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Biomedical subjects

M Keim

Publications and source records attributed to M Keim.

17 recordsLinked to original sources
PubMed2004

[Left ventricular apical ballooning].

HISTORY: A 40-year-old woman and a 50-year-old man were admitted with acute chest pain indicative of an acute coronary syndrome. INVESTIGATIONS: In addition to ECG changes suggestive of acute ischemia and a minor increase in the serum concentration of troponin-I both patients had a severely reduced left ventricular function with extensive apical akinesis on echocardiography (LV- ejection fraction 20, respectively 40%). Stenotic coronary artery disease was excluded by coronary angiography, however left ventriculography showed a "ballooned" apex resembling an aneurysm. DIAGNOSIS, TREATMENT AND COURSE: Both patients were observed and treated symptomatically in the intensive care unit. Within four weeks the LV-function had completely recovered in both patients. Both patients had an atypical acute coronary syndrome as indicated by electrocardiographic signs of ischemia and serological markers. After perusal of the relevant literature the diagnosis of "apical ballooning" based on the finding of a "ballooned" akinesis of the left ventricular apex in the absence of coronary artery stenosis or a reasonable alternative cause of myocardial ischemia was made. The aneurysm-like left ventricular dysfunction is fully reversible without specific treatment. CONCLUSION: Left apical ballooning is a rare, but increasingly recognized diagnosis in patients presenting with the clinical picture of cardiac ischemia in the absence of coronary artery disease. The pathogenesis of the LV-dysfunction, which is reversible, is not known and the prognosis is good in patients who survive the initial period of severe ventricular dysfunction.

Acute Disease↗
PubMed2004

Acute sialadenitis after percutaneous coronary intervention.

A 63 year old woman developed a swelling of the submandibular glands following PTCA. An ENT specialist made the presumptive diagnosis of viral sialadenitis. The submandibular swelling subsided completely within 48 hours. Sialadenitis is a rare side effect of ionic and nonionic radiocontrast agents. The pathogenic mechanism is not known. The swelling is self-limited with an excellent prognosis without specific therapy.

Angioplasty, Balloon, Coronary↗
PubMed1999

Do US emergency medicine residency programs provide adequate training for bioterrorism?

Currently, there is no standardized curriculum for training of emergency physicians about the health hazards related to weapons of mass destruction. Opportunities for the widespread teaching of this material have remained limited, and the range of knowledge regarding even general disaster medical care is also variable among most residency training programs in the United States. We developed a survey to ascertain whether any formal training in biological weapons is conducted in emergency medicine programs; to determine the overall subjective ability of program directors or residency directors to recognize and clinically manage casualties of biological weapons agents; and to identify which resources might be used by emergency physicians to identify and treat biological warfare casualties. We also document a baseline of current practices regarding biological weapons training in emergency medicine residency programs.

Biological Warfare↗
PubMed1999

Principles for emergency response to bioterrorism.

The recent occurrence of a series of anthrax-related hoaxes illustrates the need to educate emergency services personnel about how to best ensure patient and worker safety in the case of suspected exposure to biological threat agents. There are very few data to support the methods being used or the variation in current care. Emergency physicians, first responders, and hazardous materials response teams need a standardized approach to the management of patients who may have been exposed to biological threat agents. Currently recommended hospital infection control procedures seem appropriate for the level of risk involved with aerosolized biological threat agents. Such recommendations include standard and transmission-based precautions. These groups need a working knowledge of the isolation and infection control measures recommended for the treatment of patients exposed to those biological threat agents at outlined in the Centers for Disease Control and Prevention Guideline for Isolation Precautions in Hospitals.

Biological Warfare↗
PubMed1999

Implementation of an interactive computer-assisted infection monitoring program at the bedside.

