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Biomedical subjects

M David

Publications and source records attributed to M David.

At least 829 records · Page 46Linked to original sources
PubMedDate not supplied

[The probability of spontaneous delivery -- possibility and limits of obstetric risk scores].

QUESTION: For a sound consultation of pregnant women e. g. regarding the choice of delivery place, a simple, reliable prepartal risk estimation system would be desirable. METHODS: After exclusion of all "hospital required" risk cases, out of 203,111 records from the Berlin Clinical Perinatal Data 1993 - 1999 176,734 births remained, for which all risks already discernible before delivery (catalogues of the German Maternity Guidelines) were retrospectively valued and weighted by means of a logistic regression analysis on their real importance for the prediction of a spontaneous birth. On the basis of logarithms of the odds ratio for the individual risk factors a point system was developed. RESULTS: There is a clearly higher risk for a surgical delivery in primiparae compared with multiparae. For multiparae 27, for primiparae 26 statistically significant (p < 0.01) risk factors could be identified. After conversion of the odds ratio-values into the point system of the score, for the group of primiparae the cut off value was > 1 point (with a specificity of 0.5 and a sensitivity of 0.5), in the multiparae > 3 points (sensitivity 0.7, specificity 0.7). CONCLUSIONS: As for primiparae the resulting prognosis of birth mode (spontaneous vs. surgical birth) using the described score is false at 46 %, in multiparae at 33 %, the prognosis power of the risk score can therefore only be classified as relatively poor. The risk assessment system is therefore not suitable e. g. as aid to decision-making for or against an extra-clinical delivery place where no obstetrical operations are possible.

Adolescent↗
PubMedDate not supplied

[Aromatase inhibitors--theoretical concept and present experiences in the treatment of endometriosis].

The medical treatment of endometriosis needs to be optimized. Therapeutic management strategies of endometriosis-associated pain or recurrent disease is primarily aimed at downregulating the ovarian function or at antagonizing the effect of estrogen in ectopic endometrial implants. In this context, basic research is delivering powerful tools for the possible development of new, specific treatment modalities. Recently, aromatase overexpression has been detected in endometriotic tissue. Aromatase (p450arom) is responsible for conversion of C19 androgens to estrogen in several human tissues. Aromatase activity gives rise to local estrogen biosynthesis, which, in turn, stimulates prostaglandin E(2) production by upregulation of cyclooxygenase-2 (COX-2), thus establishing a positive feedback cycle. Another abnormality in endometriosis, i. e. the deficiency in 17 beta-hydroxysteroiddehydrogenase type-II (17 beta-HSD-Type-II) expression, impairs the inactivation of estradiol to estrone. In contrast to the eutopic endometrium, these molecular aberrations collectively favour accumulation of increasing amounts of local estradiol and prostaglandin E(2) in endometriosis. In several human cell lines, prostaglandin and estrogen concentrations are associated with proliferation, migration, angiogenesis, apoptosis resistance, and even invasiveness. Consequently, aromatase and COX-2 are promising new therapeutic targets. In summary, specific aromatase inhibitors (such as Letrozole, Anastrozol or Exemestan) or selective COX-2 inhibitors (e.g. Celecoxib, Rofecoxib) are of great interest to be studied in clinical trials in premenopausal woman with endometriosis to extend the spectrum of currently available treatment options.

Aromatase↗
PubMedDate not supplied

[Incidence of increased serum Helicobacter pylori IgG antibodies in children with and without chronic abdominal pain].

The prevalence of Helicobacter pylori (HP) IgG antibodies was analysed in a group of 142 asymptomatic children (group A) and in 31 pediatric patients (group B) with recurrent abdominal pain. HP IgG antibodies were measured by a commercially available fluorescence-enzyme immuno-assay test (Heloritest IgG, Fa Eurospital). In asymptomatic children the prevalence of HP IgG antibodies increased significantly with age from 17% with 6 years to more then 40% with 14 years. A higher prevalence of HP IgG antibodies was found in children living in more crowded housing conditions. Comparing the number of HP IgG positive children in group B (58%) to a matched population from group A (35%) no statistically different prevalence rates were found. Thus HP IgG antibodies are found in similar frequencies, in both, symptomatic and asymptomatic children. Therefore the presence of HP-IgG antibodies does not necessarily indicate that the HP infection is the cause for the recurrent abdominal pain in these children.

Abdominal Pain↗
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Cytokine profile of patients with mycosis fungoides and the immunomodulatory effect of AS101.

