Search PubMed⌕ Search

Biomedical subjects

T Schaberg

Publications and source records attributed to T Schaberg.

At least 19 recordsLinked to original sources
PubMed2000

[Tumor simulating primary pulmonary cryptococcosis in an immunocompetent patient. A contribution to differential diagnosis].

Case report of a primary cryptococcosis of the lung in a 78-year old non-immunocompromised female. The patient presented with a mass in the right upper lobe, highly suspicious of lung cancer. Cryptococcus finally was detected on repeated biopsies from ulcerated and necrotic bronchial mucosa. A clinical work-up showed no evidence of dissemination and no signs of immunoinsufficiency. Mass reduction in the lung was achieved under therapy with fluconazol.

Aged↗
PubMed2000

[Results of therapy in pulmonary tuberculosis: outcome monitoring in northern Lower Saxony].

BACKGROUND: Despite it importance standardized treatment outcome-monitoring in tuberculosis patients is not officially done in Germany. METHODS: In this retrospective study we investigated tuberculosis outcome in 494 patients with pulmonary tuberculosis using the international recommended definitions. RESULTS: The median follow-up period was 62 month (36-180 month). A successful treatment could be observed in 378 (76.1%) of all patients. Treatment success was mostly documented as cure (n = 375). No documented treatment success was seen in 119 patients (23.9%). The most important reason for unsuccessful treatment was lost for follow up (transfer out) in 60/119 patients (51.2%), followed by death (24/119; 19.8%), an interrupted treatment (22/199; 18.3%) and treatment failure (13/119; 10.7%). No documented treatment success was significantly more common in retreatment cases compared to new cases (p = 0.0003) and in patients with at least a single drug resistance (p = 0.04). Beside these parameters treatment outcome was significantly superior in patients receiving a standard antituberculosis therapy including at least isoniazid and rifampin compared to patients treated with other regimens during both the initial phase (p = 0.0039) and the continuous phase (p = 0.0021) of therapy. CONCLUSION: In this retrospective study the use of the international definitions for outcome monitoring showed a substantial proportion of patients with unsuccessful therapy. For the evaluation of the success of the tuberculosis programme in Germany a prospective documentation of treatment outcome data in all patients using the international definitions seems essential.

Aged↗
PubMed1999

Phenotypically activated gammadelta T lymphocytes in the peripheral blood of patients with tuberculosis.

Surface molecules with the potential relevance for resistance against Mycobacterium tuberculosis were investigated. The expression of lymphocyte function antigen-1, very late antigen (VLA)-4, l-selectin, intercellular adhesion molecule (ICAM)-1, major histocompatibility complex class II, Fas, and CD40 on alphabeta T cells, gammadelta T cells, NK cells, and monocytes of healthy donors and patients with tuberculosis were analyzed. A high activation status of gammadelta T cells and increased levels of soluble ICAM-1 in plasma of patients with tuberculosis versus healthy individuals was detected. Tuberculosis patients with and without an underlying systemic disease could be segregated by differential expression of VLA-4 and ICAM-1 on gammadelta T cells and on monocytes. The composition of peripheral blood mononuclear cells varied slightly, whereas the proportion of monocytes decreased significantly in patients with tuberculosis, compared with healthy controls. The activation phenotype of peripheral gammadelta T cells in patients with tuberculosis emphasizes the role of these T cells in controlling the inflammatory process during tuberculosis and perhaps other microbial infections.

Adolescent↗
PubMed1999

[Invasive and non-invasive home ventilation--changes between 1982 and 1996].

PATIENTS AND METHODS: In our centre, 111 patients with chronic ventilatory insufficiency (33 females, 78 males, age 48 +/- 18 years, range 3 to 76 years) were treated by intermittent positive pressure ventilation between 1982 and 1996. Underlying diseases were neuromuscular diseases in 29%, sleep-related hypoventilation in 26%, kyphoscoliosis in 15%, chronic obstructive airway disease in 15%, and post-tuberculosis syndromes in 12%. Singular indications were 1 bronchiectasis, 1 lung fibrosis and 1 cystic fibrosis. RESULTS: Until 1991, most patients were ventilated via tracheostoma (10 of 16), in the following years 87 of 95 patients could be ventilated via a nasal or facial mask. Ventilation mode was a controlled one in 80 patients and an assisted one in 31 patients, average ventilation time during night was 6 to 8 hours. In the majority of patients hypercapnia was not only removed during ventilation but also at daytime as an indicator of improvement of ventilatory insufficiency accomplished by a clearly better quality of life and daytime activity. Ten patients (9%) died due to their underlying diseases, 5 of them in the first year of intermittent ventilation.

Adolescent↗
PubMed1998

Nosocomial pneumonia in the critical care unit.

Nosocomial pneumonia poses a major threat to the recovery of patients receiving mechanical ventilation. In addition, nosocomial pneumonia is often difficult to diagnose. This article examines the extent of the threat and some of the difficulties facing the critical care physician when diagnosing nosocomial pneumonia.

