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Biomedical subjects

M Zuber

Publications and source records attributed to M Zuber.

At least 73 records · Page 4Linked to original sources
PubMed1998

[A patient with mixed collagen disease, antiphospholipid syndrome and Sjögren syndrome].

CASE REPORT: A 32-year-old female patient is described who suffered from common symptoms such as Raynaud's phenomenon and swollen fingers, high titers of antibodies to U1RNP, SLE-like findings, scleroderma-like findings and polymyositis-like findings. A diagnosis of mixed connective tissue disease (Sharp-syndrome) was established. In addition, the patient had antibodies against cardiolipin, thrombocytopenia, recurrent fetal loss and a history of deep venous thrombosis of her left leg which is typical for an antiphospholipid syndrome. The symptoms dry eyes and dry mouth pointed at secondary Sjögren's syndrome. The diagnosis of these disease entities and the therapeutic regimens are described and discussed.

Adult↗
PubMed1998

Endoscopic surgery to the axilla--a substitute for conventional axillary clearance?

Nonpalpable, mammographically detected breast cancers are on the increase. The percentage of patients with histologically involved nodes is therefore decreasing. Axillary clearance aims at reducing the probability of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning. Minimally invasive techniques have been applied to a growing number of surgical procedures now including exploration of the axilla. The technique used and results achieved in a series of 50 consecutive patients treated by liposuction and axilloscopy by one single surgeon, including all the patients from the very first attempt, are presented here. Patients were excluded with palpable lymph nodes or a primary tumor in the direct vicinity of the axilla that could be injured by the liposuction canula. The average number of lymph nodes removed was 13.4. Thirty-four percent of patients had involved nodes. The mean number of involved nodes in these patients was 3.1. After a median follow-up time of only 15 months no axillary recurrences or trocar site metastases have been found in the first 40 patients. Using a self-assessment questionnaire, the patients rate this technique as excellent. There was no lymphedema. The cosmetic result is certainly better than after conventional axillary clearance. Great experience of laparoscopic surgery and an excellent knowledge of the axillary anatomy are prerequisites for the practice of axilloscopic treatment of the axilla. The working space within the axilla is small and a number of structures need absolutely to be preserved. A longer follow-up period than the one so far achieved in this series or any other in the literature to date is necessary before this technique can be generally recommended.

Axilla↗
PubMed1998

Echogenic structures in the left atrioventricular groove: diagnostic pitfalls.

A variety of echogenic structures that can be detected by echocardiography in the left atrioventricular groove are best seen in the parasternal long-axis view and can be missed if not carefully looked for. Normal anatomic structures or variants can be seen, for example, dilated coronary sinus, persistent left superior vena cava, or lipomatous tissue. Degenerative or inflammatory processes of the mitral annulus (calcification of the mitral annulus, mitral annular abscess) and aneurysms of the left circumflex coronary artery or of the descending aorta can depict pathologic structures. Hiatal hernia and tumors can be found as well.

Aortic Aneurysm, Thoracic↗
PubMed1998

Assessment of the subclavian vein in patients with transvenous pacemaker leads.

Thrombosis of the subclavian vein can occur after the implantation of transvenous pacemaker electrodes. Although this is seldom followed by thromboembolic complications, it can cause problems when replacing the leads. To assess the impact of the pacemaker leads on the subclavian vein, a study using noninvasive duplex sonography was performed on 56 patients at an average of 41 months after the implantation. Forty-three percent of the patients were found to have a normal function of the subclavian vein, 46% developed pathological changes of the vessel wall, and 11% occluded. These changes rarely caused symptoms, and, therefore, had little clinical significance. Moreover, the occlusion rate was found independent of the patient's age, the patient's sex, the number of electrodes, the procedure of implantation, and even the time from implantation. As a result, the clinical diagnosis of occlusion is uncertain. Therefore, duplex sonography is recommended as an easy means of excluding a totally thrombosed subclavian vein prior to replacing pacemaker leads.

Aged↗
PubMed1998

Pulmonary hypertension in POEMS syndrome: a new feature mediated by cytokines.

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome is a rare variant of plasma cell dyscrasia with multiple systemic manifestations. We followed the progress of 20 patients with POEMS syndrome in our institution over a 10-yr period. Pulmonary hypertension (PH) was observed in five patients. All patients suffered dyspnea on exertion, which always appeared during an exacerbation of POEMS syndrome. The typical echocardiographic signs of PH were observed in all of these patients, and the median pulmonary-artery systolic pressure was 57 mm Hg (range, 50 to 65 mm Hg). Mean pulmonary-artery pressure during right side heart catheterization in two patients was 32 mm Hg. No other explanation for the PH could be found. Overproduction of cytokines was found in all cases, with high serum concentrations of interleukin-1beta, interleukin-6, tumor necrosis factor-alpha, and vascular endothelial growth factor. We suggest that PH should be added to the list of symptoms of POEMS syndrome. Cytokines may mediate POEMS syndrome-associated PH, as proposed for the other systemic manifestations of this disorder.

Adult↗
PubMed1998

Markers of tumor angiogenesis and proteolysis independently define high- and low-risk subsets of node-negative breast cancer patients.

