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Biomedical subjects

A Lindner

Publications and source records attributed to A Lindner.

At least 37 records · Page 2Linked to original sources
PubMed2001

The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction.

PURPOSE: We prospectively studied the impact of transrectal ultrasound guided prostate biopsy on patient well-being. MATERIALS AND METHODS: We enrolled 211 consecutive men who underwent a total of 218 biopsy events in a questionnaire based survey focusing on pain, anxiety and erectile dysfunction risk factors. Surveys were administered before, and immediately, 1 week and 1 month after biopsy. Quantitative information on the intensity of symptoms and signs was obtained using a uniform grading system. RESULTS: Intraoperative pain considered severe in 20% of the biopsy events was associated with pain in the first 24 hours postoperatively, leading to analgesic use in 10%. Inflammatory infiltrate in the biopsy core and younger patient age correlated with persistent pain on days 2 and 7 after biopsy, respectively. Preoperative anxiety was reported in 64% of biopsy events and predictive of intraoperative pain. Anxiety peaked before result disclosure. Erectile dysfunction attributed to anxiety in anticipation of biopsy was reported in 7% of cases. At days 7 and 30, 15% of previously potent patients reported erectile dysfunction. CONCLUSIONS: The impact of prostate biopsy on patient well-being begins while waiting for the scheduled procedure. Shortening the anticipation period before results are disclosed and administering pre-biopsy anxiety decreasing measures may benefit patients. Analgesic therapy is recommended in younger patients, those reporting moderate to severe intraoperative pain and those with known prostatic inflammatory infiltrate. The risk of acute erectile dysfunction should be discussed cautiously with patients who are potent before biopsy.

Adult↗
PubMed2001

The impact of prostate biopsy on patient well-being: a prospective study of voiding impairment.

PURPOSE: We studied the possible association of transrectal ultrasound guided prostate biopsy with voiding impairment. MATERIALS AND METHODS: A total of 211 consecutive patients were prospectively enrolled. International Prostate Symptom Score (I-PSS), subjective voiding complaints and retention were recorded in 3 personal interviews before biopsy, and on postoperative days 7 and 30. RESULTS: Of the 204 patients who voided via the urethra at biopsy 52 (25%) reported subjective voiding impairment on postoperative day 7, including 12% who defined difficult voiding as mild-1 to 2 points on a 0 to 5 scale, 8% as moderate-3/5 and 5% as severe-4 to 5/5. In 5 of the latter cases (2.5%) acute urinary retention necessitated urethral catheter insertion. Transition zone volume, which was 42 ml. or larger in all patients in urinary retention, was the only independent variable associated with patient report of subjective difficult voiding and acute urinary retention during week 1 after biopsy (p = 0.03). Baseline I-PSS greater than 20 points indicated a risk of an acute transient increase in I-PSS on postoperative day 7. CONCLUSIONS: Transient voiding impairment may be precipitated by ultrasound guided prostate biopsy. To decrease this morbidity appropriate evaluation and possible treatment for bladder outlet obstruction are justified in patients with a larger transition zone and in those with preoperative baseline I-PSS greater than 20 points.

Adult↗
PubMed2001

Cryosurgical ablation for prostate cancer: preliminary results of a new advanced technique.

