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Biomedical subjects

R Abel

Publications and source records attributed to R Abel.

At least 19 recordsLinked to original sources
PubMed2006

Colorectal mucosal histamine release by mucosa oxygenation in comparison with other established clinical tests in patients with gastrointestinally mediated allergy.

AIM: This study evaluated colorectal mucosal histamine release in response to blinded food challenge-positive and -negative food antigens as a new diagnostic procedure. METHODS: 19 patients suffering from gastrointestinally mediated allergy confirmed by blinded oral provocation were investigated on grounds of their case history, skin prick tests, serum IgE detection and colorectal mucosal histamine release by ex vivo mucosa oxygenation. Intact tissue particles were incubated/stimulated in an oxygenated culture with different food antigens for 30 min. Specimens challenged with anti-human immunoglobulin E and without any stimulus served as positive and negative controls, respectively. Mucosal histamine release (% of total biopsy histamine content) was considered successful (positive), when the rate of histamine release from biopsies in response to antigens reached more than twice that of the spontaneous release. Histamine measurement was performed by radioimmunoassay. RESULTS: The median (range) of spontaneous histamine release from colorectal mucosa was found to be 3.2 (0.1%-25.8%) of the total biopsy histamine content. Food antigens tolerated by oral provocation did not elicit mast cell degranulation 3.4 (0.4%-20.7%, P = 0.4), while anti-IgE and causative food allergens induced a significant histamine release of 5.4 (1.1%-25.6%, P = 0.04) and 8.1 (1.5%-57.9%, P = 0.008), respectively. 12 of 19 patients (63.1%) showed positive colorectal mucosal histamine release in accordance with the blinded oral challenge responding to the same antigen (s), while the specificity of the functional histamine release to accurately recognise tolerated foodstuffs was found to be 78.6%. In comparison with the outcome of blinded food challenge tests, sensitivity and specificity of history (30.8% and 57.1%), skin tests (47.4% and 78.6%) or antigen-specific serum IgE determinations (57.9% and 50%) were found to be of lower diagnostic accuracy in gastrointestinally mediated allergy. CONCLUSION: Functional testing of the reactivity of colorectal mucosa upon antigenic stimulation in patients with gastrointestinally mediated allergy is of higher diagnostic efficacy.

Adult↗
PubMed2006

Pediatric spinal cord injury in a subset of European countries.

STUDY DESIGN: Postal survey. SETTING: A total of 19 countries in Europe. OBJECTIVES: Firstly, to collect information about incidence and systems of care for pediatric spinal cord injury (pedSCI); including prevention, initial care and follow-up in a subset of European countries. Secondly, to initiate a network of involved professionals for exchange of information and development of research and care programs. METHODS: A short semi-structured questionnaire was sent to respondents working with spinal cord injury (SCI) in 19 countries in Europe. RESULTS: Only in Portugal and Sweden, is the incidence of pedSCI (fatal injuries included) established, that is 27 children/million children/year and 4.6 children/million children/year, respectively. For the other countries, the estimated incidence of pedSCI (nonfatal injuries) varied from 0.9 to 21.2 children/million children/year in the age group of 0-14 years. Although the incidence varies considerably, pedSCI is rare throughout Europe. The management differs between the countries depending on the age of the child and the local organization of health care. CONCLUSIONS: The survey confirms that pedSCI is rare. In order to establish high-quality standardized care, further integration of knowledge in this area is needed throughout Europe. The contacts initiated by this survey may be used to create an international network serving as a reference for health professionals, researchers and families, thereby possibly alleviating some of the unwanted variations of care identified in this study.

Child↗
PubMed2005

[Paraplegia in cases of septic diseases of the spine].

BACKGROUND: Paraplegia of non-traumatic origin has an increasing incidence. Infection of the spine is a major contributor to the number of these cases. Besides adequate management of spinal cord injury, the treatment of these patients requires specific therapeutic techniques. PATIENTS AND METHODS: Eighteen patients with acute pyogenic infection of the spine and spinal cord injury were admitted to our facility in the years 1997-2000. All except two patients were treated by surgical debridement and internal stabilisation. RESULTS: The infections healed after surgical treatment in all cases. Neurological function improved and no patient showed neurological deterioration. Both patients who were not fit for surgery died during treatment. CONCLUSION: Surgical instrumentation and replacement of the destroyed vertebra, despite a pyogenic environment, resulted in permanent resolution of the infection. There is potential for neurological recovery but full recovery is rare.

Adult↗
PubMed2005

[Functional rehabilitation of spinal cord injured persons using neuroprostheses].

