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Biomedical subjects

K Meier

Publications and source records attributed to K Meier.

At least 19 recordsLinked to original sources

[Development and evaluation of a training program in shared decision making for primary care of depressive patients].

Patient surveys show that many patients want broad information about their disease and treatment. Often they are interested to participate in the process of medical decision making, which could be realised with the concept of shared decision making where patient's values and needs are considered to the same extent as the treatment recommendations of evidence-based medicine. In depression care, it has been demonstrated so far that the active involvement of patients contributes to higher motivation for treatment. For enhancing patient's acceptance and motivation to avail themselves of medical treatment, a training program for general practitioners was developed and evaluated. It was the aim of the training to involve depressive patients in medical decision making. The training consists of depression-specific components (e. g. diagnosis, patient information, therapy) and general components (communication and shared decision making). The training was carried out in five sessions within a 6-month period (May to October 2003) embracing 20 h of training. Participants were 20 general practitioners in Southwest Germany. Physician's satisfaction with the training program is high. Especially in the fields of diagnosis and shared decision making the physicians clearly benefited. Transfer of shared decision making into daily routine was assessed as possible by the large majority of the trainees. Application of the training concept to other diseases and evaluation on the basis of daily routine is recommended. The training effects on medical care are presently being assessed in a randomised controlled trial.

Adult↗

[Pseudotumor cerebri in minocyline treatment].

Pseudotumor cerebri or benign intracranial hypertension is a syndrome of raised intracranial pressure without obvious explanation. Most patients are obese women at childbearing age. Symptoms and signs usually include headache, nausea, vomiting, edema of the papilla, visual obscurations and rarely palsy of the nervus abducens. The prognosis is generally good, but progressive visual loss and eventual blindness are major risks. We report the case of a 21-year-old non-obese young woman who developed pseudotumor cerebri while taking minocycline for acne therapy. Identical symptoms occurred upon inadvert rechallenge with minocycline for the second time.

Acne Vulgaris↗

Rescue by birth: defective placental maturation and late fetal mortality.

OBJECTIVE: To estimate the incidence and lethality of placental maturation defect, and to determine the impact of the pattern of placental dysfunction on the risk of recurrent stillbirth or maternal disease in later life. METHODS: Questionnaire and archival analysis of fetal deaths from placental dysfunction at 32-42 weeks (1975-1995 in Zurich), classified as chronic (parenchyma loss) or acute (maturation defect of the terminal chorionic villi). Population survey of 17,415 consecutive unselected singleton placentas (1994-1998 in Berlin). RESULTS: Of the 71 stillbirths, 34 were due to parenchyma loss and 37 to maturation defect. Parenchyma loss predominated in the first pregnancy (73.5% compared with 43.2%; P <.05). The risks of recurrent stillbirth and subsequent childlessness did not differ between the two groups. Eleven percent of mothers whose placenta had maturation defect had diabetes in the index pregnancy; none of the other women in the group developed diabetes over the 5-20-year observation period. In the population survey, incidence of maturation defect was 5.7%, and was associated with fetal death in 2.3% of cases. Normal placentas were associated with fetal death in 0.033%. CONCLUSION: Placental maturation defect can be a cause of fetal hypoxia. Although the risk of stillbirth is 70-fold that of a normal placenta, few affected fetuses actually die. The risk of recurrent stillbirth is tenfold above baseline and occurs mostly after 35 weeks' gestation.

Adult↗

Roquinimex (Linomide) vs placebo in AML after autologous bone marrow transplantation.

Roquinimex, Linomide, a quinoline derivative with pleiotropic immunomodulatory activity, has previously been shown to enhance natural killer (NK) cell number and activity after ABMT in patients with AML. In this study 278 AML patients in remission were randomized to receive Roquinimex 0.2 mg/kg body weight or placebo twice weekly for 2 years following ABMT. Out of 139 patients in each group, 109 Roquinimex patients and 108 placebo patients were in their first CR. Median age at inclusion was 41 years for Roquinimex patients and 39 years for placebo patients. Twelve patients in each group had their marrow purged prior to reinfusion. Relapse and death were study endpoints. Surviving patients were followed for 2.6 to 6. 9 years. The total number of relapses was 60 in the Roquinimex group and 63 in the placebo group (not significant). Leukemia-free and overall survivals were similar in the two groups. Recovery of platelet counts was significantly delayed in the Roquinimex group as compared to placebo. No other significant differences regarding toxicity parameters were recorded. In conclusion, previous findings on NK cells could not be confirmed and the study showed no benefit for Roquinimex over placebo regarding relapse or survival following ABMT for AML in remission.

