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Biomedical subjects

W Distler

Publications and source records attributed to W Distler.

At least 19 recordsLinked to original sources
PubMed2006

Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial.

BACKGROUND: The Arimidex (anastrozole), Tamoxifen, Alone or in Combination (ATAC) trial was designed to compare the efficacy and safety of anastrozole with tamoxifen as adjuvant treatment for postmenopausal women with early-stage breast cancer. After an extended follow-up beyond the 5 years of treatment, we aimed to assess the safety, tolerability, and risk-benefit indices of these compounds. METHODS: We analysed postmenopausal women (mean age 64 years [SD 9]) with localised breast cancer randomly assigned to anastrozole (n=3125) or tamoxifen (n=3116). Efficacy measures, including death and risk-benefit indices, were analysed by intention to treat. Safety analyses were based on treatment first received (n=3092 for anastrozole and n=3094 tamoxifen). We calculated a risk-benefit analysis using the two global indices for the Women's Health Initiative and for Disease-Free Survival and Serious Adverse Events. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN18233230. FINDINGS: At median follow-up of 68 months (range 1-93), treatment-related adverse events occurred significantly less often with anastrozole than with tamoxifen (1884 [61%] vs 2117 [68%]; p<0.0001), as did treatment-related serious adverse events (146 [5%] vs 277 [9%]; p<0.0001) and adverse events leading to withdrawal (344 [11%] vs 442 [14%]; p=0.0002). Patients given anastrozole had significantly fewer overall events for the Global Index of the Women's Health Initiative (744 [24%] vs 851 [27%]; hazard ratio 0.85 [95% CI 0.77-0.94], p=0.001) and the Global Index of Disease-Free Survival and Serious Adverse Events (1453 [46%] vs 1594 [51%]; 0.88 [0.82-0.94]; p=0.0004). INTERPRETATION: Anastrozole is tolerated better than tamoxifen by postmenopausal women with early-stage breast cancer, and results in fewer serious adverse events. Furthermore, it has a more favourable overall risk-benefit profile and lower recurrence rate than tamoxifen.

Anastrozole↗
PubMed2006

Psychological and physical factors influencing the health-related quality of life of patients of a department of gynecology in a university hospital.

The aim of our study was to assess the physical and mental quality of life of in-patients of a Gynecological University Hospital and the factors influencing the quality of life. 715 women, who were treated in hospital with non-malignant or malignant gynecological or obstetrical diseases, took part in the study. Besides demographical data and relevant medical parameters the quality of life (SF-12), anxiety and depression (HADS) as well as physical discomforts (GBB) were assessed. The physical quality of life of the study population was significantly lower than that of the normal population (p < 0.001). Patients with obstetric diseases in comparison with patients with malignant gynecological and other gynecological diseases had the lowest physical quality of life. Regarding the mental factor, patients with malignant gynecological diseases feel most impaired, followed by those with other gynecological and obstetrical conditions. The multivariate analysis of the quality of life showed that up to 60% of the variance could be explained. The lowest variance elucidation was found in obstetrical patients in whom the physical complaints elucidated only a small part of the variance. Our results show on the one hand the high impairment of mental and especially of physical quality of life in women who are in hospital with gynecological or obstetrical diseases. On the other hand they show the great significance of the quality of life as an outcome parameter. These findings should be considered in gynecological in-patient treatments by using integrated psychosomatic care.

Adult↗
PubMed2000

A new screening test for toxicity testing of dental materials.

