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Biomedical subjects

H Becker

Publications and source records attributed to H Becker.

At least 109 records · Page 6Linked to original sources
PubMed1993

New aspects in spinal diagnostics with 3-D computed tomography.

Three-dimensional imaging in computer tomography (3-D CT) has been rendered feasible by the development of special software programs. On the basis of the data from 50 spinal CTs, 3-D reformations are made. The method has proved effective especially in complicated vertebral fractures. There are regular correlations between the plane of the fracture and the choice of the axis of rotation as well as the nature of the reformations. A 3-D reformation is frequently more appropriate than a coronary or a sagittal 2-D reformation. In destructions of vertebrae due to tumors, the extent of bone destruction and the altered position of the vertebrae in relation to each other can be imaged. 3-D computer tomograms do not provide fundamentally new diagnostic information, but the understanding of pathological topography is improved.

Humans↗
PubMed1993

Three-dimensional CT of the middle ear and adjacent structures.

Three-dimensional (3D) computed tomography of the middle ear and adjacent structures has been carried out in two cadaveric heads from axial and coronal high-resolution images. The structures shown on the images of the walls of the tympanic cavity are illustrated. The usefulness and limitations of the technique, in this region, are discussed: use of grey level volumes at the surface of the slices and the inclusion of structural landmarks is emphasized. The 3D representations show the anatomical spacial relationships of the small structures in and around the middle ear to advantage. The information may be of use in surgical orientation.

Cochlea↗
PubMed1993

Choledochocele: importance of histological evaluation.

Choledochocele is a rare abnormality of unknown etiology that consists of cystic or diverticular dilatations of the intramural part of the common bile duct. The authors present a case of choledochocele with a common channel in a 15-year-old boy who had a 5-year history of intermittent right upper abdominal pain. In a review of the literature, macroscopic variations were noted as well as different types of epithelial lining inside the choledochocele. Whereas in young children mostly duodenal mucosa is described, biliary tract epithelium and undifferentiated epithelium are predominant later on. Etiologically, congenital intraluminal duodenal diverticulum should be suggested in relation to the pathogenesis of choledochocele. Treatment is total excision and reinsertion of both ducts in cases of biliary or undifferentiated epithelium; endoscopic sphincterotomy or marsupialization is indicated only when duodenal mucosa covers both sides of the choledochocele.

Adolescent↗
PubMed1993

Immune cell and cortisol responses to physically and pharmacologically induced lowering of body core temperature.

In a placebo-controlled double-blind study described by Rammsayer and co-workers in this volume, we investigated the influence of decreased body core temperature (BCT) on responses of cortisol and the immune system. As described in the first paper, the decrease in BCT was achieved by: (a) exposure to ambient cold temperature of 5 degrees C for 20 min (CT group), or (b) application of a 5HT-1a agonist under normal temperature conditions (5HT group). A third group serving as control was exposed to normal temperature and placebo (NT group). The decrease of BCT seen in both CT and 5HT was accompanied by an increase in cortisol. This seemed to be due to stress experience in the CT group and to the pharmacological challenge in the 5HT group. The number of peripheral CD4+ cells was reduced in both experimental groups. This was not mediated by decreased BCT. In the CT group the reduction of CD4+ cells showed no relationship to changes in cortisol. However, in the 5HT group cortisol could be demonstrated to be the mediator of changes in peripheral CD4+ cells.

Adult↗
PubMed1993

3-D video techniques in endoscopic surgery.

Three-dimensional visualisation of the operative field is an important requisite for precise and fast handling of open surgical operations. Up to now it has only been possible to display a two-dimensional image on the monitor during endoscopic procedures. The increasing complexity of minimal invasive interventions requires endoscopic suturing and ligatures of larger vessels which are difficult to perform without the impression of space. Three-dimensional vision therefore may decrease the operative risk, accelerate interventions and widen the operative spectrum. In April 1992 a 3-D video system developed at the Nuclear Research Center Karlsruhe, Germany (IAI Institute) was applied in various animal experimental procedures and clinically in laparoscopic cholecystectomy. The system works with a single monitor and active high-speed shutter glasses. Our first trials with this new 3-D imaging system clearly showed a facilitation of complex surgical manoeuvres like mobilisation of organs, preparation in the deep space and suture techniques. The 3-D-system introduced in this article will enter the market in 1993 (Opticon Co., Karlsruhe, Germany.

