Biomedical subjects
Publications and source records attributed to M Berger.
A case of surgical reconstruction in posttraumatic necrosis of the lateral tibial plateau after impression fracture is presented. Joint reconstruction was performed by transposition of the distally pedicled lateral third of the patella combined with a cancellous bone graft. The surgical procedure is described and the indications for it are discussed.
We report three cases of restless-legs syndrome in which by polygraphic sleep recordings an accompanying sleep-apnea syndrome was detected. Etiopathological factors, in particular a dysfunction of the sleep regulating centers in the brain stem as a cause of both diseases are discussed. Our observations suggest that a polysomnographic recording including respiration parameters should be carried out in every patient suffering from restless-legs syndrome.
REM sleep abnormalities like shortened REM (rapid eye movement) latency, prolongation of the first REM period and heightening of REM density often found in patients with a major depression have prompted an increasing number of studies investigating the neurobiology and neurophysiology of REM sleep in depressive patients, as well as in healthy humans and animals. On the other hand, since the early 1970s investigation of the psychological concomitant of REM sleep, i.e., dreaming, in depressive patients has been extremely sparse. The present study aimed at investigating morning and laboratory dream recall and content in patients with a major depressive disorder to shed more light on this neglected area. In short, morning as well as laboratory dream recall in depressive inpatients was drastically reduced. The low number of scorable dream reports collected did not reveal a heightened incidence of "masochistic" or "negative" content, indeed were rather mundane. In contrast, depressive outpatients (probably less depressed) had a higher rate of morning dream recall. Interestingly, antidepressive treatment with trimipramine (an antidepressant which does not suppress REM sleep) led to a positive influence on patients' mood that was paralleled by a change of dream mood in a positive direction.
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Eighty-two men underwent spermatic vein ligation as treatment for infertility. The resultant mean rates of 22% for semen improvement and 28% for pregnancy justify the surgical approach in selected cases of male infertility.
Early identification and treatment of epidural neoplasm, before the development of significant neurologic deficits, provides the best opportunity for a favorable outcome. Among the many patients with symptoms, signs, or scintigraphic or radiographic findings suggesting possible epidural disease, a small proportion will have the lesion. The selection of patients for definitive imaging of the epidural space should be based on a determination of the risk of this complication. In this study, the medical records, plain spinal radiographs, bone scintigraphs and myelograms of 43 patients were analyzed retrospectively to assess the risk of epidural disease associated with specific clinical, radiographic, and scintigraphic findings. Cervical, thoracic, and lumbosacral spinal segments were evaluated independently. Symptomatic segments (SS) (N = 41), defined by focal pain or neurologic dysfunction, were distinguished from asymptomatic segments (AS). At SS, epidural disease was found at 86% and 8% of abnormal and normal spinal radiographs, respectively (P less than 0.001), and at 69% and 0% of abnormal and normal scintigrams, respectively (P less than 0.001), whereas at AS epidural disease occurred in 43% and 3% of abnormal and normal spinal radiographs, respectively (P less than 0.001), and 14% and 7% of abnormal and normal scintigrams, respectively (P = NS). Vertebral collapse was highly predictive of an epidural lesion. Epidural disease occurred in 12% of SS and 0% of AS with an abnormal scintigram and normal radiograph, 86% of SS and 45% of AS with abnormalities on both scintigram and radiograph, and at two AS when both were normal. Decision analysis applied to these data yielded a specific conditional probability of epidural disease for each combination of clinical, scintigraphic, and radiographic findings. These data provide a basis for the selection of patients for additional evaluation of the epidural space before neurologic deficits develop.
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The effect of human NPH insulin (Protaphan HM) and of human ultralente insulin (Ultratard HM) on the profile of blood-glucose concentration was compared, using the glucose clamp technique, in normal subjects after subcutaneous injection of 12 U each. After Protaphan, insulin concentration rose by 11.0 +/- 1.6 microU/ml; maximal glucose infusion rate (GIR) after five hours was 4.7 +/- 0.5 mg/kg.min. But after the same dosage of Ultratard, insulin concentration rose by only 4.7 +/- 1.0 microU/ml (P less than 0.02) on a maximal GIR after ten hours of 3.2 +/- 0.5 mg/kg.min (no significant difference). Ultratard had up to 70% of the maximal Protaphan effect, the infused amount of glucose, up to maximal effect at 9.5 h (72 +/- 9 g), being significantly lower (P less than 0.02) than after Protaphan (130 +/- 18 g). After, respectively, 16 (Protaphan) and 20 (Ultratard) hours, basal insulin levels were again reached. GIR 19 h after Protaphan injection was 1.3 +/- 0.4 mg/kg.min, while 24 h after Ultratard it was 1.5 +/- 0.2 mg/kg.min, which was not significantly different from the basal rate. The difference between Protaphan and Ultratard lies in the marked initial effect of NPH insulin, up to 10 h after injection. In the later phase of the effect profile both insulins were similar at the chosen dose of 12 U.
