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Biomedical subjects

J Scheele

Publications and source records attributed to J Scheele.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Endoscopic therapy of gastrojejunal dissociation in intensive care medicine].

The object of this study was to evaluate the advantages of a new three-lumen tube (Trelumina) and a percutanous endoscopic gastrostomy (EntriStar) with a jejunal insertion tube (EntriStar) as a safe way to administer early enteral nutrition and simultaneous gastric decompression and fast reduction of high gastric reflux in critical care patients. Normalization of high gastric reflux and the patient nutrition goal were reached by Trelumina and the EntriStar within 4 days, and enteral feeding by those two systems depressed the nutrition costs by more than 90% compared to total parenteral nutrition. In conclusion, the placement of the Trelumina and the EntriStar is a safe, successful, and inexpensive means of providing early enteral nutrition and simultaneous gastric reflux reduction in critical care patients.

Critical Care↗
PubMed1997

Conversion of recurrent delta-positive hepatitis B infection to seronegativity with famciclovir after liver transplantation.

BACKGROUND: Recurrent hepatitis B infection after liver transplantation is associated with poor graft and patient survival. Famciclovir is a nucleoside with virostatic action in hepatitis B infection. We report the case of a 51-year-old patient who developed recurrent delta-positive hepatitis B infection after liver transplantation. After famciclovir treatment, he became seronegative for hepatitis B early and hepatitis B surface antigens and developed protective anti-hepatitis B surface antibody titers. METHODS: After recurrent hepatitis B was confirmed, treatment with famciclovir was initiated. RESULTS: Eighteen days after starting famciclovir, the patient became seronegative for hepatitis B early antigen and delta antigen, and hepatitis B virus DNA was no longer detectable in serum. Three months later, the patient became hepatitis B surface antigen negative and remains well 16 months later with increasing anti-hepatitis B surface levels. CONCLUSIONS: Antiviral treatment with famciclovir may be useful in treatment of delta-positive hepatitis B infection following liver transplantation. Further evaluation of famciclovir in treatment and prevention of hepatitis B in these patients is warranted.

2-Aminopurine↗
PubMed1997

[Selection criteria for conservative therapy of splenic trauma in adults].

The safety and effectiveness of nonoperative management of selected adults have been confirmed in those patients who meet selection criterias of isolated splenic injury and hemodynamic stability. The CT scan is a very precise and the most specific diagnostic procedure in splenic trauma. Nonoperative treatment is successful in 80% of adults in such selected group of patients.

Adolescent↗
PubMed1996

[Interdisciplinary surgical therapy of renal tumors with intracardiac tumor thrombi].

A combination of increased perioperative morbidity, together with the technical difficulty of an R 0 (curative) resection, is responsible for the poor prognostic factors of supradiaphragmatically extending renal tumors. Six patients aged 53-70 years with vena cava thrombosis extending into the right atrium or ventricle underwent en bloc resection of the primary tumor and tumor thrombus removal. If the atrial tumor mass was large or extended into the ventricle, resection was performed during cardiopulmonary arrest using a cardiopulmonary bypass method with the patient in deep hypothermia (< 18 degrees C). Alternatively if the cardiac tumor infiltration was minimal, resection was performed during an optionally short cardiopulmonary arrest period using a cardiopulmonary bypass method with the patient in hypothermia (23 degrees C). The operative procedure was determined by intracardiac tumor extension, tumor wall adhesions and tumor wall infiltrations, all of which were assessed intraoperatively by vena cava sonography. Six patients were strongly symptomatic preoperatively. Three developed sudden life-threatening cardiopulmonary insufficiency, possibly due to longer-lasting tricuspital valve prolapse with a consecutive right-to-left shunt through a newly reopened foramen ovale. One patient died 14 months postoperatively because of multiple metastases (hepatic, pulmonary and bone). One patient is still alive and has had a local recurrence for 2 months, which was diagnosed 65 months postoperatively. The remaining four patients are alive and well. They have been tumor-free for extended periods of time (29, 34, 62 and 84 months, respectively).

Aged↗
PubMed1996

[Surgical resection of colorectal liver metastases: Gold standard for solitary and radically resectable lesions].

