Biomedical subjects

Barbara Schneider

Publications and source records attributed to Barbara Schneider.

46 records · Page 3Linked to original sources

PubMed2003

High prevalence of elevated clotting factor VIII in chronic thromboembolic pulmonary hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) is an enigmatic disorder lacking signs, symptoms and classical risk factors for venous thromboembolism. The objective of the prospective case controlled study, carried out at the Pulmonary Hypertension Unit, University Hospital Vienna, Austria, was to investigate whether plasma FVIII is elevated in CTEPH patients. The study examined 122 consecutive patients diagnosed with CTEPH. Plasma FVIII was measured and compared with plasma FVIII of healthy controls (n = 82) and of patients with nonthromboembolic pulmonary arterial hypertension (PAH, n = 88). Results show that CTEPH patients had higher FVIII levels than controls (233 +/- 83IU/dl versus 123 +/- 40IU/dl, p < 0.0001) and PAH patients (158 +/- 61IU/dl, p < 0.0001). Plasma FVIII one year after surgery (212 +/- 94IU/dl) was statistically unchanged compared with preoperative values (FVIII: 226 +/- 88IU/dl, n = 25). FVIII > 230IU/dl was more prevalent in CTEPH patients (41%) than in controls (5%, p < 0.0001) and PAH patients (22%, p = 0.022). We can conclude that elevated plasma FVIII is the first prothrombotic factor identified in a large proportion of CTEPH patients.

Adult↗

PubMed2003

Increased intramyocellular lipid concentration identifies impaired glucose metabolism in women with previous gestational diabetes.

Women with previous gestational diabetes (pGDM) are frequently insulin-resistant, which could relate to intramyocellular lipid content (IMCL). IMCL were measured with (1)H nuclear magnetic resonance spectroscopy in soleus (IMCL-S) and tibialis-anterior muscles (IMCL-T) of 39 pGDM (32 +/- 2 years, waist-to-hip ratio 0.81 +/- 0.01) and 22 women with normal glucose tolerance (NGT; 31 +/- 1 years, 0.76 +/- 0.02) at 4-6 months after delivery. Body fat mass (BFM) was assessed from bioimpedance analysis, insulin sensitivity index (S(I)), and glucose effectiveness (S(G)) from insulin-modified frequently sampled glucose tolerance tests. pGDM exhibited 45% increased BFM, 35% reduced S(I) and S(G) (P < 0.05), and 40% (P < 0.05) and 55% (P < 0.005) higher IMCL-S and IMCL-T, respectively. IMCL related to body fat (BFM P < 0.005, leptin P < 0.03), but only IMCL-T correlated (P < 0.03) with S(I) and glucose tolerance index independent of BMI. Insulin-resistant pGDM (n = 17) had higher IMCL-S (+66%) and IMCL-T (+86%) than NGT and insulin-sensitive pGDM (+28%). IMCL were also higher (P < 0.005, P = 0.05) in insulin-sensitive pGDM requiring insulin treatment during pregnancy and inversely related to the gestational week of GDM diagnosis. Thus, IMCL-T reflects insulin sensitivity, whereas IMCL-S relates to obesity. IMCL could serve as an additional parameter of increased diabetes risk because it identifies insulin-resistant pGDM and those who were diagnosed earlier and/or required insulin during pregnancy.

Adult↗

PubMed2002

Lactose intolerance: a risk factor for reduced bone mineral density and vertebral fractures?

