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Biomedical subjects

B Neundörfer

Publications and source records attributed to B Neundörfer.

At least 163 records · Page 9Linked to original sources
PubMed1998

Evidence for specific autoimmunity against sympathetic and parasympathetic nervous tissues in Type 1 diabetes mellitus and the relation to cardiac autonomic dysfunction.

There is growing evidence for the involvement of immunological factors in the pathogenesis of cardiac autonomic dysfunction in Type 1 diabetes mellitus (DM). To evaluate the presence of autoantibodies against autonomic nervous tissues and their relationship with tests of autonomic function, 64 newly diagnosed and 142 long duration Type 1 DM patients were investigated for sympathetic and parasympathetic ganglia (CF-SG and CF-PSG) autoantibodies with a complement-fixing indirect immunofluorescence technique. Five cardiac reflex tests were performed to assess autonomic function. Fifty-seven patients with neurological diseases other than diabetic neuropathy and 131 healthy control subjects were also tested for CF-SG and CF-PSG autoantibodies. CF-SG autoantibodies were observed in 47 (23%) and CF-PSG autoantibodies in 21 (10%) of 206 Type 1 DM patients (p < 0.001). In contrast, these autoantibodies were detected in 3 (5%) and 1 (2%) of patients with non-diabetic neurological diseases and 3 (2%) and 4 (3%) of control subjects (p < 0.01, p < 0.05, p < 0.0001, p < 0.05 vs Type 1 DM patients). All except two Type 1 DM patients with CF-PSG autoantibodies also presented with CF-SG autoantibodies. In diabetic patients with long duration, CF-SG autoantibodies were more frequent in patients with ECG-based cardiac autonomic neuropathy (CAN; > or =2 of 5 cardiac reflex tests abnormal) compared to patients without CAN although this did not reach statistical significance (29% vs 17%, p = 0.06). However, 4 (80%) of 5 newly diagnosed and 23 (32%) of 73 established Type 1 DM patients with abnormalities in heart rate variation during deep breathing and/or standing from lying presented with CF-SG autoantibodies compared to 12 (25%) of 58 newly diagnosed (p < 0.05) and 7 (11%) of 63 established Type 1 DM patients (p < 0.01), in whom both tests were normal. The results suggest that autoimmune factors contribute to the pathogenesis of cardiac autonomic dysfunction in Type 1 DM and that autoantibodies against sympathetic and parasympathetic nervous tissues are relatively specific for Type 1 DM.

Adult↗
PubMed1998

An instructive false diagnosis: steroid-induced complete remission of a CNS tumor--probably lymphoma.

In recent years the incidence of primary cerebral lymphomas has increased. Diagnosis by imaging techniques (CCT, angiography, MRT) and stereotactic biopsy are considered as reliable diagnostic tools. Therapeutically a combination of radio-, steroid- and chemotherapy is recommended. We report a case of space-occupying CNS lesion in which the radiopaque enhancing process completely disappeared after biopsy and steroid therapy. A year later the tumor recurred on the other side and again regressed after steroid therapy. The first biopsy showed signs of a papillar tumor, so a choroid plexus papilloma was suspected. On examination of the treatment history, however, this diagnosis had to be revised. A primary CNS lymphoma seems most probable. The phenomenon of a tumor remission under steroid administration and the problems related to the differential diagnosis are discussed.

Aged↗
PubMed1998

Ludwig Robert Müller (1870-1962)--a pioneer of autonomic nervous system research.

Ludwig Robert Müller, MD, professor of internal medicine, born in 1870 in Augsburg, Bavaria, studied medicine from 1890 to 1893 in various European cities and specialized in pathology and bacteriology. In 1895, he joined A. Strümpell, one of Germany's outstanding internists and neurologists, in Erlangen, Germany. Henceforth, Müller focused on the autonomic nervous system. In his 1898 Habilitation, a thesis required to join the academic faculty, which he entitled Anatomy and pathology of the lower spinal cord, he presented studies on the autonomic innervation of the bladder and colon. Based on animal studies, he continued to publish essential findings on the autonomic innervation of heart, lungs, and gastrointestinal tract. Müller was the first to report afferent pathways from internal organs to the brain. His book The vegetative nervous system was first published in 1920. In 1931, he wrote the book Lebensnerven und Lebenstriebe (Life nerves and life instincts). Many of his papers dealt with the regulation of thirst, hunger and sleep. He was Chairman of Internal Medicine in Würzburg, Germany, from 1914 to 1920, and also in Erlangen as Strümpell's successor from 1920 to 1936. The broad scope of Müller's publications makes him one of the important pioneers of autonomic nervous system research.

