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Biomedical subjects

J Schwarz

Publications and source records attributed to J Schwarz.

At least 127 records · Page 7Linked to original sources
PubMed1996

Improved oral delivery of desmopressin via a novel vehicle: mucoadhesive submicron emulsion.

PURPOSE: Desmopressin acetate (DDAVP) is used parenterally and intranasally in the control of several diseases. Oral administration of DDAVP, while most desirable, is not practical presently due to low bioavailability. The objective of the present study was to explore the feasibility for employing oil-in-water MucoAdhesive SubMicron Emulsion (MA-SME), a novel mucoadhesive vehicle with polymer-coated droplets, for enhanced oral delivery of DDAVP. METHODS: We used a modified pharmacopeal method, based on measurement of the antidiuretic activity, for the assessment of oral delivery of DDAVP in rats. DDAVP formulated in two MA-SME preparations, in non-mucoadhesive SME (plain-SME), in saline and in other control solutions was administered orally to rats via a stomach tube at a dose of 0.5 units/kg. At various times following DDAVP administration, water was given via a stomach tube. Excretion times for 30% and 60% of the total water load were measured. RESULTS: Excretion times for DDAVP in MA-SME formulations were always longer (up to 2-fold) than those following DDAVP in saline. By contrast, excretion times for DDAVP in plain-SME and in non-SME Carbopol (a Mucoadhesive polymer) solution were virtually identical to those for DDAVP in saline. CONCLUSIONS: Formulations of MA-SME were shown to generate substantial enhancement (up to 12-fold) of the rat oral bioavailability of DDAVP with regard to simple saline solution of the drug. From the results it is also evident that MA-SME, but not plain-SME or non-SME Carbopol solution, is responsible for the enhancement of oral delivery of DDAVP in rats.

Administration, Oral↗
PubMed1996

Can occupational therapy intervention play a part in maintaining independence and quality of life in older people? A randomised controlled trial.

The main objective of this study was to see if older people could maintain their quality of life and independence after their homes had been modified and they were using community services as recommended by an occupational therapist. There were 167 study participants aged 69 to 94 years from the Northern Sydney Area. After being assessed at home by an occupational therapist, 105 were randomly allocated to one of two groups, to either have or not have the occupational therapist's recommendations carried out. They were assessed again after six months. A third group did not require any intervention. This group was followed up by telephone and postal questionnaire at six months. The main outcome measures used were the Sickness Impact Profile, the Philadelphia Geriatric Center Morale Scale, the Life Satisfaction Index, assessment of Activities of Daily Living, the Health Assessment Questionnaire and change in residence. After six months there were no difference in outcomes among the three groups. Most study participants remained at a satisfactory level on each measure. Three people had died. One had moved to hostel care and one had moved to a nursing home. A further 14 from the group having no intervention had withdrawn from the study. A secondary objective of this study was to indicate the responsiveness of these outcome measures to change in the short term (over six months) in an elderly population. Twelve-month assessments are in progress and may indicate what to expect from these outcome measures in the medium term.

Activities of Daily Living↗
PubMed1996

Signal changes on MRI and increases in reactive microgliosis, astrogliosis, and iron in the putamen of two patients with multiple system atrophy.

A correlation of clinical, MRI, and neuropathological data is reported in two patients with multiple system atrophy (MSA). On MRI, patient 1 showed striatal atrophy, reduction of T2 relaxation times within most of the putamen, and a band of hyperintense signal changes in the lateral putamen. In patient 2, MRI disclosed only shortening of the T2 signal in the putamen. Immunohistochemistry showed pronounced reactive microgliosis and astrogliosis in the affected brain regions. In patient 1, the area with the most pronounced microgliosis and astrogliosis most likely correlated with the area of hyperintense signal changes on MRI. This area also contained the highest amount of ferric iron, which was increased in the putamen of patient 1 but not patient 2. It is unlikely that the hypointense signal changes in the putamen are due to an increase of iron alone. Reactive microglial and astroglial cells may play a part in the pathogenesis of MSA.

Adult↗
PubMed1996

[Laparoscopic hernioplasty (TAPP)--complications and recurrences in 900 operations].

