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Biomedical subjects

W Wagner

Publications and source records attributed to W Wagner.

At least 19 recordsLinked to original sources
PubMed1996

[Results of revision and new operation in arteriovenous shunt complications].

Over a 10 years period 260 arterio-venous fistulas have been performed and followed up. The Brescia-Ciminoshunt was the most frequent type (n = 174). This type of fistula has been performed in about 85.2% of all cases as primary operation method. In secondary formations the saphena-interposition was used most frequently (49.4% of all cases). A shunt revision should be performed in cases of immediate thrombosis although a shorter life time of revisioned shunts compared with new formations is known. The new formation of a shunt should be considered if terminal thrombotic changes have been detected as well as in cases of shunt infection or shunt insufficiency.

Arteriovenous Shunt, Surgical↗
PubMed1996

[The value of differential recording of subcortical somatosensory evoked potentials (SEP) in neurosurgery].

The role of subcortical median nerve somatosensory evoked potential (SEP) testing is exemplified in neurosurgical patients with syringomyelia, coma, brain death, or undergoing intraoperative monitoring. Of special importance is the isolated recording of two components with similar latencies but different generator sites: N13 (lower cervical spinal cord) and P14 (caudal brain stem). These two potentials overlap in conventional neck-scalp recordings using a frontal reference. Theoretical implications and practical aspects of a differential recording of subcortical SEP in neurosurgery are discussed.

Brain Death↗
PubMed1996

A fixed-dose combination of low molecular weight heparin with dihydroergotamine versus adjusted-dose unfractionated heparin in the prevention of deep-vein thrombosis after total hip replacement.

The low dose heparin regimen (LDH) is not appropriate for prevention of intra- and postoperative thromboembolic complications in high risk patients, especially those undergoing elective hip replacement. Despite LDH prophylaxis, the incidence of deep-vein thrombosis (DVT) remains in a range of 20 to 35%. Adjusted-dose unfractionated heparin prophylaxis is thought to be one of the most effective regimens for thrombosis prophylaxis in this indication, but it requires two or three daily injections as well as precise monitoring of the activated partial thromboplastin time (aPTT). As an attractive alternative, we investigated the efficacy and safety of the low molecular weight heparin (LMWH) certoparin combined with dihydroergotamine (DHE) given once daily. In a randomised, open clinical trial, a total number of 305 patients undergoing total elective hip replacement were enrolled and divided into two groups, either receiving a fixed-dose combination of LMWH (3,000 IU) and DHE (0.5 mg) subcutaneously once daily, or adjusted-dose unfractionated heparin (UFH) subcutaneously every 8 h. The UFH dosage was adjusted daily to keep an aPTT of about 50 s. The aPTT was determined 3 h after the morning injection. During the study, the starting dose (15,000 IU/day) was increased to a plateau value of 28,800 +/- 7,150 IU/day (mean +/- SD) to maintain the aPTT in the prescribed range. The plateau value was achieved after 8 postoperative days. For analysis of efficacy 289 patients were evaluable. The occurrence of deep vein thrombosis was determined by bilateral ascending venography, which was performed on the same day in patients with clinical signs suggesting DVT; and in all remaining patients at the end of the prophylaxis period. Deep vein thrombosis was diagnosed in 17 of 142 patients (12.0%) treated with LMWH/DHE and in 13 of 147 patients (8.8%) treated with adjusted-dose UFH. Combined distalproximal thrombosis was more frequently in patients receiving UFH (n = 5; 3.4%) compared to the LMWH/DHE group (n = 2; 1.4%). These differences are statistically not significant. In the UFH group one case of non-fatal pulmonary embolism occurred. Both prophylaxis regimens were well tolerated; wound bleeding was observed in 8 (5.3%) patients in the LMWH group and in 6 (4.0%) patients in the UFH group. Intraoperative blood-loss volume (mean +/- SD) was 751 +/- 339 mL (LMWH/DHE) and 736 +/- 380 mL (UFH), whereas postoperative drain-loss volume (mean +/- SD) was found to be 523 +/- 333 mL (LMWH/DHE) and 581 +/- 404 mL (UFH). Whole blood transfusion volumes (mean +/- SD) were 570 +/- 202 mL (LMWH/DHE) and 748 +/- 455 mL (UFH). Additionally, red cell replacement volumes (mean +/- SD) were 804 +/- 435 mL (LMWH/DHE) and 720 +/- 328 mL (UHF). Revision of wound or additional drainage were necessary in 3 LMWH/DHE and 7 UFH patients. One patient needed reoperation due to bleeding, 3 (2.0%) had petechia and 1 exhibited an allergic exanthema, all of them in the UFH group. A slight erythema at the injection site was observed in 6 (3.9%) patients receiving LMWH/DHE. During the course of prophylaxis, injection hematomas were documented in 57.9% (LMWH/DHE) and in 61.4% (UFH) of the patients. All differences were statistically not significant. Single daily subcutaneous injections of LMWH/DHE appeared to be safe and efficacious compared to adjusted-dose UFH for prophylaxis of DVT in high-risk patients.

