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  • 1
    ISSN: 1432-1084
    Keywords: Key words: MR urography – Ureteral obstruction – Kidney transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Ureteral obstruction is an infrequent complication after renal transplantation that may cause rapid loss of transplant function. We tested static fluid MR urography for determining the cause of graft hydronephrosis. Magnetic resonance urography was performed in nine transplants with dilated collecting systems on ultrasound. A heavily T2-weighted 3D turbo spin-echo sequence on a 1.5-T scanner was used and maximum intensity projections were obtained. The patients also underwent excretory urography (n = 1), renal scintigraphy (n = 1), antegrade pyelography (n = 3), voiding cystourethrography (n = 4), and non-enhanced CT (n = 2). Six patients had pathologic conditions including ureteral stricture, compression by lymphoceles, implantation stenosis, vesicoureteral reflux, and late-occurring transitional cell carcinoma at the implantation site. Static MRU was able to diagnose or exclude a dilation of the graft collecting system. It visualized the course of the ureters and localized the obstruction site in four of five obstructed transplants. In one case the ureter was obscured by lymphoceles, which were demonstrated by hydrographic MRU as well. The definite cause for obstruction was provided in only 2 of 5 cases. Dilation due to vesicoureteral reflux could not be differentiated. The current multimodality approach to renal transplant imaging already provides comprehensive assessment of graft hydronephrosis. Static MRU may be useful in some cases since complications associated with intravenous iodinated contrast or antegrade pyelography can be avoided. Its main drawback, the lack of functional information, may be overcome by combining it with contrast-enhanced MRU.
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  • 2
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Blutungsstörungen ; Hormontherapie ; Präpubertät ; Reproduktionsphase ; Postmenopause ; Keywords Dysfunctional uterine bleeding ; Hormonal treatment ; Breakthrough bleeding ; Withdrawal bleeding ; Bleeding in the postmenopause
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The hormonal treatment of dysfunctional uterine bleeding is most reasonable when the disorder is caused by a disturbed menstrual cycle. Thus, reproductive age is the domain of hormone therapy. Especially after menarche and in the premenopause, the hypothalamic-pituitary-gonadal axis shows unstable function causing several forms of bleeding disorders. Disturbances of cyclic function by endocrine or metabolic factors and organic genital lesions must be considered and should be included in the therapeutic concept. First of all, hormonal therapy of bleeding disorder provides the direct effect of the drug on the endometrium. The interferences with superior regulating mechanisms are also part of the therapy; as, for instance, in the use of GnRH analogues. In this paper, we discuss several hormonal treatment modalities regarding different clinical bleeding patterns. The limited applications of hormonal therapy before and beyond the reproductive age are also mentioned.
    Notes: Zusammenfassung Die hormonelle Behandlung gutartiger Blutungsstörungen ist v. a. dann sinnvoll, wenn diese Folge einer gestörten ovariellen Funktion sind. Besonders nach der Menarche und in der Prämenopause besteht eine Instabilität der Hypothalamus-Hypophysen-Gonaden-Achse; es resultieren daraus verschiedene Formen von Blutungsstörungen. Folglich ist der reproduktive Lebensabschnitt der Frau eine Domäne der Hormontherapie. Dabei gilt es, Beeinträchtigungen des Zyklusgeschehens durch endokrinologische, metabolische und externe Störfaktoren sowie organische Veränderungen am Genitale zu erkennen und in die Therapieentscheidung einzubeziehen. Weiterhin sind die persönlichen Vorstellungen der Patientin zu berücksichtigen. Die Hormontherapie der Zyklusstörungen zielt in erster Linie auf die Wirkung der Therapeutika am Endometrium ab. Jedoch sind auch die Modulation der übergeordneten Regulationsmechanismen Bestandteil des Therapiekonzepts, wie dies beim Einsatz der GnRH-Analoga deutlich wird. Im folgenden Beitrag werden verschiedene hormonelle Behandlungsmöglichkeiten erörtert; die Darstellung orientiert sich v. a. an den klinischen Blutungsmustern. Auf die seltenen Anwendungsmöglichkeiten einer Hormontherapie vor und nach der Reproduktionsphase wird ebenfalls eingegangen.
