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Biomedical subjects

D Heinrich

Publications and source records attributed to D Heinrich.

At least 19 recordsLinked to original sources
PubMed2003

Necrotizing sarcoid granulomatosis: a rarity in childhood.

Necrotizing sarcoid granulomatosis (NSG) is characterized by pulmonary nodular infiltrates, a typical histology, and a benign clinical course. The etiology and pathogenesis of the disease are still unknown. In childhood, it is extremely rare, with only three reported cases so far. Here we report on an 8-year-old girl, who to our knowledge is the youngest reported patient with NSG. The girl presented with shortness of breath and a sore throat. Chest X-ray and computed tomography (CT) scan revealed multiple nodular opacities of the lung. The symptoms and radiological findings disappeared within 6 months without any treatment. The diagnosis was based on the typical signs and symptoms of NSG and on the exclusion of other diseases. As abnormal immunological findings such as the lack of specific diphtheria antibodies in spite of vaccination against diphtheria were present, we suggest that immunologic mechanisms could play an etiologic role in the pathogenesis of NSG. In addition, the ratio of CD4+/CD8+ T-cells in the peripheral blood was significantly reduced, whereas the CD4+/CD8+ T-cell ratio in the immunohistochemical staining of the lung tissue was elevated. Since this compartmentalization is a typical finding in sarcoidosis, it supports the theory that NSG may represent a variant of sarcoidosis. However, because some characteristics of NSG are uncommon in typical sarcoidosis, NSG may also be an entity in its own right.

Child↗
PubMed2003

[Documentation in the cardiac catheterization laboratory using electronic databases--experiences in 176 German cath labs].

Due to the introduction of a variety of new features to the German health system, such as a new reimbursement system for inpatient work based on diagnosis-related groups, an obligation to detailed documentation for total quality management, as well as due to the continuing increase in the amount of imaging and other data within invasive cardiology, the use of electronic databases for documentation in the cardiac cath lab is of significant importance. The user friendliness and robustness of the software system for daily clinical practice is crucial for the acceptance of electronic documentation systems by physicians, nurses and technicians. This survey was aimed to explore the current practice and experiences of German cardiac catheterization labs with electronic databases particularly designed for documentation in invasive cardiology, including report generation of cath studies, risk and complication management and logistics for medical material ordering for the cath lab. Of the 176 hospitals and practices having agreed in taking part in this surveillance 165, are currently using an electronic database for administration of medical data and study reports. In 64% of the cath labs, a sub-specialized software system for detailed documentation of the course and the results of an invasive procedure, the human and material resources used, generation of the cath report, and documentation of procedural and post-procedural complications for total quality management is used. The acceptance and satisfaction with the software solutions currently available reveals to be rather inhomogeneous. While user-friendliness and flexibility of a number of software products were positively mentioned, main issues, such as missing hardware of software interfaces with the hospital information system for patient administration, missing stability of several systems, image management too complex and report configuration too inconvenient for daily clinical practice, were criticized. In general, in the light of continuing increase of the amount of clinical and imaging data as well as due to the legal obligation of detailed procedural documentation in all areas of invasive cardiology, a documentation system based on electronic databases bears the potential of an enormous economization of the daily workload of a cardiac cath lab. Prerequisites for the acceptance of such a system in clinical practice is not only the stability and reliability of the system but also the ability to link such a sub-system to existing databases via suitable interfaces and the flexibility of the system for modification of its features to meet the individual requirements of each user.

Adult↗
PubMed2001

Acute and long-term effects of booster immunisation on frequencies of antigen-specific memory B-lymphocytes.

In search for a parameter that is predictive of long-term immunity, we analysed the influence of booster immunisations on frequencies of circulating memory B-lymphocytes. Specific IgG-secreting B-cells were determined by ELISPOTassay in 13 healthy adults, using diphtheria and tetanus toxoid as model antigens. Our results show that memory B-cells accumulate with every immunisation dose and remain elevated over several years. In addition, secondary B-cell responses were studied during the first 90 days after diphtheria re-immunisation. A significant indirect correlation was found between the number of previous boosters and the magnitude of specific B-cell expansion. In contrast, effects of booster immunisations did not correlate likewise with antigen-specific serology. Hence, this study illustrates that frequencies of antigen-specific B-lymphocytes can be used as an indirect measure for immunological memory. This parameter could be helpful to find scientifically based immunisation strategies for currently available and novel vaccines.

