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Biomedical subjects

M Berger

Publications and source records attributed to M Berger.

At least 289 records · Page 16Linked to original sources
PubMed1996

[M. Linehan dialectic behavioral psychotherapy. A new concept in the treatment of borderline personality disorders].

M. Linehan developed "dialectical behavioral therapy" specifically to treat chronically suicidal borderline patients. It rests on a biosocial model that assumes a disorder in the regulation of emotions and in tolerance of stress. The numerous dysfunctional patterns of behavior such as self-destructive behavior, inability to govern impulses or severe dissociative phenomena are regarded as attempts at problem-solving. This concept of therapy focuses on the continuing balance between the necessity of accepting maladaptive behavior patterns in both an intrapsychic and an interactional context while still working to change them. A comprehensive manual outlines the clearly structured therapy and integrates a wide choice of therapeutic strategies. Parallel to development of the therapy itself, a method also was developed for testing therapist adherence to the manual's guidelines, thus providing a basis for empirical evaluation. An initial controlled, randomized study demonstrated the significant superiority of this method to methods of unspecific psychotherapy at various levels. In the current endeavor to develop disorder-specific approaches to the treatment of personality disorders, "dialectical behavioral therapy" is a noteworthy model.

Affective Symptoms↗
PubMed1996

Methods for increasing survivability during storage of exponentially growing bacteria.

A protocol has been developed for storing Gram (-) bacterial cells at 0 degrees C, which allows greater than 90% of stored cells to retain colony-forming ability for up to 60 days. The protocol, which yields essentially identical results when used with Escherichia coli or Pseudomonas aeruginosa, does not enhance survivability of Bacillus cereus. The greatest and longest survival is enjoyed when exponentially growing cells in minimal-glucose medium are deprived of carbon for about 9 h, supplemented with 750 microg/ml chloramphenicol, and immediately placed at 0 degrees C. By decreasing the period of carbon starvation from 9 to 5 h, or increasing the period of carbon starvation from 9 to 12 h, both the ultimate survival rate and kinetics of loss of culturability are affected. Survival enhancement induced by chloramphenicol is not similarly induced by kanamycin.

Bacillus cereus↗
PubMed1996

Effects of substance P and selected other neuropeptides on the synthesis of interleukin-1 beta and interleukin-6 in human monocytes: a re-examination.

Recent studies have suggested that substance P (SP) and some other neuropeptides are able to induce the synthesis of the proinflammatory cytokines interleukin-1 (IL-1) and interleukin-6 (IL-6) in peripheral blood mononuclear cells. In the present study, we re-examined these findings by using a completely endotoxin-free monocyte cultivation system. We demonstrate that the neuropeptides SP, vasoactive intestinal peptide, substance K. cholecytokinine, alpha-endorphin and beta-endorphin are consistently unable to induce the synthesis of IL-1 and IL-6 in human peripheral blood monocytes. However, low amounts of LPS (1 pg/ml) synergized with SP to induce IL-6 mRNA expression. In contrast to its lack of effect in monocytes, we were able to confirm the ability of SP to induce cytokine synthesis in astrocytic cells. Our results raise questions about previous results claiming a neuropeptide-induced synthesis of proinflammatory cytokines in human monocytes. In conjunction with other studies, we suggest that undetected levels of endotoxin/LPS in the culture medium may have been primarily responsible for results suggesting an inductive effect of neuropeptides on cytokine synthesis in monocytes.

Blotting, Northern↗
PubMed1996

The participation of interleukin-6, a stress-inducible cytokine, in the pathogenesis of Alzheimer's disease.

