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Biomedical subjects

D Riemann

Publications and source records attributed to D Riemann.

At least 109 records · Page 6Linked to original sources
PubMed1995

[Chronotherapeutic approaches in depressive disorders].

Sleep deprivation has been regarded as a beneficial treatment modality for about 60% of patients with Major Depressive Disorder. Unfortunately, however, more than 80% of the improved patients relapse into depression after the next night of sleep. In the present study we tried to prevent relapses into depression after successful total sleep deprivation (TSD) by treating 27 patients suffering from a Major Depressive Disorder according to DSM-III-R with a combination of sleep deprivation with consecutive sleep phase advance for 1 week. Advancing the sleep period to 5.00 p.m. until 12.00 p.m. following TSD and then gradually shifting back by 1 h daily the sleep period to the normal phase position (11.00 p.m. until 6.00 a.m.) prevented 61% of these patients from relapsing into depression. Thus, the combination of sleep deprivation with consecutive sleep phase advance has been proven to be an effective antidepressant treatment besides other well established antidepressive treatment modalities.

Adult↗
PubMed1995

[Case report: treatment of a patient with sleep phase advance disorder with phototherapy].

We report on a patient with a moderate form of a sleep-phase advance syndrome. As a biological correlate we found an early temperature and cortisol minimum before midnight, respectively. Light therapy during the evening hours (2500 Lux) given over 17 months induced a complete remission of the symptoms. The good treatment outcome could be maintained after the end of daily light therapy by only sporadic application.

Adult↗
PubMed1995

[Approximation of sleep duration and sleep efficiency using actography].

The actography is a cost-effective semiobjective method to measure sleep/wake-cycles. This is the reason why the actography should be used first. The actography is after the cost-intensive polysomnography the best method in diagnosis of sleep disorders and monitoring of sleep disorder therapy. Actography over several days allows a precise estimation of total sleep time and sleep efficiency and makes possible an analysis of sleep/wake in natural conditions. The estimation is better if the patient is in high wake body activity and the recording time is longer. The mean values of total sleep time and sleep efficiency from polysomnography and actography are congruent.

Adult↗
PubMed1995

[Group therapy approaches in primary/psychophysiologic insomnias].

In the last years behavioural treatment strategies have been established as alternatives to pharmacological treatment in primary/psychophysiological insomnia. Behavioural techniques for treating primary insomnia include relaxation training, psychoeducation on sleep and sleep disorders, stimulus control, sleep restriction and cognitive techniques. A combination of these techniques in a 6-week program was proven to be very effective in patients with primary insomnia who participated in the program in groups.

Adult↗
PubMed1994

Platelet and lymphocyte free intracellular calcium in affective disorders.

Many studies have demonstrated pharmacologic similarities between platelet and brain 5-HT2 binding sites. Therefore it may be possible to use platelets as a model for the central serotonergic neuron. Accordingly, a previous report (Kusumi et al. 1991b) about elevated [Ca2+]i after serotonin stimulation in platelets of depressed patients was interpreted as further evidence for enhanced serotonergic sensitivity in depression. However, a very recent study showed an enhanced thrombin-induced platelet Ca2+ response, rather suggesting abnormalities of intracellular Ca2+ regulation in affective disorders. In the present study we have determined 5-HT2- and thrombin-induced Ca2+ responses in platelets and additionally phytohemagglutin (PHA)-induced Ca2+ increase in lymphocytes of medicated depressed patients (8 mono- and 2 bipolar, HRSD > 17) and of ten sex- and age-matched controls. The results showed no significant difference in basal calcium levels between the two groups and no significant difference in the Ca2+ response to thrombin although the response was higher in the patients. The Ca2+ increase after serotonin stimulation in depressed patients was significantly (P < 0.05) higher than in healthy controls. By contrast, the Ca2+ response to PHA in lymphocytes was significantly decreased in the patients. Our data confirm elevated Ca2+ responses after 5-HT2 receptor activation even in mediated depressed patients. However, Ca2+ responses in lymphocytes were decreased. Together with the observations of an enhanced Ca2+ response in platelets after thrombin stimulation, we speculate that the findings rather suggest alterations of [Ca2+]i regulation in depression than specific changes of serotonergic sensitivity.

