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Biomedical subjects

H Michels

Publications and source records attributed to H Michels.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Quality assurance and teamwork in social medicine expert assessment exemplified by the expert assessment aid "corrective breast surgery" of the North Rhine Health Insurance Medical Service].

To standardise sociomedical expertising procedures in surgery of the breast a project team of medical advisors of the Medical Advisory and Expertising Service North Rhine worked out a manual. A form was created for sociomedical pre-advice occasions. Detail parameters for examination (time needed and advisor selection) were fixed in consent. Checklists were worked out, which may be admitted to quality assurance procedures. The manual "Medical opinion for surgery of the breast" has been implemented and is applied in the Medical Advisory and Expertising Service North Rhine since January 1999. In the sense of teamwork participation those who were involved as team-workers became participants in decision-making. The manual "Medical opinion for surgery of the breast" may be seen as an example of quality assurance and participation in socio-medical opinion procedures. The influence of this manual on the formal quality of medical opinion will be checked.

Documentation↗
PubMed1998

Energy and protein metabolism between 3 and 6 weeks of age of male broiler chickens selected for growth rate or for improved food efficiency.

1. A new open-circuit respiration unit consisting of 6 respiration chambers, gas analysis unit and data-acquisition system is briefly described. 2. Energy and protein metabolism in broiler lines selected for improved food efficiency (FC) or for growth rate (GL) were measured weekly from 3 to 6 weeks of age. 3. Gross and apparent metabolisable energy intake per kg W0.75 was on average higher for GL than for FC chickens without differences in metabolisability. Fed and fasted heat production per kg W0.75 did not differ between the lines. FC chickens retained less energy per kg W0.75 than GL chickens. 4. FC chickens deposited much less of the retained energy as fat than their GL counterparts and also showed greater protein conversion efficiency. The leaner composition of the body weight gain in FC chickens was confirmed by the estimated lower fat deposition per kg W0.75 and by the lower fat: protein ratio.

Aging↗
PubMed1998

Clinical benefits of diagnosing incipient AA amyloidosis in pediatric rheumatic diseases as estimated from a retrospective study.

OBJECTIVE: The diagnosis of AA amyloidosis could not be made in eight patients with pediatric rheumatic diseases as later verified employing the more sensitive combination of Congo red and additional immunocytochemistry (CRIC). The objective of this paper is to estimate the benefit of CRIC by reevaluating the historical charts with respect to the question as to which of the diagnostic and therapeutic measures would have been altered if the correct diagnosis had been known at the time of the primary biopsy. METHODS: All subsequent biopsies of eight children with historically missed AA amyloidosis in their primary biopsies were retrieved, together with the historical data including the Congo red stains of the biopsies. The biopsies were reexamined blindly for the presence of amyloid and the results were compared with the historical data concerning diagnostic and therapeutic measures. RESULTS: Using CRIC, AA amyloidosis could be identified an average of approximately three years earlier as compared to the historical data. This gain in time would certainly have altered the diagnostic as well as the therapeutic options, i.e. 10 out of 21 biopsies would have been spared and the earlier diagnosis would have initiated more significant antiinflammatory therapy. CONCLUSION: Very early detection of amyloid reduces the diagnostic burden and unveils an option for a consequent antiinflammatory therapy very early in the course of AA amyloidosis.

Amyloidosis↗
PubMed1997

The effect of methotrexate and azathioprine on the serum levels of IgA-alpha 1-antitrypsin complex in juvenile chronic arthritis.

In the present study we investigated the influence of methotrexate (MTX) and azathioprine (AZA) on the serum levels of the IgA-alpha 1-antitrypsin (IgA-AT) complex in patients with the systemic form of juvenile chronic arthritis (JCA). Fifty-six JCA patients (22 treated with MTX, 18 treated with AZA, and 16 not treated with any immunosuppressive agent) were enrolled in the study. MTX dosage ranged from 0.3 to 0.5 mg/kg-1 week-1, while AZA was given daily at an average dose of 1 mg/kg. MTX was given for 13 months (SD = 7 months) whereas AZA for 11 months (SD = 6 months). The average value of the complex was higher in JCA patients than in both control groups (0.74 +/- 0.73 U vs 0.37 +/- 0.13 U (control children), P < 0.001 and vs 0.23 +/- 0.12 U (control adults), P < 0.001). Values exceeding the normal range were found in twenty-two JCA patients (39.4%). Serum IgA-AT level was lowest in the MTX group compared to AZA and non-treated patients (0.56 +/- 0.24 U, 0.76 = 0.43 U, 0.95 +/- 0.52 U, respectively, P < 0.05). IgA values exceeding normal levels for age were found in 14% of the patients. A correlation between the levels of the IgA-AT complex and C-reactive protein (r = 0.43, P < 0.01), alpha 1-acid-glycoprotein (r = 0.45, P < 0.01), alpha 1-antichymotrypsin (r = 0.52, P < 0.01), alpha 1-antitrypsin (r = 0.40, P < 0.01) and IgA (r = 0.56, P < 0.01) was established.

