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Biomedical subjects

T Binder

Publications and source records attributed to T Binder.

At least 37 records · Page 2Linked to original sources
PubMed1999

NC100100, a new echo contrast agent for the assessment of myocardial perfusion--safety and comparison with technetium-99m sestamibi single-photon emission computed tomography in a randomized multicenter study.

BACKGROUND AND HYPOTHESIS: Myocardial contrast echocardiography using second-generation agents has been proposed to study myocardial perfusion. A placebo-controlled, multicenter trial was conducted to evaluate the safety, optimal dose, and imaging mode for NC100100, a novel intravenous second-generation echo contrast agent, and to compare this technique with technetium-99m sestamibi (MIBI) single-photon emission computed tomography (SPECT). METHODS: In a placebo-controlled, multicenter trial, 203 patients with myocardial infarction > 5 days and < 1 year previously underwent rest SPECT and MCE. Fundamental and harmonic imaging modes combined with continuous and electrocardiogram-- (ECG) triggered intermittent imaging were used. Six dose groups (0.030, 0.100, and 0.300 microliter particles/kg body weight for fundamental imaging; and 0.006, 0.030, and 0.150 microliter particles/kg body weight for harmonic imaging) were tested. A saline group was also included. Safety was followed for 72 h after contrast injection. Myocardial perfusion by MCE was compared with myocardial rest perfusion imaging using MIBI as a tracer. RESULTS: NC100100 was well tolerated. No serious adverse events or deaths occurred. No clinically relevant changes in vital signs, laboratory parameters, and ECG recordings were noted. There was no significant difference between adverse events in the NC100100 (25.7%) and in the placebo group (17.9%, p = 0.3). Intermittent harmonic imaging using the intermediate dose was superior to all other modalities, allowing the assessment of perfusion in 76% of all segments. Eighty segments (96%) with normal perfusion by SPECT imaging also showed myocardial perfusion with MCE. However, a substantial percentage of segments (61-80%) with perfusion defects by SPECT imaging also showed opacification by MCE. This resulted in an overall agreement of 66-81% and a high specificity (80-96%), but in low sensitivity (20-39%) of MCE for the detection of perfusion defects. CONCLUSION: NC100100 is safe in patients with myocardial infarction. Intermittent harmonic imaging with a dose of 0.03 microliter particles/kg body weight can be proposed as the best imaging protocol. Myocardial contrast echocardiography with NC 100100 provides perfusion information in approximately 76% of segments and results in myocardial opacification in the vast majority of segments with normal perfusion as assessed by SPECT. Although the discrepancies between MCE and SPECT with regard to the definition of perfusion defects requires further investigation, MCE with NC 100100 is a promising technique for the noninvasive assessment of myocardial perfusion.

Aged↗
PubMed1999

Identification of human cytomegalovirus variants by analysis of single strand conformation polymorphism and DNA sequencing of the envelope glycoprotein B gene region-distribution frequency in liver transplant recipients.

Single strand conformation polymorphism analysis (SSCP) of PCR-amplified DNA and subsequent DNA sequencing of human cytomegalovirus (HCMV) glycoprotein B (gB) gene were applied to identify known HCMV strains and to detect new virus variants. 61 HCMV PCR positive patients were studied out of a cohort of 410 patients after liver transplantation (LTX). SSCP was able to distinguish between strains Davis, AD169, and Towne, and in addition could identify five new virus variants (Berlin B, C, E, F, and H). Their frequency, gB and gH types were determined. Simultaneous infections with two or three strains or variants, as well as a switch from one virus to another virus were observed during long-term follow-up. No correlation between the occurrence of certain virus strains or gB types and defined clinical manifestations of HCMV infection after LTX was drawn.

Base Sequence↗
PubMed1999

Artificial neural networks and spatial temporal contour linking for automated endocardial contour detection on echocardiograms: a novel approach to determine left ventricular contractile function.