Adult↗
PubMed1994

Sleep EEG of patients with obsessive-compulsive disorder.

Twenty-two patients suffering from an obsessive and compulsive disorder (OCD) according to DSM-III-R were investigated by polysomnographic sleep EEG recordings under drug-free conditions and compared to age- and sex-matched healthy controls. Sleep efficiency was significantly lower and wake % SPT was significantly increased in the patient group compared to healthy subjects. Sleep architecture did not differ among the two samples. Especially REM sleep measures, in particular, REM latency did not differ among the groups. No positive correlation was found between sleep variables and rating inventories for obsession and compulsions (Y-BOCS), depression (Hamilton) and anxiety (CAS). A secondary depression did not influence sleep EEG variables. The results of this study contradict the assumption that OCD patients show REM sleep and slow wave sleep abnormalities similar to those shown by patients with primary depression.

Adult↗
PubMed1994

Sleep in depression: the influence of age, gender and diagnostic subtype on baseline sleep and the cholinergic REM induction test with RS 86.

One hundred and eight healthy controls and 178 patients with a major depressive disorder according to DSM-III were investigated in the sleep laboratory after a 7-day drug wash-out period. Subsamples of 36 healthy controls and 56 patients additionally took part in the cholinergic rapid eye movement (REM) sleep induction test with RS 86. Data analysis revealed that age exerted powerful influences on sleep in control subjects and depressed patients. Sleep efficiency and amount of slow wave sleep (SWS) decreased with age, whereas the number of awakenings, early morning awakening, and amounts of wake time and stage 1 increased with age. REM latency was negatively correlated with age only in the group of patients with a major depression. Statistical analysis revealed group differences for almost all parameters of sleep continuity with disturbed indices in the depressed group. Differences in SWS were not detected. REM latency and REM density were altered in depression compared to healthy subjects. Sex differences existed for the amounts of stage 1 and SWS. The cholinergic REM induction test resulted in a significantly more pronounced induction of REM sleep in depressed patients compared with healthy controls, provoking sleep onset REM periods as well in those depressed patients showing baseline REM latencies in the normal range. Depressed patients with or without melancholia (according to DSM-III) did not differ from each other, either concerning baseline sleep or with respect to the results of the cholinergic REM induction test. The results stress the importance of age when comparing sleep patterns of healthy controls with those of depressed patients. Furthermore they underline the usefulness of the cholinergic REM induction test for differentiating depressed patients from healthy controls and support the reciprocal interaction model of nonREM-REM regulation and the cholinergic-aminergic imbalance hypothesis of affective disorders.

Adolescent↗
PubMed1994

Treatment of primary insomnia with trimipramine: an alternative to benzodiazepine hypnotics?

A group of 19 middle aged patients suffering from primary insomnia according to the DSM-III-R were treated in a single-blind study with trimipramine, a sedating antidepressant. A total of 15 patients completed the study protocol and were evaluated. The present pilot study aimed at investigating the sleep-inducing properties of trimipramine, and at clarifying the question of whether short- or long-term rebound insomnia occurs after discontinuation of this drug. At four measurement points, i.e. under baseline conditions, under treatment and 4 and 14 days after drug discontinuation, sleep was recorded with an ambulatory-electroencephalogram (EEG) monitoring device in the patient's home environment. Simultaneously, psychometric tests were applied to measure withdrawal symptoms, subjective sleep quality and well-being during daytime. Trimipramine at a mean dose of 166 +/- 48 mg led to a significant increase in sleep efficiency, total sleep time, and stage 2% sleep-period time (SPT), whereas a significant decrease in wake time and stage 1% SPT was noted. Insomniac patients reported an improvement in subjectively perceived sleep quality following trimipramine. Additionally, an improvement in well-being during the daytime occurred. Negative side effects were limited to dry mouth due to the anticholinergic properties of the drug. Discontinuation of trimipramine did not provoke either short- or long-term rebound insomnia in objective and subjective sleep measurements considering mean values of the whole sample, although a subgroup of patients did display total sleep times below baseline values during short- and long-term withdrawal, but generally without a concomitant worsening of sleep quality according to the sleep questionnaire.

