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Biomedical subjects

A Hartmann

Publications and source records attributed to A Hartmann.

572 records · Page 32Linked to original sources
PubMedDate not supplied

Twenty-four hour cortisol release profiles in patients with Alzheimer's and Parkinson's disease compared to normal controls: ultradian secretory pulsatility and diurnal variation.

Endocrine abnormalities of the hypothalamic-pituitary-adrenal (HPA) system in patients with Alzheimer's disease (AD) and Parkinson's disease (PD) have been described repeatedly. However, no data are available on the diurnal cortisol secretory pattern in these major neurodegenerative disorders. Therefore, we studied 24-h pulsatile cortisol secretion in 12 patients with AD and 12 patients with PD compared to 10 normal community- and age-matched volunteers (NV). Twenty-four hour blood sampling was performed from 1800 h to 1800 h at 15-min intervals. Cortisol half-life, number of cortisol secretory bursts/24-h, interpulse interval, mass of cortisol secreted per burst, amplitude of cortisol secretory bursts, pulsatile cortisol production rate, 24-h mean, and integral cortisol concentrations were calculated by applying deconvolution analysis. Furthermore, the relative diurnal variation and the quiescent period were determined. Patients with AD and PD were found to have significantly higher total plasma cortisol concentrations (24-h pulsatile cortisol production rate: AD + 56%; PD + 52%/24-h integrated cortisol: AD + 37%; PD + 29%) compared to NV. This sustained hypercortisolism is due to a higher mass of cortisol secreted per burst (AD + 62%; PD + 79%), but not to increased cortisol half-life or secretory pulse frequency or amplitude. Despite these similarities between AD and PD patients, relative diurnal variation of cortisol secretion was significantly decreased in patients with PD (-22%), whereas the pattern of secretory curves was not different between NV and AD patients. This observation was indirectly supported by a reduction of the quiescent period in patients with PD (-74 min) compared to the NV and AD group. Based on these results and recently published animal data, we hypothesize that decreased expression of hippocampal mineralocorticoid receptors (MR) may account for the flattened diurnal cortisol secretory curve observed in PD patients, whereas the intact diurnal profile in AD patients may be due to a relative increase in MR compensating for the hippocampal neuronal loss commonly occurring in this disorder.

Activity Cycles↗
PubMedDate not supplied

Diagnosis of congenital absence of left pericardium by MR imaging.

Congenital absence of the pericardium, whether partial or total, is a rare abnormality. It can be very difficult to diagnose clinically as well as to confirm radiographically. Plain film fluoroscopy and CT have been shown to be of value in differentiating this entity from others with similar findings. We report a case in which magnetic resonance was utilized to confirm the diagnosis and the findings of this new technique are described.

Adolescent↗
PubMedDate not supplied

Prospective study on the complication rate of carotid surgery.

BACKGROUND: Randomized trials of carotid endarterectomy for high-grade stenosis have shown a benefit for surgery under the condition of low perioperative complication rates. Concerns have been expressed that the complication rates of carotid surgery are higher in everyday practice and may vary considerably between centers. We prospectively established the complication rate for carotid surgery in a single institution. DESIGN: Prospective 2-year study. All patients received pre- and postoperative neurological evaluation. Laboratory tests included pre- and postoperative brain imaging, intracranial and neck vessel sonography, conventional angiography, magnetic resonance angiography, and intraoperative monitoring. PARTICIPANTS: 108 consecutive patients: 54 symptomatic patients fulfilling the inclusion criteria of the European Carotid Surgery Trial (ECST) and 54 asymptomatic patients fulfilling the inclusion criteria of the North American Trial on Asymptomatic Stenoses (ACAS). SETTING: Single academic center with a high volume of carotid endarterectomies (>50 per year). Participating center in ECST. MAIN OUTCOME MEASURES: Stroke or death as defined in the randomized trials. RESULTS: The overall complication rate was 8.3% (95% CI 4.1-15.6%). Complications were more frequent in patients with symptomatic stenosis (11.1%, CI 4.6-23.3%) than in asymptomatic cases (5.6%, CI 1.5-16.4%). Three patients died (2 strokes, 1 myocardial infarction). Disabling strokes were found in 2 patients (Rankin scale scores 3 and 4). Nondisabling strokes (Rankin scale score 1 and 2) occurred in 4 patients. The complication rates for symptomatic and asymptomatic patients were higher than the ones reported in the randomized trials, but 95% confidence intervals showed that the differences were not statistically significant. The point estimates of complication rates still supported a benefit of surgery for patients with symptomatic stenosis, but denied a positive effect of endarterectomy for patients with asymptomatic stenosis. CONCLUSION: In this center, a beneficial effect of carotid surgery for asymptomatic stenoses cannot be safely assumed.

