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Biomedical subjects

S Andreas

Publications and source records attributed to S Andreas.

At least 19 recordsLinked to original sources
PubMed2006

[Efficacy of a cognitive-behavioral program with pharmacological support to achieve smoking cessation].

BACKGROUND AND OBJECTIVE: In Germany over 30% of the population are smokers. Only very few smokers succeed in giving up smoking, because of the addictive nature of nicotine use. The objective of the present study was to evaluate a smoking cessation program which was recently established at a tertiary care clinic. PATIENTS AND METHODS: The median age of the 275 participants was 45.5 years; 60.4% of participants were female. Participants had tobacco dependence of 5.1 (Fagerstrom scale). The cognitive-behavioral smoking cessation program implemented in this clinic consisted of 8 sessions. Pharmacological support was recommended. A standardized evaluation was carried out after 6 and 12 months. RESULTS: All 275 smokers took part in the program over a period of 21 months. At the end of the course, 72% of participants had become non-smokers, after 6 months 37.6% and after 12 months 27.1% had stopped smoking. Those who have not yet been evaluated 12 months after the end of the program demonstrated a point prevalence of 45.7% after 6 months. The cigarette consumption of participants who were smoking at the end of the course was reduced to less than half. 6 months later they smoked an average of 18.0 cigarettes /day; 12 months after ending the course, 19.0 /day were consumed (p<0,001). Costs of about 250 Euro per gained life year were approximated. CONCLUSION: It is possible to establish a smoking cessation program at a large clinic. The results correspond to international published experiences and confirm that such a program is efficacious and cost-effective.

Adolescent↗
PubMed2006

Angiotensin II blockers in obstructive pulmonary disease: a randomised controlled trial.

In chronic obstructive pulmonary disease (COPD), the sympathetic nervous system, as well as the renin-angiotensin system, is activated with possible negative systemic effects on skeletal muscles. Angiotensin II type-1 receptor blockers inhibit the sympathetic and renin-angiotensin systems and might improve skeletal and respiratory muscle strength in patients in whom these systems are activated. The effects of the angiotensin receptor blocker irbesartan given over 4 months was evaluated in 60 patients with COPD and a forced expiratory volume in one second of <50% of the predicted value and without obvious cardiovascular disease that would necessitate the administration of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Irbesartan was well tolerated, but did not exert a significant effect on the primary end-point maximum inspiratory pressure. Spirometric results were not affected, but total lung capacity was reduced. Irbesartan led to a significant decrease in haematocrit (46.4+/-3.6 to 43.9+/-4.3% versus 47.5+/-2.4 to 48.7+/-3.0% with placebo). In conclusion, respiratory muscle strength in chronic obstructive pulmonary disease patients was not influenced by angiotensin II receptor blockade. However, the changes in haematocrit and total lung capacity following irbesartan raise the possibility that well-known cardiovascular drugs can produce unanticipated beneficial effects in chronic obstructive pulmonary disease patients.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2003

[The development of a case group concept for patients with mental diseases].

In the year 2000 the German legislative decided to implement a case-dependent reimbursement system in an acute inpatient setting beginning in 2003. The German-Diagnoses Related Group System (G-DRGs) will adopt the refined version of the Australian-Diagnoses Related Group System (AR-DRG, version 4.1). Based on empirical data and expertś panels the acute psychiatric hospitals have been exempted from the adoption of the case-based payment system. With regard to national and international experiences in the development of patient classification systems in psychiatry and medical rehabilitation this article illustrates the development of a case group concept for patients with mental disorders.

Australia↗
PubMed2001

Marked sympathetic activation in patients with chronic respiratory failure.

