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Biomedical subjects

C Kurth

Publications and source records attributed to C Kurth.

At least 19 recordsLinked to original sources
PubMed2001

Risk assessment of alcohol withdrawal seizures with a Kohonen feature map.

Recently, it has been suggested that alcohol-induced hyperhomocysteinaemia in patients suffering from chronic alcoholism might be a risk factor for alcohol withdrawal seizures. In the present follow-up study 12 patients with chronic alcoholism who suffered from withdrawal seizures had significantly higher levels of homocysteine (Hcy) on admission (71.43 +/- 25.84 mol/l) than patients (n = 37) who did not develop seizures (32.60 +/- 24.87 mol/l; U = 37.50, p = 0.0003). Using a logistic regression analysis, withdrawal seizures were best predicted by a high Hcy level on admission (p < 0.01; odds ratio 2.07). Based on these findings we developed an artificial neural network system (Kohonen feature map, KFM) for an improved prediction of the risk of alcohol withdrawal seizures. Forty-nine patients with chronic alcoholism (12 with alcohol withdrawal seizures and 37 without seizures) were randomized into a training set and a test set. Best results for sensitivity of the KFM was 83.3% (five of six seizure patients were predicted correctly) with a specificity of 94.4% (one false positive prediction of 19 patients). We conclude that in patients with alcohol-induced hyperhomocysteinaemia the KFM is a useful tool to predict alcohol withdrawal seizures.

Adult↗
PubMed2001

Fixation-off sensitivity in an adult with symptomatic occipital epilepsy.

An adult patient had EEG occipital spike fixation-off sensitivity and spontaneous occipital seizures due to perinatal asphyxia with bioccipital hemorrhage. EEG abnormalities consisted of repetitive posterior spikes that occurred when the eyes were closed and other conditions of fixation-off. Magnetic resonance imaging (MRI) documented severe posterior lesions with wallerian degeneration of the optic radiation. Electron capture detector single-photon emission computed tomography (ECD-SPECT) during the state of fixation-off showed regional hyperperfusion in the right posterior regions. We suggest that partial denervation of the primary visual cortex in this patient resulted in an increased cortical excitability and that the inhibitory effect of central vision and fixation leads to a suppression of spontaneous epileptic activity. This unusual symptomatic case may serve as a model for the pathophysiology in the more often reported cases of idiopathic benign epilepsy syndrome of childhood.

Adult↗
PubMed2000

Oxidative stress and an altered methionine metabolism in alcoholism.

The exact mechanism of brain atrophy in patients with chronic alcoholism remains unknown. There is growing evidence that chronic alcoholism is associated with oxidative stress and with a derangement in sulphur amino acid metabolism (e.g. ethanol-induced hyperhomocysteinemia). Furthermore, it has been reported that homocysteine induces neuronal cell death by stimulating N-methyl-D-aspartate receptors as well as by producing free radicals. To further evaluate this latter hypothesis we analysed serum levels of both homocysteine and markers of oxidative stress (malondialdehyde) in alcoholic patients who underwent withdrawal from alcohol. Homocysteine and malondialdehyde were quantified by high performance liquid chromatography (HPLC) in serum samples of 35 patients (active drinkers). There was a significant correlation (P<0. 01) between blood alcohol concentration and elevated homocysteine (Spearman's r=0.71) and malondialdehyde (r=0.90) levels on admission. In addition, homocysteine and malondialdehyde levels were found to be significant decreased after 3 days of withdrawal treatment (Wilcoxon test: homocysteine, Z=-5.127; malondialdehyde, Z=-3.120; P<0.01). We postulate that excitatory neurotransmitters and mechanisms of oxidative stress in patients with chronic alcoholism may partly mediate excitotoxic neuronal damage and hereby cause brain shrinkage.

Adult↗
PubMed2000

Homocysteine and alcoholism.

Chronic alcohol consumption can induce alterations in the function and morphology of most if not all brain systems and structures. However, the exact mechanism of brain damage in alcoholics remains unknown. Partial recovery of brain function with abstinence suggests that a proportion of the deficits must be functional in origin (i.e. plastic changes of nerve cells) while neuronal loss from selected brain regions indicates permanent and irreversible damage. There is growing evidence that chronic alcoholism is associated with a derangement in the sulfur amino acid metabolism. Recently, it has been shown that excitatory amino acid (EAA) neurotransmitters and homocysteine levels are elevated in patients who underwent withdrawal from alcohol. Furthermore, it has been found that homocysteine induces neuronal cell damage by stimulating NMDA receptors as well as by producing free radicals. Homocysteine neurotoxicity via overstimulation of N-methyl-D-aspartate receptors may contribute to the pathogenesis of both brain shrinkage and withdrawal seizures linked to alcoholism.