OBJECTIVES: The development of a micro plate assay for cytotoxicity testing of dental materials based on a bioassay using brine shrimp larvae (artemia salina) as sensitive organisms. METHODS: Brine shrimp larvae are commonly used for cytotoxicity assays in pharmacology. These larvae are sensitive to toxic substances. The ratio between dead larvae (no motility) and living larvae (high motility) in comparison to a control without any toxic substances is used to estimate the toxicity of the test solutions. The test materials (Arabesk((R)), Solitaire((R)), Pertac((R)) II, Tetric((R)), Herculite((R)) and the compomer materials Dyract((R)), Hytac((R)), Compoglass((R))) were polymerized and consecutively milled. After incubation of 1g in 4ml distilled water at 37 degrees C for 48h, the solid materials were separated by centrifugation. The solutions were equibrilated with NaCl to a salt content of 25g/l. Aliquots of 200microl were distributed in eight micro wells and 50microl of a artemia salina containing (n=8-14) solution were added to each well. As controls eight wells with 250microl salt solution containing a comparable number of brine shrimp were used. At baseline, after 2, 5, 24 and 48h, the dead shrimp were counted using a stereo microscope. Finally all shrimps were sacrificed using Na-acid (5%) and counted to get the number of shrimps per well. RESULTS: All compomers and Solitaire caused 100% brine shrimp lethality after 24h and showed significantly (p<0.01, signed rank test) higher toxicities than the remaining composites. With the exception of Pertac II, all composites showed significantly higher toxic values than the control. Pertac II did not show any differences from the controls used. CONCLUSIONS: This new technique has some advantages for toxicity testing of restorative materials, because it can quickly be carried out at low costs. The disadvantage is the high quantity of material used and the low sensitivity.

Animals↗
PubMed2000

[Urinary incontinence--taboo during postmenopause].

Urinary incontinence affects 30-60% of all women in the postmenopause. More and more women want to remove the taboo attached to incontinence, because they do not accept the reduction in quality of life, social and domestic activities. Detrusor instability (urge incontinence) and/or urethral sphincter incompetence (genuine stress incontinence) are the principal mechanisms, which lead to involuntary urine loss in older women. It is quite evident that additional factors as hypoestrogenism and urogenital atrophy influence urinary incontinence. Since in the postmenopause urge incontinence combined with urogenital atrophy its found predominantly, pharmacologic therapy with anticholinergic drugs and estrogen replacement are generally effective. Surgical therapy should be restricted to older women with genital prolapse and/or stress incontinence. In genuine stress incontinence, estrogen replacement therapy can lead to subjective improvement, but urodynamic parameters do not change objectively.

Attitude to Health↗
PubMed1999

[Redox sensitive behavior of selenite in the presence of reactive oxygen species. Are there nonenzymatic direct reaction pathways].

From extensive research over the last decade it has been known that selenium is essential as necessary component of selenoaminoacids and of specific enzymes. Among others, the redoxpair GSH/GSSG is closely connected with antioxidative processes. Moreover it inhibits and/or activates molecular key reactions with the involvement of various small reactive O- and N-species. We investigated the direct interaction of selenite with components of the respiratory burst of human blood cells, considering the redoxamphoterie of alkali-selenite. Selenite tend to redox-disproportation depending on the pH-value. Whether selenite leads to oxidation or reductation is dependent not only on the pH-value, but also on the redox-potential of the reaction partners. In in-vivo adapted in-vitro conditions (ph = 7.4; mumolar concentrations of reaction partners) we observed the following results: 1. SeO3(2-) is not oxidized by H2O2/NO or triplet-oxygen, when the oxidatives are applied alone; 2. SeO3(2-) is quantitatively oxidized from SeO4(2-) by the combination H2O2/NO2- or O2-/NO; 3. SeO3(2-) is semiquantitatively oxidized by singlett oxygen to SeO4(2-). The composition of reaction products was measured by 77Se-NMR-spectroscopy. The reactive intermediate product for the 2. reaction should be peroxynitrite (HOONO). One cannot rule out the possibility that HOONO reacts on a large scale with H2O2 to singlett oxygen. Subsequently singlett oxygen oxidizes selenite. The pathophysiological impact of singlett oxygen in processes like arteriosclerosis is now being investigated. It has been supposed, that singlett oxygen is participating in processes of lipidperoxidation invivo. Further investigations have to show, to what extent selenite is effective as direct 1O2-scavanger.

Arteriosclerosis↗
PubMed1999

Elution parameters and HPLC-detection of single components from resin composite.

