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Biomedical subjects

R Kessler

Publications and source records attributed to R Kessler.

At least 145 records · Page 8Linked to original sources
PubMed1992

Epidemiology of bovine anaplasmosis and babesiosis in Latin America and the Caribbean.

The various parameters which interact in the epizootiology of babesiosis and anaplasmosis and which it is necessary to obtain in a survey are analysed and the two diseases compared. Where no data are available from Latin America and the Caribbean, the references from Australia and the United States of America are discussed. The two principal objectives of a study on the epidemiology of babesiosis and anaplasmosis are: to determine the risk of occurrence to understand the relevant factors leading to outbreaks. The first objective is relatively simple to achieve for both diseases by calculating the animal inoculation rate (h) at a determined age and the critical value of h for enzootic stability. The second objective requires exhaustive and complex studies. For babesiosis epidemiology, studies of the tick infection rate, cattle infestation rate, genetic composition of cattle, acaricides, stocking rate, climatic data and other factors are necessary. Anaplasmosis epidemiology cannot be satisfactorily explained by considering it purely as a tick-borne disease. Difficulties to be overcome include the great diversity of haematophagous Diptera in Latin America, and the scarcity of data on the capacity of these insects as anaplasmosis vectors and their feed preferences on cattle.

Anaplasma↗
PubMed1992

[What is the role of thoracoscopy in the preoperative staging of non-small cell bronchial cancer?].

It is of paramount importance to clearly separate the non small cell bronchogenic cancers involving the chest wall or the diaphragm (T3) and those metastasizing to the pleura (T4). In both events, surgery is either technically demanding or contraindicated. What is the contribution of thoracoscopy to diagnosis? Very few authors have used thoracoscopy in a restricted number of cases and with varying results to confirm tumoral extent to the chest wall. We are of opinion that this approach is only warranted in patients at major operative risk, in order to prevent an unprofitable thoracotomy. Concomitant pleural effusion as indication for thoracoscopy should be discussed with respect to the following data: 1) Among all bronchogenic cancers, 10% present with a concomitant pleural effusion detected on chest radiograms, 60% of which are metastatic. The significance of effusions disclosed by CT scan has not yet been established. 2) Pleural involvement inconsistently produces an effusion; the prevalence compiled from thoracotomies is varying according to the authors. 3) The sensitivity of thoracoscopy for the positive diagnosis of malignant effusions is about 95%. The concomitant pleural effusion is predictive of poor prognosis, but does not preclude operability. Cytology of thoracentesis specimens and pleural needle biopsy are the consistent first steps towards diagnosis; thoracoscopy should be restricted to the failures of these techniques.

Carcinoma, Non-Small-Cell Lung↗
PubMed1992

In vitro and in vivo evaluation of BMY 45243, a new 5-amino-naphthyridone derivative.

BMY 45243 is the first representative of 5-amino naphthyridone derivatives prepared following a new methodology developed by the authors. BMY 45243 is a highly lipophilic compound, very active in vitro and in vivo on S. aureus and was found to be as potent as ciprofloxacin on Gram-negative organisms with identical in vivo activity against Pseudomonas aeruginosa. Pharmacokinetics in mice showed better AUC and Cmax and longer t1/2 for BMY 45243 than for sparfloxacin and ciprofloxacin.

Animals↗
PubMed1992

Chronic obstructive pulmonary disease and sleep apnea syndrome.

The term "overlap syndrome" was introduced by Flenley to describe the association of sleep apnea syndrome (SAS) with chronic obstructive pulmonary disease (COPD). Epidemiologic data on the prevalence of the overlap syndrome are not available, but the frequency of an associated COPD in SAS patients has been emphasized in almost all the studies analyzing the development of respiratory insufficiency in SAS patients. In a large series (n = 264) of unselected SAS patients who had undergone detailed pulmonary function tests, we observed an obstructive ventilatory defect (FEV1/VC < 60%) in 30 of 264 patients (11%). These patients had lower daytime PaO2 and higher PaCO2 than the other patients and they had higher resting and exercising pulmonary artery mean pressure (right heart catheterization was performed in 215 of 264 patients). We conclude that the risk of developing respiratory insufficiency and cor pulmonale is higher in overlap patients.

Adult↗
PubMed1992

Efficacy, complications, and cost of a comprehensive blood conservation program for cardiac operations.

