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Biomedical subjects

M Kreuter

Publications and source records attributed to M Kreuter.

At least 19 recordsLinked to original sources
PubMed2006

Correlation of neuropilin-1 overexpression to survival in acute myeloid leukemia.

Neuropilin-1 (NRP-1), a vascular endothelial growth factors and semaphorin receptor functioning as mediator of angiogenesis and neuronal guidance, is expressed by various solid tumors. The importance of NRP-1 in hematological malignancies such as acute myeloid leukemia (AML) remains to be elucidated. Therefore, we determined NRP-1 expression by immunohistochemical analysis of bone marrow biopsies of patients with newly diagnosed, untreated AML. The expression of NRP-1 was significantly increased in AML patients (n = 76; median 12.9 arbitrary units (a.u.)) as compared with controls (n = 38; median 2.75 a.u.). Survival was significantly poorer in patients with high (> median) versus low (< or = median) NRP-1 expression levels with 5-year overall survival rates of 16.9 versus 49.6% (P = 0.050). In conclusion, our data provide evidence of increased NRP-1 expression in AML with significant correlation to survival. Thus, NRP-1 might constitute a promising target for antileukemic and antiangiogenic treatment strategies in AML.

Acute Disease↗
PubMed2005

Effects of abdominal binding on breathing patterns during breathing exercises in persons with tetraplegia.

STUDY DESIGN: Cross-sectional, experimental. OBJECTIVES: To investigate and compare static lung volumes and breathing patterns in persons with a cervical spinal cord lesion during breathing at rest, ordinary deep breathing, positive expiratory pressure (PEP) and inspiratory resistance-positive expiratory pressure (IR-PEP) with and without an abdominal binder (AB). SETTING: The outpatient clinic at the Spinal Unit at Sahlgrenska University Hospital, Goteborg, Sweden. METHOD: The study group consisted of 20 persons with complete cervical cord lesion at C5-C8 level. Breathing patterns and static lung volumes with and without an AB were measured using a body plethysmograph. RESULTS: : With an AB, static lung volumes decreased, vital capacity increased, breathing patterns changed only marginally and functional residual capacity remained unchanged during PEP and IR-PEP. CONCLUSION: Evidence supporting the general use of an AB to prevent respiratory complications by means of respiratory training is questionable. However, the interindividual variation in our results indicates that we cannot rule out that some patients may benefit from the treatment.

Abdomen↗
PubMed2005

Health and quality of life of persons with spinal cord lesion in Australia and Sweden.

STUDY DESIGN: Cross-sectional questionnaire study. OBJECTIVES: The aim of the study was to demonstrate the value of common general health-related quality of life (HRQL) instruments, readily available for cross-cultural comparisons, in persons with spinal cord lesion (SCL) treated at spinal units in Melbourne, Australia and in Gothenburg, Sweden. Another aim was to determine as to which of the independent variables were the most powerful predictors of global QL in the two SCL groups. SETTINGS: Australia and Sweden. METHODS: Two groups consisting of 89 Australian and 71 Swedish SCL persons were surveyed. The two groups were matched according to sex, age, time since injury and level of injury. The 36-item short-form health survey (SF-36) and the Spinal Cord Injuries Quality of Life-23-item questionnaire were used to cover essential generic and specific domains of health and quality of life. Clinical and sociodemographic data were collected using questionnaires. For interpretation purpose, available general population data were used. RESULTS: The most important predictors of QL perception in the Australian group were the same as for the Swedish group; mood, physical and social functioning and problems regarding injury. In total, 61% (Australian group) and 52% (Swedish group) of the variance was explained by these variables. Despite similarities of health profiles, some areas of the SF-36 differed between the two groups. CONCLUSION: The demonstrated HRQL profiles in SCL persons have shown that valid measures can provide new information of clinical value beyond the self-evident physical and practical restrictions due to injury. Illustrative comparisons, such as those presented here between Australia and Sweden, may extend our knowledge about areas where the SCL persons themselves are the logical experts, for example, maintenance of personal roles, social interaction and emotional well-being.

Activities of Daily Living↗
PubMed2005

Patient-staff agreement in the perception of spinal cord lesioned patients' problems, emotional well-being, and coping pattern.

