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W Schneider

Publications and source records attributed to W Schneider.

At least 55 records · Page 3Linked to original sources
PubMed2002

[Aggressive digital papillary adenocarcinoma - case report].

Digital papillary adenocarcinoma is a rare tumour originating from sweat glands, often occurring in digits of the hand or foot. We present the case of a 52-year-old mechanic with this tumour at the distal phalanx of the middle finger. It was primarily excised. After histological verification of the diagnosis, amputation and axillary lymphadenectomy was performed. So far, no clinical or histological parameters were found to be predictive for recurrence or metastasis. This indicates that the originally proposed criteria for distinguishing between benign (adenoma) and malignant (adenocarcinoma) do not necessarily predict biologic behaviour. As according to the available literature metastases occurred in 14 % of the described patients within ten years, we propose an aggressive surgical approach consisting of amputation and regional lymph node dissection.

Adenocarcinoma, Papillary↗
PubMed2002

[The influence on nerve regeneration by the beta2-receptor agonist clenbuterol].

PURPOSE: Clenbuterol has shown a neuroprotective action in the central nervous system by induction of growth factors after cellular damage. Additionally, the atrophy of sceletal muscle is attenuated by the application of Clenbuterol after denervation. This experiment was performed to show the influence of Clenbuterol on regeneration of peripheral nerves. MEHOD AND MATERIAL: In a rat model, the sciatic nerve was transected and microsurgically coaptated. Eight animals in each group received a daily oral dosage of 100 microg/kg bodyweight during four, respectively six weeks. Two control groups received only drinking water under the otherwise same protocol. The assessment was done histologically, morphometrically and clinically. The weight ratio of the soleus and extensor digitorum muscles of the operated to the contralateral side was measured. RESULTS: The groups treated with Clenbuterol showed histologically and morphometrically a significantly increased axon count and a better g-ratio. The muscle weight ratio was significantly higher in the Clenbuterol group after six weeks and more animals in this group were able to spread their toes. CONCLUSION: The oral application of Clenbuterol in a rodent model shows a positive influence on nerve regeneration.

Adrenergic beta-Agonists↗
PubMed2002

Is global outcome predictable in the rehabilitation of patients with musculoskeletal disorders? A pilot study.

Definition of prognostic factors for outcome quality is of increasing interest in rehabilitation medicine. The main question of this pilot study in 552 patients was whether global outcome could be predicted by a team-based chief physician specialized in physical medicine and rehabilitation (PMR), and whether other predictive factors would exist (ICIDH-2 levels, pain, working incapacity). Little data is available about the possibility of global prediction of prognosis in the rehabilitation of patients with musculoskeletal disorders. All 552 patients met each member of the rehabilitation team and key data from each patient was discussed at the rehabilitation conference within the first 2 days. On entry to the study, a chief physician specialized in PMR assessed the patient's key data, which was structured according to ICIDH-2 (ICF) and assessed quantitatively on a scale from zero to ten. Second, the PMR physician rated the expected global prognosis on the basis of ICIDH-2 and other key data, and in respect to the defined rehabilitation goals (see Table 2). At the same time, the patient and an assistant doctor (AD) assessed pain scores (VAS 0-10) and the actual working incapacity (%). These assessments were completed within the first 3 days and were repeated before discharge. Assessment of outcome was rated by both, separately, according to the above-mentioned scale. Different regression models were calculated, searching for significant differences between the numerous variables. In the regression models, the best predictor for outcome was the PMR physician assessment. Complete and good correspondence between prediction and outcome was obtained in 71.4% (42.1% and 29.3%, respectively) in the descriptive model. Quantitatively assessed ICIDH-2 levels, pain at entrance and working incapacity at entrance were not predictive factors for global outcome. The global outcome was rated as very good/good in 79.0% of cases by patient and in 75.1% cases by the AD, as moderate in 13.9% of cases by the patient and 18.4% of cases by the AD, and as poor/worsening in 7.1% of cases by the patient and in 6.5% of cases by the AD. Rating of outcome by the patient and the AD gave complete and good correspondence in 87.6% and no correspondence in only 2.6% of cases. Pain could be reduced highly significantly (P<0.001). There was a highly significant degree of correlation between quality of outcome and pain relief (outcome 'very good' and 'good', P<0.001; 'moderate', P=0.003; 'poor/worsening', not significant). Partial or complete reduction of working incapacity could be reached in 30% of the patients. This had no statistical influence on global outcome; neither did persistent working incapacity. Prediction of global outcome by a team-based PMR assessment seems to be a useful semiquantitative method with high predictive value. The method, including the critical point of validation, is currently being extensively discussed. Prediction is an integral process based on the high information grade of a multiprofessional rehabilitation team, the ICIDH-2 structures, the definition of rehabilitation goals, the knowledge and experience in bio-psycho-social medicine and the application of common sense. Rating of global outcome by the patient/AD is an integrative process as well. Pain relief is an important and very strong factor, with a high degree of influence on global outcome in musculoskeletal rehabilitation, probably by improving quality of life. Working incapacity is no reason for refusing patients rehabilitation and both improvement of working capacity and persistence of working incapacity, has no statistical influence on global outcome. Finally, the extent of the four ICIDH-2 levels, especially negative contextual factors, were not predictive, that is, they had no significant influence on global outcome in this study. In conclusion, prediction of global outcome by a team-based chief physician specialized in PMR is of high predictive value, practicable and useful for rehabilitation processes, quality assurance, insurance companies and health policies. To our knowledge, this is the first published study on this topic.

