[Acute worsening of vision in an HIV-positive female patient with a helper cell level of over 200/microl].
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Adult↗
Biomedical subjects
M Schürmann
Publications and source records attributed to M Schürmann.
[Evaluation of sympathicolysis after continuous brachial plexus analgesia using laser Doppler flowmetry in patients suffering from CRPS I].
OBJECTIVE: The aim of this study was to evaluate continuous brachial plexus analgesia in terms of pain relief and sympathicolysis in patients suffering from CRPS I. METHODS: A detailed clinical examination comprised measurement of temperature changes (Infrared Thermometry), pain rating (VAS scale) and assessment of peripheral sympathetic nervous function using laser Doppler flowmetry. A total number of 12 patients (mean age: 56 +/- 9 years, range: 30 to 69 years) received continuous brachial plexus analgesia after placing a catheter in the perineurial sheath of the brachial plexus through an axillary approach. Prior to continuous analgesia (Morphin 0.04 mg/ml, Clonidin 1.5 microg/ml, Bupivacaine 0.0625 %) running at 4 ml/h a test dosis of 20 ml Bupivacaine 0.25 % was applied to establish brachial plexus block. RESULTS: After an equilibration period of 2 hours, consecutive pain measurements revealed sufficient pain relief in 9 out of 12 patients (75 %) with a mean pain rating dropping from 4.7 +/- 0.68 to 1.59 +/- 1.02 (p < 0.001). Pain reduction was accompanied by a significant temperature increase from -0.78 degrees C to 1.7 degrees C (p < 0.05). However measurement of sympathetic function by laser Doppler flowmetry revealed that no significant sympathicolysis occurred. CONCLUSIONS: The study shows that clinical investigation of temperature change is not reliable in the evaluation of sympathicolysis. This is of special interest in patients who are suspected of having sympathically maintained pain (SMP) and are treated by brachial plexus analgesia.
Adult↗
Structural analysis of the SiO2/Si100 interface by means of photoelectron diffraction.
The local environment of Si atoms at the interface between a thermally grown SiO2 film and Si(100) was studied by angle-scanned photoelectron diffraction. Experimental photoelectron diffraction patterns for each Si oxidation state were obtained from the results of least squares fitting on Si 2p core-level spectra. A comparison of the diffraction patterns with multiple-scattering calculations including an R-factor analysis was performed. An excellent agreement between experimental and simulated data was achieved within the proposed bridge-bonded interface model [Phys. Rev. Lett. 84, 4393 (2000)]].
Journal Article↗
[An update on thrombosis prophylaxis in orthopaedic and accident surgery].
The prevention of deep venous thrombosis has become a routine in orthopaedic surgery. While the necessity for prophylaxis is not questioned, its practice is still a matter of controversy. The development of new anticoagulants increases the variety of prophylactic methods but leads to a need for additional information. This review deals with the indications for thrombosis prophylaxis in relation to exposing and predisposing risk factors. The currently available modalities of prophylaxis, their pharmacological details and clinical significance are presented. Evidence based data, recommendations on the duration of prophylaxis derived from official guidelines, issues of the cost/effectiveness, and medico-judicial aspects are discussed.
Anticoagulants↗
Activation of the human posterior parietal and temporoparietal cortices during audiotactile interaction.
We recorded cortical-evoked responses with a whole-scalp neuromagnetometer to study human brain dynamics associated with audiotactile interaction. The subjects received unilateral auditory (A) or tactile (T) stimuli, or both stimuli simultaneously (AT), alternating to the left and right side. Responses to AT stimuli differed significantly from the algebraic sum of responses to A and T stimuli (A + T) at 75-85 and 105-130 ms and indicated suppressive audiotactile interaction. Source modeling revealed that the earlier interaction occurred in the contralateral posterior parietal cortex and the later interaction in the contralateral parietal opercula between the SII cortex and the auditory cortex. The interaction was significantly stronger in the left than the right hemisphere. In most subjects, AT responses were far more similar to T than to A responses, suggesting suppression of auditory processing during the spatially and temporally concordant audiotactile stimuli in which the tactile component was subjectively more salient.