BACKGROUND: The purpose of the present study was to determine differences, if any, in bone mineral density, the risk of fracture, and clinical behavior in patients with lactose intolerance investigated by hydrogen breath test. METHODS: The study population (n = 218; age, mean +/- SD, 58.2 +/- 11.5 years) consisted of 103 healthy individuals negative hydrogen breath test (Delta H2 0-20 ppm; group I), and 115 individuals with evidence of lactose intolerance according to the hydrogen breath test (Delta H2 > 20 ppm), of whom 40 individuals had test results of 20 ppm < Delta H2 < 59 ppm (group II). The remaining 75 individuals were strongly positive on the hydrogen breath test (Delta H2 > 60 ppm; group III). The entire study population was measured for bone mineral density in the nondominant forearm and in the vertebra (quantitative computed tomography [qCT]). Radiographs of the spine were studied for fractures. RESULTS: In healthy individuals, bone mineral density in the vertebra assessed by qCT (mean +/- SD, 111.2 +/- 31 mg/cc) did not significantly differ between those with mild (qCT, mean +/- SD, 109.8 +/- 35 mg/cc) and those with severe (qCT, mean +/- SD, 107.7 +/- 36 mg/cc) lactose intolerance. Lactose-intolerant individuals had more vertebral fractures per patient when compared with those with mild lactose intolerance or controls ( P < 0.05). Considering vertebral and self-reported non-vertebral fractures, no statistically significant differences were found. In the entire group, the overall occurrences of fracture in the presence of lactose intolerance and in controls were comparable after correction for age and body mass index (BMI). CONCLUSIONS: Individuals with lactose intolerance verified by the hydrogen breath test appear not to be at risk for accelerated bone loss. Nevertheless, a relationship between vertebral fractures and an apparent lactose intolerance cannot be excluded, as a few individuals with severe lactose intolerance had a large number of vertebral fractures.

Absorptiometry, Photon↗

PubMed2002

Problems, interventions and complications in long-term oral anticoagulation therapy.

BACKGROUND: If problems, interventions and complications occurring during oral anticoagulation (OAC) are related with age, indication for OAC, hypertension, diabetes, previous stroke, and number of additional drugs. MATERIAL AND METHODS: Clinical characteristics, additional drugs, problems, interventions and complications of outpatients whose OAC was controlled between two years were registered. Potential gastrointestinal and urologic bleeding sources were eliminated prior to initiation of OAC. Five-hundred-seventy-nine patients (mean age 65 years, 44% female) were observed for 590 patient-years. RESULTS: Medical problems occurred in 352/100 patient-years (% p-y), organisational problems in 276% p-y, interventions in 636% p-y and complications in 13.8% p-y. Patients >65 years had less organisational problems (254 vs. 302% p-y, p = 0.0092) and interventions (574 vs. 713% p-y, p = 0.0003) than patients < or =65 years. The 35 patients with heart valve prosthesis had more life-threatening and fatal complications (12% p-y) than the 360 patients with atrial fibrillation (1.0% p-y), 128 patients with venous thromboembolism or 56 patients with other indications (0.0% p-y, p = 0.0024). Problems, interventions and complications were not related with hypertension (n = 297), diabetes (n = 97) or previous stroke (n = 90). Patients with >3 additional drugs/day had a higher complication rate than patients with < or =3 drugs/day (21 vs. 8.7% p-y, p = 0.0238). Patients with complications had more headache (27 vs. 20% p-y, p = 0.0036), chest pain (45 vs. 27% p-y, p = 0.0150), abdominal pain (25 vs. 15% p-y, p = 0.0350) and pain in the limbs (55 vs. 42% p-y, p = 0.0044) than patients without complications. CONCLUSIONS: By careful monitoring, eliminating potential bleeding sources, treating pain adequately and minimizing additional drugs the complications of OAC can be kept low.

Aged↗

PubMed2002

[Difficulties in the evaluation of depressive symptoms in patients with dementia].

Depressive symptoms are often found in dementia (up to 86 %). Therefore, adequate treatment is necessary. Depressive symptoms appear significantly more often in vascular dementia than in dementia in Alzheimer's disease, but severity and profile of depressive symptomatology are independent of the etiology of dementia. The aim of this review is to help clinicians to select appropriate psychometric instruments to identify and measure depressive symptomatology in dementia. Frequently used scales are described, e.g. the Dementia Mood Assessment Scale and the Cornell Scale for Depression in Dementia - specific scales developed for rating severity of depression in dementia - and the Geriatric Depression Screening Scale. Methodological problems and limitations of psychopathological assessment in dementia caused by restriction of self-report, information gathered by collateral sources, manifestations of age and interference of somatic symptoms are discussed.