PURPOSE: To compare the prognostic impact of tumor angiogenesis factors (vascular endothelial growth factor [VEGF], angiogenin, and basic fibroblast growth factor [bFGF]), tumor proteolysis factors (urokinase-type plasminogen activator [uPA] and plasminogen activator inhibitor-1 [PAI-1]), and conventional tumor markers (stage, grade, and steroid receptors) in early breast cancer. PATIENTS AND METHODS: In the primary clinical study, tumor angiogenesis and other factors were detected in frozen biopsies from 305 primary breast tumors. VEGF expression was assessed by chemiluminescence immunosorbent assay (ICMA); angiogenin, bFGF, uPA, and PAI-1 by enzyme-linked immunosorbent assay (ELISA); and steroid receptors (estrogen receptor [ER] and progesterone receptor [PgR]) by enzyme immunoassay (EIA). In the validating clinical study, another set of 190 node-negative primary breast tumor samples were collected at a separate institution. RESULTS: Univariate analysis of the primary study showed that VEGF levels were positively correlated with recurrence (P < .001). Angiogenin levels were positively correlated with disease relapse (P < .005) for the overall collective group, but not within the node-negative subset. No significant correlations were found between tumor bFGF levels and patient survival. In multivariate regression analysis, the only independent predictors of relapse-free survival (RFS) were VEGF, uPA, and lymph node status. In the validation set, the distribution of VEGF and uPA values were similar to those in the primary study; low expression of both VEGF and uPA identified patients with a < or = 20% likelihood of recurrence within 7 years. CONCLUSION: Separate primary and validating clinical studies concur that tumor VEGF level is the most important prognostic parameter among several markers of tumor angiogenesis and proteolysis.

Adult↗
PubMed1998

[Heart valve disease in women in the reproductive age].

About 1% of pregnant women have concomitant cardiac disease. An understanding of the impact of the physiologic changes associated with pregnancy upon structural cardiac disease is essential for proper counseling and management of these complex patients, which should be treated in a specialized team with experience in congenital as well adult disease. The availability of echocardiography provides information about disease aetiology, accurate and non invasive assessment of severity and means of monitoring progression. Contraindication for pregnancies still remain severe pulmonary artery hypertension and Eisenmenger-syndrome and severe surgical non corrected cyanotic disease as well. Postrheumatic stenosis, even when previously asymptomatic, can lead to pulmonary edema. Although pregnancies with asymptomatic regurgitant lesions are better tolerated. The best procedure in severe aortic insufficiency still remains controversial. Patients with Marfan syndrome and aortic root dilatation are at risk for aortic dissection and are difficult to manage. In patients with artificial valves continuing anticoagulation with warfarin is proposed in Europe. Due to accelerated valve deterioration during pregnancy the use of bioprotheses in women who need valvular heart surgery before pregnancy necessitate later valve replacement again and perhaps an autograft or homograft could be an alternate approach. Bacterial endocarditis in pregnancy shows a low incidence and is often associated with prior history of rheumatic or congenital heart disease. Therefore prophylaxis is recommended. There is an increase in the incidence of congenital heart disease among the offsprings of affected parents. Fetal echocardiography, in combination with a multidisciplinary postnatal approach, can be used in the successful treatment of severe form of congenital heart disease.

Adult↗
PubMed1998

[Endoscopic axilla dissection in invasive breast carcinoma. Initial experiences with a new technique].

The presence or absence of involved axillary lymph nodes is the single best predictor of survival of breast cancer, and important treatment decisions are based on it. For staging purpose as well as for local control a level I and II dissection is recommended. In order to lower the morbidity of axillary lymph node dissection less invasive treatment modalities have been evaluated. Beside the sentinel lymph node biopsy another new method is discussed: the endoscopic axillary lymph node dissection. After liposuction of the axillary fat the lymph nodes of level I and II are removed by endoscopy. With this technique enough lymph node can be removed which allows a sufficient staging as well as local control. This technique is not to be recommended for general use unless long term results have proven its value.

Axilla↗
PubMed1998

[Quality assurance in rheumatology--the rheumatologic anamnesis].

The systemic character of the rheumatic diseases has to be considered in the interview of a patient with rheumatic symptoms. It is the aim of this article to point to the importance of the anamnesis as part of the quality control in rheumatology and to present a short list of concise questions which proved to be valuable when dealing with patients with rheumatic symptoms. A physician not trained in rheumatology should be enabled to appreciate extraarticular symptoms in the context of the systemic nature of the rheumatic diseases.

Germany↗
PubMed1998

[Initial experiences with the Advanced Breast Biopsy Instrumentation (ABBI), a system for stereotactic excision of non-palpable breast lesions].

The advanced breast biopsy instrumentation (ABBI) allows the radiologically guided stereotactic excision of non-palpable radiodense lesions with high accuracy. Forty-six patients with suspicious clusters of microcalcifications (n = 37) and with round lesions (n = 9) of the breast were investigated using the ABBI. Tissue cylinders were successfully removed in 98% of cases. No wound complications occurred and cosmesis was excellent. Histopathology revealed 35 benign (76%) and 11 malignant (24%) lesions. With the ABBI system, non-palpable breast lesions can be precisely localized and excised.

Adult↗
PubMed1997

A Francisella tularensis DNA clone complements Escherichia coli defective for the production of Era, an essential Ras-like GTP-binding protein.

We cloned the era gene of Francisella tularensis from a plasmid library by heterologous genetic complementation of an Escherichia coli mutant conditionally defective for the production of Era, an essential protein for cell growth. Nucleotide sequence analysis indicated that, in F. tularensis, era constitutes a single gene operon. ORFs aspC and mdh encoding aspartate aminotransferase and malate dehydrogenase, respectively, flank era in F. tularensis. Although classified as Gram-, the flanking regions and the relative location of era in F. tularensis are distinctly different from those of typical Gram- and Gram+ bacteria. Computer analysis of bacterial Era protein sequences identified conserved domains in addition to the common G domains of most GTP-binding proteins.

Amino Acid Sequence↗