Adolescent↗

Effect of pyriproxyfen in the blood diet of cat fleas on adult survival, egg viability, and larval development.

The activity of pyriproxyfen in the blood diet was investigated for its efficacy against adult, egg, and larval stages of the cat flea, Ctenocephalides felis (Bouché). Adult fleas were housed in plastic cages and fed treated bovine blood using an artificial membrane system that allows fleas to feed ad libitum through a parafilm membrane. Control fleas received blood without pyriproxyfen. Results showed that ingested pyriproxyfen was relatively nontoxic to adult fleas over a period of 10 d at concentrations as high as 100 ppm. These findings are in sharp contrast to earlier studies that showed that residues of pyriproxyfen on filter paper or dog hair were highly toxic to adult cat fleas at concentrations as low as 12.5 ppm. Fleas obviously fed on blood containing pyriproxyfen because they produced large numbers of eggs. However, none of the eggs hatched. Also, larvae of untreated fleas failed to develop to adults when they were fed fecal blood excreted by pyriproxyfen-treated fleas. The results indicate that although ingested pyriproxyfen was relatively nontoxic to adult fleas, enough chemical was absorbed through the gut wall to cause ovisterilant activity, while the remainder was excreted.

Animals↗

Pectins and xyloglucans exhibit antimutagenic activities against nitroaromatic compounds.

Because a high daily consumption of polysaccharides-containing food is assessed to decrease the risk of cancer of the gastrointestinal system, different types of carbohydrates were investigated for their antimutagenic activity against different standard mutagens. Within the screening pronounced antimutagenic effects were found for xyloglucan and different pectins and pectin-like rhamnogalacturonans against 1-nitropyrene induced mutagenicity. Inhibition rates were dose-dependent and varied between 20 and 50%. Concerning the mode of action a direct interaction of the polymers with the cells is claimed, protecting the organisms from the mutagenic attack.

Anticarcinogenic Agents↗

Using qualitative methods to elicit recall of a critical time period.

The period during and after puberty seems to be important for breast cancer initiation. Because experiences during that time are likely to be influenced by a woman's cultural background, we conducted a pilot study among Hispanic and Caucasian women to elicit their memories of early life events. These data were used to design culture-specific questionnaire modules for the retrospective assessment of peripubertal breast cancer risk factors, using specific strategies to trigger accurate recall. Study subjects were volunteer breast cancer survivors or relatives of survivors. In carrying out this work, we took methods from the social sciences and applied them to a research question in chronic disease epidemiology. We found both qualitative and quantitative differences in recall of peripubertal exposures and experiences between Hispanic and Caucasian subjects. Our preliminary data indicate that in contrast to Caucasian women, Hispanic women consider the church rather than school a touchstone for recalling past events. Under the domain "body development," Hispanic women are more likely to mention menstruation than Caucasian women but less likely to recall changes in body hair and breast development. Caucasian women cited team sports as an important physical activity during the peripubertal period, whereas Hispanic women listed more sedentary games and housework as the main activities. Results of our pilot study support the view that to enhance the validity of retrospective data on peripubertal breast cancer risk factors, it is important to take account of cultural differences. Our experience using qualitative methods to elicit data of this kind in the context of a larger epidemiologic research effort suggests that such innovative approaches are valuable.

Adolescent↗

[Heparin-induced thrombocytopenia with unfractionated heparin. A prospective study of inpatient treatment of internal medicine patients].

