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Biomedical subjects

B Werner

Publications and source records attributed to B Werner.

At least 19 recordsLinked to original sources
PubMed1992

[Surgical treatment of bacterial endocarditis of the tricuspid valve].

We present a rare case of bacterial endocarditis of tricuspid valve caused by temporary intracardiac pacing. The 48-year old male patient developed complete a-v block during the 1st day of acute inferior myocardial infarction. Intracardiac electrode was inserted for temporary pacing. After 4 days signs of bacterial endocarditis developed. Patient was markedly febrile, moderate tachycardia with gallop rhythm and systolic murmur of tricuspid valve insufficiency were present. Dullness to percussion was audible at the base of right lung. Hepato- and splenomegaly appeared during the second month of hospitalization. Laboratory tests revealed: elevated ESR, leukocytosis with a shift to the left, several blood cultures were positive to Staphylococcus aureus. On repeated chest X-ray patchy infiltrates with thin-walled translucent pools were visible. Transthoracic and transoesophageal++ echocardiography provided more precise informations. Bacterial vegetations were visualised on the tricuspid valve. Coronary angiography revealed proximal occlusion of the right coronary artery and 75-80% stenosis of the left circumflex artery. Antibacterial treatment guided by blood cultures was begun: vancomycin combined with netilmycin, then tienamycin and diflucan--after 10 weeks treatment was decided to be unsuccessful and the decision about surgical treatment was made. In extracorporeal circulation posterior left leaflet together with granular bacterial growths was excised. Septal and anterior leaflets were found normal. Cultures made of excised tissue were positive for Staphylococcus aureus and subsequent treatment with fluoroquinolones gave satisfactory result. Postoperative echocardiography revealed only small tricuspid valve insufficiency. Coronary by-pass surgery was performed later because of the high risk of simultaneous operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocarditis, Bacterial↗
PubMed1992

[Analysis and assessment of hospital length of stay by the medical service].

New German social legislation has considerably widened the scope of activities and responsibilities of the Medical Advisory Service of the German Compulsory Sickness Insurance Bodies. One of the consequences of the rapid rise in the cost of inpatient care is that compulsory sickness insurance bodies in germany must consult the Medical Advisor much more often than before. Inpatient care cost is of course most closely related to the patient's length of stay in hospital. If suitable data are available, the stay in hospital can be analysed and assessed by correlating the data with several factors such as diagnosis and age of the patients, proportion of patients of short stay, tracer diagnoses, special departments, outputs, costs and prices. Assessment of the length of stay involves the structure of the patients and comparing hospitals with one another. This leads to results that help the sickness insurance bodies in deciding on budget demands made by hospitals, and in clarifying the extent to which hospitals are genuinely in need of help (utilisation of or shortage of bed capacity, for example) and in gaining an insight into the economy with which a hospital is being run.

Age Factors↗
PubMed1991

[The subjective and objective assessment of the functional treatment results after combined orthodontic and oral surgical measures].

The status of temporomandibular joint and muscle function was examined in a group of 22 adult patients, who underwent combined orthodontic and surgical treatment. Even though nearly all patients were very content with the results of the therapy, 2/3 showed a rather reduced movement of the condyle after mandibular sagittal split osteotomy. The causing factors are: arthrosis, permanent displacement of the disc or a change of muscle function after surgery.

Adult↗
PubMed1990

Non-invasive 31P magnetic resonance spectroscopy revealed McArdle disease in an asymptomatic child.

A Turkish couple suffering from McArdle disease (myophosphorylase deficiency) and their two sons aged 5 and 9 years, respectively, were studied using 31phosphorus magnetic resonance spectroscopy (31P MRS). During exercise both sons showed the same pathological pattern as their parents. In contrast to healthy volunteers, intracellular pH (pHi) as measured by 31P MRS every 10 s during exercise, never fell below the lower 95% confidence limit (6.94) of pHi at rest (7.06), but tended to be raised. It is of special interest that the 5-year-old boy was completely asymptomatic, although the enzyme defect seems to be fully expressed at the cellular level.

