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Biomedical subjects

R Weber

Publications and source records attributed to R Weber.

At least 199 records · Page 11Linked to original sources
PubMed1996

[Intestinal cryptosporidiosis in HIV infection: clinical features, course and therapy].

OBJECTIVE: To determine retrospectively the clinical features and course of HIV-associated intestinal Cryptosporidium infection and its response to paromomycin. PATIENTS AND METHODS: Case notes of all patients treated for cryptosporidiosis over a two-year period at an HIV out-patient clinic were analysed (26 men, four women; median CD4-lymphocyte count: 20/microliter). Median follow-up time was 6(1-22) months. RESULTS: 15 patients had persistent diarrhoea, two remained asymptomatic, seven had a remission and in five the disease took a fulminant course with severe diarrhoea ending in death within 4 months. 15 of the patients died during the period of observation, eight of them of cryptosporidiosis-associated cachexia. Mean survival time was about one year. Eight patients had multiple intestinal infections at the time the diagnosis was made and seven developed them later, which correlated with the poorer survival chances. Four patients had proven and 13 probably cryptosporidiosis-associated involvement of the biliary tract, but this did not affect the survival chances. 21 of 28 patients with diarrhoea were treated with paromomycin. In 13 of them there was for a time complete or partial response to treatment, but no response in eight. Those who responded well or partially to paromomycin had a significantly better survival chance than those without response. There was no correlation between the severity of immunosuppression and the severity of the cryptosporidiosis-associated diarrhoea, the response to paromomycin and the worse survival chance in the presence of multiple intestinal infections. CONCLUSIONS: The reasons for the different courses taken by HIV-associated cryptosporidiosis and the different therapeutic responses remain unclear. There is no known causal treatment, but 60% of patients improved temporarily on paromomycin.

Adult↗
PubMed1996

Management of dural lesions occurring during endonasal sinus surgery.

BACKGROUND: Dural lesions incurred during endonasal sinus surgery must be repaired surgically because of the risk of potentially fatal late meningitis. DESIGN: Retrospective survey. SETTING: Ear, nose, and throat department of a university teaching hospital. PATIENTS: Consecutive sample of 47 patients who had undergone duraplasty for repair of a dural lesion that occurred as a complication of endonasal sinus surgery. Forty-two patients were interviewed after an average postoperative period of more than 5 years. INTERVENTION: Endonasal duraplasty, external duraplasty (fronto-orbital or transfrontal extradural approach) by underlay or onlay technique. MAIN OUTCOME MEASURES: Fluorescein test (intrathecal administration of fluorescein sodium and subsequent nasal endoscopy), subjective complaints, history of meningitis, cerebrospinal fluid rhinorrhea, or hyposmia. RESULTS: There were 44 endonasal and 3 external duraplasties (2 by the fronto-orbital and 1 by the transfrontal extradural approach); the underlay technique was used in 25 and the onlay technique in 22. The fluorescein test, performed in 43% (20/47) of the patients was negative in all cases. Twenty-six percent of the patients had had 1 or more episodes of bacterial sinusitis without meningitis. Duraplasty was clinically intact in 100%. Postoperative olfactory disturbances were reported in 17%. CONCLUSIONS: Duraplasty can be performed satisfactorily by the endonasal route, thus avoiding the disadvantages of the fronto-orbital approach (visible scar, risk of damage to the supraorbital nerve, and removal of bone from the floor of the frontal sinus with a tendency to stenosis of the nasofrontal duct and subsequent mucocele). Allogeneic connective tissue in combination with fibrin glue has proved suitable as a graft material.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1996

Effect of omeprazole on the course of associated esophagitis and laryngitis.

