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Biomedical subjects

H Grehl

Publications and source records attributed to H Grehl.

33 records · Page 2Linked to original sources

Widespread expression of the peripheral myelin protein-22 gene (PMP22) in neural and non-neural tissues during murine development.

The gene encoding the peripheral myelin protein PMP22 is affected by various mutations in the hereditary peripheral neuropathies Charcot-Marie-Tooth disease type 1A (CMT1A), Déjérine-Sottas syndrome (DSS) and hereditary neuropathy with liability to pressure palsies (HNPP). In contrast to the recent remarkable progress in the genetics of the PMP22 gene, the biological function of PMP22 remains largely unknown. In this report, we have confirmed by using in situ hybridization techniques that high levels of PMP22 mRNA are present in maturing peripheral nerves of the 2-week-old mouse, a finding consistent with the PNS-specific defect observed in hereditary peripheral neuropathies. However, high levels of PMP22 transcripts were also found in the villi of the adult gut, and PMP22 expression was detected in various non-neural tissues during embryonic mouse development. In early embryogenesis (9.5 days postconception, dpc), PMP22 RNA expression appears restricted to the epithelial ectodermal layer. During early organogenesis (11.5 dpc), particularly high levels of expression are present in the capsule surrounding the liver and in the forming gut, while low levels of PMP22 mRNA can be found in precartilagous condensations forming the vertebrae and the ventricular layer of the myelencephalon. During midgestation development (14.5 dpc to 16.5 dpc), the number of PMP22-positive tissues increases, and high expression is detected in several mesoderm-derived tissues, in particular connective tissues of the face region, bones including the vertebrae, the lung mesenchym, and in muscles. In addition, high expression is also found in ectoderm-derived tissues, especially the epithelia of the lens and the skin. These findings strongly suggest that PMP22 serves not only a PNS-specific function but is also of broader biological significance in cell proliferation and/or differentiation.

Age Factors↗

Myotonic dystrophy: correlation of clinical symptoms with the size of the CTG trinucleotide repeat.

An unstable DNA sequence of a gene encoding a protein kinase has been identified as the molecular basis of myotonic dystrophy. The correlation between different symptoms of myotonic dystrophy and the size of this unstable base triplet (CTG)n repeat was investigated in 14 patients. DNA was prepared from whole blood by standard procedures. Detailed clinical, psychological, electrophysiological (quantified measurement of myotonia, electrocardiography) and other laboratory examinations (muscle biopsy in 4 patients, slit lamp examination) were performed. Triplet size correlated significantly with muscular disability and inversely with age at onset of the disease. A greater frequency of mental and gonadal dysfunction could be observed in patients with a larger repeat size. Other symptoms, however, such as cataract, myotonia, gastrointestinal dysfunction and cardiac abnormalities were not correlated with repeat size. Somatic mosaicism with different amplification rates in various tissues might be one possible explanation for the variable phenotypes. Furthermore, other factors such as different expression of the myotonic dystrophy gene might contribute to the clinical variability of the disease at a given triplet size.

Adult↗

[Value of proximal conduction block study in diagnosis of inflammatory neuropathies].

Conduction block is a common finding in inflammatory neuropathies, indicating circumscribed demyelination. Since demyelination and conduction block are often localized proximally, the whole ulnar nerve including its proximal segments was studied fractionally in 31 patients with inflammatory neuropathies. In 5 of 15 patients with Guillain-Barré syndrome, conduction block at the spinal roots was the first electrophysiological finding indicating demyelinating neuropathy. Segmental conduction blocks were also found in 8 of 9 patients with chronic inflammatory demyelinating polyneuropathies (CIDP) and 4 of 4 patients with atypical neuropathies. In 3 patients, multifocal motor neuropathy (MMN) could only be differentiated from motor neuron disease by recording proximal conduction block. Corresponding to clinical recovery, conduction block improved with immunoglobulin therapy in CIDP and MMN patients. The technique of proximal conduction block studies clearly improves the diagnosis of focal demyelination in inflammatory, treatable neuropathies. They should be performed particularly in patients with atypical neuropathies in whom electrophysiological tests of distal nerve segments show normal results.

Adolescent↗

[Paranoid hallucinatory psychoses as the first manifestation of HIV infection].

