Biomedical subjects

K Wilhelm

Publications and source records attributed to K Wilhelm.

At least 19 recordsLinked to original sources

PubMed1992

Safety of virus inactivated antithrombin III concentrate antithrombin III immuno (AT III).

In a prospective clinical trial the risk of infection after application of virus inactivated antithrombin III concentrate ANTITHROMBIN III IMMUNO (AT III) was investigated in patients undergoing cardiovascular surgery. The study was conducted according to the recommendations of the International Committee on Thrombosis and Hemostasis (ICTH), with the exception that most patients required additional blood products as well as AT III. Twenty-seven patients were eligible to test for the risk of acquiring hepatitis B. Twenty-six patients could be evaluated in terms of hepatitis NANB transmission considering ALT-levels whereas 20 patients could be tested for anti-HCV one year after surgery. Samples from 78 patients could be monitored for anti-HIV-1. None of these patients showed any signs of infection. AT III IMMUNO seems to be an antithrombin III concentrate with low or absent infectivity.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Deoxyuridylate-hydroxymethylase of bacteriophage SPO1.

Phage SPO1 of Bacillus subtilis carries hydroxymethyl-deoxyuridylate in place of thymidylate in its DNA. The enzyme, responsible for the conversion of dUMP to HmdUMP, is a dUMP hydroxymethylase, encoded by the SPO1 gene 29. Here we describe the cloning and sequencing of the gene and the overexpression of the gene product. DNA hybridization using the DNA of bacteriophage T4 dCMP-hydroxymethylase gene as a probe, allowed us to identify and map g29 on a 3.9-kb restriction fragment, EcoRI*11. We determined the nucleotide sequence. One of the open reading frames detected, coding for a putative 44.6-kDa protein, showed significant amino acid homologies with all known thymidylate synthases. Gp29 was overexpressed in the pT7 system. Extracts prepared from induced cells show hydroxymethylase activity in a tritium release assay.

Amino Acid Sequence↗

PubMed1992

Comparison of clinician rated and family corroborative witness data for depressed patients.

There appear to be few published studies that have examined the levels of agreement between ratings of features of depression as assessed by clinicians and by corroborative witnesses. We therefore report a study of 141 depressed patients assessed by a clinical psychiatrist at a semi-structured interview, reviewing family and historical data as well as depressive symptoms, and rated on a series of designated mental state signs. A family member completed questionnaire data assessing the same features. Moderate agreement was obtained only for several historical items (e.g., previous depressive episode, response to ECT). Agreement was minimal or non-existent on numerous clinical symptoms and signs of depression. A number of sources of disagreement are considered, and it is suggested that discordance may have emerged principally from the contrasting domains and training experiences of the clinicians and the corroborative witnesses.

Adjustment Disorders↗

PubMed1992

Are there any differences between bipolar and unipolar melancholia?

Although it is now more than 30 years since Leohard originally proposed the distinction between bipolar and monopolar (unipolar) forms of affective disorder, there have been relatively few studies which have investigated clinical features which may differentiate the depressed phase of bipolar disorder from unipolar depression. In this study we examined the value of a new scale for rating depressive mental state signs (the 'core' score system), and a large series of symptoms and risk factors, in distinguishing between 27 age and sex-matched pairs of bipolar and unipolar patients diagnosed as melancholic on several diagnostic criteria. In general, we found a marked similarity between the groups on clinical features of the depressive episode when allowance was made for multiple tests. Bipolar patients, however, had shorter episodes of depression and were less likely to demonstrate 'slowed movements' than unipolar subjects. There were also consistent trends on other items for psychomotor retardation to be less common and agitation to be more likely in the bipolar patients. At the least, these findings suggest that the widely-held belief that bipolar depressed patients typically have psychomotor retardation is not as clear-cut as has been previously described.

Bipolar Disorder↗

PubMed1992

Predicting the course of melancholic and nonmelancholic depression. A naturalistic comparison study.

