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Breath Tests↗
Biomedical subjects
G Bernhard
Publications and source records attributed to G Bernhard.
Complications and adverse effects of colonoscopy with selective sedation.
BACKGROUND: Cardiopulmonary adverse effects are commonly observed in patients undergoing colonoscopy with sedation. This study determines the incidence of such events when sedation is given only when required. METHODS: In 2500 consecutive patients, colonoscopies were started without premedication but sedation was offered if significant discomfort occurred. Parameters of blood pressure, heart rate, oxygen saturation and patient appearance were continuously recorded by a nurse assistant. Additional adverse effects occurring during or after the procedure were noted in the patients' protocol. Risk factors for the development of complications were evaluated with the use of a logistic regression model and the odds ratio. RESULTS: Ninety-five percent of all patients required neither sedation nor analgesia. Adverse effects occurred in 59 patients (2. 4%). Twenty-six of these patients (1.0%) had short-lasting episodes of oxygen desaturation and 22 patients (0.9%) experienced vasovagal reactions. Mechanical complications occurred in a total of 8 patients (0.3%) and consisted of 2 perforations and 6 episodes of hemorrhage. In the logistic regression model, impaired physical status was the single most important risk factor for the development of cardiopulmonary complications (odds ratio 4.7; 95% confidence interval [2.0, 11.4]). CONCLUSIONS: In experienced hands, patients undergoing colonoscopy rarely require sedation. If selective sedation is used, cardiopulmonary adverse effects occur in approximately 2% of all patients, most of whom require no medical intervention.
Aged↗
The impact of open access 24-h pH-metry on the diagnosis and management of esophageal reflux disease.
OBJECTIVE: This study investigates whether the results of 24-h pH-metry can be predicted from clinical information and whether they affect patient management. METHODS: A total of 200 consecutive patients referred for 24-h pH-metry underwent structured interviews as well as endoscopic and manometric investigations. The most recent 53 patients were prospectively followed to determine the impact of pH monitoring on long term management. RESULTS: Among a variety of risk factors, the presence of lower esophageal sphincter hypotension (OR = 3.3) and erosive esophagitis (OR = 2.3) were highly predictive of a pathological pH test result. If both abnormalities were present, the risk for an abnormal 24-h pH study increased by a factor of seven. Twenty-four-hour pH monitoring led to an immediate change in management in 42% of all investigated patients. However, such alterations in therapy were maintained for prolonged periods in less than half of them and only 6% of all patients associated changes in management with an improvement of symptoms. CONCLUSIONS: The results of "open access" 24-h pH-metry are often predictable, and only a minority of patients benefit from this procedure in terms of a change in therapy and an improvement of symptoms.
Adult↗
[Prospective observational study of surgical therapy of renal hyperparathyroidism].
A prospective long-term follow-up study in patients who had had surgical therapy for renal hyperparathyroidism was launched to investigate the results of surgical treatment and to evaluate possible correlations between preoperative laboratory values and the course of symptoms. From August 1987 to December 1995, 79 patients underwent surgery for renal hyperparathyroidism. It was the first neck exploration for 72 patients. Total parathyroidectomy with autotransplantation to a forearm was our preferred procedure (n = 67). The postoperative course of all patients is know. We carried out one to nine reexaminations (median 4) in 74 of 79 patients. The follow-up period ranged from 1 month to 5 years with a median of 18 months. After the operation transient hypocalcaemia occurred in 84.4% of patients. Postoperative hypocalcaemia correlated negatively with the preoperative levels of alkaline phosphatase and intact parathyroid hormone. Within the first month after surgery 60% of the preoperatively affected patients completely recovered from pruritus, whereas the skeletal syndrome took longer to disappear. One year after surgery 75% of the patients with pruritus and 79% of those with skeletal syndrome had became asymptomatic. After total parathyroidectomy with autotransplantation, patients with preoperatively elevated concentrations of alkaline phosphatase (> 200 U/I) experienced faster relief from joint pain than patients with preoperatively normal concentrations (P = 0.0297). To date 4.5% of the patients developed recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Morbidity of surgery for renal hyperparathyroidism is influenced by patients' risk factors. Postoperative hypocalcaemia correlates negatively with the grade of renal osteopathy at the time of operation. Preoperative concentrations of alkaline phosphatase influence the rapidity of the relief from joint pain.
Adult↗
Anal ultra slow waves: a smooth muscle phenomenon associated with dyschezia.
