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R Richter

Publications and source records attributed to R Richter.

At least 19 recordsLinked to original sources
PubMed1992

[Hickman catheter for long-term parenteral therapy. A prospective interdisciplinary study].

160 patients with a median age of 38 years (range two months to 84 years) having silicone rubber central venous access catheters for long-term parenteral nutrition or chemotherapy were studied prospectively. Two different types of catheters were used, the Broviac-type "life-cath" and the Groshong -catheter. Intraoperative complications were not noticed. Parenteral therapy was performed in 124 patients (81%) without any complications. After a mean postoperative interval of 36 weeks there were 34 catheters removed because of end of therapy. 78 patients died with the catheter in place. 40 catheters had to be removed before end of therapy due to catheter-related complications. Occlusion of the lumen occurred in nine patients after an interval from three to 20 weeks. Explantation of catheters due to a suspected catheter-related sepsis was performed in 17 patients. Both types of catheter showed a high cumulative patency rate of 90% after a twelve months period. However, there were catheters that had to be removed before planned end of therapy. Thus, the cumulative rate of functioning catheters is lower (44% of all catheters).

Adolescent↗
PubMed1992

Density distribution and immunological reactivity of tumor cells from peritoneal effusions of patients with ovarian neoplasms.

Ascitic samples from 19 patients with primary ovarian non-mucinous carcinomas, three with Krukenberg tumors and eight with noncancerous peritoneal effusions were studied by conventional cytology and immunocytochemical staining. Density gradient centrifugation was applied to fractionate ascitic fluid cells. The enrichment of cell types by this method facilitated their cytomorphological characterization and identification of neoplastic cell subpopulations existing in peritoneal effusions. Immunophenotypic studies of cells were made using monoclonal antibodies (mAbs) against ovarian carcinoma-associated antigens (OC 125, 10B, 8C) and carcino-embryonic antigen (CEA). Non-specific cross-reacting antigen (NCA) was applied as a marker for granulocytes which often accompany peritoneal effusions. Our results indicated that immunofluorescence (IF) staining contributed to the distinction between the primary and secondary ovarian carcinomas. Density gradient centrifugation appeared to be a useful method for separation of mesothelial cells.

Adenocarcinoma↗
PubMed1992

[Comparison of two different methods for measuring interoception of obstructions in asthma patients].

For measuring the interoception of airway resistance, bronchial obstructions are often simulated by flow-resistive loads applied externally (i.e. outside the body) into the respiratory flow. However, it is open to doubt whether interoception characteristics obtained in this manner are really related to the clinical pattern of complaints of asthmatic patients. Possibly such externally applied resistance simulates merely an aspect of the physics of apnoea but not a clinical and hence also psychological aspect of the same. To estimate the significance of these aspects for the perception of obstructions, this ability was measured in 25 asthmatic patients first by means of external added loads; this test was then repeated by noting the subjective assessment of bronchial obstructions caused during a routine histamine provocation test. Both interoception parameters correlated only slightly (rxy = 0.31) which is discussed as a pointer to the assumption that, among other parameters, psychological factors may considerably modify the perception of flow resistivity. No correlations were seen between the characteristic interoception value obtained by means of mesh resistivities and the different variables of the clinical pattern of symptoms. On the other hand, the interoception parameter measured on the basis of bronchial obstructions revealed significant connections with several clinical variables: the greatly increased incidence of respiratory distress at night or during certain external conditions, coping medication, physical exercise and style. It is concluded that only such parameters of perception of obstructions are clinically relevant for patients suffering from asthma, which consider not only the somaticophysical but also the psychic component of asthmatic respiratory distress.

Adolescent↗
PubMed1991

Ifosfamide, methotrexate and 5-fluorouracil for pretreated advanced breast cancer.

