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Biomedical subjects

M Langer

Publications and source records attributed to M Langer.

At least 307 records · Page 17Linked to original sources
PubMed1990

[Vascular pedicled pelvic bone span. Value of digital subtraction angiography in pre- and postoperative diagnosis].

The pedicled pelvic bone graft is a new operative technique for the treatment femoral head necrosis. 29 femoral head necroses were examined by i.a. DSA before a pedicled pelvic bone graft was implanted. 11 pedicled pelvic bone grafts were investigated postoperatively. The pre- and postoperative findings are presented. I. a. DSA is a valuable method for the evaluation of the vascularisation of the femoral head before and after surgery.

Adult↗
PubMed1989

[Possibilities for imaging intracardiac thrombi with indium 111 thrombocyte scintigraphy].

Intracardiac thrombi can be localized and quantified by indium-111-labelling of thrombocytes with a high sensitivity and specificity. The scintigraphic procedure has a complementary evidence to echocardiography. Scintigraphy shows activity and age of thrombosis, whereas echocardiography seems to be superior in determination of mass and localization. In older thrombi scintigraphy fails because of organisation and endothelialization of the thrombus surface. For the reason of determination of the age of an intraventricular thrombus this method might have an increasing acceptance.

Aged↗
PubMed1989

[Side effects of adjuvant therapies of breast cancer: their significance for the patient].

In a retrospective survey we interviewed 53 patients with respect to side effects of adjuvant therapy for breast cancer. All of them had undergone modified mastectomy and were randomly assigned to either chemotherapy, irradiation or a combination of both. Standardized questionnaires concerning the side effects and semi-structured, focusing counseling talks were the methods used in questioning the patients. Patients named significantly more side effects of severe and extreme intensity with chemotherapy, and especially in the group given combination therapy, where chemo- and radiotherapy could be directly compared by the patient. The experience was particularly threatening when several side effects occurred simultaneously. Different psychological aspects and visualisation of systemic and local side effects are discussed with respect to the patient's ability to cope with adjuvant therapy. Consequences for routine care are: continuous explanatory talks about side effects throughout the whole process, muscle relaxation and interdisciplinary cooperation.

Adult↗
PubMed1989

Radioimmunoscintigraphy of ovarian cancer with 131-iodine labeled OC-125 antibody fragments.

Radioimmunoscintigraphy (RIS) with 131I labeled OC-125 F(ab')2 monoclonal antibody fragments was prospectively studied in 43 women for primary diagnosis and follow up of ovarian cancer. Total body planar photoscans with a scintillation camera were performed one to seven days after antibody application and results were compared with operation and or CT examination. By the region of interest technique the tumor to non tumor tissue ratio (T/N) was calculated in vivo. Sensitivity in primary diagnosis was 100% (10/10), specificity 33% (1/3). For local recurrency, sensitivity was 86% (19/22), for metastatic loci 80% (17/21). Specificity was 75% and 50%. T/N ratio was in the rage from 1.3 to 2.8. Sensitivity for ovarian cancer is high in primary diagnosis and follow up. By the region of interest technique it is possible to detect small recurrencies and to presume peritoneal carcinosis. Antibody accumulations in diseases different from ovarian cancer however diminish specificity.

Adult↗
PubMed1989

Experience with itraconazole in cryptococcosis and aspergillosis.

Cryptococcosis and aspergillosis in immunocompromised patients are extremely difficult clinical conditions to manage and treatment with available antifungal drugs often fails. Itraconazole, R-51211, Janssen Pharmaceutica, a new orally absorbed triazole, is a possible alternative drug which is potentially effective and nontoxic. Preliminary experience with 28 patients, eight with cryptococcosis and 20 with aspergillosis, is reported. Of these patients, 16 were immunocompromised (seven with the acquired immune-deficiency syndrome (AIDS), five heart transplant recipients and four with leukaemia or lymphoma). Overall, results of treatment were good (18 in remission, four markedly improved, four moderately improved and two failed). Prevention of relapses of cryptococcosis was obtained in all patients with AIDS on long-term itraconazole monotherapy (3 mg/kg). Treatment of invasive aspergillosis required a higher dosage (about 5 mg/kg) and prolonged administration. Besides its efficacy this antifungal agent allowed outpatient management.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Ultrasound as a medium of communication].

Following Watzlawick's general theory of human communication, ultrasound is evaluated using the categories syntax, semantics and pragmatics. Material for this survey mainly comes from routine scanning in pregnancy care. It can be shown that the criteria mentioned above may well be applied, since ultrasound has a number of similarities with mass media. Consequences of this outlook in terms of doctor-patient relationship, determining the sex of the child, and prenatal diagnosis of fetal malformations are discussed.