Recent technological advancements in microelectronics have led to the establishment of systems for restoration of basic functions in spinal cord injured (SCI) persons using functional electrical stimulation (FES). FES systems for the restoration of bladder and diaphragm function are well established in clinical practice. While FES systems in the lower extremities for standing/walking have not yet achieved widespread clinical acceptance, devices which enhance or restore the grasp function in tetraplegic patients with missing control of hand and fingers are demonstrably successful. Especially with the use of implantable systems a reliable, easy to handle application is possible. The most recent developments in micromechanical engineering are aimed at providing minimally invasive, subminiature systems for functional support in incomplete SCI persons. The possibility of direct brain control of FES systems will expand the application of neuroprostheses for patients with injury of the high cervical spinal cord.

Electric Stimulation Therapy↗
PubMed2003

[Possible conservative treatment methods for patients with spinal claudication].

The success of multimodal therapy for patients with symptoms of spinal canal stenosis lasting >6 months was investigated in a prospective study. Clinical (age, weight, height) and morphological data were collected for 36 patients (21 women and 15 men) with an average age of 67 years. The extent of narrowing in the spinal space (diameter of the dural sac <100 mm(2)) was measured by magnetic resonance imaging at segments L1-S1. Impairments in daily activities were assessed by questionnaire before a 3-week multimodal treatment regimen and 3 weeks and 6 months thereafter. In addition, depression status and walking distance on a treadmill were evaluated. Of the 180 segments examined, 124 evidenced a diameter of the dural sac of <100 mm(2). The average functional capacity improved with treatment from 46.7 to 53.5 (p<0.001) and the average depression status decreased from 13.5 to 11 (p>0.05). The average walking distance was 373 m before treatment and 565 m after treatment (p<0.001). Short-term improvement of the walking distance was achieved with the conservative treatment implemented. Medium- and long-term results remain unclear. Predictors for treatment success (age, sex, BMI, functional capacity, walking ability before treatment) could not be found. No scientific evidence can be gleaned from the literature in this regard so that further prospective studies should be performed.

Aged↗
PubMed2003

Multilevel epidural abscess formation with paraplegia in a healthy 33-year-old man caused by Staphylococcus aureus (MSSA).

We report an unusual case of a devastating multilevel pyogenic spondylitis with paraplegia and soft tissue abscess formation in a previously healthy young man. Methicillin susceptible Staphylococcus aureus (MSSA) was identified as causal pathogen. The infection could only be managed after surgical debridement of all spinal manifestations and a prolonged course of antibiotic therapy. It is possible that delayed surgical debridement of all infection sites fostered the course of the disease.

Adult↗
PubMed2003

Use of the ring fixator in the treatment of fractures of the lower extremity in long-term paraplegic and tetraplegic patients.

STUDY DESIGN: Retrospective study. OBJECTIVES: To examine the value of operative fracture stabilization by means of the ring fixator in fractures of the lower extremity in the presence of chronic paralysis caused by transverse lesions of the spinal cord. SETTING: A specialist center for the treatment of spinal cord injuries in Germany. METHODS: Clinical examination of the lower extremities with side-for-side comparison, radiological investigation of the fractures, patient survey. PATIENTS: In 21 patients with chronic spinal cord lesions, 22 fractures of the lower extremities were treated with the ring fixator. RESULTS: At follow-up a mean of 41.5 months after fracture healing it could be shown that movement in the knee and ankle joints on the same side as the fracture was not restricted by more than 10 degrees in any of our patients. No losses affecting activities of daily living were reported, and 19 of the 21 patients were satisfied with the result achieved with this technique. After four of the 22 operations there were complications. Malalignments were visible radiologically following five of the fractures. CONCLUSIONS: In osteoporosis-induced fractures of the lower extremities in chronically paraplegic and tetraplegic patients, fracture stabilization with the ring fixator, with fewer complications and better results in terms of joint mobility, is superior to the conservative treatment so far given preference in the literature. It should be offered as an alternative to conservative treatment in the case of pathological fractures.

Adult↗
PubMed2003

Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation.

STUDY DESIGN: Retrospective study utilising clinical records and public administration databases. OBJECTIVES: This study was performed to analyse the clinical presentation and survival rate of individuals with spinal cord injury (SCI) due to spinal metastasis after primary treatment, and to evaluate the efficacy of rehabilitative efforts. SETTING: Spinal Cord Injury Unit, University Hospital, Heidelberg. METHODS: A total of 68 consecutive patients were included. Demographics, clinical data, tumour type, level and completeness of SCI, initial treatment, functional independence measure (FIM) and survival time were derived from hospital and public administration databases. Cox regression and fuzzy logic rule generation were used for statistical analysis. RESULTS: Of the 68 patients, 66 patients died 11 months (median, interquartile range (IQR) 4-29 months) after the onset of neurological symptoms at an average age of 58 years. The functional independence measure (FIM) score describing the general clinical and functional status proved to be the most reliable prognostic factor of survival. Other more specific parameters (eg tumour type or level of lesion) did not have such an impact. In total, 51 patients completed the rehabilitation programme within 50 days (median, IQR 27-99 days). The FIM score improved from 62 at admission to 84 at discharge. CONCLUSION: The clinical and functional status is a valuable prognostic factor for survival. Since institutionalised rehabilitative efforts are effective, this group of patients should be accepted into such a program.

