Biomedical subjects

E Klemm

Publications and source records attributed to E Klemm.

At least 19 recordsLinked to original sources

PubMed2005

[Allergies in adults].

Only few epidemiological studies have assessed allergic diseases in adults. In a follow-up study of the MONICA survey S3 (1994/95), which was performed 1997-1999, a total of 1,537 persons were interviewed and tested by skin prick and patch test. Furthermore data of the MONICA survey (RAST, cholesterol, food diaries) could be used. Within survey S4 (1999/2001) a total of 4,261 subjects were interviewed concerning their personal history of atopic diseases and the corresponding history of their partners. In survey S3 the prevalence of allergic sensitisation was 20.5 % for persons without formal graduation from school and 48.1 % for those with a university degree. 20.8 % reported a hypersensitivity to food and about one quarter exhibited a positive reaction in skin prick test. Atopic eczema and hay fever increased over quartiles of HDL cholesterol. Similar, allergic sensitisation (RAST) increased over quartiles of uptake of unsaturated fatty acids in men. 40 % of those who were patch tested exhibited a positive reaction, with perfume mix, nickel, thimerosal and balsam of Peru being the most prominent allergens. Inhabitants of the City of Augsburg were sensitised more often (34.0 % overall, 23.9 % pollen) than inhabitants of villages with (29.4 %, 17.0 %). Full time farmers were sensitised less frequently (22.0 %, 8.4 %). In survey S4 the lifetime prevalence of atopic diseases diagnosed by doctors was 5.1 % for atopic eczema, 6.1 % for asthma and 13.7 % for hay fever. Subjects who lived together with a partner who suffered from hay fever were affected in 19.6 % whereas 13.1 % had hay fever when the partner was not affected. Future studies will offer an unique opportunity to analyse the incidence and remission of manifestations of atopy in adults.

Adult↗

PubMed2005

[Acute mastoiditis in children, a retrospective analysis about a period of 25 years].

BACKGROUND: During the last years the classical signs of the acute mastoiditis have changed. Aim of the following study was to examine the change of symptoms as well as the change of incidence. METHODS/PATIENTS: The records of 113 children who received mastoid surgery due to acute mastoiditis were retrospectively investigated. Data covered a regional group of patients during a period of 25 years (1979 - 2003). RESULTS: Considering the drop of the birthrate from 1991 in the East German countries, there was a significant increase of the incidence of acute mastoiditis. The patients had a mean age of 2,5 years. The classical symptoms like "retroauricular swelling, tenderness and protrusion of the auricle" were only noted by 47 children (41.6 %). Preoperative complications appeared as facial palsy, abscess and septic lateral sinus thrombosis in 11 children. Bacterial cultures, taken during surgery yielded in 55.7 % Streptococcus pneumoniae. The therapy contained a surgical intervention combined with antibiotics. CONCLUSIONS: An early surgical treatment by mastoidectomy or antrotomy supported by antibiotics represents the safest method to avoid complications.

Acute Disease↗

PubMed2004

Does my partner cause my allergy?

BACKGROUND: The study of partners can help to understand the impact of environmental influences on the development of allergies. We aimed to test the hypothesis that subjects whose partners have hay fever are at increased risk for the same disease and that the risk increases with the time subjects live together with an affected partner. METHODS: A nested unmatched case-control study was performed in a random sample of 4261 inhabitants, aged 25-74 years, of the City of Augsburg, Germany, and two adjacent counties. Using standardized computer-assisted face-to-face interviews, we determined the risk of doctor-diagnosed hay fever in subjects who lived together with a partner having the same disease as opposed to subjects living with an unaffected partner. Furthermore, the risk of doctor-diagnosed hay fever depending on the time the subjects had lived together with an affected partner was calculated. RESULTS: After adjustment for age, sex, parental predisposition and social status, the risk of hay fever was more than double in subjects who lived together with a partner having the same disease (odds ratio, OR(adj.), 2.41; 95% confidence interval, CI, 1.48-3.92). If subjects lived together with an affected partner, the risk of developing the disease increased with the time the partners lived together (1-11 years, OR 1; 12-23 years, OR 1.8; 24-35 years, OR 7.4; 36-54 years, OR 13.7). CONCLUSION: The risk of developing hay fever is significantly elevated in subjects who live together with a partner having the same disease. The risk further increases with the time the partners live together. This points to important shared environmental influences or behaviours and raises speculations on a transmissible cause.

