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Biomedical subjects

D Spiegel

Publications and source records attributed to D Spiegel.

At least 19 recordsLinked to original sources
PubMed2005

Caucasian patients with type 2 diabetes mellitus have elevated levels of monocyte chemoattractant protein-1 that are not influenced by the -2518 A-->G promoter polymorphism.

AIM: To investigate the association of serum levels and the -2518 A-->G promoter polymorphism of the gene for chemokine monocyte chemoattractant protein-1 (MCP-1), a major chemoattractant of monocytes and activated lymphocytes, with metabolic parameters as well as insulin, leptin and the cytokines tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in 534 Caucasian patients with type 2 diabetes mellitus. METHODS: MCP-1 concentrations were measured by enzyme-linked immunosorbent assay. MCP-1 genotyping was performed by RFLP analysis in a subset of 426 patients. RESULTS: Two hundred and thirty-one (54.2%) patients were homozygous for the wildtype allele (AA), 156 (36.6%) were heterozygous (AG) and 39 (9.2%) were homozygous for the mutated allele (GG). Allelic frequency was similar to non-diabetic populations (wildtype allele A: 0.73; mutated allele G: 0.27). MCP-1 mean concentrations and percentiles were substantially higher in non-diabetic populations but were not influenced by the genotype (AA: 662.0 +/- 323.0 pg/ml; AG: 730.6 +/- 491.4 pg/ml; GG: 641.2 +/- 323.8 pg/ml). MCP-1 serum levels and genotypes were only marginally related to hormones (insulin and leptin) and cytokines (TNF-alpha and IL-6). CONCLUSIONS: This is the first study providing MCP-1 levels, percentiles and genotype frequency in a large and representative cohort of patients with type 2 diabetes mellitus. Compared to the literature, MCP-1 levels were found to be substantially higher in patients with type 2 diabetes mellitus. In contrast, genotype frequencies were similar compared to those in non-diabetic patients and were not related to MCP-1 levels. The mechanisms behind these elevated MCP-1 serum levels in type 2 diabetes are not to be explained by simple associations with hormones, cytokines or genotypes.

Aged↗
PubMed2004

A comparison of the fixed combination of latanoprost and timolol with the unfixed combination of brimonidine and timolol in patients with elevated intraocular pressure. A six month, evaluator masked, multicentre study in Europe.

PURPOSE: To compare the intraocular pressure (IOP) reducing effect and safety of fixed combination (FC) latanoprost/timolol with unfixed combination (UFC) brimonidine/timolol in patients with increased IOP. METHODS: In this 6 month, randomised, evaluator masked, parallel group European study, patients with glaucoma or ocular hypertension and IOP > or =21 mm Hg on monotherapy or >16 mm Hg on dual therapy received either FC latanoprost/timolol at 8:00AM or UFC brimonidine/timolol at 8:00AM and 8:00PM. The primary outcome was the difference from baseline to month 6 in mean diurnal IOP reduction. RESULTS: 325 of 334 randomised patients were included in intent to treat analyses (FC latanoprost/timolol, 163; UFC brimonidine/timolol, 162). Baseline diurnal IOP levels were similar: FC latanoprost/timolol, 26.4 (SD 2.7) mm Hg; UFC brimonidine/timolol, 26.5 (SD 2.8) mm Hg (p = 0.851). At month 6, levels were 16.9 (SD 2.8) mm Hg in FC latanoprost/timolol patients and 18.2 (SD 3.1) mm Hg in UFC brimonidine/timolol patients (p<0.001). No adverse events were reported by 76.4% and 75.5% of patients receiving FC latanoprost/timolol versus UFC brimonidine/timolol, respectively. Larger proportions of brimonidine/timolol treated patients reported study medication related adverse events (18.6% v 7.3%) and discontinued study participation because of this (10.8% v 1.8%). CONCLUSION: Fixed combination latanoprost/timolol administered once daily is both more effective and better tolerated than twice daily dosing with UFC brimonidine/timolol.

