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Biomedical subjects

H Liess

Publications and source records attributed to H Liess.

11 recordsLinked to original sources
PubMed2000

Primary care involvement in human immune deficiency virus infection-a pan-European view. The Eurosupport Study Group.

OBJECTIVE: The aim of this study was to compare the primary care experiences of human immunodeficiency virus (HIV)-positive individuals across Europe. METHODS: An anonymous self-administered questionnaire study was carried out between August 1996 and August 1997. A total of 15 HIV/AIDS treatment centres and 14 HIV support organizations in 11 European countries participated in the distribution of questionnaires. Overall, 1366 completed questionnaires were included in the analysis from a total of 2751 distributed (50% response rate). The majority of respondents were homosexual men (53.6%), and 54.2% had AIDS or symptomatic HIV disease. The main outcome measures were use of GP services in the preceding 6 months, GP involvement in HIV care provision, satisfaction with current service provision and reasons for non-involvement of the primary care services. RESULTS: Most patients (64.8%) had visited their GP at least once in the preceding 6 months, but 53.9% of respondents reported that their GP was not involved in their HIV care. Of these patients, 53.4% would like their GP to be involved. Patients from central European countries were more likely to have seen their GP than their counterparts from northern and southern countries (P < 0.005), and were less worried that the GP would not have enough knowledge about HIV (P = 0.002) or would not be sympathetic (P = 0.052). CONCLUSIONS: There are clear differences in GP utilization by HIV-positive individuals across Europe, reflecting in part local service provision but primarily patients' attitudes and beliefs. Strategies to promote the involvement of primary health care services need to address patients' core beliefs, if these are to be changed.

Adult↗
PubMed1995

Endoscopic ultrasound in the diagnosis and staging of gastrointestinal Kaposi's sarcoma.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasonography (EUS) has been evaluated for diagnosing and staging of a variety of gastrointestinal tumors, but there are no data on EUS in Kaposi's sarcoma (KS). The aim of the present study was to evaluate the role of EUS in addition to endoscopy in the diagnosis and staging of patients with established or suspected upper gastrointestinal KS. PATIENTS AND METHODS: 22 male acquired immune deficiency syndrome (AIDS) patients were prospectively studied, three of them before and after chemotherapy with liposomal doxorubicin. The features of gastrointestinal KS were recorded, and EUS was assessed for diagnosis in endoscopically negative or inconclusive cases, and for staging in endoscopically visible KS lesions. RESULTS: The typical EUS feature of KS was a hypoechoic and nonhomogeneous lesion leading predominantly to mucosal and submucosal thickening, whereas a few lesions presented only with submucosal involvement. EUS detected suspicious lesions in two patients with negative endoscopy, which turned out to be KS on follow-up. Restaging after chemotherapy in three patients showed regression of lesions both on endoscopy and EUS. CONCLUSIONS: EUS may contribute to better detection of early KS lesions and a more reliable delineation of the extent of gastrointestinal KS, which is valuable for assessing the effect of various forms of therapy.

Adult↗
PubMed1994

Improvements in volumetric quantification of circumscribed hepatic lesions by three dimensional sonography.

The size of hepatic tumors is commonly estimated by ultrasound as well as by computed tomography by measuring the three diameters followed by computing of the volume by applicating the ellipsoid formula. Using the new technique of three-dimensional-sonography it is possible to perform volume measurement by computer-linked planimetry. Initial tests with water filled balloons of defined volume revealed the accuracy (mean error of 3.0%) and high reproducibility (low intra- and inter-observer variance) of the method applied by one investigator (intraindividual SD +/- 1.3%) as well as by four different investigators (interindividual SD +/- 2.1%). Circumscribed hepatic lesions of 63 patients were investigated by using conventional sonography (ellipsoid formula), computed tomography (ellipsoid formula) and three-dimensional-sonography (ellipsoid formula, ortrip, planimetry). As a volume of reference a mathematical approximation for infinite sonographical slices (planimetry) of a very well circumscribed hemangioma of the liver was defined. Based on these results a mean error of -6% (SD +/- 39%) was determined for conventional sonography. For computed tomography a mean error of 2+ (SD +/- 35%) was found, for three-dimensional-sonography that figure was -6% (SD +/- 5%). Follow up investigations can only demonstrate significant alterations of volume when the SD-interval is exceeded. Therefore, three-dimensional-sonography provides a more sensitive and reliable recognition of volumetric changes of liver tumors than conventional sonography or computed tomography does.

