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Biomedical subjects

J Mayer

Publications and source records attributed to J Mayer.

At least 19 recordsLinked to original sources
PubMed2007

Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery.

BACKGROUND: Thermodilution technique using a pulmonary artery catheter (PAC) is a widely used method to determine cardiac output (CO). It is increasingly criticized because of its invasiveness and its unclear risk-benefit ratio. Thus, less invasive techniques for measuring CO are highly desirable. We compared a new, semi-invasive device (FloTrac/Vigileo) using arterial pressure waveform analysis for CO measurement in patients undergoing cardiac surgery with bolus thermodilution measurements. METHODS: Forty patients undergoing coronary artery bypass grafting or valve repair were enrolled. A PAC was inserted and routine radial arterial access was used for semi-invasive determination of CO with the Vigileo. CO was measured simultaneously by bolus thermodilution and the Vigileo technique after induction of anaesthesia (T1), before cardiopulmonary bypass (CPB) (T2), after CPB (T3), after sternal closure (T4), on arrival in the intensive care unit (ICU) (T5), and 4 h (T6), 8 h (T7), and 24 h after surgery (T8). CO was indexed to the body surface area (cardiac index, CI). RESULTS: A total of 244 pairs of CI measurements were analysed. Bias and precision (1.96 sd of the bias) were 0.46 litre min(-1) m(-2) and +/- 1.15 litre min(-1) m(-2) (r = 0.53) resulting in an overall percentage error of 46%. Subgroup analysis revealed a percentage error of 51% for data pairs obtained intraoperatively (T1-T4), 42% in ICU (T5-T8), and 56% for values obtained during low CI (T1-T8). CONCLUSIONS: In cardiac surgery patients, CO measured by a new semi-invasive arterial pressure waveform analysis device showed only moderate agreement with intermittent pulmonary artery thermodilution measurement.

Adult↗
PubMed2006

Clinical outcomes and direct hospital costs of reduced-intensity allogeneic transplantation in chronic myeloid leukemia.

A reduced-intensity conditioning allogeneic stem cell transplantation was given to 19 patients (aged 15-59 years) in the first chronic phase and one patient in the accelerated phase with chronic myeloid leukemia (CML) after a regimen consisting of fludarabine (Flu), busulfan (Bu) and ATG Fresenius. The median follow-up was 27 months. Until day +100, no transplant-related mortality was recorded. The incidence of acute and chronic graft-versus-host disease (GvHD) was 55 and 75%, respectively. Two patients (10%) died from GvHD. Fourteen (70%) patients achieved molecular remission. Additional post-transplant intervention (donor lymphocyte infusion, imatinib) was necessary, however, in 10 patients (50% of the patients; non-achievement of stable molecular remission or later relapses). The total direct cost of the transplantation treatment for all of the patients came to 1,572,880 euro. If the patients had been treated with imatinib and followed-up with the same time period as they were following a transplantation, the direct cost of the imatinib treatment would have been 2,005,117 euro. The transplantation treatment appears to be less expensive after approximately 2 years of follow-up. Flu+Bu+ATG is a low-toxicity regimen for patients with CML. However, a close follow-up is necessary and about 50% of the patients require further therapeutic intervention.

Adolescent↗
PubMed2006

Resolution of sirolimus-induced pneumonitis after conversion to everolimus.

BACKGROUND: Sirolimus-induced pneumonitis usually requires the complete cessation of sirolimus. Herein we have reported five cases of recovery from sirolimus pneumonitis after conversion from sirolimus to everolimus. PATIENTS: All five cases were comparable with regard to their clinical conditions. The ages were between 46 and 64 years. They had received kidney transplants 3 to 18 years earlier. In four cases, the reason for sirolimus therapy was toxicity due to calcineurin inhibitors on a transplant biopsy; three of the patients also displayed malignant tumors: renal cell carcinoma, spinocellular carcinoma, or melanoma. Their serum creatinine levels were elevated between 150 and 350 micromol/L. In all five cases, bronchoscopy disclosed lymphocytic pneumonitis and bronchiolitis obliterans. The immunosuppressive co-medications were prednisolone in three, azathioprine in one, and mycophenolate mofetil in four cases. The previous sirolimus dose was 1 to 4 mg/day, with sirolimus trough levels between 5 and 12 ng/mL. The patients were switched to everolimus at doses between 1 x 0.25 and 2 x 0.75 mg/day to achieve trough concentrations between 3 and 8 ng/mL. Pulmonary symptoms and radiological findings resolved completely within 1 to 4 weeks. CONCLUSION: Everolimus is more hydrophilic by virtue of differing from sirolimus by one hydroxyl group. Sirolimus-induced pneumonitis improved after conversion to everolimus.

