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Biomedical subjects

A Gerl

Publications and source records attributed to A Gerl.

71 records · Page 4Linked to original sources
PubMed1992

[Interstitial lupus nephritis].

A 17-year old-male presented with a 6-week history of weight loss, lassitude and calf pains. On examination he was very pale. Laboratory tests showed a very high erythrocyte sedimentation rate (155 mm in the first hour), anaemia (haemoglobin 10.1 g/dl), and a raised serum creatinine of 1.54 mg/dl. Microhaematuria (5-10 erythrocytes/microliter) and pronounced pyuria (500 leucocytes/microliter) were present, but the urine was sterile and there was no increase in albumin excretion. The serum IgG was raised to 75.7 g/l, suggesting an autoimmune disorder. Anti-nuclear antibodies (titre 1 : 1920) and anti-double-stranded DNA antibodies (31 U/ml) were present, while the serum complement C4 was decreased to 0.11 g/l. Renal histology showed an interstitial nephritis without glomerular involvement, while the bone marrow showed vasculitis accompanied by a prominent plasma-cell infiltrate. A diagnosis of interstitial nephritis associated with systemic lupus erythematosus was made, with asymptomatic cardiac and hepatic involvement. Renal function recovered rapidly with prednisolone therapy (initial dose 2 mg/kg.d). While glomerulonephritis is the most common lupus-associated renal disorder, isolated interstitial nephritis may occur in some cases, often with an absence of proteinuria.

Adolescent↗
PubMed1992

Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid.

This report describes paraneoplastic visceral neuropathy including achalasia, gastroparesis, subileus and constipation in a 59 year old patient with metastasising atypical bronchial carcinoid. Achalasia was successfully treated by cardiomyotomy and fundoplication; additionally, extramucosal pylorectomy was undertaken to improve gastric emptying. Endoscopic papillotomy was necessary because of a functional stenosis of the sphincter of Oddi with development of obstructive jaundice. Symptoms of intestinal pseudoobstruction did not improve with cisapride or corticosteroid treatment. Histological examination of gastrointestinal specimens revealed a lymphocytic infiltration of the myenteric plexus associated with loss of neurones. The rheumatoid factor was positive, there was evidence of circulating immune complexes and antibodies to Sm-antigen were present, suggesting a possible autoimmune pathogenesis.

Bronchial Neoplasms↗
PubMed1991

[Listeriosis in malignant diseases].

Listeriosis occurred in two patients, a 46-year-old woman and a 41-year-old man, in the course of an underlying malignant disease. The woman had a metastasizing pancreatic apudoma, requiring partial pancreas resection with splenectomy. After the end of cytostatic treatment she developed headaches and fever up to 40 degrees C. Listeria monocytogenes was demonstrated in the blood and cerebrospinal fluid. She went into coma on the day after hospital admission and, despite antibiotic administration, she died on the fourth day of treatment. The 41-year-old man was suspected of having an angioimmunoblastic lymphoma. Severe haemolytic anaemia (haemoglobin 4.4 g/dl) was treated with glucocorticoids, massive blood transfusions and splenectomy, at first without success. During immunosuppressive treatment with prednisone and cyclophosphamide the haemoglobin rose. But he was still feverish with nocturnal sweating. Neurological symptoms of motor aphasia, cranial nerve deficits and incomplete hemiparesis rapidly developed. Computed tomography revealed a focus in the internal capsule. Blood culture grew Listeria. The focal encephalitis healed with minor sequelae after antibiotic treatment. Both patients had hypogammaglobulinaemia, but no granulocytopenia. It is stressed that listeriosis should be included in the differential diagnosis in cases of septicaemia or cerebral infection occurring in the course of malignant disease.

Adult↗
PubMed1991

Improvement of local control by regional hyperthermia combined with systemic chemotherapy (ifosfamide plus etoposide) in advanced sarcomas: updated report on 65 patients.

From July 1986 to 1990, 65 patients with deep-seated, advanced sarcomas (43 soft-tissue sarcomas, 12 Ewing's sarcomas, 7 chondrosarcomas and 3 osteosarcomas) were entered in a protocol involving regional hyperthermia (RHT) combined with systemic ifosfamide and etoposide. RHT was produced by an electromagnetic deep regional heating device (BSD Medical Corporation, Salt Lake City, Utah). Of these patients, 62% (40 patients) had received ifosfamide-containing drug regimens before entering the RHT study, 26% (17 patients) were pretreated by surgery and/or radiation and 12% (8 patients) were treated primarily. A total of 426 RHT treatments (mean 6.6 RHT/patient) were applied predominantly within the pelvic region (82%) bearing relative large tumours (mean volume 500 cm3). For systemic chemotherapy, all patients received ifosfamide (1.5 g/m2, days 1-5), etoposide (100 mg/m2, days 1, 3, 5) and 2-mercaptoethanesulphonic acid (mesna; 300 mg/m2 x 4, days 1-5) with RHT only given on days 1 and 5 in repeated cycles every 4 weeks. Detailed thermal mapping by invasive thermometry was performed in all patients. In 61 patients evaluable for tumour control the overall objective response rate including 9 complete responders (CR), 4 partial responders (PR) and 8 patients with favourable histological response (FHR) was 34% (95% confidence limits, 23%-46%). Following CR, the patients are alive and remain disease-free (mean disease-free survival 15.6 months). Of the patients with PR and FHR, 3 died from metastatic and/or local disease after 4, 17, and 39 months, and 1 patient died from other disease (acute myelocytic leukemia) after 27 months. The other 8 patients remain stable at 29, 25, 17, 11, 10, 8, 7, and 6 months. Twenty-two patients revealed no change and 18 patients showed local tumour progression (PD). Side-effects of RHT were tolerable and there was no indication of enhanced bone marrow toxicity due to the addition of RHT to the systemic chemotherapy. By analysis of temperature parameters, the time-averaged temperatures of all RHT treatments calculated for 20% (T20), 50% (T50) or 90% (T90) of measured tumour sites differed significantly between responders (CR + PR + FHR) and non-responders (PD), respectively (T20, P = 0.001; T50, P = 0.0005; T90, P = 0.0001). the data further support a strong potential for ifosfamide plus etoposide combined with RHT in pretreated patients with advanced sarcomas.

