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Biomedical subjects

R Heitmann

Publications and source records attributed to R Heitmann.

At least 19 recordsLinked to original sources
PubMed2004

Escalating immunotherapy of multiple sclerosis--new aspects and practical application.

Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies. Initiation of treatment after the first relapse may be indicated if there is clear evidence on MRI for subclinical dissemination of disease. Recent trials show that the efficacy of interferon beta treatment is more likely if patients in the secondary progressive phase of the disease still have superimposed bouts or other indicators of inflammatory disease activity than without having them. There are now data available, which suggest a possible dose-effect relation for recombinant beta-interferons. These studies have to be interpreted with caution, as some potentially important issues in the design of these studies (e. g. maintenance of blinding in the clinical part of the study) were not adequately addressed. A meta-analysis of selected interferon trials has been published challenging the value of recombinant IFN beta in MS. The pitfalls of that report are discussed in the present review as are other issues relevant to treatment including the new definition of MS, the problem of treatment failure and the impact of cost-effectiveness analyses. The MSTCG panel recommends that the new diagnostic criteria proposed by McDonald et al. should be applied if immunoprophylactic treatment is being considered. The use of standardized clinical documentation is now generally proposed to facilitate the systematic evaluation of individual patients over time and to allow retrospective evaluations in different patient cohorts. This in turn may help in formulating recommendations for the application of innovative products to patients and to health care providers. Moreover, in long-term treated patients, secondary treatment failure should be identified by pre-planned follow-up examinations, and other treatment options should then be considered.

Clinical Trials as Topic↗
PubMed1996

Lung function testing: the dilemma of predicted values in relation to the individual variability.

Quantitated lung function parameters are usually interpreted in relation to so-called "normal ranges' obtained from healthy study groups. The aim of this paper is the critical review of formulas and the evaluation of intraindividual variation in modern lung function testing. To which extent is the total variation of lung function parameters in cross-sectional studies (usually serving as basis for the normal range) attributed to the intraindividual variation between repeated measurements? This question raises a further question: are lung function values in the normal range really normal? To assess spirometric and body plethysmographic parameters 26 healthy subjects from three medical centers underwent 30-72 measurements over a period of 2 months for the determination of variations due to (1) intraindividual variation over time and (2) interindividual variation. For each subject, predicted values of different lung function parameters published by Quanjer et al. [Eur Respir J 1993; 6:5-40.1], of intrathoracic gas volume by Ulmer et al. [Die Lungenfunktion; Stuttgart, Thieme, 1991] and of total airway resistance by Ruehle and Matthys [Pneumologie 1976;153:223] were applied. When converted into percent predicted and adjusted for differences in medical centers, the intraindividual standard deviation was estimated to be about half of the interindividual standard deviation. We conclude that the normal range of lung function parameters derived from the standard deviation within populations is too wide for the assessment of individual values. Interpretation of individual lung function measurements should primarily be based on the "individual normal range' derived from former lung function measurements of the individual and only secondly on the "predicted value'.

Adult↗
PubMed1995

[Isolated echinococcosis of the lung].

This is a report of a 81 year old women with a cyst of echinococcus granulosus, that was almost completely taking over the lower lobe of the left lung. This case study shows on one hand the diagnosis of echinococcosis is a part of the differential diagnosis even for an elderly patient. On the other hand we were able to demonstrate, that elderly patients can benefit from the surgical treatment especially since medication has a lot of side effects and a fairly high rate of failures.

Aged↗
PubMed1994

[Psychosomatic aspects of focal dystonia: two case reports].

Dystonic movements and other dyskinesias often cause diagnostic difficulties due to their complex symptomatology. Namely focal dystonias are frequently misdiagnosed as conversion reactions. Idiopathic dystonias are generally considered a nonstructural (neurobiochemical) disorder of the basal ganglia. Many case reports, however, have dealt with patients presenting with "atypical" dystonia whose symptoms were relieved by psychotherapy or hypnosis. We present the histories of two young women exhibiting focal dystonia emerging for the first time under circumstances of profound emotional trouble. We discuss the general difficulties in the diagnosis of dystonic movement disorders and review the criteria for the diagnosis of "psychogenic dystonia". The basal ganglia integrate limbic, proprioceptive and sensorimotor inputs to create emotionally and functionally appropriate voluntary movements. Therefore, the traditional dichotomy "psychogenic-somatogenic" appears to be inappropriate when applied to extrapyramidal movement disorders. In a psychosomatic understanding, the assumption of a psychogenic "trigger" for a somatic movement disorder does not mean a contradiction.

Adolescent↗
PubMed1993

[Experiences with high dosage immunoglobulin G in neuromuscular diseases].

High-dose intravenous immunoglobulin G (IVIG) was used as alternative treatment in 39 patients with crisis in myasthenia gravis (MG), acute polyneuritis (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP). Of 10 patients with MG, 3 recovered completely, 5 patients improved except for long-standing ocular signs, 1 patient was weaned from artificial ventilation, and one patient did not improve after IVIG, but did so after plasma exchange. 25 GBS patients were treated with IVIG, progression of weakness was stopped in 24; 12 showed complete or near complete recovery and 6 improved markedly. Of 4 patients with CIDP, 2 responded definitely. The majority of patients with MG, GBS, CIDP, respond to IVIG treatment. The effect seems to be equivalent to plasma exchange. In GBS, IVIG may be superior. Side effects of IVIG are negligible, and there is no risk of transmission of AIDS-, hepatitis-, or other viruses.

Adult↗
PubMed1989

The complete apallic syndrome--a case report.

In six patients with apallic syndrome the EEG was isoelectric, although the patients were breathing spontaneously and vegetative functions remained stable for a long period of time. No cortical somatosensory evoked potentials could be recorded in four of the patients examined. Cranial CT performed in three patients revealed extensive hypodensity of the cortex, whereas the brain stem showed no major damage. This syndrome is labelled a "complete apallic syndrome". None of our patients, and none of the 23 patients described in the literature, recovered.

Adult↗
PubMed1984

[Limitations of neurologic intensive care].

The indication for intensive care in incurable neurological diseases is discussed. An attempt is made to analyse the problem by presenting two cases of multiple sclerosis and two other cases of amyotrophic lateral sclerosis. There is a clear indication for intensive-care treatment in all cases with life-threatening symptoms and complications, provided there seems to be a chance of reversibility in spite of an eventually poor prognosis. If there is no chance of improvement, and the illness has reached its terminal stage, we do not think, that intensive care is of any benefit for the patient. However, we are not able to make a decision should he insist on such a treatment. When the patient is doomed to die in any case, there is no obligation to inform him about a life-prolonging treatment which is not indicated.

Adult↗
PubMed1978

[Toxic rhabdomyolysis after alcohol and drug intoxications (author's transl)].

The clinical picture of toxic rhabdomyolysis after alcohol and drug intoxications is characterized by severe pain, swelling, and inability to move the affected muscle group. The disintegration of necrotic muscle tissue leads to hyperkalaemia, excessive increase of creatine kinase in serum, and a myorenal syndrome with anuria. Pathogenetically the combined effects of toxic vascular damage and local pressure and cold influence are assumed to occur. In anuria, resistant to conventional medication, early and repeated plasma exchanges are considered to be a therapeutic alternative to haemodialysis.

Adult↗