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Biomedical subjects

C Schmid

Publications and source records attributed to C Schmid.

At least 181 records · Page 10Linked to original sources
PubMed1996

Age-related differences in patients with nonpalpable breast carcinomas.

BACKGROUND: The survival benefit of screening mammography may be influenced by the age of the screened population. The current series examines the influence of age on the clinical, histopathologic, and prognostic features of nonpalpable breast carcinoma. METHODS: Needle localization and biopsy of suspicious mammographic lesions identified 173 breast carcinomas that were occult by physical examination. The mammographic appearance, the tumor histology and size, as well as axillary lymph node and estrogen receptor status of these carcinomas were reviewed. RESULTS: Mammographic findings of a mass or density (without calcifications) were most common (46%) and the majority of tumors were invasive ductal carcinoma (70%). The median age of the patients was 59 years. Tumor histology and mammographic findings varied by age: women with ductal carcinoma in situ (DCIS) had a median age of 50 years, whereas patients with invasive ductal carcinoma without associated intraductal tumor had a median age of 65 years. Both younger age (P = 0.001) and microcalcifications (P = 0.0001) were strongly correlated with DCIS. The mean greatest tumor dimension was 1.34 cm. Axillary metastases were found in 21%, 15%, and 50% of invasive tumors with sizes of < 1 cm, < 2 cm, and > 2 cm, respectively, and were uninfluenced by age. Estrogen receptor analysis of invasive tumors was > 10 fmol/mg in 47% and 84% of women aged < 50 years and > 50 years, respectively. CONCLUSIONS: Mammographically detected lesions in younger women are typified by a higher incidence of DCIS or tumors with an intraductal component. Nonpalpable invasive carcinomas in women < or = 50 years and > 50 years appear to be biologically similar by virtue of axillary lymph node status, although estrogen receptor positive tumors are more common in older patients. These age-related differences may partially account for age-related variations in the survival impact of mammographic screening programs.

Adult↗
PubMed1996

[Bone density and laboratory parameters of bone metabolism in patients with terminal heart disease].

PURPOSE: The purpose of this study was to assess bone mineral density (BMD) and parameters for bone metabolism in patients with end-stage heart disease awaiting heart transplantation to determine whether these patients are at increased risk of bone disease. PATIENTS AND METHODS: 39 adult men (mean age 52.3, range 21-65 years) with ischemic (41%), idiopathic (43.5%), valvular (2.5%) and diverse (13%) end-stage heart disease were studied prior to heart transplantation. BMD was measured using dual-energy x-ray absorptiometry at the lumbar spine (L2-L4) and at the upper femur (Ward's triangle and femoral neck). Renal and bone biochemical profiles, parathyroid hormone (PTH), 25-OH-vitamin D3, testosterone, alkaline bone phosphatase, osteocalcin, and deoxypyridinoline and calcium excretion were measured. RESULTS: No fractures were found. Mean z-scores were -1.06 +/- 2.02 (mean +/- SD) at the lumbar spine, -1.12 +/- 2.03 at the femoral neck and -0.25 +/- 1.06 at Ward's triangle. Significantly decreased values were seen at the lumbar spine and at the femoral neck compared to age matched healthy controls. Mean values of serum creatinine and parathyroid hormone were elevated (114.4 +/- 29.5 mumol/l and 84.3 +/- 67.8 ng/l, respectively). 7 (18%), 10 (26%) and 22 (56%) of the 39 patients had values beneath the normal range of 25-OH-vitamin D3, testosterone and osteocalcin respectively. Mean urinary deoxypyridinoline/creatinine ratios were elevated (9.46 +/- 8.52 nmol/mmol, normal range 2.5-5). No correlation existed between osteocalcin and urinary deoxypyridinoline/creatinine ratio. Using a multiple linear regression model, serum PTH and cardiac ejection fraction (EF) weakly predicted BMD at the femoral neck (r2 = 0.26). CONCLUSIONS: (1.) Lumbar spine and femoral neck BMD are low in patients awaiting heart transplantation. (2.) A low EF and a high PTH weakly correlate with a decrease in BMD at the femoral neck. (3.) In patients with end-stage heart failure the coupling of bone formation to bone resorption is frequently disturbed. (4.) Testosterone and 25-OH-vitamin D3 levels are low in a number of patients and in such cases replacement therapy may be appropriate.

Absorptiometry, Photon↗
PubMed1996

1 alpha,25-dihydroxyvitamin D3 increases IGF binding protein-5 expression in cultured osteoblasts.

Rat osteoblasts produce insulin-like growth factors (IGFs) and IGF binding proteins (IGFBPs). Expression of IGFBP-5, an IGFBP which stimulates DNA synthesis of osteoblasts, was studied in vitro under the influence of 1 alpha,25-dihydroxyvitamin D3 (1,25(OH)2D3) and parathyroid hormone (PTH). These two calcium-regulating hormones stimulated the expression of IGFBP-5 mRNA in cultured rat osteoblasts at low concentrations (10 pM) and in a dose- and time-dependent manner. Intact IGFBP-5 was not detected in the culture medium, but was found attached to the cell layer. IGFBP-5 may thus direct IGFs to the sites of bone remodeling.

