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Biomedical subjects

T Winter

Publications and source records attributed to T Winter.

At least 19 recordsLinked to original sources
PubMed1995

[Calciphylaxis].

HISTORY AND CLINICAL FINDINGS: Acute, zigzag-shaped livid skin markings developed on both thighs of a 55-year-old woman who had been on dialysis for 6 years. Within 7 days these areas increased in size to about 10 cm in diameter and contained central dry and painful necroses. On legs, lower arms and hands hard subcutaneous nodules were palpable with a diameter up to 3 mm. For many years the phosphate and parathormone levels, as well as alkaline phosphatase activity had been raised. The patient had often failed to follow treatment recommendations. TESTS: There were increased serum concentrations of calcium (2.8 mmol/l) and phosphate (1.78 mmol/l). The calcium phosphate ion product was 4.98 (mmol/l)2. Furthermore, there were raised levels of alkaline phosphatase (315 U/l) and parathormone (1076 ng/l, normal: 10-65). X-ray film of the hands showed soft tissue and arterial calcifications, while histological examination of a deep skin biopsy revealed calcium phosphate emboli of the main vessels. TREATMENT AND COURSE: Excision of the cutaneous necroses was followed by parathyroidectomy at which only three parathyroid glands were identified and removed. The parathormone level fell postoperatively, but rose again after 4 weeks. The fourth parathyroid gland was then found and removed, after which the parathormone level fell below measurable levels. The skin ulcers healed completely 4 weeks after the second operation.

Calciphylaxis↗
PubMed1995

Persistent mirror movements: force and timing of "mirroring" are task-dependent.

A simple isometric motor task was used to quantify intended and unintended finger movements in two subjects (father and son) with persistent mirror movements. One hand voluntarily changed grip force between thumb and index finger at different amplitudes and frequencies, while the other hand was to maintain a constant force. During all experimental conditions the "steady" hand showed insuppressible, highly cross-correlated contractions, compatible with bilateral distribution of a single motor command to the spinal cord. However, these associated movements were not strictly mirror images, nor did they show a fixed relationship to the voluntary movements across experimental conditions. The ratio of mirror to voluntary movement ranged from 1.4 to 19.1% and from 3.4 to 78.4% in the two subjects and was directly related to voluntary strength and speed. At maximum speed, mirror activity tended to precede voluntary activity, while it was delayed in slow force changes. Comparable time lags were not found in control subjects instructed to simulate mirror movements. We conclude that neuronal mechanisms in addition to bilateral corticomotoneuronal connections are at work in persistent mirror movements.

Adult↗
PubMed1995

Migraine and concomitant symptoms among 8167 adult twin pairs.

We studied the inheritance of migraine and concomitant symptoms among 2690 monozygotic (1524 female and 1166 male) pairs and 5497 dizygotic (2951 female and 2546 male) twin pairs. Our material consists of a population-based questionnaire study among Finnish twins in 1981. The definition of migraine is based on a questionnaire method. Concordance was assessed using probandwise concordance rates and tetrachoric correlations for monozygotic (MZ) and dizygotic (DZ) twin pairs. For estimating the contribution of genetic factors to the susceptibility of migraine, a polygenic multifactorial model was used. Structural equation models were applied for estimating variance components and to compare different genetic models. Nearly one-half (40% to 50%) of the liability to migraine is attributable to genetic factors. In all structural analyses, the model with both additive genetic and unshared environmental component had the best goodness-of-fit value. The genetic component varied between 34% to 51% in different migraine types. There were no remarkable differences between sexes except in the effects due to dominance, where the proportion was 26% for men and 14% for women. Concomitant symptoms among subjects within pairs concordant for headache had genetic effects varying from 56% (subjects with unilaterality) and 56% (subjects with visual symptoms) to 45% (persons with nausea and vomiting). The two threshold model of headache points to the continuum model of headache, and the thresholds represent different levels of severity of the pain. Our results emphasize a multifactorial and higher than previously reported genetic pattern in the etiology of migraine. Also unshared environmental factors play an important role.

Diseases in Twins↗
PubMed1994

Coexistence of cholinergic and somatostatin receptors on astrocytes of rat CNS.

Electrophysiological studies have shown that somatostatin (SOM; 10(-8) and 10(-7) M) causes a hyperpolarization of the majority of astrocytes in explant cultures of rat spinal cord and cortex. When SOM and the cholinergic agonists muscarine and nicotine (10(-6) M) were tested on the same cell, all three compounds produced hyperpolarizations, suggesting a colocalization of functional cholinergic and SOM receptors on the glial membrane. Combined immunohistochemical and autoradiographic binding studies demonstrating that almost all astrocytes which were immunostained by the monoclonal muscarinic or nicotinic antibodies were also intensely labelled by 125I-SOM, provide further evidence for the coexistence of cholinergic and SOM receptors on astrocytes.

Animals↗
PubMed1994

Magnetic resonance imaging signal changes in denervated muscles after peripheral nerve injury.

