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Biomedical subjects

P Roth

Publications and source records attributed to P Roth.

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

Implications of the introduction of fixed reimbursement rates in Germany.

The introduction of fixed reimbursement rates in Germany for cardiac surgery of adults, mainly coronary artery bypass grafting (CABG) and valve surgery, has shifted the financial risk from insurers to providers of medical care, namely hospitals. Costs in turn are closely related to the preoperative condition of a patient, implicating that surgery in high-risk patients may result in financial losses for the operating institution. Furthermore, reports from the Society of Thoracic Surgeons national database indicate a trend over time towards a higher proportion of patients with adverse risk factors for the United States. To determine whether these trends are holding true for Germany, we conducted an analysis of the data from two institutions with the following questions: 1. Is there a trend over time towards unfavourable risk factors, and 2. Is there a relation between preoperative risk factors and postoperative length of stay? From 1987 to 1995, 3872 patients underwent CABG at the Departments of Cardiovascular Surgery of Justus-Liebig University Giessen and German Heart Center Munich. Medical history, preoperative condition, intra-, and postoperative course were recorded for these patients according to the protocol of the German quality assurance program. Preoperative condition of the patient was summarized with an additive risk score. The correlation between postoperative length of stay in the intensive care unit (ICU) and preoperative risk was investigated. For a subgroup of 30 patients, detailed cost analysis was performed and the relationship to preoperative risk examined. For all risk factors examined, a significant increase in prevalence between 1987 and 1995 was observed. A close correlation between preoperative risk and postoperative length of stay in the ICU was found. A similar correlation existed between preoperative risk and actual costs of treatment. In addition, high-risk patients had a significantly higher likelihood of being discharged directly from our ICU to the ICU of other hospitals. Postoperatively, high-risk patients suffer more often from morbidity with subsequent prolonged intensive care and are, therefore, a financial burden for the operating institution in a reimbursement system with fixed rates. This is aggravated by the fact that a trend towards adverse risk profiles among patients undergoing cardiac surgery can be observed. Both factors combined may result in a scenario where those who would benefit most are denied surgical treatment.

Aged↗
PubMed1996

Lymphocytes subsets in normal individuals: analysis by four color immunofluorescence and flow cytometry on whole blood.

In order to precisely define human lymphocytes subsets, we used four color immunofluorescence analysis and flow cytometry. We report here the results of systematic studies performed on whole blood from 20 normal volunteers. This was performed using monoclonal antibodies recognizing 18 different CD molecules and analyzed here into 14 different 4-color immunofluorescence combinations. This showed that among T cells, the two major CD3+CD8+ and CD3+CD8- subsets differed greatly in the percentage of cells expressing CD26, CD27, CD28, CD38, CD45RA, CD45RO, CD57, S6F1, BY55, CD101 and their respective combination representing an array of subsets. Furthermore the minor NK subsets, i.e. CD2+CD3-CD8+, CD2-CD3-CD8+, CD2+CD3-CD8-, CD2-CD3-CD8- also differed in percentages of cells expressing CD16, CD56, CD57, S6F1, BY55 and their combinations.

Antigens, CD↗
PubMed1996

[Ultrasonic diagnosis and laparoscopic treatment of an ovarian pregnancy. A case report and review of the literature].

Ovarian pregnancy is an uncommon type of ectopic pregnancy. Incidence has been estimated at 1 per 7 000 pregnancies and 1 to 6% of ectopic pregnancies. Pathogenesis is different from tubal pregnancy. Generally it occurs as a single event in an otherwise healthy woman. Early diagnosis of ectopic pregnancy is essential and is now possible with the advent of endovaginal sonography associated with serum beta-hCG assay. There are various forms of ectopic pregnancies. Macroscopically, 4 forms can be distinguished: hematoma, clar ovum, embryonnized ovum, and placenta with fetus. Histology alone can confirm the diagnosis and distinguish between the 4 forms: intrafollicular, justafollicular, justacortical and interstitial pregnancy. For many authors, laparotomy is required in all cases, but in any case, the ovary can generally be preserved as implantation is usually superficial. We describe here a case of ovarian pregnancy after stimulated ovulation. Early diagnosis with correct localization was achieved with endovaginal sonography. Conservative treatment with laparoscopy was successful.

Adult↗
PubMed1996

[Hereditary angioneurotic edema in gynecology-obstetrics. Management].

Hereditary angioneurotic edema is a rare disease (250 cases currently identified in France). It is the most frequent among hereditary deficiencies of the complement system. This severe disease is fatal in 15-20% of the patients before 40 years of age. Death can be prevented if correct steps are taken in case of even minor trauma, which often trigger acute, potentially fatal, episodes. Danazol is used as preventive therapy before surgery and C1-esterase inhibitor or fresh frozen plasma is given for acute episodes. In case of obstetrical trauma, C1-esterase inhibitors should be used either as prophylaxy or as treatment. Fresh frozen plasma is used if C1-esterase inhibitors are not available. We report here our experience with three patients with known hereditary angioneurotic edema. Gynecology surgery was required in two.

