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Biomedical subjects

C Doberauer

Publications and source records attributed to C Doberauer.

At least 19 recordsLinked to original sources
PubMed2001

Sleep-Disordered breathing in patients referred for angina evaluation--association with left ventricular dysfunction.

BACKGROUND: Clinical observations have linked sleep-disordered breathing to cardiovascular morbidity and mortality, and especially to coronary artery disease. HYPOTHESIS: The study was undertaken to determine the prevalence of sleep-disordered breathing in consecutive patients referred for angina evaluation, and analyzed the parameters influencing the severity of sleep-disordered breathing. METHODS: In all, 68 consecutive patients (53 men, 15 women, aged 63.4 +/- 10.0 years) referred for angina evaluation were studied. Coronary angiography, selective left ventriculography, and a polygraphic study with a validated six-channel monitoring device were performed. Full-night polysomnography was used to reevaluate patients with an apnea/hypopnea index > or = 10/h. RESULTS: Sleep-disordered breathing as defined by an apnea/hypopnea index > or = 10/h was found in 30.9% of patients; its prevalence was not increased in patients with and without coronary artery disease (26.5 vs. 42.1%). Multiple stepwise linear regression analysis revealed that the severity of sleep-disordered breathing was significantly and independently associated with left ventricular ejection fraction (r = -0.38; p = 0.002), but not with age, body mass index, gender, diabetes mellitus, hypertension, hyperuricemia, hypercholesterolemia, smoking habits, or coronary artery disease. In this group of patients, multiple logistic regression analysis could not demonstrate sleep-disordered breathing to be an independent predictor of coronary artery disease. CONCLUSIONS: Sleep-disordered breathing is common in patients referred for angina evaluation. The degree of sleep-disordered breathing is mainly determined by the extent of left ventricular dysfunction.

Angina Pectoris↗
PubMed2000

[Duodeno-ileal fistula development due to retroperitoneal lymph node metastases of sigmoid carcinoma].

We report on a 75-year-old patient suffering from persistent diarrhea with consecutive weight loss of 50 kg over a nine month period. Three years ago the patient had been operated on a sigmoid cancer. Ultrasonography and CT-scan revealed retroperitoneal masses due to lymph node metastases. Enteroclysis demonstrated a fistula between the duodenum and the terminal ileum. Whereas duodenocolic fistulae due to malignancies are well known to the best of our knowledge a fistula between retroperitoneal parts of the duodenum and the intraperitoneal intestine have not descripted so far.

Aged↗
PubMed1999

Prevalence of ventricular late potentials in patients with obstructive sleep apnea syndrome.

BACKGROUND: It is known from various cardiac disorders that the presence of ventricular late potentials (VLP) in the signal-averaged electrocardiogram (ECG) is associated with an increased risk of sudden cardiac death. HYPOTHESIS: In view of the increased cardiovascular mortality of patients with obstructive sleep apnea syndrome (OSAS), we assessed the prevalence of VLP in these patients. METHODS: In all, 118 consecutive patients with polysomnographically verified OSAS were prospectively studied; 21 snorers without evidence of a sleep-related breathing disorder served as a control group. Signal-averaged ECG and 24-h Holter ECG were performed in all patients and controls, and left ventricular function was determined by radionuclide ventriculography in the OSAS group. Furthermore, patients and controls were followed for up to 45.5 months for arrhythmic events, syncopes, or sudden cardiac death. RESULTS: An abnormal signal-averaged ECG was seen in seven patients (5.9%) and in one snorer (4.8%). Patients with and without VLP did not differ with respect to age, body mass index, left ventricular ejection fraction, or ectopic activity in the 24-h Holter ECG, but the former had significantly higher mean (standard deviation) apnea/hypopnea indices [55.4 (25.2)/h vs. 37.4 (22.6)/h; p < 0.05]. Of the 118 patients, 110 could be followed for 26.7 (7.9) months. During this period, two patients had syncopes and one patient had sudden cardiac death. The seven patients with VLP remained free of events during the follow-up period, as did the 21 snorers. CONCLUSIONS: Patients with OSAS have a low prevalence of VLP in the signal-averaged ECG, not exceeding that in normal subjects. Moreover, abnormal signal-averaged ECGs do not appear to be useful as a prognostic marker.

