[Evaluation of velopharyngeal closure in preoperative planning of maxillary advancement].
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Adult↗
Biomedical subjects
U Hess
Publications and source records attributed to U Hess.
[Mumps: efficacy of booster immunization].
10 children aged 15 years, who presented with anti-mumps antibodies of < 3 PEI (Paul Ehrlich Institute) despite documented mumps vaccination in the past, were boosted with Triviraten Berna (Rubini mumps strain) and the antibody response was assessed after 7, 28 and 90 days. All 5 children boosted with the same vaccine (Rubini mumps strain) had a titer rise as early as day 7 persisting for 3 months. The 4 children primed with the Jeryl Lynn mumps strain showed a primary immune response, i.e. a rise of the antibody titer after 28 days only, which did not persist well. The child originally primed with the Urabe mumps strain did not show any significant immune response on day 28, which means a negative result. Children apparently susceptible to mumps cannot be differentiated from immune children by measurement of antibody titers. Reexposure to the homologous vaccine virus elicited a persisting immune response: however, revaccination with a heterologous vaccine virus elicited an immune response directed against different antigenic epitopes, followed by limited persistence of circulating antibodies. The efficacy of a second dose of mumps vaccine was demonstrated in 9/10 children. Only by using a two-dose immunization schedule is it possible to effectively avoid the occasionally serious complications of this viral infection, as has been achieved in Finland.
Adolescent↗
[Participation in multicenter studies as quality control in the therapy of Hodgkin disease: an interim report].
UNLABELLED: From 1988 to 1992 the Swiss Group for Clinical Cancer Research (SAKK) entered 113 patients with Hodgkin's disease into three stage adapted trials (HD-4-6) from the German Hodgkin Study Group (DHSG). In an interim analysis freedom from treatment failure (FFTF) and overall survival (OS) of the SAKK patients (SAKK-pt) were compared to the remaining study population (GHSH-pt) (median follow-up: 30 months for HD-4 and HD-5, 24 months for HD-6). RESULTS: HD-4: SAKK (n = 16), DHSG (n = 241), FFTF-SAKK: 100%, FFTF-DHSG: 85%, p: ns, OS-SAKK: 100%, OS-DHSG: 99%, p: ns, HD-5: SAKK (n = 66), DHSG (n = 639), FFTF-SAKK: 90%, FFTF-DHSG: 85%, p: ns, OS-SAKK: 93%, OS-DHSG: 95%, p: ns, HD-6; SAKK (n = 31), DHSG (n = 411): FFTF-SAKK: 62%, FFTF-DHSG: 68%, p: ns, OS-SAKK: 70%, OS-DHSG: 88%, p < 0.008. The results in the SAKK patients with advanced disease are unsatisfactory. Despite the fact that the treatment was given on time with full doses, 10/30 patients achieved no complete remission (CR). Only one patient relapsed after an initial CR. 6 patients had primary progressive disease. 6 patients died despite conventional salvage chemotherapy. High dose chemotherapy/autologous bone marrow transplantation (HDC/ABMT) was only given to 3 out of 8 potential candidates. Only 2/11 patients are still alive and disease-free after relapse or initial progression. Both had received HDC/ABMT as part of their salvage regimen. This interim analysis identifies a group of patients in which treatment strategies need to be optimized.
Adult↗
[Mumps vaccines: vaccination failures from an immunological viewpoint].
The significance of mucosal and systemic immunity is illustrated with the example of the different immune response of Poliovaccine live oral (Sabin) and Poliovaccine inactivated parenteral (Salk). On the occasion of rubella- and measles-outbreaks it will be demonstrated that in vaccinated people subclinical reinfections may much more frequently occur than clinically manifest diseases. On the basis of these findings one may consider the large number of parotitis cases without complications in mumps vaccinated Swiss pupils as secondary mucosal vaccine failures at a time, when systemic immunity still was protective. Significance for vaccination policy and consequences for handling of vaccines shall be briefly discussed.
Adolescent↗
[Videocinematography and pre- and postoperative diagnosis of lip-maxillary-palatal clefts].
Videocinematography is a valuable tool in the diagnostic workup and planning of functional surgery in cleft patients. The high resolution and depiction of the finest mucosal structures in motion allow objective and dynamic assessment of the individual velopharyngeal function. A total of 170 cleft patients were examined by videocinematography, and the results were compared to nasoendoscopy and to the clinical examination. The marked superiority of this radiological technique with regard to clearness of depiction and ease of use is shown. It can therefore be recommended without reservation for the pre- and postoperative assessment of cleft patients.
Adolescent↗
[Analysis and radiologic staging of the type and severity of aspiration].