Aged↗
PubMed2006

Ultrasonically implanted PLA suture anchors are stable in osteopenic bone.

We compared the in vitro pullout strengths of a metallic screw-type suture anchor (5-mm Corkscrew) and a new ultrasonically implanted absorbable pin from cadaveric humeral heads with different bone densities. They were assessed quantitatively using microcomputed tomography. Pullout tests were done at four standardized sites and then correlated with the local bone density. The mean pullout strengths for the 5-mm Corkscrew and the 3.5-mm polylactic pin were similar in weak bone (76 +/- 24 N versus 104 +/- 46 N), intermediate quality bone (194 +/- 81 N versus 218 +/- 76 N), and strong bone (349 +/- 127 N versus 325 +/- 100 N). Pullout strength correlated with bone density for both implants (r = 0.76 and r = 0.86 for the Corkscrew and polylactic pin, respectively). The ultrasonically implanted absorbable 3.5-mm polylactic pin achieved equal pullout strength in weak bone as the larger 5-mm titanium Corkscrew. Bone density is highly variable in humeral heads and influenced the pullout strength of both implants.

Absorbable Implants↗
PubMed2006

Clinical approach to renal neoplasia in budgerigars (Melopsittacus undulatus).

Renal neoplasia in budgerigars (Melopsittacus undulatus) is seen regularly in general practice and is of interest to many practicing veterinary surgeons. This review article provides an overview of the current knowledge and the most recent reports in avian literature regarding renal tumours in budgerigars, with the emphasis on clinical diagnosis and treatment. The high prevalence of renal neoplasia in budgerigar is discussed, with notes on the most commonly diagnosed tumours, possibility of metastases, sex and age predisposition. The possibility of ultrasonography and radiography in the diagnosis of this pathological condition are compared as well as the possible role of blood and urine analyses. Two studies are described, both of which investigate the possible involvement of a retrovirus as the aetiological agent.

Animals↗
PubMed2006

[Effect of high-dose chemotherapy with subsequent transplantation of blood-forming cells on left ventricle function in patients with malignant lymphomas treated with doxorubicin in primary chemotherapy].

PURPOSE OF STUDY: The authors examined whether high-dose chemotherapy with hematogenic tissue transplantation might negatively affect function of left ventricle (LV) in oncology patients with malignant lymphomas initially treated with conventional chemotherapy consisting of doxorubicin (DOX) in contrast to patients treated without the transplantation in medium-term follow up. PATIENTS AND METHODOLOGY: The follow up group included 77 patients (39 women/38 men) at the age of 36 +/- 15 (median 30, 16-67 years). All 77 patients were treated with initial chemotherapy with DOX, 22 out of that group later received high-dose chemotherapy with hematogenic tissue transplantation (HTT). 16 (73 %) patients of this subgroup underwent autologous transplantation and 5 (23 %) allogeneic transplantation. One female patient (4 %) underwent both autologous and allogeneic transplantation. The follow up period after completion of initial chemotherapy was 5-10 years (median 6 years). The patients were examined with rest echocardiography before start, after chemotherapy, and during follow-up examination. Spiroergometric test (SET) was only performed at the follow-up examination. RESULTS: Both subgroups showed significant decrease of ejection fraction (EF) after chemotherapy, with further decrease in the control examination period, without mutual difference. While the HTT (HTT+) group showed no EF drop below 50 %, in the non-HTT (HTT-) group EF dropped in two (4 %) patients after chemotherapy and in four (8%) patients at the control examination. Progressing decrease of EF > 10 % was reported with 25 % of the HTT- patients (p < 0.05), but with just 13 % of the HTT+ patients (non-significant). The diastolic insufficiency (DF) was present identically in both groups with 36 % of the patients, which represents a statistically significant increase in comparison to the pre-chemotherapy condition. SET did not show any differences in burden toleration and circulation indicators between the two groups. The drop of pVO2 < 20 ml/kg/min occurred with 22 patients of both groups. Linear regression data analysis revealed existence of a significant relationship between EF change, some diastolic function indicators, pVO2 and cumulative dose of DOX (p < 0.05). The current age significantly and negatively correlated with pVO2 (p < 0.001) and DF indicators (p < 0.001). The follow up period inversely correlates with the changes of EF (p < 0.05) and pVO2 (p < 0.05), not correlating with diastolic function indicators. Multi-variant analysis did not confirm any higher risk of administration of high-dose chemotherapy with HTT for significant drop of EF or its drop down to the pathological zone below 50 % (OR = 0.46; non-significant), for discovery of reduced cardio-pulmonary performance (pVO2 < 20 ml/kg/min) (OR = 0.35; non-significant) or for development of diastolic dysfunction (OR = 1.0; non-significant). CONCLUSIONS: Treatment with high-dose chemotherapy with HTT application within medium-term follow up does not result in any significant systolic or diastolic malfunction of myocardium and deterioration of cardiopulmonary performance in comparison to patients not undergoing this therapy. Treatment with cardiotoxic doxorubicin administered in the context of basic conventional chemotherapy is most likely to be responsible for occurrence of the pathological effects across the followed up group. Length of monitoring is a significant factor correlating with changed ejection fraction. This finding justifies the need for long-term prospective monitoring of ejection fraction of the left ventricle in adult patients treated with cardiotoxic chemotherapy.

