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Biomedical subjects

A Opitz

Publications and source records attributed to A Opitz.

At least 19 recordsLinked to original sources
PubMed2006

Improved protocol for treatment of pemphigus vulgaris with protein A immunoadsorption.

BACKGROUND: Pemphigus vulgaris is a life-threatening autoimmune blistering skin disease, usually treated with high-dose corticosteroids in combination with other immunosuppressants. However, this regimen may prove inadequate in severe cases and can cause dangerous side-effects. We have recently reported protein A immunoadsorption (PAIA) to be an effective adjuvant treatment for induction of remission in severe pemphigus. However, in a significant number of cases, the disease rapidly recurred once PAIA and immunosuppressive medication were tapered. AIMS: The aim of the present study was to develop a PAIA-based therapeutic regimen that would result in a more prolonged remission of pemphigus. METHODS: Nine patients with pemphigus vulgaris were treated with a modified protocol characterized by a combination of PAIA with a higher initial dose of systemic methylprednisolone (2 mg/kg). In addition, azathioprine or mycophenolate mofetil was administered as a steroid-sparing agent. RESULTS: In all nine patients treated with this regimen, we observed a sharp decline of circulating autoantibody levels and dramatic improvement of cutaneous and mucosal lesions within 4 weeks of therapy. The patients remained free of clinical disease for up to 26 months after PAIA treatment was discontinued. CONCLUSION: The improved treatment protocol appears to combine highly effective induction of clinical remission in severe or treatment-resistant pemphigus with a prolonged subsequent symptom-free interval.

Aged↗
PubMed2004

Surgery and adjuvant dendritic cell-based tumour vaccination for patients with relapsed malignant glioma, a feasibility study.

Patients with relapsed malignant glioma have a poor prognosis. We developed a strategy of vaccination using autologous mature dendritic cells loaded with autologous tumour homogenate. In total, 12 patients with a median age of 36 years (range: 11-78) were treated. All had relapsing malignant glioma. After surgery, vaccines were given at weeks 1 and 3, and later every 4 weeks. A median of 5 (range: 2-7) vaccines was given. There were no serious adverse events except in one patient with gross residual tumour prior to vaccination, who repetitively developed vaccine-related peritumoral oedema. Minor toxicities were recorded in four out of 12 patients. In six patients with postoperative residual tumour, vaccination induced one stable disease during 8 weeks, and one partial response. Two of six patients with complete resection are in CCR for 3 years. Tumour vaccination for patients with relapsed malignant glioma is feasible and likely beneficial for patients with minimal residual tumour burden.

Adjuvants, Immunologic↗
PubMed2003

Protein A immunoadsorption: a novel and effective adjuvant treatment of severe pemphigus.

BACKGROUND: Pemphigus foliaceus (PF) and pemphigus vulgaris (PV) are autoimmune blistering skin diseases usually treated with high-dose systemic corticosteroids and other immunosuppressants that may cause severe side-effects. Plasmapheresis also has been demonstrated to be of benefit in the treatment of pemphigus. In contrast to plasmapheresis, staphylococcal protein A immunoadsorption (PA-IA) specifically removes immunoglobulin from the circulation, allows treatment of larger plasma volumes, and does not require the substitution of plasma components. OBJECTIVES: To determine the effectiveness and side-effects of PA-IA in patients with severe pemphigus. METHODS: Five patients with severe pemphigus (PV, n = 4; PF, n = 1) were treated by PA-IA. Three of these patients had been refractory to various treatment regimens. In addition to PA-IA, methylprednisolone, 0.5 mg x kg-1 body weight day-1 was given initially and subsequently tapered. RESULTS: In all patients, a dramatic clinical improvement was seen within 2 weeks after initiation of therapy. Patients were free of lesions after 3, 4, 4, 10 and 21 weeks of treatment, respectively. Concurrently, autoantibody levels decreased rapidly. CONCLUSIONS: PA-IA is a rational, effective, and safe adjuvant therapy for severe pemphigus and warrants wider use for this indication. A controlled study should compare side-effects and effectiveness of PA-IA with other treatment options for pemphigus.

Adjuvants, Immunologic↗
PubMed1999

[Using the internal thoracic artery of patients with reduced left ventricular function].

