Mitral and pulmonary venous flow under influence of positive end-expiratory pressure ventilation analyzed by transesophageal pulsed Doppler echocardiography.
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Adult↗
Biomedical subjects
R Hoffmann
Publications and source records attributed to R Hoffmann.
[Current treatment methods in cholelithiasis: the "Zürcher indications"].
The increasing number of therapeutic modalities and growing experience in the treatment of gallstones involve continuous changes in the indications and contraindication of each method. The advantages of the conservative, non-surgical and interventional procedures are that patients can become free of symptoms and stones without the use of general anaesthesia or surgery, however, there is the risk of recurrence. On the other hand, invasive surgical methods provide a definitive solution to the problem by removal of the focus, eliminating the risk of recurrent disease. To our opinion, it is important to offer as many therapeutic modalities possible to be selected as individual treatment by patients and physicians.
Chenodeoxycholic Acid↗
[30-months extracorporeal electrohydraulic shock-wave lithotripsy of gallstones using the MPL-9000 at the Zurich University Hospital].
The effect of extracoporeal shockwave lithotripsy (ESWL) in combination with oral chemolitholysis on gallstone clearance was tested in a prospective study. We used a non-waterbath lithotripter, and the patients were treated without general anesthesia or intravenous analgesia. They solely received oral or subcutaneous premedication. Within the 30 months study-period 78 patients were selected according to the "Munich-criteriae". At the end of the study period 33 patients were free of stones, 20 patients had residual fragments, and 25 patients stopped the therapy prior to complete stone clearance because of compliance (n = 11), or methodological (n = 14) problems. This includes 3 patients in whom the ESWL had to be discontinued because of pain. No severe complications were seen with the exception of one attack of acute pancreatitis, from which the patient recovered. The rate of stone clearance was analyzed using the life-table calculation according to KAPLAN-MEIER to weigh the follow-up time of each patient. At 12 months it revealed a stonefree rate of 70% in patients who did not discontinue the treatment because of methodological problems. The advantage of ESWL is the possibility to treat gallstones without general anesthesia or intravenous analgesia. However, the patient-population must be highly selected, and there is the risk of recurrence.
Adult↗
[Papillary thyroid carcinoma in a median ectopic thyroid associated with intra-abdominal thyroid tissue].
A 17-year-old female underwent surgical removal of a painless submental lump presumed to be a median cervical cyst. Histology showed a papillary thyroid carcinoma with invasion of the surrounding connective tissue. A 99m-technetium scan, performed in preparation for a planned total thyroidectomy, demonstrated no thyroid tissue. On subsequent 123-iodine scanning there was an area of increased uptake about 3 cm above the larynx, but no normal thyroid tissue. Histological sections, obtained during further surgical exploration of the base of the tongue, showed scattered thyroid cell rests in the lingual muscles. Whole-body scanning, carried out in connection with administration of radioiodine for ablation of remaining thyroid tissue, disclosed an unexpected area of increased uptake in the epigastrium. Sonography and CT scans failed to demonstrate any corresponding morphological abnormality. Following a further dose of radioiodine 4 months later, no areas of increased uptake were noted.
Abdominal Neoplasms↗
Rupture of the ankle ligaments.
A prospective randomised trial of treatment of ruptured ankle ligaments was carried out at our institute. Two hundred patients were randomly assigned to 4 treatment groups. The results at 1 and 2 years after injury showed that functional treatment with a newly designed brace appeared to be the method of choice. This gives good mechanical stability, a shorter time off work and the ability to resume full sporting activity within 3 months of injury. Operation is only indicated for dislocations of the ankle and foot, ankle ligament rupture with additional intraarticular damage and second stage injuries or re-ruptures.
Adolescent↗
Transesophageal Doppler analysis of pulmonary venous flow in cardiac transplant recipients.
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Echocardiography, Doppler↗
Phosphofructokinase from mollusc muscle is activated by phosphorylation.