Adult↗
PubMed1990

Intestinal obstruction at the onset of acute lymphoblastic leukemia in a child.

Surgical complications need not be fatal in acute leukemia. If these are promptly diagnosed and properly treated, the prognosis will improve. This report deals with a case of acute lymphoblastic leukemia presenting with an acute abdomen following surgery for choledochal cyst. A peripheral blood smear and examination of the bone marrow revealed acute lymphoblastic leukemia. The child received transfusions of blood and platelets. Pretreatment with prednisolone was started as therapy for leukemia, and 2 days later, the patient underwent surgery. Therapy was continued until the general condition allowed a more aggressive form of treatment. Complete remission was achieved, and the patient is still in good health 48 months after diagnosis and 15 months after discontinuation of treatment. The favorable outcome in this child shows that prompt surgery is sometimes an essential step in the treatment of childhood leukemia.

Abdomen, Acute↗
PubMed1989

[Costs in the hospital (in the diagnosis of liver and pancreatic tumors using imaging procedures)].

The proportion of inpatients with tumours of the liver and pancreas is rather small, being only 0.25% of all the patients. Nevertheless, imaging methods may still be employed to an extent that is out of proportion to the small number of such patients. Although it is not possible at present to assess the cost arising from using the imaging methods for the diagnosis of these particular patients, an analysis of the performance data stated in the annual balance sheets of hospitals definitely shows an upward trend in respect of the use of imaging methods in diagnostic procedures in general. Despite the reductions in individual methods, such as, for example, roentgenoscopic screening or fluoroscopy, there are disproportionate increases in the total number of x-rayed patients while at the same time other imaging methods such as sonography, computed tomography and endoscopy show steep increases. It can be assumed that this applies likewise to patients with tumours of the liver and pancreas. Side by side with the tendency to extend the spectrum of use there is also an individual cost increase per case. Whereas the total cost for all Hamburg hospitals increased by 5.2% between 1985 and 1986, cost of materials and equipment rose by 6.8% and specifically in the x-ray sector by 10.2%. Seen from this point of view, the x-ray sector has become a growing cost factor. Of course that does not mean that the multitude of procedures to which the patient is subjected is always meaningful and mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1988

A new test to predict reversibility of hydronephrotic atrophy after stable partial unilateral ureteral obstruction.

In previous studies we showed that hydronephrotic atrophy develops only in the first weeks after stable partial ureteral obstruction, and does not progress thereafter. Relief of obstruction only in the "destructive phase" and not in the later "steady-state phase" seems to improve or prevent hydronephrotic atrophy. Since the duration of partial ureteral obstruction is often not known, we studied urinary enzymes of rat kidneys after stable partial unilateral ureteral obstruction to identify the destructive phase. We chose as an example of the tubular lysosomal enzyme N-acetyl glucosaminidase (NAG) and as an example of the brush border enzyme gamma-glutamyl-transferase (Gamma-GT). NAG concentration but not so much Gamma-GT concentration was higher in the urine of the obstructed kidneys than in the urine of the contralateral control kidney, in the first two weeks after operation, and then returned to normal. These observations lead to the conclusion that the "destructive phase" after ureteral obstruction can be identified by the appearance of high urinary tubular lysosomal enzyme content. The clinical implication is that the timing of relief of asymptomatic stable partial ureteral obstruction of unknown duration can be based on the concentrations of urinary lysosomal enzymes.

Acetylglucosaminidase↗
PubMed1988

[Magnetic resonance in pediatric research and clinical practice. II. Studies on the development and pathology of the brain in neonates, infants and young children].

