Biomedical subjects
Publications and source records attributed to R Becker.
We report on prenatal diagnosis in a case of Klippel-Trenaunay syndrome with excessive tumour manifestations concerning thorax and upper extremities. The child was delivered at 37 weeks' gestation by cesarean section and, after several operations, is developing normally up to now.
This article is concerned with the increase of alkaline phosphatase of a 32-year old primipara, five to six times higher than the upper basal values, during the last trimenon of pregnancy. The physiological increase of serum total alkaline phosphatase levels during pregnancy were two to three times higher than the basal values (4, 11). Hepatopathies, osteopathies, endocrinological disorders, infections as well as other medical causes were excluded by anamnesis due to close-meshed laboratory chemical and clinical controls relating to differential diagnosis. Thus, only pregnancy could be considered as a trigger mechanism. Differentiating the alkaline phosphatase by laboratory chemical means in the course of this pregnancy, an isolated increase of the alkaline phosphatase placenta isoenzyme (PLAP) was seen. Besides premature labour pains, which led to the admission of the patient to the maternity ward, around a calculated 32nd week of pregnancy, a discreet foetal growth retardation was recognised, which continued to increase constantly up to a minus discrepancy of three weeks. The delivery of a dystrophic girl took place at the beginning of the 37th week of pregnancy. Post partum alkaline phosphatase levels normalised to basal values. The correlation: the increase in PLAP and intra-uterine foetal growth-retardation was evident in the case presented and was also discussed in connection with previous observations by other authors of similar studies.
In order to investigate the role of the microsomal epoxide hydrolase (mEH) in the detoxification of arene oxides in the presence of a high endogenous glutathione S-transferase (GST) activity-a situation found in several organs--we expressed the rat mEH cDNA in BHK21 Syrian hamster cells. These cells have high GST activities but contain an extremely low endogenous mEH enzyme activity. We obtained several cell clones which expressed the mEH heterologously, as determined by immunoblotting. The cell clone BHK21-mEH/Mz1 had the highest level of mEH protein. Immunofluorescence showed that the level of expression was almost homogeneous throughout the cell population. Total protein isolated from the cell line BHK21-mEH/Mz1 had a specific mEH activity of 123 pmol/min/mg protein, as determined with benzo[a]pyrene 4,5-oxide (B[a]P 4,5-oxide), which was 60 times higher than the activity in the parental cell line and eight times lower than the activity found in rat hepatocytes. However, BHK21-mEH/Mz1 cell homogenates were found to catalyze the conjugation of B[a]P 4,5-oxide to glutathione extremely well. The ratio of the GST enzyme activity to the mEH enzyme activity towards this substrate was 23 in the BHK21-mEH/Mz1 cell line. For hepatocytes this ratio was only six. Despite their already high potential to inactivate B[a]P 4,5-oxide by conjugation to glutathione, BHK21-mEH/Mz1 cells were better protected against the toxic and mutagenic effects of B[a]P 4,5-oxide than the parental cell line due to the expression of the mEH. The mEH, however, failed to protect the cells from the toxic and mutagenic effects of the bay region epoxide anti-7-methylbenz[a]anthracene-3,4-diol 1,2-oxide.
The aim of parenteral nutrition in tumour patients is to offer an alternative nutritional support to the patient without accelerating the growth of the tumour. For this purpose we fed a total of 100 rats, divided into five groups of 20 animals each (10 with and 10 without tumours), for a total period of 15 days with various nutritional regimes. Group 1 received glucose, group 2 long-chain triglycerides, group 3 medium-chain triglycerides (MCT), group 4 omega-3 fatty acids, and group 5 an oral diet. On the 10th day the Yoshida sarcoma in its ascites form was implanted into the tumour-bearing rats. In animals receiving MCT or omega-3 fatty acids tumour growth was considerably smaller than in the other groups (group 1 vs. groups 3 and 4; p < 0.05). Unfavourable effects of the administration of these fatty acids on the general condition of the animals were not observed [muscle nitrogen content (mg/kg body weight): MCT = 82.3, omega-3 fatty acids = 65.25]. The impulse cytophotometric measurements did not demonstrate any influence on the pattern of cell division (p > 0.05). We think that modulation of the immune system by feeding with MCT or omega-3 fatty acids was responsible for the reduced tumour growth in relation to the other groups. The extrapolation of these results to the clinical situation, however, may not be possible.
