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Biomedical subjects

K Neumann

Publications and source records attributed to K Neumann.

At least 73 records · Page 4Linked to original sources
PubMed1997

The McRoberts' maneuver for the alleviation of shoulder dystocia: how successful is it?

OBJECTIVE: Our purpose was to determine the rate of success of the McRoberts' maneuver as the initial treatment for shoulder dystocia and to compare the rate of maternal and neonatal morbidity with those cases of shoulder dystocia requiring additional obstetric maneuvers. A secondary goal was to assess those factors associated with successful McRoberts' maneuvers. STUDY DESIGN: A retrospective review of shoulder dystocia cases occurring between 1991 and 1994 was performed. The identified cases were divided into two groups on the basis of the maneuvers used to relieve the shoulder dystocia. The first group comprised cases in which the McRoberts' maneuver was used as the sole treatment and the second group consisted of cases in which additional maneuvers were subsequently used. Exclusion criteria included lack of documentation concerning the maneuvers used or cases in which the McRoberts' maneuver was not the initial technique used. The two groups were compared with respect to various antepartum, intrapartum, and neonatal characteristics. RESULTS: During the study period we identified 250 cases of shoulder dystocia among 44,072 vaginal deliveries, for an incidence of 0.57%. Of these, 236 cases (94%) fulfilled entry criteria. The McRoberts' position alone successfully alleviated the shoulder dystocia in 98 cases (42%). In the group of cases where the McRoberts' maneuver was the sole maneuver used, there were significantly lower mean birth weights (p = 0.008), shorter durations of the active phase of labor (p = 0.009), and shorter second stages (p < 0.0001). In the group of cases that required additional maneuvers to relieve the shoulder dystocia, there was a trend toward an increased incidence of postpartum hemorrhage and brachial plexus injury (p = 0.07). CONCLUSIONS: These data suggest that the McRoberts' maneuver is associated with a significant degree of success in relieving shoulder dystocia and may be associated with decreased morbidity compared with other maneuvers. On the basis of these findings, we recommend the McRoberts' maneuver as the initial technique for disimpaction of the anterior shoulder.

Adult↗
PubMed1997

Computed tomographic study of bone availability for facial prosthesis-bearing endosteal implants.

In a computed tomographic study, 56 patients with facial defects were examined to assess the availability of bone for extraoral Brånemark implants (3 or 4 mm long, 3.75 mm diameter) to bear facial prostheses. Bone depths were determined in the auriculotemporal (2-8 mm), infraorbital (0-10 mm), lateroorbital (8-14 mm), supraorbital (1-14 mm) and medioorbital (1-6 mm) areas as well as at the base of the nasal skeleton (1-5 mm). The low values for the supraorbital and infraorbital areas were determined at the points closest to the frontal- and maxillary sinuses, respectively. Implantation in these areas would be permissible only under certain conditions. The very thin osseous structures of the nasal region also present problems for implants. In the auriculotemporal region, the bone width is always sufficient, but at the orbital margin it can vary from 3 to 8 mm. The three-year success rates for implant survival were found to be 100% and 85.8% respectively for auricular and orbital defects. No serious skin complications were seen. Six patients (10.7%) required secondary corrective surgery in a total of 13 implant areas.

Adult↗
PubMed1997

Smoking and in vitro fertilization: a meta-analysis.

PURPOSE: Including our own data and seven relevant publications from the literature, this meta-analysis aimed to establish the influence of the status of female smokers on the clinical pregnancy rate after the first attempt at in vitro fertilization-embryo transfer (IVF-ET). METHODS: We started to collect information about our own patient's smoking habits in January 1996 to evaluate prospectively the influence on IVF success. Information regarding 799 patients (607 nonsmokers and 192 smokers) was obtained. Additionally we retrieved seven relevant publications from the unabridged MEDLINE 1982-1996. They were recalculated to first cycles, because from a biometrical point of view, only the results of the first IVF cycle are really well comparable, as the number of necessary IVF cycles always correlates with the number of pregnancies. These data were compared in the nonparametric sign test according to Dixon-Mood and calculated as relative success ratios, defined as the quotient of the probability of IVF-ET success of nonsmokers divided by that of smokers for each publication. RESULTS: This meta-analysis, based on a total of 2314 first IVF-ET treatments, showed that almost twice as many IVF-ET cycles were needed for smokers as for nonsmokers to become pregnant. For the success quotient, we obtained a ratio of 1.79, with an associated 95% confidence interval of from 1.24 to 2.59. The total analysis shows, with a P value of less than 0.01, significantly higher pregnancy rates (21%) in nonsmokers compared to smokers (14%). CONCLUSIONS: Based on the analyzed data there exists--from a statistical point of view--a significant negative effect on the chances of success for smokers to become pregnant compared to nonsmokers.