The evaluation of peripheral nerve disorders has traditionally relied on a clinical history, physical examination, and electrodiagnostic studies. Recent studies have used magnetic resonance imaging (MRI) to evaluate a variety of both nerve and muscle disorders. In this article, we describe the use of MRI, using short-tau inversion recovery (STIR) sequences, to evaluate muscle signal characteristics in a variety of peripheral nerve disorders. A total of 32 patients were studied, and 12 representative cases are discussed in detail. Increased STIR signal in muscle was seen in cases of severe axonotmetic injuries involving the transection of axons producing severe denervation changes on electromyography. The increased STIR signal in denervated muscles was seen as early as 4 days after the onset of clinical symptoms, which is significantly earlier than changes detected on electromyography. The MRI signal changes were reversible when the recovery of motor function occurred as a result of further muscle innervation. In cases of neurapraxic nerve injuries, characterized by conduction block without axonal loss, the STIR signal in muscle was normal. These findings show that MRI using STIR sequences provides a panoramic visual representation of denervated muscles useful in localizing and grading the severity of peripheral nerve injury secondary to either disease or trauma. MRI using STIR sequences may therefore play an important role in the prediction of clinical outcome and the formulation of appropriate therapy early after peripheral nerve injury.

Adolescent↗
PubMed1994

Development of an innovative nursing care delivery system.

In the reform of healthcare lies its renaissance, and in its challenges lie its opportunities. Faced with the changing needs of consumers, the evolving roles of care givers, technologic advances, and economic pressures, institutions are redesigning their physical facilities and systems of care delivery in preparation for a new era in healthcare. Innovative care delivery systems, developed to complement creative facility designs, will provide an approach to health-care that promotes administrative efficiency, patient/care giver satisfaction, and cost-effective use of resources. This article chronicles the development of a care delivery system for obstetric nursing, a blueprint for future healthcare at one institution.

Data Collection↗
PubMed1993

Electrophysiological evidence for the presence of receptors for cholecystokinin and bombesin on cultured astrocytes of rat central nervous system.

The action of cholecystokinin (CCK) and bombesin (Bom) was studied on the membrane potential of astrocytes in explant cultures of rat cortex, cerebellum, brain stem and spinal cord. Both peptides (10(-8) and 10(-7) M) caused a hyperpolarization of most astrocytes studied. The hyperpolarization by CCK was markedly reduced or blocked by the CCKB-antagonist L-365,260 whereas addition of the Bom-antagonist [D-Phe12,Leu14]-Bom antagonized the effects of Bom, suggesting a specific action of these peptides. When CCK and Bom were tested on the same cell, both peptides were effective, indicating a colocalization of receptors for CCK and Bom on the glial membrane. Our electrophysiological investigations provide strong evidence for the existence of functional CCK and Bom receptors on astrocytes.

Animals↗
PubMed1993

Fetal Doppler echocardiography in pulmonary atresia.

The prenatal diagnosis of pulmonary atresia is of particular importance because the affected neonate may be dependent on ductal blood flow to the lung, requiring urgent administration of prostaglandins. We review eight cases studied by ultrasonography in utero. Severe tricuspid regurgitation was present in six fetuses. Right ventricular size varied among cases. Right atrial enlargement was present in seven, usually with tricuspid regurgitation. Failure to identify the main pulmonary artery or valve on a single examination was not specific. Doppler flow studies were most reliable for the diagnosis by establishing the existence of retrograde flow in the ductus arteriosus from the aorta.

Blood Flow Velocity↗
PubMed1992

Triple therapy with sucralfate is as effective as triple therapy containing bismuth in eradicating Helicobacter pylori and reducing duodenal ulcer relapse rates.

Duodenal ulcer relapse rates after therapy with sucralfate or bismuth are lower than those after H2-receptor antagonist therapy. This may be mediated by an antibacterial effect of these drugs on Helicobacter pylori. Bismuth has become an integral part of 'triple therapy' because of its documented anti-H. pylori effect. In vitro and clinical data suggest that sucralfate may also have an anti-H. pylori effect. The aim of this randomized, prospective therapeutic trial was to compare the efficacy of triple therapy containing bismuth with that containing sucralfate and to determine the effect of therapy with these combinations on duodenal ulcer relapse. Forty H. pylori-positive duodenal ulcer patients were healed with omeprazole and randomized to receive either 1 g sucralfate four times daily or 120 mg bismuth compound four times daily. All patients received 400 mg metronidazole three times daily and either 250 or 500 mg tetracycline four times daily for 7-14 days. Thirty-five patients could be analysed. Overall eradication rates did not differ in the treatment groups (10 of 17 eradicated with sucralfate and 11 of 18 with bismuth). Relapse rates were significantly lower in the eradicated group (1 of 21 compared with 8 of 14 in the non-eradicated group) and did not differ between treatment groups in those patients not eradicated. A triple therapy regimen utilizing sucralfate appears to be as effective as the bismuth-containing regimen.

Bismuth↗
PubMed1989

[Percutaneous drainage of fistula-associated abscesses and biliary fistulas].