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  • 3
    ISSN: 1432-0584
    Keywords: Key words Hodgkin's disease ; Non-Hodgkin's lymphoma ; Salvage therapy ; ASHAP protocol ; High-dose therapy ; Autologous stem cell transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: This study was performed to examine the efficacy and toxicity of the combination of adriamycin (ADR), methylprednisolone (solumedrol), cytarabine (Ara-C), and cisplatin (CDDP) in patients with recurrent and refractory malignant lymphomas. Patients and methods: Sixty-five patients with Hodgkin's disease (HD) (n=14) or non-Hodgkin's lymphomas (NHL) (n=51) were enrolled in the study. The ASHAP therapy consisted of ADR (40 mg/m2 by continuous infusion (CI) over 96 h), methylprednisolone (500 mg i.v., days 1–5), Ara-C (2 g/m2 as a 2-h infusion on day 5), and CDDP (100 mg/m2 by CI over 96 h). Results: Twenty-five patients (38%) achieved complete remission (CR) and 20 (31%) were taken into partial remission (PR) for an overall response rate of 69%. Thirty-two patients with CR or PR following ASHAP underwent high-dose therapy (HDT) with subsequent hematopoietic stem cell transplantation. After a median follow-up of 52 months, 13 patients are in continuous CR (CCR), the 3-year event-free survival (EFS) was 30% for responders and 21% for all patients. The median overall survival (OS) was 12 months (range 0–70 months), and the OS rate after 3 years was 32%. Unfavorable prognostic factors for EFS and OS by univariate analysis were an elevated value of the serum lactate dehydrogenase and refractory lymphoma. The most frequently observed side effects following ASHAP were leukocytopenia and thrombocytopenia of World Health Organization (WHO) grades III/IV in approximately 80% of all courses. Non-hematological toxicities such as gastrointestinal side effects, infections, mucositis, renal and neurotoxicity occurred more rarely and reached WHO grades III/IV only occasionally. No treatment-related mortality with ASHAP was observed. Conclusions: ASHAP is an effective and moderately toxic salvage therapy for patients with recurrent or refractory HD and NHL. The results in patients responding to ASHAP and afterwards undergoing HDT with stem cell support are comparable with other established protocols and indicate an improvement in survival if HDT is carried out as intensification.
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  • 4
    ISSN: 1434-0879
    Keywords: Key words Renal tubular transport ; p-Aminohippurate ; Stimulation ; Renal cell carcinoma ; Dexamethasone ; Triiodothyronine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This paper is the third of a long-term planned series of papers dealing with ex vivo investigations of drug transport in human kidney. The aims of this study are (a) to investigate whether or not human renal cell carcinoma (RCC) can actively accumulate p-aminohippurate (PAH) and (b) to test the response of RCC on dexamethasone or triiodothyronine (T3) using tissue slices ex vivo. By this approach, the accumulation capacity of RCC should be stimulated as a prerequisite for an increased uptake of anti-tumour drugs. Tissue slices of RCC samples of 30 patients were incubated for 24 h in Williams medium E containing 0.01–50 μM dexamethasone or T3. Thereafter, slices were placed in PAH-containing Cross–Taggart medium, and PAH uptake into kidney tissue was measured for 2h under standardised conditions as described previously. In intact human renal cortical slices, PAH uptake capacity, expressed as slice to medium ratio (Q S/M), was about 2.8 ± 0.16 after 24 h of incubation and increased significantly in dexamethasone-containing medium in a concentration-dependent manner, up to ∼150%, whereas T3 did not influence PAH accumulation. On the other hand, in RCC the PAH accumulation capacity was completely abolished (Q S/M∼1). However, after administration of dexamethasone, the accumulated amount of PAH increased significantly in RCC tissue in a concentration-dependent manner, up to ∼190%. T3 was without effect in RCC, too. Surprisingly, the dexamethasone-mediated stimulation could be differentiated into responders and non-responders, with maximal effects at different concentrations for each patient. Nevertheless, the maximal transport rates remained low in RCC, even under hormone influence. In conclusion, a moderate stimulation of tubular transport capacity can be shown ex vivo in human RCC. This phenomenon is only of a relatively low degree compared with intact renal tissue. However, in principle, the response of RCC on dexamethasone could form a basis for further therapeutic strategies to overcome multi-drug resistance in RCC patients. For this purpose, additional experiments analysing the expression of transporters of the ABC cassette-type are in progress.
