Search PubMed⌕ Search

Biomedical subjects

R Bittner

Publications and source records attributed to R Bittner.

At least 91 records · Page 5Linked to original sources
PubMed1991

Borrelia burgdorferi as an etiologic agent in chronic heart failure?

Since 1980 cardiac manifestations of Lyme borreliosis have been described as selflimited conduction and transient left ventricular disorders or even cardiomegaly. An etiologic role of Borrelia burgdorferi in long-standing chronic heart disturbances is suggested by the cultivation of a strain of Borrelia burgdorferi which we were able to isolate from an endomyocardial biopsy of a patient with long-standing dilated cardiomyopathy. The aim of this study was to acquire information about the prevalence of serum antibodies to Borrelia burgdorferi in patients with dilated cardiomyopathy. By ELISA, we studied the sera of 72 consecutive patients with chronic heart failure due to dilated cardiomyopathy, of 55 patients with coronary heart disease, and of 61 healthy blood donors; positive ELISA values were determined in 26.4%, 12.7%, and 8.2% of serum samples, respectively. These findings further suggest an association or even an etiologic role for Borrelia burgdorferi in dilated cardiomyopathy.

Adult↗
PubMed1990

[Magnetic resonance tomography in orthotopic liver transplantation].

14 patients with orthotopic liver transplantation were prospectively studied with MR imaging. MR imaging demonstrated a perivascular collar surrounding central portal venous branches in 14 patients. The perivascular collar had low signal intensity on T1-weighted and high signal intensity on T2-weighted images. In 10 of the 14 patients, a perivascular collar was also observed around peripheral portal venous branches. The perivascular collar is probably caused by intraoperative interruption of hepatic lymph vessels and resultant impaired lymph drainage. It is a normal postoperative phenomenon in hepatic transplants. MR imaging is particularly useful in the distinction of postoperative hematoma from other intra- and extrahepatic fluid collections and may provide a noninvasive assessment of liver transplant rejection.

Adult↗
PubMed1990

MR-imaging findings in children with Sturge-Weber syndrome.

Intracranial extent and distribution of leptomeningeal angiomatosis, visualized by magnetic resonance imaging (MRI) with Gadolinium-DTPA (Gd-DTPA) enhancement, is demonstrated in four children with Sturge-Weber syndrome (SWS). Aged 7, 9, 11 and 19 months, they presented with cutaneous, neurologic and ocular symptoms at the time of MRI examination. Angiomatous alteration of the skull, atypically located and congested intracerebral and basal veins as well as intracerebral changes secondary to the leptomeningeal angiomatosis are demonstrated with T2 weighted images. Gd-DTPA enhanced T1 weighted images exhibit clearly the regional distribution of angiomatosis in the skull, meninges and within the brain. Before calcifications in children with SWS are detectable by CT, MRI is the method of choice to detect intracranial involvement. Enhancement with Gd-DTPA improves the diagnostic value of MRI, before neurological symptoms appear. Follow-up studies with Gd-DTPA enhanced MRI can be applied to recognize thrombotic changes of leptomeningeal angiomatosis as well as subsequent intracerebral impairment.

Atrophy↗
PubMed1990

Neuromuscular diseases: evaluation with high-frequency sonography.

Forty-four patients with clinically suspected neuromuscular disease and 12 healthy volunteers underwent high-frequency ultrasound examination of the rectus femoris, vastus medialis, vastus lateralis, and biceps brachii muscles, and the number of perimysial septa was determined. These numbers and muscle/soft-tissue ratios of the lower extremity were compared. Findings were correlated with results of muscle biopsy in all patients with suspected disease. Using the number of perimysial septa in the lower extremity, the authors found significant differences between the muscles of healthy volunteers and those of patients with Duchenne muscular dystrophies, other muscular dystrophies, and spinal muscular atrophies: The receiver operating characteristic curve showed that an average of 12 perimysial septa within 1 cm of muscle is the ideal cutoff value to differentiate subjects without morphologic changes from those with pathologic findings. The authors conclude that this measurement is useful for differentiation of neuromuscular diseases and may be a noninvasive, reproducible means with which to evaluate disease progression.

Adolescent↗
PubMed1990

Regional chemotherapy in liver metastases of colorectal carcinoma: monitoring with arterial computed tomography.

