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Biomedical subjects

C Kessler

Publications and source records attributed to C Kessler.

At least 109 records · Page 6Linked to original sources
PubMed1994

Thalamic stroke: correlation of clinical symptoms, somatosensory evoked potentials, and CT findings.

We studied 18 patients with a single ischemic thalamic lesion, who had somatosensory disturbances and/or central pain in the opposite hemibody, by correlating their clinical symptoms, somatosensory evoked potentials (SEPs), and computed tomography (CT) findings. Patients were divided into three groups: (1) those with somatosensory deficits, central pain, and abnormal SEPs, which comprised two thirds of the patients (classic thalamic pain syndrome), (2) those with somatosensory deficits, no central pain, and abnormal SEPs (analgetic thalamic syndrome), and (3) those with almost normal sense perception, central pain, and normal SEPs (pure algetic thalamic syndrome). CT evidence of a paramedian or anterolateral thalamic lesion might be an indicator for the development of central pain, because these types of infarctions occurred only in patients with the classic thalamic syndrome or the pure algetic thalamic syndrome. The differentiation of the thalamic syndrome into three subtypes is of prognostic value, because patients with a loss of cortical SEPs and a posterolateral ischemic thalamic lesion on the CT scan probably will not exhibit central pain.

Aged↗
PubMed1994

[Psychiatric comorbidity in dissociative disorders in neurology].

We studied consecutively 50 neurologic inpatients of a university neurological department with dissociative (conversion) disorders with regard to their associated psychopathologic features as well as to their comorbidity. The study involved both self-measuring instruments and a standardized psychiatric interview. As a result patients with conversion disorders appeared as a psychopathologic highly disturbed group. We found that although the dissociative symptoms are phenomenological very predominant and were the reason for hospital admission in all cases, they must be interpreted as accompanying features in the context of complex psychiatric disorders. Diagnostic and therapeutic consequences are discussed with regard to the neurology.

Adolescent↗
PubMed1994

[The Erlangen Support Ring for management of congenital and acquired acetabular defects. Intermediate term results of 43 implantations].

Between January 1987 and December 1989, at the Department of Trauma Surgery of the University of Erlangen 41 patients were treated at one or both hips with the uncemented hip replacement "Erlanger Modell" including a special supporting ring because of the bad condition of the bone surrounding the acetabular region. In 41 cases the implantation was a revision. 2 patients have not been operated on before. They suffered from congenital hypdysplasia with severe bone destruction at the area of the acetabulum. The supporting ring and the cup are made of the titanium alloy TiAl5 Fe2.5. Using the supporting ring, it is possible to fix the socket within the bone graft and to diminish the pressure exerted on the socket by transferring a lot of stress directly to the iliac bone and the oubic bone. The results of 41 patients (43 joints) ranging from 21 to 57 postoperative months giving an average of 32 months, are very encouraging. 76.6% of the patients feel no or not much pain, 67.4% can walk without hooked stick and 79% can walk a distance of more than 1000 m. The range of movement of the hip joint could be improved, especially abduction and extention. Good results based on patients satisfaction were obtained in 95.4%.

Acetabulum↗
PubMed1993

Three-year randomised study of high-purity or intermediate-purity factor VIII concentrates in symptom-free HIV-seropositive haemophiliacs: effects on immune status.

The availability of monoclonal-antibody-purified factor VIII (FVIII) concentrates allows us to test the hypothesis, based on in vitro observations, that their use in HIV seropositive haemophiliacs would result in a difference in the rate of deterioration of immune function. We designed a multicentre, prospective, randomised, controlled study of symptom-free HIV-infected patients with haemophilia A who were assigned to receive either an intermediate-purity or monoclonal-antibody-purified product. All had CD4 lymphocyte counts of 100-600/microL, were negative for hepatitis B surface antigen, had not received any antiretroviral or immunomodulating drugs before study entry, and had previously received replacement therapy with intermediate purity FVIII concentrates. Use of antiretroviral therapy was permitted. 60 patients were recruited and 30 were assigned to each group. 35 completed the 3 year study, 20 in the monoclonal arm and 15 in the intermediate-purity arm. Among those completing the study, there were no differences between the two groups in the occurrence of AIDS-defining diagnoses (1 in each group). There were, however, striking and significant differences in terms of changes in absolute CD4 counts. The group receiving monoclonal-antibody-purified concentrates had essentially stable counts while a significant drop was observed in the group receiving intermediate-purity FVIII. These differences were independent of the use of antiretroviral therapy. These observations support the use of high-purity concentrates in the treatment of symptom-free HIV-positive patients with haemophilia A, and they should be taken into account along with cost, by doctors making therapeutic decisions.

Adolescent↗
PubMed1993

Use of porcine factor VIII in the treatment of patients with acquired hemophilia.

