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Biomedical subjects

M Hoppe

Publications and source records attributed to M Hoppe.

66 records · Page 4Linked to original sources
PubMedDate not supplied

Local intraarterial thrombolysis: in vitro comparison between automatic and manual pulse-spray infusion.

PURPOSE: Manual and automatic pulse-spray infusion techniques are compared in vitro to evaluate the efficacy of thrombolysis and the distribution of urokinase and saline solution within thrombus using a pulse-spray catheter. METHODS: A pulse-spray catheter was introduced into a human thrombus within a stenotic flow model. Automatic and manual pulsed infusion of urokinase and automatic pulsed infusion of saline solution were compared. To quantify the efficacy of thrombolysis, pressure gradients were recorded proximal and distal to the thrombus and during the course of infusion. Distribution of infused urokinase was assessed radiographically. RESULTS: The fastest and most homogeneous dissolution of the thrombus was achieved with automatic pulsed infusion of urokinase, shown by decreasing transthrombotic pressure gradients (p < 0.001, Wilcoxon, matched pairs). Manual pulsed infusion of urokinase or saline solution resulted in inhomogeneous thrombus dissolution and delayed thrombolysis. CONCLUSION: Application of automatic pulse-spray injectors seems beneficial for more effective and homogeneous intraarterial pulse-spray thrombolysis when compared with conventional manual pulsed technique.

Humans↗
PubMedDate not supplied

Local intraarterial thrombolysis: in vitro comparison of various infusion catheters.

PURPOSE: Catheters are compared in vitro to evaluate the efficacy of thrombolysis during urokinase infusion within the thrombus. METHODS: Six catheters were introduced individually into human thrombus within a stenotic flow model. Urokinase was infused continuously into the thrombus. To quantify the efficacy of thrombolysis, pressure gradients were recorded proximal and distal to the thrombus and during the course of infusion. Uniformity of lysis was assessed radiographically. RESULTS: The fastest and most homogeneous thrombolysis was achieved with the EDM and the straight-flush catheter, shown by decreasing transthrombotic pressure gradients. All other catheter designs showed less homogeneous and delayed thrombolysis (p </= 0.001, Friedmann-Test, Schaich-Hamerle). There was no significant difference in the efficacy of thrombus dissolution between the EDM and the straight-flush catheter (Wilcoxon, matched pairs, p > 0.7). CONCLUSION: The EDM catheter and the straight flush catheter achieved the most homogeneous and fastest thrombolysis, apparently due to the best urokinase distribution within the thrombus.

Catheterization↗
PubMedDate not supplied

The precise determination of vascular lumen and stent diameters: correlation among calibrated angiography, intravascular ultrasound, and pressure-fixed specimens.

PURPOSE: Luminal diameters measured in vivo by calibrated-catheter angiography and by intravascular ultrasound were correlated with those obtained from pressure-fixed histologic cross-sections to determine the accuracy of both methods. METHODS: Angiographic and endosonographic diameter measurements were performed in the center of stents placed in the iliac arteries of 10 miniature pigs and were compared with luminal and stent diameters in postmortem, pressure-fixed, histologic cross-sections from identical locations. RESULTS: Compared with histologic diameters, magnification-corrected angiographic measurements still magnified vascular luminal diameters by 0.7 +/- 0.71 mm (r = 0.41, Pearson; p < 0.003, Wilcoxon, matched pairs), whereas intravascular ultrasound measurements proved to be almost identical to the histologic lumina (r = 0.95, Pearson; p > 0. 5, Wilcoxon, matched pairs). Similarly, stent diameters correlated well between endosonographic and histologic measurements (r = 0.91; p = 0.002), and less well between angiographic and histologic diameters (r = 0.62; p = 0.002). CONCLUSION: Since calibrated angiography still overestimates vascular lumina, endosonography is the preferred technique for accurate in vivo measurements.

Angiography↗
PubMedDate not supplied

Failed surgery for temporal lobe epilepsy: predictors of long-term seizure-free course.

