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Helmuth Steinmetz

Publications and source records attributed to Helmuth Steinmetz.

18 recordsLinked to original sources
PubMed2004

Morphological brain differences between adult stutterers and non-stutterers.

BACKGROUND: The neurophysiological and neuroanatomical foundations of persistent developmental stuttering (PDS) are still a matter of dispute. A main argument is that stutterers show atypical anatomical asymmetries of speech-relevant brain areas, which possibly affect speech fluency. The major aim of this study was to determine whether adults with PDS have anomalous anatomy in cortical speech-language areas. METHODS: Adults with PDS (n = 10) and controls (n = 10) matched for age, sex, hand preference, and education were studied using high-resolution MRI scans. Using a new variant of the voxel-based morphometry technique (augmented VBM) the brains of stutterers and non-stutterers were compared with respect to white matter (WM) and grey matter (GM) differences. RESULTS: We found increased WM volumes in a right-hemispheric network comprising the superior temporal gyrus (including the planum temporale), the inferior frontal gyrus (including the pars triangularis), the precentral gyrus in the vicinity of the face and mouth representation, and the anterior middle frontal gyrus. In addition, we detected a leftward WM asymmetry in the auditory cortex in non-stutterers, while stutterers showed symmetric WM volumes. CONCLUSIONS: These results provide strong evidence that adults with PDS have anomalous anatomy not only in perisylvian speech and language areas but also in prefrontal and sensorimotor areas. Whether this atypical asymmetry of WM is the cause or the consequence of stuttering is still an unanswered question.

Adult↗
PubMed2004

Serum S100B predicts a malignant course of infarction in patients with acute middle cerebral artery occlusion.

BACKGROUND AND PURPOSE: Early predictors of infarct volume may improve therapeutic decisions in patients with acute cerebral ischemia. We investigated whether measurements of serum astroglial protein S100B can predict a malignant course of infarction in acute middle cerebral artery (MCA) occlusion. METHODS: We included 51 patients (24 women, mean age 69.1+/-12.4 years) admitted within 6 hours after stroke symptom onset caused by proximal MCA occlusion, as shown by magnetic resonance angiography (n=39), intra-arterial angiography (n=4), or transcranial duplex sonography (n=8). Blood samples were drawn at hospital admission and 8, 12, 16, 20, and 24 hours after symptom onset. Serum S100B concentrations were determined using a fully automated immunoluminometric assay. A malignant course of infarction was defined as the occurrence of clinical signs of cerebral herniation within the first 7 days of treatment or the clinical decision to perform decompressive hemicraniectomy caused by critical space-occupying swelling as detected by repeated neuroimaging. RESULTS: Sixteen patients developed malignant infarction (31%). Beginning with the 12-hour value, mean S100B serum concentrations were significantly higher in patients with a malignant course compared with those without (12 hours 1.23+/-1.24 versus 0.29+/-0.45 microg/L; 16 hours 1.80+/-1.65 versus 0.38+/-0.53 microg/L; 20 hours 1.90+/-1.53 versus 0.44+/-0.48 microg/L; and 24 hours 2.41+/-1.59 versus 0.57+/-0.66 microg/L; all P<0.001). A 12-hour S100B value >0.35 microg/L predicted malignant infarction with 0.75 sensitivity and 0.80 specificity. A 24-hour value >1.03 microg/L provided 0.94 sensitivity and 0.83 specificity. CONCLUSIONS: The serum marker S100B can predict a malignant course of infarction in proximal MCA occlusion. This finding may improve the identification and monitoring of patients at particularly high risk for herniation.

Acute Disease↗
PubMed2004

Mutations in the lysyl oxidase gene not associated with intracranial aneurysm in central European families.