The estimated number of the incidence of undiagnosed chronic aspiration pneumonia after cerebral or cerebrovascular injury seems very high. According to American statistics, at least 6% of these patients die from aspiration pneumonia within the first year. The high temporal resolution of cineradiography with frame rates of the complex process of pharyngeal swallowing lasting 0.7 s. The method enables us to differentiate between so-called pre-, intra- and postdeglutitive aspiration, which means aspiration before, during and after the triggering of the swallowing reflex. Together with an established score for the severeness of the aspiration, the method supplies important data for setting up a functional surgical and/or conservative program for rehabilitation and for follow-up-studies.
Barium Sulfate↗
[A motivation-stress-health model applied to marital relations and work].
The present article takes position regarding the proverb "a healthy mind in a healthy body". A review of the literature suggests that, in fact, a healthy mind is as important if not more for a healthy body. Empirical evidence is presented to show the impact of psycho-social stressors on negative affect and on mental as well as physical health. The authors propose that motivation as well as the innate need for self-determination, competence, and relatedness play a crucial role in the understanding of the antecedants and consequences of psychological stress as well as for well-being and health. A model summarizing the theoretical and empirical work of our laboratory in the fields of relationships and work, two areas, central to adult life, is presented.
Adult↗
[High-frequency videocinematograpphy for the objective imaging of the velopharyngeal closure mechanism in cleft palate patients].
The use of high-frequency video cineradiography makes possible an objective and dynamic rendering of the individual velopharyngeal closer pattern. The high resolution and the depiction of the finest mucosal structures while in motion achieved by this technique opens up the possibility of exact and objective 3-dimensional evaluation of the velopharyngeal gap. Following secondary velopharyngoplasty on 80 cleft palate patients, the velopharyngeal closure was studied by means of high-frequency video cineradiography and this rendering was then compared to results obtained by nasoendoscopy and to the clinical findings. It became definitely apparent that the radiological technique is markedly superior in relation to clearness of depiction and ease of use, especially in young children. This imaging technique can be recommended without reservation for pre- and postoperative control of speech-improving procedures.
Adolescent↗
High incidence of infections after 2-chlorodeoxyadenosine (2-CDA) therapy in patients with malignant lymphomas and chronic and acute leukaemias.
BACKGROUND: 2-chlorodeoxyadenosine (2-CDA) is a new purine analogue which has been shown to be highly active in lymphoproliferative disorders. In this clinical trial we assessed 2-CDA toxicity and response rate in patients with various haematological malignancies who were heavily pre-treated and mostly refractory to standard treatment regimens. PATIENTS AND METHODS: Twenty-two refractory patients, 51 relapsing after standard chemotherapy and seven non-pre-treated patients were treated in a non-randomized prospective phase II multicentric study. Their median age was 54 years (range 18-84) and 56 of them were male. Thirty-one had non-Hodgkin's lymphoma (NHL), 11 chronic lymphocytic leukaemia (CLL), 1 prolymphocytic leukaemia (PLL), 13 hairy-cell leukaemia (HCL), 2 mycosis fungoides (MF), 3 multiple myeloma, 7 acute myeloblastic leukaemia (AML), 2 acute lymphoblastic leukaemia (ALL), 6 chronic myeloid leukaemia (CML) in blast crisis, 2 Hodgkin's disease, 1 Waldenström's macroglobulinemia and 1 Langerhans histiocytosis. 2-CDA 0.1 mg/kg/day was given as a continuous intravenous infusion for 7 days and recycled every 4 weeks. RESULTS: One hundred thirty-two courses of 2-CDA were administered to 80 patients, 76 of whom were evaluable for response. A) Toxicity: Myelosuppression: Neutropenia to over 50% of initial value occurred in 46% of patients, thrombocytopenia in 8%, and lymphopenia < 0.5 x 10(9)/l was seen in 41%. Infections occurred in 34/80 patients (43%). The risk of severe infections (WHO grades 3-4) correlated with increasing number of years after first diagnosis (p = 0.01) and low lymphocyte counts on days 1 and/or 14 (p = 0.04); 21 infections were opportunistic. B) Response: 70% patients with lymphoproliferative disorders of low malignancy attained complete or partial response (low-grade NHL 12/16, CLL + PLL 9/12, HCL 13/13, MF 2/2, myeloma 0/3); in patients with AML, ALL, CML in myeloid (n = 4) or lymphoid (n = 2) blast crisis and high-grade lymphoma responses were seen in only 11%. Response was inversely related to the number of pretreatments (p = 0.045). In responding NHL patients the mean lymphocyte count on day 14 of cycle 1 was significantly lower (median 0.6 x 10(9)/l) than that of non-responders (1.2 x 10(9)/l, p = 0.04). CONCLUSION: 2-CDA had a high activity even in heavily pretreated and refractory patients with low-grade lymphoproliferative disorders. In contrast to previously published studies, infections, mainly opportunistic, were a serious side effect in our study. In patients with severe lymphopenia at therapy initiation, the value of prophylactic anti-infective treatment should be studied.
