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Biomedical subjects

P Walger

Publications and source records attributed to P Walger.

At least 19 recordsLinked to original sources
PubMed2007

[Assessing psychopathic personality disorders for legal procedures for using a version for adolescents of Hare's revised checklist].

In accordance with Robert Hare's concept, the term psychopathy was operationalized in 1985 when the revised form of the psychopathy checklist (PCL-R) was published. Since then, the PCL-R has been used internationally. For several years in North America and now even in England and the Netherlands, personality traits of psychopathy have also been studied in children and juveniles. Based on the PCL-R, a checklist for adolescents (PCL-YV) was developed that takes the special conditions of adolescents into account. The goal of this paper was to test the applicability of the PCL-YV retrospectively in a sample of forensic psychiatric evaluations of delinquent juveniles that were assigned to the Clinic for Child and Adolescent Psychiatry at the University of Cologne, Germany. Based on results collected with the PCL-YV, data on groups of low- and medium-scoring juveniles were classified which partially differed significantly in relation to sociodemographic and anamnestic data. Furthermore, factor analyses showed a three-factor model solution. Associations with legal issues such as the question of criminal responsibility could not be found. In summary, the results indicate the applicability of the PCL-YV for adolescents but show the difficulties of retrospective design without conducting PCL interviews.

Adolescent↗
PubMed2006

[The modified Bonn Malmö protocol (MBMP) in the treatment of acquired haemophilia A].

BACKGROUND AND OBJECTIVE: Autoantibodies directed against clotting factors can induce life threatening bleeding with a mortality rate up to 22%. Although the incidence of the disease is low (1-4 x 10(-6)), costs of treatment due to long-term clotting factor substitution can be enormous. Aim of an optimal treatment strategy should be to control bleedings by a rapid and safe elimination of the inhibitor and reinducing long-term immune tolerance. PATIENTS AND METHODS: Treatment of 48 patients with acquired haemophilia A (m=20, f =28, age 61.3 (SD 16.4)), the largest patient collective world-wide, was monitored for a mean of 48 months. Three patients received only conservative treatment. 45 patients were treated intensively by a multimodal strategy including: 1. immunoadsorption for antibody elimination; 2. FVIII substitution; 3. intravenous immunoglobulin substitution and 4. immunosuppression. The times required for inhibitor elimination, factor VIII substitution and the duration of the MBMP were documented. RESULTS: In 45 patients with a high titre critical bleeding was controlled immediately after the initiation of MBMP. There were no deaths from bleeding or the treatment. Inhibitor levels decreased to undetectable levels within a median of 3 days (95% CI, 3-7 days), factor substitution was terminated within a median of 13 days (95% CI, 10-16 days) and the treatment was completed within a median of 15 days (95% CI, 13-17 days). The overall response rate for complete remission (CR) was 91%. When cancer patients were excluded, the CR rate was 97%. CONCLUSION: Considering the short duration and amount of factor VIII substitution, the short time of hospitalization and the long-term median follow up of 48 months without bleeding events, the MBMP appears to have a modifying effect on the immunological response.

Aged↗
PubMed2003

[Syncope with cardiac arrest in a 30-year-old woman].

HISTORY AND ADMISSION FINDINGS: A 30-year-old woman presented with a cardiac arrest, which spontaneously converted into a regular sinus rhythm. The patient had no prior history of cardiovascular diseases. On admission, the cardiovascular clinical examination of this young female was regular. INVESTIGATIONS: On admission, discrete inferior repolarisation changes were documented which were slightly progressive during the next day. Electrophysiologic examination of the heart was regular, angiography showed a coronary fistula and an atypical descense of the circumflex artery from the right coronary artery. DIAGNOSIS: Right coronary artery fistula to the right ventricle. Atypical descense of the circumflex artery from the right coronary artery. TREATMENT AND COURSE: During hospitalisation no arrhythmias or pauses were revealed. The patient underwent cardiac pacemaker implantation. We plan a transcatheter closure of the fistula. CONCLUSIONS: Coronary fistulas are a rare cause of cardiac arrhythmias. Angiography performed at an early stage is therefore crucial in the initial assessment of a young adult presenting with cardiac arrest and subsequent changes in the ECG, as a small proportion may have coronary vascular abnormalities. The occlusion of the fistula by transcatheter or cardiac surgery is appropriate, especially as the risks of the interventions are limited.

