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Biomedical subjects

J Kramer

Publications and source records attributed to J Kramer.

At least 109 records · Page 6Linked to original sources
PubMed1994

Isolated or dominant lesions of the patella in gout: a report of seven patients.

Isolated or dominant osteolytic lesions of the patella are an unusual manifestation of gout. We present seven patients who had such patellar lesions unilaterally (six patients) or bilaterally (one patient) and analyze the radiologic characteristics to determine whether they can be differentiated from those of other osteolytic lesions of the patella. The lesions were uniformly characterized by a geographic pattern of bone destruction in the superolateral aspect of the patella. Five lesions were each accompanied by a peripatellar soft tissue mass, four of which contained calcification. It therefore appears that an osteolytic lesion of the superolateral portion of the patella, especially when associated with a peripatellar calcified soft tissue mass, should alert one to the possible diagnosis of gout. Awareness of this possibility may obviate the need for invasive diagnostic procedures.

Adult↗
PubMed1994

Breaking bad news: realistic versus unrealistic hopes.

Hope is an essential aspect of the therapeutic relationship between cancer patients and their carers. Realistic hopes provide considerable support, whereas unrealistic hopes can be destructive by impairing the ability to make appropriate decisions about future plans, treatment, and issues of personal importance. Realistic hopes exist for cancer patients at all stages of their illness. Provision of realistic hope facilities the process of breaking bad news. In this article, the role of hope is explored. Appropriate hopes are identified from the time of pre-diagnostic work-up throughout the phase of definitive treatment and into the transition to palliative and supportive care. A practical approach is developed, which emphasises communication and listening skills, the importance of providing time and the benefits of intermediate goals that facilitate a gradual adjustment in hopes as the disease progresses.

Attitude to Death↗
PubMed1994

Magnetic resonance angiography and selective angiography following extra-intracranial bypass operations.

Magnetic resonance angiography (MRA) was compared with conventional angiography in 14 patients following extra-intracranial arterial anastomosis. In 13 patients the bypass was shown by MRA and confirmed by conventional angiography. In five of these, the anastomosed vessels, in particular the superficial temporal artery, was of the same calibre or smaller than the same vessels on the contralateral, healthy side. In one patient no anastomosis could be shown by MRA, and occlusion of the bypass was confirmed by conventional angiography. Absence of dilatation of the anastomotic vessels may indicate insufficient bypass function due to stenosis or an incorrect indication for surgery.

Adult↗
PubMed1994

MR-appearance of the pituitary gland before and after resection of pituitary macroadenomas.

Pituitary macroadenomas can cause severe compression and displacement of the pituitary gland. This study was undertaken to determine the value of contrast administration for the detection of the pituitary gland in patients with pituitary macroadenomas, to evaluate the preoperative location and configuration of the pituitary gland and to describe its postoperative changes after tumour resection. Preoperative and postoperative MR imaging examinations of 30 patients with histologically proven pituitary macroadenomas were retrospectively evaluated. The examinations were performed on a 1.5 T unit, by obtaining T1-weighted sagittal and coronal images after administration of gadopentetate dimeglumine. On preoperative MR images, contrast administration increased the detectability of the anterior lobe from 30% to 80%. Depending on the size and extension of the adenoma, the pituitary gland was displaced to the suprasellar space (53%) and/or deformed to a club-shaped (27%) or sickle-shaped (47%) configuration. In six patients, the sickle-shaped pituitary gland was interposed between the cavernous sinus and the adenoma ('rim-sign'), which was seen only on gadopentetate dimeglumine-enhanced images. In these cases, there was no infiltration of the cavernous sinus at surgery. Postoperatively, descent of the pituitary gland was found in 63%, and reexpansion in 54%. We conclude that contrast administration improves the detectability of the pituitary gland on preoperative MR images, and that the displacement and deformation of the pituitary gland depend on the size, location and extension of the adenoma. Preoperatively, demonstration of the pituitary gland interposed between the cavernous sinus and the adenoma ('rim-sign') is a very useful sign for exclusion of cavernous sinus infiltration, best seen on contrast-enhanced coronal MR images. The normal postoperative changes of the pituitary gland after tumour resection include repositioning and re-expansion.