Adult↗

PubMed2004

Otosyphilis: report on six cases.

Syphilis is a multisystemic disease that may also affect the inner ear. The objective of this study was to investigate the frequency, clinical presentation and outcome of otosyphilis. A retrospective analysis of inpatients seen by a team of ENT specialists and dermatologists at a teaching hospital in Dresden, Germany, during 1986-2000. Six cases of otosyphilis had been diagnosed. None was related to risk factors such as HIV infection or drug abuse. We identified four female and two male patients, age range 25-58 years. Four patients suffered from syphilis stage II, one from syphilis stage and another from congenitial syphilis. ENT complaints included loss or impairment of hearing, tinnitus and nystagmus. All were treated with penicillin G. Adjuvant therapy included systemic corticosteroids oral pentoxifillin in two patients each. Improvement of ENT symptoms was achieved in all but one patient, who suffered from congenitial syphilis. This study confirms that otosyphilis is still a complication of syphilis in developed countries. The first line therapy is systemic penicillin G. There is a lack of controlled trials for adjuvant treatments such as corticosteroids and pentoxifillin. Clinical cooperation between dermatologists/venereologists and ENT specialists supports the best outcome.

Adult↗

PubMed2003

Mycological and histological investigations in humans with middle ear infections.

The aim of our investigations was to characterize fungal colonization of the ear in immunocompetent patients. From 1993 to 2000, 128 patients supposed to suffer from otomycosis were included. Mycological examination conducted by direct microscopy and fungal cultures was performed on 139 specimens. Among these, 115 patients suffered from chronic otitis media with persisting tympanum perforation and otorrhea. A further 13 patients had clinical signs of an otitis externa only. Out of 139 samples, fungi were identified in the auditory canal (n = 54), on the tympanic membrane (n = 5), and in the middle ear (n = 5). Two-thirds were as moulds and one-third yeasts. The dominating species were Aspergillus niger and Candida parapsilosis. Samples from 15 patients supposed to have mastoiditis or cholesteatoma were examined histologically. Fungal hyphae were observed in the middle ear cavity and/or between horny lamellae of cholesteatoma in four patients. In the middle ear of immunocompetent patients chronic-hyperplastic (polypoid) inflammation was detected with increased production of mucus, which probably promotes colonization by pathogenic fungi in the middle ear as well as in the auditory canal. Invasive fungal growth into the subepithelial connective tissue was not observed.

Adult↗

PubMed2003

Merkel cell carcinoma--a retrospective analysis of 17 cases.

OBJECTIVE: To report clinical experience with the rare neuroendocrine Merkel cell carcinoma of the skin. SUBJECTS AND SETTING: Seventeen patients with Merkel cell carcinoma of the skin treated at the Departments of Dermatology and ENT, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany, during the years 1984-2000 were evaluated. METHODS: A retrospective analysis was performed. Age and sex distribution, clinical data and therapy were collected. Outcome measures including overall survival, tumour-free survival and relapse-free survival were determined. RESULTS: Six male and 11 female patients with an age range of 68-90 years (mean age 73.3 years) were identified. The primary tumour localization was head and neck region (n = 8), upper limbs (8), lower limbs (1). Twelve patients presented in tumour stage I, three in stage II and one in stage III. First line therapy was complete surgical excision with wide margins in 16 patients followed by loco-regional radiation in 12 of 16 cases. In 16 patients follow up data were available. After primary treatment complete response was achieved in 14 of 16 patients (87.5%), two patients had a partial response. The median of relapse-free survival was 44 weeks [mean +/- standard deviation: (44 +/- 118) weeks]. The median of overall survival was 102 weeks [mean +/- standard deviation: (137 +/- 94) weeks]. Three patients with a PR after primary treatment had a median overall survival of only 48 weeks [mean +/- standard deviation: (51 +/- 20) weeks]. CONCLUSIONS: Primary surgical treatment with wide excision combined with radiotherapy seems to be a reasonable first-line treatment but prospective controlled multicentre trials are necessary for validation.

