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Biomedical subjects

M Fuchs

Publications and source records attributed to M Fuchs.

At least 91 records · Page 5Linked to original sources
PubMed2000

[Telemedicine in otorhinolaryngology exemplified by a Tübingen-Leipzig video conference].

"Telemedicine" is a major new development with great potential for improving health care delivery. It therefore affects each department in medicine. There is a great deal of telemedicine activity around the world. However, the term telemedicine is not clear. It describes all forms of medical information, transferred from a relevant distance by an electronic transfer media. An essential condition for communication is the intelligibility between transmitter and receiver. Because of different transmitting technologies and networks in distinct countries, towns, or even academic institutions, satisfactory contact is not possible. In the last decade, the demand for worldwide audiovisual data transmission has led to the standardization of telecommunication media. Therefore it is no longer necessary to transport medical data (or even patients) by conventional manners, e.g., post, car, or aircraft. Telemedicine for diagnosis and management can be bidirectional in real-time, long-distance videoconferencing, in which the patient consults a specialist located at the remote site, or it can be the transmission of either real-time or pre-recorded images and data to a remote expert, as in teleradiology or telepathology. Another application is the use of videoconference systems in the course of meetings. The remote specialist has the opportunity to take part in the session, e.g., with a lecture. Furthermore, the remote specialist can demonstrate special operative techniques for teleteaching purposes, some of which may be specialities of the particular medical unit, e.g., operation in open NMR, telemanipulation, or telerobotic procedures. In this paper, we describe the use and benefit of a videoconference between the departments of otolaryngology and head and neck surgery of the Universities of Tübingen and Leipzig by means of an "ISDN-based videoconference system". During the meeting, the "operating course for reconstructive surgery in the head and neck", the practicability, reliability, costs and quality were determined and compared with other technologies for audiovisual data transfer.

Curriculum↗
PubMed2000

[Resection of the calcaneus as a treatment option in osteitis following an open calcaneus fracture].

Surgical treatment of calcaneal fractures is demanding due to the poor musculocutaneous coverage. Infection with osteitis is a severe complication with open fractures. The appearance of osteitis requires aggressive surgical treatment including amputation in case of persistence, leading to considerable invalidism. We report the case of an 37-year-old mason with an grade III open calcaneal fracture caused by a fall. Osteitis appeared after primary osteosynthesis with open reduction and eventually--after several revisions--required a calcanectomy. By preservation of the forefoot and midfoot and thanks to sufficient orthosis treatment the patient was able to return to his profession after eight months.

Accidental Falls↗
PubMed2000

Fatal thrombotic thrombocytopenic purpura as a rare complication following allogeneic stem cell transplantation.

Thrombotic thrombocytopenic purpura (TTP) is a rare disease which, together with hemolytic uremic syndrome, is subsumed under thrombotic microangiopathy. After stem cell transplantation (SCT), this syndrome represents a possibly fatal complication with a higher incidence in allogeneic SCT than in autologous SCT. Although plasmapheresis offers an encouraging treatment modality in classic TTP, this seems less effective in bone marrow transplant-associated microangiopathy. This is probably due to a different etiology. We present a case of transplant-associated TTP with a fatal outcome despite multiple courses of plasmapheresis.

Fatal Outcome↗
PubMed2000

The effects of thiopentone on free intracellular amino acids in polymorphonuclear leucocytes.

Previous studies have shown the inhibitory effects of thiopentone on polymorphonuclear leucocyte (PML) function. However, major biochemical mechanisms which have been involved are still unknown. The aim of this study was therefore to investigate thiopentone's effects on intracellular amino acid metabolism in PML using both advanced PML separation- and HPLC techniques, especially developed for this purpose and precisely validated in our institute. Overall, our study indicates important dose-dependent alterations of free intracellular amino acid metabolism following thiopentone treatment and draw attention to the biochemical mechanisms which may be involved in both thiopentone-induced modulation in PML function and cellular immunocompetence.

Adult↗
PubMed2000

High platelet contamination in progenitor cell concentrates results in significantly lower CD34+ yield after immunoselection.

