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Biomedical subjects

R Becker

Publications and source records attributed to R Becker.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Mild ventriculomegaly, mild cerebellar hypoplasia and dysplastic choroid plexus as early prenatal signs of CHARGE association.

CHARGE association has been diagnosed postnatally in increasing numbers since the first description in 1979. The acronym CHARGE includes the abnormalities ocular Colobomas (iris, retina or nervus opticus), Heart disease, Atresia of choanae, Retarded growth and development and/or central nervous system anomalies, Genital hypoplasia, Ear anomalies and deafness. So far, no prenatal diagnosis of the CHARGE association has been described; only one case report presents prenatal symptoms detected at 31 gestational weeks. In our case, prenatally detected mild cerebral ventriculomegaly and dysplasia of choroid plexus were abnormalities visible as early as 15+6 weeks as well as mild cerebellar hypoplasia at 21+1 weeks. At 28+6 weeks, in addition polyhydramnios could be found. The combination of the 'benign' central-nervous findings raised suspicion of a severe congenital malformation at 21+1 weeks which was confirmed postnatally in the form of diagnosis of CHARGE association.

Adult↗
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Prenatal diagnosis of isolated foramen ovale obstruction. A report of two cases.

Premature obstruction of the foramen ovale is a rare but serious clinical entity. Obstruction can be associated with right ventricular failure, fetal hydrops, tricuspid regurgitation, left heart obstructive defects and supraventricular tachycardia. In most cases, the diagnosis is made at the postmortem examination. The etiology is unknown. We discuss 2 prenatal cases with the sole diagnosis of ventricular asymmetry. The right ventricle was dilated and hypertrophic, and the foramen ovale ballooned into the left atrium without color Doppler detection of right-to-left flow. After delivery, the infants had no hydrops or symptoms of cardiac or respiratory distress. Echocardiography demonstrated a structurally normal heart with increased right ventricle dimensions until the 7th day of life. Delivery should be induced if possible in cases of foramen ovale obstruction with signs of cardiac decompensation.

Echocardiography↗
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Prediction of fetal distress and poor outcome in intrauterine growth retardation--a comparison of fetal heart rate monitoring combined with stress tests and Doppler ultrasound.

One hundred and three intrauterine growth retardation (IUGR) pregnancies were scheduled for pulsed Doppler ultrasound of the common carotid and the umbilical artery, nonstress and contraction stress tests (NST/CST) as well as vibroacoustic stimulation tests (VAST). The last examinations < 3 days before birth were compared by receiver-operator characteristics: Results of the resistance indices of fetal common carotid/umbilical artery and NST were more predictive of later fetal distress during labour, compared to CST and VAST (p < 0.001/< 0.01). Similar results were found for the prediction of low pH and Apgar values, though differences were less pronounced. Our results suggest that stressful examinations should be abolished from mother and fetus in the supervision of IUGR.

Female↗
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Successful treatment of primary fetal hydrothorax by long-time drainage from week 23. Case report and review of the literature.

We report on a case of unilateral primary fetal hydrothorax leading to nonimmunological fetal hydrops (NIHF). The NIHF was treated successfully by inserting two consecutive intrauterine catheters at 23 weeks gestation. The first catheter was dislocated through the uterine wall to the maternal peritoneal cavity. At 36 weeks gestation, the mother had a spontaneous onset of labor after premature rupture of membranes and a normal vaginal delivery of a healthy infant with good perinatal outcome. Shunting of PFHT has rarely been described up to now. This case report supports observations of previous authors that early shunting of pleural effusions may prevent progression of NIHF as well as postnatal pulmonary hypoplasia. Unexpected perinatal complications of fetus, mother or both should not be neglected.

Adult↗
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Prediction of fetal distress and poor outcome in prolonged pregnancy using Doppler ultrasound and fetal heart rate monitoring combined with stress tests (II).

Postterm pregnancies of more than 290 completed gestational days (n = 110) were simultaneously supervised after admission by pulsed Doppler ultrasound of the common carotid and the umbilical arteries, nonstress and contraction stress tests (NST/CST) and vibroacoustic stimulation tests (VAST). The results of these tests were blinded for the clinicians. Further decision making was based mainly on fetal heart rate (FHR) monitoring. The prognostic value of tests performed < 3 days before birth predicting fetal distress, low Apgar and pH values in the umbilical artery were compared by receiver operator characteristics. Results of the NSTs and fetal Doppler measurements of the ratio of resistance indices of common carotid/umbilical artery were more predictive of later fetal distress than both, VAST and CST (p < 0.01, p > 0.05, respectively). There were no significant differences in the prediction of low Apgar values. NST was the only significant test for predicting a low pH in the umbilical artery immediately after birth compared to the other examinations (p < 0.05). The results suggest that even in prolonged pregnancies VAST and CST might be released from routine supervision.

