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Biomedical subjects

M Fischer

Publications and source records attributed to M Fischer.

At least 37 records · Page 2Linked to original sources
PubMed1992

Influence of stress on the healing and relapse of duodenal ulcers. A prospective, multicenter trial of 2109 patients with recurrent duodenal ulceration treated with ranitidine. RUDER Study Group.

The influence of psychologic factors on the healing and relapse of duodenal ulcers under treatment with ranitidine was studied in a prospective, multicenter trial in 2109 patients with an endoscopically proven duodenal ulcer (DU) and a history of recurrent duodenal ulceration. All patient received ranitidine (300 mg daily), and, after healing, 1899 patients continued maintenance treatment (ranitidine, 150 mg daily) for 2 years. A physician's assessment of stress (stress or no stress) was made at every consultation. In the healing phase an overall classification of stress as absent, intermittent, or continuous was made, and in the maintenance phase patients were classified dichotomously as having stress (stress on at least half of the follow-up consultations) or no stress. In addition, at the start of the healing phase stress was measured by means of a standardized questionnaire. Continuous stress, as assessed by the physicians, was associated with a lower 14-day healing rate (35.7%) than intermittent or absent stress (42.4%; relative risk (RR) for delayed healing in patients with continuous stress, 1.19; 95% confidence interval (CI), 1.06-1.33; P < 0.02). Differences in the 14-day healing rate for patients with low and moderate stress scores (43.1%) compared with those with high and very high stress scores (37.9%) just failed to reach statistical significance (RR for patients with stress, 1.14; 95% CI, 0.998-1.29; P = 0.051). During the 1st year of maintenance treatment 18.3% of patients with stress, but 10.9% of patients without stress, had a DU relapse (RR of stress for DU relapse during the first year, 1.73; 95 CI, 1.44-2.09; P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Normative parameter characterization for the auditory brainstem response of the normal newborn].

The auditory brainstem response generated by clicks was studied in 119 normal newborns. One ear was studied in detail at 20, 40 and 60 dBnHL, the other at 20 and 30 dBnHL, increasing the intensity if no response was found. The latency for waves I, III and V in the detailed studied ear was 2.7 +/- .39, 5.4 +/- .44 and 7.7 +/- .48, respectively. 85% of newborns had thresholds for auditory brainstem response less than 40 dBnHL, 54% less than 20 dBnHL and 15% between 40 and 60 dBnHL. These findings are compatible with conductive loss in the higher threshold group and support data from Stockard, regarding high risk groups. Additionally, our data suggests that an adequate level to screen for hearing loss in newborns is between 30 and 40 dBnHL.

Auditory Threshold↗
PubMed1992

[Decrease of postoperative morbidity in coronary surgery using the two internal mammary arteries].

The surgical risk of bilateral internal mammary artery grafting was analyzed in 100 successive patients separated chronologically into two groups. These groups were not statistically different in terms of age, severity of angina, and extent of coronary artery disease. The number of grafts per patient and the time of aortic cross clamping were not statistically different in the two groups. The postoperative mortality was 1% in the 100 patients. The incidence of perioperative myocardial infarction was not statistically different in the two groups. No mediastinal suppuration was observed. The mean postoperative hemorrhage was 633 +/- 558 ml in the first 50 patients and 560 +/- 410 ml for the last 50 patients (p < 0.05). The percentage of patients receiving no homologous blood transfusion was 64% in the first 50 patients and 94% in the last 50 patients. The percentage of phrenic palsy was 36% in the first 50 patients and 6% in the last 50 patients (p < 0.05). With surgical experience, the risk of coronary bypass with bilateral internal mammary artery was lowered and very similar to the surgical risk of conventional aorto-coronary bypass with saphenous veins or one mammary artery.

Adult↗
PubMed1992

[Surgical indications for partial inpatient and ambulatory surgery of the lower extremities].

Outpatient (ambulatory) surgery has become widely accepted in free-standing outpatient surgery centres and in hospitals covering the field of hand surgery as well as, increasingly, the field of lower-extremity surgery. Three factors are decisive for secure ambulatory surgery: adequate material and personal resources guaranteeing a round-the-clock medical service, outpatient anesthesia which focuses mainly on the perioperative care of outpatient surgery, and a well-informed patient. Under these prerogatives the majority of surgical procedures of the lower extremities are performed on an outpatient basis without any undue risk. This includes also the diagnostic and operative arthroscopy of different joints.