A new computer-assisted infection monitoring (CAI) software program has been developed for use in an intensive-care unit (ICU). By means of an interactive dialogue with physicians at the bedside, infection diagnoses and therapeutic decisions were recorded prospectively during a 3-month test period. By linking epidemiological data with information about therapeutic decisions, CAI could assess the quality of the therapeutic decisions. Antibiotics chosen empirically before the availability of any culture results, matched the antibiotic susceptibility patterns of the subsequently identified pathogens in 74% of the cases. Therapy chosen in collaboration with the computer after the pathogen was known, but before sensitivity results were available, corresponded with the eventual antibiograms of the microorganisms in 90% of the cases. Data analysis by CAI allowed us to assess critically the diagnostic and therapeutic habits in our ICU. Using the query-by-example method, CAI automatically calculated device-associated infection rates.

Adolescent↗
PubMed1998

Medical preparedness for a terrorist incident involving chemical or biological agents during the 1996 Atlanta Olympic Games.

During the 1996 Centennial Olympic Games in Atlanta, Georgia, unprecedented preparations were undertaken to cope with the health consequences of a terrorist incident involving chemical or biological agents. Local, state, federal, and military resources joined to establish a specialized incident assessment team and science and technology center. Critical antimicrobials and antidotes were strategically stockpiled. First-responders received specialized training, and local acute care capabilities were supplemented. Surveillance systems were augmented and strengthened. However, this extensive undertaking revealed a number of critical issues that must be resolved if our nation is to successfully cope with an attack of this nature. Emergency preparedness in this complex arena must be based on carefully conceived priorities. Improved capabilities must be developed to rapidly recognize an incident and characterize the agents involved, as well as to provide emergency decontamination and medical care. Finally, capabilities must be developed to rapidly implement emergency public health interventions and adequately protect emergency responders.

Anti-Infective Agents↗
PubMed1997

[Ball variance and fracture of a Smeloff-Cutter prosthesis 24 years after aortic valve replacement].

This report documents a case of ball variance in a Smeloff-Cutter aortic prosthesis occurring 24 years after implantation. After episodes of embolic complications the patient died in acute shock. The silicone rubber ball showed several alterations including discoloration, grooving, cracking, swelling and subtotal fracture of the poppet. Terminal valvular malfunction was caused by complete thrombosis of the prosthesis. In most patients ball variance occurred during the first years after valve replacement; thus, the observed case is a very rare late complication of a ball-valve prosthesis.

Aortic Valve↗
PubMed1993

Synovial sarcoma of childhood and adolescence. Report of the German CWS-81 study.

BACKGROUND: Synovial sarcoma is the third most common pediatric soft tissue tumor. It requires an aggressive approach to achieve a cure. However, optimal treatment modalities adapted to disease extension and histologic variants have not been determined because there is little information about prospectively treated patients. METHODS: A multicenter trial for soft tissue sarcomas (Protocol CWS 81) was conducted in West Germany between 1981-1985, and 31 patients with synovial sarcoma were registered. Treatment included multiagent chemotherapy and irradiation after initial tumor excision or biopsy. The male-female ratio in this group was 1:1.6 with a median age of 14 years (range, 1-19 years). The median follow-up time after diagnosis was 101 months (range, 77-131 months). RESULTS: The overall event-free survival (EFS) for patients with synovial sarcoma was 74.2% at 5 years. Group I-II tumors had a significantly better prognosis than those in Group III-IV (EFS at 5 years 84.4% and 58.3%, respectively; P = 0.024). Small tumors (< 5 cm) responded better than larger tumors (> or = 5 cm; EFS, 93% versus 58%; P = 0.029). Synovial sarcoma involved the extremities in 28 patients who had a better outcome compared with those with extremity rhabdomyosarcoma in this study (EFS for Group I-IV was 82% versus 24%, P = 0.001). CONCLUSIONS: The results appeared superior to previous experience using radical surgery alone and suggested that after initial, nonmutilating surgery, adjuvant chemotherapy, and irradiation contributed to the improved long-term survival.

Adolescent↗
PubMed1992

Treatment of soft tissue sarcoma in childhood and adolescence. A report of the German Cooperative Soft Tissue Sarcoma Study.

