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Biomedical subjects

G Bachmann

Publications and source records attributed to G Bachmann.

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

Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate.

OBJECTIVE: To evaluate the efficacy of lower doses of conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) for relieving vasomotor symptoms and vaginal atrophy. DESIGN: A randomized, double-blind, placebo-controlled trial (the Women's Health, Osteoporosis, Progestin, Estrogen study). SETTING: Study centers across the United States. PATIENT(S): Two thousand, six hundred, seventy-three healthy, postmenopausal women with an intact uterus, including an efficacy-evaluable population (n = 241 at baseline). INTERVENTION(S): Patients received for 1 year (13 cycles; in milligrams per day) CEE, 0.625; CEE, 0.625 and MPA, 2.5; CEE, 0.45; CEE, 0.45 and MPA, 2.5; CEE, 0.45 and MPA, 1.5; CEE, 0.3; CEE, 0.3 and MPA, 1.5; or placebo. MAIN OUTCOME MEASURE(S): Number and severity of hot flushes and Papanicolaou smear with vaginal maturation index (VMI) to assess vaginal atrophy. RESULT(S): In the efficacy-evaluable population, reduction in vasomotor symptoms was similar with CEE of 0.625 mg/d and MPA of 2.5 mg/d (the most commonly prescribed doses) and all lower combination doses. CEE of 0.625 mg/d alleviated hot flushes more effectively than the lower doses of CEE alone. VMI improved in all active treatment groups. CONCLUSION(S): Lower doses of CEE plus MPA relieve vasomotor symptoms and vaginal atrophy as effectively as commonly prescribed doses.

Adult↗
PubMed2001

A new nephelometric assay for beta-trace protein (prostaglandin D synthase) as an indicator of liquorrhoea.

OBJECTIVES: To determine the sensitivity and specificity of a nephelometric beta-trace protein assay for the diagnosis of liquorrhoea. METHODS: One hundred and forty clinical samples with suspected liquorrhoea were analysed by a newly developed nephelometric assay. An established electroimmunoassay served as a reference method. The sensitivity and specificity of the beta-trace nephelometric assay were calculated by a 2x2 contingency table for 10 different versions of a dichotomised nephelometric variable. In 52 patients (79 samples), the nephelometric findings were validated by referring to the clinical diagnosis based on the course of the disease, imaging techniques, and surgical inspection. RESULTS: Given a specificity of 100%, a beta-trace protein concentration of 6 mg/l or higher in a sample indicated liquorrhoea with a sensitivity of 92% compared with the reference method and of 93% compared with the clinical evaluation. The relation between the electroimmunoassay and the nephelometric assay was highly significant (p<0.001). CONCLUSIONS: The nephelometric beta-trace protein assay is a simple and rapid method for the detection of liquorrhoea with high sensitivity and specificity and may facilitate the diagnosis of fistulas leaking CSF.

Adult↗
PubMed2001

Traces of perilymph detected in epipharyngeal fluid: perilymphatic fistula as a cause of sudden hearing loss diagnosed with beta-trace protein (prostaglandin D synthase) immunoelectrophoresis.

The incidence of perilymphatic fistula as cause of sudden hearing loss is not known. We present a case with sudden unilateral hearing loss associated with a positive beta-trace protein test of an epipharyngeal fluid sample. The patient presented with sudden sensorineural hearing loss on the right side. A stapedotomy had been performed nine months previously due to otosclerosis. Intravenous therapy for the treatment of sudden hearing loss was unsuccessful. At the time of sudden hearing loss, epipharyngeal fluid was collected using a Raucocel sinus pack. Investigation using rocket immunoelectrophoresis showed the presence of beta-trace protein. Upon repeating tympanoscopy there was no obvious labyrinthine fluid egress, but the oval window was sealed with fibrin sponge and fibrin glue. The patient's hearing improved over a period of five months.

Adult↗
PubMed2001

Physiologic aspects of natural and surgical menopause.

With oophorectomy, the physiologic changes associated with menopause occur quickly and with a significant impact on a woman's quality of life. In naturally menopausal women, ovarian hormone biosynthesis provides low circulating levels of estrogen and androgen. In the surgically menopausal woman, estrogen and androgen levels are significantly reduced. In surgically menopausal women for whom supplemental estrogen is prescribed, sex hormone binding globulin levels increase dramatically, resulting in reduced bioavailability of the remaining estrogens and androgens that result from peripheral conversion. This paper reviews the physiologic changes associated with natural and surgical menopause and the effects of estrogens and androgens at the cellular level. It describes the effects of hormone replacement on endogenous hormones and on the symptoms of menopause that result from physiologic changes, including vasomotor instability, sexual dysfunction and urinary complications. It also addresses the effects of estrogen/androgen therapy on physiologic symptoms.

