An integrated system-wide strategy for quality improvement in cancer surgery.
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Colorectal Neoplasms↗
Biomedical subjects
B Langer
Publications and source records attributed to B Langer.
Charging mechanisms of trapped element-selectively excited nanoparticles exposed to soft x rays.
Charging mechanisms of trapped, element-selectively excited free SiO2 nanoparticles by soft x rays are reported. The absolute charge state of the particles is measured and the electron emission probability is derived. Changes in electron emission processes as a function of photon energy and particle charge are obtained from the charging current. This allows us to distinguish contributions from primary photoelectrons, Auger electrons, and secondary electrons. Processes leading to no change in charge state after absorption of x-ray photons are identified. O 1s-excited SiO2 particles of low charge state indicate that the charging current follows the inner-shell absorption. In contrast, highly charged SiO2 nanoparticles are efficiently charged by resonant Auger processes, whereas direct photoemission and normal Auger processes do not contribute to changes in particle charge. These results are discussed in terms of an electrostatic model.
Journal Article↗
[Amniotic fluid embolism: two case reports].
We report two cases of amniotic fluid embolism, confirmed by histological examination. Both patients had an immediate post-partum haemorrhage that required an haemostatic hysterectomy. A typical symptomatology of amniotic fluid embolism revelated the first case. The patient survived without any sequelae. In the second case, amniotic fluid embolism occurred immediately after the delivery. The patient developed an acute respiratory distress with a shock syndrome. Despite haemostatic hysterectomy and resuscitative efforts, she died 6 days later.
Adult↗
Shared decision making for in-patients with schizophrenia.
OBJECTIVE: Patients' participation in treatment planning is being increasingly advocated in mental health. The model of "Shared Decision Making" (SDM) is proposed as a promising method of engaging patients in medical decisions and improving health-related outcomes. In the present study, the feasibility and effects of SDM for in-patients with schizophrenia should be evaluated. METHOD: Randomized controlled trial comparing a SDM program with routine care (n = 107). RESULTS: The intervention studied was feasible for most of the patients and did not take up more of the doctors' time. Patients in the intervention group had a better knowledge about their disease (P = 0.01) and a higher perceived involvement in medical decisions (P = 0.03). The intervention increased the uptake of psychoeducation (P = 0.003). CONCLUSION: Sharing medical decisions with acutely ill in-patients with schizophrenia is in many cases possible and improves important treatment patterns. This might help in destigmatizing this group of patients and improving schizophrenia-related health outcomes.
Acute Disease↗
[Immediate and long term complications of episiotomy].
OBJECTIVE: The objective of this review was to describe the complications of episiotomy. MATERIAL AND METHODS: A systematic review on Medline Database set was performed with the key words: episiotomy, dyspareunia, fecal incontinence, urinary incontinence, maternal morbidity, pelvic floor defects and sexual function. Four hundred seventy two articles were selected. RESULTS: When performed liberally, episiotomy appears to increase the risk of post partum bleeding. More restrictive use does not appear to increase the risk of serious perineal injury. In the event of instrumental extraction, use of episiotomy appears to be associated with more severe damage. Medial episiotomy does not appear to be associated with third or fourth degree tears. Following delivery, patients who had an episiotomy complain of perineal pain more than those with an intact perineum or first or second degree tears. Three months after delivery, there is no difference. While episiotomy appears to be a source of dyspareunia during the first weeks after delivery in comparison with spontaneous tears, this does not appear to be true later after delivery. CONCLUSION: Episiotomy appears to be the cause of more perineal pain and dyspareunia during the early post partum weeks.
Adult↗
Twin pregnancies and delayed-interval delivery: report of two cases with delivery after 35 weeks' gestation.
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Abnormalities, Multiple↗
[Assessment of cost-benefit analysis in integration projects on drug addiction].
The purpose of this study is to make a cost-benefit-analysis for integration projects helping drug addicts and substitutes to reintegrate into society. The study is intended to contribute to a better allocation of resources under the trade-off-situation that only a limited number of integration projects can be realized due to budget limitations. This pilot study represents an economic evaluation of health activities on integration based on the example of study projects offered by Mudra e. V. As a result the study showed that the evaluated projects are economically advantageous during the investigated research period. Furthermore, the study contains a non-monetary analysis of intangible effects which shows significant improvements in quality of life. Although the results are substantial, further research is mandatory focussing on the economic benefits of integration projects.
Cost of Illness↗
Probing the molecular environment using spin-resolved photoelectron spectroscopy.