Anal ultra slow waves (USWs) have been described in a variety of anorectal disorders, all of which may be associated with constipation. We investigated whether they represent a marker for dyschezia and whether their occurrence can be modified. Manometric and endosonographic studies were performed in 25 patients with dyschezia, in 25 age- and sex-matched controls, and in an equal number of patients with hemorrhoids. Patients exhibiting ultra slow waves were repeatedly studied with and without local administration of isosorbide dinitrate. In addition, we determined whether stimulatory maneuvers modify the occurrence of USWs. Anal USWs were persistently found in 56% of patients with dyschezia, in 8% of patients with hemorrhoids, and in none of the healthy controls. They were stimulated by anal squeeze and completely abolished by local administration of isosorbide dinitrate. Ultra slow waves always occurred in conjunction with an increase in anal resting pressure and were tightly associated with a fluctuation in slow wave amplitude. Anal sphincter morphology was similar in patients with dyschezia and in controls. We conclude that anal USWs occur most frequently in patients with dyschezia and indicate smooth muscle dysfunction. Treatment directed at abolishing this motor phenomenon may represent a novel approach to the management of patients with dyschezia.
Adult↗
Anorectal function and morphology in patients with sporadic proctalgia fugax.
PURPOSE: The pathophysiology of sporadic proctalgia fugax remains unknown. This study investigates whether patients with this syndrome exhibit alterations in anal function and morphology. METHODS: Eighteen patients with sporadic proctalgia fugax and 18 sex-matched and age-matched healthy controls were studied. Manometric studies investigated anal resting and squeeze pressures, the rectoanal inhibitory reflex, rectal compliance, and smooth muscle response to edrophonium chloride administration. External and internal sphincter thickness was measured endosonographically. RESULTS: Patients had slightly higher (P = 0.0291) anal resting pressures (65.5 +/- 11.4 mmHg) than controls (56 +/- 9.9 mmHg). However, anal squeeze pressure, sphincter relaxation during rectal distention, and rectal compliance were similar in both groups, and no alterations were detected in external and internal anal sphincter thickness. Edrophonium chloride administration was followed by sharp postrelaxation contractions in two patients, whereas anal function remained unaltered in controls. Acute episodes of proctalgia, which occurred in two patients while under study, were associated with a rise in anal resting tone and an increase in slow wave amplitude. CONCLUSIONS: In the resting state, patients with proctalgia fugax have normal anorectal function and morphology. However, they may exhibit a motor abnormality of the anal smooth muscle during an acute attack.
Adult↗
[Morbidity in concomitant interventions in neck exploration for primary hyperparathyroidism. Results of a prospective study].
A prospective follow-up study was undertaken in patients undergoing surgical therapy for primary hyperparathyroidism to establish the frequency of concomitant surgical procedures and their influence on the morbidity of cervical exploration. From 1 August 1987 to October 1995, 231 patients underwent cervical exploration for primary hyperparathyroidism. In 16 patients 18 (7.8%) concomitant abdominal and thoracic surgical procedures as well as surgical interventions for soft-tissue tumors were performed. A total of 133 patients (57.6%) underwent thyroid resections of varying extent; 4.8% had carcinoma of the thyroid. Catamnestic data were obtained on the basis of a standardized follow-up in 94.4% of all patients (1-9 follow-up examinations in 216 patients). Hematoma occurred after adrenalectomy in a patient undergoing a concomitant extracervical procedure. In patients with a first manifestation of primary hyperparathyroidism due to a solitary parathyroid adenoma (n = 189), an increase in the morbidity of parathyroid surgery performed in combination with a thyroid resection was observed. Furthermore, a relationship was established between the number of intraoperatively identified parathyroid glands and the incidence of permanent hypoparathyroidism (permanent hypoparathyroidism: initial cervical intervention with parathyroid exploration alone, 2.2%; with concomitant thyroid resection, 6.5%; after secondary thyroid resection and parathyroid exploration alone, 0%; after concomitant thyroid resection, 28.6%; four parathyroid glands identified intraoperatively, 3.1%; fewer than four parathyroid glands identified, 8.2%). The increase in the morbidity of parathyroid surgery in combination with thyroid resection is justifiable, because unsuspected thyroid carcinomas can potentially be treated curatively.
Abdominal Neoplasms↗
Colonoscopy without premedication versus barium enema: a comparison of patient discomfort.
