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Biomedical subjects

M Schemper

Publications and source records attributed to M Schemper.

At least 127 records · Page 7Linked to original sources
PubMed1985

Liver amino acids in sepsis.

The metabolic derangement of sepsis leads to changes of the plasma and muscle amino acid (AA) pattern. In this study the influence of a septic process on liver AA pattern was investigated. In seven patients with abdominal sepsis, liver AA concentrations were determined during surgery and compared with those of four patients who had undergone cholecystectomy. In sepsis lowered AA levels were found for most of the AAs. Outstanding decreases exhibited the levels of the gluconeogenetic AAs (especially threonine and alanine), the branched chain AAs, lysine, and taurine. In the patients who did not survive the septic process, the depletion of these AAs was even amplified. Slightly increased AA levels were analyzed for P-ethanolamine, cystathionine, citrulline, beta-alanine, tyrosine, and phenylalanine. The results indicate a disturbed free AA pattern of the septic liver. Despite the increased flux of gluconeogenetic AA from muscle to liver in sepsis, as reported by several authors, no accumulation of these AAs occurs in the liver.

Adolescent↗
PubMed1984

[Surgical therapy of breast cancer: to operate radically or to preserve the breast?].

Surgical treatment, i.e. partial resection (R) versus modified radical mastectomy (M) in lymph node negative T1/2 patients and M versus the classical Halsted procedure (RM) in lymph node positive cases, as well as adjuvant treatment forms, namely chemotherapy (B) and chemoimmunotherapy (C) versus a control group treated by surgery only (A) have been evaluated in 241 patients with breast cancer follow up over a median observation time of 48 months. Whereas M showed significantly better results than R, no difference was detected between M and RM. The incidence of recurrence in the R group did not appear to be markedly reduced by cytotoxic treatment. In the same way, the data from a retrospective study on non-randomized patients treated by breast resection, showed a relatively high local recurrence rate (23.6%) at a median observation level of 10 years. Considering the various forms of surgical treatment for operable breast cancer by analysing the data from retrospective studies and prospective randomized trials from the literature as well as our own results, the only recommendation for the standard treatment of patients with primary operable breast cancer should be nothing less than modified radical mastectomy. Breast-conserving treatment forms should be tested only within the framework of controlled clinical trials.

Breast Neoplasms↗
PubMed1984

[Statistical standards for clinical long-term studies].

Interest in the implementation of long-term clinical studies has grown considerably in Austria in recent years, partly encouraged by studies of this nature performed in West Germany, Great Britain and the United States. However, such studies have to be based on biometric standards that must be adhered to in the planning, implementation and reporting phases of long-term studies if they are to be regarded as authoritative and to find international acceptance. The present paper deals with such standards, based on the current level of methodological development as well as the authors' experience gathered over many years of participation in such projects. Special emphasis is placed on planning, random sampling and analysis, randomization, documentation, organization, termination of studies, reporting, multicentre investigations and cooperation between doctors and statisticians. The authors present several alternatives with and without the use of computers, attempt to explain to clinicians the role of the biostatistician in the supervision of long-term studies and offer their services to those interested in their cooperation.

Austria↗
PubMed1984

[The PTFE plastic prosthesis as an arterial replacement: experiences over a 5-year period].

Unilateral iliac femoral reconstructions with PTFE are yielding good results-similar to those with Dacron, with patency rates of 75, 67, and 65% at 1, 2 and 3 years, respectively (Kaplan-Meier). PTFE has additional advantages compared with other materials: a) no need of preclotting; b) smooth inner surface-easy thrombectomy in case of thrombosis and c) good handling characteristics. In view of the above-mentioned facts PTFE can be recommended without restriction for unilateral pelvic reconstructions. The functional early results of bilateral aorto-femoral Goretex-Y bifurcation grafts in 50 cases after 2 years are encouraging. Long-term results are still pending. Reports of other groups using this material as aorto-bifemoral substitute are not yet available. The functional results with PTFE for femoro-popliteal grafts are not satisfactory: 35% after 2.5 years. Extra-anatomical bypasses yielded 70% one-year functioning rate. Especially the ring-or spiral-armoured PTFE grafts seem to be suitable for these reconstruction procedures.

Aged↗
PubMed1984

[Causes of death in patients with pacemakers - with respect to the indication for implantation].

We compared the life expectancy of 1559 patients with an implanted pacemaker (PM) with a normal age-matched population and found a significantly reduced survival rate in paced patients. Patients paced for heart failure have the lowest survival rate, whilst those paced for Adams-Stokes attacks do slightly better. Patients with Adams-Stokes equivalents do not differ significantly from our normal population. 54% of patients with PM implanted for heart failure died due to heart failure despite PM implantation. The relative percentage of sudden death after PM implantation is high in groups with Adams-Stokes attacks (16%) and Adams-Stokes equivalents (20%). In both of these groups sudden death occurred especially during the first two years after PM implantation. The high risk of sudden death after PM implantation should increase our efforts to monitor patients carefully after PM implantation for the occurrence of malignant tachyarrhythmias.

