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Biomedical subjects

G Neuwirth

Publications and source records attributed to G Neuwirth.

At least 19 recordsLinked to original sources
PubMed2001

[Renal papillary necrosis in a diabetic patient].

The authors present a case of a young diabetic patient with acute symptoms of pyelonephritis. The specific and permanent antibiotic treatment was ineffective and septic condition developed complicated by renal papillary necrosis. Because of the strong flank pain extensive examinations were done with negative result. The patient's condition was improving only slowly and there was need for treatment after her discharge as well. Long-term antibiotic treatment is an effective therapy to cure this previously deadly complication. Special attention should be given to diabetic patients because of frequent urinary tract infection and increased risk of renal damage among them.

Adult↗
PubMed2001

Sealing of postoperative axillary leakage after axillary lymphadenectomy using a fibrin glue coated collagen patch: a prospective randomised study.

Seroma formation after axillary lymphadenectomy in women with breast cancer remains a problem despite many efforts to reduce surgery-related morbidity. In a prospective, randomised, open, parallel-group, controlled clinical trial we evaluated the effect of a fibrin-glue coated collagen patch (TachoComb H, Nycomed Pharma AS, Denmark) on volume and duration of postoperative axillary drainage, duration of hospital stay, and procedural safety. Sixty patients were included in the study. Patients did not differ with respect to general characteristics, such as age, body mass index, treatment modality, and tumor stage distribution. In 29 patients, a fibrin-glue coated collagen patch was applied from the apex axillae to the thoracic longus nerve and half a patch was applied to the lateral border of the axillary nerve-vessel bundle. Thirty-one patients were randomised to standard closure of the axillary lymphadenectomy area. The mean duration of axillary drainage was 3.8 +/- 1.9 days in the fibrin-glue treatment group and 3.9 +/- 1.8 days in the control group (p = NS). The mean total drainage volume was 338.5 +/- 251.8 ml in the fibrin-glue treatment group and 370.8 +/- 314.6 ml in the standard closure group (p = NS). The mean length of post-operative hospital stay was 9.1 +/- 2.7 days in the fibrin-glue treatment group and 9.3 +/- 3.6 days in the standard closure group (p = NS). Seven patients (25%) and eight patients (25%) were diagnosed with local inflammation in the fibrin-glue treatment group and the standard closure group, respectively (p = NS). Seroma formation after drain removal was found in 11 patients (39%) in the fibrin-glue treatment group and in 13 patients (42%) in the standard closure group (p = NS). In summary, we observed no statistically significant differences with respect to axillary drainage time, drainage volume, length of hospital stay, local inflammation, and seroma formation after drainage removal.

Axilla↗
PubMed2000

[Gastrointestinal hemorrhage needing blood transfusion as the first manifestation of small bowel carcinoid tumor].

Carcinoid tumors arise from enterochromaffin or enterochromaffin-like cells that are present in the gastrointestinal tract, ovaries, and lungs. Over 90% of carcinoids originate in the gastrointestinal tract with the most common sites in order of frequency being the appendix, terminal ileum, rectum, and the remainder of the colon. Gastroduodenal and pancreatic carcinoids are infrequent. Carcinoid syndrome is associated with small intestine carcinoids in about 40%. Common symptoms include intermittent intestinal obstruction with crampy abdominal pain and vomiting, and weight loss. Upper gastrointestinal bleeding with melaena or hematochezia is a relatively rare early symptom of patients with small intestine carcinoid tumors. We report on a 69-year-old man, treated with acenocoumarol for previous thromboembolic complications of hereditary protein S deficiency. He was admitted to hospital because of an acute episode of hematochezia followed by melaena. Endoscopic evaluation of esophagus, stomach, duodenum and colonoscopy revealed no apparent source of bleeding. Selective angiographic evaluation of mesenterial arteries showed pathologic vasculature approximately in mid jejunum. Laparotomy revealed bleeding from a small submucosal malignant carcinoid tumor in small intestine and multiple large metastases within mesenteric tissue. Segmental resection of small intestine and exstirpation of the metastatic masses was performed. Postoperative period was uneventful. Cytotoxic chemotherapy in this adjuvant setting has not been recommended. Small intestinal carcinoid tumor has to be considered as a rare cause of gastrointestinal bleeding with melaena or hematochezia. Nevertheless, bleeding is a relatively rare early symptom of patients with small intestine carcinoid tumor.

