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Biomedical subjects

C Muller

Publications and source records attributed to C Muller.

At least 19 recordsLinked to original sources
PubMed1992

Cost effectiveness of cervical cancer screening for the elderly.

OBJECTIVE: To analyze the costs and benefits of alternative cervical cancer screening schedules among elderly women. SETTING: Population-based screening programs. DESIGN: A Markov model predicts the outcomes of periodic screening, diagnosis, and treatment for cervical cancer among women from 65 to 109 years of age. PATIENTS: A hypothetical cohort of one million 65-year-old women; representative of the U.S. population. MEASUREMENTS: The costs and yields of screening. RESULTS: Triennial screening reduced mortality from cervical cancer among the elderly by 74% at a cost of $2254 per year of life saved. Annual screening increased costs to $7345 per year of life saved; less frequent schedules yielded lower costs but decreased savings in life. These results were most sensitive to the quality of the Papanicolaou smear and the characteristics of the women using the benefit. If the sensitivity of the Papanicolaou smear was reduced from a baseline estimate of 75% to 50% and the specificity was decreased to 87% from 95%, the cost effectiveness ratio increased by nearly $7000 per year of life saved. If triennial screening is targeted to women who have not had regular screening, the program will save money as well as years of life; however, screening women who have been screened regularly is considerably less efficient, increasing costs to $33,572 per year of life saved. CONCLUSION: The success of the new Medicare benefit depends substantially on physicians assuring that their elderly patients, particularly women without regular prior screening, obtain high quality Papanicolaou smears. The data also show that after a woman 65 years of age or older has a history of regular negative smears, screening is inefficient and can cease.

Aged↗
PubMed1992

Sensitivity of fresh acute myeloid leukemia cells to etoposide: relationship with cell growth characteristics and DNA single-strand breaks.

In this study, we evaluated the individual in vitro sensitivity of fresh acute myeloid leukemia (AML) cells to VP-16, and attempted to correlate VP-16 cytotoxicity with AML cell growth characteristics and drug-induced DNA single-strand breaks (SSB). Primary (PE1) colony inhibition assays allowed us to characterize two distinct groups of AML: group I (patients 1 through 6), which displayed sensitivity to VP-16 similar to that of normal CFU-GM (IC90 of 20.52 +/- 2.44 micrograms/mL v 20.48 +/- 2.23 micrograms/mL after 1 hour drug exposure, respectively); and group II (patients 7 through 11), which was more sensitive to VP-16 (IC90 of 7.26 +/- 2.93 micrograms/mL, P = .004). Subsequently, groups I and II were termed normosensitive and hypersensitive, respectively. This objective VP-16 sensitivity classification, as determined by PE1, remained unaltered when assessed by secondary (PE2) colony inhibition assay (evaluating the self-renewal fraction of AML progenitors), or by cytofluorometric viability assay (evaluating the ultimately differentiated blast cell population). These findings would suggest that individual sensitivity to VP-16 of a particular cell population is maintained throughout CFU-AML differentiation. Finally, we report that sensitivity of AML cells to VP-16 did not correlate either with cell growth characteristics or with SSB generation. Indeed, AML cell sensitivity to VP-16 appeared more closely related to DNA repair kinetics after drug removal, ie, hypersensitivity being essentially characterized by a prolonged retention of SSB during the posttreatment period. Interestingly, the established HL-60 cell line, which presented greater sensitivity to VP-16 cytotoxicity than KG1, HEL, and K562, was also found to exhibit delayed DNA SSB repair kinetics, as compared with the other AML cell lines. These results suggest that hypersensitivity to VP-16 of some AML cells may be related to a deficient DNA-repair mechanism.

Cell Division↗
PubMed1992

Prevention of hepatic veno-occlusive disease after bone marrow transplantation by continuous infusion of low-dose heparin: a prospective, randomized trial.

