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Biomedical subjects

R Mader

Publications and source records attributed to R Mader.

At least 19 recordsLinked to original sources
PubMed1992

Infections that cause vasculitis.

An infectious cause has long been suspected for most forms of vasculitis. In most cases vascular damage has been ascribed to immune-mediated mechanisms rather than direct microbial toxicity. Evidence cited in this review provides further support for a causal role of infection in the vasculitides by strengthening the link between group A streptococci and hepatitis B virus with polyarteritis nodosa and Kawasaki syndrome. It is anticipated that the application of new molecular technology will provide definitive evidence for the role of infection in the etiopathogenesis of the vasculitides.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1991

Study of the mechanism of the photoisomerization and photooxidation of bilirubin using a model for the phototherapy of hyperbilirubinemia.

Liquid chromatography was employed for a study of photochemical degradation of bilirubin in the complex with human albumin, using a model system in the presence of riboflavin. The concentrations of bilirubin, the photoisomers and biliverdin were monitored. The reaction mechanism was verified using a quantified mathematical model and was represented by a reaction scheme. Photoisomerization is the initial process, followed by photooxidation to degradation products of the tetrapyrrole skeleton, with formation of biliverdin as an intermediate. The blood of newborns that were irradiated for treatment of hyperbilirubinemia was studied for the sake of comparison. The effect of some biochemically important substances was followed, in view of possible inhibition of the processes. The experimental results demonstrate that riboflavin acts as a catalyst, even at the concentrations typical for its occurrence in blood. The results are discussed from the point of view of the mechanism of bilirubin degradation during phototherapy.

Bilirubin↗
PubMed1991

Complete remission of metastasised clear cell sarcoma of tendons and aponeuroses.

Clear cell sarcoma of tendons and aponeuroses is a rare disorder which originates from migrated neural crest cells. It tends to local recurrences and dissemination and the prognosis has to be considered as poor. Based on a small series of patients, a wide surgical excision of the primary tumour or amputation are the therapies of choice. Radiotherapy might be of some value as an adjuvant treatment but radiotherapy and chemotherapy are of little value in the treatment of the advanced disease. Because of the lack of treatment alternatives we treated a 40-year-old female patient with disseminated clear cell sarcoma with interferon-alpha 2b (IFN-alpha 2b) perilesionally after several courses of systemic chemotherapy and radiotherapy had failed. After 4 months of therapy the patient came into a complete pathological remission which lasted for 17 months. A relapse of round cell sarcoma on both tumour sites was then noted. This outcome shows that IFN-alpha 2b was able to induce a complete remission in clear cell sarcoma and might have altered the natural course of the disease. IFN-alpha should be studied as adjuvant therapy after surgery of primary clear cell sarcoma and as a first-line palliative treatment in disseminated disease.

Adult↗
PubMed1991

[5-Fluorouracil (5-FU)/leucovorin in comparison to other current chemotherapy protocols in metastasizing colorectal carcinoma].

17 patients with metastasizing colorectal cancer were treated in a phase II-study with systemic intravenous chemotherapy (Petrelli N, Proc ASCO 286, 1987) consisting of leucovorin 500 mg/m2 in a 2 hr infusion and 5-fluorouracil (5-FU) 600 mg/m2 bolus one hour after the commencement of the leucovorin infusion. Limiting toxicities were gastrointestinal, in form of nausea/vomiting of WHO grade 3 (n = 1) and of diarrhoea of maximal grade 4 (n = 5), as well as haematological with a maximal nadir of leucocytes of WHO grade 4 (n = 1) and of thrombocytes of WHO grade 1 (n = 1). Of the 14 evaluable patients an objective response was achieved in 21% of cases (CR: n = 1, PR: n = 2). 64% of the patients showed no change and 14% showed progression of their disease, 7 out of the 17 patients have died; the median survival was 24 months. With respect to objective remission, our result of 21% response rate is lower than the median of 32% of 24 different studies comprising 695 patients; nevertheless, the present response rate is within the range observed in the published studies of between 0% and 67%. In order to estimate the antitumoral efficacy of the new regimen 5-FU/leucovorin more objectively, a retrospective comparison of the therapy regimens used most frequently in disseminated colorectal cancer (5-FU monotherapy, 5-FU/methotrexate (MTX), 5-FU/MTX/low dose leucovorin, 5-FU/cisplatin, 5-FU/leucovorin) has been performed. The continuous administration of 5-FU monotherapy, with an objective response rate of 26%, was superior to standard 5-FU monotherapy as a bolus injection or short-term infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Malabsorption in systemic lupus erythematosus].

