No evidence of deficiency of vitamins A, E, beta-carotene, B1, B2, B6, B12 and folate in neuropathic type II diabetic women.
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Aged↗
Biomedical subjects
R H Straub
Publications and source records attributed to R H Straub.
A modified method of electronystagmography for recording eye movement during the galvanic vestibular test.
This study demonstrates a new technique for recording galvanic nystagmus using conventional electrooculography: a first pair of electrodes is placed at the nasal and lateral orbital margin of the left eye. An additional pair of electrodes is placed near the left angle of the mouth. This latter pair of electrodes picks up voltage variations induced by heart beat but only a minimal part of voltage variations caused by eye movements during bipolar, binaural electric stimulation. Electronic subtraction of the voltage variations near the angle of the mouth from the voltage variations at the equilateral eye cancels the cardiac interference and allows a pure recording of horizontal eye movements. 35 of 40 subjects could be examined successfully.
Adult↗
Evaluation of the galvanic vestibulo-ocular response recorded with a modified electronystagmographic technique.
Previously, a simple method for recording galvanic nystagmus (GN) using conventional electronystagmography (ENG) was demonstrated. The present study reports on investigations made to examine the applicability of that technique. During a standard stimulus over 20 s, amplitudes and rate of saccades show no tendency to diminish. In a series of 10 repeated standard stimuli over 16 min, a parabolic relationship is observed between time on one side and on the other, the mean amplitude, the mean rate of saccades and the sum of amplitudes per stimulus duration. The threshold of GN was 1.29 mA and that of induced tilting sensation 3.64 mA. In a series of 8 repeated threshold stimuli, thresholds of GN and tilting sensation linearly increase (p less than 0.001). During the slow increase of the current, the amplitudes and frequency of saccades and the slow-phase velocity linearly increase (p less than 0.01). The direction of per- and poststimulatory galvanic nystagmus and tilting sensation were investigated. Several autonomic reactions and psychophysical sensations during stimulation were noted. In conclusion, it is thought that the modified ENG technique is a valid method for further clinical use and basic research and its applicability has proven to be good.
Adaptation, Physiological↗
The pupillary light reflex. 1. Age-dependent and age-independent parameters in normal subjects.
A hundred and three normal subjects (14-75 years old) were examined with a modified infrared TV videopupillometer that had previously been developed. Maximal pupillary diameter (p less than 0.00001), pupillary diameter in percent of iris diameter (p less than 0.00001), maximal pupillary area (p less than 0.00001), latency time of the light reflex (p less than 0.00001), maximal contraction velocity (p less than 0.00002), contraction velocity at 1 s (p less than 0.00001) and dilatation velocity at 6 s (p less than 0.0001) are strongly age dependent. A statistical formula is given to allow the calculation of the exact percentile for every parameter. Parameters which are age independent if they are expressed in percent of the maximal pupillary area are contraction velocity at 1 s (r = 0.042, p = 0.68) and dilatation velocity at 6 s (r = -0.150, p = 0.13). They can be used if age-matched study groups are not available. Furthermore, it is shown that most parameters of the pupillary light reflex correlate significantly with each other. The highest correlations are found with the maximal pupillary area. Differences between sexes are not evident. It is thought that this infrared videopupillometry and the given data base are useful for further clinical studies to investigate the autonomic nervous system.
Adolescent↗
The pupillary light reflex. 2. Prevalence of pupillary autonomic neuropathy in diabetics using age-dependent and age-independent pupillary parameters.
