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Biomedical subjects

H Berkel

Publications and source records attributed to H Berkel.

17 recordsLinked to original sources
PubMed2005

[Resuscitation after intoxication with amitriptylin].

Intoxications with tricyclic antidepressants are often life threatening situations. In consequence of interference with many organ systems specific treatment consists in transportation to hospital under cardiopulmonary monitoring by physicians. The multiple possibilities of complications require the following treatments: continuous monitoring of the cardiovascular system, gastrolavage, application of carbon through a nasogastric tube, intubation and controlled ventilation in case of coma and continuous stand by for defibrillation. Additionally patients with stable parameters should be monitored in intensive care units because often there are no precursors of cardiac or pulmonary complications. We report the case of a 49-year old women with ingestion of 2500 mg of amitriptyline who suffered from multiple cardiac arrhythmias with following cardiac arrests and who required multiple defibrillations and resuscitation.

Amitriptyline↗
PubMed2000

Comparison of utilization of preventive health care services between two racial populations.

PURPOSE: The difference in utilization of existing preventive health care services (PHCS) may be related to race. We compared the difference in use of PHCS between black and white males in Northwest Louisiana.METHODS: A cross-sectional survey regarding utilization of preventive health care services was conducted from 09/93-10/97. Approximate equal number of white and black males participated in this quota survey.RESULTS: 70% of black males said they had ever gone to the doctor for routine preventive check-up, while 79% of white males did so (p < 0.001). For those who previously had a routine preventive check-up, 88% had their last one within one year. Most routine check-ups are provided as part of the employment. The white males are 1.4 times more likely to have a routine check-up as compared to black males (p < 0.05). Factors which have a positive effect on use of PHCS are education (OR = 1.07, p < 0.01); intent to get a check-up (OR = 9.0, p < 0.001); the doctor spending enough time with the patients (OR = 2.4, p = 0.01); and wanting some health information (OR = 1.7, p < 0.001). Factors which have a negative effect on use of PHCS are cost (OR = 0.73, p = 0.046); having to go to different places (OR = 0.65, p = 0.024); and being scared of the doctor (OR = 0.46, p < 0.001). An indication of a negative effect-although not statistically significant-was found for long waiting time (OR= 0.73, p = 0.55) and the doctor not spending enough time explaining to patients (OR = 0.47, p = 0.054).CONCLUSIONS: White males that are more likely to use PHCS as compared to African-Americans. People of higher education with a positive intent and actively seeking health information are more likely to use PHCS. The more time the doctor spends with the participant, the more likely it is the participant will come for a routine check-up. The barriers for use of PHCS are cost, having to go to different places, and being scared of the doctor.

Journal Article↗
PubMed2000

Outcome of patients with metastatic breast carcinoma treated at a private medical oncology clinic.

BACKGROUND: Metastatic breast carcinoma usually is fatal. The median survival after recurrence is 2 years. Five-year survival after recurrence is approximately 10-20%. Although encouraging data have been reported from clinical trials, two issues confound the translation of clinical research to the general medical community: patient selection bias and the absence of untreated controls. Therefore, the authors examined their community-based metastatic breast carcinoma patients, comparing their results with reports from clinical trials and with untreated historic controls. METHODS: This was a nonconcurrent cohort study of 407 community-based metastatic breast carcinoma patients treated at the authors' private medical oncology clinic in northeast Louisiana. Prognostic variables were correlated with survival time. RESULTS: The median age of the patients at the time of diagnosis of breast carcinoma was 61 years. The median age at the time of first recurrence was 65 years. The median overall survival and median survival after recurrence were 4. 5 years and 20.1 months, respectively. The 5-year and 10-year survival rates were 17% and 2.5%, respectively. CONCLUSIONS: Although clinical trial participants and the authors' private practice cohort are incommensurable, outcomes in these disparate groups were similar but, unfortunately, not much different from those of untreated historic controls.

Adult↗
PubMed1999

Prostate-specific antigen (PSA) in women.

Prostate-specific antigen (PSA) is a valuable tumor marker for prostate cancer. It was believed that PSA was produced exclusively by the epithelial cells of the prostate gland, but a large body of evidence demonstrates that PSA is not a prostate-specific molecule. PSA has been shown to be expressed in many forms of female tissues. The breast is a major female organ able to produce PSA. PSA is detected in both normal and abnormal breast tissues, as well as in various breast fluids including milk, nipple aspirate, and cyst fluid. Androgens and progesterones, via their receptors, regulate the production of PSA in breast tissue. Clinical studies demonstrate that PSA in breast cancer is associated with the expression of estrogen receptor and progesterone receptor. Women with PSA-positive breast cancer have better disease-free survival as well as overall survival than those with PSA-negative breast cancer. PSA levels in nipple aspirate fluid may be indicative of breast cancer risk. High concentrations of PSA are found in amniotic fluid and the levels change with gestational age. Pregnant women have elevated serum PSA. PSA levels in serum also vary during menstrual cycles and increase in women with excess androgen. Clinical implications of PSA in amniotic fluid and female serum have been suggested. More studies are needed to further explore their utilities.

