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K Weigel

Publications and source records attributed to K Weigel.

At least 19 recordsLinked to original sources

Random regression models for male and female fertility evaluation using longitudinal binary data.

A longitudinal Bayesian threshold analysis of insemination outcomes was carried out using 2 random regression models with 3 (Model 1) and 5 (Model 2) parameters to model the additive genetic values at the liability scale. All insemination events of first-parity Holstein cows were used. The outcome of an insemination event was treated as a binary response of either a success (1) or a failure (0). Thus, all breeding information for a cow, including all service sires, was included, thereby allowing for a joint evaluation of male and female fertility. An edited data set of 369,353 insemination records from 210,373 first-lactation cows was used. On the liability scale, both models included the systematic effects of herd-year, month of insemination, technician, and regressions on age of service sire and milk yield during the first 100 d of lactation. The random effects in the model were the 3 or 5 random regression coefficients specific to each cow, the permanent effect of the cow, and the service sire effect. Using Model 1, the estimated heritability of an insemination outcome decreased from 0.035 at d 50 to 0.032 at d 140 and then increased continuously with DIM. The genetic correlations for insemination success at different time points ranged from 0.83 to 0.99, and their magnitude decreased with an increase in the interval between inseminations. A similar trend was observed for heritability and genetic correlations using Model 2. However, the average estimate of heritability was much higher (0.058) than those obtained using Model 1 or a repeatability model. In addition, the estimated genetic correlations followed the same trend as Model 1, but were lower and with a higher rate of decrease when the interval between inseminations increased. The posterior mean of service sire variance was 0.01 for both models, and permanent environmental variance was 0.05 and 0.02 for Models 1 and 2, respectively. Model comparison based on the Bayes factor indicated that Model 1 was more plausible, given the data.

Animals↗

Genetic analysis of male and female fertility using longitudinal binary data.

A longitudinal Bayesian threshold analysis of insemination events during the first 250 d after calving of first-parity Holsteins was carried out. The outcome of an insemination event was treated as a binary response of either a success (1) or a failure (0). Thus, all breeding information for a cow, including all service sires, was included, thereby allowing for a joint evaluation of male and female fertility. An edited data set of 297,823 insemination records from 151,758 first lactation cows was used. On the liability scale, the model included the systematic effects of herd-year of insemination, technician, month of insemination, and regressions on age of service sire, 3 test days in the first 100 d of lactation (early milk yield), and days in milk at insemination. The random effects in the model were the additive breeding value, the permanent effect of the cow, and the service sire effect. Posterior mean (standard deviation) of the dispersion parameters in the model were 0.034 (0.006), 0.009 (0.001), and 0.171 (0.013) for the additive, service sire, and permanent environmental variances, respectively. The residual variance was fixed at 1, as a result of the nonidentifiability of the threshold model. The posterior mean (standard deviation) of heritability was 0.028 (0.005). This point estimate of heritability is well within the range of available estimates for the trait. Thus, these estimates suggest that some genetic variation exists that can potentially be used to improve reproductive performance or at least avoid its further deterioration. The estimate of the regression coefficient on age of service sire was 0.001, indicating better fertility among older bulls. However, this result has to be interpreted with caution given the preferential use of proven bulls on well-managed cows (as opposed to problem breeders). The estimate of the regression coefficient was negative (-0.005) for early milk yield, as expected, and positive (0.003) for days in milk at insemination. This suggests that high-producing cows are less likely to conceive at the beginning of lactation.

Age Factors↗

Interstitial granulomatous dermatitis with plaques and arthritis.

Interstitial granulomatous dermatitis and arthritis (IGDA) is a rare disease entity with female predominance. The case of a 53-year-old woman with erythemas, plaques and nodules associated with polyarthritis is presented. She was treated with cyclosporin A, with improvement of the joint affliction and complete clearance of skin lesions. The differential diagnosis of IGDA is discussed briefly.

Arthritis↗

Factors associated with inadequate blood pressure control in hypertensive hemodialysis patients.