Autonomic Nervous System↗
PubMed1998

Pattern of autonomic dysfunction in time course of complex regional pain syndrome.

The objective of the present investigation was to describe and localize autonomic dysfunction in acute and chronic stages of complex regional pain syndrome (CRPS). Patients were investigated twice: the first investigation was performed as soon as diagnosis was established during the acute stage of CRPS and the second investigation was performed about 2 years later. Twenty-one patients completed the follow-up investigation. The median duration of CRPS was 5 (range 2-21) weeks at first investigation and 94 weeks (22-148) at follow-up. Skin temperature was recorded by thermography, sudomotor function was assessed by thermoregulatory sweat test (TST) and quantitative sudomotor axon reflex test (QSART). Skin temperature was warmer on the affected side at the first investigation (P < 0.001) and colder at follow-up (P < 0.02) compared with the contralateral limb. Sudomotor output was enhanced after both TST (P < 0.005) and QSART (P < 0.05) at the first investigation on the affected side. However, at follow-up, sweating after TST was still increased (P < 0.04) while QSART responses were not different between the affected and unaffected limbs. As compared to controls there was no statistically significant difference, neither in skin temperature nor sweating, neither on the affected nor on the unaffected side. In conclusion, the present investigation proved that vasomotor and sudomotor control are substantially altered in CRPS. In the acute stage vasomotor control is decreased in the affected limb whereas sudomotor function is enhanced. This may be the result of disturbances of thermoregulation, but different secondary peripheral mechanisms, concerning vasomotor and sudomotor function, contribute to clinical presentation of CRPS and affect autonomic function at all stages of CRPS.

Adult↗
PubMed1998

[Transcranial Doppler exercise test in patients with chronic tension headache].

In the etiopathology of tension type headache, vascular and autonomic disorders are discussed. Fifteen patients with chronic tension type headache according to the criteria of the IHS were investigated using the TCD-ergometer-test--a method used to evaluate the myogenic mechanism of cerebrovascular autoregulation--and the results were compared with the findings in fifteen healthy control subjects. The patients' Mean Flow Velocity (TAVmean) and Resistance Index (RI) at rest and after exercise were significantly decreased (p < 0.05). During exercise they normalized. The patients' endtidal pCO2 at rest and during exercise was significantly lower than the corresponding values of the control group (p < 0.05). Regarding blood pressure elevation and heart rate increase during exercise both groups did not differ significantly (p > 0.05). These findings suggest that patients with tension type headache have a diminished vascular tone in the cerebral vessels at rest which is normalised during exercise. The reduced endtidal pCO2 is considered as a physiological response to increase vascular tone via metabolic mechanism of cerebrovascular autoregulation. In conclusion it is suggested that therapeutic procedures which activate sympathetic autonomic nervous function to train cerebral vessels should be more carefully considered.

Adolescent↗
PubMed1998

[A rare cause of peracute vision loss: pseudotumor cerebri. Case report of course with recurrence after decompression of the optic nerve].

In primary pseudotumor cerebri (PTC) intracranial pressure is elevated by so far unknown mechanisms. There is a wide range of clinical courses. Therapy is controversial. We present a case of PTC with acute visual loss. After optic nerve sheath decompression a relapse occurred. A 30-year old female patient experienced visual loss within 48 h accompanied by headache and slight neck stiffness. Visual acuity was 1/50 in the right eye; in the left eye just hand movements and light were perceived. Fundoscopy revealed a 9 dptr. prominent optic disc bilaterally. After optic nerve sheath decompression (ONSD) she improved, but underwent a relapse after 3 months. Twenty-four-hour measurement of intracranial pressure revealed elevated values. As a consequence ventriculo-peritoneal shunting was performed, leading to prominent improvement. Primary PTC can cause acute visual loss. If conservative treatment fails, different surgical procedures should be considered.

