Biomedical subjects
Publications and source records attributed to E Schulz.
A 2 1/2-year-old boy inflicted on his 7-day-old brother suction and bite injuries of the head with loss of tissue of nose and lips. Place of the incident was the parents' bed. The event motivated us to report on the assignment of such injuries and the reasons for sibling violence.
It has become evident in recent years that autoimmune thyroglobulin (Tg) antibodies of Graves disease and Hashimoto's thyroiditis show a restricted epitope repertoire compared to Tg heteroantibodies. We have produced monoclonal antibodies (Mab) against human Tg by the hybridoma technique and the epitope specificity was determined by crossblocking experiments. Six noncrossreactive Mabs were used in a double determinant IRMA system for plasma Tg measurements. Sensitivity of the assays was between 1 and 2 ng/ml, intraassay variation less than 5%. Recovery experiments with added Tg were performed in 25 Graves sera with elevated Tg autoantibodies. Monoclonal antibody Tg13 showed an unusual strong interference with autoantibodies resulting in a very low recovery in all sera (median: less than 10%). In further studies Tg was digested by trypsin and after Western blotting, the resulting fragments were incubated with different Mab antibodies, a polyclonal antibody and 10 different Graves sera with high Tg autoantibodies. In contrast to all other mabs only Mab Tg13 showed several low molecular weight bands between 17 and 50 KD. The major bands recognized by Mab Tg13 corresponded to bands obtained by the autoimmune sera, which showed a very homogeneous band pattern. We conclude that Mab Tg13 is specific for an autoimmunodominant B cell epitope of human Tg.
The role of cytokines in patients with chronic renal failure is currently under investigation. We therefore studied the release of leukotriene B4 (LTB4) from polymorphonuclear leukocytes (PMN) in stable dialysis patients treated with two different cellulose membranes, Cuprophan and Hemophan, a modified cellulose with less complement activation. Six patients were treated for four weeks with Cuprophan then switched to Hemophan for another four weeks. Before and after the last treatment of each period, PMN were separated from 20 ml heparinized blood by FICOLL density gradient centrifugation. Portions of 5 x 10(6) PMN were resuspended in Hanks' buffer and stimulated for 5 minutes with calcium ionophore A23187 (5 micrograms/ml). LTB4 in cell supernatants was determined by specific radioimmunoassay. PMN from dialysis patients before HD released significantly (p less than 0.01) more LTB4 than healthy donors. No significant difference between pre- and post-dialysis values was observed with Cuprophan or Hemophan dialyzers. Our data suggest that the acute effects of blood membrane interaction with either complement activating or non-activating dialyzers do not lead to changes in post-dialysis leukotriene metabolism, but leukotriene production is enhanced chronically in dialysis patients.
In Golgi-Cox impregnated parietal cortex (regio postcentralis) of two children (20 months of age or 6 years of age) with Down's syndrome the pyramidal neurons of lamina III and V were investigated qualitatively and quantitatively. Fives types of pyramidal neurons were classified and compared statistically. As parameters for characterizing pyramidal neurons served dendritic lengths for all dendritic orders, within single dendritic fields, in apical and basal parts of the dendritic tree, and of the whole neuron. Normal values obtained in brains of the same age were not available, therefore, we compared our results with those published by other authors. To study the developmental stage of the pyramidal neurons in both our cases, we compared analogue pyramid types in both brains. The pyramidal neurons showed different qualitative abnormalities in their dendritic tree configuration. The comparison of quantitative parameters suggests the pyramidal cells of the older child show more degenerative changes, concerning especially lamina III pyramids but in lamina V pyramids as well. These changes might be structural correlates of the mental retardation: the 6 year old child was strongly retarded in clinical symptoms, too. The results are discussed and critically evaluated in view of the clinical signs of Morbus Down. Finally we should await the investigations of more cases for demonstrating the normal as well as the abnormal development of the human cerebral cortex.
Renal cell carcinoma is a rare disease in children and difficult to distinguish from Wilms-tumor before surgery. We present case histories of two children with renal cell carcinoma and discuss the problems of differential diagnosis versus nephroblastoma, therapy and prognosis. In contrast to Wilms-tumors, the most common kidney-tumor in children occurring mostly in young infants, renal cell carcinoma is rare in childhood and predominantly manifests in school-age. Only a few cases of renal cell carcinoma in younger children are described in the literature. Diagnostic imaging cannot reliably distinguish renal cell carcinoma from other neoplasm of the kidney. However, hematuria in patients with small tumors or no response to preoperative chemotherapy may indicate the presence of renal cell carcinoma rather than nephroblastoma. The determination of "tumor-associated trypsin inhibitor" (TATI) might give further contribution of differential diagnosis. It was measured only in one of our patients and was markedly elevated. Complete surgical resection (nephrectomy with lymphadenectomy) is a curative therapy in patients with tumors limited to the kidney. Chemotherapy and irradiation show no convincing effect. In metastatic tumors therapy with interleukin 2 may be successful.