Apgar Score↗
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Post-stroke depression: relationships to functional impairment, coping strategies, and rehabilitation outcome.

This study examined the phenomenon of post-stroke depression and evaluated its impact on rehabilitation outcome. Sixty-four patients presenting to a rehabilitation program within weeks of first stroke were evaluated for depression through self-report measures and staff ratings. Patients also rated the particular coping strategies which they used in dealing with their illness and hospital stay. Physical and occupational therapists provided measures of functional impairment at admission and discharge. A high (47%) prevalence of depression was found in this population, with no overall differences observed between patients with right or left hemisphere lesions. Depressed patients, in comparison to non-depressed, evidenced greater functional impairment at both admission and discharge. However, both groups showed similar gains over the course of rehabilitation. Coping strategies employed by depressed patients appeared to reflect a lower level of participation in the rehabilitation process. A subgroup of patients evaluated 6 weeks after discharge revealed that depression was associated with a worsening on one measure of functional status. These findings indicate that depression is a frequent companion of stroke, that it is associated with degree of functional impairment, and that it may exert a negative impact on the rehabilitation process and outcome.

Adaptation, Psychological↗
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Teaching communication with the dying across cultural boundaries.

This article is based upon the author's personal experience, gained as a teacher of palliative care, when he was invited to be part of a small humanitarian aid team of experienced British nurse educators which worked for 2 weeks in the newly opened First Moscow Hospice in October 1997. The team was to act as both teachers and clinicians assisting the Russian health professionals to both understand and use the palliative care approach in a workable context for their culture. A case study is used to illustrate the ethical and practice-based nursing issues that arose which were related to communication difficulties, challenging myths and cultural norms, and the use of 'self' to demonstrate good practice. This article highlights how it is possible to overcome some of these difficulties, and shows what an honest and sensitive approach to communicating with the dying can achieve.

Aged↗
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The recovery of cerebrospinal fluid acetylcholinesterase activity in Alzheimer's disease patients after treatment with metrifonate.

We investigated the relationship between peripheral and central cholinesterase (ChE) inhibition levels after chronic treatment of Alzheimer's disease (AD) patients with metrifonate (MTF). In a 6-month, double-blind, placebo-controlled trial in AD patients treated with a weekly 2.9 mg/kg MTF dose, we observed 17.15 +/- 23.43, 66.92 +/- 7.30 and 60.80 +/- 12.20% inhibition (n = 6) of cerebrospinal fluid (CSF) and red blood cell (RBC) acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE), respectively. In another study, AD patients were treated with daily MTF to achieve RBC AChE inhibition levels of 85.90%. The CSF AChE inhibition was 67.93 +/- 13.69% (n = 3) at 3-4 h after the last treatment and 6.62 +/- 9.36% (n = 2) at 8 days after dosing. The recovery half time of CSF AChE was 2.21 +/- 1.22 days. These data show that CSF AChE recovers faster than the peripheral plasma and RBC enzymes. Under conditions of chronic weekly dosing with MTF, RBC AChE inhibition does not reflect CSF, and arguably, brain AChE inhibition. Our data do not support continuous central neuronal AChE inhibition as the mechanism for the long-term efficacy of metrifonate for the treatment of AD.

Acetylcholinesterase↗
PubMedDate not supplied

[Validation of the Tekscan system for statistic and dynamic pressure measurements of the human femorotibial joint].