Adult↗
PubMed1994

Cholinergic neurotransmission, REM sleep and depression.

It is known from animal experiments that the regulation of REM and Non-REM sleep is governed by cholinergic and serotonergic/adrenergic neurons in the brain stem. Cholinergic neurons in the gigantocellular field of the tegmentum seem to be responsible for the triggering and maintenance of REM sleep. These findings are of special interest for interpreting abnormalities of REM sleep in depression. Psychiatric sleep research in the last two decades has demonstrated that an early onset of REM sleep and heightened REM density frequently occurs in patients suffering from depression. Extrapolating from animal data on REM sleep regulation, the premature onset of REM sleep in depression may be interpreted as the consequence of a central nervous cholinergic overactivity or muscarinic supersensitivity. In our experimental work we have tested assumptions of the so-called reciprocal interaction model of NonREM and REM sleep by cholinergic/anticholinergic stimulation strategies of sleep in healthy subjects. Furthermore, the impact of cholinergic stimulation on sleep in depression, healthy control subjects and other psychopathological conditions was investigated. These studies demonstrated that the most pronounced REM sleep response to cholinergic stimulation occurred in depression.

Adolescent↗
PubMed1994

Influence of the cholinesterase inhibitor galanthamine hydrobromide on normal sleep.

Evidence from animal experiments has suggested that the triggering and maintenance of rapid eye movement (REM) sleep is mainly under the control of cholinergic neurons in the brain stem. Correspondingly, studies in humans have demonstrated that the application of cholinergic agonists or cholinesterase inhibitors provokes an earlier onset of REM sleep. The present study investigated the influence of galanthamine hydrobromide, a reversible cholinesterase inhibitor, on REM sleep regulation in 18 healthy volunteers. After an adaptation night, the subjects were given two doses of galanthamine (10 mg and 15 mg) or placebo at 10 p.m. in a randomized double-blind design. Both doses of galanthamine shortened REM latency (with statistical significance depending on the definition of REM latency used), increased REM density, and reduced slow wave sleep mainly in the first non-REM cycle. Higher doses of galanthamine (15 mg) seem to be accompanied by unwanted side effects that warrant the application of a peripheral antidote. These results are comparable to those for other cholinomimetics and stress the usefulness of galanthamine for pharmacological challenge studies in healthy subjects and depressed patients.

Adult↗
PubMed1994

Expression of aminopeptidase N/CD13 in tumour-infiltrating lymphocytes from human renal cell carcinoma.

We have previously demonstrated the expression of aminopeptidase N (APN, CD13) on synovial T cells from patients with different forms of arthritis. T cells of peripheral blood and serous body fluids are CD13-negative but can be stimulated to express CD13 after activation, e.g., with Con A. In the present report, double-labelling and flow cytometry analyses were performed to characterize the phenotype of tumour-infiltrating lymphocytes (TIL). A large panel of antibodies specific for different activation-associated molecules on T cells was used. In contrast to TIL of lung cancer, TIL of renal cell carcinoma (RCC) consisted of significantly higher percentages of T cells expressing CD13, dipeptidylpeptidase N (DPIV, CD26) and HLA-DR, whereas T cells of lung cancer expressed more CD25, CD69 and CD54/ICAM1. No differences could be found in the expression of CD45RO, CD49a/VLA-1 and CD62L/L-selectin. Our results demonstrate that T cells in RCC and lung cancer differ in their phenotype, especially with respect to surface aminopeptidases. Investigations into the function of APN on T cells could be of help in gaining deeper insight into tumour defence as well as into general mechanisms of T cell functions.

Adenocarcinoma↗
PubMed1994

Characterization of the immunophenotype and functional properties of fibroblast-like synoviocytes in comparison to skin fibroblasts and umbilical vein endothelial cells.