Hypertension is common in hemodialysis patients and increases cardiovascular morbidity and mortality. We determined the prevalence of inadequate control of hypertension in 489 patients receiving hemodialysis and identified factors associated with uncontrolled hypertension. We interviewed the patients and abstracted demographic and clinical information from a computerized database. The prevalence of uncontrolled hypertension (average predialysis blood pressure, > or =160/90 mm Hg) was 62%. Ninety-one percent of patients with uncontrolled hypertension were receiving submaximal antihypertensive drug therapy, and 59% withheld their medications before dialysis. Uncontrolled hypertensives had a greater interdialytic weight gain (3.8% v 3.5%, P = 0.07) and a greater excess weight gain (3.1 +/- 1.6 kg v 2.5 +/- 1.4 kg; P < 0.05) compared with controlled hypertensives. Patients with uncontrolled hypertension showed higher interdialytic weight gain (2.7 +/- 0.06 kg v 2.2 +/- 0.13 kg; P < 0.05), were more likely to be black (94% v 81%; P < 0.05), were more likely to have hypertension as the cause of their end-stage renal disease (ESRD) (42% v 24%; P < 0.05), and had been receiving hemodialysis for a shorter time (4.3 +/- 2 yr v 6.1 +/- 0.9 yr; P < 0.05) compared with normotensive patients. There was significant correlation between diastolic blood pressure and both interdialytic weight gain (r = 0.31, P < 0.05) and percent weight gain (r = 0.34, P < 0.05) in the hypertensive but not in the normotensive patients (r = -0.21). Interdialytic weight gain and hypertension as a cause of ESRD were independent predictors of predialysis systolic blood pressure. We conclude that hypertension is uncontrolled in most patients undergoing hemodialysis. Submaximal antihypertensive therapy, excessive interdialytic weight gain, and withholding antihypertensive medication before dialysis are correctable factors potentially contributing to uncontrolled hypertension.

Algorithms↗

Renal function following conversion from Sandimmune to Neoral in stable renal transplant recipients.

Conversion of stable renal transplant patients from Sandimmune to Neoral may pose a risk of short-term nephrotoxicity. Serial serum creatinine concentrations were measured in 141 kidney and simultaneous kidney-pancreas transplant recipients converted from Sandimmune to Neoral on a 1:1 dosing basis and followed for up to 11 months. Following conversion, cyclosporine dose was reduced in 74% of patients with a mean dose reduction of 22.6% for the entire cohort. Serum creatinine concentrations transiently increased to more than 30% above baseline in 48% of patients and remained more than 30% above baseline in 16% of patients. Multivariate analyses suggested that acute rejection, maintenance steroid therapy, young age, Sandimmune dose prior to conversion, and an increment in trough cyclosporine levels after conversion were positive predictors of renal insufficiency following conversion. Lower doses of Neoral should be considered at the time of conversion to minimize nephrotoxicity.

Adult↗

Prednisone improves renal function and proteinuria in human immunodeficiency virus-associated nephropathy.

PURPOSE: To determine if prednisone ameliorates the course of human immunodeficiency virus-associated nephropathy (HIV-AN). PATIENTS AND METHODS: Twenty consecutive HIV-infected adults with biopsy-proven HIV-AN (n = 17) or clinical characteristics of HIV-AN (n = 3) with serum creatinine concentrations > 177 mumol/L (2 mg/dL) or proteinuria > 2.0 g/d or both were prospectively evaluated and treated with prednisone at a dose of 60 mg/d for 2 to 11 weeks, followed by a tapering course of prednisone over a 2- to 26-week period. Serum creatinine concentration, 24-hour protein excretion, serum albumin, and steroid-related adverse effects were assessed before and after treatment. RESULTS: Nineteen patients had serum creatinine concentrations > 117 mumol/L (2 mg/dL). Two of them progressed to end stage renal disease (ESRD) in 4 to 5 weeks. In 17 patients serum creatinine levels decreased from 717 +/- 103 mumol/L (8.1 +/- mg/dL) (mean +/- SE) to 262 +/- 31 mumol/L (3.0 +/- 0.4 mg/dL) (P < 0.001). Five patients relapsed after prednisone was discontinued and were retreated. In these 5 the serum creatinine declined from 728 +/- 107 mumol/L (8.2 +/- 1.2 mg/dL) to 344 +/- 47 mumol/L (3.9 +/- 0.5 mg/dL) (P < 0.01) in response to the second course of prednisone. Twelve of 13 tested patients showed a reduction in 24-hour urinary protein excretion with an average decrement from 9.1 +/- 1.8 g/d to 3.2 +/- 0.6 g/d (P < 0.005). Serum albumin increased from 24.4 +/- 3.6 g/L to 29.3 +/- 2.6 g/L (P = NS) in the 11 patients with paired 24-hour urine collections for whom pre- and post-treatment determinations were available. In one non-azotemic patient with nephrotic syndrome, protein excretion declined from 15.2 to 2.2 g/day and the serum albumin increased from 4.0 g/L to 31.0 g/L. The 20 patients have been followed for a median of 44 weeks (range 8 to 107). Eight ultimately required maintenance dialysis. Eleven died from complications of HIV disease 14 to 107 weeks after institution of prednisone; none was receiving prednisone at the time of death. Seven are alive and free from ESRD a median of 25 weeks (range 8 to 81) from the initiation of prednisone therapy. Six patients developed a total of seven serious infections while receiving prednisone, including Mycobacterium avium-complex infection in 2 and CMV retinitis in 3. CONCLUSION: Prednisone improves serum creatinine and proteinuria in a substantial proportion of adults with HIV-AN. Corticosteroid-related side effects are not prohibitive. A prospective, randomized controlled trial is required to confirm these preliminary results.