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  • 5
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Retrograde Kavitätenaufbereitung ; Ultraschallpräparation ; Mikrokopfpräparation ; Apikaler Verschluss ; Key words Retrofilling preparation ; Ultrasonic preparation ; Mikrohead preparation ; Apical seal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The purpose of this in vitro and in vivo study was to compare the quality of retrograde cavities and retrofilling using various retrograde techniques (microhead, ultrasonic). The quality was evaluated on the basis of dye penetration, macroscopic control, and both light microscopic and scanning electron microscopic examination. A total of 40 extracted teeth with a single canal were analyzed. The clinical result was evaluated in 25 patients with root-filled teeth and the indication of apicoectomy. Statistical analysis indicated that the seal was significantly better with ultrasonically prepared cavities than with microhead preparation. Retrofillings prepared ultrasonically also showed significantly fewer peripheral fissures. The scanning electron microscopic examination, however, demonstrated peripheral fissures in all filled teeth. Furthermore, the cavities prepared ultrasonically had a smoother surface and a lower smear layer. This preparation produced a more pleasing final result. The advantages of better accessibility during the preparation, namely, more precise preparation of the retrofilling and only minor substance loss were confirmed clinically. Using the ultrasonic equipment, absolutely sterile working conditions are present.
    Notes: Die Qualität retrograder Kavitäten und der applizierten Füllungen wurde vergleichend nach herkömmlicher Präparation mit dem Mikrokopf und nach Aufbereitung mittels Ultraschall in vitro untersucht. Dies geschah anhand von Penetrationsversuchen, makroskopischen Kontrollen mit einer Lupe (2,5fach), lichtmikroskopischen sowie REM-Untersuchungen. Die Untersuchungen wurden an 40 extrahierten, einwurzligen, einkanaligen Zähnen und an 25 Patienten mit wurzelgefüllten Zähnen und der Indikation zur Wurzelspitzenresektion vorgenommen. Die statistische Untersuchung zeigte eine signifikant geringere Farbstoffpenetration nach apikal bei der Ultraschall- im Vergleich zur Mikrokopfgruppe. Die Untersuchung mittels Lupe bestätigte eine geringere Spaltbildung bei den mit Ultraschall präparierten Kavitäten, obwohl dieser Unterschied rasterelektronenmikroskopisch nicht mit statistischer Signifikanz zu verifizieren war. Insgesamt wiesen die mit Ultraschall präparierten Kavitäten eine glattere Oberfläche mit weniger Dentinsplittern auf und ließen eine grazilere Gestaltung zu. Die erwarteten Vorteile der besseren Zugänglichkeit während der Präparation und der exakteren retrograden Aufbereitung des Kanals bei gleichzeitiger Substanzschonung bestätigten sich beim klinischen Einsatz am Patienten. Dabei gewährleistet das von uns eingesetzte Ultraschallgerät den Vorteil einer absolut sterilen Arbeitsweise während der Präparation.
