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Biomedical subjects

D Christmann

Publications and source records attributed to D Christmann.

At least 19 recordsLinked to original sources
PubMed2001

CSF-folate levels are decreased in late-onset AD patients.

Folates are involved in the cerebral metabolism of cobalamine, methionine, L-tyrosine and acetylcholine. Remarkably CSF-folate levels are 3 to 4 times higher than blood-folate levels. To reach the brain, folates are actively transported by choroid plexus (CP) as well as vitamins B6, B12, C and E. Epithelial atrophy having been reported in aging and in Alzheimer's disease (AD), we measured the CSF folate-levels of 126 patients, including 30 AD consecutive patients to evaluate whether CP functions of folate-transport were impaired. CSF-folate concentrations did not vary with age (10.47 +/- 1.93ng/ml between 20 and 60 years; 9.96 +/- 2.01 ng/ml in elderly control patients older than 60 years of age, p > 0.05) while late-onset AD patients had significantly lower CSF-folate levels (8.26 +/- 1.82 ng/ml, p < 0.001). These data support a specific alteration of CP transport function in AD patients.

Adult↗
PubMed2000

Randomized trial on the effect of radiotherapy in addition to 6 cycles CMF in node-positive breast-cancer patients. The German Breast-Cancer Study Group.

In 1984 the GBSG started a multicenter randomized trial to compare the effectiveness of 6 cycles of cyclophosphamide, methotrexate and fluorouracil (CMF) with or without radiotherapy (RT) as adjuvant treatment in node-positive breast-cancer patients treated by mastectomy. During 5 years, 199 patients were randomized. After a median follow-up of about 9 years, the treatment groups 6 x CMF and 6 x CMF + RT were compared regarding time to recurrence and death. As the first event of failure, we observed locoregional recurrence in 22 patients, distant metastases in 66 patients, a secondary malignancy in 9 patients and death without previous event in 5 patients. For event-free survival (EFS), no significant difference was observed [relative risk (RR) 6 x CMF + RT vs. 6 x CMF 0.82, 95% confidence interval (CI) 0.55-1.21]. Event-specific analysis showed a significant decreased risk after radiotherapy for locoregional recurrence. The risk for distant metastases was estimated as slightly decreased and the risk for secondary malignancy and for death without previous event was estimated as increased in treatment group 6 x CMF + RT in comparison with treatment group 6 x CMF, but these effects were not significant. For overall survival (OS) and breast-cancer-specific survival (BCS), no significant treatment effect could be demonstrated. There is a beneficial effect of radiotherapy on locoregional recurrence. For EFS and BCS, a tendency in favour of radiotherapy is observed, but this is not significant; for OS, no difference can be demonstrated, but the power of the study is too low to detect small treatment effects.

Adult↗
PubMed2000

Radiological evaluation of Duhamel's operation in Hirschsprung's disease. Attempt at radio-clinical correlation.

The aim of this study was to evaluate the results of the Duhamel cure technique in a case of Hirschsprung's disease with a barium colorectal opacification by low approach. The overall height of the rectal stump (HR), the depth of the blind part of the rectum (PR), the rectal diameter (DR), the diameter of the colorectal anastomosis (DA) were measured. The rectal volume of its blind part (VRB), the rectal volume of its functional part (VRF), the surface of the colorectal and subanal anastomosis, the VRF/VRB ratio were calculated. Two types of subgroups were analysed: -the patients in whom the rectal stump had been closed by stapling (13 cases) and those where the rectal stump was manually closed (13 cases). -the patients who had no transit trouble (20 cases) and those in whom a stercoroma or coproma had formed, including phenomena either similar to encopresia or to soiling. The manual suture of the top of the rectal stump does not show any significant difference compared to stapling. The rectal height (HR=71 mm+/-1.9), the blind rectal stump depth (PR = 36 mm+/-2.2) of the 6 patients with stercoroma are significantly higher than with the other 20 patients (HR = 51.6+/-2.6 and PR = 24.4+/-2.7, i.e. respectively p = 0.0005 and p = 0.03). VRF and VRB are equal in the group with stercoroma, and VRF is twice or more than VRB in the group without any problem. If it is impossible to obtain a sufficiently short rectal pouch, an excessive HR may be balanced by a longer colorectal anastomosis with a higher VRF/VRB ratio. This is of importance in laparoscopic procedure.