Adolescent↗
PubMed1997

Course of mixed connective tissue disease in children.

Mixed connective tissue disease (MCTD) was first reported 25 years ago. This report provides an assessment of the course of juvenile (J) MCTD in 224 patients available in the literature until 1996, including our own 33 patients. Most patients improved and remissions were observed in 3-5% (up to 27%). Among the long-term problems, a loss in joint function was seen in up to 29% of the cases, renal involvement in up to 47%, restrictive lung disease in up to 54% and gastrointestinal manifestations consisting of oesophageal dysmotility in up to 29%. Cerebral involvement was rare but severe. Cardiovascular problems observed include cardiomyopathy, myopericarditis and pulmonary hypertension. Among other long-term problems were Raynaud's phenomenon and scleroderma-like skin changes in up to 86% of the patients. Seventeen of the 224 patients had died (7.6%) because of sepsis or infection (7), cerebral complications (3), heart failure (2), pulmonary hypertension (2), renal failure (2) or gastrointestinal bleeding (1). The mortality rate of JMCTD seems to be in the same range as that of juvenile systemic lupus erythematosus, dermatomyositis and scleroderma. When compared with the other connective tissue diseases, however, mainly minor long-term problems are seen in the surviving patients.

Child↗
PubMed1997

[The chronically ill child with rheumatoid arthritis].

Juvenile chronic arthritis (JCA) and other pediatric chronic rheumatic diseases such as the more rare juvenile collagenoses and the systemic vasculitides represent illnesses with a substantial potential of long-term problems and are additionally associated with a significant degree of mortality. Seen among the long-term problems associated with JCA are functional loss, deformities and the destruction of afflicted joints, a visual loss which may extend as far as blindness as a consequence of rheumatic iridocyclitis, irreversible organ damage caused by AA-amyloidosis as well as growth failure. Apart from cutaneous manifestations, on the other hand, the collagenoses and systemic vasculitides also demonstrate an involvement of specific organ systems, particularly of the kidneys, the lungs, the brain or the gastrointestinal tract. There is no causal therapy available. However, the application of a multidimensional therapeutic regimen primarily involving antirheumatic drugs, physiotherapeutic and ergotherapeutic methods as well as the application of a psychosocial treatment and the aid of governmental support, has resulted in good long-term results for most children suffering from JCA. The collagenoses and systemic vasculitides, however, have proven to be more problematic although the full utilization of the possibilities which are available today has provided encouraging results for most of these afflicted children. The complex therapeutic scheme, however, requires interdisciplinary cooperation. The pediatrician and/or family physician must fulfill crucial responsibilities which are relevant for the continuing prognosis of the illness. The pediatrician/general practitioner must thereby maintain a situation of close cooperation with the patient and their family as well as with the various colleagues active in the therapeutic team, especially with the pediatric rheumatologists. Moreover, these physicians also play a central role in establishing an early diagnosis in monitoring the disease progress and the therapy as well as in providing the mandatory assistance in the event of acute problems.

Adaptation, Psychological↗
PubMed1996

Endocrine aspects of paediatric rheumatic diseases.

Compared to the now numerous studies on the endocrinology of rheumatic diseases in adults, only a small number of studies has been published on children with rheumatic diseases. Prolactin has been most extensively investigated, showing interesting parallels with the findings in adults with rheumatological diseases. Thus, analogous to adult RA most forms of JRA or JCA (with the exception of ANA-positive JRA with uveitis) appear to show, if anything, low to normal levels of prolactin. Since the prolactin levels in adult RA depend on the inflammatory activity, and the physiological prolactin secretion decreases in chronic stress (especially sleep disorders), these results are most likely to be explained as reactive non-specific mechanisms in the stress of the disease. However, specific mechanisms are also being discussed to explain the low prolactin levels in adult RA. The results of prolactin measurements in juvenile SLE, juvenile ankylosing spondylitis and ANA-positive JRA with a raised incidence of uveitis, contrast with this. These conditions sometimes show significantly higher prolactin levels compared to healthy controls. A correlation of the increase of prolactin concentration with the inflammatory activity has been described for juvenile ankylosing spondylitis. These results correlate well with those of adult forms such as diseases of the seronegative spondyloarthropathies type, SLE and iridocyclitis. Raised prolactin concentrations are also found in these diseases. The inflammation promoting and immunostimulatory effects of prolactin found especially in animal experiments are confirmed clinically in these diseases by reports of successful treatments with the prolactin inhibitor, bromocriptine. The results available up to now for human growth hormone in JRA and JCA tend to be comparable with the results for prolactin in these form of paediatric rheumatological diseases. Besides normal values above, all lowered concentrations are measured for this hormone. Apart from other non-specific factors, its diminished secretion is mainly determined by the inflammatory activity of the disease. Low levels of growth hormone are likely to be a significant factor in the growth retardation in children with inflammatory rheumatological diseases. Up to now, the small number of investigations on gonadotrophins and the sex hormones in juvenile SLE and various forms of JRA published have not as yet yielded unequivocal results. The endocrine aspects of paediatric rheumatological diseases are thus still incompletely elucidated. However, there are many promising avenues for further fruitful research in this field.