Acute Disease↗
Effect of combination therapy with all-trans-retinoic acid and recombinant human granulocyte colony-stimulating factor in patients with myelodysplastic syndromes.
Since all-trans retinoic acid (ATRA) and granulocyte colony-stimulating factor (G-CSF) not only enhance proliferation and differentiation of normal myeloid cells but also synergistically promote the differentiation of myeloid leukemic blast cells in vitro, we have started a pilot study of combined treatment with ATRA and G-CSF in patients with myelodysplastic syndrome, to analyze the effect of these drugs on hematopoietic differentiation. ATRA was given at 45 mg/m2/day p.o. from week 1-12 and G-CSF at 5 micrograms/kg/day s.c. from week 5-12 with dose modifications according to the absolute neutrophil counts (ANC). A total of 15 patients, predominantly with refractory anemia, were treated. During initial ATRA therapy, a bilineage response with increases of both ANC and platelet counts occurred in three patients. During combined ATRA/G-CSF therapy, ANC increased in all patients, and platelets increased in three out of 14 evaluable patients. An increase in hemoglobin concentration and a decrease in transfusion requirements occurred in one patient each. In the bone marrow, the myeloid-to-erythroid ratio increased during ATRA treatment and remained increased during concomitant G-CSF administration, while the maturation index of myeloid cells increased only in response to ATRA therapy, but returned to baseline during ATRA/G-CSF treatment. Cytogenetic analysis demonstrated persistence of the abnormal clones in all patients. The number of circulating progenitor cells CFU-GM increased in all patients studied. Serum concentrations of the soluble TNF receptor and IL-2 receptor both increased, while TNF-alpha--already elevated prior to therapy--and soluble ICAM-1 concentrations did not significantly change. Adverse effects included dermatitis and cheilosis in most patients, and a drop in platelet counts related to G-CSF in one patient. The pilot study demonstrates that the combination treatment with ATRA/G-CSF is well tolerated, leading to normalization of ANC in most, and improvement of platelets and red blood cells in a subgroup of patients.
Adult↗
Cladribine and severe myelotoxicity.
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Aged↗
Consumer attitudes towards alternative diets.
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Adult↗
Transformations for within-subject designs: a Monte Carlo investigation.
We explored the use of transformations to improve power in within-subject designs in which multiple observations are collected for each S in each condition, such as reaction time and psychophysiological experiments. Often, the multiple measures within a treatment are simply averaged to yield a single number, but other transformations have been proposed. Monte Carlo simulations were used to investigate the influence of those transformations on the probabilities of Type I and Type II errors. With normally distributed data, Z and range correction transformations led to substantial increases in power over simple averages. With highly skewed distributions, the optimal transformation depended on several variables, but Z and range correction performed well across conditions. Correction for outliers was useful in increasing power, and trimming was more effective than eliminating all points beyond a criterion.
Adult↗
Effect of long-term treatment with recombinant human interleukin-3 in patients with myelodysplastic syndromes.
In a phase II study, involving nine patients with refractory anemia or refractory anemia with ring sideroblasts, the effects of treatment with recombinant human interleukin-3 (IL-3) on hematopoietic function were assessed. Doses of IL-3 ranging from 60 micrograms/m2 during weeks 1-6 to 125 micrograms/m2 during weeks 7-12 were administered as subcutaneous bolus injections three times per week for 12 weeks. Platelet counts increased in six patients. Platelet increase correlated with stable or decreased serum tumour necrosis factor alpha (TNF-alpha) levels, while an increase of TNF-alpha levels during IL-3 therapy occurred in patients with no change or a decrease of platelet counts. Leukocyte counts increased in two patients and reticulocytes in three, without an effect on hemoglobin levels. Morphological analysis of the bone marrow revealed an expansion of the myeloid compartment in seven of eight evaluable patients, mainly due to stimulation of the precursor cells. No improvement of the in vitro growth of hematopoietic progenitor cells was observed. Sequential cytogenetic analyses indicate that IL-3 treatment does not act preferentially on either the cytogenetically abnormal or the normal clones. These results suggest that long-term treatment with low-dose IL-3 stimulates megakaryopoiesis with increase of platelet counts, but that additional later-acting cytokines probably will be required to augment neutrophil and erythrocyte counts.
Aged↗
Pharmacokinetics of pamidronate in patients with bone metastases.
