Biomedical subjects
Publications and source records attributed to C Müller.
The author discusses whether post-partum psychoses are to be considered as a clinical entity per se. The studies conducted in Lausanne seem to demonstrate that the authors of DSM III were correct in excluding this possibility - of all the patients with a post partum episode, 65% had one or several relapses without connection with the puerperium.
Between 1978 and 1982 mitral valve replacement was performed in a total of 43 patients with mitral valve disease in the presence of functional tricuspid insufficiency (TI). The concomitant tricuspid valve regurgitation was treated conservatively in 17 patients, a Carpentier ring prosthesis was implanted in 9 patients. De Vega annuloplasty was performed in 13 patients and 4 times the valve was replaced with a Hancock bioprosthesis. The hospital mortality of 26% (11 patients) was high, due to the poor clinical condition of the patients. In a mean follow-up of 43.1 +/- 18,0 months, 20 patients could be restudied by clinical and echocardiographical investigation. Tricuspid insufficiency was found in all of the 9 patients who had been treated conservatively. Seven out of 11 patients operated showed no signs of TI, 3 had mild TI and 1 patient had severe TI. In the conservatively treated group, the preoperative mean pulmonary vascular resistance (PVR = 296 +/- 161 dynes x sex x cm-5), pulmonary artery pressure (PAP = 46.1 +/- 16.2 mmHg) and rise of right atrial V-wave (15.8 +/- 3.6 mmHg) were only slightly higher than n the operatively treated group (PVR - 274 +/- 146 dynes x sex x cm-5), PAP = 43.2 +/- 13.6 mmHg, V-wave = 18.5 +/- 6.4 mmHg) with no statistically significant difference. Preoperative hemodynamic findings in patients with and without TI a follow-up were also not significantly different. These results indicate that the recurrence of functional TI depends on the method of treatment, rather than preoperative increased PVR, PAP or V-wave rise.
The author raises the issue of patients' late improvement with chronic schizophrenia. Five out of 289 reassessed chronic schizophrenics--1.7% of that population--have been found improved. Two cases are described in detail and finally some hypotheses are suggested in relation to the possible mechanisms underlying these rare courses of schizophrenia.
We have developed a rapid and cost-effective enzyme immunoassay for dehydroepiandrosterone sulfate (DHEA-S) in plasma, performed with samples on a microtitre plate within 2.5 h. No extraction or centrifugation steps are involved. The 3-hemisuccinate of dehydroepiandrosterone is labeled with horseradish peroxidase, then mixed with hydrogen peroxide substrate in the presence of the chromogen, tetramethylbenzidine. The detection limit of the assay is 12.5 pg of DHEA-S per well. Intra- and interassay CVs at three steroid concentrations (12.8, 1.28, and 0.16 mumol/L) ranged from 2.3 to 5.4% and 6.1 to 8.4%, respectively. Results correlated well (r = 0.95) with those of a radioimmunoassay with iodinated DHEA-S. The turnaround time for 41 samples (in duplicate) is 2.5 h, which includes 2 h of incubation time. The sensitivity of this one-step version and the linearity of its standard curve are equivalent to those of a less practicable two-step version. This technique may replace coated-tube enzyme immunoassays for routine use.
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Trial to define position and variability of radioisotope functional diagnostics of placental perfusion in comparison with urinary estrogen excretion by serial examinations. - In case of placental insufficiency estrogen values are significantly reduced starting from the 32nd to 35th gestational week as compared with normal values. In general, placenta perfusion shows delayed half-life periods of the increase in activity in all risk pregnancies beginning from the 28th week of pregnancy. A direct correlation between estrogen values and placenta perfusion can only be detected in cases of chronic placental insufficiency with intrauterine growth retardation. A prolonged perfusion time reveals a fetal hypotrophy in 53% of the cases. Late gestosis takes the first place about all risk pregnancies, connected with placental insufficiency in 30% of the cases. The tendency towards a development of placental insufficiency can be early detected by determination of placental perfusion time.
