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Biomedical subjects

M Heim

Publications and source records attributed to M Heim.

At least 19 recordsLinked to original sources
PubMed2006

A review of the aetiological factors and results of trans-ankle (Syme) disarticulations.

INTRODUCTION: Ever since James Syme described his amputation at the ankle joint, most authors have agreed that Syme's amputation should not be considered for patients with diabetic vascular disease (DVD). The aim of the study was to record our experience with Syme's amputations and to search for any predictive criteria that may enhance successful results. PATIENTS AND METHODS: Seventy patients underwent a Syme amputation between the years 1980 and 2000 in our department, 51 owing to DVD. The other 19 patients had their amputations because of other pathologies. RESULTS: The 19 patients of the non-DVD group showed a success rate of 94.7% (18/19). The overall success rate of the DVD patients was 49% (25/51). When we analysed the DVD group by age, the cut-off point was 65 years old. Patients aged 65 or less had a success rate of 68.2% (15/22), and over the age of 65 years the success rate was only 30.8% (8/26). CONCLUSIONS: Patients with DVD should be considered good candidates for a Syme amputation if they are younger than 65 years old.

Aged↗
PubMed2006

Platelets do not adsorb HLA class I molecules during storage of pooled platelet concentrates.

The origin of HLA class I molecules on platelets is still under discussion. Adsorption of HLA molecules on platelets using specific experimental conditions has been described. The study presented investigates whether there is a significant elution and adsorption of HLA class I molecules on platelets during storage of pooled random platelet concentrates (PRPC) under routine conditions. Platelet concentrates (PCs) from whole blood were prepared from HLA-A2-positive and HLA-A2-negative donors, pooled and stored under routine conditions. In addition, platelets from HLA-A2-negative donors were pelleted and resuspended in cell-free plasma from HLA-A2-positive donors. HLA-A2-positive PCs (positive control), HLA-A2-negative PCs (negative control) and HLA-A2-negative platelets in plasma from HLA-A2-negative donors were stored simultaneously. Binding of FITC-conjugated monoclonal murine antihuman HLA-A2 antibodies (anti-HLA-A2-mab) was measured during 5-day storage by flow cytometry. An increased binding of anti-HLA-A2-mab during storage was found on HLA-A2-negative platelets (P < 0.005) independently whether they were incubated with cell-free plasma or platelets from HLA-A2-positive donors or autologous HLA-A2-negative cell-free plasma. However, non-specific binding of IgG controls increased equally, whereas anti-HLA-A2-mab binding to platelets from HLA-A2-positive donors did not decrease during storage. This study suggests that there is no significant elution and adsorption of HLA class I antigens of platelets in pooled PCs during storage under the usual conditions for platelet storage. Increased anti-HLA-A2-mab signal was due to non-specific binding. Therefore, HLA class I compatible platelets should maintain their compatibility for an immunized patient when stored in a pool with HLA incompatible platelets and shortened survival after transfusion should not be expected.

Adsorption↗
PubMed2004

Evaluation of prosthetic usage in upper limb amputees.

PURPOSE: Upper limb amputations cause severe functional disability and lower the patient's self body image, with severe psychological implications. Many parameters are involved in the successful rehabilitation of upper limb amputations. The aim of this study was to investigate whether there are any parameters that might predict the successful prosthetic rehabilitation of upper limb amputees. METHOD: The records of 45 patients who had undergone an upper limb amputation were traced. The patients were evaluated according to four parameters: (1) Modified upper extremities amputees' questionnaire; (2) Pain level according to Visual Analog Scale (VAS), range from 1 (lowest) up to 10 (highest); (3) Pain type - phantom or pain in the stump; (4) Functional assessment of prosthetic usage. RESULTS: Thirty (71.43%) of the patients reported difficulties with prosthesis usage. Twenty-three patients (54.76%) were satisfied with their prosthesis - 19 had cosmetic prosthesis and four had body-powered prosthesis. CONCLUSION: No significant affect of the amputation level except for trans-wrist amputation with 100% prosthesis use. No significant difference was found between prosthesis type and the correlation to stump problems. The above-elbow amputees, with dominant hand amputation, who used functional prosthesis (body-powered), achieved the best functional outcome and result.

