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Biomedical subjects

H Gabriel

Publications and source records attributed to H Gabriel.

At least 19 recordsLinked to original sources
PubMed2003

Pacemaker endocarditis due to Propionibacterium acnes.

Propionibacterium acnes belongs to the cutaneous flora of humans; it is often considered to be contaminant but has also been found to be a pathogen in human diseases. It is an uncommon causal agent in infective endocarditis and appears to have a predilection for prosthetic valves and foreign bodies. We describe a case of pacemaker endocarditis which shows that so-called harmless bacteria like P. acnes must be considered to be potential pathogens.

Adult↗
PubMed2001

Mutations in the connexin26/GJB2 gene are the most common event in non-syndromic hearing loss among the German population.

Congenital sensorineural hearing loss affects approximately 1/1,000 live births. Mutations in the gene encoding connexin26 (GJB2) have been described as a major cause of genetic nonsyndromic hearing impairment. Additionally, another gap junction gene, connexin30 (GJB6), was found to be responsible for hereditary hearing loss. We have studied 134 patients with severe to profound hearing loss or deafness and 13 patients with mild to moderate nonsyndromic sensorineural hearing loss in order to evaluate the prevalence of connexin26 and connexin30 mutations in Germany. Mutations in the connexin26 gene were found in 30 patients (22%) with profound to severe hearing impairment whereas only one novel single nucleotide polymorphism (396G-->A) in the connexin30 gene was detected. Among the 13 patients with mild to moderate hearing loss neither mutations in the connexin26 nor in the connexin30 gene could be detected. These results demonstrate that mutations in the connexin26 gene are also a frequent cause of hereditary non-syndromic hearing loss in Germany. Therefore a screening of mutations in the connexin26 gene should be performed in every case of non-syndromic hearing loss of unknown origin.

Adolescent↗
PubMed2001

Painful regional anaesthesia induces an immunological stress reaction: the model of retrobulbar anaesthesia.

BACKGROUND AND OBJECTIVE: Laboratory stress studies found that acute psychological stresses may elicit changes in leukocyte numbers similar to those occurring in physical stresses. Both types of stress evoke - mainly by release of catecholamines - leukocytosis resulting from a release of natural killer cells (NK-cells), of CD8+ T-cells, of monocytes and of neutrophils. However, there is little proof that laboratory stress models can be applied to daily clinical routines. As a likely inductor of an immunological stress response the setting of retrobulbar anaesthesia prior to intraocular surgery permits the study of a short-term painful anaesthetic procedure under highly standardized conditions. This was examined in 16 female patients. METHODS: Counts of leukocyte subsets, serum cortisol and cardiovascular variables were measured 30 min and 1 min prior to retrobulbar anaesthesia as well as 2, 15 and 45 min afterwards. RESULTS: The setting of retrobulbar anaesthesia induced an increase in total leukocytes [+380 cells microL-1; P < 0.01 (means; significance level)] mainly due to rising counts of neutrophils (+241 cells microL-1, P < 0.01). Of all lymphocyte subpopulations, natural killer cells increased most markedly (+64 cells microL-1; P < 0.01). Furthermore, the retrobulbar block induced an increase in systolic arterial pressure (+15.2 mmHg; P < 0.01). CONCLUSION: These changes in immunological and cardiovascular variables are considered to be elements of a sympatho-adrenal stress reaction; catecholamines are considered to induce a demargination of leukocytes by binding to beta2-adrenoceptors and by modifying the avidity state of adhesion molecules.

Aged↗
PubMed2000

Neurological rehabilitation of severely disabled cardiac arrest survivors. Part I. Course of post-acute inpatient treatment.