OBJECTIVES: To identify prognostic factors which predict the outcome 2 years after TLE surgery in those patients who were not seizure-free at the 6-month postoperative examination. METHODS: We included 86 postoperative TLE patients who had undergone presurgical evaluation, including video-EEG and high-resolution MRI, and who had seizures between the second and sixth postoperative months. RESULTS: 32% of patients were seizure-free in the second postoperative year. We found that normal MRI findings and secondarily generalized seizures (SGTCS) preoperatively were associated with a non-seizure-free outcome, while rare postoperative seizures and ipsilateral temporal IED with seizure-free outcome. Newly administered levetiracetam showed a significant positive effect on the postoperative outcome independent of other prognostic factors. Five of seven patients who received levetiracetam became seizure-free (p = 0.006). CONCLUSION: One-third of patients who did not become seizure-free immediately after surgery, eventually achieved long-term seizure freedom. We suggest watching for long-term seizure freedom after failed epilepsy surgery especially in patients who had rare postoperative seizures, focal MRI abnormality, ipsilateral temporal spikes, or no SGTCS preoperatively. Levetiracetam may have a positive effect on postsurgical seizures.

Adult↗
PubMedDate not supplied

Nitinol prostheses for the treatment of inoperable malignant esophageal obstruction.

PURPOSE: This uncontrolled prospective study was undertaken to evaluate a new nitinol stent in the treatment of dysphagia due to inoperable malignant esophageal obstruction. PATIENTS AND METHODS: Eighteen consecutive patients (15 men, three women; mean age, 66 years +/- 15) with inoperable malignant obstructions of the esophagus or esophagogastric junction due to esophageal carcinoma (n = 14) or extrinsic obstruction (n = 4) were treated with self-expanding nitinol endoprostheses (diameter, 18 mm). Dysphagia score and activity index were assessed before and every 4 weeks after stent insertion. RESULTS: Eighteen stents were deployed successfully. One stent expanded insufficiently and was removed inadvertently during retrieval of the application system. Mean time until complete expansion of the stent was 7.1 days +/- 5. Stent placement resulted in a significant decrease in the dysphagia score (2.7 +/- 0.7 before vs 0.6 +/- 0.7 after stent placement, P < .00005 by Wilcoxon matched-pairs test) and a significant increase in the activity index (2.6 +/- 1 before vs 1.7 +/- 0.9 after stent insertion; P < .005). There were no procedure-related complications. Follow-up period (mean, 155 days +/- 100) revealed recurrent dysphagia in four patients. Two patients experienced food bolus impaction, another two had tumor ingrowth through the mesh after 170 and 186 days. Fourteen patients died after a mean survival time of 158 days +/- 106, all with patent stents. CONCLUSIONS: Self-expanding nitinol esophageal stents are safe and effective in the treatment of malignant esophageal obstructions.

Aged↗
PubMedDate not supplied

Assessment of the hemodynamic result of PTA with a Doppler guide wire: initial experience.

PURPOSE: To determine the usefulness of a Doppler guide wire for assessing the hemodynamic results of balloon dilation of atherosclerotic arterial obstruction. MATERIALS AND METHODS: A 0.018-inch 12-MHz Doppler guide wire was used to measure the maximum peak velocity and the time-averaged peak velocity (APV) proximal to, inside, and distal to lesions in 10 consecutively seen patients (six men, four women; mean age, 68 years +/- 11 [standard deviation]). Measurements were made before and after percutaneous transluminal angioplasty (PTA). RESULTS: The proximal-to-intrastenotic APV ratio was the best predictor of the grade of residual stenosis and correlated well with angiographic measurements (r = .8). Balloon dilation resulted in a significant increase in mean APV distal to the obstruction (12.5 cm/sec before versus 27.6 cm/sec after PTA; P < .05). The mean proximal-to-distal APV ratio also decreased significantly (3.7 before versus 1.0 after PTA; P < .005). CONCLUSION: The Doppler guide wire can be used for direct intravascular evaluation of the result of balloon dilation in atherosclerotic obstructions.

Aged↗
PubMedDate not supplied

Nutrition education in schools of nursing in the United States. Part 2: The status of nutrition education in schools of nursing.

