Search PubMed⌕ Search

Biomedical subjects

M Wolf

Publications and source records attributed to M Wolf.

At least 397 records · Page 22Linked to original sources
PubMed1990

Fibrous dysplasia of the temporal bone presenting as an osteoma of the external auditory canal.

The involvement of the temporal bones by fibrous dysplasia is uncommon. This disease is usually manifested by a conductive hearing loss. We describe a case of fibrous dysplasia misdiagnosed as an osteoma in a young man. This case emphasizes the need to suspect fibrous dysplasia of the temporal bone as the cause of bony lesions in the external auditory canal in young patients.

Adolescent↗
PubMed1990

Toxoplasma gondii pneumonia in patients with the acquired immunodeficiency syndrome.

PURPOSE: To perform a retrospective and descriptive study of Toxoplasma gondii pneumonia in patients infected with the human immunodeficiency virus (HIV). Clinical presentation, diagnostic procedures, results of therapy, and hypotheses on pathophysiology are discussed. PATIENTS AND METHODS: The study consisted of 13 HIV-infected patients who had developed T. gondii pneumonia. Eight had acquired immunodeficiency syndrome (AIDS) prior to T. gondii pneumonia and three of them had non-Hodgkin's lymphoma. Mean CD4 cell count was 32 x 10(6)/L. Serum anti-toxoplasma antibody titers were measured by an indirect hemagglutination assay and/or by an indirect immunofluorescence assay. RESULTS: All patients had fever and bilateral pulmonary infiltrates; two of them presented with septic shock. Mean arterial oxygen tension was 47 +/- 12 mm Hg. The diagnosis was established by bronchoalveolar lavage in 10 of 11 cases, open lung biopsy in one case, and postmortem biopsy in two cases. Serologic evidence of past infection was observed in 11 of 12 cases, while one patient presented with acute disseminated disease and absence of serum anti-toxoplasma antibody response. Extrapulmonary involvement was present in seven patients: liver (four), brain (three), bone marrow (two), heart (two), stomach (one). Ten patients recovered from T. gondii pneumonia. CONCLUSION: T. gondii pneumonia must be considered in AIDS patients with severe diffuse bilateral pneumonia, especially when associated with a very low CD4 cell count or non-Hodgkin's lymphoma. In most of these cases, disseminated disease was associated with reactivation of prior latent infection.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Granulocyte colony-stimulating factor and neutrophil recovery after high-dose chemotherapy and autologous bone marrow transplantation.

Granulocyte colony-stimulating factor (G-CSF) was administered by continuous subcutaneous infusion to 15 patients with non-myeloid malignancies treated by high-dose chemotherapy and autologous bone marrow infusion. G-CSF was given at variable dosage based on neutrophil count. Sustained serum levels of G-CSF were achieved. Neutrophil recovery was accelerated in G-CSF treated patients compared with 18 historical controls and exceeded 0.5 x 10(9)/l at a mean of 11 days after marrow infusion compared with 20 days for controls, a significant difference. This reduction led to significantly fewer days of parenteral antibiotic therapy, 11 versus 18 days in controls, and less isolation in reverse-barrier nursing, 10 versus 18 days.

Agranulocytosis↗
PubMed1989

Prehospital use of APSAC: results of a placebo-controlled study.

Thrombolytic treatment efficacy is greater when the delay between onset of pain and treatment is short. To give treatment before admission to a coronary care unit, responsibility needs to be transferred from cardiologists to other physicians working in mobile care units. We conducted a 2-part feasibility study to investigate this strategy. Part 1 evaluated the diagnostic accuracy of mobile care unit physicians. Results from this study indicate that with regard to the diagnosis of acute myocardial infarction, the risk of a wrong diagnosis is low. Part 2 was a placebo-controlled trial involving 100 patients in which 57 received anisoylated plasminogen streptokinase activator complex (APSAC) (30 U) at home and 43 received placebo at home. Patients receiving placebo at home were reevaluated on arrival in a coronary care unit and received APSAC (30 U) if indicated. The main results were that (1) diagnostic accuracy was good--all patients had an acute coronary syndrome and 97 of 100 patients had myocardial infarction; (2) time gain was approximately 60 minutes; (3) coronary patency rate was 72%; (4) ejection fraction was higher in the prehospital group (56.7%) than in the control group (53.4%), but the difference was not significant; (5) there was no rhythmic or bleeding complication related to the prehospital treatment; (6) 5 patients died from cardiogenic shock--2 between home and hospital and 3 in the hospital (3 received thrombolytic treatment at home and 2 received placebo at home and APSAC in the hospital); and (7) prehospital administration of APSAC did not induce a delay in arrival to the coronary care unit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Intestinal infections in patients with acquired immunodeficiency syndrome. A prospective study in 132 patients.