Data have been collected from 47 centers in Europe and North America on the treatment with porcine factor VIII concentrate of 74 acute bleeding episodes in 65 patients with acquired hemophilia. The median initial anti-human factor VIII auto-antibody inhibitor level was 38 Bethesda unit (BU)/mL (range 1.2 to 1,024) whereas that against porcine was 1 BU/mL (range 0 to 15). The mean initial dose of porcine factor VIII infused was 84 IU/kg, which increased the plasma factor VIII:C activity by 0.85 IU/mL. Therapy was continued for a mean of 8.5 days during which time the average number of infusions was 11. Objective clinical responses were rated as good or excellent in 78% of recipients. Side effects were uncommon; only one patient experienced a severe anaphylactic reaction necessitating the discontinuation of porcine FVIII therapy. After therapy, no increase in the median level of anti-human FVIII or anti-porcine antibody was noted in the group as a whole, although 13 patients showed individual increases in either anti-human or anti-porcine antibody levels or both of more than 10 BU/mL. Of the 7 patients who subsequently rebled, 5 were successfully re-treated and 2 did not respond to further porcine factor VIII treatment. Porcine factor VIII is safe and clinically effective treatment for bleeding episodes associated with acquired hemophilia and should be considered as first-line therapy for patients whose acquired anti-factor VIII:C antibody cross-reacts with porcine factor VIII:C at low levels.

Adolescent↗
PubMed1993

Thrombosis of the right vein of Labbé: radiological and clinical findings.

A rare case of aseptic thrombosis of the right vein of Labbé in a young woman is reported. Cerebral venous thrombosis was suggested by computed tomography and confirmed by angiography. Mild left-sided neurological deficits resolved almost completely. The combination of a nonspecific clinical picture with an atypical lesion on CT may favour the diagnosis of cortical venous thrombosis.

Adult↗
PubMed1993

Disseminated Pneumocystis carinii infection involving the neck and nasopharynx.

In summary, several points should be emphasized: 1. Adenoidal hypertrophy in a person who previously underwent adenoidectomy should lead to the suspicion of HIV infection. 2. P. carinii should be included in the differential diagnosis of adenoidal enlargement in HIV infections. 3. Extrapulmonary calcification should lead to the suspicion of P. carinii infection.

AIDS-Related Opportunistic Infections↗
PubMed1993

Low-tension glaucoma: a comparative study with retinal ischemic syndromes and anterior ischemic optic neuropathy.

In low-tension glaucoma (LTG), nerve-fiber-bundle defects are assumed to result from ischemia of the choroidal branches of the posterior ciliary arteries, due either to local vascular changes or, presumably, hemodynamically occlusive carotid artery disease. To study the possible hemodynamical origin of LTG, we examined and compared, clinically and by ultrasound (continuous-wave Doppler and duplex-scanning), the extracranial carotid arteries of (1) 21 patients (34 eyes) with LTG, (2) 48 patients (49 eyes) with retinal ischemic syndromes (RIS), and (3) 15 patients (17 eyes) with anterior ischemic optic neuropathy (AION). High-grade stenoses and occlusions of the internal carotid arteries ipsilateral to the affected eyes were significantly more frequent in the RIS patients (17 of 49) than in the LTG patients (2 of 34; P < .01) and the AION patients (0 of 17; P < .01). Among our relatively small group of LTG patients, we found no striking evidence supporting a hemodynamic origin of LTG.

Aged↗
PubMed1993

[Eight years experience with the "Erlangen Model" titanium prosthesis--results of cementless implantation of 250 hip prostheses].

Between March 13, 1984 and March 28, 1988, 233 patients (age range from 21 to 73 years) with osteoarthritis of one or both hips were treated with the uncemented hip replacement "Erlanger Modell" (Prof. H. Beck/P. Brehm Chirurgie-Mechanik GmbH). The cause of the osteoarthritis was variable. Hip replacement was carried out for the following conditions: rheumatoid arthritis including ankylosing spondylits (n = 29), aseptic necrosis of the femoral head including posttraumatic and idiopathic forms (n = 17), osteoarthritis of unknown origin (n = 111), osteoarthritis following dysplasia or subluxation of the hips (n = 56) and loosened cemented hip prostheses (n = 37). Full weight bearing was not permitted for 50 days postoperatively, but mobilization and isometric exercises began 2 days after operation and isotonic exercises are introduced later. Complications included fracture of the femoral shaft during operation (3.3%), fracture of the femoral shaft postoperative (1.6%), dislocation (0.8) and infection early after operation (0.4%) and aseptic loosening (3.7%). Our results of 233 patients (250 joints), ranging from 4 to 8 postoperative years giving an average of 5.3 years, are encouraging. Good results based on patients satisfaction were obtained in 95.2% (83.8% after revision) and poor results in 1.0% (2.7% after revision). 3.8% (13.5 after revision) judged their situation as unchanged. 93.3% of the patients can walk without hooked stick (53.3% after revision), 90.2% of the patients can walk more than 1000m (69.4% after revision).

