[Experience and adjustment to hysterectomy].
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Adaptation, Psychological↗
Biomedical subjects
M Langer
Publications and source records attributed to M Langer.
Prolonged independent lung respiratory treatment after single lung transplantation in pulmonary emphysema.
Single lung transplantation (SLT) is now successfully used in patients with severe emphysema. Mechanical imbalance between the native emphysematous and the healthy transplanted lung can be easily managed, unless severe graft failure occurs, leading to acute respiratory failure. Emergency retransplantation has been used in this setting, since the conventional approach to adult respiratory distress syndrome (ARDS) (mechanical ventilation and positive end-expiratory pressure [PEEP]) fails, due to the mechanical discrepancy between the two lungs. We describe two cases of severe graft failure following SLT in emphysema patients that were successfully treated with prolonged independent respiratory treatment. Mechanical ventilation and PEEP were applied to the failing transplanted lung while the native emphysematous lung was maintained on spontaneous breathing to avoid hyperexpansion and barotrauma. The independent lung respiratory treatment lasted 35 and 25 days, respectively: to our knowledge, these are among the longest-lasting independent respiratory treatments reported. The management was simplified by the early use of a double-lumen tracheostomy cannula as an alternative to orotracheal double lumen tube.
Graft Rejection↗
Femoral head perfusion in patients with femoral neck fracture and femoral head necrosis.
Femoral head perfusion in adults was studied by superselective i.a. DSA in 35 normal subjects, in 9 patients with medial femoral neck fracture preoperatively, and in 36 patients with femoral head necrosis before bone grafting, and as therapeutic control after grafting. All patients with femoral neck fracture showed an interruption of the proximal nutrient branches. In 93% of the cases with femoral head necrosis, these branches were rarefied or the medial circumflex femoral artery was interrupted. Postoperative DSA after pedicled pelvic bone graft revealed a regularly perfused graft in 82%. Superselective i.a. DSA is a valuable procedure for the therapeutic decision in selected patients with femoral neck fracture as well as before pedicled pelvic bone grafting and as therapeutic control after grafting.
Adult↗
[Integrative imaging of nephroblastomas and nephroblastomatosis].
Studies on Wilms' tumor have led to intensive investigation of the relationship between nephroblastosis and nephroblastomatosis. Diagnostic strategies have changed: excretory urography is no longer recommended since all information needed is readily obtained by other imaging modalities. Ultrasound is used for the initial examination and confirms the presence and the localization of the mass. CT scan reveals perirenal invasion, and MRI allows the determination of tumor volume and confirmation or exclusion of vascular involvement.
Humans↗
[Imaging in rheumatoid arthritis].
The radiographic changes of rheumatoid arthritis (RA) consist of periarticular soft tissue swelling, osteoporosis, symmetric narrowing of the joint space associated with marginal or central erosions. Conventional radiography is the basic imaging method in RA due to its high impact on differential diagnosis. MRI and bone scintigraphy are second line imaging methods in early stages of arthritis. Hypervascularized pannus can noninvasively and in a detailed way be depicted using intravenously applied Gadolinium-DTPA. Follow-up examinations of the clinical and radiographic findings are adequate in advanced stages. Additional sonography and computed tomography are supplementary methods.
Arthritis, Rheumatoid↗
[Primary femoral recanalization using a slowly rotating catheter system].
Over a period of 2 years, 26 patients with chronic occlusions of the superior femoral and popliteal arteries were referred for recanalization. In two cases, the origin of the superior femoral artery could not be detected. A primary recanalization was achieved in 21 of 24 patients by the catheter system used by us (Viadyn). A stent (extensor) had to be implanted in one case because of a considerable lesion of the intima. A short-term clot lysis was indicated for another patient. On the basis of our results, rotation angioplasty with a slowly rotating catheter system seems to be the therapeutic method of choice for chronic arterial occlusions in the thigh.
Aged↗
Xenogeneic orthotopic liver transplantation in nonhuman primates.
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Animals↗
[Imaging of the normal anatomy of the hand using high resolution magnetic resonance tomography and surface coils].
Magnetic resonance imaging can visualize the soft tissue and the bone marrow of the hand. High spatial resolution requires the use of a surface coil. Signal-to-noise contrast was measured and compared for 3 different coils. Optimal results were obtained with a surface coil with a diameter of 8.5 cm. The wrist and the fingers of 10 volunteers each were examined. Images with a high spatial resolution and a good signal/noise contrast were obtained, enabling the delineation of small structures like Gynon's channel and the median nerve.