Animals↗
PubMed1993

[Influence of nCPAP therapy on bradycardic arrhythmias in sleep apnea].

In 5-10% of patients with sleep apnoea, AV conduction block or sinus arrest up to several seconds can be demonstrated. We studied the effect of nCPAP treatment on apnoea-associated heart blocks. 10 consecutive patients (9 m, 1 f) between 28-56 years of age (mean value 43.4 y) were studied. The diagnosis of sleep apnoea and nocturnal heart blocks during the first visit at the outpatient department were the only selection criteria. A standard polysomnography before and during nCPAP was performed. Mean pretreatment RDI was 91/h. Repetitive II degrees and III degrees AV conduction blocks were diagnosed in 2 patients (pts) and sinus arrest of 2 to 11 s in 8 pts at the study without therapy. 89.2% of heart blocks occurred during REM-sleep. In 8 pts a complete reversal of heart blocks could be demonstrated during nCPAP. In 2 pts heart blocks persisted at a reduced number during REM-sleep, mainly during ineffective nCPAP. In 80% of our pts nCPAP leads to a complete reversal of heart blocks. The indication for pacemaker implantation must be established on an individual basis.

Adult↗
PubMed1993

[Stable xenon computed tomography. Methodology and clinical application].

According to the principle of the dynamic computed tomography, stable xenon computed tomography allows measurement of the increase in density caused by xenon in the brain tissue. During a period of about 4 min a patient inhales a mixture of xenon (33%) and oxygen. By means of a special software, this method can be used to calculate flowmaps and to determine the local cerebral blood flow in a 1 cm x 1 cm areal. Stable xenon computed tomography is used mainly for cerebral blood flow measurements in patients with cerebrovascular diseases and also allows calculation of cerebral reserve capacity following stimulation of blood flow by the carboanhydrase inhibitor acetazolamide (Diamox).

Acetazolamide↗
PubMed1993

[Increased activation of CD8-positive lymphocytes in patients with Crohn's disease].

CD8+ (suppressor/cytotoxic) T lymphocyte subpopulations were studied in the peripheral blood of patients with Crohn's disease by flow cytometry analysis. Consistent with earlier reports, increased numbers of CD8+CD57+ cells were observed as compared with controls. However, expanded CD8+CD57+ cells were not found to be present in a distinct clinical subset of patients. A substantial number of patients had enhanced numbers of DR+ and CD45RO CD8+ cells. In addition, high numbers of CD8+ cells which were CD57CD45RO double positive, and a correlation between numbers of CD8+CD57+ and CD8+DR+ lymphocytes were detected. By use of an enzyme immunoassay, significantly elevated levels of soluble CD8 antigen were demonstrated in patients' sera, and results were associated with ESR values. Taken together, the data suggest increased activation of CD8+ lymphocytes which might result from systemic disease activity. Disturbances within CD8+ lymphocytes do not seem to be specific to Crohn's disease since similar alterations could be observed in patients with another inflammatory condition, rheumatoid arthritis.

Adolescent↗
PubMed1993

[Health management of dependent chronic schizophrenic patients in community psychiatric treatment].

This retrospective study evaluates the question, if the sectored psychiatric organisation of Hannover's University Hospital (MHH) is able to provide the full range of necessary services including suitable facilities for the most unmanageable chronic schizophrenics. It was concluded that during the observation period (1988 to early 1991) under the prevailing nursing conditions it was impossible to adequately care for, within the sector, a small number (5.2%) of these patients (approx. 0.57% of all schizophrenic inpatients). These "new long-terms" shared the characteristics of poorly controlled symptomatology with persistent active symptoms and unpredictability of behaviour; some were assaultive, hyperactive or suicidal. Finally, appropriate characteristics of planning and evaluating services able to offer adequate long-term (in-) patient care for this studied population are discussed.

