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Biomedical subjects

R Manz

Publications and source records attributed to R Manz.

At least 19 recordsLinked to original sources
PubMed1998

Analysis and sorting of T cells according to cytokine expression.

Functional distinct populations of T helper cells can be defined according to the expression of cytokines. A remarkable diversity of cytokine expression has been demonstrated in single T cells even from clonal populations and up to now no stable surface markers have been described which on the single-cell level directly correlate with the secretion of a certain cytokine. Since cytokines are the major parameters of T cell effector function we have developed strategies which now allow to separate cells according to the specific cytokines they secrete. The "affinity matrix technology"--secreted molecules are relocated to the cell surface by an artificially created antibody matrix--allows to isolate cells according to a distinct secreted product. In addition to this universal, but laborious technology, we could demonstrate by high-sensitivity immunofluorescence that IFN-gamma and IL-10 but not IL-2 and IL-4 are specifically expressed in low copy number on the surface of cells secreting these cytokines. Surface IFN-gamma and IL-10 are the first unambiguous surface markers for pro-inflammatory IFN-gamma-secreting Th 0/1 cells and IL-10-producing anti-inflammatory Th2/3 cells. We have used purified cytokine-secreting T cells to study in individual T cells the sequential production of IL-2, IFN-gamma, and IL-10, the stability of IFN-gamma expression and the selective homing of IFN-gamma-producing cells into inflamed tissues.

Animals↗
PubMed1997

[Body image disturbances in patients with anorexia nervosa 12 years after clinical consultation].

Of 103 patients with anorexia nervosa, 50 women and 5 men were followed-up on the average 11.8 year after clinical presentation with a differentiated method for body awareness according to Askevold. A considerable number of women with body image disturbances, however, largely corresponded to those of a healthy female control group. Both the male anorexia nervosa patients and the healthy male controls had normal findings. Applying to touch-induced stimulus, the body assessment indices only increased in former male anorexia patients but remained the same in female anorexia patients, while they clearly normalized in the sense of a realistic assessment in the two healthy control groups. Surprisingly, there was only little correlation between the visually measured body perception disorder and the self (EDI) and expert assessment (Sianex) at the time of follow-up (exception: the EDI scale 3 [dissatisfaction with one's own body). The global expert rating of body image disturbances at clinical presentation was important as a predictor for the severity of anorexia nervosa after 12 years. The findings were discussed under methodological and clinical aspects.

Adult↗
PubMed1997

[Confounding effects in social science studies and their control. The examples of personality, social support, psychiatric disease].

Social scientific investigations on coping with illness, on the relevance of life events or social support for psychic disorders are concerned with a variety of constructs with interdependent structures. Hypotheses in interrelationships are set up and tested on the construct level. A problem quite often overlooked here is that almost all constructs overlap to a considerable extent both with regard to their content as well as operationally, i.e. they are confounded. Interrelations of constructs which are strongly content-related or operationally confounded are thus in danger of demonstrating artificial results. Data from an extensive epidemiological research project on the incidence and prevalence of psychic disorders in the general population are used applying structural equation models for latent variables to demonstrate confoundation effects for the constructs personality, social support and state of health. Appropriate control methods are described. The results show that partner support maintains a strong influence on the psychic and physical state of health even confoundation of content has been excluded. Application of this method of content confoundation control is discussed with regard to research on coping life event research etc.

Adaptation, Psychological↗
PubMed1996

Pneumococcal cell wall components induce nitric oxide synthase and TNF-alpha in astroglial-enriched cultures.

