Lyme borreliosis: a case of transverse myelitis with syrinx cavity.
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Arrhythmias, Cardiac↗
Biomedical subjects
J Kohler
Publications and source records attributed to J Kohler.
Increasing methotrexate effect with increasing dose in the treatment of resistant rheumatoid arthritis.
Forty-six patients with recalcitrant rheumatoid arthritis entered a trial encompassing a 2-week inpatient period plus a 16-week, randomized double blind, parallel study comparing placebo, 5 mg/m2 and 10 mg/m2 oral weekly methotrexate (MTX). An additional 6 patients, given 20 mg/m2 MTX, contributed to the toxicity, but not the efficacy analysis. All patients had "failed" either gold or D-penicillamine. A linear dose response relationship (placebo vs 5 mg/m2 vs 10 mg/m2) was found for 5 of 11 outcome variables: patient pain and patient global scale, physician global scale, joint tenderness count and activity of daily living scale (p less than 0.05 for each). Gastrointestinal toxicity (p = 0.002), dyspepsia (p less than 0.03) and stomatitis (p less than 0.09) occurred more commonly with MTX, and a general trend, although not significant, was found toward a dose toxicity relationship.
Activities of Daily Living↗
Insect cells as substrates for biologicals.
Various methods for the growth of insect cells and the production of recombinant human beta-interferon (rHu beta-IFN) by insects cells, Spodoptera frugiperda, IPL-Sf-21AE after infection with recombinant AcNPV are described. Using a suspension perfusion Biospin filter culture system, an IPL-Sf-21AE cell line was propagated in a semi-controlled environment. To obtain and maintain high cell densities and viabilities in this system, the culture medium for suspension methods was modified by supplementing with ZnSO4, ALCl3, methyl cellulose and Darvan #2. Using these improved conditions, multiple harvests of rHu beta-IFN were collected in the cell culture supernatant for downstream processing.
Animals↗
Computed tomography in cases of multiple sclerosis: problems of differential diagnosis in cases with atypical findings.
The value of computed tomography in the diagnosis of multiple sclerosis is undisputed. The examination is usually carried out as a routine part of the examination program. We report on the CT results of 112 patients with confirmed or suspected MS. Seventy-three patients were examined without, 39 with intravenous administration of a contrast medium. In 41% of the patients, isolated or multiple hypodense foci were found as a manifestation of a multilocular demyelinization process. In 17.8%, only cerebro-atrophic changes were encountered. In 30.3% of the cases the CT showed normal results. In the group of patients examined with a contrast medium, a pathological contrast medium concentration was found in 30.7%. The differential diagnostic demarcation against other diseases of the CNS with similar CT findings and problems of differential diagnosis with MRI are discussed.
Adult↗
Limbic encephalitis: two cases.
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Encephalitis↗
Left ventricular function at rest and during exercise in acute hypothyroidism.
The effect of hypothyroidism on left ventricular function at rest and during exercise was studied in nine patients without demonstrable cardiovascular disease who had had total thyroidectomy and ablative radioiodine treatment for thyroid cancer. Radionuclide ventriculography and simultaneous right heart catheterisation were performed while the patients were hypothyroid two weeks after stopping triiodothyronine treatment (to permit routine screening for metastases) and while they were euthyroid on thyroxine replacement treatment. When the patients were hypothyroid, cardiac output, stroke volume, and end diastolic volume at rest were all lower and peripheral resistance was higher than when they were euthyroid. Pulmonary capillary wedge pressure, right atrial pressure, heart rate, left ventricular ejection fraction, and the systolic pressure:volume relation of the left ventricle, which was used as an estimate of the contractile state, were not significantly different when the patients were hypothyroid or euthyroid. During exercise, heart rate, cardiac output, end diastolic volume, and stroke volume were higher when the patients were euthyroid than when they were hypothyroid. Again, pulmonary capillary wedge pressure, ejection fraction, and the systolic pressure:volume relation were similar in both thyroid states. The data suggest that the alterations in cardiac performance seen in short term hypothyroidism are primarily related to changes in loading conditions and exercise heart rate; they do not suggest that acute thyroid hormone deficiency has a major effect on the contractile properties of the myocardium.