Adult↗
PubMed1992

[Total intravenous anesthesia using propofol and alfentanil as compared to combined inhalation anesthesia reduces the flow velocity in the middle cerebral artery. A Doppler sonographic study].

Anesthesia for craniotomies should guarantee hemodynamic stability, preservation of cerebral autoregulation, and rapid postoperative recovery of consciousness. Increases in intracranial pressure (ICP) and postoperative respiratory depression should be avoided. Combined anesthesia (KA) with N2O and volatile anesthetics may increase cerebral blood flow (CBF), ICP, and cerebral oxygen consumption. According to recent studies, total intravenous anesthesia (TIVA) with propofol and alfentanil seems to best fulfill the requirements. Using transcranial Doppler sonography (TCD) (TC2-64, EME), we studied the influence of TIVA and KA under normo- and hyperventilation on the blood flow velocity (BFV) and pulsatility of the middle cerebral artery (MCA). METHODS. Two groups of 10 patients each undergoing craniotomy were investigated. Systolic and mean BFV, pulsatility index, mean arterial blood pressure, heart rate, and arterial CO2 tension were measured at four time intervals: (1) preoperatively; (2) 15 min after anesthesia induction under normoventilation, preoperatively; (3) 25 min after anesthesia induction under hyperventilation, preoperatively; and (4) 6 h postoperatively. The patients were premedicated with flunitrazepam 1 mg PO. TIVA was induced with 60 mg propofol, 1 mg alfentanil, and 6 mg vecuronium; simultaneously infusions of propofol (15 mg/min) and alfentanil (0.3 mg/min) were started and were maintained until the dura was completely opened. The infusion rates were then reduced to 6 mg/min propofol until skin suturing and 0.1 mg/min alfentanil until dural suturing was completed. Patients were ventilated with O2/air (fiO2 = 0.5). In the KA group anesthesia was induced with 4-6 mg/kg thiopental, 0.15 mg fentanyl, and 6 mg vecuronium and maintained with boluses of fentanyl, N2O (fiO2 = 0.5), and isoflurane (1.3 MAC). The time course is illustrated in Figs. 1 and 2 and the results are shown in Tables 1 and 2. They were tested using a one-factor analysis of variance and the Kruskal-Wallis range test. RESULTS. There was a significant decrease in systolic and mean BFV combined with an increase in pulsatility index after induction of TIVA, while KA induction effected no significant change in cerebral hemodynamics. The subsequent hyperventilation caused a similar decrease in mean BFV and increase in pulsatility index in both groups. CONCLUSION. Using the assumption that the diameter of the MCA is nearly constant, the reduction in BFV associated with an increase in pulsatility during TIVA is explainable as a decrease in CBF. By having a comparable influence on hemodynamics, the reduction in CBF with increase in cerebral vascular resistance seems to make TIVA the more advantageous anesthesia technique for patients with reduced intracranial compliance.

Adult↗
PubMed1992

[Coronary artery bypass with 2 internal mammary arteries. Early clinical and angiographic results in 100 patients].

One hundred patients underwent coronary revascularisation with both internal mammary arteries between 1987 and 1990. The average age of the patients was 55 years. The left internal mammary was used in 97 of the 100 cases as a pediculated graft to revascularise the left anterior descending (66 cases), left lateral (27 cases) or a bissecting artery (4 cases). The right internal mammary was used as a pediculated graft in 51 cases and as a free graft to revascularise a left lateral (51 cases), left anterior descending (29 cases) or right coronary artery (20 cases). There was one death in the first 30 postoperative days. Morbidity was low with no cases of sternal infection. The average postoperative bleeding was 633 +/- 550 ml per patient. The incidence of phrenic nerve paralysis decreased from 36% in the first 50 patients to 6% in the second 50 patients. Angiography at the 10th postoperative day showed 4 occlusions out of 132 internal mammary arteries opacified (97% patency). Ninety four patients are asymptomatic and have negative exercise stress tests. Mortality and morbidity of coronary surgery using the two internal mammary arteries are therefore the same as those of conventional coronary surgery using saphenous veinar only one internal mammary artery, providing that it is reserved for patients in good general condition, under 65 years of age, without obesity or diabetes. This technique of coronary artery revascularization should provide better long-term results because of the high patency rate of the grafts.

