PubMed Health⌕ Search

Biomedical subjects

A Brandes

Publications and source records attributed to A Brandes.

At least 19 recordsLinked to original sources
PubMed2006

Depression assessed over 1-year survival in patients with myocardial infarction.

OBJECTIVE: To estimate the prevalence of ICD-10 depression using a self-reported questionnaire and to examine if depression is associated with increased 1-year mortality in patients with myocardial infarction (MI). METHOD: In total, 763 MI-patients completed the Major Depression Inventory at discharge. Information from hospital notes was collected and patients were followed 1 year for re-admission and mortality through national registries. RESULTS: Seventy-three patients (9.6%) were depressed at discharge. Depression was not a significant independent predictor of mortality; however, there was a significant trend for increasing mortality with increasing severity of the depressive state (P = 0.028). All mortality among depressed patients was in patients with non-Q-wave infarction. CONCLUSION: Ten per cent of MI-patients fulfilled diagnostic criteria for depression at discharge. There was a significant trend for increasing mortality with increasing severity of the depressive episode. All mortality among depressed patients was seen in patients with non-Q-wave infarction. These findings indicate future studies in selected subgroups of MI-patients.

Aged↗
PubMed2005

Psychosocial predictors of depression in patients with acute coronary syndrome.

OBJECTIVE: To describe the prevalence of depression according to ICD-10 criteria using a self-completed questionnaire and to identify psychosocial predictors of depression at discharge in patients with acute coronary syndrome. METHOD: A total of 899 patients with acute coronary syndrome completed the Major Depression Inventory at discharge and a questionnaire regarding previous depression and family history of depression. Information concerning civil status was obtained from the Civil Person Registry. RESULTS: Ninety patients (10%) were depressed according to ICD-10 criteria at discharge with 7.2% having a moderate to severe depression at discharge. Women were significantly more frequently and severely depressed than men. Patients with and without depression reported primarily somatic symptoms of depression. Cardiovascular risk factors or treatment did not differ between patients with and without depression. Previous depression (OR 2.9, 95% CI 1.4-6.0 adjusted) and female gender (OR 2.5, 95% CI 1.5-4.3 adjusted) predicted depression at discharge in a logistic regression model. CONCLUSION: Somatic symptoms of depression are prevalent in patients with acute coronary syndrome. The use of self-completed non-diagnostic questionnaires assessing symptoms of depression therefore is cautioned as patients may wrongly be identified as depressed. In patients with acute coronary syndrome depression is predicted by well-known psychosocial risk factors.

Acute Disease↗
PubMed2004

Area under the curve of methotrexate and creatinine clearance are outcome-determining factors in primary CNS lymphomas.

Although high-dose methotrexate (HD-MTX) is the most effective drug against primary CNS lymphomas (PCNSL), outcome-determining variables related to its administration schedule have not been defined. The impact on toxicity and outcome of the area under the curve (AUC(MTX)), dose intensity (DI(MTX)) and infusion rate (IR(MTX)) of MTX and plasmatic creatinine clearance (CL(crea)) was investigated in a retrospective series of 45 PCNSL patients treated with three different HD-MTX-based combinations. Anticonvulsants were administered in 31 pts (69%). Age >60 years, anticonvulsant therapy, slow IR(MTX) (</=800 mgm(-2)h(-1)), and reduced DI(MTX) (</=1000 mgm(-2)wk(-1)) were significantly correlated with low AUC(MTX) values. Seven patients (16%) experienced severe toxicity, which was independently associated with slow CL(crea). A total of 18 (40%) patients achieved complete remission after chemotherapy, which was independently associated with slow CL(crea). In all, 22 patients were alive at a median follow-up of 31 months, with a 3-year OS of 40+/-9%; slow CL(crea) and AUC(MTX) >1100 micromol hl(-1) were independently associated with a better survival. Slow CL(crea) and high AUC(MTX) are favourable outcome-determining factors in PCNSL, while slow CL(crea) is significantly related to higher toxicity. AUC(MTX) significantly correlates with age, anticonvulsant therapy, IR(MTX), and DI(MTX). These findings, which seem to support the choice of an MTX dose >/=3 gm(-2) in a 4-6-h infusion, every 3-4 weeks, deserve to be assessed prospectively in future trials. MTX dose adjustments in patients with fast CL(crea) should be investigated.

