evaluate early reliable radiographic signs of loosening in cementless total hip arthroplasty compared to clinical follow-up. METHODS: Within a time interval of 5 years 89 patients with 101 hips underwent total hip arthroplasty using the Autophor 900 S-prosthesis. Clinical and radiographic follow-up were first performed retrospectively followed by a prospective investigation. RESULTS: Radiographic evaluation showed prosthesis fixation in 93%. Loosening of the prosthesis was identified in 4 cases of the acetabular component and in 4 cases of the femoral stem. Pain was associated with radiographically detectable loosening of the cementless arthroplastic components in only two cases. CONCLUSION: Within a follow-up period of up to five years, loosening of cementless total hip arthroplasty occurs in about 7%. The most reliable radiographic signs of loosening are complete radiolucent zones wider than 2 mm at the bone-component interface, progressive subsidence, migration, or tilt of the component. Pain and movement disorders are not specific symptoms and do not necessarily indicate a loosening of the prosthesis.

Adult↗
PubMed1997

Gastric emptying of milk feedings in infants and children. Anterior versus conjugate counting.

UNLABELLED: The radionuclide milk scan is a valuable tool for the evaluation of gastroesophageal reflux and gastric emptying in children. There is uncertainty as to whether anterior imaging alone is sufficient for determining gastric emptying in these patients. METHODS: Twenty-five children underwent Tc-99m sulfur colloid milk scans with images acquired in the anterior and posterior projections. Calculations of the 1 hour and 2 hour percentage of gastric residual activity were performed using the anterior counts alone and the geometric mean of the anterior and posterior counts. The anterior and posterior images were visually assessed for the presence of gastroesophageal reflux. RESULTS: The means of the absolute differences at 1 and 2 hours for the two methods of gastric residual calculation were 4.1% +/- 2.1% and 3.4% +/- 2.8%, respectively. There was good correlation between the two methods at 1 and 2 hours with r values of 0.991 and 0.997 respectively. Gastroesophageal reflux was more obvious in the anterior images and three small episodes were only seen on the anterior view. CONCLUSION: Anterior images alone give reliable results for the determination of gastric emptying, and gastroesophageal reflux is more readily visualized anteriorly in the pediatric population.

Adolescent↗