Alcohol and cardiovascular disease: the status of the U shaped curve.
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Alcohol Drinking↗
Biomedical subjects
E Brunner
Publications and source records attributed to E Brunner.
Health inequalities among British civil servants: the Whitehall II study.
The Whitehall study of British civil servants begun in 1967, showed a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases. Between 1985 and 1988 we investigated the degree and causes of the social gradient in morbidity in a new cohort of 10,314 civil servants (6900 men, 3414 women) aged 35-55 (the Whitehall II study). Participants were asked to answer a self-administered questionnaire and attend a screening examination. In the 20 years separating the two studies there has been no diminution in social class difference in morbidity: we found an inverse association between employment grade and prevalence of angina, electrocardiogram evidence of ischaemia, and symptoms of chronic bronchitis. Self-perceived health status and symptoms were worse in subjects in lower status jobs. There were clear employment-grade differences in health-risk behaviours including smoking, diet, and exercise, in economic circumstances, in possible effects of early-life environment as reflected by height, in social circumstances at work (eg, monotonous work characterised by low control and low satisfaction), and in social supports. Healthy behaviours should be encouraged across the whole of society; more attention should be paid to the social environments, job design, and the consequences of income inequality.
Adult↗
Fluoxetine versus placebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy.
In a double-blind trial 40 patients with bulimia nervosa according to DSM III-R criteria were randomly assigned either to a 60 mg fluoxetine group or to a placebo control group. Fluoxetine or placebo was given over a period of 35 days. Parallel to the drug trial, patients participated in an intensive inpatient behavioral psychotherapy program. There were no dropouts at all in the study. Fluoxetine was well tolerated and had only minor adverse effects. In self-ratings and expert ratings concerning attitudes towards eating, eating behavior, and general psychopathology, significant improvements over time were observed in both groups. Using analysis of variance (ANOVA), however, there were no statistically significant "group by time" differences. Results show that the intensive inpatient-care and psychotherapy program was highly effective in changing eating behavior and attitudes as well as general psychopathology. Fluoxetine showed a significant reduction in body weight, especially during the first three weeks of fluoxetine treatment. It was not possible to demonstrate a statistically significant improvement in eating attitudes, eating behavior, and general psychopathology beyond that elicited by intensive inpatient psychotherapy and general inpatient care. These results can possibly be explained by the existence of a "ceiling effect".
Adult↗
A nonparametric estimator of the shift effect for repeated observations.
In a nonparametric two-sample model for independent observations with repeated measurements, a new point estimator and a new distribution-free confidence interval for the difference in means are introduced. The method is based on some ideas in Hodges and Lehmann (1963, Annals of Mathematical Statistics 34, 598-611). The asymptotic theory in Brunner and Neumann (1983, Biometrical Journal 24, 373-389; 1986; Biometrical Journal 28, 394-402) and the results for small sample sizes in Brunner and Compagnone (1988, Statistical Software Newsletter 14, 36-42) are used. The new estimators are applied to a problem in morphometry.
Animals↗
Relevance of methods of skin incision technique on development of wound infection.
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Animals↗
Disturbances in the hypothalamo-pituitary-adrenal and other neuroendocrine axes in bulimia.
Disturbances in the hypothalamo-pituitary-adrenal (HPA) and other endocrine axes were assessed in 24 women with bulimia and healthy controls. Overnight blood samples for measuring nocturnal plasma cortisol, prolactin (PRL), growth hormone (GH), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were obtained at 30-min intervals. A 1.5 mg dexamethasone suppression test (DST) and a TRH-test were performed. Patients were monitored closely while their nutritional intake was recorded over 21 days. Compared with healthy controls, nocturnal cortisol plasma levels were not elevated in the bulimics. There was a trend toward insufficient cortisol suppression in the DST in patients with bulimia, which was most pronounced in patients with signs of restricted caloric intake. Plasma dexamethasone levels were significantly reduced in bulimics compared with healthy controls. There was a trend for blunted thyrotropin stimulating hormone (TSH) responses to thyrotropin releasing hormone (TRH) in bulimia. The prolactin response to TRH was significantly reduced in bulimics with a history of anorexia nervosa. Plasma LH and plasma FSH were significantly reduced in bulimics with signs of reduced caloric intake [low T3, high levels of beta-hydroxy-butyric acid (BHBA), reduced daily caloric intake, high number of fasting days] as compared with healthy controls. Bulimics with high BHBA levels had significantly reduced nocturnal prolactin plasma levels. Results show that multiple neuroendocrine disturbances exist in bulimia in a milder form than in anorexia nervosa. Evidence for the impact of caloric intake on endocrine functions is presented. Endocrine dysfunctions in our bulimic sample did not show a positive association with the presence of depressive symptoms.
Adult↗
General anesthetics modulate GABA receptor channel complex in rat dorsal root ganglion neurons.