From 1960 to 1993, a total of 1.766 patients with liver metastases from colorectal carcinoma was recorded. Five-hundred-and-eight patients (28.8%) underwent hepatic resection which was performed with curative intent in 473 patients (26.8%). 30-day mortality in this group was 4.5%, being 2.6% (4 out of 155) since 1990. Significant morbidity was observed in 16% of patients with a decrease to 7% for the last 4 years. A 99.5 percent follow-up until January 1, 1996, was achieved. Excluding operative mortality there are 376 patients with "potentially curative" initial liver resection, and 65 corresponding patients with minimal macroscopic (n = 19) or microscopic (n = 46) residual disease. The latter group demonstrated a poor prognosis with median and maximum survival times of 14.8 and 56 months, respectively. Among the 376 patients having potentially curative resection the actuarial five, ten, and twenty year survival was 39 +/- 3, 26 +/- 5 and 21 +/- 13 percent, respectively. Tumor-free survival was 34 +/- 3 percent at 5 years. In the univariate analysis, the following factors were associated with decreased crude survival: Presence and extent of mesenteric lymph node involvement (p = 0.0001), poor grading of the primary tumor (p = 0.008), synchronous diagnosis of metastases (p = 0.004), satellite metastases (p < 0.0001), an increasing metastasis diameter (p < 0.0001), preoperative CEA elevation (p = 0.0002), a resection margin of less than 1 cm (p = 0.018), extrahepatic disease (p = 0.02), non-anatomical procedures (p = 0.008), and an operative blood loss exceeding 2.000 ml (p = 0.02). With respect to disease-free survival, extrahepatic disease (p = 0.09) failed to achieve statistical significance, while patients with colon cancer and with delayed resection of synchronous metastases did significantly better than those with rectal cancer (p = 0.02) and with a simultaneous procedure (p = 0.04), respectively. Multiplicity and bilobar involvement did not affect prognosis. Similarly, no significant predictive value of an increasing number of metastases (1-3 vs > or = 4) on either overall (p = 0.35) or disease free survival (p = 0.55) was found after a radical excision of all detectable disease. Using Cox's multivariate regression analysis, presence of satellite metastases, anatomical vs non-anatomical approach, primary tumor grade and diameter of the largest metastasis all independently affected both crude and tumor-free survival (p < 0.05). With respect to survival, this was complemented by the margin of clearance (0.05 < p < 0.1), while for disease-free survival primary tumor site and time of metastasis diagnosis had some additional influence. Twenty-six patients with R0-reresection of the liver, and 32 patients with radical excision of extrahepatic recurrent disease had a subsequent 5-year survival of 57 +/- 15 percent and 32 +/- 12 percent, respectively. This confirms the effectiveness of a close follow-up policy.

Adult↗
PubMed1995

Bile-independent absorption of cyclosporine from a microemulsion formulation in liver transplant patients.

A microemulsion formulation of CsA, which was anticipated to be independent of bile for oral absorption, was compared with the currently marketed formulation in liver transplant patients with external biliary drainage. Eleven patients aged 47.6 +/- 13.1 years and weighing 75.8 +/- 5.7 kg received single 400-mg oral doses of each formulation in a randomized, crossover protocol on days 4 and 6 after transplant. Serial venous blood samples were collected over a 12-hr period after each administration and whole blood CsA concentrations were determined by a validated RIA specific for the parent compound. Systemic exposure to CsA was consistently higher from the microemulsion formulation in all patients, as judged by the peak concentration and the area under the curve. Specifically, the area under the concentration-time curve was 943 +/- 400 vs. 2378 +/- 911 ng.hr/ml, indicating an average 156% higher bioavailability from the microemulsion compared with the currently marketed formulation in liver transplant patients in the absence of bile.

Absorption↗
PubMed1995

Proximal gastric vagotomy: effects of two surgical modifications on oral and intravenous glucose tolerance in the conscious rat.

Vago-vagal nervous links between different splanchnic organs, the stomach included, may modulate glucose metabolism. Therefore, the effect of highly selective (HSV, cutting nerve fibers and vessels) and superselective vagotomy (SSV, cutting nerve fibers only) on oral and intravenous (IV) glucose tolerance was studied in the rat. Gastric emptying was normal in HSV and SSV. After oral glucose, cumulative blood glucose and insulin were significantly lower in SSV than in controls, whereas in HSV, both parameters tended towards lower values. After IV glucose, cumulative blood glucose was significantly lower than in controls following both vagotomies, whereas cumulative insulin was lower in HSV and significantly higher in SSV. The former effect may be insulin-independent. The latter reflects enhanced insulin sensitivity in HSV and increased glucose-stimulated insulin release in SSV. The improvement of oral and IV glucose tolerance by both procedures may reflect the abolition of physiological vagal (SSV) or partial abolition of sympathetic (HSV) nervous links between the stomach and the pancreas, which modulate insulin secretion or organ sensitivity to insulin.