Adolescent↗
PubMed2006

[Density expression of the CD20 antigen on population of tumor cells in patients with chronic B-lymphocyte lymphoproliferative diseases].

BACKGROUND: Rituximab is being used successfully in the treatment of patients with chronic B-cell lymphoproliferative diseases. The success of treatment by rituximab is influenced, among other factors, by the antigen density on tumor cells. Therefore, the authors analyzed and compared the densities of the CD20 antigen in patients with chronic lymphoproliferative diseases. METHODS AND RESULTS: Previously untreated patients with B-chronic lymphocytic leukemia (B-CLL), mantle-cell lymphoma (MCL), and small-cell lymphocytic lymphoma (SCLL) were evaluated by flow cytometry. The control group consisted of blood donors. The CD20 density was measured on tumor cell populations in patients and on the B-lymphocytes of the control group. The density was expressed in MESE In the patients with B-CLL and SCLL, the CD20 density was low (25,300 vs. 36,100 MESF) and it was significantly lower than in donors (172,800 MESF; p<0.001). The difference between B-CLL and SCLL patients was not statistically significant. The density in MCL patients (196,300 MESF) was comparable to that of donors. CONCLUSIONS: We did not prove statistical different density of CD20 antigen in patients with SCLL when compared with B-CLL patients. High density in MCL patients may be helpful in differential diagnosis against B-CLL and

Aged↗
PubMed2006

[Molecular genetic characterization of chronic lymphocytic leukemia aggressivity in Czech patients: a nucleotide variability of genes coding for heavy chain of immunoglobulin].

BACKGROUND: Chronic lymphocytic leukemia is a heterogeneous disease manifesting with a variable clinical course. It is evident from many studies, that the division into two main prognostic categories is possible on the basis of mutation status of the immunoglobulin heavy-chain gene. The objective of our work was to identify a presence or absence of IgVH gene mutations in B-CLL patients which are monitored or treated on hematological clinics and to determine the presence of individual D and J, subgenes in malignant population of B-cells. METHODS AND RESULTS: A nucleotide sequence of IgVH gene of neoplastic cells was analyzed by appropriate molecular-genetic methods. RNA/cDNA was collected from 358 patients and a spectrum of individual subgenes translocations was identified. Our results show that 56.3% of patients manifested an unmutated variable (VH) segment. It is expected from the published data that this group of patients will suffer from aggressive course of the disease and will exhibit a substantially shorter survival in comparison to patients possessing somatic hypermutations. An expanded population of leukemic B-cells showed increased occurrence of clones whose variable segments belong to three different families. VH3 alleles are the ones most frequently used. A frequency of unmutated alleles is prominently shifted into families with V I homology. The preferred "diversity and joining" segments are D3, D2 and JH 4 and JH 6. CONCLUSIONS: The analysis of heavy chain immunoglobulin gene after recombinant VH-D-J11 segments translocation belongs to a standard hematooncological investigation. The results are an important prognostic criterion for prediction of expected disease aggressivity and for a minimal residual disease monitoring.

Base Sequence↗
PubMed2005

Characterization of bacterial community structure in rhizosphere soil of grain legumes.