Acute Disease↗
Multiple sclerosis presenting as chronic atypical psychosis.
Two patients with multiple sclerosis are reported in whom psychopathological symptoms were present for many years. An exact psychiatric classification of the clinical syndrome was not possible. At no time during the illness were abnormal neurological findings observed. Multiple sclerosis was proven following necropsy in one patient. In the second patient a possible diagnosis of multiple sclerosis was made. This patient was found to have multiple lesions in the white matter which were evident on MRI and in the isoelectric focusing (IEF) of cerebrospinal fluid oligoclonal bands were found.
Adult↗
Chronic central nervous system involvement in Lyme borreliosis.
We describe four patients with marked chronic meningoencephalomyelitis caused by tick-transmitted Borrelia burgdorferi infection. Imaging techniques showed either MS-like lesions or evidence of vascular involvement, as in other spirochetal infections, especially in meningovascular syphilis.
Adult↗
Relation of noninvasive parameters and pulmonary artery mean pressure in patients with chronic obstructive lung disease.
A series of 31 patients with various degrees of chronic obstructive pulmonary disease (COPD) underwent radionuclide ventriculography with right heart catheterization. The patients were divided into 2 groups on the basis of their reduction in forced expiratory volume in 1 s (FEV1). In patients with FEV1 greater than or equal to 1,300 ml (group 1) the oxygen partial pressure (PaO2) did not significantly change with exercise, while in patients with FEV1 less than or equal to 1,200 ml (group 2) the PaO2 significantly decreased (p less than 0.05) with exercise. The groups were significantly different from each other as to the correlation between hemodynamic and noninvasive parameters. In the resting state, the correlation between pulmonary artery mean pressure (PAP) and both residual volume to total lung capacity (RV/TLC) and PaO2 was close only in group 2. By contrast, the right ventricular end diastolic wall thickness (RWD) correlated closely with PAP in both groups. With exercise close correlations were observed between PAP and the noninvasive parameters: RWD, PaO2 and right ventricular ejection fraction in both groups. Arterial CO2 partial pressure (PaCO2) was only increased (greater than or equal to 45 mm Hg) in group 2. This parameter correlated moderately closely with PAP both in the resting and the exercise state only in group 2. The predictive value of PaCO2 greater than or equal to 45 mm Hg for estimation of PAP greater than 35 mm Hg during exercise was 100%. We conclude that separation of patients with COPD into groups with different impairments of the lung function parameter FEV1 can improve the correlation coefficients between noninvasive and invasive parameters. The exercise values obviously correlate more closely than the resting values. An increased value of echocardiographically determined RWD seems to be a reliable parameter for prediction of PAP.
Adult↗
Lymphomatous meningitis appearing as Garin-Bujadoux-Bannwarth meningopolyneuritis.
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Borrelia Infections↗
Nicardipine for the treatment of Raynaud's phenomena: a double blind crossover trial of a new calcium entry blocker.
Fifteen patients with Raynaud's phenomenon [systemic lupus erythematosus (6), progressive systemic sclerosis (8) and rheumatoid arthritis (1)] and 12 patients with Raynaud's disease participated in a parallel, 4-week/arm, double blind, crossover study of nicardipine, an experimental calcium channel blocker. Nicardipine significantly improved pain (p = 0.03), decreased number of Raynaud's attacks (p less than 0.03), and was preferred over placebo (p less than 0.05) in the patients with Raynaud's disease, but showed an effect only in the number of attacks (p = 0.049) among the group with Raynaud's phenomenon. Plethysmography showed no drug effects. One patient discontinued the trial after developing headaches while taking placebo. Nonlimiting toxicity occurred more commonly with drug than placebo (15 vs 9 times, p less than 0.05). Our study demonstrated that nicardipine improves symptoms in Raynaud's disease, but is not effective in Raynaud's phenomenon.