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  • 6
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Odontogene Infektionen ; Anaerobe Keime ; Penizillinresistenz ; Key words ; Odontogenic infections ; Anaerobic bacteria ; Resistance to penicillin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Out of 440 dentogenic pyogenic infections, 171 exclusively caused by anaerobes were investigated to understand the importance of anaerobic bacteria in dental pyogenic processes better. Grampositive anaerobic bacteria dominated. The predominant grampositive isolates in monoinfections were Peptostreptococci and in the case of mixed infections, strains of the genus Eubacterium. Strains of Prevotella and Porphyromonas dominated the gramnegative anaerobic spectra. The resistance to penicillin was very low. Altogether, only one strain of Prevotella oris and one strain of Prevotella oralis showed resistance to penicillin.
    Notes: Zum besseren Verständnis der Bedeutung einzelner anaerober Spezies bei odontogenen pyogenen Infektionen wurden von 440 Fällen jene 171 ausgesucht, bei denen ausschließlich anaerobe Keime mikrobiologisch nachgewiesen werden konnten. Hierbei dominierten grampositive Spezies im Vergleich zu gramnegativen. Bei anaeroben Mischinfektionen überwogen unter den grampositiven Keimen Stämme des Genus Eubacterium, bei Monoinfektionen hingegen Stämme des Genus Peptostreptococcus. Unter den gramnegativen Anaerobiern wurden am häufigsten Prevotella- und Porphyromonasarten isoliert. Bei den 171 odontogenen Infektionen wurde eine sehr niedrige Quote penizillinresistenter Stämme beobachtet. Nur 2 Stämme von Prevotella oris bzw. Prevotella oralis waren gegenüber Penizillin resistent.
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  • 7
    ISSN: 1077-3118
    Source: AIP Digital Archive
    Topics: Physics
    Notes: By employing high-temperature superconducting quantum interference device (SQUID) magnetometers, we have assembled a second-order gradiometer for magnetocardiography (MCG) in unshielded environment. With this high-temperature superconductor (HTS) SQUID system, we demonstrated its diagnostic relevance for MCG in terms of signal-to-noise ratio, spatial resolution, frequency bandwidth, rejection of environmental disturbances, and long-term stability. The electronically balanced gradiometer consists of three HTS radio-frequency SQUIDs with superconducting coplanar resonators, mounted in axial gradiometric arrangement with a baseline of 7.5 cm. The system achieves a common mode rejection for axial homogeneous fields of about 104 without any mechanical balancing, and a white noise about 130 fT/(square root of)Hz at 77 K, with an 8×8 mm2 flux pickup area. MCG maps above volunteers' chests have been recorded in unshielded environment in a bandwidth of about 130 Hz. We showed the influence of several notch filters (suppressing the power line frequency) on the quality of the MCG signals. © 2000 American Institute of Physics.
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  • 8
    ISSN: 1089-7550
    Source: AIP Digital Archive
    Topics: Physics
    Notes: This article describes three planar layouts of superconducting multiturn flux transformers integrated with a coplanar resonator for radio frequency (rf) superconducting quantum interference device (SQUID) magnetometers. The best magnetic field noise values of 22 and 11.5 fT/Hz1/2 in the white noise regime were obtained for the layout with two input coils and the layout with the labyrinth resonator, respectively. Excess low-frequency noise (about 200 fT/Hz1/2 at 10 Hz) was present. Computer simulation showed that the loss in this trilayer system was dominated by the high loss tangent of the dielectric film used for the separation of the upper and lower superconducting films. The rf coupling coefficient krf between the resonator and the flip-chip-coupled SQUID was also estimated. The values krf2(approximate)14×10−3 obtained for the layout with two input coils, and krf2(approximate)45×10−3 for the layout with the labyrinth resonator were considerably higher than the typical value of krf2(approximate)7×10−3 for the single-layer coplanar resonator. These high coupling coefficients have compensated the somewhat degraded unloaded quality factor of the resonator, thus securing the optimum operation of the rf SQUID. © 2000 American Institute of Physics.
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