Esophagitis has increasingly been implicated as a cause of chronic laryngitis and there is some evidence that gastro-esophageal reflux disease (GERD) is more common in patients with laryngitis. The aim of this study was to evaluate whether patients with esophagitis and laryngitis responded to treatment with omeprazole. Of 74 consecutive patients with endoscopically proven GERD, 21 had laryngitis. These 21 patients with associated esophagitis and chronic laryngitis were treated for 4 weeks with omeprazole 40 mg per day. After 2 weeks of treatment and at the conclusion of the study, 2 weeks later, esophagoscopy and laryngoscopy were performed and the patients responded to a questionnaire on their symptoms. The follow-up period was 1 year. Twenty-one of the 74 patients (28.4%) had esophagitis (grade I, n = 12; grade II, n = 9) and associated laryngitis (grade I, n = 14; grade II, n = 7). The severity of the esophagitis accorded with the severity of the laryngitis. After 2 weeks' treatment with omeprazole, both the esophageal and the laryngeal symptoms had improved in all 21 patients. Endoscopically, the healing rates were 62% for esophagitis and 33.3% for laryngitis. At the end of the study period, at 4 weeks, all patients were symptom-free and the esophagitis and laryngitis had healed completely. No patient suffered from drug-induced side effects. Patients with associated laryngitis and esophagitis should be given adequate anti-reflux therapy. Both the laryngeal and esophageal symptoms improved with the omeprazole treatment, suggesting that reflux was the underlying etiology.

Adult↗
PubMed1996

Immigration and the public transfer system: some empirical evidence for Switzerland.

"Do immigrants subsidize the native population or vice versa? Is immigration a cost factor or a net benefit for the public transfer system? On the basis of the 1990 Swiss Consumer Survey, an attempt is made to answer these questions empirically.... The degree of participation of foreigners in the Swiss welfare state is estimated.... To this end, the public transfer balance (difference between government revenue and government expenditure) is empirically estimated for both native and foreign households. The method chosen covers public monetary transfers as well as the supply of goods and services by the government (real transfers). Social security insurance, redistribution through taxes, infrastructure investment (club goods) and immaterial goods such as the legal system (public goods) are thus covered."

Cost-Benefit Analysis↗
PubMed1996

[Long-term results of endonasal frontal sinus surgery].

Most conditions of the frontal sinus requiring surgery can now be managed successfully by endonasal procedures. To date there has been no clear position regarding indications and results of different types of endonasal frontal sinus drainage. In a retrospective study we evaluated long-term results of Draf's type II and III endonasal frontal sinus drainages using endoscopy and computed tomography. Twelve to 98 months following type II drainage, 58% of 83 frontal sinuses were ventilated and normal. A ventilated frontal sinus but with hyperplastic mucosa was seen in 12%. Scarred occlusion with total opacification on CT occurred in 14%. Furthermore, total opacification in 16% was due to recurrent polyposis. Patients were free of symptoms or had only minor problems in 79%. Twelve to 89 months following type III drainage, 59% of 81 frontal sinuses were ventilated and normal. A ventilated frontal sinus with hyperplastic mucosa was seen in 17%. Scarred occlusion with total opacification on CT was present in 7%. Furthermore, total opacification in 16% was due to recurrent polyposis. In all, 95% of the patients were free of symptoms or had only minor problems. Combining our results with those of other authors and utilizing the physiology of wound healing after sinus surgery, we developed a protocol of differential indications for endonasal frontal sinus drainage.

Adolescent↗
PubMed1996

Computer-assisted documentation and analysis of wound healing of the nasal and oesophageal mucosa.

Our aim was to analyse the dynamics of healing processes in the nose and oesophagus by videoendoscopic examination and reconstruction of the natural dynamics and continuity of a process using modern computer technology and so-called morphing software. Thirteen patients were followed-up for six months after sinus surgery and three weeks after oesophagitis. Four overlapping and meshing phases of wound healing following sinus surgery with significant interindividual differences. Topical budesonide shortened the duration of wound healing phases. Healing of oesophagitis occurred approximately symmetrically from the wound edges to the centre with constant velocity. Computer-assisted morphing enables dynamic analysing of mucosal processes under the following preconditions: Availability of a valid imaging method for documentation and measurement with the generation of congruent images. The process under analysis must run without sudden leaps and there must be adequate choice of timing of single measurement procedures.