BACKGROUND: Some survivors of out-of-hospital cardiac arrest (CA) sustain anoxic brain injury. The aim of this study was to offer these patients a new treatment approach, to describe the course and outcome of rehabilitation, and to judge whether rehabilitation provided benefit. METHODS: Twenty severely disabled patients (mean age 47.6 years, 17 M:3 F) were admitted for inpatient rehabilitation after sustaining anoxic brain damage secondary to CA. The multidisciplinary treatment approach aimed at orientation, communication, mobility, and self care. Function was assessed using Barthel index (BI) score. On discharge, placement and global outcome was noted. Medical charts of consecutive patients were reviewed retrospectively. RESULTS: Inpatient rehabilitation lasted on for average 12 weeks. Improvement in function was slow with a median increase of 1.88 BI score per week. Patients achieved clinically significant functional improvement as measured by pre-post comparison of BI (P<0.001). On discharge, overall disability was mild in 2 (10%), moderate in 7 (35%), and severe in 11 (55%) patients. CONCLUSION: Rehabilitation of selected CA survivors is appropriate, reducing the subsequent burden of care. Although in 55%, only minor dependence on care persisted, on a group level, the potential for rehabilitation was modest, and recovery curve was flat. Before admission, families should be given realistic information about the possible outcome, because independence was rarely achieved.

Acute Disease↗
PubMed2000

Limitations of the transpulmonary indicator dilution method for assessment of preload changes in critically ill patients with reduced left ventricular function.

OBJECTIVE: We examined whether intrathoracic blood volume (ITBV) and total end-diastolic volume (TEDV), determined by the transpulmonary indicator dilution technique, adequately reflect preload changes during fluid administration in patients with reduced left ventricular function. DESIGN: A prospective, controlled, clinical study. SETTING: Medical intensive care unit in a university hospital. PATIENTS: A total of 18 sedated, mechanically ventilated, and moderately hypovolemic intensive care unit patients, eight with reduced left ventricular function (ejection fraction area, 24.9+/-8.0%, group A), ten with normal left ventricular function (ejection fraction area, 57.6+/-13.0%, group B). INTERVENTIONS: Continuous crystalloid infusion over 120 mins at a constant rate of 8 mL/kg/30 mins. MEASUREMENTS AND MAIN RESULTS: Stroke volume index, central venous pressure, pulmonary artery occlusion pressure (PAOP), TEDV, and ITBV were determined simultaneously at baseline and serially every 30 mins during continuous crystalloid infusion. A similar series of measurements was obtained during control conditions. Performance of various variables during fluid administration was assessed by time correlation analysis. Sensitivity for various variables defined as the ability to detect increasing amounts of administered fluid in individual patients was calculated. All examined variables increased during fluid administration and were unaffected during the control period. Mean time correlation (r2) was significantly higher for pressure monitoring (central venous pressure, r2 = 0.8281; PAOP, r2 = 0.5476) than for volume variables (TEDV, r2 = 0.0256; ITBV, r2 = 0.0729) in group A and was high for all variables in group B (central venous pressure, r2 = 0.7056; PAOP, r2 = 0.6241; TEDV, r2 = 0.49; ITBV, r2 = 0.4225). Sensitivities for central venous pressure, PAOP, TEDV, and ITBV after 120 min were 63%, 75%, 25%, and 25% in group A and 90%, 100%, 60%, and 60% in group B, respectively. CONCLUSION: This study demonstrates limitations of the transpulmonary indicator dilution technique for monitoring of intravascular volume in patients with reduced left ventricular function.

Critical Care↗
PubMed2000

[Thrombocytopenic purpura as sole manifestation of brucellosis in children].

Thrombocytopenic purpura associated with brucellosis has rarely been described in children. The thrombocytopenic purpura is usually part of the array of manifestations of brucellosis, such as fever, malaise, arthralgia, arthritis, hepatosplenomegaly and lymphadenopathy. We describe a 4-year-old girl in whom severe thrombocytopenic purpura was the only manifestation of brucellosis and resolved after appropriate antibiotic therapy. We conclude that brucellosis should be included in the differential diagnosis of thrombocytopenic purpura in areas endemic for brucellosis, and when there is a history of exposure to infected food products.

Anti-Bacterial Agents↗
PubMed1999

Imaging features of focal breast fibrosis: mammographic-pathologic correlation of noncalcified breast lesions.

