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Biomedical subjects

M Neher

Publications and source records attributed to M Neher.

At least 19 recordsLinked to original sources
PubMed2006

Granulocyte colony-stimulating factor does not affect contusion size, brain edema or cerebrospinal fluid glutamate concentrations in rats following controlled cortical impact.

INTRODUCTION: Granulocyte colony-stimulating factor (G-CSF) is an established treatment in the neutropenic host. Usage in head-injured patients at risk for infection may aggravate brain damage. In contrast, evidence of G-CSF neuroprotective effects has been reported in rodent models of focal cerebral ischemia. We investigated effects of G-CSF in acute focal traumatic brain injury (TBI) in rats. METHODS: Thirty-six male Sprague-Dawley rats were anesthetized with 1.2%) to 2.0% isoflurane and subjected to controlled cortical impact injury (CCII). Thirty minutes following CCII, either vehicle or G-CSF was administered intravenously. Animals were sacrificed 24 hours following CCII. Glutamate concentrations were determined in cisternal cerebrospinal fluid (CSF). Brain edema was assessed gravimetrically. Contusion size was estimated by 2,3,5-triphenyltetrazolium chloride staining and volumetric analysis. RESULTS: Dose-dependent leukocytosis was induced by infusion of G-CSF. Physiological variables were unaffected. Water content of the traumatized hemisphere and CSF glutamate concentrations were unchanged by treatment. Contusion volume was similar in all groups. CONCLUSIONS: A single injection of G-CSF did not influence cortical contusion volume, brain edema, or glutamate concentrations in CSF determined 24 hours following CCII in rats. G-CSF, administered 30 minutes following experimental TBI, failed to exert neuroprotective effects.

Animals↗
PubMed2006

Repeated digital substraction angiography after perimesencephalic subarachnoid hemorrhage?

BACKGROUND AND PURPOSE: In patients with perimesencephalic subarachnoid hemorrhage (pSAH) DSA is recommended to exclude aneurysms to due false negative findings in CT-angiography. However, whether a second DSA is indicated during the clinical course to exclude--in addition to aneurysms--fistulas, too, is still under debate. We aimed to evaluate the benefit of repeated DSA in patients with pSAH. METHODS: The source of data was a prospective database set up at the neurological, neurosurgical and neuroradiological departments in our institution. A total of 69 patients with pSAH were enrolled and analyzed by reviewing the medical records and neuroradiological findings. RESULTS: 68 patients presented with Hunt & Hess Grade I-II and one patient with Hunt & Hess Grade III. Median in-hospital stay was 8 days (3-22). In 2 patients mild vasospasm were diagnosed. DSA was performed in all patients at least once. DSA was repeated in 38 patients (55%) after a median of 7 (3-21) days. None of the repeated DSA did show any additional distinctive features with respect to the first DSA. CONCLUSIONS: In our opinion the procedure of repeating DSA in patients with pSAH is likely to become obsolete. One DSA should be performed prior to discharge--and subsequent to possible vasospasm--to exclude hemorrhage caused by aneurysms of the posterior circulation mimicking a perimesencephalic SAH pattern.

Angiography, Digital Subtraction↗
PubMed2002

[CT-guided sympathicolysis in peripheral artery disease - Indications, patient selection and long-term results].

PURPOSE: Assessment of long-term results of CT-guided lumbar sympathicolysis (LSL) in advanced peripheral arterial vascular disease (pavd). Establishment of a suitable patient selection. PATIENTS AND METHODS: LSL was performed in 138 cases with Fontaine stages III (13 %) and IV (87 %). 250 consecutive patients were examined with a radionuclide perfusion study of the feet prior to and during peridural anaesthesia (PDA) in order to select suitable patients for LSL. LSL was not performed in patients with impaired perfusion under PDA (n = 112). Early and long-term results after one to five years were evaluated. RESULTS: In 79 % an initial improvement was found after LSL. After more than one year success was established in 38 %. 49 % of the cases had a progression of the disease. This is significantly better compared to a control group with conservative treatment and an initial improvement of 36 %. After more than one year only12 % revealed an improvement. In 82 % the disease was progressive. Diabetics showed also a positive response to LSL. CONCLUSION: LSL has a positive influence on the course of pvad in patients selected by radionuclide perfusion studies. Diabetes and angiographic findings do not play any first role in patient selection for LSL.