A loss of synapses in the cortices of demented persons appears to be the primary correlate of Alzheimer's disease (AD). However, it is still unclear how synaptic pathology is connected to other pathological findings such as neurofibrillary and neuritic degeneration or inflammatory markers in AD. Interleukin-6 (IL-6) immunoreactivity has previously been detected in plaques in the brains of AD patients. In addition, elevated IL-6 concentrations have been measured biochemically in the brains of AD patients. Since transgenic mice bearing additional copies of the IL-6 gene under the control of a brain-specific promoter develop a marked cortical pathology including severe alterations of the dendritic arborization of cortical neurons, an IL-6 related inflammatory event could well be connected to the synaptic pathology in AD. In this study, we investigated whether IL-6 immunoreactivity in plaques could already be found prior to the onset of neuritic changes, or whether the presence of this cytokine is restricted to the later stages of plaque formation. While diffuse plaques represent an early stage of plaque formation, primitive and classic plaques (displaying neuritic pathology) are thought to reflect later stages of plaque pathology. Using a silver-staining method, we classified plaque stages in serial sections of paraffin-embedded cortices of clinically diagnosed and histopathologically confirmed AD patients and of control persons with no clinical history of dementia. Adjacent sections were stained with an antibody directed against IL-6. IL-6 was detectable in a significant proportion of plaques, but only in the brains of demented patients. In the AD cases, IL-6 was found in diffuse plaques in a significantly higher ratio as would have been expected from a random distribution of IL-6 among all plaque types. This observation suggests that IL-6 expression may precede neuritic changes and that in AD an immunological mechanism may be involved both in the transformation from diffuse to primitive plaques and in the development of dementia. The reasons for the increased expression of IL-6 in the brains of AD patients are still unknown. Basal IL-6 levels were found to be slightly elevated along normal aging. Based on several studies indicating that IL-6 expression is inducible also by psychological stress, one could speculate whether long-lasting stressful experiences may contribute to the pathological process underlying Alzheimer's disease.

Aged↗
PubMed1996

Prehension with trunk assisted reaching.

For prehensile tasks, where objects are located beyond the normal reaching space, the trunk is bent forward to assist in the transport of the wrist to the object. Such task behaviors raise complex motor control issues such as how is the trunk movement incorporated into the motor plan. In this experiment, seated subjects were asked to reach and grasp a small and a large object placed on a table located beyond their maximal reach. Forward trunk bending was required to extend the reach distance. For such reaching movements, the wrist velocity consisted of a bell shape profile similar to those seen when the arm is the sole transport agent. In most trials, the trunk was the first to initiate movement, although there was no strict pattern of initiation order. The transport data showed that trunk and arm movement components were decoupled at the end of the reach. While the object was being grasped and lifted, the trunk continued moving for approximately 180 ms after the grasp. Wrist deceleration time expressed in absolute and relative values was sensitive to object size. The time from maximum peak aperture to the end of wrist movement also was significantly longer for grasping the small compared to the large object. No such relationships were observed for the trunk. Temporal coupling was only observed between the grip and wrist transport component. Time to maximum aperture was significantly correlated with time to peak wrist deceleration and only rarely with time to trunk deceleration peak. When the trunk participates in the transport of the wrist to an object, these findings suggest that only the wrist component is directly related to the achievement of the grasp. While the trunk assisted the arm to reach the object, the kinematic parameter recorded did not reveal any evidence of direct coupling. The presented data suggests that the planning takes place at the level of the hand and that endpoint is the primary variable controlled.

Acceleration↗
PubMed1996

An acute psychotic disorder caused by pefloxacin: a case report.

1. The patient, a 59 year old woman, developed a state of acute excitation several hours after the administration of 400 mg of the fluorquinolone pefloxacin in combination with 1000 mg paracetamol. Nine days later, after a total dosage of pefloxacin of 800 mg, she was admitted to our hospital with a psychotic disorder. 2. There was a full remission of symptoms after treatment with perazine up to a dosage of 500 mg/day. 3. Three years ago, the patient had developed a manic state under a medication with corticosteroids. 4. So far, the mechanism of--in this case--long-lasting central nervous side effects of fluorquinolones is not known. In patients with increased vulnerability of the CNS or in advanced age the application of fluorquinolones should be considered critically, in particular in combination with non-steroidal anti-inflammatory drugs.

Female↗
PubMed1996

Combined treatment with lithium and nimodipine in a bipolar I manic syndrome.

1. The benefit of a combined treatment with the calcium antagonist nimodipine and lithium in a bipolar I disorder (currently manic, DSM IV 296.44, ICD 10 F 31.1) was explored and documented in a longitudinal single case study. 2. Nimodipine (270 mg/d) was added to lithium (900 mg/d), substituting for previously administered neuroleptics, in an up to then unsatisfactorily treated manic patient. 3. A clear-cut improvement in the patient's condition was achieved within a fortnight, and lasted over the continuation period of this drug regimen. This combined treatment was discontinued after eight weeks and lithium alone was then administered. Within three months another manic episode appeared. 4. Side-effects and changes of lithium blood levels were not observed during the combined treatment with nimodipine and lithium. 5. Further research on the benefits of adding a calcium antagonist, instead of neuroleptics, to lithium therapy for bipolar manic disorder patients who do not respond sufficiently to lithium is recommended. In addition, the benefits of a long term prophylaxis of nimodipine alone or in combination with lithium should be evaluated in those bipolar patients who still show a high relapse frequency on lithium alone.