Adult↗
PubMed1999

Insulin-like growth factors and cancer.

Insulin-like growth factors (IGFs) regulate important cellular activities involving cell proliferation, differentiation, and apoptosis. Emerging evidence suggests that members of the IGF family, including IGF-1, IGF-2, the IGF-1 receptor (IGF-1R), and the IGF binding proteins (IGFBPs), play important roles in the development and progression of cancer. Both in vitro and in vivo studies show that IGFs are strong mitogens for a variety of cancer cells. IGF-1 also has an antiapoptotic action on cancer. IGF-1R, overexpressed in cancer cells, mediates the effects of IGFs and plays a role in cell transformation induced by tumor virus and oncogene products. IGFBPs inhibit the actions of IGFs and mediate the anti-proliferative effect of wild-type p53 protein, retinoic acid, vitamin D, and transforming growth factor-beta (TGF-beta). Findings from epidemiologic studies support the involvement of IGF in cancer etiology. Diet, nutrition, and other lifestyle features affect the expression and production of IGF-1 and other members of the IGF family. This may provide new approaches for cancer prevention. Growth hormone (GH) stimulates the production of IGF-1. Use of GH replacement therapy to improve physiological and psychological well-being and to prevent aging-related diseases has been recommended. Given the close relationship between GH and IGF-1, the long-term safety of GH treatment warrants a serious concern.

Apoptosis↗
PubMed1997

Tobacco use among male high school athletes.

PURPOSE: The purpose of this study was to compare tobacco use among high school male athletes with their nonathlete counterparts. We hypothesized that there was an inverse correlation between the intensity level of the sport and frequency of tobacco use. METHODS: Students were surveyed at seven high schools in northwest Louisiana using a 109-item questionnaire. Of the 1,200 males tested, 83% participated in one or more sports. The mean age was 15.8, and mean grade level was 10th. Sixty-seven percent were white, 27% African-American (AA), and 6% other. RESULTS: Forty-one percent of the adolescent males tested were one or more tobacco products, 31% reported cigarette smoking, 21% chewed tobacco, and 18% used snuff. Eleven percent reported using all three tobacco products. Race was a significant determinant of tobacco use, with whites being more likely to use each of the three tobacco products (P < .001). Medium- and high-intensity athletes were significantly (P < .01) less likely to be heavy smokers than athletes participating in low-intensity sports and nonathletes. However, athletes of each intensity sport used chewing tobacco and snuff at significantly higher rates (P < .001) than nonathletes. When race and grade point average were controlled, sports intensity was a significant predictor of smokeless tobacco use but not overall smoking behavior. Both AA and white high school male athletes at all sport intensity levels were using chewing tobacco and snuff at a rate higher at least 1.5 times that of their nonathlete counterparts. CONCLUSIONS: In our study, high school males' sports participation was a predictor of smokeless tobacco use but not overall smoking behavior. Although the probability of AA high school athletes using smokeless tobacco was low compared to whites, the pattern of use was similar across intensity levels of sports.

Adolescent↗
PubMed1996

[Resuscitation in multiple trauma].

We report on a case of successful outpatient cardiopulmonary resuscitation of cardiac arrest after blunt multisystem injury. The literature is discussed and prognostic indicators are described.

Accidents, Traffic↗
PubMed1996

[Bleomycin-induced pneumonia].

We report on a case of a 38-year old patient with fatal bleomycin-induced pneumonitis. Clinical presentation, the impact of risk factors, therapeutic means and perioperative considerations to prevent this rare but life-threatening complication are reviewed.

Adult↗
PubMed1994

Colon carcinoid tumors. A population-based study.

