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Biomedical subjects

K Wiedemann

Publications and source records attributed to K Wiedemann.

At least 91 records · Page 5Linked to original sources
PubMed1991

Sleep EEG and nocturnal secretion of testosterone and cortisol in patients with major endogenous depression during acute phase and after remission.

Sleep EEG and the nocturnal secretion of cortisol and testosterone in 12 male patients (mean age 46.4 +/- 11.26 years) with major endogenous depression were investigated concomitantly during acute depression, before treatment and after recovery and drug cessation. Testosterone concentration increased after remission, while cortisol secretion decreased. Sleep EEG disturbances remained unchanged in remitted patients. The data suggest that a blunted testosterone and an elevated cortisol secretion are state markers of acute depression, which normalize independently from sleep structure. An interaction between the hypothalamic-pituitary-gonadal axis and the limbic-hypothalamic-pituitary-adrenocortical axis appears likely.

Adult↗
PubMed1991

[Esophageal perforation and pneumothorax. Complications due to placement of a stomach tube].

Perforation of the oesophagus, as well as a pneumothorax are described as complications of the use of a nasogastric feeding tube. Clinical tests to determine correct placement are noted to be unreliable and the importance of radiological control, especially in the unconscious patient, ist stressed. The suspected diagnosis of oesophageal perforation should be verified without delay to immediately initiate conservative or surgical treatment.

Adult↗
PubMed1991

Influence of human corticotropin-releasing hormone and adrenocorticotropin upon spontaneous growth hormone secretion.

Hormones of the hypothalamo-pituitary-adrenocortical (HPA-) axis are considered to be of physiological and clinical relevance in regulating spontaneous growth hormone (GH) secretion. To further investigate interdependencies between both systems, we studied the effects of adrenocorticotropin [ACTH(1-24)] and human corticotropin-releasing hormone (h-CRH) upon spontaneous GH secretion in 10 male volunteers. Administration of 1 microgram ACTH (1-24), 10 micrograms h-CRH or saline (control: CTL) every hour from 9.00 to 6.00 p.m. resulted in significant differences of cortisol secretion during the entire observation period (8.00 a.m.-3.00 a.m.) between the three groups (p less than 0.001, Friedman two-way ANOVA). Mean area under the time course curve (AUC) values (+/- SEM) for cortisol expressed as ng x 1,000 x min/ml showed also significant differences between the three treatments from 8.00 a.m. to 3.00 a.m.: CTL 64.0 +/- 6.4, ACTH(1-24) 178.5 +/- 9.4 (p less than 0.01, Wilcoxon test), h-CRH 88.5 +/- 5.6 (p less than 0.01). The main portion of cortisol was released during daytime from 8.00 a.m. to 11.00 p.m., where the most significant differences in the AUC values emerged: CTL 59.6 +/- 5.8, ACTH(1-24) 171.5 +/- 8.8 (p less than 0.01, Wilcoxon test), h-CRH 80.2 +/- 5.1 (p less than 0.01). With regard to GH secretion, significant differences became obvious between the three treatments during daytime from 8.00 a.m. to 11.00 p.m. and the sleep-related period from 11.00 p.m. to 3.00 a.m. (p less than 0.01 and p less than 0.02, Friedman two-way ANOVA).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Formation and metabolism of catecholestrogens in depressed patients.

The evidence that catecholestrogens are formed in the brain and exert behavioral effects in animal models suggest that these steroids might have psychotropic activities. In the present investigation, the formation and metabolism of catecholestrogens were studied in depressed patients. Twenty-four-hr urine samples were collected from 6 male patients (59 +/- 8 years) with endogenous retarded depression (subtype primary, endogenous, and recurrent according to Research Diagnostic Criteria) and from 12 male control subjects (51 +/- 4 years). The patients were treated with the monoamine oxidase inhibitor tranylcypromine (10-40 mg/day for 3-4 weeks). The concentrations of primary estrogens, 4- and 2-hydroxyestrogens and 2-methoxyestrogens, were measured in the urine samples after multiple chromatographic separation steps by radioimmunoassay. In the depressed patients, the excretion rates of 4-hydroxyestrogens were significantly lower than in control subjects. The ratio 2-methoxyestrogens:2-hydroxyestrogens as an index for 2-O-methylation was 3.8 +/- 1.6 in patients and 1.8 +/- 0.7 in controls. The increased methylation and reduced 4-hydroxylation rates of patients were not affected by treatment with tranylcypromine though the psychopathological state was improved by 46%. Therefore, it seemed unlikely that the observed alterations were pathognomonically relevant in these depressed patients. The alterations in the formation and methylation of catecholestrogens show that the depressed patients exhibited remarkable metabolic disturbances. The functional role of these disturbances remains to be clarified.