Animals↗
PubMed1996

Retransplantation reverses mononuclear infiltration but not myointimal proliferation in a rat model of chronic cardiac allograft rejection.

Episodes of acute rejection seem to play an important role in the development of chronic allograft failure. Whereas acute rejection appears to be fully reversible, at least at early stages, reversibility of chronic graft alterations is still unclear. Male Fisher F344 rat hearts were heterotopically transplanted into Lewis recipients (n=8/group). Minimal immunosuppression (rapamycin 0.5 mg/kg for 14 days) guaranteed allograft survival during the observation period (group 1). Allografted hearts were retransplanted into syngeneic recipients after 14 days (group 2) and 50 days (group 3) and compared with F344 isografts undergoing retransplantation after 4 days (group 4) and with F344 isografts without a second procedure (group 5). All organs were removed after 100 days and morphologically and immunohistologically assessed. Allografts of group 1 developed concentric myointimal proliferation with dense intramural and perivascular mononuclear infiltration and intravascular thrombosis in 59 +/- 7% of coronary arteries. Retransplantation into syngeneic recipients almost completely abolished mononuclear infiltration, but did not affect the development of myointimal proliferation (groups 2/3: 46 +/- 7%/31 +/- 24%, NS). Isograft retransplantation resulted in a similar incidence of coronary lotions (group 4: 37 +/- 9%, NS), whereas coronary arteries of isografts without a second transplant procedure (group 5) remained normal (0%, P<0.001). In conclusion, syngeneic retransplantation of allografts reverses mononuclear infiltration but not myointimal proliferation. The development of coronary lesions in retransplanted isografts underlines the participation of antigen-independent stimuli in the development of myointimal proliferation. These experiments further support the hypothesis of an interaction of antigen-dependent and antigen-independent factors for the development of coronary myointimal proliferation.

Animals↗
PubMed1996

Triiodothyronine increases glucose transporter isotype 4 mRNA expression, glucose transport, and glycogen synthesis in adult rat cardiomyocytes in long-term culture.

Effects of T3 treatment (day 2-day 12) on the expression of the insulin-regulated GLUT4, on 2-deoxyglucose uptake, and on glycogen synthesis were studied in ARC after 12 days of culture in T3-depleted 20% fetal calf serum. GLUT4 mRNA expression was low in controls, but increased in a dose-dependent manner by T3 treatment up to 2.8-fold at 100 nM. In parallel, 100 nM T3 increased basal 2-deoxyglucose uptake 1.95-fold and insulin-stimulated uptake 1.75-fold. In addition, T3 enhanced basal and insulin-stimulated [14C] glucose incorporation into glycogen 1.86- and 1.5-fold, respectively. Hence, ARC may meet part of their increased energy requirements in response to T3 by enhancing GLUT4 expression.

Animals↗
PubMed1996

A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia.

OBJECTIVE: To study the effect of fluoxetine (FL) and amitriptyline (AM), alone and in combination, in patients with fibromyalgia (FM). METHODS: Nineteen patients with FM completed a randomized, double-blind crossover study, which consisted of 4 6-week trials of FL (20 mg), AM (25 mg), a combination of FL and AM, or placebo. Patients were evaluated on the first and last day of each trial period. Outcome measures included a tender point score, the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression Inventory (BDI) scale, and visual analog scales (VAS) for global well-being (1 completed by the physician and 1 by the patient), pain, sleep trouble, fatigue, and feeling refreshed upon awakening. RESULTS: Both FL and AM were associated with significantly improved scores on the FIQ and on the VAS for pain, global well-being, and sleep disturbances. When combined, the 2 treatments worked better than either medication alone. Similar, but nonsignificant, improvement occurred in the BDI scale, the physician global VAS, and the VAS for fatigue and feeling refreshed upon awakening. Trends were less clear for the tender point score. CONCLUSION: Both FL and AM are effective treatments for FM, and they work better in combination than either medication alone.

Adolescent↗
PubMed1996

Infection-associated cellular activation accelerates chronic renal allograft rejection in rats.

The etiology of chronic rejection is unknown, although acute rejection, viral infection, and initial graft ischemia have been implicated. To test the effects of infections on the process of chronic rejection, we simulated bacterial infection by the administration of the endotoxin lipopolysaccharide (LPS), a potent activator of various cell types in an established rat model of chronic rejection. Lewis recipients of Fisher 344 kidneys were treated with a single dose of LPS or vehicle 8 weeks following transplantation and grafts were examined at various time points. In the chronically rejecting controls, leukocytic infiltration and the expression of cytokines peaked at 16 weeks. In LPS-treated hosts, leukocyte infiltration and cytokine expression peaked at 12 weeks. By 16 weeks, glomeruli in LPS-treated recipients had become far more sclerotic than those in controls, mimicking the changes observed in controls at 24 weeks. We conclude that infections may play an important role in the development of chronic rejection.

Animals↗
PubMed1996

Cardiopulmonary bypass in patients with heparin-induced thrombocytopenia using Org 10172.

