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Biomedical subjects

P Baumgart

Publications and source records attributed to P Baumgart.

At least 19 recordsLinked to original sources
PubMed1992

[Adrenal cortex carcinoma: diagnosis, therapy and course in 10 cases].

Data from ten cases with carcinoma of the adrenal cortex, diagnosed between 1981 and 1988, have been extensively reevaluated. Six patients suffered from a hormonally active tumor with proven clinical and laboratory signs of hypercortisolism and/or hyperandrogenism. Female patients dominated the cohort (eight of ten). No preference for particular age (35 to 64, mean 52) or lateralisation of the tumor was recognisable. In all cases signs for endocrinopathy and/or tumor disease lead to investigative intervention. Nonspecific symptoms like pain, reduction of weight and fatigue were registered most frequently. In three patients an abdominal tumor was palpable. Investigation of hormone levels and imaging procedures (sonography and CT scan) assured correct diagnosis in all cases. Since prior to operation metastases have been detected in five cases and in eight cases capsular invasion was proven histologically only, one patient was free of tumor after operation but developed hepatic metastases later on. Altogether nine of ten patients developed metastases later on. Seven of the patients died from the perioperative period up to 8.4 +/- 8.15 months. Mean survival of all patients was 20.5 +/- 24.5 months. Histological grading and assessment of anaplasia did not correlate with either survival or tumor stage. None of the patients presented with tumor stage I according to the TNM system by MacFarlane (55). All four patients with advanced disease in stage IV died within the first year after operation. Eight patients were treated with 1 to 6 g of the adrenolytic o,p'DDD (mitotane, Lysodren). In one of these cases, a sonographically documented remission lasting for over eight years was observed. A second patient with anaplastic carcinoma showed a reduction of the size of pulmonary metastases under continuous therapy with o,p'DDD and a cyclic polychemotherapy. After the latter was discontinued, the course was progressive.

Adrenal Cortex Hormones↗
PubMed1992

[Cortical necrosis of the transplanted kidney. MR tomographic confirmation of the diagnosis?].

Cortical necrosis is a rare complication of renal transplants, which requires urgent diagnosis and management to avoid unnecessary immunosuppression. Seven renal transplants with suspected cortical necrosis were evaluated by Doppler-US, 99mTc-DTPA-perfusion study and Gd-DTPA-enhanced dynamic MRI. In four transplants, cortical necrosis was confirmed by angiography and histology. In diagnosing cortical necrosis with preserved medullary perfusion (n = 2) dynamic MRI was superior to the other modalities. Totally necrotic renal transplants (n = 2) were reliably diagnosed by all imaging methods.

Adult↗
PubMed1992

[Evaluation parameters of ambulatory blood pressure monitoring: mean values versus percent values].

In 1039 ambulatory blood pressure (BP) recordings, we studied if mean values or blood-pressure load (% of elevated readings) is superior for evaluation. There was a nonlinear correlation between the two parameters with high correlation coefficients (syst. r = 0.98, diast. r = 0.97). At very high (low) BP levels the differentiation of the percentage-scale is insufficient, whereas in the central BP range it is too detailed as compared with the accuracy and reproducibility. Due to the nonlinear correlation with BP, treatment effects cannot be easily compared by percentage-values, since identical BP differences correspond with varying percentage. Intervals between readings are usually shorter during daytime than during nighttime. In contrast to the BP load, the resulting problems for 24-h statistics can be easily avoided by calculation of weighted mean values (from hourly means). In summary, weighted mean values are rather suited for evaluation of ambulatory blood pressure than is BP load.

Adolescent↗
PubMed1991

Blood pressure elevation during the night in chronic renal failure, hemodialysis and after renal transplantation.