Aged↗
PubMed1995

Properties of human affect induced by static color slides (IAPS): dimensional, categorical and electromyographic analysis.

Human affect elicited by static color slides was evaluated quantitatively using dimensional (N = 60 subjects) and differential or categorical (N = 57) self report, and facial electromyography (N = 20). Mean dimensional self reports of affective responses were highly replicable across cohorts. Mean categorical response profiles over seven affective categories were monomodal for some slides, but multimodal for most, and nearly identical within the same cohort for slides of similar content. Mean categorical response profiles for individual slides were also similar across different cohorts and for different experimental conditions. Valence calculated from weighted categorical self report scores was highly correlated with the self reported valence (r = +0.98), demonstrating a simple, linear relationship between dimensional and categorical (differential) measures of affect. Categorical response strength was synergically patterned, i.e. invariably correlated positively for affect of the same dimensional valence and generally correlated negatively for affect of opposite valence. Facial electromyograms associated with affective responses to slides were correlated with valence, but smaller in magnitude than those associated with the weakest possible voluntary facial movements involving the same muscles. This study, therefore, demonstrates that self reported affective responses to color IAPS slides are replicable within and between cohorts, complex but synergically patterned, and relatively weak.

Affect↗
PubMed1995

Retained pieces of wood in the retromaxillary space: a case report.

Detection and operative removal of wood as a foreign body in the cranio-maxillary area has received frequent attention in the literature. However, as a rule, most of the cases described are related to the orbit or the orbito-neurocranial space. Almost no literature exists on the detection and treatment of wooden foreign bodies in the retromaxillary space. The authors present an unusual case of long-term retained wood in this area in a child. The case inspires discussion of the general problem of detecting retained retromaxillary wood, even using modern diagnostic tools in this area and the question of the operative therapy, especially the most favourable surgical access.

Child↗
PubMed1995

Intraoperative monitoring of median nerve somatosensory evoked potentials in cervical syringomyelia: analysis of 28 cases.

Intraoperative median nerve somatosensory evoked potentials (SEP) were monitored in 28 patients undergoing surgery for cervical or cervicothoracic syringomyelia. Analysis was focused on SEP components N13 (spinal cord), P14 (brain stem), and N20 (cortex). N13 was lacking in nearly 87% of the patients (due to a combined effect of syringomyelia and general anesthesia) and never recovered. P14 showed a significant (> 10%) intraoperative latency increase in two patients; this was irreversible in one patient who had a postoperative worsening of sensory function. N20 showed no relevant alterations. Pure motor deficits after surgery were not predicted by SEP monitoring. In conclusion, intraoperative P14 recording helped to identify harm to the dorsal columns and probably prevented the cord from irreversible damage in one case, whereas N13 recording did not contribute to the monitoring of spinal cord function during surgery for syringomyelia.

Adult↗
PubMed1995

Transcranial Doppler and cortical microcirculation at increased intracranial pressure and during the Cushing response: an experimental study on rabbits.

The effect of increased intracranial pressure on the flow velocity of the basilar artery was measured with transcranial ultrasonic Doppler in New Zealand White rabbits under alpha-chloralose anesthesia and artificial respiration. Laser Doppler flowmetry served to study changes of the cortical microcirculation. The results confirm a high inverse correlation of the diastolic flow velocity, the pulsatility index, and the resistance index with the cerebral perfusion pressure (CPP). During acute intracranial hypertension, however, these parameters do not show a good correlation with the local cortical blood flow. The absence of a correlation was evident over a wide CPP range down to values of 35 mm Hg. Only at CPP values below this critical threshold is the microcirculation impaired. The threshold is reached at pulsatility index values of more than 2.0 and at resistance index values of more than 0.8. Therefore, transcranial Doppler indices permit the detection of critical reductions of microcirculatory blood flow. The Cushing reaction occurred with a constant time lag of 5.5 +/- 0.7 seconds after the loss of CPP. The Cushing reaction did not establish systolic blood flow, which remained below the functional threshold, as concluded from the temporary loss of somatosensory evoked potentials.