Embryo Transfer↗
PubMed1997

On the power of confession evidence: an experimental test of the fundamental difference hypothesis.

In Arizona v. Fulminante (1991), a U.S. Supreme Court majority stated that confessions are similar to, not fundamentally different from, other types of evidence. To evaluate this claim, three mock juror studies compared the impact of confessions to other common forms of evidence. In Experiment 1, participants read summaries of four criminal trials (murder, rape, assault, theft), each of which contained a confession, an eyewitness identification, character testimony, or none of the above. Significantly, the confessions produced the highest conviction rates. In Experiments 2 and 3, participants read a murder or assault trial containing all three types of evidence and made a series of midtrial judgments. Results indicated that the confession was seen as the most incriminating, followed by the eyewitness and character testimony. Although the comparisons we made are limited in certain respects, our findings suggest that confessions are uniquely potent.

Analysis of Variance↗
PubMed1997

[CT volumetry of the liver before transplantation].

PURPOSE: Purpose of the study was to assess the predictive accuracy of preoperative CT volumetry for water displacement volume after liver transplantation. METHODS: In a retrospective study the liver volume of 52 patients who underwent an orthotopic liver transplantation, was calculated preoperatively based on incremental and spiral computed tomography (CT). The calculated values were compared with the liver volume measured by water displacement and weight of the extirpated liver. RESULTS: Marked differences of 19-21.5% were seen between calculated CT volume and water displacement volume for the entire group, and of 12.4-16.9% for livers with a plausible physical liver density (0.9 and 1.1 g/cm3). In this group, 68-86% of the livers were in the acceptable tolerance range for a predictive accuracy (+10% to -20%). Other error sources, such as the breathing shift of the abdominal organs and interobserver variability (1.5-2.7%), were of minor importance for volume calculation. CONCLUSION: In conclusion, both incremental CT and spiral CT are reliable methods for the preoperative estimation of the liver volume, whereas best accordance with the corrected water displacement volume was obtained using the individual segmentation thresholds.

Adolescent↗
PubMed1997

Heat treatment results in a loss of transgene-encoded activities in several tobacco lines.

Heat treatment (37 degrees C) of transgenic tobacco (Nicotiana tabacum) plants led to a reversible reduction or complete loss of transgene-encoded activities in about 40% of 10 independent transformants carrying the luciferase-coding region fused to the 355 cauliflower mosaic virus or the soybean small subunit promoter and the nopaline synthase promoter driving the neomycin phosphotransferase gene, whereas the other lines had temperature-tolerant activities. Temperature sensitivity or tolerance of transgene-encoded activities was heritable. In some of the lines, temperature sensitivity of the transgene-encoded activities depended on the stage of development, occurring in either seedlings (40% luciferase and 50% neomycin phosphotransferase) or adult plants (both 40%). The phenomenon did not correlate with copy numbers or the homo- or hemizygous state of the transgenes. In lines harboring a temperature-sensitive luciferase activity, reduction of bioluminescence was observed after 2 to 3 h at 37 degrees C. Activity was regained after 2 h of subsequent cultivation at 25 degrees C. Irrespective of the reaction to the heat treatment, the level of luciferase RNA was slightly increased at 37 degrees C. Only in lines showing temperature sensitivity of transgene-encoded activities was the amount of luciferase and neomycin phosphotransferase strongly reduced. In sterile culture, heat treatment for 15 d did not cause visible damage or changes in plant morphology. In all plants tested a slight induction of the heat-shock response was observed at 37 degrees C.

Cell Line↗
PubMed1997

[Imaging methods in diagnosis of pheochromocytoma].

In the radiological evaluation of adrenal masses today computed tomography (CT) has the highest sensitivity of all imaging modalities for tumor detection. In addition, CT is able to assess potential concomitant processes in the surrounding tissues. Magnetic resonance imaging (MRI) is the method of choice, when adrenal masses cannot be differentiated by CT. When chemical-shift imaging, fat-suppression, and dynamic contrast-enhanced sequences are used for tissue characterization, pheochromocytomas can be distinguished from adenomas. Due to the multiplanar imaging ability MRI is optimal for the preoperative work-up of the anatomical situation in patients with adrenal masses. Extraadrenal paragangliomas can be assessed with MRI, too. Ultrasound is of minor relevance in the assessment of pheochromocytomas and other adrenal masses, as is angiography, which is only carried out in special cases to evaluate the vascular supply.

