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Biomedical subjects

M Langer

Publications and source records attributed to M Langer.

At least 253 records · Page 14Linked to original sources
PubMed1992

[Reactive enlargement of cervical lymph nodes and cervical lymph node metastases: sonography (M/Q quotient) and computed tomography].

Ranking of sonographic maximum/transverse diameter quotients was compared with the ranking of CT in respect of identification and exclusion of cervical lymph node metastases. Both sonography and CT are distinguished by a high degree of sensitivity in the imaging of cervical lymph node metastases. Sonography, with the assistance of the maximum/transverse diameter quotient, can differentiate between benign enlarged and non-enlarged lymph nodes on the one hand and cervical lymph node metastases on the other, with a safety of 95 per cent. CT can yield definite information regarding the tumour status only after contrast medium administration under the criteria of central hypodensity and peripheral marginal enhancement. CT is much less specific than the sonographic M/T quotient (66% vs 95%). Accuracy of sonography (94%) is clearly superior to that of CT (79%).

Adult↗
PubMed1992

[The splenic steal syndrome and the gastroduodenal steal syndrome in patients before and after liver transplantation].

The study describes new pathologic entities, the splenohepatic steal-syndrome and the gastroduodenal steal-syndrome, which could be demonstrated by angiography in 17 patients before and after liver transplantation. After the first observation of a splenohepatic steal-syndrome in a patient with unexplained elevation of hepatic enzymes after liver transplantation, a prospective angiographic study was performed, including all liver transplant recipients and patients after liver transplantation with unexplained impaired liver function tests. 9 splenohepatic steal-syndromes could be demonstrated before and 7 after hepatic transplantation, one gastroduodenal steal was seen after liver transplantation. The different therapeutic modalities are discussed.

Angiography↗
PubMed1991

[Percutaneous sonographically guided fine-needle puncture and drainage of pyogenic abscesses].

Between January 1988 and April 1991, a total of 79 ultrasound-directed percutaneous punctures and (or) drainage of abscesses were performed on 31 patients (15 men, 16 women; mean age 63 [31-85] years). There were 14 hepatic, 4 splenic, 4 abdominal wall and 3 pancreatic abscesses, and one each subphrenic, presacral, retrocaecal, ischiorectal, pulmonary and in the psoas. After ultrasound localization of the abscess a fine-needle puncture was performed, after which the abscess cavity was emptied as much as possible or, in abscesses larger than 5 cm in diameter, drained through a pig-tail catheter (6-8, 4 F). Several punctures were needed in 16 patients, while in 15 a percutaneous drainage over 2-8 days was necessary. Treatment was successful after 4-17 days in 25 patients. One patient died in septic shock. Operative intervention after diagnostic puncture was undertaken in 5 patients. There were no complications related to the method. In 11 patients the further course was determined by an underlying malignant disease. No recurrence has been noted (4-36 months after treatment) in 14 patients with a benign underlying disease. Percutaneous puncture and drainage of pyogenic abscesses is a technically simple method which achieves good results.

Abscess↗
PubMed1991

[Lysis of gallstones with methyl tert-butyl ether: percutaneous transhepatic or transpapillary?].

Thirty patients (23 women, 7 men, mean age 53 [24-77] years) with symptomatic radiolucent gallbladder stones were treated by litholysis with methyl tert-butyl ether (MTBE), introduced through a catheter inserted into the gallbladder either by the percutaneous-transhepatic route (n = 19) or the transpapillary route (n = 11). Correct placing of the catheter was more frequently successful by the percutaneous-transhepatic route than the transpapillary one (90 vs 73%). The duration of lysis (median: 7 h and 8 h, respectively) and the proportion of stones which were completely dissolved immediately after lysis (53 vs 55%) were similar in both groups. Supplemented by subsequent oral therapy, the success rate at 6 months was higher in the percutaneous-transhepatic group (83 vs 64%), however, recurrences were more frequent. In the percutaneous-transhepatic group there was one case of gall-bladder leak and one catheter dislocation, and in the transpapillary group there was one case of pancreatitis, one of induction of ether anaesthesia and one pulmonary embolism. MTBE lysis is a relatively speedy and effective mode of non-operative therapy for gall-bladder stones. The percutaneous-transhepatic method is suitable for younger patients with a normal gall-bladder. The transpapillary procedure is preferable for older patients, and also when gall-bladder puncture proves difficult or when there is concurrent choledocholithiasis.