BACKGROUND: In the first German soft tissue sarcoma (STS) study, CWS-81, 344 patients younger than 19 years of age who had previously untreated soft tissue sarcoma were studied. For this analysis, there were 218 patients with chemosensitive STS (Group A: rhabdomyosarcoma [RMS], synovial sarcoma, extraosseous Ewing sarcoma, leiomyosarcoma, undifferentiated sarcoma, and malignant peripheral neuroectodermal tumor) who could be studied for a minimum potential follow-up time of 6 years. METHODS: A staging system based on the postoperative extent of the disease was used. The chemotherapy for Stage I-III disease consisted of vincristine, dactinomycin, cyclophosphamide, and doxorubicin (VACA). Patients with metastatic disease and patients with Stage III disease who failed to respond to VACA were given ifosfamide instead of cyclophosphamide. The definitive procedure for local tumor control (either no radiation exposure, 40 Gy, or 50 Gy) for patients with Stage II-III disease depended on the tumor status at second-look surgery after 16 weeks of chemotherapy. RESULTS: The rates of disease-free survival (DFS) and survival after 5 years was 61% +/- 4% and 57% +/- 4%, respectively, in group A; for patients with nonmetastatic tumors (Stages I-III), the rates were 69% +/- 4% and 72% +/- 4, respectively. Patients with nonmetastatic rhabdomyosarcoma had a similar prognosis: the survival rate was 73% +/- 4%, and the DFS rate was 68% +/- 4%. There was no difference in prognosis between patients with Stage I and and those with Stage II disease (DFS rate, 88% +/- 5% and 88% +/- 6%, respectively). The DFS rate for patients with Stage III disease was 54% +/- 5% and for those with Stage IV, 11% +/- 5%. Lack of local tumor control was the primary cause of therapy failure: 10% of patients with localized disease did not achieve complete remission, whereas 18% who were in complete remission experienced local relapse. The most important prognostic factors were tumor size (P = 0.005) and the degree of tumor regression after primary chemotherapy (P = 0.007). The prognosis also differed according to primary site: paratesticular tumors had the best prognosis, whereas tumors located in the parameningeal regions of the head and neck had the worst prognosis (DFS rate, 96% +/- 4% versus 49% +/- 7%, respectively). CONCLUSIONS: The following conclusions were drawn from the CWS-81 study: (1) intensive chemotherapy (VACA for 35 weeks) provides long-term control for most patients with Stage I-II disease; (2) patients with primary unresectable tumors (i.e., Stage III) who achieve complete remission with chemotherapy alone have the same prognosis as patients with postoperative disease of Stages I and II; (3) tumor size and the degree of tumor regression after primary chemotherapy influence outcome and thus can be used as a basis for risk-adapted therapy.

Adolescent↗
PubMed1990

Development of antibodies to unprotected glycosylation sites on recombinant human GM-CSF.

In 4 out of 16 patients receiving recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) in phase I/II studies antibodies developed to the recombinant protein. The antibodies react with sites on the native protein backbone which are normally protected by O-linked glycosylation but which are exposed in rhGM-CSF produced in yeast and Escherichia coli. Antigenicity of recombinant human proteins due to non glycosylation may have relevance to the choice of host system for production of factors for clinical use.

Antibodies↗
PubMed1989

Soft tissue sarcomas in infants younger than 1 year of age: a report of the German Soft Tissue Sarcoma Study Group (CWS-81).