Adult↗
PubMed1996

Differential uptake of myo-inositol in vivo into rat brain areas.

Oral inositol has been reported to have antidepressant and antipanic properties in humans. Inositol enters the brain poorly and high doses are required. Natural uptake processes and specific transporters are involved. We here report that intraperitoneally administered inositol is taken up differently by various brain areas and that brain areas have different baseline inositol levels. These effects could be important in understanding the differential effects of lithium-induced lowering of inositol and of behavioral effects of exogenous inositol.

Animals↗
PubMed1996

The influence of gender on the outcome of arterial procedures in the lower extremity.

OBJECTIVES: To determine the outcome of arterial reconstructive procedures, we audited retrospectively peripheral bypass grafts and endarterectomies performed between 1982 and 1990. MATERIALS AND METHODS: 1005 peripheral arterial procedures were performed in 862 lower limbs in 782 patients. 62% of the limbs were critically ischaemic. The procedures include 565 bypasses, 346 endarterectomies and 94 combinations of both. 30% of the patients were women. Follow-up information was obtained from practitioners in charge of post-hospital care by questionnaires. Factors potentially affecting patency were investigated by multivariate analysis and patency rates were calculated by life-tables. MAIN RESULTS: Overall secondary patency was 61% at one year and 35% at 5 years. Bypasses and endarterectomies in women yielded lower patency rates than in men (49% vs. 67% at 1 year, p < 0.001). The relative risk of failure in women as compared to men was 1.30. The risk of failure was further increased by "redo" surgery (relative risk 1.51), diabetes (1.40), critical ischaemia (1.34) and crural procedures (1.34). CONCLUSIONS: Secondary patency rates were significantly lower in women than in men. This is in agreement with some other studies, although gender has gained little attention as a risk factor in vascular surgery.

Aged↗
PubMed1996

Effects of smoking on blood pressure and proteinuria in patients with diabetic nephropathy.

OBJECTIVES: To investigate the effects of smoking on blood pressure and proteinuria in hypertensive diabetic patients with nephropathy. DESIGN: Controlled, randomized, cross-over study. SETTING: Tertiary care centre, University Hospital of Düsseldorf, Germany. SUBJECTS: A total of 25 subjects were recruited, each of whom smoked at least 20 cigarettes a day: 10 normotensive healthy volunteers and 15 hypertensive type 1 (insulin-dependent) diabetic outpatients with diabetic retinopathy and persistent micro- or macroalbuminuria; 10 diabetic patients had normal autonomic function test, whilst five patients showed signs of autonomic neuropathy. INTERVENTIONS: Controlled smoking or nonsmoking over a period of 8 h on separate days. MAIN OUTCOME MEASURES: Blood pressure was measured every 10 min with an automatic device and urine samples were collected every 3 h. RESULTS: Systolic blood pressure increased during smoking in controls (mean) (11.5 mmHg, P = 0.0001) and in diabetic patients without autonomic neuropathy (7.9 mmHg; P = 0.018), but not in patients with autonomic neuropathy (-2.4 mmHg; P = 0.792). Diastolic blood pressure increased during smoking in controls (6.2 mmHg; P = 0.019) but not in diabetic patients (2.5 mmHg; P = 0.204. 0.2 mmHg; P = 0.956). During smoking, median proteinuria and albuminuria increased in diabetic patients without autonomic neuropathy (8.1 mg mmol-1 creatinine, P = 0.002; and 2.6 mg mmol creatinine, P = 0.084). No significant changes in albuminuria or proteinuria occurred in the other two groups. CONCLUSIONS: Smoking increases blood pressure values in healthy subjects and in hypertensive patients with diabetic nephropathy and without autonomic neuropathy. This effect of smoking may be partly responsible for the faster progression of diabetic nephropathy in smoking diabetic patients.

Adult↗
PubMed1996

Adenosine A2b receptors mediate an increase in interleukin (IL)-6 mRNA and IL-6 protein synthesis in human astroglioma cells.

