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Biomedical subjects

M Schemper

Publications and source records attributed to M Schemper.

At least 73 records · Page 4Linked to original sources
PubMed1990

Antiplatelet treatment prolongs survival after carotid bifurcation endarterectomy. Analysis of the clinical series followed by a controlled trial.

To examine the role of antiplatelet drugs in the secondary prevention of arteriosclerotic arterial disease following carotid endarterectomy, a clinical series (n = 252) was analyzed. Based on these results a prospective randomized trial was initiated, comparing the effect of antiplatelet drugs (acetyl-salicylic acid [ASA] 1000 mg/day) versus untreated controls. In both investigations patient survival was the primary end point. A cardiac risk (n = 91) implied a significant reduction in patient survival (p less than 0.019 Breslow, p less than 0.052 Mantel). Antiaggregating drugs prolonged survival in the collective series (p less than 0.0001 Breslow, p less than 0.0002 Mantel) and in the subgroup of patients with cardiac risk (p less than 0.014 Breslow, p less than 0.020 Mantel) as well. In the prospective trial 66 patients were recruited, receiving ASA (n = 32) versus no therapy (n = 34). During follow-up 15 patients died, 4 in the treatment, and 11 in the control group. Between both groups there was a significant difference in the probability of survival (p less than 0.021 Breslow, p less than 0.048 Mantel).

Aspirin↗
PubMed1990

Oestrogen and progesterone receptor content as a prognostic factor in advanced epithelial ovarian carcinoma.

Levels of oestrogen receptor (ER) and progesterone receptor (PgR) in ovarian cancer tissue were examined with regard to their prognostic importance for survival in 179 patients with primary epithelial ovarian cancer stage III or IV in relation to: FIGO-stage, histological type, histological grade, age, ascites, and postoperative residual tumour. Hormone receptor content was determined with the DCC-method, receptor values higher than 9 fmol/mg protein were considered positive. Response to postoperative chemotherapy was significantly correlated with PgR content (80% responders in the group with PgR positive tumours and only 61% responders in the group with PgR negative tumours). A Cox proportional hazards regression model identified histological grade, residual tumour, age and PgR content as independent prognostic factors for survival in advanced epithelial ovarian carcinoma. PgR content had particularly significant prognostic relevance for patients with postoperative residual tumour mass less than or equal to 2 cm in diameter. Within this group of patients, those who are PgR positive have a 2-years survival probability of 83% compared with only 51% in the PgR-negative group.

Female↗
PubMed1990

[Evaluation of shoulder function after removal of the latissimus dorsi muscle for surgical flap].

The latissimus dorsi muscle is frequently used in reconstructive surgery. The present study was undertaken to determine the post-operative function of the shoulder girdle with respect to dominance in 26 patients following latissimus dorsi flap transplantation mainly for soft tissue coverage in the lower leg. The patients were interviewed and examined, with special attention being paid to shoulder mobility, dexterity and muscular strength. On interview, a considerable majority felt that very good results had been achieved. Raising the latissimus dorsi flap did however influence shoulder retroversion, particularly when surgery was performed on the non-dominant side. The influence of dominance was further noted as regards inward rotation of the shoulder and the ability to lead the hand backward over the shoulder. Dexterity was determined by a modified tapping test in the sagittal plane. Other than a minor correlation with age, post-operative function depended on whether the latissimus dorsi flap had been raised from the dominant or non-dominant shoulder. No effect of operation or dominance was observed in terms of isometric muscular strength, measured with an electronic device (Hottinger-Baldwin-Messtechnik). We believe that the function of the latissimus dorsi muscle can be compensated for by synergistic muscles. Yet, in rehabilitation, particular attention must be paid to the function of the non-dominant shoulder since it is used less in daily activity.

Adolescent↗
PubMed1990

[The value of 2 distinct prognosis scores in patients with peritonitis. The Mannheim Peritonitis Index versus the Apache II score].

Seventy patients suffering from purulent peritonitis entered this study, 31 of them were taken in prospectively, to contrast two different prognostic scores, the Mannheim Peritonitis Index (MPI) vs. the Apache II (APS II). The MPI is shown as a prognostic index for peritonitis with high accuracy in individual prognosis. The simultaneous use of both scores, the MPI as well as the APS II, leads to a negligible improvement of prognostic accuracy. Moreover, sensitivity and specificity with the MPI are of higher accuracy than calculated with the APS II.

Adolescent↗
PubMed1989

[Prognostic factors for survival in perforated colonic diverticulitis].

