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Biomedical subjects

L Brandt

Publications and source records attributed to L Brandt.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Indications and implications of surgical maxillary expansion in orthodontic surgery].

Surgically assisted rapid maxillary expansion is an accepted method for correction of transverse skeletal and dental discrepancies. The surgical technique includes a Lefort I osteotomy with medial palatine osteotomy. The maxillary must be totally released to achieve the desired expansion. There are several advantages: bone apposition in osteotomy sites, reduced risk of dental version or extrusion compared with orthopedic care, secondary surgical cure of complex dysmorphism requiring fewer segmentary osteotomies. Finally, we examined skeletal side effects induced by surgically assisted rapid maxillary expansion in the vertical and sagittal dimension of the face.

Adult↗
PubMed1999

Additional colloids have only a minor haemodilutive effect after surgery for aneurysmal subarachnoid haemorrhage.

Haemodilution is commonly used as prophylaxis, as well as treatment for cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). Thirty-six patients operated for aneurysmal SAH were evaluated retrospectively; 24 received haemodilutive therapy and 12 patients, as a control group, received no additional therapy. There was a 'spontaneous' drop in haematocrit by 22% in both groups, and a corresponding drop in haemoglobin by 23% in the treatment group and 19% in the non-haemodiluted group, during the first 4 days after the SAH. After the initial decrease the haematocrit remained stable between 0.28 and 0.33 until day 14 in both groups. The haemodilutive group had only a minor lower haematocrit level during days 8-12 as the additional fluid resulted in increased renal excretion. This minor difference was, however, significant (p < 0.02).

Adult↗
PubMed1999

Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration.

OBJECTIVE: Intracerebral microdialysis has been demonstrated to be a useful method for detection of brain ischemia in experimental models and in patients. We have applied new mobile microdialysate analysis equipment that allows a bedside comparison of changes in neurochemistry with the neurological status of the patient. Ten patients with severe aneurysmal subarachnoid hemorrhage (that is, with a high risk of vasospasm and a high risk of subsequent ischemic deficits) were selected. METHODS: Microdialysis catheters were inserted into the temporal and subfrontal cortex at the end of aneurysm surgery. Samples, collected hourly for 4 to 11 days, were analyzed immediately at the bedside for glucose, lactate, and glycerol and later for pyruvate and glutamate. The patients' neurological status was monitored constantly, and daily recordings of blood flow velocities were performed using transcranial Doppler sonography. RESULTS: Concentrations of the measured substances varied widely. Individual analyses revealed that patients with uneventful clinical courses generally demonstrated low and stable levels of the different metabolites, and those with signs of cerebral ischemia demonstrated various patterns of neurochemical changes. Lactate and glutamate seemed to be sensitive markers of impending ischemia, and increased glycerol levels were associated with severe ischemic deficits. Obtaining the microdialysis data directly at the bedside seemed to be of great advantage when relating the values to other clinical findings. CONCLUSION: Bedside intracerebral microdialysis monitoring of patients with subarachnoid hemorrhage and signs of delayed ischemia revealed dramatic changes in extracellular concentrations of glucose, lactate, and glycerol that could be directly correlated to the clinical status of the patients. These findings emphasize the potential of microdialysis in neurosurgical intensive care patients.

Adult↗
PubMed1999

Differential T-cell recognition of native and recombinant Mycobacterium tuberculosis GroES.

