PubMed Health⌕ Search

Biomedical subjects

R Becker

Publications and source records attributed to R Becker.

At least 109 records · Page 6Linked to original sources

Application of new electrosurgical devices and probes in endoscopic neurosurgery.

Complex demands and new indications in neurosurgery have led to the need for new electrosurgical generators (ESUs). For the first time, newly developed, automatically controlled ESUs make it possible to use extremely small and flexible instruments safely and to achieve reproducible microcuts and microcoagulations. These specifications make them suitable for neuroendoscopic interventions. In a series of more than one hundred patients with different intracranial and intraspinal pathologies the new electrosurgical devices and probes were used not only for coagulation but also for cutting. The main indications were endoscopic ventriculo-cisternostomy, ventriculo-cystostomy, and membranectomy. The electrosurgical generators as well as the bipolar microcoagulation and -cutting probes proved to be safe and effective for neuroendoscopic interventions.

Electrocoagulation↗

Structural bone grafting in arthroplasty for congenital hip dysplasia: 35 hips followed for 5-10 years.

We assessed 35 hip arthroplasties in 30 patients with an average follow-up of 7 years. All patients suffered from secondary osteoarthrosis due to congenital dysplasia. The mean age at the time of surgery was 54 (19-77) years. Part of the femoral head used as a graft was fixed to the superolateral region of the acetabulum. A 100% bone coverage of the acetabular component was achieved initially. The mean support by the graft was 34%. The graft size, measured in the AP view, decreased on average 29% after 7 years. The resorption caused a reduction in cup coverage to 94%. There was no correlation between the clinical outcome and the graft size. Graft resorption occurred in the horizontal and vertical axes, but hardly affected the contact region with the iliac bone. Radiolucent lines according to DeLee were found in zone I in 4, zone II in 6 and zone III in 7 cases. The Harris Hip Score improved from 37-85 points. 1 revision was necessary 7 months postoperatively after cup dislocation.

Adult↗

[Hepatocellular carcinoma as a rare cause of excessive rise in alpha-fetoprotein in pregnancy].

OBJECTIVE: Elevation of alphafetoprotein in pregnancy warrants a thorough diagnostic workup. In most cases, no pathologic result in the fetus will be obtained. CASE REPORT: A case report is presented on a hepatocellular carcinoma (HCC) during pregnancy, in which a massive increase of alpha-fetoprotein (AFP) was found during a routine screening for neural tube defects in the 17th week of gestation. The amniocentesis revealed a normal AFP value in the amniotic fluid. Liver sonography in the 21st week of gestation showed a 5 cm tumor, which was interpreted as nodular focal hyperplasia. In the control sonography in the 32nd week of gestation, there was a growth to 12 cm. The subsequently performed magnetic resonance imaging (MRI) and fine needle aspiration led to the diagnosis of a HCC. Delivery was performed in the 34th week of gestation by cesarean section followed by surgical therapy of the HCC. CONCLUSIONS: Unexplained cases of alphafetoproteinelevation in pregnancy can be caused by maternal disease and should prompt a directed amnamnestic and diagnostic search for maternal causes. Nuclear magnetic resonance beyond the first trimester of gestation can help to clarify the diagnosis in liver tumors.

Adult↗

Nuchal cord.

Explore the source record for details and available documents.

Female↗

Differential modulation of CYP2E1 activity by cAMP-dependent protein kinase upon Ser129 replacement.

