PubMed Health⌕ Search

Biomedical subjects

Karl-Heinz Schulz

Publications and source records attributed to Karl-Heinz Schulz.

At least 19 recordsLinked to original sources
PubMed2006

Psychosocial aspects of pediatric living donor liver transplantation.

While the medical aspects of living donor liver transplantation (LDLT) have been investigated to a comparatively large degree, only in recent years have psychosocial aspects like donors' quality of life and attitude towards living donation been dealt with. In the course of a retrospective study, we examined 36 pediatric living liver donors at an average of 4.5 +/- 2.8 years postoperatively. The donation's impact on the family was considered "very high," "high," or "average" by 48% of the donors. The physical impact of the donation was regarded as being higher than the emotional impact. Subjective full recovery was achieved at an average of 4.5 months postoperatively. All patients stated that they would donate again. Donors' quality of life, as assessed with the 36-Item Short-Form Quality of Life Questionnaire (SF-36), was significantly higher than the German normative sample. Anxiety and depression, assessed with the Hospital Anxiety and Depression Scale-German version, were significantly lower compared to healthy controls. However, 14 patients (39%) described persistent, mostly physical, symptoms more than 1 yr postoperatively. In conclusion, the study's findings may enable clinicians to achieve a better understanding of living donors' situations, both pre- and postoperatively, and may help to assess the psychosocial risk of LDLT. Knowledge of possible ongoing problems may facilitate intervention at an early stage and should be included among the information given to potential living liver donors. Prospective studies using more specific instruments with an emphasis on the long-term psychosocial outcome of LDLT are needed for future research.

Adult↗
PubMed2006

Physical exercise in multiple sclerosis: supportive care or a putative disease-modifying treatment.

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease affecting young adults and leading to considerable disability. For many years, patients have been advised to avoid physical activity. Today, however, an increasing number of studies have shown beneficial effects of exercise training in MS. It has been reported that such programs not only improve fitness parameters but can also enhance quality of life and beneficially affect some suggestive disability measures. Pilot studies even indicate a neuroprotective potential. This review summarizes the findings of the major clinical trials on exercise in MS. Possible biological effect mediators, such as neurotrophic factors or anti-inflammatory cytokines, will be discussed. Exercise management guidelines will be proposed and possible further research strategies are presented.

Exercise↗
PubMed2005

Cognitive abilities in children after liver transplantation.

BACKGROUND: The authors investigated the cognitive status during the late postoperative phase in children who had undergone liver transplantation (LTx). METHODS: The authors examined 44 children who had undergone liver transplantation at their center. The children were 8.9+/-2.3 (mean+/-SD) years of age and had received the transplant 6.1+/-2.6 years previously. In 24 of the 44 children, a living-related transplantation had been carried out. Cognitive abilities were assessed with the three subscales of the Kaufman Assessment Battery for Children (K-ABC): the sequential processing scale (SES), the simultaneous processing scale (SIS), and the achievement scale (AS). RESULTS: The children scored below the population mean but within the normal range on all subscales of the K-ABC. In the SIS and the AS, age at transplantation influenced the cognitive outcome, as the children who were younger at transplantation scored significantly better than the older children and their results were within the normal range. However, for the SES, no such differences were found. A multiple regression analysis revealed that duration of illness and height at transplantation predicts the performance in the SIS and the AS. To a lesser degree, type of transplantation (cadaveric vs. living-related) predicts performance in the AS. Performance in the SES was not predicted by any of these variables. Time since LTx and type of immunosuppressive regimen were not associated with the cognitive status after transplantation. CONCLUSIONS: Children who are younger, with a shorter duration of illness, and who are more physically developed before LTx have a better prognosis regarding their mental development. However, this result does not hold for sequential processing functions, which showed no relationship with any of these variables. This could indicate differential effects of liver disease and consecutive metabolic derangements on brain development during the preoperative phase.

Adolescent↗
PubMed2005

Hypothalamo-pituitary-adrenal axis activity predicts disease progression in multiple sclerosis.