Aged↗

PubMed2002

Chest pain in hospitalized patients: cause-specific and gender-specific differences.

OBJECTIVES: The aim of this prospective cardiological-linguistic study was to assess cause-specific and gender-specific differences in the reported symptoms and description of chest pain. METHODS: In patients hospitalized because of chest pain, location, radiation, quality of chest pain, pain precipitating and relieving factors, and additional symptoms were assessed. The cause of chest pain was assessed as either coronary or noncoronary. Patients' pain descriptions were taped for linguistic narrative analysis and transcribed according to ethnomethodological standards. RESULTS: The cause of chest pain was assessed as coronary in 43 (18 females, 25 males, mean age 63 years) and noncoronary in 49 (30 females, 19 males, mean age 62 years) patients. Only few cause-related differences in the symptoms were found. In patients with a coronary cause, the location of chest pain was more often retrosternal (93% vs. 71%, p = 0.0078), in the right arm (23% vs. 6%, p = 0.0186), and less often in the back (28% vs. 51%, p = 0.0241) than in patients with a noncoronary cause of chest pain. Coronary patients more often had a pressing pain quality (81% vs. 61%, p = 0.034), less often pain precipitated by respiration (16% vs. 45%, p = 0.0032), and vertigo (21% vs. 43%, p = 0.0252) than noncoronary patients. The women were older than the men (mean age 65.6 vs. 59.0 years, p = 0.01). Women with a coronary cause more often had a gradual pain onset (78% vs. 48%, p = 0.0488) and relief by rest (78% vs. 40%, p = 0.0139) than men with a coronary cause. Linguistic analysis revealed that men presented themselves as interested in the cause of the chest pain, observing and describing pain concretely, whereas women presented themselves as prevailingly pain enduring, describing their pain diffusely. CONCLUSIONS: Cause-related and gender-related differences in symptoms are too unspecific to distinguish between coronary and noncoronary causes. The strong gender differences in self-presentation and description of chest pain might be an explanation for underdiagnosis and undertreatment of women with coronary heart disease and should be considered when taking the clinical history of a female patient.

Aged↗

PubMed2002

The immunophenotype of 325 adult acute leukemias: relationship to morphologic and molecular classification and proposal for a minimal screening program highly predictive for lineage discrimination.

Bone marrow cells of 325 adults with acute leukemia were immunophenotyped using a panel of monoclonal antibodies proposed by the European Group for the Immunological Characterization of Leukemias (EGIL). Of these, 97.2% could be assigned clearly to myeloid or lymphoid lineage (254 acute myeloid leukemias [AMLs], 48 B-cell lineage acute lymphoblastic leukemias [ALLs], 14 T-cell lineage ALLs), 1.8% as biphenotypic, and less than 1% as undifferentiated. Immunologic subtyping of ALLs revealed an association between early precursor phenotypes and coexpression of myeloid antigens, particularly CD15/CD65s coexpression and pre-pre-B cell-specific phenotypes and genotypes. The common ALL phenotype was associated with BCR-ABL translocation. Among AMLs, CD2 coexpression was almost exclusively restricted to French-American-British subtypes M3 variant and M4Eo and related molecular aberrations. The most valuable markers to differentiate between myeloperoxidase-negative AML subtypes M0 and ALLs were CD13, CD33, and CD117, typical of M0, and intracytoplasmic CD79a, intracytoplasmic CD3, CD10, and CD2, typical of B cell- or T cell-lineage ALL. Our results confirm excellent practicability of the EGIL proposalfor immunologic classification of acute leukemias. For myeloperoxidase-negative AMLs, we suggest a scoring system based on markers most valuable to distinguish between AML-M0 and ALLs.

