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Biomedical subjects

C Mueller

Publications and source records attributed to C Mueller.

At least 19 recordsLinked to original sources
PubMed2006

Randomised phase II study comparing topotecan/carboplatin administration for 5 versus 3 days in the treatment of extensive-stage small-cell lung cancer.

BACKGROUND: Topotecan is an active drug in small-cell lung cancer (SCLC). In our previous study, a combination of topotecan with cisplatin was associated with a median overall survival of 7.6 or 8.7 months, depending on the duration of treatment. We have replaced cisplatin by carboplatin in this trial, with the objective of creating a more convenient schedule for our patients. Furthermore, we have also compared the standard 5-day schedule with an experimental 3-day schedule. PATIENTS AND METHODS: A total of 100 patients with metastatic disease were included. Patients were randomly assigned to receive either topotecan 0.75 mg/m2, days 1-5, and carboplatin AUC 5, day 5 (arm A) or topotecan 1.25 mg/m2, days 1-3, and carboplatin AUC 5, day 3 (arm B). Six cycles were given at a 3-week interval. RESULTS: A total of 91 patients were assessable for response. The response during therapy was 86.9% in arm A and 80.0% in arm B. Median survival in arm A was 11.8 months and in arm B 11.6 months (P=0.37). CONCLUSIONS: The combination of topotecan and carboplatin is active in extensive-disease SCLC. Toxicity and median survival were comparable in both arms. Three days of treatment seems to be similar to the 5-day regimen.

Adolescent↗
PubMed2006

The use of B-type natriuretic peptide in the management of patients with diabetes and acute dyspnoea.

AIMS/HYPOTHESIS: The aim of this study was to determine the impact of measurement of B-type natriuretic peptide (BNP) levels on the management of patients with diabetes presenting with acute dyspnoea. METHODS: This study evaluated the subgroup of 103 patients with diabetes included in the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation (BASEL) study (n=452). Patients were randomly assigned to a diagnostic strategy with (n=47, BNP group) or without (n=56, control group) the use of BNP levels assessed by a rapid bedside assay. Time to discharge and total cost of treatment were recorded as the primary endpoints. RESULTS: Although similar with regard to age and sex, patients with diabetes more often had pre-existing cardiovascular and renal disease and heart failure as the cause of acute dyspnoea compared with patients without diabetes. In addition, medical and economic outcomes were worse in patients with diabetes. The use of BNP levels significantly reduced time to discharge (median 9 days [interquartile range (IQR) 2-16] in the BNP group vs 13 days [IQR 8-22] in the control group; p=0.016). At 30 days, the diabetic patients in the BNP group had spent significantly fewer days in hospital compared with the diabetic patients in the control group (9 days [IQR 2-19] vs 16 days [IQR 8-24], respectively; p=0.008). Total treatment costs at 30 days were US$5,705 (IQR 2,285-9,137) in the BNP group and US$7,420 (IQR 4,194-11,966) in the control group (p=0.036). CONCLUSIONS/INTERPRETATION: The results of this study indicate that measurement of BNP levels improves the management of patients with diabetes presenting with acute dyspnoea.

Acute Disease↗
PubMed2006

Prevention of contrast-induced nephropathy with volume supplementation.

Volume supplementation remains the cornerstone for the prevention of contrast-induced nephropathy (CIN). Current evidence suggests that the combination of intravenous and oral volume supplementation effectively prevents CIN in low- and moderate-risk patients. Normal isotonic (0.9%) saline should be started 12 h before (or at least in the morning of) the contrast procedure with an infusion rate of 1 ml/kg of body weight per hour and be continued for 24 h. In addition, patients should be encouraged to drink plenty of fluids (tea, mineral water). The use of bicarbonate infusion may allow shorter volume supplementation periods. Combined intravenous and oral volume supplementation protocols feasible for outpatients who limit the intravenous infusion to the contrast procedure are under investigation. Future studies are necessary to define further details regarding the optimal use of volume supplementation.

Contrast Media↗
PubMed2006

Pulmonary perfusion in acute pulmonary embolism: agreement of MRI and SPECT for lobar, segmental and subsegmental perfusion defects.