The toxic effects of mercury derived from amalgam fillings have been a focus of controversy in Germany during the last 25 years. As alternatives to amalgam, composites are used widely to restore anterior and posterior permanent teeth. This study quantifies the amount of TEGDMA and methacrylic acid that can be derived from a polymerized commercial hybrid composite material. Different specimens were made with different curing methods with and without an oxygen inhibition layer. To simulate the removal of composite fillings, some samples were pulverized. The specimens were eluted in distilled water at 37 degrees C for different time intervals. To check the influence of acid conditions, pulverized material was incubated in 6 M HCl. The separation of the eluted chemical resin components was done by HPLC. A defined mixture of pure components was used as an external standard for the identification and quantification of the eluted components. The results focus on the release of triethylengly-coldimethacrylate (TEGDMA) and methacrylic acid. Concerning the different incubation methods, the results showed higher TEGDMA elution with oxygen inhibited surface layer and with the pulverized samples. Within acid conditions, the amount of TEGDMA found was low, but the amount of methacrylic acid increased. Small resin monomers like TEGDMA are primarily eluted from composite in aqueous solutions. Within acid conditions a hydrolytic disintegration of the ester bonding of the monomers could be observed. Methacrylic acid--a substance with allergenic potential--could be detected.

Bisphenol A-Glycidyl Methacrylate↗
PubMed1999

[Hyperthyroidism and acute renal failure in partial bladder mole].

We report on a 31-year-old II gravida I para treated because of a hydatidiform mole, hyperthyroidism and acute renal failure in the 16th week of pregnancy. The pathomechanism of trophoblast-induced hyperthyroidism will be discussed. To our knowledge this is the first report on acute renal failure in association with trophoblast-induced hyperthyroidism.

Abortion, Eugenic↗
PubMed1998

Comparison of tissue polypeptide antigen (TPA) with cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) in follow-up of breast cancer.

Cancer antigen 15-3 (CA 15-3), carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA) were measured in 679 sera of breast cancer patients and in 94 sera of women without breast cancer. The tumour markers were determined using immunoluminometric assays (ILMA). The assays are characterised by an inter-assay-imprecision and intra-assay-imprecision <4 %. The breast cancer patients were staged according to the TNM classification stage 0-IV (by UICC) in patient groups with a compatible prognosis. Median and range of each stage were investigated. The cut-off values (95th and 97.5th percentile of control group) of CA 15-3, CEA and TPA were determined; specificity, sensitivity, positive and negative predictive value (PV) and efficiency were investigated for these cut-off's and the receiver operating characteristic (ROC) curves were calculated. The differences between control group and stage 0-3 were shown as non-significant for CA 15-3 and CEA but significant for TPA. Significant differences were found in stage 4 for all three tumour markers. The three tumour markers did not have differences in specificity, positive and negative PV and efficiency. TPA and CA 15-3 demonstrated comparable results in sensitivity and ROC curve analyses. These results were better than those from CEA.

Adult↗
PubMed1998

[Fetal acidemia and neonatal encephalopathy].

OBJECTIVE: The purpose of this study was to determine the significance of fetal acidemia for newborn encephalopathy (NEP) and for the combination of NEP and multiorgan system dysfunction (MOS). In particular the influence of acidemia will be contrasted with criteria of pregnancy and delivery. STUDY DESIGN: 248 infants delivered with cord umbilical arterial pH < 7.15 (UApH) were retrospectively studied. Infants with similar or identical neonatal characteristics formed different groups: unaffected neonatal development, NEP, NEMO (NEP combined with MOS), other diseases, infection, exitus letalis. Statistics and calculations were done by means of factor analysis, univariate analysis, Student-Newman-Keuls-test, and Chi 2-test (p < 0.05). RESULTS: Twenty seven infants with UApH < 7.15 suffered from NEP. NEP in combination with MOS occurred in 11 cases. There was no relationship between the degree of acidemia and a single NEP. Infants with NEMO differ from all other groups in their mean UApH (p < 0.05). The Apgar scores 1 min and 5 min (A1, A5) separated newborns with unaffected neonatal development from all other groups (p < 0.05). UApH-differences in the group: NEMO resulted from a combination of acute intranatal fetal distress and operative delivery and a combination of A1, A5, preterm delivery, and pathologic CTG (p < 0.01). CONCLUSIONS: The degree of acidemia impacts the occurrence of NEMO. However, UApH alone does not predict this combination of characteristics. The Apgar score should be taken into account to evaluate an acidemic UApH. In case of acidemia complex factors of pregnancy and delivery are associated with an increased risk of NEMO.

