Biomedical subjects

M Kalder

Publications and source records attributed to M Kalder.

10 recordsLinked to original sources

PubMed2006

Bone mass and the risk of breast cancer: the influence of cumulative exposure to oestrogen and reproductive correlates. Results of the Marburg breast cancer and osteoporosis trial (MABOT).

BACKGROUND: Recent studies suggest an inverse relation between breast cancer and osteoporosis. Oestrogen is important in the pathophysiology of both breast and bone, and although cumulative exposure to oestrogen may explain the link between breast cancer and bone mass, this has never been proved. The Marburg breast cancer and osteoporosis trial (MABOT) aimed to elucidate the relation between breast cancer and bone mass ascertained by ultrasonometry measurement and to investigate whether endogenous and exogenous exposure to oestrogen and reproductive correlates has a role in this association. METHODS: We performed a case-control study including 2492 women (mean age+/-S.D., 54.4+/-10.3 years) in whom diseases and drug treatments known to affect bone metabolism, except for HT, had been excluded. All women underwent ultrasonometry measurement at the heel; 242 of the women had an incident breast cancer without a prior, specific pharmacological breast cancer treatment. The ultrasonometry variables - speed of sound (SOS), broadband ultrasound attenuation (BUA) and the stiffness index (SI) - were calculated and compared in women with and without breast cancer. Because of significant intergroup differences in factors such as age, body mass index and exposure to oestrogen, a multiple linear regression analysis as well as a second analysis of ultrasonometry variables was undertaken using a randomly selected sample of 242 healthy women post-matched with the breast cancer group for possible confounding variables. Odds ratios were used to compare the relation between breast cancer risk and ultrasonometry heel measurements. RESULTS: Women with breast cancer were significantly older, weighed more, had a higher body mass index, were more likely to be parous and to have breast fed, were older at the menopause and had been exposed to oestrogen for longer than control women. In addition, the ultrasonometry variables speed of sound and the stiffness index T- and Z-score were significantly higher in women with breast cancer even after a matched pair analysis was performed (p<0.001). Additionally, results of a multiple linear regression showed that women with breast cancer had a significantly higher SOS (p<0.001), body weight (p<0.05) and duration of breast feeding (p<0.05) while osteoporotic fracture were reduced (p<0.001). When women with breast cancer and their matched controls were finally grouped according to SOS and T-score quartiles, the odds ratios (95% confidence intervals) for breast cancer risk in the second, third and fourth quartiles compared with the lowest quartile were 2.5 (1.4-4.3), 3.1 (1.8-5.3) and 4.7 (2.7-8.2) as well as 1.9 (1.1-3.2), 2.3 (1.3-3.9) and 2.9 (1.7-5.0), respectively. CONCLUSIONS: The ultrasonometry variables speed of sound, stiffness index, T- and Z-score are higher in women with an incident breast cancer than in healthy controls, even after post-matching for possible confounding variables. This association was confirmed in a multiple linear regression model. Women with SOS and T-score values in the higher quartiles have a greater risk of breast cancer than women in the lowest quartile. We found no association between the higher ultrasonometry variables and cancer specific characteristics or reproductive correlates such as age at menarche and menopause or cumulative oestrogen exposure. Although the biological mechanisms linking bone mass and the risk of breast cancer are not fully understood, factors other than reproductive correlates, endogenous and exogenous exposure to oestrogen must play a part.

Adult↗

PubMed2006

Anti-emetic prophylaxis with oral tropisetron and/or dexamethasone.

BACKGROUND: The corticosteroid dexamethasone and the serotonine3 -antagonist tropisetron are both effective drugs for the prophylaxis of post-operative nausea and vomiting (PONV) when given intravenously. The aim of this trial was to evaluate the oral use of both drugs as part of a routine oral premedication and to compare their single and combined effectiveness. MATERIALS AND METHODS: In this randomized, placebo-controlled, double-blind study, 320 inpatients with a moderate-high risk of PONV (> or = 40% according to two validated risk scores) received an oral premedication 1-2 h pre-operatively with placebo, a fixed dose of tropisetron 5 mg, dexamethasone 8 mg, or a combination of both drugs. A standardized general anaesthesia was performed, including benzodiazepine premedication, propofol, rocuronium, desflurane in air/O2, fentanyl or sufentanil followed by a continuous infusion of remifentanil. Post-operative analgesia and anti-emetic rescue medication were standardized. The main outcome measures were the severity of PONV within the first 24 h (rated by a standardized scoring algorithm). The incidence of PONV was used as the secondary outcome. RESULTS: Data from 310 patients were analyzed. The mean severity score in the placebo-, tropisetron-, dexamethasone- and the combined-groups was 1.37, 0.8, 0.8 and 0.38, respectively. The incidence of PONV of any severity was 59.2%, 37.5%, 40% and 22.8%, respectively. The reduction of the incidence and the severity of PONV were statistically significant with all three interventions. Results from additional analyses suggested that both drugs were equally effective and that there was a simple additive effect of tropisetron and dexamethasone compared with placebo. CONCLUSION: Oral tropisetron and dexamethasone were both equally effective in reducing the severity and incidence of post-operative nausea and vomiting. The latter could be reduced by approximately 35% in a population of moderate-high risk for PONV. Both drugs had an additive effect. However, even in the combination group there still remained an unacceptably high incidence of PONV of more than 20%. This highlighted the need for a multimodal anti-emetic approach in high-risk patients and the importance of treatment of PONV.