Diurnal blood pressure variation was studied by ambulatory 24-hour monitoring in patients with advanced chronic renal failure (n = 20), on chronic hemodialysis (n = 20), after renal transplantation (n = 21) and in matched control groups without renal disease. Nocturnal blood pressure reductions were significantly blunted in all patient groups as compared with the respective control groups. In almost none of the 61 controls did the mean values during nighttime (8 p.m.-8 a.m.) exceed the mean day time values (8 a.m.-8 p.m.). In 10 of the 61 renal patients blood pressure was higher during the night. In patients with chronic renal disease nocturnal blood pressure elevation may be diagnosed by ambulatory 24-hour monitoring. This may require adaptation of antihypertensive treatment.

Adult↗
PubMed1991

Circadian rhythm of blood pressure: internal and external time triggers.

Diurnal blood pressure (BP) fluctuations are superimposed by a 24-h rhythm with usually lower levels during the night and higher levels during the day. In contrast to other rhythmic bioparameters, the diurnal BP rhythm is largely dependent on activity and sleep rather than on clock time. This has been demonstrated by the BP characteristics after shifted sleeping and working phases, during transition from sleep to wakefulness, and by the influence of sleep and activities on the 24-h BP curve during normal daily routines. Whereas the circadian rhythm of BP is predominantly governed by external time triggers, endogenous rhythmicity can only be detected by time microscopic analysis or in conditions where effects of external time triggers are almost excluded.

Adaptation, Physiological↗
PubMed1991

[Long-term ambulatory blood pressure monitoring: what is normal?].

Various parameters can be evaluated in ambulatory blood pressure monitoring: mean values, percentages of elevated readings, highest and lowest single values, variability, and rhythm. In most parameters only distributions (mean, standard deviation, percentiles) of the results were investigated in selected (usually normotensive or hypertensive) samples. Attempts to define limits of normalcy were predominantly focused on mean values. For the mean values during daytime the equivalent levels of office blood-pressure readings were now defined. This provides evaluation of ambulatory blood pressure monitoring in terms of the established office blood-pressure scale. For mean daytime values, the limits of normalcy (corresponding to 140/90 mmHg office-BP) are about 135/85 mmHg. Clearly, hypertensive mean values (corresponding to 160/95 mmHg office BP) are 146/87 mmHg. These limits of blood pressure mean values during daytime may be considered for therapeutic decisions.

Blood Pressure↗
PubMed1990

Reference data for ambulatory blood pressure monitoring: what results are equivalent to the established limits of office blood pressure?

In 1039 subjects ambulatory blood pressure monitoring was performed to define threshold values, which are equivalent to the established limits of the office blood pressure. Mean values and proportions of elevated single readings were correlated to office blood pressure by regression analyses. To avoid impact of varying sleeping periods on 24 h blood pressure, only daytime readings were considered. Correlations between average daytime blood pressure and office blood pressure were linear: Mean daytime values of 135 mmHg (systolic) and of 84 mmHg (diastolic) were equivalent to the casual blood pressure limits of 140 mmHg and 90 mmHg. Correlations between percentages of elevated single readings and office blood pressure were nonlinear: Proportions of 25% systolic readings greater than 140 mmHg and of 17% diastolic readings greater than 90 mmHg were equivalent to casual blood pressure limits of 140 mmHg and 90 mmHg. On the basis of the regression equations, any result of ambulatory blood pressure recording during daytime can now be evaluated in terms of the established standards of office blood pressure.

Blood Pressure Monitors↗
PubMed1990

[Pneumocystis carinii pneumonia in HIV-positive and HIV-negative patients].

Bronchoalveolar lavage was used in 170 immunocompromised patients for detection of causative agents. Pneumocystis carinii was isolated 18 times from HIV-positive patients and 14 times from patients suffering from immunodeficiencies due to various other diseases. Patients with AIDS were in better clinical condition, had fewer infiltrates on chest x-ray, a higher oxygen partial pressure and lower LDH-plasma concentration than HIV-negative patients. In spite of the earlier stage of the disease patients with AIDS experience prodromal symptoms for a longer time and the number of isolated pneumocystis was larger. Mortality in AIDS patients was significantly lower than in patients with other causes of immunodeficiency.