Depressive Disorder↗
PubMed1990

The effect of dexamethasone dosage upon plasma cortisol and dexamethasone during the DST.

To investigate the effect of dexamethasone dosage upon the outcome of the dexamethasone suppression test (DST) and the role of concurrent plasma dexamethasone concentrations, four different dexamethasone dosages were administered to 119 hospitalized depressed patients (0.5 mg: n = 12; 1.0 mg: n = 30; 1.5 mg: n = 42; 2.0 mg: n = 35). Independent of the dosage, dexamethasone plasma concentrations at 4.00 p.m. were lower in DST non-suppressors than in suppressors, although differences were statistically significant only for the 1.5-mg and 2.0-mg dosages. Our findings confirm recent reports that the actual plasma concentration of dexamethasone at 4.00 p.m. does not determine DST outcome.

Depressive Disorder↗
PubMed1990

B-HT 920--a novel dopamine autoreceptor agonist in the treatment of patients with schizophrenia.

In an open clinical trial the azepine derivative B-HT 920 was administered to patients with schizophrenia, paranoid type (according to ICD-9 and DSM-III criteria), in order to examine whether dopamine autoreceptor stimulation exerts antipsychotic effects. Twelve patients participated in the study and received the test drug orally for up to 28 days in a dose range from 0.3 to 1.2 mg/day. The following results emerged: in four patients a significant amelioration (reduction of initial BPRS scores by more than 50%) of psychotic symptomatology was observed; eight patients remained without improvement of psychopathology. Psychomotor activation was observed in seven patients, and prompted termination of the trial in two cases. No other marked adverse effects of B-HT 920 were noted, including EEG, ECG, and clinical chemistry parameters. As it was to be expected from the pharmacology of B-HT 920, plasma prolactin concentrations were significantly reduced two hours after oral application of a single dose of the drug. It remains to be clarified whether chronic treatment with B-HT 920 induces antipsychotic efficacy within as yet unidentified subsamples of schizophrenic patients. The observed activating effects of B-HT 920 may focus future investigative efforts toward study samples where negative symptoms predominate.

Adult↗
PubMed1989

[Lung injuries].

Explore the source record for details and available documents.

Humans↗
PubMed1989

Diagnostic determinants of response to treatment with tricyclic antidepressants: a polydiagnostic approach.

In an attempt to find diagnostic predictors of treatment response, 45 inpatients with major depression in a randomized trial received amitriptyline or imipramine for 23 days after a washout period of 16 days. A polydiagnostic approach was applied to the classification of endogenous depression. Only a minority of diagnostic schedules for endogenous depression proved predictive of a more favorable course during antidepressant treatment: the criteria of D. F. Klein, the Newcastle Scale II, and the Vienna Research Criteria. The symptoms of nonreactivity of mood and diurnal variation were the only endogenous symptoms with predictive ability. In addition, psychotic features and secondary depression predicted an unfavorable course, whereas characteristics of previous course (bipolarity, recurrence) were not predictive.

Adult↗
PubMed1989

Computerized brain tomography measures compared with spontaneous and suppressed plasma cortisol levels in major depression.

We determined brain density and ventricular measurements with computerized tomography (CT) in 33 depressed patients and compared the results with basal plasma cortisol and its suppressibility by dexamethasone. Mean plasma cortisol was positively related to elevated ventricular brain ratio (VBR). No association could be found between dexamethasone suppression test (DST) status and VBR or any other CT parameter. Elevated plasma cortisol levels and increased VBRs were positively correlated with total scores on the Brief Psychiatric Rating Scale, the Global Assessment Scale and the Bech-Rafaelsen Melancholia Scale, but they were not significantly correlated with total score on the Hamilton Anxiety Scale.

Adult↗
PubMed1989

Development and validation of a radioimmunoassay for serum melatonin.

