Biomedical subjects

M Berger

Publications and source records attributed to M Berger.

At least 1,225 records · Page 68Linked to original sources

PubMedDate not supplied

Antipsychotic efficacy of the antidepressant trimipramine: a randomized, double-blind comparison with the phenothiazine perazine.

BACKGROUND: The tricyclic antidepressant trimipramine exhibits several features (e. g., dopaminergic effect, molecular structure similar to a neuroleptic, receptor-binding profile similar to clozapine) that suggest its potential as an antipsychotic medication. The aim of the study was to investigate the antipsychotic potential of trimipramine in a controlled clinical trial comparing its antipsychotic efficacy with that of a neuroleptic. METHOD: In a German multi-center, randomized, double-blind trial, the antipsychotic efficacy of trimipramine was compared with that of the phenothiazine neuroleptic perazine, using the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impressions (CGI). Antidepressant efficacy of both agents was measured by use of the Bech-Rafaelsen Melancholia Scale (BRMES). Ninety-five patients with acute schizophrenia (DSM-III-R) and a BPRS total score > 40 at baseline were treated with either 300-400 mg trimipramine or 450-600 mg perazine for 5 weeks. RESULTS: Therapeutic equivalence of both treatments (in the dosages used) could not be demonstrated (change in BPRS total score, per-protocol [PP] analysis, one-sided equivalence testing). However, intention-to-treat (ITT) as well as PP analysis showed a statistically significant decrease in the BPRS total scores in both treatment groups (PP: trimipramine, 56.5 +/- 9.8 to 44.1 +/- 17.9; perazine, 56.4 +/- 10.8 to 37.9 +/- 12.9). Significant decreases in all BPRS and PANSS subscores as well as CGI results and response rate support the antipsychotic efficacy of trimipramine. The BRMES total scores significantly decreased in both treatment groups without showing a significant difference between the two agents. Trimipramine was better tolerated than perazine and did not elicit extrapyramidal symptoms. CONCLUSION: Trimipramine failed to exhibit therapeutic equivalence to perazine in the dosages used. However, there was evidence of a substantial antipsychotic effect of trimipramine. It may be a useful medication if depressive symptoms in psychotic patients require antidepressant treatment or if other antipsychotics cannot be administered.

Antidepressive Agents↗

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Complement deficiency and neutrophil dysfunction as risk factors for bacterial infection in newborns and the role of granulocyte transfusion in therapy.

The similarity in the susceptibility to bacterial infections of newborns and older patients with complement deficiencies, neutropenia, or neutrophil function defects has suggested that neutrophils and/or complement might also be defective in newborns. Although no individual element of the phagocytic host defense system is severely deficient, several partial deficiencies have been identified. These involve important amplification pathways of complement and neutrophil activation and may combine to cause significant decreases in phagocyte activity at sites of infection. Because of decreased specific antibody, initial activation of the classical complement pathway is decreased. Low levels of C3 and factor B decrease amplification by the alternative pathway and result in marked decreases in opsonization and generation of chemotactic activity from C5. There are also quantitative and qualitative neutrophil defects. The recent observations that newborns' neutrophils are relatively deficient in membrane expression of their major adherence protein/C3bi receptor help explain the decreased mobility and phagocytic activity of these cells. Thus, several partial deficiencies combine to cause severe impairments in delivery of neutrophils to sites of infection and contribute to the increased susceptibility of the newborn to infection.

Bacterial Infections↗

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Targeted immunoglobulin therapy for the prevention of neonatal infections.

Premature infants demonstrate hypoglobulinemia and are at increased risk for serious infections. Although a cause-and-effect relation between low serum IgG levels and neonatal infections has not been established, prophylaxis of such severe infections may be possible by replacement of antibody with intravenous immunoglobulin (IVIG). For success, IVIG must provide specific antibodies to neonatal pathogens and reach therapeutic serum IgG target levels. Pilot investigations have demonstrated that IVIG reduces the incidence of bacterial sepsis among premature infants. Infants received IVIG every 2 weeks (or more frequently) until they weighed 2,000 g. Serum IgG levels were monitored after each dose so that the dose could be adjusted to achieve a target IgG level greater than 700 mg/dL. The observation that infection among placebo-treated patients occurred when the serum IgG level declined to less than 400 mg/dL suggests the importance of achieving a target level. In our preliminary analysis, the IVIG used did not reduce the incidence of infection with respiratory syncytial virus (RSV) and rotavirus or of necrotizing enterocolitis. That the lot of IVIG used did not contain significant antibody to RSV or rotavirus emphasizes the importance of pathogen-specific antibody. Because of the preliminary nature of these results and the potential for undetermined short-term and long-term sequelae, we do not recommend the indiscriminant use of IVIG for prevention or treatment of neonatal infections.

