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Biomedical subjects

W Thomas

Publications and source records attributed to W Thomas.

225 records · Page 13Linked to original sources
PubMedDate not supplied

[113 Re-operations to correct loosening of prosthesis shafts - personal experiences and conclusions (author's transl)].

one hundred and thirteen re-operations necessitated by loosening of the prosthesis shaft were analyzed with regard to surgical stress, technique and results. Of these operations to replace the prosthesis shaft, the surgical technique employed depended on the individual situation in 94 cases. In some, the implant and cement cone were removed, in some the medullary space was foragad, and in others single or multiple fenestration was performed. The surgical investment in these 94 operations proved to be especially high. The main disadvantage of individually oriented, partly improvised procedures is that granular tissue remains in the former contact zone between cement cone and bone. Uncovering of the shaft of the femur in a planned procedure employing the fenestration/chiseling method (19 patients) represents a way of cleaning the medullary cavity completely prior to fitting the replacement implant, with a low level of surgical stress. Implants whose shape corresponds as closely of the shaft are preferred to the so-called long-shaft implants. The authors see a considerable improvement in the departure from individually oriented and partially improvised procedures in replacement interventions: the surgical stress imposed by the operation is easier to assess and the safety of the implant renders the chances of success greater.

Femoral Fractures↗
PubMedDate not supplied

Comparison of predictive capabilities of diabetic exchange lists and glycemic index of foods.

To determine whether the diabetic exchange lists or the glycemic index of foods better predicts postprandial responses to carbohydrate-containing foods eaten as part of a mixed meal, three test meals were developed and fed to 12 subjects with non-insulin-dependent diabetes mellitus (NIDDM) and 13 healthy subjects. Each test meal contained exactly the same exchanges (1 milk, 4 starch, 2 fruit, 2 meat, 3 fat, 1 vegetable). In one meal, foods of high glycemic index (GI) were used, in a second meal, foods of intermediate GI were used, and in a third meal foods of low GI were used. The total GIs of the meals were: high, 184; intermediate, 131; and low, 107, thus predicting responses to intermediate and low GI, which were 71 and 58%, respectively, of the responses to high GI. Although some of the observed differences in the glycemic responses to the test meals were statistically significant, primarily in healthy subjects, the differences were usually much less than predicted by the GIs of the meals. In NIDDM subjects, peak postprandial plasma glucose, plasma glucose area, plasma glucose area increment, and mean plasma glucose responses after intermediate and low GI were greater than 90% of the corresponding responses to high GI. In healthy subjects, only the plasma glucose area increment after the low-GI meal was close to the predicted response. High GI produced significantly greater insulin responses than low GI in healthy subjects. We conclude that the diabetic exchange lists more accurately predict postprandial responses to carbohydrate-containing foods eaten as part of a mixed meal than does the GI of foods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Ovarian myxoma: ultrastructural and immunohistochemical findings.

The ultrastructural and immunohistochemical findings are reported in two ovarian myxomas, one of which was also associated with a sclerosing stromal tumor of the same ovary. Both neoplasms showed a myxoid, moderately cellular proliferation of spindle and stellate cells interspersed with areas of fibrosis and hemorrhage as well as delicate vascular spaces. Ultrastructurally, stellate neoplastic cells with irregular nuclei and occasional nucleoli were embedded in a mucinous and loose collagen matrix. Their cytoplasm showed abundant intracytoplasmic thin filaments that rarely condensed into poorly formed dense bodies. These thin filaments correlated with immunoreactivity for muscle-specific actin and vimentin. The neoplastic cells showed no immunoreactivity with antibodies to desmin, S-100 protein, cytokeratin AE1:AE3, factor VIII-related protein, or placental alkaline phosphatase. These ultrastructural and immunohistochemical findings are consistent with myofibroblastic differentiation. These ancillary studies exclude important, clinically more aggressive differential considerations such as myxoid rhabdomyosarcoma, myxoid liposarcoma, myxoid neural tumors, mucinous adenocarcinoma showing pseudomyxomatous change, and myxoid-appearing endodermal sinus (yolk sac) tumor.

Actin Cytoskeleton↗
PubMedDate not supplied

[Multimedia learning program for medical consultation].