OBJECTIVE: Our objective was to describe the spectrum of imaging and histologic findings of focal breast fibrosis with an emphasis on noncalcified lesions, thereby offering a means of confirming mammographic-pathologic concordance on core biopsy of this increasingly encountered diagnosis. MATERIALS AND METHODS: Retrospective review of 610 core needle biopsies revealed the histologic diagnosis of focal fibrosis in 89 (15%). Thirty-nine cases were excluded: 17 in which focal fibrosis was not the primary diagnosis and 22 in which calcifications were the main imaging findings. The 50 remaining patients with noncalcified lesions that proved on histology to be focal fibrosis constituted the basis of the study. RESULTS: Mammographically, focal fibrosis presented as a mass in 68% of patients (n = 34), architectural distortion in 12% (n = 6), and asymmetric density in 10% (n = 5); focal fibrosis was mammographically occult in 10% (n = 5). Sonographically, 72% (n = 36) of cases of focal fibrosis presented as masses with three echo texture patterns: hypoechoic, isoechoic, and centrally echogenic with a peripheral hypoechoic rim. The sonographic margins were well circumscribed (n = 21), lobulated (n = 10), or ill defined (n = 5). Histologic review revealed three morphologic patterns of collagen deposition: perilobular, septal, and haphazard fibrosis. Correlation with the imaging findings showed that septal and perilobular fibrosis most often presented as hypoechoic or centrally echogenic masses, whereas the haphazard form was more often seen with architectural distortion. CONCLUSION: Focal fibrosis often presents as a noncalcified mass on mammography or sonography. The diagnosis of focal fibrosis on core needle biopsy can be considered concordant for a mass exhibiting well-circumscribed or partially obscured margins. Imaging findings discordant with focal fibrosis, such as marginal spiculation, require excisional biopsy.

Adult↗
PubMed1998

Therapeutic efficiency of lipoprotein(a) reduction by low-density lipoprotein immunoapheresis.

This study was performed to investigate the effect of low-density lipoprotein (LDL) immunoapheresis on lipoprotein(a) [Lp(a)] reduction in patients with heterozygous and homozygous familial hyperlipidemia (N=16) and insufficient response to lipid-lowering agents. By desorption of approximately 5,700+/-500 mL of plasma, a mean reduction in total cholesterol of 62% (P < .001) and in LDL-cholesterol of 70% (P < .001) was achieved. Lp(a), which was elevated at study entry in seven of these patients (82.1+/-34.3 mg/dL; range, 48 to 148 mg/dL), was reduced during the initial LDL-apheresis procedure by 74.8%+/-14.1% (P < .001). Long-term apheresis treatment performed at weekly intervals resulted in an mean reduction in Lp(a) pretreatment values to 39.1+/-28.5 mg/dL (-54%; P < .001). Desorbed Lp(a) was measured at the waste of the columns for 31 apheresis treatments. Lp(a) concentration of the column waste was higher in patients with elevated serum Lp(a) pretreatment values as compared with those with Lp(a) serum values within the normal range (elevated Lp(a), 1,420+/-380 mg; without elevated Lp(a), 235+/-190 mg; P < .001). The rate of return of Lp(a) following apheresis treatment scheduled at weekly intervals was comparable to that of LDL-cholesterol.

Adolescent↗
PubMed1998

Mammographic screening in women more than 64 years old: a comparison of 1- and 2-year intervals.

