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Biomedical subjects

M Stoll

Publications and source records attributed to M Stoll.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Group B streptococcal meningitis revealing an inner ear congenital malformation. A case report in an adult].

INTRODUCTION: Group B streptococcal meningitis is unusual in adults. It occurs in patients with a chronic disease. EXEGESIS: We report a case of group B streptococcal meningitis that occurred in a 32-year-old woman, uncovering inner ear congenital malformation associated with cerebrospinal fluid fistula. There was no recurrent episode of meningitis during a 2-year period following surgical correction of the malformation. CONCLUSION: Clinical signs suggesting cerebrospinal fluid fistula should be considered in any adult patient with severe group B streptococcal infection.

Adult↗
PubMed1999

Orthostasis as a test for cerebral autoregulation in normal persons and patients with carotid artery disease.

Orthostasis reduces mean flow velocity (FVmean) in cerebral arteries. This might be used as an alternative provocation test for cerebral hemodynamics in patients with carotid artery disease (CAD). In 21 unilateral CAD patients and 21 controls, FVmean in both middle cerebral arteries (MCA) was measured by transcranial Doppler, together with blood pressure (BP) and heart rate (HR) during a tilt table test. Cerebrovascular reserve (CVR) was measured by an acetazolamide test. In all cases, FVmean dropped to a lower level (controls: 81.9 +/- 9.4% of baseline; patients: 84.3 +/- 7.9% symptomatic side, 85.6 +/- 9.0% contralateral). Impaired CVR patients showed a smaller (p < 0.01) decrease (90.6 +/- 3.3%) compared to contralateral (84.9 +/- 6.0%), to normal CVR patients (81.1 +/- 7.8%) and to controls. Heart rate increased in both groups (controls: +16.6 +/- 9.9%, patients +10.3 +/- 9.9%; p < 0.01); BP showed no change. Orthostasis induces a decrease of MCA FVmean as already previously described. This decrease is significantly smaller in patients with impaired CVR. Since BP does not change, some authors explain the lower MCA Fvmean during orthostasis as caused by sympathetic induced vasoconstriction of cerebral resistance vessels. The authors speculate that in impaired CVR-patients autoregulative protection against ischemia might limit vasoconstriction. In combination with standard tests for measurement of CVR, this test might be useful for evaluation of cerebral autoregulation.

Acetazolamide↗
PubMed1999

Lipid evaluation in HIV-1-positive patients treated with protease inhibitors.

There is accumulating evidence that human immunodeficiency virus type 1 (HIV-1) protease inhibitors (PIs) can induce hyperlipidaemia. To evaluate the frequency and type of hyperlipidaemia in PI-treated patients, 98 outpatients were prospectively analysed for their lipoprotein characteristics at the Medizinische Hochschule in Hannover, Germany. Fifty-seven percent of the patients studied presented with hyperlipidaemia. Both hypertrigylceridaemia (type IV and V hyperlipoproteinaemia, 33%) and hypercholesterolaemia (type IIa hyperlipoproteinaemia, 6%) were detectable. The remaining 18% had a type IIb hyperlipoproteinaemia. Increased lipid levels were highly statistically significant compared to a control group of PI-naive HIV-1-infected patients [low-density lipoprotein (LDL) 146 mg/dl (range, 53-274 mg/dl) versus 105 mg/dl (range, 22-188 mg/dl; P=0.0006); very-low-density lipoprotein (VLDL) 35.5 mg/dl (5-253 mg/dl) versus 18 mg/dl (range, 3-94 mg/dl; P=0.0002)]. All PIs used (saquinavir, indinavir, nelfinavir and ritonavir) were associated with this variable form of hyperlipidaemia according to the Fredrickson classification. There was no significant correlation of any determined lipid value with the duration of treatment. A higher frequency of the apolipoprotein E2 allele and E4 allele was observed in the hyperlipidaemic subjects. Patients with excessive hypertriglyceridaemia showed a reduced lipoprotein lipase activity. Lipodystrophy was observed especially in hyperlipidaemic patients and to a lesser extent in normolipidaemic subjects. The frequency of hyperlipidaemic risk factors was surprisingly high in the group studied, which in turn may explain the proposed increased risk of atherogenesis in HIV-1 PI-treated patients. Therefore, PI-treated subjects should also be evaluated for their lipoprotein pattern, which may require antihyperlipidaemic interventions.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Repression of c-fos and c-jun gene expression is not part of AT2 receptor coupled signal transduction.