Humans↗

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Diagnosis and successful management of septal myocardial abscess: a complication of bacterial endocarditis.

A case of acute enterococcal aortic valve endocarditis is presented in which the complication of a septal myocardial abscess was diagnosed clinically and successfully treated surgically. This represents the first instant, to our knowledge, in which the preoperative diagnosis of a myocardial abscess served as the indication for emergency cardiac surgical intervention in active endocarditis with successful outcome. The diagnostic parameters permitting clinical recognition of a myocardial abscess include the development of advancing degrees of atrioventricular and bundle branch block, and the finding of pericarditis or pericardial effusion in aortic valvular infections. Two additional findings were noted in the present case: echocardiographic evidence of septal thickening, and loss of septal Q waves on the electrocardiogram. Since myocardial abscesses do not respond to medical therapy, continuous electrocardiographic monitoring and frequent echocardiographic determinations are recommended in cases of active aortic valve endocarditis to permit early diagnosis and surgical management of this complication.

Abscess↗

PubMedDate not supplied

A multi-institutional retrospective study of intracranial ependymoma in children: identification of risk factors.

PURPOSE: The goal of this multi-institutional retrospective study of children with intracranial ependymoma was to identify risk factors associated with unfavorable overall survival (OS) and event-free survival (EFS). PATIENTS AND METHODS: Clinical data, including demographics, tumor location, spread, histology, details of surgery, radiation treatment, and chemotherapy were collected. Clinical characteristics and univariate and multivariate analyses of risk factors for OS and EFS are presented. RESULTS: Eleven U.S. institutions contributed 83 patients treated from 1987 to 1991. The OS at 5 and 7 years was 57% and 46%, and EFS at 5 and 7 years was 42% and 33%. Patients 3 years of age or younger differed from the older group by more common infratentorial location, less common gross total resection (GTR), and postoperative use of chemotherapy rather than radiation. This younger group of patients had worse survival (P < 0.01) than the older age group. Other than young age, less than GTR and World Health Organization (WHO) II grade 3 histology were significant adverse risk factors for EFS in univariate and multivariate analyses. OS shared the same adverse risk factors except for histology in multivariate analysis, which was only of borderline significance (P = 0.05). Progression at the original tumor location, present in 89% of patients, was the major pattern of tumor recurrence. Adjuvant chemotherapy in the group older than 3 years or craniospinal radiation in M0 patients did not significantly change EFS. CONCLUSIONS: Adverse outcome in childhood intracranial ependymoma is related to age (3 years or younger), histology (grade 3), and degree of surgical resection (less than GTR). New approaches, particularly for local tumor control in younger patients, are needed to improve survival.

Brain Neoplasms↗

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Pediatric spine tumors with spinal cord compromise.

Twenty-nine pediatric spine tumor patients with neurologic deficit were reviewed retrospectively to evaluate tumor control, neurologic course, spinal deformity, and response to treatment. Diagnoses included 10 neuroblastomas, nine sarcomas, eight astrocytomas, and two lymphomas. Mean duration of symptoms at presentation was 8 weeks. Mean clinical follow-up was 7 years 4 months, with patient survival of 66% and a local recurrence rate of 34%. Twenty-four percent (seven of 29) of patients recovered minimal neurologic function with treatment, 76% (22 of 29) showed significant recovery, and two thirds (20 of 29) developed spinal deformity. The initial clinical response to chemotherapy appeared to be most pronounced in sarcoma patients (66% positive response).

Adolescent↗

PubMedDate not supplied

Diabetes care based upon self-monitoring and self-treatment by the patient.