In a retrospective study we attempted to find prognostic factors for the mortality in perforated colonic diverticulitis. All patients of the First Surgical Department of Vienna University from 1965-1986 with complicated diverticulitis were included in this study. 47 patients had a perforated diverticulitis with a local abscess or a generalized peritonitis. In 35 patients a resection, in 12 patients a faecal diversion was performed. The mortality was 27%. A marked influence of age and preoperative complications on the prognosis was shown statistically. The operative procedure seems of secondary importance for operative mortality.

Abscess↗
PubMed1989

[Prevention of infection in implantation of femur head prostheses].

An account of 581 patients managed with head prosthesis after femoral neck fractures between 1975-1988 revealed that the administration of prophylactic antibiotics coupled with the use of a laminar airflow system in the operating room reduced the infection rate from 5% to 0.75%. The important risk factors which predispose infection are poor physical state, chronic urinary tract infection as well as diabetes mellitus.

Aged↗
PubMed1989

CA 125 as an independent prognostic factor for survival in patients with epithelial ovarian cancer.

Serum CA 125 levels (upper normal value less than 35 U/ml) determined before surgery and 3 months after surgery were evaluated as independent prognostic factors for survival in patients with epithelial ovarian carcinomas. In 163 women preoperative serum levels of CA 125 (p = 0.13) gave no additional information with regard to the relationship of survival prognosis to histologic grade (p = 0.04) and to the diameter of residual tumor mass (p = 0.03). In 132 patients serum CA 125 levels were also determined 3 months after surgery and reflected the effectiveness of the first two cycles of postoperative cytotoxic treatment. At that time CA 125 was the strongest independent prognostic factor for survival (p = 0.0006 Cox model), as compared with histologic grade (p = 0.06), International Federation of Gynecology and Obstetrics stage (p = 0.15), and diameter of residual tumor mass (p = 0.66). Therefore, we concluded that serum CA 125 levels determined 3 months after surgery can identify a high-risk population among patients with epithelial ovarian carcinomas for whom a more aggressive or more intensive treatment might be beneficial.

Aged↗
PubMed1989

The prognostic value of plasmaproteins in patients with abdominal sepsis.

In the course of the history of patients with severe peritonitis, opsonins, complements and other proteins of the plasma showed no significant difference between the data of the patients who later died or survived. We conclude that simple parameters like platelet count, creatinine and respiratory function are more sufficient.

Adult↗
PubMed1988

[Androgen receptors in primary breast carcinoma. Relation to prognostic factors in comparison with estrogen and progesterone receptors].

Androgen receptor content was correlated with various prognostic factors in 274 patients with breast cancer. Receptor content was determined by the dextran-coated charcoal method (DCC). No direct relationship was found between androgen receptor content and age of patient, menstruation status, TN status and number of affected lymph nodes. But in 232 patients in whom tumour differentiation could be determined, there was a highly significant relationship between it and androgen receptor content (P less than 0.01). Similar correlations were found also between these prognostic factors and oestrogen or progesterone receptors. The percentage distribution of tumours of different degrees of differentiation was independent of the kind of demonstrable steroid-hormone receptor. However, the frequency of highly differentiated tumours rose with the number of different receptors that were determined. Thus steroid-hormone receptors can be considered as markers for differentiation. It seems possible that the additional determination of androgen receptors allows for a more exact selection of patients who should receive hormonal treatment.

Adult↗
PubMed1988

Influence of postoperative anticoagulant treatment on patient survival after femoropopliteal vein bypass surgery.

To examine whether anticoagulants given after autologous saphenous bypass surgery influenced patient survival 119 patients who received such a graft for obliterative arterial disease were recruited for a controlled clinical trial. Patients were randomly assigned to start, in the second postoperative week, phenprocoumon (60 patients) or no treatment (59 patients). The median duration of survival for all patients was greater than 60 months, and the 75%-quartile was 39.0 (SE of the median 3.9) months. 10 patients died in the treated group and 20 in the control group. The treated group had a greater probability of survival (p less than 0.023, Breslow; p less than 0.043, Mantel). Graft occlusions occurred in 11 patients in the treatment group and in 17 controls. When these patients were excluded from the analysis, the difference in probability of survival between the two groups remained significant (p less than 0.009, Breslow; p less than 0.013, Mantel).

Aged↗
PubMed1988

Histopathologic characterization of human breast cancer in correlation with estrogen receptor status. A comparison of immunocytochemical and biochemical analysis.