Molecular techniques were used to characterize bacterial community structure, diversity (16S rDNA), and activity (16S rRNA) in rhizospheres of three grain legumes: faba beans (Vicia faba L., cv. Scirocco), peas (Pisum sativum L., cv. Duel) and white lupin (Lupinus albus L., cv. Amiga). All plants were grown in the same soil under controlled conditions in a greenhouse and sampled after fruiting. Amplified 16S rDNA and rRNA products (using universal bacterial primers) were resolved by denaturing gradient gel electrophoresis (DGGE). Distinct profiles were observed for the three legumes with most of the bands derived from RNA being a subset of those derived from DNA. Comparing the total bacterial profiles with actinomycete-specific ones (using actinomycete-specific primers) highlighted the dominance of this group in the three rhizospheres. 16S PCR and RT-PCR products were cloned to construct libraries and 100 clones from each library were sequenced. Actinomycetes and proteobacteria dominated the clone libraries with differences in the groups of proteobacteria. Absence of beta-subdivision members in pea and gamma-subdivision members of proteobacteria in faba bean rhizosphere was observed. Plant-dependent rhizosphere effects were evident from significant differences in the bacterial community structure of the legume rhizospheres under study. The study gives a detailed picture of both residing and "active" bacterial community in the three rhizospheres. The high abundance of actinomycetes in the rhizospheres of mature legumes indicates their possible role in soil enrichment after the legumes are plowed into the soil as biofertilizers.

DNA, Bacterial↗
PubMed2005

Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients.

Autologous stem cell transplantation (ASCT) has an established role in the treatment of symptomatic multiple myeloma (MM). Our aim was to analyse the impact of selected prognostic parameters on the survival of patients with MM after ASCT. The new International Staging System (ISS) was also evaluated. A total of 133 MM patients were transplanted in our centre between 1995 and 2002. Following ASCT, 35% of patients were in complete remission (CR) and 60% were in partial remission (PR). The median progression-free (PFS) and overall (OS) survival from transplantation were 29.5 and 68.8 months, respectively. Transplant-related mortality (TRM) was 3%. On multivariate analysis, factors associated with significantly shorter OS were lack of CR after transplant (P = 0.002, hazard ratio (HR): 3.1), stage 3 according to ISS (P = 0.001, HR: 3.0) and age at transplant over 60 years (P = 0.035, HR: 2.0). The status of disease before ASCT did not significantly affect PFS and OS after transplantation. We conclude that ASCT is a safe and effective procedure in MM patients, associated with low TRM. The survival after ASCT was dependent on response after ASCT, stage according to ISS and age.

Adult↗
PubMed2005

Pulse cyclophosphamide for corticosteroid-refractory graft-versus-host disease.

Corticosteroid-resistant GVHD is difficult to manage and is associated with high morbidity and mortality. Cyclophosphamide (Cy) is an established immunosuppressive and cytotoxic drug widely used as part of pretransplant conditioning regimens. In a retrospective study of 15 patients who had not responded to corticosteroids (nine with acute GVHD, three with GVHD after donor leukocyte infusion, and three progressive chronic GVHD), pulse Cy at a median dose of 1 g/m(2) was very effective in the treatment of skin (100% response), liver (70% response), and the oral cavity (100% response). Severe intestinal GVHD responded poorly. The toxicity profile was acceptable, with manageable, short-term myelosuppression in some patients. The risk of opportunistic infections, mixed chimerism, relapses, or post-transplant lymphoproliferative disease was not increased. Overall survival was 57%, with median and maximum follow-up of 9 and 37 months, respectively. The cost of the drug was negligible, especially when compared to monoclonal antibodies. Pulse Cy requires further investigation in corticosteroid-resistant GVHD.

Adolescent↗
PubMed2005

Human endogenous retroviruses in the primate lineage and their influence on host genomes.

Primates emerged about 60 million years ago. Since that time various primate-targeting retroviruses have integrated in the germ line of primate species, and some drifted to fixation. After germ line fixation, continued activity of proviruses resulted in intragenomic spread of so-called endogenous retroviruses (ERVs). Variant ERVs emerged, amplified in the genome and profoundly altered genome structures and potentially functionality. Importantly, ERVs are genome modifiers of exogenous origin. The human genome contains about 8% of sequences of retroviral origin. The human ERVs (HERVs) comprise many distinct families that amplified to copy numbers of up to several thousand. We review here the evolution of several well-characterized HERV families in the human lineage since initial germ line fixation. It is apparent that endogenous retroviruses profoundly affected the genomes of species in the evolutionary lineage leading to Homo sapiens.