OBJECTIVE: The purpose of our study was to determine if annual mammographic screening was superior to biennial screening in women more than 64 years old by examining differences in various prognostic indicators. MATERIALS AND METHODS: We reviewed the records of 119 consecutive women 65 years old and older with 120 cases of breast cancer who had a previous normal screening evaluation for breast cancer that included mammography and physical examination 8-30 months before diagnosis. A search of the computerized tumor registry, clinical records, and breast imaging records from November 1988 to April 1995 provided our cases. Screening intervals were defined as 6-18 months (annual) and 19-30 months (biennial). Mammographic, histologic, and clinical features were reviewed. Disease severity (DS) levels were assigned to each tumor as follows: DS-1 included minimal disease (ductal carcinoma in situ [TisNO], T1aN0, and T1bN0 tumors), DS-2 included all T1cN0 tumors, DS-3 included tumors larger than 2 cm in diameter with lymph nodes that were negative for cancer, and DS-4 included all metastatic disease. Statistically significant differences were calculated using the Wilcoxon rank sum test, Fisher's exact test, and the chi-square test. RESULTS: Ninety-three tumors were found in the group of patients who were annually screened, and 27 were found in the group of patients who were screened biennially. The women who underwent yearly screening mammography had significantly smaller invasive tumors (average, 10.7 mm; median, 9.5 mm versus 16.5 mm and 15.0 mm, respectively; p = .0086). The women who were screened annually also had significantly less advanced disease than women screened biennially (annually screened patients versus biennially screened patients: DS-1, 72% versus 44%; DS-2, 23% versus 37%; DS-3, 2% versus 11%; DS-4, 3% versus 7%; p = .0071). The group of patients screened annually had fewer cases of lymph node metastases (3% versus 8%; p = .12) and three times as many cases of ductal carcinoma in situ (22% versus 7%, p = .10). CONCLUSION: Annual screening mammography revealed significantly smaller tumors and less advanced cases of cancer than biennial screening, providing inferential support for annual mammographic screening of women more than 64 years old.

Age Factors↗
PubMed1998

Effect of antihypertensive treatment with doxazosin on insulin sensitivity and fibrinolytic parameters.

The effects of the selective alpha-1-adrenoceptor antagonist doxazosin on metabolic and fibrinolytic parameters were studied in hypertensive patients with various degrees of fasting plasma insulin levels (Group A: 22.5 +/- 3 microU/ml, Group B: 8.1 +/- 1.5 microU/ml; p <0.01) to disclose a potential link between a doxazosin-induced alteration of insulin and/or lipid metabolism and possible changes of these parameters on the fibrinolytic system. Doxazosin treatment resulted in a dose-dependent reduction of basal insulin levels in group A to 16 +/- 3 microU/ml; p <0.05. This finding was paralleled by a dose-dependent increase in t-PAmass concentration in the same patient group (basal t-PAmass from 9.7 +/- 1 to 15.5 +/- 2 ng/ml; p <0.05). As PAI-1 "active" as well as total antigen levels were not altered in parallel, the net effect on the endogenous fibrinolytic system is an increase of the fibrinolytic potential.

Antihypertensive Agents↗
PubMed1997

[Pulmonary hypertension and cor pulmonale].

Pulmonary hypertension is a severe disorder of the pulmonary circulation and occurs in a variety of vascular and parenchymal lung diseases. It leads to volume and/or pressure overload of the right ventricle and finally to right heart failure. Pulmonary vascular diseases such as chronic pulmonary embolism cause a drastic increase in pulmonary vascular resistance, which results in extremely high pulmonary artery pressures that can even reach systemic levels. On the other hand, moderate pulmonary hypertension can also occur in chronic obstructive and restrictive lung diseases. For a long time, the diagnosis of pulmonary hypertension and cor pulmonale was based upon findings in echocardiography and right heart catheterization. Today modern imaging techniques allow the radiologist to assess right ventricular and pulmonary artery morphology and function. The application of spiral CT, electron-beam CT and MRT permits the diagnosis and differential diagnosis of pulmonary hypertension and also the evaluation and follow-up of underlying vascular or parenchymal lung disorders. In addition, quantification of right ventricular function and calculation of pulmonary hemodynamic parameters are possible.

Adult↗
PubMed1997

[Aortic coarctation--long-term follow-up in adults].

