Biomedical subjects
Publications and source records attributed to J Bauer.
This is a report about a 20-month-old child with acquired os odontoideum caused by a fall. Diagnosis of atlanto-axial instability was eventually made 29 months later after repeated trauma and transitory tetraparesis. Dorsal C1/2 fusion with an autogenic rib graft and plaster fixation for 8 weeks failed; an autogenic iliac bone graft plus external fixation for 12 weeks finally resulted in solid fusion.
Catamenial seizures are defined as epileptic seizures occurring during distinct phases of the menstrual cycle (i.e., periovulatory, premenstrually and during menstruation). The cyclic changes of the gonadotropic hormones are thought to be the main cause of the seizures. This hypothesis is supported by results of animal experiments, which have shown oestrogens to increase neuronal excitability whereas progesterone lowered it. We investigated 21 women with epilepsy who reported a catamenial increase in seizure frequency. Only 24% of these women actually exhibited a catamenial manifestation in more than 75% of seizures. The incidence of catamenial seizures is reported in the literature to be between 10% and 72%. Catamenial seizures are treated with anticonvulsant drugs. However, when anticonvulsants have failed to suppress seizures, progesterone or progesterone-derivates have been administered with success. We treated 16 patients with a synthetic GnRH-analogue to suppress the hormonal release of gonadotropins. Four of the six patients with only catamenial seizure manifestations and no other seizures became seizure free. Ten patients had catamenial seizures as well as seizures not related to the menstrual cycle. A decrease in seizure frequency by more than 50% was achieved in 7 of these 10 patients.
The development of new antiepileptic drugs in recent years has enlarged the number of anticonvulsant compounds for the treatment of intractable focal epilepsies. The anticonvulsant potency of these drugs is usually compared by the number of patients who achieve a reduction in seizure frequency of more than 50%. Such an effect can be observed in approximately 20-30% of patients with pharmacoresistant focal epilepsies and is about the same with all the new compounds. In addition to the influence on focal seizures some of the novel anticonvulsant drugs exhibit efficacy in generalized seizures or in Lennox-Gastaut syndrome. In general there are fewer side effects in newly developed drugs than in standard anticonvulsants. However, in some cases characteristic side effects may occur: weight gain, depression or psychosis from vigabatrin; lamotrigine may provoke allergic rashes and felbamate may cause gastrointestinal side effects and sleeplessness. Apart from felbamate, there are no interactions with an antiepileptic comedication or they are of little importance. The development of the new anticonvulsants follows a rational design based on pathophysiological aspects: the main aim is to influence synaptic transmission, resulting in an increase in inhibitory and a decrease in excitatory transmitters. Thus, vigabatrin and tiagabine enhance the endogenous GABA amount, whereas felbamate and remacemide interact with the NMDA-receptor complex. Because it is not possible to draw sufficient conclusions from add-on studies in clinical testing it is necessary to establish new forms of trial design. Monotherapy designs are favored because they lack possible interactions with comedication and make the anticonvulsant efficacy of the compound better comparable to those of established anticonvulsants.(ABSTRACT TRUNCATED AT 250 WORDS)
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A link between changes in tonic accommodation (TA) produced by sustained near work and the development of adult-onset myopia has been suggested in studies of young adults. Measures of TA before and after near work have been lacking in children of school age, which is the most susceptible period for the development and progression of juvenile-onset myopia. In the present study accommodation was measured in 87 children, aged 7 to 16 years, before and after 15 minutes of video game playing. All children were refracted before testing and wore optical correction during measures of accommodation with a Canon R1 autorefractor. Most children showed initial values of TA (far focus minus dark focus) between 0.0 and 1.0 D, with a mean of 0.68 D. Grouped by refractive status, the myopic children initially showed 0.30 D of TA, while the emmetropic children showed 0.75 D and the hyperopic children showed 0.94 D. After playing the video game, TA of the myopes increased by 1.15 D, compared to smaller increases for the emmetropes (0.68 D) and hyperopes (0.24 D). Comparable values have been obtained from young adults. These results indicate that the smallest initial values of TA and the largest inward shifts in TA are found during the period of acquisition and progression of myopia, regardless of age.
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Trichothecenes like T-2 toxin, diacetoxyscirpenol, and deoxynivalenol, which occur in feed, are metabolized preponderant in a biphasic way. Oxidation and hydrolysis are carried out in phase 1, while the transformation products are conjugated with glucuronic acid in phase 2; in addition, the epoxide ring is cleaved by the gut microflora. Metabolites of T-2 toxin are HT-2 toxin, 3'-hydroxy-T-2 toxin, 3'-hydroxy-HT-2 toxin, neosolaniol, 4-deacetylneosolaniol, T-2 triol, T-2 tetraol, and de-epoxide T-2 tetraol. Diacetoxyscirpenol is transformed to 15-monoacetoxyscirpenol, scirpenetriol, de-epoxide 15-moneacetoxyscirpenol, and de-epoxide scirpenetriol. Deoxynivalenol undergoes no extensive metabolism; only the production of deoxynivalenol glucuronide and de-epoxide deoxynivalenol is assumed. As trichothecenes are rapid metabolized, the diagnosis of an intoxication by the analysis of samples of pig origin should be hardly possible; for the same reason, the possibility of an enrichment of trichothecene metabolites in edible tissues is graded as low.
