Search PubMed⌕ Search

Biomedical subjects

J Maurer

Publications and source records attributed to J Maurer.

At least 91 records · Page 5Linked to original sources
PubMed1996

The efficacy of complaints management training in facilitating benzodiazepine withdrawal.

The study aimed at evaluating the efficacy of complaints management training (CMT) compared to that of anxiety management training (AMT) in patients undergoing benzodiazepine withdrawal. CMT focused on techniques to alleviate reported withdrawal symptoms. Nineteen patients were randomly allocated either to CMT or to AMT. Both groups received 9 weekly treatment sessions and were assessed every other week. Withdrawal was designed to be gradual over the first 4 weeks. CMT proved more successful than AMT in terms of abstinence rate, reported number of severe withdrawal symptoms, depression and anxiety. At follow-up after 6 months, there was no difference between groups in terms of abstinence rate.

Adaptation, Psychological↗
PubMed1996

Field examination of ground water quality as an indicator of microbiological activity at gasoline contaminated sites.

Various portable electrodes and an on-line colorimetric test kit were used in the field to examine ground water quality as an indicator of natural bioremediation across two sites in Connecticut having subsurface gasoline contamination. The parameters examined included dissolved oxygen, dissolved carbon dioxide, direct redox potential (Eh), nitrate, ammonia and pH. These parameters permitted delineating regions of aerobic and anaerobic microbiological activity. Variations in these parameters over an eighteen month period along with gas chromatographic analyses of certain gasoline components in the ground water indicated that in-situ bioremediation was effective at containing the petroleum contamination at both sites. It was found that a new on-line colorimetric test kit for the determination of oxygen was more accurate than a commonly used dissolved oxygen electrode.

Ammonia↗
PubMed1996

Quality of life following transplantation of the heart, liver, and lungs.

The purpose of this study was to describe the quality of life of patients who have received a transplant of the heart, liver, and lungs. We wished to document how the different patient groups fared in relation to each other with respect to physical, psychological, and social functioning, as well as in relation to published normative data. We also wished to identify factors that contribute to better functioning. We sent out a questionnaire by mail and received responses from 55 heart, 149 liver, and 59 lung transplant recipients (82% response rate). Measures included the SF-36, Mental Health Inventory, the State Anxiety Inventory, the UCLA Loneliness Scale-Revised, a quality of life measure that rated degree of improvement since transplantation, a measure of degree of difficulty in following medical and lifestyle regimens, sleep disturbance, and the Illness Intrusiveness Rating Scale. Results indicated that lung transplant patients reported better functioning than heart or liver transplant patients in all three domains of physical, psychological, and social functioning. Lung patients' level of functioning was equivalent to or better than published norms for the SF-36. Heart and liver recipients reported equivalent functioning to published norms in some domains, but reported impairment in the areas of physical and social functioning. Heart patients especially reported greater intrusiveness of their illness on their daily lives and indicated more difficulty complying with their lifestyle regimen. In all three groups, a large majority of patients reported feeling that life had improved since transplant with respect to health, energy level, activity level, and overall quality of life. Fewer patients reported improvements in the areas of sex life, marriage, family relationships, and social relationships. Where there were differences among the three patient groups, again it was the lung patients who reported more improvement in life since transplantation. Patients with better physical functioning tended to have more energy and pep, to be younger, to see themselves as being in better health, to feel less intrusion on their lives of their illness, and to be employed. Those with better psychological functioning tended to report less sleep disturbance, less loneliness, better social functioning, more vitality, and to be older. Better social functioning was associated with better mental health, less illness intrusiveness, and less role impairment as a result of physical or emotional factors. Relatively few patients-roughly a quarter of the total sample-reported that they were working either full or part time. We conclude that transplantation results in improved quality of life overall, but that problems persist for some patients in their physical and social functioning. Interventions aimed at improving rehabilitation in specific targeted areas may enable patients to resume a more fulfilling lifestyle posttransplant.

Activities of Daily Living↗
PubMed1996

Prognostic significance of additional chromosome abnormalities in adult patients with Philadelphia chromosome positive acute lymphoblastic leukaemia.

