Biomedical subjects

E Schmitt

Publications and source records attributed to E Schmitt.

At least 19 recordsLinked to original sources

PubMed2007

[Renal arteriovenous fistula].

Arteriovenous malformations are important but uncommon differential diagnoses for space occupying renal lesions with unknown genesis. In the following case report, a 41-year-old patient complained about continuing right flank pain. Computer tomography indicated a possible renal cell carcinoma and the patient was admitted to our clinic. Further diagnostics, including contrast medium-enhanced bolus CT, colour coded duplex sonography, renovasography and MR-angiography, revealed a large arteriovenous fistula of the entire right kidney. Because of the size and aneurysmatic appearance of this fistula, we performed a nephrectomy. Since this operation the patient has been free of complaints.

Adolescent↗

PubMed2006

Intracellular and extracellular functions of heat shock proteins: repercussions in cancer therapy.

Stress or heat shock proteins (HSPs) are the most conserved proteins present in both prokaryotes and eukaryotes. Their expression is induced in response to a wide variety of physiological and environmental insults. These proteins play an essential role as molecular chaperones by assisting the correct folding of nascent and stress-accumulated misfolded proteins, and preventing their aggregation. HSPs have a dual function depending on their intracellular or extracellular location. Intracellular HSPs have a protective function. They allow the cells to survive lethal conditions. Various mechanisms have been proposed to account for the cytoprotective functions of HSPs. Several HSPs have also been demonstrated to directly interact with various components of the tightly regulated programmed cell death machinery, upstream and downstream of the mitochondrial events. On the other hand, extracellular located or membrane-bound HSPs mediate immunological functions. They can elicit an immune response modulated either by the adaptive or innate immune system. This review will focus on HSP27, HSP70, and HSP90. We will discuss the dual role of these HSPs, protective vs. immunogenic properties, making a special emphasis in their utility as targets in cancer therapy.

Animals↗

PubMed2006

Heat shock proteins: endogenous modulators of apoptotic cell death.

The highly conserved heat shock proteins (Hsps) accumulate in cells exposed to heat and a variety of other stressful stimuli. Hsps, that function mainly as molecular chaperones, allow cells to adapt to gradual changes in their environment and to survive in otherwise lethal conditions. The events of cell stress and cell death are linked and Hsps induced in response to stress appear to function at key regulatory points in the control of apoptosis. Hsps include anti-apoptotic and pro-apoptotic proteins that interact with a variety of cellular proteins involved in apoptosis. Their expression level can determine the fate of the cell in response to a death stimulus, and apoptosis-inhibitory Hsps, in particular Hsp27 and Hsp70, may participate in carcinogenesis. This review summarizes the apoptosis-regulatory function of Hsps.

Animals↗

PubMed2006

[MRI findings in a case of prolonged status epilepticus].

We report the MR imaging findings in a 20 year old woman with status epilepticus of more than 3 months duration following an episode of lymphocytic meningitis. Repeated MR examinations showed progressive symmetrical cortical lesions, followed by subcortical and basal ganglia lesions which evolved to cortical laminar necrosis and hemorrhagic necrosis with eventual subcortical cerebral atrophy. This case has similarities with animal status epilepticus models. Biological investigations were all negative. This suggests that the brain lesions may be related to the prolonged status epilepticus.

Adult↗

PubMed2006

[Imaging follow-up of post-traumatic myelomalacia].

The authors report a case of secondary worsening of neurological symptoms in a patient 2 months after cord injury at T5 causing paraplegia. The MRI showed myeolomalacia, which appears as cord oedema, located in the grey matter, extending increasingly from the initial lesion (eighth thoracic vertebra) to the bulb. This cord lesion known as grey matter cytotoxic oedema, evolved into a syringomyelic cavity.

Adult↗

PubMed2006

[Cerebral gliomas: imaging diagnosis and follow-up].

The management of gliomas evolves towards more aggressive strategies with a combination of surgery, radiotherapy and chemotherapy. Follow-up imaging based on morphological MRI, with simple and reproducible protocols, may be associated with functional MRI and spectroscopy. Baseline postsurgical MRI must be performed within the first three days. Follow-up examinations should be done 2 months after radiotherapy and during chemotherapy, usually after each cycle of two or three treatments. Continued follow-up after therapy is recommended to assess response and detect recurrences or therapeutic complications.

Aged↗

PubMed2006

[V.A.C.-therapy: a treatment option for wound healing complications after achilles tendon reconstruction].