Seventy-seven diabetics with a duration of the disease ranging from 2 to 55 years (average 18.5 years) were studied with infrared videopupillometry. The prevalence of diabetic autonomic neuropathy at the pupillary control system (pANP) was studied comparatively using several pupillary tests. The average prevalence using age-dependent parameters was 30.2% [maximal pupillary area: 22.1%, maximal contraction velocity: 24.7%, contraction velocity at 1 s (CV1): 28.6%, and dilation velocity at 6 s (DV6): 45.5%]. Comparing these percentages to prevalences of other diabetic late complications, e.g. retinopathy (49.4%), DV6 seems to be good for the diagnosis of pANP. If CV1 and DV6 are expressed in percent of the maximal pupillary area (CV1% and DV6%), they become age-independent. The average CV1% and DV6% of diabetics differ highly significantly from those of normals (CV1%: 58.6 +/- 14.5 vs. 64.1 +/- 6.4%, 2 p less than 0.005, and DV6%: 6.0 +/- 2.9 vs. 7.3 +/- 1.1%, 2 p less than 0.001). The average prevalence of pANP using these age-independent parameters was 25.4%. These data suggest that the prevalence of pANP, especially disorders of pupillary dilation (DV6), is high in long-standing diabetes. Furthermore, CV1% and DV6% have proved to be valid parameters in finding differences in the light reflex in non-age-matched study groups.
Adolescent↗
[Infections and vasculitis].
Vasculitides are rare diseases characterized by inflammation of blood vessels. According to diameter of the blood vessels involved in the inflammatory process, the clinical presentation and the histological appearance, different vasculitic syndromes may be distinguished. Primary vasculitides are of unknown origin while secondary vasculitides may be caused by drugs, malignancy or infection. Panarteriitis nodosa caused by chronic Hepatitis B and mixed cryoglobulinemia secondary to chronic Hepatitis C are classical examples of vasculitides triggered by infections. However, these are rare complications of chronic viral hepatitis. Patients infected by HIV frequently suffer from vasculitis, which may be caused by opportunistic infections and by defects in immune regulation. In numerous case reports, various other infectious particles have been reported to cause different forms of vasculitis, either by direct infection of endothelial cells or by induction of an immunologic process leading to blood vessel destruction. Immunologically mediated vasculitis secondary to infection may be due to a predisposing reactivity of the patient's immune system. After successful treatment of the infection, the vasculitis usually subsides. Therefore, all patients with vasculitis should be evaluated for underlying infection.
Antigen-Antibody Reactions↗
Pneumocystis carinii pneumonia as a complication of immunosuppressive therapy.
BACKGROUND: Patients receiving immunosuppressive therapy with corticosteroids and cytotoxic agents may develop opportunistic infections such as Pneumocystis carinii pneumonia (PCP). This indicates a severe T-cell defect, but so far there are no established criteria for identifying patients at risk. PATIENTS AND METHODS: CD4+ and CD8+ T-lymphocyte counts were determined by flow cytometry in seven HIV-negative patients who developed PCP as a complication of immunosuppressive treatment. RESULTS: CD4+ T-lymphocyte counts (T-helper phenotype) were less than 200/microl in all seven patients (mean 90.6/microl). The markedly reduced CD4 counts measured in these patients are similar to those observed in organ transplant recipients who developed PCP during immunosuppressive therapy for prevention of graft rejection and in HIV-positive patients with PCP as an AIDS-defining illness. CONCLUSION: Measuring CD4+ T-lymphocyte counts may be helpful in determining the risk of PCP not only in HIV-positive patients, but also in patients receiving immunosuppressive therapy. The risk of acquiring PCP seems to increase when CD4+ lymphocyte counts drop below 200/microl, regardless of the underlying disease.
CD4 Lymphocyte Count↗
Estimation of the cut-off value in cardiovascular autonomic nervous function tests: not-age-related criteria or the age-related 5th percentile.
The aim of the study was to estimate the cut-off value of cardiovascular tests using not-age-related criteria or the age-related 5th percentile in 165 diabetic patients. The cANP, pANP, and smNP were assessed using previously recommended standardized test procedures. Prevalence of overall definite (borderline) cANP was 35.2% (23.0%) when using the 5th percentile or 16.4% (27.9%) when using not age-related criteria (p for the difference < 0.0001) (p = 0.3205). Prevalence of pANP was 54.0% and of smNP 37.0%. Concerning cANP, the number of test results below the 5th percentile (N5) correlated significantly with the number of abnormal test results using not age-related criteria (Nnar) (p < 0.000001) but the slope of the regression line differed substantially from 1. Using the 5th percentile as the cut-off value for cANP testing, sensitivity and specificity were calculated for not age-related criteria for respiratory sinus arrhythmia (90.5%, 80.2%), Valsalva test (30.4%, 98.0%), lying-to-standing test (46.3%, 98.7%), orthostatic systolic blood pressure fall (69.0%, 78.3%), and overall definite cANP (44.8%, 92.8%). The statistical analysis revealed that the age-related 5th percentile is superior to the not-age-related cut-off values in diabetic patients. We therefore suggest that age-related normal values (percentiles) have to be applied when cANP is estimated.