Adenoma↗
PubMed1994

Analysis of autoregulation at the level of pre-mRNA splicing of the suppressor-of-white-apricot gene in Drosophila.

The Drosophila suppressor-of-white-apricot [su(wa)] protein regulates/modulates at least two somatic RNA processing events. It is a potent regulator of its own expression. We report here new studies of this autoregulatory circuit. Among other things, our studies show the following. First, new evidence that su(wa) expression is autoregulated at the level of pre-mRNA splicing is reported. su(wa) protein represses accumulation of the fully spliced su(wa) mRNA encoding it and promotes accumulation of high levels of incompletely spliced su(wa) pre-mRNA. Second, the fully spliced su(wa) mRNA is sufficient for all known su(wa) genetic functions indicating that it encodes the sole su(wa) protein. Third, the incompletely spliced su(wa) pre-mRNAs resulting from autoregulation are not translated (probably as a result of nuclear retention) and apparently represent nonfunctional by-products. Fourth, the special circumstances of su(wa) expression during oogenesis allows maternal deposition exclusively of fully spliced su(wa) mRNA. Fifth, su(wa) protein immunolocalizes to nuclei consistent with its being a direct regulator of pre-mRNA processing. We discuss the implications of our results for mechanisms of splicing regulation and for developmental control of su(wa) expression.

Animals↗
PubMed1994

Managing special education needs: helping and involving parents.

This paper reviews a period of enormous change and flux in the English education service. It notes that a number of the supports and sources of advice traditionally available to parents of young people with special educational needs and to the young people themselves are now reduced, are being changed or are in the process of being removed. It proposes a new emphasis for service professionals, administrators and the voluntary bodies working in the area of special educational needs. The central premise is that the work and role of the voluntary bodies, in supporting young people with special needs and their parents, should be welcomed and confirmed as a vital element within the educational process. A range of practical service strategies is proposed which is intended to sustain a user friendly educational service during a time of massive change. A model for confirming the potentially significant role of the voluntary bodies in this important area of educational need is offered.

Education, Special↗
PubMed1994

Preoperative staging of osteosarcoma: efficacy of MR imaging in detecting joint involvement.

OBJECTIVE: Selecting the appropriate surgical procedure for treatment of patients with osteosarcoma requires accurate preoperative evaluation of tumor extent. Establishing the presence or absence of joint involvement is particularly important. Accordingly, we studied the efficacy of MR imaging for detecting joint involvement in 46 patients with osteosarcoma around joint spaces. SUBJECTS AND METHODS: Preoperative MR examinations were performed in 46 consecutive patients with osteosarcoma whose tumors were located around the knee (n = 33), the hip (n = 8), or the shoulder (n = 5). T2-weighted and unenhanced and contrast-enhanced T1-weighted spin-echo MR images were obtained for all patients. We assessed the presence or absence of tumor invasion of the intracapsular-intrasynovial joint space, either by disruption of the joint capsule or by intraarticular destruction of the cortical bone and articular cartilage or the intracapsular-extrasynovial cruciate ligaments of the knee. All patients subsequently had surgery. The MR findings were correlated with findings from macroscopic and microscopic pathologic examinations. RESULTS: All 10 patients who subsequently proved to have tumor involvement of the joint were correctly identified (sensitivity, 100%). The tumor involved the knee joint in seven patients, the hip joint in two, and the shoulder joint in one. However, the MR diagnosis was false-positive in another 11 patients who did not have joint involvement at surgery (specificity, 69%). In the knee, MR imaging was more accurate in identifying tumor extension to the cruciate ligaments than to the intrasynovial joint space. Post-contrast T1-weighted images were most useful in detecting joint involvement. CONCLUSION: MR imaging is highly sensitive for detecting joint invasion of osteosarcoma. However, false-positive diagnoses may lead to overstaging of tumor and result in unnecessarily radical surgical procedures.