Aged↗

PubMed2002

[Histologic studies on otomycosis].

Fungal infections of the ear are mostly described as mycoses of the auditory canal. The aim of our investigations was to find out how fungi colonize the ear in immunocompetent patients. In the years from 1993 to 2000, 128 patients suspected of having otomycosis were examined. Of these 115 patients suffered from chronic otitis media with persisting tympanum perforation and otorrhea. A further 13 patients had clinical signs of otitis externa only. In 54 out of 139 samples, fungi were found in the auditory canal, in five on the tympanic membrane, and in five in the middle ear. Two-thirds were isolated as moulds and one-third as yeasts. Dominating species were Aspergillus niger and Candida parapsilosis. Samples of 15 patients suspected of having mastoiditis or cholesteatoma were examined histologically. Fungal hyphae were observed in the middle ear cavity and/or between horny lamellae of cholesteatoma in 4 patients. In the middle ear of immunocompetent patients chronic-hyperplastic (polypous) inflammation was detected with increased production of mucus, which probably promotes the colonization with pathogenic fungi as in the middle ear just like in the auditory canal.

Aspergillosis↗

PubMed2001

[Arteriovenous fistula of the maxillary artery, eustachian tube dysfunction and tinnitus after Le Fort I osteotomy].

A 36-year-old woman with a maxillary retrognathia underwent a Le Fort I osteotomy. Postoperatively, she complained of pulsatile noise and hearing loss in the left ear. Carotid arteriography revealed an arteriovenous fistula of the left maxillary artery; in addition, a persistent eustachian tube dysfunction with left middle ear effusion was noticed. After embolization of the fistula and ventilation tube treatment, improved hearing and a significant reduction of tinnitus were achieved. Arteriovenous fistulas after orthognathic surgery are very rare. Postoperative eustachian tube dysfunction has not yet been reported in the literature.

Adult↗

PubMed2001

Posterior cerebral artery Wada test: sodium amytal distribution and functional deficits.

Inadequate sodium amytal delivery to the posterior hippocampus during the intracarotid Wada test has led to development of selective tests. Our purpose was to show the sodium amytal distribution in the posterior cerebral artery (PCA) Wada test and to relate it to functional deficits during the test. We simultaneously injected 80 mg sodium amytal and 14.8 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO) into the P2-segment of the PCA in 14 patients with temporal lobe epilepsy. To show the skull, we injected 116 MBq 99mTc-HDP intravenously. Sodium amytal distribution was determined by high-resolution single-photon emission computed tomography (SPECT). In all patients, HMPAO was distributed throughout the parahippocampal gyrus and hippocampus; it was also seen in the occipital lobe in all cases and in the thalamus in 11. Eleven patients were awake and cooperative; one was slightly uncooperative due to speech comprehension difficulties and perseveration. All patients showed contralateral hemianopia during the test. Four patients had nominal dysphasia for 1-3 min. None developed motor deficits or had permanent neurological deficits. Neurological deficits due to inactivation of extrahippocampal areas thus do not grossly interfere with neuropsychological testing during the test.

Adult↗

PubMed2001

Case report: regional cerebral hypoperfusion induced by ventricular tachycardia - short-term hippocampal hypoperfusion and its potential relationship to selective neuronal damage.

