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Biomedical subjects

P Siemens

Publications and source records attributed to P Siemens.

16 recordsLinked to original sources
PubMed2002

[PACS: from project to reality. Report of experiences on full digitalisation of the radiology department of a major hospital].

OBJECTIVE: To assess the time needed and the resulting effects of a complete digitalisation of a radiological department of a major hospital (856 beds, 28,000 in-patients, 35,000 out-patients/year) a pilot study was performed. This had to be done without interrupting routine services. RESULTS: After intensive preparations were performed and the hospital-network was completed, within a two year period all radiological functions (mammography excluded), reporting stations and archives were changed to a complete digital workflow. All modalities (provided by 3 different companies) are now connected by DICOM-work lists. The picture-files (4 GB/day) are automatically routed to the work-stations (n = 10), where the reporting and file shows are performed, to the digital archive and to the peripheral viewing-stations (n = 44). The distribution of the digital pictures takes place all over the hospital including the ORs and special units. We accomplished, to connect electronically the report and the image data. The clinical file shows are also performed completely digitally. The access to the data of the deep archive is possible by the dept. of radiology without any manual interaction. The film consumption was reduced to an amount of less than 10%, as compared to the prior PACS situation. Since PACS has been introduced the radiological productivity increased by more than 15% and throughput-time was clearly reduced. CONCLUSIONS: The complete digitalisation increases productivity and attractiveness of a hospital-radiology and helps to shorten diagnostic and therapeutic decision-making. The transfer from a conventional to a digital workflow is possible without interrupting the clinical services. Extensive preparations and ongoing assistance of such projects though are clearly needed.

Computer Systems↗
PubMed2000

Perspectives for microelectrode arrays for biosensing and membrane electroporation.

Electrochemical microelectrode devices are among the great challenges for bioelectrochemistry, cell biology and recently also for biomedical research and new clinical electrotherapies. Two representative cases in cell biology and medical research for new trends in the technical devices are selected, heading at new diagnostic and therapeutic clinical applications. One example is from the field of biosensing cholinergic neurotransmitter substances by the nicotinic acetylcholine receptor (AcChoR) in solid-supported lipid bilayer membrane and the other one refers to new developments of electrode systems for the electrochemical delivery of drugs and genes to biological cell aggregates and tissue by the powerful method of membrane electroporation. In both cases addressed to, the new developments include the use of electrical feedback control of electrode arrays for biosensing processes as well as for the extent and duration of tissue electroporation. In line with the impressive advances in medical microsurgery, where increasingly smaller organ targets become accessible, microelectrode systems have become a continuous technical challenge for bioanalytical purposes and, as discussed here in some detail, for the new field of the electroporative delivery of effector substances like drugs and genes, using miniaturized electrochemical electrode arrays.

Biosensing Techniques↗
PubMed1998

Semiclosed iliac recanalisation by an inguinal approach--modified surgical techniques integrating interventional procedures.

OBJECTIVES: Technical success and early outcome of modified surgical techniques integrating interventional procedures for iliac recanalisation performed through an incision in the groin. MATERIALS: Sixty-one consecutive iliac arteries in 59 patients with long occlusions in 16, occlusions of the common iliac in 11, occlusions of the external iliac in 24 and multiple stenoses of the iliac in 10 cases underwent semiclosed recanalisation through a groin incision. METHODS: Passage of the lesion by guidewire permits retrograde ring-stripper endarterectomy over the wire as a guiding splint or thrombectomy with a double lumen balloon catheter. Residual lesions are corrected by balloon or stent angioplasty. Adequate outflow is established by femoral patch plasty. RESULTS: Conversion to a standard operation was required in 10 limbs (failure to recanalise the lesion in nine, rupture after angioplasty in one). Initial technical success was achieved in the remaining 51 limbs (recanalisation by ring stripper endarterectomy in 36, thrombectomy in 14, both in six, additional intraoperative angioplasty in 42). Five postoperative thromboses were successfully treated by a combined surgical and interventional approach accounting for a 1-month 100% secondary patency. CONCLUSION: Iliac recanalisation through the groin by modified ring stripper endarterectomy or modified thrombectomy in combination with intraoperative angioplasty is a safe and effective procedure. Long-term results are required to evaluate the procedure.

Adult↗
PubMed1998

[The possibilities and risks of outpatient PTA in patients with peripheral arterial obstructive disease].

PURPOSE: To evaluate risk and feasibility of outpatient PTA in patients with iliac-femoral artery disease we conducted a prospective study. MATERIAL AND METHOD: Out of a total group of 263 patients we selected 100 p. (38%) according to pre-defined criteria. The following criteria and others excluded the patients from outpatient procedures: insulin-dependent diabetes, poorly controlled hypertension, cardiac failure grade III and IV, chronic haemodialysis, severe overweight, elective stent implants. RESULTS: 90 of 100 patients for whom we had planned an outpatient procedure, could leave the day-clinic after a maximum of 10 hours of observation. For 10 patients we changed the procedure to an inpatient stay because of prolonged heparinisation, sudden elevation of arterial pressure, secondary stent implants and the need for local fibrinolysis therapy. Complications showed a trend to be lower in the outpatient group than in the inpatient group (2.0% vs 4.3%). CONCLUSIONS: Performing iliac-femoral PTA on an outpatient basis demands strict selection criteria and a close tie-up to a day clinic. In 2/3 of our patients we preferred to perform PTA on an inpatient basis. A higher incidence of risks was seen in the inpatient group.