All parts of the central nervous system may be involved in HIV infection, resulting in a variety of neuropsychiatric syndromes some of which resemble functional psychoses. Corresponding to the HIV-associated disease these syndromes differ in course and severity. A very common form is the AIDS-dementia complex, especially late in the course of disease. Up to now, however, a specific therapy is not available. A case of severe psychosis with paranoid delusions and hallucinations in a patient with otherwise asymptomatic HIV infection is reported. From her biography it was concluded that the infection occurred 10 years earlier. During therapy with azidothymidine, symptoms disappeared within 3 months, and more than one year after admission to our hospital the patient was still able to work. According to the course of the disease in this patient, reports from the literature and pathogenetic theories, an early therapy with antiviral agents is recommended in HIV-induced subacute encephalitis.

AIDS Dementia Complex↗

Electrophysiologic evidence for a toxic polyneuropathy in rats after exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD).

At present, experimental data on the neurotoxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin are still lacking. Therefore, electrophysiologic studies were performed in 80 adult, male Han/Wistar rats intraperitoneally injected with a single, low dose of TCDD (8.8, 6.6, 4.4 or 2.2 micrograms/kg) dissolved in corn oil. 20 control animals received corn oil only. The typical 'wasting syndrome' of high-dose TCDD-intoxication was therefore not observed. Motor and sensory nerve conduction velocities in the right sciatic nerve showed dose-dependent and statistically significant slowing in TCDD-exposed rats as compared to controls. Spontaneous activity in the flexor digitorum muscle of the right hind paw and in tail muscles could be seen in the electromyogram of TCDD-group 1 (100%), group 2 (93%), groups 3 and 4 (87% each). This was significantly less frequent in the controls (21%). These findings give electrophysiologic evidence for a toxic polyneuropathy in rats after a single, low dose of TCDD.

Animals↗

Histologic evidence for a toxic polyneuropathy due to exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in rats.

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a considerable environmental hazard in industrial societies. Its toxic effects on animals and humans are numerous, but little is known about its neurotoxicity. We studied the neurotoxic effects of TCDD in 80 male, adult Wistar rats. The substance was dissolved in corn oil and a single dose injected intraperitoneally (8.8 micrograms, 6.6 micrograms, 4.4 micrograms or 2.2 micrograms/kg). Neurophysiological examinations proved a dose-related, statistically significant slowing of sensory and motor conduction velocities. Ten months after the application of TCDD peripheral nerves showed a progressive, and proximally accentuated neuropathy. The extent of changes, however, differed remarkably between individual animals. Our data indicate that TCDD caused a toxic polyneuropathy in rats.

Animals↗

[Peripheral facial paralysis as the first symptom of unknown metastatic primary tumor].

The spread of metastases to the brain and the leptomeninges is usually a terminal event in patients with known malignancies. We report on two patients, in whom the diagnosis of a diffusely metastasizing carcinoma was considerably delayed by the initial symptom of a peripheral facial nerve paralysis. The clinical, neuroradiologic and cerebrospinal fluid findings are discussed. A malignant neoplasm with diffuse or focal metastasis to the leptomeninges is a rare cause of peripheral facial paralysis of unclear genesis. The necessity of a lumbar puncture plus magnetic resonance imaging of the brain to enable an early diagnosis is emphasized.

Adenocarcinoma, Mucinous↗

Significance of degenerating endoneurial cells in peripheral neuropathy.

In 42 human sural nerve biopsies degeneration of endoneurial cells was evaluated semiquantitatively at the electronmicroscopic level. These cells were of non-Schwannian origin since they were not surrounded by a basement membrane. Most of the degenerating cells resembled endoneurial fibroblasts: their remaining cytoplasmic processes were quite extensive, not finger-like as in macrophages, and their cytoplasm did not contain conspicuous lysosomes or phagolysosomes that would identify them as degenerating macrophages. Criteria for regarding these cells as degenerating were defects of the cytoplasmic surface membrane with extracellularly situated organelles. The ratio between normal and degenerating endoneurial cells in five different groups of peripheral neuropathies was compared to a group of normal controls. No degenerating endoneurial cells were found in the latter. The largest proportion of degenerating endoneurial cells was noted in patients with panarteritis nodosa (30% of the endoneurial cells evaluated). Between 9% and 18% of the evaluated endoneurial cells were seen degenerating in hereditary motor and sensory neuropathies, in neuropathies associated with IgG or IgM gammopathy, and in chronic demyelinating inflammatory polyradiculoneuropathy. These findings suggest that degeneration of endoneurial cells is a nonspecific sign of peripheral neuropathy occurring in various types of neuropathy, although vasculitis represents the most frequent cause. Thus, degeneration of endoneurial cells can be added to the growing list of changes that possibly indicate an inflammatory disorder, even during the intervening stage when apparent inflammatory cell infiltrates are lacking.