BACKGROUND: Colonoscopy is considered a painful procedure requiring routine intravenous sedation. We investigated whether unsedated colonoscopy causes more discomfort than barium enema. METHODS: Procedure-related discomfort was determined in 100 consecutive patients undergoing colonoscopy without premedication and in an equal number of patients referred for sigmoidoscopy and barium enema. All patients underwent such examinations for the first time and had no history of previous bowel surgery. During colonoscopy, sedation was offered if significant pain or discomfort occurred. RESULTS: In patients without stenosis and with satisfactory preparation, the completion rate of colonoscopy was 95%. Five percent of all patients undergoing endoscopy required sedation. On an analog scale ranging from 1 to 9, patients undergoing colonoscopy and barium enema reported similar ratings for procedure related discomfort (3.2 +/- 1.7 and 3.1 +/- 1.9) and for discomfort caused by bowel preparation (3.2 +/- 2.1 and 3.1 +/- 1.8). Eighty-seven percent of all patients undergoing colonoscopy stated that they would prefer no premedication in the event of repeated examinations. CONCLUSIONS: Colonoscopy with sedation on demand does not cause more discomfort than barium enema and will be accepted by the vast majority of patients undergoing this procedure.
Barium Sulfate↗
Weekly high-dose leucovorin versus low-dose leucovorin combined with fluorouracil in advanced colorectal cancer: results of a randomized multicenter trial. Study Group for Palliative Treatment of Metastatic Colorectal Cancer Study Protocol 1.
PURPOSE: To determine the most effective dose of leucovorin (folinic acid [FA]) within a weekly bolus fluorouracil (FU) schedule, we conducted a randomized multicenter trial to compare therapeutic effects and toxicity of high-dose FA versus low-dose FA combined with FU at equal doses in both treatment groups. PATIENTS AND METHODS: Patients with measurable inoperable or metastatic colorectal cancer were randomized to receive weekly FU 500 mg/m2 by intravenous (IV) bolus combined with high-dose FA 500 mg/m2 (group A) or low-dose FA 20 mg/m2 (group B) by 2-hour infusion. RESULTS: Of 291 assessable patients (group A, n = 148; group B, n = 143), we observed, in group A, complete response (CR)/partial response (PR) in 32 (21.6%), no change (NC) in 64 (43.2%), and progressive disease (PD) in 52 (35.1%); and in group B, CR/PR in 25 (17.5%), NC in 63 (44.1%), and PD in 55 (38.5%). The median response duration was 24.8 weeks in group A and 23.1 weeks in group B. Median progression-free intervals were 29.3 weeks (group A) and 30 weeks (group B). The median survival time was 55.1 weeks in group A and 54.1 weeks in group B. Overall toxicity was moderate. Mild nausea and vomiting, and stomatitis were common side effects in both groups. The incidence of World Health Organization (WHO) grade III/IV diarrhea was significantly higher in group A (40 v 23 patients). Severe side effects were observed only in a minority of patients in both arms. WHO grade IV diarrhea was observed in seven patients: four in group A and three in group B. The rate of toxicity-related adjustments of dose and schedule was comparable in both groups. CONCLUSION: High-dose FA/FU is not superior to low-dose FA/FU within a weekly treatment schedule. Response rates and survival were comparable in both treatment arms. Treatment-related toxicity was higher in group A (high-dose FA). Therefore, low-dose FA combined with weekly FU may be considered the preferred treatment for metastatic colorectal cancer.
Adult↗
Treatment of proctalgia fugax with salbutamol inhalation.
OBJECTIVES: Although no generally effective treatment for proctalgia fugax is known, inhalation of salbutamol has been reported to shorten pain attacks in isolated cases. METHODS: We conducted a randomized, double-blind, placebo-controlled, crossover trial of inhaled salbutamol in 18 patients with proctalgia fugax. The clinical effect was evaluated by recording the duration of severe pain and discomfort during acute attacks. In addition, anorectal motility recordings were analyzed for possible changes in anal resting tone, sphincter relaxation during rectal distension and in rectal compliance prior to and following administration of the two test substances. RESULTS: Sixteen patients completed all investigations. Compared to placebo, salbutamol inhalation shortened the duration of severe pain (p = 0.019). The effect was most marked in patients having prolonged attacks. In the asymptomatic state, neither salbutamol nor placebo led to a significant change in anal resting pressure, anal relaxation during rectal distension, or rectal compliance. Salbutamol also did not alter the threshold for rectal sensation. CONCLUSIONS: Salbutamol inhalation shortens attacks of severe pain in patients with proctalgia fugax. The mechanism of this effect remains unexplained.