Animals↗
PubMed1995

Median nerve somatosensory evoked potentials in cervical syringomyelia: correlation of preoperative versus postoperative findings with upper limb clinical somatosensory function.

Median nerve somatosensory evoked potentials (SEPs) were recorded in 30 patients with cervical syringomyelia before and after surgery. The different SEP components were compared with clinical somatosensory findings. The N13 potential (generated in the dorsal horn at C5-C6) was pathological in 85% of the upper extremities, or 90% of the patients, and correlated with pain/temperature as well as vibration/joint position sense; it was of higher sensitivity in syringomyelia than any other clinical symptom or SEP component. P14 (brain stem) and N20 (postcentral cortex) were less often affected and correlated with only vibration/joint position sense. Short-term postoperative clinical or SEP changes were most often seen after syringoendoscopy and less often after syringostomy, resection of cerebellar tonsils, or tumor extirpation. Alterations of SEPs after surgery occurred in more patients (60%) than did changes in clinical condition (approximately 27%); there was, however, no general correlation between these findings. We conclude that median nerve SEP testing with a proper recording technique identifying the different subcortical components is a valuable supplement in the pre- and postoperative diagnostic evaluation of syringomyelia and is of higher sensitivity than clinical somatosensory examination alone.

Adult↗
PubMed1995

Fluvoxamine. A review of global drug-drug interaction data.

The overall reporting rate of drug-drug interactions with fluvoxamine is very low: only 73 cases have been identified from an estimated exposure of over 8 million patients worldwide. The reporting rate is similar in men and women, and most events relate to the use of fluvoxamine in conjunction with psychotropic compounds and anticoagulants. Two deaths have been documented. One involved a female patient who was given concomitant tryptophan and reportedly developed neuroleptic malignant syndrome. The causative role of fluvoxamine/tryptophan interaction in this case is unknown. The other reported death was considered to be unrelated to fluvoxamine. Fluvoxamine interactions with anti-epileptic or antidepressant drugs resulted in elevated plasma concentrations of the target drug and/or clinical symptoms, while interactions with neuroleptic or anticoagulant agents mostly resulted in clinical symptoms. Fluvoxamine increased plasma concentrations of tricyclic antidepressants by varying extents, particularly those of clomipramine (maximum reported increase 8-fold). Generally, clinical symptoms were infrequent and varied widely; no symptom clusters were identified. Those agents metabolised by cytochrome P450 1A2 isoenzyme appear most likely to be involved in drug-drug interactions with fluvoxamine.

Animals↗
PubMed1995

[Hemiprosthesis in femoral neck fracture].

From 1968 to 1993 835 hemiarthroplasties were performed at the Department of Trauma Surgery of the University of Erlangen. Until 1984 Moore (297) and Thompson (148) prostheses were implanted. After this period 390 patients were treated with a bipolar headneck replacement. Average age of patients at the time of surgery was 80.2 years from 1968 to 1980 and 83.1 from 1981 to 1993. All hemiarthroplasties were performed due to intracapsular fractures of the femoral neck. 5.9% of the Thompson and Moore prostheses were revised to total hip arthroplasty, the rate of revisions of bipolar prostheses was 4.9%. Main causes of revision for Thompson and Moore prostheses were acetabular erosion and protrusion (5.2%). Revision of bipolar prostheses became necessary because of recurrent luxation in 4.1%. The social status of the patients was examined 1 year after the operation. From 1968 to 1980 67% of the patients lived in their own home or with their families, compared to 39% from 1981 to 1993. The percentage of patients in retirement homes tripled from 9% to 29% for the same period.

Activities of Daily Living↗
PubMed1995

[Surgical tooth reconstruction in conjunction with irradiation of malignant tumors].

An infected osteoradionecrosis (IORN) is one of the most problematic sequelae of radiation in the course of cancer treatment in the head and neck. To prevent this, prophylactic dental extractions have been demanded before radiation, as well as specific measures (epiperiostalplastic cover, perioperative antibiotic treatment) if a tooth has to be extracted after the radiation treatment has been carried out. From 1980 until 1993, 812 Patients who had to be irradiated underwent a prophylactic dental extraction programme. Only in 0.5% of these cases an infected osteoradionecrosis developed later on. 167 patients were treated after the radiation had been applied, using perioperative antibiotic treatment and meticulous soft tissue cover following epiperiostal preparation of the gingiva. In spite of 25% of localised dehiscences no immediate infection of the bone was observed. At the same time 53 infected osteoradionecrosis were treated, 43% of which were of dental origin. Most of these were seen in the lower molar area. The results show the high value of prophylactic dental extractions before radiation as well as the benefit of careful extractions with epiperiostal gingival cover, after the radiation treatment, especially in the area of the posterior lower alveolus.