Todate internal mammary artery (IMA) is routinely used in coronary artery bypass grafting even in elder patients. However in patients with poor left ventricular function use of the IMA is discussed controversely in Germany. Main arguments against IMA are an increased operation time, initially lower blood flow, higher rates of reoperation for bleeding and more perioperative complications. In this study we investigated use of the IMA in patients with poor left ventricular function (LVEF < 40%) compared to exclusively veingraft bypass surgery. 137 patients (105 m/32 f) suffering from coronary artery disease with reduced LVEF (12-40%) were randomized in the study. 67 patients received exclusively vein grafts (group I), 70 patients routinely obtained an IMA graft. Criteria used for evaluation of IMA graft were operation time, postoperative bleeding, need for catecholamines, requirement of intensive care, perioperative myocardial infarction and mortality. The number of distal anastomoses in each group was 3.1 (2-5). The operation time varied in compliance with the number of distal anastomoses, but there were no significant differences between both groups. Postoperative bleeding until the second postoperative day was 905 ml in group II versus 569 ml in group I; the difference was significant (p < 0.05). The need of catecholamines after operation and hemodynamic parameters were comparable in both groups, there were no significant differences. Intensive care was required for a mean of 1.6 days in both groups, postoperative ventilation was 5.8 hours in group I versus 7.9 hours in group II, differences not significant. Ischemia or myocardial infarction could be demonstrated in 2 patients of group I (3%) versus 4 patients of group II (5.7%). The differences between the groups were not significant. Cardiac low output syndromes without sights of myocardial infarction were apparent in 9 patients of group I (13.5%) versus 2 patients of group II (2.9%), this difference being significant (p < 0.05). Mortality after operation in both groups was higher than in patients with normal ventricular function, however the differences between the evaluated groups were not significant (5.9% in group I versus 4.3% in group II). Summarizing the above it can be concluded that patients with poor left ventricular function are at a higher risk when subjected to bypass operation; the use of IMA did not show any disadvantages in comparison to exclusively veingraft surgery, except of a higher perioperative bleeding risk. Due to better long term results IMA should be used routinely also in bypass-patients with poor left ventricular function.

Aged↗
PubMed1999

Anesthesiology and intensive care during epilepsy surgery in children and adolescents.

Thus far there are no known studies of the management of anesthesiology and intensive care in cases of implantation of subdural plates for the purpose of determining the epileptogenic areal and of subsequent epilepsy surgery. Such operative measures are still considered too risky, especially in the case of small children. The authors report on cases of 45 children and adolescents who underwent this kind of surgery between December 1992 and December 1997 in Gilead hospital. In order to judge the anesthesiological risk the children were divided into three age groups: A, 1-5 years (n = 12); B, 6-11 years (n = 14); C, 12-18 years (n = 19). In none of these groups were there complications which in retrospect would have shed a negative light on the operation.

Adjuvants, Anesthesia↗
PubMed1998

Binding of 2-azaanthraquinone derivatives to DNA and their interference with the activity of DNA topoisomerases in vitro.

We have investigated the binding ability to DNA of compounds belonging to the 2-azaanthraquinone-type structure and have examined the effect on the activity of DNA gyrase as well as on mammalian topoisomerases in vitro. Using different biophysical techniques it was found that one of these ligands, 9-((2-dimethylamino)ethyl)amino)-6-hydroxy-7-methoxy-5, 10-dihydroxybenzo[g]isoquinoline-5,10-dione (TPL-I), is an intercalating DNA binding agent, whereas the parent compound tolypocladin (TPL) and a derivative (TPL-II) showed almost no similar affinity to DNA. CD measurements demonstrated a significant and selective binding tendency of TPL-I to alternating purine/pyrimidine sequences with some preference for poly(dA-dT). poly(dA-dT). Tm values were increased of the ligand complex with the alternating AT-containing duplex polymer. The binding to various DNAs was characterized by CD and visible absorption spectral changes. From the latter, different binding constants of 6.2 x 10(5) and 1.5 x 10(5) M-1 were obtained for poly(dA-dT).poly(dA-dT) and poly(dA). poly(dT), respectively. Sedimentation measurements with supercoiled pBR322 plasmid DNA clearly indicated an intercalative binding mechanism associated with an unwinding angle of about 18 degrees. These results suggest that the intercalative binding of TPL-I is promoted by the 2-(dimethylamino)ethylamino group substituted on carbon 9 of the anthraquinone system. The cytotoxic compound TPL-I, but not TPL or TPL-II, effectively inhibited the DNA supercoiling reaction of DNA gyrase and the activity of mammalian topoisomerases I and II as measured by the relaxation assay. TPL-I affects the cleavage reaction of topoisomerases on a single site located in alternating purine-pyrimidine sequence regions. The inhibitory potency of TPL-I can be ascribed to a blocking of cleavage sites on the DNA substrate, which correlates with the sequence preference of the ligand.

