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H Weitzel

Publications and source records attributed to H Weitzel.

At least 19 recordsLinked to original sources
PubMed2001

Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: a neglected population at risk of suicide.

OBJECTIVES: Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients. METHODS: The characteristics of DSH patients who were discharged directly from an A&E department over a 2-year period were investigated, comparing those who had a psychiatric assessment with those who did not. In a matched control design, the outcome of a group of patients who did not receive a psychiatric assessment was compared with that of a group of patients who were assessed. RESULTS: Of DSH patients who were discharged directly from the A&E department 58.9% (145/246) did not have a psychiatric assessment. Nonassessed patients were more likely to have a past history of DSH, to be in the 20-34 year age group, and to have exhibited difficult behaviour in the A&E department. Patients presenting between 5 p.m. and 9 a.m. were less likely to be assessed than those attending between 9 a.m. and 5 p.m. Further DSH during the subsequent year occurred in 37.5% of the nonassessed patients compared with 18.2% of matched assessed patients. They were also more likely to have psychiatric treatment. CONCLUSION: A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk.

Adult↗
PubMed2001

Excretion of low molecular weight heparin in human milk.

AIMS: The excretion of low molecular weight heparin (LMWH) in breast milk was investigated in 15 lactating mothers after Caesarean section. METHODS: Blood and milk samples were collected before and 3-4 h after once daily routine subcutaneous injection of 2500 IU dalteparin. Anti-Xa activity was measured by an assay utilizing prolonged clotting times in plasma or breast milk as an index of LMWH activity. RESULTS: Plasma anti-Xa activities ranged from 0.074 to 0.308 IU ml(-1) of plasma. Anti-Xa activities in breast milk ranged from < 0.005-0.037 IU ml(-1) of milk. This is equivalent to a milk/plasma ratio of < 0.025-0.224. CONCLUSIONS: Therefore, it appears highly unlikely that puerperal thromboprophylaxis with LMWH has any clinically relevant effect on the nursing infant.

Anticoagulants↗
PubMed1999

Failure to demonstrate postpartum functional iron deficiency using quantitative red blood cell analysis.

OBJECTIVE: The aim of this prospective study was to assess erythropoiesis and test for functional iron deficiency in the postpartum period using quantitative red blood cell analysis. STUDY DESIGN: Parameters were determined on admission for delivery and postpartum from 82 obstetric patients at Zurich University Hospital: full blood count, hypochromic and microcytic red cells, reticulocyte count (including subsets), reticulocyte mean corpuscular volume, reticulocyte mean hemoglobin content and reticulocyte mean corpuscular hemoglobin concentration. RESULTS: Microcytic cells increased from 0.9% prepartum to 1.4% on day 42 postpartum; hypochromic cells decreased from 4.3 to 1.9%; reticulocyte mean corpuscular volume decreased from 134 to 125 fl; reticulocyte mean hemoglobin content was unchanged. CONCLUSION: To our knowledge, this is the first medium scale application of quantitative red blood cell analysis to normal pre- and postpartum women. Our data show no evidence of functional iron deficiency or increased erythropoiesis in the postpartum period.

Adult↗
PubMed1998

Elevated serum prolactin level with high-dose estrogen contraceptive pills.

BACKGROUND AND OBJECTIVES: There are currently groups of women using high-dose estrogen contraceptive pills, especially in the developing countries. The aim of this study was to determine the correlation between the duration of contraceptive pill intake, the dose of steroid contained in the contraceptive pills and the incidence and degree of serum prolactin level elevation in those women. STUDY DESIGN: This study was conducted in 100 contraceptive pill users. Women were randomly selected for this study with an age range from 19 to 35 years and duration of contraceptive pill intake from 6 to 120 months. Cases were classified into two groups. The first group (50 cases) were taking high-dose estrogen pills (50 micrograms) and the second group (50 cases) were taking low-dose estrogen pills (30 micrograms). RESULTS: The results of the present study showed that there was a significant elevation in serum prolactin level in both groups, with a more significant elevation in the high-dose pill users. CONCLUSIONS: There is a positive relationship between serum prolactin level and the duration of pill intake and their steroid content, and this relationship is not related to the age and parity of the women. The groups of women studied are scheduled for follow-up to determine if there is any future drawback which results as a consequence of the developed hyperprolactinemia. Prolactin determination should be considered for all women prior to pill intake. This determination of serum prolactin level prior to pill use will be useful in the evaluation of the future relationship between the estrogen content of the pills and the later development of hyperprolactinemia.