INTRODUCTION: The postoperative course after Achilles tendon reconstruction is associated with a high incidence rate of infections and wound healing complications, which can lead to protracted healing process and, hence, limit the clinical outcome. PATIENT-METHODS: A 66-year-old male was referred to our clinic with an Achilles tendon rupture. MRI confirmed the diagnosis, an augmented tenoplasty was performed for tendon reconstruction. 11 weeks after surgery the patient presented himself again with an open wound and local infection signs. RESULTS: The surgical treatment included debridement and jet lavage. The V.A.C.-device with the white polyvinyl sponge at an initial pressure of 200 mm Hg was used. A pathogen organism could not be identified. For infection eradication a broad spectrum systemic antibiosis (cefuroxime and gentamicin) was applied. On 3., 6. and 14. day the dressings were changed and the wound was revised under progredient closure. At beginning formation of granulation tissue the pressure was reduced to 150-100 mm Hg. At decreasing blood inflammation parameters and amelioration of the local wound condition the patient could check out after 3 weeks hospitalization. After further successful ambulant management by means of the V.A.C.-therapy a meshgraft transplantation was performed (enlargement factor 1.5; layer thickness 0.3 mm). The V.A.C.-device was applied again at a pressure of 150 mm Hg with a single dressing change after 5 days. At a follow-up of 31 months no further complications occurred. DISCUSSION: The V.A.C.-therapy seems to be a valuable tool in the treatment of wounds with a critical local vascularity. After successful wound preconditioning the healing process of skin grafts transplants can be also optimised by means of the V.A.C.-device.

Achilles Tendon↗

PubMed2006

[Indications for use of the V.A.C.-system in the orthopedic surgery].

INTRODUCTION: The vacuum-assisted closure (V.A.C.)-therapy is accepted for an efficient option in the treatment of infected wounds with healing complications. However, reports on its use in the septic orthopedic surgery are seldom. Hence, the aim of this study is to demonstrate our experience with the V.A.C.-system in the treatment of orthopedic-related infections. PATIENTS-METHODS: Various musculoskeletal infections with prolonged wound healing (infections after Achilles tendon reconstruction, fibula osteosynthesis, dorsal spondylodesis, and total hip arthroplasty, skin necrosis after total knee arthroplasty and wound dehiscence after resection and irradiation of a liposarcoma) have been treated with the V.A.C.-device. After infection sanitation we performed skin graft transplantation in 3 cases for definitive wound closure, also assisted by the V.A.C.-therapy. RESULTS: An infection eradication with implant preservation, where necessary, could have been achieved in all cases. No complications were observed in the cases with the skin graft transplantations. No infection persistence or reinfection occurred at a mean follow-up of 36 months. DISCUSSION: The V.A.C.-therapy seems to be a valuable adjunct in the treatment of infected wounds in the orthopedic surgery, however, definitive conclusion should await the results of future clinical studies with large series.

Aged↗

PubMed2005

Genotoxicity of phytoestrogens.

Plant extracts containing phytohormones are very popular as 'alternative' medicine for many kinds of diseases. They are especially favored by women who enter menopause and are concerned about the side effects of hormone replacement therapy. However, adverse health effects of phytoestrogens have often been ignored. This review examines the literature on genotoxicity and apoptotic effects of phytohormones. Genistein, coumestrol, quercetin, zearalenone, and resveratrol exerted genotoxic effects in in vitro test systems. Other phytoestrogens such as lignans, the isoflavones daidzein and glycetein, anthocyanidins, and the flavonol fisetin exhibited only weak or no effects in vitro. However, some metabolites of daidzein showed a genotoxic activity in vitro. Practically all of the phytoestrogens exhibit pro-apoptotic effects in some cell systems. Further investigations regarding dose-response-relationships and other aspects relevant for extrapolation to human exposure seem necessary. Until then, care may be advised in taking concentrated phytohormones. Nevertheless, the intake of substantial amounts of plant-food in a normal diet constitutes an important, individual contribution to cancer prevention.

Animals↗

PubMed2005

Adjuvant treatment with interleukin-2- and interferon-alpha2a-based chemoimmunotherapy in renal cell carcinoma post tumour nephrectomy: results of a prospectively randomised trial of the German Cooperative Renal Carcinoma Chemoimmunotherapy Group (DGCIN).