Anthraquinones↗
PubMed1994

[Epidural blood patch for the treatment of postspinal puncture headache. Successful therapy after 6 weeks following accidental dura perforation in obstetric PDA].

The frequency of postspinal headaches after accidental puncture of the subarachnoid space with 16-18 G Tuohy needles is reported at 59-85%. A case of postspinal headache syndrome persisting over a period of 6 weeks following epidural anaesthesia during labour is described. The treatment is discussed. CASE REPORT. A 30-year-old woman had severe postspinal headache for 6 weeks after epidural anaesthesia during labour. Conservative therapy for 3 days and 4 days of bedrest followed by crystalloid infusions during a 3-week hospital stay and a subsequent 3-week period of bedrest at home did not lead to lasting pain relief. Intracranial haematoma and other abnormal processes were excluded by CCT. A pathologic EEG was not confirmed by cranial MRT. A lumbar epidural blood patch of 15 ml of autologous blood was performed at L3/4. The patient stayed in bed for 12 h. After 3 h free of pain the patient complained of recurring headache. After a further 48 h of bedrest she had recovered. Because of lumbar pain 4 days after the epidural blood patch a MRT was performed, which showed the blood at L4 to S3 in the epidural space. DISCUSSION. The diagnosis of a cerebrospinal fluid leakage was based on the history and the main symptom of postspinal headache: the pain onset in the supine position. Such possible treatments as diminishing subarachnoidal pressure by bedrest, increasing cerebrospinal fluid production by infusions, increasing epidural pressure by epidural infusions and closing the cerebrospinal fluid leakage by epidural blood patch are discussed. The average success rate with the epidural blood patch is 93%. Volumes ranging from 5 to 20 ml are discussed for the autologous blood. We chose 15 ml of blood, to take account of the possibility that blood might settle in the wide sacral space. We were able to document the position of the blood patch as L4 to S3 on MR tomography (the injection site was L3/4). Most patients are free of headache 1 h after epidural blood patch. Our patient had to be confined to bed for another 48 h because of recurring headache. The blood patch alone was not immediately sufficient to prevent all further cerebrospinal fluid leakage. Probably more than one subarachnoidal puncture had been made during the difficult epidural anaesthetic procedure. On the other hand, the leak was probably only diminished because of the blood patch descending down to the wide sacral space. The combination of the large-volume blood patch, which diminished the leakage, and conservative treatment, which narrowed the transdural pressure difference, was successful: the 6-week postspinal headache was cured. CONCLUSION. Prolonged postspinal headache should be treated by epidural blood patch. The use of over 10 ml cannot be generally recommended, although in this case most of the blood patch of 15 ml was localized caudally. Careful monitoring for side effects is necessary with blood volumes larger than 10 ml. If there is no immediate relief, conservative therapy with 24-48 h of bedrest is recommended. If the headache persists a second blood patch should be performed, with the volume and the probable caudal spreading of the first taken into account.

Adult↗
PubMed1986

[Vascular and capsule-band reconstruction following knee joint dislocation].

This is a report about bilateral dislocations of the knee joints in one patient with arterial and venous stop because of endothelial lesions and thrombosis of the popliteal vessels on both sides. After reconstruction of circulation by means of vena saphena, the disrupted knee ligaments were also sutured. Large ventral exposure of the knee joint is recommended for both reconstruction of vessels and ligaments.