Angle- and spin-resolved photoelectron spectroscopy with linearly and circularly polarized synchrotron radiation were used to study the electronic structure of model triatomic molecules, hydrogen sulfide, and carbonyl sulfide. The spin-polarization measurements of the molecular field split components of the S 2p photolines revealed a strong effect of the different molecular environments. The validity of simple atomic models to explain the results is discussed.
Journal Article↗
Cardiac safety of trastuzumab in combination with epirubicin and cyclophosphamide in women with metastatic breast cancer: results of a phase I trial.
This prospective, parallel-group, dose-escalation study evaluated the cardiac safety of trastuzumab (Herceptin) plus epirubicin/cyclophosphamide (EC) in women with human epidermal growth factor receptor-2 (HER2)-positive metastatic breast cancer (MBC) and determined an epirubicin dose for further evaluation. HER2-positive patients received standard-dose trastuzumab plus epirubicin (60 or 90 mg/m(2))/cyclophosphamide (600 mg/m(2)) 3-weekly (EC60+H, n=26; EC90+H, n=25), for four to six cycles; 23 HER2-negative patients received EC alone (90/600 mg/m(2)) 3-weekly for six cycles (EC90). All patients underwent thorough cardiac evaluation. Two EC90+H-treated patients experienced symptomatic congestive heart failure 4.5 and 6 months after the end of chemotherapy. One EC60+H-treated patient experienced an asymptomatic decrease in left ventricular ejection fraction (LVEF) to <50% 6 months after the end of chemotherapy. No such events occurred in control patients. Asymptomatic LVEF decreases of >10% points were detected in 12 (48%), 14 (56%) and 5 (24%) patients treated with EC60+H, EC90+H, and EC90. Objective response rates with EC60+H and EC90+H were >60%, and 26% for EC90 alone. These results indicate that trastuzumab may be combined with EC with manageable cardiotoxicity and promising efficacy.
Adult↗
[Initial management of primary postpartum hemorrhage].
Accurate management of primary postpartum hemorrhage requires perfect knowledge of a recent protocol accessible at all times. Staff members and equipment need to be adjusted to the emergency situation. The first step is to establish a rapid diagnosis. This could be done with collecting bags, placed immediately after the birth. Once the diagnosis has been established, it has to be communicated to the whole team including obstetricians, midwives and anesthetists. A search for the cause of the hemorrhage is premordial. Abdominal uterine palpation confirms the diagnosis of uterine atony, the most frequent cause of postpartum hemorrhage. Two management schemes are possible depending on whether or not there is retention of the placenta. When the placenta is retained, manual removal has to be performed to empty the uterine cavity and to rule out uterine rupture. After placental delivery, manual control of the uterine cavity is always required. Uterine massage has to be performed after the intrauterine manoeuvres and must not be stopped too quickly. Rapidly other origins can be excluded: episiotomy or low genital tract lacerations requiring rapid repair, coagulation disorders requiring specialised care, or hematomas. During the same time, uterotonic drugs have to be used. Oxytocin (intravenous injection of 5 to 10 IU) is generally employed. Prostaglandins cannot be proposed as publications reporting their efficiency are not validated. Meanwhile, the anesthetists will have begun the first measures of resuscitation.
Decision Trees↗
[Obstetrical management in the event of persistent or worsening postpartum hemorrhage despite initial measures].
Sulprostone infusion must be started without further delay if the first treatment (oxytocin, manual removal of the placenta, uterine revision, vaginal and cervical examinations) has been unsuccessful in the first 30 minutes after delivery. In France, the use of this treatment has been officially authorized in this indication (marketing approval, AMM). Intramuscular and intramyometrial injections being contraindicated, sulprostone is administered through continuous intravenous infusion. Dosage is 500 microg (one vial) per hour. Starting dose is 1.7 microg/min (10 ml/h), and can be increased if necessary in steps of 1.7 microg/min (but not exceeding 8.3 microg./min). The success rate of this treatment is linked to the rapidity of its commencement (within 30 min of the diagnosis of postpartum hemorrhage). In case of contraindications, since postpartum hemorrhage is life-threatening, the benefit-risk ratio needs to be estimated. A strict monitoring of cardiovascular parameters is compulsory before and after its administration. There is no time limit after which this treatment can be considered as ineffective: it depends on the amount of blood lost, the patient's clinical state, and on means that have already been used to stop the bleeding. However, if after 30 min of sulprostone infusion, there is no improvement or if the situation is worse, other therapeutic strategies must be considered (e.g., embolization, surgery). The use of intra-rectal misoprostol is still under assessment. To date, we have been unable to find studies that justify this treatment. Intra-uterine balloon, tube, or mesh packing has been studied in a few small series, where it was successful. Use of these strategies must not delay the treatment by sulprostone.