Adult↗
PubMed2003

VO2, VCO2, and RQ in a respiratory chamber: accurate estimation based on a new mathematical model using the Kalman-Bucy method.

A respiratory chamber is used for monitoring O(2) consumption (Vo(2)), CO(2) production (Vco(2)), and respiratory quotient (RQ) in humans, enabling long term (24-h) observation under free-living conditions. Computation of Vo(2) and Vco(2) is currently done by inversion of a mass balance equation, with no consideration of measurement errors and other uncertainties. To improve the accuracy of the results, a new mathematical model is suggested in the present study explicitly accounting for the presence of such uncertainties and error sources and enabling the use of optimal filtering methods. Experiments have been realized, injecting known gas quantities and estimating them using the proposed mathematical model and the Kalman-Bucy (KB) estimation method. The estimates obtained reproduce the known production rates much better than standard methods; in particular, the mean error when fitting the known production rates is 15.6 +/- 0.9 vs. 186 +/- 36 ml/min obtained using a conventional method. Experiments with 11 humans were carried out as well, where Vo(2) and Vco(2) were estimated. The variance of the estimation errors, produced by the KB method, appears relatively small and rapidly convergent. Spectral analysis is performed to assess the residual noise content in the estimates, revealing large improvement: 2.9 +/- 0.8 vs. 3,440 +/- 824 (ml/min)(2) and 1.8 +/- 0.5 vs. 2,057 +/- 532 (ml/min)(2), respectively, for Vo(2) and Vco(2) estimates. Consequently, the accuracy of the computed RQ is also highly improved (0.3 x 10(-4) vs. 800 x 10(-4)). The presented study demonstrates the validity of the proposed model and the improvement in the results when using a KB estimation method to resolve it.

Carbon Dioxide↗
PubMed2003

European Organization for Research and Treatment of Cancer (EORTC) open label phase II study on glufosfamide administered as a 60-minute infusion every 3 weeks in recurrent glioblastoma multiforme.

BACKGROUND: Glufosfamide is a new alkylating agent in which the active metabolite of isophosphoramide mustard is covalently linked to beta-D-glucose to target the glucose transporter system and increase intracellular uptake in tumor cells. We investigated this drug in a multicenter prospective phase II trial in recurrent glioblastoma multiforme (GBM). PATIENTS AND METHODS: Eligible patients had recurrent GBM following surgery, radiotherapy and no more than one prior line of chemotherapy. Patients were treated with glufosfamide 5000 mg/m(2) administered as a 1-h intravenous infusion. Treatment success was defined as patients with either an objective response according to Macdonald's criteria or 6 months progression-free survival. Toxicity was assessed with the Common Toxicity Criteria (CTC) version 2.0. RESULTS: Thirty-one eligible patients were included. Toxicity was modest, the main clinically relevant toxicities being leukopenia (CTC grade >3 in five patients) and hepatotoxicity (in three patients). No responses were observed; one patient (3%; 95% confidence interval 0 to 17%) was free from progression at 6 months. Pharmacokinetic analysis showed a 15% decrease in area under the curve and glufosfamide clearance in patients treated with enzyme-inducing antiepileptic drugs, but no effect of these drugs on maximum concentration and plasma half-life. CONCLUSION: Glufosfamide did not show significant clinical antitumor activity in patients with recurrent GBM.

Adult↗
PubMed2001

Diversity, origin, and distribution of retrotransposons (gypsy and copia) in conifers.