AIM: To investigate the influence of unfractionated heparin on heparin-induced thrombocytopenia (HIT) type II. PATIENTS AND METHOD: In 162 patients with internal diseases treated therapeutically of prophylactically with unfractionated heparin (heparin sodium, heparin calcium), we carried out a prospective study to determine the incidence of HIT type I and II. 55.6% of the patients were female (n = 90) with an average age of 76.5 years (range: 25 to 96 years) and 44.4% male (n = 72) with an average age of 67.5 years (range: 17 to 93 years). A platelet count was taken regularly before the start of heparin treatment, on the first day of treatment and then every second day from day 5 to 20. Whenever HIT II was suspected, an HIPA test was performed. RESULT: Type I HIT occurred in 10%, type II in 3% of the cases. Two of the 5 patients with type II developed severe thrombotic complications. CONCLUSION: In view of the high incidence of HIT, regular platelet counts should always be carried out in patients receiving heparin treatment.

Adult↗

[Upper gastrointestinal hemorrhage caused by necrotizing cholecystitis with gallstone perforation into the duodenum].

A 68-year-old woman suffering from severe upper gastrointestinal bleeding underwent an urgent laparotomy. A necrotizing cholecystitis was found. The source of the bleeding was the eroded cystic artery. Perforation of a giant gallstone led to a fistula into the duodenum. The gallstone was removed from the distal jejunum. The patient's postoperative course was uneventful. Later on a choledochal stenosis had to be treated by stenting. One year after the procedure the patient is alive and well.

Aged↗

A statistical survey of dioxin-like compounds in United States beef: a progress report.

The USEPA and the USDA have completed the first statistically designed survey of the occurrence and concentration of CDDs and CDFs in the fat of beef animals raised for human consumption in the United States. Back fat was sampled from 63 carcasses at federally inspected slaughter establishments nationwide. The sample design called for sampling beef animal classes in proportion to national annual slaughter statistics. All samples were analyzed using a modification of EPA method 1613, using isotope dilution, High Resolution GC/MS to determine the rate of occurrence of 2,3,7,8-substituted CDDs/CDFS. The whole weight method detection limits ranged from 0.05 ng kg-1 for TCDD to 3 ng kg-1 for OCDD. The results of this survey showed a mean concentration (reported as I-TEQ, lipid adjusted) in U.S. beef animals of 0.35 ng kg-1 and 0.89 ng kg-1 when either non-detects are treated as 0 value or assigned a value of 1/2 the detection limit, respectively.

Animals↗

Tubular gelatinase A (MMP-2) and its tissue inhibitors in polycystic kidney disease in the Han:SPRD rat.

Thickening of the tubular basement membrane is one of the hallmarks of the polycystic kidney disease (PKD). The present study was conducted to investigate the potential role of the matrix metalloproteinase-2 (MMP-2) and its specific tissue inhibitors (TIMP-1 and TIMP-2) in the accumulation of matrix components in PKD. As a model of PKD, two-month-old heterozygous Han:SPRD rats, which are at an early stage of cystogenesis, were used. MMP-2, but not MMP-9 (gelatinase B) nor MMP-3 (stromelysin) could be detected in proximal tubules of the normal rat kidney. The presence of the inhibitors TIMP-1 and TIMP-2 was confirmed on the mRNA level. In tubules from PKD rats MMP-2 activity was lower (31 +/- 8 vs. 58 +/- 7 U/prep., N = 9, P < 0.05), mRNA of MMP-2 was reduced 4.2 +/- 0.6-fold (N = 4, P < 0.05) and enzyme protein was depressed 3.8 +/- 0.8-fold (N = 4, P < 0.05). By contrast, TIMP-1 mRNA was 9.0 +/- 1.1-fold and TIMP-2 mRNA 3.8 +/- 0.7-fold (N = 4, P < 0.05) elevated over controls. Cyst fluid from homozygous rats contained MMP-2 protein and activity. These findings indicate that tubular MMP-2 activity is reduced in PKD, due to down-regulation of MMP-2, up-regulation of TIMP-1 and TIMP-2, and luminal secretion of the enzyme. It is conceivable that these alterations relate to the enhanced matrix accumulation observed in the evolution of PKD.

Animals↗

Protein restriction influences glomerular matrix turnover and tubular hypertrophy by modulation of renal proteinase activities.