Evaluation of the spoken and written language skills of prelingually deaf pupils is necessary to improve existing language curricula. Research on written language shows notable delays and substantial differences in the development of written language in comparison to hearing peers. It is difficult to investigate the spontaneous speech because of methodological problems (no control of speech parameters, language becomes a confounding variable). The written language is therefore a good indicator of language development. Nevertheless, oral communication ability can only be studied through spoken utterances. The present study deals with oral and writing performance of 23 prelingually deaf pupils from 9 to 15 years of age whose hearing losses range from 85 to 117 dB. Tape-recorded short picture sequences described by the children and adolescents were examined by experienced listeners. Furthermore, the written narratives of these picture sequences were also analyzed. Parameters included frequency of occurrence of content and function words, type-token ratio, mean length of sentence, and speech fluency. Speech intelligibility was rated by a panel of naive listeners. The results demonstrate the enormous retardation of oral and written language development and specific qualitative differences compared to hearing children. Language skills improve with age, especially in writing. However, oral and written narrative abilities are positively correlated. The loss of sound requires substitutional media for the acquisition of a formal language system. This should be taken into account in the teaching of language to the deaf in order to build up a language competence which is adequate for their age.
This study had two primary aims: (1) to determine the usefulness of a telephone-administered health status questionnaire as an epidemiological survey instrument in groups at high risk for morbidity and disability; and (2) to evaluate the value of a telephone interview for making judgments about individual patient management. A structured telephone interview was compared with a face-to-face interview in 366 individuals with a stroke or an orthopedic condition up to 5 years after discharge from a rehabilitation hospital. Standardized assessments including the Barthel Index, the Zung Scale, the Reintegration to Normal Living (RNL) Index, and the Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ), along with questions on health, medication use, and health events were administered using both modes. Comparability between the modes was also assessed according to the type of respondent, self, or proxy. On the Barthel Index, the Zung Scale, the RNL Index, and the SPMSQ the percentage of patients indicated as having no disability was similar between the modes. Proxies' responses were, in general, as consistent between the modes as patients' responses. The reliability coefficients indicated moderate to substantial agreement between the modes on the majority of indices and health-related questions. Discord between modes, when present, was greatest for individuals with moderate and severe disability, with less frequent reporting of disability on the telephone. This study supports the use of telephone interviews in determining the prevalence of disability in the community and supports the use of the telephone interview in the case finding process.
A patient with obstructive sleep-apnea-syndrome and congenital temporal and cervical hemangiomas developed severe headache under nasal BiPAP ventilation. Internal hydrocephalus was diagnosed by CCT and MRI and rise of intracranial pressure (ICP) under artificial ventilation was supposed. Polysomnography, ICP-measurement with a ventricular catheter and resistance to outflow-measurement were used to clarify differential diagnosis. During periods of apnea ICP was raised severely with a maximum in REM-sleep. With nasal ventilation no apnea was observed and ICP was normalized. Resistance to outflow was normal. A disturbance of CSF-dynamics or CSF-absorption leading to the patient's headache could be excluded. Duplex-sonography and cerebral angiography did not provide further information. After exclusion of other causes artificial respiration dependent swelling of the subcutaneous temporal and cervical hemangiomas was the most likely cause triggering the headache. A sufficient therapy however was not yet available. Probably the patient suffers from an abortive form of a Sturge-Weber-Krabbe-Dimitri-Syndrome.