Adult↗
PubMed1997

[Accuracy of ultrasound weight assessment--comparison of vertex vs. breech presentation].

AIM: To determine the quality of prenatal sonographic weight estimation, comparing breech and vertex presentations. METHOD: In 147 breech presentations (BP) and 149 vertex presentations (VP), the biparietal head diameter (BPD), the fronto-occipital head diameter (FOD) and the transverse abdominal diameter (ATD) were measured. From these data, the weight was estimated, using Shepard's formula before 28 weeks and Hansmann's thereafter, and compared to the delivery weight. Both formula were modified to incorporate the virtual BPD (vBPD), derived from the BPD, FOD and the calculated head circumference. In the BP group, the role of examiner skills was evaluated, comparing the accuracy of experienced (DEGUM II qualifications) and average individuals. RESULTS: The accuracy for BP was nearly identical to that for VP (= 0.915 vs. = 0.929). The examiners' qualifications had a detectable but not significant influence on the results (= 0.942 vs. = 0.892). CONCLUSION: Ultrasound measurements yield comparable results in both BP and VP, if the vBPD is used. In our opinion, ultrasonic weight estimation is a useful adjunct when determining the manner of delivery in BP.

Birth Weight↗
PubMed1997

Pharmacokinetic analysis of octa-alpha-butyloxy-zinc phthalocyanine in mice bearing Lewis lung carcinoma.

OBJECTIVE: In this study, the pharmacokinetics of octa-alpha-butyloxy-zinc phthalocyanine (8-alpha-bo-ZnPc) was studied with regard to Lewis lung carcinoma in mice after intravenous administration of 7.8 mumole/kg body weight at different incubation intervals. SUMMARY BACKGROUND DATA: The newly synthesized potential photosensitizer 8-alpha-bo-ZnPc is characterized by a high absorption coefficient at the far red wavelength (735 nm) with a good singlet oxygen quantum yield. METHODS: After intravenous administration of 7.8 mumole/kg body weight in mice bearing Lewis lung carcinoma, the accumulated photosensitizer was chemically extracted (at incubation intervals of 2, 6, 12, 24, 48, and 168 hours) from selected tissues, and the concentrations were measured by absorption spectroscopy. RESULTS: The parenchymatous organs, liver, and spleen showed maximum 8-alpha-bo-ZnPc concentrations after 6 hours of incubation. An extensive uptake was detected in lung extracts taken at 6, 12, 24, and 48 hours. The malignant tissue did not accumulate high 8-alpha-bo-ZnPc during the entire investigation period. The photosensitizer extracted from muscle, representing normal tumor-surrounding tissue and skin, was even lower. CONCLUSIONS: Because of the extremely low accumulation rate of the tumor, 8-alpha-bo-ZnPc is suggested to be administered topically or in combination with a suitable carrier system in order to increase the photosensitizer concentration in the target tissue, as well as to decrease the loss of dye to other tissues.

Animals↗
PubMed1997

Knowledge-based system ADNEXPERT to assist the sonographic diagnosis of adnexal tumors.

ADNEXPERT is a knowledge-based system for the computer-assisted ultrasound diagnosis of adnexal tumors. In a case-based approach, ADNEXPERT used histopathologic and sonographic data from 2,290 adnexal tumors. After an ultrasound examination, the gynecologist interacts with the system. A maximum of 15 questions are posed; all but one question (age) relate to the sonographic findings. The help system gives online access to an ultrasound image library. Once the dialogue is complete, ADNEXPERT assesses the adnexal tumor pathology and makes a histological classification. A certainty factor (CF) model is used for knowledge representation. The CFs of the knowledge base are computed from the case database. During system evaluation, the accuracy of ADNEXPERT was tested by 69 new adnexal tumor cases, for which verified histopathological diagnoses were available. ADNEXPERT accurately assessed pathology in 49 cases (71%); in 10 cases (14%) correct indications to pathology were given; no diagnostic hints were attained in 2 cases (3%); and 8 cases (12%) were falsely diagnosed. Based on the positive results of the evaluation, ADNEXPERT will be tested under clinical conditions.

Adolescent↗
PubMed1996

Hepatocellular carcinoma as a rare cause of an excessive increase in alpha-fetoprotein during pregnancy.