Androgens↗
PubMed2000

[Beta-trace protein in diagnosis of cerebrospinal fluid fistula].

Beta-trace protein is a lipocalin that was recently identified as prostaglandin D synthase and represents a major constituent of human cerebrospinal fluid. Beta-trace protein, similar to beta 2-transferrin, has been used as an immunological marker for the detection of cerebrospinal fluid. Between 1982 and 1999, 130 specimens from 101 patients with suspected cerebrospinal fluid leaks of the anterior or lateral skull base have been investigated for beta-trace protein. The specimens were analyzed by one-dimensional immunoelectrophoresis using Laurrell's electroimmunoassay. In all, beta-trace protein could be detected in 57 specimens and was absent in 73. All case notes were studied retrospectively. In correlation with the clinical course and the findings of CT of the paranasal sinuses, high resolution CT of the petrous bones, CT cisternography, NMR, 111In-DTPA radionuclide cisternography, intraoperative findings, visualization of sodium-fluorescein stained cerebrospinal fluid using endoscopic blue light or testing for glucose, there was no false-positive result. A false-negative result occurred in two cases. These findings show that the beta-trace test has a sensitivity of 97.3% and a specificity of nearly 100%. Our findings show that analysis of beta-trace protein can be a valuable test for detecting CSF leakage and has certain advantages in comparison with the beta 2-transferrin assay.

Adolescent↗
PubMed2000

Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease.

In a prospective, randomized, controlled, double-blind trial we compared the effectiveness of endonasal irrigations with Ems salt solution to that with sodium chloride solution in the treatment of adult patients with chronic paranasal sinus disease. Subjects (n = 40) were randomly allocated to treatment either with isotonic Ems salt solution or with isotonic sodium chloride solution. The treatment consisted of endonasal irrigation twice daily and additional nasal spray as required. Nasal endoscopy, plain radiography of the paranasal sinuses, olfactometry, anterior rhinomanometry, and a saccharin-clearance test were carried out on days 1 and 7. Patients recorded rating scales of general discomfort, nasal airway obstruction, agreeableness of the irrigation, duration of improved nasal resistance after each irrigation, and the amount of additional nasal spray in a diary. Nasal air flow was not improved significantly. Subjective complaints, endonasal endoscopy, and radiography results revealed a significant improvement in both groups (P = 0.0001). In comparison, the two groups were not significantly different in outcome. Endonasal irrigations with salt solutions are effective in the treatment of chronic sinusitis, and a significant difference between Ems salt and sodium chloride was not observed.

Adult↗
PubMed2000

Clinical experience with beta-trace protein as a marker for cerebrospinal fluid.

beta-Trace protein is an immunological marker for the detection of cerebrospinal fluid traces. The aim of the study was to evaluate the predictive value of the beta-trace protein test. We investigated 145 specimens for cerebrospinal fluid using beta-trace protein. All case notes were retrospectively reviewed and tabulated for indication and procedure with focus on outcome. The specimens were analyzed by immunoelectrophoresis. beta-Trace protein was detected in 62 specimens and was absent in 83. In correlation with the clinical course, the clinical findings, the results of high-resolution computed tomography of the paranasal sinuses or petrous bone, computed tomographic cisternography, magnetic resonance imaging, indium 111-pentetic acid radionuclide cisternography, intraoperative findings, and visualization using sodium-fluorescein, there were no false-positive results. In 6 cases, a false-negative result occurred. The overall accuracy was 95.68%. The beta-trace test has a specificity of near 100% and a sensitivity of 91.17%. Analysis of beta-trace protein is a valuable test and has some advantages in comparison with the beta2-transferrin assay.

Adolescent↗
PubMed2000

Component perimetry: a fast method to detect visual field defects caused by brain lesions.