We conducted a prospectively randomised clinical trial to investigate the role of adjuvant outpatient immunochemotherapy administered postoperatively in high-risk patients with renal cell carcinoma. In total, 203 renal carcinoma patients' status post radical tumour nephrectomy were stratified into three risk groups: patients with tumour extending into renal vein/vena cava or invading beyond Gerota's fascia (pT3b/c pN0 or pT4pN0), patients with locoregional lymph node infiltration (pN+), and patients after complete resection of tumour relapse or solitary metastasis (R0). Patients were randomised to undergo either (A) 8 weeks of outpatient subcutaneous interleukin-2 (sc-rIL-2), subcutaneous interferon-alpha2a (sc-rIFN-alpha2a), and intravenous 5-fluorouracil (iv-5-FU) according to the standard Atzpodien regimen (Atzpodien et al, 2004) or (B) observation. Two-, 5-, and 8-year survival rates were 81, 58, and 58% in the treatment arm, and 91, 76, and 66% in the observation arm (log rank P=0.0278), with a median follow-up of 4.3 years. Two, 5-, and 8-year relapse-free survival rates were calculated at 54, 42, and 39% in the treatment arm, and at 62, 49, and 49% in the observation arm (log rank P=0.2398). Stage-adapted subanalyses revealed no survival advantages of treatment over observation, as well. Our results established that there was no relapse-free survival benefit and the overall survival was inferior with an adjuvant 8-week-outpatient sc-rIL-2/sc-rIFN-alpha2a/iv-5-FU-based immunochemotherapy compared to observation in high-risk renal cell carcinoma patients following radical tumour nephrectomy.

Adult↗

PubMed2005

[Do we live in an ageist society? Results from an empirical study].

It is the starting-point of this contribution that--on the precondition that requirements for development and usage of older people's potentials for creativity are adequately met--population ageing does not necessarily imply a loss in society's capability for innovation. Following a brief sketch of central perspectives in public discourse on demographic change cognitive representations of ageing are described as an important factor in the realisation of potentials in old age. This realisation might not only threatened by an exaggeration of negative aspects of ageing but also by an exaggeration of positive aspects. By contrast, only a society which takes note of the magnitude of different abilities, needs, and lifestyles in older people is able to meet the challenges of demographic change and to increase productivity in old age. Results from an empirical study suggest that cognitive representations of ageing are less salient, more differentiated and more optimistic than might be expected from the popular notion of ageist western societies. Similarly, policy makers show an increasing consciousness for the potentials of old age. The latter point is illustrated by the leading perspectives of the German government's fifth report on old age and older people.

Aged↗

PubMed2005

[Neuroimaging of hereditary hemorrhagic telangiectasia].

Hereditary Hemorrhagic telangiectasia is an autosomal dominant vascular disorder with high penetrance and variable expressivity. Most cases are caused by mutations in the endoglin gene on chromosome 9 (HHT type 1) or the activin receptor-like kinase 1 gene on chromosome 12 (HHT type 2). HHT is characterized by mucocutaneous telangiectases and visceral arteriovenous malformations (AVMs). Neurological complications occur in 8 to 10% of the patients. Brain ischemia or abscess are often associated with pulmonary arteriovenous fistula. Cerebral or spinal arteriovenous malformations are frequent but have a lower risk of haemorrhage than sporadic AVMs and routine screening should not be practiced in adult patients. Routine screening should be discussed for children with a familial history of cerebral haemorrhage and/or HHT type 1.

Brain Diseases↗

PubMed2005

[Risks and responsibilities in diagnostic and interventional radiology. Ethical and medicolegal considerations].

Medical risk management has one main purpose: to ensure the safety of care. The law of March 2002 has generated a true cultural revolution. The radiologist is involved with new and difficult areas of medical liability due to technical advances, the increasing number of imaging techniques, the increasing complexity of imaging techniques, their efficiency and the need for multidisciplinary approach. Imaging recommendations requiring increasing levels of technical and clinical skills. The radiologist is liable with regards to the indications of imaging studies, and also with regards to informed consent. The prevention of medicolegal problems is achieved by competency, which must be combined to good liability insurance and ongoing vigilance supported by appropriate continuous medical education.

France↗

PubMed2004

Contrast-enhanced transcranial Doppler sonography in the follow-up of intracranial aneurysms after endovascular treatment.

Two pilot studies on a small number of patients demonstrated the feasibility of transcranial Doppler ultrasound evaluation in the follow-up of intracranial aneurysms treated with detachable coils. This prospective study aimed to assess the sensitivity of contrast-enhanced transcranial echo-Doppler in detecting partial aneurysmal occlusion following endovascular treatment. Transcranial Doppler sonography (TCD) with contrast administration and magnetic resonance angiography (MRA) or angiography were carried out after endovascular treatment in 92 patients for 98 aneurysms of the anterior circulation. In 18% of cases, the quality of ultrasound exploration was deemed unsatisfactory for evaluation of the aneurysmal site. Results were concordant in 63% of patients (49/78). When occlusion appeared satisfactory at angiography or MRA, the result was concordant with TCD in 68% of cases (44/77). When a residual aneurysm was detected, TCD sensitivity was 38% (8/18). An analysis of subgroups failed to disclose anatomic or morphological aneurysm features in which transcranial echo-Doppler is sufficiently sensitive and specific to detect possible residual aneurysm or recanalisation. In our experience, even after contrast administration TCD is not sufficiently sensitive or specific in the detection of residual aneurysm to replace angiography or MRA.

