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Biomedical subjects

M Kroll

Publications and source records attributed to M Kroll.

At least 55 records · Page 3Linked to original sources
PubMed1995

Osteoporosis prevention and treatment with sex hormone replacement therapy.

Oestrogen deficiency is by far the major factor contributing to the high rate of osteoporotic fractures in women. The anti-osteoporotic effect of estrogen may be explained by its property to regulate cytokine secretion and thus balance bone remodeling. In oestrogen deficiency, increased resorption and remodeling will occur leading to osteoporosis. It has been extensively shown that oestrogen replacement therapy (ERT) prevents postmenopausal bone loss and reduces fracture risk by half, provided that an appropriate dose is used. In order to optimize osteoporosis prevention, ERT should be started a early as possible in menopause and be maintained as long as possible. ERT may also be effective in elderly osteoporotic patients in preventing bone loss and, reducing fracture risk. The acceptance of ERT, however, at an older age has not been thoroughly evaluated. A reduction of cardiovascular disease and of climateric symptoms are among other benefits of ERT. So far, only few postmenopausal women are treated with ERT. ERT without progestins has been repeatedly found associated with an increased risk of developing endometrial cancer, but the cyclic addition of progestins protects from endometrial hyperplasia and carcinoma. Combined oestrogen-progestin therapy is as efficient as estrogen therapy alone, but not more so. Since progestins may oppose some of the beneficial effects of estrogens, the lowest dose with the least metabolic impact should be prescribed. Women who have had a hysterectomy, should probably be treated by estrogen replacement therapy only. Meta-analyses concerning breast cancer associated with ERT found a very moderately increased risk (RR = 1.06). Therefore ERT prescription should be discussed openly with women considering all risks and benefits. In women who have suffered from breast cancer, a bone sparing effect of tamoxifen has been shown.

Estrogen Replacement Therapy↗
PubMed1995

Compliance to hormone replacement therapy.

Hormone replacement therapy (HRT) after menopause can effectively reduce climacteric-related symptoms and therefore increase quality of life. A large number of studies have also demonstrated that with a sufficient dosage bone loss can be prevented and fracture frequency reduced. Epidemiological and experimental studies also suggest a decrease in cardiovascular mortality and morbidity among HRT users compared to nonusers. From an epidemiological perspective, in order to obtain optimal prevention of osteoporosis and of cardiovascular diseases, a high proportion of postmenopausal women should be treated using long-term therapy. Surveys generally show that only a small proportion of postmenopausal women use hormone replacement therapy (in Belgium, around 14%) and that the long-term compliance to treatment, which is mandatory in the prevention due to low compliance remains unknown. The reasons why patients patients do not pursue their treatment in the long run remain unclear. Fear of cancer and drug-related side effects, such as unacceptable bleeding, have been among the most frequently mentioned causes. Thus, individual information on patients regarding HRT seems to be crucial issue. A few recent studies have suggested a favorable role of osteoporosis prevention and bone mass measurements to increase compliance, but this is not well established and will depend on the physician's attitude toward HTR and osteoporosis prevention. At present, very little is known about the physician's decision to treat postmenopausal women with HRT. Sometimes, the physician's attitude has been reported was very negative toward HRT-apparently, many physicians think HRT increases cardiovascular risk, even though most data suggest a reduction of cardiovascular risk among HRT users. Very little research has actually been performed on how to improve compliance. Education and behavioral strategies may be of use. Improved communication between patients and physicians, establishing a confidential relationship with patients, and the involvement of nursing counseling are all strategies which may improve compliance. The use of easy-to-take medication that induces no bleeding, supported by calendar devices or reminders, may facilitate chronic use of medication. Future research needs to investigate the physician's and patient's decision-making processes and the reasons for those decisions.

Estrogen Replacement Therapy↗
PubMed1994

A tool for measuring functional outcomes after total hip arthroplasty.

PURPOSE: To describe a functional milestone scale (FMS) for measuring functional progression following total hip arthroplasty and to demonstrate that this scale meets accepted standards of scale construction. METHODS: Inter-observer reliability of the scale was determined for 30 patients using a kappa coefficient of concordance (k) for ordinal data, representing 221 pairs of observations. There were 79, 54, 44, and 44 pairs of observations for transfer, walker, crutch, and stair ambulation, respectively. RESULTS: The k coefficient ranged from 0.82 to 0.91. Agreement between therapists was almost perfect according to the criteria of Feinstein. CONCLUSIONS: The FMS exhibits substantial inter-observer reliability and moderate to substantial validity. We have demonstrated its clinical applications as well as showing it to be a useful management and research tool.

Activities of Daily Living↗
PubMed1993

Liposome-based flow-injection immunoassay for determining theophylline in serum.

We developed a method for quantitatively determining theophylline in serum, using a heterogeneous immunoassay called flow-injection immunoanalysis. The reaction involves competition between serum theophylline and theophylline-labeled liposomes. Separation occurs on a solid-phase reactor column containing immobilized antibody to theophylline incorporated in a flow-injection system. Subsequent lysis of the bound liposomes provides sensitive detection of the analyte. Effective regeneration of the immobilized antibody activity allows the reactor to be reused for hundreds of sequential samples. Comparison of the results of the flow-injection immunoassay method with results obtained with a commercially available fluorescence polarization method showed an excellent correlation.

