Biomedical subjects
Publications and source records attributed to M Bauer.
Specific binding of ATP to bovine serum albumin (BSA) is demonstrated employing ATP derivatives spin-labeled at either N6 or C8 of adenine ring or at the ribose moiety. Based on a 1:1 stoichiometry binding constants are in the 50-100 microM range. Binding is largely competitive with ATP or stearic acid. A small fraction of the labeled nucleotides could not be liberated by these ligands. Binding of AMP is in the millimolar range, only.
A questionnaire was mailed to 30 owners of paraplegic dogs who had been caring for their dogs at home for 3 to 72 months. It was designed to collect information on demographic variables, duration of ownership and paralysis, age of the pet, pet/owner relationship, owner expectations and perceptions of the pet's quality of life, problems the pet experienced, effect that maintaining a paralyzed pet had on the owners' quality of life, and whether use of a cart was beneficial. Significant correlation was found between prior expectations that the pet would lead a high-quality life and perception that the pet, in fact, had a high quality of life during paralysis (r2 = 0.61, P = 0.01). Owners who had anticipated that extra work would be necessary to care for their paraplegic dog had a more positive attitude toward home care (r2 = 0.55, P = 0.03). Overall, owners involved in the study were satisfied with all aspects of maintaining paraplegic dogs at home. Our findings support the feasibility of dedicated owners successfully maintaining small (average body weight, 9 kg) paraplegic dogs at home for extended periods.
Seventy-three dermotomy-fasciotomies (DFs) were performed in 68 patients from 1986 to 1991. A database record was compiled on each patient. Variables included age, mode of injury, method of initial wound closure, and associated injuries. A multivariate stepwise logistic regression analysis was performed to determine which variables were associated with wound complications. Thirty-eight percent of patients who underwent DF developed wound complications. One hundred percent of those patients with postoperative arterial or graft thrombosis developed wound complications (p less than 0.01) as did 78% of those with thromboembolic disease (p less than 0.05). Conversely, only 5% of those who underwent closure of their DF wounds utilizing skin grafts developed wound complications (p less than 0.01) as compared with 51% of those who underwent secondary or primary closure only. Subsequent analysis of the remaining patients, excluding those with severe soft tissue injury, showed an association between location of DF (upper versus lower extremity) and the development of wound complications that approached statistical significance (p less than 0.06). DF is frequently necessary in the treatment of patients with compartment syndrome but is associated with significant morbidity. This study suggests that closure of DF wounds utilizing skin graft allows for continued osteofascial decompression while concomitantly minimizing invasive sepsis.
Between Oct. 1987 and Oct. 1991 150 patients of the Frauenklinik Freiburg were examined by MR pelvimetry (MRI), 135 of which were "ante partum", i.e. just before delivery. The indications were: earlier operative or strongly protracted delivery, clinical suspicion of disproportion between head and pelvis, or obstetrical "problem pelvis" indicated by manual pelvic examination or ultrasonic foetometry. Previous experimental measurements with a phantom and the comparison with conventional radiograms by Guthmann and Martius of 10 patients in puerperium have shown, that the mean divergence was +/- 2 mm, the maximum divergence 5 mm. The MRI method for pelvimetry "ante partum" or in childbed, proved to be a method of high accuracy and a very good option to judge the pelvic shape, whilst being well accepted by the patients. Furthermore, it allows to determine the foetal BIP (biparietal head-diameter), to judge the pelvic soft-tissue, as well as the visualisation of the birth canal, all without any exposure to radiation. MR pelvimetry is thus part of today's clinical routine. The disadvantages are still the high costs as well as the fact, that only few centres have access to MRI equipment. Nevertheless, the pelvimetry "post partum" can be safely practised radiologically due to the very low radiation exposure.
