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Biomedical subjects

J Kugler

Publications and source records attributed to J Kugler.

At least 37 records · Page 2Linked to original sources
PubMed2000

Comparison of survival and quality of life in advanced non-small-cell lung cancer patients treated with two dose levels of paclitaxel combined with cisplatin versus etoposide with cisplatin: results of an Eastern Cooperative Oncology Group trial.

PURPOSE: Treatment with cisplatin-based chemotherapy provides a modest survival advantage over supportive care alone in advanced non-small-cell lung cancer (NSCLC). To determine whether a new agent, paclitaxel, would further improve survival in NSCLC, the Eastern Cooperative Oncology Group conducted a randomized trial comparing paclitaxel plus cisplatin to a standard chemotherapy regimen consisting of cisplatin and etoposide. PATIENTS AND METHODS: The study was carried out by a multi-institutional cooperative group in chemotherapy-naive stage IIIB to IV NSCLC patients randomized to receive paclitaxel plus cisplatin or etoposide plus cisplatin. Paclitaxel was administered at two different dose levels (135 mg/m(2) and 250 mg/m(2)), and etoposide was given at a dose of 100 mg/m(2) daily on days 1 to 3. Each regimen was repeated every 21 days and each included cisplatin (75 mg/m(2)). RESULTS: The characteristics of the 599 patients were well-balanced across the three treatment groups. Superior survival was observed with the combined paclitaxel regimens (median survival time, 9.9 months; 1-year survival rate, 38.9%) compared with etoposide plus cisplatin (median survival time, 7.6 months; 1-year survival rate, 31.8%; P =. 048). Comparing survival for the two dose levels of paclitaxel revealed no significant difference. The median survival duration for the stage IIIB subgroup was 7.9 months for etoposide plus cisplatin patients versus 13.1 months for all paclitaxel patients (P =.152). For the stage IV subgroup, the median survival time for etoposide plus cisplatin was 7.6 months compared with 8.9 months for paclitaxel (P =.246). With the exceptions of increased granulocytopenia on the low-dose paclitaxel regimen and increased myalgias, neurotoxicity, and, possibly, increased treatment-related cardiac events with high-dose paclitaxel, toxicity was similar across all three arms. Quality of life (QOL) declined significantly over the 6 months. However, QOL scores were not significantly different among the regimens. CONCLUSION: As a result of these observations, paclitaxel (135 mg/m(2)) combined with cisplatin has replaced etoposide plus cisplatin as the reference regimen in our recently completed phase III trial.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

INAA and PIXE of atmospheric and combustion aerosols.

Using instrumental neutron activation analyses and photon-induced x-ray emission techniques for analysis of size-fractionated atmospheric and combustion aerosols and other emission samples arising from fluidized-bed combustion of North Bohemian lignites up to 42 elements were determined in all samples types. This allowed the evaluation of element enrichment, time trends, and inter-element correlations and the performance of factor analysis of various fractions of atmospheric aerosols. The data obtained on mass and element size distributions of aerosols and emission samples obtained upon lignite combustion in an experimental scale atmospheric fluidized-bed combustor without and with added hydrated lime and limestone were used to elucidate the mechanism of abatement of toxic trace and matrix elements from flue gas.

Aerosols↗
PubMed1999

Anxiety moderates cardiovascular responses to painful stimuli during sphygmomanometry.

Sphygmomanometry is the most common technique of blood pressure (BP) determination. We were interested in the role of anxiety as a predictor of BP changes induced by painful stimuli during sphygmomanometry. We studied 141 normotensive healthy subjects who were asked to complete a State-Trait-Anxiety-Inventory (STAI) prior to the experiment. BP was determined continuously and non-invasively using a Finapres device (Penaz-technique) and by arm sphygmomanometry. Five sphygmomanometric measurements took place, during the fourth the arm cuff was inflated to 300 mmHg (unpredictable to the subject), the others were done with a pressure of 175 mmHg. State and trait anxiety (STAI X1 and X2) correlated positively with diastolic BP changes during inflation of the arm cuff (state anxiety: r = 0.26, P < 0.05; trait anxiety: r = 0.20, P < 0.05). Our results suggest that anxiety may have an impact on cardiovascular responses following painful stimuli.