We studied prospectively 132 patients with acquired immunodeficiency syndrome to define the spectrum of enteric pathogens during this disease, with special reference to the correlation between the lesions, the infections, and the symptoms. Forty-four percent of the patients harbored at least one enteric pathogen: the most frequently recovered were Cryptosporidium (28), cytomegalovirus (16), Entamoeba histolytica (13), Giardia lamblia (9), and Mycobacterium avium intracellulare (7). Patients harboring pathogens were more likely to be diarrheics (69%) than patients without a pathogen (38%; P = 0.01) and more likely to have endoscopic lesions (29%) than patients without a pathogen (4%; P less than 0.001). The most common pathogen associated with diarrhea was Cryptosporidium. Cytomegalovirus, Entamoeba histolytica, and Salmonella typhimurium were each significantly associated with endoscopic lesions. Patients with cytomegalovirus infection tended to have a greater incidence of ulcer than patients without cytomegalovirus infection. Stool analysis diagnosed 61% of the infections, while endoscopy diagnosed 44%. Seven percent were recognized by stool analysis and endoscopy. When considering the 24 patients in whom accurate diagnosis warranted endoscopic biopsies, stool examination alone would have given an incomplete diagnosis in 14 patients (due to the presence of polyinfection). The frequency of inaccurate diagnosis of infection by stool determination alone, plus the development of new antiviral agents that suppress cytomegalovirus, may favor the earlier application of endoscopic evaluation in these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The disturbance of hemostasis in septic shock: role of neutrophil elastase and thrombin, effects of antithrombin III and plasma substitution.

In 42 patients with septic shock, 29 of whom underwent substitution with antithrombin III concentrate and fresh frozen plasma for coagulation disorders, the proteinase-inhibitor complexes thrombin-antithrombin III and neutrophil elastase-alpha 1 proteinase inhibitor, were elevated on admission. On admission, the elastase complex was significantly higher in the patients receiving substitution (p = 0.0039), but at the endpoint it was higher in the non-survivors (p = 0.0040). The elastase decrease was confined to the substitution group with the thrombin complex decreasing in both groups. Initially the thrombin complex correlated with prothrombin times and factor XIII, while the elastase complex correlated with creatinine, thrombocyte count and prothrombin times in the late stages. Hemostatic disturbance, thrombin generation and neutrophil elastase release were favorably influenced by substitution. Furthermore, in this uncontrolled pilot study, the survival rate was higher in the treated (16 of 29) than in the untreated (1 of 13) patients, although the treated patients initially had pronounced hemostatic disturbances.

Adolescent↗
PubMed1989

Thyroid hormone and growth hormone interact to regulate insulin-like growth factor-I messenger ribonucleic acid and circulating levels in the rat.