To explore whether nurses in academic institutions are being adequately educated to care for patients' nutritional needs, we conducted a survey of National League for Nursing accredited baccalaureate programs in the United States and their associated graduate programs. Data indicate that nutrition content is an integral part of baccalaureate nursing programs. Less emphasis is reported on nutrition content at the graduate level. Recommendations include revision of the substantive nutritive content and increased clinical experience in nutrition in both undergraduate and graduate nursing education.

Curriculum↗
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Intellectual deficits associated with early onset of insulin-dependent diabetes mellitus in children.

Twenty-seven children with early-onset (less than 4 yr) diabetes (EOD), 24 children with late-onset (greater than 4 yr) diabetes (LOD), and 30 sibling controls were compared in their performance on tests of intellectual functioning and school achievement. The results indicated that children with EOD, particularly girls, scored lower than the other groups of diabetic children and siblings on tests of visuospatial (P less than .05) but not verbal ability. Many of the girls with EOD were also having difficulty at school, and several were receiving special education. Children with EOD had more hypoglycemic convulsions than those with LOD. Both convulsions and age of onset were associated with poorer performance on spatial tasks. Girls with EOD had lower spatial test scores regardless of convulsion history, whereas boys with EOD scored lower only if they had had a convulsion.

Achievement↗
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Sex differences in student preference for family medicine.

Differences between male and female students at the University of Washington School of Medicine in their choices of family medicine specialization were examined over a ten-year period. Specialty choices during the second year of medical school were compared to later residency selections. Women showed a significantly stronger early preference for family practice but were less likely to select a family medicine residency than their male counterparts. Although the magnitude of the differences was modest, the possible decline in interest among a group of students who intuitively seem particularly suited to this specialty appears worthy of note. Possible implications of these findings are discussed.

Career Choice↗
PubMedDate not supplied

Monitoring of therapy in inoperable lung cancer patients by measurement of CYFRA 21-1, TPA- TP CEA, and NSE.

In a series of 381 consecutive patients with lung tumors and benign pulmonary diseases, we examined whether tumor markers CYFRA 21-1 (EIA, Boehringer, Mannheim), TPA-M (IRMA AB Sangtec Medical, Bromma, Sweden), TPS (IRMA, Beki Diagnostics AB, Bromma, Sweden), CEA and NSE (EIA, Roche, Basel) have the potential to contribute to clinical decision-making processes with respect to diagnosis and assessment of response to therapy. The sensitivity values of the marker tests in NSCLC (CYFRA 21-1: 44.4% > 3.9 ng/ml, TPA-M: 39.4% > 200 U/ml, TPS: 13.2% > 230 U/ml, CEA: 37.5% > 8.6 ng/ml), in SCLC (NSE: 61.9% > 14.0 ng/ml) and in pleural mesothelioma (CYFRA 21-1 and TPS: 36.4%) were found to be clearly inferior to the yield of standard cytopathological examinations (85-98%) when using the 95% specificity versus the group with benign pulmonary disease as cut-off values. Therefore, currently available tumor markers are of minor value in the primary diagnosis of lung tumors. After curative surgery (Ro) of NSCLC only CYFRA 21-1 levels dropped to the normal range within one week. The other markers simulated residual tumor mass by displaying elevated marker levels after surgery. During the monitoring of response to chemo-/radiotherapy the changes in marker levels were compared to the clinical assessment according to standard criteria of the WHO. The criteria defined for marker response were a 65% decrease for a partial response and a 40% increase of the marker levels for progressive disease. Concordant results were obtained in 59.4% of the cases for CYFRA 21-1 (TPA-M: 63.3%, TPS: 65.5%, CEA: 54.8%, NSE: 68.9%). Most discordant results were obtained in tumor remission due to an insufficient decrease in the markers. Progressive disease was most effectively indicated by CYFRA 21-1 in NSCLC 60%) and by NSE in SCLC (70.0%). It is concluded that increasing marker levels may contribute to clinical decision making, at least in helping to decide which patients should no longer treated by ineffective and toxic drugs.

Adult↗