PURPOSE: The aim of our investigation was to evaluate the clinical presentation of patients with carcinoid tumors of the colon and to estimate the survival and potential prognostic factors of this tumor type. METHODS: A population-based study was performed using data from the Alberta Cancer Registry between 1964 and 1988 (inclusive). The clinical records and the pathologic material of eligible patients were reviewed. Survival was estimated both as crude survival and with the Kaplan-Meier method. RESULTS: During the 25-year study period (1964-1988), 36 true carcinoid tumors of the colon were diagnosed in Alberta. Carcinoids of the ileocecal region and of the rectum were excluded from the study. The average age at time of diagnosis was 68.4 years; there were 20 males and 16 females. Symptoms (abdominal pain, diarrhea, weakness, anorexia) occurred late in the course of the disease: 64 percent of the lesions were in Dukes D stage and 22 percent were Dukes C at diagnosis. Only one patient presented with a malignant carcinoid syndrome. Lesions occurred most frequently in the cecum (39 percent), followed by transverse and sigmoid colon. Most of the patients were managed surgically. The perioperative mortality rate was with 22 percent, which is quite high. The average size of the lesions was 5.8 (range, 2-10) cm, and most tumors (31/36) had invaded the pericolic fat. The most common immunohistochemical pattern was argentaffin/argyrophil negative and neuron-specific enolase positive. Two-year and five-year actuarial (Kaplan-Meier) survival was 34 percent and 26 percent, respectively. Survival for carcinoids of the colon was significantly lower compared with carcinoids of the rectum or appendix, and with colon adenocarcinomas. Size of the tumor and tumor invasion into the muscularis propria--the two major histopathologic prognostic factors for carcinoids of the gastrointestinal tract--were not found to influence survival significantly. Rather, tumor stage, histologic pattern, tumor differentiation, nuclear grade, and mitotic rate were found to significantly influence the survival rate. CONCLUSION: Carcinoid tumors of the colon are extremely rare tumors, diagnosed late in the course of the disease, and they carry a bad prognosis. Prognostic factors are tumor stage, histologic pattern, differentiation, nuclear grade, and mitotic rate of the tumor.

Aged↗
PubMed1993

[First aid and prognosis following drowning accidents. Results of a retrospective study of 115 cases].

OBJECTIVE AND STUDY DESIGN: In 115 cases of submersion the initial findings of the rescue team, the patients status in the emergency room and the course of clinical treatment were analyzed retrospectively. RESULTS: Submersion accidents happened preferably in February, March and in the summertime from May to August. Most of the accidents took place in public waters or public baths (85.2%). Children below 10 years of age were involved in 34.8% of the submersion accidents. 57 patients were near drowned and 58 patients were drowned. The prognosis of patients with detectable heartbeat at the site of the accident depends on the primary pulmonary lesion. If respiratory insufficiency is recognized early and treated aggressively by intubation and mechanical ventilation with PEEP, these patients have an excellent prognosis. Only one patient with detectable heartbeat died, typically, after delayed treatment of respiratory failure. 55 patients recovered completely; one patient was suffering from a lesion of the n. medianus. Contrariwise, the prognosis of patients without detectable heartbeat is mainly determined by the consequences of hypoxaemia and is, overall, poor. Though resuscitation succeeds in 50% of submersion victims, only one out of four successfully resuscitated patients survived with little or no neurologic damage. Severe hypothermia may improve the prognosis of submersion victims. CONCLUSION: Thus, there are no useful parameters that would accurately predict the individual course of a submersion victim.

Adolescent↗
PubMed1993

Breast cancer diagnosis and survival in women with and without breast implants.

The stage at diagnosis and the survival experience of 41 women who developed breast cancer after cosmetic breast augmentation were compared with those of all other patients with breast cancer (n = 13,246) diagnosed in Alberta from 1973 to 1990 (inclusive). The tumors in women with breast implants were smaller (65.9 percent < or = 2 cm) as compared with the tumors in women without implants (34.1 percent < or = 2 cm), but lymph node and distant metastases were equally frequent in the two groups. The distribution of tumor histologic types did not differ significantly between women with or without implants. Women who had an implant were younger at diagnosis of breast cancer compared with women with breast cancer and no breast implants. The relative 5- and 10-year survival rates did not differ significantly between the two groups, and the Kaplan-Meier survival estimate also was similar. It is concluded that women with breast implants in whom breast cancer develops are not diagnosed in a later stage and do not experience an impaired survival as compared with breast cancer patients without implants.

Adult↗
PubMed1992

Breast augmentation: a risk factor for breast cancer?

BACKGROUND: A relation between breast augmentation and the subsequent risk of breast cancer has been postulated. Since an estimated 2 million women in the United States alone have received breast implants, even a small increase in the risk of breast cancer could have considerable public health consequences. METHODS: We performed a population-based nonconcurrent cohort-linkage study. All women in Alberta, Canada, who underwent cosmetic breast augmentation from 1973 through 1986 were included in the implant cohort (n = 11,676). This cohort was compared with the cohort of all women in Alberta in whom a first primary breast cancer was diagnosed (n = 13,557). The expected number of breast-cancer cases in the implant cohort was estimated by applying age-specific and calendar year--specific incidence rates of breast cancer (obtained from the Alberta Cancer Registry) to the implant cohort. Standardized incidence ratios were calculated by dividing the observed by the expected number of breast-cancer cases in the implant cohort. RESULTS: Forty-one patients with implants were subsequently found to have breast cancer. The expected number was 86.2. The standardized incidence ratio was thus 47.6 percent, significantly lower than expected (P less than 0.01). The average length of follow-up in the implant cohort was 10.2 years, and the average length of time from breast augmentation to the diagnosis of breast cancer was 7.5 years. CONCLUSIONS: Women who undergo breast augmentation with silicone implants have a lower risk of breast cancer than the general population. This finding suggests that these women are drawn from a population already at low risk and that the implants do not substantially increase the risk.

