Search PubMed⌕ Search

Biomedical subjects

I Meller

Publications and source records attributed to I Meller.

At least 55 records · Page 3Linked to original sources
PubMed1999

Depression symptoms in late life assessed using the EURO-D scale. Effect of age, gender and marital status in 14 European centres.

BACKGROUND: Data from surveys involving 21,724 subjects aged > or = 65 years were analysed using a harmonised depression symptom scale, the EURO-D. AIMS: To describe and compare the effects of age, gender and mental status on depressive symptoms across Europe. METHOD: We tested for the effects of centre, age, gender and marital status on EURO-D score. Between-centre variance was partitioned according to centre characteristics: region, religion and survey instrument used. RESULTS: EURO-D scores tended to increase with age, women scored higher than men, and widowed and separated subjects scored higher than others. The EURO-D scale could be reduced into two factors: affective suffering, responsible for the gender difference, and motivation, accounting for the positive association with age. CONCLUSIONS: Large between-centre differences in depression symptoms were not explained by demography or by the depression measure used in the survey. Consistent, small effects of age, gender and marital status were observed across Europe. Depression may be overdiagnosed in older persons because of an increase in lack of motivation that may be affectively neutral, and is possibly related to cognitive decline.

Age Distribution↗
PubMed1999

The role and biology of cryosurgery in the treatment of bone tumors. A review.

The application of liquid nitrogen as a local adjuvant to curettage in the treatment of bone tumors was introduced three decades ago. This technique, termed cryosurgery, was shown to achieve excellent local control in a variety of benign-aggressive and malignant bone tumors. However, early reports showed that cryosurgery was associated with a significant injury to the adjacent rim of bone and soft-tissue, resulting in high rates of fractures and infections. These results reflected an initial failure to appreciate the potentially destructive effects of liquid nitrogen and establish appropriate guidelines for its use. We review the biological effect of cryosurgery on bone, surgical technique, and current indications for its use.

Bone Cements↗
PubMed1999

Prognostic factors in non-metastatic limb osteosarcoma: A 20-year experience of one center.

The purpose of this study was to evaluate the prognostic significance of variables in osteosarcoma. We performed a retrospective analysis of 35 patients with non-metastatic limb osteosarcoma that were treated between 1973 and 1994. The following variables were evaluated: age, sex, ethnic group, tumor histology and primary site, alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) levels at diagnosis, treatment regimen, and the histologic response to treatment. Three variables showed significant correlation with prognosis: i) histologic response to preoperative treatment. Disease-free survival (DFS) was 89% in patients with grade III-IV histologic response after a median follow-up (MFU) of 64 months, 67% in patients with grade II after an MFU of 64 months, the patients with grade I response died within 15 months (p<0.0001); ii) treatment regimen. DFS was 83% after an MFU of 42 months, 62% after an MFU of 82 months, and 30% after an MFU of 177 months in patients treated by the 90's, 80's, and 70's protocols, respectively (p<0.05); iii) corrected ALP (cALP) levels at diagnosis. DFS was 78% after an MFU of 88 months in patients with cALP levels <200, and 32% after an MFU of 56 months in patients with cALP levels >200 (p=0.01). Low ALP levels, good histologic response to preoperative chemotherapy, and the new therapeutic regimen correlated with good prognosis in patients with osteosarcoma.

Adolescent↗
PubMed1998

Postsurgical etoposide-ifosfamide regimen in poor-risk nonmetastatic osteogenic sarcoma.

This prospective study was designed to test the activity of an ifosfamide-etoposide (VP-16) regimen on poor-risk, nonmetastatic, osteogenic sarcoma. A total of 13 patients with nonmetastatic osteogenic sarcoma with a poor histologic response to primary high-dose methotrexate-doxorubicin (Adriamycin)-cisplatinum chemotherapy received a total of six 5-day courses of ifosfamide (1,800 mg/m2) and etoposide (100 mg/m2) at three weekly intervals. The protocol was well tolerated, with only one case of transient renal failure. At present, eight patients (62%) have been in sustained complete remission with no evidence of recurrent disease for a mean follow-up of 3.4 years (range, 1.5-7.0 years). One patient is alive with lung metastases, and four have died of progressive disease. This prospective, albeit small, study confirms the efficacy of an ifosfamide-VP-16-based regimen in poor-risk, extremity, nonmetastatic osteogenic sarcoma. The demonstrated activity should spark large trials of ifosfamide-containing regimens in osteogenic sarcoma.

