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Biomedical subjects

A F Hahn

Publications and source records attributed to A F Hahn.

At least 73 records · Page 4Linked to original sources

Complement depletion suppresses Lewis rat experimental allergic neuritis.

Lewis rats immunized with myelin and complete Freund's adjuvant were treated with cobra venom factor (CVF) which depletes the C3 component of complement. CVF given at day 9 delayed the onset of experimental allergic neuritis (EAN) by 2-3 days and when given at days 9 and 12 delayed the onset of EAN by 4-5 days. Lumbar nerve roots of CVF-treated rats had significantly less demyelination than those from control EAN rats.

Animals↗

Development of myelinated nerve fibers in the sixth cranial nerve of the rat: a quantitative electron microscope study.

Myelination was studied quantitatively in the sixth cranial nerves of rats by counting and measuring all myelinated fibers during the first three postnatal weeks. In transverse semithin and thin sections cut serially at a well-defined anatomical site in the midsphenoid region, only a few axons (mean 12) were myelinated at birth. On days 2, 4, and 8, counts of myelinated fibers were respectively 5 times (mean 57), 20 times (mean 230), and 24 times (mean 273) the number seen at birth. During the second postnatal week, the number of myelinated fibers remained constant, whereas growth of axons and their myelin sheaths continued. By 15 days these fibers were large and relatively uniform in size; they had compact, circular myelin sheaths. During the third postnatal week, myelination of previously unmyelinated, smaller axons began. The number of myelinated fibers increased again and the size distribution of myelinated fibers became bimodal. Axon diameters, fiber diameters, and myelin sheath dimensions for all fibers were calculated from measurements made on electron micrographs. The transverse length of the myelin membrane increased exponentially with time. The growth increased rapidly during the formation of the first 20 spiral layers and remained relatively constant during the subsequent enlargement of the compact sheath. The association of axon diameter and myelin sheath thickness was poor at young ages, but it improved progressively with maturation of the sheath. The results show that myelination begins around axons that have a wide range of diameters. Also, the first axons to be myelinated become the large myelinated fibers of the sixth nerve. The small myelinated fibers originate from axons that do not become myelinated until the third postnatal week. Myelination, though differing in onset by 2 weeks, appeared to be similar in both populations as judged by similarity of sheath morphology and growth rates. It is of interest that at the level studied, the sixth nerve also contains a fascicle of unmyelinated cranial sympathetic fibers.

Abducens Nerve↗

P2, P1, and P0 myelin protein expression in developing rat sixth nerve: a quantitative immunocytochemical study.

Myelination and the expression of myelin proteins P2, P1, and P0 were studied quantitatively in the rat sixth cranial nerve during development. The postnatal development and growth of all myelin sheaths in this nerve have been studied morphometrically in a companion paper. Epon-embedded blocks with closely matched topography in the transverse plane were selected from rats perfused at ages 1-4, 8, 15, and 20 days. From each block, serial semithin sections were cut, etched, and immunostained according to the peroxidase-antiperoxidase method with well-characterized polyclonal antisera that reacted specifically with P0 glycoprotein and the basic proteins P1 and P2. The immunoreactivities of individual myelin sheaths were measured by densitometry. Numbers of compact myelin lamellae, myelin spiral lengths, and axon diameters were determined on electronmicrographs of adjacent thin sections. At birth anti-P0 immunoreactivity was found on sheaths with two and more compact lamellae; neither P1 nor P2 immunoreactivity was observed. On day 2, myelin sheaths with five and eight lamellae were stained respectively by anti-P1 and anti-P2. On day 3 the percentages of myelin sheaths stained were substantially higher: P0 95%, P1 78%, P2 15%. By day 4, anti-P0 and anti-P1 immunoreactivity was present in 95% of myelin sheaths; 35% were stained by anti-P2. For P2, staining intensity and percentage of myelin sheaths stained continued to increase and by day 20, 85% were anti-P2-positive. The density of immunoreactivity was not uniform in all myelin sheaths. At young ages staining varied with all three proteins. The variability decreased as myelin sheaths thickened; it persisted longest for anti-P2. We conclude that the density and distribution of immunoreactivities of P0, P1, and P2 reflect their relative concentrations during myelin sheath development and growth. We attribute lack of detectable anti-P2 immunoreactivity in some small sheaths at 20 days to their early stage of myelination and also to limitations of the method. We infer from our observations that all myelin-forming Schwann cells express P2 basic protein.

Abducens Nerve↗

Treatment of experimental allergic neuritis with prednisolone.

