Biomedical subjects

M Zimmermann

Publications and source records attributed to M Zimmermann.

At least 109 records · Page 6Linked to original sources

PubMed2000

Persistence of goiter despite oral iodine supplementation in goitrous children with iron deficiency anemia in Côte d'Ivoire.

BACKGROUND: In developing countries, many children are at high risk of goiter and iron deficiency anemia. Because iron deficiency can have adverse effects on thyroid metabolism, iron deficiency may influence the response to supplemental iodine in areas of endemic goiter. OBJECTIVE: The aim of this study was to determine whether goitrous children with iron deficiency anemia would respond to oral iodine supplementation. DESIGN: A trial of oral iodine supplementation was carried out in an area of endemic goiter in western Côte d'Ivoire in goitrous children (n = 109) aged 6-12 y. Group 1 (n = 53) consisted of goitrous children who were not anemic. Group 2 (n = 56) consisted of goitrous children who had iron deficiency anemia. At baseline, thyroid gland volume and urinary iodine, thyrotropin, and thyroxine were measured by using ultrasound. Each child received 200 mg I orally and was observed for 30 wk, during which urinary iodine, thyrotropin, thyroxine, hemoglobin, and thyroid gland volume were measured. RESULTS: The prevalence of goiter at 30 wk was 12% in group 1 and 64% in group 2. The mean percentage change from baseline in thyroid volume 30 wk after administration of oral iodine was -45.1% in group 1 and -21.8% in group 2 (P < 0.001). Among the anemic children, there was a strong correlation between the percentage decrease in thyroid volume and hemoglobin concentration (r(2) = 0.65). CONCLUSION: The therapeutic response to oral iodine was impaired in goitrous children with iron deficiency anemia, suggesting that the presence of iron deficiency anemia in children limits the effectiveness of iodine intervention programs.

Administration, Oral↗

PubMed2000

Iron supplementation in goitrous, iron-deficient children improves their response to oral iodized oil.

OBJECTIVE: In developing countries, many children are at high risk for both goiter and iron-deficiency anemia. Because iron deficiency may impair thyroid metabolism, the aim of this study was to determine if iron supplementation improves the response to oral iodine in goitrous, iron-deficient anemic children. DESIGN: A trial of oral iodized oil followed by oral iron supplementation in an area of endemic goiter in the western Ivory Coast. METHODS: Goitrous, iodine-deficient children (aged 6-12 years; n=109) were divided into two groups: Group 1 consisted of goitrous children who were not anemic; Group 2 consisted of goitrous children who were iron-deficient anemic. Both groups were given 200mg oral iodine as iodized oil. Thyroid gland volume using ultrasound, urinary iodine concentration (UI), serum thyroxine (T(4)) and whole blood TSH were measured at baseline, and at 1, 5, 10, 15 and 30 weeks post intervention. Beginning at 30 weeks, the anemic group was given 60mg oral iron as ferrous sulfate four times/week for 12 weeks. At 50 and 65 weeks after oral iodine (8 and 23 weeks after completing iron supplementation), UI, TSH, T(4) and thyroid volume were remeasured. RESULTS: The prevalence of goiter at 30 weeks after oral iodine in Groups 1 and 2 was 12% and 64% respectively. Mean percent change in thyroid volume compared with baseline at 30 weeks in Groups 1 and 2 was -45.1% and -21.8% respectively (P<0.001 between groups). After iron supplementation in Group 2, there was a further decrease in mean thyroid volume from baseline in the anemic children (-34.8% and -38.4% at 50 and 65 weeks) and goiter prevalence fell to 31% and 20% at 50 and 65 weeks. CONCLUSION: Iron supplementation may improve the efficacy of oral iodized oil in goitrous children with iron-deficiency anemia.

Administration, Oral↗

PubMed2000

Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency.

