Epicardial echocardiography during implantation of a novel injectable pulmonary valve.
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Adult↗
Biomedical subjects
A Kühn
Publications and source records attributed to A Kühn.
Right heart failure due to an unroofed coronary sinus in an adult.
An unroofed coronary sinus is a rare congenital malformation with a strong association to a persistent left vena cava superior. In most cases it occurs together with complex cardiac anomalies such as left isomerism. We report on a 72-year-old man with clinical signs of right heart failure caused by an isolated unroofed coronary sinus: The diagnosis was made by means of transesophageal echocardiography with contrast injection.
Aged↗
Inhibitory and excitatory intracortical circuits across the human sleep-wake cycle using paired-pulse transcranial magnetic stimulation.
Studies using single-pulse transcranial magnetic stimulation (TMS) have shown that excitability of the corticospinal system is systematically reduced in natural human sleep as compared to wakefulness with significant differences between sleep stages. However, the underlying excitatory and inhibitory interactions on the corticospinal system across the sleep-wake cycle are poorly understood. Here, we specifically asked whether in the motor cortex short intracortical inhibition (SICI) and facilitation (ICF) can be elicited at all in sleep using the paired-pulse TMS protocol, and if so, how SICI and ICF vary across sleep stages. We studied 28 healthy subjects at interstimulus intervals of 3 ms (SICI) and 10 ms (ICF), respectively. Magnetic stimulation was performed over the hand area of the motor cortex using a focal coil and evoked motor potentials were recorded from the contralateral first dorsal interosseus muscle (1DI). Relevant data was obtained from 13 subjects (NREM 2: n=7; NREM 3/4: n=7; REM: n=7). Results show that both SICI and ICF were present in NREM sleep. SICI was significantly enhanced in NREM 3/4 as compared to wakefulness and all other sleep stages whereas in NREM 2 neither SICI nor ICF differed from wakefulness. In REM sleep SICI was in the same range as in wakefulness, but ICF was entirely absent. These results in humans support the hypothesis derived from animal experiments which suggests that intracortical inhibitory mechanisms are involved in the control of neocortical pyramidal cells in NREM and REM sleep, but along different intraneuronal circuits. Further, our findings suggest that cortical mechanisms may additionally contribute to the inhibition of spinal motoneurones in REM sleep.
Adolescent↗
[Structural validity of the Short Form 36 (SF-36) in patients with rheumatic diseases].
BACKGROUND: Quality of life is gaining relevance as a criterion of success in therapeutic outcome studies. In order to record quality of life, disease-specific instruments are being used as well as generic instruments. Generic instruments offer the possibility to compare outcome among different indications; however for this it is necessary to prove the differential factorial validity of the instrument's structure. AIM OF THE STUDY: Using structural equation modeling the SF-36 was administered to a sample of patients with rheumatic diseases. The sensitivity to change of the measure was calculated after six months. Furthermore, age- and sex-specific scale values were calculated and compared with norm data. METHODS: SF-36 data of 436 patients as well as sex and age from two scientific rehabilitation research projects were pooled for this secondary analysis. RESULTS: The structure of the questionnaire proves to be acceptable and comparable with international results. The confirmatory analysis supports the best fit for a model with crossloadings assuming correlated main dimensions. Sensitivity to change is low in general. The best effect size is found for the subscale pain. The comparison with norm data shows that patients are impaired particularly within their physical health (regarding the SF subscales) both at the beginning of the treatment and after six months. In all age groups men have better conditions than women. CONCLUSIONS: The generic SF-36 show sufficient factorial validity. From this point of view there is no objection to using the SF-36 in patients with rheumatic diseases. Indeed the use of the SF summary scales as a representation of (uncorrelated) physical and mental health must be questioned critically.
Adolescent↗
[Preoperative mapping of speech-eloquent areas with functional magnetic resonance imaging (fMRI): comparison of different task designs].
PURPOSE: Functional magnetic resonance imaging (fMRI) is a well-established, non-invasive method for pre-operative mapping of speech-eloquent areas. This investigation tests three simple paradigms to evaluate speech lateralisation and visualisation of speech-eloquent areas. MATERIALS AND METHODS: 14 healthy volunteers and 16 brain tumour patients were given three tasks: to enumerate months in the correct order (EM), to generate verbs fitting to a given noun (GV) and to generate words fitting to a given alphabetic character (GW). We used a blocked design with 80 measurements which consisted of 4 intervals of speech activation alternating with relaxation periods. The data were analysed on the basis of the general linear model using Brainvoyager(R). The activated clusters in the inferior frontal (Broca) and the posterior temporal (Wernicke) cortex were analysed and the laterality indices calculated. RESULTS: In both groups the paradigms GV and GW activated the Broca's area very robustly. Visualisation of the Wernicke's area was best achieved by the paradigm GV. The paradigm EM did not reliably stimulate either the frontal or the temporal cortex. Frontal lateralisation was best determined by GW and GV, temporal lateralisation by GV. CONCLUSION: The paradigms GV and GW visualise two essential aspects of speech processing: semantic word processing and word production. In a clinical setting with brain tumour patients, both, GV and GW can be used to visualise frontal and temporal speech areas, and to determine speech dominance.