STUDY DESIGN: Matched patient/staff study. OBJECTIVES: To investigate spinal cord lesion (SCL) rehabilitation staff perceptions of SCL patient problems, coping efforts, and well-being, and to compare these evaluations with patient self-reports of the same aspects. SETTINGS: Spinal Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: In all, 29 persons with SCL and 24 members of the caring staff participated. Each patient was matched to a staff person actually involved in his or her care. The participants completed a study-specific questionnaire containing 45 SCL-related problems covering six problem areas: somatic symptoms, functional limitations, role problems, family-related problems, psychosocial problems, and emotional problems. Coping activities were assessed by a self-report 47-item questionnaire covering eight aspects of coping: self-trust, problem focusing, acceptance, fatalism, resignation, protest, minimization, and social trust. The patients were instructed to respond to the items included in the questionnaires according to their situation during the last week, while staff members were instructed to reply as 'they thought that their matched patient would answer'. RESULTS: Moderate but statistically significant correlations were demonstrated between patient and staff ratings of most investigated problem areas. However, the staff systematically overestimated patients' emotional as well as family problems, and tended to underestimate patients' reported coping ability and mental health. Staff were most accurate in assessing patients' physical symptoms, functional limitations, and role problems, but less accurate in their perception of less visible symptoms. CONCLUSION: Relatively high agreement between patients and staff concerning patients' problems and states is possible to obtain in a caring setting. This may be more related to the quality of caring in the studied unit than to the study methodology used. Small units with high staff density and a long stay and/or prolonged contact with the patients probably facilitate communication with and knowledge about the patients. Interventions aimed at increasing staff awareness of patients' coping efforts may further improve staff ability to understand and support patients in their adaptation process.

Adaptation, Psychological↗
PubMed2005

Acquired haemophilia in a patient with gram-negative urosepsis and bladder cancer.

We here report a patient who developed a high titer antibody to factor VIII (FVIII) during gram-negative urosepsis caused by enterobacter cloacae after complete resection of rectal cancer. The patient initially presented with a life threatening spontaneous hematothorax and multiple large haematomas. Coagulation studies revealed a severe FVIII deficiency <1% with a high FVIII antibody titer of 64 BU. The bleeding responded rapidly to infusions of recombinant factor VIIa. After achievement of a partial remission (FVIII activity 28%) by combined immunosuppressive therapy (prednisone, cyclophosphamide, plasmapheresis and immunoadsorption), subsequently, two relapses occurred following steroid tapering. Resumption of prednisone and cyclophosphamide treatment combined with immunoadsorption induced a second and third remission, respectively. After resection of a papillary carcinoma of the bladder 6 months later and continuous immunosuppressive therapy with cyclophosphamide, FVIII levels remained stable within normal ranges. This clinical course suggests that the cause of inhibitor formation against FVIII resulting in severe acquired haemophilia was multifactorial and was initiated by the gram-negative urosepsis and probably by the underlying malignancies.

Aged↗
PubMed2003

Acupuncture to reduce nausea during chemotherapy treatment of rheumatic diseases.

OBJECTIVE: To study if acupuncture, combined with ondansetron treatment, reduces nausea and vomiting associated with cyclophosphamide infusion in patients with rheumatic diseases. METHODS: Thirty-nine patients were treated with acupuncture at point PC 6 and/or in the ear to decrease nausea and vomiting. The patients reported the severity of nausea and number of bouts of vomiting at the start of chemotherapy and after 4, 8, 24, 48 and 72 h. RESULTS: Compared with ondansetron treatment alone, the combined acupuncture-ondansetron treatment significantly decreased both the severity of nausea and the number of bouts of vomiting 24 and 48 h after the subjects had received acupuncture at the first treatment session (nausea: P < 0.0001; vomiting: P < 0.0035). Nearly the same results were seen 48 and 72 h after the subjects had had their last treatment of acupuncture (nausea P < 0.0080). Similar results were found after 24 to 48 h, when a comparison was made between two sessions close in time (nausea: P < 0.0001 after 24 h, P < 0.0003 after 48 h; vomiting: P < 0.0007). CONCLUSIONS: Our results clearly indicate that combined treatment with acupuncture and ondansetron reduces the severity and the duration of chemotherapy-induced nausea as well as the number of bouts of vomiting as compared with ondansetron therapy alone, in patients with rheumatic diseases.