In vitro dynamic pressure measurements in the healthy and pathologically altered knee joint help to improve our understanding of the loading pattern on femorotibial surfaces. The aim of the study was to evaluate a piezoresistive pressure measuring system. A human cadaveric knee was mounted in a material-testing machine (Bionix 858) using a specially designed knee-holding device. Axial loading of the knee, flexed at 20o, at 500 N, 1000N and 1500 N was then carried out. For the static investigations, the piezoresistive measuring system (Tekscan), was compared with the FUJI measuring system. In addition, dynamic measurements were also performed with the Tekscan System. With the exception of the lateral compartment at a load of 1500 N, no differences in maximum pressures were observed between the two systems. Nor were there any differences with regard to contact surfaces, either in the medial or lateral compartment (p > 0.05). However, the reproducibility of the data was significantly higher with the Tekscan System (p < 0.01). Dynamic pressure measurements obtained with the knee flexed 20 to 90o showed that the lateral contact area shifted from anterior to posterior, while the medial contact area remained virtually unchanged. The Tekscan System proved to be more reliable than the FUJI System, and permits simultaneous measurements in both compartments. The Tekscan System is suitable for dynamic measurement of the femorotibial joint, and permits measurements to be made under more physiological conditions.

Aged↗
PubMedDate not supplied

Glycosphingolipid component profiles or human gliomas--correlation to survival time and histopathological malignancy grading.

BACKGROUND: Glycosphingolipids (GSL) are expressed on the surface of neuroectodermal cells. The correlation of a variety of distinct GSL with different primary brain tumors has been demonstrated. Three distinct GSL-component profiles (GSL-types I, II and III) of human gliomas have been defined by our group. The purpose of this study was to evaluate the correlation of the established GSL-types I-III with survival time and histopathological malignancy grading in 40 human gliomas. METHODS: Neutral and acidic GSL-component patterns, histopathological malignancy grade and survival time, and a number of other relevant variables were examined. Kaplan-Meier survival curves were analyzed with the log rank test. RESULTS: GSL-type I was expressed in 18 tumors (17 Glioblastoma multiforme (GBM) and 1 anaplastic astrocytoma (AA)). GSL-type II was expressed in 11 tumors (7 GBM, 3 AA, 1 low grade astrocytoma (LGA)). 10 patients presented with GSL-type III (3 GBM, 4 AA, 3 LGA). Kaplan Meier survival curves of GSL-types I-III differed significantly (p = 0.0231, log-rank-test). However, survival time correlated better to the WHO grades. Within a given malignancy grade, GSL-types gave additional informations about the proliferative properties. CONCLUSIONS: This is the first report of a correlation between survival time and human glioma neutral and acidic GSL-components. The results are in agreement with observations of other investigators. The analysis of GSL-type expression might give useful additional information about proliferative properties of human gliomas in a given malignancy grade. In particular, the early prediction of outcomes in anaplastic or low grade gliomas might be possible.

Aged↗
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[Maxillary antrum surgery with or without bone lid formation. Retrospective comparative study].

A long-term study was performed after conservative maxillary antrum surgery with (50) and without (106) bone lid formation including a total of 154 patients. While no differences were found regarding the patients' sensitivity to changes in the weather, neurological disorders, or complaints of pressure sensations, considerably better results were obtained with respect of the time until a stable postoperative condition was achieved, the radiographic and the local findings, after surgery with the use of a bone lid.

Humans↗
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[Introduction of diagnostic statistics in accord with section 16 of the Federal Ordinance for Hospitalization Cost Rates (BPflV). Basic documentation for the clinical branch of oral and maxillofacial surgery].

In 1984 a first diagnosis and treatment code was developed for the computer documentation of patient data at the clinical department for oral and maxillofacial surgery of the Münster University Hospital. After a long time of testing and improving in day-by-day practical use, it today includes a total of 126 diagnoses and 169 forms of treatment. When in 1986 the Federal Ordinance for Hospitalization Cost Rates came into power, this documentation system had to be re-coded to comply with ICD 9 and, at the same time, a documentation sheet had to be developed that would meet both the necessary scientific standards and the given administrative criteria. In this paper a documentation sheet is presented that fulfills both requirements and, by virtue of its simplicity, avoids almost any loss of data.

Dental Records↗
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[The value of continuous respiration monitoring in the early diagnosis of potentially life-threatening diseases in newborn infants].

In 1983, 1 466 newborn children were monitored with the help of "apnea mattresses" during hospitalization in the Klinikum Steglitz. Sixteen children were transferred to the Pediatric Clinic for further diagnosis because of pathological respiratory rate patterns. Fourteen of those children had pathological findings with a predominance of infectious problems. Major health disorders in newborns seem to announce themselves, among other things, by an irregular breathing pattern. An early diagnosis of it is possible with the help of continuous respiratory monitoring.

Apnea↗