Adult↗
PubMed2003

Developing a free supportive care program for cancer patients within an integrative medicine clinic.

The cancer patient's journey not only includes a threat to one's life, but the need to face many medical and emotional challenges. The free Cancer Supportive Care Program (CSCP) within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics has been identified as a successful model for helping patients to deal with these challenges. Its programs include informational lectures, support groups, chair massages, exercise, alternative modality classes, a Life Tapes Project, an informational website, and a bimonthly newsletter available free to anybody touched by cancer. Now in its third year, this program benefits from a blending of leadership resources, availability of space, institutional agreement on patient need and funds from private and corporate donations. By presenting the basic premises of the Cancer Supportive Care program and outlining specifics about the program, institutions in various national and international demographic regions may implement similar programs according to their resources and the needs of patients. It is our hope that the CSCP can become a model for the development of similar programs in various parts of the United States and abroad.

Adult↗
PubMed2002

A comparison of the effects on intraocular pressure of latanoprost 0.005% and the fixed combination of dorzolamide 2% and timolol 0.5% in patients with open-angle glaucoma.

PURPOSE: To compare the effects on intraocular pressure (IOP) of latanoprost 0.005% and the fixed combination of dorzolamide 2% and timolol 0.5%. METHODS: Overall, 226 patients whose IOP was insufficiently controlled by timolol alone were randomized to receive either latanoprost once daily or the fixed combination of dorzolamide plus timolol twice daily. Intraocular pressure was measured at 10:00 am and 5:00 pm at baseline and after 3 months of treatment. RESULTS: Mean IOP was reduced from baseline in both groups (p < 0.001), with a mean +/- SEM reduction of - 4.3 +/- 0.3 mmHg (19%) for the latanoprost treatment group and - 4.0 +/- 0.3 mmHg (17%) for the dorzolamide plus timolol treatment group. The two therapies were similarly effective in lowering IOP levels (mean difference in reduction: - 0.4 +/- 0.4; 95% confidence interval: - 1.1, 0.4). CONCLUSIONS: Monotherapy with latanoprost once daily was as effective in reducing mean IOP as the fixed combination of dorzolamide plus timolol twice daily in patients with IOP insufficiently controlled by timolol alone.

Adult↗
PubMed2002

Pro12Ala polymorphism in the peroxisome proliferator-activated receptor-gamma2 (PPARgamma2) is associated with higher levels of total cholesterol and LDL-cholesterol in male caucasian type 2 diabetes patients.

UNLABELLED: The peroxisome proliferator-activated receptor-gamma2 (PPAR(gamma2)) represents the transcriptional master regulator of adipocyte differentiation and therefore has been suggested as candidate gene for the pathogenesis of obesity, type 2 diabetes and related metabolic disorders. Aim of our study was to determine the frequency of a missense point mutation within exon 2 of PPAR(gamma2), Pro12Ala, and its possible association with metabolic parameters as well as diabetic retinopathy (in a population-based sample of 560 (318 male ad 242 female) type 2 diabetic patients. Subsequent to genomic PCR amplification, the Hpa-II RFLP analysis was used for genotyping. RESULTS: 436 (77.9%) subjects were homozygous for the wildtype allele (Pro/Pro), 118 (21.1%) were heterozygous (Pro/Ala) and 6 (1.1%) were homozygous for the mutated allele (Ala/Ala). Genotype frequency was calculated to be 0.81 for the wildtype and 0.19 for the mutated allele. These frequencies did not differ from non-diabetic cohorts examined earlier. In contrast to females, total cholesterol and LDL-cholesterol were significantly higher in males (Total cholesterol: 281.8 +/- 51.3 vs 253.1 +/- 49.8 mg/dl, p < 0.0001; LDL-cholesterol: 182.0 +/- 49.2 vs 155.6 +/- 42.0 mg/d, p < 0.0001) in the presence of the mutated allele as compared to the wildtype subgroup. No differences were found with respect to BMI, HbA1c, blood pressure and serum levels of leptin nor to prevalence of retinopathy. Pro12Ala polymorphism of PPAR(gamma2) gene is not associated with diabetic retinopathy but is associated with dyslipidemia in male type 2 diabetic patients.