Hepatic veno-occlusive disease (VOD) is a major regimen-related toxicity after bone marrow transplantation (BMT). Endothelial injury, leading to deposition of coagulation factors within the terminal hepatic venules, is believed to be the key event in the pathogenesis of VOD. To evaluate the benefit and the safety of a VOD prophylaxis with anticoagulants, we conducted a prospective randomized trial of continuous infusion of low-dose heparin among 161 patients under-going either allogeneic (n = 79) or autologous BMT (n = 81). Patients were randomized to receive (n = 81) or not receive (n = 80) prophylactic heparin 100 U/kg/d by continuous infusion from day -8 until day +30 post-BMT. Heparin was found to be highly effective in preventing VOD, which occurred in 11 of 80 patients (13.7%) in the control group versus 2 of 81 (2.5%) in the heparin group (P less than .01). Furthermore, none of the 39 patients in the heparin group developed VOD after allogeneic BMT, versus 7 of 38 (18.4%) in the control group (P less than .01). This prophylactic effect was achieved without added risk of bleeding. Indeed, the low-dose heparin we used did not prolong the partial thromboplastin time and did not increase the red blood cell and platelet requirements. It is therefore recommended that heparin prophylaxis be part of early mortality prevention programs after BMT.

Adult↗
PubMed1992

High cell density-dependent resistance and P-glycoprotein-mediated multidrug resistance in mitoxantrone-selected Chinese hamster cells.

Mitoxantrone (MIT) resistance has been studied in a colony selected from the CHO AA8 parental line in one step under a low degree of selective pressure (9 nM). The cells of the clonal isolate AA8/MIT C1(0) were sensitive to 9 nM MIT at low cell density but able to grow at high density. Parental AA8 cells were not able to grow under the latter condition. Decreased MIT accumulation (-20%) was observed at this step (step 0) in the absence of overexpression of mdr RNA coding for the drug efflux pump P-glycoprotein. Furthermore, AA8/MIT C1(0) did not exhibit cross resistance to vincristine, Adriamycin and etoposide at low cell density. During subsequent controlled growth for 2 months at high cell density in the presence of 9 nM drug, an additional selection occurred leading to a 4-fold MIT-resistant subline AA8/MIT C1(+). This subline was characterized at this step (step I) and after an additional 4 months of culture in the presence of 9 nM MIT (step II). Analysis of mdr gene expression and gene copy number showed an increase in mdr RNA and a pattern of mdr gene amplification which changed between step I and II. AA8/MIT C1(+)II exhibited a classical multidrug resistance phenotype with decreased accumulation of [14C]MIT and cross-resistance to vincristine, Adriamycin and etoposide. The ability to form the cleavable complex in the presence of etoposide in DNA topoisomerase II-containing nuclear extracts was identical in AA8/MIT C1(+)II and AA8 cell lines. These results demonstrate a new sequence of events in MIT resistance: low level of drug resistance at high cell density followed by mdr gene amplification.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1992

Using patient reports to assess hospital treatment of persons with AIDS: a pilot study.

Providing efficacious, compassionate, and efficient medical care to persons with HIV infection is one of the greatest challenges that will face US hospitals this decade. Unfortunately, there have been almost no studies of how organizational arrangements are related to the quality of care. We developed an interview protocol and conducted a pilot study to evaluate the instrument's ability to detect differences in selected interpersonal aspects of care provided to persons with AIDS. We evaluated the care received in two different treatment models in a major teaching hospital: a designated AIDS unit and general medical beds. We assessed several areas of patient care that are clinically important and that patients can evaluate: communication between patients and providers, patient education, respect for patient preferences, emotional support, involvement of family and friends, trust and confidence, physical care, pain management, AIDS knowledge, perceived segregation, confidentiality, and financial information. Patients generally were very satisfied with their hospital care, but many reported problems with certain aspects of their care. The instrument used detected differences between the care reported by patients treated in general hospital beds and in a designated AIDS unit in several specific aspects of care.

Acquired Immunodeficiency Syndrome↗
PubMed1992

A primary cutaneous multi-lobed B-cell lymphoma.