We are investigating metabolism and morphological differentiation of the developing brain in neonates and children under non-invasive conditions combining MR imaging (MRI) with spectroscopy (MRS) on a high-field/small-bore (2.35 Tesla/40 cm) system. By the end of 1987, 116 neonates, infants and young children with various perinatal problems, congenital abnormalities and different neurological diseases have been examined with MRI. In addition, MRS studies were subsequently performed on 46 of these children using the same instrument and within the same session. The small, sometimes very sick and instable patients require careful monitoring and elaborate technical devices in the high magnetic field. We are presenting solutions for methodological and technical developments and adaptations, concepts for sedation and measurement protocols in various age groups and first results of the combined use of MRI and MRS to investigate the brain in neonates and infants.

Brain↗
PubMed1986

[Diagnosis and course of synovial sarcoma. Comparison of x-ray diagnosis and bone scintigraphy].

The unfavourable prognosis of malignant synoviomas makes it essential to arrive at an early diagnosis. The early clinical symptoms and radiological appearances may be minimal and sometimes absent. It is therefore advisable to obtain bone scintigrams with perfusion and early images as well as the radiographs. The local extent of the tumour can be evaluated by ultrasound and CT. Angiography is required only if the relationship to the vessels cannot otherwise be ascertained, or if intra-arterial therapy is being considered. The final diagnosis depends on a biopsy. For subsequent observation, both scintigrams and radiographs should be obtained. It is essential to perform a three-phase scintigram. This improves the recognition of recurrences and of soft tissue or bone metastases. Most bone metastases are visible on scintigraphy, but a normal scintigram in the presence of an osteolytic lesion on a radiograph may be obtained. Pulmonary metastases can only be demonstrated radiologically.

Adolescent↗
PubMed1986

Structure and replication of the genome of the hepatitis delta virus.

The hepatitis delta virus can be found in the serum and liver of some hepatitis B virus patients. We now report that the RNA genome of serum-derived delta virus is single-stranded and circular. Livers of infected chimpanzees or woodchucks contained as many as 300,000 copies of genomic strand RNA per average cell, and at least some of this RNA had a circular conformation. Also present in the livers were RNA species complementary to the virion RNA. The genomic RNA was 5-22 times more abundant than this antigenomic strand. Some of the antigenomic RNA was complexed with genomic RNA, as evidenced by the fact that at least 34% of the antigenomic RNA was resistant to digestion with either RNase A in 0.3 M NaCl or S1 nuclease. Some of the antigenomic RNA was in a circular conformation. These and other findings showed that the structure and replication of hepatitis delta virus are in many ways similar to those of the previously described plant viroids, virusoids, and satellite RNAs.

Animals↗
PubMed1986

Effect of long-term anemia and retransfusion on central circulation during exercise.

The purpose of this study was to evaluate the effect of long-term anemia and subsequent retransfusion of erythrocytes on various circulatory parameters. Anemia was induced in nine healthy male subjects by repeated venesections. The stored blood was retransfused after 9 wk (range 8-11 wk). Exercise tests were performed before venesection in the control state (C), in the anemic state (A), and 48 h after retransfusion (R). Hemoglobin concentration levels were 146 +/- 10 g/l in C, 110 +/- 7 g/l in A, and 145 +/- 9 g/l in R. Maximal O2 uptake was 4.55 +/- 0.6, 3.74 +/- 0.7, and 4.45 +/- 0.6 l/min in C, A, and R, respectively. A decrease in heart rate of 7 beats/min (P less than 0.01) and in cardiac output of 2 l/min (P less than 0.05) at maximal exercise occurred in the anemic state compared with control values. These decreases were not reversed but, rather, were further accentuated after retransfusion. The adaptive response to submaximal exercise (cycling at 150-175 W) in anemia was mediated to the amount of 50% by an increase in cardiac output (mainly an increase in heart rate) and 50% was due to increased O2 extraction in the peripheral tissue. In conclusion, long-term anemia was found to decrease the heart rate and cardiac output at maximal exercise. Furthermore the close correlation between hemoglobin concentration and maximal O2 uptake in humans is confirmed.

Anemia↗