The clinical and biological significance of additional chromosome aberrations was investigated in a large series of 66 adult patients with Philadelphia (Ph) chromosome positive acute lymphoblastic leukaemia (ALL). Additional chromosome changes were observed in 71% of the cases. 9p abnormalities were identified in 26%, and monosomy 7 as well as hyperdiploid karyotypes 50 were both found in 17% of cases. 9p anomalies were characterized by a low complete remission (CR) rate (58%) and an extremely short median remission duration (MRD: 100 d). In patients with monosomy 7, the poor treatment outcome was confirmed (CR rate 55%: MRD 113 d). In contrast, all patients with hyperdiploid karyotypes 50 achieved CR, and the overall survival was superior to all other Ph-positive ALL patients except those without additional chromosome aberrations. Exclusive rearrangement of the minor breakpoint cluster region of the BCR gene and lack of coexpression of myeloid-associated antigens in cases with 9p anomalies as well as a high frequency of rearrangements of the major breakpoint cluster region of the BCR gene in patients with monosomy 7 (89%) further substantiated that additional chromosome aberrations may characterize distinct subgroups of Ph-positive ALL. Moreover, the necessity of the complementing use of chromosome banding analyses, polymerase chain reaction (PCR) assays, and fluorescence in situ hybridizations in the accurate identification of Ph-positive patients has become evident due to variant Ph translocations in 3%, and negative PCR assays in 4% of the cases.

Adolescent↗
PubMed1996

[Noninvasive determination of pressure relations of intracranial and intracochlear fluid spaces during the glycerol test in normal probands and patients with Menière's disease].

BACKGROUND: The cochlear aqueduct is a route for direct pressure transfer between intracranial and intracochlear fluids. In patients with Menière's disease, intracochlear pressure is presumably disturbed. The "Tympanic Membrane Displacement Analyser (TDA)" is a new system which provides a useful noninvasive method of detecting intracranial and intracochlear pressure changes. PATIENTS: In this study TDA measurements in combination with a glycerol test were performed in nine patients with Menière's disease and in seven normal persons. RESULTS: Before ingestion of glycerol, no significant difference in pressure was found between the two groups. After ingestion of glycerol a temporary decrease in intracochlear pressure was detected in both groups without any significant difference between the two groups. CONCLUSION: These results show that the combination of glycerol testing and TDA measurements does not seem to be helpful for the differential diagnosis of Menière's disease.

Adult↗
PubMed1996

Extrathoracic angiomyolipomas in lymphangioleiomyomatosis.

Pulmonary lymphangioleiomyomatosis (LAM) is a rare disorder that affects women and can lead to serious respiratory impairment. Since Bourneville's tuberous sclerosis (TS) was first reported, the striking similarities between the two entities have led many to believe that LAM is a forme fruste of TS. This is suggested by reports that angiomyolipomas, rare tumours in themselves, are reported in 40-80% of TS patients and occur in 15-30% of LAM patients. A retrospective chart review was conducted of 14 patients that presented to our institution with a diagnosis of LAM. We sought to document the clinical manifestations, particularly the incidence and location of extrathoracic tumours, in order to further support the hypothesis that LAM is a forme fruste of TS. Twelve patients had premenopausal onset of symptoms and two postmenopausal. The diagnosis was confirmed histologically (n = 12) and/or by computed tomography (CT) scan of the thorax (n = 12). Imaging investigations revealed extrathoracic tumours in 12 of 14 patients (86%). Eight of the 14 patients (57%) had renal tumours consistent with angiomyolipomas (bilateral in five patients). Only one patient had renal symptoms (flank pain and haematuria). All had normal serum creatinine, one had a reduced creatinine clearance. Extrathoracic nonrenal tumours were discovered in the pancreas, adrenals and uterus, findings previously unreported in LAM. In summary, the incidence of extrathoracic tumours in lymphangioleiomyomatosis patients is much higher than previously reported in the literature. This increased association supports the theory that lymphangioleiomyomatosis and tuberous sclerosis represent part of a spectrum of a similar disease process.

Adrenal Gland Neoplasms↗
PubMed1996

Bronchodilator response at low lung volumes predicts bronchiolitis obliterans in lung transplant recipients.