Adult↗
PubMed2001

Regulation of matrix metalloproteinases and their inhibitors in uterine endometrial cells of patients with and without endometriosis.

OBJECTIVE: To determine whether alterations in the secretion and regulation of matrix metalloproteinases (MMPs) and their inhibitors are present in uterine endometrial cells from endometriosis patients. STUDY DESIGN: In an in vitro study, uterine endometrial cells from 19 regularly cycling women with and 32 without endometriosis were treated with diethyl stilbestrol, promegestone (R5020), interleukin-1 (IL-1) and tumor necrosis factor a (TNF-alpha). Culture supernatants were assayed for MMPs 1, 2, 3, and 9, and for tissue inhibitors of MMP (TIMP-1 and TIMP-2) by ELISA. RESULTS: MMP-3 was secreted in high concentrations, moderate concentrations were seen for MMP-1 and MMP-2, and very low concentrations for MMP-9. Substantially more TIMP-1 than TIMP-2 was secreted. MMP-1 and MMP-3 were uniformly attenuated by R5020, while MMP-2 was not influenced by hormone treatment. MMP-3 was upregulated by TNF-alpha in all samples while IL-1 only increased secretion in cells from endometriosis patients. CONCLUSION: The upregulation of MMP-3 by IL-1 may contribute to an increased invasiveness of uterine endometrial fragments in endometriosis patients.

Adult↗
PubMed2000

Adenosine-induced expression of interleukin-6 in astrocytes through protein kinase A and NF-IL-6.

In various neurologic diseases, astrocytes express interleukin-6 (IL-6), which is an endogenous pyrogen, a neuroprotective factor, and a regulator of the blood-brain barrier. The expression of IL-6 in astrocytes is stimulated by extracellular adenosine through A(2B) receptors. To investigate the signaling cascade that induces IL-6 gene transcription further, we transfected primary mouse astrocytes with a reporter gene construct, in which luciferase expression is directed by the human IL-6 promoter. Expression of PKI, an inhibitor of protein kinase A (PKA), interfered with IL-6 transcription indicating that PKA mediates the effect of adenosine. The CAAT box of the IL-6 promoter is necessary for the stimulation by adenosine as a mutation in this element reduced the stimulation by adenosine. Indeed, the cAMP agonist forskolin increased the binding of the transcription factors NF-IL-6 and C/EBPdelta to the CAAT box of the IL-6 promoter in nuclear extracts of astrocytes. Inhibition of the de novo synthesis of NF-IL-6 by cycloheximide or an antisense oligonucleotide reduced the enhancement of NF-IL-6 binding to the CAAT box and inhibited stimulation of IL-6 transcription by forskolin. In addition, overexpression of NF-IL-6 induced IL-6 transcription. This suggests that adenosine induces the de novo synthesis of NF-IL-6 through activation of PKA and thereby stimulates transcription of IL-6 in astrocytes.

Adenosine↗
PubMed1997

Stimulation of interleukin-6 secretion and gene transcription in primary astrocytes by adenosine.

During cerebral ischemia, the expression of interleukin-6 (IL-6), which has neuroprotective properties, increases. To understand the underlying mechanism, the regulation of IL-6 expression by neurotransmitters that accumulate during cerebral ischemia was investigated. Adenosine stimulated IL-6 secretion in primary astrocytes four- to 10-fold. The effect was concentration dependent, the EC50 being approximately 8 microM. Although the nonselective analogue 2-chloroadenosine (2CA) increased IL-6 secretion to a similar extent, the A1-selective agonist N6-cyclopentyladenosine or the A2a agonist CGS-21680 had only a marginal effect on IL-6 secretion. IL-6 secretion stimulated by 2CA (10 microM) was inhibited by the nonselective adenosine antagonist 8-(p-sulfophenyl)theophylline, whereas the A1-selective antagonist 8-cyclopentyl-1,3-dipropylxanthine or the A2a-selective antagonist 8-(3-chlorostyryl)caffeine had no effect, to a concentration of 0.1 microM. Transcription of the IL-6 gene was investigated by transfecting primary astrocytes with a reporter fusion gene containing the human IL-6 promoter (-179/+12). 2CA stimulated IL-6 gene transcription 2.5-fold. Mutations of the binding site for NF-kappaB or NF-IL6 abrogated the response to 2CA. Thus, an increase of extracellular adenosine during focal cerebral ischemia may stimulate IL-6 expression via A2b receptors. The induction of IL-6 expression appears to involve a transcriptional effect that depends on NF-kappaB and NF-IL6.