Adult↗
PubMed1990

[Doctor's-office blood pressure, home blood pressure, ergometry blood pressure and 24-hour blood pressure. The correlations with the echocardiographic parameters of heart muscle mass].

In 62 untreated hypertensives (31 men, 31 women; median age 40 [17-57] years) blood pressures (BP) were measured in the doctor's office, at home (self-measured) and every 15 min during 24-hour monitoring (by portable automated oscillometry), the results being compared with echocardiographic measurements of ventricular septal thickness (VST), left ventricular muscle mass (LVM) and left ventricular mass index (LVMI), in 41 of them also during and 5 min after 100 W bicycle ergometry. In the total cohort, 24-hour values correlated better with diastolic VST (systolic: r = 0.706, P less than 0.00001; diastolic: r = 0.507, P less than 0.0001) than office BP (systolic: r = 0.381, P less than 0.01; diastolic: r = 0.177, not significant) and home BP (systolic: r = 0.477, P less than 0.0001; diastolic: r = 0.371, P less than 0.05). In the 41 exercised hypertensives the correlation with echocardiographic values was less close than with their 24-hour BP, but slightly better than with office and home BP. Systolic BP correlated better than diastolic BP with echocardiographic values. VST generally correlated better with BP than LVM and LVMI. It is concluded that (1) 24-hour BP values correlate more closely with LVM than any other noninvasive BP measurement; (2) VST is affected more by systolic than diastolic BP; and (3) VST more specifically reflects the influence of BP on myocardial structure than does LVM and LVMI.

Adolescent↗
PubMed1990

[Pneumonia in immunocompromised patients: the value of non-biopsy bronchoscopic examination procedures in the diagnosis of pathogens].

Bronchoscopy was performed on 101 immunocompromised patients with fever and pulmonary infiltrates. Underlying diseases were mainly hematological malignancies. In 71% of cases, etiology of pneumonia was clarified by nonbioptic bronchoscopic methods (bronchoalveolar lavage, bronchial secretions, protected specimen brush). In 51% of cases, empirical antibiotic treatment was modified following bronchoscopy. In patients with early bronchoscopy a better prognosis regarding healing and survival was observed than in those cases, where bronchoscopy was performed later during pneumonia. Bronchoalveolar lavage was particularly suited for diagnosis of Pneumocystis carinii and pneumonia due to viruses or Legionella. Sensitivity and specificity of bronchoscopy were lower for diagnosis of mycotic pneumonia and of Gram-negative or Gram-positive bacteria.

Aspergillosis↗
PubMed1990

[Fever, dyspnea].

A 52-year-old female complained about non-distinct symptoms such as fatigue, night sweats and bone pain. Because of a febrile bronchitis, chest X-ray was performed, which disclosed enlarged hilar nodes and intestinal and acinar pulmonary infiltrates. Endobronchial biopsy and cultures from bronchial aspirate permitted to diagnose infection by legionella concomitant with sarcoidosis. After antibiotic treatment for legionellosis over four weeks, immunosuppressive therapy for sarcoidosis was initiated with glucocorticoids.

Diagnosis, Differential↗
PubMed1990

[Morning rise in blood pressure: before or following awakening?].

The coincidence of the circadian peak of cardiovascular events with the morning blood pressure rise suggests causal connections. Rapidly acting antihypertensives taken before getting up may attenuate the increase early enough, if the onset does not occur before awakening. In 111 normotensives and in 109 subjects with untreated essential hypertension ambulatory blood pressure monitoring was performed to study whether the onset of the blood pressure rise occurs before or after waking up. The individual 24 h blood pressure profiles obtained by intermittent readings at intervals of 15 minutes were synchronized by the time of waking up. The resulting blood pressure curves showed no substantial blood pressure rise during sleep, but steep increases after awakening: Within the first hour after waking up blood pressure increased from 107.3 + 11.4/62.3 +/- 9.6 mm Hg (mean + sd) to 121.4 +/- 16.0/75.3 + 12.6 mm Hg in normotension and from 124.7 + 16.0/72.7 + 12.2 mm Hg to 140.3 + 17.2/84.5 + 13.3 mm Hg in hypertension. The velocity of this increase was dependent on the lag between waking up and getting up. There was no phase difference between early morning blood pressure and heart rate rises. Thus to attenuate the morning blood pressure increase, rapidly acting drugs after awakening may be considered instead of long acting antihypertensives administered prior to sleep.