OBJECTIVES: In 1994, WHO/International Council for the Control of Iodine Deficiency Disorders recommended replacing the WHO 1960 four-grade goiter classification with a simplified two-grade system. The effect of this change in criteria on the estimation of goiter prevalence in field studies is unclear. In areas of mild iodine deficiency disorders (IDD) where goiters are small, ultrasound is preferable to palpation to estimate goiter prevalence. However, in areas of moderate to severe IDD, goiter screening by palpation may be an acceptable alternative to thyroid ultrasound. To address these two issues, we compared WHO 1960 and 1994 criteria with thyroid ultrasound for determination of goiter prevalence in areas of mild and severe IDD in Morocco. DESIGN: A cross-sectional study of 400 six- to 13-year-old children from two mountain villages (Ait M'hamed and Brikcha) in rural Morocco was carried out. METHODS: Urinary iodine concentration (UI), whole blood TSH and serum thyroxine were measured. Thyroid size was graded by inspection and palpation by two examiners using both WHO 1960 and 1994 criteria. Thyroid volume was determined by ultrasound. Variation between examiners and examination methods was assessed. Sensitivity and specificity of the two classification systems compared with ultrasound were calculated. RESULTS: Median UIs in Aït M'hamed and Brikcha were 183 and 24 microg/l respectively. In Ait M'hamed, using 1960 and 1994 criteria, goiter prevalence was 21 and 26% respectively, compared with 13% by ultrasound. In Brikcha, with 1960 and 1994 criteria, goiter prevalence was 64 and 67% respectively, compared with 64% by ultrasound. Agreement between observers was better with the 1994 criteria than with the 1960 criteria in Ait M'hamed (kappa=0.53 and 0.47 respectively), while in Brikcha observer agreement was similar with the two systems (kappa=0.67). Using either the 1994 or 1960 criteria, agreement with ultrasound was only moderate in Ait M'hamed (kappa=0.41-0.44), but good in Brikcha (kappa=0.55-0.64). Overall, compared with ultrasound, sensitivity increased 3-4% using 1994 criteria, while specificity decreased 4-5%. CONCLUSIONS: The WHO 1994 criteria are simpler to use than the 1960 criteria and provide increased sensitivity with only a small reduction in specificity. Agreement between observers is better with the 1994 criteria than with the 1960 criteria, particularly in areas of mild IDD. Like the 1960 criteria, the 1994 criteria overestimate goiter prevalence in areas of mild IDD, compared with ultrasound. However, the 1994 palpation criteria provide an accurate estimate of goiter prevalence in areas of severe IDD, and may be an acceptable and affordable alternative to thyroid ultrasound in these areas.

Adolescent↗

PubMed2000

[Life and work of the surgeon Ernst von Bergmann (1836-1907), long-term editor of the "Zentralblatt für Chirurgie"].

Ernst von Bergmann (* December 16, 1836 at Riga- [symbol: see text] March 25, 1907 at Wiesbaden) was one of the most famous and successful surgeons in Europe at the end of the 19th century. Having passed his medical education at the University of Dorpat/Latvia he did his doctorate on a pharmacological subject and habilitated as a young assistant already in 1863 with a well-founded experimental study on animals to the question of fat embolism. The voluntary participation as medical officer in three wars (1866, 1870/71, 1877/78) gave him the qualification to express important logistic conditions for the case of vast numbers of wounded soldiers, to demand an increased deployment of better trained ancillary and nursing staff as well as to establish a modified procedure for the treatment of gunshot wounds, particulary of the joints and the skull. In his position as regular professor and head of the surgical department at the Universities of Dorpat (1871-1878), Würzburg (1878-1882) and Berlin (1882-1907) he redressed quickly architectural and infrastructural mismanagements despite of complex obstacles, spoke up for a diversified education of the students he has been entrusted with, supported untiringly the career path of his collaborators and published a huge number of internationally approved scientific articles. In addition to his very time-consuming clinical activities, which even took him to the highest social classes, von Bergmann became initiator of the surgical asepsis and developed operative methods valid up to this day in traumatology, abdominal, tumour and, above all, in neurological surgery. Being member or chairman of different medical associations and editor of prestigious periodicals, he started an effective post-graduate training for interested colleagues and arranged the first qualified exhaustive rescue service in the German capital.

General Surgery↗

PubMed2000

Low dose oral iodized oil for control of iodine deficiency in children.