Head and Neck Neoplasms↗
PubMed1995

[Neoadjuvant radiochemotherapy in locally advanced non-small cell bronchial carcinoma. Initial results of a prospective multicenter study].

PURPOSE: In the last years new encouraging methods in the therapy of bronchial carcinoma have been elaborated. The early stages of bronchial carcinoma are still a domain of operative treatment. The long-term results of surgical treatment for locally advanced disease are considered to be unfavourable. Multimodal treatment concepts with simultaneous or consecutive application of radio-chemotherapy followed by surgical resection seem to reveal improved possibilities of therapy. PATIENTS AND METHODS: General treatment consists of 2 blocks of neoadjuvant chemotherapy with carboplatin, ifosfamide and etoposide, followed by a third course, consisting of carboplatin and vindesine. Simultaneously with the third course a hyperfractionated, accelerated radiotherapy with a single dose of 1.5 Gy 10 times per week is applied. The total dose is 45 Gy in 3 weeks, given at least to the 80% isodose. After restaging, tumor resection is carried out. Patients without tumor are randomized for prophylactic brain irradiation. RESULTS: From January 1992 up to 1.10.1993 25 patients have been treated in accordance to the study. All tumors were locally advanced (stage IIIa and IIIb). Until 1.10.1993 4 patients died, 2 of them certainly related to the tumor. Thirteen patients have been resected after neoadjuvant treatment. In 11 of these cases a R0-, and in 2 cases a R1 resection has been carried out. Tumor cells have been found only in 5 histologies. The hematotoxic side effects under competing RTX/CTX seemed to be unproblematical (RTOG/grade II). Problems occurred with 4 cases of serious esophagitis (RTOG/grade III to IV) and 2 cases of pneumonitis with 1 case ending lethally. CONCLUSION: Preliminary results of our study show the feasibility of multimodal treatment. A favourable 1-year survival rate after aggressive multimodal therapy and a high resection rate in previously unresectable patients could be demonstrated.

Adenocarcinoma↗
PubMed1995

[Intraoperative radiotherapy (IORT) in malignant brain tumors].

PURPOSE: Feasibility and morbidity of IORT for malignant brain tumors as well as value of innovative imaging for diagnosis of rest tumors and recurrences were examined. METHODS AND MATERIALS: Between May 1992 and November 1993, 23 patients with malignant brain tumors were treated in Münster with IORT. The patient collective was heterogeneous and negatively selected, i.e. beside of primary treatments, also patients with extensive previous treatment, recurrent tumors or metastases were included. Therapy consisted of radical surgical resection and intraoperative electron radiotherapy using total doses from 15 Gy to 25 Gy relative to the 90% isodose. Afterwards, patients without prior treatment underwent percutaneous irradiation with a maximum dose of 60 Gy, related to the small volume of the tumor area plus a safety margin of 2 cm. RESULTS: No increase of peri-operative morbidity or subacute sequelae was observed. Overall 1-year survival was 67% for grade III gliomas (WHO), and 56% for glioblastoma multiforme. When the Matsutani selection criteria (primary therapy of a supratentorial, peripheral astrocytoma grade III or glioblastoma smaller than 5 cm in diameter with a Karnofsky performance index of more than 60% and possible wide resection) were applied, 1-year survival increased to 75%. Nuclear medical diagnostics using 123I-alpha-methyltyrosin SPECT proved a valuable method for imaging of non-resectable tumor tissue and diagnosis of recurrences. CONCLUSIONS: The results of this study indicate that IORT can contribute to successful tumor treatment while neither increasing peri-operative morbidity nor subacute sequelae.

Adult↗
PubMed1995

[Endoluminal HDR brachytherapy in the palliative treatment of patients with the recurrence of a non-small-cell bronchial carcinoma after prior radiotherapy].