Adult↗

The effects of angiotensin II receptor blockade with losartan on systemic blood pressure and renal and extrarenal prostaglandin synthesis in women with essential hypertension.

The major antihypertensive effect of losartan, a nonpeptide angiotensin II antagonist, is thought to be due to inhibition of the pressor effects of angiotensin II. It is possible, however, that losartan alters the synthesis of vasodilator or vasoconstrictor prostaglandins (PG), thus contributing to its antihypertensive effect. Sixteen postmenopausal women with essential hypertension, with a mean age of 59 years and diastolic blood pressures of 95 to 115 mm Hg, were enrolled in a 12-week, single-blind study to determine the effects of losartan on blood pressure, renal and extrarenal PG production, plasma renin activity (PRA), plasma aldosterone, and routine biochemical parameters. The subjects received placebo during weeks 1 to 4, 50 mg losartan daily during weeks 5 to 8, and placebo during weeks 9 to 12. During the 4-week treatment period, there were no significant, sustained changes in renal or extrarenal synthesis of PGE2, PGI2, or thromboxane A2. Losartan significantly reduced systolic blood pressure from 155 +/- 11 mm Hg (mean +/- SD) to 139 +/- 13 mm Hg (P = .001) and diastolic blood pressure from 100 +/- 2 mm Hg to 87 +/- 5 mm Hg (P < .001) despite the fact that the majority of patients had low PRA. Plasma aldosterone concentration decreased from 9.7 +/- 6.5 ng/dL to 5.1 +/- 3.9 ng/dL (P = .002) and serum uric acid declined from 4.6 +/- 0.8 mg/dL to 4.2 +/- 0.8 mg/dL (P = .018) after 4 weeks of treatment with losartan. We conclude that 1) losartan decreases blood pressure in women with essential hypertension and low plasma renin activity; 2) the antihypertensive effect is not associated with sustained changes in renal or extrarenal PG production; and 3) losartan reduces plasma aldosterone and serum uric acid concentrations in patients with essential hypertension.

Aged↗

Urological findings in patients with neurosurgically treated tethered spinal cord.

We studied 42 consecutive patients with spina bifida to ascertain the urological relevance of the tethered spinal cord in this condition. We evaluated 35 patients before untethering and 21 with pathological findings after untethering. The main difference after untethering was an increase in bladder capacity in 10 of 17 patients. The general clinical condition improved in 13 patients, was stable in 5 and became worse in 3.

Child↗

Stereotactic brain biopsy in AIDS.