Adult↗
PubMed2000

Myocardial gene transfer by selective pressure-regulated retroinfusion of coronary veins.

Catheter-based percutaneous transluminal gene delivery (PTGD) into the coronary artery still falls behind the expectations of an efficient myocardial gene delivery system. In this study gene delivery was applied by selective pressure-regulated retroinfusion through the coronary veins to prolong adhesion of replication defective adenovirus within the targeted myocardium. Adenoviral vectors consisted either of luciferase (Ad.rsv-Luc) or beta-galactosidase (Ad.rsv-betaGal) reporter gene under control of an unspecific promotor derived from the Rous sarcoma virus (RSV). In this pig model, selective retrograde gene delivery into the anterior cardiac vein during a brief period of ischemia substantially increased reporter gene expression in the targeted myocardium (LAD region) compared with antegrade delivery as a control. Repeated retrograde delivery during two periods of brief ischemia resulted in a more homogeneous transmural expression predominantly observed in cardiomyocytes (X-gal-staining). In the nontargeted myocardium (CX region) there was no evidence for adenoviral transfection. From our data we infer that selective pressure-regulated retroinfusion is a promising approach for efficient percutaneous transluminal gene delivery to the myocardium. Gene Therapy (2000) 7, 232-240.

Adenoviridae↗
PubMed1999

Comparison of Pura-Vario and Palmaz-Schatz stents following implantation using normal and high pressure in pigs: immediate and late results assessed by 3-dimensional IVUS.

INTRODUCTION: The Pura-Vario stent features 2 newly designed "bridging segments" for enhanced longitudinal flexibility, in order to allow easier and safer stent implantation. METHODS: The aim of the present experimental investigation was to analyze the expansion characteristics of the Pura-Vario stent (PV), and to compare it with the Palmaz-Schatz stent (PS). Furthermore, stent implantation using "high pressure" (18 atm) (HP) was compared with "normal pressure" (12 atm) (NP). Stents (n = 16) were implanted into the left anterior descending artery (LAD) and the circumflex artery (CX) of 8 pigs. Stent area, lumen area and stent asymmetry were measured by means of three-dimensional intravascular ultrasound (3D-IVUS): (1) immediately after implantation, and (2) at 14-days follow-up. RESULTS: Stent expansion was found not to be uniform: the "bridging segments" were significantly larger than the "diamond segments" in either stent model at day 0; this difference, however, disappeared at 14-days follow-up. Despite higher flexibility of the Pura-Vario stent, no difference in stent expansion was found between both stent models, neither immediately after implantation (mean lumen area: 9.75 +/- 0.28 mm2 (PV) vs. 9.82 +/- 0.34 mm2 (PS)), nor at 14-days follow-up (7.44 +/- 0.16 mm2 (PV) vs. 7.45 +/- 0.22 mm2 (PS)). Pura-Vario stents, however, were less asymmetric in the cross-sectional view. Implantation using "high pressure" resulted in larger and less asymmetric stent expansion only at day 0 (lumen area: 9.54 +/- 0.39 mm2 (HP) vs. 8.77 +/- 0.33 mm2 (NP) (p < 0.05)); this difference, however, disappeared after 14 days due to higher stent recoil in the "high pressure" group. CONCLUSION: Despite higher flexibility of the Pura-Vario stent, expansion characteristics of both stent models were comparable. "High pressure" implantation compared favorably with "normal pressure" implantation only at day 0, whereas no difference could be found between both techniques at 14-days follow-up.

Animals↗
PubMed1997

Near infrared diffuse reflection and laser-induced fluorescence spectroscopy for myocardial tissue characterisation.

In order to evaluate the potential of cardiovascular tissue characterisation using near-infrared (NIR) spectroscopy, spectra in a previously unexplored wavelength region 0.8-2.3 micron were recorded from various pig heart tissue samples in vitro: normal myocardium (with and without endo/epicardium), aorta, fatty and fibrous heart tissue. The spectra were analysed with principal component analysis (PCA), revealing several spectroscopically characteristic features enabling tissue classification. Several of the identified spectral features could be attributed to specific tissue constituents by comparing the tissue signals with spectra obtained from water, elastin, collagen and cholesterol as well as with published data. The results obtained with the NIR spectroscopy technique in terms of its potential to classify different tissue types were compared with those from laser-induced fluorescence (LIF) using 337 nm excitation. LIF and NIR spectroscopy can in combination with PCA be used to discriminate between all previously mentioned tissue groups, apart from fatty versus fibrous tissue (LIF) and aorta versus fibrous tissue (NIR), respectively. The NIR analysis was improved by focusing the PCA to the wavelength segment 2.0-2.3 microns, resulting in successful spectral characterisation of all cardiovascular tissue groups.