BACKGROUND: Selection of CD34+ cells by specific immunoselection leads to a significant loss of those cells. The factors influencing the yield and purity are not well identified. The results of CD34+ selection from peripheral blood progenitor cells (PBPCs) with high and low platelet contamination that are harvested with two different cell separators are reported. STUDY DESIGN AND METHODS: A progenitor cell concentrator (Ceprate SC, CellPro) was used to select CD34+ cells from 41 PBPC concentrates from 23 consecutive patients with relapsed non-Hodgkin's lymphoma (n = 3), breast cancer (n = 17), and multiple myeloma (n = 3). PBPC collection was performed by using two cell separators (CS3000 Plus, Fenwal: Group A, n = 11; and Spectra, COBE: Group B, n = 9). To reduce platelet contamination in the Spectra PBPC concentrates, an additional low-speed centrifugation was performed before CD34+ cell selection (Group C, n = 3). Leukapheresis components were stored overnight at 4 degrees C and combined with the next day's collection before the CD34+ selection procedure in 19 patients. RESULTS: A median of 1.5 leukapheresis procedures per patient were performed. Pooled PBPC concentrates showed no statistical difference in median numbers of white cells and CD34+ cells in Groups A and B: 3.2 (0.8-9.2) versus 4.4 (1.6-8. 3) x 10(10) white cells per kg and 15.0 (4.7-24.0) versus 12.0 (5. 6-34.0) x 10(6) CD34+ cells per kg. Platelet contamination was significantly higher in Group B: 0.67 (0.15-2.4) versus 2.3 (0.5-7. 1) x 10(11) (p = 0.0273). After the selection process, there was a significantly greater loss of CD34+ cells in Group B than in Group A: 39.1 versus 63.2 percent (p = 0.0070), with a median purity of 78. 0 percent versus 81.0 percent. An additional low-speed centrifugation before CD34+ cell selection seemed to reduce CD34+ cell loss in Group C with 16.9, 31.9, and 37.5 percent, respectively. CONCLUSION: CD34+ cell selection from PBPC concentrates resulted in an increased loss of CD34+ cells in concentrates with a higher platelet content. To improve CD34+ yield, PBPC concentrates with an initially low platelet contamination should be used, or additional low-speed centrifugation should be performed.

Antigens, CD34↗
PubMed2000

Synergistic sedation with low-dose midazolam and propofol for colonoscopies.

BACKGROUND AND STUDY AIMS: Patients undergoing colonoscopy are often sedated with benzodiazepines and long-acting opiates. Since low-dose midazolam also acts synergistically with short-acting propofol, we compared this synergistic sedation with a standard combination of midazolam and the opioid nalbuphine for colonoscopies. PATIENTS AND METHODS: A total of 79 patients presenting for colonoscopies were randomly assigned to the following protocols. Patients in group I (n = 32) received a median dose of 9 mg midazolam (interquartile range [IQR] 6 to 12); 20 patients (59%) needed additional nalbuphine (median 20 mg, IQR 10 to 20). Patients in group II (n = 47) received 2 mg midazolam and repeated injections of propofol (median 100 mg, IQR 53 to 145) with a maximal bolus of 50 mg. RESULTS: Patients treated with the synergistic sedation (group II) recovered remarkably sooner after the procedure compared with those in group I, with a median time to discharge of 17 minutes vs. 93 minutes (P<0.001). Of the patients treated with analgosedation (group I), 28 % were unable to take part in a reaction time measurement and attention awareness test 1 hour after the procedure. All patients treated with the synergistic sedation were able to participate (P=0.002), and performed better. Despite a lower proportion of complete amnesia, patients treated with synergistic sedation more often rated the procedure as comfortable (81% vs. 50 %). Quality of sedation from the point of view of the endoscopist, and cardiorespiratory parameters, were similar in both groups. CONCLUSIONS: Low-dose midazolam combined with propofol is an effective and economic alternative to benzodiazepine-based analgosedation. It is associated with a high degree of patient comfort and rapid recovery times, and has a potential cost benefit concerning nursing care and bed facilities.

Adult↗
PubMed2000

Treatment of infected pancreatic pseudocysts by endoscopic ultrasonography-guided cystogastrostomy.

It has been appreciated for a long time that surgery is the treatment of choice for symptomatic, and especially infected, pancreatic pseudocysts. This paradigm is now being challenged by endoscopic cystoenterostomy and cystogastrostomy, which have both been employed with success in selected patients. We present three cases in which infected pancreatic pseudocysts resolved following endoscopic cystogastrostomy guided by endoscopic ultrasonography (EUS).

Adult↗
PubMed2000

Source reconstruction of mesial-temporal epileptiform activity: comparison of inverse techniques.

PURPOSE: To evaluate whether advanced source reconstruction such as current density reconstruction (CDR) provides additional hints for clinical presurgical evaluation, different source reconstruction techniques with idealized spherical as well as realistically shaped head models (boundary element method, BEM) were applied on interictal and ictal epileptiform activity in presurgical evaluated patients with temporal lobe epilepsy. It is discussed whether CDR and BEM give additional information for presurgical evaluation compared to "conventional" strategies, such as single moving, and spatio-temporal dipole modeling with spherical head models. METHODS: A variety of source reconstruction procedures were applied to the data of five patients with pharmacoresistent temporal lobe epilepsy with probable mesial origin: (1) single-moving dipole in a spherical head model and (2) in BEM, (3) spatio-temporal dipole modeling in a spherical head model and (4) in BEM; and (5) deconvolution with fixed locations and orientations and (6) with cortically constrained L1-norm CDR in BEM. In addition, simulated sources of temporal lobe origin were calculated in each subject with CDR to prove the basic feasibility of this technique in the particular application. RESULTS: Source activity was correctly localized within the affected temporal lobe by all source reconstruction techniques used. Neither single moving dipole, spatio-temporal modeling, nor CDR was able to localize sources at a sublobar level. In the case of two sources, single moving dipole solutions showed changes in dipole orientation in time and spatio-temporal modeling separated two sources, whereas CDR at the peak latency failed to distinguish among different origins. BEM enhanced localization accuracy. CONCLUSION: There was no advantage of using CDR. Single moving dipole as well as spatio-temporal dipole modeling in BEM leads to more precise localization within the individual anatomy and provides a simple algorithm, which is capable of indicating both the time course and the number of sources.