Cytokines are known to play a major role in the pathogenesis of mycosis fungoides, a cutaneous malignant neoplasm of CD 4 T cells. In the present study, we investigated the effect of AS101, a tellurium-based compound with immunomodulating properties, on the pattern of lymphokine production by peripheral blood mononuclear cells (PBMCs) from patients with mycosis fungoides. PBMCs were isolated from 35 patients with mycosis fungoides stage IA and IB before initiation of treatment and from 20 healthy sex and age-matched controls. Unstimulated and phytohaemagglutinin-stimulated PBMCs were tested with and without the addition of AS101. The production of interferon-gamma, interleukin 2 (IL-2), IL-2 receptor (IL-2R), interleukin 5 (IL-5) and interleukin 10 (IL-10) was determined by enzyme-linked immunosorbent assays. The effects of AS-101 on mycosis fungoides PBMCs were compared to those of healthy donor PBMCs. Significantly higher levels of IL-2R, IL-5 and IL-10 and significantly lower levels of interferon-gamma were found in the patients compared to the controls. There was no significant difference between the groups in the production of IL-2. AS101 inhibited the production of IL-2R, IL-5 and IL-10 and induced a significant increase in IL-2 levels in the mycosis fungoides PBMCs. These findings may have important clinical implications for the possible therapeutic benefit of AS101 in mycosis fungoides.

Adjuvants, Immunologic↗
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Distribution of mucosal pH on the bucca, tongue, lips and palate. A study in healthy volunteers and patients with lichen planus, Behçet's disease and burning mouth syndrome.

Saliva coating all oral surfaces has a buffering capacity that neutralizes bacterial and cariogenic acids. The aim of our study was to determine the surface pH in different regions of the oral cavity in healthy volunteers and in patients with diseases affecting the oral mucosa. Oral pH was measured with a flat glass electrode on the anterior third of the ventral surface of the tongue, middle hard palate, buccal mucosa and inner lips in 32 healthy volunteers, 12 patients with Behçet's disease, 23 patients with oral lichen planus, and 11 patients with burning mouth syndrome. The present study showed that there was an uneven distribution of oral surface pH. The palate had a higher pH than most other sites in all groups, and in patients with lichen planus, the palate pH was higher than that in healthy controls. Those with dentures had lower pH values in the hard palate than dentate patients. The relatively high pH in the palate region in all patient groups as well as healthy volunteers needs to be further studied to clarify its mechanisms and clinical relevance.

Adult↗
PubMedDate not supplied

Congenital Wells syndrome.

We describe a girl with eosinophilic cellulitis (Wells syndrome) in whom the disease appeared immediately after birth with subcutaneous nodules on the scalp and trunk, followed by the characteristic skin swelling and erythema at the age of 6 months. The lesions disappeared after a few weeks, but recurred several times. The mother had consumed large quantities of medications during the pregnancy, including iron, vitamins, and "natural remedies." Based on time of onset, this may be regarded as a unique case of congenital Wells syndrome. Its relation to the medications taken by the mother remains speculative. Subcutaneous nodules may be the presenting sign of Wells syndrome in children.

Cellulitis↗
PubMedDate not supplied

Very low maternal serum unconjugated estriol and prenatal diagnosis of steroid sulfatase deficiency.

Twenty-four women out of 7,875 pregnant women who enrolled in a prenatal screening program showed extremely low levels of unconjugated estriol (< 0.15 MOM). In 19 cases, intrauterine fetal death was reported. In 1 case anencephalus was detected. In the remaining 4 cases apparently normal healthy babies (1 female and 3 males) were born following uneventful pregnancies. Physical examination of the 3 boys at 4-6 weeks revealed mild ichthyosis compatible with the X-linked type. Two of them had a positive family history of X-linked ichthyosis. The examination of the girl did not reveal any significant findings. In both cases in which amniocentesis was performed, low levels of steroid sulfatase and arylsulfatase C were found. The prevalence of X-linked ichthyosis in this study is higher than previously reported, i.e. 1:1,300 males. Our results suggest that the prenatal screening program for neural tube defects and for Down's syndrome is useful for the prenatal detection of X-linked ichthyosis as well. These results are in accordance with two recent reports. The implications regarding genetic counseling are discussed.

Adult↗
PubMedDate not supplied

Unconjugated estriol as maternal serum marker for the detection of Down syndrome pregnancies.