Following renal ablation, there is marked compensatory renal growth, which is associated with alterations in the activities of renal proteinases. In the present study, rats underwent 5/6 nephrectomy (5/6-NX). Sixteen weeks after surgery, glomeruli and tubules were isolated and proteinase activities were determined using fluorogenic peptidyl substrates. Following 5/6-NX, there was considerable compensatory renal growth resulting in a final weight of 1,923 +/- 46 mg for the remnant kidney as compared to 1,402 +/- 63 mg for the left kidney of SHAM animals. This hypertrophic response was associated with lower activities of tubular cysteine proteinases (cathepsin L & B: -43%; cathepsin B: -61%; cathepsin H: -53%). Significantly reduced activities were also observed for glomerular collagenase (20.2 +/- 6.2 vs. 53.4 +/- 5.7 mU/micrograms DNA) and gelatinase (24.1 +/- 5.0 vs. 130.8 +/- 8.4 mU/micrograms DNA) activities. Protein restriction (5 vs. 20% casein) considerably attenuated compensatory renal growth after surgical ablation (790 +/- 45 vs. 1,923 +/- 46 mg) and partially prevented the fall in tubular cathepsin activities. In terms of glomerular enzymes, protein restriction caused a significant increase in the activity of gelatinase from 24.1 +/- 5.0 to 66.7 +/- 9.2 mU/micrograms DNA, while collagenase remained unchanged. From these data, we conclude that compensatory renal growth is strongly influenced by the amount of protein ingested. It appears that this effect is mediated by modulation of renal proteinase activities.

Animals↗

Phorbol ester has different effects on forskolin and beta-adrenergic-stimulated cAMP accumulation in mouse parotid acini.

Phorbol 12-myristate 13-acetate (TPA) augmented the effects of forskolin, and inhibited the effects of isoproterenol on cAMP accumulation in mouse parotid acini. Treatment of intact cells with the phosphodiesterase inhibitor, 3-isobutyl-1-methylxanthine (MIX), blocked TPA inhibition of isoproterenol but not forskolin-stimulated cAMP accumulation. TPA also caused the translocation of protein kinase C (PKC) from cytosol to membrane. Pre-treatment of parotid acini with TPA for 30 min enhanced the forskolin and isoproterenol-stimulated adenylate cyclase activity in isolated parotid membranes. Addition of purified PKC (pPKC) to parotid membranes mimicked the effects of TPA in increasing cAMP synthesis; the effects were blocked in the absence of calcium and phospholipid, and in the presence of the synthetic peptide (PKC 19-36). Purified PKC also mimicked the effects of TPA in augmenting forskolin and isoproterenol-stimulated adenylate cyclase activities in the cell-free system. Data suggest that the differential regulation of forskolin and isoproterenol-stimulated cAMP accumulation by TPA results from modification of enzymes that synthesize and degrade cAMP.

1-Methyl-3-isobutylxanthine↗

Histomorphometric results after late microsurgical nerve grafting of the inferior alveolar nerve of the rabbit.

An experimental study was conducted to evaluate the regenerative potential of the inferior alveolar nerve after nerve transection and microsurgical reconstruction at different intervals. Histomorphometric parameters of regenerating axons were assessed using a computer-assisted image analysis system. A continuous decrease in axon density and a reduction in axon diameter was noted in all groups. The average regeneration rate ranged from 42% to 60%. The results of this study indicate that microsurgical reconstruction of the inferior alveolar nerve is even possible 12 months after nerve transection.

Anastomosis, Surgical↗

[Problems associated with fractures of the visceral cranium involving multiple injuries in children].

The relatively low incidence of facial fractures can be related to certain growth factors. The cranium and forehead are comparatively large, and shield the facial skeleton from injury. Fractures of the mandible occur in greater frequency than those of the middle third of the face. Emphasis is placed on pediatric maxillofacial trauma and the potential of deformity due to growth disorders. Fractures of the visceral cranium are often accompanied by other injuries, especially fractures of the skull and intracranial injuries. Of primary importance is an early assessment of the patient's general condition and concomitant injuries.

Adolescent↗