BACKGROUND: In patients with heparin-induced thrombocytopenia undergoing cardiac operations, anticoagulation with heparin should be avoided. The low-molecular-weight glycosaminoglycan Orgaran has been used as an alternative, but the overall experience is limited. METHODS: Two patients with heparin-induced thrombocytopenia underwent cardiopulmonary bypass using Orgaran for anticoagulation. A 30-year-old woman suffered from emboli to her brain through a secondary atrial septal defect, a 14-year-old boy from ischemia of his left leg due to recurrent embolism originating from the mitral valve. In both cases, cardiopulmonary bypass was performed in a routine manner, except for using low-dose Orgaran instead of heparin. Anticoagulation was monitored during cardiopulmonary bypass by measuring Orgaran plasma levels and activated clotting time. RESULTS: No thromboembolic or bleeding complications occurred during and after atrial septal defect repair and mitral valve replacement, respectively. In the former case, thrombotic material from the inferior vena cava was removed during hypothermic circulatory arrest within the same procedure. Activated clotting time did not correlate with plasma levels of Orgaran. CONCLUSIONS: Orgaran might be a useful alternative for anticoagulation during extracorporeal circulation. Adequate dosages and measurement of plasma levels are recommended for its use in cardiopulmonary bypass.

Adolescent↗
PubMed1996

Biological bridging after repair of an anomalous origin of a left coronary artery.

We report on an unusual case of surgical repair for anomalous origin of the coronary artery from the pulmonary artery, in a young patient who underwent tunnel repair with concomitant heterotopic heart transplantation to support severely impaired left ventricular function. Four years later, the graft was removed after confirmation of ventricular arrest and excellent recovery of the patient's own heart.

Coronary Vessel Anomalies↗
PubMed1996

Mycophenolate mofetil inhibits lymphocyte binding and the upregulation of adhesion molecules in acute rejection of rat kidney allografts.

Mycophenolate mofetil (MMF) interacts with purine metabolism and possibly with the expression of adhesion molecules. In the present study, we analysed the expression of these molecules in transplanted kidney allografts treated with RS LBNF1 kidneys were orthotopically transplanted into Lewis rats and either treated with RS (20 mg/kg/day) or vehicle. Rats were harvested 3, 5 and 7 days following transplantation. For binding studies, fresh-frozen sections of transplanted kidneys were incubated with lymph node lymphocytes (LNL) derived from transplanted rats. Additionally, immunohistology was performed with various monoclonal antibodies. In general, MMF resulted in better preservation of graft structure by 7 days. Cellular infiltration and tubular atrophy were less pronounced. At day 3, macrophages were diminished in MMF-treated animals to a high extent, while the number of T cells was almost identical to that of controls. In addition, the number of cells positive for MHC class II and LFA-1 was reduced in the MMF-treated animals. These findings correlated with the binding results. Three days following engraftment, LNL bound to MMF-treated kidneys to a lesser extent compared to controls. In conclusion, MMF resulted in a markedly reduced leucocytic infiltrate, presumably based on a reduced expression of lymphocytic adhesion molecules and an interaction with macrophages.

Animals↗
PubMed1996

The use of a Perma-Flow graft for coronary artery bypass surgery.

We report on our first clinical use of a Perma-Flow graft for coronary artery bypass surgery (CABG). It may well be that repeated successful use of this graft will offer a chance for revascularization to patients who might otherwise have been denied for lack of appropriate vessels.

Aged↗
PubMed1996

Beating heart implantation of a wearable NOVACOR left-ventricular assist device.

Implantable left-ventricular assist devices (LVAD) are successfully used as a bridge to transplant if the patient's condition is worsening and no donor organ is available. They allow recovery of compromised organ function. However, postoperative bleeding, thrombemboelism, and right-heart failure may jeopardize the important improvement of organ function and may even lead to death. We introduce our strategy for implantation of the Novacor LVAD system, which aims at minimal bleeding and maintained right-heart function. The Novacor LVAD was implanted with the heart beating during extracorporeal circulation in 8 patients, 3 of whom had previous cardiac surgery. Postoperatively, no patient developed right heart failure or had to undergo redo thoracotomy.

Adult↗
PubMed1996

Trends and strategies for myocardial revascularization.

Refinements in patient assessment, perioperative management and surgical technique have considerably improved the outcome and thus widened the indication for coronary bypass surgery. General indications for CABG surgery include left main stem stenosis or involvement of the LAD. Currently, there is no optimal technique or management, rather an individualized strategy considering the individual findings and risks. However, the trend points toward a wider use of arterial conduits and avoidance of proximal anastomoses. Recently evolving strategies including minimal invasive surgery and transmyocardial laser revascularization may indicate the beginning of a new era and show that coronary bypass grafting is still an evolving field for cardiac surgeons.

Angioplasty, Balloon, Coronary↗
PubMed1996

Multiple cardiac procedures after heart transplantation: a case report.

We report on a 56-year-old patient who underwent coronary artery bypass grafting, tricuspid valve replacement, and pacemaker implantation within 49 months after heart transplantation. This case readily demonstrates that multiple cardiac procedures can be safely performed after heart transplantation and may thus serve as an alternative to retransplantation.

Cardiac Surgical Procedures↗