Biomedical subjects

K Leder

Publications and source records attributed to K Leder.

16 recordsLinked to original sources

PubMed1998

Home-based treatment of cellulitis with twice-daily cefazolin.

OBJECTIVE: To assess the clinical outcome and pharmacokinetics of therapy with cefazolin for patients with cellulitis in a hospital-in-the-home (HIH) program. DESIGN: Observational study with outcome data compared with previously published reports of therapy for cellulitis. SETTING: A university teaching hospital and HIH unit, July 1996-December 1997. PARTICIPANTS: Patients with cellulitis were eligible for inclusion provided their medical condition was stable, they did not require surgical intervention, and their social circumstances allowed home-based therapy. INTERVENTION: Cefazolin 2 g intravenously twice daily, with regular nursing and medical assessment. MAIN OUTCOME MEASURES: Clinical efficacy; peak and trough serum concentrations of cefazolin. RESULTS: Fifty-seven patients (37 were men) with a mean age of 48 years (range, 18-90 years) had 61 episodes of moderate to severe cellulitis (41, lower limb; 17, upper limb; and three, face). They received a median of 11 doses of cefazolin (range, 3-27 doses). Clinical outcomes were: cure in 54, improvement in one, treatment failure in three, and in the remaining three episodes the outcome was indeterminate. Cefazolin concentrations were measured in 27 patients. All peak concentrations were more than 40 micrograms/mL, while trough concentrations were all above the MIC90 of the expected pathogens: median, 3.2 micrograms/mL (range: 0.4-18.5 micrograms/mL). Cefazolin was well tolerated. CONCLUSIONS: Twice-daily cefazolin 2 g intravenously is a convenient and effective option for home-based treatment of patients with cellulitis. Its clinical efficacy is comparable with other treatment regimens.

Administration, Oral↗

PubMed1998

[Partial sphincterectomy in cataract surgery. Clinical and patho-histologic results].

BACKGROUND: We perform partial sphincterectomy during cataract surgery in cases with very small pupil (< 3 mm). We assume that the small pupil is mainly due to a fibrosis ring of the sphincter muscle. PATIENTS: In 35 patients we performed the complete ophthalmological routine checkup. The pupil diameter was analysed by perimeter: a base value, with light, and in pharmaceutical mydriasis. Moreover 15 preparations were analysed histologically. RESULTS: Average pupil diameter was: base value 3.76 mm, with light 3.24 mm, in pharmaceutical mydriasis 4.84 mm. The showed pathohistological examination that in all excisions a part of the sphincter muscle was verifiable. We found fibrosis of different grades in various locations. CONCLUSION: In most cases functional pupil movement can be verified after operation. In an intended partial sphincterectomy part of the sphincter muscle can be excised. The different pupil diameter is due to the different degree of fibrosis of the sphincter muscle.

Adult↗

PubMed1998

Microsporidial disease in HIV-infected patients: a report of 42 patients and review of the literature.

Microsporidiosis is recognized as an increasingly important infection, particularly in patients with human immunodeficiency virus (HIV) infection. In this retrospective study we have reviewed the clinical features, laboratory findings and management of 42 HIV positive patients co-infected with microsporidia. All patients had spores identified in faeces stained with a modified trichome blue stain. Patients were all markedly immunosuppressed (median CD4 20 cells/microl). Common symptoms included weight loss, diarrhoea, abdominal pain, anorexia and nausea. 29 patients were diagnosed with Enterocytozoon bieneusi infection; 13 were infected with Encephalitozoon intestinalis, and disseminated disease was confirmed in 8. Albendazole therapy in patients with E. intestinalis (but not E. bieneusi) resulted in good clinical response.

Adult↗

PubMed1998

"Flexispira rappini" bacteremia in a child with pneumonia.

We describe a case of "Flexispira rappini" bacteremia from a 9-year-old girl who presented with a 5-day history of fever, productive cough, and malaise. A chest X-ray result was compatible with right middle lobe pneumonia. Blood culture grew a gram-negative spiral fusiform bacterium 2 days after the inoculation. Biochemical tests showed the organism to be catalase negative, oxidase positive, sodium hippurate hydrolysis negative, and urea hydrolysis negative. 16S rRNA gene sequencing identified this organism as "F. rappini," showing a six-base substitution from the type strain. This is the first report of "F. rappini" bacteremia in a human, suggesting that this organism has the potential of causing invasive infection, but its role in pneumonia is uncertain and could be unrelated to the bacteremia.

