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  • Articles: DFG German National Licenses  (156)
  • 2000-2004  (155)
  • 1965-1969  (1)
  • 1890-1899
  • 1820-1829
  • Keywords
  • Prognosis
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  • Articles: DFG German National Licenses  (156)
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Year
Keywords
  • 101
    Electronic Resource
    Electronic Resource
    Monströses benignes Schwannom der Mandibula (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. 387-390 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Schwannom ; Benigner Tumor ; Intraossäre Lokalisation ; Mandibula ; Unterkieferteilresektion ; Mikrochirurgische Nervenrekonstrukion ; Keywords ; Schwannoma ; Benign tumor ; Intraosseous localisation ; Mandible ; Partial resection of mandible ; Microsurgical reconstruction of nerve
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Background: Schwannomas are rare benign neurogenic tumors that arise from Schwann cells of the peripheral nervous system. The most frequent localisation is the head and neck area. Extracranial schwannomas are most often located in the deep soft tissues. Intraosseous tumortypes are rare; the mandible is the most common site. Case report: We present the case of a 63-year-old woman with a schwannoma which originated from the mandible nerve and describe the therapy of this neoplasm. A rare malignant transformation cannot be excluded. Therefore, the treatment of choice is radical local resection.
    Notes: Hintergrund: Schwannome sind benigne Neubildungen, die ihren Ursprung von den Schwann-Zellen nehmen. Ihre Prädilektionsstelle ist die Kopf-Hals-Region. Sie treten zumeist im Verlauf des VIII. Hirnnervs auf. Extrakranial sind die Schwannome überwiegend ¶in den Weichgeweben lokalisiert. Eine intraossäre Lage ist selten, dann jedoch gewöhnlich in der Mandibula anzutreffen. Fallbericht: Eine 63-jährige Patientin wird vorgestellt, und die Therapie wird aufgezeigt. Die Behandlung sollte vergleichsweise radikal erfolgen, da trotz stabiler benigner Eigenschaften die Transformation in ein Malignom nicht definitiv ausgeschlossen werden kann.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100060000249
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  • 102
    Electronic Resource
    Electronic Resource
    Evaluation of p21WAF1/CIP1 and cyclin D1 expression in the progression of superficial bladder cancer (2000)
    Springer
    Urological research 28 (2000), S. 285-292 
    Details
    ISSN: 1434-0879
    Keywords: Key words Superficial bladder cancer ; p21WAF1/CIP1 ; Prognosis ; Cyclin D1
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Immunoreactivity of p21WAF1/CIP1 and cyclin D1 proteins was assessed in a cohort of 207 patients with superficial (pTa-pT1) bladder cancer followed up for a mean of 4.9 years. The results of the immunostainings were compared with T category, WHO grade, tumor cell proliferation rate (MIB-1 score), the expressions of p53 and bcl-2 as well as survival. Sixty-eight percent and 75% of the tumors were p21WAF1/CIP1 positive (≥5% of cells positive) and cyclin D1 positive (≥10% of cells positive), respectively. The p21WAF1/CIP1 expression was related to cyclin D1 immunolabelling (P 〈 0.001) but not to the other variables studied. The expression of cyclin D1 was inversely associated with T category (P=0.001), WHO grade (P=0.006), MIB-1 score (P=0.014), p53 expression (P=0.001), and bcl-2 (P=0.011) immunoreactivity. In univariate analysis, T category (P=0.0001), WHO grade (P 〈 0.0001), MIB-1 score (P 〈 0.0001), bcl-2 (P=0.0092), p53 (P=0.0016) and p21WAF1/CIP1 (P=0.009) expressions were significant prognostic factors with regard to tumor progression, whereas cyclin D1 was without any prognostic significance (P=0.1). Out of 123 p21 positive tumors 21 progressed, whereas only 2 out of 58 p21 negative tumors progressed. In multivariate analysis, the MIB-1 score was the only independent predictor of cancer-specific survival (P=0.03), whereas tumor grade (P=0.002) and cyclin D1 expression (P=0.04) were independent predictors of tumor recurrence. Only the WHO grade (P=0.04) retained its prognostic value indicating the risk of progression. We suggest that in superficial bladder cancer p21WAF1/CIP1 and cyclin D1 immunohistochemistry provide no additional prognostic information compared with already established prognostic factors for predicting the risk of progressive disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002400000116
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  • 103
    Electronic Resource
    Electronic Resource
    Leukemic hypopyon in acute myelogenous leukemia (2000)
    Springer
    Annals of hematology 79 (2000), S. 455-458 
    Details
    ISSN: 1432-0584
    Keywords: Key words Anterior chamber ; Hypopyon ; Leukemia ; Extramedullary ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We encountered a patient with acute myelogenous leukemia (AML) who developed leukemic hypopyon. Leukemia initially spread into the pharynx, gingiva, lymphnode, and bone marrow. He achieved complete remission after chemotherapy but developed blurred vision and hypopyon. Anterior chamber paracentesis disclosed leukemic infiltration of the anterior chamber. Infiltration of the central nervous system also occurred. He received systemic chemotherapy, intrathecal chemotherapy, and local chemotherapy. However, he did not achieve prolonged remission. These findings suggest that these chemotherapy treatments have an inadequate effect for AML with anterior chamber infiltration. This rare complication is associated with extramedullary infiltration of leukemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770000164
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  • 104
    Electronic Resource
    Electronic Resource
    Allogeneic bone marrow tranplantation for young adult patients with newly diagnosed acute myeloid leukemia: HLA-Matched sibling donor availability does not improve treatment ouctome (2000)
    Springer
    Hematology and cell therapy 42 (2000), S. 119-129 
    Details
    ISSN: 1279-8509
    Keywords: Acute myeloid leukemia ; Chemotherapy ; Allogenic transplantation ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In order to assess the place of HLA-identical allogeneic bone marrow transplantation (BMT) and to compare it to other post-induction therapies, we analyzed patient outcome in intention-to-treat based on the presence or not of an HLA-identical familial donor in young adults with de novo acute myeloid leukemia (AML) in first complete remission (CR). Between 1985 and 1998, 152 consecutive AML patients aged less than 41 years old, seen in our institution, were treated according to 3 different successive protocols (LYLAM85, LAM90, AML10). 144/152 patients entered our prospective study in which they were registered at time of diagnosis for presence or absence of HLA-identical donor and analyzed in intention-to-treat. In this study, 52 patients (36%), who had at least one identical sibling donor (group 1), were offered allogeneic BMT after CR achievement. The 92 patients without donor were allocated to group 2 and were assigned to receive chemotherapy or autologous transplantation as post-remission according to the protocol they were initially included in. Patients from both groups had similar disease characteristics at diagnosis. Karyotypes at diagnosis were defined as low risk (t(8;21) or t(15;17) or chromosome 16 abnormalities(, intermediate risk (normal karyotypes), or high risk (other abnormalities). Overall, 114/152 patients (75%) achieved a CR. Of the 144 eligible patients, 46/52 (88%) with a donor and 68/92 (74%) without a donor achieved a CR. The median follow-up duration of the 144 patients was 21.2 months. The relapse rate was higher in group 2 (56%) than in group 1 (31%). However, the overall survival was not different between patients with and without donor (median survival respectively at 16.7 months and 26.6 months with estimated survival at 5 years respectively at 32% and 34%). Thirty-four patients from group 1 (65%) were actually transplanted in first CR. The probability of 5-year survival for patients receiving effectively allogeneic BMT was 44% and was not significantly better than that of patients who did not. In univariate as in multivariate analysis, karyotypic status was the main prognostic factor for CR achievement (p = 0.002), CR duration (p 〈 0.0001), and overall survival (p 〈 0.0001). There were no significant differences between group 1 and group 2 when survivals were compared with adjustment for karyotypes. We conclude that the availability of an HLA-identical sibling donor did not confer any prognostic advantage in terms of outcome for young adults with AML in first CR. These results make allogeneic BMT process questionable as systemic post-remission therapy in patients with an HLA-identical familial donor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00282-000-0119-8
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  • 105
    Electronic Resource
    Electronic Resource
    Incarcerated direct inguinal hernias: a three-year series at a large volume teaching hospital (2000)
    Springer
    Hernia 4 (2000), S. 145-147 
    Details
    ISSN: 1248-9204
    Keywords: Hernia ; Strangulation ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary It is believed that direct hernias are less likely to strangulate because, in contrast to an indirect inguinal hernia, the neck of the direct hernia is wide. For this reason, some surgeons do not repair direct hernias in I elderly patients. We analyzed all incarcerated hernias repaired on an emergency basis during a 3-year period in order to discover the extent of incarcerated direct hernias in our practice. A total of 293 patients with incarcerated hernia were evaluated; of these, 222 were inguinal (193 indirect −86.9%- and 29 direct −13.1%-). The strangulation rate for inguinal hernias was found to be 29.7%. There was a significant difference between indirect and direct inguinal hernias in respect to strangulation rate (32.6% vs 10.3% p = 0.014). However, we did not find any difference between bowel resection rates in incarcerated-strangulated indirect and direct hernias (14/193 −7.3%- vs 2/29 −6.9%-, p = 0.95). Hospitalization time was significantly longer for the patients who developed strangulation than those who did not. The side of direct hernia had no effect on strangulation (10.5% for right-sided vs 10.0% for left-sided, p = 0.97). The only prognostic factor for strangulation and resection in regression analysis was the age-group of the patients (〈 60 vs. 60 or older). At operation the average diameter of the defect in the transversalis fascia was 23.8 mm. The diameter of the defect had no effect on strangulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01207592
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  • 106
    Electronic Resource
    Electronic Resource
    The insertion of the lesser and greater gastric omenta and its significance for the T classification of gastric carcinomas (UICC) (2000)
    Springer
    Surgical and radiologic anatomy 22 (2000), S. 135-138 
    Details
    ISSN: 1279-8517
    Keywords: Gastric carcinomas ; Cardiac carcinomas ; TNM-classification ; Prognosis ; Lesser and greater omenta
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The problem of T classification of proximal gastric carcinomas is becoming increasingly important due to a rise in the incidence of these tumors. The aim of this study was to examine the gastric insertion of the lesser and greater omenta and its role in the T classification of gastric carcinomas. The stomach and greater and lesser omenta were removed from 76 fixed cadavers and 12 measurements each were done in defined localizations. The lesser omentum extended to the gastric wall in 98% of the cases. This junction as well as the omental thickness and thus the retroperitoneal part are especially pronounced in the cardiac region. According to the current UICC classification, even advanced tumors extending into the gastric wall can be classified T2 as long as they do not penetrate the visceral peritoneum. This results in « understaging » and a seemingly poorer prognosis for cardiac carcinomas. Our study results support the recommendation of Hermanek and Wittekind [5] to subdivide the T2 stage of gastric carcinomas on the basis of infiltration depth.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00276-000-0135-y
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  • 107
    Electronic Resource
    Electronic Resource
    αvβ3 expression on blood vessels and melanoma cells in primary lesions; differential association with tumor progression and clinical prognosis (2000)
    Springer
    Cancer immunology immunotherapy 49 (2000), S. 314-318 
    Details
    ISSN: 1432-0851
    Keywords: Key wordsαvβ3 ; Integrins ; Melanoma ; Blood vessels ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The αvβ3 integrin has emerged as a key mediator in angiogenesis. Its role in tumor-induced angiogenesis is supported by its up-regulation in vivo in the vasculature of a number of different types of carcinoma. The potential clinical significance of αvβ3 expression on blood vessels in carcinomas is suggested by its association with tumor progression. Currently no information is available about the clinical significance of αvβ3 expression on the vasculature of lesions of melanocytic origin. Since we have previously found that αvβ3 expression on melanoma cells in primary lesions is associated with a poor prognosis, in the present study we have compared αvβ3 expression on blood vessels and on cells of melanocytic origin in nevi and in malignant melanoma lesions. In addition we have examined the lesions for expression of the αv subunit to gain information on the regulation of αvβ3 expression on endothelial cells and on cells of the melanocyte lineage. αvβ3 expression on endothelial cells and on melanocytic cells was a relatively sensitive and specific marker for malignant lesions. However, αvβ3 expression on endothelial cells in primary melanoma lesions was not associated with the prognosis of the disease. The αv subunit and the αvβ3 complex were differentially expressed on endothelial cells and on melanocytic cells, implying that different regulatory pathways control their expression. This finding may account for the differential clinical significance of αvβ3 expression on tumor vasculature and on melanoma cells we observed in our patient cohort. Lastly, αvβ3 may be a useful target for immunotherapeutic approaches in melanoma because of its high expression on the vasculature of all metastatic lesions tested and its restricted distribution in normal tissues.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002620000124
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  • 108
    Electronic Resource
    Electronic Resource
    Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score (2000)
    Springer
    Intensive care medicine 26 (2000), S. 915-921 
    Details
    ISSN: 1432-1238
    Keywords: Key words Mortality ; Oliguria ; Multiple organ failure ; Severity-of-illness ; Prognosis ; Scoring systems