Adult↗
PubMed2002

[Local and systemic symptoms after snake bite by a diamondback rattlesnake (Crotalus atrox)].

The incidence of snake bites grows more and more. The effects of the snake poison depend on the snake species. They can be cardio-, neuro-, myo-, tissue-, and/or cytotoxic, as well as hemorrhagically. In most cases a symptomatically therapy together with close controls of the labor parameters and a good monitoring is enough. Antivenom-therapy should be reserved for cases with strong indication.

Adult↗
PubMed2001

[An uncommon cause of severe soft tissue bleeding during phenprocoumon treatment].

HISTORY AND ADMISSION FINDINGS: A 66-year-old patient presented to our clinic with extensive left arm and left flank haematomas, anaemia, a prolonged activated partial thromboplastin time (aPTT), and reduced factor IX activity 6 weeks after prosthetic mechanical aortic valve implantation. INVESTIGATION: Treatment with both vitamin K and a single injection of factor IX concentrate led to normalization of the activated partial thromboplastin time and factor IX activity, which remained constant for several days. No acquired factor IX inhibitor was detectable. Analysis of exon 2 of the factor IX gene revealed a C-->T mutation in codon 10 of the propeptide region, resulting in the substitution of alanine by valine. Echocardiography revealed a significant paravalvular leak. TREATMENT AND COURSE: The substitution of valine for alanine in the factor IX propeptide leads to an impaired affinity of factor IX to the vitamin K-carboxylase complex. In this situation, treatment with coumarin derivatives can profoundly reduce factor IX activity and result in severe bleeding episodes. This patient was re-exposed to warfarin under close hematological monitoring. After 4 days factor IX activity had decreased to 15%, which was associated with an increase of the aPTT and a mild decrease of the prothrombin time. Due to rapid progression of the paravalvular leak and almost impossible long-term orale anticoagulation with coumarin derivatives, we recommended replacement of the prosthetic mechanical valve with a biological device. CONCLUSION: The development of severe bleeding in the context of initiating warfarin therapy raises the suspicion of a factor IX propeptide mutation. The initial screening test is the activated partial thromboplastin time, which is elevated in the presence of the mutation. If concomitantly diminished factor IX activity is found the factor IX propeptide mutation should be excluded. Use of lifelong coumarin derivatives is contraindicated in patients with this mutation. However, a general screening of the activated partial thromboplastin time after coumarin initiation is not justified by cost/benefit analysis.

Aged↗
PubMed2001

[Nosocomial pneumonia].

Nosocomial pneumonia is a frequent complication, particularly during mechanical ventilation. Microbial patterns differ according to the time of onset: whereas early onset pneumonia (up to the fourth day of hospitalization) is mostly caused by Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae, leading pathogens of late onset pneumonia (after the fourth day) additionally include gram-negative Enterobacteriaceae and potentially drug resistant microorganisms. These general patterns are modified in the presence of specific individual risk factors. The diagnostic work-up of pneumonia is aimed at the assessment of severity, the confirmation of the presence of pneumonia as well as the identification of the causal pathogens. The results of microbiological investigations must always be interpreted in the clinical context. Antimicrobial treatment must always be initiated empirically based on expected microbial patterns as outlined above. Nosocomial pneumonia in nonventilated and ventilated patients requires different empirical antimicrobial treatment approaches. All patients with antimicrobial treatment failures must be comprehensively reevaluated.

Anti-Bacterial Agents↗
PubMed2000

The effect of C1-esterase inhibitor in definite and suspected streptococcal toxic shock syndrome. Report of seven patients.

