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Biomedical subjects

T Bregenzer

Publications and source records attributed to T Bregenzer.

12 recordsLinked to original sources
PubMed1999

Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome.

OBJECTIVE: Severe twin-twin transfusion can be treated by either serial amniocenteses with removal of large volumes of amniotic fluid or by endoscopic laser coagulation of the communicating vessels. We investigated the benefit of laser surgery in comparison to serial amniocenteses in terms of pregnancy outcome. STUDY DESIGN: The data used in this comparative study were collected from 116 patients with severe twin-twin transfusion syndrome between 17 and 25 weeks' gestation. The patients were grouped according to the treatment center. The first group comprised 73 patients (median gestational age 20.7 weeks) treated in Hamburg by fetoscopic laser coagulation of the vascular placental anastomoses between January 1995 and May 1997. The second group comprised 43 patients (median gestational age 20.4 weeks), fulfilling identical diagnostic criteria and treated in Bonn by serial amniocenteses between 1992 and 1996. RESULTS: The overall fetal survival rate was not significantly different (61%, 89/146, vs 51%, 44/86; P =.239). There was a significantly higher proportion of pregnancies with >/=1 survivor in the laser-treated group (79%, 58/73, vs 60%, 26/43; P =.033). The number of cases with spontaneous intrauterine fetal death of both fetuses was significantly lower in the laser-treated group (3%, 2/73, vs 19%, 8/43; P =.003). The incidence of abnormal ultrasonographic findings in the brain was significantly lower among surviving neonates after laser surgery than after amniocenteses (6%, 5/89, vs 18%, 8/44; P =. 03). For pregnancies with >/=1 live-born baby, a significantly longer interval between first intervention and delivery (median 90 vs 72 days, P =.022) leading to a significantly higher gestational age at delivery (median 33.7 vs 30.7 weeks, P =.018) was observed for the laser-treated group. The birth weights of the donor fetuses were significantly higher in the laser-treated group (median 1750 vs 1145 g, P =.034), and a trend toward higher birth weight was also found for recipient fetuses (median 2000 vs 1560 g, P =.076). CONCLUSIONS: These findings indicate that endoscopic laser coagulation of placental vascular anastomoses offers a more effective alternative to serial amniocenteses as a treatment of severe second-trimester twin-twin transfusion syndrome.

Amniocentesis↗
PubMed1998

Is routine replacement of peripheral intravenous catheters necessary?

BACKGROUND: Guidelines developed by the Centers for Disease Control and Prevention, Atlanta, Ga, recommend that peripheral intravenous catheters be changed every 3 days. However, routine replacement of central venous catheters is no longer supported in their latest update. OBJECTIVE: To evaluate the risk to patients of having peripheral intravenous catheters left in place for as long as they are clinically indicated. METHODS: This observational study in a university-affiliated, 700-bed hospital was designed to evaluate the day-specific risk (incidence density) for phlebitis, catheter infection, and obstruction with catheters remaining in place as long as clinically indicated. All consecutive patients who required peripheral intravenous catheterization for 24 hours or more were enrolled during a 10-week period. Outcome variables are phlebitis, catheter-related infections, and obstruction. Evaluated risk factors include age, sex, underlying disease, anatomical insertion site, catheter diameter, first or subsequent catheter, duration of catheterization, type of admission, hospital location, type of infusate, and antibiotic therapy. RESULTS: A total of 609 catheters that were in place for 1 to 28 days were evaluated. Phlebitis, catheter-related infection, and obstruction occurred in 19.7%, 6.9%, and 6.0% of catheters, respectively. We were unable to demonstrate an increased risk after 3 days of catheterization. The day-specific risk indicated a linear function of all outcome variables. CONCLUSIONS: The hazard for catheter-related complications--phlebitis, catheter-related infections, and mechanical complications--did not increase during prolonged catheterization. The recommendation for routine replacement of peripheral intravenous catheters should be reevaluated considering the additional cost and discomfort to the patient.

Adolescent↗
PubMed1998

[Aortic valve replacement as an independent predictive factor for later development of aortic dissection].