A prospective study of 900 patients with inguinal hernia who underwent transabdominal preperitoneal laparoscopic hernia repair (TAPP) was performed. The median operation time was 50 minutes (range 20-155); overall 44 complications (4.8%) were recorded. 8 patients (0.9%) required reoperation, in 6 cases because of postoperative bleeding or haematoma formation respectively, in one case because of testicular tenderness and in one case because of a mesh infection. Now, with the maximum follow-up of 26 months, 12 recurrences have been noted, giving a 1.33% recurrence rate. Return to work was 21 days (range 4-47 days). One year postoperatively about 83% of patients were without any complaints. A strict correlation between the complication and recurrence rate and the learning curve was found. It is concluded, that laparoscopic hernia repair (TAPP) is a safe and effective procedure. Complications and hernia recurrences diminish with experience.

Adolescent↗
PubMed1996

Iodine-123-iodobenzamide binding in parkinsonism: reduction by dopamine agonists but not L-Dopa.

UNLABELLED: The aim of the present study was to investigate the effect of treatment with L-Dopa or a dopamine agonist, or both, on specific striatal 123I-iodobenzamide (IBZM) binding using an intraindividual longitudinal design. METHOD: We prospectively studied the effect of dopaminomimetic treatment on specific [123I]IBZM binding measured by SPECT in 29 patients with a clinical diagnosis of Parkinson's disease, none of whom had previously received dopaminomimetic drugs. The patients had been selected on the basis of normal subsequent specific [123I]IBZM binding, semiquantitatively calculated as the basal ganglia/frontal cortex ratio, and a positive response to the dopamine agonist apomorphine before initiation of dopaminomimetic therapy. A second 123I-IBZM SPECT investigation was performed after 3-6 mo of treatment with L-Dopa or a dopamine agonist, or both. RESULTS: Specific [123I]IBZM binding was unchanged in 10 patients treated with L-Dopa alone. However, after treatment with a dopamine agonist there was a significant decline in specific [123I]IBZM binding (p < 0.05). After treatment with a combination of L-Dopa and a dopamine agonist, specific [123I]IBZM binding was reduced without reaching a level of significance (p = 0.08). CONCLUSION: Short-term treatment with a dopamine agonist but not with L-Dopa reduces specific [123I]IBZM binding. Therefore, before performing an [123I]IBZM SPECT scan in patients previously treated with dopaminomimetic drugs, dopamine agonists should be discontinued.

Antiparkinson Agents↗
PubMed1995

Starnberg trial on epidemiology of Parkinsonism and hypertension in the elderly. Prevalence of Parkinson's disease and related disorders assessed by a door-to-door survey of inhabitants older than 65 years.

OBJECTIVE: To investigate the prevalence of different types of parkinsonism (PS) in the elderly, regardless of health care service or drug prescription, by a door-to-door survey in two German villages. DESIGN: We investigated the prevalence of PS in a rural Bavarian population of individuals older than 65 years (982 participants; response rate, 82.5%) using a door-to-door-survey and a biphasic approach. MAIN OUTCOME MEASURES: Two investigators employed a pretest screening questionnaire and motor tests for signs of PS. Individuals suspected of suffering from PS were reinvestigated by two neurologists trained in movement disorders, and computed tomographic scans were performed. RESULTS: The prevalence of Parkinson's disease in individuals older than 65 years was 0.71% (95% confidence interval, 0.19% to 1.23%), with a male predominance (five men, two women). Parkinsonism of other pathogenesis included drug-induced PS (0.41%, four of 982 inhabitants), vascular PS (0.20%, two of 982), multiple system atrophy (0.31%, three of 982), and Fahr's disease (0.10%, one of 982). The high prevalence of normal-pressure hydrocephalus (0.41%, four of 982 inhabitants) was an unexpected finding that was confirmed by computed tomography. Fifty percent of cases of PS were newly diagnosed. CONCLUSIONS: This study represents the first door-to-door survey on PS in Germany. In addition, for the first time, it includes a clinical differentiation between Parkinson's disease, multiple system atrophy (of the striatonigral type), and PS of other pathogenesis. The prevalence of Parkinson's disease corresponds to that reported in other surveys of people older than 65 years. Normal-pressure hydrocephalus and multiple system atrophy, on the other hand, were more prevalent than expected, and all these cases were newly diagnosed.

