Biomedical subjects
K L Schmidt
Publications and source records attributed to K L Schmidt.
[Fever, a defence mechanism?].
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[Immunological reactions during elevated body temperature].
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[Treatment of rheumatoid arthritis using D-penicillamine].
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Developing and implementing an ongoing competency evaluation program for rehabilitation nurses.
Ongoing competency evaluation of all nursing staff in rehabilitation settings is mandated by regulatory bodies. Rehabilitation nurse educators are challenged to design competency evaluation programs that meet regulatory standards, promote the professional development of rehabilitation nurses, and are cost-effective. The competence of rehabilitation nurses is maintained through a combination of ongoing assessment and education activities. Key components of program development include identifying critical nursing and rehabilitation nursing skills; developing an efficient documentation system; designing the evaluation, program promotion, and implementation activities; and evaluating the program. The strategies described meet administrative and educational needs.
Gender differences in ethanol oxidation and injury in the rat stomach.
A significant fraction of orally consumed ethanol is metabolized by the alcohol dehydrogenase (ADH) enzyme present in the gastric mucosa. Human studies have shown that this "first pass metabolism" of ethanol correlates quite closely with gastric ADH activity which has been demonstrated to be greater in men than women. The present study was undertaken to determine if gender influences the magnitude of ethanol-induced injury in rat gastric mucosa and whether any differences can be linked to altered levels of ADH activity. Since prostaglandins (PGs) have been shown to markedly attenuate the severity of gastric injury induced by ethanol in the rat stomach, a further goal of this study was to determine whether the efficiency of PG's protective action was in any way influenced by gender. Accordingly, both male and female rats were pretreated subcutaneously with 16,16-dimethyl PGE2 (10 micrograms/kg) or saline 30 minutes prior to administering an oral dose of 50% ethanol in saline or saline alone. They were then sacrificed 5 minutes later. In a portion of animals (n = 6 per group), samples of mucosa from the glandular stomach were obtained and kinetic activity of ADH determined. In another portion of animals (n = 6 per group), gastric tissue samples from the glandular mucosa were examined by light microscopy and the magnitude of mucosal injury quantified. Alcohol-treated females showed significantly (p less than 0.05) less superficial and more deep mucosal injury than male counterparts. Further, ADH kinetic activity in female rats was significantly less than that observed in male counterparts of similar weight (83% of males; p less than 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)
Effective development and utilization of self-learning modules.
This article provides guidelines to assist the nurse educator in designing self-learning modules for appropriate topics and learners, in creating the module, and in developing tools to evaluate the effectiveness of the module. By following the guidelines presented, the nurse educator can create cost-effective learning opportunities for professional nurses. Utilization of self-learning modules encourages nurses to be self-directed and allows the nurse educator to be the resource rather than the source of learning.
[Ceruloplasmin and immunoglobulins under controlled D-penicillamine therapy in rheumatoid arthritis].
In a controlled therapeutic trial 17 patients with active rheumatoid arthritis (stage II and III) were divided in two randomized groups. One group of 9 patients was treated with 900 mg of D(-)penicillamine (Trolovol) plus 1500 mg of salicylate per day, the other group of 8 patients with 10 mg of prednisolone plus 1500 mg of salicylate daily. Before and after 1, 2, 3, 4 and 6 months of treatment IgA, IgG, IgM and caeruloplasmin were estimated with immunodiffusion technique. In both groups the IgA and IgG levels remained unchanged; unter D-penicillamine, on the contrary, a statistically significant and continuous fall of IgM and caeruloplasmin was observed; prednisolone treatment induced only a temporary fall of caeruloplasmin. In the DPA treated patients, a significant correlation of IgM with caeruloplasmin and of caeruloplasmin with ESR was found. In both groups there was no correlation between joint count and caeruloplasmin, joint count and IgM, caeruloplasmin and copper, copper and ESR; in the prednisolone group no correlation between caeruloplasmin, ESR and IgM was observed. The correlations suggest that the remarkable fall of IgM and caeruloplasmin under D(-)penicillamine treatment is caused at least partially by direct interference of DPA with these plasma proteins.
