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Biomedical subjects

H Schmid

Publications and source records attributed to H Schmid.

At least 19 recordsLinked to original sources
PubMed1992

Pre-spinal convergence between thoracic and visceral nerves of the rat.

Dichotomizing sensory axons have been demonstrated in a number of species and are of significance in understanding the possible mechanisms underlying referred pain. The present study reviews work employing fluorescent dyes as tracers to demonstrate afferent dichotomization in the peripheral nervous system. Dichotomization between the intercostal and splanchnic nerves of the rat was demonstrated by means of intraneural transport of Diamidino yellow or Fast blue. Frequency of pre-spinal somato-visceral convergence averaged 2% (range 0.1-21%). Average frequency of convergence was 8.3% (range 2-23.1%) between internal and external intercostal nerves. Control experiments in which axoplasmic transport was inhibited by vinblastine ruled out the possibility of errors from non-axoplasmic transport of the markers. Thoraco-visceral pre-spinal convergence occurs in the rat and is variable in extent.

Afferent Pathways↗
PubMed1992

[Recurrence of vulvar cancer--treatment, experiences and results].

At the University Hospitals of Heidelberg (1970-1988) and Homburg/Saar (1988-1990), 182 patients with vulvar carcinoma were treated. 51 patients had a recurrence of vulvar carcinoma and 21 patients showed a persistence of this tumour. 19 women had a second recurrence of vulvar disease. In these cases, therapy ranged from local surgery to exenteration, depending on the site and tumour extension. 18 patients underwent successful reconstructive surgery. Prognosis was better in cases with local recurrence in comparison to distant sites of metastatic progression (i.e. inguinal nodes or disseminated disease) (p less than 0.001). The five-year survival (after diagnosis of recurrent disease) for patients with early onset of recurrence (less than 20 months after initial therapy) was 28% compared to 68% for patients with late onset of recurrent disease (p less than 0.01).

Female↗
PubMed1992

[Results of treatment in vulvar cancer from 1970 to 1990].

From 1970-1990, 159 patients with invasive malignant tumours of the vulva (150 squamous cell carcinomas) underwent surgery at the University Hospitals, department of gynaecology. Heidelberg (1970-1988) and Homburg/Saar (1988-1990). 73% of the patients were more than 60 years old and 3% were less than 40 years old. The mean age was 69 years. 30% of the patients had diabetes mellitus. As a standard therapy, 101 patients had radical vulvectomy with bilateral inguinal node removal in accordance with S. Way. If nodes were found to be positive, the inguinal/pelvic region was irradiated postsurgically with 40-50 Gy. The 5 years survival rate for all patients with vulvar carcinoma was 69%. For early stage carcinomas (pT1, depth of invasion < or = 1 mm) a restricted radical therapy should be considered. 9 patients with early stage carcinomas survived disease-free for a period of 70 months. Significant prognostic differences were noticed if node histology was N- as opposed to N+ (p < 0.001), if depth of invasion was < or = 1 mm as opposed to > 10 mm (p < 0.001), if stage was pT1 as opposed to pT2 to pT4 (p < 0.001) or if lymphangiosis carcinomatosa (p < 0.01) was present or not. Prognostic differences were also noticed, if cytological grading was done in accordance with Broders (p < 0.09). 27 patients had successful reconstructive surgery with local cutaneous or myocutaneous flaps at the time of initial surgery. The median recovery period after radical vulvectomy with bilateral inguinal lymph node excision was 22 days. The median recovery period after radical vulvectomy with bilateral node removal and reconstructive surgery was 25 days. Early recurrence of carcinoma (< or = 6 months after initial therapy) was 5.9%, late recurrence was 12%.

Aged↗
PubMed1992

[Palliative laser therapy in gynecologic oncology].

Local recurrences of carcinomas of the breast and genitals are a severe psychic and physical strain on the patients. Continuous confrontation with an often visible and generally painful tumour manifestation is an indication for palliative treatment, if other oncological therapies can no longer be employed. In these cases, the possibility of laser use represents a new therapeutic approach. In a pilot study at the University of Heidelberg, Department of Obstetrics and Gynaecology, a palliative laser therapy was performed on 45 patients with locally recurrent carcinomas of the breast (n = 29) and genitals (n = 16). Carbon dioxide and Nd:YAG lasers were utilized for tumour resection, vaporisation and coagulation. This new concept, the combined application of both wavelengths has been proved to be most efficient.

