PubMed Health⌕ Search

Biomedical subjects

A Kübler

Publications and source records attributed to A Kübler.

At least 37 records · Page 2Linked to original sources
PubMed2000

Effect of sepsis and cardiac surgery with cardiopulmonary bypass on plasma level of nitric oxide metabolites, neopterin, and procalcitonin: correlation with mortality and postoperative complications.

OBJECTIVES: To examine the hypothesis that nitrite/nitrate, neopterin, and procalcitonin (PCT) levels can be useful predictors of sepsis-associated mortality and predictors of the postoperative complications after cardiopulmonary bypass (CPB). DESIGN: Prospective clinical study. SETTING: Intensive care unit of the Medical University Hospital. PATIENTS: 41 patients with sepsis, 42 patients subjected to open heart surgery with CPB, and 30 healthy volunteers. MEASUREMENTS AND RESULTS: Nitrite/nitrate, neopterin, and PCT levels were measured in septic patients as soon as sepsis was recognized and then on the 2nd, 3rd, and 5th days of treatment. Statistically significant differences between survivors and nonsurvivors were found for neopterin and PCT. The area under receiver operating characteristic curve (AUC) for both parameters as predictors of mortality was above 0.8. The nitrite/nitrate level was also higher in nonsurvivors, but the AUC remained below 0.8, which indicates poor predictive power. The same parameters were measured in patients undergoing cardiac surgery before, during and after CPB establishment. The development of post-operative complications was correlated with increased postoperative neopterin and PCT levels. Additionally, neopterin was found as an early marker for the prognosis of postoperative complications, since patients who developed organ dysfunction had had elevated concentration of this parameter even before surgery (AUC 0.83). Measurement of NO metabolite levels was less specific and less sensitive. CONCLUSIONS: Our results confirm the value of PCT and neopterin measurement as diagnostic tools in monitoring the clinical course of patients in intensive care units.

Area Under Curve↗
PubMed2000

The thought translation device (TTD) for completely paralyzed patients.

The thought translation device trains locked-in patients to self-regulate slow cortical potentials (SCP's) of their electroencephalogram (EEG). After operant learning of SCP self-control, patients select letters, words or pictograms in a computerized language support program. Results of five respirated, locked-in-patients are described, demonstrating the usefulness of the thought translation device as an alternative communication channel in motivated totally paralyzed patients with amyotrophic lateral sclerosis.

Biofeedback, Psychology↗
PubMed2000

[Drug interactions in anesthesiology].

In modern anaesthesiology drug interactions are inevitable. The interactions between anaesthetic drugs are well known for anaesthesiologists and even purposely used to obtain optimal anaesthetic effects. More complicated are interactions between anaesthetic drugs and chronic medications of the patients. This kind of interactions may be dangerous for the patients during anaesthesia procedure. In this survey the most common interactions between anaesthetics and popular groups of drugs were discussed. The knowledge of drug interactions is very important and useful for the practice of anaesthesia.

Anesthetics↗
PubMed1999

The thought translation device: a neurophysiological approach to communication in total motor paralysis.

A thought translation device (TTD) for brain-computer communication is described. Three patients diagnosed with amyotrophic lateral sclerosis (ALS), with total motor paralysis, were trained for several months. In order to enable such patients to communicate without any motor activity, a technique was developed where subjects learn to control their slow cortical potentials (SCP) in a 2-s rhythm, producing either cortical negativity or positivity according to the task requirement. SCP differences between a baseline interval and an active control interval are transformed into vertical or horizontal cursor movements on a computer screen. Learning SCP self regulation followed an operant-conditioning paradigm with individualized shaping procedures. After prolonged training over more than 100 sessions, all patients achieved self-control, leading to a 70-80% accuracy for two patients. The learned cortical skill enabled the patients to select letters or words in a language-supporting program (LSP) developed for inter-personal communication. The results demonstrate that the fast and stable SCP self-control can be achieved with operant training and without mediation of any muscle activity. The acquired skill allows communication even in total locked-in states.

Adult↗
PubMed1999

An argon-dye laser system for photodynamic therapy and diagnosis.

An argon-dye laser system for the clinical application of photodynamic therapy and photodynamic diagnosis is presented. Two out-patient treatment rooms and three operating theaters are served by an argon-dye laser system which can be accessed by remote-control from each treatment room. The argon-dye laser offers a wide range of light wavelengths with sufficient energy for all kinds of photosensitizers and fluorescent substances. This report presents our experiences with the first remote-controlled laser configuration which is being used routinely in clinical practice for photodynamic therapy and photodynamic diagnosis.

Ambulatory Care↗
PubMed1999

Lactoferrin increases the output of neutrophil precursors and attenuates the spontaneous production of TNF-alpha and IL-6 by peripheral blood cells.

