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Biomedical subjects

K Gebauer

Publications and source records attributed to K Gebauer.

At least 19 recordsLinked to original sources
PubMed2006

Tacrolimus ointment does not affect the immediate response to vaccination, the generation of immune memory, or humoral and cell-mediated immunity in children.

BACKGROUND: Concern exists that the prolonged application of immunomodulators to treat atopic dermatitis may cause systemic immunosuppression. AIMS: In a 7-month, multicentre, randomised, controlled trial, we investigated the equivalence of response to vaccination against meningococcal serogroup C disease with a protein-conjugate vaccine in children (2-11 years) with moderate to severe atopic dermatitis, by applying either 0.03% tacrolimus ointment (TAC-O; n = 121[corrected]) or a hydrocortisone ointment regimen (HC-O; n = 111). METHODS: TAC-O was applied twice daily (bid) for 3 weeks, and thereafter daily until clearance. 1% hydrocortisone acetate (HA) for head/neck and 0.1% hydrocortisone butyrate ointment for trunk/limbs was applied bid for 2 weeks; thereafter HA was applied bid to all affected areas. At week 1, patients were vaccinated with protein-conjugate vaccine against meningococcal serogroup C, and challenged at month 6 with low dose meningococcal polysaccharide vaccine. The control group (44 non-atopic dermatitis children) received the primary vaccination and challenge dose. Assessments were made at baseline, weeks 1 and 5, and months 6 and 7. The primary end point was the percentage of patients with a serum bactericidal antibody (SBA) titre > or = 8 at the week 5 visit. RESULTS: The response rate (patients with SBA titre > or = 8) was 97.5% (confidence interval (CI) approximately 97.3 to 100), 99.1% (94.8 to 100) and 97.7% (93.3 to 100) in the TAC-O, HC-O and control groups, respectively. CONCLUSIONS: The immune response to vaccination against meningococcal serogroup C in children with atopic dermatitis applying either 0.03% TAC-O or HC is equivalent. Ointment application does not affect the immediate response to vaccination, generation of immune memory or humoral and cell-mediated immunity.

Administration, Topical↗
PubMed2005

Photodynamic therapy with topical methyl aminolaevulinate for 'difficult-to-treat' basal cell carcinoma.

BACKGROUND: Basal cell carcinoma (BCC) may be difficult to treat by conventional means, particularly if the lesions are large or located in the mid-face (H-zone). Photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL) may be a good noninvasive option for these patients. OBJECTIVES: To investigate the efficacy and safety of PDT using MAL for BCCs defined as 'difficult to treat', i.e. large lesions, in the H-zone, or in patients at high risk of surgical complications. METHODS: This was a prospective, multicentre, noncomparative study. Patients were assessed 3, 12 and 24 months after the last PDT treatment. One hundred and two patients with 'difficult-to-treat' BCC were treated with MAL PDT, using 160 mg g(-1) cream and 75 J cm(-2) red light (570-670 nm), after lesion preparation and 3 h of cream exposure. Results Ninety-five patients with 148 lesions were included in the per protocol analysis. The histologically confirmed lesion complete response rate at 3 months was 89% (131 of 148). At 12 months, 10 lesions had reappeared, and therefore the cumulative treatment failure rate was 18% (27 of 148). At 24 months, an additional nine lesions had reappeared, resulting in a cumulative treatment failure rate of 24% (36 of 148). The estimated sustained lesion complete response rate (assessed using a time-to-event approach) was 90% at 3 months, 84% at 12 months and 78% at 24 months. Overall cosmetic outcome was judged as excellent or good in 79% and 84% of the patients at 12 and 24 months, respectively. Follow-up is continuing for up to 5 years. CONCLUSIONS: MAL PDT is an attractive option for 'difficult-to-treat' BCC. Because of the excellent cosmetic results, the treatment is particularly well suited for lesions that would otherwise require extensive surgical procedures.

Administration, Topical↗
PubMed2001

Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: results of a multicenter 6-week dose-response trial.

BACKGROUND: Superficial basal cell carcinoma (sBCC) is an increasingly common tumor in fair-skinned populations throughout the world. Imiquimod, an immune response modifier that induces cytokines including interferons, has been shown in preliminary studies to have an effect when applied topically to BCC. OBJECTIVE: We conducted a multicenter, randomized, open-label dose-response trial of imiquimod 5% cream in the treatment of primary sBCC assessing efficacy and safety of different dose regimens. METHODS: Ninety-nine patients were randomized to 6 weeks' application of imiquimod in 1 of 4 treatment regimens: twice every day, once every day, twice daily 3 times/week, once daily 3 times/week. The treatment site was excised and examined histologically 6 weeks after cessation of imiquimod. RESULTS: Intention-to-treat analysis revealed 100% (3/3) histologic clearance in the twice-daily regimen, 87.9% (29/33) clearance in the once every day regimen, 73.3% (22/30) clearance in the twice-daily 3 times/week regimen, and 69.7% (23/33) clearance in the once-daily 3 times/week regimen. Dose-related inflammatory skin reactions at the site of application were common. The majority were well tolerated and only 1 patient withdrew from the trial as a result of a medication-related skin reaction. CONCLUSION: Imiquimod 5% cream appears to have potential as a patient-administered treatment option in sBCC.