We reviewed blood use in 118 consecutive patients who underwent primary, elective cardiac operations in 1989. In June 1989 we initiated a blood conservation program that included attempts to limit preoperative aspirin use, intraoperative phlebotomy and hemodilution, use of a cell conservation device (Electromedics, Inc., Englewood, Colo.) to concentrate residual oxygenator contents, reinfusion of chest drainage, and acceptance of a minimum hemoglobin level of 8.0 gm/dl in stable patients. Patient characteristics were similar for patients operated on both before (n = 58) and after (n = 60) initiation of the blood conservation program, except for age and preoperative aspirin use (both greater in postconservation patients). Fewer blood products were transfused (5.8 +/- 5.7 units per patient before conservation versus 4.0 +/- 7.4 units per patient after conservation; p = 0.005). More complete data were available for 82 patients (40 patients before conservation and 42 after conservation). In the postconservation patients, 20 of 42 had 575 +/- 140 ml of blood withdrawn before cardiopulmonary bypass and reinfused afterward, 26 of 42 had 806 +/- 376 ml of blood processed with the cell conservation device returned, and 21 of 42 patients had an average of 287 +/- 127 ml of chest drainage reinfused. Chest tube drainage, postoperative hematologic parameters, and the prevalence of complications were not significantly different between groups. Stepwise linear regression analysis identified intraoperative withdrawal of blood before cardiopulmonary bypass, bypass duration, and preoperative hematocrit value as predictors of blood use. Intraoperative withdrawal of blood before cardiopulmonary bypass is an important conservation measure, and its use should be expanded.

Aspirin↗
PubMed1991

[The drug abuse patient as emergency].

Acute drug intoxication is a medical emergency considering its potential interference with vital functions. All 157 cases with drug overdose admitted to the emergency department of the "Inselspital" in Berne over 183 days between July 1989 and June 1990 were analyzed retrospectively. In the vast majority of cases heroin overdose was involved. In mixed poisonings with heroin mostly flunitrazepam and alcohol contributed to the clinical picture, less commonly cocaine. There were very few intoxications with cocaine alone. A practical approach to the management of patients with certain or suspected drug intoxication presenting with coma and depressed respiration is proposed. In the therapy of acute intoxications with opiates and benzodiazepines there are specific antagonists available. In contrast, therapy of cocaine overdose remains symptomatic. The medical complications of acute heroin and cocaine intoxications are discussed separately.

Adolescent↗
PubMed1991

Constrictive pericarditis from Nocardia asteroides infection.

Human nocardiosis usually involves the respiratory tract or the skin but may disseminate to virtually any organ. It occurs in immunocompromised hosts as well as individuals with no apparent predisposition. Involvement of the pericardium is uncommon, having been reported infrequently in the past, but mandates surgical management. This report describes the course of a patient with chronic constrictive pericarditis from nocardia successfully treated with pericardiectomy and appropriate antibiotic therapy.

Humans↗
PubMed1991

Penile implants in the treatment of Peyronie's disease.

The treatment of Peyronie's disease remains controversial. Patients who fail conservative therapy may require surgical intervention to restore the ability to have sexual intercourse. Plaque excision and dermal grafting have not been universally successful, and alternate procedures that rely on the placement of a penile prosthesis have gained in popularity. We reviewed our experience with 35 patients with advanced Peyronie's disease treated with a penile prosthesis. Preoperatively, 55% of the patients were unable to engage in intercourse due to pain or angulation of the penis and 25% were unable to achieve any erection at all. Postoperatively, with a mean followup of 6.9 years, 88% of the patients were able to engage in intercourse and were satisfied with the results obtained. In selected patients with advanced disease the implantation of a penile prosthesis remains a highly successful and satisfying alternative for the treatment of Peyronie's disease.

Adult↗
PubMed1991

Macroscopic vasovasostomy re-examined.

Results of 273 consecutive macroscopic vasovasostomy procedures performed at a single institution over a nine-year period between 1978 and 1987 were reviewed. When patients operated on less than five years after vasectomy were compared with those in whom more than five years had elapsed since vasectomy, significant declines in technical success rates as measured by return of sperm to the ejaculate (93% vs. 74%, p less than 0.004), biologic recovery as measured by mean sperm counts (55 million vs. 35 million) and mean progressive sperm motility (30% vs. 13%), and clinical success as measured by pregnancy rates (52% vs. 30%, p less than 0.02), were observed. Examination of complications of vasovasostomy showed a 7.7 percent overall complication rate and a 1.5 percent incidence of major complications.

Adult↗
PubMed1991

Evolution of physiological variables in patients with chronic obstructive pulmonary disease before and during long-term oxygen therapy.

In 24 patients with severe chronic obstructive pulmonary disease (COPD), we investigated the evolution of pulmonary volumes, arterial blood gases (ABG) and mean pulmonary artery pressure (PAP), before (T0-T1) and during (T1-T2) long-term oxygen therapy (LTO). LTO was initiated at T1 on usual criteria (PaO2 persistently less than or equal to 55 mm Hg) and was given during greater than or equal to 16 h/day. The T0-T1 period ranged from 12 to 186 months (mean 53 +/- 41 months) and the T1-T2 period from 12 to 120 months (mean 44 +/- 30 months). There was a significant worsening of the obstructive pattern (FEV1 decreasing from 1,084 +/- 326 to 879 +/- 318 ml, p less than 0.005) and of ABG (PaO2 decreasing from 58.2 +/- 9.2 to 51.6 +/- 6.5 mm Hg, p less than 0.01) before the onset of LTO, whereas there was a rather good stability of ABG during LTO and the changes in pulmonary volumes were modest and statistically nonsignificant (FEV1 decreased from 879 +/- 318 to 809 +/- 247 ml). PAP tended to increase from T0 to T1 and to decrease from T1 to T2, but these changes only reached the level of statistical significance when they were expressed as changes per year (+1.0 +/- 2.7 vs. -1.3 +/- 4.5 mm Hg, p less than 0.05). The evolution of physiological variables was nearly identical in subgroups of patients who had died (n = 13) or were still alive (n = 11) at the time of data collection (T3) and this held particularly true for PAP.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1991

The genetic epidemiology of bulimia nervosa.