Acupuncture Therapy↗
PubMed2003

Breathing patterns during breathing exercises in persons with tetraplegia.

STUDY DESIGN: Cross-sectional, observational, controlled study. OBJECTIVES: To survey breathing patterns during breathing at rest, ordinary deep breathing (DB), positive expiratory pressure (PEP) and inspiratory resistance-positive expiratory pressure (IR-PEP) among individuals with a cervical spinal cord lesion (SCL) compared with able-bodied controls. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden. METHOD: Participants consisted of 20 persons with a complete SCL at the C5-C8 level (at least 1 year postinjury) and 20 matched, able-bodied controls. Breathing patterns and static lung volumes were measured using a body plethysmograph. RESULTS: Compared to the controls, breathing patterns at rest among the people with tetraplegia were characterised by a decreased tidal volume, stable respiratory rate and total cycle duration resulting in decreased mean inspiratory and expiratory flow, and alveolar ventilation. All volume and flow parameters increased except respiratory rate, which decreased during DB and PEP. During IR-PEP, tidal volume increased less compared to PEP, and combined with a decreased respiratory rate the alveolar ventilation was lower than during breathing at rest. The functional residual capacity increased during PEP and IR-PEP in people with tetraplegia. CONCLUSION: DB exercises with or without resistance during expiration or the whole breathing cycle affect the breathing pattern in persons with tetraplegia. DB was superior in increasing volumes and flow. PEP and IR-PEP increased FRC but IR-PEP decreased volumes and flows. However, large interindividual differences in the SCL group indicate the need for caution in generalising the results. SPONSORSHIP: This work was supported in part by grants from the Memorial Foundation of the Swedish Association of registered Physiotherapists and the Association of Cancer and Road Accident Victims.

Adult↗
PubMed2002

Linkages between coping and psychological outcome in the spinal cord lesioned: development of SCL-related measures.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To investigate relationships between coping and mental well-being with clinical relevance to spinal cord lesion (SCL). SETTING: The Gothenburg Spinal Injuries Unit in Sweden. METHODS: The study sample comprised 274 persons. From in-depth interviews, literature reviews, and the transactional theory of stress and coping, items reflecting coping and psychological outcome, respectively were generated. Principal components factor analysis, multi-trait analysis, and structural equation modelling were used. RESULTS: The coping scale comprised three factors: Acceptance (i.e. revaluation of life values); Fighting spirit (i.e. efforts to behave independently); Social reliance (i.e. a tendency towards dependent behaviour). The outcome scale included the factors: Helplessness (i.e. feeling perplexed, out of control and low self-esteem); Intrusion (i.e. bitterness and brooding); Personal growth (i.e. positive outcomes of life crisis). Acceptance showed a positive relation to Personal growth and was inversely related to both Helplessness and Intrusion. Fighting spirit had a weak negative association to Helplessness and a weak positive association to Personal growth. Social reliance was positively related to Helplessness and Intrusion. Only Social reliance showed any association to neurological status. Those lesioned 1-4 years reported more Helplessness, Intrusion, Social reliance, and less Acceptance than those lesioned >or=5 years. CONCLUSION: Coping is related to psychological outcome in SCL. Our situational coping measure may be a candidate to assess intervention effects.

Adaptation, Psychological↗
PubMed2002

Effects of coping on psychological outcome when controlling for background variables: a study of traumatically spinal cord lesioned persons.

STUDY DESIGN: Cross-sectional. OBJECTIVES: In a previous study we found spinal cord lesion (SCL)-related coping factors to be distinctly related to levels of SCL-related psychological outcome. However, we did not control for other potentially confounding variables. In this study we investigated effects of coping strategies on psychological outcome reactions in traumatically spinal cord lesioned persons controlling for sociodemographic, disability-related and social support variables. SETTING: The Gothenburg Spinal Injuries Unit in Sweden. METHODS: The study sample comprised 255 persons and a subsample of 157 persons. A series of stepwise multiple regression analyses were performed. RESULTS: SCL-related coping factors clearly predicted psychological outcome even when background variables were controlled. Higher levels of acceptance coping predicted decreased psychological distress and increased positive morale. Elevated social reliance coping predicted heightened distress. Higher levels of social support predicted lower feelings of helplessness. Sociodemographic and disability-related variables were weak predictors of psychological outcome with one exception: higher education predicted less bitterness and brooding. CONCLUSION: SCL-related coping remained the most important predictor of psychological outcome even when a wide range of variables was controlled. Thus we conclude that psychosocial interventions aimed at helping individuals develop their coping strategies might be of substantial value in their adjustment to SCL.