BACKGROUND: Focussing on regional cerebral hypoperfusion during hemodynamically stable, but borderline hypotensive, sustained ventricular tachycardia (VT) experimental studies show (1) a reduction of cerebral blood flow (CBF) during tachyarrhythmias in contrast to the concept of CBF autoregulation, (2) a mediation of hypoperfusion by neuronal and humoral mechanisms, and (3) an involvment of microcirculation due to an ischemic stress response of the cerebral tissue. The clinical relevance of these observations remains still unclear. CASE REPORTS: Two patients with coronary artery disease, left ventricular dysfunction and sustained monomorphic VT underwent electrophysiological study. VT was induced and the tracer (99m)Tc-HMPAO was injected after 3 minutes of ongoing VT. Regional CBF during this life threatening arrhythmia was determined with brain SPECT. A scanning protocol was performed after termination of VT. The measurements were repeated at baseline during normofrequent sinus rhythm (SR) one week later. CBF during SR was significantly reduced in the temporal lobe in comparison to the conditions during stable VT, particularly in the left hippocampus. CONCLUSION: The reduction of hippocampal CBF due to cerebrovascular vasoconstriction and neuronal reflex mechanism previously observed in experiments during stable, sustained VT can be confirmed in a clinical scenario by high resolution (99m)Tc-HMPAO brain SPECT. This supports the hypothesis that repetitive stable VT can play a role in the pathophysiology of cerebrovascular insufficiency. Further clinical studies are needed to analyze the impact of tachyarrhythmias on cognitive and mnemic function.

Aged↗

PubMed2000

SATSCOM--Selective amobarbital test intraarterial SPECT coregistered to MRI: description of a method assessing selective perfusion.

For evaluation of potential functional deficits, an intraarterial amobarbital test is performed prior to neurosurgical or neuroradiological interventions. To visualize individual amobarbital perfusion patterns, simultaneous injection of (99m)Tc-HMPAO was performed previously. The present study describes for the first time a method of coregistration of intraarterial SPECT during selective amobarbital test to MRI. Three patients undergoing selective amobarbital test of the posterior cerebral artery were included. SATSCOM (Selective amobarbital test intraarterial SPECT coregistered to MRI) was performed by skull extraction in SPECT and MRI followed by surface matching. In all three patients, SATSCOM revealed accurate matching results. With this functional-anatomical mapping, suppression of higher cortical functions can be correlated to anatomical regions. Furthermore, a more precise mapping of amobarbital effect improves planning invasive interventions, particularly those close to eloquent areas.

Adult↗

PubMed2000

Evidence for altered basal ganglia and cortical functions in transient idiopathic dystonia.

Idiopathic dystonia with onset in the first year of life has been described as a transient movement disorder, in contrast to other forms of idiopathic dystonia We report on a girl who showed, from her 5th month, episodes of dystonic postures of her neck and arm, which lasted for seconds and occurred several times a day. Neurologic findings and the psychomotor development were and remained normal. Neurometabolic screening tests and cerebral magnetic resonance imaging showed normal results. Functional cerebral imaging showed decreased perfusion of the basal ganglia and the left temperomesial cortex using single photon emission computed tomography (SPECT with technetium 99m hexamethylpropyleneamine oxime [99mTc-HMPAO]) and decreased glucose metabolism in the basal ganglia and the cerebellum using positron emission tomography (PET with [18F]fluorodeoxyglucose [18FDG]). Follow-up revealed that the episodes disappeared at the age of 16 months. The findings of PET and SPECT give evidence of an alteration in basal ganglia function but also in functions of other central nervous system regions, which may, however, be temporary.

Basal Ganglia↗

PubMed1999

Amobarbital effects on the posterior hippocampus during the intracarotid amobarbital test.

OBJECTIVE: To relate functional effects on the hippocampus during the intracarotid amobarbital test (IAT) to its direct perfusion with amobarbital. METHODS: In 17 patients with intractable temporal lobe epilepsy, 28 hemispheres were perfused with 2.3 mL of 10% solution of 200 mg amobarbital and 37 MBq 99mTc-hexamethylpropylene amine oxime (HMPAO). For evaluation of amobarbital effects, data were combined from stereo-EEG (S-EEG) recordings from intrahippocampal depth electrodes and high-resolution SPECT after intracarotid injection of HMPAO. RESULTS: Perfusion of the entire hippocampus was observed only in hemispheres with a fetal origin of the posterior cerebral artery (PCA). In 10 hemispheres, S-EEG recordings could not unequivocally be assigned to either the anterior or the posterior part of the hippocampus. In the remaining 18 hemispheres, only the two with a fetal type of PCA showed perfusion of the entire hippocampus. In both, hippocampal electrical activity changed under the influence of amobarbital but did not differ in anterior and posterior contacts. In 15 of 16 hemispheres in which SPECT demonstrated perfusion of the anterior hippocampus only, amobarbital injection resulted in significant S-EEG activity change in both the anterior and the posterior parts of the hippocampus. CONCLUSION: S-EEG effects on the posterior hippocampus during the IAT can occur without direct perfusion of those brain areas.

