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Biomedical subjects

K Schimrigk

Publications and source records attributed to K Schimrigk.

189 records · Page 11Linked to original sources
PubMedDate not supplied

Tick-borne encephalitis diagnosis in patients with inflammatory changes in the cerebrospinal fluid in a region with very low prevalence.

Tick-borne encephalitis (TBE)-IgG antibodies are used for the serologic detection of antigen contact caused by TBE infection or immunization. In the present study, enzyme-linked immune sorbent assay (ELISA) results from a group of patients with inflammatory changes in the cerebrospinal fluid (CSF) were re-examined using Western blot technology. The result of the TBE-IgG-ELISA was positive in 47 of the 904 sera samples tested. Retesting the sera with a Western blot confirmed this result in only 31.8% of the positive cases. In 134 of the 904 sera, the ELISA result was borderline. In 5.5% of these sera, the Western blot reacted specifically. The remaining 723 sera samples tested negative with the ELISA. Of these sera, 15 were selected randomly and retested with the Western blot; none of them tested positive. The high number of false positive ELISA results can be explained by the highly selected group of patients and the low prevalence of TBE in the region studied. In patients with meningitis or encephalitis with positive ELISA results and uncharacteristic clinical symptoms, the treating physician should consider the possibility of nonspecific reactions involving inflammatory mediators or cross-reactivity with other flaviviruses. The ELISA-mediated diagnosis of TBE should therefore be verified by means of the patient's history and clinical symptoms, as well as further serologic tests including the Western blot, the hemagglutination test and the neutralization test.

Blood↗
PubMedDate not supplied

Tick-borne encephalitis in the Saarland and the Rhineland-Palatinate.

The Saarland and the Rhineland-Palatinate are not considered endemic regions for tick-borne encephalitis (TBE), and patients in this region have not been routinely advised to undergo vaccination or serologic testing for TBE. In 1994, a significantly increased incidence of TBE cases was noted in the neighbouring state of Baden-Württemberg. In the same year, the first TBE acquired in the Saarland was diagnosed. To investigate the infection risk for TBE in the Saarland and Rhineland-Palatinate, the records of 2,123 serologic tests for TBE collected since 1989 were systematically examined. In addition, 904 frozen sera of patients displaying inflammatory changes in the cerebrospinal fluid (CSF) were analyzed. IgG and IgM antibodies against TBE virus were found in 15 patients, four of which were verified clinically and serologically as TBE. One of these four cases was certainly and another was probably acquired in the Saarland. Three other patients displayed serologic signs of a TBE virus contact. The results of this study suggest that the occurrence of single cases in the Saarland has to be considered, but the risk is very small.

Adult↗
PubMedDate not supplied

[Blood group antigens and ABH secretor status in dystrophia myotonica (Curschmann-Steinert)].

The linkage between the dominantly inherited Dystrophia myotonica and ABH-Secretor locus is well known. It has been used as a genetic marker for the early detection of heterozygous patients. Genetic counselling, however, requires exact knowledge of the gene combination. 25 persons from a special ambulance, patients and their advice seeking relatives, were examined for ABH, Lewis, Kidd, and Lutheran blood groups. Secretor test was performed from saliva. In 42% of the patients the combination of Dystrophia myotonica to the (Se) or (se) allele could not be exactly determined, nor in any of their relatives because the number of family members available for analysis was insufficient. Therefore this genetic marker is considered to be of limited practical importance for genetic counselling despite of its high theoretical value. The occurrence of lewis-b-antigen in the saliva of 3 nonsecretor patients cannot be explained yet.

ABO Blood-Group System↗
PubMedDate not supplied

Neurochemical differences in the CSF between Binswanger's and Alzheimer's disease.

In 21 patients suffering from Binswanger's disease (BD) and in 53 patients suffering from Alzheimer's disease, we measured cerebrospinal fluid (CSF) concentrations of somatostatin-like immunoreactivity (SLI), high molecular weight form somatostatin (HMV-SST), somatostatin-25/28 (SST-25/28), somatostatin-14 (SST-14), Des-ala-somatostatin (Des-ala-SST), homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA). The patients were classified into three stages of intellectual deterioration according to the global deterioration scale (GDS). Levels of SLI were significantly decreased in BD in general and in SDAT patients with severe dementia (GDS 7), compared to a control group (BD overall 19.7 +/- 11.6 fmol/ml, SDAT 18.6 +/- 7.9 vs. 30.5 +/- 8.6 fmol/ml in controls, p < 0.01 for both). In SDAT patients, SLI levels correlated with dementia scores (r = -0.65, p < 0.05), but not in BD. HVA levels were decreased significantly in SDAT and BD patients with severe dementia (SDAT 273.5 +/- 138.7, BD 224.3 +/- 69.9 vs. 364.9 +/- 103.8 nmol/ml, p < 0.01 in controls, p < 0.05 for both). In BD patients with light dementia (GDS 2-4), HVA levels were significantly elevated (p < 0.05). In BD, HVA levels correlated with dementia (r = -0.59, p < 0.01). 5-HIAA was significantly elevated in BD patients with light dementia (p < 0.05). Qualitative and quantitative changes in the molecular forms of SLI are compatible with a dysregulated posttranslational processing SDAT and BD. We also observed significant correlations between SLI, 5-HIAA and HVA in BD indicating a neurochemical heterogeneous and generalized process affecting several transmitter systems and functions. In summary, our study shows that despite their quite different neuropathology, SDAT and BD do not differ fundamentally in their neurochemical profile.

