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Biomedical subjects

M Esser

Publications and source records attributed to M Esser.

At least 19 recordsLinked to original sources
PubMed2005

[Vertebrobasilar ischemia as a complication of temporal arteritis. Results of a prospective, clinical, ultrasonographic study].

BACKGROUND: Cerebral symptoms in temporal arteritis (TA) may occur if large arteries are affected. To avoid progression of the disease, the immediate administration of adequate doses of steroids is mandatory. PURPOSE: The prevalence and severity of vertebrobasilar ischemia (VBI) and its relation to structural abnormalities of the vertebral arteries were studied. METHODS: Clinical and ultrasound data were analyzed in a hospital-based group of 91 patients who received the diagnosis of TA following standard criteria. RESULTS: In contrast to the occurrence of neuro-ophthalmological complications (27.5%), the rate of VBI was low (4.4%). TIA occurred in three cases and mild stroke in one. Ultrasound demonstrated severe occlusive disease of the extradural parts of the vertebrobasilar arteries consisting of hypoechogenic, concentric, mural thickening. The same was found in the superficial temporal arteries. CONCLUSIONS: In elderly patients presenting with VBI, TA affecting the vertebral arteries should be considered. In experienced hands, ultrasonography allows the atraumatic preliminary diagnosis of TA.

Aged↗
PubMed2003

Catheter occlusion by calcium carbonate during simultaneous infusion of 5-FU and calcium folinate.

BACKGROUND: The treatment of colorectal cancer with administration of a 2-h infusion of calcium folinate followed by a 24-h infusion of 5-fluorouracil (5-FU) is a standard therapy. Based on newly published data we have applied an infusion of both compounds, 5-FU and calcium folinate, mixed together in an ambulatory pump. PATIENT AND METHODS: We report on a patient suffering from metastatic rectal cancer. After first and second line chemotherapy we started third line chemotherapy consisting of calcium folinate (1,000 mg) and 5-FU (4,000 mg) mixed together in a total volume of 240 ml in an ambulatory pump and administered over a period of 24 h. After a total of 11 applications the patient developed a port thrombosis resistant to lysis with urokinase. The blocked catheter was surgically explanted and the firm material inside was analyzed. RESULTS: The material from inside the lumen of the catheter was analyzed using x-ray spectroscopy and a scanning electron microscopy. Both analyses confirmed that the isolated material is calcium carbonate. CONCLUSION: This case and the results of the analyses are in accordance with the described problems and results published earlier. A physical and/or chemical in vitro compatibility of 5-FU and calcium folinic acid, without validated clinical data is not sufficient to use this mixture in routine clinical practice.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

[Development of a compact, semi-robotic platform for an electronic surgical microscope].

In the context of the development of a new, electronic microscope for surgical interventions a semirobotic motion platform for the spatial placement and fixation of a stereoscopic camera is currently being developed. Based on an inquiry about the medical, technical and user-requirements, different phases and characteristics concerning frequency, workspace, speed and accuracy of camera movement during an intervention have been specified. To meet these requirements, a differentiated concept for the platform has been developed including a serial structure for manual pre-positioning, a parallel robot for motor-movement during surgical work and different user-interfaces for suitable robot-control.

Equipment Design↗
PubMed2000

Paclitaxel as weekly second-line therapy in patients with advanced pancreatic carcinoma.