PURPOSE: The preferred primary treatment in non-small cell lung cancer is surgical resection. In fact, only less than 25% of patients are resectable with curative intent. The remaining patients are primarily treated with radiation therapy or combined radiochemotherapy, achieving remission rates up to 60% but 5-year survival rates of only about 5%. Therefore an effective palliative treatment is important. The aim of our study was to show that using intraluminal HDR brachytherapy, tumor-induced bronchial obstruction and its symptoms can be relieved in the majority of cases. PATIENTS AND METHODS: Sixteen patients with recurrent previously irradiated non-small cell lung cancer were treated with intraluminal high dose rate iridium-192 afterloading irradiation at the Department of Radiotherapy and Radiation Oncology of the University of Münster between 1989 and 1993. There were 15 men and 1 woman with a median age of 61 years. As a primary treatment, 50 to 60 Gy had been delivered percutaneously. The recurrences were treated with HDR brachytherapy using 2 to 4 applications of 5 Gy to 6 Gy each to a tissue depth of 0.5 cm. RESULTS: In 13 of 16 patients dyspnoea could be improved and in 15 of 16 patients atelectasis could be dissolved. Nine of 16 patients achieved a partial or complete remission evaluated by bronchoscopic criteria. The median period of remission was 4 months. The median survival time, measured from the start of therapy and analysed using the Kaplan-Meier method, was only 9 months. As side effects, 1 pneumothorax and 1 tracheomediastinal fistula occurred, the latter presumably related to tumor progression. CONCLUSION: Our results show the importance of intraluminal HDR brachytherapy in the palliative treatment of patients with recurrent non-small cell lung cancer.

Adenocarcinoma↗
PubMed1994

[The long-term functional results following velopharyngoplasty as a speech-improving measure].

Forty three out of 148 patients who had undergone velopharyngeal flap graft between 1980 and 1992 to treat velopharyngeal insufficiency, and for whom pre- and postoperative data were available, were studied for the purpose of determining the long term morphological functional results of the treatment. Almost all of the 43 patients (93.5%) had received a velopharyngeal flap graft according to Sanvenero-Rosselli. The remaining 4.7% had received a velopharyngeal adhesion according to Stellmach. Four physicians from the fields of oral surgery, orthodontics, phoniatrics, and logopedics evaluated the pre- and postoperative data as well as the results of the follow-up examination according to subjective criteria from their respective disciplines. All four physicians judged that following velopharyngeal flap graft a gradual improvement in the ability to speak had been achieved in 86% of the patients in the follow-up study. At the time of the follow-up examination 70% of these cases were judged to have achieved a "good" qualitative level of articulation and 21% were judged to have achieved a "usefull" level. The best results were obtained in patients who had been operated on before the age of six. The reason is that in these young patients muscular malfunction and pathological movement patterns can be more easily modified than in older patients. In many cases additional speech improvement was achieved through logopedic therapy following the velopharyngeal flap graft. In the most difficult cases intensive therapy while the patients were still hospitalized proved to be especially effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Cleft Lip↗
PubMed1994

Caesarean section in a diabetic patient with a recent myocardial infarction.

This is a report of a 38-yr-old parturient with multiple medical problems including diabetes mellitus, bronchial asthma, chronic myelogenous leukaemia, pre-eclampsia and a recent myocardial infarction. After medical management in the coronary care unit, it was decided to proceed with a Caesarean section. The choice of anaesthetic was made by the patient and had to be modified in accordance with her medical condition. Cardiovascular monitoring included PA catheterisation and transoesophageal echocardiography. A general anaesthetic was performed using fentanyl, thiopentone and succinylcholine. The outcome was satisfactory for both parturient and baby.

Adult↗
PubMed1994

Biochemistry and molecular genetics of Leishmania glucose transporters.

Glucose is utilized as a significant source of metabolic energy by Leishmania parasites. This sugar is accumulated by the parasite via a specific carrier-mediated transport system located in the parasite membrane. Parasites may also contain another transporter that shuttles glucose between the cytoplasm and the glycosome, a membrane-bound organelle where the early steps of glycolysis occur. The transport systems of both the insect stage promastigotes and the intracellular amastigotes have been characterized and shown to have kinetic properties that are consistent with the different physiological environments of the insect gut and the macrophage phagolysosome. Several genes have been cloned from Leishmania species which encode proteins with substantial sequence similarity to glucose transporters from mammals and lower eukaryotes. Two of these genes are expressed preferentially in the promastigote stage of the life cycle, where glucose is more readily available and more rapidly transported and metabolized than in the intracellular amastigotes. One of these two developmentally-regulated genes has been functionally expressed in Xenopus oocytes and shown to encode a glucose transporter. A third gene encodes a protein that is also a member of the glucose transporter family on the basis of sequence similarity and proposed secondary structure. However, the significant differences between this protein and the other two suggest that it is likely to transport a different substrate. Functional expression will be required to define the specific biochemical role of each gene within the parasite.

Animals↗