Search PubMed⌕ Search

Biomedical subjects

P Meier

Publications and source records attributed to P Meier.

At least 91 records · Page 5Linked to original sources
PubMed1996

Endoscopic management of biliary tract strictures in primary sclerosing cholangitis.

BACKGROUND AND STUDY AIMS: In a subgroup of patients, primary sclerosing cholangitis (PSC) is complicated by high-grade focal strictures of the bile ducts, and this can have an unfavorable influence on the natural course of the disease. The aim of this study was to evaluate the efficacy and safety of endoscopic treatment in this selected patient group. PATIENTS AND METHODS: Twelve symptomatic patients with primary sclerosing cholangitis and major ductal strictures were included in a prospective study of endoscopic treatment. All patients were managed by repeated angioplasty-type balloon dilation and nasobiliary catheter perfusion. A minimum of two treatment sessions was used, and therapy was continued until satisfactory reopening of the strictures was obtained. Routine endoscopic follow-up was performed after three, six, 12, 18, and 24 months, and then at yearly intervals. The efficacy of therapy was assessed by evaluating clinical symptoms, laboratory data, and cholangiograms. RESULTS: The long-term follow-up averaged 23 months (range: 12-50 months). Two to nine (mean: three) treatment sessions were required to obtain satisfactory reopening of major biliary strictures. Eight patients showed considerable and sustained improvement. The mean serum bilirubin, alkaline phosphatase, gamma-glutamyl-transpeptidase, and alanine aminotransferase levels felt significantly by 73% (P = 0.0164), 46% (P = 0.0022), 55% (P = 0.0022), and 58% (P = 0.0022), respectively. The average radiographic stricture score before treatment was 3.2 +/- 0.8 (P = 0.0033). Three patients required liver transplantation seven, 12, and 40 months after the initiation of endoscopic treatment, due to a deterioration in hepatic function or an inability to exclude complex biliary malignancy. No major procedure-related side effects were observed. CONCLUSIONS: Our results suggest that the endoscopic treatment of PSC patients with dominant bile duct strictures is effective, safe, and well-tolerated. However, it is important not to overlook the potential development of cholangiocarcinoma.

Adolescent↗
PubMed1996

[Vitreous and fundus changes in Terson syndrome. 3 case reports].

BACKGROUND: Terson syndrome is defined as the presence of intraocular hemorrhages in association with a sudden increase in intracranial pressure. The hemorrhages can occur in the subretinal space, within the sensory retina, between the retina and the hyaloid membrane and in the vitreous cavity. PATIENTS: We report about three eyes from two patients with Terson syndrome, in which vitreous hemorrhages were noted. In one eye we observed a preretinal macular hemorrhage. Pars plana vitrectomy was performed in two eyes. RESULTS: The hyaloid was surgically peeled away, which showed a membrane covering the macula. When this membrane was stripped away a retinal fold 360 degrees surrounding the macula was noted, in one eye a light fibrotic line was visible. The premacular hemorrhage and the intrahyaloidal hemorrhages in this eye were resorbed spontaneously after 5 months. In all eyes visual acuity increased to 1,0. CONCLUSION: In most eyes with Terson syndrome it is possible to wait for the spontaneous resorption of the blood. It is hypothesized that blood from a ruptured vein or capillary hydrodissects the internal limiting membrane from the underlying neurosensory retina. If a pars plana vitrectomy is performed the possibility of a hydraulical dissected internal limiting membrane has to be considered. Postoperatively perimacular retinal folds or fibrotic lines may occur, they didn't have any clinical evidence.

Adolescent↗
PubMed1996

The protective effect of immunologic boosting against zoster: an analysis in leukemic children who were vaccinated against chickenpox.

Whether reexposure of varicella-immune persons to varicella-zoster virus would protect against or predispose to development of zoster was analyzed. The rate of zoster in 511 leukemic recipients of varicella vaccine who had 1 or > 1 dose of varicella vaccine and in those who did or did not have a household exposure to varicella was determined. A Kaplan-Meier life-table analysis revealed that the incidence of zoster was lower in those given > 1 dose of vaccine (P < .05). A Cox proportional hazards analysis showed that both household exposure to varicella and receipt of > 1 dose of vaccine were highly protective (P < .01) against zoster. Thus, the risk of zoster is decreased by reexposure to varicella-zoster virus, either by vaccination or by close exposure to varicella.

Chickenpox↗
PubMed1996

Resolution of intracranial calcifications in infants with treated congenital toxoplasmosis.

