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Biomedical subjects

K Breuer

Publications and source records attributed to K Breuer.

At least 19 recordsLinked to original sources
PubMed2003

[Epidemiology of food allergies].

Difficulties resulting from diagnosis of food allergies show an impact on the validity of epidemiological data, which are mainly based on questionnaire data or results from allergy tests for evidence of specific IgE antibodies. The frequency of self-reported adverse food reactions in population based studies ranges between 5% and 33% with women reporting a higher frequency of such reactions. Only two epidemiological studies have performed double blind, placebo-controlled oral food challenge tests. Extrapolating these results, the prevalence of food allergies is estimated at 2% within the general population. An epidemiological questionnaire-based study in France reports on 3.5% of the general population suffering from food allergies. According to studies of the Allergy Ward in Zürich, in 46-60% of all cases skin and mucosa are predominantly affected, with oral allergy syndrome and urticaria being the most frequent manifestations. A food allergy is significantly associated with different manifestations of atopy and predominantly to hay fever, atopic eczema, urticaria and asthma.

Allergens↗
PubMed2003

[The impact of food allergy in patients with atopic dermatitis].

Besides other trigger factors food allergens have been shown to play a major role in the exacerbation and maintenance of eczematous lesions in patients with atopic dermatitis (AD), particularly in children. Food allergy may not only present as a flare up up of eczema in these patients, but also immediate type reactions and mixed reactions can be observed under food challenge tests. Whereas cow's milk hen's egg, wheat and soy have been identified as important triggers in infants, pollen related foods like nuts, fruit und vegetable have a greater impact in adolescents and adult Food specific T cells have been identified as effector cells in food responsible eczema and food specific T cell clones could be generated from lesional skin of patients who reacted with a worsening of their AD upon oral challenge tests. Due to the poor reliability of in-vitro (RAST) and skin tests (skin prick test (SPT), atopy patch test (APT)) the double blind placebo controlled food challenge (DBPCFC) is regarded as the gold standard in the diagnostic work-up of food allergy. Once a food allergy has been diagnosed, a specific elimination diet represents the first line therapy, which has to consider the supplementation of essential nutrients.

Adult↗
PubMed2002

Staphylococcus aureus: colonizing features and influence of an antibacterial treatment in adults with atopic dermatitis.

BACKGROUND: The skin of up to 100% of patients with atopic dermatitis (AD) is colonized with Staphylococcus aureus. Of all S. aureus strains isolated from lesional skin, up to 65% have been shown to produce exotoxins with superantigenic properties. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. These studies did not consider the anterior nares as a reservoir of S. aureus, or the possibility of transmission between patients and their contacts. Moreover, adult patients have not so far been investigated. OBJECTIVES: To investigate the colonizing features of S. aureus in adults with AD and in their contacts, and the effect of an antimicrobial treatment of the patients and their partners. METHODS: Swabs were taken from the skin and anterior nares of 66 adults with AD. S. aureus strains were screened for the production of exotoxins in 32 patients. Ten patients (two with toxigenic strains, eight with non-toxigenic strains) were treated orally with cefalexin, chlorhexidine ointment was applied to the skin, and the anterior nares were treated with mupirocin ointment. A bath containing potassium permanganate was taken daily. In addition, their partners were treated topically. RESULTS: Sixty-two of 66 patients (94%) were carriers of S. aureus, and mostly harboured the bacteria on both skin and anterior nares. Ten of 32 (31%) patients were colonized with toxigenic strains. The Severity Scoring in AD (SCORAD) score decreased in nine of 10 patients who received antimicrobial treatment (P < 0.001), and this effect was more pronounced in patients with a baseline SCORAD > 50. CONCLUSIONS: S. aureus may play an important role as an aggravating factor in adults with AD, as antimicrobial treatment leads to a significant improvement of AD in patients who are colonized with the bacterium.

Adult↗
PubMed2002

Hodgkin's disease in the elderly: current status and future directions.

In general, it was agreed that high rates of toxicities during treatment occur in the elderly and that there is a frequent occurrence of early relapse. It is clear that different combinations of effective therapies with lower toxicity are required. It was felt, however, that certainly in the 60-70 year age group, approaches should be vigorous to and the same diagnostic and staging procedures as in younger individuals, but with much closer monitoring of toxicity and response to treatment. It was felt that as part of the approach, liberal support with haemopoeitic growth factors (G-CSF) was necessary to reduce prolonged neutropenia. It is important to understand that age in general is not a contrary indication for aggressive treatment and that biologically younger patients under the age of 65 years, in good physical and mental condition, often should be given with stage-adapted treatment, analogous to conventional treatment protocols for the <60 years age group. It was also considered that, in patients who clearly could not accept conventional treatment, study groups could begin to define the best palliative care for patients with pre-existing organ impairment, and that in all situations of assessment, whether in trial or not, there should be a detailed prospective assessment of quality of life parameters.

