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Biomedical subjects

R Hoffmann

Publications and source records attributed to R Hoffmann.

At least 253 records · Page 14Linked to original sources
PubMed1995

Unrecognized pneumothorax as a cause of intraspinal air.

STUDY DESIGN: This is a case report. OBJECTIVE: A case of intraspinal air in a polytraumatized patient with unrecognized pneumothorax after blunt chest trauma is reported. SUMMARY OF BACKGROUND DATA: In most cases, intraspinal air is associated with degenerative disc disease, epidural abscess, or synovial cyst, or it follows iatrogenic manipulation. Scialdone and Wagle first reported a case of intraspinal air due to a laceration of the right main bronchus. No previous case of intraspinal air after a simple unsuspected pneumothorax following blunt chest trauma has been reported. METHODS: During routine x-ray and computed tomography examination of a polytraumatized patient, an unsuspected pneumothorax due to a rib fracture was detected in a thorax computed tomography scan. Computed tomography scans of the cervical spine showed a collection of intraspinal air. RESULTS: The computed tomography examination of a polytraumatized patient with an unsuspected pneumothorax after blunt chest trauma showed the embolization of air in the paravertebral vein plexus and in the intraspinal canal. CONCLUSION: These observations suggest a wider indication for computed tomography scans of the thorax in blunt chest trauma. Also, whenever intraspinal air is found in the diagnostic course of a traumatized patient, a hidden pneumothorax should be suspected and ruled out.

Adult↗
PubMed1995

Variable degree of slime production is linked to different levels of beta-lactam susceptibility in Staphylococcus epidermidis phase variants.

Recently we demonstrated that lack of mecA transcription was responsible for the decreased methicillin resistance phenotype of strongly slime-negative Staphylococcus epidermidis phase variants [Mempel M, Feucht H, Ziehbuhr W, Endres M, Laufs R, Grüter L (1994) Antimicrob Agents Chemother 38: 1251-1255]. In the present study we compared the beta-lactam susceptibility and the slime production capacity of 60 phenotypic variants of S. epidermidis parent strain RP62A identified by their colony morphology on congo red agar. We could show that the variable degree of slime production is linked to different levels of beta-lactam susceptibility in intermediate-stage phase variants. The increased deltahemolysin production of slime-negative phase variants may indicate an accessory gene regulator-like control.

Anti-Bacterial Agents↗
PubMed1995

Double dislocation of the fifth metacarpal.

A case of traumatic, simultaneous, double dislocation of the fifth metacarpal bone is presented. Closed reduction was easily achieved and held with transarticular, crossed Kirschner wire fixation.

Adult↗
PubMed1995

Functional assessment of PTCA results by stress echocardiography: when and how to test.

Angiographic follow-up has shown that restenosis after PTCA is a continuous and ubiquitous process rather than a dichotomous event. Since the functional significance of restenosis involves more factors than minimal lumen diameter, functional tests after PTCA cannot be expected to match exactly the degree of angiographic restenosis. In the past, nuclear perfusion imaging has been the most accurate non-invasive method to predict restenosis, but now there is a new technique: stress echo. This uses physical (treadmill, exercise), pharmacological (dipyridamole, dobutamine), or pacing stress (together with transoesophageal imaging) for the detection of stress-inducible wall motion abnormalities; resolution of resting abnormalities may also be observed. These stress modalities have been employed to detect restenosis in limited numbers of patients, with diagnostic accuracies (so far, except for dobutamine) comparable to nuclear imaging. Therefore, it seems that the decision to use echo stress testing depends on patient characteristics, availability of methods, and, importantly, experience of the echo laboratory. Timing of the test after PTCA must take into account delayed functional recovery after PTCA; this has been well described by nuclear perfusion imaging. Thus, very early (< 1 month) tests lack specificity. On the other hand, development of restenosis after 6 months is rare. Stress tests therefore should be performed within the time window of 1 to 6 months after PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1995

Exercise echocardiography performed early and late after percutaneous transluminal coronary angioplasty for prediction of restenosis.

