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Biomedical subjects

D Apel

Publications and source records attributed to D Apel.

At least 19 recordsLinked to original sources
PubMed2003

[Symptomatic pericardial effusion as initial manifestation of gastric signet ring cell carcinoma].

HISTORY: A 78-year-old woman presented at our hospital with palpitation, tachycardia and progressive dyspnea. The health history included the diagnosis of diabetes mellitus and chronic obstructive pulmonary disease. INVESTIGATIONS: The ECG showed atrial fibrillation, later changing with sinus rhythm and low voltage. The echocardiography revealed pericardial effusion. The cytology showed signet ring cells from the stomach. Endoscopic study revealed a 3 cm tumor in the posterior wall of the upper part of the body. The histopathological examination diagnosed cancer of diffuse type according to Lauren, with signet-ring cells. TREATMENT AND CLINICAL COURSE: After treating the atrial fibrillation a pericardial drainage was performed. The pericardiocentesis yielded 500 ml of serous fluid. In an echocardiogram after pericardial drainage, pericardial effusion was no longer present. During the clinical course the patient suffered a stroke and the chemotherapy could not be initiated. The patient died 2 months after diagnosis. CONCLUSION: Cardiac involvement with clinical manifestations and pericardial effusion may be associated with a malignant neoplasm. Echocardiography and pericardiocentesis are helpful for the diagnosis of cardiac metastases.

Aged↗
PubMed2001

[Photodynamic therapy of dysplasias and early carcinomas in Barrett esophagus with a diode laser system--a pilot study].

BACKGROUND: Photodynamic therapy (PDT) of dysplasia and early cancer of the esophagus could show good results in the potential of ablation. Unfortunately, the existing expensive and temperamental dye laser systems foiled a broad clinical use. In this pilot study, we investigated the feasibility of an inexpensive and maintenance-free diode laser system for PDT of dysplasia and early cancer in Barrett's esophagus. PATIENTS AND METHODS: Eight patients with Barrett's esophagus and/or early cancer were treated. As light source we used a diode laser system with a maximum power output of 2 W and a wavelength of 633 +/- 3 nm. One patient was treated initially with Photosan-3, seven patients received 5-aminolevulinic acid. RESULTS: In all patients we could achieve reduction in length and/or histologically proven downgrading. In three quarters of the patients, complete eradication of adenocarcinoma could be attained. Columnar-lined metaplastic epithelium could also be completely eradicated. CONCLUSION: PDT using a diode laser system is comparably effective in Barrett's esophagus/early cancer as PDT with dye laser systems. PDT is a gentle and effective technique with little side effects.

Adenocarcinoma↗
PubMed2001

Photodynamic therapy with 5-aminolevulinic acid is not effective in bile duct cancer.

BACKGROUND: The results of preliminary studies of photodynamic therapy (PDT) for palliation of patients with bile duct cancer with hematoporphyrin derivative have been good. Rapid elimination of a photosensitizer could potentially shorten the time requirement for shielding from light. This would enhance the benefit of this form of palliative treatment. Therefore the feasibility of PDT was investigated for nonresectable bile duct cancer by using 5-aminolevulinic acid. METHODS: Four patients with nonresectable bile duct cancer underwent cholangiography, cholangioscopy, and intraductal US before PDT. Light activation was performed 5 to 7 hours after oral administration of 5-aminolevulinic acid. All patients had an endoprosthesis placed in the bile duct after PDT. RESULTS: Cholangioscopy 72 hours after PDT revealed superficial fibrinoid necrosis. However, 4 weeks after PDT there was no significant reduction in bile duct stenoses. Two patients had infectious complications develop, but phototoxicity was not observed. CONCLUSIONS: Although superficial tumor necrosis was evident, PDT with 5-aminolevulinic acid failed to significantly reduce malignant bile duct obstruction. Therefore 5-aminolevulinic acid-PDT cannot be recommended for the palliative treatment of bile duct cancer.

Administration, Oral↗
PubMed2001

Reversible pancreatic duct stricture after a blunt abdominal trauma.

A 32-year-old man developed acute pancreatitis with a main duct stricture resulting from blunt abdominal trauma sustained during a car accident 11 weeks before admission. No interventions were performed and unusually, after 3 months' follow-up, the pancreatic main duct stricture resolved and the patient remained asymptomatic. There are no other reports in the literature demonstrating resolution of pancreatic main duct stricture without any endoscopic or surgical treatment subsequent to a blunt abdominal trauma.

Abdominal Injuries↗
PubMed2001

Photodynamic therapy for palliation of nonresectable bile duct cancer--preliminary results with a new diode laser system.