In areas where iodized salt is not available, oral iodized oil is often used to correct I deficiency despite a lack of consensus on the optimal dose or duration of effect, particularly in children, a main target group. Annual doses ranging from 400 to 1000 mg have been advocated for school-age children. Because lower doses of iodized oil have been shown to be effective in treating I deficiency in adults, the aim of this study was to evaluate the efficacy and safety of a low dose of oral iodized oil in goitrous I-deficient children. Goitrous children (n 104, mean age 8.4 years, range 6-12 years, 47% female) received 0.4 ml oral iodized poppyseed-oil containing 200 mg I. Baseline measurements included I in spot urines (UI), serum thyroxine (T4), whole blood thyroid-stimulating hormone (TSH), and thyroid-gland volume using ultrasound. At 1, 5, 10, 15, 30 and 50 weeks post-intervention, UI, TSH and T4 were measured. At 10, 15, 30 and 50 weeks, thyroid-gland volume was remeasured. At 30 and 50 weeks the mean percentage change in thyroid volume from baseline was -35% and -41% respectively. The goitre rate fell to 38% at 30 weeks and 17% at 50 weeks. No child showed signs of I-induced hypo- or hyperthyroidism. UI remained significantly increased above baseline for the entire year (P < 0.001); the median UI at 50 weeks was 97 micrograms/l, at the World Health Organization cut-off value (100 micrograms/l) for I-deficiency disorders risk. In this group of goitrous children, an oral dose of 200 mg I as Lipiodol (Guerbert, Roissy CdG Cedex, France) was safe and effective for treating goitre and maintaining normal I status for at least 1 year.

Child↗

PubMed1999

Improved treatment results in childhood B-cell neoplasms with tailored intensification of therapy: A report of the Berlin-Frankfurt-Münster Group Trial NHL-BFM 90.

In study NHL-BFM 90, we investigated whether the serum lactate dehydrogenase (LDH) concentration and early response are useful markers for stratification of therapy for childhood B-cell neoplasms in addition to stage, if the outcome of patients with abdominal stage III and LDH >/=500 U/L can be improved by high-dose (HD) methotrexate (MTX) at 5 g/m(2) instead of intermediate-dose (ID) MTX at 500 mg/m(2) in the preceding study 86; whether 2 therapy courses are enough for patients with complete resection; and whether combined systemic and intraventricular chemotherapy is efficacious for central nervous system-positive (CNS(+)) patients. After a cytoreductive prephase, treatment was stratified into 3 risk groups: patients in R1 (completely resected) received 2 5-day courses (ID-MTX, dexamethasone, oxazaphorins, etoposide, cytarabine, doxorubicin, and intrathecal therapy), patients in R2 (extra-abdominal primary only or abdominal tumor and LDH <500 U/L) received 4 courses containing HD-MTX, and patients in R3 (abdominal primary and LDH >/=500 U/L or bone marrow/CNS/multilocal bone disease) received 6 courses. Incomplete responders after 2 courses received an intensification containing HD-cytarabine/etoposide. Patients with no or necrotic tumor thereafter received 3 more courses; 6 patients with viable tumor received autologous bone marrow transplantation. From April 1990 through March 1995, 413 evaluable patients were enrolled (R1, 17%; R2, 40%; and R3, 43%). The 6-year event-free survival (pEFS) was 89% +/- 2% for all and 100%, 96% +/-2%, and 78% +/- 3% in R1, R2, and R3, respectively. The pEFS of patients with abdominal stage III and LDH >/=500 U/L was 81% +/- 4% as compared with 43% +/- 10% in study 86. Of 26 CNS(+) patients, 5 died early, but only 3 relapsed.

Adolescent↗

PubMed1999

Biosynthesis of phytochelatins in the fission yeast. Phytochelatin synthesis: a second role for the glutathione synthetase gene of Schizosaccharomyces pombe.

By complementation screening of a cadmium-sensitive Schizosaccharomyces pombe mutant deficient in phytochelatin synthesis, but with 44% of the wild-type glutathione content, we cloned a DNA fragment involved in phytochelatin synthesis. Sequence analysis revealed that it encodes the second enzyme involved in glutathione (GSH) biosynthesis, glutathione synthetase (GSH2) (E.C.6.3.2.3, Wang and Oliver, 1997). The mutant allele shows a single base-pair exchange at the 3' end of the reading frame leading to a single amino acid change from glycine to aspartate. This mutation leads to a significant reduction of phytochelatin synthesis, whereas glutathione synthesis is impaired to a far lesser extent. Complementation with the Arabidopsis thaliana GSH2 cDNA led to a partial restoration of phytochelatin synthesis. These data strongly suggest that the GSH2 gene encodes a bifunctional enzyme that is able to catalyse both the synthesis of GSH by adding glycine to the dipeptide (gammaGlu-Cys) and the synthesis of phytochelatins. The sequence has been submitted to EMBL, Accession No. Y08414.