Dissection of the ascending aorta (type A) following later after aortic valve replacement has been described with increasing frequency. This study analyzes the role of aortic valve replacement for the evolution of late dissection. In a series of 80 consecutive patients with type A dissection, a previous aortic valve replacement had been performed in 12 cases (15%). In addition to arterial hypertension (p < 0.001) and Marfan syndrome (p < 0.01), multivariate analysis identified previous aortic valve replacement (p < 0.01) as an independent predisposing factor for type A dissection. Dissection occurred 3 +/- 4 years after aortic valve replacement with a clinical and anatomical profile similar to classic dissection as proven by comparison to a group of 62 patients with classic dissection associated with arterial hypertension or Marfan syndrome. With 75% and 66%, respectively, 30 day and 1 year survival of patients with dissection following later after aortic valve replacement was similar to patients with classic type A dissection. Extensive thinning and/or fragility (p < 0.05) of the aortic wall in the presence of a mildly dilated aorta (45 +/- 5 mm) at the time of aortic valve replacement was associated with a high risk for late dissection; this finding was substantiated by comparison to a control group of 10 consecutive patients with a similarly dilated aortic root but no dissection. Type and diameter of valve prostheses, cross-clamp time, NYHA functional class, and left ventricular ejection fraction were unrelated to late dissection. Previous aortic valve replacement is an independent predisposing factor for a dissection of the ascending aorta later. At the time of aortic valve replacement, prophylactic replacement or wrapping of the ascending aorta should be considered in patients with a thinned/fragile aortic wall even without a markedly dilated aortic root.

Adult↗
PubMed1998

[p53 mutations and HPV infections in squamous epithelial carcinomas of the head-neck region. Long-term follow-up].

Mutations of the p53 gene are the most commonly observed genetic alterations in malignant tumors and are often associated with a loss of the tumor suppressor function of the p53 protein. We have analyzed specimens of head and neck squamous cell carcinomas (HNSCC) from 110 patients for p53 gene mutations and 92 of them additionally for human papillomavirus (HPV) infection in order to evaluate the prognostic significance of these factors by comparison with clinical follow-up data. Using the method of polymerase chain reaction (PCR)/temperature gradient gel electrophoresis (TGGE), mutations within the exons 5 to 8 of the p53 gene were found in 48 tumors (44%). Sequencing revealed missense mutations in most cases (15/20). Frequency of p53 gene mutations was not related to the tumor stage, the grade of differentiation, the presence of lymph node metastases, or the smoking history of the patients. With the help of a highly sensitive PCR/hybridization assay, an infection with the high-risk HPV types 16 and 18 could be detected in 39/92 tumor specimens (42%). Follow-up data were obtained from 99 patients with a range of 2-112 months. No correlation of overall survival on the presence of p53 gene mutations or HPV infection could be observed. The absence of statistically significant correlations between p53 gene mutations and progressive disease, however, does not exclude its putative relevance in early phases of tumor development.

Adult↗
PubMed1997

Low risk of bacteremia during catheter replacement in patients with long-term urinary catheters.

BACKGROUND: Geriatric patients with long-term urinary catheters have an increased morbidity and mortality. It is conceivable that catheter replacement causes bacteremia and contributes to this morbidity and mortality. The purpose of our study was to determine the incidence and clinical relevance of bacteremia induced by urinary catheter replacements. METHODS: We analyzed clinical signs and symptoms and laboratory measures (leukocyte count, C-reactive protein, urine sediment, urine culture) during 120 routine catheter replacements in geriatric patients. In addition, blood cultures were drawn before and at 5, 15, and 30 minutes after catheter replacement. RESULTS: The urine cultures showed growth of 1 to 5 different microorganisms before replacement. Of 480 blood cultures, 27 (5.6%) were positive. However, the same species grew from blood and urine in only 5 catheter replacements. None of the patients met criteria for systemic inflammatory response syndrome. There were no significant differences in clinical and laboratory findings between patients with and without bacteremia. Coagulase-negative staphylococci grew in 12 blood cultures. Their distribution over time suggested that they mainly represented catheter replacement-related bacteremia rather than contaminants. Consequently, 64 intraurethral catheter segments were additionally cultured. Coagulase-negative staphylococci grew in 10 catheter cultures, but in only 2 simultaneously cultured urine samples. CONCLUSION: Bacteremia induced by routine replacement of long-term urinary catheters occurred in 4.2% (5/120) of replacements in geriatric patients. Such bacteremia did not have a detectable clinical relevance in our study.

Aged↗
PubMed1997

p53 gene mutations and HPV infection in primary head and neck squamous cell carcinomas do not correlate with overall survival: a long-term follow-up study.