OBJECTIVES: Preliminary results of photodynamic therapy (PDT) of bile duct cancer have shown astonishingly good results in the reduction of cholestasis, improvement of quality of life, and even prolongation of the survival time. Unfortunately, the existing dye laser systems are large and costly, and their maintenance is expensive. Therefore, we investigated the feasibility of a diode laser system for PDT of nonresectable bile duct cancer. METHODS: Eight patients with nonresectable bile duct cancer were treated. Forty-eight hours after i. v. application of 2 mg/kg body weight of Photosan-3, light activation was performed by a transpapillary (four patients) or percutaneus (four patients) access. We used a cylindrical diffusor tip and illuminated using a wavelength of 633+/-3 nm and a total energy of 200 J/cm2. All patients were additionally provided with bile duct endoprostheses after PDT. RESULTS: Four weeks after initial PDT all patients showed a marked reduction of bile duct stenosis. The median serum bilirubin value declined from 5.8 mg/dl (2.0-10.1) to 1.0 mg/dl (0.8-4.4). The median survival time at the time of writing is 119 days (52-443). Five patients are still alive. In four patients we could change from percutaneous to transpapillary drainage after PDT, two patients showed infectious complications. CONCLUSION: PDT with the diode laser system seems to be effective in reducing malignant bile duct stenosis. This treatment is minimally invasive and has a low specific complication rate. Randomized, controlled studies comparing PDT with the insertion of endoprostheses and long term follow-up of results are needed to confirm the promising short term results.

Aged↗
PubMed2000

Emergency endoscopy.

The need for emergency endoscopy is a matter of debate. The time interval for emergency procedures remains to be defined. Most authors propose a time span of 24 h as emergency time, while some define a period of 72 h (especially in acute pancreatitis). Several studies have shown a possible benefit for a select group of patients. Four main indications are established for emergency endoscopy: acute gastrointestinal bleeding (variceal and nonvariceal), acute biliary pancreatitis and acute cholangitis. In the case of upper gastrointestinal bleeding, emergency endoscopy enables exact diagnosis and appropriate therapy, and provides important prognostic information. There is some evidence that emergent endoscopic injection therapy improves clinical outcome and reduces mortality in patients with acute ulcer bleeding. Patients do not benefit if endoscopy is performed only as a diagnostic procedure. Controversial results were published recently for emergency endoscopy in acute biliary pancreatitis. There is good evidence that emergency endoscopic retrograde cholangiopancreatography is helpful in patients with severe pancreatitis and stone impaction if performed within the first 24 h after onset of symptoms. However, emergency endoscopic retrograde cholangiopancreatography is not beneficial for patients with mild pancreatitis if performed later than 72 h (or 24 h) after onset of symptoms. There is a limited number of well established evidence-based indications for emergency endoscopy. Some other indications are still a matter of debate, and controversial opinions have been published.

Acute Disease↗
PubMed1999

Electrohydraulic lithotripsy treatment of gallstone after disimpaction of the stone from the duodenal bulb (Bouveret's syndrome).

A 75-year-old man with right upper quadrant abdominal pain was diagnosed by gastroscopy to have an impacted gallstone in the duodenal bulb. Using the polypectomy loop, the stone was extracted from the bulbus and mobilized into the stomach. After failure to remove the stone from the stomach as well as fragmentation by mechanical lithotripsy, electrohydraulic lithotripsy was used to break up the stone, parts of which passed spontaneously through the bowel. Thus, it was unnecessary to proceed with surgical enterolithotomy to remove, from the duodenal bulb, the impacted gallstone responsible for the gastric outlet obstruction.

Aged↗
PubMed1998

[Preliminary treatment results of relapsed or refractory acute leukemia using two and three drug regimens].

36 patients with relapsed (29) or refractory (7) acute lymphoblastic or nonlymphoblastic leukaemia received regimens employing 1-3 courses of mitoxantrone (or idarubicin), intermediate doses of cytarabine and etoposide. Complete remission (CR) was achieved in 30% of patients (5/15 ALL, 6/21 AML, 5 cases of refractory and 6 of relapsed leukaemia). Duration of CR was 3-6+ months (3 patients are still alive). Toxicity of the treatment was acceptable, however 5 patients with severe granulocytopenia died from sepsis.

Adult↗
PubMed1996

Nursing staff responses to violent events in closed psychiatric wards: a comparison between attributional and cognitive-neo-associationistic analyses.

This paper examines the behavioural response of nursing staff in psychiatric wards to a patient's violent behaviour towards a staff member as a function of whether the patient's behaviour was presented as arbitrary or not. The participants were 133 nurses. They were given two vignettes describing an arbitrary and a non-arbitrary behaviour of a patient and were asked what the typical response in their ward to each event would be. The results show that when the patient's behaviour was perceived as arbitrary, staff was believed to respond with a therapeutic reaction more frequently than to non-arbitrary behaviour. Moreover, participants' professional characteristics played a greater role in the non-arbitrary scenario. It is suggested that a therapeutic response to a patient's violent behaviour requires a recognition that the patient's behaviour is consistent with his/her role as a patient. The implication of these results for Berkowitz & Heimer's (1989) cognitive-neo-associationistic analysis is discussed.

