Art in dermatology versus dermatology in art. Anton Elfinger (1821-1864) and Carl Heitzmann (1836-1896) Hebra's forgotten painter-physicians.
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Austria↗
Biomedical subjects
C Schmidt
Publications and source records attributed to C Schmidt.
The Vienna implantable centrifugal blood pump.
Because of the inherent disadvantages of membrane pumps, rotary pumps have been increasingly investigated in recent years. As a result of improving biocompatibility, extended assistance with implantable devices is of special interest. Questions arise concerning shear stress, blood traumatization, design of seals, and specific control conditions. In their development of an implantable impeller pump, the Vienna group studied the minimization of hemolysis and thrombus formation by means of numerical simulation, visualization, and in vitro blood evaluation. The latter was revealed to be the most powerful tool for pump evaluation. With optimization of geometry, a hemolysis of in vitro: IH = 0.008; MIH = 0.58; and in vivo: 2.1 to 3 mg% plasma-free hemoglobin could be obtained. For proper control and physiological adaptation, a controller based on a nonlinear and a fuzzy strategy was developed. Furthermore, a method for evaluation of the contractility of the assisted heart during nonpulsatile support was tested by computer simulation. This paper summarizes the evaluation methods used and provide an overview of the results of pump and controller design.
Animals↗
Phosphorus magnetic resonance spectroscopy: a noninvasive technique for the study of occlusive arterial leg disease and peripheral vasodilator therapy.
Using 31P nuclear magnetic resonance spectroscopy of the calf muscle, the authors studied patients with peripheral arterial occlusive disease. They studied PCr depletion and intracellular pH during aerobic exercise in patients and controls. The phosphocreatine (PCr) index ([PCr]/([PCr] + [Pi])) at rest was correlated with blood flow measured by plethysmography. During aerobic exercise a greater decrease in pH was obtained in patients (p < 0.03). They also studied the work necessary to reach a PCr index = 0.5 during ischemic exercise. This workload was lower in patients than in controls: 32.99 +/- 3.04 J vs 58.89 +/- 8.55 J, p < 0.05. After vasodilator therapy the workload was improved in patients: 32.99 +/- 3.04 J vs 38.85 +/- 3.54 J, p < 0.05. These results suggest that therapy resulted in improved tissue perfusion in patients.
Arterial Occlusive Diseases↗
Dermato-pathologia 1792 and Henry Seguin Jackson (1750?-1816): a bicentennial.
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Dermatology↗
C-type natriuretic peptide (CNP) in the pituitary: is CNP an autocrine regulator of gonadotropes?
Natriuretic peptides act via receptors with intrinsic guanylate cyclase activity to stimulate cGMP production and are thought to be important regulators of neuroendocrine systems. C-Type natriuretic peptide (CNP) is of particular interest in this regard because the highest tissue concentrations of CNP occur in the anterior pituitary, where it is a highly potent stimulator of cGMP production. Here we show that pituitaries of rats and mice contain abundant CNP prohormone messenger RNA (mRNA), but no atrial natriuretic peptide or B-type natriuretic peptide prohormone mRNAs. Using reverse transcriptase-polymerase chain reaction, both A- and B-type natriuretic peptide receptor (GC-A and GC-B, respectively) transcripts were detected in rat and mouse pituitaries, although only the GC-B mRNA was measurable by Northern blotting. Immunohistochemistry revealed CNP-positive cells in the anterior, but not posterior, pituitaries of rats, and the vast majority of these cells were identified as gonadotropes by colocalization of CNP and LH immunoreactivities. Targeted toxicity using GnRH conjugated to the ricin-A chain was used to test whether gonadotropes are also direct targets for GnRH action. The conjugate dose dependently inhibited the proliferation of alpha T3-1 cells (gonadotrope-derived cells with GnRH receptors), but had no such effect on GH3 cells (which do not have GnRH receptors). Culture of rat pituitary cells with the conjugate caused comparable reductions in CNP-stimulated cGMP production, GnRH-stimulated LH release, and CA2+ ionophore (A23187)-stimulated LH release, but did not measurably alter cAMP production in response to pituitary adenylate cyclase-activating polypeptide. We conclude that CNP is synthesized in the pituitary, where it is located predominantly in gonadotropes, and GC-B receptors expressed in the pituitary mediate the direct effects of CNP in gonadotropes. Together with the recent demonstration of CNP synthesis and action in alpha T3-1 cells, the data suggest CNP to be a novel autocrine regulator of gonadotropes.
Animals↗
Reflex laryngospasm induced by stimulation of distal esophageal afferents.
