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Biomedical subjects

R Voigt

Publications and source records attributed to R Voigt.

At least 19 recordsLinked to original sources
PubMed2006

Weak VLPP and MUCP correlation and their relationship with objective and subjective measures of severity of urinary incontinence.

The aims of the present study were to find the correlation between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP) and to determine whether the water perfusion maximum urethral closure pressure (MUCP) correlates with VLPP. Seventy-nine women with previously untreated stress urinary incontinence were recruited to participate in a clinical study. Their mean age was 56.4 years, mean BMI was 27.8, and mean parity was 1.9. The mean values of VLPP and CLPP were 50.4 and 52.9 cm H(2)O, respectively. We did not find statistically significant differences in the mean values of VLPP and CLPP. The mean value of MUCP at rest was 44.2 cm H(2)O and the mean value of MUCP during maximal Valsalva maneuver was 37.2 cm H(2)O; with 500 ml of sterile saline in the bladder the difference between them is statistically significant. In the study group (n=79), 56 patients (77%) had low VLPP (< or =60 cm H(2)O), 21 patients (30%) had low MUCP (< or =30 cm H(2)O), and 8 patients had MUCP< or =20 cm H(2)O (all at rest). Of the 56 patients with low VLPP, 16 also had a low MUCP (< or =30 cm H(2)O). This study mainly compares two parameters-the MUCP and the VLPP. Based on our results we can conclude that there is no correlation between these parameters. MUCP measures urethral resistance at rest and VLPP measures urethral resistance during increased intra-abdominal pressure (Valsalva maneuver).

Adult↗
PubMed2006

A community randomized controlled clinical trial of mixed carotenoids and micronutrient supplementation of patients with acquired immunodeficiency syndrome.

OBJECTIVE: This clinical trial aims to evaluate if natural mixed carotenoids supplementation can improve the health and survival of acquired immunodeficiency syndrome (AIDS) patients. DESIGN: A placebo-controlled, prospective, randomized, double-blind, multicenter clinical trial. SETTING: Community, tertiary care human immunodeficiency virus (HIV) clinics of the Canadian HIV Trials Network (CTN). PARTICIPANTS: Three hundred and thirty-one adults with advanced AIDS on conventional management were recruited during routine clinic visits. INTERVENTIONS: All participants, including 166 controls, received daily oral specially formulated multivitamins including vitamin A and trace elements; 165 treatment group participants received additional daily oral natural mixed carotenoids, equivalent to 120,000 IU (72 mg) of beta-carotene daily. Follow-up was quarterly at routine clinic visits. RESULTS: Mean (s.d.) follow-up was for 13 (6) months. Thirty-six participants died by 18 months. Serum carotene concentration <1.0 micromol/l was present in 16% participants at baseline. Despite variation in carotene content of the treatment medication, serum carotene concentrations increased significantly to twice the baseline levels to 18 months follow-up in participants who received carotenoids treatment compared with controls (P < 0.0001). Although not statistically significant, mortality was increased in participants who did not receive carotenoids treatment compared with those who did (HR time to death 1.76, 95% CI 0.89, 3.47, P = 0.11). In multivariate analysis, survival was significantly and independently improved in those with higher baseline serum carotene concentrations (P = 0.04) or higher baseline CD4 T-lymphocyte counts (P = 0.005). Adjusted mortality was also significantly and independently increased in those who did not receive carotenoids treatment compared with those who did (HR time to death 3.15, 95% CI 1.10, 8.98, P = 0.03). CONCLUSIONS: Low serum carotene concentration is common in AIDS patients and predicts death. Supplementation with micronutrients and natural mixed carotenoids may improve survival by correction of a micronutrient deficiency. Further studies are needed to corroborate findings and elucidate mechanism of action.

Acquired Immunodeficiency Syndrome↗
PubMed2006

[Presenting problem: abdominal pain].

The Saxon Study for General Medicine (SESAM) investigated the reasons why patients consulted the general physician, what diagnoses were established, and how the patients were subsequently treated. In the majority of cases, the reason for the abdominal complaints was located in the gastrointestinal or urogenital tract, in the presence of infections or psychosomatic problems. Gynecological problems must also be considered, while diseases other than gastrointestinal are of no significance for the differential diagnosis of abdominal complaints in the general physician's office.

