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Biomedical subjects

M Schulte

Publications and source records attributed to M Schulte.

At least 19 recordsLinked to original sources
PubMed1998

[Color Doppler controlled needle biopsy in diagnosis of soft tissue and bone tumors].

In a prospective study we investigated 168 patients with musculoskeletal tumors, including 71 sarcomas, by core needle biopsy using the high-speed device Autovac. Monitoring with colour-coded duplex sonography allowed a well-aimed puncture of smaller or deeply localized lesions and also permitted the discrimination of necrotic and viable parts of the tumor. Adequate material for histologic diagnosis including grading and determination of tumor subtype was obtained from soft tissue sarcomas, soft tissue metastases, malignant lymphomas, plasmacytomas, and osteolytic skeletal secondaries. In contrast, in benign soft tissue and bone tumors the diagnosis could be established in only 66% of cases. Although skeletal sarcomas were identified as malignant mesenchymal lesions, a complete histologic classification of tumor subtype frequently was not possible due to an insufficient tissue specimen. With an accuracy of 97% for the diagnosis of malignancy and of 94% for the diagnosis of soft tissue sarcoma the results of core needle biopsies were comparable to those of incisional biopsies, the reference standard in the diagnosis of musculoskeletal tumors. Regarding the known disadvantages and the oncological risks of incisional biopsies, needle biopsy should replace the open procedure as the primary means of diagnosis in soft tissue and osteolytic bone tumors.

Adult↗
PubMed1998

[Primary malignant tumors of the sacrum].

The oncological and functional results of 16 patients with primary malignant sacral tumors (12 chordomas, 3 chondrosarcomas, 1 fibrosarcoma) during the past decade are reported. Dorsal approach was used in 10 cases, ventral or combined ventrodorsal procedure in 5 cases; in 1 case only biopsy was taken. Amputation of rectum with colostomy was necessary in 9 cases, ileosacral stabilization in 2 cases. Eight patients died, 5 of the disease and 3 of complications, with a mean survival time of 25.8 months. Local recurrence occurred in 4, distant metastases in 3 cases. Six of the 8 survivors--mean survival is 59 (21-112) months--showed good or excellent functional results according to the Enneking score system. Local complications, mostly wound healing problems, were observed in 9 (56%), neurological disorders in respect of the resected sacral nerve roots in 11 (68%) cases. The oncological and functional results after resection of primary malignant sacral tumors, especially of chordomas, justify radical surgical procedures sacrificing the sacral nerve roots.

Chondrosarcoma↗
PubMed1997

Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage.

BACKGROUND: Subarachnoid haemorrhage is commonly associated with natriuresis and hyponatraemia. One possible explanation for these features is a defect in the central regulation of renal sodium reabsorption with increased secretion of a natriuretic factor. We investigated whether excess sodium secretion in patients with subarachnoid haemorrhage is related to increased secretion of natriuretic peptides or to the presence of digoxin-like immunoreactive substances. METHODS: We measured the plasma concentrations of digoxin-like immunoreactive substances (by a fluorescence polarisation immunoassay) and natriuretic peptides, aldosterone, renin, and antidiuretic hormone (by radioimmunoassay) in ten patients with aneurysmal subarachnoid haemorrhage, ten patients undergoing elective craniotomy for cerebral tumours, and 40 healthy controls of similar age and sex distribution. Samples were collected before surgery, 1 h, 4 h, and 12 h after surgery, then daily until 7 days postoperatively in the two groups of patients. FINDINGS: All patients with subarachnoid haemorrhage, but none of the tumour patients, showed increased urine output and urinary excretion of sodium (p = 0.018 for comparison of means of curves to 7 days). The patients with subarachnoid haemorrhage had much higher plasma concentrations of brain natriuretic peptide (BNP) than controls, on admission (mean 15.1 [SE 3.8] vs 1.6 [1.0] pmol/L, p < 0.001) and throughout the study period, accompanied by lower than normal aldosterone concentrations and normal plasma concentrations of atrial and C-type natriuretic peptides (ANP, CNP). The patients with tumours had similar plasma concentrations of ANP, BNP, and CNP to the controls. We did not detect digoxin-like immunoreactive substances in either group of patients. INTERPRETATION: Salt-wasting of central origin may induce hyponatraemia in patients with aneurysmal subarachnoid haemorrhage, possibly as a result of increased secretion of BNP with subsequent suppression of aldosterone synthesis.

Brain Neoplasms↗
PubMed1997

Bone and soft tissue manifestations of alveolar echinococcosis.

