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Biomedical subjects

M Langer

Publications and source records attributed to M Langer.

At least 505 records · Page 28Linked to original sources
PubMedDate not supplied

[Cost of ICU in Italy. Results from an empirical study on a sample of 12 hospitals].

BACKGROUND: The Italian hospital payment system based on DRG doesn t properly include Intensive Care Units (ICU) costs. Since great emphasis has been recently given to rationing health care resources, assessing ICU costs seems to be dramatically relevant. Aim of the study was to assess the average yearly cost and the cost per diem of a sample of Italian multispecialistic ICU wards. METHODS: In September 1995, a questionnaire concerning data on variable and fixed cost was sent to 25 Italian ICU wards, 11 NHS hospital-based (Northern Italy: 5; Central Italy: 4; Southern Italy: 2) and 14 school of medicine-based (Northern Italy: 7; Central Italy: 5; Southern Italy: 2). Variable cost data included: disposable, drugs, blood and blood-derived products, physical tests, chemical and microbiological routines, instrumental diagnostic procedures and physiotherapy. Concerning fixed costs, data on personnel and equipment were requested. In addition, some hospital overheads data (utilities; power; heating; maintenance; cleaning; laundry; accounting; waste disposal; cafeteria) were collected. RESULTS: On the basis of the 12 questionnaires returned (Northern Italy: 9; Central Italy: 3; Southern Italy: 0), the yearly cost of an ICU ward is Liras 4,580,032,000 (range 2,739,277,000-7,704,292,000), whereas the average cost per diem is Liras 1,802,000 (range 1,234,000-3,179,000). Cost of personnel is about 61% of the above mentioned costs. CONCLUSIONS: Despite the lack of questionnaires from Southern Italy and the unavailability of some data concerning both the cost of equipment and the overheads, the remarkable average cost values obtained could support further research.

Costs and Cost Analysis↗
PubMedDate not supplied

Thrombectomy discloses intravascular growth of chondroid liposarcoma mimicking a long distance vena cava thrombosis.

A 22-year-old woman with a newly detected chondroid liposarcoma located in the iliac muscle was diagnosed as having bilateral pulmonary embolism. Gadolinium-enhanced MRI further revealed a long distance thrombus reaching from the iliac vein to the right atrium. The thrombus was attributed to a hypercoagulability state which has been described for chondroid liposarcoma. High-dose chemotherapy with autologous stem cell support reduced the tumor burden and led to a symptom-free interval of 6 months. Despite therapeutic anticoagulation, repeated imaging showed no reduction or remodeling of the thrombus. However, when the thrombus progressed again, the patient underwent cardiac surgery and histology revealed the intravascular growth of the known chondroid liposarcoma. We conclude that in sarcoma patients intravascular tumor growth must be kept in mind when imaging is suggestive for thrombosis.

Adult↗
PubMedDate not supplied

Single lung transplantation for emphysema. Lessons learned on the field. The Lung Transplant Group of the Ospedale Maggiore of Milan.

Emphysematous patients that were once treated with double lung transplantation can now also be treated with single lung transplantation. However, single lung transplantation in emphysematous patients presents problems in lung size matching, choice of side to transplant and post-operative assistance. Analysing their own experience of three single lung transplants performed on emphysematous patients, the Authors evaluate the effectiveness of the operation, the results and the difficulties encountered. Single lung transplantation is a good therapeutic option for end-stage emphysematous patients. In these patients right lung transplantation is preferable and the donor organ should be oversized. Positive and expiratory pressure in the native emphysematous lung should be applied with extreme caution.

Adult↗
PubMedDate not supplied

High grade cardiac lymphoma vitality monitoring by gadolinium-enhanced magnetic resonance imaging (MRI).

Primary cardiac lymphoma (PCL) is a rare disorder with a poor prognosis and response monitoring is often difficult. Delay in the diagnosis and infiltration of cardiac structures contribute to the unfavorable prognosis. We report on a 76-year-old woman who was diagnosed as having an immunoblastic B-cell PCL according to a histology attained by catheter-guided biopsy. Systemic chemotherapy with six cycles of CHOP (Cyclophosphamide, Doxorubicine, Vincristine = Oncovine, Prednisone), combined with the monoclonal anti-CD20 antibody Rituximab induced only a partial remission, based solely on monitoring of tumor size. However, cardiac gadolinium-enhanced magnetic resonance imaging (CMR) disclosed a reduced lymphoma perfusion and, therefore, indicated decreased tumor vitality. Nine months after the final treatment, the cardiac tumor further decreased to 10% of the initial size, and the patient is in sustained remission as monitored by CMR and validated by florine-18 fluorodeoxyglucose positron emission tomography (PET). Determination of PCL perfusion was, in our case, beneficial for clinical decision making on additional therapy.