Fingers↗
[Bolus administration in spiral CT of the upper abdomen].
In 60 patients the density increases in the abdominal aorta and pancreas were examined quantitatively the visualisation of the arterial liver blood flow qualitatively in a test volume by means of spiral CT and a feed or speed differentiation of 10 mm/s for three different contrast medium boli. It was shown that during the entire study over 24 seconds the boli with 100 ml contrast medium at injection speeds of 3 ml/s and 50 ml contrast medium at 1.5 ml/s resulted in a continual density increase of the abdominal aorta from 221 to 265 Hounsfield Units (HU) or 161-167 HU, respectively. For measuring the abdominal aorta the bolus of 50 ml contrast medium at 3 ml/s was less suitable than the boli of 100 ml contrast medium with 3 ml/s and 50 ml with 3 ml/s because of the rapid in density from 250 to 118 HE. The bolus of 50 ml contrast medium and 3 ml/s, on the other hand, with 54 HU enhancement of the pancreas was approximately equal to the larger amount of contrast medium of 100 ml contrast medium and 3 ml/s with 56 HU, whereas 50 ml contrast medium and 1.5 ml/s with 46 HU was inferior. While all boli could sufficiently enhance the extrahepatic section of the hepatic artery, the larger amount of contrast of 100 ml proved to be superior to the other boli in the visualization of central intrahepatic vascular branches.
Adult↗
[Radioimmunoscintigraphy of colorectal tumors with 99m-Tc marked CEA antibodies. Indications and clinical value].
In Germany, radioimmunoscintigraphy (RIS) (scintigraphic, specific imaging of benign and malignant diseases by radioactively labelled monoclonal antibodies) has been employed since 1985 in clinical trials involving patients with colorectal cancer. After proving successful for identifying primary tumors, RIS is now increasingly being used for the early diagnosis of recurrent and metastatic lesions. In this prospective study involving 75 patients with colorectal tumors confirmed by endoscopy and biopsy, it was shown that RIS using the SPECT technique with 99m-Tc-labelled monoclonal CEA antibodies has a sensitivity of 78% in the detection of local recurrent disease in cases in which diagnostic work-up has been inconclusive.
Adult↗
A baboon model to test physiological and adverse effects of human red cells loaded with inositol hexaphosphate (IHP).
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Animals↗
Granulomatous tonsillitis. A rare extraintestinal manifestation of Crohn's disease.
Oral lesions, varying in nature and location, appear to be one of the common extraintestinal manifestation of Crohn's disease. In particular, oral involvement preceding intestinal disease may lead to the diagnosis of Crohn's disease. The present case report of a 17-year-old male patient describes a very rare nonintestinal manifestation of Crohn's disease with severe granulomatous involvement of the tonsils. A sore throat caused by hyperplastic tonsils with granulomatous inflammation as an oral manifestation of Crohn's disease was the leading symptom in this case.
Adolescent↗
Prognostic value of hemostatic parameters after liver transplantation.
The prognostic value of hemostatic parameters after orthotopic liver transplantation was evaluated in 37 consecutive patients. Six simple hemostatic parameters (prothrombin time, activated partial thromboplastin time, thrombin time, thrombin coagulase time, plasma fibrinogen and platelet count) were obtained for each patient pre-transplantation and daily post-transplantation for at least 8 days. Using the results of these tests, the degree of hemostatic impairment was arbitrarily scored from 0 to 6. Starting from the first day post-transplantation, hemostatic parameters improved progressively, reaching plateau values on day 7 post-transplantation. On day 8 there were significant differences in the activated partial thromboplastin time, prothrombin time, and in the overall hemostatic scores between patients who survived at least 6 months and those who died. Comparing these hemostasis parameters with such liver function tests as AST, ALT and serum bilirubin, univariate analysis showed that activated partial thromboplastin time, coagulation score and AST were significant predictors of 6-month survival, but by multivariate analysis (Cox proportional hazard rate model) only the activated partial thromboplastin time was an independent predictor. Hence, a simple coagulation test is useful for predicting the survival of patients undergoing liver transplantation.
Adolescent↗
CCRT (computer controlled radiation therapy) for non-small cell lung cancer: sensitivity of clinical gains to organ tolerance restrictions.