Activities of Daily Living↗
PubMed1993

[Diagnosis and therapy of cecal diverticulitis].

Acute pain in the lower right side of the abdomen caused by caecal diverticulitis is very rare and hardly to distinguish from acute appendicitis. Therefore it is usually diagnosed intraoperatively. We report our experience with 12 patients, who received surgical treatment from 1984 to 1991. The diagnosis was made not before operation in 11 cases. Because of a severe inflammation of the caecal wall we performed an ileocaecal resection in 10 cases, in 2 cases it was necessary to perform a right hemicolectomy because of additional diverticulitis of the ascending colon. The surgical resection of the inflammatory mass was followed by an uncomplicated postoperative healing in all cases.

Adult↗
PubMed1993

[Hemodynamics and sleep structure in attempted weaning after nCPAP ventilation therapy of obstructive sleep apnea syndrome].

nCPAP (continuous positive airway pressure) treatment is presently the standard therapy in marked obstructive sleep apnoea syndrome. Fundamentally, this is a long-term treatment. Various authors have been making different recommendations in respect of the frequency of application, based partly only on the patient's individual pattern of complaints and symptoms. Our study aimed at examining the short-term nocturnal effects of discontinuing the treatment course in 12 patients, using polysomnography as a diagnostic tool. Results showed that directly after discontinuation of therapy the sleep structure, respiration during sleep and the nocturnal blood pressure pattern returned to baseline findings. It is concluded from this that nCPAP treatment should be strictly adhered to every night to minimise the risk of cardiovascular complications in the patients concerned.

Adult↗
PubMed1993

[Indications and application of BiPaP therapy].

BiPAP allows the independent adjustment of in- and expiratory pressure. BiPAP may thus be used as a "physiologic" CPAP if high expiratory pressure values are not tolerated or as a pressure limited ventilator in pts. suffering from central sleep related breathing disorders (SRBD). 12 pts with SRBD were treated with nBiPAP: 7 did not tolerate the expiration against the elevated pressure, 4 pts suffering from MSA who still presented relevant CSA or central Hypoventilation during nCPAP and 1 pt. with CSA who did not respond to nCPAP. Mean age was 52.3 y (range 33-70) and mean broca index was 149.6 (range 115-254). RDI before therapy ranged between 33-152/h (mean value 79/h); in the five pts. who tolerated nCPAP, the reduction of the RDI obtained was considered insufficient (RDI during nCPAP: 16-71/h). During BiPAP mean RDI was 6.8/h (range 1-17) at pressure levels of 10/7 to 16/13 cm H2O (inspiratory/expiratory pressure) in those pts. that had not tolerated CPAP and 7.9/h (range 2-16.5) in the pts. suffering from central SRBD: in one pt. BiPAP could successfully replace a combined treatment with CPAP and IPPV. 11 pts. are using BiPAP for 10 to 25 months (mean value 13.5) now at home. If CPAP proves ineffective (central SRBD, high expiratory pressure) BiPAP constitutes an effective alternative therapy.

Adult↗
PubMed1993

[Use of intravenous immunoglobulins for immunomodulating therapy of inflammatory rheumatic diseases].

The use of immunosuppressive and long-acting antirheumatic drugs in the treatment of rheumatic diseases is often limited by their side effects. Therefore, it is urgent to search for drugs which are better tolerated and which are at least as effective. Several studies have been performed using intravenously administered immunoglobulins in rheumatoid arthritis patients and in small groups of patients suffering from other connective tissue diseases. The results demonstrate a rapid onset of clinical improvement in patients who respond to this treatment. The tolerance has been excellent so far. This therapy is immunomodulating, since it induces changes in B- and T-lymphocyte function, especially in immunoregulatory T-cell subpopulations. Future work should focus on the establishment of treatment schedules and on the definition of patient subgroups which might benefit most from intravenous immunoglobulin therapy.

Arthritis, Rheumatoid↗
PubMed1992

Immunosuppression by human gangliosides: I. Relationship of carbohydrate structure to the inhibition of T cell responses.