BACKGROUND: Pamidronate is a second-generation bisphosphonate used in the treatment of tumor-induced hypercalcemia and in the management of bone metastases from breast cancer, myeloma, or prostate cancer. The pharmacokinetics of pamidronate is unknown in cancer patients. PURPOSE: To determine the influence of the rate of administration and of bone metabolism, we studied the pharmacokinetics of pamidronate at three different infusion rates in 37 patients with bone metastases. METHODS: Three groups of 11-14 patients were given 60 mg pamidronate as an intravenous infusion over a period of 1, 4, or 24 hours. Urine samples were collected in the three groups of patients. Plasma samples were obtained only in the 1-hour infusion group. The assay of pamidronate in plasma and urine was performed by high-performance liquid chromatography with fluorescence detection after the derivatization of pamidronate with fluorescamine. RESULTS: The body retention (BR) at 0-24 hours of pamidronate represented 60%-70% of the administered dose and was not significantly modified by the infusion rate. In particular, the BR at 0-24 hours was not reduced at the fastest infusion rate. Among patients, a threefold variability in BR at 0-24 hours occurred, which was related directly to the number of bone metastases and, to some extent, to creatinine clearance. At 60 mg/hour, the plasma kinetics followed a multiexponential course characterized by a short distribution phase. The mean (+/- SD) half-life of the distribution phase was 0.8 hour (+/- 0.3), the mean (+/- SD) of the area under the curve for drug concentration in plasma x time at 0-24 hours was 22.0 +/- 8.8 mumol/L x hours, and the mean (+/- SD) of the maximum plasma concentration was 9.7 mumol/L (+/- 3.2). Pharmacokinetic variables remained unchanged after repeated infusions applied to four patients. Clinically, the three infusion rates were equally well tolerated without significant toxicity. CONCLUSIONS: The 1-hour infusion rate could be proposed as kinetically appropriate for the administration of pamidronate to patients with metastatic bone diseases.
Aged↗
Sequential in vivo treatment with two recombinant human hematopoietic growth factors (interleukin-3 and granulocyte-macrophage colony-stimulating factor) as a new therapeutic modality to stimulate hematopoiesis: results of a phase I study.
In a phase I study, the sequentially administered combination of recombinant human interleukin-3 (rhIL-3) and rhGM-CSF was compared with treatment with rhIL-3 alone in 15 patients with advanced tumors but normal hematopoiesis. Patients were initially treated with rhIL-3 for 15 days. After a treatment-free interval, the patients received a second 5-day cycle of rhIL-3 at an identical dosage, immediately followed by a 10-day course of rhGM-CSF, to assess the toxicity and biologic effects of this sequential rhIL-3/rhGM-CSF combination. rhIL-3 doses tested were 125, and 250 micrograms/m2, whereas rhGM-CSF was administered at a daily dosage of 250 micrograms/m2. Both cytokines were administered by subcutaneous (SC) bolus injection. rhIL-3/rhGM-CSF treatment was more effective than rhIL-3 but equally effective to each other in increasing peripheral leukocyte counts, especially neutrophilic and eosinophilic granulocyte counts. In contrast, both modes of cytokine therapy raised the platelet counts to the same degree. rhIL-3/GM-CSF treatment was more effective than rhIL-3 in increasing the number of circulating hematopoietic progenitor cells BFU-E and CFU-GM. High-dose rhIL-3, but not low-dose rhIL-3, was as effective as the rhIL-3/rhGM-CSF combinations in increasing the number of circulating CFU-GEMM. The increase in absolute neutrophil counts correlated with the increase in the number of circulating CFU-GM. Side effects, mainly fever, headache, flushing, and sweating, were generally mild, but in two patients the occurrence of chills, rigor, and dyspnea after initiation of GM-CSF treatment necessitated dose reduction and discontinuation, respectively. These results indicate that sequential treatment with rhIL-3 and rhGM-CSF is as effective as single-factor treatment with rhIL-3 in stimulating platelet counts, whereas the effect of combination therapy on neutrophil counts and circulating progenitor cells is superior.
Antineoplastic Agents↗
The facilitative effect of facial expression on the self-generation of emotion.
Twenty-seven female undergraduates completed three tasks: (1) feel four emotions (happiness, sadness, anger, peacefulness); (2) express these emotions, without trying to feel them; and (3) feel and express clearly these four emotions. During each trial subjects pressed a button to indicate when they had reached the required state, and the latency from emotion cue to button press was measured. Heart rate, skin conductance and EMG from four facial sites (brow, cheek, jaw and mouth) were recorded for 15 s before and after the button press and during a baseline period prior to each trial. Self-reports were obtained after each trial. Facial EMG and patterns of autonomic arousal differentiated among the four emotions within each task. Shorter self-generation latency in the Feel-and-Show versus the Feel condition indicated the facilitative effect of facial expression on the self-generation of emotion. Furthermore, the presence of autonomic changes and self-reported affect in the Show condition supports the sufficiency version of the facial feedback hypothesis. The self-generation method employed as an emotion elicitor was shown to reliably induce emotional reactions and is proposed as a useful technique for the elicitation of various emotional states in the laboratory.
Adult↗
Myelokathexis treated with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF).
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Adult↗