OBJECTIVE: The present study demonstrates the osseous and soft tissue manifestations of alveolar echinococcosis (AE). PATIENTS: We report on eight patients with AE with bone or soft tissue involvement confirmed at biopsy or needle cytology. RESULTS: All eight patients showed hepatic involvement. Four exhibited infiltration of the spine as a result of direct spread of the hepatic primary lesion; distant metastases were observed in only three of these patients. Calcifications, which are typical for hepatic manifestations of the disease, were observed in soft tissue in only two of eight cases (25%); we observed no instances of endovesicular daughter cysts. CONCLUSIONS: AE manifests itself in the vertebral column as a form of spondylitis and in soft tissue presents similar to an abscess. Since in most of these cases spread of the disease per continuitatem from the liver is present, the diagnosis is easily made from the characteristic hepatic findings.

Adult↗
PubMed1997

Glomus tumor with diffuse infiltration of the quadriceps muscle: a case report.

A case of a diffuse growing glomus tumor with interstitial infiltration of the musculus vastus medialis and intermedius (quadriceps muscle) in a 21-year-old woman is reported. The tumor was diagnosed by needle biopsy and then removed with wide margins. The typical histological appearance and the immunohistochemical findings in the resected specimen confirmed the diagnosis. Histogenesis and the biological behavior of glomus tumors are discussed.

Adult↗
PubMed1997

Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap.

OBJECTIVES: To determine risk factors for Serratia marcescens infection or colonization, and to identify the source of the pathogen and factors facilitating its persistence in a neonatal intensive-care unit (NICU) during an outbreak. DESIGN: Retrospective case-control study; review of NICU infection control policies, soap use, and handwashing practices among healthcare workers (HCWs); and selected environmental cultures. SETTING: A university-affiliated tertiary-care hospital NICU. PATIENTS: All NICU infants with at least one positive culture for S marcescens during August 1994 to October 1995. Infants who did not develop S marcescens infection or colonization were selected randomly as controls. RESULTS: Thirty-two patients met the case definition. On multivariate analysis, independent risk factors for S marcescens infection or colonization were having very low birth weight (< 1,500 g), a patent ductus arteriosus, a mother with chorioamnionitis, or exposure to a single HCW. During January to July 1995, NICU HCWs carried their own bottles of 1% chlorxylenol soap, which often were left standing inverted in the NICU sink and work areas. Cultures of 16 (31%) of 52 samples of soap and 1 (8%) of 13 sinks yielded S marcescens. The 16 samples of soap all came from opened 4-oz bottles carried by HCWs. DNA banding patterns of case infant, HCW soap bottle, and sink isolates were identical. CONCLUSIONS: Extrinsically contaminated soap contributed to an outbreak of S marcescens infection. Very-low-birth-weight infants with multiple invasive procedures and exposures to certain HCWs were at greatest risk of S marcescens infection or colonization.

Anti-Infective Agents, Local↗
PubMed1997

Medical complications of anorexia nervosa.

Anorexia nervosa is often characterized by progressive deterioration in many different organ systems. Most medical complications are the result of starvation and can be reversed with a well-planned refeeding program. While some of the complications of anorexia nervosa are predictable physiologic adaptations to the self-imposed starvation, many others are potentially life threatening. It is therefore incumbent upon all primary care physicians to become familiar with this disorder, because it is increasing in incidence and is commonly burdened by substantial chronicity and recidivism.

Adolescent↗
PubMed1997

Musculoskeletal involvement in cystic echinococcosis: report of eight cases and review of the literature.

OBJECTIVE: Our purpose was to describe the morphologic appearance of musculoskeletal lesions in patients with cystic echinococcosis shown by CT and MR imaging. CONCLUSION: Patients with musculoskeletal lesions of cystic echinococcosis typically have cystic structures in adjacent soft tissues. These cysts morphologically resemble abscesses, with peripheral uptake of contrast medium and variable signal intensities on T1-weighted MR images. The absence of calcifications or endovesicular daughter cysts does not exclude the diagnosis of cystic echinococcosis.

Adult↗
PubMed1997

[A method for nidus localization in osteoid osteomas].

A method for localization of the nidus of osteoid osteomas using CT-controlled needle placement and subperiosteal marking with methylene blue is demonstrated. Our clinical experience in 13 patients is reported. This method allows proper intraoperative localization of the nidus of osteoid osteomas without problems. Thus, osseous resection can be reduced and additional stabilization by internal fixation or defect filling by bone graft are not necessary.

Adolescent↗
PubMed1996

Predictors of mortality after acute hip fracture.