Adrenal Gland Neoplasms↗
PubMed1997

[CT angiography of the pulmonary artery in patients with bronchial carcinoma].

The aim of the study was to evaluate 3D computed tomography (3D-CT) for the visualization of tumor extent with respect to the infiltration of the pulmonary arteries in patients with locally advanced small and nonsmall-cell lung cancer. A total 61 examinations in 40 patients with bronchial carcinoma were performed with contrast-enhanced (150 ml injected with 4 ml/s after bolus tracking) 2 mm spiral CT (pitch 1.5, increment 1 mm) (Somatom Plus4, Siemens AG, Germany). Using the implemented software cine mode, surface shaded display (SSD), and maximum intensity projection (MIP), reconstructions of the pulmonary arteries and the tumors were generated. In comparison to conventional spiral thoracic CT, the optimized cross-sectional images of the mediastium represented a benefit with the technique described, and this can help to diagnose vessel infiltration and may therefore be of value for pre- and post-therapeutic staging in modern stage-adapted multimodality treatment programs.

Angiography↗
PubMed1996

Initial clinical experience with spiral CT and 3D arterial reconstruction in intracranial aneurysms and arteriovenous malformations.

We studied 32 consecutive patients with known or suspected cerebrovascular abnormalities studied with spiral CT following a intravenous bolus injection of iodinated contrast medium with a power injector. Flow was 3 or 4 ml/s. In an attempt to define the appropriate delay time and scan duration a cranial angio-CT without table increment was performed on 10 patients. Enhancement was measured by manually placed regions of interest within the left middle cerebral artery and the inferior sagittal sinus. All patients except one had intraarterial angiography (DSA) for comparison. In 6 patients with an arteriovenous malformation (AVM) follow-up was possible after one and/or two embolisation procedures. These patients had plain and contrast-enhanced spiral CT. The diagnosis was aneurysm in 9 (8 berry aneurysms, one giant fusiform aneurysm), AVM in 13 (all supratentorial) and traumatic arteriovenous fistula in one. In 9 patients there were no detectable pathological vascular findings. After 3D reconstruction the size (between 5 and 28 mm), location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs and the distribution of the embolisation material could be demonstrated clearly. The main feeding vessel(s), nidus and draining veins were reliably shown. The decreased extent of the AVMs after embolisation was clearly demonstrated. There was no difference in diagnosis when DSA and 3D-CT were compared by two independent radiologists. We consider arterial spiral CT with 3D reconstruction to have the potential of offering important diagnostic information for the treatment of intracranial AVMs and aneurysms.

Adult↗
PubMed1996

Expression and potential role of E-cadherin in pancreatic carcinoma.

CONCLUSION: Our results indicate that loss of E-cadherin might be associated with a more invasive phenotype in pancreatic cancer. BACKGROUND: A reduced expression of the calcium-dependent E-cadherin cell-cell adhesion molecule on tumor cells has been described as an important factor for tumor invasion and metastasis. METHODS: Pancreatic tissues (carcinoma, chronic pancreatitis, and normal) as well as 12 pancreatic tumor cell lines were investigated for E-cadherin expression by immunohistochemistry. To correlate the motility of pancreatic tumor cells in vitro with E-cadherin expression, we used a Boyden chamber assay. RESULTS: In pancreatic carcinoma tissues, diffuse growing tumor cells showed a decrease or loss of E-cadherin expression, whereas in areas of compact tumor growth, only a slight decrease of E-cadherin was observed compared to normal pancreas or chronic pancreatitis. No correlation between the E-cadherin expression and the grading of the tumor cells, the tumor stage, or the disease progression was detectable. Of four tumor cell lines that migrated in the Boyden chamber, three were predominantly E-cadherin negative. In contrast, seven of eight cell lines that did not migrate in vitro revealed E-cadherin expression.

Adult↗
PubMed1996

Expression of bcl-2--protein in small cell lung cancer.