Carcinoma, Hepatocellular↗
PubMed1994

[Volume determination with 3D ultrasound exemplified by aneurysms of the abdominal aorta].

Ultrasound is the first diagnostic method concerning initial and follow-up investigations of patients with abdominal aortic aneurysms. The indication is given by threatening rupture when disease is progressing. The aim of the presented study was to find out the applicability of 3D ultrasound and volumetry and to elaborate possible advantages of the new method in comparison with 2D sonography concerning the estimation of volumes. Preliminary investigations of defined volumes of waterfilled balloons confirmed the accuracy of +/- 4% (4 investigators) and the reliability of +/- 2% (10 investigations). With well-defined rating categories 3D scans were found to be quite good as well as excellent in 55% of the processed 3D data. Estimation of volume using 2D linked ellipsoid formula showed higher results in 92% of the cases than performing 3D volumetry. For a high accuracy of 3D volume estimation, contouring of 5 representative slices was quite sufficient. The presented results suggest a high accuracy and reliability of the new method. Further clinical investigations are necessary to find out the clinical relevance concerning the follow-up of patients with abdominal aortic aneurysms.

Aged↗
PubMed1994

[3D-ultrasound of soft tissues and joints].

Sonography has become a reliable diagnostic method in musculo-skeletal diseases. It allows a simple and noninvasive examination of joints and soft tissues. Especially in rheumatic diseases meaningful findings can be obtained. In the present study first results of three-dimensional (3D) sonography of the musculo-skeletal system are reported. The method was first validated by examining healthy test persons and criteria for regular findings were defined. In the second part of the study an unselected group of patients with inflammatory and noninflammatory joint and soft tissue diseases were examined and the obtained results were compared with the findings of the conventional real-time sonography. Comparison of the 2D and 3D procedure showed a superiority of the 3D method with regard to the assessment of large (hip), middle-sized (elbow) and small joints (finger, toe). Additional information about the synovial space, the surface of the cartilage, and the thickness of the synovial membrane was provided by 3D sonography. Volumetry of joint effusions and Baker cysts was easier to perform and more reliable than with the conventional method. Soft tissue alterations could be delineated reliably, depending on their size. Our results demonstrate that 3D sonography can improve the diagnostics of musculo-skeletal diseases. In the future, 3D sonography should play an important part in the diagnosis of joint and soft tissue diseases.

Arthritis, Rheumatoid↗
PubMed1994

[3-D ultrasound in gastroenterology].

Three-dimensional (3D) sonography represents a development of noninvasive diagnostic imaging by real-time two-dimensional (2D) sonography. The use of transparent rotating scans, comparable to a block of glass, generates a 3D effect. The objective of the present study was to optimate 3D presentation of abdominal findings. Additional investigations were made with a new volumetric program to determine the volume of selected findings of the liver. The results were compared with the estimated volumes of 2D sonography and 2D computer tomography (CT). For the processing of 3D images, typical parameter constellations were found for the different findings, which facilitated processing of 3D images. In more than 75% of the cases examined we found an optimal 3D presentation of sonographic findings with respect to the evaluation criteria developed by us for the 3D imaging of processed data. Great differences were found for the estimated volumes of the findings of the liver concerning the three different techniques applied. 3D ultrasound represents a valuable method to judge morphological appearance in abdominal findings. The possibility of volumetric measurements enlarges its potential diagnostic significance. Further clinical investigations are necessary to find out if definite differentiation between benign and malign findings is possible.

Carcinoma, Hepatocellular↗
PubMed1994

[Diagnosis and therapy of gastrointestinal Kaposi's sarcoma in AIDS].