Clinical studies have shown that groups of multiple sclerosis (MS) patients exhibit a chronically activated hypothalamo-pituitary-adrenal (HPA) axis. However, the association of HPA axis activity and disease progression in MS is unknown. In this longitudinal study over a 3-year follow-up period, we report that patients who exhibited stronger HPA reactivity at baseline were significantly more likely to experience progression as measured by the Expanded Disability Status Scale (EDSS) during the follow-up period. Furthermore, HPA axis activity correlated with progression ratings and cognitive impairment three years later. Tests of HPA axis activity may be useful biomarkers for disease progression in MS.

Adrenocorticotropic Hormone↗
PubMed2005

[The concept of allostasis and allostatic load: psychoneuroimmunological findings].

Classical theories have conceptualized stress as a reaction to threat to the homeostasis within the organism requiring an adaptive response. However, postulating mechanisms that could link such responses to long-term detrimental health outcomes remains difficult. The allostatic load concept enables us to think about how mediators can be protective in the short run but may have damaging effects when overused and/or not shut off. It further facilitates the formulation of cause-effects cascades to explain the link of dysregulations in stress mediators such as glucocorticoids and catecholamines and increased susceptibility for certain diseases. In the first section, we briefly summarize the theoretical background. We then employ the concept to integrate findings from basic and clinical research on dysregulations of the stress response systems in multiple sclerosis and breast cancer. Based on this model, it seems likely that such dysregulations are implicated in progression and possibly pathogenesis of these diseases. When using allostatic load as a heuristic model, one needs to consider that stress mediators and outcomes are interconnected in a non-linear network.

Adaptation, Physiological↗
PubMed2005

Altered cytokine responses to cognitive stress in multiple sclerosis patients with fatigue.

This study intended to examine if the immune response to a cognitive task as a variant of psychological stress in MS patients is distinct from healthy controls. The experiment was part of a larger study on mechanisms and measurements of MS fatigue. Patients (n =23) and controls (n =25) participated in a cognitive task lasting 40 minutes, in which the heart rate was continuously monitored. Blood samples were taken at baseline and directly after the stress-inducing task Whole blood stimulated cytokine production representative of the TH-1 (i.e. IFNgamma, TNFalpha) and TH-2 paradigm (i.e. IL-10) was evaluated in relation to disability, fatigue, cognitive deficit, and anxiety. Patients scored high on a disease specific fatigue score compared to controls, whereas baseline cytokine patterns did not differ between the groups. MS patients displayed a blunted response of IFNgamma (P =0.03) whereas TNFalpha and IL-10 responses did not change. Additionally MS patients showed a significantly lower heart rate increase after the task (P <0.001). Cognitive impairment was associated with a decreased heart rate reactivity (P =0.02) while depressive symptoms correlated with stronger IL-10 responses (P =0.05). Overall, cognitive stress induces IFNgamma production in healthy controls but not in MS patients with fatigue. Furthermore, a reduced cardiac response might indicate an autonomic dysfunction in this group of patients.

Adult↗
PubMed2004

Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis.

In recent years it has become clear that multiple sclerosis (MS) patients benefit from physical exercise as performed in aerobic training but little is known about the effect on functional domains and physiological factors mediating these effects. We studied immunological, endocrine and neurotrophic factors as well as coordinative function and quality of life during an 8-week aerobic bicycle training in a waitlist control design. In the immune-endocrine study (1) 28 patients were included, the coordinative extension study (2) included 39 patients. Training was performed at 60% VO(2)max after determining individual exertion levels through step-by-step ergometry. Metabolic (lactate), endocrine (cortisol, adrendocortico-releasing hormone, epinephrine, norepinephrine), immune (IL-6, soluble IL-6 receptor), and neurotrophic (brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF)) parameters were compared from a prestudy and a poststudy endurance test at 60% VO(2)max for 30 min. In study (1), lowered lactate levels despite higher workload levels indicated a training effect. Disease-specific quality of life (as measured by the Hamburg Quality of Life Questionnaire for Multiple Sclerosis, HAQUAMS) significantly increased in the training group. No significant training effects were seen for endocrine and immune parameters or neurotrophins. In study (2), two out of three coordinative parameters of the lower extremities were significantly improved. In summary, low-level aerobic training in MS improves not only quality of life but also coordinative function and physical fitness.