Adult↗
PubMed2001

A randomized monocentric trial in febrile neutropenic patients: ceftriaxone and gentamicin vs cefepime and gentamicin.

A prospective, randomized, controlled monocentric trial was performed to evaluate the efficacy and safety of once daily ceftriaxone 2 g plus gentamicin 5 mg/kg in comparison to cefepime 2 g t.i.d. plus gentamicin 5 mg/kg q.d. in the treatment of neutropenic fever. In case of fever (oral temperature > or =38.5 degrees C on one occasion or > or =38.0 degrees C twice within 24 h) and a granulocytopenia (neutrophil count below 500 or below 1000/microl when expected to fall below 500 within 72 h), patients with hematological malignancies or solid tumors were assigned to ceftriaxone or cefepime, each with gentamicin. The primary endpoint was defined as defervescence on day 4-6 followed by at least 7 afebrile days. Secondary endpoints were overall response, defined as defervescence on day 28 and toxicity. Two hundred eleven episodes were included. Fever of unknown origin (FUO) accounted for 124 episodes (58.8%), microbiologically defined infection (MDI) for 39 (18.5%), clinically defined infection (CDI) for 25 (11.8%), and both clinically and microbiologically defined infection (CMDI) for 19 episodes (9%). On an intent-to-treat basis 207 episodes were evaluable for the primary endpoint. Ceftriaxone plus gentamicin and cefepime plus gentamicin were successful in 49.5% and 51%, respectively. Overall response was achieved on study day 28 in 92.5% and 91%, respectively. Diarrhea was more frequent with ceftriaxone/gentamicin (6.5% vs 17%), while nausea/vomiting was less (12.1% vs 5%). Once-daily ceftriaxone plus gentamicin was not inferior to cefepime t.i.d. plus gentamicin q.d. in the empirical treatment of neutropenic fever.

Anti-Bacterial Agents↗
PubMed2001

Non-Hodgkin's lymphoma after primary Hodgkin's disease in the German Hodgkin's Lymphoma Study Group: incidence, treatment, and prognosis.

PURPOSE: The cumulative incidence for non-Hodgkin lymphoma's (NHL) after primary Hodgkin's disease (HD) ranges between 1% and 6%. To investigate the course of disease for secondary NHL, we retrospectively analyzed patients treated within clinical trials of the German Hodgkin's Lymphoma Study Group (GHSG) since 1981. PATIENTS AND METHODS: From 1981 to 1998, the GHSG conducted three generations of clinical trials for the treatment of primary HD involving a total of 5,406 patients. Reference histology by an expert panel was obtained for 4,104 of the patients. Data on incidence, treatment, and outcome of secondary NHL were updated in March 1999. RESULTS: At first diagnosis of HD, the pathologists rejected 114 (2.1%) of 5,520 cases initially diagnosed as HD and rediagnosed them as primary NHL. Fifty-two (0.9%) of the remaining 5,406 patients developed a secondary NHL. One patient was excluded from further analyses because of insufficient documentation. Six patients had no further therapy because of patient refusal (n = 1) or rapidly progressive disease (n = 5). For the remaining 45 patients, overall response rate was 43% (36% complete response and 7% partial response). The actuarial 2-year freedom from treatment failure (FFTF) and overall survival (OS) for all patients was 24% and 30%, respectively, and for patients with diffuse large-cell lymphoma, it was 28% and 35%, respectively. Time of occurrence of secondary NHL after first diagnosis of HD and variables employed in the age-adjusted International Prognostic Factor Index (IPFI) significantly influenced treatment outcome. CONCLUSION: In the GHSG, the incidence of secondary NHL with 0.9% is relatively low compared with previously reported series. The prognosis of secondary NHL seems dismal and is significantly influenced by time of occurrence and the age-adjusted IPFI. In a subset of patients with secondary NHL, long-term disease-free survival could be achieved.

Actuarial Analysis↗
PubMed2001

Male gonadal dysfunction in patients with Hodgkin's disease prior to treatment.