Administration, Topical↗
PubMed1998

Technetium-99m-sestamibi scintimammography for the detection of breast carcinoma: comparison between planar and SPECT imaging.

UNLABELLED: The purpose of our study was to compare the results of planar and SPECT scintimammography for the detection of breast carcinoma. In addition, our goal was to determine whether SPECT reconstructed with filtered backprojection (FBP) or with iterative algorithms (ISA) can improve the sensitivity and specificity of planar scintimammography (SMM). METHODS: One hundred thirteen patients with suspicious physical examinations and/or mammography underwent planar lateral and anterior breast imaging as well as SPECT imaging after injection of 99mTc-sestamibi. We used a blind evaluation, both separately and combined, for planar SMM, ISA-SPECT and FBP-SPECT. Scintigraphic findings were correlated with the final histopathological diagnoses. RESULTS: The sensitivity of planar SMM was 80% with a specificity of 83%. All ISA-SPECT studies were of diagnostic quality, while FBP-SPECT was considered nondiagnostic in 14 that were excluded for statistical calculation. Sensitivity of ISA-SPECT and FBP-SPECT were 71% and 69%, respectively. Specificity was 70% for ISA-SPECT and 66% for FBP-SPECT. Combined planar SMM plus ISA-SPECT sensitivity was 85% (81% for planar SMM plus FBP-SPECT) with a specificity of 72%. Three carcinomas indeterminate on planar SMM were correctly identified by combined planar SMM plus ISA-SPECT. ISA-SPECT and FBP-SPECT provided additional information to planar SMM with respect to localization of sestamibi uptake, tumor extent, improved diagnostic certainty and detection of axillary nodes in 40 and 14 patients, respectively. CONCLUSION: ISA reconstruction is the preferable approach to SPECT data. Combined with planar SMM, ISA-SPECT can improve sensitivity. SPECT is useful in cases of indeterminate and positive planar SMM.

Algorithms↗
PubMed1997

[Management of violent acts within the scope of a pedagogic concept of self and social development--or: talking with school children about violence].

In order to deal with physical aggression in schools it is necessary to develop an educational concept in which the teachers parallel to their observations of the subject orientated learn-track include the relationship- and the self-development-track (three-track-education). In this concept of classifying dialogs which follow the conflict situations have equal importance to other events during school-lessons. The dialogs take place parallel to the lessons. This method requires a flexible organisation of the lessons in which the pupils are used to work on their own. An extension of the teachers competence is necessary. The extension of competence is related to a close observation of social events and to a development of models to explain the problematic behavior of pupils. If it becomes possible for example to interpret part of the pupils' behavior as scenic acting this new point of view may lead to new solutions. The educational concept is orientated on a model of psychoanalytical explanation in which the current situation stands in the foreground. The problem which thus becomes apparent can be now be handled by reconstructing the exterior events (interactions) and by the symbolic presentation of the interior perception (annoyance, anger, rage). Thus the pupils learn to deal with their inner turbulences in the constructive manner. For the acting in the public forms of making amends are practised. Physical aweness and fitness is seen as an important base for self- and social processes. The work of a man within a boys' group and of a woman within a girls' group offers the possibility of sexual identity.

Adolescent↗
PubMed1996

[The effect of midazolam after intranasal administration on spontaneous respiration and respiratory control in young children].

AIM: The aim of this study was to investigate the influence of intranasally administered midazolam in different doses on spontaneous respiration in children. METHODS: 40 children received in randomised order 0.2, 0.4 or 0.6 mg/kg b.w. midazolam intranasally or NaCl 0.9% as control. 10 minutes later, anaesthesia was induced by inhalation of halothane, nitrous oxide and oxygen. The children were breathing spontaneously at a PEEP of 5 cm H2O on a circle system with a fresh gas flow of 61/min (FIO2 = 0.33). Intubation was performed in deep anaesthesia without muscle relaxant. Halothane concentration was reduced to an endtidal concentration of 0.4 Vol%. With a baby pneumotachograph, minute ventilation, tidal volume, peak inspiratory and expiratory flow and respiratory rate were recorded during quiet breathing. Endtidal pCO2 was measured. Ventilation was then stimulated with 0.2 and 0.41/min CO2 and the same parameters were recorded. Regression analysis was performed for minute ventilation and endtidal pCO2 to obtain the slope which is a parameter for the sensitivity of the chemoreceptor mediated control of ventilation. RESULTS: The tidal volume and peak inspiratory flow were significantly reduced for a dose of 0.6 mg/kg compared to the control group. No statistical difference could be found for any other parameter between the control and study groups. CONCLUSION: We conclude that nasally administered midazolam reduces tidal volume and inspiratory peak flow in spontaneously breathing children at a dose of 0.6 mg/kg b.w. compared to control during halothane--nitrous oxide--oxygen anaesthesia. The CO2 mediated control of respiration under this condition is preserved.