A case report is presented on a hepatocellular carcinoma (HCC) during pregnancy, in which a massive increase in alpha-fetoprotein (AFP) was found during a routine screening for neural tube defects in the 17th week of pregnancy. The amniocentesis revealed a normal AFP level in the amniotic fluid. Liver sonography in the 21st week of pregnancy showed a 5-cm tumor, which was interpreted as nodular focal hyperplasia. In the control sonography in the 32nd week of pregnancy, there was growth to 12 cm. The subsequently performed magnetic resonance imaging and fine-needle aspiration led to the diagnosis of a HCC. Delivery was performed in the 34th week of pregnancy by cesarean section, and surgical therapy of the HCC followed.

Adult↗
PubMed1996

[137 local recurrences after breast carcinoma--a retrospective study].

A retrospective study was performed to follow up the course of the disease in 137 female premenopausal and postmenopausal patients in whom local recurrence of carcinoma of the breast had occurred. Particular attention was given to the dependence of the recurrence-free interval on the tumorobiological parameters of the primary tumour. In 23% of the cases the local recurrence was an expression of generalisation of the tumour with simultaneous occurrence of distant metastases. The average recurrence-free interval was four years, but more than half of the recurrences were seen during the first two postoperative years. For the following parameters we found a statistically significant correlation with the recurrence-free interval: size of the primary tumour (p = 0.0003), the nodal status (p = 0.0006) and in this connection also the number of the metastatically involved lymphatic node level (p = 0.00001). There was also a significant correlation between the duration of the recurrence-free interval and the immunohistochemical oestrogen and progesterone receptor status (p = 0.0005) and the growth fraction (p = 0.0106) determined with the monoclonal antibody Ki67. However, although there was no correlation between recurrence-free survival and the kind of surgical primary therapy that had been employed, adjuvant therapy did exercise a decisive influence: there was significant later incidence of local recurrences (p = 0.00001) subsequent to adjuvant radiotherapy.

Adult↗
PubMed1996

Paracetamol self-poisoning. Characteristics, prevention and harm reduction.

BACKGROUND: Paracetamol is now the most common drug used for self-poisoning in the UK and is associated with potentially fatal liver damage. Patients admitted to hospital because of paracetamol overdoses were studied in order to determine their characteristics and factors which might have deterred them from taking paracetamol or reduced the dangers of the overdose. METHOD: Eighty patients were studied in hospital using a structured interview schedule, measures of depression and suicidal intent, information collected through the Oxford Monitoring System for Attempted Suicide, and the results of liver function tests. RESULTS: Acute liver dysfunction (25 patients) was associated with consumption of more than 25 tablets (odds ration 4.46, 95% CI 1.31 to 17.41, P = 0.014). The proportionate use of tablets from blister packs (60%) and loose preparations (46%; 5 patients using both types) reflected their general availability. More of those who took tablets from a loose preparation consumed 25 or more tablets (69%) than those who used a blister-pack preparation (40%; odds ratio = 3.0, 95% CI 1.12 to 9.95, P = 0.028). Only 20 patients thought that any type of warning label would have deterred them from taking a paracetamol overdose. CONCLUSIONS: Establishing a maximum number of tablets (e.g. 25) that can be available in individual preparations is likely to reduce the dangers of paracetamol self-poisoning. The potential effects of other measures are uncertain.

Acetaminophen↗
PubMed1996

[Cystosarcoma phylloides of the breast. A retrospective analysis of 12 cases].

INTRODUCTION: Phyllodes tumours, also known as cystosarcoma phyllodes (CSP), are rare fibroepithelial tumours with an incidence of 0.3-1.0% of all breast neoplasms. CSP tends to recur locally and metastasizes haematogenously. The treatment of CSP remains controversial. The present study demonstrates the recent experiences in diagnosis, therapeutical management and clinical follow-up of this disease. MATERIALS AND METHODS: Twelve female patients who developed CSP from 1982 to 1994 were recalled for clinical assessment and examined for local recurrence or metastatic disease. All histological samples from cases of CSP were evaluated by a single pathologist who was blinded to the patients' histories. The tumours were classified according to international criteria of three types of tumour status: benign CSP, borderline type tumours and malignant tumours. RESULTS: The average age of disease was 46 years. Three patients had benign tumours. There was one borderline type of tumour and eight malignancies. Six patients with malignant CSP underwent mastectomy and axillary dissection. In two cases of malignant CSP simple mastectomy was performed. In two cases of malignancy the operation was followed by radiation therapy. The borderline type of tumour and the benign CSP were treated by tumour removal, segmental resection or subcutaneous mastectomy. In one case of benign CSP two more benign recurrencies ocurred 18 months after the initial operation. Preoperative determination of the tumour marker CEA was normal. The tumour marker CA 15-3 was only elevated in one case. The growth fraction varied from 5-40%. In 8/8 patients the oestrogen and progesterone receptors were negative. We could not find any correlation between the development of cystosarcoma phyllodes and oral contraceptives, nicotine use, diabetes mellitus, age of menarche, allergies, or family history of cancer. CONCLUSION: The clinical finding of a large, firm, non-tender, well-defined, mobile tumour with gradual growth should lead to a suspicion of a phyllodes tumour. Our results and the review of the current literature lead to the following therapeutic recommendations: 1. Benign phyllodes tumour warrants wide local excision with a 2 cm tumour-free zone. 2. Borderline malignant phyllodes tumours should be treated via simple mastectomy. 3. Axillary dissection is recommended only if nodes are palpable. 4. Adjuvant radiation is necessary, if wide local spread of the tumour is present and a resection of the lesion with a 2 cm tumour-free zone is not possible. Close follow-up is mandatory.