Adult↗
PubMed1999

Reducing myoclonus after etomidate.

BACKGROUND: The authors hypothesized that myoclonus after etomidate is dose-related, could be suppressed when small doses of etomidate were administered before induction, and is unassociated with seizure-like activity on electroencephalogram (EEG). METHODS: Three studies were performed. In the first study, 36 men were randomly assigned to receive 0.025, 0.050, 0.075, 0.100, 0.200, or 0.300 mg/kg of etomidate. In a second crossover study, eight men were randomly allocated to receive either a pretreatment dose of 0.050 mg/kg etomidate or placebo 50 s before 0.300 mg/kg etomidate was injected. EEG was recorded for subjects in the first two studies. In a third study, 60 patients were randomly allocated to one of three pretreatment doses of etomidate: 0.030, 0.050, or 0.075 mg/kg before 0.300 mg/kg was given. RESULTS: In Study 1, myoclonus was not observed after 0.025 or 0.050 mg/kg etomidate. One volunteer had myoclonus after 0.075 mg/kg and another after 0.100 mg/kg etomidate; three had myoclonus after 0.200 mg/kg; and five after 0.300 mg/kg. Incidence of myoclonus was dose-related (P < or = 0.01). In Study 2, two volunteers (25%) with etomidate pretreatment had mild myoclonus compared to six (75%) with placebo pretreatment (P < or = 0.05). EEG changes, other than delta waves, were not seen during myoclonic epochs. In Study 3, myoclonus was less likely after the small pretreatment doses (0.030 or 0.050 mg/kg) than after the large dose (0.075 mg/kg, P < or = 0.01). CONCLUSIONS: Incidence and intensity of myoclonus after induction with etomidate are dose-related, suppressed by pretreatment, and unassociated with seizure-like EEG activity.

Adult↗
PubMed1998

[Change sensitivity and construct validity of the revised multi-dimensional pain scale].

PROBLEM: Assessment and evaluation of perceived pain is an interdisciplinary task. This study focused on the change sensitivity and construct validity of the German version of the Revised Multidimensional Pain Scale (MSS). METHODS: In this experiment, 72 students were assigned to one of three treatments:a) Applying a blood pressure sphygmomanometry cuff with a maximum pressure of 300 mm Hg, b) or with a maximum pressure of 175 mm Hg, c) or a control condition, applying a cuff with no pressure. During the treatment, blood pressure was continuously non-invasively measured by the Penazmethod. At the end of the experiment, the subjects worked on the revised multidimensional pain scale, on the state/trait anxiety inventory (STAI) and a Likert-scale (range 1-28) for perceived pressure. RESULTS: As expected, inflating the arm cuff induced a significant increase in pressure perception compared to the control group. However, only the subscales electrical and thermic of the MSS showed an increase across the treatment groups. No differences were found for the anxiety ratings. Correlation analysis showed that state anxiety was positively related with the subscales chronic, chemical, and thermic. Trait anxiety was related with the subscales chronic, inconvenient, and chemical. Systolic blood pressure increase was positively correlated with the subscale general of the MSS. DISCUSSION: The study shows that the MSS has a limited change sensitivity for short term pain stimuli like arm cuff pressure. Anxiety was correlated with three subscales of the MSS, indicating that perceived pain intensity assessed with the MSS is more related to emotional factors rather to the physical intensity of the arm cuff pressure.

English Abstract↗
PubMed1998

[Costs and fees in health care. Evaluation and assessment by cardiological patients].