To identify determinants of mortality after hip fracture, we performed a multicenter, retrospective study of 390 Medicare beneficiaries. Independent predictors of 30-day mortality included a history of congestive heart failure (odds ratio [OR] 32; 95% confidence interval [CI] 5, 192), angina (OR 26; 95% CI 4, 184), or chronic pulmonary disease (OR 11; 95% CI 2, 62). Postoperative use of aspirin was associated with a reduced risk of mortality (OR 0.24; 95% CI 0.08, 0.70). Cardiovascular events were the presumed cause of 63% of in-hospital deaths. Aspirin may have significant potential to reduce mortality in this population and deserves further study.

Aged↗
PubMed1996

Quality assurance by specification and achievement of goals in palliative cancer treatment.

As the goals of palliative cancer treatments have not always been clearly specified, this paper describes how frequently the goals of palliative cancer treatment can be specified according to a given definition and how frequently those specified goals can be achieved. The clinical problems of 171 cancer patients were discussed in the Interdisciplinary Oncologic Conference (IOC) of the Cancer Centre University of Ulm (CCUU) and recommendations concerning further diagnostic treatments and/or therapy were provided. These recommendations had been documented and analysed retrospectively. The goals were classified as either cure or palliation or further investigation. If the goal was palliation, it was investigated whether or not the goal was specified as either alleviation of existing problems or prevention of impending problems. The achievement of the specified goals was assessed. Palliation was the goal of treatment in 119 (71%) of the 168 evaluable recommendations. In 83 of the 119 cases (70%), immediate treatment was recommended. The goal was specified in 57 (69%) of the 83 recommendations and could be realized in 24 of 57 specified cases (42%). Patients in this group survived longer (p < 0.01) than patients in whom the goals could not be achieved. Impending problems could be prevented more often (p = 0.001) in 14 out of 18 cases, while existing problems could be alleviated in only 10 out of 34 cases. It is concluded that specification of the goals of palliation is necessary because it is impossible to decide if a goal of treatment could be achieved or not unless the goal of treatment has been defined (as existing/impending problem). The prevention of impending problems could be investigated in prospectively controlled clinical trials.

Adult↗
PubMed1996

[Communication in hand surgery].

Computer-aided communication provides us with an easy way of exchanging different messages. Personal data (E-Mail) can be transferred as easy as pictures. News-groups would be intended to act as a forum where many people could interact and share information on issues related to the practice and the advancement of hand surgery. This paper explains the technique and the advantage of electronic communication. Using already existing computer-networks will enable us to start communication at once.

Computer Communication Networks↗
PubMed1996

[Primary malignant bone and soft tissue tumors of the pelvis--oncologic and functional outcome].

Surgical treatment of primary malignant bone and soft tissue tumors involving the innominate bone has to be considered an extensive procedure with high incidence of complications. It requires the knowledge of different techniques of resection and reconstruction of bone, joints, soft tissue and intrapelvic organs, as well as a multidisciplinary management. Therefore, it should be limited to specialized centers. The best oncological and functional results can be achieved by continuity resection and pelvic reconstruction in low grade malignant bone tumors [1-3].

Adult↗
PubMed1995

[Diagnosis and spontaneous course of non-traumatic localized myositis ossificans].

Non-traumatic localized myositis ossificans is a rare variant of pseudotumoral muscular ossification. In the early stage it may be misdiagnosed as soft tissue sarcoma or some kind of osteosarcoma. Myositis ossificans itself does not always require therapy; when diagnosed on the basis of the typical features revealed by meticulous non-invasive investigation, biopsy is not mandatory for confirmation of the diagnosis. The diagnostic procedures needed - radiography, ultrasound, MRI, and isotope bone scan - are discussed with reference to three clinical case reports.

Adult↗
PubMed1995

Diagnosis of pyogenic abscesses by ultrasound.

Pyogenic infections are common in tropical countries and draining pus is one of the most frequent surgical operations all over the developing world. While superficial abscesses are easily detectable by clinical means the diagnosis of deeper abscesses in muscles, joints, parenchymatous organs and body cavities is frequently difficult or even impossible. In those situations B-mode ultrasound represents a valuable diagnostic tool. Furthermore, diagnosis may be confirmed or defined by ultrasound guided needle aspiration and ultrasound-guided drainage. Those measures may save surgical interventions and cost. Based on our experience with more than 3820 ultrasound examinations in 2746 patients of Northern Zaire sonographic characteristics of pyogenic abscesses are defined. Clinical examples of pyogenic affections with the corresponding ultrasound morphology are presented.

Abdomen, Acute↗