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Biomedical subjects

D Brandt

Publications and source records attributed to D Brandt.

At least 37 records · Page 2Linked to original sources
PubMed1996

p-Glycoprotein expression as a predictor of breast cancer recurrence.

BACKGROUND: Many new prognostic factors for breast cancer have been described, and yet the ability to predict patient outcomes remains poor. Overexpression of p-glycoprotein (p-gp), the multidrug resistance efflux pump, confers a worse prognosis to patients with certain leukemias and other tumors. The purpose of this study was to analyze the potential usefulness of p-gp expression as a prognostic factor in patients with breast cancer. METHODS: Paraffin blocks were obtained from 55 previously untreated patients who underwent surgery between 1987 and 1988. To determine p-gp expression, tumor cell suspensions were incubated with the p-gp-specific C219 monoclonal antibody and analyzed using an indirect immunofluorescent flow cytometric assay. RESULTS: Twenty-four (44%) of the tumors were p-gp positive and 31 (56%) were p-gp negative. Among the p-gp positive patients, 65% had recurrence of their disease, whereas only 13% of the p-gp negative patients experienced recurrence (p = 0.0001). The 5-year disease-free rate for p-gp positive patients was 39% compared with 83% for p-gp negative patients (p = 0.0001). In univariate analysis examining 10 different variables, significant predictors of recurrence were p-gp, stage, and tumor size. Multivariate analysis using Cox Proportional Hazards regression showed that only p-gp and stage were significant independent predictors of recurrence (p = 0.0002). CONCLUSIONS: p-gp is frequently expressed in patients with untreated breast cancer, with p-gp-positive patients being at significantly greater risk for disease recurrence. p-gp appears to be a useful prognostic factor in breast cancer and could potentially help guide management.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1996

The reported health and functioning of children maltreated while in family foster care.

The ability to assess accurately risk factors for maltreatment while in family foster care is essential for developing prevention and intervention strategies. Yet information about children involved in maltreatment episodes while in foster care is severely limited. This correlational study reports on characteristics, health, and functioning parameters of all 78 children with substantiated maltreatment reports between 1984-1988 in an urban foster care program as compared to a random sample of 229 nonmaltreated children in foster care in the same time period. Almost 50% of the substantiated maltreatment was sexual abuse with the remainder physical abuse and neglect. Problems in health, development, and functioning were reported in the social services record for a large number of all children, but children sexually abused while in care were significantly more likely to have a nonkinship placement, and to have mental health and development problems identified. Physical abuse and neglect while in foster care were not associated with child health and functioning characteristics. The implications of these results are discussed within the context of the data source used.

Baltimore↗
PubMed1995

[Isosorbide-5-mononitrate in silent ischemia].

Thirty six patients with documented coronary artery disease and exercise-induced silent ischemia were evaluated in a double-blind randomised placebo-controlled crossover study. The effect of once daily 60 mg sustained-release isosorbide-5-mononitrate (IS-5-MN) was tested on exercise-induced and ambulatory silent ischemia. After a wash-out period in which no cardioactive drugs were administered, each patient received IS-5-MN for the first week, followed by placebo for the second week, or vice versa. A symptom-limited bicycle exercise test and Holter monitoring over a 24-hour period were performed after wash-out and at the end of each one-week treatment period. In comparison with wash-out IS-5-MN significantly (p < 0.05) prolonged time on onset of 1 mm ST-segment depression during exercise testing. On the other hand, the number and circadian variation of ischemic episodes during Holter monitoring were not influenced by IS-5-MN. Thus, 60 mg IS-5-MN once daily significantly improved silent ischemia during exercise testing but not during Holter monitoring. This discrepancy may be due to different pathogenetic mechanisms of ischemia during ergometry as opposed to the everyday situation; nitrates may also provoke silent ischemia by increasing the heart rate. Furthermore, the choice of only one antiischemic drug at a fixed dosage may not be aggressive enough in suppressing ischemia completely.

Adult↗
PubMed1994

Types and frequency of child maltreatment by family foster care providers in an urban population.

Types and frequency of child abuse and neglect reports in family foster care in Baltimore, Maryland as compared to reports among nonfoster families are reported. Data on maltreatment incidents in foster homes were abstracted from Child Protective Services investigation records for the years 1984-1988. Comparisons were made to community reports. Results indicated that foster families had over a three-fold increased frequency of maltreatment reports as compared to nonfoster families. Report frequency was highest for physical abuse with a seven-fold risk of report as compared to nonfoster families. Overall, 20% of foster care reports were substantiated as compared to 35% of nonfoster reports, although the risk of having a substantiated report was significantly higher in foster care. The distribution of report types in foster care differed from those in the community with physical abuse the most frequent allegation in foster care, as compared to neglect as the most frequent allegation in the community. Explanations for these findings including differences in criteria for report and substantiation are advanced.