Adult↗
PubMed1998

Myogenic cerebrovascular autoregulation in migraine measured by stress transcranial Doppler sonography.

BACKGROUND AND PURPOSE: Transcranial Doppler sonography (TCD) studies may help to elucidate the nature and role of vascular abnormalities in migraine. Our aim in this study was to evaluate cerebrovascular autoregulative response in migraine patients with and without aura to blood pressure increase using stress TCD. PATIENTS AND METHODS: Using transcranial Doppler ultrasound at rest and during ergometer stress (stress TCD), we studied the changes in mean flow velocities and resistance index (RI) in relation to physical stress in the middle cerebral artery. Fifteen migraine patients without aura, 15 migraine patients with aura, and 15 healthy control subjects were examined. Patients suffered from predominantly unilateral headache and were studied during an attack-free period. The Pourcelot's RI as a measure of cerebrovascular reactivity was calculated by dividing the difference between systolic and diastolic velocity by the systolic velocity. RESULTS: None of the subgroups showed any difference during ergometer exercise with regard to blood pressure, endtidal CO2, heart rate, or mean flow velocity. In all subgroups, sufficient physical stress was achieved. With respect to RI change, migraine patients without aura and healthy controls did not differ (p > 0.05). However, the RI change of migraine patients with aura was significantly lower than the RI change of migraine patients without aura or healthy subjects (p > 0.05). The discrimination analysis showed in addition that RI change (absolute and as a percentage) and mean flow velocity change (as a percentage) could be used as diagnostic variables to detect patients with aura symptoms. CONCLUSION: Differences exist in cerebrovascular reactivity in migraine patients with aura that may contribute to the neurologic disturbances in these patients during attack. We propose that there is disorder of myogenic cerebrovascular autoregulation in migraine patients with aura during headache-free intervals.

Adult↗
PubMed1998

[Polyneuropathies from solvents].

Polyneuropathy is a clinically diagnosed disorder. The diagnostic features consist mainly of subjective complaints about distally marked paresthesia or dysaesthesia, pain and motor disturbances like cramps. Neurological examination typically shows weak or absent tendon reflexes (early signs: weak or absent Achilles tendon reflexes), distally marked disturbances of sensitivity (early sign: reduced sense of vibration), atrophic paresis, cranial nerve impairment and disturbances of the autonomic nervous system. Results of additionally performed electrophysiological examinations (nerve conduction studies, vibratometry and thermotesting) contribute to the diagnosis. Polyneuropathy is undoubtedly induced by carbon disulfite, ethylene glycol, n-hexane and methyl-n-butylketone, triorthocresyl phosphate and solvent mixtures. Induction of polyneuropathy is doubtful with the following substances: tetrachloride, trichlorethylene, styrene, toluene. Additional impairment of the central nervous system is often indicated by clinical findings of brisk patellar tendon reflexes or the occurrence of Babinski's sign.

Humans↗
PubMed1998

Central nervous system involvement in thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is an uncommon multisystem disease characterized by microangiopathic hemolytic anemia, thrombocytopenic purpura, fluctuating neurologic dysfunctions, renal disease, and fever. Delayed diagnosis and treatment may lead to a high mortality rate that can be as great as 90%. We describe 7 patients in whom CNS involvement was the first clinical manifestation of TTP. Despite early diagnosis and treatment, 3 patients died because of multiple system organ failure. Four patients recovered completely. In patients with focal neurologic disorders in whom infectious CNS diseases were excluded TTP should be considered in the differential diagnosis.

Adult↗
PubMed1997

[Managing life and death wishes of invasively ventilated amyotrophic lateral sclerosis patients].