Adolescent↗
PubMed1998

Transarticular tumor invasion via ligamentum teres. A clinical-pathologic study of 12 patients.

We studied 12 patients who were operated on for malignant tumors in and around the hip joint. A correlative study, including preoperative staging studies and anatomical-pathologic aspects of the hip joint, was performed. In 4 of the 12 patients, we found direct histologic evidence of tumor invasion from the head of the femur through the ligamentum teres to the acetabular fovea and vice versa. It seems that the ligamentum teres is a potential route for transarticular spread of a tumor.

Aged↗
PubMed1997

High dose tumor necrosis factor-alpha and melphalan administered via isolated limb perfusion for advanced limb soft tissue sarcoma results in a >90% response rate and limb preservation.

BACKGROUND: Recombinant tumor necrosis factor-alpha (rTNF-alpha) is a highly potential antineoplastic agent. However, its systemic administration in humans has resulted in a life-threatening septic shock-like syndrome, and its use has been abandoned. The administration of high dose rTNF-alpha and melphalan via isolated limb perfusion (ILP) eliminated the systemic side effects and was shown to be very effective for metastatic melanoma confined to the limb. The purpose of the current study was to assess the role of rTNF-alpha and melphalan administered via ILP in patients with soft tissue sarcoma. Amputation is unavoidable in 10% of these patients despite aggressive conventional therapy. Limb preservation was the objective in this select group of candidates for amputation or mutilating surgery. METHODS: During a 36-month period, 35 patients with high grade soft tissue sarcoma underwent 41 ILPs with high dose rTNF-alpha (3-4 mg) and melphalan (1-1.5 mg/kg). There were 21 males and 14 females. The mean age was 48 years (range, 14-80 years). Histologic subtypes included malignant fibrous histiocytoma, synovial, liposarcoma, malignant schwannoma, desmoid, clear cell, epithelioid, rhabdomyosarcoma, leiomyosarcoma, and unclassifiable. Twenty-one patients presented with recurrent and 14 with very extensive primary tumors. The tumors were located in the upper extremity in 8 patients and in the lower extremity in 27 patients. Twenty-five patients were candidates for amputation and 10 for extensive mutilating surgery. ILP was performed via the corresponding vessels proximal to the tumor. Six patients with partial response (PR) insufficient to render them resectable underwent a second ILP. With the exception of 4 of 9 patients with multifocal lesions and 1 who refused surgery, resection of the residual tumor or tumor bed or limb was performed 6-8 weeks after ILP. RESULTS: Marked tumor softening occurred within 48 hours, and in tumors protruding through the skin hemorrhagic necrosis was evident within 24 hours. The overall response rate was 91%. Thirteen patients (37%) had a complete response and 19 (54%) had a PR; in 5 of these patients > 90% necrosis of the tumor occurred. In 3 patients (8.5%), only minimal regression was observed (stabilization of disease). The rate of limb sparing was 85% (29 of 34 patients). CONCLUSIONS: The combination of high dose rTNF-alpha and melphalan given via ILP appears to be effective in patients with advanced soft tissue sarcoma confined to the limb, achieving a high response rate and limb preservation.

Adolescent↗
PubMed1997

Risk factors and psychosocial consequences in depression of octo- and nonagenerians: results of an epidemiological study.

In a two-wave community study in Munich, Germany, a representative sample of 402 people older than 85 years was restudied 1 year later. In the first cross section a total of 358 (89.1%) subjects were interviewed. One year later 263 (73.5%) subjects were reexamined. Several diagnostic systems were used. The probands showed a high prevalence of depression--nearly one quarter of the interviewees. In this extreme age group gender differences in depression were minimal. Depressive were distinctly impaired in daily life. Depressive probands were more often found in institutions than in private households. Depressives were high users of the medical care system, but very rarely treated by specialists. Need for care and certain specific especially threatening life events were identified as risk factors for depression.

Aged↗
PubMed1997

Combined hemodilution and hypotension monitored with jugular bulb oxygen saturation, EEG, and ECG decreases transfusion volume and length of ICU stay for major orthopedic surgery.