Thyroid hormones influence growth in part by altering the secretion and effects of GH. GH, in turn, mediates its effects by regulating the synthesis and secretion of insulin-like growth factor-I (IGF-I). IGF-I is a pleiotropic growth factor that is synthesized by many tissues and acts on many tissues to regulate both cellular replication and differentiated function. We have studied the direct effects of thyroid hormones and the combined effects of thyroid hormones and GH on the regulation of IGF-I synthesis and secretion in hypophysectomized (hypox) rats in vivo. All rats, except normal littermates and a hypox control group, received 100 micrograms hydrocortisone/100 g BW for 10 days. Circulating IGF-I was measured by specific RIA (normal rats, 1 U/ml), and hepatic IGF-I mRNA was measured by Northern blot hybridization with an antisense cRNA probe. 1) Hypox rats treated with hGH (75 micrograms, ip, twice daily) for 10 days gained 17 g BW vs. 70 g for normal littermates. GH markedly increased hepatic IGF-I mRNA and circulating IGF-I (0.52 +/- 0.14 U/ml 12 h after the last GH injection vs. 0.03 +/- 0.02 for hypox controls). 2) T4 (1 micrograms/100 g BW, ip) for 10 days increased neither weight, hepatic IGF-I mRNA, nor circulating IGF-I. 3) Rats treated with T4 for 10 days followed by a single injection of 1 mg GH, ip, increased hepatic IGF-I mRNA and circulating IGF-I levels comparably as in rats receiving acute GH alone (IGF-I, 12 h, 0.31 +/- 0.09 vs. 0.36 +/- 0.06 U/ml). 4) Hypox rats treated with a single injection of T3 (1.5 micrograms/100 g BW, ip) had slightly increased hepatic IGF-I mRNA, but showed no significant change in circulating IGF-I levels. 5) A single injection of T3 plus GH to hypox rats increased IGF-I mRNA levels above those in rats injected with GH alone and increased serum IGF-I levels to 0.48 +/- 0.12 U/ml compared to 0.36 +/- 0.06 U/ml for GH alone. 6) After 10 days of GH treatment, a single injection of T3 lowered both hepatic IGF-I mRNA and circulating IGF-I (0.52 +/- 0.14 to 0.16 +/- 0.06 U/ml, 6 h after T3). These studies demonstrate that thyroid hormones have relatively little direct effect on IGF-I synthesis but can have major effects on GH-stimulated IGF-I synthesis and secretion. The pattern of these effects depends on the integrity of the pituitary gland, prior exposure of the liver to GH and/or thyroid hormones, and the temporal relationship between GH and thyroid hormone administration.

Animals↗
PubMed1989

[Prehospital thrombolysis. Evaluation of preliminary experiences at Val-de-Marne].

Benefits of thrombolysis have been shown to be greater when therapy is administered early, and this led us to consider the value of starting thrombolytic treatment in the patient's home. However, this implies the transfer of responsibility of patient management from the cardiologist to the physician in charge of the mobile emergency care team. A study was undertaken in the Val-de-Marne department to assess the benefits and risks of this therapeutic approach. The first phase was designed to evaluate the reliability of the emergency care team's diagnosis and the second phase of the study was a randomised double blind prehospital therapeutic trial of a thrombolytic agent, acylated streptokinase (intravenous bolus of 30 units in 4 minutes) against placebo. The nature of prehospital treatment was revealed on hospital admission and thrombolytic therapy was immediately given to those patients allocated to placebo at home providing the admitting cardiologist confirmed the indication. A total of 100 patients were included; 57 were allocated to thrombolytic therapy and 43 to placebo in the prehospital phase. The diagnosis of acute coronary insufficiency was confirmed in all cases and 97 p. 100 of patients had signs of acute myocardial infarction. No complications were attributable to prehospital administration of the thrombolytic. The average time gain in instituting treatment was 60 minutes. At control coronary angiography, 72 p. 100 of the coronary arteries thought to the responsible for the infarct were shown to be patent. The global left ventricular ejection fraction of patients treated with thrombolysis at home was 56.7 p. 100 compared with 53.4 p. 100 in the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗
PubMed1989

Reduced fibrinolytic capacity and its restoration by plasminogen substitution in acute renal failure.

A common finding in acute renal failure, particularly if it is caused by septic shock, consists of fibrin deposits in the intrarenal blood vessels. In a study of fibrinolytic parameters in 82 patients with severe bacterial infections, a significant negative correlation between plasminogen plasma concentration and serum creatinine was found. On admission the plasminogen levels were lower than the alpha 2-antiplasmin concentrations, which means a reduction of the fibrinolytic capacity due to a preponderance of the inhibitor. Preliminary experience with a replacement therapy is here reported. In 9 patients with an acute renal failure due to septicaemia or other serious diseases with shock, a substitution with fresh frozen plasma and antithrombin III concentrate was carried out in order to stop disseminated coagulation. A considerable increase of urine excretion was observed in 5 of these patients in close connection with the additional administration of a plasminogen concentrate.

Acute Kidney Injury↗
PubMed1989

Experience of a German multicenter study group with ifosfamide in small cell lung cancer.

