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Biomedical subjects

S Schumacher

Publications and source records attributed to S Schumacher.

At least 19 recordsLinked to original sources
PubMed2006

Virulence profiles of Shiga toxin 2e-producing Escherichia coli isolated from healthy pig at slaughter.

Recently, virulence patterns of Stx2e-producing Escherichia coli from pigs with edema disease and from humans were compared and strains from diseased pigs were reported to be unlikely human pathogens [Sonntag, A.K., Bielaszewska, M., Mellmann, A., Dierksen, N., Schierack, P., Wieler, L.H., Schmidt, M.A., Karch, H., 2005. Shiga toxin 2e-producing Escherichia coli isolates from humans and pigs differ in their virulence profiles and interactions with intestinal epithelial cells. Appl. Environ. Microbiol. 71, 8855-8863]. In the present study, 31 Shiga toxin-producing E. coli (STEC) strains harboring stx2e, which were previously isolated out of fecal samples from healthy pigs at slaughter [Kaufmann, M., Zweifel, C., Blanco, M., Blanco, J.E., Blanco, J., Beutin, L., Stephan, R., 2006. Escherichia coli O157 and non-O157 Shiga toxin-producing Escherichia coli in fecal samples of finished pigs at slaughter in Switzerland. J. Food Prot. 69, 260-266], were characterized by phenotypic and genotypic traits. Nine of the thirty-one sorbitol-positive non-O157 STEC (stx2e) isolated from healthy pigs belonged to serotypes found in STEC isolated from humans, including two serotypes (O9:H-, O26:H-) reported in association with hemolytic-uremic syndrome. Otherwise, the serotypes were different from those isolated from cases of edema disease in pigs. The eae (intimin) gene, which is strongly correlated with severe human disease, was not detected. Moreover, all strains were lacking the genes for enterohemolysin (ehxA), porcine A/E associated protein (paa), STEC autoagglutinating adhesin (saa) and the serin protease EspI (espI). Nine strains tested positive for astA (EAST1), one O141:H17 strain for fedA (F18 fimbrial adhesin) and one O159:H- strain for terF (tellurite resistance). Similar to the Stx2e-producing E. coli isolated from humans, which are mainly lacking further virulence factors, genes of an iron uptake system on the high-pathogenicity island (irp2, fyuA) were detected in three ONT:H10 and ONT:H19 strains from healthy pigs. Consequently, although the isolated strains are unlikely to be associated with severe human diseases, healthy pigs cannot be excluded as a potential source of human infection with Stx2e-producing STEC.

Abattoirs↗
PubMed2006

[Epidemiology and pathophysiology of overactive bladder].

According to the new ICS classification overactive bladder (OAB) is defined as a complex of symptoms such as frequency, nocturia, and urgency with or without urge urinary incontinence. Urgency is the key symptom that leads to the diagnosis. The prevalence of overactive bladder in the general adult population is approximately 17%. This number increases with advancing age. Incontinence events are reported in approximately one-third of these patients. Symptoms of overactive bladder have a negative impact on quality of life in every second patient and on sexuality in every fourth patient. In addition to neurogenic and myogenic factors, nowadays urothelial dysfunction is being discussed in the etiology of OAB.

Age Distribution↗
PubMed2005

The degradation of alpha-quaternary nonylphenol isomers by Sphingomonas sp. strain TTNP3 involves a type II ipso-substitution mechanism.

The degradation of radiolabeled 4(3',5'-dimethyl-3'-heptyl)-phenol [nonylphenol (NP)] was tested with resting cells of Sphingomonas sp. strain TTNP3. Concomitantly to the degradation of NP, a metabolite identified as hydroquinone transiently accumulated and short-chain organic acids were then produced at the expense of hydroquinone. Two other radiolabeled isomers of NP, 4(2',6'-dimethyl-2'-heptyl)-phenol and 4(3',6'-dimethyl-3'-heptyl)-phenol, were synthesized. In parallel experiments, the 4(2',6'-dimethyl-2'-heptyl)-phenol was degraded more slowly than the other isomers of NP by strain TTNP3, possibly because of effects of the side-chain structure on the kinetics of degradation. Alkylbenzenediol and alkoxyphenol derivatives identified as metabolites during previous studies were synthesized and tested as substrates. The derivatives were not degraded, which indicated that the mineralization of NP does not proceed via alkoxyphenol as the principal intermediate. The results obtained led to the elucidation of the degradation pathway of NP isomers with a quaternary alpha-carbon. The proposed mechanism is a type II ipso substitution, leading to hydroquinone and nonanol as the main metabolites and to the dead-end metabolites alkylbenzenediol or alkoxyphenol, depending on the substitution at the alpha-carbon of the carbocationic intermediate formed.