Many toxic compounds are activated by cytochrome P450 (CYP) 2E1 to reactive metabolites, which represents a potential hazard for cellular homeostasis. Therefore knowledge about CYP2E1 regulation could be of great biological importance. It has been shown that CYP2E1 is controlled transcriptionally and post-translationally by phosphorylation. In the present study we investigated the role of serine-129 (Ser129) in the protein kinase A (PKA) recognition sequence motif Arg-Arg-Phe-Ser129. To gain further insights into the possible relevance of Ser129 for CYP2E1 function, Ser129 was replaced by alanine (Ala) or glycine (Gly) by site-directed mutations of the cDNA coding for CYP2E1. The mutant cDNAs were transfected into Chinese hamster lung fibroblast V79 cells. Despite the mutation in the PKA phosphorylation motif, all strains produced catalytically active CYP2E1. However, there was a marked change in the substrate preference: The Gly129-containing strains hydroxylated p-nitrophenol (PNP) to a markedly higher extent than the wild-type cDNA-containing cells, while they demethylated N-nitrosodimethylamine (NDMA) to a markedly lower extent than the wild-type cells. All the strains activated NDMA to mutagenic products. Treatment with the membrane-permeating cAMP derivative db-cAMP reduced markedly both the PNP hydroxylase and the NDMA demethylase activities as well as the mutation frequency induced by NDMA in the Ser129-containing strain. This decrease in activity was not accompanied by a decrease in CYP2E1 content. In addition, the catalytic activities of CYP2E1 were decreased in microsomes from rat hepatocytes treated with db-cAMP. Also in this case, the decrease in activities was not accompanied by a decrease in enzyme protein. These findings argue that involvement of Ser129 and its phosphorylation is not in determining CYP2E1 protein level, but rather in controlling its catalytic activity. In contrast, in the strains containing Ala129 or Gly129, treatment with db-cAMP caused a marked increase in both PNP hydroxylase and NDMA demethylase. In these strains a similar db-cAMP-mediated increase was also observed in the mutation frequency, resulting from the treatment with the promutagen NDMA, which is activated by CYP2E1. Our results show that CYP2E1 in V79 cells responds in two separate ways to db-cAMP exposure depending on the amino acid residue present in the PKA recognition sequence. The enzyme is committed to a negative regulation by db-cAMP if Ser129 is the target amino acid for PKA, leading to a decrease in the metabolic activation to mutagenic and carcinogenic species. On the other hand, Ala129 or Gly129 substitution directed CYP2E1 toward a positive regulation by increasing its catalytic activities and metabolic activation to mutagenic intermediates in the presence of db-cAMP. We also obtained evidence that cAMP-mediated downregulation of wild-type (Ser129) CYP2E1 was not accompanied by its destruction but instead by its stabilization, which shows that Ser129 is not involved in CYP2E1 degradation but dictates requirements for its specific activities.

Amino Acid Substitution↗

Thrombin generation, inhibition and clinical outcomes in patients with acute myocardial infarction treated with thrombolytic therapy and heparin: results from the GUSTO-I Trial. GUSTO-I Hemostasis Substudy Group. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.

OBJECTIVES: We sought to assess the effects of antithrombotic therapy after thrombolysis for acute myocardial infarction on markers of thrombin generation and activity and to determine the relation of these markers with clinical outcomes. BACKGROUND: Thrombin activation and generation often occur with thrombolysis for acute myocardial infarction. Antithrombotic regimens have been developed to reduce the resulting thrombotic complications. METHODS: We sampled plasma markers of thrombin generation and activity after thrombolysis in 292 patients. We assessed the relations of these markers with clinical outcomes at 30 days. RESULTS: Fibrinopeptide A (FPA), a marker of thrombin activity toward fibrinogen, was elevated at baseline (12.3 ng/ml) and increased to 18.4 ng/ml by 90 min after streptokinase and subcutaneous heparin treatment. With intravenous heparin, this increase was attenuated, but intravenous heparin did not prevent thrombin generation, as measured by prothrombin fragment 1.2 (F1.2). Heparin level, measured by anti-Xa activity, correlated with activated partial thromboplastin time (aPTT, r = 0.62 to 0.67). Thrombin activity, measured by FPA, was as closely related to aPTT as to the heparin level. Baseline levels of F1.2 were significantly related to the risk of death or reinfarction at 30 days (p = 0.008); values 12 h after enrollment also were related to 30-day mortality (p = 0.05). CONCLUSIONS: Although intravenous heparin partly suppresses the increased thrombin activity associated with thrombolysis, it does not inhibit thrombin generation. The aPTT was as good a measure of suppression of thrombin activity as the heparin level itself. Hematologic markers of thrombin generation were found to be related to the subsequent risk of thrombotic events.