We characterized the immunophenotype as well as functional properties--phagocytosis, the uptake of acetylated LDL, and the expression of HLA class II antigens, adhesion molecules, and cytokine mRNA--of fibroblast-like synoviocytes from rheumatoid arthritis synovium. Skin fibroblasts (FB) and umbilical vein endothelial cells (HUVEC) were studied in parallel. Cytofluorometric immunophenotyping by use of 84 mAb and 2 lectins and immunofluorescence microscopy indicated a high degree of homology between the three cell types. Only staining with mAb to von Willebrand factor (vWF) and CD31 and the lectin UEA-I appeared specific to HUVEC, whereas the mAb 5B5 to prolyl 4-hydroxylase that has been reported to be specific to FB stained HUVEC as well as synoviocytes and FB. All of the cells phagocytosed fluorescent latex beads of 1.7 and 2.6 microns in size. The uptake of acetylated LDL could be shown by HUVEC and, surprisingly, by synoviocytes, but not by FB. The induction of HLA-DR, -DP, and -DQ by IFN-gamma on the three cell types showed a similar dose-dependence. The upregulation of ICAM-1 by IL-1 alpha, TNF-alpha, and IFN-gamma appeared similar, whereas the induction of VCAM-1 by IL-1 alpha, IL-4, TNF-alpha, and IFN-gamma showed differences between the three cell types. ELAM-1 was expressed only on HUVEC after treatment with IL-1 alpha and TNF-alpha. The capacity of the cells to produce cytokines was studied at the level of mRNA by reverse transcription and PCR. All three cell types expressed the mRNA of IL-1 alpha, IL-6, IL-8, GM-CSF, and TGF-beta 1 spontaneously or after LPS stimulation, but never TNF-alpha mRNA. Our results indicate a high degree of relationship between the three cell types. In contrast to HUVEC, none of the markers and functional properties investigated appear specific to FB. Therefore, the issue of the origin of fibroblast-like synoviocytes and the role of vascular endothelial cells in the inflamed synovium is discussed.

Antibodies, Monoclonal↗
PubMed1994

Influence of biperiden and bornaprine on sleep in healthy subjects.

Biperiden, 4 mg, an anticholinergic drug that is relatively selective for the M1 receptor subtype, and bornaprine, 4 mg, a nonselective M1 and M2 antagonist, were administered orally in a randomized, double-blind design to twelve healthy volunteers to investigate the effect on polysomnographically recorded sleep. Both drugs suppressed rapid eye movement (REM) sleep as reflected by an increase of REM latency and a decrease in the percentage of REM sleep period time with the effects of biperiden being more pronounced. No significant effect on slow wave sleep was observed. The results of this study support the hypothesis that both the M1 and the M2 receptor subtype are involved in the regulation of REM sleep in humans.

Adult↗
PubMed1994

[Depression and sleep--the status of current research].

Abnormalities of REM sleep, i.e. shortening of REM latency, lengthening of the duration of the first REM period and heightening of REM density, which are frequently observed in patients with a Major Depressive Disorder (MDD), have attracted considerable interest. Initial hopes that these aberrant patterns of sleep constitute specific markers for the primary/endogenous subtype of depression have not been fulfilled. The specificity of REM sleep disinhibition for depression in comparison to other psychopathological groups is also challenged. Demographic variables like age and sex exert strong influences on sleep physiology and must be controlled when searching for specific markers of depressed sleep. It is still an open question whether abnormalities of sleep are state-markers or trait-markers of depression. Beyond baseline studies, the cholinergic REM induction test (CRIT) indicated a heightened responsitivity of the REM sleep system to cholinergic challenge in depression compared with healthy controls and other psychopathological groups, with the exception of schizophrenia. A special role for REM sleep in depression is supported by the well known REM sleep suppressing effect of most antidepressants. The antidepressant effect of selective REM deprivation by awakenings stresses the importance of mechanisms involved in REM sleep regulation for the understanding of the pathophysiology of depressive disorders. The positive effect of total sleep deprivation on depressive mood which can be reversed by daytime naps, furthermore emphasizes relationships between sleep and depression. Experimental evidence as described above instigated several theories like the REM deprivation hypothesis, the 2-process model and the reciprocal interaction model of nonREM-REM sleep regulation to explain the deviant sleep pattern of depression. The different models will be discussed with reference to empirical data gathered in the field.