We examined the diversity, evolution, and genomic organization of retroelements in a wide range of gymnosperms. In total, 165 fragments of the reverse transcriptase (RT) gene domain were sequenced from PCR products using newly designed primers for gypsy-like retrotransposons and well-known primers for copia-like retrotransposons; representatives of long interspersed nuclear element (LINE) retroposons were also found. Gypsy and copia-like retroelements are a major component of the gymnosperm genome, and in situ hybridization showed that individual element families were widespread across the chromosomes, consistent with dispersion and amplification via an RNA intermediate. Most of the retroelement families were widely distributed among the gymnosperms, including species with wide taxonomic separation from the Northern and Southern Hemispheres. When the gymnosperm sequences were analyzed together with retroelements from other species, the monophyletic origin of plant copia, gypsy, and LINE groups was well supported, with an additional clade including badnaviral and other, probably virus-related, plant sequences as well as animal and fungal gypsy elements. Plant retroelements showed high diversity within the phylogenetic trees of both copia and gypsy RT domains, with, for example, retroelement sequences from Arabidopsis thaliana being present in many supported groupings. No primary branches divided major taxonomic clades such as angiosperms, monocotyledons, gymnosperms, or conifers or (based on smaller samples) ferns, Gnetales, or Sphenopsida (Equisetum), suggesting that much of the existing diversity was present early in plant evolution, or perhaps that horizontal transfer of sequences has occurred. Within the phylogenetic trees for both gypsy and copia, two clearly monophyletic gymnosperm/conifer clades were revealed, providing evidence against recent horizontal transfer. The results put the evolution of the large and relatively conserved genome structure of gymnosperms into the context of the diversity of other groups of plants.

Animals↗
PubMed2000

Time- and dose-limiting erysipeloid rash confined to areas of lymphedema following treatment with gemcitabine--a report of three cases.

Gemcitabine is a deoxycytidine analog with broad antitumor activity. Its main toxicities include myelosuppression, flu-like symptoms, bronchospasms and mild skin rash. We report three cases, in which the patients developed time- and dose-limiting erysipeloid skin reactions confined to areas of impaired lymphatic drainage after application of gemcitabine. Three patients with metastatic tumors (breast cancer, endometrial cancer and non-small cell lung cancer) received weekly infusions of gemcitabine (1000 mg/m2). All patients suffered from lymphedema of different origin and developed an erysipeloid erythema 40-48 h after chemotherapy within their preexisting lymphedema. Genuine erysipela was ruled out by laboratory tests and clinical observation. The skin reaction was repeatedly observed and faded after 14 days without specific treatment. Although the pathogenesis of the observed reaction is unclear, it is suspected that the skin symptoms were caused by gemcitabine or its metabolites. Gemcitabine is usually metabolized fast and excreted renally. In areas with impaired lymphatic drainage pharmakocinetics might be altered: inactivation happens slower and the drug might accumulate in the s.c. and cutaneous tissue, thus increasing local toxicity. Clinical judgement and biochemical parameters can help to tell apart genuine erysipela and the erysipeloid reaction.

Aged↗
PubMed1999

Stereoselective Mukaiyama-Michael/Michael/Aldol Domino Cyclization as the Key Step in the Synthesis of Pentasubstituted Arenes: An Efficient Access to Highly Active Inhibitors of Cholesteryl Ester Transfer Protein (CETP).

Seemingly heartbreaking for a stereochemist, the one-step selective construction of a stereopentad and its prompt destruction by aromatization has been proven to be an efficient strategy for the synthesis of fivefold substituted, pharmacologically highly active arenes (see scheme).

Journal Article↗
PubMed1999

Impressive remission in a patient with locally advanced malignant pleural mesothelioma treated with gemcitabine.