The effectiveness of unconjugated estriol (uE3) as a serum marker for the detection of Down syndrome (DS) during the 2nd trimester of pregnancy was evaluated. A population of 18,764 normal singleton pregnancies was screened for alpha-feto-protein and human chorionic gonadotropin. In 9,311 women, uE3 was added. Using a risk of 1:250 at term as a cutoff value, the false-positive rates were 4.1 and 4.3% without and with uE3, respectively. The detection rates in 47 DS serum samples, some of which were studied retrospectively, were 66% without uE3 and 57% with uE3. In 12 of 25 younger women and in 19 of 22 older women, DS was detected without uE3. The uE3 contributed to the detection of 4 additional DS pregnancies (1 in the young and 3 in older women). On the other hand, 8 DS pregnancies (3 in younger women and 5 in older women) escaped detection. In our sample the addition of uE3 lowered the detection rate of DS pregnancies with only a small and insignificant effect on the false-positive rate. Our results call for special caution in the addition of markers for risk calculations. We suggest that pregnancies with a calculated risk of > 1:250 following maternal serum alpha-fetoprotein and human chorionic gonadotropin markers tests should be regarded as high-risk pregnancies, even in cases in whom the addition of uE3 lowers the risk beneath the cutoff value.

Adult↗
PubMedDate not supplied

Familial blepharophimosis: an uncommon marker of ovarian dysgenesis.

We report on six young female patients from two families who were found to have a very rare form of ovarian failure. Hypogonadism is inherited with an ocular abnormality consisting of a congenital dysplasia of the eyelids. In one family inheritance is autosomal dominant and in the other it is a de novo mutation. The patients have no other dysmorphic features and are of normal intelligence. Plasma levels of follicle-stimulating and luteinizing hormones are significantly elevated. Examination of the internal genitalia by laparoscopy was performed in four cases with ovarian biopsy in one case; the results are compatible with gonadal dysgenesis. Cytogenetic studies indicate the absence of chromosomal defects.

Adolescent↗
PubMedDate not supplied

Successful treatment of Kasabach-Merritt syndrome with prednisone and epsilon-aminocaproic acid.

The Kasabach-Merritt syndrome is characterized by thrombocytopenia and localized coagulopathy associated with a hemangioma. Most techniques applied to eradicate the tumor or accelerate its involution (surgery, radiation therapy, embolization) are invasive and require transfusion of large amounts of blood products. In some cases, medical treatment is the only alternative. Efficacy of steroids and antifibronolytic agents has already been described, but even this approach is associated with the administration of blood products. We report two cases of infants with Kasabach-Merritt syndrome associated with cardiac and hepatic hemangiomas. At admission, both had signs of cardiac failure. They were successfully treated with prednisone and epsilon-aminocaproic acid (EACA). Blood products were not required once the diagnosis was made. These observations have important implications for the management of patients with Kasabach-Merritt syndrome because they show that even in severe cases blood transfusions can be avoided by the use of prednisone and EACA.

Aminocaproic Acid↗
PubMedDate not supplied

Penile prolapse and urethral obstruction secondary to lymphosarcoma of the penis in a dog.

A 5-year-old Chihuahua presented for clinical signs of dysuria and penile prolapse. Radiographic studies identified a urethral obstruction distal to the junction of the proximal and middle third of the os penis that appeared to be secondary to swelling of the penis. Penile resection combined with a scrotal urethrostomy was performed. Histopathological examinations of tissue samples of the body of the penis revealed lymphosarcoma. Lymphosarcoma of the penis is a rare finding in all species. It can occur as a primary tumor of the penis in dogs. Penile lymphosarcoma should be considered in the differential diagnosis of dogs affected with penile prolapse and dysuria.

Animals↗
PubMedDate not supplied

[Gel agglutination test--a new test system for semiquantitative detection of feto-maternal transfusion in Rhesus incompatibility].