We assessed improvement patterns and predictors of outcome over a 1-year period, in a sample of depressed patients receiving treatment from a specialized mood disorders unit. Patients with melancholia had a differential improvement pattern from the nonmelancholics in the first 20 weeks, but case rates and severity levels were comparable at 20 weeks and at 1 year. Only three variables (older age at first episode, less severe depression and extraversion) were predictors of improvement in both groups. Improvement was predicted by less psychomotor disturbance, absence of personality disorder, and higher social functioning in the melancholic patients. A reported absence of timidity and shyness in childhood, a briefer duration of depression, and receipt of individual psychotherapy predicted a better outcome in the nonmelancholic patients. Although significant predictors were few overall, the suggested differential relevance for most of the isolated predictors argues for outcome studies that examine melancholic and nonmelancholic depressive disorders separately.

Age Factors↗

PubMed1992

Interpersonal sensitivity and the one-year outcome of a depressive episode.

Previous studies have demonstrated that abnormalities of personality can contribute to a poor prognosis following a depressive episode. In this study the relevance of a specific personality trait, interpersonal sensitivity, to poor outcome was examined. One hundred and eleven depressives completed the Interpersonal Sensitivity Measure (IPSM) twenty weeks after a baseline assessment. High scores on the IPSM were associated with a poor outcome at one year following the baseline assessment, judged according to whether they had remitted clinically or not and by the degree of change in depression severity measured using the Hamilton and Zung Depression Rating Scales. The relevance of this personality trait to the course and treatment of depression is discussed.

Adolescent↗

PubMed1992

[MR tomography of cystosarcoma phylloides. A case report].

This is the first time a report is being published in medical literature on the MR imaging of a cystosarcoma phylloides tumour after intravenous contrast agent administration. MR tomography enabled complete visualisation of the tumour even in the region close to the thoracic wall, as well as clear delineation against the non-tumorous glandular tissue. This means that the limits along which complete extirpation of the tumour could be performed, were determined accurately before the operation, such complete removal being imperative to avoid tumour recurrence.

Breast Neoplasms↗

PubMed1992

[Lobular carcinoma of the breast in magnetic resonance tomography. A case report].

The invasive lobular carcinoma of the breast, the incidence of which is 10-15 per cent, occupies a special position in respect of histological differentiation and biological behaviour. No MR signal enhancement was seen after contrast medium application in the tumoral tissue in the case described here, namely, an invasive lobular carcinoma of the breast of 2 cm size. Hence, it is not always possible to exclude with absolute certainty the presence especially of an invasive lobular carcinoma of the breast in the absence of contrast medium uptake.

Breast Neoplasms↗

PubMed1992

[Osteoid osteoma of the elbow].

The osteoid osteoma is a rare, benign neoplasm of bone, most frequently located in the lower extremity (head of the tibia). Because of its rarity and its mostly rather unspecific clinical symptoms, diagnosis of the tumor is frequently problematic. Ideally, osteosclerosis surrounding a central focus (nidus) is revealed by radiology. Radiological imaging seems to be the most effective tool in reaching the correct diagnosis. Operative resection of the nidus is the only known curative therapy for osteoid osteoma.

Adult↗

PubMed1991

Age and depression.

The interaction of age and depression was investigated by comparing differences between elderly (greater than or equal to 60 years old) and younger consecutive in- and out-patient referrals to a tertiary referral mood disorders unit. Older patients with unipolar major depressive episode were more likely to be psychotic and agitated regardless of depressive subtype and less likely to have personality inadequacies or a family history of affective disorder. In this sample, elderly depressives' rating of diagnosis, severity, endogeneity and social impairment were similar, irrespective of age of first onset of depression, but a positive family history and personality abnormalities were less likely in late-onset depressives.

Adjustment Disorders↗

PubMed1991

Distinguishing psychotic and non-psychotic melancholia.

To examine the necessary and sufficient status of delusions and hallucinations as clinical features of psychotic (delusional) depression, we studied a consecutive sample of 137 patients meeting DSM-III, RDC and our clinical criteria for endogenous depression/melancholia, of whom 35 had delusions and/or hallucinations, and represented our putative 'psychotic depressives' (PDs). The PDs were contrasted with the remaining 'endogenous depressives' (the EDs), and an age- and sex-matched subsample of the latter, the MEDs. Univariate and multivariate analyses of clinical features established that, in addition to the presence of delusions and/or hallucinations, the PDs could be distinguished in particular by severe psychomotor disturbance, as well as by sustained and unvarying depressive content, the absence of any diurnal mood variation and by constipation. Latent class analyses suggested that overt psychotic features (such as delusions and hallucinations) were sufficient but not necessary for a subject to be assigned to the 'psychotic' latent class, and a subsequent chart review suggested that, in some PDs actual psychotic features may not be able to be elicited because of severe psychomotor change, suggesting that clinical reliance on eliciting delusions or hallucinations may result in a number of 'masked psychotic depressives' escaping valid diagnosis.