Adult↗
PubMed1992

The receptor for the plasminogen activator of urokinase type is up-regulated in transformed rat thyroid cells.

Five rat thyroid cell lines were tested for the expression of the cell surface receptor for urokinase type plasminogen activator (uPA). All tested lines were found to bind uPA, but transformed 1-5G and Ki-Mol cells, which are also high uPA producers, bound at least ten times more uPA, as compared to non-producers, 'normal' TL5 cells. Moreover, it was possible to remove membrane-bound uPA by treating the cells with phosphatidylinositol-specific phospholipase C, suggesting that rat uPAR, like its human counterpart, is linked to the membrane by a glucosyl-phosphatidylinositol anchor. The specificity of the binding was tested by competition with three different synthetic peptides corresponding to amino acids 14-37 of human, rat and mouse uPA. The results indicate also that the receptor binding region of rat uPA is located within the growth factor domain of the molecule and that its expression may be dependent on the transformed state of the cells.

Amino Acid Sequence↗
PubMed1992

Bilateral rupture of the patellar tendon without predisposing systemic disease.

Bilateral rupture of the patellar ligament in a 49-year-old woman is reported. She sustained a relatively minor trauma and no underlying systemic disease could be found. This is the 14th case of simultaneous spontaneous rupture of the patellar tendons reported in the literature. The diagnostic features were diffuse swelling around the knees, visible and palpable infrapatellar defects, and an inability to extent either leg.

Female↗
PubMed1992

[CO2 test with transcranial Doppler sonography in cerebral ischemia].

We evaluated the CO2-induced vasomotor reactivity of the cerebral vasculature in 48 patients with high degree stenosis or occlusion of the internal carotid artery by transcranial Doppler ultrasonography measuring changes of flow velocities in the middle cerebral artery. Further, the vasomotor reactivity of the basilar artery was measured in 48 patients with vertebro-basilar ischemia. These results were compared with the findings in normal individuals. The vasomotor reactivity was significantly reduced in patients with stenosis or occlusion of the internal carotid artery as compared to normal controls. In patients with high degree ICA stenoses, undergoing to carotid surgery, CO2-test showed a significant improvement of the pathological vasomotor reactivity 6 month after the operation. In the group of patients with vertebro-basilar ischemia, the vasomotor reactivity measured in the basilar artery, was significantly reduced in patients with completed brainstem infarctions but not in patients with transient brainstem ischemia or infarctions in the posterior cerebral artery territory. We conclude that evaluation of the cerebral vasomotor reactivity by transcranial Doppler ultrasound is able to identify an inadequate cerebral blood supply and may help to estimate the hemodynamic effect of stenosis or occlusion of the extracranial brain supplying arteries.

Adult↗
PubMed1992

Obstetric performance in patients with the lupus anticoagulant and/or anticardiolipin antibodies.

Antiphospholipid antibodies, notably the lupus anticoagulant and anticardiolipin antibodies, are associated with recurrent fetal wastage, pregnancy complications, and thromboses. Aggressive medical treatment using aspirin and steroids has been recommended. Fifty-one patients with antiphospholipid antibodies, only four with underlying connective tissue disorders, were followed through 53 pregnancies. Aggressive therapy was used in 33 pregnancies, 90.9% of which resulted in successful obstetric outcomes, a highly statistically significant difference compared with previous pregnancies in the same patients. Most pregnancies among nine patients receiving single-agent therapy (aspirin or steroids alone) and eight patients not treated also had successful outcomes. A 48.6% complication rate was found in association with therapy, particularly gestational diabetes mellitus. There was no statistical correlation between dose or duration of therapy and development of treatment-related complications. Although a subgroup of patients with antiphospholipid antibodies will benefit from aggressive therapy, the high complication rate warrants close observation.

Adrenal Cortex Hormones↗
PubMed1992

Production of transient ischaemic events by platelet emboli in baboons.

To investigate the pathophysiological process of transient ischaemic events in a clinically relevant model, we produced transient focal cerebral ischaemia in five baboons using endogenously generated platelet microemboli. Thrombogenic segments of Dacron vascular graft were incorporated as unilateral carotid arterio-arterial shunts to produce endogenous platelet microemboli. The embolized microparticles were quantified by isotopic imaging using 111In-platelets and by transcranial Doppler ultrasonography. Platelet microemboli accumulated rapidly in the shunted carotid territory and reached a maximum value of 3.2 +/- 0.8 x 10(9) in the embolized hemisphere 20 min after initiating blood flow through the graft segment. Sixty min after removing the grafts 111In-platelets were largely cleared from hemispheric vasculature. Recovered animals exhibited mild contralateral hemiparesis which disappeared completely within 24 h. We conclude that endogenously generated platelet microemboli accumulate transiently in the dependent cerebral circulation and produce corresponding transient focal neurological dysfunction. This model may be useful in the evaluation of new therapeutic strategies in acute stroke.