Adult↗
PubMed1999

Multiple myeloma involving the stomach with vitamin B12 deficiency.

Involvement of the gastrointestinal tract by plasmocytoma is rare. In a 78-year-old man with IgA lambda multiple myeloma stage IIIB, the evaluation of a megaloblastic anaemia revealed a subnormal vitamin B12 level. Urinary excretion of isotope-labelled vitamin B12 was reduced. Tests for gastric parietal cell and intrinsic factor antibodies were negative. There were no clinical signs of an insufficient absorption in the ileum. Biopsy specimens of the stomach showed a dense, diffuse infiltrate of malignant plasma cells in the lamina propria of fundus and corpus. A urease test for Helicobacter pylori was positive. There was a minor haematological improvement when vitamin B12 was given parenterally. Several combinations of cytostatic drugs had no effect on the manifestations of the multiple myeloma. In our patient the vitamin B12 deficiency may be related to a displacement or destruction of parietal cells by malignant plasma cells.

Aged↗
PubMed1998

Vitamin supplementation during weight reduction--favourable effect on homocysteine metabolism.

Moderately elevated homocysteine concentrations, reflecting deficiency of some nutritional factors required for homocysteine metabolism (folate, vitamin B-6, vitamin B-12) and/or less severe genetic defects, are common in the general population. Several studies have indicated the role of homocysteine as an independent risk factor for vascular disease. A pilot study published recently suggested that plasma homocysteine levels increase during weight reduction in slightly overweight, otherwise healthy subjects (group A). We examined a comparable group of 13 overweight subjects (group B) using a standardised caloric intake and defined vitamin supplementation (Medyn: folate 0.2 mg/ vitamin B-68.0 mg/ vitamin B-120.010 mg three times the day orally) to determine the effect of weight reduction on serum homocysteine levels and to compare the results with those of the pilot study. Mean body weight declined from 87.0 +/- 20.2 to 84.2 +/- 20.1 kg (P < 0.05) in group A and 85.7 +/- 11.3 to 82.5 +/- 9.9 kg (P = 0.049) in group B. Serum homocysteine levels rose from 7.9 +/- 2.0 to 8.7 +/- 2.3 mumol/l (P < 0.0001) in group A and decreased from 8.19 +/- 1.73 to 7.35 +/- 0.88 mumol/l (P = 0.0022) in group B. No correlation was found between the changes in body weight and in homocysteine levels (r = 0.02 in group A, r = 0.18 in group B). Additionally, no correlation was found between serum folate levels and changes in homocysteine levels (r = 0.03 in group A, r = 0.09 in group B). The results suggest that an adequate oral vitamin-supplementation protects against increased homocysteine production during weight reduction.

Adult↗
PubMed1997

Pulmonary hypertension in patients with obstructive sleep apnea syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with an increased cardiovascular morbidity, including pulmonary hypertension. Little is known about factors influencing the degree of pulmonary hypertension and left ventricular dysfunction in patients with OSAS, especially in the absence of concomitant lung disease. METHODS: Right heart catheterization, arterial blood gas analysis, and pulmonary function tests were performed in 92 consecutive patients (81 men and 11 women; mean +/- SD age, 53.1 +/- 11.0 years) with polysomnographically verified OSAS, in whom clinically significant lung disease was excluded. RESULTS: Eighteen patients (20%) had mild pulmonary hypertension; 8 (44%) of them also had increased pulmonary capillary wedge pressures (Ppew). Left ventricular dysfunction was associated with arterial hypertension. Only Ppcw (r = 0.51; P < .001) and the percentage of time during sleep spent with an oxygen saturation below 90% (as an indicator of the severity of OSAS) (r = 0.34; P = .003) were significantly and independently associated with pulmonary artery pressure. CONCLUSIONS: Obstructive sleep apnea syndrome can cause mild pulmonary hypertension, even in the absence of pulmonary disease. In these patients, pulmonary hypertension is of the postcapillary type, or-in patients with normal left ventricular function-strongly related to the severity of OSAS. Our findings indicate that OSAS may constitute an important, and independent, risk factor for pulmonary hypertension.