Adolescent↗
PubMed2002

Intertrochanteric osteotomy for avascular necrosis of the head of the femur. Survival probability of two different methods.

We have compared different types of intertrochanteric osteotomy for avascular necrosis of the hip and evaluated their performance in the light of improving outcome after total hip arthroplasty (THA). During a period of 14 years we performed 63 flexion osteotomies (partly combined with varus or valgus displacement), 29 rotational osteotomies, 13 varus osteotomies, eight medialising osteotomies and two extension osteotomies. The mean period of follow-up for all 115 operations was 7.3 years (maximum 24.6). At follow-up, 27 of 29 patients with a rotational osteotomy had already undergone a THA, compared with 36 of 63 after flexion osteotomy. A high incidence of complications (55.2%) was seen early after rotational osteotomy, compared with 17.5% after flexion osteotomy. For all osteotomies there was a high correlation between the size of the necrotic area and the incidence of failure, which also correlated with the preoperative Ficat and Steinberg stages. Using Kaplan-Meier survivorship analysis, Sugioka's rotational osteotomy showed a survival probability after five years of 0.26 (95% confidence interval 0.49 to 0.14), and after ten years of 0.15 (CI 0.36 to 0.06). The survival probability for flexion osteotomy was 0.70 (CI 0.83 to 0.59) after five years and 0.50 (CI 0.65 to 0.38) after ten years. The subgroup of flexion osteotomy with a necrotic sector of less than 180 degrees achieved the best survival probability of 0.90 (CI 1.00 to 0.80) after five years and 0.61 (CI 0.84 to 0.45) after ten years. The indications for intertrochanteric osteotomy for avascular necrosis of the hip have to be addressed critically. Even flexion osteotomy in cases with small areas of necrosis provides only temporary benefit. Rotational osteotomy was associated with a high incidence of complications.

Adult↗
PubMed2002

Juvenile bone-marrow oedema of the acetabulum treated by iloprost.

The bone-marrow oedema syndrome is associated with local vascular disturbances and may be treated either conservatively or by core decompression after which recovery may take several weeks. We describe a 15-year-old girl with bone-marrow oedema of the left acetabulum which was confirmed by MRI. She presented with a four-week history of severe constant pain. Routine blood tests and plain radiographs were normal. She was treated with intravenous infusions of iloprost on five consecutive days (20 microg administered in 500 ml of sodium chloride). Iloprost causes vasodilatation with reduction of capillary permeability and it inhibits platelet aggregation. She had relief from pain at rest after three days of treatment and was completely free from symptoms after two weeks. MRI after six weeks showed almost complete resolution of the marrow oedema and was normal after four months. This is the first report of the pharmacological treatment of the bone-marrow oedema syndrome in children.

Adolescent↗
PubMed2001

["Medical expert assessment in psychosomatic and psychotherapy medicine--social justice questions" guideline].

Guidelines on the medico-legal assessment of patients in the field of psychosomatics and psychotherapy prepared by the "German Society für Psychotherapeutic Medicine" is presented. These guidelines are based on published evidence and on expert consensus among psychotherapists, psychiatrists, judges and social security experts. They give a systematic overview on aspects relevant to the assessment of persons suffering from somatoform disorders, psychological factors in organic diseases and posttraumatic, anxiety, depressive, personality and eating disorders. These aspects are disability, severity, assessment of malingering, of disability and causality.

Disability Evaluation↗
PubMed2001

Regeneration of peripheral nerves after clenbuterol treatment in a rat model.