BACKGROUND: Lysyl oxidase is a promising candidate gene for a mutation search in intracranial aneurysm families because (a) it controls the processing, cross-linking and maturation of collagen and elastin fibers in the blood vessel wall, (b) its expression levels and activity are altered in different animal models of aneurysm pathogenesis, and (c) it is encoded within the chromosome 5q22-31 region of suggestive linkage to intracranial aneurysms. METHODS: We have performed genomic sequencing of all 7 exons including the intron-exon splice sites and of the putative promoter region for lysyl oxidase in 25 patients from intracranial aneurysm multiplex families resident in Central Europe. RESULTS: We observed 4 genetic variants including 2 novel polymorphisms, 1 in the noncoding sequence of exon 7 and the other upstream from the lysyl oxidase promoter. None of these single nucleotide polymorphisms showed an allelic association or cosegregation with intracranial aneurysm in the families. CONCLUSIONS: Genetic variants in the lysyl oxidase gene do not appear to be a major factor in the etiology of intracranial aneurysms in Central Europe.

Adenine↗
PubMed2004

Gender differences in cortical complexity.

Cortical complexity, a measure that quantifies the spatial frequency of gyrification and fissuration of the brain surface, has not been thoroughly characterized with respect to gender differences in the human brain. Using a new three-dimensional (3D) analytic technique with magnetic resonance imaging, we found greater gyrification in women than men in frontal and parietal regions. Increased complexity implies more cortical surface area, which may offset gender differences in brain volume and account for behavioral gender differences.

Cerebral Cortex↗
PubMed2004

Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction.

OBJECT: Whether decompressive hemicraniectomy is an appropriate treatment for space-occupying middle cerebral artery (MCA) infarction is still a controversial issue. Previous studies are in agreement on a reduction of the mortality rate, but the reported functional outcome was highly variable. The authors sought to determine functional impairment, disability, and health-related quality of life (QOL) outcome in long-term survivors who had undergone this procedure, and tried to identify factors related to functional outcome. METHODS: The study included 36 consecutive patients (mean age 58.8 +/- 12.7 years, 20 men and 16 women) who underwent decompressive hemicraniectomy for treatment of malignant MCA infarction (29 on the right and seven on the left side; mean time to surgery 37.8 +/- 20 hours). The survival rate was determined at 6 months: 13.7 +/- 6.7 months after the stroke, a cross-sectional personal investigation of survivors was performed to assess functional impairment, disability, and health-related QOL. Survival rates were 78% at 6 months and 64% at the time of the follow-up investigation; one patient was lost to follow up. Sixteen of 22 long-term survivors lived at home. The median Barthel Index (BI) was 45 (25th and 75th percentile 19 and 71) and the BI correlated negatively with patient age (r = -0.58, p = 0.005). Three patients reached a BI of at least 90. Older age, more severe neurological deficit on admission, and longer duration of intensive care treatment and mechanical ventilation were significantly associated with worse disability (BI < 50). The health-related QOL was considerably impaired in the subscales of mobility, household management, and body care. CONCLUSIONS: Decompressive hemicraniectomy improves survival in patients with malignant MCA infarction when compared with earlier reports of conservative treatment alone. Functional outcome and QOL remain markedly impaired, especially among elderly patients and in those with a severe neurological deficit at admission.

Adult↗
PubMed2003

Elastin polymorphism haplotype and intracranial aneurysms are not associated in Central Europe.

BACKGROUND AND PURPOSE: The occurrence of intracranial aneurysms and of aneurysmal subarachnoid hemorrhage are influenced by genetic factors. Recent genomic studies in Japan have defined 3 chromosomal loci and 1 haplotype of elastin polymorphisms as important risk factors, both for affected sib pairs and sporadic patients. METHODS: We have genotyped 2 single nucleotide polymorphisms in the elastin gene and evaluated their allelic association with intracranial aneurysm in a Central European sample of 30 familial and 175 sporadic patients and 235 population controls. RESULTS: We found no allelic association between this elastin polymorphism haplotype and intracranial aneurysm. CONCLUSIONS: Our data probably reflect increased genetic heterogeneity of intracranial aneurysm in Europe compared with Japan.

Adult↗
PubMed2003

Internal carotid artery angle of origin: a novel risk factor for early carotid atherosclerosis.