Endoscopy↗
PubMed1996

Progressive withdrawal of muscle nerve sympathetic activity preceding vaso-vagal syncope during lower-body negative pressure.

We report the observation of a vaso-vagal syncope (VVS) occurring during lower body negative pressure in a young male volunteer. Recording of the peripheral blood flow, blood pressure and muscular sympathetic nerve activity revealed first a progressive withdrawal of muscle nerve sympathetic activity with redistribution of blood flow before the onset of the VVS.

Adult↗
PubMed1996

[Effects of postoperative care on wound healing after endonasal paranasal sinus surgery].

BACKGROUND: There is no standard for postoperative care after paranasal sinus surgery. METHODS: In a prospective study we evaluated the influence of modifications of postoperative care on wound healing after paranasal sinus surgery. We used a new method of documenting the natural dynamics of wound healing after endonasal paranasal sinus surgery that combines morphing and time-lapse video. Computer-assisted morphing means transformation of one shape into another by means of two-dimensional interpolation. The computer reconstructs the changes between the single frames taken by videoendoscopy at each examination by morphing. Editing all single frames from videoendoscopy and from morphing together resulted in a 60-second video showing wound healing over a period of six months. We documented wound healing 23 operations. Twelve patients with chronic polypoid sinusitis of similar extent were documented in a similar manner. Minimal postoperative care consisted of packing the operative cavity with rubber fingers for three days and irrigation with Ems brine. The effect of long-term packing and topical application of budesonide were studied. Analysis consisted of evaluating the time-lapse videos and final flexible endoscopy of the sinuses. RESULTS: Wound healing after complete endonasal sinus surgery varies greatly. In the first 7-12 days blood crusts covered the whole wound. Granulation was visible for 2-4 weeks. The increasingly edematous swelling reached its maximum in the 3rd-5th week and decreased in 7th-12th week. A macroscopically normal mucosa was observed from the 12th-18th weeks. Subepithelial changes occurred for longer than 6 months. CONCLUSIONS: The following measures are recommended for decreasing postoperative granulations, edema and swelling: minimizing the surgical trauma, long-term packing with a occlusive, nonadherent material (rubber finger packing), topical steroids (Budesonide). Stenosis of paranasal sinuses due to excessive scarring could not be prevented (especially in the frontal sinus).

Administration, Topical↗
PubMed1996

[Dura-plasty in the area lf the sphenoid sinus].

BACKGROUND: Surgical treatment of CSF leakage in the sphenoid sinus is difficult for several reasons: 1. the close neighbourhood between the sphenoid sinus and the internal carotid artery, the cavernous sinus and cranial nerves (II, III, IV, VI), 2. a strong liquorrhoea caused by basal cisterns surrounding the sphenoid sinus, 3. it can be difficult to visualise completely the sphenoid sinus depending on the extent of pneumatisation. MATERIALS AND METHODS: In this retrospective study 20 cases of duraplasty around the sphenoid sinus were evaluated. The approach, materials, operative techniques and results are described. RESULTS: 90% of the dura lesions were closed successfully by one operation (average follow-up time 5 years). Including our two revisions all defects have been sealed effectively. CONCLUSIONS: Currently, the endonasal approach using microscope and endoscope is the technique of choice for dura repair in the sphenoid sinus. The different techniques and materials vary in order of size, location and etiology of the dura lesion.

Aged↗
PubMed1996

[Individual learning curves with reference to endonasal micro-endoscopic pan-sinus operation].