Adult↗
PubMed1992

[4-years experience with quality control of decentralized reflectometry blood glucose measurement in the Vienna-Lainz hospital].

Since 1987 a quality control programme for ward-based blood glucose assays has been established in Lainz Hospital, Vienna. In 1991 following a decision to standardise the type of reflectometer used in the ward, 62 Reflolux IIS reflectance meters (Boehringer Mannheim) were assessed in a quality control consisting of 4 ring trials a year (blood glucose determination in two "unknown" samples) and in daily measurements of control solutions of known glucose concentrations. Experience with this quality control procedure is reported in this presentation of the relevant results of the ring trials. The most frequent errors in performing the test are discussed and the importance of instructing and training the nursing staff in the proper use and maintenance of the meters is pointed out.

Austria↗
PubMed1991

Influence of severity of heart failure on the efficacy of angiotensin-converting enzyme inhibition.

Angiotensin-converting enzyme (ACE) inhibition slowed the progression of congestive heart failure (CHF) in 170 patients who were randomly assigned to either captopril or placebo in the Munich Mild Heart Failure Trial. The two major end points were progression from New York Heart Association (NYHA) functional classes I, II, or III to class IV, despite optimal, adjusted standard therapy, and death due to CHF. The relative risk for progressive CHF with captopril therapy was 0.34 (95% confidence interval = 0.17-0.68; p = 0.01). A total of 52 prerandomization variables were tested to determine their contribution to disease progression. Logistic regression analysis revealed 5 independent risk factors for progressive CHF: NYHA class, left ventricular end-systolic diameter, need for diuretic, age, and cardiothoracic ratio. The presence of greater than 2 of these risk factors increased the odds ratio for progression to 8.13 (p less than 0.001) compared with the presence of 0-2 risk factors. However, the effectiveness of captopril in preventing progression was higher within the subgroup of patients who had less severe CHF: the odds ratio was 0.12 (95% confidence interval = 0.03-0.45; p less than 0.01) for patients in NYHA class I or II on captopril and was 0.83 for those in class III. We conclude that the severity of CHF, as represented by the above-defined risk factors, is directly related to the likelihood for the development of progressive heart failure. However, the less severe the heart failure, the more effective the treatment with captopril will be in preventing disease progression. Thus, ACE inhibition has considerable potential for improving the prognosis of patients with mild heart failure.

Age Factors↗
PubMed1991

Are admission plasma fibrinogen levels useful in the characterization of risk groups after myocardial infarction treated with fibrinolysis?

The aim of our study was to prove or disprove the independent prognostic importance of fibrinogen after myocardial infarction. Plasma fibrinogen levels were determined on admission in 135 patients with an acute myocardial infarction and symptoms up to 4 h (mean: 1.8 h) immediately before starting fibrinolytic treatment with 1.5 mio U. streptokinase i.v. All patients were free from other diseases which are known to cause elevated fibrinogen levels. Coronary angiography was carried out in 87%. During a mean follow-up period of 26.2 months 31 coronary events could be observed in 26 patients: 18 reinfarctions, 6 cases of sudden death, and 7 coronary artery bypass graft surgeries because of new symptoms. While plasma fibrinogen levels were higher in smokers than in non-smokers (3.30 vs 2.94 g/l p = 0.011) and correlated with the number of involved coronary arteries (p = 0.08), values were similar in patients with and without coronary events during follow-up (3.07 vs 3.16 g/l, p = 0.70). This applied as well to univariate analysis as to multivariate Cox's regression model. We conclude that plasma fibrinogen levels determined very early in patients with acute myocardial infarction do correlate with other important prognostic variables, but have no independent prognostic importance.

Diagnostic Tests, Routine↗
PubMed1991

Cytokine production by mature and immature thymocytes.