Adult↗
PubMed2004

High-dose treosulfan in patients with relapsed or refractory high-grade lymphoma receiving tandem autologous blood stem cell transplantation.

This phase I/II study evaluated high-dose treosulfan in patients with high-grade lymphoma. In all, 21 patients (median age 51, 25-60 years) with primary refractory disease (n=3) or early (n=11) or late (n=7) relapse received DexaBEAM and one course etoposide for cytoreduction and PBPC mobilization. Subsequently, 16 patients received 30 g/m2 treosulfan and 140 mg/m2 melphalan, followed by autologous transplantation. Nine patients received a 2nd high-dose treatment (HDT) with 30 g/m2 treosulfan and 750 mg/m2 thiotepa. Recovery time to >1/nl leukocytes and >25/nl thrombocytes was 8.9 (range 8-11) and 11.9 (8-16) days after 1st and 9.6 (7-13) and 13 (9-19) days after 2nd HDT. Reversible grade 3 or 4 nonhematologic toxicities included mucositis (n=7), infection (n=7) and one episode of re-entry tachycardia. Two treatment-related deaths occurred after 2nd HDT. Since three dose-limiting toxicities occurred among nine patients receiving tandem HDT, 30 g/m2 of treosulfan was considered MTD in this setting. Patients with late compared to early relapse or refractory disease had a higher probability of CR (6/7 vs 3/14 patients, P=0.017) and overall survival (71 vs 21%, P<0.05, 24-49 months follow-up). In conclusion, high-dose treosulfan as major therapy component induces sustained complete remissions in relapsed high-grade lymphoma with acceptable toxicity.

Adult↗
PubMed2004

Yttrium synoviorthesis of the elbow joints in persons with haemophilia.

Yttrium has been used as the material of choice for synoviorthesis in our centre since 1984. An audit was carried out to determine the long-term results of this modality for treating elbow joints. An unacceptably high percentage of patients lost range-of-movements in the articulation treated. Good results were achieved with respect to a reduction in the bleeding incidences. It is suggested that another isotope be utilized and that other centres carry out an audit and publish their data.

Elbow Joint↗
PubMed2003

The phytoestrogen genistein enhances osteogenesis and represses adipogenic differentiation of human primary bone marrow stromal cells.

In the present study, we investigated the role of the phytoestrogen genistein and 17beta-estradiol in human bone marrow stromal cells, undergoing induced osteogenic or adipogenic differentiation. Profiling of estrogen receptors (ERs)-alpha, -beta1, -beta2, -beta3, -beta4, -beta5, and aromatase mRNAs revealed lineage-dependent expression patterns. During osteogenic differentiation, the osteoblast-determining core binding factor-alpha1 showed a progressive increase, whereas the adipogenic regulator peroxisome proliferator-activated receptor gamma (PPARgamma) was sequentially decreased. This temporal regulation of lineage-determining marker genes was strongly enhanced by genistein during the early osteogenic phase. Moreover, genistein increased alkaline phosphatase mRNA levels and activity, the osteoprotegerin:receptor activator of nuclear factor-kappaB ligand gene expression ratio, and the expression of TGFbeta1. During adipogenic differentiation, down-regulation in the mRNA levels of PPARgamma and CCAAT/enhancer-binding protein-alpha at d 3 and decreased lipoprotein lipase and adipsin mRNA levels at d 21 were observed after genistein treatment. This led to a lower number of adipocytes and a reduction in the size of their lipid droplets. At d 3 of adipogenesis, TGFbeta1 was strongly up-regulated by genistein in an ER-dependent manner. Blocking the TGFbeta1 pathway abolished the effects of genistein on PPARgamma protein levels and led to a reduction in the proliferation rate of precursor cells. Overall, genistein enhanced the commitment and differentiation of bone marrow stromal cells to the osteoblast lineage but did not influence the late osteogenic maturation markers. Adipogenic differentiation and maturation, on the other hand, were reduced by genistein (and 17beta-estradiol) via an ER-dependent mechanism involving autocrine or paracrine TGFbeta1 signaling.

Adipocytes↗
PubMed2003

[Cancer fatigue syndrome].