BACKGROUND: We examined how surgeons in training will develop into experienced surgeons in sinus surgery by analysing their individual learning curve. METHODS: In a retrospective study we evaluated complications in 818 surgical procedures (362 revisions = 44.3%) performed by four different surgeons. RESULTS: We found a dural lesion in six cases (0.75%), opening of the periosteum of the orbit in 30 cases (3.7%), and control of bleeding from the anterior ethmoidal artery in 36 cases (4.4%). No lesions of the internal carotid artery or lacrimal duct system occurred. The complications were not distributed equally. We observed a three-phase learning process which we describe using the example of a traffic light: red with a high risk of complications, yellow with a minor one, and green for the experienced surgeon. The first phase consists of the first 20 procedures, yellow from the 20th to the 100th, and green for procedures performed thereafter. CONCLUSIONS: Each inexperienced surgeon has to determine his position on the learning curve. He or she should be supervised accordingly.

Clinical Competence↗
PubMed1996

[Orbital hematomas].

BACKGROUND: Orbital hematomas may occur spontaneously, as a result of vascular anomalities, or they may be induced by trauma or occur following paranasal sinus surgery. The retrobulbar hematoma requires special attention because of its potential compression of the optic nerve may compromise vision or cause blindness. PATIENTS AND METHODS: We report on four cases: two subperiostal orbital hematomas, a spontaneous retrobulbar hematoma, and one orbital hematoma due to trauma. RESULTS: In one case a vascular anomality was detected by angiography. Though temporary blindness occurred in this case, it was possible to preserve 30% vision by surgery. An infected subperiostal hematoma was successfully treated using an endonasal approach. Two cases (a traumatic and a subperiostal orbital hematoma) required no operative treatment. CONCLUSIONS: The diagnosis of an orbital hematoma should be made as quickly as possible to permit adequate early therapy. Decrease of vision or blindness caused by orbital hematoma may be improved through a lateral canthotomy as emergency measure and subsequently by draining the hematoma to relieve compression of the optic nerve.

Adult↗
PubMed1996

[Pneumosinus dilatans frontalis. Etiology, symptoms and surgical technique].

BACKGROUND: Pneumosinus dilatans of the frontal sinus is a very rare condition in which deformity is caused by progressive enlargement of the brow ridges and lower forehead. PATIENTS: Etiology of the reported two cases was unknown although some hypotheses have been presented. RESULTS AND CONCLUSIONS: We corrected the aesthetic deformity using an osteoplastic flap and removing horizontal bone chips from the anterior wall of the frontal sinus. Postaoperative results were satisfactory. In one case, obliteration of the sinus with fat was necessary, because of polypous mucosa.

Adult↗
PubMed1996

Prosthetic rehabilitation after craniofacial surgery.

We report our experience during the last 6 years with 20 patients fitted with prosthesis (19 patients with osseointegration of screw, 1 patient with primarily gluing method) for camouflage of congenital or acquired (trauma, tumor resection) defects of the ear, nose, or eye. Out of a total of 53 extra-oral implants fitted, 3 were lost in the orbital area due to loosening 6 months after radiation treatment. Another three implants were removed at the request of an 80-year-old patient who preferred a prosthesis retained by spectacles because of recurring infection around one of the implants. On average, 43 months (range, 7 months to 8 years) after completion of the prosthesis, 85% of the patients assessed the result as excellent, 15% as good, 0% as fair, and 0% as poor. The ENT surgeon and the prosthesis designer were slightly more critical (ENT surgeon-95% good or excellent and 5% fair, prosthesis designer-90% good or excellent, 10% fair).

Journal Article↗
PubMed1996

Immunologic and molecular characteristics of Encephalitozoon-like microsporidia isolated from humans and rabbits indicate that Encephalitozoon cuniculi is a zoonotic parasite.