Multi-lobed non-Hodgkin's lymphoma (NHL) has recently been recognized as a NHL variant. A patient presented with a scalp nodule which, upon skull X-Ray, was seen to be associated with a bone defect. Immunophenotyping clearly demonstrated that this was a B-cell proliferation. Histologically the B-lymphocytes were closely related to centroblasts. There were no other extra cutaneous localizations. The present report emphasizes the importance of this clinico anatomical entity which shows prominent extra-nodal involvement, large lymphoid cells with multi-lobed nuclei and a good response to chemotherapy. Multi-lobed NHL may be a T-cell lymphoma, or a B-cell lymphoma closely related to centroblastic NHL. Although multi-lobed lymphomas have a predilection for cutaneous localizations, our case is the first primary cutaneous multi-lobed B-NHL, proven by immunophenotyping.

Female↗
PubMed1992

Contact and photocontact allergy to oxybenzone.

The purpose of this study was to determine the frequency of contact allergy and photocontact allergy to sunscreens. A consecutive series of 54 patients with suspected clinical photosensitivity were assessed. All had the same standardized photobiological investigation from January 1989 to December 1990, including patch tests and photopatch tests with 6 sunscreen agents. Oxybenzone was found to cause 4 cases of allergic contact dermatitis (with photoaggravation in 2), and 3 cases of photocontact dermatitis (13% of patients). This is probably due to the wide distribution of oxybenzone in sunscreens and other cosmetics, 2 patients with polymorphic light eruption and persistent light reactivity, respectively, were regular sunscreen users. Photobiological investigation is necessary to ensure accurate diagnosis, since sunscreen contact or photocontact allergy may simulate other photosensitivity eruptions.

Adult↗
PubMed1992

Carpal tunnel syndrome and systemic sclerosis.

Carpal tunnel syndrome (CTS) was observed in 4 cases of a consecutive series of 16 patients admitted for the initial diagnosis or follow-up of systemic scleroderma from 1986 to 1990. We also observed one case of ulnar nerve compression. Neurological involvement was confirmed by electromyogram, and motor and sensory nerve conduction studies. The neurological signs appeared at the beginning of the disease in two cases and preceded the discovery of scleroderma in two. CTS is not rare in scleroderma and must be carefully sought, both clinically and electrophysiologically. Patients with 'idiopathic' CTS might need clinical follow-up for early diagnosis of scleroderma.

Adult↗
PubMed1992

The inpatient AIDS unit: a preliminary empirical investigation of access, economic, and outcome issues.

An AIDS unit model ("cluster beds") and a general inpatient placement model ("scatter beds") in a major teaching hospital were compared to determine whether they differed on several dimensions of care. After controlling for severity of illness, (the major predictor of admission to the AIDS unit), length of stay, charges, and inpatient mortality rates did not differ between the two settings. Equal proportions of White, Hispanic, male, and privately insured patients were found in both settings. Nursing staff turnover rates were comparable to those of other sites. However, the data raise new issues regarding access to AIDS units for older, Black, and female patients.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Schnitzler's syndrome (urticaria and macroglobulinemia) associated with pseudoxanthoma elasticum.

Schnitzler's syndrome, first described in 1974, is defined by chronic non-pruritic urticaria, osteocondentation, and a monoclonal IgM dysproteinemia, but without criteria of lymphoproliferative disease. We report a patient with chronic urticaria and macroglobulinemia. In addition, he had double monoconal dysproteinemia IgM kappa (31.3 g/l) and IgA lambda, osteocondensation, and some cutaneous lesions of pseudoxanthoma elasticum. Only 20 cases of Schnitzler's syndrome have been reported hitherto. This is the first case associated with pseudoxanthoma elasticum, which was localized and discovered at the same time as Schnitzler's syndrome. We discuss the possible role of monoclonal immunoglobulin in the occurrence of localized elastorrexhis.

Aged↗
PubMed1992

[Persistent photosensitivity: treatment with puvatherapy and prednisolone (corticopuvatherapy)].