Adaptation, Psychological↗
PubMed2001

Rapid extracellular release of cytochrome c is specific for apoptosis and marks cell death in vivo.

Diverse death stimuli including anticancer drugs trigger apoptosis by inducing the translocation of cytochrome c from the outer mitochondrial compartment into the cytosol. Once released, cytochrome c cooperates with apoptotic protease-activating factor-1 and deoxyadenosine triphosphate in caspase-9 activation and initiation of the apoptotic protease cascade. The results of this study show that on death induction by chemotherapeutic drugs, staurosporine and triggering of the death receptor CD95, cytochrome c not only translocates into the cytosol, but furthermore can be abundantly detected in the extracellular medium. The cytochrome c release from the cell is a rapid and apoptosis-specific process that occurred within 1 hour after induction of apoptosis, but not during necrosis. Interestingly, elevated cytochrome c levels were observed in sera from patients with hematologic malignancies. In the course of cancer chemotherapy, the serum levels of cytochrome c in the majority of the patients grew rapidly as a result of increased cell death. These data suggest that monitoring of cytochrome c in the serum of patients with tumors might serve as a useful clinical marker for the detection of the onset of apoptosis and cell turnover in vivo.

Adult↗
PubMed2001

Stable remission after administration of the receptor tyrosine kinase inhibitor SU5416 in a patient with refractory acute myeloid leukemia.

The small molecule receptor tyrosine kinase (RTK) inhibitor SU5416 targets the vascular endothelial growth factor receptor 2 and the stem cell factor receptor c-kit. Herein is described the successful treatment of a 65-year-old woman with SU5416, in second relapse of acute myeloid leukemia (AML) and refractory toward standard chemotherapy regimens. After 12 weeks of treatment with SU5416, the blast cell counts (blood and bone marrow) decreased to undetectable levels and the peripheral blood cell counts normalized with the exception of the platelet count (50-80 x 10(9)/L [50-80 x 10(3)/microL]). The duration of the remission is longer than 4 months during maintenance therapy with SU5416. Microvessel density in the patient's bone marrow dropped from 33.4 to 12.3 microvessels/x500-field 8 weeks after SU5416 administration and remains in the normal range. This is the first report of a stable remission achieved after administration of the RTK inhibitor SU5416 in a patient with AML relapse.

Acute Disease↗
PubMed2000

Spinal cord injury and partner relationships.

INTRODUCTION: Among the many issues confronting a newly spinal cord injured (SCI) person are apprehension about the potential impact of the acquired disability on present or future intimate relationships. OBJECTIVE: To summarize the research regarding partner relationships and SCI. METHOD: Medline, Psychlit and Cinahl database researches were undertaken. RESULTS: Several studies have focused on the issue of marital status before and after the onset of the injury. The results of the studies carried out on the prevalence of divorce are conflicting. Divorce rates have been reported to be anywhere from 8% to 48%. It appears that divorce rates tend to decline to the normal rate for the general population after the initial high risk period. Some studies have shown that marital status is a powerful predictor of independent-living outcome variables. Thus, marital stability is a concern in SCI care. The study investigating why able-bodied women might choose to marry men with a permanent physical disability, such as a SCI, showed a substantial overlap with existing models of courtship. It was also shown that a SCI person who strives to minimise the impact of the disability on a potential partner makes a more attractive candidate for a long-term relationship than an individual who has come to rely on others. CONCLUSION: Partner relationships seem to be affected by a SCI, although not as much as is widely believed. There are, however, problems interpreting the varying results of the studies due to culture differences, changes in family life in society in general and the different methodologies used. Systematic research that puts the patients' and partners' problems into perspective is necessary. Uniformity in measurement instruments would facilitate comparisons of studies.