Afferent Pathways↗
PubMed1995

Both Pbx1 and E2A-Pbx1 bind the DNA motif ATCAATCAA cooperatively with the products of multiple murine Hox genes, some of which are themselves oncogenes.

E2A-PBX1 is the oncogene produced at the t(1;19) chromosomal breakpoint of pediatric pre-B-cell leukemia. Expression of E2A-Pbx1 induces fibroblast transformation and myeloid and T-cell leukemia in mice and arrests differentiation of granulocyte macrophage colony-stimulating factor-dependent myeloblasts in cultured marrow. Recently, the Drosophila melanogaster protein Exd, which is highly related to Pbx1, was shown to bind DNA cooperatively with the Drosophila homeodomain proteins Ubx and Abd-A. Here, we demonstrate that the normal Pbx1 homeodomain protein, as well as its oncogenic derivative, E2A-Pbx1, binds the DNA sequence ATCAATCAA cooperatively with the murine Hox-A5, Hox-B7, Hox-B8, and Hox-C8 homeodomain proteins, which are themselves known oncoproteins, as well as with the Hox-D4 homeodomain protein. Cooperative binding to ATCAATCAA required the homeodomain-dependent DNA-binding activities of both Pbx1 and the Hox partner. In cotransfection assays, Hox-B8 suppressed transactivation by E2A-Pbx1. These results suggest that (i) Pbx1 may participate in the normal regulation of Hox target gene transcription in vivo and therein contribute to aspects of anterior-posterior patterning and structural development in vertebrates, (ii) that E2A-Pbx1 could abrogate normal differentiation by altering the transcriptional regulation of Hox target genes in conjunction with Hox proteins, and (iii) that the oncogenic mechanism of certain Hox proteins may require their physical interaction with Pbx1 as a cooperating, DNA-binding partner.

Animals↗
PubMed1995

A comparison of the concentrations of certain chlorinated hydrocarbons and polychlorinated biphenyls in bone marrow and fat tissue of children and their concentrations in breast milk.

Chlorinated hydrocarbon (CHC) and polychlorinated biphenyl (PCB) concentrations in the bone marrow of 57 children were compared with the concentrations in adipose tissue of 50 children and the concentrations in breast milk in the Federal Republic of Germany from 1984 to 1991. The concentrations of hexachlorobenzene (HCB), the dichlorodiphenyltrichloroethane (DDT)-metabolites, and polychlorinated biphenyl (PCB) congeners no. 138 and no. 153 were increased threefold, while the concentrations of several hexachloro-cyclohexane (HCH)-isomers and PCB congener no. 180 were only increased twofold. Because breast feeding is the primary source of CHC and PCB in toddlers and infants we also compared the concentrations in bone marrow of children with the concentrations in breast milk and found approximately fourfold higher concentrations for the most highly chlorinated PCB congener no. 180, but only threefold higher concentration for PCB 138 and 153 and the DDT-metabolites. The concentrations of beta-HCH and HCB were only slightly higher in bone marrow.

Adipose Tissue↗
PubMed1995

[Recurrent tumor after R0 resection of colorectal liver metastases. Incidence, resectability and prognosis].

In the period 1960 to 1992 a total of 366 patients underwent macroscopic and histologic complete resection (R0) of colorectal liver metastases. Excluding 16 operative deaths and 4 patients with incomplete follow-up information, 346 patients form the basis for this report. Of them, 240 (69.4%) developed recurrent disease involving the liver in 136 (39.3%) instances. 71 patients underwent a tumor related reoperation with a re-resection performed in 60 cases. This involved the liver in 22 patients. 47 of these procedures (19.6% of all recurrences), and 16 re-resections of the liver (11.8% of hepatic recurrences) were ultimately classified R0. Additional 9 patients who had the initial liver resection performed in other hospitals underwent hepatic re-resection which was classified R0 in 8. Out of 8 subsequent reoperations, 3 addressed the liver. Operative mortality in the 34 re-resections at the liver was 2.9% while nonlethal morbidity was 17.7%. After a minimum and median follow-up time of 18 and 49 months, resp., 27 patients are alive without recurrent disease, including 11 patients with hepatic re-resection. Another 4 patients are alive with disease, one of them after repeat liver resection. 5-year survival from re-resection is 39.0% for the entire group of 55 R0-patients, and 45.6% for the 24 who underwent hepatic R0-re-resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Factors influencing the natural history of colorectal liver metastases.

