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Biomedical subjects

J Hoffmann

Publications and source records attributed to J Hoffmann.

At least 181 records · Page 10Linked to original sources
PubMed1994

[Fever and lung abscesses in anorexia nervosa after infusion therapy].

A 26 year old female patient was admitted to our hospital because of septic temperatures and chills. In the patient's history renal insufficiency has been known for several years due to agenesia of the right and pyelonephritic renal congestion of the left kidney. Long lasting anorexia nervosa had been treated by psychotherapeutical interventions for years and when failing it necessitated repeated intravenous nutrition by central venous lines. The prominent symptom of the intravenously treated young woman was fever up to 39.7 degrees C and pneumonia, which was considered by the first treating clinic to be caused directly by diminished immunoreactivity in malnutrition and preuremia. The chest X-ray confirmed pneumonia and revealed multiple abscesses in both lungs (Figure 1). After being transferred to our intensive care unit the pathophysiological context became obvious. From inspection (positive jugular pulsation), from auscultation (holosystolic murmur at the left parasternal border) tricuspid incompetence due to infective endocarditis was suspected. This was confirmed immediately by TM and two-dimensional transthoracic echocardiography, which showed a large vegetation on the anterior tricuspid valve leaflet (Figures 2a and 2b). Tricuspid regurgitation was also ascertained by color flow echocardiography (Figure 2c). Several blood cultures were positive for staphylococcus aureus. Clinical and laboratory recovery was achieved by antibiotic therapy with vancomycin and cephtazidim for 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Timing of surgery in relation to menstrual cycle does not predict the prognosis in primary breast cancer. Danish Breast Cancer Cooperative Group.

From 1977 to 1989 6488 patients under 50 years with primary breast cancer were registered in the nationwide Danish Breast Cancer Cooperative Group (DBCG). Among these, information on last menstrual period prior to surgery was available in 1635 cases which constitute the study group of the present analysis. The group was representative of all women operated upon during the period with regard to prognostic factors and survival. In the study group time of surgery in relation to last menstrual period was found to have no influence on 5 and 10 years survival.

Adult↗
PubMed1993

Purification and characterization of a scorpion defensin, a 4kDa antibacterial peptide presenting structural similarities with insect defensins and scorpion toxins.

Insect defensins are a group of inducible small-sized antibacterial peptides with three intramolecular disulfide bridges. NMR studies have recently shown that they share striking structural similarities with scorpion toxins. We have investigated in a scorpion species, Leiurus quinquestriatus, the potential presence of antibacterial molecules and report the isolation and structural characterization of a novel insect defensin homologue, which we refer to as scorpion defensin. This peptide shows a remarkably high degree of sequence homology with a defensin recently characterized in a species belonging to the ancient insect order of the Odonata with which it defines a novel ancient subclass of defensins. The scorpion defensin has in common with the scorpion toxins a consensus sequence Cys-[...]-Cys-Xaa-Xaa-Xaa-Cys-[...]-Gly-Xaa-Cys-[...]-Cys-Xaa-Cys present in all scorpion toxins characterized so far.

Amino Acid Sequence↗
PubMed1993

[Results of treatment of 475 second- and third-degree open fractures of long tubular bones (1974-1988)].

Open fractures with severe soft tissue damage are undergoing a change in therapeutic management. The impairment of vascularisation concerning bone and surrounding tissue has been gaining increasing importance. In addition to the primary stabilisation of 2 degrees and 3 degrees open fractures of long bones by external fixation including open wound treatment with artificial skin substitutes, local or free muscle flaps became an essential part of therapy. The early change of method after reconstruction of the soft tissue defect from external fixation to an internal osteosynthesis, i.e. the interlocking nail, as well as the use of autogenous cancellous bone graft and the possibility of segmental transport techniques are additional procedures. From 1974 to 1988 a total of 475 2 degrees and 3 degrees open fractures of long bones were initially treated at the BGU Tübingen. The follow-up of three groups of patients shows the development in therapeutic management of these severe injuries. In spite of a considerable rate of postoperative infections most cases show satisfactory functional results within an acceptable period of time (infection rate between 11.4 and 22.2%, average bone healing between 26 and 30 weeks).

Adult↗
PubMed1993

Comparison of a felodipine-metoprolol combination tablet vs each component alone as antihypertensive therapy. The German Multicentre Study Group.