Between November 1987 and May 1991 217 stereotactic examinations of the breast were performed in the Breast Clinic of the University of Freiburg, including 136 stereotactic biopsies and 81 localisations. Indications were localisation of lesions which were only visible in one plane on mammography, preoperative definition of lesions which could be recognised only by mammography, cytological confirmation of benign lesions and preoperative cytological confirmation of malignant lesions before carrying out conservative resections. Cytological diagnosis was possible in 81 patients (59%) (1988-26%, 1989-67%, 1990-74% and up to May 1991-80%). All carcinomas diagnosed cytologically were confirmed histologically (8 cases with a diameter up to 5 mm). Comparison of the preoperative diagnosis (81 cases) with histological findings showed a high proportion of grade 2 and 3 proliferative mastopathies and papillomatoses (45 patients = 81%).
We performed a prospective study of the type, frequency, temporal profile, and prognostic role of cerebrovascular complications in 86 adults with bacterial meningitis. Cerebral angiography was performed in 27 patients (31.4%) who had focal deficits either clinically, on cranial CT, or both, and in patients who had persistent coma without explained cause despite 3 days of antibiotic therapy. Alterations of the vessel systems, including involvement of major arteries at the base of the brain, medium-sized arteries, small vessels, and major sinuses and cortical veins, were present in 13 of the 27 patients who had angiography. Typical cerebrovascular complications were arterial narrowing of the supraclinoid portion of the internal carotid artery; vessel wall irregularities, focal dilatations, and occlusions of distal branches of the middle cerebral artery; focal abnormal parenchymal blush; and thrombosis of the sagittal superior sinus and cortical veins. Prognosis for those patients with cerebrovascular complications was unfavorable. Six patients died, one remained in a vegetative state, four were moderately or slightly disabled, and only two recovered completely. The study showed that angiographically documented cerebrovascular complications are the most frequent intracranial complications in bacterial meningitis of the adult (37.1%) and are major determinants in the prognosis of this disease.
In a prospective randomized trial, two methods of internal fixation of femoral neck fractures were compared. Totally, 179 patients with 180 fractures were treated with either two Uppsala screws (n 96) or two Hansson pins (n 84). In all, 130 fractures were primarily displaced (Garden stages III and IV), whereas 88 percent of the fractures in both groups were well reduced. The patients were followed clinically and radiographically for 1 year. Thirty-six patients died within 12 months after the operation. The functional results and the incidence of segmental collapse and nonunion did not differ between the groups. However, at the 4-month follow-up, 2 of 59 of the Garden's stages III and IV in the Uppsala-screw group were found displaced, whereas the corresponding result in the Hansson-pin group was 9 of 52 (P = 0.03).
Because of small direct contact to the fracture fragments reduction of metatarsal fractures can be achieved only indirectly by applying traction to the toes. In this article a method for simple direct manipulation of the distal main fragment of metatarsal fractures is described: A K-wire is drilled in dorsi plantar direction across the head of the fractured metatarsal and mounted on a traction bow. In this manner the distal fracture fragment can be moved in all directions and placed exactly onto the proximal fragment. All 8 patients with multiple metatarsal fractures could be treated by closed reduction and percutaneous pinning. The described method allows simple and precise reduction of metatarsal fractures, reduced x-ray exposure of the surgeon's hand by short operation times, and manipulation for fracture reduction outside the x-ray beam.
Thirty-one patients with osteochondritis dissecans of the capitellum humeri were followed for an average of 23 years. There were symptoms in about half of the elbows at the follow-up examination. Impaired motion and pain on effort were the most common complaints. Roentgenographic signs of degenerative joint disease were present in more than half of the elbows and correlated with a reduced range of motion. The diameter of the radial head increased in comparison with the contralateral elbow in two thirds of the patients.
From 12. 1988 to 6. 1990 we carried out on 27 patients at the Department of Gynaecology of the University of Freiburg an open study to compare the two water-soluble, nonionic, monomeric contrast agents (Iopamidol-300 corresponding to Solutrast-300 and Iopamidol-370 corresponding to Solutrast-370) with different osmolality (616 mosm/kg H2O resp. 799 mosm/kg H2O) and concentration (300 mg I/ml resp. 370 mg I/ml). It is a remarkable fact that the contrast quality in the x-rays was higher for Iopamidol-300. Complications such as hypersensitivity reactions or local irritations were not recorded. Iopamidol-300 was found to be the best tolerated of the two contrast media in respect of mildest intensity of pain.