Adult↗
PubMed1995

L-dopa therapy of uremic and idiopathic restless legs syndrome: a double-blind, crossover trial.

We report the effects of a single bedtime dose of L-dopa 100-200 mg on sleep quality, frequency of periodic leg movements (PLM) and daily living in patients with idiopathic and uremic restless legs syndrome (RLS). Seventeen patients with idiopathic and 11 with uremic (on continuous hemodialysis) RLS were evaluated comparatively by polysomnography, actigraphy and subjective ratings in a randomized, controlled and double-blind crossover trial with L-dopa and placebo for 4 weeks each. Neurophysiologic assessments showed significant reduction of the number of periodic leg movements (p = 0.003) and the PLM-index (p = 0.005) most pronounced during the first 4 hours of bedtime after L-dopa (p = 0.001). Subjective evaluation confirmed improvement of sleep quality (p = 0.002) and showed significantly higher quality of life during daytime (p = 0.030) while the patients received L-dopa therapy. We conclude that L-dopa 100-200 mg proved to be effective in idiopathic RLS and for the first time under controlled conditions in uremic RLS without any severe side effects.

Adult↗
PubMed1995

[Meningitis after travel in the Mediterranean region, caused by the sandfly fever virus].

Sandfly fever virus is the causative agent of sandfly fever (pappataci fever). The virus is endemic in the Mediterranean region and is transmitted by bites of Phlebotomus species. The three sandfly fever virus serotypes, Sicilian (SFS), Naples (SFN) and Toscana (TOS), are of travel-related significance. In addition to a flu-like illness, the sandfly fever virus may result in a serious neurological disease with meningitis and encephalitis. Due to the high number of travelers may occur in nonimmune persons. Since many clinicians are not aware of this disease, sandfly fever is still rarely diagnosed.

Adult↗
PubMed1995

[Standardized laparoscopic hernioplasty vs. Shouldice repair. Results of a randomized comparative study].

From 5/93 up to 12/93 a prospective randomized trial was performed. 102 patients with unilateral primary inguinal hernias were included. In 48 patients a Shouldice repair and in 54 patients a laparoscopic TAPP procedure was performed. The laparoscopic method is described. There were significantly less pain and quicker mobility in the laparoscopic group. In addition a shorter period of disability of work was seen (21 vs. 38 days) in the same group. The morbidity of the procedures was as low in the Shouldice as in the laparoscopic group. There was a regular control of all patients. The current follow-up period is 16 months (13-21) in median. In both groups there were no recurrences up to now. The efficiency of laparoscopic hernia repair is discussed.

Adolescent↗
PubMed1995

Expression of mef2 genes in the mouse central nervous system suggests a role in neuronal maturation.

Members of the myocyte enhancer factor 2 (MEF2) gene family are expressed in a dynamic pattern during development of the CNS of pre- and postnatal mice. The four MEF2 genes, Mef2A, -B, -C, -D, encode transcription factors belonging to the MADS (MCM1-agamous-deficiens-serum response factor) superfamily of DNA binding proteins. MEF2 factors have previously been shown to be positive regulators of gene expression in terminally differentiated muscle cells. To begin to determine the role of MEF2 factors in CNS development, we used in situ hybridization with gene-specific cRNA probes to define the expression patterns of each of the four Mef2 mRNAs in the developing and mature mouse CNS. Mef2C mRNA was first detected in a ventral portion of the telencephalon at 11.5 d postcoitum (p.c.). By 13.5 d p.c., each of the four Mef2 genes were expressed in overlapping yet distinct patterns in regions of the frontal cortex, midbrain, thalamus, hippocampus, and hindbrain. Temporal and spatial patterns of embryonic Mef2 gene expression appeared to follow gradients of neuron maturation and suggested that the onset of Mef2 gene expression coincides with withdrawal from the cell cycle and initiation of neuronal differentiation. This correlation is particularly striking for Purkinje cells in the cerebellum. Since the molecular mechanisms that regulate neuron differentiation are unknown, we propose that the MEF2 factors are likely to play an important role in this process.

