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S Reuter

Publications and source records attributed to S Reuter.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Placement of an implantable defibrillator via the endocavitary route in a patient presenting with a univentricular heart and a Glenn anastomosis].

We report the observation of a female 45 year old patient presenting with a post-surgery complex congenital cardiopathy, associated with serious ventricular rhythm disorders necessitating the placement of an implantable defibrillator. The palliative surgery performed (cavo-pulmonary Glenn anastomosis) does not allow the usual access to the right ventricle via the superior vena cava. The different possibilities for defibrillator implantation are discussed. These include associating a surgical approach to introduce the bipolar probe with subcutaneous tunnelling to connect the probe to the box.

Arrhythmias, Cardiac↗
PubMed2001

[Surgical therapy of alveolar echinococcosis and long-term outcome].

INTRODUCTION: The incidence of alveolar echinococcosis (AE) is low, and studies and progress reports with regard to surgical procedures are rare. METHODS: Retrospective analysis of surgical therapy of AE and its long-term results between 1983 and 2000 by evaluating medical records and questionnaires. SETTING: German university hospital within the endemic area. RESULTS: Twenty-five surgical procedures were performed in 19 patients with AE (12x partial resection of the liver, 3 of them with additional extrahepatic resection; 3x just extrahepatic resection, 4x bilidigestive anastomosis, 5x exploratory laparotomy, 1x bypass procedure). Fifteen patients were operated on the first time with that diagnosis, four due to a relapse. Seven surgical procedures were estimated to be curative, whereas 18 were palliative, because the parasitic mass could not be resected in toto. One patient died from persistent systemic sepsis as a consequence of microbial superinvasion of a splenic parasitic mass. Morbidity was 28%. All patients had additional medical treatment and periodic follow-up. Three of seven patients estimated for curative surgery developed a relapse. One of the patients discharged following palliative surgery died 13 years after diagnosis with liver insufficiency. Advances in conservative and interventional treatments have greatly improved the prognosis of the disease. CONCLUSION: Curative surgery for AE is feasible only in a minority of patients, because frequently the disease has already spread widely when diagnosed. The minimum distance between the lesion and the cut surface should be 2 cm. Taking the advances in conservative treatment into consideration, the benefit of palliative surgery is uncertain and today there is no evidence for prolonged survival by palliative surgical procedures. Palliative surgery should therefore be reserved for cases with complications that could not be managed by conservative and interventional treatment.

Adult↗
PubMed2001

Long-term seropositivity against Echinococcus multilocularis in an epidemiological follow-up study in southwestern Germany (Römerstein).

BACKGROUND: Out of 2,560 participants in an epidemiological survey of alveolar echinococcosis (AE) performed in 1996 in southwestern Germany, 47 participants had tested seropositive in one of two crude antigen screening ELISAs and were inconspicuous on hepatic ultrasound. PATIENTS AND METHODS: Out of these 47 seroreactors, 36 attended a follow-up examination 30 months after the primary examination, including ultrasound and serology with various Echinococcus multilocularis-specific antigens. RESULTS: No lesion suspicious for AE was detected in any participant. Serology showed only minor changes as compared to the earlier results. CONCLUSION: Persistent seropositivity without detectable hepatic lesions could be interpreted as an early sign of sonographically not yet detectable AE, immunity to E. multilocularis or unspecific serological reactivity. For seropositive and clinically inconspicuous inhabitants of areas endemic for AE follow-up examinations at intervals of 2-3 years seem to be adequate.

Adolescent↗
PubMed2001

Intra-uterine implant (GyneFix) lost via intestinal route?

Uterine perforation has long been regarded as a complication of the insertion of an intra-uterine contraceptive device (IUD). The development of modern devices with sophisticated insertion systems as well as advanced training requirements seeks to minimise the risk of adverse insertion incidents for women choosing intra-uterine contraception. This case report highlights the continuing need for intra- and post-insertion vigilance as even recent advances in IUD technique and technology do not guarantee risk-free insertion.

Adult↗
PubMed2000

Formation and release of residues of the 14C-labelled herbicide isoproturon and its metabolites bound in model polymers and in soil.