The purpose of this prospective study was to examine the incidence of exercise-induced ischaemia before and after angioplasty as well as 4 months later by exercise echocardiography, to evaluate the prognostic value of exercise echocardiography performed after angioplasty as regards the development of restenosis and to determine whether serial exercise tests increase the accuracy of detecting angiographically relevant restenosis. Fifty patients (39 males; mean age 52 +/- 9 years) without prior Q wave infarction entered the study protocol. Exercise echocardiography was performed 2 days prior to angioplasty, 13 +/- 6 days after successful angioplasty as well as at routine follow-up angiography 3.8 +/- 1.6 months after angioplasty. Angiographically successful angioplasty was achieved in 94% (47150) of patients, and early and late follow-up examinations were performed in all 47 patients. Average luminal diameter stenosis decreased from 65 +/- 5% to 26 +/- 9% immediately after angioplasty. Control angiography showed significant restenosis in 30% (14147) of patients. Exercise echocardiography before angioplasty was positive in 90%, continued to be positive in 30% of patients after angioplasty and was positive in 43% at control angiography. The exercise echocardiogram performed early after angioplasty had an overall accuracy for prediction of restenosis of 70%, with a positive predictive value of 50%, and a negative predictive value of 79%. Sensitivity for detection of restenosis at control angiography was high (86%), but specificity (76%) was moderate. Exercise echocardiograms showing deterioration from 2 weeks to 4 months after angioplasty were taken as a sign of restenosis and resulted in an increased specificity of 94%. Sensitivity, however, decreased to 36%, indicating that some patients with an early positive stress echo had already suffered restenosis 13 days after angioplasty. In conclusion, exercise echocardiography documents improvement in regional function after angioplasty. However, a significant proportion of patients continue to have a positive exercise echocardiogram even though angioplasty was angiographically successful, probably due to persistent ischaemic regions or early restenosis. While exercise echocardiography performed early after angioplasty is of insufficient value for the prediction of restenosis, if performed at late follow-up it has a good diagnostic accuracy for detecting restenosis.

Adult↗
PubMed1995

Immunohistochemical evidence for differential distribution of 5 alpha-reductase isoenzymes in human skin.

Antibodies raised against fragments of synthetic peptides of human 5 alpha-reductase isoenzymes 1 (h5 alpha r1) and 2 (h5 alpha r2) were applied to paraffin sections of human skin (scalp, eyelid, lip, breast, scrotum). Immunoreactive sites were differentially distributed, in that h5 alpha r1 immunoreactivity was present in the nuclei of cells in the stratum germinativum (basal and lower portion of the spinous layer) of the epidermis, subepithelial fibroblasts, adipocytes, smooth muscle cells of the scrotal tunica dartos, basal cells of sebaceous glands, excretory duct cells of sweat glands, cells of the dermal papilla and fibrous and outer epithelial sheath of hair roots, as well as endothelial cells of small vessels and Schwann cells of cutaneous myelinated nerves. In contrast, immunoreactivity for h5 alpha r2 was found in the cytoplasm of the cells of the spinous layer (and far less intensely in the basal layer) of the epidermis, subepidermal fibrocytes, and especially in subcutaneous adipocytes. Immunoreactivity was strongest in the non-keratinized portion of the inner epithelial sheath and the cuticle of hair follicles, whereas other portions of the hair root were negative. Sweat glands were stained, whereas sebaceous glands showed only weak diffuse immunoreactivity. In mucocutaneous zones, salivary glands and conjunctival epithelium showed immunoreactive cells. Vascular endothelium displayed immunoreactivity only in the genital region. We present experimental evidence for a differential distribution of 5 alpha-reductase isoenzymes in human skin. This might reflect a diversity in the response of different areas of the skin to androgenic challenge.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1995

Inter- and intrafamilial variability in mucolipidosis II (I-cell disease).

In this paper nine patients with mucolipidosis II (I-cell disease) are described. They had clinical features commonly found in mucolipidosis II, including disproportionate dwarfism, coarse facial features and mental retardation. However, there was remarkable variability in age of onset, organ manifestation and radiological findings. Some had unusual clinical symptoms including pericardial effusion and profound brain atrophy. Striking differences in phenotypic expression were also seen in two affected siblings. Clinical heterogeneity is observed not only in mucolipidosis II but also in many other lysosomal storage disorders. The factors that may contribute to this clinical diversity are discussed.

Age of Onset↗
PubMed1995

Chemical phosphorylation of the peptides GGXA (X = S, T, Y): an evaluation of different chemical approaches.