The autonomic nervous system may be disturbed in chronic respiratory failure. We tested the hypothesis that there is increased sympathetic activity in patients with chronic hypoxemia. Furthermore, we examined the effect of short-term oxygen on muscle sympathetic nerve activity (MSNA) in these patients. We performed microneurography of the peroneal nerve in 11 patients with hypoxemia due to chronic obstructive pulmonary disease (COPD, n = 6) or lung fibrosis (n = 5) and in 11 healthy subjects matched for age and sex. MSNA was measured during normal breathing in all subjects. In eight patients and in seven control subjects, MSNA was also measured during nasal oxygen (4 L/min). MSNA was higher in the patients with chronic respiratory failure compared with the healthy subjects during normal breathing (61 +/- 5 versus 34 +/- 2 bursts/min, mean +/- SEM; p = 0.0002, paired t test). During oxygen administration, MSNA decreased from 63 +/- 6 to 56 +/- 6 bursts/min in the patients (p = 0.0004, ANOVA); there was no change in sympathetic activity in the control subjects. For the first time, there is direct evidence of marked sympathetic activation in patients with chronic respiratory failure. This is partly explained by arterial chemoreflex activation and may play an important role in the pathogenesis of the disease.

Adult↗
PubMed2001

Short term effect of continuous positive airway pressure on muscle sympathetic nerve activity in patients with chronic heart failure.

OBJECTIVE: To test the hypothesis that the short term application of continuous positive airways pressure (CPAP) increases muscle sympathetic nerve activity in patients with congestive heart failure. SETTING: University hospital and tertiary referral centre. PATIENTS: 10 patients with congestive heart failure (New York Heart Association functional class III; mean (SEM) left ventricular ejection fraction 22 (1)%) and 10 healthy subjects matched for age, sex, and weight. MAIN OUTCOME MEASUREMENTS: Muscle sympathetic nerve activity, assessed by microneurography of the peroneal nerve, blood pressure, heart rate, minute ventilation, transcutaneous oxygen saturation, and end tidal PCO(2) were measured during normal breathing, mask breathing, and CPAP at 5 and 10 cm H(2)O. RESULTS: CPAP induced an increase in muscle sympathetic nerve activity and blood pressure in both the patients and the control subjects. In the patients, sympathetic nerve activity increased from 43 (14) bursts/min during mask breathing to 47 (13) bursts/min at CPAP 10 cm H(2)0 (p = 0.03); mean blood pressure increased from 80 (3) mm Hg to 86 (4) mm Hg (p < 0.001). Oxygen saturation improved during CPAP in the patients, from 95.7 (0.6)% to 96.6 (0.7)% (p = 0.004) and remained stable in the control group. There was no effect of CPAP on minute ventilation or heart rate. CONCLUSIONS: In patients with congestive heart failure, short term CPAP elicits sympathetic activation, probably because of unloading of the aortic or cardiopulmonary baroreceptors.

Adult↗
PubMed2000

Central sleep apnea and chronic heart failure.

Central sleep apnea with Cheyne-Stokes respiration (CSR) during sleep affects about 40 % of patients with chronic heart failure (CHF). During CSR simultaneous periodic fluctuations in wakefulness and respiration with accompanying changes in blood pressure and heart rate are observed. CSR can be described as an oscillation of the ventilatory feedback loop controlling respiration. The major synergistically acting mechanisms causing this oscillation include reduced body stores of oxygen and carbon dioxide, hyperventilation with concomitant hypocapnia, prolonged circulation time, and a relatively high hypercapnic ventilatory response. The repetitive desaturations and arousals following CSR cause daytime symptoms and an increase in sympathetic activity. In CHF chronically increased sympathetic activity has negative effects on left ventricular function and is associated with reduced exercise tolerance and poor prognosis. Therefore CSR is expected to have an unfavorable influence on the course of CHF. Whether successful treatment of nocturnal CSR has any impact on the high mortality of CHF needs to be resolved in controlled studies with sufficient sample size.

Chemoreceptor Cells↗
PubMed2000

Endothelin-1 plasma levels are not elevated in patients with obstructive sleep apnoea.