Adult↗
PubMed1992

The development of staging data for use in the microsimulation of lung cancer.

Lung cancer incidence rates by cell type and stage were required for a lung cancer microstimulation submodel developed at Statistics Canada. Lung cancer incidence rates not disaggregated by stage were calculated for different histological cell types using Canada's National Cancer Incidence Reporting System data. In the absence of national lung cancer staging information, staging data from the province of Alberta were collected and rates of occurrence were calculated for different stages of lung cancer at time of diagnosis. Imputation procedures were used to maximize the amount of usable staging data. The Alberta stage rates were combined with the Canadian incidence rates to obtain estimates needed by the microsimulation submodel of the annual probability of an individual of a particular sex and age being diagnosed with lung cancer of each cell type at each stage. This project, although highly specialized, illustrates the need for more extensive and standardized staging data for cancer in Canada.

Adolescent↗
PubMed1990

Early prediction of prognosis in out-of-hospital cardiac arrest.

Of 347 victims of out-of-hospital cardiac arrest 196 (56.5%) died before and 109 (31.4%) after admission to hospital, while 42 patients (12.1%) were discharged alive. The 37 patients (10.7%) discharged without severe hypoxic brain damage were assigned to the group with "good", the remaining 310 patients to the group with "poor outcome". From results of stepwise logistic regression, a score was derived to specifically identify victims with poor prognosis (values in brackets = score points; cutpoint: score greater than 3 points): age less than or equal to 70 (0), 71-80 (1), greater than 80 (2); ECG ventricular fibrillation (0), other (1); no aspiration (0), aspiration (1); pupils round (0), not round (1); gasping (0), apnea (1); bystander resuscitation--yes (0), no (1). Evaluation of the score revealed a specificity of 100% (0.95 confidence interval: 80%-100%) and predictive value of 100% (0.95 confidence interval: 95%-100%). A predictive score for specific identification of victims with poor prognosis can contribute to decision making in out-of-hospital cardiac arrest.

Aged↗
PubMed1987

Multiple endocrine neoplasia syndrome type 2: the value of screening and central registration. A study of 15 kindreds in The Netherlands.

Since 1975, 10 families with the multiple endocrine neoplasia (MEN)-2A syndrome and five with the MEN-2B syndrome, making a total of 101 patients, have been identified in The Netherlands. Twenty-three of the MEN-2A patients died before the start of the screening program. The average age of the patients whose death was due to pheochromocytoma (n = 11) or medullary thyroid carcinoma (n = 12) was 34.9 and 49.2 years, respectively. Eighty-seven patients with the MEN-2A syndrome and eight with the MEN-2B syndrome underwent thyroidectomy for C-cell hyperplasia and/or medullary thyroid carcinoma. Eighteen patients had signs or symptoms caused by MEN-2A (group A), 60 were relatives of these patients who had been found to be affected at the first screening of the family (group B), and nine relatives had had negative screening results that later became positive (group C). Five patients had signs or symptoms due to MEN-2B (group A) and three were relatives of these patients who had been found to be affected at the initial screening (group B). To assess the effect of screening, we compared these groups with respect to the occurrence of metastatic medullary thyroid carcinoma at thyroidectomy and the results of the postoperative calcitonin tests. Among the MEN-2A families, 72 percent of group A, 33 percent of group B, and none of group C were found to have metastatic medullary thyroid carcinoma at surgery. In the MEN-2B families, all five patients in group A and one of the three patients in group B had metastatic disease. The "cure rates" in these three groups with MEN-2A, as determined by stimulated calcitonin assessment, were 11, 57, and 100 percent, respectively. One of the five patients with MEN-2B in group A and two of the three patients in group B showed normalization of the stimulated calcitonin value after surgery. From these results, it may be concluded that screening can lead to the detection of medullary thyroid carcinoma in an earlier stage, which in turn may permit curative treatment and improvement of both prognosis and life expectancy. The need for supervision of affected families by central registration to promote periodic examination and to guarantee the continuity of such screening is discussed.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

New concepts in health care: some preliminary ideas.

Health care discussions in many countries tend to focus on cost containment without taking into account the problem of quality of care. The starting point for our ideas is the description of quality as the optimal relation between care demander and care provider. The difficulties in assessing quality of care are outlined. The question remains which health care model offers the best opportunities to have both high quality care and affordable costs. A proposal is made for a model in which the care demander and care provider, i.e. the client and physician, are natural allies. A special role is fulfilled by the family physician: a key role, as case manager, as gatekeeper. Special attention should be directed towards the financial consequences. It is proposed that small-scale experiments should be started to evaluate the model advanced in the text.

Cost Control↗