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To describe risk factors for the development of acute renal failure (ARF) in a population of intensive care unit (ICU) patients, and the association of ARF with multiple organ failure (MOF) and outcome using the sequential organ failure assessment (SOFA) score. Design: Prospective, multicenter, observational cohort analysis. Setting: Forty ICUs in 16 countries. Patients: All patients admitted to one of the participating ICUs in May 1995, except those who stayed in the ICU for less than 48 h after uncomplicated surgery, were included. After the exclusion of 38 patients with a history of chronic renal failure requiring renal replacement therapy, a total of 1411 patients were studied. Measurements and results: Of the patients, 348 (24.7 %) developed ARF, as diagnosed by a serum creatinine of 300 μmol/l (3.5 mg/dl) or more and/or a urine output of less than 500 ml/day. The most important risk factors for the development of ARF present on admission were acute circulatory or respiratory failure; age more than 65 years, presence of infection, past history of chronic heart failure (CHF), lymphoma or leukemia, or cirrhosis. ARF patients developed MOF earlier than non-ARF patients (median 24 vs 48 h after ICU admission, p 〈 0.05). ARF patients older than 65 years with a past history of CHF or with any organ failure on admission were most likely to develop MOF. ICU mortality was 3 times higher in ARF than in other patients (42.8 % vs 14.0 %, p 〈 0.01). Oliguric ARF was an independent risk factor for overall mortality as determined by a multivariate regression analysis (OR = 1.59 [CI 95 %: 1.23–2.06], p 〈 0.01). Infection increased the risk of death associated with all factors. Factors that increased the ICU mortality of ARF patients were a past history of hematologic malignancy, age more than 65 years, the number of failing organs on admission and the presence of acute cardiovascular failure. Conclusion: In ICU patients, the most important risk factors for ARF or mortality from ARF are often present on admission. During the ICU stay, other organ failures (especially cardiovascular) are important risk factors. Oliguric ARF was an independent risk factor for ICU mortality, and infection increased the contribution to mortality by other factors. The severity of circulatory shock was the most important factor influencing outcome in ARF patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051281
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  • 109
    Electronic Resource
    Electronic Resource
    Acute renal failure in patients over 80 years old: 25-years' experience (2000)
    Springer
    Intensive care medicine 26 (2000), S. 400-406 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute renal failure ; 80 years old ; Etiology ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine the epidemiological trends, spectrum of etiologies, morbidity and mortality of acute renal failure (ARF) in patients over 80 years old.¶Design: Historical cohort analysis.¶Setting: Intensive care unit (ICU) of nephrology, Tenon Hospital, Paris.¶Patients and participants: The criteria of inclusion was ARF, defined on the basis of a creatinine value over 120 μmol/l, in patients over 80 years of age admitted between October 1971 and September 1996. When moderate chronic nephropathy was pre-existing, ARF was defined by the increase of at least 50 % over the basal creatininemia.¶Measurements and results: Three hundred and eighty-one patients over 80 years of age were included. The etiology and mechanism of ARF are detailed. 29 % of the patients received dialysis. Global mortality at the hospital was 40 %. Factors significantly associated with a poor prognosis are identified. Mean survival after hospitalization was 19 months.¶Conclusion: The frequency of admission to ICUs for ARF in patients older than 80 years seems to be on the increase. Mortality is less severe than expected. These patients could benefit from the renal replacement therapy of modern intensive care medicine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051173
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  • 110
    Electronic Resource
    Electronic Resource
    The epidemiology of the systemic inflammatory response (2000)
    Springer
    Intensive care medicine 26 (2000), S. S064 
    Details
    ISSN: 1432-1238
    Keywords: Key words Bacteraemia ; Sepsis ; Septic shock ; Epidemiology ; Prognosis ; Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To examine the incidence, risk factors, aetiologies and outcome of the various forms of the septic syndromes (the systemic inflammatory response syndrome [SIRS] sepsis, severe sepsis, and septic shock) and their relationships with infection.¶Design: Review of published cohort studies examining the epidemiology of the septic syndromes, with emphasis on intensive care unit (ICU) patients.¶Results: The prevalence of SIRS is very high, affecting one-third of all in-hospital patients, and 〉 50 % of all ICU patients; in surgical ICU patients, SIRS occurs in 〉 80 % patients. Trauma patients are at particularly high risk of SIRS, and most these patients do not have infection documented. The prevalence of infection and bacteraemia increases with the number of SIRS criteria met, and with increasing severity of the septic syndromes. About one-third of patients with SIRS have or evolve to sepsis. Sepsis may occur in approximately 25 % of ICU patients, and bacteraemic sepsis in 10 %. In such patients, sepsis evolves to severe sepsis in 〉 50 % of cases, whereas evolution to severe sepsis in non-ICU patients is about 25 %. Severe sepsis and septic shock occur in 2 %–3 % of ward patients and 10 %–15 % or more ICU patients, depending on the case-mix; 25 % of patients with severe sepsis have shock. There is a graded severity from SIRS to sepsis, severe sepsis and septic shock, with an associated 28-d mortality of approximately 10 %, 20 %, 20 %–40 %, and 40 %–60 %, respectively. Mortality rates are similar within each stage, whether infection is documented or not, and microbiological characteristics of infection do not substantially influence outcome, although the source of infection does. While about three of four deaths occur during the first months after sepsis, the septic syndromes significantly impact on long-term outcome, with an estimated 50 % reduction of life expectancy over the following five years. The major determinants of outcome, both short-term and long-term, of patients with sepsis are the severity of underlying diseases and comorbidities, the presence of shock and organ failures at onset of sepsis or evolving thereafter. It has been estimated that two-thirds of the overall mortality can be attributed to sepsis.¶Conclusions: The prevalence of sepsis in ICU patients is very high, and most patients have clinically or microbiologically documented infection, except in specific subset of patients. The prognosis of septic syndromes is related to underlying diseases and the severity of the inflammatory response and its sequelae, reflected in shock and organ dysfunction/failures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051121
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  • 111
    Electronic Resource
    Electronic Resource
    Prognostic significance of DNA cytometry in thymoma (2000)
    Springer
    Journal of cancer research and clinical oncology 126 (2000), S. 280-284 
    Details
    ISSN: 1432-1335
    Keywords: Key words Thymoma ; Prognostic factors ; Prognosis ; DNA cytometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Purpose: The aim of this work was to evaluate the prognostic significance of DNA image cytometry in thymoma. Patients and methods: Image cytometric studies with an automatic video-based analysis system (LEYTAS) were carried out on 47 archival specimens from 36 patients with thymomas who underwent operation at a single institution from 1954 to 1992. The significance of aneuploidy DNA-content (5c-exceeding events), and nuclear size on stage and survival were evaluated. The median follow-up was 52.7 (6–164) months. Results: Masaoka's stage was predictive of aneuploidy (P 〈 0.01) and disease-free survival (P 〈 0.015). In stage I 18% of the tumors were aneuploid, in stage II 78%, in stage III 85% and in stage IV 100%. The occurrence of 5c-exceeding events was associated with both decreased disease-free survival (P 〈 0.01) and overall survival (P = 0.013). Nuclear size was not significantly correlated to stage. Under multivariate analysis, aneuploidy and DNA content failed to attain independent significance for stage, performance status, and histology. Conclusion: DNA image cytometry may provide additional information about the prognosis of resected thymoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050343
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  • 112
    Electronic Resource
    Electronic Resource
    Procalcitonin in patients undergoing cardiopulmonary bypass in open heart surgery – first results of the Procalcitonin in Heart Surgery study (ProHearts) (2000)
    Springer
    Intensive care medicine 26 (2000), S. S193 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiopulmonary bypass ; Coronary artery bypass graft ; Valve surgery ; Thoracic aortic surgery ; Prognosis ; Hypotension ; Systemic inflammatory response syndrome (SIRS) ; Procalcitonin ; Endotoxin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate procalcitonin (PCT) levels in patients undergoing cardiopulmonary bypass (CPB) in order to assess the prevalence and prognostic capacity of elevated PCT levels following CPB in open heart surgery.¶Design: prospective observational study in consecutive patients.¶Setting: Twenty-four-bed ICU, department of thoracic and cardiovascular surgery, university hospital.¶Patients: Seven hundred and twenty two patients, 691 of whom underwent CPB, i. e., 476 had coronary bypass surgery (CABG), 130 valve replacement, 34 combined CABG and valve replacement, and 23 thoracic aortic surgery.¶Interventions: Standard perfusion techniques were used with cardioplegic arrest and mild hypothermia (28–32 °C). With the exception of thoracic aortic procedures, full–flow perfusion was performed.¶Measurements and results: PCT was measured prior to surgery and daily thereafter until ICU discharge or death. PCT significantly increased at day 1 postoperatively compared to baseline values (0.25 ± 1.65 vs 6.49 ± 22.0 ng/ml, p 〈 0.005). However, in 55.1 % of patients PCT was below 1.0 ng/ml. In 12.8 % of CABG patients PCT was increased to 〉 5.0 ng/ml, compared to 39 % in valve patients and 35 % of patients with aortic surgery. An elevated PCT level 〉 1.0–5.0 ng/ml at day 1 was highly predictive of mortality (P 〈 0.03, vs 〈 1.0 ng/ml), with an additional accuracy when levels 〉 5.0 ng/ml were measured (P 〈 0.002 vs 〈 1.0 ng/ml).¶Conclusions: These results provide evidence that PCT might serve as an early prognostic marker in patients undergoing CPB in open heart surgery. It may be worth considering immunomodulating approaches in patients presenting elevated PCT levels in the early phase after CPB.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051143
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  • 113
    Electronic Resource
    Electronic Resource
    Morphologie, DNA-Zytophotometrie und Prognose gastrointestinaler neuroendokriner Tumoren (Karzinoide) (2000)
    Springer
    Der Pathologe 21 (2000), S. 73-81 
    Details
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Gastrointestinaltrakt ; Karzinoid ; Neuroendokrine Tumoren ; DNA-Zytophotometrie ; Prognose ; Key words Gastrointestinal tract ; Carcinoid ; Neuroendocrine tumors ; DNA cytophotometry ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A total of 123 manifestations (97 primary tumours and 26 metastases) of neuroendocrine tumours of the gastrointestinal tract observed in 95 patients was investigated for the prognostic value of clinical, histological and DNA cytophotometric parameters. Metastases almost exclusively occurred among ileal carcinoids, which also were responsible for all 14 cases of lethal outcome observed during the follow-up period of mean 42 months. Aneuploid DNA values could be determined significantly more frequently among ileal than in non-ileal carcinoids and showed – upon analysis of the total group of gastrointestinal neuroendocrine tumours – a significant correlation to lethal course of disease. In addition, among 18 cases with primary and secondary carcinoid manifestations available for DNA cytophotometry, an association between the DNA content of metastatic neuroendocrine tumours and prognosis came to light. When applicated to the group of ileal neoplasms, however, the parameter DNA content did not allow a better prognostic assessment.
    Notes: Zusammenfassung Untersucht wurden 123 Manifestationen (97 Primärtumoren und 26 Metastasen) von bei 95 Patienten beobachteten neuroendokrinen (NE-)Tumoren des Gastrointestinaltrakts auf die prognostische Bedeutung verschiedener klinischer, histologischer und DNA-zytophotometrischer Parameter. Metastasen traten fast ausschließlich bei ilealen Karzinoiden auf, denen auch sämtliche 14 während der durchschnittlichen Nachbeobachtungszeit von 42 Monaten aufgetretenen letalen Erkrankungsverläufe zuzuordnen waren. Aneuploide DNA-Verteilungsmuster wurden signifikant häufiger bei ilealen als bei nichtilealen Karzinoiden angetroffen und waren – bezogen auf die Gesamtgruppe – signifikant mit tödlichem Krankheitsausgang korreliert. Darüber hinaus zeigte sich bei 18 Fällen mit DNA-zytophotometrisch auswertbaren primären und sekundären Karzinoidmanifestationen eine Assoziation zwischen dem DNA-Histogrammtyp metastatischer Karzinoide und der Prognose. Innerhalb der Gruppe der Ileumtumoren erlaubte der Parameter DNA-Gehalt aber keine Verbesserung der Prognoseabschätzung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002920050008
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  • 114
    Electronic Resource
    Electronic Resource
    Apoptose und Proliferation im Knochenmark bei chronischen myeloproliferativen Erkrankungen – biologische und prognostische Bedeutung (2000)
    Springer
    Der Pathologe 21 (2000), S. 55-62 
    Details
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Apoptose ; Proliferation ; Hämatopoetischer Zellumsatz ; Topoisomerase II α ; PCNA ; Chronische myeloproliferative Erkrankungen ; Prognose ; Reaktive Läsionen ; Key words Apoptosis ; Proliferation ; Hematopoietic turnover index ; Topoisomerase II α ; PCNA ; Chronic myeloproliferative disorders ; Prognosis ; Reactive lesions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Apoptosis and proliferation are important regulators of normal development and homeostasis in the bone marrow. Therefore, dynamics of hematopoiesis is mainly defined by these two parameters. However, since only few data are available from previous studies, we performed a retrospective analysis to elucidate some aspects of this complex pathomechanism. A total of 400 patients with chronic myeloproliferative disorders (CMPDs) and corresponding reactive bone marrow lesions were enrolled into this study. Apoptosis was detected in bone marrow tissue by the ISEL-technique and topoisomerase II α expression was demonstrated by the monoclonal antibody Ki-S1. Furthermore, by determination of the proliferating-cell nuclear antigen labeling (PCNA) index, we were able to calculate the proportion of cells in the G2/M phase, because both nuclear antigens are expressed in different phases of the cell cycle. Patients with IMF, PV, and ET revealed a normal range of apoptosis, whereas in chronic myeloid leukemia (CML) a significant increase could be observed. On the other hand, IMF and PV were characterized by a raised proliferative activity. Dynamics of hematopoiesis was assessed by calculation of the so called hematopoietic turnover index. In CML and reactive lesions no alterations of this parameter were detectable, but IMF and PV showed a significant increase. Survival analysis disclosed a relevant worsening of life expectancy for patients with reduced apoptosis and proliferation. In conclusion, our in-situ results confirm and extend previous experimental data on hematopoietic cell kinetics. In this context, a greater regenerative capacity of hematopoiesis may be reflected by an increased rate of apoptosis and/or proliferation and therefore is associated with a more favorable outcome.