Phosphofructokinase was purified from muscle tissue of two different molluscs, edible snails, Helix pomatia (gastropoda), and mussels, Mytilus edulis (bivalvia). Under denaturing conditions, both enzymes had a molecular mass of 82 kDa. In the presence of ATP-Mg2+, the enzymes were rapidly phosphorylated in vitro by the catalytic subunit of cyclic AMP (cAMP)-dependent protein kinase purified from snail muscle and also by the C subunit of protein kinase from bovine heart. The extent of phosphorylation was 0.6 and 0.5 phosphate residues per subunit for the snail and the mussel phosphofructokinase, respectively. Phosphorylation of both phosphofructokinases effected a decrease in ATP inhibition at neutral or slightly acidic pH values and increased the affinity for fructose 6-phosphate. The resulting activation in the presence of suboptimum fructose 6-phosphate concentrations was more distinct for the snail enzyme. In addition, phosphorylated phosphofructokinase from mussels exhibited a marked increase in Vmax when activated by either 5'-AMP or fructose 2,6-bisphosphate.
Adenosine Monophosphate↗
Hepatitis B virus antigen-specific T-cell activation in patients with acute and chronic hepatitis B.
Since the hepatitis B virus is noncytopathic, it is generally believed that the individual specific immune response determines the course of infection. The lack of data about hepatitis B virus-specific T-cell reactions in acute infection led us to investigate the specific cellular immune response of infected individuals in terms of proliferation, and gamma-interferon and lymphotoxin production. Our results demonstrate that peripheral blood mononuclear cells (PBMNC) from patients with acute and chronic hepatitis B respond weakly to HBsAg. In contrast, patients with acute hepatitis show a vigorous response to the nucleocapsid antigen (HBcAg) in terms of proliferation and lymphokine production, while only few chronic virus carriers gave a proliferative response. Either of the antigens could activate lymphocytes to produce gamma-interferon and lymphotoxin, cytokines which may modulate antiviral immune response.
Acute Disease↗
Ascorbic acid requirements for smokers: analysis of a population survey.
The recommended dietary allowance (RDA) of ascorbic acid for smokers was recently increased from 60 to 100 mg. To determine whether this new RDA for smokers is sufficient to reduce the risk of low serum ascorbic acid (AA) concentrations (LoC) to the same concentration as nonsmokers, we analyzed the dietary intakes and serum concentrations of AA in 11,582 adult respondents in the National Health and Nutrition Examination Survey (1976-1980). Serum AA concentrations and the risk of LoC (serum ascorbic acid levels less than 23 mumol/L) for smokers consuming different amounts of AA were compared with those for nonsmokers whose AA intake exceeded the RDA (60 mg). Serum AA concentrations were reduced, and risk of LoC increased, in smokers maintaining AA intakes greater than 60, 100, and 150 mg. Only smokers consuming greater than 200 mg AA/d had serum ascorbate concentrations and risk of LoC equivalent to nonsmokers meeting the RDA.
Adult↗
Influence of antihypertensive drug therapy on sleep pattern and sleep apnea activity.
Sleep apnea, which affects 10% of men in the mean age group, is a common illness, and arterial hypertension one of its early symptoms. For the large group of, mainly young, patients with mild to moderate sleep apnea and arterial hypertension it is important to have a drug treatment available which will effectively control blood pressure without exacerbating symptoms of sleep apnea. We studied the effects of antihypertensive agents on blood pressure, sleep and sleep apnea in a randomized double-blind study of 24 patients with a sleep apnea activity of more than 10 apnea phases per hour of sleep and arterial hypertension with diastolic blood pressure values in the sitting position greater than or equal to 95 mm Hg. Mean age was 51 (range: 33-69) years, mean body mass index 31.4 (24.9-40.6) kg/m2. The study protocol envisaged two baseline measurements in the sleep laboratory, after which the medication was administered for 8 days. On the last 2 days of the treatment, polysomnographic leads were once again recorded in the sleep laboratory. The patients received either the beta-blocker metoprolol (1 x 100 mg/day) or the angiotensin-converting enzyme inhibitor cilazapril (1 x 2.5 mg/day). Systolic and diastolic blood pressure were decreased by both substances as expected. Total sleep time was 358 (233-425) min vs. 332 (255-383) min in the metoprolol group and 368 (295-424) min vs. 341 (265-434) min in the cilazapril group which is statistically not different between the two groups nor between the proportions of non-REM and REM sleep.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Papillary carcinoma in an ectopic thyroid.