Migration disorders of foetal neurons are rare conditions which are normally diagnosed after birth and may be followed by severe alterations of neurological development. We describe a case of foetal hemilateral polymicrogyria in combination with hemihypoplasia of the brain, the symptoms of which were diagnosed in the 23rd week of pregnancy, leading to termination of pregnancy. To the best of our knowledge, this is the first case report of antenatal diagnosis of this disorder by vaginal sonography.
A case of foetal non-immune hydrops fetalis is presented. A second gravida was referred to our department at 31 weeks' gestation after normal pregnancy course. Sonography revealed marked foetal ascites as well as a polyhydramnion. Prenatal examinations did not yield a safe diagnosis. The foetal ascites was punctured via a pigtail-catheter that was left in the foetal abdomen. This procedure was supposed to facilitate the development of foetal lungs. At 33 weeks' gestation, after spontaneous rupture of membranes, a boy was spontaneously delivered. Postpartal radiography pointed to bowel perforation. Surgery on the first day of life showed a severe meconium peritonitis following a perforation of the ileum. 22 months after this operation, the boy is physically and mentally well developed. Until now, there is no sign of mucoviscidosis. We believe that early diagnosis, the possibility of prenatal therapy and the close collaboration of disciplines made the survival of this child possible.
Australia has a long legacy of providing asylum to refugees who, it is now well established, suffer high rates of psychological and psychiatric problems requiring specialised treatment. In this paper we outline the special stressors faced by asylum-seekers who have not obtained formal refugee status and who are at risk of being forcibly repatriated. We suggest that the experiences they undergo in Australia, particularly that of prolonged detention, risk retraumatising an already vulnerable group. The implications for policy formulation are considered.
A case of occipital encephalocele combined with right-sided pulmonary agenesis in one sibling of a twin gestation is presented. Both, encephalocele and lung aplasia, are rare conditions, the former occurring with a frequency of 1:3000-1:30,000, the latter in 1:10,000-1:30,000. Although both conditions may show concomitant malformations, to our knowledge this is the first case of a combination of these two malformations to be reported.
A total of 219 women with complicated pregnancies had Doppler assessment of uteroplacental arteries, the umbilical artery, the fetal common carotid artery and the descending thoracic aorta to determine the prognostic value of Doppler examinations to predict the birth of a small-for-gestational-age (SGA) infant with or without fetal distress. Preliminary reproducibility studies showed that the resistance index, pulsatility index and intensity weighted flow velocity had the lowest coefficients of variation. Data on the systolic/diastolic ratio and mean blood flow volume were, therefore, not considered for further evaluation. Measurements were classified according to the time interval of the examination to the delivery of the baby according to the following groupings: 0-14 days, 15-28 days and 29-42 days. For evaluation of the SGA fetus complicated by fetal distress, only measurements within 2 weeks of delivery were analyzed. Significant differences were calculated by considering the area below the receiver operator characteristic (ROC) curves. Only Doppler studies of the uteroplacental arteries (mainly resistance index) were predictive of the later development of the SGA fetus. All fetal parameters showed an increasing improvement in the predictive capacity for an SGA infant, the closer the measurements were made to the time of delivery. This improvement was not observed for uteroplacental vessels. The resistance index of the uteroplacental vessels was significantly higher in SGA pregnancies complicated by fetal distress compared to SGA pregnancies alone. However, ROC analysis revealed that fetal Doppler velocimetry was more strongly related to fetal distress than SGA only. The single best fetal parameter was the mean velocity in the fetal descending thoracic aorta but the velocity ratio of the fetal common carotid artery over the fetal descending thoracic aorta had the highest predictive capacity for the SGA pregnancy complicated by fetal distress.
A series of benzobisthiazoles were screened for antiinflammatory activity in the carrageenan paw edema and adjuvant arthritis tests. Compound 26, 2,6-bis(N,N-diethylamino)benzo[1,2-d:5,4-d']bisthiazole, was found to inhibit the swelling of the uninjected paw in the prophylactic adjuvant arthritis model with an ED50 of 2.3 mg/kg orally. As with most compounds of this series, 26 was inactive in acute model of inflammation, such as paw edema; like steroids, it showed activity in the granuloma pouch assay but did not inhibit cyclooxygenase, indicating a mode of action different from the classical nonsteroidal antiinflammatory drugs (NSAID's). At doses higher than those producing antiinflammatory activity, 26 had some immunoregulating properties.