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is the major obstacle to long-term lung allograft viability. The diagnosis often occurs after significant organ dysfunction is present, and BOS is often unresponsive to standard immunosuppressive agents. We have observed bronchodilator responses (BRs) at low lung volumes in many of our patients who have developed BOS. We therefore assessed whether BR could predict the development of BOS. METHODS: We conducted a retrospective review of the clinical and pulmonary function laboratory records of 146 patients who underwent transplantation between March 1983 and November 1993. BR was defined as 25% or more increase in forced expiratory flow at 50% of vital capacity or 30% or more increase in forced expiratory flow at 75% of vital capacity. BOS was defined according to recently published FEV1 criteria. Bronchiolitis obliterans was defined histologically according to criteria of the Lung Rejection Study Group. RESULTS: Of the total population, 52 were excluded because of death or insufficient information. BRs of the small airways were seen in 31 patients (33%), 25 of whom developed BOS (83%). Approximately half of those with BR who developed BOS had evidence of acute rejection in the month prior to the onset of BR. Two thirds (four of six) of patients with BR not developing BOS had acute rejection in the previous month. The sensitivity of BR in predicting BOS was 51% with a specificity of 87%. The positive predictive value was 81%. CONCLUSIONS: BR appears to be useful as an early marker of BOS. The development of BR in selected patients should lead to closer monitoring and possibly a trial of augmented immunosuppression to arrest the establishment of BOS.

Adolescent↗
PubMed1996

Bronchiolitis obliterans organizing pneumonia (BOOP) in lung transplant recipients.

We reviewed all tissue specimens from 163 transplant patients (108 double lung transplant [DLT], 55 single lung transplant [SLT]) between November 1983 and January 1994 for abnormalities indicating bronchiolitis obliterans organizing pneumonia (BOOP) and found 17 cases (14 DLT and 3 SLT). Of the three SLTs, BOOP was diagnosed by open lung biopsy (OLB) in two and one was found at autopsy. Of the 14 DLTs, BOOP was diagnosed by transbronchial biopsy (TBB) specimens (9), OLB specimens (2), autopsy (1), TBB and OLB specimens (1), and OLB specimens and autopsy (1). BOOP was found between 1 and 43 months posttransplantation; time of survival from diagnosis was between 2 and 36 months with 9 patients presently alive. Concurrent pathologic diagnosis at the time of BOOP findings were as follows: acute rejection (7) (grade 1 [4] and grade 2 [3]), BO and grade 1 rejection (2), BO and grade 2 rejection (2), BO and Aspergillus infection (1), acute alveolar injury (1), acute alveolar injury and pulmonary embolus (1), acute rejection (grade 1) and Burkholderia cepacia pneumonia (1). No other pathologic diagnosis was found in 1 patient. In total, 11 of 17 patients (65%) had associated acute rejection. Of the 17 patients, 7 subsequently developed BO and 3 had BO before the finding of BOOP. Death occurred in 8 patients (5 DLT and the 3 SLT) between 2 and 6 months after the diagnosis. We conclude that BOOP is an important complication after lung transplantation; it was present in 13% of DLTs and 5% of SLTs. BOOP was most often associated with acute rejection.

Acute Disease↗
PubMed1996

[Microsurgical endonasal decompression in traumatic and neoplastic optic nerve compression].

UNLABELLED: The therapy of traumatic optic neuropathy remains controversial. Some authors recommend observation and others, the use of megadose corticosteroids or surgical decompression of the optic nerve. Improvements in visual acuity from no light perception (NLP) preoperatively to close to normal visual acuities have been reported after transethmoidal decompression and systemic steroids. The transnasal microscopic approach offers safe and effective access to the optic canal. MATERIALS AND METHODS: Retrospectively 15 patients (13 men/2 women) ranging in age from 17 to 67 years, who were surgically decompressed in the Ear-Nose-Throat Department between 1989 and 1994, were analyzed. Thirteen patients had experienced sudden visual loss after trauma; in 2 patients a tumor was diagnosed. After an initial ophthalmologic examination and CT scans, the patients underwent transnasal decompression of the optic canal for at least 180 degrees. In the postoperative period, visual acuity, pupillary reaction, visual field and optic nerve morphology were monitored. RESULTS: The overall visual results were poor. In 8 patients with no light perception (NLP) preoperatively, no improvement in visual acuity was found. Minor improvements were seen with an initial vision of 20/200 or less. Dramatic improvements were found in both patients with rapidly progressive neoplastic optic nerve compression. No intra- or postoperative complications were seen. CONCLUSION: In our study we were unable to reproduce the good visual results of some series. If there is NLP preoperatively, surgical intervention does not seem to be promising. However, in patients with incurable tumors transnasal decompression of the optic canal offers a minimally invasive palliative measure to preserve and restore vision.

