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  • 1
    ISSN: 1432-1041
    Keywords: Emiglitate (BAY o 1248) ; sucrose ; starch ; postprandial hyperglycaemia ; glucosidase inhibitor ; blood glucose ; serum insulin ; serum GIP ; breath hydrogen ; adverse effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The absorbable deoxynojirimycin derivative emiglitate (BAY o 1248) is a potent competitive inhibitor of small intestinal α-glucosidases in man. In two similar randomized, placebo-controlled, double blind investigations, the efficacy, duration of action and tolerability of single doses of 10, 20 and 40 mg emiglitate have been assessed in healthy male volunteers after repeated sucrose or maize-starch loads at 08.00, 12.00 and 17.00 h. Even at the lowest dose used, emiglitate almost abolished the glycaemic (−88%) and hormonal responses after the first sucrose meal, simultaneously evoking significant hydrogen evolution (mean peak H2-concentration 〉100 ppm), which was not related to the dose, and which induced unacceptable symptoms of carbohydrate malabsorption, i.e. at the dosages tested, the inhibition of glycaemic and hormonal responses was at the expense of intolerable gastrointestinal adverse effects. Flattening of postprandial responses of blood glucose, serum insulin and gastric inhibitory polypeptide was still apparent after a second sucrose load 4 h later, demonstrating long-lasting inhibition of α-glucosidase activity. After starch, the dose dependency of inhibition emerged more clearly than after sucrose, i.e. the reduction was less pronounced. However, emiglitate led to significant reduction of the glycaemic and hormonal rises after both the first and second starch meals. Symptoms of carbohydrate malabsorption were absent after 10 mg and were negligible with 20 mg or 40 mg emiglitate. Breath hydrogen concentration increased gradually, indicating slight but significant carbohydrate malabsorption after the highest dose of the α-glucosidase inhibitor. The results show that a single morning dose of 20–40 mg emiglitate might be useful in the control of postprandial hyperglycaemia after breakfast and lunch. This dose of the inhibitor was effective after either both 50 g starch or 50 g sucrose as the substrate, but was only tolerable after the starch meal.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1433-0385
    Keywords: Key words: Breast carcinoma ; Magnetic resonance mammography ; Breast preservation ; Impact on ; Schlüsselwörter: Mammacarcinom ; Magnetresonanzmammographie ; brusterhaltende Operation ; Einfluß auf das operative Vorgehen.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Einleitung: In einer prospektiven Studie wurden der diagnostische Stellenwert sowie der Einfluß der Magnetresonanzmammographie (MRM) auf das operative Vorgehen bei Patientinnen (n = 125) geprüft, bei denen aufgrund der klinischen, sonographischen oder mammographischen Untersuchung der Verdacht auf ein Mammacarcinom bestand. Diese Patientinnen wurden zusätzlich einer bilateralen MRM zugeführt. Besonderes Interesse bestand hinsichtlich der Erkennung multifocaler, multizentrischer und kontralateraler Läsionen. Methode: Nach kompletter operativer Entfernung aller diagnostizierten Läsionen erfolgte die Ermittlung von Sensitivität und Spezifität der diagnostischen Methoden sowie einer Korrelation zwischen den apparativen und den histologischen Befunden. Ergebnisse: Bei 112 Patientinnen lagen vollständige Daten für die Auswertung vor: Allein mit Hilfe der konventionellen Verfahren wurden 91 Malignome entdeckt; dabei betrug die Sensitivität/Spezifität für die klinische Untersuchung 73 % bzw. 67 %, für die Mammasonographie 58 % bzw. 86 % und für die Röntgenmammographie 89 % bzw. 20 %. In diesem vorselektionierten Patientinnenkollektiv (Prävalenz 81,25 %) wurden durch die MRM die bereits durch konventionelle Verfahren entdeckten Läsionen mit einer Sensitivität von 96,7 % und einer Spezifität von 19 % bestätigt. Darüber hinaus wurden durch die MRM 46 weitere suspekte Läsionen diagnostiziert. Es fanden sich histologisch 28 maligne (25 ipsilaterale multifocale oder multizentrische Läsionen, 3 kontralaterale Carcinome) und 18 benigne Tumoren. Die Rate falsch-positiver MRM-Befunde lag bei 18 %. Aufgrund der MRM-Befunde wurde in 14,3 % der Fälle anstatt des ursprünglich geplanten brusterhaltenden Verfahrens eine Mastektomie durchgeführt. Schlußfolgerung: Anhand unserer Untersuchungsergebnisse ist die MRM das Verfahren der Wahl in der Differentialdiagnose diskrepanter Befunde von Mammographie und Sonographie und stellt die sensitivste Methode zum Ausschluß einer Multifocalität oder Multizentrizität dar. In unserem Patientinnenkollektiv beeinflußten die Befunde der MRM die Planung des operativen Vorgehens erheblich. Für den sinnvollen Einsatz der Methode sind ein hoher technischer Standard sowie eine hohe Qualifikation des Untersuchers und eine enge interdisziplinäre Kooperation zwischen Radiologen, Pathologen und Chirurgen Voraussetzung.