Adult↗
PubMed1997

[Villous bile duct adenoma with mucinous bile ].

HISTORY AND ADMISSION FINDINGS: A 75-year-old woman was admitted because of colicky upper abdominal pain. Physical examination was unremarkable. INVESTIGATIONS: Alkaline phosphatase and gamma-glutamyl transpeptidase activities as well erythrocyte sedimentation rate were increased. Sonography revealed mild enlargement of the hepatocholedochal duct to 1.1 cm. Retrograde endoscopy showed a band-like immobile structure in the cystic duct. TREATMENT AND COURSE: At operation the hepatocholedochal duct was found to contain a greenish mucinous mass: no cause was discovered. Three years later a tumor, 1 x 0.5 cm, was found in the common hepatic duct at sonography, with clinical signs of recurrent chronic cholitis and early liver damage. Because of hepatic dysfunction and hypersplenism no surgical intervention was undertaken. When cholestasis progressed further, a partial full-thickness resection of the hepatic duct with removal of the tumor and the mucinous bile had to be performed two years later. Histological examination revealed a villous adenoma with slight epithelial dysplasia and mucus formation. CONCLUSIONS: Villous bile duct adenoma is a very rare cause of cholestasis. Mucous production can lead to mucinous bile, with resulting chronic cholecystitis and secondary biliary cirrhosis. The adenoma should be completely excised because of the danger of malignant transformation and risk of local recurrence.

Adenoma, Villous↗
PubMed1997

[Hereditary nonpolyposis colonic carcinoma with primary extra-colic manifestation].

A 62-year-old woman presented with nausea, weakness, and vasovagal attack. She had a history of a carcinoma of the endometrium 19 years prior to admission, and adenocarcinomas of the cecum, ascending colon, transverse colon, rectum and sigmoid during the subsequent years. Due to the typical history, including family history, hereditary nonpolyposis colorectal cancer (HNPCC) was diagnosed 6 months prior to admission. Physical examination was normal with the exception of pallor of the skin and the palpebral conjunctivas. Laboratory values showed hypochromic, microcytic anemia (hemoglobin: 6.5 g/dl; MCV 70.1 fl; MCH 22.8 micrograms). Esophagogastroduodenoscopy revealed an exophytic mass protruding into the lumen of the inferior part of the duodenum. Carcinoma of the duodenum as a manifestation of HNPCC was diagnosed and partial duodenectomy performed. Macroscopic and microscopic examination revealed two adenocarcinomas--next to one another--7.0 cm and 2.5 cm in diameter. HNPCC is often overlooked and its relevance underestimated. Since diagnosis of this disease has major implications, all patients with colorectal cancer, and also young women with carcinoma of the endometrium, should be screened for HNPCC.

Adenocarcinoma↗
PubMed1995

[Bowenoid papulosis, Bowen's disease and squamous cell carcinoma of the anus and vulva in congenital intestinal lymphangiectasis].

A 32-year-old woman with congenital intestinal lymphangiectasia (CIL) and warts (condylomata acuminata) was found to have bowenoid papulosis, Bowen's disease and squamous-cell carcinoma, at first in the anus, later also in the vulva. Limited surgical measures and laser vaporization with systemic and topical administration of interferon controlled the tumour development for some time. But after 7 years the squamous-cell carcinoma recurred with infiltration of the outer anogenital region. The patient then had an episode of thrombotic cerebral ischemia, which prevented a planned abdominoperineal resection with radical vulvectomy. Instead she received chemotherapy with bleomycin, mitomycin and cisplatin. But she died 8 weeks later, from tumour cachexia. Occurrence of a squamous-cell carcinoma of the anus and vulva in this young patient suggests a high oncogenic potential of the papilloma virus (HPV) infection. The latent period was probably shortened by a cellular immune deficiency as part of CIL. Treatment of the various carcinomatous manifestations should as long as possible be by local measures and interferon administration.

Adult↗
PubMed1995

[Effects of nCPAP therapy on the blood picture in patients with obstructive sleep apnea].

