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Biomedical subjects

D Dommasch

Publications and source records attributed to D Dommasch.

At least 19 recordsLinked to original sources
PubMed2004

Escalating immunotherapy of multiple sclerosis--new aspects and practical application.

Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies. Initiation of treatment after the first relapse may be indicated if there is clear evidence on MRI for subclinical dissemination of disease. Recent trials show that the efficacy of interferon beta treatment is more likely if patients in the secondary progressive phase of the disease still have superimposed bouts or other indicators of inflammatory disease activity than without having them. There are now data available, which suggest a possible dose-effect relation for recombinant beta-interferons. These studies have to be interpreted with caution, as some potentially important issues in the design of these studies (e. g. maintenance of blinding in the clinical part of the study) were not adequately addressed. A meta-analysis of selected interferon trials has been published challenging the value of recombinant IFN beta in MS. The pitfalls of that report are discussed in the present review as are other issues relevant to treatment including the new definition of MS, the problem of treatment failure and the impact of cost-effectiveness analyses. The MSTCG panel recommends that the new diagnostic criteria proposed by McDonald et al. should be applied if immunoprophylactic treatment is being considered. The use of standardized clinical documentation is now generally proposed to facilitate the systematic evaluation of individual patients over time and to allow retrospective evaluations in different patient cohorts. This in turn may help in formulating recommendations for the application of innovative products to patients and to health care providers. Moreover, in long-term treated patients, secondary treatment failure should be identified by pre-planned follow-up examinations, and other treatment options should then be considered.

Clinical Trials as Topic↗
PubMed1992

Impaired visual perceptual categorization in right brain-damaged patients: failure to replicate.

The association of both Perceptual Categorization (PC) and Semantic Categorization (SC) with sensory performance was investigated. 28 RBD, 27 LBD and 21 non-brain-damaged subjects were tested with the PC and SC tasks described by Warrington and Taylor (1978) and with 6 sensory tasks. PC was related to sensory performance in RBD but not in LBD patients. SC was only marginally associated with sensory ability in both lesion groups. RBD and LBD patients differed significantly at neither PC nor at SC. Thus the dissociation between PC and SC, described by Warrington and Taylor (1978) was not replicated. Moreover, PC and SC were significantly correlated in both RBD and LBD patients. This suggests that the serial organization of PC and SC is questionable. It is concluded that the associations we obtained between SC, PC and sensory performance are likely to be functional. The contribution of a cognitive factor ("abstraction") to PC and SC is discussed.

Brain Injuries↗
PubMed1988

Cyclosporine versus azathioprine in the long-term treatment of multiple sclerosis--results of the German multicenter study.

In a double-blind controlled trial of 194 patients with clinically definite active multiple sclerosis, 98 were randomized to treatment with cyclosporine (CyA, 5 mg/kg/day), and 96 to treatment with azathioprine (Aza, 2.5 mg/kg/day). Eighty-five patients in the CyA group and 82 in the Aza group completed a treatment period of 24 to 32 months in accordance with the study protocol. No significant differences could be detected between the two treatment groups at the end of the trial. Assessment was done by serial quantitative neurological examinations and Kurtzke's Expanded Disability Status Scale. Frequency of relapse and patient self-evaluation also failed to show significant differences. Overall deterioration observed in both groups during the trial was only minor. The incidence of side effects in the CyA group was more than two times that in the Aza group. We conclude that CyA as a single agent cannot be the drug of final choice in long-term immunosuppressive treatment of relapsing-remitting and relapsing-progressive multiple sclerosis.

Adolescent↗
PubMed1988

Comparative clinical trial of cyclosporine in multiple sclerosis: the pros.

In a German multicenter study (L. Kappos, U. Patzold, D. Dommasch, S. Poser, et al) the effects of cyclosporine A on multiple sclerosis (MS) were compared to those of azathioprine in a blind controlled trial of 194 patients. At the time of this report, each of the patients had completed at least 2 years of treatment, and several had been treated for 3 years. Included in the study were patients with MS diagnosed according to Schumacher criteria, who had one or more cerebrospinal fluid changes typical for this disease. We admitted only patients between the ages 18 and 50, who had not had an acute relapse within 10 weeks of entrance to the study and whose Kurtzke Disability Status Scale (DSS) rating was below 6.5. Our findings indicate that the drug was well tolerated; however, elevated serum creatinine values and elevated blood pressures (not always related to each other) were the main side effects, despite a meticulous monitoring of cyclosporine A blood levels. There was only a minor overall clinical deterioration in both groups.

