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Biomedical subjects

H Schmid

Publications and source records attributed to H Schmid.

At least 127 records · Page 7Linked to original sources
PubMed1992

[Renal cell cancer in childhood].

Renal cell carcinoma is a rare disease in children and difficult to distinguish from Wilms-tumor before surgery. We present case histories of two children with renal cell carcinoma and discuss the problems of differential diagnosis versus nephroblastoma, therapy and prognosis. In contrast to Wilms-tumors, the most common kidney-tumor in children occurring mostly in young infants, renal cell carcinoma is rare in childhood and predominantly manifests in school-age. Only a few cases of renal cell carcinoma in younger children are described in the literature. Diagnostic imaging cannot reliably distinguish renal cell carcinoma from other neoplasm of the kidney. However, hematuria in patients with small tumors or no response to preoperative chemotherapy may indicate the presence of renal cell carcinoma rather than nephroblastoma. The determination of "tumor-associated trypsin inhibitor" (TATI) might give further contribution of differential diagnosis. It was measured only in one of our patients and was markedly elevated. Complete surgical resection (nephrectomy with lymphadenectomy) is a curative therapy in patients with tumors limited to the kidney. Chemotherapy and irradiation show no convincing effect. In metastatic tumors therapy with interleukin 2 may be successful.

Carcinoma, Renal Cell↗
PubMed1991

[Experience with Ender nailing in 671 cases].

Between 1976 and 1987 at the Surgical Department of the University of Erlangen-Nürnberg, 671 fractures of the trochanteric region of the femur were treated by Ender nailing. In 54 cases (8.0%) there were intraoperative complications, in 82 cases (12.2%) postoperative complications occurred. Reoperation became necessary at 57 (8.5%) patients. Because of this complication rate we only see indications for Ender nailing in patients with skin lesions over the fracture site, valgus angulation of the proximal fragment and in the palliative treatment of pathological fractures.

Adult↗
PubMed1991

Effect of intraperitoneal recombinant human tumour necrosis factor alpha on malignant ascites.

29 patients with refractory malignant ascites due to metastatic peritoneal spread of adenocarcinomas originating from the ovary, gastrointestinal tract, liver, breast and uterus were treated in a phase I trial of intraperitoneal infusions of recombinant human tumour necrosis factor alpha (rhTNF-alpha). Patients received 40-350 micrograms/m2 rhTNF-alpha intraperitoneally once weekly for 2 months or for a shorter period in case of early resolution of ascites. Systemic side-effects resembled those reported for rhTNF-alpha given intravenously. No dose-limiting toxicities were found and thus a maximum tolerated dose of intraperitoneal rhTNF-alpha was not established. Out of 29 patients, 22 responded with a complete (16) or partial (6) resolution of their ascites. There was a less than 50% reduction in 4, and no increase in ascites in 1. 1 patient showed progressive ascites formation, and another patient was not eligible because of early death unrelated to treatment. Trials in patients with smaller tumour burden are warranted.

Adenocarcinoma↗
PubMed1991

Crossed immunoelectrophoresis applied to representative strains from 11 different Pasteurella species under taxonomic aspects.

Crossed immunoelectrophoresis evaluated on a numerical basis revealed a close antigenic relationship between species of the genus Pasteurella. By cluster analysis, 4 groups on similarity levels between 87% and 72% S could be separated which were connected by a minimum level of 69.5% S. One subgroup included all biovars or subspecies consisting of strains with mucoid growth. Another feature governing the antigenic relationship seemed to be the host range of Pasteurella species. Despite a considerable number of cross-reacting antigens, representative strains of the genera Haemophilus and Actinobacillus were clearly separated from Pasteurella. Similarly, "Pasteurella" haemolytica and Taxon 16 strains tested did not belong to this genus. An Escherichia coli strain showed a higher number of cross-reacting antigens, confirming known antigenic relationship among Gram-negative bacterial species.

Animals↗
PubMed1991

[Systemic therapy in recurrent and primary advanced cervix cancer].