Adult↗
Identification of right atrial mass preceding interventional ASD closure.
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Echocardiography, Transesophageal↗
Combined 123I-FP-CIT and 123I-IBZM SPECT for the diagnosis of parkinsonian syndromes: study on 72 patients.
72 consecutive patients with suspected parkinsonian syndromes (PS) were studied by dopamine transporter (DAT) and D2 receptor SPECT in order to evaluate the accuracy of combined SPECT imaging. In the follow-up, the patients were diagnosed as having Parkinson's disease (PD, n = 25), dementia with Lewy bodies (DLB, n = 6), multiple system atrophy (MSA, n = 13), progressive supranuclear palsy (PSP, n = 8), corticobasal degeneration (CBD, n = 9), and essential tremor (ET, n = 11). Using the iteratively estimated optimal cutoffs, DAT was reduced in 57/61 PS patients, whereas all ET patients were identified as "normal". Reduced D2 receptor binding had 7/13 patients with MSA, 6/8 patients with PSP, 2/9 patients with CBD and no ET, PD or DLB patients. FP-CIT SPECT allows an accurate detection of nigrostriatal affection in neurodegenerative PS. IBZM SPECT is useful to approve the diagnosis of PSP and MSA although a normal finding cannot exclude an atypical PS. IBZM SPECT seems to be of restricted value in CBD.
Aged↗
Impaired left ventricular function after arterial switch operation: exclusion of significant coronary artery stenosis with an intravascular Doppler guidewire.
Patients after arterial switch operation for transposition of the great arteries are at risk for coronary artery stenosis or obstruction due to intraoperative manipulation. This case describes an infant with impaired left ventricular function 8 months after arterial switch operation. A hemodynamically significant left coronary artery stenosis was excluded by determination of coronary flow reserve using an intravascular Doppler guidewire.
Cardiac Surgical Procedures↗
Myocardial perfusion and coronary flow reserve assessed by positron emission tomography in patients after Fontan-like operations.
Ventricular dysfunction in patients after Fontan-like operations (FLOs) is a serious complication that might contribute to poor long-term results. Ischemic heart disease will have debilitating consequences on a Fontan heart. Ten patients (15.8 +/- 5.01 years) after FLO had transesophageal echocardiography and cardiac catheterization 9.3 +/- 4.2 years after surgery. Myocardial perfusion was assessed by NH3-positron emission tomography (rest/adenosine) and compared with that of 10 healthy adults (26.1 +/- 6.3 years). Ventricular function was normal in 4 and reduced in 6 patients; end systolic and end diastolic meridional wall stress was significantly elevated in the FLO group. Coronary angiography revealed no stenosis of the coronaries. Compared to normals, myocardial blood flow (MBF) at rest was higher in the FLO group (0.99 +/- 0.25 vs 0.77 +/- 0.17 ml/g/min, p <0.05), whereas MBF after vasodilatation (2.12 +/- 0.78 vs 3.10 +/- 0.85 ml/g/min, p <0.05) and coronary flow reserve (CFR) was reduced (2.5 +/- 0.88 vs 4.1 +/- 1.01, p <0.05), especially in those with impaired ventricular function. Coronary vascular resistance after vasodilatation was elevated in the FLO group (38.2 +/- 17.4 vs 24.5 +/- 8.3 mmHg/ml/g/min, p <0.05). Altered MBF, increased meridional wall stress, and impaired CFR are common findings in FLO. Attenuated CFR and reduced ventricular function are significantly correlated and may be risk factors for the long-term outcome.
Adolescent↗
Corticospinal excitability in human sleep as assessed by transcranial magnetic stimulation.
The excitability of the corticospinal system was studied in 23 healthy subjects in sleep stages NREM2, NREM4, REM, and wakefulness using transcranial magnetic stimulation. Assessment of motor thresholds, stimulus-response curves, and latencies of motor evoked potentials shows activation of the fast-conducting corticospinal fibers in all sleep stages and a neuronal recruitment pattern similar to wakefulness, however, at a lower level of excitability and with significant differences between sleep stages.
Adult↗
Myocardial blood flow and flow reserve after coronary reimplantation in patients after arterial switch and ross operation.