Adolescent↗
PubMed1996

Elective bedside tracheostomy in the intensive care unit.

BACKGROUND: Tracheostomy is a frequently performed procedure, and historically has had a high reported complication rate. This has led some authors to suggest that a tracheostomy should be done only in the operating room (OR). Concerns regarding the hazards of transporting critically ill patients to the OR may inhibit the use of tracheostomy. Bedside tracheostomy in the Intensive Care Unit (ICU) has been shown to be safe, but this concept has not been widely accepted. STUDY DESIGN: We retrospectively reviewed consecutive patients undergoing tracheostomy over a four-year period and compared the safety of elective beside tracheostomy with OR tracheostomy. RESULTS: We studied 536 patients who underwent tracheostomy during the four years, in 470 of whom the procedures were elective. Of these, 66 percent were done at the bedside without an anesthesiologist present. For the 311 patients who underwent bedside tracheostomy, the complication rate was 8.7 percent compared to 9.4 percent of 159 patients undergoing OR tracheostomy (p values were not significant). No deaths were directly associated with tracheostomy procedures, although the overall hospital mortality rate for these patients was 59 percent. CONCLUSIONS: A tracheostomy can safely be performed in an ICU without requiring transport of the patient to the operating suite, thereby eliminating the hazards of transport.

Adolescent↗
PubMed1996

Yield of surveillance transbronchial biopsies performed beyond two years after lung transplantation.

BACKGROUND: Acute lung rejection after transplantation may lead to significant graft dysfunction. Hence surveillance protocols which include transbronchial biopsies have been established to monitor for early findings suggestive of acute rejection. However, the frequency of acute rejection diminishes as time from the transplant procedure increases. We therefore sought to examine the incidence of acute rejection seen on surveillance transbronchial biopsy performed at least 2 years after transplantation. METHODS: A retrospective review of all transbronchial biopsy was conducted. Forced expiratory volume in 1 second at the time of transbronchial biopsy and in the preceding 6 months was recorded. RESULTS: A total of 102 transbronchial biopsy procedures were assessed. Histologic evidence of at least grade 2 rejection (including three judged as grade 1 to 2) occurred in biopsy samples from 10 procedures (9.8%). Five of the episodes occurred at 2 years, three occurred at 3 years, and two occurred at 4 years. Inadequate biopsies occurred on 22 occasions (21.6%). A corresponding significant change in forced expiratory volume in 1 second ( >or= 10% decline) compared with the preceding 6 months was seen in 4 of 10 episodes of grade 2 acute rejection. Only one of five episodes occurring at least 3 years after transplantation was associated with a decline in forced expiratory volume in 1 second. No evidence of acute rejection was found in any of 15 transbronchial biopsy procedures beyond 4 years after transplantation where adequate material for histologic interpretation was obtained. However, no statistically significant change was found in the proportion of transbronchial biopsy procedures showing acute rejection as a function of time. CONCLUSIONS: We conclude that transbronchial biopsy-proven acute rejection may occur in patients with asymptomatic, stable conditions who have survived at least 2 years, but the yield of transbronchial biopsy performed beyond 4 years is exceedingly low.

Biopsy↗
PubMed1996

Previous intrapleural procedures do not adversely affect lung transplantation.

BACKGROUND: Initially a previous intrapleural procedure causing a partially or completely fused pleural space represented a contraindication to lung transplantation. However, as experience with transplantation increased, particularly in patients with septic lung diseases who frequently have pleural adhesions, a previous intrapleural procedure became a relative rather than an absolute contraindication. The "clam shell" incision, which allows better control of the pleural spaces than a median sternotomy, contributed to this change. METHODS: The outcome of 18 patients with a previous intrapleural procedure was compared with 18 paired controls without previous surgery involving the transplanted pleural space. RESULTS: Five study patients had a predictably fused pleural space from their previous surgery, and four had extensive adhesions (major previous intrapleural procedures). The nine patients with minor previous intrapleural procedures had undergone more limited intrapleural procedures (open lung biopsy or chest tube drainage of a pneumothorax). There was no statistically significant trend for the operating time, blood loss, transfusion requirements, time intubated, and intensive care unit stay to be greater in the study population than in the controls. However, the major previous intrapleural procedure patients were younger, required longer cardiopulmonary bypass, and had a longer intensive care unit stay. The 6- and 12-month forced expiratory volumes in 1 second from the patients with major previous intrapleural procedures were not different from those of either the patients with minor previous intrapleural procedures or the controls. CONCLUSIONS: A previous intrapleural procedure, even when resulting in a fused pleural space, did not have a significant detrimental impact on outcome. Therefore a previous intrapleural procedure should neither preclude listing a patient for transplantation nor significantly influence the choice of recipient when lungs become available for transplantation.