Adult↗
PubMed1992

[Cryopreservation of erythrocytes with hydroxyethyl starch. In vitro results leading to an autologous retransfusion model in the dog].

Although the effectiveness of hydroxyethyl starch (HES) as a cryoprotectant for human red blood cells (HRBC) is well known, no clinical application has evolved so far. In contrast to glycerol HES has the advantage of causing no hemolysis per se. This offers the opportunity of a one-step procedure without a time consuming postthaw washing procedure prior to transfusion. In this study the in vitro results obtained with red blood cells from 8 dogs (DRBC) are reported and compared to HRBC (n = 5). It turned out that DRBC had a similar 2,3-DPG and a lower ATP content. Postthaw survival in terms of saline stability differed markedly (67 +/- 6 and 86 +/- 2%, respectively). DRBC were more susceptible to hypotonic stress than HRBC. Nevertheless, after cryopreservation 91% (HRBC) and 92% (DRBC) of the original 2,3-DPG were found in the thawed RBC concentrates.

2,3-Diphosphoglycerate↗
PubMed1992

[Rapeseed poisoning of wild herbivores].

Beginning with the simultaneous occurrence of the first extensive sowing of 00-rape and local increased losses among hares and roe deer in Western Germany and Austria at the end of 1986, the clinical and morphological symptoms of rape poisoning are discussed. They consist of damage to endo- and epithelium, cell membranes, blood, liver and in the so called "rape-blindness". Subsequently, the most important toxic agents of rape including their metabolites are presented. They consist in alkenyl- and indolyl-glucosinolates, leading to isothiocyanates (mustard oils), thiocyanates or thiocyanate ions resp., nitriles and antithyroid agents (e.g. goitrin) as well as S-methylcysteine sulphoxide and its metabolites, particularly dimethyl disulphide. Finally, the activity spectrum of the toxic agents or the metabolites and the clinical picture of the affected wildlife in 1986 are compared with the result that the losses of that period are most likely to be traced back to rape poisoning and that the rape-blindness mentioned is to be interpreted as a thiocyanate-psychosis.

Animals↗
PubMed1992

[Renal cell cancer in childhood].

Renal cell carcinoma is a rare disease in children and difficult to distinguish from Wilms-tumor before surgery. We present case histories of two children with renal cell carcinoma and discuss the problems of differential diagnosis versus nephroblastoma, therapy and prognosis. In contrast to Wilms-tumors, the most common kidney-tumor in children occurring mostly in young infants, renal cell carcinoma is rare in childhood and predominantly manifests in school-age. Only a few cases of renal cell carcinoma in younger children are described in the literature. Diagnostic imaging cannot reliably distinguish renal cell carcinoma from other neoplasm of the kidney. However, hematuria in patients with small tumors or no response to preoperative chemotherapy may indicate the presence of renal cell carcinoma rather than nephroblastoma. The determination of "tumor-associated trypsin inhibitor" (TATI) might give further contribution of differential diagnosis. It was measured only in one of our patients and was markedly elevated. Complete surgical resection (nephrectomy with lymphadenectomy) is a curative therapy in patients with tumors limited to the kidney. Chemotherapy and irradiation show no convincing effect. In metastatic tumors therapy with interleukin 2 may be successful.

Carcinoma, Renal Cell↗
PubMed1991

[Experience with Ender nailing in 671 cases].

Between 1976 and 1987 at the Surgical Department of the University of Erlangen-Nürnberg, 671 fractures of the trochanteric region of the femur were treated by Ender nailing. In 54 cases (8.0%) there were intraoperative complications, in 82 cases (12.2%) postoperative complications occurred. Reoperation became necessary at 57 (8.5%) patients. Because of this complication rate we only see indications for Ender nailing in patients with skin lesions over the fracture site, valgus angulation of the proximal fragment and in the palliative treatment of pathological fractures.

Adult↗
PubMed1991

Effect of intraperitoneal recombinant human tumour necrosis factor alpha on malignant ascites.