Adult↗
PubMed1991

Epidemiology and risk factors of pneumonia in critically ill patients. Intensive Care Unit Group for Infection Control.

Risk factors for pneumonia were analysed in a large population of critically ill patients, collected in two prospective multicentre "pneumonia studies" in Italy. Twenty-three intensive care units were involved and the study time was 150 unit months. Only patients without previous pulmonary infection, with intensive care unit stay greater than or equal to 48 hours and no rapidly irreversible illness at admission were included. The incidence of pneumonia in the 1475 selected patients was 15% (220 cases). 239 patients died in ICU; the mortality rate was significantly higher in patients developing pneumonia (p less than 0.0001); pneumonia was found to be an independent highly significant risk factor for death in critically ill patients (OR = 3.88; p less than 0.0001). Multivariate analysis of seven risk factors for pneumonia showed a significantly higher risk in patients with neuromuscular disease (OR = 3.8, p less than 0.002), impairment of airway reflexes at admission (OR = 2.93, p less than 0.0001), and greater than or equal to 24h respiratory assistance (OR = 3.05, p less than 0.0001). Impairment of airway reflexes at admission to the emergency room or intensive care unit identifies the population who will experience 3/4 of the overall lower respiratory tract infections. Rapid recognition of at-risk patients seems clinically important and may improve awareness programs and preventive approaches.

Acute Disease↗
PubMed1991

Psychosomatic aspects of galactorrhea.

We interviewed 33 women with non-puerperal galactorrhea, 5 (15%) of whom had HPRL levels greater than 18 ng/ml and 24 controls, namely women with benign breast lesions. We used a semi-structured interview covering the duration of symptoms, preceding life events and the effect on the relationship of the couple. We also used the Beck depression inventory, the Strauss and Appelt body image questionnaire and an 8 item Visual Analogue Scale (VAS). Galactorrheic women were more depressive (P less than 0.1), had more prior life events (P less than 0.001), longer duration of symptoms (P less than 0.01), and less fear of their disease (P less than 0.05) than did controls. Both groups had similar results with the body image questionnaire. Within the study group, results were independent of prolactin (HPRL) levels or amenorrhea.

Adenofibroma↗
PubMed1991

The effect on minimum tumor dose of restricting target-dose inhomogeneity in optimized three-dimensional treatment of lung cancer.

An examination was made of the effect upon the minimum tumor dose of a limit placed on the variation of dose across target. If the required level of target dose uniformity is slightly relaxed, a substantial improvement in the minimum tumor dose might appear. It was conjectured that this effect could be seen with treatments optimally planned and evaluated in three-dimensions. A model of advanced carcinoma of the lung treated with a computer controlled accelerator was used to test this hypothesis. A mathematical program for optimizing beam weights was used to determine the largest minimum tumor dose possible. In the six cases tested, a minimum tumor dose of greater than 80 Gy could be delivered if a 20% inhomogeneity limit was accepted. The minimum tumor dose fell to the range 44-64 Gy when the inhomogeneity limit was tightened to 13-17%. The results imply a need to examine the choice of a required level of dose uniformity from the range of values suggested in the 2-dimensional planning literature. If a strict bound-on-dose uniformity is preserved, mechanisms--such as formal optimization--which can reduce target dose inhomogeneity will be valuable.

Dose-Response Relationship, Radiation↗
PubMed1991

[Gadolinium-DTPA as an oral contrast medium for magnetic resonance tomography of the pancreas].

52 patients with normal pancreas, pancreatitis and pancreatic tumors were examined by magnetic resonance imaging (Magnetom 0.5 T). Using T1-, proton density- and T2-weighted spin-echo sequences images were obtained before and after oral administration of Gadolinium-DTPA (Gd-DTPA, 1 mM, 15 g/l Mannit, 5-13 ml/kg). Gd-DTPA resulted in hyperintense labeling of small bowel in all sequences and improved visualization of pancreatic head, body and tail in 15, 14 and 7 of 27 patients with normal pancreas and in 17, 8 and 6 of 25 patients with diseased pancreas. Better delineation of pseudocysts and tumorous gut wall invasion were diagnostically profitable. With regard to motion artifact reduced MRI of the intestine using fast sequences Gd-DTPA may be a suitable oral contrast agent to improve the imaging of the pancreas.