Administration, Inhalation↗
Access to medical care among persons with musculoskeletal conditions. A study using a random sample of households in San Mateo County, California.
OBJECTIVE: To study access to medical care services, including subspecialty care, among persons with musculoskeletal conditions. METHODS: In early 1993, a random sample of households in San Mateo County, California, was screened for the presence of household members with musculoskeletal conditions, and a member of each household so identified was administered a structured survey about access to medical care and other related subjects. RESULTS: Eighty-six percent of all persons with a musculoskeletal condition had ever seen at least one physician for the condition, but only 6.5% had ever seen a rheumatologist. Those without health insurance were only 82% as likely as those with health insurance to have ever seen a physician. CONCLUSION: Most persons with a musculoskeletal condition have seen a physician for the condition, but lack of health insurance significantly reduces the proportion who have done so.
Adult↗
Treatment of advanced pancreatic cancer with 5-fluorouracil, folinic acid and interferon alpha-2A: results of a phase II trial.
Interferon alpha-2a (IFN-alpha) and folinic acid (FA) have been shown to modulate the cytotoxic effects of 5-fluorouracil (5-FU) in the treatment of cancer. A phase II study was initiated to evaluate the effect of a combination of 5-FU/FA/IFN-alpha in patients with advanced pancreatic cancer. Sixty previously untreated patients with advanced adenocarcinoma of the pancreas were treated with 500 mg m-2 FU via an intravenous bolus 1 h after the initiation of a 2 h infusion of 500 mg m-2 FA. Before starting the FA infusion, 6 million units (MU) of IFN-alpha was administered subcutaneously. The treatment was repeated once a week. Of 57 evaluable patients, eight (14%) had a partial response (PR), eight (14%) a minor response (MR) and 28 (49%) no change of disease (NC). Thirteen patients (23%) had progressive disease (PD). The median survival time was 10 months for all patients, 22 months for patients with partial remission and 5 months for patients with progressive disease. Many patients with tumour-related pain whose tumours were affected in terms of PR, MR, NC were free of pain during treatment with this regimen (22/36 patients). The common toxicities observed were fever (56%), nausea (37%) and diarrhoea (33%). These data suggest that biochemical modulation of 5-FU with FA and IFN-alpha has some positive effects in the treatment of pancreatic cancer of moderate toxicity.
Adenocarcinoma↗
Autonomic dysfunction in patients with achalasia.
It has been previously shown that patients with achalasia may have motor abnormalities of the stomach, small bowel and biliary system. This study investigates whether a disturbance of extraintestinal autonomic function occurs. Autonomic function studies were performed in 15 patients with achalasia and 15 age- and sex-matched healthy controls. Pupillograms were obtained during darkness, light exposure and after pilocarpine administration. Cardiovascular function studies included determinations of heart rate variation during deep breathing and orthostasis. In addition, we determined blood pressure changes in response to sustained handgrip, cold exposure and orthostasis. Neurohormonal function was investigated by measuring serum pancreatic polypeptide (PP) levels prior to and following sham feeding. Pupillary function did not differ in patients as compared with controls. However, 9 of 15 patients (95% CI: 32-84%) and none of the controls showed at least one abnormal autonomic cardiovascular response. A significant difference between the two groups was observed in sympathetic function (P = 0.023). More patients than controls did not respond to sham feeding with a PP increase. It is concluded that some patients with achalasia exhibit an abnormality of the autonomic nervous system that extends beyond the gastrointestinal tract. These abnormalities mainly concern cardiovascular function but may also involve neurohormonal responses.
Adult↗
Education program for general practitioners on breast and cervical cancer screening: a randomized trial. PRE.SA.GF Collaborative Group.
This study was aimed at evaluating the effects of an education program for general practitioners on their prescribing behaviour for cervical and breast cancer screening tests, and assessing the feasibility of general practitioners participation in screening programs. All three cytology laboratories and 19 of the 20 radiologists in one administrative region ("Haute-Savoie") in France agreed to participate. The 278 general practices in this region were randomly assigned to either the intervention group (a one-day seminar on screening for breast cancer and cervical cancer) or the control group (n for both = 139). The prescriptions of tests for the following year were noted from the laboratories' and radiologists' records. No significant differences were observed between the intervention group and the control group for the number of mammographies prescribed with a mean of 19.3 and 15.2 per practice, respectively. However, significantly more mammographies were prescribed in women aged over 50 by the intervention group (p = 0.038). Inversely, fewer smear tests were prescribed in the intervention group (mean per practice: 40.5 and 46.1, respectively). A significantly higher number of practices in the intervention group did not prescribe any smear tests (p = 0.007). This study suggests that it is possible to influence general practitioners' participation in screening programs, but that the messages should be carefully presented, since negative effects are possible.