    Notes: Summary. Introduction: In a prospective study the diagnostic validity of magnetic resonance mammography (MRM) as well as its impact on the choice of the operative procedure in the treatment of breast cancer was examined. In 125 patients who were suspected of having breast cancer by clinical examination, ultrasound, and X-ray mammography, additional bilateral MRM was performed. Of special interest was the diagnostic potential of MRM with regard to multifocal, multicentric and contralateral lesions. Methods: After a complete resection all lesions diagnosed by the various conventional methods were examined pathohistologically. In 112 patients, complete data were available to calculate the sensitivity and the specificity of each method as well as to correlate its results with the pathohistological findings. Results: In 91 cases, a breast carcinoma was diagnosed by conventional methods, with a sensitivity/specificity of 73 %/67 % for clinical examination, of 58 %/86 % for ultrasound, and of 89 %/20 % for X-ray mammography. In this preselected series of patients with a prevalence of 81.25 % the diagnosis established by the various methods was confirmed by MRM with sensitivity of 96.7 % and specificity of 19 %. Forty-six additional suspicious lesions were found only by MRM, of which 28 were malignant (25 multifocal or multicentric and 3 contralateral carcinomas), and 18 benign. The rate of false-positive MRM results was 18 %. Due to the MRM findings, the therapeutic procedure was changed from breast preservation to mastectomy in 14.3 %. Conclusion: Not only for the differential diagnosis of discrepant findings between X-ray mammography and ultrasound, but especially for the diagnosis of multifocal or multicentric lesions, MRM seems to be the method of choice. Consequently, MRM plays an important role in planning the operative procedure in breast cancer patients, especially in the context of breast preservation. To ensure optimal use of this new diagnostic tool high technical standards, proper expertise on the part of the examining radiologist, and effective cooperation among the involved disciplines (radiology, pathology, surgery) must be guaranteed.
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  • 3
    ISSN: 1432-0843
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The kinetics of melphalan leakage into the peripheral blood were studied in 21 patients undergoing hyperthermic isolation perfusion of the upper or lower limb as an adjuvant treatment in high-risk melanoma; in 5 patients cisplatin was added. The melphalan concentrations in the peripheral blood rose predominantly during the first 20 min of perfusion and levelled out to an apparent steady state of about 0.28 μg/ml in upper extremity perfusions, and 0.34 (without cisplatin) and 0.37 μg/ml (with cisplatin) in lower extremity perfusions. Erythrocytes labelled with technetium Tc 99m, which were added concomitantly with melphalan to the perfusion medium, appeared in the systemic circulation of the patients at an almost constant rate of 0.32% (lower and upper limb perfusions without cisplatin and 0.37% (with cisplatin) of total tracer/min. This perfusate flow rate indicated by labelled erythrocytes completely explained the leakage of melphalan from the perfusion circuit into the peripheral blood. Peak concentrations of melphalan in the peripheral blood were observed immediately after reconstitution of normal hemodynamic conditions once isolation perfusion had been teminated. This fraction of melphalan might originate from tissue-binding sites, but also from vascular compartments; therefore, a thorough washing-out procedure might minimize this effect.
    Type of Medium: Electronic Resource
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