Animals↗
PubMed1995

[Treatment of chronic virus hepatitis with acetylsalicylic acid].

The treatment of chronic hepatitis B and C with recombinant interferon (IFN) has only poor durable response rates. In the past only the lack of any prior effective therapy regimen could justify the use of this expensive agent. Dose escalating or prolonged treatment courses did not enhance the rate of sustained remissions. Pre- or cotreatment with antiviral (e.g. acyclovir, ribavirin, isoprenosin) or immunomodulating (e.g. prednisone, gamma IFN) drugs have not influenced the resistance to exogenous (IFN) of many patients. The mechanisms underlying resistance to this drug remain unknown. Some hypotheses focus on IFN antibodies, down regulation of IFN receptors or defects in the postreceptor response of cells to IFN. In 1991 Hannigan and Williams (Science 1991; 251: 204-207) described a synergistic signal transduction effect in human fibroblasts after exposure to IFN. Arachidonic acid (AA) activation from membrane phospholipid pools is common to many receptors and can be followed by metabolization of AA by cyclooxygenase to prostanoids, thromboxanes and eicosanoids and by lipoxygenase to leukotrienes; inhibition of these AA oxidation pathways by addition of inhibitors of these enzymes (e.g. indomethacin) resulted in marked amplification of the IFN signal, possibly by using the epoxygenase enzyme family as an alternative pathway. Our data are taken from the pretreatment part of a current study for evaluation of pre- and combination treatment with acetylsalicylic acid (ASA) as cyclooxygenase inhibitor and IFN in chronic hepatitis C. 27 patients with histologically proven chronic active hepatitis C were divided into two groups. Group A (16 patients) were treated with a daily dose of 100 mg ASA orally, and the 11 patients in group B served as untreated controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Influence of polyclonal immunoglobulins on the polymorphonuclear leukocyte response to lipopolysaccharide of Salmonella enteritidis as measured with luminol-enhanced chemiluminescence.

In gram-negative sepsis, the activation of polymorphonuclear leukocytes (PMN) by lipopolysaccharide (LPS) and the resulting production of superoxide and other oxygen radicals may be an important cause of tissue damage. A suppression of the PMN response to LPS stimulation would be therapeutically beneficial. The aim of this study was to determine whether different polyclonal immunoglobulins (Igs; 5S-Ig, 7S-Ig, and 19S-Ig) influence the PMN response to LPS of Salmonella enteritidis in vitro. The respiratory burst activity of PMN was measured with luminol-enhanced chemiluminescence. After addition of a 5S-Ig solution containing F(ab')2 fragments of IgG and a 19S-Ig solution containing 12% polyclonal IgM, luminol-enhanced chemiluminescence was reduced by 27% (P < 0.05) and 46% (P < 0.005), respectively. However, after addition of a 7S-Ig solution containing polyclonal IgG, luminol-enhanced chemiluminescence was increased fourfold (P < 0.05). The results suggest that the influence of polyclonal Igs on PMN response to LPS stimulation is dependent on the Ig class, F(ab')2 fragments of IgG and IgM leading to LPS neutralization and IgG leading to the production of potentially toxic oxygen radicals.

Humans↗
PubMed1993

Upper gastrointestinal hemorrhage preceding development of Bouveret's syndrome.

Gastric outlet obstruction by a gallstone is a very uncommon clinical entity; it was first reported by Bouveret in 1896. In the patient presented, we were able to show the development of formation of the bilioenteric fistula with massive arterial bleeding from the eroded cystic artery until duodenal occlusion. The process was endoscopically and radiologically observed and documented. Although the diagnosis was made immediately, the patient had to undergo surgery because the gallstone proved to be too large to be extracted endoscopically.