Bacteremia↗

PubMed1998

Polymorphism within the cyclin D1 gene is associated with prognosis in patients with squamous cell carcinoma of the head and neck.

We have examined the correlation of a frequent A/G polymorphism within exon 4 of the cyclin D1 gene (CCND1) with genetic susceptibility and clinical outcome in 384 patients with squamous cell carcinoma (SCC) of the head and neck. CCND1 genotype frequencies were similar in the cases and 191 controls. Furthermore, the CCND1 genotype was not associated with susceptibility to SCC of the larynx, pharynx, or oral cavity. The influence of the CCND1 genotype on clinical outcome was also assessed. We found no correlation between genotype and tumor size (T1-T4), the involvement of nodes at presentation, or patient age and gender. However, the distribution of CCND1 genotypes in cases with poorly differentiated tumors was significantly different to that in patients with well-/moderately differentiated tumors (P = 0.016; chi2(2) = 8.71). Homozygosity for CCND1*G (GG genotype) was associated with poorly differentiated tumors (G3). We used Cox's proportional hazards model to investigate the influence of the CCND1 genotype on disease-free interval. CCND1 GG was associated with reduced disease-free interval [P = 0.001; hazard ratio (HR) = 2.95; 95% confidence interval (CI) = 1.54-5.63]. This remained significant after correction for tumor differentiation (P = 0.013; HR = 2.34; 95% CI = 1.2-4.6) and tumor stage (P = 0.005; HR = 2.64; 95% CI = 1.34-5.19). Analysis of the data from patients with tumors at different sites showed that the CCND1 GG genotype was associated with reduced disease-free interval in laryngeal (P = 0.004; HR = 3.63; 95% CI = 1.44-8.83) and pharyngeal (P = 0.006; HR = 3.48; 95% CI = 1.43-8.46) tumors. This is the first report of an association between CCND1 polymorphism and prognosis in SCC of the head and neck. These data show that the CCND1 GG genotype is an independent prognostic indicator of disease-free interval and supports initial observations in non-small cell lung cancer, that polymorphism within CCND1 influences tumor behavior.

Adult↗

PubMed1997

A pretransplant infection with precore mutants of hepatitis B virus does not influence the outcome of orthotopic liver transplantation in patients on high dose anti-hepatitis B virus surface antigen immunoprophylaxis.

Hepatitis B virus (HBV) infection of the liver graft is a major complication after orthotopic liver transplantation (OLT) for HBV-related cirrhosis. A high viral load before OLT is a known risk factor, whereas the relevance of precore mutants of HBV is a subject of controversy. The aim of this study was to correlate the pretransplantation viral load and a pretransplantation infection with precore mutant HBV (pmHBV) or wildtype HBV (wtHBV) with allograft damage, graft failure, and survival after OLT. Sixty-nine patients with HBV cirrhosis underwent OLT under high dose immunoprophylaxis with anti-hepatitis B surface (HBs) hyperimmunoglobulins (HBIg). A pretransplantation infection with pmHBV and wtHBV was detected by polymerase chain reaction (PCR) and direct sequencing in 30 patients each (pmHBV and wtHBV group). Nine of 69 patients were PCR-negative (noHBV group). Median pretransplantation levels of HBV DNA assessed by hybridization assay were 42 pg/mL for pmHBV and 54 pg/mL for wtHBV patients. HBV recurred in 17 of 30 (57%) of pmHBV and in 14 of 30 (47%) of wtHBV patients and graft failure occurred in 6 of 30 (20%) of pmHBV and 7 of 30 (23%) of wtHBV patients. Neither HBV recurrence nor graft failure occurred in patients in whom no HBV DNA could be detected by PCR using primers flanking the HBV precore region (noHBV) patients. Allograft damage assessed by histology activity index (HAI) scoring was median 6 for pmHBV and 7 for wtHBV patients. Cumulative survival after 5 years was 72% for pmHBV, 74% for wtHBV, and 100% for noHBV patients. In this study, we provide evidence that pretransplantation viral load, but not infection with pmHBV, determines the outcome after OLT in patients on high dose HBIg prophylaxis.

Adult↗

PubMed1994

The effect of FK506 versus cyclosporine on glucose and lipid metabolism--a randomized trial.