Explore the source record for details and available documents.
The stage of neuronal development in the parietal (postcentral) cortex of human newborns was studied quantitatively in postmortem cases of different gestational (37th or 40th week) and postnatal age (2 hours or 3 weeks). In GOLGI-impregnated tissue obtained by autopsy, layer III pyramidal neurons were investigated. Comparatively, data were collected about dendrite parameters such as dendritic branching, length and spine density. The spine distribution (number and density) at the apical main dendrite, the apical tuft dendrites and in single basal dendritic fields as well, typically for the human layer III pyramidal neuron at the end of the gestational period, is described. Dendritic parameters from basal dendritic fields were compared in the three cases investigated (37th week with 2 hours or with 19 days of survival; 40th week of gestation with 2 days of survival). The large increase in spine number and density, especially in the second and higher orders of dendritic branching was obvious in the 19 days old infant brain. Special pathological aspects of the cases influencing the neuronal development are discussed. By means of a computerized method, quantitative data characterizing the human lamina III pyramidal neuron at the end of gestation are provided.
The question of recognition and possibilities of proof regarding impairment by narcotics and drugs is gaining significance also in Germany. Therefore, it is necessary to deal more closely with the United States "Drug Evaluation and Classification Program" and consider its application in Germany as well. The American program is based on standardized education of drug recognition expert trainees and well-tested methods of examination. The results are convincing. The expert reports prepared by the examiners and the chemical-toxicological results correlate in 80 to 97% of the cases. As long as no definite findings regarding dose/concentration effect relationships exist, the classification of behavior, appearance and medical examination plays a significant role. To a great extent, the program makes allowance for the existing possibilities in Germany as well. The authors of this article would consider it to be wrong if, in Germany extensive, time-consuming field studies were undertaken to obtain further knowledge prior to introduction of such a program. On the other hand, despite the existing difficulties, it should be endeavored to find dose/concentration effects.
Explore the source record for details and available documents.
The effect of peritoneal dialysate on the capacity of peripheral blood polymorphonuclear (PMNL) and mononuclear leukocytes (MNC) to release leukotriene B4 (LTB4) and tumor necrosis factor alpha (TNF alpha) was investigated in vitro. Following density gradient separation, aliquots of 5 x 10(6) PMNL or MNC were incubated in peritoneal dialysis fluid containing 1.5% glucose or Hanks' buffer (= control) for 1-2 h at 37 degrees C. TNF alpha and LTB4 production was stimulated with Escherichia coli lipopolysaccharide (LPS) and calcium ionophore A23187, respectively. MNC incubated in buffer and LPS produced (mean +/- SD) 1,006 +/- 522 pg TNF alpha/5 x 10(6) cells; no significant amounts of TNF alpha were detectable in the presence of dialysate. An inhibition of TNF alpha release was also observed in MNC exposed to bicarbonate-buffered dialysates (pH 7.40) and 4.25% and 1.5% glucose solution with physiologic osmolality. Incubation of PMNL in Hanks' buffer followed by A23187 stimulation led to production of 29.1 +/- 19.2 ng LTB4/5 x 10(6) cells, whereas glucose-incubated cells were refractory to ionophore stimulation (less than 0.1 ng LTB4/5 x 10(6) cells). The failure of dialysate-exposed leukocytes to release inflammatory mediators in response to adequate stimuli may contribute to the impairment of cellular host defense in the setting of continuous ambulatory peritoneal dialysis.
DL-omega-phenyl amino acid esters turned out to be inhibitors of the sheep vesicular gland prostaglandin H synthase in addition to their antiphlogistic action on the carrageenan-induced oedema of the rat paw and weak antihistaminic actions. The inhibition of the prostaglandin H synthase was dose-dependent, the inhibitory potencies were however much lower than that of indomethacin. Some but not all derivatives, such as DL-4-amino-4-phenylbutyric acid octyl ester, also caused inhibition of the pure lipoxygenase from rabbit reticulocytes and the conversion of arachidonic acid to leukotriene B4 and 5S-hydroxy-6E,8Z,11Z,14Z-eicosatetraenoic acid by human polymorphonuclear leukocytes as well as inhibition of antigen-induced release of histamine from mast cells of ovalbumin-sensibilized rats. Since no clear relations between the data of the in vitro and in vivo models were obtained, further studies on the pharmacokinetics and possible biotransformations are required.
