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Biomedical subjects

G Schmutz

Publications and source records attributed to G Schmutz.

At least 19 recordsLinked to original sources
PubMed2005

Mitochondrial DNA depletion in liver tissue of patients infected with hepatitis C virus: contributing effect of HIV infection?

OBJECTIVES: It has been suggested that chronic hepatitis C virus (HCV) infection depletes mitochondrial DNA (mtDNA) in the liver. Because decreased mtDNA levels were also found in humans infected with HIV, we investigated whether HIV may have aggravated hepatic mtDNA depletion in individuals with HCV infection. METHODS: In this cross-sectional study, liver biopsies were performed in a total of 40 individuals prior to any antiviral therapy. The individuals were recruited from the Hospital Clinic, Barcelona and the HIV Centre, Dusseldorf. Seventeen patients were negative for HIV and HCV and were biopsied for liver enzyme elevation of unknown cause (controls), 14 individuals had chronic HCV but no HIV infection, and nine subjects were coinfected with both viruses. mtDNA and liver histology were centrally assessed. RESULTS: The groups did not differ with respect to age, gender, liver function tests and HCV viral load, where applicable. mtDNA levels were decreased by 19% in the HCV-monoinfected group (P=0.03) and by 27% in the HIV/HCV-coinfected subjects (P=0.02) compared to controls. The mtDNA content, however, did not differ between individuals with HCV monoinfection and HCV/HIV coinfection (P=0.75). The degrees of liver fibrosis, inflammatory activity or steatosis did not correlate with mtDNA content. CONCLUSIONS: Liver mtDNA content is reduced in both HCV-monoinfected and HIV/HCV-coinfected patients. Under the limitations of our study, we could demonstrate only a slight trend towards more pronounced mtDNA depletion in HIV/HCV-coinfected subjects.

Adult↗
PubMed2004

Safety, efficacy and development of resistance under the new protease inhibitor lopinavir/ritonavir: 48-week results.

BACKGROUND: Within this open-label, uncontrolled prospective trial we evaluated safety, efficacy and development of genotypic resistance under the new protease inhibitor lopinavir/ritonavir (LPV/r) in antiretroviral (ARV) HIV patients. PATIENTS AND METHODS: 58 patients with virological failure under their current ARV therapy were started on a LPV/r containing regimen. Median baseline HIV RNA and CD4 count were 4.6 log(10) cps/ml (range 2.1-6.4) and 128 x 10(6)/l (0-767), respectively. CD4 count, HIV RNA and metabolic parameters were assessed at weeks 0, 4, 8, 12, 16, 24, 32, 40, 48. Genotypic resistance testing was performed at baseline and again at weeks 12, 24 and 48 in the event of virological failure. RESULTS: Until week 48, viral load (VL) decreased by a median of 1.9 log(10) cps/ml (-0.8-3.8). A VL below 80 cps/ml was found in 20/58 patients (34.5%) at week 48. In parallel, CD4 cells increased to a median of 332 x 10(6)/l (8-905). Nine patients discontinued study treatment. At 48 weeks, median triglyceride and cholesterol levels increased significantly. While the median number of overall protease mutations at baseline was four in all patients, it was six in patients virologically failing on LPV/r. The average number of mutations increased significantly to eight at week 48. Several mutations were detected considerably more often in the event of failure than in response to treatment, e. g. at amino acid positions 10, 24, 54, 71, 82, 84. CONCLUSION: LPV/r is effective in heavily pretreated patients. Discontinuation due to adverse events is infrequent. No individual mutation can be associated with failure on LPV/r. However, a greater number of protease mutations at baseline is associated with poorer treatment outcome and several mutations seem to be related to treatment failure.

Adult↗
PubMed2004

[Esophageal disease: is cross sectional imaging contributive?].

For a long time, esophagography and endoscopy were the major diagnostic tests used for evaluation of the esophagus. Now, the development of computed tomography, endosonography and MR imaging has permitted more comprehensive evaluation of esophageal diseases. Cross sectional imaging is essential to evaluate the relationship between esophageal lesions and adjacent mediastinal structures and to evaluate the thickness of the esophageal wall.

Esophageal Diseases↗
PubMed2004

A prospective, controlled study assessing the effect of lopinavir on amprenavir concentrations boosted by ritonavir.

In a controlled, prospective study, the efficacy of ritonavir 200 mg twice daily (bid) in inhibiting the decrease of amprenavir plasma concentrations caused by co-administration of lopinavir was assessed. Twelve HIV-seropositive patients were enrolled, and nine patients completed the 28-day study. At day 14, plasma concentrations of amprenavir 600 mg bid and ritonavir 200 mg bid were determined over 12 h. At day 15, lopinavir 400 mg bid was added. At day 28, plasma concentrations of amprenavir, ritonavir and lopinavir were assessed. Co-administration of lopinavir was found to decrease the amprenavir concentration, determined as the median area under the curve over 12 h (AUC12), by 25% (AUC12 24.9 microg/h/mL vs. 18.5 microg/h/mL; P<0.01), despite the presence of ritonavir 200 mg bid. Eight participants discontinued the study regimen during the first 6 weeks because of adverse gastrointestinal events. In conclusion, gastrointestinal tolerance of a regimen containing an increased dose of ritonavir 200 mg bid was low, while the regimen did not prevent a decrease of amprenavir and possibly lopinavir plasma concentrations.