Adams-Stokes Syndrome↗
PubMed1984

Postoperative infections in colonic surgery after enteral bacitracin-neomycin-clindamycin or parenteral mezlocillin-oxacillin prophylaxis.

In a prospective randomized, blind trial, three groups of patients undergoing elective colonic surgery were compared for frequency of surgical wound infection, intra-operative wound contamination and other postoperative infections. All patients allotted to the three groups received whole gut irrigation (101 balanced salt solution) by gastric tube on the evening before surgery and were treated as follows. Group A: no antibiotics; Group B: neomycin (1 g/l) + bacitracin (50,000 IU/l) + clindamycin (900 mg/l), contained in the last 31 of irrigation fluid; Group C: mezlocillin (4 g) + oxacillin (2 g) intravenously (iv) at induction of anaesthesia, followed by two identical doses at 8 and 16 h. The rate of postoperative wound infection was highest in A (38 per cent) and much lower in B (3.3 per cent, P less than 0.002) and C (6.9 per cent, P less than 0.004). The difference between B and C was statistically not significant. In A a correlation was established between the degree of wound contamination and the occurrence of wound infection. Intra-operative wound contamination was lowest in B (30 per cent), equal in A (58.1 per cent) and B (55.2 per cent). Other infections were least frequent in group C (four of 29 patients), but were not significantly different to groups B (six of 30) and A (nine of 31). It is concluded that antibiotics together with an effective mechanical preparation considerably reduce the rate of wound infection in colonic surgery.

Adult↗
PubMed1984

Postoperative assessment of below-knee bypass grafts.

Our results seem to demonstrate that, even when healthy or arteriosclerotic arteries tolerate knee flexion without any impairment of blood flow, all bypass materials, to a certain extent, have a tendency toward morphologic changes, such as kinking, looping, stenosis and decrease of peripheral blood flow. Reocclusion in below-knee reconstruction, which cannot be explained by poor outflow situation or technical faults, might be related to the graft material used as well as hemodynamic changes caused by flexion of the knee joint. With the use of ASV grafts, these changes are minimal and of little or no clinical importance; when HUV is used, these changes are more distinctive and might, in some instances, be the cause of reocclusion. This could explain the difference in the late results with the use of ASV or HUV. The results of reinforced PTFE still await evaluation. However, it should be kept in mind that the results in addition to the already mentioned influences are also caused by neointima proliferation and progression of the disease.

Aged↗
PubMed1983

The use of the Haemoccult test for detection of blood in gastric aspirates.

The guaiac test has recently been used as a determinant of gastric mucosal bleeding in trials comparing different therapeutic regimens for the prevention of gastric stress ulceration. A prospective study, evaluating the efficacy of cimetidine in controlling the gastric pH in 44 patients in our intensive care unit, demonstrated a significant direct correlation between the pH of the gastric aspirate and the Haemoccult test result. The percentage of positive test results decreased progressively with declining pH. Since this seemed to contradict all modern concepts of gastric mucosal damage, we investigated further the pH-dependent sensitivity in vitro. Using different test solutions (NaCl, gastric juice, duodenal juice, and bile) we demonstrated a strong pH-dependent decrease of sensitivity to detect blood below a pH of 4. These results led to the conclusion that the guaiac test is not a valid measure of gastric mucosal bleeding unless used on buffered gastric aspirates.

Cimetidine↗
PubMed1982

[Randomization for controlled therapeutic trials].

The choice of an adequate randomization procedure, the organization of the randomization process and its correct implementation are questions that may influence the quality of a controlled therapeutic trial. Starting with a brief critical review of randomization procedures now available, this paper presents in greater detail one method which is thought to be optimal for clinic trials of typical sample sizes. The "adaptive randomization" procedure of Pocock and Simon [3] keeps all 2-8 factors of prognostic importance in satisfactory balance-as has been confirmed by trials in the past 4 years. An interactive computer program, RANDOM, is introduced, whereby easy and safe use of the procedure is enabled via a video terminal. Furthermore, standardized recording of the randomization process by a clerk for medical documentation in the central randomization office is described. The possibility of randomizing multi-factorial trials and the admissibility of eliminating already randomized patients from a trial are discussed. The working group on documentation and biometry of the 1st Department of Surgery, Vienna University Medical School, offers the program to any centres that may be interested and is also willing to undertake randomizations (by phone) for clinical trials within Austria.