Adult↗
PubMed1996

Methotrexate can halt the progression of bronchiolitis obliterans syndrome in lung transplant recipients.

BACKGROUND: Methotrexate has been used successfully to treat refractory or recurrent rejection in heart transplant recipients. We therefore conducted an open pilot study to determine whether methotrexate is useful in the treatment of chronic rejection after lung transplantation. METHODS: Between December 1993 and January 1995 methotrexate was prescribed to 10 patients with persistent or progressive bronchiolitis obliterans despite multiple attempts to control the chronic rejection with conventional treatment (pulse steroids or antilymphocyte products, or both). Data from the nine patients with a minimum of 6 months of follow-up were collected. RESULTS: No patients have died. The spirometry data of the eight patients with declining values of forced expiratory volume in 1 second are presented. Before initiation of methotrexate therapy the median decline in forced expiratory volume in 1 second was 1.4 +/- 0.8 L, or 43% +/- 17%, from the highest preinterventional forced expiratory volume in 1 second value during the preceding 12 months. At 6 months the median decline in forced expiratory volume in 1 second from the time methotrexate therapy was started was 0.1 +/- 0.2 L, or 3% +/- 11%. At 9 months (n = 6) the value was 0.2 +/- 0.2 L, or 6% +/- 12%. At 12 months (n = 5) the median decline was 0.4 +/- 0.3 L, or 9% +/- 16%. In two patients there has been no further decline in forced expiratory volume in 1 second since methotrexate therapy was started (one patient has had a slight but sustained improvement). Five patients have had a reduction in forced expiratory volume in 1 second of 10% or less at most recent follow-up, and only one patient has derived no apparent benefit from methotrexate therapy. Toxicity has been minimal. CONCLUSIONS: Methotrexate is a potentially promising therapeutic alternative in the therapy of bronchiolitis obliterans syndrome in lung transplant recipients.

Adult↗
PubMed1995

Multi-organ donor transmission of hepatitis C virus to five solid organ transplant recipients and lack of transmission to corneal transplant recipients.

BACKGROUND: A multi-organ donor seronegative for hepatitis C virus (HCV) by 1st generation enzyme immunoassay (EIA) supplied 5 solid organs and 2 corneas to 7 recipients. This donor was retrospectively shown to be 2nd generation HCV EIA-positive and polymerase chain reaction (PCR)-positive. All 5 solid organ recipients but none of the corneal recipients developed HCV infection. OBJECTIVES: To demonstrate the discordance between serological and PCR-based HCV detection in solid organ transplant recipients and the lack of transmission of HCV to the two corneal transplant recipients. STUDY DESIGN: All 5 solid organ recipients were retrospectively shown to be HCV PCR-negative and -seronegative pre-transplant and HCV PCR-positive post-transplant. Serial serum samples on 3 recipients were evaluated by 2nd generation EIA, a prototypic structural and non-structural dual bead assay (EIA-SA, Abbott), the Chiron Recombinant Immunoblot Assay, 2nd generation (RIBA-2), and the Chiron RIBA HCV Test System Strip Immunoblot Assay 3.0 (RIBA-3, Chiron). RESULTS: The dual bead EIA-SA and RIBA-3 were able to detect HCV seroconversion approximately 6 months earlier than the 2nd generation EIA in 2 recipients, and in 1 recipient only PCR detected infection within the first 10 months. There was no evidence of HCV transmission to the corneal recipients. CONCLUSIONS: Although third generation assays such as the RIBA-3 and EIA-SA narrowed the window of HCV seronegativity in transplant recipients compared with the 2nd generation EIA, PCR was the most sensitive method of detecting acute HCV infection. Despite transmission of HCV to all of the solid organ recipients HCV was not transmitted to the corneal transplant recipients.