Animals↗
PubMed1995

Epidemiological, genetic, pharmacological, kinesiological, nuclear medical (IBZM-SPECT), standard and functional MRI studies on Parkinson's disease and related disorders and economic evaluation of Parkinson's disease therapy--clinical projects in the BMFT-research program Munich: "Parkinson's disease and other basal ganglia disorders".

The results of selected clinical research projects related to epidemiological, genetic, pharmacological, kinesiological, and neuroimaging aspects (SPECT, PET, MRI, functional MRI) of basal ganglia disorders such as Parkinson's disease, Progressive Supranuclear Palsy, Multiple System Atrophy and Wilson's disease are summarized. A retrospective pharmacoeconomic analysis of Parkinson's disease is presented. These studies are part of a nationwide research program of the German ministry of research and technology (BMFT) entitled "Parkinson's disease and other basal ganglia disorders" and were carried out at the Department of Neurology, LMU München.

Basal Ganglia Diseases↗
PubMed1994

n of 1 trials comparing a non-steroidal anti-inflammatory drug with paracetamol in osteoarthritis.

OBJECTIVE: To evaluate the efficacy of paracetamol and a non-steroidal anti-inflammatory drug for symptom relief in osteoarthritis. DESIGN: Double blind, randomised, controlled trials in individual patients (n of 1 trials). Three treatment cycles with two weeks' each of paracetamol (1 g twice daily) and diclofenac (50 mg twice daily) prepared in identical gelatin capsules. SETTING: General practices in metropolitan Sydney, Australia. SUBJECTS: 25 patients (median age 64 years) with pain of osteoarthritis (median duration of disease eight years) considered by their general practitioners to require regular treatment. 20 were already taking non-steroidal anti-inflammatory drugs. MAIN OUTCOME MEASURES: Diary of pain and stiffness, function, and side effects. RESULTS: 15 patients completed the study, five withdrew early but had made a therapeutic decision, and five dropped out very early. Results from 20 patients were analysed. Several patterns of response evolved. Eight of the 20 patients found no clear difference, symptoms being adequately controlled by paracetamol; five indicated a clear preference for the non-steroidal anti-inflammatory drug; two showed control of symptoms after their initial two weeks of the non-steroidal anti-inflammatory drug which continued throughout subsequent treatment changes; in five the non-steroidal anti-inflammatory drug may have been better but neither agent gave satisfactory control. After three months nine of the 20 patients had adequate symptom control with paracetamol alone. CONCLUSIONS: Of 1 studies--that is, randomised trials in individual patients--are clinically useful in deciding treatment in heterogeneous conditions which require long term symptomatic relief. In osteoarthritis many patients currently receiving or being considered for non-steroidal anti-inflammatory drugs may achieve adequate control with paracetamol.

Acetaminophen↗
PubMed1994

Clinical progressive supranuclear palsy: differential diagnosis by IBZM-SPECT and MRI.

In order to in vivo identify subgroups in eight patients with the clinical diagnosis of progressive supranuclear palsy (PSP), we have performed 123I-iodobenzamide single photon emission computed tomography (IBZM-SPECT), a nuclear medicine technique, to visualize dopamine D2 receptors in vivo, and high resolution (TE/TR 2900/20-90) magnetic resonance imaging (MRI) to evaluate morphological CNS changes. All patients exhibited similar clinical features including supranuclear vertical gaze palsy, especially of downward gaze, predominantly axial rigidity especially in the neck, bradykinesia, instability of balance with easy falls, and poor response to dopaminergic drugs. Specific striatal dopamine D2 receptor binding in IBZM-SPECT, as calculated by a basal ganglia to frontal cortex ratio (BG/FC) was reduced in 5 patients, but normal in 3 patients. In MRI, these 3 patients exhibited multiple hyperintense white matter lesions; 2 of them had no midbrain atrophy. In contrast, all 5 patients with reduced IBZM binding lacked multiple white matter lesions in MRI, but 4 of them showed marked midbrain atrophy. This pilot study with IBZM-SPECT for in vivo imaging of striatal dopamine D2 receptors and T2-weighted MRI supports published neuropathological findings that clinical signs of PSP appeared to be due to heterogeneous neuropathology.

Aged↗