Adolescent↗

PubMed1999

SPECT patterns in probable Alzheimer's disease.

The primary objective of this study was to test hypotheses about the relationship between HMPAO-SPECT findings and probable Alzheimer's disease (DAT) in a relatively large sample of patients diagnosed according to DSM-III-R. SPECT patterns of 20 controls and 116 DAT patients were investigated. Left and right frontal, temporal, parietal and occipital regions of the brain were rated as showing a hypoperfusion or not. A wide variety of patterns were found and these are described in detail below. In DAT patients, temporal and/or parietal regions were affected significantly more often (88%, p > 0.001) than frontal and/or occipital regions (70%). A bilateral temporoparietal pattern, which has been repeatedly reported as typical for DAT, was observed in 48% of DAT patients, but also in 25% of controls, and did not differentiate significantly between these two groups (p > 0.05). Conversely, more than three regions with hypoperfusion were observed significantly more often in DAT patients (48%, p < 0.01) than in controls (10%). In DAT patients, the number of regions with hypoperfusion correlated significantly with the score of the Mini Mental State Examination (MMSE, r = 0.33, p < 0.001). The frequency of at least one hypoperfusion was approximately equal in left and right hemispheres (77% vs. 73%, p = 0.2). The hypothesis that cognitive decline in DAT starts in the temporal regions was tested in 14 SPECT patterns showing only one region with hypoperfusion. In 12 of these patterns, a temporal region was in fact affected (p < 0.001). Whereas hypoperfusion in frontal areas was not accompanied by a significantly lower MMSE than when only temporoparietal regions were affected, MMSE scores were significantly lower when occipital regions were affected in addition to temporoparietal regions (p < 0.05). The clinical use of SPECT findings was tested in discriminating analyses with the MMSE and a delayed recall test as additional predictors of DAT. Whereas the MMSE and the delayed recall test differentiated significantly between DAT patients and controls, SPECT findings yielded no further differentiation. In conclusion, the theoretical and clinical implications of SPECT findings and their relationships to other physiological and psychological variables deserve further investigation.

Aged↗

PubMed1999

[Tracheotomy: discussion of various surgical procedures using argon plasma coagulation].

BACKGROUND: At present there is a discernible lack of consensus among different medical specialties regarding methods of tracheotomy in an intensive care setting. There is an obvious preference for percutaneous dilatational tracheotomy methods. Comparison of different methods are necessary to determine whether this trend is justified. METHOD: ENT and intensive care departments together performed 270 tracheotomies using different techniques in longtime-intubated adults over a period of 4 years. Severe complications were compared. Twenty conventional surgical tracheotomies were performed by using argon-plasma coagulation (APC). RESULTS: Comparison of 2175 percutaneous and 3263 conventional surgical tracheotomies reveals a nearly identical rate of severe perioperative complications. Percutaneous methods are most frequently used in patients with initially uncomplicated conditions. CONCLUSIONS: On the basis of our experience with 270 tracheotomies we have found there are clear indications for the various methods of tracheotomy. They depend on both the history of the disorder and its course and on the known contraindications to percutaneous tracheotomy methods. For safety reasons, we do not perform percutaneous tracheotomies on patients with severe brain damage who tend to aspirate and require prolonged neurological rehabilitation. Preoperative bleeding in percutaneous tracheostomies is the most important complication. It led to a life-threatening situation in 2.4% of our cases. Preoperative neck ultrasound may decrease the risks due to unusual anatomical conditions. Comparison of significant perioperative complications does not appear to favor any one method at present. In light of our effective cooperation with other specialties in planning and performing tracheotomies we do not feel that the current general preference for percutaneous methods in intensive care medicine is justified. Initial experience with APC shows promising results concerning its use in conventional tracheotomies. However, we noticed a shorter operation time, reduction of bleeding complications, and use of less suture material. The effectiveness of surgical intervention is improved by a number of factors.