A 25-year-old man, who was admitted for evaluation of arthralgia and fever of 2-weeks duration, complained of a 10 kg weight loss during the previous weeks. Systemic lupus erythematosus (SLE) was diagnosed on the basis of leukopenia, LE cells, antinuclear antibodies, antibodies to double-stranded DNA, and arthritis, Malabsorption was diagnosed because of the finding of hypoalbuminemia, fat droplets in the feces, a pathological D-xylose test, and an appropriate X-ray image. Approximately half the patients with SLE develop minor expressions of gastrointestinal tract involvement, such as nausea, vomiting, and diarrhea. Major manifestations, such as intestinal obstruction or perforation, ascites, peritonitis and pancreatitis have been reported with varying frequency. Despite the frequent association of SLE with gastrointestinal manifestations, malabsorption, as in this case, has rarely been reported.

Adult↗
PubMed1990

[Pseudomonas aeruginosa arthritis and discitis in systemic lupus erythematosus].

Patients with systemic lupus erythematosus (SLE) are prone to develop opportunistic infections. Nevertheless, arthritis due to Pseudomonas aeruginosa in SLE is very rare and seems to be related to corticosteroid therapy and previous penetrating injury. A 17-year-old girl with SLE and Pseudomonas arthritis and discitis which followed laparotomy is described. Arthritis is a common manifestation of SLE, but arthritis due to infection with Pseudomonas is very serious and the diagnosis should not be missed.

Adolescent↗
PubMed1990

On the treatment of the alcoholic organic brain syndrome with an alpha-adrenergic agonist modafinil: double-blind, placebo-controlled clinical, psychometric and neurophysiological studies.

1. In a double-blind study forty abstinent hospitalized male patients with an alcoholic organic brain syndrome (OBS) were treated for 6 weeks with either 200 mg modafinil or placebo. 2. Modafinil (CRL 40476) is a putative central alpha-1 adrenergic agonist. It's pharmacological profile is quite different from that of amphetamine, which can be seen by the lack of peripheral sympathomimetic effects. The vigilance promoting effect of modafinil has been shown previously in pharmaco-EEG and psychometric studies as well as in clinical studies involving treatment of daytime sleepiness in idiopathic hypersomniacs and narcoleptics. 3. The present clinical investigations demonstrated that the spontaneous restitution of the alcoholic OBS was significantly augmented and accelerated by modafinil. 4. Psychometric tests did not show significant intergroup differences. Modafinil- and placebo-treated patients improved continously over the 6-week period. 5. Psychophysiological and autonomous nervous system parameters were affected neither by placebo nor by modafinil. 6. Neurophysiological investigations by means of quantitative pharmaco-EEG showed partly inconsistent findings. However, superimposed dosages of modafinil (on the top of 6 weeks chronic administration) induced a decrease of slow activity and an increase of alpha activity suggesting an improvement of vigilance after the daily drug intake. 7. Considering the beneficial effects of modafinil in abstinent chronic alcoholic patients, it may be said that activation and improvement of adaptive behaviour by an alpha-adrenergic agonist could be regarded as a therapeutic principle in the treatment of the OBS, eventually due to noradrenergic deficits.

Adrenergic alpha-Agonists↗
PubMed1990

Phase I-II study on weekly administration of pirarubicin in patients with metastatic breast cancer.