Aged↗

Management strategies for a better outcome in unstable coronary artery disease.

Unstable coronary artery disease is a term encompassing both unstable angina and non-Q-wave (non-ST-segment elevation) myocardial infarction. Patients with these conditions are at risk of early progression to acute myocardial infarction and death. Thus, management of these conditions must aim to reduce long-term mortality and morbidity. Risk stratification is crucial for the identification of patients whose risk of early progression is high; they may require coronary angiography and (if suitable) either percutaneous transluminal coronary angioplasty or coronary artery bypass surgery. No single variable can accurately predict risk, but considerable data are emerging to show that biochemical markers of myocardial injury, such as troponin-T and troponin-I, are valuable in combination with electrocardiographic findings and clinical features. Routine early invasive procedures (coronary angiography with or without revascularization) have not yet been shown to have any significant advantage over conservative regimens for the majority of patients. Antiplatelet, anticoagulant, and anti-ischemic agents remain the mainstay of treatment in the acute phase. New agents, such as glycoprotein IIb/IIIa receptor inhibitors and low-molecular-weight heparins, as well as antithrombins and Factor Xa inhibitors add to the treatments currently available. Thrombolytic agents are contraindicated in the absence of ST-segment elevation. After clinical stabilization, ongoing assessment should include exercise testing for all patients who are able; other imaging techniques should be used for patients unable to exercise. A profile indicating a high risk of future events is an indication for elective angiography and consideration for revascularization.

Algorithms↗

How breast cancer treatment decisions are made by women in North Dakota.

BACKGROUND: Although equally effective, women in rural midwestern states choose modified radical mastectomy (MRM) over breast conservation surgery for early stage breast cancer. This study assessed treatment decisions by the women of North Dakota. METHODS: Surveys were sent to women treated for early stage breast cancer from 1990 through 1992. Separate surveys were sent out to surgeons in the state. The questions assessed physician and patient perceptions of treatment and the decision making process. RESULTS: A majority of surgeons believed that the long-term and disease-free survival was equal and that the preference for choosing MRM was due mostly to inconvenience of radiotherapy. The women reported that the surgeon was the most influential in the treatment decision and that concerns over radiation, duration of treatment, and travel restrictions all were factors in the decision. CONCLUSIONS: Education of surgeons and patients plus the early involvement of the radiation oncologist in discussing options is essential in the treatment of early stage breast cancer.

Aged↗

Effect of alpha-tocopherol, taurine and selenium on the attenuation of ischemia/reperfusion injury of splanchnic organs.

BACKGROUND: Splanchnic artery occlusion shock is caused by increased capillary permeability and cellular injury precipitated by oxygen derived free radicals following ischemia and reperfusion of splanchnic organs. The purpose of this study was to assess the role of several well-known oxygen-derived free radical scavengers in ameliorating or preventing this syndrome. STUDY DESIGN: Anesthetized rats were subjected to periods of occlusion of the visceral arteries and reperfusion. Tocopherol, taurine, selenium or a 'cocktail' of these three agents was injected subcutaneously for 4 consecutive days prior to operation. Mean arterial blood pressure was measured throughout the experimental period. Fluorometry and technetium-99m pyrophosphate counting of the visceral organs were performed as well as a histologic grading system for intestinal viability. RESULTS: Final mean arterial blood pressure associated with the 'cocktail' and selenium groups was 79.1 +/- 27.4 mmHg and 83.6 +/- 17.8 mmHg, respectively. These values were significantly higher than the control group, 40.8 +/- 11.4 mmHg (P < 0.05). Similar patterns of the benefit of selenium in contrast with the other groups were obtained with fluorescein perfusion, radioisotopic activity and histologic analysis. CONCLUSION: Pretreatment with selenium of splanchnic ischemia and reperfusion in the rat improves mean arterial blood pressure and microcirculatory visceral perfusion. Further analysis of the precise protective mechanism of selenium for reperfusion injury will enable visceral organs to withstand the consequences of increased capillary leakage and oxidant injury.