Adult↗

[Vasculitic neuropathy in the Garin-Bujadoux-Bannwarth syndrome. A contribution to the understanding of the pathology and pathogenesis of the neurological complications in Lyme borreliosis].

Clinical examinations and nerve biopsies were performed on four patients with meningoradiculoneuritis and positive serology for Borrelia (Garin-Bujadoux-Bannwarth syndrome). Three patients had a painful multiplex mononeuropathy, while one presented with a picture resembling a Guillain-Barré syndrome. Nerve biopsy in two patients revealed marked perivasculitis, in part with thrombosis of the epineural vasa nervorum. In the other two patients there were small pericapillary infiltrates in the endoneurium with strikingly many plasma cells. These findings speak, on the one hand, for angiopathic-ischaemic nerve damage, but on the other for a local immune reaction to the causative microorganism, because of the plasma-rich endoneural infiltrates. The authors suggest that angiopathic-ischaemic tissue lesions and/or local immune reactions may play a role also in the pathogenesis of CNS complications of Lyme disease.

Biopsy↗

[Hereditary neuropathy with liability to pressure palsies. A contribution to the differential diagnosis of multiplex mononeuropathy].

Hereditary neuropathy with liability to pressure palsies could be diagnosed in two families. This little-known, dominantly inherited disorder is clinically characterised by recurring, spontaneously regressive palsies of peripheral nerves, mostly after minimal mechanical compression of the nerve concerned. It can be clearly differentiated from mononeuropathies of different pathogenesis even in clinically not involved nerves, by means of pathological neurographic findings and by the detection of pathognomonic myelinic thickenings in nerve biopsies. Prognosis is favourable if recurrences are avoided. This means that counselling of the patients and their families is of prophylactic significance.

Adult↗

Disposition of clotiazepam: influence of age, sex, oral contraceptives, cimetidine, isoniazid and ethanol.

Factors influencing the disposition of clotiazepam in man were evaluated in a series of pharmacokinetic studies in healthy volunteers given a single 5 mg dose. Old age caused an increased volume of distribution of clotiazepam in women, and its clearance tended to be reduced in elderly men. Use of oral contraceptives, cimetidine, isoniazid or a single dose of ethanol had no significant effect on the kinetics of clotiazepam. Although clotiazepam is biotransformed by microsomal oxidation, its clearance appears to be relatively uninfluenced by factors known to alter the clearance of other oxidized benzodiazepines.

Adult↗

Neuropeptide content of peripheral nerve in relation to nerve function in neuropathy.

OBJECTIVE: In this study an APAAP (alcalic-phophatase-anti-alcalic-phosphatase) technique was used to distinguish afferent (calcitonin-gene-related-peptide (CGRP) or substance-P-(SP) positive) and autonomic (tyrosin-hydroxylase (TH), neuropeptide Y (NPY) or vasoactive-intestinal-polypeptide- (VIP) positive) nerve fibers in sural nerve biopsy material from patients with moderate sensory neuropathy. A panneuronal marker against protein-gene-product 9.5 (PGP 9.5) was used for detection of the total amount of nerve fibers. Second aim was to analyze possible correlations between the impairment in tests for the function of unmyelinated fibers (i.e. thermal threshold testings, sensitivity to painful mechanical stimulation, axon reflex-mediated flare reaction and sudomotor activity) and nerve pathology. RESULTS: A high correlation between CGRP and SP (p < 0.00003) and between TH and NPY, respectively, (p < 0.004) was found, but not between afferent and autonomic markers or between specific markers and PGP 9.5. While no correlations between sensory neuropeptides (CGRP and SP) and specific testings of afferent fiber function or between neuropeptide content and clinical data could be demonstrated, there was a significant correlation between the TH content of the sural nerve and the sweat output, stimulated by acetylcholine iontophoresis at the level of the foot (p = 0.019) and upper leg (p = 0.011). CONCLUSION: This study demonstrates the possibility of visualizing subgroups of unmyelinated nerve fibers in sural nerve biopsies selectively with this technique. The density of TH-positive sympathetic nerve fibers, but not the density of afferent c-fibers, is correlated with corresponding results in specific tests of c-fiber function.

Adult↗