BACKGROUND: Coronary reimplantation is used in therapy for congenital heart disease, such as in the arterial switch (ASO) and Ross operations. The adequacy of myocardial perfusion may remain a matter of concern. The aim of the present study was to stratify the effect of coronary reimplantation on myocardial perfusion and to highlight the clinical relevance of any attenuation in myocardial perfusion. METHODS AND RESULTS: A total of 21 children with transposition of the great arteries at a mean interval of 11.2+/-2.9 years after ASO and 9 adolescents at a mean interval of 4.2+/-2.1 years after the Ross procedure were investigated. All patients were asymptomatic and had a normal exercise capacity. On stress echocardiography, 2 of the ASO patients had dyskinetic areas within the left ventricular myocardium, and 5 had adenosine-induced perfusion defects on positron emission tomography. No coronary obstruction was detected on coronary angiography in any patient, but a common finding was right coronary dominance and a small caliber of the distal part of the left anterior descending artery. Coronary flow reserve (CFR) was significantly reduced in all patients after ASO when compared with 10 normal healthy volunteers (age, 25.6+/-5.3 years). CFR was normal in the 9 patients who had the Ross operation (age, 19.2+/-7.6 years); exercise-induced perfusion defects were not detected in the Ross patients. CONCLUSIONS: Children after ASO are asymptomatic, without clinical signs of coronary dysfunction. In contrast to patients who had the Ross operation, stress-induced perfusion defects and an attenuated CFR were documented. The prognostic implications of these findings and the clinical consequences are unclear; nevertheless, close clinical follow-up of ASO patients is mandatory.
Adolescent↗
[Development of a questionnaire for assessing motivational conditions for prediction of therapy cooperation of LVA insured patients during inpatient medical rehabilitation--initial results of scale development].
Medical staff working in rehabilitation often criticize their in-patients' lack of motivation to cooperate in therapy. Consequently, very often the aims of the therapy would not be reached. That, again, causes expenses that could be avoided and it also causes frustration on both sides. On the basis of Schwarzer's Health Action Process Approach (HAPA) we designed a questionnaire on motivation to predict the degree of the in-patients' cooperation in therapy during rehabilitation. The results presented here are based on an interim analysis of 508 questionnaires answered by LVA insurees (Landesversicherungsanstalten, wage earners' pension insurance funds) who had applied for rehabilitation in a clinic. The applicants suffered from illness of the back and spine as well as degenerative illness of the joints. A first examination of the scales Specific Outcome Expectancies, Specific Self-efficacy and Intention of the questionnaire showed very good statistical results as well as correlations between these variables that correspond to HAPA. It also turned out that there is a direct connection between the scores of the motivation variables (e.g. Specific Self-efficacy) and that of cooperation in therapy. These initial test results indicate a generic character of the instruments used in this research project. They also point out starting points for interventions to increase motivation that are to be developed.
Adult↗
[Results of an evaluation of psychotherapeutic care from the viewpoints of patients and therapists in Saxony-Anhalt].
With the enforcement of the German law for psychotherapeutics at the beginning of 1999, the field of psychotherapy detached from a widespread "delegation procedure" through the possibility of first-access for patients to a psychotherapist. In the form of an experiment, Saxony-Anhalt practiced as the only land in the Feral Republic of Germany a modified form of delegation procedure in the legal health insurance since 1992. The most important modification consisted in the possibility of first-access for the patient to the psychotherapist. Using selected results of the investigation in the view of psychotherapy patients and from medical and psychological psychotherapists, the situation after 5 years since introduction of this model in the out-patient, psychotherapeutic care in Saxony-Anhalt will be shown, as well as experience gained from this model.
Ambulatory Care↗
Automated amplified flow immunoassay for cocaine.
An amplified flow immunoassay (AFIA) was developed for cocaine, which combines a noncompetitive immunoenzymometric assay (IEMA) with an on-line detection of the enzyme label alkaline phosphatase (ALP) by a substrate-recycling biosensor. In the IEMA, the analyte cocaine first binds to a labeled polyclonal anti-cocaine antibody. Then, the excess labeled antibody is separated on an affinity column that contains a perfusion chromatography carrier modified by immobilized cocaine. The unbound complexes of the analyte cocaine with the ALP-labeled antibody are detected postcolumn. The detector senses phenol produced by ALP from phenyl phosphate. As detector, an amperometric substrate-recycling biosensor was used, which consists of a Clark-type oxygen electrode covered by tyrosinase and pyrroloquinoline quinone-dependent glucose dehydrogenase. The lower limit of detection is 380 pM (38 fmol) for cocaine. The sampling rate is 26/h. Cocaine could be detected from "real samples" with an imprecision of +/- 10% (n = 3) and with a recovery of 49 +/- 3% for various concentrations. AFIA is generally important as a new approach for the fast detection of picomolar concentrations of haptens.