We have studied the ability of subpopulations of activated thymocytes to produce four cytokines (IL-2, IL-4, IFN-gamma and TNF-alpha) which are believed to play roles in T cell development. Supernatants from various thymocyte subsets activated with calcium ionophore and PMA were tested for these cytokines. All CD3hi thymocyte subsets (CD4+8-, CD4-8- and CD4-8+) produced high titers of these four cytokines except CD3+4-8+ thymocytes, which did not produce IL-4. In contrast, CD4+8+ thymocytes did not produce any detectable cytokines. CD3-4-8- thymocytes produced IL-2, IFN-gamma, and TNF-alpha (but not IL-4) when activated by calcium ionophore + PMA and IL-1. We then separated CD3-4-8- thymocytes into IL-2R+ and IL-2R-. CD3-4-8-IL-2R+ thymocytes only produced small amounts of IL-2 when activated with calcium ionophore + PMA + IL-1, whereas CD3-4-8-IL-2R- thymocytes did not require IL-1 to produce IL-2, IFN-gamma, and TNF-alpha. Finally, CD4-8+3- thymocytes (an immature population believed to be an intermediate between CD3-4-8- and CD4+8+ thymocytes) only produced marginally detectable levels of IL-2 upon stimulation with calcium ionophore, PMA, and the addition of IL-1 did not result in increased levels of cytokine production. These observations indicate discrete patterns of cytokine production by the subsets studied and suggest specific controls of cytokine gene expression during T cell development.

Animals↗
PubMed1991

Antigen presenting ability of thymic macrophages and epithelial cells: evidence for defects in the antigen processing function of thymic epithelial cells.

We compared the antigen presenting ability of cloned thymic macrophage and epithelial cell lines using T cell hybridomas with well-characterized activation requirements. A cloned thymic epithelial cell line (3D.1), preinduced with interferon-gamma (IFN-gamma) activated the T cell hybridoma 3DO-18.3 but not the T cell hybridoma DO-11.10. Analyses using preprocessed antigen suggest that the failure of 3D.1 to activate DO-11.10 is due to its inability to process chicken ovalbumin to produce a peptide recognized by the Ag:MHC T cell receptor of DO-11.10. The epithelial cell line 3D.1 was able to activate DO-11.10 if the superantigen staphylococcal enterotoxin B was used for activation instead of ovalbumin. These observations indicate that IFN-gamma-induced 3D.1 expresses sufficient I-Ad molecules to activate DO-11.10 but is unable to produce the peptide of ovalbumin recognized by DO-11.10. Furthermore, 3D.1 appears to be representative of nonmacrophage thymic stromal cells cultured in vitro, since heterogeneous cultures containing epithelial cells exhibited the same selective T cell activation characteristics. In contrast, thymic macrophage cell lines activated all T cells studied. These results suggest that there is a functional difference between the capacity of thymic epithelial cells and macrophages to process and present antigen to T cells.

Animals↗
PubMed1991

C1-esterase inhibitor in uncomplicated pregnancy and mild and moderate preeclampsia.

Routine coagulation tests and measurement of the plasma levels of C1-esterase inhibitor (C1-INH) and antithrombin III were performed in 17 women with mild preeclampsia, 10 women with moderate preeclampsia and 20 women with uncomplicated pregnancy. All pregnant probands were within the third trimester of pregnancy. 20 non-pregnant women were used as controls. The groups were matched in age and the pregnant ones were also matched in gestational age. C1-INH activity and antigen were significantly reduced (p less than 0.002) in normally pregnant women as compared with non-pregnant ones. Further, C1-INH activity was lower in women with mild preeclampsia and significantly lower in women with moderate preeclampsia (p less than 0.05) as compared with normally pregnant women. None of the plasmatic coagulation tests was indicative of a consumption reaction. We conclude that C1-INH activity and antigen reductions are commonly associated with pregnancy. Furthermore, as markedly lower values can be found in mild and moderate preeclampsia, measurement of the C1-INH activity in pregnant women within the third trimester might proof useful to establish the diagnosis of a preeclamptic condition.

Adult↗
PubMed1991

Apolipoprotein A and prognosis after myocardial infarction in non-diabetic men.