PURPOSE: To assess prospectively the agreement of magnetic resonance (MR) pulmonary perfusion with single-photon emission computed tomography (SPECT) perfusion for perfusion defects down to the subsegmental level in patients with suspected pulmonary embolism (PE). MATERIAL AND METHODS: In 41 patients with suspected PE, contrast-enhanced MR pulmonary perfusion (3D-FLASH, TR/TE 1.6/0.6 ms) was compared to SPECT perfusion on a per-examination basis as well as at the lobar, segmental, and subsegmental level. RESULTS: The MRI protocol was completed in all patients, and mean examination time was 3 min 56 s. MR perfusion showed a very high agreement with SPECT (kappa value per examination 0.98, and 0.98, 0.83, and 0.69 for lobar, segmental, and subsegmental perfusion defects, respectively). Of 15 patients with PE, MR perfusion detected 14 cases. CONCLUSION: The very high agreement of MR perfusion with SPECT perfusion enables the detection of subtle findings in suspected PE.

Acute Disease↗
PubMed2006

Right bundle branch block and long-term mortality in patients with acute congestive heart failure.

OBJECTIVES: Risk stratification in acute congestive heart failure (ACHF) is poorly defined. The aim of the present study was to assess the impact of right bundle brunch block (RBBB) on long-term mortality in patients presenting with ACHF. METHODS AND RESULTS: The initial 12-lead electrocardiogram was analysed for RBBB in 192 consecutive patients presenting with ACHF to the emergency department. The primary endpoint was all-cause mortality during 720-day follow-up. This study included an elderly cohort (mean age 74 years) of ACHF patients. RBBB was present in 27 patients (14%). Age, sex, B-type natriuretic peptide levels and initial management were similar in patients with RBBB when compared with patients without RBBB. However, patients with RBBB more often had pulmonary comorbidity. A total of 84 patients died during follow-up. Kaplan-Meier analysis revealed that mortality at 720 days was significantly higher in patients with RBBB when compared with patients without RBBB (63% vs. 39%, P = 0.004). In Cox proportional hazard analysis, RBBB was associated with a two-fold increase in mortality (hazard ratio 2.18, 95% CI 1.26-3.66; P = 0.003). This association persisted after adjustment for age and comorbidity. CONCLUSIONS: RBBB is a powerful predictor of mortality in patients with ACHF. Early identification of this high-risk group may help to offer tailored treatment in order to improve outcome.

Aged↗
PubMed2006

Brain imaging in psychiatry - a study of 435 psychiatric in-patients at a university clinic.

OBJECTIVE: The use of brain imaging in psychiatry still lacks clear guidelines. We investigated the referral practice, outcome and predictive factors of neuroimaging in a Swiss psychiatric university clinic. METHOD: Medical files were reviewed retrospectively for 435 consecutively hospitalized patients who were subjected to neuroimaging. The association between the sociodemographic and clinical characteristics and the scan results was analyzed using bivariate and multivariate analyses. RESULTS: Of overall examinations, 69.4% were normal, 16.3% equivocal and 14.3% abnormal; 2.9% of scans ordered for screening only showed pathology. Neurologic signs and advanced age of patients predicted abnormal scan findings, whereas other variables such as EEG results showed no significant association. CONCLUSION: Our results support the need for clear indications for using brain imaging in psychiatric in-patients. Focal neurologic signs and advanced patient age seems to predict abnormal scan results. However, these criteria are not sufficiently sensitive to predict significant scan findings in all patients.

Adult↗
PubMed2005

Coronary artery disease and outcome in acute congestive heart failure.

OBJECTIVES: To quantify the prognostic impact of coronary artery disease (CAD) on patients with acute heart failure (HF). DESIGN: Prospective cohort study of 217 consecutive patients presenting with acute HF to the emergency department. Treatment, hospitalisation, the use of revascularisation procedures, and survival were observed during follow up of up to three years. RESULTS: CAD was present in 153 patients (71%). Patients with and without CAD were similar with respect to age and sex. Although adequate HF treatment was initiated more rapidly among patients with CAD, their initial outcomes including hospitalisation rate, time to discharge, and total treatment cost were significantly worse. Moreover, despite higher use of angiotensin converting enzyme inhibitors and beta blockers during follow up, patients with CAD had a significantly lower survival rate. Cumulative survival at 720 days was 48.7% of patients with CAD as compared with 76.4% of patients without CAD (p = 0.0004). In Cox regression analysis the presence of CAD increased the risk of death by more than 250% (hazard ratio 2.57, 95% confidence interval 1.50 to 4.39, p = 0.001). This strong association persisted after multivariate adjustments. The use of coronary angiography and coronary revascularisation procedures was low, both at initial presentation and during follow up. CONCLUSION: CAD is a strong and independent predictor of mortality among patients with acute HF. Whether, for example, less restrictive use of revascularisation procedures in this elderly HF population can improve the outcome for patients with CAD warrants further study.