A phase I-II study of weekly low-dose pirarubicin was performed in 19 patients with advanced breast cancer. The goal was to establish the optimal dose intensity, i.e., the maximal dose applicable at tolerable toxicity within the intended schedule. Each of the four different dose groups used (20, 24, 25, and 27 mg/m2) comprised 4-5 patients. In over 47% of patients, objective remissions were obtained (confidence interval 26%; 71%) including one complete and eight partial remissions; the median duration of remission was 41 weeks (range 16-72), and the median time to reach remission was 12 weeks (range 6-36). Efficacy of treatment was more dependent on prior chemotherapy than on pirarubicin dosage. The weekly i.v. push injection of the drug was easily applicable at an outpatient clinic and well tolerated. WHO grade 3 was the highest toxicity observed for leukopenia (3/19), leukopenia associated with infection (1/19), nausea/vomiting (2/19) and alopecia (6/19). More severe myelosuppression was avoided by interrupting the weekly application until recovery of leukocytes to greater than or equal to 3.5 x 10(3)/mm3. No clinical signs of cardiotoxicity were observed. Generally, mild to moderate signs of cardiac dysfunction acquired during therapy were detected by special cardiac monitoring. Only in 3 of 19 patients was a cumulative dose of more than 550 mg/m2 surpassed. This was accepted as the upper limit for conventional anthracycline therapy. The median cumulative dose applied was 325 mg/m2/week (range 58.2-800.0). Because of maldistribution of prognostic factors, no dose-response relationship could be established. With respect to the total time for which each patient was studied, the dose group of 27 mg/m2 achieved the highest dose intensity with a median of 17.4 mg/m2/week (range 13.5-22.4). Therefore, the dosage of 27 mg/m2/week is recommended to be used in further phase II-III trials of weekly applied pirarubicin.

Adult↗
PubMed1990

Diagnosis of chronic alcoholism--classificatory problems.

Since Magnus Huss introduced the diagnosis of 'chronic alcoholism' into medical literature in 1849, two unsolved problems concerning classification have remained: (1) Differentiation between problem drinkers and chronic alcoholics fluctuates, whereby the cut point of differentiation between abuse and addiction remains differently defined by different authors. Some authors view alcohol-induced damage as a building-stone of diagnosis of chronic alcoholism whereas other authors define these damages as illnesses developed as a consequence of chronic alcohol intake. This fact is also mirrored in the different definitions of chronic alcoholism by different classification systems, like ICD-9, DMS-III or DMS-III-R. Valid and reliable questionnaires, like the Munich Alcoholism Test or the Problem Drinking Scale did not succeed in solving this problem of definition, either. (2) The fact that chronic alcoholics are sick--in the sense of a biological-medical approach--is undoubted. Our research group was able to prove that chronic alcoholic patients metabolize methanol in a different way from that of healthy persons. The biological, sociological and psychopathological heterogeneity of this illness has been stressed for more than a century. A prospective long-term study carried out over 4-7 years has led to the development of a new typology in chronic alcoholism that is able to differentiate subgroups of chronic alcoholic patients cross-sectionally in a clinical, biochemical and neurophysiological way. Diagnosis according to this typology qualitatively differentiates patients in many spheres other than drinking behavior. These subgroups also require correspondingly modified therapeutic strategies.

Alcohol Drinking↗
PubMed1989

Mucin-like cancer-associated antigen (MCA) compared with CA 15-3 in advanced breast cancer.

Mucin-like cancer-associated antigen (MCA), a new tumor marker using the mouse monoclonal antibody b-12 is thought to be of value in the management of patients with breast cancer. In this study sera from 191 female patients with breast cancer (112 with progressive disease [PD] and 79 with no evidence of disease [NED]) were analyzed for MCA levels and compared with those of cancer antigen 15-3 (CA 15-3) in single determination and in combination with carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA). A cut-off level of 14 U/ml for MCA seems to be more appropriate than the recommended 11 U/ml to distinguish between PD and NED in patients with breast cancer. Although there was a fairly good correlation of MCA to CA 15-3, MCA was inferior in sensitivity and specificity to CA 15-3. Patients with osseous metastases and those with more than one metastatic site showed higher MCA levels than patients with visceral or soft tissue metastases, a fact which was comparable to CA 15-3. Combining MCA and CA 15-3 resulted in a gain in specificity but marked loss of sensitivity. The combination of MCA and CEA results also in a loss of sensitivity whereas the combination of CA 15-3 and CEA showed an increased specificity and only a negligible loss of sensitivity. The combination of MCA with TPA is of little value in the follow-up of breast cancer, as is the combination of CA 15-3 with TPA. The combination of CA 15-3 with CEA can be still recommended for follow-up for early detection of metastases in breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Chronic subdural hematoma simulating transient ischemic attacks].

