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Biomedical subjects

P Bartmann

Publications and source records attributed to P Bartmann.

At least 73 records · Page 4Linked to original sources
PubMed1994

Interleukin-6: a sensitive parameter for the early diagnosis of neonatal bacterial infection.

OBJECTIVE: Early recognition is important for the successful treatment and outcome of neonatal infections. As interleukin-6 (Il-6) plays a critical role in the induction of C-reactive protein (CRP) synthesis in the liver, it was hypothesized that this cytokine could be detected earlier in blood than the CRP during the course of bacterial infection. DESIGN: In a prospective study of 298 newborns who were admitted to the nursery unit, CRP levels, blood cell count with differential, and Il-6 levels were determined at the time of admission and 24 hours after admission. Seventy-six newborns were excluded from the study because of incomplete or incorrect blood sampling. RESULTS: The remaining 222 newborns were assigned to one of five groups: 11 newborns with blood culture-positive sepsis (sensitivity of Il-6 on admission 73%), 15 newborns with clinical sepsis (sensitivity of Il-6 on admission 87%), 41 newborns with infection (sensitivity of Il-6 on admission 68%), and 54 newborns without clinical and laboratory evidence of infection (specificity 78%). The remaining 101 newborns were defined as a mixed group because the diagnosis of neonatal infection could not clearly be made. Seventy-five percent of infected newborns had negative Il-6 levels 24 hours after admission. Of the 18 infected newborns with negative Il-6 levels on admission, 10 newborns had elevated CRP levels, suggesting that Il-6 was already negative because of the short half-life of Il-6. Sensitivity of Il-6 in CRP-negative newborns on admission was 100% in newborns with blood culture-positive and clinical sepsis. Il-6 was more sensitive than CRP in infected newborns on admission (73% vs 58%). CONCLUSION: Il-6 is a sensitive parameter for diagnosing neonatal bacterial infection. The combination of CRP and Il-6 seems to be the ideal tool for the early diagnosis of neonatal infection.

Bacterial Infections↗
PubMed1993

Rapid increase of blood pressure in extremely low birth weight infants after a single dose of dexamethasone.

Blood pressure was retrospectively studied in all 22 extremely low birth weight infants (ELBW) (birth weight median 720 g, range 450-1020 g) who were admitted between July 1989 and October 1991 and received dexamethasone on days 2-25 (median 10) because of bronchopulmonary dysplasia or since lung function had not improved after installation of bovine surfactant. The average blood pressure during the 4 h before dexamethasone increased significantly (median individual increase 8 mmHg, P = 0.0005) until 8-12h thereafter. In addition to the lung disease, ten infants showed severe arterial hypotension with prolonged capillary refilling time ( > 3s) and oliguria and needed continuous infusion of epinephrine to increase blood pressure and urinary flow after treatment with colloids, dopamine and dobutamine had proved ineffective. Epinephrine infusion could be stopped in eight infants 8 h after dexamethasone administration. In ELBW infants blood pressure rose 8-12 h after a single dose of 0.25 mg/kg dexamethasone. In ELBW infants suffering from arterial hypotension who do not respond to infusion of colloids and catecholamines, dexamethasone may represent a new therapeutic tool.

Blood Pressure↗
PubMed1993

Antiretroviral therapy in sporadic adult amyotrophic lateral sclerosis.

Clinical and experimental findings in idiopathic amyothrophic lateral sclerosis (ALS) would be compatible with a retroviral involvement. In 35 adult patients with non-familial ALS we observed elevated circulating immune complexes, a decrease in IgG3 isotype and enzyme-linked sorbent assay (ELISA) serum antibodies against human spuma retrovirus (HSRV), confirmed by specific human foamy virus immunoblots. All 35 were negative for IgM or relevant IgG anti-ganglioside antibodies. We treated 12 HIV-negative, immune-complex-positive ALS patients with 500 mg d-1 zidovudine p.o. over 2-10 months and found reductions of serum creatine kinase and circulating immune complexes from two days to two weeks after the beginning of medication.

Adult↗
PubMed1993

[Amyotrophic lateral sclerosis--indications of increased antiretroviral seroreactivity without obvious epidemiology].