We analyzed specimens of head and neck squamous cell carcinomas (HNSCC) from 110 patients for p53 gene mutations, and 92 of them for human papillomavirus (HPV) infection, in order to evaluate the prognostic significance of these factors by comparison with clinical follow-up data. Mutations within the exons 5 to 8 of the p53 gene were found in 48 tumors (44%). Sequencing revealed in most cases mis-sense mutations (16/21). Frequency of p53 gene mutations was not related to the tumor stage or the presence of lymph node metastases. Of the 46 tumors that were analyzed by immunohistochemistry, 26 stained positively (56%). The number of positively stained nuclei increased slightly with decreasing differentiation of the tumors, whereas no correlation was found between tumor stage and immunoreactivity. An infection with the high-risk HPV types 16 and 18 could be detected in 39/92 tumor specimens (42%). Follow-up data were obtained from 99 patients within a range of 2 to 112 months. No dependence of overall survival on the presence of p53 gene mutations or HPV infection could be observed. The absence of statistically significant correlations between p53 gene mutation and progressive disease, however, does not deny its putative relevance in early phases of tumor development.

Adult↗
PubMed1996

[Clinical aspects and prognosis of candidemia, a 6-year retrospective study].

In recent decades an increase in the incidence of fungal infection has been reported. We retrospectively analyzed 41 patients with candidemia seen at Basel University Hospital over a six-year period. 1.2-6.7 candidemias per 10000 admissions were observed. In contrast to other studies, there was no increase during the study period. Out of 41 patients, 19 were hospitalized in ICUs. All patients had risk factors such as intravascular catheters (92.7%), antibiotic therapy (88%), immunosuppressive therapy (31%), indwelling Foley catheters (54%) and previous surgery (63%). The most frequent symptoms were fever with rigor, tachycardia and hypotension. The isolates were Candida albicans (n = 28), Torulopsis glabrata (n = 5), C. krusei (n = 3), C. parapsilosis (n = 2), C. guilliermondii, C. kefyr and C. lusitaniae (n = 1 each). In 22 patients, candida colonization had been documented and 5 patients had superficial mucocutaneous candidiasis before candidemia. The initial foci were the gastrointestinal tract (n = 13), an intravascular catheter (n = 8), the urinary tract (n = 5), the respiratory tract, or intravenous drug use (n = 3 each). Out of 32 patients who were treated either with amphotericin B or fluconazole, 13 died. 5 of the untreated patients died, in 3 instances before microbiological diagnosis. The mortality was similar for treatment with amphotericin B and with fluconazole (50% vs. 33%) (p = 0.3).

Adult↗
PubMed1990

[Therapy changes and cost development in bronchial asthma. A 10-year retrospective study at the medical outpatient clinic of the Zurich University Hospital].

The changes that have taken place in asthma therapy during the past ten years and their consequences regarding costs were studied analyzing retrospectively 285 clinical histories of asthmatics treated at the University Hospital Zurich in 1977, 1982 and 1987. The following changes in the use of the five basic antiasthmatic drugs i.e. beta-adrenoceptor agonists, anticholinergic drugs, xanthines, glucocorticosteroids and antiallergic drugs were observed: In 1977 80% of asthmatics received beta-agonists, in 1987 90%. Conversely, parasympatholytics were rarely used: In 1977 in only 2%, in 1982 in 16% and in 1987 in 27% of patients. In 1987 xanthines were prescribed in only 50% of asthmatics whereas in 1982 after the introduction of retarded preparations, these drugs were given to 86% of patients. In 1977 only one-third of asthmatics received glucocorticosteroids; in 1987, however, three-quarters of them. Antiallergic drugs were prescribed in 1977 and 1987 in about 25% of the asthmatics, in 1982 in only 13%. Considering the form of application there was a significant trend towards metered aerosols. This was true for betamimetics, parasympatholytics and glucocorticosteroids. Fixed combinations and rectal applications of xanthines were substituted for retarded formulations. In 1977 one or two antiasthmatic drugs accounted for 75% of asthma therapy. In contrast, in 1987 60% of asthmatics received more than two antiasthmatic drugs. The dosages of salbutamol and beclomethasone increased significantly from 1977 to 1987. Other changes in dosages were not significant. The change in costs of antiasthmatic therapy revealed significant savings in regard of xanthines and antiallergic drugs. During the past ten years the overall costs of antiasthmatic drugs therapy remained the same despite more complex therapy.

Adrenergic beta-Agonists↗