Barium Sulfate↗
PubMed2000

[Contribution of 3D CISS MRI for pre- and post-therapeutic monitoring of obstructive hydrocephalus].

This report describes the use of the recent three-dimensional Fourier transform constructing imaging in the steady state (CISS) MR sequence in the management of obstructive hydrocephalus. It is a gradient-echo imaging technique with high resolution which remains sensitive to flow. It enables locating the obstruction and determining the upstream impact. It provides anatomical information about third ventricle (V3) morphology and relationships useful before ventriculostomy. Twenty patients with obstructive hydrocephalus at the level of cerebral aqueduct or posterior V3 underwent sagittal 3DFT-CISS acquisition, supplemented by frontal, axial and coronal reformations in the cerebral aqueduct axis. 9 patients were examined after ventriculostomy with the same protocol. CISS-3DFT allows good visualization of the cerebral aqueduct and diagnosis of the underlying cause of obstruction (malformation, tumor), sometimes better than classical sequences. In case of complete obstruction, the flow-related signal void is usually absent in the cerebral aqueduct or V3. The position of V3 floor and its relationship with the tip of basilar artery are well analyzed. The dilatation of the anterior V3 recesses is a better sign of activity of hydrocephalus - and then of therapeutical indication - than classical transependymal resorption signs which are not always present in chronic longstanding adult hydrocephalus. Of the 9 ventriculostomy patients seven had linear flow-related signal void through V3 floor, from anterior V3 to basal cisterns on the postoperative MR study. This flow void confirms patent ventriculostomy.

Adolescent↗
PubMed1999

Intestinal intussusception survey about diagnostic and nonsurgical therapeutic procedures.

OBJECTIVE: To provide an overview of the diagnostic and therapeutic procedures performed by European paediatric radiologists in the management of intussusception. MATERIALS AND METHODS: A postal survey was sent to the European members of ESPR. Items surveyed included diagnostic imaging procedures (plain films, US, contrast enema [CE]), contrast medium used (barium, iodine, air, saline solution), and imaging technique used for monitoring during reduction (films, fluoroscopy, US). Multiple answers were possible. Other data, including contraindications, maximum pressure, pressure and irradiation monitoring, presence of a surgeon, sedation, number and duration of attempts, and hospitalisation were also obtained and analysed. RESULTS: There were 204 respondents (60.2 %). Regarding diagnosis, 72.5 % of respondents used plain radiographs, 93 % US, and 34 % CE. Reduction was performed using air (55 %), a barium suspension (32 %), iodinated contrast medium (24 %), or a saline solution (10 %). Reduction was monitored using fluoroscopy alone (46 %), fluoroscopy and radiographs (49.5 %), US alone (9.5 %), or a combination of radiology and US (18 %). Pressure was monitored by 81 % of respondents. Most respondents (82.4 %) used a maximum pressure between 100 and 120 mm Hg. CONCLUSIONS: US is widely used for diagnosing intussusception. For treatment, contrast medium and air reduction are used almost equally. A large number of radiologists are now performing intussusception reduction using US monitoring.

Child↗
PubMed1999

Isolated renal Aspergillus abscess in an AIDS patient with a normal CD4+ cell count on highly active antiretroviral therapy.

Isolated renal Aspergillus abscess is a very rare complication of HIV infection. It usually occurs in patients with severe immune deficiency. The case of a 29-year-old HIV-infected homosexual male, a nonintravenous drug abuser, who developed a right renal Aspergillus abscess despite normalization of the CD4+ cell count after highly active antiretroviral treatment is described. When antimicrobial treatment failed (amphotericin B followed by itraconazole), he was cured by right nephrectomy and remains in good health 3 months later with no recurrence. In cases of Aspergillus renal abscess in HIV-infected patients, surgery is the treatment of choice, especially in the current era of highly active antiretroviral therapy.

