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Biomedical subjects

I Meller

Publications and source records attributed to I Meller.

At least 73 records · Page 4Linked to original sources
PubMed1996

Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas. The cumulative multicenter European experience.

OBJECTIVE: The objective of the study was to achieve limb salvage in patients with locally advanced soft tissue sarcomas that can only be treated by amputation or functionally mutilating surgery by performing an isolated limb perfusion (ILP) with tumor necrosis factor (TNF) + melphalan (M) as induction biochemotherapy to obtain local control and make limb-sparing surgery possible. SUMMARY BACKGROUND DATA: To increase the number of limb-sparing resections in the treatment of locally advanced extremity soft tissue sarcoma, preoperative radiation therapy or chemotherapy or a combination of the two often are applied. The ILP with cytostatic agents alone is another option but rarely is used because of rather poor results. The efficacy of the application of TNF in ILP markedly has changed this situation. METHODS: In 8 cancer centers, 186 patients were treated over a period of almost 4.5 years. There were 107 (57%) primary and 79 (43%) recurrent sarcomas, mostly high grade (110 grade III; 51 grade II; and 25 very large, recurrent, or multiple grade I sarcomas). The composition of this series of patients is unusual: 42 patients (23%) had multifocal primary or multiple recurrent tumors; median tumor size was very large (16 cm); 25 patients (13%) had known systemic metastases at the time of the ILP. Patients underwent a 90-minute ILP at 39 to 40 C with TNF + melphalan. The first 55 patients also received interferon-tau. A delayed marginal resection of the tumor remnant was done 2 to 4 months after ILP. RESULTS: A major tumor response was seen in 82% of the patients rendering these large sarcomas resectable in most cases. Clinical response rates were: 33 complete response (CR) (18%), 106 partial response (PR) (57%), 42 no change (NC) (22%), and 5 progressive disease (PD) (3%). Final outcome was defined by clinical and pathologic response: 54 CR (29%), 99 PR (53%), 29 NC (16%), and 4 PD (2%). At a median follow-up of almost 2 years (22 months; range, 6-58 months), limb salvage was achieved in 82%. Regional toxicity was limited and systemic toxicity minimal to moderate, easily managed, with no toxic deaths. CONCLUSIONS: In the setting of isolated limb perfusion, TNF is an active anticancer drug in patients. The ILP with TNF + melphalan can be performed safely in many centers and is an effective induction treatment with a high response rate that can achieve limb salvage in patients with locally advanced extremity soft tissue sarcoma.

Adolescent↗
PubMed1996

Giant cell tumors with intraarticular fracture. Two-stage local excision, cryosurgery and cementation in 5 patients with distal femoral tumor followed for 2-4 years.

We describe a two-stage operation for intraarticular fracture through a giant cell tumor of the bone. The first stage aims at accurate reduction and fracture union, including curettage, open reduction and minimal internal fixation, autologous bone grafting and temporary bone cement filling. Following bone union, the second operation aims at tumor eradication, including meticulous recurettage, cryosurgery, cementing and stable internal fixation. We report our preliminary results in 5 patients, who were followed 2-4 years. All fractures united, there were no early complications or local recurrences and good function was achieved.

Adolescent↗
PubMed1996

[Isolated limb perfusion with tumor necrosis factor for malignancies of the limbs].

Tumor necrosis factor (TNF) induces rapid necrosis in a variety of experimental neoplasms. However, its clinical application is limited by life-threatening systemic toxicity. Isolated limb perfusion (ILP) enables administration of large doses of TNF and cytotoxic drugs directly to the affected limb, avoiding systemic toxicity. We describe our experience in 20 consecutive patients (10 with melanoma and 10 with soft tissue sarcoma) treated with high-dose TNF and melphalan via ILP. ILP was performed via the external iliac (10 cases), femoral (2), popliteal (5) or brachial (3) vessels. Patients received 3-4 mg TNF to an upper, and 1-1.5 mg/kg to a lower extremity. Isolation efficiency was determined by injection of radiolabelled albumin. The procedure was successful in all 20 patients. Local complications included wound infection in 6 cases and hematoma in 2. 1 patient developed sepsis secondary to extensive necrosis of a large, secondarily infected tumor. The first 6 patients who underwent high-flow perfusion experienced systemic side-effects, mainly hypotension. These side-effects were eliminated when low-flow perfusion was introduced. The response rate was 100%. In the sarcoma group, 5/10 had complete response, and 5 partial response. Amputation or mutilating surgery was avoided in 9/10. Of the 10 with melanoma, 7 had complete, and 3 partial response. We conclude that administration of TNF via ILP is a safe and effective modality for treating advanced neoplasms of the limbs.

Adolescent↗
PubMed1995

Isolated metastases to peripheral nerves. Report of five cases involving the brachial plexus.