Acidosis↗
PubMed1996

-Case report of clinical and pathophysiological similarities of Moschkowitz disease and HELLP syndrome-.

This case report describes for the first time a manifestation of thrombotic thrombocytopenic purpura (TTP, Moschcowitz's disease) during pregnancy. The characteristic neurologic symptoms of TTP were missing, while the typical clinical signs of the HELLP syndrome could be observed. Furthermore the biochemical proof of TTP was obtained by tracing ultra-large clotting factor VIII (von Willebrand factor) multimers in the patient's plasma. Thus the assumption is supported that TTP and HELLP syndrome are diseases of one pathophysiological entity with different symptomatologies. Because of the frequent relapse of TTP, differentiation between TTP and HELLP syndrome is of great clinical importance, independent of future pregnancies.

Adult↗
PubMed1994

Pattern of gonadotrophin secretion in patients with hyperandrogenaemic amenorrhoea before and after ovarian wedge resection.

The follow-up of androgen and gonadotrophin concentrations after ovarian wedge resection is reported in two patients with hyperandrogenaemic amenorrhoea. Elevated testosterone concentrations decreased immediately and androstenedione after 3 months. In a patient with polycystic ovarian disease, luteinizing hormone (LH) amplitudes were reduced in the presence of unchanged pulse frequency. Small decreases in mean LH baseline values were accompanied by increases in follicle stimulating hormone concentrations. Our data provide evidence that reduction of elevated ovarian androgen concentrations leads (directly or indirectly) to a decrease of exaggerated LH pulse amplitude in patients with hyperandrogenaemic amenorrhoea.

Adult↗
PubMed1993

Pulsatile luteinizing hormone secretion pattern in hyperandrogenemic women.

OBJECTIVE: To elucidate changes in gonadotropin secretion pattern in patients with hyperandrogenemic chronic anovulation of various origins. DESIGN AND PARTICIPANTS: Hyperandrogenemic patients (n = 32), divided into subgroups according to certain clinical and biochemical criteria, and a control group (n = 9) of regularly cycling women with normal androgen and PRL levels were prospectively investigated. SETTING: Infertility and Biochemical Endocrinology Unit, Department of Obstetrics and Gynecology, University of Düsseldorf, Düsseldorf, Germany. MAIN OUTCOME MEASURES: Blood samples for radioimmunological analyses of gonadotropins and steroids were taken at 10-minute intervals for 12-hour sampling periods. In nonamenorrheic patients, investigations were performed on the 5th day of a cycle. Pulsatile LH and FSH data were analyzed by computerized peak identification programs. RESULTS: In hyperandrogenemic women, mean LH levels were higher than controls, the most elevated concentrations being observed in women with secondary amenorrhea (subgroup 5), in those selected for elevated mean LH levels (subgroup 3), and in those with elevated T and/or androstenedione (A) but normal DHEAS levels (subgroup 1). With the exception of patients with DHEAS elevations but normal T and A levels (subgroup 2), LH pulse frequency and amplitude were increased with most distinct effects occurring in subgroups 3 and 5. Highly elevated T and free T levels were observed in subgroup 5 and in overweight patients (subgroup 6). Estrone (E1) serum concentrations were highest in those subgroups (3 and 5) in which acceleration of LH pulse frequency and increments in LH pulse amplitude were most pronounced; these parameters correlated significantly with E1 levels. CONCLUSIONS: Changes in pulsatile LH release in patients with hyperandrogenemic chronic anovulation correlate primarily with elevated E1 levels, rather than with T or A serum concentrations.

Adolescent↗