A total of 51 fully evaluable patients with advanced and intensively pretreated breast cancer were treated with a combination chemotherapy of ifosfamide plus mesna, methotrexate and 5-fluorouracil. All patients had received at least one series of combined chemotherapy, 30 patients had received more than one combination and 41 patients had had anthracyclines before. Metastatic lesions in more than one site were found in 42 patients, and 24 patients had metastatic liver lesions. Partial remission was achieved in 10 patients (20%) and no change in 16 patients (31%). Survival was almost identical in both groups of responding patients and significantly shorter in treatment failures. Response was favorable in patients without pretreatment with anthracyclines. Two patients who received this protocol directly after progression with cyclophosphamide, methotrexate and 5-fluorouracil (CMF protocol) responded with a partial remission. Median time to progression was 7 months for partial responders and 4.5 months for patients achieving a no-change status. Median survival was 8 months for all patients. Toxicity was tolerable. Leukocytopenia and thrombocytopenia were treatment-limiting parameters. Overall, this protocol is well tolerable and effective in breast cancer patients with advanced disease and in intensively pretreated patients.

Adult↗
PubMed1991

Effect of trospium chloride on urodynamic parameters in patients with detrusor hyperreflexia due to spinal cord injuries. A multicentre placebo-controlled double-blind trial.

In a multicentre placebo-controlled double-blind study 61 patients with spinal cord injuries and detrusor hyperreflexia were treated: 20 mg trospium chloride was given twice daily over a period of 3 weeks. Pre- and posttreatment urodynamic measurements demonstrated large improvements in maximum cystometric capacity (mean = 138.1 ml), decreased maximum detrusor pressure (mean = -37.8 cm H2O) and an increase in compliance (mean = 12.1 ml/cm H2O) in the treatment group. Urodynamic parameters in the placebo group remained substantially unchanged. Comparisons between the two groups revealed highly significant differences for these parameters (all, p less than 0.001). No effect on maximum flow rate and residual urine was detected in either group. The incidence of spontaneously reported side-effects was extremely low and comparable for both groups.

Adult↗
PubMed1991

A device for functional residual capacity controlled biofeedback of respiratory resistance.

A computer-aided procedure is presented providing subjects with analogous visual feedback of respiratory resistance, which is continuously measured using the forced oscillation method. Simultaneous pneumotachographical control of the breathing volume curve makes it possible to prevent reinforcement for decreases of respiratory resistance which are due to increases of functional residual capacity (FRC). Lung hyperinflation is an unsuitable way to reduce respiratory resistance; if it occurs, feedback is interrupted until the subject decreases his FRC to its initial level. Analysis of the data of 15 adult asthmatic subjects which underwent a 12-sessions feedback training showed that no substantial changes of FRC appeared within feedback trials. Advantages of this new biofeedback technique compared to other procedures are discussed with regard to volume control and feedback signal.

Airway Resistance↗
PubMed1991

CA 125 and carcinoembryonic antigen levels in cyst fluid, ascites and serum of patients with ovarian neoplasms.

The levels of CA 125 and carcinoembryonic antigen (CEA) in tumour cyst fluid, ascites and serum of patients with epithelial ovarian neoplasms were estimated. In addition, the serum concentration of both antigens was evaluated 10 days after operation. Independently of histological type of ovarian tumour, CA 125 and CEA values were significantly higher in cyst and ascitic fluid than in corresponding patients' serum. The higher values of both markers were also found in malignant than benign ovarian cysts. CEA occurred at higher concentrations in mucinous carcinomas whereas CA 125 values were comparable both in mucinous and serous cyst fluid. The levels of these markers in cyst fluid did not correlate with the serum concentrations. The significant individual differences existed in the ability of tumour cells to produce and release both studied antigens. Post-operative CEA levels returned to normal more slow than CA 125 values.

Adenocarcinoma, Mucinous↗
PubMed1991

[Do asthmatic patients have deficits in symptom perception? Quasi-experimental and experimental findings on introception of airway obstruction].