Affective Disorders, Psychotic↗

PubMed1991

Growth hormone and other hormonal responses to clonidine in melancholic and nonmelancholic depressed subjects and controls.

To study putative differences in central neurotransmitter function in depressive subtypes, growth hormone, adrenocorticotropic hormone (ACTH), cortisol, and prolactin responses to the alpha 2-noradrenergic receptor agonist clonidine (1.3 micrograms/kg i.v.) were examined in 26 subjects with major depression, 13 of whom had melancholia. The responses of 10 of these endogenous/melancholic subjects were compared with those of 10 controls who were matched to the patients on age, sex, and menopausal status. In 15 of the depressed subjects, prolactin and cortisol responses to the putative serotonergic agonist fenfluramine were also examined to test for associations between these challenges. There were no significant differences in any of the responses between melancholic and nonmelancholic depressive subgroups after controlling for age and sex. With the exception of a greater reduction in ACTH in the endogenous/melancholic subjects, there were also no significant differences in hormonal responses between these patients and controls. There was, however, a significantly greater reduction in systolic blood pressure in the control subjects. There were no significant correlations between the responses to clonidine and fenfluramine. The findings suggest that clonidine at a dosage of 1.3 micrograms/kg is neither able to differentiate reliably between depressive subtypes nor to differentiate reliably between depressed and control subjects.

Adrenocorticotropic Hormone↗

PubMed1991

Psychosocial risk factors distinguishing melancholic and nonmelancholic depression: a comparison of six systems.

We examined six systems or scales designed to distinguish melancholia from residual nonmelancholic depressive disorders in a sample of 305 patients. A count of the number of significant psychosocial risk factors showed that a clinical diagnosis was the most differentiating (19 significant risk factors), followed by the Newcastle index (13), DSM-III (10), and the CORE system (10)--the last essentially assessing psychomotor change; Research Diagnostic Criteria (RDC) (7) and an endogeneity symptom scale (2) were the least differentiating. A subsample of "composite melancholics" was derived, comprising 138 who met "melancholia" criteria for DSM-III, RDC, and CORE, and they were contrasted with residual depressives. The composite melancholics were older, had had a briefer depressive episode, and differed significantly on 12 risk factors, essentially being less likely to report deprivational experiences such as deficient parenting and dysfunctional marital relationships. We suggest that such a risk factor strategy is of potential use in refining the clinical definition of melancholia.

Adaptation, Psychological↗

PubMed1991

Mouse proacrosin gene: nucleotide sequence, diploid expression, and chromosomal localization.

Acrosin is a serine proteinase located in the acrosome of the sperm in a zymogen form, proacrosin. As deduced from the cDNA sequences of human, boar, and mouse proacrosin, the enzyme is synthesized as a preproenzyme, preproacrosin, which contains a hydrophobic leader sequence of 15 to 18 amino acid residues. We have isolated the gene coding for mouse proacrosin from a mouse cosmid library, using cDNA clones as probes. The gene comprises six exons, and one of the five introns is located in the 5'-untranslated region. The transcription initiation site of the preproacrosin mRNA could be assigned to the residue T, 581 nucleotides upstream of the translation initiation codon ATG, with primer extension analysis. TATA and CAAT boxes could be identified at positions -26 and -97, respectively. Similar to other serine proteases, the coding sequence encompasses five exons and the three active-site residues His, Asp, and Ser are encoded by three different exons (E2, E3, E5). The proline-rich domain, which is a characteristic feature of the proacrosin polypeptide, is encoded in exon 5 with the serine active-site residue. The gene is located on chromosome 15 of the mouse genome, bands E/F, and is a member of a syntenic group that was mapped on human chromosome 22, q13-qter. During spermatogenesis the proacrosin gene in the mouse is expressed diploid, in contrast to a haploid expression observed in bull, boar, and rat.