Adult↗
PubMed1995

[Ambulatory operations in orthopedics].

Outpatient surgery in orthopedics, which ist becoming increasingly popular and is promoted by present-day health care legislation, is associated with a whole range of ifs and buts. Patient-related factors, including age, readiness and ability to cooperate, and home care, need just as much consideration as physician-related factors (experience of the surgeon, anesthesist und surgical team). Architectural and equipment-related facilities need to be investigated. Not every intervention that is theoretically possible on an outpatient basis can be recommended--for example if intensive aftercare, which is better performed on an inpatient basis, should be necessary. The usual postoperative risks (e.g. thrombosis) must be taken into account, and in such cases, proper care must be guaranteed.

Ambulatory Surgical Procedures↗
PubMed1995

Colony-stimulating factor-1 expression in the human fetus and newborn.

Colony-stimulating factor-1 (CSF-1) is a hematopoietic growth factor that regulates the survival, proliferation, and differentiation of mononuclear phagocytes. Because this cellular compartment undergoes major changes during fetal and neonatal life, we examined concurrent CSF-1 expression during human development. While levels increased dramatically after full-term birth, CSF-1 concentrations steadily declined in the preterm circulation from 2.7 to 1.9 times adult values as gestational age increased. CSF-1 was already detectable at 10 weeks gestation in spleen, intestine, lung, kidney, heart, and liver in order of decreasing concentration, but a positive correlation with gestational age was seen only in lung and intestine. Although a 4.4-kb CSF-1 mRNA was detectable in all tissues at all gestational ages, increased expression with advancing gestational age was observed in lung and kidney, whereas a rise and fall was observed in spleen. We conclude that CSF-1 concentration in the human circulation is developmentally regulated and that its expression in fetal tissues is compatible with its role in regulating the development of tissue mononuclear phagocytes.

Adult↗
PubMed1995

Influence of the administered mass of tellurium on plasma clearance in rabbits.

The combination of analytical techniques such as PNA and SIMS with a compartmental approach enables the study of the metabolism and biokinetics in humans of several elements by using stable isotopes as tracers. The techniques developed for Te require the administration of greater masses than those used for similar studies performed with radioactive tracers, therefore a test was carried out in rabbits in order to assess the possible influence of the administered amounts on the determination of the biokinetic parameters. The behaviour of the tracers was found to be similar for Te administration of up to 70 micrograms/kg of body weight. An inter-individual variability in the size of the transfer compartment was observed and has to be taken into account.

Animals↗
PubMed1995

Evaluation of the 131I thyroid-monitoring measurements performed in Ukraine during May and June of 1986.

After the Chernobyl accident in 1986, about 150,000 monitoring measurements were performed in Ukraine. From this data base, 40,000 measurements were selected for which the results of the reference-source measurements could be analyzed by statistical means. The majority of these measurements are of high quality. In this paper, the uncertainties introduced due to the variabilities of anatomic parameters and the measurement geometry are quantified by measurements using a thyroid-neck phantom. Parameters considered are the thyroid mass, the thickness of the tissue overlying the thyroid as well as the detector-neck distance, the orientation, and the horizontal and vertical position of the detector. The uncertainty introduced due to the variability of these factors corresponds to a coefficient of variation in the range of 25-40% for the measured activity.

Adolescent↗
PubMed1995

Proton activation analysis of stable isotopes for a molybdenum biokinetics study in humans.

Molybdenum is a trace element essential to life. Nevertheless, little information is available on its metabolism in humans. A methodology based on stable isotope administration that combines compartmental analysis, simultaneous use of two tracers, and proton nuclear activation (PNA) is presented. A four-compartment metabolic model was adopted. The compartments are stomach, small intestine, transfer compartment, and unquantified tissue pool. The employment of two different stable isotopes of the element under investigation as tracers was made possible by PNA. Optimization of the technique for molybdenum determination in plasma led to the choice of 95Mo and 96Mo as tracers. Their concentrations in plasma can be determined measuring the disintegration gamma lines of the corresponding technetium radioisotopes produced via (p,n) reaction. In the adopted experimental conditions, a minimum detectable concentration of 2 ng isotope/ml plasma was attained. A kinetics study was performed on two healthy volunteers. To both subjects one tracer was orally administered, and the other intravenously injected. Venous blood samples were withdrawn at different postinjection times and the concentrations for both isotopes determined. The model parameters describing molybdenum kinetics were obtained for the two individuals. Total absorbed fraction was found to be 0.84 +/- 0.03 and 0.86 +/- 0.07, respectively.

Activation Analysis↗
PubMed1995

Colony-stimulating factor 1 in the human response to neonatal listeriosis.