Adult↗
PubMedDate not supplied

Transcranial Doppler waveform blunting in severe extracranial carotid artery stenosis.

OBJECTIVE: To investigate the frequency of transcranial Doppler (TCD) waveform blunting in patients with severe (80-99%) symptomatic or asymptomatic extracranial carotid artery stenosis. BACKGROUND: Severe carotid artery stenosis has been identified as a risk factor for ischemic stroke. Blunted Doppler flow waveforms (reduced systolic flow velocity and pulsatility) of the middle cerebral artery (MCA) are inferred to reflect hemodynamic impairment, possibly indicating an increased risk of stroke. METHODS: The 114 consecutive patients (mean age 72.4 years, SD 9.0 years; 37% women; 46 clinically symptomatic, 68 asymptomatic) with 80-99% stenosis of the extracranial internal carotid artery (ICA), as determined by duplex sonography, were examined with TCD. Flow velocities, pulsatility index, and spectral waveforms of the MCA distal to the ICA stenosis were assessed blinded to the clinical status of the ICA: Doppler waveform blunting was defined as loss of the characteristic systolic peak. Odds ratios with 95% confidence intervals and chi(2) statistics were used to describe the association between waveform blunting and the symptomatic status of the ICA stenosis. RESULTS: Among symptomatic patients, 23 (50%) had completed strokes, and a further 23 (50%) had transient neurologic deficits in the territory of the stenotic ICA. Blunted spectral waveform was found in 37 (80%, 95% CI 68-92%) of the symptomatic and 25 (37%; 95% CI 25-49%) of the asymptomatic patients. Symptomatic patients had significantly increased odds of having blunted TCD waveforms (OR 7.5, 95% CI 3.1-18.1, p < 0.001). CONCLUSIONS: Our findings suggest that TCD waveform blunting in the MCA as here described may be an additional risk factor in the setting of severe extracranial carotid artery stenosis. A prospectively designed study to confirm our results seems warranted.

Aged↗
PubMedDate not supplied

Endothelium-dependent and endothelium-independent flow regulation in coronary vascular regions supplied by arterial and venous bypass grafts.

The endothelium-dependent and endothelium-independent vasodilation of arterial and venous coronary bypass grafts and of epicardial conduit vessels and microcirculatory coronary vessels supplied by these grafts was investigated. Vasodilatory response and flow regulation were tested with cumulative intracoronary doses of acetylcholine (25 and 50 micrograms i.c.), nitroglycerin (0.3 mg i.c.), and papaverine (10 mg i.c.) in 10 patients (age 60 +/- 2.3 years) with arterial grafts and in 16 patients (age 57.7 +/- 1.5 years) with venous grafts. The effect of acetylcholine on arterial and venous bypass grafts and on large conduit arteries was evaluated by quantitative coronary angiography. Coronary blood flow velocity changes as a parameter of microcirculatory function were measured by intraluminal Doppler ultrasound. Indices for coronary flow and coronary resistance were calculated from the mean Doppler flow velocity and the computed cross-sectional vascular area. The coronary resistance decreased endothelium dependent after 25 and 50 micrograms of acetylcholine by 16 +/- 30% (p < 0.05 vs. control) and 22 +/- 25% (p < 0.05 vs. control), respectively, in regions supplied by venous grafts and by 48 +/- 20% (p < 0.05 vs. control and vs. venous graft) and 41 +/- 32% (p < 0.05 vs. control), respectively, in regions supplied by arterial grafts. The coronary resistance decreased endothelium independent after 0.3 mg nitroglycerin and 10 mg papaverine by 18 +/- 56% (p < 0.05 vs. control) and 39 +/- 29% (p < 0.05 vs. control), respectively in regions supplied by venous grafts and by 45 +/- 45% (p < 0.05 vs. control) and 70 +/- 12% (p < 0.05 vs. control and vs. venous graft), respectively in regions supplied by arterial grafts. In conclusion, during the long-term course after coronary artery bypass grafting, vascular regions supplied by arterial grafts have a better preserved endothelium-dependent and endothelium-independent flow reserve as compared with vascular regions supplied by venous grafts.

