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Biomedical subjects

Heinz Reichmann

Publications and source records attributed to Heinz Reichmann.

27 records · Page 2Linked to original sources
PubMed2003

Primary central nervous system lymphoma: results of a pilot and phase II study of systemic and intraventricular chemotherapy with deferred radiotherapy.

PURPOSE: To evaluate response rate, response duration, overall survival (OS), and toxicity in primary CNS lymphoma (PCNSL) after systemic and intraventricular chemotherapy with deferred radiotherapy. PATIENTS AND METHODS: From September 1995 to July 2001, 65 consecutive patients with PCNSL (median age, 62 years) were enrolled onto a pilot and phase II study evaluating chemotherapy without radiotherapy. A high-dose methotrexate (MTX; cycles 1, 2, 4, and 5) and cytarabine (ARA-C; cycles 3 and 6)-based systemic therapy (including dexamethasone, vinca-alkaloids, ifosfamide, and cyclophosphamide) was combined with intraventricular MTX, prednisolone, and ARA-C. RESULTS: Sixty-one of 65 patients were assessable for response. Of these, 37 patients (61%) achieved complete response, six (10%) achieved partial response, and 12 (19%) progressed under therapy. Six (9%) of 65 patients died because of treatment-related complications. Follow-up is 0 to 87 months (median, 26 months). The Kaplan-Meier estimates for median time to treatment failure (TTF) and median OS were 21 months and 50 months, respectively. For patients older than 60 years, median survival was 34 months, and the median TTF was 15 months. In patients younger than 61 years, median survival and median TTF have not been reached yet; the 5-year survival fraction is 75%. Systemic toxicity was mainly hematologic. Ommaya reservoir infection occurred in 12 patients (19%), and permanent cognitive dysfunction possibly as a result of treatment occurred in only two patients (3%). CONCLUSION: Primary chemotherapy based on high-dose MTX and ARA-C is highly efficient in PCNSL. Response rate and response duration in this series are comparable to the response rates and durations reported after combined radiotherapy and chemotherapy. Neurotoxicity was infrequent.

Adult↗
PubMed2003

Analysis of HLA class I and II alleles in sporadic inclusion-body myositis.

Sporadic inclusion body myositis (s-IBM) is characterised by progressive weakness of proximal and distal limb muscles. Most patients are aged over 50 years at disease onset. Muscle biopsy reveals an inflammatory myopathy and cytoplasmic amyloid deposits. The mononuclear infiltrate is dominated by CD8+ T-cells. Several investigators have described associations between s-IBM and certain HLA antigens and alleles. However, to date neither HLA class I nor II alleles have been analysed in a large series of patients. We typed various HLA class I and II alleles in 47 patients suffering from s-IBM using sequence specific-primer pairs (SSPPCR). The results were compared with published German controls. Additional Bonferroni adjustment was performed over all allele groups corresponding to serologically defined antigens within one HLA class I or II locus. After Bonferroni adjustment, we found a significant increase in frequency of the following HLA alleles for s-IBM patients when compared with normal controls: A*03 (p = 0.0002), B*08 (p = 0.002), DRB1*03 (p = 0.0000002), and DQB1*05 (p = 0.02). HLA typing may be helpful to distinguish between subgroups of s-IBM patients. Moreover, HLA analysis may aid in identifying patients who might profit from future therapeutic strategies.

Alleles↗
PubMed2003

Mitochondrial cytopathies.

Mitochondrial cytopathies represent a heterogeneous group of multisystem disorders which preferentially affect the muscle and nervous systems. They are caused either by mutations in the maternally inherited mitochondrial genome, or by nuclear DNA-mutations. Today, approximately 200 different disease causing mutations of mitochondrial DNA (mtDNA) are known, and due to the increased knowledge about nuclear genetics during the last few years, more and more nuclear mutations are being described. Owing to the non-uniform distribution of mitochondria in tissues and the co-existence of mutated and wildtype mtDNA (heteroplasmy) in these organelles, these disorders may present with a huge variety of symptoms, even if the same mutation is involved. Diagnostic investigations should include the measurement of serum and CSF lactate, neuroradiological tests and a muscle biopsy to show the characteristic ragged-red fibres and cytochrome c oxidase deficient cells and also to provide material for genetic analysis. To date, the treatment of these diseases remains supportive and should focus on typical complications such as cardiac dysrhythmia and endocrinopathy.

Animals↗
PubMed2003

Metabolic patterns in meningiomas.

The aim of this investigation was to define characteristic properties of cellular energy metabolism in meningiomas in vitro dependent on the histological subtype. We analysed marker enzymes of representative metabolic pathways localized in the mitochondria (respiratory chain, citric acid cycle, beta-oxidation of fatty acids) and in the cytoplasm (glycolysis, pentose phosphate shunt). The activities of the intramitochondrial enzymes were significantly reduced in the meningiomas compared to normal cortex tissue. Glycolytic enzymes were not significantly different, but the marker enzyme of the pentose phosphate shunt was increased by a factor of 3.5-6 in the tumours. Further analysis of the histological subtypes showed that phosphofructokinase and lactate dehydrogenase were significantly increased in the anaplastic meningiomas compared to the benign subtypes.