Twenty-one patients with acute leukemia in second to fifth remission were treated with bone marrow transplantation: 19 patients with transplants from HLA-matched siblings and two with transplants from identical twins. Twelve patients survived from 15 to 1,625 days after transplantation: six of 11 in the ALL group and six of 10 in the AML group. Recurrence of leukemia after marrow transplantation occurred in five patients. The cause of death in five patients was infection, in two patients combined with graft-versus-host disease. Long-term disease-free survival can probably be achieved in 30%-35% of all patients with acute leukemia who receive a marrow transplant in second or subsequent remission.
Skin biopsies of 26 patients with leukemia and seven patients with aplastic anemia were investigated before and at different stages after allogeneic bone marrow transplantation (BMT) to establish the immunological criteria which distinguish skin alterations during normal reconstitution from dermal lesions mediated by graft-versus-host disease (GvHD). Of the 33 patients studied 27 presented with clinically diagnosed acute and/or chronic GvHD, one patient died of bone marrow rejection. Immunohistological analysis of the respective skin biopsies with selected monoclonal antibodies against human leukocyte antigens (HLA) and differentiation antigens of the lympho-hematopoietic cells revealed low dermal mononuclear cell counts with phenotypically normal constituents in five cases with uncomplicated reconstitution post-grafting. In contrast, increased dermal cellular infiltrates predominantly consisting of Lyt 3+, OKT 8+ T-lymphocytes, as well as of a large number of Ia-like (immune response associated = HLA-D) determinant + monocytes/macrophages were observed in all patients with active acute/chronic GvH reactivity. As sign of activation simultaneous expression of HLA-D region products was also found on a subset of the invading OKT8+ T-lymphocytes. Progression of GvHD was associated with additional surface staining of keratinocytes for Ia-like determinants. Loss of Ia-like determinant+, OKT6+ dentritic epithelial cells in all leukemic patients, as well as in patients with aplastic anemia with or without GvHD suggested damage of Langerhans cells due to the previous radiotherapy and/or specific immunological destruction. In patients with fatal outcome of GvHD prolonged reduction of these dentritic epithelial cells seemed to be indicative of impaired immune reconstitution or bone marrow dysfunction. Thus immunopathological features of skin GvHR may enable early recognition and prognostic evaluation of this disease possibly allowing more effective therapy.
The ECG-telephone-transmission (TTM) was used to record an ECG-strip during a typical symptomatic period in patients complaining of symptoms possibly caused by arrhythmias (palpitations, dizziness, paroxysm tachycardia, pulse irregularities; angina and dyspnea only if other reasons could be excluded). Patients complaining of syncope only were not admitted, because of the inability to make a telephone call successfully during such a symptomatic period. The ECG was transmitted to the CCU using a frequency modulation technique. In 60% of 196 patients an ECG-TTM could be achieved during a typical symptomatic period, whereas arrhythmias as cause for the symptoms could be excluded in 51 patients (26%). The remaining 66 patients (34%) demonstrated various arrhythmias ranging from simple SVPB and PVC to total AV-block and sustained VT. TTM, an easy-to-perform and cost-effective method allowed a successful ECG registration during a symptomatic period in almost two-thirds of symptomatic patients. In these patients arrhythmias could be verified or excluded as cause of the symptoms.
Historically, surgery for peptic ulcer has seen the evolution of differing operative principles: resection, vagotomy (truncal, selective, highly selective), and a combination of vagotomy and resection (antrectomy). The long-term effects of the various operations can now be evaluated from several published studies. Though vagotomy and antrectomy is the most "efficient" operation (ulcer recurrence rate 1%), it has the highest morbidity (15-20%) and mortality (1.5-2%); while highly selective vagotomy is the least "efficient" operation (ulcer recurrence rate 10%), it has the lowest morbidity (5%) and mortality (less than 0.5%). In the future, reduced recurrence rates should be possible by improving surgical technique and by better selection of the operative procedure (on the basis of a better selection of the operative procedure (on the basis of a better understanding of ulcer pathogenesis), but without sacrificing the advantages of highly selective vagotomy--low morbidity and mortality--for the majority of patients. Intraoperative testing of the completeness of vagotomy, and addition of a drainage such as pyloroplasty or antrectomy for juxtapyloric ulcers, may help to achieve this goal.