Acoustic Stimulation↗
[Acute CRPS I (morbus sudeck) following distal radial fractures--methods for early diagnosis].
INTRODUCTION: CRPS I represents a frequent complication following distal radial fractures. Early diagnosis may prevent chronification of the disease. However posttraumatic pain, swelling and motor disturbances render the differentiation from normal fracture patients more difficult. The incidence of CRPS I in patients at risk and the diagnostic value of clinical evaluation, radiography and thermography in the early posttraumatic phase are analysed. METHODS: 158 consecutive patients with distal radial fractures were followed-up for 16 weeks after trauma. Apart from a detailed clinical examination 8 and 16 weeks after trauma, thermography and bilateral radiographs of both hands were performed. RESULTS: At the end of the observation period 18 patients (11%) were clinically identified as CRPS I. The severity of the preceding trauma and the chosen therapy did not influence the process of the disease. 16 weeks after trauma easy differentiation between normal fracture patients and CRPS I patients was possible. 8 weeks after distal radial fracture clinical evaluation showed a sensitivity of 78% and a specificity of 94%. Thermography (58%) however and bilateral radiography (33%) revealed a poor sensitivity, respectively. The specificity was high for radiography (91%) and again poor for thermography (66%), respectively. CONCLUSION: The results of the study support the importance of clinical evaluation in the early diagnosis of CRPS I. Plain radiographs facilitate the diagnosis as soon as bony changes develop.
Acute Disease↗
CARD15 gene mutations in sarcoidosis.
Sarcoidosis, Blau syndrome and Crohn's disease are complex disorders, characterised by granulomatous inflammation affecting a variety of organs. Mutations of the CARD15 gene, on chromosome 16, have been shown to contribute significantly to Crohn's disease and to cause Blau syndrome. These factors prompted the current authors to study CARD15 mutations in sarcoidosis. A total of 138 families were genotyped, including 302 patients with sarcoidosis and 127 patients without a family history of sarcoidosis (together with their parents), for four main coding CARD15 polymorphisms associated with increased risk of Crohn's disease. Furthermore, the gene segment that harbours Blau syndrome mutations was sequenced in 39 selected patients from 39 families with affected siblings identical for one or two parental chromosomes 16s and in eight patients from multi-case families. None of the reported Blau syndrome mutations and no new sequence alterations were found. There was an increased frequency of transmission of the rare allele of the polymorphic sites 802C>T (SNP5) and 2722G>C (SNP12) in at least one of the two study groups. In conclusion, CARD15 mutations, which are important in Crohn's disease and Blau syndrome, play no major role in sarcoidosis in this study population. However, these mutations could be of limited importance, especially in patients without a family history of sarcoidosis.
Adolescent↗
Effectiveness of twice-weekly pyrimethamine-sulfadoxine as primary prophylaxis of Pneumocystis carinii pneumonia and toxoplasmic encephalitis in patients with advanced HIV infection.
The safety and efficacy of a fixed 25 mg pyrimethamine-500 mg sulfadoxine combination supplemented with 15 mg folinic acid twice a week as primary prophylaxis of Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis was evaluated in 106 patients infected with the human immunodeficiency virus. All patients had a CD4+ T-lymphocyte count of less than 100 cells/microl at study entry. Efficacy in this single-arm open-label prospective study was analyzed on an as-treated basis. No patient received highly active antiretroviral treatment, including protease inhibitors or non-nucleoside reverse transcriptase inhibitors, while on study medication. PCP developed in four patients, one of whom had been noncompliant. No PCP episode occurred in the first year. Probabilities of freedom from PCP were 0.97 (95%CI, 0.92-1) after 24 months and 0.93 (95%CI, 0.84-1) after 36 months. Of 74 (69.8%) patients positive for anti-toxoplasma IgG antibodies, one noncompliant patient developed toxoplasmic encephalitis after 24 months. Allergic reactions were observed in 18 (17%) patients and resulted in permanent discontinuation in 7 (6.6%) patients. One (0.9%) patient who had continued prophylaxis despite progressive hypersensitivity reactions developed a serious adverse reaction (Stevens-Johnson syndrome). The median survival of study participants was 29 months, with relentless progression of AIDS accounting for most deaths. The prophylaxis regimen studied appeared safe and effective for primary prophylaxis of PCP and toxoplasmic encephalitis. Severe adverse events can likely be prevented by discontinuation of prophylaxis at the time allergic reactions are noted. Rechallenge frequently results in tolerance. Efficacy and safety compare favorably with previously studied regimens. This simple prophylactic regimen may provide a convenient alternative for patients failing or intolerant to approved regimens.