Alkaline Phosphatase↗
Comparative analysis of histology, DNA content, p53 and Ki-ras mutations in colectomy specimens with long-standing ulcerative colitis.
Neoplastic progression in patients with chronic ulcerative colitis is characterized by the development of epithelial dysplasia, which is accompanied by genetic alterations. This study determined the time of onset of p53 and Ki-ras mutations as well as DNA aneuploidy during histological progression towards carcinoma. In all, 278 samples of 7 colectomy specimens were analyzed by flow cytometry, histology and single-strand conformation polymorphism analysis. Of the samples, 22% (61/278) were dysplastic and 43% (122/278) aneuploid, while 25% (71/278) showed p53 and 4% (11/278) Ki-ras mutations. The correlation between aneuploid status and p53 mutations varied among the patients. A strong correlation was noticed between histological progression from low-grade dysplasia to carcinoma and p53 mutations as well as DNA aneuploidy. Ki-ras mutations were found in 40% (2/5) of the carcinomatous samples. The correlation between p53 mutations and the histological status of the samples suggest the involvement of this genetic event in the development of colon cancer in patients with ulcerative colitis. In contrast to Ki-ras mutations, the appearance of p53 mutations is an early event. Therefore p53 analysis might be helpful in the classification of indefinite dysplasia and in the identification of patients at risk for cancer development. Further studies are necessary to detect the additional genetic alterations preceding the development of DNA aneuploidy.
Aneuploidy↗
[Saxony-Anhalt/Necklenburg-Vorpommern Scientific Rehabilitation Research Groups].
Interfaces in Medical rehabilitation are the central target of the research collaboration in Sachsen-Anhalt/Mecklenburg-Vorpommern. Six scientific projects and one inter-project initiative aim at questions and problems concerning regional rehabilitation resources, the motivation of applicants and ways of access to rehabilitation, steering mechanisms in the allocation of medical rehabilitation, stages and phases in the rehabilitation system, cost-effectiveness of out-patient rehabilitation and ways and means of adaptation of medical rehabilitation to Job requirements. Research focuses on rehabilitation in persons with chronic back pain, traumatic and vascular CNS injury and coronary infarction.
Forecasting↗
Neuroarchitecture of the lower division of the central body in the brain of the locust (Schistocerca gregaria).
We have investigated the anatomical organization of the lower division of the central body in the brain of the locust Schistocerca gregaria. Bodian preparations, Golgi impregnations, and intracellular filling with Lucifer yellow have revealed that the lower division of the central body is organized into six horizontal layers and sixteen vertical columns. Neurons of the lower division of the central body have been classified into five types of tangential neuron (TL1-TL5) and two types of columnar neuron (CL1, CL2). TL1-TL4 neurons ramify in specific layers in the lower division of the central body and in the lateral triangle (TL1, TL2 neurons), the median olive (TL3 neurons), or the dorsal shell (TL4 neurons) of the lateral accessory lobe. TL5 neurons ramify in the protocerebral bridge, in the lateral accessory lobe, and in all layers of the lower division of the central body. The two types of columnar neurons have arborizations in the protocerebral bridge and in the lower division of the central body and project to the lateral triangle of the lateral accessory lobe (CL1 neurons) or to the lower subunit of the nodulus (CL2 neurons). Possible functional implications for the processing of neuronal information in the central complex are discussed.
Animals↗
Distribution of cell populations with DNA aneuploidy and p53 protein expression in ulcerative colitis.
OBJECTIVE: Patients with ulcerative colitis are at an increased risk for developing colorectal neoplasms. p53 mutations and the occurrence of DNA aneuploidies are common events in the development of sporadic colorectal neoplasias. This study tried to determine the frequency of these events during the development of colitis-associated colorectal neoplasms. DESIGN/METHODS: Four colectomy specimens with a total of 124 biopsies were investigated. DNA content was measured by flow cytometry and p53 protein expression was detected by immunohistochemistry. These results were correlated with histological findings. RESULTS: DNA aneuploidies were found in 58 (46.8%), and p53 protein expression in 30 samples (24.2%). The presence of DNA aneuploidy as well as of p53 protein expression correlated with the histological characteristics of neoplastic transformation. In areas without dysplasias or with indefinite dysplasias, 31.5% of the samples showed DNA aneuploidies and in about 9% of the samples p53 protein expression could be detected; 33.7% of samples without or with indefinite dysplasias showed p53 protein expression and/or DNA aneuploidies. CONCLUSION: These results show that the occurrence of DNA aneuploidies and nuclear p53 protein expression is a common event in the development of colitis-associated colorectal neoplasias. p53 protein expression seems to be an early event in this process. DNA aneuploidies occur even earlier and more frequently in the absence of p53 protein expression. Therefore, other genetic alterations besides p53 gene mutations might be involved in colitis-associated tumour development.
Adult↗