29 patients with refractory malignant ascites due to metastatic peritoneal spread of adenocarcinomas originating from the ovary, gastrointestinal tract, liver, breast and uterus were treated in a phase I trial of intraperitoneal infusions of recombinant human tumour necrosis factor alpha (rhTNF-alpha). Patients received 40-350 micrograms/m2 rhTNF-alpha intraperitoneally once weekly for 2 months or for a shorter period in case of early resolution of ascites. Systemic side-effects resembled those reported for rhTNF-alpha given intravenously. No dose-limiting toxicities were found and thus a maximum tolerated dose of intraperitoneal rhTNF-alpha was not established. Out of 29 patients, 22 responded with a complete (16) or partial (6) resolution of their ascites. There was a less than 50% reduction in 4, and no increase in ascites in 1. 1 patient showed progressive ascites formation, and another patient was not eligible because of early death unrelated to treatment. Trials in patients with smaller tumour burden are warranted.

Adenocarcinoma↗
PubMed1991

Crossed immunoelectrophoresis applied to representative strains from 11 different Pasteurella species under taxonomic aspects.

Crossed immunoelectrophoresis evaluated on a numerical basis revealed a close antigenic relationship between species of the genus Pasteurella. By cluster analysis, 4 groups on similarity levels between 87% and 72% S could be separated which were connected by a minimum level of 69.5% S. One subgroup included all biovars or subspecies consisting of strains with mucoid growth. Another feature governing the antigenic relationship seemed to be the host range of Pasteurella species. Despite a considerable number of cross-reacting antigens, representative strains of the genera Haemophilus and Actinobacillus were clearly separated from Pasteurella. Similarly, "Pasteurella" haemolytica and Taxon 16 strains tested did not belong to this genus. An Escherichia coli strain showed a higher number of cross-reacting antigens, confirming known antigenic relationship among Gram-negative bacterial species.

Animals↗
PubMed1991

[Systemic therapy in recurrent and primary advanced cervix cancer].

Therapeutic results in advanced cervical cancer have not been showing any progress for more than 30 years. Only by means of systemic therapy does it seem possible, that further treatment results may be obtained similar to those in squamous cell carcinoma of the head and neck. Therefore, between 1985 and 1990 we tried to apply an aggressive polychemotherapy regimen for 5 days with cisplatinum and 5-fluorouracil with supportive treatment in 47 patients with either primary advanced inoperable (n = 25) or recurrent (n = 22) cervix carcinomas. Complete (n = 12) and partial remissions (n = 24) could be obtained in 36 out of 47 cases (= 77%). However, this high response rate conceals the fact, that this aggressive palliative treatment in case of recurrence and/or distant metastases means a considerable deterioration of quality of life with a median survival time of only 9.5 months. Although primary therapy with combined chemoradiotherapy shows good results, it is, however, only a real advantage for patients with complete response. Taking into account the short period of observation (median 25 months), the overall survival of all primary advanced cervix carcinomas is 13 + months, in case of complete remission 20 + months. It remains to be seen, whether sequential or simultaneous chemoradiotherapy will prove superior. Due to severe haematoxicity (WHO grade IV) after the first 3 treated patients, a dose reduction of 20% of chemotherapy was necessary. No further severe toxicities occurred. By means of supportive care, other side effects could also be well controlled, so that this effective polychemotherapy regimen is not only efficacious but also practicable. Prospective randomised studies are required to determine the importance of exclusive or combined chemoradiotherapy in advanced as well as in operable cancer of the cervix.

Adult↗
PubMed1991

[Intra-arterial chemotherapy in locally advanced breast carcinomas].

Transcatheter arterial chemotherapy with mitoxantrone was carried out in 9 patients suffering from advanced breast cancer. The anticancer agent was selectively injected in the internal mammary artery. In 2 cases the catheter was super-selectively advanced into a peripheral branch of the internal mammary artery supplying the breast carcinoma. No complication of the transcatheter treatment could be observed. CT examinations for controlling the catheter position showed perfusion of breast cancers between 40 and 90 per cent. Histological examinations of the 7 resected specimens revealed extensive necrosis in all cases. All 7 patients who underwent surgery have been without local recurrence for 3 to 12 months after treatment.

Adult↗
PubMed1991

A model of cardiovascular activation components for studies using autonomic receptor antagonists.