Although the prognosis for patients with pancreatic adenocarcinoma is still poor, gemcitabine has shown significant impact upon survival and quality of life. Our aim was to examine the potential effectiveness of a second- or third-line therapy with paclitaxel (Taxol) after confirmed progression with a gemcitabine-containing schedule for patients remaining in good clinical condition. Eighteen patients with stage IVb disease participated in this study. Pretreatment with gemcitabine was performed either as monotherapy and/or in combination with 5-fluorouracil (5-FU) and folic acid (FA). Paclitaxel was administered at weekly intervals on an outpatient basis. We observed 238 weekly treatments with a median number per patient of 12 treatments. The median dosage was 73 mg/m2 paclitaxel (range 55-88 mg/m2). Regarding toxicity, only one patient each presented with anemia and leukocytopenia of WHO grade III. Hepatotoxicity with a temporary increase in aminotransferase of WHO grade II occurred in three patients. Higher-grade symptomatic toxicity was rare, except alopecia. At this time, the median survival time is 17.5 weeks (range 7-88 weeks) since the start of therapy. Stable disease was observed in five patients. One patient achieved complete remission within 37 weeks. At this time, he has survived for more than 56 weeks after confirmed progression under first-line therapy. In conclusion, this schedule demonstrates that weekly therapy with paclitaxel after pretreatment can be effective with a low toxicity profile. This opens up an additional therapeutic option for a selected patient group with a poor prognosis so far.

Aged↗
PubMed1997

[Diagnosis of blunt thoracic trauma in emergency care. Use of continuous pulse oximetry monitoring].

Chest trauma cases benefit to a great degree from adequate, timely initiated and consistent prehospital treatment. However, prehospital determination and evaluation of blunt chest trauma is associated with a high degree of uncertainty. The purpose of our study was to examine and determine, in a collective of 255 trauma patients, the value of additional prehospital pulse oximetric monitoring regarding the optimization of the emergency physician's diagnosis and treatment of blunt chest trauma. We conclude from our findings that, in addition to the physical examination, with the application of pulse oximetry the prehospital diagnosis of lung contusion as well as the early detection of tension pneumothorax are more accurate. Therefore, the combination of physical examination and pulse oximetric monitoring is a requirement for the optimization of prehospital diagnosis and therapy in blunt chest trauma.

Adolescent↗
PubMed1993

The failure of conventional methods to promote spontaneous transpyloric feeding tube passage and the safety of intragastric feeding in the critically ill ventilated patient.

Nasoenteral tube feedings are often recommended in critically ill patients when gastrointestinal tract function is intact. Conventional methods of placement include turning the patient on the right side and the use of drugs that stimulate peristalsis to promote transpyloric passage. A prospective study was initially performed to assess the success of conventional methods used to promote transpyloric feeding tube placement in patients requiring assisted ventilation admitted to the Surgical Intensive Care Unit (SICU) (Part I of the study). In 68 critically ill ventilated patients, placement of nasoduodenal feeding tubes was attempted. Successful transpyloric placement was achieved in only ten patients. There was no correlation between age, gender, admitting diagnosis, time of tube placement and successful placement. The second part of the study was initiated to assess the safety of nasogastric feeding in critically ill ventilated patients. Forty-two patients admitted to the SICU were considered candidates for gastrointestinal tract feeding and were fed through the gastric route. Twenty-five patients reached enteral feeding goal rate within 72 hours, while 34 patients achieved goal rate by five days. Eight patients required total parenteral nutrition to meet nutritional needs because of an inability to achieve adequate nutritional support enterally. There were 11 complications noted in ten patients, including one episode of aspiration pneumonia. The presence of complications was not related to age, gender, admitting diagnosis, infusion method or type of formula used. Duodenal intubation using conventional methods in critically ill ventilated patients is unsuccessful in most patients. Nasogastric feeding in this group of patients can be safely administered in selected instances.

Critical Illness↗
PubMed1992

Biological function of the retinoblastoma protein requires distinct domains for hyperphosphorylation and transcription factor binding.

Despite the importance of the retinoblastoma susceptibility gene to tumor growth control, the structural features of its encoded protein (pRb) and their relationship to protein function have not been well explored. We constructed a panel of deletion mutants of pRb expression vectors and used a biological assay for pRb that measures growth inhibition and morphologic changes in pRb-transfected Saos-2 cells to correlate structural alterations of the pRb coding region with function. We tested the deleted proteins for the ability to bind to viral oncoprotein E1A and to the transcription factor E2F. We also measured the ability of the mutant proteins to become hyperphosphorylated in vivo and to be recognized as substrates in vitro by a cell cycle-regulatory kinase associated with cyclin A. We identified two regions of pRb that are required for E2F binding and for hyperphosphorylation. E1A binding domains partially overlap but are distinct from both of these other two regions. Biological function of pRb is dependent on retention of the integrity of both of these biochemically defined domains. These data support the model that pRb is a transducer of afferent signals (via the kinase that phosphorylates it) and efferent signals (through transcription factor binding), using distinct structural elements. Preservation of both of these features is essential for the ability of pRb to induce growth inhibition and morphologic changes upon reintroduction into transfected cells.