Aged↗
PubMedDate not supplied

Diagnostic accuracy of MRI for preoperative staging of pancreatic carcinoma: tendency for understaging.

OBJECTIVE: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for preoperative staging in pancreatic carcinoma. MATERIALS AND METHODS: MRI investigations, including MR-angio and MR-cholangiopancreatography (MRCP) of 19 patients who underwent surgery for pancreatic carcinoma were retrospectively evaluated by two radiologists. The size, localization of the tumor and possible infiltration of neighboring organs, as well as the presence of enlarged lymph nodes, were determined to define a preoperative, radiological TN stage. Lymph node metastasis was defined as peripancreatic lymphoma greater than 10 mm. Our findings were correlated to postoperative diagnosis. RESULTS: The T-stage was correctly evaluated in 52.6% of the cases (10/19). Understaging took place in 31.6% (6/19) and overstaging in 15.8% (3/19). In three cases of understaging, a micro-infiltration of the peripancreatic tissue was not visible in MRI. Pathologically enlarged lymph nodes were correctly found in 63.2% of the cases (12/19). Overstaging took place in 21.1% of the cases (4/19) and understaging in 15.8% (3/19). CONCLUSION: MRl for preoperative staging of pancreatic carcinoma showed a tendency to understage tumor size in this study population. Especially in cases of small tumor size, micro-infiltration of peripancreatic tissue or the common bile duct may not be detected by MRI. Concerning N-stage, the 95% confidence interval reveals a distribution of over- and understaged.

Aged↗
PubMedDate not supplied

Whole-body MRI in comparison to skeletal scintigraphy in detection of skeletal metastases in patients with solid tumors.

AIM: To evaluate the diagnostic value of whole-body magnetic resonance imaging (MRI) and skeletal scintigraphy in the detection of skeletal metastases in patients with solid tumors. MATERIALS AND METHODS: One hundred and twenty-nine tumor patients were examined with whole-body MRI using coronal TIRM sequences for the different anatomical regions. Skeletal scintigraphy was performed with 99mTc-DPD. RESULTS: In 105/129 (81%) patients, the whole-body MRI and skeletal scintigraphy findings were concordant. In 56/129 (43%) patients, both imaging modalities excluded skeletal metastases. In 49/129 (38%) patients, whole-body MRI and skeletal scintigraphy revealed metastases, however whole-body MRI demonstrated more extensive disease in 22/49 (45%) cases. In 6/49 (12%) cases, skeletal scintigraphy was superior to whole-body MRI in detecting more skeletal metastases. In 24/129 (19%) cases, the imaging findings were discordant. In 15 cases, skeletal scintigraphy was negative, whereas whole-body MRI revealed skeletal metastases. In 9 cases, skeletal scintigraphy was positive, whereas whole-body MRI failed to detect these metastases. In 77/129 (60%) patients, whole-body MRI revealed additional tumor-related findings. CONCLUSION: Whole-body MRI, as a new staging method, is superior to skeletal scintigraphy with respect to the detection of skeletal metastases and the extent of metastastic disease. Furthermore, whole-body MRI yields additional tumor-related findings. Therefore, whole-body MRI should be performed as an alternative to skeletal scintigraphy for the assessment of skeletal metastases.

Adolescent↗
PubMedDate not supplied

Occlusion of aortofemoral bifurcation grafts: how to improve the results?

Forty-three patients with graft occlusion after aortofemoral bifurcation bypass surgery were analysed (1971-1986, 52 bypass branches, 75 graft occlusions). The late occlusion dominated with 73.1%. A poor run off was the main reason in 40.4%. A reduced inflow was responsible in 36.6%, especially caused by graft kinking. Bypass thrombectomy was performed in 56.7%, in 35.8% in combination with a distal reconstruction. Graft exchange was indicated in 39.6% but in 25.6% extraanatomical reconstruction was performed due to a high risk situation. Perioperative mortality rate measured 13.9%, not depending on the surgical procedures. Four times a major amputation was unavoidable. Therefore, in nine patients (= 20.9%) extremity or life could not be preserved. The rate of bifurcation graft occlusions can be reduced by technical improvement of the proximal anastomosis as to the mentioned guidelines.