The effects of halothane, isoflurane, and enflurane on ionic currents induced by bath application of gamma-amino-butyric acid (GABA) were studied with the rat dorsal root ganglion neurons maintained in primary culture. The whole-cell patch clamp technique was used to record the current. In normal neurons before exposure to anesthetics, GABA at low concentrations (1-3 x 10(-6) M) induced a small sustained inward current. At higher concentrations (3 x 10(-5) M-1 x 10(-3) M), GABA induced a large inward current, which decayed to a steady-state level (desensitization). Halothane (0.86 mM), isoflurane (0.96 mM), and enflurane (1.89 mM), each equivalent to the respective 2 minimum alveolar concentration (MAC) units, augmented the sustained current evoked by 3 x 10(-6) M GABA to 330-350% of control and the peak current evoked by 3 x 10(-5) M of GABA to 136-145% of control. The decay phase of the current was accelerated by the anesthetics, the time for the current to decline to 70% of the peak being reduced to 23-39% of control. In contrast, the densitized steady-state current evoked by high concentrations of GABA was decreased by anesthetics. In conclusion, general anesthetics exert a dual effect on the GABA receptor channel complex: to potentiate the nondesensitized (both peak and sustained) current and to suppress the desensitized steady-state current. The potentiation of the GABA receptor channel response may be a primary action of anesthetics leading to surgical anesthesia.
Anesthetics↗
Desensitization to trimethoprim sulfamethoxazole in patients with acquired immune deficiency syndrome and Pneumocystis carinii pneumonia.
In three of eight patients with the acquired immune deficiency syndrome the Pneumocystis carinii pneumonia treated with intravenous trimethoprim sulfamethoxazole, drug-related reactions occurred 9, 10, and 13 days after therapy. The symptom complex consisted of a maculopapular eruption, fever, eosinophilia, and leukopenia. Oral desensitization with graded doses of trimethoprim sulfamethoxazole was successfully achieved in two of the three patients.
Acquired Immunodeficiency Syndrome↗
[Determination of the diameter of erythrocytes in the urine in urologic diseases and so-called asymptomatic microhematuria].
In a blind-study with 96 patients analysis of erythrocyte diameters permits to differentiate between renal-parenchymatous and post-renal microhaematuria in 89.9% of the cases. Erythrocytes on renal-parenchymatous microhaematuria are distinctly smaller (Average diameter 3.2 microns-5.6 microns) than those on post-renal microhaematuria (average diameter 5.4 microns-8.8 microns). In addition to the evaluation of erythrocyte morphology erythrocyte morphometry represents further possibility in diagnosis.
Adolescent↗
[Radiodiagnosis of temporal bone anomalies].
The X-ray findings in temporal bone anomalies are reviewed. Radiological procedure and examination technique are presented, as are symptoms of important anomalies. The methods available are plain film X-ray of temporal bone, multi-directional tomography, and high-resolution CT. Although some of the abnormalities are visible even in plain films, consistent use of conventional tomography or CT is necessary for correct diagnosis. This procedure is indicated not only when an abnormality is clinically obvious, but also in all cases of unexplained hearing loss without evidence of acquired disease. The advantage of CT over conventional tomography is that soft tissue anomalies, such as primary cholesteatoma or tumor simulating vascular abnormalities, can be demonstrated. In these cases CT is obligatory.
Cochlea↗
[Insulin therapy of obese diabetic patients? Consequences for the evaluation of insulin secretion and metabolic behavior].
UNLABELLED: In 83 diabetics insulin secretion was examined after a mean diabetes duration of 7.5 years, when an insufficient metabolic situation could be found. Insulin secretion was stimulated with 100 g glucose (orally) and 1.0 mg glucagon i.v. (60 min after glucose intake). We investigated additionally in a retrospective manner blood-glucose and urine glucose behaviour as well as the development of the body weight. In dependence of the actual body weight at the time of investigation of insulin secretion, two groups were formed: b. w. less than 120% acc. Broca index, group A, n = 38; b. w. greater than 120% acc. Broca index. group B, n = 45). Immediately after manifestation of the disease 71 diabetes were treated with pure dietetic measures. At the examination of insulin secretion all patients were treated with glibenclamide. After this examination in 20 patients of the group A and in 17 patients of the group B an insulinisation was started. In the others glibenclamide treatment was continued. The general characteristics of the whole group was a significant reduction of the maximum stimulability of insulin secretion, compared with the insulin secretion of n = 19 healthy probands (11 probands with normal body weight and 8 obese probands). A hyperinsulinism (maximum values higher than mean + 1 s of the health persons) could not be found in any case. The mean of the maximum insulin values was below mean - 1 s of the healthy persons. Insulinisation provoked an improvement of the metabolic situation. This was correlated with an additional improvement of the subjective behaviour. CONCLUSION: Evaluation of insulin secretion in obese diabetics with bad metabolic situation is necessary to find out those who are to be treated with insulin. We have no clinical or other possibilities to recognize patients with a hyperinsulinism or reduced insulin secretion than by evaluation of insulin secretion alone. But higher degrees of decompensated metabolism are nearly always explained by a significant reduction of insulin secretion.