Distal esophageal sensory nerves were stimulated in 17 anesthetized dogs divided into three age groups to determine the laryngeal, cardiovascular, and respiratory effects. Group I puppies were 5 to 6 weeks of age, group II puppies were 8 to 19 weeks of age, and group III animals were adult dogs. Marked laryngeal adductor activity and laryngospasm were observed in group II puppies, while no or minimal laryngeal adduction was seen in younger puppies and adult dogs. Mean arterial pressure and heart rate increased significantly in groups II and III (P < .005) but remained unchanged in group I animals (P > .4). This response is distinctly different from the laryngeal chemoreflex because central apnea, hypotension, and bradycardia were absent. The afferent limb of the response is mediated by the vagus nerve as bilateral transthoracic truncal vagotomy eliminated the reflex. The laryngeal response observed following stimulation of distal esophageal afferent fibers may be important in the mechanism of apparent life-threatening events (ALTEs) and the sudden infant death syndrome (SIDS) associated with gastroesophageal reflux disease.
Afferent Pathways↗
Total hip replacement in patients with osteoarthritis of the hip: improvement in pain and functional status.
A simple, self-rating questionnaire was developed to assess the clinical outcome related to pain and function after total hip replacement surgery followed by physical therapy. Twenty-two patients, 57 to 86 years of age, with osteoarthritis of the hip who underwent total hip replacement surgery and received physical therapy following surgery, participated in the study. A questionnaire consisting of 11 items was developed to ascertain the level of pain, functional ability and the assistive ambulatory device used to perform selected activities of daily living. A maximum cumulative score of 55 points was possible. The functional categories monitored included: sitting, standing, sleeping, functional walking, distance walking, stair climbing, sitting/standing from a toilet seat, driving, and sexual activities. The questionnaires were completed preoperatively, and postoperatively at 3 and 6 months. The results showed an overall improvement of 56% at 3 months and 64% at 6 months after surgery. Twenty of 22 patients obtained "excellent" results with total hip replacement surgery and follow-up physical therapy. Results of this study indicated that total hip replacement followed by physical therapy decreases joint pain and improves function in patients with osteoarthritis of the hip.
Activities of Daily Living↗
Increasing occupational therapy research: is it time to try something new?
Lack of substantial occupational therapy research is a recognized and persistent problem; which is often discussed throughout the literature but not truly addressed. Action must be taken to involve clinicians in the effort to substantiate the efficacy of treatments through outcome studies. We offered several proactive recommendations that could be implemented on a national level to encourage hesitant practitioners to conduct research. Past recommendations have not tapped the expertise of a large segment of our profession. Our recommendations will enhance the accessibility of research to a greater percentage of occupational therapy professionals by specifically targeting problems related to money, education, and time.
Education, Continuing↗
[Focus on a quick reading of nailfold capillaroscopy].
The diagnostic value of nailfold capillaroscopy was assessed through blind analysis of a continuous series of 307 examinations and a method for quick reading of nailfold capillaroscopy was elaborated with discriminant analysis. The best criteria for predicting the existence of a systemic disease were: major dystrophies (megacapillary, neocapillary and regressive capillary), minor dystrophies and capillary bed abnormalities, especially in patients presenting with vascular disorders of the upper extremities. Capillaroscopic stages and existence of systemic disease were significantly correlated. Discriminant analysis could globally predict the existence of a systemic disease with age and 4 criteria. In subjects with vascular disorders of the upper extremities it needed only age and 3 criterias (abnormal coloration, major dystrophy presence and percentile of minor dystrophies greater than 15%) but without higher diagnostic value (94.2% of patients with systemic disease and 65.6% of patients without systemic disease were correctly classified). Discriminant analysis allows quick reading of nailfold capilloroscopy in the first examination of patients with vascular disorders of the upper extremities.
Adult↗
[Opto-electronic volumetry: another method for quantification of edema].
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Adult↗
[Management of indoor air pollution by polychlorinated biphenyl compounds exemplified by two Hagen schools].
An indoor pollution of polychlorinated biphenyls (PCB) of about 4000 ng/m3 could be reduced by an average amount of 68% by temporary sealing of the primary source in combination with intensive cleaning. The costs were around DM 100,000.- for the school building containing 12 classrooms. Due to this procedure a continued usage of the building is possible until a concept of decontamination is available. In another building the PCB indoor pollution was reduced by 73% in a representative trial restoration, whereas the stripping of the paint with a chemical caustic substance induced a significant reduction of the PCB concentration. The usage of special air conditioners--called "Luftwäscher"--in the classrooms did not reduce the PCB concentration. The realisation of disturbing factors such as the fluctuation of the temperature is of great importance for judging the efficiency of decontamination procedures. The possible misinterpretation regarding the results and the data of decontamination procedures can be excluded by parallel measurements in control rooms. Costs induced by these additional analyses will be reduced by the early realization of ineffective steps.