Arthritis, Juvenile↗
PubMed1996

Pattern of joint involvement in children with Lyme arthritis.

Following the clinical observation of a peculiar joint pattern in children with Lyme arthritis, we classified the pattern of joint involvement in children with oligoarticular arthritis (2-4 joints) of different causes, including Lyme arthritis, juvenile chronic arthritis and juvenile spondyloarthropathy, as: (1) symmetrical: arthritis of the same joints on both sides of the body; (2) unilateral: all involved joints on the same side; (3) predominantly unilateral: joints involved on the contralateral side also showed ipsilateral involvement; (4) oblique: involvement on the contralateral side of one or more joints that did not show ipsilateral involvement. The oblique pattern was found in 13 of 42 children with early-onset pauciarticular juvenile chronic arthritis and in 17 of 32 patients with juvenile spondyloarthropathy, but not in 32 of 32 children with Lyme arthritis. If confirmed, these results may have implications for the diagnosis and pathogenesis of Lyme arthritis.

Adolescent↗
PubMed1996

Psoriatic arthritis in children.

Juvenile psoriatic arthritis has been accepted as a disease entity. Arthritis and psoriasis occur in the same individual more often than would be expected by pure coincidence and appear in about 2% to 4% of children with chronic arthritis. A genetic background becomes obvious with a family history of psoriasis in half of the patients, but no consistent HLA associations have been detected. A joint pattern with asymmetric arthritis of big and small joints and a high rate of dactylitis is typical for the disease. However, juvenile psoriatic arthritis presents in subsets that are similar to the subgroups of juvenile chronic arthritis but occurs with different frequencies. Oligoarticular courses dominate in psoriatic patients, and systemic manifestations are extremely rare. For children with symmetric polyarthritis who are at risk to develop severe disabling disease, early aggressive therapy should be considered.

Arthritis, Psoriatic↗
PubMed1995

High-sensitivity diagnosis of AA amyloidosis using Congo red and immunohistochemistry detects missed amyloid deposits.

Biopsy diagnosis of early amyloid-A (AA) amyloidosis has often been difficult. Examination of 57 consecutive biopsy specimens from 42 patients with inflammatory pediatric diseases permitted comparison of the precision of biopsy amyloid diagnosis in six different laboratories (labs), which applied the following methods: Congo red alone (four unspecialized labs combined as Lab 1), Congo red and electron microscopy (Lab 2), or Congo red and immunohistochemistry using monoclonal antibodies (Lab 3). Lab 3 reexamined the diagnoses made by Lab 1 and Lab 2. Of the 42 patients, 17 patients with 32 biopsies were selected for this study based on the presence of amyloid in at least one biopsy. Whereas massive or no amyloid was concordantly recognized by all labs in 18 biopsies from nine patients, discordance was demonstrated in 14 biopsies from eight patients. Comparison of Labs 1-3 revealed amyloid in 12 rectal and 18 renal biopsies evaluated by Lab 3, whereas Lab 2 missed amyloid in two of 18 renal biopsies and Lab 1 missed amyloid in 11 of 12 rectal biopsies. Most amyloid was missed when only minute amounts of amyloid were present. Had our technique (Lab 3) been available at the time of biopsy, amyloid could have been diagnosed years earlier, thereby sparing the patient further biopsies and allowing initiation of earlier treatment before organ damage could occur.

Adolescent↗
PubMed1995

[Cooperation between the public health office and federal health insurance in the area of health promotion].

During the last few years several health projects were realised in cooperation with health insurance societies. One of the projects concerned the sports possibilities for people suffering from chronic diseases. Another one supplied information on symptoms of cardiac infarction. Cholesterol levels were analysed, height an body weight were determined and blood pressure was measured. Additionally, several data on anamnesis were stored anonymously as data files. One of the projects was performed with a normal part of the population in the office of a bank. During this arrangement many young people were also examined. Another event was a "doctor-patient-seminar" on the subject of cardiac infarction. We wanted to demonstrate a few interesting differences between the two groups that were examined. We found a circadian difference in the means of blood samples taken at 1-hour intervals, in respect of the cholesterol levels, the time difference being approximately two hours after the last ingestion. The cooperation with health insurance societies is a good possibility in view of the difficult situation of local or communal finances, to realise health education projects with financial support by health insurance societies. The statistical difference between the two examined populations for special risks shows that population groups with coronary insults in their anamnesis and hence treated "on target", yield statistically significantly better results in respect of cholesterol, systolic and diastolic blood pressure, than the group defined as a normal population.