Acenocoumarol↗
PubMed1998

Activation of the haemostatic system in children with juvenile rheumatoid arthritis correlates with disease activity.

Twenty-four children with juvenile rheumatoid arthritis (JRA) and 10 children with postinfectious arthropathies were investigated for markers of blood coagulation and fibrinolytic activity: Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and D-Dimer were measured using solid phase enzyme linked immunosorbent assays (ELISA). Results were compared with clinical and conventional laboratory signs of disease activity. F1+2, TAT, D-Dimer, and fibrinogen were significantly elevated in children with JRA as compared with healthy children and children with postinfectious arthropathies. F1+2, TAT, and D-Dimer correlated significantly with disease activity, assessed by determination of the joint index score and C-reactive protein (CRP). The study demonstrates a subclinical activation of the haemostatic system in children with JRA correlating with disease activity, which might be caused by the action of several immunomediators on cells (monocytes, endothelial cells) playing a role in the regulation of blood coagulation activity.

Adolescent↗
PubMed1998

[Cerebrovascular reactivity in non-insulin dependent diabetes mellitus (preliminary results)].

AIMS: Previously numerous investigators reported about impairment of cerebrovascular reserve capacity in Type I, diabetes mellitus. However, no similar data are available about patients suffering from Type II diabetes. The goal of the study was to assess cerebrovascular reserve in Type II diabetic patients. PATIENTS AND METHODS: 14 NIDDM patients and 20 healthy controls were studied. Middle cerebral artery mean blood flow velocity was measured at rest and during 20 minutes after i.v. administration of 1 g. acetazolamide. Velocities measured after acetazolamide were compared to resting values and were expressed as the percent increase of the mean velocity. Data obtained in diabetics and healthy persons were compared using Student's t-test. The correlation between age of the patients, diabetes duration, actual blood glucose-, insulin-, glycosylated hemoglobin-, urine microalbumin concentrations and resting blood flow velocity and cerebrovascular reserve capacity was assessed using linear regression analysis. RESULTS: Resting cerebral blood flow velocities, cerebrovascular reactivity and reserve capacity did not differ from that of healthy controls. No correlation has been found between obtained laboratory parameters and resting cerebral blood flow velocities and cerebrovascular reserve capacity. CONCLUSIONS: Vasodilatory ability of the cerebral arterioles in NIDDM-patients did not differ from that of healthy control persons. Further studies are needed to find out an accurate screening method for detection of cerebral microangiopathic changes in Type II diabetes mellitus.

Acetazolamide↗
PubMed1997

Impairment of cerebrovascular reactivity in long-term type 1 diabetes.

The early preclinical detection of cerebrovascular complications in individuals with diabetes is one of the goals of care described in the St. Vincent Declaration. In accordance with this goal, the aim of the present work was to investigate whether altered cerebral microvascular function in patients suffering from type 1 diabetes can be detected with a transcranial Doppler probe after the administration of acetazolamide. A total of 72 type 1 diabetic patients and 40 healthy control subjects entered the study. Patients were divided into two groups: those with long-term diabetes (disease duration of >10 years, n = 37) and those with short-term diabetes (disease duration of < or =10 years, n = 35). Mean blood-flow velocity in the middle cerebral artery (MCAV) was measured at rest and at 5, 10, 15, and 20 min after intravenous administration of 1 g acetazolamide with a transcranial Doppler probe and expressed as the percentage change from the pretest measurement. The percentage increase in MCAV (cerebrovascular reactivity) was calculated at each time point and compared between the groups. Cerebrovascular reserve capacity (CRC), expressed as the maximal percentage increase of the MCAV, was compared between the groups. Additionally, a reproducibility study of CRC was performed in 10 patients, using intraclass correlations. Cerebrovascular reactivity in the long-term diabetes group was lower (means +/- SD: 5 min, 23.4 +/- 15.4%; 10 min, 28.8 +/- 17.0%; 15 min, 30.0 +/- 15.6%; 20 min, 24.2 +/- 17.8%) than that of the control subjects (5 min, 43.5 +/- 23.9%; 10 min, 55.3 +/- 24.0%; 15 min, 56.7 +/- 23.8%; 20 min, 54.8 +/- 25.9%) and the short-term diabetic patients (5 min, 43.6 +/- 25.9%; 10 min, 52.2 +/- 27.7%; 15 min, 55.3 +/- 32.2%; 20 min, 45.8 +/- 35.8%). CRC was lower in the long-term diabetes group than in the control group or the short-term diabetes group. Impairment of cerebrovascular reactivity was associated with retino- and nephropathy and increased levels of fibrinogen. In contrast, CRC was independent from actual glucose, insulin, glycosylated hemoglobin, von Willebrand factor antigen, and alpha-2 macroglobulin levels. Transcranial Doppler measurements of the changes in MCAV after stimulation with acetazolamide can detect altered cerebral microvascular function in patients with diabetes. Cerebrovascular reactivity and reserve capacity are reduced in patients with long-term diabetes. Further prospective studies should delineate the clinical significance of our results.