A radioimmunoassay using N-[3-(4-hydroxy-3-[4-hydroxy-3- [125I]iodophenylpropionyl)]-5-methoxytryptamine as tracer for determination of melatonin in the serum of different species is described. Melatonin antisera were raised in rabbits by immunization with a bovine serum albumin conjugate of N-[3-(2-aminoethyl)-5-methoxy indole] hemisuccinamide. A single high affinity, specific antiserum was obtained. In contrast to previous studies, the tracer was synthesised in one step in the absence of water, giving an excellent yield of highly pure product. No chromatographic purification step was needed. Polyethylene glycol in combination with goat antirabbit immunoglobulins was used to separate bound and unbound tracer. Sera were delipidized with Lipoclean prior the extraction of melatonin with diethyl ether. This sample preparation allows the determination of melatonin in the presence of widely varying amounts of lipids in human, rat and hamster serum. Using this extraction procedure, the sensitivity of the radioimmunoassay was approximately 1 ng/l of serum. Dilutions of sera and of synthetic melatonin gave the same parallel response in the radioimmunoassay. High performance liquid chromatography analysis of a serum extract showed only one immunoreactive peak co-eluting with synthetic melatonin. Characteristic diurnal rhythms of melatonin were observed in all species. All assay components including standards and serum controls are stable for at least 1 year at 4 degrees C, thus facilitating the determination of melatonin in a routine laboratory.

5-Methoxytryptamine↗
PubMed1989

[The incidence of tuberculosis at an intensive care unit].

From 1986 to 1988 84 patients with tuberculosis were treated in the Intensive Care Unit of the Thorax Clinic Heidelberg (2.8% of total admissions). Only 18% (n = 15) of the cases were referred in the course of conservative treatment while 82% (n = 69) were admitted after thoracic surgery. In 49 of these patients (71%) the diagnosis of tuberculosis could be confirmed only postoperatively by histological examination. This diagnosis should be considered in any ICU patient belonging to the typical groups at risk or showing clinical signs of tuberculosis, e.g. weight loss, chronic productive cough and fever. For the confirmation of the diagnosis both microscopic examination and mycobacterial cultures are necessary. In cases of open tuberculosis in which mycobacteria are identified in sputum, urine or fistula secretion, the most important step of infection prophylaxis is the isolation of these patients (single rooms) and the prevention of airborne transmission by using face masks and protective gowns.

Antitubercular Agents↗
PubMed1989

[Bilateral giant distended cysts in lymphangioleiomyomatosis of the lung as a rare cause of inflow obstruction].

We report on a 27-year-old female developing acute thoracic inlet obstruction by bilateral pulmonary cysts which arose from pulmonary lymphangioleiomyomatosis and increased with respiratory treatment. Bilateral synchronous bullectomy via median sternotomy was necessary to resolve the life-threatening condition. The most frequent differential diagnoses are tension pneumothorax and pericardial tamponade. Although this case of thoracic inlet obstruction was caused by a rare disease it may serve to recall the therapeutic problems encountered in bullous pulmonary lesions under tension, especially regarding acute volume expansion due to one-way valve mechanism during respiratory treatment or general anaesthesia.

Adult↗
PubMed1989

[Severe injuries of the cervical spine in childhood, an interdisciplinary consideration].

Since 1976 in the department of pediatric surgery in Heidelberg we treated five fractures of the cervical spine with luxation, three patients demonstrated a high spinal lesion with tetraplegia. During the past five years eight subluxations were hospitalised. In this paper we relate the various injury mechanisms and fracture forms; especially the typical lesions of the altanto-axial region are discussed. The importance of modern imaging techniques, including NMR, as well as the age- and situation-dependent therapy are detailed. Based on a case report on a four year old boy with upper cervical spine lesion and tetraplegia medical nursing and logistic problems are discussed. Incentives of intensive care albeit limited, in pediatric surgical and pediatric anaesthesiological departments, not specialised in the management of tetraplegia, are pointed out.

Cervical Vertebrae↗
PubMed1988

Exaggerated corticotrophic cell response to human corticotropin-releasing hormone in two patients during long-term carbamazepine treatment.