The cytokine interleukin (IL)-6 has recently been demonstrated to play a role in the pathology of Alzheimer's disease (AD). The mechanisms leading to increased IL-6 levels in brains of AD patients are still unknown. Because in experimental animals ischemia increases both the levels of cytokines and the extracellular concentrations of adenosine in the brain, we hypothesized that these two phenomena may be functionally connected and that adenosine might increase IL-6 gene expression in the brain. Here we show that the mixed A1 and A2 agonist 5'-(N-ethylcarboxamido) adenosine (NECA) induces an increase in IL-6 mRNA levels and protein synthesis in the human astrocytoma cell line U373 MG. The A1-specific agonists R-phenylisopropyladenosine and cyclopentyladenosine are much less potent, and the A2a-specific agonist CGS-21860 shows only marginal effects. Increased levels of mRNA are already found within 30 min after NECA treatment. The A2a-selective antagonists 8-(3-chlorostyryl) caffeine and KF17837 [(E)-8-(3,4-dimethoxystyryl)-1,3-dipropyl-7-methylxanthine] , which have also some antagonistic properties at A2b receptors, and the nonspecific adenosine antagonist 8-phenyltheophylline were equipotent at inhibiting the NECA-induced increase in IL-6 protein synthesis, whereas the specific A1 antagonist 8-cyclopentyl-1,3 dipropylxanthine is much less potent. The results indicate that adenosine A2b receptors participate in the regulation of the IL-6 gene in astrocytoma cells.

Adenosine↗
PubMed1996

Interleukin-1 beta uses common and distinct signaling pathways for induction of the interleukin-6 and tumor necrosis factor alpha genes in the human astrocytoma cell line U373.

Cytokines are involved in the etiology of different disorders of the CNS. For a better understanding of their pathogenic role, we analyzed signal transduction pathways mediating the interleukin (IL)-1 beta-induced synthesis of IL-6 and tumor necrosis factor alpha (TNF alpha) in the human astrocytoma cell line U373 MG. Both protein kinase C and reactive oxygen intermediates (ROIs) were involved in IL-6 and TNF alpha gene expression by IL-1 beta. In contrast, protein tyrosine kinases were only necessary for expression of the IL-6 gene. Whereas activation of protein kinase A was able to induce expression of the IL-6 gene, it did not induce TNF alpha gene expression and was not involved in IL-1 beta-induced IL-6 and TNF alpha gene expression. Activation of the transcription factor nuclear factor-kappa B by IL-1 beta involved ROIs, whereas the IL-1 beta-induced activation of the transcription factor AP-1 was mediated via protein kinase C. Our findings provide the basis for the development of specific drugs for the treatment of disorders of the CNS in which cytokines play a pathogenic role.

Astrocytoma↗
PubMed1996

Interleukin-1 beta and tumor necrosis factor-alpha induce expression of alpha 1-antichymotrypsin in human astrocytoma cells by activation of nuclear factor-kappa B.

The protease inhibitor alpha 1-antichymotrypsin (ACT) has been suggested to be involved in the etiology of Alzheimer's disease (AD). Increased levels of ACT have been found in serum and brains of AD patients, and ACT has been proposed to regulate beta-amyloid fibril formation in vitro. To gain insight into the regulation of ACT in the brain, we investigated the signal transduction pathways involved in ACT gene expression and protein synthesis in the human astrocytoma cell line U373. This cell line has previously been shown to respond with strong ACT synthesis on stimulation with interleukin-1 beta (IL-1 beta) or tumor necrosis factor-alpha (TNF alpha). Here, we describe that both IL-1 beta and TNF alpha activate the transcription factor nuclear factor-kappa B (NF-kappa B) via production of reactive oxygen intermediates resulting in ACT expression. In addition, we show that neither protein kinase C nor protein kinase A is involved in IL-1 beta- or TNF alpha-induced ACT expression. These results suggest that activation of NF-kappa B may be one possible cause of increased ACT levels in AD and provide a basis for the development of drugs used for the modulation of inflammatory processes occurring in AD.

Astrocytoma↗
PubMed1996

Addition of lamotrigine to valproate may enhance efficacy in the treatment of bipolar affective disorder.