Astroglia and microglia, the most numerous cells in the central nervous system (CNS), have been shown to produce the inducible nitric oxide synthase (iNOS) and tumor necrosis factor-alpha (TNF-alpha) upon stimulation with the cytokines IFN-gamma, IL-1-beta, or bacterial lipopolysaccharides (LPS). However, it is not known whether gram-positive bacteria like Streptococcus pneumoniae cause astroglial cells to release nitric oxide (NO) and TNF-alpha. S. pneumoniae meningitis still has a high incidence and mortality in spite of antibiotic therapy. Cell wall components from S. pneumoniae (pneumococcal cell-wall components, PCW) and TNF-alpha have been shown to cause meningeal inflammation and cerebrovascular changes in experimental meningitis. Addition of PCW to cultured rat astroglial cells increased nitrite in the supernatant significantly after 24 h, from 17 +/- 21 to 133 +/- 62 nM/micrograms protein. Nitrite release was dose-dependent in a range shown to cause meningeal inflammation in vivo and was inhibited by the competitive NO synthase inhibitor NW-nitro-L-arginine (L-NA 10(-4 M)) and dexamethasone (10(-6 M)), with transcriptional and translational inhibition by actinomycin D and cycloheximide, respectively. PCW caused a significant increase in the release of TNF-alpha from astroglial cells after 4 h, from 2 +/- 3.5 pg/ml to 102 +/- 13.5 pg/ml, which was inhibited by dexamethasone (10(-6 M)). Our results suggest a role for astroglial-derived NO and TNF-alpha as mediators of vascular and inflammatory response in the early phase of experimental pneumococcal meningitis.

Animals↗
PubMed1995

Analysis and sorting of live cells according to secreted molecules, relocated to a cell-surface affinity matrix.

We have developed a technology for analysis and sorting of live cells according to secreted molecules. An artificial affinity matrix, specific for the secreted product of interest, is created on the cell surface, and the cells are allowed to secrete for a defined time period. The secreted molecules bind to the affinity matrix on the secreting cell and are subsequently labeled with specific fluorescent or magnetic staining reagents for cytometric analysis and cell sorting. Crossfeeding of the secreted products to other cells is prevented by decreasing the permeability of the incubation medium. This approach will have a wide range of applications in biotechnology and biomedical research. Here, we describe analysis and sorting of hybridoma cells, according to secreted antibodies, and of activated T lymphocytes, according to secreted cytokines.

Animals↗
PubMed1995

[Postoperative pulmonary function after lung surgery. Total intravenous anesthesia with propofol in comparison to balanced anesthesia with isoflurane].

After lung resection, early extubation and the rapid return of the patients ability to cooperate is the predominant goal. Propofol anaesthesia is characterised by rapid awakening and recovery of cognitive and psychomotor functions and is consequently desirable for such operations. Experience so far in lung surgery, however, is limited. Besides the level of consciousness we investigated various spirometric parameters after lung resection. Total intravenous anaesthesia was performed with propofol, while balanced anaesthesia was performed with isoflurane. METHODS. A total of 93 patients evaluated electively for wedge excision or lobectomy were enrolled in an open, prospective, randomised, interindividual comparative study. Sixty-three patients could be evaluated with complete data sets. In the evening and the morning before the operation the patients were premedicated orally with clorazepate 0.5-0.7 mg/kg. Anaesthesia was induced in group 1 with propofol (1.0-2.5 mg/kg) and maintained with propofol (4-12 mg/kg) in 50% O2/air. The patients in group 2 received methohexital (1-2 mg/kg) for induction and isoflurane (0.4-2.0 vol%) in 50% O2/air for the maintenance of general anaesthesia. In both groups analgesia was achieved by using fentanyl (up to 10 micrograms/kg) and muscle relaxation by using atracurium. Psychomotor tests (minimal mental state, reaction time) were performed the day before the operation (t1), immediately prior to induction of anaesthesia (t2) and 5 min, 30 min, 60 min, 90 min, 24 h, and 7 days after extubation (t3-t8). Spirometry (forced expiratory volume in 1 s, FEV1; forced vital capacity, FVC; peak expiratory flow, PEF) was carried out at times t1, t2 and t5-t8. RESULTS. The two groups were comparable regarding preoperative status (age, sex, preoperative risk score, psychomotor tests, and spirometric values) and the operation performed (wedge excision/lobectomy, duration of anaesthesia). The extubation time was slightly shorter in the propofol group (18 +/- 8 min) than in the isoflurane group (20 +/- 6 min). Also, the results of the psychomotor tests were somewhat better in the propofol group than those in the isoflurane group. The clearest differences were found in the early postoperative period, but not all differences were significant. Statistically highly significant differences between the two groups were found for the three spirometric parameters. Based on the FEV1 value of the 7th postoperative day, FEV1 taken 60 min after extubation declined by 27.9% in the propofol group vs. 51.7% in the isoflurane group (P = 0.01). At 90 min after extubation the corresponding decline in the propofol group was 26.6%, in the isoflurane group 51.1% (P = 0.003). In addition, the decline of FVC and PEF measured 60 min and 90 min after extubation was significantly smaller in the propofol group than in the isoflurane group. CONCLUSION. The postoperative impairment of lung function after lung resection under propofol anaesthesia is statistically significantly smaller than under isoflurane anaesthesia. Total intravenous anaesthesia with propofol is particularly suitable for this kind of operation.