Animals↗
PubMed2005

[A modern method for differential gene expression analysis and its significance for cancer diagnostics and therapy].

Contemporary approaches to diagnostics and therapy in oncology are nowadays tightly coupled to novel findings of biomedical science. One of the main trends in molecular medicine is the development of methodologies enabling parallel monitoring of expression of large quantities of genes or proteins--so called functional genomics and proteomics. These techniques allow determination of differential gene expression, i.e. evaluation of differences in gene expression between two or more cell or tissue samples of different types (e.g. normal or cancer cells) or coming from different culture conditions. These approaches help in elucidating causes of malignant transformation and can serve as a base for development of targeted anticancer gene therapy, monitoring of patient response to treatment and prediction of further disease development. Genomic approaches have undergone rapid development in the last few years--from differential and subtractive hybridisation through differential display all the way to serial analysis of gene expression and DNA microarrays. Besides that, tissue and protein arrays and other proteomic approaches have been also used. Currently DNA microarrays covering expression of the whole human genome, having significant potential in oncological research and clinical praxis, have been used more and more frequently. Many new tumor growth and progression markers were found using such approaches. Some of these markers have been already successfully used in clinical practice (e.g. in breast cancer) for therapy optimisation and minimisation of patient discomfort.

Gene Expression Profiling↗
PubMed2005

Significance of qualitative PCR detection method for preemptive therapy of cytomegalovirus infection in patients after allogeneic hematopoietic stem cell transplantation -- single-centre experience.

Both early cytomegalovirus (CMV) monitoring and prophylactic antiviral therapy can decrease clinical complications or can prevent them in patients after allogeneic hematopoietic stem cell transplantation (HSCT). Presented paper summarizes experiences with using regular monitoring of reactivation of CMV after allogeneic HSCT by qualitative polymerase chain reaction (PCR) method to prevent the development of symptomatic CMV disease. Samples of peripheral blood leukocytes (PBL) in 71 patients were monitored. Because of retransplantation in two patients, 73 transplantations, each followed by the monitoring, were performed. Patients were monitored weekly after the transplantation for CMV DNA-emia in PBL. An episode of CMV infection representing an indication for preemptive ganciclovir (GCV) or foscarnet (FOS) therapy was defined as two consecutive positive PCR results in 4-7 days. Median time of monitoring was 313 days. The CMV infection was found in 28/73 monitorings (38.4%) and always was followed by preemptive therapy. One recurrence of CMV infection was observed in 4/28 (14.3%) monitorings and two recurrences in 1/28 (3.6%) monitorings. Presented approach resulted in complete prevention of overt CMV disease and this study enable to show that qualitative PCR method for determination of incipient CMV infection followed by preemptive therapy is suitable for preventing patients after allogeneic transplantation from CMV disease.

Adult↗
PubMed2005

Acute myeloid leukemia treatment in patients over 60 years of age. Comparison of symptomatic, palliative, and aggressive therapy.

State-of-art of aggressive treatment of acute myeloid leukemia (AML) in patients older than 60 years is one of the least satisfactory topics of present-day hematology. This fact led us to ask the following questions: Does it make sense to administer aggressive treatment to older patients with AML? Could it be that we only complicate the rest of the life of these older patients with AML, by using aggressive treatment? Would they not benefit more from palliative or symptomatic therapy? What is the quality of life of older patients with AML like? Therefore, to try to answer these questions, we performed the next analysis. A retrospective analysis was performed including (without any selection) all consecutive patients over 60 years of age who were treated with AML in our centre from 1998 till 2003. We have analyzed data from 137 elderly patients who were diagnosed with AML (excluding acute promyelocytic leukemia). Median survival from diagnosis in the aggressive (curative) therapy group was 4 months, in palliative therapy group 2 months and in symptomatic therapy group 0.8 months. Patients receiving curative therapy spent in a hospital (in-patient stay) 70% (median) of their life after diagnosis of AML, patients receiving palliative treatment 64% (median) of their life after diagnosis, and patients receiving symptomatic treatment 100% (median), respectively. Only marginal advantage in the median overall survival is observed in the group of aggressively treated patients.

Acute Disease↗