Mycobacterium tuberculosis GroES was purified from culture filtrate, and its identity was confirmed by immunoblot analysis and N-terminal sequencing. Comparing the immunological recognition of native and recombinant GroES, we found that whereas native GroES elicited a strong proliferative response and release of gamma interferon-gamma by peripheral blood mononuclear cells from healthy tuberculin reactors, the recombinant protein failed to do so. The same difference in immunological recognition was observed in a mouse model of TB infection. Both the native and recombinant preparations were recognized by mice immunized with the recombinant protein. Biochemical characterization including sodium dodecyl sulfate-polyacrylamide gel electrophoresis, two-dimensional electrophoresis, and mass spectrometry analysis of both proteins demonstrated no differences between the native and recombinant forms of GroES except for the eight additional N-terminal amino acids derived from the fusion partner in recombinant GroES. The recombinant fusion protein, still tagged with the maltose binding protein, was recognized by T cells isolated from TB-infected mice if mixed with culture filtrate before affinity purification on an amylose column. The maltose binding protein treated in the same manner as a control preparation was not recognized. Based on the data presented, we suggest that the association of biologically active molecules from culture filtrate with the chaperone GroES may be responsible for the observed T-cell recognition of the native preparation.

Animals↗
PubMed1999

Double-blind, randomized, vehicle-controlled study of high-dose tirilazad mesylate in women with aneurysmal subarachnoid hemorrhage. Part I. A cooperative study in Europe, Australia, New Zealand, and South Africa.

OBJECT: Findings from previous multicenter clinical trials have suggested that tirilazad mesylate, a synthetic nonhormonal 21-aminosteroid, might be effective in preventing delayed cerebral ischemia following subarachnoid hemorrhage (SAH). This beneficial effect, however, was greater in males than females, possibly because of gender-related pharmacokinetic differences. The authors sought to assess the effects of administering a larger dose of tirilazad in women with SAH. METHODS: To test the efficacy of a higher tirilazad mesylate dose in female patients, a prospective randomized, double-blind, vehicle-controlled trial was conducted at 56 neurosurgical centers in Europe, Australia, New Zealand, and South Africa. Eight hundred nineteen patients were randomly assigned to receive either 15 mg/kg/day of tirilazad mesylate or a placebo containing the citrate vehicle. The two groups were similar in prognostic factors for delayed cerebral ischemia and overall outcome. High-dose tirilazad appeared to be well tolerated because no differences in the incidence of untoward medical events were noted between the two groups. Medical and surgical interventions were no different in the two treatment groups except for hyperdynamic therapy (intentional hypervolemia, induced hypertension, and/or hemodilution), which was more often used in the placebo-treated group to counteract symptomatic vasospasm (24% of patients given placebo compared with 18% of patients given tirilazad, p = 0.02). Mortality rates and overall outcome, assessed using the Glasgow Outcome Scale at 3 months post-SAH, were not different between the two groups, despite a significantly lower incidence of delayed cerebral ischemia in patients given tirilazad. Post hoc subgroup analysis by neurological grade also did not reveal significant differences in outcome, although a trend toward a lower mortality rate favoring the study drug was present in patients with neurological Grade IV and V at admission (32% compared with 37%). Symptomatic vasospasm occurred in 33.7% of the placebo-treated patients as opposed to 24.8% of the patients who were given tirilazad (p = 0.005). The severity of symptomatic vasospasm was also attenuated by administration of the study drug (severe symptomatic vasospasm was reported in 11% of the placebo-treated patients compared with 6% of patients in the tirilazad-treated group (p = 0.008). Clinical cerebral infarction from vasospasm was also reduced from 13% in the vehicle-treated group to 8% in the tirilazad-treated group (p < 0.04). CONCLUSIONS: The authors conclude that high-dose tirilazad mesylate is well tolerated in women with aneurysmal SAH. Although a significant reduction in the incidence of symptomatic vasospasm was observed in the treatment group, the primary end point (mortality rate at 3 months post-SAH) was not affected by the study drug. The use of other potentially effective rescue therapies (that is, hypervolemia, hemodilution, and induced hypertension) to counteract vasospasm may have been responsible for these contrasting observations between the two groups.

Dose-Response Relationship, Drug↗
PubMed1998

Transcranial cerebral oximetry related to transcranial Doppler after aneurysmal subarachnoid haemorrhage.

