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Biomedical subjects

T Spiegel

Publications and source records attributed to T Spiegel.

11 recordsLinked to original sources
PubMed1998

[Screening in prostate carcinoma].

With an increasing incidence, prostate cancer has become the most common cancer in males in the USA. In Germany, 20,000 new cases of prostate cancer were detected in 1995. Only organ confined prostate cancer is curable. Therefore the main intention of screening is an increasing detection rate of clinically significant tumors in time. Cancer specific mortality and morbidity should be decreased by screening. Whether screening can actually achieve this has to be proven in prospective randomized trials, which have only been started recently. Therefore, valid results cannot be expected before the year 2007. Different trials revealed the combination of digital rectal examination and the measurement of prostate specific antigen to be the most useful tools in screening at present. In conclusion, at present, the recommendation is an urological examination once a year in men from 45-50 (depending on risk) to 70-75 years of age--if the patient agrees to the possible diagnostic and therapeutic consequences.

Adult↗
PubMed1997

The influence of controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV) and biphasic intermittent positive airway pressure (BIPAP) on duration of intubation and consumption of analgesics and sedatives. A prospective analysis in 596 patients following adult cardiac surgery.

The aim of the study was the determination of the influence of ventilation modes on the consumption of analgesics and sedatives, duration of intubation and pulmonary gas exchange. Assist/controlled mandatory ventilation (S-CMV, 123 patients), synchronized intermittent mandatory ventilation (S-IMV, 431 patients) and biphasic positive airway pressure ventilation (BIPAP, 42 patients) were compared in a prospective, controlled, open clinical trial over an 18-month period. Five hundred and ninety-six adult patients with normal pulmonary function before surgery and uneventful course following coronary artery bypass graft surgery were studied. Patients ventilated with BIPAP had a significantly shorter mean duration of intubation (10.1 h, P < 0.05) than patients treated with S-IMV (14.7 h) and S-CMV (13.2 h). In the S-CMV group, 39.9% of the patients required single or multiple doses of midazolam, but only 13.5% in the S-IMV group and 9.5% in the BIPAP group. The mean total amount of midazolam administered to these patients was significantly higher in the S-CMV group (8.8 mg) than in the S-IMV group (6.6 mg, P < 0.05) and in the BIPAP group (4.3 mg, P < 0.05). The consumption of pethidine and piritramide did not differ between S-CMV and S-IMV, but was significantly lower during BIPAP (P < 0.05). After extubation the patients' PaCO2 was highest in the S-CMV group. We conclude that ventilatory support with BIPAP reduces the consumption of analgesics and sedatives, and the duration of intubation. The possibility of unrestricted spontaneous breathing in all phases of the respiratory cycle is considered to be the reason. BIPAP seems to be an alternative to S-CMV and S-IMV in short-term ventilated patient.

Analgesics↗
PubMed1994

[Urogenital malformation complex including the Mullerian system].

Symptomatic cystic epididymis in a 21-year-old man led to the detection of several genital malformations, including a partially obstructing pelvic cyst, prostatic and bilateral testicular atrophy and penoscrotal hypospadias. These malformations are probably due to a deficiency of either testosterone or müllerian inhibiting hormone (MIH). Development of the male genitalia is influenced by testosterone secreted in the Leydig cells during weeks 8-16 of gestation, while regression of the müllerian ducts is induced by MIH secreted in the Sertoli cells from weeks 9-12 of gestation.

Abnormalities, Multiple↗
PubMed1992

Use of low-osmolality contrast medium does not increase prevalence of medullary sponge kidney.

To assess the prevalence of intrapapillary linear collections of contrast medium as well as of homogeneous papillary blush on excretory urograms obtained with a low-osmolality contrast medium, iohexol was used in 300 patients. Intrapapillary linear collections of contrast medium (ie, three or more linear collections of contrast material within a papilla) were found in 10 (9.5%) of the 105 patients with renal stone disease and two (1.0%) of the 195 patients without nephrolithiasis (P less than .001). These prevalences are similar to those found in a previous study with use of a high-osmolality contrast medium (sodium amidotrizoate). The difference in the prevalence of homogeneous papillary blush between stone formers and non-stone formers was nonsignificant. The authors conclude that intrapapillary linear collections of contrast medium on excretory urograms obtained with use of a low-osmolality contrast medium should be considered to have the same clinical significance as those on excretory urograms obtained with use of a high-osmolality contrast medium, that is, as indicating the presence of medullary sponge kidney.

Adolescent↗
PubMed1991

Ileal bladder substitute: antireflux nipple or afferent tubular segment?