Adolescent↗
Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate.
We describe a fully automated particle-enhanced turbidimetric assay for cystatin C in undiluted serum and EDTA-plasma. The throughput is 90 samples per hour and urgent samples can be analyzed in 7 min. The assay range (0.4-14.1 mg/L) covers the concentration range in health and disease. The within- and between-run imprecision is 0.9% and 2.2%, respectively. Analytical recovery of additions of recombinant cystatin C averaged 98%. Rheumatoid factors (< or = 323,000 IU/L), bilirubin (< or = 150 mumol/L), hemoglobin (< or = 1.2 g/L), and triglycerides (< or = 8.5 mmol/L) do not interfere in the assay. In view of the superior (by ROC analysis) diagnostic accuracy of serum concentrations of cystatin C for reduced glomerular filtration rate (GFR) in comparison with creatinine, cystatin C seems an attractive alternative to creatinine for estimation of GFR.
Autoanalysis↗
In vitro chamber specification during embryonic stem cell cardiogenesis. Expression of the ventricular myosin light chain-2 gene is independent of heart tube formation.
The molecular cues that control patterning of the heart tube during early cardiogenesis are largely unknown. The present study has explored the embryonic stem (ES) cell differentiation system to determine if this in vitro model could be useful in studying the process of regional specification of cardiac muscle cells at the earliest possible stages. As assessed by polymerase chain reaction, ribonuclease protection, in situ hybridization, and immunohistochemical analyses, ES cell differentiation into embryoid bodies is characterized by the transcriptional and translational activation of the ventricular regulatory (phosphorylatable) myosin light chain gene, demonstrating that ventricular specification occurs during ES cell cardiogenesis. The finding of a ventricular-specific marker in an in vitro system in the absence of an intact heart tube provides evidence for cardiac regional specification independent of positional cues or physiologic stimuli. The temporal expression of the myogenic regulatory factors, myogenin and MyoD, suggests activation of the skeletal muscle program following cardiac myogenesis in vitro, indicating temporal fidelity to the progression of in vivo myogenesis. These data establish the mouse embryonic stem cell system as a model for cardiac chamber specification and suggest a promising approach in the study of regional specification in genetically engineered cardiac muscle cells.
Animals↗
[Muscle weakness].
A 61 year old man complained initially about pain in the left lower leg with increasing swelling of the entire left leg. A slight swelling of the left ankle and knee and an erythematous skin change of 5 cm diameter developed and disappeared after a few hours. Two days later the patient complained about a sudden and massive weakness of the proximal skeletal muscles, progressive disturbance of swallowing, hoarseness and dark red to bluish erythematous skin eruptions on the right knee and buttock. An elevated creatinine-kinase and lactate-dehydrogenase were found. Dermatomyositis was diagnosed and treatment with high dose steroids initiated. Under this treatment the patients condition deteriorated dramatically. A treatment with plasmapheresis and cyclophosphamide was begun. A significant improvement occurred over three weeks. The patient was discharged, rehabilitated and remains free of symptoms on 10 mg cortisone. A neoplasm has so far not been detected.
Acute Disease↗
[Peri-ungual capillaroscopy. Value in the diagnosis of systemic diseases].
The diagnostic value of nailfold capillaroscopy was assessed through blind analysis of a continuous series of 354 examinations. Major and minor dystrophies and capillary bed abnormalities are the best criteria, especially in patients presenting with vascular disorders of the upper extremities. A systemic disease (specificity: 82.7 percent; negative predictive value (NPV): 90.2 percent) and specifically a systemic scleroderma (sensitivity: 97.1 percent and NPV: 99.4 percent) is improbable in case of normal capillaroscopy. First component analysis distinguished patients with definite systemic disease from normal subjects. Its value is dubious in other connective tissue diseases systemic lupus erythematosus, rheumatoid arthritis, Sjögren's disease, etc.).
Adult↗
[Diarrhea].
A 50-year-old female patient complained about watery diarrhea for two weeks. Because of back pain nonsteroidal antirheumatics had been prescribed for months before. The endoscopic and radiologic investigation demonstrated a large gastrocolic fistula due to NSAID-induced gastric ulceration and an acid-induced colitis in the transverse colon. Treatment consisted in partial gastric resection and resection of the transverse colon.
Anti-Inflammatory Agents, Non-Steroidal↗
[Diarrhea].
A 54-year-old man had recurrent watery diarrhea with up to 10 stools per day for 4 years. The initial evaluation including coloscopy did not disclose a pathologic finding. The symptoms subsided initially after four weeks. Three years later massive watery diarrhea recurred with up to fifteen daily stools. A reevaluation of the patient disclosed the diagnosis of collagen colitis in the colonic biopsy.
Colitis↗