The aim of this report was to investigate the effects of bovine lactoferrin (BLF) taken orally (per os) by healthy individuals, on selected immune parameters. Three groups of volunteers (7 persons per group) were taken daily for 7 days, one capsule containing 2, 10 or 50 mg of BLF. A control group has taken placebo only. Venous blood was taken for tests a few hours before the first dose of BLF, one day and 14 days after the last dose of the preparation. For the evaluation of BLF action on the immune response system we have chosen 3 parameters: content of neutrophil precursors in the peripheral blood (in percentage), spontaneous production of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) by unstimulated blood cell cultures. We found that oral treatment of volunteers with BLF caused a transient (one day after last dose) increase of immature forms of neutrophils in the circulating blood. That increase was more than 2-fold in the case of 10 mg dose. However, statistically significant increases in the percentage of neutrophil precursors were also registered at doses of 2 and 50 mg of BLF. No change in the immature cell content was observed in the placebo group. The treatment with BLF also resulted in a profound decrease of the spontaneous production of IL-6 and TNF-alpha by cultures of peripheral blood cells. This decrease was significant (10 mg/dose) one day following the last dose of BLF and persisted for additional 14 days. These results confirmed our earlier data on the effects of per os treatment with a nutritional preparation containing BLF. Furthermore, we were able to closer establish the optimal dose of BLF affecting selected immune indices.

Adjuvants, Immunologic↗
PubMed1998

[Squamous epithelial carcinoma in a 27-year-old patient with cellular immune defect].

Squamous cell cancer of the oral cavity mainly occurs in older patients or in patients with alcohol or nicotine abuse. Younger patients are seldom involved. The case of a 27-year-old woman with a squamous cell cancer of the right cheek will be presented. Without any risk factors, an immune defect resulting in chronic Candida infection of the oral cavity seems to be responsible for the carcinogenesis.

Adult↗
PubMed1998

Treatment of oral leukoplakia by topical application of 5-aminolevulinic acid.

A new therapy for the treatment of oral leukoplakia by 5-aminolevulinic acid (ALA) and photodynamic therapy (PDT) is presented. ALA, a precursor in the biosynthesis of haeme, induces the production of the endogenous photosensitizer protoporphyrin IX which can be used for PDT. Twelve patients, who had been suffering from leukoplakia of the oral mucosa for several years, were treated by ALA-mediated PDT. ALA was used as a topical photosensitizer and 20% ALA cream was applied to the leukoplakia lesion of the oral mucosa for two hours and then light activated at 630 nm, 100 mW/cm2 and 100 J/cm2. Five patients showed complete response to the treatment, four patients showed a partial response and in three patients treatment was unsuccessful. One patient with partial response was retreated, after which the lesion disappeared.

Administration, Topical↗
PubMed1998

Lactoferrin lowers serum interleukin 6 and tumor necrosis factor alpha levels in mice subjected to surgery.

Mice subjected to thymectomy or splenectomy in general anesthesia release interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) into circulation reaching high concentrations after 4 h following operation. In the case of thymectomy IL-6 can be detected only on the day of operation and TNF-alpha attains a maximal value on day 3 postoperation. Splenectomy, which is a more extensive surgical operation, results in a higher, and more prolonged existence of IL-6 in circulation accompanied by higher levels of TNF-alpha. Bovine lactoferrin (BLF; 10 mg/mouse), given intravenously (i.v.) 24 h before thymectomy, reduced, on average, the level of serum IL-6 by 70% as measured 4 h after operation. The inhibiting effect of BLF on TNF-alpha production was smaller with a mean 30% reduction. The effects of BLF (i.v.) administration on the cytokine levels following splenectomy were less inhibitory. BLF caused an approximate 35% fall in IL-6 levels and even weaker effects (20% inhibition) on TNF-alpha release. Application of much lower (1-0.2 mg) per os doses of BLF was even more effective in lowering IL-6 levels after thymectomy (up to 90%) after 5 BLF doses, and by 55% of TNF-alpha. The data suggest that lactoferrin may find therapeutical application for diminishing manifestations of shock caused by clinical insults.

Administration, Oral↗
PubMed1998

Lactoferrin effects on the in vitro immune response in critically ill patients.