The humic monomer catechol was reacted with (14)C-isoproturon and some of its metabolites, including (14)C-4-isopropylaniline, in aqueous solution under a stream of oxygen. Only in the case of (14)C-4-isopropylaniline, incorporation in oligomers, in fulvic acid-like polymers, and in humic acid-like polymers by covalent bonds was observed. The main oligomer was identified by mass spectrometry as a trimer, 4,5-bis-(4-isopropylphenylamino)-3,5-cyclohexadiene-1,2-dione. Biomineralization of (14)C-compounds to (14)CO(2) in a loamy soil and release of (14)C from soil columns into percolate water decreased in the order: free isoproturon >free 4-isopropylaniline>fulvic acid-like polymers>trimer>humic acid-like polymers. In soil columns, a small but measurable migration of (14)C from polymers from upper to deeper soil layers could be detected; most of this (14)C was bound again in a non-extractable form. It is concluded that aniline-derived pesticides bound in soil by covalent binding may not be fully undegradable, nor fully immobile.

Journal Article↗
PubMed2000

Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature.

Mebendazole and albendazole are the drugs of choice for the treatment of alveolar echinococcosis. In this open-labelled observational study we present and evaluate the outcome of long-term treatment with these drugs and present results of different treatment regimens. Thirty-five patients were started on either mebendazole or albendazole at the beginning of 1992 and followed for an average of 39 months (range 12-79 months). Treatment was classed as successful if the disease had not progressed for >1 year and if there were no side-effects necessitating a change of treatment. Lack of progression was evaluated mainly using ultrasound and computed tomography and was further substantiated by laboratory tests and clinical findings. The overall success rate was 97%. An initial regimen for cases of alveolar echinococcosis was recurrence-free in 71% of those treated with mebendazole and in 78% of those treated with albendazole. Four out of five cases with progressive disease stabilized after the therapeutic regimen was changed. Seven patients received a continuous regimen with albendazole. These patients were observed over an average of 28 months (range 13-50 months) without signs of progression or significant side-effects. This open-labelled prospective study demonstrates the high therapeutic efficacy of both mebendazole and albendazole with similar response rates in the treatment of alveolar echinococcosis. Albendazole reduced costs by >40% and is easier for patients to take, further arguing in favour of its preferred use. Albendazole in alveolar echinococcosis is only licensed for intermittent application. None the less, continuous treatment is safe and well tolerated and showed promising results when applied to patients in whom other treatment regimens had failed. It should thus be strongly considered in inoperable cases or progressive disease.

Adolescent↗
PubMed2000

Intermediate-term results of biventricular pacing in heart failure: correlation between clinical and hemodynamic data.

Biventricular (BV) pacing acutely improves the hemodynamic status of patients with chronic heart failure (CHF) and wide QRS complex. Long-term data are few. This study examined the relationship between hemodynamic and clinical status of BV-paced CHF patients over an intermediate duration of follow-up. Forty-seven patients (mean age 64 +/- 11 years, 19% women, LVEF 0.23 +/- 0.07) with QRS > or = 140 ms received a DDD-BVP device for management of CHF due to ischemic disease in 21 (45%) patients. Clinical, electrocardiographic, exercise testing, and hemodynamic measurements were followed over an 8-month period. Seven patients died during the study, four patients suddenly. A significant decrease in NYHA class, from 3.3 +/- 0.6 before implantation, to 2.5 +/- 0.57 months after device implantation (P < 0.01) was measured, although 23% of patients reported no symptomatic improvement. Paced QRS narrowing by BVP was unchanged throughout follow-up (166 +/- 28 vs 159 +/- 23 ms, P = NS). Maximal VO2 values did not change (15.7 +/- 5 vs 16 +/- 8 mL/kg per min, P = NS). Echocardiographic parameters showed that the degree of mitral regurgitation was significantly decreased during BV pacing compared with no pacing (1.8 +/- 1.0 before implantation vs 1.3 +/- 0.7, P < 0.01). The radionuclide LVEF was not statistically different during no pacing, versus BV pacing at 3 months or 8 months after pacemaker implantation (24 +/- 9 vs 26 +/- 11 vs 25 +/- 10%, respectively, P = NS). Of nine patients whose QRS duration was prolonged by BV pacing, two were not hemodynamically and clinically improved at the end of follow-up. Patients not improved by BV pacing had the same degree of QRS shortening (203 +/- 39 vs 167 +/- 26 ms, P < 0.01) as patients who were clinically improved during follow-up (193 +/- 40 to 171 +/- 24 ms, P < 0.01). In multivariate analysis, ischemic heart disease (P = 0.025), absence of mitral regurgitation regression (P = 0.01), and older age (P = 0.04) predicted the absence of improvement by BV pacing. By standard noninvasive measures, intermediate-term BV pacing was associated with no objective hemodynamic improvement, though more than three fourths of the patients reported being clinically improved. A global improvement in left ventricular function by BV pacing may become apparent only over longer periods of observations. Patients with CHF unimproved by BV pacing are more likely to suffer from ischemic heart disease and less likely to have BV pacing induced regression of mitral regurgitation, regardless of changes in QRS duration.