Endothelin-1 (ET-1), a potent vasoconstrictor, is released mainly by vascular endothelial cells under the influence of hypoxia and other stimuli. ET-1 is related to endothelial dysfunction, as well as arterial and pulmonary hypertension, all of which are thought to be associated with obstructive sleep apnoea (OSA). This study evaluated venous plasma concentrations of ET-1 and noradrenaline and 24-h systemic blood pressure in 29 patients with OSA (age=56.9+/-1.6 yrs; body mass index=29.5+/-0.7 kg x m2 (mean+/-SEM)). Blood samples were taken in the morning, evening and during sleep. In the same way, the patients were assessed during a night of continuous positive airway pressure (CPAP) and after 13.9+/-1.4 months while still on CPAP. ET-1 levels were compared to those of control subjects, who were selected from in- and outpatients and were matched to patients for age, sex, presence of arterial hypertension and coronary artery disease. ET-1 plasma levels were not elevated in the patients compared to the controls (41.6+/-2.2 and 44.9+/-1.3 pg x mL(-1), respectively, p=0.20). The ET-1 concentration did not change significantly, neither during sleep nor in the first night on CPAP therapy, nor under long-term treatment with CPAP. ET-1 neither correlated to the severity of OSA nor to that of systemic hypertension. The results suggest that endothelin-1 does not play a crucial role in the pathophysiology of obstructive sleep apnoea.

Blood Pressure Monitoring, Ambulatory↗
PubMed2000

Diagnosis of pulmonary aspergillosis using optical brighteners.

Invasive pulmonary aspergillosis (IPA) is increasingly recognized especially in immunocompromised patients, but early diagnosis remains a problem. Fungal elements in clinical specimens can be directly stained with an optical brightener. The high intensity of the elicited fluorescence allows for rapid and reliable microscopic screening. In the present study the authors aimed to validate this method. All specimens from bronchial secretions or pleural fluid suspected of mycosis (n=94) and all bronchoalveolar lavages (n=439) were prospectively evaluated by culture and staining with the optical brightener Blankophor-P-Flüssig. IPA was diagnosed for 17 specimens from 13 patients, using a combination of clinical, culture and radiological data, and by biopsy (n=3) or autopsy (n=3). The overall incidence of IPA was 3.3%. Nine of the 13 patients with IPA died (mortality=69%). Staining with the optical brightener and consecutive microscopic screening took 9+/-3 min. For the diagnosis of invasive aspergillosis, sensitivity was 0.88 and specificity was 0.99. Using culture, sensitivity was 0.76 and specificity was 0.99. In conclusion, direct examination of clinical specimens using the optical brightener has a high diagnostic potential for the diagnosis of invasive pulmonary aspergillosis. The reliability, simplicity and speed of the method render it suitable for routine diagnostic work.

Aspergillosis↗
PubMed2000

The structure of attitudes: attribute importance, accessibility and judgment.

Two studies related attribute importance to accessibility and speed of judgment. Attitudes were assessed by a direct attitude measure and a modal set of 15 attributes. Attributes were rated in terms of their probability and desirability. Subsequently, participants were required to select the five attributes they considered to be most important. Results of Study 1 (dealing with attitudes towards condom use) show that individually selected, important attributes are more easily retrieved and judged faster than non-selected, less important attributes. Judging attributes took less time than evaluating one's overall attitude, suggesting a bottom-up process in which the various attributes are combined to form an overall attitude. Study 2 (dealing with attitudes towards smoking) extends these findings and also addresses the stability of attitude structure. Important attributes were again associated with reduced response times, and attribute-related judgments took less time than judging one's overall attitude. Accessibility of important attributes remained stable over time as indicated by the results of a lexical decision task one week later. Finally, important attributes were also recalled better than less important attributes. Implications for research on attitude structure are discussed.

Adult↗
PubMed1999

Multiple transrectal ultrasound guided prostatic biopsies: morbidity and tolerance.

OBJECTIVE: Early detection of prostate cancer has become a matter of vital importance in modern societies. Ultrasound guided transrectal biopsy is the current standard urological procedure to detect prostate cancer. In this study our intention was to confirm the high tolerance and low complication rate of this procedure, facts already established in urologists' minds. MATERIAL AND METHODS: In order to evaluate the morbidity as well as the acceptance of the procedure, we investigated 120 patients who underwent ultrasound guided transrectal biopsies of the prostate, in our department from September 1995 to January 1996. All patients at each biopsy underwent 6 needle passes and took periprocedural antibiotic therapy. Alongside with recording the periprocedural side effects of this method patients answered a questionnaire in order to evaluate the pain they experienced by this procedure. RESULTS: Twenty patients were found to have prostate cancer at various stages. All patients tolerated well the whole procedure. Pain was the most common complaint among patients. Several complications were recorded; the most common of all was haematuria. Only two patients required admission to hospital because they developed fever after the procedure. CONCLUSION: Ultrasound guided transrectal biopsy of the prostate is a well-tolerated and effective method for obtaining multiple biopsy specimens from the prostate with low incidence of serious complications. Its is also accurate enough, allowing its use in everyday urology, as a diagnostic procedure.