Clenbuterol is known to act as a neuroprotective substance in the central nervous system, and also reduces muscle atrophy after denervation. The aim of this study was to evaluate its influence on peripheral nerve regeneration. The rat sciatic nerve model was used in four groups (n = 8 per group). After complete nerve transection and microsurgical coaptation, two groups received a daily oral dose of 100 microg/kg clenbuterol and two served as controls. Regeneration was assessed clinically, histologically, and morphometrically after 4 and 6 weeks. The weight ratios of calf muscles were calculated. Histological examination showed significantly increased axon counts in the clenbuterol group and a better degree of myelination. Muscle weight ratios of the clenbuterol group were significantly increased after 6 weeks, and the animals showed improved function of the hindlimb. Thus, therapy with 100 microg/kg clenbuterol daily after coaptation of a sciatic nerve showed a positive influence on clinical, histological, and morphometrical parameters in the rat model. The underlying mechanism remains unclear.

Animals↗
PubMed2001

The role of accuracy motivation on children's and adults' event recall.

To examine the role of accuracy motivation in event recall, 6-, 7-, and 8-year-old children and adults were shown a short video about a conflict between two groups of children. Three weeks later, participants were asked a set of unbiased specific questions about the video. Following A. Koriat and M. Goldsmith's (1994) distinction of quantity- and quality-oriented memory assessments, and based on their model of strategic regulation of memory accuracy (1996), accuracy motivation was manipulated across three conditions. Participants were (a) forced to provide an answer to each question (low accuracy motivation), (b) initially instructed to withhold uncertain answers by saying "I don't know" (medium accuracy motivation), or (c) rewarded for every single correct answer (high accuracy motivation). When motivation for accuracy was high, children as young as 6 were to withhold uncertain answers to the benefit of accuracy. The expected quality-quantity trade-off emerged only for peripheral items but not for the central items. Participants who were forced to provide an answer gave more correct answers but also high numbers of incorrect answers than participants who had the option to answer "I don't know." The results are discussed in terms of the underlying model as well as in terms of forensic interviewing.

Adolescent↗
PubMed2001

The credibility of children's testimony: can children control the accuracy of their memory reports?

In previous work with adults (A. Koriat & M. Goldsmith, 1994, 1996c), it was shown that people can enhance the accuracy of their testimony substantially when they (a) are effective in monitoring the correctness of their answers, (b) are free to control their reporting accordingly (i.e., to decide which pieces of information to volunteer and which to withhold), and (c) are given incentives for accurate reporting. A theoretical model was developed, which specifies the critical role of metacognitive monitoring and control processes in mediating free-report memory accuracy. The present study applies that model to examine the strategic regulation of memory accuracy by children. Three experiments indicate that both younger (ages 7 to 9) and older (ages 10 to 12) children can enhance the accuracy of their testimony by screening out wrong answers under free-report conditions but suggest a developmental trend in the level of memory accuracy that is thereby achieved. The implications of the results for the dependability of children's testimony in legal settings are discussed.

Age Factors↗
PubMed2001

[Surgical treatment of axillary hidradenitis suppurativa].

INTRODUCTION: Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas and abscesses, mostly located in the groin and axillary regions. A conservative treatment can not prevent a recurrence. PATIENTS AND METHODS: We report on 16 patients with axillary hidradenitis suppurativa. The inflammatory region was excised, followed by immediate coverage with a transposition flap according to Limberg. Postoperatively, all patients received antibiotic treatment. After 2 weeks, physiotherapy was begun. RESULTS: All wounds healed primarily. Functional and aesthetic results were very satisfactory. Movement of the shoulder showed no restrictions. There was no major complication. The recurrence rate was low. DISCUSSION: Only radical debridement prevents a recurrence. The therapy of choice is radical excision of the affected region and immediate coverage by a transposition flap. Open granulation or split-skin grafting are inferior compared with a primary closure by transposition flap. Using the Limberg flap the donor site can be closed primarily.

Adult↗
PubMed2001

[Heterotopic replantation after bilateral lower leg amputation].

INTRODUCTION: Replantation is an established procedure in reconstructive surgery. In a bilateral lower leg amputation attempts should be made to rescue at least one extremity, if the patients' vital conditions are stable. PATIENT AND METHOD: We report on a patient who has suffered a bilateral lower leg amputation. Due to the complex injuries the left leg was heterotopically (cross-over) replanted to the right leg. At the left leg an above knee stump was created. In a second operation a soft tissue defect at the replanted extremity was covered by a free microvascular latissimus dorsi muscle flap. In addition, the tibial nerve was reconstructed. Thirteen months later the patient is able to walk with a prosthesis for his left leg and complete weight bearing of the replanted extremity. DISCUSSION: Indication for replantation depends on accompanying injuries and vital functions of the patient. Compared to a simple amputation a lower leg replantation prolongs hospital stay, delays mobilisation of the patient, and increases the necessary secondary procedures. However, after replantation functional outcome is mostly better than with prosthetic fitting, especially if reconstruction of sensation in the weight-bearing area is successful. Thus, in a bilateral amputation movement and stability, as well as quality of life, are improved by a replanted extremity.