In the hope of finding a treatable condition, the need for rapid diagnosis in HIV-seropositive patients with brain lesions is apparent. In order to evaluate the efficacy of stereotactic brain biopsy in AIDS patients, we retrospectively studied 25 HIV-infected patients undergoing stereotactic biopsy. Brain lesions were identified with gadolinium-enhanced MRI and/or contrast CT. Brain biopsy was performed using the system of Riechert. From 8 up to 15 small tissue samples from one or two targets were obtained in every patient. The biopsy material was examined cytologically, histologically (including electron microscopy), immunohistochemically and, in part, by animal test and polymerase chain reaction (PCR). A definite diagnosis was achieved in 92%. Diagnosis included primary central nervous system lymphoma (PCNSL) (10), toxoplasmosis (10), progressive multifocal leukoencephalopathy (2) and one case of co-existing toxoplasmosis and cytomegalovirus infection. Two biopsies were non-diagnostic. All PCNSLs showed polymorphic B-cell populations of high malignancy; accurate classification according to the Kiel classification was not possible. In 3 lymphomas Epstein-Barr nuclear antigen (EBNA) 2-mRNA could be detected by PCR and confirmed immunohistochemically by EBNA 2 expression. In 6 cases autopsy confirmed the biopsy diagnosis. Conventional histology was not sufficiently decisive for toxoplasmosis and progressive multifocal leukoencephalopathy, so that immunohistochemistry and animal tests became very important for a final diagnosis. With the help of different morphological and molecular biological techniques stereotactic brain biopsy appears to be an effective method in the diagnosis of HIV-associated brain lesions. In view of the marked radio- and chemosensitivity of PCNSLs it is mandatory to establish an early and accurate histological diagnosis for adequate treatment.

Acquired Immunodeficiency Syndrome↗

[Primary and secondary tethered cord syndromes. Their nuclear magnetic tomographic diagnosis and comparison with the surgical findings in 40 patients].

The MRT findings in 40 patients with the tethered cord syndrome (TCS) have been compared with the operative findings. In cases of primary TCS (17 patients), MRT showed a low conus medullaris in 15 cases and this was confirmed surgically in 14. Other abnormal findings were lipomas (MRT 12/operatively 13), diastematomyelia (MRT 2/operatively 2) and thickened filum terminale (MRT 6/operatively 3). In secondary TCS (23 patients) postoperatively adhesions were prominent (MRT 16/operatively 23) while low position of the conus was found by MRT in 19 and surgically in 18 patients. Other findings were lipomas (MRT 5/operatively 6), epidermoids (MRT 2/operatively 2) and diastematomyelia (MRT 2/operatively 0). Agreement between MRT and operative findings regarding fixation of the spinal cord is closer in primary TCS (15/17, 88%) than in secondary TCS (16/23, 69%).

Adolescent↗

Strategy for diagnosis of Toxoplasma gondii in stereotactic brain biopsies.

The colloidal gold method using polyclonal antitoxoplasma antibodies was used to detect Toxoplasma organisms in stereotactic brain biopsies of patients with AIDS. For comparison, conventional histologic staining and additional other immunohistochemical methods were also studied in the same cases. Compared to the other stains, a reliable diagnosis of Toxoplasma gondii could be established with the colloidal gold method in all patients investigated. This method was highly specific and sensitive and stained both the encysted and the tachyzoite forms of the organism. Stronger contrast of the single parasite and better identification is possible if it is applied together with silver enhancement. Conventional staining and immunohistochemical peroxidase techniques are not advantageous, because they allow a diagnosis only by observation of the rare pseudocysts and not by free parasites in tissue, so the colloidal gold method appears to be the preferred method for a rapid diagnosis of cerebral toxoplasmosis, especially in cases where only small amounts of tissue can be obtained.

Acquired Immunodeficiency Syndrome↗

[Brain biopsies in HIV-infected patients].

Stereotactic brain biopsies of 25 HIV-seropositive patients (age range between 20 and 56 years, 23 males, 2 females) were retrospectively studied. Biopsy material was examined cytologically, histologically, immunohistochemically and electron microscopically. A definitive diagnosis could be established in 23 cases (92%). Diagnosis included non-Hodgkin's lymphoma (10 cases), toxoplasmosis (10 cases), progressive multifocal leukoencephalopathy (PML) (2 cases) and combined toxoplasmosis and lymphoma (1 case). Two biopsies were non-diagnostic. All lymphomas were B-cell lymphomas of high malignancy including one K1-lymphoma. In six cases, in which autopsy was performed, biopsy diagnosis could be confirmed. In one patient suffering from toxoplasmosis, autopsy demonstrated an additional cytomegalovirus infection. Conventional histology was not sufficiently decisive for toxoplasmosis, for some lymphomas and for PML. Stereotactic brain biopsy appears to be an effective method in the diagnosis of HIV-associated brain lesions.

Adult↗

Experience with the intraoperative frozen section technique for stereotaxic brain tumor biopsies.