33 abdominal abscesses associated with fistulae in 31 patients were treated by percutaneous drainage. 19 of these patients had had surgery immediately preceding the drainage. In 64% the percutaneous drainage led to a diagnosis of an internal fistula. Additional therapeutic measures, because of the fistula, were necessary in 45% (operation, biliary drainage, repositioning of catheter). The average duration of drainage was 29 days. 77% of those abscesses which could be drained were treated successfully. Mortality in the entire series was 19%.

Abdomen↗
PubMed1989

[Percutaneous drainage treatment of abscess and fluid retention following abdominal surgery].

61 patients with abdominal abscesses and fluid collections as a postoperative complication underwent percutaneous drainage. 60 abscesses, 11 haematomas, 3 steril seromas and 3 bile collections were drained. The fluid collections were associated with biliary or enteric fistulae in 16 cases. The percutaneous drainage was successful in 69%, additional surgery was required in 15%. The overall mortality rate was 13%. Reasons for drainage failure were infected clots, phlegmonic abscesses and pancreas involvement of the abscesses.

Abdomen↗
PubMed1989

[Report of experiences with 31 surgically treated patients with deformity of the femur shaft].

In 1986/1987 we made a follow-up of 31 patients having undergone a surgical treatment of a deformity of the femur shaft in 1971 through 1981. For a better interpretation of the results we divided these patients into three partly overlapping groups: Patients with deformities of the angel or rotation, patients being shortened in case of length-differences and those being elongated. Finally we investigated, that in nine out of ten cases we got a good result by correcting angle-and rotation-deformities and by the shortening osteotomy. The extension osteotomy caused more complications and not so good results than those of the first two groups. We recognized, that the follow-up treatment was very long, and the method of the operation was not standardized but was adapted to the circumstances of the single case.

Bone Diseases↗
PubMed1985

[Arthrodesis of the upper ankle joint following trauma. Follow-up study].

During a period of more than 20 years, 63 patients having undergone a trauma were submitted to arthrodesis of the upper ankle joint. 31 out of them could be followed up from autumn 1982 through spring 1983. The primary reasons and the individual courses making necessary the arthrodesis varied to such an extent that there were no identical anamneses in any of the patients. The destruction of the upper ankle joint by high kinetic energy was apparently an essential factor in the anamnesis of arthrodesis of the upper ankle joint. There is no correlation between the number of posttraumatic arthrodeses and the number of fractures of the ankle joint treated by surgery during the same period. A "good" or "satisfactory" result was achieved in nine out of ten cases submitted to arthrodesis, and it seemed to be unimportant which of the usual techniques was applied. The high complication rate reported in literature, too, has possibly to be considered as a consequence of the gravity of the disease. It seems to be independent of the previously existing risk factors. The follow-up period is very long.

Adult↗
PubMedDate not supplied

[Unreported cases--obstacle to exact research in clinical orthopedics and traumatology].

In number 2 1991 of the "Orthopädie Mitteilungen" we referred to problems in obtaining valid data in orthopaedics and orthopaedic traumatology. There we mentioned several unknown cases in the epicrisis related to anamnestic facts. Now we continue the report with the support of our completely quality checked basis documentation. The comparison of the operation-report and the epicrisis shows us that data in three out of four cases are identical. We get nearly the same result, if we compare the operation-site (left or right are in four out of five cases identical). Furthermore we discuss a critical research of aneurysmatic bone cysts out of 24,000 epicrisis. Research into benign tumors or tumorlike lesions is very difficult, because the patients normally leave the hospital before the exact diagnosis was made. Therefore we must take into account uncertain results of our investigations. As far as possible our results take into account rare bibliographic data. Therefore we can show that our modified documentation of all epicrisis should be preferred to documentation of specific forms. Furthermore the investigation demonstrates, that our "frame coding system" is superior to a "precise coding system" for the precise system does not regard the background of the inquiries. But considering the background, we are able to discover most of the unknown cases and make them part of our conclusions.

Humans↗
PubMedDate not supplied

[Basic differential documentation as conditio sine qua non for effective quality assurance].

The quality check in medicine increases not at all by judges order. This contribution shows in what point of medical-documentation quality check must begin, if she should be effective. Some examples explain, that only a discriminated and a by specialist examined basic documentation is able to give us valid statistics of clinical data. Some results of our quality checked basis documentation were presented too.

Cross-Sectional Studies↗
PubMedDate not supplied

[Additional coding for legally required ICD-9 as the basis for high quality patient record searches].

We are convinced, that the updating of the ID DIACOS diagnosis catalogue fits better to the today's medical language, than the former one. By using a consequent additional code we could eliminate several lacks of the ICD-9. Valid and reproducible diagnosis statistics are now possible. Subjective coding mistakes are largely avoidable. Inquiries of certain diagnosis can be answered by using the one of the two codes, that describes the diagnosis in the best form. Regarding the allotments of the best form. Regarding the allotments of the catalogue of orthopedic and traumatic diagnosis including the possibility of double-coding we got a special better version of ID DIACOS than before.

Data Collection↗