Adult↗
PubMed1995

[The course of immunologic parameters in inpatient psychotherapy exemplified by 2 single case studies].

Psycho-neuroimmunology depicts a conceptual frame in which possible interactions between psychic and physical processes can be examined. It could be very significant in the field of psychosomatics when the courses of psychic and somatic processes are examined. However, the research results from this field of study are varied and only for a few parameters of immunity is it possible to prove correlations with psychic variables. Many of the studies that have been conducted up to date were construed as cross-section studies and possibly therefore are not very suitable for depicting the probably very complicated forms of interactions between psychic and somatic levels in an adequate manner. In the framework of stationary psychosomatic psychotherapy two single case studies were carried out in order to examine temporal connections between psychic and immunological course parameters. Both single case studies are to be viewed as explorative attempts of examining questions of examination design and organization which are highly resolved regarding time. Furthermore we report several interesting individual results which emphasize in general the correlation between psychic and somatic parameters also in the course of time. However the limits of such studies regarding the significance of the individual immunological parameters, using time serial analytical methods as well as constructing models in the field of psycho-neuroimmunology are discussed.

Adult↗
PubMed1995

[What modifies the course of Crohn disease?].

This paper presents empirical results concerning the interdependency of somatic and psychological factors in the course of Crohn's disease. Data derived from the Heidelberg psychosomatic study on Crohn's disease are explored with the help of canonical correlation analysis. Somatic data recorded in the acute stage of Crohn's disease were not empirically found to be predictive of the psychological status after convalescence empirically. On the other hand, we did find psychological data that allowed prediction of the somatic status when the patients were in remission. Of these psychological data, coping resources are the most important predictors of the course of the disease. In particular, depressive forms of coping are correlated with personality factors, whereas active coping forms are not. The results have implications for scientific theory as well as for clinical practice.

Adaptation, Psychological↗
PubMed1995

[Methodological and statistical aspects of therapy evaluation exemplified by the Berlin psychotherapy study].

The answer to the question concerning the efficacy of psychotherapy is increasingly sought metaanalytically. For this purpose almost exclusively investigations are taken into consideration which have at least one control group. Using realistic data, the present paper refers to some basic considerations for the investigation and evaluation of therapeutic changes, which are however not always satisfyingly solved in metaanalytical studies. Investigations, therefore, especially of naturalistic samples, such as may be found in the context of outpatient or inpatient routine care, have a high clinical relevance for the evaluation of therapeutic changes even if they do not satisfy experimental requirements/standards. However, they do supplement experimental studies where the important aspect of external validity is concerned.

Germany↗
PubMed1994

[Do patients with anorexia nervosa return to psychological health? results of a 12-year follow-up of 103 patients].