Of 25 male and 13 female patients diagnosed as sporadic cases of amyotrophic lateral sclerosis between 1989 and 1992, 17 had reproducible serum antibodies against human foamy virus (HFV = human spuma retrovirus, HSRV). HFV-positive ALS patients had higher IgG3 concentrations than HFV-negatives (P < 0.05) and competed better on maedi-visna retroviral antigen than HFV-negatives or controls (P < 0.05), but did not differ otherwise. Two HFV-positive patients were living in the same building; two other ALS patients lived within 300 m of one another, and three HFV gag reactive men (2 ALS, 1 control) were living in neighbouring villages. These were the closest geographic clusters found among current patients. We summarize recent findings compatible with a pathogenetic role for endogenous and/or exogenous retroviral sequences in adult motor neuron disease, and confirm a male preponderance as well as an inverse correlation between survival time and age at onset.

Adult↗
PubMed1992

Early treatment of respiratory distress syndrome with bovine surfactant in very preterm infants: a multicenter controlled clinical trial.

OBJECTIVE: To determine the effect of bovine surfactant (SF-RI 1, Alveofact) administered during the first hour following birth to very premature infants [gestational age (GA), 25-30 weeks] in a multicenter, controlled trial. HYPOTHESIS: Survival without bronchopulmonary dysplasia (BPD; definition: ventilator dependency or FiO2 greater than 0.3 during spontaneous respiration) at day 28 is increased in surfactant-treated infants (sequential analysis). PATIENTS AND METHODS: Thirty-four infants [GA 28.0 +/- 1.5 SD weeks, birth weight (BW), 1,048 +/- 299 g] received 50 mg/kg BW surfactant, whereas 35 infants (GA, 27.6 +/- 1.5 weeks, BW 969 +/- 269 g) served as controls. Retreatment with surfactant (up to three identical doses) 12-24 hours after the previous dose was permitted if FiO2 was greater than 0.5. RESULTS: Survival without BPD was significantly higher in surfactant treated infants (26/34) compared to controls (14/35; P = 0.003), but in the incidence of pulmonary air leaks, patent ductus arteriosus, intracranial hemorrhage, and nosocomial infections they were not different. CONCLUSION: Bovine surfactant treatment improves survival without BPD in very premature infants at risk for neonatal respiratory distress syndrome (RDS).

Bacteria↗
PubMed1992

Plesiomonas shigelloides sepsis and meningoencephalitis in a neonate.

A newborn infant is described who presented with septicaemia and meningoencephalitis caused by Plesiomonas shigelloides, a Gram-negative rod belonging to the family Vibrionaceae. The patient in this case, the first to be documented in Europe, developed multilocular lysis of the brain despite immediate treatment with antibiotics active in vitro. A cranial CT revealed garland-like calcifications and a large amount of medullary necrosis was seen on MRI.

Bacteremia↗
PubMed1992

Immunogenicity and immunomodulatory activity of bovine surfactant (SF-RI 1).

Respiratory distress syndrome in preterm infants can be treated successfully by endotracheal administration of a bovine surfactant preparation (SF-RI 1). Before the routine use of xenogenic surfactant preparations can be recommended, their immunogenicity as well as their in-vivo and in-vitro immunomodulatory activity have to be investigated. High titers of anti-surfactant antibodies were detected by a sensitive ELISA after immunizing rats, rabbits and mice with SF-RI 1. Repeated endotracheal administration of SF-RI 1 resulted in a humoral antibody response in three out of eight rabbits. After treatment of 34 preterm infants with SF-RI 1 (50-200 mg/kg), a humoral immune response to SF-RI 1 could not be detected. In-vitro restimulation of peripheral blood lymphocytes with SF-RI 1 after primary in-vivo administration did not result in cell proliferation as measured by 3H-thymidine incorporation. SF-RI 1 did not stimulate peripheral blood lymphocytes of neonates in vitro. The mitogenic response of these cells to stimulation with PHA, ConA or PWM was heavily impaired in the presence of SF-RI 1 concentrations increasing from 0.04 to 4 mg/ml. These data indicate that SF-RI 1 is immunogenic and that it may have an influence on lymphocyte proliferation in vivo.

Animals↗
PubMed1992

Short-term outcome in infants with birth weights less than 1750 g born to mothers with HELLP syndrome.

Premature infants born to mothers with HELLP syndrome were reported to have a less favourable outcome compared to infants with uncomplicated maternal history. We investigated the short term outcome in 21 premature infants with birth weights less than 1750 g born to mothers with HELLP syndrome. Median birth weight was 1050 g (range 420 g-1750 g), corresponding gestational age 29 weeks (range 26-35 weeks). Mechanical ventilation for RDS was necessary in 15 infants. Intracranial hemorrhage was diagnosed in 2 infants, 1 of the surviving infants developed bronchopulmonary dysplasia. Acute renal failure was observed in 3 infants immediately after birth. Mortality was attributed to progressive respiratory failure in 2 patients (b.w. 420 g and 490 g) and persisting acute renal failure in 1 patient (b.w. 520 g) Leucocytopenia (less than 9000/mm3) was observed in 13 infants and thrombocytopenia (less than 115000/mm3) was noted in 4 infants during the first day. Eighteen infants survived. We conclude, that the short term outcome in infants born to mothers with HELLP syndrome is not as poor, as previously reported.

