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Biomedical subjects

M Berger

Publications and source records attributed to M Berger.

At least 343 records · Page 19Linked to original sources
PubMed1995

Elastin and collagen degradation products in urine of patients with cystic fibrosis.

Elastin degradation has been reported to be increased in patients with cystic fibrosis (CF). In order to further explore evidence for elastin degradation in a group of 18 patients with CF with a wide range of disease severity, we used an isotope dilution method to measure urinary desmosine (DES) and isodesmosine (IDES), amino acids derived exclusively from cross-linked elastin, and hydroxylysylpyridinoline (HP) and lysylpyridinoline (LP), amino acids derived exclusively from cross-linked collagen. Urinary DES and IDES (mean +/- SD) were 23.9 +/- 30.7 and 18.5 +/- 22.4 micrograms/g creatinine, respectively, in the patients with CF versus 7.5 +/- 1.7 and 6.8 +/- 1.4 micrograms/g creatinine, respectively, in 10 healthy control subjects (p < 0.001); only two patients with CF had DES values within the control range. The values of urinary HP and LP in the CF group were 54.9 +/- 39.1 and 12.3 +/- 8.6 nmol/mmol creatinine, respectively, versus 24.5 +/- 5.8 and 5.1 +/- 2.7 nmol/mmol creatinine, respectively, in the controls (p < 0.005). Both HP and LP were highly correlated (r = 0.71, p < 0.0001). Patients with CF had active pulmonary inflammation; neutrophils were abundant in the bronchoalveolar lavage fluid of the CF group and correlated with elastase activity measured with methoxysuccinyl Ala-Ala-Pro-Val paranitroanilide (r = 0.61, p < 0.05). Airway neutrophils had decreased expression of the complement receptor CR1 (CR1/CR3 of 0.17 +/- 0.15 versus 1.0 for blood neutrophils), a change known to be caused by uninhibited neutrophil elastase. We conclude that lung elastin is the most likely source of the increased DES and IDES in CF.

Adult↗
PubMed1995

Inflammatory cytokines in cystic fibrosis lungs.

Chronic pulmonary infection with Pseudomonas aeruginosa continues to be the major cause of morbidity and mortality in cystic fibrosis (CF). Several characteristics of CF, including the excessive influx of neutrophils into the airways, cachexia, and hyperglobulinemia, could reflect the effects of cytokines, such as interleukin-1 (IL-1), IL-6, IL-8, and tumor necrosis factor (TNF-alpha). We hypothesized that these pro-inflammatory cytokines, produced by alveolar macrophages in response to pseudomonas and/or other microorganisms, promote the destructive inflammatory process in the lung. We evaluated bronchoalveolar lavage (BAL) fluid and BAL macrophages from 22 CF patients and 13 healthy control (HC) subjects, measuring soluble TNF-alpha, IL-1 beta, IL-6, and IL-8 and the regulatory molecules TNF soluble receptor (TNF-sR), IL-1 receptor antagonist (IL-1Ra), and IL-10 (cytokine synthesis inhibitory factor). Levels of the proinflammatory cytokines were higher in CF versus HC BAL (p < or = 0.05 for IL-1, TNF, and IL-8; p = 0.06 for IL-6). In contrast, HC BAL contained significantly more IL-10 than CF BAL (p < 0.05), but TNF-sR and IL-1Ra were similar. Immunocytochemistry demonstrated a higher percentage of CF than control BAL macrophages expressing intracellular cytokines (p < 0.05). Thus, enhanced macrophage production of proinflammatory cytokines and decreased production of the regulatory molecule IL-10 may have important roles in the pathogenesis of CF lung disease.

Adult↗
PubMed1995

Normal bronchial epithelial cells constitutively produce the anti-inflammatory cytokine interleukin-10, which is downregulated in cystic fibrosis.