Noninvasive methods for detecting cerebral artery vasospasm, still a serious complication following aneurysmal subarachnoid haemorrhage, are of vital interest. Up-to-date transcranial Doppler ultrasound (TCD) has proved to be sensitive in detecting vasospasm in the middle cerebral artery, but has less accuracy for other cerebral arteries. Transcranial cerebral oximetry (TCCO) is a new non-invasive technique which may increase the reliability for detecting cerebral ischaemia. The purpose of the present study was to evaluate a putative correlation between TCCO and TCD. We examined the two hemispheres in 14 patients with the aim of evaluating a proposed correlation between TCD and TCCO. Analysis of all absolute values (maximum TCD mFV and minimum TCCO saturation, respectively) in all series indicate a correlation between TCCO and TCD, p < 0.01, r = -0.62. All patients with TCD mean flow velocity > 120 cm/s also presented TCCO saturation < 60%. Conversely, all patients with normal TCCO saturation (> or = 63%) presented normal or moderately increased TCD velocities. In clinical neurosurgical practice it is of great interest if a true correlation between TCD and TCCO exists. The present results support the assumption that TCCO may enhance the reliability for detecting cerebral ischaemia after aneurysmal subarachnoid haemorrhage.

Aneurysm, Ruptured↗
PubMed1998

Changes on the Temperament and Character Inventory after paroxetine treatment in volunteers with generalized anxiety disorder.

Previously untreated symptomatic volunteers with generalized anxiety disorder (GAD) performed the Temperament and Character Inventory at baseline and after 4 to 6 months of paroxetine treatment. Scores from 29 volunteers were analyzed with paired t-tests. A marked reduction was noted in Harm Avoidance and a marked increase was noted in Self-Directedness. Smaller changes were noted in Cooperativeness and Novelty Seeking. Overall, treatment was associated with a reduction in maladaptive personality traits.

Adult↗
PubMed1998

Blood transfusion at delivery and risk of subsequent malignant lymphoma in the mother.

BACKGROUND AND OBJECTIVES: Blood transfusion has been shown to be a risk factor for non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: In a cohort of 77,928 women with bleeding complications at delivery in the period of 1973-1986, subsequent NHL cases were identified and the number was compared with the number expected from national incidence rates. In a case-control study the proportion of transfused NHL cases was compared with the proportion of transfused controls. RESULTS: The observed number of NHL in the cohort was 18 versus 22.0 expected. Information on transfusion was obtained for 15 of the NHL cases and none (0%) was transfused versus 32 out of 136 controls (23%). CONCLUSIONS: Blood transfusion at delivery is not a risk factor for NHL. The immune tolerance induced by pregnancy may reduce the risk of NHL associated with the transfusion of allogeneic blood cells.

Adult↗
PubMed1997

Fusion or stabilization alone for acute distractive flexion injuries in the mid to lower cervical spine?

Long-term pain problems and residual restricted mobility were evaluated for patients sustaining acute distractive flexion injuries to the cervical spine. To assess which of two alternative surgical approaches gives better long-term outcomes, 58 patients were studied, 29 in each group. The results of posterior wire stabilization without fusion according to Brandt were contrasted with those of the Cloward technique. We found significantly more late pain problems and restricted neck mobility in the group treated with wiring without fusion than in those managed with anterior fusion. We conclude that this continuing pain may be due to residual mobility in the damaged degenerated non-fused motion segment, and that the difference between the two groups may reflect the difference in the quality and rate of fusion achieved by the two surgical approaches.

Adolescent↗
PubMed1997

Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study.

