Implantable devices in patients with haematological diseases.
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Adolescent↗
Biomedical subjects
A Feldges
Publications and source records attributed to A Feldges.
Indication for invasive diagnostic studies and surgical therapy in cerebral ischemia, based on results of non-invasive transcranial Doppler sonography.
In order to better define patients who might benefit from cerebral revascularization surgery, transcranial Doppler sonography was used in more than 480 patients. Thus invasive diagnostic studies could be limited to probable surgical candidates. Transcranial Doppler sonography has proven to be reliable for the study of the degree of efficacy of intracranial collateral pathways in hemodynamic borderline situations. Over the last 4 years, the application of the algorithm presented in this paper resulted in a reduction of the number of candidates for surgical revascularization to 19.
Algorithms↗
[Computed tomographic assessment of orbital fractures in traumatic damage of the optic nerve].
Ten patients with orbital fractures and optic nerve trauma are reported. Fractures of the optic canal could be demonstrated by computed tomography in six cases and fractures of the orbital apex in another three cases. Surgical decompression of the optic canal was performed in seven cases. Computed tomography enhanced decision for surgery in cases of intraorbital haematoma with exophthalmus and narrowing of the canal by bony fragments, especially in those patients presenting with incomplete or progressive visual disturbance.
Emergencies↗
[The use of trans-cranial Doppler sonography in a neurosurgical intensive care unit. Intracranial pressure, intracranial circulatory arrest].
Transcranial Doppler Sonography (TCD) is a noninvasive simple bedside procedure to control continuously cerebral blood flow velocity in basal brain arteries in comatose patients of an intensive care unit (ICU). This measure can already be performed at ICU, to determine timing of angiography for confirming intracranial circulatory arrest when an organ explantation of patients judged clinically brain-dead is intended. TCD is also carried out to assess cerebral circulation in patients with intracranial hypertension. 64 patients are repeatedly evaluated by TCD and have been continuously monitored for ICP at the same time. According to our results a strong correlation between the flow parameters derived from TCD and the ICP exists when the ICP surpasses the level of 25 mmHg. Furthermore repeated control-TCD-examinations of 150 comatose patients in our ICU have elucidated the significant prognostic value of the pulsatility index representing the cerebrovascular resistance. Thereby important informations concerning further clinical course of patients suffering from intracranial hypertension are available. Additionally a clinical example of complete failure of cerebrovascular autoregulation shortly after hypoxic brain damage is demonstrated.
Blood Flow Velocity↗
Two cases of sudden death by rupture of traumatic and bacterial aneurysms.
Unexpected subarachnoid hemorrhage with a fatal outcome was seen in two patients in intensive care in association with trauma and an intracranial inflammatory abscess. The cause of SAH was disclosed at autopsy: traumatic and bacterial aneurysms of the basilar artery respectively. In the reported cases the symptoms of SAH did not suggest an origin.
Adult↗
[Therapy of aneurysm-induced subarachnoid hemorrhage].
Based on our experience with 115 consecutive patients treated in our department for aneurysmal subarachnoid haemorrhage between August 1984 and January 1988, problems of patient selection for early and late surgery as well as medical therapy are discussed. Overall surgical mortality was 6.7%. Surgical mortality was 12.1% for patients operated within 72 hours post SAB, whereas it was 4.2% for patients treated at later intervals. The value of transcranial Doppler sonography for timing of aneurysm surgery is stressed.
Follow-Up Studies↗
Isolated central nervous system relapse in acute lymphocytic leukemia (ALL) in children. Experiences of the Swiss Pediatric Oncology Group (SPOG/SAKK) 1976-1986.
The incidence of isolated CNS-relapse in the SPOG ALL studies 1976-1986 was analyzed and the prophylaxis of meningosis leucaemica of the different studies was compared. In the SPOG ALL high-risk study 1979-1983, the incidence of isolated CNS-relapse was significantly higher (17/71, 24%) than in the other studies. In this period, radiotherapy was omitted and the prophylactic treatment consisted only of moderately high doses of intravenous methotrexate and intrathecal methotrexate. In other studies, it was shown that the prophylactic combination of CNS-radiotherapy and intrathecal methotrexate, or the periodic administration of combined intrathecal chemotherapy alone, during the whole therapy of 2 1/2 years, produced comparably good results. The prophylaxis with the combined intrathecal chemotherapy was less neurotoxic and allowed the use of a curative radiotherapy in case of a CNS-relapse.