Adult↗

PubMed2004

[MRSA-infections-treatment with intraoperatively produced gentamycin-vancomycin PMMA beads].

INTRODUCTION: We present gentamicin-vancomycin-impregnated beads that can be produced intraoperatively in moulds and demonstrated their successful use in ten cases of problematic Methicillin-resistant Staphylococcus aureus (MRSA) infection. METHODS: To produce the antibiotically loaded PMMA beads, a two-part mould of polyoxymethylene was used. The mixture of PMMA and antibiotic is poured into the mould halves, and during polymerisation the halves bond together. The in vivo antibiotic concentrations of wound secretion from the redon drainage were measured by fluorescence-polarisation immunoassay, and a concentration/time function was determined. The PMMA beads (2 g of vancomycin plus 0.5 g of gentamicin plus 40 g of PMMA) were implanted in ten patients aged 41-76 years. RESULTS: In all ten patients, the infection was cured (follow-up 15 months). CONCLUSION: The combination of gentamicin and vancomycin in the PMMA of standardised beads represents a good alternative in the treatment of MRSA infections. Understanding of the mechanism of antibiotic release from PMMA allows differentiated dosing during systemic application.

Adult↗

PubMed2004

Anti-fetal immune response mechanisms may be involved in the pathogenesis of placental abruption.

Placental abruption is an unpredictable severe complication in pregnancy. In order to investigate the possibility that the activation of the fetal nonadaptive immune system may be involved in the pathogenesis of this disease, IL-6 release from cord blood monocytes was examined by intracellular cytokine staining and flow cytometric analysis. Our results demonstrate that preterm placental abruption (n = 15) in contrast to uncontrollable preterm labor (n = 33) is associated with significantly (P < 0.001) increased release of IL-6 from the fetal monocytes. The same holds true for rhesus disease (n = 9, P < 0.001) that is characterized by a maternal production of antibodies against the rhesus-D antigen expressed by the fetal erythrocytes. This suggests that during rhesus disease, IL-6 release of monocytes is induced by antibody-mediated cross-linking of these cells to the erythrocytes in the fetal circulation. Hence, this assumption favors the idea that also in case of placental abruption, an increased maternal antibody production against paternal antigens leads to an elevated IL-6 release by the fetal monocytes. To elucidate this potential mechanism, the presence of anti-HLA-antibodies was assessed in the maternal circulation of patients with placental abruption (n = 17) and patients with uncontrollable preterm labor (n = 29). The percentage of women producing anti-paternal HLA-antibodies was significantly (P < 0.01) increased in the group of women with preterm placental abruption (47%) in comparison to women with uncontrollable preterm labor (14%). Therefore, our results suggest that an increased humoral immune response of the mother against the fetus may be decisively involved in the pathogenesis of placental abruption.

Abruptio Placentae↗

PubMed2004

[Primary spinal melanoma: a case report].

Intra spinal primary melanoma is a rare entity. We report a new case, atypical in relation to its primary radicular location, and to its early metastatic intradural and extra-medullary location, six months later. MRI is the more valuable examination, showing a spontaneously hyper-intense lesion on T1-weighted MR images, intense enhancement after gadolinium administration, and decreased signal on T2-weighted MR images, thus suggesting a diagnosis of melanocytic or hemorrhagic lesion. Signal abnormalities are not specific and definitive diagnosis is established after histological analysis.

Adult↗

PubMed2004

Activation of multidomain and BH3-only pro-apoptotic Bcl-2 family members in p53-defective cells.

In the p53-deficient human B lymphoma Namalwa cell line that quickly undergoes apoptosis after DNA topoisomerase I inhibitor (camptothecin, CPT) treatment, we observed rapid and slight induction of the pro-apoptotic BH3-only Bik, Bim-EL, Bim-L and Bim-S proteins. In contrast, the expression levels of Bad and multidomain Bax-alpha and Bak remained mostly unchanged after CPT treatment. However, multiple pro-apoptotic proteins, including Bax-alpha, Bak, Bik, Bim-EL and Bim-L, translocated rapidly to the mitochondria after CPT treatment. Gel filtration chromatography experiments demonstrated that somes of the pro-apoptotic proteins assemble themselves into high molecular weight protein complexes. The protein composition of these oligomers was further analyzed by co-immunoprecipitation experiments performed on highly purified mitochondrial fractions, which revealed the formation of Bax/Bak, Bax/VDAC1, Bak/VDAC1, Bim/VDAC1 and Bim/Bcl-2 complexes after DNA damage induction. Thus, it appeared that induction, mitochondrial translocation and assembly in multimeric protein complexes of several pro-apoptotic members of the Bcl-2 family correlated with the rapid activation of apoptosis in a p53-independent pathway after CPT-mediated DNA strand breaks.

Apoptosis↗