The implications of apolipoproteins A-I and A-II for the prognosis of 178 non-diabetic men after acute myocardial infarction were studied. During a mean follow-up period of 4 years, one or more "coronary events" (nonfatal myocardial infarction, fatal coronary heart disease, coronary artery bypass graft surgery, deterioration of exercise ECG) were recorded in 37 patients. Serum levels of apolipoproteins A-I and A-II did not discriminate between patients with and without coronary events. This applied to the entire sample as much as to subgroups defined by presence or absence of interventions (coronary artery bypass graft surgery, long-term therapy with beta-blockers or lipid-lowering drugs). We conclude that coronary events in the first years after myocardial infarction cannot be predicted by apolipoprotein A-I or A-II levels.

Adrenergic beta-Antagonists↗
PubMed1991

Localization of type X collagen in canine growth plate and adult canine articular cartilage.

Type X collagen was extracted from ends of canine growth plates by pepsin digestion after 4 M guanidine hydrochloride extraction, purified by stepwise salt precipitation (2.0 M NaCl in 0.5 M acetic acid), and chromatographed on a Bio-Gel A1.5 M column in 1.0 M CaCl2. Without reduction on sodium dodecyl sulfate (SDS) polyacrylamide gels, the preparation yielded a single, high-molecular-weight (mol wt) band; after reduction, a single band of relative mol wt 5.0 x 10(4) was found. Polyclonal sera were raised against the purified collagen and used in the immunolocalization of canine type X collagen. As expected, indirect immunoperoxidase (IP) or indirect immunofluorescent staining with the polyclonal sera demonstrated that most of the immunoreactivity was localized in the zone of provisional calcification of the growth plate and in cartilage remnants in the metaphyseal region of the physis. A progressive decrease in staining toward the diaphysis of the fetal canine long bone was apparent as the trabecular structures were remodeled to bone. Unexpectedly, type X collagen was also detected in the zone of calcified, mature articular cartilage. It was concentrated in the pericellular matrix of the chondrocytes, appeared at or just above the tidemark, and was expressed immediately before mineralization. Identification of type X collagen in both the canine growth plate and the zone of calcified articular cartilage suggests that cells in the deep layer of cartilage and in the zone of calcified cartilage in the adult animal retain some characteristics of a growth plate and may be involved in regulation of mineralization at this critical interface. The expression of growth plate-like properties would allow the deep chondrocytes of mature articular cartilage to play a role in remodeling of the joint with age and in the pathogenesis of osteoarthritis.

Animals↗
PubMed1991

Metaiodobenzylguanidine (mIBG) in treatment of 47 patients with neuroblastoma: results of the German Neuroblastoma Trial.

From 1984 to 1989, 47 children with relapsed, refractory, and/or metastasized neuroblastoma were treated with 131I-metaiodobenzylguanidine (mIBG) in several different treatment combinations. At initial diagnosis, 36 children had Evans stage IV and 11 stage III disease. In 16 of the 47 children, tumor recurred after complete remission prior to mIBG treatment, 26 of 47 progressed from residual or nonresponding tumor, and in 5 of 47 tumor progression during chemotherapy was observed. Altogether the children were treated with a total of 112 courses (range 1-6) with a mean dosage of 8.9 +/- 6.7 mCi/kg body weight/treatment course. Total dose was 283.2 +/- 203.7 mCi for stage III and 388.9 +/- 218.6 mCi for stage IV. Nine of 47 children reached a complete or a very good partial remission (CR and VGPR) from mIBG treatment alone, 13 of 47 achieved partial remission (PR). In an early analysis, 10 patients treated with mIBG in the neuroblastoma trial NB 85 of the German Society of Pediatric Oncology showed no significant difference in survival time compared with 30 conventionally treated children. However, the recent therapy series has been done with higher doses of mIBG, and during improved therapeutic scanning many more bone lesions could be detected than during earlier diagnostic scanning. We conclude that mIBG treatment has not yet fulfilled the expectations for it but still seems for certain indications to be a promising tool to treat neuroblastoma in the future. Moreover, the frontier of neuroblastoma detection is still advancing.

3-Iodobenzylguanidine↗