Alleles↗

PubMed1999

Open MRI-guided neurosurgery.

OBJECTIVES: A number of different image-guided surgical techniques have been developed during the past decade. None of these methods can provide the surgeon with information about the dynamic changes that occur intra-operatively. MATERIAL AND METHOD: The first vertical open 0.5T MRI-scanner for intra-operative MRI-guided neurosurgery in Germany was installed at the University of Leipzig during the summer 1996. Since autumn 1996 a number of surgical procedures including biopsies (n = 31), craniotomies (n = 32), transsphenoidal procedures (n = 8) and interstitial lasertherapies (n = 3) have been performed using intra-operative MR image guidance. RESULTS: The development of MR-compatible and MR-safe non-magnetic instruments and components had to be solved. Specific surgical instruments were developed to perform biopsies, craniotomies, microsurgical tumour resections and transsphenoidal procedures in the 0.5-T open MRI. Several components required adaptation including the head holder the stereotactic navigation device, the high speed drill, the suction unit, the ultrasonic aspirator, the bipolar coagulation, the laser probe and the surgical microscope. All these newly developed technical features enable the neurosurgeon to perform a large number of surgical procedures under direct control and guidance of intra-operative MR imaging. In contrast to frame-based for framless navigation systems, intra-operative MRI provides accurate and immediate information during the progress of surgery. These intra-operative images allow definitive localization and targeting of the lesions and accommodate anatomical changes that may occur during surgery. CONCLUSION: Intra-operative MRI is helpful for navigation as well as determining of tumour margins to achieve a complete and safe resection of intracranial lesions. Complications related to the surgical procedure are reduced and the risk of neurological deterioration due to tumour removal and postoperative complications is minimized. It can be concluded that the intra-operative application of interventional MRI technology may represent a major step forward in the field of neurosurgery.

Biopsy↗

PubMed1999

Cerebellopontine angle lipoma: case report and review of the literature.

Intracranial lipomas located in the cerebellopontine angle are extremely rare. These tumours are mal-developmental lesions which can cause slowly progressive neurological symptoms. The clinical management of these tumours differs significantly from other lesions in this region. A 27 year old woman presented with a 2-month history of vertigo and a slowly progressive deterioration of hearing in the left ear. Computed tomography (CT) revealed a large low-density mass in the left cerebellopontine angle without any contrast-enhancement. In T1-weighted magnetic resonance imaging (MRI) the lesion was hyper-intense and did not enhance after application of gadolinium. Areas of lower signal intensity inside of the lesion were suggested as incorporated cranial nerves. A left retro-sigmoidal approach in a semi-sitting position was chosen to expose the tumour. After reducing the tumour mass, the tumour was dissected from the cranial nerves which were incorporated into the tumour. The residual tumour was adherent to the brain stem and the encased lower cranial nerves, allowing only a near subtotal resection of the highly vascularized tumour in order to avoid neurological deficits. The histological examination revealed a lipoma. Attempts at complete removal of cerebellopontine angle lipomas usually result in severe neurological deficits. Conservative treatment should therefore be preferred. Limited surgery is indicated if the patients suffer from disabling neurological symptoms and signs e.g., vertigo, nausea, trigeminal neuralgia, facial weakness or facial spasm.

Adult↗

PubMed1999

Myelodysplastic syndrome, juvenile myelomonocytic leukemia, and acute myeloid leukemia associated with complete or partial monosomy 7. European Working Group on MDS in Childhood (EWOG-MDS).