Biodegradation, Environmental↗
PubMed2005

[Pathophysiology of urge, stress, and mixed incontinence].

According to the new ICS classification, urinary incontinence is subdivided by symptomatic, clinical, and urodynamic criteria. Understanding the pathophysiological interactions is important to find the correct diagnosis. Disturbances in bladder storage include urge incontinence due to neurogenic or non-neurogenic (idiopathic) detrusor hyperactivity as well as stress urinary incontinence caused by an insufficient urethral closure mechanism due to reduced pressure transmission (active-passive), hypotonic urethra, hyporeactivity of sphincter musculature, or involuntary relaxation of the urethra. Stress and urge incontinence can occur in combination and then be defined as mixed incontinence.

Diagnosis, Differential↗
PubMed2004

Phenotypic and genotypic characteristics of non-O157 Shiga toxin-producing Escherichia coli (STEC) from Swiss cattle.

A total of 42 Shiga toxin-producing (STEC) strains from slaughtered healthy cattle in Switzerland were characterized by phenotypic and genotypic traits. The 42 sorbitol-positive, non-O157 STEC strains belonged to 26 O:H serotypes (including eight new serotypes) with four serotypes (O103:H2, O113:H4, O116:H-, ONT:H-) accounting for 38.1% of strains. Out of 16 serotypes previously found in human STEC (71% of strains), nine serotypes (38% of strains) were serotypes that have been associated with hemolytic-uremic syndrome (HUS). Polymerase chain reaction (PCR) analysis showed that 18 (43%) strains carried the stx1 gene, 20 strains (48%) had the stx2 gene, and four (9%) strains had both stx1 and stx2 genes. Of strains encoding for stx2 variants, 63% were positive for stx2 subtype. Enterohemolysin (ehxA), intimin (eae), STEC autoagglutinating adhesin (saa) were detected in 17%, 21%, and 19% of the strains, respectively. Amongst the seven intimin-positive strains, one possessed intimin type beta1 (O5:H-), one intimin gamma1 (O145:H), one intimin gamma2/theta, (O111:H21), and four intimin epsilon (O103:H2). The strains belonged to 29 serovirotypes (association between serotypes and virulence factors). O103:H2 stx1eae-epsilon ehxA, O116:H- stx2, and ONT:H- stx2c were the most common accounting for 29% of the strains. Only one strain (2.4%) of serovirotype O145:H- stx1stx2eae-gamma1ehxA showed a pattern of highly virulent human strains. This is the first study providing characterization data of bovine non-O157 STEC in Switzerland, and underlining the importance of the determination of virulence factors (including intimin types) in addition to serotypes to assess the potential pathogenicity of these strains for humans.

Adhesins, Bacterial↗
PubMed2004

Surfactant function in children with chronic airway inflammation.

Pulmonary surfactant is necessary to keep the terminal conducting airways patent. It is unknown whether mild to moderate airway inflammation may influence surfactant function and thus contribute to the pathogenesis of chronic airway inflammation in children. To answer this question, 21 children with chronic obstructive bronchitis and 19 asymptomatic children with long-term tracheostomy and increased numbers of neutrophils in their airways were compared with 15 healthy controls. Bronchoalveolar lavage fluid was separated into large surfactant aggregates (LA) and a supernatant containing inhibitory constituents. Surfactant function of LA, recombinations of LA and supernatant, and recombinations of a defined bovine surfactant and supernatant was assessed in a capillary surfactometer. Compared with controls, the function of the LA surfactant was reduced and there was no difference between children with tracheostomy and chronic obstructive bronchitis. The function of LA-supernatant recombinations was poor in all subjects. This may be explained by the well-known protein influx during the lavage procedure. The activity of bovine surfactant-supernatant reconstitutions was impaired in children with tracheostomy. In all surfactant mixtures assessed, surfactant function was inversely correlated to the number of neutrophils in the lavage fluid. Chronic lower airway inflammation with mild or no clinical symptoms is associated with impaired surfactant function. The dysfunction may contribute to airflow restrictions frequently observed in these children.

Bronchitis, Chronic↗
PubMed2004

[An endocranial complication of sinogenic origin without initial classical neurological symptoms].

A 14 year old male developed a subdural empyema with a leptomeningeal infection of sinogenic origin. Initially, there were none of the expected neurological symptoms such as worsening headaches, vomiting, alteration in the level of consciousness and neck stiffness. Later, focal neurological deficits and seizures occurred. An endonasal sinus drainage was performed simultaneously with a neurosurgical exploration. We started an antibiotic therapy. All neurological deficits disappeared rapidly.