Experimental allergic neuritis (EAN) in Lewis rats was treated with prednisolone given prophylactically or therapeutically. Rats treated from the time of immunization with myelin or after the establishment of clinical disease improved more rapidly than controls. Treatment at the onset of clinical signs resulted in less severe disease and more rapid recovery. Rats treated just prior to the onset of clinical signs (day 10) did not develop significant clinical disease and appeared to have less inflammation in their nerves and nerve roots on microscopic examination.

Animals↗

Critical illness polyneuropathy. A complication of sepsis and multiple organ failure.

Nineteen patients developed polyneuropathy complicating critical illness. They had been admitted to a critical care unit following intubation for cardiac or pulmonary disease and had developed sepsis and multiple organ failure. Approximately one month following intubation, failure to wean from the ventilator and limb weakness prompted neurological referral. Examination disclosed weakness and wasting of muscles and impaired tendon reflexes in most, but not all, patients. Electrophysiological studies in 17 patients revealed attenuated compound muscle and sensory nerve action potential amplitudes and widespread denervation on needle electromyography. Autopsy in 9 patients who died of their critical illness revealed widespread primary axonal degeneration of motor and sensory fibres, with extensive denervation atrophy of limb and respiratory muscles. Survivors recovered from the polyneuropathy three to six months following discharge. Seventeen of the patients were segregated by electrophysiological criteria into mild (8) and severe (9) polyneuropathy categories. An analysis of these two groups failed to reveal putative metabolic, drug, nutritional or toxic factors that might be responsible for the polyneuropathy. Our studies suggest that the mechanism may be a fundamental defect, still unknown, which causes dysfunction of all organ systems in this syndrome.

Adult↗

An acute axonal form of Guillain-Barré polyneuropathy.

Five patients with a clinical diagnosis of acute Guillain-Barré polyneuropathy (GBP) had electrically inexcitable motor nerves. All were quadriplegic. One patient died and 3 of the 4 survivors showed poor recovery. Autopsy studies on the patient who died showed severe axonal degeneration in nerve roots and distal nerves without inflammation or demyelination. Electrophysiological studies in these patients suggested that the predominant process was axonal degeneration. These cases may represent a separate clinicopathological entity, and constitute a variant of GBP characterized by an acute axonal neuropathy.

Acute Disease↗

Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain-Barré syndrome.

A polyneuropathy of varying severity has been observed in association with sepsis and critical illness in 15 patients. Since clinical evaluation is often difficult, electrophysiological studies provided definitive evidence for polyneuropathy. These revealed reductions in the amplitudes of compound muscle and sensory nerve action potentials, the most marked abnormality. Near-nerve recordings confirmed such reductions for sensory fibres. Needle electromyography revealed signs of denervation of limb muscles. Phrenic nerve conduction and needle electromyographic studies of chest wall muscles suggested that the polyneuropathy partially explained difficulties in weaning patients from the ventilator, an early clinical sign. No defect in neuromuscular transmission was demonstrated, despite the use of aminoglycoside antibiotics in some patients. In those who survived the critical illness, clinical and electrophysiological improvement occurred. The 15 critically ill polyneuropathy patients were compared with 16 Guillain-Barré syndrome patients observed during the same period. The analysis showed that the two polyneuropathies are likely to be separate entities that can be distinguished in most instances by the predisposing illness, electrophysiological features and cerebrospinal fluid results.

Aged↗

Nemaline myopathy with associated cardiomyopathy. Report of clinical and detailed autopsy findings.

We describe the clinical features and autopsy findings of an adult patient who had nemaline myopathy and an associated progressive cardiomyopathy. The spinal cord and the results of morphometric analysis of multiple peripheral nerves were normal. There was probable intrafusal fiber involvement, in addition to the typical histopathologic features of extrafusal fibers. Cardiac dysfunction was a prominent clinical and autopsy feature, but it has been infrequently recognized in this entity. Our findings suggest that there is a poor correlation between clinical and pathologic features in this disorder, and they support the need for careful cardiac evaluation of affected patients. Furthermore, the constellation of features favors a myopathic basis for the disease, in contradistinction to some previously expressed views.

Adult↗

Blood-nerve barrier studies in experimental allergic neuritis.