BACKGROUND: Primary true isolated metastasis in a peripheral nerve trunk is considered a rare phenomenon. Several routes of tumor invasion of the peripheral nervous system from different types of cancer and in various anatomic locations have been described in the literature; however, the brachial plexus is an uncommon site of such blood-born metastases. METHODS: Five patients with severe brachial plexus neuropathy without obvious external signs of tumor masses and no detectable regional lymph node involvement underwent exploration of the plexus. RESULTS: Isolated metastatic deposits were identified inside the nerve trunks. Radiation therapy to the area of the lesion provided good symptomatic relief to all patients and local arrest of the disease to four of five. CONCLUSIONS: Despite its rich vascularity, the Peripheral nerve has relative resistance to metastatic spread because there are blood-nerve barriers. This barrier should be investigated further in a tumor model.

Adult↗
PubMed1995

Cognitive impairment and depression in the oldest old in a German and in U.S. communities.

Data on cognitive impairment in the oldest old is reported comparing two different samples, one in Munich, Germany, and the other in the United States (Epidemiologic Catchment Area [ECA] study). In both studies the Mini Mental State Examination (MMSE) was used for assessing cognitive impairment. The Munich sample consisted of 402 and the ECA sample of 827 very old people aged 85 years and above. The results indicate that approximately 40% of each sample scored below 24 points in the MMSE indicating at least mild cognitive impairment. Severe cognitive impairment was found in 13.4% of the Munich and in 14.6% of the American sample. The prevalence of major depression was 1.4% in Munich and 2.0% in the ECA study, and dysthymia was found in 5.1% in the Munich and in 2.0% in the ECA sample aged 85 years and above. Persons living in institutions in both studies more frequently showed signs of cognitive impairment than those living in private households. The ECA sample, but not the Munich sample, showed a significantly higher prevalence of cognitive impairment for females and for the oldest age cohort above 90 years of age. Major depression was more frequent in Munich in persons living in institutions and in the ECA study among the oldest age cohort above 90 years of age. Dysthymia in both studies did not show any association with sociodemographic factors. Most of the excess comorbidity (cognitive impairment and depression) was observed among subjects with mild (and not with severe) cognitive impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

Dementia and cognitive impairment in the oldest old in the community. Prevalence and comorbidity.

BACKGROUND: The study focuses on the prevalence of dementia in the oldest old. METHOD: A community sample (n = 402) of the oldest old in Munich (> or = 85 years) was assessed with different methods. Four instruments and a 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 physicians, who made their diagnoses according to ICD-10 and DSM-III-R. RESULTS: The structured interviews (GMS-A: 25.4%; SIDAM/SISCO: 28.0%; SIDAM/DSM-III-R: 27.8%; SIDAM/ICD-10: 16.1%) gave lower point prevalence rates of dementia than physicians' clinical diagnoses (43.1%). The rates were 21.2% based on the MMSE. Depressive syndromes and anxiety syndromes were the most frequent psychiatric disturbances associated with dementia in the very old. CONCLUSION: Dementia rates were high in the oldest old, showed an increase with age but no sex differences. Interview methodology has a major impact on results.

Activities of Daily Living↗
PubMed1994

Transient swelling of the costochondral and sternal region in infants.

Four children aged 9 months, 11 months, 1 year, and 1 year 4 months, respectively, presented to the emergency room with an acute tender swelling of the sternum or sternocostal cartilage. Three of these resolved spontaneously within a few weeks of presentation, and in one curettage was carried out. We were unable to find any other references in the literature of this condition occurring in infants. Acute swelling of the chest wall frequently is due to neoplastic or infectious disease, and culture of aspirated material and possibly biopsy has been recommended in all cases. Our experience suggests that this may not always be necessary.

Cartilage↗
PubMed1993

Mental and somatic health and need for care in octo- and nonagenerians. An epidemiological community study.

Mental and somatic illness, utilization of psychosocial facilities and need for care in persons aged 85 years and older were examined. Data were based on a representative community sample (n = 402) of Munich city. A total of 358 (89%) subjects of the sample were interviewed, 42 subjects (10.5%) refused, and 2 persons could not be traced. Dementia and depression had the highest prevalence of mental disorders according to the AGECAT (automated geriatric examination for computer assisted taxonomy) computer program of the Geriatric Mental State Interview. In all, 23.6% of the interviewees fulfilled criteria for depression, 25.4% for dementia. We analysed somatic illness according to mental status, the utilization of psychosocial facilities and need for care with regard to mental and somatic illness.

Aged↗
PubMed1992

Localization of Tc-99m DTPA in a chordoma.

The authors report a patient with chordoma that was demonstrated as a photopenic region on Tc-99m MDP bone imaging but that localized Tc-99m DTPA intensely. An explanation for the discrepancy is discussed. Complementary Tc-99m DTPA imaging in the preoperative evaluation of sacral tumors is suggested.

Adult↗
PubMed1992

Synovial sarcoma associated with osteofibrous dysplasia. A case report and review of the literature.

We report on a 14-year-old boy who demonstrated an unusual association between osteofibrous dysplasia and synovial sarcoma. This case suggests that a patient who presents with osteofibrous dysplasia of the tibia can eventually develop a malignant musculoskeletal tumor in the same anatomical location (same limb). This experience suggests that a patient who presents with osteofibrous dysplasia should be followed up for the possibility of a coexisting synovial sarcoma in the same leg.