Abdominal Pain↗
PubMed2005

[Insect stings and their sequelae].

In the summer months, insect stings are a common reason for seeking help from the general physician. In the majority of cases a local reaction is seen, but, far less often, an anaphylactic reaction may also occur. Such an acute situation requires calm but decisive action, and the initiation of an evaluation by an allergy specialist. The family doctor should regularly review the facilities for treating an anaphylactic reaction in his office, and, where necessary, optimize them.

Anaphylaxis↗
PubMed2004

Low-level gonosomal mosaicism in women undergoing ICSI cycles.

PURPOSE: Females with low-level gonosomal mosaicism (LLGM) scheduled for ICSI were retrospectively analyzed and compared to control groups. The prevalence of this mosaicism as well as its impact for an ICSI treatment were evaluated. METHODS: Routine cytogenetic analysis was done in 891 females scheduled for ICSI treatment. For comparison 294 females with recurrent abortions and 104 women with clinical or cytogenetical affected children, who also had routine chromosome analysis, were acquired. RESULTS: In the ICSI group the incidence of LLGM was significantly lower compared to the group of females with recurrent abortions (3.9% vs. 8.5%, p < 0.01). The incidence was similar between the groups of ICSI females and females with cytogenetical or clinically affected children (5.8%, p = 0.43). Neither anamnestic factors nor outcome parameters were different between females with and without LLGM undergoing ICSI. CONCLUSION: There is no higher incidence of LLGM in females undergoing ICSI. In those who show LLGM, fertility capacity is not reduced.

Abortion, Habitual↗
PubMed2004

[Correlation of maximum urethral closure pressure and Valsalva leak-point pressure in patients with genuine stress incontinence].

OBJECTIVE: The aim of our study was to find correlation between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP) and to determine whether water perfusion maximum urethral closure pressure (MUCP) correlates with Valsalva leak-point pressure (VLPP). DESIGN: Cross-sectional clinical study. SETTINGS: Gynecological and Obstetric Clinic, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. MATERIAL AND METHODS: Thirty women with previously untreated GSI were recruited to participate in a clinical study. Their mean age was 56.9, mean body mass index (BMI) 27.6, and mean parity 1.8. As part of the urethral pressure profile we determined MUCP and functional length (FUL) of the urethra. VLPP and CLPP were assessed during US examination using an ultrasound contrast medium and the color Doppler velocity (CDV). Funneling was described as the increase in distance between the inner edges of proximal urethra during Valsalva maneuver. RESULTS: We did not find statistically significant differences in the mean value of VLPP and CLPP. The mean value of VLPP was 51.6 cm H2O (SD=26.5) and CLPP 53.1 cm H2O (SD=25.5). The mean values of MUCP were 39.7 cm H2O (SD=22.1) with 500 ml and 41.5 cm H2O (SD=22.7) with 300 ml of sterile saline; the difference between them is not statistically significant. In the study group (n=30), 22 patients had low VLPP (< or = 60 cm H2O). Only 8 patients had simultaneously MUCP < or = 30 cm H2O and of these patients only 2 had simultaneously MUCP < or = 20 cm H2O (the bladder volume 300 ml). Similar results were obtained with the bladder volume 500 ml. We did not find statistically significant differences in the funneling of proximal urethra between the groups of patients with low MUCP (< or = 30 cm H2O) and with higher MUCP (> 30 cm H2O) and between the groups of patients with low VLPP (< or = 60 cm H2O) and with higher VLPP (> 60 cm H2O). CONCLUSIONS: This study mainly compares two parameters--the MUCP and the VLPP. Based on our results we support the theory that ISD has a multifactorial basis, and a low MUCP or a low VLPP derives from two different pathogenic mechanisms. We support the Pajoncini hypothesis that low VLPP correlates with a deficiency in mucosal sealing and compromise of the intrinsic proximal component at the level of the bladder neck, and low MUCP correlates with a deficiency at the level of the rhabdosphincter in the middle urethra. In the future we must establish the prognostic value of the VLPP and the MUCP in the postoperative follow-up.

Adult↗
PubMed2003

SCA17 caused by homozygous repeat expansion in TBP due to partial isodisomy 6.

