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Biomedical subjects

N Vetter

Publications and source records attributed to N Vetter.

At least 37 records · Page 2Linked to original sources
PubMed1998

A comparative study of levofloxacin and ceftriaxone in the treatment of hospitalized patients with pneumonia.

A multinational, multicentre, open, randomised study in hospitalised patients with pneumonia compared levofloxacin 500 mg twice daily with ceftriaxone 4 g i.v. once daily. Levofloxacin patients started on i.v. treatment and switched to oral on d 3-5 of therapy if signs and symptoms had improved. The minimum treatment duration was 5 d, except for treatment failure, and the median 8 d. The primary efficacy analysis was based on the per-protocol assessment of the clinical cure rate determined 2-5 d after the end of treatment in the per-protocol (PP) population (levofloxacin 127, ceftriaxone 139). Of 625 patients enrolled and randomized, 6 received no treatment, giving an intention-to-treat (ITT) population of 619 (levofloxacin 314, ceftriaxone 305). At the clinical endpoint, 2-5 d after the end of treatment, the cure rates for levofloxacin and ceftriaxone were similar in both the ITT (76% and 75%, respectively) and PP (87% and 86%, respectively) populations. Both drugs were well tolerated. Twice-daily levofloxacin 500 mg, either i.v. or as sequential i.v./oral therapy, was as effective as i.v. once-daily ceftriaxone 4 g in the treatment of hospitalized patients with pneumonia and offers the advantage of sequential therapy.

Adolescent↗
PubMed1998

[Comparison of addition of theophylline to inhaled steroid with doubling of the dose of inhaled steroid in asthma].

The anti-asthmatic effect of theophylline may supplement those of inhaled steroids in asthma. The aim of the present trial was to study how the addition of theophylline compares to doubling the dose of inhaled steroid in asthmatics who remain symptomatic on beclomethasone dipropionate (BDP) 400 micrograms/day. The trial was designed as a randomized, double-blind, parallel-group study in several European countries. 69 patients were treated for 6 weeks with theophylline plus BDP 400 micrograms/day, compared to 64 patients treated with BDP 800 micrograms/day. The mean +/- SD serum theophylline concentration was 10.1 +/- 4.2 mg/l. Lung function measurements were made throughout the study and patients kept daily records of peak expiratory flow rate (PEF), symptoms and salbutamol usage. Forced expiratory volume in one second and PEF at week 6 were significantly increased by both treatments (p < 0.01). PEF variability was reduced by about 30% in both groups. There were significant improvements in asthma symptoms and rescue medication use (p < 0.001). There were no significant differences between the treatment groups. The study demonstrated clinical equivalence of theophylline plus beclomethasone dipropionate 400 micrograms/day and beclomethasone dipropionate 800 micrograms/day in patients whose asthma is not controlled on beclomethasone dipropionate 400 micrograms/d. The results support the use of theophylline as steroid-sparing agent. The combination of low-dose inhaled steroid plus theophylline is a suitable treatment for moderate asthma.

Adolescent↗
PubMed1997

Comparison of addition of theophylline to inhaled steroid with doubling of the dose of inhaled steroid in asthma.

The anti-asthmatic effects of theophylline may supplement those of inhaled steroids in asthma. The aim of the present trial was to study how the addition of theophylline compares to doubling the dose of inhaled steroid in asthmatics who remain symptomatic on beclomethasone dipropionate (BDP) 400 microg x day(-1). The trial was designed as a randomized, double-blind, parallel-group study in several European countries. Sixty nine patients were treated for 6 weeks with theophylline plus BDP 400 microg x day(-1), compared to 64 patients treated with BDP 800 micro x day(-1). The mean+/-SD serum theophylline concentration was 10.1+/-4.2 mg x L(-1). Lung function measurements were made throughout the study and patients kept daily records of peak expiratory flow (PEF), symptoms and salbutamol usage. Forced expiratory volume in one second and PEF at week 6 were significantly increased by both treatments (p<0.01). PEF variability was reduced by about 30% in both groups. There were significant improvements in asthma symptoms and rescue medication use (p<0.001). There were no significant differences between the treatment groups. The study demonstrated clinical equivalence of theophylline plus beclomethasone dipropionate 400 microg x day(-1) and beclomethasone dipropionate 800 microg x day(-1) in patients whose asthma is not controlled on beclomethasone dipropionate 400 microg x day(-1). The results support the use of theophylline as a steroid-sparing agent. The combination of low-dose inhaled steroid plus theophylline is a suitable treatment for moderate asthma.