Carbamazepine, a tricyclic anticonvulsant with chemical resemblance to imipramine, has been recently successfully introduced as a prophylactic agent and acute treatment modality for manic-depressive illness (Ballenger and Post 1980; Okuma 1983; Post et al. 1984). The interest in carbamazepine emerges from its ability to dampen paroxysmal neuronal activity not only in epilepsy, but also in those particular systems that appear to be involved in the etiology of episodic affective illness (Post et al. 1983). These affective episodes are frequently associated with endocrine irregularities of the hypothalamic-pituitary-adrenocortical (HPA) axis, including increased cortisol secretion (Halbreich et al. 1985), nonsuppression of corticosteroids following dexamethasone, and blunted corticotropin (ACTH) release after stimulation with human corticotropin-releasing hormone (h-CRH) (Holsboer et al. 1986, 1987) or its heterologous ovine analog (Gold et al. 1986). Some recent reports have shown that carbamazepine treatment may interfere with HPA physiology, as it induces Dexamethasone Suppression Test (DST) nonsuppression (Privitera et al. 1982; Rubinow et al. 1984) and enhances mean urinary free cortisol secretion (Rubinow et al. 1986). To further explore the pathophysiology of this phenomenon of an altered HPA function, we conducted h-CRH tests in six patients in stable remission from major depression during long-term carbamazepine treatment to look for possibly drug-induced modulations. In two of six patients, we observed highly abnormal ACTH responses.

Adrenocorticotropic Hormone↗
PubMed1988

Human beta-casomorphin-8 immunoreactive material in the plasma of women during pregnancy and after delivery.

A method for the extraction of human beta-casomorphin-8 immunoreactive material from human plasma and a radioimmunoassay for its determination in the plasma extracts were developed. Blood was collected from 34 men, from 35 non-pregnant women, from 35 pregnant women and from 138 women after delivery and plasma extracts were assayed for the presence of human beta-casomorphin-8 immunoreactive materials. No human beta-casomorphin-8 immunoreactive material was detected in the plasma of men or non-pregnant women, whereas such material was found in the plasma of 26 out of 35 pregnant women and in the plasma of 100 out of 138 women after parturition. Material collected from women after delivery was characterized by gel filtration and high-performance liquid chromatography (HPLC) and was found to be of different composition in various individuals; its components, one of which coeluted with human beta-casein from the HPLC column, have apparently higher molecular weights than human beta-casomorphin-8. Some of these compounds seem to be very stable against enzymatic degradation at 37 degrees C in human plasma, whereas human beta-casomorphin-8 proved to be degraded very fast under identical conditions. A physiological significance of mammary products of the beta-casomorphin type during pregnancy or after parturition is suggested.

Caseins↗
PubMed1988

Serial partial sleep deprivation in depression--clinical effects and dexamethasone suppression test results.

Thirty depressed patients were deprived of sleep during the second half of the night after they were characterized according to their Research Diagnostic Criteria diagnosis, severity of depression, current medication and dexamethasone suppression test status. After applying partial sleep deprivation (PSD) treatment three times within 1 week, we observed in 17 patients an improvement of their initial depressive symptomatology of 50% or more. No pretreatment variable except the degree of improvement after the first PSD was predictive for therapeutic effects of the entire PSD series. Beneficial effects of PSDs were not specific for the endogenous type of depression. A trend was found indicating that concurrent psychotropic drug treatment enhances the beneficial effect of serial PSDs.

Adult↗
PubMed1987

Plasma dexamethasone kinetics during the DST after oral and intravenous administration of the test drug.

We compared early biophase kinetics of dexamethasone in 33 patients with a major depression who received a DST either by an oral (n = 20) or an intravenous (n = 13) route. After an oral DST, the dexamethasone kinetics between 14 suppressors and 6 nonsuppressors were indistinguishable during the early distribution phase. However, elimination of dexamethasone from the circulation was significantly enhanced in DST nonsuppressors, resulting in an association of decreased plasma dexamethasone with elevated post-DST cortisol levels. Following intravenous DST administration, we identified 5 nonsuppressors and 8 suppressors whose plasma dexamethasone kinetics were indistinguishable, and during the elimination phase, were in the same order of magnitude as those of nonsuppressors after an oral DST. We suggest that the actual plasma concentration at the conventional post-DST sampling times does not reflect the biopotency of the test drug to suppress the pituitary adrenocortical activity. Plasma dexamethasone concentrations after an oral DST that were associated with nonsuppressed cortisol seem to be coherent phenomena of the underlying endocrine disturbance, the precise nature of which deserves further study.

Administration, Oral↗