Aged↗
PubMed1982

The value of prognostic parameters for the stratification of advanced breast cancer patients.

One hundred seventy-five patients with metastatic breast cancer, treated with a combination chemotherapy (Cooper regimen), were analyzed retrospectively to identify the value of the traditional prognostic parameters (disease-free interval; menopausal status; dominant site of metastatic lesion) for the stratification of patients before randomization. Response rate and survival time were not significantly affected by the disease-free interval and menopausal status. A significant difference was detected among the three categories of dominant disease (locoregional; osseous; visceral). However, an estimate of total extent of disease (according to Swenerton) was found to be the most important factor for predicting response and survival time after combination cytotoxic treatment. The differences between the dominant size of metastatic disease are mainly influenced by different size of metastatic spread. Therefore, there is found a significant correlation between the different types of dominant lesions and total extent of disease. In conclusion, the particular sites of metastatic spread seem to be of less importance than overall extent of disease in predicting the outcome. A critical evaluation of the three traditional stratification parameters and introduction of a semiquantitative estimation of total tumor burden as a new stratification parameter seems to be necessary when planning and comparing future trials.

Adult↗
PubMed1982

[Malnutrition and postoperative complication rate in cancer patients (author's transl)].

The nutritional status and skin reactivity of 82 cancer patients were determined before surgery and compared with the postoperative complication rate. The nutritional status of 47 patients was evaluated by weight, height, weight-loss, arm muscle circumference, triceps skin-fold measurements, serum albumin, pre-albumin, retinolbinding protein, tranferrin, and cholinesterase. In 35 patients protein catabolism was assessed by the urea production rate (catabolism greater than 15 g/d). Immunity was assessed by the total lymphocyte count and a skin reactivity test. Using these criteria, 55% of the patients were malnourished. Curative operations could only be carried out in 17.4% of the malnourished, but in 50% of the normally nourished patients (P less than 0.0001). Postoperative complications were increased in malnourished patients (47%) when compared with normally nourished patients (20%, P less than 0.05). In anergic and malnourished cancer patients no curative surgical treatment was possible. Due to the increased postoperative complication rate in malnourished cancer patients, nutritional assessment, including the determination of cellular immunity should be performed after admission.

Body Height↗
PubMed1982

Metabolic disorders in severe abdominal sepsis: glutamine deficiency in skeletal muscle.

The metabolic profiles of 14 patients with prolonged abdominal sepsis were analysed on the second day after laparotomy. The profiles of survivors were compared with those of non-survivors who died one to five days after the time of evaluation due to uncontrollable multiple organ failure. In the non-surviving patients plasma glucose and glucagon levels were significantly higher than in surviving patients. The plasma concentrations of phosphoserine, cysteine, valine, phenylalanine, and 3-methylhistidine were found to be significantly increased in non-survivors and their muscle tissue showed significantly decreased concentrations of glutamine, proline and lysine with increases in valine and leucine. A correct classification of non-survivors and survivors could be obtained from the plasma and muscle amino acid concentrations, the highest discriminant power being from muscle glutamine. In severe sepsis metabolic changes correlate with the outcome of the patients, and amino acid metabolism seems to be characterised by low concentrations of muscle glutamine and high levels of the branched chain amino acids possibly indicating an inhibited intracellular glutamine formation in muscle tissue.

Journal Article↗
PubMed1982

Acetylsalicylic acid in combination with dihydroergotamine for preventing thromboembolism.

In a prospective randomized clinical trial involving 150 patients who underwent major abdominal surgery, acetylsalicylic acid (ASA) and dihydroergotamine (DHE) were examined either alone or in combination for their potential to prevent thromboembolism. Combined treatment with ASA and DHE was found to be more effective in preventing the spread of thrombi and their propagation to the femoral veins.

Adult↗
PubMed1981

[Problems arising in connection with surgical management of renovascular hypertension (author's transl)].

65 consecutive renal artery stenosis reconstructions for the treatment of severe renovascular hypertension are reported. 63% of the cases were males, 37% females. The disease was caused by arteriosclerosis in 66% of cases and in 23% by fibromuscular dysplasia or other pathological changes of the renal artery; the mean age was 47 in the former. and 31 years in the latter group. An aortorenal saphenous vein bypass was performed in 35% cases, a dacron graft was used in 29% and thrombendarteriectomy was carried out in 23% cases. Positive results were achieved in 68.8% of the patients. 63% of the females became normotensive. Operative mortality due to faulty technique was 4.9% initially. The operative mortality has been zero since 1973. nor have there been any therapeutic failures on a technical basis. No significant correlation was established between age of the patients and result of operation.

Adult↗