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Biomedical subjects

M Neidhardt

Publications and source records attributed to M Neidhardt.

At least 19 recordsLinked to original sources
PubMed1996

Prospective study of quality of life before and after open heart operations.

BACKGROUND: The aim of this prospective study, with completion of questionnaires before and 3 months after open heart operations, was to evaluate the improvement of quality of life brought about by these operations and the predictors of this improvement. METHODS: The Nottingham health profile questionnaire contains 38 subjective statements divided into six sections: energy, physical mobility, emotional reaction, pain, sleep, and social isolation. Factors influencing quality of life scores were determined by analysis of covariance. Factors influencing the status of the patients (improved or worsened) were determined by logistic regression. RESULTS: From January to July 1994, 215 consecutive patients underwent elective open heart operations. The comparison between mean preoperative and postoperative scores showed an improvement in all sections of quality of life. An average of 80% of patients were improved by their operations. Independent predictors of less improvement of quality of life scores were as follows: for the energy section, age over 70 and New York Heart Association functional class III or IV; for sleep, age over 70; for physical mobility, New York Heart Association functional class III or IV; for social isolation, female gender; and for pain, age over 70 and abnormal segmental wall motion. Independent predictors of patients worsened by operation were as follows: New York Heart Association functional class III or IV in the energy section (odds ratio = 3.7, 95% confidence interval 1.4 to 9.8) and in the physical mobility section (odds ratio = 2.4, 95% confidence interval 1.02 to 5.5), female gender in the social isolation section (odds ratio = 2.8, 95% confidence interval 1.03 to 7.7), and presence of at least one comorbid disease in the emotional reaction section (odds ratio = 2.5, 95% confidence interval 1.17 to 5.2). CONCLUSIONS: Cardiac operations improve quality of life in patients. The improvement is similar for patients undergoing coronary artery bypass grafting versus valve replacement, and for patients with no postoperative events versus those with nonlethal postoperative complications. The strongest predictive factors for quality of life are age and New York Heart Association functional class.

Activities of Daily Living↗
PubMed1996

Inter-observer reliability in the interpretation of coronary angiograms.

The interpretation of coronary angiograms is indispensable in determining procedure in coronary surgery. The aim of this study was to measure the overall reliability of a group of surgeons in the interpretation of coronary angiograms, surgical procedure and the evaluation of operative risk. Ten coronary angiograms were interpreted by eight cardiac surgeons at four different medical centers. Evaluation of coding discrepancies, in this case of multiple raters applying an ordinal-scale classification scheme (0, 1, 2) with no expert yardstick available for coding, was explored by a two-way random factor analysis of variance. Reliability was substantial for the assessment of stenosis irrespective of the artery (intraclass correlation coefficient (ICC) ranging from 0.92 to 1), and good for the distal part of the artery (ICC ranging from 0.83 to 0.86) as well as for the collateral provision (ICC ranging from 0.75 to 0.94). Agreement between surgeons was good with respect to the number of bypasses to be performed (ICC = 0.88). The number of bypass per patient varied from 2.6 to 3.2 depending on the surgeon. Agreement as to whether or not to bypass was substantial for the right coronary artery (ICC = 0.92), good for the marginal artery (ICC = 0.87) and fair for the left anterior descending artery (ICC = 0.60) and the circumflex artery (ICC = 0.60). There was a higher rate of agreement concerning inferior wall motion (ICC = 0.98) than of the anterior wall motion (ICC = 0.78). Agreement was substantial for ejection fraction (ICC = 0.93), operative risk (ICC = 0.93) and the type of coronary tree (ICC = 0.85). With respect to the overall set of items, no one surgeon disagreed significantly with the rest of the group. Some disagreement regarding anatomy suitable for revascularization exists between surgeons. Surgical assessment of risk is similar. Cardiac surgeons quickly learn to assess risk in a similar manner, even though they might not always graft the same anatomic vessels or assess regional wall motion similarly.

Coronary Angiography↗
PubMed1996

Is surgery for aortic stenosis justified in patients over 75 years of age?

UNLABELLED: The upper age limit for cardiac surgery has constantly been extended since the 1980's, with the most pronounced extension observed in surgery of the calcified aortic stenosis (CAS). The aim of this study was to examine whether surgery is beneficial to the elderly population in terms of hospital mortality, long-term survival and quality of life. Between January 1989 and October 1992, 95 patients over 75 years of age underwent aortic valvular replacement (AVR) for CAS. There were 54 male and 41 female patients with a mean age of 79.7 +/- 2.8 years. All of them suffered from isolated or predominant CAS, associated with a coronary lesion requiring additional bypass procedures in 14 cases. Before surgery 67% of the patients were in NYHA class III and IV and 30% of them had suffered from acute pulmonary edema. Surgical priority was urgent in 10 patients. Mean aortic clamp time was of 55 minutes for the isolated CAS and 78 minutes for the bypass-associated CAS. A Carpentier-Edwards supra-annular bioprosthesis was implanted in 95.7% of the cases, associated with coronary bypass in 14 cases, with a mean of 1.6 bypasses per patient. Global hospital mortality was 11.5%. Emergency surgery was a predictive factor of in hospital mortality in multivariate analysis. Among the 84 survivors, 12 died secondarily, 4 of them due to cardiac causes during the follow-up period (26 +/- 4 months); similar to the mortality rate of the global population for the same age. The factors responsible for this late mortality in multivariate analysis were poor left ventricular status and diabetes mellitus. Survivor's quality of life is excellent with 78.6% of patients termed class I, autonomous and free of sequelae. IN CONCLUSION: despite an operative mortality rate much higher than in patients under 70, AVR for CAS is justified even in patients over 75 years as it offers a good quality of survival and a life expectancy identical to that of the general population of the same age.