Adolescent↗
Treatment of relapsing acute lymphoblastic leukemia in childhood. I. Experiences with 82 first bone marrow and 17 isolated central nervous system relapses observed 1968-1980.
Of 99 patients with acute lymphoblastic leukemia in first bone marrow or isolated CNS relapse seen between 1968 and 1980, 48 were treated without standardized protocol and 51 according to a relapse protocol. Of 16 patients with bone marrow relapse after cessation of the initial treatment 6 survived 8 1/2 years or more, of 66 with bone marrow relapse while on therapy only 4 survived. All of the latter were low risk patients with an initial WBC of less than 20 x 10(9)/l and no enlargement of the mediastinum. All of the 17 patients with isolated CNS relapse died. The relapse protocols used probably improved the chances of children with first bone marrow but not of those with isolated CNS relapse.
Antineoplastic Combined Chemotherapy Protocols↗
Treatment of relapsing acute lymphoblastic leukemia in childhood. II. Experiences with 45 first bone marrow and 24 isolated central nervous system relapses observed 1981-1984.
Of 45 children with ALL who had a first hematological recurrence between 1981 and 1984, 33 relapsed while still on treatment and 12 after cessation of therapy. Of the former 1 of 16 high risk (initial WBC greater than or equal to 20 x 10(9)/l and/or enlargement of the mediastinum) and 5 of 17 low risk patients (initial WBC less than 20 x 10(9)/l and no enlargement of the mediastinum), of the latter 6 patients survived after a minimum follow-up of 20 months. During the same time period, a first isolated CNS relapse was observed in 24 children of whom 16 survived. These results suggest that at the time of evaluation 1. the prognosis of children with ALL in first hematological relapse during the years 1981-1984 was not significantly different from that of similar children treated earlier; and 2. the prognosis of children with isolated CNS relapse had improved.
Antineoplastic Combined Chemotherapy Protocols↗
[The Port-a-Cath in pediatric oncology].
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Adolescent↗
[Genetic factors linked to the HLA system conferring increased susceptibility to acute lymphoblastic leukemia in children].
Inheritance of HLA antigens in 55 families of patients with ALL was analyzed. Significantly increased sharing of DR antigens was observed among the parents of the affected children (p = 0.003). A similar increase was noted in the sharing of HLA-B antigens (p = 0.02). The observed number of DR homozygotes among the patients was twice the expected value in families where the parents shared a B and a DR antigen. Segregation analysis of the shared antigens disclosed significant prevalence of heterozygotes among the healthy siblings, which suggested the occurrence of gametic selection in such families. This study indicates that mating of certain shared alleles of the HLA system (especially of the DR locus) is associated with a risk for the offspring to develop ALL in childhood. Restricted heterogeneity of the parental HLA gene pool favours the expression of linked recessive genes and, presumably, of those involved in susceptibility to ALL.
Child↗
[Acute leukemias and tumors of childhood--a problem solved?].
Cancer is a rare disease in children, in whom some 200 new cases are recorded every year in Switzerland including about 20 in the eastern part of the country. In contrast to cancer in adults, many malignancies of the child have prospects of cure. This improved prognosis is mainly the result of interdisciplinary cooperation within the framework of controlled national and international protocols. Progress in the treatment of two representative forms of cancer (acute lymphocytic leukemia and Wilms tumor) is illustrated. 50% of all children from the eastern part of Switzerland with acute lymphocytic leukemia and 70% of those with Wilms tumor have been cured in the past 7 years. These impressive advances are unfortunately overshadowed by late sequelae of the therapy, which are described and must be taken into account in future therapeutic approaches.
Acute Disease↗
Systemic lupus erythematosus in Staphylococcus aureus hyperimmunoglobulinaemia E syndrome.
The prevalence of autoimmune diseases, including systemic lupus erythematosus, is increased in failure of certain host defence mechanisms. Systemic lupus erythematosus, however, has not been recorded as a late complication of the Staphylococcus aureus hyperimmunoglobulinaemia E (hyper-IgE) syndrome. Such a case was investigated in a man suffering from a classic example of the syndrome. Antinuclear antibodies were analysed on a molecular basis. The emergence of immunological and clinical features of systemic lupus erythematosus in patients with defective host defence mechanisms against staphylococcal infections is unlikely to be fortuitous and may help elucidate the pathogenesis of systemic lupus erythematosus. The observations will also aid the long term management of patients with S aureus hyper-IgE syndrome.