OBJECTIVE: The authors seek to clarify, from both an epidemiologic and genetic perspective, the major risk factors for bulimia nervosa and to understand the relationship between narrowly defined bulimia and bulimia-like syndromes. METHOD: Personal structured psychiatric interviews were conducted with 2,163 female twins from a population-based register. Psychiatric disorders were assessed using DSM-III-R criteria. RESULTS: Lifetime prevalence and risk for narrowly defined bulimia were 2.8% and 4.2%, respectively. Including bulimia-like syndromes increased these estimates to 5.7% and 8.0%, respectively. Risk factors for bulimia included 1) birth after 1960, 2) low paternal care, 3) a history of wide weight fluctuation, dieting, or frequent exercise, 4) a slim ideal body image, 5) low self-esteem, 6) an external locus of control, and 7) high levels of neuroticism. Significant comorbidity was found between bulimia and anorexia nervosa, alcoholism, panic disorder, generalized anxiety disorder, phobia, and major depression. Proband-wise concordance for narrowly defined bulimia was 22.9% in monozygotic and 8.7% in dizygotic twins. The best-fitting model indicated that familial aggregation was due solely to genetic factors with a heritability of liability of 55%. A multiple threshold model indicated that narrowly defined bulimia nervosa and bulimia-like syndromes represented different levels of severity on the same continuum of liability. CONCLUSIONS: The liability to fully syndromal bulimia nervosa, which affects around one in 25 women at some point in their lives, is substantially influenced by both epidemiologic and genetic risk factors. The same factors that influence the risk for narrowly defined bulimia also influence the risk for less severe bulimia-like syndromes.

Adolescent↗
PubMed1991

Magnetic resonance imaging in the diagnosis of pulmonary infarction.

We report for the first time, to our knowledge, MRI features which could differentiate noninvasively pulmonary infarction from pneumonia. Three subjects with angiographically proven pulmonary infarction showed high T1 weighted MRI signals located in the embolic territory. Three patients with pneumonia and one patient with emboli, but without infarction, did not have these T1 weighted images.

Diagnosis, Differential↗
PubMed1991

Fructose-2,6-bisphosphate metabolism in permeabilized yeast cells.

Several methods for the permeabilization of Saccharomyces cerevisiae M1 were compared. Cells were permeabilized in the presence of 3% toluene/mercaptoethanol, and the activities of 6-phosphofructo-2-kinase, fructose-2,6-bisphosphatase and alkaline phosphatase were measured during growth of yeast on glucose. In the exponential phase of growth, the specific activities of 6-phosphofructo-2-kinase and fructose-2,6-bisphosphatase decrease significantly. The specific activities of 6-phosphofructo-2-kinase and high-affinity fructose-2,6-bisphosphatase increase again during the transition phase and reach maximum values in the stationary phase. In contrast to the specific activities, the activity concentrations of 6-phosphofructo-2-kinase and fructose-2,6-bisphosphatase remain nearly constant in the exponential phase, but increase in the transition and the stationary growth phase. The concentration of fructose-2,6-bisphosphate drops from about 6 microM in the exponential phase to very low levels in the transition phase, but increases slightly in the stationary phase. In Saccharomyces cerevisiae M1 several fructose-2,6-bisphosphate degrading activities were measured differing in the behaviour during growth on glucose, in the pH-optimum and the inhibition by fructose-6-phosphate.

Alkaline Phosphatase↗
PubMed1991

[Cystic fibrosis and bronchial hyper-reactivity].

An increased airway responsiveness to inhaled nonspecific stimuli has been often observed in cystic fibrosis patients. But bronchial hyperreactivity in such patients is due, in most cases, to damaged bronchial mucosa rather than to coexistent asthma, and it remains under question whether or not bronchodilators are of help in cystic fibrosis. Indeed some authors reported adverse effects after inhalation of beta-mimetic drugs. This behavior seems to be due to an "instability" of the bronchial walls in cystic fibrosis. Nevertheless other studies showed that bronchodilators could be of help when administered in some cases and during definite periods in the evolution of the disease. Indeed, variability in responsiveness to bronchodilator drugs is one of the features of cystic fibrosis and therapy must be adjusted to this variability in every patient. In any way, pulmonary functional tests must be performed before and after administration of a bronchodilator drug and before beginning such therapy.

Asthma↗