In a long-term follow-up study over 12.7% (range 9-19) years, 16 of 103 patients with anorexia nervosa died. 92% of the survivors were followed up personally, 7% only indirectly. The paper presents the psychological changes assessed by means of the Anorexia Nervosa Symptom Score in the course of the disorder. At the time of catamnesis, the psychic condition of the patients was furthermore evaluated in more detail by procedures of independent assessment (DSM III-R, Impairment-Score (IS), Confidant Rating) as well as by using different instruments of self-assessment (Eating Attitude Test, Eating Disorder Inventory, Social Network Questionnaire). In a case conference taking into account all relevant findings, 40.1% of the patients were found to be healthy, 30.4% were considered to still show severe psychic disorders, and 29.4% were rated as desolate. These results suggest that part of the patients become psychicalls healthy again. Altogether, however, the long-term prognosis of anorexia has to be regarded as rather poor.

Adaptation, Psychological↗
PubMed1994

[Results of psychoanalytic therapy].

Within a naturalistic design 44 psychoanalytic treated patients are examined with regard to qualitative and quantitative outcome. The results are compared to 56 dynamic and 164 inpatient therapies. A comparison of symptoms, diagnoses and motivation before therapy leads to the conclusion that there are very different patient groups treated within this different settings. Therefore randomization seems to be an inadequate strategy to compare groups in different therapeutic settings. Using different criteria of outcome it can be demonstrated that psychoanalytic treated patients improve very well and to a larger extent than psychodynamically treated patients or inpatients. Different criteria of outcome and different observing perspectives (patient/therapist) lead to interesting results. Patients report primarily improvements in somatic, anxiety and depressive complaints. Therapists moreover report substantial improvements in interactional symptoms and behaviour. The different results in using several criteria are presented and discussed with regard to the methodology of outcome measurement. Finally recommendations for further studies in the psychoanalytic context are presented.

Ambulatory Care↗
PubMed1993

[The prognostic significance of the therapeutic working alliance from the perspective of the patient and therapist].

In general, the prognostic relevance of a working alliance for both the course and the outcome of psychotherapy is no longer a matter of dispute. Since a working alliance is conceived as an interactional variable, the results must be interpreted on the basis of several important dimensions: the perspective of the investigator and the time structure during the course of therapy. Using the data available from the Berlin Psychotherapy Study (Rudolf 1991), we investigated for the 238 patients (inpatients and outpatients who received psychoanalytically oriented therapy in the study) the prognostic relevance of diagnostic and therapy-related working alliance variables for the various outcomes investigated. A complex correlation-statistical method (latent-trait-model) was used to consider the investigator perspective with regard to the working alliance and the outcome as well as the time structure and the diagnostic variables. Our results emphasize the relevance of the therapist's perspective beginning with the diagnostic indication, the working alliance and finally the outcome. The patient's perspective, however, seems to be less relevant. The results are presented and discussed in relation to the relevant literature. One result we have found as a further important dimension is that the kind of therapy carried out must be taken into consideration. This implies that as in our study for all phases of the investigation therapy specific instruments must be applied. In this regard our results also contribute to the validation of the instrument used to measure the working alliance TAB.

Adult↗
PubMed1993

[KOPS: a self-rating instrument for assessment of physical, psychological and social communication impairments].

In this article the development of a self-rating symptom questionnaire is described. The questionnaire records physical, psychological and social-interactionary impairments typical for neurotic and psychosomatic disorders. Contrary to most of the established self-assessment instruments the KOPS-questionnaire consequently records symptoms from these three areas. The questionnaire contains 64 items scaled on four steps and can be filled out by the test person in a short period of time. The results depicted here from different sample groups which were examined verify the differential and criterion related validity and furthermore an explorative factor analysis also verifies the content validity. The instrument is suited for screening purposes as well as for clinical course studies of psychological disorders. The problems of the assessor perspective (by an expert or by a patient) in recording symptoms is discussed.

Adult↗
PubMed1991

[Social support and its relation to physical and emotional findings in Crohn's disease patients].