Causes of cellular immunodeficiency frequently associated with cancer remain poorly understood. One possible mechanism is tumor cell membrane shedding of immunosuppressive molecules, such as the sialic acid-containing glycosphingolipids, gangliosides. To explore this interesting hypothesis and establish structure-activity relationships, we examined the effects of a series of highly purified human gangliosides on T cell function. In all, ten individual molecular species of two major biosynthetic pathways were compared for their ability to inhibit human T cell proliferative responses. They include GM1, GD1a, GD1b, and GT1b (the predominant normal brain species), and GM4, GM3, GM2, GD3, GD2 and GQ1b. Strikingly, each HPLC-purified molecule, from the simplest monosialoganglioside to the most complex polysialoganglioside, had potent inhibitory activity; even the ganglioside with the most elemental carbohydrate structure (GM4, one sialic acid linked to a monosaccharide) strongly inhibits T cell proliferative responses to tetanus toxoid (ID90 = 1.5 microM). The data also reveal a complex interplay between elements of oligosaccharide structure in determining immunosuppressive activity. Sialic acid is critical to maximal activity, and (i) immunosuppression is most potent in gangliosides containing a terminal sialic acid. (ii) Total desialylation almost abolishes activity and (iii) partial alteration (lactone formation) reduces activity. (iv) Activity is generally but not always higher with higher numbers of sialic acid residues/molecule, and (v) some larger neutral glycosphingolipids retain measurable immunosuppressive activity. Overall, the potent inhibition by gangliosides supports the hypothesis that shedding of these molecules by tumors creates a highly immunosuppressive microenvironment around the tumor, thereby inhibiting the function of infiltrating host leukocytes and contributing to diminished T cell responses in cancer.

Carbohydrate Conformation↗
PubMed1992

[The echocardiographic demonstration of a right atrial thrombus and its embolization into the lung].

A 43-year-old man was hospitalized because of extensive bilateral pulmonary tuberculosis. After several weeks of tuberculostatic treatment--at first applied orally, then because of nausea and vomiting parenterally via a central venous catheter--he acutely developed nocturnal dyspnoea and symptoms of shock requiring artificial ventilation. Echocardiography demonstrated dilatation of the right ventricle and a large floating thrombus in the right atrium. During the examination complete displacement of the worm-like thrombus into the pulmonary artery was observed echocardiographically. Despite anticoagulation and immediate operation the patient died 2 days later of protracted shock. The thrombus was found to have been formed in the superior vena cava after placement of the central venous catheter.

Adult↗
PubMed1992

Role of octreotide in the prevention of postoperative complications following pancreatic resection.

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. We conducted a randomized, double-blind, placebo-controlled, multicenter trial in 246 patients undergoing major elective pancreatic surgery. Patients were stratified into a high-risk stratum (limited to patients with pancreatic and periampullary tumors) or low-risk stratum (patients with chronic pancreatitis). Patients received octreotide (3 x 100 micrograms) or placebo subcutaneously for 7 days perioperatively. Eleven complications were defined: death, leakage of anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency, and postoperative pancreatitis. Two hundred patients underwent pancreatic head resection, 31 patients underwent left resection, and 15 patients had other procedures. The overall mortality rate within 90 days was 4.5%, with 3.2% in the octreotide group and 5.8% in the placebo group. The complication rate was 32% in the patients receiving octreotide (40 of 125 patients) and 55% in patients receiving placebo (67 of 121 patients) (p less than 0.005). In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.

Double-Blind Method↗
PubMed1992

Down syndrome complicated by brain tumors: case report and review of the literature.

This report concerns a 24-year-old male patient with Down syndrome, complicated by a benign but true neoplastic lesion of a differentiated papilloma of the choroid plexus which simultaneously displayed a dysgenetic character. A review of the literature revealed a lack of single case reports of Down syndrome with brain tumors, which may reflect chance occurrence; however, the brain tumors in Down syndrome patients are characterized by their dysontogenetic or dysgenetic character.

Adult↗