The smear preparation technique is usually employed intraoperatively for stereotaxic brain tumor biopsies, whereas the frozen section technique is used in conventional operations, where larger tissue specimens can be obtained. 130 brain tumor biopsies were processed with the frozen section technique and postoperatively submitted to immunohistochemical examination. Subsequent paraffin embedding was not performed. In our study, frozen section diagnosis corresponded in 84% with the immunohistochemistry. Broggi et al. (1984) and Kleihues et al. (1984) demonstrated a similar positive correlation between intraoperative smear preparations and postoperative paraffin embedding. In our investigation, the greatest difficulties arose in cases of suspected lymphoma. Postoperatively, all lymphomas could be immunohistochemically clarified. Due to insufficient material 8% of the cases remained unclarified. Compared to smear preparation, the intraoperative frozen section technique during intervention provided a more accurate assessment of the histology. Furthermore the time needed for the procedure is not much longer than for smear preparation techniques. Reliable antibodies can be used in the remaining frozen material for further differentiation.

Biopsy↗

A case of dyschondroplasia associated with brain stem glioma: diagnosis by stereotactic biopsy.

We present a 24-year-old patient with multiple chondromas of both hands, the pelvis, the left leg, and an associated brain stem glioma. There was no evidence of hemangioma or dyschromia, and the condition was diagnosed as Ollier's disease, a special type of dyschondroplasia like Maffucci's syndrome and Kast's disease. An increased overall risk for development of malignant skeletal and nonskeletal tumors is associated with Maffucci's syndrome. The risk of malignant degeneration is lower in Ollier's disease. A glioma in the pons and the right lobe of the cerebellum was found in this patient. The literature describes an association with gliomas in only 12 cases of dyschondroplasia and an infratentorial localization in just one case. Signs of malignancy were histologically confirmed in 7 cases without significant preponderance of any one type. Our patient had a low-grade brain stem astrocytoma with fibrillar and gemistocytic components. A stereotactic serial biopsy made it possible to rule out malignant degeneration. Stereotactic brain tumor biopsy as a routine neurosurgical procedure is particularly valuable for deep space-occupying processes and forms the basis for therapy. In the present case, irradiation was not recommended.

Adult↗

[Initial experiences with implanted drug pumps for continuous intrathecal calcitonin therapy in therapy-resistant pain].

The hormone calcitonin has proved itself for some years in the treatment of chronic pain syndromes. In addition to its known influence on calcium exchange it gives vise to an analgesic effect within the central nervous system and this follows systemic administration or after bolus intrathecal injection. Two patients with chronic non malignant pain are presented in whom continuous delivery pumps have been used for intrathecal Lachs-Calcitonin (Karil, Fa. Sandoz).

Brachial Plexus Neuritis↗

Hemangioblastomas of the central nervous system. A 10-year study with special reference to von Hippel-Lindau syndrome.

The findings of a 10-year study (1976 to 1986) conducted in southwest Germany on hemangioblastomas (HBL's) of the central nervous system (CNS) are presented. During that period, 47 HBL's were diagnosed and surgically removed in 44 patients, with a good postoperative survival rate and prognosis. The majority (83%) of these tumors were located in the cerebellum. By thorough clinical examination of the patients and careful evaluation of their family background, it was found that 23% of the HBL patients were afflicted with von Hippel-Lindau syndrome. In addition to the CNS tumors, 14 neoplastic or similar lesions were detected in other tissues. These included angiomatosis of the retinae, pheochromocytomas, pancreatic cysts, renal cysts, and renal carcinoma. The diagnosis of von Hippel-Lindau syndrome was thus established in seven families. The authors suggest the need for a screening program for patients with HBL of the CNS which is designed to confirm or exclude ocular or visceral lesions associated with von Hippel-Lindau syndrome.

Adolescent↗

Somatostatin-like immunoreactivity in cerebroventricular fluid of patients with basal midline tumours.

The concentration of somatostatin-like immunoreactivity (SLI) was determined by specific radioimmunoassay in the cerebroventricular fluid of patients with tumours of the basal midline and compared to findings in patients with multiple sclerosis. Mean SLI levels of the two groups were not significantly different. In patients with basal tumours (astrocytoma, craniopharyngioma, etc.) SLI levels varied widely and tended to increase with increased intracranial pressure. Lateral ventricular SLI levels decreased in patients with blockade of foramen Monro and in patients with communicating hydrocephalus or post-radiation encephalopathy. There was no apparent correlation with dysfunction of the hypothalamohypophyseal axis.

Adolescent↗