Successful diabetes care can be effectively symbolized and explained when looking at the Joslin emblem, which depicts the three bases of diabetes therapy in the form of three horses arranged in a Troika-like formation. These three horses, standing for insulin, exercise, and diet are supposed to carry the Troika to victory, i.e. through therapy is a patient's life handicapped to the least possible extent by diabetes. For someone who knows something about horses and/or looks closely at how these animals are depicted by the artist, it is quite clear that they are not only strong, and thus effective, but that they have a distinct tendency to revolt, to break out to the right or the left. Thus, whether or not the Troika can proceed to victory safely in a straight line at speed depends largely on whether the driver is able to balance the forces of these three horses against each other. The main mistake diabetologists have made in the past decade can also be exemplified using this picture: many (if not all) of them have thought that the driver of the Troika represented the physician. This, of course, was a tragic error: it is, without any doubt, the patient who has to run the Troika, and it is the patient who has to lead and balance the wild horses and to keep the carriage on a straight road to victory by constantly being alert and responsible. The physician is not in the picture at all.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗

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Scintigraphy of the sacroiliac joint region in asymptomatic riding horses: scintigraphic appearance and evaluation of method.

The sacroiliac region in 33 clinically normal riding horses was examined with scintigraphy to determine the normal scintigraphic appearance, to evaluate a semiquantitative method used to calculate a sacroiliac joint (SI joint) ratio, and to identify factors that affect the scintigraphic appearance of the pelvis. The scintigraphic examination included dorsal views of each SI joint region and one lateral view of the urinary bladder. Two predefined areas (the SI joint and the area between the tuber sacrale and the SI joint) were evaluated subjectively by comparing the intensity in each area to the intensity in the tuber sacrale, and a semiquantitative method was applied on the images to calculate an SI joint ratio. The thickness of the muscle mass overlying each SI joint was measured by using ultrasound. A corrected ratio was calculated based on a corrected pixel count for each SI joint. Of 29 evaluated horses, 28 had normal radiotracer uptake in the SI joints and 10 horses had symmetric normal radiotracer uptake in the area between the tuber sacrale and the SI joint. The mean SI joint ratio was 0.53 on both the left and right sides, and the mean corrected SI joint ratio was 2.15 on the left side and 2.13 on the right side. Factors that affect the scintigraphic appearance of the pelvis were identified and included attenuation, radioactive urine, and muscle symmetry. The muscle thickness ranged from 8-11 cm, causing 71-82% attenuation. Radioactive urine in the urinary bladder was located ventral to the SI joint region in 16 horses, and four of these were excluded from further evaluation because of risk of misinterpretation. A visual assessment of symmetry of the horses' gluteal muscle mass was compared with the ultrasound measurements. Fourteen horses (14/33) were regarded symmetric by both techniques. Soft tissue attenuation was found to severely compromise the result and indicated that only lesions in the SI joint with severely increased radiotracer uptake can be detected with scintigraphy. Knowledge about presence of radioactive urine ventral to the SI joint region and assessment of muscle symmetry is essential for a correct subjective evaluation. Any situation with difference in muscle mass between the left and right side of the pelvis will give a false impression of increased radiotracer uptake on the side with lesser muscle mass.

Animals↗

PubMedDate not supplied

Evaluation of the German version of the PTSD Symptom Scale (PSS).

The psychometric properties of the PTSD Symptom Scale (PSS) were evaluated in a clinical sample of severely injured in-patients after a traffic accident (n = 123). The PSS contains 17 items which were derived from the DSM-III-R criteria of posttraumatic stress disorder (PTSD). The results indicate that the PSS has satisfactory reliability and validity (internal and external). The results are in correspondence with the results of Foa et al. using a sample of rape and non-sexual-assault patients.

Accidents, Traffic↗

PubMedDate not supplied

The peritoneal route as a safe pathway for early in utero therapies: illustration by a 12-year follow-up after conservative management of severe Rhesus allo-immunization.

OBJECTIVE: We report a case of an extremely severe Rhesus allo-immunization treated very early in pregnancy 12 years ago. METHODS AND RESULTS: After chorionic villus sampling at 12 weeks for fetal blood phenotyping, two intraperitoneal transfusions at 14 and 15 weeks were given followed by two intravascular and seven exchange transfusions. A girl weighing 2,940 g was delivered vaginally at term after external cephalic version for breech presentation. To date her neurological and social development is normal. CONCLUSIONS: Since the success of haematopoietic stem cell transplantations for the treatment of congenital haematologic diseases could imply early and repetitive procedures, this observation enlightens the technical feasibility of such an invasive approach and its relative safety for subsequent development.

Adult↗

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Obesity and hypertension: cardiovascular response of weight reduction.