Adolescent↗
PubMed2004

[The modified ureterosigmoidostomy (Mainz pouch II) as a continent form of urinary diversion].

INTRODUCTION AND OBJECTIVES: The purpose of this study was to examine the outcome of the "Mainz Pouch II" urinary diversion at two different centers (the Klinik und Poliklinik für Urologie, Bonn and the Ospedale "San Salvadore", Pesaro, Italy) in terms of different techniques of ureteral implantation. MATERIALS AND METHODS: Between March 1995 and February 2003, the procedure was performed on 83 patients with 165 renal units (RU). Ureteral implantation with the Goodwin-Hohenfellner technique was performed in 57 RU, with the Abol-Enein modification in 23 RU and the Le-Duc procedure in 85 RU. Follow-up was available for 71 patients (85%) with a period of 1 to 82 months (mean 19.5 months, median 12 months). A non-validated questionnaire was used in the Bonn series to determine specific urinary diversion items. RESULTS: Early complications occurred in 12%, three requiring surgical intervention. Two patients died within the first 30 days after initial surgery. Pyelonephritis occurred in 12 RU (14% of the patients, 8.5% of the RU). Ureteral stenosis requiring reimplantation was found in two RU. The continence rate was 100% during daytime in the Bonn series; all but one patient had to get up for urination at night. A total of 63% of the patients were able to distinguish between stool and urine. CONCLUSION: Mainz pouch II is a quick, safe and easy to perform urinary diversion which serves as a satisfying alternative to other forms of continent diversion. Follow-up shows a low complication rate with good results in terms of continence; however, long term results have to be evaluated. There are no significant differences in complication rates for the different ureteral implantation techniques.

Colon, Sigmoid↗
PubMed2004

[Stress incontinence and mixed incontinence].

According to the new ICS classifications urinary incontinence is divided by symptomatic, clinical and urodynamic criteria. Urinary incontinence is a non life-threatening condition, which may affect life quality a lot. Stress incontinence may present alone or may occur as mixed incontinence. The understanding of pathophysiological interactions is important to perform adequate diagnostics and start appropriate therapy. The patients should be informed about the wide spectrum of different conservative and surgical treatment options, their results and typical complications. Further randomised trials are necessary for critical evaluation of each treatment option.

Clinical Trials as Topic↗
PubMed2004

Lack of ultrastructural detrusor changes following endoscopic injection of botulinum toxin type a in overactive neurogenic bladder.

INTRODUCTION: Endoscopical injections of Botulinum toxin type A into the detrusor muscle are gaining clinical acceptance in the treatment of neurogenic detrusor overactivity. Structural effects of Botulinum toxin type A are only known from studies on striated muscles, where a widespread nerve sprouting occurs temporarily. The aim of this study was to evaluate the ultrastructural effects of Botulinum toxin type A injections on the human detrusor. MATERIAL AND METHODS: 30 detrusor biopsies were obtained from 24 patients with neurogenic detrusor overactivity. Patients were divided into two groups: Group I included 13 biopsies from patients before the first Botulinum toxin type A injection. Group II included 6 biopsies from patients within 3 months after the first injection and 11 biopsies at the time of decreasing efficacy of Botulinum toxin type A. The biopsies were processed by standard procedure for detailed electron microscopic study and evaluated by 2 examiners without prior knowledge of clinical/urodynamic data. RESULTS: No statistically significant detrusor changes have been found concerning muscle cell fascicle structure (p = 0.445), width of intercellular space (p = 0.482) and number/kind of muscle cell junctions (p = 0.443). A median of 70% of intrinsic axon terminals presented with signs of degeneration in group I, a median of 66% in group II (p = 0.840). Out of 309 evaluated axon terminals in both groups, 1 sprouting axon was found in group I, 3 sprouting axons in group II (p = 0.864). Specimen from group I and group II showed only limited collagen deposits within the detrusor. No changes in the ultrastructure of the detrusor have been observed in those biopsies obtained before and after the Botulinum toxin type A injection of the same patient. CONCLUSION: This study verifies our earlier report of severe intrinsic axon degeneration in the detrusor of patients with neurogenic detrusor overactivity. It also shows nearly no structural differences of the detrusor before and after Botulinum toxin type A injections. Contrary to reports of striated muscle, axonal sprouting within the detrusor was very limited after Botulinum toxin type A injections indicating pathophysiologically different reactions to the toxin either between striated muscle and smooth muscle or between different treated diseases.