In order to evaluate the effect of cyclosporine (CsA) versus FK506 on glucose and lipid metabolism, an oral glucose tolerance test (OGTT) was performed in 101 patients after orthotopic liver transplantation (OLT) (mean interval after OLT: 511 days). The liver graft recipients had been randomized prospectively to two groups prior to OLT to receive either immunosuppression with CsA, azathioprine, and corticosteroids (CsA group) or FK506 and corticosteroids (FK group). Along with the OGTT, serum insulin, insulin C-peptide and glucagon as well as serum lipids were monitored. There was no statistically significant difference in the occurrence of impaired glucose tolerance (IGT) or manifest diabetes mellitus disease between the two groups. In fact, not a single patient developed new-onset diabetes in any group. In male and female patients, serum levels of cholesterol and triglycerides increased significantly under FK506 and CsA treatment after OLT. Cholesterol was significantly higher in the CsA group in men, in women this was marked, but not significant. While triglycerides were significantly higher in women on CsA treatment, there was no such difference in men. In conclusion, both CsA and FK506 proved to have similar effects on glucose metabolism, while there was a different spectrum of serum lipid alterations.

Adolescent↗

PubMed1994

[Osteonecrosis].

The causes of osteonecrosis are varied. The pathogenesis of osteonecrosis subsequent to trauma is well known. Furthermore, an association of this disorder with cortisone, haemoglobinopathies, rare metabolic diseases, and risk factors seems to be evident. However, a sizable proportion of patients have osteonecrosis in which none of these associations exists, referred to as idiopathic osteonecrosis. Generally, intraosseous vascularization represents the common pathway for the various causes of the disease. The prognosis is influenced by the age of the patient, the location of the necrosis and the stage of the disease at the time of diagnosis. In recent times diagnosis has been improved by the use of modern imaging modalities, and MR imaging is now widely accepted as the imaging method of choice. It not only allows early diagnosis but also yields exact staging information in advanced disease, which is a requirement for adequate therapy.

Adult↗

PubMed1994

[The non-traumatic femur head necrosis in the adult. I: pathophysiology, clinical picture and therapeutic options].

Intraosseous vascularization is the common pathway of the multifactorial causes of avascular necrosis of the hip (AVN). Recurring ischemic phases could lead to bone necrosis in the initial stage of the disease, when it is still reversible. A spontaneous repair mechanism can lead to complete healing at this stage. The necrotic area demarcates the superior-anterior aspect from the residual femoral head with a reactive interface in the irreversible early stage of the disease. In this stage damage to the femoral head can only be delayed with core decompression or femoral osteotomy, because a sufficient repair mechanism is no longer possible. When the articular surface collapses the early stage gives way to the late stage. Cartilage incongruence and microfracture lead to progressive destruction of the femoral head and to secondary osteoarthritis. In this late stage femoral osteotomy is only successful in carefully selected patients. Total hip replacement is the last resort for patients with painful destruction of the joint. As clinical symptoms are unspecific, MRI plays an important role for early diagnosis of AVN in the initial or early stages. Conservative treatment is not successful in any of the three stages of the disease.

Adult↗

PubMed1993

[Bone marrow edema--an early form of femur head necrosis].

We examined 15 patients (16 hips) with painful hips whose radiographs were either normal (n = 9) or showed a minimal decrease in radiodensity (n = 7). The available bone scintigrams of 9 cases were positive. T1-weighted images visualised a diffuse signal loss of the bone marrow in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions were hyperintensive on T2-weighted images. Focal anomalies were not seen in any of the cases. All patients underwent core decompression treatment. Histology of 13 hips confirmed not only the presence of bone marrow oedema but of bone changes corresponding to those of avascular necrosis. Follow-up examinations with MR after core decompression showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for identifying bone marrow oedema. Due to our histological results bone marrow oedema should be included in the differential diagnosis as an early stage of necrosis of the hip.

Adult↗

PubMed1993

[Femur head necrosis and bone marrow edema syndrome in pregnancy].

MR examinations were performed in 9 patients suffering from severe pain of the hip during the third trimenon without any relief after birth. Pathologic signal changes could be observed in 11 hips (oedema in the region of the femoral head and neck (n = 8); avascular necrosis of the femoral head surrounded by bone marrow oedema (n = 3)). In 7 hips a relatively rapid decrease of the oedema following core decompression was demonstrated. Focal necrosis, however, did not show any changes. In two patients, treated conservatively, markedly delayed healing was evident. MR imaging is the modality of choice for early diagnosis as well as follow-up of therapy of the bone marrow oedema syndrome or avascular necrosis and can be performed already during pregnancy.

Adult↗

PubMed1993

Bone-marrow oedema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression.