Adolescent↗
PubMed1980

[Bilateral craniectomy in the treatment of severe traumatic brain edema].

The extensive bilateral craniectomy with opening of the dura offers the possibility of rapid reduction of intracranial pressure. The reactive brain edema with imminent or beginning decompensation indicates the need for operation. Technically, it is easy to carry out bilateral cranial decompression. The open dura results in no additional postoperative problem. 21 of our 30 patients died postoperatively within 8.6 days, 2 patients in state of apallic syndrome after 4 and 16 months. 2 patients are living now with apallic syndrome for 17 and 20 months. All apallic patients show a massive hydrocephalus internus. 5 patients demonstrate a full restitution. In this group there is an interval of 3.2 days between accident and operation, the duration of the postoperative unconsciousness was 9.4 days. In children a spontaneous ossification of the bone defect may be expected if the periost is conserved. The article compares the bilateral craniectomy with other conservative and operative methods of treatment.

Adult↗
PubMed1980

[Surgery of carpal tunnel syndrome without interfascicular neurolysis].

198 operations of carpal tunnel syndrome demonstrated that the simple dissection of the ligamentum carpi transversum is followed by excellent results. One year after the operation among the hands with thenar muscle atrophy 82% returned to normal and 11% were improved. Among the cases with preoperative complete loss of function (axonotmesis) of the power grade 5 postoperatively. The capacity for regeneration is not different between the motor and the sensory fibers of the nerve. The restoration of the muscle power depends on the grade of the muscle fibrosis after long denervation. The comparison with the results of other authors demonstrates no advantage of the additional interfascicular neurolysis.

Carpal Tunnel Syndrome↗
PubMed1980

[Postoperative compression and regeneration following ulnar nerve transposition].

In 58 patients with sulcus ulnaris syndrome the ulnar nerve was transposed intermuscularly under the ulnar flexor muscles. All the patients were examined after the operation clinically and electrophysiologically for recognizing the grade of postoperative regeneration and the possibility of a new compression. 86% postoperatively showed a good functional result. Electrophysiologically there was often found no normal duration and amplitude of the muscle action potential. 2 Patients showed symptoms of a postoperative compression of the transposed ulnar nerve under the origin of the ulnar flexor muscles. In order to avoid this complication the divided muscles must not be reunited with the medial epicondyle. Bad results after intermuscular transposition of the ulnar nerve are explained neither by a new compression nor by an unsatisfying regeneration of the nerve. They are the consequence of wrong diagnosis, common nerve lesion or fibrosis of muscle. A comparison with the results of other authers demonstrates that an additional interfascicular neurolysis is not necessary. The deep transposition of the ulnar nerve is recommended as the method of choice.

Adolescent↗
PubMed1978

[Hanging legs for sural nerve excision (author's transl)].

The sural nerve is widely used as a graft in autologous nerve transplantation. In major operations on the upper extremities and the brachial plexus the lateral or ventral position of the patient most convenient for harvesting the graft is impossible. It is, however, easy to excise the sural nerve if the legs are hanging.

Humans↗
PubMedDate not supplied

Is serum tumor marker half-life a guide to prognosis in metastatic nonseminomatous germ cell tumors?

BACKGROUND: The value of serum tumor marker kinetics of AFP and HCG assessed by marker half-life (MHL) analysis for diagnosis and in the follow-up of patients with nonseminomatous germ cell tumors (NSGCT) is still debated controversally. The aim of this retrospective study was therefore to investigate the influence of serum MHL during the first two cycles of chemotherapy on the long-term outcome in metastatic NSGCT. MATERIAL AND METHODS: 147 patients with at least 2 abnormal marker values > 7 days after start of chemotherapy were investigated for HL analysis (HL cut off 3.5 days for HCG and 7 days for AFP). HCG and AFP determinations were performed by a double monoclonal IRMA (HCG) and conventional RIA (AFP) developed by our laboratory. RESULTS: According to these cut offs 35/108 patients (32.4%) had a prolonged HCG HL and 41/114 patients (36%) a prolonged AFP HL. Patients with either MHL prolonged had a significantly inferior overall survival (OS; 10 year OS 37% vs. 75%, p = 0.0005) and progression-free survival (PFS; 10 year PFS 29% vs. 69%, p < 0.0001) than those with a prolonged HCG MHL (OS; 10 year OS 36% vs. 65%, p = 0.003; 10 year PFS 28% vs. 56%; p = 0.001) and even more than those with a prolonged AFP MHL (10 year OS 39% vs. 70%, p = 0.02; 10 year PFS 32% vs. 56%, p = 0.01). CONCLUSION: The remarkable prognostic information assessed by MHL analysis in this retrospective study merits further confirmation by a prospective study for its appropriateness in selecting patients for high dose chemotherapy.

Biomarkers, Tumor↗