Female↗
Anthracycline and trastuzumab in breast cancer treatment.
This study was designed to evaluate the cardiac safety of the combined treatment of HER2-positive metastatic breast cancer patients with trastuzumab (Herceptin) plus epirubicin and cyclophosphamide (EC) in comparison with EC alone in HER2-negative metastatic breast cancer patients. Patients included those with metastatic breast cancer without any prior anti-HER2 treatment, anthracycline therapy, or any other chemotherapy for metastatic disease. This was a nonrandomized, prospective, dose-escalating, multicenter, open-label, phase I study in Germany. A control group of 23 patients received EC 90/600 mg/m2 3-weekly for six cycles (EC90 alone). A total of 26 HER2-positive patients were treated with trastuzumab, or H (2 mg/kg weekly after an initial loading dose of 4 mg/kg), and EC 60/600 mg/m2 3-weekly for six cycles (EC60+H); another 25 HER2-positive patients received H and EC 90/600 mg/m2 3-weekly for six cycles. Asymptomatic reductions in left ventricular ejection fraction (LVEF) of more than 10% points were detected in 12 patients (48%) treated with EC60+H and in 14 patients (56%) treated with EC90+H vs 6 patients (26%) in the EC90 alone cohort. LVEF decreases to <50% occurred in one patient in the EC60+H cohort and in two patients in the EC90+H cohort during the H monotherapy. No cardiac event occurred in the cohort with EC90 alone. The overall response rates for EC60+H and EC90+H were >60%, vs 26% for EC90 alone. The interim results of this study approve the cardiac safety of the combination of H with EC, with low risk of cardiac toxicity. The combination regimen revealed promising efficacy.
Adult↗
[Routine use of ST-segment of fetal electrocardiogram for monitoring labor. A year's experience (preliminary results)].
OBJECTIVES: Two randomized trials found that monitoring labor by analyzing the fetal electrocardiogram (STAN) appears to offer better sensitivity and specificity in screening for metabolic acidosis than cardiotocography (CTG) does. We report here the results of a descriptive study of 173 cases between 1 June 2001 and 31 May 2002, the objectives of which were twofold: to determine the number of possible false negatives (defined by neonatal metabolic acidosis with a pH less than 7.05 and base deficit (BD) greater than 12 mmol/l, in the absence of a STAN decisions event more than 30 min before birth), and to assess whether STAN indicated the need for operative intervention too late in cases of fetal distress. PATIENTS AND METHODS: Our study was conducted on an at-risk population with CTG changes. STAN was used with a scalp electrode to monitor labor according to a protocol based upon the FIGO CTG classification and the clinical instructions used in the Swedish trial. Accordingly, we compared two groups: in group 1, a STAN decision event required a rapid conclusion to labor, while in group 2, the absence of any STAN decision event meant that labor continued, despite the changes in the tracing. RESULTS: We found seven cases with a neonatal pH less than 7.05, but only one may involve a false negative by this method. The mean arterial pH and the number of fetuses born with an arterial pH less than 7.10 did not differ significantly between the two groups, nor were there any significant differences in the mean BD at birth, or the number of children with a BD greater than 12 mmol/l. CONCLUSION: The results appear to indicate that use of STAN with the usual CTG enables an appropriate response to cases of fetal distress, but it remains difficult to determine the real benefits that can be expected from this method in France. Longer assessment in our population is required before we can assess its actual advantages.
Acidosis↗
[Pyelectasy].
Ultrasonography is undoubtedly an effective tool for identifying fetal urinary tract anomalies. Fetal pyelic dilatations are common and of controversial pathological significance. A 5 mm threshold for a pelvic anteroposterior diameter can be used to detect dilatation during the second trimester of pregnancy, if, and only if, all suspected dilatations are verified during the third trimester. Only the dilatations larger than 10 mm after 28 weeks merit further postnatal exploration. Urological postnatal exploration should be done if the abnormalities persist at the postnatal sonographic control. This control, if normal, should be repeated at least once at the age of one month. Further investigations are necessary to evaluate the incidence and significance of VUR, since it has been reported associated in certain cases with isolated pyelic dilatation. However, there are no grounds at present for justifying routine retrograde cystography in case of an isolated fetal pyelic dilatation. A karyotype study is not indicated in the presence of an isolated pyelic dilatation.