Biomarkers, Tumor↗
PubMed2003

[Teaching of psychosomatic medicine and psychotherapy as an element of the Dresden DIPOL-Curriculum -- the PBL-course "Nervous system" and psyche].

A federal law, the "Approbationsordnung für Arzte", regulates Medical education in Germany. In 2002 a revised version of this law demanded of the medical faculties to implement interdisciplinary and problem-based (PBL) courses in their curriculum. Already in 1998 the faculty of medicine of the TU Dresden decided to reform the traditional curriculum. The reform-curriculum is being created in close co-operation with the Harvard Medical School. It is a hybrid curriculum retaining traditional elements as lectures and bedside teaching with PBL-tutorials and a special doctor-patient-communication-training, which is based on role-play exercises. Psychosomatic Medicine is taught together with neurology and psychiatry as a major topic of the 7,5-week PBL-course "Nervous System and Psyche" but there are also lectures and special skills training exercises in other PBL-courses like "Oncology" or "Emergency medicine". Data of the external evaluation showed, that the students accepted psychosomatic topics of the curriculum very well. This paper describes concept, implementation and evaluation data of the PBL-course "Nervous System and Psyche".

Clinical Competence↗
PubMed2003

Pramipexole in routine clinical practice: a prospective observational trial in Parkinson's disease.

OBJECTIVE: The mixed dopamine D2/D3 receptor agonist pramipexole is effective as monotherapy in early Parkinson's disease and as adjunctive therapy in advanced disease. Clinical trials suggest that the benefits of pramipexole may extend beyond the relief of motor symptoms (akinesia, rigidity and tremor at rest) to amelioration of depressive symptoms in Parkinson's disease. The aim of this study was to confirm the beneficial effects of pramipexole on the core symptoms of Parkinson's disease (with a focus on tremor), as well as to assess its antidepressant activity, during routine clinical practice. The study also aimed to demonstrate the practicability of the Snaith-Hamilton Pleasure Scale (SHAPS-D), the Tremor Impact Scale (TIS) and the Short Parkinson's Evaluation Scale (SPES) under conditions of routine clinical practice. STUDY DESIGN: This was a prospective observational study. PATIENTS: Data for 657 outpatients with Parkinson's disease were collected from German hospitals and specialist practices. The majority of patients were in Hoehn & Yahr stage II or III and were receiving levodopa. METHODS: Pramipexole (Sifrol) was initiated at a dosage of 0.375 mg/day (using a three-times-daily schedule) and titrated upwards, as required, at weekly intervals over a 4-week period to a maximum dosage of 4.5 mg/day (three times daily). Clinical evaluation was performed at baseline, at the end of the titration phase and at the end of maintenance therapy. Patients were assessed via the German questionnaire versions of the physician-assessed SPES, the self-evaluated TIS and the SHAPS-D. Changes in scale scores were evaluated nonparametrically, using the Wilcoxon-matched pairs test. Cronbach's alpha was used as a measure for item consistency. RESULTS: Pramipexole significantly improved SPES subscores for motor symptoms, complications of therapy, psychological status and activities of daily living. Pramipexole also reduced the detrimental effect of tremor on activities of daily living and social interactions, as assessed by patients via the TIS. As indicated by the results of the SHAPS-D questionnaire, pramipexole significantly reduced anhedonia in patients who had associated depression. Internal consistency of SPES subscales was found to be unaltered between the initial evaluation and follow-up. Likewise, internal consistency for TIS and SHAPS-D was demonstrated. Pramipexole was well tolerated and accepted by the vast majority of physicians and patients. CONCLUSION: In addition to ameliorating the core symptoms of akinesia and rigidity in Parkinson's disease, pramipexole improves tremor and depressive symptoms in routine clinical practice. The SPES, TIS and SHAPS-D were found to be useful instruments with validity in this study.

Activities of Daily Living↗
PubMed2002

Neuroprotection in idiopathic Parkinson's disease.

Neuroprotection may be defined as measures to protect neurons from degenerative processes by use of medication, to stop or prolong cell death and to positively interfere with the underlying cell death mechanism(s) in Parkinson's disease. So far, the question whether neuroprotection exists in parkinsonian treatment was difficult to answer because we had no objective method to check for dopaminergic cell death. Imaging techniques such as beta-CIT-SPECT or F-Dopa-PET are the best methods to approach this goal. This paper critically reviews the two most recently published studies on the possible neuroprotective effect of the dopamine agonists pramipexole and ropinirole. For the first time, these two drugs have shown a significantly smaller decrease in dopamine cell function when compared to levodopa. Nonetheless, there may still be some hesitation to accept the good correlation between imaging techniques and dopamine cell function. For obvious reasons, neither study included a placebo arm, since ethical reasons forbid a period of 2 to 4 years without treatment. Thus, the question, whether these two dopamine agonists are really neuroprotective or whether levodopa increases cell death in Parkinson's disease has to stay open. A rather remarkable finding was that, in both studies, motor function was slightly better in the levodopa arm, which raises the question whether imaging techniques really reflect improvement in cell function in those patients treated with dopamine agonists. We certainly have to continue our search for even better tools to evaluate neuroprotection.

Antiparkinson Agents↗