An expanded polyglutamine domain in the TATA-binding protein (TBP) has been described in patients with spinocerebellar ataxia type 17 (SCA17) characterized by cerebellar ataxia associated with dementia. TBP is a general transcription initiation factor that regulates the expression of most eukaryotic genes transcribed by RNA polymerase II. SCA17, as an autosomal dominantly inherited progressive neurodegenerative disorder, is caused by heterozygous expansion of a CAG repeat coding for glutamine. Alleles with 27 to a maximum of 44 glutamine residues were found as the normal range, whereas expansions above 45 repeat units were considered pathological. Here, we present a patient with a very severe phenotype with a late onset but rapidly progressing ataxia associated with dementia and homozygous 47 glutamine residues caused by an apparent partial isodisomy 6. This extraordinary case has important implications for the insights of TBP and SCA17. The expanded polyglutamine domain in both TBP copies is not correlated with embryonic death indicating that the normal function of the protein is not disrupted by this kind of mutation but may account for the dementia seen in this patient.

Adult↗
PubMed2003

[Pseudoaneurysm--a rare complication of internal jugular vein cannulation: two case reports in liver transplant patients].

Internal jugular vein catheterization is nowadays a routine procedure in clinical practice. Arterial puncture is the most common complication of internal jugular vein catheterization. Two cases of pseudoaneurysm formation as a complication of accidental arterial puncture in liver transplant patients with coagulopathy are presented. Punctures of the common carotid artery, thyrocervical trunk, respectively were the source for these lesions. Coagulopathy is seen as an essential factor in the formation of pseudoaneurysm. Especially in patients with coagulopathy the threshold for ultrasound guidance should be low. Under these circumstances using the external jugular vein seems to be more prudent as it eliminates the risk for arterial punctures. We illuminate the genesis, signs and symptoms, diagnosis, and therapy of pseudoaneurysm. Recommendations for risk reduction are given.

Aneurysm, False↗
PubMed2001

Long-term combination of interferon alfa-2b and ribavirin for hepatitis C recurrence in liver transplant patients.

The purpose of this study was to evaluate the feasibility, tolerability and efficacy of long-term combination therapy with interferon-alfa 2b (IFNalpha-2b) and ribavirin (Rb) for recurrent hepatitis C after liver transplantation. Fifteen patients with histologically confirmed hepatitis C after liver transplantation were treated. After a basic course of 12 months (IFNalpha-2b 3 MU/3 times a week; Rb 3 x 200 mg/day), patients achieving clearance of viremia underwent maintenance therapy with ribavirin (3 x 200 mg/day). Patients without virological response continuously received combination therapy. Levels of HCV RNA, aminotransferases and bilirubin were followed. Therapy led to a significant decline of transaminases and bilirubin in all patients (p < 0.05). Sixty-four per cent of patients had clearance of viremia after 12 months. Sustained virolo gical response was 88%. In patients without virological response, continuation of combination therapy prevented another biochemical relapse of hepatitis. Treatment was accompanied by severe hematological side-effects, requiring medical support in a majority of patients. In two patients (13.5%), therapy finally had to be withdrawn because of major hematological disorders. These results indicate that long-term combination therapy with IFNalpha-2b and Rb is effective in the treatment of recurrent hepatitis C and in preventing further relapse of disease after liver transplantation, but side-effects may require cessation of therapy.

Adult↗
PubMed2001

Ultrasound imaging of the lower urinary system in women after Burch colposuspension.

OBJECTIVE: Most of the relevant surgical procedures employed in the management of genuine stress urinary incontinence (GSI) involve the technique of bladder neck elevation. The appropriate level of suspension is an important (but frequently overlooked) consideration as the clinical consequences of over-correction of the posterior angle are voiding dysfunction and urgency symptoms. The aim of our study was to compare ultrasound characteristics in women with GSI with those of women before and after Burch colposuspension. The findings of our study should have implications for GSI management. DESIGN: Prospective randomized clinical study at the Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. METHODS: Seventy women with previously untreated GSI (preoperative group) and 52 women (42 of whom had been in the preoperative group) who were studied 3-12 months after receiving Burch colposuspension (postoperative group) took part in the study. The standard transperineal and introital ultrasound scans were performed. The mobility of the bladder neck was assessed transperineally with a curved array probe after instillation of 300 mL of saline. The bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) was measured. RESULTS: We found significant differences in bladder neck position, mobility, and in bladder wall thickness. Where symptoms of urgency occurred, the average bladder wall thickness was > 5 mm, the gamma angle < 40 degrees, and lower bladder neck mobility was evident. CONCLUSION: These findings supported our hypothesis that signs of urgency follow over-elevation of the bladder neck. These results helped us significantly to refine our GSI management.