The new antiepileptic lamotrigine has been shown to be effective in the treatment of focal epilepsies with or without secondary generalization and has also been suggested to be efficacious in the treatment and prophylaxis of affective disorders. Therefore, we analyzed its possible benefit in a patient with refractory bipolar affective disorder. Lamotrigine (up to 150 mg/d) was added to valproate (2700 mg/d), substituting previously administered neuroleptics. A considerable improvement of the patient's condition was achieved several days after the beginning of lamotrigine co-administration, and lasted over the total follow-up period of more than one year. The plasma concentrations after total remission were in the range of 1.9 to 6.2 mg/l for lamotrigine and 57.1 to 95.2 mg/l for valproate. This positive action of lamotrigine is discussed in the context of the drug's elementary effects on sodium and calcium channels.

Adult↗
PubMed1996

Effects of enalapril and nitrendipine on exercise albuminuria in normotensive type I diabetic patients with incipient nephropathy.

Based on animal experiments it has been proposed that antihypertensive agents may differentially influence albuminuria through their divergent effects on glomerular haemodynamics or glomerular sieving properties and may beneficially influence the progression of diabetic nephropathy even without an effect on blood pressure. However, to date this hypothesis has not been tested in normotensive patients with diabetic nephropathy. The main aim of this study was therefore to investigate the effects of the administration of two antihypertensive agents on albuminuria during rest and exercise. The study consisted of 3 x 3 randomised, cross-over periods with five days double blind administration of enalapril (E: 2.5 mg bid), nitrendipine (N: 5 mg bid) and placebo (P) on 18 Type 1 normotensive (blood pressure < 140/90 mmHg) diabetic patients with incipient diabetic nephropathy (albuminuria 30-300 mg/24 h, normal glomerular filtration rate, diabetes duration > 6 years and presence of diabetic reinopathy. The aim of this study was to investigate the effect of enalapril and nitrendipine on blood pressure values and albuminuria during exercise challenge (bicycle ergometry: 20 min at 75 W and 20 min at 100 W) in comparison to the placebo. Albumin excretion rates during pre-exercise rest (mean +/- SD; E: 6.2 +/- 6.0; N: 7.1 +/- 8.0; P: 7.7 +/- 7.0 mg/mmol creatinine) and during exercise (E: 8.7 +/- 9.4; N: 8.2 +/- 8.2; P: 11.1 +/- 11.4 mg/mmol creatinine) were comparable between the drugs and not significantly different after administration of placebo. Blood pressure values were significantly different between the medications (systolic blood pressure: p = 0.0269; diastolic blood pressure: p = 0.0021, ANOVA for repeated measurements). There were no significant correlations between blood pressure values and albuminuria at any time. In normotensive patients with incipient diabetic nephropathy low-dose administration of enalapril, nitrendipine and placebo does not result in clear cut differences in albuminuria.

Adolescent↗
PubMed1996

Diabetes as a predictor of mortality in a cohort of blind subjects.

BACKGROUND: There is only a little information about survival in newly registered blind subjects. METHODS: A closed cohort of blind subjects (n = 2680, 1803 of them women), newly registered between 1990 and 1993 in the district of Württemberg-Hohenzollern, Germany, was observed for up to 48 months. Mortality was compared to that of the general population. Predictors of mortality within that cohort were identified by Cox proportional hazards regression analysis. RESULTS: Before 1 February 1994, 582 of the subjects had died. Diabetes had been diagnosed in 772 of the subjects, 226 of them died. The overall incidence rate of death was 12179 per 100,000 per year. The probability of survival after 47 months was 0.64 (95% confidence interval (CI): 0.59-0.70) in the non-diabetic, and 0.46 (95% CI: 0.37-0.55) in the diabetic subjects. Predictors of mortality in the regression model were age (risk ratio [RR] per year of age 1.047), sex (RR for men 1.247) and diabetes (RR when blindness was unrelated to diabetes: 1,448, RR when diabetes was the only cause of blindness: 2,253). Compared with the entire population, mortality was considerably increased in the blind cohort (comparative mortality figure [CMF] 4.79), particularly in individuals with diabetes (CMF = 6.55). The relative risks decreased with increasing age. CONCLUSIONS: Overall mortality in this cohort was high, even higher than in previous studies on the mortality of the blind. Diabetes increased the risk of death. In addition, the cause of blindness in diabetic individuals was a major predictor of mortality.

Adolescent↗