Acetylcholine↗
PubMedDate not supplied

Prolonged disturbances of regional cerebral blood flow in transient ischemic attacks.

Regional cerebral blood flow (rCBF) was measured over both hemispheres in 20 patients with unilateral transient ischemic attacks (TIA) of the territory of the internal carotid artery on the day of the TIA. rCBF was estimated with the nontraumatic Xenon 133-inhalation technique using the initial slope index. 13 patients experienced their first TIA, 7 had several attacks. In 14 patients the first rCBF-measurement was performed during the presentation of clinical symptoms. The 2nd rCBF-measurement was done on day 2, the last one on day 7. Scans of the 15 patients studied with CT were normal. On day 1 mean rCBF of the TIA-side was significantly lower than that of the contralateral hemispheres. 22% of all areas showed a significant reduction of flow compared to mean rCBF. Mean rCBF of both the TIA- and the contralateral side was significantly reduced compared to the bi-hemispheric mean rCBF of a control group with no history of TIA or completed strokes but at least 2 risk factors for cerebrovascular disease. Whereas mean rCBF did not change in the contralateral side it increased significantly (+6.9%) in the TIA-side from day 1 to day 2 but not from there to day 7. This is reflected by the increase of the total number of ROI with normal flow from day 1 to day 2. Considering the actual flow and the flow course of that tissue which was believed to be responsible for the clinical symptoms the following regional patterns were observed: normal rCBF in 6 patients; early return to normal concomitant to the clinical course (n = 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Effect of stable xenon in room air on regional cerebral blood flow and electroencephalogram in normal baboons.

Measurement of regional cerebral blood flow (rCBF) was performed in 6 healthy baboons during ventilation with 35% stable xenon in artificial air. rCBF was measured with the intraarterial xenon-133 method. EEG was recorded continuously. All CBF areas of interest over one hemisphere reacted in the same way. Mean flow increased during short-term exposure to stable xenon and decreased if stable xenon inhalation was continued for at least 24 minutes. EEG showed a decrease of alpha- and beta-wave patterns a short time after the start of stable xenon inhalation without further changes over the period when rCBF finally decreased. CO2 reactivity increased in most animals, and autoregulation to mild arterial hypotension was significantly impaired with increased flow. It is concluded that 35% stable xenon in artificial air increases rCBF after short-term exposure and decreases rCBF after longer exposure. EEG changes were noted after short-term exposure. rCBF and EEG recovered rapidly after the end of stable xenon inhalation.

Administration, Inhalation↗
PubMedDate not supplied

Determinants of resource utilization in the treatment of brain arteriovenous malformations.