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We compared the life expectancy of 1559 patients with an implanted pacemaker (PM) with a normal age-matched population and found a significantly reduced survival rate in paced patients. Patients paced for heart failure have the lowest survival rate, whilst those paced for Adams-Stokes attacks do slightly better. Patients with Adams-Stokes equivalents do not differ significantly from our normal population. 54% of patients with PM implanted for heart failure died due to heart failure despite PM implantation. The relative percentage of sudden death after PM implantation is high in groups with Adams-Stokes attacks (16%) and Adams-Stokes equivalents (20%). In both of these groups sudden death occurred especially during the first two years after PM implantation. The high risk of sudden death after PM implantation should increase our efforts to monitor patients carefully after PM implantation for the occurrence of malignant tachyarrhythmias.
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The function of B cells from the peripheral blood of splenectomized patients has been investigated at the cellular level. The peripheral blood of these patients contained normal numbers of mononuclear cells (MNC) spontaneously secreting IgG and IgM, but an increased amount of IgA-secreting cells. In contrast to MNC isolated from healthy controls, the patients' peripheral blood MNC were unable to differentiate into immunoglobulin-secreting cells in a pokeweed mitogen-driven culture system. Proliferation in response to pokeweed mitogen, however, was significantly higher with patient MNC as compared to control MNC.
A position in regard to evaluation of the efficacy of psychotherapy with schizophrenia is presented. It is suggested that personal motivation is essential in this type of treatment.
A model of experimental post-traumatic osteomyelitis is described in which the femur of guinea pigs was fractured and infected with E. coli (10(5)) or Staphylococcus aureus (10(4)). Traumatized uninfected animals served as controls. The animals were further divided within each group by treating the fractured site with an intramedullary wire in one half. Osteomyelitis developed and became chronic in all guinea pigs infected with Staph. aureus, and in nine of 12 infected with E. coli. All animals infected with E. coli treated with an intramedullary wire developed chronic osteomyelitis; only four of seven from E. coli-infected animals with fractures developed this disease. Moreover, Staph. aureus could be recovered from the osseous tissue in the chronic stage of the disease regularly, while E. coli was only present in the early weeks after operation, but not in the chronic stage.
Proton extrusion by roots of intact sunflower plants (Helianthus annuus L.) was studied in nutrient solutions or in agar media with a pH indicator. Proton extrusion was enhanced by either iron deficiency, addition of fusicoccin, or single salt solutions of ammonium or potassium salts. The three types of proton extrusion differ in both localization along the roots and capacity. From their sensitivity to ATPase inhibitors it seems justified to characterize them as proton pumps driven by plasma membrane APTases.Enhanced proton extrusion induced by preferential cation uptake from (NH(4))(2)SO(4) or K(2)SO(4) was uniformly distributed over the whole root system. In contrast, the enhancement effect of fusicoccin was confined to the basal root zones and that of iron deficiency to the apical root zones. Also the rates of proton extrusion per unit of root fresh weight differed remarkably and increased in the order: Fusicoccin << K(2)SO(4) < (NH(4))(2)SO(4) < iron deficiency.Under iron deficiency the average values of proton extrusion for the whole root system are 5.6 micromoles H(+) per gram fresh weight per hour; however, for the apical root zones values of about 28 micromoles H(+) can be calculated. This high capacity is most probably related to the iron deficiency-induced formation of rhizodermal transfer cells in the apical root zones. It can be assumed that the various types of root-induced acidification of the rhizosphere are of considerable ecological importance for the plant-soil relationships in general and for mobilization of mineral nutrients from sparingly soluble sources in particular.