BACKGROUND: Cryosurgery is a minimally invasive treatment option for prostate cancer. OBJECTIVES: To report on the first series of cryosurgical ablation for prostate cancer performed in Israel. METHODS: Cryosurgical ablation of the prostate was undertaken in 12 patients aged 53-72 diagnosed with adenocarcinoma of the prostate. The procedures were performed percutaneously and were monitored by real-time trans-rectal ultrasound. The CRYOHIT machine applying Argon gas was used with standard or ultra-thin cryoprobes. The average follow-up was 12.8 months postsurgery (range 1-24 months). RESULTS: No rectal or urethral injuries occurred and all patients were discharged from hospital within 24-48 hours. The duration of suprapubic drainage was 14 days in 10 patients and prolonged in 2. Early complications included penoscrotal edema in four patients, perineal hematoma in three, hemorrhoids in two and epidydimitis in one. Long-term complications included extensive prostatic sloughing in one patient and a perineal fistula in another, both of whom required prolonged suprapubic drainage. Minimal stress incontinence was noted in two patients for the first 8 weeks after surgery. None of the patients has yet regained spontaneous potency. A prostate-specific antigen nadir of less than 0.5 ng/ml was achieved in eight patients and an undetectable PSA level below 0.1 ng/ml in five patients. CONCLUSION: Cryoablation for prostate cancer is safe and feasible, and the preliminary results are encouraging. Further study is needed to elucidate the efficacy of the procedure.

Adenocarcinoma↗
PubMed2000

Viscous fingering in a yield stress fluid

We study the Saffman-Taylor or viscous fingering instability in yield stress fluids. The theory for yield stress fluids shows that the dispersion equation of the instability is similar to that for Newtonian fluids; however, the capillary number governing the instability now contains the yield stress. Experiments using gels and foams reveal very branched fingers in the gel. The results are in excellent agreement with theory for the gel, with, in addition, a crossover from yield stress dominated to viscous behavior. The results for foams are very different due to the existence of wall slip.

Journal Article↗
PubMed2000

[Erythema palmare hereditarium ("red palms")].

We report a woman with erythema palmare hereditarium, an anomaly not documented so far in the German literature. It is characterized by a bright erythema of the palms, usually persistent since birth. It is transmitted in an autosomal-recessive mode and has a benign course. In our patient it was possible to trace the palmar erythema over three generations.

Adult↗
PubMed2000

Initiation of smooth-pursuit eye movements to first-order and second-order motion stimuli.

Since normal human subjects can perform smooth-pursuit eye movements only in the presence of a moving target, the occurrence of these eye movements represents an ideal behavioural probe to monitor the successful processing of visual motion. It has been shown previously that subjects can execute smooth-pursuit eye movements to targets defined by luminance and colour, the first-order stimulus attributes, as well as to targets defined by derived, second-order stimulus attributes such as contrast, flicker or motion. In contrast to these earlier experiments focusing on steady-state pursuit, the present study addressed the course of pre-saccadic pursuit initiation (less than 100 ms), as this early time period is thought to represent open-loop pursuit, i.e. the eye movements are exclusively driven by visual inputs proceeding the onset of the eye movement itself. Eye movements of five human subjects tracking first- and second-order motion stimuli had been measured. The analysis of the obtained eye traces revealed that smooth-pursuit eye movements could be initiated to first-order as well as second-order motion stimuli, even before the execution of the first initial saccade. In contrast to steady-state pursuit, the initiation of pursuit was not exclusively determined by the movement of the target, but rather due to an interaction between dominant first-order and less-weighted second-order motion components. Based on our results, two conclusions may be drawn: first and specific for initiation of smooth-pursuit eye movements, we present evidence supporting the notion that initiation of pursuit reflects integration of all available visual motion information. Second and more general, our results further support the hypothesis that the visual system consists of more than one mechanism for the extraction of first-order and second-order motion.

Adult↗
PubMed2000

Early postoperative transcranial sonography (TCS), CT, and MRI after resection of high grade glioma: evaluation of residual tumour and its influence on prognosis.