Adenovirus E1A Proteins↗
PubMed1989

Semiquantitative grading of mitral regurgitation by color-coded Doppler echocardiography.

We evaluated patients with mitral regurgitation by color-coded Doppler echocardiography using a semiquantitative score system, which is useful in the clinical setting, by providing rapid discrimination between mild, moderate and severe regurgitation. The study was performed in 42 patients (19 female, 23 male) mean age 58 years, range 23-75 years with mitral regurgitation of different etiology. Color-coded Doppler measurements were compared to angiographic findings using a three point score system. In addition to such parameters as maximal jet length, area and the ratio jet area/left atrial area, we also considered the duration of regurgitant flow. The best correlation was obtained for the maximal area of the jet multiplied by the duration of regurgitant flow/cycle length (r = 0.88), determined in the apical plane where the jet was best visualized. For the parameter area of jet alone, the correlation coefficient was 0.81, for the length of the jet the value was r = 0.65 and comparison of the areas of jet and left atrium gave a coefficient of 0.77. A clear separation between mild and severe regurgitation was observed only for the parameter calculated by multiplying the area of the jet by the duration of mitral regurgitation. In only 7% of the patients with moderate and severe regurgitation could we observe an overlap. This parameter, therefore, represents a useful method for estimating in a semiquantitative manner the severity of mitral regurgitation by color-coded Doppler echocardiography.

Adult↗
PubMed1989

Flow patterns of mitral regurgitation due to different etiologies: analysis by color-coded Doppler echocardiography.

We have used cross-sectional real time color-coded Doppler echocardiography to characterize the patterns of the regurgitant jet seen in mitral valvar disease of different etiologies. We studied 118 patients with mitral regurgitation due to rheumatic valve disease (n = 26), hypertrophic obstructive cardiomyopathy (n = 22), dilated cardiomyopathy (n = 35) and prolapse of the leaflets of the mitral valve (n = 35). We analyzed the origin, spatial distribution, extent and duration of the regurgitant jet. A semiquantitative grading system was used to evaluate the extent of the jet by measuring its maximal area and the duration of regurgitant flow. Typical flow patterns could be observed in hypertrophic obstructive cardiomyopathy, (in which the crescent shaped jet was elongated in midsystole and directed posteriorly) in dilated cardiomyopathy (in which oval shaped jets were observed throughout systole) and in prolapse of the leaflets (in which early or late systolic regurgitant jets occurred with an eccentric "drop-like" pattern, being directed posteriorly in patients with a prolapse of the aortic leaflet and anteriorly in those with a prolapse of the mural leaflet of the valve). A large variety of patterns was found in rheumatic disease due to the individual deformation of the leaflets. A comparison of the measured area of the jet revealed no significant differences between regurgitation caused by rheumatic valve disease and dilated cardiomyopathy. The regurgitation in 80% of these patients was of moderate to severe degree. In contrast, regurgitation due to prolapse of the leaflets or hypertrophic obstructive cardiomyopathy appeared to be of mild to moderate degree in 90% of cases.

Adult↗
PubMed1989

Successful piezoelectric lithotripsy of a common bile duct stone.

The "problematic common bile duct stone", which cannot be extracted primarily by routine endoscopic methods is one of the indications for extracorporeal shock wave lithotripsy (ESWL). We report on the successful piezoelectric lithotripsy of a large common bile duct stone in an 86-year-old patient. Focusing was achieved by ultrasound without problems; the resulting fragments were extracted endoscopically without difficulty. No side effects were observed in this painless piezoelectric lithotripsy.