UNLABELLED: Infertility after treatment of patients with Hodgkin's disease (HD) is considered as a side effect of alkylating agent containing chemotherapy regimens. To investigate whether gonadal failure is related primarily to the toxic effect of chemotherapy or rather to the disease itself, we investigated the fertility status before the onset of treatment. PATIENTS AND METHODS: Semen quality and hormonal status were evaluated in 158 patients with first diagnosis of HD enrolled into trials of the German Hodgkin Lymphoma Study Group (GHSG). The median age of the patients was 28 years (range 16-52). Twenty patients (13%) were classified as early stage HD, 63 patients (40%) as intermediate stage, and 75 patients (47%)) as advanced stage according GHSG grading. Sixty-seven patients (42%) showed systemic symptoms. Semen analysis was performed according to WHO guidelines. Follicle-stimulating hormone (FSH) and luteinising hormone (LH) plasma levels were measured by specific double-antibody radio-immune-assay (RIA) methods. RESULTS: Prior to treatment, severe damage of fertility, i.e.. azoospermia and oligoasthenoteratospermia (OAT-syndrome) was found in 13 (8%) and 20 patients (13%), respectively. Thirty-eight patients (24%) had single, i.e., oligo-(O), astheno-(A) or teratospermia-(T), and 40 patients (26%) showed combined damages, i.e., OA, OT or AT. In 47 patients (30%) a normal sperm count was found. Thus, III patients (70%) showed semen abnormalities before the onset of treatment. In a multivariate analysis elevated ESR (P < 0.003) and advanced stage of disease (P < 0.01) could be distinguished as prognostic factors for severe damage of fertility. No correlation was found between pre-therapeutic gonadotropine levels and fertility status. CONCLUSION: Patients with HD have an increased risk for inadequate semen quality even prior to treatment. Infertility is more frequent in patients with elevated ESR and advanced stage of disease. This association demonstrates the predominant influence of the disease on fertility. Assuming HD is the major initial cause for infertility efforts should be made to identify new non-gonadal toxic chemotherapies to be able to regain fertility after effective therapy. Further investigations have to be performed to clarify mechanisms inducing fertility defects in patients with HD.

Adolescent↗
PubMed2001

Urine eosinophil protein X (EPX) is an in vitro parameter of inflammation in atopic dermatitis of the adult age.

BACKGROUND: Eosinophils are important effector cells in several atopic diseases. The levels of eosinophil granule-derived mediators (ECP, EPX) in serum and body fluids have been proven to be correlated with disease activity in atopic respiratory diseases and atopic dermatitis. The study aimed to demonstrate an interrelationship between urine EPX and disease activity in adult patients with atopic dermatitis. METHODS: We determined urine EPX concentration, serum ECP concentration, and peripheral blood eosinophil count in 40 adult patients with mild to severe atopic dermatitis and compared it with the disease activity as assessed with the SCORAD index. RESULTS: Urine EPX and serum ECP concentrations were significantly higher in patients with severe atopic dermatitis than in patients with mild or moderate disease (median values 123.5 vs 78.3 microg/mmol creatinine, P<0.0001; 25.4 vs 14.9 microg/l, P<0.0001, respectively). We found a significant correlation between urine EPX levels, serum ECP levels, and the SCORAD (r=0.36, P<0.0001 and 0.34, P<0.0001, respectively). CONCLUSION: Urine EPX is a useful in vitro parameter of inflammation in atopic dermatitis of the adult age.

Adult↗
PubMed2000

[Long-term toxic sequelae of the treatment of Hodgkin's disease].

In recent years, continuous optimization of therapy has decisively improved the prognosis of Hodgkin's disease. However, this improvement in overall survival has also led to an increase in several possible late effects which the clinician must be aware of. Due to the appearance of chronic fatigue symptoms, cardiopulmonary problems, hypothyreosis and damage to the gonadal system including azoospermia and ovarian insufficiency, the mostly young patients often suffer a persistent reduction in quality of life. In addition, the increased incidence of second malignancies following successful primary treatment presents a considerable problem. While complete remission and prolonged survival were previously the main objectives in the therapy of malignant lymphomas, reduction or avoidance of toxicity is now becoming more and more central. This development has led to the increasing importance of late sequelae and quality of life as endpoints in modern therapy trials in oncology.

Adult↗
PubMed2000

Behavioural response to humans and the productivity of commercial dairy cows.