Therapeutic results in advanced cervical cancer have not been showing any progress for more than 30 years. Only by means of systemic therapy does it seem possible, that further treatment results may be obtained similar to those in squamous cell carcinoma of the head and neck. Therefore, between 1985 and 1990 we tried to apply an aggressive polychemotherapy regimen for 5 days with cisplatinum and 5-fluorouracil with supportive treatment in 47 patients with either primary advanced inoperable (n = 25) or recurrent (n = 22) cervix carcinomas. Complete (n = 12) and partial remissions (n = 24) could be obtained in 36 out of 47 cases (= 77%). However, this high response rate conceals the fact, that this aggressive palliative treatment in case of recurrence and/or distant metastases means a considerable deterioration of quality of life with a median survival time of only 9.5 months. Although primary therapy with combined chemoradiotherapy shows good results, it is, however, only a real advantage for patients with complete response. Taking into account the short period of observation (median 25 months), the overall survival of all primary advanced cervix carcinomas is 13 + months, in case of complete remission 20 + months. It remains to be seen, whether sequential or simultaneous chemoradiotherapy will prove superior. Due to severe haematoxicity (WHO grade IV) after the first 3 treated patients, a dose reduction of 20% of chemotherapy was necessary. No further severe toxicities occurred. By means of supportive care, other side effects could also be well controlled, so that this effective polychemotherapy regimen is not only efficacious but also practicable. Prospective randomised studies are required to determine the importance of exclusive or combined chemoradiotherapy in advanced as well as in operable cancer of the cervix.

Adult↗
PubMed1991

[Intra-arterial chemotherapy in locally advanced breast carcinomas].

Transcatheter arterial chemotherapy with mitoxantrone was carried out in 9 patients suffering from advanced breast cancer. The anticancer agent was selectively injected in the internal mammary artery. In 2 cases the catheter was super-selectively advanced into a peripheral branch of the internal mammary artery supplying the breast carcinoma. No complication of the transcatheter treatment could be observed. CT examinations for controlling the catheter position showed perfusion of breast cancers between 40 and 90 per cent. Histological examinations of the 7 resected specimens revealed extensive necrosis in all cases. All 7 patients who underwent surgery have been without local recurrence for 3 to 12 months after treatment.

Adult↗
PubMed1991

A model of cardiovascular activation components for studies using autonomic receptor antagonists.

Alpha-adrenergic, beta-adrenergic, and cholinergic responses are often considered important activation components when conceptual and empirical analyses are made of single physiological variables and of patterns of cardiovascular reactivity; these autonomic distinctions are also of particular significance in autonomic blockade studies. A Model of Cardiovascular Activation Components is introduced that relates these components to both the measured cardiovascular variables and the protocol of autonomic blockade studies. It is pointed out that a restricted form of the complete model is often implicitly used in cardiovascular psychophysiology. The differential consequences of an erroneous employment of the restricted model are discussed for single and dual blockade protocols. Critical evaluations of autonomic blockade as a tool in cardiovascular psychophysiology are examined and are proposed to be often the consequence of the restricted model assumptions. Lastly, the utility of the Activation Components Model for a componential description of tasks and for componential intertask relationships is illustrated with data from the literature.

Arousal↗
PubMed1991

[The expertise situation as pathoplastic factor].

Underlying attitudes of apprehension or desire have an essential pathoplastic function, especially in the situation of medical assessment. The functionality of symptoms and complaints requires a diagnostic approach which is not oriented simply towards the "exclusion of organic causes". Interaction between somatogenic and psychogenic factors is by far more common than sheer functionality. Although widely neglected in our medical teaching and literature, these problems are not confined to the mere assessment of temporary or permanent invalidity, but are of great importance for the entire medical sphere, including manifestations and course of a disease, therapeutic success etc. In Austria, the population of foreign workers is in a special position due to socio-economic preconditions, partly due to short-sighted policy devoid of psycho-hygienic considerations. This situation requires thorough analysis free of emotions, which should lead to the development of sensible, although in some respects belated, measures. The latest economical recession has revealed several faulty courses of development in our system of social and health insurance, which needs revision urgently lest it should collapse. In this respect, the medical profession is called upon to contribute to a necessary curtailment of excessive misuse within a system that has become inflexible during the past decades, thereby endangering the valuable achievements of social medicine.