Acrosin↗

PubMed1991

Perceived interpersonal risk factors of non-endogenous depression.

In a case-control study, two potential interpersonal risk factors of non-endogenous depression, namely a patient's perception of their current intimate partner as dysfunctional and a patient's recall of exposure to previous deprivational parenting, were quantified. The interpersonal characteristics of the partner were assessed principally by a brief self-report questionnaire, the Intimate Bond Measure (IBM). By cross-sectional and longitudinal comparison of this instrument with other interview-derived and self-report measures, the convergent, discriminant and predictive validity of the IBM in depressed patients was established. Further, little evidence of any distorting effect of depressed mood or neuroticism was detected. The perception of the current intimate partner as dysfunctional imparted a risk to non-endogenous depression of at least five times, while reported exposure to parental 'affectionless control' was quantified as a four times' risk. Importantly, IBM care scores predicted the course of the depressive disorder over a six-month period.

Adaptation, Psychological↗

PubMed1991

[The feasibility of magnetic resonance tomography in the diagnosis of non-palpable breast tumors].

This study deals with the role of MRI in elucidating clinically silent lesions of the breast with indeterminate changes on mammography. MRI localisation of suspected lesions was possible in all cases by using double coils after contrast enhancement of the glandular tissue, independent of the findings on mammography. Inability to demonstrate micro-calcification did not prove a disadvantage. MRI cannot provide a definite tissue diagnosis, since there is overlap between the appearances of malignant and benign lesions.

Adult↗

PubMed1991

Psychotic depression: a review and clinical experience.

We review research literature on psychotic (delusional) depression, including demographic, illness pattern, clinical, biological marker and treatment issues. Secondly, we report a study of a consecutive sample of 137 patients meeting criteria for DSM-III melancholia, RDC definite endogenous depression and our "clinical" criteria for endogenous depression, of whom there were 35 "psychotic depressives" (PDs). The PDs were contrasted with the remaining 76 depressives (EDs) and with an age and sex-matched subset (MEDs). The PDs were distinctly older than the EDs at assessment and at initial onset of any affective disorder. Compared to the MEDs, they tended to have longer illnesses, were more likely to be hospitalised (and to have longer stays), to receive (in the past and for the current episode) combination antipsychotic/antidepressant medication and/or ECT, and to have a poorer course over the following year. They were no more likely to have a bipolar pattern, a family history of depressive disorder, schizophrenia or alcoholism, or vegetative depressive features. Developmental psychosocial stressors and antecedent life event stressors were not over-represented. Most of the PDs had delusions, one-fifth reported hallucinations and psychomotor disturbance was marked. Other differential clinical findings were sustained mood disturbance, constipation, and the absence of a diurnal variation in mood and energy.

Adult↗

PubMed1991

Depression sub-typing: unitary, binary or arbitrary?

The strongest statistical support for the binary view of depression has been provided by factor (principal components) analytic studies which delineate a bipolar factor with features interpreted as reflecting "endogenous depression" and "neurotic depression" at opposing poles. We review the seminal studies to suggest instead that the bipolar factor has generally polarised depression and anxiety, and that no such entity or symptom complex of "neurotic depression" has been isolated. Instead "neurotic depression" has been defined principally by features of anxiety and personality style. We argue that the suggested entity is, in fact, a pseudo-entity, being no more than a residual group of non-depressive features without any significant intrinsic depressive characteristics. We support our interpretation by showing comparable solutions in published studies of depressives alone, contrasted with separate analyses of anxious and depressed patients. We also report two studies in which the "neurotic depressive" pole is made to appear and disappear by the inclusion and exclusion of anxiety items. As factor analytic studies have defined the "residual" pole so variably, we argue that some features held to distinguish neurotic depression are of no utility and that such a diagnosis is meaningless. We suggest that the clinician should not proceed (after excluding endogenous depression) to conclude that the default option is necessarily an entity "neurotic depression" and that instead a heterogeneous group of options (e.g. anxiety, personality disorder) require review. If the "neurotic depressive" type of the multivariate analytic studies is a pseudo-entity, then a modified unitary view of depression may be valid.

Adult↗