Immunity to Listeria monocytogenes, an important pathogen in human neonatal sepsis, is mediated by mononuclear phagocytes, which are regulated by the hematopoietic growth factor colony-stimulating factor 1. Neonates with listeriosis had higher circulating colony-stimulating factor 1 levels and subsequent monocyte counts than those of both noninfected newborns and newborns infected with nonlisterial organisms.

Humans↗
PubMed1995

Differences in calcium kinetic pattern between CAPD and HD patients.

To assess the effect of different dialysis modalities on calcium turnover, we studied 57 patients on maintenance hemodialysis treatment (HD) and 38 patients on continuous ambulatory peritoneal dialysis (CAPD) with tracer kinetic studies using two calcium isotopes (45Ca by mouth and 47Ca intravenously). The two groups were comparable in age, sex and prevalence of diabetes. The groups did not differ in their serum concentrations of intact parathyroid hormone (iPTH), calcium, inorganic phosphate and 1,25-dihydroxyvitamin D. 25-hydroxy-vitamin D and alkaline phosphatase were found to be significantly higher in HD patients. Despite these similarities, CAPD patients showed a significantly lower calcium kinetic response as measured by calcium retention and plasma calcium efflux than HD patients. Mean calcium retention was 39.5% in HD patients compared to 31.2% in the CAPD group (p < 0.05). Plasma calcium efflux was significantly lower in the CAPD group (2.7 vs 3.2 respectively; p < 0.01). iPTH correlated with calcium retention and plasma calcium efflux in HD patients (r = 0.69 and r = 0.67 respectively). In CAPD patients, the correlation coefficient between iPTH and calcium retention was markedly lower (r = 0.54), whereas no correlation was found between iPTH and plasma calcium efflux (r = 0.08). In addition, the slope of the correlation curve were higher in HD patients (p < 0.01 and p < 0.001, respectively), indicating a better response of this patient group to the action of parathyroid hormone. Our data are in accordance with recently published results showing that the dialysis modality has a major impact on bone turnover and on the progression of uremic bone disease. It has been shown that CAPD is an independent risk factor for the development of the adynamic form of renal bone disease. This finding may be explained by the lower response of calcium turnover to the action of PTH as shown here with tracer kinetic studies.

Adult↗
PubMed1994

Gamma 2b transgenic mice as a model for the role of immunoglobulins in B cell development.

The development of B lymphocytes is tightly linked to the expression of immunoglobulins (Igs). Pro/preB cells which do not correctly rearrange heavy/light chain genes are aborted. Correctly rearranged Ig transgenes are apparently recognized by the developing B cells and can prevent the rearrangement of endogenous Ig genes. Both mu and gamma 2b heavy chain genes cause this feedback inhibition of heavy chain gene rearrangement. Mu transgenes can in addition replace endogenous MU in its preB cell survival/maturation function. However, several different transgenic lines have shown that gamma 2b transgenes do not provide the nurturing functions of mu, except for one unique gamma 2b transgenic line, the C line. In this line mature B cells express gamma 2b only. Presumably, an unknown gene has been activated at the transgene integration site whose product overcomes the need for mu. The function of this gene depends of the presence of the surrogate light chain (sL), and thus must operate in combination with the preB cell receptor or in a downstream signaling/antiapoptosis event requiring the gamma 2b/sL receptor. The analysis of the two types of gamma 2b transgenic mice shows that the signals for preB cell development are highly complex and promises to reveal new insights into the molecular and cellular mechanisms of B cell maturation.

Animals↗
PubMed1994

Evidence for abnormal calcium homeostasis in patients with adynamic bone disease.

To investigate whether the derangements in calcium kinetics in patients with renal osteodystrophy are similar in the various histologic forms of this metabolic bone disease, 43 patients on chronic maintenance dialysis underwent calcium kinetic studies using the double isotope technique, iliac crest bone biopsies for mineralized bone histology and histomorphometry and determinations of serum indices of calcium and bone metabolism. Intestinal calcium absorption was not different among the three histologic groups. However, women exhibited lower calcium absorption in each histologic form (P < 0.01). Patients with predominant hyperparathyroid bone disease showed plasma calcium efflux, calcium accretion rate and calcium retention markedly above normal values. Patients with low turnover bone disease exhibited a normal or slightly decreased plasma calcium efflux and calcium accretion rate together with a disproportionately low calcium retention. Patients with mixed uremic osteodystrophy presented with a calcium kinetic profile intermediary to the two other forms. Good relationships existed between plasma calcium efflux, calcium accretion rate, calcium retention and histomorphometric parameters of bone turnover as well as serum levels of parathyroid hormone. However, no serum parameter could indicate with certainty the underlying bone disease. These findings demonstrate that adynamic bone disease does not merely represent an academic finding but is characterized by a very low bone capacity to buffer calcium and inability to handle an extra calcium load. This is particularly relevant for the daily care of end-stage renal failure patients presently receiving higher than ever amounts of vitamin D and calcium salts.

Adolescent↗