Adrenocorticotropic Hormone↗
PubMed2004

Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases.

OBJECTIVE: During the last 14 years, living donor liver transplantation (LDLT) has evolved to an indispensable surgical strategy to minimize mortality of adult and pediatric patients awaiting transplantation. The crucial prerequisite to performing this procedure is a minimal morbidity and mortality risk to the healthy living donor. Little is known about the learning curve involved with this type of surgery. PATIENTS AND METHODS: From January 1991 to August 2003, a total of 165 LDLTs were performed in our center. Of these, 135 were donations of the left-lateral lobe (LL, segments II and III), 3 were of the left lobe (L, segments II-IV), 3 were full-left lobes (FL, segments I-IV), and 24 were of the full-right lobe (FR, segments V-VIII). We divided the procedures into 3 periods: period 1 included the years 1991 to 1995 (LL, n = 49; L, n = 2; FR, n = 1), period 2 covered 1996 to 2000 (LL, n = 47), and period 3 covered 2001 to August 2003 (LL, n = 39; FR, n = 23; FL, n = 3; L, n = 1). Perioperative mortality and morbidity were assessed using a standardized classification. Length of stay in intensive care unit, postoperative hospital stay, laboratory results (bilirubin, INR, and LFTs), morbidity, and the different types of grafts in the 3 different periods were compared. RESULTS: One early donor death was observed in period 1 (03/07/93, case 30; total mortality, 0.61.%). Since 1991, the perioperative morbidity has continually declined (53.8% vs. 23.4% vs. 9.2%). In period 1, 28 patients had 40 complications. In period 2, 11 patients had 12 complications, and in period 3, 6 patients had 9 complications. Within the first period, 1 donor underwent relaparotomy because of bile leakage. Postoperative hospital stay was 10 days, 7 days, and 6 days, respectively. Donation of the full right lobe, in comparison with that of the left lateral lobe, resulted in a significantly diminished liver function (bilirubin and INR) during the first 5 days after donation but did not increase morbidity. One donor from period 1 experienced late death caused by amyotrophic lateral sclerosis. CONCLUSIONS: In a single center, morbidity after living liver donation strongly correlates to center experience. Despite the additional risks associated with temporary reduction of liver function, this experience enabled the team to bypass part of the learning curve when starting right lobe donation. Specific training of the surgical team and coaching by an experienced center should be implemented for centers offering this procedure to avoid the learning curve.

Adult↗
PubMed2003

Cognitive performance of children who have undergone liver transplantation.

BACKGROUND: We investigated the cognitive status and quality of life (QoL) in the late postoperative phase of children who had undergone liver transplantation (LTx). METHODS: The sample consisted of 29 children who had undergone LTx at our center. The children were at least 6 years of age and had received the transplant between 3 and 10 years (mean 6.4 years) previously. In 16 of the 29 children, a living-related transplantation had been performed. Cognitive function was assessed with the three subscales of the Kaufman Assessment Battery for Children (K-ABC): the sequential processing scale, simultaneous processing scale, and achievement scale. QoL was measured with a specific questionnaire for children. RESULTS: The children scored below the population mean but within the normal range on all subscales of the K-ABC, except for the sequential processing scale, on which the children scored significantly below the norm and below their own performance on the simultaneous processing scale. Scores were below average for everyday and psychic functions and in the normal range for social and physical functions on the QoL questionnaire. Age at transplantation and achievement in the K-ABC were highly negatively correlated. A multiple regression analysis revealed that age and height at transplantation, and also to a lesser degree the type of transplantation, predict the level of cognitive functioning in the late postoperative phase. CONCLUSION: We conclude that the cognitive functions and QoL of children in the late postoperative phase who have undergone LTx are at the lower end of the norm in the long-term follow-up. Children who are younger and more physically developed at the time of transplantation will have a better mental-development prognosis.