PURPOSE: In this prospective study the results of multimodal postoperative neuro-imaging were related to the survival of patients with high grade gliomas. METHODS: All 73 patients included underwent microsurgical tumour resection and had postoperative CT and transcranial sonography (TCS) examinations. In addition, 35 of the 73 patients received an early postoperative MRI. Patients were followed up for at least one year. FINDINGS: At the end of the 7 year study period 56 patients had died. The median survival time was 371 days. Survival rate was significantly higher in patients with anaplastic astrocytomas and inpatients displaying complete tumour resection on MRI (log-rank-test, p < 0.05) or a small postoperative residual tumour bulk on TCS (log-rank-test, p < 0.05). Cox proportional hazards model identified histological tumour grade, postoperative Karnofsky index, complete resection based on MRI and small postoperative residual tumour mass on TCS as independent predictors of survival. INTERPRETATION: This study demonstrates that early postoperative neuro-imaging has prognostic implications for the survival of patients with high grade gliomas. According to our results postoperative imaging with MRI and TCS is a valuable prognostic with regard to patient survival and should therefore be implemented in postoperative follow-up. It also helps to evaluate the efficacy of adjuvant therapy.

Adolescent↗
PubMed2000

Predictive value of S-100beta and neuron-specific enolase serum levels for adverse neurologic outcome after cardiac surgery.

OBJECTIVES: The aim of this study was to evaluate the time course of S-100beta and neuron-specific enolase serum levels after cardiac surgery and their clinical relevance in predicting postoperative adverse neurologic outcomes; the 2 proteins are only released in peripheral blood in association with nervous system lesions. METHODS: We neurologically assessed 190 consecutive patients undergoing elective cardiac operations for coronary artery bypass (n = 147), valve replacement (n = 29), or both (n = 14), before as well as after the operation. Postoperative outcome was classified as type I (uncomplicated), type II (confusion, agitation, disorientation, or epileptic seizures), or type III (stroke, stupor, or coma). Levels of S-100beta and neuron-specific enolase were evaluated in venous blood samples drawn preoperatively and then daily in the first 5 postoperative days. RESULTS: Levels of S-100beta and neuron-specific enolase differed significantly among the 3 groups (type III > type II > type I) throughout the postoperative period and had a diagnostic specificity and specificity of 89% and 79%, respectively, in identifying patients with type III outcome. S-100beta (but not neuron-specific enolase) levels were identified as significant independent predictors for type II and III outcomes (odds ratio 16.2, P <.0004). The same was true for duration of cardiopulmonary bypass (odds ratio 1.02, P <.006). CONCLUSIONS: Serum levels of S-100beta are reliable markers for adverse neurologic outcomes after cardiac surgery.

Biomarkers↗
PubMed2000

Differentiation between true microembolic signals and artefacts using an arbitrary sample volume.

We evaluated a new discrimination technique between microemboli (MES) and artefact signals. Monitoring was performed over the middle cerebral artery (55 mm) and the brain parenchyma (29 mm). Intensity changes were expressed as percent of change compared to the value measured in the proximal depth. The cut-off value providing the highest sensitivity and specificity in the differentiation was evaluated using 250 MES and 250 artefact signals, and subsequently analysed in the first part of the study. Intensity values derived from the distal depth were subsequently evaluated in 10 patients undergoing cardiac surgery and 45 patients with potential arterial or cardioembolic source. Intensity changes of 87% (84%-90%) and -58% (-71%-(-48%)) were measured in the initial 500 signals for MES and artefact signals, respectively. The best intensity cut-off value was calculated at 27%. This value was subsequently applied to a total of 1858 MES and 1958 artefacts, resulting to sensitivity and specificity of 96% and 98%, respectively. The proposed technique provided adequate results, warranting further evaluation.

Artifacts↗
PubMed2000

Prostate cryoablation without an insertion kit using direct transperineal placement of ultrathin freezing probes.

A modified technique for prostate cryoablation is described. Prostate cryoablation was performed with a gas-based cryomachine using multiple 17-gauge probes. The 17-gauge probes were inserted via a transperineal route directly into the prostate without using an insertion kit. Probe insertion and positioning are simplified, and operative time is reduced. The perineum is less crowded with devices and tubes. Miniaturizing the cryoprobes and their tubing is feasible. The smaller diameter enables direct insertion without an insertion kit. The surgical result does not seem to be inferior to that of conventional ablation, and penetrating trauma to the prostate is minimal. To the best of our knowledge, this is the first report of transperineal prostate cryoablation performed without an insertion kit.