This study investigated the use of artificial neural networks (ANN) for image segmentation and spatial temporal contour linking for the detection of endocardial contours on echocardiographic images. Using a backpropagation network, the system was trained with 279 sample regions obtained from eight training images to segment images into either tissue or blood pool region. The ANN system was then applied to parasternal short axis images of 38 patients. Spatial temporal contour linking was performed on the segmented images to extract endocardial boarders. Left ventricular areas (end-systolic and end-diastolic) determined with the automated system were calculated and compared to results obtained by manual contour tracing performed by two independent investigators. In addition, ejection fractions (EF) were derived using the area-length method and compared with radionuclide ventriculography. Image quality was classified as good in 12 (32%), moderate in 13 (34%) and poor in 13 (34%) patients. The ANN system provided estimates of end-diastolic and end-systolic areas in 36 (89%) of echocardiograms, which correlated well with those obtained by manual tracing (R = 0.99, SEE = 1.44). A good agreement was also found for the comparison of EF between the ANN system and Tc-radionuclide ventriculography (RNV, R = 0.93, SEE = 6.36). The ANN system also performed well in the subset of patients with poor image quality. Endocardial contour detection using artificial neural networks and spatial temporal contour linking allows accurate calculations of ventricular areas from transthoracic echocardiograms and performs well even in images with poor quality. This system could greatly enhance the feasibility, accuracy and reproducibility of calculating cardiac areas to derive left ventricular volumes and ejection fractions.

Adult↗
PubMed1999

[Cesarean section and perinatal mortality 1993-1996 in a regional perinatology center].

During the period between 1993-96 the authors made at the Second Gynaecological and Obstetric Clinic 1099 caesarean sections. The investigated group was subjected to frequency analysis. The relationship with perinatal mortality and early neonatal mortality was assessed. In a group of 287 caesarean sections in 1996 the authors analyzed indication spectra and maternal morbidity. The results were compared with data in the literature. From the assembled data ensues that although the rate of caesarean sections practically does not change, perinatal mortality decreased significantly. This positive result is due mainly to better perinatal and neonatological care. In the indications for caesarean section the authors did not reveal statistically significant deviations from nationwide average figures.

Cesarean Section↗
PubMed1998

Kinetics of the graft-versus-leukemia response after donor leukocyte infusions for relapsed chronic myeloid leukemia after allogeneic bone marrow transplantation.

Little is known about the mechanisms and the kinetics of the so-called graft-versus-leukemia (GVL) response induced by donor lymphocyte infusions (DLI) in patients with leukemic relapse after allogeneic bone marrow transplantation (BMT). We sought to elucidate this problem by sequentially studying three patients with relapsed chronic myeloid leukemia after sex-mismatched BMT from time before donor leukocyte infusion until achievement of complete molecular remission. Lineage-specific chimerism was assessed longitudinally by a combined fluorescent immunophenotyping and sex chromosome-specific in situ hybridization approach. Results were related to quantitative detection of bcr-abl transcripts by competitive differential reverse transcriptase-polymerase chain reaction (RT-PCR), qualitative bcr-abl RT-PCR, and multiplex PCR-based DNA donor/recipient chimerism. All patients had predominant donor lymphopoiesis at the time of DLI, suggesting a state of tolerance to recipient leukemic and/or normal cells. In contrast, granulopoiesis and erythropoiesis were mainly recipient derived in both patients with hematologic relapse and partly recipient derived in the patient with molecular relapse. Eighty percent, 90%, and 8% of CD34(+) cells, respectively, were found to be of recipient origin at relapse, and few donor stem cells predicted for cytopenia post-DLI. Responses were seen after a time lag of 5 to 13 weeks after DLI and resulted in reversal to full donor chimerism within a critical switch period of 4 to 5 weeks. A sudden decrease in recipient cells was paralleled by a sharp decrease in bcr-abl transcript numbers detectable several weeks before achievement of molecular remission and onset of clinical graft-versus-host disease (GVHD). This response pattern was confirmed by retrospective RT-PCR analysis in an additional five patients. Prospective monitoring of stem cell chimerism and response may enable us to individually tailor adoptive immunotherapy in the future.

Adult↗
PubMed1998

[Echocardiography: indications].

Echocardiography is the most important non-invasive test for many cardiovascular diseases. Morphologic and haemodynamic evaluation can be performed in a short time. In this review we will discuss the most common and the most important indications for an echocardiographic assessment. A detailed list for a quick reference is included at the end.