Amputation, Surgical↗
PubMedDate not supplied

Left lung allotransplantation in pig feasibility and transplanted lung function. Experimental Lung Transplant Group of Ospedale Maggiore of Milan.

Changing attitudes to animals in research and practical considerations prompted the authors to evaluate whether the pig might be a suitable substitute for dog and baboons for single left lung transplants. Twenty-nine paired pigs were used. The first transplants on 13 pairs (group 1) were done to adapt the lung transplant technique to pigs; later transplants on 16 pig pairs (group 2) were done to evaluate operative survival, and function and histological modifications of the transplanted lung in the absence of immunosuppressive treatment. Surgical and anesthetic techniques for both donor and recipient are described in detail. The survival rate in group 2 was 68%. Hemodynamic and blood gas changes were assessed during operation. PaO2 did not drop significantly after occluding the right pulmonary artery by an inflatable cuff placed around it; this suggests that the function of the transplanted lung was preserved. The pigs were put down on the third postoperative day. Vascular and bronchial anastomoses were patent and intact, but the transplanted lung was macroscopically and microscopically altered. Lung transplants can be performed in pigs and the transplanted lung seems to be capable of functioning immediately after the operation. Alteration in the lung after 3 days is probably due to rejection.

Animals↗
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[Coping with illness and body image following different surgical techniques in breast cancer].

Coping and body image were studied in 80 patients with breast cancer. We compared three groups, who had undergone different operative strategies: temporary expander prothesis (n = 19), excisional biopsy (n = 20) and modified radical mastectomy (n = 40). Instruments were: the Herschbach coping questionnaire, the Strauss and Appelt body image questionnaire and a semi-structured interview. Patients after excisional biopsy showed significantly less illness-related stress than the other two groups, both in the number of all items named (p less than 0.02) and in the weighted total (p less than 0.05). Patients after modified mastectomy had chosen a different, "unfavourable" pattern of coping mechanisms than patients after expander prothesis or excisional biopsy: more resignation (p less than 0.05), less fighting and talking (p less than 0.05, respectively). In the body image questionnaire, no significant difference was found. However, in the semi-structured interview, patients after mastectomy mentioned more frequently that they avoided looking at the scar (p less than 0.05). These results underline the importance of preoperative counselling.

Adaptation, Psychological↗
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[Angiographic diagnosis in liver transplantation. II: Angiography after transplantation].

Our study includes 15 posttransplant angiographies in 10 patients after liver transplantation and 3 cases with embolisation of the splenic artery because of a splenohepatic steal syndrome. The results of the angiographies are demonstrated and discussed. In cases with non-conclusive ultrasound or CT findings, angiography is the method of choice, if an arterial anastomotic complication or a chronical rejection is suspected.

Adult↗
PubMedDate not supplied

[Personality-dependent anxiety reactions in primiparous patients].

The emotional state of the gravida shortly before childbirth has a predictive value for her comportment during parturition. We evaluated, whether the concept of defensive coping with fear (repression vs. sensitization) contributed to a better identification of patients at risk. Both repression and sensitization are inadequate attempts of warding off fear, the difference being the interpretation of the triggering situation. We interviewed 101 primiparous women during routine pregnancy check-ups between the 34th and 40th week of pregnancy. The following instruments were applied: demographic data, repression-sensitization scale, scales concerning birth preparation and fear of birth, Spielberger's STAI-X and the Giessen scale of psychosomatic complaints. Three days post partum a scale concerning the experience of birth and the STAI-X were completed. Sensitizers had a tendency to admit fears more openly in the STAI-X and to experience birth as threatening. They complained about more psychosomatic symptoms than the repressor group in the Giessen scale. Non defensive-copers were found in-between. Sensitizers showed highest levels of fear of birth. No differences between repressors, non-defensive copers and sensitizers could be found concerning demographic data like birth complications (spontaneous delivery vs. cesarean section/forceps delivery). Neither did the groups show differences concerning the attendance of birth preparation courses.

Adolescent↗
PubMedDate not supplied

[Mother-daughter relationship as a motive for "late" pregnancy].

Two cases of elder multiparae are presented, who conceived a "late" pregnancy subsequent to their daughters' pregnancies. Both women shared specific pregnancy motives, which stemmed from unresolved conflicts in the mother-daughter--relationship. A second cluster of motives focuses around the wish to compensate for the perceived loss of youthfulness and reproductive ability or the loss of a partner in a symbiotic relationship.

Conflict, Psychological↗