The signal transduction mechanism coupled to angiotensin AT2 receptors is still a matter of debate. Based on the findings that AT2 receptor stimulation causes inhibition of proliferation, and that other antiproliferative agents such as transforming growth factor-beta, retinoic acid, and MyoD act via repression of immediate early gene (IEG) expression, this study was aimed at elucidating whether downregulation of IEG expression is also part of the AT2 receptor coupled signaling mechanism. Stimulation of angiotensin AT2 receptors in the rat pheochromocytoma cell line PC12 W following pretreatment with growth factors was able to counteract growth factor induced proliferation but not to repress growth factor induced c-fos and c-jun expression; neither did AT2 receptor stimulation cause an induction of c-fos expression. We conclude that, in contrast to other growth-inhibiting agents, the antiproliferative effect of angiotensin II via the AT2 receptor is not mediated by repression of the immediate early genes c-fos and c-jun.

Angiotensin II↗
PubMed1998

[Value of antibody titers for diagnosis of neuroborreliosis].

Neuroborreliosis is a very frequent subtype of infection with Borrelia burgdorferi. Because of the widely spread inapparent infections finding of diagnosis by analysis of serum antibodies is very difficult. In the years 1990-1994 the serum of 6.775 patients of the Department of Neurology in Homburg, Germany was analysed with regard to Borrelia burgdorferi specific IgG antibodies. 24% showed a positive serum titer and 20% a borderline result. 73 patients showed a specific intrathecal IgG antibody synthesis. In contrast to patients with antibodies in serum these patients showed a significant cumulation during summer. The high percentage of positive serum titers and the season independence support the assumption of widely spread inapparent infections. If a patient shows neurological symptoms the finding of serum antibodies against Borrelia burgdorferi is not sufficient for the diagnosis of Neuroborreliosis. A specific intrathecal synthesis of antibodies, is the most reliable serological indicator for Neuroborreliosis. Intrathecal synthesis usually starts three to four weeks after the first clinical symptoms.

Antibodies, Bacterial↗
PubMed1998

Physiological and pharmacological implications of AT1 versus AT2 receptors.

Angiotensin II (Ang II) has diverse physiological actions that lead, for instance, to increases in extracellular volume and peripheral vascular resistance and blood pressure, and it has also been implicated in the regulation of cell growth and differentiation. Molecular cloning and pharmacological studies have defined two major classes of Ang II receptors, designated AT1 and AT2. Most effects of Ang II are mediated by AT1 receptors. Much less is known about the physiological role of AT2 receptors. Recent evidence suggests involvement of AT2 receptors in development, cell differentiation, apoptosis, and regeneration in various tissues. AT1 and AT2 receptors have been shown to exert counteracting effects on cellular growth and differentiation, vascular tone, and the release of arginine vasopressin. In each condition, the AT2 receptor appears to down-modulate actions mediated by the AT1 receptor, resulting in decreased cellular proliferation, decreased levels of serum arginine vasopressin levels, or decreased vasoconstrictor responses. In addition, in neuronal cell lines, the AT2 receptor exerts antiproliferative actions and promotes neurite outgrowth, an effect accompanied by significant changes in the expression pattern of growth/differentiation-related genes.

Angiotensin I↗
PubMed1998

Hemodynamics of stroke patients under therapy with low molecular weight hydroxyethyl starch.

In stroke penumbra perfusion depends passively on hemodynamics. So far hemodynamic effects of low molecular weight hydroxyethylstarch (HES) has not been investigated. Ten stroke patients received hypervolemic HES therapy. Cardiac output and heart rate were monitored using the bioimpedance method, blood pressure by conventional measurement. The Scandinavian Stroke Scale assessed clinical outcome. Circadian cardiac output changes were measured in 20 controls. Patients' cardiac output increased after the loading dose (5.3 +/- 1.4 l min(-1) to 6.5 +/- 1.7 l min(-1), p < 0.01), fluctuating then between 5 and 7 l min(-1) without nocturnal decrease. Beside an initial increase, the heart rate showed, like blood pressure, no remarkable changes. The Scandinavian Stroke Scale score did not change significantly. The controls showed a circadian cardiac output fluctuation (2.00 am, 5.3 +/- 0.3 l min(-1); 8.30 am, 8.1 +/- 0.6 l min(-1). Our patients showed a hemodynamic and clinical stabilization under therapy with low molecular weight HES. The physiological nocturnal decrease of cardiac output and blood, which might cause clinical deterioration in stroke patients, was avoided.