Adolescent↗
PubMed2003

Management of degenerative changes and stenosis of the lumbar spinal canal secondary to cervical spinal cord injury.

We describe the case of a 47-year-old female who sustained a C5/6 fracture with C6 complete spinal cord injury 26 years ago. She presented with increased spasticity of the lower extremities, the abdominal wall and episodes of autonomic dysreflexia. Imaging of the spine revealed post-traumatic kyphosis at the level of the injury and degenerative changes of the lumbar spine with marked facet joint hypertrophy at the level of L4/5 causing severe spinal canal stenosis. Discussants of this case comment on the possible pathophysiological mechanisms causing autonomic dysreflexia, especially the development of degenerative changes, Charcot arthropathy and the role of tethering mechanisms. The diagnostic options and management approaches are also discussed.

Diagnosis, Differential↗
PubMed2002

Differential parallel processing of olfactory information in the honeybee, Apis mellifera L.

Two distinct neuronal pathways connect the first olfactory neuropil, the antennal lobe, with higher integration areas, such as the mushroom bodies, via antennal lobe projection neurons. Intracellular recordings were used to address the question whether neuroanatomical features affect odor-coding properties. We found that neurons in the median antennocerebral tract code odors by latency differences or specific inhibitory phases in combination with excitatory phases, have a more specific activity profile for different odors and convey the information with a delay. The neurons of the lateral antennocerebral tract code odors by spike rate differences, have a broader activity profile for different odors, and convey the information quickly. Thus, rather preliminary information about the olfactory stimulus first reaches the mushroom bodies and the lateral horn via neurons of the lateral antennocerebral tract and subsequently odor information becomes more specified by activities of neurons of the median antennocerebral tract. We conclude that this neuroanatomical feature is not related to the distinction between different odors, but rather reflects a dual coding of the same odor stimuli by two different neuronal strategies focusing different properties of the same stimulus.

Action Potentials↗
PubMed2002

[Poorly tolerated or genuinely allergic? How to properly assess food allergies].

Massive immune reactions to certain foods may be traced back to immunological, but also to non-immunological mechanisms. The diagnostic work-up must therefore aim to distinguish an allergy from other inflammatory, neoplastic or immunoregulative disorders. The most common form of gastrointestinal-mediated allergy form are the IgE-mediated reactions of the immediate type (Type 1 allergy). The routine diagnostic investigation includes history-taking, a daily diary of foods eaten, skin tests and antibody determination. The diagnosis of an allergy is often complicated by the multitude of possible manifestation sites, a possibly localized effect, and variations in the depth of allergic processes. To confirm the diagnosis, an oral provocative test should always be performed.

Administration, Oral↗
PubMed2002

Gait analysis on the treadmill - monitoring exercise in the treatment of paraplegia.

STUDY DESIGN: A prospective study was performed to evaluate the gait training of seven consecutive spinal cord injured patients and 10 controls on a treadmill using instrumented gait analysis and video documentation. OBJECTIVES: To determine whether it is possible to maintain gait motion within physiological limits during treadmill training. SETTING: Primary and secondary care unit for spinal cord injury, Heidelberg, Germany. METHODS: Treadmill training was instituted as early as possible. Gait analysis was performed when the patients were stable enough to walk without manual aid from therapists and enough endurance to allow measurements. A control group of healthy volunteers were examined as well. Video documentation and a camera system using passive markers were employed. RESULTS: Treadmill training started with weight reduction of 25% of bodyweight (18 (0-35) kg), maximum walking speed 0.28 (0.15-0.7) m/s and maximum walking duration 4.7 (3-7) min. At the end of the training, weight reduction decreased to 9.3 (0-20) kg, maximum walking speed increased to 0.67 (0.23-1.1) ms with a maximum walking duration of 11 (8-15) min. 3-D motion analysis of hip, knee and ankle demonstrated joint excursions almost entirely within the limits of normal gait. Exceptions were due to fixed contractures. CONCLUSIONS: Our data suggests that it is possible to perform early gait training on a treadmill with no supportive orthoses within the physiologic range of joint motion. The risk for repetitive stress injuries or other negative effects is low.

