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Biomedical subjects

S Conrad

Publications and source records attributed to S Conrad.

72 records · Page 4Linked to original sources
PubMed1992

[Obstructive uropathy after kidney transplantation. Experiences with endourologic incision of ureteral stenoses].

Between 1985 und March 1991 we have managed 8 upper urinary tract obstructions in kidney transplants using an endourological approach. After a graft rejection was excluded an obstruction was initially diagnosed by nephrosonography and further confirmed by IVP or antegrade pyelography. To investigate the urodynamic relevance of the stenosis, all patients underwent preoperative diuretic isotope renography. In all cases a percutaneous pyelostomy was done to preserve renal function. 7 of these 8 patients demonstrated a stenosis of the ureter, while in one case, the obstruction was caused by a coagulum in the renal pelvis. Incision of the stricture then was performed with a flexible knife antegrade or retrograde and stented for 4-6 weeks. In 6 out of 7 cases with a proven stenosis of the ureter, the cold knife incision lead to a successful outcome, while in one patient, the kidney had to be removed due to uncontrolled bleeding 12 days after successful percutaneous incision. Our results indicate, that the cold-knife-technique for the management of upper urinary tract obstructions in kidney transplants is a promising, fast and in most of the cases effective method. Due to its minimalinvasive character and excellent results, this approach is able to replace open reintervention in most cases.

Adolescent↗
PubMed1991

Herpes simplex virus type 1 long-term persistence, latency, and reactivation in infected Burkitt lymphoma cells.

The two herpes simplex virus type 1 (HSV-1) strains F and AK which differ in virus-cell interaction and in DNA organization, were used to establish persistently productive infections in Burkitt lymphoma-derived cell lines BJAB and Raji. Four such lines could be maintained over a period of three years. Like the uninfected parental lines, the persistently infected cells display a cyclic pattern of cell proliferation. The expression of HSV-1-specific antigens proved to be variable. As a consequence, virus yields also vary within a subcultivation period. Pooled human HSV antisera, when continuously present, suppress virus production (inducible latency) and support cell proliferation to higher rates. By contrast, removal of the antiserum after a certain period of cultivation leads to virus reactivation with a delay of 8 to 20 days. After cultivation periods of more than 3 to 12 weeks, replacement of HSV antiserum does no longer result in virus reactivation and even inducers fail to reactivate.

Antibodies, Viral↗
PubMed1991

The cold-knife technique for endourological management of stenoses in the upper urinary tract.

Between 1985 and October 1989 we managed 13 patients with primary and 43 with secondary obstruction of the upper urinary tract with the endourological cold-knife technique. We treated 26 patients with stenosis of the ureteropelvic junction, 9 with infundibular stenosis, 12 with ureteral obstruction after inflammation or radiation therapy, 7 with stricture of the ureter in kidney transplants and 2 with stenosis of the ureter after ureterosigmoidostomy. Endourological management was successful in 42 of 56 cases with a decrease or total elimination of obstruction. Stenosis recurred in 9 patients. Our results indicate that the cold-knife technique should be attempted as the initial approach in all cases of primary or secondary obstruction of the upper urinary tract.

Adolescent↗
PubMed1991

Complicated urinary tract infections.

Complicated urinary tract infections (UTIs) are defined as those infections causing severe complications, such as urosepsis, renal scarring, and end-stage renal disease. Major complicating factors are infection stones, infected atrophic kidney, renal papillary necrosis, indwelling catheters, and other causes of bacterial persistence, as well as vesicoureteral reflux and urinary tract obstruction in recurrent UTI. Operative therapy is mandatory in all types of persistent UTI besides chronic bacterial prostatitis, as well as in UTI associated with urinary tract obstruction. Recurrent UTI complicated by vesicoureteral reflux, on the other hand, should be managed conservatively.

Atrophy↗
PubMed1991

[Pheochromocytoma of the urinary bladder. Diagnosis and therapy based on a case report].