PURPOSE: To determine the natural history of intracranial calcifications in infants with treated congenital toxoplasmosis. MATERIALS AND METHODS: Between January 1982 and March 1994, cranial computed tomography was performed in 56 infants with treated congenital toxoplasmosis when they were newborns and approximately 1 year old. Locations and sizes of intracranial calcifications were noted. RESULTS: Forty newborns had intracranial calcifications. By 1 year of age, calcifications diminished or resolved in 30 (75%) and remained stable in 10 (25%) of these treated infants. Ten (33%) of the 30 infants whose calcifications diminished versus seven (70%) of the 10 infants with stable calcifications received less intensive antimicrobial treatment than the other treated infants. In contrast, a small number of infants who were untreated or treated 1 month or less had intracranial calcifications that increased or remained stable during their 1st year of life. CONCLUSION: Diminution or resolution of intracranial calcifications was an unexpected and remarkable finding in infants with treated, congenital toxoplasmosis, consonant with their improved neurologic functioning.

Anti-Infective Agents↗
PubMed1996

[Not Available].

Explore the source record for details and available documents.

Complementary Therapies↗
PubMed1996

[Postoperative vomiting after pars plana vitrectomy].

In the present investigation we compared two different techniques of anaesthesia--total intravenous anaesthesia (TIVA) versus balanced anaesthesia--with and without antiemetic prophylaxis, with regard to postoperative nausea, strangling irritation and vomiting and their influence upon postoperative complications (intraocular bleedings) and postoperative intraocular pressure after pars plana vitrectomia. For this investigation four groups were formed. The anaesthesias were carried out as orotracheal intubational anaesthesia following two standard techniques, which only differ in the choice of the narcotics. Half the patients in each group were treated with an antiemetic prophylaxis of 2.5 mg DHBP. With regard to the occurrence of postoperative nausea and vomiting, the TIVA-groups proved to be better than those with balanced anaesthesia (16% to 43.5%; p < 0.05): DHBP in both methods led to a reduction of postoperative vomiting and nausea, but the differences showed not to be significant (p > 0.05). Best results were achieved with a combination of TIVA (propofol, alfentanil, atracurium, air/O2) and DHBP (4.7%). The total rate of postoperative complications in form of intraocular bleedings amounted to 8.6%. The appearance of complications increased when postoperative nausea and vomiting or increased intraocular pressure were observed (16.6% to 6.3%; 21.2% to 6.1%). Intraocular pressure, measured for four hours postoperatively, was significantly lower in the TIVA-groups than in the balanced anaesthesia-groups (15.5 +/- 7.7 mmHg to 18.3 +/- 8.2 mmHg). Therefore, we conclude that TIVA with propofol appears to be especially suitable for intraocular surgery.

Adult↗
PubMed1996

The Pittsburgh randomized trial of tacrolimus compared to cyclosporine for hepatic transplantation.

BACKGROUND: Tacrolimus (formerly FK506) was first used clinically in 1989 to successfully replace cyclosporine in hepatic transplant recipients who were experiencing intractable rejection or as the baseline drug from the time of operation. After extensive pilot experience, an institutional review board-mandated clinical trial comparing cyclosporine with tacrolimus was performed. STUDY DESIGN: From February 16, 1990 to December 26, 1991, 154 patients were recruited. The competing drugs were combined with equal induction doses of prednisone in both arms of the study for the first 81 patients and with subsequently higher doses of prednisone in the remaining 35 patients who received cyclosporine and were entered into the trial. Drug crossover was permitted for lack of efficacy or adverse events. End points were rejection confirmed by biopsy and treatment failure leading to retransplantation or death. RESULTS: Seventy-nine patients were randomized to the tacrolimus arm and 75 to the cyclosporine arm during 1990 and 1991. All patients were available for follow-up throughout the trial, which terminated on May 30, 1995. The mean duration of follow-up was four years. Patients randomized to the tacrolimus arm were less likely to experience acute rejection than were those receiving cyclosporine, with 36.2 percent of the patients receiving tacrolimus and 16.8 percent of the patients receiving cyclosporine showing freedom from rejection at one year (p = 0.003, likelihood ratio test). Survival of patients over the course of the study was virtually the same in the two groups.

Adolescent↗
PubMed1996

[PCR: a look behind the scenes at bovine viral diarrhea virus].

As indicated by their nucleotide sequences bovine viral diarrhea viruses (BVD-virus) are genetically quite heterogenous. Despite differences in the nucleotide sequence in the NS3 region, we found that the derived amino acid sequence of all viral strains analyzed was identical and differed from that of classical swine fever viruses, thus allowing differentiation between bovine and porcine pestiviruses. Remarkably, the BVD viral strains were isolated over a time period of some 40 years in Europe, North America and New Zealand. The nucleotide sequence of the 5' untranslated genome region of a BVD virus recently isolated in Switzerland from a calf with hemorrhagic syndrome differs from that of BVD viruses causing similar symptoms in a large epidemic outbreak in North America.

Animals↗
PubMed1995

Alternative mRNAs encode multiple isoforms of transcription factor AP-2 during murine embryogenesis.