    Notes: Zusammenfassung Apoptose und Proliferation stellen im Rahmen einer funktionsgerechten Regelung der Hämatopoese einen integralen Bestandteil für die Aufrechterhaltung des zellulären Gleichgewichts im Knochenmark dar. Insofern ist die Dynamik des hämatopoetischen Zellumsatzes durch diese beiden Parameter gekennzeichnet. Da weiterführende Untersuchungen in dieser Hinsicht lediglich vereinzelt am Knochenmark durchgeführt worden sind, haben wir im Rahmen einer retrospektiven Analyse versucht, einige Aspekte dieses komplexen Mechanismus zu beleuchten. Insgesamt wurden 400 Patienten mit chronischen myeloproliferativen Erkrankungen (CMPE) sowie korrespondierenden reaktiven Veränderungen in die Untersuchung aufgenommen. Neben dem direkten Nachweis der Apoptose im Knochenmark durch die ISEL-Technik haben wir die Topoisomerase II α Expression mittels des monoklonalen Antikörpers Ki-S1 gemessen. Zusätzlich konnten wir durch die Bestimmung der PCNA-Markierung aufgrund der Zellzyklus-spezifischen Färbereaktion beider nukleärer Antigene den Anteil der in G2-/M-Phase befindlichen Zellen ermitteln. Während die IMF, die PV sowie die ET eine im Normbereich liegende Apoptoserate erkennen ließen, war dieser Wert bei der CML signifikant erhöht. Auf der anderen Seite wiesen IMF und PV eine deutlich gesteigerte proliferative Aktivität im Knochenmark auf. Bei der Berechnung eines hämatopoetischen Zellumsatz Index (HZI) zeigten diese beiden CMPE-Subtypen einen signifikanten Anstieg, wohingegen bei der CML sowie den reaktiven Läsionen keine relevante Verschiebung dieses Parameters festzustellen war. Im Rahmen prognostischer Analysen hatten IMF und PV Patienten mit reduzierter Proliferation und Apoptoserate jeweils eine signifikant kürzere Überlebenszeit. Unsere in-situ Ergebnisse erweitern und bestätigen vorausgegangene experimentelle Studien zur hämatopoetischen Zellkinetik. Darüber hinaus lassen sich aus unseren Daten prognostische Überlegungen ableiten, da insbesondere bei der PV und IMF Apoptose und Proliferation signifikanten Einfluß auf das Überleben der Patienten hatten. In diesem Zusammenhang spiegelt eine vermehrte Apoptose- und Proliferationsrate im Knochenmark offenbar eine größere regenerative Kapazität der Hämatopoese wieder und könnte daher für einen günstigeren Verlauf verantwortlich gemacht werden.
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    Undifferenziertes kleinzelliges Hepatoblastom (2000)
    Springer
    Der Pathologe 21 (2000), S. 456-459 
    Details
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Undifferenziertes kleinzelliges Hepatoblastom ; Immunhistochemie ; Keywords Undifferentiated small-cell hepatoblastoma ; Immunohistochemistry ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Undifferentiated small-cell hepatoblastoma (HB) is a rare malignant tumor of childhood. The cell of origin is supposed to be a pluripotential, probably entodermal, stem-cell. Differential diagnosis of this type of HB is difficult among the group of small round and blue cell malignant tumors of children. The immunohistochemically determined coexpression of cytokeratin 8, 18, and 19 and of vimentin and actin, regularly in the absence of α-fetoprotein expression may be diagnostically helpful. We present the case of an undifferentiated small-cell HB of a 15-month-old girl with agenesis of the right kidney. As morphological peculiarity the tumor presented disseminated histiocytic giant cells.
    Notes: Zusammenfassung Undifferenzierte kleinzellige Hepatoblastome (HB) zählen zu den seltenen malignen Tumoren der Leber im Kindesalter. Da der Tumor in der Regel kein α-Fetoprotein exprimiert, ist der Nachweis von Zytokeratin 8, 18 und 19 sowie Vimentin und Aktin diagnostisch wegweisend. Als Ausgangszelle wird eine pluripotente, wohl entodermale Stammzelle vermutet. In der Gruppe der klein-, rund- und blauzelligen malignen Tumoren des Kindesalters bietet diese Variante des HB differenzialdiagnostische Schwierigkeiten. Wir berichten über ein undifferenziertes kleinzelliges HB eines 15 Monate alten weiblichen Kleinkindes mit Agenesie der rechten Niere. Als morphologische Besonderheit des Tumors werden disseminierte histiozytäre Riesenzellen beschrieben.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002920000420
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    Akutbehandlung des episodischen kindlichen Spannungskopfschmerzes mit Flupirtin und Paracetamol (2000)
    Springer
    Der Schmerz 14 (2000), S. 1-4 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter ; Kopfschmerz ; Kinder ; Akuttherapie ; Flupirtin ; Paracetamol ; Keywords ; Children ; Acute treatment ; Tension-type headache ; Flupirtine ; Paracetamol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: About 10% of all schoolchil- dren are suffering from migraine and 50% from tension-type headache. Headache of acute onset usually will be treated with analgesic substances like paracetamol, acetylsalicylic acid or ibuprofen, the first one being the reference drug for tension-type headache in childhood. In case of lacking improvement or side-effects there is demand for an alternative safe substance for the acute analgesic therapy. Methods: In a double-blind randomised investigation flupirtine and paracetamol were given in two consecutive attacks of episodic tension-type headache. 30 children, 6–12 years old, were included. Dosage was determined according to age and weight. The children documented the acute headache intensity and duration in a special diary. Results: Headache intensity was reduced during 2 h after intake in 89% of the 19 children treated. The reduction was 6,5 to 3,1 for flupirtine and 6,9 to 3,3/10 for paracetamol. There was no statistically significant difference between the two substances. Relevant side-effects could not be observed. Conclusion: Flupirtine has shown a convincing clinical effect treating acute episodic tension-type headache for children. The substance was well tolerated by the patients. In addition, flupirtine provides a high degree of safety.
    Notes: Zusammenfassung Hintergrund: Etwa 10% aller Schulkinder leiden nach neueren deutschen epidemiologischen Untersuchungen zumindest gelegentlich an Migräne und etwa 50% an Kopfschmerzen vom Spannungstyp. Häufig nehmen sie bei Spannungskopfschmerzen analgetische Monosubstanzen wie Paracetamol, Azetylsalizylsäure oder Ibuprofen ein. Bei nicht ausreichender Wirkung bzw. Unverträglichkeit besteht Bedarf nach weiteren Substanzen für die Akutanwendung. Methode: In einer doppelblindrandomisierten und gekreuzten Anordnung wurden Paracetamol bzw. das analgetisch und muskelrelaxierend wirksame Flupirtin 30 6- bis 12jährigen Kindern für 2 episodische Spannungskopfschmerzattacken angeboten. 10 Kinder benötigten nach dem Erstkontakt keine Medikation mehr, 1 Kind lehnte die Einnahme grundsätzlich ab. Ergebnisse: Die Kopfschmerzstärke verringerte sich laut Kopfschmerztagebuch innerhalb von 2 h nach der Einnahme auf einer numerischen Schmerzskala (0–10) von 6,5 auf 3,1 unter Flupirtin und von 6,9 auf 3,3 unter Paracetamol bei 89% der verbliebenen 19 Kinder. Statistisch signifikante Unterschiede zwischen beiden Substanzen bestanden nicht. Als Nebenwirkung trat 1-mal Erbrechen unter Paracetamol auf. Schlussfolgerung: Flupirtin hat sich in der Akutphase von episodischen Spannungskopfschmerzen beim Kind bewährt. Es verfügt über eine gute Verträglichkeit. Im Vergleich zu Paracetamol scheint v.a. bei akzidenteller Überdosierung eine größere Sicherheit zu bestehen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00009797
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    Begutachtung peripherer Nervenschäden (2000)
    Springer
    Der Schmerz 14 (2000), S. 5-9 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter ; Periphere Nervenläsionen ; Begutachtung ; Neuropathie ; Minderung der Erwerbs- fähigkeit ; Keywords ; Peripheral nerve lesion ; Neuralgia-physiopathology ; Causalgia-physiopathology ; Loss of earning capacity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Introduction: The loss of functional capacity by peripheral nerve lesion is easy to be estimated: A certain neurologic dysfunction results in a characteristic reduction of the former individual capacity. In contrast, the effect of accompanying pain to every-day life and working ability is not known exactly. In this study, we compared the results of judgement in nerve lesions under the circumstances of additional pain syndromes. Methods: From January 1994 until Dezember 1998 we saw 57 patients with peripheral nerve lesions, part of them with an additional pain syndrome. Beside conventional neurological examination a detailed pain analysis has been done. Results: Lesions of the median or ulnar nerves showed regularly disturbences in neurological functions (10/14 for the mediane nerve, 13/16 for the ulnar nerve). Astonishing is the fact, that serious pain after nerve lesion only occurs in cases of partial nerve lesion. We saw neuralgias in 6 patients with ulnar neuropathy, in three cases of median nerve lesions we could see severe neuralgia (causalgia we found in 3 cases of ulnar neuropathy, in 6 cases after Median Nerve lesion). Patients with a lesion of the central plexus brachialis showed in 10 of 11 cases an additional pain syndrome. Other nerves have been affected more rarely. For the judgement of the loss of earning capacity we saw an additional pain related diminuition of at least 10% compared to those patients without pain problems. Conclusions: The common grading scales for peripheral nerve lesions are not suitable in cases accompanied by an additional pain syndrome. Beside a functional deficit the effect of severe pain in these patients has to be estimated. On an average, patients with addtitional pain-problems get a 10% extended loss of earning capacity, even more in particular cases.
    Notes: Zusammenfassung Fragestellung: Anhand retrospektiver Daten sollten geeignete Bewertungsgrundlagen für die Begutachtung peripherer Nervenläsionen erarbeitet werden. Methode: Von Januar 1994 bis Dezember 1998 wurden insgesamt 57 Patienten (36 männlich, 21 weiblich, Durchschnittsalter 33,9 Jahre) mit dieser Fragestellung im Rahmen einer Begutachtung untersucht. Ursächlich lagen traumatische Ereignisse bei 39 (68%), postoperative Störungen bei 14 und andere Schädigungen bei 4 Patienten zugrunde. Ergebnisse: Beim N. medianus und N. ulnaris (beispielhaft) überwogen die Schmerzzustände bei inkompletten Läsionen. Neuralgien fanden sich bei 3 bzw. 6 Patienten mit N.-medianus- bzw. N.-ulnaris-Läsion. Eine Kausalgie fand sich bei 6 bzw. 3 Patienten. Mit Ausnahme von Armplexusläsionen waren andere Nerven seltener betroffen. Diese Situation wurde mit einer durchschnittlich um 10% höher gelegenen Einschätzung der Leistungseinbuße berücksichtigt, wenn gleichzeitig Schmerzen vorlagen. Schlussfolgerungen: Die für die reine Funktionseinbuße gültigen Skalen zur Bemessung peripherer Nervenläsionen können für die Begutachtung von Schmerzsyndromen nur bedingt herangezogen werden. Meist führen Schmerzen zu einer um durchschnittlich 10% höheren Einschränkung der Erwerbsfähigkeit (MdE), allerdings sind in manchen Fällen auch größere Einbußen denkbar.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004820050002
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    Chronifizierungsausmaß von Schmerzerkrankungen (2000)
    Springer
    Der Schmerz 14 (2000), S. 10-17 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter ; Schmerzerkrankungen ; Krankheitsschwere ; Chronifizierungsstadien ; Mainzer Stadienmodell ; Keywords ; Chronic pain ; Grading procedure ; Mainz Pain Staging System
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Introduction: Chronic pain is an individually variable experience, incorporating physical, psychological and social dimensions. Chronic pain occurs in a broad spectrum of severity; therefore, a grading procedure is of crucial importance in clinical research and in epidemiologic studies. The Mainz Pain Staging System is an interview-administered, multi-dimensional measure of chronic pain severity. The system suggests grading chronic pain in terms of 4 axes: time (persistence), spreading of pain site, medication use, and health care utilization. The whole scale consist of 10 items. The resulting score is used to classify the pain problem in three stages (I, II, III). Analysing the broader validity and parametric properties of the staging system is the purpose of the present study. Methods: The staging system and psychosocial data were administered to 542 consecutive patients of different diagnoses who attended one of six pain clinics in the year 1995/96. In a time period of 3 months since first contact, treatment procedures were registered. Three months after first contact patients rated the effectiveness of treatment concerning reduction of pain intensity. Results: According to the criteria of the staging system 25% of the sample belonged to each stage I and stage III, whereas 50% were classified to stage II. As a measure of validity, chronic pain status demonstrated significant correlation with psychological impairment, disability and time off work, whereas there was no correlation to pain intensity and persistence of pain. Surprisingly we found no difference in amount and quality of treatment between patients who were graded as severe pain patients (stage III) and the other stages. Furthermore, effectiveness of treatment also did not differ between the three stages. We made several proposals for optimizing the staging system. Conclusion: Given the high prevalence of recurrent and chronic pain as well as the broadness of severity, an important issue on further research is identification of factors which influence the chronification process. For this purpose improved measures of graded classification of pain status are needed.