Aged↗
PubMedDate not supplied

Highly substituted hydroxyethyl starch (HES200/0.62) leads to Type-I von Willebrand syndrome after repeated administration.

Hydroxyethyl starch (HES) is a frequently used plasma substitute that is popular due to a high degree of therapeutic safety. However, the administration of large volumes of highly substituted, high-molecular-weight starch often leads to iatrogenic von Willebrand syndrome (vWS) with hemorrhagic complications. In patients with cerebral circulatory disturbances we carried out hemodilution therapy during 9-10 days, infusing HES 200/0.62. A von Willebrand factor (vWF) multimeric analysis was carried out in 6 patients using a modified western blot according to the sodium dodecyl sulfate agarose gel electrophoresis method. The vWF multimeric analysis showed that all multimers decreased to the same degree, corresponding to type-I vWS.

Aged↗
PubMedDate not supplied

Influence of low molecular weight hydroxyethyl starch (HES 40/0.5-0.55) on hemostasis and hemorheology.

Hydroxyethyl starch (HES) with a high or medium molecular weight (MW) and a high degree of substitution is difficult to degrade and leads to an accumulation of large molecules. These molecules have a negative effect on hemostasiological parameters. In 10 patients with cerebrovascular diseases, a hemodilution therapy was carried out with low MW HES for 10 days. Due to the low MW of the HES used (56-61 kD), the rheological parameters erythrocyte aggregation and plasma viscosity were significantly lowered (p < 0.01). No coagulation parameters studied were affected beyond the dilution effect, which was measured using the decline in hematocrit. Low MW starch is a volume substitute that is well-suited for repeated infusion or hemodilution therapy, particularly for patients with increased hemorrhagic diathesis, because it does not affect hemostasis. The disadvantage of a relatively short volume effect can be compensated through a continuous infusion of a larger volume.

Aged↗
PubMedDate not supplied

No coagulation disorders under high-dose volume therapy with low-molecular-weight hydroxyethyl starch.

Hydroxyethyl starch (HES) is often used for volume therapy. Since bleeding complications have been reported repeatedly, a strict dose limitation of a maximum of 1,500 ml 6% solution per day is recommended. However, many indications require higher dosages. Bleeding complications are known to be caused by an acquired von Willebrand syndrome. It has been shown that the accumulation of large molecules and their impairment in the coagulation system can be avoided by using HES preparations with a low in vivo molecular weight. However, the effects of a high-dose therapy have not been studied yet. We have investigated, how a 4-day high-dose therapy, using 3,000 ml 6% HES 70/0.5 on the 1st day and 1,500 ml on days 2-4, affects the coagulation system and hemorheological parameters of acute stroke patients. Thromboplastin time, activated partial thromboplastin time and thrombin time showed no significant changes, except for a slight, clinically irrelevant change due to dilution. The subunits of von Willebrand factor VIII showed no significant change. Hematocrit decreased from 42.3 +/- 4.6 to 37.4 +/- 3.9% (p < 0.05) after day 1, reaching 35.3 +/- 4.2% (p < 0.01) at the end of the therapy, demonstrating a substantial volume effect. Plasma viscosity and erythrocyte aggregation decreased slightly, however not significantly. Our study shows that even a high-dose therapy with 6% HES 70/0.5 has no influence on the coagulation system.

Adult↗
PubMedDate not supplied

Comparative morphometry of myelinated nerve fibres in the normal and pathologically altered human sural and tibial nerve.

To assess neuropathological changes in human nerves, biopsies are usually performed on the sural nerve or other nerves supplying only a small area of skin. It is not yet clearly understood to what extent the changes found in this sensory nerve correspond to the changes found in other distal sensomotory nerves. To answer this question, we made a comparative morphometric analysis of the sural and tibial nerve. In 39 autopsy cases (aged 22 - 90 years) the sural and the tibial nerve were subject of image analysis. The histological picture in this study group was clearly influenced by neuropathological changes as well as age-related changes. For each morphometric parameter in the sural and tibial nerve, we evaluated Pearson's correlation. The highest coefficient of correlation (r) was seen in those parameters that represented the condition of the myelin sheath area: the density of nerve fibre area (sum of measured nerve, fibre areas/analyzed endoneural area) (r = 0.86) and the density of myelin sheath area (sum of measured myelin areas/analyzed endoneural area) (r = 0.86). Similar correlations were obtained for the mean of axon diameter (r = 0.82), the numerical density of nerve fibre count (nerve fibre count/analyzed endoneural area) (r = 0.77), the mean of nerve fibre diameter (r = 0.77) and the mean of myelin sheath thickness (r = 0.72). Our results revealed a good or very good statistical correlation of morphometric parameters between the two examined nerves. They support the assumption that the sural nerve sufficiently reflects the histological changes in other distal sensomotoric nerves. This is valid at least in systemic neuropathological diseases and age-dependent processes.

Adult↗