Symptom perception of asthmatic patients was investigated in a quasi-experimental and in two experimental studies. Simultaneous ratings and measurements of airways obstruction assessed during an inhalative provocation test were correlated in the first study, in the two latter studies psychophysical parameters of the perception of external flow-resistive loads were determined for asthmatic patients and normal controls. These are the main results: 1. Most of the asthmatic patients are rather poor in discriminating provoked airways obstructions which results in a negative coping with the illness. 2. Asthmatic patients are slightly poorer in discriminating flow-resistive loads than healthy controls. 3. A distinct tendency of asthmatic patients to dissimulation found in the first study could not be confirmed in the two experiments.

Adult↗
PubMed1991

Morphological and immunological heterogeneity of human ovarian neoplasms.

The cells of cystic fluids from patients with malignant and benign serous ovarian neoplasms were separated by density gradient centrifugation. Density distribution and morphological features of cell fractions were analyzed. The immunophenotypic characterization of each cell fraction using poly- and monoclonal antibodies was performed. The application of density gradient centrifugation allowed to yield and catalogue several cell subpopulations according to their stage of pathological differentiation starting from typical, morphologically malignant until normal epithelial cells. Significant morphological and immunological heterogeneity among and within individual tumors was found. Our studies indicated the value of isolated cell subsets for estimation of interrelationships among various neoplastic markers and for comparison the reactivity of different antibodies and evaluation of their immunodiagnostic potency.

Antibodies, Monoclonal↗
PubMed1991

[High-dose trospium chloride in therapy of detrusor hyperreflexia].

The efficacy and tolerance of a high-dose treatment with trospium chloride (20 mg twice daily) were investigated in pilot studies carried out in three trial centres and involving a total of 29 patients suffering from reflex bladder due to transverse lesions of the spinal cord with paraplegia. In all three centres the trial procedure was the same. Urodynamic measurements (maximum bladder capacity, bladder compliance, maximum detrusor pressure during micturition, urinary flow and residual urine) were taken both before and after treatment with trospium chloride for a period of at least 2 weeks. In almost all patients there was a clear rise in maximum bladder capacity, a marked decrease in maximum detrusor pressure and an increase in bladder compliance. As a result the frequency of micturitions was lowered. In the majority of patients, urinary incontinence caused by detrusor hyperreflexia was brought under control through depression of detrusor activity, and urinary continence was achieved. If necessary, intermittent catheterization was continued to empty the bladder. Tolerance of the test preparation was good, and side-effects were rare and mild.

Adult↗
PubMed1991

CEA and NCA levels in peripheral and tumour venous blood of patients with gastric and colonic carcinomas estimated by RIA and EIA methods.

Carcinoembryonic antigen (CEA) and nonspecific cross-reacting antigen (NCA) levels in draining tumour blood were compared with concentrations of these antigens in peripheral blood of patients with gastric and colonic malignancies. The controls were cases with gastric and duodenal ulcers. The results obtained by radioimmunoassay (RIA) were compared with enzyme immunoassay (EIA). It was shown that patients with high CEA levels in draining tumour blood also had elevated values of this antigen in peripheral blood, but that the CEA values in blood flowing from tumours were usually higher than in peripheral blood. CEA concentrations in tumour venous blood and in peripheral blood depended on clinical advancement and neoplastic venous invasion. NCA determination had no significance in clinical monitoring of studied neoplasms. CEA level determinations performed by the RIA using CEA standard prepared in our laboratory and assays with use of Abbott CEA-EIA kit gave fully comparable results.

Antigens, Neoplasm↗
PubMed1991

Distribution of carbohydrate structures in individual maturation stages of myeloid leukemic cells.