Age Factors↗
PubMed1992

[From central venous pressure to SVO2].

The interest and the limits of different hemodynamic parameters are recalled: measure of right arterial pressure and pulmonary artery pressure, continuous measurement of SvO2. Technological and theoretical knowledge are necessary to interpret the results.

Catheterization, Swan-Ganz↗
PubMed1987

Acute leukemia with chromosome translocation (4;11): 7 new patients and analysis of 71 cases.

Clinical and laboratory features of seven patients with acute leukemia associated with the (4;11) chromosome translocation are presented. Leukemic blasts of these patients showed lymphoid morphology in 6 (although 1 was treated for monoblastic leukemia 3 years earlier) and monocytoid morphology in 1, were positive for TdT and HD 37 (CD 19) in 6 patients, whereas weak expression of CALLA was seen in only 1 patient and T-lineage-associated antigens in none. Leukemic blasts from four patients showed the simultaneous expression of B-lymphoid and myeloid antigens, suggesting leukemogenesis in a very early multipotent progenitor cell. In 2 patients an isochromosome of the long arm of No. 7 chromosome was found in the leukemic karyotypes in addition to t (4; 11) (q 21; q 23); in one instance present at diagnosis, in the other one occurring at relapse. In one other patient leukemia karyotype also demonstrated trisomy 8. Leukemic cells of three patients were investigated by molecular genetics and demonstrated immunoglobulin gene rearrangements for the Ig heavy chain sequences but not for the light chain constant regions and T cell receptor sequences. All patients were treated by intensive chemotherapy. Four of the 7 patients are in continuous complete remission. The longest event-free survival time (over 2 1/2 years) was seen in one patient who had also DOWN-syndrome. Including these 7 patients a clinical analysis of 71 patients with t (4; 11) acute leukemia was made, emphasizing the following characteristics at diagnosis: female sex (62%), age under 2 years (49%), leukocyte count over 100 X 10(9)/1 (61%), splenomegaly (80%), CNS-disease (11%). Survival of over 2 years was reported in less than 15% of the patients. It remains to be seen if risk-adapted treatment can alter the course of this early B-precursor acute leukemia with hitherto very bad prognosis.

Acute Disease↗
PubMed1983

[Pathogenicity of Fusobacterium. Apropos of 2 cases].

Two cases of severe septico-pyohaemia due to Fusobacterium necrophorum are reported. Clinical data from human cases and experimental results from infections of laboratory animal with Fusobacterium necrophorum suggest: the important role of individual factors which enhance anaerobic growth (i.e. decrease of tissular redox potential); the involvement of thrombophlebitis with septic thrombi increasing the frequency of metastases; the early and long-lasting bacterial localisation in tissues, particularly in the liver where the proliferation of Fusobacterium necrophorum in Küpffer cells impairs macrophage function.

Adult↗
PubMed1982

Treatment of psoriasis with somatostatin.

In 22 of 26 patients suffering from psoriasis the drip infusion therapy with Somatostatin, an inhibitor of the human growth hormone (HGH), leads to complete or partial remission of skin lesions. Fast reduction of joint pains in arthropathic psoriasis could be observed in four of four patients. The repeated measurement of HGH blood level showed a decrease of HGH in five cases following the Somatostatin therapy combined with the clinical remission.

Adult↗
PubMed1981

Psoriasis and human growth hormone: aetiology and therapy.

First report on nine patients suffering from psoriasis who were treated with somatostatin or bromocriptin or both. These are inhibitors of HGH. The therapeutical effect on skin lesions and psoriatic alterations to joints is described.

Adult↗
PubMed1981

Treatment of psoriasis with bromocriptin.

Sixty patients suffering from psoriasis of all clinical forms have been treated with an increased dosage of Bromocriptin. The age of the patients ranged from 20 to 72 years. Patients with contraindications for Bromocriptin were excluded from the test. In 80% a remission or reduction of psoriasis lesions was noticed. Side effects in the form of nausea, dizziness and vomiting occurred in 15%, but decreased in the course of Bromocriptin therapy.

Adult↗
PubMed1981

[Correlation of growth hormone and aetiology of psoriasis].