Ectopic thyroid tissue can be seen anywhere from the foramen caecum to the lower neck. Most frequently it presents as a thyroglossal duct cyst associated with a normal thyroid gland. Less common is total ectopia, which can occur as a lingual thyroid or occasionally in non-lingual locations. Malignant transformation of such ectopic tissue is extremely uncommon. Only 21 cases of lingual thyroid carcinomas have been reported until 1971. We present, to our knowledge, the first case of a papillary carcinoma in a non-lingual ectopic thyroid in the absence of an orthotopic thyroid.
Adolescent↗
Immune response of peripheral blood mononuclear cells to HBx-antigen of hepatitis B virus.
The hepatitis B virus genome encodes a transcriptional transactivator protein designated HBxAg. We have investigated whether this antigen is a target structure for human T-lymphocytes. Using recombinant HBxAg protein, we found HBxAg-specific stimulation of peripheral blood mononuclear cells in patients with acute hepatitis B virus infection (6 of 6) and chronic hepatitis B virus infection (6 of 17) but not in healthy individuals. With HBxAg-specific synthetic polypeptides, several T-cell epitopes were identified. Most were located in the carboxyterminal half of the HBxAg protein. Five T-cell clones specific for a T-cell epitope located at the carboxyterminal region of HBxAg were established and found to belong to the CD2/CD4-positive, CD8-negative subtype. These data establish for the first time HBxAg as an antigen in the cellular immune response.
Acute Disease↗
[Transesophageal echocardiography in combination with atrial stimulation for detection of ischemia-induced disorders of myocardial wall motion].
The diagnostic value of exercise echocardiography has been widely reported. In up to 20% of patients conventional transthoracic exercise echocardiography however is impossible due to impaired image quality related to exercise. In addition some patients will not be able to perform a conventional bicycle exercise test due to joint disease or peripheral vascular disease or a sufficient stress is not possible because of lack of patient motivation. In an attempt to overcome these limitations, a system has been developed which combines transesophageal echocardiography with simultaneous transesophageal atrial pacing via the same probe. Three circular silver pacing electrodes were installed at a distance of 7,9 and 12 cm from the tip of the echoscope. Square wave pulses of 10 ms and an intensity of 7 to 20 mA were delivered. After baseline recording at the patient's spontaneous heart rate, atrial pacing was initiated at a rate of 100 beats/min and increased stepwise every 2 min by 20 beats/min up to 85% of the age-predicted maximal heart rate. Pacing endpoints were designated to be the development of angina pectoris or dyspnea, persisting horizontal or downsloping ST-segment depression (0.2 mV 80 ms after the J-point in the 12-lead ECG) or the development of new segmental wall motion abnormalities. In a group of 50 patients with suspected coronary artery disease, coronary artery disease (luminal narrowing of more than 70% of at least one major vessel) was detected with high sensitivity (greater than 93%) and specificity (greater than 100%).(ABSTRACT TRUNCATED AT 250 WORDS)
Coronary Disease↗
[Side effects of oral contraceptives in the first treatment cycle].