Adolescent↗
PubMed2004

EAU guidelines on chronic pelvic pain.

OBJECTIVES: On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of chronic pelvic pain patients were established. METHOD: Guidelines were compiled by a working group and based on current literature following a systematic review using MEDLINE. References were weighted by the panel of experts. RESULTS: The full text of the guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article is a short version of this text and summarises the main conclusions from the guidelines on management of chronic pelvic pain. CONCLUSION: A guidelines text is presented including chapters on prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecological practice, role of the pelvic floor and pudendal nerve, general treatment of chronic pelvic pain and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from chronic pelvic pain.

Chronic Disease↗
PubMed2004

Increased expression of connexin 43 in the overactive neurogenic detrusor.

PURPOSE: The cellular mechanisms involved in unstable uncontrolled detrusor contractions in the human bladder remain unknown. One hypothesis, based on electron microscopical observations and animal studies, is that gap junctions are present in the human detrusor and are increased in patients with detrusor overactivity. Thus intercellular electrical coupling between adjacent detrusor cells would be increased allowing electrical activity to spead more easily within the detrusor muscle mass and more readily generate significant contractions. The aim of this study was to prove this hypothesis. MATERIAL AND METHODS: Detrusor biopsies have been obtained from videourodynamically evaluated patients with neurogenic detrusor overactivity (NDO) (n = 19) [group I] and from patients with stress urinary incontinence (SUI) with stable, non-obstructed detrusors (n = 5) [group II] serving as controls. Specimens were fixed, paraffin embedded, sectioned, stained with a monoclonal connexin 43 antibody and evaluated by two blinded examiners using a semiquantitative scale. Connexin 43 mRNA levels were evaluated using quantitative RT-PCR with primers for connexin 43 and for 18S rRNA. The results were correlated with the patients' groups. RESULTS: Connexin 43 could be identified in cross sections of every detrusor biopsy. In all biopsies from patients with NDO a widespread presence of connexin 43 staining was observed, whereas only a limited presence of connexin 43 staining was observed in the specimen from patients with SUI. Connexin 43 mRNA levels within the detrusor were 3.7 fold higher in the NDO group than in the SUI group (p = 0.017). CONCLUSIONS: A limited amount of gap junctions seems to be present in every detrusor independently from its urodynamic stability or instability. But there is a significant increase in connexin 43 protein and RNA levels in patients with neurogenic detrusor overactivity underlining their role in intercellular electrical coupling.

Adolescent↗
PubMed2003

[When is a urodynamic investigation indicated for overactive bladder?].

Overactive bladder (OAB) is generally not disease specific. Symptoms are frequency, nocturia, and urgency with or without urge incontinence. The prevalence of 16.6%, evaluated in six European countries, is surprisingly high. Causes for overactive bladder are an increase of sensory stimulation and/or a decrease of sensory threshold of the bladder or a disproportion between strength of afferent stimulation and central inhibition of micturition reflex resulting in detrusor overactivity. Overactive bladder is a symptom-based diagnosis. Urodynamics is an important diagnostic tool in daily routine. Urodynamics encompasses a spectrum of different techniques and is more than just cystometry. Simple cystometry or video cystometry should be carried out after evaluation with a frequency volume chart, flow rates, and residuals, mostly by ultrasound. Urodynamic observations should never be discussed separately but always together with history, symptoms, signs, and pathological findings. It is not necessary to perform a filling and voiding cystometry in each patient with symptoms and signs of overactive bladder. Indications for cystometry are prior to invasive therapy or where previous medical or surgical therapy has failed, after pelvic surgery or pelvic irradiation, in patients with signs or symptoms suggestive of an emptying disorder, in neurological disorders, or where there is any doubt about the diagnosis. Diagnostic evaluation of geriatric patients with overactive bladder can usually be accomplished with a basic assessment while invasive procedures should be the exception.

Diagnosis, Differential↗
PubMed2003

[Ureterocystoplasty: functional results and possible problem areas].

Surgical procedures such as ileal augmentation cystoplasties are often necessary in neurogenic low-compliance bladders. Whenever possible one should avoid using segments of the GI tract in the urinary tract and preferably use the patient's own ureter for augmentation cystoplasty. This procedure includes transperitoneal nephrectomy of a nonfunctioning kidney with preservation of the renal pelvis and the megaureter, followed by detubularization of the ureter and its integration into the opened urinary bladder. We performed this procedure on four patients, two boys and two girls (aged 6-13 years). In the long-term follow-up they all had good rehabilitation results for their lower urinary tracts with an increase of the storage volume and normalization of their reduced compliance. No deterioration of the remaining upper urinary tract was found. Complications such as partial ureteral necrosis have to be taken into consideration when the vascularization of the ureter is compromised, for example, by multiple prior antireflux procedures.