Acetazolamide↗
PubMed1996

[Cerebrovascular reactivity in insulin dependent diabetes mellitus studied by an acetazolamide test].

The aim of this study was to investigate, whether the cerebrovascular reactivity (CR) was altered in diabetes mellitus and to evaluate the influence of diabetes's duration on cerebrovascular reactivity. Transcranial Doppler-Acetazolamide tests were performed on 20 insulin-dependent diabetics and in 19 controls. Patients were divided into two groups, each group consisted of 10 patients: diabetics with > 10 years disease duration and with < 10 years diseases duration. Middle cerebral artery mean velocities were measured at rest and after i.v. administration of Ig Acetazolamide (AZ). There were no differences in the absolute velocities between controls and diabetics. The percentual increase of the mean velocity after AZ was slower and less intensive in longterm diabetics (means +/- SE: 5 min: 19.4 +/- 2.8%, 10 min: 28 +/- 3.6%, 15 min: 25.7 +/- 3.8%, 20 min: 23.9 +/- 4.3%), than that in controls (5 min: 32.3 +/- 4.3% -p < 0.05-, 10 min: 45.1 +/- 4.9% -p < 0.05-, 15 min: 47.5 +/- 4.3% -p < 0.01-, 20 min: 46.5 +/- 4.7% -p < 0.01) as well as in diabetics with < 10 years disease duration (5 min.: 39.5 +/- 7% -p < 0.05-, 10 min.: 49.2 +/- 6.5% -p < 0.05-, 15 min.: 53.9 +/- 8.6% -p < 0.01-, 20 min: 32.9 +/- 5.9% -n.s.). The cerebrovascular reactivity is impaired in diabetics after long duration of the disease. The altered cerebrovascular reactivity might be caused by angiopathy of the cerebral arterioles.

Acetazolamide↗
PubMed1995

Serum cytokines in juvenile rheumatoid arthritis. Correlation with conventional inflammation parameters and clinical subtypes.

OBJECTIVE: To examine the usefulness of determining extended serum cytokine profiles in patients with juvenile rheumatoid arthritis (JRA), for the purpose of improving differential diagnosis and monitoring disease activity. METHODS: In a 2-year prospective study, serum levels of interleukin-1 beta (IL-1 beta), soluble IL-2 receptor (sIL-2R), IL-6, IL-8, tumor necrosis factor alpha (TNF alpha), and the p55 soluble TNF receptor (sTNFR) were repeatedly determined by enzyme-linked immunosorbent assay in 40 patients with JRA, 13 patients with postinfectious arthropathies, and 30 healthy controls. The data were compared with conventional parameters of inflammation, such as C-reactive protein (CRP), iron and hemoglobin levels, erythrocyte sedimentation rate (ESR), white blood cell (WBC) counts, and platelet counts. WBC subsets were analyzed by flow cytofluorometry. RESULTS: At the first visit and at the peak of inflammatory activity according to CRP levels and/or ESR, serum levels of sIL-2R, IL-6, and sTNFR in JRA patients correlated significantly with conventional inflammation indicators, whereas IL-1 beta, IL-8, and TNF alpha did not. No changes in leukocyte subset distribution were noted. Among the different clinical subtypes of JRA, sIL-2R, IL-6, and sTNFR values at the time of the initial visit showed a pattern similar to CRP, whereby patients with systemic disease exhibited by far the highest values. TNF alpha and IL-1 beta were variably elevated in certain JRA subtypes. Patients with postinfectious arthropathies showed elevated levels of CRP, sIL-2R, TNF alpha, and sTNFR, which did not differ significantly from levels in the various JRA subtypes with the exception of systemic disease. Detailed analysis of types I and II pauciarticular JRA revealed that levels of CRP, IL-1 beta, and TNF alpha were elevated in patients with type I disease. While these parameters were invariably normal in patients with type II disease, sTNFR and sIL-2R were still found to be significantly elevated. Followup studies suggested that persistently high sTNFR values are a better indicator of JRA activity than are measurements of other cytokines or CRP. CONCLUSION: JRA is associated with significant and consistent changes in serum levels of inflammatory cytokines and soluble receptors. For the clinical monitoring of JRA, determination of levels of sTNFR, and to some extent sIL-2R, may be particularly useful, since these determinations yield information about subtype and/or activity of disease that is not available from conventional parameters of inflammation.