The expression of the proto-oncogene bcl-2, whose main function appears to be an inhibition of apoptosis, was investigated in 164 cases of primary small cell lung cancer by means of immunohistochemistry in a retrospective analysis. One-hundred twenty-five cases (76%) demonstrated expression of bcl-2. There was no difference in serum LDH levels and proliferative activity between the two groups. An analysis revealed a median survival time of 12 months for patients with bcl-2 positive tumors compared to 9.5 months for patients with bcl-2 negative tumors. Although statistical significance is not achieved, there is a trend towards longer survival in patients whose tumors express bcl-2. This tendency is also reflected by a higher rate of complete remission after chemotherapy: 40% in patients with bcl-2+ tumors versus 27% in patients with bcl-2- tumors. In multivariate analysis, tumor stage followed by Karnofsky index were the most valuable predictors for complete remission. LDH and tumor stage were most predictive for 1-year survival. Bcl-2 expression is frequent in SCLC and may reflect a less aggressive mechanism of transformation and a higher susceptibility to cytostatic treatment.

Adult↗
PubMed1996

Influence of different volume therapies and pentoxifylline infusion on circulating soluble adhesion molecules in critically ill patients.

OBJECTIVE: To study the influence of long-term volume therapy with different solutions and continuous administration of pentoxifylline on plasma concentrations of circulating adhesion molecules. DESIGN: Prospective, randomized study. SETTING: A surgical intensive care unit (ICU) of a university hospital. PATIENTS: Forty-two patients with sepsis secondary to major surgery were included. INTERVENTIONS: The patients were randomly separated into three groups. In group 1 (n=14), volume therapy was exclusively carried out with 10% low-molecular-weight hydroxyethyl starch solution. In group 2 (n=14), patients exclusively received 20% human albumin for volume therapy. In group 3 (n=14), volume therapy was not defined and pentoxifylline was continuously given (1.4 mg/kg/hr iv). MEASUREMENTS AND MAIN RESULTS: From arterial blood samples, plasma concentrations of soluble adhesion molecules (endothelial leukocyte adhesion molecule-1 [soluble ELAM-1], intercellular adhesion molecule-1 [soluble ICAM-1], vascular cell adhesion molecule-1 [soluble VCAM-1], and soluble granule membrane protein-140) were serially measured on the day of admission to the ICU ("baseline" value) and during the next 5 days at noon. No significant differences between the three groups were found for macrohemodynamics. Soluble ELAM-1, soluble ICAM-1 and soluble VCAM-1 plasma concentrations were markedly higher than normal values at baseline in all groups. In the hydroxyethyl starch group, soluble ELAM-1 plasma concentration decreased to the normal range, whereas it further increased in the human albumin group and was almost unchanged in the pentoxifylline group. During the study period, soluble ICAM-1 and soluble VCAM-1 plasma concentrations remained unchanged in the hydroxyethyl starch group. However, these concentrations increased in the other groups. Soluble granule membrane protein-140 increased significantly only in the human albumin group (483 +/- 103 to 683 +/- 94 ng/mL). In the hydroxyethal starch-treated patients, Acute Physiology and Chronic Health Evaluation II score decreased significantly (from 24.3 +/- 3.4 at baseline to 17.0 +/- 3.3 at the end the study period). Only PaO2/FIO2 was correlated to plasma concentrations of adhesion molecules. CONCLUSIONS: Sepsis is associated with markedly increased plasma concentrations of adhesion molecules, indicating endothelial activation or damage. By long-term volume therapy with hydroxyethal starch solution, these concentrations remained unchanged or even decreased, whereas in patients in whom human albumin was infused or pentoxifylline was given continuously, plasma concentration of soluble adhesion molecules further increased.

Aged↗
PubMed1996

Influence of recombinant human erythropoietin therapy on in vivo chemotaxis and in vitro phagocytosis of polymorphonuclear cells of hemodialysis patients.

Recombinant human erythropoietin (rhu-EPO) mainly stimulates erythropoiesis, but also influences the production and function of polymorphonuclear granulocytes (PAN). We evaluated the influence of rhu-EPO therapy in patients on maintenance hemodialysis without iron overload on both phagocytic and chemotactic activity of polymorphonuclear leukocytes (PMN) obtained from blood and a skin chamber. The study comprised 28 dialysis patients (15 females, 13 males, age 22-78 years, dialysis sessions three times weekly 4-5 h, mean duration of dialysis treatment 4-99 months) and 20 healthy subjects (9 females, 11 males, age 18-56 years). The absolute number of leukocytes in the peripheral blood, the leukocyte mobilization (chemotactic activity) and the phagocytic activity of PMNs were tested in patients before (n = 28), and after (n = 18) reaching the target hematocrit of 30% and during the follow-up period. No alteration in the total leukocyte number (PMN, monocytes, lymphocytes) in the peripheral blood during rhu-EPO therapy could be seen. The phagocytic activity of PMNs slightly improved during the follow-up period whereas the decreased chemotactic activity remained unchanged.

Adolescent↗