In some patients with obstructive sleep apnea, changes in red blood cell count resembling polycythemia can be observed. If these changes result from the sleep-related breathing disorder, its adequate treatment should in turn induce a decrease of, for instance, hemoglobin concentration. We therefore set out by examining retrospectively the development of hemoglobin concentration under nCPAP in 130 patients with polysomnographically verified obstructive sleep apnea, comparing the values before treatment and after a mean of 12.0 months. During this period, hemoglobin mass concentration dropped from a mean of 153 +/- 13 g/Ls to 148 +/- 11 g/Ls (p < 0.001). Afterwards we prospectively examined in 50 patients the changes in complete blood cell count before and immediately after initiation of nCPAP treatment. It turned out that hemoglobin mass concentration dropped from a mean of 154 +/- 14 g/Ls to 148 +/- 14 g/Ls (p < 0.001), the erythrocyte count from 5.02 +/- 0.42/pl to 4.79 +/- 0.51/pl (p < 0.001), and hematocrit from 45.4 +/- 3.1% to 43.1 +/- 4.3% (p < 0.001) after only one night; no more significant change occurred after that. Increased hemoglobin mass concentrations, erythrocyte counts and hematocrit values can be the result of obstructive sleep apnea. Treatment of this sleep disorder with nCPAP will induce a quick and significant decrease of hemoglobin mass concentration, erythrocyte count, and hematocrit, independent of the initial values. This phenomenon points to the fact that changes in blood cell counts are not caused by a disturbance of erythropoesis but rather by alterations in volume regulation.

Adult↗
PubMed1991

Treatment of metastatic carcinoid tumors and the carcinoid syndrome with recombinant interferon alpha.

Fourteen patients with metastatic carcinoid tumors were treated with recombinant interferon alpha-2b at a dosage of 3-4 x 10(6) IU s.c. daily or every second day. No objective tumor regression was observed. Six out of 8 patients with carcinoids of the ileum and the caecum showed stable disease lasting for a median of 25 months (range 4-57). In 3 out of 6 patients with carcinoids of rectum, lung and of unknown primary site, stable disease was observed lasting for 2-7 months. The remaining patients had progressive disease. Six out of 9 evaluable patients had a more than 50% reduction of urinary 24 h 5-hydroxyindoleacetic acid excretion lasting for a median of 4 months (range 2-11). Decrease of flushing was noticed in 3 out of 6 evaluable patients and decrease of diarrhea in 5 out of 9 evaluable patients. In 4 patients dose reduction was necessary due to confusion and fatigue.

Carcinoid Tumor↗
PubMed1989

Advanced mycosis fungoides: chemotherapy with etoposide, methotrexate, bleomycin, and prednimustine.

We assessed the efficacy and toxicity of a chemotherapeutic regimen in patients with stage II-IV mycosis fungoides. Eleven previously treated outpatients received etoposide and methotrexate p.o. and bleomycin i.v. every 3 weeks. There was 1 complete remission for 2 months and 7 partial remissions with a median duration of 6 months (range 2-16 months). Three patients showed stable disease lasting 1-5 months (median 2 months). In 4 patients, remissions were maintained with prednimustine after 10 courses of induction chemotherapy. Mild nausea occurred in all patients and severe leukocytopenia and thrombocytopenia in 1 patient. Toxicity of the treatment regimen was acceptable and response rates comparable to those seen by others with more toxic single-agent or combination chemotherapies.

Adult↗
PubMed1988

Advanced male breast cancer treatment with the LH-RH analogue buserelin alone or in combination with the antiandrogen flutamide.

Ten men with advanced breast cancer were evaluated for response to treatment with the luteinizing hormone-releasing hormone (LH-RH) analogue, buserelin, alone or in combination with the antiandrogen, flutamide. One of five patients receiving buserelin as a single agent had a partial remission lasting 12 months, and with the addition of flutamide, this lasted over 24 additional months. Three patients had stable disease with a median duration of 6 months (range, two to 14). One patient had progressive disease. Of five patients receiving the combination of buserelin and flutamide from the beginning of therapy, four patients had a partial remission with a median duration of over 15 months (range, over five to 16). One patient's disease remained stable for 12 months. Major side effects were hot flushes, loss of libido, and impotence. Buserelin initiates a castration-like endocrine response and has potential in the treatment of men with disseminated breast cancer when used either alone or in combination with flutamide.

Aged↗