Adult↗
PubMed1996

[Unclassified chronic myeloproliferative Ph(-); i(17q); +8 syndrome with mixed myelo-megakaryoblastic crisis--case report].

We present a case of a 17-year old patient with extreme hepatosplenomegaly, hyperthrombocytosis, hyperleucocytosis and the presence of myelo- and megakaryoblasts in the peripheral blood film. Numerous complications that occurred in the course of the disease made cytostatic treatment difficult. Since Ph chromosome and hybrid gene bcr/abl were absent, the diagnosis of unclassified chronic myeloproliferative syndrome in the phase of blast crisis was established. Immunophenotyping confirmed a mixed myelo- megakaryoblastic character of the crisis. In the differential diagnosis other myeloproliferative syndromes were taken into account including i(17q) syndrome. The patient died after a 13-month observation due to neoplasm progression and sepsis.

Adolescent↗
PubMed1993

[Diagnostic value of acidified glycerol lysis test (AGLT) in hereditary spherocytosis and selected hematologic diseases].

AGLT and osmotic fragility test (method according to Dacie) were performed in patients with hereditary spherocytosis, their relatives and in patients with other hematological diseases. Abnormal results of both tests were observed not only in all cases of hereditary spherocytosis but also in other patients with spherocytes present in the peripheral blood film. In our opinion, AGLT is a good screening test for hereditary spherocytosis and can replace the more time consuming Dacie's method.

Hematologic Diseases↗
PubMed1991

[Morphological changes in peripheral blood and bone marrow in patients with myelodysplastic syndromes].

In 23 patients with myelodysplasia syndromes cytomorphological examinations of peripheral red blood cells and bone marrow cells were carried out. Apart from anisocytosis and poikilocytosis observed in all patients, the most frequent changes were macrocytosis and megalocytosis or erythrocytes and their precursors, presence of erythroblasts in peripheral blood and disturbances of megakaryopoiesis. None of these changes was characteristic in a given type of these syndromes.

Adult↗
PubMed1991

[Results of selected cytochemical studies of mature granulocytes in myelodysplastic syndromes and various other hematologic diseases].

The activity of alkaline phosphatase and peroxidase was measured in polymorphonuclears in 20 cases of myelodysplasia syndromes, 10 cases of chronic myeloid leukaemia. Reduced phosphatase activity was found in 5 cases and peroxidase activity in 3 cases of myelodysplasia syndromes. No evident correlation was noted between the activity of these enzymes and prognosis. Increased proportion of peroxidase-negative granulocytes was observed, moreover, in most cases of chronic myeloid leukaemia. The observations will be continued in larger material.

Alkaline Phosphatase↗
PubMed1991

[Preliminary results of the treatment of acute leukemia with mitoxantrone].

Mitoxantrone is a new anthracenodione derivative with a high antineoplastic activity in proliferative diseases of the haemopoietic system. In the Institute of Haematology in Warsaw and in the Department of Haematology, Silesian Medical Academy in Katowice this agent was used in combination with cytarabine in 49 cases of acute leukaemia (35 with acute myeloid leukaemia and 14 with acute lymphoblastic leukaemia). The preparations used were Mitoxantrone (POLFA Works in Jelenia Góra) and Novantrone (Lederle). These agents were given intravenously in doses of 10-20 mg/m2 for 3 days in combination with cytarabine in three doses: 100 mg/m2 on days 1 through 7, and 1 g/m2 or 3 g/m2 every 12 hours on days 1 through 4 of the treatment. Complete remission was obtained in 17 cases (35%), including 13 with acute myeloid leukaemia (37%) and 4 with acute lymphoblastic leukaemia (29). The most frequent side effects were: long-lasting pancytopenia (in 100% of cases), hair loss (39%) and gastrointestinal toxicity (33%). No significant differences were noted in the effectiveness and toxicity between these two preparations. In the light of the presented results it may be accepted that the combination of mitoxantrone with cytarabine is an important advance in the treatment of acute leukaemias.

Adolescent↗
PubMed1984

Prognostic value of DNA histograms of bone marrow cells in acute myeloblastic leukaemias.

DNA histograms of bone marrow cells were studied in 25 patients with acute myeloblastic leukemia before starting treatment. It was found that patients with complete remission showed a significantly higher proportion of cells in phase S of the cellular cycle (22 +/- 3%) than patients who failed to achieve remission (12 +/- 4%). Assessment of DNA histograms of bone marrow cells may be one of prognostic factors in acute myeloblastic leukemia.

Adolescent↗