Adolescent↗
Polymyalgia rheumatica: evidence for a hypothalamic-pituitary-adrenal axis-driven disease.
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Aging↗
No alterations of serum levels of adrenal and gonadal hormones in patients with ankylosing spondylitis.
Ankylosing spondylitis (AS) is a chronic inflammatory disease with a marked preponderance of affected males compared to females of approximately 6 to 1. During the last two decades, this circumstance stimulated several research groups to investigate serum levels of gonadal and adrenal sex hormones. From available results of cross-sectional studies, there seems to be no particular defect in secretion or production of adrenal, gonadal, and pituitary hormones. This is in striking contrast to diseases such as rheumatoid arthritis and other chronic inflammatory diseases. In the latter diseases, low serum levels of dehydroepiandrosterone (DHEA), DHEA sulphate (DHEAS), and testosterone have been described in an advanced chronic disease stage, whereas estrogen serum levels remain normal. Although AS is an inflammatory disease with signs of systemic inflammation such as elevated erythrocyte sedimentation rate or increased circulating proinflammatory cytokines, serum levels of adrenal and gonadal androgens are normal. It is unclear whether this can be considered as unexpected. It may be that inflammation does not reach the pituitary, adrenal, and gonadal glands or does not alter the aromatase complex in peripheral tissue. Furthermore, the inflammation-induced changes may be subtle so that only specific endocrine examination of these axes may reveal signs of alterations. In conclusion, current data on sex steroid hormones provide no straightforward explanation for the male predominance in AS. At the moment, there is no rationale to treat AS patients with sex steroid hormones.
Adrenal Cortex Hormones↗
New roles for estrogens in rheumatoid arthritis.
Sex hormones appear to play an important role as modulators of autoimmune disease onset/perpetuation. Steroid hormones are implicated in the immune response, with estrogens as enhancers at least of humoral immunity, and androgens and progesterone (and glucocorticoids) as natural immune suppressors. Serum levels of estrogens have been found to be normal in rheumatoid arthritis (RA) patients. Synovial fluid levels (SF) of proinflammatory estrogens relative to androgens are significantly elevated in both male and female RA patients as compared to controls, which is most probably due to an increase in local aromatase activity. Thus, available steroid pre-hormones are rapidly converted to proinflammatory estrogens in the synovial tissue in the presence of inflammatory cytokines (i.e. TNF alpha, IL-1, IL-6). The increased estrogen concentrations observed in RA SF of both sexes are characterized mainly by the hydroxylated forms, in particular 16 alpha-hydroxyestrone, showing a mitogenic stimulating role. Indeed, recent studies by us indicate that 17-beta estradiol (E2) clearly enhanced the expression of markers of cell growth and proliferation, whereas testosterone (T) induced an increase in markers indicating DNA damage and apoptosis. In particular, our data further shows that the enhancing role of estrogens on the immune/inflammatory response is exerted by activating the NFkB complex. In conclusion, locally increased estrogens may exert activating effects on synovial cell proliferation, including macrophages and fibroblasts, suggesting new roles for estrogens in RA.
Adult↗
Low density of CD1+ cells in the synovial tissue of patients with rheumatoid arthritis.