Anti-HIV Agents↗
PubMed2003

[Micturition disorders in elderly patients].

After clinical evaluation, imaging is extremely important in determining the type of treatment and approach of micturition disorders in elderly. In this article, the advantages and limitations of each of the relevant techniques are reviewed and highlighting, with correlation to clinical evaluation. Sonography has become the most widely used technique to study bladder dysfunction. CT and MRI have specific indications.

Adult↗
PubMed2002

[The three-dimensional spiral scanner and volume rendering technique: importance in craniofacial traumatology and reconstructive surgery].

There are two reconstruction methods for 3D imaging with a helical scanner: a surface rendering process providing a 3D-SSD (Surface Shaded Display) image that looks like a plaster cast skull and 3D-VRD (Volume Rendering Technique) which is more precise and gives 3D images similar to radiographs. We review briefly the techniques used to acquire these images and present 3D volume-rendering scanners, pointing out its usefulness in craniomaxillofacial traumatology and reconstructive surgery.

Adolescent↗
PubMed2001

[HIV-lipodystrophy syndrome].

CLINICAL FINDINGS: The HIV-associated lipodystrophy syndrome is reported with an increasing incidence predominantly in HIV-seropositive patients on antiretroviral therapy. The core of the lipodystrophy syndrome consists of fat loss in face, extremities and buttocks with or without a visceral fat accumulation, hyperlipidemia and a disturbed glucose metabolism are considered essential parts of the syndrome too. Additional metabolic abnormalities are regarded as syndrome related. PATHOGENESIS: Currently identified risk factors associated with the development of lipodystrophy are antiretroviral treatment (duration, number and kind of drugs), low CD4 cell count, higher age and metabolic abnormalities. The currently favored hypotheses to explain the lipodystrophy syndrome are essentially based on the assumption that antiretroviral treatment is the cause of the disorder. TREATMENT: The short-term benefit of antiretroviral treatment is greater than the disadvantages of the lipodystrophy syndrome, in the long term, however, the cardiovascular risk associated with the metabolic disturbances may result in an increased mortality on its own. The current approach to treatment includes modification of antiretroviral therapy and specific treatment of symptoms.

Antiretroviral Therapy, Highly Active↗
PubMed2001

L-Carnitine in the treatment of HIV-associated lipodystrophy syndrome.

The objective of this pilot study was to assess the effect of L-carnitine on the course of the HIV-associated lipodystrophy syndrome. Twelve patients presenting with combined atrophic and hypertrophic changes of body fat were treated with L-carnitine 1000 mg bid for 3 months. No marked improvement of the body changes was observed. However a reduction in serum cholesterol levels, but not triglycerides, was noted. These preliminary data do not support the use of L-carnitine for the rapid reversal of advanced fat tissue alterations due to HIV-associated lipodystrophy.

Body Weight↗
PubMed2001

Simultaneous determination of the new HIV protease inhibitor lopinavir (ABT 378) and of indinavir(1), amprenavir, saquinavir, ritonavir (ABT 538)(2) and nelfinavir(3) in human plasma by gradient HPLC.

Protease inhibitors are known by their inhibition of a viral protease that leads to production of immature and non-infectious virus particles. The novel protease inhibitor KALETRA is a co-formulation of lopinavir and ritonavir. Ritonavir reduces the metabolization of lopinavir by the cytochrome P450 3A4 isoenzyme which leads to markedly increased plasma levels of lopinavir(4). A new rapid and sensitive HPLC method for the simultaneous determination of lopinavir, indinavir, amprenavir, saquinavir, ritonavir and nelfinavir in human plasma has been developed. An aliquot of 500 microl plasma, spiked with internal standard, was extracted with 500 microl 0.1 M ammonium hydroxide solution and 5 ml tert. -butyl ether. After drying under a nitrogen stream, the residue was redissolved in an eluent consisting of 50 mM phosphate buffer, pH 5.40 and acetonitrile (50:50, v/v). Chromatographic separation was accomplished on a C-18 column using a non-linear gradient elution and ultraviolet detection at 215 nm.

Carbamates↗
PubMed2000

Liver adenomatosis: reappraisal, diagnosis, and surgical management: eight new cases and review of the literature.