Gastrointestinal Kaposi's sarcoma (KS) is one of the most frequent neoplastic diseases seen in AIDS. Visceral involvement is associated with shorter survival as compared to cutaneous KS. Our aim was therefore to investigate patients with KS endoscopically. In order to improve the early diagnosis of gastrointestinal KS we also employed endoscopic ultrasonographic examinations (EUS). 22 patients recruited for a prospective trial addressing this issue were examined by endoscopy and by EUS. 21 patients had severe cutaneous KS, one patient had no cutaneous KS but showed signs and symptoms of gastrointestinal KS. 15/22 patients (68%) had gastrointestinal KS. Seven patients (32%) had endoscopically normal mucosa. In 2 patients only EUS showed findings suggestive for KS which had not been seen by endoscopy. Follow-up examinations proved typical KS lesions endoscopically in those 2 patients. Using liposomal encapsulated Doxorubicin within a trial (20 mg/m2 intravenously every 3 weeks), we were able to follow 3 patients prior to and during therapy. EUS showed a significant reduction in number and volume of KS lesions as well as a reduction of infiltration depth. In one patient macroscopic and histologic examinations showed complete remission. We conclude that EUS of the upper gastrointestinal tract can be used as a sensitive method for the detection of early gastrointestinal KS. Furthermore, EUS is a method which allows determination of tumor volume and helps in quantification of tumor response after chemotherapy.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Clinical application of three-dimensional sonography in internal medicine.

Three-dimensional sonography represents a development of non-invasive diagnostic imaging by real-time two-dimensional sonography. The use of transparent rotating scans, comparable to a block of glass, generates a three-dimensional effect. The first clinical application of this technique was in the field of gynecology and obstetrics, namely in prenatal diagnostics. In this study we describe its first application in internal medicine. In preliminary examinations on healthy volunteers we obtained specific processing data for optimal imaging results. This was followed by secondary examinations on 123 patients who had previously undergone conventional sonography with pathological findings. In more than 75% of the cases examined we found an optimal reproduction of sonographic findings with respect to the evaluation criteria developed by us for the three dimensional imaging of processed data. With the inclusion of measurement parameters such as distance determination and volume measurements the data gathered will allow the generation of reproducible results. Future studies will confirm the value of this method in diagnostic imaging.

Adult↗
PubMed1992

Critical evaluation of the 'heated-hand-technique' for obtaining 'arterialized' venous blood: incomplete arterialization and alterations in glucagon responses.

In order to test the degree of 'arterialization' and the occurrence of arterio- (or capillary-) venous differences in glucose concentrations for commonly used blood sampling sites (including the retrogradely cannulated dorsal hand vein with application of dry heat to this hand/arm--the 'heated-hand-technique'), oxygen partial pressure (oxygen saturation) and plasma glucose was determined in blood drawn from different venous sites before and after an oral glucose load (75 g). Experiments with and without heating (hot air 68 degrees C) were compared in nine healthy volunteers. Basal pO2 (and oxygen saturation) increased in the order cubital fossa vein less than superficial forearm vein less than dorsal hand vein. Heating raised pO2 by approximately 20 mmHg; P = 0.008) and oxygen saturation (P = 0.008-0.02) at all sites, including those on the contralateral arm. Capillary-venous glucose differences after the glucose challenge were significantly related to the sampling site (P less than 0.0001). They were reduced by approximately 50% in response to heat exposure (P = 0.008-0.011) and could be correlated to pO2-values (r = 0.92; P = 0.01). The lowest capillary-venous glucose concentration difference was measured with the 'heated-hand-technique' (0.4 +/- 0.1 mmol l-1). Heating did not alter integrated incremental glucose (capillary values), insulin, and C-peptide-responses and late, counter-regulatory responses (120-240 min after glucose) of cortisol, growth hormone, and adrenalin. However, the late glucagon response was enhanced (P = 0.011) by heating, concomitant with a significantly reduced 'reactive' decrement in glucose concentrations. In conclusion, the 'heated-hand-technique' provides blood more similar to arterial blood that can be obtained from other venous sampling sites. However, significant residual differences in pO2 and glucose concentrations remain. In addition, altered counter-regulatory hormone responses may occur with heating.

Adult↗