Acute Disease↗

PubMed2002

Discovery of decomposed and mummified corpses in the domestic setting--a marker of social isolation?

Mass media reports attribute the occurrence of decomposed or mummified corpses in a domestic setting mainly to an increasing social isolation of elderly people. Not much is known about the demographic and medical conditions under which individuals are found months or even years after death in their homes. For this study, autopsy reports of individuals found dead and mummified or decomposed between 1993 and 1997 with those from 1963 to 1967 were retrospectively analyzed. Between 1993 and 1997, a total number of 320 individuals were found decomposed at home compared to 412 such cases between 1963 and 1967. The proportion of individuals older than 64 years was significantly higher during the 1990s study period. Furthermore, the proportion of deaths attributable to natural causes was significantly lower during the 1990s, whereas the rate of suicides was nearly three times higher.

Adult↗

PubMedDate not supplied

Diabetic atrial fibrillation patients: mortality and risk for stroke or embolism during a 10-year follow-up.

BACKGROUND: To compare in atrial fibrillation patients with and without diabetes, (1) baseline characteristics, (2) additional risk factors for stroke or peripheric or visceral embolism (hypertension, previous stroke, age >75 years), (3) mortality, (4) stroke or embolism, and (5) oral anticoagulation in the year 2000. METHODS: Included were 409 outpatients with nonrheumatic atrial fibrillation (62 +/- 12 years, 36% female). All underwent transthoracic and transesophageal echocardiography. Patients with thrombi received oral anticoagulation; patients without thrombi received aspirin until the follow-up in 1995; afterwards, oral anticoagulation according to risk factors for stroke or embolism was recommended. Patients were contacted during the year 2000. RESULTS: Type 2 diabetes was diagnosed in 73 patients (18%). Sixteen (22%) diabetic and 169 (50%) nondiabetic patients had no other risk factors for stroke or embolism (p < 0.0001). Diabetic patients were older, had more frequent heart failure, hypertension, myocardial infarction, left ventricular dysfunction, valvular abnormalities, left atrial or appendage thrombi, larger left atria, and left atrial appendages than nondiabetic patients. Mean follow-up was 115 months. Diabetic patients had a higher mortality than nondiabetic patients (7%/year versus 4%/year, p < 0.0001). The rate of stroke or embolism of diabetic (3%/year) and nondiabetic patients (2%/year) was similar. The rate of oral anticoagulation was higher in diabetic than in nondiabetic patients (p = 0.0066). CONCLUSIONS: Diabetic patients with atrial fibrillation frequently have additional risk factors for stroke or embolism, and thus should be treated with oral anticoagulation. Whether in the rare cases of atrial fibrillation, in whom diabetes is the only clinical risk factor, oral anticoagulation is indicated cannot be answered by the present study.

Aged↗

PubMedDate not supplied

Arterial embolization of unresectable hepatocellular carcinoma with use of microspheres, lipiodol, and cyanoacrylate.

We performed a retrospective analysis of 46 patients with histologically confirmed hepatocellular carcinoma (HCC) who were treated with transarterial embolization (TAE) of the hepatic arteries. To induce permanent embolization, microspheres (Embosphere; 100 to 700 micron) and a mixture of ethiodized oil (Lipiodol Ultrafluide) with cyanoacrylate (Glubran) was injected. A total of 106 TAE procedures were performed. Cumulative survival rates were calculated. No patient died during embolization or within the first 24 hours. Severe procedure-related complications were observed in 2 patients. At the time of analysis, 38 of 46 patients were alive. The 180-, 360-, 520-, and 700-day cumulative survival rates for the total study population were 80.6%, 70.7%, 70.7%, and 47.1%, respectively, with a median survival of 666 days. TAE with the use of microspheres and Lipiodol and cyanoacrylate for unresectable HCC is a feasible treatment modality. Bland embolization with the use of microspheres can be used in patients for whom chemoembolization is not desired.

Acrylic Resins↗