Brain Mapping↗
PubMed1999

Evidence for independent thalamic and cortical sources involved in the generation of the visual 40 Hz response in humans.

Multichannel EEG was recorded to study the gamma-band (30-70 Hz) activity phase-locked to visual checkerboard stimulus onset, in grand-average data of 10 subjects and in three additional individuals. Two different approaches for source analysis were applied to reveal source locations and to determine there time course of activity. Two source regions were separated: one in the depth of the brain, suggested to reflect near thalamic activity, and a second at the visual cortex. Analysis of the source activity in time demonstrated significant different frequencies of the deep at 40 Hz and the cortical source at 37 Hz. There was no consistent phase relation between these source activities. These results contradict the thesis of recurrent thalamocortical activity causing gamma-band oscillations involved in the generation of phase-locked visual checkerboard evoked potentials.

Adult↗
PubMed1999

Quantitative determination of free intracellular amino acids in single human polymorphonuclear leucocytes. Recent developments in sample preparation and high-performance liquid chromatography.

The described procedure allows quantitative, highly precise and reproducible analysis of free amino acid concentrations in single polymorphonuclear leucocytes (PMLs). This method is superior to previously described procedures with regard to sample size, PML separation, sample preparation and stability, as well as the chosen fluorescence high-performance liquid chromatography procedure, and can satisfy the high demands for ultra-sensitive and comprehensive amino acid analysis, especially for the continuous surveillance of severe diseases and organ dysfunction.

Amino Acids↗
PubMed1999

Complex feedback regulation of bile acid synthesis in the hamster: the role of newly synthesized cholesterol.

Hepatic bile acid synthesis is regulated by recirculating bile acids, possibly by modulating the availability of newly synthesized and preformed cholesterol. Because data in the hamster on this mechanism are lacking, we fitted these animals with an extracorporeal bile duct and administered tritiated water intraperitoneally to label newly formed cholesterol. After interruption of the enterohepatic circulation, physiological and double-physiological doses of conjugated cholate (25 or 50 micromol/100 g. h) or of unconjugated deoxycholate (6 or 12 micromol) were infused intraduodenally for 54 hours and compared with controls. De novo and preformed cholesterol directly secreted into bile or used for cholate and chenodeoxycholate synthesis were quantitated by high-pressure liquid chromatography (HPLC)-liquid scintillation. Directly after depletion of the bile acid pool (6-9 hours) at nearly physiological conditions, chenodeoxycholate synthesis was significantly reduced by cholate and deoxycholate by up to 45% to 51%, whereas cholate formation decreased by approximately 22% during deoxycholate. This short-term effect was mainly mediated by reduced synthesis from preformed cholesterol. After long-term bile depletion (30-54 hours), bile acid synthesis returned to control levels during 25 micromol of cholate and of both deoxycholate doses. In contrast, only 50 micromol of cholate prevented derepression of bile acid synthesis. This long-term effect was mainly attributed to a diminished formation from de novo cholesterol exceeding the reduced synthesis from preformed cholesterol. In summary, short- and long-term regulation of bile acid synthesis in hamsters differs with respect to availabilities of preformed and de novo cholesterol.

Amino Acids↗
PubMed1999

[Iatrogenic Cushing syndrome and mutatio tarda caused by dexamethasone containing nose drops].

Nasal steroid drops can produce iatrogenic Cushing's syndrome if the recommended dose is exceeded. We now report a 19-year-old male patient for whom dexamethasone nasal drops were prescribed because of nasal obstruction. He had been using these drops for more than 5 years, with a daily dexamethasone dose of 0.7-1.0 mg. It is likely that significant amounts of dexamethasone were swallowed and absorbed by the patient's gastrointestinal tract. As a consequence, the patient developed Cushing's syndrome with panhypopituitarism, growth retardation, osteoporosis and hypertension. A boyish size of the larynx resulted in a fundamental speaking frequency of a child. After discontinuing the intranasal use of the of dexamethasone and adjusting doses of hydrocortisone over 3.5 months a normalization of endocrine function occurred with the beginning of puberty and normal sexual changes. These findings show that the use of nasal steroid drops particularly in children should be limited to a short period and drugs with a low absorption dose employed.

Administration, Intranasal↗