OBJECTIVE: Liver adenomatosis (LA) is a rare disease originally defined by Flejou et al in 1985 from a series of 13 cases. In 1998, 38 cases were available for analysis, including eight personal cases. The aim of this study was to review and reappraise the characteristics of this rare liver disease and to discuss diagnosis and therapeutic options. BACKGROUND: LA was defined as the presence of >10 adenomas in an otherwise normal parenchyma. Neither female predominance nor a relation with estrogen/progesterone intake has been noted. Natural progression is poorly known. METHODS: The clinical presentation, evolution, histologic characteristics, and therapeutic options and results were analyzed based on a personal series of eight new cases and an updated review of the literature. RESULTS: From a diagnostic standpoint, two forms of liver adenomatosis with different presentations and evolution can be defined: a massive form and a multifocal form. The role of estrogen and progesterone is reevaluated. The risks of hemorrhage and malignant transformation are of major concern. In the authors' series, liver transplantation was indicated in two young women with the massive, aggressive form, and good results were obtained. CONCLUSION: Liver adenomatosis is a rare disease, more common in women, where outcome and evolution vary and are exacerbated by estrogen intake. Most often, conservative surgery is indicated. Liver transplantation is indicated only in highly symptomatic and aggressive forms of the disease.

Adenoma, Liver Cell↗
PubMed1997

[Intra-parotid neurogenic tumors of the facial nerve. Value of MRI].

Facial nerve intraparotid neuromas are rare. We report two cases with no facial paralysis. In the first case, the clinical protocol for the evaluation of a parotid mass did not suggest the intramastoid tumor extension. This extension was shown by CT and MRI and confirmed by gross and microscopic appearance. In the second case, no intrapretrous extension was observed with MRI. The diagnosis of neuroma was made during surgery. With a literature review, we discuss the diagnostic difficulties encountered in the investigation of parotid facial nerve tumors, emphasizing on the usefulness of CT and MRI in its diagnosis.

Adult↗
PubMed1994

[The effect of a low-dose hydrochlorothiazide therapy on the bone mineral content of the axial and peripheral skeleton].

An increase in bone mineral content (BMC) as well as a decrease in the incidence of fracture of the proximal femur have been described in patients on thiazide diuretic treatment. A study was undertaken to assess, by means of dual X-ray absorptiometry, the effect of chronic low-dosage antihypertensive treatment with hydrochlorothiazide (HCT; < or = 25 mg daily) on lumbar vertebrae (representing the axial skeleton) and the nondominant radius (peripheral skeleton). Measurements were made on 27 women (mean age 63.8 +/- 8.2 years) and 23 men (65.9 +/- 9.5 years) and compared with a control group of 19 women (62 +/- 8.7 years) and 20 men (65.9 +/- 9.5 years) with minor surgical or dermatological lesions who had never taken HCT or other drugs with potential effects on mineral bone metabolism. In men who had been on HCT for more than 5 years, BMC of the lumbar vertebrae was higher by 10.3% and of the radius by 3.8% than among the controls (differences not significant). In women who had been on HCT for more than 5 years, the corresponding increases were 19.6% (P < 0.05) and 5.4% (not significant). Among those patients who had been on HCT for less than 5 years there were no significant differences compared with the control group. There were no significant differences between the groups relating as regards the proximal radius which, in contrast to the ultradistal radius, consists predominantly of cortical bone. -These data indicate that, while HCT has only a slight influence on BMC, it can be considered to have a desirable associated effect in the antihypertensive treatment of elderly patients.

Absorptiometry, Photon↗
PubMed1991

Contribution of discography to the diagnosis and treatment of lumbar disc herniation.

In this study, based on 600 cases of lumbar disc herniation treated by chemonucleolysis, the authors underline the importance of performing good discography and interpreting its results. A discographic classification of intervertebral disc deterioration is suggested. A CT-discographic study is reported and its results are compared with those of standard discography. On the basis of these studies, the authors have established methodological data concerning the efficacy of chemonucleolysis and its evaluation.

Chymopapain↗
PubMed1990

[Abdominal echography in colonic diseases].

In the past few years, several studies have assessed the visualization of digestive diseases by ultrasound, but its clinical accuracy has been rarely defined. Thus we evaluated the contribution of sonographic examination as an initial diagnostic mean in the detection of colonic lesion. During a period of thirty six months (June 85-June 88) when we performed a standard sonographic abdominal examination, we utilized ultrasound to look for thickening or other modifications of the large bowel wall, if the clinical findings suggested a colonic disease. In these conditions we performed 453 US examinations. In our study, 363 cases were considered to be negative and the controls demonstrated colonic wall lesions in 24 cases. Thus the sensitivity was one of 77%. The sonographic examination was positive in 90 cases with 6 false positives. Thus our specificity reached 98.2% and the accuracy achieved was 93.3%. Thus sonographic examination appears to be a rapid, non invasive, mobile, mean of examining the abdominal cavity and also the large bowel in all patients. If this examination is negative, a colonic disease is possible since sensitivity is 77%. On the other hand, if the examination is positive, a colonic disease is very probable, since specificity reached 98.2%. The accuracy of US Colonic examination is 93.3% and with using abdominal plain film, theses percentages may be improved.

Adult↗