Adult↗
PubMed1998

Changes of cerebral perfusion after osmotherapy in acute cerebral edema assessed with perfusion weighted MRI.

Perfusion is thought to be impaired in brain edema due to reduced perfusion pressure. Brain edema therapy is assumed to improve perfusion. We assessed regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) and mean transit time of blood (MTT) using perfusion-weighted magnetic resonance imaging (MRI) in 15 patients showing acute local brain edema due to infarction or intracerebral hematoma. Patients were treated by intravenous infusion of 125 ml 40% sorbitol over 10 min. rCBF, rCBV and MTT in the edematous region were measured before and 30 min after treatment. Before treatment rCBF (46.5 +/- 12.1 vs. 42.9 +/- 10.5 ml 100 g-1 min-1), MTT (4.7 +/- 1.9 vs. 4.0 +/- 1.7 s) and rCBV (5.4 +/- 1.7 vs. 4.7 +/- 1.1 ml 100 g-1) were significantly (p < 0.05) increased in the edematous region compared to the contralateral side. After treatment no significant differences could be found. We interpret the elevation of MTT and rCBV in the edema as signs of an autoregulative compensation of an impaired perfusion. rCBF is even over-compensated. After brain edema therapy perfusion seems normalised. This new MRI method appears as useful for measuring therapeutic effects on cerebral perfusion.

Aged↗
PubMed1998

GB virus C/hepatitis G virus infection: a favorable prognostic factor in human immunodeficiency virus-infected patients?

To investigate a possible influence of GB virus C (GBV-C) in immunocompromised patients, the prevalences of GBV-C RNA and anti-E2 antibody in 197 human immunodeficiency virus (HIV)-infected patients and in 120 control blood donors were studied. GBV-C RNA was detected in 33 of 197 HIV-infected patients (16.8%) compared with 1 in 120 blood donors (0.8%) (P < .001). Previous exposure to GBV-C (anti-E2 antibody-positive) was shown in 56.8% of HIV patients and in 9% of blood donors. GBV-C viremia was not associated with hepatitis. Despite approximately equal duration of HIV infection in all subgroups, the CD4 cell counts were significantly higher in GBV-C-viremic patients (344 cells/microL) compared with exposed (259 cells/microL) and unexposed (170 cells/microL) patients (P = .017 and P < .001). Furthermore, Kaplan-Meier analysis demonstrated significantly better cumulative survival in GBV-C RNA-positive HIV-infected patients, suggesting that GBV-C might be a favorable prognostic factor in HIV disease.

AIDS-Related Opportunistic Infections↗
PubMed1998

Hand gripping and acetazolamide effect in normal persons and patients with carotid artery disease.

Transcranial Doppler measurement (TCD) of cerebrovascular reserve (CVR) is usually performed by the CO2 test, the acetazolamide test, or the breath-holding test. Since these tests are time-consuming and labor-intensive, alternative methods such as the hand-gripping test are of interest. Twenty-one normal persons and 25 patients with unilateral carotid artery disease were studied. Flow velocity changes in both middle cerebral arteries (MCAs) during bilateral hand gripping were measured by TCD and compared with acetazolamide test results. The increase in MCA mean flow velocity (FVmean) during hand gripping was 18.0 +/- 6.3% in normal persons; the increases in the post-stenotic MCA were 15.8 +/- 9.7% in all patients and 9.4 +/- 5.4% in patients with impaired CVR as determined by the acetazolamide test. Only in the group with impaired acetazolamide reactivity was the increase in the poststenotic MCA significantly lower compared to that in controls (p < 0.01) and to the contralateral, nonstenotic side (p < 0.01). Nevertheless the FVmean increases in both tests showed a weak, but significant correlation (r = 0.59, p < 0.01). All FVmean increases during hand gripping were significantly (p < 0.01) lower than those during the acetazolamide test. The test appears as a weaker stimulus for MCA blood flow velocity increase than the acetazolamide test. Thus, only a substantial reduction of acetazolamide reactivity leads to a reduced MCA FVmean increase using hand gripping. Although it is highly specific but less sensitive, hand gripping does not appear to be suitable as a screening measure of CVR, but might be useful in addition to standard tests.