In a severe traumatized patient (34 years old, 182 cm tall, 90 kg body wt.), we inserted a Swan-Ganz catheter (110 cm, 5 lumina, Modell 93A-831-7.5F, Baxter Healthcare) via the right internal jugular vein. Infusion was started using the proximal lumen. Several hours later we observed a large swelling on the right side of the neck and the supraclavicular region due to paravasal fluid administration while recording normal pulmonary artery and wedge pressure curves. The reasons and consequences are discussed.
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This article describes a new design, phase ILE/II dose searching, used in four prospective, randomized, multicenter clinical trials of escalating total doses of hyperfractionated radiation. This design combines an experimental protocol with a statistical application of ranking and selection theory. Its purpose was to identify (within a certain margin of error) a dose that achieved the highest rate of clinical response from a set of doses that were tolerable in terms of both acute (within 90 days) and late (more than 90 days) toxic effects (LE). We calculated the number of patients required to reliably test toxicity under various assumptions. To determine the maximum tolerated total dose for hyperfractionated radiation, we randomly assigned patients with tumors that responded to radiation therapy in a dose-dependent manner from four body sites (lung, upper respiratory and digestive tract, bladder, and brain) to one of three regimens receiving total doses (D1, D2, or D3) differing by increments of 4.8 Gy. All patients received two fractions of 1.2 Gy each (separated by 4-6 hours) daily 5 days a week. The lowest total dose was set at the level considered tolerable with standard once-a-day radiation therapy. We tested tumor responses and late toxic effects of higher doses by assigning patients to these three regimens until acute effects and early estimates of late effects were found to be acceptable for the highest dose D3; thereafter, regimen D1 was closed, and additional patients were assigned to D2, D3, and D4 (an escalated total dose greater than D3 by an increment of 4.8 Gy). The assignment of patients was performed in a weighted manner (1:1:2), so that greater numbers were assigned to the highest dose regimen (whether D3 or D4) to allow rapid evaluation of the feasibility of the highest dose.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Magnetic resonance imaging (MRL) allows for the first time direct determination of maternal pelvic dimensions without ionising radiation. Phantom measurements and the correlation with traditional pelvimetric measurements in 10 patients after Caesarean section have shown mean differences of +/- 2 mm, with a maximum of 5 mm. The evaluation of pelvic configuration is obtained analogous to the conventional roentgenogram. In addition to conventional or digital x-ray pelvimetry, the soft tissues of the maternal pelvis and the presenting part of the foetus is delineated with high contrast. Positioning in the body coil can be accomplished even late in pregnancy or in impending labour, acceptance by the pregnant women being high. Whereas in a given indication after delivery conventional x-ray pelvimetry continues to be performed, antenatally MRI pelvimetry has now been established in our Departments as the method of choice--based on meanwhile 107 examinations. Present drawbacks are the relatively high cost and the limited availability of MR units.
It has been suggested that there is a curvilinear relationship between lean body or fat-free mass and body fat mass. In order to confirm this relationship, body composition was measured by determining body density and total body water using deuterium-labeled water in subjects varying widely in body fat mass. There were 29 males and 75 females with body mass index ranging from 20 to 66 kg/m2. The relationship between fat-free mass and fat mass appeared to be linear over the range of body fat from 10 to 90 kg: males R2 = 0.67 (p less than 0.0001) and females, R2 = 0.47 (p less than 0.0001). The amount of variance explained was not greater when the log of fat mass was used in place of fat mass alone. Multiple regression analysis demonstrated that the relationship between fat-free mass and fat mass remained significant (p less than 0.001) after adjusting for body height, age, and fat distribution. It is concluded that over the range of body fat extending from 10 to 90 kg there is a positive and linear relationship between fat-free body mass and fat mass.