Echocardiography↗
PubMed1998

Human herpesvirus type 6 variants identified by single-strand conformation polymorphism analysis.

Six human herpesvirus 6 (HHV-6) variants were analyzed for heterogeneity using the polymerase chain reaction (PCR) and single-strand conformation polymorphism (SSCP). Two independent DNA regions were selected: a fragment of the gene U11 (position 18966-21578) coding for a basic phosphoprotein, the major antigenic structural protein pp100; and a fragment from an open reading frame (ORF) area of the gene U67, previously referred to as 13R (position 102458-103519), coding for a product of unknown function. The two PCR systems based on the above DNA sequences yielded products of 187 bp and 223 bp, respectively. DNA obtained from three laboratory reference strains (U1102, R104 and St.W.) and from HHV-6 infected peripheral white blood cells of bone marrow transplant patients and blood donors was used to test the applicability of two different SSCP analysis systems for the identification of HHV-6 variants using amplicons derived by PCR from the two genomic regions described above (U11 [pp100], U67 [13R-ORF]). The generation of characteristic SSCP patterns enables the rapid differentiation of HHV-6 A and B strains for the classification of variants derived from clinical samples, reducing the need for expensive and time-consuming direct sequencing analyses.

Base Sequence↗
PubMed1998

Accuracy and feasibility of contrast echocardiography for detection of perfusion defects in routine practice: comparison with wall motion and technetium-99m sestamibi single-photon emission computed tomography. The Nycomed NC100100 Investigators.

OBJECTIVES: We sought to assess the feasibility and accuracy of myocardial contrast echocardiography (MCE) using standard imaging approaches for the detection of perfusion defects in patients who had a myocardial infarction (MI). BACKGROUND: Myocardial contrast echocardiography may be more versatile than perfusion scintigraphy for identifying the presence and extent of perfusion defects after MI. However, its reliability in routine practice is unclear. METHODS: Fundamental or harmonic MCE was performed with continuous or triggered imaging in 203 patients with a previous MI using bolus doses of a perfluorocarbon-filled contrast agent (NC100100). All patients underwent single-photon emission computed tomography (SPECT) after the injection of technetium-99m (Tc-99m) sestamibi at rest. Quantitative and semiquantitative SPECT, wall motion and digitized echocardiographic data were interpreted independently. The accuracy of MCE was assessed for detection of segments and patients with moderate and severe sestamibi-SPECT defects, as well as for detection of patients with extensive perfusion defects (>12% of left ventricle). RESULTS: In segments with diagnostic MCE, the segmental sensitivity ranged from 14% to 65%, and the specificity varied from 78% to 95%, depending on the dose of contrast agent. Using both segment- and patient-based analysis, the greatest accuracy and proportion of interpretable images were obtained using harmonic imaging in the triggered mode. For the detection of extensive defects, the sensitivity varied from 13% to 48%, with specificity from 63% to 100%. Harmonic imaging remained the most accurate approach. Time since MI and SPECT defect location and intensity were all determinants of the MCE response. The extent of defects on MCE was less than the extent of either abnormal wall motion or SPECT abnormalities. The combination of wall motion and MCE assessment gave the best balance of sensitivity (46% to 55%) and specificity (82% to 83%). CONCLUSIONS: Although MCE is specific, it has limited sensitivity for detection of moderate or severe perfusion defects, and it underestimates the extent of SPECT defects. The best results are obtained by integration with wall motion. More sophisticated methods of acquisition and interpretation are needed to enhance the feasibility of this technique in routine practice.

Contrast Media↗
PubMed1998

Endocarditis and aortal embolization caused by Aspergillus terreus in a patient with acute lymphoblastic leukemia in remission: diagnosis by peripheral-blood culture.

Disseminated infection with Aspergillus terreus is a rare disease that affects only the immunocompromised host. We report a case of systemic infection with A. terreus resulting in endocarditis, aortic embolization, and splenic infarction in a patient with acute lymphoblastic leukemia. Diagnosis through peripheral blood culture, lack of pulmonary involvement, and onset of disease during complete remission from leukemia constitute uncommon features of this case.

Aorta, Abdominal↗
PubMed1998

Pharmacokinetic and safety evaluations of ketoprofen gels in subjects with adult periodontitis.