We reviewed the clinical features, treatment, and outcome of 100 children with myelodysplastic syndrome (MDS), juvenile myelomonocytic leukemia (JMML), and acute myeloid leukemia (AML) associated with complete monosomy 7 (-7) or deletion of the long arm of chromosome 7 (7q-). Patients with therapy-induced disease were excluded. The morphologic diagnoses according to modified FAB criteria were: MDS in 72 (refractory anemia (RA) in 11, RA with excess of blasts (RAEB) in eight, RAEB in transformation (RAEB-T) in 10, JMML in 43), and AML in 28. The median age at presentation was 2.8 years (range 2 months to 15 years), being lowest in JMML (1.1 year). Loss of chromosome 7 as the sole cytogenetic abnormality was observed in 75% of those with MDS compared with 32% of those with AML. Predisposing conditions (including familial MDS/AML) were found in 20%. Three-year survival was 82% in RA, 63% in RAEB, 45% in JMML, 34% in AML, and 8% in RAEB-T. Children with -7 alone had a superior survival than those with other cytogenetic abnormalities: this was solely due to a better survival in MDS (3-year survival 56 vs 24%). The reverse was found in AML (3-year survival 13% in -7 alone vs 44% in other cytogenetic groups). Stable disease for several years was documented in more than half the patients with RA or RAEB. Patients with RA, RAEB or JMML treated with bone marrow transplantation (BMT) without prior chemotherapy had a 3-year survival of 73%. The morphologic diagnosis was the strongest prognostic factor. Only patients with a diagnosis of JMML fitted what has previously been referred to as the monosomy 7 syndrome. Our data give no support to the concept of monosomy 7 as a distinct syndrome.

Acute Disease↗

PubMed1999

Definition of a standard-risk group in children with AML.

To define paediatric AML patients with a favourable outcome in order to design a risk-adapted therapy, we analysed 489 children under 17 years of age treated similarly in studies AML-BFM 83 and 87. 369 patients (75.4%) achieved remission. Estimated probabilities of survival, event-free survival (EFS) and disease-free survival (DFS) at 5 years were 50% (SE 2%), 43% (SE 2%) and 58% (SE 3%), respectively. Multivariate analysis revealed bone marrow blasts on day 15, morphologically defined risk groups and hyperleucocytosis to be of prognostic value. EFS at 5 years estimated for patients with < or = 5% and >5% blasts on day 15 were 56% (SE 3%) v 27% (SE 4%); for the favourable morphological subgroups (M1/M2 with Auer rods, M3 and M4eo) it was 60% (SE 4%) compared with other patients (33%, SE 3%), P (Kaplan-Meier) = 0.0001 each. Hyperleucocytosis proved to be an independent prognostic factor, indicating a high risk, especially for early failure. The specific karyotypes t(8;21), t(15;17) and inv16 were closely related to the favourable morphology and outcome was in the same range. We conclude that for the definition of a standard-risk group a combination of morphological and response criteria may be sufficient. The standard-risk group defined by favourable morphology and a blast cell reduction on day 15 (not required for M3) comprises 31% of all patients, P survival, pEFS and pDFS at 5 years were 73% (SE 4%), 68% (SE 5%) and 76% (SE 4%), respectively.

Acute Disease↗

PubMed1999

Serum S-100B protein in severe head injury.

OBJECTIVE: Despite the significant recent progress in cerebral monitoring, it is still difficult to quantify the extent of primary brain injury and ongoing secondary damage after head injury. The objective of our study was to investigate S-100B protein as a serum marker of brain damage after severe head injury. METHODS: Eighty-four patients with severe head injury (Glasgow Coma Scale score < or =8) were included in this prospective study. Venous blood samples for S-100B protein were obtained as soon as possible after admission and every 24 hours thereafter, for a maximum of 10 consecutive days. Serum levels of S-100B protein were compared with outcome after 6 months, clinical variables, and the category of the Marshall classification of initial computed tomographic findings. RESULTS: Patients who died had significantly higher serum S-100B values compared with those who survived (median, 2.7 microg/L versus 0.54 microg/L; P < 0.0001, Mann-Whitney U test). Nineteen (58%) of 33 patients who died had peak S-100B values of 2 microg/L or higher, compared with 4 (8%) of the 51 surviving patients (P < 0.0005, Fisher's exact test). There was also a strong correlation between S-100B values and computed tomographic findings. Logistic regression analysis in a model with age, Glasgow Coma Scale score, intracranial pressure, and computed tomographic findings revealed S-100B as an independent predictor of outcome. Persistent elevation of S-100B levels for 2 to 6 days, even in patients with favorable outcome, may reflect ongoing secondary damage after severe head injury. CONCLUSION: S-100B may be a promising serum marker for assessing the extent of primary injury and the time course of secondary damage after severe head injury.

Adolescent↗

PubMed1999

Association between nonreentrant supraventricular tachycardia and atrioventricular node reentrant tachycardia: a presentation of dual AV node physiology.