BACKGROUND AND PURPOSE: Established "systemic" vascular risk factors do not fully explain the occurrence of atherosclerosis at the carotid bifurcation. Local anatomic and hemodynamic factors may also influence the initiation of the atherosclerotic process. We determined whether the angle of internal carotid artery (ICA) origin is a risk factor for early atherosclerosis. METHODS: In 1300 individuals from a normal population aged 40 to 70 years, we measured both carotid intima-media thickness (IMT) at 3 arterial sites (common carotid artery; carotid bifurcation; ICA bulb) and the presence of any atherosclerotic plaque within the ICA bulb bilaterally by means of high-resolution ultrasound. A standardized transverse insonation was used to determine the angle of ICA origin, expressed as the angle of rotation relative to the external carotid artery. RESULTS: This angle was positively associated with ICA bulb IMT but not with IMT at other sites. After we controlled for age, sex, and other cardiovascular risk factors, a dorsal/dorsomedial ICA origin (angle >or=60 degrees ) conferred an odds ratio for having an ICA bulb IMT in the highest quartile of 2.99 (95% CI, 1.86 to 4.83) on the left and 2.01 (95% CI, 1.31 to 3.09) on the right side (both P<0.001). A similar relationship was found for plaque; odds ratios on multivariate analysis were 3.67 (95% CI, 1.49 to 9.03) on the left and 2.07 (95% CI, 1.10 to 4.83) on the right side (both P=0.035). CONCLUSIONS: This study suggests that the angle of ICA origin may be an independent risk factor for early atherosclerotic changes at the ICA bulb. This new hypothesis should be tested in prospective studies.

Adult↗
PubMed2003

Significant relation between MR measures of planum temporale area and dichotic processing of syllables in dyslexic children.

In the present study, we investigated differences between dyslexic and normal reading children in asymmetry of the planum temporale area in the upper posterior part of the temporal lobe and dichotic listening performance to consonant-vowel syllables. The current study was an extension of previous studies in our laboratory on the same participants, now including also girls and left-handers. There were 20 boys and 3 girls in the dyslexic group and 19 boys and 4 girls in the normal reading group. The age of the participants was 10-12 years for both groups. The participants were screened from a population of 950 students in the fourth school grade in the greater Bergen district. The planum temporale area was measured in sagittal magnetic resonance (MR) images. Mean left and right area and asymmetry index were compared between the groups. Dichotic presentations of consonant-vowel syllables made it possible to separately probe left and right hemisphere phonological function, and to correlate this with planum temporale area. The results showed a significantly larger left than right planum temporale area for both groups. However, while the right planum temporale area was similar for the dyslexic and control groups, the left planum temporale was significantly (one-tailed t-test) smaller in the dyslexic group. Both groups also showed a significant right ear advantage to the consonant-vowel syllables in the dichotic listening test. The relation between planum temporale and dichotic listening asymmetry showed a significant correlation for the dyslexic group only, indicating a positive relation between brain structure and function in dyslexic children. The results are discussed in terms of important subject characteristics with regard to brain markers of dyslexia.

Case-Control Studies↗
PubMed2003

Single-needle acupuncture alleviates gag reflex during transesophageal echocardiography: a blinded, randomized, controlled pilot trial.

OBJECTIVES: To study the effect of single-needle acupuncture in suppressing gag-reflex in transesophageal echocardiography (TEE). DESIGN: Prospective, blinded trial. Settings/locations: Patients with ischemic stroke or transient ischemic attack undergoing TEE because of presumed cardioembolic origin in a specialized stroke unit of the Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. Subjects/Study interventions: Forty-one (41) patients were studied. Patients received single-needle acupuncture with a 0.2 x 13 mm disposable acupuncture needle (Suzhou Medical Appliances, China), 10-mm deep either at Chengjiang (midline between lower lip and chin) or superficially at a sham point (tip of the chin) during TEE or no acupuncture for alleviating gag reflex. OUTCOME MEASURES: Severity of gagging was rated on a visual-analogue scale. RESULTS: The acupuncture group experienced significantly less gagging than the sham group (p = 0.037) or the nonacupuncture group (p = 0.013). CONCLUSIONS: Acupuncture of CV24 is an easy to apply and effective method to reduce gag reflex during TEE.