Aging↗
PubMed2003

Basal serum levels and reactivity of nerve growth factor and brain-derived neurotrophic factor to standardized acute exercise in multiple sclerosis and controls.

Neurotrophins like brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are thought to play an important role in neuronal repair and plasticity. Recent experimental evidence suggests neuroprotective effects of these proteins in multiple sclerosis (MS). We investigated the response of serum NGF and BDNF concentrations to standardized acute exercise in MS patients and controls. Basal NGF levels were significantly elevated in MS. Thirty minutes of moderate exercise significantly induced BDNF production in MS patients and controls, but no differential effects were seen. We conclude that moderate exercise can be used to induce neutrophin production in humans. This may mediate beneficial effects of physical exercise in MS reported recently.

Adult↗
PubMed2003

Endocrine and cytokine responses to standardized physical stress in multiple sclerosis.

Since the earliest descriptions psychological and physical stress has been considered a controversial but potentially important factor in the onset and course of multiple sclerosis (MS). During recent years it has become clear that MS patients benefit from physical exercise as performed in aerobic training. As acute exercise has profound effects on immune and endocrine parameters we studied endocrine and immune response to standardized physical stress in MS within a study of aerobic training. Fifteen MS patients completed an eight-week aerobic training program, 13 patients were part of a wait-control group. Twenty healthy controls were recruited as well. A step-by-step bicycle ergometry was performed to determine individual exertion levels. For the endurance test patients exercised at 60% VO2 max for 30 min. Blood samples were drawn before, directly after and 30 min after completion of the exercise. Heart rate and lactate increased in all groups (p<.0001). We furthermore saw significant increases in endocrine parameters (epinephrine, norepinephrine, ACTH, and beta-endorphin; all p<.0001) in healthy individuals and in MS patients but without a differential effect. Whole-blood stimulated production of IFN-gamma (IFNgamma) was induced similarly in all groups (p<.01). TNF-alpha (TNFalpha) and IL-10 were less inducible in MS patients (trend). From these data we could not demonstrate a proinflammatory immune deviation in response to physical stress in MS. The observed trend of hyporesponsive TNFalpha and IL-10 responses in MS warrants further investigation.

Adrenocorticotropic Hormone↗
PubMed2003

Cognitive impairment in multiple sclerosis does not affect reliability and validity of self-report health measures.

Patient self-report health measures have received increasing recognition as supplementary outcome parameters in multiple sclerosis (MS). Given the high prevalence of cognitive problems in this population, reliability and validity of self-report instruments in patient groups with cognitive impairment is essential, especially when using such scales longitudinally. A sample of 80 MS patients with cognitive dysfunction according to Symbol Digit Modalities Test (SDMT) score and 107 unimpaired patients were included in the analyses. Data was available from the Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS), the Hospital Anxiety and Depression Scale (HADS), clinical rating scores [Expanded Disability Status Scale (EDSS) and FS (Functional Status) scales, CAMBS (Cambridge MS Basic Score)] and objective tests of upper and lower limb function [Timed 8 Meter Walk (T8) and Nine Hole Peg Test (9HPT)). Both self-report questionnaires showed satisfactory internal consistencies and retest reliability. Pattern and magnitude of correlations with other health status measures supported the validity of both instruments. However, there was a marked discrepancy between subjective and objective measures of cognitive function. Cognitively impaired patients furthermore showed significantly higher depression and anxiety as well as lower quality of life (QoL). The report provides evidence that QoL and affective symptomatology can be reliably assessed in MS patients with cognitive dysfunction. The common pattern of poor correlation between self-rated and objective cognitive function thus appears to be a result of the patients' (adaptive or maladaptive) coping mechanisms rather than being due to inaccurate measurement.

Adult↗
PubMed2002

Endocrine and cytokine responses to acute psychological stress in multiple sclerosis.