    Notes: Zusammenfassung Hintergrund: Die Beschreibung von Schmerzsyndromen ist durch eine Diagnose allein nicht ausreichend gewährleistet; erst die Angabe der Krankheitsschwere ermöglicht sowohl die Indikation der entsprechenden Behandlung als auch eine Vergleichbarkeit von Fällen. Patienten und Methode: In einer multizentrischen Studie wurde bei 542 Patienten das aus der Mainzer Arbeitsgruppe um Gerbershagen 1986 vorgestellte Stadienmodell der Chronifizierung ermittelt und in Abhängigkeit von Patienten- und Diagnosemerkmalen sowie im Hinblick auf seine parametrischen Eigenschaften analysiert. Ergebnisse und Diskussionen: Die Ergebnisse der Untersuchung bestätigen die gute Validität des Verfahrens im Hinblick auf seine Unabhängigkeit von schmerzspezifischen Parametern. Es besteht theoriegemäß eine gute Übereinstimmung zum Ausmaß der emotionalen Befindlichkeit (Depression), zur subjektiven Beeinträchtigung und zum Ausmaß der Arbeitsunfähigkeit. Die Ergebnisse zeigen auch Ansätze für Verbesserungsmöglichkeiten. Einige der berücksichtigten Kriterien sind vermutlich überflüssig, während der zusätzliche Einbezug des subjektiven Beeinträchtigungserlebens notwendig erscheint. Ob ein übergreifendes Graduierungsmodell für verschiedene Schmerzerkrankungen überhaupt valide sein kann, muss eine weitergehende Analyse zeigen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004820050003
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    Langzeitbehandlung mit Flupirtin (2000)
    Springer
    Der Schmerz 14 (2000), S. 29-32 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter ; Flupirtin ; Langzeitbehandlung ; Keywords ; Flupirtine ; Long-term treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Case report: The worker O.H., born in 1959, had in 1992 an accident as a car driver. His injuries were a severe acceleration trauma of the cervical spine with rupture of the longitudinal ligament, a concussion of the brain, and an eye injury. Therapy: After the emergency treatment, the multidisciplinary management could not resolve the persistent musculoskeletal cervicocephal and -brachial pain syndrome. The long-term application of 100 mg flupirtine tid improved the chronic pain state for 50–60%. Due to this regimen, the patient could be rehabilitated.
    Notes: Zusammenfassung Fallbericht: Der 1959 geborene Arbeiter (O.H.) erlitt im September 1992 als PKW-Fahrer einen Wegeunfall mit schwerem HWS-Trauma, Commotio cerebri, Oberlidverletzung und Augapfelprellung rechts. Danach persistierten zervikozephale und zervikobrachiale Schmerzen. Behandlung: Nach der Evaluation verschiedener Therapieverfahren erfolgte die Einstellung auf durchschnittlich 3-mal 100 mg Flupirtin täglich mit dem Ergebnis einer durchschnittlich 50- bis 60%igen Linderung starker, belastungsabhängiger Dauerschmerzen. Dank dieser Medikation konnte der Betroffene beruflich integriert werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004820050006
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    Erste Erfahrungen mit der Mehrzeilendetektorspiral-CT in der Diagnostik der Arteriosklerose der Koronargefäße (2000)
    Springer
    Der Radiologe 40 (2000), S. 118-122 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter ; Mehrzeilen-CT ; Elektronenstrahl-CT ; Koronar-Screening ; CT Angiographie ; Koronarsklerose ; Keywords ; Multidetector CT ; Electron beam CT ; Coronary screening ; CT angiography ; Coronary atherosclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: Multirow-detector-spiral-CT (MSCT) allows for 250 ms effective exposure time. The purpose of this study was to demonstrate the possibilities and limitations of this CT technology for non enhanced and contrast enhanced investigation of the coronary arteries. Methods: Investigation of the coronary arteries without contrast medium for quantification of coronary calcifications was performed in an obese patient (140 kg) with MSCT and electron beam CT (EBCT). In 56 patients contrast enhanced CT angiography of the coronary arteries was performed to determine image quality depending on the heart rate. Results: In the obese patient superior image quality could be achieved with MSCT allowing for reliable quantification of coronary calcifications. With MSCT angiography of the coronary arteries good image quality was achieved in patients with a heart rate of 59±8 beats per minute. Conclusion: Even if there are limitations in patients with higher heart rates with an effective exposure time of 250 ms MSCT has clear advantage of image quality in the assessment of non enhanced and contrast enhanced coronary arteries.
    Notes: Zusammenfassung Fragestellung: Mit dem Mehrzeilendetektorspiral-CT (MSCT) sind effektive Aufnahmezeiten von 250 ms möglich. Die Möglichkeiten und Grenzen dieser CT-Technologie zur nativen und kontrastverstärkten Untersuchung der Koronargefäße sollen in dieser Arbeit dargestellt werden. Methode: Die native Untersuchung der Koronargefäße zur Quantifizierung von Koronarkalk wurde bei einem Patienten mit Adipositas (140 kg) mit dem Elektronenstrahl-CT (EBCT) und dem MSCT vorgenommen. Bei 56 Patienten wurde eine kontrastverstärkte MSCT-Angiographie der Koronargefäße vorgenommen und festgestellt, bei welcher Herzfrequenz eine diagnostisch ausreichende Bildqualität zu erreichen ist. Ergebnisse: Bei der Untersuchung des Patienten mit Adipositas konnte mit dem MSCT eine erheblich bessere Bildqualität erreicht werden, die eine Quantifizierung von Koronarkalk erheblich erleichterte. Mit der MSCT-Angiographie der Koronargefäße konnte bei einer Herzfrequenz von 59±8 Schlägen/min eine diagnostisch gute Bildqualität erreicht werden. Schlussfolgerung: Auch wenn mit einer effektiven Aufnahmezeit von 250 ms Limitationen bei höheren Herzfrequenzen zu erwarten sind, können mit dem MSCT entscheidende Vorteile in der Bildqualität in der nativen und kontrastverstärkten Untersuchung der Koronargefäße erreicht werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050019
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    Predicting the prognosis of non-small cell lung cancer patient treated with conservative therapy using contrast-enhanced MR imaging (2000)
    Springer
    European radiology 10 (2000), S. 1770-1781 
    Details
    ISSN: 1432-1084
    Keywords: Key words: MR imaging ; Non-small cell lung cancer ; Therapeutic effect ; Prognosis ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to evaluate the therapeutic effect more accurately and predict the prognosis of treated non-small cell lung cancer by using contrast-enhanced magnetic resonance imaging (CE-MRI). Contrast-enhanced computed tomography (CE-CT) and CE-MRI were examined 90 non-small cell lung cancer patients treated with conservative therapies. Enhancement patterns of CE-MRI were classified into three types: peripheral; mottled; and homogeneous. Reduction ratio of tumor size (RRT) based on the World Health Organization response criteria and a new response rate; reduction ratio of viable tumor size (RRVT) which evaluates not only the reduction of tumor size but also changes in necrosis and/or cavity size, were evaluated. Changes of enhancement pattern were compared and correlated with pathological diagnosis. The RRTs, RRVTs, and interobserver agreements evaluated by all modalities were compared. The RRTs and RRVTs in each subgroup were correlated and compared with prognoses. Change of enhancement pattern depended on therapy had no tendency (p = 0.06). Enhancement pattern had significant correlation with pathological diagnosis (p 〈 0.0001). Partial response (PR) case of RRVT had significant difference between imaging techniques (p = 0.04). The RRVT of other cases and RRT had no significant difference. Interobserver agreements of RRT and RRVT were almost perfect (ϰ≥ 0.93). Prognosis had better correlation with RRVT than with RRT. Differences of relapse-free survival and survival between patients considered as having no change (NC) by RRT and PR by RRVT (NC-PR) and patients considered as having NC by RRT and RRVT were significant (p = 0.03, p = 0.01). There were no significant differences of relapse-free survival and survival between NC-PR patients and patients considered as having PR by RRT and RRVT. The CE-MRI technique could accurately evaluate the therapeutic effect and predict the prognosis of treated non-small cell lung cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300000542
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    Course and prognosis of spinal epidural abscess. Report of five cases (2000)
    Springer
    European journal of orthopaedic surgery & traumatology 10 (2000), S. 199-202 
    Details
    ISSN: 1432-1068
    Keywords: Abscess ; Prognosis ; Spinal epidural abscess
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Five patients suffering from spinal epidural abscess associated with neurologic deficit are reported. Four patients underwent a decompressive procedure for abscess drainage, and one patient was medically treated. One of the patients showed a neurologic deterioration at the early postoperative period. The long-term follow-up showed a good outcome in all patients. It is concluded that epidural abscess associated with progressive neurologic deficit requires immediate decompression and administration of antibiotic. Postoperative neurological deterioration may be seen despite proper and immediate decompression and in such a case neurologic improvement is observed in the late postoperative period.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01682319
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    Behaviour of interleukin-2 serum levels in advanced non-small-cell lung cancer patients: relationship with response to therapy and survival (2000)
    Springer
    Cancer immunology immunotherapy 49 (2000), S. 530-536 
    Details
    ISSN: 1432-0851
    Keywords: Key words IL-2 serum levels ; NSCLC ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Interleukin(IL)-2 is a T helper (Th) 1 type cytokine that has been shown to play an important role in antitumour immune responses. In this study, the prognostic significance of serum IL-2 levels was investigated in 60 advanced non-small-cell lung cancer (NSCLC) patients. IL-2 serum levels were determined before chemotherapy, at the end of chemotherapy and during follow-up, using a commercially available enzyme-linked immunoadsorbent assay kit. The results were analysed according to the response to therapy and were used to generate a model predicting overall survival and time to treatment failure. All 60 patients were shown to have higher IL-2 serum levels than controls (P 〈 0.0001). Stage IV patients had significantly lower IL-2 levels than stage III patients (P 〈 0.0001), although they were still significantly higher than controls (P 〈 0.0001). It is interesting that, when patients were divided into responders and non-responders according to the response to therapy, the former were shown to have significantly higher pre-chemotherapy levels than the latter (P 〈 0.0001). Moreover, a further significant increase in IL-2 serum levels (P=0.004) and a significant decrease (P 〈 0.0001) were shown in responders and non-responders, respectively at the end of the therapy. Using univariate and multivariate analyses, both overall survival and time to treatment failure were shown to be affected by the mean pathological levels of IL-2. Furthermore, the prognostic significance of the serum level of IL-2 was confirmed by the stepwise regression analysis. In conclusion, determination of pre-treatment IL-2 serum levels was shown to be of independent prognostic utility in patients with advanced NSCLC; therefore, its possible use for prediction of outcome is proposed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002620000150
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    Neurophysiological studies in acute transverse myelitis (2000)
    Springer
    Journal of neurology 247 (2000), S. 943-948 
    Details
    ISSN: 1432-1459
    Keywords: Key words Transverse myelitis ; Motor evoked potentials ; Somatosensory evoked potentials ; Electromyography ; Prognosis ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A systematic evaluation of anterior horn cell, motor and sensory pathways is possible by electromyography (EMG), motor (MEPs) and somatosensory (SEPs) evoked potentials, respectively, which may provide valuable information on acute transverse myelitis (ATM). In a prospective hospital-based study, EMG, MEP and SEP studies were carried out on admission and after 3 months in 39 patients with ATM. All the patients also underwent detailed clinical evaluation, and spinal magnetic resonance imaging (MRI) was performed in 28. Outcome was defined at the end of 3 months as poor, partial or complete recovery on the basis of functional status. Spinal MRI revealed hyperintense signal changes in T2 extending for two segments to the entire spinal cord. Central motor conduction time to tibialis anterior (CMCT-TA) was more frequently abnormal (90%), followed by tibial SEP (77%). CMCT to abductor digiti minimi (ADM) was abnormal in 30% and median SEP in 15% of patients. Evidence of denervation on EMG was present in 51% of patients. The CMCT-TA improved in 48% patients and tibial SEP in 32%. Median SEP improved in all patients, and CMCT-ADM remained prolonged in two. At 3 months 2 patients had died, and 18 had poor, 10 partial and 9 complete recovery. CMCT was correlated with miscle power, tone, reflec and MRI changes. Patients' outcome of was correlated with CMCT, SEP and EMG. These results are consistent with pronounced involvement of dorsal region of spinal cord in ATM. MEP is more frequently abnormal than SEP.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150070051
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    Differential response to corticosteroid therapy of MRI findings and clinical manifestations in spinal cord sarcoidosis (2000)
    Springer
    Journal of neurology 247 (2000), S. 544-549 
    Details
    ISSN: 1432-1459
    Keywords: Key words Sarcoidosis ; Spinal cord ; Magnetic resonance imaging ; Corticosteroid therapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Spinal cord sarcoidosis is a rare disorder whose natural history and therapeutic outcome are not fully known. We examined four patients with spinal cord sarcoidosis both clinically and radiologically, particularly in relation to corticosteroid treatment. The initial manifestation was cervical myelopathy in three and uveitis in one. All four patients progressed slowly until corticosteroid therapy was initiated. The cervial spine was involved in all patients. Magnetic resonance imaging (MRI) showed spinal cord swelling with T2-weighted high intensity and linear leptomeningeal and patchy or diffuse intramedullary enhancement with gadolinium diethylene triaminepentaacetic acid. With corticosteroid therapy, dramatic improvement was seen on MRI, including disappearance or marked reduction of swelling and enhancement. Plasma levels of angiotensin-converting enzyme (ACE) were also markedly improved. In contrast, the clinical symptoms were little improved in one patient, unchanged in two, and rather worsened in one patient. Recurrence was seen on MRI at the maintenance dose in all four patients, without any dramatic change in clinical manifestation. MRI findings and plasma ACE are well correlated with active leasion of the spinal cord sarcoidosis, providing a useful marker for recurrence, but do not parallel the clinical manifestations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150070154
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  • 126
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    Treatment of fallopian tube cancer (2000)
    Springer
    Archives of gynecology and obstetrics 264 (2000), S. 13-19 
    Details
    ISSN: 1432-0711