Acupuncture Points↗
PubMed2002

Brain size and grey matter volume in the healthy human brain.

Magnetic resonance imaging was used to evaluate the influence of sex and brain size on compartmental brain volumes (grey matter, white matter, CSF) in a large and well-matched sample of neurologically normal women (n = 50) and men (n = 50). As expected, we found a significant sex difference for the absolute volumes of total brain, grey matter, white matter and CSF, with greater volumes for men. Relating these compartmental volume measures to brain volume resulting in proportional volume measures revealed a higher proportion of grey matter in women. No significant sex differences were found for white matter and CSF proportions. However, when the influence of sex was partialized out by regression analyses, brain volume explained 40-81% of the variance of the absolute grey matter, white matter and CSF volumes. Performing these regression analyses for the proportional volume measures revealed that brain volume explained approximately 16% of the variance in grey matter proportion. Sex or the interaction between sex and brain volume revealed no additional predicitve values. Interestingly, the correlation between brain volume and grey matter proportion was negative, with larger brains exhibiting relatively smaller proportions of grey matter. Thus, sex is not the main variable explaining the variability in grey matter volume. Rather, we suggest that brain size is the main variable determining the proportion of grey matter.

Adult↗
PubMed2002

The temporal lobe in schizophrenia from uni- and multiply affected families.

To investigate the effect of genetic loading on brain structure in schizophrenia, we hypothesized that separating families into uniaffected and multiply affected would reveal effects of schizophrenia and family type. Volumes and asymmetries of the amygdala-hippocampus-complex (AHC) and sylvian fissure (SF) were determined using magnetic resonance imaging of subjects with schizophrenia from 12 uniaffected and 14 multiply affected families, and ten healthy controls. AHC volume was reduced in schizophrenia, particularly on the right side in subjects from uniaffected families. AHC asymmetry was disturbed, too. Enlargement of the right SF and disturbed SF asymmetry was demonstrated in subjects from uniaffected families as well. Comparing subjects from uni- and multiply affected families may be a useful strategy to reduce variability for future studies of environmental interactions with genetic risk for schizophrenia.

Adult↗
PubMed2002

Helicobacter pylori infection, the cytotoxin gene A strain, and carotid artery intima-media thickness.

BACKGROUND: Chronic Helicobacter pylori infection has been implicated as a risk factor for stroke and other cardiovascular disease. It has been suggested that it acts by promoting atherogenesis. A particular strain of H. pylori, the cytotoxin gene A strain (CagA strain), which has been associated with increased inflammation, has been reported to account for much of this relationship. An early estimate of atherosclerosis can be obtained by ultrasonic imaging of the carotid artery to determine intima-media thickness (IMT). We determined whether H. pylori infection, and particularly the CagA strain, is associated with increased IMT. METHODS: In 983 normal population individuals we measured common carotid artery (CCA) IMT. From serum samples we determined H. pylori and CagA status. RESULTS: There was no significant association between H. pylori seropositivity and CCA IMT after controlling for age and gender. There were significant relationships between H. pylori seropositivity and a number of conventional cardiovascular risk factors (age, systolic and diastolic blood pressure, body mass index, smoking) and after controlling for these the magnitude of the regression coefficient was reduced by a further half. Amongst H. pylori seropositives the CagA strain was associated with increased IMT after controlling for age and gender (B = 0.0256, 95% CI 0.001-0.050, P = 0.038). The relationship was no longer significant after controlling for other cardiovascular risk factors. (B = 0.0194, 95% CI -0.004-0.042, P = 0.098). CONCLUSIONS: H. pylori and the CagA strain are not major risk factors for early arteriosclerosis as assessed by carotid artery intima-media thickness.

Adult↗
PubMed2002

C-reactive protein and carotid intimal medial thickness in a community population.