The aim of the study was to investigate whether lactoferrin can improve the immune competence of cells from patients with systemic inflammatory response syndrome (SIRS). We studied the effect of lactoferrin (LF) on the proliferative response of peripheral blood mononuclear cells (PBMC) to lipopolisaccharide (LPS) in vitro and its influence on production of 2 proinflammatory cytokines: interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha). Three groups of patients: septic survivors, septic nonsurvivors and multiple trauma patients, were investigated. Blood samples were taken upon admission to intensive care unit and after 2, 3 and 5 days. The proliferative response of PBMC in vitro was tested using 3-day culture with LPS. Cell proliferation/death was measured using MTT colorimetric method. The spontaneous and LPS-induced activity of TNF-alpha and IL-6 were measured with bioassays using indicator cell lines WEHI-164.13 and 7TD1, respectively. We demonstrated that LF inhibited the proliferative response, both spontaneous and LPS-induced, in all groups of patients. Lactoferrin alone was a good inducer of IL-6 and TNF-alpha production by monoclear cells in vitro. Addition of LF to the cultures of LPS-activated mononuclear cells stimulated IL-6 production, most markedly in the group of septic survivor patients (mean 1479, 1452, 1728, 1980 pg/ml on day 1, 2, 3 and 6 respectively). Lactoferrin also upregulated TNF-alpha production. That effect was very significant in the septic survivor patients (mean 7407, 6739, 7498 and 8509 pg/ml on day 1, 2, 3 and 5 respectively) and less pronounced in the group of trauma patients. We conclude that lactoferrin exhibited regulatory actions on the altered reactivity of PBMC from patients with sepsis and multiple injury. Lactoferrin is a good inducer of IL-6 and TNF-alpha production. However, in most cases of septic nonsurvivors LF could not abolish low reactivity of cells with regard to cytokine production.

Adolescent↗
PubMed1998

Effect of general and regional anesthesia on some neutrophil functions.

Transient immunosuppression in patients during anesthesia and surgery may cause postoperative infections. In the immunity against pathogens the processes of non-specific defence are of special importance and engage neutrophils as the major cell type. The aim of this study was to monitor activity of neutrophils during and after surgery, applying different methods of anesthesia. The status of neutrophils was determined by evaluation of chemotactic, phagocytic and chemiluminescence (bactericidal) activities. The study included 78 patients, who underwent surgery due to pathological injury-effected changes or due to varicose veins of extremities. Blood samples for determination of the neutrophil activity were taken just before anesthesia, when the symptoms of anesthesia occurred, 15 min after starting of surgery, 24 h and 5-7 day after surgery. In majority of patients we observed neutrophilic leukocytosis. There was a statistically significant correlation between leukocytosis and percentage of neutrophils in the subsequent days after surgery, depending on a kind and extension of surgical intervention. In addition, we have found a decrease in chemotactic, phagocytic and bactericidal activity after all kinds of anesthesia. The decrease in the phagocytic activity lasted longer, usually at least 24 h after surgery, whereas chemotaxis and chemiluminescence returned quickly to control levels. In the spinal anesthesia the chemiluminescence was not altered; this phenomenon could result from blockade of the sympathetic nerve system and activation of neutrophils metabolism. The brachial plexus blockade had the statistically smallest effect on the function of neutrophils. In the long-term anesthesia (longer than 2 h), particularly using halothane, we have observed depressed values of chemotaxis, phagocytosis and chemiluminescence which lasted longer than in other studied group of patients. We conclude that monitoring of the neutrophil functions is a useful form of studying immune reactions of patients to anesthesia and surgery.

Anesthesia, Conduction↗
PubMed1998

Immunoregulatory effects of a nutritional preparation containing bovine lactoferrin taken orally by healthy individuals.

The aim of this study was to monitor several immune parameters in 17 healthy volunteers taking orally commercially available capsules containing bovine lactoferrin (BLFT) for 10 days (40 mg of BLFT daily). We determined leukocyte number and content of main blood cell types, spontaneous and phytohemagglutinin A (PHA)-induced proliferation of lymphocytes, plasma levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) as well as spontaneous and lipopolysaccharide (LPS)-induced production of these cytokines in peripheral blood cell cultures. All measurements were performed before, one day and 14 days following cessation of BLFT treatment. We established some, transient drop in the percentage of neutrophils accompanied by an opposite phenomenon with regard to lymphocyte levels. More profound changes were registered in the percentage of other cell types, for example a 100% increase in the level of immature cell forms (bands) was noted. At the same time the percentages of eosinophils and monocytes declined significantly. All these changes were, however, more individual and regulatory, the direction of these changes depended on initial picture of blood cells. Although the proliferative response of lymphocytes showed, on average, a transient decrease, differentiated effects of BLFT treatment were observed depending on initial ability of lymphocytes to proliferate. TNF-alpha serum levels showed a tendency to decrease during the monitoring time, the changes of IL-6 levels were, however, not significant. As in the case of the proliferative response, the treatment with BLFT was regulatory with respect to serum TNF-alpha levels. When we analyzed spontaneous and LPS-induced cytokine production in cell cultures we found that mainly the mean spontaneous response was affected (inhibition). We also observed a typical, regulatory action of BLFT on the level of spontaneously produced IL-6. This kind of regulatory action of BLFT was also found in the case of spontaneously produced TNF-alpha in cell cultures. The influence of other ingredients such as selenium or vitamins, contained in the capsules, cannot be excluded, although our latest data showed that orally taken bovine lactoferrin alone can induce identical changes as BLFT. Taken together, we revealed regulatory effects of oral treatment with commercially available capsules, containing BLFT. The results indicate that oral administration on BLFT-containing capsules may regulate some immune parameters in healthy individuals. In addition, the data suggest that bovine lactoferrin may be applied in clinic to improve the immune status of patients.