    Keywords: Key words Fallopian tube cancer ; Radiotherapy ; Chemotherapy ; Lymph node metastasis ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective: To contribute toward the understanding of the therapeutic management of fallopian tube cancer. Methods: Recent studies related to the treatment of fallopian tube cancer were reviewed. Results: Current evidence indicates that even patients in early stages have nodal disease, and often experience relapses in distant sites. In advanced stages, survival prolongation by the use of platinum-based chemotherapy has been demonstrated. Aggressive cytoreductive surgery followed by chemotherapy and negative second-look laparotomy offer the possibility of long-term survival. However, a significant fraction of patients eventually relapses after negative second-look laparotomy, and a poor survival rate after positive second-look laparotomy has been observed. Conclusions: This series suggests the need for thorough evaluation of lymph nodes at the time of surgery. The use of platinum-based chemotherapy is probably the best adjuvant therapy for both early stages and advanced stages. The clinical value of second-look laparotomy will remain limited until effective salvage therapy is developed. The potential benefits of neoadjuvant chemotherapy and the use of paclitaxel will be increasingly important.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007475
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    Expression of blood group antigens A, B and H in carcinoma tissue correlates with a poor prognosis for colorectal cancer patients (2000)
    Springer
    Journal of cancer research and clinical oncology 126 (2000), S. 375-382 
    Details
    ISSN: 1432-1335
    Keywords: Key words Blood group antigen ; ABH isoantigens ; Colorectal carcinoma ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The deletion of blood group ABH isoantigens on tumor tissues has been reported to be an adverse prognostic marker for patients with various solid tumors. In the present study, we evaluated the prognostic value of altered expression of ABH isoantigens in colorectal carcinomas. Using monoclonal antibodies, the expression of A, B, and H antigens was assessed by immunohistochemistry on paraffin-embedded carcinoma samples from 82 patients who had undergone surgery for colorectal cancer. ABH isoantigens were found to be deleted in 36 carcinomas (43.9%) and expressed in 46 (56.1%). Univariate and multivariate analysis using a logistic regression model revealed that N factor (lymph node metastasis) and blood group type were independently related to the expression of ABH isoantigens. In contrast to previous reports on other cancers, patients whose colorectal carcinomas express ABH isoantigens had a poorer prognosis than those whose carcinomas showed deletion of ABH isoantigens (P = 0.0008). The expression of ABH isoantigens was an independent prognostic variable, in addition to T (depth of tumor invasion), N, and M (distant metastasis) factors, as shown by means of Cox regression analysis. In conclusion, the expression of ABH isoantigens in carcinoma tissue is an important poor prognostic factor in patients with colorectal cancer. This variable needs to be considered in the design of future trials of therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008485
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    The contribution of prenatal diagnosis to the understanding of malformative intracranial cysts: state of the art (2000)
    Springer
    Child's nervous system 16 (2000), S. 618-626 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Intracranial cyst ; Prenatal ; Fetus ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This review evaluates the contribution of prenatal diagnosis to the understanding of intracranial cysts. We describe the outcome of 54 fetuses in which prenatal investigations indicated the presence of such lesions. The cysts were diagnosed between 20 and 30 weeks of gestation. Most (63%) were supratentorial and interhemispheric. There was only a single sylvian cyst. In the infratentorial compartment, median retrocerebellar cysts were predominant. Incisural cysts accounted for 14.8% of the series. Nine pregnancies were interrupted because of the presence of associated brain disorders. Forty-five children are alive. Thirty-four had neuropsychological tests. Cysts rarely progressed, most frequently stabilized and often regressed postnatally. Hydrocephalus was rare. In two cases delivery was precipitated at 36 weeks to allow urgent treatment of rapidly evolving cysts. Thirteen children (28.2%) were treated postnatally, in general for developing cysts. The median follow-up for the whole series exceeds 4 years. Behavior, neurological development, and intelligence are normal in 88% of the cases, and 91% have a normal neurological status. Prognosis at the time of the prenatal consultation was correct in 89% of the cases. We emphasize the value of prenatal magnetic resonance imaging and karyotype studies to limit risks of incorrect prognosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810000316
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    Lectin-binding patterns in normal, hyperplastic and neoplastic endometrium: the prognostic value of concanavalin A (2000)
    Springer
    Virchows Archiv 436 (2000), S. 52-58 
    Details
    ISSN: 1432-2307
    Keywords: Key words Endometrium ; Endometrial carcinoma ; Lectins ; Con A ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Lectins are proteins and glycoproteins of non-immune origin which bind specifically to carbohydrate residues, agglutinate cells and/or precipitate complex carbohydrates. Lectin-binding patterns in normal, hyperplastic and neoplastic endometria were studied using four biotinylated lectins (Con A, LCA, e-PHA, l-PHA) and the avidin-biotin-peroxidase technique. Canavalia ensiformis agglutinin (ConA) and Lens culinaris agglutinin (LCA) reacted strongly with the luminal borders and the cytoplasm of epithelial cells but, whilst in normal and benign endometrial tissues the cytoplasmic staining was confined to the apical and the basal aspect of the cells, in endometrial carcinomas and in some atypical hyperplasias lectin binding also occurred in the lateral cytoplasm (Con-A-lat), although in differing proportions of cells. Interestingly, extensive Con-A-lat in the tumour cells was much more frequent in non-endometrioid carcinomas (P〈0.05) and was significantly associated with poor histological differentiation (P〈0.0001), low oestrogen and progesterone receptor content (P〈0.01 and P=0.0001, respectively) and an unfavourable long-term survival (P〈0.05). With Phaseolus vulgaris erythroagglutinin (e-PHA) and leucoagglutinin (l-PHA) a linear, rather inconsistent, staining at the level of the basement membranes was observed in the glands: this, also noted with LCA, appeared intact in normal and hyperplastic glands without cytological atypia, and fragmented or absent in malignant glandular structures and in most hyperplastic glands showing cytological atypia. It is concluded that changes in the distribution of lectin-binding molecules in the endometrial cells are associated with the malignant state, whilst the extent of Con-A-lat reflects the biological behaviour of the tumours.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008198
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    Prognostic significance of apoptosis and associated factors in oral squamous cell carcinoma (2000)
    Springer
    Virchows Archiv 436 (2000), S. 102-108 
    Details
    ISSN: 1432-2307
    Keywords: Key words Oral ; Squamous cell carcinoma ; Proliferation ; Apoptosis ; Tumour suppressor gene ; Oncogene ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Tumour progression is characterised by an imbalance between cell proliferation and apoptosis. The aim of our study was to estimate the importance of proliferation and apoptosis associated parameters in primary squamous cell carcinomas (SCCs) of the oral cavity and oropharynx. For determination of apoptosis, the enzymatic labelling of DNA fragmentation with a terminal transferase reaction was used in 156 tissue samples of 107 patients, including corresponding lymph-node metastases in nine cases. P53, bcl-2, and Ki-67 were determined immunohistologically. P53 was detectable in 50.5% of the cases. Positive staining was associated significantly with decreased apoptosis (P〈0.003). Bcl-2 was upregulated in 31.8% of the cases depending on the tumour grading (P〈0.001) and correlated negatively with apoptosis (P〈0.001). Proliferation (P〈0.006) and apoptosis (P〈0.03) were enhanced in larger tumours, though a direct correlation between these two parameters was not proven. Nevertheless, in contrast to the conventional tumour staging and grading, neither the expression of p53 or bcl-2 nor the apoptosis or Ki-67 measurements were able to predict survival or recurrence-free survival of the patients suffering from a SCC in the oral cavity or oropharynx. Our observations suggest that the function of wild-type p53 to induce apoptosis is lost in at least half of the SCCs under study and that the physiological function of bcl-2 as potent inhibitor of apoptosis is widely preserved in oral SCC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008207
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    CD44 expression in soft tissue sarcomas (2000)
    Springer
    Virchows Archiv 436 (2000), S. 574-578 
    Details
    ISSN: 1432-2307
    Keywords: Key words CD44 ; Adhesion molecules ; Prognosis ; Soft tissue sarcoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Recent studies have shown that expression of alternatively splicing variants of CD44 is correlated with prognosis for several kinds of malignant tumors. However, little is known about the expression of CD44 standard and variant isoforms in soft tissue sarcomas. In this study 47 cases of soft tissue sarcoma [18 malignant fibrous histiocytomas (MFHs), 13 synovial sarcomas (SSs), 7 malignant schwannomas (MSs), and 9 liposarcomas (LSs)] were examined immunohistochemically. The monoclonal antibodies to the standard form of CD44 (CD44H) and variant exons of CD44v3, 4, 5, 6, 7, 9, and v10 were used. We analyzed the membranous expression pattern of CD44H and CD44 variant exons and assessed the relation between expression of CD44s and metastasis-free survival rates (MFSR) of patients with soft tissue sarcoma. A few sarcomas expressed CD44v3 (2/47) and v7 (2/47), but none of the sarcomas expressed CD44v10. CD44v4 (5/47), v5 (4/47), v6 (10/47), and v9 (9/47) are relatively common types of variant isoforms in soft tissue sarcomas. Expression of CD44v6 is more frequently detected in high-grade than in low-grade tumors. CD44v6 or CD44v9 expression was correlated with metastasis-free survival of patients with soft tissue sarcomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004289900159
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    Traumatic brain stem lesions in children (2000)
    Springer
    Child's nervous system 16 (2000), S. 21-24 
    Details
    ISSN: 1433-0350
    Keywords: Key words Children ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Prognosis ; Traumatic brain stem lesions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Glasgow Coma Scale (GCS) scores on admission may be predictors of outcome in patients with brain injuries. This study correlated the outcomes of children with traumatic brain stem lesions with their initial GCS scores and morphological patterns of injury as shown on computed tomography (CT) or magnetic resonance (MR) imaging. During the last 16 years, we have treated 1,108 children with brain injuries. The entire series included only 21 (1.9%) children who had clinical signs of brain stem lesions with morphological correlates on CT or MR imaging. Clinical findings were assessed according to the GCS and compared with scores on the Glasgow Outcome Scale (GOS). Of these 21 children, 16 (76%) had morphological lesions seen on CT scans. In 5 (24%) of the children only the MR images revealed brain stem lesions and their CT scans were negative. Generalized severe brain swelling was present in 6 cases (28%). There was a significant difference in GOS scores between patients with initial GCS scores of 3 and 4 and those with GCS scores between 5 and 7 (P〈0.02). Children with intracranial pressure higher than 40 mmHg had poorer outcomes than patients whose intracranial pressure was lower, but the differences were not significant. Outcome did not correlate significantly with morphological patterns of injury or the presence of extracranial injuries. The GCS is a reliable indicator of severity of injury and of outcome in children with brain stem injuries. MR imaging was more sensitive than CT in detecting brain stem lesions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050005
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    Rehabilitation of brain-injured children (2000)
    Springer
    Child's nervous system 16 (2000), S. 760-764 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Children ; Brain-injury ; Network ; Prognosis ; Visuo-spatial neglect
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A care network has been created in the Paris area according to two criteria – the continuity and the specificity of the care, with a single place to manage pediatric neurosurgical emergencies. This network makes possible research about brain-injured children. Until recently, the ”Kennard principle”, that is, the assumption that recovery after similar lesions is greater in children than in adults has been supposed to be always true. In fact, if the lesions are diffuse, recovery is not greater in children compared with adults, or in younger children compared with older ones: the prognosis depends on the remaining ability to learn new practices. Normal IQ does not mean absence of sequelae. The cognitive deficits are very similar to those found in adults at the acute phase. For instance, visuo-spatial neglect appears as rather frequent when systematically looked for. The final assessment of outcome after childhood traumatic brain-injury should be done only after several years.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810000349
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    Therapeutische Orientierung und Wahrnehmung des Patienten bei der Erstuntersuchung (2000)
    Springer
    Psychotherapeut 45 (2000), S. 108-115 
    Details
    ISSN: 0935-6185
    Keywords: Schlüsselwörter Therapeutische Orientierung ; Therapeutenvariable ; Erstuntersuchung ; Arbeitsbeziehung ; Prognose ; Key words Therapeutical orientation ; Therapist variable ; Diagnostic interview ; Working alliance ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Psychology , Medicine
    Description / Table of Contents: Summary The present study is aimed at investigating differences between therapists of different theoretical orientations regarding their perception of patients who applied for psychotherapy at a university outpatient department. It was based on the judgements of nine psychodynamically and four cognitive-behaviorally oriented therapists about 144 and 89 patients, respectively, who were assessed after having completed their diagnostic interviews. Cognitive-behaviorally oriented therapists perceived the quality of the working alliance to be better and their feelings of sympathy towards the patients they had interviewed to be stronger than did psychodynamically oriented therapists. Psychodynamic therapists saw higher distress in the early childhood, whereas behavior therapists rated patients’ present coping abilities higher. In addition, the latter judged patients’ motivation, a common understanding of the illness, several prognostical factors and the global prognosis more favourable. Regarding the frequencies of disorder categories and the severity of functional restriction due to the disorders no differences were found. The results are discussed from both a cognitiv-behavioral and a psychoanalytical point of view.