Most elderly persons with dementia are cared for at home, usually by the spouse or an adult child. The objective of the present study was to determine whether there is an excess of psychological and physical health problems among family caregivers (CGs) of elderly persons with dementia. Data were obtained by interview from close family members of dementia patients (CGs), and from a comparison group made up of close family members of patients undergoing cataract surgery (non-caregivers, NCGs). CGs had significantly higher levels of depression and physical symptoms than NCGs. The association between caregiving and the health variables was stronger among subjects who were the patient's spouse than among those who were the patient's child. Furthermore, greater behavioral disturbance in the demented patient was associated with higher levels of morbidity in the CG. The results suggest that CGs might benefit from careful monitoring of their health status, and from greater access to specialized support services.
From 1.1.1990 to 15.3.1991, in 1074 women between the 13th and 40th weeks of pregnancy, the biparietal diameter (BIP), fronto-occipital diameter (FOD) and kephalic index (KI = BIP/FOD) were measured. The median of the kephalic index varied between 0.81 and 0.84 during different pregnancy weeks, with a range between 0.67 and 1.00. Correction to normokephaly (KI = 0.84) produced differences of up to 10 mm to measured values of BIP. We believe it necessary to determine the kephalic index in each kephalometry and to correct the measured value of BIP at least in those cases where the measured kephalic index differs significantly from normokephaly (KI = 0.84).
During an altitude training camp (23 days, 1850 m above sea level) we collected night urine from 36 German elite rowers in order to measure the excretion of urea, creatinine, 17-ketosteroids (17-KS), and 17-hydroxycorticosteroids (17-OHCS). 17-KS and 17-OHCS represent the major metabolites from endogenous anabolic and catabolic steroid hormone systems. There was no significant change in the excretion of 17-OHCS during the training camp (mean value: females 0.0025 +/- 0.0011, males 0.0033 +/- 0.0012 mg/kgbw.h). Significant increases in the excretion of 17-KS (mean value: females 0.007 +/- 0.003, males 0.0092 +/- 0.0039 mg/kgbw.h) and in the ratio 17-KS/17-OHCS (mean value: females 3.13 +/- 1.65, males 3.11 +/- 1.71) were found during the first week and towards the end of the training camp. To investigate training effects on the excretion of these hormone metabolites, we used a recently described classification for rowing training (categories I to IV of rowing-specific training according to lactate levels and non-rowing specific categories) and a corresponding rowing data base. More than 80% of training was performed at a lactate level lower than 2 mmol/l. Using multiple regression analysis, the general finding was that in males the ratio of 17-KS/17-OHCS increased with rowing specific and non specific training regimes where a lactate level below 2 mmol/l was observed. Training at higher lactate levels caused a decrease in the ratio that may be interpreted as a shift in the production from endogenous androgenic steroid hormones to cortisol. No significant effects of single training variables were found in female rowers, which indicates major training influences on testosterone metabolism. The influence of further factors such as a relationship between urine urea and 17-KS in males are described and need further explanation.
43 patients suspected clinically of having tumours of the adnexa were examined by MR and 40 by endosonography in a prospective study. All underwent surgery. Correct lateralisation of the tumour was achieved by MR in 39 out of 43 cases (91%) and by endosonography in 32 out of 40 cases (80%). By means of MR it was possible to recognise the affected organ in 79%, and by vaginal sonography in 70% of women. Prediction of malignancy was possible with MR in 39 out of 43 cases (91%) and by endosonography in 30 out of 40 cases (75%). Infiltration into the omentum and gut and peritoneal metastases was missed by both methods (4 out of 4 cases).