To assess the zoonotic potential of Encephalitozoon-like microsporidia, we isolated and cultivated spores from specimens of urine, respiratory secretions, and stool from six patients infected with human immunodeficiency virus and from nine rabbits. Because spores of Encephalitozoon-like species are indistinguishable by microscopy, we characterized the isolates by western blot analysis and by restriction enzyme analysis of the small subunit (SSU) rDNA after amplification by the polymerase chain reaction. We identified Septata intestinalis in one patient and Encephalitozoon hellem in two symptomatic patients. Encephalitozoon cuniculi was found in all rabbits and in three patients. One of these patients had clinical manifestations of infection with this parasite (severe interstitial pneumonitis). We observed abatement of symptoms and cessation of parasite excretion when these patients were treated with albendazole. Our findings suggest that E. cuniculi may be pathogenic in humans and that it is a zoonotic parasite.

AIDS-Related Opportunistic Infections↗
PubMed1996

Diagnostic performance of amplified Mycobacterium tuberculosis direct test with cerebrospinal fluid, other nonrespiratory, and respiratory specimens.

The Gen-Probe Amplified Mycobacterium tuberculosis Direct Test (MTD) was adapted to be used for cerebrospinal fluid (CSF) and a large variety of other nonrespiratory specimens. Standardized with artificially spiked dilution series of CSF, the modified MTD procedure consists of (i) increasing the amount of sample 10-fold, (ii) pretreating the specimen with a detergent, and (iii) increasing the amplification time from 2 to 3 h. Performance of MTD in a clinical mycobacteriology laboratory was tested over an extended period of time, involving a total of 322 nonrespiratory as well as 1,117 respiratory specimens from 998 patients. Results from MTD were compared with those from microscopy, culture, analysis of tuberculostearic acid by gas-liquid chromatography-mass spectrometry (CSF only), and the final clinical diagnosis. When MTD results were compared with resolved data, the sensitivity, specificity, and positive and negative predictive values for MTD were 93.1, 97.7, 90.0, and 98.5%, respectively, for nonrespiratory specimens and 86.6, 96.4, 76.8, and 98.1%, respectively, for respiratory specimens. Our data demonstrate that (i) MTD is a robust, highly sensitive and specific technique for the rapid detection of M. tuberculosis complex in all types of clinical specimens, (ii) there was no statistically significant difference (P > 0.005) in sensitivity and specificity for nonrespiratory compared with respiratory specimens, and (iii) repeating all MTDs which yield a result between 30,000 and 200,000 relative light units would help prevent a large number of false positives and, thus, enhance test specificity.

Adolescent↗
PubMed1996

Epidemiology of cryptosporidiosis among European AIDS patients.

OBJECTIVE: To study epidemiology and possible risk factors associated with the development of cryptosporidiosis among European patients with AIDS. METHODS: An inception cohort of 6548 patients with AIDS, consecutively diagnosed from 1979 to 1989, from 52 centres in 17 European countries was studied. Data on all AIDS defining events were collected retrospectively from patients' clinical records. Kaplan-Meier estimates, log rank tests and Cox proportional hazard models were used to examine for possible risk factors associated with cryptosporidiosis. RESULTS: Cryptosporidiosis was diagnosed in 432 (6.6%) patients, 216 at time of the AIDS diagnosis and 216 during follow-up. The probability of being diagnosed with cryptosporidiosis at AIDS diagnosis was significantly lower for intravenous drug users (1.3%) than for homosexual men (4.1%) and for patients belonging to other transmission categories (4.0%) (p < 0.001). The probability was also higher for patients from Central Europe compared with patients from South Europe (4.1% versus 2.5%, p = 0.005). The rate of developing cryptosporidiosis after the diagnosis of AIDS was 3 per 100 patient years of follow-up. The rate was significantly lower for intravenous drug users than for homosexual men (relative risk 0.34, 95% confidence limits 0.22-0.54) and for women compared with men (RR 0.43 (0.21-0.87)). The risk was higher in North Europe than in South and Central Europe. In a multivariate analysis only transmission category remained a significant predictor for the development of cryptosporidiosis. CONCLUSION: The development of cryptosporidiosis in AIDS patients may be associated with sexual risk behaviour.

AIDS-Related Opportunistic Infections↗