This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a visual analogue scale (VAS), muscle strength was measured by a hand-held dynamometer, Vigorometer and pinchometer. Sensory loss and paraesthesia were recorded. The measurements were performed before treatment (control 1), 4 months after the start of treatment (control 2) and after a further 12 months (control 3). A healthy control group was used for comparison and to test the reliability of the muscle-strength measurements. The study found that before start of treatment the groups were uniform with respect to pain, motor weakness and sensory loss. At control 2 the surgery group reported less pain, less sensory loss and had better muscle strength, measured as the ratio of the affected side to the non-affected side, compared to the two conservative treatment groups. After a further year (control 3), there were no differences in pain intensity, sensory loss or paraesthesia between the groups. An improvement in muscle strengths, measured as the ratio of the affected to the non-affected side, was seen in the surgery group compared to the physiotherapy group in wrist extension, elbow extension, shoulder abduction and internal rotation, but there were no differences in the ratios between the collar group and the other treatment groups. With respect to absolute muscle strength of the affected sides, there were no differences at control 1. At control 2, the surgery group performed some-what better than the two other groups but at control 3 there were no differences between the groups. We conclude that pain intensity, muscle weakness and sensory loss can be expected to improve within a few months after surgery, while slow improvement with conservative treatments and recurrent symptoms in the surgery group make the 1-year results about equal.

Adult↗
PubMed1997

IQ and risk for schizophrenia: a population-based cohort study.

BACKGROUND: This study aimed to quantify the association between low IQ and the later development of psychosis in a population-based cohort study of 18-year-old conscripts. METHODS: Fifty thousand males conscripted into the Swedish army in 1969-1970 were followed by means of the Swedish National Register of Psychiatric Care up to 1983. Tests of verbal and visuospatial abilities, general and mechanical knowledge and several psychosocial variables were recorded at conscription. RESULTS: One hundred and ninety-five subjects were admitted to hospital with schizophrenia and 192 with a non-schizophrenic psychosis on ICD-8 criteria. The distribution of scores in those later diagnosed as suffering from schizophrenia was shifted in a downward direction, with a linear relationship between low IQ and risk. This remained after adjustment for potential confounders. The risk for non-schizophrenic disorders was also higher in those with lower IQ but the effect was less marked and non-linear. Only poorer performance on the verbal tasks and mechanical knowledge test conferred a significantly increased risk for schizophrenia after taking into account general intellectual ability. Low IQ at conscription was not related to age of onset. CONCLUSIONS: The results confirm the importance of low intellectual ability as a risk factor for schizophrenia and other psychoses. This is unlikely to be due to prodromal decline or known confounders. The association could be directly causal with cognitive impairment leading to false beliefs and perceptions, or could be indirect with any factors causing lower IQ, such as abnormal brain development increasing the risk for schizophrenia.

Adolescent↗
PubMed1997

Has mortality in drug addicts increased? A comparison between two hospitalized cohorts in Stockholm.

BACKGROUND: Substance abusers are known to have a high mortality, but the mortality rate and cause of death pattern has varied between studies and over time. The aim of the study was to compare the mortality in two cohorts of hospitalized drug addicts in Stockholm County identified in 1971-1972 and 1980-1981, respectively. METHOD: Two cohorts consisting of all patients admitted for drug dependence in 1971-1972 and in 1980-1981, were selected from Stockholm County inpatient register. Both cohorts were followed for a mean time of 10 years with regard to mortality. Standardized mortality ratios (SMR) and Cox hazard regression models were computed. RESULTS: Mortality in the two cohorts did not differ significantly. However, differences were found between subgroups. Thus for addicts using opiates, the death rate was twice as high as that of central stimulant users. For those addicts mixing drugs, the death rate was 48% higher compared to the central stimulant users. Males and people over 34 years of age had a significantly higher death rate than females and younger people. Mortality in drug addicts, especially opiate addicts, remained very high, though stable, over the study period. Patients in the 1980-1981 cohort were at risk of HIV/ AIDS but this had not increased the excess mortality. CONCLUSIONS: There was no significant difference in overall mortality between the two cohorts and the causes of death patterns seemed quite stable over time.

Adolescent↗
PubMed1997

Modulation by the endothelium of the inhibitory effects of pinacidil and nimodipine on endothelin-induced contraction in cerebral arteries.