Of 357 patients with soft tissue sarcomas (STSs) who were registered between 1981 and 1986 in the CWS-81 study, 21 (5.8%) were younger than 1 year of age. Six cases were probably of congenital origin since they were diagnosed in the 1st month of life. There was no difference in clinical grouping (staging and primary site) between infants and older patients. The major histological subsets comprised 12 patients with embryonal rhabdomyosarcoma (57% vs. 44% in older patients) and five patients with fibrosarcoma (23% vs. 2% in older patients). Of 21 patients, 17 received chemotherapy. The response rate (tumor reduction more than 1/3) to exclusive cytostatics therapy within 7-9 weeks, of ten evaluable patients, was 100% (vs. 86% in older patients). Eight of the responders achieved complete remission after 16 weeks of therapy and are in continuous complete remission (CCR). Most patients received 20-50% of the recommended chemotherapy dose for older children, which was calculated using body surface area. No fatal or life-threatening complications were observed. The event-free survival rate for children younger than 1 year of age with rhabdomyosarcoma was 70% vs. 47% in older children (no significant difference). Now, 2-5 years after therapy all five fibrosarcoma patients are alive and free of disease. Our data indicate that children under 1 year of age with rhabdomyosarcoma have a slightly better prognosis than older children, when therapy modalities are adapted to age.

Age Factors↗
PubMed1989

New aspects in the treatment of childhood rhabdomyosarcoma: results of the German Cooperative Soft-Tissue Sarcoma Study (CWS-81).

The results of the German Co-operative Soft-Tissue Sarcoma Study (CWS-81) of the treatment of rhabdomyosarcoma are presented. Prior to the introduction of chemotherapy only 10%-20% of the children were successfully treated. Combined multi-agent cytostatic treatment improved the results dramatically. In patients with primary stage III rhabdomyosarcoma, local tumour control by surgery or radiotherapy should be undertaken earlier than week 16, if complete remission has not been achieved by 7-9 weeks. Patients with complete remission or partial tumour regression should be treated with the same combination of chemotherapy, while only partial responders need radiotherapy in addition. Patients with tumours which are primarily resectable without mutilation have a 90% chance of cure; this also applies to patients with primarily unresectable tumours who achieve complete remission after 7-9 weeks of chemotherapy. Total disease-free survival rate for stage III rhabdomyosarcoma patients was 53%. The role of surgery includes primary removal of the tumour or assessment of remission by means of histological spot checks.

Child↗
PubMed1989

Comparison of the rates of response to ifosfamide and cyclophosphamide in primary unresectable rhabdomyosarcomas.

In the 1981 cooperative soft-tissue sarcoma (CWS-81) study, a clear correlation between the degree of response to initial chemotherapy comprising vincristine, actinomycin D, cyclophosphamide, and Adriamycin (VACA) and the survival of patients with rhabdomyosarcoma was found. In the subsequent CWS-86 study, cyclophosphamide was replaced by ifosfamide (VAIA) in the expectation that the combination VAIA might be more effective than VACA. In both studies, the initial cytostatic response for primary unresectable tumors was evaluated after the first cycle of chemotherapy at weeks 7-9. The reduction in tumor volume was measured by computerized axial tomographic (CAT) scan or sonography, and the patients were categorized as complete responders, patients with a tumor regression of greater than 2/3 albeit incomplete, patients with a tumor regression of less than 2/3 but greater than 1/3, and nonresponders, who underwent either a tumor regression of less than 1/3 or tumor progression. We compared the response rate obtained with VACA chemotherapy and that resulting from VAIA chemotherapy. The preliminary data from this comparison show a tendency for a higher rate of good responders (complete and less than 2/3 tumor regression) to be induced by VAIA therapy (71%) than that obtained using the VACA combination (55%). From the response-prognosis relationship, we confidently expect that the final outcome for patients in the present study will be better than that in the previous study.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

The predictive value of initial cytostatic response in primary unresectable rhabdomyosarcoma in children.

The relation between the initial tumour regression produced by chemotherapy and the later event-free survival was studied in a prospective multicentre study on soft-tissue sarcomas in children. The event-free survival rate in patients with complete remission after seven weeks of chemotherapy was 95%; in patients with incomplete tumour reduction of greater than 2/3, 61%; and in patients with tumour reduction of less than 2/3 but greater than 1/3, 31%. Patients with partial remission at week 7, who achieved complete remission by week 16 after additional chemotherapy had an event-free survival rate of 64%. A multivariate analysis suggested that the response per unit of time was an important prognostic factor.

Antineoplastic Combined Chemotherapy Protocols↗