OBJECTIVE: CD1 molecules present microbial and self glycolipid antigens to a defined T cell subset with features of natural killer cells. CD1 molecules are up-regulated by inflammatory stimuli such as GM-CSF, and we would expect to find increased CD1 expression in the synovium of patients with rheumatoid arthritis (RA) as compared to osteoarthritis (OA). This study was initiated to compare the density of CD1a+, CD1b+, and CD1c+ synovial cells in RA and OA patients. METHODS: Expression of CD1a+, CD1b+, and CD1c+ molecules in synovial tissue was assessed by semiquantitative immunohistochemistry. For comparison, serological, functional, and typical immunohistochemical markers of inflammation were detected. RESULTS: Although patients with RA as compared to OA had highly significantly increased signs of inflammation, the density of CD1a+, CD1b+, and CD1c+ synovial cells was similar This was also true for the density of CD1+ cells in relation to that of activated CD163+ macrophages. There was a high correlation between the densities of CD1a,b,c positive cells, which suggests the existence of similar regulatory pathways. In a combined analysis of RA and OA patients, there existed a negative association between prior NSAID therapy and the density of CD1a+, CD1b+, and CD1c+ synoviocytes in relation to CD163+ macrophages. This is interesting because a similar immunosuppressive aspect of NSAID has never been shown before and this might represent a hitherto unrecognized immunosuppressive aspect of NSAID. CONCLUSION: Considering the high synovial inflammation in patients with RA, the densities of CD1a+, CD1b+, and CD1c+ synovial cells were low compared to patients with OA. Further studies in RA patients are needed to clarify whether a defect in CD1 regulation may exist. Such a defect may lead to an insufficient immune response against microbial glycolipids, which would support smoldering or repeated inadequately responded infection.
Adult↗
Does stress influence the course of rheumatic diseases?
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Adaptation, Psychological↗
Cardiovascular and pupillary autonomic nervous dysfunction in patients with rheumatoid arthritis - a cross-sectional and longitudinal study.
OBJECTIVES: Patients with inflammatory diseases often demonstrate autonomic nervous dysfunction. This study was initiated to investigate cardiovascular (CAD) or pupillary autonomic dysfunction (PAD) in patients with rheumatoid arthritis (RA). METHODS: Between 1997 and 1998, 33 RA patients were examined for characteristics, and parameters of CAD and PAD. In a longitudinal part of this study, thirty patients have been re-evaluated 8.3 +/- 0.1 yr later (response rate = 91%). RESULTS: A total of 18 patients (60%) demonstrated either CAD or PAD. The prevalence of CAD was 6/30 (20%) and the prevalence of PAD was 15/30 (50%). Of all cardiovascular tests, the Ewing test demonstrated the worst results (13/30 patients were below the 5th percentile). Similar as in other diseases, several RA patients demonstrated autonomic nervous hyperreflexia with values above the 95 th percentile (relative variation coefficient: 7/30; respiratory sinus arrhythmia measure: 12/30; Valsalva measure: 1/30; Ewing measure: 0/30; latency time of pupillary light reflex: 5/30; maximal pupillary area: 0/30). During the 8-year observation period, 4/30 RA patients died. Non-survivors as compared to survivors had increased heart rate variation in the respiratory arrhythmia test (p= 0.038, hyperreflexia) but largely decreased heart rate variation in the Ewing test (p= 0.009, hyporeflexia). Non-survivors as compared to survivors demonstrated more frequent pupillary autonomic dysfunction (100% vs. 42%, p= 0.035). CONCLUSION: This study demonstrates that CAD and PAD were frequent in patients with RA. Patients with a poor test result in the Ewing test and PAD might have an increased risk of death. This study in RA patients demonstrates similar results as in patients with diabetes mellitus.
Adult↗
Biometry with a video-genlock interface and a computer-based image-analyzing system: use as a TV-videopupillometer.
TV-videobiometry is frequently used in biomedical research. Usually, the video images are digitized by computer systems. In contrast, the technique described uses a device known as a video-genlock interface (genlock). The genlock mixes a computer picture with the picture of a video device (synchronization). This technique and the custom-made software provide the following advantages: programmable user interface, low-budget system, user-friendly, manual-based software package, precision, and usefulness in different videobiometric setups such as infrared videopupillometry, which is described. In the demonstrated videopupillometry, the area resolution is 0.0009 mm2 per pixel and the length resolution 0.03 mm per pixel side. The relative coefficient of variation for 20 repeated measurements of pupillary area lies between 0.15 and 0.35%. The mean error of three measurements of a model pupil is less than 1%.
Biometry↗