Rapid eye movement (REM) sleep disinhibition at the beginning of the night is one of the most frequently described biologic abnormalities in depression. As REM sleep in animals and humans seems to be facilitated by cholinergic neuronal activity, it has been postulated that REM sleep disinhibition in depression is a consequence of cholinergic neuronal overactivity. The current study with the newly available cholinergic agonist RS-86, which is orally active, has a half-life of six to eight hours, and exhibits only minor peripheral side effects, supports this assumption. The application of this compound before sleep led to a significantly faster induction of REM sleep at the beginning of the night in patients with major depressive disorders compared with healthy subjects and patients with other nondepressive psychiatric diseases, such as eating disorders. Whereas 14 of 16 depressed patients displayed sleep-onset REM periods after the administration of RS-86, this happened only in three of the 16 healthy controls and in one of the 20 patients with other diagnoses. The increased susceptibility of REM sleep to cholinergic stimulation was limited to the state of depression and was not observed in a group of remitted depressed patients.
A follow-up study of 116 Type 1 (insulin-dependent) diabetic patients on long-term continuous subcutaneous insulin infusion was conducted after 4.5 +/- 0.2 years. The average HbA1c-value of these patients decreased by 1% to 6.7 +/- 0.1% during this observation period. Typical side effects of continuous subcutaneous insulin infusion such as skin inflammation at the catheter insertion site occurred with similar frequency as has been reported previously by other authors. Diabetic ketoacidosis (0.14 per patient year) and disabling hypoglycaemia (0.1 per patient year, including 0.05 hypoglycaemic coma per patient-year) occurred at substantially lower rates than in other comparable studies with Type 1 diabetic patients at a similar degree of metabolic control. Subgroup evaluation suggested that a normal (less than 5.6%) HbA1c-value at follow-up was associated with increased incidence of disabling hypoglycaemia, whereas poor metabolic control (HbA1c greater than 7.5%) was associated with increased rates of skin complications and hospital treatment for ketoacidosis. Thus, under the policies of this diabetes centre, continuous subcutaneous insulin infusion has proved to be beneficial to a large proportion of experienced adult Type 1 diabetic patients, who voluntarily had opted for, and continued with, this particular mode of insulin treatment.
The role of variations in plasma insulin concentrations as a factor possibly involved in abnormalities of haemostatic functions, and (or) the development of arterial disease, has been the subject of controversy. This study examines the "in vivo" effect of hyperinsulinaemia on haemostatic parameters in seven healthy men. Two studies were carried out in random order: (a) Hyperinsulinaemia study. Human insulin was infused by a calibrated infusion pump (0.7 mU kg-1 min-1, for 8 h) during a euglycaemic glucose clamp, and (b) Control study 0.15 mmol/l NaCl solution was infused over 8 h. Plasma epinephrine and norepinephrine concentrations remained constant throughout the studies. Mean insulin levels during the hyperinsulinaemia study were 46.2 +/- 1.6 microU/ml, i.e. approximately eightfold higher than those at baseline, whereas plasma glucose levels remained constant at 4.9 +/- 0.1 mmol/l. During the control study, mean insulinaemia was 5.0 +/- 0.9 microU/ml, and plasma glucose 5.2 +/- 0.1 mmol/l. No statistically significant changes were observed during, or after insulin or 0.15 mmol/l NaCl infusions with regard to platelet parameters, blood coagulation, and coagulation inhibitors. These data suggest that abnormalities of the haemostatic function described during insulin-induced hypoglycaemia or in hyperinsulinaemic patients are not due to a direct action of insulin.
Neuroendocrine disturbances [low plasma levels of triiodothyronine (T3), high plasma concentrations of cortisol], morphological brain alterations [enlarged external cerebrospinal fluid (CSF) spaces, dilatation of the ventricles] and altered sleep patterns [fragmented sleep continuity, a reduction of slow wave sleep (SWS) or REM sleep] have been described in patients with anorexia nervosa and bulimia nervosa. The present study investigates to what degree these disturbances interact with each other. In ten anorexic and five bulimic patients cranial computed tomography (CT) to estimate the size of the CSF spaces, blood sampling to measure cortisol and T3 plasma concentrations, and all-night polysomnography were performed. In comparison with patients with normal CT scans, the patients displaying enlarged CSF spaces spent more time in SWS, and the duration of REM sleep was reduced. In the whole sample, a negative correlation was found between the amount of REM sleep and cortisol, whereas a positive association was found between the amount of REM sleep and the T3 level. In addition, the degree of brain shrinkage correlated positively with cortisol and negatively with T3. On the basis of these results, it can be assumed that in patients with eating disorders the disease process with its neuroendocrine alterations affects brain morphology as well as EEG sleep.