Explore the source record for details and available documents.
Refraktive development in seven patients operated on early in life for bilateral congenital cataract has been documented over periods of 6-11 years. Attenuation of hyperopia was seen in four patients during the first 4 years of life, and even later in some of them. The three other patients did not show any considerable refractive changes. A refractive change can occur as a sudden event during the first 2 years of life or be continuous during the first decade of life, the change varying over a range of 3-12 D. One patient showed an increase in hyperopia compared with the data immediately after the cataract operation. As the refractive changes varied over a range of 6 D this cannot be explained by inaccurate measuring techniques, but is interpreted as changeable refraction that may be normal in childhood. Refractive surgery, e.g. insertion of an IOL and epikertophakia, should also be discussed on individually, as refractive changes are not generally predictable.
Explore the source record for details and available documents.
Acute pancreatitis is a disease characterized by abdominal pain, low-grade fever, abdominal tenderness and rigidity, and moderate elevation of the white blood cell count. A widely used revised classification of pancreatitis is that proposed in 1984 at Marseille. It only distinguishes between acute and chronic pancreatitis. In 61 cases were 40 men and 21 women. The mean age in the total series was 52.5 years. The etiology of the acute condition was alcoholism in 32.8% and biliary tract disease in 23%. In 9.8% the acute pancreatitis is associated with alimentary tract diseases (adipositas, hyperlipidemia). The severity of acute pancreatitis is pathological anatomy determined by three stages. In pathogenesis the process of digestion is caused by activated pancreatic enzyme with acinar cell injury. The acinar cell is normally protected from the action of its own enzymes by elaborate intracellular compartmentation of enzymes. Acute pancreatitis is triggered by pancreatic phospholipase A leading to necrosis of lipolytically active fat cells with release of membrane-toxic fatty acids with following destruction of adjacent tissue. Fat necrosis initiates an acute inflammatory reaction with immigration of granulocytes and liberation of kinins, which activate pancreatic enzyme. Pancreatic enzymes are similar to lysosomal enzymes with regard to substrate specificity. Activation will be also triggered by lysosomal enzymes of necrotic acinar cells.
Contrecoup fractures of the base of the skull are regarded as rare in the clinical literature. In our material (n = 171 falls on the same level and on or from stairs), the overall frequency of contrecoup fractures of the anterior cranial fossa in fatal cranio-cerebral trauma due to falls was 12%, as compared to 24% with occipital point of impact of the head. The relationships between the impact site on the head, form of fracture at the point of impact with involvement of the skull cap and/or the base of the skull, coup and contrecoup injuries of the brain, localization of contrecoup fractures in the anterior cranial fossa and the occurrence of monocle and spectacle haematomas display a major variability. Fractures occur in the form of simple fractures and as impression fractures (fracture fragments or fracture boundaries displaced to the inside). Clinical diagnosis is difficult because of the concealed position of the anterior skull base. Contrecoup fractures become of forensic medical significance when symptoms of a frontobasal injury occur for the first time after trauma which has occurred some time in the past and when the question arises as to the causal connection with the original trauma. In investigation of living persons, it may be difficult to decide whether haemorrhages in the region of the orbit and its vicinity result from a direct blunt force or derive from fractures of the base of the skull, especially contrecoup fractures.
The visual acuity values obtained with the four test figures of Lithander's "Kolt-test" have been compared with Landolt ring acuity under standardized conditions which meet the requirements of DIN 58,220 and ISO/DIS 8596/7. For a given test figure size, the Kolt-test optotypes turned out to be somewhat easier legible than the Landolt ring. On average, visual acuity measured with the Kolt-test exceeded Landolt ring acuity by 0.08 log (angle of resolution) units. Thus, according to DIN and ISO criteria, the legibility of the Kolt-test is not equivalent to the standard Landolt ring. Equal acuity values could be obtained by increasing the observation distance proposed by the manufacturer of the Kolt-test by 19%. The legibility of the four optotypes differs on adult subjects: "circle" is more difficult, "cross" is easier legible than "square" and "triangle". Confusion of Kolt-test figures is basically restricted to two pairs of two optotypes ("cross" - "triangle", "square" - "circle").
Five improvements of surgical instruments for strabismus-surgery are introduced; these are a small muscle-hook, a broad, flat muscle-hook, two variants of a retractor and one instrument for the resection or tucking of a rectus-muscle. All instruments have proved to be less traumatic and seem much safer than others even in less experienced hands. Most of them have been used over a period of more than 10 years in a specialized department.