Adolescent↗
PubMed1993

[Calcium antagonists in therapy of arterial hypertension].

Calcium antagonists reduce the peripheral vascular resistance thus lowering an elevated blood pressure. Due to their properties they are regarded as basic antihypertensiva. They do not affect metabolism, cause a regression of left ventricular hypertrophy and improve the vascular compliance. Serious side effects are extremely rare. Because of their effects they are especially suitable for the therapy of arterial hypertension with certain attendant and resultant diseases of high blood pressure and with the existence of certain demographic factors like age and race.

Adult↗
PubMed1991

Loss of heterozygosity for the short arm of chromosome 11 (11p15) in human milk epithelial cells immortalized by microinjection of SV40 DNA.

We have developed, by microinjection of SV40 DNA into human milk epithelial cells, a new mammary cell line, Hu-MI, which exhibits the phenotype of luminal cells or so-called "breast cancer precursor cells." This cell line retains the phenotype of primary cells as demonstrated by the expression of keratins 18 and 19 and of polymorphic epithelial mucins. However, the cells do not grow in agar after more than 80 passages, nor do they form tumors in nude mice. Established cells contain 2 copies of SV40 DNA integrated into the cellular genome and up to 14 copies of free SV40 DNA. A deletion of the short arm of chromosome 11 (11p15) including the c-Ha-ras and the beta-globin genes was found in the immortalized cells when the DNA from these cells was compared to the DNA from peripheral blood mononuclear cells obtained from the same donor. In addition, this cell line showed a good transfection efficiency for other DNA sequences using classical transfection and selection techniques with a neomycin resistance gene (pKOneo). Selective microinjection of DNA into tumor precursor cells may prove useful for the study of the molecular mechanisms involved in breast carcinogenesis. The possible significance of the loss of 11p13-15 in malignant progression of breast cancer is discussed.

Aneuploidy↗
PubMed1991

Is pulsed Doppler velocimetry useful in the management of multiple-gestation pregnancies?

Few studies have addressed the significance of umbilical artery pulsed Doppler velocimetry in multiple gestation. Level II ultrasonography and pulsed Doppler studies were performed in 94 twin pairs and seven sets of triplets, which yielded data on 207 fetuses. A systolic/diastolic ratio was calculated for each fetus; abnormal pulsed Doppler velocimetry showed high correlation with adverse pregnancy events. Those with abnormal Doppler findings tended to be born 3 to 4 weeks earlier and to exhibit a greater number of stillbirths and structural malformations, as well as greater morbidity, when compared with fetuses without abnormal Doppler results. Fifteen of 17 infants with abnormal antenatal waveforms suffered serious morbidity. Seven were small for gestational age, and two were borderline for small for gestational age. An additional five infants with abnormal waveforms were appropriate for gestational age but were either recipient or donor in the twin transfusion syndrome. Eleven fetuses with this syndrome are described. Donor twins tended to be severely small for gestational age, with 7 of the 11 infants showing elevated systolic/diastolic ratios. Amniotic fluid volume tended to be diminished in the donor's sac but normal or increased in the recipient's sac. The observations in the study correlate with suspected physiologic changes of this syndrome. Because present findings suggest that fetuses with abnormal velocimetry suffer increased morbidity and mortality, a more rational method of management that uses Doppler data is suggested for multiple gestations.

Blood Circulation↗
PubMed1990

201Tl myocardial SPECT and beta-endorphin levels in patients with suspected silent ischemia.

Today silent myocardial ischemia (SMI) is a well-recognized phenomenon. However, in the absence of clinical signs suggesting coronary artery disease (CAD), a streamlined diagnostic approach for precise clarification has proved to be difficult. Sensitivity and specificity of ergometric results are rather poor in symptom-free patients. Thus the question arises, whether the necessity of coronary angiography can be established more precisely by 201Tl myocardial SPECT in these patients. Treadmill exercise according to the Bruce protocol, 201Tl myocardial SPECT and coronary angiography were performed in a total of 106 patients with suspected SMI. In group I (high probability of ischemia; n = 46), reversible defects detected by SPECT correlated well with significant stenoses and irreversible defects with subtotal stenoses or complete occlusions. SPECT sensitivity in the detection of ischemia was 91%, its specificity 96%. In group II (low probability of ischemia; n = 60), SPECT sensitivity was as high as in group I (94%) but due to a high number of false-positive results (e.g. cardiomyopathy) specificity was only 75%. However, SPECT was superior to exercise ECG (sensitivity 70%; specificity 56%) in the detection of SMI. In addition, beta-endorphin levels were determined in 180 healthy subjects, 37 patients with symptomatic CAD and in 34 patients with SMI before and during maximum exercise. Exercise values in patients with SMI were significantly higher than in healthy subjects or in patients with symptomatic CAD.