Interleukin-10 (IL-10) is a potent regulatory cytokine that decreases inflammatory responses and T-cell stimulation. We have found that respiratory epithelial lining fluid (ELF) from patients with cystic fibrosis (CF) contains significantly less soluble IL-10 than ELF of healthy control subjects. Although macrophages from the chronically infected lungs of CF patients appear to be one source of IL-10, little or no intracellular IL-10 was found in bronchoalveolar lavage macrophages from healthy control subjects, suggesting that there must be another source of this cytokine in healthy lungs. We found that bronchial epithelial cells from healthy control subjects constitutively produce IL-10, which appears to be downregulated in CF patients. It is thus likely that the bronchial epithelium plays an important role in regulating the local immune response, producing IL-10 to decrease inflammation in the healthy lung. Conversely, downregulation of epithelial IL-10 production in CF airways may contribute to enhancing local inflammation and tissue damage.

Adult↗
PubMed1995

[Recommendations for the diagnosis and therapy of insomnia. German Society of Sleep Research and Sleep Medicine DGSM].

There exist a variety of American and European recommendations regarding treatment with hypnotics, especially the duration of treatment. The German Sleep Society now publishes its own view to help physicians to cope with these different recommendations, some of which are contradictory. Therapy with hypnotics must include substantial information on the type of drug, dose, timing and duration as well as information about the possibility of interval treatment. Agonists at the benzodiazepine receptor, like the conventional benzodiazepines and zopiclone or zolpideme, are indicated in short-lasting adjustment insomnia as well as in long-lasting psychophysiological insomnia. Regarding the duration of prescription the German Sleep Society recommends a period of 14 days in de novo patients, which can be repeated once only. In persisting insomnias further approaches should disregard benzodiazepine receptor agonists, but rely on other classes of substances such as tricyclic antidepressants instead. If such approaches are ineffective, the intake of benzodiazepine receptor agonists may be extended to 6 months, when a sleep log and objective observations have documented a true sleep deficit, when daytime impairment arises, when daytime impairment arises, when rebound insomnia, organic or mental insomnias and dependencies have been excluded, and when the indication is monitored at 14-day intervals. If the insomnia persists, during and in spite of therapy a specialist in sleep medicine should be consulted. If therapy is still ineffective after 3 months of daily treatment, a sleep laboratory should be consulted.

Anti-Anxiety Agents↗
PubMed1995

[Implementation and evaluation of quality circles in general practice].

In the beginning of 1993, society of panel doctors Südbaden, Germany, has constituted a group of experts from the Department of General Medicine of the university hospital and practising general practitioners (GPs) to develop an organisational and conceptional framework for setting up quality circles. At present, 23 quality circles with 6-12 participants are holding regular meetings every 4 to 8 weeks in the region of Südbaden. The group members, who are all physicians working in primary health care, are selecting and discussion topics which are important in general practice. In order to facilitate the discussions, the research group has developed predefined guidelines covering a wide range of common and important conditions in general practice (Hypertension, sleeping disorders, diabetes mellitus, COPD, dementia, lower back pain, cardio-vascular disease, depression, headache, vertigo etc). In presenting these structurized guidelines, the moderator prompts and encourage the group members to identify common problems in their own practices. The use of these guidelines in, quality circles and research may provide a starting point for developing consensus guidelines. The quality circle projects is given as systematic evaluation for both participants and moderators at different levels. Main objectives of the assessment are the recruitment, motivation and the specific goals of general practitioners to participate in quality circles. Currently, we are evaluating the development of quality circle for a period of 18 months.

Education, Medical, Continuing↗
PubMed1995

Pregnancies in women with diabetic nephropathy: long-term outcome for mother and child.