Aged↗
PubMed1991

Omega-oxidized leukotriene B4 detected in the broncho-alveolar lavage fluid of patients with non-cardiogenic pulmonary edema, but not in those with cardiogenic edema.

Leukotriene (LT) generation has been implicated in the pathogenesis of the acute respiratory distress syndrome, ARDS. In the present study, we analysed broncho-alveolar lavage fluids of patients on mechanical ventilation because of ARDS (17 samples taken from 9 patients) or because of cardiogenic edema (8 samples taken from 6 patients) and of healthy volunteers (10 samples from different donors). LTs were separated as methylated and non-methylated compounds using different HPLC procedures, and were identified by chromatographic mobility, on-line UV-spectrum analysis and post HPLC immunoreactivity. In the lavage samples of the healthy volunteers and the patients with cardiogenic edema, no LTs were detected by these techniques (detection limit congruent to 0.1-0.2 ng/ml lavage fluid). By contrast, in 15 out of 17 samples from patients with ARDS LTB4 or its metabolites 20-OH-LTB4 and 20-COOH-LTB4 were detected. The endproduct of omega-oxidation, 20-COOH-LTB4, represented the quantitatively predominant compound, detected in the range of 0.3-2.6 ng/ml perfusate. We conclude that the chemotactic agent LTB4 may be involved in the amplification of inflammatory events encountered in ARDS, and that the oxidized metabolites of LTB4 are particularly suitable for monitoring lung leukotriene generation under conditions of neutrophil efflux and oxidative stress.

Adult↗
PubMed1990

Virus safe plasma exchange medium containing essential human plasma proteins.

CFFP (Coagulation Factor Free Plasma from Biotest) is manufactured under standardized conditions from pooled human plasma of more than 1000 donors per lot. It is sterilized by beta-PL/UV and has not the risks of FFP to transmit viral diseases. CFFP offers desirable advantages as a plasma exchange solution over albumin and FFP as it avoids serious depletions or deviation of normal plasma constituents.

Blood Proteins↗
PubMed1990

[Pulmonary function parameters of shock lung patients--results of a follow-up study].

In seventeen patients out of a total of 219 survivors who had received long-term ventilation for pulmonary failure, an examination was carried out to clarify the question as to late pulmonary sequelae. The following sequelae were detected: 1. a diffusion disturbance in five cases, 2. load-dependent pulmonary hypertension in four cases, and 3. a considerable reduction in compliance.

Adult↗
PubMed1988

Deposition of terminal C5b-9 complement complexes on erythrocytes and leukocytes during cardiopulmonary bypass.

Hemolysis, leukopenia, a hemostatic deficit, and nonspecific systemic reactions collectively known as the postperfusion syndrome develop in patients who undergo cardiopulmonary bypass. We now report that terminal C5b-9 complement complexes are deposited on erythrocytes and polymorphonuclear neutrophilic leukocytes during cardiopulmonary bypass. Plasma samples taken from 48 unselected patients during and at the end of cardiopulmonary bypass contained raised levels of fluid-phase SC5b-9 complement complexes, indicating that the complement sequence had been activated to completion. Various degrees of overt intravascular hemolysis were observed in all the patients, and lysed erythrocyte membranes were recovered from the blood samples. Immunoassays performed with use of antibodies to C5b-9 neoantigens demonstrated the presence of C5b-9 on red-cell ghosts but not on intact erythrocytes. The appearance of ghosts carrying C5b-9 always coincided with hemolysis. Furthermore, granulocytes isolated from 20 patients during bypass were all found to carry C5b-9 complexes, whereas cells isolated before or 24 hours after surgery carried no C5b-9. The neoantigen-positive material present in detergent extracts of granulocytes sedimented in a broad peak (25 to 40 sedimentation coefficient [S]) in sucrose-density gradients, exactly as did pore-forming C5b-9 complexes. Deposition of C5b-9 on blood cells during cardiopulmonary bypass may be partly responsible for the hemolysis and may augment granulocyte activation by the stimulation of arachidonate metabolism in those cells.

Autoantibodies↗
PubMed1988

"Haemostasis time", a modified bleeding time test and its comparison with the Duke and Ivy/template bleeding times. II. Application in bleeding disorders.