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The ED1 monoclonal antibody recognizes an antigen in lysosomal membranes of phagocytes. The expression of this antigen in cells increases during phagocytic activity. Here we describe the expression of ED1-immunoreactivity during the various stages of both acute (monophasic) and chronic relapsing experimental autoimmune encephalomyelitis (EAE) in the Lewis rat. During the first attack of acute and chronic relapsing EAE, ED1-immunoreactivity was present in macrophages and in cells which displayed morphologic features of activated microglial cells (i.e., cells with thick short processes). At the ultrastructural level these cells were seen to contain phagocytosed myelin structures in lysosomes. ED1-immunoreactivity in these cells was present in the cytoplasm near lysosomes. During the remission phase of acute EAE and the relapse phase of chronic relapsing EAE, ED1-positive cells with dendritic morphology not only were present in or nearby lesions, but were also found at sites distant from lesions throughout large parts of the brain. These cells had a morphology comparable to microglial cells in normal brain. A major difference between animals which were in remission and animals which on day 25 were suffering from a relapse, was that the latter showed the presence of lesions with darkly stained round ED1-positive macrophages and activated microglial cells. These results indicate that during a relapse, newly recruited blood-borne macrophages infiltrate the brain and, together with activated lymphocytes and microglial cells, recommence a new demyelination process.
BACKGROUND: There has been no new effective drug therapy for patients with severe ulcerative colitis since corticosteroids were introduced almost 40 years ago. In an uncontrolled study, 80 percent of 32 patients with active ulcerative colitis refractory to corticosteroid therapy had a response to cyclosporine therapy. METHODS: We conducted a randomized, double-blind, controlled trial in which cyclosporine (4 mg per kilogram of body weight per day) or placebo was administered by continuous intravenous infusion to 20 patients with severe ulcerative colitis whose condition had not improved after at least 7 days of intravenous corticosteroid therapy. A response to therapy was defined as an improvement in a numerical symptom score (0 indicated no symptoms, and 21 severe symptoms) leading to discharge from the hospital and treatment with oral medications. Failure to respond to therapy resulted in colectomy, but some patients in the placebo group who had no response and no urgent need for surgery were subsequently treated with cyclosporine. RESULTS: Nine of 11 patients (82 percent) treated with cyclosporine had a response within a mean of seven days, as compared with 0 of 9 patients who received placebo (P < 0.001). The mean clinical-activity score fell from 13 to 6 in the cyclosporine group, as compared with a decrease from 14 to 13 in the placebo group. All five patients in the placebo group who later received cyclosporine therapy had a response. CONCLUSIONS: Intravenous cyclosporine therapy is rapidly effective for patients with severe corticosteroid-resistant ulcerative colitis.
Molecular studies of amyloid pathology have tended to obscure the fact that plaques and neurofibrillary tangles are highly unspecific changes that are also found in most elderly nondemented individuals. Recent work suggests that an interleukin 6-mediated immunological process is an important, possibly specific, element of Alzheimer's disease. The present review summarizes a number of somewhat neglected aspects of the disease and draws attention to a number of pharmacotherapeutic possibilities. Finally the article discusses evidence that appears to indicate that stress factors may also be involved in the pathogenesis of this condition.
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The biological activities of vitamin E are related to the cellular functions and presence of sufficient tissue concentrations of this micronutrient. Most of the stored vitamin E is in the adipose tissue where it appears to be distributed equally. The breast adipose tissue has similar vitamin E concentrations as other parts of the body. The ductal systems also store vitamin E in sufficient concentrations to maintain cellular functions. The milk secreted from the ducts of the breast contains a high concentration of tocopherol. Whereas the normal breast tissue presumably utilizes vitamin E as an antioxidant, tumor tissue appears to handle vitamin E differently. Breast tumors possessing estrogen negative receptors and having poor histological differentiation have lower concentrations of vitamin E than tumors with positive estrogen receptors and well differentiated histology. Since vitamin E is considered the principal, if not sole, chain-breaking lipophilic antioxidant in plasma and tissue, its role as a potential chemopreventive agent in breast cancer should be further investigated. The combination of vitamin E with other cancer chemopreventive agents appears to be a reasonable procedure.
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Between March 1990 and March 1993 some 822 consecutive patients underwent an attempt at laparoscopic cholecystectomy. Intravenous cholangiography (IVC), ERCP, and selective intraoperative cholangiography (IOC) were used in the evaluation of common bile duct (CBD) stones. Two hundred thirteen patients (26%) were identified preoperatively with either abnormal liver functions or a dilated common bile duct suggestive of CBD stones. IVC was performed in 143 patients (67%). Choledocholithiasis was identified in 14 patients (10%). Preoperative therapeutic ERCP was successful in all 14 patients (100%). Diagnostic ERCP was attempted in 61 patients and successful in 59 (97%). Choledocholithiasis was identified in 25 patients (41%). Successful extraction was accomplished in 23 patients (92%). Transcystic common bile duct exploration was used effectively in the patients with an unsuccessful ERCP. IOC was attempted in 50 patients and successful in 48 (96%). Choledocholithiasis was identified in three (6%). A retained CBD stone was present in eight patients (1%). There was one level I CBD injury (0.122%). The use of IVC, selective ERCP, and selective IOC is a reasonable approach in the performance of laparoscopic cholecystectomy.
We measured postictal prolactin (PRL) levels during repetitive seizures in 14 patients (10 men and 4 women) suffering from epilepsy with focal and/or secondarily generalized seizures. Between two and six seizures occurred per patient (mean 2.7). The interveral between seizures was 15 min and 8 h 40 min (mean 3 h 32 min). Five of the 14 patients showed a marked postictal PRL rise after each seizure (i.e. concentrations above 700 microU/ml for women, 500 microU/ml for men). In the remaining 9 patients there was no detectable rise in PRL. A decrease in PRL did not occur in any of the 14 patients. In those patients who had shown a marked PRL increase after the first seizure, the PRL continued to rise in subsequent seizures. Unlike previous investigations, these results show that repetitive epileptic seizures are not necessarily followed by a decrease in postictal PRL levels. A decrease in PRL response is known to occur if there is progression to status epilepticus.