The results of treatment of malignant pleural mesothelioma are quite unsatisfactory regardless of the substance or schedule employed. Although some activity is proved for anthracyclines, platinum compounds and alkylating substances, no chemotherapeutic regimen has emerged as a standard of care. Response rates documented in literature are between 10 and 20% for all these regimens. We report about a patient with locally advanced, unresectable pleural mesothelioma treated with the nucleoside analog gemcitabine (2,2-difluorodeoxycytidine). A 54-year-old male patient with unresectable pleural mesothelioma confirmed by thoracoscopic biopsy was treated with seven cycles of gemcitabine (1000 mg/m2 on day 1, 8 and 15) over a period of 36 weeks. Restaging by thoracic computed tomography (CT) scan was performed after 8, 20 and 36 weeks. At week 36 after beginning of treatment, the CT scan exhibited a substantial partial remission with a reduction of tumor volume of over 50%. The adverse effects of the therapy were very moderate with a hematotoxicity not exceeding WHO grade I and a mild 'flu-like syndrome' during the first three cycles which responded quite well to steroids. The compliance of the patient was excellent and his general condition improved significantly under therapy. Gemcitabine seems to be an active drug for the treatment of pleural mesothelioma. Compared to other active regimens it is normally very well tolerated by the patients. Because of these characteristics gemcitabine seems a suitable antineoplastic substance, especially in palliative settings. It would be worthwhile to test its activity in pleural mesotheliomas in controlled trials.

Antimetabolites, Antineoplastic↗
PubMed1999

Diagnosis of atrial undersensing in dual chamber pacemakers: impact of autodiagnostic features.

Atrial undersensing occurs in a considerable number of patients, both with single lead VDD pacemakers and with DDD devices. The aim of this study was to investigate the diagnostic efficacy of electrocardiographic methods and autodiagnostic pacemaker features to detect atrial sensing dysfunction. Two hundred and thirty-one patients with AV block received single lead VDD pacemakers or DDD devices. Atrial sensitivity was programmed to 0.1 or 0.18 in VDD devices and to 0.5 mV in DDD devices; the rate limits were set to 40 and 160 beats/min. Twelve-lead ECG recording for 1 minute during deep respiration and change of body position, 24-hour Holter ECG recording, and treadmill exercise were performed 2 weeks and 15 months after pacemaker implantation. AV synchrony and, if available, P wave amplitude histogram were sampled by autodiagnostic pacemaker features and compared to electrocardiographic findings. Atrial undersensing was assumed, if AV synchrony was below 100% or if minimal P wave amplitude (PWA) was equal to the programmed atrial sensitivity. Intermittent atrial undersensing occurred in 20.7% of patients. The diagnostic sensitivities of the various methods used to detect atrial sensing failures were: 24-hour Holter monitoring 97.5%, P wave amplitude histogram 90.0%, stored AV synchrony 68.0% without significant difference between the various devices, treadmill exercise testing 58.8%, and 12-lead ECG recording 21.3%. In one patient, atrial undersensing was exclusively detected by exercise testing. In conclusion, autodiagnostic pacemaker features facilitate the evaluation of atrial sensing performance. However, to exclude intermittent atrial malesensing, routine Holter monitoring and treadmill exercise are still needed.

Aged↗
PubMed1999

Atrial sensing and AV synchrony in single lead VDD pacemakers: a prospective comparison to DDD devices with bipolar atrial leads.

INTRODUCTION: Single lead VDD pacing has offered an alternative to DDD systems in patients with isolated AV block. Up to now, however, the relative performance of these pacemaker systems was not systematically compared. METHODS AND RESULTS: Three hundred sixty patients who received either a VDD pacemaker (n = 180) or a DDD device (n = 180) with a bipolar atrial lead were investigated prospectively for a mean period of 30 +/- 13 months. Pacemaker function was analyzed by telemetry, Holter monitoring, and exercise ECG. Time of implantation and fluoroscopy was significantly lower with VDD devices (44.3 +/- 5.1 min vs 74.4 +/- 13.5 min and 4.6 +/- 2.5 min vs 10.3 +/- 5.6 min in DDD pacemakers, respectively). Intermittent atrial undersensing occurred in 23.3% of patients with a VDD pacemaker and in 9.4% with DDD devices (NS). The incidence of atrial tachyarrhythmias did not differ between the VDD (6.7%) and the DDD group (6.1%). Sinus node dysfunction developed in 1.9% of patients, but the vast majority (85.7%) of patients were asymptomatic. There was a tendency for a higher rate of operative revisions in the DDD group (6.1% vs 3.3% in VDD pacemakers, P = 0.15). Cumulative maintenance of AV-synchronized pacing mode was 94.9% in patients with VDD pacemakers and 92.1% with DDD devices (NS). CONCLUSION: With the benefit of a simpler implant procedure, long-term outcome of single lead VDD pacing is equivalent to DDD pacing in patients with AV block and preoperative normal sinus node function.