The effects of pinacidil and nimodipine on endothelin-1-induced contractions in isolated cerebral arteries with and without endothelium were compared. The sensitivity to endothelin-1 was increased (0.5 log units) in the rabbit basilar artery after removal of the endothelium. The nitric oxide synthase inhibitor N omega-nitro-L-arginine (0.1 mM) also increased the sensitivity to endothelin-1 (0.6 log units) in basilar arteries with endothelium, whereas N omega-nitro-D-arginine (0.1 mM) and indomethacin (3 microM) had no effect, indicating that withdrawal of endothelium-derived nitric oxide may account for the enhancement of the endothelin-1-induced contraction after endothelial denudation. Pinacidil (1 microM) shifted the concentration-response curve for endothelin-1 to the right without affecting the maximal response in arteries without endothelium, but had no effect on the endothelin-1-induced contraction in vessels with endothelium. Nimodipine (1 microM) reduced the maximal endothelin-1-induced contraction by approximately 50% in both the presence and absence of endothelium, whereas the sensitivity to endothelin-1 was reduced only in vessels without endothelium. Incubation in "calcium-free" medium reduced the maximal endothelin-1-induced contraction by 69% and 80% in vessels with and without endothelium, respectively. In human pial arteries with endothelium, pinacidil did not affect the endothelin-1-induced contraction, whereas nimodipine and exposure to "calcium-free" solution reduced the maximal response by 31% and 74% respectively. The results show that, in the rabbit, pinacidil and to a lesser extent nimodipine preferentially act on cerebral arteries with disrupted endothelium, indicating that vasoactive factors liberated from the endothelium may modify the effect of a vasodilator.

Animals↗
PubMed1997

Nerve conduction and autonomic nerve function in diabetic children. A 10-year follow-up study.

In order to study the long-term development of diabetic neuropathy in children with newly diagnosed diabetes mellitus, 144 children were entered in a prospective study of nerve conduction and autonomic nervous function. Neurophysiological recordings of nerve conduction and parasympathetic function (R-R variations) were made at onset of diabetes and after 2, 5 and 10 years. Low sensory nerve conduction and autonomic dysfunction were found in approximately 25% of the children at onset of diabetes when the patients were not yet in complete remission. During years 0-2, an initial improvement of sensory conduction velocities was found. After 2 years, deteriorations in sensory and motor nerve conduction and autonomic nerve function were common and further deterioration was seen over time. A correlation was found between nerve conduction and glycaemic control.

Adolescent↗
PubMed1996

Key epitopes on the ESAT-6 antigen recognized in mice during the recall of protective immunity to Mycobacterium tuberculosis.

The recall of long-lived immunity in a mouse model of tuberculosis (TB) is defined as an accelerated accumulation of reactive T cells in the target organs. We have recently identified Ag 85B and a 6-kilodalton early secretory antigenic target, designated ESAT-6, as key antigenic targets recognized by these cells. In the present study, preferential recognition of the ESAT-6 Ag during the recall of immunity was found to be shared by five of six genetically different strains of mice. Overlapping peptides spanning the sequence of ESAT-6 were used to map two T cell epitopes on this molecule. One epitope recognized in the context of H-2b,d was located in the N-terminal part of the molecule, whereas an epitope recognized in the context of H-2a,k covered amino acids 51 to 60. Shorter versions of the N-terminal epitope allowed the precise definition of a 13-amino acid core sequence recognized in the context of H-2b. The peptide covering the N-terminal epitope was immunogenic, and a T cell response with the same fine specificity as that induced during TB infection was generated by immunization with the peptide in IFA. In the C57BL/6j strain, this single epitope was recognized by an exceedingly high frequency of splenic T cells (approximately 1:1000), representing 25 to 35% of the total culture filtrate-reactive T cells recruited to the site of infection during the first phase of the recall response. These findings emphasize the relevance of this Ag in the immune response to TB and suggest that immunologic recognition in the first phase of infection is a highly restricted event dominated by a limited number of T cell clones.

Amino Acid Sequence↗