Adult↗
PubMed1994

Sera from JRA patients contain antibodies against a defined epitope in chromosomal protein HMG-17.

Autoantibodies against the nonhistone nucleosomal protein HMG-17 have been detected in a high percentage of ANA-positive patients with pauciarticular-onset JRA4. Here we report on the epitope mapping of the HMG-17 autoantigen with a set of overlapping and nested synthetic peptides spanning the entire amino acid sequence of the human HMG-17 protein. Competition ELISA experiments defined a proline and lysine rich octapeptide PKPEPKPK as the major epitope recognized by more than 70% of the HMG-17 positive JRA sera. Point mutations introduced in the autoimmune peptide determined the amino acid residues important for autoantibody recognition. Computer based sequence comparison shows close homology between the HMG-17 autoimmune epitope and certain infectious organisms, supporting the possibility that molecular mimicry is an important factor in the etiology of JRA.

Amino Acid Sequence↗
PubMed1993

Glycosylation of alpha 1-acid glycoprotein in systemic onset juvenile rheumatoid arthritis and acute bacterial infection: value in differential diagnosis.

Agarose based affinity immunoelectrophoresis with free concanavalin A (Con-A) as ligand was used to examine the microheterogeneity of alpha 1-acid glycoprotein in sera of patients with systemic onset juvenile rheumatoid arthritis (JRA) and acute bacterial infections. In JRA, a decreased proportion of Con-A reactive alpha 1-acid glycoprotein variants was found when compared to healthy control. In contrast, acute bacterial infection showed an increased reactivity. Investigation of glycosylation may be useful in the differential diagnosis of systemic onset JRA and acute bacterial infection.

Acute Disease↗
PubMed1992

Autoantibodies to the chromosomal protein HMG-17 in juvenile rheumatoid arthritis.

OBJECTIVE: To determine the antibody profiles in sera from patients with juvenile rheumatoid arthritis (JRA). METHODS: Immunoblotting using nuclear extracts and recombinant high-mobility group (HMG) nonhistone chromosomal proteins. RESULTS: Antibodies directed against HMG-17 were found in 47% of antinuclear antibody (ANA)-positive patients with pauciarticular-onset JRA and in 16% of ANA-positive patients with polyarticular-onset JRA. HMG-17 values of 6% and 8%, respectively, were detected in ANA-negative patients with JRA and in those with nonrheumatic diseases. CONCLUSION: There is evidence for a high prevalence of anti-HMG-17 antibodies in sera of patients with pauciarticular-onset JRA.

Adolescent↗
PubMed1992

Soluble interleukin-2 receptors in children with juvenile chronic arthritis.

Concentrations of interleukin-2 receptors were studied in sera of 81 patients with pauciarticular-, polyarticular-, and systemic-onset juvenile chronic arthritis using a double antibody "sandwich" enzyme-linked immunosorbent technique. Serum concentrations were significantly increased in all subgroups when compared with the healthy controls. Higher concentrations were found in systemic onset disease than in pauci- or polyarticular onset disease. Serum levels were found to be increased in both inactive and active disease, showing maximal values in patients with systemic features. A correlation to C-reactive protein, alpha 1-acid glycoprotein, and erythrocyte sedimentation was observed. Increased sIL-2R values suggest disease activity despite the absence of clinical symptoms.

Acute-Phase Proteins↗
PubMed1991

Expression of the CD2 activation epitope T11-3 (CD2R) on T cells in rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, and Lyme disease: phenotypic and functional analysis.

CD2R is an activation-associated epitope unmasked by a conformational change of the CD2 cell-surface glycoprotein. In spite of elaborate studies on the role of CD2 and CD2R in adhesion and stimulation of T cells in vitro, no instances of CD2R expression in vivo were known to date. We report high levels of CD2R observed on blood and synovial fluid T cells in rheumatoid arthritis and on peripheral blood T cells in juvenile rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, and Lyme disease. In vivo, expression of CD2R was restricted to T cells, not limited to a particular T-cell subset and not correlated with the expression of p55 interleukin 2R (IL-2R) (CD25) or major histocompatibility complex (MHC) class II molecules. When stimulated to proliferation via CD2 or CD3, ex vivo CD2R+ T cells showed the same basic activation requirements as CD2R-T cells.

Antigens, Differentiation, T-Lymphocyte↗