Adult↗
PubMed1998

Surface EMG and myosonography in the detection of fasciculations: a comparative study.

Surface electromyography (EMG) and muscle sonography both facilitate the detection of fasciculations. This study was conducted to evaluate the prevalence of fasciculations in 10 lower extremity muscles in 58 subjects 47 +/- 18 years of age without and 54 patients 52 +/- 15 years of age with various neuromuscular diseases (3 with inflammatory myopathy, 15 with lower motor neuron disease, 22 with acquired and 11 with hereditary motor and sensory neuropathy (HMSN), and 3 with adrenomyeloneuropathy). When each muscle was screened by means of myosonography for 10 seconds, fasciculations were found in up to 8 muscles in 11 control subjects (19%) and in up to 10 muscles in 41 patients (76%). Within the same recording period surface EMG revealed fasciculations in 5 control subjects (9%) and 30 patients (56%), whereas during a recording time of 20 minutes fasciculations were detected in 55 (95%) control subjects and all patients. An amplitude of 400 microV proved to be the optimum cutoff between fasciculations for healthy subjects and patients with neuromuscular disease (accuracy, 74%). Myosonography allowed differentiation of both groups with an accuracy of 79%. Surface EMG was more liable to artifacts than myosonography. The average interval between subsequent fasciculations cannot be used to differentiate patients with acquired and hereditary polyneuropathy and with lower motor neuron disease. Long-term surface EMG recording indicates fasciculations to occur in almost all patients with neuromuscular disease and the vast majority of healthy subjects. Muscle ultrasonography was more convenient and reliable than surface EMG in differentiating patients and healthy subjects.

Adult↗
PubMed1998

The lateralizing value of ictal clinical symptoms in uniregional temporal lobe epilepsy.

In order to assess the lateralizing value of several ictal and postictal clinical symptoms in temporal lobe epilepsy (TLE), we analyzed 89 seizures of 20 left dominant patients with intractable left (n = 9) versus right (n = 11) TLE who had undergone successful anterior temporal lobectomy. In left TLE, movement arrest at seizure onset, postictal dysphasia > 120 s and postictal dyslexia > 180 s were the most typical findings and associated with a sensitivity of 94, 94, and 100%, respectively. The highest specificity of 100% each was evident for contralateral versions of eyes and head and dystonic posturing. In right TLE, the highest sensitivity was seen for whole-body movements at seizure onset, postictal dysphasia < 120 s and postictal dyslexia < 180 s with figures of 82, 87, and 93%, respectively. As compared to left TLE, contralateral version and dystonic posturing, ictal speech, and postictal dyslexia < 180 s each had a specificity of 100%. The careful combined analysis of certain ictal clinical signs combined with consistent findings of interictal EEG and neuroimaging studies may be often sufficient to proceed with epilepsy surgery without invasive recordings even if ictal scalp EEG is not unambiguous.

Adolescent↗
PubMed1997

Isolated ataxia as an idiosyncratic side-effect under gabapentin.

Gabapentin has been accepted worldwide as a novel antiepileptic drug with a favourable tolerability profile. However, movement disorders have been reported previously as rare side-effects in individual patients. We report on two patients who developed isolated severe ataxia under low-dose gabapentin which resolved abruptly after discontinuation of the drug. This side-effect probably resembled a rare idiosyncratic adverse reaction. We propose the gabapentin-specific neuronal binding site which has a high density in the cerebellum as a possible mechanism of action and suggest that the initiation of gabapentin requires caution if pre-existing cerebellar function impairment is evident.

Acetates↗
PubMed1996

Fasciculations: clinical, electromyographic, and ultrasonographic assessment.