2-Chloroadenosine↗
PubMed1996

Gastrointestinal bleeding of obscure origin: role of enteroclysis.

The purpose of this work was to assess retrospectively the yield of enteroclysis in 124 unselected patients presenting with obscure gastrointestinal bleeding. Of 1000 consecutive patients who were examined by enteroclysis 124 presented with occult gastrointestinal bleeding. A total of 61 patients with an unknown source of bleeding at the time of discharge, but with established gastrointestinal bleeding, were followed up by questionnaire to correlate the initial degree of bleeding with the incidence of recurrence of bleeding. Enteroclysis was normal in 109 cases. An abnormality was found subsequently be the cause of bleeding in the small intestine in 16 patients. Enteroclysis was positive in 14 cases, negative in 2 and false positive in 1. There was positive correlation between the initial degree of haemorrhage and the rate of recurrence. Enteroclysis detected the cause in 11% of patients who presented with bleeding of unknown origin. In patients with minor haemorrhage there was no recurrence of bleeding in most cases.

Adolescent↗
PubMed1986

[Acute necrotizing pancreatitis. Synoptic observation of clinical and pathologic-anatomical findings].

In 95 patients with acute necrotising pancreatitis the clinical severity of the disease was compared with morphological criteria of operative specimens. In addition, various morphological phenomena, typical in acute and chronic pancreatitis, were investigated in 3 aetiologically different groups. In these groups pathohistologic alterations, associated with aetiological factors, were seen frequently. Furthermore, there was a good correlation between classifications according to gravity criteria in the assessment of the underlying disease. About 90% of cases clinically classified as acute pancreatitis proved, on the basis of the morphology, to be chronic recurrent pancreatitis. It thus follows that "genuine" acute pancreatitis is a rather rare syndrome.

Acute Disease↗
PubMed1984

[Bleeding into the intestinal wall during anticoagulant therapy. Diagnosis using sonography and computerized tomography].

As a complication of anticoagulant treatment, intramural intestinal bleeding occurred in two patients. The diagnosis was made by ultrasound. This showed an abnormally broad, echo-sparing circular structure as a sign of a thickened intestinal wall as well as an echo-rich centre, corresponding to the stenosed intestinal lumen. Since the halo (or target) sign is also seen in neoplasms, occlusion of the mesenteric arteries or inflammatory disease of the intestines, bleeding can be confirmed by measuring the density by computed tomography. Serial ultrasound examination can objectify the course and surgical intervention may be avoided.

Adult↗
PubMed1984

[Cholelithiasis and acute pancreatitis].

In acute biliary pancreatitis it is the acute inflammatory pancreatitis rather than the cholelithiasis which dominates. Among 2161 patients with cholelithiasis seen from 1972 to 1983, 21% were found to have choledochal stones at operation. A total of 121 patients (5.6%) had "associated pancreatitis" according to the history as well as clinical and intra-operative findings. Frequency and site of cholelithiasis, as well as treatment and its results were compared with those in a group of patients with "acute pancreatitis of biliary origin" (145 of 447 patients from 1972 to 1983). Choledocholithiasis occurred equally often in both groups (36-39%). Impacted papillary concrements were found in 2.9% of patients with acute biliary pancreatitis, in 7.4% of those with "associated pancreatitis". Early intervention is practised only in case of impacted papillary stones, preferably by endoscopic papillotomy. Otherwise the timing of any operative procedure will be determined entirely by the severity and course of the acute pancreatitis.

Acute Disease↗
PubMed1984

[Necrotizing inflammation of the vulva--a symptom of Richter intestinal wall hernia].