PURPOSE: Noise field campimetry, performed according to Aulhorn and Köst, confronts patients with a large field of irregularly flickering dots, and many patients immediately perceive their visual field defects. The original method had a somewhat low specificity and sensitivity, especially for patients with visual field defects caused by cortical lesions. METHODS: The method was improved in two ways. First, the grain of the visual noise was increased toward the periphery of the visual field to accommodate the peripheral decrease in visual acuity. Second, the type of stimulus pattern was varied to include separate investigations of different visual components or functions (color, motion, temporal resolution, line orientation, stereoscopic depth, acuity, and figure-ground segmentation). To evaluate the reliability of the method, the visual fields were compared, as assessed by the new method, with those of conventional perimetry in 41 patients with neurologic disorders and 22 normal control subjects. RESULTS: The results were encouraging. All patients with suprageniculate lesions subjectively experienced visual field defects in component perimetry. Sizes of visual field defects obtained with both methods corresponded qualitatively with each other, with a highly significant correlation. The specificity of component perimetry was higher than that of the original noise field campimetry. CONCLUSIONS: This pilot study indicates that component perimetry is a subjective but relatively reliable method for detecting disorders of visual perception caused by lesions at different stages along the visual pathway, permitting fast screening of the visual field. In addition, this method seems to allow examination of the visual field, not only for defects in contrast sensitivity, as does conventional light perimetry, but also for the status of other components of vision such as color or motion perception. Further evaluation with larger patient cohorts is needed to allow exact assessment of the clinical usefulness of the method.

Adolescent↗
PubMed1999

An ACOG-affiliated medical student obstetrics and gynecology club.

An ACOG-affiliated obstetrics and gynecology club for medical students was developed at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School to introduce medical students to the specialty early in their careers, to educate them about obstetrician-gynecologists effect on women's health, and to guide them through exploration of the field. With ACOG District III Fellow and Junior Fellow support and collaboration, the club was formed and operational within 6 months. Because of this club students feel included in the district and national organizations by participating in Junior Fellow and Fellow activities. Through Junior Fellow activities, medical students get first-hand exposure to numerous obstetrics and gynecology residency programs. Through workshops and noncredit electives, medical students receive personal mentoring by Fellows and Junior Fellows. Students participate in community projects and from those programs can better understand the needs of women, especially women with inadequate or no health insurance. The collaboration between Junior Fellows, Fellows, and medical students is the most important component in establishing a student-run club affiliated with ACOG. This project has effectively introduced students to the field of women's health early in their careers and could provide a model for implementation at other medical schools.

Adult↗
PubMed1999

[The value of magnetic resonance imaging in the clinical course of osteochondrosis dissecans in the knee and ankle joints].

PURPOSE: Definition of the prognostic value of clinical and morphological findings in the mid-term follow-up of OCD of the femoral condyle and talus. Demonstration of the consolidation of OCD on MRI depending on different therapies. MATERIALS AND METHODS: 76 patients were examined before and at an average of 30 months after conservative or surgical therapy using T1 and T2 weighted SE and 3D-FISP sequences and contrast enhanced studies. Six clinical (age, gender, site, duration and severity of symptoms, therapy) and six morphological (size, signal intensity, fragmentation, contrast enhancement, condition of cartilage, staging) data were registered on first MRI and correlated with the degree of consolidation of OCD (partial and complete remission, no change and progression) on control MRI. RESULTS: Patients under 17 years showed partial or complete remissions in 73%, those of 17 years or older in 33%. Conservatively treated patients had a higher remission rate (54%) than those treated with different surgical techniques (drilling 50%, refixation 43%, abrasio 38%). Small OCDs had a higher remission rate than large lesions (63% vs. 33%). OCDs covered with intact cartilage healed better than lesions with chondral defects (61% vs. 26%). Contrast enhancing fragments had a better prognosis than non-enhancing lesions (100% vs. 40%). CONCLUSIONS: Prognosis of OCD can be better estimated when size of OCD, condition of cartilage and enhancement of contrast agent is graduated with MRI and patient age is registered. The consequences for therapy planning are great.

Ankle Joint↗
PubMed1999

Successful treatment of an invasive aspergillosis of the skull base and paranasal sinuses with liposomal amphotericin B and itraconazole.

Invasive aspergillosis and fulminant aspergillosis are rarities with a high mortality. In the literature there is no patient surviving an extended invasive aspergillosis of the paranasal sinuses and skull base after failure of operative intervention and of postoperative amphotericin B therapy. We report a complete remission of an invasive, partially fulminant aspergillosis. After an incomplete removal of the mycotic mass, we started postoperative drug therapy with amphotericin B. Under this treatment, the mycosis progressed. Additionally, the patient developed severe side effects, so that the treatment was interrupted. At this moment, we started a combined antimycotic drug therapy with liposomal amphotericin B and itraconazole. Within 10 weeks, clinically and radiologically, there was complete remission. The patient died 63 weeks after this treatment, due to a fulminant bacterial pneumonia. Postmortem histologic examination showed no aspergillosis in the skull base, paranasal sinuses, or lung.