Combined Modality Therapy↗
[Does pure-tone audiometry provide inferences for a vascular cause of sudden deafness?].
The theory that sudden hearing loss is caused by some form of vascular catastrophe has not been confirmed by pathological evidence, but it agrees with a number of clinical observations. But there are several pieces of experimental and clinical evidence that cast serious doubt upon a vascular hypothesis, especially the considerable variability in site and degree of cochlear and vestibular impairment. A review of the vascular anatomy of the inner ear makes it clear that many clinically observed audiometric patterns and associated partial vestibular deficits in idiopathic sudden hearing loss cannot be explained by assigning a site of presumed vascular occlusion. We investigated 166 pure tone audiograms of patients with idiopathic sudden hearing loss by using the statistical method of cluster analysis, which allow an explanation based on the vascular anatomy. Three types of audiograms could be found which differed not in shape but in the degree of hearing loss. None of them can be explained by the vascular anatomy. The three groups of audiograms with different degrees of hearing loss allowed investigations of the influence of age, sex, vestibular disturbance and vascular disease. Men are more often affected, the degree of the hearing loss is not dependent on age, vestibular disturbance, vascular disease, diabetes or smoking. The prognosis for sudden hearing loss is independent of all the investigated parameters. Our findings support the conclusion that a vascular hypothesis cannot adequately explain the clinical findings in idiopathic sudden hearing loss.
Audiometry↗
Selection bias and randomized consent designs.
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Clinical Trials as Topic↗
[High-resolution sonography after surgery of cystadenoma lymphomatosum of the parotid gland].
Clinical and sonographic examinations were carried out on 38 patients who had undergone excision of a parotid gland for adenolymphomas and the results were compared. In 23 of these patients (60%) sonography showed further tumours on the same or opposite side, or bilaterally. The incidence of multiple tumours is therefore significantly higher than has been assumed so far. In 76% of patients, sonography showed clinically occult cystadenoma lymphomatosum. Only 14% of tumours smaller than 12 mm were detected clinically. In four patients, tumours larger than 12 mm, but lying deep in the gland were missed on palpation. In view of the frequency of multi-local or bilateral tumours, sonography of both parotids should be performed if there is clinical suspicion of a parotid tumour.
Adenolymphoma↗
[Significance of computerized tomography in middle ear diagnosis].
Due to the important improvement represented by the latest computed tomography (CT) technology in respect of detail and excellent contrast resolution normal and pathological structures of the inner and middle ear can be visualised. The clinical and diagnostic value of CT in comparison to standard x-rays and tomography is prospectively evaluated on the basis 74 patient examinations. Today CT is unsurpassed in the diagnosis of cholesteatomas and glomus tumours and ranks first among all imaging modalities. Chronic inflammatory diseases and deformities of the middle ear can be evaluated in most cases on the basis of standard x-rays and tomography. The importance of CT is primarily complementary, except in preoperative cases. Fractures should be visualised first via standard x-rays. In cases of questionable complications (e.g. tympanic or intracranial haematomas), CT should be the next step. Conventional tomograms are not necessary.
Adolescent↗
On the mathematical basis of Zelen's prerandomized designs.
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Biometry↗
[Computerized tomography in middle ear diagnosis--a comparison with conventional methods].
Due to important improvement in detail resolution and the excellent contrast resolution, in the newest computed tomography (CT) units, normal and pathologic structures of the inner and middle ear can be visualized. The clinical value of CT in comparison to standard X-rays and tomography is prospectively evaluated on the basis of 50 patient examinations. Today CT is unsurpassed in the diagnosis of cholesteatomas and glomus tumors and is superior to all other imaging techniques. Chronic inflammatory diseases of the middle ear can be evaluated in most cases on the basis of standard X-rays and tomography. CT's importance is primarily complementary, except for preoperative cases. Fractures should be visualized first on standard X-rays. If questionable complications are involved (e.g., tympanic or intracranial hematomas), CT should be the next step. Conventional tomograms are not necessary.
Cholesteatoma↗
[Long-term course of type I-simulating type II-diabetes mellitus].
In only few cases of primarily non- insulin-dependent diabetes mellitus after many years an absolute insulin dependency can develop. Within 5000 patients of a diabetic outpatient clinic in 2 years this happened in 21 patients. These patients offered a C-peptide-secretion after stimulation which was typical for an insulin dependent diabetes. The investigation of HLA-frequencies showed a marked increase of the DR 3 und DR 4 loci. These results demonstrate that obviously the genetically as type I characterized diabetes may appear clinically in the picture of type II-diabetes for many years. This must be taken in consideration in therapeutic or epidemiologic questions.
Blood Glucose↗