Transcription factor AP-2 has been implicated as an important regulator of gene expression during vertebrate embryogenesis. We report here the cDNA cloning and analysis of mouse embryonic mRNA splice variants encoding four AP-2 isoforms. Isoform 1 is the homolog of the previously known human (HeLa) AP-2. The three new AP-2 isoforms all share the same DNA binding/dimerization domain as isoform 1 but either lack the proline-rich transcriptional activation domain encoded by exon 2 (isoform 2) or have different amino-termini encoded by two previously unknown alternative first coding exons for AP-2 (isoforms 3 and 4). All four AP-2 mRNA variants are present at significant levels between Days 11.5 and 17.5 of mouse embryogenesis. Variants 1, 3, and 4 show qualitatively but not quantitatively similar restricted expression patterns in 8.5-12.5 dpc embryos examined by in situ hybridization. At mid-embryogenesis, variant 3 is the major AP-2 mRNA species in the nervous system and in total embryo RNA but is less prevalent than variants 1 and 4 in the epidermis. The four mRNAs are all induced, although unequally, during differentiation of P19 cells into neural cell types and by cAMP stimulation of primary astrocytes. Variants 1-3 are coexpressed in different ratios in HeLa cells and in three human glioblastoma cell lines. These findings reveal that transcriptional regulation by AP-2 is likely to be more complex than previously assumed given the potential for multiple AP-2 homo- and heterodimeric DNA binding forms.

Alternative Splicing↗
PubMed1995

Getting enough: mothers' concerns about breastfeeding a preterm infant after discharge.

OBJECTIVE: To describe maternal concerns about breastfeeding a preterm infant in the postdischarge period and to delineate the strategies mothers used in managing these concerns. DESIGN: Naturalistic inquiry was used. SETTING: A semistructured interview was conducted with the mother in the home 1 month after discharge of the infant. PARTICIPANTS: Twenty mothers of preterm infants; the infants had been in a level 3 hospital nursery, and the mothers had received individualized breastfeeding support services in the hospital. MAIN OUTCOME MEASURES: Three categories of maternal concerns emerged from the data: adequate milk consumption by infants; milk composition; and problems with the mechanics of breastfeeding a preterm infant. Mothers identified strategies for these concerns. RESULTS: The mothers' main concern was whether infants consumed an adequate volume of milk by breastfeeding alone. Strategies for managing concerns about getting enough included using supplemental and complemental feeding, using ongoing cues to tell that the infant is getting enough, and persevering with breastfeeding. CONCLUSIONS: Mothers of preterm infants have unique concerns about breastfeeding in the postdischarge period and need individualized interventions.

Adaptation, Psychological↗
PubMed1995

Human cytomegalovirus (HCMV) immediate-early enhancer/promoter specificity during embryogenesis defines target tissues of congenital HCMV infection.

Congenital human cytomegalovirus (HCMV) infection is a common cause of deafness and neurological disabilities. Many aspects of this prenatal infection, including which cell types are infected and how infection proceeds, are poorly understood. Transcription of HCMV immediate-early (IE) genes is required for expression of all other HCMV genes and is dependent on host cell transcription factors. Cell type-specific differences in levels of IE transcription are believed to underlie differences in infection permissivity. However, DNA transfection experiments have paradoxically suggested that the HCMV major IE enhancer/promoter is a broadly active transcriptional element with little cell type specificity. In contrast, we show here that expression of a lacZ gene driven by the HCMV major IE enhancer/promoter -524 to +13 segment is restricted in transgenic mouse embryos to sites that correlate with known sites of congenital HCMV infection in human fetuses. This finding suggests that the IE enhancer/promoter is a major determinant of HCMV infection sites in humans and that transcription factors responsible for its regulation are cell type-specifically conserved between humans and mice. The lacZ expression patterns of these transgenic embryos yield insight into congenital HCMV pathogenesis by providing a spatiotemporal map of the sets of vascular, neural, and epithelial cells that are likely targets of infection. These transgenic mice may constitute a useful model system for investigating IE enhancer/promoter regulation in vivo and for identifying factors that modulate active and latent HCMV infections in humans.

Animals↗
PubMed1995

Neurologic and developmental outcome in treated congenital toxoplasmosis.