Communication↗
PubMed1989

[Digital image intensifier radiography--application in angiography, urography and bone diagnosis].

In a retrospective study, the clinical usefulness of digital image intensifier radiography was analysed. It could be demonstrated that for angiographic procedures the image quality of a 1024(2) matrix is superior to a 512(2) matrix. For digital excretory urography it could be seen that in 80 to 90% the images were at least sufficient to analyse the renal pelvis. Digital image intensifier radiography of bones was diagnostically sufficient in 76% and analysis of bone architecture was possible in 85%.

Angiography↗
PubMed1989

[Imaging diagnosis of aggressive fibromatosis and the MRT-pathological correlation].

Aggressive fibromatoses (desmoid tumours) tend to grow in an infiltrative and destructive manner without metastases. Computed tomography of aggressive fibromatoses yields no uniform attenuation pattern. The tumours are typically isodense when no contrast medium is used and enhance clearly to hyperdense during infusion of contrast medium. In magnetic resonance tomography (MRT) a high signal (long T2) on T2-weighted pulse sequences as well as an accumulation of i.v. Gd-DTPA seems to be the characteristic appearance of aggressive fibromatoses, although different signal intensities can be seen. The MRT histopathologic correlation shows increasing signal intensities on T2-weighted sequences dependent on an increment in cellular content of the tumours. Only histopathological methods can provide a definite diagnosis.

Adolescent↗
PubMed1989

The pharmacokinetics of aztreonam and penetration into the bronchial secretions of critically ill patients.

The pharmacokinetics of aztreonam were studied in ten critically ill intubated patients with lower respiratory tract infections. Serum and urinary concentrations of the drug and its penetration into bronchial secretions after a 2-g intravenous bolus were measured. Using a two-compartment linear model a terminal half-life of 1.87 + 0.46 h was determined. No interpatient differences were found for half-life values, AUC or volume of distribution, except in the case of one obese patient. The greatest variability was observed in the clearance values, and in particular the extrarenal clearance which ranged from 0.3 to 9.6 1/h. Maximum concentrations in bronchial secretions were reached very quickly in the 2 h after drug administration, with a range of 4.8-18.7 mg/l. No accumulation of aztreonam after repeated doses was detected.

Adolescent↗
PubMed1989

Prevention of pneumonia in an intensive care unit: a randomized multicenter clinical trial. Intensive Care Unit Group of Infection Control.

In a randomized multicenter clinical trial on antibiotic prophylaxis, 1,319 patients in 23 ICUs were enrolled over a 4-month period. The end-point of the study was the prevention of early onset pneumonia (EOP), defined as acquired pneumonia diagnosed within 4 days of ICU admission; this accounted for greater than 50% of overall pneumonia. Patients eligible for the study were divided into three groups which received either cefoxitin (2 g iv for three doses/8 h), penicillin G (2 million U iv for four doses/6 h), or no antibiotic (control group). In the overall population, the incidence of EOP was 6.1% in the prophylaxis recipients vs. 7.2% in the control group (a 15.3% reduction). No statistically different rates of pneumonia or death were found among the groups. Patients with impaired reflexes on admission or prolonged ventilatory support were noted to have a lower incidence of EOP and an improved outcome when treated with cefoxitin.

Adolescent↗
PubMed1989

Regression of left ventricular hypertrophy under ramipril treatment investigated by nuclear magnetic resonance imaging.

Thirty-two hypertensive subjects with diastolic blood pressure greater than 95 mm Hg were treated with ramipril over a period of 3 months. To determine the effective decrease of blood pressure and for reliable and reproducible demonstration of regression of myocardial hypertrophy during ramipril treatment, we performed parallel measurements with magnetic resonance imaging (MRI) and echocardiography. Measurements were carried out before treatment, 4 h after the first dose, and after 14 days and 3 months of treatment. MRI slices showed a significant decrease of interventricular septal thickness from 19.57 to 15.20 mm, whereas echocardiography demonstrated an equivalent decrease from 18.78 to 14.57 mm. At each measuring point, quantification of wall thickness was performed three times and the means were calculated. The septum and the posterior wall of the left ventricle were also measured at three different points. The values were obtained with negligible scatter and the changes with ramipril treatment were highly significant (p less than 0.001). A concomitant decrease of blood pressure was also observed. The therapeutic aim to reduce diastolic blood pressures below 90 mm Hg was achieved in all patients. In addition to the significant reduction in blood pressure, the angiotensin converting enzyme (ACE) inhibitor ramipril caused a significant regression of pathologic left ventricular hypertrophy demonstrated by magnetic resonance imaging and echocardiography.