Adult↗
PubMed1991

Long-term results of treatment for children's cholesteatoma.

Fifty-seven of 98 children with cholesteatoma treated between 1976 and 1985 were available for long-term follow-up. The clinical records of the 57 children were analyzed retrospectively. The purpose of this study was to compare the incidence of recurrent and/or residual cholesteatoma, postoperative otorrhea, and hearing results between two groups of patients. One group (n = 40) of children was treated with a radical mastoidoepitympanectomy (RMET) and the other group (n = 17) was treated with intact canal wall tympanoplasty/mastoidectomy (ICWT). Residual cholesteatomas were twice as frequent (17% versus 7.5%) in the ICWT group while recurrent disease was the same. There was no difference in postoperative otorrhea between the two patient groups. Hearing results were equally good in the Type III and in the ICWT group with staged TORP. It is concluded that a Type III tympanoplasty is an excellent one-stage method of hearing reconstruction in patients with good eustachian tube function and an intact stapes and that a correctly performed RMET offers a safe trouble free alternative to ICWT. In selected patients with limited disease and a well pneumatized mastoid, ICWT is still used.

Child↗
PubMed1990

Allogeneic bone marrow transplantation for Langerhans' cell histiocytosis.

A group of proliferative diseases of the epidermal Langerhans' cells are commonly referred to as Langerhans' cell histiocytosis (LCH). A small number of the patients with this disease face an unfavorable disease course despite chemotherapy and radiation therapy. In LCH patients with a poor prognosis, allogeneic bone marrow transplantation (BMT) could be the appropriate treatment with proven antiproliferative effects and may be able to repopulate the recipient with stem cell-derived Langerhans' cells from the donor or correct the presumed underlying immunodeficiency. An LCH was diagnosed in a 15-year-old boy with multiple osteolytic lesions, anemia, and diabetes insipidus centralis. Repeated flare-ups of the disease had necessitated several courses of conventional chemotherapy including cyclophosphamide (CY), prednisolone (P), 6-mercaptopurine (6-MP), vincristine (VCR), and additional local irradiation without stable remission. Three years after first being diagnosed with LCH the patient underwent high-dose chemotherapy-radiation therapy followed by allogeneic BMT from his human lymphocyte antigen (HLA)-identical brother. Currently, he is alive and well and has been disease-free for more than 41 months after BMT.

Adolescent↗
PubMed1990

Ifosfamide combination chemotherapy in advanced breast cancer.

The objective of our clinical studies was to develop an effective combination chemotherapy regimen (CHT) with acceptable side effects, consisting of the two most potent drugs used as single agents in breast cancer. We tested the combination of an anthracycline, epirubicin (A) at 70 mg/m2 i.v. on day 1 or (B) at 120 mg/m2 i.v. on day 1 with an alkylating drug ifosfamide (IFO), (C) at 2.5 g/m2 in an i.v. infusion given over 4 h on days 1-3 or (D) at 5 g/m2 in a 24-h i.v. infusion given on day 1. Courses were repeated every 4 weeks. The combinations were given as first-line therapy as follows: CHT (A, C) in six cases and CHT (B, C) in five cases of advanced breast carcinoma, and CHT (B, D) in seven patients with primary inflammatory breast cancer. Due to side effects (e.g., stomatitis, mental disturbances) and applicability, CHT regimen (B, D) was preferred. Responses (12/18) occurred 1-3 cycles earlier than those previously achieved using the conventional epirubicin/cyclophosphamide CHT. We conclude that 5 g/m2 IFO given i.v. over 24 h with uroprotection (mesna) in a two-drug regimen is an effective dose with tolerable toxicity. Alopecia was seen in all cases. However, according to our experience, myelotoxicity is the dose-limiting factor for both of these drugs.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Ifosfamide/etoposide and mesna uroprotection in advanced breast cancer.