Administration, Oral↗
PubMed1991

[Superselective intra-arterial DSA in femur head necrosis and femoral neck fractures].

The prospective study includes 25 patients without pathology of the femoral head for the evaluation of the normal femoral head perfusion. In addition 34 patients with femoral head necrosis underwent i.a. DSA preoperatively before pedicled pelvic bone grafting. 15 patients after pelvic bone graft operation and 7 patients with medial femoral head fracture were also examined via superselective DSA. In cases with femoral head necrosis a rarefaction or interruption of the rami nutricii proximales, or an occlusion of the medial circumflex femoral artery were observed. Patients with medial femoral neck fracture showed an interruption of the rami nutricii proximales of the femoral head. Postoperative DSA--after pedicled pelvic bone graft--revealed a regular arterial graft perfusion in 82%.

Adult↗
PubMed1991

[The differential diagnosis of liver metastasis and regional fatty liver: a comparison of CT and MRT].

Differentiation between liver metastases and local fat deposition may be difficult when using CT; the value of MRI was therefore investigated in 18 patients with metastases and ten patients with fat deposits. CT shows both lesions as similar hypodense areas. MRI, however, produces different appearances: T1- and 2-weighted images show marked differences in the signal arising from metastases, whereas local fat collections in both sequences differ little in their signal from normal liver. Quantitative MRI signal intensity of the two types of lesion were also different. Where the differentiation by CT may be difficult, it may be made with certainty by means of MRI.

Adult↗
PubMed1991

[Cervical lymph node metastasis: significance of computerized tomography and palpation. A histologically controlled comparison].

Palpation and CT are used before treatment, in addition to sonography, in patients with tumours in the head and neck for lymph node staging. The accuracy of CT in identifying lymph node metastases is 79% and in our clinical material is similar to the accuracy of palpation (81%). Sensitivity of CT (93%) is better than palpation (82%). Specificity of CT (65%) is less than that of palpation (82%). The high percentage of false positives from CT (35%) is due to enlargement of the lymph nodes resulting from sinus histiocytosis or follicular hyperplasia. CT is significantly superior to palpation in demonstrating the relationship of the lymph nodes to the surrounding tissues (vessels, muscles, bones).

Adult↗
PubMed1991

[The place of angiography and radiologic intervention before and after liver transplantation].

The study demonstrates the value of angiography and radiological interventions before and after liver transplantation. From September 1988 till February 1991 84% out of 124 hepatic transplant recipients underwent pretransplant angiography evaluation for the exact demonstration of arterial and portal venous blood supply of the liver. Posttransplant angiography was performed in cases with suspected vascular complications, chronic rejection, and spleno-hepatic steal syndrome. Radiological interventions were performed for bacteriological examination and percutaneous drainage of encapsulated fluid collections.

Angiography↗
PubMed1991

Penetration of ceftazidime into bronchial secretions in critically ill patients.

Five adult patients admitted to ICU, with respiratory failure, required endotracheal intubation and respiratory support. They were treated with ceftazidime because of lower respiratory tract infections. All patients were given ceftazidime at 1, 2 and 3 g dosages in a randomized sequence and timed serum and bronchial secretion samples collected. Mean peak serum concentrations of 60.3, 148.7 and 224.8 mg/L were found in the three treatment groups and mean trough levels of 1.02, 1.85 and 1.63 mg/L respectively. Ceftazidime appeared rapidly in bronchial secretions reaching mean maximal concentrations of 2.2, 4.81 and 5.69 mg/L in the first sampling period (0-2 h). Serum and bronchial secretions AUCs have been calculated showing that both almost doubled their values between 1 and 2 g dosing, while between 2 and 3 g doses only a moderate and non-significant increase were found. On the basis of these results, the existence of a saturable transport mechanism for ceftazidime from serum to bronchial secretions can be postulated.

Adult↗