A method is described for allowing the entrance angles of beams to vary along the longitudinal axis of the target volume using a computer controlled radiation therapy (CCRT) treatment technique. The increase in tumor dose potentially available with this technique is evaluated for the case of a non-small cell carcinoma of the lung for which treatment is constrained by a clinically relevant tolerance condition. Tolerance is expressed in terms of that volume of unaffected contralateral lung allowed to receive greater than 20 Gy. The evaluation is repeated with small changes made to the constraining condition in order to explore the sensitivity of the dose gain to the definition of tolerance. For the chosen example, at least an additional 10 Gy could be prescribed to the tumor with the CCRT technique when the 20 Gy contralateral lung volume was held to less than 30%. A gain of 7 Gy was found when the 20 Gy volume was held to 27% and 1 Gy when the 20 Gy volume was reduced to 25%. CCRT treatment can result in a significant dose gain under a clinically relevant condition for tolerance. Its measured advantage strongly depends on the dose constraints specified. Sensitivity analysis is necessary to meaningfully evaluate the merits of alternative treatment techniques.
Carcinoma, Non-Small-Cell Lung↗
[The value of radioimmunoscintigraphy compared to computed tomography in the diagnosis and relapse diagnosis of colorectal tumors].
Radioimmunoscintigraphy (= RIS, scintigraphic "specific" imaging of benign and malignant diseases by means of radioactively marked monoclonal antibodies) has been performed in Germany in clinical studies since 1985 in patients suffering from colorectal cancer. After having been successfully proven in primary studies, RIS is now being used in the early diagnosis of recurrences and metastases. In the prospective study presented here the clinical usefulness of RIS was assessed in comparison against well-tried diagnostic methods including computed tomography in patients suffering from colorectal cancer. It was shown that RIS in SPECT technique (= single photon emission computed tomography) with 99mTc-labelled monoclonal CEA antibodies can visualise local recurrences if diagnostic findings are doubtful, with a sensitivity of 78% versus 50% for CT findings.
Adult↗
[The HR computed tomography of interstitial lung diseases].
In 50 patients with pulmonary disease of varying aetiology and involvement of the pulmonary interstitium, high resolution CT with 1 mm sections have been performed. Various morphological changes within the secondary lobule could be demonstrated which helped in reducing the differential diagnosis. Compared with conventional CT with 10 mm cuts it was also possible to improve the demonstration of pleural lesions by changing window levels.
Asbestosis↗
[Psychological aspects of Cesarean section].
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Adaptation, Psychological↗
[Plasma- and tissue concentrations following intramuscular administration of etofenamat. Pharmacokinetics of etofenamat and flufenamic acid in plasma, synovium, and tissues of patients with chronic polyarthritis after administration of an oily solution of etofenamat].
Studies on Plasma and Tissue Concentrations of Etofenamate following Intramuscular Application/Pharmacokinetics of etofenamate and flutenamic acid in plasma, synovia and tissues of patients with chronic polyarthritis after application of oily etofenamat solution Pharmacokinetics of etofenamate (ETO, CAS 30544-47-9; Rheumon i.m.) and flufenamic acid (FLU, CAS 530-78-9) were investigated in plasma, synovial fluid, and tissues after single intramuscular application of etofenamate to patients with rheumatoid arthritis. 62 patients with indicated operative procedure in the knee-joint received a single dose of etofenamate dissolved in oil before operation. At definite times between 1.5 and 48 h post injectionem samples from 6 patients of each time group were collected. Samples of plasma, synovial fluid, synovial membrane, muscle, bone, hyaline cartilage, and fat tissue and in some cases meniscus cartilage were taken. Concentrations of ETO and its active metabolite, FLU, were determined by HPTLC. In all tissues investigated, concentration/time courses of ETO and FLU were observed. ETO and FLU were measured first in all matrices 1.5 h at the latest 3 h post injectionem. Pharmacokinetics in tissues follows that in plasma. Rate-limiting step is the liberation of drug from the oil depot. For a long period pharmacokinetics of ETO and FLU is mainly determined by the constant liberation from the oil depot (zero order kinetics of liberation). Zero order kinetics is deduced from the linear ascent of the cumulated AUC (in percent) vs. time plot. It is directly related to the liberation of drug from the galenical formulation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