Adolescent↗
PubMed1985

Changes in plasminogen activator activity and plasmin inhibition in the pig during experimental hypovolaemia.

A markedly decreased plasminogen activator activity (PAA) was seen in lung, heart and kidney after experimental hypovolemia in the pig. In 2 of 12 cases, an increased PAA was found in liver and spleen. In skeletal muscle, skin, sciatic nerve and in 10 of 12 cases in liver and spleen PAA was unchanged. A slightly increased plasmin inhibition was noted only in the lung. These changes in tissue PAA were reflected by an increase in the PAA of euglobulin fractions concomitant with a decrease in antiplasmin activity in the blood samples obtained during the bleeding experiments.

Animals↗
PubMed1983

[Treatment results of late surgery in subcutaneous ruptures of the Achilles tendon].

15 patients with neglected subcutaneous ruptures of the tendo Achilles where operated at an average interval of 7 weeks after the accident. Up to 7 weeks after the rupture direct suture was possible, when the scar tissue was not removed. After a longer interval additional reinforcement of the suture or plastic repair was necessary. As immobilisation a low leg cast for 6 weeks is sufficient. Weight bearing is permitted after wound healing. Late results on 11 patients showed in all of them a loss of muscle strength of at least 10% as compared to the other leg. Also limitations of motion of the ankle joint is to be expected. 3 patients had infections. The use of non absorbable suture material is not to be recommended. The "pen-box operation" (Griffelschachtelplastik) leads to less devascularisation of the material then other methods with twisting a flap from the proximal tendon-stump for 180 degrees (Umkipp-Plastik).

Achilles Tendon↗
PubMed1983

[Mechanical strain in the forearm bones].

Knowledge of the physiologic distribution of strain in bone is essential for a successful osteosynthesis by means of compression plate. This method guarantees optimum stability if the plate acts as a tension band. If the side of tensile stresses varies within the bone, strain may not only occur on the side of the plate but also on the opposite cortex. In such cases the distribution of pressure in the fracture gap is of special importance. For determining the distribution of strain on the radius, it is necessary to examine the forces caused by the flexor- and extensor muscles of the wrist and fingers. Additional forces come also from flexor- and extensor muscles of the elbow. The frame formed by the bow-shaped radius and the ulna is of further importance for the distribution of strain. Kind and amount of tension is fundamentally influenced by forearm rotation. Anatomic studies on post-mortem specimens showed how the direction of muscle action to wrist and fingers changed in relation to the position of a plate fixed to the proximal shaft of the radius. This already demonstrates possible variations in the bending forces caused by forearm rotation. An analysis of the distribution of strain in the forearm bones was carried out on a biomechanical model using strain gauges. This method allows the simulation of strain to the skeleton caused by muscle force and the influence of load. The distribution of strain can be studied on the same model in various different positions of elbow and forearm. Six muscles and two muscle groups were simulated by means of wire pulls with calibrated strain gauges; these muscles and muscle groups act, on account of the physiological cross section and their position, as bending forces to the forearm bones in a dorsovolar plane. The tensile force on radius and ulna were each controlled by three strain gauges in four sections. The characteristic quantities of these sections were determined by evaluation of the appropriate computertomograms. With the aid of three strain gauges per section it was possible to assess the strain at any one desired point. Distribution of strain was determined by pull to each "muscle" in the extreme position of forearm rotation and three different positions of flexion to the elbow. The tensile force was expressed on graphs as muscle tension of 2 kp/cm2 per cross section (ill. 6 to 12).(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗
PubMed1983

[Exact method for the measurement of the rotation of the humerus head in the shoulder joint using computed tomography].

An exact method of measuring the degree of inward-and outward rotation in the humero-scapular joint is demonstrated. The advantage of the use of computed tomography as compared with the clinical method of measurement is the accurate differentiation of the mobility of the individual parts of the arm's mobile elements with respect to the trunk and the documentation of the result. For inward rotation we have measured a mean value of 38 degrees on the right side and of 37 degrees on the left; the corresponding values for outward rotation were 37 and 41 degrees. In eleven patients who had undergone Bankart's operation we found the outward rotation of the arm in the shoulder joint decreased to a mean value of 15 degrees.

Anthropometry↗