STUDY OBJECTIVE: To assess the efficacy and safety of hemodilution combined with induced hypotension during surgery. DESIGN: Randomized, nonblinded, controlled study. SETTING: Operating room suite and intensive care unit (ICU) at a university hospital. PATIENTS: 16 ASA physical status I and II patients who underwent general or general plus epidural anesthesia for major orthopedic surgery. INTERVENTIONS: In Group 1 (n = 10), mean arterial blood pressure (MAP) was decreased to 50 mmHg by increasing the inspired concentration of isoflurane and injecting 75 mg of 0.5% bupivacaine into the epidural catheter. Hematocrit was decreased to 20% by phlebotomy and simultaneous infusion of crystalloid and colloid. In Group 2 (n = 6), isoflurane was adjusted to maintain MAP within 20% of baseline values, and no phlebotomy or hemodilution was used. MEASUREMENTS AND MAIN RESULTS: Efficacy of hemodilution combined with induced hypotension (Group 1) was compared to standard management of blood volume and pressure (Group 2) by measuring transfusion volume and length of ICU stay. Safety of hemodilution/hypotension was determined by measuring the electroencephalogram, internal jugular venous oxygen saturation, the electrocardiogram, and central venous oxygen saturation. In Group 1, both the volume of homologous blood (225 +/- 150 ml) and total blood (1440 +/- 286 ml) was significantly less than the volume of homologous blood transfused in Group 2 (2650 +/- 878 ml). No patients in Group 1, but all patients in Group 2 required ICU admission (3.5 +/- 1.6 days) for treatment to prevent sequelae from, or progression of, moderate-severe tissue edema and metabolic acidosis. Cerebral and myocardial measures were not significantly different between groups. CONCLUSIONS: Hemodilution combined with induced hypotension was safe and may reduce the need for transfusion and ICU admission.

Adult↗
PubMed1997

The role of the gastrocnemius muscle flap in limb-sparing surgery for bone sarcomas of the distal femur: a proposed classification of muscle transfers.

Limb-sparing surgery for bone and soft-tissue sarcomas involves three phases: (1) resection of the tumor with free margins, (2) reconstruction of the bone and joint defect, and (3) reconstruction of the soft tissues. This presentation focuses on the third phase. Between January of 1988 and January of 1994 we performed 33 distal femoral resections, 32 for malignant and 1 for benign tumors. There were 19 men and 14 women aged from 6 to 78 years (mean age 28 years). Twenty-seven patients had gastrocnemius muscle flap transfers, 24 having "primary" transfers and 3 having "secondary" transfers. The lateral gastrocnemius muscle was used in 18 patients, the medial in 8 patients, and both in 1 patient. We propose a classification of the transfers based on the size of the soft-tissue defect above the prosthesis needing coverage and the length of the neurovascular bundle of the muscle. Twenty-six of the 27 muscles survived; one patient had necrosis of the skin and muscle. Two patients had persistent sinuses at the scar that were managed successfully (one of them was before a secondary muscle transfer). Six patients did not have gastrocnemius muscle flap transfers. Two of them had persistent sinuses for years, and one patient had titanium "synovitis" and needed repeated operations including removal of the prosthesis and revision. The particular vascularization of the gastrocnemius muscle (one pedicle at the level of the knee joint) situated close to its origin, the size of the muscle belly, and the fact that it is situated in the dissection field and its transfer does not affect the function of the spared limb make it particularly suitable for the coverage of wide areas of skin and muscle loss at the knee region. In the classification that we propose, type I is reserved for coverage of small areas, while types II and III are used for coverage of larger areas. Flap transfer should be performed primarily at the time of the resection in order to avoid complications of wound healing and to reduce delays in chemotherapy protocols.

Adult↗
PubMed1997

Palliative major amputation and quality of life in cancer patients.

Limb sparing surgery has replaced the amputation surgery in the treatment of limb sarcomas. Recurrent or persistent disease constitutes a major problem. Local symptoms such as agonizing pain, fractures, tumor fungation, inability to walk and inability to maintain daily activities, further impair the patient's quality of life. In this clinical set-up palliative amputation should be considered. Eighteen patients with soft-tissue or bone sarcomas and 3 patients with metastatic carcinoma underwent palliative major amputation. Hemipelvectomy was performed in 3 patients, hip disarticulation in 10, knee disarticulation or below-knee amputation in 3 patients, shoulder disarticulation in one patient and forequarter amputation in 4 patients. Local control of the disease and pain and improvement of the performance status were observed in 19 evaluable patients. The mobility was restored in 15 patients with lower limb surgery. The median survival following the procedure was 9 months. There was only one case of immediate post-operative death. Severe phantom pain was not reported by any of the patients. Quality of life was reported to be improved by two-thirds of the patients. To conclude, we have, found palliative major amputation surgery worth performing in low-performance status cancer patients with locally advanced disease.