    Notes: Zusammenfassung Die vorliegende Arbeit hat das Ziel, Unterschiede in der Wahrnehmung des Patienten bei der psychotherapeutischen Erstuntersuchung je nach theoretischer Orientierung des Diagnostikers zu untersuchen. Sie basiert auf den Einschätzungen von neun tiefenpsychologisch/analytisch und vier kognitiv-verhaltenstherapeutisch orientierten Therapeuten, die 144 bzw. 89 Patienten einer universitären psychotherapeutischen Poliklinik nach dem Erstgespräch beurteilten. Kognitiv-verhaltenstherapeutisch orientierte Erstuntersucher nahmen die Qualität der therapeutischen Arbeitsbeziehung signifikant als besser und die Patienten, die sie untersuchten, als sympathischer wahr. Tiefenpsychologisch orientierte Diagnostiker sahen stärker ausgeprägte frühkindliche Belastungen, wohingegen Verhaltenstherapeuten die aktuelle Bewältigungskompetenz der Patienten höher bewerteten. Zudem schätzen sie die Motivation des Patienten, das gemeinsame Krankheitsverständnis, verschiedene prognostische Faktoren sowie die globale Prognose als günstiger ein. Hinsichtlich der Häufigkeit diagnostischer Kategorien und der Beurteilung der Beeinträchtigungsschwere fanden sich keine Unterschiede je nach therapeutischer Orientierung. Die festgestellten Unterschiede werden sowohl vor einem kognitiv-verhaltenstherapeutischen als auch vor einem psychoanalytischen Theoriehintergrund interpretiert.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002780050208
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    Prognostic value of Doppler transmitral flow patterns and cardiac natriuretic peptides in patients with chronic congestive heart failure admitted for episodes of acute decompensation (2000)
    Springer
    Heart and vessels 15 (2000), S. 53-60 
    Details
    ISSN: 1615-2573
    Keywords: Key words Heart failure ; Doppler transmitral flow pattern ; Cardiac natriuretic peptide ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was designed to determine whether the restrictive filling transmitral flow velocity pattern is associated with increased plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). It was also designed to evaluate the prognostic value of these parameters from patients with chronic congestive heart failure (CHF) admitted for episodes of acute decompensation. We performed Doppler echocardiography, measured plasma levels of ANP and BNP in 33 patients at the time of admission, and assessed the subsequent cardiac mortality for 3 months. Eleven patients (33%) had a restrictive filling pattern of deceleration time (DcT) 〈120 ms. Plasma ANP and BNP levels were markedly increased in all patients to 189 ± 145 pg/ml and 865 ± 559 pg/ml, respectively. Seventeen patients (52%) showed more than 700 pg/ml of plasma levels of BNP. There was a significant correlation of DcT with the plasma ANP level (r = −0.41, P = 0.017), and a better correlation of DcT with the plasma BNP level (r = −0.50, P = 0.003). The combined index of both shorter DcT (〈120 ms) and higher plasma BNP levels (〉700 pg/ml) was the best predictor of cardiac mortality by Cox univariate analysis (χ2 = 5.87, P = 0.015). Furthermore, the sensitivity and specificity of this index for the detection of cardiac mortality were 80% and 86%, respectively. In conclusion, the combined analysis of the Doppler transmitral flow velocity pattern and measurement of the plasma BNP level is noteworthy since it is noninvasive and convenient. Moreover, it is extremely useful in predicting the prognosis for patients with chronic CHF admitted for episodes of acute decompensation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003800070032
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    A novel color M-mode Doppler echocardiographic index for left ventricular relaxation: depth of the maximal velocity point of left ventricular inflow in early diastole (2000)
    Springer
    Heart and vessels 15 (2000), S. 205-213 
    Details
    ISSN: 1615-2573
    Keywords: Key words Diastolic function ; Prognosis ; Myocardial infarction ; Color M-mode Doppler echocardiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Color M-mode Doppler echocardiography (CMD) has been utilized in assessing left ventricular (LV) filling dynamics. We tested a novel CMD index, the depth of the spatiotemporal maximum of early diastolic inflow (D-maxV) in the left ventricle, to clarify its significance in assessing LV diastolic function. In 26 normal subjects and 32 patients with ischemic heart disease, D-maxV was determined with CMD as the distance from the mitral valve opening point to the center of the aliasing area in early diastole. Transmitral flow velocity was measured with pulsed Doppler. During routine catheterization, high-fidelity LV pressure measurements yielded diastolic variables in patients. D-maxV was significantly lower in the patients than the normals (13.0 ± 7.0 vs 23.4 ± 6.8 mm, P 〈 0.0001). D-maxV exhibited significant linear correlations with the minimal first derivative of LV pressure (r = 0.72, P 〈 0.01), the time constant of isovolumic relaxation (r = −0.67, P 〈 0.01), and LV minimal pressure (r = −0.53, P 〈 0.02) in the patients with wide ranges of peak early to late inflow velocity ratio (0.43–3.9) and deceleration time of early filling (79–293 ms). D-maxV showed an inverse correlation with LV end-diastolic pressure (r = −0.53, P 〈 0.02) and no significant correlation with mean pulmonary capillary wedge pressure. Moreover, Kaplan-Meier analysis focusing on the patients with myocardial infarction revealed that the group with D-maxV 〈 10.4 mm (n = 13) exhibited a lower cumulative cardiac event-free rate than that with D-maxV ≥ 10.4 mm (n = 14) (49.4% vs 92.9% at 5 years, P 〈 0.05). The depth of the spatiotemporal maximum of early diastolic LV inflow velocity reflects LV relaxation and is free of pseudonormalization. Evaluation of the LV relaxation separately from preload may have a prognostic value for myocardial infarction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003800070009
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    Kann die Kontinenzfunktion nach Rectumresektion prognostiziert werden? (2000)
    Springer
    Der Chirurg 71 (2000), S. 932-938 
    Details
    ISSN: 1433-0385
    Keywords: Schlüsselwörter: Inkontinenz ; Rectumcarcinom ; Manometrie ; Prognose ; Anus. ; Keywords: Incontinence ; Rectal cancer ; Anorectal manometry ; Prognosis ; Anus.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. Aim: To determine clinical and physiologic parameters enabling the prognosis of continence after protective ileostomy closure secondary to rectal resection for rectal cancer. Method: Patients who had undergone rectal resection (n = 65, of whom 24 had had radiochemotherapy) were evaluated by clinical examination, anorectal manometry and orthograde contrast enema before ileostomy closure. Continence was evaluated by clinical findings 91 ± 52 weeks after stoma closure with the help of standardized questionaires and classified according to the Wexner continence score. The relationship between findings before stoma closure and continence score was calculated with Pearson's correlation coefficient. Results: Correlations were found to be significant between the continence score and the level of anastomosis (r = –0.58, p 〈 0.001), median resting pressure (r = –0.52, p 〈 0.001), rectal compliance (r = –0.43, p 〈 0.001). Additionally, radiochemotherapy impairs continence (p = 0.0001). Correlations were not significant between continence and functional sphincter length, squeeze pressure, threshold for perception, urge and maximal tolerable volume, and continence for semiliquid contrast medium. Conclusion: Incontinence after rectum resection is multifactorial: the level of anastomosis, resting pressure, rectal compliance and radiochemotherapy all play a dominant role. Based on these findings, the continence score can be calculated before closure of a diverting ileostomy by applying multivariate analysis with the help of the following formula: Continence score = 18.23–0.94 · level of anastomosis – 0.18 · resting pressure + 3.72 · radiochemotherapy.
    Notes: Zusammenfassung. Ziel dieser Studie war eine Evaluation von klinischen und physiologischen Parametern zur Vorhersage des Kontinenzgrades nach Rückverlagerung der protektiven Loop-Ileostomie nach Rectumresektion wegen eines Carcinoms. Methode: 65 Patienten wurden klinisch mittels anorectaler Manometrie und orthograder Röntgenkontrastmitteldarstellung vor der Ileostomieresektion untersucht. Bei 24 Patienten war eine Radiochemotherapie durchgeführt worden. Der klinische Status wurden 91 ± 52 Wochen nach der Ileostomieresektion mittels eines standardisierten Fragebogens erhoben und der Kontinenzgrad nach dem Wexner-Kontinenzscore bewertet. Der postoperative Kontinenzscore wurde mit den Befunden vor Stomarückverlagerung korreliert und ein Pearson-Korrelationskoeffizient berechnet. Ergebnisse: Es ergab sich eine signifikante Korrelation des Kontinenzgrades mit der Anastomosenhöhe (r = –0,58, p 〈 0,001), dem mittleren Ruhedruck (r = –0,52, p 〈 0,001) und der rectalen Compliance (r = –0,43, p = 0,001). Die Kontinenz war nach Radiochemotherapie schlechter (p = 0,0001). Es fand sich keine signifikante Korrelation zwischen Kontinenzgrad und funktioneller Sphincterlänge, Kneifdruck, Perceptionsschwelle, Drangschwelle, maximal tolerablem Volumen und Kontinenz für semiliquides Kontrastmittel. Schlußfolgerung: Inkontinenz nach Rectumresektion ist multifaktoriell. Anastomosenhöhe, mittlerer Ruhedruck, rectale Compliance und Radiochemotherapie (RCT) spielen eine dominante Rolle. Basierend auf diesen Befunden ist über die Berechnung einer multivariaten Regressionsanalyse eine Abschätzung des Kontinenzgrades vor Ileostomieresektion mit folgender Formel möglich: Prognose-Wexner-Score = 18,23–0,94 · Anastomosenhöhe – 0,18 · Ruhedruck + 3,72 · RCT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040051158
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    Sterilitätsbehandlung mit donogener Insemination (2000)
    Springer
    Reproduktionsmedizin 16 (2000), S. 249-252 
    Details
    ISSN: 1434-808X
    Keywords: Schlüsselwörter ; Artifizielle donogene Insemination • Rechtsfragen ; Keywords ; Artificial insemination from the donor • Legal aspects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Therapeutical inseminations from the donor take place in Germany for more than tens of years. The 73th German Phycians × Meeting has given consent in 1970. Today more than 60,000 to 70,000 children live in Germany born after fecundation by donor sperm. Selection of spermdonors takes place in aggreement to international criteria. The priciples of treatment of donogen insemination are in hand as recommendation. But some legal problems demand lawfull regulation for instance anonymity of the donor, law of family and successions, safe-keeping of documents, fees for the donor.
    Notes: Zusammenfassung Therapeutische donogene Inseminationen werden seit mehr als 3 Jahrzehnten in Deutschland durchgeführt. Der 73. Deutsche Ärztetag hatte 1970 seine Zustimmung gegeben. Heute leben in Deutschland mehr als 60.000–70.000 Kinder, die ihr Leben der Befruchtung mit Spendersperma verdanken. Die Auswahl der Spermaspender erfolgt nach international üblichen Kriterien. Es liegen Behandlungsgrundsätze für die donogene Insemination als Empfehlungen vor. Aber einige rechtliche Probleme wie Anonymität des Spenders, Familien- und Erbrecht, Verwahrfrist der Akten, Spenderhonorar bedürfen noch einer gesetzlichen Regelung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004440000194
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  • 139
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    Die Psyche in der Peri- und Postmenopause (2000)
    Springer
    Reproduktionsmedizin 16 (2000), S. 253-260 
    Details
    ISSN: 1434-808X
    Keywords: Schlüsselwörter ; Depressionen • Schlafstörungen • Sexualität • Hormontherapie • Einstellung zu Menopause ; Keywords ; Depression • Sleep disorders • Sexuality • Hormone therapy • Attitudes towards menopause
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract During the menopausal transition biological and psychosocial factors are closely interrelated. The retrospective view on the previous life span and the attitudes towards the menopause influence the severity of climacteric complaints and symptoms as well as the acceptance of hormone therapy. Most women use hormones to suppress symptoms and not to prevent e. g. osteroporosis. Depressive symptoms become more frequent, however, more than half of the variance results from psychosocial factors and a positive history of depression. Sleep disturbances increase and can only in part be explained as the result of vasomotor symptoms or as correlates of depression. Sexual activity often changes. However, subjective feelings of being attractive and/or the quality of partnership are more important than the widely discussed genital atrophy and dyspareunia. Hormone therapy should be restricted to cases with objective vaginal atrophy. Sleep disturbances frequently respond to hormones, as well as minor depressive symptoms. More pronounced depressive syndromes should be referred to “classical” psychological and psychopharmacological treatments. Results obtained in studies with surgical menopause must not be easily generalized to women with a natural menopause.
    Notes: Zusammenfassung In den Wechseljahren sind biologische und psychosoziale Faktoren eng miteinander verknüpft. Die Bilanzierung des bisherigen Lebens oder auch die Vorstellungen von der Menopause beeinflussen das Ausmaß klimakterischer Beschwerden und die Bereitschaft zu einer Hormonbehandlung. Letztere wird von den Frauen überwiegend zur symptomatischen Behandlung eingesetzt. Depressive Verstimmungen werden häufiger, jedoch erkranken vorwiegend Frauen mit einer anamnestisch höheren Vulnerabilität für Depressionen. Schlafstörungen nehmen zu und sind nur teilweise als Folge vasomotorischer Symptome oder im Zusammenhang mit Depressionen zu sehen. Die sexuelle Aktivität verändert sich, jedoch spielen hier Aspekte der erlebten Attraktivität und die Qualität der Paarbeziehung eine größere Rolle als die immer wieder diskutierte Dyspareunie. Hormontherapien sind außer zur Behandlung einer objektivierten Schleimhautatrophie nicht zur Behandlung von Sexualstörungen zu empfehlen. Schlafstörungen verbessern sich bei vielen Frauen unter einer Hormonbehandlung. Bei depressiven Verstimmungen sind „klassische“ psychotherapeutische und -pharmakologische Therapien Mittel der Wahl. Allgemein können bei „künstlich“ menopausalen Frauen erzielte Effekte nicht ohne Überprüfung auf natürlich menopausale Frauen übertragen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004440000195
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  • 140
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    Generativität und Kinderwunsch (2000)
    Springer
    Reproduktionsmedizin 16 (2000), S. 265-273 
    Details
    ISSN: 1434-808X
    Keywords: Schlüsselwörter ; Beratung • Einflussfaktoren • Generatives Verhalten • Kinderlosigkeit • Kinderwunsch • Therapieplanung ; Keywords ; Childlessness • Consulation • Desire for children • Generative behavior • Influencing factors • Therapy planning
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract This article presents the heuristics concerning description of individual generative behavior. The aim is to describe the development of the desire for children, the generative action and the dealing with generative decisions for intended and unintended childless women and men as well as parents. The main emphasis of the existing heuristics is placed on psychological questions. These heuristics explain patterns and influencing factors of generative action as well as positive and negative influencing factors of the coping process. It may be helpful to use heuristics which describe development of and coping with generative action as background information to ensure comprehensive consultation and therapy planning.