Administration, Inhalation↗
PubMed1996

A district-wide examination of 75-year olds suggests discrimination in the provision of services.

The aim of this study was to assess the adequacy of existing services across a whole health district for those aged 75 years, in an attempt to detect shortfalls and biases in the provision of services. This study was carried out as a cross-sectional survey using community based nurses in the county of South Glamorgan. 1376 people in their 75th year who were registered with a general practitioner were visited, and their problems assessed by community based nurses. There was a marked difference in the results of the assessment for different services. It was estimated that 76% of the 75-year olds would benefit from additional health services, and 37% from social services. There was a striking difference between the services in the proportion of people whose problems were satisfactorily solved, according to the criteria used by the community nurses. The proportion of problems that were solved varied according to the degree of dependency of the individuals, and the service involved. Some services showed a clear trend to care more for dependent people; services with a relatively undeveloped home delivery system seemed likely to discriminate against people who were dependent.

Aged↗
PubMed1995

[Idiopathic CD4+ T-lymphocytopenia in 2 patients without indications for HIV infection].

We report on two patients with idiopathic CD4+ T cell depletion. A 26 year-old woman presented to us with acute respiratory failure requiring mechanical ventilation. Despite combined antibiotic therapy parenterally the opacities increased in the chest X-ray. An open lung biopsy was performed and led to the histological diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). Respiratory function was improved impressively by high dose parenteral cortisone administration. This patient showed a general lymphocytopenia with severe CD4+ T cell depletion (60(37%)/mm3 blood). The CT4+ T cell concentration increased during a follow up period of 14 months, but did not reach normal values. The second patient was a 33 year-old homosexual. He was admitted with a mucocutaneous fungal infection which was successfully treated by antifungal drugs. This patient demonstrated a transient CD4+ T cell depletion (350(32%)/mm3 blood). In both patients HIV type 1 and 2 infections were excluded by antibody- and p 24-antigen testing, polymerase chain reaction and virus culture. CONCLUSION. Idiopathic CD4+ T lymphocytopenia differs from HIV infection in immunological profile, in the tendency to reversal of the CD4+ T cell depletion over time and in its better prognosis. It is unclear if this is a new syndrome and whether a transmissible agent, or possibly a genetically-determined reaction to noxious agents is responsible.

Adult↗
PubMed1994

[Home care of AIDS patients from the medical and nursing viewpoint--a project in Vienna].

Based on the longer survival time of HIV-infected patients the spectrum of HIV associated complications changed. The frequency of neurological diseases, as AIDS dementia complex, is increasing. Therefore there is more need for nursing of AIDS patients. Aim of the study was to evaluate the cost-effectiveness, the practicability and the influence of home care on the outcome of the patients. During a 1-year period 7 AIDS patients were treated by 4 nurses and 1 doctor in a home care setting. Three of these patients were immobile and needed nursing; the four other received their parenteral therapy at home. Nursing took 2 to 7 hours, the administration of parenteral therapy one and a half hour per day and patient. 226,520 Austrian Schillings were spent for the care of the 7 patients during 1 year. By minimizing the duration and the number of hospital stays the quality of life of the patient was improved. Home care did not influence the outcome of the patients negatively.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Clarithromycin versus cefaclor for the treatment of mild-to-moderate acute bacterial bronchitis.

Four hundred and eight outpatients with the clinical signs and symptoms of mild-to-moderate acute bronchitis of bacterial aetiology were enrolled in a multicentre, double-blind, randomized clinical trial comparing the efficacy and safety of clarithromycin and cefaclor, both administered orally. Two hundred and seven patients received clarithromycin 250 mg bd and 201 patients received cefaclor 500 mg tds for a maximum of seven days. Clinical and bacteriological evaluations were performed before treatment was initiated, during the course of treatment, and within 72 h of completing therapy; all adverse events were recorded. Two hundred and three patients in the clarithromycin group and 195 in the cefaclor group were evaluable for clinical response and 129 and 124 patients in the clarithromycin and cefaclor groups, respectively, were evaluable for bacteriological response. The clinical response rates three to five days after starting treatment and at the post-treatment assessment were 97% (193/199) and 99.5% (202/203), respectively, for the clarithromycin group and 97.4% (187/192) and 97.9% (191/195), respectively, for the cefaclor group. The bacteriological cure rates were 94.6% (122/129) for the clarithromycin group and 90.3% (112/124) for the cefaclor group. None of the differences between the groups was statistically significant. Adverse events, which were generally mild and predominantly related to the gastrointestinal tract, were reported by 5.8% of clarithromycin-treated patients and 10.4% of cefaclor-treated patients. Adverse reactions caused one patient in the clarithromycin group and three in the cefaclor group to discontinue treatment prematurely. The results of this study indicate that clarithromycin and cefaclor are comparable with respect to efficacy and safety when used as treatment for patients with mild-to-moderate acute bacterial bronchitis.