Cross Infection↗
PubMed1998

Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function.

STUDY OBJECTIVE: In patients with severe COPD, acute infective exacerbations are frequent. Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacteria in sputum cultures from these patients. We hypothesized that in patients with advanced disease, Gram-negative bacteria other than H influenzae play at least an equally important role. METHODS: We evaluated clinical data and sputum culture results from 211 unselected COPD patients admitted to our hospital with an acute infective exacerbation of COPD. One hundred twelve patients fulfilled our protocol criteria of reliable microbiologic results and reproducible lung function tests; the patients were categorized according to the recently published three stages of severity. RESULTS: Lung function tests revealed an FEV1 of > or =50% of the predicted value in 30 patients (stage I), an FEV1 of 35% to <50% of the predicted value in 30 patients (stage II), and an FEV1 of < or =35% of the predicted value in 34 patients (stage III). Bacteria were classified into three groups: group 1 contained S pneumoniae and other Gram-positive cocci; group 2, H influenzae and Moraxella catarrhalis; and group 3, Enterobacteriaceae and Pseudomonas spp. For all patients together, the most frequently isolated bacteria were group 3 organisms (Enterobacteriaceae and Pseudomonas spp, 48.2%), followed by group 1 organisms (S pneumoniae and other Gram-positive cocci, 30.4%), and group 2 organisms (H influenzae and M catarrhalis, 21.4%). In stage I patients, 14 of 30 had bacteria from group 1, seven of 30 had group 2, and nine of 30 had group 3. In stage II patients, eight of 30 had group 1 bacteria, 10 of 30 had group 2, and 12 of 30 had group 3. In stage III patients, 12 of 52 had group 1 bacteria, seven of 52 had group 2, and 22 of 52 had group 3. The three groups of bacteria causing infective exacerbations were unevenly distributed among the three severity stages of lung function (p=0.016). CONCLUSION: There is a correlation between deterioration of lung function and the bacteria isolated from patients with infective exacerbations of COPD. In acute infective exacerbations, Enterobacteriaceae and Pseudomonas spp are the predominant bacteria in patients with an FEV1 < or =35% of the predicted value.

Acute Disease↗
PubMed1997

[Changes in the spectrum of the causative agents of community-acquired pneumonias (1982-1992)].

BACKGROUND AND OBJECTIVE: The picture of pneumonia acquired out of hospital is continually changing. Microbial aetiology as well as predisposing factors, course and prognosis of this disease were prospectively analysed over a period of 10 years. PATIENTS AND METHODS: In three prospective studies, undertaken between 1982 and 1992, data from 448 patients with out-of-hospital acquired pneumonia were analysed. Microbiological evidence was obtained through blood cultures, from purulent sputum or bronchial secretions, as well as by determining serum antibodies or antigens in urine. RESULTS: Proof of causative organism was achieved in 282 patients (64.1%), with identification of 337 different ones. The spectrum of causative microbes shifted during the study period from predominantly gram-positive bacteria to largely atypical organisms (from 12.5% during 1982/1983, to 36.7% in 1991/1992). Although pneumococci continued to dominate, Chlamydia pneumoniae appeared as an important cause of pneumonia, at 11.4% the most important atypical organism in 1991/1992. -Most patients (74.3%) had a chronic underlying disease. The death rate remained relatively constant at 12.9% during the 10-year period. CONCLUSION: The observed changes in microbial spectrum should be taken into account when specific antibiotic treatment is given. History as well as clinical, radiological and laboratory findings are of only limited value as pointers to the possible microbial cause.

AIDS-Related Opportunistic Infections↗
PubMed1997

Lymphocyte subsets in peripheral blood and smoking habits.

The investigation of peripheral blood lymphocyte (PBL) subpopulations is of interest in a wide variety of inflammatory diseases. Since the number of circulating lymphocytes has been shown to be affected by smoking habits, it seems useful to know how PBL subpopulations are influenced. We therefore determined percentages and absolute numbers of a wide range of PBL subpopulations in smokers (n = 14) and nonsmokers (n = 14). PBLs were obtained from healthy volunteers and analyzed by flow cytometry using antibodies for the detection of CD3, CD4, CD8, CD19, CD56, CD57, CD45RO, CD45RA, alpha/beta and gamma/delta T cell receptor epitopes. With the exception of CD3+ cells, no differences between smokers and nonsmokers were found regarding percentages of PBL subpopulations. Smokers were found to have higher absolute numbers of PBLs in the following subpopulations compared with nonsmokers: CD3+, CD4+, CD3+ alpha/beta +, CD45RO+/CD4+, and CD45RA+/CD4+. Cytotoxic lymphocytes, natural killer cells, and B cells did not differ in number between smokers and nonsmokers. There was likewise no difference in the number of the CD8+ alpha/beta + and all cells bearing the gamma/delta T cell receptor. Smoking increased the number of T cells and mainly CD4+ PBLs. The smoking habits of healthy control groups should therefore be taken into account when comparing lymphocyte subpopulations in different diseases.