Administration, Oral↗

PubMed2002

Influence of pregnancy and breast-feeding on quantitative ultrasonometry of bone in postmenopausal women.

OBJECTIVE: Reproductive factors such as parity and breast-feeding may be associated with low bone mass and osteoporotic fractures in later years. In this study, os calcis quantitative ultrasonometry was used to elucidate the relationship between parity, lactation and bone mass in postmenopausal women. DESIGN: This was a comparison study using subsequent matched pairs analysis as well as multiple linear regression analysis. The study was carried out at five centers in Germany. The study included 2,080 postmenopausal women (age (mean +/- SD) 58.8 +/- 8.2 years), who were attending for routine check-up and in whom diseases and drug treatments known to affect bone metabolism had been excluded. METHODS AND OUTCOME MEASURES: Women underwent quantitative ultrasonometry (QUS) measurement at the heel. Values of the ultrasonometry variables -speed of sound, broadband ultrasound attenuation and stiffness index -were calculated and compared for nulliparous and parous women and for women who had and had not breast-fed. Because of some significant intergroup differences, and to determine any effect of the number of live births and the duration of breast-feeding on ultrasonometry results, second analyses were undertaken using equally sized samples, matched for possible confounding variables such as age and body mass index (matched pairs). In these analyses, nulliparous women were compared with parous women, grouped according to number of live births, and women who had never breast-fed were compared with women who had breast-fed, grouped according to duration of breast-feeding. Furthermore, a multiple linear regression analysis was performed to examine the combined effects of reproductive factors on QUS variables. RESULTS: No statistically significant associations were found between ultrasonometry variables and parity or breast-feeding, even after controlling for confounding variables in matched-pairs analysis or in a multiple linear regression analysis.

Adult↗

PubMed2001

[Scientific presentation using modern media].

When showing slides with so called "Blue Prints", it is often difficult to explain complex graphics despite the help of a Laserpointer. The Notebook and Videoprojector aid modern presentations in the step by step development of complex graphics. The audience's eyes are directly guided towards the projected image; the attention of the audience is more easily won and held through animation and moving pictures. The central messages of a scientific work can be more simply and clearly conveyed. This method also allows an up-dating of the picture contents at short notice, which is not possible with the common slide. Considering these advantages, modern media should be promoted within the framework of conferences, seminars and further education courses despite the need of greater technical and material equipment.

Attention↗

PubMed1996

[Severe HELLP syndrome with temporary kidney and lung failure].

This report is on a severe case fo a HELLP-syndrome (H haemolysis, EL elevated liver enzymes, and LP low platelets). A 32-year old gravida developed severe preeclampsia with epigastric pain at 33 weeks' gestation. During a few hours post partum she showed disseminated intravascular coagulation (DIC) and required intensive care. The severe HELLP-syndrome was combined with a fast increasing acute respiratory distress syndrome (ARDS) and acute oligo-anuric renal failure. She was treated in the intensive-care unit for several days with artificial respiration, 10 acute haemodialyses, 4 plasma exchanges with fresh-frozen plasma and many blood and platelet transfusions. An early Caesarean section and treatment in the intensive care unit managed to turn the otherwise complicated progression of the disease. It is pointed out that plasma exchange with fresh-frozen plasma is a rarely employed treatment.

Acute Kidney Injury↗

PubMed1996

[Prognostic value of Doppler flow measurement of the middle cerebral artery for morbidity of premature infants with null or negative flow in umbilical arteries].