Surgical repair of coarctation of the aorta has been performed since 1945. Although surgical techniques have improved, problems such as restenosis and aneurysm at the operation site or hypertensive cardiovascular disease, still remain. To evaluate the long-term results after surgical repair of coarctation, 41 patients, 25 male and 16 female patients (mean age: 28 +/- 11 years, range 14-57 years), were studied 16 +/- 8 years after surgery (range 3-44 years). Mean age at surgery was 12 +/- 9 years (range 0.5-35 years). In 24 patients resection and end-to-end anastomosis had been performed, patch graft aortoplasty in nine patients, tube interposition graft in seven patients and one patient had undergone the subclavian flap technique. All patients were assessed by exact physical examination, the resting arm-to-leg systolic pressure gradient was measured by Doppler sonography, a bicycle exercise test and an echocardiogram were performed. Twenty-one patients reported postoperative symptoms such as dizziness (n = 12), headache (n = 3), cold legs (n = 10) and/or dyspnea (n = 8). In two patients the resting arm-to-leg pressure gradient was greater than 30 mm Hg, in two patients it was greater than 20 mm Hg. Gradient calculated by Doppler echocardiography ranged from 0 to 80 mm Hg (21 +/- 17 mm Hg) and showed poor correlation with the arm-to-leg pressure difference. The mean functional capacity was 89 +/- 18% (range 42-110%). In 18 patients exercise-induced hypertension was found, while in only eight patients arterial hypertension had already been known. To evaluate the morphology of the aorta MRI was performed in 28 patients. No aneurysm was found. In five patients a minimal lumen diameter as small as 9-11 mm was measured. Patients were divided into two groups according to their age at operation, group I: < 9 years (n = 19) and group II: > 9 years (n = 22). Resting blood pressure was significantly higher in group II (135 +/- 27 mm Hg vs 114 +/- 20 mm Hg, p < 0.009), anti-hypertensive medication (43% vs 11%, p < 0.04) and symptoms were more frequent in these patients (15/22 vs 6/19, p < 0.04). However at time of follow-up examination the age of patients of group II was significantly higher (33 +/- 12 vs 22 +/- 5 years, p < 0.0005). Between these two groups there was no difference in follow-up time and results of echocardiography or stress test. In conclusion, despite good long-term results after surgical repair of coarctation of the aorta, patients should be followed on a regular basis primarily in order to recognize systemic hypertension as early as possible and to improve the long-term outcome in these patients by antihypertensive treatment.

Adolescent↗
PubMed1997

Enhanced expression of HLA-DR, Fc gamma receptor 1 (CD64) and leukocyte common antigen (CD45) indicate activation of monocytes in regenerative training periods of endurance athletes.

The aim of this study was to test the hypothesis whether endurance athletes have distinct expressions of functionally relevant surface antigens of monocytes. Under standardized experimental and laboratory conditions CD 14+ blood monocytes of 55 males (22 sedentary controls [CO], individual anaerobic threshold [IAT]: 2.2 +/- 1.2 W.kg-1, VO2 max: 47 +/- 12 ml.min-1.kg-1; 13 endurance athletes, training: 3-10 hours weekly [E1], IAT: 3.0 +/- 1.1 W.kg-1, VO2max 57 +/- 5 ml.min-1.kg-1; 20 endurance athletes training: > 10 hours weekly [E2], IAT: 3.7 +/- 1.3 W.kg-1, VO2max: 64 +/- 6 ml.min-1.kg-1) were investigated for relative surface receptor expression of CD45, CD64 and HLA-DR (direct immunofluorescence, flow cytometry). E1 and E2 showed significantly (ANOVA, Tukey's HSD test; each p < 0.01) higher relative receptor expressions for CD64 in comparison to CO (E1: +62/E2: +71%; percentage of increase compared to CO value), CD45 (+44/+32%) and HLA-DR (+22/+35%). Cell counts of four monocyte subpopulations (CD56+, CD14bright+CD16-, CD14bright+CD16dim+, CD14dim(+)-CD16bright+) did not show significant differences between the groups. These data suggest that in endurance athletes during regenerative training period circulating monocytes show an enhancement of functionally relevant surface receptors indicating an activation monocytes.

Adult↗
PubMed1997

The acute immune response to exercise: what does it mean?

