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Biomedical subjects

H Jäger

Publications and source records attributed to H Jäger.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Comparison of liver resection with sequential transarterial chemoembolization in stage pT3 or pT4 hepatocellular carcinoma].

Between January 1990 and January 1996, 39 consecutive patients with histologically improved pT3 or pT4 HCC tumors underwent curative resection (n = 19) or sequential transarterial chemoembolization (n = 20) with a median time interval of 7 weeks up to six times with an emulsion of Lipiodol, Epirubicin and Cisplatin. The 30-day mortality rate for all sessions of TA was 3.8% vs. 21.8% in the resection group (p < 0.05); the cumulative survival rate for the embolization group at 6, 12, 18 and 24 months was 72.3%, 50.1%, 41.2%, 35.4% vs. 42.1%, 31.6%, 31.6% and 14.2% following resection, which cannot be considered statistically significant. Patients with T3 and T4 HCC, treated with sequential embolization or resection, seem to have a comparable survival time.

Carcinoma, Hepatocellular↗
PubMed1995

[Secondary prevention of sexually transmissible diseases in public health service--analysis of initial experiences in a Bremen counselling office of the chief public health office].

Medical activities of the Public Health STD programme in Bremen were analysed during a period of one year. This experimental project comprises various activities on primary prevention, counselling services, including streetwork, on social and health issues related to sexual health and confidential, anonymous diagnosis and treatment of STD. 621 examination in 248 patients were evaluated. The need for STD screening and treatment has not yet been assessed in Bremen. Nevertheless, a considerable number of individuals considered themselves in need for STD screening or treatment in a public health setting. In comparison with 1975-1985, when bimonthly mandatory screening on female prostitutes was common in Bremen, the number of examinations declined by a factor of ten, whereas the actual number of treated persons remained stable. Of all examinations, 511 (82.3%) were carried out on females, 110 (17.7%) on males, 351 (56.5%) on German citizens and 270 (43.5%) on clients with foreign citizenship. 461 (74.2%) of all examinations involved female prostitutes. Sexually transmitted diseases were shown to be present in 39.3% (244/621) of the examinations. In addition, "vaginitis" was found in 47.7% of gynaecological checks. The STD prevalence was extraordinary high in female drug-addicted (75%) and foreign prostitutes (40.6%). Only in foreign prostitutes a significant association between incidence of STD and age was found. Costs in relation to the detection of one STD were found to be rather low compared to the benefit to the individuals and the society. Therefore, the STD/HIV prevention programme should be maintained.

Adolescent↗
PubMed1994

[Disseminated histoplasmosis in AIDS].

A 41-year-old man infected with HIV-1 developed fever up to 39.8 degrees C together with nonproductive cough and dyspnoea. Lactate dehydrogenase concentration rose from a level of 998 U/l to 6307 U/l. As pneumocystis carinii pneumonia was at first suspected he was treated with co-trimoxazole (1600 mg sulfamethoxazole and 320 mg trimethoprim, four times daily). But the symptoms did not abate. Bone-marrow puncture revealed numerous macrophages containing ovoid inclusions typical of Histoplasma capsulatum varietas capsulatum. The diagnosis of disseminated histoplasmosis was confirmed by culture and serologically by an increase in Histoplasma polysaccharide antigen. On treatment with amphotericin B (at first 10 mg, then 50 mg daily for 4 weeks) the symptoms regressed within a few days. After the concentrations of lactate dehydrogenase and Histoplasma antigen had become normal again, maintenance treatment was changed to itraconazole (200 mg twice daily), after a total amphotericin B dose of 1150 mg. The patient has remained free of recurrence.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Adjuvant corticoid administration within the scope of HIV disease. Indications in wasting syndrome and other diseases within the scope of AIDS].

While at the start of the AIDS epidemic, corticosteroids were considered to be contraindicated, about 10 indications have since been identified for the specific use of glucocorticoids in HIV infection. Some of these indications have already been confirmed in controlled scientific studies, for example, pneumocystis carinii pneumonia or HIV-induced high-grade non-Hodgkin's lymphoma. In the case of other indications, for example, cerebral toxoplasmosis or certain forms of the wasting syndrome, clinical observational studies and, in particular, empirical data provided by large groups working on AIDS, are available. The use of corticoids for such other indications as pulmonary involvement in the case of Kaposi's sarcoma, or thrombopenia in HIV patients, is still experimental. To date, the initially feared high rate of side effects due to the theoretically possible impairment of immunological function, has not been observed. The effect of the corticosteroids appears to be concentrated more in their anti-inflammatory action than in substitution in the event of adrenal insufficiency. The carefully considered and selective use of corticosteroids can both improve the quality of life and lengthen the life expectancy of many HIV victims.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Pressure-volume analysis of wound suction drainage containers and suction capacity of drainage tubes].