AIDS-Related Opportunistic Infections↗
[41-year-old patient after liver transplantation with acute abdominal pain].
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Abdomen, Acute↗
Long-term results after posterior fixation of thoraco-lumbar burst fractures.
Current concepts of treating thoraco-lumbar burst-compression injuries are based on posterior transpedicular fixation techniques which are angular stable. However, the long-term results of this approach are controversial due to inconsistent reports and due to a paucity of data on late outcome. In the present study we analyzed 50 patients retrospectively who had an unstable burst-compression injury at T 11-L 2 (type A 3 according to Magerl) without a neurological deficit. All fractures were stabilized by an internal fixator either with or without transpedicular spongiosa grafting. Patients were treated between 1991 and 1997. Follow-up times ranged from 36 to 103 months. Follow-up examinations collected occupational, subjective and clinical data (activity score, Hannover spine score) and included radiographic measurements. The latter were used to calculate the sagittal index (SI) which measures deformities of the fractured vertebral body, and the sagittal plane kyphosis (SPK) which additionally describes an eventual destruction of the affected intervertebral disc. Compared with the preinjury status, the percentage of subjects who were able to do physical labor was reduced by half at follow-up, and four times as many patients had a permanent disability. Correspondingly, activity scores and Hannover spine scores declined significantly. After the initial surgical correction SI remained stable until follow-up, whereas SPK decreased again towards pre-operative values indicating a progressive deformity of the intervertebral disc space. Clinical results did not correlate with radiographic results, and neither the time until follow-up nor the type of fracture n or the use of transpedicular bone grafting affected clinical or radiographic results significantly.
Adult↗
No linkage of the interleukin-4 receptor locus on chromosome 16p11.2-12.1 with sarcoidosis in German multiplex families.
We typed 241 members of 62 sarcoidosis families with 136 affected siblings for three single nucleotide polymorphisms of the interleukin-4 receptor alpha-chain gene (IL4R). Allele frequencies in patients were compared to those of healthy unrelated control individuals. The segregation of the three-point IL4R haplotypes completed by two flanking highly polymorphic microsatellite polymorphisms revealed no evidence for linkage of the IL4R gene locus with sarcoidosis.
Chromosome Mapping↗
The first bismuth phosphonate cluster. X-ray single crystal structure of [(ButPO3)10(ButPO3H)2Bi14O(10).3C6H(6).4H2O].
The reaction of triphenylbismuth and tert-butylphosphonic acid gives the bismuth phosphonate phase (ButPO3H)3Bi and the first bismuth phosphonate cluster [(ButPO3)10(ButPO3H)2Bi14O(10).3C6H(6).4H2O].
Journal Article↗
Stronger reactivity of the human primary motor cortex during observation of live rather than video motor acts.
The monkey premotor cortex contains neurons that are activated both when the monkey performs motor acts and when he observes actions made by others. A similar mirror neuron system, involving several brain areas, has been found in humans. We recorded neuromagnetic oscillatory activity from the primary motor cortex of 10 healthy subjects when they observed live and videotaped finger movements. The left and right median nerves were stimulated alternatingly and the poststimulus level of the approximately 20 Hz rhythm was quantified. Compared with the rest condition, the approximately 20 Hz rhythm was dampened 15-19% more when the subjects observed live rather than videotaped hand movements, indicating stronger activation of the primary motor cortex. These results suggest that the human mirror neuron system differentiates natural and artificially presented movements.
Adult↗
Results from a genome-wide search for predisposing genes in sarcoidosis.