Widespread fasciculations are an important clinical sign in, for example, degenerative lower motor neuron diseases (LMND). Usually they are detected by clinical inspection and electromyography. Recently myosonography has been proposed for the detection of fasciculations. This prospective study compares the value of these three modes of examination in patients with degenerative LMND. Seventy healthy control persons and 34 patients (11 women, 23 men; aged 43-78 years; median age 60.5) with LMND were included in the study. All participants were subjected to thorough visual screening for the presence of fasciculations. Fourteen muscles were examined bilaterally by myosonography and a median of 8 muscles were screened electromyographically (only in the patients); the investigators were blinded to the other findings. Clinical inspection and ultrasonography exhibited fasciculations in up to 5 and 8 muscles, respectively, in 8 healthy persons. Ultrasonography demonstrated fasciculations in all patients, clinical inspection in all but 2, and electromyography in 26 of 33 patients (1 patient was not examined electromyographically). Comparing the three methods, clinical observation revealed fasciculations in 42%, electromyography in 39%, and ultrasonography in 67% of all muscles. Thus, ultrasonography was significantly more sensitive than the other techniques (P < 0.001). The interrater agreement (correlation coefficient) r in respect of the presence or absence of fasciculation was 0.71 for the clinical, 0.85 for the electromyographic and 0.84 for the myosonographic examinations. Ultrasonography and electromyography were more reliable than the clinical examination (P < 0.001 and P < 0.01, respectively). Our study indicates that ultrasonography is more sensitive than clinical and electromyographic examination in visualizing fasciculations in patients with LMND. Additionally, it is more reliable than clinical examination.

Adult↗
PubMed1996

Dieting in sixth grade predicts alcohol use in ninth grade.

Recent studies of community-based populations have shown that the comorbidity seen in clinical studies of individuals with eating disorders and substance abuse extends in a graded manner to subclinical levels of each dysfunction as well as to adolescent populations. We hypothesized that frequency of dieting in the sixth grade would predict later alcohol use in middle school students. Data from 1,905 participants in a middle school health promotion project were analyzed. We found a positive, graded relationship between the frequency of dieting in the sixth grade and the frequency of alcohol intake in the ninth grade. We also found that frequency of dieting in sixth grade was a more powerful predictor of future drinking than such parameters as others' approval of alcohol use, perceptions of peer use of alcohol, and personal feelings of shyness and self-satisfaction. Implications of these findings are discussed.

Adolescent↗
PubMed1996

Dieting severity and gastrointestinal symptoms in college women.

Young women report symptoms associated with irritable bowel syndrome (IBS), such as pain, bloating, and changes in bowel movements, more often than young men. Young women with eating disorders also report these gastrointestinal symptoms frequently. We hypothesized that if dieting behaviors were associated with these symptoms, the prevalence and frequency of the symptoms would be positively related to dieting severity in young women. We interviewed 301 1st-year college women representing the continuum of dieting severity. We found that severity of dieting was positively related to frequency of abdominal pain, bloating, diarrhea, and constipation, and that the women who reported 3 or more symptoms regularly scored higher on a scale for dieting severity. Although this study did not examine the relationship between dieting severity and clinical IBS, the findings suggested that dieting is associated with gastrointestinal symptoms in young women.

Comorbidity↗
PubMed1996

Ictal near infrared spectroscopy in temporal lobe epilepsy: a pilot study.

Near infrared spectroscopy (NIRS) is a non-invasive method to measure cerebral tissue oxygenation continuously with an adhesive optode system which can be easily placed on the skin. We coupled NIRS with video-electroencephalography (video-EEG) during the presurgical evaluation of two patients with intractable localization-related epilepsy of mesial temporal origin. Cerebral oxygen saturation was measured either ipsilaterally (three seizures) or contralaterally (four seizures) to the primary epileptogenic zone. Since NIRS measures cerebral tissue oxygenation in a depth of only few centimetres, it did not record within the primary epileptogenic zone in our patients. Therefore we decided to place the NIRS optodes comfortably for the patients on the hairless skin corresponding with measurement of the oxygenation within the corresponding frontal cortex. Ipsilateral measurement revealed a marked desaturation in the course of the seizure with a postictal maximum whereas contralateral findings were inconsistent. The favourable outcome of selective amygdalahippocampectomy in both cases retrospectively confirmed the correct lateralization by video-EEG and the concordant NIRS findings. Our preliminary results suggest that NIRS might be a simple, cost-effective and non-invasive additional method to lateralize the primary epileptogenic zone in temporal lobe epilepsy and should be further investigated in larger series of patients.

Adult↗
PubMed1992

Food preferences in human obesity: carbohydrates versus fats.

A large clinical sample of obese men and women were asked for a self-generated list of ten favorite foods. The lists were characterized by frequent instances of foods that are major nutrient sources of fat in the American diet. While obese men listed mainly protein/fat sources (meat dishes) among their favorite foods, obese women tended to list predominantly carbohydrate/fat sources (doughnuts, cookies, cake) and foods that were sweet. There was no evidence that selective preferences for a single macronutrient, carbohydrate, were a standard feature of human obesity. Rather, preferences for major nutrient sources of fat as opposed to carbohydrate may be a primary characteristic of human obesity syndromes.

Adult↗
PubMed1992

The relationship of dieting severity and bulimic behaviors to alcohol and other drug use in young women.