This was a 12-week double-blind, parallel-group study of 186 patients with supine diastolic blood pressure between 95 and 115 mmHg randomised to receive either 5 mg of felodipine or 50 mg of metoprolol, or a combination tablet containing the two drugs at the same dosages, given once daily. All drugs were extended-release formulations and blood pressure was measured 24 h after drug administration. After 12 weeks of treatment, the mean systolic/diastolic blood pressure reduction was significantly greater with the felodipine-metoprolol combination (28/18 mmHg) compared with felodipine (18/12 mmHg) or metoprolol (19/12 mmHg) alone. Antihypertensive response rate, defined as the percent of patients achieving a supine diastolic blood pressure < or = 90 mmHg and/or a reduction of > or = 10 mmHg with treatment, was significantly greater with the fixed combination (98%) than with either felodipine (79%) or metoprolol (82%) as monotherapy. The mean reduction in heart rate was significantly less with the combination (2 beats/min) than with metoprolol alone (4 beats/min), and heart rate was virtually unchanged in the felodipine group. The increased antihypertensive efficacy of the combination was associated with good tolerability that was similar to that of the monotherapies. Adverse events were mainly those related to arteriolar dilatation with felodipine and the combination, and dizziness and fatigue with metoprolol. Two patients taking the combination were withdrawn due to adverse events.

Adult↗
PubMed1992

[Surgical interventions in ulcer diseases in Denmark. A questionnaire study].

Surgical practice in the treatment of peptic ulceration in Denmark is illustrated by means of a questionnaire. The percentage of replies was 96. The investigation reveals that the predominant method of elective surgery for duodenal ulceration is still proximal gastric vagotomy rather than vagotomy+antrectomy. In elective surgery for prepyloric ulcer, vagotomy+antrectomy is employed most frequently and for elective operation for gastric ulcer partial gastric resection. In operative interventions for complications of ulceration such as haemorrhage and perforation, the operative strategy appears to be determined by the difficult current possibilities for training in ulcer surgery to a not inconsiderable extent, rather than to be based on a rational scientific basis as the definitive intervention here is replaced to a great extent by minor interventions such as simple undersewing of a bleeding gastric ulcer followed by H2-blocker treatment and simple closure of a perforated duodenal ulcer.

Denmark↗
PubMed1992

[Axillary band contractures after axillary lymph node excision].

Three patients are described who developed painful bands across the axilla which severely restricted shoulder abduction after breast surgery and axillary lymph-node dissection. They were treated by transection of the bands with excellent results in two of the three patients. The underlying pathology is apparently thrombosis, obstruction and inflammation of lymphatic channels. Treatment should be conservative in most cases, with surgery reserved for patients with intolerable symptoms.

Adult↗
PubMed1992

The 'absent' appendix.

During an operation for suspected appendicitis, the surgeon concluded that the appendix was absent. The causes of this situation are presented and a guide to its management is suggested.

Abdominal Pain↗
PubMed1992

Surgical complications of intraoperative radiation therapy: the Radiation Therapy Oncology Group experience.

Intraoperative radiotherapy (IORT) is being used with increasing frequency in many institutions in the United States but little is known about the surgical complication rates. The Radiation Therapy Oncology Group initiated three prospective studies in IORT in 1986 and we report here the experience in advanced malignancies of the stomach, pancreas, and rectum. The incidence and nature of major surgical complications were reviewed and presented with their implications in regard to future IORT trials. Two hundred twenty-seven patients were entered on three studies by 20 participating institutions between 1985 and 1989. One hundred twenty-nine patients received IORT while 98 patients were found to have too advanced disease to be benefited by IORT and underwent palliative surgical procedures only. IORT doses ranged from 12-22 Gy and bowel anastomoses were not irradiated. Wound infection in the IORT group was 6% vs. 2% in the non-IORT patients but this was not significant at the P = 0.05 level. Other complications included anastomotic leak (n = 5), operative bleeding (n = 10), pancreatitis (n = 2), and were not statistically different in the IORT and non-IORT groups. The mortality rate for the IORT and non-IORT groups combined was 1.8%. This large multi-institutional experience in patients with advanced malignancy demonstrates that patients receiving IORT do not have a higher surgical complication rate than those not receiving IORT. Long-term survival data await the implementation of Phase III trials in advanced intra-abdominal malignancy.

Combined Modality Therapy↗
PubMed1992

Regression of left ventricular hypertrophy during long-term antihypertensive treatment--a comparison between felodipine and the combination of felodipine and metoprolol.