Chronic subdural hematoma presenting as transient ischemic attacks (TIA) is very rare. In a 74-year-old man in whom chronic subdural hematoma was responsible for recurrent attacks of local neurological deficiencies, the diagnosis was established by computerized tomographic (CT) scanning. Both TIA and chronic subdural hematoma usually occur in the elderly. Since the prognosis as well as the therapeutic approach are completely different in the 2 conditions, it is advisable to use imaging techniques, such as CT scanning, when there are recurrent TIA.

Aged↗
PubMed1989

Medication and drug abuse in relation to road traffic safety.

Apart from alcohol, various other substances with a psychotropic effect have been discussed recently in relation to their association with road traffic safety. There has been a general lack of hard facts, however, on how much drug use and abuse influence this. In the absence of data on the frequency of such effects, a representative random sample (approx. 8000 persons) of the Austrian population was interviewed and questioned on their drug intake. A smaller sample (2007 persons) was also questioned as to their behaviour regarding road traffic participation. The results showed that those drugs taken most frequently belong to the 'analgesic' group, whilst the frequency in use of substances to which greater importance is attached currently regarding road safety is relatively low (tranquillizers by 4%; strictly 'psychotropic' drugs by 0.3% to 0.6% of the population). These findings are similar to those reported in English-speaking countries. Data analysis showed that socio-cultural factors (age, sex, marital status and profession) influence the frequency and type of drug intake. The definition of drug abuse and addiction used (increase of dosage, inappropriate use, effect changes) proved somewhat unreliable and called into question the criteria used for diagnosis and categorization of persons at risk. In view of the results of previous studies and the importance attached by critics, an unexpected finding of this survey was the minor influence exerted by tranquillizers on road traffic safety. However, the number of cases for individual drug classes was relatively small and there is a need for more broadly based studies of a similar design before reaching firm conclusions.

Accidents, Traffic↗
PubMed1988

Toxicity and response to high-dose ifosfamide + mesna as salvage therapy for advanced breast cancer.

Twenty-six cycles of high-dose ifosfamide + mesna (HD-IFO + M) were applied to seven female patients with advanced breast cancer refractory to prior treatment, using three different durations of continuous infusion (4, 24, and 48 h) every 3 weeks. To evaluate the most tolerable time schedule, the duration of the infusions was changed periodically in each patient. Toxicity was low in general, but continuous infusion of HD-IFO + M over 24 h appeared to be the best tolerated. One partial response lasting 27 weeks was achieved and four patients achieved stable disease lasting from 9 to 12 weeks.

Adult↗
PubMed1988

[Angioimmunologic lymphadenopathy evolving into malignant lymphoma and associated with Kaposi's sarcoma].

Angioimmunoblastic lymphadenopathy with dysproteinemia is a recently described entity with severe clinical symptoms and characteristic histological findings in the lymph nodes with occasional malignant transformation. Kaposi's sarcoma is a neoplastic angiomatous growth of unknown origin. Alterations in the immune system have been reported in both diseases. The association of angioimmunoblastic lymphadenopathy with dysproteinemia and Kaposi's sarcoma in the same patient may suggest a common origin for both.

Bone Marrow↗
PubMed1987

[Carpal tunnel syndrome in polymyalgia rheumatica. Clinical and electromyographic response to systemic treatment].

The association between carpal tunnel syndrome and Polymyalgia Rheumatica has already been described. As in other systemic diseases the bilaterality of the syndrome is a common finding. Surgical treatment is usually necessary in carpal tunnel syndrome. Three cases of the syndrome associated with polymyalgia rheumatica are presented. Clinical remission and normalization of the electromyographic tracing were achieved by systemic corticosteroid treatment. The relationship between these two conditions is once more confirmed. A "wait and see" period which might eventually avoid unnecessary surgical intervention is strongly recommended.

Adrenal Cortex Hormones↗