Patients with bulimia nervosa frequently have problems with alcoholism and other substance abuse. The goal of this study was to assess whether this relationship between eating abnormalities and substance abuse extends to subthreshold levels of dieting and substance use. A self-administered questionnaire assessing dieting and substance use (alcohol, cigarettes, and marijuana) was completed by 1,796 women prior to their freshman year in college. Using a scale derived from DSM-III-R criteria for bulimia nervosa and previous research in this population, subjects were categorized as nondieters, casual, intense, severe, at-risk or bulimic dieters. The relationship between the dieting-severity category and frequency and intensity of alcohol use and frequency of marijuana and cigarette use was assessed. DSM-III-R criteria for bulimia nervosa were met by 1.6% of the women. Only 13.8% of these women were nondieters. Increasing dieting severity was positively associated with increasing prevalence of alcohol, cigarette, and marijuana use and with increasing frequency and intensity of alcohol use. The bulimic and at-risk dieters were similar in their alcohol and drug use. The relationship between eating disorders and alcoholism and other substance abuse noted in clinical populations extends in a continuous, graded manner to subthreshold levels of dieting and substance use behaviors. Dieting-related attitudes and behaviors in young women may be related to increased susceptibility to alcohol and drug abuse.

Alcoholism↗
PubMed1990

[Pre- and postoperative ultrasonic studies in stomach carcinoma and in colonic carcinoma].

Ultrasonographic findings in gastric cancer are essential for assessment of operability. In surveillance programs, endoscopy is important in detecting secondary gastric carcinomas, whereas ultrasonographic examination has no clinical value. Preoperative ultrasonography in colorectal carcinoma focuses on detection of liver metastases and, if metastases are detected, on assessment of resectability. Sonographic surveillance at short intervals in thus important for possible therapeutic interventions.

Colorectal Neoplasms↗
PubMed1990

Cholesterol reduction through low-intensity interventions: results from the Minnesota Heart Health Program.

The National Cholesterol Education Program has underscored the need for health professionals to work together to promote dietary changes and reduce blood cholesterol levels across the population. This article reports the results of an evaluation of several low-intensity intervention programs designed for the general public that could be offered on a larger scale, either through traditional outlets for short courses or on an outpatient basis after physician referral. The interventions were designed as classes, required approximately 8 hr of contact time with the participants, cost approximately $20 per participant, and were taught by nutritionists and dietitians recruited from the community and trained for this program. Results indicated that similar net reductions in total cholesterol of about 4% were achieved at 1-yr follow-up either from a course which focused on changing eating patterns or from one which focused on weight loss and weight-loss management. These results support the hypothesis that cholesterol reduction is possible with inexpensive and simple methods in healthy, low-risk populations.

Adult↗
PubMed1989

Measuring and tracking education program implementation: the Minnesota Heart Health Program experience.

In an overall framework uniting program planning and evaluation, process evaluation can assist community-based health promotion programs in establishing participation objectives, monitoring their achievement and the quality of interventions used, and translating these into useful information for managing and developing programs. This research reports on efforts by the Minnesota Heart Health Program to develop a system that permitted tracking educational program contacts, its implementation, and its use to make management decisions about program activities. The system was developed as part of a planning and evaluation framework with specific criteria for developing and tracking educational programs drawn from the social-learning literature. Overall, the system helped to make participation objectives more concrete, aided decision making about allocation of personnel and material resources, and encouraged the development of innovative programs.

Cardiovascular Diseases↗
PubMed1988

Parent involvement with children's health promotion: the Minnesota Home Team.

This study compares the efficacy of a school-based program to an equivalent home-based program with 2,250 third grade students in 31 urban schools in Minnesota in order to detect changes in dietary fat and sodium consumption. The school-based program, Hearty Heart and Friends, involved 15 sessions over five weeks in the third grade classrooms. The home-based program, the Home Team, involved a five-week correspondence course with the third graders, where parental involvement was necessary in order to complete the activities. Outcome measures included anthropometric, psychosocial and behavioral assessments at school, and dietary recall, food shelf inventories, and urinary sodium data collected in the students' homes. Participation rates for all aspects of the study were notably high. Eighty-six per cent of the parents participated in the Home Team and 71 per cent (nearly 1,000 families) completed the five-week course. Students in the school-based program had gained more knowledge at posttest than students in the home-based program or controls. Students in the home-based program, however, reported more behavior change, had reduced the total fat, saturated fat, and monounsaturated fat in their diets, and had more of the encouraged foods on their food shelves. The data converge to suggest the feasibility and importance of parental involvement for health behavior changes with children of this age.

Child↗