Amputation Stumps↗
PubMed2001

[Therapy of chest wall osteomyelitis].

INTRODUCTION: Chronic osteomyelitis of the chest wall requires radical debridement and defect coverage with well-perfused tissue. The implantation of synthetic material is still under discussion because of the risk of infection. METHODS: A retrospective study was conducted on the complications and functional and aesthetic results of 26 patients with chest wall osteomyelitis after radiation or sternotomy treated by radical debridement and neurovascular pedicled latissimus dorsi muscle. RESULTS: The functional results were excellent with a low complication rate. The muscle showed electric activity synchronous with inspiration and clinically a stabilization of the thoracic defect. DISCUSSION: Maintained muscular activity may play an essential role for stabilizing thoracic defects of up to four ribs or the sternum; implantation of synthetic material is not necessary.

Adult↗
PubMed2001

[Surgical treatment of cicatricial carcinoma--methods and results].

INTRODUCTION: The prognosis of scar carcinoma, also known as Marjolin's ulcer, is poor. Metastases of lymph nodes often appear because of late diagnosis and the underestimation of clinical findings. This has a deep impact on the quality of life of the patients. Scar carcinoma often occurs in burn scars, but also in chronic ulcers of the lower extremities and in chronic pressure sores. METHODS: Between 1994 and 1998 12 patients with scar carcinoma were treated at our hospital. In all cases radical surgery of the entire scar area was undertaken, followed by dissection of the draining lymph nodes. Free flaps, pendicular flaps or splint skin grafts were used to cover the resulting defects. RESULTS: In 16.6% we observed positive lymph nodes. There were two cases of local recurrence. Five patients died during the observation time. In one patient the extremity had to be amputated. CONCLUSION: Early diagnosis and radical excision are requirements, and the quality of life can be improved with plastic surgery. Aftercare and yearly staging measures are mandatory.

Aged↗
PubMed2001

Surgery for hallux valgus. The expectations of patients and surgeons.

Two-hundred patients who had undergone surgery for hallux valgus were interviewed in an attempt to study the different variables which may have contributed to the success of their surgery. These data were compared to the results obtained by using clinically applied scores. To obtain data on surgeons' expectations, 186 members of two national orthopaedic foot societies were interviewed in order to quantify the importance and value of these variables in prognosis. The main interest of the patients is a painless great toe which, when wearing conventional shoes, gives no problems. They also wish to have their bursitis and bunion treated in order to regain their ability to walk as much as they wish. Surgeons are not only specially interested in pain and shoe problems but also in restoring an adequate range of motion in the metatarsophalangeal joint (MTP), removal of the bunion and the treatment of tender callosities. We found that the correction of footwear problems, alleviation of pain and restoration of adequate walking are the most important factors influencing the outcome of surgery. It was surprising that these expectations are only partly revealed by using clinical foot scores.

Adult↗
PubMed2001

Occupational hand dermatitis in food industry apprentices: results of a 3-year follow-up cohort study.

OBJECTIVE: The aim of this prospective follow-up study was to quantify the impact of hand dermatitis (HD) in bakers, confectioners and bakery shop assistants, and to investigate related risk factors. METHOD: Bakers', confectioners' and bakery-shop assistants were included in a prospective follow-up study in the region of East Thuringia starting in August 1996. At the beginning of their vocational training 91 apprentices were interviewed and examined in a standardised way. Follow-up examinations and interviews were done after 6 months (n = 79), 12 months (n = 63) and at the end of the training (n = 69) after 36 months. RESULTS: In their case histories 3.3% (n = 3) of the apprentices reported previous HD in childhood and adolescence. The first assessment after 2 to 4 weeks of vocational training revealed HD in 17.5% (n = 16) of the individuals. At the follow-up examination after 6 months, point prevalence of HD was 29.1% (n = 23), after 12 months 27.0% (n = 17) and after 36 months 27.5% (n = 19). Mild to moderate irritant contact dermatitis was the most frequent finding. Finally, an atopic skin diathesis (> 10 points, "atopy score") (OR = 4.89; CI 95% 1.15-20.79), previous HD (OR = 41.1; CI 95% 4.99-339.13) as well as flexural dermatitis (OR = 6.8; CI 95% 1.72-27.22) proved to be predictive factors for the development of HD. No association was found to respiratory atopy (OR = 1.29; CI 95% 0.35-4.7) and metal sensitisation (OR = 1.1; CI 95% 0.29-4.35). Exogenous irritant factors did not show a strong association towards a risk increase. Wet work in general, as well as distinct occupational tasks showed only a tendency for being a risk factor for HD. However, leisure time activities, especially house building and rebuilding (OR = 5.4; CI 95% 1.05-27.81), were associated with an elevated risk. CONCLUSIONS: Endogenous and exogenous factors contribute to the development of HD in bakers' and confectioners' apprentices.