Adolescent↗
PubMed1994

Single payer: the California referendum.

The California Health Security Act is likely to appear on the November 1994 ballot. The bill would provide universal coverage to California residents and assign the state as the single payer for all medical care provided, financed with funding for programs already in place, employer payroll taxes, individual income taxes and taxes on tobacco products.

California↗
PubMed1994

Primary isolated coronary artery bypass in left ventricular dysfunction: survival and predictors of survival.

Coronary angiograms of 462 patients with ejection fractions below 51% who underwent primary isolated coronary artery bypass at the Cleveland Clinic from 1981 to 1985 were available for review. They were divided into two groups: group 1 (n = 166) with severe ventricular dysfunction (ejection fraction less than 30%) and group 2 (n = 296) with moderate ventricular dysfunction (ejection fraction 31 to 50%) at a median follow-up of 5.8 years/patient. The actuarial survival was 64.3% in group 1 and 80.6% in group 2 (P = 0.0001). By multivariate analysis, congestive heart failure (P = 0.0001) was the single most important factor affecting survival for both groups. In addition, in group 1 the preoperative use of inotropes (P = 0.03) and in group 2 the presence of peripheral vascular disease (P = 0.001) affected long term survival.

Actuarial Analysis↗
PubMed1994

[Basics of MRI technique and MRI image interpretation].

Today magnetic resonance imaging (MRI) is an important routine diagnostic tool in orthopaedics. It is based on the nuclear magnetic resonance phenomenon: "free" hydrogen atoms (mainly from water) become field-parallel in a strong outer magnetic field. They reach a higher energy level by application of an additional electromagnetic field. After shutdown of this outer field the atoms send out electromagnetic waves (radiowaves), representing the MR signal. Different amounts of "free" water result in various image characteristics. Typically, a higher tissue water content is represented by high MR signals, e.g. in blastomas, inflammations and degenerative changes. Waterless structures such as calcified or fibrous tissues, tendons and ligaments show low MR signals. Fatty structures have high signals; proteins dissolved in "free" water change the water signal dramatically. Besides these basic parameters, para-, ferro- and super-paramagnetic materials--ether naturally present in the human body, such as methemoglobin, or artificially introduced, such as MR contrast media--and flow are responsible for different grey shades in MRI. MRI is not associated with ionizing radiation and allows imaging in all planes without changing the patient's position. Disadvantages of MRI are high costs and low availability. Future technical developments will result in shorter imaging times and broadening of the application spectrum, leading towards "MR fluoroscopy" and MR interventions.

Adolescent↗
PubMed1994

[Bone inflammation (including spondylitis)].

MRI diagnosis of bony inflammations has sensitivity of up to 96%, but specificity of only 70-87%. The most common reasons for false-positive results are fractures, infarctions, neoplasms, septic arthritis and aggressive metastasis. Early MRI diagnosis is based on bone marrow oedema, which is hypointense on T1-weighted images, hyperintense on T2-weighted images. Reactive fibrovascular tissue and hyperaemia lead to contrast enhancement. Necrosis, calcification and sequestra show low signal intensities. Increasing calcifications and restructuring of spongiosa are not well visualized in MRI. In spondylitis, fat conversion is a good marker for healing. Complications of osteomyelitis (e.g. soft tissue abscesses) can be diagnosed by MRI with high sensitivity. In the primary diagnosis and follow-up of osteomyelitis (spondylitis), standard X-ray exams should be performed first. In the initial studies MRI can replace bone scintigraphy, which has poor morphological resolution. Semiquantitative follow-up studies can be done by MRI or scintigraphy.

Adolescent↗
PubMed1994

[Osteonecrosis].