Sixty-seven in vitro fertilization (IVF) patients who underwent ultrasonically guided oocyte pickup (OPU) after induction of superovulation with human menopausal gonadotropins were submitted to two different protocols of embryo transfer. In the first group of 33 patients, four to five embryos were transferred to the uterus 48 hr after OPU. In the second group of 34 patients two to three embryos were transferred at 48 hr after OPU and two other embryos were transferred after freezing and thawing 48 hr later (96 hr after OPU). The pregnancy rate achieved in the double embryo transfer (ET) protocol was significantly higher than in the single-ET protocol (32.4 vs. 18.2%, respectively; P less than 0.05).
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The effects of neonatal administration of cyproterone acetate on the growth, hormone responsiveness, DNA and protein concentrations, protein profiles, protein synthetic patterns and nuclear androgen binding sites of epididymis, vas deferens and seminal vesicles were investigated in adult mice. The weight of epididymis and seminal vesicle was significantly depressed and the reductions observed were secondary to cellular hypoplasia in epididymis and to cellular hypotrophy in seminal vesicle. The 3 organs studied showed a limited response to exogenous androgens at adulthood. When assessed by the number of cells the response of the 3 organs was similar to that of controls but it was significantly reduced from 25 to 35% when measured in term of cellular concentration of proteins. The protein profiles from homogenates of whole organs and the protein synthetic patterns after [35S]methionine incorporation, analyzed by polyacrylamide gel electrophoresis, showed reproducible persistent alterations. The total number of nuclear androgen binding sites was significantly reduced in seminal vesicles.
To assess the prevalence and flow characteristics of valvular regurgitation detected by Doppler echocardiography in normal subjects, pulsed and continuous wave Doppler studies were performed in 100 adult volunteers without evidence of heart disease. Evidence of valvular regurgitation was present in 73% of subjects. There were 46 subjects with regurgitation of one valve, 24 with regurgitation of two valves and 3 with regurgitation of three valves. Right-sided regurgitation was significantly more common than was left-sided regurgitation (81 versus 22 valves, p less than 0.01). Regurgitant flow was never detected farther than 1 cm from the valve by pulsed Doppler study. Tricuspid regurgitation was detected in 50 subjects and was characterized by a holosystolic velocity signal; a complete spectral envelope was recorded in 32 subjects. The peak velocity of the regurgitant jet for this group was 1.7 to 2.3 m/s (mean 2.0 +/- 0.2). Thirty-one subjects were found to have pulmonary regurgitation with a peak velocity of 1.2 to 1.9 m/s (mean 1.5 +/- 0.2); no subject demonstrated regurgitant flow in early diastole. There were 21 subjects with mitral regurgitation; continuous wave Doppler signals were always of low intensity with a poorly defined spectral envelope and an absence of high velocities. Peak velocities ranged from 1.1 to 4.4 m/s (mean 2.3 +/- 0.9) and in 19 subjects were less than 3.5 m/s. The mean age of subjects with mitral regurgitation was significantly higher than that of subjects without mitral regurgitation (p = 0.01). Aortic regurgitation was detected in only one subject. This study provides further evidence that valvular regurgitation is frequently detected by Doppler echocardiography in normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
A comparison of the sleep EEG patterns of patients with a major depressive disorder intraindividually between remitted and depressed state revealed an improvement of parameters of sleep continuity and a tendency for normalization of rapid eye movement (REM) latency and REM density in the former. Additional application of the cholinergic agonist RS 86 prior to sleep did not reveal a heightened sensitivity of the REM sleep system in the remitted sample. Whereas a group of presently ill depressives displayed a drastic reduction of REM latency, results of the remitted patients were comparable to healthy controls. Furthermore, RS 86 significantly reduced slow-wave sleep in all groups investigated and had a differential impact on the density of the first REM period and early morning awakening in actively ill patients as compared to remitted patients. The results do not favor the hypothesis of a trait specificity of REM sleep abnormalities for depressive disorders. Furthermore they support the model of a cholinergic supersensitivity, as measured by REM induction after RS 86, as a state but not a trait marker of affective illness. Generalization of the present study may, however, be limited by the fact that the remitted patients were free of symptomatology and psychoactive medication for a long period (mean 3 years), therefore constituting an untypical group of formerly depressed patients with a seemingly low risk of relapse.