Adolescent↗
PubMed2001

Reactivity of macroprolactin in common automated immunoassays.

OBJECTIVES: To evaluate a simple assay for macroprolactin for use with the Bayer Immuno 1 analyzer, and to compare the reactivity of macroprolactin in commonly used automated prolactin assays. METHODS: Macroprolactin in serum was precipitated in a buffer containing 13.3% polyethylene glycol (PEG) 8000, redissolved, and assayed on the Bayer Immuno 1 for PRL. Presence of macroprolactin was confirmed in some sera by FPLC using a Pharmacia Superose 12 column, followed by prolactin assay of the fractions on the Immuno 1. Sera with and without macroprolactin were then also assayed on the Abbott AxSYM, Bayer Centaur, Beckman Access, and Roche Elecsys. RESULTS: The PEG precipitation assay is simple and reproducible (CVs < 15%), and we established a normal range of < 20% precipitation of total PRL by PEG. The assay correlates well with the amount of macroprolactin separated by FPLC as a peak with a MW of approximately 180 kDa. Macroprolactin showed the following cross-reactivities in commonly used PRL assays: Roche Elecsys > Bayer Immuno 1 > Abbott AxSYM > Bayer Centaur > Beckman Access, with the Centaur showing more variability than other assays. CONCLUSION: Macroprolactin can be easily quantitated using the Immuno 1 PRL assay after PEG precipitation. It cross-reacts to different degrees with common prolactin assays, and is a major source of variability between them.

Autoanalysis↗
PubMed2001

Pharmacokinetics and metabolism of formestane in breast cancer patients.

Formestane (Lentaron(R), 4-hydroxyandrostenedione) is a steroidal aromatase inhibitor used for treatment of advanced breast cancer. Clinically, it is administered as a depot form once fortnightly by intramuscular (i.m.) injection. To investigate the pharmacokinetics, bioavailability and metabolism of the drug, seven patients received single 250 mg i.m. doses of commercial formestane on Days 0, 21, 35, 49 and 63 of this trial. On Day 63, three of the patients received an additional single intravenous (i.v.) pulse dose of 1 mg of 14C-labelled formestane. The plasma kinetics after i.m. dosing confirmed a sustained release of formestane from the site of injection. Within 24-48 h of the first dose, the circulating drug reached a C(max) of 48.0+/-20.9 nmol/l (mean+/-S.D.; N=7). At the end of the dosing interval, after 14 days, the plasma concentration was still at 2.3+/-1.8 nmol/l. The kinetic variables did not significantly change during prolonged treatment. Intramuscular doses appear to be fully bioavailable. Following i.v. injection of 14C-formestane, the unchanged drug disappeared rapidly from plasma, the terminal elimination half-life being 18+/-2 min (N=3). Plasma clearance, CL was 4.2+/-1.3 l/(h kg) and the terminal distribution volume V(z) was 1.8+/-0.5 l/kg. The drug is mainly eliminated by metabolism, renal excretion of metabolites accounting for 95% of dose. The excretory balance of 14C-compounds in urine and faeces totals up to 98.9+/-0.8% of the i.v. dose after 168 h. The 14C-compounds in plasma and urine were separated by HPLC, and three major metabolites were submitted to structural analysis by MS, NMR and UV spectroscopy. One of the metabolites is the direct 4-O-glucuronide of formestane. The other two represent 3-O-sulfates of the exocons 3beta,4beta-dihydroxy-5alpha-androstane-17-one and 3alpha,4beta-dihydroxy-5alpha-androstane-17-one, their ratio being 7:3. These exocons are formed by stereoselective 3-keto reduction, accompanied by reduction of the 4,5-enol function. The exocons do not inhibit human placental aromatase activity in vitro.

Aged↗