Acetazolamide↗
PubMed1997

[Rhabdomyolysis in antiretroviral therapy with Lamivudin].

HISTORY AND CLINICAL FINDINGS: Six weeks after antiretroviral treatment with lamivudin (a nucleoside analogue) had been started (300 mg daily) in a 31-year-old man with AIDS developed pain and weakness in his muscles. On admission he had myalgia on pressure and movement as well as weakness of the entire body musculature, especially of the arms. The history and findings suggested bacterial or HIV-associated myositis. INVESTIGATIONS: Creatinekinase activity (4442 U/l) and myoglobin concentration (3250 micrograms/l) were greatly increased, while creatine (96 mumol/l) and C-reactive protein (22 mg/l) levels were only slightly raised. Serology was negative for acute and bacterial infections and autoimmune myositis. Magnetic resonance imaging and biopsy indicated marked rhabdomyolysis without myositis. DIAGNOSIS, TREATMENT AND COURSE: After excluding other causes, lamivudin and other drugs were discontinued, drug-induced rhabdomyolysis being suspected. This and the administration of prednisolone (100 mg daily) improved the symptoms. Creatinekinase activity and myoglobin level became normal within 14 days. On renewed administration of lamivudin creatinekinase and myoglobin concentrations in serum doubled to 180 U/l and 110 micrograms/l, respectively. Cessation of medication once again restored them to normal. CONCLUSION: Rhabdomyolysis is a serious but rare side effect of lamivudin treatment. Appropriate biochemical monitoring should therefore be undertaken when it is used in the treatment of HIV-positive patients.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The angiotensin AT2 receptor down-regulates neurofilament M in PC12W cells.

The angiotensin (ANG II) AT2 receptor mediates antiproliferative effects and induces neurite outgrowth in PC12W cells. To further investigate the molecular events following AT2 receptor stimulation in these cells, we determined the expression pattern of the middle-sized neurofilament subunit (NF-M) using Western and Northern blot analysis and reverse-transcription polymerase chain reaction. On both, the protein and the mRNA level, ANG II via AT2 receptors not only counteracted nerve growth factor (NGF)-mediated NF-M up-regulation but also reduced NF-M levels in the absence of NGF by maximally 72%. The ANG II-induced effects were completely abolished by pretreatment with the AT2 receptor antagonist, PD123177. In view of previous findings of decreased NF levels in regenerating neurons and in neuronal cultures undergoing apoptosis, our observation suggests a new role of AT2 receptors in either of these processes.

Angiotensin Receptor Antagonists↗
PubMed1997

[Perfusion-MRI in cerebral infarct].

PURPOSE: To investigate the hemodynamic changes in patients with acute cerebral stroke by perfusion MRI. MATERIAL AND METHODS: In 12 patients with acute stroke in the territory of the middle cerebral artery, perfusion MRI was performed. Peak time, mean transit time, regional cerebral blood volume and regional cerebral blood flow were calculated in the infarction, the peri-infarction area and the contralateral hemisphere. RESULTS: In the infarction the mean blood flow was 29 ml/100 g/min, compared to about 40 ml/100 g/min in the peri-infarction area and the contralateral hemisphere. In two patients increased cortical blood flow was found in the infarction due to luxury perfusion. The cerebral blood volume was reduced in the infarction, but significantly increased, to 7.3 ml/100 g, in the peri-infarction tissue. CONCLUSION: Perfusion MRI allows one to differentiate various patterns of perfusion disorders in patients with acute cerebral stroke. The resulting data may be helpful in describing the pathophysiologic mechanisms of compensation.

Acute Disease↗
PubMed1997

Hepatitis B and C in HIV-infected patients. Prevalence and prognostic value.