Adult↗
PubMed1993

[Pyogenic liver abscess. Analysis and follow-up examination of a personal patient sample 1981-1992].

From January 1, 1981 to January 1, 1992 a total of 30 liver abscesses were treated in the University Clinic for Surgery in Cologne. 23 patients underwent an primary operative treatment and seven patients received a controlled guided percutaneous drainage. During the observation period four patients (13.3%) died by the effect of the liver abscess. 20 patients (66.7%) were subjected to clinical, laboratorical and computertomographical post examinations. The primary rate of operation success amounted to 47.8%, that of controlled guided percutaneous drainage of 42.8% (NS). The secondary success rate (that means after successful operative reintervention) amounted to 86.9% by the operative and to 85.7% by the percutaneous drainaged cases. During the post examination no relapse was determinated. Larger or chambered liver abscesses as well as extrahepatic spreading required operative drainage and, in cases of multifocal spreading, a resection with concomitant antibiotics. In case of solitary abscesses the controlled guided percutaneous drainage is the least harmful and low-prices method.

Cause of Death↗
PubMed1992

[Digital cineradiography (DCR) of the act of swallowing. The initial clinical experiences].

Twenty-seven patients with different swallowing disorders were studied by employing digital cineradiography (DCR) for rapid imaging of the pharynx with a temporal resolution of up to 50 frames per second and a maximum spatial resolution of .8 per/mm. To facilitate therapy planning, the DCR study can be transferred to the otorhinolaryngologist via videotape. DCR is capable to substitute analog cine or video techniques in the pre- and postoperative examination of patients with swallowing disorders.

Cineradiography↗
PubMed1991

[A rare constellation of findings: bile duct cancer, ulcerative colitis, deep venous thrombosis of the leg].

A case of a 28-year-old patient with long-standing chronic ulcerative colitis is presented, in whom cholangiocarcinoma was diagnosed by CT and ultrasound guided liver biopsy. This association is well known, because the incidence of bile duct carcinoma in patients with chronic ulcerative colitis is increased. A possible precursor of the disease is thought to be primary sclerosing cholangitis which also more frequently occurs in patients with ulcerative colitis. Our patient was initially hospitalized for deep venous thrombosis, which in retrospect had to be interpreted as a paraneoplastic syndrome.

Adenocarcinoma↗
PubMed1982

[Treatment of ankylosing spondylitis with slow-release diclofenac sodium in a single daily dose].

The efficacy and tolerability of slow-release diclofenac sodium were investigated in 40 patients with ankylosing spondylitis. The patients received one coated tablet of 100 mg daily in the morning for 21 days in addition to standard physiotherapy. The efficacy of the trial treatment was evaluated by measuring the chin-to-manubrium sterni and fingertips-to-floor distances, Schober's sign, and chest expansion. Every morning and evening the severity of pain and the degree of spinal stiffness were recorded by the patients on visual analogue scales. A significant improvement of the symptoms was found in 35 of the patients as compared to the initial findings. The slow-release formulation of diclofenac Na was very well tolerated. The necessity of balneophysical therapy in ankylosing spondylitis is emphasized, which in most cases will only be possible in combination with adequate drug therapy.

Adult↗
PubMedDate not supplied

CT-guided lumbar sympathectomy: results and analysis of factors influencing the outcome.

PURPOSE: To prospectively analyze the effectiveness of computed tomography-guided percutaneous lumbar sympathectomy (CTLS) in patients with peripheral arterial occlusive disease in relation to angiographic findings and vascular risk factors. METHODS: Eighty-three patients were treated by CTLS. After clinical evaluation of the risk profile and diagnostic intraarterial digital subtraction arteriography, 14 patients underwent unilateral, and 69 bilateral one-level treatment. Follow-up studies took place on the day following the intervention, after 3 weeks, and after 3 months. RESULTS: A total of 152 interventions were performed in 83 patients. After 3 months, clinical examination of 54 patients (5 patients had died, 24 were lost to follow-up) revealed improvement in 46% (25/54), no change in 39% (21/54), and worsening (amputation) in 15% (8/54). There was no significant statistical correlation among any of the analyzed factors (diabetes mellitus, arterial hypertension, smoking, hyperlipidemia, obesity, hyperuricemia, number of risk factors, ankle-arm index, and angiography score) and the outcome after CTLS. Three major complications occurred: one diabetic patient developed a retroperitoneal abscess 2 weeks after CTLS, and in two other patients ureteral strictures were detected 3 months and 2 years after CTLS, respectively. CONCLUSION: As no predictive criteria for clinical improvement in an individual patient could be identified, CTLS, as a safe procedure, should be employed on a large scale in patients who are unsuitable for treatment by angioplasty or revascularization.

Adult↗