Adult↗
PubMed1990

[Bronchoscopic diagnosis of therapy refractory pneumonia].

In 73 patients with pneumonia treated empirically with antibiotics or antimycotics, a bronchoscopy with bronchoalveolar lavage was performed in an attempt to identify the pathogens involved. Patients in whom it proved possible to detect a specific pathogen showed a lower mortality rate than did those in whom it was not possible to clarify the aetiology of the pneumonia (24 per cent and 34 per cent, respectively). In patients receiving empirical treatment over a long term, pneumonia persisted longer, and the mortality rate was higher, than in patients who were submitted to invasive examination early on.

Adolescent↗
PubMed1989

Diurnal variations of blood pressure in shift workers during day and night shifts.

The dependence of blood pressure upon internal rhythms and the short-term effects of shift rota on the blood pressure were investigated in shift workers. Blood pressure was measured every 30 min using automatic records for 24h in 17 physically working men in a chemical factory during their morning and night shifts. There were no differences of the mean blood pressure between the respective sleeping phases or between the working periods. The amplitudes of circadian blood pressure variations were equal. There was a phase difference of 8h corresponding to the lag between the working periods. At this 8-h lag the hourly means of the 24-h blood pressure were closely correlated (r=0.69). Comparisons of 24-h blood pressure profiles during the first and last days of night shift week showed that the effects of night work on the blood pressure were already fully developed within the first 24h (r=0.86). Thus the diurnal variations of the blood pressure are determined by the working and sleeping periods and largely independent of endogenous rhythm. There is no short-term alteration of the mean 24-h blood pressure after shift rota.

Adult↗
PubMed1989

Primary angiosarcoma of the heart.

A case report on a 27 year old woman with an inoperable angiosarcoma of the right atrium is presented. The tumor localization was established by echocardiography, computed tomography and cinecardiography. There was no evidence of distant metastases at diagnosis. After exploratory thoracotomy with surgical biopsy a radiotherapy was started covering the whole heart and the mediastinum. Superior Vena Cava Syndrome was improved quickly and reducing the target volume to the right atrium after 40 Gy radiotherapy was continued up to a total dose of 60 Gy. A complete remission was documented by echocardiography and computed tomography. Chemotherapy ("VAPAC") for distant metastases led to partial remission. The patient died 15 months after diagnosis from brain metastases. Autopsy revealed no macroscopic evidence of tumor in the right atrium. A combined modality approach with surgical tumor mass reduction followed by high dose locoregional radiotherapy (60 Gy) and combination chemotherapy (e.g. "VAPAC") is suggested.

Adult↗
PubMed1989

Nocturnal hypertension in renal failure, haemodialysis and after renal transplantation.

Diurnal blood pressure variations in 20 patients with advanced renal failure, 20 patients on chronic haemodialysis, and 21 renal transplant recipients were compared with those of matched control groups without renal disease, using 24-h ambulatory blood pressure monitoring. Whereas the blood pressure during the day (from 8 a.m. to 8 p.m.) was roughly the same in the patients compared with their respective control groups, during the night (from 8 p.m. to 8 a.m.) it was substantially higher in all patient groups. The differences between the mean daytime and night-time values were significantly lower in the patients (P less than 0.05 to P less than 0.001). The nocturnal blood pressure decrease may be attenuated or even reversed in renal failure, in haemodialysis and after renal transplantation. In a proportion of these patients, 24-h ambulatory blood pressure monitoring showed an elevated nocturnal blood pressure, which may require some modification of treatment.

Blood Pressure↗