Adult↗
Evidence for HLA-linked susceptibility factors in childhood leukemia.
To test the hypothesis that susceptibility to leukemia can be governed by (a) recessive gene(s) associated with the major histocompatibility complex (MHC) in man, we performed an analysis of the inheritance of HLA antigens in 55 families in which one of the children developed ALL. We found among the parents of affected children a highly significant increased compatibility at the DR locus (p = 0.003). A similar increase was observed in sharing HLA antigens of the B locus (p = 0.02). The observed number of homozygotes among the patients was twice the expected value in families where the parents shared a B and a DR antigen. In segregation analysis, heterozygotes for the shared parental HLA antigen were significantly more prevalent among the healthy siblings. Our genetical analysis indicates that mating of certain shared alleles of the HLA system (especially of the DR locus) is associated with the risk for the offspring to develop ALL in childhood. This situation favors the expression of recessive genes associated with the MHC, and presumably those involved in the susceptibility to acute leukemia. Because familial leukemia is a rare event, the susceptibility to childhood ALL must also implicate genes outside the MHC and important environmental factors.
Child↗
[Chance of a second remission in acute juvenile lymphoblastic leukemia with favorable prognosis].
24 children with low risk acute lymphoblastic leukemia (ALL) in first relapse were re-treated with an aggressive protocol. Therapy of the first episode had adopted two different but equivalent approaches (SAKK-ALL "low risk" 76 and CALGB protocol 7611). With one exception, relapse occurred in all children before discontinuation of therapy. complete remission was achieved in 20 of the 24 children (83%). Five of 11 children in whom the length of the second remission could be evaluated had, at the time of the cutoff, been in continuous remission for 18 to 40 months. The therapy displayed considerable toxicity. From this study it is concluded that remission is achieved in the majority of children with first relapse of ALL, but that the remission can be maintained beyond 18 months only in a few children.
Adolescent↗
[Cooperation of the family physician with the oncology center in the care of the children with tumors].
With a cure rate of over 50% pediatric oncology contrasts with the adult oncology. The success is the result of a multimodal approach with surgery, radiotherapy and chemotherapy to almost all forms of childhood cancer as outlined in various national and international protocols. These are evaluated permanently concerning efficacy and toxicity at one organisation (in Switzerland: the pediatric section of the "Schweizerische Arbeitsgruppe für klinische Krebsforschung"). For the care of the children with malignancy however a specialist physician team at a tumor center is not enough. Without the cooperation of the family doctors of the area proper referral of the patients and long term treatment can not be realized. Good information and adequate teaching appears to be necessary to give these patients optimal care.
Antineoplastic Agents↗
Adjuvant chemotherapy with procarbazine, vincristine and prednisone for medulloblastomas. A preliminary report.
The survival of 20 children with medulloblastoma who received adjuvant chemotherapy with procarbazine, vincristine and prednisone after resection and craniospinal irradiation is compared with the preliminary results of the Children's Cancer Study Group (CCSG) and the international Society of Pediatric Oncology (SIOP) medulloblastoma studies. Survival with the chemotherapy used in the SPOG study ws not superior to the survival of children who received craniospinal irradiation only.
Cerebellar Neoplasms↗
[Malignat non-Hodgkin Lymphoma in childhood. Therapeutic results in 47 patients].
A preliminary report is presented on survival in 16 children with non-Hodgkin's lymphoma treated since 1975, as compared with that in 31 similar children treated between 1962 and 1974. In the former group, 10 of 14 children (71%) survived one or more years and 5 of 9 children (56%) two or more years with no evidence of disease. In the latter group, the corresponding survival rates were 26% and 19% respectively. This improvement is due to the introduction of an aggressive multidrug chemotherapy combined with radiotherapy, similar to the LSA2-L2 protocol. Considerable toxicity was observed with the new treatment. 23 of the 46 patients with diffuse non-Hodgkin's lymphoma had a Burkitt-type tumor. Treatment failures occurred mainly in children with a Burkitt-type tumor with primary intraabdominal localization.
Adolescent↗