Administration, Intranasal↗
PubMed1996

[Diagnostic approach to von Willebrand's disease in childhood].

Von Willebrand's disease seems to be the most common hereditary bleeding disorder in children. Every form of this disease is based on quantitative or qualitative disorder of von Willebrand's factor influencing adhesion of thrombocytes (primary hemostasis) and stabilization FVIII:C in circulation (secondary hemostasis). We present contemporary knowledge on epidemiologic investigations, molecular biology, classification and rational diagnostic approach to von Willebrand's disease in children. We also report on evaluating laboratory tests' reliability in 51 examined children with von Willebrand's disease. It can be concluded that most laboratory tests are highly specific and significant for diagnosis. Determination of vWF activity has optimal value for establishing laboratory diagnosis of von Willebrand's disease; RIPA and multimer analysis are valuable for subtype classification.

Adolescent↗
PubMed1991

Glycine receptor-mediated fast synaptic inhibition in the brainstem respiratory system.

The involvement of glycinergic neurotransmission in the central regulation of respiration was investigated by administration of specific receptor agonists and antagonists into the 4th cerebral ventricle of the rabbit. Central respiratory activity was assessed by cycle-triggered averaging of phrenic nerve activity (PNA). Glycine reduced the peak amplitude of PNA and increased the duration of the respiratory phases. Conversely, strychnine decreased the duration of both phases, being more effective in expiration. Strychnine converted inspiratory ramp activity to a decrescendo type of pattern, with the highest discharge activity present at the onset of the inspiratory phase. Strychnine induced tonic PNA lasting throughout expiration with a decrescendo type of activity. In many cases strychnine induce apneusis with tonic PNA being at a level of about 2/3 of its maximum value during control. We conclude that glycinergic neurotransmission is important for the maintenance of the respiratory rhythm as well as the generation of normal respiratory pattern. Glycine could be involved in phasic as well as tonic inhibitory neurotransmission within the central respiratory system.

Animals↗
PubMed1991

Sweet's panniculitis.

We report the development of acute, tender, erythematous plaques in a 65 year old female with Myelodysplastic Syndrome transforming to Acute Myeloid Leukaemia. The clinical presentation strongly suggested Sweet's syndrome. Histopathological examination of the plaques showed a normal epidermis, dermal and subcutaneous oedema, and large numbers of polymorphs in the panniculus. The eruption responded quickly to systemic steroids, with recrudescence when steroid dosage was reduced. She remained symptom free when prednisolone dosage was reduced more slowly.

Acute Disease↗
PubMed1991

Cutaneous mercury granuloma.

Mercury poisoning arising from cutaneous mercury deposition is highly unusual. The diagnosis is difficult to make when no history of a penetrating injury is given. We report such a case and discuss investigation and management. Other cutaneous manifestations of mercury exposure are outlined.

Adult↗
PubMed1991

GABAA receptor mediated fast synaptic inhibition in the rabbit brain-stem respiratory system.

The involvement of GABA mediated neurotransmission in the central control of respiration was investigated by administration of the specific GABAA receptor agonist muscimol and the specific GABAA receptor antagonist biculline into the fourth cerebral ventricle of the rabbit. Cycle-triggered averaging of the phrenic nerve activity (PNA) was used to quantify drug-induced changes of the central respiratory pattern. Muscimol reduced the peak amplitude of PNA and increased the duration of the respiratory phases. High amounts of muscimol led to a long-lasting but reversible central apnea. Bicuculline very effectively blocked the effects of externally applied muscimol. Blockade of intrinsically active GABAergic neurotransmission by bicuculline resulted in a multitude of effects. Peak amplitude of PNA increased whereas the duration of both inspiration and expiration decreased. In this respect, effects of bicuculline and muscimol were complementary. Bicuculline reduced the slope of the inspiratory ramp, increased postinspiratory activity and induced an augmenting type of discharge activity in the last part of expiration resulting in a smooth transition between expiration and inspiration. In some cases the respiratory modulation was completely lost and PNA became perfectly tonic. This 'apneustic' type of respiratory pattern could be transformed into rhythmic breathing by increasing the respiratory drive. We conclude that neurotransmission via GABAA receptors is important for the maintenance of respiratory rhythm as well as the generation of normal respiratory pattern.

Animals↗
PubMed1990

Toxic pustuloderma. A drug induced pustulating glandular fever-like syndrome.

A striking cutaneous eruption developed in a fifty-eight year old woman with bipolar affective disorder three weeks after starting carbamazepine therapy. She had an infectious mononucleosis-like systemic illness associated with myriads of cutaneous micropustules, erythroderma and a high eosinophil count. A similar eruption due to carbamazepine has been reported only twice before, but isolated cases ascribed to other medications exist. We believe that this reaction is a specific class of drug eruption best named Toxic Pustuloderma.

Carbamazepine↗