OBJECTIVE: To evaluate the effect of adjunctive C1-esterase inhibitor substitution therapy on clinical characteristics and outcome of patients with streptococcal toxic shock syndrome (TSS). DESIGN: Observational. SETTING: Medizinische Poliklinik, University of Bonn, Germany. PATIENTS: Seven patients with direct or indirect evidence of streptococcal TSS. INTERVENTION: In addition to conventional and supportive therapy, all patients received 2-3 single doses of C1-esterase inhibitor totaling 6,000-10,000 U within the first 24 h after admission. MEASUREMENTS AND RESULTS: All patients developed fulminant septic shock, multiorgan failure and/or capillary leak syndrome and necrotizing fasciitis within 10-72 h following the onset of first symptoms. Between 1 and 4 days following administration of C1-esterase inhibitor, a marked shift of fluid from extravascular to intravascular compartments took place in all but one patient, accompanied by a transient intra-alveolar lung edema and rapidly decreasing need for adrenergic agents. Six of seven patients survived. CONCLUSIONS: These clinical observations in a small series of patients and the favorable outcome point towards a positive effect of early and high-dose administration of C1-esterase inhibitor as adjunctive therapy in streptococcal TSS. The possible mechanism involved may be the attenuation of capillary leak syndrome (CLS) via early inactivation of complement and contact systems. Controlled studies are needed to establish an improvement of the survival rates of patients with streptococcal TSS following administration of C1-esterase inhibitor.

Adult↗
PubMed1997

[Severe soft tissue infection with bulla formation, sepsis, multiple organ failure].

A 53-year old patient with diabetes mellitus presented with a painful swelling of the left thigh in an out-of-town hospital. Because of the slow progression associated with multiorgan dysfunction, a soft-tissue infection with sepsis was suspected. Strains of streptococcus of serogroup B were isolated from specimens, taken from certain areas of the affected skin. After transferring the patient to our hospital the diagnosis of a B-streptococcal associated necrotizing fasciitis was confirmed. Despite intensive medical treatment and several surgical interventions the patient deceased due to an acute severe liver failure as a consequence of a secondarily developed septic shock. In comparison to the well-known cases caused by streptococcus group A, the B-streptococcal associated necrotizing fasciitis is a rather rare occurring disease.

Diagnosis, Differential↗
PubMed1997

Elevated serum concentrations of soluble adhesion molecules in coronary artery disease and acute myocardial infarction.

OBJECTIVES: Adhesion molecules are involved in a number of chronic conditions and diseases like rheumatoid arthritis, tumor growth and wound repair. Soluble adhesion molecules (SAM) play an important role in angiogenesis which is a common aspect of the conditions mentioned above and atherosclerosis. The aim of the present study was to assess the prevalence and the impact of elevated soluble adhesive molecule plasma concentrations in patients with atherosclerosis. DESIGN AND SUBJECTS: In this study, we measured the soluble forms of intercellular adhesive molecule (sICAM), endothelial adhesive molecule (sELAM) and vascular adhesive molecule (sVCAM) using a sandwich ELISA technique in plasma of patients with acute myocardial infarction (AMI), coronary heart disease (CHD) and in healthy subjects (HS). RESULTS: Patients suffering from CHD and AMI showed significant higher plasma concentrations of sICAM (p <0. 05 and p <0.005), sELAM (p <0.01 and p <0.001) and sVCAM (p <0.001 and p <0.005) than HS. In patients with fatal outcome of myocardial infarction the plasma concentrations of sICAM, sELAM and sVCAM were significantly elevated compared to surviving patients (p <0.005; p <0.005; p <0.05). In patients undergoing thrombolytic therapy there were no significant differences of plasma adhesive molecule concentrations. The levels of SAM were not related to other risk factors like diabetes, nicotin abuse, hyperlipidemia, hypertension and a familiary history of cardiovascular disease. CONCLUSIONS: Elevated levels of SAMs are found in patients with coronary heart disease. High SAM levels in plasma seem to be a prognostic factor in acute myocardial infarction. This effect is independent from other concomitant risk factors. Our results suggest that SAMs are involved both in acute phase of myocardial infarction and chronic process of atherosclerosis. It seems that similiar to other chronic inflammatory diseases, atherosclerosis seems to be modulated by soluble forms of adhesive molecules.