Aged↗
PubMed2002

Trabecular meshwork bypass tube shunt: initial case series.

AIMS: This study describes a prospective consecutive case series of the initial six eyes of five patients undergoing implantation of the trabecular bypass tube shunt. METHODS: A prospective consecutive case series. The initial six eyes of five patients with uncontrolled open angle glaucoma who had never previously undergone ocular surgery. Implantation of the trabecular bypass tube shunt measuring 150 micro m outer diameter and 50 micro m inner diameter was performed with the distal end placed in Schlemm's canal and the proximal end in the anterior chamber. The main outcome measures were visual acuity, intraocular pressure, glaucoma medication use. RESULTS: The tube was successfully implanted in five of six eyes. In four eyes longer term follow up of 5-9 months showed no loss of visual acuity with decreased intraocular pressure from preoperative levels (mean 23.4-16.5 mm Hg) and reduced requirement of glaucoma medications (mean 3-0.5). In a subset of two eyes, there was no measured increase in aqueous flare or reduction of endothelial cell count. In one eye the tube was explanted because of presumed misplacement by excessive bleeding during surgery. Two eyes showed a diffuse bleb. CONCLUSIONS: This study reports the initial experience with a novel approach to surgical glaucoma therapy. This very small tube allows a direct communication to be established between the anterior chamber and Schlemm's canal, effecting a trabecular bypass. In this small number of eyes this procedure reduced intraocular pressure and the need for glaucoma medications without appreciable side effects.

Adult↗
PubMed2001

Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial.

BACKGROUND: Metastatic breast cancer carries with it considerable psychosocial morbidity. Studies have shown that some patients with metastatic breast cancer experience clinically significant anxiety and depression and traumatic stress symptoms. Supportive-expressive group psychotherapy was developed to help patients with cancer face and adjust to their existential concerns, express and manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control. METHODS: Of 125 women with metastatic breast cancer recruited into the study, 64 were randomized to the intervention and 61 to the control condition. Intervention women were offered 1 year of weekly supportive-expressive group therapy and educational materials. Control women received educational materials only. Participants were assessed at baseline and every 4 months during the first year. Data at baseline and from at least 1 assessment were collected from 102 participants during this 12-month period, and these participants compose the study population. RESULTS: Primary analyses based on all available data indicated that participants in the treatment condition showed a significantly greater decline in traumatic stress symptoms on the Impact of Event Scale (effect size, 0.25) compared with the control condition, but there was no difference in Profile of Mood States total mood disturbance. However, when the final assessment occurring within a year of death was removed, a secondary analysis showed a significantly greater decline in total mood disturbance (effect size, 0.25) and traumatic stress symptoms (effect size, 0.33) for the treatment condition compared with the control condition. CONCLUSION: Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.

Adaptation, Psychological↗
PubMed2001

[Central retinal artery occlusion. Importance of selective intra-arterial fibrinolysis].

