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Biomedical subjects

H C Koch

Publications and source records attributed to H C Koch.

At least 19 recordsLinked to original sources
PubMed2001

Peripheral hemodialysis shunt with intracranial venous congestion.

BACKGROUND: Intracranial venous congestion is often caused by local venous thrombosis or brain arteriovenous fistulas. Hemodialysis shunts are known to cause venous enlargement in the arm or chest but have not been related to intracranial vascular pathology. Case Description- A 59-year-old woman who presented with increasing headache, gait instability, and memory loss was a renal transplant recipient who still carried a left upper arm shunt. Cranial CT scan showed enlarged veins in the posterior fossa with incipient hydrocephalus. Extracranial duplex sonography revealed reversed flow in the left internal jugular vein, which normalized on cuff inflation around the shunt-carrying arm. The reversed flow, intracranial venous congestion, and neurological status improved after surgical shunt ligation. CONCLUSIONS: To our knowledge, this is the first case description of an intracranial venous outflow obstruction caused by a peripheral arteriovenous shunt.

Arteriovenous Shunt, Surgical↗
PubMed2001

Testicular germ cell tumor with rhabdomyosarcoma successfully treated by disease-adapted chemotherapy including high-dose chemotherapy: case report and review of the literature.

Treatment and prognosis have not been well characterized in germ cell tumors (GCT) with a malignant nongerm cell component. Patients with a mediastinal tumor, neural or rhabdomyosarcomatous differentiation and distant metastases have the poorest prognosis. We report a rare case of mixed GCT composed of seminoma, teratoma and rhabdomyosarcoma with the rhabdomyosarcomatous component metastasized into the liver and bone marrow (BM) causing hypercalcemia. The patient was treated with differentiation-tailored chemotherapy (CHT) including a disease-adapted high-dose (HD) CHT regimen with purified autologous PBSCT (APBSCT) and pamidronate. To date, remission has lasted for 4 years. Tumor-adapted CHT including HD-CHT with APBSCT can induce long term remissions in high-risk patients with transformed GCT. A review of the literature is given.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Interrater agreement for high grade carotid artery stenosis measurement and treatment decision.

OBJECTIVES: Randomized trials in North America (NASCET, ACAS) and Europe (ECST) have shown a beneficial effect of endarterectomy for patients with high grade carotid artery stenosis. The results of the NASCET and the ECST further suggest that the effect of endarterectomy differed by degree of stenosis, supporting the importance of stenosis measurement as a factor in the decision process regarding surgery. We investigated the interrater agreement for carotid artery stenosis measurements and treatment decision in a post hoc study on patients undergoing carotid surgery. METHODS: In a one-year series, 45 consecutive patients underwent preoperative conventional cerebral angiography followed by endarterectomy. Using a magnifying eyepiece and applying the two different measurement criteria of the randomized trials, angiograms were re-evaluated post hoc by three masked raters. Intra-class correlation coefficients (ICCs) with one-sided 95% confidence intervals (CIs) were calculated for the estimation of interrater agreement for degree of stenosis. Conger s kappa (k) statistics were used for the estimation of interrater agreement for a dichotomized stenosis evaluation, i.e. therapeutic decision on surgery (cut-off point for symptomatic stenosis: 70%, cut-off point for asymptomatic stenosis: 60%). RESULTS: ICCs were.74 (CI.63) for NASCET/ACAS criteria and.72 (CI. 59) for ECST criteria. k values were.55 (CI.42) for NASCET/ACAS criteria and.57 (CI.44) for ECST criteria. Disagreement for a therapeutic decision was seen in 6 of 23 symptomatic patients by NASCET criteria, in 2 of 23 symptomatic patients by ECST and in 4 of 22 asymptomatic patients by ACAS criteria. CONCLUSIONS: Overall, the interrater agreement for stenosis measurements was good. Agreement for therapeutic decisions on carotid surgery, however, was less strong. These findings suggest that accurate stenosis measurement may not suffice for reliable treatment decisions in patients with high grade carotid artery stenosis.