Adult↗
PubMed1995

Familial adenomatous polyposis and inflammatory bowel disease associated in two kindreds.

We describe two families in which some members are affected by familial polyposis syndrome: in one family a case of ulcerative colitis and in the other a case of Crohn's disease were found. This is the first report about this family association, but in our opinion the fact that two cases have been found in one series suggests that this association could be more frequent than reported so far. The research for a genetic pattern of inflammatory bowel disease could be addressed towards chromosome 5.

Adenomatous Polyposis Coli↗
PubMed1992

[Adrenal cortex carcinoma: diagnosis, therapy and course in 10 cases].

Data from ten cases with carcinoma of the adrenal cortex, diagnosed between 1981 and 1988, have been extensively reevaluated. Six patients suffered from a hormonally active tumor with proven clinical and laboratory signs of hypercortisolism and/or hyperandrogenism. Female patients dominated the cohort (eight of ten). No preference for particular age (35 to 64, mean 52) or lateralisation of the tumor was recognisable. In all cases signs for endocrinopathy and/or tumor disease lead to investigative intervention. Nonspecific symptoms like pain, reduction of weight and fatigue were registered most frequently. In three patients an abdominal tumor was palpable. Investigation of hormone levels and imaging procedures (sonography and CT scan) assured correct diagnosis in all cases. Since prior to operation metastases have been detected in five cases and in eight cases capsular invasion was proven histologically only, one patient was free of tumor after operation but developed hepatic metastases later on. Altogether nine of ten patients developed metastases later on. Seven of the patients died from the perioperative period up to 8.4 +/- 8.15 months. Mean survival of all patients was 20.5 +/- 24.5 months. Histological grading and assessment of anaplasia did not correlate with either survival or tumor stage. None of the patients presented with tumor stage I according to the TNM system by MacFarlane (55). All four patients with advanced disease in stage IV died within the first year after operation. Eight patients were treated with 1 to 6 g of the adrenolytic o,p'DDD (mitotane, Lysodren). In one of these cases, a sonographically documented remission lasting for over eight years was observed. A second patient with anaplastic carcinoma showed a reduction of the size of pulmonary metastases under continuous therapy with o,p'DDD and a cyclic polychemotherapy. After the latter was discontinued, the course was progressive.

Adrenal Cortex Hormones↗
PubMed1991

Blood pressure elevation during the night in chronic renal failure, hemodialysis and after renal transplantation.

Diurnal blood pressure variation was studied by ambulatory 24-hour monitoring in patients with advanced chronic renal failure (n = 20), on chronic hemodialysis (n = 20), after renal transplantation (n = 21) and in matched control groups without renal disease. Nocturnal blood pressure reductions were significantly blunted in all patient groups as compared with the respective control groups. In almost none of the 61 controls did the mean values during nighttime (8 p.m.-8 a.m.) exceed the mean day time values (8 a.m.-8 p.m.). In 10 of the 61 renal patients blood pressure was higher during the night. In patients with chronic renal disease nocturnal blood pressure elevation may be diagnosed by ambulatory 24-hour monitoring. This may require adaptation of antihypertensive treatment.

Adult↗
PubMed1990

Reference data for ambulatory blood pressure monitoring: what results are equivalent to the established limits of office blood pressure?