Persistent simultaneous conduction of P waves over a fast and a slow nodal pathway defines the nonreentrant type of supraventricular tachycardia, usually not associated with reciprocating movements. We report a unique association between this uncommon tachycardia and a usual AV nodal reentrant tachycardia, made possible by the existence of three different nodal pathways.

Atrioventricular Node↗

PubMed1999

Differential induction of proto-oncogene expression and cell death in ocular tissues following ultraviolet irradiation of the rat eye.

BACKGROUND/AIMS: Ultraviolet (UV) irradiation of mammalian cells in culture evokes the transcriptional activation of different proto-oncogenes, among them members of the fos/jun family which are known to play an important role in cell proliferation and differentiation. To investigate in vivo UV induced proto-oncogene expression of irradiated ocular cells, the expression of JunB, JunD, and Egr-1 was analysed in the cornea, lens, and retina. Furthermore, UV radiation is known to induce pleiotrophic events in irradiated cells which include growth arrest, inflammation, and even cell death. In order to determine the type of cell death--for example, apoptosis versus necrosis, sections of UV irradiated rat eyes were further examined for distinct ultrastructural morphology of cell death and DNA fragmentation. METHODS: Eyes of anaesthetised rats were exposed to 1.5 J/cm2 of ultraviolet radiation (280-380 nm). Animals were perfused 6 and 16 hours after irradiation and tissue sections of enucleated bulbi were processed for light and electron microscopy. RESULTS: Under control conditions, Jun B was constitutively expressed in numerous superficial cells but also in scattered basal cells of the corneal epithelium. After UV exposure JunB expression was massively upregulated in many cells of the basal cell layers of the corneal epithelium, although during the entire experiment, both the corneal stroma and endothelium were JunB negative. In contrast, Egr-1 was expressed exclusively in lens epithelium showing only a faint expression pattern under control conditions. However, Egr-1 expression increased after UV exposure, so that many Egr-1 positive cells of the lens epithelium could be found several hours after UV illumination. JunD was expressed in single cells of both the ganglion cell layer and the inner nuclear layer of the retina, a pattern of expression which did not change after UV exposure. Regarding the type of cell death, features of apoptosis were only occasionally present in scattered superficial cells of the corneal epithelium of control eyes. After UV exposure, however, morphological signs of apoptosis and TUNEL positive cells were visible both in the stroma and epithelium of the rat cornea. In contrast, UV irradiated lens epithelial cells exhibited features typical of necrosis. The corneal endothelium and the retina did not show any indications of morphological changes indicative of cell death after UV irradiation. CONCLUSION: Each proto-oncogene encoded protein was found to be expressed in a tissue specific manner and UV irradiation differentially modulates the expression pattern of these transcriptional regulatory proteins. This temporospatial expression pattern of these proteins is accompanied by two morphologically distinct types of cell death in the cornea and lens after UV irradiation.

Animals↗

PubMed1999

Endotoxin adsorbent based on immobilized human serum albumin.

Extracorporeal apheresis of endotoxins and pro-inflammatory cytokines is still a therapeutic option in the early hyper-inflammatory phase of gram-negative sepsis. There is therefore ongoing interest in adsorber materials suitable for that kind of clinical application. Here we describe lipopolysaccharide (LPS) and cytokine adsorption characteristics of a new adsorbent based on purified human serum albumin (HSA) covalently linked to macroporous polymer beads (iHSA). Multipoint attachment of HSA to acrylic beads via carboxyl groups of the protein resulted in an increased affinity to LPS. In adsorption experiments (adsorbent/ plasma ratio 1:3) a 70-80% reduction of limulus amoebocyte lysate (LAL) activity from 8.59+/-2.07 EU/ml (mean+/-SD) to 1.82+/-0.77 EU/ml (S. abortus equi; n=40) (p < 0.001) and from 115.13+/-53.76 EU/ml to 17.70+/-11.68 EU/ml (E. coli F583; n=6) (p < 0.01) was achieved. iHSA-purified plasma samples showed a decreased capability of inducing cytokine release from peripheral monocytes. Direct haemoperfusion of LPS pre-stimulated whole blood over iHSA resulted in decreased tumour necrosis factor alpha (TNFalpha) concentrations (30-40% reduction) whereas induced levels of interleukin (IL)-1beta and IL-6 were not affected. Depending on the means of immobilization, iHSA shows higher affinity for LPS than native albumin present in plasma. We demonstrated an efficient removal of LPS from plasma in vitro. Adsorption over immobilized HSA appears to be a simple and effective means of removing LPS and perhaps pro-inflammatory cytokines from the circulation.