There is a close epidemiological association between obesity and blood pressure for all age groups, although not every obese individual becomes hypertensive. In populations without age-related increases in body weight, an elevation of blood pressure with age is not seen. Treatment of obesity by weight loss decreases blood pressure substantially; however, in a minority of patients blood pressure does not fall with weight loss. Blood pressure generally decreases before normal weight is achieved. Blood pressure after weight loss remains reduced as long as there is no marked regain of body weight. Salt intake reduction does not appear to explain why weight reduction lowers blood pressure. Reduced levels of plasma renin activity, serum aldosterone levels, catecholamine levels, and serum insulin levels may be involved in the blood pressure lowering associated with weight loss. Since the risk to the hypertensive patient is not only determined by the blood pressure, an overall treatment that aims at reduction of all risk factors is advocated. Some risk factors, e.g., glucose intolerance, may be normalized only when desirable weight is achieved. Thus, in any obese hypertensive patient with other risk factors, normalization of excess body weight appears to be the first the most important step of any rational therapeutic strategy.

Adolescent↗

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Hepatic and peripheral glucose metabolism in intensive care patients receiving continuous high- or low-carbohydrate enteral nutrition.

BACKGROUND: The suppression of endogenous glucose production during parenteral nutrition is impaired in critically ill patients. It is, however, unknown whether enteral administration of carbohydrates, which normally promote hepatic glucose uptake, improves hepatic glucose metabolism in such patients. METHODS: We studied two groups of 7 patients during a 3-day continuous isocaloric enteral nutrition. A high-carbohydrate, low-lipid (EN-C) or a high-lipid, low-carbohydrate (EN-L) nutrient mixture was administered. RESULTS: Endogenous glucose production assessed with [2H7]glucose was similarly increased in both groups, indicating absence of its suppression by carbohydrate feeding. Gluconeogenesis estimated from [13C]glucose synthesis during [13C]bicarbonate infusion also was not suppressed by EN-C compared with EN-L. Systemic appearance of exogenous glucose was monitored by enteral infusion of [6,6-2H]glucose and was not different from the rate of glucose equivalent administered enterally, indicating no significant hepatic uptake of glucose in both groups. Plasma glucose and insulin concentrations were slightly higher with EN-C, although not significantly, and plasma triglycerides were similar in both groups. Both nutrition formulas were well tolerated clinically. CONCLUSIONS: These results indicate that enteral carbohydrate administration, whatever its quantity, fails to suppress endogenous glucose production and to promote net splanchnic glucose uptake in critically ill patients.

Adult↗

PubMedDate not supplied

Rapid hypertensinogenic effect of lead: studies in the spontaneously hypertensive rat.

Chronic lead exposure may cause hypertension in normotensive rats. This hypertensinogenic effect has been attributed to perturbations in the renin-angiotensin axis, the contractile response of the vascular smooth muscle, or the intracellular Ca2+ homeostasis as a consequence of the inhibition of Na(+)-K(+)-ATPase activity. In this study we examined the short-term effect of lead exposure on blood pressure, plasma renin activity, vascular contractility, and renal Na(+)-K(+)-ATPase activity and abundance in the spontaneously hypertensive rat. Our data indicate that modest lead exposure caused blood pressure elevation within two weeks in this rat strain that is genetically susceptible to the development of hypertension. This rapid blood pressure-elevating effect did not appear to depend on the mechanisms described in hypertension associated with more chronic lead exposure listed above. This acute model provides an additional approach to the study of lead-induced hypertension.

Animals↗

PubMedDate not supplied

Rapid prediction of individual dosage requirements for lignocaine.

The mean and standard deviation of lignocaine (lidocaine) pharmacokinetic parameters in a patient population were determined on the basis of 327 serum concentration measurements obtained in 42 patients treated for ventricular arrhythmias. The application of a Bayesian forecasting method, which uses the estimates of the population parameters and 1 or 2 serum concentration measurements as feedback information, was tested retrospectively in 17 of the 42 patients (group I, 32 levels), and prospectively in 10 additional patients (group II, 20 levels). With 1 individual feedback concentration, sampled 2 to 4 hours after the start of lignocaine infusion, serum concentrations at 12 and 24 hours could be accurately predicted. The prediction error (measured minus predicted concentration) ranged between -1.2 and +1.6 (mean -0.03) mg/L in group I, and from -0.7 to +1.5 mg/L (mean +0.13) mg/L in group II; the correlation coefficient of measured and predicted levels were 0.92 and 0.86, respectively. In contrast, a prediction of lignocaine concentrations in these patients using only population parameters without feedback was poor: range of the prediction error = -3.1 to +3.0 mg/L (mean = +0.001 mg/L, r = 0.63, groups I and II, n = 52). The results demonstrate that with the Bayesian forecasting technique, accurate assessment of individual dosage requirements can be obtained within a few hours after starting lignocaine therapy.