Adolescent↗
PubMed1991

Radionuclide imaging of soft tissue masses with Tc-99m DTPA.

A scintigraphic study was carried out on 48 patients presenting with palpable soft tissue masses. Imaging was carried out using Tc-99m DTPA in three phases (dynamic, blood pool after 5 minutes, followed by late scans after 2 hours). The resultant uptake of the agent was categorized as consistently positive (14 cases), initially positive but progressively negative (7 cases), initially negative but progressively positive (7 cases), and consistently negative (20 cases). Histopathologic examinations were carried out for all cases following biopsy. A variety of malignant and benign masses were found to localize DTPA, whereas all masses that did not concentrate the agent were proven to be lipomas. In order to determine whether the uptake of DTPA bore any relationship to blood flow, additional studies using Tc-99m labeled red cells were carried out on 15 patients with soft tissue tumors. There was no correlation between blood flow or pooling and the degree of Tc-99m DTPA uptake by the palpable masses. The sensitivity of DTPA uptake as indicative of nonlipomatous tissue was 100%, and its specificity was 91%. The predictive probability that a lesion was a liopoma if there was no DTPA uptake at any phase was 100%.

Erythrocytes↗
PubMed1991

A new surgical classification system for shoulder-girdle resections. Analysis of 38 patients.

A new, six-stage surgical classification system is described for shoulder-girdle resections for patients being treated by limb-sparing procedures for bone and soft-tissue tumors. The classification is based upon current concepts of oncological surgery, the structures removed, the type of resection performed, and the relationship of the resection to the glenohumeral joint, and it indicates the increasing surgical magnitude of the procedure. Data from 38 patients with an average follow-up period of 4.6 years (range, two to 8.4 years) were analyzed. Thirty-two tumors were in bone and six in soft tissue. Eighty-seven percent (33 of the 38 tumors) were malignant. Twenty-four lesions were located in the proximal humerus and 14 in the scapula. The system permitted classification of all shoulder girdle resections done in this study's institutions. The classification is proposed as a means of establishing a uniform terminology in the comparison of such data.

Adolescent↗
PubMed1990

[Misdiagnosis of psychic symptoms of hyperthyroidism in affective psychosis].

A 71-year-old woman known to have suffered from a depressive illness for fifty years developed further psychological and somatic symptoms 18 months ago (agitation, increased impulsiveness, depressive mood, decreased appetite, diarrhoea and weight loss). Within five days there occurred nocturnal confusion with disordered word finding and counting. Biochemical tests indicated hyperthyroidism and scintigraphy showed multifocal activity increase. The psychological and somatic symptoms responded to thyrostatic treatment with carbimazole, 30 mg daily. This case demonstrates that added somatic causes of psychological symptoms should be thought of in previously known psychiatric illness.

Affective Disorders, Psychotic↗
PubMed1989

The use of psychiatric facilities by depressives: results of the Upper Bavarian Study.

Utilization of psychiatric facilities by noninstitutionalized persons aged 20 years and older, identified as "depressive cases", was examined. Data were based on the representative community sample of the Upper Bavarian follow-up field study with an original sample size of 1668 people. In the 5-year follow-up 1384 (83%) subjects were interviewed, while 80 subjects (4.8%) had died. The 5-year prevalence of depressive disorders, according to the definition used, was 10.3%. We analyzed which people with depressive disorders sought help from mental health professionals according to type of depressive disorder, sociodemographic data, psychosocial factors and course of disorder. The psychiatric treatment rate (in- or outpatient) was 23.9% of the depressive cases. The majority of treated persons were outpatients. Patients with the diagnosis of endogenous depression were most likely to have received psychiatric treatment. Limitation in the ability to work due to depression was the most important psychosocial factor influencing help-seeking behavior. The highest consultation rate in psychiatric facilities was obtained from the depressives who had grown up without their parents.

Adult↗
PubMed1989

The role of the general practitioner in the care of mentally disturbed subjects in the general population--results of the Upper Bavarian Study.

The role of the general practitioner in the care of mentally disturbed non-institutionalised persons aged 20 years and older was examined. Data were based on the representative community sample of the Upper Bavarian Field Study with a sample size of 1495 interviewees--aged 20 years and older. The 5-year prevalence of mental illness according to the definition used was 32.8%. 38.5% of all persons, identified as cases, consulted their general practitioner because of psychiatric or emotional problems. Females and the elderly were most likely to have received treatment by their general practitioner. The majority of treated persons were neurotic and psychosomatic patients. The general practitioner provided care for more psychiatric patients than the psychiatrist and for 25% of all "cases", without additional psychiatric consultation.

Adult↗
PubMed1989

[Therapy refractory depression--causes and treatment possibilities].

Despite the advances in the treatment of depression, 10 to 30% of all depressions remain--depending on the definition of the term--refractory to treatment. Having clarified possible causes such as wrong diagnosis, poor compliance, inadequate treatment, drug interactions and psychological factors, various treatment methods can be applied. However it is necessary to know not only the efficacy but also the side effects and contraindications of these methods.

Antidepressive Agents↗