Th2-mediated atopic disease protection in Th1-mediated rheumatoid arthritis.
OBJECTIVE: The balance between CD4+ T-helper (h) cell subsets (Th1 and Th2) plays an important role in the pathogenesis of rheumatoid arthritis (RA) and atopy. While RA is believed to be a Th1 mediated disease, Th2 cells predominate in atopic disorders. The purpose of this study was to investigate differences in the occurrence of allergy, hay fever, house dust mite sensitivity and asthma, as well as total serum IgE levels in RA patients and controls. METHODS: The case history of atopic disorders was assessed in 134 RA patients and compared to those found in 305 healthy blood donors. RA patients also answered clinical questions concerning disease activity and severity. Total serum IgE levels were measured in both groups, taking into consideration disease modifying therapy. RESULTS: A significantly lower occurrence of medical history of hay fever (2.3%) and house dust mite sensitivity (3.1%) was found among RA patients compared to controls (24.2% and 12.2%, respectively; p < 0.0001 and p < 0.003 respectively). Moreover, RA patients had significantly lower total serum IgE levels than control subjects (p < 0.0001). RA was less severe in patients with atopy compared to non-atopic RA patients. CONCLUSION: These results support the concept that RA and atopy antagonize each other and that a change in the cytokine patterns of Th1 and Th2 cells could provide an indication for curative effects on RA.
[New pathogenetic aspects of ankylosing spondylitis].
Ankylosing spondylitis is one of the oldest diseases in humans; however, it is still one of the most fascinating and mysterious in human pathology. The unusual combination of both fundamental pathological processes: inflammation and ossification (which are mostly independent in respect to time and place) is unique. Until 1973, ankylosing spondylitis did not attract much immunological research. After the detection of an association between HLA B27 and the disease, clinical and immunological research was stimulated. It was supposed that HLA B27 may be a pathogenic factor. Meanwhile, it has become well known that HLA B27 itself is not required for development of the disease; however, discovery of immunological cross-reactivity between HLA B27 and some Klebsiella antigens inspired pathogenic considerations. It is discussed that the structural similarities between enteric bacteria and HLA B27 induce autoantibodies, or that HLA B27 plays a role in antigen recognition. Possibly, HLA B27 may also act as a receptor for infectious agents and their products. Fascinating, but controversely discussed is the hypothesis that bacterial products modify the B27 molecule and, in this way, trigger the disease. All present theories about pathogenesis of ankylosing spondylitis are unsatisfactory, because many important questions cannot be answered. There are no explanations for the unusual affinity of possible pathogenic immune reactions to the spine and other organs, the induction of ossification, the merging of cartilage, or the development of sacroilitis. Especially, we do not know the important bridge (if one exists) between inflammation and ossification. The typical ossification of the spine is of dramatic consequence for the patient in respect to function and mobility.(ABSTRACT TRUNCATED AT 250 WORDS)
The Schmidt Model for program planning.
The purpose of this program planning model is to provide a guide for program planners that will result in effective training programs. This program planning model emphasizes the importance of identifying learners' stressors, decreasing stress to a therapeutic level, developing a trust relationship between the programmer and the learners, and positively reinforcing learned behavior in the classroom and clinical settings.
[Extreme atrophy of the shoulder muscles in juvenile ankylosing spondylitis as a (misleading) main symptom].
An extreme unilateral muscular atrophy of the shoulder and upper arm region was a symptom of juvenile ankylosing spondylitis in a 20-year-old female patient. No pathological patterns were found in electromyographic, bioptic, and tomographic (CT, NMR) investigations. The muscular atrophy was caused by a shoulder arthritis with severe erosive damage. The false assumption of a neurological disorder and the disregard of anamnesis and low back pain delayed for several years an accurate diagnosis. After the onset of an arthritis of hip joints a collagen disease with myositis was supposed falsely in spite of normal electromyographic results. The unusual muscular atrophy around the shoulder joint probably must be interpreted as a consequence of reflex inhibition and partly due to inactivity. A real myositis seems to not be probable, because newer investigations in contrast to earlier findings show no evidence for inflammatory muscle disease in ankylosing spondylitis.