BACKGROUND AND PURPOSE: Preoperative embolization of arteriovenous malformations (AVMs) is thought to improve outcome following surgical resection of these lesions. The purpose of this study was to examine the cost associated with preoperative embolization and different surgical risk categories in the surgical treatment of brain AVMs. METHODS: In a review of 126 patients treated surgically for resection of AVMs, we noted the total days spent in the hospital and calculated the associated costs (from hospital and estimated professional fees). Surgical risk category was determined using the Spetzler-Martin grading system. We examined the effect of risk category, preoperative embolization, and outcome (Rankin score) on cost and inpatient days. RESULTS: Preoperative embolization and greater surgical risk were independently associated with higher total costs. Average adjusted cost for embolization and surgery was $78,400 +/- $4,900 versus $49,300 +/- $5,800 for surgery alone. Patients ranged in preoperative risk category from Spetzler-Martin grades II through V, with an average increase of $20,100 in total cost per Spetzler-Martin grade (95% CI, $13,500 to $28,100). Higher surgical risk category was also associated with more days spent in hospital, with an average increase of 6 days per increment in Spetzler-Martin grade (95% CI, 4 to 8). After surgical resection of an AVM, new neurologic deficits were associated with large differences in cost: $68,500 +/- $6,100 and 15 +/- 2 days in hospital for patients who were neurologically worse after surgery, versus $44,700 +/- $3,900 and 10 +/- 1 days for patients who were unchanged. CONCLUSION: Preoperative embolization in the treatment of AVMs is associated with higher cost but not more days in the hospital. Patients with higher Spetzler-Martin grade AVMs utilize more hospital resources, in part because they have poorer neurologic outcome, and postoperative deficits are associated with higher costs and more days in the hospital.

Adult↗
PubMedDate not supplied

[Borderline syndrome and eating disorders. Review of the literature and interview study of 172 consecutive patients of the Freiburg Eating Disorders Outpatient Clinic].

The comorbidity of personality discorders and eating discorders is an important topic of theoretical and empirical investigation in the field of eating disorders. There is disagreement both concerning the extent of such comorbidity and it's clinical implications for the development and conduct of treatments. After a critical review of the literature up to 12/1994, we report on the results of a standard screening for borderline personality disorder (BPD) with the Diagnostic Interview for Borderlines--Revised (DIB-R) administered by trained and reliable raters in a consecutive sample of 172 first attenders of a regional eating disorders clinic (anorexia, restrictive type [DSM-IV 307.1]: n = 31, anorexia, binge eating/purging type [DSM-IV 307.1]: n = 29, bulimia nervosa [DSM-IV 307.51]: n = 80, eating disorder NOS [DSM-IV 307.50]: n = 32). 8.8% of all eating disordered patients (n = 172) and 10.0% of patients fulfilling the criteria for either anorexia or bulimia (n = 140) met the criteria of a BPD (DIB-R score > or = 8). There were no significant differences between the anorectic and bulimic subgroups. BPD-patients did not differ from the non-BPD patients in the extent or type of their eating disorder. These results differ substantially from those reported in (mostly) smaller and more selected samples. Their nosological and clinical implications are discussed.

Adolescent↗
PubMedDate not supplied

[Psychoanalytically oriented treatment of anorexia nervosa. Methodology-related critical review of the literature using meta-analysis methods].

UNLABELLED: Psychodynamic approaches to treatment in anorexia nervosa (AN) remain influential. It is unclear, how a psychodynamic orientation influences outcome with this patient group. To our knowledge, there exists no systematic review (sensu Cochrane) of the subject. METHODS: Extensive electronic and hand searches were conduced (updated in December 1995) to identify case reports and all longitudinal and comparison studies using "psychodynamic" treatment approaches, published in English, French and German. Case reports were examined for treatment "components". Group studies meeting operationalised criteria were independently rated for methodological quality, 12 aspects of treatment and its delivery (setting, type, orientation and focus) and therapy dose and duration. Effect sizes were calculated for post treatment and follow-up. Multiple regression analysis was used to identify outcome predictors. FINDINGS: Six treatment comparison studies and seven follow-up studies met criteria. In most case reports and studies treatment included different settings and techniques and an explicit focus on the symptom. In the two studies directly comparing undifferentiated psychodynamic treatment and "treatment as usual" resp. With psychodynamically based disorder specific treatments the latter had better results. Outpatient treatment was as successful as inpatient treatment (in somewhat different populations). It was not possible to identify outcome predictors. INTERPRETATION: "Psychodynamic" treatment in AN is more pragmatic and disorder orientated than generally acknowledged; patients seem to fare better in specialized treatment programmes delivered by experienced teams; less cachectic patients can be treated as outpatients by a specialized team. The exact contribution to treatment outcome of the psychodynamic orientation remains to be delineated. There is a great need for well designed and well presented treatment outcome studies.

Adolescent↗