Animals↗

[Ocular pulse amplitude during manipulation of systemic perfusion parameters].

BACKGROUND: The mechanism for the control of choroidal perfusion is unclear. The present study was designed to investigate for the effect of standardized alteration of systemic perfusion parameters on choroidal hemodynamics in healthy volunteers. METHODS: Intraocular pressure (IOP; German abbreviation: IOD), Ocular Pulse Amplitude (OPA), systemic blood pressure, and pulse rate were measured, and ocular perfusion pressure was calculated in 14 otherwise non-smoking, healthy volunteers prior to and following exercise and smoking. RESULTS: Exercise significantly (sig., p < 0.05) increased pulse rate, systolic blood pressure and ocular perfusion pressure, while it sig. (p < 0.05) reduced IOP and diastolic blood pressure. However OPA was not sig. (p > 0.1) affected by changes in these parameters. Smoking sig. (p < 0.05) increased systolic blood pressure, diastolic blood pressure, pulse rate, and ocular perfusion pressure but did not sig. (p > 0.09) alter OPA. CONCLUSION: Despite affecting ocular and systemic perfusion parameters, exercise and smoking did not alter OPA, suggesting functional isolation i.e. autoregulation of the choroidal and/or ophthalmic artery circulation.

Adult↗

C-myc mRNA expression in epithelial ovarian carcinomas in relation to estrogen receptor status, metastatic spread, survival time, FIGO stage, and histologic grade and type.

Recently, it has been suggested that c-myc expression might correlate with estrogen receptor (ER) status and metastatic spread in ovarian cancer. In this study, expression of c-myc mRNA in 90 epithelial ovarian carcinomas was determined using the S1 nuclease protection assay. Expression of c-myc mRNA was detectable in 27 of 90 tumors. There was no significant association between c-myc mRNA expression and metastatic spread, survival time, FIGO stage, or histologic grade and type. C-myc mRNA was expressed in 45% of ER-positive tumors but only 24% of ER-negative tumors (p = 0.094; Fisher's exact test). Similarly, 44% of progesterone receptor (PR)-positive and 23% of PR-negative tumors expressed c-myc mRNA (p = 0.098). However, the association between c-myc mRNA expression and ER and PR status was not statistically significant. The ratio of mean expression of c-myc mRNA in patients with FIGO stages III/IV compared with patients with FIGO stages I/II was 2.1:1, an insignificant difference (p = 0.57, Wilcoxon rank sum test). In conclusion, c-myc was not significantly associated with the clinical parameters investigated in this study.

Carcinoma↗

Management of aneurysms of the vertebral artery-posterior inferior cerebellar artery complex.

Aneurysms of the vertebral artery (VA) and posterior inferior cerebellar artery (PICA) account for only about 3% of all diagnosed intracranial aneurysms. The surgical therapy of these aneurysms is complex and difficult due to the close topographical relationship between the neurovascular structures. Here, we report upon 27 patients with 29 such aneurysms. Of these, 22 patients (81%) were hospitalized because of a subarachnoid hemorrhage. Sixteen of these patients (72%) had an additional intraventricular hemorrhage. Twenty-one patients (78%) were surgically treated for their aneurysms, three of them also for an associated arteriovenous malformation. Aneurysms of the VA and the proximal PICA were exposed via a transcondylar (n = 11) or lateral suboccipital (n = 3) approach, those originating from the distal PICA via a paramedian suboccipital (n = 7) route. Endovascular therapy was used in three patients. A patient with a fusiform aneurysm of the vertebrobasilar junction was treated with a ventriculoperitoneal shunt only. Three aneurysms with a complex morphology were not treated. Of the patients operated upon, two died postoperatively due to vasospasm. Two other patients developed an incomplete dorsolateral medullary syndrome. One individual was lost for follow-up. The median follow-up period was 4.6 years (range 3-86 months). Both, the overall mortality (2/27) and morbidity (2/27) were 7.5%, respectively. Our results show that even complex vascular lesions of the posterior fossa can be treated with a satisfactory long-term outcome in the majority of our patients (85%). The multimodal management and an individually tailored microsurgical approach are key issues for the treatment of such aneurysms.