In order to improve the basis upon which to advise women with diabetic nephropathy about pregnancy, we studied the effect of diabetic nephropathy on the course of pregnancy, perinatal outcome, infant development and long-term outcome of the mothers. All pregnancies of women with diabetic nephropathy (defined as proteinuria > 400 mg/day (n = 26), creatinine clearance < 80 ml/min and hypertension in the first trimester (n = 10)) followed at our centre from 1982 to 1992 were identified (34 White class F and 2 White class T) and the women and their children re-examined in the spring 1993. From the first to the third trimester the percentage of women with proteinuria over 3 g/day increased from 14 to 53% and those treated with antihypertensive medication from 53 to 97%. There were no intrauterine or perinatal deaths, but one child died suddenly 4 weeks postpartum. Of 36 newborns (gestational week at birth 36(3), birth weight 2384(834) g)), 11 were born before week 34 and 8 had respiratory distress syndrome. Renal function in the first trimester, diastolic blood pressure in the third trimester and an HbA1c above normal were predictive of gestational age at delivery and low birth weight (stepwise regression analysis). At follow up of the children (n = 35, age 4.5 (0.4-10) years) the majority (n = 27) were normally developed but seven had psychomotor retardation (four of them major). One child had a severe motor retardation due to a congenital anomaly. At follow up, 21 of the 29 mothers had preserved renal function (creatinine 1.3 (0.8-4.3) mg/dl and 8 had developed end stage renal disease and required dialysis (2 of whom were White class T) within 3 (1-9) years postpartum.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Treatment of panic disorders and agoraphobia. Psychotherapy, psychopharmacotherapy and their combination].

During the last two decades substantial progress has been achieved in the development and evaluation of effective treatment approaches to panic disorder and agoraphobia. Many clinical research studies in this area were begun after the definition of operationalized diagnostic criteria for panic disorder and agoraphobia in the DSM-III in 1980. Different concepts concerning the etiology, pathogenesis and maintaining factors of these disorders are still controversial. At the beginning of this controversy, psychopharmacological treatment was believed to suppress spontaneous panic attacks while behavioral treatment mainly focused on anticipatory fears and avoidance behavior. Meanwhile both treatment approaches have proved their effectiveness in reducing panic attacks and agoraphobia. Therefore, it was hypothesized that a combination of both individual treatments could enhance therapeutic efficacy. The few studies examining this question did not allow clear conclusions because of methodological shortcomings. In the short run, there seems to be a trend for better results with combined treatment. In the long run, however, combined therapy has not been observed to be superior to cognitive-behavioral therapy without any psychopharmacological support. In practice, adverse side effects restrict the application of psychopharmacological approaches. On the other hand, qualified cognitive-behavioral therapists are not always available, or patients are referred to them by general practitioners and psychiatrists after a delay. Criteria for the application of behavioral therapy, psychopharmacological therapy and their combination are proposed and discussed.

Agoraphobia↗
PubMed1995

[Interferon-alpha controls HPV infection in cervix epithelium].

UNLABELLED: Decreased immune response is necessary for a prolonged HPV-infection and allows HPV to be virulent as an oncogene. This study shows that HPV-infection in cervical epithelium is determined by the immune system and IFN-alpha can be shown to be a prognostic parameter for the HPV-infection. The cytokines (IFN-alpha, IFN-gamma, and TNF-alpha) from stimulated peripheral blood mononuclear cells (PBMC) were measured using monoclonal IFN-antibodies and ELISA test. To detect HPV-16, PCR (e6 and e7 areas) was used, followed by southern-blot of the PCR-products. In all of our patients (n = 139) no cytological change was observed in the cervical epithelium over a period of 3 years. Comparison was made between 3 groups: 1: controls (n = 89, HPV-pos. n = 6) 2: registered prostitutes without drug abuse (n = 30, HPV-pos. n = 6) and 3: HIV-infected, previous drug users (CDC II, n = 20, HPV-pos. n = 2). RESULTS: The stimulated IFN-alpha values are highest in the control collective (169 +/- 35 U/ml) and are significantly lower in the prostitutes (98 +/- 26 U/ml, p < 0.05) and in the HIV-infected group (49 +/- 15 U/ml, p < 0.01). The difference between the latter groups being significant as well (p < 0.05). Dividing the controls into HPV-16 positive and HPV-16 negative subgroups, the IFN-alpha values are significantly higher in HPV-16 negative group (193 +/- 48 U/ml) compared to HPV-16 positive group (38 +/- 3 U/ml, p < 0.05). Also in the collective of prostitutes and HIV infected patients there is a similar significant difference between the HPV-16 positive and HPV-16 negative patients (Prostitutes: HPV-16 negative = 94 +/- 21 U/ml, HPV-16 positive = 36 +/- 7 U/ml, p < 0.05; HIV-infected: HPV-16 negative = 35 +/- 13 U/ml, HPV-16 positive = 13 +/- 3 U/ml).