Flow Injection Analysis↗
PubMed1991

[The effect of topical heparin on histamine-induced wheals. A double-blind study].

Since it is difficult to demonstrate the effectiveness of heparin-containing ointments in the treatment of thrombophlebitis under clinical conditions, a double-blind experimental trial was performed in 18 volunteers. To produce a reproducible inflammation, ten drops of a histamine solution containing 10 mg histamine/100 ml, were applied to an area measuring 4 x 7 cm2 on both forearms of each test subject. Under each drop, the skin was pricked five times. Ten minutes after induction of inflammation, one forearm of each subject was treated in a double-blind randomized manner with an ointment containing heparin (50,000 IU heparin/100 g), the other arm being treated with the heparin-free ointment base. As a criterion of the effectiveness of the ointment, the course of the temperature of the forearms was measured using thermography. Ten minutes after application of the histamine solution, the temperature increased by a mean of about 3 degrees centigrade. After 30 minutes' treatment with heparin-containing ointment, the temperature then decreased by 1.77 degrees C, while that of the forearms treated with heparin-free ointment base decreased by only 1.14 degrees C. The difference was statistically significant (p less than 0.001). Sixty minutes after treatment the differences were still significant at p = 0.012. This study thus demonstrates the effectiveness of heparin-containing ointment in the treatment of histamine-induced inflammation.

Administration, Topical↗
PubMed1991

Does tourniquet use during anterior cruciate ligament surgery interfere with postsurgical recovery of function? A review of the literature.

This article explores the issue of whether use of a tourniquet during arthroscopically assisted repair of the anterior cruciate ligament (ACL) slows the postoperative recovery of function. A tourniquet is customarily used to provide a bloodless field, thus enabling the surgeon to visualize the joint clearly. However, there is increasing evidence that tourniquets cause muscle and nerve damage that can have long-term consequences for the recovery of function following surgery. The two randomized trials that investigated tourniquet use during meniscectomy reached contradictory conclusions about the effects of the tourniquet. There have been no randomized trials of tourniquet use during the longer and more complex ACL surgery. This article reviews the pertinent literature and suggests some clinical implications of the available information.

Anterior Cruciate Ligament↗
PubMed1991

[Evaluation of pharmacodynamic equivalence of glycerol trinitrate-containing sprays for oral administration with or without chlorofluorocarbons ].

Evaluation of Pharmacodynamic Equivalence of Glyceryl Trinitrate Sprays for Oral Application with or without Fluorochlorohydrocarbons. The pharmacodynamic equivalence of a fluorochlorohydrocarbons(FCH)-free vs a FCH-containing glyceryl trinitrate (NTG, CAS 55-63-0) spray was investigated. Three oral sprays were administered at 24 h intervals to 9 male and 6 female healthy subjects in a double-blind placebo-controlled period-balanced 3-way cross-over study design: treatment NT (FCH-free, NTG-containing spray, dose of 0.8 mg NTG), treatment NR (FCH- and NTG-containing spray, dose of 0.8 mg NTG) and treatment PL (placebo: FCH- and NTG-free spray, dose of 2 puffs). The treatments were administered after suitable preparation and under strict standardisation. Subsequently digital plethysmography (systolic a-wave, dicrotic b-wave and the c-incisura) was monitored for 2 h. After administration of the NTG-containing sprays (NR and NT) the median a-wave increased rapidly, the median c-incisura deepened and the median b-wave rose slightly. The time courses of these changes and those of the resulting b/a- and c/a-ratios were superimposable and clearly distinct from those after PL. On the basis of the analysis of variance of the response variables (Rmin: maximum drop, and A(0-60): the area under the time course during the first hour after dosing) of the c/a-ratio as change from the predosing baseline, the following point estimates and 90% confidence intervals (CI) were calculated for the true ratio of treatments NT/NR: 104.4%, CI: 88.3 to 120.5% for Rmin, and 101.4%, CI: 79.3 to 123.5% for A(0-60).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1990

Twenty-four-hour profiles of growth hormone, prolactin and cortisol in the chronic vegetative state.