An evaluation was made of the two methods most commonly used for phosphorylation of hydroxyamino acids in peptides, i.e. the tetrazole-catalysed phosphitylation by di-tert-butyl-N,N-diethylphosphoramidite followed by oxidation and the phosphorylation by dibenzylphosphochloridate. As model system the sequence GGXA (X = S, T, Y) was used which represents a random-coil sequence avoiding the influence on the reaction kinetics of secondary structure formation. In the case of serine- and threonine-containing peptides, both synthetic methods gave comparable yields of the desired phosphopeptides. The phosphorylation of tyrosine was achieved more favorably via the phosphoramidite method. However, phosphotyrosine peptides are most easily obtained by peptide synthesis using Fmoc-Tyr(PO3Me2)OH as building block. The dibenzylphosphochloridate method yields the expected phosphopeptides as the only peptide derivative and in addition, a great number of unidentified by-products which can be removed by ion-exchange chromatography. The phosphoramidite method consistently resulted in three peptide derivatives, i.e. the desired phosphopeptide, the phosphitylated peptide and a bridged derivative with two GGXA fragments linked through a phosphodiester bridge. The derivatives were characterised by RP and ion-exchange chromatography, 31P- and 1H-NMR spectroscopy, and ion-spray and electrospray mass spectrometry. Interestingly, even these mild ionisation techniques resulted in partial fragmentation. The observed fragmentation pathways seem to be a diagnostic tool for the identification of phosphorylation sites in peptides. Both the phosphorylated serine and threonine peptide lost phosphoric acid (98 mass units), the tyrosine peptide lost phenyl phosphate (174 mass units).(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1995

Application and perspectives of transesophageal stress echocardiography using monoplane and biplane instruments.

Transesophageal stress echocardiography has been reported to have a high sensitivity and specificity for noninvasive identification and assessment of coronary artery disease. Its advantage is the virtually never obstructed acoustic window on the heart yielding superior image quality in almost all patients. Pharmacological stress as well as simultaneous atrial pacing--attaching electrodes to the echoscope--have been applied as stress modalities. Both transesophageal stress echocardiography modalities have been shown to be well tolerated, safe, and feasible in most patients. These promising initial experiences led to clinical application of this method for preoperative risk evaluation, for detection of restenosis after PTCA, and for evaluation of hibernating myocardium. This technique was also successful for evaluation of stress induced changes of transmitral and pulmonary venous flow in patients with left ventricular hypertrophy and coronary artery disease. Although all studies published so far were performed with monoplane technique, the sensitivity for detection of one-vessel and, even more so, multivessel disease was high. However, apical and basal wall-motion abnormalities may go undetected using monoplane equipment. The advent of biplane transesophageal imaging enables the visualization of more ventricular segments. Future studies will show to which degree biplane transesophageal stress echocardiography improves the diagnostic accuracy.

Angioplasty, Balloon, Coronary↗
PubMed1995

Does interleukin-1 induce hair loss?

Cytokines play an important role in both physiology and pathophysiology of human skin, and the possibility that they coordinate the cyclical hair growth cannot be excluded. Several clinical and experimental data point towards interleukin-1 which might be a crucial inducer of hair loss in various hair disease. An aberrant expression of interleukin-1 beta was detected in affected areas of the scalp in alopecia areata. On the other hand, interleukin-1 has been shown to be a potent inhibitor of human hair growth in vitro. Mice showing an overexpression of the interleukin-1 alpha gene develop patchy hair loss. Taking all of the presently available data together, we hypothesize that interleukin-1 is a crucial mediator inducing cessation of hair growth.

Alopecia Areata↗
PubMed1995

[Improved evaluation of prosthetic heart valve regurgitation with multiplanar transesophageal echocardiography].