Journal Article↗
PubMed1995

Recombinant human stem cell factor does exert minor stimulation of growth in small cell lung cancer and melanoma cell lines.

We have previously reported on the stimulation of clonal growth of a glioblastoma cell line by rhSCF (Berdel et al., Cancer Res 1992, 52, 3498-3502). Within an extensive screening programme of haematopoietic growth factor activity on malignant cells, the effects of rhSCF were further tested on the growth of 29 different human cell lines derived from a wide range of solid tumours, among them six lung cancers and five melanomas. RhSCF (0, 1, 10, 100 ng/ml) was tested in a human tumour cloning assay (HTCA) which reliably detects growth modulation of tumour cells by cytokines. Additionally, a tritiated thymidine uptake test was used. Growth of 27 of the 29 cell lines tested was not affected by rhSCF. However, growth of the small cell lung cancer (SCLC) cell line HTB 120 was slightly stimulated (1.5 fold that of controls), and that of the melanoma cell line MeWo was stimulated up to 1.3-fold. This activity was eliminated dose-dependently by the tyrosine kinase inhibitor, genistein. We further analysed the cell lines for expression of the proto-oncogene C-KIT and its ligand SCF. All melanoma and lung cancer cell lines expressed SCF as assessed at the mRNA level. Northern blotting also revealed clear C-KIT mRNA expression in three melanoma (HAS, MeWo, SK-MEL-28), one NSCLC (HTB 53), and four SCLC cell lines (HTB 119, HTB 120, HTB 171, HTB 175). Furthermore, C-KIT protein expression was detected by flow cytometric analysis on the cell surface of MeWo, HTB 119 and HTB 120 cells. Our data indicate that SCF can be operative in growth modulation of non-haematopoietic malignant cells, especially SCLC and melanoma. However, our extensive screening of SCF/tumour cell interaction shows that this interaction is rare and makes potential hazards, such as tumour stimulation upon clinical use of rhSCF in conjunction with chemotherapy in cancer patients, unlikely for the majority of other tumour histologies.

Base Sequence↗
PubMed1995

Effects of contralateral white noise stimulation on transitory evoked otoacoustic emissions in patients with acoustic neuroma.

Transitory evoked otoacoustic emissions are normal phenomena observed in most persons with hearing levels greater than 35 dB. Further, masking of the contralateral ear produces amplitude reductions in the transitory evoked otoacoustic emissions. We have undertaken a study of transitory evoked otoacoustic emissions in 20 patients with acoustic neuroma. All patients were assessed for transitory evoked otoacoustic emissions bilaterally, with and without contralateral masking with white band noise at 40, 50, and 60 dB. We found that transitory evoked otoacoustic emissions were present in 30% of ears with tumor and that the presence of transitory evoked otoacoustic emissions is associated with improved preoperative hearing levels, but that tumor size is not associated with the presence or absence of transitory evoked otoacoustic emissions. The amplitude of transitory evoked otoacoustic emissions from ears with tumor, when present, is decreased when compared with normal ears of normal patients. Further, with contralateral masking little of the amplitude reduction observed in normal patients is observed in the ears with acoustic neuroma. However, with masking of the contralateral ear, the ear without tumor demonstrated significantly greater amplitude reductions than normal ears from normal patients (p = 0.0006). Pertinent anatomy and possible explanations for these findings are discussed.

Acoustic Stimulation↗
PubMed1995

[Pressure relations between endocranial and intracochlear fluid spaces in patients with inner ear diseases].

Intracranial pressure is transmitted to the perilymph of the cochlea via the cochlear aquaeduct and via Reissner's membrane to the endolymph. The "Tympanic Membrane Displacement Analyser (TDA)" is a new device that may be a useful non-invasive method to show intracranial and intracochlear pressure changes indirectly measured by tympanic membrane displacement during stapedial reflex contraction. The TDA was utilised in 20 normal persons and in 29 patients with unilateral diseases of the inner ear. No significant differences in the tympanic membrane displacement were found between patients with sensorineural hearing loss, patients with Ménière's disease, and normal persons.

Adolescent↗