Azathioprine↗
PubMed1986

Primary non-Hodgkin's lymphomas of the CNS.

This paper reports on 10 patients (4 male, 6 female) with primary non-Hodgkin's lymphomas of the brain (CNS-NHL--mean age 46.8 years, mean postdiagnostic survival 10 months). Pathological CSF (cerebrospinal fluid) was found in all 8 patients examined (positive cytology in 7/8 cases). Solitary tumors, diffuse periventricular infiltration or diffuse cerebral infiltration were demonstrated in cerebral computer-assisted tomography (CAT). Angiographical findings were unspecific. The histologic subtypes were lymphoplasmacytoid immunocytoma (4), unclassified low grade (1), centroblastic (1), B-immunoblastic (1), T-immunoblastic (1), lymphoblastic convoluted T-cell type (1), unclassified high grade (1) NHL. Patients who had received radiotherapy (+/- surgery) in this group had a mean survival of 15.66 months (sigma = 7.63). In addition, an overview of 83 well-documented, cases of the literature tries to characterize main histological and topographical distributions, histology-, patient's age-, and therapy-related survival. Patients with primary CNS-NHL have a 5-year survival expectancy of 30% compared with 2.3% in secondary CNS-manifestations of systemic non-Hodgkin's lymphomas. In this report, the beneficial effect of radiotherapy (mean survival 30.3 months) compared to surgery or symptomatic treatment (3.6 or 3.3 months) could be confirmed. It is concluded that primary CNS-NHL frequently present with atypical neuropsychiatric syndromes; diagnosis should be established preferentially with CAT and CSF-examinations or stereotactic biopsies, whereas open surgery should be avoided. An approach to exact classification should be attempted, as survival is clearly related to histological subtypes.

Adult↗
PubMed1981

Myelin basic protein in cerebrospinal fluid of patients with multiple sclerosis and other neurological diseases.

Cerebrospinal fluid (CSF) from 105 patients was analyzed by radioimmunoassay for the presence of material cross-reactive with peptide 89-169 of bovine myelin basic protein (BP). In a group of 72 multiple sclerosis patients, 52 showed higher BP content than the control group, i.e. more than 2 ng/ml CSF. Increased BP or BP fragments could be detected in CSF from almost all patients who recently (within 2 weeks) had had an acute episode, or after deterioration in the progressive form of the disease. Fifteen to 30 days after the onset of exacerbation or in a stable period, BP content decreases and in the slowly progressive form was in the range of the control group with one exception. BP content was also elevated in the CSF of patients with other neurological diseases. The presence of BP in the CSF from patients with isolated retrobulbar neuritis is of particular interest. Thus the presence of material cross-reactive with BP fragment 89-169 is not specific for multiple sclerosis, but is a useful parameter in diagnosis and evaluation of MS.

Cerebrovascular Disorders↗
PubMed1979

Zoster meningitis and radiculomeningitis after tick bite. Cytological findings in cerebrospinal fluid.

Cytological changes in 9 samples of cerebrospinal fluid (CSF) from 5 patients with zoster meningitis and 12 samples from 5 patients with radiculomeningitis after tick bite were examined. 5 days after the onset of the skin eruption, the CSF cells in zoster meningitis consisted of many mononuclear blast forms--large lymphocytes and 'immature' plasma cells. 11-15 days after the onset of the skin rash, they were replaced by small lymphocytes, some 'mature' plasma cells and monohistiocytes. In radiculomeningitis after tick bite, however, the CSF cells examined 10-21 days after the onset of radicular pain consisted of many large lymphocytes, immature plasma cells and a few neutrophils. From these findings, it might be suggested that the acute meningeal reaction of zoster meningitis subsides within about 1 week after the onset of the skin rash, but that of radiculomeningitis after tick bite continues at least for 2-3 weeks after the onset of radicular pain.