Acute Disease↗
PubMed2005

Randomized phase II study comparing topotecan/cisplatin administration for 5 days versus 3 days in the treatment of extensive stage small cell lung cancer (SCLC).

BACKGROUND: Topotecan (T) is an active drug in SCLC. A combination of topotecan with cisplatin (DDP) was suggested to be highly synergistic. This phase II trial was initiated to assess the activity of T/DDP in chemotherapy-naive patients suffering from extensive disease small cell lung cancer (SCLC) and to compare the conventional 5-day regime with an experimental 3-day schedule. PATIENTS AND METHODS: A total of 86 patients were included. Patients were randomized to receive either T 1.0 mg/m2 d 1-5 and DDP 75 mg/m2 d 5 (arm A) or T 1.5 mg/m2 d 1-3 and DDP 75 mg/m2 d 3 (arm B). Six cycles were given at a 3-week interval. RESULTS: Data of 84 evaluable patients (67 males and 17 females) were analysed. All patients had metastatic disease. The best response rate was 61.9% in arm A and 59.5% in arm B. Median overall survival was 8.7 months in arm A and 7.6 months in arm B (p=0.6809). CONCLUSIONS: Combination of T and DDP is active in ED SCLC. Toxicity and median survival were comparable in both arms. Three days treatment seems to be similar to the 5 days regime.

Adult↗
PubMed2005

Use of pro-atrial natriuretic peptide in the detection of myocardial ischaemia.

BACKGROUND: Because of its unique storage and release mechanisms allowing a very rapid response to haemodynamic changes, pro-atrial natriuretic peptide (proANP) may be a helpful cardiac marker in the detection of myocardial ischaemia. MATERIALS AND METHODS: A total of 260 consecutive patients with suspected myocardial ischaemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography (SPECT) were enrolled. Levels of plasma proANP were determined before and 1 min after maximal exercise. RESULTS: Baseline proANP and peak exercise proANP were significantly higher in patients with myocardial ischaemia as compared to those without ischaemia (median, 82 [IQR, 57-112] vs. 67 [IQR, 50-106] pmol L(-1), P = 0.007; and 89 [IQR, 65-121] vs. 78 [IQR, 57-116] pmol L(-1), P = 0.033). The area under the ROC curve for baseline proANP was 0.597 (95% CI, 0.527-0.667), as compared to 0.577 (95% CI, 0.507-0.648) for peak exercise proANP. Exercise-induced changes in proANP were similar in patients with and without myocardial ischaemia, and showed no correlation with the extent of myocardial ischaemia. CONCLUSIONS: Baseline proANP and peak exercise proANP are significantly higher in patients with myocardial ischaemia. However, because of considerable overlap in proANP levels between patients with and without myocardial ischaemia, neither measurement seems helpful in the detection of myocardial ischaemia in clinical practice.

Aged↗
PubMed2005

The use of B-type natriuretic peptide in the management of elderly patients with acute dyspnoea.

OBJECTIVES: The aim of this study was to define the impact of B-type natriuretic peptide (BNP) levels on the management of elderly patients presenting with acute dyspnoea. DESIGN: We performed a prospective randomized controlled study in 269 elderly patients at least 70 years of age included in the B-type natriuretic peptide for Acute Shortness of breath Evaluation (BASEL) study. Patients were randomly assigned to a diagnostic strategy with (n = 136, BNP group) or without (n = 133, control group) the use of BNP levels provided by a rapid bedside assay. The time to discharge and the total cost of treatment were the primary end-points. RESULTS: Amongst elderly patients, baseline characteristics were well matched between both groups. The use of BNP levels significantly reduced the time to discharge (median 9.0 in the BNP group versus 11.0 days in the control group; P = 0.029). Total treatment cost was $5381 (95% CI, 4482-6280) in the BNP group when compared with $7411 (95% CI, 6180-8642; P = 0.009) in the control group. In addition, a significant reduction in 30-day mortality was observed (9% in the BNP group versus 17% in the control group; P = 0.039). CONCLUSIONS: Used in conjunction with other clinical information, rapid measurement of BNP in the emergency department improved the management of elderly patients presenting with acute dyspnoea and thereby reduced the time to discharge and the total treatment cost. In addition, BNP testing seemed to reduce 30-day mortality.