Adult↗
PubMed1989

Synchronous early gastric cancer.

Synchronous early gastric cancer (EGC) has a prevalence of approximately 9%. The barium study findings of 73 patients with 163 synchronous EGC tumors were retrospectively reviewed, and the size, location, and morphologic type of each lesion considered malignant were analyzed and correlated with the endoscopic and final pathologic findings. Barium studies and endoscopy each correctly demonstrated 116 of the 163 synchronous EGC lesions. Those lesions not demonstrated by either technique were small, shallow, or flat and confined to the mucosa. Our results indicate that a careful preoperative evaluation with radiography and endoscopy currently can depict about 70% of these lesions.

Barium Sulfate↗
PubMed1987

Associations between occlusal characteristics and signs and symptoms of TMJ dysfunction in children and young adults.

Cross-sectional data were obtained from 1,342 subjects 6 to 17 years of age and analyzed for the prevalence of (1) specific types of occlusion, and (2) subjective symptoms and clinical signs of TMJ dysfunction. The results, as they pertained to occlusion and clinical signs, were as follows: functional shift was negatively associated with TMJ and muscle tenderness; open bite was positively associated with TMJ and muscle tenderness; excessive or negative overjets were more likely to have joint tenderness; older subjects with a cusp-to-cusp or a Class II molar relationship were more likely to experience TMJ and muscle tenderness, and restricted opening; and buccal crossbites had a significantly higher prevalence of joint sounds in older children. Results pertaining to occlusion and subjective symptoms were as follows: Class II molar relationship was positively associated with joint noise in the 6 to 8 and 15 to 17-year age groups; and subjects with negative overjet were more likely to report joint noise. Our conclusions were that (1) statistical associations exist between certain features of occlusion and TMJ signs/symptoms, and (2) such associations are greater in the older groups tested.

Adolescent↗
PubMed1987

The effectiveness of tactile stimulation as a form of early intervention: a quantitative evaluation.

The results of studies examining the effectiveness of tactile stimulation as a form of sensory enrichment for infants and young children were analyzed by the use of recently developed quantitative methods that treat research synthesis as a unique type of scientific inquiry. Nineteen studies meeting certain predetermined criteria were included in the review. The 19 studies contain 103 statistical hypothesis tests that evaluated the effectiveness of tactile stimulation programs. Analysis of these tests, based on the calculation of effect sizes, revealed that subjects receiving some form of controlled tactile stimulation performed better on a variety of dependent measures than subjects not receiving intervention. Larger treatment effects were associated with pre-experimental designs, and also with studies in which the internal validity was rated as poor. Several other study characteristics, such as how the subjects were assigned to conditions and how the dependent measure was recorded, were related to study outcome as measured by effect size. The results indicate that an accurate interpretation of tactile stimulation studies cannot be made without consideration of specific design variables and study characteristics.

Child Development↗
PubMed1986

[Pharmacologic modification of diastolic ventricular function in patients with coronary heart disease].

The influence of 2 different cardiac pharmaceutics on the diastolic ventricular function (VF) in patients with ischaemic heart disease was examined. Diltiazem, a calcium antagonist, and k-strophanthine led to a reduction of time constant T of the isovolumic relaxation from 49 +/- 9 to 39 +/- 7 msec (p less than 0.005), to an increase of the quotient dt/T from 2.4 +/- 0.5 to 3.0 +/- 0.6 msec (p less than 0.01), to an increase of the peak filling rate (PFR) from 2.08 +/- 0.65 EDV/sec to 2.34 +/- 0.67 EDV/sec (p less than 0.001), to an increase of the filling fraction (FF) from 30 +/- 12% to 33 +/- 15% (p less than 0.001). The ejection fraction (EF) and the maximum rise of pressure dp/dt did not change significantly. After k-strophanthine T was reduced from 49 +/- 7 to 46 +/- 11 msec (p less than 0.05). The increase of dt/T from 2.5 +/- 0.4 to 2.7 +/- 0.4 msec was not significant. The PFR with 2.16 +/- 0.7 and 2.08 +/- 0.8 EDV/sec and the FF with 32 +/- 14 and 34 +/- 18% did not show any significant changes. The EF rose from 52 +/- 15 to 55 +/- 16 (p less than 0.05) and dp/dt rose from 1855 +/- 468 to 2124 +/- 591 (p less than 0.05). Diltiazem improves the diastolic VF without deteriorating the systolic VF in patients with ischaemic heart disease. K-strophanthine improves the systolic VF and the velocity of the isovolumic relaxation. The other variables of the diastolic VF did not show any directed changes.