Arthritis, Rheumatoid↗
Left heart function in chronic obstructive lung disease.
In patients with varying degrees of chronic obstructive pulmonary disease (COPD), simultaneous measurements of central hemodynamics and left ventricular radionuclide ventriculograms at rest and during exercise were made. In 21 of these patients, satisfactory echocardiograms could be performed. In seven of the patients, arterial blood pressure at rest was increased. Decreased compliance of the left ventricle was thought to be present in patients with COPD and additional arterial hypertension. The left ventricular ejection fraction (LVEF) at rest was in the high normal range in all patients. During exercise, no further increase was observed. This pattern of LVEF response seems to be typical in patients with COPD. Because the highest values were observed in the more severe COPD and right ventricular hypertrophy, it is unlikely that an impairment of left ventricular function is caused by COPD. In five of 27 patients, an abnormal decrease of LVEF and regional hypokinesis occurred during exercise, thus suggesting additional coronary heart disease. The fact that at least 30% of the patients with COPD suffered from arterial hypertension and 20% of the patients exhibited unexpected ischemia detected by regional hypokinesis in RNV during exercise, but not in the ECG, may be of practical relevance. Coronary angiography was not indicated because most of these patients were over 65 and the factor limiting the working capacity was ventilatory impairment and not angina pectoris, in all patients. For this reason, a diagnostic uncertainty remains with regard to additional coronary heart disease in the older patients with advanced chronic obstructive pulmonary disease.
Aged↗
Interactions of vasodilators with calcium entry- and beta-blockers in patients with coronary heart disease.
Combinations of antianginal drugs may be used for an additive effect against angina, but also to off-set unwanted effects of one drug with another, either by direct effects or by a reduction of dosage of each drug. Based on earlier studies with separate drugs we have now examined the effect of 150 mg bupranolol combined with 40 mg isosorbide dinitrate (ISDN) in one retarded tablet, given twice daily. 22 patients with CHD entered the study, 11 of those with and 11 without signs of ischemia during exercise. In an acute radionuclide ventriculographic (RNV) study 2 h after the tablet, ejection fraction (EF) during exercise increased only in patients with exercise ischemia (+6%, p less than 0.001). In the other patients EF did not change. After 21 days of treatment echocardiographically determined end-systolic and end-diastolic diameters decreased, resulting in an increase of shortening fraction by 15.6% (p less than 0.05). Heart rate, systolic and diastolic pressure and ST-segment depression decreased significantly. In another acute RNV study the effect of a venous vasodilator, molsidomine 4 mg s.l., was examined after nifedipine 10 mg s.l. in 19 patients with CHD, 9 with and 10 without exercise ischemia. Differences between drugs were most prominent during exercise. In the nonischemic group EF rose by 6.6% after nifedipine (n.s.) and by 14% after molsidomine (p less than 0.01 against control). In the group with ischemia EF rose by 12.6% after nifedipine and by 17.4% after additional molsidomine, significant against control (p less than 0.01) as well as against nifedipine (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Bupranolol↗
Right ventricular function in patients with chronic obstructive pulmonary disease.
Simultaneous right heart catheterization and radionuclide ventriculography were performed in 27 patients with a wide range of chronic obstructive pulmonary disease. Central hemodynamics and radionuclide studies were done at rest and during exercise. In the resting state the right ventricular ejection fraction (RVEF) was in the normal range (43.3 +/- 6%). During exercise a significant (p less than 0.001) decrease of RVEF to 38.8 +/- 6.7% occurred. The pulmonary artery mean pressures were 19.9 +/- 3.8 at rest. During exercise a significant (p less than 0.001) increase to 41 +/- 9.8 mm Hg occurred. There was a linear relationship between pulmonary pressures and RVEF during exercise in patients with pulmonary artery pressures not exceeding 35 mm Hg. In patients with right ventricular end-diastolic wall thickness greater than or equal to 6 mm a curvilinear relationship between these parameters could be observed with a flattening of the curve at higher pressures (greater than 35 mm Hg) and lower ejection fractions (less than 35% RVEF). Radionuclide ventriculography cannot substitute for right heart catheterization. Echocardiography is useful for interpretation of right ventricular ejection fractions in advanced chronic obstructive pulmonary disease.