Four low-vacuum systems and eight high-vacuum systems were examined with special reference to the pressure-volume relations. The maximum filling volume for adequate transport of wound secretion was determined for each type. The use of a synthetic wound fluid instead of water resulted in a smaller aspiration volume. Enlargement of the tube diameter resulted in a reduced initial vacuum for the low-vacuum systems, whereas the high-vacuum systems were not affected. Normal drain tubes were compared with "Ulm drains" and silicon tubes for suction capacity. The suction maximum of normal tubes and silicon tubes was located at the proximal holes of the perforated tubes. The "Ulm drain," with perforation diameter increasing continuously to the distal end of the tube, was found to exert suction even at the more distal part of the tube. It is estimated that this tube allows locally more balanced vacuum in the wound.

Animals↗
PubMed1994

[Fluconazole sensitivity of Candida strains in vitro in the microdilution test and agar diffusion test].

The comparison of the in vitro-susceptibility of Candida isolates collected from the oral cavity of different groups of patients to fluconazole ist reported. The isolates of HIV-patients treated with fluconazole, HIV-patients and dermatological patients without fluconazole exposure were investigated. The in vitro-susceptibility of these isolates was determined by microdilution test and agar diffusion test. 88.7% of the 194 Candida isolates were susceptible in vitro, 6.7% less sensitive and 4.6% resistant to fluconazole. Comparing the susceptibility within the groups there was a higher number of isolates less sensitive (14.7%) and resistant (11.8%) to fluconazole in the group of HIV-patients treated with fluconazole than in the other 2 groups without treatment. The less sensitive isolates were 4 C. albicans and 6 C. glabrata. The resistant isolates were 2 C. albicans, 2 C. glabrata and 4 C. krusei. In the group of HIV-patients without fluconazole exposure there were only 2.7% of the isolates less sensitive (2 C. glabrata) and 1.4% resistant to fluconazole (1 C. glabrata). In dermatological patients there were 2% of the isolates less sensitive (2 C. glabrata) and no resistant isolate. Resistance both in vivo and in vitro was found in 2 patients.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Lumbar puncture--the post-puncture syndrome. Prevention with an "atraumatic" puncture needle, clinical observations].

Postlumbar puncture syndrome (PPS) is caused by continuous leakage of CSF through the dural puncture defect. While it has long been known that the symptoms are dependent on the diameter of the puncture needle, the influence of the needle point on the frequency of PPS has now also been examined. Following diagnostic and/or therapeutic lumbar puncture (LP) with Sprotte's "atraumatic" needle, the symptoms in 600 patients during a period of 8 days were recorded. In 92% of the patients LP involved no problems. In 7% the puncture was successful only at the second or third attempt. In 4 cases it was necessary to carry out the procedure under X-ray control. While the literature shows that PPS following lumbar puncture with a 21 G needle occurs in 30-40% of cases, only 3.6% of the patients complained about position-dependent headaches where the Sprotte needle was used. Nausea, dizziness and tinnitus were extremely rare (< 1%).--The "atraumatic" puncture needle reduces the frequency and the degree of PPS to the minimum and makes the lumbar puncture procedure possible on an outpatient basis.

Adolescent↗
PubMed1993

Increased levels of serum intercellular adhesion molecule 1 in HIV infection are related to immune activation.

Cytopathic mechanisms in human immunodeficiency virus type 1 (HIV-1) infection involve syncytia formation, and it appears likely that increased expression of intracellular adhesion molecule 1 (ICAM-1) is involved in these cell adhesion phenomena. In this study, we determined serum concentrations of soluble ICAM-1 (sICAM-1) in 27 patients with HIV-1 infection and a control group. In addition, we compared sICAM-1 values to CD4+ T-cell counts, serum beta 2-microglobulin (beta 2M) and serum neopterin levels. HIV-1-infected patients had significantly higher sICAM-1, beta 2M and neopterin levels than controls. The subgroup of patients with Walter-Reed stages 3-6 had only slightly higher sICAM-1 concentrations in serum than Walter-Reed stages 1-2. The sICAM-1 concentrations in HIV-1-seropositive patients correlated with beta 2M levels but neither with neopterin nor with CD4+ T-cell counts. Increased sICAM-1 may result from immune activation, which enhances the expression of ICAM-1 in patients with HIV-1 infection.

Adult↗
PubMed1993

[Prevention of sexually transmitted diseases or control of prostitutes and patients with venereal diseases? An exemplary, epicritical study in Bremen].

Data derived from laboratory and activity statistics of the Venereal Disease" department of the Public Health Office in Bremen were analysed between 1961 and 1991. The traditional concept to fight venereal diseases" aimed at controlling persons "at risk" for syphilis, gonorrhoea, chancroid or lymphogranuloma. This "high-risk" approach of STD prevention stressed the compulsory, at least twice monthly screening of female prostitutes and neglected other population groups like clients of prostitutes and young people, who might have an elevated risk in acquiring STD. The spread of STD like chlamydia, HPV, herpes and even HIV in considerable parts of the general population underlines the need for developing a more effective STD prevention, based on scientific diagnosis and treatment. Intervention programmes in STD control must be performed in full partnership with the targeted population; this can require great effort and time. But STD control certainly cannot be achieved under the threat of punishment or proscription.

