Biomedical subjects
Publications and source records attributed to M Langer.
The results of the first 71 magnetic resonance studies in 57 children are analysed. Indications, advantages and disadvantages of MR in this age group are described and compared with the results reported in recent literature.
Intravenous and intra-arterial digital subtraction angiography is able to demonstrate hypervascular tumours in the ear, nose and throat territory. Direct puncture of a venous bypass used for intra-arterial chemotherapy, within the external carotid artery territory, is devoid of risk and can be used for assessing the accessibility of the tumour. Lesions of low vascularity can only be recognised by DSA on the basis of vessel displacement. These lesions are not a primary indication for examination by digital angiography.
Glycated plasma proteins (GPP) and glycated hemoglobin (G Hb) has been evaluated in 134 non-diabetics (ND), 299 women with potential abnormality of glucose tolerance (pot.AGT), 75 with impaired glucose tolerance (IGT) and 34 insulin dependent diabetics (IDDM) during pregnancy or postpartum including 94 cord blood determinations. Mean HbA1c levels were significantly elevated in IDDM (6.6 +/- 1.3% M +/- SD) compared to ND (5.1 +/- 0.7%; P less than 0.01), but were similar for the other groups studied. Mean GPP were increased for the IDDM (0.58 +/- 0.29 nmol 5- HMF/mg protein; M +/- SD) and the IGT-group (0.53 +/- 0.22) over ND (0.3 +/- 0.13; P less than 0.01) and the Pot.AGT group (0.37 +/- 0.14; P less than 0.01). 6% of the ND, 15% of the Pot AGT-, 52% of the IGT- and 62% of the IDDM group were found to have GPP values exceeding the 97% confidential limit of the ND. However, the large overlap of individual values from patients with different degrees of glucose intolerance with the normal range of pregnancy precludes the use of GPP as a screening parameter for IGT during pregnancy. A 30-35% reduction of fetal hemoglobin- and plasma protein glycosylation relative to maternal values was observed.
Intravenous DSA was performed on 45 patients for diagnosis of otorhinolaryngologic diseases. Hypervascular glomus tumours can be accurately diagnosed. Furthermore, vascular architecture and topography can be analysed to allow the planning of tumour embolization or surgery. Hypovascular tumours are inadequately demonstrated by intravenous DSA. A specific and detailed analysis of thin vessel architecture in malignant tumours is impossible by intravenous DSA.
The authors compared the clinical courses and the CT courses recorded at the same time in patients with primary or secondary cerebral tumors. 69 patients improved their neurologic state under external radiotherapy, 35 patients remained unchanged, and 8 patients had a deteriorated condition. The changes in computed tomography and the modifications of the clinical state of patients corresponded only in 55% of all cases. The reasons are discussed. Some patients suffered from fatigue and weak concentration about three months after the end of radiotherapy, in some cases even the neurologic state was deteriorated. These manifestations known as "early delayed reaction" were reversible.
We analyzed the incidence, timing and appearance of reversible CT findings in 55 patients undergoing radiation therapy (dose 60 Gy) for brain tumors. Three patients had "early delayed reactions" within three months of irradiation. CT studies showed increased size of the central zone of necrosis with contrast enhancement in the form of rings or garlands. Differentiation between these findings and recurrence of tumor was possible only through follow-up studies.
100 intravenous digital subtraction angiograms of bifurcations were compared to one hundred plain film arteriograms. Both types of examinations were of excellent image quality. Arteriosclerotic lesions in the posterior circumference of the internal carotid artery were found in 55% plain film angiograms and in 49% of intravenous DSA examinations. Plain film angiography was significantly more accurate in the evaluation of arteriosclerotic ulcerations than i.v. DSA. The total amounts of arteriosclerotic stenoses with a smooth or rough surface were equal with both methods. The interindividual comparative study demonstrated that in respect of diagnosis of ulcerative lesions, i.v.. DSA is inferior to plain film angiography, even if an excellent image quality for all projections is achieved in i.v. DSA.
The diagnostic possibilities of intraarterial DSA are demonstrated by means of 76 investigated haemodialysis shunts. No complications were seen. In 85% of the cases venous stenoses or occlusions were proved. 18% of these were localised in the proximal part of the draining veins. For this reason, investigation of the venous inflow into the V. cava superior is recommended in every case.
In 60 patients with an average age of 60 years, the essential angiographic findings of renal cell carcinoma were analysed and described in order of their frequency. Localisation, size and vascularisation were evaluated. Involvement of the v. cava inferior and/or of the v. renalis was found with 13% of the tumours on the right and with no tumour on the left side. It is recommended not to perform cavography in case of correct filling of the left renal vein in the late phase of angiography.
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It has been reported before that pentazocine (I) and pentazocine-glucuronide (II) form an artifact (III) by the addition of water to the double bond in the presence of HCl. This reaction leads to different results concerning the investigation of the rate of hydrolysis of II and the recovery of I. The glucuronide was quantitatively hydrolyzed by 20% HCl, but yielded only 15% of I (about 64% was detected as III). With 5% HCl the rate of hydrolysis only amounted to 40%-43%, whereas I yielded 31% (only 9% was recovered as III). The best III yield was obtained with a HCl concentration of 17.5%.