Acute Disease↗
PubMed1993

[Contribution of nuclear medicine to management of pulmonary complications in patients with acquired immune deficiency].

Opportunistic lung infections and malignancies are life-threatening complications in HIV-positive patients. In 72 HIV-positive patients the role of different non-invasive tests such as lung function tests, blood gas analysis, 67 gallium scanning and epithelial lung clearance with 99m Tc-DTPA for the management of these patients was prospectively studied. For all non-invasive tests the mean values of patients with pulmonary complications (n = 25) differed significantly from those of asymptomatic HIV-positive patients (n = 47) (p < 0.001). In 10 patients presenting with acute Pneumocystis carinii pneumonia, 99m Tc-DTPA clearance rates and 67 gallium uptake differed significantly before and after therapy (4.80 +/- 1.23%/min vs 2.47 +/- 0.72%/min and 2.15 +/- 0.42 vs 1.39 +/- 0.18, respectively). Follow-up after therapy revealed different time courses of these tests for normalization. A significant inverse correlation was found between DLCO and 99m Tc-DTPA lung clearance (r = -0.90, p < 0.001, n = 35). A diffuse homogeneous 67 gallium uptake is not diagnostic for PCP, the same pattern was found in a patient with lymphoid interstitial pneumonitis and in patients with CMV pneumonitis; these patients also had accelerated epithelial lung clearance rates. 67 gallium (6/6) was superior to 99m Tc-labelled immunoglobulin G (3/6) for detection of PCP. The 3 patients with Kaposi sarcoma of the lung had negative 67 gallium scans, but positive 201 thallium scans and increased 99m Tc-DTPA clearance rates.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1992

[Differential diagnosis of ascites and abscess forming hepatitis in AIDS patients with reference to the first patient with microsporidia infection in Austria].

We report on a 30 years-old female AIDS patient suffering from generalized pneumocystosis and intestinal microsporidiosis. The chest X-ray showed a right-sided pleural effusion; the lungs showed no areas of consolidation and the heart and the vessels were normal in size. Sonography revealed multiple cystic lesions of the liver measuring 1-3 cm in diameter, as well as ascites. Pneumocystis carinii was detected on cytological examination of the bronchoalveolar lavage fluid, the pleural effusion and the ascitic fluid. Intestinal microsporidiosis was diagnosed by cytological examination of the stool. Both pneumocystis carinii infection and microsporidiosis may cause hepatitis and ascites. In our patient the organ manifestations of the two infections did not overlap. Since simultaneous organ manifestations are possible the differential diagnosis is discussed. This is the first case of microsporidiosis reported in Austria.

AIDS-Related Opportunistic Infections↗
PubMed1991

Induced sputum and cytological diagnosis of lung cancer.

Diagnosis of lung cancer by examination of induced sputum specimens for malignant cells may be a valuable alternative to diagnosis by bronchoscopy. Patients suspected of having lung cancer were recruited and randomly distributed into two groups, one group (n = 34) having sputum induced by use of an ultrasonic nebuliser before bronchoscopy, and the other (n = 33) undergoing ordinary expectoration before bronchoscopy. 25 patients in the induced-sputum group were diagnosed as having primary lung cancer; induced sputum was positive for malignant cells in 21 of these patients (84%), whereas bronchoscopy was positive in 23 (92%) (not significantly different). In comparison, ordinary sputum was positive in 15 of 29 patients (52%) diagnosed as having primary lung cancer, whereas bronchoscopy was positive in 28 (97%) (p less than 0.001). Induction of sputum by an ultrasonic nebuliser was an effective procedure for diagnosis of primary lung cancer.

Administration, Inhalation↗
PubMed1991

[Differential diagnosis of necrotizing sarcoid angiitis: necrotizing sarcoid angiitis and collagen disease--a case report].