Parietal hernias, often also known as Littre's hernia and Richter's hernia, are a special kind of inguinal hernias. In this type of hernia, part of the abdominal (intestinal) wall is strangulated in "calotte form" in the hernial orifice; as a result, parietal hernias often cause only mild complaints and are surgically treated only in the late stage of enterocutaneous faecal fistula. In contrast to incarcerated inguinal hernias resulting in diffuse faecal peritonitis via infarction and necrosis, parietal hernia of the Richter type is locally restricted in extension because of the narrow hernial orifice, as far as the extension into the abdominal cavity is concerned; intestinal patency is usually maintained. The possibility of the existence of a perforated parietal hernia should always be considered in necrotising inflammations in the inguinal and vulvar regions, even if abdominal signs and symptoms are absent.

Female↗
PubMed1984

[Echinococcus cysticus of the pancreas in the clinical picture of acute pancreatitis].

A 30-year-old Italian male was admitted to the hospital showing all clinical signs of acute pancreatitis. With the help of computerized tomography, ultrasonic and angiographic methods multiple cysts in pancreatic body and tail as well as close to the hilus of the spleen could be shown. Positive serological tests made the diagnosis "echinococcus granulosus" likely. Resection of the left part of the pancreas as well as resection of the spleen eliminated the parasite. Histologically hydatid cyst was traceable in the pancreatic duct.

Acute Disease↗
PubMed1983

[Intraoperative ultrasound studies in pancreatic surgery].

In 32 patients with benign or malignant disease of the pancreas direct ultrasound imaging of the pancreas was performed during the operative procedure. Benign could be distinguished from malignant lesions on the basis of different ultrasound patterns, changes in the pancreatic duct and size of the organ. A further improvement in diagnostic accuracy was obtained by intraoperative staging with ultrasound-directed small-needle biopsy of that part of the pancreas which looked suspicious macroscopically and by ultrasound. Previously unknown tumour infiltration was also revealed by ultrasound imaging. Intraoperative ultrasound is a new helpful method for the surgeon. Since it is easy it should be used in all doubtful instances, even though the interpretation requires considerable experience.

Humans↗
PubMed1983

[Surgical treatment in acute pancreatitis. The change as influenced by sonography and computer tomography].

The diagnosis of acute pancreatitis is based on anamnestic, clinical and chemical data. Ultrasound and computed tomography permit direct visualisation of the pancreas and establish the diagnosis. In cases of haemorrhagic-necrotising pancreatitis they demonstrate the extent of morphological changes and permit exclusion of other causes of an acute abdomen. The imaging methods support indications for operation in cases of subtotal or total parenchymatous necrosis and in pancreatic abscesses. Conservative expectant approaches in patients with severe clinical course and slight morphological changes as well as in agreement of clinical and morphological findings are facilitated. Complete demonstration of parenchymatous and peripancreatic necroses furnishes useful additional information for total extirpation. Gallstone disease can be demonstrated or excluded preoperatively. Since introduction of ultrasound and computed tomography for the diagnosis of acute pancreatitis a marked diminution of early surgical intervention and delayed operation has been achieved.

Acute Disease↗
PubMed1983

[Relaparotomy, retrospective analysis and intensive care aspects].

A high mortality rate of the patients in the Surgical University Clinic Mainz in 2441 laparotomies from 1977 to 1979 with 92 relaparotomies in 66 patients (40% proving fatal) could be associated with the following factors: female sex, old age in males, malignant disease, esp. carcinoma of pancreas, colon and rectum, upper gastrointestinal bleeding, presence of concomitant affections, esp. three or more and particularly angiocardiopathy, liver diseases and after radiotherapy, long lasting primary operation, several operations in short intervals (about a week). Astonishingly we found a lower rate of mortality in cases of: Primary laparotomy in an emergency situation, postoperative complications within the first two days or after several weeks, multiple relaparotomies within intervals of at least two weeks. In cases of several severe postoperative complications, esp. renal insufficiency with dependence on dialysis and simultaneous respiratory insufficiency with dependence on artificial respiration a relaparotomy is indicated, if the intra-abdominal complication can be cured. In these cases the intensive care cannot cure the patient's conditions, but mechanical respiration and dialysis improve it. The existence of lethal trias of renal and respiratory insufficiency with a surely unremovable surgical problem forbids a relaparotomy.

Adolescent↗