Aged↗
PubMed1999

Development of sinus node disease in patients with AV block: implications for single lead VDD pacing.

OBJECTIVE: To investigate the incidence of sinus node disease after pacemaker implantation for exclusive atrioventricular (AV) block. DESIGN: 441 patients were followed after VDD (n = 219) or DDD pacemaker (n = 222) implantation for AV block over a mean period of 37 months. Sinus node disease and atrial arrhythmias had been excluded by Holter monitoring and treadmill exercise preoperatively in 286 patients (group A). In 155 patients with complete AV block, a sinus rate above 70 beats/min was required for inclusion in the study (group B). Holter monitoring and treadmill exercise were performed two weeks, three months, and every six months after implantation. Sinus bradycardia below 40 beats/min, sinoatrial block, sinus arrest, or subnormal increase of heart rate during treadmill exercise were defined as sinus node dysfunction. RESULTS: Cumulative incidence of sinus node disease was 0.65% per year without differences between groups. Clinical indicators of sinus node dysfunction were sinus bradycardia below 40 beats/min in six patients (1.4%), intermittent sinoatrial block in two (0.5%), and chronotropic incompetence in five patients (1.1%). Only one of these patients (0.2%) was symptomatic. Cumulative incidence of atrial fibrillation was 2.0% per year, independent of the method used for the assessment of sinus node function and of the implanted device. CONCLUSIONS: In patients undergoing pacemaker implantation for isolated AV block, sinus node syndrome rarely occurs during follow up. Thus single lead VDD pacing can safely be performed in these patients.

Aged↗
PubMed1998

[Foreign body removal in orbits and frontal cranial base].

Owing to their rare incidence, foreign body injuries in the region of the orbit, skull base and skull have up to now mostly been treated in the literature by means of case reports. Here we present our experience and treatment regimen for ten patients we have treated during the last 3 years. In seven cases the foreign body was located in the orbit alone, whereas in three others the orbit and the frontal base were equally involved. Except for one case, the foreign material could be removed completely. Three patients suffered from partial or complete loss of vision and one patient developed a psychosyndrome during the follow-up period, but no late effects were registered in the remaining six cases. Before removing the foreign body and carefully reconstructing the accident, however, we strongly recommend the documentation of possible functional deficits, preferably by means of photography. CT is the method of choice for localising the foreign body, except for the depiction of wood particles. Here, sonography and MR should be performed. As the therapeutic approach, the cooperation of an interdisciplinary team of ophthalmogists, neuro- and maxillofacial surgeons seems mandatory. To avoid inflammation, the immediate removal of the foreign material is recommended in cases with considerable intracranial lesions: post-operative neurologic and intensive care monitoring should be provided. Treatment is completed by high-dose antibiotics, using CSF-soluble substances and, if necessary, anti-convulsives.

Adolescent↗
PubMed1998

Unusual nasal and orbital involvement of glioblastoma multiforme: a case report and review of the literature.

We describe a case of glioblastoma treated with chemoradiotherapy that spread to the dura mater with direct invasion of the skull base, protrusion into the homolateral nasal fossa, and penetrated of the frontal sinus, the orbital wall and the ethmoidal sinuses. Only eight cases of glioblastoma showing this development have been described in the literature; one of these, however, had a sarcomatous component which was absent in our case.

Aged↗
PubMed1998

Molecular-cytogenetic characterization of the Vicia faba genome--heterochromatin differentiation, replication patterns and sequence localization.