A detailed histopathologic analysis of 399 primary breast carcinomas was performed, and several morphologic features were correlated with the estrogen receptor (ER) status. In all cases ER status was determined immunocytochemically by estrogen receptor immunocytochemical assay (ER-ICA). In 359 carcinomas ER status was also biochemically determined. Invasive lobular, mucoid, and tubular carcinomas rather than ductal carcinomas were ER-positive more frequently in ER-ICA. Medullary and papillary carcinomas had corresponding lower or higher ER positivity, respectively, by both methods. The correlation of histologic grade and its single factors with ER status was statistically significant by both methods. Lymphocytic reaction to tumor showed a significant inverse relationship to ER status by both methods. A statistically significant higher number of ER-positive carcinomas in ER-ICA and dextran-coated charcoal assay (DCC) occurred when elastic tissue was present. Different associations were found between stromal content, tumor diameter, and ER status in DCC and ER-ICA, respectively.

Adenocarcinoma↗
PubMed1988

[Multiple transplantation of the kidney as a risk factor].

The influence of match, immunological therapy, age of the recipient and sex has been analysed by graft survival in 91 patients receiving a second kidney graft. Effects of these risk factors in first kidney grafts are not demonstrable in second grafts with the exception of cyclosporin which also produces better second graft survival. The main active risk factor for second transplants is endurance of function of the first graft. Function of the first graft over a period exceeding 1 year gives a significantly better second graft survival rate than function lasting less than one year.

Adult↗
PubMed1988

Non-parametric analysis of treatment-covariate interaction in the presence of censoring.

The demonstration of varying treatment efficacy among different subsets of patients is an important part of the analysis of clinical trials. The paper commences by clarifying the meaning of interaction and by reviewing valid procedures of analysis in the presence of interaction. Suitable descriptive measures of treatment-covariate interactions are (ratios of) hazard ratios to which generalized Patel-Hoel tests for qualitative or ordinal categorical covariates are related. Both the hazard ratios and the tests are given in a formulation for use with different scoring systems such as u- or e. Furthermore, the procedures are related to common k-sample tests and thus are suitable for proportional and for converging hazards. A worked example is included.

Aged↗
PubMed1988

Results of a rigorous follow-up system in colorectal cancer.

Results of a computer-aided follow-up programme for patients with colorectal cancer are analyzed. Between 1978 and 1987 1293 patients underwent this programme, the drop-out rate was 17%. 299 recurrences in 168 patients were discovered (40% local recurrence, 29% liver metastases and 31% others). Fifty-one per cent of patients with local recurrence and 47% with liver metastases were symptom free. Radical surgery could be performed in 50% of local recurrences and in 26% of liver metastases. The three year survival rate after radical surgery for recurrence was 35% for local recurrences and 33% for liver metastases, the five-year-survival rate 23% and 15%, respectively.

Cohort Studies↗
PubMed1988

Rectal cancer: factors influencing the development of local recurrence after radical anterior resection.

The study was designed to select criteria which influence the incidence of local recurrence after radical anterior resection for rectal cancer. Local recurrence developed in 18 patients (20%) out of 90. All patients entered a prospective clinical study for the detection of local recurrence (mean observation time: 50 months). The following criteria were evaluated retrospectively: age, sex, staging, grading, gross appearance of the tumour, lymphatic reaction, invasion of lymph- and blood vessels, perineural invasion, mucus production of the tumour and width of the distal margin of clearance (measurement in cm in the specimen immediately after resection). The incidence of local recurrence (%) depended on Dukes stage (A: 7%, B: 17%, C: 40%; p less than or equal to 0.03), grading (well differentiated: 5%, average: 20%, poorly differentiated: 55%; p less than or equal to 0.02), gross appearance (protuberant: 15%, infiltrating: 47%; p less than or equal to 0.006), lymphatic stroma reaction (yes: 10%, no: 45%; p less than or equal to 0.006), invasion of veins (yes: 75%, no: 20%; p less than or equal to 0.0002), perineural invasion (yes: 52%, no: 17%; p less than or equal to 0.001) and the margin of clearance (less than 1 cm: 52%; 1-3 cm: 10%, greater than 3 cm: 15%; p less than or equal to 0.02 Mantel, p less than or equal to 0.05 Breslow between less than 1 cm vs 1-3 cm and greater than 3 cm, respectively). Local recurrence was not related to age, sex and mucus production of the tumour. Unfavourable morphological criteria may help to define groups with a higher risk of developing local recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