AIDS-Related Opportunistic Infections↗
PubMed1995

[Quality control in peripheral vascular surgery].

Indications and modalities of quality control in infrainguinal bypass surgery are reviewed and discussed. A concept and an armamentarium for its practical use are presented. The majority of graft occlusions occur during the first postoperative year. Most failures in the first month are due to technical errors. Many of these can be detected by intraoperative completion control, and immediately repaired. This contributes to improved graft patency rates. In the further course, myo-intimal hyperplasia accounts for most graft stenoses and occlusions. If stenoses are detected and dilated before occlusion occurs, long-term patency is but little impaired. Conversely, patency rates are clearly inferior in grafts following thrombectomy or thrombolysis. Therefore, identification of failing grafts and avoidance of failure are the objectives of surveillance. We have followed routinely a surveillance program since 1991. During surgery, grafts were controlled by completion angiography. Arterial pressures were measured and the ankle-brachial index calculated postoperatively and 1, 3, 6 and 12 months after surgery. In addition, a number of grafts were followed by duplex sonography. Data were stored in an electronic data base featuring several interactive functions. E.g., ankle-brachial and duplex-sonography indices were calculated and rated automatically according to current criteria. Secondary patency after 18 months was 86 per cent in suprageniculate femoro-popliteal bypass grafts, 84 per cent in infrageniculate and 65 per cent in crural (n = 19/23/27).

Blood Vessel Prosthesis↗
PubMed1995

[Chronotherapeutic approaches in depressive disorders].

Sleep deprivation has been regarded as a beneficial treatment modality for about 60% of patients with Major Depressive Disorder. Unfortunately, however, more than 80% of the improved patients relapse into depression after the next night of sleep. In the present study we tried to prevent relapses into depression after successful total sleep deprivation (TSD) by treating 27 patients suffering from a Major Depressive Disorder according to DSM-III-R with a combination of sleep deprivation with consecutive sleep phase advance for 1 week. Advancing the sleep period to 5.00 p.m. until 12.00 p.m. following TSD and then gradually shifting back by 1 h daily the sleep period to the normal phase position (11.00 p.m. until 6.00 a.m.) prevented 61% of these patients from relapsing into depression. Thus, the combination of sleep deprivation with consecutive sleep phase advance has been proven to be an effective antidepressant treatment besides other well established antidepressive treatment modalities.

Adult↗
PubMed1995

[Case report: treatment of a patient with sleep phase advance disorder with phototherapy].

We report on a patient with a moderate form of a sleep-phase advance syndrome. As a biological correlate we found an early temperature and cortisol minimum before midnight, respectively. Light therapy during the evening hours (2500 Lux) given over 17 months induced a complete remission of the symptoms. The good treatment outcome could be maintained after the end of daily light therapy by only sporadic application.

Adult↗
PubMed1995

The start in speed skating: from running to gliding.

The purpose of this study was to describe the push-off kinematics in speed skating using three-dimensional coordinates of elite male sprinters during the first part of a speed skating sprint. The velocity of the mass center of the skater's body VC, is decomposed into an "extension" velocity component VE, which is associated with the shortening and lengthening of the leg segment and a "rotational" velocity component Vr, which is the result of the rotation of the leg segment about the toe of the skate. It can be concluded that the mechanics of the first strokes of a sprint differ considerably from the mechanics of strokes later on. The first push-offs take place against fixed location on the ice. In these "running-like" push-offs the contribution of Vr in the forward direction is larger than the extension component Ve. Later on, the strokes are characterized by a gliding push-off in which Ve increases. In these gliding push-offs no direct relation exists between forward velocity of the skater and the extension in the joints. This allows skaters to obtain much higher velocities than can be obtained during running.

Acceleration↗