Aged↗
PubMed1987

Bone grafting for protrusio acetabuli during total hip replacement. A review of the Wrightington method in 61 hips.

Total hip replacement has been very successful in patients with painful, stiff hips associated with protrusio acetabuli, but the heat of polymerisation of methylmethacrylate cement may cause necrosis of the thin medial wall with consequent danger of migration of the cup. Since 1968 at Wrightington, thin slices of the head of the femur have been used as bone grafts to reinforce the acetabulum. We have reviewed 61 hips in 51 patients at an average of 4 years 3 months after operation. Grading for severity is discussed and the degree of physiological remodelling of the medial wall of the acetabulum after grafting assessed. There was an average of about 4 mm of remodelling, but this varied considerably; most took place within the first year. In no case was there relapse of the protrusio.

Acetabulum↗
PubMed1987

Osteotomy of the trochanter in open reduction and internal fixation of acetabular fractures.

Osteotomy of the trochanter can enhance lateral and posterior exposures of the acetabulum and the retro-acetabular space. Over a two-year period, an osteotomy of the trochanter was done in ten patients in connection with open reduction and internal fixation of a displaced acetabular fracture. The trochanter was reattached by two 6.5-millimeter cancellous screws. All of the osteotomies healed uneventfully, with no evidence of migration of the trochanter. Since these fractures tend to occur in younger patients who have healthy bone, non-union of the trochanter is unlikely to be a problem.

Acetabulum↗
PubMed1986

Release of gentamicin from bone cement. An ex-vivo study.

Gentamycin-loaded cement from 16 patients undergoing revision of hip arthroplasty was studied. Samples removed at surgery were analyzed for gentamicin using an enzyme-linked immunoassay. Seventy-eight (55-98) per cent of the gentamicin was retained within the cement after 24 (1-48) months.

Bone Cements↗
PubMed1985

[Trust-promoting variables in child-adult interaction].

As interpersonal trust is recognized as a central variable in child-psychotherapy, and as psychological research has not yet developed strategies to advance interpersonal trust, the question arose by which social behavior variables children's trust is determined in the interaction process between adults and children. After having developed a most concrete definition of trust in terms of social interaction behavior, everyday pedagogical interaction sequences involving adults and children were analyzed in order to identify behavioral elements or patterns of interaction conducive to trust. According to the hypotheses, the behavior classes "positive adult reaction", "adult trusting behavior" and the interaction pattern "positive adult response to child trusting behavior" were found as conducive to interpersonal trust in children. Furthermore the realisation of the pattern "alternation of trusting child behavior and positive adult behavior" for a longer period of interaction was identified as material to the foundation of interpersonal trust. The realisation of that pattern is encouraged by positive and permanent reinforcement of different child reactions by the adult and by the child's readiness to react trustfully to positive adult behavior.

Adaptation, Psychological↗
PubMed1982

Pyocin-resistant lipopolysaccharide mutans of Neisseria gonorrhoeae: alterations in sensitivity to normal human serum and polymyxin B.

Pyocins from Pseudomonas aeruginosa were used to select several lipopolysaccharide (LPS) mutants of Neisseria gonorrhoeae strain FA19. Three classes of LPS mutans were found in the initial group selected for study. The LPS of one class lacked galactose. That of a second group lacked the typical heptose found in the parental LPS, was reduced in glucose, galactose, and N-acetylglucosamine content, appeared to contain a new unidentified sugar component, and consisted of two species of LPS separable on sodium dodecyl sulfate-polyacrylamide gels. The LPS of a third strain lacked the heptose, glucose, galactose, and N-acetylglucosamine found in the oligosaccharide portion of parental FA19 LPS. The minimal inhibitory concentration for polymyxin B of the mutant strains was 3 to 4 times that of the parental strain. The strains lacking only galactose were as resistant as the parent to the bactericidal action of normal human serum, but cells of the other two classes were quickly killed by serum. Gonococcal LPS thus appears to be important in determining phenotypic properties of the cells.

Blood Bactericidal Activity↗