The causes of osteonecrosis are varied. The pathogenesis of osteonecrosis subsequent to trauma is well known. Furthermore, an association of this disorder with cortisone, haemoglobinopathies, rare metabolic diseases, and risk factors seems to be evident. However, a sizable proportion of patients have osteonecrosis in which none of these associations exists, referred to as idiopathic osteonecrosis. Generally, intraosseous vascularization represents the common pathway for the various causes of the disease. The prognosis is influenced by the age of the patient, the location of the necrosis and the stage of the disease at the time of diagnosis. In recent times diagnosis has been improved by the use of modern imaging modalities, and MR imaging is now widely accepted as the imaging method of choice. It not only allows early diagnosis but also yields exact staging information in advanced disease, which is a requirement for adequate therapy.

Adult↗
PubMed1994

[The non-traumatic femur head necrosis in the adult. I: pathophysiology, clinical picture and therapeutic options].

Intraosseous vascularization is the common pathway of the multifactorial causes of avascular necrosis of the hip (AVN). Recurring ischemic phases could lead to bone necrosis in the initial stage of the disease, when it is still reversible. A spontaneous repair mechanism can lead to complete healing at this stage. The necrotic area demarcates the superior-anterior aspect from the residual femoral head with a reactive interface in the irreversible early stage of the disease. In this stage damage to the femoral head can only be delayed with core decompression or femoral osteotomy, because a sufficient repair mechanism is no longer possible. When the articular surface collapses the early stage gives way to the late stage. Cartilage incongruence and microfracture lead to progressive destruction of the femoral head and to secondary osteoarthritis. In this late stage femoral osteotomy is only successful in carefully selected patients. Total hip replacement is the last resort for patients with painful destruction of the joint. As clinical symptoms are unspecific, MRI plays an important role for early diagnosis of AVN in the initial or early stages. Conservative treatment is not successful in any of the three stages of the disease.

Adult↗
PubMed1994

[The non-traumatic femur head necrosis in the adult. II: radiologic diagnosis and staging].

In recent years diagnosis, and in particular early diagnosis, of osteonecrosis of the hip has been much improved by modern imaging modalities. Magnetic resonance imaging is widely accepted as the primary imaging modality for the early detection of this disorder and can help to facilitate the therapeutic management in later stages. However, plain radiographs, bone scans and computed tomography are still important techniques, which cannot be avoided in most cases. This paper describes the relative values of the different modalities. The staging system used is the international ARCO system.

Adult↗
PubMed1994

The diagnostic value of magnetic resonance imaging for the detection of tumor recurrence in patients with carcinoma of the ovaries.

Disease status during follow-up evaluation of patients with carcinoma of the ovaries is the main criterion for the selection of appropriate management. A cohort analysis was performed to investigate if magnetic resonance imaging (MRI) could improve noninvasive assessment of disease status in patients with carcinoma of the ovaries during follow-up examination. Twenty-four women with carcinoma of the ovaries after primary surgical treatment with subsequent platinum containing chemotherapy were entered into the study. MRI was performed in addition to sonography and computed tomography (CT). Patients without evidence of disease underwent restaging laparotomy. Sensitivity of sonography, CT and MRI was 50, 63 and 75 percent, respectively. Combination of CT and MRI revealed a 75 percent sensitivity rate. Specificity for sonography, CT and MRI was 100, 94 and 94 percent, respectively, and for the combination of CT and MRI, 88 percent. Positive and negative predictive value and accuracy of these methods were 100, 80 and 83 percent for sonography; 83, 83 and 83 percent for CT; 86, 88 and 88 percent for MRI, and 75, 88 and 83 percent for the combination of CT and MRI. In one instance of false-negative sonographic and CT results, MRI detected recurrence located in postoperative scar tissue. In one instance, MRI did not add essential information to the other imaging methods. Therefore, MRI as a time- and cost-intensive procedure should be reserved for instances in which there are doubtful findings arising with other diagnostic tools, rather than as an indispensable routine procedure in the follow-up evaluation of patients with carcinoma of the ovaries.

Adult↗