Aged↗
Drinking water and cancer incidence in Iowa. III. Association of cancer with indices of contamination.
With data from the Iowa Cancer Registry, age-adjusted sex-specific cancer incidence rates for the years 1969-1981 were determined for towns with a population of 1,000-10,000 and a public water supply from a single stable ground source. These rates were related to levels of volatile organic compounds and metals found in the finished drinking water of these towns in the spring of 1979. Results showed association between 1,2 dichloroethane and cancers of the colon and rectum and between nickel and cancers of the bladder and lung. The effects were most clearly seen in males. These associations were independent of other water quality and treatment variables and were not explained by occupational or other sociodemographic features including smoking. Because of the low levels of the metals and organics, the authors suggest that they are not causal factors, but rather indicators of possible anthropogenic contamination of other types. The data suggest that water quality variables other than chlorination and trihalomethanes deserve further consideration as to their role in the development of human cancer.
Adolescent↗
Etiology of atrioventricular-conduction abnormalities following cardiac surgery.
Atrioventricular-nodal-conduction abnormalities following cardiac surgery have been attributed to the potassium ion in cardioplegic solutions. To clarify the etiology of these rhythm problems, 15 dogs were subjected to (I) 60 min 4 degrees C potassium cardioplegic arrest; (II) 30 min normothermic ischemic arrest; or (III) cardiac hypothermia without ischemia. In sinus rhythm and during atrial pacing, A-H and H-V intervals, Wenckebach cycle length (WCL), atrial- and AV-nodal refractory periods (ARP and NRP) were measured at 37 degrees C before and 30 min after arrest (groups I and II) and at various myocardial temperatures (group III). Following cardioplegic arrest and reperfusion, all AV-nodal-conduction properties were unchanged from preischemic values. In contrast, unprotected ischemia significantly prolonged AV-nodal-conduction time (P less than 0.01) and myocardial hypothermia resulted in prolonged WCL (P less than 0.01), prolonged functional NRP (P less than 0.05), in addition to delayed A-H interval (P less than 0.05). The data suggest that properties of AV-nodal conduction are preserved following potassium cardioplegic arrest, but impaired by ischemic injury or persistent local cardiac hypothermia.
Animals↗
A model of cyanotic heart disease: functional, pathological, and metabolic sequelae in the immature canine heart.
To assess the etiology of depressed ventricular function in cyanotic congenital heart disease, an experimental model in immature puppies was devised in which the left atrial appendage is directly anastamosed to the distally banded pulmonary artery. The preparation results in significant cyanosis during a 3-month study period (PO2 = 91 +/- 4 vs 43 +/- 3, hematocrit = 33 +/- 3 vs 55 +/- 5). Compared to age- and weight-matched unoperated controls, cyanotic animals developed significant depression of biventricular ejection fraction (P less than 0.05), increased heart weight indexed for body weight (P less than 0.05), increased right ventricular weight (P less than 0.02), and increased right ventricular free wall thickness (P less than 0.05). There was no alteration in ventricular volumes. In addition, mean myocardial stores of high-energy phosphate compounds were unaltered. The model allows a reproducible level of hypoxemia to be produced in young animals, utilizes no prosthetic materials, and allows future experiments to be performed to ascertain the metabolic response of the cyanotic myocardium to exercise or surgically induced ischemia.
Animals↗