Animals↗
PubMed1992

Induction of transient neurological dysfunction in baboons by platelet microemboli.

BACKGROUND AND PURPOSE: To investigate experimental mechanisms of reversible cerebral dysfunction, we produced transient focal cerebral ischemia in five baboons by unilateral perfusion of internal carotid territories with platelet microemboli generated endogenously. METHODS: Platelet microemboli were formed by incorporating segments of Dacron vascular graft for 1 hour as unilateral carotid arterio-arterial shunts. Platelet embolization was assessed by ultrasonography and isotopic imaging; cerebral function was evaluated by measurements of somatosensory evoked potentials and clinical motor performance. RESULTS: Platelet microemboli, detected by transcranial Doppler ultrasonography, accumulated rapidly in the shunted carotid hemispheric territory. Indium-111-labeled platelets reached a maximum value of 3.2 +/- 0.8 x 10(9) platelets in the dependent hemisphere of five animals after 20 minutes of carotid blood flow through the grafts when measured in real time by continuous scintillation camera imaging. The retained 111In-platelet microemboli cleared from the cerebral vasculature within 1 hour after removing the grafts. Corresponding blood markers of in vivo thrombus formation, beta-thromboglobulin, platelet factor 4, and fibrinopeptide A, increased eightfold to 20-fold after incorporating graft segments and normalized within 1 hour after removing the grafts. Coincidently, focal neurological function was temporarily impaired, as shown by the ipsilateral loss of somatosensory evoked potentials 5 minutes after initiating platelet microembolization, with restoration 1 hour after removing the grafts in five baboons, and contralateral hemiparesis in two recovered baboons, with complete resolution by 24 hours. CONCLUSIONS: Endogenously generated platelet microemboli accumulate transiently in the dependent cerebral circulation and produce corresponding focal neurological dysfunction that resolves within hours after microembolization.

Animals↗
PubMed1992

Nonradioactive in situ hybridization with digoxigenin labeled DNA probes.

Nonradioactive in situ hybridization techniques are becoming increasingly important tools for rapid analysis of the topological organization of DNA and RNA sequences within cells. Prerequisite for further advances with these techniques are multiple labeling and detection systems for different probes. Here we summarize our results with a recently developed labeling and detection system. The DNA probe for in situ hybridization is modified with digoxigenin-labeled deoxyuridine-triphosphate. Digoxigenin is linked to dUTP via an 11-atom linear spacer (Dig-[11]-dUTP). Labeled DNA probes were hybridized in situ to chromosome preparations. The hybridization signal was detected using digoxigenin-specific antibodies covalently coupled to enzyme markers (alkaline phosphatase or peroxidase) or to fluorescent dyes. Color reactions catalyzed by the enzymes resulted in precipitates located on the chromosomes at the site of probe hybridization. This was verified by hybridizing DNA probes of known chromosomal origin. The signals were analyzed by bright field, reflection contrast and fluorescence microscopy. The results indicate that the new technique gives strong signals and can also be used in combination with other systems (e.g., biotin) to detect differently labeled DNA probes on the same metaphase plate.

Animals↗
PubMed1992

[Are metipranolol eyedrops responsible for intraocular side effects?].

Metipranolol is a beta-blocker that has been used in ophthalmology and in systemic therapy for about 10 years. Reports about reversible uveitis under the product Glauline (metipranolol-containing eye drops) in England were the reason for extensive studies with metipranolol-containing eye drops produced with different methods. Analytical studies concerning the influence of irradiation sterilization on the drug containers, studies on the toxicity of the ophthalmic drug on tissue cultures, and prospective and retrospective clinical studies on 2,800 glaucoma patients were performed. Irradiation sterilization leads to the formation of free radicals on the surface of the containers and, depending on the radiation dose, to a decrease in the pH of the drug solution. In prospective studies involving 1,516 glaucoma patients, no intraocular side effects due to metipranolol-containing eye drops were found. In the retrospective examination including 1,306 glaucoma patients, 19 cases of uveitis were found. Thirteen cases of recurring iritis were diagnosed, which had already been observed before the onset of glaucoma therapy. In 2 cases the iritis led to secondary glaucoma and was treated with metipranolol. In 2 cases glaucoma was treated with pilocarpine (and dipivefrin) and metipranolol concomitantly. One case of rubeosis iridis was incorrectly classified as iritis. One case is possibly related to metipranolol despite the assessment to the contrary by the ophthalmologist in question. Following the results of these studies, an accumulation of cases of uveitis caused by metipranolol can be excluded.

Adolescent↗