Sarcoidosis is a systemic disease of granulomatous inflammation and unknown etiology. An inherited predisposition is involved, and many candidate susceptibility genes have been tested in association studies. We have applied the more general strategy of genome-wide microsatellite linkage analysis to identify chromosomal regions that contribute to the risk of sarcoidosis. On the basis of 225 microsatellite markers tested in 63 families with affected siblings (138 patients) and multipoint nonparametric linkage (NPL) analysis, we found the most prominent peak (six adjacent markers including D6S1666; NPL score = 2.99; p = 0.001) at the major histocompatibility complex (MHC). Six minor peaks (p < 0.05) were found on chromosomes 1 (D1S1665 ), 3 (D3S1766 ), 7 (D7S821 and D7S3070), 9 (D9S934), and the X chromosome (DXS6789). A subset of nine families with more than two affected siblings (30 patients) contributed little to the peak at the MHC (D6S1666; NPL score = 0.79; p = 0.21). Our results point to locus heterogeneity of susceptibility to sarcoidosis, with a major effect of the MHC.
Adult↗
[Important acute measures after fractures. Rapid and adequate treatment of pain].
Pain caused by bone fractures needs to be treated promptly and adequately to avoid negative secondary effects. Pain therapy and the healing of soft tissue are goals that are equally as important as healing of the fracture. The following factors have analgesic potential: reduction, immobilization, cooling measures, limb elevation and fasciotomy. Symptomatic treatment of pain is orientated to the WHO stepped approach, which attaches particular importance to the regular administration of analgesics, as dictated by clinical effectiveness.
Analgesics↗
[When fracture pain does not subside. Recognizing complications].
Over the long term, the evolution of pain caused by fractures is determined by the quality of immobilization, the extent of edema, and by surgical, analgesic and physiotherapeutic treatment. Development of chronicity is initiated by secondary deterioration, persistence of pain in the absence of improvement, changes in the nature of the pain, its spontaneous occurrence, and the appearance of concomitant symptoms. Differential diagnostic considerations must include surgical complications, but also damage to nerves, or the complex regional pain syndrome (CRPS). A particular differential diagnostic problem is the differentiation between CRPS and other complications. Treatment must be matched to the diagnosis: conservative attempts at treatment may have to be followed up with surgical revision. Drug treatment of pain is oriented to the stepped WHO schema. Physiotherapy, physical treatment and ergotherapy play a major role in the treatment of CRPS.
Chronic Disease↗
Local atomic environment of Si suboxides at the SiO2/Si(111) interface determined by angle-scanned photoelectron diffraction.
Local environments of Si suboxides at the interface between a thermally grown SiO2 film and Si(111) were studied by angle-scanned photoelectron diffraction. Si 2p core-level spectra containing chemically shifted components were recorded. The components were deconvoluted by least squares fitting and assigned to different Si oxidation states. The obtained diffraction patterns of the various suboxides exhibit different features. Comparison of these patterns with multiple scattering calculations including a multipole R-factor analysis shows that a simple chemical abrupt interface model describes well the environment of the suboxides and indicates ordered SiO2 close to the interface.
Journal Article↗
Wavelet entropy: a new tool for analysis of short duration brain electrical signals.
Since traditional electrical brain signal analysis is mostly qualitative, the development of new quantitative methods is crucial for restricting the subjectivity in the study of brain signals. These methods are particularly fruitful when they are strongly correlated with intuitive physical concepts that allow a better understanding of brain dynamics. Here, new method based on orthogonal discrete wavelet transform (ODWT) is applied. It takes as a basic element the ODWT of the EEG signal, and defines the relative wavelet energy, the wavelet entropy (WE) and the relative wavelet entropy (RWE). The relative wavelet energy provides information about the relative energy associated with different frequency bands present in the EEG and their corresponding degree of importance. The WE carries information about the degree of order/disorder associated with a multi-frequency signal response, and the RWE measures the degree of similarity between different segments of the signal. In addition, the time evolution of the WE is calculated to give information about the dynamics in the EEG records. Within this framework, the major objective of the present work was to characterize in a quantitative way functional dynamics of order/disorder microstates in short duration EEG signals. For that aim, spontaneous EEG signals under different physiological conditions were analyzed. Further, specific quantifiers were derived to characterize how stimulus affects electrical events in terms of frequency synchronization (tuning) in the event related potentials.
Adult↗