Cryosurgery↗
PubMed2000

Elevated prostate specific antigen serum levels after intravesical instillation of bacillus Calmette-Guerin.

PURPOSE: We determined whether intravesical bacillus Calmette-Guerin (BCG) instillation is associated with elevated prostate specific antigen (PSA). MATERIALS AND METHODS: We treated 36 consecutive patients with bladder cancer with a 6-week course of BCG, followed by cystoscopy at 6 weeks. Blood samples for PSA determination were obtained before each BCG instillation and at cystoscopy with each patient also serving as a control. PSA elevation was defined as 2-fold the baseline level in at least 2 specimens and any PSA level greater than 4 ng./ml. was considered clinically significant. Digital rectal examination was done to identify firm nodules and prostate size. The prostate was examined histologically by transrectal ultrasound guided biopsy or after radical cystectomy. RESULTS: We observed elevated PSA in 27 men (75%) during BCG treatment, of whom 15 (41.6%) had a clinically significant elevation. Overall average PSA increased from 1.3 ng./ml. before BCG instillation to 3.8 during treatment (range 0.1 to 21.5, p <0.0001). In those with a clinically significant elevation average PSA increased from 2.31 ng./ml. at baseline to 6.97 during treatment (p <0.0001) and returned to 3.86 ng./ml. 3 months after treatment. Palpation demonstrated prostatic findings in 10 patients, including firm nodules in 7, while there was significantly elevated PSA in 5 with firm nodules and 2 with diffuse prostatic enlargement. Histological examination of the prostate in 10 patients was diagnostic for granulomatous prostatitis, nonspecific inflammation and benign prostatic hyperplasia in 3, 3 and 4, respectively, of whom none had prostate cancer. CONCLUSIONS: Intravesical BCG therapy is associated with significantly elevated PSA in up to 40% of cases. This effect is self-limited and PSA reverts to normal in 3 months. Therefore, we suggest that prostate biopsy be withheld in such patients and PSA monitored.

Adjuvants, Immunologic↗
PubMed2000

Predicting CAP in patients with intermediate PSA using modified PSA indices.

OBJECTIVES: To test a new PSA index: peripheral zone fraction PSA (PSA-PZ) and evaluate its' predictive value in patients with intermediate PSA. METHODS: Fifty seven of 273 patients with serum PSA 4-10 ng/ml had CAP (21%). Total prostate volume and transition zone volume were calculated. Different cut-off points were used to calculate specificity, sensitivity, efficacy, positive and negative predictive values for PSA, PSAD, PSA-TZ and PSA-PZ (PSA-PZ= serum PSA((Total gland volume-TZ volume)/(Total gland volume)) RESULTS: The distribution of PSA-PZ is presented. PSA-PZ is shown to be effective in DRE negative patients with serum PSA 4-10 ng/ml. For patients with PSA-PZ (1.5 ng/ml the biopsy may be spared with no cancer being missed. CONCLUSIONS: The mathematical formula for PSA-PZ is straightforward and easy to use. Its application is convenient in the clinical setting. We suggest the use of PSA-PZ mainly in DRE negative patients having large glands and serum PSA between 4-10.

Aged↗
PubMed1999

Mitochondrial 3243 A-->G mutation (MELAS mutation) associated with painful muscle stiffness.

The mitochondrial mutation A-->G at nucleotide position 3243 is associated with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and other mitochondrial encephalomyopathies. We found this mutation in a 61-year-old patient who developed at the age of 54 a myopathy with painful muscle stiffness as the predominant symptom. Additionally hypacusis, a mild hemisensory syndrome and impaired glucose tolerance were present. Muscle histopathology showed few ragged red fibers. The mutation was detected heteroplasmatically in DNA from muscle and blood. So far painful muscle stiffness has not been a known phenotype of the 3243 mutation.

DNA, Mitochondrial↗