BACKGROUND: Conventional treatment of a central retinal artery occlusion usually has a poor prognosis but intra-arterial fibrinolysis (IF) of the ophthalmic artery is an invasive treatment option. The importance of IF was evaluated in 62 patients with central retinal artery occlusion and in addition the risk spectrum for this disease was considered. MATERIAL AND METHODS: Data from charts of 62 patients were retrospectively analysed. Visual recovery after IF (n = 17) was compared to conventional treatment (e.g. decrease of IOP, improvement of rheological conditions, n = 45). Patients were excluded from IF if the occlusion was present for more than 8 h, if there was a history of bleeding and previous operations, or if they were older than 85 years. IF was performed using either urokinase (n = 7) or tPA (n = 10). RESULTS: Out of 62 patients, 22 (35%) with central retinal artery occlusion underwent catheterisation. Stenosis of the carotid artery excluded IF in 5 out of these 22 cases, therefore only 17 patients were treated by IF. Of the patients, 40 (65%) were excluded from IF for various reasons: 47% (19/40) arrived later than 8 h after occlusion, 17% (7/40) did not consent to IF, 15% (6/40) had medical contraindications and 13% (5/40) were over 85 years of age. Two patients required no IF because of a cilioretinal anastomosis with moderate visual acuity and another patient showed spontaneous visual recovery during ophthalmic examination. Of the 17 patients treated with IF, 4 achieved an improvement of visual acuity by more than 2 lines, no change of visual acuity was observed in 12/17 patients and 1/17 lost more than 2 lines after treatment. Of the 45 conservatively treated patients, 16 achieved improvement by more than 2 lines and no change occurred in 29/45 patients. Three patients treated with IF suffered from a stroke during treatment. The main risk factor for central retinal artery occlusion was high blood pressure in 32% of all cases and nicotine abuse in 16%. CONCLUSIONS: Many patients presented too late for IF. However, there was no statistical difference between patients with IF and conventional treatment with regards to the improvement of visual acuity. Additionally there is an increased risk of a stroke from IF, therefore a prospective study is necessary to evaluate the importance of IF. Stabilisation of high blood pressure may be the best prophylaxis for preventing a central retinal artery occlusion.

Adult↗
PubMed2001

[Implant in Schlemm's canal. A new method for regulating intraocular pressure in patients with primary open-angle glaucoma?].

BACKGROUND: A surgical technique was developed using a Schlemm's canal implant to bypass the obstruction of outflow of the juxtacanalicular trabecular meshwork in patients with primary open-angle glaucoma. The implant device should also bridge healing processes after trabeculotomy and laser techniques. PATIENTS AND METHODS: An 8- to 15-mm-long silicone tube was implanted in each of two human autopsy eyes connecting the anterior chamber directly with Schlemm's canal. Serial sectioning was performed at two sections of 1-mm length. RESULTS: Implantation of the tube was technically uneventful. Histological examination showed no evidence of mechanical disruption of the endothelial lining of the inner wall of Schlemm's canal. CONCLUSION: These preliminary results demonstrate the possibility of shunting aqueous directly into Schlemm's canal using a silicone tube. A clinical study in a selected group of patients is planned.

Glaucoma, Open-Angle↗
PubMed2001

Comparison of frequency doubling perimetry and standard achromatic computerized perimetry in patients with glaucoma.

PURPOSE: To evaluate the reproducibility and efficacy of frequency-doubling perimetry (FDP), a new perimetric method for the detection of functional glaucomatous damage. METHODS: Thirty-four glaucomatous eyes of 34 patients were examined by FDP (using the complete N30 threshold test of the Humphrey Frequency Perimeter) and by standard achromatic computerized perimetry (SAC; using the full threshold program 30-2 of the Humphrey Field Analyzer). Twenty-six of these eyes were examined twice by FDP. Reproducibility of repeated FDP was tested by the difference and the average of mean deviations (MD). Efficacy was studied by comparison of FDP and SAC using MD, as well as threshold results of FDP and corresponding SAC-tested areas. Spearman's rank correlation was calculated. RESULTS: A significant correlation of repeated FDP examinations was found regarding MD [r=0.94, P<0.00001 (n=26)]. The reproducibility of FDP was independent of the glaucomatous damage [r=0.04, P=0.85 (n=26)], based on the correlation of the difference, and the average of MD. The MD of FDP and that of SAC showed a significant correlation [r=0.87, P<0.00001 (n=34)]. In advanced glaucoma, FDP tended to yield lower measurement values than SAC. Regarding corresponding areas, there was a significant correlation between threshold results of FDP-tested areas and the corresponding SAC testpoints [r=0.92, P<0.00001 (n=34)]. The conformity decreased from the peripheral to the central tested visual field. CONCLUSIONS: Sufficient reproducibility of FDP could be demonstrated in early and advanced glaucomatous visual field defects. Conformity between FDP and SAC was shown in terms of MD and threshold results of FDP-tested areas and corresponding SAC testpoints.