Divorce↗
PubMed2000

Sitting position - posture and performance in C5 - C6 tetraplegia.

OBJECTIVES: To investigate how sitting position and seating affect posture and performance (balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration) in persons with C5 and C6 tetraplegia. SETTING: Outpatient clinic 'Spinalhälsan', Göteborg, Sweden. METHOD: Baseline measurements of sitting position and performance were performed followed by an intervention period. The intervention was individually adapted to each person with emphasis on reduction of kyphotic posture and pelvic obliquity. Furthermore, a functional requirement was that the new sitting position was used in everyday life and did not impair balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration. RESULTS: Four persons with complete C5 - C6 tetraplegia who reported dissatisfaction with posture and seating took part in the study. A comparison of photographs before and after the intervention showed a reduction of kyphotic posture and pelvic obliquity. Balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration were affected by the sitting position in an individual manner. CONCLUSION: Solution of problems concerning sitting and posture for persons with C5 - C6 tetraplegia requires good knowledge of the physical impairment, wheelchair adaptation, seating systems and cushions as well as an understanding of the individual's demands and wishes. Due to the complexity of the issue, standard solutions are not applicable. Thus, an analytical working method is required and co-operation between professionals - occupational therapists and physiotherapists - is important.

Adult↗
PubMed2000

Spinal cord injury and quality of life measures: a review of instrument psychometric quality.

INTRODUCTION: Quality of life (QOL) is often considered the primary endpoint in research, clinical medicine, and health promotion when impairments are incurable or insufficiently understood. For spinal cord injured (SCI) persons extended life spans and the need for life-long follow-up make it important to expand the outcome parameters of medical care and health services to include QOL measures. STUDY DESIGN: Review. OBJECTIVES: The aim of this study was to evaluate QOL research in SCI persons from the perspective of current criteria for instrument psychometric quality developed by Medical Outcomes Trust (MOT). METHODS: Relevant articles were extracted from the Medline, Cinahl, and PsycLit databases for approximately a recent 30-year period (1966 - 1999). The keyword 'spinal cord injuries' was cross-indexed with 'quality of life', 'personal satisfaction' and 'life satisfaction'. A total of 105 articles were identified and 46 met our inclusion criteria: (a) report of original research; (b) evaluation of QOL by self-report questionnaires or scales; and (c) publication in English. RESULTS: The quality of the research designs varied widely. Most of studies were cross-sectional with limited study populations. The number of instruments or different combinations of instruments nearly equalled the number of studies conducted. Most questionnaires were condition-specific and only used by the developers. The variety of instruments and the diversity of their core content made results difficult to compare, and evaluations and conclusions unpredictable and sometimes contradictory. The low psychometric standard of many instruments used further aggravates the interpretation of results. CONCLUSION: To improve future research in special populations such as the SCI, the MOT criteria for review of QOL instruments should be further disseminated and applied to reach desirable consensus of a limited number of standardised generic and condition-specific QOL measures.

Humans↗
PubMed1999

Principles of practice for academic/practice/community research partnerships.

CONTEXT: Researchers and practitioners are increasingly realizing that improvements in public health require changes in individual, social, and economic factors. Concurrent with this renewed awareness there has been a growing interest in working with communities to create healthful changes through academic/practice/community research partnerships. However, this type of research presents different challenges and requires different skills than traditional research projects. The development of a set of principles of practice for these types of research projects can assist researchers in developing, implementing, and evaluating their partnerships and their project activities. OBJECTIVE: This paper describes the different ways in which academics and community groups may work together, including academic/practice/community partnerships. Several principles of practice for engaging in these research partnerships are presented followed by a description of how these principles have been put into operation in a family violence prevention program. CONCLUSIONS: The principles presented are: (1) identify the best processes/model to be used based on the nature of the issue and the intended outcome; (2) acknowledge the difference between community input and active community involvement; (3) develop relationships based on mutual trust and respect; (4) acknowledge and honor different partner's "agendas"; (5) consider multi-disciplinary approaches; (6) use evaluation strategies that are consistent with the overall approach taken in the academic/practice/community partnership; and (7) be aware of partnership maturation and associated transition periods. The limitations of these principles and their application in various settings are discussed.

Academic Medical Centers↗