This clinical trial used a randomized, partially double-blind, controlled parallel design to evaluate the pharmacokinetics and safety of the NSAID, ketoprofen (KTP), in gel formulations. Forty-two subjects, ages 35 to 57 years, with generalized, moderate to advanced adult periodontitis were recruited and randomized to one of 5 treatments over a 14 1/2-day treatment period: (1) 0.5% KTP gel; (2) 1.0% KTP gel; (3) 1.0% KTP alternate gel; (4) 2.0% KTP gel; and (5) 25 mg KTP capsule (positive control). Plasma samples were obtained on days 1 (pre-dosing, 0.5, 1, 2, 3, 6 hr), 8 (pre-dosing, 2 hr), 15 (pre-dosing, 2 hr), and 22 (7 days post-treatment). Plasma KTP concentrations were determined by means of high-performance liquid chromatography. Significant differences in mean area under the plasma concentration vs. time curve (AUC(0-infinity)) among the groups were detected (p < 0.001), with the 25 mg p.o. capsule exhibiting the largest value (5054 ng-hr/mL), the 2.0% gel exhibiting an intermediate value (2244 ng-hr/mL), the 1.0% gels exhibiting lower but comparable values (1516 for the alternate formulation vs. 1461 ng-hr/mL), and the 0.5% gel showing the lowest value (736 ng-hr/mL). Significant differences in dose- and weight-adjusted maximum plasma concentration (Cmax/dose/kg) were detected overall such that the 25 mg p.o. capsule demonstrated higher values as compared with the 4 gel formulations (p = 0.001). The 5 treatments exhibited similar mean times of maximum plasma concentration (tmax) values ranging from 0.6 to 1 hr. Systemic exposures relative to dose and body weight were lower for the gel formulations than for the capsule. The relative systemic bioavailability of the gels compared with peroral administration ranged from 54% to 69%.

Administration, Oral↗
PubMed1998

[Effect of combined administration of TRH and dexamethasone in pregnant women and the course of their pregnancy].

UNLABELLED: Extremely immature neonates are threatened during the first days after delivery by many conditions which are due to incomplete development.--A key role is played during the first days of extrauterine life by the incidence and degree of the respiratory distress syndrome (RDS). Its incidence in neonates born before the completed 32nd week of gestation is very common. Causal treatment of RDS is not known. To overcome it the neonatologist must use in the majority of infants invasive techniques of controlled ventilation which are associated with the risk of further complications such as barotrauma, retinopathy and later the development of bronchopulmonary dysplasia. Attempts to influence intrauterine maturation of the lungs were started in the fifties. As a routine procedure nowadays corticoids are administered antenatally. Their limited effect divert the attention of perinatologists to other substances which could enhance maturation of pulmonary tissue. In human medicine ambroxol was introduced, in animals opiates are tested as well as beta-mimetics, aminophylline. The greatest hopes were aroused by trials with the use of T-hormones. T-hormones have a maturating regulating function in the foetal organism. They have an affinity for pneumocytes and in animal experiments they have a positive effect on surfactant formation. Moreover they act synergically when combined with corticoids. OBJECTIVE OF STUDY: a) to evaluate the safety of the method from the aspect of undesirable side-effects of hormone administration to the mother b) evaluation of hormone levels: TSH, total T4, total T3, TRH and prolactin in maternal serum.

Dexamethasone↗
PubMed1997

Rearranged Ig heavy chain DNA is detectable in cell-free blood samples of patients with B-cell neoplasia.