The distribution of peanut agglutinin (PNA) receptors, nonspecific cross-reacting antigen (NCA) molecule and 3-fucosyl-N-acetyllactosamine (FAL) in myeloid leukemic cells isolated by density gradient centrifugation was compared using immunofluorescence test (IF). Patients with acute myelocytic leukemias (AML) type M2 and M5 showed low percentage of NCA+ and PNA+ cells. In chronic and acute phase of chronic myelocytic leukemias (CML) the number of NCA containing cells increased and the amount of PNA-binding cells decreased as more mature granulocytic fractions were isolated on Ficoll--Uropoline density gradient. In patients with myeloblastic crisis of CML (CML-BC) the number of cells expressing FAL structure did not change in relation to maturation stage of myeloid cells. Our results revealed that the expression of various markers could change in a different way during the differentiation of cells from myeloblasts to mature granulocytes.

Antigens, Neoplasm↗
PubMed1991

[Cancer pain therapy in children and adolescents using morphine].

Systematic treatment in children suffering from cancer pain is a field of pediatric oncology that was neglected for a long time. Investigations have shown that pain therapy oriented to the special situation of the child's body is urgently necessary. In Germany, an unpublished study by Fengler (Berlin), who reviewed all pediatric cancer centers, revealed serious deficiencies in the therapy of pain in children. In our study, we attempted to develop a new concept of cancer pain management, with the emphasis on cooperation between pediatric oncologist and anesthesiological pain therapists. PATIENTS AND METHODS. A total of 36 children and adolescents suffering from malignant tumors and in whom pain therapy according to WHO stage III was necessary were treated. After being seen by a pediatric oncologist and an anesthetist (pain therapist) each patient received either slow release oral morphine (MST, 0.5-1 mg/kg per dose) two to three times a day or a continuous infusion of morphine (0.05 mg/kg per h). The amount of morphine administered was quickly raised until the young patients were free of pain. Drug actions (pain score) and side effects were registered continuously with a documentation form. The morphine was combined with dipyrone 5-15 mg/kg per dose five times a day. The intravenous dosage of oral dipyrone was 2-5 mg/kg per h. RESULTS. The average age of the patients treated was 12 years (1.5-19 years); 10 were inpatients, and 26 were outpatients. All patients were treated successfully. The doses of morphine required for pain relief varied substantially (1-25 mg/kg per day p.o. and 0.05 mg-1 mg/kg per h i.v.). We did not observe extreme sedation or respiratory depression. In our patients we did not observe opioid-induced nausea such as is frequently seen in adults. All children needed laxatives. In 2 children, intolerable itching was experienced after oral administration of slow-release morphine. In 20 patients cortisone was given as adjuvant therapy, in 5 patients with neuropathic pain, anticonvulsants e.g., carbamazepine. In 6 patients we administered benzodiazepines successfully for sedation and anxiolysis. CONCLUSIONS. Therapy of pain in children with advanced cancer requires interdisciplinary cooperation. In most children therapy of pain can be successfully administered with slow-release morphine in combination with dipyrone, so that the children can remain in their usual social environment.

Adolescent↗
PubMed1990

Reactivity of polyclonal and two monoclonal antibodies with cell subsets isolated from cystic fluids of ovarian serous neoplasms.

The distribution of antigenic determinants on a cellular level in serous ovarian neoplasms was evaluated using polyclonal and two monoclonal antibodies (OC 125 and 10B). The expression of antigens was estimated by an immunofluorescence test on each cell fraction isolated by density centrifugation from cystic fluids of individual malignant and benign ovarian tumors, taking into account the density and cytomorphologic features of cell subpopulations. It was found that the studied antibodies recognized different antigenic determinants. Significant immunologic heterogeneity of cells among and within individual tumors was shown. Our studies show the value of isolated cell subpopulations for comparing the reactivity of different antibodies and estimating their immunodiagnostic potency.

Antibodies, Monoclonal↗
PubMed1990

[Venous long-term indwelling catheter and port systems in children. Progress in pediatric oncology].

Long-term indwelling catheters of the Broviac, Hickman, Groshong type, and the Port Systems have proved highly suitable as a supportive measure in pediatric oncology. They are indicated for cytostasis, bone marrow transplantation and long-term parenteral nutrition. They provide reliable and safe venous access for therapy and blood sampling. Therapy is thus faciliated, and the quality of the patient's life is significantly improved by reducing the number of venipunctures required.