This study examined the relationships between the attitude and the behaviour of the stockperson towards cows and the behavioural response to humans and the milk production of cows at 31 commercial dairy farms over one lactation. The attitude of the stockperson was measured on the basis of the stockperson's opinion of the cow's behaviour and how the stockperson evaluated his own behaviour. The behaviour of the stockperson was measured by recording the nature and frequency of the tactile interactions and some visual and auditory interactions directed towards the cows. The behavioural response of cows to humans was assessed by observing their approach behaviour to an unfamiliar experimenter in a standard test and production records were collected for the entire lactation at each farm. Correlation and regression analyses using farm averages were used to examine relationships between human and cow variables. Several cow behaviour variables, indicative of fear of humans, were moderately (P<0.05) to highly (P<0.01) correlated with milk yield and composition and regression analysis indicated that fear of humans accounted for 19% of the variation in milk yield between farms. The results suggest that at farms where milk yield was low, cows showed less approach to the experimenter in the standard fear test than at farms where milk yield was higher. A composite attitude score, based on the responses of stockpeople to questions about patting and talking to cows, ease of movement of cows and cows recognising unfamiliar stockpeople, was moderately (P<0.05) to highly (P<0.01) correlated with the behaviour of the stockperson. While a number of stockperson behaviour variables were correlated (P<0.05) with milk yield, the former variables were generally poorly correlated with cow behaviour. Therefore these preliminary findings provide evidence that, as seen in the pig industry, sequential relationships may exist between the attitude and behaviour of the stockperson and the behaviour and productivity of commercial dairy cows. Research is required to further examine these relationships because of the possible implications on cow productivity and welfare.

Journal Article↗
PubMed2000

Is the international prognostic score for advanced stage Hodgkin's disease applicable to early stage patients? German Hodgkin Lymphoma Study Group.

BACKGROUND: The seven-factor International Prognostic Score (IPS) has been developed and verified for patients with advanced stage Hodgkin's disease (HD). This report aims to assess the predictive power of the IPS for early stage HD patients. PATIENTS AND METHODS: Data on patient characteristics, therapy and follow-up were available for 1424 adult patients in clinical stages I-IIIA treated for primary HD in two German Hodgkin's Lymphoma Study Group (GHSG) trials (1988-1994). Patients with risk factors or in stage IIIA received chemo radiotherapy (CMT; trial HD5); others received extended field radiotherapy (RT) alone (HD4). The IPS could be calculated for 712 HD5 and 249 HD4 patients (70%). The prognostic value of the IPS and its component factors was assessed using Cox proportional hazards regression. A search was made for additional factors which could add predictive power to the IPS. RESULTS: The IPS identified 40% of the unfavourable early stage patients with an 8% lower disease-free survival at six years (hazard ratio 1.66, P = 0.0018). The factor 'low albumin' was the only score component giving a significant individual contribution. Allowing for the IPS, extranodal involvement, particularly in stages IIB-IIIA, was associated with worse prognosis, but no further significantly prognostic factors were revealed. The IPS identified a similar hazard ratio in HD4, although here the effect was not significant. CONCLUSIONS: The IPS for advanced HD has modest predictive ability in unfavourable early stage patients. Modification of the IPS for use with early stages may improve its prognostic power.

Adolescent↗
PubMed2000

Severe atopic dermatitis is associated with sensitization to staphylococcal enterotoxin B (SEB).

BACKGROUND: Staphylococcus aureus has been identified as a possible trigger factor in atopic dermatitis (AD). Some 30-60% of S. aureus strains isolated from patients with AD are able to produce exotoxins with superantigenic properties, mostly staphylococcal enterotoxins A, B, C, and D (SEA-D) and toxic shock syndrome toxin-1 (TSST-1). Recently, it was demonstrated that the presence of IgE antibodies to SEA and SEB is correlated with the severity of skin lesions in children with AD. To determine the relevance of staphylococcal enterotoxins in adult patients with AD, we investigated the relationship between the severity of skin lesions and sensitization to SEA and SEB. METHODS: Clinical severity was determined by the SCORAD index. Circulating IgE antibodies to SEA and SEB, serum eosinophil cationic protein (ECP) levels, and urine eosinophil protein X (EPX) levels were measured. RESULTS: The skin condition was significantly worse in patients sensitized to SEB than in unsensitized patients. Serum ECP and urine EPX levels were found to be significantly higher in SEB-sensitized patients, confirming the higher degree of cutaneous inflammation. CONCLUSIONS: Our results demonstrate a relationship between severity of skin lesions and sensitization to SEB in adult patients with AD, but a relationship between disease activity and sensitization to SEA could not be shown.

Adolescent↗
PubMed1999

Prognostic factors for subdiaphragmatic involvement in clinical stage I-II supradiaphragmatic Hodgkin's disease: a retrospective analysis of the GHSG.