Aged↗
PubMed1998

[Cheyne-Stokes respiration in patients with congestive heart failure].

Cheyne-Stokes respiration (CSR) during sleep is common in patients with severe congestive heart failure induces repetitive oxygen desaturation with arousals, and impairs sleep. This causes daytime symptoms and likely an increase in sympathetic activity. It has, therefore, been suggested that CSR is independently related to mortality. The major mechanisms behind CSR include reduced body stores of oxygen, a low apneic threshold for carbon dioxide, prolonged circulation time between the lung and the carotid body, and disturbance of respiratory control due to arousals. It is apparent that the main task in treating CSR is the therapy of congestive heart failure. Indeed, diuretics to treat pulmonary congestion as well as ACE-inhibitors reduce CSR. Recently, theophylline (an antagonist of the ventilatory depressant adenosine) was shown to reduce CSR and oxygen-desaturation. Continuous positive airway pressure did improve CSR but not sleep and may reduce cardiac output in a subgroup of patients with heart failure. Nocturnal oxygen reduces CSR and improves exercise tolerance as well as sleep. This and its apparent safety makes oxygen an appropriate treatment for nocturnal CSR. Whether successful treatment of nocturnal CSR has any impact on the natural course of heart failure needs to be determined in further studies.

Cheyne-Stokes Respiration↗
PubMed1998

Telomere shortening in uterine leiomyomas.

OBJECTIVE: To gain a better understanding of proliferation control mechanisms in a common benign tumor, we investigated the mean telomere length and the clonality of uterine leiomyomas. STUDY DESIGN: Deoxyribonucleic acid from uterine leiomyomas and from the adjacent normal myometrium of 51 patients (total number of uterine leiomyomas 107; 28 patients with single leiomyoma, 23 patients with multiple leiomyomas ranging from 2 to 8 myoma nodules per case) was hybridized to a telomeric oligonucleotide probe by Southern blot and chemiluminescent detection. The mean telomere length was evaluated by densitometry. Clonality was assessed with use of the phosphoglycerokinase gene polymorphism. RESULTS: The mean telomere length was significantly shorter in uterine leiomyomas (median 7950 bp, interquartile range 7261 to 8372 bp) than in normal myometrium (median 9688 bp, interquartile range 8528 to 10535 bp) (P < .001). There was no correlation between tumor size and telomere attrition. Multiple uterine leiomyomas were found to have an independent clonal origin. CONCLUSIONS: Telomere attrition in uterine leiomyomas reflects enhanced proliferation activity in the course of tumor evolution. The basic telomere lengths differ in the myocytes from which the uterine leiomyomas originate, probably explaining the lack of correlation between telomere attrition and tumor size.

Adult↗
PubMed1998

Complete morphologic and functional resolution of endocarditis of a Toronto stentless porcine bioprosthesis: a study by serial transesophageal echocardiography.

Prosthetic valve endocarditis is a serious complication after valve replacement with an incidence of 0.8% for both mechanical and bioprosthetic valves. The new Toronto stentless porcine valve (SPV) for aortic replacement offers promising early results in hemodynamics and a low incidence of valve-related complications. The yearly incidence of bacterial endocarditis was reported to be 1% to 1.5%. Though complications such as a perivalvular abscess or anular dehiscence require immediate surgery, a conservative management of infective endocarditis may be possible in carefully selected cases. This is the case of a patient with late prosthetic valve endocarditis of a Toronto SPV bioprosthesis, who, in spite of large vegetations on all three valve cusps, responded well to conservative treatment. This response was monitored through repeated transesophageal echocardiographic studies (TEE), which documented complete functional recovery of the valve.

Aged↗
PubMed1998

Nocturnal oxygen and hypercapnic ventilatory response in patients with congestive heart failure.