Micturition difficulties associated with unstable hypertension, tachycardia and profuse sweating could be a sign of pheochromocytoma of the urinary bladder. Of all pheochromocytomas, 10-36% are located extradrenally, in which case they are also referred to as paragangliomas, and 1-3% are found in the urinary bladder. The case history of a 44-year-old female patient with typical symptoms is described. Diagnosis required not only CT, NMR, excretory urography and MIBG scintigraphy, but also hormonal analyses. Histology reveals malignancy in up to 20%; it is thought that focal invasions of tumor into vessels and destruction of connective tissue might be pathognomonic. A precise history and careful diagnosis are necessary before a pheochromocytoma of the bladder can be disclosed and treated.

Adult↗
PubMed1990

[Long-term results in the treatment of metastasizing kidney carcinoma using recombinant alpha-2 or gamma interferon].

To evaluate whether response to alpha-2- or gamma-interferon in metastatic renal cell carcinoma is associated with a prolonged survival, we studied a total of 65 patients being treated in two phase-II- or phase-III-trials between 1984 and 1986 with one of these interferons. After a median follow-up of 3 years for the alpha-interferon-treated patients and of more than 4 years for gamma-interferon-therapy, respectively, there is a significantly increased duration of survival for patients showing an objective response or stabilisation of the disease due to either therapy compared to those with continuing progression. Therapy with alpha-interferon leading to objective remissions in 26% or with gamma-interferon with an objective response rate of 36% therefore is beneficial for responding patients and can be performed with moderate side effects on an out-patient basis.

Adult↗
PubMed1990

[Use of electronic data processing at a urologic polyclinic--a program packet for recording and evaluating data of specialized consultations].

A software package was developed for computerized recording and processing of clinical data in a urological out-patient clinic. In a pilot study this program proved to be useful for the rapid evaluation of all important clinical and laboratory results of patients with renal cell carcinoma, and its use also accelerated the preparation of medical reports. The experience gained in this initial project shows that the application of this newly developed concept of data processing can easily be extended to routine out-patient followup in other special areas within the field of oncology.

Aftercare↗
PubMed1988

[Treatment of metastatic kidney cancer with recombinant alpha-2 or gamma interferon. Results of 2 clinical phase II and III studies].

In a phase-II and a phase-III study patients with histopathologically documented metastatic renal cell carcinoma were treated either with gamma-interferon in two different doses (100 micrograms/m2 3x/week for 4 h i.v. every other week or 500 micrograms/m2 5x/week for 24 h i.v. every other week) or with alpha-2-interferon alone (18 x 10(6) U 3x/week weekly i.m.) or in combination with vinblastine (0.1 mg/kg every third week i.v.). The purpose of these studies was to evaluate the response rate, the duration of response, the survival, the efficacy and the toxicity of the different forms of treatment. The overall response rate to gamma-interferon was 30% in both regimens. The response rate of treatment with alpha-2-interferon was found to be 31%. The duration of response ranged between 2 and 34+ months in patients treated with gamma-interferon and between 2 and 24+ months in those receiving alpha-2-interferon. Patients with objective tumor response showed a significantly longer survival than those not responding (p = 0.0056). Low-dose-gamma-interferon and alpha-2-interferon treatment could be easily done on an outpatient basis. In conclusion, interferon treatment seems to be of value in the therapy of patients with well documented progressive disease in metastatic renal cell cancer.

Adult↗
PubMed1988

Recombinant interferon gamma in the treatment of metastatic renal cell carcinoma. Results of a phase II trial.

A clinical Phase II study was performed to evaluate the efficacy and safety of treatment with interferon gamma in patients with metastatic renal cell carcinoma. Patients received interferon gamma by two different regimens: 1. 100 micrograms/m2 3x/week i.v. over 4 h every other week--low dose. 2. 500 micrograms/m2 5x/week i.v. over 24 h every other week--high dose--for non-responders to regimen 1. The response rate, duration of response, survival and toxicity in the two regimens were evaluated. Treatment with interferon gamma resulted in an overall response rate of 31%, with a duration of response ranging between 2 and 44+ months. Patients responding objectively to interferon gamma or showing stable disease survived significantly longer than non-responders (p = 0.0056).