Pathological alterations of capillaries, accelerated epidermopoesis, increased rate and extent of metabolism in the psoriatic lesion and first manifestation of psoriasis rarely in the first 20 years of life made us decide to investigate the human growth hormone (STH) in blood serum. In 70 patients suffering from psoriasis we found that the extention of skin lesions was correlated to the STH levels, which were determined every 2 h all over the day. The average STH level in psoriasis was three times as high as average value in the group of 40 controls. Thus, one can conclude that psoriasis is caused by a persistence of STH with individual penetrance.

Adolescent↗
PubMed1980

[Relationship between psoriasis and human growth hormone (author's transl)].

The behavior of the capillary bed, increased epidermopoiesis, increased total metabolism of psoriasis efflorescence and its first manifestation, principally in the second decade of life, drew our attention to the behavior of the human growth hormone. A rise in the serum level of the human growth hormone compared with the normal (40 control subjects) significantly correlating with the extent of the skin symptoms, acuteness and therapy was established in the serum by diurnal determination in 70 psoriasis patients. According to this, psoriasis is the etiological consequence of hereditary persistence of production of the human growth hormone with individual penetrance.

Adolescent↗
PubMed1979

[ALL therapy study 1971-1974 of the German working group for leukemia research and therapy in childhood: prognostic significance of initial features and different therapeutic modalities (author's transl)].

495 children and adolescents with acute lymphoblastic leukemia entered a non-randomized therapy study between January 1st, 1971, and December 31st, 1974. They were treated at 40 pediatric clinics in the Federal Republic of Germany according to the protocol of the Deutsche Arbeitsgemeinschaft für Leukämieforschung und -Behandlung im Kindesalter, which was closely adapted to the Memphis protocol VII. These patients were analyzed retrospectively, data of evaluation was July 31st, 1978. 7 patients (1.4%) did not achieve remission, 14 patients (2.8%) died during the induction period, and another 37 patients (7.5%) died in continuous complete remission (CCR). For purposes of comparison only the remaining 437 patients were evaluated (remission group). The 7 1/2 years' probability of CCR is 0.33 +/- 0.02 for the total group (495 patients) and 0.37 +/- 0.03 for the remission group. The probability of survival for these groups is 0.40 +/- 0.03 and 0.45 +/- 0.03, respectively. After relapse the 5 years' probability of survival is 0.03 +/- 0.02. Patients with testicular relapse have a markedly better prognosis compared to those with bone-marrow or central nervous system relapses. The most important prognostic factor was found to be the white blood count at diagnosis. There is a negative correlation between the initial white blood count and the probability of CCR. Girls fared significantly better than boys (0.46 +/- 0.04 vs 0.31 +/- 0.03 in CCR, p less than 0.01). There is convincing evidence that the impaired prognosis in boys is at least partly due to the incidence of testicular relapses (36 of 268 relapses were found to be testicular, isolated in 20 patients and combined with bone-marrow relapse in 16 patients). Patients with thymic involvement and/or positive reaction of the acid phosphatase in their blast cell did significantly worse (0.12 +/- 0.05 in CCR). Irradiation of the skull was performed in two different doses (1800 and 2400 rads). Concerning the incidence of relapses primarily located in the central nervous system patients with low-dose irradiation had no worse prognosis than those with high-dose irradiation but the incidence of bone-marrow relapses was found to be higher in the 2400 rad group (50.5% vs. 41.7% in the 1800 rad group), possibly due to the higher initial white blood count (median 8900/mul vs. 6500/mul). The addition of vincristine/prednisone reinduction courses during the first year of continuation therapy showed no significant advantage.

Child↗
PubMed1977

[Changes in the dental hard tissues and supporting structures in tetanic syndrome. I. Review of the literature].

The authors give a survey of the literature on the tetanic syndrome and its effects on the dental hard tissues and the tooth supporting structures. In cases of normocalcaemic tetany, no pathological alterations have been observed in the dental hard tissues, the pulp and the periodontium. On the contrary, enamel hypoplasia, broad pulp chambers, shortened tooth rootsdelayed dentition, hypodontia, inflammatory changes and bleedings from the periodontal ligament, bone densification and chronic gingivitis have been found in patients with hypocalcaemic tetany.

Anodontia↗
PubMed1977

[Changes in the dental hard tissues and the supporting structures in tetanic syndrome. 2. Personal studies].

The authors present the changes of the orofacial system observed in 30 patients (of both sexes) with tetanic syndrome in the framework of a pilot study. The DMF-S values varied for different age groups from 40.6 to 79.5. The hypoplasia index was 1.3-2.1; and the periodontal disease index according to Kötzschke, 18.6-48.2%. Epithelial desquamation of varying markedness and intensity was seen in half of the patients. The interpretations of the radiographs revealed generalized denticle formation in 13.3% of the 30 patients; and isolated denticles in 73.3%. The authors observed a loosening of the spongiosa structure in the majority of patients, and localized radiolucencies of the jaw bone in two thirds of them. The average intra-alveolar root-length index was 46.4%.

Adolescent↗