Adult↗

PubMedDate not supplied

Interaction between plastic catheter tubings and regular insulin preparations used for continuous subcutaneous insulin-infusion therapy.

In search of possible interactions between plastic tubings used for insulin-pump treatment and commercial regular insulin preparations, various catheter sets made from polyvinyl chloride (PVC), polyethylene (PE), and nylon plastics were perfused at 30 degrees C in a laboratory setting for up to 72 h. The perfused insulin solutions were analyzed by high-performance liquid chromatography and atomic absorption spectroscopy. Although no plasticizer, e.g., dioctyl phthalate, or nickel or chromium ions were found in the perfusates, substantial interactions between the plastics and the insulin solutions were detected, extraction of bacteriostatic additives from the insulin solutions in particular. The PVC retained up to 88% of the bacteriostatics from the insulin preparations, whereas PE tubings retained only 10-15%. Whether the loss of preservatives during perfusion through PVC catheters predisposes to cutaneous infections during insulin-pump therapy remains to be shown.

Catheterization↗

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Less expensive, reliable blood glucose self-monitoring.

We examined the reliability of split test strips for blood glucose self-monitoring. One hundred visual readings were performed with each of the following test strips: original Haemoglukotest 20-800 (HGT 1/1; Boehringer-Mannheim, Mannheim, FRG) and Haemoglukotest 20-800 halved either by a splitting device (HGT 1/2 SP) or by a pair of scissors (HGT 1/2 SC). Within the plasma glucose range of 20-360 mg/dl, there was a close correlation between the results of all three test-strip readings and the values obtained by the reference method (Beckman glucose analyzer): HGT 1/1, r = .950; HGT 1/2 SP, r = .966; and HGT 1/2 SC, r = .966. Absolute deviations from the reference values were 17 +/- 2, 17 +/- 1, and 17 +/- 1 mg/dl (mean +/- SE). Analysis of variance did not reveal any significant differences between the values of each of the three procedures compared with the reference method (P = .98). These results indicate that visual reading of split test strips is as reliable as the reading of original test strips. A special splitting device is not necessary. Diabetic patients should be advised to use split test strips for blood glucose self-monitoring to reduce costs.

Analysis of Variance↗

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Acute cutaneous complications and catheter needle colonization during insulin-pump treatment.

Forty unselected type I (insulin-dependent) diabetic patients with insulin pumps were examined three times for cutaneous complications and bacterial colonization of their subcutaneous catheter needles. Fifty-eight of the 120 needles were contaminated, 42 of them with Staphylococcus epidermis. Cutaneous complications, i.e, erythema of greater than or equal to 1-mm diam at the needle-insertion site, were seen with similar frequency. Significantly fewer (P less than .001) cutaneous complications and contaminated needles were found when a disinfectant was sprayed on the skin before insertion of the needle. The results indicate that infection along the indwelling subcutaneous needle contributes substantially to cutaneous complications during continuous subcutaneous insulin infusion and that these complications can successfully be prevented by appropriate antiseptic measures.

Adult↗

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Computer simulation of plasma insulin and glucose dynamics after subcutaneous insulin injection.

We developed a computer program for the simulation of plasma insulin and glucose dynamics after subcutaneous injection of insulin. The program incorporates a pharmacokinetic model to calculate the time courses of plasma insulin for various combinations of popular preparations (regular, NPH, lente, and ultralente). With the use of a pharmacodynamic model describing the dependence of glucose dynamics on plasma insulin and glucose levels, the program can predict the expected time course of plasma glucose in response to a change in carbohydrate intake, insulin dose, timing, or regimen. A set of typical parameters has been obtained by analysis of data from the literature. The results of several computer simulations are presented showing the effect on a 24-h insulin and glucose profile of systematically changing insulin regimen, dose, timing of meals, or timing of preprandial insulin administration. The program can be used to explore on a theoretical basis the impact of various factors associated with glycemic control in insulin-dependent diabetes mellitus. As an educational tool, the program provides a realistic environment for demonstration of the combined or isolated effects of insulin and diet on glycemia.

Absorption↗