Aged↗
PubMed1998

[Septo-optic dysplasia (de Morsier syndrome)].

Septo-optic dysplasia (or de Morsier syndrome) is a congenital disorder characterised by anomalies in cerebral midline structures, optic nerve hypoplasia, and hormonal deficiencies. Diagnosis should be made early, due to the possibility of treating the hormonal disturbances. We describe here a case with decreased visual acuity, one-sided hemianopia, nystagmus und agenesis of the septum pellucidum and discuss the heterogeneous appearance of this syndrome. There are two theories regarding its pathogenesis. The first postulates simultaneous damage to both cerebral structures and optic nerve development around the 6th week of gestation, while the other favours secondary degeneration of optic nerve fibres due to a cerebral lesion.

Adolescent↗
PubMed1998

The value of intraoperative angiography for surgical treatment of cerebral arteriovenous malformations in eloquent brain areas.

Intraoperative digital subtraction angiography (DSA) allows intraoperative assessment of outcome of cerebral arteriovenous malformations (AVM). This study reports on 21 patients with AVMs in eloquent areas of the brain extirpated between July 1995 to March 1998. Extirpation was always followed by intraoperative DSA. Intraoperative angiography disclosed an occult residual nidus in 4 cases (19%). Complete extirpation of the AVM was achieved in all cases. Following surgery the neurological condition improved in 15 cases (71%), remained unchanged in 5 (24%), and worsened in 1. There were no secondary postoperative haemorrhages, nor complications related to the angiography. These results indicate that intraoperative DSA should be considered in the course of surgical treatment of cerebral AVMs in eloquent areas of the brain.

Adolescent↗
PubMed1995

Motivating staff through teamwork: process review and data display.

Outlines four interconnecting factors which are essential to motivating staff: an understanding of the "psychology of excellence in teams"; establishing cross-functional quality improvement teams; understanding and reviewing processes of care and service; and the use of data display.

Attitude of Health Personnel↗
PubMed1992

Whole-body cesium 137 activity up to 4 years after the Chernobyl reactor accident in premature newborns, newborns, infants, and children.

Cesium 137 activity was measured after the Chernobyl incident in a whole-body radiation counter (4-pi-scintillation counter) in 85 premature and mature newborns (group 1), 174 infants and young children up to 2 11/12 years (group 2), and 48 children between 3 and 8 years (group 3) from Bonn (Germany) and surroundings. In 1987 the mean level of radioactivity in group 2, at 3.7 Bq/kg body weight corresponding to a mean radiation exposure of 11 muSv/y, was lower than that of group 1 (5.8 Bq/kg, 17 muSv/y) and 3 (9.4 Bq/kg, 28 muSv/y). Up to 1990 the values of all groups revealed a continuous decrease. The latest measurements showed mean values of 0.5 Bq/kg (1.5 muSv/y) in group 1, 0.6 Bq/kg (1.8 muSv/y) in group 2, and 0.8 Bq/kg (2.4 muSv/y) in group 3. A comparison with present cesium 137 values and determinations of the end of the 1950s and beginning of 1960s, both in adults, showed good agreement. The effective dose-equivalent rates amounted to less than 1% of that from natural radiation exposure. These levels should present no teratogenic risks to the population studied and, while there are theoretical mutagenic risks, the dose is so low that no increase in measurable mutagenic effects should be observed.

Accidents↗
PubMed1991

[Color-coded duplex sonography and ultrasound contrast media--detection of renal perfusion defects in experimental animals].

The diagnostic use of microbubble consisting transpulmonary ultrasound contrast media in combination with color-coded duplex sonography (CCDS) has not been evaluated. Perfusion of the orthotopic kidney was therefore examined in an animal experiment with CCDS and transpulmonary echocontrast agent. The contrast agent consists of tiny stabilized air bubbles which survive the lung passage after peripheral venous injection and cause echo-enhancement of the arterial blood. The combination of CCDS and this contrast agent permits demonstration of the renal perfusion including the peripheral parenchyma. Even small experimental perfusion defects can be identified by this method. The use of this contrast agent in combination with CCDS might contribute significantly to the diagnostic potential of ultrasound.