Adult↗
PubMed1982

Transcutaneous bilirubin measurements in full-term infants.

A total of 292 transcutaneous bilirubin (TcB) measurements were performed in 157 white full-term infants: 157 were obtained from the forehead and 135 from the midsternum. TcB measurements correlated well with serum bilirubin determinations (r = .93, P less than .0001). The sensitivity of the test was 100% and the specificity 97%. It was possible to establish guidelines for the TcB measurement which identified all infants whose serum bilirubin concentrations exceeded 12.9 mg/100 ml (221 mumoles/liter) with no false-negative and only five false-positive determinations (3%). The positive predictive value for the TcB measurements was 58%. This implies that, in our population, an infant with a TcB index greater than or equal to 24 has a 58% chance of having a serum bilirubin concentration greater than 12.9 mg/100 ml. The negative predictive value was 100%. Thus, a negative test will correctly predict the absence of hyperbilirubinemia in all cases. As these measurements were obtained prospectively in a well-baby population with a prevalence of hyperbilirubinemia (greater than 12.9 mg/100 ml) of 4.5%, the positive predictive value should be applicable to other similar populations and will, in fact, increase in populations with a higher prevalence of hyperbilirubinemia. TcB measurements can be recommended for the identification of significant neonatal jaundice in full-term infants. It is important to recognize, however, that because of potential variations in TcB meters as well as serum bilirubin measurements in different laboratories, each institution should establish its own criteria for the use of this instrument.

Bilirubin↗
PubMedDate not supplied

Colonization and infection with fluoroquinolone-resistant Escherichia coli among cancer patients: clonal analysis.

Escherichia coli with high-level fluoroquinolone resistance were isolated from feces and/or various body sites of 16 cancer patients who were on oral fluoroquinolone prophylaxis. Population analysis of fecal isolates in 11 patients showed that fluoroquinolone-resistant E. coli was the only aerobic gram-negative bacillus present and exhibited a relatively homogenous fluoroquinolone MIC distribution. Molecular typing by pulsed field gel electrophoresis of chromosomal DNA digests or by random amplified polymorphic DNA fingerprinting confirmed the clonal nature of gastrointestinal tract colonization with E. coli. Genotyping of ten colonies picked from the same fecal culture demonstrated identical strains in four of four patients examined. Identical genotypes from the same patient were isolated over prolonged periods of time in 12 of 12 cases examined, with one patient (with the longest follow-up of 14 months) who lost his initial genotype and became persistently colonized with a new genotype. In the 11 patients who developed infection due to fluoroquinolone-resistant E. coli, molecular typing also indicated that fecal colonization was associated with, and presumably preceded infection due to an indistinguishable genotype of fluoroquinolone-resistant E. coli.

Anti-Infective Agents↗
PubMedDate not supplied

Ensuring quality care: what do you get for your money?

In the rush to produce balanced scorecards and outcomes measures, managed care organizations must recognize the need to better assess the clinical competencies of their contracted skilled nursing facilities. Health plan quality management staffs, although composed of gifted professionals, generally do not have sufficient skilled nursing facility (SNF)-related experience or knowledge to support evaluation and qualification of these providers. The successfully implemented Altman-Conrad (A-C) SNF quality management process objectively measures and monitors managed care contracted services provided by SNFs. The A-C process requires a health plan's quality management/utilization management staff to engage in a team-based educational endeavor. This effort is designed to generate measurable outcomes specific to the health plan's needs. The proven benefits of the process include improved member services, greater member satisfaction, more productive days for SNFs, more effective discharges, and the generation of a win-win relationship between the health plan and its contract providers.

Clinical Competence↗