Adult↗

Pharmacokinetics of tramadol and bioavailability of enteral tramadol formulations. 2nd communication: drops with ethanol.

The pharmacokinetics and the absolute bioavailability of tramadol hydrochloride (CAS 36282-47-0) after oral administration of Tramal drops (with ethanol) were determined in a balanced cross-over study in 8 (4 male and 4 female) volunteers in comparison with the intravenous injection. Each fasting volunteer received two single doses of 100 mg tramadol-HCl, one by oral (1 ml of drops) and one by intravenous route (2 ml of a solution for injection). The formulations were administered in the morning; the washout period was one week. Serum and urine concentrations of tramadol-HCl were determined by gas chromatography-mass spectrometry and gas chromatography, respectively, and the pharmacokinetic evaluation was carried out model-dependently. Only the extent of bioavailability and the renal clearance were calculated model-independently. The extent of the absolute bioavailability (F) of tramadol after oral administration of the drops, based on AUC data, was 66.3% (point estimate; n = 8) with a 95% confidence interval of 58.1-75.6% (ANOVAlog). The areas under the serum concentration curves of tramadol-HCl calculated by curve fitting (AUC), which agreed very well with the model-independently determined areas (AUC), were 2390 +/- 712 h.ng/ml (p.o.) and 3490 +/- 510 h.ng/ml (i.v.) (mean +/- SD; n = 8). After oral administration the means of the serum concentration peaks were 308 +/- 89 ng/ml (cmax) and 1.20 +/- 0.39 h (tmax), the half-life of absorption was 0.34 +/- 0.18 h (t1/2,ka) and the lag time 0.23 +/- 0.01 h (t0). The biological half-life in the terminal phase (t1/2,beta) was 5.5 +/- 0.9 h and agreed well with the value of 5.2 +/- 0.8 h determined after i.v. injection. There were large differences between the volunteers in the distribution rate. For the slower distribution half-life (t1/2,alpha) mean values of 1.2 +/- 0.7 h (p.o.; n = 6) and 1.9 +/- 0.7 h (i.v.; n = 6) were obtained. The values determined after i.v. injection for the total distribution volume and the total and renal clearance were 216 +/- 21 l (Vd,beta), 487 +/- 71 ml/min (Cltot) and 77 +/- 20 ml/min (Clren), respectively. These results show that after administration of the drops (with ethanol) the active ingredient tramadol is rapidly absorbed and that the extent of the absolute bioavailability is about the same as after oral administration of tramadol capsules.

Administration, Oral↗

Mechanisms of pacing interventions in atrial fibrillation.

Atrial flutter is due to large single reentrant loops, typically oriented around the caval veins and a line of functional conduction block in between. These reentrant circuits can easily be terminated by properly timed extra beats colliding in the antidromic direction with the reentrant orthodromic wavefront and being blocked in the orthodromic direction within the area of slow conduction. Due to the complex situation in atrial fibrillation with multiple, ever-changing wavelets and a marked functional inhomogeneity of the atrial tissue, these simple concepts do not apply. However, regional control of atrial tissue by rapid pacing is feasible during atrial fibrillation, and through a multisite approach, this pacing modality might lead to a situation where the remaining nonentrained atrial tissue is just no longer reaching the critical mass. Single-site, dual-site, and biatrial pacing seems to reduce the incidence of atrial fibrillation recurrences. Specific advantages and disadvantages of each approach still need to be elucidated. Apart from preventing bradycardia, preventive pacing modes reduce intra-atrial conduction times and might reduce intra-atrial dispersion of refractoriness. Still, the specific mechanisms relevant for their effectiveness need further clarification.

Atrial Fibrillation↗

mdm 2 mRNA expression is associated with survival in ovarian cancer.