PATIENTS AND METHOD: In a pilot study 70 patients treated in the Department of Cardiology were asked to asses the cost of coronary angiography, PTCA, heart transplantation, pacemakers and prosthetic heart valves. Salaries of physicians and nurses should be estimated, and causes of increase of costs in health care be defined. RESULTS: 91.7% patients criticized health care as too expensive but reasonable with regard to output and efficacy. As most important reasons for increase of cost were given "expensive drugs" (70.6%), "great number of drugs" (56.9%) and "increased number of old patients" (56.9%). Costs of coronary angiography were overestimated (twice) and those of PTCA were underestimated (half). Two thirds of the patients guessed the price of pacemakers and prosthetic heart valves much to low. Salaries of physicians had been estimated near the upper reference value, those of nurses near the lower reference value. CONCLUSION: Most of our patients were insufficiently informed about costs in health care. Clarification and more transparency are needed.

Adult↗
PubMed1998

[Neglect of tuberculosis in medical education. How medical students perceive the incidence of tuberculosis in Germany].

BACKGROUND: Tuberculosis is still a health problem. Due to an increasing number of immunosuppressed patients the probability of getting infected with tuberculosis in the hospital rises up. SUBJECTS AND METHODS: For prevention of infections, medical students play a critical role: Firstly, because of bedside-teaching in the hospital, medical students are at risk of getting infected with tuberculosis. Secondly, immediately after university training, it is expected that they are capable to diagnose tuberculosis. The following study analysed the incidence-estimation of medical students (n = 278) of tuberculosis-morbidity and tuberculosis-mortality in Germany. RESULTS: It becomes obvious, that medical students still have gaps in their knowledge about tuberculosis. They underestimated the incidence of tuberculosis and they overestimated the mortality of tuberculosis. CONCLUSION: The study indicates a misperception of relevant health problems which may be due to the study situation at German Medical Schools. Medical students need more information and counselling about epidemiology of infectious diseases including tuberculosis.

Adult↗
PubMed1998

[Psychological concepts in pain therapy practice. 2: Behavior therapy, self-management and overview of cognitive interventions].

In this part, the contribution of cognitive behavior therapy and the self management approach in psychological pain therapy is presented. A five-step-model of cognitive behavior is explained. The different steps are diagnostics, development of a new cognitive model of the disorder, acquisition of coping strategies, applications, transfer and relapse prevention. Focus of this paper are the coping strategies, thus, the interventions in confrontation with a pain stimulus. The self management approach has the goal to enable the patient to use coping strategies as quickly as possible by himself and to support the self-regulation of the patient. At the end, a survey about cognitive self-control strategies is given.

Adaptation, Psychological↗
PubMed1997

Quality of life of patients with renal cell carcinoma or prostate cancer after radical surgery.

OBJECTIVES: To study the impact of radical tumour surgery in prostate and renal cell cancer patients on quality of life (QOL). METHODS: In 38 male patients suffering from organ-confined prostate or renal cell cancer, a prospective study was performed. For the evaluation of QOL, we used the EMPK (Erfassung multipler psychischer Konstrukte). Urologic symptoms were evaluated with a specially designed symptom score. The test instrument was filled out the day before surgery and one year after operation. RESULTS: The EMPK was able to detect and describe significant changes in certain aspects of QOL in renal cell cancer and prostate cancer patients. Moreover, there seems to be a difference between the two groups. A direct relation between QOL and the different quality and quantity of operation-related symptoms, however, could not be proven. CONCLUSIONS: In this pilot study, radical surgical therapy did not significantly change QOL in prostate cancer patients, but seemed to have a positive influence on the QOL of renal cell cancer patients.

Aged↗
PubMed1997

Retest-reliability and convergent validity of noninvasive blood pressure determination: arm sphygmomanometry vs. Peñaz-method.

Blood pressure is usually determined by arm sphygmomanometry. However, this technique does not allow continuous blood pressure monitoring. Over the last years, a technique introduced by Peñaz makes it feasible to determine blood pressure noninvasively and continuously from the finger artery. Study on 46 normotensives showed that both methods have high retest-reliabilities for systolic blood pressure while for diastolic blood pressure, arm sphygmomanometry resulted in lower reliabilities than the Peñaz-method. Between-method-comparisons showed only small correlations. Diastolic blood pressure levels were significantly lower in the Peñaz-method than in arm sphygmomanometry. In conclusion, blood pressure levels determined by arm sphygmomanometry and the Peñaz-method differ systematically because of different methodologies. If blood pressure or blood pressure changes are determined, the method and the circumstances of its application need to be carefully reported.