BACKGROUND: Earlier studies have shown that infants with untreated congenital toxoplasmosis and generalized or neurologic abnormalities at presentation almost uniformly develop mental retardation, seizures, and spasticity. Children with untreated subclinical disease at birth have developed seizures, significant cognitive and motor deficits, and diminution in cognitive function over time. OBJECTIVE: To determine neurologic, cognitive, and motor outcomes for children with congenital toxoplasmosis who were treated for approximately 1 year with pyrimethamine and sulfadiazine. DESIGN AND METHODS: Systematic, prospective, and longitudinal neurologic, cognitive, and motor evaluations were performed for 36 individuals with congenital toxoplasmosis. These infants were born between December 1981 and January 1991 and were treated with pyrimethamine and sulfadiazine for approximately 1 year beginning in the first months of life. Compliance with medications was documented. These individuals were evaluated in a standardized manner in a single center in the first months of life and at approximately 1, 3.5, 5, 7.5, and 10 years of age. Their cognitive function was compared with the cognitive function of a nearest-age, same-sex sibling when such siblings older than 3.5 years were available for study. RESULTS: Signs of active central nervous system infection (eg, cerebrospinal fluid [CSF] pleiocytosis, hypoglycorrhachia, elevated CSF protein, and, in some instances, seizures and motor abnormalities) resolved during therapy. Six of the 36 children had perinatal seizures. Four had their anticonvulsant therapy discontinued successfully within the first months of life, and two additional children developed new seizures at 3 and 5 years of age. Tone and motor abnormalities resolved by 1 year of age in 12 of 20 infants who exhibited abnormalities of tone and motor function at their initial neonatal evaluation. By February 1992, 29 of the 36 children had been evaluated when they were 1 year old, and 23 (79%) had a mean +/- standard deviation Mental Developmental Index (MDI) of 102 +/- 22 (range, 59 to 140). Six (21%) had a measure of their cognitive function that was less than 50. Results of sequential IQ tests, performed at 1.5 year intervals or greater, did not differ significantly over time (P > .05). Seven children with MDIs greater than 50 were compared with sibling controls; they had scores of 87 +/- 11 (range, 68 to 97) and their siblings had scores of 112 +/- 15 (range, 85 to 132) (P = .008). Seventeen of 18 children without hydrocephalus and six of eight children with obstructive hydrocephalus responsive to shunting had normal or near-normal neurologic and developmental outcomes. Children with hydrocephalus ex vacuo present at birth, with high CSF protein, and with lack of response to shunting have done less well. CONCLUSIONS: Neurologic and developmental outcomes were significantly better for most of these treated children than outcomes reported for untreated children or those treated for only 1 month (P < .001). Although the level of cognitive function for treated children was less than for their uninfected siblings (P < .008), there was no significant deterioration in neurologic and cognitive function of the treated children tested sequentially. These favorable treatment outcomes justify systematic identification and treatment of pregnant women with acute gestational Toxoplasma infection and young infants with congenital toxoplasmosis.

Child Development↗
PubMed1994

Noncytopathic strains of bovine viral diarrhea virus prime bovine bone marrow-derived macrophages for enhanced generation of nitric oxide.

Bovine bone marrow-derived macrophages (BBMM) were infected in vitro with a cytopathic (cp) and a noncytopathic (ncp) biotype of bovine viral diarrhea virus (BVDV). The virus strains used, TGAN (ncp) and TGAC (cp), originate from one animal and are antigenically closely related. Both TGAC and TGAN infected a subset of BBMM. Only cp BVDV induced a cytopathic effect. Infection of BBMM resulted in the modulation of certain macrophage functions. Only ncp strains of BVDV primed BBMM for enhanced reactive nitrogen production in response to Salmonella dublin. In contrast, infection with both biotypes did not influence bacteria-induced procoagulant activity and both biotypes equally reduced PMA-induced superoxide production. This suggests that the two biotypes differentially and selectively affect certain macrophage functions related to host defense. For the first time, a BVDV biotype-associated difference has been related to a biochemical parameter of the host cell.

Amino Acid Oxidoreductases↗
PubMed1994

[Mycotic retrobulbar neuritis].

BACKGROUND: Fungal disease is one of the most common complications of malignant haematologic disease. In the major part of the patients the lungs and the gastrointestinal tract are affected. Infections of the eyes and adnexa are very rare. PATIENT AND METHODS: A 75-year-old woman presented with acute unilateral loss of vision. The history revealed an anaplastic anemia. Vision of the affected eye decreased to light perception. The ophthalmoscopic findings were normal. A retrobulbar tumor was diagnosed by ultrasonography and CT. It was regarded as a glioma or a meningioma. A Non-Hodgkin lymphoma of low malignancy was proven by biopsy of bone marrow; hence a retrobulbar lymphoma was included in the differential diagnosis. Radiation was started, but the general state of health worsened and the patient died. AUTOPSY FINDINGS: A severe mycotic infiltration of the left optic nerve sheath was found, which had broadened the spatium intervaginale. Cause of death was a pneumonia by generalized immunocytoma. CONCLUSIONS: In cases with retrobulbar tumors and malignant haematologic diseases fungal infections should be included in the differential diagnosis. Serologic investigations are useful. The prognosis is poor and depends on the course of the basic disease.

Aged↗
PubMed1994

[Not Available].

Explore the source record for details and available documents.

Environment↗