Adult↗
PubMed1997

Penetration of sparfloxacin and ciprofloxacin into alveolar macrophages, epithelial lining fluid, and polymorphonuclear leucocytes.

Sparfloxacin (SPX), a novel fluoroquinolone with a broad spectrum of antibacterial activity, has been shown, in vitro, to be more effective against common pulmonary pathogens, particularly Streptococcus pneumoniae, Mycoplasma pneumoniae and some intracellular organisms, than ciprofloxacin (CPX). The objective of this open, comparative, randomized study in two parallel groups was to assess the serum concentrations and penetration of SPX and CPX into alveolar macrophages (AMs), epithelial lining fluid (ELF), and peripheral polymorphonuclear leucocytes (PMNs). Patients received either a single oral dose of SPX, 400 mg (16 patients), or CPX, 500 mg (15 patients), at various times before a routine diagnostic bronchoscopy was performed. Antibiotic concentrations were determined by using a microbiological assay. The median serum elimination half-lives were 17.3 h for SPX and 5.3 h for CPX. Peak levels (median+/-68% confidence range) of CPX were attained in AMs (7.6+/-1.7 mg x L(-1)) at 5 h after admission, and in both ELF (2.13+/-0.91 mg x L(-1)) and PMNs (9.1+/-6.2 mg x L(-1)) at 2.5 h after administration. SPX achieved comparable peak levels in PMNs (median+/-68% range, 9.4+/-1.1 mg x L(-1) at 5 h), but peak concentrations attained in AMs and ELF (35.1+/-15.4 and 32.2+/-28.2 mg x L(-1), respectively, at 24 h) were several times higher than those of CPX. SPX demonstrated substantially greater accumulation in all three sites than did CPX (peak site to serum ratios of 11.0+/-4.3, 65.5+/-28.4 and 63.0+/-66 versus 4.94+/-0.64, 10.6+/-3.7 and 10.6+/-3.7 for PMNs, AMs and ELF, respectively). The results indicate, that sparfloxacin has a long elimination half-life and that it achieves higher concentrations in alveolar macrophages and epithelial lining fluid than ciprofloxacin. Site concentrations of sparfloxacin greatly exceeded the minimal inhibitory concentrations of common respiratory pathogens.

Anti-Infective Agents↗
PubMed1997

Molecular diagnosis of tuberculosis: current clinical validity and future perspectives.

The rapid development and availability of a variety of new molecular genetic technologies present the clinician with an array of options for the accurate diagnosis of infectious diseases. This is particularly the case for tuberculosis, since molecular methods have been rapidly introduced into all working areas of the mycobacteriology laboratory. Nucleic acid amplification methods to detect Mycobacterium tuberculosis in clinical specimens are increasingly used as a tool to diagnose tuberculosis. The bulk of recently available data from clinical evaluations performed under routine laboratory conditions indicate that these molecular methods are rapid and sensitive, but yet inferior, to culture with regard to sensitivity and specificity. Therefore, until gene amplification tests have proved to be reliable and quality control procedures exist, their clinical validity remains controversial. Consequently, definition of selected clinical applications of gene amplification to routine diagnosis of tuberculosis is important and need to be discussed. This review will focus on the clinical role of molecular methods in the direct detection and diagnosis of M. tuberculosis in clinical samples. In addition, molecular genetic approaches designed to determine drug susceptibility and to discriminate strains below the species level will be outlined and discussed in terms of their current and future clinical applicability.

DNA Fingerprinting↗
PubMed1997

Lung function tests in patients with idiopathic pulmonary fibrosis. Are they helpful for predicting outcome?

STUDY OBJECTIVE: Idiopathic pulmonary fibrosis (IPF) varies widely in its course. To evaluate predictive parameters at presentation to the hospital, we investigated 99 patients with IPF (47 women), focusing on extensive lung function tests. METHODS: Standard tests of lung volumes, arterial oxygen tension, and gas exchange at rest and during bicycle exercise were performed. Survival rates in relation to functional parameters were calculated using the actuarial method. Differences in survival proportions were summarized as hazard ratios, and significance levels were determined by log-rank test. RESULTS: At presentation, most patients showed a reduced total lung capacity (TLC) of 79.2 +/- 21.1%, an arterial oxygen tension (PaO2) considered pathologic in 63%, when related to age, a significant decrease of PaO2 with 11.8 +/- 12.1 mm Hg and an increase of the alveolar-arterial oxygen pressure difference with 46.4 +/- 16.4 (12.2 to 76.8) mm Hg during bicycle exercise. Diminished survival was associated with an age older than 50 years, a reduced value to more than 2 SDs below the predicted values of both, TLC alone, or in combination with a reduced vital capacity. Factors not influencing survival were gender, parameters of gas exchange at rest, and PaO2 at rest and during bicycle exercise. CONCLUSIONS: We conclude that standard lung function tests make it possible to assess the prognosis of patients with IPF, while extensive tests like gas exchange measurements at rest and during bicycle exercise do not contribute additional information to make the prognostic estimations more precise.

Exercise Test↗