Adjuvants, Immunologic↗
PubMed1998

[Organization of services for treatment of postoperative pain--3-year experience].

We report organisation principles and three year experience of Acute Pain Service in general surgery clinic. 481 patients were treated after abdominal and vascular interventions, hemorrhoidal varices and mammectomies. Continuous epidural, combined spinal-epidural, intrapleural anaesthesia and continuous brachial plexus block were used for pain control. Time of analgesia varied from 1 to 4 days. The level of analgesia was assessed as good (VAS 3) in 94.8% of cases. Complications were mainly technical due to catheter or antibacterial filter failure. In 2% of cases cardiovascular complications were observed. Respiratory depression occurred in 1 patient. The work of APS team was assessed as very good by both surgeons and patients.

Acute Disease↗
PubMed1997

Photodynamic therapy and hyperthermia as an adjuvant modality in preventing tumor recurrence.

BACKGROUND AND OBJECTIVE: The objective of this study was to determine the relative efficacy in preventing tumor recurrence by photodynamic therapy (PDT), and by ablative CO2 laser surgery followed by PDT, compared to ablative surgery alone (negative control) or ablative surgery followed by a course of hyperthermia (positive control). STUDY DESIGN/MATERIALS AND METHODS: The cheek pouches of 36 hamsters were treated with 0.5% 9,10 dimethyl-1,2-benzanthracene in acetone three times a week. After 12 weeks all animals showed tumors of their cheek pouches and were divided into four groups. In groups number I, II, and III, all visible tumors were removed by aid of a CO2 laser. Animals of group I did not receive any further treatment. After tumor resection, the cheek pouches in group II were treated with hyperthermia by aid of a Nd:YAG laser and a temperature of 43 degrees C for 30 minutes. In group III after resection of the tumors, the cheek pouches were treated with PDT (75mW/cm2 175J/cm2--3mg/kg Photofrin i.p./24h). In group IV, the tumors were not excised, instead they were only treated with PDT (as above). All animals were observed for 50 days for any signs of tumor recurrence. RESULTS: In group I (CO2) all tumors (100%) recurred within 50 days. In group II (CO2 + hyperthermia) 61%, in group III (CO2 + PDT) 27.7%, and in group IV (PDT) 50% of all tumors recurred. The first signs of recurrence could be seen in group I, followed by groups II and IV. Group III was the last one presenting tumor recurrence. CONCLUSIONS: The combination of CO2 surgery and PDT produced significantly better results than CO2 surgery or PDT alone, and better than the combination of CO2 surgery and hyperthermia.

Animals↗
PubMed1997

[Multi-local angiosarcoma of the oral mucosa].

A 64-year-old man presented with a bluish, livid swelling in the region of the lateral alveolar processes of all four quadrants. Evaluation and histopathological findings resulted in the diagnosis of an angiosarcoma at multiple sites. A survey of the literature and an epidemiologic review of our own patients prove this to be an extremely rare occurrence. A partial resection of the maxilla and the mandible on both sides was performed in sano. After discharge, however, a sarcoma was detected in the region of the right scapula 5 months after surgery. Therefore radiation treatment was initiated. The patient died 4 weeks later. The course confirms the poor prognosis of this tumor.

Bone Neoplasms↗
PubMed1997

Redifferentiation of oral dysplastic mucosa by the application of the antioxidants beta-carotene, alpha-tocopherol and vitamin C.

In a clinical trial the effect of chemoprevention with beta-carotene, vitamin E and C on dysplastic tissue was studied. The study included 24 patients with oral leukoplakia and 24 patients after radical resection of a primary oral cancer. There was a reduction of increased cell kinetic parameters like the S-phase portion or the average number of nuclear-organizer regions (NOR) per cell nucleus, a decrease of the micronuclei portion and a normalization of the cytokeratin gene-expression. The general response was 97.5%. Stopping the alcohol and tobacco abuse the effect of the antioxidative vitamins on redifferentiation of the oral mucosa was more intense than by persistance of the alcohol and tobacco abuse, but a long term prevention seems to be ineffective.

Antioxidants↗