The 24-h profiles of growth hormone (GH), prolactin (PRL) and cortisol were obtained from 11 patients in the chronic vegetative state in order to gain more insight into the neuroendocrine alterations caused by widespread suprahypothalamic brain damage. Age and sex-matched normal subjects served as a control group. Patients had fewer high-amplitude GH peaks (greater than 20 mU/l: 6 peaks/24 h vs 21 peaks/24-h in controls) and a (non-significant) tendency towards higher basal GH concentrations. PRL concentrations were higher in patients (296 +/- 212 (SD) vs 120 +/- 28 mU/l). Cosinor analysis also showed that 24-h rhythmicity was preserved, but acrophases were more dispersed. A nocturnal PRL acrophase occurred in only three of 11 patients but in 10 of 11 control subjects. The number of PRL peaks was the same in patients and controls. Cortisol concentrations were also higher in patients (298.3 +/- 114.6 vs 193.6 +/- 97.4 nmol/l) with a preserved circadian rhythm. The acrophases, however, were likewise more dispersed. There was no difference in the number of cortisol peaks between patients and controls, but the mean peak duration was shorter in patients (75.4 +/- 28.1 vs 109.5 +/- 28.2 min). The stage of remission was negatively correlated with the 24-h mean and the mean peak amplitude of PRL. No patient showed a normal organization of sleep stages. On visual analysis there was no apparent association between EEG patterns and hormonal parameters. These results suggest that the endocrine hypothalamus is essentially intact in the chronic vegetative state. The observed changes may be due to an altered input from extrahypothalamic brain structures.

Adolescent↗
PubMed1990

Arthrometric evaluation of knees that have a torn anterior cruciate ligament.

We used the KT-1000 arthrometer to test the knees of 107 patients who had an acute tear of the anterior cruciate ligament, 153 patients who had a chronic tear, and 141 control subjects, for a total of 401 individuals. The three testing parameters were the extent of anterior translation at eighty-nine newtons of force and at maximum manual force, and the compliance index. The differences between the involved and the uninvolved knees were calculated. At eighty-nine newtons, all but one of the control subjects had anterior translation of ten millimeters or less, compared with 58 per cent of the patients who had a chronic tear. At maximum manual force, all but two of the control subjects had translation of ten millimeters or less, compared with 20 per cent of the patients who had an acute or a chronic tear. Analysis of variance showed that the clinical diagnosis correlated well with the results for all tests (p less than 0.001). However, when the uninjured knees of patients who had an acute or a chronic tear were compared with the knees of the control subjects, significant differences were noted (p less than 0.001 to 0.006). In the patients who had a chronic tear, there was no relationship between the time from injury to operation and the extent of anterior translation. The arthrometric test at maximum manual force was the strongest discriminant; it differentiated normal from abnormal knees (p less than 0.001) with high sensitivity (92 per cent), high specificity (95 per cent), and high positive predictive accuracy; the cut-off point was eleven millimeters or less.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Malignant fibrous histiocytoma. Prognostic value of the histological findings].

Surgical specimens after excision of malignant fibrous histiocytomas from 41 patients were classified histologically according to subtype; semiquantitatively by cell content, mitosis count, necrosis tendency and cell polymorphism; and "subjective grading". There was no significant difference in survival time between storiform-pleomorphic and myxoid subtypes. The marked scatter in the storiform-pleomorphic subtype reflects the inhomogeneity of this group. Analysis of the individual semiquantitative criteria gave better results. Cases with many mitoses, many necroses, marked cell polymorphism and high cell content had significantly shorter survival times than those with less marked changes. "Subjective grading" was also of prognostic value. However, overlapping of prognostic factors and limitations due to tumour biology allow of only a rough orientating prediction based on histological assessment of malignancy grade.

Histiocytoma, Benign Fibrous↗
PubMed1986

Serum enzyme, myoglobin and muscle strength relationships in polymyositis and dermatomyositis.

Strength of the quadriceps and hamstring groups was biomechanically assessed in terms of isometric torque production in 14 patients with inflammatory myopathy. Eleven had polymyositis and 3, dermatomyositis. Determinations of serum creatine kinase, lactate dehydrogenase, transaminase, and myoglobin were simultaneously obtained over an average period of observation of 1.8 years. In certain individual patients, there were significant correlations between laboratory indices and strength during the entire course of illness. In others, this was not the case. In the total group of patients, absolute values of the laboratory indices did not correlate well with strength except in the case of serum myoglobin, where there a significant inverse relationship. Logarithmic transformations of the laboratory data increased the inverse correlations. High strength and low myoglobin were related to high prednisone dose. Since laboratory guides are not always related to disease activity, quantitative assessment of muscle strength is necessary.

Adult↗
PubMed1983

Dissociation of light onset and wake onset: effect on rhesus monkey growth hormone secretion.

Synchronization of GH-secretory episodes occurs at light onset in the rhesus monkey and is later lost during the 24-h day. The stimulus for this synchronization was studied in nine male adult monkeys prepared with chronic jugular catheters. In a first experiment, light onset was delayed by 2 h (from 0600 to 0800 h) on days 2-6 and returned to 0600 h on day 7. The animals were allowed to sleep on during the additional time of darkness. The early morning GH peak was immediately shifted to the new light-onset times, both after introduction of the delay and after its reversal. In a second experiment, the animals were awakened in darkness during a similar light-onset delay. Now the GH peaks constantly occurred at the time of awakening shortly after 0600 h, and no GH peak was seen after light onset at 0800 h. Neither experimental condition had an influence on the patterns of plasma PRL and cortisol. These results suggest that the early morning synchronization of the GH-secretory pattern in the rhesus monkey is triggered by awakening and not by light onset.

Animals↗