Animals↗
PubMed1994

Prevalence of insomnia in elderly general practice attenders and the current treatment modalities.

This study aimed to assess the prevalence and treatment modalities of elderly practice attenders. A total of 330 patients aged over 65 years were investigated with a questionnaire in general practice. To assess insomnia, operationalized diagnostic criteria according to DSM-III-R were applied. Twenty-three percent of the elderly patients suffered from severe, 17% from moderate and 17% from mild insomnia. More than 80% of the patients reported suffering from insomnia for 1-5 years or longer, which indicates a chronic course. Elderly patients showed unrealistic expectations concerning duration of sleep and spend more time in bed than they realistically can expect to sleep. More than half of the elderly patients reported habitual daytime napping. Sleep-disturbed elderly patients did not differ significantly from good sleepers in their habit of taking daytime naps, but even when taking daytime naps, good sleepers slept significantly longer than the sleep-disturbed patients. A significant association was found between insomnia and mental disorders, i.e., depression and organic brain syndrome according to the diagnosis of the general physician. In about half of the cases the primary care physician was not aware that the elderly patient suffered from severe insomnia. More than half of the elderly severe insomniacs took prescribed hypnotics habitually, mainly benzodiazepines.

Aged↗
PubMed1994

Scanning and transmission electron microscopy of human donor lungs: fine structure of the pulmonary parenchyma following preservation and ischemia.

In six cases of clinical single-lung transplantation, the contralateral donor lungs were studied by means of scanning (SEM) and transmission (TEM) electron microscopy. SEM and TEM revealed an overall good to excellent preservation of the pulmonary parenchyma. Since the donor double lung blocks, which were preserved by means of pulmonary arterial perfusion with modified Euro-Collins solution, were separated immediately prior to transplantation, transplanted and contralateral lungs had been subjected to identical influences. Comparing the arterial oxygenation achieved in the recipient 6 h after transplantation with the structural data of the corresponding contralateral donor lung, the degree of epithelial alterations appeared to be most important in determining postoperative lung function. Concerning the assessment of the quality of the alveolar epithelium, gradings performed independently by means of SEM and TEM yielded largely corresponding scores, while a significant shortcoming of SEM was the very limited access to the endothelial surface. Taking into account the relevance of epithelial injury in determining postoperative lung function, SEM can provide clinically relevant data more quickly than TEM. To quantify the fine structural alterations of human donor lungs, however, TEM-based morphometry is required.

Adolescent↗
PubMed1994

Immunophenotype of lymphocytes in pericardial fluid from patients with different forms of heart disease.

Cytofluorometric analysis was performed to characterize the immunophenotype of lymphocytes of the pericardial fluid (PF) from 127 patients undergoing open cardiac operation (heart valve disease, congenital heart defects, chronic ischemic heart disease). Macrophages and T cells represented the dominant cell types. Similar to T cells of body fluids other than peripheral blood, a high percentage of PF T cells expressed CD45RO and activation-associated molecules such as HLA-DR, CD69, CD54 and CD26. Surprisingly, we could demonstrate a very high proportion of CD11b+ T cells in PF. Furthermore, a significant proportion of PFT cells expressed aminopeptidase N/CD13. PF was further analyzed for the presence of IL-6, TGF-beta as well as TNF-alpha. IL-6 levels were low (undetectable to 4,500 U/ml), TGF-beta levels ranged from < 3 ng/ml up to 80 ng/ml, and TNF-alpha levels from < 3 pg/ml to 233 pg/ml. These findings show evidence of the presence of activated lymphocytes with a special immunophenotype as well as multiple cytokines in PF of patients with different forms of heart disease.

Adolescent↗