Animals↗
PubMed1991

[The demonstration of the patency of the uterine tubes with color-coded duplex sonography in combination with ultrasonic contrast media].

Tubal patency was studied in 17 sterile women by means of colour-coded duplex sonography (CCDS) with local injection of an ultrasonic contrast medium. The results were compared with a conventional hysterosalpingogram. CCDS demonstrated all the soft tissues and their mobility. The ultrasonic contrast medium was SH U 454 (Schering). The colour signals generated by the air bubbles makes it possible to demonstrate tubal patency on both sides. The combination of an ultrasonic contrast medium and CCDS provides a simple, rapid, accurate and safe method for demonstrating tubal patency. Tubal patency can be demonstrated in the presence of anatomical complications and requires only a small amount of contrast medium.

Adult↗
PubMed1989

Criteria-based performance evaluations for hospital library managers.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) currently requires healthcare institutions use specific, criteria-based evaluations to measure employee performance. These evaluations must be closely linked to each employee's position description. This paper discusses the revision of the library manager's position description and correlating criteria-based performance evaluation to more closely meet JCAHO requirements. The paper uses a case study featuring Chelsea Community Hospital Medical Library, Chelsea, Michigan.

Employee Performance Appraisal↗
PubMed1988

[One year after Chernobyl. Cesium-137 levels in premature, newborn and nursing infants and in younger and older children of Bonn and environs].

From May to August 1987, 137Cs activity was measured in a total-body counter (4 pi counter) in 33 premature and mature newborns (group I), 40 infants and young children up to 2 4/12 years of age (group II), and 15 children between 3 and 6 8/12 years (group III), all from Bonn or its environs. The mean of measurements in group II, at 3.7 Bq/kg body-weight, was lower than that of group I (5.8 Bq) and III (9.4 Bq). Mean radiation exposure, calculated from these data, was 1.7 mrem/a for group I, 1.1 mrem/a for group II, and 2.8 mrem/a for group III. A comparison with present Cs values in adults and measurements made at the end of the 1950's and beginning of 60's showed good agreement. There were no significant differences, as regards Cs activity, between newborns or infants who had been formula-fed or breast-fed. The measured radiation exposure of the three groups is about 1% of natural radiation exposure. Thus, present-day results indicate that there will be no damage to health outside the natural scatter.

Accidents↗
PubMed1983

Changes in personal construing in three psychotherapy groups and a control group.

Two repertory grids were administered at four-weekly intervals to members of three psychotherapy groups and one waiting-list control group. Individualized and general predictions of possible therapeutic change were made. More individualized than general predictions were confirmed, adding further support to the use of client-centred outcome measures. The outcome data indicated significant improvement in each therapy group. Process results were consonant with Yalom's (1970) curative factors of universality, modelling and family re-enactment and Malan's (1979) resolution of triangle of person. Finally, a model for further evaluation of group psychotherapy is outlined developing personal construct methodology within a group setting.

Adult↗
PubMed1983

Correlates of changes in personal construing of members of two psychotherapy groups: changes in affective expression.

Changes in verbal affective expression within sessions of two psychotherapy groups run along group-analytic lines were measured using the Process Affective Scoring System developed by Gibbard & Hartman (1973). Tape recordings of group sessions were rated by trained undergraduate students for presence or absence of verbal affect. Relationships between these changes and changes in personal construing were sought. Expression of hostility and affection were found to be good predictors of a successful outcome of therapy. Factors which might account for the unexplained variance of changes in outcome variables are put forward.

Affect↗
PubMed1979

Evaluation of behavior therapy intervention in general practice.

Thirty general practitioner consultations with patients with psychological problems referred to a clinical psychologist for behaviour therapy, were examined. Treatment was carried out wholly within the practice. Consultations for advice and psychotropic drug prescriptions were compared during one year, both before and after treatment, and were found to be reduced by over 50 per cent following treatment. Contact with clinical psychology services, therefore, considerably reduced the demand made by these patients for general practitioner time.

Adult↗