We analysed 78 fetuses with absent or reverse endiastolic flow velocities (AREDFV) of the umbilical arteries with respect to fetal acidosis, resistance index of the middle cerebral artery (MCA) and abnormal neurological evaluations. A control group was matched for gestational age and normal umbilical artery flow velocity waveforms. Fetuses with AREDFV showed an increased incidence of fetal acidosis. The number of fetuses with abnormal neurological signs was significantly increased compared to the control group. Most of these fetuses (86%) showed abnormal blood flow velocity waveforms of the middle cerebral arteries called "brain-sparing effect". The combination of premature delivery in the 30th week of gestation, severe idiopathic respiratory distress syndrome, and a resistance index under the 10th percentile in the middle cerebral arteries seems to be a risk factor of the early neurological morbidity in fetus with AREDFV.

Blood Flow Velocity↗

PubMedDate not supplied

[Fetal development in mild and severe pre-eclampsia: correlation with maternal laboratory parameters and Doppler ultrasound].

During three and a half years we observed 83 single pregnancies all delivered by caesarean section. All of them had a mild (systolic blood pressure > 140, diastolic > 90 and proteinuria > 0.5 g/dl) or a severe preeclampsia (systolic blood pressure > 160, diastolic > 100 and proteinuria > 3.0 g/dl). We found significantly twice as many abnormal uteroplacental blood flow velocities in the severe preeclampsia group than in the mild one. These results draw us to the conclusion that possible pathological changing of the vessels is due to preeclampsia which does not need to correlate with a placental insufficiency and fetal growth retardation. An abnormal uteroplacental blood flow velocity connected with an abnormal umbilical blood flow velocity raises the fetal morbidity and the early childhood morbidity. Fetal outcome in mild compared to severe preeclampsia definitively shows a worse prognosis for those fetuses whose mother developed a prepartal severe preeclampsia. A distinctly increased rate of cerebral haemorrhages, abnormal neurological signs, acute respiratory distress syndromes and bronchopulmonary dysplasia was found. Finally we show an additional risk for fetal outcome in absent or reverse enddiastolic flow velocity (AREDFV) in the severe preeclampsia group. We observed in the AREDFV group with severe preeclampsia in comparison to a group of AREDFV without maternal preeclampsia more than twice as many cerebral haemorrhages, abnormal neurological signs and bronchopulmonary dysplasia.

Adult↗

PubMedDate not supplied

[Blood flow profile in the uterine artery. Correlation with placental morphology and clinico-obstetrical data within the scope of pre-eclampsia].

Within a group of preeclamptic women we found severe histologic placental pathology with functional relevance when both the uteroplacental and fetoplacental flow velocity waveforms showed elevated resistance indices. These pathological findings were a reduced decidual area, infarction and villus maturation failures with a high rate of intrauterine growth retardation, acidosis and premature delivery. In cases with normal flow velocity waveforms these pathologic findings were much rarer although the patients were preeclamptic, too.

Arteries↗

PubMedDate not supplied

[Late neurologic morbidity of premature infants with intrauterine diagnosis of null- or negative flow of the umbilical arteries].

Absent or reverse enddiastolic flow velocities (AREDFV) of the umbilical arteries are associated with fetal distress and adverse fetal outcome. We studied 68 fetuses with AREDFV with respect to abnormal neurological evaluation up to two years. A control group was matched for gestational age and had normal umbilical artery flow velocity waveforms. Fetuses with AREDFV showed increased abnormal neurological signs, compared with the control group (31% vs. 12%). Our results confirm the significance of AREDFV in growth retarded infants with respect to neurological development in early childhood.

Blood Flow Velocity↗

PubMedDate not supplied

[Doppler sonographic flow measurements of the middle cerebral artery in end-diastolic zero flow in the umbilical arteries in relation to fetal outcome].

Absent or reverse end-diastolic flow velocities (AREDFV) of the umbilical arteries are associated with fetal distress. We studied 74 fetuses with AREDFV with respect to the resistance index of the middle cerebral artery (MCA). The change in the resistance index of MCA was applied to the fetal outcome. The fetuses were retrospectively divided into 3 groups: 1) The fetuses in the first group did not show any changes in the course of observation of the MCA. 2) In the second group a drop followed by an increase in the resistance index of the MCA was confirmed. This is known in literature as "cerebral oedema". 3) The third group showed only a drop in the resistance index, described in literature as "brain-sparing-effect". The increase in the resistance index of the MCA points to a danger for the fetus, since the incidence of fetal acidosis, low birth weight, severe idiopathic respiratory distress syndrome in these fetuses was extremely high. In particular every second fetus in this group showed neurological complications. The change in the cerebral perfusion known as "cerebral oedema" which is extremely dangerous for the fetus has to be avoided.

Adult↗