Adolescent↗
PubMed2002

Improvements in activities of daily living following functional hand surgery for treatment of lesions to the cervical spinal cord: self-assessment by patients.

STUDY DESIGN: Tetraplegic patients were tested for hand strength before and after hand surgery. They also answered questions about how they rated the results of surgery. OBJECTIVES: Presentation of the efficacy of reconstruction of hand raising, lateral grip, and cylindrical grip in the tetraplegic hand. SETTING: The study was conducted in the Werner Wicker Clinic, Bad Wildungen, Germany, from 1991 to 1998. METHODS: The results of reconstruction surgery performed on 23 tetraplegic hands, as reflected in lifting the hand (n=3), lateral grip (n=21), and cylindrical grip (n=14), are presented. In a follow-up study in 22 patients, their management of activities of daily living 34.1 months (9-51 months) after the surgery is compared with the preoperative situation. Subjective satisfaction levels were elicited for each of the 22 patients by means of a questionnaire. RESULTS: The gain in force corresponded to 893 g (150-1500 g) for cyclindrical grip and 488 g (100-1200 g) for lateral grip, while they were able to develop grade 4 force for lifting the hand. After the operation 28 aids/appliances that patients had formerly used regularly were no longer necessary. There were 75 separate activities listed in the questionnaire, and on average the 22 patients were able to perform 8.7 (0-20) more of these. Most patients (19) said they would advise others to have the operation and 18, that they would have the operation again. There were 12 complications in nine patients. CONCLUSION: Reconstructive surgery on the hands of tetraplegic patients leads to gains in both cylindrical grip and lateral grip force and to increased manual dexterity. Patient satisfaction with the procedure is high.

Activities of Daily Living↗
PubMed2002

[A modular method for automated evaluation of gait analysis data].

A modular methodology for automated gait data evaluation: The aim of Instrumented Gait Analysis is to measure data such as joint kinematics or kinetics during gait in a quantitative way. The data evaluation for clinical purposes is often performed by experienced physicians (diagnosis of specific motion dysfunction, planning and validation of therapy). Due to subjective evaluation and complexity of the pathologies, there exists no objective, standardized data analysis method for these tasks. This article covers the development of a modular, computer-based methodology to quantify the degree of pathological gait in comparison to normal behavior, as well as to automatically search for interpretable gait abnormalities and to visualize the results. The outcomes are demonstrated with two different patient groups.

Biomechanical Phenomena↗
PubMed2001

Structure and response patterns of olfactory interneurons in the honeybee, Apis mellifera.

To analyze morphologic and physiological properties of olfactory interneurons in the honeybee, Apis mellifera, antennal lobe (AL) neurons were intracellularly recorded and subsequently labeled with Neurobiotin. Additional focal injections were carried out with cobalt hexamine chloride and dextran fluorescent markers. Olfactory interneurons (projection neurons, PNs) project by means of five tracts, the lateral, the median, and three mediolateral antennocerebral tracts (l-, m-, and ml-ACT, respectively) to the mushroom bodies (MBs) and the protocerebral lobe (PL) of the ipsilateral protocerebrum. Uniglomerular PNs of the m- and l-ACT receiving input from a single glomerulus of the AL also arborize in different regions of the AL. The vast majority of l-ACT innervate the T1 region, whereas m-ACT neurons arborize exclusively in the T2, T3, and T4 regions (T1-4 : AL projection area of sensory cells from the antennae). In the calyces of the MB, uniglomerular PNs form varicosities in the basal ring and the lip region. Individual neurons of both types exhibit unequal innervation within and between the two calyces. In addition, m-ACT fibers ramify more densely within the lip neuropil and show a higher incidence of spine-like processes than l-ACTs. In the PL, l-ACTs arborize exclusively within the lateral horn, whereas some m-ACT neurons innervate a broader region. Multiglomerular neurons of the ml-ACT leave the AL by means of three subtracts (ml-ACT 1-3). Two different types can be distinguished according to their protocerebral target areas: ml-ACTs projecting to the lateral PL (LPL) and to the neuropil around the alpha-lobe (tracts 2 and 3) and neurons projecting only to the LPL (tract 1). Intracellular recordings indicate that both l- and m-ACT neurons respond to general odors but with different response properties, indicating that odor information is processed in parallel pathways with different functional characteristics. Just like m-ACT neurons, ml-ACT neurons respond to odors with complex activity patterns. Bilateral interneurons, originating in the suboesophageal ganglion, connect glomeruli of both AL, and send an axon through the m-ACT in each hemisphere of the brain, terminating in the lip region of the calyces. These neurons respond to contact chemical stimuli.

Action Potentials↗