Adolescent↗
PubMed1977

Autoradiographic demonstration of proliferating cells in cerebrospinal fluid.

The proliferative activity of cells, isolated from 82 human CSF specimens, was examined by 3H-thymidine autoradiography. High labelling indices (LI) were found in acute viral meningitis (up to 8 per cent) and radiculitis (up to 6 per cent). CSF cell proliferation was also shown in the subacute stages of viral diseases and in other inflammatory processes (LI ranging from 0.5 per cent to 3 per cent). Most of the cells labelled from these CSF specimens were large lymphocytes, "lymphoid cells" and plasmacytes. Their presence in CSF is presumed to indicate an immune reaction. By the demonstration of a proliferative activity of these cells, aseptic inflammatory processes can be differentiated from "unspecific" pleocytosis. Because of a correlation between the LI of CSF cells and the stages of some inflammations, this method is suggested for an assessment of pregression or remission of chronic processes, e.g. "chronic meningitis" and multiple sclerosis. It can also be used in experimental research: the same type of mononuclear cells was labelled after having been cultured for 23 hours prior to the incubation with 3H-thymidine. Proliferating tumor cells as well as proliferating non-neoplastic mononuclear cells were demonstrated in CSF from various neoplastic diseases. In the clinical diagnosis of these processes, the method is of limited value. It proved very useful, however, for an assessment of the therapeutic effects of intrathecal cytostatic therapy. CSF specimens from non-inflammatory and non-neoplastic diseases regularly contained very few proliferating cells (LI: less than 0.1).

Autoradiography↗
PubMed1977

[Intensive care in rabies. A case report (author's transl)].

A case of human rabies is reported showing a peculiar course in some respects. The lack of a satisfactory history concerning an animal bite 5 months earlier as well as a misleading psychiatric history led to difficulty and delay in reaching a diagnosis. Under intensive care, including mechanical ventilation and cardiac pacing, the disease reached a final stage, which is rarely seen. The clinical course and the pathological findings are described in detail and the etiology and prognosis of the disease are discussed. The latter remains rather hopeless de spite modern intensive care.

Adult↗
PubMed1976

Intrathecal cytostatic chemotherapy of meningitis carcinomatosa. Clinical manifestation and cerebrospinal fluid cytology in a case of metastatic carcinoma of the breast.

Effects of intrathecal cytostatic chemotherapy on the clinical symptoms and cerebrospinal fluid (CSF) findings are being demonstrated in a case of metastatic carcinoma of the breast with sighns of meningeal irritation and cranial nerve involvement. Clinical symptoms disappeared after repeated intrathecal applications of methotrexate. CSF cell counts were reverted to normal but tumor cells were found to be persistant in CSF over a period of 19 months. Risks of combined intrathecal and systemic cytostatic therapy and possible effects of parenteral citrovorum factor applications are being discussed. The importance of continued intrathecal chemotherapy and of regular and thorough examination of CSF cells in meningitis carcinomatosa is emphasized. Cytological methods included investigations on viable CSF cells.

Adenocarcinoma, Mucinous↗
PubMed1975

Monocytes and histiocytes in cell cultures of cerebrospinal fluid. Morphology of cultured CSF cells.

A method of CSF cell culturing, based on observations of cultured cells isolated from 700 CSF specimens obtained for routine diagnostic procedures by lumbar puncture from patients who had no proven or suspected neoplastic disease, is described which enables the demonstration of proliferating mononuclear elements even when they are present in specimens with low cell count. Spread on surfaces of plastic and glass material, monocytes and histiocytes in CSF cell cultures can appear as polygonal or crescent shaped epitheloid cells, may assume spindle shapes, or transform into multinucleated giant cells. Some cells given rise to clones with different rates of proliferation, up to the formation of a monolayer. After short term culturing the cytochemical characteristics of the cells are comparable to those of the native cells. Phagocytosis in culture is possible. Cells with a high rate of proliferation can be isolated from CSF specimens in subacute non-bacterial inflammatory processes, in chronic meningitis, in the state of repair of bacterial meningitis and subarachnoid hemorrhage, after repeated lumbar punctures and other unspecific irritations such as myelography and pneumencephalography, and in the course of intrathecal cytostatic therapy.

Acid Phosphatase↗