Blood Flow Velocity↗
PubMed2000

Hemodynamic assessment of right, left, and biventricular pacing by peak endocardial acceleration and echocardiography in patients with end-stage heart failure.

Multisite ventricular pacing acutely improves the hemodynamic status in heart failure, though longer-term observations require invasive procedures. The hemodynamics of multisite ventricular pacing were assessed by echocardiography and peak endocardial acceleration (PEA) measured by a pacemaker sensor. PEA variations are highly correlated with those of dP/dt. Thirteen end-stage heart failure patients (left ventricular ejection fraction < 0.30) with a QRS > or = 140 ms received a DDD PEA sensor-driven pacemaker allowing right (RV), left (LV) and biventricular (BV) pacing. Ten days after implantation, standard echocardiographic parameters and variations in PEA were measured after 20 minutes at each pacing mode. The aortic systolic preejection time interval was statistically comparable between RV and LV pacing (218 +/- 24 vs 219 +/- 34 ms; P = NS), and significantly shorter with BV pacing (198 +/- 27 ms; P = 0.013). Aortic ejection duration was nonsignificantly shorter during BV pacing than during LV pacing (-.061, P = 0.09). The aortic velocity time integer increased during LV pacing versus RV pacing (+21%, P < 0.05) and during BV pacing versus RV pacing (+37%, P = 0.05). As a result, the values of the PEA variations over a 15-minute period were significantly greater during LV pacing and BV pacing versus RV pacing (+43%, P < 0.05, and +38%, P = 0.05, respectively) and were statistically comparable between BV pacing and LV pacing (9% for LV pacing, P = NS). During various ventricular pacing configurations, PEA measurements were consistent with echocardiographic data, showing comparable hemodynamic effects of BV and LV pacing. The PEA sensor is a promising tool for long-term hemodynamic monitoring and serial evaluation of the effects of multisite ventricular pacing in heart failure patients.

Cardiac Pacing, Artificial↗
PubMed2000

[What methods are available to assess quality of life of patients fitted with a pacemaker?].

Quality of life (QOL) measurements are one of the main determinants for indication and technologic choice in permanent cardiac pacing. QOL measurements are obtained using questionnaire application. Questionnaire for QOL has to be reliable, comprehensive, sensitive and specific. Pacing mode and pacemakers algorithms have been evaluated by QOL measurements: VVI vs DDD, DDD vs VVIR, AAI vs DDD, fall back, algorithm.... Survival data and costs are also relevant aspects of cardiac pacing evaluation.

Humans↗
PubMed1999

A model for the formation and degradation of bound residues of the herbicide 14C-isoproturon in soil.

The humic monomer catechol was reacted with 14C-isoproturon and some of its metabolites, including 14C-4-isopropylaniline, in aqueous solution under a stream of oxygen. Only in the case of 14C-4-isopropylaniline, incorporation in oligomers, in fulvic acid-like polymers, and in humic acid-like polymers was observed. The main oligomer was identified by mass spectrometry as 4,5-bis-(4-isopropylphenylamino)-3,5-cyclohexadiene-1,2-dione. Oligomers and polymers containing bound 14C-4-isopropylaniline were subjected to biodegradation studies in a loamy agricultural soil during 55 days by quantifying 14CO2 evolved. In all cases, significant mineralization rates could be determined, which, however, were much smaller than those of free 14C-4-isoproturon and free 14C-4-isopropylaniline in the same soil.