The object of the study was to evaluate the effectiveness of ifosfamide/etoposide and mesna therapy in advanced breast cancer. A total of 44 patients with breast cancer were included in the trial. Eligibility criteria included measurable, refractory disease; prior anthracycline therapy (or its contraindication); a life expectancy of at least 3 months; and adequate hepatic, renal, CNS and bone marrow function. All patients were less than or equal to 70 years of age and had a Karnofsky performance status of greater than or equal to 50%. There were 36 evaluable cases. Sites of metastatic disease included bone (19), skin (18), liver (9), lung (14), lymph node (19), and miscellaneous (7). Treatment consisted of 1,500 mg/m2 ifosfamide given i.v. on days 1-5, 120 mg/m2 etoposide given i.v. on days 1-3, and 400 mg i.v. mesna given with and at 4 and 8 h after ifosfamide. Cycles were repeated every 28 days. Initial doses were reduced by 25% or 50% in patients who had previously undergone both chemotherapy and radiotherapy. A median of 4 cycles (range, 2-8) were given. The myelotoxicity was marked: WHO grades 3/4 leukopenia (n = 37), grades 3/4 thrombocytopenia (n = 12), and grades 2/3 anemia (n = 13). Due to myelotoxicity, dose reduction or prolongation of treatment-free intervals was necessary in 28 cases. Alopecia was seen in 35 patients and CNS toxicity, in 8. Partial remission (PR) was obtained in five cases and complete remission (CR), in three. Sites of response included the lung (5), skin (4), lymph node (5), and peritoneum (1). The duration of response was 4 (n = 2) and 8 (n = 1) months for CR and 2 (n = 2), 6 (n = 2), and 10 (n = 1) months for PR. We conclude that the ifosfamide/etoposide and mesna regimen is effective, but its myelotoxicity is treatment-limiting.

Adult↗
PubMed1990

[Therapy of ascites with tumor necrosis factor in ovarian cancer].

The biotechnological production of human recombinant tumour necrosis factor (rHuTNF) makes this drug available for clinical application. This endogenous compound exhibits tumouricidal activity and regulatory functions within the immune system. 20 out of 23 (87%) patients with refractory recurrent malignant ascites from ovarian cancer were successfully treated in a phase-I and II-study. The production of ascites was either completely suppressed or reduced to a minimum for at least 4 weeks after maximally three intraperitoneal (i.p.) applications. Two of the three non-responders were mucinous carcinomas. In the phase-I study the evaluation of a maximal tolerable dose was not possible due to the rapid therapeutic success at low doses of TNF. The effective dosage was 0.08-0.14 mg TNF/m2 given i.p. Side effects which occurred 2 to 24 hours after the application of TNF were flue-like symptoms combined with general malaise. The side effects were not dose related. All concomitant signs and symptoms could be minimized by prophylactic or therapeutic application of indometacine, paracetamol or pethidine. This applied especially for the typical early phase cytokine side effects e.g. chills and febrile temperatures. The side effects were not dose related. The i.p. treatment with rHuTNF appears to be a novel practicable and effective method for palliation in patients with recurrent ascites even in multiple pretreated patients.

Adenocarcinoma, Mucinous↗
PubMed1990

Development of a multiple thin-film semimicro DC-probe for intracerebral recordings.

A thin-film multiple-electrode probe for measuring de potentials at eight sites with interdistances of 1 mm was constructed for the investigation of slow potential changes in deep regions of the human brain during surgery. The thin-film electrodes had to be placed on curved cylinder-shaped surgical instruments with dimensions of 2 mm diameter and 33 cm length used with the Freiburg stereotactic equipment. Several novel technological steps had to be introduced for the solution of the encountered problems: 1) Structuring of the metal layers on curved substrates was accomplished by using flexible masks. 2) Special feed-through technologies had to be invented in order to obtain reliable connections between the thin-film sensors and the copper wires inside the stereotactic instrument. 3) Thin-film Ag-AgCl electrodes had to be formed in order to obtain satisfying recordings of slow potential changes below 10 Hz. Slow potential changes were recorded from different depths in interdistances of only 1 mm with these new miniaturized thin film Ag-AgCl electrodes and bipolar recordings with an electrode interdistance of only 3 mm showed clearly the appearance of Bereitschaftspotentials.

Brain Mapping↗