Adult↗
PubMed1997

[The determinants of the quality of life after a type-III open tibial fracture. The results of a multicenter study].

This study investigated to what extent quality of life four years or more after the fracture is determined by initial staging (Gustilo subclassification, time from injury to arrival at hospital), by the therapeutic course (length of hospital stay, number of operations), by complications (amputation, infection) and by demographic factors (gender, age). A total of 197 patients after type III open tibial shaft fractures (type IIIA 70, type IIIB 85, type IIIC 42) from nine centers volunteered to participate in this study. During patients' follow-up appointments (mean duration of follow-up 50 months), therapeutic course, pre-surgical staging and demographic data were recorded by the surgeon. Patients were asked to rate quality of life on the Nottingham Health Profile and on a visual analogue scale. Multiple regression analysis (stepwise) identified two predictors for reducing overall quality of life (F-test: P = 0.007): number of operations (adjusted beta: -0.21) and age (adjusted beta: -0.17). Other factors showed no significant relationship with overall quality of life or with subscales of the Nottingham Health Profile. These findings indicate a dilemma between two therapeutic goals: good functional outcome, which often requires repeated operations, and quality of life, which suffers under prolonged surgical treatment.

Adult↗
PubMed1997

Pharmacokinetics and pharmacodynamics of propofol in a new solvent.

UNLABELLED: Pain on injection is the most commonly reported adverse event after propofol injection. In a randomized, cross-over study in two groups of 12 healthy male volunteers (24-42 yr), we compared the pharmacokinetics and pharmacodynamics of two new propofol formulations (1% and 2% concentrations) in a fat emulsion consisting of medium- and long-chain triglycerides with the standard propofol formulation. After a single intravenous bolus injection of 2 mg/kg, propofol blood levels were measured for 24 h and evaluated according to an open three-compartment model. The derived pharmacokinetic variables were not different among formulations. Additionally, electroencephalographic recordings of the onset and duration of hypnotic action were comparable with all formulations. After propofol 1% in the new formulation, fewer volunteers reported severe or moderate pain on injection (9%) than after the standard formulation (59%) (P < 0.05). We attribute this result to a lower concentration of free propofol in the aqueous phase of the new formulation. IMPLICATIONS: Changing the composition of the carrier fat emulsion for propofol does not have an impact on the pharmacokinetics and efficacy of propofol, but it promises to provide better patient acceptance by lowering the incidence of moderate and severe pain on injection.

Adult↗
PubMed1997

Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients.

PURPOSE: A minority of cancer survivors develops long-term postsurgical neuropathic pain. Based on evidence that capsaicin, the pungent ingredient in hot chili peppers, might be useful for treating neuropathic pain, we developed the present clinical trial. PATIENTS AND METHODS: Ninety-nine assessable patients with postsurgical neuropathic pain were entered onto this study. After stratification, patients were to receive 8 weeks of a 0.075% capsaicin cream followed by 8 weeks of an identical-appearing placebo cream, or vice versa. A capsaicin/placebo cream was to be applied to the painful site four times daily. Treatment evaluation was performed by patient-completed weekly questionnaires. RESULTS: During the first 8-week study period, the capsaicin-cream arm was associated with substantially more skin burning, skin redness, and coughing (P < .0001 for each). Nonetheless, treatment was stopped for patient refusal or toxicity just as often while patients were receiving the placebo as compared with the capsaicin. The capsaicin cream arm had substantially more pain relief (P = .01) after the first 8 weeks, with an average pain reduction of 53% versus 17%. On completion of the 16-week study period, patients were asked which treatment period was most beneficial. Of the responding patients, 60% chose the capsaicin arm, 18% chose the placebo arm, and 22% chose neither (P = .001). CONCLUSION: A topical capsaicin cream decreases postsurgical neuropathic pain and, despite some toxicities, is preferred by patients over a placebo by a three-to-one margin among those expressing a preference.

Administration, Topical↗