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system. An impaired hypothalamopituitary axis and stress reactivity have extensively been discussed without convincing experimental evidence. We choose a standardized acute psychological stressor to determine whether MS patients show altered endocrine and immune responses to stress. In 35 relapsing-remitting MS patients we found elevated baseline levels for catecholamines, prolactin, and IL-6 compared to 15 healthy controls. All neuroendocrine parameters declined during the stress intervention in MS as well as in stress-exposed controls. But only prolactin showed a significantly larger decline in stressed MS patients versus controls. During exposure to the stress we found no significant changes in serum levels of IL-6, IL-6 receptor, or TNF-alpha in either MS patients or controls after stimulation of a whole blood culture. An altered neural immune signaling in relapsing-remitting MS patients during acute experimental stress could not be proven for the parameters analyzed.

Acute Disease↗
PubMed2002

Oral terbutaline differentially affects cytokine (IL-10, IL-12, TNF, IFNg) release in multiple sclerosis patients and controls.

Administration of beta-receptor agonists alleviate experimental multiple sclerosis (MS) in animal models. In this study, we investigated the effects of terbutaline (5 mg) on IL-10, IL-12, IFN-gamma and TNF-alpha production in whole blood stimulation cultures. IL-10 and IL-12 production were significantly enhanced in controls but not in MS patients (p=0.03 and p=0.001). Effects were not associated with an ongoing immunomodulatory therapy. We conclude that administration of terbutaline induces anti-inflammatory (IL-10) as well as IL-12 protein production in healthy controls but not in MS patients. Our findings might reflect a disturbed autonomic control of the immune system in MS.

Administration, Oral↗
PubMed2002

Cognitive impairment correlates with hypothalamo-pituitary-adrenal axis dysregulation in multiple sclerosis.

Hypothalamo-pituitary-adrenal (HPA) dysregulation has recently been demonstrated in multiple sclerosis (MS) by means of combined dexamethasone corticotropin-releasing hormone (Dex-CRH) suppression tests. Authors found a correlation with course of disease and to a lesser extent with depressive symptoms. In this study, we aimed to further evaluate whether HPA disturbances in MS are correlated with cognitive impairment, disability status, and fatigue. Dex-CRH tests were performed in a total of 40 patients and 11 healthy controls. Concomitantly, cognitive impairment was evaluated using the symbol digit modalities test and fatigue was assessed by different fatigue severity scales. When comparing patient subpopulations to healthy subjects, Dex-CRH stimulation tests indicated an HPA hyperactivity in primary and secondary progressive MS, while relapsing-remitting patients had response patterns similar to controls. However, results were only significant for one of the six analysed parameters, i.e. area under the curve calculations of ACTH stimulation. Within the patient sample, clear-cut differences emerged between groups of different cognitive impairment, being significant for all ACTH response parameters. Our results suggest an HPA hyperactivation related to increased cognitive impairment. Indicators of HPA axis activation further correlated substantially with neurologic disability, but only moderately with duration of disease and even less with depressive symptoms and fatigue. We conclude that the observed dysregulation is more likely a secondary effect of the extent of brain damage rather than primarily involved in the pathogenesis of MS.

Adrenocorticotropic Hormone↗
PubMed2002

[Willingness to donate organs - Strategies to influence attitude].

While organ shortage remains one of the major problems in the treatment of many terminally ill patients with more than 13 000 patients currently on the waiting list in Germany, surveys are showing positive attitude towards organ donation in the general population. In this paper, several possible explanations for this apparent contradiction are discussed. Considering the fact that organ donation is supported by a vast majority in the general population while the donation rate remains considerably low, the significance of mass media campaigns to support donation is re-evaluated. Empirical studies have shown that the support for organ donation can hardly be further increased by campaigns. However, it has been shown that involvement with the topic may be increased significantly. This may play an important role because high involvement seems to be associated with actual behavior (e.g. signing a donor card). Since the donation rate is influenced by a whole array of factors, we argue that it may only be increased by using an "orchestra" of coordinated strategies. Such an orchestra is outlined and the role of mass media campaigns discussed within such a concept.

Attitude↗