Amphotericin B↗
PubMed1998

Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee.

OBJECTIVE: To evaluate the efficacy of estrogen therapy in the treatment of postmenopausal women with symptoms and signs associated with urogenital atrophy, by meta-analysis of available data. METHODS: We searched the literature (Excerpta Medica, Biosis, MEDLINE, and hand search) for studies published between January 1969 and April 1995. Criteria for inclusion were English-language articles, peer-reviewed original publications, and urogenital atrophy assessed by at least one of the following outcomes: patient symptoms, physician report, pH, or cytologic change. Data had to allow comparison between treated and control groups in controlled trials or an estimated change from baseline in uncontrolled series. Meta-analytic methods were applied separately to controlled clinical trials and uncontrolled studies. RESULTS: Of the 77 relevant articles reviewed, nine contained ten randomized controlled trials. Meta-analysis of these using the Stouffer method revealed a statistically significant benefit of estrogen therapy for all outcomes studied. In 54 uncontrolled case series, the patient symptoms were treated by 24 different treatment modalities. All routes of administration appeared to be effective and maximum benefit was obtained between 1 and 3 months after the start of treatment. As expected, the least systemic absorption of estrogen was seen with estriol (administered orally or vaginally), then vaginal estradiol as measured by pretherapy and posttherapy serum estradiol and estrone. CONCLUSION: Estrogen is efficacious in the treatment of urogenital atrophy and low-dose vaginal estradiol preparations are as effective as systemic estrogen therapy in the treatment of urogenital atrophy in postmenopausal women.

Atrophy↗
PubMed1998

[Ultrasonography as a diagnostic measure in the rupture of fibular ligaments. Comparative study: sonography versus radiological investigations].

PURPOSE: The present prospective clinical study was designed to verify the value of ultrasound examination concerning injuries of the fibular ligaments of the ankle using functional examinations under ultrasound supervision. METHOD: 34 patients who had sustained a lesion of the fibular ligaments of the ankle were compared with 42 healthy persons. The lateral malleolus and the collum tali were used as reproducible bony landmarks in ultrasound. The distance between those two points is first of all was measured in neutral position and later on under the influence of supinating force of 15 kp using a Telos fixation device. RESULTS: The average lateral opening of the upper ankle joint measured with the dynamic ultrasound examination was 4.4 mm (1-12 mm) in the group of patients who had been suffering from rupture of the fibular ligaments. In comparison the average lateral opening of the healthy contralateral ankle was 3.9 mm (1-9 mm). The control group showed an average lateral opening of 0.9 mm (0-5 mm). CONCLUSION: Direct ultrasonic visualisation of the fibular ligament is not yet reliable. The described method allows an estimation of the stability of the fibular ligaments even in cases of chronic instability. The ultrasound investigation method discussed is difficult to handle and for that reason it cannot replace the standardised x-ray examination.

Adolescent↗
PubMed1998

[Value of ultrasound and magnetic resonance imaging in the control of the postoperative progress after Achilles tendon rupture].

AIM: A comparison of clinical examination, sonography and MRI in the follow-up of suture of the Achilles tendon. METHOD: 60 patients were examined in a prospective study for 6-78 months following suture of the Achilles tendon repair; both sides were compared clinically and sonographically; in 30 patients MRI was also used. Morphometric measurements (antero-posterior and transverse measurements) and changes in morphological structure were correlated with clinical results. RESULTS: All patients showed thickening of the Achilles tendon postoperatively. Morphometric and morphological changes showed positive and significant correlation between sonography and MRI (p = < 0.001, p = 0.004). Structural changes in sonography had positive correlation with general symptoms (p = < 0.001), pain on movement (p = < 0.001), reduced function (p = 0.005), and reduced sporting activity (p = 0.034). MRI findings showed significant regression with time (p = 0.05). CONCLUSION: Following repair, the Achilles tendon remained thickened throughout the period of observation. Post-operative changes in the structure of the tendon regressed partially. Sonography and MRI correlate significantly with the clinical findings. Sonography is the imaging method of choice, MRI is an additional procedure.

Achilles Tendon↗