Patients with congestive heart failure and Cheyne-Stokes respiration have a low arterial oxygen saturation, especially during sleep, which can be increased by breathing oxygen. Chronic alterations in blood gases are known to modulate the hypercapnic ventilatory response (HCVR). We therefore evaluated whether the HCVR is influenced by nocturnal nasal oxygen in patients with heart failure and Cheyne-Stokes respiration. Twenty patients with chronic congestive heart failure and a left ventricular ejection fraction < or = 35% (mean 18.3% +/- SD 6.0%) as well as 25 healthy control subjects were studied. The patients were assigned to 1 week each of nocturnal nasal oxygen and room air with a flow of 41 min-1 in a randomized cross-over fashion. After each week resting ventilation and HCVR were evaluated by the rebreathing technique. Breathing oxygen during the night for 1 week increased the basal nocturnal oxygen saturation from 92.5% +/- 1.6% to 96.5% +/- 0.9% (P < 0.000,01) and reduced Cheyne-Stokes respiration. HCVR was 1.22 +/- 0.90 l min-1 mmHg-1 after nocturnal room air and did not differ from that in the control subjects (1.31 +/- 0.62 l min-1 mmHg-1). In the patients HCVR decreased to 0.91 +/- 0.52 l min-1 mmHg-1 after nocturnal oxygen (P = 0.019). There were no significant changes with nocturnal oxygen in resting minute ventilation, respiratory rate or end-tidal PCO2. We conclude that nocturnal nasal oxygen reduces HCVR in patients with congestive heart failure and Cheyne-Stokes respiration.

Carbon Dioxide↗
PubMed1998

Coxsackievirus genome in myocardium of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.

Enteroviruses are known as major infectious agents for inflammatory heart diseases such as myocarditis and dilated cardiomyopathy (DCM). Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) is characterized by replacement of right ventricular myocardium by fatty and fibrous tissue. In about 65% of patients inflammatory infiltrates suggest an inflammatory or infectious etiopathogenesis. To test this hypothesis, we investigated endomyocardial biopsies of patients with ARVC, with myocarditis or DCM, and from patients with non-inflammatory cardiac disorders for the presence of enteroviral genome. Enteroviral RNA with homology to coxsackieviruses type B was detected in 3 of 8 patients with ARVC (37.5%), in 7 of 23 patients with myocarditis or DCM (30.4%), but in none of 5 patient with non-infectious myocardial diseases (p < 0.05 compared to ARVC patients). These results support earlier suggestions that coxsackievirus infection of the myocardium is possibly related to the pathogenesis of ARVC.

Adult↗
PubMed1998

Treatment of Cheyne-Stokes respiration with nasal oxygen and carbon dioxide.

Cheyne-Stokes respiration (CSR) is common in patients with congestive heart failure (CHF) and is associated with significant nocturnal O2 desaturation, arousals and sympathetic activation. Nocturnal O2 reduces CSR by only about 50%. More complete suppression of CSR may be achieved by adding CO2 to O2. This study therefore aimed to evaluate the effects of nocturnal O2 plus CO2 on CSR, sleep and sympathetic activation. Nine patients with CHF (age 59+/-5 yrs; left ventricular ejection fraction 17.8+/-1.2% (mean+/-SEM) were studied in a cross-over, single-blind, placebo-controlled trial. After an accommodation night the patients were randomly assigned to one night each of O2 plus CO2 as well as air applied by nasal prongs. Nocturnal O2 plus CO2 reduced the duration of CSR as percentage of total sleep time (48.0+/-10 versus 7.4+/-2.0%; p=0.008) and increased arterial oxygen saturation (Sa,O2) as well as mean transcutaneous carbon dioxide tension (Ptc,CO2) (5.2+/-0.3 kPa (39+/-2 mmHg) versus 5.7+/-0.3 kPa (43+/-2 mmHg) p=0.011). Sleep did not improve and arousals were not reduced. Plasma noradrenaline was higher on the treatment night (486+/-116 versus 669+/-163 ng x L(-1); p=0.035). In conclusion, nocturnal O2 plus CO2 improves Cheyne-Stokes respiration in patients with congestive heart failure but has adverse effects on the sequel of Cheyne-Stokes respiration, namely sympathetic activation.

Administration, Intranasal↗