AIDS-Related Opportunistic Infections↗
PubMed1999

[A case report of post-rubella myelitis in an adult].

Neurological complications following rubella are only rarely encountered. We report a case of isolated myelitis. A 44-year-old healthy female suffered from an erythematous macular rash which rapidly cleared. However, the following days, dysuria initiated hospitalization. On admission, she was febrile but alert and in normal mental status. General physical examination was quite unremarkable. Four days later, she suffered from acute urinary retention, fecal retention and vaginal hypoesthesia. Routine laboratory data, chest skull and spinal column X-rays were unremarkable. The sterile cerebrospinal fluid contained 30 lymphocytes/mm3, 0.48 g/ml of protein but normal amount of glucose. Rubella antibody titers showed a significant elevation and specific IgM were detected by immunocapture. Improvement was rapid and recovery was uneventful except a mild vaginal hypoesthesia that persisted 5 weeks later. Diffuse myelitis occurring shortly after rubella vaccination have also been described. The immunopathological mechanisms by which involvement of the nervous system occurs is far from clear. Little is known about the pathogenesis of post-vaccination myelitis and although the mecanism of sensitization and the specific neural antigens are not known, post-infectious and post-vaccinal myelitis are thought to share a common pathogenic basis.

Adult↗
PubMed1999

[Prenatal and neonatal management of digestive tract duplications. Diagnostic difficulties and therapeutic implications].

OBJECTIVE: To insist on the difficulty of the antenatal diagnosis of digestive duplications, to show the importance of a complete malformative screening, and the need for immediate management at birth. MATERIAL AND METHODS: A cystic duplication of the tongue, a duplication, abdomino-thoracic transdiaphragmatic, and a duplication of the small bowel are described and compared with cases previously reported in th literature. RESULTS: Antenatal evacuation puncture of a duplication of the tongue must be reserved for exceptional situations. Foregut duplications are often associated with other malformations. The duplication of the small intestine can exceptionally expose to a mechanical complication, mostly during the postnatal period, which may require emergency surgery. CONCLUSION: Duplications of the alimentary tract should be detectable on prenatal ultrasound examination. A complete antenatal malformative screening is required and in utero transfer is warranted because emergency surgery may be required.

Abnormalities, Multiple↗
PubMed1998

[Group A Streptococcus pyomyositis].

BACKGROUND: Pyomyositis is a group of infectious diseases involving muscle tissue. Staphylococcus aureus is usually the causal agent. Group A Streptococcus infections are uncommonly isolated in pyomyositis. Streptococcal pyomyositis can be distinguished by its severity. Death rate may be as high as 50%. CASE REPORTS: Diagnosis of cervical pyomyositis was made in 2 patients on the basis of ultrasound and computerized tomography findings. Group A Streptococcus was isolated from local samples. The diagnosis was confirmed at surgery. Host defense mechanisms were not deficient in either patient. Outcome was favorable in both patients after antibiotic therapy. DISCUSSION: Because of the seventy of group A streptococcal pyomyositis, early diagnosis is essential for prognosis. Ultrasound and computerized tomography are very helpful. Group A streptococcal pyomyositis should be considered as a life-threatening disease.

Adult↗
PubMed1998

[Emphysematous pyelonephritis].

Pyelonephritis is a frequent infection of variable severity. Mortality is low since the era of antibiotics. Emphysematous pyelonephritis is however a rare but life threatening form of kidney infection, which affect more frequently diabetic subjects, characterized by gas producing bacteria. These gaseous lesions can be localized in the renal parenchyma or in the perirenal or retroperitoneal space. Diagnosis became easier with the advent of CT scan. Treatment usually requires surgery and antibiotics. We report a case of emphysematous pyelonephritis in a diabetic patient. The CT scan strongly suggested the diagnosis which was confirmed per-operatively. Proteus mirabilis is exceptionally described in emphysematous pyelonephritis.