    Notes: Zusammenfassung In diesem Beitrag wird eine Heuristik zur Beschreibung des individuellen generativen Verhaltens dargestellt. Ziel der Heuristik ist es, die Entwicklung des Kinderwunsches, das generative Verhalten sowie die Verarbeitung der generativen Entscheidungen für ungewollt und gewollt kinderlose Frauen und Männer sowie für Eltern zu beschreiben. Dabei greift die vorliegende Heuristik schwerpunktmäßig psychologische Fragestellungen auf und gibt Aufschluss über Verlaufsmuster und Einflussfaktoren des generativen Verhaltens sowie über positive und negative Einflussfaktoren des Verarbeitungsprozesses. Eine Heuristik zur Beschreibung der Entwicklung und der Verarbeitung generativen Verhaltens kann als Hintergrundwissen zur Gewährleistung einer umfassenden Beratung und Therapieplanung hilfreich sein.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004440000188
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  • 141
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    Zweikernige Rieseneizellen – ein möglicher Ausgangspunkt für die Entstehung triploider Zygoten und Embryonen (2000)
    Springer
    Reproduktionsmedizin 16 (2000), S. 261-264 
    Details
    ISSN: 1434-808X
    Keywords: Schlüsselwörter ; Rieseneizellen • Zweikernige Eizellen • Triploidie • IVF • ICSI ; Keywords ; Giant oocytes • Binuclear oocytes • Triploidy • IVF • ICSIRID=""ID=""Danksagung. Der Autor dankt Frau Prof. Dr. C. Brucker und Herrn Dr. M. Schneider für die kritische Durchsicht des Manuskripts.RID=""ID=""〈E6〉Dr. biol. hum. B. Rosenbusch〈/E6〉 Universitätsfrauenklinik, Sektion Gynäkologische Endokrinologie und Reproduktionsmedizin, Prittwitzstrasse 43, 89075 Ulm e-mail: bernd.rosenbusch@medizin.uni-ulm.de
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zusammenfassung Zweikernige Rieseneizellen werden gelegentlich im Rahmen der assistierten Fertilisation in unterschiedlichen Reifestadien angetroffen. Sie weisen einen um 20–30 % größeren Durchmesser und damit das 1,5–2 fache Volumen einer normalen Oozyte auf. Ihre Entstehung wird der unterbliebenen zytoplasmatischen Teilung von Oogonien nach der Kernteilung bzw. der Verschmelzung 2 er Oogonien zugeschrieben. Die Reifung zur Metaphase II kann sich unter Beibehaltung des 2-kernigen Zustands oder unter Vereinigung der beiden Kerne vollziehen. Die Befruchtung durch ein Spermatozoon führt daher zur Ausbildung von 3 oder nur 2 Vorkernen. Der diploide Zustand reifer Rieseneizellen und deren Befruchtungsfähigkeit wird durch die Literatur und eigene Untersuchungen belegt. Somit besitzen Rieseneizellen Relevanz für die Entstehung chromosomal triploider Zygoten und Embryonen. Die Triploidie ist eine der häufigsten zytogenetischen Ursachen für Spontanaborte; die äußerst seltenen Lebendgeburten weisen schwerste Fehlbildungen auf. Aus diesen Gründen erscheint ein Ausschluss der Rieseneizellen vom Versuch einer Fertilisierung gerechtfertigt. Ist hingegen eine Befruchtung mit Ausbildung von 2 Vorkernen erfolgt, sollte die betreffende Rieseneizelle, wie für Stadien mit mehreren Vorkernen üblich, verworfen und nicht für den Transfer oder die Kryokonservierung vorgesehen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008902
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  • 142
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    Junge oder Mädchen: Sollten sich Eltern das Geschlecht ihrer Kinder aussuchen dürfen? (2000)
    Springer
    Reproduktionsmedizin 16 (2000), S. 274-278 
    Details
    ISSN: 1434-808X
    Keywords: Schlüsselwörter ; Geschlechtswahl • Abtreibung • Präimplantationsdiagnostik • Spermienseparation • Künstliche Befruchtung • Ungleichgewicht der Geschlechter ; Keywords ; Sex selection • Abortion • Preimplantation genetic diagnosis • Sperm separation • Artificial insemination • Sex ratio imbalance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract „MicroSort” promises to become a reliable method for preselecting the sex of our children. As so many innovations in the field of assisted reproductive technology, however, sex selection raises difficult moral and legal issues. In this paper, we focus on the question whether or not sex selection calls for a legal ban. Since it does not seem to imply any serious harm to others, we argue in favour of the legalization of sex selection.
    Notes: Zusammenfassung Mit „MicroSort“ ist eine Spermienseparationstechnik entwickelt worden, die es uns schon bald erlauben wird, das Geschlecht unserer Kinder selbständig zu wählen. Wie so viele Innovationen auf dem Gebiete der Reproduktionsmedizin, so wirft allerdings auch die Geschlechtswahl schwierige ethische und rechtliche Fragen auf. In unserem Beitrag gehen wir speziell der Frage nach, ob die Geschlechtswahl gesetzlich erlaubt oder verboten werden sollte. Da sie keine Schädigung Dritter beinhaltet, sprechen wir uns für eine Legalisierung der Geschlechtswahl aus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004440000198
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  • 143
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    Erektile Dysfunktion nach radikaler Prostatektomie (2000)
    Springer
    Reproduktionsmedizin 16 (2000), S. 279-283 
    Details
    ISSN: 1434-808X
    Keywords: Schlüsselwörter ; Erektile Dysfunktion • Prostatakarzinom • Radikale Prostatektomie • Therapie •Ätiologie ; Keywords ; Erectile dysfunction • Prostate cancer • Radical prostatectomy • Therapy • Etiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Erectile failure after radical prostatectomy is a common postoperative disorder. However, nerve-sparing technique provides in about 50–60 % erections sufficient for sexual intercourse. Damage to the cavernous nerves or vascular injuries are responsible for erectile dysfunction. Alprostadil is most commonly used for self-injection monotherapy or in combination with other vasoactive drugs. Intraurethral administration of alprostadil failed to reproduce promising early results. The oral drug Sildenafil showed to be effective in patients with partial erections, however, it failed to work after non nerve-sparing radical prostatectomy. Negative pressure devices and penile prosthesis can be considered as alternative therpeutic options. Autologous N. suralis transplantation during radical prostatectomy might further improve erection rates in the near future.
    Notes: Zusammenfassung Eine erektile Dysfunktion nach radikaler Prostatektomie ist immer noch ein häufiges postoperatives Problem; nach nerverhaltender Technik werden jedoch GV-fähige Erektionsraten von 50–60 % von den operierten Patienten berichtet. Ätiologisch ist überwiegend von einer neurogenen, seltener von einer vaskulären Komponente auszugehen. Therapeutisch haben sich über Jahre die Anwendung vasoaktiver Substanzen als Monosubstanz oder in Kombination in Form der Schwellkörperautoinjektionstherapie bewährt; häufigste z. Z. verwendete Substanz ist Alprostadil. Die intraurethrale Applikation von Alprostadil hat sich wegen erheblicher Nebenwirkungen und schlechter Wirksamkeit nicht durchgesetzt. Als peripher wirkende orale Substanz zeigt Sildenafil eine gute Wirksamkeit, falls nicht eine komplette Denervierung des Penis vorliegt und noch spontan Tumeszenzen erreicht werden. Alternative Therpieoptionen sind die Anwendung von Vakuumpumpen und als ultima ratio die Implantation einer Penisprothese. Die Nervtransplanation von autologen Stücken des N. suralis während der radikalen Prostatektomie könnte in Zukunft die Raten an spontanen Erektionen weiter erhöhen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004440000199
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  • 144
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    Epidemiology and prognostic factors in meningococcal disease in a small island population: Malta 1994–1998 (2000)
    Springer
    European journal of epidemiology 16 (2000), S. 1051-1056 
    Details
    ISSN: 1573-7284
    Keywords: Epidemiology ; Meningococcal ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Study objective: To review the epidemiology of meningococcal disease in Malta over the period 1994–1998, and to identify factors at presentation and in the management of meningococcal disease which may influence mortality. Design: All admissions with meningococcal disease to a national hospital in a population-based study over the period 1994–1998 were studied retrospectively. Main results: Fifty-six cases were diagnosed over 1994–1998, the incidence rising from 0.8/100,000 to 7.2/100,000 total population (p 〈 0.0001). The median time interval from arrival at hospital to administration of parenteral antibiotic decreased over the 5-year period from 4.4 to 1.2 hours (p = 0.025), with no significant change in the case-fatality rate. There was no association between the time interval from arrival at hospital to parenteral antibiotic administration, and mortality. The following features at presentation were associated with increased mortality: older age (p = 0.03), meningococcaemia compared with meningitis (p = 0.05), shock (p 〈 0.0001), disseminated intravascular coagulation (p = 0.0001), a normal/low white blood cell count (p = 0.0003), a low platelet count (p = 0.0001) and a high serum creatinine (p = 0.003). Conclusions: The upsurge of cases in the population was accompanied by a decrease in intervention time in the general hospital, probably due to increased awareness of the disease. This study did not show a positive relationship between early in-hospital administration of antibiotics and improved survival, probably because antibiotics were given earlier to those with fulminant disease and, with therefore, an inherently worse outcome. Stratification of cases by severity on admission is recommended in future studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1010865315425
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  • 145
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    Electronic Resource
    Herpes Zoster in Breast Cancer Patients after Radiotherapy (2000)
    Springer
    Strahlentherapie und Onkologie 176 (2000), S. 513-516 
    Details
    ISSN: 1439-099X
    Keywords: Key Words: Breast cancer ; Zoster ; Radiotherapy ; Prognosis ; Schlüsselwörter: Mammakarzinom ; Zoster ; Radiotherapie ; Prognose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Hintergrund: Wir haben in einer retrospektiven Analyse die Häufigkeit eines Herpes zoster bei Patientinnen mit Mammakarzinom und postoperativer Radiotherapie untersucht. Patientinnen und Methode: Von Januar 1985 bis Dezember 1993 erhielten 1 155 Patientinnen an unserer Klinik eine postoperative Bestrahlung nach Mastektomie (n = 961) oder brusterhaltende Operation (n = 194) in kurativer Intention. Das Alter betrug 34 bis 79 Jahre. 443 (38%) waren prä- und 712 (62%) postmenopausal, 21% hatten T3- bis T4-Tumoren, und 55% wiesen einen axillären Lymphknotenbefall auf. Alle Patientinnen erhielten eine Bestrahlung der Restbrust bzw. Thoraxwand bis 50 Gy, bei mastektomierten Patientinnen wurden zusätzlich die regionären Lymphknoten mit 44 Gy bestrahlt. 65% der Patientinnen erhielten eine zusätzliche Systemtherapie. Die Nachbeobachtungszeit betrug drei Monate bis 12,5 Jahre (Median 3,1 Jahre). Ergebnisse: 41/1 155 Patientinnen (3,7%) entwickelten im Nachbeobachtungszeitraum einen Herpes zoster. Alle Infektionen waren lokalisiert, eine generalisierte Hautinfektion oder systemische Infektionen traten nicht auf. Alter, Menopausenstatus, Erkrankungsstadium oder Art der Therapie (Brusterhaltung vs. Mastektomie, zusätzliche Chemotherapie) hatten keinen Einfluss auf die Frequenz von Zoster. Patientinnen mit starker akuter Hautreaktion waren ebenfalls nicht signifikant stärker betroffen als Patientinnen mit geringer Hautreaktion im Bestrahlungsfeld (5% vs. 2%). Das Auftreten eines Zosters nach Therapie hatte keinen Einfluss auf die Prognose hinsichtlich lokaler Kontrolle oder Überleben. Schlussfolgerungen: Die beobachtete Häufigkeit von Herpes zoster (etwa 4% nach drei Jahren Follow-up) lässt vermuten, dass ein Herpes zoster im untersuchten Kollektiv etwa drei- bis fünffach häufiger auftritt als anhand der Inzidenzen in der Normalbevölkerung erwartet. Dies ist nicht mit einer schlechteren Prognose assoziiert. Ob die erhöhte Frequenz auf die Radiotherapie zurückzuführen ist oder in Zusammenhang mit der Krebserkrankung steht, kann nich beurteilt werden.