BACKGROUND: Staging laparotomy and splenectomy were routinely performed in patients with early-stage Hodgkin's disease (HD) qualifying for radiotherapy alone to determine the exact extent of disease. However, staging laparotomy is associated with a considerable number of side effects, warranting more sophisticated diagnostic procedures and new therapy strategies. We retrospectively analyzed patients undergoing staging laparotomy to identify pretherapy risk factors predicting the probability of abdominal disease and to define high-risk groups that might benefit from staging laparotomy and subsequent stage-adjusted treatment. PATIENTS AND METHODS: Between February 1988 and January 1993, 391 patients with CS I-II supradiaphragmatic Hodgkin's disease underwent staging laparotomy and splenectomy according to the treatment policy of the German Hodgkin's Lymphoma Study Group (GHSG) for early stages of Hodgkin's disease. Univariate and multivariate analysis of pretherapeutic clinical characteristics were performed in an attempt to predict staging laparotomy results and to identify risk groups. RESULTS: Of the 391 patients, 81 (21%) had subdiaphragmatic disease. Eighteen percent were upstaged to PS III and three percent to PS IV. By a multivariate model the following parameters were independent risk factors for positive surgical staging: left cervical involvement (P < 0.001), mediastinal involvement (P < 0.009), Karnofsky performance status (P < 0.004) and histology (P < 0.04). In our analysis gender (P < 0.08) and ESR (P < 0.06), often described as of high prognostic value, was not significant. The presence of systemic symptoms, number of involved areas and clinical stage were not associated with abdominal disease, as described in several former publications. To define high-risk groups, which comprise at least 15% of patients of the cohort and have a risk of subdiaphragmatic involvement of > 35%, combinations of only two or three of the predictive factors were analyzed. With respect to these criteria the following subgroups of patients were identified as having a high risk for subdiaphragmatic disease (> 35%): a) left cervical lymph node involvement and no mediastinal involvement (n = 98, observed risk 36%); b) no mediastinal involvement and MC/LD histology (n = 113, observed risk 40%). CONCLUSIONS: We conclude that initial clinical characteristics are predictive for occult abdominal involvement in early clinical stages of Hodgkin's disease. The impact of these risk factors on future therapeutical strategies have to be evaluated.

Adult↗
PubMed1996

A comparison of body fat estimates using anthropometry and bioelectrical impedance analysis with distinct prediction equations in elderly persons in the Republic of Guatemala.

Bioelectrical impedance analysis (BIA) has been proposed as a technique to estimate body composition. Its application has extended beyond the clinical setting, however, it remains to be determined if the BIA prediction formulas published to date provide comparable body composition estimates in elderly populations. The objective of this study was to compare the estimates of body fat derived from published prediction equations in a developing country's population such as Guatemala. A total of 234 elderly persons were studied (108 males and 126 females), with ages of 78 +/- 7 and 77 +/- 8 (mean +/- SD) yr, respectively. The height and weight averaged 156.4 +/- 7.9 and 144.0 +/- 7.0 cm, and 54.5 +/- 9.4 and 49.4 +/- 10.6 kg, for males and females, respectively. Measurements included skinfolds (triceps, biceps, subscapular, and suprailiac), and body resistance (BIA). Body fat estimates were derived from four BIA-prediction formulas and three equations based on anthropometry. Mean percent body fat estimates for the overall population obtained from anthropometry and BIA prediction formulas ranged from 22 to 50%. Females had higher estimates compared to males without regard for the method used. Highly significant intermethod correlations were seen, but differences in fat estimation among prediction formulas were noticed and the magnitude of the differences were BIA-formula dependent.

Adipose Tissue↗
PubMed1994

[Relationship between plasmatic lipids and fat soluble vitamins in Guatemalan periurban elderly].

The levels of plasmatic lipids and fat liposoluble vitamins were measured in 107 elderlies (29% males, 71% females) who were residents of a poor periurban neighborhood of Guatemala City. The age ranged between 60-103 years (means +/- sd 69 +/- 8). The mean and sd for the plasmatic levels of lipids and vitamins were (ranges in parenthesis): cholesterol 220 +/- 42 mg/dl (128 to 428); triglycerides: 189 +/- 92 mg/dl (54 to 513); retinol 50 +/- 16 ug/dl (4.5 to 103); beta-carotene 17 +/- 12 ug/dl (12 to 60), tocopherol 1.32 +/- 0.36 mg/dl (0.54 to 2.46). A significant correlation was found in both sexes between cholesterol and retinol (r = 0.3, p < 0.05) and cholesterol and tocopherol (r = 0.4, p < 0.05), triglycerides and retinol (r = 0.3, p < 0.05). Cholesterol and beta-carotene was also significant in women (r = 0.5, p < 0.05). The correlation between triglycerides and beta-carotene by gender was not significant.

Aged↗