UNLABELLED: To study the value of the newly introduced multiplane transesophageal transducer technology for the assessment of prosthetic valve regurgitation, 63 consecutive patients with 35 mitral and 33 aortic prostheses (23 bioprostheses and 45 mechanical prostheses) were examined. Transvalvular, paravalvular, and, in mechanical valves, normal or pathological transvalvular regurgitation were identified using first 0 degrees (transverse) and 90 degrees (longitudinal) planes combined with flexion of the echoscope tip and then additionally using multiple intermediary planes by transducer rotation. In a subgroup of 20 patients interobserver variability was evaluated. Both methods showed regurgitation in 56/58 valves; one additional case of regurgitation was seen by multiplane imaging only. However, there were 19 cases of regurgitation not clearly classifiable by biplane technique compared to only three using multiplane technique. Grading of severity was concordant by both modalities in 66 and discordant in only two cases. Observers disagreed on severity in 2/20 cases based on biplane imaging, but in none based on multiplane imaging; classification of regurgitation differed in 6/20 biplane and 1/20 multiplane images respectively. CONCLUSION: Multiplane transesophageal imaging improves classification of prosthetic regurgitation, but has little effect on severity grading.

Adult↗
PubMed1995

Profile of mood states and cardiac rehabilitation after acute myocardial infarction.

Following an acute myocardial infarction, evaluation of a patient's own perceptions of health, including mood state, provides useful information about the efficacy of rehabilitation when data are available for patients randomized to both control and intervention. Data are presented on the Profile of Mood States (POMS) in 187 patients, with mild to moderate scores for Spielberger state anxiety and/or Beck depression, who were randomized within 6 wk of acute myocardial infarction to usual care or to brief cardiac rehabilitation lasting 8 wk and who were followed-up during the 12 months following the acute event. Repeated measures multivariate analysis of covariance identified significant main as well as time effects in POMS scores over 12 months. Repeated measures analysis of variance over the 12 months demonstrated significant improvement for both depression and anxiety in both groups. At 8 wk, improvement was greater in the rehabilitation patients than usual care patients but only in the tension-anxiety, depression-dejection and vigor-activity dimensions of POMS and only in anxiety in those patients with above mean anxiety scores. Overall, rehabilitation and control patients showed similar and significant improvements in anxiety, depression and in mood states over the duration of the 12-month trial.

Adult↗
PubMed1995

[Traumatic thrombosis of the ulnar artery].

A case report describing thrombosis of the ulnar artery after blunt direct trauma of the hand is presented. Traumatic thrombosis of the ulnar artery is rare. An isolated direct trauma is the most frequent pathogenetic mechanism. The patient's history is of great importance for reconstruction of the accident and for insurance questions. To clarify the etiology and angiography or the new method of MRI-angiotomography is mandatory. The therapy is usually conservative, and only in selected cases (aneurysm, old thrombosis) should an operative therapy be considered.

Adult↗
PubMed1995

[Continuous cryotherapy--progress in therapy of post-traumatic and postoperative edema].

In patients with foot and ankle trauma, surgery and postoperative mobilization are often delayed owing to swelling. The aim of this study was to assess whether continuous cryotherapy is better than standard therapy with intermittently applied cool packs. For continuous cryotherapy the Polar Care Model 500 (BREG) was used. From May to November 1993, a series of 40 patient (22 ankle fractures, 13 ruptured lateral ankle ligaments, 4 calcaneus fractures, 1 metatarsal fracture) were prospectively randomized to continuous or intermittent cryotherapy. After 24 h treatment the patients with continuous cryotherapy showed an average reduction of 34% in swelling around ankle, midfoot and forefoot. With intermittent cryotherapy the swelling was reduced by 18%. After 4 days of treatment in the postoperative period the swelling subsided by 43% with intermittent cryotherapy, as against 69% with continuous cryotherapy. Continuous cryotherapy proved to be highly effective in treating posttraumatic and postoperative edema. It therefore seems preferable to the therapy with cool packs regarded as standard hitherto.

Adult↗
PubMed1995

[Management of ipsilateral fractures of the femur shaft and proximal femur--therapy overview and current management].

Fractures of the femoral shaft are combined in 2-5% of all cases with an ipsilateral fracture of the proximal femur. These double fractures are mostly caused by high energy trauma. An analysis of 9 selected papers points to the problem. In more than 10% the proximal fracture is not diagnosed initially. In the literature nearly 30 different operative treatments are described and underline the demands on proper operative techniques and implants for ipsilateral femoral shaft and hip fractures. In this publication the new unreamed femoral nail system (UFN) with a special proximal interlocking option for double fractures will be presented. This system provides a good possibility to stabilize femoral double fractures in an easy and safe manner.

Adult↗