Bone-marrow oedema syndrome (BMOS) of the hip gives a characteristic MRI pattern, in association with severe pain, non-specific focal loss of radiological density and a positive bone scan. In our MRI-controlled study, nine patients with non-traumatic BMOS in ten hips all had core decompression. Bone-marrow pressure measurements and intraosseous venography in five cases showed pathological values. All patients had immediate relief of pain, with return of MRI signals to normal after three months. Regular review was continued for at least 24 months with serial clinical radiological and MRI assessment. At a mean follow-up of 33 months all patients remained free of pain with normal radiographs and MR scans. The histological evaluation of undecalcified sections obtained from eight core decompressions confirmed the presence of bone-marrow oedema, with necrotic and reparative processes involving bone and marrow similar to those of early avascular necrosis but with no evidence of 'osteoporosis'. These findings support the assumption that BMOS may be the initial phase of non-traumatic avascular necrosis. In most patients BMOS will have a self-limiting course, but the duration of symptoms may be reduced by core decompression treatment.

Adult↗

PubMedDate not supplied

[Results of medullary space decompression in the early stage of so-called idiopathic femur head necrosis].

The results of 47 cases of core decompression in 42 patients with stage I and stage II (according to Ficat) avascular necrosis of the femoral head who had been followed up for a minimum of two years were subjected to retrospective analysis. All these cases involved so-called "idiopathic necrosis" of the head of the femur including patients with risk factors (alcohol abuses, lipometabolic disorders and hyperuricemia). 87% of the 30 stage I hip joints showed no radiological signs of deterioration and could also be classified as clinically successful (average follow-up time 47 months (24-100 months). After an average follow-up period of 38 months (24-86 months), 41% of the 17 stage II hip joints had to be classified radiologically as failures. A good clinical or radiological result could be achieved in 59% of these cases. This procedure has proved to entail low risk, and can be recommended as the first choice of therapy at early stages of necrosis of the head of the femur.

Adult↗

PubMedDate not supplied

[The Akin-New method for surgery of hallux valgus. 1-year results of a covered surgical method].

A new technique of operation on hallux valgus according to the method of Akin (1925) was introduced to us by Dr. Theodore O. New in 1983. From small skin incisions the removal of the bunion and a corrective osteotomy of the phalanx are accomplished. The results of the operation in 72 out of a total of 77 operated feet one year after operation are reviewed. By the patients 40 (55%) of the results were judged as excellent (A), 23 (32%) as good (B) and 9 (13%) as not satisfying (C). The results of objective assessment were less favorable. 11 (15%) excellent (A) and 34 (48%) good (B) were opposed by 27 (37%) non satisfying results. These are attributed to the stringent rules of judgment and the lack of experience in suitable indications. Saving the metatarsophalangeal joint, minimal postoperative pain and early rehabilitation are advantages of this technique.

Adult↗

PubMedDate not supplied

Bone marrow edema of the hip: MR findings after core decompression.

Magnetic resonance imaging is an extremely sensitive technique for evaluation of bone marrow changes at an early stage of avascular necrosis (AVN) of the hip. We therefore examined 11 painful hips whose clinical symptoms led us to suspect idiopathic AVN. The radiographs of all of these either were normal or demonstrated a minimal decrease in radiodensity. Magnetic resonance demonstrated diffuse signal loss of the bone marrow at short TR/TE images of the femoral head in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions turned iso- to hyperintense on long TR/TE images compatible with bone marrow edema (BME). Focal abnormalities characteristic for AVN were not seen in any of the cases. Radionuclide studies performed in six cases were positive. All patients underwent core decompression treatment. Hydrostatic bone marrow pressure measurement and intraosseous venography were positive in five cases when measured. Histology available in eight cases confirmed the presence of BME. Furthermore, the bone changes corresponded to those of early AVN. Follow-up examinations after core decompression with MR showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for BME and can monitor the therapeutic success of core decompression. Whether BME of the femoral head constitutes a distinct transient syndrome or represents an early form of AVN is controversial at present. Our findings support those who believe that BME may represent an initial stage of idiopathic AVN.

Adult↗

PubMedDate not supplied

[The DA240-4 discrete biochemical autoanalyser].

The principle of operation, design and main technical characteristics are described of a discrete biochemical autoanalyzer DA240-4 jointly elaborated by the USSR and GDR. This unit can be employed in big biochemical laboratories and in prophylactic institutions.

Autoanalysis↗