In 1039 subjects ambulatory blood pressure monitoring was performed to define threshold values, which are equivalent to the established limits of the office blood pressure. Mean values and proportions of elevated single readings were correlated to office blood pressure by regression analyses. To avoid impact of varying sleeping periods on 24 h blood pressure, only daytime readings were considered. Correlations between average daytime blood pressure and office blood pressure were linear: Mean daytime values of 135 mmHg (systolic) and of 84 mmHg (diastolic) were equivalent to the casual blood pressure limits of 140 mmHg and 90 mmHg. Correlations between percentages of elevated single readings and office blood pressure were nonlinear: Proportions of 25% systolic readings greater than 140 mmHg and of 17% diastolic readings greater than 90 mmHg were equivalent to casual blood pressure limits of 140 mmHg and 90 mmHg. On the basis of the regression equations, any result of ambulatory blood pressure recording during daytime can now be evaluated in terms of the established standards of office blood pressure.

Blood Pressure Monitors↗
PubMed1990

[Pneumocystis carinii pneumonia in HIV-positive and HIV-negative patients].

Bronchoalveolar lavage was used in 170 immunocompromised patients for detection of causative agents. Pneumocystis carinii was isolated 18 times from HIV-positive patients and 14 times from patients suffering from immunodeficiencies due to various other diseases. Patients with AIDS were in better clinical condition, had fewer infiltrates on chest x-ray, a higher oxygen partial pressure and lower LDH-plasma concentration than HIV-negative patients. In spite of the earlier stage of the disease patients with AIDS experience prodromal symptoms for a longer time and the number of isolated pneumocystis was larger. Mortality in AIDS patients was significantly lower than in patients with other causes of immunodeficiency.

Adult↗
PubMed1990

[Doctor's-office blood pressure, home blood pressure, ergometry blood pressure and 24-hour blood pressure. The correlations with the echocardiographic parameters of heart muscle mass].

In 62 untreated hypertensives (31 men, 31 women; median age 40 [17-57] years) blood pressures (BP) were measured in the doctor's office, at home (self-measured) and every 15 min during 24-hour monitoring (by portable automated oscillometry), the results being compared with echocardiographic measurements of ventricular septal thickness (VST), left ventricular muscle mass (LVM) and left ventricular mass index (LVMI), in 41 of them also during and 5 min after 100 W bicycle ergometry. In the total cohort, 24-hour values correlated better with diastolic VST (systolic: r = 0.706, P less than 0.00001; diastolic: r = 0.507, P less than 0.0001) than office BP (systolic: r = 0.381, P less than 0.01; diastolic: r = 0.177, not significant) and home BP (systolic: r = 0.477, P less than 0.0001; diastolic: r = 0.371, P less than 0.05). In the 41 exercised hypertensives the correlation with echocardiographic values was less close than with their 24-hour BP, but slightly better than with office and home BP. Systolic BP correlated better than diastolic BP with echocardiographic values. VST generally correlated better with BP than LVM and LVMI. It is concluded that (1) 24-hour BP values correlate more closely with LVM than any other noninvasive BP measurement; (2) VST is affected more by systolic than diastolic BP; and (3) VST more specifically reflects the influence of BP on myocardial structure than does LVM and LVMI.

Adolescent↗
PubMed1990

[Pneumonia in immunocompromised patients: the value of non-biopsy bronchoscopic examination procedures in the diagnosis of pathogens].

Bronchoscopy was performed on 101 immunocompromised patients with fever and pulmonary infiltrates. Underlying diseases were mainly hematological malignancies. In 71% of cases, etiology of pneumonia was clarified by nonbioptic bronchoscopic methods (bronchoalveolar lavage, bronchial secretions, protected specimen brush). In 51% of cases, empirical antibiotic treatment was modified following bronchoscopy. In patients with early bronchoscopy a better prognosis regarding healing and survival was observed than in those cases, where bronchoscopy was performed later during pneumonia. Bronchoalveolar lavage was particularly suited for diagnosis of Pneumocystis carinii and pneumonia due to viruses or Legionella. Sensitivity and specificity of bronchoscopy were lower for diagnosis of mycotic pneumonia and of Gram-negative or Gram-positive bacteria.

Aspergillosis↗