Adult↗

PubMed1999

Fungal colonization of the paranasal sinuses.

Fungal infection of the paranasal sinuses occur in four primary types: acute invasive (1), chronic invasive (2), chronic fungus ball (3) and allergic fungal sinusitis (4). The first and second form can be fatal and is often found in immunosuppressed patients. The present paper concerns a group of immunocompetent patients with non-invasive chronic sinusitis caused by moulds. Over the period from 1994 to 1998, 132 tissue samples from the paranasal sinuses obtained by endoscopic operation from 117 patients was examined for mycotic infections. The mycological examination was carried out if granulomatous and crumbly material was seen in the sinus by endoscopy (91 times maxillary sinus, 23 times ethmoid sinus, 11 times frontal sinus, 7 times sphenoid sinus). Out of 117 patients 29 were positive (24.9%). From 132 surgical specimens fungi were proved in 34 times (25.7%). The following fungal species were isolated: Aspergillus fumigatus 17 times, other Aspergillus spp 6 times, Alternaria alternata 2, Penicillium rugulosum 1, and moulds without differentiation 5 times. In the histological examination an invasive mycelial growth in the mucous membrane or in the bones was never observable. Our findings represented a commensal colonization of the paranasal sinuses, but not a mycosis. The colonization is evidently assisted by a chronic hypertrophic sinusitis with increased mucus production which impedes the mucociliary clearance. For immunosuppressed patients, however, this situation causes a danger of invasion with fatal consequences.

Alternaria↗

PubMed1998

D2-dopamine receptor occupancy measured by IBZM-SPECT in relation to extrapyramidal side effects.

The purpose of this study was to compare striatal D2 dopamine receptor occupancy of various typical neuroleptics and clozapine in relation to the occurrence of extrapyramidal side effects (EPS). Forty-four inpatients with schizophrenia, including 12 patients with schizodominant schizoaffective disorder, were evaluated using 123I-iodobenzamide (IBZM) and single photon emission computed tomography. Striatal D2 dopamine receptor occupancy was estimated by use of a striatal/frontal cortex ratio (ST/FC) of IBZM binding. Fourteen patients were neuroleptic-free and served as controls. Six patients were treated with clozapine and 24 patients were treated with various typical neuroleptics. ST/FC ratios in patients taking typical neuroleptics were significantly lower than those who were neuroleptic free or treated with clozapine. Patients with EPS had lower ST/FC ratios than those without EPS. A significant linear relationship between ST/FC ratios and severity of EPS estimated by the Simpson-Angus-Scale was established (r=-0.51, p=0.041).

Adult↗

PubMed1998

Pathological regional cerebral blood flow in opiate-dependent patients during withdrawal: a HMPAO-SPECT study.

The aims of the present study were to investigate regional cerebral blood flow (rCBF) in heroin-dependent patients during withdrawal and to assess the relation between these changes and duration of heroin consumption and withdrawal data. The rCBF was measured using brain SPECT with 99mTc-HMPAO in 16 heroin-dependent patients during heroin withdrawal. Thirteen patients received levomethadone at the time of the SPECT scans. The images were analyzed both visually and quantitatively. A total of 21 hypoperfused brain regions were observed in 11 of the 16 patients. The temporal lobes were the most affected area, hypoperfusions of the right and left temporal lobe were observed in 5 and 5 patients, respectively. Three of the patients had a hypoperfusion of the right frontal lobe, 2 patients showed perfusion defects in the left frontal lobe, right parietal lobe and left parietal lobe. The results of the quantitative assessments of the rCBF were consistent with the results of the qualitative findings. The stepwise regression analysis showed a significant positive correlation (r = 0.54) between the dose of levomethadone at the time of the SPECT scan and the rCBF of the right parietal lobe. Other significant correlations between clinical data and rCBF were not found. The present results suggest brain perfusion abnormalities during heroin withdrawal in heroin-dependent patients, which are not due to the conditions of withdrawal.

Adult↗