BACKGROUND/AIMS: There is only limited information on the prevalence and influence of coinfection with either hepatitis B or C on the clinical course in patients infected with the human immunodeficiency virus (HIV). METHODS: Follow-up was available in 232 HIV-infected patients (age 37+/-8 years, CD4 count 167+/-167 microl; 46% had AIDS). Samples were investigated for markers of HBV and HCV infection (HBsAg, HBeAg, HBV-DNA, Anti-HBs, anti-HBc, anti-HCV, HCV-RNA). RESULTS: 60/232 patients (23%) were anti-HCV positive. 78% of these sera were positive for HCV-RNA. 22/232 patients (9%) suffered from chronic HBV infection (HBsAg positive), 18/22 (82%) of these sera had detectable HBeAg and 19/22 (86%) HBV-DNA. Presence of HCV-RNA, HBeAg and amount of HBV-DNA were related to the degree of immunodeficiency. In contrast to the control group without HBV or HCV infection, patients infected with HIV and either HBV or HCV showed a direct correlation between a reduction in CD4 counts and decreased cholinesterase activity. In patients with AIDS, coinfection with HBV or HCV was associated with a reduced survival compared to controls (HBV: 212 days, 95%CI, 106-317; HCV: 267, 95%CI, 112-396; controls: 439 days, 95%CI, 364-513). CONCLUSIONS: Coinfection of HIV and HBV or HCV is frequently observed. Our results suggest that with prolonged survival of HIV-infected patients, coinfection with either HBV or HCV correlates with a reduced survival rate.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The role of angiotensin receptors in cardiovascular diseases.

As an antihypertensive regimen, angiotensin I-converting enzyme (ACE) inhibition appears to have an antiproliferative cardiovascular effect that is not caused by blood pressure reduction alone. On the other hand, ACE inhibition has been shown to induce neocapillarization in hypertrophied myocardium. The possible mechanisms behind these beneficial cardiovascular effects of ACE inhibition are the suppression of angiotensin II formation and the potentiation of bradykinin. Angiotensin II receptor antagonism appears to have a similar antiproliferative effect on myocardium and vascular smooth muscle as ACE inhibition. This suggests that the antiproliferative action of both regimens is due only to the reduction of the pressor and growth effects of angiotensin II, or that both regimens have an additional, similarly effective antiproliferative action. Recently, knowledge about angiotensin II receptors has almost exponentially expanded. The two main classes of angiotensin II receptors, type 1 and 2 (AT1 and AT2), have been shown to belong to the same receptor family. However, their signal transduction and function seem to differ totally. The function and signal transduction of AT1 are to a large extent known. All the well-known physiological and pathophysiological effects of angiotensin II have been attributed to AT1. On the other hand, AT2 has quite recently been shown to mediate antiproliferation and differentiation at least in some tissues and cells, e.g. in vascular endothelial cells and some cells of neuronal origin. This review highlights the recent findings on angiotensin II receptors, and discusses the mechanisms behind the beneficial cardiovascular effects of interfering with the renin-angiotensin system.

Animals↗
PubMed1997

[Coinfection of hepatitis B and C in HIV-infected patients].

There is only limited information on the prevalence and influence of coinfection with either hepatitis B or C on the clinical course in patients infected with the human immunodeficiency virus (HIV). Samples of 232 HIV infected patients were investigated for markers of HBV and HCV infection (HBsAg, HBeAg, Anti-HBs, anti-HBc, anti-HCV, HCV-RNA). 60/232 patients (23%) were anti-HCV positive. 78% of these sera were positive for HCV-RNA. 22/232 patients (9%) suffered from chronic HBV-infection (HBsAg positive), 18/22 (82%) of these sera had detectable HBeAg. Presence of HCV-RNA, HBeAg was related to the degree of immunodeficiency. In patients with AIDS coinfection with HBV or HCV was associated with a reduced survival compared to controls (HBV: 212 days, 95% CI, 106 to 317; HCV: 267, 95% CI, 112 to 396; controls: 439 days, 95% CI, 364 to 513). Coinfection of HIV and HBV or HCV is frequently observed. Our results suggest that in HIV-infected patients with AIDS coinfection with either HBV or HCV was associated with a reduced survival rate.

AIDS-Related Opportunistic Infections↗