"Haemostasis time" (HT), the occlusion time of a Butterfly 25 short cannula inserted into the cubital vein, is a bleeding time modification comparable to the skin bleeding times according to Duke and Ivy/Mielke. It also measures platelet function and is not influenced more than the latter tests by clotting factors. In HT, subendothelium is replaced by a standard artificial surface. The technique was investigated in patients with haemophilia A and B, von Willebrand's disease (vWD), and defects of factors VII and XI. HT was prolonged in 9/16 patients with haemophilia A/B, but did not correlate with the factor VIII:C/IX:C values. However, it reflected the different bleeding tendencies in those patients as represented by early or late onset of bleeding symptoms and occurrence of spontaneous haemarthroses. Of the vWD patients, not classified by multimeric analysis, 15/31 had prolonged Simplate II bleeding times, 14/31 prolonged HTs. Only 20/31 patients had corresponding normal or prolonged bleeding times with both techniques. HT correlated significantly with the Duke bleeding time (p = 0.011), ristocetin cofactor activity (p = 0.003) and von Willebrand factor antigen (p = 0.022), while no correlations were found between these parameters and the Simplate II method. Statistical evaluation shows, that in vWD, HT can replace the less precise Duke bleeding time but not the non-related Ivy/Simplate techniques.

Adolescent↗
PubMed1988

Effects of unfractionated and fractionated heparin on platelet function.

Heparin-induced alterations of platelet function have repeatedly been reported over the last 30 years. The development of low-molecular-weight (LMW) heparin fractions prompted us to compare the effect of unfractionated (UF) heparin and LMW heparin on platelet function. Heparin was applied intravenously to healthy volunteers in a dose of 100 U (antifactor Xa)/kg body weight. Sequential evaluation of platelet function ex vivo confirmed that UF heparin may activate platelets in vivo. Studying the ADP-induced fibrinogen binding to platelets in vivo, we were able to show that the effect of heparin on platelets is antibody- and antithrombin-III-independent. LMW heparin fractions in general exhibit a reduced platelet activating activity although there are differences between the LMW heparin fractions available. The stimulating effect of LMW heparin on platelets disappears below a mean molecular weight of 3,000 daltons.

Blood Platelets↗
PubMed1988

Alterations of antithrombin III after acute myocardial infarction.

The antithrombin III (AT III) activity and the AT III concentration were investigated in 62 consecutive patients with acute myocardial infarction (AMI). To identify the reactant pattern of AT III in postaggressive situations, we also determined labile and acute phase proteins. Firstly, 29 patients were nourished orally and then 33 patients were fed by i.v. hyperalimentation (additional caloric intake of approximately 1,000 cal). AT III activities and concentrations as well as prealbumin and retinol-binding protein decreased concomittantly and significantly whereas haptoglobin, C-reactive protein and fibrinogen increased significantly after AMI. The changes cannot be interpreted as being alterations of the haematocrit. The alterations of AT III correlated significantly with the changes of labile proteins but not with the acute phase reactant proteins. The AT III decrease in the postinfarctional phase may promote a prethrombotic state. In In addition it can be concluded from our results that AT III reacts as (nutritive-dependent) labile protein, which is lowered in postaggressive situation and does not increase as an acute phase reactant. This is in accordance with results from recent animal experiments.

Antithrombin III↗
PubMed1987

Immunohistochemical and biological evidence for a neuromodulator function of neuropeptide Y in the human oviduct.

By means of the peroxidase-antiperoxidase technique the existence of neuropeptide Y-immunoreactivity (NPY-IR) in nerve fibers of the normal human uterine tube was established. NPY-IR fibers are found to supply vascular and non-vascular smooth muscles of the uterine tube. In both systems the density of NPY-IR nerves is markedly high. The NPY-IR nerves exhibit a predominance for the arterial portion of the oviductal vasculature in the serosal, the muscle and the mucosal layer. Furthermore in the mucosal layer, some NPY-IR fibers occur in contact with the surface epithelium. In-vitro experiments with helical strips of the human uterine tube reveal no significant effects of NPY alone of the different parameters (resting tension, frequency and amplitude of spontaneous contractions) of mechanical activity while it seems to act in combination with acetylcholine. Thus, the distinct innervation patterns of the NPY-IR nerve fibers as well as the results obtained by bioassay may suggest a neuromodulator function of this neuropeptide in the human uterine tube. In this respect, NPY may play an important role in the transport of the eggs through the tube.

Arteries↗