BACKGROUND: C-reactive protein (CRP) has been linked to cardiovascular disease and atherosclerosis. Large-scale epidemiological studies have shown a correlation of CRP level with risk of stroke, myocardial infarction and peripheral arterial disease. Nevertheless, the question whether serum CRP itself is an independent indicator of the atherosclerotic process remains unanswered. METHODS: In a community-based sample free of advanced atherosclerotic disease (n = 1018; mean age +/- SD, 54.1 +/- 12.0 years; 49.7% women) we examined the relationship between carotid intimal medial thickness (IMT), conventional vascular risk factors (that is, smoking, obesity, elevated blood pressure, diabetes mellitus, hypercholesterolaemia) and serum CRP. RESULTS: We found an association between increasing IMT values with increasing CRP values for all sites within the carotid system (for example, common carotid artery [CCA-] IMT, beta = 0.174, P < 0.001). The relationship was weakened after accounting for the above-mentioned conventional risk factors (linear regression), particularly body mass index, but remained significant (for example, mean CCA-IMT beta = 0.02, P = 0.042). Including fibrinogen in the regression made the relationship no longer significant (mean CCA-IMT beta = 0.01, P = 0.277). CONCLUSION: It is unlikely that CRP per se is a major independent cause of early arteriosclerosis. Elevations of CRP, or less specifically chronic inflammation, may mediate the effect of certain conventional risk factors on promoting atherogenesis, especially obesity.

Adult↗
PubMed2002

Recanalization results after carotid stent placement.

BACKGROUND AND PURPOSE: The details of stent reconstruction in the vascular lumen and of the adaptation of carotid stents, the vessel wall, and the vascular anatomy are only occasionally reported. The purpose of this study was to determine the immediate and longer-term anatomic results after implantation of self-expanding carotid stents. METHODS: In a retrospective study, pre- and postprocedural angiograms and duplex sonograms from 40 consecutive carotid stent procedures in 39 patients (22 men, 17 women; mean age, 67 years; age range, 53-84 years) with high-grade (> or =70 %) internal carotid artery (ICA) stenoses were evaluated to assess the expansion of the vascular lumen, apposition of the stent, and geometric changes in the ICA after the implantation of rolling-membrane and carotid Wallstents (n = 22) or Easy Wallstents (n = 18). RESULTS: Optimal widening of the lumen and apposition of the stent were achieved in 11 (28%) of 40 arteries. Residual stenoses (n = 16), free stent filaments not attached to the vessel wall (n = 21), and stent-induced kinking of the ICA (n = 6) were minor shortcomings of stent reconstruction. Because of one death, peri-interventional morbidity and mortality rates were 3%. During follow-up (median, 24 months), one high-grade restenosis, one ipsilateral stroke, and two ipsilateral transient ischemic attacks were observed. CONCLUSION: Suboptimal anatomic results frequently occur after endovascular treatment of atherosclerotic carotid artery stenosis with self-expanding Wallstents. With the exception of one symptomatic restenosis, no major complications or longer-term sequelae were clearly related to these findings, but further controlled follow-up studies of larger samples are required.

Aged↗
PubMed1996

Microembolism in Carotid Artery Disease.

Abnormal high intensity transient signals detectable with transcranial Doppler (TCD) sonography have been associated with formed cerebral microembolism. Using long-term TCD monitoring, these clinically silent microembolic events can be observed in patients with cerebrovascular disease. Downstream of high grade internal carotid artery (ICA) stenosis, they occur significantly more frequently in neurologically symptomatic than in asymptomatic patients. Although the occurrence of microemboli is random, the individual rate underlies circadian fluctuations and seems to decline within the first weeks after an ischemic event. Pathoanatomic work suggests that luminal ulcer and thrombosis of the stenosed ICA are the major sources of microemboli. Thus, by tapping into an important pathomechanism, the detection of clinically silent cerebral microembolism appears to provide paraclinical evidence of "unstable carotid artery disease" and may help to evaluate more specific treatment strategies. (ECHOCARDIOGRAPHY, Volume 13, September 1996)

Journal Article↗