It was the aim of the present study to identify correlations between social, psychological and physical findings in 57 unselected patients with Crohn's disease from a gastroenterological outpatient department. Social support was registered using the confidant rating and the social network using a network questionnaire. Additional internal-medical and psychodiagnostic test instruments were used for a specific description of the sample. Anxieties, depressive moods and emotional lability were significantly less pronounced in patients with a confidant than in those without or with a less supportive partner. And the former also seemed to be more able to adequately cope with the disease than the patients of the other groups. With respect to the physical findings, the differences between the groups were less pronounced: Nevertheless, patients who were supported by a partner tended to show lower activity levels for Crohn's disease (Best index) than the others. The results obtained by the network questionnaire were less specific but altogether confirmed the results of the confidant rating. The study confirms the results of comparable investigations done in other clinical patient groups. The construct of social support is discussed critically with respect to psychoanalytical and family-dynamic concepts.

Adaptation, Psychological↗
PubMed1990

[A 20-year follow-up study of a sample of 50 pairs of twins with neurotic-psychosomatic disorders].

As part of a research project, examination was made of a sample of 50 pairs of twins (21 pairs of identical twins, 16 pairs of non-identical twins of the same sex, and 13 pairs of male-female twins [n = 100 test persons]) between 1963 and 1969 and again recently after a period of 20 years. The index twins were drawn from among the patients who made use of the services of an out-patient psychotherapeutic clinic, and they were determined to be either psychoneurotic, character neurotic, or psychosomatically ill. The question examined was again one of nature vs. nurture. Identical twins showed a significantly higher similarity with regard to the seriousness of their neuroses and the manifestation of neurotic symptoms than did non-identical twins. Noticeable similarities existed in cases of depressive disturbances, disturbances of oral and aggressive behavior, and disturbances of interpersonal contact. With regard to the influence of variables in the environment, we examined the effect of factors in early childhood on neurotic development. Lack of a reference person, a negative attitude on the part of parents toward the child, etc., frustration within and outside the family have an effect on the manifestation of neuroses and on the course of their development. The influence of early childhood factors on the degree of neurotic disorder is still to be noted in the current point prevalence.

Adult↗
PubMed1989

The epidemiology of psychogenic disorders and consequences for prevention.

After discussing social issues of epidemiologic research on neurotic, character and psychosomatic disorders, we outline the main results of a field cohort study on 600 representative adults of Mannheim, a West German industrial city. According to ICD 300-307 (WHO 8th revision) and to a quantitative case definition clinically based on the severity of the symptoms we find an overall case rate of 26% in which females prevail over men by a ratio of approximately 2:1 and the rate of lower social class members over that of higher ones. We then turned to conclusions of our research for matters of primary and secondary prevention. Concerning primary prevention of psychogenic diseases life circumstances during childhood proved to be relevant as predisposing variables and risk factors often indicating poor emotional relationships between the child and its caretakers. Furthermore, we deal with protective factors preserving mental and physical health in spite of heavy burdens during childhood. Turning to secondary prevention we examine risk factors in present life, the importance of the lay system, and the influence of life events as well as the true demand for psychotherapy.

Adult↗
PubMed1988

[Life events, coping and social support: attempt at integration from the psychoanalytic viewpoint].

In the Federal Republic of Germany, few attempts have been made to subject psychoanalytical theories of illness to empirical examination using the modern methods of science. There are also very few established connections between these theories and recognized socio-psychological concepts, and theoretical constructs that are in fact quite similar have thus led a separate but parallel existence because of differences in terminology. In our epidemiological research project (begun in 1978), we concentrate on the observation of psychic health and/or psychogenic illness as influenced by factors of personality and of symptom-causing conditions, drawing on the methods of socio-psychological research. In this study, we present 1) our results from the areas "Life-events", "Coping", and "Social support" and 2) a quantification of the pathogenic influence of these three factors based on regression analysis; finally, 3) we try to establish the connection to psychoanalytic concepts of symptom-causing temptation and failure situations and to ego-related models of defense and adaptation.

Adaptation, Psychological↗