[Circadian rhythm of cortisol and corticotropin (ACTH) in patients with rheumatoid arthritis in relation to inflammatory activity].
In patients with rheumatoid arthritis, corticosteroids are usually given as a single morning dose to minimize adrenal suppression, because of the well-known circadian rhythm of the secretion of cortisol and corticotropin. However, it has not been so far examined whether there really is a normal secretion pattern of those hormones in all patients with rheumatoid arthritis, as there is in healthy subjects. We therefore studied twelve patients with rheumatoid arthritis who had never been treated before with corticosteroids and disease-modifying drugs such as gold, D-penicillamine or immunosuppressive drugs. The study was designed to examine adrenal secretory activity by measuring the cortisol and corticotropin levels at 2 h intervals throughout a 24 h cycle. The circadian secretion patterns of cortisol and corticotropin were disturbed in most patients. High inflammatory activity of the disease was accompanied by a severe disturbance of the circadian rhythm, whereas patients with low inflammatory activity showed a nearly normal secretion pattern. Besides other causes, the influence of mediators of inflammation on hypothalamic centers, analogous to endogenous pyrogen in fever, must be discussed.
Gastric injury induced by water immersion stress: prevention by prostaglandin and the role of glutathione.
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[Status of arthrosonography in rheumatologic diagnosis: examination technic, findings and their interpretation. I. The elbow joint].
Between July 1984 and October 1985 the elbow joints of 135 patients were examined by arthrosonography. Of these 97 patients suffered from rheumatoid arthritis, 4 from psoriatic arthritis, 2 from suspected ankylosing spondylitis, 1 from gout, and 27 patients were found to be normal. The equipment used was a Kretz sector scanner Combison 320 and a Siemens Sonoline SL linear scanner. The examination was divided into three parts: longitudinal and transversal scans of the fossa olecrani, the fossa coronoidea and fossa radii. We found, that inflammation of the elbow joint has to be evaluated separately for each part of the joint. The more intense the inflammation, the more certain diagnosis becomes. Bursitis and rheumatoid nodules could be separated sonographically. Also synovialitic complications such as of the bone and the development of synovial cysts could easily be recognized. These arthrosonographical findings are a valuable help in the diagnostics of rheumatic diseases. Their interpretation, however, requires the input of all clinical data.
Heat, cold and inflammation.
Although therapeutic heat and cold measures are widely used in rheumatic diseases, their application in joint inflammations is still broadly empirical. Animal experiments concerning the effects of systemic hyperthermia and of local heat and cold applications upon experimentally induced inflammations (dextran edema, formol edema, kaolin edema, carrageenan edema, adjuvant arthritis) show that some inflammations are significantly depressed, i.e. they are effected by a useful therapeutic influence, but that cold and heat can also act as enhancing inflammatory stimulus. Under certain conditions, whole-body hyperthermia has immuno-suppressive effects. Although the exact points of intervention of heat and cold investigations, acute exsudative inflammations seem to be better influenced by cold; on the contrary, chronic torpid and proliferous inflammations are better influenced by heat. Prostaglandin mediated inflammations can be aggravated by cold, because it stimulates the prostaglandin synthesis; acute exsudative inflammatory processes are most often aggravated by heat. These results show that both therapeutic agents should be applied within a well-defined range and with care.
[Unusual coincidence of dens aplasia and atlas malformation with early childhood spastic tetraparesis. Case report on the differential diagnosis of inflammatory atlantoaxial dislocation].
We report on the case of a 33 year old woman with acute tetraparesis and radiological evidence of atlantoaxial dislocation who had to undergo several attempts at osteosynthetic stabilisation of the cervical spine. She was afflicted with a spastic walk since the early years of childhood which had been explained by encephalitis after umbilical sepsis. The etiology of this severe and grave cervical instability however was found in a very rare congenital developmental disturbance of the occipitocervical passage with dystope os odontoid, extreme hypoplasia of the dens axis and additionally an osseous link between left processus transversus atlantis and occiput. Diagnostic problems arose from a simultaneous psoriasis, because a psoriatic cervical spondylitis seemed possible.
[Significance of the lymphatic system in the pathogenesis of adjuvant arthritis in rats].
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