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R Töpper

Publications and source records attributed to R Töpper.

57 records · Page 4Linked to original sources

Different mechanisms underlie the long-latency stretch reflex response of active human muscle at different joints.

1. Stretch of voluntarily activated human muscle results in a reflex response consisting of short-latency (M1) and delayed long-latency (M2) components. The mechanism of the M2 response remains the subject of controversy. The present study tested the universality of the hypothesis that the M2 response results from the transmission of low-threshold muscle afferent input travelling over a long-loop supraspinal pathway. Muscle reflex responses resulting from imposed stretch were obtained from the first dorsal interosseus (FDI), biceps brachii (BB), triceps brachii (TB) and triceps surae (TS) muscles. 2. Patients suffering from Huntington's disease (HD) show a selective loss of FDI-M2 responses, with sparing of the M1. This has been attributed to disruption of supraspinal pathways as a part of the disease pathology. Accordingly, HD has been used in the present study as a model to test the universality of the long-loop hypothesis: if this is so, then HD patients with an absent FDI M2 should also fail to show an M2 response in other muscles. 3. It is shown that a group of HD patients in whom the FDI-M2 response was absent or residual developed clear M2 responses in the TB, BB and TS muscles following stretch sufficient to invariably evoke this component in normal subjects. 4. It is thus concluded that longer-latency stretch reflex components are not invariably mediated over long-loop supraspinal pathways, but that this mode of control is dominant only in muscles, such as those of the hand, whose function depends largely on direct cortical control.

Adult↗

Influence of an infectious disease service on antibiotic prescription behavior and selection of multiresistant pathogens.

BACKGROUND: A routine infectious disease service was established in January 1998 in order to optimize the antibiotic usage and prescription pattern of a neurologic intensive care unit (NICU). METHODS: Treatment guidelines for the most prevalent infections were implemented and individual antibiotic regimes were discussed at the bedside with infectious disease experts. RESULTS: This interdisciplinary cooperation reduced the total number of antibiotics prescribed by 38.1%, from 7,789 in 1997 to 4,822 in 1998, without compromising patient outcomes (mortality rate: 22/313 patients in 1997 vs. 32/328 patients in 1998). Total patient days (2,254 days vs. 2,296 days) and average length of stay in the NICU (7.2 days vs. 7.0 days) were comparable. Antimicrobial expenditure decreased by 44.8% (71,680 Euros in 1997 vs 39,567 Euros in 1998). Taking into account the costs for the infectious disease service (approximately 8,000 Euros in 1998), a total saving of 24,113 Euros was made. The dramatic reduction in antibiotic usage (mainly of carbapenems) resulted in a statistically significant decreased isolation of Stenotrophomonas maltophilia (p<0.05), Enterobacter cloacae (p<0.05), multiresistant Pseudomonas aeruginosa (p<0.05) and Candida spp. (p<0.05), without any change in the infection control guidelines. CONCLUSION: These data show that an infectious disease service can optimize and reduce antibiotic usage. This results in a decrease in the occurence of multiresistant gram-negative pathogens and Candida spp. in intensive care units and, at the same time, saves costs.

Anti-Bacterial Agents↗

5'-nucleotidase positive microglia reaction in the central nervous system.

Following peripheral nerve injury the proliferation of 5'-nucleotidase positive microglial cells has been noticed around projective motoneurons and autonomic preganglionic neurons of the central nervous system. Similar events were observed in the central arborization fields of the primary sensory fibers. Our results may suggest an important role of glial cells in the neuronal plasticity.

5'-Nucleotidase↗