Aged↗
PubMed2001

Mind matters. Coping and cancer progression.

The idea that having an 'attitude' about cancer makes a difference in its course is a popular but controversial one. Most oncologists and surgeons believe that tumor type and stage, general health, and medical treatment are all that account for the variance in outcome. Many patients and their families believe that having the right attitude makes a difference in the course of disease. This leads us to two empirical questions: (1) Does coping make a difference in disease progression when medical prognostic variables are taken into account? and (2) What constitutes the 'right attitude'?

Adaptation, Psychological↗
PubMed2001

The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998).

B. Rind, P. Tromovitch, and R. Bauserman (1998) examined the long-term effects of childhood sexual abuse (CSA) by meta-analyzing studies of college students. The authors reported that effects "were neither pervasive nor typically intense" and that "men reacted much less negatively than women" (p. 22) and recommended value-neutral reconceptualization of the CSA construct. The current analysis revealed numerous problems in that study that minimized CSA-adjustment relations, including use of a healthy sample, an inclusive definition of CSA, failure to correct for statistical attenuation, and misreporting of original data. Rind et al.'s study's main conclusions were not supported by the original data. As such, attempts to use their study to argue that an individual has not been harmed by sexual abuse constitute a serious misapplication of its findings.

Adaptation, Psychological↗
PubMed2001

Psychoneuroimmune and endocrine pathways in cancer: effects of stress and support.

The bulk of cancer research has productively focused on the pathophysiology of the disease, emphasizing tumor biology, especially tumor characteristics such as DNA ploidy and estrogen/progesterone receptor status as predictors of disease outcome, at the expense of studying the body's psychophysiological reactions to tumor invasion. These reactions are mediated by brain/body mechanisms, including the endocrine, neuroimmune, and autonomic nervous systems. Although a large portion of the variance in any disease outcome is accounted for by the specific local pathophysiology of that disease, some variability must also be explained by 'host resistance' factors, which include the manner of response to the stress of the illness. The evidence of links between social support, stress, emotional state, and immune and endocrine function is growing. Here we examine evidence that 2 especially promising mechanisms, one immune, one endocrine, may mediate the relationship between stress and social support on the one hand and cancer progression on the other. We chose natural killer (NK) cells and cortisol because they are particularly good examples of mediating mechanisms for which there is solid basic and clinical evidence. NK cells are of great interest because they are involved in tumor surveillance, and because their activity can be measured in vitro.

Arousal↗
PubMed2001

Suppression, repressive-defensiveness, restraint, and distress in metastatic breast cancer: separable or inseparable constructs?

A longstanding hypothesis links affective and behavioral inhibition with cancer incidence and progression though it does not clarify psychometric distinctions among related constructs. We hypothesized that repressive-defensiveness, suppression, restraint, and distress would be separable factors in our sample of metastatic breast cancer patients. Our results support the discriminant validity of these constructs in our total sample, and the stability over 1 year in our control group. Using factor analysis, we found 4 separate factors at our prerandomization baseline corresponding closely to hypothesized constructs. Additionally, associations in a multi-trait, multi-occasion (baseline and 1 year) matrix met each of the 3 Campbell and Fiske (1959) criteria of convergent and discriminant validity. Future research testing the links between psychological, physiological, and survival outcomes with affective inhibition in cancer patients will be clearer when informed by these distinctions.

Adult↗