To improve communicative competence during physicians' consultations, we developed a computer-assisted multimedia learning programme. This programme can be used in medical education as well as in continuing education for physicians. Dependent on individual skills and needs, the system, based on hypertext links, can be tailored to expand and improve communicative competence in a series of steps. The programme is based on a manual of medical interviewing and breaking bad news. The user gains information about theory and techniques of verbal intervention. He is trained to be able to reflectively observe and interactively intervene in video-taped and transcribed physician-patient dialogues. In a contrast-typological approach to model learning, in which negative and positive cases can be compared in a problem-based concept, alternative types of interventions can be recognised and evaluated. Finally, the learning goals in verbal intervention techniques should be subject of self-evaluation which can be objectified by further evaluations.

Communication↗
PubMedDate not supplied

Immunologically-mediated tumour cell apoptosis: the role of TRAIL in T cell and cytokine-mediated responses to melanoma.

Immune responses against human melanoma are common and are believed to influence the natural history of the disease. In particular, CD4 T cell infiltrates are associated with regression of primary melanoma and with responses to treatment with interferon-alpha2 (IFN-alpha2). Our studies have shown that CD4 T cells appear to kill melanoma by means of a member of the tumour necrosis factor (TNF) family expressed on their surface and called TNF related apoptosis inducing ligand (TRAIL). Moreover, sensitivity to TRAIL also predicts responsiveness of melanoma to CD4 T cells. TRAIL is not expressed on resting lymphocytes but is expressed at high levels after exposure to IFN-alpha2 and on activated T cells. Lymphocytes from melanoma patients in early stages of the disease show high levels of expression after exposure to IFN-alpha2 and IFN-gamma but expression was less on lymphocytes from stage IV patients. This may be due to factors from melanoma cells in that supernatants from some melanoma cultures suppressed IFN-alpha2 upregulation of TRAIL. Sensitivity of melanoma cells to TRAIL can be increased by inhibition of the activation of NF-kappaB and anti-apoptotic events downstream of NF-kappaB. These results suggest that TRAIL may be an important mediator of responses against melanoma induced by immunotherapy or by treatment with IFN-alpha2 and interleukin-2. Studies on surgical biopsies of melanoma however show that fresh isolates appear less sensitive to TRAIL-induced apoptosis and effective therapy may involve combinations with other agents.

Apoptosis↗
PubMedDate not supplied

The health of children adopted from Romania.

OBJECTIVE: To determine the medical condition of Romanian adoptees and the effects of the Romanian orphanage system on their health. DESIGN: Case series. SETTING: The international adoption clinics at the University of Minnesota, Minneapolis, and the New England Medical Center, Tufts University, Boston, Mass. PARTICIPANTS: Sixty-five Romanian adoptees who were brought to the United States during a 12-month period beginning in October 1990. MAIN OUTCOME MEASURES: Incidence of hepatitis B, intestinal parasites, tuberculosis, syphilis, human immunodeficiency virus type 1, growth failure, and developmental delay. RESULTS: Although the adopted children were presumably chosen from the most vital and attractive adoptees, only 15% were judged to be physically healthy and developmentally normal. Fifty-three percent had serological evidence of past or present hepatitis B infection, and 20% of screened children tested positive for hepatitis B surface antigen. In children aged 7 months or older, the overall prevalence of chronic hepatitis B was 23%. Intestinal parasites were found in 33% of subjects, and 45% of infected children had two or more pathogens identified. All the children tested for human immunodeficiency virus type 1 were negative. Two patterns of growth failure were observed that resembled the two subtypes of psychosocial short stature that occur in association with prolonged psychological harassment or emotional deprivation. Infants' length, weight, head circumference, and weight-for-height were adversely affected by institutionalization. Older children's height was reduced. Only 10% of children older than 12 months were developmentally normal. CONCLUSION: Romanian adoptees are an extraordinarily high-risk pediatric group as a consequences of decades of government-sanctioned child neglect and abuse.

Adoption↗
PubMedDate not supplied

Effects of progesterone on postoperative adhesion formation in hysterectomized rabbits.

Progesterone has been reported to have an antiinflammatory as well as immunosuppressive effect, and may prevent adhesion formation. In this study, nine treated and seven control rabbits were randomly selected for either pre- and postoperative progesterone treatment or no treatment. All rabbits underwent hysterectomy, focal peritoneal denudation, and intraabdominal instillation of suspended talc. Adhesion formation was evaluated 1 month postoperatively during repeat exploratory laparotomy. Progesterone-treated and control rabbits did not show any significant difference overall in the incidence of adhesion formation. Subgrouping of adhesion formation into adhesions formed by major surgical tissue trauma or minor peritoneal damage revealed a beneficial effect of progesterone in the reduction of only minor adhesion formation.

Animals↗