A comprehensive survey of the molecular-cytogenetic features of the Vicia faba chromosome complement (2n = 12) is given. It includes previous as well as new original data. Various Giemsa, restriction endonuclease and fluorochrome banding patterns, azacytidine-mediated segment extension, replication patterns, lateral A/T asymmetry and sequence localization data for tandemly arranged simple sequence repeats, dispersed repeats and coding sequences as well as histone acetylation patterns are considered. This allows not only to distinguish and characterize telomeres, subtelomeres, centromeres and the NOR, but also the structure of the 5S rRNA gene loci and two main types of interstitial heterochromatin. Additionally, it offers physical landmarks within euchromatic areas. Thus, the field bean genome, exemplified by the reconstructed karyotype ACB, belongs to the cytogenetically best investigated plant genomes.

Chromosome Banding↗
PubMed1998

Should unipolar leads be implanted in the atrium? A Holter electrocardiographic comparison of threshold adapted unipolar and high sensitive bipolar sensing.

The accuracy of atrial sensing plays a central role in dual chamber pacing. Recent Holter electrocardiographic studies showed a high incidence of atrial malsensing. We investigated the efficacy of bipolar atrial sensing at high sensitivity compared to threshold adapted unipolar sensing. One hundred consecutive patients with identical dual chamber pacemakers and bipolar atrial leads were investigated. Mean and individual range of 40 unipolar and bipolar telemetered atrial potentials were calculated; sensing threshold was determined by a semiautomatic sensing test. Oversensing was investigated with the help of a muscle provocation test. Twenty-four-hour Holter monitoring was performed at the highest bipolar sensitivity as well as at a unipolar sensitivity of half the measured sensing threshold. Mean atrial potential was significantly lower during bipolar mode compared to the unipolar sensing configuration, 3.66 +/- 1.75 versus 3.85 +/- 1.62 mV, P = 0.02. The bipolar atrial potentials showed a higher individual range than the unipolar signals, 2.44 +/- 2.62 versus 1.79 +/- 0.92 mV, P < 0.01. Sensing threshold did not differ significantly, 2.76 +/- 1.33 versus 2.67 +/- 1.29 mV. Mean oversensing threshold was 1.21 mV at unipolar configuration, whereas oversensing could not be provoked at a bipolar sensitivity of 0.5 mV. The incidence of atrial undersensing was significantly higher at threshold adapted unipolar sensing compared to bipolar sensing at highest atrial sensitivity, 35% versus 22%, P = 0.04. Oversensing did not occur at bipolar sensing, but was observed in 56% of patients at unipolar mode. Thirty-two percent of patients showed both atrial undersensing and oversensing at the unipolar sensing configuration. The muscle provocation test reached a sensitivity of 89% and a specificity of 95% in prediction of atrial oversensing during daily life. In conclusion, unipolar atrial potentials are more stable than bipolar ones. On the other hand, bipolar atrial sensing is less prone to the perception of myopotentials. Programming a high bipolar sensitivity significantly improves atrial sensing. Thus, bipolar leads should generally be implanted in the atrium.

Aged↗
PubMed1997

[Life-threatening swelling of the tongue in antihypertensive therapy with ACE inhibitors].

Although generally showing a low incidence of side effects, inhibitors of angiotensin-converting enzyme (ACE) may in rare cases induce angioedemas, mainly located in the oro-facial area and larynx. The interval between the beginning of the ACE inhibitor therapy and the occurrence of such angioedemas may range from a few hours to a few years. Here, the case of a 53-year-old man with massive swelling of the tongue after dental surgery is presented who had started with ACE inhibitor therapy only 24 h before. At admission to the clinic, obstruction of the upper airway due to the tongue swelling had already progressed so far that fiberoptic intubation was necessary. Additionally, the patient was treated with corticosteroids, antihistaminics and epinephrine, avoiding any further administration of the ACE inhibitor. The swelling resolved within 48-72 h. Dentists and physicians should take into consideration this potential side effect in patients treated with ACE inhibitors.

Angioedema↗