Birth Weight↗
PubMed1992

In vitro lymphocyte functions in the presence of bovine surfactant and its phospholipid fractions.

Endotracheal administration of human or xenogenic surfactant preparations is an effective treatment of the respiratory distress syndrome of preterm infants. The application of large amounts of phospholipids to the lung may result in a significant alteration of the local immune response. We studied the influence of the bovine surfactant preparation SF-RI 1 (Alveofact) on lymphocyte functions in vitro. PHA-induced cell proliferation and immunoglobulin synthesis in the presence of whole surfactant as well as six different defined phospholipids were investigated. A marked concentration-dependent suppression of immunoglobulin production independent of the immunoglobulin isotype and cell proliferation was observed in the range of 5 ng/ml-3 mg/ml of a single phospholipid (or SF-RI 1 respectively). It could be demonstrated that suppression of lymphocyte functions was only due to the phospholipid content of the surfactant preparation. These data indicate that in vivo immune functions may be significantly altered by the administration of exogenous surfactant. This may be particularly important in the presence of primary or secondary pulmonary infections.

Chromatography, Thin Layer↗
PubMed1992

[In vitro studies of cellular immunity in chronic bronchitis with and without corticosteroid medication].

In 29 patients with chronic bronchitis, 17 of whom were receiving systemic prednisolone, parameters of cellular and humoral immunity from the blood were evaluated and compared with a control group. Serum concentrations of immunoglobulins IgG, A and M, IgG subclasses, lymphocyte subsets and lymphocyte response to mitogenes (PHA, ConA, PWM), antibodies (anti-CD3) and tetanus antigen were determined. Whereas T cell subsets did not show any difference between all groups, the relative proportion of B lymphocytes was lower in the patient group without corticosteroids. Both patient groups showed a decreased lymphocyte response. As expected, serum IgG was lower in the steroid group, which could not be explained by additional cellular findings. Our data indicate that patients suffering from chronic bronchitis may show signs of a decreased cellular immunity.

Aged↗
PubMed1991

IgG2 deficiency in children with human immunodeficiency virus infection.

Infection with the human immunodeficiency virus (HIV) induces a polyclonal B-cell activation. Despite elevated serum immunoglobulin levels, a significant deterioration of the antigen specific humoral immune response exists in most cases. We studied the influence of HIV infection on the serum levels of IgG subclasses in children. We investigated 76 children (aged 15 months to 18 years) with HIV-1-infection. Most children (88%) showed elevated serum immunoglobulin levels. IgA (87%) and IgM (74%) were more often above normal levels for age than IgG (60%). IgG subclass serum levels were significantly altered. The increase in total IgG was mainly due to a marked augmentation of the IgG1 fraction. In most cases IgG3 was simultaneously elevated. Ten children (13%) had very low IgG4 levels (less than 0.03 g/l). Out of 61 patients older than 2 years 8 (13%) had a profound IgG2 deficiency with normal or elevated total IgG. Four of them also had low IgG4 levels (less than 0.03 g/l). A correlation between IgG2 deficiency and HIV infection according to the Centres for Disease Control classification for acquired immunodeficiency syndrome could not be demonstrated (three patients with symptomatic and five with asymptomatic infection).

Acquired Immunodeficiency Syndrome↗
PubMed1991

Gonadal agenesis in a 46,XY female with multiple malformations and positive testing for the sex-determining region of the Y chromosome.

A full-term 46,XY female newborn presented with respiratory failure due to a right-sided diaphragmatic hernia. During surgical repair, exploration revealed isolated dextrocardia and hypoplasia of the right lung. Neither gonads nor wolffian or müllerian structures could be palpated. Cardiac catheterization demonstrated defects of the ventricular septum, hypoplasia of the right pulmonary artery, persistence of the left vena cava superior and a patent ductus arteriosus. Anthropometric data were normal at birth, but fell below the 3rd percentile during follow-up. Body proportions displayed a predominance of the upper compared to the lower segment. Endocrine studies indicated no defect of steroid biosynthesis and no functional gonadal tissue. Using genetic analyses of various loci within the testis-determining region of the Y chromosome, a mutation could not be detected. The patient died from pneumonia at the age of 19 months. Postmortem examination confirmed the diagnosis of gonadal agenesis.