Adolescent↗
PubMed2003

[Bladder dysfunction due to rare neurological disorders].

Diseases or lesions of the central or peripheral nervous system involving the innervation of the lower urinary tract lead to neurogenic bladder dysfunction. Results are typical changes in storage and voiding function of the bladder according to pathophysiological and urodynamical criteria. In case of neurological disorders the neurological symptoms are not always the leading ones. The differential diagnosis of correlating bladder dysfunction is often difficult and special pathophysiological knowledge is necessary. Etiological factors are congenital, degenerative, vascular, inflammatory and immunological processes or tumour-specific changes of the nervous system. In many cases urodynamic evaluation and early interdisciplinary cooperation is necessary for special differentiation and diagnosis, especially of those diseases which rarely lead to initial bladder symptoms. The "nonneurogenic neurogenic bladder" or "Hinman-Syndrom" is well known in the literature but shouldn't be diagnosed until possible neurological reasons are excluded by modern diagnostic tools with newest imaging techniques.

Diagnosis, Differential↗
PubMed2002

Selective block of urethral sphincter contraction using a modified Brindley electrode in sacral anterior root stimulation of the dog.

AIMS: Patients with spinal cord injury often present with dysfunction of urinary bladder and urethral sphincter. One treatment option is sacral rhizotomy and sacral anterior root stimulation with the Finetech Brindley stimulator. However, a major disadvantage is the lack of selective stimulation, resulting in simultaneous contraction of sphincter and bladder followed by unphysiological micturition. This study investigated the possibility of selective bladder stimulation by using a Brindley electrode. METHODS: In 11 male anaesthetized foxhounds, a complete posterior rhizotomy was perormed. The anterior S2 roots were stimulated with different quasi-trapezoidal (QT) pulses (pulse length range, 600-1,400 microsec; stimulation current, 0.1-2.0 mA; frequency, 20 Hz) by using a tripolar Brindley electrode. Sphincter and bladder pressures were measured urodynamically. RESULTS: All 11 animals showed a maximal reduction of the highest sphincter pressure over 80%, and in 6 of 11 trials, the sphincter pressure was inhibited completely (100%). With stimulations at maximal sphincter blockade, the average achievable bladder pressure was 33.48 cm H(2)O higher than the average sphincter pressure, and in three cases, a strong micturition was observed. Selective blockade of the sphincter was possible by applying QT pulses. The bladders remained uninfluenced by this blockade and kept their excitability at any time. CONCLUSIONS: This study shows that selective bladder stimulation with little or no coactivation of the sphincter is possible. A physiological micturition can be achieved by using a tripolar Brindley electrode. Introduction of this stimulation technique into clinical practice should not face major difficulties, considering that the device is an established electrode.

Animals↗
PubMed2002

[In vivo measurement of temperature during phacoemulsification].

BACKGROUND: Based on our experience of in vitro measurements of temperature in the anterior chamber in 1994 we designed a new spatula with an integrated probe that enabled us to measure temperature continuously during phacoemulsification without any surgical effort. METHODS: We measured the temperature in the anterior chamber during 50 cases of phacoemulsification. Depending on the indications, we used different energy modes (0-100%) and pulse modes ranging from 3 to 10 pulses per second or continuous ultrasonic output. Different viscoelastic substances were also used. RESULTS: The average temperature in the anterior chamber was 30 degrees C and adapted to the temperature of the irrigation fluid within seconds as soon as irrigation was started. During phacoemulsification each ultrasonic output causes an increase of temperature. In the case of continuous mode, the maximum rise in temperature was 3.5 degrees C. When the pulse mode was used the temperature increased up to 1.7 degrees C. It is important to note that one single pulse may increase the temperature by 0.8 degree C close to the phacotip. The rise of temperature correlated with the viscosity of the viscoelastic substance used. CONCLUSIONS: The new probe proved to be a practical device to monitor temperature in the anterior chamber during phacoemulsification. Up to now we did not encounter any critical degrees of temperature but it should be pointed out that a functional irrigation unit, the use of pulse mode or permanent ultrasonic output and in particular the type of viscoelastic material used are all important parameters influencing the rise of temperature during phacoemulsification. Further experience and results obtained with the new probe will be reported in the future.

Anterior Chamber↗