Continuous chemotherapy was administered to 82 patients through the hepatic artery via Infusaid pumps. In order to obtain a primary status and to evaluate the success of therapy, the perfusion patterns of the liver and of the existing tumor masses in the liver were estimated by conducting arterial angiocomputed tomographies (AACTs) immediately after pump implantation of every 3 months thereafter. In 70% of the patients, findings showed both liver lobes to be homogeneously perfused, 24% demonstrated distinct inhomogeneities. The response of the latter cases should depend primarily on the efficacy of the administered cytostatic agent. Six percent of the patients showed selective perfusion of either the left or right hepatic lobe. In these cases, only the perfused liver regions exhibited stable disease or regression of the metastases, whereas the metastases of the nonperfused regions progressed. At 3-month follow-up, the majority of the patients (50-57%) showed homogeneous hepatic perfusion. Inhomogeneities were found in 26-36% of the patients, 12 patients demonstrated incomplete perfusion. There was no association between the perfusion patterns of the metastases or of the prechemotherapeutic liver involvement and the response of the metastases to regional chemotherapy. In regional chemotherapy, liver perfusion should be controlled both intraoperatively or directly postoperatively and during therapy.

Antineoplastic Agents↗
PubMed1990

Duodenum-preserving resection of the head of the pancreas--an alternative to Whipple's procedure in chronic pancreatitis.

Duodenum-preserving resection of the head of the pancreas is a low-risk operation for patients with chronic pancreatitis. Subtotal resection of the head of the pancreas does not result in a significant diminishment in the exocrine and endocrine functions of the pancreas. Owing to the limited nature of the intervention, hospital and late mortality rates are low. More than 80% of the patients with CP have experienced long-lasting relief of pain after this procedure. In comparison with the Whipple operation duodenum-preserving resection of the head of the pancreas spares the patient a gastrectomy, a duodenectomy, and resection of the extrahepatic bile duct.

Anastomosis, Surgical↗
PubMed1990

[Stomach, duodenal and pancreatic injuries: diagnosis, surgical procedure].

Whereas ruptures of the spleen and liver are comparatively frequent, traumas to the pancreas, stomach and duodenum belong to the rarities. Thus, observed in our own patient material from 1982 to 1988, out of 218 surgically treated patients with a blunt abdominal trauma, we found only 1 duodenal rupture, 1 rupture of the stomach and 5 injuries to the pancreas. Diagnostics and therapy however can raise considerable problems. The indication for surgery is obtained clinically, the peritoneal lavage being the most important diagnostic procedure. Whereas treatment of a gastric rupture is not a problem, treatment of a duodenal rupture depends on the type of rupture. Lesions to the pancreas carry a bad prognosis depending on the degree of seriousness. Mortality is high ranging between 10 and 20%. Therapy depends on the degree of seriousness and has to be limited to a drainage operation in the individual case.

Abdominal Injuries↗
PubMed1990

[Effect of liver passage on peripheral glucose and hormone concentrations in early postoperative enteral nutrition].

Early postoperative disorders of blood glucose homeostasis and its hormonal regulation do not allow a normal caloric enteral or parenteral substrate supply in this period. Eleven land pigs were investigated to find out how the surgical trauma of a partial gastrectomy influences the absorptive capacity of the small intestine and the hormonal regulation after intraduodenal administration of a glucose solution. We therefore conducted portal vein measurements to correlate the influence of the liver passage of early postoperative changes in blood glucose and hormonal levels. Our data show that neither the porto-arterial differences in blood glucose nor those in hormonal concentrations are significant. Therefore, we conclude that peripheral measurements can be used as good and reliable parameters for such investigations of absorption or hormonal regulation in the early postoperative period.

Animals↗
PubMed1990

[Effect of enteral and parenteral nutrition on glucose tolerance in the early postoperative phase].

In a randomized clinical trial in 24 patients with colorectal resections the different behaviour of glucose tolerance (GT) in the early post-operative period was investigated. Especially, we were concerned with the way nutritional substrate were applicated. Therefore 2 groups were randomly formed for a six day period of enteral versus parenteral nutrition. To check the GT enteral tolerance-tests were done preoperatively, and on day 1, 3 and 6 postoperatively. Our results show a significant improvement of GT in the enteral group on 3, and 6, postoperative days, as well as a significantly higher insulin secretion on 3, postoperative day. C-Peptide displays similar high concentrations as a sign of elevated insulin secretion. These results prove, that enteral glucose application is superior to the parenteral way in early postoperative nutrition.

C-Peptide↗
PubMed1990

[Value of magnetic resonance tomography in Pancoast and other tumors with infiltration of the thoracic wall].

Twenty-two patients with intrathoracic malignancies and suspected Pancoast and "break-out" tumours were submitted to a comparative investigation using CT scanning and MRI to detect infiltration of the chest-wall. In the patients, the lesion had been confirmed at surgery, which revealed malignant infiltration in 19 cases, and excluded in filtration in 3 cases. In 14 out of 19 patients, the CT scan revealed tumourous involvement of the chest-wall, while in five out of 19 patients, no such involvement was detected. Using MR imaging, tumour infiltration was detected in all 19 patients. A reliable MR sign of tumour involvement was the detection of signal-intensive lesions within the chest-wall in T1-weighted images following the administration of Gd-DTPA, and in the T2-weighted images. In contrast, signal enhancement of the pleura was found both in tumour involvement and in inflammation. In suspected tumorous chest-wall invasion MR imaging can demonstrate tumour involvement of the chest-wall when CT is equivocal.