In order to investigate whether the variations in prolactin (PRL) secretion found in patients with liver cirrhosis are related to the derangement of neurotransmitter metabolism, serum PRL levels were measured in 8 patients with hepatic encephalopathy (a condition where neurotransmission is severely deranged), in 10 patients with liver cirrhosis but without encephalopathy and in 10 control subjects under control conditions and in response to nomifensine, levodopa and synthetic TRH administration. Inhibition of endogenous catecholamine reuptake by nomifensine was able to significantly reduce PRL levels in normal subjects and in patients with liver cirrhosis, whereas only one out of 8 patients with hepatic encephalopathy showed a reduction in PRL levels. On the contrary, levodopa administration was able to reduce PRL secretion in all the subjects studied. PRL release by TRH was greater in patients with liver disease than in controls. The results seem to indicate that the derangement in neurotransmitter metabolism which occurs in liver cirrhosis is one, but not the sole cause of alterations of PRL secretion in liver cirrhosis. The failure of nomifensine to depress PRL is an early finding in the course of encephalopathy and may be of diagnostic value.
Three hundred and sixty-two cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynecology, Vienna, from 1950 to 1977. As the method of choice an individually dosed, fractioned, and protracted radium-telecobalt therapy was employed. Comparing the last period analyzed (1971-1977) with another period 20 years earlier (1951-1956), a marked increase of advanced stages and older patients can be observed. These changes are reflected in the 5-year remission rate: in the total population it was 39.8%, as compared to 32% for the period from 1971 to 1977. For a group of 99 patients, who were treated between 1971 and 1977, the therapeutic effect of different therapy schemes is reported. The benefit of teletherapy is remarkable for advanced states, whereas for stages I and II an intrauterine application may be of importance. The complication rate amounted to 8% recto- or vesicovaginal fistulas and 41% and 43% cystitis and proctitis. The central importance of gynecological screening, especially for older women, is emphasized.
The quality of intravenous digital subtraction angiograms was sufficient for diagnostic evaluation in 90%. The accuracy of the method was 90% for the internal carotid artery. 40% of the internal carotid arteries showed stenoses, whereas the common and external carotid arteries were not narrowed in 90%. On behalf of these data the authors consider that i.v. DSA of the carotid vessels is a suitable screening method for carotid arterial occlusive disease.
Psychological effects of an ultrasound exam in early pregnancy were assessed on 59 women (33 primiparae, 26 multiparae). The subjects were between their 12 to 18th week of pregnancy and did not have a prior ultrasound exam in the present pregnancy. Ultrasound was performed under high feedback conditions explaining the image on the screen thoroughly. After the exam patients rated the method and the emotions accompanying it on polarity profiles. Ultrasound as a method was evaluated highly positive with only very few deviant opinions. The emotions raised by it did vary considerably, however, despite the basically positive attitude. Of the 59 women interviewed, 53 and 52, resp., agreed with the statement, that they could gain a clearer image of the baby and of their own body.
From June 1980 to December 1982 164 patients with ovarian cancer stage III and IV were randomized into the three-legged Austrian Ovarian Cancer Study. A new polychemotherapy, known as the "changing-scheme" (adriamycin/cisplatinum--vincristine/cyclophosphamide--high dose methotrexate), developed in Vienna, was compared with adriamycin/cyclophosphamide and adriamycin/cisplatinum. The risk factors were stratified by means of special computer-assisted randomization. The first study evaluation in 1982 showed a significant advantage for the changing-scheme with regard to recurrence-free interval and survival (Mantel test: p less than 0.01, Breslow test: p less than 0.03). No difference was found between the combinations of adriamycin/cyclophosphamide and adriamycin/cisplatinum. At the second study evaluation in June 1984 the differences previously observed were no longe present to the same significant extent. The changing-scheme continued to be superior for the subgroups of patients with highly differentiated tumors, without ascites, with larger postoperative tumor burden and with liver metastases. The use of this therapy is be recommended for women with advanced ovarian cancer, especially in consideration of the much lower toxicity caused by the less frequent cisplatinum administrations as compared to the adriamycin/cisplatinum combination.
In a clinical study with 663 patients the influence of compression and compound technique of the visualisation of the abdomen was tested with a real-time-scanner Combison 100, compound scanner Combison 202 and the Octoson-machine. In 66 patients the retroperitoneal space was not demonstrated. Compression with the real-time-transducer improves demonstration in 50% (33/66), compound-technique 20% (19/66). Compound-technique was handicapped in 30% (19/66) by velocity errors and reflection which causes a deterioration in resolution.
The examination of 91 patients was undertaken in order to establish the relevance of tomographical measurement of the regional cerebral blood-flow, following inhalation of 133Xenon, as a complementary method to the conventional carotis-angiography. In many cases the findings revealed a more precise or even deviating judgement on the hemodynamic relevance of stenosis and obliteration than was proved only by angiography. Especially in the stages I and IV of cerebrovascular disease of the a. cerebri anterior, a. carotis interna and a. carotis communis the rCBF-measurement seemed to be an important parameter for the decision between conservative and surgical therapy as a prognostic parameter for the individual risk of many patients to suffer a cerebral infarction.