    Notes: Background: We have studied the incidence of herpes zoster in patients with adjuvant radiotherapy for breast cancer with special emphasis on possible correlations with other prognostic factors or survival. Patients and Methods: From 1/1985 through 12/1993, 1 155 breast cancer patients received postoperative radiotherapy with curative interent in our department. After mastectomy 961 patients were irradiated and after breast-preserving treatment 194 patients. The age ranged from 34 to 79 years, the median follow-up was 3.1 years (range: 0.3 to 12.4 years). There were 443 women (38%) pre- and 712 (62%) postmenopausal. 21% had T3- to T4-tumors, 55% had axillary lymph node involvement, and 65% received additional systemic hormonal and/or cytotoxic therapy. In case of postmastectomy radiotherapy, the lateral chest wall and lymphatics (axilla, parasternal and supraclavicular nodes) were irradiated with an anterior photon field to 50 Gy (axilla 44 Gy) and most of the chest wall with an electron field to 44 Gy in 2-Gy fractions. After breast-preservation, the breast was irradiated via tangential fields with 6- to 8-MV photons up to 50 Gy plus 8 Gy electron boost to the tumor bed. Most of the patients were followed routinely in the department for 2 to 5 years. The frequency of zoster was determined retrospectively by reviewing the patients' records. Results: A zoster after radiotherapy occurred in 41/1 155 patients (3.7%), mostly within the first 2 years after completion of radiotherapy. All infections remained localized and there was no evidence for systemic infections. Type of treatment (mastectomy vs breast-preservation) had no impact on the frequency of herpes zoster (36/961 patients after mastectomy and 5/194 patients after breast-preservation). There was also no correlation with other prognostic factors such as age, menopausal status, stage of disease or the use of adjuvant chemotherapy, nor was the occurrence of zoster linked to the degree of acute skin reaction in the radiation field. Moreover, patients with zoster had the same prognosis as compared to patients without zoster with regard to local control and survival. Conclusions: The observed frequency of zoster (about 4% of patients after postoperative radiotherapy) in this retrospective study suggests that the risk of developing zoster in this patient group may be 3- to 5-fold higher as compared to the incidence in the general population. However, the occurrence of zoster was not linked to prognosis and treatment response.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002318
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  • 146
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    Procalcitonin and C-Reactive Protein Levels in Community-Acquired Pneumonia: Correlation with Etiology and Prognosis (2000)
    Springer
    Infection 28 (2000), S. 68-73 
    Details
    ISSN: 1439-0973
    Keywords: Key words Pneumonia ; Procalcitonin ; C-reactive protein ; Etiology ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background: The diagnostic value of admission serum levels of procalcitonin (PCT) and C-reactive protein (CRP) as indicators of the etiology and prognosis was prospectively investigated. Patients: 96 patients, 50–85 years of age, treated in the hospital for community-acquired pneumonia (CAP). Results: On admission, all patients had elevated CRP levels (〉 10 mg/l), but only 60 patients (54%) had elevated PCT levels (〉 0.1 μg/l). The severity of disease measured by APACHE II score was strongly associated with admission levels of PCT (p = 0.006), but not with CRP. Eight of nine patients with pneumonia caused by atypical agents had PCT levels 〈 0.5 μg/l compared with 6/27 patients with pneumonia caused by classical bacterial pathogens, mainly Streptococcus pneumoniae (p = 0.03). No such correlation between CRP levels and etiology was found. Conclusion: Our data indicate that in patients admitted to the hospital with CAP, measurement of PCT gives information about the severity of the disease, and may aid the physician to differentiate typical bacterial etiology from atypical etiology, and thereby to choose appropriate initial antibiotic treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s150100050049
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  • 147
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    Adjuvant chemotherapy for non-organ confined disease after radical cystectomy (2000)
    Springer
    International urology and nephrology 32 (2000), S. 59-62 
    Details
    ISSN: 1573-2584
    Keywords: Bladder neoplasms ; Chemotherapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Of 50 patients with pT3b, pT4 and/or pN+ disease after cystectomy, 27 were administered adjuvant four cycles of cisplatin, methotrexate and vinblastine (CMV) and 23 were followed expectantly (no-treatment group).Median follow-up was 14 months in CMV group and 11 months in no-treatment group. Median recurrence-free survival was 21 months in CMV group and 17 months in no-treatment group (p = 0.573). Median overallsurvival was 41+ months in CMV group and 84+ months in no-treatmentgroup, respectively (p = 0.501). In our experience, adjuvant chemotherapy after cystectomy seemed not to provide a survival advantage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007152016341
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  • 148
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    Basaloid squamous cell carcinoma of the supraglottic larynx (2000)
    Springer
    European archives of oto-rhino-laryngology and head & neck 257 (2000), S. 154-157 
    Details
    ISSN: 1434-4726
    Keywords: Key words Basaloid squamous cell carcinoma ; Laryngeal neoplasms ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Basaloid squamous cell carcinoma (BSC) is regarded as a variant of squamous cell carcinoma, but displays distinct morphological and biological features as well as a different clinical course. The tumor is frequently seen in the head and neck and is preferentially located in the larynx, especially in supraglottic sites. Ten patients with BSC of the supraglottic larynx were treated from 1991 to 1995 at the Medical Faculty of the University of Istanbul. Results of treatment were compared retrospectively with a control group consisting of 44 patients with well-differentiated squamous cell carcinomas. Ages, ¶localizations, stages and treatment procedures were similar. In both groups mean survival, nodal involvement and distant metastases were comparable although the local ¶(laryngeal) recurrence rate in patients with early supraglottic (T2) disease in the BSC group after conservative partial surgery was distinct compared to the control group (P 〈 0.05). These results indicate that conservative surgery should be assessed with caution in patients with BSC, and postoperative irradiation be taken into consideration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050213
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  • 149
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    Prognostic significance of argyrophilic nucleolar organizer regions in nasopharyngeal carcinoma (2000)
    Springer
    European archives of oto-rhino-laryngology and head & neck 257 (2000), S. 517-520 
    Details
    ISSN: 1434-4726
    Keywords: Key words Nucleolar organizer region ; Nasopharyngeal carcinoma ; Silver-staining ; Prognosis ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Increased expression of argyrophilic nucleolar organizer regions (AgNORs) has been identified in certain malignant tumors including nasopharyngeal carcinoma (NPC). However, its prognostic significance in NPC is uncertain and remains to be evaluated. To address this we silver-stained 63 paraffin sections of NPC cases, and examined the correlation between AgNOR count and area, calculated by the CAS 200 image analysis system, and tumor behavior, locoregional control, and survival of patients. The mean AgNOR count and area were 1.62 ± 0.31 and 3.98 ± 11.4 μm2, respectively. The AgNOR area was positively associated with T stage (r = 0.26, P = 0.04). The Mann-Whitney test confirmed no significant difference in AgNOR area and count between patients with different outcomes. Multivariate analysis using the Cox proportional hazard model showed neither AgNOR count nor area to be significant predictors of actuarial survival or disease-free survival. It is concluded that AgNOR does not have an independent and significant prognostic value in NPC. AgNOR expression may be merely a reflection of malignant phenotype as well as cellular activity but not necessarily the ultimate behavior of the tumor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050000265
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  • 150
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    A prospective study on the prognosis of multiple sclerosis (2000)
    Springer
    Neurological sciences 21 (2000), S. S831 
    Details
    ISSN: 1590-3478
    Keywords: Key words Multiple sclerosis ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Two hundred and twenty-four patients at their first diagnosis of multiple sclerosis (MS) were prospectively followed for a mean period of 9.78 years. We considered as endpoints the time to reach non-reversible disability levels corresponding to EDSS scores of 4.0 and 6.0, and the beginning of a secondary progressive phase in the relapsing-remitting subgroup of patients. An initially progressive course and higher basal EDSS scores proved to be the best predictors of unfavorable prognosis. A greater number of functional systems involved at onset as well as higher residual deficits in pyramidal, visual, sphincteric and cerebellar systems were other factors predictive of a poor outcome, whereas sensory system involvement turnet out to be favorable. A longer first inter-attack interval was associated with a better prognosis. However, overall number of relapses in the first two years of the disease was of no prognostic value. The presence of oligoclonal banding in the cerebrospinal fluid and a cerebral MRI exam strongly suggestive or suggestive of MS in the early phases of the disease were associated with a higher probability of a worse outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100720070021
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  • 151
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    Early onset multiple sclerosis (2000)
    Springer
    Neurological sciences 21 (2000), S. S861 
    Details
    ISSN: 1590-3478
    Keywords: Key words Multiple sclerosis ; Early onset ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Multiple sclerosis (MS) onset is usually in adult life (age 20–40 years). Discordant data have been reported concerning the frequency of early onset MS (EOMS) that ranges from 2.7% to 5%, whereas there is a general agreement on prevalence of female sex, particularly after puberty. The initial symptoms in EOMS are frequently characterized by visual loss whereas the other functional systems are involved with a variable frequency. Literature data show that EOMS tends to have a relapsing-remitting course, a high rate of recovery from the initial attack, a long time interval between the first and second attacks and a slow progression rate. A poor prognosis is reported in a few cases of EOMS and seems to be related to number of relapses and to the delay between the first and second attacks.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100720070027
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  • 152
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    Electronic Resource
    Clinical and neuroradiological aspects of Sneddon's syndrome and primary antiphospholipid antibody syndrome. A follow-up study (2000)
    Springer
    Neurological sciences 21 (2000), S. 157-164 
    Details
    ISSN: 1590-3478
    Keywords: Key words Sneddon's syndrome ; Primary antiphospholipid syndrome ; Differential diagnosis ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We performed a study to investigate differences and similarities between patients with Sneddon's syndrome and those with primary antiphospolipid syndrome (PAS), by clinical follow-up, magnetic resonance imaging (MRI) and angiography. Nine patients with Sneddon's syndrome and 11 patients with PAS were assessed at diagnosis and followed for a mean fo 6 years. The clinical and MRI findings indicated that Sneddon's syndrome and PAS are distinct entities. Patients with Sneddon's syndrome had a progressive clinical course with increasing disability and cognitive deterioration; patients with PAS had a more benign course. Infarcts in territories of the main cerebral arteries were frequent in PAS, while leukoaraiosis and smaller lacunar infacts were more comon in Sneddon's syndrome. In 3 of 7 women initially diagnosed with PAS, the diagnosis was changed to systemic lupus erythematosus during follow-up. Differential diagnosis of Sneddon's syndrome and PAS is important, as early therapy is effective for the latter, more benign, condition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100720070091
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  • 153
    Electronic Resource
    Electronic Resource
    Type, causes, and prognosis of stroke recurrence in the province of Teruel, Spain. A 5-year analysis (2000)
    Springer
    Neurological sciences 21 (2000), S. 355-360 
    Details
    ISSN: 1590-3478
    Keywords: Key words Recurrent stroke ; Causes ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recurrent strokes are an important cause of morbidity and mortality. Identification of the causes of recurrence and its treatment may play an essential role in the prevention of further strokes. The aim of our work is to analyze the type and causes of stroke recurrence in a 5-year period and to determine if recurrent stroke is of the same type as index stroke. In a retrospective study, we reviewed the clinical records and database of our hospitals and found a total of 1108 patients admitted because of primary stroke. The patients with recurrent stroke were selected for a comprehensive analysis. Age, vascular risk factors and fatality rates of these patients were compared with those obtained in recurrence-free patients. We identified 135 patients with recurrent stroke. The most frequent type of recurrence was large vessel atherothrombotic stroke followed by the cardioembolic or lacunar stroke. The major contributing factors were hypertension, atrial fibrillation, and cardiomyopathies. The fatality rate did not differ from the overall mortality by stroke in these years, but the majority of deaths occurred in long-term recurrences. The functional status was worse after recurrent stroke than after index stroke. Although any pattern of recurrence is possible. There is a major trend to occur in the same vascular territory by the same pathophysiologic mechanism. Recurrent stroke frequently carries a worse functional status than index stroke. In many patients, despite the appropriate treatment, stroke recurrence was an unavoidable consequence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100720070050
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  • 154
    Electronic Resource
    Electronic Resource
    Peroneal mononeuropathy: predisposing factors, and clinical and neurophysiological relationships (2000)
    Springer
    Neurological sciences 21 (2000), S. 367-371 
    Details
    ISSN: 1590-3478
    Keywords: Key words Peroneal nerve ; Mononeuropathy ; Predisposing factor ; Electrodiagnosis ; Prognosis ; Peroneal mononeuropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The most common mononeuropathy in the lower extremity involves the nerve. We retrospectively evaluated the etiological predisposing factors and clinical-neurophysiological features of 36 patients affected by peroneal mononeuropathy (PM). In 30 patients, a clear predisposing factor was identified. PM was more frequently perioperative (11 cases), associated with axonal involvement. Unexpectedly, PM was not only due to surgery close to the peroneal region, but was mostly associated with hip surgery and, rarely, with thoracic-abdominal surgery. A postural predisposing factor of PM was also frequently observed, usually associated with a pure conduction block. Conversely, most patients with bedridden predisposing factor presented axonal involvement, which was rarely associated with conduction block. In 25 of 36 PM cases, a long-term follow-up lead to an improvement (12 cases) or to good recovery (13 cases) of PM. In conclusion, our study shows that: (1) in most PM cases it is possible to identify a predisposing factor; (2) there is a good correlation between predisposing factor and neurophysiological involvement, and (3) PM usually has usually a good prognosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100720070052
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  • 155
    Electronic Resource
    Electronic Resource
    Trauma, stress and multiple sclerosis (2000)
    Springer
    Neurological sciences 21 (2000), S. S849 
    Details
    ISSN: 1590-3478
    Keywords: Key words Multiple sclerosis ; Trauma ; Stress ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract It has been suggested that physical trauma, involving the cervical spinal cord or the brain, and psychological stress may precede MS onset or may influence the disease course, although this hypothesis has mainly come from anecdotal case reports or small uncontrolled or controlled studies. So far there are no studies providing a clear causative relationship between physical trauma (especially head trauma) and MS onset, exacerbation or progression of the disease. On the other hand, recent MRI and experimental studies, supporting the important role of nervous and immune system interactions, particularly by the hypothalamic-pituitary-adrenal axis and by the sympathetic nervous pathways, seem to demonstrate a significant correlation between stress and MS exacerbations. Further, frequent MRI and immunological evaluations should be warranted to objectively document the temporal association between stress and clinical and/or sub-clinical disease activity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100720070024
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  • 156
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    Electronic Resource
    Klinisch-statistische Verlaufsuntersuchungen bei der Encephalomyelitis disseminata (1968)
    Springer
    European archives of psychiatry and clinical neuroscience 211 (1968), S. 109-117 
    Details
    ISSN: 1433-8491
    Keywords: Disseminated Sclerosis ; Type of Illness ; Prognosis ; Clinical Symptomatology ; Encephalomyelitis disseminata ; Krankheitsart ; Prognose ; Klinische Symptomatik
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Klinisch-statistische Untersuchung über 200 Kranke mit der gesicherten Diagnose einer Encephalomyelitis disseminata. Es wurden zwei Verlaufsformen („schubweise“ und „protrahiert“) voneinander unterschieden und die so erhaltenen Krankenkollektive im Hinblick auf Geschlecht, Alter, Beruf, Vorkrankheiten, Krankheitsbeginn und Initialsymptomatik verglichen. Dabei erwiesen sich die chronischen Verlaufsformen als abhängiger von zusätzlichen Einflüssen und wiesen darüber hinaus auch hinsichtlich ihrer Symptomatik Unterschiede auf, die es unserer Ansicht nach rechtfertigen, dem chronisch-protrahierten Verlaufstyp der Encephalomyelitis disseminata eine gewisse klinische Eigenständigkeit einzuräumen.
    Notes: Summary This paper reports a statistical and clinical research on 200 patients with the diagnosis of disseminated sclerosis. The patients were divided into 2 groups; 1. Intermittent. 2. Chronic protracted, according to the course of their disease. These groups were compared according to sex, age, profession, previous illnesses, onset of disease and first symptoms. In this way, it was shown that the second group was more dependent than the first on additional influences. Also, both groups showed differences in their symptomatology. This suggests to a certain degree a clinical autonomy of the chronic protracted form of disseminated sclerosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00344408
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