Adsorption↗

PubMed1999

Expression of the C-kit receptor (CD117) is a feature of almost all subtypes of de novo acute myeloblastic leukemia (AML), including cytogenetically good-risk AML, and lacks prognostic significance.

Because of conflicting reports on the prognosis of patients with c-kit receptor positive AML and lacking correlations with cytogenetic analyses, we prospectively evaluated the c-kit receptor expression in 917 AML patients (750 adult patients; 167 children) using flow cytometry and compared the results to the immunophenotype, morphological and cytogenetic findings as well as clinical outcome. Expression of the c-kit receptor was present in 63% of all AML investigated. Among these an immature immunophenotype was more frequent and 30% had a CD34+/CD15- and 37% a CD34+/CD14- phenotype, whereas only 9% and 10% showed these phenotypes in the c-kit receptor negative group, respectively. C-kit receptor expression ranged average in M0 and M1 subtypes (69% versus 70%) but was less pronounced among M5 subtypes (21%). Results of karyotyping were available in 280 patients. C-kit receptor expression occurred in 37 of 42 (88%) patients with favorable cytogenetic abnormalities such as t(8;21), t(15;17) or inv(16) which exceeded the expression rate in patients with intermediate risk, poor risk or other abnormalities. Information about the clinical outcome was available in 228 patients treated according to the protocols of two German multicenter trials (AML-BFM, AMLCG). We found no difference of CR-rate or event-free survival (EFS) in adults with or without c-kit receptor expression. Children with c-kit receptor negative AML had a lower CR-rate and EFS, but also a lower median age and a higher frequency of M5 subtype as compared to children with c-kit receptor expression. In conclusion, analysis of c-kit receptor expression may help to identify phenotypically immature AML but fails to identify myeloid differentiation of leukemic blasts in approximately one third of patients. We found no evidence of an adverse prognosis in AML patients with c-kit receptor expression. Analysis for c-kit receptor expression does not appear to add information to established prognostic parameters in AML.

Adolescent↗

PubMed1999

[Determinations in the applications for a medical rehabilitation--screening of blue color workers in the statutory pension insurance in Schleswig-Holstein].

During the first 6 months of 1997 the number of applications for medical rehabilitation measures dropped markedly by 50% compared with the number in the previous year. To clarify the reasons for this decline the regional statutory pension fund of blue collar workers in Schleswig-Holstein (LVA) and the Institute for Social Medicine, Medical University Lübeck initiated a survey among 4400 blue collar workers (2% of the LVA population aged of 40-59 years). Between November 1997 and January 1998 a postal survey inquired of the perceived need for rehabilitation and various criteria influencing the decision to apply for such a measure. After two months the response rate was 64%. A quarter of the workers answering considered themselves in need of rehabilitation. Of those 41% intended to file an application, 34% intended not to do so and 25% were undecided. The main reasons for supporting an application were encouragement by the GP and family members as well as the hope to improve working capacity. The decision against applying for rehabilitation was evoked by consequences of the recent legislation (WFG), job uncertainty and the public debate about the rehabilitation system in Germany.

Adult↗

PubMed1999

[Subjective need for rehabilitation, intention to apply and application for medical rehabilitation--results of a survey of federal insurance office].

The survey "Determinants in Applying for Medical Rehabilitation" intended to examine the interest of using rehabilitation services among workers in need of rehabilitation and clarify the reasons for the decline in applications for rehabilitation since 1995. For this reason 4400 blue collar workers of the regional pension fund (2% of the LVA population aged 40-59 years) were asked with a postal questionnaire. The response rate was 64%. In order to ensure the validity of the intentions stated, the pension fund verified how many workers actually filed an application for medical rehabilitation during the following twelve months. A quarter of the workers answering considered themselves in need for rehabilitation. Of these, 41% intended to file an application, 34% intended not to do so and 25% were undecided. The main reasons for intending to apply were encouragement by the GP and family members as well as the expectation of improving the working capacity. After one year, only 11% of the workers who claimed themselves to be in need for rehabilitation had filed an application for rehabilitation. This low number of applications from workers in subjective need for rehabilitation indicates a deficit in medical rehabilitation provision.

Adult↗