Spheroidal bladder substitutes made from double-folded ileal segments, similar to Goodwin's cup-patch technique, are devoid of major coordinated wall contractions. This, together with the reservoir's direct anastomosis to the membranous urethra, prevents major intraluminal pressure peaks and assures a residue-free voiding of sterile urine. In order to determine whether, under these conditions, an afferent tubular isoperistaltic ileal segment of 20-cm length protects the upper urinary tract as efficiently as an antireflux nipple, 60 male patients who were subjected to radical cystectomy were prospectively randomised to groups in which a bladder substitute was formed together with either of these 2 antireflux devices. An analysis of the results obtained in 20 patients from each group who could be followed for more than 1 year (median observation time 30 and 36 months) showed no differences between the groups in metabolic disturbances, kidney size, reservoir capacity, diurnal and nocturnal urinary continence, the incidence of urinary tract infection or episodes of acute pyelonephritis. Later than 1 year postoperatively, intravenous urograms of the renoureteral units of 25% of the patients with antireflux nipples showed persistent but generally slight dilatation of the upper urinary tracts. This observation was significantly more frequent than it was in patients with afferent tubular segments. Urodynamic and radiographic studies showed that the competence of the antireflux nipples was secured by the raised surrounding intravesical pressure. This, however, also resulted in a transient functional obstruction, and a gradual rise of the basal pressure in the upper urinary tracts was recorded. In patients with afferent ileal tubular segments, contrast medium could be forced upwards into the renal pelvis when the bladder substitutes were overfilled. However, despite raised intravesical pressures, peristalsis in the isoperistaltic afferent tubular segment gradually returned contrast medium back to the reservoir. Our results suggest that the combination of an ileal low-pressure reservoir together with an afferent tubular isoperistaltic limb is at least as good as an antireflux nipple valve. Moreover, the use of the afferent ileal limb makes it possible to resect the distal and often diseased ureters together with the paraureteric lymphatics at a safe distance from the bladder tumor. This avoids also distal ischemic ureteric stenosis and makes possible a simple end-to-side ureterointestinal anastomosis with a small complication rate.

Anastomosis, Surgical↗
PubMed1986

Group therapies for rheumatoid arthritis. A controlled study of two approaches.

An important unanswered question about rheumatoid arthritis (RA) is how the patient's psychological or emotional state relates to disease activity and functional status. No controlled studies of psychotherapeutic interventions in RA have been reported. To test the hypothesis that a psychosocial intervention would lead to improvement in functional status or disease activity, 57 RA patients were randomly assigned to 1 of 3 groups, which received: 1) conventional group psychotherapy; 2) group assertion/relaxation training; or 3) no treatment (control group). Patient and physician questionnaires collected at baseline, immediately after the interventions, and 12 months after baseline provided outcome data on functional status, social and psychological adaptation, psychological symptoms, and disease activity. There were few outcome measures for which either treatment resulted in significantly higher scores than were seen in controls, though more improvement did occur among patients who received conventional group psychotherapy.

Activities of Daily Living↗
PubMed1984

CT assessment of the adult intrathoracic cross section of the trachea.

After phantom validation of the method, normal tracheal morphology of 25 women and 25 men was studied retrospectively at level 1, the thoracic inlet; level 2, the supracarinal level, and level 3, halfway between. In no case was the minimal cross-sectional area less than 68% of the maximum of the three levels. Areas at the same level were different depending on sex, but not on other body parameters, and so were the means of the three levels: 194 mm2 (SD 35) in women and 272 mm2 (SD 33) in men. Mean tracheal area correlated with mean tracheal diameter (r = 0.98). Average configuration of the trachea was sagittal at the thoracic inlet and transverse supracarinally. Absolute tracheal cross sections of less than 120 mm2 in women and 190 mm2 in men and relative values of less than two-thirds compared with other levels should suggest an abnormality. Although static and not in competition with functional tests, noninvasive CT area calculation may be useful in demonstrating and quantifying tracheal obstruction when mediastinal neoplasms are staged or as a complementary morphological test when ventilatory studies do not afford enough information to localize the lesion and to decide about treatment.

Adult↗
PubMed1981

Spontaneous hepatic rupture in rheumatoid arthritis.

A fatal hepatic rupture developed, in a patient with rheumatoid arthritis, as a result of hepatic arteritis. The patient had hypotension, falling hematocrit level, hepatomegaly, and evidence of progressive hepatocellular dysfunction. Hepatic dysfunction is not uncommon in rheumatoid arthritis, but is usually asymptomatic. Hepatic arteritis is a rare manifestation of rheumatoid arthritis; however, recognition of this complication is important, since early intervention may be important in successful management.

Arteritis↗
PubMedDate not supplied

Biliary secretion of sulindac and metabolites in man.

The biliary secretion of sulindac and metabolites after a single 400 mg oral dose of the drug was studied in 3 elective gallbladder surgical patients following placement of an occludable T-tube in the common bile duct. Bile and systemic plasma were sampled at frequent intervals for up to 36 h postdose. The apparent biliary clearance (Vcl,bile) of the prodrug sulindac is about 25 times greater than that of the pharmacologically active sulfide metabolite. The total biliary flux of drug in normal man with an uninterrupted enterohepatic cycle, calculated from Vcl,bile and historic mean plasma drug AUCinfinity0 values, averages 144 and 12.2 per cent of the dose as sulindac and the sulfide metabolite, respectively. Thus, enterohepatic recycling of the drug in man is principally in the form of the prodrug which not only limits exposure of the intestine to the active moiety but also sustains systemic concentrations of active drug upon reabsorption of the prodrug.

Aged↗
PubMedDate not supplied

Flexible sigmoidoscopy training for nurses.

Colorectal cancer will account for approximately 55,300 deaths in 1995. In addition, 138,200 new cases of colorectal cancer will occur. The American Cancer Society encourages accessible, affordable sigmoidoscopy by primary care physicians or highly trained paramedical personnel for all persons, aged 50 years and older, every 3 to 5 years or as advised by their physician. As a result of these recommendations, there has been an increase in demand for the screening sigmoidoscopy. The increase in requests for this examination has overwhelmed existing resources, including physician time, space, and staff in the ambulatory care setting. The Kaiser Foundation Health Plan of Georgia, Inc., has developed an innovative approach to performing screening sigmoidoscopies by training two registered nurse endoscopists to conduct these examinations. The goal of the nurse endoscopy program is to provide quality colorectal cancer screening within an established appointment standard while promoting comfort and safety.

Clinical Competence↗