Adult↗
PubMed1985

[Results of emergency aortocoronary bypass surgery in patients with acute myocardial ischemia after percutaneous transluminal coronary angioplasty].

From April 1980 to June 1985 7.3% (15) of 205 PTCA-treated patients required emergency operations. The spectrum of PTCA-induced ischemia included anginal pain alone (2/1, 13%) or transmural infarction (13/15, 87%) with hypotension (8/15), cardiac arrest (4/15), and severe cardiogenic shock (3/15, 20%). 14 patients underwent saphenous-vein-bypass-graft operation (ACBG) with a mean of 1.7 grafts performed per patient. The average time from onset of symptoms to completed revascularisation was 166.5 (110 to 290) minutes. Inspite of the use of IABP one hospital death (6.6%) occurred prior to the institution of ECC in a patient with previous ACBG surgery. No late death was observed during a mean follow up of 11.1 (1 to 33) months with 13/14 patients free of anginal symptoms. Retrospective assessment of postoperative serum enzyme levels of CPK and CK-MB showed evidence of myocardial infarctions in 7/14 (50%) patient. The incidence on ECG of Q-wave infarctions was 35,7% (5/14). With the exception of one patient, IABP was not used pre- or postoperatively. In patients with acute myocardial ischemia following PTCA-attempts immediate restoration of myocardial blood flow can stabilize left ventricular function and reduce the incidence and size of myocardial infarctions. The availability of emergency ACBG-surgery and facilities remain an important prerequisite of PTCA-programs due to the unpredictable natural course of PTCA-induced myocardial ischemia.

Adult↗
PubMed1984

[The hypertensive crisis].

As hypertensive crisis may lead to death or to permanent organic defects a rapid therapy is necessary. In addition to general therapies a series of highly efficient antihypertensive agents are at our disposal. Advantages as well as disadvantages of these substances and their consequences to the hemodynamic are being discussed. Giving preference to an antihypertensive agent is mainly determined by the clinical symptoms and the available monitoring devices.

Acute Disease↗
PubMed1984

[Catecholamines in internal medicine emergencies].

The most important indications for the application of the catecholamines dopamine and dobutamine in the internal intensive medical care are acute disturbances of the peripheral vascular regulation and acute heart failure. Differential therapeutic considerations are due to the different actions of both pharmaceutics. Disturbances in peripheral circulation and in renal function are of great importance in case of the septic shock. Dopamine is highly advisable for its vascular and renal efficacy. Whereas the application of dobutamine or a therapy combining the application of dobutamine and dopamine has to be preferred in case of a cardiogenic shock. A retrospective examination has shown that the mortality of patients with a cardiogenic shock after an acute myocardial infarction could be lowered by a therapy of the current catecholamines dobutamine and dopamine.

Acute Disease↗
PubMed1984

[Lusitropic behavior in patients with coronary heart disease].

To determine the diastolic function of the left ventricle, the peak filling rate (PFR), the filling fraction (FF) and the time to peak filling rate normalized by the RR interval (TPFR/RR) were measured by means of a conventional gamma camera computer system and a mobile ventricular probe (nuclearstethoscope). In a part of the patients moreover indices of the isovolumic relaxation were measured by invasive methods. In the first part of the investigation the correlation of the variables measured by the gamma camera and the ventricular probe and the intraobserver reliability of measurements by the ventricular probe were examined. Besides, the interactions between the variables of the isovolumic relaxation and the ventricular filling were investigated. A close correlation was found between the indices of the diastolic function measured by the Anger-camera and the ventricular probe (p less than 0,01). The intra-observer reliability of the dates measured by the nuclearstethoscope proved to be a good one. A significant correlation between the time constant of isovolumic relaxation (T) and the quotient dt/T on the one hand and the variables of the diastolic filling on the other hand has been proved. In the second part of the investigation the diastolic variables in normals and in patients with coronary heart disease (CHD) were measured. By means of the PFR and the FF normals could be distinguished from patients with CHD at a relatively high percentage. Differences between normals and patients with CHD could be shown by the diastolic variables exposed to dynamic stress and atrial pacing and a pharmacologic stress with dipyridamole. Finally the influence of diltiazem and k-strophantin on the diastolic function of the left ventricle was examined. Diltiazem caused an improvement of the diastolic variables without deteriorating the diastolic function. K-strophantin enhances the systolic function of the ventricle thus causing a slight improvement of the isovolumic relaxation. It is concluded that the diastolic variables measured by radionuclides have to be regarded as an important contribution to the diagnosis and the estimation of the ventricular function in patients with CHD.

Adult↗