Case-Control Studies↗
PubMed2001

Hepatitis B vaccination in sexually transmitted disease (STD) clinics: a survey of STD programs.

BACKGROUND: Hepatitis B virus infection causes substantial morbidity and mortality in the United States. Sexual activity is the most commonly reported risk factor among persons with acute hepatitis B, yet hepatitis B vaccine coverage among adolescents and adults with high-risk sexual practices is low. Sexually transmitted disease (STD) clinics are potentially efficient settings for vaccine administration to persons with high-risk sexual practices; however, little is known about hepatitis B vaccination activities in these settings. GOAL: To gain information about policies and activities for vaccinating against hepatitis B in STD clinic settings. STUDY DESIGN: In April 1997, a questionnaire was sent to managers of 65 federally funded STD programs in state and local health departments. A similar survey was sent to 89 STD clinic managers in November 1997. RESULTS: The response rate among program managers was 97% (63/65). Forty-eight percent considered hepatitis B prevention a program responsibility; 21% had developed and distributed written policies to prevent hepatitis B through vaccination; and 27% had developed policies to encourage hepatitis B education activities. The response rate among clinic managers was 82% (73/89). Forty-five percent reported that their STD clinics had implemented policies recommending hepatitis B vaccination and health education activities. Program managers and clinic managers reported that lack of funding to cover the cost of the vaccine, and lack of resources to provide prevaccination counseling, administer vaccine, and track clients for vaccine series completion were the primary barriers to the implementation of hepatitis B vaccination programs. CONCLUSIONS: To enhance hepatitis B vaccination in STD clinics, existing funding sources must be accessed more effectively. Supplemental funding mechanisms for the cost of vaccine and resources for implementing vaccination programs also need to be identified. Additionally, STD clinics and programs should continue to propose and implement hepatitis B vaccination policies.

Adolescent↗
PubMed2000

Sensory processing of water currents by fishes.

Water currents are extremely important in the aquatic environment and play a very significant role in the lives of fishes. Sensory processing of water currents involves a number of sensory modalities including the inner ear, vision, tactile sense and the mechanosensory lateral line. The inner ear will detect whole-body accelerations generated by changes in flow, or by turbulence, whereas visual and tactile inputs will signal translational movement with respect to an external visual or tactile reference frame. The superficial neuromasts of the mechanosensory lateral line detect flow over the surface of the body and have the appropriate anatomical distribution and physiological properties to signal the strength and the direction of flow and, hence, contribute to the detection of regional differences in flow over different parts of the body.

Animals↗
PubMed2000

Effectiveness and cost-benefit of enhancements to a syphilis screening and treatment program at a county jail.

BACKGROUND: High rates of syphilis are found in inmates of county jails. Treatment of this infected transient population necessitated the development of a rapid protocol. GOAL: To evaluate a rapid screening and treatment protocol for syphilis in a county jail. STUDY DESIGN: Over a 2-year period 18,442 inmates were screened for syphilis with a nontreponemal test and record search for treatment history. Confirmatory test results were reviewed following treatment. Cost was defined as deflated marginal outlays. Benefit was calculated as the discounted expected cost of treatment of congenital, late, and neurosyphilis. RESULTS: The sensitivity, specificity, and positive predictive value of the protocol were 99.6%, 80.8%, and 79.3%, respectively. Of 257 confirmed cases, 183 were offered treatment in jail. The percentage of short-term inmates treated increased following implementation. The cost-benefit ratio was 9.14:1. CONCLUSIONS: The protocol was highly effective in patient identification and treatment delivery, and cost-effective as well.

Cost-Benefit Analysis↗