Adult↗
Corticotropin-releasing hormone (CRH) is a respiratory stimulant in humans: a comparative study of human and ovine CRH.
Previous experimental and clinical studies clearly demonstrated that exogenously administered CRH possesses respiratory properties. Until now, these effects were investigated using human (h) CRH in both healthy volunteers and patients under long-term respiration. We now compared the effects of hCRH with those of ovine (o) CRH in ten healthy young males. In particular it should be evaluated whether oCRH with its longer plasma half-life induces a more profound respiratory stimulation. On two separate days within two weeks, ventilation and cardiac performance were measured during steady state conditions by using a computerized cardio-pulmonary exercise testing system. In this placebo controlled double-blind-crossover study h- and oCRH (100 ug i.v. each) both augmented minute volume significantly during the observation period. Heart rate also increased after both analogues. All effects were comparable without a significant difference between both substances. There were no major side effects observable. Our data thus demonstrate that both analogues might be suitable for both diagnostic (i.e., testing of respiratory and autonomic responses) and therapeutic purposes.
Adrenocorticotropic Hormone↗
A rapid algorithm and a computer program for multiple test procedures using logical structures of hypotheses.
It is demonstrated how improvements of general multiple test procedures can be obtained using information about the logical structures among the hypotheses. Based on a procedure of Bergmann and Hommel (B. Bergmann and G. Hommel, Improvements of general multiple test procedures for redundant systems of hypotheses, in Multiple Hypothesenprüfung--Multiple Hypotheses Testing, Eds. P. Bauer, G. Hommel and E. Sonnemann, pp. 100-115 (Springer-Verlag, Berlin, 1988)), a computer program was written by Bernhard (G. Bernhard, Computerunterstützte Durchführung von multiplen Testprozeduren--Algorithmen und Powervergleich, Doctoral thesis (Mainz, 1992)) using this information. It is applicable for a general class of systems of hypotheses which can be expressed in a linear way. By means of a simulation study it is shown that the proposed procedure is often substantially more powerful than other usual multiple test procedures.
Algorithms↗
Improved survival after colorectal cancer in patients complying with a postoperative endoscopic surveillance program.
This study investigates whether compliance with a postoperative surveillance program in patients with surgically treated colorectal cancer leads to prolongation of life. The clinical course of 212 patients who had undergone curative resections for colorectal cancer was monitored for at least five years. Eighty-eight patients adhered strictly to a rigid endoscopic surveillance program, and 124 did not. Tumor recurrences occurred in 10% of compliant and 14% of noncompliant patients. Patients with asymptomatic tumor recurrences survived significantly longer (p < 0.05; five-year actuarial survival: 42%) than those who were symptomatic (five-year actuarial survival: 8%). The overall survival rate was significantly higher (p < 0.0002) in compliant patients (five-year actuarial survival: 80%) than in noncompliant patients (five-year actuarial survival: 59%). Noncompliance increased the risk of early death by a factor of 2.5 (95% CI = 1.5; 4.2). It is concluded that postoperative endoscopic surveillance leads to early tumor detection, and is associated with an improvement in survival in patients with colorectal cancer.
Aged↗
Disability and health care use in patients with Crohn's disease: a spouse control study.
OBJECTIVES: Studies reported from tertiary referral centers suggest that patients with Crohn's disease (CD) have a high rate of long-term disability. This study investigated whether this is true for less selected patient groups. METHODS: 106 outpatients who were diagnosed to have had CD between 1974 and 1985 were invited with their partners (n = 83) for a structured interview that addressed issues of lifestyle and quality of life. In addition, patient and insurance records were reviewed to compare the use of health care services and work disability of patients with CD with those of their partners. RESULTS: Twenty percent of patients and 8% of their partners believed that illness had affected their partnership, 17% versus 11% thought it had compromised their professional career, and 28% versus 10% believed it affected the overall quality of life. A significant impact of illness on these parameters (p < 0.001) occurred only if they were evaluated with the use of an analog scale. Differences between patients and their partners in the use of health care services and in work disability became insignificant after 6 yr of observation (p = 0.1415 and p = 0.4341). CONCLUSIONS: Most patients with CD and their partners experience a similar satisfaction with life. As time progresses, a decline in disability often can be observed.
Adult↗