Expression of mdm-2 mRNA was measured in 90 ovarian-cancer tissue specimens using the S1 nuclease assay, to investigate a possible association between MDM2 expression and prognosis. mdm-2 mRNA expression was an independent prognostic factor for patients with primary ovarian cancer, FIGO (International Federation of Gynecology and Obstetrics) stages III and IV (n = 57), who all received chemotherapy with carboplatin or cisplatin and cyclophosphamide. Median survival time for patients (FIGO stages III and IV) with no detectable expression of mdm-2 mRNA (n = 14) was 171 days, as compared with 839 days for patients (n = 43) with detectable mdm-2 mRNA (p = 0.0194; log-rank test). However, no association between mdm-2 mRNA expression and survival was observed for patients with FIGO stages I and II who did not receive chemotherapy. mdm-2 expression was not associated with FIGO stage, residual disease, histologic grade and type. Our results suggest that mdm-2, which is known to disrupt p53 function, sensitizes ovarian-cancer cells to cisplatin/cyclophosphamide, possibly by inhibition of p53-mediated G1 cell-cycle arrest and p53-stimulated nucleotide-excision repair.

Confidence Intervals↗

Calculation of relative biological effectiveness for proton beams using biological weighting functions.

PURPOSE: The microdosimetric weighting function approach is used widely for beam comparison studies. The suitability of this model to predict the relative biological effectiveness (RBE) of therapeutic proton beams was studied. The RBE(alpha) (i.e., linear approximation) dependence on the type of biological end point, initial proton energy, energy spread of the input proton beam, and depth of beam penetration was investigated. METHODS AND MATERIALS: Proton transport calculations for a proton energy range from 70 to 250 MeV were performed to obtain proton energy spectra at a given depth. The corresponding microdosimetric distributions of lineal energy were calculated. To these distributions the biological response function approach was applied to calculate RBE(alpha) the biological effectiveness based on a linear dose-response relationship. The early intestinal tolerance assessed by crypt regeneration in mice and the inactivation of V79 cells were taken as biological end points. RESULTS: The RBE(alpha) values approach about 1 in the plateau region and gradually increase with the proton penetration depth. In the center of the Bragg peak, at the maximum dose delivery, the values of RBE(alpha) range from 1.1 (250-MeV beam, early intestinal tolerance in mice) to 1.9 (70-MeV beam, Chinese hamster V79 cells in G1/S phase). Distal to the Bragg peak, where only a small fraction of dose is delivered, the RBE(alpha) was found to be even higher. For modulated proton beams we found an increasing RBE(alpha) with depth in the spread-out Bragg peak (SOBP). Values up to 1.37 at the distal end of the SOBP plateau (155-MeV beam, SOBP between 5.3 and 13.2 cm) were obtained. CONCLUSION: More experimental work on the determination of microdosimetric weighting functions is needed. The results of the presented calculations indicate that for therapy planning it may be necessary to account for a depth dependence on proton RBE, especially for lower energy.

Animals↗

Dynamics of coronary thrombolysis and reocclusion.

The dynamics of coronary thrombosis and reocclusion may seem straightforward, but in actuality they are complex and incompletely understood. The pathobiology of coronary thrombosis begins with the development of the atherosclerotic plaque. The initial step in the process, endothelial cell dysfunction, alters vascular thromboresistance. Plaque erosion or overt disruption is followed by platelet adherence, aggregation, and thrombin generation that stimulates the conversion of soluble fibrinogen to fibrin. Thrombolytic therapy, although able to dissolve a high proportion of occlusive thrombi, creates a procoagulant environment by generating plasmin which, in turn, activates platelets and generates thrombin, increasing the likelihood of vessel reocclusion. Thrombin is therefore considered an important target for research, and several thrombin inhibitors have been developed. Antiplatelet agents such as aspirin are currently employed to prevent reocclusion following thrombolytic therapy; however, several new and more potent platelet antagonists are being investigated with considerable enthusiasm.

Coronary Thrombosis↗