Acute Disease↗
PubMed2004

Effects of chronic alcohol consumption on dermal penetration of pesticides in rats.

Topically applied ethanol is a well-known dermal penetration enhancer. The purpose of this work was to determine if ethanol consumption might also increase transdermal penetration. Male rats were fed either an ethanol containing or control diet for 6-8 wk. After the feeding regime was completed, skin was removed and placed in an in vitro diffusion system. The transdermal absorption of four very commonly used herbicides was determined. Penetration through skin from ethanol-fed rats was enhanced when compared to control by a factor of 5.3 for paraquat, 2.4 for atrazine, and 2.2 for 2,4-dichlorophenoxyacetic acid (2,4-D), and reduced by a factor 0.6 for trifluralin. Comparison of physical factors of the herbicides to the penetration enhancement revealed an inverse linear correlation with lipophilicity, as defined by log octanol/water partition coefficient (log Kow) with r2 =.98. These changes were at least partially reversible after 1 wk of abstinence from ethanol. These experiments demonstrate that regular ethanol consumption can alter the properties of the dermal barrier, leading to increased absorption of some chemicals through rat skin. If ethanol consumption has the same effect on human skin it could potentially have adverse health effects on people regularly exposed to agricultural, environmental, and industrial chemicals.

Administration, Topical↗
PubMed2004

Renal function and long term mortality after unstable angina/non-ST segment elevation myocardial infarction treated very early and predominantly with percutaneous coronary intervention.

OBJECTIVES: To quantify the impact of baseline renal function on in-hospital and long term mortality in patients with unstable angina/non-ST elevation acute myocardial infarction (UA/NSTEMI) treated with a very early invasive strategy. DESIGN: Prospective cohort study of 1400 consecutive patients with UA/NSTEMI undergoing coronary angiography and subsequent coronary stenting of the culprit lesion as the primary revascularisation strategy within 24 hours of admission. Patients were stratified according to calculated glomerular filtration rate (GFR) on admission. RESULTS: In-hospital mortality was 0% among patients with a GFR > or = 130 ml/min/1.73 m2, 0.4% with a GFR of 90-129 ml/min/1.73 m2, 2.6% with a GFR of 60-89 ml/min/1.73m2, and 5.1% with a GFR of < 60 ml/min/1.73 m2. Cumulative three year survival rates were 92.6%, 95.5%, 91.9%, and 76.8%, respectively. Patients with a GFR of < 60 ml/min/1.73 m2 were four times more likely to die in hospital (hazard ratio (HR) 4.0, 95% confidence interval (CI) 1.8 to 9.1; p = 0.001) and four times more likely to die during long term follow up (HR 4.0, 95% CI 2.5 to 6.4; p < 0.001). After adjusting for potential confounders, a GFR of < 60 ml/min/1.73 m2 remained a strong independent predictor of long term mortality (HR 2.6, 95% CI 1.5 to 4.5; p = 0.001). CONCLUSIONS: Baseline renal function is a strong independent predictor of in-hospital and long term mortality after UA/NSTEMI treated with very early revascularisation.

Aged↗
PubMed2004

Prevention of contrast nephropathy in critically ill patients using acetylcysteine and theophylline.

Compared with periprocedural hydration alone, acetylcysteine with hydration significantly reduces the risk of contrast nephropathy in patients with chronic renal insufficiency by 50%. For elective contrast procedures, acetylcysteine should be given in a dose of 600 mg twice daily the day before and on the procedure day. For emergency procedures, a high dose intravenous regimen (150 mg/kg in 500 mL normal saline over 30 minutes immediately before contrast followed by 50 mg/kg in 500 mL normal saline over 4h) is effective. Given the low cost and good side-effect profile of acetylcysteine, it would seem prudent to give this drug with intravenous fluids to all critically ill patients scheduled for intravenous or intraarterial contrast procedures. Theophylline in a dose of 200 mg or 2.5 mg/kg i.v. 30 minutes before contrast may be an effective alternative for emergency procedures. Although its benefit compared with periprocedural hydration alone seems less well established, theophylline is a particularly attractive option for emergency procedures.

Acetylcysteine↗