Seventy-six hypertensive patients with left ventricular hypertrophy (LVH) were randomized to receive felodipine or felodipine plus metoprolol in a double-blind parallel-group study. The doses of each treatment regimen were titrated to obtain a diastolic blood pressure (BP) of less than 95 mmHg. The duration of the treatment was 9 months. At the end of the study, BP was significantly reduced in both groups, and the reduction did not differ between the groups. Left ventricular posterior wall and septum thickness were significantly and similarly reduced in both groups. Left ventricular systolic and diastolic end diameters were not significantly changed. Left ventricular mass (LVM) was significantly and similarly reduced in both treatment groups, as was the ratio of LVM and left ventricular end diastolic volume. In conclusion, felodipine and the combination of felodipine and metoprolol reduced left ventricular hypertrophy to the same extent when BP was similarly reduced.

Adult↗
PubMed1992

Clinical studies of Ukrain in terminal cancer patients (phase II).

Phase II of clinical studies was performed on 70 patients, ranging in age from 14 to 80 years, (27 male, 43 female) to determine the appropriate dose range for Ukrain and the clarification of dose/response relationships, in order to provide an optimal background for wider therapeutic trials. The following parameters were studied: physiological (pulse, blood pressure, temperature); biochemical, haematological and immunological. Electrolytes and trace elements were investigated, as well as neopterin, tumour markers, immune complexes, non specific blocking factors, development of tumours and metastases in quantitative respects (by X-ray, CT, scintigrams and US). The patients' general conditions were also assessed. Ukrain was given intramuscularly or intravenously every one, two, three, four or five days, or according to other schemata, in the dose range of 2.5, 5, 10, 15, 20 or 25 mg increasing (2.5 to 25 mg per injection), decreasing (25 to 2.5 mg per injection) and stable (5, 10, 15, 20 or 25 mg per injection). Duration of one course of therapy was between 10 days and 90 days. Intervals between courses ranged from 7 days to 3 months. In order to find dose/duration/interval/response-relationships, some cases were treated after chemoradiotherapy, some as adjuvant therapy to chemo-radiotherapy and alternatives such as iscador, and some as monotherapy. All patients were at terminal stages of their disease.

Adolescent↗
PubMed1991

Relationship between a subunit of NADH dehydrogenase (complex I) and a protein family including subunits of cytochrome reductase and processing protease of mitochondria.

The primary structure of a 40 kDa subunit of the respiratory chain NADH:ubiquinone reductase from Neurospora crassa was determined by sequencing cDNA, genomic DNA and the N-terminus of the mature protein. The gene which is interrupted by 7 introns encodes a preprotein consisting of 375 amino acids with a 26 amino acid long presequence typical for a mitochondrial targeting signal. The sequence of the mature subunit shows conspicuous similarities to the recently [(1989) Nature 339, 147-149] discovered protein family which includes subunits I and II of the ubiquinol:cytochrome c reductase, and the processing proteins, matrix processing peptidase and processing enhancing protein, of mitochondria. The possible role of the subunit is discussed.

Amino Acid Sequence↗
PubMed1991

Assessment of the reliability of the symptoms and signs of acute appendicitis.

The reliability of the signs and symptoms of acute appendicitis are reviewed. The wide variation in clinical findings when the different studies are compared can probably be explained by the huge quantity of retrospective studies. Migration of pain to the right iliac fossa and/or guarding/rigidity support the diagnosis of appendicitis. The diagnosis of appendicitis should be doubted when anorexia, nausea and vomiting are absent, when symptoms have persisted for more than 72 h without apparent perforation, or when tenderness in the right iliac fossa is absent. Presentation in proximity to menstruation, cervical dislocation tenderness and bilateral adnexal tenderness indicates pelvic inflammatory disease. Small children have high perforation rates because of their uniform response to many illnesses and relative inability to express themselves and cooperate. The clinical findings in young and old patients are similar, except for a higher rate of abdominal distension in old patients. With a more thorough knowledge of the signs and symptoms of acute appendicitis and a constant awareness of its possible presence, it should be possible to increase the diagnostic accuracy.

Abdominal Pain↗
PubMed1991

Ultraconservative management of appendiceal abscess.

An appendiceal abscess is usually treated conservatively. Drainage of the abscess is instituted if this treatment is unsuccessful. Some surgeons practise immediate appendectomy and abscess drainage. An alternative ultraconservative approach whereby abscess drainage is avoided has been reviewed retrospectively. Twenty-eight patients were treated by observation only. They remained in hospital for between 1 and 36 days (median 10 days) until their signs and symptoms disappeared. No patient required surgery or developed complications in hospital. One patient developed acute appendicitis 10 days after discharge. One developed a recurrent abscess. Another group of 19 patients were treated over the same period of time by immediate operation. Ten developed postoperative complications. Hospitalization ranged from 4 to 36 days (median 8 days). Ultraconservative management of appendiceal abscess is a safe and effective alternative to immediate surgery, or ultrasound- or computed tomographic-guided drainage.

Abscess↗