Adolescent↗
PubMed1995

[Radiologic image of massive diverticulosis of the small intestine].

Diverticulosis of the small bowel is rare compared with diverticular disease of the colon. Diverticulosis of the duodenum is more common than the involvement of the whole small bowel including the ileum which is a very rare condition. In a patient presenting with gastrointestinal bleeding extensive diverticulosis of the whole small bowel was identified; the etiology is discussed.

Aged↗
PubMed1985

Hepatitis B vaccination and immune response in children with malignant diseases.

Fifty children with malignant diseases were vaccinated against hepatitis B. Twenty-nine children suffered from leukaemia or non-Hodgkin's lymphoma; 14 of these were on intensive chemotherapy (group I) and 15 were without intensive therapy (group II). The other 21 children had various forms of solid tumours, 14 of them were on intensive therapy (group III) and 7 were without intensive therapy (group IV). To evaluate the immune response, we determined antibody titres over a period of more than 14 weeks after the first vaccination. As 22 out of 50 patients had received passive immunisation together with either the first or the first and second vaccination, antibody titres at the 14th and 18th week (i.e. more than 10 weeks after passive immunisation) were used to evaluate the vaccination results. An antibody titre of greater than or equal to 10 mIU/ml was considered to be a positive response. All patients of group IV, but only 4 out of 14 in group III, 4 out of 15 in group II, and 0 out of 14 in group I produced antibody titres higher than 50 mIU/ml. In contrast to the full response in group IV, two-thirds of all other patients had no immune response (less than 10 mIU/ml). Based on our experience we recommend vaccinating patients suffering from solid tumours and receiving no intensive therapy (group IV) against hepatitis B and protecting all the other children with malignant diseases by passive immunisation, if necessary.

Adolescent↗
PubMed1984

Cross-cultural validity: ethnocentrism in health studies with special reference to the Vietnamese.

The paper presents a methodological analysis of some recent studies concerned with health and socio-cultural adaptational problems of Vietnamese refugees. Using certain methodological rules, developed by social scientists for comparative research, such as conceptual equivalence or equivalence of measures, the claim of the studies to have employed cross-culturally valid instruments is examined. Since none of the studies have sought to achieve conceptual equivalence of their comparative concepts it is shown that several salient cultural differences in beliefs regarding the conception and treatment of illness among Vietnamese are over-looked. The studies only use indicators derived from, and based on, American samples and do not take into account culturally conditioned responses. Thus it is shown in some detail that the claim of cross-cultural validity should be seriously questioned as far as the Social Readjustment Rating Questionnaire and the Cornell Medical Index are concerned. The social class differences between 1975 and 1979 Vietnamese refugees are discussed in order to caution the reader that findings based on 1975 refugees will not apply to 1979 refugees. The paper concludes with the suggestion that different research strategies are required namely that open-ended interviews be used in societies of which our knowledge concerning salient cultural differences is fragmentary.

Attitude to Health↗
PubMed1978

[Pseudohypoparathyroidism type I and vitamin D therapy].

In pseudohypoparathyroidism type I pharmacologic dosis of vitamin-D can correct hypocalcemia. Several authors who had investigated vitamin-D-metabolism in these patients, found impaired renal conversion of 25-hydroxyvitamin-D to 1,25-dihydroxy-vitamin-D. Treatment of 2 patients with pseudohypoparathyroidism type I with vitamin-D-3 and 1 alpha-Hydroxycholecalciferol consecutively resulted in a nonuniform response with regard to the normalisation of serum-calcium. This led us to the conclusion that the disturbances of vitamin-D-metabolism in pseudohypoparathyroidism type I is heterogenous.

Adolescent↗