BACKGROUND: Find of life decisions of patients with amyotrophic lateral sclerosis and respiratory failure are influenced by several environmental factors. PATIENTS AND METHODS: We describe the course of disease and decision making of four of these patients. RESULTS: Most decisions have been inconsistent and were seen to be depending on actual situations. Main factors were: 1. preclinically (before respiratory failure) medical information, 2. during respirator dependency in the hospital's intensive care unit the clinical setting and the individual perspective depending on the patient's private situation, 3. at home ventilation the family's situation and conflicts. Especially the patients requests for disconnection from the respirator overtaxed their carers capacities. CONCLUSION: We conclude that there is need for professional psychosocial intervention for the patients and their families.

Adult↗
PubMed1997

[Outpatient management of chronic pain in Middle Franconia].

UNLABELLED: In Middle Franconia, one of the larger Bavarian administrative division (population 1994: 1,657,101), the number of patients suffering from cancer pain, chronic headache and chronic back pain is not known. Furthermore, there are no data on interdisciplinary organization of outpatient pain management. METHODS: All physicians and psychologists involved in outpatient pain management in Middle Franconia (n=2130) were asked (questionnaires) to estimate the number of patients suffering from cancer pain, chronic (>6 months) headache and chronic (>6 months) back pain treated the last 12 months. RESULTS: 264 (12.4%) responses were analyzed; 107,346 patients had been treated in the last 12 months, 67% by a single specialist and 33% by two or more specialists. The participation of psychotherapists and anesthetists in outpatient management of pain patients was poor; 22,754 (21%) patients were thought to need multidisciplinary analgesia therapy in a pain clinic, which actually does not exist in Middle Franconia. CONCLUSION: The data presented suggest that patients suffering from chronic pain are not optimally managed in Middle Franconia. Regional institutions for multidisciplinary pain treatment have to be established close to where chronic pain patients live.

English Abstract↗
PubMed1997

[Hepatitis C-associated vasculitic mononeuritis multiplex].

HISTORY AND CLINICAL FINDINGS: A 56-year-old woman with hepatitis C had symptoms of a polyneuropathy with asymmetrical distal pareses and painful sensory disturbances in the limbs. INVESTIGATION: In addition to positive serology for hepatitis C cryoglobulins were demonstrated and complement C4 was reduced. Biopsy of the sural nerve showed a vasculitic neuropathy. TREATMENT AND COURSE: The multiple neuropathy (cryoglobulinaemia neuropathy), associated with hepatitis C, was treated with corticosteroids (starting with 60 mg/d prednisolone) and the neurological abnormalities regressed well. CONCLUSION: Vasculitis associated with hepatitis C should be included in the differential diagnosis of peripheral neuropathy.

Chronic Disease↗
PubMed1997

Effects of cutaneous histamine application in patients with sympathetic reflex dystrophy.

Thirty-six patients suffering from acute reflex sympathetic dystrophy (RSD) were examined in order to evaluate nociceptive C-fibers. Axon reflex vasodilatation was induced by iontophoresis of histamine and recorded (laser Doppler flux). The strength of concomitant sensation was rated on a visual analogue scale, and the quality was characterized as itching or burning pain. Skin temperature was recorded by infrared thermography. The results were compared with investigations of unaffected limbs of patients and volunteers. The histamine-induced sensation on the symptomatic side was more often burning pain than itching (P < 0.001), and skin temperature was increased on the affected limb (P < 0.001). Axon reflex vasodilatation and the strength of sensations were unaltered. In conclusion, this study rules out a significant deterioration of afferent C-fibers in RSD, but gives evidence of sensitization of nociceptive function. This nociceptive sensitization has to be taken into consideration for effective treatment of RSD.

Adult↗
PubMed1997

[Recommendations of Bavarian Muscle Centers of the German Neuromuscular Disease Society for home ventilation of neuromuscular diseases of adult patients].

During recent years home ventilation has been shown to be useful for a growing number of patients with neuromuscular diseases and respiratory insufficiency caused by weakness of the respiratory muscles. Despite its technical simplicity, home ventilation leads to a number of social, ethical, medical and infrastructural problems. This consensus paper discusses the special situation of patients with neuromuscular diseases in home ventilation and describes the current thinking in the following topics: (1) definition of home ventilation; (2) aims of home ventilation; (3) indications and preconditions of home ventilation; (4) techniques and forms of home ventilatory support; (5) preparation for and practical questions of home ventilation; (6) stopping home ventilation.

Adult↗