Palliative treatment of unresectable colorectal liver metastases is common and often justified with reference to historical data on the natural history of the disease. However, in view of the improved diagnostic accuracy of modern imaging techniques, these previously published series do not provide sufficient guidance to judge the prognostic efficacy of palliative treatment. In the late 1970s we started prospectively to collect data on consecutive patients with colorectal liver metastases according to a standard protocol. We now present data derived from this series on factors that may affect outcome in untreated patients. Between January, 1980, and December, 1990, 1099 consecutive patients were recorded, of whom 566 (51.5%) received no treatment for their hepatic tumour. Excluding 34 early deaths and 48 patients with a second malignant tumour, 484 patients provided the basis for analysis. All patients were followed up to July 1, 1993, or death. At the closing date of the study only 1 untreated patient was still alive. The impact of various factors on survival was analysed by univariate and multivariate analyses. Six independent determinants of survival were identified in the following order: percentage liver volume replaced by tumour (LVRT), grade of malignancy of the primary tumour, presence of extrahepatic disease, mesenteric lymph-node involvement, serum carcino-embryonic antigen, and age. The subsequent combination of the independently significant factors, separately for patients with up to or more than 25% LVRT, yielded a prognostic tree that displayed median survival times of various subgroups of 3.8 to 21.3 months. These findings provide a framework to estimate the survival expectancy of untreated patients, thereby allowing improved assessment of the prognostic significance of palliative therapeutic approaches.

Colorectal Neoplasms↗
PubMed1994

A pilot study on polychlorinated biphenyl levels in the bone marrow of healthy individuals and leukemia patients.

In this pilot study the concentrations of polychlorinated biphenyls (PCBs) was determined by capillary column gas chromatography in bone marrow from 29 adults. The highest concentration in all adult individuals was detected for PCB no. 180 (mean = 0.991) followed by two other highly chlorinated PCBs, no. 153 (mean = 0.918) and no. 138 (mean = 0.927). The less chlorinated PCBs, no. 101 (mean = 0.255), no. 52 (mean = 0.161), and no. 28 (mean = 0.324) contributed to a lesser extent. Additional samples from children (N = 19) were used to assess the dependence of PCB concentrations on patient age (Scheele et al. Eur J Pediatr 1992; 151:802-805). When comparing the data of adult leukemia and lymphoma patients with a reference group of healthy adult individuals, no significant increase in the leukemia patients was found.

Adult↗
PubMed1993

Use of immunoscintigraphy in the diagnosis of fever of unknown origin.

Fever of unknown origin (FUO) has been defined as an elevation in temperature (38 degrees C) for at least 2-3 weeks despite intensive investigation. The value of immunoscintigraphy with the technetium-99m-labelled anti-granulocyte antibody anti-NCA-95 (BW 250/183, IgG1) was studied retrospectively in 34 consecutive patients with FUO. Every effort was made to confirm a diagnosis, including methods such as ultrasonography, computed tomography, magnetic resonance imaging, bacteriological tests, surgical intervention and clinical follow-up. In 58.8% of the patients, an infectious cause for the fever was found, in 30.2% of the patients, a benign or malignant haematological disease, pancreatitis or thyrotoxicosis was found. No cause for fever could be found in 11%. The overall diagnostic sensitivity and specificity of immunoscintigraphy for infection were 40% and 92% respectively. The positive predictive value was calculated to be 88% and the negative predictive value was calculated to be 52%. False-negative scans were especially noted in patients with endocarditis, pneumonia and small brain abscesses, where the lesions did not exceed a diameter of 0.5 cm. If patients with endocarditis were excluded, the imaging sensitivity and specificity were increased to 57% and 95%. This study demonstrates that 99mTc-anti-NCA-95 scanning is able to localize infectious causes of FUO, other than endocarditis.

Adult↗