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Biomedical subjects

H Zimmerman

Publications and source records attributed to H Zimmerman.

18 recordsLinked to original sources
PubMed1999

Drug-induced liver disease.

The past year has seen several additions to the list of drugs that cause hepatic injury. Many of these agents produce fulminant hepatic necrosis and, in some cases, were withdrawn from the market (eg, bromfenac). Other drugs had warnings placed in their labeling along with stringent monitoring guidelines to alert physicians and patients alike to the potential for severe hepatic injury (eg, troglitazone, tolcapone). New reports of hepatoxicity continued to appear for many older agents, in some cases expanding the hepatotoxic spectrum for the drugs. Vanishing bile duct syndrome has drawn increasing attention and is now associated with more than 30 drugs. Ibuprofen is among those drugs newly described as causing this syndrome. Hepatitis C virus infection was reported as a possible risk factor for ibuprofen hepatotoxicity, raising the issue of safe use of nonprescription as well as prescription drugs in patients with underlying liver disease. Reports have appeared about acetaminophen-induced hepatotoxicity in several dozen children from unintentional overdoses, in addition to cases of therapeutic misadventure in adults.

Journal Article↗
PubMed1998

Abdominal irradiation in unilateral nephroblastoma and its impact on local control and survival.

PURPOSE: The influence of abdominal radiotherapy was analyzed in 122 patients with unilateral Wilms tumor eligible for local irradiation according to postoperative SIOP-stage. MATERIAL & METHODS: 122 of 454 children with Wilms tumor diagnosed between January 1989 and March 1994 in Germany were eligible for abdominal irradiation after preoperative chemotherapy and tumor resection according to SIOP9/GPOH protocol. There were 88 children with standard histology (SH; local Stage IIN+ and III) and 34 children with unfavorable histology (UH; anaplastic, clear cell and rhabdoid, local Stages II and III). Local irradiation was given postoperatively parallel to polychemotherapy according to protocol with appropriate dose reductions of Actinomycin D (dactinomycin) during the course of radiotherapy. Fifteen Gy to the tumor bed were prescribed in standard histology, with 30 Gy to regional lymph nodes, if histologically positive. Thirty Gy were given in unfavorable histology. Boost doses up to 15 Gy were possible for macroscopic residuals. Ages ranged between 6 months and 21 years (median 4.2 years). RESULTS: Only 98 of 122 eligible children were irradiated. Reasons for ommission of radiotherapy were: Stage III only due to intraoperative biopsy (n = 6), due to resected cava thrombus (n = 5); young age (n = 2); undergrading/understaging (n = 7); other reasons (n = 4). There were 19 abdominal recurrences (4 of 88 with SH; 15 of 34 UH). In 5 patients, local recurrence was the only site of failure. There were 6 local failures in 24 nonirradiated but eligible children (25%) vs. 13 of 98 in irradiated children (13%); p = 0.15. In SH 0 of 15 nonirradiated vs. 4 of 73 treated children (p = NS) and in UH 6 of 8 nonirradiated vs. 9 of 26 irradiated children developed local recurrence (p < 0.05). Of 19 children with local recurrence as one site of failure, 18 have died. This comprises 67% of 27/122 children with fatal outcome in the observation period. In the patients eligible for abdominal radiotherapy, projected 3-year relapse-free survival is 85% for the group of children with standard histology and 41% for the children with unfavorable histology. CONCLUSION: Despite impressive overall results for this multicenter trial in unilateral nephroblastoma, local recurrence remains a grave prognostic parameter. Evaluation of irradiated vs. eligible but not irradiated children suggests that radiotherapy to the tumor bed is of considerable impact for local control in the risk groups eligible for abdominal irradiation as defined in the SIOP9/GPOH protocol.

Adolescent↗
PubMed1998

Granulomas in the livers of humans and fischer rats associated with the ingestion of mineral hydrocarbons: A comparison

Ninety-day feeding studies were conducted in Fischer 344 rats using a series of highly refined mineral hydrocarbons which included mineral oils and waxes representative of those used in consumer products and food applications. The series included materials which had been refined by oleum or hydrogenation. The materials tested were representative of the range of carbon chain lengths, molecular weights, and viscosities which are currently in use. Findings revealed the presence of granulomatous lesions in the liver and histiocytosis in the lymph nodes. Some mineral hydrocarbons did not induce any lesions; others induced relatively minor effects; and a low melting point wax induced the largest lesions in both liver and mesenteric lymph nodes, with inflammation and areas of focal necrosis in the livers. The majority of lesions reported were associated with the highest dose levels used. These studies are in contrast to studies in Sprague-Dawley rats in which comparable doses did not induce similar lesions, indicating marked strain variability. Lipogranulomas associated with the ingestion of mineral oil have been reported in humans. The comparative morphology of the lesions seen in the Fischer rat study and those observed in the human are discussed and differences are highlighted. The lesions in the human are not believed to progress to lesions of clinical significance. The pathogenesis of the lesions induced in Fischer rats and in humans is discussed and it is concluded that the majority, if not all of the lesions, in the rats are of no significance for humans. The possibility that a small proportion of cases of granulomatous hepatitis in humans may represent an atypical response to mineral hydrocarbons may need further investigation. Copyright 1998 Academic Press.

Journal Article↗
PubMed1998

Granulomas in the livers of humans and Fischer rats associated with the ingestion of mineral hydrocarbons: a comparison.