Adult↗
PubMed1996

Elevated keratin 18 protein expression indicates a favorable prognosis in patients with breast cancer.

This study was performed to determine if keratin 18 (K18) has prognostic significance in breast cancer cell lines and patients with breast carcinoma. Paraffin sections of primary breast carcinoma tumors and human breast carcinoma cell lines were examined for K18 expression by immunohistochemical staining with the monoclonal antibody CK2. K18 protein expression was low in highly metastatic cell lines and, conversely, high in weakly metastatic cell lines, suggesting that it may function as a prognostic indicator. K18 expression was consequently examined in 134 patients with breast cancer. The staining intensity was compared with clinicopathological variables and follow-up data spanning 8 years. A definitive positive staining was observed in 22 (16.4%) women. The mortality rate was 4. 5% in the K18-positive group and 44.6% in the K18-negative group. Multivariate analysis found K18 expression to be an independent and significant predictor for overall survival.

Adult↗
PubMed1995

[Diagnostic reliability of vaginal ultrasound in ectopic pregnancy].

The therapeutic approach to ectopic pregnancy (EP) has changed over the last decade. A prerequisite for a differentiated management is an early diagnosis of EP. This can be achieved by transvaginal sonography (TVS). The purpose of this study was to evaluate the accuracy of TVS in the diagnosis of EP. 184 patients with clinically suspected ectopic pregnancy were examined by TVS. In 103 cases suspicion of EP was confirmed, in 81 cases it was ruled out. All cases were evaluated by laparoscopy, D&C, serial HCG determinations or sonographic follow-up in case of an intrauterine pregnancy. Sensitivity of TVS in the diagnosis of EP was 96%, specificity 88%, the positive predictive value was 89%, the negative predictive value was 95%. Four cases with a false negative result at TVS were very early in pregnancy and were subjected to laparoscopy because of persistent high HCG values without demonstration of an intrauterine pregnancy. Five cases of sonographically confirmed ectopic pregnancies were missed by the first laparoscopy. These cases required intervention because of clinical symptoms and had low levels of HCG. TVS has a high diagnostic accuracy in the diagnosis of ectopic pregnancy.

Adolescent↗
PubMed1995

[Prevention of neonatal risk by general screening for diabetes in pregnancy, intensive diagnosis and subsequent therapy].

Only 10% of all gestational diabetic mothers in Germany are diagnosed with the current risk-screening. The elevated perinatal risks in case of an unrecognized or insufficiently treated gestational diabetes remains controversial. The purpose of our study was to determine if the number of recognized cases could be increased by a general screening method, and with intensive medical diagnostics the complication rate reduced. Routine blood glucose samplings during the outpatient care were performed throughout the pregnancy. In case of values over 100 mg/dl a 75 g OGTT was done for an exclusion of gestational diabetes. In case of gestational diabetes the patients were asked to follow a special exercise and diet programme as well as self-blood glucose determinations throughout the day. The amniotic fluid insulin level was of substantial value for the indication of insulin therapy. In 6% of the screened patients a gestational diabetes was diagnosed. There was a significant increase (p < 0.001) of fetal macrosomia and diabetic fetopathy in the group without amniocentesis (n = 22) in comparison to the group with invasive (n = 81). We demand the introduction of a general screening for every pregnant patient. By an intensification of the diagnostic methods as well as by a strictly appropriate therapy it should be possible to reduce the fetal and neonatal complications.

Amniotic Fluid↗