The purpose of this article is to provide information about the exercise-induced alterations of cellular immune parameters depending on the intensity related to the individual anaerobic threshold (IAT) and duration of exercise. Immunological parameters were differential blood counts (CD14, CD45), monocyte subpopulations (CD14, CD16), lymphocyte subpopulations (CD3, CD4, CD8, CD45RO, CD19, CD16, CD56, HLA-DR) and natural killer cells (CD3, CD16, CD56), oxidative burst activity of neutrophils, and phagocytosis of neutrophils (flow cytometry). The main results were: (a) "Moderate" exercise (duration < 2h at about 85% of the IAT corresponding to a lactate steady state at about 2 mmol.l-1, < 30 min at the IAT corresponding to a lactate steady state of 4 mmol.l-1) elicits lower changes in cell concentrations and hormonal responses than strenuous exercise [exhaustive exercise at 100% IAT or above; (exhaustive) long-term (> 2-3h) endurance exercise]. Similar investigations about cell functions to decide about the positive or negative nature of these observations will have to follow in the future. (b) The neutrocytosis following exercise is more dependent on the duration than on the intensity of exercise. Especially exercise sessions that lead to a strong incline of the adrenocorticotropic hormone, beta-endorphin and cortisol are associated with this neutrocytosis. (c) Neutrophils' function during the exercise-induced neutrocytosis indicated by phagocytosis and oxidative burst activity is unchanged or reduced following strenuous endurance exercise, whereas bacterial URTI leads to similar neutrophil counts but significantly increased cell activities indicating the diverse meaning of the leukocytosis in infections (primed cells, enhanced cell activity, stimulated defense mechanism) and following exercise (impaired cell function, suppressed defense mechanism). (d) Regular monocytes (early differentiation stage) are strongly recruited into the circulation during long-term aerobic exercise, whereas mature monocyte cell counts (premacrophages) increase most with highly intensive (an)aerobic exercise above the IAT. Infections induced a maturation from regular to mature monocytes as a response to the infectious antigenic stimulus, whereas exercise does not, indicating the diversity between change of cell counts and function. (e) Long-term endurance diverse meaning leads to increases of activated CD45RO+ T cells (memory cell phenotype) but compared to the incline of cell concentrations and activation levels (% HLA-DR+ T cells) during infections like infectious mononucleosis this effect is small indicating only minor effects on T cell function by exercise. The effect of single bouts of exercise on immune cell counts is large but the effects on the cell function is - i.e. compared to bacterial URTI - relatively small.

Acute-Phase Reaction↗
PubMed1997

Breast cancer in women 65-74 years old: earlier detection by mammographic screening.

OBJECTIVE: Our objective was to investigate the value of screening mammography in 65- to 74-year-old women by determining differences in various prognostic indicators in screened and nonscreened groups. MATERIALS AND METHODS: We reviewed 103 malignant breast tumors detected in 102 women 65-74 years old over a period of 73 consecutive months (February 1988-March 1994). A screening interval of less than 18 months was chosen to separate the screened from the nonscreened populations. Mammographic, histologic, and clinical features were reviewed. Statistically significant differences were calculated using Fisher's exact test and Wilcoxon's rank sum test. RESULTS: Thirty-two patients were in the screened population; 70 patients were in the nonscreened population. Ninety-nine percent (102/103) of the carcinomas were apparent mammographically. We found significant differences between the screened and the non-screened groups with respect to the size of lesions revealed by mammography (11 mm versus 21 mm; p = .0002) and the incidence of minimal tumors (20/32 (63%) versus 26/70 (37%), p = .0198). The incidence of lymph node metastases was 3/27 (11%) for the screened group versus 14/47 (30%) for the nonscreened group (p = .0875). The overall positive predictive value of mammography for the 65- to 75-year-old patients was higher than in our general population, 47% versus 28%. CONCLUSION: Screening mammography revealed significantly smaller and earlier stage tumors in 65- to 74-year-old women. This finding inferentially supports the efficacy of screening in this age population.

Aged↗