Tumor-derived DNA has been shown in various cell-free body fluids. In this study, soluble tumor-derived DNA was analyzed in serum and plasma samples of patients with B-cell malignancies. DNA was extracted from tumor cell specimens as well as serum and plasma samples collected from 110 patients with non-Hodgkin's lymphoma and acute B-precursor lymphoblastic leukemia and was subjected to polymerase chain reaction (PCR) analysis for rearranged immunoglobulin heavy chain DNA. In 54% of serum or plasma samples analyzed at different times before and during treatment, clonal DNA from a rearranged immunoglobulin heavy chain locus was detectable. When examined at diagnosis and before any treatment, clonotypic DNA was found in serum or plasma of 86% of the patients. Serum or plasma from patients with systemic or bulky disease was uniformly PCR positive, whereas clonotypic DNA was also recovered from the serum or plasma from the majority of patients with limited disease stages. Degradation of clonal DNA by nucleases in vitro was shown to be one cause of false-negative PCR results. This technical drawback can be relieved by adding a nuclease inhibitor like EDTA, ie, by using plasma instead of serum for PCR analysis. Treatment of patients with cytotoxic drugs was followed by rapid clearance of DNA from the peripheral blood, suggesting that soluble tumor-derived DNA might be associated with viable and proliferating tumor cells. Follow-up studies showed a close correlation of persisting soluble tumor-derived DNA with resistant disease or early relapse. In summary, these data suggest that tumor-derived DNA can be detected in serum or plasma of the majority of patients with B-cell malignancies and that testing of serum or plasma for tumor-associated DNA may be a novel parameter for monitoring response to treatment.

Base Sequence↗
PubMed1997

The abundant presence of Söderström bodies in cytology smears of fine-needle aspirates contributes to distinguishing high-grade non-Hodgkin's lymphoma from carcinoma and sarcoma.

Söderström bodies, also termed lymphoglandular bodies (LGB) and detectable in fine-needle aspiration cytology smears, have long been accepted as indicative of lymphoid tissues. To investigate the validity of this association, we examined 588 cytologic smears from high-grade non-Hodgkin's lymphoma (NHL), carcinoma, and sarcoma. Slides with lymphocytes in the vicinity of carcinoma and sarcoma cells had been excluded. Two independent observers scored smears to number, size, color, form, and smear background of the LGB. In 68 of 359 (19%) nonlymphoid malignancies rare (defined as < 1 LGB per high-power field) or occasional LGB (defined as 1-20 LGB per high-power field) were detectable. Half of these tumors consisted of melanomas, small cell lung carcinomas, and teratomas; the other half encompassed undifferentiated sarcomas. However, none of the smears obtained from carcinoma or sarcoma tissue had abundant LGB (defined as > 20 LGB per high-power field). When number of LGB was estimated to be abundant, the sensitivity for diagnosing a lymphoma was 54%; however, specificity was 100%. The difference in showing LGB between high-grade NHL and carcinoma/sarcoma was highly significant (p = 0.0001). The presence of abundant LGB in cytologic smears strongly suggests the diagnosis of lymphoma, while the absence of LGB nearly excludes this diagnosis. No trends were observed with the other criteria which were tested. LGB in aspiration cytology smears from malignant tumors thus represent a useful tool to distinguish high-grade NHL from carcinoma and sarcoma.

Biopsy, Needle↗
PubMed1997

Transesophageal versus intracoronary Doppler measurements for calculation of coronary flow reserve.

OBJECTIVE: The present study was performed to compare coronary flow reserve by transesophageal Doppler echocardiography and intracoronary Doppler flow wire measurements in patients with LAD disease. METHODS: 17 patients with various degree of LAD stenosis were studied. Intracoronary LAD Doppler measurements were performed at baseline and after intracoronary injection of 18 micrograms adenosine. Transesophageal coronary sinus and LAD Doppler measurements were performed at baseline and after intravenous dipyridamole (0.6 mg/kg/5 min). Coronary flow reserve was calculated as the ratio of hyperemic to baseline average peak velocities. RESULTS: Coronary flow reserve was 2.44 +/- 0.62 and 2.19 +/- 0.76 for proximal and distal intracoronary measurements and was 2.25 +/- 0.64 and 1.74 +/- 0.63 for transesophageal LAD- and coronary sinus measurements. Proximal intracoronary flow reserve significantly correlated with transesophageal coronary sinus (r = 0.73, p < or = 0.001) and LAD (r = 0.70, p < or = 0.005) measurements, whereas distal intracoronary flow reserve only correlated with transesophageal coronary sinus flow reserve (r = 0.56, p < or = 0.02). Receiver operating characteristic curve analysis demonstrated similar diagnostic accuracy of all applied techniques for detection of a significant LAD stenosis. CONCLUSIONS: Coronary flow reserve by both transesophageal techniques correlated with intracoronary Doppler flow wire measurements, however considerable discrepancies may occur in the individual patient.

Adenosine↗