Adult↗
PubMed1989

Long-term respiratory support and risk of pneumonia in critically ill patients. Intensive Care Unit Group of Infection Control.

In 724 critically ill patients who had received prolonged (greater than 24 h) ventilatory assistance since admission to the ward, we analyzed the relationship between artificial ventilatory support and pulmonary infection. Two different approaches were used. The first, plotting the incidence of pneumonia versus the duration of ventilatory support, confirms previous data: the incidence rises from 5% in patients receiving one day of respiratory assistance to 68.8% in patients receiving more than 30 days. In the second approach, the same data were computed as an actuarial life table with the day of pneumonia onset as terminal event. This different approach, focusing on the onset of infection rather than on incidence, allows a new insight into the problem of nosocomial infection: pneumonia in patients with respiratory support is an early occurrence with a high and constant rate of acquisition and, therefore, a high risk of infection in the first eight to ten days. Later pneumonia acquisitions were rare, and the risk after ten days of ventilatory support is low.

Adult↗
PubMed1989

Prospective counselling after prenatal diagnosis of fetal malformations: interventions and parental reactions.

A model of prospective counselling and intervention after prenatal diagnosis of fetal malformation is presented. 13 patients/couples with severe malformations were fully counselled, 3 patients/couples interviewed post-termination. Objectives of the counselling strategy were to support patient autonomy, facilitate mourning and reduce narcissistic damage. Counselled patients showed certain benefits concerning the acceptance of the malformation and feelings of autonomy. Integration of psychodynamic knowledge into routine care and obligatory psychotherapeutic counselling are proposed.

Abortion, Induced↗
PubMed1989

Renal excretion of iopromide and iopamidol after intravenous administration in digital subtraction angiography.

After injection of iopromide or iopamidol into a central vein in 40 patients ages 57 +/- 14 years and 57 +/- 11 years, respectively, with normal renal function, iodine concentration and total iodine excretion were determined in pooled urine over 0 to 2 hours and 2 to 24 hours after injection. Iopromide excretion of 46.4 +/- 9.8% of the dose during the first 2 hours after injection was significantly (p less than 0.05) higher than that of iopamidol, which amounted to 41.4 +/- 10.5% of the dose. This is presumably due to the fact that iopromide has lower protein binding than iopamidol. Excretion of the two nonionic contrast media up to 2 hours after injection decreased constantly with increasing age. In the case of iopromide, a mean excretion of 55% of the dose in a patient 25 years old decreased to about 40% for a patient 90 years of age (p less than 0.05). The clinical relevance of the observed differences and correlations is discussed.

Adult↗
PubMed1989

Hemorrheologic effects of iotrolan after intra-arterial injection in rabbits: comparison with other types of contrast media.

Aqueous solutions of the x-ray contrast media (CM) iotrolan and meglumine diatrizoate with and without gelatin added were injected into the rabbit aorta just above the bifuraction in a dose of 0.3 g I/kg and the duration of opacification of the vessel was measured. The difference between the periods recorded for iotrolan and the viscous diatrizoate solution (4 to 6 seconds) and those for the pure diatrizoate solution (3 to 4 seconds) was statistically significant (p less than or equal to 0.05). The differences are directly correlated to the viscosity of the CM solutions. At first the intra-aortal injection of iotrolan causes a somewhat more marked decline in femoral artery blood flow than diatrizoate. The increase in blood flow, which begins 10 seconds after injection is, however, significantly (p less than or equal to 0.05) less after iotrolan than after diatrizoate. This is attributable to the differences in the osmolalities of the two CM. Due to the fact that it is isotonic to blood and because of its viscosity, iotrolan has certain advantages over conventional agents for arteriography that are relevant to clinical practice.

Angiography↗
PubMed1989

Tolerance of iopromide in angiography: a multicenter study.

This prospective multicenter study analyzes the image quality and incidence of undesirable side effects in 2543 film and 1133 intravenous digital subtraction angiographic (DSA) examinations with iopromide. It can be shown that the frequency of undesired side effects in both methods is twice as high in patients at risk as in patients without special risk factors. The most frequent side effects are gastrointestinal and, in cerebral angiography, of a central nervous system nature. The image quality for 99% of the film angiographies was good or better. It could be demonstrated for the DSA that a higher iodine concentration of 370 mg I/ml tends to result in a reduction of the image quality with an increased rate of side effects.

Adolescent↗