Adolescent↗
PubMed1992

Treatment of diarrhoea in human immunodeficiency virus-infected patients with immunoglobulins from bovine colostrum.

Diarrhoea and weight loss are found in more than 50% of patients with the acquired immunodeficiency syndrome (AIDS). In some patients the symptoms can be very severe, leading to death even in the absence of opportunistic infections. In 30% of these patients, enteric pathogens cannot be identified, and approximately only half of the identifiable aetiologic agents of diarrhoea in patients infected with the human immunodeficiency virus (HIV) were treatable with antibiotics. Immunoglobulins from bovine colostrum (Lactobin, Biotest, Dreieich, FRG) contain high titers of antibodies against a wide range of bacterial, viral and protozoal pathogens as well as against various bacterial toxins. Lactobin (LIG) is quite resistant to 24-h incubation with gastric juice. In a multi-center pilot study 37 immunodeficiency patients with chronic diarrhoea [29 HIV-infected patients, 2 patients with common variable immunodeficiency (CVID), one unidentified immunodeficiency, five patients with graft versus host disease (GvHD) following bone marrow transplantation] were treated with oral LIG (10 g/day for 10 days). Good therapeutic effects were observed. Out of 31 treatment periods in 29 HIV-infected patients 21 gave good results leading to transient (10 days) or long-lasting (more than 4 weeks) normalisation of the stool frequency. The mean daily stool frequency decreased from 7.4 to 2.2 at the end of the treatment. Eight HIV-infected patients showed no response. The diarrhoea recurred in 12 patients within 4 weeks (32.4%), while 19 patients were free of diarrhoea for at least 4 weeks (51.3%). In 5 patients intestinal cryptosporidiosis disappeared following oral LIG treatment. LIG treatment was also beneficial in 4 out of 5 GvHD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

[Sexually transmittable diseases and the public health service--recommendations for the reorganization of counseling centers for sexually transmittable diseases].

Sexually transmitted diseases (STD), including HIV infection, are a major and increasing health problem in Germany. Primary infection, complications and sequelae of STD are causative for an increasing economic burden. In addition a considerable part of the normal population suffer from persistent refractory virus infections and associated sequelae. The epidemic of both HIV and other STD and iv-drug abuse are closely related. The Public Health strategy in Germany is regulated by an outdated legislation to fight venereal diseases (Gesetz zur Bekämpfung der Geschlechtskrankheiten, July 1953) and traditionally consisted in screening tests for bacterial STD in female prostitutes and in case-finding produres. Results of recent epidemiological, social and behavioural research urgently suggest a new approach for STD programmes on the lines of recommendations by the World Health Organization.

Communicable Disease Control↗
PubMed1991

How do patients with HIV perceive their general practitioners?

OBJECTIVE: To study the perceptions of patients with HIV of their general practitioners in terms of knowledge, abilities, confidence, and satisfaction. DESIGN: Questionnaire survey of inpatients, outpatients, and members of a self help group. SETTING: Two city hospitals, three outpatient clinics, and one AIDS self help group in Munich and Berlin, Germany. SUBJECTS: All 402 patients available between 1 September 1988 and 31 May 1989. MAIN OUTCOME MEASURES: General practitioners' attitudes towards the patients' HIV status; patients' experience of treatment rejection; reception in the general practitioner's office; the doctor's perceived knowledge about HIV and AIDS. RESULTS: 394 of 402 patients consented to interview; 87% were registered with a general practitioner and 91% of those indicated that the doctor was aware of their HIV diagnosis. The overwhelming majority of patients (94%) had a friendly or at least neutral reception in the general practitioner's surgery and only six patients' general practitioner changed his or her behaviour for the worse because of the HIV diagnosis. Two thirds of patients said they would consult first with their primary care doctor for a physical problem, but only 13% would do so for psychological problems. Over a third of the patients did not routinely inform other doctors or medical staff about their HIV status, but there was no significant correlation between this concealment and ever having been rejected by a doctor (7%) or a dentist (12%). CONCLUSION: Most patients expressed a high degree of satisfaction with their general practitioners in terms of confidential issues, attitudes, knowledge, and management.

Attitude of Health Personnel↗
PubMed1991

The determination of antipyrine elimination in saliva by liquid chromatography.

A simple, fast and reliable liquid chromatographic method for the determination of antipyrine in saliva is described. The elimination of antipyrine is a good indicator for general evaluation of the liver function for dispositional purposes for example in occupational and environmental medicine. The described LC method was compared with a more extensive photometric procedure. The results obtained from both methods show very good correlation. Only one measurement is necessary to determine the antipyrine clearance. Furthermore the antipyrine dosage can be minimized, because of the sensitivity of the HPLC-method.

Antipyrine↗