Adolescent↗
PubMed1997

Malignant bone and soft tissue tumors of the shoulder girdle. A retrospective analysis of 30 operated cases.

From 1988 to 1995, 30 patients (16 men) with malignant bone (n 23) and soft tissue (n 7) tumors of the shoulder girdle underwent surgery in our department. The mean age was 34 (6-80) years. 26 patients had primary and 4 had metastatic lesions. The average follow-up period was 3 (2-8) years, at the end of which 18 patients showed no evidence of disease, 2 were alive with disease, and 10 had died (9 because of tumor). 25 of the operations were limb-sparing procedures, while the other 5 were major amputations. Radical resection was performed in 4 patients, wide resection in 25 and marginal resection in 1. Local recurrence was observed in 2 patients. 10 patients with stage IIB tumors of the proximal humerus underwent extraarticular humeral and glenoid resection. Reconstruction was performed with either a modular or an improvised implant. Following surgery, those patients had a concave contour of the shoulder and poor abduction ability. Overall functional outcome was good in 18 patients, moderate in 11 and poor in 1. No correlation was found between functional outcome and reconstruction technique.

Activities of Daily Living↗
PubMed1996

Solitary eosinophilic granuloma of the pelvis in children. A report of three cases.

We present three cases of eosinophilic granuloma of the ilium in children. Imaging investigations (computed tomography and magnetic resonance imaging) did not elucidate the disease but rather revealed patterns more like malignant tumours than a benign condition. However, these investigations were of value in directing the surgeon to the correct site for biopsy.

Adolescent↗
PubMed1996

Incidence of dementia in a Munich community sample of the oldest old.

In a two-wave community study a representative sample of 402 very old people (older than 85 years) was restudied 1 year later. Four instruments in the clinical examination were used for case identification: (a) the Geriatric Mental State Interview (GMS-A); (b) the Structured Interview for the Diagnosis of Dementia (SIDAM); (c) the Global Deterioration Scale (GDS); and (d) the Mini Mental State Examination (MMSE). The clinical examination was performed by the interviewing physician who made a diagnosis according to DMS-III-R. The focus of the present study is on the (true) incidence of dementia in a representative community sample. The establishment of incidence rates is particularly important for dementia because the prevalence of dementia is affected by the length of survival, which is reduced in dementia and with increasing age. The annual incidence rates per 1000 person years on the basis of the SIDAM DSM-III-R were 116.6 for all cases at risk, 113.6 for those aged 85-89 years, 112.5 for those aged 90-94 years and 235.7 for those aged 95 years and older at first assessment (t1). Incidence rates based on the other methods of assessment are reported. In order to obtain the most meaningful estimate of incidence rates a compound dementia diagnosis was defined. According to this the annual incidence rate per 1000 person years was 144.1 for all persons at risk. The incidence rate tended to be higher in the older-age cohorts: It was 126.2 for those aged 85-89 years, 193.1 for those aged 90-94 years and 295.5 for those aged 95 years and older. In comparison with the literature the incidence rates were high. The results are plausible when the very old age of the sample is taken into account.

Cohort Studies↗
PubMed1996

Incidence of depression in octo- and nonagenerians: results of an epidemiological follow-up community study.

The incidence rate of depression in very old people was examined. In a two-wave community study of Munich, Germany a representative sample of 402 people older than 85 years was restudied 1 year later. In the first cross section a total of 358 (89%) subjects were interviewed. One year later 263 (73.6%) subjects could be reexamined. Only persons with two examinations were included for analysis of incidence. Several diagnostic systems were used. According to the project diagnosis of 203 persons at risk, 25 subjects suffered 1 year later from depression. The incidence rate amounted to 133.49 per 1000 person years at risk. According to the project diagnosis of 203 persons at risk, 25 subjects suffered 1 year later from depression. The incidence rate amounted to 133.49 per 1000 person years at risk. According to the GMS-A computer AGECAT diagnosis the incidence rate amounted to 140.97 per 1000 person years at risk. The younger age cohort, persons with changing living situations and subjects suffering from dementia in the first cross section had a higher risk for depression. The results were not significant.

Aged↗