Blood Specimen Collection↗
PubMed1990

Antenatal microbiologic and maternal risk factors associated with prematurity.

In a prospective study of 202 women (gestational age 24 +/- 4 weeks), we evaluated possible influences of lower genital tract infection or bacterial conditions on obstetric outcomes, including preterm labor, preterm premature rupture of membranes, and preterm birth. The presence of bacterial vaginosis (18.7%) was associated with an increased risk of preterm labor (relative risk, 2.6; 95% confidence interval, 1.08 to 6.46). For women with bacterial vaginosis who also had Mobiluncus species morphotypes identified on Gram stain, the relative risk of preterm labor was 3.8 (95% confidence interval, 1.32 to 11.5). Presence of vaginal Mycoplasma hominis (10.8% of patients) was associated with both preterm labor (relative risk, 1.8; 95% confidence interval, 0.77 to 4.4) and preterm birth (relative risk, 5.1; 95% confidence interval, 1.45 to 17.9). Recovery of Staphylococcus aureus (3.0%) was associated with preterm labor (relative risk, 3.1; 95% confidence interval 1.12 to 8.7). Identification of two or more bacterial-linked abnormalities was also associated with preterm labor (relative risk, 3.3; 95% confidence interval, 1.44 to 7.58). An increased level of vaginal wash protease (greater than or equal to 10 trypsin units) (16%) was associated with preterm labor and was noted in 50% of women with preterm premature rupture of membranes. A history of prior preterm birth was the single best historical predictor of both preterm labor (relative risk, 3.6; 95% confidence interval, 1.92 to 6.83) and preterm birth (relative risk, 6.7; 95% confidence interval, 2.2 to 20.4). History of three or more abortions, antenatal urinary tract infection, and occurrence of medical complications during pregnancy also correlated with increased risk of preterm labor. These findings affirm and refine associations of various maternal reproductive tract infections with preterm labor, premature rupture of membranes, and birth, allowing for controlled treatment trials aimed at prevention of preterm birth.

Adult↗
PubMed1990

Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment.

Available information suggests that some instances of preterm birth or premature rupture of membranes are associated with clinically unrecognized infection and inflammation of the lower uterine segment, decidua, and fetal membranes. Various cervicovaginal microorganisms have been recovered from these sites. Many of these microorganisms produce factors that may lead to weakening of the fetal membranes, release of prostaglandins, or both. This study evaluated the presence of various lower genital tract microflora and bacterial conditions in 229 women enrolled in a double-blind, placebo-controlled trial of short-course erythromycin treatment at 26 to 30 weeks' gestation to prevent preterm birth. Demographic, obstetric, and microbiologic parameters were prospectively evaluated. Premature rupture of membranes occurred less frequently (p less than 0.01) among women who received erythromycin (6%) versus placebo (16%). Preterm premature rupture of membranes also occurred less frequently, although not significantly (p = 0.3) in patients who received erythromycin (2%) versus placebo (5%). Erythromycin treatment significantly decreased the occurrence of premature rupture of membranes among women who were initially positive for Chlamydia trachomatis infection. Logistic regression analysis demonstrated that C. trachomatis (p = 0.05; odds ratio, 9), vaginal wash phospholipase C (p = 0.08; odds ratio, 6) and prior preterm birth (p = 0.007; odds ratio 17) were associated with increased risk of preterm birth. Bacterial vaginosis, Mycoplasma hominis, Ureaplasma urealyticum were not significantly associated with increased risk of preterm birth or preterm rupture of membranes. These findings support a role for selected lower genital tract microflora in preterm birth and premature rupture. Large controlled treatment trials of specific infections or conditions associated with preterm birth and premature rupture of membranes are required to confirm the value of antimicrobial treatments in prevention of microbial-associated preterm birth.

Adolescent↗