Eight patients, six men and two women, had chronic photosensitivity of 2.0 +/- 1.1 years' duration. The clinical and photobiological signs were consistent with a diagnosis of chronic actinic dermatitis syndrome. Photosensitivity was extremely severe, and the minimal erythematous dose (MED) in polychromatic light was dramatically decreased in all eight patients (82 +/- 20 mJ/cm2; range: 25-200 for a normal MED range of 1.000 to 2.000 mJ/cm2). Photopatchtests were positive to phenothiazine in four patients, to fragrance mix and oxybenzone in two patients, to balsam of Peru and musk ambrette in one patient each. Seven patients were treated with corticopuvatherapy. They all were markedly improved after one month of treatment, recovering normal MED and outdoor activities. Corticosteroid therapy was gradually reduced and stopped after 3 months, while puvatherapy was continued for several months. Treatment was withdrawn in three patients. The minimal erythematous dose was monitored after discontinuation of therapy: a progressive decrease of MED was observed, accompanied by a relapse in two of the three patients. This relapse was well controlled by another course of corticopuvatherapy. Four other patients had, after discontinuation of treatment, another course of corticopuvatherapy reinstituted in the early spring. Puvatherapy was stopped at the end of october. One patient did not receive corticopuvatherapy because she was living far from a puvatherapy centre. She was treated with azathioprine for 6 months without improvement, then with azathioprine+prednisolone 20 mg daily during 2 years with slight improvement. Corticopuvatherapy is a very efficient means of treating severe chronic actinic dermatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[The gallbladder with severe pathologic changes: a contraindication for laparoscopic cholecystectomy?].

In the beginnings of laparoscopic cholecystectomy a severe pathological alteration of the gallbladder or stones of the common bile duct were regarded as relative contraindications to the method. However increasing experience and improve technic have shown, that even a severe pathology of the gallbladder such as chronic cholecystitis with wall thickening, acute or subacute inflammation or a porcelaine gallbladder can be laparoscopically managed. Operation time in such cases is longer, but median hospital stay is the same as in uncomplicated cases. However postoperative morbidity may be increased. For patients with CBD stones preoperative ERCP with papillotomy followed by laparoscopic cholecystectomy some days later offers a treatment with low morbidity and optimal comfort for the patient.

Adult↗
PubMed1992

[Recurrent inguinal hernias: surgery with transversalis fascia repair].

Some authors recommend different prosthetic repairs for treatment of recurrent groin hernia. In our institution groin hernias are treated by a modified Shouldice-repair, which considers the transversalis fascia layer only. In this prospective study 240 consecutive patients with 298 groin hernias were operated on. 46 patients were treated for 53 recurrent hernias. It was possible to carry out the operative procedure of transversalis plasty in all recurrent cases. 90% of these patients were followed-up by personal examination after a median of 26 months after operation (range 12-36 months). 89% of the patients with primary operation have been checked 15 months postoperatively. 2 patients (4.5%) of the recurrent hernias had a recurrence. This compares well with the 3.2% recurrence rate (7 patients) in the patients with primary hernias. The difference is not significant (p greater than 0.5). The only observed difference between recurrent and primary hernias was in the rate of testicular atrophy (6.8% for recurrent and 0% for primary hernias). According to our experience large prosthetic repairs are not necessary for the common case of recurrent groin hernia, but may be useful in specially selected situations.

Adult↗
PubMed1991

[Esophageal manometry prior to and following anti-reflux surgery].

We analysed the esophageal manometry of 36 patients before, and of 25 patients 1 to 14 years (5.8 years) after, fundoplication. The results were compared with the findings in 30 asymptomatic volunteers. Fundoplication raised the mean lower esophageal sphincter pressure from 6.2 mm Hg to 14.5 mm Hg, i.e. normal values (controls 20.2 mm Hg). The shortened lower esophageal sphincter length and its intraabdominal segment were overcorrected (increase from 3.2 to 5.2 cm [controls 4.1 cm] and 1.3 to 2.6 cm [controls 2.1 cm] respectively). The rate of non-specific motility disorders after fundoplication was reduced from 61% to 28% (controls 7%). A clear relationship between the success of fundoplication and either preoperative or postoperative manometric results could not be established.

Adult↗