Abnormalities, Multiple↗
PubMed1990

[Primary antibody deficiency syndrome. Improved life expectancy and immunoglobulin G substitution].

Recurrent pyogenic infections are the leading clinical symptom in patients with antibody deficiency syndromes. In accordance with the WHO-classification at least nine different diseases are differentiated. In some cases diagnosis can be made simply by determining the immunoglobulin serum levels. Some diseases, such as Ig-heavy chain gene deletions, are clearly characterized by molecular biological methods, while other terms, such as common variable immunodeficiency, cover a collection of different diseases with changes predominantly of B-cell functions. The main features of the antibody deficiency syndromes are described. In most cases adequate therapy can be achieved by IgG replacement therapy.

Humans↗
PubMed1990

[Treatment of respiratory distress syndrome in very small premature infants with bovine surfactant].

In a clinical, uncontrolled study, bovine surfactant was administered intratracheally to 32 very low birth weight infants. In the first 18 patients, the dose was 20-40 mg/kg body weight (group 1, median birth weight 750 g) in the other 14 infants 40-50 mg/kg (group 2, median birth weight 840 g). The bovine surfactant was given, if the peak inspiratory pressures (PIP) were above 22-27 cm H2O depending on the infant's birth weight or whether the fraction of inspired oxygen (FiO2) was greater than 0.5. The FiO2 decreased from the pretreatment value of 0.7 to 0.46 after 1 hour, whereas PIP could not be lowered as rapidly as FiO2 (PIP from 29 to 26 cm H2O after 1 h). Surfactant treatment was more effective in group 2 comparing the reduction in FiO2 (delta FiO2 0.34 versus 0.16 in group 1 after 1 h), survival in group 2 was higher (71%) than in group 1 (56%). Our data are consistent with those of other groups using other natural surfactant preparations.

Birth Weight↗
PubMed1990

[Effect of a bovine surfactant in very low birth weight premature infants with congenital pneumonia].

15 VLBW-infants, who were classified to suffer from congenital pneumonia, were treated with a bovine surfactant. Mean gestational age was 25.5 weeks (range 23-27 weeks), mean birth weight was 700 g (range 530-930 g). Surfactant was instilled intratracheally at a mean dose of 41 mg/kg body weight (b.w.) (range 30-50 mg) 8 h after birth (range 6-12 h), if the fraction of inspired oxygen (FiO2) was greater than 0.5 or the peak inspiratory pressure (PIP) was greater than 22 cm H2O (b.w. less than 750 g) or greater than 25 cm H2O (b.w. 751-1000 g). Retreatment up to a total maximum of 4 doses of surfactant was permitted. Surfactant treatment reduced FiO2 from a pretreatment value of 0.79 to 0.50 one hour after application, however, 12 h later FiO2 had increased again to 0.75. Ventilation pressures showed a slight decrease during 12 h after surfactant treatment. 6 infants received 1 dose, multiple doses were given to 9 infants. 5 infants survived, 4 infants died from respiratory failure, 4 from sepsis and 2 from severe intracranial haemorrhage.

Bacterial Infections↗
PubMed1989

A role for protein kinase C in the electrically evoked release of [3H] gamma-aminobutyric acid in rabbit caudate nucleus.

A possible participation of protein kinase C (PKC) in depolarization-induced release of gamma-aminobutyric acid (GABA) in rabbit caudate nucleus was examined by means of phorbol esters and staurosporine. Slices of caudate nucleus were loaded with [3H]GABA, then superfused and stimulated electrically (3 ms, 5 Hz, 24 mA, 5 V/cm) for 2 min. Aminooxyacetic acid and the uptake inhibitor nipecotic acid were present throughout. The PKC activator 4 beta-phorbol 12,13-dibutyrate (4 beta-PDB) markedly enhanced the evoked [3H]GABA release. In contrast, its biologically inactive isomer, 4 alpha-PDB, did not facilitate transmitter release. Staurosporine, an inhibitor of PKC, diminished [3H]GABA release and counteracted the effects caused by 4 beta-PDB. The above results suggest a participation of PKC in depolarization-induced GABA release in rabbit caudate nucleus. The mechanism underlying the modulation of GABA release by PKC seems to be independent of presynaptic GABA, dopamine and 5-hydroxytryptamine receptors.

Alkaloids↗