Age Factors↗
Negligible adjuvant effect for antibody responses and frequent adverse events associated with IL-12 treatment in humans vaccinated with pneumococcal polysaccharide.
To assess whether co-administration of recombinant human IL-12 (rhIL-12) and 23-valent pneumococcal polysaccharide vaccine (PPV) enhances the antibody response to this T cell-independent antigen, healthy immunocompetent volunteers (n=34, 55-65 years old) were vaccinated intramusculary with PPV and concurrently-treated subcutaneously with either rhIL-12 (1 or 4 microg) or placebo. The increases of total anti-pneumococcal IgG antibodies were numerically higher among the rhIL-12 recipients compared with placebo recipients, but the difference was not significant. The rhIL-12 recipients had a high incidence of local and systemic side effects. Given the lack of convincing evidence that rhIL-12 enhances the antibody response to PPV, the frequency and severity of the side effects was unacceptable.
Adjuvants, Immunologic↗
Inverse detection and heteronuclear editing in 1H-15N correlation and 1H-1H double-quantum NMR spectroscopy in the solid state under fast MAS.
Signal enhancement in heteronuclear correlation spectra as well as signal selection in 1H experiments can be achieved through inverse, i.e., 1H, detection in the solid state under fast MAS conditions. Using recoupled polarization transfer (REPT), a heteronuclear 1H-15N single-quantum correlation (HSQC) experiment is presented whose symmetrical design allows the frequency dimensions to be easily interchanged. By observing the 15N dimension indirectly and detecting on 1H, the sensitivity is experimentally found to be increased by factors between 5 and 10 relative to conventional 15N detection. In addition, the inverse 1H-15N REPT-HSQC scheme can be readily used as a filter for the 1H signal. As an example, we present the combination of such a heteronuclear filter with a subsequent 1H-1H DQ experiment, yielding two-dimensional 15N-edited 1H-1H DQ MAS spectra. In this way, specific selection or suppression of 1H resonances is possible in solid-state MAS experiments, by use of which the resolution can be improved and information can be unravelled in 1H spectra.
Journal Article↗
Recurrence of hydatid disease.
Surgical management of hepatic hydatid disease has been associated with an overall local recurrence rate of approximately 10%. Local recurrence is rarely seen following complete resection of an intact cyst and is usually the result of spillage of live parasites or leaving a residual cyst wall containing germinal epithelium, daughter cysts, or protoscolices during surgery. Recurrence is frequently asymptomatic, so the diagnosis depends on dedicated follow-up of treated patients with serology and either ultrasonography or computed tomography. The management of locally recurrent disease should include administration of albendazole followed by the appropriate application of interventional radiotherapy or operation. As with the treatment of primary disease, the preservation of liver function and minimizing the risk to the patient remain the guiding principles of therapy of local recurrence.
Albendazole↗
Antiphospholipid antibodies and preeclampsia: a case-control study.
OBJECTIVE: To assess the association between the occurrence first of preeclampsia and antiphospholipid antibodies. METHODS: We conducted a prospective case-control study of 180 pregnant women with their first incidents of preeclampsia and no histories of thrombosis or systemic autoimmune diseases. Preeclampsia (n = 180) was defined as blood pressure (BP) at least 140/90 mmHg after 20 weeks' gestation and proteinuria at least 0.3 g per 24 hours. Two control subjects were matched to each case (n = 360). They were pregnant women without hypertension or proteinuria and without histories of thrombosis or systemic autoimmune disease. Lupus anticoagulant (activated partial thromboplastin time, diluted thromboplastin time, platelet neutralization procedure) and anticardiolipin antibodies (immunoenzymatic assays) were assessed in both groups, and the coagulation state (levels of thrombin-antithrombin III complexes, fragments 1 + 2 of prothrombin) was also evaluated. The analysis design was a sequential plan with 5% type I error and 95% power. RESULTS: There was no association between antiphospholipid antibodies and preeclampsia. The odds ratio for the association was 0.95 (95% confidence interval 0.45, 2.61). Antiphospholipid antibodies were detected in eight of 180 preeclamptic women and in 19 of 360 controls. In contrast, there was a clear, confirmed activation of coagulation during preeclampsia. CONCLUSION: Despite evidence of a prothrombotic state during preeclampsia, it is unlikely that antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies) represent risk factors for preeclampsia among women with no previous preeclampsia and no histories of thrombosis or systemic autoimmune disease.
Adult↗