Aged↗
PubMed1997

[Rheumatoid purpura and intravenous immunoglobulins].

Henoch-Schönlein purpura is a vasculitis usually with a benign course. Abdominal symptoms occur in 70% of cases, with possible intussusception or intestinal perforation. There is no clear evidence of the efficacy of a treatment in complicated cases of Henoch-Schönlein purpura. Corticosteroids improve abdominal pain but they do not have any effect on renal involvement or prevention of relapses. Intravenous immunoglobulins have been efficient in some cases with recurrent abdominal symptoms or progressive renal lesions. We report the case of a 19-year-old patient with severe abdominal involvement and early renal manifestations of Henoch-Schönlein disease, rapid and sustained improvement was obtained by intravenous immunoglobulins given during 48 hours.

Adult↗
PubMed1997

[Superior sagittal sinus thrombosis and nephrotic syndrome: favorable outcome with low molecular weight heparin].

BACKGROUND: Nephrotic syndrome is known to be associated with thrombosis but rarely of cerebral vessels. CASE REPORT: A 3-year old child with steroid-dependent nephrotic syndrome was hospitalized for drowziness followed by a left hemiparesis. The CTscan showed a superior sagittal sinus thrombosis. The child completely recovered after treatment by low molecular weight heparin (LMWH). CONCLUSION: LMWH could be used for preventing and/or treating thrombosis associated with nephrotic syndrome. Nevertheless, controlled studies are necessary for assessing its efficacy and absence of risk in children.

Anticoagulants↗
PubMed1997

[Malaria brought into Strasbourg: an epidemiological, clinical, biological and therapeutic study].

In a retrospective study, we registered 210 patients hospitalized in Strasbourg for malaria from 1984 to 1995. The diagnosis was always confirmed by presence of the parasite on blood smears. We analysed the epidemiological, clinical, biological and therapeutic data. The number of cases rose each year, with a maximum in 1995. The majority of cases occurred in January and from August to October, these periods corresponding with the return of travelers. In most cases, infection took place in Africa. In this region, Plasmodium falciparum is the most frequent species of the parasite. The mean age of the patients was 33 years. The clinical manifestations were polymorphic: fever, chills, sweating, and headache were very frequent. We noted 15 serious infections (with the WHO's definition) and two cases of cerebral malaria. All cases had a favorable outcome. Five cases occurred in pregnant women; two of them had a severe form of malaria. Among the biological abnormalities, we found thrombopenia, haemolysis, hypocholesterolaemia and hypertriglyceridaemia. The significance of disturbance of the lipid metabolism is not known. Hypocholesterolaemia is very frequent, and hypertriglyceridaemia seems to be associated with severe malaria. Most malaria attacks occurred in patients without adequate chemoprophylaxis. This confirms the importance of prophylactic information given to patients by their physicians. Resistance develops against each new medication that is available; among these quinine remains the drug of choice to cure severe malaria.

Adult↗
PubMed1997

Cerebrospinal fluid transthyretin: aging and late onset Alzheimer's disease.

The deposition of insoluble beta-amyloid protein fibrils is probably the central event in the pathogenesis of Alzheimer's disease. Cerebrospinal fluid inhibits this fibril formation, likely by the intervention of one or several proteins binding to soluble beta-amyloid protein. In vitro, transthyretin (TTR), a CSF protein, impedes amyloid fibrillogenesis. Lowered concentrations of CSFTTR could therefore be associated with Alzheimer's disease. Concentrations of TTR in CSF samples from 149 consecutive patients were assayed, using a kinetic nephelemetric method. These concentrations were correlated positively with age, but were significantly lower in patients with Alzheimer's disease. These data raise the possibility that amyloid fibril formation could be promoted in patients with late onset Alzheimer's disease by the lack of sufficient concentrations of TTR.

Adolescent↗