Biodegradation, Environmental↗
PubMed1999

Expression of CD30 mRNA, CD30L mRNA and a variant form of CD30 mRNA in restimulated peripheral blood mononuclear cells (PBMC) of patients with helminthic infections resembling a Th2 disease.

It has been proposed that CD30, a member of the tumour necrosis factor (TNF) receptor superfamily, is preferentially up-regulated on Th2-type human T cells. In order to investigate a correlation between infection with Echinococcus multilocularis and CD30 expression, we analysed regulation of CD30 mRNA, a variant form of CD30 mRNA (CD30v) and CD30 ligand (CD30L) mRNA expression on PBMC from patients with alveolar echinococcosis (AE) using reverse transcriptase-polymerase chain reaction (RT-PCR). In PBMC of patients with AE as well as healthy donors, spontaneous expression of CD30L mRNA and the CD30v mRNA could be detected. However, the intact form of CD30 mRNA could be detected neither in freshly isolated PBMC of patients nor in PBMC of healthy individuals. Expression of CD30L mRNA and the variant form of CD30 mRNA was frequently detected at individual time points during 72 h of culture of PBMC stimulated with crude Echinococcus antigen. In contrast to CD30v or CD30L mRNA expression, induction of CD30 mRNA expression was detected only in three out of six (50%) healthy donors and in 10 out of 21 (48%) patients with alveolar echinococcosis after 72 h of incubation. As a control, mitogenic stimulation of PBMC of both healthy individuals and infected patients led to expression of intact CD30 mRNA within 24 h of culture. These data demonstrate the different expression of two different forms of CD30 mRNA in PBMC of human individuals. The specific induction of CD30 expression is correlated only in rare cases with the clinical status of patients with AE, indicating the lack of a general induction of CD30 mRNA in this Th2-type-dominated helminthic disease. The data provide further evidence that the CD30 receptor is not an exclusive marker for a Th2-type response.

Adult↗
PubMed1999

Zinc status in patients with alveolar echinococcosis is related to disease progression.

Zinc is an essential trace element for immune function that plays a role in immune response against parasites. To determine a possible relationship between zinc level and disease status in alveolar echinococcosis (AE), we investigated serum concentrations of zinc, immunoglobulin (Ig)E, IgG, and C-reactive protein (CRP) in 40 AE patients and 20 controls. Patients were classified into three groups: group A: patients after curative surgery, group B: patients with stabilized disease, group C: patients with progressive disease. Patients showed significantly higher levels of IgE and IgG than controls. Amounts of IgE and IgG were related to disease severity, achieving highest levels in group C and lowest in group A. Zinc levels were comparable in patients and controls. However, there was an obvious association between zinc concentration and disease severity. Zinc was far below the normal range in group C (median 9.2 micromol/l) and significantly diminished compared to group B and controls. An inverse pattern was seen for CRP. In conclusion, lowered zinc concentration in progressive cases may be caused by enhanced immune activation but consumption of zinc by the growing parasite may also play a role. Furthermore, decreased zinc levels may contribute to the observed immunosuppression in AE.

Adult↗
PubMed1999

Pericystic metabolic activity in alveolar echinococcosis: assessment and follow-up by positron emission tomography.

Information on parasite viability in alveolar echinococcosis (AE) cannot be obtained by conventional imaging techniques. We evaluated the glucose metabolism of AE lesions by use of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) in 12 inoperable patients. Eight patients showed either perilesional or focal enhancement ("hot spots"), whereas 4 patients had nonenhancing (metabolically inactive) lesions. With PET, necrotic parasitic lesions and areas of enhanced metabolic activity could be clearly discriminated. Most notably, 3 of 8 patients with metabolically active lesions who were reexamined after chemotherapy treatment clearly showed improvement: the initial surrounding hot spots had disappeared in 2 of them, and had significantly decreased in 1. PET may prove valuable in assessing the efficacy of chemotherapy by showing the disappearance of metabolic activity and may also be useful for timely detection of relapses and metastases. Although costly and not readily available, FDG-PET is a promising tool toward improved management of AE and may thus help lower costs of long-term chemotherapy.

Adult↗