In order to compare the secondary effects of oral contraceptive pills during the first cycle of application, 308 women between the age of 25 and 45 were interrogated by questionnaires about their subjective complaints. The patients received a contraceptive within an In-vitro-Fertilization-program (IVF-program) in preparation for a stimulation treatment to follow. The study consisted of two parts: at the beginning a pilot study was carried out in which retrospectively a pill containing 0.150 mg Desogestrel and 0.030 mg Ethinylestradiol and a contraceptive containing 0.075 mg Gestoden and 0.030 mg Ethinylestradiol were compared. In a following prospective randomized examination a product, new on the market, containing 0.250 mg Norgestimat and 0.035 mg Ethinylestradiol, was included. The most common secondary effects, occurring in 34% of our patients, were spottings and break through bleedings. Regarding the secondary effects--during the first cycle of application--no significant difference between the contraceptives could be established.
Adult↗
[Clinical management problems in mass accidents].
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Disaster Planning↗
[Three-dimensional measurement of fracture gap motion. Biomechanical study of experimental tibial fractures with anterior clasp fixator and ring fixator].
A computer-linked magnetic motion tracker was used to monitor the six components of elastic fracture motions in cadaver tibia with simulated mid-shaft oblique fractures or segmental defects. The limbs were mounted in a servo-hydraulic load frame and stabilized with an Ilizarov frame or an AO-Unifix external fixator. A cyclic load of 150 or 300 N was applied along the long axis of the tibia. Under 150 N load, elastic displacements ranged up to 1.7 mm and elastic rotations ranged up to 0.6 degrees. Under 300 N load, elastic displacements went up to 3.6 mm and elastic rotations ranged up to 1.5 degrees. Comparison of the two fixators showed that the Ilizarov permitted up to 1.75 times more axial pistoning and up to 4 times more A-P displacement. The AO-Unifix permitted up to 4 times more varus-valgus and up to 7 times more A-P angulation. The technique developed for measuring the three-dimensional motion of fractures may have wide applications in further biomechanical and fracture healing studies.
Biomechanical Phenomena↗
Risk factors in abdominal surgery.
The term risk is understood to be the danger of the occurrence of an undesired, life-threatening event. The probability of this undesired event is greater in the presence of a risk factor than in its absence. In general surgery, these risk factors can be classified into five groups: The environment, the surgeon, the operation per se, the disease, and the patient himself. Abdominal surgery is especially suited to clarify and to illustrate this classification. Some typical risk factors are described, and for each group the measures for risk prevention or risk reduction are discussed.
Abdomen↗
The thrombo-embolic risk in surgery.
Postoperative deep-vein thrombosis can lead to fatal pulmonary embolism on one side, and the development of a disabling postthrombotic syndrome, which can occur after some time. General thrombo-embolic prophylaxis can reduce the risk of postoperative thrombo-embolic complications. Predisposing factors include age, obesity, immobilization and recumbency. Cardiovascular diseases, malignant neoplasms, venous disorders, diseases associated with increased viscosity of blood, past deep-vein thrombosis and pulmonary embolisms, some infectious diseases with raised fibrinogen levels, and inherited or acquired clotting factor deficiency syndromes (antithrombin III, protein C, protein S) have an elevated risk of thrombosis. The surgery itself, when taking more than 20 minutes and performed under general anesthesia, is a major risk factor, as proven initiation of thrombosis is often on the operation table. Patients receiving regional or local anesthesia have a clearly reduced risk of thrombosis. After general surgery without thrombosis prophylaxis, a deep-vein thrombosis can be demonstrated by the fibrinogen uptake test in about 30% of all patients over the age of 40. After abdominal surgery an incidence of thrombosis of 14-33%, and after hip surgery an incidence of nearly 50%, have been established by means of the fibrinogen uptake test. However only 10% of these thromboses are expressed clinically. We therefore recommend Liquid Crystal Contact Thermography, which has a sensitivity of 94% and a specificity of over 80%, as a non-invasive, easily performed screening method in the diagnosis of deep-vein thrombosis. Apart from the physical methods, the use of heparin is also indicated in thrombo-embolic prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)
Abdomen↗