BACKGROUND: The postpartum administration of an adequate amount of anti-D immunoglobulin to the mother in cases of Rhesus incompatibility requires the exact quantification of the amount of Rh-positive fetal cells that may be present in the Rh-negative maternal circulation. The classical methods to detect an intrapartum fetomaternal hemorrhage are either time-intensive (such as the Kleihauer-Betke test), of low specificity (such as the indirect Coombs test), or technically cumbersome (such as flow cytometry). The goals of our study were to develop a simple screening test that may be used routinely to quantify fetomaternal hemorrhage in cases of Rhesus incompatability and to evaluate this test in clinical practice. STUDY DESIGN AND METHODS: In cases of Rhesus-negative mothers of Rhesus-positive neonates, 2.5 ml of maternal Rhesus negative blood was sampled in an EDTA tubes immediately postpartum and was incubated with anti-D antibodies. Thereafter, a semiquantitative determination was made of the amount of antibody that remained unbound in the serum via a gel agglutination test (GAT) (DiaMed., Switzerland) after mixing with test red blood cells. The amount of anti-D consumed (bound to fetal cells in the first phase) is the semi-quantitatively indicated by the degree of positivity in the second phase the weaker reaction--the more anti-D absorbed in the first phase--the more Rhesus-positive fetal cells present in the maternal sample--the larger the fetomaternal hemorrhage. Following the development of a discrimination zone using this GAT which could ascertain an Rhesus-positive erythrocyte concentration of over 0.2%, the test was applied in a clinical setting. Between September 1995 and April 1998 in unselected postpartum blood samples from 603 Rhesus negative parturients, the GAT was used to test the same blood samples as those requiring evaluation for HbF concentration using the traditional Kleihauer-Betke test. RESULTS: In 585 of the 603 cases (97%) there was no evidence of a fetomaternal transfusion following testing using both methods. Furthermore, both tests showed significant evidence for a fetomaternal transfusion in five cases. The Kleihauer-Betke test was false-positive in three cases of mothers who had a hereditary elevation of the HbF concentration. The GAT showed three false-positive reaction due to a Dweak maternal varient. In two cases, the disparity between the GAT and the Kleihauer-Betke test could be attributed to an antecedant dose of anti-D antibody. In the two cases, the Kleihauer-Betke test results were 0.3% while the GAT was only 0.2%. CONCLUSION: The GAT may be used as a screening method in routine clinical practice. This is a quick test that allows for the specific determination and semiquantitative evaluation of the Rh-positive erythrocyte concentration in clinically relevant concentrations. Thus, following a positive GAT screening test, a further specific test such as the Kleihauer-Betke test may be utilized to absolutely quantify the amount of blood transfused from fetus to mother. It is also possible to perform such a quantification test with the GAT by eventually using a diluted maternal blood sample.

Female↗
PubMedDate not supplied

[Frequency and susceptibility to antibiotics of Neisseria gonorrhoeae at Lomé].

A cross-sectional study was carried out by the bacteriology laboratory of the Lome-Tokoin University Hospital, to determine the frequency of gonorrhea in patients providing vaginal or urethral samples, and to investigate the susceptibility of N. gonorrhoeae to antibiotics. The samples were treated according to classic bacteriological methods and the disk diffusion tests were used to investigate antibiotic susceptibility. The samples were taken from 420 patients, 246 of whom were male (26.86% ¿NdT: d'où vient ce chiffre??, 58.33% si 420 patients, 61.19% si 402 patients¿) and 156 of whom were female (37.14% ¿NdT: plutôt 38.8% si 402 patients¿) ¿NdT: et le reste?? Il me semble que c'est plutôt 402 patients en total (= 246 + 156). Sinon il y a 18 patients qui ne sont ni male ni femelle?!¿. N. gonorrhoeae was isolated from 88 patients, giving a prevalence of 20.95% ¿NdT: ou 21.89% si 402 patients¿. We isolated strains of the bacterium from 76 men (25.78% ¿NdT: incorrect, 30. 89%¿ and 12 women (7.69%). Ciprofloxacin, ofloxacin and netilmicin were the most effective antibiotics. The cyclins, cotrimoxazole and penicillin were less effective.

Adolescent↗
PubMedDate not supplied

Evolution of a single unit from general to geriatric surgery: a retrospective study comparing surgical management of elderly patients.

The increase in the geriatric population in recent decades was not followed by a corresponding increase in attention on the part of surgeons to elderly patients until, in the '80s, many clinical studies showed that postoperative morbidity and mortality were related to the associated diseases rather than to the patients' age. To evaluate whether greater attention to the elderly is capable of increasing the number of operations that can be performed when necessary, we retrospectively surveyed the activity of a division of general surgery over two different periods of 5 years: the first one from 01/01/1985 to 31/12/1989 and the second from 01/01/1995 to 31/12/1999, when a team was specifically set up to take care of elderly patients. We registered a significant difference in the number of elderly patients operated on for tumours (134 vs. 208), an increase in colorectal neoplasms (24 vs. 70) and significant differences between radical and palliative surgery (P = 0.03). The extension of radical interventions for cancer to the elderly resulted in a moderate increase in postoperative complications. The surgery-related mortality was around 3.5% in both periods. Thus, a team of surgeons specifically dedicated to aged patients can improve the number of surgical operations performed in these subjects when required without any rise in postoperative mortality.

Aged↗