The integrity of the blood-nerve barrier (BNB) was studied during the development of experimental allergic neuritis (EAN). Lewis rats immunized with bovine nerve or myelin plus complete Freund's adjuvant developed histological lesions of EAN in nerve roots by 10-12 days and in sciatic nerves by 12-14 days. Evans blue-albumin (EBA) and horseradish peroxidase (HRP) were injected i.v. 1 h prior to killing on days 6-18. Perivascular and diffuse endoneurial leakage of the tracers was seen in nerve roots by 10-12 days post immunization (p.i.) and in sciatic nerves by 12-14 days. This coincided with the appearance of endoneurial infiltration with inflammatory cells and endoneurial proteinaceous edema at a time when Schwann cell and myelin changes were still minimal. Therefore, an alteration in BNB permeability occurs early in EAN, coincident with inflammatory cell infiltration. This could be an expression of delayed hypersensitivity, yet it would also facilitate the entry of anti-myelin antibodies into the endoneurium where they could initiate demyelination.

Animals↗

The pathological basis of conduction block in human neuropathies.

Conduction block was detected in patients with neuropathy by measuring a decrease in the size of the compound muscle action potential of more than 20% on proximal versus distal stimulation of the peroneal, median or ulnar nerve in the absence of excess temporal dispersion of the potential. The teased fibre analyses of nerve biopsies from four patients with "definite" and six patients with "probable" conduction block and from seven patients with neuropathy but without conduction block were compared. All patients with conduction block had significant demyelination (X% demyelinated and remyelinated fibres = 50%) while those without conduction block did not (X = 5.0%). Demyelination is the pathological basis of conduction block in human neuropathies.

Adult↗

Circulating lymphocyte subpopulations in experimental allergic neuritis.

T-cell subsets in the peripheral blood were analyzed using monoclonal antibodies during the development of experimental allergic neuritis in Lewis rats. Percentages of helper and suppressor cells and ratios of helper/suppressor cells did not exceed normal limits during the development of the disease.

Animals↗

Polyneuropathy in critically ill patients.

Five patients developed a severe motor and sensory polyneuropathy at the peak of critical illness (sepsis and multiorgan dysfunction complicating a variety of primary illnesses). Difficulties in weaning from the ventilator as the critical illness subsided and the development of flaccid and areflexic limbs were early clinical signs. However, electrophysiological studies, especially needle electrode examination of skeletal muscle, provided the definite evidence of polyneuropathy. The cause is uncertain, but the electrophysiological and morphological features indicate a primary axonal polyneuropathy with sparing of the central nervous system. Nutritional factors may have played a role, since the polyneuropathy improved in all five patients after total parenteral nutrition had been started, including the three patients who later died of unrelated causes. The features allow diagnosis during life, and encourage continued intensive management since recovery from the polyneuropathy may occur.

Adult↗

Intraneural injection of lymphocytes in experimental allergic neuritis.

Passive transfer of experimental allergic neuritis (EAN) lymph node cells (LNC) by intraneural injection did not produce significant demyelination. EAN-LNC stimulated with myelin in vitro produced mild demyelination while those incubated with Concanavalin A had no effect. The lack of demyelination by unstimulated EAN-LNC is in contrast to the marked demyelination produced by intraneural injection of EAN serum. The mononuclear cell infiltration and demyelination of classical EAN seem to require both cellular and humoral immune responses.

Animals↗

Paraparesis following intrathecal chemotherapy.

We studied a case of flaccid paraplegia that immediately followed intrathecal injection of cytosine arabinoside diluted in 1.5% bacteriostatic water (1.5% benzyl alcohol in H2O). The complication was reversed by rinsing the CSF space with saline. Autopsy showed fibrosis and remyelination of lumbosacral nerve roots. In acute and chronic animal experiments, we showed that benzyl alcohol in commercially used concentrations can have a local anesthetic and an irreversible toxic effect on nerve fibers. This provides a sufficient explanation for many cases of paraparesis following intrathecal chemotherapy.

Animals↗

A variant form of metachromatic leukodystrophy without arylsulfatase deficiency.

The clinical, pathological, and biochemical findings in a young woman with a new variant of metachromatic leukodystrophy (MLD) are reported. The patient showed slow early development and deteriorated further during her first two decades. Nerve conductions were slow, and a sural nerve biopsy showed features of a sulfatide lipidosis. Urinary sulfatide excretion was comparable to that of patients with classic MLD, yet in vitro activity of arylsulfatase A and B and cerebroside sulfatase activity were normal. Skin fibroblasts cultured in medium supplemented with 3H-labeled sulfatide showed accumulation of labeled sulfatide in large amounts, implying a defect in sulfatide hydrolysis in vivo in spite of intact enzyme activity in vitro.

Adult↗