The chest x-ray showed a bilateral micronodular pattern and hilar lymph nodes. Lung function test revealed a diminished VC, TLC and a reduced compliance and CO diffusion capacity. The histological examination of the lung biopsy showed sarcoid-like necrotising granulomatous formations of the vessel walls and destruction of these. Unusual was the coincidence of a sarcoidal necrotizing angiitis and a connective tissue disease which presented as Raynaud's disease. Antinuclear antibodies and antibodies against SSA-RO and Scleroderma 70 were identified. The histological examination of the skin biopsy showed changes pertaining to scleroderma. In accordance with the definition by Laevitt (4, 5), this disease is a polyarteritis overlap syndrome.

Adult↗
PubMed1991

[Wegener's granulomatosis with splenic involvement and Hashimoto's lymphomatous thyroiditis].

A case of a 37-year old female patient suffering from Wegener's granulomatosis is reported. The chest x-ray showed a tumorous consolidation of the right upper lobe and of the apical segment of the right lower lobe. The histological examination of the lung, the kidney and the spleen revealed necrotising granulomas typical of Wegener's granulomatosis. Additionally, a thyroiditis lymphomatosa Hashimoto was diagnosed. So far, coincidence of thyroiditis Hashimoto and Wegener's granulomatosis has not been reported in the literature. The involvement of the spleen was a rare manifestation of Wegener's granulomatosis.

Adult↗
PubMed1990

[Comparison of an oxygen-conserving module "Oxytron" and the reservoir cannula "Oxymizer Pendant" with continuous oxygen administration via nasal prong in hypoxemic patients].

High costs involved in administering continuous long-term oxygen therapy to patients with chronic lung diseases and limited portability of oxygen sources stimulated research into and development of oxygen conserving devices. Oxytron (Weinmann, Hamburg) is a new electronic demand oxygen delivery system which limits oxygen flow to the early phase of inspiration. The reservoir cannula Oxymizer Pendant (Chad-Therapeutics Inc.) is a nasal prong system incorporating a pendant reservoir which stores oxygen during expiration and delivers it as a bolus at the onset of inspiration. Ten patients with significant hypoxaemia at rest received oxygen delivered at various breath interval settings with the Oxytron method and at flow rates of 2, 3 and 41/min with the reservoir cannula Oxymizer Pendant and with continuous flow. The results indicate that significantly less oxygen was required to provide equivalent oxygen saturation with Oxytron as compared with steady flow delivery: an oxygen flow reduction of greater than 75% was achieved at all Oxytron settings tested. With the reservoir cannula oxygen saving was most evident at low oxygen flows: 29.3, 19.4 and 4.7% less oxygen was required than with continuous flow at 2, 3 and 41/min. Individual patient acceptance of various drug delivery systems and response to therapy should be considered when prescribing home oxygen therapy. The use of oxygen saving techniques could result in a substantial cost saving and greater mobility may help to improve compliance in patients requiring continuous oxygen therapy.

Adult↗
PubMed1990

Serum neuron-specific enolase is a useful tumor marker for small cell lung cancer.

Small cell lung cancer (SCLC) may be potentially curable. A correct diagnosis of cancer cell type is important and serum markers are of great value. Although several markers have been suggested, they have been of limited value because of insufficient specificity. To assess the value of serum neuron-specific enolase (S-NSE) as a possible marker of SCLC, the serum levels of 81 patients with SCLC (59 patients with extensive disease and 22 patients with limited disease) were compared with the serum levels of patients with non-small cell lung cancer (N-SCLC) and 93 patients with nonmalignant lung diseases. The S-NSE level also was measured in 104 patients with extensive disease of various other malignancies, including 71 solid tumors and 33 malignant hematologic disorders. From 105 healthy control subjects, the upper limit of the normal range (x + 2 standard deviations [SD]) was determined as 12.3 ng/ml. The S-NSE level was elevated in 78% of patients with SCLC, including 11 of 22 (50%) with limited disease and 52 of 59 (88%) with extensive disease. In contrast, the S-NSE level was raised only in 18% of patients with advanced N-SCLC (nine of 50) and 6% of patients with nonmalignant lung diseases (six of 93). Twelve patients (17%) with other solid malignant tumors and two patients (6%) with malignant hematologic disorders had raised S-NSE levels. Serial N-NSE levels were obtained in 13 patients with SCLC. S-NSE levels fell in all patients responding to chemotherapy and increased again with progression of disease. Our results indicate that S-NSE seems to be specific for SCLC (85%), whereas sensitivity seems to be dependent on the stage of disease. Further, S-NSE may be a useful marker for monitoring treatment and predicting relapse in patients with SCLC.

Biomarkers, Tumor↗