Tumour-related fatigue, which occurs in almost all tumour patients under therapy--very often even years after a successful therapy--has a considerable impact not only on the quality of life, but apparently also on the course and outcome of treatment. There is little known about where cancer fatigue syndrome comes from. Medical research is required particularly for the continuous states of tiredness persisting for years. The questionnaires currently in use permit an accurate evaluation of the existence and the course of tumour-related fatigue. The treatment of the cancer fatigue syndrome includes the correction of underlying metabolic disorders as well as--even more importantly--physical training and psycho-oncological measures in order to better cope with the disease. Many questions, however, are left open, for instance the impact of cancer fatigue syndrome on disability pensions of tumour patients. The German Fatigue Society (DfaG) was therefore founded in March 2002 in order to find out the correlations between these questions and the cancer fatigue syndrome.

Combined Modality Therapy↗
PubMed2003

Psoriasis and the effect of prosthetic fitting.

This contribution presents the case histories of two patients who underwent limb amputation. One patient suffered from psoriasis prior to the surgery and the second developed psoriatic lesions post surgery. Both patients were provided with a prosthesis and despite the multiple cutaneous complications of the psoriasis both patients ambulate. It was expected that Koebner's phenomenon would create hardships but to date this has not happened.

Adult↗
PubMed2003

An assistive device designed to convey independent donning of a shuttle lock trans-tibial prosthesis for a multiple limb amputee.

This contribution describes a simple device designed to convey independent donning of a shuttle lock trans-tibial prosthesis for a multiple limb amputee. The device is made of a post with a shuttle lock mechanism at one end and a plate covered by rubber at the other end. This device enables correct positioning of the silicone liner and independent attachment to the prosthesis.

Amputees↗
PubMed2002

The effect of resistance training on the frequency of bleeding in haemophilia patients: a pilot study.

The benefits and feasibility of progressive resistance training on muscle strength and bleeding profile were studied prospectively in two patients with severe haemophilia. Additionally, retrospective data were collected from three patients who had been training for 11-21 years (one patient for 21 years and two patients for 11 years). Muscle strength increased, especially in muscle groups surrounding the target joints (elbow and knee). Bleeding frequency decreased from 2-3 times per week to 1-2 times per week. Patients who had been training for > 11 years reported bleeding episodes of 2-4 times per month prior to training, but after > 11 years of progressive training a marked decrease in bleeding occurred, as well as a decrease in severity. These data support the importance of resistance training for haemophilia patients, not only for increasing muscle strength, but also for decreasing the frequency and severity of bleeding episodes and the associated pain. A controlled study, with a greater number of patients, is needed to confirm the suggested benefits of resistance training in haemophilia patients.

Adult↗
PubMed2002

The treatment of intra-articular synovitis by the use of chemical and radioactive substances.

As the Chairperson of the session relating the intra-articular use of chemical and radioactive substances it would seem appropriate to give credit to those who contributed to the recent supplement of our Journal Haemophilia. I have extracted key sentences and concepts from the contributed articles. All the papers can be found in Haemophilia, Volume 7, Supplement 2, July 2001. The title, authors and page numbers are provided [1].

Hemophilia A↗
PubMed2002

CT findings in eosinophilic enterocolitis with predominantly serosal and muscular bowel wall infiltration.

A 44-year-old female presented with tenderness of her abdomen, vomiting, intestinal obstruction, hypoalbuminemia and blood eosinophilia. Gastroscopy was normal and colonoscopic biopsies showed only non-specific inflammation of the colonic mucosa and submucosa. CT revealed large amounts of ascites and bilateral pleural effusions but eosinophil counts in the ascites were normal. At CT the jejunum was dilated and showed marked prominence of the valvulae whereas the ileum and the colon presented with a diffuse and hypoattenuating bowel wall thickening. The bowel wall thickening was most pronounced in the colon which especially showed also an impressive thickening and hyperenhancement mainly of its outer bowel wall layers. Parasitic infection could be excluded as well as a specific allergic response. In context with the known blood eosinophilia the diagnosis of an eosinophilic enterocolitis was suspected already by CT but finally only surgical full thickness biopsies could confirm the rare diagnosis of an eosinophilic enterocolitis with predominantly serosal and muscular bowel wall infiltration.

Adult↗