Ninety-day feeding studies were conducted in Fischer 344 rats using a series of highly refined mineral hydrocarbons which included mineral oils and waxes representative of those used in consumer products and food applications. The series included materials which had been refined by oleum or hydrogenation. The materials tested were representative of the range of carbon chain lengths, molecular weights, and viscosities which are currently in use. Findings revealed the presence of granulomatous lesions in the liver and histiocytosis in the lymph nodes. Some mineral hydrocarbons did not induce any lesions; others induced relatively minor effects; and a low melting point wax induced the largest lesions in both liver and mesenteric lymph nodes, with inflammation and areas of focal necrosis in the livers. The majority of lesions reported were associated with the highest dose levels used. These studies are in contrast to studies in Sprague-Dawley rats in which comparable doses did not induce similar lesions, indicating marked strain variability. Lipogranulomas associated with the ingestion of mineral oil have been reported in humans. The comparative morphology of the lesions seen in the Fischer rat study and those observed in the human are discussed and differences are highlighted. The lesions in the human are not believed to progress to lesions of clinical significance. The pathogenesis of the lesions induced in Fischer rats and in humans is discussed and it is concluded that the majority, if not all of the lesions, in the rats are of no significance for humans. The possibility that a small proportion of cases of granulomatous hepatitis in humans may represent an atypical response to mineral hydrocarbons may need further investigation.

Animal Feed↗
PubMed1996

Astigmatism reduction: no-stitch 4.0 mm versus sutured 12.0 mm clear corneal incisions.

PURPOSE: To compare the effect on astigmatism of phacoemulsification using a 4.0 mm, no-stitch, clear corneal incision with that of extracapsular cataract extraction (ECCE) using a 12.0 mm, sutured, clear corneal incision. SETTING: Augenklinik, Städtisches Klinikum Karlsruhe, Germany. METHODS: The study comprised 211 patients who had cataract extraction and intraocular lens implantation through a superior clear corneal incision; 108 patients had phacoemulsification with a 4.0 mm no-stitch incision, and 103 had ECCE using a 12.0 mm sutured corneal incision. The main outcome measure was amount of astigmatism preoperatively and at 1 week and 3 and 6 months postoperatively. Corresponding medians (lower and upper quartiles) were evaluated. RESULTS: Median surgically induced cylinder was 1.00 diopter (D) (range 0.56 to 1.50 D) in the 4.0 mm no-stitch incision group and 1.75 D (range 1.00 to 2.62 D) in the 12.0 mm sutured incision group. In eyes with preoperative with-the-rule astigmatism, astigmatism decreased from a median of 0.75 D (range 0.50 to 1.00 D) to 0.50 D (range 0 to 1.50 D) in the 4.0 mm incision group. The difference between preoperative and postoperative astigmatism in the 12.0 mm incision group was not statistically significant. CONCLUSION: Clear corneal cataract surgery leads to a predictable reduction in astigmatism when performed on the steeper axis with a small, no-stitch incision. Larger sutured incisions are not suitable for planned refractive changes but are still recommended in certain cases such as hard cataract and glaucoma.

Astigmatism↗
PubMed1991

Even isoflurane.

Explore the source record for details and available documents.

Anesthesia↗
PubMed1989

Cost-benefit analysis of interferon alfa-2b in treatment of hairy cell leukemia.

The clinical benefits as well as the cost benefits of use of recombinant interferon (IFN) alfa-2b instead of conventional chemotherapy (primarily chlorambucil) for progressive hairy cell leukemia were assessed retrospectively on the basis of 12 months of clinical data from 128 patients treated with IFN alfa-2b. Data from 71 matched historical control patients who had received conventional treatment were used for survival analysis. Hematologic response (reversal of cytopenias) was achieved by 18% of the control patients versus 73% of the IFN-treated patients. This response was associated with virtual elimination of the need for transfusions and splenectomy as well as dramatic decreases in the frequency of fatal infections (22.5% vs. 1.6%) and the 12-month mortality rate (28% vs. 3.1%). Direct costs per patient per year for medical care (transfusions, antibiotic treatment, splenectomy, and chemotherapy) of those receiving IFN alfa-2b were 2.8-fold lower than costs for medical care of control patients ($5,027 vs. $14,046). Indirect costs, which reflect the present value of future earnings lost due to premature death, were 13.3-fold lower for IFN-treated patients than for control patients ($4,771 vs. $63,507). Our analysis demonstrates that IFN alfa-2b offers substantial clinical and cost advantages to patients with hairy cell leukemia and that the introduction of this therapy using novel biotechnology furthers the health care community's commitment to cost containment.

Adult↗
PubMed1985

Prevention of duodenal ulcers in the rat using a combination of ranitidine and sucralphate in subtherapeutic doses.

This study investigated whether ulcer prevention would be greater with the combined use of an acid-inhibiting agent, ranitidine, given together with a mucosal-protective agent, sucralphate. Duodenal ulcers were induced in rats with the secretagogues pentagastrin and bethanechol. Subtherapeutic doses of ranitidine (5 mg/kg/6 hours) and sucralphate (50 mg/6 hour) yielded an ulcer index of 4.0 and 4.1 respectively, not significantly different from the control (untreated) ulcer index of 4.3. Therapeutic doses of ranitidine (20 mg/kg) and sucralphate (200 mg/animal) gave an ulcer index of 0.4 and 0.5 respectively. Subtherapeutic doses of ranitidine and sucralphate given in combination yielded an ulcer index of 0.7. Thus, subtherapeutic doses of ranitidine and sucralphate given in combination had a synergistic effect equal to therapeutic doses of each of these drugs given alone. The therapeutic implications of combined acid inhibiting drugs with mucosal protective drugs is discussed.

Aluminum↗