Alpha-adrenergic, beta-adrenergic, and cholinergic responses are often considered important activation components when conceptual and empirical analyses are made of single physiological variables and of patterns of cardiovascular reactivity; these autonomic distinctions are also of particular significance in autonomic blockade studies. A Model of Cardiovascular Activation Components is introduced that relates these components to both the measured cardiovascular variables and the protocol of autonomic blockade studies. It is pointed out that a restricted form of the complete model is often implicitly used in cardiovascular psychophysiology. The differential consequences of an erroneous employment of the restricted model are discussed for single and dual blockade protocols. Critical evaluations of autonomic blockade as a tool in cardiovascular psychophysiology are examined and are proposed to be often the consequence of the restricted model assumptions. Lastly, the utility of the Activation Components Model for a componential description of tasks and for componential intertask relationships is illustrated with data from the literature.

Arousal↗
PubMed1991

[The expertise situation as pathoplastic factor].

Underlying attitudes of apprehension or desire have an essential pathoplastic function, especially in the situation of medical assessment. The functionality of symptoms and complaints requires a diagnostic approach which is not oriented simply towards the "exclusion of organic causes". Interaction between somatogenic and psychogenic factors is by far more common than sheer functionality. Although widely neglected in our medical teaching and literature, these problems are not confined to the mere assessment of temporary or permanent invalidity, but are of great importance for the entire medical sphere, including manifestations and course of a disease, therapeutic success etc. In Austria, the population of foreign workers is in a special position due to socio-economic preconditions, partly due to short-sighted policy devoid of psycho-hygienic considerations. This situation requires thorough analysis free of emotions, which should lead to the development of sensible, although in some respects belated, measures. The latest economical recession has revealed several faulty courses of development in our system of social and health insurance, which needs revision urgently lest it should collapse. In this respect, the medical profession is called upon to contribute to a necessary curtailment of excessive misuse within a system that has become inflexible during the past decades, thereby endangering the valuable achievements of social medicine.

Adult↗
PubMed1991

Long-term results of treatment for children's cholesteatoma.

Fifty-seven of 98 children with cholesteatoma treated between 1976 and 1985 were available for long-term follow-up. The clinical records of the 57 children were analyzed retrospectively. The purpose of this study was to compare the incidence of recurrent and/or residual cholesteatoma, postoperative otorrhea, and hearing results between two groups of patients. One group (n = 40) of children was treated with a radical mastoidoepitympanectomy (RMET) and the other group (n = 17) was treated with intact canal wall tympanoplasty/mastoidectomy (ICWT). Residual cholesteatomas were twice as frequent (17% versus 7.5%) in the ICWT group while recurrent disease was the same. There was no difference in postoperative otorrhea between the two patient groups. Hearing results were equally good in the Type III and in the ICWT group with staged TORP. It is concluded that a Type III tympanoplasty is an excellent one-stage method of hearing reconstruction in patients with good eustachian tube function and an intact stapes and that a correctly performed RMET offers a safe trouble free alternative to ICWT. In selected patients with limited disease and a well pneumatized mastoid, ICWT is still used.

Child↗
PubMed1990

Allogeneic bone marrow transplantation for Langerhans' cell histiocytosis.

A group of proliferative diseases of the epidermal Langerhans' cells are commonly referred to as Langerhans' cell histiocytosis (LCH). A small number of the patients with this disease face an unfavorable disease course despite chemotherapy and radiation therapy. In LCH patients with a poor prognosis, allogeneic bone marrow transplantation (BMT) could be the appropriate treatment with proven antiproliferative effects and may be able to repopulate the recipient with stem cell-derived Langerhans' cells from the donor or correct the presumed underlying immunodeficiency. An LCH was diagnosed in a 15-year-old boy with multiple osteolytic lesions, anemia, and diabetes insipidus centralis. Repeated flare-ups of the disease had necessitated several courses of conventional chemotherapy including cyclophosphamide (CY), prednisolone (P), 6-mercaptopurine (6-MP), vincristine (VCR), and additional local irradiation without stable remission. Three years after first being diagnosed with LCH the patient underwent high-dose chemotherapy-radiation therapy followed by allogeneic BMT from his human lymphocyte antigen (HLA)-identical brother. Currently, he is alive and well and has been disease-free for more than 41 months after BMT.

Adolescent↗