In three German multicenter randomized trials, which included 718 patients, the activity of ifosfamide in small cell lung cancer (SCLC) was tested. In study 1, IE (ifosfamide, 1.5 g/m2, days 1 through 5; etoposide, 120 mg/m2, days 3 through 5) alternating with CAV (cyclophosphamide, 600 mg/m2, days 1 and 2; doxorubicin, 50 mg/m2, day 1; vincristine, 2 mg, day 1) was compared with a response-oriented treatment with IE therapy up to maximum response and subsequently an immediate switch to CAV. After chemotherapy, patients with limited disease received chest irradiation with 45 Gy. Prophylactic cranial irradiation (30 Gy) was given to all patients who achieved complete response (CR). A total of 324 patients were evaluable. Total response rate (CR + partial response [PR]) was 75% v 78% for the two treatment groups; the CR rate was 29% for both groups. Survival was nearly identical in both arms, with a median survival of 10.0 months for all patients, 12.0 months for those with limited disease (LD), and 7.5 months for those with extensive disease (ED). The 2-year survival rate was 11%. In study 2, IE was compared with PE (cisplatin, 90 mg/m2, day 1; etoposide, 150 mg/m2, days 3 through 5). A total of 141 patients were evaluable. Total response (CR + PR) rate was 65% for PE and 68% for IE; the CR rate for PE was 32% v 20% for IE. Survival favored PE with a median survival of 11.6 months v 9.4 months for all patients, 14.8 months v 11.0 months for LD, and 8.9 months v 7.5 months for ED. Two-year survival rates were 12% v 9% for all patients, 23% v 10% for those with LD, and 5% v 9% for those with ED. From these trials, we conclude that IE is an active and well-tolerated regimen for SCLC, and that PE may be superior to IE in limited-stage disease. Taking these results into account, we modified our chemotherapy protocols in study 3 and compared IAV (ifosfamide, 2 g/m2, days 1 to 5; doxorubicin, 25 mg/m2, days 1 and 2; vincristine, 2 mg, day 1) alternating with either PE or JE (carboplatin, 300 mg/m2, day 1; etoposide, 120 mg/m2, days 1 to 3). Interim results of 253 evaluable patients are as follows: CR + PR rate after 4 cycles was 68%; the CR rate was 28%; median survival was 11.6 months for all patients, 14.8 months for LD, and 10.2 months for ED.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1989

[The effect of delayed medical consultation on the results of ergotherapy].

In connection with 567 patients suffering from finger and metacarpale fractures who were treated conservatively the influence of the delaying time on the ergotherapy with its consequences was investigated, but also the influence of the ergotherapy itself. 80.3% of the patients showed a complete rehabilitation after an immediate beginning of ergotherapy. Only 41.0% of the patients remained without residual defects with the beginning of the ergotherapy after a conservative immobilisation therapy. Similar insufficient results were obtained in the group without ergotherapy (only 51.1%). Though after some years the function at late injuries was improved by the help of training in daily life and by means of work remarkable differences between the ergotherapy group and the collective without ergotherapy are recognizable.

Disability Evaluation↗
PubMed1989

[Accidental falls using ladders leaning against a wall. A study of 266 cases in relation to the cause of the accident, sequelae and prevention].

Falling accidents rank high on the list of industrial accidents in the building industry, accounting for 5.6 per cent (2) of allnotifiable cases. Studies were conducted into 266 falling accidents from lean-to-wall ladders, with age, trade, time of accident, cause of accident, and consequences being separately analysed. More than 50 per cent of all falling accidents occurred to workers while they were climbing ladders. Slight injuries accounted for 60.5 per cent, moderate injuries for 32.7 per cent, and severe injuries for 6.8 per cent. The falling depths of 79 per cent were between 0.3 m and 1.99 m. Lower extremities were primarily affected by distortion or dislocation, while upper extremities were more often injured by fractures. Non-compliance with safety rules was the most common single cause.

Accident Prevention↗
PubMed1989

[Ergotherapy in finger and middle hand fractures].

The value of ergotherapy (ET) was examined again. Two groups of patients were compared. 223 patients-treated with and 344 patients-attended without ET. It could be shown, that ET reduce the disablement in cases of fractures of metacarpalia and phalanges 1. In all cases with ET is the function of the injured hand something better and the rehabilitation more extensive. This could be underlined to, by measurement of ADUK.

Adolescent↗