Adult↗
PubMed1990

The duodenum preserving resection of the head of the pancreas (DPRHP) in patients with chronic pancreatitis and an inflammatory mass in the head. An alternative surgical technique to the Whipple operation.

Since 1972, resection of the head of the pancreas with preservation of the duodenum has been carried out in 141 patients with chronic pancreatitis and an inflammatory mass in the head of the gland. One patient died in hospital (0.7%), and seven further patients died during the median follow-up period of 3.6 years (range 0.5-16). In contrast to the Whipple procedure, this operation spares the patient a gastric resection, a duodenectomy, and resection of the common bile duct. In terms of long lasting relief of pain and preservation of the endocrine function of the pancreas, the limited resection with preservation of the duodenum is highly effective and the mortality and late morbidity are low.

Chronic Disease↗
PubMed1990

[Effect of the surgical procedure on disorders of wound healing in abdomino-perineal rectum excision].

We found the infection rate to be significantly lower performing metachronous procedures although surgery lasted significantly longer than synchronous extirpation. From our results and other data from literature we conclude that occlusion of the natural anus in case of treatment with synchronous procedure leads to high intraluminal pressures during mobilisation of the rectum from sacral cavity. This enables germs to pass through the intact intestinal wall and results in contamination of the wound cavity.

Abdomen↗
PubMed1989

Regional chemotherapy for hepatic metastases of colorectal carcinoma (continuous intraarterial versus continuous intraarterial/intravenous therapy). Results of a controlled clinical trial.

Sixty-four patients with a biopsy diagnosis of colorectal cancer with liver metastases were treated with 5-fluorodeoxyuridine (FUDR) infusions. In a pilot study, the first 20 patients were given hepatic artery infusions of FUDR by implanted pumps. The remaining 44 patients were then randomized prospectively to compare the effectiveness of continuous hepatic artery and intravenous infusion of FUDR (IA/IV group; 21 patients) with hepatic artery infusion alone (IA group; 23 patients). A continuous 14-day infusion regimen of FUDR was applied each month. The dosage was 0.2 mg/kg/d of FUDR for the IA group and 0.3 mg/kg/d for the IA/IV group. The complete and partial response rates were each 50% in the pilot study and 52% and 48% in the IA and IA/IV randomized groups, respectively. Drug toxicities in the 64 patients included gastroenteritis (21%), chemical hepatitis (57%), and biliary sclerosis (25%). There was no difference in the toxicity of FUDR in the two randomized groups (P greater than 0.1). Extrahepatic spread of cancer during therapy was found in 61% (n = 14) of the IA group and 33% (n = 7) of the IA/IV group. There was no difference in survival between the randomized groups. The 64 patients were categorized into the following two groups according to their response to therapy: (1) responders (patients with complete or partial remission [n = 32]) or nonresponders (patients with stable disease or progression of metastases [n = 32]). The median survival time was 31 months for responders and 16 months for nonresponders (P less than 0.0001). Intraarterial FUDR infusion provided control of liver metastases. The combination of intraarterial and intravenous therapy seemed to prevent extrahepatic spread during therapy in most of the patients. Survival appeared to be significantly prolonged in patients with a regression of metastases.

Adenocarcinoma↗
PubMed1989

[Duration of the preventive use of antibiotics in colorectal surgery--single administration versus short-term prevention].

The effect of a combination of 4 g mezlocillin and 0.5 g metronidazole for the prophylaxis against infections in a one-shot dose immediately preoperatively compared to a short-time dose of 2 days given to 90 patients with resection of colorectal carcinoma was investigated in a prospective and randomized study. 6 patients developed a wound infection in the early postoperative phase; 4 of these infections (3 were severe, 1 was mild) occurred in the one-shot group and 2 in the short-time prophylaxis group. After more than 20 days postoperatively 3 late infections were observed which had a mild course (2 cases in the one-shot group, 1 case in the short-time prophylaxis group). All infections were localized in the sacral wound region in patients with abdominoperineal resection. The abdominal wounds healed per primam in each case. Besides those, 26 infections of the urinary tract were observed, which occurred significantly more often after the one-shot dose (40.9%) than with the short-time prophylaxis (18.6%). Intraoperative smears of the lumen of the bowels showed a remaining bacterial settlement. Besides Bacteroides species, especially Escherichia coli were found among the isolates. Moreover in some cases Clostridium, Klebsiella, Proteus and Pseudomonas could be identified. Smears of the site of operation (sacral/peritoneal cavity) were contaminated in over 50%, above all by Bacteroides species; besides those, E. coli were found most often. The subcutaneous smears showed a growth of the germs only in a few cases. Aerobic bacteria in 93.8%, anaerobic bacteria except for thetaiotaomicron and B. asaccharolyticus in 85.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